336 FEVER. 



acid is also increased; the urine pigment ( 19), derived from the hemoglobin, may be increased 

 twenty 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 oxida- 

 tion in a* warm medium is very much greater than in the cold {D. Finkler). The amount of 

 CO, in the blood is diminished, but not at once after the onset even of a very severe fever 

 (Oeppert). 



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

 several stages in a fever () 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 to 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 hat given off 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, 4 C. 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 or three times the 

 normal. The heat-production is either increased, normal, or sub-normal, so that under these 

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



(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 enables normal animals to maintain their normal 

 temperature in a warm medium ( 214), is much less in fever (D. Finkler). 



The accessory phenomena of fever are very important : Increase in the intensity and 

 number of the heart-beats ( 214, II., 2) and respirations (in adults 40, and children 60 per 

 min. ), both being compensatory phenomena of the increased temperature ; further, diminished 

 digestive activity and intestinal movements ( 186, D) ; disturbances of the cerebral activities \. 

 of secretion; of muscular activity; slower excretion, e.g., of potassium iodide through the 

 uriue. In severe fever, molecular degenerations of the tissues are very common. For the con- 

 dition of the blood-corpuscles in fever, see 10, the vascular tension, 69, the saliva, 146, 

 digestion, 186. 



Quinine, the most important febrifuge, causes a decrease of the temperature by limiting the 

 production of heat ( 213, 6). Toxic doses of the metallic salts act in the same way, while 

 there is at the same time diminished formation of C0 2 . [Antipyretics or Febrifuges. All 

 methods which diminish abnormal temperature belong to this group. As the constant tempera- 

 ture of the body depends on (1) the amount of heat-production, and (2) the loss of heat, we 

 may lower the temperature either in the one way or the other. When cold water is applied to 

 the body, it abstracts heat, i.e., it affects the results of fever, so that Liebermeister calls such 

 methods antithermic. But those remedies which diminish the actual heat-production are true 

 antipyretic. In practice, however, both methods are usually employed, and spoken of col- 

 lectively as antipyretics.] 



[Amongst the methods which are used to abstract heat from the body, are the application 

 of colder fluids, such as the cold bath, affusion, douche, spray, ice, or cold mixtures, &c. A 

 person suffering from high fever requires to be repeatedly placed in a cold bath to produce any 

 permanent reduction of the temperature. Some remedies act by favouring the radiation 

 of heat, by dilating the cutaneous vessels (alcohol), while others excite the sweat-glands i.e., 

 are sudorifics so that the water by its evaporation removes some heat. Amongst the drugs 

 which influence tissue changes and oxidation, and thereby lessen heat-production, are quinine, 

 salicylic acid, some of the salicylates, digitalis, and veratrin. Blood-letting was formerly used 

 to diminish abnormal temperature. Amongst the newer antipyretic remedies are hydrochlorate 

 of kairin and antipyrin, both of which belong to the aromatic group (derivatives of benzol), 

 which includes also many of our best antiseptics.] 



221. ARTIFICIAL INCREASE OF THE BODILY TEMPERATURE. If 

 mammals are kept constant/// in air at 40 C, the excretion of heat from the body 

 ceases, so that the heat produced is stored up. At first the temperature falls some- 

 what for a very short time, but soon a decided increase occurs. The respirations 

 and pulse are increased, while the latter becomes irregular and weaker. The O ab- 

 sorbed and C0 2 given off are diminished after six to eight hours, and death occurs 

 after great fatigue, feebleness, spasms, secretion of saliva, and loss of consciousness, 

 when the bodily temperature has been increased 4 or at most 6 C. Death does 

 not take place owing to rigidity of the muscles, for the coagulation of the myosin 

 of mammals' muscles occurs at 49 to 50 C, in birds at 53 C, and in frogs at 

 40 C. If mammals are suddenly placed in air at 100 C, death occurs (in 15 to 



