Fever; What to Do - and What Not to Do - When the Heat Is On

By Hecht, Annabel | FDA Consumer, November 1985 | Go to article overview

Fever; What to Do - and What Not to Do - When the Heat Is On


Hecht, Annabel, FDA Consumer


"Fever" can be a frightening word, particularly when it is part of the name of a disease, as in "yellow fever," "typhoid fever," "scarlet fever," "childbed fever," and so on. Literary descriptions of a heroine languishing with fevered brow or a hero dying of an unknown fever give the word an air of mystery, while "feverish activity" or similar phrases suggest frenzied excitement.

Unless it is very high, a fever is not to be feared. It is not a disease, simply a symptom, a warning sign that something is wrong with the body that needs investigation. A fever may even serve a useful purpose.

Fever usually occurs with a bacterial or viral infection or inflammation. Noninfectious conditions, such as thyroid and adrenal disease, dehydration in infants and the elderly, some skin conditions, stroke, cancer, and even some adverse drug reactions may also cause a fever.

The cause of some fevers, particularly in children, are not so easily pinned down. These "fevers of unknown origin," as they are called, are characterized by a rectal temperature of 101.3 degrees Fahrenheit or higher, measured on at least four occasions over a two-week period. They may often defy diagnosis for as long as a week. About half of these fevers in children are ultimately found to be caused by infections; 20 percent are caused by collagen inflammatory diseases, such as juvenile rheumatoid arthritis; and 10 percent are the result of cancer, primarily leukemia. The remainder are of miscellaneous or truly unknown origins.

That fever is associated with disease has been known and accepted for centuries. However, views on waht should be done about it have not been as consistent. Ancient medical savants looked upon fever as something to be encouraged. It was considered the most important of the body's natural defenses against increases of phlegm, one of the four "humors" of ancient physiology. (An overabundance of phlegm was associated with apathy and indolence.) The 17th century English physician Thomas Sydenham called fever "nature's engine," brought to the field to fight the enemy.

Medical attitudes toward fever changed in the 19th century when the French physiologist Claude Bernard reported that death in experimental animals quickly occurred when the body temperature rose to more than 107 degrees Fahrenheit. From then on, fever was deemed injurious to health and was treated vigorously with antipyretics--fever-reducing drugs--and "heroic measures" such as bleeding.

In modern medicine, the focus is on finding out what is causing the fever and treating that illness, rather than on treating the fever itself. Of course, if the fever results in severe weakness, causes major symptoms such as convulsions or dehydration, or is affecting the central nervous system, the doctor will take steps to reduce it, whether or not the cause has been discovered.

There are some very good reasons for not treating a fever. For one, ther is some evidence that a fever may play a role in stimulating the body's natural defenses. The ups and downs of a fever also help in diagnosing an illness and following its course. And fever also help in diagnosing an illness and following its course. And fever is often the only way to determine whether a particular treatment is working. If a patient is on an antibiotic, for instance, a persistent fever would indicate that the drug is probably not effective and that an alternative should be used.

A number of recent studies involving parents of young children have shown that the old fears about the dangers of fever still persist. Several researchers have dubbed this parental concern "fever phobia."

In general, the studies revealed that parents worry a lot about fever and its possible harmful effects. They do not understand what constitutes a "high fever," they fear that if the fever isn't treated it will continue to rise to dangerous levels, and they believe that even moderately high temperatures could cause permanent harm, such as "brain damage.

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