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From this date improvement was marked; only twice, viz., on the 28th and 29th, did the tempera- ture rise above 01° F, the pains in the joints gradually subsided and the patient was convalescent by the 4th May.
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Remarks.-I report this to show the efficacy of the wet pack even in the hyperpyrexia occurring in the course of rheumatic fever.
2. ENTERIC FEVER. PROFUSE HEMORRHAGE.
HIGH TEMPERATURE.
L. S., Male. Aged 32.
RECOVERY.
Admitted on 28th December, 1896, from the U. S. S. “Machias," complaining of general malaise for two weeks before admission with fever for the last 4 or 5 days.
His temperature on admission was 105° F and remained between 103° F and 105° F for the next five days, on the 2nd January a crop of roseola developed on the skin of the abdomen.
On the evening of the 5th January at 7.30 p.m. there was a profuse attack of haemorrhage from the bowel, quite three pints of blood coming away. grain of morphia and To grain Citrate of Ergo- tine were at once given hyperdermically; his temperature, which had been 104° in the morning, was now 99° F.
As at 12.20 p.m. that night there was a return of the haemorrhage the morphia and ergotine were repeated.
On the morning of the 6th another profuse attack occurred and was again checked with morphia and ergotine, the patient being kept perfectly still and taking nothing but ice and iced water.
On the 7th instant there was slight hematemesis.
The fever was of a continued type up to the 22nd instant when marked morning remissions oc- curred, that morning it was down to 101° F, the following morning it was 100.2°, and on the 24th it was 99° F; a rigor occurred this day at 12.30 p.m. and the temperature rapidly rose to 105°; ten grains of phenacetin were given when it fell to 103°; as it had risen to 106° F by 6.25 p.m. the wet sheet was applied and by midnight the temperature had fallen to 98°. From this date he began to improve, the temperature only once reaching 102°.
The convalescence was somewhat delayed, but he was eventually discharged cured on the 20th
March.
3. GANGRENOUS DYSENTERY.
RECOVERY.
A. D., Male. Aged 30.
Admitted to hospital on the 12th February with a history of fever for three days accompanied by diarrhea with dysenteric stools.
On admission his temperature was 101° F, that day the bowels were open twelve times, the stools containing blood and mucus; in the evening the temperature was 102.4° F.
He was placed on a strict milk diet and half drachm doses of Ipecacuanha powder were given twice daily.
At first this appeared to check the disease as on the 14th the bowels were moved but six times; four doses of the Ipecacuanha powder had by this time been given.
Salol and quinine were now substituted, and by the 17th instant the blood and mucus had all disappeared, but as there was still some tenesmus and the temperature remained up on the 18th, ipecacuanha was again administered, this time the powder sine emetin being given in doses of ten grains thrice daily as the ordinary powder had produced considerable nausea.
This was not so efficacious, accordingly on the 19th the pulv ipecac. ver. was given again, this being repeated in the evening and again the following morning; on this day a note was made "no blood, less tenesmus."
As on the 22nd the bowels had been open five times another powder was given.
On the 23rd instant a large slough of the mucus inembrane of the bowel quite 3 inches long by inch wide was passed; a boracic acid enema was at once given followed by an enema containing Pulv Ipecac. Ver. 3ii, Mucilag Acacia 3ss Aqua ad iii; the following day at 8 a.in. two more larger sloughs of the bowel were passed, an enema similar to the above being given and repeated in the evening.
On the 25th as the stools were very offensive two more enemata were given.
There was a small slough passed in the morning of the 27th; after this an enema of pulv ipecac. ver. 3ii was given.
From this date convalescence commenced and as the stools became more formed ipecacuanha was discontinued and pernitrate of iron given instead.
During the time the sloughs were coming away the patient was very low and his strength was maintained by champagne, small doses of brandy in his milk and Brand's Essence.
He recovered completely and up to the present has had no ill after-effects such as contraction of the bowel.
This case seems worthy of record as it is seldom that a case of gangrenons colitis like this
recovers.