Concepts of fever: recent advances and lingering dogma.

Fever has been a preoccupation of clinicians since medicine's beginning. One might therefore expect that basic concepts relating to this physiological response would be well delineated and that such concepts would be widely known. In fact, only in the past several decades has the febrile response been subjected to scientific scrutiny. As a result of recent scientific investigation, modern concepts have evolved from a perception of fever as nothing more than a rise in core temperature to one in which fever is recognized as a complex physiological response characterized by a cytokine-mediated rise in temperature, as well as by generation of acute-phase reactants and activation of a panoply of physiological, endocrinologic, and immunologic systems. The average clinician appears to have little more than a regrettably rudimentary knowledge of these modern concepts of fever. This symposium summary considers many such concepts that have immediate relevance to the practice of medicine.

A brief history and discussion of certain mycotic infections and their importance to physicians.

Mycotic infections are common and their incidence is increasing. They can be difficult to distinguish from other infections, particularly tuberculosis, but there are numerous clinical clues that can help suggest the presence of systemic mycoses. Histoplasma skin tests, serologic tests, and agent isolation can aid in the confirmation of a fungal infection. Clinical considerations must be put in the proper perspective before a definitive treatment is proposed. Specific chemotherapy is often curative.

Epidemiologic classics of Carter, Maxcy, Trudeau, and Smith.

Four great epidemiologists whose work so concisely linked clinical observations, epidemiologic clues, and logical preventive measures are discussed. Henry Rose Carter set the stage for the Walter Reed successes in Cuba by showing that 9-16 days must elapse after contact before yellow fever develops. This provided the link for the Reed group to allow the "virus" to incubate in the mosquito before becoming infectious. Kenneth Maxcy clarified the controversy between endemic typhus fever and Brill's disease in the southeastern United States. His clinical, epidemiologic, and laboratory findings led him to propose that the causative organism (Rickettsia typhi) was in rodents and the probable vector, fleas. When confirmed, effective control measures were applied. Two other American investigators, Edward L. Trudeau and Theobald Smith, helped prove Robert Koch wrong on three counts: (1) Tuberculin is not an effective therapeutic agent for tuberculosis; (2) there are two distinct types of tubercle bacillus, human and bovine; and (3) the bovine form of Mycobacterium tuberculosis is remarkably pathogenic for humans. The significance of these findings is unlimited.

Epidemiologic classics.

Epidemiology is the study of the relationships of the various factors determining the frequency and distribution of disease in a human community; the field of medicine concerned with the determination of the specific causes of localized outbreaks such as hepatitis,..., or any other disease of recognized etiology.