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FEVER
Body temperature is controlled by the hypothalamus. Neurons in
both the preoptic anterior hypothalamus and the posterior
hypothalamus receive two kinds of signals: one from peripheral
nerves that reflect warmth/cold receptors and the other from the
temperature of the blood bathing the region. These two types of
signals are integrated by the thermoregulatory center of the
hypothalamus to maintain normal temperature. In a neutral
environment, the metabolic rate of humans consistently produces
more heat than is necessary to maintain the core body
temperature at 37°C. Therefore, the hypothalamus controls
temperature by mechanisms of heat loss.
A normal body temperature is ordinarily maintained, despite
environmental variations, because the hypothalamic
thermoregulatory center balances the excess heat production
derived from metabolic activity in muscle and the liver with
heat dissipation from the skin and lungs. According to recent
studies of healthy individuals 18 to 40 years of age, the mean
oral temperature is 36.8° ± 0.4°C (98.2° ± 0.7°F), with low
levels at 6 A.M. and higher levels at 4 to 6 P.M. The maximum
normal oral temperature is 37.2°C (98.9°F) at 6 A.M. and 37.7°C
(99.9°F) at 4 P.M.; these values define the 99th percentile for
healthy individuals. The normal daily temperature variation is
typically 0.5°C (0.9°F). Rectal temperatures are generally 0.4°C
(0.7°F) higher than oral readings. The lower oral readings are
probably attributable to mouth breathing, which is a
particularly important factor in patients with respiratory
infections and rapid breathing. Lower esophageal temperatures
closely reflect core temperature.
In women who menstruate, the A.M. temperature is generally lower
in the 2 weeks before ovulation; it then rises by about 0.6°C
(1°F) with ovulation and remains at that level until menses
occur. Seasonal variation in body temperature has been described
but may reflect a metabolic change and is not common. Body
temperature is elevated in the postprandial state, but this
elevation does not represent fever. Pregnancy and endocrinologic
dysfunction also affect body temperature. The daily temperature
variation appears to be fixed in early childhood; in contrast,
elderly individuals can exhibit a reduced ability to develop
fever, with only a modest fever even in severe infections.
The individual first notices vasoconstriction in the hands and
feet. Shunting of blood away from the periphery to the internal
organs essentially decreases heat loss from the skin, and the
person feels cold. For most fevers, body temperature increases
by 1 to 2°C. Shivering, which increases heat production from the
muscles, may begin at this time; however, shivering is not
required if heat conservation mechanisms raise blood temperature
sufficiently. Heat production from the liver also increases. In
humans, behavioral instincts(e.g., putting on more clothing or
bedding) lead to a reduction of exposed surfaces, which helps
raise body temperature.
The processes of heat conservation (vasoconstriction) and heat
production (shivering and increased metabolic activity) continue
until the temperature of the blood bathing the hypothalamic
neurons matches the new thermostat setting. Once that point is
reached, the hypothalamus maintains the temperature at the
febrile level by the same mechanisms of heat balance that are
operative in the afebrile state. When the hypothalamic set point
is again reset downward (due to either a reduction in the
concentration of pyrogens or the use of antipyretics), the
processes of heat loss through vasodilation and sweating are
initiated. Behavioral changes triggered at this time include the
removal of insulating clothing or bedding. Loss of heat by
sweating and vasodilation continues until the blood temperature
at the hypothalamic level matches the lower setting.
In some rare cases, the hypothalamic set point is elevated as a
result of local trauma, hemorrhage, tumor, or intrinsic
hypothalamic malfunction. The term hypothalamic fever is
sometimes used to describe elevated temperature caused by
abnormal hypothalamic function. However, most patients with
hypothalamic damage have subnormal, not supranormal, body
temperatures. These patients do not respond properly to mild
environmental temperature changes. For example, when exposed to
only mildly cold conditions, their core temperature falls
quickly rather than over the normal period of a few hours. In
the very few patients in whom elevated core temperature is
suspected to be due to hypothalamic damage, diagnosis depends on
the demonstration of other abnormalities in hypothalamic
function, such as the production of hypothalamic releasing
factors, abnormal response to cold, and absence of circadian
temperature and hormonal rhythms.
It is important to distinguish between fever and hyperthermia
since hyperthermia can be rapidly fatal. However, there is no
rapid way to make this distinction. Hyperthermia is often
diagnosed on the basis of the events immediately preceding the
elevation of core temperatureΎ e.g., heat exposure or treatment
with drugs that interfere with thermoregulation. However, in
addition to the clinical history of the patient, the physical
aspects of some forms of hyperthermia may alert the clinician.
For example, in patients with heat stroke syndromes and in those
taking drugs that block sweating, the skin is hot but dry.
Moreover, antipyretics do not reduce the elevated temperature in
hyperthermia, whereas in feverΎand even in hyperpyrexiaΎadequate
doses of either aspirin or acetaminophen usually result in some
decrease in body temperature.
PYROGENS
The term pyrogen is used to describe any substance that causes
fever. Exogenous pyrogens are derived from outside the patient;
most are microbial products, microbial toxins, or whole
microorganisms. The classic example of an exogenous pyrogen is
the lipopolysaccharide endotoxin produced by all gram-negative
bacteria. Endotoxins are potent not only as pyrogens but also as
inducers of various pathologic changes in gram-negative
infections. Another group of potent bacterial pyrogens is
produced by gram-positive organisms and includes the
enterotoxins of Staphylococcus aureus and the group A and B
streptococcal toxins, also called superantigens. One
staphylococcal toxin of clinical importance is the toxic shock
syndrome toxin associated with isolates of S. aureus from
patients with toxic shock syndrome. Endotoxin is a highly
pyrogenic molecule in humans:
Approach to the Patient
History:
It is in the diagnosis of a febrile illness that the science and
art of medicine come together. In no other clinical situation is
a meticulous history more important. Painstaking attention must
be paid to the chronology of symptoms in relation to the use of
prescription drugs (including drugs or herbs taken without a
physician's supervision) or treatments such as surgical or
dental procedures. The exact nature of any prosthetic materials
and/or implanted devices should be ascertained. A careful
occupational history should include exposures to animals; toxic
fumes; potential infectious agents; possible antigens; or other
febrile or infected individuals in the home, workplace, or
school. A history of the geographic areas in which the patient
has lived and a travel history should include locations during
military service.
Information on unusual hobbies, dietary proclivities (such as
raw or poorly cooked meat, raw fish, and unpasteurized milk or
cheeses), and household pets should be elicited, as should that
on sexual orientation and practices, including precautions taken
or omitted. Attention should be directed to the use of tobacco,
marijuana, intravenous drugs, or alcohol; trauma; animal bites;
tick or other insect bites; and prior transfusions,
immunizations, drug allergies, or hypersensitivities. A careful
family history should include information on family members with
tuberculosis, other febrile or infectious diseases, arthritis or
collagen vascular disease, or unusual familial symptomatology
such as deafness, urticaria, fevers and polyserositis, bone
pain, or anemia.
Physical Examination:
A meticulous physical examination should be repeated on a
regular basis. All the vital signs are relevant. The temperature
may be taken orally or rectally, but the site used should be
consistent. Axillary temperatures are notoriously unreliable.
Particular attention should be paid to daily (or sometimes more
frequent) physical examination, which should continue until the
diagnosis is certain and the anticipated response has been
achieved.
Special attention should be paid to the skin, lymph nodes, eyes,
nail beds, cardiovascular system, chest, abdomen,
musculoskeletal system, and nervous system. Rectal examination
is imperative. The penis, prostate, scrotum, and testes should
be examined carefully and the foreskin, if present, retracted.
Pelvic examination must be part of every complete physical
examination of a woman, with a search for such causes of fever
as pelvic inflammatory disease and tubo-ovarian abscess.
Laboratory Tests :
Few signs and symptoms in medicine have as many diagnostic
possibilities as fever. If the history, epidemiologic situation,
or physical examination suggests more than a simple viral
illness or streptococcal pharyngitis, then laboratory testing is
indicated. The tempo and complexity of the workup will depend on
the pace of the illness, diagnostic considerations, and the
immune status of the host. If findings are focal or if the
history, epidemiologic setting, or physical examination suggests
certain diagnoses, the laboratory examination can be focused. If
fever is undifferentiated, the diagnostic nets must be cast
farther, and certain guidelines are indicated, as follows.
CLINICAL PATHOLOGY :
The workup should include a complete blood count; a differential
count should be performed manually or with an instrument
sensitive to the identification of eosinophils, juvenile or band
forms, toxic granulations, and Dohle bodies, the last three of
which are suggestive of bacterial infection.
Neutropenia may be present with some viral infections,
particularly parvovirus B19 infection; drug reactions; systemic
lupus erythematosus; typhoid; brucellosis; and infiltrative
diseases of the bone marrow, including lymphoma, leukemia,
tuberculosis, and histoplasmosis.
Lymphocytosis may occur with typhoid, brucellosis, tuberculosis,
and viral disease. Atypical lymphocytes are documented in many
viral diseases, including infection with Epstein-Barr virus,
cytomegalovirus, or HIV; dengue; rubella; varicella; measles;
and viral hepatitis. This abnormality also occurs in serum
sickness and toxoplasmosis. Monocytosis is a feature of typhoid,
tuberculosis, brucellosis, and lymphoma. Eosinophilia may be
associated with hypersensitivity drug reactions, Hodgkin's
disease, adrenal insufficiency, and certain metazoan infections.
If the febrile illness appears to be severe or is prolonged, the
smear should be examined carefully for malarial pathogens (where
appropriate) as well as for classic morphologic features, and
the erythrocyte sedimentation rate should be determined.
Urinalysis, with examination of urinary sediment, is indicated.
It is axiomatic that any abnormal fluid accumulation (pleural,
peritoneal, joint), even if previously sampled, merits
reexamination in the presence of undiagnosed fever.
Joint fluids should be examined for bacteria as well as
crystals.
Bone marrow biopsy (not simple aspiration) for histopathologic
studies (as well as culture) is indicated when marrow
infiltration by pathogens or tumor cells is possible.
Stool should be inspected for occult blood; an inspection for
fecal leukocytes, ova, or parasites also may be indicated.
CHEMISTRY :
1. Electrolyte, glucose, blood urea nitrogen, and creatinine
levels should be measured.
2. Liver function tests are usually indicated if efforts to
identify the cause of fever do not point to the involvement of
another organ. Additional assessments (e.g., measurement of
creatinine phosphokinase or amylase) can be added as the workup
progresses.
MICROBIOLOGY :
Smears and cultures of specimens from the throat, urethra, anus,
cervix, and vagina should be assessed when there are no
localizing findings or when findings suggest the involvement of
the pelvis or the gastrointestinal tract. If respiratory tract
infection is suspected, sputum evaluation (Gram's staining,
staining for acid-fast bacilli, culture) is indicated. Cultures
of blood, abnormal fluid collections, and urine are indicated
when fever is thought to reflect more than uncomplicated viral
illness. Cerebrospinal fluid should be examined and cultured if
meningismus, severe headache, or a change in mental status is
noted.
RADIOLOGY :
A chest x-ray is usually part of the evaluation for any
significant febrile illness.
Outcome of Diagnostic Efforts : In most cases of fever, either
the patient recovers spontaneously or the history, physical
examination, and initial screening laboratory studies lead to a
diagnosis. When fever continues for 2 to 3 weeks, during which
time repeat physical examinations and laboratory tests are
unrevealing, the patient is provisionally diagnosed as having
fever of unknown origin.
TREATMENT
Some febrile diseases have characteristic patterns. With
relapsing fevers, febrile episodes are separated by intervals of
normal temperature; when paroxysms occur on the first and third
days, the fever is called tertian. Plasmodium vivax causes
tertian fevers. Quartan fevers are associated with paroxysms on
the first and fourth days and are seen with P. malariae. Other
relapsing fevers are related to Borrelia infections and rat-bite
fever, which are both associated with days of fever followed by
a several-day afebrile period and then a relapse of days of
fever. Pel-Ebstein fever, with fevers lasting 3 to 10 days
followed by afebrile periods of 3 to 10 days, is classic for
Hodgkin's disease and other lymphomas. Another characteristic
fever is that of cyclic neutropenia, in which fevers occur every
21 days and accompany the neutropenia. There is no periodicity
of fever in patients with familial Mediterranean fever.
ACONITUM NAPELLUS
Fever: Skin dry and hot; face red, or pale and red
alternately; intense nervous restlessness, tossing about in
agony; becomes intolerable towards evening and on going to
sleep.
Complaints caused by exposure to dry cold air, dry north or
west winds, or exposure to draughts of cold air while in a
perspiration; bad effects of checked perspiration.
Great fear and anxiety of mind, with great nervous
excitability; Restless, anxious, does everything in great haste;
must change position often; everything startles him.
Tongue coated white.
Intense thirst. Thirst for cold water. Bitter taste of
everything except water.
Aggravation
Evening and night, pains are insupportable; in a warm room; when
rising from bed; lying on affected side.
Amelioration
In the open air
Aconite should never be given simply to control the fever,
never alternated with other drugs for that purpose. If it be a
case requiring Aconite no other drug is needed;
ANTIMONIUM TARTARICUM
Clinically, its therapeutic application has been confined
largely to the treatment fever with respiratory diseases,
Rattling of mucus with little expectoration has been a guiding
symptom.
Tongue coated, pasty, thick, white, with reddened papillae and
red edges; red in streaks; very red, dry in the middle;
Thirst for cold water, little and often, and desire for
apples, fruits, and acids.
There is much Drowsiness, debility and sweat characteristic of
the drug.
Great sleepiness or irresistible inclination to sleep, with
nearly all complaints.
Aggravation; in evening; from lying down at night; from
warmth; in damp cold weather; from all sour things and milk.
Amelioration; from sitting erect; from eructation and
expectoration.
APIS MELLIFICA
Fever; Afternoon chill, with thirst; worse on motion and heat.
External heat, with smothering feeling. Sweat slight, with
sleepiness. Perspiration breaks out and dries up frequently.
Sleeps after the fever paroxysm. After perspiration, nettle
rash, also with shuddering.
Tongue fiery red, swollen, sore, and raw, with vesicles.
Aggravation; heat in any form; touch; pressure; late in
afternoon; after sleeping; in closed and heated rooms. Right
side.
Amelioration; In open air, uncovering, and cold bathing.
ARNICA MONTANA
For the fever resulting from mechanical injuries;
Sore, lame, bruised feeling all through the body as if beaten;
traumatic affections of muscles.
Mechanical injuries, especially with stupor from concussion;
Everything on which he lies seems too hard; complains
constantly of it and keeps moving from place to place in search
of a soft spot.
Heat of upper part of body; coldness of lower. The face or
head and face alone is hot, the body cool.
In typhoid; Unconsciousness; when spoken to answers correctly,
but unconsciousness and delirium at once return.
Aggravation; least touch; motion; rest; wine; damp cold.
Amelioration; lying down, or with head low.
ARSENIC ALBUM
Fever: High temperature. Periodicity marked with adynamia.
Septic fevers. Intermittent. paroxysms incomplete, with marked
exhaustion. Cold sweats. Typhoid, not too early; often after
Rhus. Complete exhaustion. Delirium; worse after midnight. Great
restlessness. Great heat about 3 a.m.
Great Prostration, with rapid sinking of the vital forces;
The greater the suffering the greater the anguish,
restlessness and fear of death. Mentally restless, but
physically too weak to move; cannot rest in any place; changing
places continually; wants to be moved from one bed to another,
and lies now here, now there.
Great thirst; drinks much, but little at a time.
Aggravation; After midnight [1 to 2 A. M. or P. M. ]; from
cold, cold drinks or food; when lying on affected side or with
the head low.
Amelioration ; from heat; from head elevated; warm drinks.
BAPTISIA TINCTORA
Baptisia has gained its greatest reputation as a remedy in
typhoid fever, to the symptoms of which its pathogenesis
strikingly corresponds.
Fever; Chill, with rheumatic pains and soreness all over body.
Heat all over, with occasional chills. Chill about 11 a.m.
Adynamic fevers. Typhus fever. Shipboard fever.
All exhalations and discharges foetid, especially in typhoid
or other acute diseases; breath, stool, urine, perspiration,
ulcers, etc.
Stupor; falls asleep while being spoken to or in the midst of
his answer.
Tongue: at first coated white with red papillae; dry and
yellow-brown in centre; later dry, cracked, ulcerated.
Face flushed, dusky, dark-red, with a stupid, besotted drunken
expression.
In whatever position the patient lies, the parts rested upon
feel sore and bruised.
Aggravation; humid heat; fog; indoors.
BELLADONA
Fever: A high feverish state with comparative absence of
toxaemia. Burning, pungent, steaming, heat. Feet icy cold.
Superficial blood-vessels, distended. Perspiration dry only on
head.
No thirst with fever.
Belladonna always is associated with hot, red skin, flushed
face, glaring eyes, throbbing carotids, excited mental state,
hyperaesthesia of all senses, delirium, restless sleep,
convulsive movements, dryness of mouth and throat with aversion
to water.
Worse; touch, jar, noise, draught, after noon, lying down.
Better; semi-erect.
BRYONIA ALBA
Fever; Pulse full, hard, tense, and quick. Chill with external
coldness, dry cough, stitches. Internal heat. Sour sweat after
slight exertion. Easy, profuse perspiration. Rheumatic and
typhoid marked by gastro-hepatic complications.
Complaints: when warm weather sets in, after cold days; from
cold drinks or ice in hot weather; after taking cold or getting
hot in summer; from chilling when overheated;
Lips parched, dry, cracked. dryness of mouth, tongue, and
throat, with excessive thirst. Tongue coated yellowish, dark
brown; heavily white in gastric derangement. Bitter taste.
Aggravation; warmth, any motion, morning, eating, hot weather,
exertion, touch. Cannot sit up; gets faint and sick.
Amelioration ; lying on painful side, pressure, rest, cold
things.
CHININUM SULPHURICUM
Fever; Chill daily at 3 p.m. Painful swelling of various veins
during a chill. Shivering even in a warm room.
Periodicity is extremely well marked, the attacks returning at
the same hour each day.
Great sensitiveness of the dorsal vertebrae;
CINCHONA OFFICINALIS
Fever; Intermittent fever; paroxysm anticipates from two to
three hours each attack; returns every seven or fourteen days;
never at night; sweats profusely all over on being covered, or
during sleep. All stages well marked. Chill generally in
forenoon, commencing in breast; thirst before chill, and little
and often. Debilitating night-sweats. Free perspiration caused
by every little exertion, especially on single parts.
One hand icy cold, the other warm
Pains are < by slightest touch, but > by hard pressure.
Aggravation; Slightest touch. Draught of air; every other day;
loss of vital fluids; at night; After eating; bending over.
Amelioration ; bending double; hard pressure; open air;
warmth.
FERRUM PHOSPHORICUM
In the early stages of febrile conditions, it stands midway
between sthenic activity of Aconite and Bell, and the asthenic
sluggishness and torpidity of GELS.
The remedy for first stage of all febrile disturbances and
inflammations before exudation sets in ; especially for
catarrhal affections of the respiratory tract.
Causation; Checked perspiration on a warm summer's day.
Mechanical injuries.
Aggravation; at night and 4 to 6 a.m.; touch, jar, motion,
right side.
Amelioration ; cold applications.
GELSEMIUM
Fever; Wants to be held, because he shakes so. Pulse slow,
full, soft, compressible. Chilliness up and down back. Heat and
sweat stages, long and exhausting. Dumb-ague, with much muscular
soreness, great prostration, and violent headache.
Chill, without thirst, along spine; wave-like, extending
upward from sacrum to occiput.
Bad effects from fright, fear, exciting news and sudden
emotions.
Complete relaxation and prostration of whole muscular system,
with entire motor paralysis.
Aggravation; damp weather, fog, before a thunderstorm,
emotion, or excitement, Bad news, tobacco-smoking, when thinking
of his ailments; at 10 a.m.
Amelioration ; bending forward, by profuse urination, open
air, continued motion, stimulants.
HEPAR SULPHURIS
Fever; Chilly in open air or from slightest draught. Dry heat
at night. Profuse sweat; sour, sticky, offensive.
In diseases where suppuration seems inevitable, Hepar may open
the abscess and hasten the cure.
Oversensitive, physically and mentally;
Extremely sensitive to cold air, imagines he can feel the air
if a door is opened in the next room; must be wrapped up to the
face even in hot weather; takes cold from slightest exposure to
fresh air.
Aggravation; Lying on painful side; cold air; uncovering;
eating or drinking cold things; touching affected parts; abuse
of mercury.
Amelioration; in damp weather, from wrapping head up, from
warmth, after eating.
IODUM
Fever; Shivering, even in a warm room. Flushes of heat all
over body. Marked fever, restlessness, red cheeks, apathetic.
Profuse sweat.
Right-sided pneumonia with high temperature. Pneumonia.
Hepatization spreads rapidly with persistent high temperature;
absence of pain in spite of great involvement, worse warmth;
craves cool air.
Iod. individual is exceedingly thin, dark complexioned, with
enlarged lymphatic glands, has voracious appetite but gets thin.
Hungry with much thirst. Better after eating.
Aggravation; when quiet, in warm room, right side.
Amelioration; walking about, in open air.
IPECACUANHA
Intermittent fever: in beginning of irregular cases; with
nausea, or from gastric disturbance; after abuse of, or
suppression from quinine. Intermittent dyspepsia, every other
day at same hour; fever, with persistent nausea.
Oversensitive to heat and cold.
Adapted to cases where the gastric symptoms predominate.
Tongue clean or slightly coated.
In all diseases with constant and continual nausea. Nausea;
with profuse saliva; vomiting of white, glairy mucus in large
quantities, without relief; sleepy afterwards;
Aggravation; periodically; from veal, moist warm wind, lying
down.
LACHESIS
Fever; Chilly in back; feet icy cold; hot flushes and hot
perspiration. Paroxysm returns after acids. Intermittent fever
every spring. Internal sensation of heat, with cold feet.
Typhoid, typhus; stupor or muttering delirium, sunken
countenance, falling of lower jaw; tongue dry, black, trembles,
is protruded with difficulty or catches on the teeth when
protruding; conjunctiva yellow or orange color; perspiration
cold, stains yellow, bloody.
Better adapted to thin and emaciated than to fleshy persons;
to those who have been changed, both mentally and physically, by
their illness.
Left side principally affected; diseases begin on the left and
go to the right side.
Intolerance of tight bands about neck or waist.
Wants to be fanned, but slowly and at a distance.
Aggravation; after sleep. Sleeps into aggravation; ailments
that come on during sleep; left side, in the spring, warm bath,
pressure or constriction, hot drinks. Closing eyes.
Amelioration; appearance of discharges, warm applications.
LYCOPODIUM
Fever; Chill between 3 and 4 p.m., followed by sweat. Icy
coldness. Feels as if lying on ice. One chill is followed by
another. Neglected pneumonia, with great dyspnoea, flying of
alae nasae and presence of mucous rales.
Chilliness in the afternoon from 4 to 8, with sensation as of
numbness in hands and feet.
For persons intellectually keen, but physically weak; upper
part of body emaciated, lower part semi-dropsical; predisposed
to lung and hepatic affections.
Ailments from fright, anger, mortification, or vexation with
reserved displeasure.
Intolerant of cold drinks; Craves everything warm.
Aggravation; right side, from right to left, from above
downward, 4 to 8 p.m.; from heat or warm room, hot air, bed.
Warm applications, except throat and stomach which are better
from warm drinks.
Amelioration; By motion, after midnight, from warm food and
drink, on getting cold, from being uncovered.
MERCURIUS
Fever; Generally gastric or bilious, with profuse nightly
perspiration; debility, slow and lingering. Heat and shuddering
alternately. Yellow perspiration. Profuse perspiration without
relief. creeping chilliness; worse in the evening and into
night. Alternate flashes of heat in single parts.
Great weakness and trembling from least exertion. Breath and
body smell foul.
Tongue: large, flabby, shows imprint of teeth, mapped tongue.
Intense thirst although the tongue looks moist and the saliva
is profuse.
Aggravation; at night, wet, damp weather, lying on right side,
perspiring; warm room and warm bed.
NATRUM MURIATICUM
Fever; Chill between 9 and 11 a.m. Heat; violent thirst,
increases with fever. Fever-blisters. Coldness of the body, and
continued chilliness very marked. Hydraemia in chronic malarial
states with weakness, constipation, loss of appetite, etc.
Sweats on every exertion. old chronic, badly treated cases,
especially after suppression by quinine; headache, with
unconsciousness during chill and heat; sweat >. pains.
Tongue: mapped, with red insular patches; like ringworm on
sides.
Craving for salt; great aversion to bread.
Great emaciation; losing flesh while living well. Great
liability to take cold.
Aggravation; noise, music, warm room, lying down; about 10
a.m., at seashore, mental exertion, consolation, Heat, talking.
Amelioration; open air, cold bathing, going without regular
meals, lying on right side; pressure against back, tight
clothing.
NUX VOMICA
Fever; Cold stage predominates. Paroxysms anticipate in
morning. Excessive rigor, with blueness of finger-nails. Aching
in limbs and back, and gastric symptoms. Chilly, must be covered
in every stage of fever. Perspiration sour; only one side of
body. Chilliness on being uncovered, yet he does not allow being
covered. Dry heat of the body.
Oversensitive: to external impressions; to noise, odors, light
or music; trifling ailments are unbearable; every harmless word
offends
Bad effects of: coffee, tobacco, alcoholic stimulants; highly
spiced or seasoned food; over-eating; long-continued mental
over-exertion; sedentary habits; loss of sleep; aromatic or
patent medicine; sitting on cold stones, especially in warm
weather.
Aggravation; morning, mental exertion, after eating, touch,
spices, stimulants, narcotics, dry weather, cold.
Amelioration; from a nap, if allowed to finish it; in evening,
while at rest, in damp, wet weather, strong pressure.
PHOSPHORUS
Fever; Chilly every evening. Cold knees at night. Adynamic
with lack of thirst, but unnatural hunger. Hectic, with small,
quick pulse; viscid night- sweats. Stupid delirium. Profuse
perspiration.
Thirst for very cold water.
Tongue Dry, smooth, red or white, not thickly coated.
Oversensitiveness of all the senses to external impressions,
light, noise, odors, touch.
Burning: intense heat running up the back; of every organ or
tissue of the body
Aggravation; touch; physical or mental exertion; twilight;
warm food or drink; change of weather, from getting wet in hot
weather; evening; lying on left or painful side; during a
thunder-storm; ascending stairs.
Amelioration; in dark, lying on right side, cold food; cold;
open air; washing with cold water; sleep.
RHUS TOXICODENDRON
Fever; Adynamic; restless, trembling. Typhoid; tongue dry and
brown; sordes; bowels loose; great restlessness. Intermittent;
chill, with dry cough and restlessness. During heat, urticaria.
Hydroa. Chilly, as if cold water were poured over him, followed
by heat and inclination to stretch the limbs.
Ailments: from spraining or straining a single part, muscle or
tendon; overlifting, particularly damp ground; too much summer
bathing in lake or river.
Great restlessness, anxiety, apprehension; cannot remain in
bed, must change position often to obtain relief from pain.
Corners of mouth ulcerated, fever blisters around mouth and on
chin.
Tongue: dry, sore, red, cracked; triangular red tip; takes
imprint of teeth.
Great thirst, with dry tongue, mouth and throat.
Aggravation; during sleep, cold, wet rainy weather and after
rain; at night, during rest, drenching, when lying on back or
right side.
Amelioration; warm, dry weather, motion; walking,change of
position, rubbing, warm applications, from stretching out limbs.
SILICEA
Fever; Chilliness; very sensitive to cold air. Creeping,
shivering over the whole body. Cold extremities, even in a warm
room. Sweat at night; worse towards morning. Suffering parts
feel cold.
Great weariness and debility; wants to lie down.
Ailments. caused by suppressed foot-sweat; exposing the head
or back to any slight draft of air; bad effects of vaccination,
especially abscesses and convulsions;
Has a wonderful control over the suppurative process - soft
tissue, periosteum or bone - maturing abscesses when desired or
reducing excessive suppuration.
Takes cold from exposure to feet. Sweat of hands, toes, feet
and axillae; offensive.
Aggravation; new moon, in morning, from washing, during
menses, uncovering, lying down, damp, lying on left side, cold.
Amelioration; warmth, wrapping up head, summer; in wet or
humid weather.
SULPHUR
Fever; Frequent flashes of heat. violent ebullitions of heat
throughout entire body. Dry skin and great thirst. Night sweat,
on nape and occiput. Perspiration of single parts. Disgusting
sweats. Remittent type.
When carefully- selected remedies fail to act, especially in
acute diseases; it frequently arouses the reactionary powers of
the organism.
Sensation of burning: on vertex; and smarting in eyes; in
face, without redness; of vesicles in mouth;
Constant heat on vertex; cold feet in daytime with burning
soles at night, wants to find a cool place for them.
Aggravation; at rest, when standing, warmth in bed, washing,
bathing, in morning, 11 a.m., night, from alcoholic stimulants,
periodically.
Amelioration; dry, warm weather, lying on right side, from
drawing up affected limbs.
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