TREATMENT OF THE SERIOUSLY ILL, FEBRILE PATIENT 

 WITH SURFACE COOLING* 



F. JOHN LEWIS, DEAN M. RING and JOHN F. ALDEN 



This paper will describe an effective and relatively simple method for lowering 

 the body temperature of febrile, gravely ill patients. This idea is an ancient one, but 

 the technique is new. 



Though these patients have not been cooled to truly h}'pothermic temperature 

 levels, inclusion of this discussion in a Symposium of Hypothermia can be justified 

 in several ways. First of all, the metabolic changes that accompany cooling of a 

 feverish patient to normal or slightly subnormal temperature levels mimic those 

 attained when a normothermic individual is made moderately hypothermic. In both 

 cases the pulse and respiratory rates decrease as the general metabolic processes 

 slow down. These changes accompany a significant drop in temperature which has 

 been at least 7 or 8° F. in the feverish patient. In the matter of equipment, too, 

 cooling of the febrile patient is similar to the production of hypothermia in a 

 normothermic patient. We have used the same cooling apparatus in both situations. 

 Finally, introduction of this subject into a Symposium on Hypothermia provides 

 an opportunity to bring up the topic of "Artificial Hibernation." This treatment, 

 developed by Laborit and other French investigators,- suggests by its name that a 

 a profound hypothermia, like that of hibernating animals, is produced, while ac- 

 tually only a slight drop in temperature occurs. 



Laborit and the many other European authors who describe their use of "Arti- 

 ficial Hibernation" give a number of drugs mixed to make a "lytic cocktail" and 

 then add mild surface cooling. This system is used as an anesthetic technique, 

 primarily, and good results have been reported, but there has been little enthusiasm 

 for "Artificial Hibernation" in this country as yet. This may be due simply to diffi- 

 culties in communication, but there may also be an attitude of scepticism toward 

 the use of a mixture of drugs which, separately or in combination, do not actually 

 produce a state resembling true hibernation. The chief effects of these drugs may be 

 merely sedative and vasodilatory. 



Shackman^ has analyzed the action of the "lytic cocktail" and he reports that 

 these drugs do not produce a central effect on the temperature-controlling apparatus 

 but only a peripheral vasodilatation similar to that produced by other vasodilators. 

 This effect does not produce hypothermia in the unexposed patient. Another author 

 from the British Isles, Dundee,^ has in his animal experiments reached further in- 

 teresting conclusions concerning the drugs of tlie "lytic cocktail." Fie found that 

 deep anesthesia, curarization, or the "lytic cocktail" were equally effective in fa- 

 cilitating hypothermia and his data show, in addition, that chlorpromazine alone 

 was as effective as the mixture of drugs in aiding surface cooling. Influenced by 

 this work, we have used only chlorpromazine and one otiier sedative, phenobarbital 

 sodium, while cooling our feverish patients. 



* Supported in part by Research Grant H-1374 of the National Heart Institute of tlic National 

 Institutes of Health, Public Health Service. 



394 



