Sessional_Paper_1892 — Page 438

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Appendix C.

CASE OF REMITTENT FEVER; HIGH TEMPERATURE; RECOVERY.

JAMES L.-

Et. 35.

Admitted to the Hospital 18th June, 1890, at 8.30 a.m.

On admission patient stated the fever had commenced the day previous (17th instant,) about 10 A.M.; from his account the attack was a typically 'aguish' one. His temperature, on admission, was 99° F.; he was placed on low diet with two pints of milk daily; soda and ice, and was ordered ten grains of quinine every half hour. Notwithstanding this, his temperature gradually rose, and, at 6.20 P.M., registered 103.4° F.; two minims of tincture of aconite were now ordered every ten minutes; at 8.40 P.M. his temperature had risen to 104° F., and thirty grains of antipyrin were given; at 10.10 P.M. his temperature bad fallen to 102.8° F., and ten more grains of antipyrin were now ordered, but as this made him vomit, the aconite was recommenced; at 12 midnight his temperature was 105° F., thirty grains of antipyrin were again given and this brought his temperature down to 103° in half an hour.

The aconite was continued during the night when he was awake.

19th instant, 7 A.M. temperature 103.6° F.; as the temperature at 10 A.M. was still 103° F., twenty grains of antipyrin were given; 11.30 A.M. temperature 105.4° F., the patient was now placed in a bath, temperature of water being 96° F.; he was kept in for an hour, the temperature of the water in the meantime being reduced to 80° F.; at 12.30 P.M. his temperature was 102.2° F., and at 12.40 P.M. 100.8°; he was kept in the bath until 1 P.M., by which time his temperature had fallen to 98.6° F. After being taken out of the bath he slept for an hour. At 2 P.M., ten grains of quinine were given hypodermically; he now slept until 3.40 P.M. when his temperature was found to be 101° F., as his skin was now dry, the following mixture was ordered :—

Re Tr. Aconiti

Mixt. Diaphoretic Aquam ad

.m. ii. .3ii. .3ss.

To be given every 15 minutes, notwithstanding this his temperature gradually rose as will be seen from the following observations :—

4.30 P.M.

6.00 P.M.

7,00 P.M.

8.00 P.M.

9.00 P.M.

9.40 P.M.

10.25 P.M.

11.00 P.M.

.102° F.

103° F.

104° F.

.105.6° F.

.105.6° F.

...106°

F.

107° F. ....108° F.

As the patient was now delirious he was ice-packed; at 11.54 P.M. his temperature had fallen to 105° F. and he became sensible and was conscious of what was transpiring around him.

The ice-packing was continued, and at 12.15 A.M. his temperature had fallen to 101°-sixty minims of the hypodermic solution of the acid hydrobromate of quinine (10 grains) were now injected and at 12.30 A.M. his temperature had fallen to 99.8°; the ice-packing was now discontinued and he was replaced in bed and 10 grains more of the acid hydrobromate of quinine were injected. At 1.15 A.M. his temparature was 99° F., and another ten grains of the quinine were injected. He now slept for a few hours and; as on awaking at 4.30 A.M. his temperature was found to be 101.8° and skin dry, the aconite and diaphoretic mixture was now given every half hour; profuse perspiration set in, but his temperature, however, rose slightly and at 5.30 A.M. was 102.4°.

Distressing vomiting now commenced and at 6 A.M. a mustard plaster was applied to the epigastrium; this controlled the vomiting, but the temperature still continued to rise, and at 7.30 A.M. was 104°. Wet sheets were now applied, the aconite still being given; at 9.20 A.M. his temperature was 103.6°, and at 10.30 A.M. 102.8°, by 1.30 P.M., it had fallen to 101° when sixty minims of the hypodermic solution of the acid hydrobromate of quinine were injected. At 4 P.M. his temperature was 100.6°; at 5.30 P.M. another ten grains were injected, the wet-sheet still being applied, at 7.15 P.M. his temperature was 101° F., and at 10.30 P.M., it having fallen to 99° F., ten grains more of the quinine were injected.

He now slept until 2 A.M. (21st) when his temperature was 100° F., and the wet-sheet was continued; he slept on and off during the night, at 5.40 A.M. his temperature being 100° F. His temperature this day did not rise above 101.2 (6 P.M.); at 11.30 A.M. 10 grains of the acid hydrobro- mate of quinine were injected and a similar injection was given at 10 P.M.

22nd instant: This morning his temperature fell to 99.6° (7.5 A.M.) and five grains of quinine in the form of a pill was now ordered to be given every hour. As at 3 P.M. his temperature had risen to 102.4° this was discontinued and the aconite mixture substituted. At 8 P.M. his temperature had