Abstract
The main conclusions I would draw from the consideration of the whole subject of Hyperpyrexia in
Rheumatism are these:-
1. That the condition is more prone to occur in the
warmer months of the year and apparently with greater
frequency in certain years.
2. That while it is very difficult to estimate at
all accurately the frequency of its occurrence, pro¬
bably this is about .bf amongst adult cases of
Rheumatism.
3. That the occurrence of Hyperpyrexia in Rheumatism
is practically confined to cases of this disease in
persons over 14 years of age.
4. That the rare instances of hyperpyrexia which
occur under that age are in cases of Rheumatism which
present the adult type of the disease.
5. That the absence of Hyperpyrexia from Rheumatism
in children is probably to be explained as the result
of the type Rheumatism assumes in them rather than a
mere question of the age of the sufferer.
6. That males shew a much greater proclivity to the
condition than females, which may possibly be associated with the greater strain habitually put upon their
thermo-taxic mechanism.
7. That the condition is most apt to occur in "first
attacks" of Rheumatism.
8. That persons who have suffered from the condition
would probably be apt to have a recurrence of it in any
subsequent attack of the disease (although no case of
such recurrence has as yet been published).
9. That it may ensue at any stage in an attack of
Rheumatism, but probably the second week is the most
common period of its occurrence.
10. That it may arise in even mild cases of Rheumatism, severe rheumatic symptoms being essential to
its occurrence.
11. That the onset of Hyperpyrexia, while occasionally without warning, has usually premonitory symptoms
the chief of which is Delirium.
12. That cases of true Rheumatism shewing persistence
of the pyrexia in spite of full doses of the Salicyl
compounds should be most carefully watched since Hyper¬
pyrexia frequently ensues in such instances.
13. That sudden cessation of the articular pains
without coincident fall of temperature should lead to
the suspicion of Hyperpyrexia, especially if attended
also by the cessation of sweating.
14. That MacLagan's hypothesis"that Hyperpyrexia is
due to; paresis of the Heat -inhibiting mechanism from
exhaustion in its attempt to control the exeessiva
heat production of Rheumatism is the most feasible
theory yet put forward in explanation of the condition satisfactorily
accounting for the more frequent occurrence of Hyperpyrexia in Adults than in children.
15. That the absence of Rheumatic Hyperpyrexia in
children is a strong argument against the view that
this condition is due to visceral complications, since,
it is especially in children that these visceral manifestations occur and it is just in those cases that
Hyperpyrexia is not found.
16. That in view of the resemblance in several
respects between Rheumatic Hyperpyrexia and. "Diabetic
Coma", farther investigation of this subject might
possibly throw fresh light upon the pathogenesis of
both conditions.
17. That while the mortality of Rheumatism is only
about 3%, Hyperpyrexia is probably one of the most
important immediate causes of death in this disease.
18. That the mortality of Hyperpyretic cases is very
high - probably over 50^, but statistics are very
variable because -
19. The mortality is greater the higher the temperature before treatment is begun: and
20. It is also greater amongst cases treated by
means of antipyretic drugs alone.
21. That the treatment by the application of cold
in one of its various forms is the only justifiable
method in cases of Hyperpyrexia in Rheumatism.
22. That this should be adopted even in cases
apparently: moribund and even although visceral complications may be present.
23. That while there may possibly be some risk of
congestion of internal organs as a result of this
method of treatment, this does not justify the neglect
of what is practically the only remedy for an otherwise
fatal condition.
24. That the greatest care should be taken to prevent collapse ensuing in the patient as a result of
the treatment by cold which should be stopped entirely
before temperature falls to normal.
25. That antipyretic drugs, while practically useless in the treatment of Hyperpyrexia when present,
may perhaps be of some service in preventing a recurrence
of this after the temperature has once been reduced by means of cold.
26. That in obstinate cases of Recurrent Hyperpyrexia
the method of treatment by "Disintoxication of the
Blood" adopted by Barre may probably be of service
as an adjuvant to the treatment by means of cold.
27. That a greater attention should be paid to the
Prophylaxis of Rheumatic Hyperpyrexia,, and that more
prominence should be given to the advantage of commencing treatment by cold at an early stage before
excessive temperatures are attained; in other words,
the general condition of the patient rather than the
mere height of his temperature Should be the determining factor for commencing the treatment by cold.
28. That early and complete subjection of the patient
to Anti-rheumatic treatment would probably have some
influence in preventing the occurrence of Hyperpyrexia.
