/Ae cAttAA&t. 
ON THE 
I; Treatment of Fever by Cold, 
BY H. A. DUBOIS, M. D„ 
OF' SAN RAFAEL, CAL^ 
; 'Extracted .from the Transactions of the Medical Society of the State of 
California, for the year 1876. 
Sacramento Leader Printing Office. 
1876. 
SACRAMENTO pRRATA, 
Page 1—1st line, for “willful” read “skillful.” 
Page 2 12 lines from bottom, after the word “indeed” insert “only.” Same 
line, instead of “a useful” read “an useful.” 
Page 3— 16th line, instead of “aed as” read “and so.” 
Page 4—8tli line, instead ot “impossible” read “possible.” 
Page 4—27th line, instead of “mattrass” read “mattress.” 
Page 4—2d line from bottom instead of “long” read “large.” 
Page 5 —3d line leave out the word “easily,” 
Page 5—4th line from bottom, instead of “mattrass” read “mattress.” 
Page5— 1st line from bottom, instead of “mattrass” read “mattress.” 
Pnge 5— 8th line from bottom, instead ol “springs,” read “holes.” 
Page 6 -1st and 7th lines, instead of “mattrass,’’read “mattress.” 
Page 7—3d line, instead of read “.” ON THE TREATMENT OF FEVER BY COLD. 
H. A. DUBOIS, M. D., OF SAN RAFAEL. 
The tendency of modern medicine seems to be towards a willful use 
of the most simple remedies for the cure of disease. Elaborate pre- 
scriptions are going out of use, and we are content with those that con- 
tain one or two active ingredients. With the lessening of medication, 
greater attention has been paid to the natural course of uncomplicated 
disease, and to all those external agencies which influence both health 
and disease. Amongst the chief of these, are air and water. We have 
learned something of their use, and of the control that they have over 
diseased actions, but still we are only on the threshhold of a full knowl- 
edge of their properties. Heat and cold are becoming more familiar to 
us; the therapeutic use of electricity is yet in its infancy, while the 
study of motion in its application to the cure of disease is hardly 
entered upon. It requires no prophet to foretell that the use of drugs 
will become more and more limited, and that they will be prescribed 
with greater certainty as our knowledge of various physical agencies 
increase. In times past much research was wasted on the causes of 
disease when as yet there was not a sufficient body of facts collected to 
justify generalization. Then, too, treatment was often adopted on such 
incomplete and faulty theories, which often led to the most disastrous 
results. Now we devote more time to the symptoms and immediate 
causes, and are exceedingly careful in carrying out a treatment based on 
ideas as to the ultimate cause of disease, unless experience gives proof 
of its usefulness. Amongst the symptoms common to a large class of 
diseases is an increase of heat, and we are no longer content to estimate this by the tactus eruditus, but resort to the thermometer. It is but a 
few years since this instrument has been so perfected as to make it 
generally useful at the bedside. It is now a new sense which the 
physician carries in his pocket, ready to give him the most accurate 
information. By its use he frequently discovers fever where without it 
the hand would indicate an undue absence of heat. It enables him to 
watch a case with intelligence and gives him a power of fore-telling, which 
before he did not possess. Since the thermometer has come into use 
more general attention has been paid to fever as a symptom, and various 
plans have been resorted to for reducing the heat of the body in disease. 
Our knowledge of the laws governing fever have been enlarged, and 
we have discovered that fever is often the direct cause of death through 
heart exhaustion, and that a patient with a high general temperature 
can be exposed to cold without danger, he will not take cold so long as 
his temperature is much above that of health. To Hahnemann we owe 
a debt of gratitude for the effect that his fanciful doctrines have had in 
proving that disease is often self-limited, and that recovery will take 
place without internal medication. It is useless to deny that the dim- 
inution in the quantity of medicine used now, as compared with that 
used in his day is due partly at least to the influence of his doctrines. 
We have also to thank him for calling attention to the study of symp- 
toms. To Priesznitz, who introduced the use of water as a sole means 
of cure, we are also under obligations for the effect that his ideas have 
had upon the general public, as well as upon the profession. With these 
few introductory remarks we will take up the immediate subject of this 
paper, viz : the treatment of fever by cold. It is only within a few 
years, indeed, since we have had a useful clinical thermometer that the 
use of cold bathing in fevers has been based on correct principles, and 
taken from the hands of the empiric to increase the resources of the 
physician. Before it was recommended by Niemeyer and others in 
certain diseases, but as we had no means of watching the effect with 
accuracy, and as in certain cases it resulted disastrously, it never gained 
the general confidence of the profession. No sooner had an instrument 
by which we could estimate accurately the heat of the body been made 
than experiments began to be tried, and now its use is almost general by 
the younger school of physicians in Germany, and is spreading rapidly 
through the rest of the world. In Ziemssen’s Cyclopaedia, now being 
translated from the German, will be found a number of articles illus- trating the use of cold bathing in reducing the temperature in disease ; 
particularly on its use in typhoid fever, by Liebermeister. The treat- 
ment consists in watching the temperature of the body by the ther- 
mometer and as often as it rises above F. 102°, in placing the patient, 
after the administration of a small quantity of stimulus, in a bath, ten 
or more degrees below the normal temperature, and in applying still 
colder water to the head, aud in retaining him there until the temper- 
ature has come down nearly, or quite, to that of health. In practice, it 
is found that these baths take from ten minutes to three-quarters of an 
hour and that they require to be repeated eight, ten or more times in 
the twenty-four hours. That a nervous shock is produced at first, in 
some cases amounting to a decided chill, and that there is danger from 
this cause to the heart, without its action has been stimulated pre- 
viously. After a bath the heat of the body slowly increases until the 
the temperature has again reached the point attained before (102°), 
when it has again by the same means to be reduced, and as the case pro- 
gresses, with perhaps a daily large dose of quinine. 
Now to mention nothing of the wear and tear of the body from the 
frequent movements in bathing, of the difficulties in commanding the 
necessary assistance in a large proportion of the cases in private practice 
in removing the patient to the bath, and back again to the bed ; it seems 
unphilosophical to bring the temperature suddenly down, only to let it 
rise again, if there are any means by which it may be more gradually 
lowered and kept down, near to that of health. Cold sponging, the 
wet sheet, a draught of cold air, have been used after the temperature 
has once been reduced. 
Is there no way by which the body can be cooled and kept cool, except 
by placing it in a tub of cold water ? Any one who has traveled on the 
plains will remember how soon all animal heat can be abstracted by a 
wind, the temperature of which is comparatively high, but in swift 
motion. Air, then, in motion, ten to twelve degrees- cooler than the 
body in health seems one of the most natural methods of taking away 
the excess of heat in disease. It appears to me that water in motion 
might also be employed with good results, especially locally. In reduc- 
ing the unnatural heat of disease the chief danger from the employment 
of cold is nervous shock. No one can doubt that this excess of heat 
could be more safely removed by swift-running water at the temperature 
of the body in health than by still water at a temperature from 20° to 
30° below it. 
The same holds good in regard to air. The great danger of the treat- ment, as we have said, consists in its immediate effect on the action of the 
heart, and we propose motion in the fluid at a little below the normal 
temperature of the body to overcome this objection. 
The difficulty in the employment of cold bathing is chiefly confined 
to its use in private practice, and the same is true of the methods of 
removing the heat of the body by moving air or water. Thus far we 
have tried to prove that there is no necessity of a primary shock in low- 
ering the temperature in disease, as it is impossible to employ a fluid 
only a few degrees below that of the patient in health, and if it be in 
motion we shall yet as certainly remove the surplus heat as if the body 
was bathed in water of a much lower temperature. We shall try now 
to show by what means it may be made available in the hospital and 
sick room. There seems to us little doubt but that in the not far dis- 
tant future, fever wards in hospitals will be so constructed that air of 
a suitable temperature will be admitted with a definite degree of force, 
which can be so regulated as to carry off any desired amount of heat 
from the body. It certainly seems reasonable to apply the cold to the 
inside as well as to the surface of the body and this air will do, as it 
enters the lungs, and with cold drinks which will have a similar effect 
on the stomach, the temperature of the inside of the body can be grad- 
ually and safely lowered. Water we believe will also be used in motion, 
but to make use of either moving air or water in private practice pre- 
sents many difficulties. In most cases we believe the simpler plan will 
be to cool and give motion to air by running water, and for this pur- 
pose we may use a variety of apparatus according to the amount of the 
heat we desire to abstract. Should this amount to little, we may sim- 
ply place the patient on a mattrass of woven wire, or on one of steel 
springs lightly covered. If we desire to remove heat more rapidly, we 
may place under the first, or between the springs of the last, one or 
more tubes in which water a little lower than the normal temperature 
of the body circulates. Any person of ordinary ingenuity can easily 
direct the construction of a suitable apparatus. A garden hose run up 
and down a few times might answer in an emergency. If water is laid 
on, as it is now in almost all towns of any size, a connection can easily 
be made by a small rubber tube, and the waste water can as easily be 
gotten rid of by passing a similar tube through a window. In the coun- 
try it may be necessary to have a barrel of water outside of the room, 
to which a tube can be connected. A thin French rubber tube three 
eighths of an inch in diameter, is amply long enough, and will 
be found far more portable, though a little more expensive than the American hose. The tubes under the bed can easily be made of gal- 
vanized iron costing only ten to twelve cents a foot, and connections 
can easily be made by corking the ends and passing glass or metal tubes 
through, on which the small rubber tubing can be slipped; or a tinner 
in a few hours could make a set of tin tubes connected together at 
either end. The ordinary stop-cock used with basins where water is 
laid on, will answer to regulate the rapidity of the current. The prin- 
ciple being understood of causing water at or near the temperature of 
health, to circulate below a metal mattress only lightly covered, it is 
easy to devise the necessary contrivance to carry [it out in any indi- 
vidual case. Should it be desirable to diminish the heat of a part as 
the lungs, bowels, etc, we may use besides the Running Water Bed, the 
Running Water Quilt, which is nothing more than fifteen or twenty 
feet of thin rubber tubing three eighths of an inch in diameter, quilted 
with a little wool or hair, between two pieces of muslin. It can be 
made to fit any part, and of any size—one eighteen inches wide by two 
feet long, and of an oval shape, will generally be found the most con- 
venient. The same quilt if made to fit the head will answer instead of 
the Running Water Pillow to be described hereafter. Of course this 
quilt can be kept in any shape by wires, or supported by a cradle. With 
these three, it is believed that heat can be slowly and surely abstracted 
from the body, and all that a country practitioner would require, would 
be a dozen yards or so of light three eighth inch tubing; everything 
else he could have made on the spot, though doubtless a few connec- 
tions and a small stop-cock or two, would be found convenient. 
We propose to describe a Running Water Bed, the same in principle 
as those mentioned above, but which it is thought will be found more 
portable and convenient. A wire woven mattress is fitted on a three 
quarter camp bedstead, and underneath it at the distance of a few 
inches, is hung a shallow tank of wood, metal or rubber, and the bot- 
tom is interrupted in such a way that the water will be forced to zig zag 
down from the head to the foot of the bed. This tank is covered by 
two thin closely fitting covers pierced with springs, so that when one is 
moved on the other, the holes can be closed to any desired extent. 
Water is let in at the head and carried off from tne foot. 
If the tank is made of rubber it can readily be folded up. The bed- 
stead is made to take apart, and the wire mattrass rolls up, so that 
everything can be made into a bundle six or eight inches in diameter by 
three or four feet in length. 
The best covering to the wire mattrass it is believed, will be found to be felt, pierced with holes—although a very thin hair or wool mattrass 
may be used. I have not mentioned the ordinary water bed of rubber, 
as it is expensive, difficult of movement, and easily worn out. The 
Running Water Pillow is a small rubber pillow, through which the 
water is forced to zig zag by partial partitions. 
FIGURE 1. 
Represents the Running Water Bed complete with the exception of felt 
pierced with holes, and which takes the place of the mattrass. The woven 
wire can be put on the st retch by means of a key near the head of the bed. Be* 
low is seen the double perforated cover, the upper section of which slides upon 
the lower lengthwise, so that the openings can be partly or completely closed 
The head board takes off, and the feet fold up, so that the bed is portable. FIGURE 2. 
Represents the double perforated cover lifted up so as to show the running 
water jtank. Above this is seen four cross pieces for the cover to rest on, and 
about two inches high, The wa‘ er is let on at the upper end of the bed and 
passes in a zigzag course to the lower end and is carried away by the waste 
pipe. 
In conclusion I submit the method of reducing the heat of the body 
gradually, instead of suddenly, and by moving fluid instead of by a 
still one, to your consideration, and would ask for it a trial. If the 
principle is correct, doubtless other and more convenient apparatus can 
be contrived than those mentioned above.