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Sometimes the virulent character of the disease can only be accounted for by an idiosyncrasy of the patient. Constitutional symptoms, particularly pyrexia and anæmia, are most often met with in young women. Patients over forty years of age have greater difficulty in overcoming the infection than younger adults.
Before I could get rid of my guests she had gone to bed. At length they went, and going to my study I began to smoke and think. I was now sure that the bright flush upon her cheeks was due to what we doctors call pyrexia, the initial fever of smallpox, and that the pest which I had dreaded and fled from all my life was established in my home.
In the course of a general illness in which there is moderate pyrexia and profuse sweating, some of the larger joints, and not infrequently the smaller ones also, become swollen and extremely sensitive, so that the sufferer lies in bed helpless, dreading the slightest movement. From day to day fresh joints are attacked, while those first affected subside, often with great rapidity.
The possibility of the three high temperatures with leucocytosis being due to intercurrent infections must be considered. Charles O. had high fever only for ten days during a psychosis of several months. Annie G.’s high fever was of about the same duration. Caroline DeS. had short periods of marked pyrexia in the first and seventh months of her long psychosis.
With the destruction of the ligaments, the stability of the joint is lost, and it becomes disorganised. The clinical features vary with the extent of the infection. When this is confined to the synovial and peri-synovial tissues acute serous and purulent synovitis there is the usual general reaction, associated with pyrexia and great pain in the joint.
If, however, organic disease can be excluded, and if the pyrexia is the only circumstance which prevents the decision that the child is well and should be treated as well, then the thermometer may be overruled and the pyrexia neglected.
After repeated recurrences, there is ankylosis with deformity, the patient becoming a helpless cripple. On account of the tendency to visceral complications, the tenure of life is uncertain. From the nature of the disease, treatment is for the most part palliative. Salicylates are only of service during the exacerbations attended with pyrexia.
The pyrexia may have the same periodic character as that just noted in cases of cyclic vomiting. At intervals of three, four, or five weeks there may be a rise of temperature to 103° F., or even higher, which may last for two or three days before subsiding. In other cases the chart shows a slight persistent rise over many weeks or months.
The mixed infection is chiefly responsible for the pyrexia, sweating, and emaciation which the laity associate with consumptive disease. A tuberculous abscess may in one or other of these ways be a cause of death.
When severe or prolonged pyrexia becomes a source of danger, the use of hot or cold sponging, or even the cold bath, is preferable to the administration of drugs.
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