The Temperature of the Skin
In the first place, as we know, fever is indicated by an abnormally hot skin. This
heat is noticeable even by touching the patient with the palm of the hand.
A precise measurement of this heat, of course, requires a thermometer. The best
kind is a so-called maximum thermometer.
The temperature is taken by putting the lower end of the glass into the axilla, or
arm-pit, of the arm, or in the mouth or the rectum of the patient, and leaving it there
for from 8 to 10 minutes. When withdrawn, the temperature of the patient can be
read at a glance.
The temperature of the skin, however, is not the only indication of fever. It is
accompanied simultaneously by accelerated action of the pulse, up to 120 beats per
minute, and even more; also by increased thirst and, as an indication of very intense
affection, extreme exhaustion and lassitude. The increased excretion becomes
manifest through dark and strong-smelling urine and, especially at the time when
the fever begins to abate, through intense perspiration.
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.
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