Hello shvmkt,
I understand that you are not interested in Wunderlich?s fever
norms, but all research points to he who not only studied ?normal?
body temperature, but determined 100.4F as the classic definition of a
fever! There were some studies in the 1990?s that have have challenged
Wunderlich?s data on normal temperatures, however, and I have included
references to these studies further below in the answer.
Carl Wunderlich *is* the one who established the 100.4 fever, in the
1860?s, according to The Virtual Naval Hospital. ??the classic
definition of the lower limit of fever is 100.4o F (38o C). These
values were established by Carl Reinhold August Wunderlich in the
1860's after reviewing several million temperatures in over 25,000
patients over 18 years. However, he used a thermometer that may not
have been very precise, used mainly axillary temperatures, and he did
not present his raw data, so the accuracy of his claims has been
challenged.?
?Modern studies have typically found normal body temperature to be
lower than the classic 98.6o F. A recent study by Mackowiak, et al,
found that the mean temperature for young, healthy adults was actually
98.2o F +/- 0.7o F (36.8o C +/- 0.4o C), and that the 99th percentile
for maximum normal temperature in young, healthy adults was 98.9o F
(37.2o C) at 0600 and 99.9o F (37.8o C) at 1600. Therefore, they
concluded that any temperature in young adults over 99.0o F (37.2o C)
in the morning or 99.9o F (37.8o C) at any time should be considered a
fever.?
http://www.vnh.org/GMO/ClinicalSection/30Fever.html
?Wunderlich established the normal range of body temperature in humans
as 97.25° to 99.5° F. To do this, he collected more than 1 million
temperatures from 25,000-plus patients using Fahrenheit's constant
reference point thermometer. The range established by Wunderlich in
1868 remains the standard today.?
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=270778
?Carl Reinhold August Wunderlich1 was the first to conduct extensive study on
body temperature, and published his opus magnus in 1868. In this book, The
Course of Temperature in Diseases, Wunderlich identified 98.6°F (37°C) as normal
body temperature. He also established 100.4°F (38°C) as the upper limit of
the normal range. His database was enormous, and is estimated to have included
several million observations obtained from some 25 000 subjects. Wunderlich
also concluded that fever, which had previously been viewed as a disease
process in itself, was, rather, a sign of disease. Since his time,
there have been a
number of significant developments in this area including the development of a
variety of thermometers, different sites of temperature measurement, different
normal ranges of body temperature, and understanding of the mechanisms, effects,
and treatment of fever. This review aims to summarise these developments
in relation to children.?
http://www.hkam.org.hk/publications/hkmj/article_pdfs/hkm0202p39.pdf
This abstract ?A critical appraisal of 98.6 degrees F, the upper limit
of the normal body temperature, and other legacies of Carl Reinhold
August Wunderlich.? By Mackowiak PA, Wasserman SS, Levine MM.
Disagrees with Wunderlich?s studies.
JAMA. 1992 Sep 23-30;268(12):1578-80.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=92389405&dopt=Citation
Today, it is likely that a body temperature of 100.4 is considered a
fever, as it is that point when the body starts becoming dehydrated,
demanding extra oxygen and caloric energy, and sensitive neural tissue
risks damage. For children, particularly, the risk of seizures begins
at 100.4 F. Studies have shown that for every one degree increase in
temperature, the body?s metabolic rate is increased by 15%, increasing
blood pressure, respiration and heart rate.
http://www.thrombosis-consult.com/articles/Textbook/26_febrileadult.htm
?Detecting fever is not a challenge, but determining its cause can be.
If the fever is low grade (100.3° F or below) and of short duration,
no testing or treatment may be needed. In other cases, knowledge of
the child's symptoms and a thorough examination help doctors find the
cause. In general, any infant with a temperature of 100.4° F or higher
should be seen by a doctor, as should older children with higher or
recurring fevers.?
http://www.merck.com/mrkshared/mmanual_home2/sec23/ch267/ch267i.jsp
?A temperature exceeding 38°C (100.4°F) that persists for at least 1
hour is also considered a fever.?
http://www.jfmed.uniba.sk/patfyz/separatky/FEVER_IN_THE_COMPROMISED_HOST/t.html
?Using a multivariable analysis, it was found that a young age
(defined as less than 18 months) at the time of the first seizure, a
low degree of fever (defined as less than 40°C [104°F]) in the
emergency room, a brief interval (less than one hour) between the
onset of fever and the occurrence of the seizure, and a history of
febrile seizures in a first-degree relative were all significant,
independent predictors of recurrent febrile seizures.?
http://www.aafp.org/afp/970915ap/tips6.html
Interestingly, in a reverse situation, 100.4 F is the safe point at
which you no longer need to take cooling measures with a heatstroke
victim.
?In the event of heatstroke, begin cooling the patient as quickly as
possible using whatever methods are available. Call for emergency
assistance. If you're outside, move the patient to a shaded area. Heat
loss through conduction, using water, is extremely effective. Immerse
the patient in a tub of cool water or place the patient in a cool
shower. Another effective intervention is to wrap the patient in a
cool, wet sheet, then fan vigorously. Continue cooling efforts until
the body temperature drops to 38° C (100.4° F).?
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=270778
We must distinguish fever from hyperthemia however. The hypothalamus
regulates the body temperature, through heat loss when the heat
dissipation process is disturbed etc., while a true fever is caused by
pyrogens. Pyroens are fever stimulating substances; endogenous
pyrogens include tumor necrosis factor, antibododies, and interferons,
while exogenous pyrogens include bacteria, viruses, drugs, etc..
?There are two types of pyrogens: exogenous and endogenous. Exogenous
pyrogens include: micro-organisms (primarily cell wall components),
microbial toxins (usually Gram-positive organisms), antigen-antibody
complexes, drugs, and polynucleic acids. They can induce the host
cells (primarily macrophages) to produce endogenous pyrogens. Some
endogenous molecules can also induce endogenous pyrogens; these
include antigen-antibody complexes, certain androgenic steroid
metabolites, inflammatory bile acids,
complement components, and some lymphocyte products. Endogenous
pyrogens include: interleukins (ILs)-1, 2, 6, and 8, tumour necrosis
factor (TNF)?á, and prostaglandin E, which is a component of the final
common pathway of action on the thermoregulatory centre. Endogenous
pyrogens decrease the firing rate of preoptic warm-sensitive neurons,
and increase the firing rate of the preoptic cold-sensitive neurons.
The inhibition of warm-sensitive neurons causes a decrease in heat
loss responses. Similarly, excitation of cold-sensitive neurons
increases heat production, such as shivering, and heat retention
responses, such as vasoconstriction. Pyrogen inhibition of
warm-sensitive neurons raises the regulated set-point temperature of
the anterior hypothalamus. In short, pyrogens disturb the balance in
firing
of warm- and cold-sensitive neurons in the hypothalamus, leading to
elevation of the set-point temperature.?
http://www.hkam.org.hk/publications/hkmj/article_pdfs/hkm0202p39.pdf
?Since its introduction by Carl Wunderlich in 1868, fever measurement
has been regarded as a basic tool in routine medical diagnostics.
However, although it may seem to be an uncomplicated diagnostic
method, the measured values and their interpretation vary, depending
on numerous influences. These include the type and model of
thermometer, the site of the body where the instrument is placed, the
age and sex of the patient, and circadian fluctuations in body
temperature. For example, according to Mackowiak (1997), normal
orally measured temperature fluctuates between 35.6 and 38.2 °C [96.1
°F and 100.8 °F].? See more about Mackowiak?s book below under
?Additional Reading?
http://www.braun.com/medical/bodytemperature/infocenter/fever.html
Anthony Smith said, in his 1985 book ?The Body?, "The word normal, as
applied to human body temperature, is a splendidly misleading
description. The little arrow on the clinical thermometer, doggedly
directed at 98.4 degrees F (36.9 degrees C), gives extra support to it
and the exactness of that point four of a decimal emphasizes it even
further". (Smith 1985: 365-366)
Interestingly, in the UK, 98.4 is considered the normal body temperature.
http://www.aquaticape.org/bodytemp.html
?Where is the most accurate site to obtain body temperature?
The answer is the hypothalamus. It is located in the base of the
brain and acts as the body?s thermostat. It functions by monitoring
heat sensors throughout the body and adjusting the temperature based
on the body?s needs (Severine & McKenzie, 1998). The goal of the
hypothalamus is to maintain the body?s core temperature (the
temperature of the heart, lungs, liver, kidneys, brain, etc.) between
96.9° to 100.4° F (36° to 38° C). Temperature sensors in the
hypothalamus have been identified as the prime site for
fever-producing pyrogenic action (DiBenedetto, 1993). But access to
the hypothalamus is quite inconvenient. DiBenedetto (1993) describes
body temperature as an estimate of the average temperature of the core
portions of the body as reflected by the temperature of the blood in
the major vessels.?
http://www.enw.org/Research-Thermometry.htm
===================
Additional Reading:
===================
This is a very interesting short article on Wunderlich and his
studies. (You may have to sign up for a free membership)
http://www.projo.com/opinion/contributors/content/projo_20040531_ctstan.143225.html
You may find this book interesting, and it may be available at your
library. If not, you can inquire of the librarian for a free
inter-library loan.
Fever: Basic Mechanisms and Management.
Mackowiak P (ed). New York; Raven, 1991: 155-157 Nice summary of
relation between temperature and heart rate. Chapter 5 of this book,
by the way, is an interesting history of clinical thermometry
During SARS epidemics, a fever of 100.4 is the criteria for quarantine.
http://safetyweb.uoregon.edu/SARS.htm
If any part of my answer is unclear, please request an Answer
Clarification, beofre rating. This will enable me to assist you
further, if possible. I hope this answer has not disspointed you with
the inclusion of Wunderlich as the person you are seeking. Often, when
something, like a standard for a fever is established, and there is no
contradictory evidence, the standard remains. I found, through
exhaustive research, no evidence that anyone other than Wunderlich was
your man!
Regards,
crabcakes
Search terms
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