9/20/2023 0 Comments Fever of unknown originFrom today’s perspective, one man stands by far as the most influential in fostering thermometry for clinical applications. However, as is usually the case with discoveries and inventions, the seeds were planted and then nurtured by many others long before those receiving credit for their contributions. Another assumption could lie in thinking that the thermometer’s birth occurred not long after clinicians recognized that monitoring body temperature could ferret out disease from among the many aches and minor perturbations of an otherwise healthy existence. Given this history and the prominence of Galileo, Fahrenheit, and Celsius in the history of the development of the thermometer, one may believe that clinical thermometry emerged fully formed from the heads of these great men. The Romans of his era believed that at least some cases of fever were the work of the goddess Febris, to whom they dedicated a temple on Palatine Hill to propitiate her. Humoral imbalances were thought to stem from factors including putrefaction, proximity to an external source of heat, constriction, or certain foods capable of producing heat (eg, garlic, leeks, and onions). He regarded fever as a disease itself, rather than a sign of disease. Ĭlaudius Galen of Pergamum (131–201 CE) refined these concepts sufficiently such that they dominated medical thinking for over a thousand years. Hippocratic physicians detected elevations in body temperature by palpation and recognized the association of fever with an accelerated pulse rate. Since attributed to Hippocrates of Kos (460–377 BCE), pyretos and therme (fever and heat) arose from an imbalance (or dyscrasia) of the 4 corporal elements-sanguis (blood), flegma (phlegm), melanchole (black bile), and chole (yellow bile)-in which there existed an excess of yellow bile. Akhawaynī’s theory for the pathogenesis of fever subsequently influenced the basis for the humoral theory of fifth-century Greco-Roman physicians. He authored the medical compendia Hidāyat al-Muta’allimīn fī al-Tibb ( The Student’s Handbook of Medicine), defining a system for fever curves including descriptions of tertian, quartan, double tertian, double quartan, and triple quartan fevers hundreds of years before they were routinely used in clinical settings. Humanity has but three great enemies: fever, famine, and war of these by far the greatest, by far the most terrible, is fever.Ĭoncepts of fever have changed over the past millennia, dating from the earliest known fever curves created by the 10th-century BCE Persian physician Akhawaynī. Despite recent advances and newer imaging techniques such as 18-fluorodeoxyglucose–positron emission tomography, clinical judgment remains an essential component of care.Ĭlinical thermometry, fever, fever of unknown origin, pyrexia, pyrexia of unknown origin This review considers how newer data should influence both definitions and lingering dogmatic principles. While FUO subgroups and etiologic classifications have remained unchanged since 1991 revisions, the spectrum of diseases, clinical approach to diagnosis, and management are changing. Although clinicians may have some understanding of the history of clinical thermometry, how average body temperatures were established, thermoregulation, and pathophysiology of fever, new concepts are emerging. Fever of unknown origin (FUO) was first defined in 1961 by Petersdorf and Beeson and continues to be a clinical challenge for physicians. Historical convention has mostly determined that 37.0☌ (98.6☏) should be regarded as normal body temperature, and more modern evidence suggests that fever is a complex physiological response involving the innate immune system and should not be characterized merely as a temperature above this threshold. It has been the subject of scrutiny in recent decades. Fever has preoccupied physicians since the earliest days of clinical medicine.
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