NOTES ON CERTAIN CASES OF

HYPERPYREXIA.

<f1u By C. DUER, M.B., F.R.C.S., CAPTAIN, I.M.S.

Junior Civil Surgeon, Rangoon.

(Continued from page 360.)

The first point to which I desire to draw attention is the diagnosis of these cases of sudden death from hyperpyrexia. Many are, I believe, returned as sunstroke, heat apoplexy or siriasis. For myself I may say at once that

during seven and a half years spent in many parts, and some of the hottest of Bengal Presi- dency, in Assam and Burma, on the line of march and in camp, I have never seen a case of siriasis. Other officers in the Medical Services have told me the same thing. I consider these cases to be due to malaria: unfortunately I have no evidence Irom the. plasmodium point of view to offer.

Typical cases of ague, in which the temperature rises to 105,? are not uncommon, and it is difficult to understand why it should not at times reach a higher and dangerous point. How often also

in malarial fever is the shivering of ague re-

presented by merely a passing chilliness, a slight chilliness down the spine, or not at all. I am

not aware that the cases of hyperpyrexia under discussion occur in non-malarious localities. Within recent years, during exceptionally hot weather in England and especially in London,

one has read of a good many deaths from sun-

stroke. In these I am informed that so far from the temperature being high, it was subnormal. We must remember that fatigue, and exposure

to a hot sun, which has undoubtedly a markedly depressing effect, are very likely to bring on an attack of malarial fever in malarious localities; and it is just these cases that are likely to be diagnosed as sunstroke. With regard to recog- nising the condition of hyperpyrexia it must be remembered that perhaps the commonest cause of unconsciousness that we in India and Burma have to deal with is hyperpyrexia, and therefore if called to a case of unconsciousness, the first thing to do is to take the temperature ; and the only reliable way is by placing the thermometer in the rectum. The axillary tem- perature is quite unreliable in these and all other cases. The temperature of a child should always be taken in the rectum ; that of older persons, if conscious, in the mouth ; and if unconscious, in the rectum.

Again, should we find a fever patient ap- parently sleeping heavily and snoring loudly, we must not forget the possibility of his being really unconscious from hyperpyrexia. In con- clusion I will mention a few more illustrative cases.

A Subaltern in the Sappers, whom I had treated several times for slight fever, sent for me one very hot afternoon. His temperature was IOC'S0; and he was somewhat delirious Spong- ing with ice cold water failed to bring down the temperature materially, and while this was being carried on he had an involuntary loose foetid evacuation of the bowels. (This I may mention is not an unfrequent occurrence in these cases of high fever.) He was then placed in a cold

bath, and the temperature soon began to fall. Next day he was practically well and had no' return of his fever.

A strong middle-aged Pathan, on the day of his discharge from the Dera Ismail Khan Jail, was seized with fever, the temperature rising to 108? at about 6 P.M. He was placed out of doors on a charpoy and deluged with cold water. He soon recovered consciousness and walked off, apparently quite well the next morning. I see no reason for considering this a case of siriasis. The man was exposed to no exceptional condi- tions. No doubt a high external temperature favours a high rise of temperature in malarial fever. Some four years ago a very well known

officer in the Punjab Frontier Force, a man of excellent physique, and a great sportsman, who had been accustomed to any amount of

exposure to the sun and heat of the Punjab Frontier for over ten years, got fever one day, and died with a very high temperature the same evening. His death was, I believe, returned as due to heat apoplexy, but this to my mind is difficult to accept as the correct cause.