38 IDIOPATHIC OR SIMPLE FEVER. 



is superadded to other recognised diseased states, are disinteg- 

 ration of tissue and disturbance of temperature. 



The relation which these two phenomena bear to each other, 

 as also their connection, severally and combined, with the exist- 

 ence and maintenance of the pyrexial state, are questions which 

 even yet require further elucidation by comparison of facts 

 derived from observation and experiment. 



According to investigations it has been found that in the 

 early stages of fever there is a slight increase of the discharge 

 of carbonic acid, but a constant and distinct increase in the 

 elimination of urea. Towards the termination of the fever 

 the loss of weight has been stated to be most marked, and to 

 be chiefly through that of water and carbonic acid. 



The question may be asked. Whence comes this excess of 

 nitrogen ? Not from the food, we know, for little or none 

 may be taken. It must come from the tissues, from the 

 albumen of their formed elements or the fluids ; probably 

 the former. This is believed from the fact that the salt 

 secreted in fever is potass, not soda ; thus the source of 

 the nitrogen must contain potass. But blood-plasma possesses 

 chiefly sodium salts, while the formed materials of the blood — 

 the globules and the sarcos elements of muscular tissue — 

 contain salts of the other base. Consequently urea, the 

 nitrogen compound, is probably the result of disintegration of 

 these tissues. 



As regards the production and discharge of heat in the 

 pyrexial state, there is much difiiculty ; nor will it, in all pro- 

 bability, be determined until more progress has been made in 

 our knowledge of the relations in health between temperature 

 and heat-production. It is well known that the production of 

 heat may be much increased in the animal body Avithout any 

 elevation of temperature, and that a high temperature may 

 exist without increased production. 



The results of the measurement of the actual amount of 

 heat discharged in fever has led to rather different and some- 

 what conflicting views, by different observers, as to the extent 

 of heat-production taking place. 



Whatever may be the relation of the textural changes and 

 disintegration of tissue to the febrile state, whether the heat- 

 production or the heat-distribution, or discharge, is primarily 



