CHARING-CROSS HOSPITAL

Headland
1873 The Lancet  
THE observations from which the following averages are calculated were made some years ago. I hoped to add to their number, but the necessary leisure is not now likely to return to me. Still, I have thought them worth recording, as it is only by a comparison of observations on many individuals that the normal range and variations of temperature can be determined. The most scrupulous care was taken to ensure accuracy and to exclude the influence of any disturbing cause, such as muscular
more » ... s muscular exercise, exposure to cold, and the like. The observations were taken in the cooler months, but always in a warm room, and while I myself, the subject of them, felt comfortably warm. The thermometer used for the most part was a new and delicate one by Cassella. It was placed under the tongue, and held there for from six to ten minutes. My health was, and still is, good. The total number of observations used was 154, and extended over eighteen days, at considerable intervals. The table of average differences from the mean was not deduced from the preceding table, but has an independent value. It was obtained by comparing every single reading with the readings taken at other hours of the same day, thence calculating the average difference between the temperature of each hour, and that of every other hour, and thence the difference from the mean. The highest temperature was observed at three o'clock in the afternoon, an hour after dinner, and the lowest at halfpast one on the preceding night. The law, therefore, in my case at least, is this :-In the morning, before getting up, the temperature is below the mean of the day. A rise then begins, continuing till midday. From this time until 7.30 P.M., at which hour the maximum is reached, the temperature is considerably above the mean height. Then it falls rapidly until bed-time, when the minimum occurs. But there are minor fluctuations, of pretty constant occurrence, of which the explanation is not certain, but should probably be sought in the influence of the function of digestion. Thus the fall at 2.30 and the reaction an hour after may be ascribed to the midday meal, and the high temperature in the evening may be the effect of the tea taken shortly before. It will be observed that the averages above given for the morning and afternoon accord closely with Dr. Davy's figures, and do not differ much from Dr. Ogle's. But the evening readings are remarkably low. In twenty-two observations after 11 P.M., included in the above series, the temperature never exceeded and only twice reached 978°; seventeen times it fell below 975°, and five times below 97° F. On all these occasions I was sitting by a warm fire, reading or smoking. A CASE OF DIPHTHERITIC PARALYSIS. (Under the care of Dr. HEADLAND.) Nulla autem est alia pro certo noscendi via, nisi quamplurimas etmorborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Cau8. Morb., lib. iv. Prooemium. No satisfactory explanation has ever been offered of the paralysis which occasionally follows an attack of diphtheria. According to some authorities it is due to blood-poisoning; but the fact that it not unfrequently supervenes in mild cases, and that it does not come on for two or three weeks after the disappearance of the throat symptoms, militates somewhat against this view. On the other hand, the usually complete subsidence of the paralysis in the course of time would appear to argue against the supposition of grave structural change as a cause. In many cases, if not in all, the amendment may be observed to preserve the same order as did the extension of the paralysis, commencing at the soft palate and finally reaching the lower extremities. The following case illustrates, in some degree, what has been noticed by other observers-namely, that a recurrence of the throat symptoms occasionally precedes the improvement in the paralysis. For the notes of the case we are indebted to Dr. Mitchell Bruce, registrar. H. W-, aged nineteen, a bricklayer's labourer, unmarried, was admitted on the 31st of October, 1872, complaining of loss of power in the arms and legs. The history of ordinary previous health says: the patient has not had syphilis; his father died of consumption at the age of thirty. The man states that about the 26th of July last he was taken with a cold, sore-throat, difficulty of swallowing, and profuse bleeding from the nose; that the doctor whom he consulted " burnt the throat with caustic"; and that in fourteen days he had so far recovered as to be able to resume his work. He adds that during this illness his nostrils were stuffed with tenacious matter; but that there was neither any alteration of his voice nor any regurgitation of fluids through his nose. He had returned to his work but a day or two when the first of the series of symptoms began from which he has since suffered. First his eyes and legs were affected; he saw double, for he had a squint "in the left eye"; and he was so giddy that, while at work, he was compelled to crawl along the tops of the walls instead of walking. His gait was affected, partly, be believes, from the giddiness, and partly from a peculiar movement of the legs, which would sometimes rise too high, "as if there were a step," and then come suddenly down. He now gave up work ; but previous to this he could not swallow perfectly. Dysphagia came on gradually, and never advanced so far as to prevent the patient from eating, although every morsel returned from a point opposite the pomum ; water could not be taken except in sips, otherwise it would regurgitate through the nose. At the same time the voice became nasal, and taste seems to have been impaired. The patient now consulted Mr F. H.
doi:10.1016/s0140-6736(02)72390-8 fatcat:jjdyshah7rapbmf56uj4eimhw4