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.