372 



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



in collapse.* In man, according to Sir Benjamin Brodie, section of 

 the spinal cord in the cervical region causes pyrexia, but very dis- 

 cordant results have been obtained by other observers on cases with 

 similar injury to the nervous system. Dr. Pembrey's explanation of 

 , these contradicting results seems to be the correct one. He says : 

 " The section of the spinal cord high up in the cervical region abolishes 

 the power of regulating temperature. When the patient is exposed 

 even to moderate cold, his temperature falls owing to the increased 

 loss of heat and to the diminished production of heat. On the other 

 hand, if the weather be hot and the patient be too well covered with 

 bed clothes, his temperature rises and may reach a dangerous height, 

 owing to the diminished loss and the increased production of heat 

 in the body. In the paralysed man the production of heat rises and 

 falls with the external temperature."! And Sir John Burdon Sander- 

 son writes : " Section only shows the abnormal facility with which the 

 body yields to the influence of outside conditions."! 



It might be urged that the variations of temperature, just before 

 death, are due to a similar condition, but obviously this cannot be the 

 case, for after section of the spinal cord many other factors arise which 

 are not present in those patients who suffer from no such lesion of the 

 nervous system. After section, the respiratory movements are altered 

 in character, and respiration is entirely performed by the action of the 

 diaphragm, and in consequence there is less loss of heat through this 

 channel. Again, the muscles are paralysed, and, therefore, cannot 

 produce the normal amount of heat, while the sweat glands are no 

 longer active, and thus less heat is lost by the evaporation of moisture 

 from the external surface. For these reasons alone the death varia- 

 tions of temperature found in the patients who are considered in the 

 first part of this paper are in no way analogous to the changes which 

 occur after section of the spinal cord in the cervical region. 



Arguing from the supposition that the higher centres have a tonic 

 control over the lower, it is to be expected that stimulation of the 

 higher centres should lead to a still further control and diminution of 

 the action of the lower. In this way falls of temperature may be 

 caused. How far a toxic agent will stimulate it is difficult to say. It 

 is possible that some antipyretic drugs may act in this way, such as 

 quinine and salicylic acid. Other substances seem too powerful to 

 stimulate and would appear to paralyse the higher centres. Smaller 

 doses of the poison, however, may act as a stimulant, first to the 

 higher and then to the lower centres, the former being affected before 



* Burdon Sanderson, " On the Process of Fever," ' The Practitioner,' vol. 16, 

 1876, p. 426. 



f Pembrey, Schafer's 'Text-Book of Physiology,' 1898, vol. 1, p. 862. 

 X Burdon Sanderson, " On the Process of Fever," ' The Practitioner.' vol. 16, 

 1876, p. 428. 



