For many years eminent medical savants have sought earnestly through the
vegetable and mineral worlds for some substance by means of which the high
temperature often prevailing in typhoid, malarial, and other fevers might
be reduced with rapidity and safety to the patient. A few substances have
been found which produce a decline in temperature when administered in
enormous and frequently repeated doses; but such administration has often
been found to be decidedly detrimental to the patient, producing not
infrequently serious injury to the stomach, kidneys, and sometimes the
nervous system. So great is the danger of such injurious results, few
careful practitioners have cared to adopt the heroic "antipyretic"
medication recommended by experimenters, preferring to allow their
patients to burn with fever, mitigated only by such simple means as are
commonly employed by nurses, than to require them to combat the poisonous
influences of a drug in addition to the morbid element of the disease.
Happily, however, it is not necessary to leave the patient to the unaided
efforts of nature. By cool sponging of the surface, persistently and
thoroughly applied; by large, cool compresses placed over the abdomen and
chest, or even the whole front of the body, and changed as often as warm,
or every three to five minutes; by frequently repeated cool packs; by cold
water drinking; by ice-packs to the spine; by constant application of ice
or frozen compresses to the head; by forcing perspiration by copious hot
drinks and a warm blanket pack--by any or all of these means the
temperature may be reduced with promptness in nearly every case. However,
cases will now and then occur in which the temperature remains dangerously
high, notwithstanding the thorough application of the above means. What
shall be done?
Several years ago our attention was called to a series of experiments made
by Dr. Winternitz, Professor of Hydropathy in the Medical University of
Vienna, for the purpose of determining the influence upon temperature of
enemas of water of different temperature in cases of fever. The results
claimed by Prof. Winternitz were so striking that we improved the first
opportunity to repeat his experiments, and with such results as have
justified the continued use of this means of lowering temperatures in
fever, in cases in which the ordinary measures were not efficient. The
only objection we have found to the method has been the inconvenience to
the patient occasioned by the frequent use of the bed-pan. In a recent
case in which we found it necessary to resort to this method, the nurse
observed that if the tin can of the fountain syringe used in administering
the enema happened to be lowered below the level of the bed on which the
patient lay, water which had previously been introduced into the rectum
returned readily through the tube into the can. On learning this fact, the
attendants were instructed to employ the enema in this way. From one to
two pints of water, of 70° or 75° F. temperature, were allowed to pass
into the bowels; and after being retained for five or ten minutes, or
until the patient experienced uncomfortable sensations, it was made to
pass out through the tube by simply lowering the reservoir to the level of
the floor. A new supply of water of a proper temperature being introduced
into the reservoir, it was again raised to the proper height, and the
operation so continued until six quarts of water had been used. Then the
patient was allowed to rest half an hour or an hour, according to the
height of the fever, and the same process was repeated. Careful record was
made of the temperature of the patient just before the treatment and
immediately after. It was found to be invariably reduced from one to one
and a half degrees by each treatment. The temperature, which had been
exceedingly obstinate previous to the employment of this method, ranging
from 104° to 105°, during the intervals between the treatments would, of
course, rise somewhat; but each time it stopped short of the point reached
during the previous interval, so that in the course of a few hours the
fever was brought down to very nearly a normal temperature. The
temperature of the water, when taken after passing through the bowels, was
found to have risen each time from 10° to 13°.
The great capacity of water for absorbing heat renders it one of the most
useful of all substances for lowering the temperature; and it is readily
apparent that, by the means described, heat may be abstracted from the
body almost _ad libitum_, and the temperature may thus be controlled with
a rapidity and a degree of certainty which cannot be approached by any
other method. In a still more recent case, in which the same treatment was
employed, the temperature of the patient had reached 106° F., in spite of
the vigorous application of ordinary measures of treatment, such as cold
compresses, etc.; but it was, in four or five hours, brought down to
nearly 100° by the use of the cold enemas.
The advantages of this method are: 1. It may be employed without wetting
or moving the patient; very frequently a patient will sleep continuously
during the administration of the treatment. 2. It seldom causes
chilliness, which is frequently a disturbing symptom, especially in fevers
of a low type, and even, when the temperature is alarmingly high, causing
the patient to dread the employment of sponging with cool or tepid water.
3. It is not necessary to employ cold water, a temperature of 80° or even
85° being thoroughly efficient. In the majority of cases, however, water
of 70° or even 60° may be employed without danger. The water comes in such
immediate contact with surfaces filled with large blood-vessels that a
temperature but a few degrees below that of the body is more effective
than very much colder water applied to the surface.
In cases in which the use of the cool enema is attended by chilliness,
this uncomfortable symptom may usually be relieved by the application of a
hot bag or fomentations to the spine or to the pit of the stomach.
The simple measures of treatment we have described will be found more
effective in lowering the temperature than any or all other remedies which
have ever been recommended for this purpose.--_Good Health._
* * * * *