436
Low diet, milk and soda water was ordered; his temperature rose that evening to 105.6° F. the medicine was continued every four hours, during the night profuse perspiration set in and the next morning (the 6th) at 6 A.M. his temperature had fallen to 98.4°, a five grain dose of quinine was then administered, at 9 A.M. his temperature was 98.5°, ten grains of quinine were now ordered every two hours and his temperature that day rose only to 99° F. (8 P.M.)
The next morning his temperature rose to 99.6° F., and in the evening at 8 P.M. was 101° F. The quinine was now discontinued and the aconite mixture given every four hours, the next morning the temperature fell to 99° F. the quinine was again given every two hours in 10 grain doses that evening the temperature rose to 100° F., the next morning (8th), it was down to 97.8° the quinine was given as before, a mutton chop was ordered and the highest temperature recorded that day was 98.5° F., the following day it was normal and as the patient felt quite well, at his own request he was discharged from the Hospital.
Temperature Chart (No. 1), appended.
This patient was re-admitted on August 28th, at 7.50 A.M. with a temperature of 105° F., he said he had been well since his discharge from the Hospital until the previous day when the fever came on again. The following prescription was ordered as his skin was very dry:-
Re Antipyrin,
Tr. Jaborandi, Mixt. Diaphoret ad,
.grs, xv. .mxxx.
.zi.
2 horis sdm.
with low diet, milk and soda water, 8 P.M. his temperature had fallen to 101.6°, 12 midnight temperature 102°; 29th August, 6.30 A.M. temperature 102.8°, as his bowels had not been opened for the previous 24 hours, the following powder was ordered:-
Re Calomel,
Quinine, ....
Pulv, Rhei Co. ad,.
gr. iv. ..gr. v.
grs, xv.
st. sdm. medicine as before,
midday temperature 105° F., 2.15 P.M. temperature 106.2° patient now vomited everything, so the medicine was discontinued; at 3 P.M. his temperature was 108° F., and at 3.45 P.M. it had risen to 108.2°.
As patient was now comatose and skin very dry, ice-packing was at once commenced he being placed on a mackintosh sheet covered with a sheet dipped in ice-cold water which was changed every few minutes and ice-packed all over his body, at 4.15 his temperature had fallen to 104.2°, 20 minims of the acid hydrobromate solution of quinine (1 in 6) was now injected hypodermically, ice-packing being continued, for the next few hours his temperature was as follows:-
4.50 P.M.....
5.15 P.M....
5.45 P.M.,..**** 6:30 P.M.,
..103° F.
.102° F.
.100° F.
99° F.
The ice-packing was now discontinued and as he was slightly collapsed, hot water bottles were applied and brandy administered internally. At 6.45 P.M. his temperature was 98.2°. Ten grains of quinine were now ordered every two hours which was retained, at 9 P.M. temperature 101.4°, 30th, 6.45 A.M. temperature 101.6°; 9 A.M. temperature 102.4°:--
Re Antipyrin, Aq. ad,
Zi.
XV.
2 horis sdın.
That evening it rose to 102.8° and fell during the night to 100.8°. 31st, temperature in morning 102.6° and 8 P.M. 103° F., during the night it fell to 100°. Grains viii of quinine were now given every 2 hours in place of the antipyrin, as temperature rose next morning, (1st September), to 103° the antipyrin was substituted that evening temperature fell to 101° F. and registered 100.4°, at 8. A.M. on the 2nd, only rising to 101.4° this day, two doses of antipyrin were given, and it again fell. One pint of chicken broth was now added to his diet.
The after course of the case will be seen from the Chart (No. 2,) by the 10th the temperature had fallen to normal, and fish diet was now given, it took the patient some time to regain his strength.
On the 12th, full diet and the following medicine was prescribed :-
Re Eastonii Syrupi,
Aq. ad,...
He was discharged cured on the 20th September.
REMARKS.
3ss.
.3i. tdsdm.
The first attack was evidently one of intermittent fever, the second being of the remittent type. In these severe cases I an firmly of opinion that the only way to combat the fever is by the application of external cold and administering quinine hypodermically as soon as the temperature falls, it being useless to give it by the mouth as the stomach will not retain anything.