Caring for the Patient with Fever

By: Margaret Rosenthaler, R.N.

After years of encouraging the use of aspirin and Tylenol, even "regular medicine" is slowly learning that it is usually best to let pa­tients have their fever. But as we bravely try to carry out this resolve, we are plagued by spectres planted in our thoughts and feelings.

In nursing and medical schools we learn (and teach our patients, too) to look immediately for the "worst case sce­nario." Of the child who has a fever, we say, "His temperature could go so high it could destroy his brain." This way of thinking causes us to fear such challeng­ing episodes. A certain zone of comfort is reached by eliminating the fever and by preventing "any possibility of injury."

But now we learn that in order to pass through many illnesses successfully and completely, the patient needs a fe­ver. Repeated suppression of acute ill­ness often leads to chronic debility. The importance of febrile illness in promot­ing the remodeling of the body and the flexibility of normal growth and devel­opment is forfeited if fevers and inflam­mations are suppressed. How do we find the courage and clarity that enables us to deal properly with fever? To begin with, it is essential that we no longer project this "worst case scenario" into every situ­ation and that we learn a new stance in relation to our experience of illness. Let us observe with equanimity what is in front of our eyes. "What is the real con­dition of the patient now?"

In order to be able to observe accu­rately and to intervene effectively, we need to learn something about the way warmth works in the human body.

To begin with, please consider the contrast between two children living in the same family. The younger was a girl, liable to high fevers ( 105 F- oral was not unusual for her). She seemed to manage these fevers well and could be found playing with her toys, although her mother said that 'she slowed down'. Her illnesses were dramatic, but she threw them off quickly. Her older sister ran very much lower fevers (usually 101 to 102) but would become quite ill and le­thargic even at these lower ranges. Her illnesses were more prolonged. What was the main difference in the way that these two children responded to fever?

To begin to understand this, we need to comprehend a little better how warmth works in the body. Although, in the out­side world, temperatures tend to even out and to achieve a certain uniformity, in the human organism warmth varies from one part of the body to another. The or­gans of the abdomen need to be warmer. The liver, for example, is always in a kind of fever, warmth being essential for its proper activity. Muscles become warm with exercise and need warmth for proper function. One can damage muscles by using them rigorously when they are cold. On the other hand the nervous system, especially the head, is sensitive to exces­sive heat. Remember how your head felt on a day when it had been exposed to too much of the sun's heat? It ached, and thinking was especially difficult. A "hot­headed" person is not particularly a phi­losopher. When someone is thinking clearly, we say that he has a "cool head." In general there is a polarity operating between the upper and the lower parts of our organism, the upper needing to be cooler, the lower requiring warmth. This polarity is especially important for the proper functioning of the organism. And unlike the immediately perceivable physical world, our body possesses an inner activity which regulates the tem­perature of its organs.

Think again of the two children. What was the difference between them? Why did one tolerate fever better that the other? The younger girl, who tolerated the fever better, was an expert at orga­nizing the warmth in her body, at main­taining the polarity and in keeping a "cool head." The other child was conspicu­ously weak in her ability to do this.

For patients of the second type, who have difficulty with fever and tend as a result to suffer from headache, drowsi­ness, perhaps confusion, delirium, mea­sures should be taken to strengthen the polarity working in their warmth organ­ism. Their feet, often cool, should be warmed either by rubbing or with a prop­erly covered hot water bottle. For the older patient, an arnica foot and a lemon calf wrap might be needed instead to "cool" the head. (For a description of this treat­ment and many others, please refer to the book, Caring for the Sick at Home by v.Bentheim, Bos, de la Houssaye, and Visser available from the Anthroposophi­cal Press at 518-851-2054). A child with a high fever who shows no signs of dis­comfort and neurological irritability (e.g.. the first child in our example) would not need these calf wraps.

Other measures can be taken to help the fever run a healthy course. Much of this is simply traditional knowledge, lost in recent years. Fever puts the body into what is essentially a catabolic state. The fever is like a fire that "burns up our dead wood" as Dr. Philip Incao has explained. The result of this catabolism, however, is that a lot of debris or waste is created which needs to be expelled from the body. Traditionally, the first measure with a high fever was to give an enema to empty the bowel. Care needs to be taken to see that the patient has three loose stools per day. It is amazing to see how much patients with fever can elimi­nate even when they are not eating.

Urea is a major by-product of tissue destruction and urea levels, as well as the level of other waste products in the blood, rise with fever. This is responsible for a lot of the discomfort (malaise) and neu­rologic irritability during fever. Urine is often dark in color during fever because of the increased waste being cleared from the system, helping clean the blood and protecting the kidneys which are stressed under these circumstances if one encour­ages a high intake of fluids. Some phy­sicians recommend the use of Horsetail (equisitum arvense) Tea to stimulate kid­ney function.

Should the fluids one gives be warm or cold? Please consider the polarity that has been described to you. The abdo­men should be warm, the head cool. Giving cold fluids to a person, especially during fever will tend to disturb the polarity and may push more heat into the head. So, only warm, or at least room temperature, liquids should be given.

The increased urea in the blood has another aspect that concerns us. What will be the effect of feeding protein to a person with a fever? The body is in a catabolic state, so it is not particularly inclined to build up tissue. Protein eaten during a fever is mainly broken down and adds to the toxic burden of urea in the blood. It is best to provide meals free of protein, if the patient wishes to eat at all. Grains, vegetables, and fruits can be given. Don't be surprised by weight loss during fever. It is part of the process. Because the nerves are irritable from the increased warmth of the body, and as a result of the high waste levels in the blood and tissues, it is important to protect the nervous system and the senses. The en­vironment should be quiet, the lights low. Pictures which could provide a stimulus for fevered nightmares and delirium should be removed from the walls and the room should be clean and orderly to balance the inner disturbance that the patient experiences. The severe stress they place on the nerves can predispose the patient to neurological complications.

Courses in home nursing according to these methods are especially helpful and are offered by several organizations. The Anthroposophical Nurses' Association of America (215 East Main Street, Elkton, MD 21921) offers week-long courses for nurses, therapists, care givers, and the general public in this type of healing. It is particularly important to seek a physician who is supportive of your philosophy of treatment.