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to 110.5°. A temperature of 107° indicates malignancy, and where met with for two consecutive days in typhus, scarlatina, measles, pneumonia, pyæmia, meningitis or rheumatism, death may be expected shortly. In relapsing, remittent and intermittent fevers, and in the initial chill of an abortion, the temperature may reach 107° without indicating great danger. During the last hours of life, in many diseases, the temperature rises to 109°-111°; for example,in tetanus, sun-stroke, typhus, etc. With a temperature of 95°, collapse is imminent.
A High Average Temperature (above 104°), is found in severe pneumonia, scarlatina, remittent, typhus, typhoid and relapsing fevers, pyæmia, etc. A Moderately High Temperature (102° and above), is seen in peritonitis, acute rheumatism, pericarditis, pleurisy, dysentery, cerebro-spinal-meningitis, catarrhs, etc. A temperature of 100° and above, is found in chronic affections, incipient inflammations, and mild fevers. When, in effervescence, the heat increases rapidly, it will, in defervescence, decline proportionately fast, and vice versa. Beware of a grave affection when the temperature is of a continuous type. A distinct interval between morning and evening temperature is a favorable sign. A slow and gradual increase indicates typhoid fever; in rheuinatism and anomalous fevers the increase is more rapid, and still more so in acute inflammatory disease, pneumonia, angina, pleurisy, typhus, scarlatina, rubeola, etc. It is usually very rapid in intermittent fever, febricula, and ephemeral severs. A rapid effervescence and slow defervescence indicates sme complication of disease ; the reverse order indicates great danger. When the temperature begins to fall from the evening to the morning, it is an indication of improvement: while a rise of temperature from the evening till the morning is a sure indication that the patient is worse. Stability of temperature from morning to evening is a good sign, but from evening till the morning, unfavorable.
A Decrease of Temperature below the normal heat is rare. It occurs sometimes transitorily, announcing thereby a favorable crisis, by preceding the return to a normal temperature. It is also met with occasionally during the morning remission of remittent lever; also during the apyrexia of intermittents; in acute collapse, preceded or not by fever; in chronic wasting diseases; and sometimes, also, on the approach of death, especially in typhus fever.
In Phthisis, the temperature is higher in the evening than in the morning: later, higher at early bedtime than at noon, and high again at dusk. This is a valuable and delicate test of the progress of tuberculization.
In Typhoid Fever, the accession is by a rise of one degree each day, with the diurnal variation. If the evening temperature does not exceed 103.5°, the disease will probably be mild; but a temperature of 105° in the evening in. dicates a severe type and much danger. A sudden reduction to 95° in the third week denotes intestinal hemorrhage; a lingering temperature of 101o102° in the fourth and fifth weeks indicates noncicatrization of the intestinal ulceration.
In Scarlatina, the rise of temperature is rapid, 104.70 may be reached in a few hours. It seldom rises above 105° and never above 106°; it is continual until the eruption begins to fade, when remissions take place, unless complications arise.
In Measles, 103° is the usual temperature, with daily variations, increas. ing with the eruption and catarrhal symptoms. A high temperature lasting beyond the tenth day denotes complications.
In Diphtherla, the temperature by the end of the third day will, in uncomplicated cases, not exceed 1030-104°. It falls temporarily with the exudation. Defervescence in the severe, favorable cases, is from the twelfth to the fourteenth day; in the milder cases not before the sixth. In some fatal cases it occurs early, from the third to the fourth day. In asthenic cases, the temperature of the surface falls, while that of the interior reniains high-100° in the axilla, and 103° in the rectum. During convalescence, the temperature is low, and readily depressed, but may be raised by intercurrent maladies. Any increase after the first five days, or a continuous high temperature after the first ten days, is unfavorable. A sudden rise may indicate complications.
Co. Relations of Pulse and Temperature.-As a general rule the co-relation of pulse and temperature may be stated as follows, namely: an increase of temperature of one degree above 98° F. corresponds with an increase of ten beats of the pulse per minute, as in the following table;
Temperature of 98o corresponds with a pulse of 60.
OBSTETRICAL MEMORANDA. Pregnancy. - Duration about 275 days; usually reckoned as about 280 days from the first day of the last menstruation. The extremes of 405 cases at the Hôtel Dieu were 6 months, and 11 months 8 days. Many rules for the calculation of the date when labor may be expected are given; as good a one as any is to count backward three calendar months from the last day of the last menstruation, then add 7 days to obtain the date of expected confinement (Nægelé). The French law makes a child illegitimate if born within 200 days after marriage, or over 300 days after the husband's death.
Evidences of pregnancy may include: suppression of the menses; nausea and vomiting, morning sickness; salivation; changes in the appearance of the breasts and nipples; changes in the position of the uterus, which descends during the first two months, rising from the third month, until, at the fisth, its fundus is level with the umbilicus, at the eighth nearly to the sternum, settling down at the ninth month; ædema or limbs; neck of uterus becomes shortened, the os patulous. The most positive signs are: quickening, if the statements of the women are creditable; ballottement; and above all, the pulsations of the fætal heart.
Labor. Preliminary Signs.--Abdominal tumor sinks lower, occasional uterine pains and contractions, freer respiration, discharge of glairy fluid from vagina, frequent desire to urinate, hemorrhoids, ædema of legs.
Essential Signs.- Paroxysmal pains, at regular intervals; os uteri generally low, neck effaced, os affected by each pain (easily ascertained by keeping finger on it). Dilatation of os uteri, requiring longer to acquire the size of a half-dollar, than from thence to completion. Shiverings and vomiting, tremblings and fainting, especially at complete dilatation.
Head Positions (4).--Right (ist), or left (20) occipito-anterior, forehead
backwards; right (3d), or left (4th) occipito-posterior, forehead forwards. Order of their comparative frequency: ist, 3d, 2d, 4th. The 3d rotates into the 2d, the 4th into the ist.
Facial Positions (4).-Right (ist), or left (2d) mento-posterior, forehead forwards; right (3d), or left (4th) mento anterior, forehead backwards. The 2d rotates into the 3d, and the ist into the 4th.
Pelvic, or Breech Positions (4).—Left dorso-anterior (1st), left trochanter forwards; right dorso-anterior (2d), right trochanter forwards ; left dorsoposterior (3d), right trochanter forwards; right dorso-posterior (4th), lest trochanter forwards. Order of their comparative frequency, ist, 2d, 4th, 3d.
Shoulder Positions.-Varieties (2): dorso-anterior, and dorso-posterior, the former occurring twice as often as the latter. In each variety the head may lie in either iliac fossa; the presenting shoulder being, in dorso-anterior position, the left if the head is in the right fossa; in dorso-posterior position, the left if the head is in the left fossa, and vice versa. Measurements.
AVERAGE PELVIC DIAMETERS.
Circumferential measurement of the brim-about 17 inches.
DEVELOPMENT OF THE FETUS. (Entries in the column headed “ Month” refer to the end of each month.]
Ist Ovum one-twelfth
Appears as a gray gelatinous mass. 2d Embryo 1.2 | 60 grains. Extremities apparent: points of ossifi.
cation appear. 2/2 to 372 '310 “ Neck, eyes, fingers, nails begin to form;
sexes distinct. 4th Fætus 67 to 772 9 oz. Hair, fat; muscles capable of contrac
tion. 8 to 10 10 to 12 oz. Eyebrows, skin, scrotum; nails nearly
solid. Il to 12 1 lb. Pupillary membrane formed,lips closed. 1272 to 14 223 lbs. Eyelids open, testes begin to descend,
foetus is viable. 15 to 17 1 4 to 5 lbs. Skin red, smooth, covered with down. 19 to 24 7 to 7'4 lbs. Testes near scrotum, left often therein.
DIAMETERS OF THE FETAL SKULL AT TERM.
Apex of forehead to chin.......
magnum to centre of ant. fontanelle.... 34 Ant. margin of foram. mag. to centre of
ant. font........... Between the parietal protuberances. ..... 34-4 Between the ears. ......
[Compare the articles in Part III entitled — ABORTION, AFTER-PAINS, FALSE-PAINS, HEMORRHAGE POST-PARTUM, LABOR, LACTATION, PREGNANCY, PUERPERAL DISORDERS, VOMITING OF PREGNANCY, etc.].
ASPHYXIA AND APNEA.
From Drowning.-Remove the person from the water as rapidly and gently as possible, turn the face downwards for a moment, and depress the tongue, in order that water, mucus, etc., may be removed from immediately over the entrance of the windpipe. Give the patient plenty of fresh air, fully exposing neck and chest to the breeze, unless inclement. Turn gently on the face, one forearm being under the forehead, and raise the body up that the water may have free discharge from the mouth. Place patient upon the side and apply stimulants (ammonia, etc.) near the nostrils; or the cold douche, in order to excite respiration.
The above measures being ineffectual, convey the body to the nearest convenient spot, strip it carefully and dry it, and place it on a warm bed, with head and shoulders slightly raised, and at once employ one of the following methods, known as Silvester's and Marshall Hall's.
Silvester's Method.-Pull the tongue forward, to prevent obstruction to entrance of air into the windpipe; produce expansion of the chest by drawing the arms from the sides of the body and upwards until they almost meet over the head. Then bring the arms down to the sides again, causing the elbows almost to meet over the pit of the stomach, and thus producing contraction of the chest. This imitation of the act of respiration should be continued at the rate of fifteen or sixteen times a minute, as in health.
Marshall Hall's Method. The person should be placed flat on the face, gentle intermittent pressure being made with the hands on the back, the body turned on the side, or a little beyond, then on the face, and the same pressure, etc., continued as at first. The whole body must be worked simultaneously.
The same number and frequency of these artificial processes of respiration should be employed as in the other method.
The Michigan Method.-Lay the body face down, the head upon the arm, and stand a tride it; grasp it then about the shoulders and armpits, and raise the chest as high as you can without lifting the head quite off the arm, and hold it about three seconds; then replace the body upon the ground, and press the lower ribs downwards and inwards, with slowly-increasing force, for ten seconds; then suddenly let go, to perform the lifting process again.
Whichever process be employed, the effort to restore the temperature of the body must be maintained, the body being well rubbed in an upward direction with the hands, with warm flannels, etc.; bottles of hot water, hot bricks, etc., being applied to the stomach, the axillæ, the soles of the feet, etc., stimulants and beel-tea being judiciously administered when restoration is about taking place. The attempts at resuscitation must be persevered in for several hours, if necessary.
Laryngotomy or tracheotomy, with or without catheterization, or forced insufflations of air or oxygen, have proved successful, as also electro-puncture (Garratt).
In artificial inflation, always press the larynx and trachea against the ver. tebral column, so as to close the oesophagus and thus prevent the air entering the stomach.
After Long Submersion is Recovery Possible ?-According to Harley (p. 881), dogs kept under water 1/2 minutes always died, if water had entered the lungs. If it had not, the trachea being plugged, they survived a submersion of 4 minutes. When persons rise after sinking they usually get some air, and less speedily come into a state from which recovery is impossible. The greatest period between the last inspiration and the stoppage of the heart is 4 minutes. Some think that no recovery has been made after complete cessation of the heart's action. We infer that after complete submersion for 5 minutes recovery is improbable, unless the person had been previously choked, or in a fainung state, so that no water entered the lungs. But in Anderson's case, the patient had been under water at least 15 minutes, and in Garrait's the time was variously estimated at from 15 to 60 minutes.
When is a Case Hopeless ! -Harley says (p. 892): “ If the eyes are open, the pupils dilated, the conjunctiva insensible, the countenance placid, the skin cold, frothy mucus round the nostrils and mouth, no attempt at respiration, and the heart's action inaudible (when the ear is applied to the chest), the case is hopeless."
Signs of Death.—The following have been suggested as methods of deciding whether death has occurred:
(a.) Tie a string firmly about the finger. If the end of the finger becomes swollen and red, life is not extinct.
(6.) Insert a bright steel needle into the fesh. If it tarnishes by oxidation in the course of half an hour, life may be considered not extinct.
(c.) Inject a few drops of Liquor Ammoniæ under the skin. During life a deep red or purple spot is formed.
(d.) Moisten the eye with Atropine. During life the pupil will dilate.
(e.) Look at a bright light, or at the sun, through the fingers held closely side by side. During life the color is pink; after death a dead white.
(f.) After death a dark spot is said to form gradually on the outer side of the white of the eye, from drying of the sclerotic, so that the dark choroid shows through.