"HYPERPYREXIA OP ENTERIC FEVER.' To the Editor
of
the
"
Indian Medical Gazette."
read in the Indian Medical Gazette of August 1st the record of a case of the above treated bj quinine, will you allow me to give, through the medium of your columns, the result of my experience of the same. Some years ago, while a student in England. I had the opportunity of testing the value of the different methods of reducing the temperature of enteric fever, as that fever was then very prevalent. Of all the methods used that of quinine by the mouth seemed most beneficial. It was given in gr. x doses every quarter hour for 4 doses, the temperature falling in 7 or 8 hours as much as 5 degrees or more, keeping down for 10 This return of the high or 12 hours and then rising again. temperature always took place after any of the methods, but the temperature fell more gradually and was slower to rise again after quinine than after any of the other method*. Sphymographic tracings of the pulse taken soon after th? administration of quinine compared very favourably with those taken immediately before, the pulse always seemed to improve and the hyperdicrotous condition was oiteu -reduced
Sir,?Having
November 1,
CORRESPONDENCE.
1881.]
Quinine injected subcutaneously did a subdicrotous one. not appear to have sucli a powerful effect, but it was not injected in such large doses. Sponging the surface of the body and limbs with cold water and vinegar for 20 minutes at a time was another method given an extensive trial, but the temperature was always brought down too suddenly it remained down only a very short time, and rapidly rose to
again.
Iced coils were found to be too severe, causing rapid fall of temperature with collapse, followed quickly by a rapid rise again. Cold baths 7cooled down to 05? and used for 15 minutes was another method, and although a better method than the other two by cold, yet the action seemed Jo be too superficial, the temperature becoming rapidly high, again afterwards ; and if the baths were commenced with a temperature too low, or if they were cooled down too rapidly, collapse was sure to result. Quinine appeared to act by bringing the heat out, while the other methods of applying cold to the skin, in some measure at all events, seemed to act by forcing it in, and hence its rapid return. Salicylate of Soda, grs. x. every 10 minutes for 8 doses, was another drug which reduced the high temperature very well, but it very often caused a good deal of collapse. Quinine in these large doses always caused very profuse perspiration and abundant physiological symptoms ; the latter however soon passed off. No quinine could be detected in the urine. Salicylate of Soda also caused profuse perspiration, and was found in abundance in the urine. I may add that quinine was not found to act well if given in much smaller doses than the above, and the large doses were in some of the cases often repeated with benefit. I
remain,
Yours truly,
Cecil Henderson,
Acting Zillali Surgeon, Cuddalove.
319
of
the
"
Indian Medical Gazette."
read in the Indian Medical Gazette of August 1st the record of a case of the above treated bj quinine, will you allow me to give, through the medium of your columns, the result of my experience of the same. Some years ago, while a student in England. I had the opportunity of testing the value of the different methods of reducing the temperature of enteric fever, as that fever was then very prevalent. Of all the methods used that of quinine by the mouth seemed most beneficial. It was given in gr. x doses every quarter hour for 4 doses, the temperature falling in 7 or 8 hours as much as 5 degrees or more, keeping down for 10 This return of the high or 12 hours and then rising again. temperature always took place after any of the methods, but the temperature fell more gradually and was slower to rise again after quinine than after any of the other method*. Sphymographic tracings of the pulse taken soon after th? administration of quinine compared very favourably with those taken immediately before, the pulse always seemed to improve and the hyperdicrotous condition was oiteu -reduced
Sir,?Having
November 1,
CORRESPONDENCE.
1881.]
Quinine injected subcutaneously did a subdicrotous one. not appear to have sucli a powerful effect, but it was not injected in such large doses. Sponging the surface of the body and limbs with cold water and vinegar for 20 minutes at a time was another method given an extensive trial, but the temperature was always brought down too suddenly it remained down only a very short time, and rapidly rose to
again.
Iced coils were found to be too severe, causing rapid fall of temperature with collapse, followed quickly by a rapid rise again. Cold baths 7cooled down to 05? and used for 15 minutes was another method, and although a better method than the other two by cold, yet the action seemed Jo be too superficial, the temperature becoming rapidly high, again afterwards ; and if the baths were commenced with a temperature too low, or if they were cooled down too rapidly, collapse was sure to result. Quinine appeared to act by bringing the heat out, while the other methods of applying cold to the skin, in some measure at all events, seemed to act by forcing it in, and hence its rapid return. Salicylate of Soda, grs. x. every 10 minutes for 8 doses, was another drug which reduced the high temperature very well, but it very often caused a good deal of collapse. Quinine in these large doses always caused very profuse perspiration and abundant physiological symptoms ; the latter however soon passed off. No quinine could be detected in the urine. Salicylate of Soda also caused profuse perspiration, and was found in abundance in the urine. I may add that quinine was not found to act well if given in much smaller doses than the above, and the large doses were in some of the cases often repeated with benefit. I
remain,
Yours truly,
Cecil Henderson,
Acting Zillali Surgeon, Cuddalove.
319
