COOLING PATIENTS— LEWIS, RING and ALDEN 399 



So much for the clear-cut acconiplisliiiuMit of the techiiicjue — abohshing- the fever. 

 Much more important, of course, would be establishment of the treatment's merit 

 in helping the patient to recover. But since this, like too many clinical projects, was 

 not a controlled experiment, we cannot be certain and must for the present fall 

 back on clinical impressions. We do have the impression, if not the conviction, that 

 many of the patients were benefited and the treatment was not obviously detri- 

 mental to any of them. The temperature reduction seemed to help all of the sur- 

 vivors and for a few it may have had critical value. Moreover, the temperature 

 drop appeared to benefit, temporarily, about half of the patients that died. When 

 the drop in temperature was beneficial, the exhausting effect of a fast respiratory 

 rate, a racing pulse, and purposeless muscular activity was overcome and the pa- 

 tient would then appear to rest quietly. 



W e plan to contiinie using this techni(|ue of surface cooling. Init now in a con- 

 trolled clinical experiment. Perhaps in this wa\- we will be able to make a more 

 objective analysis. 



Summary. L The paper describes a technique for reducing the l)ody temi)erature 

 of seriously ill patients with high fevers. The patient lies on a large cooling blanket 

 while chlorpromazine and phenobarbital sodium provide enough sedation to prevent 

 shivering. 



2. Thirteen of 25 patients treated, all with fevers over 103° F., survived. 



3. The survivors all appeared to have been benefited and one-half of those who 

 died may have been temporarily helped by the treatment. 



REFERENCES 



1. Dundee, J. W., Scott, W. E. B., and Mesham. P. R. : The production of livpotiiermia, P.rit. 



Med. J. 2: 1244-1246, 1953. 



2. Laborit, H., and Huguenard. P. : L'hibernation artificielle par moyens pharmacodynamiques 



et physiques en chirurgie, J. chir., Paris 67: 631-64, 1951. 



3. Lewis, F. J., and Taufic, M. : Closure of atrial septal defects with the aid of hypothermia : 



Experimental accomplishments and the report of.one successful case, Surg. 33: 52-59, 1953. 



4. Lewis, F. J., Taufic, M., Varco, R. L., and Niazi, S. : The surgical anatomy of atrial septal 



defects. Experiences with repair under direct vision, Ann. Surg. 142: 401^07, 1955. 



5. Shackman, R., Wood-Smith, F. G., Graber, I. G., Melrose, D. G., and Lynn, R. B. : The 



"lytic cocktail": Observations on surgical patients. Lancet 2.- 617-620, 1954. 



DISCUSSION 



Dr. IV. J. Kolff: Our experiences tend to confirm those of Dr. Lewis although 

 our results are less favorable due to selection of more seriously ill patients. 



In simple refrigeration, the patient is anesthetized and subsequentlv cooled. The 

 defense reactions of the body set in, and oxygen consumption is increased, at least 

 in the beginning. 



Conversely, in artificial hibernation, the patient is given a combination of drugs 

 intended to dampen certain parts of the central and the autonomic nervous sys- 

 tems.^- - The blocking is said to take place at the levels of cortex, midbrain, ganglia, 

 and nerve endings. 



The most important drugs used in artificial hibernation are derivatives of pheno- 

 thiazine : Phenergan, Dijjarcol, and chlorpromazine. Phenergan, Diparcol, and 



