404 FEVER. 



arteries were ligated at one time, with or without the related veins, 

 the temperature was observed to rise almost i C. within two hours. 



It is obvious that increased heat-production in the presence of 

 normal heat-dissipation must give rise to accumulation of heat. In 

 this category belongs the elevation of temperature following muscular 

 and mental activity, and attending digestion. Finally, the elevation of 

 temperature that appears several hours after a cold bath and is 

 brought about by increased heat-production through reflex influences 

 from the cooled skin is probably of the same character. 



If the temperature of the body as a whole is raised about 6 C. 

 death results, as in the case of heat-stroke or sunstroke. At this tem- 

 perature molecular decomposition of the tissues appears to take place. 

 With long-continued, though less marked, elevation, distinct fatty de- 

 generation of many tissues occurs. If animals whose temperature is 

 raised artificially to 42 or 44 C. are subsequently placed in a cooler 

 atmosphere, the temperature at first becomes subnormal (36 C.) and it 

 may remain so for days. 



FEVER. 



In many ways related to the accumulation of heat largely confined within 

 the limits of physiological phenomena fever occurs as the most common patho- 

 logical derangement in the bodily economy and to it some reference may be made. 

 Fever consists essentially in increased metabolism, chiefly in the muscles, together 

 with elevation of temperature. Under these circumstances a disturbance in the 

 regulation of the heat-balance must naturally take place, for if provision be made 

 that with the increased heat-production also increased heat-dissipation shall take 

 place, there can then be no elevation of temperature, or accumulation of heat. 

 According to v. Liebermeister heat-regulation is placed upon a higher temperature- 

 level during the febrile process. As in the state of fever the body appears to be 

 in large measure incapacitated for mechanical activity, the transformation of this 

 larger amount of decomposing potential energy in the body almost wholly into 

 heat, and the failure to utilize this for mechanical activity, must moreover be 

 especially emphasized as characteristic. Malarial intermittent fever may be 

 considered as the prototype of fever. It is attended with severe paroxysms of 

 fever lasting several hours in alternation with wholly afebrile periods, so that its 

 symptoms may be readily analyzed. Among the individual phenomena of fever 

 there are encountered: 



1. Elevation of bodily temperature (to 38 or 39 C. constitutes mild, and from 

 39 to 41 C. and above, severe fever) . Not only the febrile patient with a burning, 

 reddened skin (calor mordax), but also the shivering patient in a chill with an 

 apparently cold skin may exhibit elevation of temperature. The reddened skin, 

 however, is a good conductor, the pale skin a much poorer conductor of heat. 

 Therefore, the former appears the warmer to the touch. 



2. Increased heat-production, which had already been assumed by Lavoisier and 

 Crawford, can be recognized indubitably by calorimetric measurement. This can 

 be attributed only in smallest part to transformation of the increased circulatory 

 activity into heat, but in largest part it is dependent upon heat generated in the 

 processes of combustion. 



3. Increased metabolism, to which the wasting character of fever is due. This 

 was known to Hippocrates and Galen and was thus described by v. Barensprung in 

 1852 : "All so-called fever-symptoms indicate that during the febrile process tissue- 

 consumption is abnormally increased. The increased metabolism is evidenced by 

 augmented carbon-dioxid elimination (from 70 to 80 per cent.)- In addition 

 to carbon-dioxid elimination there is increased absorption of oxygen, at most 

 20 per cent, in a patient with acute fever, while the respiratory quotient 

 remains unchanged. According to D. Finkler the production of carbon dioxid is 

 susceptible of greater variation than the consumption of oxygen. The state of the 

 nutrition is an index of the size of the respiratory quotient. The increase in 

 gaseous interchange is not the result, but the cause, of the increased bodily tem- 

 perature. The former takes place also when the bodily temperature is reduced by 



