1904.] On Heat Regulation and Death Temperatures. 367 



Rise of 6°. — Peritonitis, various causes (five cases); meningitis 

 (two cases), burn, scald, spina bifida, imperforate 

 anus, gluteal abscess. 



From this list the following conclusions may be drawn : — 



1. That injuries to the head and spine generally give rise to high 

 death changes of temperature. This may be emphasised by the low 

 temperature which precede the final rise and which are the result of 

 the shock caused by the injuries. Such a condition is frequently found 

 in those patients who succumb within 24 hours after admission to the 

 hospital.* 



2. That the following diseases are the most frequent in taking the 

 first places among the death rises of temperature : — 



Head injuries : 10°, 1; 9°, 1 ; 8°, 1; 7°, 2; 6°, 1 ; 5°, 5—11 cases. 

 Spinal injuries : 9°, 1 ; 6°, 1 ; 5°, 1 — 3 cases. 

 Burns : 9°, 1 ; 7°, 2 ; 6°, 1 ; 5°, 6 — 10 cases. 

 Scalds : 6°, 1 ; 5°, 1 — 2 cases. 

 Meningitis : 6°, 2 — 2 cases. 



3. Besides the above, death in those cases associated with a rise of 

 temperatures is almost always due to some form of poisoning by septic 

 organisms. Thus the remainder of the list of cases with a death rise 

 of 5° or more, oan be summed up as follows : — Peritonitis, septicaemia, 

 pyaemia, septic meningitis, septic broncho-pneumonia, suppurative 

 nephritis, cellulitis. It appears from this that, besides the injuries 

 already mentioned, a septic process causes the death rise in almost all 

 cases. The predominance of this process in causing death in surgical 

 cases probably accounts for the difference in the numbers of the death 

 variations in medical and surgical cases. 



Medical Cases. 



Fall of 5°.— Phthisis. 



4°. — T}^phoid fever, haemorrhage (two cases) ; intestinal 

 obstruction, broncho-pneumonia, cardiac failure, 

 phthisis (two cases). 



3°. — Diphtheria, mitral disease, cirrhosis of the liver, haemor- 

 rhage, cardiac failure, bronchitis, myelitis, pneumonia, 

 chronic renal disease (two cases), tubercular menin- 

 gitis (two cases), phthisis (two cases). 



This list shows that large falls of temperature occur in diseases of 

 long duration, such' as phthisis, the absence of diseases of the nervous 

 system and the comparative frequency with which cardiac affections is 

 found are also striking facts. 



* Sawyer, "The Temperature of Coma," 'Brit. Med. Journ.,' Dec. 26, 1903. 



