A STUDY OP FEVER. 7 



Hospital, mj attention was instantly attracted by the expression 

 upon the face of a patient. He was a young, temperate Irish- 

 man, twenty years of age, and of a vigorous physique, who had 

 passed through a severe attack of inflammatory rheumatism 

 without cardiac complications, and was suffering from a re- 

 lapse, which first appeared as a subacute inflammation of the 

 knee. I had not seen the man the previous da3', but I find in 

 the note-book of Dr. Bruen, my interne, the following: — 



" Second day of relapse. This morning an acute inflammation of the 

 wrist-joints has set in ; tlie fever is very high ; temperature in the axilla 

 104° Fahr. ; ordered potassii bicarb, gr. xx every two hours." 



As we walked to the bed, in reply to a question, " What ails 

 our rheumatism patient?" Dr. Bruen said, " Nothing, unless it 

 be pericarditis. When I saw him at 10.30 A. M. there was 

 much less inflammation of the joints than the preceding morn- 

 ing, and although his temperature was as it had been, 104° 

 Fahr., and, as I thought, a pericardial friction-sound could be 

 heard, jet the man was doing fairly ; perfectly rational, with 

 a good pulse." It was now about half-past twelve, and our 

 l^atient was apparently dying. The pulse was between 160 

 and no, exceedingly feeble and thready; the pupils strongly 

 contracted, though not to pin-points ; the respirations fifteen 

 per minute, exceedingly irregular, mostly deep, jerking, and 

 interrupted; the skin pale and dr3''; the consciousness com- 

 pletely lost, violent shaking and shouting in the ear only 

 eliciting a few grunts; the temperature in the axilla 108|° 

 Fahr. ; the wrists pale, and no signs of pain elicited by vio- 

 lentl}^ moving them. On ausculting the heart I could find no 

 murmur; the first sound was very feeble, somewhat prolonged, 

 and the second sharply accentuated. 



Coming to the conclusion that our patient was dying of 

 heat/ we determined to cool him at all hazards, and, as the 

 surest and most rapid means, to employ the cold bath. 



The followins: is the record made at the time : — 



