HYPERPYREXIA.
The treatment of hyperpyrexia will be found detailed under the head ing of each primary disease in which the high temperature occurs (acute rheumatism, sunstroke, typhoid fever and malaria), but a brief summary of the usual methods may be here enumerated for convenient reference.
The new antipyretics—Antipyrine, Antifebrin, Phenacetin and other coal-tar products—are not to be depended upon. Quinine is also seldom admissible, though sometimes in the case of children it may be employed as an adjunct to other treatment, in order to prevent the temperature rising again after it has been reduced to safe limits.
The only reliable and safe method of reducing the excessive fever temperature is by abstracting the heat by means of the application of cold air or cold water to the surface of the body. The cold air plan is much less satisfactory than the hydropathic method, but occasionally in the case of children it may be employed with benefit by placing a large cradle under a sheet over the patient's naked body as he lies in bed upon a firm mattress, with a number of ice-bags suspended from the roof of the cradle.
The speediest and most efficacious of all methods, and the one which is the best suited for such conditions as acute rheumatism and sunstroke, where all movement of the patient's body is undesirable, consists in " cold effusion," when the temperature rises to 1(36° F. This is carried out with the patient lying upon a large mackintosh placed over the mattress; a single sheet being spread over his naked body, the sheet is kept wetted by a copious stream of cold water poured from a jug or watering-pot with a perforated outlet. By elevating the head of the bed and manipulating the edges of the mackintosh the superfluous water is made to flow into any convenient receptacle placed upon the floor. If the temperature of the water employed at the beginning of the affusion be about 70° to 8o° F. all feeling of shock is obviated, and cold water
(4o° to 50° F.) will then cease to be unpleasant. As soon as the rectal temperature falls below roe F. the sheet and mackintosh are to be removed, and replaced by blankets after the surface of the body has been rapidly dried.
The " cold or wet pack " is applied in a somewhat similar manner as the patient lies upon a mattress and blanket with a mackintosh placed between. A sheet wrung out of water at about 6o° F. is wrapped around him, leaving only the head and feet free. By replacing the sheet fre quently with a fresh one wrung out of cold water any desired antipyretic effect can be obtained.
The " cold bath " is used in hospital where a portable appliance and skilled attendants are always at hand. The bath being wheeled along side the patient's bed, he is lifted carefully out upon a sheet by two or three nurses, and the sheet is lowered into the water as he lies upon it. The temperature of the water at first should not be below to go° F., but after a few minutes it is gradually reduced to 65° or 7o° by the addi tion of cold water or crushed ice, and the immersion is continued till the rectal or mouth temperature falls to ioi°, which usually occurs in about 20 minutes. A further fall to normal or below it usually takes place after the patient has been lifted out of the bath and placed in his bed.
" Cold sponging " is not to be relied upon for the reduction of hyper pyretic temperatures unless carried out by heroic methods simulating cold affusion, but it is a valuable plan of controlling the fever heat after this has been first reduced by the bath, wet pack or cold affusion. In the case of children thorough cold sponging supplemented by gentle rubbing with large Pieces of ice will sometimes act as effectively as the cold bath.