by Elizabeth Iskander, MD On: Monday 05 April, 2021
Ellen White recommended hot and cold water treatments for patients fighting disease. The water cure could take the form of a fomentation or poultice to be applied to a patient lying in bed; for stronger, ambulatory patients, the patient could alternate between a hot bath or shower and a cold bath or shower. The water cure was one of the main treatments at the Battle Creek Sanitarium.
Although hot and cold water were both used in the water cure, Ellen White taught that in most cases, hot water was the more suitable and effective treatment:
I have just sent you a telegram. In a letter written to Brother Lacey, the father of Herbert Lacey, Sister Lacey was describing, I think, the treatment you were giving Brother Lacey--the ice, etc., used to keep down the fever. I feel that the ice used is a mistake. The light which has been given me in reference to several critical cases . . . and in every case the directions given were, “Do not apply ice to the head (but cool water); apply hot fomentations (to the bowels, stomach, and liver).” This will quell the fever much sooner even than cold. . . . This direction has been given me again and again. (March 10, 1897, from Cooranbong, NSW, to Brother Semmens)
We now have a scientific explanation as to why this treatment worked.
Temperature Treatments were used in the Past
In the past, physicians knew that fever and artificially elevated body temperature were beneficial in treating certain conditions. They understood that heat somehow stimulated the body’s natural defenses, even if they did not know why this worked.
Hippocrates, in the 5th century BC, was one of the first to characterize fever as part of the body’s immune response. Thomas Sydenham (1624 – 1689), known as the English Hippocrates, wrote Observationes Medicae, which for almost two centuries was a standard medical textbook; he described fever as “nature’s engine which she brings into the field to remove her enemy.”
Carl R. A. Wunderlich (1815-1877) established that the normal human temperature was 37 °C, or 98.6 ° Fahrenheit; he was the first to regularize the use of thermometers to measure temperature, and charting temperature over time, making it a standard diagnostic data point.
In an interesting early 20th Century example of using fever to fight disease, Julius Wagner-Jauregg introduced malariotherapy, the treatment of neurosyphilis by the introduction of malaria. Malaria induces fever, and the fever kills the microbe that causes syphilis, Treponema pallidum. This treatment was very effective in curing the mental illness—dementia, mania, psychosis, depression, delirium—that often appears with a late-stage syphilis infection that has entered the nervous system and the brain. Wagner-Jauregg won the Nobel Prize for Medicine in 1927.
But as antibiotics began to be widely used in the mid-20th century, interest in alternative treatments waned, and eventually body temperature manipulation as a treatment was almost forgotten. I wish there had been information on heat therapy and hydrotherapy during my medical training at Loma Linda University.
The Function of Fever
We now know that fever is a signal to the immune system that the body is fighting an infection and that certain antibodies need to be produced in quantity. The biochemical pathway is complex and not completely understood, but it happens something like this: Macrophages, which “eat” pathogens, are our first line of defense to infection. When they become overwhelmed by a pathogenic invasion, they recruit other immune system cells and begin producing “pyrogens”—from the Greek root pyro, meaning “fire.”
Pyrogens are endogenous toxins, such as the lipopolysaccharides (LPS) that reside in the outer membrane of E. coli and other gram-negative bacteria. Pyrogens create fever by tricking the hypothalamus (where the body's thermostat resides) into sensing a colder temperature than really exists. The brain responds by tapping the thermostat up a few notches. Blood rushes to the body's core to be heated, but that leaves the surface cooler than it should be—hence the chills that you feel when you have a fever. The metabolic rate rises and muscles contract.
The fever causes specialized white blood cells called B lymphocytes or B cells to produce more antibodies, which are Y-shaped protein molecules that attach, like a key into a lock, to the surface of the invading bacteria or virus; hence, the antibodies are specific to the pathogen. These antibodies enter the blood serum (the clear, yellow liquid component of blood) and go in search of biological invaders that have the “lock” corresponding to their “key.”
Once the antibody binds to the invader, there are several different mechanism by which the invader can be destroyed, such as (1) changing the chemical composition of a poison; (2) rendering microorganisms immobile or unable to penetrate body cells; (3) causing a chemical cascade or chain reaction which results either in the bursting of the invading microbe or the attraction of microbe-killing scavenger cells that ingest, or phagocytose, the invader.
We know that fever is one of the body’s natural defenses against infection, and that it stimulates the production of specific antibodies.
Anti-Pyretics Interfere with the Healing Process
But there is now much evidence that the use of anti-pyretics and anti-inflammatory medicines interferes with the healing process. French authorities recently warned that over-the-counter anti-inflammatory drugs may worsen the coronavirus. The country’s health minister, Olivier Véran, stated,
“The taking of anti-inflammatories [ibuprofen (Advil, Motrin, Midol), naproxen (Aleve, Naprosyn)] could be a factor in aggravating the infection. Anti-inflammatory drugs are known to be a risk for those with infectious illnesses because they tend to diminish the response of the body’s immune system.”
The use of antipyretic drugs to diminish fever correlates with a 5% increase in mortality in human populations infected with influenza virus. (Earn DJ, Andrews PW, Bolker BM, “Population-level effects of suppressing fever,” Proc. Biol. Sci. 2014; 281:20132570). Antipyretics negatively affect patient outcomes in the intensive care unit. (Ryan M, Levy MM. “Clinical review: fever in intensive care unit patients,” Crit. Care. 2003;7:221–225)
A study published in 2000 by Philip Mackowiak (Arch. Intern. Med. 2000;160(4):449-456) suggested that antipyretics such as aspirin and paracetamol (acetaminophen) may prolong the duration of influenza A infection. The study was a retrospective literature review and examined data from vaccine studies conducted between 1978 and 1987. In the influenza A group, the patients who had received antipyretics had a significantly longer duration of illness than those who did not. (8.8 vs 5.3 days) Similarly, the duration of another illness studied (Shigella sonnei) was also significantly longer among subjects who took antipyretics. (4.6 vs 1.9 days)
A 2005 study sought to evaluate the impact of antipyretic therapy on outcomes in critically ill patients. The patients were randomly assigned to (1) an aggressive treatment group, for which acetaminophen 650 mg was given every 6 hours for fever over 38.5° C (101.3°F) with the addition of a cooling blanket for temperature of greater than 39.5° C (103.1°F), or (2) a permissive treatment group for which anti-pyretic treatment was initiated only at a temperature greater than 40° C (104°F) with acetaminophen and cooling blankets. Remarkably, the researchers terminated the study for ethical reasons, because there had been seven deaths in the aggressive treatment group and only one death in the permissive group. (Schulman CI, Namias N, Doherty J, et al. “The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study.” Surg. Infect. (Larchmont) 2005;6:369-75.)
Matthew J. Kluger conducted some very interesting animal experiments in the 1970s. He infected iguanas with bacteria. Because iguanas are cold-blooded they could only warm their bodies by seeking outside heat, so Kluger gave them a sunlamp. Twelve of 13 iguanas sought warmth from the sunlamp to raise their body temperatures, and survived, but the thirteenth iguana, which did not seek the heat, died. Next, Kluger injected 12 different iguanas with bacteria and, at the same time administered antipyretics to them. Five of them failed to develop a fever, and died. The other seven, which somehow generated a fever despite the anti-pyretic medication, survived. (Vaughn LK, Bernheim HA, Kluger MJ. “Fever in the lizard Dipsosaurus dorsalis.” Nature 1974; 252:473–474; Kluger MJ, Ringler DH, Anver MR, “Fever and survival,” Science 1975; 188:166-8. Bernheim HA, Kluger MJ, “Fever: effect of drug-induced antipyresis on survival,” Science 1976; 193:237–239;)
Preclinical studies in rabbits infected with the rinderpest virus found a dramatic increase in mortality when fever was inhibited with Aspirin— 70% of Aspirin-treated animals died as a result of infection as compared with only 16% of animals with a normal febrile response. Kurosawa S, et al, “Effects of antipyretics in rinderpest virus infection in rabbits,” J. Infect. Dis. 1987;155:991–997.
Clearly, anti-pyretics do not, under most circumstances, promote the healing process, even though the nearly automatic use of anti-pyretics is widespread and taught in many medical schools today. Fever is a natural immune response to fight off infection. To reduce the fever with Tylenol or equivalent is to stop one of the body’s healing mechanisms. It is much more productive to allow the body to heal itself through natural processes, including fever.
Naturopathic physicians, including many Seventh-day Adventists who believe in the inspiration of Ellen White, understand that it is usually best to allow a fever to run its course. Rather than work against it, they work with the fever to stimulate the body’s natural immune response to infection. They generally prescribe bedrest and fasting until the fever breaks on its own.
A low to medium grade fever can be your friend if it is closely watched. When patients become too uncomfortable, employ cooling measures such as ice bags, and have antipyretics ready to administer if external cooling is not sufficient. It is a good idea to discuss with the patient how fever is not their enemy; the knowledge that fever is part of the healing process may help the patient tolerate the discomfort a little longer so the fever can do its work. The vast majority of fevers peak and descend within the low-grade range by themselves.
If you have a headache as part of an infectious disease, remember that Aspirin and all other over-the-counter analgesics (pain killers) are also antipyretics. I would advise avoiding them and letting your immune system wage the fight unimpeded. Lie down, put a wet cloth on your forehead, and wait as long as you can before taking that pain pill. Let your immune system wage the fight unimpeded.
Several Seventh-day Adventist physicians who have a strong belief in the inspiration of Ellen G. White and who work in self-supporting ministries have told me that if they feel an upper respiratory infection coming on, they will take a hot bath, shower, or sauna. They feel it made their infection go away or lessened the severity of the symptoms. I am thankful for the older doctors who shared their faith in Ellen White’s “water cure.” Because of their testimony, I have used pyrotherapy. Over the decades, it has helped me greatly to avoid or reduce the symptoms of an oncoming influenza infection.
Of course, it is possible to have a fever so high that it presents a danger of brain damage, which can occur when the fever exceeds 105° Fahrenheit (40.56° C). When the fever goes above 104° F it should be reduced. Cold water and/or ice packs should be applied until the fever is down to 104° F. If you are not able to get the fever down to 104° F, you should seek medical intervention immediately. Generally, aggressive anti-pyretic treatment of fever is indicated where there has been a stroke (blood blockage to the brain) or other serious brain injury (but not heat stroke, which can and should be treated without anti-pyretics). But for most bacterial or viral infections, fever is helpful.
Medicine is an art that involves balancing many factors. If the patient has a seizure disorder, a heart condition, or cannot tolerate the discomfort of fever, anti-pyretics may be appropriate. We should avoid a rigid, mechanistic approach, which is why doctors leave orders to give antipyretics "prn" which means "as needed in the judgment of the nurse." The nurse does not need a doctor’s order to put a cold wet cloth on the patient's forehead.
If there were more instruction of both nurses and doctors on the benefits of fever up to around 103-104° F, the “prn”, or as needed, instruction might result in less use of antipyretics. Nursing schools should teach the value of fever as a stimulant of the body’s infection-fighting mechanisms. This should be discussed in every high school and college health class within the Adventist educational system. If fewer antipyretics were used, it would also lessen our dependence on China, which manufactures most of our pharmaceuticals, including the anti-pyretics.
In this era of COVID-19, if you know you have been exposed, begin hydrotherapy immediately. Take a long hot bath (with an attendant) or an alternating hot and cold shower that undulates your body temperature. When immune cells sense temperature moving up, they are signaled to search for invaders. If you develop a fever, wait as long as you can or until your fever reaches around 103 to 104° Fahrenheit before taking antipyretics.
Benefits of the Sauna
Even if you haven’t been exposed to disease, the “hot sauna, cold plunge” technique leads to incredible relaxation—almost euphoria—which is why many European luxury hotels feature a sauna with an ice cold tank right outside. The Scandinavians originated a technique—a 20-minute session in the sauna, followed by a plunge into cold water of less than a minute. Ideally, this process is repeated 3 or 4 times until the body is completely relaxed. Sometimes referred to as the Nordic Cycle, the “hot sauna, cold plunge” improves blood flow, elevates the heart rate, increases adrenaline, and causes the release of endorphins. It also triggers lymphatic circulation, which tends to detoxify the body. The positive health effects have been recognized by the Nordic societies for centuries.
A recent Finnish study found that regular visits to the sauna can help lower the risk of developing dementia and Alzheimer’s disease, as well as heart ailments, Researchers at the University of Eastern Finland conducted a longitudinal study of more than 2,300 middle-aged Finnish men for more than 20 years. Men who went to the sauna four to seven times a week were found 66 percent less likely to be diagnosed with dementia or Alzheimer’s than those taking a sauna only once a week.