FEVER SUGGESTIONS.

By O. A. Palmer, M. D., Cleveland, Ohio.

It is not always an easy matter to walk over old grounds that have been tramped, criticized and discussed by the leading medical lights of the world and divide the false from the true, or the fertile soil from the non-productive. From the earliest times down to the present moment the subject of fever has been discussed, new theories advanced which were soon found untrue and the human race has gone right on suffering just the same, and few thinkers have dare! to suggest anything out of the line that is usually followed.

For a quarter of a century I have been treating fevers, quite successfully, too, I think, and yet I have been influenced all of this time largely by what has been given me by the old teachers and writers upon this subject. During the last few years we have had a better understanding of the causes of fevers given to us by capable investigators and careful thinkers, but still the medical world seems to be in a state of confusion, no more satisfactory so far as treatment is concerned than in Galen's time when he said, "A fever seems to be an elevation of temperature arising from causes that may strangely vary." Any daring genius who is a careful observer and introduces a course of treatment more or less beneficial is generally branded with irregularity.

That there is a radical need for positive knowledge in regard to the causes of fevers all will admit. To consider all of the various forms of treatment that have been used and select the good from the bad is almost a herculean task. It will be scarcely possible until we fully understand the changes that take place in the tissues, which are made up of cells in which all of these changes take place.

Taking our present knowledge as a guide we can say that a perfectly healthy body is clear of all fever, and not until one or more. functions take on deranged conditions, destroying the harmony of the perfect working body and preventing it from carrying on its cleansing work as well as nourishing the tissues, do we get conditions to cause fevers. I have always been very fond of the expression that fever is nature's own method of burning up the rubbish that accumulates in the body during the initial conditions which produce what we call a run of fever. Every physician who treats fevers starts at the bad end of the string, because the conditions that make fever are so damaging to the structures and so devitalizing in their effects upon the body that it is a hard matter to overcome the harmful effects that have already been produced. That a person suffering with fever is in a devitalized and weakened state no one can deny, that he is

charged with a large quantity of impurities and harmful material that nature is trying to excrete and destroy no one will deny.

In the way of prevention it would be wisdom so to live that we should avoid all causes of fever, but unfortunately, very few know how, and those who do know are not always so situated as to do it. Everyone versed in the laws governing the human body is well aware that the excretory organs must be capable of doing their work perfectly and the tissues should be so handled that all of the natural working ability belonging to them shall be exercised to keep clear from every harmful product.

From what has been said, I wish to make some suggestions in regard to a better management of fevers. First, the prime object of all treatments should be an immediate cleansing of the body from all chemical, bacteriological and deleterious substances that may be causes. When I look on a fever case my first thought is "What is the type of fever?" and "What are the causes?" Mention may be made of the main causes laid down by authors. There is no one pathogenic source of fever. The temperature of the body is raised in various ways, by combustion, by friction, by condensation of heat in the body. The rise of temperature or fever may be the result of combustion or an increased dehydration. The temperature may be raised by heat produced by the active life of infectious germs and by diminution of the losses of the body where the harmful material is retained. Fever may be produced by non-oxygenation. In this condition we have a still greater quantity of impurities left in the body.

All the causes of fever may be summed up into two great classes. First, fevers that are produced by impurities and imperfect cleansing; second, those that are produced by different forms of infective germs. Common-sense would teach us that in the first class as well as in the second, the cleansing processes should be the main object of all treatment. In the second class the destruction of the infectious germs should also be of the first consideration. That the medical world is in a condition to do this work there can be no doubt. Humanity goes right on suffering and dying while the medical fraternity are discussing how this cleansing and germ-destroying process should be done.

The great remedy for germs in the blood has been quinine, and it has done its work satisfactorily when properly used. The treatment for the relief of all cases not caused by germs consists in stimulating the excretory organs to as active condition as their enfeebled state will allow, at the same time administering as much water as the system will tolerate.

One great mistake in treating fevers and the most fatal that has been handed down to us from olden times is that of allowing the digestive tract to remain full of impurities to be absorbed in the system, while they should be carried off through the natural channel.

Not until I read Bouchard's great work on "Auto-Intoxication" did I dare to trample under foot what I supposed was valuable knowledge. Formerly I often wondered why nature kept up a constant discharge from the bowels in typhoid fever unless it was for some beneficial purpose. To-day I know that nature's wisdom surpassed medical practice and now I assist nature in carrying off the matter and in preventing an accumulation of material upon tissues unable to contend with an agent so destructive.

An old professor of surgery used to say, "Blood has terrorized the world, that before its shining redness millions had turned pale." I make the application of this statement to help to overcome the erroneous teachings now in existence in regard to the treatment of typhoid fever. The average practitioner's great fear is that he will have ulceration, hemorrhages, perforation, and death. Within the last fifteen years I have seen a number of cases in which this fear was the cause of nothing being done to relieve the digestive organs of the very thing that produced the destructive results. More cases will recover, and recover in one-half the time if the proper means are used to assist nature in doing what she has demonstrated ever since the disease was in existence, ought to be done.

What is the proper thing to do? Before answering this question it might be well to answer another one, "Is the typhoid bacillus truly a pathogenic cause of typhoid fever?" This organism has been known for a long time. As far back as 1871, Dr. Recklinghausen, as well as several others, and later Eberth, saw it in the form of a rod which possessed the power of changing its form frequently. This bacillus may be found in the kidneys, spleen, glands, and in the excretions from these organs.

In the majority of cases it is said that typhoid fever is transmissible, contagious. This, as has already been stated, happens by way of the drinking water. The typhoid germs that are taken in by way of the drinking water or fluids come in contact with the intestinal glands, causing lesions more or less harmful, which consist in ulceration and possibly perforation, the products of which cause more or less meteorism and fetid diarrhoea. The putrefaction that goes on in the bowels is not caused entirely by the pathogenic germ, but is caused more or less by fermentation and decomposition of materials in the intestines, these two great sources of irritation being the main causes

of the diarrhoea. The normal fæcal matter of man is toxic to a certain extent and in typhoid fever the intensity of the putrefaction may add much to the infection and it should be considered in the treatment. In many cases we have to deal with secondary infections arising from agents which are absorbed from the intestines into the blood and other tissues. There is no doubt that these infectious agents are constantly on the move, causing certain forms of abscesses as well as general breaking down of the entire system. The sudden inflammatory conditions that attack the parotid gland, the salivary ducts, the kidneys and other organs are caused by this infective matter.

It is impossible to have successful treatment based on the pathogenic view only. The destructive influence of the pathogenic germ no doubt is a great factor, but. we also have the presence of continued fever without intermission, which destroys slowly but surely. The general system is deprived of oxygen, which is one important agent for benefit and is so essential to general nutrition. The excessive temperature is very harmful to the nervous system and muscular structure. The patient has to contend not only with the direct cause of the disease, but with the harmful material within the system from which nature is so vigorously trying to free herself.

At this point I can intelligently answer the question, What is the proper thing to do? As in all other diseased conditions of the body, the first object is to remove the causes. In the case of typhoid fever, which is the great destroying fever existing at the present time, the antiseptic treatment and antiseptic laxatives should be properly used. In every instance in which I have been able to use these remedies and move the bowels every day or every other day, using sponge baths and a certain amount of diaphoretics to keep the skin a little active with the general indicated remedies, with which all are conversant, it has been an easy matter to handle this disease.

We have strong authority stating that the heat in fevers is kept up by retention. One authority says, "It is a defective distribution. of caloric." If this is true, then greater radiation of heat is the course to pursue, but lowering the temperature will not always be the means of relief because the septic condition of the general system may be sufficient to produce death. It has been proven by all of the general experiments that the skin has the power of regulating the heat of the body.

I am not a believer in the ice water or cold water treatment of fevers. It is not according to the facts known in regard to the radiation of heat. In certain cases where the sepsis is not great and the constitutional vigor is sufficient, I will admit that they can be treated

successfully by this method in spite of its baneful effects, but the main object in all cases is to overcome the septic and pyæmic disorders as well as to carry off the excessive amount of heat, so as to save the integrity of the tissues. Murri says, "The cold bath treatment physically abstracts a few degrees of heat, but afterwards favors the relaxation of the cutaneous capillaries when congestion and heating of the skin comes on." One author says, "Fever patients do not throw off carbonic acid or excrete urea when they are subjected to refrigeration." All bathing of the surface should be for the purpose of putting the skin into the best condition for the radiation of heat. The temperature of the water should not be extremely cold or hot, but nearly the normal temperature of the body preventing the action of the two extremes. The baths should be often enough to keep the skin in a condition to easily radiate heat. The use of applications to the abdomen, head and various parts of the body is very deleterious.

The diet in extreme fever cases is of very great importance, especially in typhoid, and as the body is nearly all water, nothing is so valuable as pure water. When it is remembered that the digestive tract is so seriously interfered with in its natural functions, it is folly to suppose that any food can be digested while the tract is in this condition. It has been my custom the last few years to use entirely predigested foods, giving the tract as much rest as possible and at the same time sufficient nourishment to keep the tissues in good working order. Bouchard says, "Milk, which is so easy to digest and which, from its fatty nature and its sugar, seems so well adapted to keep up the strength of fever patients and make up for the waste by combustion is not without serious drawbacks. It raises the temperature and interferes with the urinary secretion." I have never seen milk given in large quantities without aggravating the patient's condition. As I have already said I give water freely and also with it meat extracts, broths and cereals in a very digestible condition, considering these better adapted to the convalsecence than to the height of the disease.

To assist the bowels in freeing themselves of all irritating and poisonous matter, I have for some years used castor oil. It is given every day or two, enough to keep the bowels moving. In cases where. there is much diarrhoea it is not used as often. In all other cases it is used as directed above.

I cannot resist giving Dr. Lowe's findings in regard to the influence of nutrient enemas on peristalsis and secretion. He found by experiments in animals that if nutrient enemas be administered with opium, the peristaltic movements did not extend further than the ileocecal valve. Without opium they were to be observed as high as