THE ORIGIN, 
Nature and Treatment of Fever, 
IN THE 
LIGHT OF MODERN PHYSIOLOGY. 
BY 
CH. RAUSCHENBERG, M.D, 
ATLANTA, GEORGIA. 
REPRINTED FROM THE ATLANTA MEDICAL AND SURGICAL JOURNAL. 
ATLANTA, GEORGIA: 
Herald Publishing Company’s Steam Press. 
1873. THE ORIGIN, 
Nature and Treatment of Fever, 
IN THE 
LIGHT OF MODERN PHYSIOLOGY. 
BY 
OH. RAUSCHENBERG, M.H., 
ATLANTA, GEORGIA. 
REPRINTED FROM THE ATLANTA MEDICAL AND SURGICAL JOURNAL 
ATLANTA, GEORGIA: 
Herald Publishing Company’s Steam Press. 
1873. THE ORIGIN, 
NATURE AND TREATMENT OE FEYER, 
XX THE 
LIGHT OF MODERN PHYSIOLOGY. 
Tile changes which have gradually taken place during the 
last twenty or twenty-five years in the views and conceptions of 
the medical profession of Europe, and particularly of Germany, 
in relation to the causation and nature of the febrile process, 
and the fundamental principles governing its treatment, have as 
yet—if my intercourse with medical men, and my acquaintance 
with the current medical literature of this country, enable me 
to judge correctly—obtained but a very limited recognition on 
the part of the profession at large in Georgia, and perhaps 
elsewhere throughout this country, and have not yet exercised 
any marked influence on the current of thought, and the thera- 
peutical action of medical practitioners generally, in relation to 
this subject. If this observation is not entirely incorrect, it 
will explain why I bring this old but important matter, in its 
new physiological relations and pathological features, to the 
consideration of the profession.* 
The pathological process commonly called fever has, more 
than any other one, engaged the general attention of the medi- 
cal world since the days of Hippocrates. Its name, from the 
Latin “febris,” and the Greek “piiretos,” heat, indicates plainly 
that the ancients had already recognized unusual heat of the 
* A synopsis of this paper was read before the Georgia Medical Association, 
at its meeting in this city, last April, but was not published in the Transactions, 
as the author was unavoidably prevented from finishing it in due time. C. R. 4 
Origin, Nature and Treatment of Fever, etc. 
body as its most prominent and most constant symptom, and 
when Hippocrates advocated the doctrine of critical days and 
critical phenomena in fevers, as manifestations of the internal 
process of coction by which the morbid substances were grad- 
ually prepared and fitted up for elimination from the system, 
he already sowed the seed which, two thousand years later, 
ripened into the views of von Helmont, Sydenham, Stahl, Booer- 
have and others, who looked upon fever as an increased activity 
of the vital process, as a curative effort of nature intended to 
reestablish health, or in their own words, as : “Instrumentum 
naturee, quo partes impuras a purls secernat” (Sydenham); or as 
“actum vitalem motorium, secretorium et excretorium mediante quo 
proesentes queedam noxce removeantur” (Stahl.) 
It would be an easy matter to fill pages with a recapitulation 
of the many theories which have since then been developed 
and entertained by different medical authorities. De Haen, 
Cullen, Brown, Pieil, Pinel, Broussais, Schoenlein, and others, 
have advanced more or less abstract—Henle, Stilling, Wunder- 
lish, and others, more exact neuropathic—doctrines on the origin 
of fever, based upon the physiological discoveries of Bell, 
Muller, and Marshal Hall. A consideration of these or the 
still later observations and views of Claude Bernard, Ttschet- 
chechin, Traube, etc., on the same subject, seeking to establish, 
as a cause of fever, a morbid depression of the nerve-centers, 
regulating the production of caloric within the organism, falls 
beyond the limits of this paper, which is only intended to em- 
brace those points relating to genesis, nature, and treatment of 
fever, which have—as far as its author is able to judge—the 
greatest weight of evidence in favor of their correctness and 
are most generally accepted at the present period of time. 
The prominent merit of all pathological investigations of the 
present day consists in the persistent effort to base all our con- 
ceptions upon physiological and anatomical observations and 
facts, and to define morbid phenomena as perceptible changes 
of function, and, if possible, as tangible changes of structure 
of definite elements, parts, or spheres of the system, necessa- 
rily resulting from the operations of the laws of life under cer- 
tain abnormal influences. 
When we undertake to analyze the abnormal organic process 
of life, which we call fever, in its most general sense—not as a Origin, Nature and Treatment of Fever, etc. 
5 
specific disease, or species of fever, but as the most frequent 
result and manifestation of morbid impressions upon the hu- 
man organization—we should very cautiously distinguish per- 
manent and important from accidental and unimportant, primary 
from secondary, and coordinate from subordinate occurrences. 
Phenomena which exist in every case of febrile excitement as 
primary effects of the cause and coordinate to each other are : 
Acute hypercemia of the capillaries of the entire system, with expan- 
sion of their volume, redness and heed of the surface and tissues gen- 
erally, and a more or less marked general increase of the tempera- 
ture of the body above the normal standard, connected and seemingly 
depending upon an increased activity of the heart and arteries A 
These are the constant and the essential pathognomonic marks 
of fever; but as the degree and uniformity of their develop- 
ment depend, like the normal circulation, upon the quantity 
and the quality of the blood and the irritability of the nervous 
system, in each case the production of caloric as well as the 
degree of vascular excitement and capillary hyperaemia will, in 
different cases, exhibit different grades of development, and 
these again will be grouped together in various combinations. 
In debilitated and anaemic individuals with weak and frequent 
contractions of the heart, as the normal condition, febrile ex- 
citement will often cause only very moderate elevation of tem- 
perature, and lessen, for a time, the frequency and increase the 
force of the heart’s action. In extreme cases of that kind, and 
in the last stages of long-continued fevers, the frequency of the 
pulse will be very great; but the production of heat, from want 
of material, so small that the degree of bodily temperature, 
while it is still relatively higher than it would be without the 
fever, may not reach the normal temperature of the body, but 
without a relative or absohde increase of bodily temperature, fever 
proper, does not exist, and the very essence of fever consists in an in- 
creased metamorphosis of the organic material of the body. 
The disengagement of latent heat in nature takes place, in a 
large number of chemical processes, in consequence of the me- 
chanical rearrangement of the molecules constituting the sub- 
stances engaged in action. In men and higher animals, be- 
cause their organisms consist principally of oxydizable material, 
* Spiess’ Patkologische Pkysologie. See chapter on Fever. 6 
Origin, Nature and Treatment of Fever, etc. 
and the oxygen of the atmospheric air is in constant and direct 
contact with them, the production of animal heat is principally, 
but not exclusively the result of that specific chemical process 
called oxydation, which takes place partly within the blood, 
partly within the tissues, simultaneously with their metamor- 
phosis, and in close proximity to the capillaries, which furnish 
oxygen and nutritive material on the one hand, and remove 
carbonic acid and waste products on the other. 
The question arises now, How is this increased metamorphosis 
of tissue, this increased oxygenation and combustion, primarily 
occasioned? Do the first causes of it originate in the blood or 
in the nervous system, and what is their nature? 
Tbe experiments of Billroth,-' Bergmant and others, have 
proven beyond a doubt that the introduction of foreign sub- 
stances into the blood produces increased oxydation within it 
and the tissues, or, what is the same, fever. Distilled water, 
healthy blood, blood serum, the blood of fever patients, pus, 
putrid substances, pure pepsin, have been used for this purpose, 
and an increase of the temperature of the test animals, more 
or less considerable, and of longer or shorter duration, has in- 
variably been recognized after these injections. In traumatic 
fevers, pyaemia, septicaemia, etc., the presence of foreign sub- 
stances in the blood has almost become a certainty, and in the 
contagious, or so-called zymotic or catalytic diseases (measles, 
scarlatina, variola,) whose specific virus seems to be infinitesi- 
mally multiplied during the duration of the disease, like yeast 
during the process of fermentation, the introduction of a spe- 
cific poison into the blood as the first cause of the disease can 
not be denied. 
These foreign substances, disturbing the morphological in- 
tegrity and life of the blood—whether they be malaria or con- 
tagion from the outside world, mere molecular detritus, puru- 
lent or septic material from a hearth of inflammation, from a 
tuberculous or scrofulous deposit, from the surface of an un- 
healthy wound, or the mere stagnating contents of the capil- 
laries of a bruised finger, or abnormally retained secretory and 
excretory matter—are the primary instigators of the increased 
* Billroth and Pitha, Cliirurgie, p. 599, 1865. 
t Das putride Gift, die putride Intoxication. Petersburger Med. Zeitschrift 
Band, 1, 1868. Origin, Nature and Treatment of Fever, etc. 
7 
oxygenation within the blood and tissues, which we call fever. 
Where is the physician who, in course of his medical experi- 
ence has not arrived at the firm conviction that every functional 
derangement, interfering—to use the most comprehensive lan- 
guage—with the preparation or resorption of the nutritive, or 
the elimination of effete materials, consequently with the form- 
ation and maintainance of a normally composed blood, is one 
of the common causes of fever? If we frequently notice in com- 
paratively healthy persons a slight acceleration of the pulse, a 
flushed countenance, a hot surface, or, in other words, a slight 
febrile excitement after dinner, in all probability caused by an 
increased afflux of rich chyle, almost as a physiological process, 
we can not resist the conclusion that quantitative and qualitative 
deviations of the material furnished to the blood for the 'performance 
of its physiological functions, or the presence of foreign substances 
within it, disturbing them, are the principal and primary causes 
of fever. 
Does this view deserve the reproach of favoring a faulty 
humoral pathology, which attaches undue importance to the 
condition of the blood in fever and forgets the influence of the 
nervous system in its causation? 
It appears to the humble writer that this reproach would be 
just if the blood was a fluid, fully perfected by the process of 
digestion, undergoing no farther changes but quantitative con- 
sumption for the nutrition of the body. This, however, is not 
the case. Oxygen, new material from the lacteals of the ali- 
mentary canal, worn-out matter from the tissues, are continually 
received by it, and are, under the influences of chemical affini- 
ties, engaged—the former, in a process of progressive, the latter, 
in one of retrograde metamorphosis. Thus the blood under- 
goes continually a series of complicated but regularly estab- 
lished chemical changes, preparing on the one hand materials 
for the nutrition and growth of the different tissues, on the 
other, material for elimination and removal by the different 
secretory and excretory organs, and simultaneously developing 
and sustaining its own cell-life, and morphological constituents. 
Taking into consideration the multiplicity of physiological 
processes in the system, upon which the supply and preparation, 
the quantity and quality of the material needed for the normal 
progress of chemical metamorphosis and blood-life depends, 8 
Origin, Nature and Treatment of Fever, etc. 
the frequency of blood-changes, from the very slightest degree 
of physiological abnormity to the highest grades of blood- 
poisoning, and with them the frequent occurrence of all grades 
of febrile excitement of shorter or longer duration, is easily un- 
derstood. Thus increased oxydation within the blood and 
tissues, “fever,” is always primarily caused by a disturbance of 
the normal blood-life, the normal development of the blood 
within itself by the introduction or retention of more or less 
noxious substances within it, which interfere with its morpho- 
logical or chemical integrity, or both. This is the first and 
primary occurrence ; changed innervation caused by and pro- 
gressing in direct proportion with this blood-change, the sec- 
ondary one in all fevers. In idiopathic fevers the noxious sub- 
stance finds its way into the blood directly from the outside 
world, and causes primarily a morbid condition of the same; in 
symptomatic fevers a local pathological condition within the 
organism—for instance, a local inflammation—furnishes this sub- 
stance,* and the abnormal state of the blood and the fever are 
secondary phenomena. 
Let us now inquire, What portion of the nervous system partici- 
pates principally and primarily, next to the first cause, (the morbid 
change of the blood) in the further development of the febrile process? t 
General hypercemia, expansion and fullness of the capillaries, 
increased temperature of the body, with frequent and often 
full pulse, the pathological symptoms of the febrile process, do 
most positively indicate a general excitement of that portion 
of the nervous system which presides over the action of the 
heart and blood vessels, and which controls the circulation 
and regulates the metamorphosis of tissue and the production 
of animal heat, to-wit: the ganglia and vaso-motor fbres of the 
sympathetic system. By their degree and mode of activity the 
conditions are created, in the volume of the blood vessels and the 
frequency and strength of the contractions of the heart, w'hicli 
restrict or increase the results of the chemical affinity between 
the free oxygen always present in the blood of the capillaries 
and the organic tissues susceptible of oxydation. 
The ganglionic system consists principally of motor fibres. 
*See The Genesis of Acute and Chronic Inflammation, by Dr. S. Samuel. 
Atlanta Medical and Surgical Journal, January, 1873, p. 590. 
f Spiess’ Pathologische Physiologie, p. 97, etc. Origin, Nature and Treatment of Fever, etc. 
9 
The sympathetic fibres of the heart, the motory fibres of the 
stomach and alimentary canal, and also the motory fibres of 
the blood vessels, excite respectively the muscles of the heart, 
of the intestines, the smooth muscular fibres of the arteries, 
and the contractile fibres of the capillary walls in the same 
manner as the cerebro-spinal motory fibres excite those of the 
voluntary muscles over which they preside; but they do not re- 
ceive their impulses for motory action from one general center, 
like the cerebro-spinal nerves, but generally direct and imme- 
diately at the locality where their action becomes manifest. It 
can not be denied that the action of the heart and arteries can 
be influenced from the cerebro-spinal centers by the agency of 
the nerve ganglia, from which the nerves of the heart originate; 
but the fact that the normal action of the heart takes place in- 
dependent of the influence of the cerebro-spinal system is just 
as well established. A frog’s heart continues its rythmic action 
even after having been separated from the body. The action 
of the smooth muscular fibres of the stomach and intestines, 
the contractions of the womb, of the bladder, of the contractile 
ducts of excretory glands, are almost without a doubt depend- 
ent upon the mechanical irritation of their ganglionic nerves 
and nerve-centers alone, by their accumulating contents. So is 
the contraction of the muscular fibres of the skin excited by 
the impressions of the cold atmosphere, and the contractions of 
the capillaries and arteries, and of the heart, by the irritation 
produced by the living blood which they contain. Oxygenized 
blood of a certain temperature is the indispensable requisite 
for the action of the heart and blood vessels in higher animals 
and in men. 
While the anatomical connections of the ganglia amongst 
themselves and with the cerebro-spinal system, and their mutual 
influence and dependence upon each other, the existence of 
localities within the medulla oblongata, spinal marrow, and 
pneumogastric nerve, which, when irritated or destroyed, pro- 
duce respectively increased or decreased action of the heart or 
tone of the vessels, is by no means denied—as an absolute inde- 
pendence of any one portion of the system does not exist in 
any living organism—a relative but very marked independence and 
isolation of the sympathetic nerve and its ganglia from each other, 
and also from the cerebro-spinal centers, is claimed as a charactei- 10 
Origin, Nature and Treatment of Fever, etc. 
istic feature of this system of nerves, and as an essential ele- 
ment for the correct comprehension of its physiological and 
pathological manifestations. 
If we now inquire how such a general state of excitement of 
the entire vaso-motor system, as exists in the febrile process, can 
be brought about, wTe must necessarily come to the conclusion 
that an entire province of nerves can only be affected—1. Either 
by irritation of its general center and the uniform and simultaneous 
diffusion of the same to all its peripheric branches: or 2. By a uni- 
form and simultaneous irritation of all the branches ivithin their per- 
ipheric course and extension. 
One common center of the ganglionic system of nerves, from 
which all its parts and functions are simultaneously, and in the 
same manner influenced, has not yet been discovered, and its ex- 
istence, from many reasons, is quite improbable. The very safety 
of the organism forbids such an arrangement in a system of 
nerves, which provides for the supply of the different organs 
and all the different parts of the body with nutritive material. 
If such a center existed, or if all the vaso-motor nerves were 
alike subservient to impressions from the brain and spinal mar- 
row, the nutrition of the different organs and parts of the sys- 
tem, which is exclusively presided over by that.system, would 
be much more subject to general disturbances and not so often 
confined to single organs. 
If the vaso-motor nerves of the organism can not be excited 
from one common center, the cause of the irritation which pro- 
duces febrile excitement must be generally diffused throughout 
the entire organism in such manner that it remains in immedi- 
ate and permanent contact with all the vaso-motor nerves simul- 
taneously. 
The blood alone, and particularly the blood within the capil- 
lary system, comes in immediate and permanent contact with 
the vaso-motor nerves—and therefore only blood deviating from 
the healthy condition in some manner—and its influence on the 
peripheric extremities of the vaso-motor nerves can, primarily, 
occasion that excited condition of the entire system of vasb- 
motor nerves upon which the febrile process depends. The 
simultaneous influence of such a morbidly changed blood upon 
the different ganglionic centers, as well as the centers of the 
cerebro-spinal system, through which it flows, can not be de- Origin, Nature and Treatment of Fever, etc. 
11 
nied, as many of tlie different phenomena accompanying differ- 
ent kinds and types of fever, are produced by this influence; 
but the essential phenomenon of fever—the morbidly exalted 
organico-chemical process and the subsequent morbid produc- 
tion of caloric and the characteristic changes in the capillary 
circulation — are primarily excited by the direct influence of a 
morbidly altered blood, upon the peripheric vaso-motor nerves. 
The view that fever, although its first cause might be in the 
blood, could only be caused by the intermediate action of the 
brain, and particularly the spinal marrow, has been frequently 
advocated, but not well sustained. Phenomena which originate 
from the cerebro-spinal axis, bear a very different character in 
their manifestations from that of fever. They are generally 
very changeable as to intensity, duration and locality, and do 
not exhibit the regular uniform character of the febrile pio- 
cess, and indeed the most intense diseases of the substance of 
the brain and spinal marrow, unless they be inflammations, run 
their course positively without any fever. The general, uniform 
and. permanent abnormities of the circulation and production of 
caloric 'peculiar to fever can, therefore, only be successfully explained 
by the existence of a cause within the blood, in continued contact with 
the peripheric vaso-motor nerves, which stimulates the latter into 
morbid activity as long as it remains there. 
The heat, the hypermmia of the capillaries and the increased 
action of the heart characterizing fever are the immediate con- 
sequences of the increased activity of the vaso-motor nervous 
system, and their degree of manifestation depends upon the 
quantity of blood, its supply with oxygen, the condition of the 
structures of the heart and blood vessels, and the irritability of 
these nerves and the nervous system generally. According to 
the quality and quantity of the blood and the degree of irrita- 
bility of the nervous system or the manner in which these 
different conditions may be grouped together in different indi- 
viduals, we meet with sthenic and asthenic, erethic and torpid, 
cases of fever and their different grades and combinations. 
But not only the phenomena of the hot stage of fever—if we 
take a regular paroxysm of intermittent fever as the most per- 
fect and uncomplicated representation of the febrile process— 
but all others are alike susceptible of rational explanation by 
this increased action of the vaso-motor system of nerves. 12 
Origin, Nature and Treatment of Fever, etc. 
Every irritation of the vaso-motor nerves causes first a contrac- 
tion of the blood vessels, a vascular spasm, folloiced by dilatation. 
The symptoms of the cold stage are fully explained by this fact. 
The contractile fibres of the cutaneous tissues, in consequence 
of the suspension of their normal turgor, the tempory anaemia 
and loss of caloric connected with it, contract, and therefore 
the surface of the body first appears cold—so much more so as 
external atmospheric impressions act, under these circumstances, 
as additional irritants. Thus the manifestations of the increased 
action of the vaso-motor nerves is counteracted for a time, and 
the symptoms at the commencement of a febrile paroxysm appa- 
rently contradict the idea of increased vaso-motor action and 
increased production of heat. As this contraction of the skin, 
under the continued impression of the fever-cause, yields, and 
as its capillaries cease to be contracted, the skin receives grad- 
ually more and more blood, the action of the heart becomes 
more and more free and unimpeded, the skin more and more 
hyperjemic, and the increased metamorphosis and increased 
production of heat are more and more developed, and become 
more distinctly perceptible. 
These phenomena, however, do not reach the highest degree 
of intensity as long as the existing cause of irritation of the 
vaso-motor nerves prompts the arteries to increased contraction. 
This contraction, so perceptible in the tense pulse of the hot 
stage, is only gradually overcome by the active hypenumia, the 
increased impetus of the heart, the increased organico-chemical 
process, and the increased metamorphosis in the tissues. In 
consequence of the latter, an abnormal consumption of the water 
of the solid and liquid constituents of the body is established, 
and with it the thirst so characteristic in fever. Again, in con- 
sequence of this deficiency of wrater, and of the still imperfect 
relaxation and expansion of the capillaries, the secretions and 
excretions continue to appear restricted; while, in reality, with 
the increased metamorphosis and combustion in the tissues, 
they have also increased, but their products are retained within 
the blood of the different organs. 
With the decrease of the exalted, vaso-motor action, the liypercemia 
of the capillaries reaches its highest degree, because, while the 
stormy action of the heart ceases only gradually, no obstacle 
obstructs, at the periphery of the circulation, any longer the Origin, Nature and Treatment of lever, etc. 
13 
wave of the blood current, and the exalted organico-chemical 
process in the tissues still continues awhile, in gradually decreas- 
ing strength, to attract and to consume more than the normal 
quantity of blood. 
With this stage of the fever, when the irritation of the vaso- 
motor nerves has ceased, and an entire relaxation of the walls 
of the capillaries and arteries has been established, the secre- 
tions and excretions show necessarily a considerable increase 
in quantity generally, as well as in the relative amount of their 
characteristic constituents—for instance, urea in the urine—be- 
cause now the products of the febrile metamorphosis are re- 
moved from the blood by the different secretory and excretory 
organs. 
Thus the name “sweating stage,” for this period of fevers is 
certainly not very proper, as all excretory organs are in the 
same physiological condition, and engaged in the same manner 
as the excretory apparatus of the skin, whose action, in all 
probability, is not of the same general importance in the removal 
of the febrile products as that of the kidneys. 
A more rational, uniform, and harmonious explanation of all 
the phenomena of fever in their regular course of occurrence 
as the theory advanced in the preceding pages furnishes, the 
writer has not been able to find anywhere else, but in the ad- 
mirable work of Dr. G. A. Spiess, Physiological Pathology,* 
from which the above views wTere principally taken, but which, 
unfortunately, with its rich treasures of pathological truths on 
all the subjects of medicine, has not yet been translated into the 
English language. 
Many other theories in relation to the agency of the nervous 
system in the production of the febrile process, very different 
from the one advocated in the preceding pages, have been ad- 
vanced. They are all based upon isolated physiological observ- 
ations appertaining to the influences of certain portions of the 
nervous system on the circulation of the blood. It is evident 
that this, with its many different phenomena—such as frequency 
of pulse, degree of blood pressure in the heart and arteries, 
velocity of the blood current itself—is dependent upon various 
more or less important nerve influences, emanating not only 
* Physiologische Pathologie, von Dr. G. A. Spiess. 14 
Origin, Nature and Treatment of Fever, etc. 
from the sympathetic, but also from the cerebro-spinal portions 
of the nervous system. While the ganglionic centers and vaso- 
motor nerve fibres preside primarily and directly over the action 
of the muscular fibres of these organs, and while, without the 
presence of normal blood within the capillaries of the heart 
and the blood vessels, as the peripheric stimulants of their 
ganglia and vaso-motor nerve fibres, no cerebro-spinal influ- 
ences can affect these organs, the facts that division or paralysis 
of the vagus, or an irritation of the cervical portion of the sym- 
pathetic or medulla oblongata, exercise a controlling influence 
over the action of the heart and arteries—in the former case 
increasing, in the latter one decreasing, the frequency of their 
contractions — and that irritation of the medulla oblongata 
causes an increase in the tonicity and an abnormal contraction of 
the finer arteries—hence backward blood-pressure in the larger 
ones, and in the heart, etc.—are too well established by numer- 
ous experiments to be denied. 
They only demonstrate the great complicity of the process of 
blood-circulation, and therefore the fact that various nerve in- 
fluences may, in the course of the development of the febrile 
process become successively instrumental in fully establishing 
or modifying this morbid condition ; but they do not furnish a 
more rational basis for the interpretation of its morbid phe- 
nomena, nor disprove the fact that the vast system of vaso- 
motor nerves, in immediate contact with all blood vessels, is 
the first recipient of all morbid impressions arising within its 
most natural physiological stimulant, the blood, and that the 
febrile process takes its origin prominently and primarily within 
that portion of the nervous system, affecting the cerobro-spinal 
centers only secondarily. 
Thus, fever originates in more or less intense blood-changes, 
and its degree, character, and duration depend primarily upon 
the quantity, quality, and duration of the fever cause. 
A morbidly increased, general oxygenation and disintegra- 
tion of the blood and tissues—a general morbid increase of 
the metamorphosis within the human system—primarily the 
result of peripheric vaso-motor irritation by the abnormal Origin, Nature and Treatment of Fever, etc. 
15 
blood, and characterized, by an increased temperature of the body, 
constitute the essence of the febrile process. 
Irritation of any other part of the nervous system can not 
directly produce fever. The manifold and often grave cerebo- 
spinal disturbances of hysteria, for instance, may, through the 
brain and spinal marrow, produce functional abnormities of 
the vaso-motor* system of nerves. A hysterical woman may 
have a frequent pulse and a flushed countenance, and at the 
same time a cool skin; hence no fever, because the fever cause 
within the blood itself is absent. A so-called irritative fever is 
therefore an untenable pathological conception. Irritation of 
any portion of the cerebro-spinal system can never produce 
fever unless it affects the vaso-motor or trophic nerves of an 
organ of the system by reflex action, in such a manner as to 
produce local functional derangement or local inflammation, 
and thereby again chemical or histological alterations in the 
blood, and thus fever secondarily, in the manner above discussed. 
The metamorphosis in fever, however, is principally of a 
retrograde character. The functions of digestion and assimi- 
lation, in consequence of sympathetic participation of the or- 
gans by which they are carried on, become deranged at an 
early stage of the febrile process, and hence, as new material 
is but scantily furnished, the chemical affinities governing this 
metamorphosis are principally exercised in a retrograde direc- 
tion, and the organic material of the system is consumed by an 
increased production of carbonic acid and water on the one 
hand, and urea, uric acid, kreatin, etc., on the other. 
The interpretation of the febrile process of Bocerhave, Syden- 
ham, Stahl, and others, mentioned in the commencement of 
this paper, as a salutary and—so to say—physiological effort of 
nature to eliminate the very substances from the system which 
have given rise to it, is therefore entitled to a just degree of 
consideration. 
Where these noxious substances in the blood, which have in- 
stigated the fever, are of such a character, that they can be con- 
verted into excretory matter, and as such or with it removed from 
the system without causing too high a degree of and too long- 
continued combustion of the organic material of the system, 
the febrile process will terminate favorably; where this conver- 
sion and elimination excites a higher degree of temperature of Origin, Nature and Treatment of Fever, etc. 
16 
the blood, or larger amount of combustion of material than the 
system can bear, death takes place before its termination. A 
correct conception of the degree of the temperature developed 
in each case of fever, and the degree of the consumptive effect 
in each case upon the system generally, are, therefore, of the 
greatest therapeutical importance to the practicing physician. 
The great clinical importance of abnormal grades of temper- 
ature in diseases, and the high grades of it in fevers generally, 
will be more fully comprehended if the following physiological 
and pathological facts are taken into consideration : 
The temperature, of the human body in health is the same under 
all latitudes and in all climates, and this permanency of temperature, 
is an absolute necessity for the 'normal physiological action of all its 
elements and organs, and therefore for the continuation of health and 
life. 
The average temperature of men taken at the axilla is 98.6 F., 
or 37° C. The human body must therefore necessarily have 
the faculty to maintain its specific degree of temperature per- 
manently, independent of the changes in the temperature of 
the surrounding medium, and the different quantities of caloric 
produced within the blood and tissues at different times, or, in 
other words, the production and loss of caloric of the human 
system must regulate each other mutually; a high grade of 
production must always correspond with a high grade of loss, 
and so vice versa. Any material rise or fall of the bodily tem- 
perature above or below the normal standard can not exist any 
length of time without serious danger to the system: 35° C., 
(95° F.) and 42.5° C. (108.5 F.) are the extreme deviations of tem- 
perature observed in serious cases of disease; a decrease of 
1.5° F., and an increase of 9.9° F., are deviations from the nor- 
mal standard, which, according to undeniable observations, are 
almost infallibly connected with the death of the patient. If 
an increase of about 10° F. is a certain indication of early disso- 
lution, it is quite reasonable to suppose that the intermediate 
grades of increase are connected with a corresponding degree 
of danger. Experience as well as observation support the fact 
that human blood, as soon as its temperature rises Ixyond the nor- 
mal degree, begins to undergo histological changes, which make it 
unfit for healthy nutrition, in direct proportion to the increase of its 
temperature. Origin, Nature and Treatment of Fever, etc. 
17 
Schultze* has microscopically demonstrated these changes 
in their full development on blood heated on an objective table 
to 50°C., a temperature which the human blood in life never 
reaches; but his experiments establish beyond a doubt the dis- 
integrating effect of heat as a physical agent on blood, and that 
this disintegration commences as soon as its temperature be- 
gins to ascend beyond the normal degree, is at least a very 
natural conclusion, and in full accordance with the general ac- 
tion of all laws of nature. 
It is also a fact, well established by clinical observation, that 
the reparative process required for the healing of wounds or 
ulcers is considerably or entirely suspended by the occurrence 
of febrile diseases. 
Liebermeisterf has seen chancroids become phagedenic in 
individuals who were taken with typhoid fever, and every phy- 
sician has seen wounds cease to granulate and assume an un- 
healthy appearance under similar circumstances. 
The anatomical condition of the different organs of patients 
who died under the influence of high grades of fever, revealed 
by the microscope, furnishes, finally, the most conclusive evi- 
dence of the decomposing and disintegrating effect of the febrile 
combustion on the tissues, and the plainest explanation of the 
deleterious influences of high febrile temperatures on the hu- 
man system. 
Numerous post-mortem examinations, of fever patients have 
proven beyond a doubt, that those of them who died under the 
influence of a high grade of temperature, and they alone, exhib- 
ited parenchymatous degeneration of the most important or- 
gans, while those cases where such a high elevation of temper- 
ature did not occur, were free from them. 
Thus the cellular elements of the liver are always found more 
or less plainly degenerated, sometimes entirely decomposed into 
loose detritus. Similar changes are observed in the kidneys. 
The heart is unusually loose, flabby, of a paler, grayish yellow 
or brownish color, and in the primitive muscular fibres, granu- 
lar opacity, indistinctness of the transverse stripes, and accu- 
mulation of fat granules are often plainly perceptible. The 
*See Atlanta. Medical and Surgical Journal, vol. x, page 29G. 
f Uber die Behandlung cles Fiebers. Volkman’s Klin Yortraege, No. 31, p. 211. 18 
Origin, Nature and Treatment of Fever, etc. 
same changes and also waxy degeneration are often observed 
in the voluntary muscles. Similar degenerations are noticed in 
smaller blood vessels, in the substance of the brain, and many 
other parts of the organism. 
These changes are spoken of by Prof. B. Virchow, in the 16th 
chapter of his Cellular Pathology, as the highest grade of nutri- 
tive irritation (parenchymatous inflammation in his sense of the 
term) and as processes in which by the increased activity of the 
cellular elements of different organs an abnormal quantity of 
nutritive material is attracted but not converted into normal 
cell-substance, and which therefore terminate either in softening 
(necrobiosis) or in fatty degeneration. 
He speaks of them as very frequent and very serious patho- 
logical conditions, occurring principally in infectious diseases : 
the acute exanthemata (measles, scarlatina,variola,) typhus, puer- 
peral and traumatic fevers, phlegmonous and erysipelatous 
processes, and other blood intoxications. Prof. C. Liebermeister 
of Basel, one of the most prominent investigators of tempera- 
ture conditions in health and disease, and an acknowledged 
authority on these subjects, ascribes the frequent occurrence of 
these local parenchymatous degenerations in infectious disease, 
not to their infectious origin, but to the high grades of febrile 
temperature generally prevailing during their entire course, 
because these morbid anatomical conditions are alike observed 
in all cases of disease which terminate fatally, under very high 
grades of febrile temperature, whether they are of an infectious 
character or not." 
This deleterious influence of high febrile temperatures on the tis- 
sues constitutes one of the great dangers connected with acute febrile 
diseases per sc, and manifests itself principally, as it disturbs the 
heart or the cerebro-spinal centers prominently, by two trains 
of symptoms which terminate respectively in paralysis of the 
heart or the brain. 
An increasing frequency and weakness of the pulse, corres- 
ponding deficiencies of the capillary circulation, hypostatic 
troubles, cold skin and extremities, with increased internal tem- 
peratures—symptoms frequently called congestive—mark the 
former; delirium and versatility, followed by stupor, coma, in- 
*C. Liebet »iet>ter. Uber die BehancUung des Fiebers. Volkmann’s Samlung 
Klinischer Voitr.iege, No. 31, 1871. Origin, Nature and Treatment of Fever, etc. 
19 
sensibility, the latter condition of things, wherever a high febrile 
temperature continues for a longer time, the disease itself may 
be scarlatina or erysipelas of the face, pneumonia or acute 
rheumatism, or any other acute febrile condition. When prac- 
titioners speak of acute febrile diseases assuming an adynamic 
or typhoid type, they are generally dealing with the deleterious 
consequences of high febrile temperatures on the tissues of 
the heart or nervous centres, and the grave functional distur- 
bances which follow them. The most malignant forms of these 
diseases and their fatal terminations or their serious local se- 
quelae—for instance, the occasional malignancy of scarlatina, 
erysipelas, etc.—are caused by these structural degenerations of 
important organs. An acquaintance with these occurrences 
and their dependence upon high febrile temperatures is of great 
diagnostic and therapeutical importance. It demonstrates to 
the practitioner the great value of thermometrical observations 
in all febrile and inflammatory diseases, and the great necessity 
of controlling the temperature of the body in fevers in order 
to prevent the occurrence of these conditions, and enables him, 
finally, to explain severe circulatory and cerebral disturbances 
frequently without resorting to the supposition of meningeal 
inflammation or uraemic intoxication, etc. 
Another not less serious danger, directly resulting from the in- 
creased combustion and matamorphosis constituting the febrile 'pro- 
cess per se, consists in the morbid consumption of the organic mate- 
rial of the body and its subsequent depressing influences on the func- 
tions of the brain and nervous system. Every fever is a consump- 
tive process, and deserves more or less the name of a hectic 
fever. 
While in acute febrile diseases the high grade of febrile tem- 
perature causes the parenchymatous degeneration of important 
organs, in low continued fevers the long duration of a less ex- 
cessive febrile temperature sets up a waste of tissue material, 
which will destroy life in due time as certain as the former con- 
dition. 
A correct appreciation of the therapeutical importance of 
these pathological facts, the unavoidable results of the very na- 
ture of the febrile process per se, independent of its specific 
character, its local origin or complications,has initiated the most 
essential advances of modern clinical medicine in the treatment 20 
Origin, Nature and Treatment of Fever, etc. 
of febrile diseases. It has taught the profession to recognize, 
by the use of the medical thermometer, the difference between 
a febrile condition, which is destitute of danger and will termi- 
nate in health, and one which, in cod sequence of the high or 
too long-continued febrile temperature, consumption and disin- 
tegration of organic material, excludes the possibility of the 
continuation of the various processes of life, and has estab- 
lished : reduction and control of high febrile temperatures as the 
most prominent and most important general indication in the treat- 
ment of all febrile conditions. 
The necessity for a more exact measurement of febrile tem- 
peratures than the mere subjective sensation of the observer 
can furnish, has been felt for a considerable length of time, and 
De Haen, J. Currie, and other isolated investigators have al- 
ready used the thermometer for that purpose. The clinical 
importance of a knowdedge of the physiological laws by which 
the production and consumption of caloric in the human sys- 
tem is governed in health and in disease has also been appre- 
hended, and numerous physiologists and pathologists—Sancto- 
rious, of Padua, De Haen, of Yienna, Ch. Martin and Hunter, 
in England, Lavoisier and Laplace, in Prance, James Currie and 
others—have investigated and published their physiological ob- 
servations on this subject; but the introduction of regular ther- 
mometrical measurements of the temperature in diseases as an 
important auxiliary measure in establishing a correct knowledge 
of each case, its prognosis and treatment belongs to the very 
latest period of time. 
Andral, Rogers, Demarquay, and others, have, since 1840, 
paved the way by valuable observations in this direction, but 
Derensprung, Traube, and most prominently, "Wunderlich, of 
Germany, are the real founders of clinical thermometry. The 
latter, more than any one else, has established the use of the 
medical thermometer as an indispensable necessity to arrive at 
a correct understanding of the prognosis, nature and treatment 
of febrile diseases, and has elevated thermometry to an im- 
portant branch of pathology and therapeutics. The doubts 
existing in the minds of many physicians yet as to the practical 
value of thermometry will be dispelled if they will take the 
pains of studying J Wunderlich’s and Seguin’s Medical Ther- 
mometry, published by Wood & Co., New York, 1871. Wuuder- Origin, Nature and Treatment of Fever, etc. 
21 
lich, on page 25 of that book, calls thermometry: An objective 
physical method of investigation which gives, earlier than all 
other methods, a more accurate and delicate measure of the 
changes in the organism, which may be graphically expressed 
by traces, or numerically by figures, and says : “ Thermometry 
is a part of our method of diagnosis or observation of disease, 
indispensable where temperature varies, useful in doubtful 
cases, and auxiliary in almost every case. A medical attendant 
whb undertakes to decide a case of fever or febrile disease without 
hioiving the fads of thermometry is like a blind man trying to find 
his way in an unknown locality.” 
This expression may sound harsh and perhaps extreme, par- 
ticularly to those w7ho are yet practicing medicine without ever 
using a thermometer; but an observer like Wunderlich, who 
studied 25,000 cases thermometricallv, and made careful records 
within their history of several millions of single thermometrical 
observations before he published his work, has a right to speak 
definitely on the subject. 
It is beyond the reach of this paper, which considers only 
the general pathology and treatment of the febrile process, to 
enter into detailed statements of the many important data 
which this late field of observation has furnished in relation to 
differential diagnosis, prognosis and treatment of various forms 
of febrile diseases. It is, however, one of the objects of it 
to impress the fact upon the mind of the profession that 
febrile diseases cannot be treated rationally and in harmony 
with the principles of modern pathology without the aid of the 
medical thermometer and an acquaintance with the facts of 
thermometry, because only that instrument enables the practi- 
tioner to ascertain the degree of fever and the amount of dan- 
ger connected with it. It is the measure by which the time 
when, and the degree of energy and perseverance can be determined 
with which, the now accepted antifebrile fneasures should be 
used for the prevention or amelioration of the above discussed 
dangers of fever, better than by all the other symptoms together, 
although no intelligent practitioner should, on that account, 
neglect a careful consideration of the condition of every part 
and function of the organism and the relationship and influence, 
which they mutually occupy to, and exercise upon, each other. 
Thus the thermometer is as great an aid to the physician and 22 
Origin, Nature and, Treatment of Fever, etc. 
furnishes him as unmistakable indications in the treatment of 
disease as the compass does to the mariner, and its introduction 
into the practice of medicine has been and will continue to be 
followed by alike important and beneficial results. 
The most important general indication in the treatment of 
the febrile process has already been defined as: reduction and 
control of the temperature according to the data furnished by ther- 
mometrical measurement. 
This is the only indication which can be obtained by a care- 
ful study of the general pathology of that morbid process, and 
therefore a discussion of the question by what modes of treat- 
ment, and by what remedies it can directly be fulfilled, will form 
the only therapeutical consideration of this paper. 
The most direct anti-febrile or—as it is now more frequently 
designated—anti-pyretic mode of treatment consists in the ap- 
plication of cold water to the hot body of the fever patient by 
which a portion of its caloric is consumed and withdrawn. 
Physicians have in all ages, governed by the desire of their 
patients for cool drinks, cool air, etc., been more or less inclined 
to use cooling remedies, frequently, however, more for the com- 
fort of the patient than with a view of obtaining marked thera- 
peutical results. The application of cold water or ice to the 
head was, until quite recently, the most energetic remedy ever 
used for the purpose of reducing heat, and very few physicians 
would have ventured to use cold applications to the thorax o 
abdomen in [fevers, much less systematic reduction of the 
febrile temperature by frequent immersions of the entire body 
into cold baths. 
James Currie, an English physician, was the first who, near 
the end of the last century, used and introduced the systematic 
treatment of febrile diseases by cold water for the purpose of 
reducing the febrile temperature. His method found some suc- 
cessful imitators; but was soon forgotten. 
Priesnitz and his followers, the founders of the hydropathic 
treatment par excellence, used cold water for almost any other 
purpose but that of simply* reducing the temperature of the 
body, and very few physicians, during the first half of our cen- 
tury, had any confidence in its use in febrile conditions. It was 
reserved to Dr. Ernst Brandt, of Stettin, Germany, to rehabili- 
tate this method by his work on the treatment of typhoid fever. Origin, Nature and Treatment of Fever, etc. 
28 
Since that time it has gained ground rapidly, and has been 
extensively used and carefully studied by numbers of the most 
prominent pathologists of Germany. Bartels and Juergensen, of 
Kiel, Liebermeister, of Basel, Wunderlich, of Leipsic, Gerhardt, 
of Jena, Drasche, of Vienna, Ziemsen and Immerman, of Er- 
langen, Pfeufer, of Munich, and many others, have introduced 
this method in their hospitals, and have treated thousands of 
cases of enteric fever (abdominal typhus), one of the most com- 
mon diseases of Germany, in this manner. 
They have all published the results of their investigations, 
and are all more or less enthusiastic advocates of the antipy- 
retic treatment, as it has not only reduced the mortality of that 
disease greatly, but has a decided and marked influence in 
checking or ameliorating its various local symptoms. Both 
facts have been statistically demonstrated. 
Liebermeister gives the following statements in relation to 
the mortality of the disease under different modes of treatment 
at the hospital at Basel. 
1. Under expectant and symptomatic treatment: 
Year. No. of Cases. Death. Percentage of Mortality. 
1843—1853 444 153 30.4 
1854—1859 643 172 26.7 
1860-1864 631 162 25.7 
2. Under imperfect antipyretic treatment: 
1865-1866, Sept- 982 159 16.2 
3. Under energetic and continued antipyretic treatment: 
1866, Sept.—1867,(end) 339 33 9.7 
1867—1868 181 11.... 6.1 
1808—1869 186 10 5.4 
1869—1870 139 10 7.6 
845 64 7.6 
Dr. Brandt’s reports show the same favorable decrease of 
mortality from 30 per cent, to 10 per cent.; Stohr’s in Wurzburg 
from 31.5 to 6.6 per cent.; Ziemsen’s from 15.4 to 3.1 per cent. 
Liebermeister’s experiments have further established the fact 
1. That abstractions of caloric from the body of fever patients by 
cold baths, cause first an increased combustion followed after 
the bath by a decrease of combustion and temperature much 
greater than the preceding increase, and therefore more than 
■compensating its effects. 24 
Origin, Nature and Treatment of Fever, etc. 
2. That this decrease of combustion and temperature caused 
by the cold bath depends upon the duration and temperature of 
the latter. The colder the water and the longer the immersion, 
the more decided the refrigerating effect; a bath of short du- 
ration but sufficiently cold, has a more decidedly cooling effect 
than a bath of a few degrees higher temperature much longer 
continued. 
To Juergensen and Bartels in Kriel, belongs the merit of hav- 
ing demonstrated that in a very large majority of febrile pa- 
tients intensely cold baths can be used as often as needed, or in 
other words, as often as the febrile temperature rises to 39 de- 
grees C. (102 deg. F.) without any danger. From the introduc- 
tion of this energetic method of treatment (1866,) dates the 
great diminution of the mortality of abdominal typhus set forth 
in the above statistical statements. 
The leading practical points for the guidance of the practi- 
tioner in the use of this method of treatment are : 
1. Cold water as a refrigerant should be used in all cases of 
disease where the grade of the bodily temperature—39 deg. C. 
(102 deg. F.) or above—threatens to initiate the above men- 
tioned dangers of the febrile process. Abdominal typhus, meas- 
les, scarlatina, variola, pueperal fever, epidemic cerebro-spinal 
meningitis, bronchitis, severe forms of pneumonia, etc., fre- 
quently require this treatment. 
2. The success of it depends upon the energy and persever- 
ance with which it is adapted to the indications which each in- 
dividual case presents. The course of the temperature, the 
condition of the pulse, the respiration, and particularly the 
strength of the patient, must be carefully consulted, in order to 
decide what amount of benefit can be expected from abstrac- 
tions of caloric by the use of cold baths or cold applications : 
In anaemic and already much emaciated individuals and in dis- 
eases of a chronic character, for instance phthisis, its use is of 
doubtful propriety, as the increase of combustion during each 
application might, in some cases, do more harm than the sub- 
sequent decrease of it would do good. 
3. Whenever its use is deemed proper, it should be resorted 
to early and energetically to obtain the most favorable results. 
Baths and other cold applications should be used—not promis- 
cuously and in irregular intervals—but as often as the febrile tem- 
perature measures in the axilla 39 deg. C. (102 deg. F.) or above. Origin, Nature and Treatment of lever, etc. 
25 
Full baths in water of 20 deg. C. (68 deg. F.) of about ten 
minutes duration, are used by Wunderlich, Liebermeister, 
Ziemsen, and others, as the most effective antipyretic applica- 
tion. The bathing tub remains in the sick chamber and the 
same water is used during the entire day for one patient. In 
hot weather it is cooled down by the addition of ice if needed. 
"Weakly patients are kept in it only from 5 to 7 minutes at a 
time. After the bath the patient is at once put to bed, wrapped 
up in a dry cloth, without being previously tired by an effort of 
wiping his body, and covered lightly. If shivering, he takes a 
glass of good wine and his feet are kept moderately warm by 
suitable applications. In very serious cases the treatment is 
commenced with baths of a higher temperature—24 degrees C. 
(72.2 deg. F.) or with baths of 35 deg. 0. (95 deg. F.) gradually 
cooled down by the addition of cold water, but continued each 
time as long again as colder baths. 
Applications cf wet cold sheets around the entire body, leav- 
ing only the feet free, are, next to baths, the most effective mode 
of reducing the febrile temperature. Three to four consecutive 
applications of from 10 to 20 minutes duration each, produce 
the same effect as one cold bath. This method recommends it- 
self in private practice on account of its simplicity. Winter- 
nitz uses the sheets without any cover over the patient, and 
continues to sprinkle cold water on the sheets where a very high 
temperature requires it, and uses frictions on parts which re- 
main unusually cool, a condition of things occasionally occur- 
ring. 
In cases running their course with mild febrile temperatures 
and less intense nervous symptoms, or in children where the 
amount of the surface in proportion to the weight of the body 
is always more considerable than in grown persons, this method 
of abstracting caloric is very applicable and often quite suffi- 
cient. 
Cold douches as well as ablutions frequently repeated can, 
particularly in cases of sopor, etc., where an exciting effect on the 
psychical and respiratory functions is desired, be made useful, 
but as refrigerants they are, according to repeated calorimetric 
measurements, of very little lasting benefit, and no substitutes 
for cold baths or cold sheets. 
This method of treatment reduces the temperature of the *26 
Origin, Nature and Treatment of Fever, etc. 
body indirectly by the physical abstraction of caloric from its 
surface. Its energetic use is often sufficient to diminish the 
febrile temperature more or less permanently, and to obviate 
the dangers directly resulting from its continuation. Where 
this is not the case, or where this treatment is not well endured 
by the patient, or where the already existing high grade of 
bodily consumption and weakness as in phthisis forbids its en- 
ergetic use, other additional remedies are resorted to, wrhich by 
their internal influence on the blood or nervous system exercise 
a direct controlling eftect on the production of caloric. 
Quinine and veratrum viride are, next to cold water, the 
principal agents for the reduction of febrile temperatures. The 
former remedy is now extensively used in connection with the 
cold water for the accomplishment of this purpose. One large 
■close from 20 to 40 grains in adults is given at once, or within the 
■course of one hour, and repeated as often as the reduced temperature 
rises again, which is seldom the case before 48 hours from the time 
of the administration of the remedy. If 20 grains reduce the tem- 
perature to 38 deg. C. (100.5 deg. F.) this dose is sufficient. If 
they do not reduce it that far, a larger dose is given the next 
time; if they reduce it still lower, a smaller one. In this manner 
intermissions of the febrile process are produced as often as 
possible, and Liebermeister holds that the creation of complete 
intermissions in diseases running their course with long-con- 
tinued and high grades of temperature by this remedy, is one of 
the principal secrets of success in their treatment.* 
Any one, who has closely observed the effect of these large 
doses of quinine in severe cases of erysipelas, acute rheumatism, 
scarlatina, pleuritis, pneumonia, variola, abdominal typhus, 
phthisis florida, and who has measured the decrease of the 
temperature and seen the decided simultaneous amelioration of 
the circulatory and cerebral derangements following each dose, 
cannot long remain in doubt, that these derangements are prin- 
cipally caused by the effect of the high temperature on the 
heart and brain, and that quinine is, to use the older term, an 
antiphlogistic remedy in these diseases. 
How far it accomplishes this result by its direct influence on 
the nervous system remains undecided, as its relations to the 
*Uber die Behandlung des Fiebers, No. 31. Sammlung Klinischer Vortraege, 
v., Yolkman. Origin, Nature and Treatment of Fever, etc. 
27 
same have not yet been determined by actual experiment. 
That such relation exists, however, can not be denied, as its 
depressing effects on the nerves of sensation and voluntary mo- 
tion are often too plainly perceptible, and its tonic effect on the 
muscular fibres of the spleen too well established. Binz’s and 
Scharenbroich’s late investigations," however, have plainly dem- 
onstrated that quinine diminishes the capacity of the red cor- 
puscles of the blood to bind oxygen, that it prevents the devel- 
opment of microscopic organisms and arrests the process of 
fermentation and decomposition of nitrogenous substances. 
These qualities of the quinine, if blood-changes giving rise to 
fever are frequently processes more or less analogous to fer- 
mentation and decomposition, account more directly for its un- 
questionable efficiency in the treatment of febrile diseases. 
While the veratrum viride in Europe is frequently used in the 
form of its alkaloid, the introduction of Norwood’s excellent 
tincture of this plant in the practice of this country makes it 
unnecessary for American physicians to resort to the use of 
veratrine for the purpose of reducing febrile temperatures. 
Every American practitioner is familiar with the use of Nor- 
wood’s tincture in pneumonia and other inflammatory diseases 
for the purpose of arresting or diminishing the intensity of the 
local morbid process. It is alike an invaluable remedy for reduc- 
ing and controlling febrile heat in idiopathic fevers, and clear 
intermissions can often be established by its use without any 
danger to the patient. The writer has used it for the purpose 
of controlling the frequency of the pulse soon after its intro- 
duction by Norwood, and long before he knew anything about 
the medical thermometer, with the happiest effect in enteric and 
other low continued fevers. It should be administered often 
enough and in large enough doses to keep the temperature and 
pulse as near the normal standard as possible, without produc- 
ing collapse, and five drop doses every three to four hours will 
prove sufficient for that purpose in a large majority of cases. 
Digitalis has a very similar effect on the pulse and tempera- 
ture in fevers, and is frequently used in Europe. The disagree- 
able cumulative symptoms however, which occasionally follow 
its use, and its less uniform influence on pulse and temperature, 
f Binz. Experimentelle Unter suchtingen ueber das Wesen der Cbinimvirknng, 
1868.—Med. Centralbladt, 1867, No. 52. 28 
Origin, Nature and Treatment of Fever, etc. 
will enable us to dispense with its use when we possess a much 
safer and more reliable remedy in veratrum viride. 
Binz’s late experiments* have also placed alcohol in its dif- 
ferent forms amongst the antipyretic remedies. He has demon- 
strated that it diminishes the activity of the metamorphosis in 
the tissues, and reduces the temperature in fever patients. 
When it is remembered that it furnishes at the same time hydro- 
carbons to the organism for combustion, and that it has a deci 
ded antiseptic effect, its judicious use in fevers, particularly of 
a septic and adynamic character (pyaemia, puerperal fever, ty- 
phus, erysipelas, etc.,) is certainly frequently indicated, and fre- 
quently followed by very beneficial results. 
These are the only direct antipyretic remedies now known, 
and therefore the only ones that can be considered in the treat- 
ment of the febrile process in its general pathological features. 
The importance of nutritious diet in febrile processes of long 
standing is too well acknowledged by the profession generally 
to require more than mere mention in this paper. How far 
vemesection is admissible and useful in the treatment of febrile 
and inflammatory diseases, the writer will endeavor to consider 
in a future paper. 
* The Therapeutical Effect of Alcohol. Atlanta Med. and Surg. Journal, vol. 
x, page 561. ERRATA. 
Page 4, fourth line, “ Booerhave" for Boerhave. 
“ 4, thirteenth line, “ prcesentes” for prccsentes. 
“ 15, twenty-eighth line, “Booerhave” for Boerhave. 
“17, third line, “5G° C.” for 50° C.