RIGOR.
The main treatment must obviously be that indicated for the primary disease, but during and immediately after the prolonged shivering fit certain symptomatic treatment should be resorted to independent of that of the malady causing the rigor.
Following up the natural instinct of the patient, who generally has a marked desire to get as near to any convenient source of heat as possible, the physician should insist that lie take immediately to his bed, where lie may be surrounded by dry warm blankets, hot-water bottles and excess of clothing. Stimulants may be freely given. One full dose of Brandy or Whiskey should be administered as soon as possible. It is advisable to give this with sonic very hot water and a little sugar. When the heat has been brought to the surface of the body the excessive clothing may be gradually removed. As a rule it is not advisable to resort to cold sponging during the hot stage, as this may bring on another rigor. In the sweating stage much relief may be obtained by dry sponging of the entire cutaneous surface.
Nitrite of Amyl and Chloroform sometimes cut short the attack; but, upon the whole, it is advisable to maintain a position of neutrality, and await further symptoms. Quinine often prevents or modifies the severity
of recurring attacks; but, owing to its slowness of action, it has no effect whatever upon the rigor if administered during its presence. It is of most value in the rigors of prxmia. The newer antipyretics do not give any more satisfactory results. The old-fashioned plan of giving a speedy emetic at the very outset, when this is feasible, sometimes appears to modify the severity and duration of the rigors which usher in acute inflammatory or zymotic affections. When there is much constitutional excitement or apprehension on the part of the patient, a hypodermic injection of Morphia often is of great benefit. It should, however, be used with caution if renal disease is marked. In the rigors following the use of the catheter, if given immediately after the first feeling of chilliness, the rigor may be prevented, but the patient should instantly be wrapped up in warm blankets.
RINGWORM—see Tinea.