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Hyperpyrexia in rheumatism: considered chiefly from a clinical standpoint

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LangwillHG_1898redux.pdf (22.28Mb)
Date
1898
Author
Langwill, Hamilton Graham
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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.
 
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http://hdl.handle.net/1842/34943
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