Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    228/1274 (page 196)
    Fever is also a constant accompaniment of acute infective inflammations : that is to say, of those conditions in wliich a virus is present, which has been proved in most cases to be a micro-organism, which multiplies in the living body, either locally, as in local spreading or infective inflammation, or gene- rally, after entering the blood from the original centre of infection, as in many forms of septicaemia and in pyeemia, malignant pustule, &c. The fever in these cases is due, in part at least, to the admixture of the chemical products of the growth of the organism with the blood. That these substances are capable of exciting fever has been proved by the injection of the products of their growth on artificial cultivating media. Fever may also be caused by the presence in the blood of chemical sub- stances generated in the body itself. The most simple example of this is the fever that accompanies an attack of gout. It has before been pointed out that heat-production, heat-discharge, and heat-regulation are under the control of the central nervous system. Two theories have been held with regard to those fevers which are due to the ad- mixture of pyrogenic substances with the blood: the first is that the pyrogenic substance acts directly on all the tissues of the body, giving rise to increased tissue-change with development of heat ; and the second is that the impure blood circulating through the brain disturbs the heat-controlling centre, and thus indirectly acts on the tissues. The latter is the view generally accepted at the present time. VYe are yet very far from fully understanding the exact nature of fever ; but what we do know is of immense practical value. We know that in the majority of cases in which fever forms a serious feature in surgical practice, it is due to the entrance into the circulation of noxious materials generated locally, and that in its treatment our first object must be to arrest the formation of the pyrogenic material by local means. For example, in an acute abscess a fluid containing the products of destructive tissue-changes is pent up in a cavity at some degi-ee of pressure, and a certain proportion of the pyrogenic materia- it contains is constantly finding its way into the circulation. Open the abscess and cut off the supply and the fever at once subsides ; but if, for want of drainage, the cavity fills again and its contents be allowed to decompose, the fever will return more severely than before, as putrid matter is more powerfully pyrogenic than the products of simple inflammation ; open up the cavity and drain it, and again the fever will subside ; but possibly, supposing the patient to be .exposed to infection in an unhealthy and overcrowded hospital, a virus, capable of multiplying in the surrounding tissues, and perhaps of increasing, like a ferment, in the blood itself, may find its way from without into the abscess cavity and thence infect the whole system. Under such circumstances, the mere local treatment will no longer be able to arrest the febrile disturb- ance ; and, unless the patient have suflicient vitality to resist its effects, a fatal result must follow. Symptoms of Tever in General.—xVlthough inflammatory fever or pyrexia ])re8ents cliuically many varieties, certain symptoms are common to all. The first and most important of these is e.hvatim,of imperatvre, as shown by the thermometer. All temperatures above 99-5° F. (37-5° C.) must be con- sidered as indicating lever. The fever is considered slight unless the thermo- meter rises above 100-5° F. (38° C.) ; up to about 102-5° F. (39° C.) it is considered moderate ; from 102-5° F. (39° C.) to 105° F. (40-5° C.) it is