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Fever

Fever

Definition

A fever is any body temperature elevation over 100.4°F (38°C).

Description

A healthy person's body temperature fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C). The body maintains stability within this range by balancing the heat produced by the metabolism with the heat lost to the environment. The "thermostat" that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body's temperature to the thermostat, which in turn activates different physical responses designed to cool or warm the body, depending on the circumstances. These responses include: decreasing or increasing the flow of blood from the body's core, where it is warmed, to the surface, where it is cooled; slowing down or speeding up the rate at which the body turns food into energy (metabolic rate); inducing shivering, which generates heat through muscle contraction; and inducing sweating, which cools the body through evaporation.

A fever occurs when the thermostat resets at a higher temperature, primarily in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The chills that often accompany a fever are caused by the movement of blood to the body's core, leaving the surface and extremities cold. Once the higher temperature is achieved, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen have been taken, the thermostat resets to normal and the body's cooling mechanisms switch on: the blood moves to the surface and sweating occurs.

Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. The immune system chemicals that react with the fever-inducing agent and trigger the resetting of the thermostat also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria, while at the same time speeding up the chemical reactions that help the body's cells repair themselves. In addition, the increased heart rate that may accompany the changes in blood circulation also speeds the arrival of white blood cells to the sites of infection.

Demographics

Fevers are components of many disease entities. Virtually all persons experience fevers at some time in their lives. Elevations in temperature are not reportable events. Thus, accurate data regarding the prevalence of fevers are not available.

Causes and symptoms

Fevers are primarily caused by viral or bacterial infections, such as pneumonia or influenza . However, other conditions can induce a fever, including allergic reactions; autoimmune diseases; trauma, such as breaking a bone; cancer ; excessive exposure to the sun; intense exercise ; hormonal imbalances; certain drugs; and damage to the hypothalamus. When an infection occurs, fever-inducing agents called pyrogens are released, either by the body's immune system or by the invading cells themselves that trigger the resetting of the thermostat. In other circumstances, the immune system may overreact (allergic reactions) or become damaged (autoimmune diseases), causing the uncontrolled release of pyrogens. A stroke or tumor can damage the hypothalamus, causing the body's thermostat to malfunction. Excessive exposure to the sun or intense exercise in hot weather can result in heat stroke, a condition in which the body's cooling mechanisms fail. Malignant hyperthermia is a rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

How long a fever lasts and how high it may go depends on several factors, including its cause, the age of the person, and his or her overall health. Most fevers caused by infections are acute, appearing suddenly and then dissipating as the immune system defeats the infectious agent. An infectious fever may also rise and fall throughout the day, reaching its peek in the late afternoon or early evening. A low-grade fever that lasts for several weeks is associated with autoimmune diseases such as lupus or with some cancers, particularly leukemia and lymphoma.

When to call the doctor

A doctor or other healthcare provider should be called when a fever does not resolve after two to three days. Anyone with a fever over 104°F (40.0°C) should seek immediate medical treatment.

A doctor should be called when an infant's temperature rises above 100°F (37.8°C) and cannot be brought down within a few minutes. Infants whose temperatures exceed 102°F (38.9°C) should be immersed in warm or tepid water to help reduce temperature slowly, while waiting for emergency help to arrive.

Diagnosis

A fever is usually diagnosed using a thermometer. A variety of different thermometers are available. Glass thermometer should not be used since they can break and release mercury, which is toxic. Digital thermometers can and should be used in place of glass thermometers rectally, orally, and under the arm in all age groups. Electronic thermometers can be inserted in the ear to quickly register the body's temperature.

As important as registering a person's temperature is determining the underlying cause of the fever. The presence or absence of accompanying symptoms, a person's medical history, and information about what he or she may have ingested, any recent trips taken, or possible exposures to illness all help the physician make a diagnosis. Blood tests can aid in identifying an infectious agent by detecting the presence of antibodies against it or providing samples for growth of the organism in a culture. Blood tests can provide the doctor with white blood cell counts. Ultrasound tests, magnetic resonance imaging (MRI) tests, or computed tomography (CT) scans may be ordered if the doctor cannot readily determine the cause of a fever.

Treatment

Physicians agree that the most effective treatment for a fever is to address its underlying cause, such as through the administration of antibiotics . Also, because a fever helps the immune system fight infection, it usually should be allowed to run its course. Drugs to lower fever (antipyretics) can be given if a person (particularly a child) is uncomfortable. These include acetaminophen and ibuprofen. Aspirin, however, should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of Reye's syndrome . Bathing a person in tepid water can also help alleviate a high fever.

A fever requires emergency treatment under the following circumstances:

  • newborn (three months or younger) with a fever over 100.5°F (38°C)
  • infant or child with a fever over 103°F (39.4°C)
  • fever accompanied by severe headache , neck stiffness, mental confusion, or severe swelling of the throat

A very high fever in a small child can trigger seizures (febrile seizures ) and, therefore, should be treated immediately. A fever accompanied by the above symptoms can indicate the presence of a serious infection, such as meningitis , and should be brought to the immediate attention of a physician.

KEY TERMS

Antipyretic drug Medications, like aspirin or acetaminophen, that lower fever.

Autoimmune disorder One of a group of disorders, like rheumatoid arthritis and systemic lupus erythematosus, in which the immune system is overactive and has lost the ability to distinguish between self and non-self. The body's immune cells turn on the body, attacking various tissues and organs.

Febrile seizure Convulsions brought on by fever.

Hyperthermia Body temperature that is much higher than normal (i.e. higher than 98.6°F).

Malignant hyperthermia A type of reaction (probably with a genetic origin) that can occur during general anesthesia and in which the patient experiences a high fever, muscle rigidity, and irregular heart rate and blood pressure.

Meningitis An infection or inflammation of the membranes that cover the brain and spinal cord. It is usually caused by bacteria or a virus.

Metabolism The sum of all chemical reactions that occur in the body resulting in growth, transformation of foodstuffs into energy, waste elimination, and other bodily functions. These include processes that break down substances to yield energy and processes that build up other substances necessary for life.

Pyrogen A chemical circulating in the blood that causes a rise in body temperature.

Reye's syndrome A serious, life-threatening illness in children, usually developing after a bout of flu or chickenpox, and often associated with the use of aspirin. Symptoms include uncontrollable vomiting, often with lethargy, memory loss, disorientation, or delirium. Swelling of the brain may cause seizures, coma, and in severe cases, death.

Prognosis

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen, and these fevers do not produce lasting effects. The prognosis for fevers associated with more chronic conditions, such as autoimmune disease, depends upon the overall outcome of the disorder.

Prevention

Fevers may be prevented by avoiding the various diseases that cause them.

Nutritional concerns

Adequate nutrition via a well-balanced diet and sufficient intake of liquid help to reduce many fevers. Adequate intake of electrolytes such as sodium, chloride, potassium, phosphate, and bicarbonate helps to prevent dehydration that often accompanies a fever.

Parental concerns

Parents should carefully monitor their infants and young children for symptoms of fever. Any fever that exceeds 103°F (39.4°C) for more than a few minutes should be promptly treated.

Resources

BOOKS

Barlam, Tamar F., and Dennis L. Kasper. "Approach to the Acutely Ill Infected Febrile Patient." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 95101.

Beutler, Bruce, and Steven M. Beutler. "The Pathogenesis of Fever." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 173032.

Bisno, Alan L. "Rheumatic Fever." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 178893.

Dale, David C. "The Febrile Patient." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 172930.

Dinarello, Charles A., and Jeffrey A. Gelfand. "Fever and Hyperthermia." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 914.

Dumler, J. Stephen. "Q Fever (Coxiella burnetii)." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 100910.

. "Spotted Fever Group Rickettsioses." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 9991003.

Halstead, Scott B. "Yellow Fever." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 10956.

. "Dengue Fever and Dengue Hemorrhagic Fever." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 10924.

Kaye, Elaine T., and Kenneth M. Kaye. "Fever and Rash." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 95101.

Powell, Keith R. "Fever without a Focus." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 8415.

. "Fever." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 83940.

PERIODICALS

Dinarello, C. A. "Infection, fever, and exogenous and endogenous pyrogens: some concepts have changed." Journal of Endotoxin Research 10, no. 4 (2004): 20122.

Galache, C., et al. "Q fever: a new cause of 'doughnut' granulomatous lobular panniculitis." British Journal of Dermatology 151, no. 3 (2004): 6857.

Huang, S. Y., et al. "Effect of Recent Antipyretic Use on Measured Fever in the Pediatric Emergency Department." Archives of Pediatric and Adolescent Medicone 158, no. 10 (2004): 9726.

ORGANIZATIONS

American Academy of Emergency Medicine. 611 East Wells St., Milwaukee, WI 53202. Web site: <www.aaem.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/>.

American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, VA 22102. Web site: <naturopathic.org/>.

American Society of Clinical Pathologists. 2100 West Harrison Street, Chicago IL 60612. Web site: <www.ascp.org/index.asp>.

College of American Pathologists. 325 Waukegan Road, Northfield, IL 60093. Web site: <www.cap.org/>.

Meningitis Foundation of America Inc. 7155 Shadeland Station, Suite 190, Indianapolis, IN 462563922. Web site: <www.musa.org/default.htm>.

WEB SITES

"Fever." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/ency/article/003090.htm> (accessed January 6, 2005).

"Typhoid Fever." Centers for Disease Control and Prevention. Available online at <www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm> (accessed January 6, 2005).

"Yellow Fever." Centers for Disease Control and Prevention. Available online at <www.cdc.gov/travel/diseases/yellowfever.htm> (accessed January 6, 2005).

"Yellow Fever." World Health Organization. Available online at <www.who.int/csr/disease/yellowfev/en/> (accessed January 6, 2005).

L. Fleming Fallon Jr., MD, DrPH

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Fever

Fever

Definition

A fever is a rise in body temperature to greater than 100°F (37.8°C).

Description

A healthy person's body temperature fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C). The body maintains stability within this range by balancing the heat produced by the metabolism with the heat lost to the environment. The "thermostat" that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body's temperature to the thermostat. In turn, the thermostat activates different physical responses designed to cool or warm the body, depending on the circumstances. These responses include:

  • decreasing or increasing the flow of blood from the body's core, where it is warmed, to the surface, where it is cooled
  • slowing down or speeding up the rate at which the body turns food into energy (metabolic rate)
  • inducing shivering, which generates heat through muscle contraction
  • inducing sweating, which cools the body through evaporation

A fever occurs when the body's thermostat resets at a higher temperature, which primarily happens in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The chills that often accompany a fever are caused by the movement of blood to the body's core, which leaves the surface and extremities cold. Once the body reaches the higher temperature, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen (Tylenol) have

been taken, the thermostat resets to normal. When this happens, the body's cooling mechanisms switch on. The blood moves to the surface and sweating occurs.

Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. Certain chemicals in the immune system react with the fever-inducing agent and trigger the resetting of the thermostat. These immune system chemicals also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria and speed up the chemical reactions that help the body's cells repair themselves. Changes in blood circulation may cause the heart rate to increase, which speeds the arrival of white blood cells to the sites of infection.

Causes & symptoms

Fevers are primarily caused by viral or bacterial infections , such as pneumonia or influenza . However, other conditions can induce a fever, including these:

  • allergic reactions
  • autoimmune diseases
  • trauma, such as breaking a bone
  • cancer
  • excessive exposure to the sun
  • intense exercise
  • hormonal imbalances
  • certain drugs
  • damage to the hypothalamus

When an infection occurs, fever-inducing agents called pyrogens are released, either by the body's immune system or by the invading cells themselves. These pyrogens trigger the resetting of the thermostat. In other circumstances, an uncontrolled release of pyrogens may occur when the immune system overreacts due to an allergic reaction or becomes damaged due to an autoimmune disease. A stroke or tumor can damage the hypothalamus, causing the body's thermostat to malfunction. Excessive exposure to the sun or intense exercise in hot weather can result in heat stroke, a condition in which the body's cooling mechanisms fail. Malignant hyperthermia is a rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

A recent study showed that most parents have misconceptions about fever and view it as a disease rather than a symptom. How long a fever lasts and how high it may go depend on several factors, including its cause and the patient's age and overall health. Most fevers caused by infections are acute, appearing suddenly and then dissipating as the immune system defeats the infectious agent. An infectious fever may also rise and fall throughout the day, reaching its peak in the late afternoon or early evening. A low-grade fever that lasts for several weeks is associated with autoimmune diseases such as lupus or with some cancers, particularly leukemia and lymphoma.

Diagnosis

A fever is usually diagnosed using a thermometer. A variety of different thermometers are available, including traditional oral and rectal thermometers made of glass and mercury, and more sophisticated electronic ones that can be inserted in the ear. For adults and older children, temperature readings are usually taken orally. Younger children who cannot or will not hold a thermometer in their mouths can have their temperatures taken by placing an oral thermometer under their armpits. Infants generally have their temperature taken rectally using a rectal thermometer.

As important as registering a patient's temperature is determining the underlying cause of the fever. The physician can make a diagnosis by checking for accompanying symptoms and by reviewing the patient's medical history, any recent trips he or she has taken, what he or she may have ingested, or any illnesses he or she has been exposed to. Blood tests hold additional clues. Anti-bodies in the blood point to the presence of an infectious agent, which can be verified by growing the organism in a culture. Blood tests can also provide the doctor with white blood cell counts. Ultrasound tests, magnetic resonance imaging (MRI) tests, or computed tomography (CT) scans may be ordered if the doctor cannot readily determine the cause of a fever.

Treatment

Often, doctors must remind patients, especially parents, not to "overtreat" low fevers but to remember that they are symptoms of an underlying disease or condition. Alternative therapies for treatment of fever focus not only on reducing fever but also on boosting the immune function to help the body fight infections more effectively. They include nutritional therapy, herbal therapy and traditional Chinese medicine .

Nutritional therapy

Naturopaths often recommend that patients take high doses of vitamin C to ward off diseases and prevent fever. In addition to vitamin C, other antioxidants such as vitamin A and zinc also boost the immune function. Naturopaths may also suggest reducing sugar intake (even fruit juices) because sugar depresses the immune system. To replace fluid that is lost during fever, patients are advised to drink vegetable juices and eat soups.

Herbal therapy

Western herbalists use tea preparations containing herbs such as bupleurum root or boneset to reduce fever. Mild herbs such as peppermint , elderflower, or yarrow can provide comfort to the child who has a mild fever. Others believe in sweating a fever out, literally. They often recommend that patients take hot baths to induce sweating. This helps induce or increase fever, which is believed to help the body get rid of infections.

Chinese medicine (TCM) offers many herbs and formulas for fevers. There are many distinct kinds of fevers, also called heat syndromes. For example, an excess-heat syndrome is characterized by a high fever, great thirst, and lots of sweating. Deficiency heat syndrome is characterized by a low-grade fever with afternoon fevers or night sweats. For excess heat, herbs that are dispersing and cold in nature are used. For chronic and low-grade fevers, herbs that tonify the yin (cooling aspect) are used as well as herbs that get rid of heat. There are even herbs such as bupleurum root (called Chai Hu in TCM) that are used for intermittent fevers or conditions alternating between fever and chills. Alternating fevers and chills occur in malaria , conditions connected to AIDS, chronic fatigue syndrome , and Epstein-Barr virus. The individual pattern should be diagnosed by a trained practitioner.

Aromatherapy

Patients can reduce feverish symptoms by inhaling essential oils of camphor, eucalyptus , lemon, and hyssop . These oils can also be mixed with an unscented body lotion or a vegetable oil for aromatherapy massage.

Homeopathy

Homeopathic doctors may prescribe herbal remedies based on the patient's overall personality profile as well as specific symptoms.

Allopathic treatment

Physicians agree that the most effective treatment for a fever is to address its underlying cause. Also, because a fever helps the immune system fight infection, some clinicians suggest it be allowed to run its course. Drugs to lower fever (antipyretics) can be given if a patient (particularly a child) is uncomfortable. These include aspirin, acetaminophen (Tylenol), and ibuprofen (Advil). Aspirin, however, should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of Reye's syndrome. Sponging a child or infant with tepid (lukewarm) water can also help reduce mild fevers.

A fever requires emergency treatment under the following circumstances:

  • Newborn (three months or younger) with a fever above 100.5°F (38°C).
  • Infant or child with a fever above 103°F (39.4°C). A very high fever in a small child can trigger seizures (febrile seizures) and therefore should be treated immediately.
  • Fever accompanied by severe headache , neck stiffness, mental confusion, or severe swelling of the throat. A fever accompanied by these symptoms can indicate the presence of a serious infection, such as meningitis , and should be brought to the immediate attention of a physician.

Expected results

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen. Most fevers do not produce any lasting effects. The prognosis for fevers associated with more chronic conditions, such as autoimmune disease, depends upon the overall outcome of the disorder.

Resources

BOOKS

Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders, 1996.

"Children's Health." In Alternative Medicine: The Definitive Guide, compiled by The Burton Goldberg Group. Tiburon, CA: Future Medicine Publishing, 1999.

"Fever and Chills." In Reader's Digest Guide to Medical Cures and Treatment. New York: Reader's Digest Association, 1996.

Gelfand, Jeffrey, et al. "Fever, Including Fever of Unknow Origin." In Harrison's Principles of Internal Medicine, edited by Kurt Isselbacher, et al. New York: McGraw-Hill, 1997.

Tierney, Lawrence M., M.D., et al., eds. Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.

PERIODICALS

Bernath, Vivienne F."Tepid Sponging and Paracetamol for Reduction of Body Temperature in Febrile Children." The Medical Journal of Australia (February 4, 2002):130.

Huffman, Grace B. "Parental Misconceptions about Fever in Children." American Family Physician (February 1, 2002):482.

Mai Tran

Teresa G. Odle

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Fever

Fever

Definition

A fever is any body temperature elevation over 100 °F (37.8 °C).

Description

A healthy person's body temperature fluctuates between 97 °F (36.1 °C) and 100 °F (37.8 °C), with the average being 98.6 °F (37 °C). The body maintains stability within this range by balancing the heat produced by the metabolism with the heat lost to the environment. The "thermostat" that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body's temperature to the thermostat, which in turn activates different physical responses designed to cool or warm the body, depending on the circumstances. These responses include: decreasing or increasing the flow of blood from the body's core, where it is warmed, to the surface, where it is cooled; slowing down or speeding up the rate at which the body turns food into energy (metabolic rate); inducing shivering, which generates heat through muscle contraction; and inducing sweating, which cools the body through evaporation.

A fever occurs when the thermostat resets at a higher temperature, primarily in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The "chills" that often accompany a fever are caused by the movement of blood to the body's core, leaving the surface and extremities cold. Once the higher temperature is achieved, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen (Tylenol) have been taken, the thermostat resets to normal and the body's cooling mechanisms switch on: the blood moves to the surface and sweating occurs.

Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. The immune system chemicals that react with the fever-inducing agent and trigger the resetting of the thermostat also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria, while at the same time speeding up the chemical reactions that help the body's cells repair themselves. In addition, the increased heart rate that may accompany the changes in blood circulation also speeds the arrival of white blood cells to the sites of infection.

Causes and symptoms

Fevers are primarily caused by viral or bacterial infections, such as pneumonia or influenza. However, other conditions can induce a fever, including allergic reactions; autoimmune diseases; trauma, such as breaking a bone; cancer ; excessive exposure to the sun; intense exercise; hormonal imbalances; certain drugs; and damage to the hypothalamus. When an infection occurs, fever-inducing agents called pyrogens are released, either by the body's immune system or by the invading cells themselves, that trigger the resetting of the thermostat. In other circumstances, the immune system may overreact (allergic reactions) or become damaged (autoimmune diseases), causing the uncontrolled release of pyrogens. A stroke or tumor can damage the hypothalamus, causing the body's thermostat to malfunction. Excessive exposure to the sun or intensely exercising in hot weather can result in heat stroke, a condition in which the body's cooling mechanisms fail. Malignant hyperthermia is a rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

How long a fever lasts and how high it may go depends on several factors, including its cause, the age of the patient, and his or her overall health. Most fevers caused by infections are acute, appearing suddenly and then dissipating as the immune system defeats the infectious agent. An infectious fever may also rise and fall throughout the day, reaching its peek in the late afternoon or early evening. A low-grade fever that lasts for several weeks is associated with autoimmune diseases such as lupus or with some cancers, particularly leukemia and lymphoma.

Diagnosis

A fever is usually diagnosed using a thermometer. A variety of different thermometers are available, including traditional glass and mercury ones used for oral or rectal temperature readings and more sophisticated electronic ones that can be inserted in the ear to quickly register the body's temperature. For adults and older children, temperature readings are usually taken orally. Younger children who cannot or will not hold a thermometer in their mouths can have their temperature taken by placing an oral thermometer under their armpit. Infants generally have their temperature taken rectally using a rectal thermometer.

As important as registering a patient's temperature is determining the underlying cause of the fever. The presence or absence of accompanying symptoms, a patient's medical history, and information about what he or she may have ingested, any recent trips taken, or possible exposures to illness help the physician make a diagnosis. Blood tests can aid in identifying an infectious agent by detecting the presence of antibodies against it or providing samples for growth of the organism in a culture. Blood tests can also provide the doctor with white blood cell counts. Ultrasound tests, magnetic resonance imaging (MRI) tests, or computed tomography (CT) scans may be ordered if the doctor cannot readily determine the cause of a fever.

Treatment

Physicians agree that the most effective treatment for a fever is to address its underlying cause, such as through the administration of antibiotics. Also, because a fever helps the immune system fight infection, it usually should be allowed to run its course. Drugs to lower fever (antipyretics) can be given if a patient (particularly a child) is uncomfortable. These include aspirin, acetaminophen (Tylenol), and ibuprofin (Advil). Aspirin, however, should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of Reye's syndrome. Bathing a patient in cool water can also help alleviate a high fever.

A fever requires emergency treatment under the following circumstances:

  • newborn (three months or younger) with a fever over 100.5 °F (38 °C)
  • infant or child with a fever over 103 °F (39.4 °C)
  • fever accompanied by severe headache, neck stiffness, mental confusion, or severe swelling of the throat

A very high fever in a small child can trigger seizures (febrile seizures) and therefore should be treated immediately. A fever accompanied by the above symptoms can indicate the presence of a serious infection, such as meningitis, and should be brought to the immediate attention of a physician.

Prognosis

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen and do not produce any lasting effects. The prognosis for fevers associated with more chronic conditions, such as autoimmune disease, depends upon the overall outcome of the disorder.

Resources

BOOKS

Gelfand, Jeffrey. "Fever, Including Fever of Unknown Origin." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

KEY TERMS

Antipyretic A drug that lowers fever, like aspirin or acetaminophen.

Autoimmune disease Condition in which a person's immune system attacks the body's own cells, causing tissue destruction.

Febrile seizure Convulsions brought on by fever.

Malignant hyperthermia A rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

Meningitis A potentially fatal inflammation of the thin membrane covering the brain and spinal cord.

Metabolism The chemical process by which the body turns food into energy, which can be given off as heat.

Pyrogen A chemical circulating in the blood that causes a rise in body temperature.

Reye's syndrome A disorder principally affecting the liver and brain, marked by the rapid development of life-threatening neurological symptoms.

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Fever

Fever

Description

Normal body temperature varies somewhat from one individual to another but displays a general range and pattern around the "normal" temperature of 98.6°F. Early morning body temperature may be as low as 97°F, and as high as 99.3°F in the afternoon hours yet still be considered normal. Higher temperatures may be observed in healthy people, but an abnormal elevation (pyrexia) is classified as hyperthermia , or fever. Fever results from a failure in the body's ability to regulate and dissipate heat. Any fever presents an unpleasant and uncomfortable state for the patient. Fever may cause the patient to experience fatigue , chills, sweats, nausea, andin some caseslife-threatening conditions. When fevers occur in the elderly or the very young, the effects can be more harmful than in individuals who fall between those two age groups. The elderly may experience poor blood circulation, heart failure, an irregular heartbeat, or mental episodes. Children may lapse into fever-induced seizures. It is possible to treat fever with lukewarm sponge baths or bathing, removing excess clothing or bedding, and increasing the patient's fluid intake; however an important treatment is medication that lowers the body temperature to its normal range.

Causes

Fever associated with cancer can generally be categorized into four major causal groups: infection, tumors, allergic reactions to a drug, or allergic reaction to blood components in transfusion therapies. For cancer patients, fever should be considered a result of infection until an alternative cause is diagnosed. When a fever develops in a cancer patient, the individual must be thoroughly examined to determine the cause. A comprehensive physical examination should be administered by the physician and blood drawn for laboratory analysis.

Once a diagnosis has been made and treatment initiated, it is important to address problems created by the fever itself. It may be necessary to increase fluids and nutritional supplements. Because fever places increased demands on the body, this can be critical in restoring normal health for patients who may already be nutritionally compromised. Fever in a patient with neutropenia (low white blood cell count) represents the potential for a critical, life-threatening situation, and treatment should begin as quickly as the patient can reach the emergency room.

Physicians do not fully understand how tumors can cause fever, but certain correlations are well documented. Fever spikes may indicate that a tumor has grown or spread to other areas of the body, or that the tumor has produced some type of blockage. The fever associated with a tumor tends to be cyclic, and subsides with tumor treatment and recurs when the tumor returns or increases in size. In the case of drug-associated fever, the fever is an allergic-type reaction to a particular medication or combination of medications. Similarly, an immune response to donor blood cells is the typical cause of fever associated with blood components.

Treatments

Each of the major causes for fever associated with cancer has recommended conventional treatment procedures. For infection-related fever, broad-spectrum antibiotics , given orally, rectally, or intravenously, are the principle method of control. Some antibiotics may be started before a definitive diagnosis is made to retard additional complications caused by the infection. Treatment typically is administered for five to seven days as long as the fever and infection show a positive response.

Fever from a tumor is best treated by treating the tumor itself. Supplemental treatment for the fever may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Aspirin should only be used in patients with no risk of bleeding problems. The allergic responses manifesting in drug-or blood-associated fever may be treated by various methods: antihista-mines and acetaminophen may be administered prior to drug therapy or blood transfusion therapy ; discontinuing the present drug and choosing alternate medication may be required; blood may require irradiation or removal of white blood cells from the donor blood.

Alternative and complementary therapies

Some patients are investigating and adhering to the use of alternative treatments and complementary therapies. These choices may include holistic healing or herbal medication, and therapy utilizing biofeedback, relaxation therapy, and imagery techniques. Patients maintain that these alternative and complementary therapies add a sense of control to their life during a period when they have little control over anything. No conclusive data exists on the effectiveness of the therapies used alone; however in conjunction with conventional methods of fever management, they do not appear to hinder therapy and may provide the patient increased goodwill and a positive outlook.

Resources

PERIODICALS

Kern, Winfried., et al. "Oral versus Intravenous Empirical Antimicrobial Therapy for Fever in Patients with Granulocytopenia Who Are Receiving Cancer Chemotherapy."

The New England Journal of Medicine 341, no. 5 (29 July 1999): 312-318

OTHER

Herbs for Relieving Cancer. InnerSelf 2000 Copyright. 21April 2001, 1 July 2001 <http://www.innerself.com>

Jane Taylor-Jones, M.S.

KEY TERMS

Acetaminophen

The generic name for a common nonprescription medication useful in the treatment of mild pain or fever.

Antibiotic

A drug that fights infection.

Antihistamine

A drug that counteracts allergic responses.

Biofeedback

A process by which a person learns to influence two kinds of physiologic responses: those that are not ordinarily under voluntary control; and those that are easily regulated but for which regulation has broken down because of trauma or disease.

Immune response

An alteration in the reactivity of the body's immune system in response to a foreign substance.

Neutropenia

Lowered blood cell counts, especially in white blood cells, chiefly the neutrophils that aid in fighting infection.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A family of anti-inflammatory drugs that work by inhibiting the production of prostaglandins (a group of compounds that affect diverse bodily processes).

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fever

fever a term derived from the Latin febris, refers to an elevation of body temperature due to disease or injury. Man is a homeotherm, meaning that body temperature is kept within narrow limits by complex control mechanisms. This is distinct from poikilotherms, such as reptiles and amphibians, whose body temperature is just above the ambient temperature, and varies with it. Measured in the mouth, body temperature is close to 37°C (98.6°F), and does not usually vary by more than 1.5°C, although a rise up to 40°C can occur transiently in strenuous muscular exercise. In excessive heat exposure, normal temperature regulation is defeated, resulting in heat stroke. In other circumstances any deviation from the norm in an upward direction constitutes fever. Fever, or pyrexia, refers to a rise of up to 40.5°C and hyperpyrexia to a greater rise. Above about 41.5°C a person loses orientation and may become unconscious.

In some diseases the word ‘fever’ is incorporated into the common names, such as in puerperal, scarlet, typhoid, and yellow fevers, indicating that a rise in termperature is associated with the condition. Before the advent of mass vaccination programmes those with infectious fevers were taken in to isolation hospitals, often called fever hospitals. The word ‘fever’ is sometimes used in other contexts, such as ‘fever pitch’, when an individual, group, or crowd (such as a football crowd) becomes over-excited or agitated.

The body has a complex mechanism for controlling temperature that balances heat production against heat loss. Heat is continually produced by metabolism of all body cells, to an extent that varies with the activity of glands and organs, and of the muscles (shivering is an effective way to increase heat production). Heat is lost by radiation and convection, particularly from exposed parts such as the face and hands, and by evaporation of sweat. The control of the balance between heat production and heat loss is centred in the brain, in the hypothalamus, which acts basically as a thermostat. Input signals from heat- and cold-sensitive receptors in the skin relay information to the hypothalamus (these receptors are extremely sensitive: the heat receptors are able to detect a rapid rise in temperature of 0.007°C, while the cold receptors can detect a rapid fall of 0.012°C) and the ‘thermostat’ also senses the temperature of the blood passing through. While the discomfort of the experience of hot and cold environments resides in the skin, it is the body's ‘core’ temperature that matters, as many processes within the body are disrupted if the core temperature changes. Thus if the blood temperature rises, then the output signals from the thermostat lead to vasodilation of blood vessels in the skin and to sweating, thus increasing heat loss. Or, if body temperature falls, then heat loss is curtailed by vasoconstriction of surface blood vessels, and heat production may be increased by shivering.

In fever the hypothalamic thermostat becomes set at a higher temperature. The normal blood temperature is therefore sensed as being too low, and temperature-raising mechanisms come into action, accounting for initial pallor and shivering. Conversely, when fever is abating the set temperature is lowered, and the warm skin and sweating represent heat loss mechanisms.

The commonest cause of fever is infection by viruses, bacteria, yeasts, or parasites. Substances are released by these organisms which are collectively called pyrogens (substances causing a rise in temperature — pyrexia). The pyrogens act upon white blood cells to produce further, endogenous, pyrogens; these latter can also be released from tumours, from the brain after injury or stroke, from blood clots, or in autoimmune disease. The endogenous pyrogens interact in the brain with prostaglandin synthetase, the enzyme necessary for synthesis of prostaglandins, which in turn are the main agents that alter the setting of the ‘thermostat’. This explains why taking aspirin can abolish fever, since it inhibits prostaglandin synthetase; it also explains why, in the absence of fever, aspirin has no effect on body temperature.

In general, it is the practice to use drugs to reduce fever, but this may reduce the effectiveness of macrophages (white cells) to engulf and destroy bacteria. Experimental evidence indicates that prevention of pyrexia is detrimental to survival in infected animals. It is equivocal whether or not fever can be universally regarded as a body defence mechanism, particularly as its usefulness or otherwise where there is no infection is obscure.

Alan W. Cuthbert


See also heat exposure; injury; prostaglandins; temperature regulation.

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fever

fever, elevation of body temperature above the normal level, which in humans is about 98°F (37°C) when measured orally. Fever is considered to be a symptom of a disorder rather than a disease in itself. Under normal conditions the heat that is generated by the burning of food by the body is dissipated through such processes as perspiration and breathing. It is believed that infectious diseases, injury to the body tissues, and other conditions that cause inflammation lead to the release of prostaglandins, a type of hormone, which bind to sites in the hypothalamus, the center of temperature control in the body. The rise in temperature that is triggered as a result acts as part of the body's defenses against infection; white blood cells become more active, and most bacteria do not thrive as well. The effects of fever on the body are weakness, exhaustion, and sometimes a depletion of body fluids through excessive perspiration. Extremely high fevers may cause convulsive reactions and eventual death. In addition to infectious diseases (such as pneumonia and tonsillitis), disorders of the brain, certain types of cancer, and severe heatstroke may cause fever. There are also cases of fever where the cause cannot be detected. Treatment includes increasing the intake of fluids and administering aspirin and other fever-reducing medications. Aspirin may be dangerous in fevers of children because of Reye's syndrome. However, primary treatment is directed at the underlying cause unless the fever is very high (above 104°F/40°C). Persons with such dangerously high fevers are sometimes sponged with cool water or immersed in cool baths.

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Fever

Fever

How Is Body Temperature Controlled?

How Does Illness Cause Fever?

Who Gets Fever?

How Is Fever Diagnosed?

When Should a Doctor Be Consulted?

How Is Fever Treated?

How Can Fever Be Prevented?

Resource

Fever is an abnormally high body temperature that usually occurs during an infection, inflammation, or some other kind of illness. Fever is not a disease itself but it is one of the most common signs of illness, especially among children.

KEYWORDS

for searching the Internet and other reference sources

Body temperature

Febrile convulsion

Hyperthermia

Infection

Inflammation

Pyrexia

Ups and Downs

A persons temperature normally varies each day by about 1 degree F (0.6 degrees C). It is lowest in the early morning and highest in the late afternoon. This daily variation is called the circadian (sir-KADE-ee-an) rhythm. When a person has a fever, it usually follows the same daily pattern.

Other factors also can affect what is normal. In women of childbearing age, for instance, the early morning temperature usually goes up each month just before ovulation (ov-u-LA-shun), the release of an egg from the ovary. It stays elevated briefly and then returns to the lower level.

Fever of Unknown Origin

Sometimes a person has a fever that lasts for two or three weeks, and the doctor cannot find a cause, despite performing the usual array of medical tests. This condition is referred to as fever of unknown origin.

In about 90 percent of cases, a cause eventually is found. The most common causes are infectious diseases. Fever of unknown origin is particularly common in people infectedwith HIV, the human immunodeficiency virus that causes AIDS.

How Is Body Temperature Controlled?

The body adjusts its temperature in much the same way that the thermostat in a house works. With a thermostat, people set the temperature they want, and the heating or cooling system clicks on until the inside of the house reaches the right temperature. After that, the heater or air conditioner clicks on and off automatically to keep the temperature in the house hovering around the desired temperature.

The bodys thermostat is located in the hypothalamus (hy-po-THAL-a-mus), a small part of the brain that also helps control hunger, thirst, pleasure, and pain. The thermostat, called the thermoregulatory (ther-mo-REG-u-la-tor-ee) center, normally keeps the bodys temperature hovering around 98.6 degrees Fahrenheit (F) (37 degrees Centigrade).

Like a house, the body has sensors that tell the thermostat if the temperature inside is rising or falling. In the body, these sensors are cells located in the skin and in the brain itself. If the sensors report that the bodys temperature is rising, the bodys cooling system clicks on, telling the cells to burn less fuel and produce less heat. The blood vessels expand to let heat escape from the skin, sweat pours out to cool the body as it evaporates, and the brain may get a bright idea: Lets go into the shade and have a cold drink.

Fever

With fever, the thermostat in the brain is reset to a higher temperature. Instead of keeping the bodys temperature hovering around 98.6 degrees F, the bodys heating and cooling systems may keep the temperature at 100 to 102 degrees F or even higher.

Normal temperature varies a bit from person to person and from morning to evening, making it hard to state precisely where normal ends and fever begins. Many doctors, however, say that a temperature of more than 99 or 100 degrees F (37.2 or 37.8 degrees C) should be considered a fever. A temperature of 104 degrees F or higher could be considered a high fever.

Hyperthermia

Sometimes a persons temperature can rise for a different reason. Hyperthermia (hy-per-THER-me-a) occurs if the heat outside is too much for the bodys cooling system to handle, making body temperature rise. The most severe cases of hyperthermia tend to occur in people who can not sweat as much as normal, such as elderly people or those taking certain medications.

How Does Illness Cause Fever?

Bacteria and viruses themselves, as well as toxins (poisonous waste products) produced by some bacteria, cause fever. In some cases, they work directly on the brain to raise the thermostat. More commonly, they cause the bodys immune system* to produce proteins called cytokines (SY-to-kines). The cytokines help fight the infection, but they also reset the brains thermostat, causing fever.

* immune system
(im-YOON SIS-tem) is the body system made up of organs and cells that defend the body against infection or disease.

The Name Is Familiar

Many infectious diseases are named for the major symptom of fever. Most of those listed below lead to fevers of about 102 to 104 degrees F (39 to 40 degrees C). Dengue fever, Lassa fever, and yellow fever are caused by viruses. The others are caused by bacteria.

  • Dengue (DENG-e) fever causes sudden high fever, headache, extreme tiredness, severe joint and muscle pain, swollen lymph nodes, and a rash. It is spread by mosquitoes.
  • Lassa (LAH-sa) fever causes fever, headache, dry cough, back pain, vomiting, diarrhea, sore throat, and facial swelling. It is spread by rats and from person to person.
  • Q fever causes sudden high fever, severe headache, and chills. It is spread by farm animals and insects.
  • Rheumatic (roo-MAT-ik) fever causes painful, swollen joints, fever, and heart murmurs (abnormal heart sounds). It is caused by the same bacterium that causes strep throat.
  • Rat-bite fever causes sudden chills, fever, headache, vomiting, back pain, a rash on the hands and feet, and temporary arthritis (joint inflammation). It is spread by rats and mice.
  • Relapsing (re-LAPS-ing) fever causes sudden chills and high fever, fast heartbeat, severe headache, vomiting, muscle pain, and sometimes mental confusion. Symptoms can recur several times. It is spread by ticks and lice.
  • Rocky Mountain spotted fever causes fever, headache, skin ulcers (open sores), and a rash. It is spread by ticks.
  • Scarlet fever causes high fever, sore throat, flushed cheeks, and a rash, especially in children. It is caused by the same bacterium that causes strep throat.
  • Typhoid (TY-foid) fever causes fever along with abdominal pain, headache, and extreme fatigue. It is spread by food and water that contain Salmonella bacteria.
  • Yellow fever causes sudden fever, slow pulse, nausea, vomiting, constipation, muscle pains, liver failure, and severe fatigue. It is spread by mosquitoes.

Any substance that causes fever is called a pyrogen (PY-ro-jen), from the Greek word for fire-causer. If the substance comes from outside the body, such as a toxin from bacteria, it is called an exogenous (ek-SOJ-e-nus) pyrogen. The prefix exo- means outside in Greek. If the substance comes from inside the body, such as a cytokine, it is called an endogenous (en-DOJ-e-nus) pyrogen. The prefix endo- means inside in Greek.

Sometimes the immune system produces pyrogens even without an infection. For instance, this may happen if a person:

  • has an autoimmune disease*, such as rheumatoid arthritis or lupus
  • has inflammation* anywhere in the body
  • has cancer, such as leukemia or lymphoma
  • was a given a blood transfusion* that is not compatible with the persons own blood type
  • has a reaction to a medication
* autoimmune disease
(aw-to-i-MYOON disease) is a disease resulting from an immune system reaction against the bodys own tissues or proteins.
* inflammation
(in-fla-MAY-shun) is an immune system reaction to an injury irritation, or infection. It often includes swelling, pain, warmth, and redness.
* transfusion
(trans-FYOO-zhun) is the transfer of blood or blood products directly into a persons bloodstream.

People sometimes say that fever is a sign that the immune system is active, working to protect the body from illness. That may be true in some cases, but it is not always so. People often get fevers, for instance, if their immune system is weak or damaged. In reality, scientists are not sure exactly what, if anything, fever indicates about the state of the immune system.

Who Gets Fever?

Fever is caused by so many common illnesses, including colds and flu, that it happens to everyone many times in the course of a lifetime. Young children are particularly likely to get bacterial and viral infections that cause fever, such as strep throat and ear infections. Sometimes minor viral infections cause high fevers in children, while illnesses that are more serious cause milder fevers. People of all ages get fever.

Helpful fever

There is some evidence that fever can make the immune system more effective and weaken certain bacteria. However, most of this evidence comes from animals or experiments on human cells in test tubes. Scientists really do not know whether fever helps people fight off infections in real life. It could turn out that fever helps in certain cases but not in others.

Fever often can help in another way, however. It can be an important sign that a person is sick. Its movements up and down can indicate whether a person is getting better or worse.

Harmful fever

Fever often makes an illness more unpleasant. In addition, a feverish body needs more oxygen, which means that the heart and lungs have to work harder as the fever rises. This can be a problem for people who already have heart or lung problems.

Fever can make mental problems worse for elderly people who have dementia (de-MEN-sha), which is a form of mental confusion and loss of memory that can develop gradually as people age. High fever also can cause temporary mental confusion, called delirium (de-LEER-e-um), even in healthy people.

Febrile convulsion

Children under age 5 can have a different problem if their temperature rises quickly. They may experience a kind of seizure called a febrile convulsion (FEB-ryl kon-VUL-shun). Their muscles may twitch, and they may lose consciousness for several minutes. Usually, a febrile convulsion needs no treatment and may not recur. However, febrile convulsions can be very upsetting and frightening. They also can lead to injury; for example, if a child falls.

Extremely high temperatures of around 107 degrees F or higher can do permanent brain damage at any age if they last for a long time. Temperatures that high usually are caused by hyperthermia, not by fever from an illness.

How Is Fever Diagnosed?

People with a fever often feel hot, tired, achy, and generally sick. They sometimes have shaking chills as their temperature rises. Shaking helps raise the temperature to the feverish level set by the bodys thermostat. They may sweat heavily when the fever breaks (starts to go away) or if it falls temporarily as part of an up-and-down pattern. Sweating helps lower the temperature to the new, lower point set by the thermostat.

Although the classic way of checking for fever at home is to touch the persons forehead to see how warm it feels, this often does not work. The only way to tell for sure if a person has a fever is by taking the temperature with a thermometer. Three kinds of thermometers can be used: digital, mercury, or tympanic.

Digital thermometers, usually used in medical offices and hospitals as well as at home, are electronic. They can take an oral temperature when placed under the tongue, a rectal temperature when placed into the rectum, or an axillary (AK-si-lar-y) temperature when placed in the armpit. In general, rectal temperatures are about 1 degree F higher than oral ones.

Mercury thermometers, which used to be the only kind available, are made out of glass and contain liquid mercury. They come in oral or rectal versions. Either kind can be used in the armpit as well. They are cheaper than digital thermometers, but they take longer to use.

Tympanic (tim-PAN-ik) thermometers are a special kind of digital thermometer that is placed into the ear. While the other thermometers take several minutes to give a reading, the tympanic thermometer takes only a few seconds. However, tympanic thermometers are more expensive and can be inaccurate if placed improperly in the ear.

When Should a Doctor Be Consulted?

A doctor should be consulted if a fever is high, lasts longer than a few days, or is accompanied by other symptoms, such as a rash; pain in the joints, neck, or ears; unusual sleepiness; or a dazed or very sick feeling. For babies under about 3 months old, a doctor should be consulted about any fever.

Fiery Language

Many medical terms dealing with fever start with the prefix pyro- or pyr-, from the Greek word for fire. Fever itself is called pyrexia (pi-RECKS-ee-a). Substances that cause fever are called pyrogens, and medicines that reduce fever are called antipyretics.

The same Greek root has given rise to words outside medicine. A funeral pyre is a consuming blaze used to cremate (turn to ashes) a body. Pyromania is a compulsion to set fires. Pyrotechnics are fireworks. Pyrex is the trade name for a kind of glass used in baking pans because it can withstand high heat.

The doctor will try to find and treat the underlying cause of the fever. Antibiotics can cure many bacterial infections, such as those that cause many earaches and sore throats. There are no medications to treat most viral infections.

How Is Fever Treated?

In a basically healthy adult or older child, there usually is no medical reason to treat the fever itself unless it is very high. In fact, lowering the fever with drugs can make it harder to tell if a person is actually getting better or if the drugs are just keeping the fever down. In younger children, though, doctors often treat fevers of 100 or 101 degrees F, in part to avoid febrile convulsions. Of course, if a person of any age is very uncomfortable or unable to sleep, even a low fever can be treated to provide relief.

Fever can be lowered by drugs called antipyretics (an-ti-py-RET-iks) that do not require prescriptions. The major ones are acetaminophen (a-seet-a-MIN-oh-fen), Ibuprofen (i-byoo-PRO-fen), and aspirin. However, aspirin should not be given to children with a fever. If children have a viral illness, such as influenza or chickenpox, aspirin makes it likelier that they may get a rare but dangerous illness called Reyes syndrome*. This does not happen with acetaminophen or Ibuprofen.

* Reyes syndrome
(RYZESIN-drome) is a rare and sometimes fatal disease that causes vomiting, confusion, and coma. It occurs mainly in children, usually after a viral infection such as influenza or chickenpox.

Antipyretic medicines are available in pills for adults, chewable tablets for children, and liquid drops for babies. Acetaminophen also comes in suppositories (su-POZ-i-tor-eez), waxy pellets that are inserted into the rectum. They are used for people who cannot take medicine by mouth for some reason.

A lukewarm bath also can help lower a high temperature. However, cold water or alcohol rubs can do more harm than good by causing the body to shiver, which just raises body temperature more. In addition to these treatments, it is important for a person with a fever to drink plenty of liquids to avoid dehydration*. In extreme cases, a person in the hospital with a very high fever may be wrapped in a special cooling blanket or immersed in ice water.

* dehydration
(de-hy-DRAY-shun) is a condition caused by the loss of fluids from the body faster than they can be replaced. Babies, small children, and the elderly may become dehydrated faster than older children and adults.

How Can Fever Be Prevented?

Many of the diseases that cause fever can be prevented by vaccination*. These include influenza, measles, mumps, rubella (German measles), chickenpox, diphtheria, and typhoid fever. A number of other diseases that cause widespread fever in poorer nations are prevented in the United States by good sanitation systems and access to clean water. Still other diseases, such as colds and strep infections, often can be prevented by washing the hands properly before eating and, if possible, by avoiding contact with people who already have those infections.

* vaccination
(vak-si-NAY-shun) means giving a person a vaccine to protect against a particular disease. A vaccine is a preparation of a weakened or killed germ or of part of the germs structure. It stimulates the immune system to fight the germ but does not cause infection itself.

See also

Bacterial Infections

Dengue Fever

Diphtheria

German Measles (Rubella)

Heat-Related Injuries

Infection

Influenza

Lassa Fever

Mumps

Reyes Syndrome

Rheumatic Fever

Rocky Mountain Spotted Fever

Scarlet Fever

Seizures

Strep Throat

Typhoid Fever

Yellow Fever

Viral Infections

Resource

American College of Emergency Physicians, P.O. Box 619911, Dallas, TX 75261-9911. An organization of physicians that provides information about fever on its website. http://www.acep.org

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fever

fever (pyrexia) (fee-ver) n. a rise in body temperature above the normal, i.e. above an oral temperature of 98.6°F (37°C) or a rectal temperature of 99°F (37.2°C), usually caused by bacterial or viral infection. Fever is generally accompanied by shivering, headache, nausea, constipation, or diarrhoea. intermittent f. a periodic rise and fall in body temperature, as in malaria. remittent f. a fever in which body temperature fluctuates but does not return to normal. See also relapsing fever.

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fever

fe·ver / ˈfēvər/ • n. an abnormally high body temperature, usually accompanied by shivering, headache, and in severe instances, delirium. ∎  a state of nervous excitement or agitation: I was mystified, and in a fever of expectation. ∎  the excitement felt by a group of people about a particular public event: election fever reaches its climax tomorrow.

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fever

fever OE. fēfor m., corr. to MLG. feber, OHG. fiebar m. (G. fieber) — L. febris fem., of obscure orig. Reinforced in ME. from AN. fevre, (O)F. fièvre :- L. febris.
Hence feverish XIV.

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fever

fever Elevation of the body temperature above normal, that is 37°C (98.6°F). It is mostly caused by bacterial or viral infection and can accompany virtually any infectious disease.

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fever

fevercadaver, slaver •halva, salver, salvor •balaclava, Bratislava, carver, cassava, Costa Brava, guava, Java, kava, larva, lava, palaver •woodcarver •clever, endeavour (US endeavor), ever, forever, however, howsoever, never, never-never, sever, Trevor, whatever, whatsoever, whenever, whensoever, wheresoever, wherever, whichever, whichsoever, whoever, whomever, whomsoever, whosoever •delver, elver •Denver •Ava, caver, craver, deva, engraver, enslaver, favour (US favor), flavour (US flavor), graver, haver, laver, paver, quaver, raver, saver, savour (US savor), shaver, vena cava, waiver, waver •lifesaver • semiquaver •achiever, beaver, believer, cleaver, deceiver, diva, Eva, fever, Geneva, griever, heaver, leaver, lever, Neva, perceiver, receiver, reiver, reliever, retriever, Shiva, underachiever, viva, weaver, weever •cantilever

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Fever

Fever

Definition

Fever is defined as an abnormally high body temperature or a regulated rise to a new set point of body temperature. While a body temperature above 100 °F (37.8 °C) is considered to be a fever by some clinicians, a significant fever is usually defined as an oral temperature of 102 °F (39 °C) or a rectal temperature of 103 °F (39.5 °C). Fever is a sign of inflammation and represents the body's response to microbial invasion or to a disease process.

Hyperthermia is defined as abnormally high body temperature caused by disruption of the body's thermoregulatory mechanisms. Hyperthermia occurs when the body's metabolic heat production or environmental heat load exceeds the normal heat loss capacity (or when normal heat loss is impaired).

Description

The normal temperature of the human body fluctuates between 97 °F (36.1 °C) and 100 °F (37.8 °C), with the average being 98.6 °F (37 °C). There is a diurnal pattern of temperature variation in humans, with body temperature being lowest in the morning and highest in late afternoon. In women of childbearing age, there is a small rise in temperature following ovulation during the menstrual cycle, and during the first trimester of pregnancy.

The body's thermoregulatory mechanisms include changes in muscle tone, vascular tone, and sweat production, which serve to balance body heat produced by metabolism with heat lost to the environment. This balance is regulated by the hypothalamus, a small structure in the brain below the thalamus. The body's temperature regulation can be upset by environmental factors (external heat and humidity); by disorders or conditions that inhibit sweat production or evaporation; and by infectious diseases.

Fever occurs when the hypothalamus raises the body's temperature to a new set point. White blood cells called monocyte-macrophages release proteins called pyrogens when the cells encounter pathogenic microorganisms. The pyrogens act on the hypothalamus, causing it to reset the body's "thermostat" upward. The vessels that supply the skin with blood often narrow as the body's temperature is rising. This process, which is called vasoconstriction, reduces sweating and causes the body to retain more heat than it loses. Vasoconstriction in the skin and extremities allows the body to move blood toward its core, which increases the rate of metabolism and induces shivering. The chills that often accompany a fever are caused by this movement of blood to the body's core, which leaves the skin surface and extremities relatively cool. When the infection or disease process resolves, the hypothalamus attempts to reset the body's thermoregulation at its normal set point. The body's cooling mechanisms switch on as the blood returns to the extremities and skin surface, and sweating occurs.

Fever is an important component of the immune system's inflammatory response, though its role is not completely understood. A rise in body temperature has several effects. The pyrogens that trigger the resetting of the body's thermostat also increase the production of macrophages, which fight off invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria, while at the same time activating the immune system. In addition, the increased heart rate that accompanies vasoconstriction also speeds the arrival of white blood cells to the sites of inflammation.

Causes and symptoms

Causes

Fever can be caused by a wide variety of diseases and disorders, including:

  • infectious diseases, which may be caused by viruses, bacteria, fungi, rickettsiae, or parasites
  • autoimmune disorders, including systemic lupus erythematosus, rheumatic fever, adult rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, and Still's disease
  • disorders of the central nervous system (CNS), including head injuries, multiple sclerosis, tumors of the brain or spinal cord, and cerebral hemorrhage
  • cancers, including primary cancers of the colon, rectum, kidney, and liver, and metastatic cancers of the liver
  • cardiovascular disorders, including myocardial infarction and pulmonary embolism
  • reactions to such medications as methyldopa, quinidine, hydralazine, phenytoin, chlorpromazine, carbamazepine, anti-cancer drugs, and antibiotics
  • endocrine disorders, including hyperthyroidism (thyroid storm) and pheochromocytoma
  • gastrointestinal disorders, including alcoholic hepatitis, inflammatory bowel disease (IBD), and liver abscess
  • inflammation associated with indwelling catheters, intravenous lines, and nasogastric tubes
  • neuroleptic malignant syndrome, which is a rare and potentially fatal reaction to certain antipsychotic medications

Fever patterns

Fevers may be classified as intermittent (the patient's temperature falls to normal at some point during the day); sustained (the temperature remains high); or relapsing (periods of fever are followed by several days of normal temperatures). The fever pattern may be helpful in the differential diagnosis; for example, fevers related to medication reactions are more often sustained than intermittent. A relapsing pattern suggests malaria.

The degree of temperature elevation in a fever does not necessarily correspond to the seriousness of the illness. In general, children with fevers run higher temperatures than adults, while elderly persons and newborns may have less marked fevers.

Diagnosis

The differential diagnosis of fever is complicated by the variety of possible causes. In most cases, the patient's history—including a medication history and history of exposure to infectious diseases—vital signs, a complete blood count, and blood cultures will help to narrow the number of possible causes. In fevers of unknown origin (FUOs), however, the physician may need to schedule a chest x-ray or ultrasound and CT imaging.

Fevers of unknown origin (FUOs)

The origin of some fevers is difficult to determine. The term "fever of unknown origin" (FUO) has been applied to cases of fever in which the patient's temperature remains over 101 °F (38.3 °C) for three weeks and in which the diagnosis is not apparent after seven or more days of studies. The most common cause of FUOs is an infectious disease of some kind, although many cancers present initially as FUOs. About 15% of FUOs never receive a definite diagnosis.

Temperature measurement

A variety of different devices are available to register body temperature, including the traditional glass thermometers used for oral or rectal temperature readings. More recently, sophisticated electronic devices have been introduced that register body temperature as a digital readout. For younger children and infants, there are forehead meter strips and pacifiers with temperature-sensitive readouts.

Treatment

Routine measures

Most fevers are caused by common infections, are short-lived, and do not require symptomatic treatment. The patient's comfort, however, may be improved by measures to remove body heat, antipyretic medications, and fluid replacement. Measures to remove body heat include alcohol or cold sponges; ice bags; and ice baths. The most common antipyretic medications are aspirin or acetaminophen, 350-650 mg every four hours. Children or adolescents with influenza-like symptoms should not be given aspirin without consulting a physician because of the possibility of developing Reye's syndrome, a rare disorder characterized by vomiting and liver dysfunction.

Fluid replacement is an important part of fever treatment. Extra fluid is required to prevent electrolyte imbalance as well as to replace fluid lost through perspiration.

Emergency treatment

Body temperature over 105.8 °F (41 °C) in an adult is a medical emergency and requires immediate treatment.

The following indications in specific patient groups may require emergency treatment:

  • newborns (three months or younger) with fever of 100.5 °F (38 °C) or higher
  • infants or children with fever of 103 °F (39.4 °C) or higher
  • adults with fever of 101 °F (38.3 °C) or higher lasting longer than three days; or a temperature of 100.5 °F (38 °C) lasting longer than three weeks without other symptoms

A very high fever in a small child can trigger febrile seizures, and therefore requires immediate treatment. A fever accompanied by a stiff neck, severe headache, throat swelling, and changes in mental status may indicate the presence of meningitis or another serious infection, and should be brought to the immediate attention of a physician. High fever does not always produce sweating or diaphoretic symptoms, which indicates weakness in the body's defenses against severe disease.

Prognosis

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen and do not produce any lasting effects. Exceptions include fevers associated with meningitis, typhoid, or scarlet fever. High fevers can produce major disturbances of the body's metabolism and alter the body's responses to medications. In addition, a high fever during the first trimester of pregnancy increases the risk of such birth defects as anencephaly (absence of a portion of the skull and brain).

The prognosis for fevers associated with such chronic conditions as autoimmune disorders depends on the stage of the disease and its management.

Health care team roles

Nurses assess and record the fever patient's signs and symptoms. Nurses as well as physicians can obtain relevant information from the patient's medical history. Home health care and visiting nurses may also help to educate patients about at-home treatment of fevers. In some cases, home care nurses may counsel patients and caregivers over the phone, advising when the condition warrants in-person medical attention.

Prevention

Since most fevers are caused by infectious agents, careful attention to proper methods of food handling, hand washing, and similar public health measures is an important form of prevention. Fevers related to medication reactions can sometimes be prevented by substitution of drugs that are less likely to produce such reactions. Fevers related to indwelling catheters and similar devices may be avoided by removing them as soon as they are no longer required.

Hyperthermia related to environmental conditions may be prevented by proper attention to climatic conditions, adequate fluid and electrolyte intake, and acclimatization to hot environments. Educating the public about the early signs of heat disorders is another important preventive measure.

KEY TERMS

Antipyretic— A drug that lowers body temperature, such as aspirin or acetaminophen.

Autoimmune disease— A disorder in which the immune system attacks the body's own cells.

Febrile seizure— Convulsions brought on by high body temperature and inflammation of the brain or brain covering.

Hyperthermia— Abnormally high body temperature that occurs when the body's metabolic heat production or environmental heat load exceeds the normal heat loss capacity (or when heat loss is impaired). Heat stroke is an example of hyperthermia.

Hypothalamus— A region in the posterior section of the forebrain that regulates body temperature, sleep cycles, and the activity of the pituitary gland.

Intermittent— A fever pattern marked by the patient's temperature returning to normal at some point during the day.

Macrophage— A type of large white blood cell that helps the body fight off pathogenic microorganisms by ingesting them.

Malignant hyperthermia— A rare inherited condition in which a person develops a very high fever when given general anesthetics or muscle relaxants in preparation for surgery.

Pyrogen— A substance that produces a rise in body temperature. Bacterial toxins are one type of pyrogen.

Relapsing— A fever pattern in which periods of fever alternate with several days of normal temperatures.

Reye's syndrome— A rare disorder that occurs primarily in children recovering from a viral illness and associated with aspirin usage. It is characterized by vomiting, swelling of the brain, and liver dysfunction.

Vasoconstriction— Narrowing of the blood vessels, which serves to conserve body heat and maintain or raise blood pressure.

Resources

BOOKS

Gelfand, Jeffrey, et al. "Fever, Including Fever of Unknown Origin." Harrison's Principles of Internal Medicine, edited by Kurt Isselbacher, et al. New York: McGrawHill, 1997.

Haist, Steven A., MD, John B. Robbins, MD, and Leonard G. Gomella, MD. "Fever." Internal Medicine On Call, 2nd ed. Stamford, CT: Appleton & Lange, 1997.

"Respiratory Viral Diseases." Chapter 162 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

OTHER

Fever. MayoClinic.com. September 11, 2000. 〈http://www.mayoclinic.com/home?id=DS00077〉. (accessed June 18, 2001).

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Fever

Fever

John Edgar Wideman 1989

Author Biography

Plot Summary

Characters

Themes

Style

Historical Context

Critical Overview

Criticism

Sources

Further Reading

Throughout his career, John Edgar Wideman has emerged as a prominent voice of the African-American consciousness. Yet, he does not narrow his field only to African-American issues. His work, demonstrating an understanding of the greater themes that affect people of all races, speaks a universal language.

Wideman has also shown a drive for literary exploration, constantly searching for new ways to tell his stories. These characteristics combine in the title story of his 1989 short story collection, Fever. The author calls the challenging and complex “Fever” a “meditation on history.” Through its examination of Philadelphia’s 1793 yellow fever epidemic, it explores the racial ambiguities that exist in society. Wideman draws on real-life events and people to give his story a more credible and human feel. As his narrators explore the problems brought on by the fever, they present a concrete picture of the devastation the epidemic leaves behind, both in physical and emotional terms. Readers and critics alike admire “Fever” for its literary risks as well the significance of Wideman’s message. Critics have consistently noted that it is one of his most ambitious pieces of short fiction.

Author Biography

John Edgar Wideman was born on June 14, 1941, in Washington, D.C., but he spent the first 10 years of his life in Homewood, a poor African-American neighborhood in Pittsburgh. As a child, Wideman had two loves: basketball and storytelling. When he was 12, Wideman and his family moved to a predominantly white neighborhood, where Wideman attended a racially integrated high school.

Wideman was very successful throughout high school. He was a basketball star, senior class president, and valedictorian. During high school, Wideman pursued intellectual self-development, but he found the white-dominated world of academia to be incompatible with the African-American experience. Wideman tried to keep these two worlds separate to such an extent that he spent his free time with other African-American students but his class time with white students. Because of these actions, Wideman often felt isolated from his own community.

Wideman was awarded a basketball scholarship to the University of Pittsburgh, where he studied psychology and English. He continued in his attempts to divide his white world from his black world, essentially setting aside his racial identity. Wideman felt he needed to do so in order to excel academically.

In 1963, Wideman became only the second African-American Rhodes Scholar, and he studied at Oxford University in England for three years. Wideman next was made a Kent Fellow in the creative writing program at the University of Iowa, after which he joined the faculty at the University of Pennsylvania. Although he was a member of the English Department, he also helped create the Afro-American Studies program, which he chaired from 1972 to 1973. During his first year at the university, in 1967, Wideman published his first novel, A Glance Away.

In the 1960s, Wideman began to read African-American literature for the first time, beginning the process of redefining himself as an African-American man and writer. However, he still felt isolated from other African Americans. This problem was exacerbated when he and his family moved to Wyoming, where Wideman had accepted a university job. In the early 1970s, after returning to Homewood to attend his grandmother’s funeral, Wideman began to integrate African-American traditions and cultures with the intellectual world that he inhabited.

Wideman has enjoyed a productive and successful literary career. He has published numerous novels and short stories as well as autobiographical meditations, primarily based on personal misfortunes that have affected his family. He is a two-time winner of the PEN/Faulkner Award for fiction, in 1984 and 1991. He is currently a professor of English at the University of Massachusetts—Amherst.

Plot Summary

The story opens in Philadelphia in 1793. The city, one of the centers of commerce and culture of the early United States, is gripped in the throes of a yellow fever epidemic. Those people with the means have fled the infected city, while the poor have been forced to remain behind, most likely to die. The city has essentially closed down.

The story’s primary narrator is an African-American man called Allen. Although Allen has a wife and daughter, he has chosen to stay in the city, where he works for Dr. Rush, a practitioner determined to treat the fever’s victims and understand the cause of the disease. Allen, once the founder of an African-American church, now spends his days caring for the sick and dying and burying the dead.

According to white Philadelphians, the disease has been brought to the city by slaves from Santo Domingo (present-day Haiti). This belief is based, not on any scientific evidence, but merely on racist ideas. Since the fever first began to spread, African Americans have been treated as pariahs; however, their services as caregivers and cemetery workers are still in great demand. In order to secure the services of African Americans for the sick, whites even falsely claim that African Americans are immune to the disease.

Prior to the outbreak of the epidemic, however, such ingrained racism was not always apparent. African-American slaves had fled to the North, seeking freedom in this Quaker haven where Christians claimed to uphold ideas of equality. While this standard had not been adhered to everywhere—at church, African Americans were forced to worship at the back of the pews—African Americans and whites had previously gathered together to commemorate the foundation of Allen’s new church. A few Philadelphians do not fall prey to this racist rhetoric, however; some view the fever as a physical

manifestation of problems inherent in present-day society, particularly slavery.

While working for Dr. Rush, Allen has the chance to observe the doctor’s autopsies. The autopsies of both black and white victims of the disease are the same—that is, there is no difference in the effects of the fever on the human body. Rush hopes to use the results of these autopsies to prove that in order to prevent the disease, the body’s toxic fluids must be drained away.

Throughout the story, a series of disjointed voices intrude on Allen’s meditations. These voices represent people of different backgrounds, including a Jewish merchant, an African aboard a slave ship, a contemporary African-American hospital orderly, and flu victims. They fault Allen for helping Dr. Rush when he should be serving his own people, talk of racism and human suffering, discuss how African Americans view freedom, and point to the universality—over both time and place—of prejudice. The narration also talks about another tragedy that took place in Philadelphia: a firebombing that took the lives of 11 people, including several children.

The story, which does not follow a chronological plot line, has no definite end. Neither Allen’s fate nor that of many of the other characters is made clear. The final image is that of an autopsy in which the doctors will find the miniature hand of a child next to the dead person’s heart.

Characters

Master Abraham

Master Abraham is a Jewish shopkeeper from Europe. He came to America only to experience the same prejudice that drove him from Antwerp, where his son was killed in a racial attack. By the time he speaks in the story, he has become afflicted with the fever.

Allen

Much of the story is told by an African-American man named Allen, both from the first-person point of view and the second-person point of view. Many critics have suggested that Allen is based on Richard Allen, the founder of the African Methodist Episcopal Church. Allen serves as an assistant to Dr. Rush; he helps care for the victims of yellow fever, and in some cases, helps bury them. He also has a wife and a daughter from whom he is separated for fear that he will infect them. Allen spends much time thinking about the cause of the fever and ruminating on his life and the lives of other African Americans, both free and enslaved.

Before the fever epidemic, Allen had been a preacher and founder of a church for African Americans. How he has come to aide Dr. Rush is not made clear in the story, but Allen expresses his devotion to remaining in Philadelphia to help the dying. He does so out of concern for the sick, but also because the fever has, perversely, made him freer than ever because it has given him the opportunity to learn the skills of the white doctor. Allen is joined in his ministrations by his brother, Thomas.

Dr. Rush

Alternately called a charlatan and a lifesaver, Dr. Rush has remained in the city to care for the sick and to conduct research on what causes the fever. Dr. Rush has been attacked by other members of the medical profession for his practice of purging and bleeding patients. The autopsies he has performed on the bodies have led him to believe that fever victims die from drowning in their own toxic bodily fluids, and he publishes literature to this effect.

Voices

About halfway through “Fever,” Allen says, “I recite the story many, many times to myself, let many voices speak to me. . . .” Wideman includes a number of different voices in “Fever,” and these voices and their narratives expand the story’s themes from the deaths in Philadelphia and the white people’s placement of blame on African Americans to racism and prejudice in general. The characters who speak include an African aboard a slave ship; a modern-day African-American hospital orderly; and an unidentified person who refers to a firebombing that killed 11 Philadelphians in the 1980s.

Wilcox

Wilcox serves as an undertaker, carting the dead to their burial plots. After two months of such work, he is infected by a body and soon falls fatally ill with the fever himself.

Themes

Prejudice and Racism

One of the prevailing themes found in “Fever” is that of prejudice. The white Philadelphians place all blame for the yellow fever that grips the city on slaves who have been sent from Santo Domingo to Philadelphia. Although there is no factual or medical evidence linking the slaves to the spread of the fever, this belief continues to prevail. African Americans are shunned throughout the city except for when their services are required, such as for caring for the sick and burying the dead.

Through the different voices, prejudice against people other than African Americans is explored. A Jewish character, Abraham, reports how he was hated by even his employees. He also explores the universality of racism in his recollection of how European Jews were often accused of bringing fever and disease that killed entire cities.

Racism is inherent in the way African Americans are treated, both during this time of crisis and prior to it. Allen remembers how African Americans were forced to remain at the back of the church, so he founded a church solely for the worship of African Americans. At the same time, however, the story points to a time when African Americans and whites came together on an equal level, such as at the founding of Allen’s new church. The tenuous connection between white and black Philadelphians is demonstrated by the ease with which it is severed.

Slavery

Slavery is an underlying theme that affects almost all of the story’s major narratives. The description of a slave ship makes clear the horrible conditions under which Africans were brought to the Americas. The story also equates the plight of free African Americans in Philadelphia with their brothers and sisters still in chains. Thus, the issue of slavery is present in all aspects of African-American life in the 1700s, whether the African Americans are free or enslaved. Ironically, many African Americans were drawn to Philadelphia because it was a predominately Quaker city; followers of the Quaker faith emerged as some of America’s earliest opponents of slavery.

Allen, though a free man, lives in a sort of self-imposed slavery. One of the voices accuses him of following Dr. Rush like a “loyal puppy” and then proceeds with a litany of racist slurs to emphasize how Allen is not truly acting freely but instead buckling under and becoming what the whites expect of him. The voice makes the slavery analogy more explicit by comparing Allen to a potential Moses for his people. Instead of leading the Hebrews out of slavery in Egypt, the voice challenges Allen to lead African Americans from the drudgery of their Philadelphia lives and their “lapdogging” to white people to a place where they would be appreciated for their own talents and skills.

Yet another voice—that of an afflicted person—emerges to speak of what slavery means. This voice maintains that sick people are more enslaved than anyone, white or black, for those with the disease have no choice but to follow its bidding. This voice urges Allen to break the bonds of his slavery to Dr. Rush and return to his family.

Finally, voices from more contemporary times emerge to give their reflections on slavery and freedom. A former slave recalls what it was like to be at the beck and call of a master. Another thoroughly modern voice speaks out, telling of his unpleasant job in a nursing home, but ending with the words, “But me, I’m free. It ain’t that bad, really.”

Topics for Further Study

  • What insights can you draw about late 18th-century race relations from “Fever”? Explain your answer.
  • Investigate the 1793 yellow fever outbreak in Philadelphia. Try and find answers to such questions as how many people died; how people of different races were affected; how did the outbreak affect business and daily life; how and why did the outbreak end. After answering these and other questions, hypothesize how this epidemic affected the development of Philadelphia.
  • In a 1996 interview, Wideman equated the 1793 yellow fever epidemic in Philadelphia with the present-day AIDS epidemic, which was not a serious medical factor at the time he wrote “Fever.” Do you find such a comparison apt? Why or why not? Conduct additional research as necessary to formulate your argument.
  • Research the Black Plague, which devastated Europe in the 1300s, killing perhaps as much as 25 percent of the population. Draw comparisons between the Black Plague and the 1793 yellow fever epidemic of Philadelphia.
  • Find an artistic representation of any plague period. Then compare the depiction of that plague with the one described by Allen in “Fever.”
  • How experimental a work of fiction do you find “Fever”? How do the devices and narratives that Wideman employs affect your reading and your understanding of the story? Find other examples of experimental stories, and compare them to “Fever.”

Illness and Death

In a story about a raging yellow fever epidemic, illness and death play a major part. The effects of yellow fever on the body are described in the autopsy reports, as are the maladies suffered by the afflicted people. However, the illness that holds Philadelphia in its grip is also reflected in the stillness of the streets and the stoppage of business. Philadelphia has become a place utterly transformed by the disease that decimates its inhabitants, and African Americans the scapegoat for the wrath and fear of the white inhabitants. Clearly, the yellow fever epidemic has affected not only its victims’ physical bodies but also its victims’ and soon-to-be victims” mental states.

The shadow of death pervades the story. Death manifests itself in the bodies piled high in the cemetery carts, in the cries of the orphans, in Allen’s refusal to return to his wife and child, and in the almost-emptied city. However, death has the power to grab hold of everyone, as it captures Wilcox, who had been faithfully burying bodies for two months.

Style

Point of View

“Fever” does not maintain any one consistent point of view. Much of the story is told from Allen’s perspective, both from the first-person and third-person point of view; it is he who describes the dead bodies, the transformed city, and Dr. Rush’s efforts and experiments. Allen is the character that readers most closely identify with. He appears to be knowledgeable and sincere in his desire to help fever victims and in his concern for chronicling life before and during the epidemic. Because he is a person of authority and respect in his community and because he shows such care for the victims of the disease, Allen’s opinions and reflections are generally trusted.

However, many other voices, some of them not easily identifiable, emerge to give a more complete story and to broaden the story’s field of inquiry. These other voices, which include persons who range throughout time, raise issues of slavery, prejudice, and racism. They allow the reader to see other perspectives on the way in which such evils can destroy a society and its people.

There is also the point of view of a detached narrator. This narrator gives historical background about the yellow fever epidemic, describes how it is blamed on African slaves, and explains the effects it has on its victims. Such inclusion helps ground the story more firmly in the reality of Philadelphia’s 1793 yellow fever epidemic. The factual voice lends credibility to the story, making readers take its implications of racism inherent to American society more seriously.

Narrative

“Fever” utilizes a more complex narrative structure than many other short stories. It does not tell a complete story in the sense that the reader can read through and identify a clearly defined beginning, middle, and end. Instead, all the distinct sections of the story—some of which, however, do unfold chronologically and in a more ordered fashion—work together to make a composite picture of a specific time and place as well as to present more general themes about the human condition.

The story opens by firmly rooting the events about to unfold in their historical perspective by use of a quote and an address to a real person, Matthew Carey. From that point on, however, the story skips between Allen’s narration, other voices, and factual presentation concerning yellow fever’s origins and its effects on the human body. The end of the story returns the reader to contemporary times—when the story was written—with its discussion of a firebombing in Philadelphia.

Setting

The setting of the story is primarily late 18th-century Philadelphia. Wideman describes what the city was like before and during the epidemic period. He presents the complex society of Philadelphia in the interaction of its African-American and white inhabitants. Philadelphia’s general racial progres-sivism is made clear through references to the Quakers; however, the delicate nature of such racial tolerance is also made clear in the abrupt change that the city undergoes as a result of the deadly fever.

However, the story has other settings as well. Voices of characters who live in Europe and in contemporary Philadelphia also emerge. This multitude of settings serves to demonstrate that some of the ills of 18th-century Philadelphia, such as racism, fear, and lack of communication, are prevalent facets of all societies, past and present.

Metaphor

The use of metaphor is an important aspect of “Fever.” The fever becomes indicative of both suffering and injustice. Indeed, Wideman uses the yellow fever epidemic to demonstrate the insidious and destructive nature of racism. The same way that the fever has the power to destroy its victims, the racism of whites has the power to destroy goodwill and good relations between all people. The fever also represents the powerlessness that people hold over their own lives as it becomes the ultimate master of its victims, enslaving both whites and African Americans in its clutches.

Wideman makes use of other metaphors in the story. The attempts of doctors, or the holders of knowledge, to understand the cause of the disease becomes a metaphor for the attempts of humans to understand hate. Disease comes to represent not only a physical ailment but the manifestation of the sins of the unholy and unjust.

Historical Context

18th-Century Philadelphia

In 1682, colonial Pennsylvania’s capital city Philadelphia was founded by Quakers, a Protestant sect that believed in the equality of men and women, religious tolerance, and nonviolence. Only a few years later Quakers in Pennsylvania lodged the first recorded colonial protests against slavery. Throughout the next several centuries, Philadelphia, and Pennsylvania, remained a capital of Quaker thought and ideology. Pennsylvania, a state that bordered the South, also was the destination of many fleeing slaves. However, the passage of the Fugitive Slave Act of 1793, which allowed slaveowners to capture runaway slaves without a warrant, led to the capture of many legally freed African Americans.

Despite such Quaker tolerance, true racial equality and lack of discrimination did not exist in Philadelphia. For instance, white Methodists favored the emancipation of the slaves, but they did not treat African Americans as equals.

Compare & Contrast

  • 1790s: African Americans in Pennsylvania number 10,274; the white population numbers 424,099.

    1990s: African Americans make up 1,157,000 of Pennsylvania’s total population of 11,881,643.
  • 1790s: Slavery is practiced in many places around the world. The United States, Great Britain, the West Indies, South Africa, France, Denmark, Mexico, Holland, Puerto Rico, Cuba, Brazil, and Chile, as well as most parts of Central America and most Spanish colonies in South America make it legal to hold slaves.

    1990s: Most nations throughout the world have abolished slavery, although it is still practiced in some parts of Africa, Asia, and South America. The Anti-Slavery Society for the Protection of Human Rights in London estimates that forms of servitude affect more than 200 million poor people.
  • 1790s: Severe yellow fever epidemics occur in the West Indies, the United States, Spain, and parts of southern Europe, South America, and Central America.

    1990s: Populations in areas susceptible to yellow fever are generally vaccinated, but the sporadic appearance of the disease is reported in Africa and the Americas.

Richard Allen and the Yellow Fever Epidemic of 1793

In 1793, Philadelphia was hit by a yellow fever epidemic that decimated the city. The Black Plague, as it is known, took the lives of thousands of Philadelphians. While many people fled the city, others stayed behind to help care for the sick. The minister Richard Allen was one of these people. Although he had no medical training, Allen was a noted “Bleeder,” which is roughly the equivalent of a present-day surgeon. Along with his fellow African-American preacher Absalom Jones, Allen organized Philadelphia’s African-American population to nurse the yellow fever victims. Dr. Benjamin Rush, a leading physician of the time and also a signer of the American Declaration of Independence, praised Allen for the service he gave to Philadelphia during this difficult time.

Allen was born into slavery, but through hard work he was able to buy his freedom from his owner. After heading North and becoming a Methodist preacher, Allen was appointed as assistant minister to a mixed congregation in Philadelphia. When church officials denied several African-American worshipers, including Allen, the right to pray at the front of the church and instead confined them to the rear, Allen decided to build an African-American owned church. In 1794, he and a group of 10 other African-American Methodists converted a blacksmith shop into the Bethel African Methodist Episcopal Church. In 1816, several other African-American congregations joined with Bethel to form the African Methodist Episcopal Church, and Allen was named its bishop.

Racial Issues in the 1980s

Throughout the 1980s, joblessness remained high among African Americans, especially unskilled workers in the inner cities. African Americans, who on the average had less education than whites, were, along with Hispanics, the last to be hired and the first to be fired. More than 30 percent of all African Americans, or nine million people, lived in poverty. Half of these families lived in a household headed by a woman.

African Americans, however, continued to rise to political power in the nation’s cities. African-American leaders won or held the mayoral office in such prominent urban centers as Philadelphia, Chicago, New York, Los Angeles, Detroit, and Washington, D.C. On a federal level, the Reagan administration attacked and even reversed some civil rights legislation and policies. A 1988 Newsweek poll showed that 71 percent of the African-American respondents believed that the federal government was doing “too little” to help them. The Reverend Jesse Jackson, who ran for president in 1984 and 1988, became an important civil rights advocate.

Significant racial incidents also occurred in the 1980s. Riots took place in Miami, Florida after four white police officers were acquitted of beating an African-American man to death; young white men fatally shot an African American in Bensonhurt, New York; and neo-Nazis and members of the Ku Klux Klan attacked civil rights marchers who were celebrating the new Martin Luther King, Jr., holiday. Racial incidents on college campuses also rose, and many African-American students reported feeling greater hostility from whites.

The Bombing of MOVE

In May 1985 the Philadelphia police department bombed the residence of MOVE, a radical African-American group. The members had already resisted repeated orders to leave the premises, and the police force, knowing they were armed, decided that force was necessary to remove the group. The ensuing helicopter bombing of the MOVE house turned into a deadly fiasco. Police intended the bomb to open a hole in the house so officers could throw in tear gas canisters. Instead, the bomb caused a fire that killed 11 MOVE members, including 5 children. The fire soon raged out of control and burned down 53 houses located on the block, leaving an estimated 225 people without homes. This government intervention has since been called the bloodiest and the most aggressive action ever undertaken against an urban African-American community in the United States.

Critical Overview

Throughout his career, Wideman has been perceived as a serious, important interpreter of the African-American experience in America. He has examined issues ranging from the deterioration of African-American urban life, the meaning of being an African-American man, and the role that violence plays in American life. Many of these issues are raised in Fever, Wideman’s second collection of short stories, which was published in 1989.

These stories all deal with suffering, death, the failure of communication, and the quest for redemption. Wideman, however, sees “Fever” as “the key story, the pivotal story.” In an interview with Judith Rosen of Publishers Weekly in 1989 he explained: “I see the others as refractions of the material gathered there. All the stories are about a kind of illness or trouble in the air. People aren’t talking to one another or are having a difficult time talking to one another. There’s misunderstanding, not only on an individual level but on a cultural level.”

Reviewers of Fever also single out the title story, noting its uniqueness, its range, and its message. Susan Fromberg Schaeffer, writing for The New York Times, calls “Fever” “almost majestic in its evocation of the goodness and evil of the human heart.” She further notes the peculiar perspective used by Wideman in this collection, which she expresses as “not quite human but godlike, not limited by the conventions of ordinary storytelling.” She finds that “Fever” makes use of this style of storytelling successfully, culminating in “an almost unbearably anguished meditation on human nature in plague time, the power and sadness of the story are enormous, its vision triumphant.”

Wideman’s career can be characterized by his search for new ways to explore themes and ideas and to express the African-American experience. “Fever” is a boldly experimental work, one that floats back and forth between time periods and narrators and thus defies easy labeling or analysis. Randall Kenan of The Nation forthrightly deals with Wideman’s slipping back and forth in time; he presents his own reasoning: “It is as if Wideman is again playing games with us, forcing us to see the past and the present as one; how we are affected by what has gone before, not only in our thinking but in our acting and in our soul-deep believing.” Despite the story’s elusive nature and Wideman’s claims to Rosen that the story “shouldn’t be tied to any historical period,” reviewers note his evocation of a specific period in American history. Other reviewers comment on the way Wideman collapses time to present a composite picture of a certain place and mindset. Cara Hood writing for the Voice Literary Supplement claims that present-day Philadelphia emerges as the protagonist of the story.

Reviewers do not overlook the significance of Wideman’s message in examining his style. Herbert Mitgang in the New York Times finds that even after reading the story, he is left with the knowledge of Wideman’s search for “some sort of universality” to the human condition. Some reviewers, however, do not care for the way in which Wideman attempts

to get his message to readers. For instance, Clarence Major of the Washington Post believes “Fever” to be the most ambitious if not the most artistically successful story of the collection. Mitgang recognizes the importance of what Wideman is saying when he writes that Wideman’s “voice as a modern black writer with something to report comes through.” Despite this praise, Mitgang does not believe that the rest of the stories are successful, asserting in his review of the collection that they add nothing to Wideman’s reputation as a writer.

In Wideman’s extensive and accomplished body of work, “Fever” occupies only a small spot. Yet, if it accomplishes nothing more, it demonstrates Wideman’s careful exploration of relationships among people and the effects that these relationships have on society. Wideman’s interest in the issues he raises in “Fever”—including racial relations, communication, personal freedom, and violence—is seen in the works that he has written later in his career. Philadelphia Fire picks up the final section of the story in its fictionalization of the 1985 MOVE bombing. The Cattle Killing explores the devastating effects of racial prejudice on the African Americans who remained behind in Philadelphia during the 1793 yellow fever epidemic in greater detail. The body of Wideman’s work strengthens Robert Bones’ assertion, made in 1978, that Wideman is “perhaps the most gifted black novelist of his generation.”

Criticism

Rena Korb

Korb has a master’s degree in English literature and creative writing and has written for a wide variety of educational publishers. In the following essay, she examines how Wideman presents themes of racism and equality in “Fever.”

John Edgar Wideman’s life could read as any of the dramatic, brooding novels and short stories that he has produced over the course of his long, successful career. Raised in a predominately African-American neighborhood in Pittsburgh, he nonetheless moved with fluidity in both the black and the white worlds. His talent at basketball led to a scholarship at the University of Pennsylvania in Philadelphia, where he proved himself a brilliant and diligent student. He won a Rhodes Scholarship in 1963, which brought him international attention because he was only the second African American to do so. Also that year, he was the subject of a magazine

What Do I Read Next?

  • Narrative (1794) by Absalom Jones and Richard Allen is a personal memoir of Philadelphia’s 1793 yellow fever epidemic.
  • Forging Freedom (1988) by Gary B. Nash explores the formation and development of Philadelphia’s African-American community from the 18th century and until the mid 19th century.
  • Bring Out Your Dead (1949) by J. H. Powell chronicles the yellow fever epidemic that hit Philadelphia in 1793.
  • Burning Down the House (1987) by John Anderson and Hilary Hevenor explores the establishment and development of MOVE and chronicles events surrounding the 1985 bombing.
  • John Edgar Wideman’s Philadelphia Fire (1990) presents a fictionalized account of the only survivor of the 1985 bombing of the MOVE house in Philadelphia.
  • Jean Toomer’s Cane (1923), a collection of short stories and poetry, explores life for southern and northern African Americans after slavery.
  • Albert French’s novel Billy (1993) explores how racial hatred in the South leads to a horrible crime perpetrated against a young boy.
  • Also by Wideman, The Cattle Killing (1996) traces the path of an African-American preacher and other African Americans who nurse the victims of Philadelphia’s 1793 yellow fever epidemic.

zine article in Look entitled “The Astonishing John Wideman.”

Wideman saw his career as a writer take off in 1967, when he was only 26, with the publication of his first novel A Glance Away. While his writing brought him acclaim and contributed to a secondary career as a professor, his personal life was beset with difficulties. In 1976, his brother was convicted of murder and sentenced to life in prison after a man was killed by his accomplice in a burglary attempt. Then, in 1986, Wideman’s teenage son stabbed and killed a classmate during a summer-camp trip; he was sentenced to life imprisonment. After this event, articles that appeared in Vanity Fair and Esquire characterized Wideman as filled with controlled racial anger.

Wideman, whose work often focuses on the unique experiences of African-American men, the deterioration of African-American urban life, and violence and criminal behavior in America, has used his writing to work through these devastating experiences. His memoir about his brother, Brothers and Keepers, was nominated for the National Book Award. Philadelphia Fire interweaves personal feelings about what happened to his son with a plot centering around the 1985 police bombing of the Philadelphia headquarters of the radical African-American group, MOVE.

These works do not follow a traditional storytelling style, using a much freer method for exploring issues raised by questions about suffering, race, and redemption. For instance, part II of Philadelphia Fire draws on literary, historical, and sociological commentary to broaden the scope of Wideman’s narrative. The stories in Fever, Wideman’s second collection published in 1989, also stretch the limits of the mainstream short story; his narrations play with historical time, style, voice, and sequence. Perhaps none of these stories do so to the extent of “Fever,” which is in Wideman’s opinion, the key story of the collection.

“Fever” centers around a deadly yellow fever epidemic that struck Philadelphia in 1793 and the effects it had on the city’s African-American population, who were largely blamed for bringing the disease. The main figure in the story is a man named

“Wideman has truly produced a work that, while opening a door onto new ways of looking at issues, also shuts it in its complexity.”

Allen, who Wideman leads the reader to believe is based on (or indeed is) the historical figure Richard Allen. The real-life Allen, like the fictional Allen, risked his own life to remain in Philadelphia to nurse the sick and dying. However, the story is truly much more than just the story of an epidemic and one man’s role in it. It brings up significant issues of racism and prejudice and how these problems can destroy a community. In utilizing different voices and moving through time, Wideman makes clear that these problems are not tied merely to 18th-century America, but have existed throughout the world and throughout time and continue to the present day.

In discussing Brothers and Keepers Wideman had already presented his belief that telling stories in chronological order was pointless and even detracted from a truer meaning: “You never know exactly when something begins,” he wrote. “The more you delve and backtrack and think, the clearer it becomes that nothing has a discrete, independent history; people and events take shape not in orderly, chronological sequence but in relation to other forces and events, tangled skeins of necessity and interdependence and chance that after all could have produced only one result: what is.” In “Fever,” some of the most startling innovations in the story are Wideman’s use of a nonlinear time and multiple narrators, although these voices are often difficult to identify and distinguish. While such characteristics might make a cursory read of “Fever” confusing, these stylistic devices serve Wideman’s greater purpose and message: that of the prevailing nature of racism and hatred among people.

The culminating force of the various voices point out the disharmony to which racism leads. While most white Philadelphians believe that African slaves from Santo Domingo have brought the affliction to their city, no scientific evidence exists to this effect. However, such racist thought is not to be dispelled, and African Americans in Philadelphia are shunned and treated as “evil incarnate.” Allen notes, “A dark skin was seen not only as a badge of shame for its wearer, . . . It mattered not that some of us were born here and spoke no language but the English language, second-, even third-generation African Americans who knew no other country.” Allen then compares African Americans to European immigrants who do not even speak English, making clear that prejudice against Philadelphia’s African Americans is based merely on the color of their skin. The European immigrants exhibit more typically foreign traits, such as “clodhopper shoes, strange costumes, . . . Lowlander gibberish that sounded like men coughing or dogs barking”; yet, these white people are not blamed for any disease. Perhaps even more indicative of the malignant nature of white Philadelphia’s racism is the false charge that African Americans are immune to the disease, a story manufactured solely for the purpose of sending them out to the sick community as caregivers. In reality, the fever struck a severe blow to the city’s African-American population. As Allen attests, “Among the city’s poor and destitute the fever’s ravages were most deadly and we are always the poorest of the poor.”

Although Allen recognizes these falsehoods, expressing his anger against whites for their unfounded accusations—“My fellow countrymen searching everywhere but in their own hearts,” he says, “the foulness upon which this city is erected”—he still remains within the disease-stricken community to help the sick, both white and African American. For this action, some of the story’s other narrators chastise him: “Can you imagine yourself, Allen, as other than you are?” the voice of an afflicted person charges. Without his ties to Dr. Rush and the dying community, Allen would truly hold “the weight of your life in your hands,” rather than the weight of others’ lives. For Allen, this would be the harder task. “Tell me what sacred destiny, what nigger errand keeps you standing here at my filthy pallet?” asks the voice, implying that Allen, a free African American, is fulfilling the most common role of his race in America—that of a slave. Although a voice urges Allen to “dare be a Moses to your people and lead them out of this land,” Allen resists the call and instead lingers in Philadelphia under the orders of Dr. Rush, a white man.

The story also makes clear, however, that captivity can exist in many forms. Allen identifies that former African-American slaves who had struggled to reach freedom in the North fell prey to a new form of slavery, the “chains of dissolute living.” A fever victim speaks to Allen, claiming that he is “more slave than you’ve ever been,” for he does the fever’s “bidding absolutely.” Even the city itself is held captive by “long fingers of river,” and the city in turns holds many of its residents captive. One of the final voices of the story also affirms the precious gift of freedom. This voice belongs to an African-American hospital orderly who, although he complains about his job and the elderly people he cares for, ends his monologue with the words: “But me, I’m free. It ain’t that bad, really.”

The emphasis Wideman places on the various forms of slavery strengthens his thesis that the fever has not been brought by the Santo Domingan slaves but has been wrought by the evilness that lurks in human’s hearts. “We have bred the affliction within our breasts. . . . Fever descends when the waters that connect us are clogged with filth. . . . Nothing is an accident. Fever grows in the secret places of our hearts, planted there when one of us decided to sell one of us to another.” If fever is caused by slavery, slavery, he says, is caused by a failure to see beyond the color of a person’s skin.

Yet, the fever also demonstrates that humans are all the same in their response to the disease. Autopsy reports confirm that the insides of the bodies of fever victims, both whites and African Americans, look alike. “When you open the dead,” a narrator intones, “black or white, you find: . . .” The narrator then goes on to list the states of the various organs. The outer skin of the victims does, however, undergo a transformation. The skin of white people turn black, and one victim even acknowledges to Allen that “When I die, they say my skin will turn as black as yours.” The fever is truly an equalizing force, for it makes everyone bow to its will.

Another device employed by Wideman to show the inherent, though often denied equality of humans is that of twinning. Literal and figurative twins abound in “Fever.” People are paired: Dr. Rush and Deveze, Allen and his brother Thomas; the members of these two pairs perform the same function and are interchangeable. For each person, someone exists who is on the same level. The fever itself is seen as the twin to “Barbados’s distemper” and is linked to epidemics in Europe. Allen also finds twin brown babies in a cellar where two Santo Domingan refugees have died. The twinning metaphor can be further drawn. For instance, Master Abraham and Allen have very real similarities; both have left their wife and children behind to lose them forever. Further, Master Abraham’s references to Palatine fever in Europe’s cities, which many people claimed was brought by Jews, show that minority populations become the butt of racist fear at the hands of the majority. Such similarities further emphasize Wideman’s thesis of racism as a universal feeling, one that has the ultimate power of destroying those who are its victims as well as those who perpetuate it.

In many ways, however, “Fever” resists comprehensive analysis. There are simply too many unexplained and unidentified persons, events, and references. Wideman has truly produced a work that, while opening a door onto new ways of looking at issues, also shuts it in its complexity. But with a writer of Wideman’s stature and talent, clearly this confusion is intentional. Wideman may be seen as deliberately conflating characters and events in order to show that the themes of the story are so prevalent and so universal. His characters, as well as his narrative, defy labeling, even though the story actually challenges readers to do so. For instance, at times it is not even clear whether a speaker is African American or white, even though the story is so closely tied to racial issues. Wideman makes a reader ponder serious issues but allows for no real answers to any questions raised. In so doing, he opens a world of possibility for interpretation, which in turn, allows for greater personal understanding of the story.

Source: Rena Korb, Overview of “Fever,” for Short Stories for Students, The Gale Group, 1999 .

Elisabeth Piedmont-Marton

In the following essay, Piedmont-Marton explores Wideman’s use of the fever as a metaphor for racism.

Wideman calls “Fever” a meditation on history. Using the powerful and disturbing metaphor of plague or fever for racism and hatred, Wideman moves through history and brings together voices from the 18th to the late 20th centuries. He meditates on history, or past events, but also on history as the means by which human beings record and pass on knowledge. His commentary is as much about the process of history as it is about the events.

In the story’s powerful opening paragraph, readers are introduced to the first of several unnamed characters. This paragraph is not located in

“Wideman’s chilling conclusion to ‘Fever’ proves the narrator’s claim in the beginning of the story that the fever’s ‘disappearance is as certain as the fact it will come again.’”

any particular historical moment, and its ominous imagery of dead trees and impending darkness is timeless. The narrative then veers sharply from the universal to the specific as Wideman piles on the details of a terrible fever epidemic in Philadelphia. He also distinguishes yellow fever from dengue and explains the symptoms of each as if preparing readers to enter the infected area or reminding them to check themselves for rashes or aching joints. Wideman imagines the epidemic’s beginning in the hold of a slave ship and characterizes the mosquito that transmits the disease as a succubus, or evil female spirit. “In the darkness he can’t see her, barely feels her light touch on his fevered skin. Sweat thick as oil but she doesn’t mind, straddles him, settles down to do her work. She enters him and draws his blood up into her belly.”

Back in Philadelphia the narrator seems to know about the origins and course of the disease, as if he has been present at its beginnings and during other epidemics. He says: “No one has asked my opinion. No one will. Yet I have seen this fever before, and though I can prescribe no cure, I could tell stories of other visitations, how it came and stayed and left us, the progress of disaster, its several stages, its horrors and mitigations.” It’s tempting to blame the newest outsider, the narrator says, the former slave refugees from the uprising in Santo Domingo, but “to explain the fever we need no boatloads of refugees, ragged and wracked with killing fevers, bringing death to our shores.” He knows that “fever descends when the waters that connect us are clogged with filth,” but he also advances a more metaphysical and moral cause, originating from the mosquito on the slave ship: “Fever grows in the secret places of our hearts, planted there when one of us decided to sell one of us to another.” Fever will come again and again so long as hatred and racism continue to exist.

The narrator’s work with the dead and dying, then, can be seen as an attempt to treat both the symptoms and the real cause of the disease, to ease suffering and to combat racial hatred, but even his service to the sick must be understood in the context of racism itself. Even the devastation of the epidemic isn’t enough to level the barriers between white and black. The narrator spends his days helping the prominent white Dr. Rush, but still tries to devote some energy to the poorest and most desperate of the city’s black population in the caves and tunnels they live in on Water street, where they are especially vulnerable to the fever. As genuine as the narrator is in his attempts to heal the sick and comfort the dying, he knows he is being used: “The fiction of our immunity had been exposed as the vicious lie it was, a not so subtle device for wresting us from our homes, our loved ones, the afflicted among us, and sending us to aid strangers.” When fever gripped the racially divided city, the narrator explains, “We were proclaimed carriers of the fever and treated as pariahs, but when it became expedient to command our services to nurse the sick and bury the dead, the previous allegations were no longer mentioned. Urged on by desperate counselors, the mayor granted us a blessed immunity. We were ordered to save the city.” If the narrator is correct that the disease has a moral as well as a biological cause, if we have “bred the affliction within our breasts,” then the mayor’s despicable plan will only ensure fever’s cyclical and inevitable return.

If the black population’s immunity to the physical symptoms of the fever is a lie, then the narrator is also susceptible to the more insidious moral infection of the epidemic. When he enters the home of a rich white family to find everyone dead except one “loyal black maid, sick herself, who’d elected to stay when all others had deserted her masters,” he wants to ask “why she did not fly out the door now, finally free of her burden, her lifelong enslavement to the whims of white people.” Instead, he asks himself why he doesn’t fly, why he “was following in the train on Rush and his assistants, a functionary, a lackey, insulted daily by those I risked my life to heal.” That the narrator even has to consider the question demonstrates the horrible power of racism because it demands that he choose between freedom and life and asks him to give up his loved ones for the possibility of greater autonomy and material gain. The narrator explains: “Fever made me freer than I’ve ever been. Municipal government had collapsed. Anarchy ruled. As long as fever did not strike me I could come and go anywhere I pleased. Fortunes could be amassed in the streets.” Finally, with words as clearly evident of fever’s possession as the yellowed eyes of the dying, he says, “I could sell myself to the highest bidder.”

As the grim prophecy of the disease’s course predicts, the selling of human flesh—even yourself—demands a heavy price. The narrator’s wife and children succumb to the fever and he never sees them again. Also, the narrator has not achieved the freedom and wealth that he was willing to trade all else for. In the story’s final pages he is challenged, and called by name, by a elderly Jewish patient: “Can you imagine yourself, Allen, as other than you are? A free man with no charlatan Rush to blame. The weight of your life in your hands.” The narrator is trapped, enslaved, “by an endless round of duty and obligation.” The old man finally charges him: “Your life, man. Tell me what sacred destiny, what nigger errand keeps you standing here at my filthy pallet? Fly, fly, fly away home.” But the story of fever and its devastating consequences is a story that has “no beginning or end, only the waters’ flow, ebb, flood, trickle, tides emptying and returning.”

Wideman’s chilling conclusion to “Fever” proves the narrator’s claim in the beginning of the story that the fever’s “disappearance is as certain as the fact it will come again.” As the story lurches forward into the late twentieth century, the familiar narrator’s voice is interrupted by the distinctly modern voice of a hospital or nursing home attendant complaining about his job and about how badly the white people smell. Clearly the fever still grips Philadelphia. If readers doubted that, Wideman adds one more piece of evidence, “almost an afterthought.” The narrator describes the city recovering, returning “to products, pleasures, and appetites denied during the quarantine months.” But this is not aftermath of the fever epidemic that we’ve been reading about in some remote past. This is now, and the Mayor is referring to his decision to bomb a block of houses where poor blacks lived in an attempt to eradicate crime. “A new century would soon be dawning. We must forget the horrors. The Mayor proclaims a new day. Says lets put the past behind us. Of the eleven who died in the fire he said extreme measures were necessary as we cleansed ourselves of disruptive influences.” But like fever, history refuses to stay in the past. Hatred and racism will never be eradicated because they, like fever, thrive in darkness and filth, and because we guarantee future outbreaks by not recognizing that we breed “the affliction within our breasts,” that “fever descends when the waters that connect us are clogged with filth.”

Source: Elisabeth Piedmont-Marton, Overview of “Fever,” for Short Stories for Students, The Gale Group, 1999.

Barbara Kitt Seidman

In the following essay, Seidman provides a brief summary and analysis of “Fever.”

“Fever,” the title story in Wideman’s 1989 collection of short fiction, provides an illuminating metaphor for the various episodes of racial antagonism depicted in the volume. As one of the story’s narrative voices explains, “Fever grows in the secret places of our hearts, planted there when one of us decided to sell one of us to another. The drum must pound ten thousand thousand years to drive that evil away.”

The narrative focus of the tale reflects Wideman’s desire to correct the inaccurate historical record about the role of African Americans during the 1793 yellow fever epidemic that devastated Philadelphia; he dedicates the story to the author of one such fraudulent account and relies instead upon the eyewitness record left by black commentators. Among the chorus of voices in the text are those of two black men, one of them the historical Richard Allen and the other his fictionalized brother Thomas, whose differing perspectives on the disaster and its resultant hypocrisies work in counterpoint. Allen, a former slave, minister, and the founder of the African Methodist Episcopal Church, is a deeply spiritual man who identifies his vision of the mass emancipation of slaves with the promise of Christianity. Allen has been ordered to serve a Dr. Rush in his ministrations to and autopsies of plague victims. After performing exhausting labor among the whites, he turns to the destitute habitations of poor blacks whom the disease ravages with equal savagery and devotes himself to their spiritual and physical health despite their contempt.

Like many other elements of the narrative, Thomas’ story further documents the presence of blacks in the public sphere of American history: Thomas fought with the rebels in the American Revolution and, as a prisoner of the British, recognized the degree to which he had been denied participation in the society whose ideals he championed. His embittered outlook on the situation now facing blacks in the plague-ridden city

“Rather than boasting a vigorous democratic climate, Wideman’s Philadelphia festers in a stagnant environment whose waters breed contagion both literally and metaphorically.”

stems from the opportunistic shifts of white opinion regarding blacks during the epidemic; while slaves were initially blamed for importing the disease following a bloody revolt in the Caribbean, blacks were later declared immune from its ravages and coerced to serve sick and dying whites. Each of these civic fictions exposes the denial of humanity underlying racism and responsible for the cultural pathology which is Wideman’s principal target.

Philadelphia operates as symbolic setting for this story on religious as well as political grounds: Its Quaker egalitarianism does not preclude Allen’s being refused a place at the communion table with white Christians, nor does the city’s birthing of the young republic ensure that its African-American citizens will be accorded the same possibilities for prosperity available to the unending waves of European-born newcomers. Rather than boasting a vigorous democratic climate, Wideman’s Philadelphia festers in a stagnant environment whose waters breed contagion both literally and metaphorically. Nor is water the only sinister natural element pervading the landscape; apocalyptic fire fills the streets of the city as a grim purgative for its soul-sickness.

The story evolves through a polyphonic orchestration of voices combining the points of view of slave and freedman, black and white, Christian and Jew, historian and eyewitness.

Wideman’s characteristically fractured narrative jarringly shifts perspective to suggest that no one interpretation or “story” exists independent of the wider human drama playing itself out across time. Within his textual montage, Wideman melds such disparate elements as a newly enslaved African making the middle passage; a series of scientific descriptions of the fever and its assumed insect carriers; and a report of autopsy results documenting the common physical devastation visited upon Black and white plague victims alike.

Added to the individualized voices of Richard and Thomas Allen is the combative monologue of a dying Jewish merchant who describes his own experiences with bigotry and aggressively challenges Allen’s continued attentions to the white populace. This character, Abraham, alludes to the Lamed-Vov, or “Thirty Just Men” of Judaic tradition, designated by God “to suffer the reality humankind cannot bear” and bear witness to the bottomless misery and depravity of existence. Richard Allen is one such figure among many in these stories whose compassion in the face of unbearable injustice and grief offers the only hope for salvation that Wideman can envision.

To underline the timeliness of this meditation on so seemingly remote a historical episode, Wideman introduces toward the end of the story the voice of a contemporary black health-care worker contemptuous of his elderly white charges and the society that has discarded them. Finally, within a single paragraph, Wideman links the disease wasting Philadelphia’s citizens in the late eighteenth century to the factual 1985 bombing of a black neighborhood ordered by the city’s first black mayor, Wilson Goode, to eradicate the black radical group MOVE. Wideman claims that in “Fever” he “was teaching myself different ways of telling history”; with the publication of Philadelphia Fire in 1990, a novel that extends his analysis of the MOVE bombing, he returned to this later historical incident as evidence of the paradoxes of the United States’ continuing racial self-destructiveness.

Source: Barbara Kitt Seidman, “Fever,” in Magill’s Survey of American Literature, edited by Frank N. Magill, Salem Press, 1991, pp. 2109-11.

Randall Kenan

In the following excerpt, Kenan discusses the manner in which Wideman manipulates time in “Fever.”

Like present-day cosmologists, Wideman seems to have in mind not merely a blurring of the two concepts [Time and Space] but their elimination. He metajokes about our Western cultural bias toward “clock time, calendar time,” to time “acting on us rather than through us” and “that tames space by manmade structures and with the / as center defines fines other people and other things by nature of their relationship to / rather than by the independent integrity of the order they may represent.” Wideman’s true mission appears to be to replace the / at the center of all his stories, to make it subject to an internal order of things rather than to external structures and limitations. Unlike Ishmael Reed, his humor does not slice to the bone to the truth; Wideman’s humor is sparse if not (at times) nonexistent. And unlike Amiri Baraka, his rage is far from militant; it is sublimated, almost repressed.

Nowhere in this collection [Fever] is this more evident than in the title story. More a meditation than an eyewitness account, “Fever” centers around Philadelphia’s yellow fever epidemic of the late eighteenth century. Snatching up bits and pieces of history here and there, he brilliantly creates an organism, like a New Age psychic channeler, that transports the sufferers from the 1700s to the present, and takes us back in time as well. Its scenes bring to mind images from Herzog’s Nosferatu of a plague-ridden town debilitated, full of coffins, corpses, rats and decay: “A large woman, bloated into an even more cumbersome package by gases and liquids seething inside her body, had slipped from his grasp. . . . Catching against a rail, her body had slammed down and burst, spraying Wilcox like a fountain.” Yet without warning the story shifts to the present, to the aftermath of the 1985 MOVE massacre, to the voice of a black hospital orderly. It is as if Wideman is again playing games with us, forcing us to see the past and the present as one; how we are affected by what has gone before, not only in our thinking but in our acting and in our soul-deep believing. Science (knowledge) becomes a metaphor for understanding hate; disease, a euphemism for the plague visited upon the wrongs of the unholy.

And the voices. Wideman leads us to believe the main character of “Fever” to be none other than Richard Allen, who founded the African Methodist Episcopal Church. His voice, initially eighteenth-century and pious, merges with a chorus of victims, singing of guilt, of racism, of ignorance. Ultimately the voices question Allen—a freedman—for staying in Philadelphia, abandoning his wife and children, risking his life by working with the virus-infected, practically enslaving himself to strange, clueless physicians. And Allen can articulate no reason for staying to combat the “unpleasantness from Egypt.”

“Unlike Amiri Baraka, his rage is far from militant; it is sublimated, almost repressed.”

Source: Randall Kenan, “A Most Righteous Prayer,” in The Nation, Vol. 250, No. 1, January 1, 1990, pp. 25-7.

Sources

Mitgang, Herbert. A review of Fever. The New York Times, December 5, 1989, p. C21.

Rosen, Judith. An interview with John Edgar Wideman. Publishers Weekly, November 17, 1986, pp. 37-38.

Samuels, Wilfred D. Entry on John Edgar Wideman in Dictionary of Literary Biography, Vol. 33, Gale Research, Detroit, MI, 1984.

Schaeffer, Susan Fromberg. A review of Fever. The New York Times Book Review, December 10, 1989, pp. 1, 30-31.

Further Reading

Coleman, James W., Blackness and Modernism, University Press of Mississippi, 1989.

Discusses Wideman’s career in terms of his reorientation within the African-American community and cultural setting.

Mbalia, Dorothea Drummond. John Edgar Wideman, Susquehanna University Press, 1995.

Analyzes the early works of Wideman’s career as Eurocentric and the later works as indicative of his effort to reclaim the African personality.

TuSmith, Bonnie, editor. Conversations with John Edgar Wideman, University Press of Mississippi, 1998.

A collection of interviews with Wideman.

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Fever

Fever

Definition

Fever is defined as an abnormally high body temperature or a regulated rise to a new set point of body temperature. While a body temperature above 100°F(37.8°C) is considered to be a fever by some clinicians, a significant fever is usually defined as an oral temperature of 102°F (39°C) or a rectal temperature of 103°F(39.5°C). Fever is a sign of inflammation and represents the body's response to microbial invasion or to a disease process.

Hyperthermia is defined as abnormally high body temperature caused by disruption of the body's thermoregulatory mechanisms. Hyperthermia occurs when the body's metabolic heat production or environmental heat load exceeds the normal heat loss capacity (or when normal heat loss is impaired).

Description

The normal temperature of the human body fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C). There is a diurnal pattern of temperature variation in humans, with body temperature being lowest in the morning and highest in late afternoon. In women of childbearing age, there is a small rise in temperature following ovulation during the menstrual cycle, and during the first trimester of pregnancy .

The body's thermoregulatory mechanisms include changes in muscle tone, vascular tone, and sweat production, which serve to balance body heat produced by metabolism with heat lost to the environment. This balance is regulated by the hypothalamus, a small structure in the brain below the thalamus.The body's temperature regulation can be upset by environmental factors (external heat and humidity); by disorders or conditions that inhibit sweat production or evaporation; and by infectious diseases.

Fever occurs when the hypothalamus raises the body's temperature to a new set point. White blood cells called monocyte-macrophages release proteins called pyrogens when the cells encounter pathogenic microorganisms. The pyrogens act on the hypothalamus, causing it to reset the body's "thermostat" upward. The vessels that supply the skin with blood often narrow as the body's temperature is rising. This process, which is called vasoconstriction, reduces sweating and causes the body to retain more heat than it loses. Vasoconstriction in the skin and extremities allows the body to move blood toward its core, which increases the rate of metabolism and induces shivering. The chills that often accompany a fever are caused by this movement of blood to the body's core, which leaves the skin surface and extremities relatively cool. When the infection or disease process resolves, the hypothalamus attempts to reset the body's thermoregulation at its normal set point. The body's cooling mechanisms switch on as the blood returns to the extremities and skin surface, and sweating occurs.

Fever is an important component of the immune system's inflammatory response, though its role is not completely understood. A rise in body temperature has several effects. The pyrogens that trigger the resetting of the body's thermostat also increase the production of macrophages, which fight off invading bacteria or viruses . Higher temperatures also inhibit the growth of some bacteria, while at the same time activating the immune system . In addition, the increased heart rate that accompanies vasoconstriction also speeds the arrival of white blood cells to the sites of inflammation.

Causes and symptoms

Causes

Fever can be caused by a wide variety of diseases and disorders, including:

  • infectious diseases, which may be caused by viruses, bacteria, fungi , rickettsiae, or parasites
  • autoimmune disorders , including systemic lupus erythematosus, rheumatic fever, adult rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, and Still's disease
  • disorders of the central nervous system (CNS), including head injuries, multiple sclerosis, tumors of the brain or spinal cord , and cerebral hemorrhage
  • cancers, including primary cancers of the colon, rectum, kidney, and liver , and metastatic cancers of the liver
  • cardiovascular disorders, including myocardial infarction and pulmonary embolism
  • reactions to such medications as methyldopa, quinidine, hydralazine, phenytoin, chlorpromazine, carbamazepine, anti-cancer drugs, and antibiotics
  • endocrine disorders, including hyperthyroidism (thyroid storm) and pheochromocytoma
  • gastrointestinal disorders, including alcoholic hepatitis, inflammatory bowel disease (IBD), and liver abscess
  • inflammation associated with indwelling catheters, intravenous lines, and nasogastric tubes
  • neuroleptic malignant syndrome, which is a rare and potentially fatal reaction to certain antipsychotic medications

Fever patterns

Fevers may be classified as intermittent (the patient's temperature falls to normal at some point during the day); sustained (the temperature remains high); or relapsing (periods of fever are followed by several days of normal temperatures). The fever pattern may be helpful in the differential diagnosis; for example, fevers related to medication reactions are more often sustained than intermittent. A relapsing pattern suggests malaria .

The degree of temperature elevation in a fever does not necessarily correspond to the seriousness of the illness. In general, children with fevers run higher temperatures than adults, while elderly persons and newborns may have less marked fevers.

Diagnosis

The differential diagnosis of fever is complicated by the variety of possible causes. In most cases, the patient's history—including a medication history and history of exposure to infectious diseases—vital signs, a complete blood count , and blood cultures will help to narrow the number of possible causes. In fevers of unknown origin (FUOs), however, the physician may need to schedule a chest x-ray or ultrasound and CT imaging.

Fevers of unknown origin (FUOs)

The origin of some fevers is difficult to determine. The term "fever of unknown origin" (FUO) has been applied to cases of fever in which the patient's temperature remains over 101°F (38.3°C) for three weeks and in which the diagnosis is not apparent after seven or more days of studies. The most common cause of FUOs is an infectious disease of some kind, although many cancers present initially as FUOs. About 15% of FUOs never receive a definite diagnosis.

Temperature measurement

A variety of different devices are available to register body temperature, including the traditional glass thermometers used for oral or rectal temperature readings. More recently, sophisticated electronic devices have been introduced that register body temperature as a digital readout. For younger children and infants, there are fore-head meter strips and pacifiers with temperature-sensitive readouts.

Treatment

Routine measures

Most fevers are caused by common infections, are short-lived, and do not require symptomatic treatment. The patient's comfort, however, may be improved by measures to remove body heat, antipyretic medications, and fluid replacement. Measures to remove body heat include alcohol or cold sponges; ice bags; and ice baths. The most common antipyretic medications are aspirin or acetaminophen, 350–650 mg every four hours. Children or adolescents with influenza-like symptoms should not be given aspirin without consulting a physician because of the possibility of developing Reye's syndrome, a rare disorder characterized by vomiting and liver dysfunction.

Fluid replacement is an important part of fever treatment. Extra fluid is required to prevent electrolyte imbalance as well as to replace fluid lost through perspiration.

Emergency treatment

Body temperature over 105.8°F (41°C) in an adult is a medical emergency and requires immediate treatment.

The following indications in specific patient groups may require emergency treatment:

  • newborns (three months or younger) with fever of 100.5°F (38°C) or higher
  • infants or children with fever of 103°F (39.4°C) or higher
  • adults with fever of 101°F or higher lasting longer than three days; or a temperature of 100.5°F lasting longer than three weeks without other symptoms

A very high fever in a small child can trigger febrile seizures, and therefore requires immediate treatment. A fever accompanied by a stiff neck, severe headache, throat swelling, and changes in mental status may indicate the presence of meningitis or another serious infection, and should be brought to the immediate attention of a physician. High fever does not always produce sweating or diaphoretic symptoms, which indicates weakness in the body's defenses against severe disease.

Prognosis

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen and do not produce any lasting effects. Exceptions include fevers associated with meningitis, typhoid, or scarlet fever. High fevers can produce major disturbances of the body's metabolism and alter the body's responses to medications. In addition, a high fever during the first trimester of pregnancy increases the risk of such birth defects as anencephaly (absence of a portion of the skull and brain).

The prognosis for fevers associated with such chronic conditions as autoimmune disorders depends on the stage of the disease and its management.

Health care team roles

Nurses assess and record the fever patient's signs and symptoms. Nurses as well as physicians can obtain relevant information from the patient's medical history. Home health care and visiting nurses may also help to educate patients about at-home treatment of fevers. In some cases, home care nurses may counsel patients and caregivers over the phone, advising when the condition warrants in-person medical attention.

Prevention

Since most fevers are caused by infectious agents, careful attention to proper methods of food handling, hand washing, and similar public health measures is an important form of prevention. Fevers related to medication reactions can sometimes be prevented by substitution of drugs that are less likely to produce such reactions. Fevers related to indwelling catheters and similar devices may be avoided by removing them as soon as they are no longer required.

Hyperthermia related to environmental conditions may be prevented by proper attention to climatic conditions, adequate fluid and electrolyte intake, and acclimatization to hot environments. Educating the public about the early signs of heat disorders is another important preventive measure.


KEY TERMS


Antipyretic —A drug that lowers body temperature, such as aspirin or acetaminophen.

Autoimmune disease —A disorder in which the immune system attacks the body's own cells.

Febrile seizure —Convulsions brought on by high body temperature and inflammation of the brain or brain covering.

Hyperthermia —Abnormally high body temperature that occurs when the body's metabolic heat production or environmental heat load exceeds the normal heat loss capacity (or when heat loss is impaired). Heat stroke is an example of hyperthermia.

Hypothalamus —A region in the posterior section of the forebrain that regulates body temperature, sleep cycles, and the activity of the pituitary gland.

Intermittent —A fever pattern marked by the patient's temperature returning to normal at some point during the day.

Macrophage —A type of large white blood cell that helps the body fight off pathogenic microorganisms by ingesting them.

Malignant hyperthermia —A rare inherited condition in which a person develops a very high fever when given general anesthetics or muscle relaxants in preparation for surgery.

Pyrogen —A substance that produces a rise in body temperature. Bacterial toxins are one type of pyrogen.

Relapsing —A fever pattern in which periods of fever alternate with several days of normal temperatures.

Reye's syndrome —A rare disorder that occurs primarily in children recovering from a viral illness and associated with aspirin usage. It is characterized by vomiting, swelling of the brain, and liver dysfunction.

Vasoconstriction —Narrowing of the blood vessels, which serves to conserve body heat and maintain or raise blood pressure.


Resources

BOOKS

Gelfand, Jeffrey, et al. "Fever, Including Fever of Unknown Origin." Harrison's Principles of Internal Medicine, edited by Kurt Isselbacher, et al. New York: McGraw-Hill, 1997.

Haist, Steven A., MD, John B. Robbins, MD, and Leonard G. Gomella, MD. "Fever." Internal Medicine On Call, 2nd ed. Stamford, CT: Appleton & Lange, 1997.

"Respiratory Viral Diseases." Chapter 162 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

OTHER

Fever. MayoClinic.com. September 11, 2000. <http://www.mayoclinic.com/home?id=DS00077>. (accessed June 18, 2001).

Lisette Hilton

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