(A) GENERAL DESCRIPTION.
Fever is one of the protective institutions of the body, which very
often acts most advantageously in the interests of the preservation of
the organism. It is a symptom, or rather a group of symptoms, consisting
of an increase of temperature, acceleration of metabolism, excitement of
the nerves, numbness and frequently delirium.
Undoubtedly a fever of long duration and high temperature may injure the
organism to the extent that death ensues.
There have been, nevertheless, at all times, those who hold the opinion
that fever, as such, does not under any circumstances, injure the
organism of itself alone.
Fever has at all times been regarded, and to a much higher degree today
than formerly, as a healthy reaction against diseased matter, and
indeed, as an expression of the healing tendency of nature, Hippocrates
considered it an excellent remedy. Thomas Campanello recognized its
qualities of removing diseased matter.
This doctrine is corroborated by the findings in regard to infections.
Through fever the organism is freed from micro-organisms which may have
forced their way in. Fever operates like fire, destroying the contagious
matter. After this is done the remnants are excreted through intense and
extremely offensive perspiration.
Experiments have taught us that the growth and the resisting power of
many microbes decrease if the temperature of the body rises, but 1.8 to
3.6 degrees above normal. It is also a remarkable fact that in every
disease where bacteria are found, there is a special type of fever,
which takes its course in such strict accordance with its law, that the
physician is thereby able to determine the nature of the disease.
While the degree of temperature is decisive in regard to the life of
micro-organisms, the height of the temperature does not, in itself,
constitute a criterion of the gravity of danger. It is the duty of the
physician to fight the fever, since the patient may succumb to a high
temperature, as to a low one.
In order to gauge the situation accurately it is necessary to regard
fever, not as a disease, but as what it really is in essence: a symptom
which accompanies the greatest variety of the processes of
disease,--symptom of the most variable significance in various cases. It
must be fought like other symptoms, such as vomiting, coughing, pains
and diarrhoea; namely, in a general way--provided only that it is not a
manifestation of the healing tendency of the organism.
In decreasing the fever, we moderate the excitement of the nerves,
remove the numbness, secure calmness, refreshment and sleep, and defend
the patient against threatening manifestations of disease.
Very often it is not a case of treating the fever, but of dealing with
the disease which causes the fever. We must consequently not be guided
by the thermometer but by the condition of the nervous system.
Two conditions must be observed in treating fever according to the rules
of biology.
In the first place, the treatment of febrile disease must not be carried
on in accordance with general principles, but individually, according to
the nature of the disease in each particular case.
In the second place, it is necessary that the antipyretic treatment, to
reduce the fever, should not be foreign to the organism and should not
be such as is not measurable in degrees as to its effects, or has any
unpleasant accompanying effects or after-effects.
Only the biological system of healing responds to these demands. Only
cognate physical forces, in affinity with the human organism according
to biological laws, can influence vital occurrences with the hope of
success and without the danger of unfavorable accompanying effects and
consequences.
Only physical remedies and treatments permit of adequate gradations such
as will appeal to the power of reaction of the organism.
In the appropriate application of certain, influences of nature,
especially in the diversified applications of water, we possess a mode
of procedure which, assisted by an appropriate dietetic regime adapted
to the principles of biological healing and to the conditions of life in
health and disease, offers advantages which no other treatment affords
and benefits the patient to an extent which cannot be too highly
estimated.
In the treatment of fever we must, in the first place, follow the
impulses of instinct--harmonized, however, with the fundamental laws and
methods of biological treatment--if success is to be obtained.
Instinctively, in the case of a hot forehead, we turn to the application
of cold compresses; for cold feet, the use of such appliances as will
bring about heat. Tormenting thirst is assuaged by a mouthful of cooling
water. But the instinct of impulse alone might also lead one burning
with high fever to seek relief by immersion in cooling water; thus, in
order to discover the rational course we must be guided by the
fundamental laws of the biological system of healing.
(B) TREATMENT.
To these biological explanations of what fever is, it will be
interesting to add some general description and explanation of its
treatment, such as may serve in an emergency as an indication of the
proper course to be pursued and by the most simple means, pending the
attendance of an hygienic physician.
I must again call special attention to the importance of not clinging
too literally to the letter of the law,--of every rule laid down,--but
rather to study by the light of such laws and with alert intelligence
the special features of the case at issue.
Of all hygienic treatments of fever, which have come under my notice in
the course of many years, there is none more clearly, simply and
intelligibly described than that which Dr. C. Sturm, has published in
his book, "Die natur liche Heilmethode" (The Natural Method of
Healing). I will, therefore, employ it in my explanations, (as
translated from the German) adding to it my advanced methods, especially
the hydropathic and dietetic treatments which are more in accordance
with the demands of modern biological therapy.
In the first place, as we know, fever is indicated by an abnormally hot
skin. This heat is noticeable even by touching the patient with the palm
of the hand.
A precise measurement of this heat, of course, requires a thermometer.
The best kind is a so-called maximum thermometer.
The temperature is taken by putting the lower end of the glass into the
axilla, or arm-pit, of the arm, or in the mouth or the rectum of the
patient, and leaving it there for from 8 to 10 minutes. When withdrawn,
the temperature of the patient can be read at a glance.
The temperature of the skin, however, is not the only indication of
fever. It is accompanied simultaneously by accelerated action of the
pulse, up to 120 beats per minute, and even more; also by increased
thirst and, as an indication of very intense affection, extreme
exhaustion and lassitude. The increased excretion becomes manifest
through dark and strong-smelling urine and, especially at the time when
the fever begins to abate, through intense perspiration.
In the beginning of fever the change alternating between chills and
abnormal heat is very characteristic; frequently, and especially in
severe attacks, it begins with shivers. The patient suddenly feels an
intense chill, so that he commences to shake all over, his teeth chatter
and he grasps whatever covering he can for warmth. Suddenly, following
this, a rapid increase of temperature occurs, and the patient begins to
complain of intense heat. In other cases patients complain of feeling
very cold, while their skin indicates a marked degree of warmth.
With higher degrees of temperature, the fever may induce a loss of
consciousness. The patient becomes delirious, loses urinary and fecal
control and displays the signs of total collapse.
Fever, as I have already indicated, is a kind of physical revolution, a
state of excitation which, differing so widely as to cause, character
and degree, cannot be judged according to any fixed rule. The
temperature of a patient we may read from the thermometer; but the real
nature of the fever we do not learn until we consider his constitution,
his innate faculties and the strength to which his various organs have
attained. For this purpose we must take into consideration not only the
physical attributes, but also the quality of the senses and of the mind,
since these items are of the utmost importance in determining the
tenacity, i.e., the power of resistance of the patient.
From this point of view it will be understood that people possessing a
calm and phlegmatic temperament, will not attain to high degrees of
fever, except in cases of very serious complications, while nervous
people may quickly reach very considerable degrees of temperature.
Children and younger people are more inclined to high fever, since their
organs are still immature. This explains why simple inflammations, which
are not general throughout the body, or frequent indigestion, which in
itself does not figure as a dangerous illness, will in the case of
children appear under the gravest symptoms. It follows, therefore, how
necessary it is to discriminate closely and decide accordingly between
severe symptoms of fever as manifested by people of calm temperament,
and similar cases when manifested by people of nervous temperament.
Unfortunately fever has been treated in the past according to set and
rigid rules. As soon as the temperature of a patient rose from 98.6° and
99.6° to 100.4°, it was pronounced to be fever, and preparations were
made to treat it accordingly. The treatment became more energetic the
higher the fever rose to 105.8° and 107.6°.
It was said that under all circumstances the temperature must be lowered
to normal.
This idea is decidedly wrong and most dangerous for the patient. For,
while a calm and phlegmatic patient may withstand this strong reduction
of excitement in his internal organs, which in fact require it, the
procedure necessary to bring it about, as a rule exceeds what the
nervous patient can endure.
The fever should only be reduced in accordance with the strength of the
patient, otherwise extreme irritation must ensue, such as has caused the
death of hundreds of thousands in the past. It is better, therefore, to
leave a nervous patient in his fever and strengthen him by various
devices, so that he may overcome it. Later he may require and,
consequently, be able to withstand stronger measures. For this purpose I
recommend simple ablutions, in some cases the application of abdominal
packs for half an hour _using two-thirds water and one-third vinegar_,
as previously prescribed. In addition, the natural vigor of the patient
is to be strengthened by administering to him, at intervals of from half
an hour to two hours, Dechmann's Tonogen and Dechmann's Plasmogen
alternately.
The treatment must be in proportion to the strength of the patient.
Thus the quiet, energetic temperament can endure more extensive packs;
his nature in fact requires them. His body may be completely packed or
at least three-quarters, by placing the moist sheet around his entire
body except the arms, while the woolen blanket is either wrapped around
the whole body, including the arms, or, as before, leaves the patient
free to move his arms, which are then only covered by the bed-clothes. A
patient of this kind may also be treated with ablutions or put into a
half bath at 75.2°, while cooler water is poured over him. Young and
strong patients have endured even cooler baths as powerful stimulants.
The nearer a patient approaches to a nervous, weak condition, the more
caution is required to allow him hike warm baths only, or, still better,
ablutions at 77°, which may be made severer by not drying the patient.
It is very beneficial to weak patients to frequently wash their hands,
face and neck, without drying them.
A very careful treatment of the hair is also a great necessity,
especially for women. Clean and well combed hair is very beneficial to a
patient. Slight ablutions of the head and combing the hair while wet,
are very cooling and refreshing.
The stronger the nature of a patient, the safer it becomes to rely upon
a single mode of procedure. Thus, cold packs may be sufficient in case
of high fever if applied about every half hour or hour; or, if the
temperature is not quite so high, at intervals, from one hour and a half
to two hours With weaker persons more variety of procedure is
imperative, but none of them must be too stringently applied. In these
cases mild ablutions should be used several times during the day, and
they may be alternated with packs of the whole lower part of the body or
packs on the calves of the legs.
Cool or cold enemas are rapidly absorbed and thus have a quieting
influence on the large blood reservoir in the abdomen. Little mouthfuls
of water are also taken from time to time, but too much water always
weakens the patient.
(C) DIET IN CASES OF FEVER.
As diet in cases of fever I recommend the prescriptions of Professor
Moritz, which coincide with my own experiences, so far as a fever diet
is concerned; and in addition the physiologico-chemical cell-food which
I have used for many years with the greatest success (Dech-Manna Diet).
The importance of the latter is due to the fact that it not only
_prevents_ the destruction of the cells, but has a general strengthening
effect upon the system.
Whatever the differences in manifestation the febrile diseases may show,
the _febrile reduction of the digestive capacity of the stomach and the
bowels is so characteristic_, that it should be specially noted in this
connection.
True, fever shows considerable _disturbance of metabolism_, since the
_decomposition of the albumen is increased in an abnormal way_. This
fact, however, does not demand any particular attention, in regard to
diet. As far as possible during fever it is well to exercise an
economizing influence on the decomposition of the albumen of the body
through the introduction of _all kinds of food_ that produce energy, so
that it is not necessary to _give preference to any one particular kind
of food_.
The injury to digestion during fever comprises not only the peptic
functions, which manifest themselves clearly in a reduction of the
excretion of hydrochloric acid, but all functions pertaining thereto,
the motory as well as the resorptive.
The danger that the patient will receive too much solid food, hard to
digest, is generally speaking not very great since, during acute fever,
patients as a rule show a decided lack of appetite. The other extreme is
the more likely to occur; that the amount of nutrition given may be less
than what is requisite and helpful; too much deference being paid to the
inclinations of the patient. Formerly the general belief obtained that
fever would be increased, in a degree detrimental to the patient, by
allowing the consumption of any considerable amount of food, and
following this doctrine, the patient was permitted to go hungry. This,
however, is absolutely erroneous. _No one would feed a feverish person
in a forcible manner, but it is absolutely imperative to take care that
he receives food productive of energy in reasonable quantities._
As a rule hardly one-half, or at the most two-thirds of the normal
quantity of nourishment necessary for the preservation of life, may be
introduced into the organism in case of acute febrile disease. I have
already indicated that there is no particular danger in such partial
"inanition" (starvation) for a short period, but that, accordingly, the
qualitative side of the nourishment becomes more important the longer
the fever lasts. It has also been mentioned that the organism reduces
its work of decomposition, gradually adapting itself to the unfavorable
conditions of sustenance, and thus meets our efforts to maintain its
material equilibrium.
_It is important always to make use of any periods of remission and
intermission, during which the patient has a better appetite and can
digest more easily, to give him a good supply of food._ It is also well
to administer _as much nourishing food as possible_ in the beginning of
an illness, which is likely to be lengthy, provided the patient is not
yet wholly under the effects of the febrile disease. The food must then
be gradually reduced in the course of the illness.
As to quality, the diet must be selected from forms II and III (as
below), and will consequently consist of glutinous soups, in some cases
with the addition of a nutritive preparation of egg, meat jelly, milk
and possibly thin gruel and milk.
The quantity of food which the patient may receive can only be given
approximately, as follows:
For adults--(to constitute a sustaining diet). Soup 1/2 pint, milk and
milk gruel 1/3 pint, meat 3 oz., farinaceous food the same, 2 eggs,
potatoes, vegetables, fruit sauces 2 to 2-1/2., pastry and bread 2 oz.
These quantities must be considered as the maximum for each portion. The
quantity of beverage at each meal must also be very limited, not
exceeding 3 to 6 oz., so that the stomach is not overburdened
unnecessarily nor its contents too much diluted.
The reduced meals are harmonized with the object of sufficient general
nourishment by eating more frequently, about five to six times a day.
Patients with fever should have some food in small quantity every 2 to 3
hours. It is important that _the patient be fed regularly at fixed
times_. This will be found advantageous both for the patient and for
nursing.
_Form II_ comprises _purely liquid nourishment, "soup diet."_ Consommé
of pigeon, chicken, veal, mutton, beef, beef-tea, meat jelly, which
becomes liquid under the influence of bodily heat, strained soups or
such as are prepared of the finest flour with water or bouillon, of
barley, oats, rice (glutinous soup), green corn, rye flour, malted milk.
All of these soups, with or without any additions such as raw eggs,
either whole or the yolk only, if well mixed and not coagulated are
easily digested. (Besides albumen preparations, Dech-Manna powders, dry
extract of malt, etc., may be added).
_Form III_ comprises _nourishment which is not purely liquid_. Milk and
milk preparations (belonging to this group on account of their
coagulation in the stomach):
(a)--Cow's milk, diluted and without cream, dilution with 1/2 to 2/3
barley water, rice water, lime water, vichy water, pure water, light
tea.
(b)--Milk without cream, not diluted.
(c)--Full milk, either diluted or undiluted.
(d)--Cream, either diluted or undiluted.
(e)--All of these milk combinations with an addition of yolk of egg,
well mixed, whole egg, cacao, also a combination of egg and cacao.
Milk porridge made of flour for children, arrowroot, cereal flour of
every kind, especially oats, groat soups with tapioca, or sago, and
potato soup.
Egg, raw, stirred, or sucked from the shell, or slightly warmed and
poured into a cup; all either with or without a little sugar or salt.
Biscuit and crackers, well masticated to be taken with milk, porridge,
etc.
As a rule fever is accompanied by an increased thirst, which may be
satisfied without hesitation. It is unnecessary, and detrimental, for
patients suffering from an increased excretion of water through the
fever heat, to be subjected to thirst. Since the mucous membrane of the
digestive channel is usually not very sensitive to weak chemical food
irritations, the cooling drinks, which contain fruit acids, such as
fruit juices and lemonades, are as a rule permissible. Fruit soups may
also be given.
It is different, of course, if an acute catarrh of the stomach or of the
bowels is combined with the fever. In such cases fruit acids must be
avoided. Still it is not necessary to resist the desire of the patient
to take whatever may be given him, at a low temperature. Even ice cream,
vanilla or fruit water ice, may be used in moderate quantity.
Warning against cold drinks is necessary only in case of disease of the
respiratory organs when the cold liquids would cause coughing.
The use of dietetic stimulants such as Dechmann's Tonogen, Eubiogen and
Plasmogen, is the same in these cases as has been mentioned in several
places previously.
* * * * *
As soon as the patient has made sufficient progress, he may receive more
solid food.
The salivary digestion being improved, he may now be allowed several
more substantial dishes of rice and groat, cooked partly in milk, partly
in water and eaten with fruit juice. He may also have several kinds of
green vegetables, like spinach, cauliflower, asparagus, comfrey, etc.
With additional increase in his strength, fresh fish, well prepared, is
especially refreshing to a patient with light fever.
As to mental pabulum, in case of severe fever, I recommend for the
patient absolute mental and physical rest; little talking, no noise, no
visits, no disturbance of any kind. Within his system nature has to
accomplish an enormous task to facilitate which complete quiet is
essential. Just as he who has serious preoccupations needs quiet
environment, so that his attention may be devoted to his thoughts, so
also a patient in the throes of fever must relax all external
considerations in deference to the struggle of the vital forces within.
Whatever disturbance of mentality occurs has always prejudicial effects,
such indeed as may in some cases cost the life all are seeking to save.