From Adrian Jones, Paediatric Gastroenterology and Nutrition, University of Alberta
Your article on the benefits of not treating fever prompted a déjà vu moment for me (31 July, p 42). In 1972, a small group of chairs of US academic paediatric departments – and me, a youngster from Canada – took part in a three-day workshop entitled “Management of fever” at the Centers for Disease Control in Atlanta, Georgia.
It was decided that treatment for fever should not be implemented before a patient’s temperature reached 104 °F (40 °C). This was subsequently presented at my medical school, but with little effect. About a decade later, the paediatric residents also presented similar data to show that treatment below that level was rarely necessary, again to little effect. The chief obstacles were nurses and older physicians, who wanted to feel that they were providing treatment. At least we managed to get rid of the alcohol baths, cold baths and cold compresses.
As a retired paediatric gastroenterologist, I have seen a number of children treated repetitively with acetaminophen (paracetamol) but with inadequate fluid intake, who developed hepatic toxicity, and one liver transplant patient who eventually required a second new liver after acetaminophen management of a spiking fever.
I agree with your article wholeheartedly. Antipyretics like acetaminophen or ibuprofen may be used with discretion for evident discomfort, but fever has therapeutic effects in the body, and getting rid of it only requires the body to use a considerable amount of energy to push the temperature back up when the drug wears off.
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Some hospital burns units raise the room temperature to about 28 °C to help burns patients, who maintain a normal body temp of about 38 °C while in the early stages of healing. Now that’s forward thinking.
From George Mills
The Zulus in South Africa were known, at the first sign of malarial fever, to cover themselves with blankets and skins and lie in the sun for a whole day, to raise their body temperature as high as possible. The claimed result was a full cure by the following day.
This type of treatment was recorded by writers like Henry Rider Haggard in his book King Solomon’s Mines. Having no idea they were recording unique medical practice, such authors simply threw in these observations as interesting background information to give an exotic flavour to the story.
Early missionary doctors like David Livingstone introduced western medicine and put a stop to these alternative treatments, which might yet be resurrected.
Topsham, Exeter, UK
Edmonton, Alberta, Canada
