What About Fevers?
FEVERS are among the things that often cause loving mothers of infants and small children great concern. But, as we shall see, mothers are likely to be more worried than the condition warrants.
According to medical history, “fever has been known as a sign of illness since . . . observations of Hippocrates,” the so-called “father of medicine.” But the Bible shows that more than a thousand years earlier, Moses had something to say about “burning fever” in the divine legislation that he was inspired to give to the nation of Israel. (Lev. 26:16; Deut. 28:22) Many centuries after Moses, the Gospel writers tell of Jesus Christ, the Son of God, curing the mother-in-law of the apostle Peter of a “high fever,” and of the shipwrecked apostle Paul curing the fever of the father of Publius, “the principal man” of the island of Malta.—Luke 4:38, 39; Acts 28:7, 8.
Progress in Understanding Fever
Since the time of Hippocrates men have learned more and more about fevers. Quite a step forward was made in 1714 when Fahrenheit invented the first thermometer. Then about a hundred years ago it was discovered that a fever was directly related to a rise in the body’s thermostat. Even today fever is such a sensitive and reliable indicator of the presence of disease that thermometry is probably the commonest clinical procedure in use.
Only within the past twenty years have men gained a meaningful understanding as to just how a fever comes about. It had been known that the tiny gland in the brain known as the hypothalamus, which lies just back and above the bridge of the nose, regulates the body’s temperature. But how?
It was discovered that the white corpuscles in the blood, when combating an infection, produce pyrogens, literally “fire producers.” This substance acts on the cells in the forepart of the hypothalamus, causing it to raise its “thermostat.” For this reason it has been said that a fever is an elevated temperature, the result of a disturbance of the central temperature-regulating mechanism in the brain. One result of this changing of the “thermostat” is that the body feels as if it were actually cold and so the individual has chills and shivers, even though his body temperature is above normal.
Recent research has also shown that the constancy of the temperature of the body is related to the balance of sodium and calcium in the hypothalamus. Calcium appears to act as a kind of brake that keeps the sodium ions from raising the temperature of the body too high. It appears that the pyrogen of the white corpuscles or leukocytes removes the calcium brake.
Among the questions raised at an international fever symposium held in London (1970) were: Why a fever? Of what do those pyrogens consist? Are they hormones? Why is the average normal body temperature 98.6 degrees Fahrenheit and not 90 degrees or 108 degrees? Also, some have asked, Why does aspirin have no effect upon the body’s temperature if it is normal, but is increasingly effective as the temperature gets higher and higher?a
Normal Temperature Relative
It is indeed of interest that, even though the environment may vary as much as two hundred degrees, yet 98.6 degrees Fahrenheit is ordinarily considered “normal” temperature. Such things as race, diet, climate and sex have very little bearing on one’s temperature; still there are other factors that do cause variations. For example, one’s temperature varies throughout the day. It is the lowest between three and six o’clock in the morning and the highest between four and five o’clock in the afternoon. Then again, the temperature varies in different parts of the body. The rectal temperature is one degree higher than that of the mouth; the hands and feet are lower in temperature and the tips of the nose and ears have the lowest temperature.
Such things as exercise or emotional upsets will raise the body’s temperature. But such a condition could not be a true fever, for the body returns to its normal temperature as soon as exercise stops, no pyrogen having acted upon the hypothalamus.
So it follows that anything between 97 degrees and 100 degrees Fahrenheit may be normal and that even 101 degrees for children may be simply due to exercise or emotional upset. For children a high fever usually is from 103 degrees to 105 degrees Fahrenheit, and anything above is usually considered dangerous. The highest fever from which a person recovered without brain damage was reportedly 114.8 degrees Fahrenheit.
What causes the hypothalamus to raise its thermostat, as it were? The most common cause, without a doubt, is infection. However, there are also other causes of fever. Among these are drugs, poisons, severe accidents, especially to the central nervous system, and various malfunctions of the brain. Then again, simply overheating the body to an extreme degree can bring on a fever, as in the case of sunstroke or heatstroke, where the body’s central mechanism for cooling seems suddenly to fail. Such an individual ceases to sweat despite his rising temperature.
Why a Fever?
Does a fever serve any good purpose? Does it result in any benefit to the body? This is a somewhat controversial question. There are modern authorities that will answer Yes, while others say No. Thus a 1973 textbook on human physiology written by an English professor flatly states: “The function of fever is unknown; it does not appear to enhance the body’s ability to cope with disease.” And an American authority states that demonstrations to show that fevers have a positive value “have not been convincing.”
However, the chairman of that international symposium on fever favors an opposing view, for he stated: “It seems unlikely that this universal response of warm-blooded animals would have survived . . . if it did not confer an essential defence against disease.” And another authority states: “A fever of moderate degree is a provision of Nature by which the infection is combatted and the recovery encouraged.” Experiments have shown that animals inoculated with bacteria and then kept at 105 degrees Fahrenheit resisted infection better than those not subjected to higher temperature.
Thus in times past, before notable strides were made in chemotherapy, that is, in the use of drugs, such diseases as syphilis, asthma and arthritis were treated by induced fevers. Episodes of acute diseases (such as measles) with their fevers have been noted to have a beneficial effect on other preexisting diseases. In fact, it is a matter of record that Pasteur challenged the members of the French Academy of Medicine to inoculate a chicken with a fatal dose of anthrax. They could not do it because a chicken has a normal temperature of 107 degrees, which will not permit anthrax bacteria to live.
Among other reasons that some give in support of the position that fevers serve a useful purpose are these: Fevers cause the body to produce a recently discovered substance, inferon, helping it to combat viruses. Fevers also stimulate the production of enzymes and white corpuscles. Nevertheless, fever has its detrimental aspects too. The heartbeat is increased and there is a loss of weight, body fluids and salt, accompanied by headaches and other discomforts.
What to Do About a Fever
There was a time when nearly everybody considered fever to be an unmitigated evil and therefore a condition that should be lowered at once by aspirin, cold water, ice cubes or cold towels. This may still be recommended in certain instances, but more and more the consensus is to let the fever run its course unless it is very high or is accompanied by complications such as vomiting, diarrhea or difficulty in breathing. In this regard, some liken a fever to a fire alarm. The important thing is not to silence the alarm but to put out the fire. And so merely taking measures to reduce the fever without searching for and treating the cause usually is pointless.
Still, it is reasonable to try to make a feverish individual comfortable. Sometimes this may mean reducing his temperature somewhat; to this end some suggest medication such as aspirin, others add an ice bag to the head or give enemas. Since a fever rapidly depletes caloric stores, long-standing diseases marked by fever may require careful attention to diet. In short-term fevers the patient, as a rule, has no appetite for food and is usually better off to limit his intake of solids. Although there may be differences of opinion on whether to feed or to starve a fever, it has been well established that feverish patients need plenty of liquids. For every degree of fever metabolic activity is increased about 7 percent and an adult is said to lose a quart of water by evaporation, and so extra fluids not only make him comfortable but are most important. Some recommend that such liquids include fruit juices and vegetable broths. Of course, any extremely high or long-lasting fever logically should have the attention of a doctor.
Perhaps the most concerned of all as regards fevers are mothers of small children or babies. Temperature changes can occur suddenly and be accompanied by alarming symptoms, and so mothers do tend to be easily concerned and worried if their pediatrician does not do something about it. But, more and more, authorities are urging mothers to calm down. As one of them put it: “I consider the thermometer often a source of undue parental anxiety. Physicians frequently are asked to ‘treat’ a fever, but this pressure to ‘do something’ should be tempered by the realization that, in most cases, fever is merely the body’s defense against a self-limited disease.” (Incidentally, this argues that fevers are beneficial!) In the same vein, another noted pediatrician urges “treat the child, not the thermometer.” And that is also good advice for grown-ups!
a Aspirin does seem to reduce the yield of pyrogens, but that does not account for all of its effect.