PROGNOSIS— TREA TMENT 



1457 



prognosis is, ilierefore, always serious, and becomes worse if cyanosis 

 or convulsions appear. In the Chicago outbreak 68 out of 158 died, 

 and 58 of these never recovered consciousness. 



It is too early at present to say how far lumbar puncture will aid 

 the prognosis. 



Treatment. — Loosen the clothing at once, and remove the patient 

 to as cool a place as can be found and take off his clothes, and, if 

 possible, lay him on a bed covered with a large indiarubber sheet, 

 or put him in a bath (care being taken to keep the head supported 

 by some mechanical means, so that it cannot slip down into the 

 water), and apply an ice-bag to the head, while pieces of ice arerubbed 

 over the body, and at the same time cold sponging is carried on. 

 The cold douche may also be applied with markedly beneficial 

 effect. Also large enemata of iced water may be given. 



While this is being done, vigorous friction should be applied to 

 the parts which have been rubbed with ice, in order to promote 

 circulation in the cooled skin. 



If there is no ice, wring out a sheet in as cold water as can be 

 found, and allow water to drip on the patient all over. 

 ' In places where no cold water is available, the ordinary water 

 can be chilled by dissolving a fair quantity of salt in a bath of water, 

 squeezing the juice of some limes into this, and then adding a quantity 

 of vinegar and a little eau-de-Cologne, and sponging the patient 

 with this mixture. 



The danger in cold sponging is collapse; consequently the rectal 

 temperature milst be carefully taken every few minutes, and when it 

 falls in the rectum to about 10 1 -6° F. sponging must be stopped, the 

 patient covered up with blankets, put to bed, and must be most 

 carefully watched. 



If the temperature comes down with a run and collapse sets in, the 

 cold applications should be stopped, and treatment must be applied 

 as described under heat syncope (p. 1459). The patient must in 

 any case be carefully watched, and ice, cold sponging, or both, must 

 be resorted to again and again till the temperature remains down. 



While these immediate remedies are being applied preparations 

 may be made for lumbar puncture a^nd the removal of a quantity 

 of cerebro-spinal fluid. If the fever is not reduced by this treatment , 

 and the pulse is bounding, the body cyanosed, and the heart's 

 action embarrassed, the median basilic vein may be opened and 

 the patient freely bled; but if little or no blood comes, then an 

 intravenous injection of a pint of normal saline at 98-6° F. (37° C.) 

 may be run in. Cardiac stimulants such as caffein, digitalis, and 

 strophanthus must be employed to keep up the heart's action. 

 ^ Antipyretics are useless, as is also quinine, for this fever. 



If the breathing stops, it is advisable to try artificial respiration 

 for half an hour, or, according to some observers, for several hours, 

 as sometimes good results have ensued. If the heart begins to fail, 

 hypodermics of strychnine, provided there are no convulsive 

 symptoms, digitalin, or adrenalin, may be given. If convulsions 



92 



