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.

    62/642 (page 56)
    [123° F.]. This was a case of lesion of the cervical part of the spine, which recovered. The injury to the spinal marrow was most probably the cause of the increase of temperature. The course of the temperature in tzventj-foiir Iiours can vary much only in fever. Most fevers show distinct fluctuations, in that toward mornini^ the temperature falls more or less {I'cmissioii) until it reaches the daily minimum; thence in the course of the day it rises {exacerba- tion), and toward evenin<; reaches the daily maximum. The difference between the daily maximum and the daily minimum in fever is called, as in normal temperature, the daily difference. While the course of the temperature in fever is analogous to that of health, not unfrequently the minimum and maximum come at quite a different time; as, for instance, the maximum may be at midday or at midnight; a complete reverse may even take place, so that the maximum occurs in the morn- ing and the minimum in the evening [typus inversus). From this it is seen how the temperature must be exactly measured every hour of the day and night if it is of importance to know whether a patient has fever or not. There have been cases when the persons were thought to be without fever until the physician thought of ascer- taining the temperature at an unusual hour, as at night. The exacerbation of the fever is frequently connected with shivering. If the temperature rises very rapidly (it may rise several degrees in a single hour), generally there is a chill—that is, a decided feeling of chilliness, with severe shaking of the whole body and chattering of the teeth, where very soon, contrary to the subjective chill, there appears a high internal temperature. The skin is at first pale, livid, and generally cool; toward the end of the chill, however, it is regularly very hot. On the other hand, the decrease of bodily heat is frequently accom- panied by perspiration. A rapid change in temperature seems in itself to be able to produce perspiration ; but specific toxical influences prob- ably play a part in certain diseases which are accompanied by frequent and abundant perspiration, as in tuberculosis and [acute] articular rheumatism. According to the amount of the daily difference we distinguish three types of fever: Continued fever: daily difference not more than i° C. (chiefly high temperature). Remittent fever: daily difference over 1° C. Intermittent fever: maximum very high, minimum within the normal (or even below). 4. The Subnormal Temperature.—It begins at 36.25° C.; the lowest observed temperature is 22° C. I. It is observed in febrile diseases as an expression of two directly opposite conditions—namely : {a) In a sudden fall of the high fever with an advance to recovery, the crisis, the critical decline of the fever. In this case the tem- perature falls during perspiration sometimes to below 34° C, and only in the course of one, two, or three days again returns to the normal. We recognize the crisis by the simultaneous diminution of the fre- quency of the pulse and the respiration, and the feeling of comfort and returning health by the patient.