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The Treatment of Fever

temperature, process, ailment, sign, run and patient

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If what has been said about the cause of in creased temperature has been understood, it will be clear that, in most cases, treatment merely to lower the temperature is uncalled for.

The high temperature is merely the evidence of a process going on in the body, of which it is a result. You may alter, diminish, or even abolish the evidence without affecting in the least the thing of which it is only a sign, namely the morbid process going on in the blood and tissues. On the other hand, if you can arrest or modify the ailment, the morbid process, the temperature will immediately subside of itself. If the morbid process has been arrested, or has of itself come to an end, and yet the fever per sists, then you may be sure either that you have mistaken the cause of the elevated tem perature or have been in error in supposing it had ceased, or that some complication has arisen to continue the febrile condition.

Now, a large number of the diseases accom panied by fever tend to come to an end of them selves at a specified time ; all the ordinary infectious fevers do, as well as pneumonia, and other inflammations. It is also true of these diseases that they run a definite course, which cannot be terminated sooner than its own speci fied time. It is clear, then, that in all such cases the treatment of the disease is the treatment of the temperature as well, in the ordinary and un complicated case. It is obvious, therefore, that the first and urgent thing is the settlement of the true nature of the ailment, of which the heightened temperature is only one sign, but possibly the earliest, and it may be, for some days, the only sign. It may, therefore, fre quently be a wise thing to let the temperature alone, in order that its behaviour may be observed, and thus the earliest possible indica tion be obtained of the exact ailment one is dealing with. Parents and friends are often apt to be impatient if seine fever mixture or other is not immediately ordered by the phy sician to check the fever. If they understand what has been written they will perceive that it may be the wisest course, for the patient, not to try to do so. But if so, the physician must

have taken every other means open to him to- endeavour-to settle without delay the true nature of the illness, and he must have given instructions meantime regarding the general management of the patient as to diet, move ment of bowels, &c. Only if these conditions are fulfilled can he plead justification for delay in taking other steps. For increased tempera ture, though commonly only a sign of a disease that will run its own course in spite of any and all interference, is nevertheless occasionally a manifestation of au ailment that can be checked, if dealt with early and vigorously enough. The vital thing, then, we repeat, is to determine the cause of the fever; that being settled, whether active steps should be taken to deal with the temperature itself is easily decided.

In most cases, and certainly in all of the fevers accompanied by eruption, the treatment consists in general measures, chiefly seeing that the patient is comfortably in bed, is kept clean, is placed on simple diet, and that the bowels are moved and the urine duly passed.

It is only when the temperature runs high, and threatens to injure by its mere intensity, when sleeplessness, restlessness, and delirium are marked, that the physician certainly be comes justified in endeavouring to reduce it, and to calm the irritated nervous system. This will be more necessary with some individuals than with others, and it certainly is more frequent with children than with adults. But no routine should be adopted: each individual case should be treated on its merits. In many cases the restlessness, excitement, sleeplessness, &c., seem to depend on the height of the fever, at least to run parallel with it, and the reduction of the temperature is accompanied by calmness and sleep; in other cases the reduction of the temperature does not produce the expected soothing effect, and other measures have to be adopted.

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