MAINTENANCE OF THE BODY TEMPERATURE 373 



heat production of the restless patient with his rapid 

 heart and breathing is higher than it would be if he were 

 well and lying comfortably in bed. But it is by no means 

 so high as it might be if he were well and taking exercise. 

 The best statement that we can make regarding fever is 

 that the trouble is with the nerve centers through which 

 the balance between thermogenesis and thermotaxis is 

 normally maintained. When a fever is holding a steady 

 course the balance is, in fact, preserved as delicately as 

 in health. It is the false standard to which the system is 

 held which is the real characteristic. 



It will be well to point out here something which may 

 have been gathered from statements made earlier in the 

 book. This is the fact that our sensations are altogether 

 unreliable as indicators of the body temperature. They 

 are entirely dependent upon the skin. If the surface of 

 the body is warm we say that we are warm. The glow 

 produced by alcohol furnishes this impression, but what 

 is actually sensed on such occasions is the flux of heat 

 from within the body to the exterior. The subject feels 

 warm because heat is escaping through his skin. Sub- 

 normal temperatures have often been recorded when the 

 influence of alcohol has been coupled with exposure to 

 cold. 



Conversely, when the circulation in the skin is abnor- 

 mally reduced the feeling is likely to be one of chilliness, but 

 the restriction of heat loss at such a time may lead to a rise 

 of the internal or true body temperature. In the chills 

 of malaria this is just what happens. The patient can 

 scarcely be made to feel comfortably warm because of the 

 severe constriction of the vessels of the skin. The sur- 

 face cooling leads to reflex shivering and the muscles 

 produce extra heat which is retained in the internal organs. 

 The temperature mounts high above the normal while 

 the sufferer appeals for more covering. Later, the skin 

 becomes flushed and the sensation is one of rising tem- 

 perature, though the fact is that the system is parting 

 with its stored heat and returning to the normal state. 



