ORIGIN OF DISEASE AND THE GERM THEORY. 151 



immense periods of time. Moreover, it is to be remarked that 

 the associates of work have alternated with the associates of rest 

 to a large extent in the same way as day has alternated with 

 night, and on a larger scale to some extent as summer with 

 winter. Consequently we shall not be surprised to find later on 

 that the rhythm of surrounding conditions has left its impress 

 on the organic rhythm. 



The Vhenomena or Associates of Work. — An animal at work 

 has an acceleration of pulse and respirations, displays excitement, 

 increase of perspiration and of fecal discharge, and augmentation 

 of metabolism and of the temperature of the body. Now there 

 certainly is evidence to show that, if some of these be aroused 

 there is a tendency for others, or of all, to be also aroused. If 

 the temperature of an animal be artificially raised, the pulse and 

 the respirations are accelerated, and the cutaneous glands are 

 more active. The converse is the case if the temperature be 

 reduced. A muscle, while contracting, rises in temperature, 

 and there seems to be a very considerable total increase of heat 

 in the body during action. Again, together with action, with 

 excitement and with alarm, provided it be not too great, there 

 is also associated an acceleration of the pulse. 



In cases of exophthalmic goitre the heart beats more frequently, 

 the action of the cutaneous glands is increased, there is a mani- 

 festation of restlessness, the bowels are generally freely open 

 although the patient be confined to bed, the peripheral tempera- 

 ture is elevated, and at times also the oral temperature. These 

 are the associated phenomena of work. Dr. D. A. Gresswell 

 made daily observations for thirty- three days in regard to a 

 woman aged 32 years, suffering from this condition, under the 

 care of Dr. Southey, at St. Bartholomew's Hospital. Her pulse 

 was always above 110, even when she was asleep. Her respira- 

 tions were always above 22. The bowels were very freely open 

 every day, on an average two to four times. The daily discharge 

 of urine averaged fifty- two fluid ounces, varying, however, from 

 forty to eighty fluid ounces. She slept fairly when sedatives 

 were administered, but otherwise she was restless. The skin was 

 at all times warm and moist, and the tongue also was always moist. 

 The appetite was always excellent. The oral temperature was 

 generally normal ; but it rose at times to about 100 deg. F., and 

 the palmar temperature was generally nearly as high as the oral. 



