Fever

=Fever= is due to various causes, so that a definite statement cannot

always be given as to the cause of fever in every disease. Each fever

case, like all other disorders, is a law unto itself; different causes

are found in different cases. Moreover, often only theories, and not

absolute facts, can be given.

Fever may be present when a local disease assumes a constitutional

character or when the constitutional character is manifested from

the beginning of the disease. Fever may be a systemic disorder or

a symptom of disease, and is characterized by an increase of body

temperature. Other symptoms are usually present, as an accelerated

pulse, disturbances of distribution of the blood, increased catabolism,

and disordered secretions.

=Etiology.=—In infectious diseases fever is due chiefly to the action

of various toxic or harmful agents, produced by the disease, upon the

fluids of the body and upon the nervous system. Disturbances of the

thermogenic centers and nerves of the brain or cord by harmful agents,

or by lesions of the anatomical structures affecting these nerves, are

sources of fever. Also disturbances of the vasomotor centers (in the

medulla and auxiliary centers along the cord) and nerves are causes

of fever in many instances. A disturbed or lessened function of the

nerves controlling sweating is an important factor. The multiplication

of micro-organisms in the body, acting directly on the tissues or

by producing toxic substances which affect the nervous system, is a

fruitful source of fever. A few cases may be caused by direct affection

of the nervous system, as is shown by appearance of fever in epileptic

attacks, or by the passage of a catheter into the bladder. In a large

number of all cases a demonstrable cause can be found upon careful

examination, whether the fever be due to a necrosed mass of tissue, the

introduction into the system of decomposed food, infectious diseases, a

lesion of some anatomical structure affecting a thermogenic, vasomotor

or sweat center, a lesion to the innervation to the heart (vagi and

cervical sympathetic) causing a rapid heart, or a lesion to the

lymphatic system.

=Treatment.=—The treatment of fevers in a general way consists

principally of thorough inhibition to the posterior spinal nerves of

the upper cervical region in order that the center of the vasomotor

system in the medulla may be affected, probably by the way of the

superior cervical ganglion of the sympathetic. Thus the entire

vascular system is equalized, for there is always a disturbance in the

distribution of the blood in fever and if the center controlling the

nerves that govern the lumen of the blood-vessels can be brought under

control, there will result an equalization of the vascular system; if

such occurs, health must ensue. Besides the vasomotor nerves to the

blood-vessels being affected by this treatment, the nerves governing

the lymphatics and the sweat glands will also be controlled. The

sweat glands as a rule are rendered active by affecting directly the

innervation of the glands, also the glands are controlled indirectly by

the blood supply; this aids materially in lessening the temperature of

the body. Treatment for a few minutes to the upper posterior cervical

region would also affect the thermogenic centers and nerves of the

brain reflexly in the same manner as the vasomotor and sweat centers

and nerves are affected, thus tending to equalize the mechanism of the

thermogenic system. Besides this action on the vasomotor, sweat, and

the thermogenic nerves, there is produced an increased exhalation of

moisture from the lungs, on account of an increase of vascular area in

the lungs through vasomotor action. Also the large vascular area in the

abdomen, under control of the splanchnic nerves, becomes constricted.

Thus there is brought about a lessening temperature by evaporation,

heat radiation, and perspiration; and an increased action of the

general nervous system, a stronger cardiac force, an equalization of

the vascular system, and a more perfect elimination of toxic properties

by the skin, kidneys and lungs; consequently a reduction of the fever.

The foregoing treatment is successful to a limited extent, only in

such cases where causative factors of the fever are involving the

predominating centers controlling the heat production or dispersion

and the vasomotor system directly; for if the lesion that is causing

the disorder should be affecting an auxiliary center along the spinal

cord instead of the predominating center, as is oftentimes the case,

treatment of the predominating center would be useless as far as any

permanent benefit is considered; although a temporary effect will be

gained by lessening the fever at that point. Consequently, in many

cases, the lesion lies within the jurisdiction of auxiliary centers

which are situated at various points along the spinal cord. When

such is the case, it will be of little benefit to give the cervical

treatment. In such instances the lesion to the auxiliary center would

have to be removed in order to cure. One cannot depend upon a set rule

to reduce a fever; determine the cause, as in any other disease or

symptom, and remove it.

In addition to the treatment to the cervical region and along the

spinal column, as are indicated upon an examination, attention should

be given to the heart’s action. The equilibrium between the accelerator

and inhibitory nerves (cervical sympathetic and vagi) should be

maintained. The interchange of gases in the lungs should be rendered

as nearly normal as possible; this is best accomplished by raising

and spreading of the ribs from the second to the seventh dorsals,

particularly in the region of the fifth and sixth. Also stimulation

of the vagi will aid by increasing the motor power of the lungs.

The kidneys and bowels should be kept active so as to favor a rapid

elimination of various toxic properties; besides they have control

over large vascular areas. Treatment over the ureters will prevent any

clogging that might occur in them from a condensation of the urine.

Attention, also, should be given the tissues at the fifth lumbar and

over the iliac vessels to influence the circulation in the pelvis.

The =food= of the patient should be liquid—milk, soup, broths, etc.,

and almost any quantity of water allowed if called for, given little

at a time and at frequent intervals. The room should be well lighted,

ventilated, clean and kept at an even temperature.

=Two points= should always be remembered relative to fever:

First—That there are many causes of fever; and in order to reduce the

fever the cause must be determined and removed, the same as in any

disorder. A definite fever treatment cannot be given any more than a

definite constipation treatment; the case must be seen in order to

determine the cause.

Second—The reduction of fever is not necessary; the fever should be

treated only as a symptom of disease when it exists as such. In fact,

fever is beneficial, for it is one of nature’s methods to relieve an

over-burdened system from harmful agents, unless the temperature is

excessive and continuous and is likely to cause more harm than the

primary trouble.

Absolute =rest= in bed always is of decided benefit in lessening the

temperature.

=Hydrotherapy= is of immense value in reducing a fever. It is an agent

that has been greatly used, and if applied intelligently cannot but

be of aid. There is much ignorance in regard to the principles and

practice of hydrotherapy, not only among all classes of people, but

among well informed practitioners in medicine. The most important

function of the skin is as a heat regulator. Knowing this fact, the

osteopath treats the vasomotor nerves that control the cutaneous

circulation and the nerves that control the excretion of the skin;

the nerve supply being from the cerebrospinal and sympathetic nerves.

In many difficult and obstinate cases hydrotherapeutic measures

should be used to aid the skin in regulating the temperature, as well

as to enhance system functions for the same reason that osteopathic

manipulations are given. Maintaining an equilibrium in heat production

and heat dispersion is necessary in order that the standard of the

body temperature may be kept; and the amount of the arterial blood

circulating within a tissue determines its temperature.

The principal effect of water as a thermic agent when applied

externally is due to the influence of the action of the water upon the

cutaneous circulation. Lesser effects would be the mere extraction of

heat from the body by evaporation and the equalization of temperatures

of two bodies coming into contact. As the body is endowed with

compensatory powers, this latter means would apply only to a limited

extent. The temperature of the water used is important, as the colder

the bath the less effective would its power be in reducing internal

temperature. When a cold bath is used there is a driving of the blood

away from the surface on account of the contraction of the peripheral

vessels; consequently increasing the cutaneous circulation and cooling

by radiation is prevented and less heat is lost. A collateral hyperemia

occurs in the underlying parts which acts as a protection to the deeper

tissues. The cold also inhibits the vasomotor nerves controlling the

abdominal splanchnics, and thus a larger amount of blood passes to

this immense vascular area. On the other hand, when a warmer bath is

used the effect is opposite, and a lowering of the temperature is the

result. The cutaneous vessels being dilated, the superficial blood is

rapidly replaced by blood from the deeper vessels, thus allowing a

cooling of the body to a large degree.

In the various fevers where hydrotherapeutic measures are employed, the

object to be gained by such methods is not primarily an anti-thermic

one but an anti-febrile reaction; consequently the use of cold

water is employed. In mere heat reduction the warmer water would be

more effective; but by the aid of the colder water the cause of the

increased temperature, as in infectious fevers, is lessened; besides

a refreshing and stimulating effect upon the entire system is gained.

Thus the aim of the cold bath and friction, is not primarily to subdue

the temperature by heat radiation or evaporation, but to correct

disturbances governing the formation and the dissipation of heat

caused by infectious fevers, and, moreover, to stimulate the nervous

system, prevent heart failure, increase the eliminating power of the

skin, kidneys and lungs, and to influence the corpuscular and chemical

constituents of the blood to a more normal condition.

The full cold bath and friction (Brand Method) is commonly employed

in infectious fevers. The half bath, wet pack, or sponging may be

used. The modus operandi of each is given under the hydrotherapeutic

treatment of typhoid fever.