Lectures on the Practice of Medicine
Authors: C. Murchison
Journal: BMJ (1872)

BRiTISHMEDiCAL 7OURNAL.'75~~~~~~~~ of urea and uric acid voided in the urine is, as we have seen, largely in- * Pec in fpvpr L hprp iC PuViUnop .1anLhnI4 fIJhA inLrVU Ai. n L E L1 I U Ft. EL of urea precedes any rise of temperature; and although the amount of ON urea cannot be measured by the degree of heat, there is a direct relation E PRACTICE OF MEDICINE.~~~~~between the two.As a rule, the temperature is highest, and the quan- THE R C I E O E I I E tity of urea greatest, in the early stages of a fever ; and when there is BY ~~~~~~~~~an unusual elevation of temperature, there is an unusual amount of urea.CHARLESM RCHISON, .D., LL.D, F.R.S.,There are, no doubt, exceptions.The temperature is modified by the PscHaRLEoSt.Toa' URHositalN,Mnd.,inLecture on.RedcSn.a amount of evaporation going on from the surface of the skin; and the Phsca oSt.Thomas's Hospital, andJintSho Letctue.nMeiieaurea may be lessened by albuminoid matter, more or less changed,St. Thmas'sHospial Meical chool etc.being retained in the blood.In badly nourished persons, also, it has been found that comparatively little urea is eliminated notwithstanding the rise of temperature; but the latter is also less than in the robust x.Difinition.2. GniiSeS. .Symposa.nceedTm rtu; and well fed, and may be due to an increased formation of carbonic b Alteationsin theOrgans ofmiruato; c.Ancelseraented R i;esia acid.-.In one respect, the source of temperature in fever differs from tio;i ; d.Drynes ns of C.5ukai; e. DAeerangmnso ietied Functions; that in health.In health, the elimination of nitrogen is entirely regu- f Dragemnt ofSereton; g Dranemntsoftim Nrvos ys lated by the amount entering the body with the food, as has been Der.4 arigenetes 01 Pecrexia;s aMi; b.Iernfammatsory;l lc.oAsthenic; well shown by Parkes and other observers ; but the increase of nitrogen de/.4.Typhoid;ie.Hecic Intermittent,4ili b Reitnt,andmt; cntinuedeFever eliminated in fever does not come from the food, for it is out of all pro.5l.tjhoiio y ofPye.xHcin.6.nDiamioseis. 7 Remiotezosisd 8.Teamntindee.portion to it.The fixed albumen of the muscles, brain, and nerves 5 -alhlo6y o Pyexi. 6Dig;zsis 7.Proizois.8.reaillnt.breaks down into circulating albumen, to be in its turn transformed into V. Patholog(y of Pyrexiaz.-It would be more curious than instruc-urea and other nitrogenous excreta.Hence it is that the muscles waste tive to discuss the numerous views according to which medical writers and the brain becomes atrophied.The large amount of cerebral fluid have endeavoured to explain the phenomena of fever ; to show how the so common in protracted fevers is merely thrown out from the blood to humoral pathologists, hieaded by Hippocrates and Galen, looked upon fill the space vacated by the brain, and is not of inflammatory origin, as fever as the result of a contest on the part of Nature to expel from the was once believed.In all fevers the muscles become wasted, and, on -system a superabundance of one or other of what were called the microscopic examination, the muscular fibres can often be seen in the four humours-blood, phlegm, yellow and black bile; how, on the act of disintegration.The granular and waxy degenerations of the one hiand, Tweedie insisted that the blood was primarily affected, muscles found by Zenker in enteric fever occur in all severe fevers, and whiile, on the oth-er, Cliristison urged that the first link in the chain of in typhus the cervical ganglia of the sympathetic have been shown to events was derangement of the nervous system ; how Brown held that undergo a granular degeneration.The impairedl nutrition of the heart fever was an asthenic state of the system arising from an abstraction of and of the nitrogenous tissues accounts in part for the weakened car- the niatural stimuli, or from exhaustion, direct or indirect, of the diac action and for the stagnation of blood in the capillary circulation, -excitability ; how Ploucquet, Beddoes, Clutterbuck, Armstrong, and which are so common in the advanced stages of fever.The only parts li'roussais maintained that fever was always the result of inflammation of the bodly that do not waste in fevers are the glandular organs, and or congestion.especially the liver, spleen, kidneys, and lymphatic glands, which be- It is however, not a little remarkable that modern investigations tendl come enlarged and congested from the increased functions thrown upon to reproduce in a scientific form certain crude opinions concerning the them, the enlargement being greatest in the young and robust, who niature of fever which were entertained by the earliest writers on me-have most tissue to spare for conversion into urea.The gland-cells dicine.The abstract definition of fever given by Hippocrates, Galen, of these organs become swollen with minute granules ; and a similar and Avicenna was, "1Essentia vero febrium est proeter naturam cali-appearance is often presented by the white corpuscles of the blood, ditas"-and the definitions generally accepted by modern pathologists which are usually increased in number.are very similar.Thius, according to Professor Virchow, " Fever con-The large amount of nitrogenous detritus formedl in fever may be all sists essentially in elevation of temperature which must arise in increased eliminated by the kidneys or bowels, or a portion may be retained in tissue-change, and have its immediate cause in alterations of the nervous the blood, either as urea or as some half-transformed albuminoid systemn"; and according to Traube, "IFever consists essentially in an matter, and then the temperature may be elevated without a correspond- increased temperature of the blood."In fact, increased bodlily heat is, ing augmentation of urea in the urine.Critical deposits of lithates irtt as we have found, now looked upon as the pathognomonic sign of the urine are chiefly observed in those cases of fever where, from the fever.