HYPERPYREXIA IN SCARLET FEVER

J.Clay Beckitt
1893 The Lancet  
On Aug. 1st I saw a schoolboy aged eight. He was found to be suffering from a typical attack of simple scarlet fever. The rash was extremely well marked, the tonsils were red and swollen, with a few slightly enlarged glands in the neck, and the temperature was 101° F. On Aug. 4th the rash had disappeared, the throat was much improved, no ulceration having taken place, and perspiration was free. He asked for solid food and comic papers, which were refused. The temperature was ranging between 99°
more » ... ranging between 99° and 100°. The patient continued in practically the same condition for the following six days, his temperature often falling to normal. On the morning of Aug. 9th there was a decided change ; the temperature rose to 103°, there being a dry skin, thirst and constipation. An aperient was administered and after a fair motion the temperature fell to 101'2°. The next morning, however, it was again 1034°, but the patient said that he was quite comfortable and wished to sit up. His urine was examined with a negative result. Aconite was administered every hour, and by 10 P. M. his temperature was 105°, the pulse was 120, strong and regular, and the respiration was 26. His chest was carefully examined, but nothing unusual was elicited. Eight grains of antipyrin were administered and he had some hot baths, but the temperature steadily rose, till at5A.M. it was 107°. Antipyrin (ten grains) was again given and was repeated in an hour. Now for the first time the patient said he felt ill, and hyperæsthesia was present. He had neither pain nor any affection of the joints to indicate rheumatism and there had been no rigors or spasms. The temperature continued to rise and at 7 A.M. it was 115°. The thermometer was checked by two others which registered the same. The patient now became unconscious and died half an hour later from asphyxia. Hyperpyrexia sometimes follows infectious diseases, especially scarlet fever, as the result of nervous exhaustion, when the temperature has been maintained at a high level for a considerable time ; but after a case which was so short and so mild as the present one it must be rare and some other explanation must be looked for to account for the result. I am, Sirs, yours truly, J. CLAY BECKITT, M. R. C. S. Eng., L. R. C. P. Lond. Queen-street, Wigan, Aug. 21st, 1893. J. CLAY BECKITT, M.R.C.S.Eng., L.R.C.P. Lond. DEATH UNDER CHLOROFORM. I am, Sirs, yours faithfully, JOHN BRAITHWAITE, House Surgeon. To the Editors of THE LANCET. SIRS,-A strong, healthy girl aged twenty-one was admitted into the Royal Infirmary, Newcastle-on-Tyne, on July 25th, suffering from a small bony growth of the septum nasi. It interfered with her breathing, so she was anxious to have it removed. On Aug. 9th chloroform was administered by one of the house surgeons. It was given on a single piece of lint from a drop bottle. On auscultation the heart sounds were found to be normal. She did not take it well, repeatedly holding her breath. Once or twice during the operation she partly came out of the chloroform owing to the difficulty of administration, the operator being in the chloroformist's way. She vomited once. The operation lasted twenty minutes, at the end of which her breathing became stertorous and her face cyanosed. Her radial artery was felt, but there was no pulsation. The mouth was opened and the tongue pulled out with forceps. Artificial respiration was resorted to, ether was injected, the sphincter ani was dilated, the legs were raised, the interrupted current was applied, the throat was swabbed out with brandy, amyl nitrite was held to the mouth, tracheotomy was performed as the air did not seem to be entering the chest well, oxygen was administered by the tube and, lastly, the heart was punctured by a needle, to which the battery was applied. These remedies were continued for over an hour without any response from the patient. The pupils did not begin to dilate until half an hour after the operation was finished. A little over half an ounce of chloroform was given. A post-mortem examination was not allowed. "CHLOROBROM IN SEA-SICKNESS." To the -Editors of THE LANCET. SIRs,-Does it not come to be nearly as crude to vaunt chlorobrom for sea-sickness as to urge the beggar to wear boots to prevent sore feet ? Of course chlorobrom is good for sea-sickness ; so are bromide of potassium, chloral, bismuth and opium in their way. My experience of sea-sickness is. that nothing in particular can be a specific ; rarely should two cases be treated alike. I have treated a good many cases and I know of no other affection that requires a finer adjustment of drugs. Sea-sickness is the very last diseaseregarding which one can afford to be empirical in treatment.. Inasmuch as sea-sickness is in most instances chiefly cerebral, chlorobrom, chloral or potassium bromide generally do some. good. Cases that are cerebral and stomachic will be benefited by these drugs also, but better still by a combination to meet the conditions of both regions. To be severely empirical in theraupeutics is to run very near quackery. " What is one man's medicine is another man's poison " is only another w ay of expressing the fact that no two cases of any disease are alike and idiosyncrasy stands ever ready to adulterateconditions fashioning similitude. I shall never forget thewords of one great master of my student's days, " Learn to make your own prescriptions and never write two alike." I am, Sirs, yo-urs trulv, HAYDN BROWN, Surgeon, Hôpital de St. Pierre Port, Guernsey. THE PONTYPRIDD RAILWAY ACCIDENT. To the Editors of THE LANCET. SIRS, -I have at present under my care a gentleman who was. unfortunately one of those who were injured in the recent Taff' Vale railway accident. He was removed with several others to the Cardiff Infirmary, and I must say that the account hegives of his sojourn there has caused me no small amount of surprise. He was admitted between 5 and 6 P. M. on Saturday, Aug. 12th, and he remained in the institution until about 2 o'clock on the following day. During the whole of this. time he assures me that, with the exception of a very small quantity of milk, which was given to him from a bottle, and some water, he was not supplied with anything in the. shape of food or drink, neither did he have any medicine or stimulant, although he was suffering much from shock and loss of blood. On Sunday morning the ordinary patients in the ward had substantial breakfasts brought to. them, but for some unaccountable reason the requirements of the "accident cases" were completely ignored. To use thegentleman's own expression, he "felt he would have given anything for a cup of tea." " A fellow suffererin the next bed to his complained bitterly of hunger, he having had nothing to. eat since the previous morning. My patient left the infirmary at his own request and soon had his creature comforts attended to by friends and sympathisers. Now, Sires, surely this 'was. a great oversight, and after making all due allowance for an overworked staff and the hurry and bustle consequent upon the simultaneous arrival of so many urgent cases I still think that some explanation of this rather unusual treatment is due. It is only fair to the gentleman in question to say that he did not tell me the foregoing story of his. troubles by way of complaint. On the contrary, he is rather. disposed to excuse the inattention he received on the ground that "the nurses were all so busy. " In fact, he related his. experiences "more in sorrow than in anger." I am, Sirs, yours truly, SIRS—A letter under the above heading in your last week's issue signed "The Surgeon," and describing his experience, has so strong a resemblance to the experience of the managers. of a friendly societies medical association in the county town of -, as, I think, to merit insertion in your journal. From "The Surgeon's" letter it would appear that he accepted the post for what he calls-of course, in derision—"themunificent sum of ;E150 " a year. He also says he was allowed .f:15 for cab hire, and there does not from "The' Surgeon's " letter appear to have been any other payment orequivalent. Surely any medical man must have been in dire straits to have accepted such an appointment. In our case we gave E150 salary, residence rent free and taxes paid, and the responsibility of repairs, as good as E50 altogether ;. all the confinement fees ; paid cab fare bill (£15 16s.) for the whole of the year 1892 ; and in addition paid .f:9 for medical attendance during the medical officer's holiday. At the end of the year we were indebted to the treasurer £4 1s. M-
doi:10.1016/s0140-6736(00)59656-1 fatcat:647ourrp7rd2pj6rcjrje5v2ty