Report on the Temperature of Certain Nervous Diseases. BY W. J. CONKLIN, M.D., OF DAYTON, OHIO. ASSISTANT PHYSICIAN OF SOUTHERN OHIO LUNATIC ASYLUM, DAYTON, OHIO. If there is one thing more than another that gives character to the present era in medical history, it is the tendency to make use of collateral means in the investigation of disease. The stethoscope, sphygmograph, laryngoscope and thermometer, all tend to give a certainty to our examinations, unattainable in the earlier days of clinical study. Thermometry is an outgrowth of the recent advances made in the departments of physics and physiology. True in the days of Hippocrates, the increase of bodily heat in disease was recognized, and Sanctorius, early in the 17th century, applied instruments for its measurement. During the succeeding hundred years, the thermometer almost passed from the memory of man, when its study was again revived through the labors of Boerhave. A few years later, DeHaen, a pupil of Boerhave, and the "first clinical teacher of Vienna and Germany," worked out many important facts connected with the subject, and gave them to the profession in his "Ratio Medendi." Interesting as his investigations were, they fell still-born, and were compelled to await further advances in the kindred sciences of chemistry and physiology, before their full importance could be appreciated. Liebig, carrying out the in vestigations of the great Lavoisier as to the origin of animal heat, together with the brilliant discovery of Mayer, Helmholz, Joule and Grove, "of the correlation of the physical forces," and the mutual convertibility of the different forms of force without loss, placed thermometry on vantage ground, and since then its study has advanced with rapid strides. In the present paper we propose to confine our discussion to one branch of the subject, i. e. the value of the thermometer in certain diseases of the nervous system. The stability of the temperature in the healthy organism, furnishes the foundation upon which the superstructure of thermometry rests. It has been abundantly proven by different observers, that the ordinary surroundings of life and the ever-changing processes of nutrition and growth do not, in any notable degree, affect the diurnal variations peculiar to health. This makes the mensuration of bodily heat the surest test of health, and gives importance to those departures from the normal range found in disease. This equability of temperature is most probably preserved through the influence of the nervous system. Brodie, supported by many of the ablest physiologists of his day, even attributed the origin of heat to the nervous system; and Chossat, afterwards, localized it in the sympathetic system. Physiologists now generally agree that the healthy metamorphoses of the blood and tissues, and the temperature of the body, which is the result of such metamorphoses, are under the control of the nerves, and particularly of the sympathetic. So long as the integrity of the nervous system is unimpaired, like the governors to the engine, it is capable of so harmonizing the various forces of the body as to preserve under ordinary circumstances the normal standard of heat. Its function interfered with, either from some local trouble or blood-poison, a corresponding departure from the healthy range is registered by the thermometer. The sympathetic is essentially the vaso-motor nerve, and consequently exercises a controlling influence over the phenomena of circulation, nutrition and heat. The experi ments of Bernard and Brown-Sequard, show that division of the cervical sympathetic causes, among other phenomena, dilatation of the arteries, and an increase of temperature on the operated side. Galvanizing the nerve produce a train of precisely opposite phenomena. Dr. William Ogle, reported a case to the Royal Medical Society, in which an abscess on the right side of the neck, had eaten through the cervical sympathetic. Among the symptoms noted, was the increased warmth of the ear, nostril and mouth of the right side when the patient was at rest. With violent exercise, the thermometrical conditions were inverted, the left side becoming the hotter. At the same time the left side of face, head and neck sweated profusely, while the right remained perfectly dry. The vaso-motor nerves include not only fibres from the sympathetic, but also fibres from the cerebro-spinal system. The precise location of the vaso-motor center has not, as yet been positively ascertained. Lesions of the corpora striata and optic thalami affect the circulation on the side corresponding to the paralysis. Pathology shows that fibres of the sympathetic must extend higher up into the cerebrum, as many cases of lesion of this portion of the encephalon are on record, attended by phenomena similar to those produced by experiment. Brown-Sequard, (a) sums up thus: "The effects of excitation of the vaso-motor nerves, consist essentially in a contraction of blood-vessels, which is followed by a diminution in the quantity of blood, in the temperature and in the activity of nutrition. The effects of interruption of continuity of the vaso-motor nerves (i. e. their paralysis) consist essentially in a paralytic dilatation of blood-vessels, which is followed by a greater afflux of blood, an increase of temperature, and a greater activity of nutrition." Dr. Robert T. Edes, (b) in bis most excellent prize essay denies the proposition that increased nutritive action results from the increased blood supply in (a) Physiology and Pathology of Nervous Centres, p. 205. (b) The Physiology and Pathology of the Sympathetic or Ganglonic Nervous System. |