Choice gleanings.

The Reduction of Temperature in Children.

The available means of reducing temperature in diseases of children (when necessary to do so) may be classed as medicinal and non-medicinal. Among the latter are baths and mechanical methods of producing diaphoresis (as adding more clothing, the hot water bottle, and other means of external heat, the pediluvia, etc.,). The medicinal treatment consists in the administration of such medicines as are known to directly, or indirectly, influence the production of heat, and of such as promote elimination by way of the gastro-intestinal tract, the skin and the kidneys.

The eclectic specific medicationist is fortunate in having at his command safe and effective remedies for these purposes. These do not include the coal tar antipyretics, which are but rarely used by him, though they are unstintedly employed and recommended by teachers and practitioners of high repute in the dominant school of practice.

When elevation of the temperature in children is caused by the ingestion of improper or unwholesome food, or by immoderate quantities, or more than the stomach can digest, then the best method of treatment is elimination. If nature has not already asserted her prerogative and the tongue is heavily coated at the base, and there is nausea, a liberal dose of ipecac, or of common salt and bicarbonate of sodium, may promptly give relief. We have seen a violent headache, with high temperature, both relieved by this method in merely the time taken to produce emesis.

If there are no indications for the emetic, then the bowels should be cleansed with neutralizing cordial (glyconda), syrup of rhubarb, castor oil, or a solution of citrated magnesia. Our old school friends employ calomel and soda largely for this purpose. The action of the purgative should be aided by thoroughly flushing out the lower bowels by means of copious soapy enemata. Here the fever is most likely due to faulty digestion or acute indigestion, giving rise to toxaemia. Careful feeding should follow during the next few days.

Other cases of elevated temperature may be reduced by aiding elimination by way of the skin. Here the special sedatives, together with such aids as jaborandi or asclepias, may be used. Many cases are best relieved by baths, of which there are many kinds. The most universally satisfactory to us has been the tepid sponge bath, repeated gently as needed, without greatly exciting the patient. The cold pack is effective but must be intelligently applied by the nurse. Yet, in many instances, the shock to the little patient more than outweighs the good that we might hope to accomplish by it. The tepid bath, with gentle fanning, has been far preferable to other forms of the bath with us for the gradual and effectual reduction of temperature.

The drugs that aid us in reducing temperature are to be used strictly according to indications, only when clearly indicated, and not haphazardly. Much harm can be done by the reckless or injudicious use of antipyretics. In fact, sometimes it is better to reduce temperature in a roundabout way than by the use of the sedatives. As a rule, however, the "special sedatives," so-called, of Eclectic therapeutics, are of prime importance in the treatment of febrile states of children. It is well, however, before their use, to see that the general condition of the system is such as to insure their kindly action. Sometimes the tongue and membranes show the decided deep red color and the tongue is contracted and small. Here hydrochloric acid will prepare the way for the selected sedative, or, perhaps, will control the temperature without the aid of the latter. The same is true of the indication for alkaline treatment. The pallid membranes and broad white tongue show unmistakably the need of sodium bicarbonate, or, if a mawkish fetor be present, of sodium sulphite. The indications for an emetic are also plain and should be heeded before the special sedatives can be made to operate kindly.

The medicinal agents that are best known to combat excess of temperature, with their specific indications, are as follow: Aconite is, without doubt, the most frequently indicated of the arterial sedatives. Used with judgment and according to indications it will prove beneficial and is very prompt to control temperature. In the long continued fevers and where the temperature is excessively high, it is less valuable than gelsemium or veratrum, both of which are more generally indicated in high temperature on account of the excitation present and usually its sudden occurrence. The indication, the small frequent pulse with elevation of temperature, is the unerring guide for the selection of aconite. So kindly is its action generally, that it has long since been known as the child's sedative.

The dose given has frequently been too large, for when indicated it acts kindly in the minute dose. From one to three drops of specific aconite in a half-glass of water, the dose of which is a teaspoonful every one to two hours, is plenty for a child under seven years of age. Infants frequently suffer from the tingling sensation imparted to the mouth by aconite and roll the head and cry as if afflicted with the earache. A weak wash of vinegar and water will often relieve this; if it does not, then the sedative must be discontinued.

Veratrum is less frequently demanded in the fevers of childhood than aconite, yet we have seen it indicated throughout the greater part of a typhoid. Like aconite, in all the continued fevers its use is not likely to prove beneficial as long as some other remedies, as rhus or baptisia. With the full, bounding pulse and sthenic condition, however, no remedy is more decided or pleasing in action, nor is any other more efficient to bring down a high temperature suddenly occurring at the outset of an attack of illness. As with aconite, the smallest dose capable of producing results should be used; then heart depression is not likely to be produced by it. Five drops of specific veratrum to a half-glass of water, of which the dose is a teaspoonful every one to two hours, is sufficient.

Gelsemium is the child's remedy when there is violent throbbing of the carotids, a rapid pulse, and great nervous excitation. The child trembles, the face is flushed, and the eyes brilliant and staring, with contracted pupils. The heat may be intense, and as the nervous tension is brought under control the heat diminishes, relaxation takes place, and rest replaces the nervous agitation. From ten to twenty drops of specific gelsemium to one-half glass of water, in teaspoonful doses every one-half to two hours, is the average prescription for the child.

Belladonna is frequently a remedy to control febrile processes accompanied with pain and dryness of the skin. The patient is dull and apathetic, may be extremely pale, has dilated pupils, the secretions are restrained, and there is a strong tendency to sleep. The remedy is usually administered with minute doses of aconite. As secretion becomes re-established and the pupils approach the normal, the nervous system reacts and the temperature is reduced. Belladonna is an ideal remedy in the fevers of childhood and may be often needed throughout the whole of a long course of fever, to sustain the circulation and respiration. From three to five drops of specific belladonna may be added to a half glass of water, the dose of which is one teaspoonful every one-half to two hours.

Asclepias is an agent of great value when the febrile processes can be broken, by the production of diaphoresis. It is best adapted to the reduction of heat in respiratory affections, and is indicated by the vibratile quick pulse, with hot skin, showing a tendency to moisture. From one to two drachms of specific asclepias may be added to a half glass of water, or added to the special sedative, or given in hot water. Of such a mixture the dose is usually a teaspoonful.

Bryonia is frequently of service in controlling temperature, particularly if occurring as a part of acute rheumatism, or inflammation of the serous membranes, or of the respiratory tract. It may be given with the indicated sedative, and will be particularly effective if there is frontal headache, a sharp vibratile pulse, and pain of a lancinating character. Five drops of specific bryonia should be added to a glass of water, the dose of which is a teaspoonful.

Jaborandi proves an important agent when there is evident lack of action on the secretory glands. When indicated, it is one of the most valued of diaphoretics. Like veratrum, it is a remedy for sthenic fevers and inflammation, and is indicated by the full, hard pulse with marked dryness of the skin and membranes. As a remedy for painful inflammatory affections and in dry throat inflammations it fulfills a useful purpose. Care should be had not to carry its action to emesis. From five to twenty drops of specific jaborandi may be added to half a glass of water, of which the dose is a teaspoonful every one or two hours.

Rhus, perhaps more than any other remedy except aconite, belladonna and gelsemium, is most often indicated in the fevers of childhood. There is a nervous element in the cases requiring rhus, that makes it specifically indicated. The patient is very restless, inclined to delirium, starts suddenly from a sleep with a cry, as if frightened. There is frontal headache, the characteristic long-pointed tongue, with prominent papillae, and the whole condition is one of hypersesthesia. Here rhus will give eminent satisfaction. Add five to ten drops of specific rhus to a half glass of water and administer of the solution so made a teaspoonful every one-half hour to two hours.

Arnica occasionally proves a useful remedy to control temperature. It may be used where there is a lack of nerve power, and the pulse is rapid and pain simulating that of a bruise is present. Add five to ten drops of specific arnica to half a glass of water, the dose of which is a teaspoonful every hour. Or it may be required in connection with the special sedatives.

Baptisia, though not directly an antipyretic, has such a control over the typhoid element, that it often proves a valuable aid on lowering temperature. The dusky membranes and skin, the appearance as of having been chilled or frozen, and the prune juice alvine discharges, point directly to it as a remedy. From ten to thirty drops of specific baptisia may be added to a half glass of water, the dose of which is a teaspoonful every one or two hours.

Echinacea, like baptisia, has little control directly over the temperature, but is employed to combat the blood dyscrasia and the typhoid element in the adynamic continued fevers. It is doubly efficient if the fever be due to sepsis of any form. Drop doses of specific echinacea or of echafolta may be given frequently in the drinking water furnished the child.

Quinine is a valuable though much abused remedy for lowering temperature. If selected when there is marked periodicity, and the tongue, membranes, and skin incline to moisture, and there is but little nervous excitation, it will act promptly and kindly. In opposite conditions it is nearly always sure to aggravate the condition.

A state favorable to its action may sometimes be brought about by the employment of gelsemium or aconite, according to indications. Then the condition of periodicity is more readily reached by the cinchona salt. We prefer the acid solution, prepared as follows: Take of quinine sulphate one dram, hydrochloric acid one dram, water sufficient to make four ounces. This gives practically two grains to the teaspoonful, which is quite sufficient for a child when the drug is well indicated. It may be repeated every three to six hours, according to the needs of the case. The quinine inunction is an admirable method of administering quinine to infants.

Editorial, Eclectic Med. Gleaner.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.