According to general, though not universal experience, a rise of temperature above 108° F. is quickly fatal, and a range between 105° and 112°, which may occur in acute rheumatism, etc., has been specially termed "hyper-pyrexia." Under the systematic use of cold applications, some remarkable recoveries from this critical condition have taken place, and two cases fully reported by Dr. Wilson Fox attracted much professional attention to the subject. They were both cases of rheumatic fever with cardiac complications: one, a woman of forty-nine, was lowered at 9.50 p.m. into a bath at 96°, when her temperature was 109.1° F. She was unconscious, the pulse imperceptible, the face cyanotic, the respiration irregular and gasping. At 9.55 p.m., the rectal temperature was 110°. "Ice was fetched, a large lump was placed on her chest, another on her abdomen, a bag filled with ice was tied down the length of the spine, and while two assistants bailed the warmer water out of the bath, two others poured ice-water, as rapidly as the pails could be filled, over the patient." At 10.10 p.m., temperature was 109.1°; at 10.25 p.m. it was 106°; the pulse now became perceptible (140), and the patient showed signs of consciousness. Brandy was freely given. At 10.35 p.m. the temperature was 103.6° F., and the patient was taken out of the bath. At 10.55 the temperature was 100.6° F., lividity had disappeared, the patient could speak, and had a certain imperfect consciousness; the temperature continued to fall, till at 11.25 p.m. it was at 97.4° (vagina), and hot applications and an enema of brandy were required to prevent collapse. Another bath was given next day, when the body temperature had risen to 104.5° F., the bath was at 64° F., and was continued for twenty minutes; on removal, the patient's temperature was 103.9°, and it continued to fall for forty minutes longer till it reached 99.4°. Rigors occurred, and hot applications were again required. From this time, the cold treatment was continued by ice-bags to the spine, which sometimes were effective in reducing the body heat, and sometimes not, but within a week from the baths, the patient was sitting up convalescent, and within a month was able to travel.

The second case presented more difficulties, and required a longer treatment: it occurred in a man aged thirty-six, suffering from double pneumonia, double pleuritis, and pericardial effusion. On the seventeenth day of his disease, the temperature rising rapidly to 107° F., and delirium setting in, he was placed in a bath at 89° F., which was cooled to 86°. The after-effect of this was a fall of body temperature to 98°, and return of consciousness. For eight days cold applications were kept up almost continuously; eight baths were given, of duration varying from twenty-five minutes to seventy minutes, and in the intervals, the ice-bag or wet-pack was used, the object being to keep the temperature under 103° F. at least. This patient also made a good recovery, but the temperature did not remain normal until thirty-one days after this treatment was commenced (Lancet, ii., 1871).

Shortly before these cases, Dr. Meding, treating rheumatic hyper-pyrexia in a female, aged twenty-two, with enemata of iced water every half-hour, and the application of iced cold cloths, reduced the temperature in five hours from 108.6° to 99.5° F., and the pulse from 140 to 72; no further rise ensued, and no relapse.

Of course, all cases have not been so successful, and Dr. Fox refers to several that ended badly; yet those quoted are sufficient to show the immense power of this mode of treatment, and it has, since that time, been fully endorsed by many English authorities. Dr. Anstie especially pressed its adoption, and Dr. Waters (Liverpool) has recently given good illustrations of its value in two cases of rheumatic fever, one with pericarditis, and both reaching a temperature of 106.7° F., and treated by baths at 95° to 100°, cooled to 70°, and sometimes lower (British Medical Journal, i., 1878). In a careful paper, Dr. Ord has given details of the use of graduated cold baths in ten cases of hyper-pyrexia, of which two were fatal (one of these had only one bath, and died eleven days afterward of lung-congestion). In several of the cases, relief to nerve-excitement, and even to bronchial and congestive lung-condition, as well as to pyrexia, was marked; six was the largest number of baths given in any one case. The only contra-indication is excessive weakness. Dr. Ord advocates the systematic early use of this treatment, but also points out the difficulties in thoroughly carrying it out ("St. Thomas's Hospital Report," 1879).