delirium and other symptoms which occur in cerebral rheumatism continue, and especially should they be severe, it would be, in the writer's opinion, proper to employ the methods that are now resorted to when hyperpyrexia accompanies those symptoms; for patients suffering from cerebro-spinal disturbance or rheumatic fever, although unattended by hyperthermia, do die if those symptoms continue. Moreover, the hyperthermia may at any moment supervene; it is itself perhaps as much a nervous disturbance as delirium, and apt to succeed the latter. It was in these very cases in which the delirium preceded the hyperpyrexia that the London committee to be presently mentioned found the highest {66} mortality. If along with these nervous symptoms the articular pain or the sweating disappear suddenly, or if the pulse suddenly increase in frequency without demonstrable increase of cardiac mischief, there is reason to anticipate the supervention of hyperpyrexia. (2) When the cerebro-spinal disturbance of rheumatic fever is followed, preceded, or accompanied by hyperpyrexia, there is one indication for treatment which dominates all others, and that is the prompt reduction of the hyperthermia. The terrible danger of this condition in rheumatic fever is known to all persons who have had much experience of the disease. Wilson Fox in 1871 had not known a case recover after a temperature of 106° unless under the use of cold, yet that is not an alarming temperature in intermittent or relapsing fever, and is often recovered from in typhoid fever. Thanks to Wilson Fox,[199] Meding,[200] H. Thompson,[201] H. Weber,[202] I. Andrew,[203] Maurice Raynaud,[204] Black,[205] Fereol,[206] and many others since, it has been established that when the hyperthermia is removed by external cold the nervous disturbances also usually at once disappear or lessen very much. And thus we are brought to the treatment of the hyperpyrexia of acute articular rheumatism. On this important topic it will be most satisfactory and convincing to give some of the conclusions arrived at respecting hyperpyrexia in acute rheumatism by a committee of the Clinical Society of London.[207] I will condense some of them. [Footnote 199: _Treatment of Hyperpyrexia_, 1871, and _Lancet_, ii., 1871.] [Footnote 200: _Archiv für Heilkunde_, 1870, xi. 467.] [Footnote 201: _Brit. Med. Jour._, ii., 1872; _Lancet_, ii., 1872; and _Clinical Lectures_, 1880.] [Footnote 202: _Clin. Soc. Transactions_, v. 136.] [Footnote 203: _St. Bartholomew's Hosp. Repts._, x. 337.] [Footnote 204: _Journal de Thérap._, No. 22, 1874.] [Footnote 205: _Gaz. Hebdomad. de Méd. Sci._, 1875.] [Footnote 206: _Soc. Méd. des Hôpitaux_, 8 Juin, 1877.] [Footnote 207: _Brit. Med. Jour._, i. 82, 807.]