On the temperature in diseases : a manual of medical thermometry.

  • Carl Reinhold August Wunderlich
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On the temperature in diseases : a manual of medical thermometry. Source: Wellcome Collection.

Provider: This material has been provided by the Gerstein Science Information Centre at the University of Toronto, through the Medical Heritage Library. The original may be consulted at the Gerstein Science Information Centre, University of Toronto.

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    ture during the rlieumatisui itself is not generally much altered^ but it displays irregularities^ and if death occurs at an early date, the characteristic descent is either wholly wanting or interrupted. Death, which results in these cases, not from the actual disease itself, but from the unfortunate course taken by some local manifes- tation of it, or some comphcation, may be preceded by a very marked fall of temperature. {h) In other cases which are just as commonly included with acute rheumatism, a malignant character sometimes reveals itself from the very beginning, at other times during the further progress of the disease, at first in symptoms which may easily be misinterpreted, but further on shows itself more powerfully. The most commonly observed symptoms of a pernicious nature are rigors, very intense fever, various severe nervous symptoms, jaundice, haemorrhages, diarrhcea, and enlargement of the spleen. No one of these symptoms by itself is perfectly diagnostic, but the combination of several of them characterises the case as a ma- lignant one. The pains in the joints are more or less severe, and generally extend to the muscles, over the head, chest, and abdomen. Death generally occurs with very considerable and sometimes enor- mous elevation of tenijoerature (to 43° C. or even 44° C. and more = 109*4° Eahr. and iii2°rahr. Cases by Qndncke; and II. Weher in London (' Transactions of the Clinical Society^), and by myself (Wunderlich). These cases, which, perhaps, ought to be called rather rheumatoid affections, though regarded as genuine articular rheumatism, dis- play as far as my observations have yet extended, peculiar differ- ences, in three distinct directions = a pycemic, an icteric, and a nervous form. They rank along with spontaneous pyaemia, with primary pernicious jaundice [acute yellow atrophy], and with those rapid and pernicious nervous catastrophes which are devoid of an anatomical basis; and they are only to be distinguished from these forms by the fact that the strongly pronounced articular pains, for some time at least, simulate acute rheumatism. These differences are, however, by no means strongly marked; and one might say that the nervous form was the least perfectly developed, the icteric form the most pronounced, and the pysemic form the most complete. In the completest (pysemic) form, indications of the malignant nature of the process may be very early recognised; the fever is very intense, whilst rigors, jaundice, and enlarged spleen are met 26