The following article deals at length on steps that one can take at home to reduce fever or body temperature for patients. The article is entitled ‘Home Care of Fever Cases’.
THE HOME CARE OF FEVER CASES
The Reduction of Temperature or Fever
ELEVATION of temperature is the most striking characteristic of fever; hence the treatment for the reduction of temperature is a matter of primary importance. It should be known, however, that fever is not necessarily destructive in its influence. It is only when the febrile process rises to an extreme degree that it becomes in itself harmful. Careful investigations have shown that the fever is a part of the curative process, aiding in the development of neutralizing substances which destroy the germ poisons,— really the chief source of danger.
It is practically impossible to reduce the temperature of the fever patient to the normal without the use of measures so extreme as to endanger the patient. The reason of this is, that in the state of fever a new standard of temperature is established which is considerably higher than the normal standard. The normal fever temperature has been determined to be from 101° to 102° F., or about three degrees higher than the temperature of health. As long as the temperature does not rise above this point, the curative process may be considered as proceeding in a natural way toward recovery. When, however, as is generally the case in fever, the temperature rises higher, it is an indication that the disease process is progressing with dangerous intensity, and effective measures should be applied at once and continued until the temperature is brought within the normal fever limit.
We are now brought to the discussion of proper measures for lowering the temperature in fever:—
The Wet-Sheet Pack.— Without doubt, the wet-sheet pack is the most generally serviceable and efficient measure which can be used for the reduction of temperature. Sheets and water at ordinary air temperature are always available. What is known as the cooling pack should be applied. The patient is wrapped in the wet sheet and covered with a single blanket. As soon as the sheet is warmed, it is replaced by a freshly cooled sheet, and this again by another as soon as it approaches the temperature of the skin. This process is continued until the sheet is no longer quickly warmed, or until the temperature of the blood has been lowered, as indicated by shivering. In obstinate cases it may be necessary to continue these cooling packs for two or three hours, or even longer. Generally, however, five or six changes will be sufficient to lower the temperature
one or two degrees, or below 102° F. In employing the wet-sheet pack, it is important to remember that the pack should be carefully covered by at least a single flannel blanket. .’No attempt should be made to increase the cooling by allowing evaporation from the surface of the sheet. This produces slow chilling of the surface and contraction of the blood vessels, the opposite of which is desired. The sheet should be covered so that reaction will take place. With the reaction, the surface vessels are dilated, and the blood is thus brought to the surface where it may be cooled by contact with the cool sheet. It is also injurious to leave the sheet in contact
with the skin after the body temperature has been raised, as superheating may thus occur, so that the fever may be actually increased. As soon as the sheet is warm, it should be replaced by another. The first sheet may be warmed in six or eight minutes. The second sheet will probably require a longer time, — ten or twelve minutes; the third, perhaps, fifteen minutes; the fourth, twenty minutes; the fifth may require a still longer time, which will indicate that the effect desired has been obtained.
If the warming of the sheet does not occur quite promptly, reaction may be encouraged by rubbing the surface of the sheet with the hands placed beneath the blanket, but the sheet should never be left uncovered, even for a moment, and changes should be made as quickly as possible.
By the systematic employment of this valuable cooling measure from the commencement, the duration of most fevers may be very materially shortened, and its mortality enormously lessened, while the suffering and inconvenience may be diminished to an almost incalculable degree. If, however, the cooling measure is not resorted to until after the patient has been sick for several days, it may be found quite difficult to control the fever, and the best results may not be obtained.
In such neglected cases, it is only by the most persistent efforts that the intensity of the disease process may be controlled, and the fever rendered- manageable. Failure to obtain immediate success should not, however, lead to discouragement and abandonment of the method as useless or inefficient; experience in a vast number of cases has shown that the cooling wet-sheet pack is capable of lowering the temperature in every single case, if properly and persistently employed.
The Cold Bath. — A bath for fifteen minutes at 68° F. is the method generally employed in Germany for reducing temperature in fevers. The patient sits in a bath of from four to six inches of water. Two attendants rub his back and legs, pouring colder water upon his head and spine at intervals of three or four minutes. At intervals of a few minutes the patient lies down in the tub for a few seconds. The rubbing is vigorous and continuous, the purpose being to keep the blood in the skin so that it may be rapidly cooled. When the patient begins to shiver, he is taken out and put to bed. The temperature usually falls in the bath or immediately afterward. As soon as the temperature exceeds 102°, the bath is repeated. Several baths are given daily, if necessary. A German physician has collected records of eight hundred cases of typhoid fever treated by this method without a death. The mortality in several thousand cases of this disease was only three per cent, while the ordinary mortality is about twenty per cent. If the cold-bath treatment could be generally introduced and applied with thoroughness from the beginning of the disease, few persons would die of this malady.