^?' .

August, 1884.] COLD WATER TREATMENT OF FEVER. 215

ORIGINAL COMMUNICATIONS.

ON THE COLD WATER TREATMENT

OF FEVER.

By G. C. Roy, m.d., f.r.c.s., Lond.

It is now many years since the cold water method

of treating fever has come into vogue, but it has not

made any sensible progress in India, where the people still retain their prejudices against the use of cold

water, in febrile states of the body. Even cold

drinks are prohibited, and in an orthodox house the

physician has a poor chance of being called in a

second time if he dares defy the old established

principle. Hence in private practice one has very seldom

the opportunity of putting it to the test, and the ex-

perience gained in a mofussil hospital is eminently unsatisfactory, where the arrangements are imperfect and the patients refuse to be kept under observation.

Yet the cold water treatment in fever had been in use

amongst the native population, though in different

form, for a long time before it came to be tried by continental physicians. It was not an uncommon

thing amongst the ' kabirajes'to use lapc or plaster over the body in high fever. Or, in the last stage of

fever, to administer Bis Boree or the poisonous pill, and to counteract its heating tendency by allowing the body to be bathed in cold water. In all these

instances the medicines used with cold water took

the credit of the cure, whilst the latter, from its very

simple nature, was ignored. Much of the success of

treatment of some of the quacks consists in ordering daily plunge baths in a tank as a necessary adjunct to their treatment.

The rationale of the treatment, however, has not yet been worked out. The last discussion in the Medi- cal Society in London only shows how divergent is Medical opinion on the subject. Does it act by the

mechanical abstraction of heat and thus obviate or

counteract one of the dangerous incidents of febrile

state, or has it any effect on the nervous centres by Which it soothes the irritability, supplies tone and equalizes the circulation ? It is beyond dispute that

!t has no curative virtue, and the immediate rise of

temperature after a bath shows that at best it is a

palliative measure. If fever be due to the existence of a toxic germ or bacillus that sets up in the blood a process akin to fermentation, the cold bath has no

virtue to destroy or neutralise the poison or shorten

the duration of fever, though it may temporarily reduce the paroxysmal heat. One thing, however, is certain, that it is most re-.

freshing and grateful to the patient. It is nearly five years since I have adopted it in my practice, and

can speak of it in unmeasured terms of commend-

ation from experience gained in hospital and private practice.- - Notwithstanding the vaunted discovery of the frequency of typhoid fever in India, I have the humiliating confession to make, that I have not

met with more than half a dozen cases the symp-

toms of which simulated or approached that condi-

tion, and I am yet doubtful as to the propriety of

placing them under that category. My remarks,

therefore, should be-taken to refer more to malarious

fever of India.

The external application of cold may be either

partial or general, as when cold is applied to the

head to relieve heaviness or congestion, or when the whole body is enveloped in a wet sheet or immersed

in water. The local, by its continued abstraction of

heat, has ultimately a general cooling effect on the

wholecirculati.il. The tinkering method of apply-

ing a wet cloth over the forehead is too limited an

application to have any constitutional effect. The,

whole head ought to be shaved and wetted as well

as the face. In low fevers, with a tendency to conges- tion of thoracic or abdominal organs, or where from

weakness a general immersion of the body is not

desirable, this is the safest refrigerating method.

Where ice is not procurable, fanning the surface or

flapping the face with a wet cloth has a powerful effect. Application of cold to the eyes is most

refreshing and agreeable, and who has not experi- enced the relief of washing the face with cold water after a hot journey ? The general application of cold consists in tepid and cold sponging, tepid and cold pack, and tepid and cold bath. It will seem

an inconsistency to include tepid sponging in the

category of cold applications ; yet when we bear in

mind that tepid water at io'o? applied over a surface heated to 103? or 104? will have the effect of abstract-

ing heat from that surface, the apparent inconsistency ceases. Besides tepid water applied over the body soon cools down by evaporation, and with it brings down the heat. When, therefore, it is thought desir- able to avoid the sudden depressing effect of chill the same effect of refrigeration is obtained by using water just above the normal temperature of the body

216 THE INDIAN MEDICAL GAZETTE. [August, 1884.

as when cold water is used. But when, with a

temperature above 105? or 106?, we find danger imminent, the sooner the heat is abstracted by cold affusion or sponging, the better for the safety of

the patient. In cases of insolation with dry pungency of the skin, or in intermittent fevers

where the temperature at once runs up to 105?, this is a very powerful and effective mode of treatment.

In the latter the heat is not persistent, and it is not many hours before it as rapidly declines. In the

general run of cases, therefore, cold application be- comes unnecessary, yet there are instances where the

patient feels, as it were, overwhelmed with heat. He

is restless, and tosses about in bed, or moans from the intensity of suffering. If the temperature indicate

105?, and at the same time the skin be dry and pun- gent, the cold application should be no longer deferred. I was induced to try it first in the case of my wife, who was restless from the burning heat of an attack of intermittent fever. In half an hour the temper- ature was reduced almost to a normal point, and the conflagration was literally extinguished. I have tried

it since in many cases with equally satisfactory re-

sult. My method of application is as follow :? I wet a soft towel in cold water, and having drained

off the excess of water, first sponge one arm and as

rapidly wipe it with a dry towel, then the other, then the front of the chest and sides and dry them also, then the back, and so on repeat the process rapidly one after another for half an hour till I find permanent reduc- tion of temperature. In this process of rapid spong- ing and drying, if done with the precaution of

avoiding exposure to draught, no bad consequence need be apprehended. I have done it even in very weak cases without the risk of inducing any inter-

nal inflammation, and can compare the relief

obtained with the description of calm after a

storm.

The tepid and cold pack, as resorted to by the

hydropaths, is not so powerful in its effect as the

sponging, as the cold is not repeated so often as in

sponging. Hence on account of its mildness and

for the greater facility in administration, it is more

applicable to children than to adults. The patient should be completely undressed and laid on a wet

sheet from neck to foot, and covered up and rolled into a blanket, which should be well tucked in to

prevent any access of air, the head being bathed at the same time with cold water. He lies straight in it as a mummy, and in eight cases out of ten falls into a

most refreshing slumber. After half an hour, the

wet clothes are removed, the patient is rapidly dried and put into bed.

The effect of wet pack is to induce diaphoresis and to quiet the nervous irritability. Very often the

temperature rises again, but the patient is quieter and

better able to resist the onslaught. The hydropaths believe in a molecular interchange of fluid by endos- mosis and exosmosis by which a portion of the poi* sonous element of the blood finds its way out of

the body. Whatever be the explanation, its soothing effect on the nervous system is beyond question. In fevers attended with persistent rise of temperature, great restlessness, wakefulness or tendency to convul-

sion, a cold pack or a bath is the sovereign remedy. When any internal inflammation is threatened, such

as bronchitis, pneumonia, diarrhoea or albuminuria, I prefer the tepid to the cold pack.

In a Hindu house no suitable arrangement exists

for a bath, and when one is to be given, it has to be

extemporised. A big gumlah will be the best sub-

stitute. Baths should be commenced at a temperature of 98? or ioo?, and when the patient is in it, the

water to be cooled down to 750 or 8o#. Below this

there will be the likelihood of inducing chill and

so necessitating the discontinuance of the process. A quarter of an hour is the usual time I have the

body immersed. In weak patients I give a dose of

stimulant to guard against syncope or sudden failure

of the heart's action. The water should reach up to

the neck in sitting posture, whilst the head should be

kept bathed in cold water. I will never forget the

wonderful change I first noticed in a patient that was

suffering from fever of a typho-malarious type. He

was almost unconscious when I dipped him into the

water. He then at once began to converse, and said

how nicely he felt, and refused to come out of it. He

was overpowered with the intensity of heat, and the

cold application at once roused up the prostrate nervous energy. When the temperature goes up

to

1060 I have already stated that such applications should no longer be delayed, or when in the course

of

a prolonged suffering the temperature keeps persis- tently above 103? it should be resorted to. Rheu-

matic fevers in this country are seldom so fatal as in

England, and hyper-pyrexia in rheumatism is an acci-

dental phenomenon. The diseases requiring the use

of baths are, therefore, restricted to typhoid fevers, or

rather fevers of a typho-malarial type. Although the

temperature rises very soon afterwards, I had very

August, 1884.] TOMES ON CANCER OF THE PENIS. ai7

seldom any necessity of repeating the bath in the

course of 24 hours.

To prevent any undue reaction, I content myself

by giving a ten grain dose of quinine immediately after the patient is removed from the bath. I have

very seldom observed any bad effect resulting from

the immersion, and even in the event of a subsequent rise I have found my patient calm and more composed than before. To repeat the bath as often as the tem-

perature would indicate it may be a successful heroic

measure, but bearing in mind that the remedy is not a curative one, and that each application and conse-

quent removal is attended with expenditure of nervous force and exhaustion, I think that constant repetitions are undesirable.