FEVER AND ITS PHENOMENA. 451 



During fever, the body is greatly incapacitated for performing mechanical work. 

 It is evident, therefore, that the large amount of potential energy transformed is 

 almost all converted into heat, so that the non-transformation of the energy into 

 mechanical work is another important factor. 



We may take intermittent fever or ague as a type of fever, in which violent 

 attacks of fever of several hours duration alternate with periods free from fever. 

 This enables us to analyse the symptoms. The symptoms of fever are : 



(l.) The increased temperature of the body. (38-39C., slight; from 



39-41C. and upwards, severe). The high temperature occurs not only in cases 

 where the skin is red, and has a hot burning feeling (calor mordax), but even 

 during the rigor or the shivering stage, the temperature is raised (Ant. de Haen, 

 1760). The congested red skin is a good conductor of heat, while the pale blood- 

 less skin conducts badly; hence, the former feels hot to the touch (v. Barensprung 

 compare 212). 



(2.) The increased production Of heat (assumed by Lavoisier and Crawford) 

 is proved by calorimetric observations. This is, in small part, due to the increased 

 activity of the circulation being changed into heat ( 206, 2, a), but for the most 

 part it is due to increased combustion within the body. 



(3.) The increased metabolism gives rise to the "consuming" or "wasting " 

 character of fever, which was known to Hippocrates and Galen, and in 1852 v. 

 Barensprung asserted that "all the so-called febrile symptoms show that the 

 metabolism is increased." The increase of the metabolism is shown in the 

 increased excretion of C02 = 70-80 per cent. (Leyden and Frankel), while more 

 O is consumed, although the respiratory quotient remains the same (Zuntz and 

 Lilienfeld). According to D. Finkler, the C0 2 excreted shows greater variations 

 than the consumed. The excretion of urea is increased to f . In dogs suffering 

 from septic fever, Naunyn observed that the urea began to increase before the temper- 

 ature rose, "prefebrile rise." Part of the urea, however, is sometimes retained 

 during the fever, and appears after the fever is over, " epicritical excretion of 

 urea" (Naunyn). The uric acid is also increased; the urine pigment ( 19) 

 derived from the haemoglobin, may be increased 20 times, while the excretion of 

 potash may be seven-fold. 



It is important to observe, that the oxidation or combustion processes within the 

 body of the fever patient, are greatly increased, when he is placed in a warmer 

 atmosphere. The oxidation processes in fever, however, are also increased under 

 the influence of cooler surroundings ( 214, I, 2), but the increase of the oxidation in a 

 warm medium is very much greater than in the cold (D. Finkler). The amount 

 of C0 2 in the blood is diminished, but not at once after the onset even of a very 

 severe fever (Goppert). 



(4.) The diminished excretion Of heat varies in different stages of a fever. 

 We distinguish several stages in a fever (a) The cold stage, when the loss of 

 heat is greatly diminished, owing to the pale bloodless skin, but at the same time 

 the heat-production is increased 1^-2^ times. The sudden and considerable rise of 

 the temperature during this stage shows that the diminished excretion of heat is not 

 the only cause of the rise of the temperature, (b) During the hot Stage, the heat 

 given of from the congested red skin is greatly increased, but at the same time more 

 heat is produced. Liebermeister assumes that a rise of 1, 2, 3, 4C. corresponds 

 to an increased production of heat of 6, 12, 18, 24 per cent, (c) In the sweating 

 Stage, the excretion of heat through the red moist skin and evaporation are 

 greatest, more than two to three times the normal (Leyden). The heat-production 

 is either increased, normal, or sub-normal, so that under these conditions the 

 temperature may also be sub-normal (36C.). 



(5.) The heat-regulating mechanism is injured. A warm temperature 



of the surroundings raises the temperature of the fever patient more than it does 

 that of a non-febrile person. The depression of the heat-production, which 



