630 FEVER 



increased, that therefore there exists a particular com- 

 bination of disturbance of heat production and of heat 

 elimination. " 



Increased Excitability of Heat Regulating Centres in 

 Fever and its Reduction by Antipyretics. As causative of 

 such disturbance we may, in accordance with R. Gottlieb's 

 statement, think of a condition of pathologically increased 

 excitability involving the heat regulating centres. It is fun- 

 damentally one and the same thing whether this excitation 

 is brought about by electrical or mechanical initiation (as in 

 the heat puncture) or whether it is the result of stimulation 

 by toxic bacterial products. It is, however, of the utmost 

 significance that the antipyretics (as Filehne also has held) 

 owe their effect clearly in the first place to a quieting of 

 the heat-regulating centres which are in a state of patho- 

 logical irritation, and that the typical fever remedies are 

 also on the whole l ' analgesics " and " sedatives, " that is, 

 weak narcotics for the sensory area of the cerebral cortex. 

 In conformity with this thought, for example, even small 

 doses of morphine are capable of interfering with the hy- 

 perthermia of cerebral puncture. 55 



Pyrogenic Properties of Proteins and Protein Deriva- 

 tives. We may at this point turn to a brief consideration of 

 those chemical agencies which possess the ability to act as 

 excitants of fever when introduced into the blood stream. 



Krehl and Matthes were first inclined to connect the ob- 

 servation that many febrile diseases are accompanied by 

 an albumosuria directly with the production of fever in 

 infectipus diseases; but later they withdrew this opinion 

 as incorrect. The question of the presence of albumoses in 

 the blood, as previously stated, is apparently not as yet 

 satisfactorily understood ; but undoubtedly an albumosuria 



68 R. Gottlieb in H. H. Meyers' and R. Gottlieb's Experimentelle Pharma- 

 kologie, pp. 389 et seq., 1910; cf. therein, as well as in O. Lowy, Ergebn. d. 

 Physiol., 3, 357-372, 1904, and in Noorden's Handb. d. Pathol. d. Stoffw., 2, 

 781-797, 1907, for a detailed analysis of the action of antipyretics, also for 

 appropriate Literature. 



