In most if not all of these frightful cases of sudden accession of severe nervous symptoms in rheumatism the temperature will be found, on testing it, to be exceedingly high—­108 deg., 109 deg. or even 110 deg.  Fahrenheit.  If the views advocated in this paper be correct, it is not the rheumatism, but the intense bodily heat, which causes the severe symptoms, and finally death.  The joints lose their sensitiveness, not because the disease has left them, but because the heat so overpowers the brain that it has lost its power of perception:  the patient’s leg might be cut off without his feeling it.  In such a case the proper treatment is to take away the heat by plunging the patient into a cold bath.  But can there be anything more shocking to the universal belief and prejudices than to put a patient dying of acute rheumatism into an almost ice-cold bath?

Last spring there was in my ward in the Philadelphia Hospital a stout young Irishman who had passed through an acute attack of inflammatory rheumatism, and was suffering from a sharp relapse.  Entering the ward one day, I saw at once that the man was unconscious, and turning to the resident physician asked, “What is the matter with James?” “Nothing,” was the reply:  “I saw him an hour and a half ago, and he was doing very well, except that the fever was very high.”  “He is dying now, at any rate,” was my rejoinder.  On going to the bedside the patient was found perfectly unconscious, the skin dry and intensely hot, the affected joints pale and devoid of sensibility, the breathing irregular and jerking, the pulse 170 and scarcely perceptible, every muscle relaxed as in death, every power of perception abolished.  A thermometer placed in the armpit registered 108-4/5 deg.  Fahrenheit.

Believing that the symptoms were due simply to this excessive temperature, I ordered the man to be at once stripped and put in a full bath drawn from the cold-water spigot.  The temperature of this bath was found to be 60 deg.  Fahrenheit.  In one minute and a half after the patient had been placed in the tub he recovered consciousness sufficiently to put out his tongue when told to do so in a loud, commanding tone.  In three minutes he began to struggle to get out and to complain of the cold.  In six minutes and a half he had become quite rational.  He was now taken out, only partially wiped, laid upon an India-rubber blanket and covered with a single sheet, the temperature of the room being between 65 deg. and 70 deg.  Three minutes after this the temperature in the armpit was 94 deg., in the mouth 105-3/5 deg.; five minutes later the mouth-thermometer marked 103 deg., and the pain and tenderness had reappeared in the affected joints.  It would be out of place here to give further details as to his treatment.  It is enough to state that, although owing to a misunderstanding of my orders, the man was left in a cool room for twelve hours upon the gum blanket, wet and covered only with a sheet—­or possibly because he was so left—­he recovered without a relapse or any bad symptoms.