I may add, in conclusion, that, in my case, the eyes were well formed, except in respect of the anomalies already described; and that the lenses were not notched or deformed in their lower portion, as has been sometimes observed in cases of cleft iris.

VII.-ON THE NORMAL TEMPERATURE IN CHILDREN.

By JAMES FINLAYSON, M.B., L.R.C.S.E., House Surgeon to the Clinical Hospital and Dispensary for Children, Manchester.

BEING interested in the investigation of the temperature of children affected with disease, I have been led to make some observations* to satisfy myself as to what was to be regarded as the normal temperature in the child. I had observed that during the convalescence from several diseases, the evening temperatures frequently went down to a point which I was disposed at first to regard as abnormally low, but as they continued low, even when the child had completely recovered, it seemed important to ascertain what the normal temperature really was, and what daily variation occurred in the healthy subject. The following case may serve as an illustration :—

No. 1.

K. D., aet. 5 years 9 months. Measles rash appeared morning of July 18, 1868; attack of mildest possible character. Temperatures in rectum, taken by myself.

The fever in this case having been very slight, the morning temperatures are scarcely, if at all, above the normal, but in the course of the disease the evening temperatures undergo a fall, which though slight, is quite distinct and unmistakable.

A similar observation seems to have been made by Dr James Paterson Cassells, in some cases of measles, although

* Submitted at the Meeting of the Medical Branch of the Manchester Royal Institution, Nov. 4, 1868.

he does not allude to the evening temperature being especially low, and he was induced to make some observations on perfectly healthy children, with the view of ascertaining the normal temperature in infancy. These observations he communicated to the Glasgow Medical Journal, February, 1867, and I here reproduce two of his cases, reduced from the diagrammatic to the tabular form, so that the difference between the morning and evening temperatures may be more readily noticed. Dr Cassells considered that his observations proved that the normal temperature in infancy was lower than had been generally supposed, but he does not call attention to the fact that the evening temperatures were almost invariably lower than the morning ones.

No. II.*

DR CASSELLS' case; healthy female infant 14 months old. Temperatures taken with registering thermometer in groin.

Average difference between morning and evening temperature 0°.86. * Compiled from Diagram, No. 4, of paper on "Normal Temperature of the Body in Infancy and Childhood," by James Paterson Cassells, M.D. Glasgow Medical Journal, February, 1867.

Average difference between morning and evening temperatures, 0°.89 lower in evening; both sets of observations being made in groin, and the same registering thermometer being used.

With regard to my own observations in the following tables, I have now to mention the conditions observed:—(1.) All the temperatures were taken in the rectum, except in one series (duly specified) for the sake of comparison as between rectum and axilla. (2.) The thermometers used were those made by Casella, with the degrees of Fahrenheit's scale subdivided into fifths, so that a reading could be easily made to the tenth of a degree. (3.) The same thermometer was always used for a given case. (4.) The time during which I retained the thermometer in the rectum was, at first, very considerable; ultimately, I only retained it till the mercury had ceased rising for a minute or two; as a rule, the maximum is reached in less than five minutes. When the temperatures were taken by nurses, I directed them to retain the thermometer in position fifteen minutes. (5.) The temperatures taken wholly, or chiefly by myself, are specified at the top of the tables. As to the two nurses who took many of the temperatures, especially at the midnight and morning hours, I satisfied myself (by repeated testing) of their ability to read the scale correctly, and frequently tested their observance of the proper hours by looking into the wards at unexpected hours, and occasionally I took the temperature myself a few minutes after they had * Compiled from Diagram, No. 5, of same paper.

recorded their observations. I thus felt confident of the practical accuracy of the figures, although, no doubt, an error might occasionally be made, as, indeed, is possible to any one. (6.) The extent to which the bulb was introduced into the rectum was regulated by always introducing the thermometer up to the curve, in the case of the curved instrument, and up to a corresponding point, marked by a band, in the case of the straight thermometer. I had observed that a slight difference in this respect gave frequently a considerable variation. (7.) The subjects of my observations were mostly patients in the Manchester Clinical Hospital; there are also a few observations on patients in the Crumpsall Workhouse, two miles north of Manchester. The subjects are pretty fully described at the beginning of each table, any disease or trace of disease being specified. (8.) The conditions of life observed by the children here spoken of varied only slightly during the term of observations: Breakfast about 7 a.m. (temperatures at 7 are before rising, washing, and breakfast); dinner between 12 and 1 o'clock (in many cases with an intermediate luncheon about 10 a.m.); tea between 4 and 5 p.m.; occasionally a light supper about 6 p.m.; bed-time, 7 p.m.; all patients usually asleep by 8 o'clock; no food was given after this till morning. In only two cases were the patients in bed during the day.

It is proper to remark, for the sake of those not familiar with the thermometer as used in the rectum, that when the instrument is oiled and introduced carefully, no pain is caused, and, as a rule, no annoyance is felt by the child; indeed, with a little care in turning the child on to the left side, and avoiding the glaring of light on the face, the observations can frequently be made without disturbing the sleep. In very many cases, the child goes to sleep during the course of the observation, and only in a very few cases is any difficulty experienced in taking the temperature satisfactorily. Of course, when children are restless and ill, the taking of temperatures anywhere is sometimes impossible.

The advantage of the rectum over the axilla or groin is, that the maximum temperature is, as a rule, reached much

sooner, the perfect position of the bulb is secured without fear of displacement, while the temperature of the part is, without doubt, & more uniform index of the internal heat.

I have selected the tabular form for the observations, as being sufficiently marked for those who wish really to compare the figures. The form of diagram with curves, though more attractive to the eye, is, I believe, very apt to mislead, wherever there is a slight gap or a slight variation in the time or form of the observations. Such gaps are often inevitable in practice; the curve is indicated in stating average results, rather than individual cases.

No. IV.

M. K. M., aet. 3 years. For 3 months, strumous disease of knee-joint, not then involving general health, which seemed excellent. Temperature taken first week in rectum, second week in axilla, by myself, Registering thermometer used. Patient in bed.

MORNING, 7 A.M.

1867.

Re

Aug. Temp. Pulse. Resp. Temp. Pulse. Resp. Temp.

Pulse. Resp. marks.

Mean 99°.12 105.50 22.40 99°.44 110 28.80 97°.01 97.28 23.14