A STUDY OF FEVER. 13 



rurgie^ Bd. YL, p. 441), is an example of a pure neurosis. It 

 is impossible, in some of these cases, that there can be injury 

 to the urethra, much less any alteration of the blood. The 

 fever is due to a mere local irritation, which effects no local 

 nutritive change, and it must therefore be produced through 

 the nervous system. 



The following case of uretkral fever occurred in the practice 

 of a friend, and may here serve as an illustration : — 



, set. 40, was treated in the Philadelphia Hospital during 



August, 18T3, for very tight irritable stricture of the urethra. 

 It admitted, when treatment was commenced, only a small- 

 sized whalebone bougie. About two weeks were occupied in 

 treatment by gradual dilatation until it was sufficiently dilated 

 to admit a Holt's dilator, when the stricture was ruptured, 

 after which a No. 12 Thompson's sound was introduced. 

 There was a good deal of subsequent shock and urethral fever, 

 which yielded to treatment. Four days afterward, on Sunday 

 morning, the attending surgeon found some contraction in the 

 calibre of the canal, and introduced with difficulty No. 12 

 Thompson's sound, following it by Nos. 14 and 16. Considera- 

 ble difficulty was met with in their introduction; the patient 

 suffered a good deal of pain, and l»led freely from the urethra. 

 This operation was performed about 12 o'clock ; about 3 o'clock 

 the patient had a chill, followed by high fever, thermometer regis- 

 tering 103°-104° F. He was treated by quinine and opium, 

 which controlled the s^'mptpms somewhat ; the next day, how- 

 ever, at about 9 A. M. the temperature, in spite of treatment, 

 rose again to 105°. There was an increase during the morn- 

 ing to 104° at ten o'clock. The man was rational; the pain 

 had been relieved by opium ; no immediate danger was appre- 

 hended. The resident physician (Dr. Bruen) was sent for 

 about three o'clock in the afternoon, with news that the man 

 was dying. He found the patient was entirely unconscious ; 

 breathing stertorous; pupils fixed, neither dilated nor con- 



