A STUDY OF BODY TEMPERATURE IN PARALYTIC

DEMENTIA.

By A. B. COLEBURN, M. D.,

(From the Laboratory of the Connecticut Hospital for the Insane.)

The variations of body temperature have been studied by many writers, and there is universal testimony that the normal individual shows daily variations of .5° to 2° C. (.9° to 3.6° F.). While observers differ as to the point of highest daily temperature and its range, there is an almost complete unanimity of opinion that the lowest temperatures occur between midnight and 6 a. m. No doubt the causes of this daily fluctuation must be apportioned to several different factors-muscular activity, sleep and recumbent position, and ingestion of food being the most active.

The work of Benedict and Snell (1) has determined definitely the amount of heat production resultant on muscular work; the temperature of the subject rising as soon as work was begun, remaining fairly constant during the period of exertion, and dropping during the period of rest; the average rise being about 1° C. The repeated observations of these authors coincide very closely with the experiments recorded by Oberneir (2), Jürgenson (3), Leibermeister and Hoffman (4), and Mosso (5).

Benedict and Snell (1) record three temperature curves which they regard as normal, the records being taken in the rectum every four minutes, night and day, with an electrical resistance thermometer devised by them. The first curve gives a variation of 2.18° F., with a mean average of 98.7° F. In the second curve, the variation is 2.41° F., and the mean daily average 98.34° F. The third curve, taken in the calorimeter while the subject was at rest, is the average of four days and gives a mean daily average of 99° F., and a difference between maximum and minimum of 1.64° F. Chart I shows the normal curves given by Benedict, arranged as if temperatures were taken at two- and four-hour

113 7 11 3 7 11 3 7 11 3 7 11 3 7 11 3 7 113 7 11 3 7 11 3 7 11 7 113 11 3 7 11 3 7 11 3 7 11 3 7 11 8 7 11 8 7 11

intervals, with specimens of temperature of some of the subjects

of this study.

Professor Benedict states that of the large number of temperature curves he has since obtained practically all follow the same variations as those quoted (6).

While mental work has less effect on the body temperature than muscular, Mosso (7) and others have maintained that intense psychical processes may set free so much heat in the brain that its temperature may rise .2° to .4° C. (.36° to .72° F.). Pembrey (8) regards this local rise of temperature as due to vascular changes rather than to mere active combustion in the ganglion cells.

The ingestion of food has a marked effect on body temperature, and in a study of the daily temperature curves given by Pembrey and Benedict it is plainly apparent that the rise occurs when food is being assimilated, and the minimum temperatures occur when the processes of digestion are inactive. It is, of course, to be remembered that the rise is also fairly coincident with the period of the subject's greatest physical activity.

On the other hand, fasting reduces the daily fluctuations of temperature, and so far as experiments show the average temperature is lower.

Sleep in itself has little or no influence on the body temperature. The observations of Leibermeister (4) and others have shown that the temperature of a man asleep does not materially differ from that found at the same time of day when quiet and recumbent. As Pembrey (8) says, "Inactivity causes a fall of temperature, and sleep is a condition in which inactivity is most marked."

Mosso (7), Carter (9), Benedict (1) and Gibson (10) report interesting studies of the results of inversion of the daily routine on the normal temperature curve, their experiments tending to show that while the variation was less in extent, the tendency to persistence of the daily curve was strongly marked.

All observers agree that the temperature in old age is likely to be found equal to or above that of adults. The foetus before birth has a slightly higher temperature than the mother's womb. At birth the average rectal temperature is 99.5° F., falling shortly to about 98.15° F., then rising within a fortnight to between 99° and 99.7° F., the daily fluctuations being more pronounced than

in adults. The average temperature falls one to two-tenths of a degree from infancy to puberty, and about the same amount from puberty to middle age, thence rising, and about the eightieth year being almost as high as in infancy (8).

No definite agreement between observers has been made as to the influence of the seasons on man, the only constant effect being apparently due to variations in external temperature. Bosanquet (11) states that the highest sustained average rectal temperature occurs during the winter and early spring months.

In 1880 Dr. Mickle, in a work, "General Paralysis of the Insane," as previously reported in various articles on the subject, reiterated the statement that in this disease there is a very definite increase of temperature, stating also that a rise of temperature may accompany a maniacal paroxysm, precede or accompany a convulsive seizure when these are pronounced, may occur without any apparent physical or mental cause, may accompany a rapidly progressing case without complications, etc.

Riva (12) confirmed Mickle's observations of rise of temperature during epileptiform attacks in general paresis, and suggested that the (so-called) thermic center is then affected. He (13) later states that in typical cases the temperature is always slightly though irregularly above the normal, and that periods of excitement are always preceded by increase of temperature, though this also may go before stupor or epileptiform attacks. Crömer (14) found that, as a rule, the temperature in paralytic dementia is lower than in health or in other diseases, but that the great differences of temperature occur with the paralytic attacks.

Wirsch (15) found that the temperature was higher during excitement with grandiose ideas, and fell when the mood became calmer, as a rule, but not all maniacal attacks raised the body temperature.

Rottenbiller (16) gave results of 4724 observations of temperature in 33 cases of paralytic dementia, deducing that the prevailing temperature is subnormal, that great daily variations frequently occur without apparent cause, and that these characteristics are present in the early stages of the disease and in remissions, and are consequently of diagnostic value.

Dr. Savage (17) opined that in dementia paralytica there was little increase in the earlier stages, but in the later stages, besides