Dr. J. Burdon Sanderson on the process of fever.
- Burdon-Sanderson, John Scott, 1828-1905.
- Date:
- [1875]
Licence: Public Domain Mark
Credit: Dr. J. Burdon Sanderson on the process of fever. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![between the fevered and the healthy body, consisting chiefly in this, that whereas the former discharges a quantity of nitrogen equal to that taken in, the latter wastes the store of nitrogen contained in its own j uices. That this disorder of nutrition is an essential constituent of the febrile process is indicated by the fact that it not only accompanies the other phenomena of fever during their whole course, but precedes the earliest symptoms and follows the latest. I hat it anticipates the be- ginning of fever was first demonstrated by Dr. Sidney Ringer * in his investigation of the relation between temperature and the discharge of urea in ague. That the same condition continues after the crisis has past, i.c., the temperature has begun to sink, has been shown by Dr. Squarey from his investigation of eighteen cases of typhus, in all of which the daily excretion of urea was measured, and the variations of temperature were observed during the whole course of the disease, and the obser- vations were continued until convalescence was completely established. In these cases it was found that, whereas the bodily temperature which in this disease rises rapidly at the beginning, and keeps up without sen- sible abatement during a period which often extends to the middle of the second week, usually begins to fall after the tenth day, the daily rate of discharge of ,urea, although usually above the normal during the first week did not attain its maximum until the temperature had been falling for some days. I The question of the source from which the urea increment of fever comes is one which can be better discussed subsequently. At present it is sufficient to notice that the anticipation of the obvious symptoms of illness, particularly of the pyrexia, by the increased excretion of urea, as well as the continuance of the urea excess during the epicritical period, plainly indicate that pyrexia is not the agent by the direct influence of which the increased secretion of urea is produced. Another consideration suggested by the same facts is this, that the mere increase of the per-centage of urea discharged, affords an inadequate measure of the waste of nitrogen, i.c. of albumin, which actually occurs in fever; for to form a just estimate, the overlapping at both ends of the process ought clearly be taken into account. Moreover, in fever there are very frequently losses of nitrogen by the bowels and skin, as well as by exudations, the amount of which scarcely admits of being determined. It having been established that there is an increased d ischarge of nitrogen in fever it remains to state what is known as to its source. There are two sources which are open to discussion, viz. : (1) the albumin of the blood and lymph, and (2) that of the tissues; or, to use the expression which the researches of Yoit have rendered current in physiology, store albumin, and tissue albumin. By the former we understand the albu- minous constituents of the corpuscles and plasma as well as of the tissue juice or lymph ; by the latter, the material of protoplasm, including that of the blood corpuscles. Here the basis of observation is furnished by researches made by Dr. Salkowski, relating to the proportion of potassium salts discharged * On the connection between the heat of the body and the excreted amounts of urea, chloride of sodium, &c., during a fit of ague. Medico-chirurgical Transactions, vol! XLII. ]). 361. In this paper Dr. Ringer recorded more exact observations than had before been made as to the relation between the temperature and the other phenomena ot the paroxysm of ague.^ In the course ot them he made the important discovery referred to in the text, viz : that in this disease the augmentation of the urinary discharge of nitrogen not. only begins some time before the accession of the cold stage but even precedes the rise of temperature. \ Observations on the temperature and the urine in Typhus fever. Medico-chirur- gical Transactions, vol. L., p. 329. Arp. No. 1. Ou the Process of Fever, by Dr. Burdon](https://iiif.wellcomecollection.org/image/b22356861_0013.jp2/full/800%2C/0/default.jpg)
