Asthenic or Adynamic Fevers.
It will be observed in the study of the above remedies as applicable to the reduction of fevers, that with the exception of one or two they are to be prescribed only in sthenic fever—in which there is an apparent temporary exaltation of vital force—in which the inherent dynamic influences have unwarranted exercise. Where temporarily, the nervous and vital powers have reacted above or beyond physiological limits, the agents are prescribed to exercise a restraining or inhibiting influence upon the fever, by a sedative or depressing influence upon the nervous system or upon the heart and circulatory apparatus. They depress vital force.
In many cases fever exists where the vital forces are already depressed or exhausted to a greater or less extent, and where there is extreme feebleness. In such a case depressants of vital force are contra-indicated.
In these asthenic or adynamic conditions, it is necessary that the fever be controlled as in sthenic but a class of remedies must be used which stimulate, encourage or increase the vital forces, in direct opposition to the action of those advised in sthenic cases.
The conditions in which adynamia with exalted temperature is apt to prevail, are in the later stages of typhus and typhoid fevers, in protracted fevers of any kind where there has been a great draft upon the vital forces, in the progress of severe inflammation which has resulted in the breaking down of structure and the deposit of inflammatory products, and in tubercular or other cachexia.
While the vital forces must be nourished, supported and encouraged toward ultimate restoration, measures must be used also, which will restrain the temperature, if possible, at the same time. We have a limited number of remedies that act specifically for this purpose, and they cannot be placed in a distinct class. This influence of these agents will be found fully considered in the class in which the agent is placed because of a wider influence. They will be found classed usually as nerve or heart stimulants.
Bryonia and Rhus of the previous class have a most important place in these fevers, as has been specified. One of the best, if not, the best of the remedies for this purpose is Cactus, which will be found among the specified heart tonics. Digitalis is excellent for this purpose, although while it sustains the heart through the progress of the fever, it does not, to so great an extent as cactus, cause a reduction of the temperature or improve the general nerve tone and add to the nutrition of the heart. Strophanthus acts much the same as digitalis. Anhalonium is said to possess this power, but it has not yet been widely used. Other agents will be mentioned as we progress.
One of the safest measures is the abstraction of heat by the use of water. Much care must be exercised that the water be not too cold. The temperature of the water is lowered in proportion as the vital force is able to react under it. In feeble cases, sponging with water at temperature from 100 to 110 degrees is most satisfactory.
Judicious nutrition and perfect elimination are essential considerations in the treatment of adynamic fevers.
Note—The study of this first chapter of remedies has proven the statement previously made, that it is impossible as yet to arbitrarily classify our agents. It will be seen that, while these agents are used in the control of fevers, and as nerve sedatives, they are also antispasmodics to a marked degree in some cases, hypnotics, analgesics, diaphoretics, diuretics or alteratives. In each of the following classes the same fact will be found true. We have endeavored to classify the remedies as they are most commonly used, but each must be studied without regard to class, in the entire field of its action, especially as indicated by its specific symptomatology.
The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.