Read manhwa The President’s Special Instructions / My Boss’s Special Request / Married to

my boss /사장님의 특별지시 / 成 裁的合 丈夫 / 社長の特別命令

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Married to my boss

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Alt Names: 사장님의 특별지시,
edy
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 Married to my boss

Read manhwa The President’s Special Instructions / My Boss’s Special Request / Married
to my boss /사장님의 특별지시 / 成 裁的合 丈夫 / 社長の特別命令
Soohyeon’s dreams of prosperity fall short of reality when he finds himself working as a
secretary with an average salary. On top of that, his boss is Choi Jungwoo, nicknamed
“Satan” due to her unyielding personality. One day, she requests something unexpected:
she asks him to marry her. Just as he’s about to resign, she hands him a contract with
conditions he can’t resist. If he marries her for one year, he’ll have all the money he
needs to give his parents a better life. But… can he do it?

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Other documents randomly have
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will scarcely rise above the average degrees." And again, "M. Andral
has similarly established for adults that the temperature remains
normal, even in pulmonary consumption, so long as there is no
fever."
 THE TEMPERATURE IN ACUTE PHTHISIS. 413
complications, there is no fever in the stage of deposit {' De la
Phthisie Pulmonaire/ Paris, 1867, p. 200). Dr. Pinlayson also objects
to Dr. Einger's statement, that there is a continued elevation of
temperature in all cases of tuberculosis and tubcrculisation, and that
the thermometer will always detect it. He thinks many of Dr. Ringer's
temperatures are too low, which he ascribes to the thermometer
being retained only five minutes. His own observations on children
with tubercular disease (made in the Manchester Clinical Hospital for
Children) lead him to believe that there are three principal types of
tubercular disease, corresponding to Sir W. Jenner's clinical
classification of " the insidious, the active febrile, and the adynamic."
In this way he combines the views of Jochmann (Berlin) and of
Wunderhch. These three types may be briefly expressed as follows:
Firsi type. — The morning temperatures are normal, or rather less
than normal, whilst the evening temperatures are more or less high.
E. g., a child has a temperature of 99'33° Pahr, (in the rectum) in the
morning, whilst the evening temperature = loi "53 or ioi"8o° Pahr.
This equals the insidious and often unexpectedly fatal type. Second
type. — The morning and evening temperatures are hotk high,
whilst there are evening exacerbations. F. g'.: a child has a morning
temperature of ioo*i6° P. (rectum), whilst the evening temperatures
are from ioi*57° P. to 103*67° P. = the active febrile type. Third
type. — The morning and evening temperatures are Iwtli high, but
there is a tendency to exacerbations at odd times. E. g. : on one day
the child has a morning temj^erature in the rectum of 103° P., and
in evening one of 102*33 P. 0^ another day the morning and
evening temperatures may be 102*6° and 104° P. respectively. This
characterises the adynamic type. Dr. Pinlayson lays most stress on
the continued absence of that evening fall in temperature which he
considers as so characteristic of healthy children. He contends that
the daily range of temperature in the healthy child is greater than in
the adult, amounting to as much as two or three degrees
Pahrenheit, and that there is invariably a fall of temperature in the
evening, amounting to one, two, or three degrees Pahrenheit ; the
most striking fall usually occurring between 7 and 9 p.m., often
before sleep comes on. See 'On the Temperature of Children in
Phthisis and Tuber 
The text on this page is estimated to be only 13.11%
accurate

HI Tin; TliMPEUATURE IN ACUTE THTHISIS. culosis/ by

James Fiiilnysoii, M.D., p. 32, Dunn and Wriglil, (jllasijow, and the
'Glasgow ]\redical Journal/ November, i(S69. Dr. llillicr also admits
that the morning and evening temperatures in pliihisis may
sometimes be normal, and even Dr. llinger admits this. It is therefore
rather the course of the temperature than its height on a particular
day Avliich must be cur guide. — Trans.] [Dr. Finlayson's table of the
variations of temperature in twentyfour hours in. healthy children is
here combined with Dr. Ogle's tables of temperature in adults (male
and female) referred to at p. loj, and for convenience represented by
a diagram. — Tuans.] Fig. 40. ^^ — 1 fA > ^^^ "^^^ ¥ > ^^ 1 PI
OS ^/ \ N 1 cxc ^ c^ 1 ^ \ Co 1 -«r 1 1 0 1 ,-'— H — 1 f\ 1 Sf ^
^^\■ t-i \ ^ \ c?*^ N Cj \ .t^ '^ \ '^l^ ! ' ^ ^ 1-= ^H! \ t^ "^ ^ ^
1 1 ^ 4 ^ 1 f^ 1 a. ev Ci 00 Vs
 THE TEMPERATURE IN TRICHINOSIS. 115 ' XXVII.—
Trichinosis. Trichinosis cannot have a typical form of fever; for the
participation of the system in general is essentially determined by
the numerical circumstance of the little foci of inflammation induced
by the parasite being more or less numerous. Notwithstanding this,
the course of the temperature in this disease is more than usually
interesting, because it affords us almost the only certain proof that a
considerable elevation of the general temperature of the body may
be brought about by purely local, although enormously multiphed
disturbances (inflammations), for a considerable time at least ; for
when the disease has lasted some time, and the deposits have
reached a later stage, it is quite true that further mischief is
developed ; which is shown by the implication of the brain, lungs,
and kidneys, and by the simultaneous disease of other organs in
which there are no trichinse. In such advanced cases it is clearly not
possible to determine how much of the fever which is present should
be ascribed to the topical inflammation of the muscles, and how
much to the cerebral disease, the pneumonia or nephritis, and such
like. Observations on patients sufl'ering from Trichinse show — (i) In
spite of tolerably extensive muscular symptoms, and, doubtless, no
inconsiderable localisation of Trichinae, there may be perfect
freedom from fever, or a sub- febrile condition, or at most a very
slight febrile movement.^ (3) In the same manner the fever is either
absent or only slight, M'lien the muscles are first attacked. (3) When
the symptoms grow increasingly severe in the further course of the
disease, the temperature may be very considerably varied, and even
40° — 41° C. (= 104° — 105-8° Eahr.) may be reached; only such
high temperatures are interrupted by more or less considerable
remissions, generally reaching the normal point, or 1 In a mau
admitted into the London Hospital, under Mr. Curling's care, and who
died almost immediately in consequence of having been run over in
the street, almost all the voluntary muscles were thickly studded
with trichinte. Yet Dr. Bathurst Dove, who made the post-mortem
which discovered this fact, found, on careful inquiries of his nearest
relatives and friends, that he had never complained of any of the
usual symptoms, and considered himself as almost a model of
health.
 -ilQ THE TEMPEKATLUE IN MALIGNANT DISEASES. even
descending beneatli it, so that there is then an almost daily
compensation or re-establishment of an equilibrium of temperature.
(4) Such high degrees of temi)crature do not persist long. Even in
fatal cases they are interrupted by the occurrence of either normal
or only sh'ghtly elevated temperatures for several days together. (5)
These circumstances combined, render the course of the
temperature in trichinosis somewhat characteristic, at least in those
cases where the temperature reaches high degrees. In such cases
there is little danger of confounding it with typhoid fever, and with
the fever of articular rheumatism; it is more likely to be confused
with acute tuberculosis, or with cases of internal suppuration
running a rapid course. On the other hand, when the fever continues
to be very moderate and inconsiderable, all characteristic features
are lost. See the curves in lithograph at end, Plate Yll. XXVIII. —
Malarious Diseases. Only the intermittent form of malarious infection
is accurately known as regards the course of the temperature. There
is no opportunity in our country of making any observations on the
remittent forms. We must distinguish in this kind of disease between
the course of the temperature in the several paroxysms and its
course during the entire duration of the disease. § I . The separate
paroxysms are each characterised by a sudden rise of temperature
(generally with rigors and " cold shivers^^), to a height of extreme
fever, and an equally rapid return to the normal or a little below it.
The temperature begins to rise before any other symptom of the
incipient attack announces itself. The rise of temperature is,
however, comparatively slow just at first, that is, it may continue for
a couple of hours without reaching more than 38-5° or 39° C. (=
101-3° or 102-3° Fahr.). As soon as the rigor occurs, which may
begin at temperatures of varying height, the rise becomes more
rapid, and in the course of about an hour has reached a height of
41° — 41-5° C. (105-8° to 106-7° Fahr.), or only exceptionally a little
higher. Meanwliile, the stage of dry heat (hot stage) may have set in,
and during tliis, the rise of teinpe.
 THE TEMPERATURE IN MALARIAL DISEASES. 417 rjiture
may still go on. This ascent to the summit or acynS of the
temperature of the paroxysm is generally quite steady and
uninterrupted; at the furthest the temperature halts once or so, for a
few minutes at some given point; or occasionally there occurs a
slight fluctuation just close to the highest point [so that the summit
is slightly bifid] . The maximum of the temperature is reached in the
stage of dry heat, though sometimes perhaps, after the appearance
of partial sweating. It only lasts for a few minutes. When the
sweating becomes general [moist stage], the temperature begins to
fall again, only slowly for the first hour or half hour; and sometimes
it fluctuates a little ; then it begins to fall somewhat more rapidly,
without any fresh rise occurring : it does so, however, in such a way
that the temperature halts for a quarter or even half an hour, and
then falls about one or two tenths of a degree Cent. (= one fifth to
one third of a degree Tahr. nearly), then rests again, then begins to
fall again and so on (so as to resemble terraces) ; M'hen this has
continued some four hours or so, and the temperature has fallen to
somewhere about 40° C. (104° Fahr.), it sinks somewhat more
rapidly; requiring, however, some ten or twelve hours or more before
it regains the normal point. During the intermission or apyrexia
which succeeds, the temperature is sometimes a little under the
normal ; but if the apyrexia lasts more than one day, there is a very
slight evening exacerbation, which scarcely exceeds the range of a
normal daily fluctuation. Not infrequently, especially after the use of
febrifuges (quinine, &c.), there occur paroxysms without any
subjective symptoms, which only announce themselves by the
elevated temperature, and run their course without a rigor and
without any sweating or only very triflingperspiration. The maximal
height in these attacks may equal, or very nearly so, that of the
perfect fever paroxysm ; the rise and fall of temperature are,
however, compressed within a briefer period than is the case in
paroxysms accompanied with a rigor.^ ' As the two facts of the rise
of temperature during the cold stage, and the existence of
paroxysms of fever (as shown by the thermometer) after the
apparent cure by antiperiodics — attacks which are scarcely known
to the patient himself — are still unknown to a large number of
medical men, and even denied by some, although recognised by dc
Haeu (see Chapter II of this work), it is jicrhaps not superfluous to
remark that I have often verified this observation, and have
demonstrated the fact to others. Were it necessary I could easily
furnish corroborative cases from my note-book, — [Teans.1 27
 418 THE TEMPERATURE IN MALARIAL DISEASES. This
bcliaviour of the tcmpcralurc in tlio ])aroxysin and the apyrcxia which
succeeds it, is itself so characteristic of intermittent fevers (agues,
&c.), that it renders tlie diagnosis tolerably certain. There are
extremely few forms of disease in which there is so rapid a rise of
temperature from the normal level to a height of 41° or 41*5° C.
(105-8° to 1067° Fahr.), immediately followed by an equally rapid
return to the normal temperature. Hardly any except ephemera, the
solitary relapse into fever during convalescence from typhoid fever,
the paroxysms of acute tuberculosis and those of pyaemia, display a
similar course ; and to distinguish between these diseases it is in
general sufficient to wait for a second paroxysm, and at the same
time to pay attention to the exact time of its occurrence. However,
even a single paroxysm is enough to enable us to distinguish
intermittent fever from those affections for which it is most Hkely to
be mistaken when its symptoms are severe, such as typhus,
meningitis, and cholera. In these, which often resemble a very
intense and pernicious intermittent in all the other symptoms, the
course of the temperature is so perfectly diff'erent, that the use of
the thermometer makes our diagnosis absolutely certain. § 2. In
relation to the manner in which the paroxysms of intermittent fever
succeed one another, it has long been known that this may happen
in various kinds of rhythm. It appears to me, after making very
numerous observations, that the most normal course, i. e. that
which is undisturbed by individual pecuharities, complications, &:c.,
is that in which the paroxysms are repeated after about fortyfour to
forty-six hours (tertiana anteponens). Thermometry alone is often
able to reveal the fact that the apparently pure quotidian, tertian, or
quartan rhythm is duplicated; and that either stronger paroxysms
alternate with weaker ones (in the apparently quotidian rhythm) ; or
that between the separate paroxysms which are completely
developed m all their symptoms, there are attacks interposed which
only announce themselves by the elevated temperature. In a similar
manner complete recovery from intermittent fever can only be
guaranteed by the thermometer. Thermometric observation teaches
us that the disease does not generally terminate with a well-
pronounced paroxysm, but that fresh attacks may succeed which
consist only in a rise of temperature (which is sometimes very
great), and announce themselves in no other way but
 THE TEMPERATURE IN CHOLERA. 419 which may again
give place to perfectly developed paroxysms if the treatment be too
early discontinued. Besides Zmmermann and Barensprung , special
reference may be m.ade to Michael's paper in the^Archiv filr physiol.
Heilkunde' (for 1865), xv, 39, entitled^ " Specialbeobachtungen der
Korpertemperatur im iutermittirenden Fieber." See the curves in the
lithographs at the end. Plate VII. XXIX. — The Temperature in
Cholera. § I . Observations on temperature in cholera are attended
with some special difficulties, and in particular the results derived
from those taken in different regions of the body, require to be
separately estimated, since they do not run parallel courses.
Temperatures taken in the axilla cannot be trusted unles's taken with
great precautions. The mercury rises very tardily, and sometimes
takes half an hour before it becomes stationary, particularly in the
cold stage. However carefully taken, these axillary temperatures in
the cold stage afford no correct standard of the general temperature
of the body (or temperature of the blood). However they are
valuable, because they represent the conditions of the surface
temperature (the heat of the skin). In the reaction stage, the axillary
temperatures are once more trustworthy standards for the general
temperature of the body. The degree of surface warmth, or the
extent rather to which the skin is cooled, is indicated far more
perfectly on exposed parts of the body, and particularly in the hands
and feet. But any accurate measurement of temperature in these
spots is almost impossible, and the results obtained are, therefore,
comparatively worthless. During the algide stage temperatures taken
in the mouth give hardly any idea of the general temperature. They
may, indeed, be of some value, as giving indications as to the
temperature of the expired air ; though, indeed, these are
comphcated, and little trustworthy. Only observations taken in the
rectum or vagina can serve as a standard of the general temperature
of the body. The former, however, are difficult to make at this period
of the disease, and are easily disturbed by the action of the bowels.
Vaginal measurements are by far the best, but cannot be had
recourse to in some females ; or, at least, caimot be repeated
sufficiently often ; and may be affected
 420 THE TEMPERATURE IN CHOLERA. by the croupous
(iliplitheritic) affections of tlie vagina which often supervene iu these
cases. There is very often a considerable contrast between the
results obtained by readings taken in various parts; and sometimes
this ver^ contrast may afford us valuable hints {lit. winks) for
prognosis. Thus a great difference between the axillary and rectal or
vaginal temperatures is decidedly unfavorable, and in the progress of
recovery we often observe the temperature in the mouth to rise,
while the vaginal temperature falls.^ The behaviour of the
temperature in sporadic cases of cholera, when these are severe,
does not essentially differ from that of the epidemic form. Only the
average differences of temperature are rather less, unless the
choleriform attack accompanies some special affection, which
necessitates considerable alteration of temperature.^ § 2. Even
before the heginning of any other symptoms, a fall of lemperatui'c
may be observed m patients previously suffering from fever, when
they become infected with cholera (as Friedlmder has shown from
observations made in my wards) ; which although closely connected
with the still latent infection, yet demonstrates clearly, that the
decrease of temperature of the surface is in no way the result of the
evacuations alone ; [perhaps, however, it does result from the
increased flow into the intestinal canal, just as a fall of temperature
succeeds internal haemorrhages. — Teans.] In the stage of
evacuations (cholera flux), in slight eases which do not become
asphyxiated, both the axillary, vaginal, and rectal temperatures are,
as a rule, normal, or (particularly the vaginal temperature) a httle
raised. As soon as there is any indication of asphyxia, the
temperatures are always more divergent; the vaginal temperature
appears somewhat higher, and the axillary temperature somewhat
lower than normal. If the algide form is developed, the temperature
of internal parts in cases which recover, is moderate, as a rule,
although sometimes rather high (in a case of Giiterfjock's it was
39*6° C. = 103*28° Fahr.), and it is exceptional to find it normal or
dimuiished, ^ See note to page 183. 2 Numerous cases in the
medical journals, especially in 1806, when attention was drawn to
the subject by several physicians, show that all the appearances of
cholera may be perfectly simulated by many other affections — as
perforating ulcers, toxic influences, intestinal obstructions,
hajmorrhages, &c. &c. — TuA>-s.]
 . THE TEMPERATURE IN CHOLERA. 421 In cases in -whicli
deatli occurs in the asphyxiated stage, the temperatures in the
vagina and rectum sometimes reach still higher degrees (40° C. =
104° Fahr.), or more, and in one case of Gilterhock's, even 42*4° 0.
= 108-32° Fahr.). Any considerable rise of temperature, or any
considerable fall, indicates great danger, and with either alteration
quickened respiration.^ Cyanosis, asphyxia, and suppression of
urine, may be present. Very profuse and violent alvine discharges
are generally indicated by a fall of temperature, though sometimes
only accompanied or preceded by a relative fall. When the
temperature rises, although the rise may be only relative, the alvine
discharges cease, and if the temperature rise higher there is a
tendency to coma (sopor). Both a rapid fall of considerable amount,
and a rapid and considerable rise of temperature are indications of
approaching death. On the contrary, the less the temperature
fluctuates, the less it varies from the normal, the more probability
there is of recovery. On the cutaneous surface, even in the axilla, the
temperature during the algide stage is, as a rule, diminished,
sometimes, indeed, very greatly so, yet not often below ^^° C. (95°
Tahr.) . The axillary temperatures generally show less striking
fluctuations than the heat of internal parts of the body. There is
especial danger when the surface temperature of the body remains
persistently low, or after being considerably lessened, rises rapidly,
or sinks afresh after it had begun to rise. On the other hand, it is a
good sign when the low temperatui'e slowly and steadily begins to
rise with only slight fluctuations, and thus the normal temjierature is
not exceeded or only slightly. The temperature under the tongue
may be still more diminished. In the stage of asphyxia, the
temperature there seldom exceeds 31° C. (87-8° F.), and even in
cases which recover may fall to about 26° C. (78*8° P.). If it falls
below this, recovery would appear to be impossible. § 3. In the post-
choleraic stage (period of reaction) the temperature in favorable
cases is normal or approximately normal. In this stage, from its
previously abnormal condition, it returns to tlie normal acrain. *&•■ '
Quickened respiration is present in almost all cases of cholera, as it
is in nearly all fevers, probably from failure of muscular power, or to
compensate the pulse frequency. — [Trans.]
 •l-^S THE TEMPRRATURK IN CnOLERA. Yot moderately
febrile rises of temperature arc by no means signs of great danger;
they are, however, suspicious, and denote complicatious of some
sort. !Morc considerable elevations of temperature are a sure sign of
complications, and of the supervention of various local afTections,
and give little prospect of recovery. Very high temperatures are
particularly induced by parotitis and erysipelas, and sometimes,
though less invariably, by pneumonia, which only exceptionally
pursues a typical course. Patchy exanthems [roseola, &c.], do not
invariably induce a rise of temperature. A normal or approximately
normal course of temperature in the post-choleraic stage is,
however, by no means an absolute guarantee of recovery. When the
reaction assumes an actually typhoid form, the temperature in many
cases is normal, or only slightly elevated. It is true these are in
general favorable cases with but slight development and
inconsiderable local affections, yet even in these all danger is by no
means got rid of. However, the temperature may rise, and that
pretty considerably, even in the typhoid form, and the type is for the
most part remittent. These are cases which run a stormy course,
with severe local disorders, and if they do not suddenly end fatally,
they lead us to expect that the disease will be protracted.
Parenchymatous nephritis occurs indifferently both in cases with
moderate and those with elevated temperatures. The most
unfavorable thing in the post-choleraic stage, is for a previously
normal or elevated temperature to suddenly sink below normal. Even
a considerable diminution of the peripheral heat [surface-warmth] at
this period, indicates considerable danger. In many cases, the
temperature of the body falls more or less suddenly after death. Yet
m some cases when the temperature has previously been but
slightly raised as well as more especially in those with already high
temperatures, the temperature actually rises for some minutes, or
about half an hour after death. § 4. The temperature in cholera has
attracted attention for a long while, and from the time of the first
appearance of the disease in Europe, thermometric observations
have been published {Czermaky Goppert, LockstdcU) . These earlier
observations, however, were not worth much. The observations
made in the years 1848-52 by Ross,
 TEMPERATURE IN INJURIES OF CORD, ETC. 423 Mair,
Bernhardt and LeuluscJier, Roger, Boy ere. Briquet and Mignot,
Iluhbeuet, and Biirensprung, were more valuable. The most
important facts in a diagnostic and prognostic point of view were
discovered in the epidemic of 1866. Consult particularly Charcot (on
the temperature of the rectum in cholera, ^Gazette Medicale/ 1866,
11). 2Io7iti (' Jahrb. d. Kinderheilk./ 1866, p. 109) and Guterloch
("die Temperaturverhaltnisse in der Cholera," 1867, in ' Virchow's
Archiv/ xxxviii, 30). [Particular reference may also be made to the
authorities quoted in the notes to pp. 183 and 204. By an accidental
omission in the latter place, Mr. E. Nettleship's name does not
appear as it should amongst those who contributed largely to our
knowledge of the temperature in the cholera epidemic of 1866. Dr.
Thudichum^s arrangement of some of the observations made in the
London Hospital, appears in the 9th ' Report of the Medical Officers
of the Privy Council.^ Por some reason Dr. Thudichum has, however,
fixed the line of normal temperattire at 36'8° C. (98*24° P.), which is
a lower average temperature than that generally admitted as
normal. — TeaoS's.] XXX. — Injuries op the cervical portion of the
Spinal Cord. B. Brodie (in 1837, in the ^ Medico-Chirurgical
Transactions/ XX, 146), first made the remark, as an addendum to
Chossat's experiments, that he had observed a considerable rise of
temperature in several cases of injury to the spinal marrow; and
published his celebrated case of laceration of the lower portion of
the cervical cord, in which death occurred after twenty-two hours,
after the inspirations had fallen to five or six in the minute, and the
thermometer applied between the thigh and the scrotum had
marked 43*9° C. (cii-02° Pahr.). Since that time other observations
have been made which confirm the influence of injuries of the
cervical portion of the spinal cord in producing enormous elevations
of temperatui'e, by Billroth (^ LangenbecFs Archiv,' 1862, rise of
temperature to 42*2° C. (io7'96° Pahr.); Quincke (^Berliner klmische
Wochenschrift,' 1869, No. 29. Two cases with temperature of
43'4°and 43"6°C. = iiO"i2° and 110*48° Pahr.). IFeler in London
('Transact, of the Clinical Society,' vol. i (1868), two cases, one with
temperature
 424- TEMPERATURE IN NEUROSES. of 44^ C. — 11 ra*^
Falir. ; the other with a post-inorlcm temperature of 4^-f C. = 109-
94^ Eahr.). Flsc/icr {' Centralblatt/ i86y, J). 2-^9 ; a rise to 42*9° C.
= 109*22° Ealir.). On the otlier haud, the latter has observed two
cases of injuries of the cervical portion of the spinal cord with a
diminution of temperature in one case to 34° C. ( = 93*2° Eahr.), in
the rectum, in the other to 30-2° C. ( = 86-36° Fahr.) in the axilla.
[See also JBbiz on alcohol in paralytic fever in the ' Practitioner/ July,
1870, and a paper on the temperature of shock in surgical cases by
W. W. AFagstafTe, F.E.C.S., ^St. Thomas's Hospital Heports/ vol. i,
new series, p. 466, where {inter alia), a case is given of fracture and
dislocation of sixth cervical vertebra, which died after forty-eight
hours, when temperatures of 92*3° Fahr. on admission, and 8175°
Fahr. (forty-five hours after injury) were recorded. See also a paper
by Dr. Frederic Churchill in the same volume on shock and visceral
lesions. Compare also remarks on injuries of the nervous system at
pages 145, &c. — Trans.] XXXI. — Neuroses. Uncomplicated
neuroses, whether evincing their presence in psychical, sensitive, or
motorial functions, do not, as a rule, exhibit any alteration of
temperature at all, whether they are recently developed or long
existing, or extremely chronic, or, at all events, the alterations of
temperature are very inconsiderable. The following exceptions must
be made : {a) Sometimes intermittent neuroses are developed under
malarious influences, and in their attacks there may be an elevation
of temperature. {b) The hysterical neuroses, in which elevations of
temperature even to excessive heights may occur, like every other
possible symptom, to all appearance without any motive at all. (c)
Those affections which we may designate as vaso-motor neuroses,
which are by no means thoroughly understood as yet ! In these
cases also there may be alterations of temperature. In psychical
neuroses, indeed, there is generally no particular alteration of
temperature to be observed, unless it is produced by intercurrent
corporeal affections. Yet a rather subnormal temperature may be
constantly observed in many insane persons (Geistcs 
 TEMPERATURE IN NEUROSES. 425 krankeii), and iu others
again moderate and apparently objectless elevations of temperature
are sometimes seen which for the most part scarcely reach the'
limits of fever. In cases of extreme inanition, exposed to great
external cold, the temperature of the insane may also sink in a most
extraordinary manner. See the remarkable case by Lowenhardt
already quoted on page 204. On the other hand, West/phal has
pubhshed observations (in * Griesinger's Archiv fi Ir Psychiatric/ i,
337), according to which very considerable elevations of temperature
occurred in an intercurrent manner in paralytic lunatics. However,
they occurred along with epileptic and apoplectic attacks; but
Westphal implies that they had no relation to the muscular spasms
or their intensity, and even when the muscular movements were
very shght they occurred, and sometimes when these were
altogether absent, and also that the epileptic attacks in themselves
caused no very special elevation of temperature. He believes just as
little in the dependence of the elevated temperature on the generally
co-existent acute affections of the respiratory organs, since the latter
are by no means always present in the attacks with elevated
temperature. [The observations of Br. T. S. Clouston in the ' Journal
of Mental Science,' ' Edinburgh Medical Journal,' and elsewhere, of
which there is a very good abstract in the New Sydenham Society's
'Year Book' for 1863, p. no, would seem to show that tuberculosis is
present in a large number of cases of insanity.] It is also quite proper
to note, as only apparent exceptions — where there are latent
processes going on in a case in which, at the same time, only the
neurosis is to be recognised, and deviations of temperature result ;
or where complications interrupt the quiet course of a neurotic
affection, and although by no means visible, constantly affect the
temperature. On the other hand, there is a very peculiar symptom to
which I first drew attention, although it has since been confirmed by
several observers {Billroth, Ley den, Ebmier, Ferber, Erh, Quincke,
and Monti) ; namely, that in the last stage of fatal neuroses, and
more particularly in Tetanus, although met with in very many other
disorders of the nerve-centres (of the brain), the temperature begins
to rise, and rises in the briefest space of time to extraordinary
heights ; to heights, indeed, which are only exceptionally reached in
diseases which are of distinctly febrile origin (sometimes to 43° C.
(109-4° Fahr.), or even to above 44° C. (iii'2° Fahr.) and in one case
of tetanus to 4475° C. (iia"55° Fahr,), which is usually succeeded by
a still further post-mortem rise of temperature
 '1-20 TFMPERATURE IN NEUROSKS. amounting to a few
tenths of a degree. Ilerr llofratli Unlcrhcrfjer, Professor of Veterinary
Surgery in Dorpat, has informed mc in a letter, that he has observed
temperatures of above 43° C. (107*6° Falu".), in fatal cases of
tetanus in horses. These facts, taken in conjunction with the equally
extraordinary high temperatures which are observed in tissue
changes of the brain and upper ])art of the spinal cord, appear to
show as has been adduced already (pp. 150 and 195) that there are,
apparently, moderating centres or apparatus in the brain, the
paralysis of which is succeeded by a morbidly increased action of the
processes which produce warmth. This observation is of practical
importance, because it indicates that any considerable elevation of
temperature in patients suffering from neuroses, when no particular
reason can be assigned for the fever which is developed, affords the
worst possible prognosis. Mt/ own piihlicatluns on this behaviour of
the temperature may be found in the 'Archiv der Ileilkunde' for 1861,
ii, 547; 1862, iii, 175; and 1864, v, 205; and those of Erb in the
'Deutsch. Archiv fiir klinische Medicin,^ 1866, i, 175. [In addition to
the author's remarks on neuroses, I may just remind the reader of
the remarks made at pp. 106 — 145, &c., 195 and the note to p.
225. In studying the temperature in neuroses, we have, of course, to
eliminate the influence upon temperature of the primary cause of
the neurosis ; thus, for instance, in most of the fatal cases of chorea,
this symptom supervenes upon acute rheumatism or scarlet fever,
whilst in most of the cases which recover the setiology is obscure or
utterly unknown. Of the latter class of cases, Br. Finlayson states
that in a girl aged 9:^ suffering from chorea, the average of six
observations of morning temperature was 99-01° Tahr. (37*22° C.)
in the rectum, whilst the average evening temperature of eleven
observations was 103*21° Fahr. (39*56° C). In a boy aged jo^ the
average of eleven morning observations was 99*44° Fahr. (37*46°
C.) ; and that of thirteen evening temperatures was 98*93° Fahr.
(37*18° C). //. Eager also states that in chorea there is little or no
alteration of temperature. Br. Long Fox ('Med. Times and Gazette,'
1870), says the temperatures in chorea are seldom over 99° Fahr.,