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NOTES ON TEMPERATURE IN DISEASE.
Temperature, average normal, of adults, 98.6° F.; of children, 99°; of the aged, 98.8°. Diurnal variation 1° to 1.5° F., highest from 9 A. M. to 2 P. M. Above 108° F. is a fatal sign, which issue may be averted by cold baths, reduced by ice from 96o to about 60° F. (A.). The clinical thermometer placed in the mouth, axilla or rectum, and retained in situ for five minutes, should go hand in hand with Aconite in the treatment of inflammations (R.). [For antipyretics see the articles FEVER, INFLAMMATION, in part III, also the list of these agents on page 42.]
Clinical Thermometry is one of the principal means of positive diagnosis. The thermometer should be self-registering, certified, and accurately marked according to the Fahrenheit scale. The most reliable temperature is that in recto, or in the vagina; less so in the axilla and folds of skin, and still less reliable in the mouth. A correct reading of the thermometer cannot be obtained in less time than five to seven minutes. (Da Costa.) The Average Normal Temperature of the body is 98.6°; which, like the pulse, will
vary somewhat in individual cases; as a general practical result, it is agreed that in temperate regions the normal temperature at completely sheltered parts of the surface of the human body amounts to 98.4° Fahr., or a few tenths more or less; and a rising above 99.5°, or a depression below 97 3° F., are sure indications of some kind of disease, if the increase or depression is persistent. The temperature is increased at the prime of life, is raised and depressed temporarily by the influence of diet, stimulants, exercise, etc. The minimum diurnal temp. is observed at 2 A. M., the maximum at 4 to 6 P. M. Any rise above 99.5°, or fall below 97.3° if persistent, indicates disease; on the other hand, a normal temperature does not always indicate good health. The greatest recorded range of temperature in disease is 50.4°; the minimum is 71.6° in a case of sclerema neonatorum (Quain's Dict.), the maximum 122°. In severe and fatal cases it rarely exceeds 107°, and rarely falls below 92°, even in fatal collapse. It may rise 3°-4° after death, as observed in a case of typhoid fever in which death occurred with a temperature of 107°, which increased shortly afterward to 110.5°. A temperature of 107° indicates malignancy, and where met with for two consecutive days in typhus, scarlatina, measles, pneumonia, pyæmia, meningitis or rheumatism, death may be expected shortly. In relapsing, remittent and intermittent fevers, and in the initial chill of an abortion, the temperature may reach 107° without indicating great danger. During the last hours of life, in many diseases, the temperature rises to 109°-111°; for example, in tetanus, sunstroke, typhus, etc. With a temperature of 96° collapse is imminent.
Abnormally High Temperatures reported in the British Medical Jour., by Dr. Donkin. In these eight cases all but one were in females, and none proved fatal. Pain was a prominent symptom in all. No. 1, 111.6°; convalescing from enteric fever. No. 2, 108°; no organic lesions; ovarian pain. No. 3, 115.8°; great abdominal pain and excitement. No. 4, 111°; convalescing from enteric fever. No. 5, 113°; enteric fever and double pneumonia. No. 6, 112°; synovitis. This was the only male. No. 7, 112°; painful stump, with necrosis. No. 8, 117°; pyonephrosis.
A High Average Temperature (above 104°), is found in severe pneumonia, scarlatina, remittent, typhus, typhoid and relapsing fevers, pyæmia, etc. A Moderate High Tem perature (102° and above), is seen in peritonitis, acute rheumatism, pericarditis, pleurisy, dysentery, cerebro-spinal-meningitis, catarrhs, etc. A temperature of 100° and above is found in chronic affections, incipient inflammations, and mild fevers. When, in effervescence, the heat increases rapidly, it will, in defervescence, decline proportionately fast, and vice versa. Beware of a grave affection when the temperature is of a continuous type. A distinct interval between morning and evening temperature is a favorable sign. A slow and gradual increase indicates typhoid fever; in rheumatism and anomalous fevers the increase is more rapid, and still more so in acute inflammatory disease, pneumonia, angina, pleurisy, typhus, scarlatina, rubeola, etc. It is usually very rapid in intermittent fever, febricula, and ephemeral fevers. A rapid effervescence and slow defervescence indicates some complication of disease; the reverse order indicates great danger. When the tem perature begins to fall from the evening to the morning, it is an indication of improvement; while a rise of temperature from the evening to the morning is a sure indication that the patient is worse. Stability of temperature from morning to evening is a good sign, but from evening to the morning, unfavorable.
A Decrease of Temperature below the normal heat is rare. It occurs sometimes transitorily, announcing thereby a favorable crisis, by preceding the return to a normal temperature. It is also met with occasionally during the morning remission of remittent fever; also during the apyrexia of intermittents; in acute collapse, preceded or not by fever; in chronic wasting diseases; and sometimes, also, on the approach of death, especially in typhus fever.
In Phthisis, the temperature is higher in the evening than in the morning; later, higher at early bedtime than at noon, and high again at dusk. This is a valuable and delicate test of the progress of tuberculization.
In Typhoid Fever, the accession is by a rise of one degree each day, with the diurnal variation. If the evening temperature does not exceed 103.5°, the disease will probably be mild; but a temperature of 105° in the evening indicates a severe type and much danger. A sudden reduction to 95° in the third week denotes intestinal hemor rhage; a lingering temperature of 101°-102° in the fourth and fifth weeks indicates noncicatrization of the intestinal ulceration.
In Scarlatina, the rise of temperature is rapid, 104.7° may be reached in a few hours. It seldom rises above 105° and never above 106°; is continuous until the eruption begins to fade, when remissions take place, unless complications arise.
In Measles, 103° is the usual temperature, with daily variations, increasing with the
eruption and catarrhal symptoms. A high temperature lasting beyond the tenth day denotes complications.
In Diphtheria, the temperature by the end of the third day will, in uncomplicated cases, not exceed 103°-104°. It falls temporarily with the exudation. Defervescence in the severe, fivorable cases, is from the twelfth to the fourteenth day; in the milder cases not before the sixth. In some fatal cases it occurs early, from the third to the fourth day. In asthenic cases the temperature of the surface falls, while that of the interior remains high -100° in the axilla, and 103° in the rectum. During convalescence, the temperature is low, and readily depressed, but may be raised by intercurrent maladies. Any increase after the first five days, or a continuous high temperature after the first ten days, is unfavorable. A sudden rise may indicate complications.
Co-Relation of Pulse and Temperature. As a general rule the co-relation of pulse and temperature may be stated as follows, namely: an increase of temperature of one degree above 98° F. corresponds with an increase of ten beats of the pulse per minute, as in the following table :
Pregnancy. Duration about 275 days; usually reckoned as about 280 days from the first day of the last menstruation. The extremes of 405 cases at the Hôtel Dieu were 6 months, and 11 months 8 days. Many rules for the calculation of the date when labor may be expected are given; as good a one as any is to count backward three calendar months from the last day of the last menstruation, then add 7 days to obtain the date of expected confinement (Nægelé). The French law makes a child illegitimate if born within 200 days after marriage, or over 300 days after the husband's death.
Evidences of pregnancy may include: suppression of the menses; nausea and vomiting, morning sickness; salivation; changes in the appearance of the breasts and nipples; changes in the position of the uterus, which descends during the first two months, rising from the third month, until, at the fifth, its fundus is level with the umbilicus, at the eighth nearly to the sternum, settling down at the ninth month; e lema of limbs; neck of uterus becomes shortened, the os patulous. The most positive signs are quickening, if the statements of the women are credible; ballottement; and above all, the pulsations of the fetal heart.
Labor. Preliminary Signs.-Ab lo ninal tumor sinks lower, occasional uterine pains and contractions, freer respiration, discharge of glairy fluid from vagina, frequent desire to urinate, hemorrhoids, oedema of legs.
Essential Signs.-Paroxysmal pains, at regular intervals; os uteri generally low, neck effaced, os affected by each pain (easily ascertained by keeping finger on it). Dilatation of os uteri, requiring longer to acquire the size of a hilf-dollar, than from thence to completion. Shiverings and vomiting, tremblings and fainting, especially at complete dilatation.
Head Positions (4).-Right (1st), or left (5) occipito-anterior, forehead backwards; right (3d), or left (4th) occipito-posterior, forehead forwards. Order of their comparative frequency; 1st, 3d, 2d, 4th. The 3d rotates into the 2d, the 4th into the 1st.
Facial Positions (4).—Right (1st), or left (2d) mento posterior, forehead forwards; right (3d), or left (4th) ment-anterior, forehead backwards. The 2d rotates into the 3d, and the Ist into the 4th.
Pelvic, or Breech Positions (4).—Left dorso-anterior (1st), left trochanter forwards; right dorso-anterior (2) right trochanter forwards; left dorso-posterior (3), right trochanter forwards; right dorso-posterior (4), left trochanter forwards. Order of their comparative frequency, 1st, 2d, 4th, 3d.
Shoulder Positions.-Varieties (2); dorso-anterior, and dorso-posterior, the former occurring twice as often as the latter. In each variety the head may lie in either iliac fossa; the presenting shoulder being, in dorso-anterior position, the left if the head is in the right fossa; in dorso-posterior position, the left if the head is in the left fossa, and vice versa.
AVERAGE PELVIC DIAMETERS.
As usually given.
2/2 to 3/2
8 to 10
II to 12 121⁄2 to 14
Circumferential measurement of the brim-about 17 inches.
DEVELOPMENT OF THE FETUS.
[Entries in the column headed Month" refer to the end of each month]
15 to 17
19 to 24
4.8 in. 5.2"
10 to 12 oz.
I lb. 223 lbs.
Prof. E. Wallace gives
4 to 5 lbs. 7 to 74 lbs.
Appears as a gray gelatinous mass. Extremities apparent ; points of ossification appear.
Neck, eyes, fingers, nails begin to form; sexes distinct.
DIAMETERS OF THE FOETAL SKULL AT TERM.
Hair, fat; muscles capable of contrac
Eyebrows, skin, scrotum; nails nearly solid.
Pupillary membrane formed, lips closed. Eyelids open, testes begin to descend, foetus is viable.
Skin red, smooth, covered with down.
314 514-521⁄2 42-5
[Compare the articles in Part III, entitled-ABORTION, ÄFTER-PAINS, FALSE PAINS, HEMORRHAGE POST-PARTUM, LABOR, LACTATION, PREGNANCY, PUERPERAL DISORDERS, VOMITING OF PREGNANCY, etc.