362 Mr. E. M. Corner and Dr. J. E. H. Sawyer. [Apr. 4, 



19 per cent, of medical cases, a definite change of over 1°*5 F. 

 occurs during the 12 hours immediately preceding death. These 

 figures are the absolute minimum for about 2500 consecutive cases 

 which have been collected from the records of St. Thomas's Hospital. 

 In instances where no such sudden change occurs, the temperature 

 may remain about the same level, but the more usual procedure is for 

 it to slowly and steadily fall. On the other hand, it is not common 

 for the bodily temperature to rise slowly, for, when an elevation 

 occurs at all, the change is generally a sudden one. The character of 

 the temperature charts as death approaches is naturally affected by the 

 types of fever from which the patients may be suffering, such as 

 remittent, intermittent, etc. The influence of these fevers cannot be 

 eliminated, and it is an interesting point that such cases frequently 

 show a very decided variation in the character of the temperature 

 near the fatal termination. The performance of tepid sponging, or the 

 exhibition of antipyretic drugs, just before the death of the patient, 

 renders the chart valueless for this research. For these, and similar 

 reasons, many variations of temperature have been necessarily 

 neglected. 



There are other changes in the temperature charts which have to be 

 considered in these investigations. Sometimes, about 24 hours before 

 death, the temperature falls suddenly, anything from 1 — 5° F., and 

 then rises rapidly, and at this point death may occur. On the other 

 hand, the fatal result may be postponed, and, after the temperature 

 has reached its maximum, defervescence may begin again. Such 

 fluctuations as these are more commonly found among surgical than 

 among medical cases. The following is a good example of these 

 changes : — a baby girl, aged 7 weeks, was severely burnt, and died on 

 the fifth day ; the temperature during the last 36 hours of life repre- 

 sented these variations ; it fell 4°*3, rose 6°*4, falling again 4 0, 2. 

 Again, in a woman, aged 28 years, who suffered from general 

 peritonitis and appendicitis, there was a fall of 4° in the temperature, 

 followed by a rise of 8°, when death occurred. These early deviations 

 of the temperature begin about 24 hours before the death of the 

 patient, and may exaggerate either the death rise or the death fall, or 

 may mask them altogether. 



Of the 2500 cases which were examined, 1305 were medical cases, 

 the remainder, 1195, being surgical. Changes in the bodily tem- 

 perature of over l°-5, occurring during the last 12 hours of life, were 

 found in 34 per cent, of all the records examined ; in 49 per cent, of 

 surgical, and in only 19 per cent, of medical cases. On account of 

 this great difference of 30 per cent., the two lists of cases have been 

 kept separate, although in many instances they overlap. The explana- 

 tion of the difference which is found between the medical and surgical 

 cases has to be sought for in the other particulars. 



