472 



panied by au acceleration of the heart's action, a quickening of the 

 respiration, and au aberration in the functional activity of the various 

 organs of the body. These organs may be stimulated to the perform- 

 ance of excessive work, or they may be incapacitated from carrying 

 out their allotted tasks, or in the course of a fever the two conditions 

 may both exist, the one succeeding the other. To fever as a disease is 

 usually added chills as an essential symptom. 



Fevers are divided into essential fevers and symptomatic fevers. In 

 symptomatic fever some local disease, usually of an inflammatory char- 

 acter, develops first, and the constitutional febrile phenomena are the 

 result of the primary point of combustion, irritating the whole body, 

 either through the nervous system or directly by means of the waste 

 material which is carried into the circulation and through the blood 

 vessels, and is distributed to distal parts. Essential fevers are those in 

 which there is from the outset a general disturbance of the whole econ- 

 omy. This may consist of an elementary alteration in the blood, or a 

 general change in the constitution of the tissues. 



Essential fevers are subdivided into ephemeral fevers, which last but 

 a short time and terminate by critical phenomena ; intermittent fevers, 

 in which there are alternations of exacerbations of the febrile symp- 

 toms and remissions, in which the body returns to its normal condition 

 or sometimes to a depressed condition, in which the functions of life 

 are but badly performed ; and continued fevers, which include the conta- 

 gious diseases, as glanders, influenza, etc., the septic diseases, as pysemia, 

 septicaemia, etc., and the eruptive fevers, as variola, etc. 



Whether the cause of the fever has been an injury to the tissues, as a 

 severe bruise, a broken bone, an inflamed lung, or excessive work 

 which has surcharged the blood with the waste products of the com- 

 bustion of the tissues, which were destroyed to produce force j or the 

 puUalation of the ferments of influenza in the blood which destroy the 

 red blood corpuscles; or the "presence of irritating material, either in 

 the form of living organisms or of their products, as in glanders or 

 tuberculosis, the general train of symptoms are the same, only varying 

 as the amount of the irritant differs in quantity, or when some special 

 quality in them has a specific action on one or another tissue. 



There is in fever at first a relaxation of the small blood vessels, 

 which may have been preceded by a contraction of the same if there 

 was a chill, and as a consequence there is an acceleration of tlie cur- 

 rent of the blood. There is then an elevation of the peripheral tem- 

 perature, followed by a lowering of tension in the arteries and an ac- 

 celeration in the movement of the heart. These conditions may be 

 produced by a primary irritation of the nerve centers, or the brain 

 from the effects of heat, as is seen in thermic fever or sunstroke, in 

 which trouble the extremes of symptoms may sometimes be seen alter- 

 nating with a very short period, to be counted scarcely by hours. 



There are times when it is difiQcult to distinguish between the exist- 



