A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt.

  • Oswald Vierordt
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    to remove these first, because experience has taught that in such a case the record of the temperature is too low. The axilla is not a perfectly closed cavity, but becomes a closed cavity only after the upper arm is pressed against the chest-wall when it begins to take the temperature of the body, but it almost never completely reaches it. On the contrary, the temperature here always remains a little below that of the inside of the body. In every case this is a few tenths of a degree lower, but in very thin subjects, where the cavity closes imperfectly round the thermometer, it remains much below the temperature of the inside of the body. The time required for the skin of the axilla and the instrument to reach the maximum temperature varies greatly, especially in collapsed patients with a cool surface of body and if bathed in perspiration. It is therefore necessary always first to wipe the axilla dry. Generally the maximum temperature is reached in ten to fifteen minutes. The best way is to look at the index after eight to ten minutes without moving the thermometer from its position, and to examine it again after ten to twelve minutes, to see whether the mercury is still rising. Care has to be taken to carefully place the bulb in the axillary cavity and to keep the upper arm closely against the chest-wall while the thermometer is in place. From what has been said, it is evident that the so-called minute thermometers, apart from their inexactness, are of no use for taking the temperature in the axilla, since the axilla itself does not reach the temperature of the body in so short a time. Generally one has to be content with taking the temperature in the axilla, and, as a rule, no important error is made if he considers the temperature taken in this manner as the temperature of the body. On the other hand, if one measures the temperature in the rectum and axilla alternately, it is well to add in the former case about two-tenths of a degree [two-fifths of a degree Fahrenheit]. From what has been said above, in collapsed and greatly emaciated patients one should occasionally at least make a controlling measure- ment in the rectum or vagina. In such cases I have not infrequently found that the temperature in the axilla, in spite of the greatest care in taking it, was one degree [Cent.] or more too low, even after the ther- mometer had been in the axilla a quarter of an hour. But-in children and in unruly patients the rectal measurement is always to be preferred. In these cases one has particularly to look out that they remain quiet, lest the thermometer be broken. [Practical experience teaches that the best place to take the tempera- ture varies in different cases and subjects. In the case of children and infants the rectum is the best place. This is also true of many adults who are violent or restless, and likewise very aged persons. If the patient is conscious and quiet, it is much more convenient and also more reliable during a series of observations to take the temperature by placing the thermometer under the tongue, and directing and assist- ing the patient to keep the mouth tightly closed, with the instrument steadied in place by grasping it between the teeth. Thermometers of the best make are thoroughly reliable for reading after being in the mouth for three minutes. It is necessary to know whether the patient