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

  • Wunderlich, C. A. (Carl August), 1815-1877.
Date:
1871
    § 14.—Itijhioice of menstruationy of pregna)ic]), and of tlte puer- peral state (Wochenbett) upon temperature. Normal menstruation, ill healthy women, according to the observations of all trustworthy observers (which agree with what I myself have found to be true), is, as a rule, without any influence at all upon the general temperature of the body. On the other hand, we sometimes find elevations of temperature during the flow of the catameuia, which cannot be con- sidered as anvthincc but decidedlv febrile, and which are sometimes accompanied with other functional disturbances, and sometimes not, without any special pathological process being either indicated or induced (sich anschlosse) .^ Pregnancy has next to no influence (so gut wie keinen) on the bodily temperature. Only during the last two months the vaginal temperature appears to be slightly elevated: the morniwi mean being 38-15° C. (100-5°F.), ^^^ minimum 37-9° C. (100-3° F.), and the maximum 38-35° C. (100-9° P.); whilst the evening mean is 38-22° C. (ioo-8°r.),the minimum 38-i°C (100-5° I"-), tte maxi- mum 38-65° C. (101-5° 1\). Schroder {' Virchow^s Archiv,^ xxv, 253) estimates that the tem- perature of the gravid uterus is about -3° C. (4-° Fahr. nearly) higher than that of the axilla, and on an average about -15° C. (^° Fahr. nearly) warmer than the vagina, which is doubtless independent of the warmth of the foetus. Immediately before the beginning of the labour pains, no eleva- tbe room, but coincident with increased CO^ exhaled, and urea excreted (see Dr. E. Smith's Paper, in 'Proceedings of Royal Society,' 3olhMay, 1861). It was not due to light. General conclu&mis.—Miniimtm at 6 a.m. Maximum late in afternoon. A rise produced by both food and exercise. Tea retards the fall. Alcoliol causes a fall, but probably the reaction reaches a higher temperature than if no alcohol were taken.—[Trans.] ^ In young women, otherwise healthy, who suffer from dysmenorrhcea, or sometimes in the T^rs^ menstruation, I have often found swelling, redness and pain in the fauces and tonsils, with temperatures of 103^ 104°, and 105'^ P. (=39'5, 40^, and40'6"j, with extreme depression, restlessness, perhaps semi- delirium, and occasionally vomiting, without being able to trace any scarlatinal or other febrile poison. These cases differ from scarlatina in their sudden onset, their equally sudden recovery (being well as soon as the catamenial flow ceases, or \5 fully established), and their having no desquamation of the cuticle, or other sequelae. The sympathy between the tonsils and the generative organs has been known from great antiquity, but I do not know that this pseudo-amygdalitis has ever been described before.—[Trans.]
    tion of temperature is noticed. During the pains there occurs a rise of some tenths (Centigrade) 'a to '25 (i to -^ Pahr. nearly), in such a way that ih the pains^ and immediately after, the temperature rises somewhat; and in the pauses hetioeen the pains it falls again. However, the daily healthy fluctuation is not much affected by labour. The temperature during labour exhibits a mean rise of •18° C. (4-°r.) in the morning hours, and -250. (t"/F.) in the evening hours, as compared with the preceding period, and in the second stage of labour about '07° {-^ 1\) above the temperature of the first stage. According to Hecker, the elevation of the tempera- ture is proportionate to the intensity of the pains, and the quick- ness with which they succeed one another. However, his materials afford too scanty data to settle this point. Schroder found that during labour the excess of the uterine tem- perature over the axillary and vaginal was somewhat greater than in pregnancy: "83° C. (= i'49° I".) more than in the axilla, and •175° C. ("32° r ) more than in the vagina. In a later work he considers thf temperature of women in labour to be very changeable, and expresses a strong opinion that this chiefly depends upon the amount of heat lost in various ways being more or less. Immediately after deliver?/ a fall of temperature has been observed by Barensprung, even as low as 36*2 C. (= g'j'16'^ F.), and on an average about 37*1° C (98"78° F.) and, indeed, especially when the birth happened between midnight and mid-day; while Witickel has onlv verified this fall in those cases where the birth fell within the time of the daily remission. Schroder found the lowest temperature in those who had given birth to children at eleven in the morning. In the first twelve hours after delivery Winchel found a moderate rise, in the second period of twelve hours a corresponding fall. The average minimum of the normal lying-in period is estimated by Griinewaldt at 37° (98-6° P.). Amongst 57 lying-in women he found temperatures of 36*6° C. (97'8° F.) three times, of 36"8°C. (98*24° F.) nine times, and of 37° C. (98'6° F.), or more, forty-five times. The maximum temperatures often exceeded 38° C. (ioo"4°F.) especially in cases of constipation, and when there was distension of the mammary "lands, but the above-named observer considers that all temperatures above 30-2 E. (= 100° Fahr. or 37-8 Cent.) in lying- in women are very suspicious. Schroder points out that lying-in women, even when they have subsequent puerperal mischief, may
    exhibit a perfectly normal temperature in the first period {i.e., a few- hours after the birth). lie further remarks that the course taken by the temperature after delivery is composed of two factors; on the one hand, of the regular daily iluctuatiou (a rise towards 5 p.m., a fall from then till I a.m.), on the other hand of the rise induced by the process of labour in the first twelve hours, and the fall in the second period of twelve hours. On this account the course or curve of the tempera- ture will vary with the hour at which birth occurs, so that if the birth happens in the forenoon, the temperature will reacli its highest point from 5 to 8 p.m.; the lowest about midnight, when the birth has fallen within the early morning hours, because, in the first instance, the daily rise and the first puerperal elevation, in the latter case the daily fall and the first puerperal diminution coincide. IFincl-el further propounds that at the end of the first four hours, after the beginning of the fall of temperature, the temperature begins to rise slowly again, and the evening temperature is on this account commonly higher than the morning, but the daily excursus (or amount of variation) less, so that as a rule the rise of temperature keeps pace with the secretion of milk, and on this account is most evident on the third, fourth, or fifth day, and that as soon as the draught or flow of milk is established : or, if the mother does not suckle, with the drying up of the milk a gradual decrease of temperature is noticeable; further, that nursing women^ and those who do not suckle, primiparce and multiparas do not differ from one another as regards their temperature, and that normal after-pains are with- out any influence at all! Lastly, that the mean temperature of puerperal women is a trifle higher than the average normal tempera- ture of other healthy women. In so far, however, as the puerperal state is admitted to exhibit a great mobility of temperature, it must be considered as belonging to pathology. However, according to Winclcel, the differences between the axillary and vaginal temperatures in lying-in-women are wholly without parallel, even in cases of disease of the uterus or vagina. Schroder found that in puerperal women the difference between the temperature of the uterus, as compared with the axillary and vaginal temperatures, amounted to only '28° C. ("5° P.) above the axillary, and "11° C. ('19° C.) more than the vaginal. See also besides Earensprung the following authors on the tem- perature in pregnancy, labour, and the puerperal state—llecker.
    ' Annalen des Charite-Krankenliauses/ 1854, p. 333; Wind-el, "Temperatur Studien bei der Geburt und im Wochenbctt ^^ (in the ' IMonatsschrift fi,ir'Geburtskunde/ 1862^ Bd. 30, p. 409, and 1863, Bd. 22, p. 321); Griinewaldt, "Uber die Eigenwiirme Gesunder und Kranker Wochnerinnen/^ in the ^ Petersburg Med. Zeitung/ 1863, Bd. 5. p. I ; ''Oscar IFoIf, " Beitriige zur Kenutnisz der Eigenwarme im "Wochenbett," Marburg Thesis, 1866; Baum- /elder, " Beitrag zu den Beobachtungen der Korperwarme, der Puis und Respirations, frequenz im Wochenbette/' Leipzig Thesis, 1867; Schroder (loc. cit., and especially in ' Schwangerschaft, Geburt, und Wochenbett/ 1867, p. 117; Squire, in the 'Lancet/ 1867, No. 10, and in the 'Obstetrical Transactions/ vol. ix, p. 129.^ § 15.—The Influence of Rest, of Muscular Activity, and of Worh (Arbeit) upon the Temperature, The contrast between movement and rest, as regards their respec- tive influence upon temperature, is by no means a simple fact, nor can it be elucidated by a bare recital of facts. It has been shown by Helmholtz that the contraction of a muscle is accompanied by a rise of temperature, and in later times especially, Solger, Ileidenhain, Meirstein, and Thiry have investigated it, and found, amongst other results, that in the flrst moment of stimula- tion the muscle itself actually becomes a little colder (negative warmth-variation, afterwards contradicted by Heidenhain), and then begins to grow warmer, but that the degree of warmth generated is never entirely proportionate to the mechanical work done; and, ' Dr. Squire's temperatures were taken in the vagina. After the sixth month of pregnancy he finds the temperature to be a little over 99° F. (=37-3"C.). He considers the vaginal temperature and the axillary to differ by only i° or i° except during labour. He found the temperature to gradually rise till the birth of the child, and soon after to slowly decline during the 24 hours after, to normal, or even below it. The most constant disturbance ushers in, and accompanies the formation of milk—it attains a certain prominence 48 hours after delivery. As soon as milk flows freely there is a considerable fall. He objects to the axilla as not furnishing trustworthy details after labour. It is probable that he omitted to dose the axilla previousli/, as recommended by Wunderlich. The whole paper, however, is well worthy of study.— [Trans.]
    further, that the muscle when stimidafed develops more heat, if its contraction be hindered (or resisted) than when this is not done, and that with equal weiglits, the lieat developed by continuous con- tractions decreases as the muscle gets " tired out," and this more quickly than the mechanical results would lead us to suppose, and that by increasing the weight the heat increases up to a certain point, and then decreases again. According to the theory of J. R. Mayer, we must admit that during rest the chemical affinities (spannkriifte) or combining forces, which are set free through the combination of oxidisable substances with oxygen, are perfectly changed into heat, whilst during work of any kind, some part of these summed-up forces are translated into mechanical results by means of them. There- fore, during rest, the heat produced should be greater, to which must be added that the loss of heat by respiration, and transpira- tion, is also less during rest. Indeed, Mayer quotes from Bouville, the fact that the latter found a temperature of 40*2° C. (io4"36° F.) in a negro, who lay lazily basking in the sun, Avhilst the temperature of the same man, when hard at work in the sun, was only 3975° C (io2'88°F.). AA'hilst, however, during active bodily work, a part of the force set free by chemical processes, is so far lost, as regards the production of heat, by being changed into mechanical results, and producing motion; so, on the other hand, there is a simultaneous diminution of the amount of tissue-changes, the amount of oxygen is increased by the quickening of respiration, and by the more rapid circulation of the blood, the number of blood-discs brought within the range of the oxygen in a given time is increased, as well as the chemical action, on which the warmth-production depends, more complete and more rapid, and indeed the increased production is not entirely compensated by the conversion of a part of the total force into mechanical results; but the force generated or liberated by the action of the muscles, through the coincident increased chemical action is doubtless in general greater than that consumed by conversion into work done (Arbeit). In addition to the mechanical results there is therefore an overplus of warmth. Ilini, whilst at rest, produced 155 calorien (or heat-units) per hour, and 251 whdst working in the treadmill. But a long series of con- trivances carries off the overplus of heat in a healthy man. This is effected by more rapid breathing, quicker circulation of the blood through the skin, and therefore quicker cooling there, and by sweat-