Dr. J. Burdon Sanderson on the process of fever.

  • Burdon-Sanderson, John Scott, 1828-1905.
Date:
[1875]
Catalogue details

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.

    8/38 (page 16)
    Apr; No. 1. On tlio Process of Fever, by Dr. liurdou Sanderson. and in bed, is unfortunately very limited. Indeed, the only observations J on the subject which are available, are those made by Dr. Unruh* on three i patients in Professor Leyden’s wards at Konigsberg in 1869. The patients in question were affected with non-febrile diseases. The first, a cabman aged 47, suffering from carcinoma ventriculi, weighed 104 lbs. His diet consisted of beef tea or broth, with an egg or two. The quantity was probably excessively small, for the daily discharge of chloride of sodium scarcely exceeded one gramme. He was under rl observation 19 days, during which his temperature was normal, and the a specific gravity of his urine was natural. The mean daily discharge of urea was 17'5 grammes. In two other patients affected with syphilis,, each of whom was observed during 13 days, the daily means of urea* were severally 18-58 and 16-267, both being on fever diet with milk,. Thus we have 17 466 grammes(=270 grains) as the mean of the threat observations ; or 0-3835 gramme per kilo, of body weight ; whereas the • normal excretion of urea per kilo, is about half a gramme. The mean'] discharge of uric acid in the first case was 0 009 per kilo, per diem. Having obtained this basis, Dr. Unruh proceeded to investigate in a similar way cases of different kinds of febrile disease, of which thffl results will be found stated in a long series of tables in his memoire.. They are summed up by him as follows :— Assuming that 0-38 grammes per kilo, per diem (=2-68 grains per lb.) represents sufficiently accurately the normal low diet discharge of urea * in health, he found that in one case of relapsing fever, with an evening; temperature of 400,8 C. (105°-4 F.), and a morning temperature of 38° 2. (100°-76 F.), the discharge was on one occasion as great as 65-97 grammes - i.e. 1 18 per kilo, per diem, more than three times the normal, this being: the highest result obtained. The lowest amount in a case of pneumonia (with a history of previous chronic disease) was 18-6 per diem, which is- scarcely above the normal. This condition presented itself only during : the first few days of observation. The general result of the whole series • was that the normal urea discharge per diem in intense fever may be set: down at 30-576 grammes (= about 470 grains,) hence, something like one and a half times as much as would be discharged by a healthy person i on fever diet. Dr. Senator thinks this estimate too low, on the ground that in most of the cases the beginning of the febrile process was not included, aud consequently that during the period of observation, the patient having : been previously subjected for a length of time to the combined influence of inanition and fever, was already exhausted of his store albumin, so » that Dr. Unruh’s mean could not be regarded as a fair one ; and refers in support of his view to the published urine analyses of Moos and ! Rosenstein in typhoid and typhus, both of which show that the urea discharge is larger at the very beginning of the attack than it is after- wards. Unfortunately, the number of cases in which the urea discharge has been observed from the beginning to the end, is exceedingly small. Dr. Senator has been able to meet with only two, one observed by himself, the other by Dr. Wachsmutli, which were complete iu this respect. He has, however, brought together 13 selected cases in which the observations were begun sufficiently early, and in which the signifi- cance of the results was not impaired by any conditions affecting the * patient. He has divided tlieso 13 cases, which must be regarded as ■ by far the most important body of clinical evidence which exist.-- on the question of the exchange of nitrogen in fever, into categon * Unruh, Ueber die Stickstoffausscheidung bei fieberhaften Krankheiten: t lrcliow s Archiv., vol. xlviii. p. 227.