1904.] On Heat Regulation and Death Temperatures. 371 



temperature. In about 2,500 medical and surgical cases, an elevation 

 of temperature of over 1°'5 was found in 26 per cent., or just over 

 a quarter of all the cases, while a fall occurred in 8 per cent. only. 

 The percentage of rises of temperature in surgical cases is 37, and in 

 medical 15. It is a most remarkable fact that this sudden elevation 

 of temperature is observed to take place so frequently in surgical 

 cases (in over a third of all the cases examined), and that this change 

 should be found to occur more than twice as often in surgical as in 

 medical cases. As the surgical diseases in these records are of shorter 

 duration, as a rule, than the medical, the tissues in consequence have 

 not been so long exposed to abnormal conditions, and so their heat 

 producing functions are less likely to be impaired. Again, falls of 

 temperature are proportionally much more common in patients dying 

 from disease than from injury. It may be presumed, therefore, that 

 the loss of control of the nerve centres in an exhausted organism only 

 occasionally results in an elevation of the bodily temperature, whereas 

 with less exhausted tissues an increase in the animal heat occurs. 

 From these considerations it would appear that heat production is 

 constantly in excess, and that in consequence of this the organism 

 must exercise some tonic control over the process, in order to keep its 

 temperature at a constant level. 



The idea of the thermogenetic control of the higher centre over the 

 lower gives point to the modified and accepted view of Liebermeister 

 that, " in consequence of the injurious action of the fever-producing 

 cause, the organism loses its power of keeping itself at the normal 

 temperature."* The poison will, unless it has special affinities, affect 

 the higher and the more complex centres before the lower. Hence, 

 the " spastic " over-production of heat which may result in fever. 

 The great frequency of death rises of temperature in cases of head 

 injuries, some spinal injuries, meningitis, brain diseases, etc., 

 emphasises the possible cutting off of the controlling function of the 

 higher centres. On the other hand, it should be remembered that 

 many of the patients had pyrexial temperature charts, it may be for 

 some days before the preagonistic variations of temperature occurred. 

 The regulation of the bodily heat in these cases was already partially 

 out of the control of the nervous system, and the further elevation 

 of temperature during the last 12 hours of life may be thought to be 

 due to an increasing loss of this control on the part of the organism. 



In small animals, after section of the spinal cord in the cervical 

 region, the temperature falls rapidly ; in larger animals, such as dogs r 

 if kept in an envelope of non-conducting material in an ordinary 

 room, the temperature of the body rises to above that of fever, but 

 without clothing the temperature rapidly falls until the animal dies. 



* Burdon Sanderson, Allbutt's ' System of Medicine/ vol. 1. 



