Speaker 1: Experiment one. A large vessel containing one hundred and seventy
Speaker 1: gallons of salt water was placed in the open air.
Speaker 1: The atmosphere was damp and raw. The thermometer, both in
Speaker 1: the air and in the water, stood at forty four
Speaker 1: degrees fahrenheit. The subject of the experiment was Richard Edwards,
Speaker 1: a healthy man twenty eight years of age, with black
Speaker 1: hair and a ruddy complexion. The hour chosen for his
Speaker 1: immersion was four in the afternoon, about two hours after
Speaker 1: his dinner, a time doctor Curry tells us appointed rather
Speaker 1: for his own convenience than as being most proper for
Speaker 1: the purpose. The heat of the person who was the
Speaker 1: subject of the experiment was ninety eight degrees before undressing,
Speaker 1: his pulse one hundred in the minute. He was undressed
Speaker 1: in a room where the mercury was at fifty six degrees,
Speaker 1: and afterwards stood naked before the fire till his heat
Speaker 1: and pulse were examined again and found as before. He
Speaker 1: then walked pretty briskly into an open court, where the
Speaker 1: northeast wind blew sharply upon him. He was exposed to
Speaker 1: it for a minute, and then plunged suddenly into the
Speaker 1: water up to the shoulders. The thermometer, which had been
Speaker 1: kept in a jug of warm water at the heat
Speaker 1: of one hundred degrees, was introduced into his mouth with
Speaker 1: the bulb under his tongue. As soon as the convulsive
Speaker 1: sobbings occasioned by the shock were over, the mercury fell rapidly,
Speaker 1: and a minute and a half after immersion it stood
Speaker 1: at eighty seven degrees. He remained motionless in the water,
Speaker 1: and the mercury rose gradually. At the end of twelve
Speaker 1: minutes it stood at ninety three and a half degrees.
Speaker 1: Doctor Curry expected to see the mercury rise on changing
Speaker 1: the medium of water for air, and therefore he kept
Speaker 1: him exposed naked to the wind two minutes after taking
Speaker 1: him out of the bath. To his surprise, although the
Speaker 1: attendants were rubbing him dry with towels during this time,
Speaker 1: the mercury fell rapidly. He was put into a warm bed,
Speaker 1: and his heat, when examined under the tongue, was eighty
Speaker 1: seven degrees. Frictions were used and brandy mixed with water administered.
Speaker 1: Three hours afterwards, however, he had not entirely recovered his
Speaker 1: former heat, but by eight at night he was in
Speaker 1: all respects.
Speaker 2: As usual.
Speaker 1: Convulsive sobbings. As soon as I read that, I was like,
Speaker 1: that's the one.
Speaker 3: Oh yeah, they kept him cold for so long.
Speaker 1: So keep in mind that was experiment one, Experiment one.
Speaker 1: In subsequent experiments, doctor Curry seemed only encouraged to try harder.
Speaker 2: Okay, So like.
Speaker 1: The experiment seven, at which I almost included, and I
Speaker 1: was like, no, no, that's that's enough. I'll just reach
Speaker 1: you a little bit. It's supposed to be tried on
Speaker 1: Richard Sutton, aged nineteen, of a pale complexion and feebler frame. Okay,
Speaker 1: And then it said so he was in the water,
Speaker 1: intended to be in the water for forty five minutes,
Speaker 1: but only made it to like thirty five. And then
Speaker 1: when they put the thermometer in, the doctor was like, well,
Speaker 1: it's reading eighty three degrees. But it must be that
Speaker 1: his teeth are chattering so much, and so it's just
Speaker 1: the cold air causing the temperature drop. Oh god, So
Speaker 1: that was from an experiment I don't know. A paper
Speaker 1: by James Curry titled an Account of the Remarkable Effects
Speaker 1: of a Shipwreck on the Mariners, with Experiments and Observations
Speaker 1: on the influence of immersion in fresh and salt water,
Speaker 1: hot and cold on the Powers of the Living Body
Speaker 1: from the same work from seventeen ninety four, which explains
Speaker 1: like the most long detailed title and also like everything.
Speaker 2: They did in the paper.
Speaker 3: Yeah, yoh wow, well that's a lot.
Speaker 1: Yeah. Hi, I'm Aaron Welsh.
Speaker 2: And I'm Erin Olman Updyke.
Speaker 1: And this is this podcast will kill you. I like
Speaker 1: forgot that I had to do that part.
Speaker 2: Well, I mean we did have the episode, it seems.
Speaker 1: It really does seem like that. Yeah, it was a
Speaker 1: long one, oh.
Speaker 2: But really good.
Speaker 3: Really really sets us up well, I think for today's topic,
Speaker 3: which I am thrilled about. Mm hm, we are veering
Speaker 3: just slightly off course of typical. Really not that far
Speaker 3: off course.
Speaker 2: Let's be honest.
Speaker 3: Yeah, we are talking today about a medical invention called
Speaker 3: the thermometer.
Speaker 1: The thermometer, the thermometer, so I will say this is
Speaker 1: my little kind of caveat. Okay, the focus, I would
Speaker 1: say about half of my part is on the thermometer. Okay, yeah,
Speaker 1: I'll explain later. Okay, I can't wait.
Speaker 3: I'm going to talk about fevers because like, what do
Speaker 3: we use a thermometer for checking if you have a fever.
Speaker 1: That's mostly what I'm going to be talking about. Too. Great,
Speaker 1: it'll be good.
Speaker 2: I can't wait, be really fun.
Speaker 1: Yeah, but we have a few things to get out
Speaker 1: of the way before we get into like the content.
Speaker 2: So of course we do. Yeah, it's quarantine, ay time.
Speaker 1: It is, and we're drinking this week. Give Me Fever, Give.
Speaker 2: Me Fever like that that's the song, right, that's the song.
Speaker 1: Yeah, In Give Me Fever, we figured we would have
Speaker 1: to do like some sort of hot cocktail, something spicy hot. Yeah,
Speaker 1: hot isn't spicy. And so we're doing and I don't
Speaker 1: know if we've done this before, but we're doing a
Speaker 1: pineapple margarita mm hmm with hellipens, caw and mescal. Don't
Speaker 1: know if we've done this exact variation, hope not, but
Speaker 1: it's it's delicious and we will post the full recipe
Speaker 1: for the quarantini and the non alcoholic La Si rita
Speaker 1: on our website This podcast will Kill You dot Com
Speaker 1: as well as on all of our social media channels.
Speaker 2: We sure will yes on our website This podcast will
Speaker 2: kill You dot Com.
Speaker 3: There's just so many things that you can find there.
Speaker 3: You can find transcripts from all of our episodes. You
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Speaker 1: Yeah, send us episode suggestions, you know. Yeah, weekly episodes.
Speaker 1: We need some ideas. You have lots of them, and
Speaker 1: they have so manyone who has sent incredible suggestions. We
Speaker 1: are taking you up on some of those this season.
Speaker 2: It's going to be a great season.
Speaker 1: Well, should we get into fever? Yeah, I think we should.
Speaker 1: Let's take a quick break and then jump in.
Speaker 3: I'm going to try and start at the beginning here ready.
Speaker 3: Pretty much all animals seek to exist at a particular
Speaker 3: temperature set point that we have to do that, and
Speaker 3: this particular temperature that our body likes to exist at
Speaker 3: varies animal to animal. I'm not going to get into
Speaker 3: the details of it. Endotherms like mammals like us, maintain
Speaker 3: our temperature by physiologic mechanisms like energy production and then
Speaker 3: vasodilation or sweating to cool ourselves off. If we get
Speaker 3: too hot and produce too much heat or vasoconstriction or
Speaker 3: shivering or non shivering thermogenesis. If we get too cold,
Speaker 3: as endotherms, we generate our own heat via our metabolism
Speaker 3: in our body and our brain. Specifically, our hypothalamus has
Speaker 3: an internal thermometer that keeps really tight control over our temperature.
Speaker 3: Humans have to stay at around thirty seven degrees celsius
Speaker 3: ninety eight point six fahrenheit plus or minus like one degree,
Speaker 3: and our body and our brain does a really really
Speaker 3: good job of keeping us there. Despite the fact that
Speaker 3: as humans we live at all of these extremes of temperature,
Speaker 3: and despite the fact that we have massive fluctuations in
Speaker 3: our energy expenditure and our energy intake in all of
Speaker 3: these things.
Speaker 1: Why I have questions, I'm interrupting you. Why ninety eight
Speaker 1: point six or thereabouts?
Speaker 2: I have no idea.
Speaker 3: That's a really fun and interesting question because it totally
Speaker 3: varies mammal to mammal. I mean, dogs and cats run
Speaker 3: a lot warmer birds are.
Speaker 1: Super warm, and then you have things like apossums, which
Speaker 1: are like ninety four degrees.
Speaker 2: Right, well, and bears.
Speaker 3: I did a little bit of a deep dive on bears,
Speaker 3: and like animals who hibernate in the.
Speaker 1: Winter, scot we love some hibernation, I know, but I
Speaker 1: don't know.
Speaker 3: I don't know why, like why each animal has evolved
Speaker 3: their particular temperature. It might just assuman has something to
Speaker 3: do with the rate of metabolism.
Speaker 1: Or right, so there's like body size in terms of
Speaker 1: metabolism and stuff like that, and like heart rate. But right,
Speaker 1: it could also just be like drift to a certain extent,
Speaker 1: like there might not be a like a driver of
Speaker 1: it exactly.
Speaker 3: Oh, I have a lot of feelings about drivers in general.
Speaker 3: And we'll keep talking about like, okay, okay, certain things.
Speaker 1: I'll let you keep going.
Speaker 2: Okay. It's a great question, though.
Speaker 3: So extremes of temperature can and do, as we heard
Speaker 3: in our first hand account, result in things like hypothermia
Speaker 3: eighty six degrees is not okay for a human body
Speaker 3: to exist at, or heat stroke on the other end,
Speaker 3: which kills lots of people every year. But here's where
Speaker 3: things get really interesting in hypothermia or in hyperthermia. So
Speaker 3: when we are exposed to extremes of environmental temperatures, our
Speaker 3: brain would still be doing its darndest to keep our
Speaker 3: bodies at a balmy thirty seven celsius. Our temperature set
Speaker 3: point would remain the same. A fever is what happens
Speaker 3: when our temperature set point gets moved. When our body,
Speaker 3: our brain, our hypothalamus that's controlling our temperature set point
Speaker 3: decides and we'll talk about why and how decides. We
Speaker 3: got to heat things up a little bit, and so
Speaker 3: it moves that temperature set point, and then our body
Speaker 3: actively seeks to raise its temperature.
Speaker 2: And that's a fever.
Speaker 1: Okay, when can I start asking more questions? Should I
Speaker 1: just let you keep going and assume that you'll explain
Speaker 1: it all?
Speaker 3: I mean, I'll probably answer them, but like I guess
Speaker 3: what order you want things?
Speaker 2: And you can hit me with questions.
Speaker 1: Now, no, just go, just go, just go, okay, Okay.
Speaker 3: If I don't answer them, then it'll be really fun
Speaker 3: to try and figure out how to answer them. The
Speaker 3: first question that I assumed that you would ask is
Speaker 3: how high is a fever?
Speaker 2: But maybe that's too easy of a question.
Speaker 3: But it turns out, actually when I was reading this
Speaker 3: that like different places actually do define it differently. So
Speaker 3: it made me feel like I need to get off
Speaker 3: of my high horse a little bit.
Speaker 2: Because I do exist on a high horse when it
Speaker 2: comes to fever.
Speaker 1: Wait, wait, what do you mean by you exist on
Speaker 1: a high horse when it comes to fever?
Speaker 3: Well, okay, I have always, one hundred percent of the
Speaker 3: time learned that a fever is anything above thirty eight celsius,
Speaker 3: which is one hundred point four fahrenheit.
Speaker 2: So, like, there are a lot of times.
Speaker 3: When people will say, oh, I have a small fever
Speaker 3: like ninety nine point nine. That is not a fever.
Speaker 3: That is my high horse. That's me on my high horse.
Speaker 1: Ye you correcting someone. Thank god they didn't also say
Speaker 1: a spider is a bug. They would be dead to you.
Speaker 2: It would be the end of a friendship for sure. Anyways.
Speaker 1: Yeah, so is there a difference between low grade fever? Okay?
Speaker 3: Is this so they you ask that question? I hate
Speaker 3: the term low grade fever. It's another high horse. But
Speaker 3: that's just me that like lots of people use that term.
Speaker 3: So when I then was digging into this some organizations
Speaker 3: like the Infectious Disease Society of America and the American
Speaker 3: College of oh I forget the actual acronym, but it's
Speaker 3: the intensive care like academy in the US. They actually
Speaker 3: said that they kind of consider it more like thirty
Speaker 3: eight points three celsius or one on one fahrenheit, which
Speaker 3: is even higher.
Speaker 1: Wow. And so you could have been even higher on
Speaker 1: your horse.
Speaker 3: Exactly, I could have like ninety nine to nine is
Speaker 3: definitely not a fever. But it's really if you think
Speaker 3: about it, if you think of thirty seven as the
Speaker 3: kind of human typical temperature set point, it's plus or
Speaker 3: minus one degree is normal, and our temperature is going
Speaker 3: to vary throughout the day, So one degree off is
Speaker 3: really not that abnormal. And so I think that that's
Speaker 3: kind of like the main point is that, and we'll
Speaker 3: really get into like what happens when we have a fever,
Speaker 3: and like is it.
Speaker 2: Bad, is it good?
Speaker 1: What?
Speaker 3: And so I think that's why in a kind of
Speaker 3: critical care scenario, you might end up tolerating a little
Speaker 3: bit higher before you need to say this is a
Speaker 3: fever that we need.
Speaker 2: To do something about. If that makes sense, okay, And.
Speaker 3: When it comes to a fever, our body also generally
Speaker 3: has a lot of mechanisms in place that keep this
Speaker 3: from getting too high. Usually it stops around forty one
Speaker 3: celsius or one oh five point eight fahrenheit, although some
Speaker 3: papers that I read said that pre antibiotics, we saw
Speaker 3: more like forty two degrees celsius or one oh seven
Speaker 3: point six.
Speaker 2: So it's not that it's impossible to go higher.
Speaker 3: But usually if it's a fever and not heat stroke
Speaker 3: or heat exhaustion that's happening from external factors entirely, but
Speaker 3: a fever caused by this shift in your internal set point,
Speaker 3: then there's also these mechanisms in place that will stop
Speaker 3: it from getting too high. So then what is causing this?
Speaker 3: Like why does our brain decide all of a sudden
Speaker 3: to change our temperature set point and thereby cause a fever.
Speaker 3: Most of the time, it takes two different things to
Speaker 3: start a fever. It takes some exogenous substance, something from
Speaker 3: outside of us that we do not produce, like for example,
Speaker 3: a bacterial endotoxin, or like viral proteins, something that our
Speaker 3: body recognizes as foreign as not self, that interacts with
Speaker 3: our immune system and then it takes substances that we
Speaker 3: do produce, and these are called pyrogens. Really, they're both
Speaker 3: called pyrigens, exogenous and endogenous pyrogens. Our endogenous ones are
Speaker 3: things like inter lukens and TNF alpha. And I'm not
Speaker 3: going to get into the nitty gritty because it's not
Speaker 3: that important. The point is that these things together act
Speaker 3: on our hypothalamus where that temperature set point is, and
Speaker 3: our hypothalamus then produces something that we've talked about on
Speaker 3: this podcast before, which is prostaglandin E two, which acts
Speaker 3: on yet another part of our hypothalamus to kind of
Speaker 3: slow down how much our warm sensitive neurons fire, and
Speaker 3: that's what then results in the increase in our body temperature. Now,
Speaker 3: the deep deep details of like what's hitting what and
Speaker 3: why is it doing xyz we don't fully understand, but
Speaker 3: that is the basic picture of it. It's stuff in
Speaker 3: our body that our immune system recognizes, usually bacteria or
Speaker 3: viral infections that then trigger our brain to say, hey,
Speaker 3: we need to raise the temperature. So that really raises
Speaker 3: this question of is a fever this adaptive mechanism to
Speaker 3: fight off infections? Because the vast majority of the time
Speaker 3: or maybe not the vast majority, but like a lot
Speaker 3: of the time a fever is associated with an infection.
Speaker 3: So there is a lot of literature about this hypothesis
Speaker 3: that because fever is this response to infection, that it
Speaker 3: has adaptive significance specific to reducing pathogen survival. And we
Speaker 3: talked about this kind of in our blastomecosis episode, just
Speaker 3: in like, yeah, how the evolution of endothermy and like
Speaker 3: having a higher body temperature at base line might have
Speaker 3: been adaptive against fungal pathogens like blastomycosis. So then if
Speaker 3: you take that one step further, then perhaps having a
Speaker 3: fever intermittently raising our temperature even higher protects us against
Speaker 3: other pathogens as well. And we do have some support
Speaker 3: for this idea, both directly and indirectly. So indirectly, there's
Speaker 3: a lot of evidence that ectotherms like lizards will lay
Speaker 3: out in the sun to induce a fever, they will
Speaker 3: raise their own body temperature in order to fight off
Speaker 3: pathogens when they're infected, or fish, some fish will swim
Speaker 3: to warmer water if they're infected, which I find so cool,
Speaker 3: really cool. Now, in humans, the studies are a little
Speaker 3: bit maybe more indirect. I guess I don't know, but
Speaker 3: in some studies, for example in the ICU, people who
Speaker 3: have sepsis and have a fever that's not too high,
Speaker 3: so usually not above like forty one or forty even celsius.
Speaker 2: People who have a fever have.
Speaker 3: Lower mortality rates than people who do not have a fever.
Speaker 3: But if that fever gets too high, then it's no
Speaker 3: longer true. And then there's also like in vitro studies
Speaker 3: that show that various organisms that tend to cause infections
Speaker 3: in humans do poorly at higher temperatures, and that fever.
Speaker 3: One like hypothesis as to the mechanism of why is
Speaker 3: that increased temperatures increase the iron requirements of bacteria and
Speaker 3: then reduces their survival.
Speaker 2: I also found this really fun.
Speaker 3: Paper that tried to like dig deep onto like different
Speaker 3: hypotheses of like how you can inhibit pathogen growth. It's
Speaker 3: too much detail, but I'll post it because it's really fun.
Speaker 3: But the idea is just that we have pathogens that
Speaker 3: are less well adapted to survive at higher temperatures, so
Speaker 3: raising our body temperature helps us to fight off those
Speaker 3: infections I mean.
Speaker 1: And also the fact that fever is highly conserved across mammals,
Speaker 1: like mammals in general have fevers, so like and whether
Speaker 1: it's adaptive across the board, I don't think I actually,
Speaker 1: I don't think anyone has has really like tried to
Speaker 1: argue that point specifically, Like, I think it's always been.
Speaker 1: There's nuance to it, because back even in the nineteen
Speaker 1: twenties or even before then, people were seeing fever as
Speaker 1: being adaptive, but also realizing that some pathogens cause fever
Speaker 1: on their own and actually replicate better, i e. Malaria
Speaker 1: parasites replicate better at higher temperatures. So it depends.
Speaker 3: I guess it depends aarin, and fever is not a
Speaker 3: response that's specific to pathogens, right either, So we also
Speaker 3: can see fever in malignancies. We see fever in autoimmune conditions. Now,
Speaker 3: in those cases, it's very likely that the fever mechanism,
Speaker 3: like the generation of that fever, is due to the
Speaker 3: same underlying inflammatory mechanisms, right, It's still like our immune
Speaker 3: system activating the same pathways, just without the presence of
Speaker 3: a bacterial endotoxin to start.
Speaker 2: It off, if that makes sense.
Speaker 3: But then we also see fever in people with traumatic
Speaker 3: brain injury. We see fever from endocrine disruptions like hyperthyroidism,
Speaker 3: and then there's also like drug induced hyperthermia where you
Speaker 3: can get incredibly high body temperatures as a result of
Speaker 3: drug interactions, which is kind of separate, like a separate
Speaker 3: mechanism entirely. So then the question is like, can fever
Speaker 3: be bad? And like the short answer is yes, definitely, yeah, right,
Speaker 3: And part of it is that fever is not an
Speaker 3: isolated phenomenon.
Speaker 1: Yeah, so your face is like, Okay, are there people
Speaker 1: who do not get fevers or cannot change that set point?
Speaker 3: That's an excellent question, definitely, and I think that's part
Speaker 3: of why. So in some of those studies where they
Speaker 3: have looked at patients in ICUs who have sepsis, people
Speaker 3: who don't have a fever at all, who are either
Speaker 3: normalthermic or even hypothermic have less good outcomes like higher
Speaker 3: mortality and things like that. So not being able to
Speaker 3: mount a fever response is usually a sign that your
Speaker 3: immune system is not activating enough. So in terms of
Speaker 3: what the specific cause of that could be, I don't
Speaker 3: have like a list of things for you, but definitely
Speaker 3: there are instances where you could have an immune system
Speaker 3: that's not able to mount a febrile response.
Speaker 1: But I mean, like just people like that is you
Speaker 1: you can never not just situationally, but like can have
Speaker 1: never been able to have a fever.
Speaker 2: I don't.
Speaker 3: I don't know if there's like a documented human who's
Speaker 3: never fevered.
Speaker 2: Well, I'm just it.
Speaker 1: It makes me think a lot about like why is
Speaker 1: it in this part of the brain hypothalamus? When did
Speaker 1: we talk about prostaglandins on this Oh.
Speaker 2: When we talked about thailan all and when we talked about.
Speaker 1: Oh that makes sense, yeah aspirin. Yeah, okay, yeah, anyway, interesting,
Speaker 1: I'm like I now I'm sort of even struggling to
Speaker 1: think about like body heat period. Oh my gosh, what
Speaker 1: what is it?
Speaker 2: I have deep?
Speaker 3: I've got like four more pages from a paper that
Speaker 3: goes deep into like the generation of heat in mammals
Speaker 3: and different mammals and like heat generation and heat loss
Speaker 3: and all of these like thermo dynamics stuff.
Speaker 2: Because there's a lot there.
Speaker 1: I can't wrap my head around it. So I'm sorry
Speaker 1: to have interrupted. Let's just keep going.
Speaker 3: Okay, it's okay, it is really fascinating. But when we
Speaker 3: look at fever specifically, it's not an isolated phenomenon. Your
Speaker 3: brain is not causing a fever, and that's the only
Speaker 3: thing that's happening in your body, whether it's during an
Speaker 3: infection or during malignancy or whatever.
Speaker 2: The cause is.
Speaker 3: The mechanisms of that inflammatory response that are triggering fever
Speaker 3: also trigger things like an increase in your heart rate,
Speaker 3: an increase in your metabolism and oxygen requirements.
Speaker 2: And these things.
Speaker 3: Are not physiologically benign, right, they are costly for us.
Speaker 3: So that is one way that fever can actually cause
Speaker 3: more damage. Right, It's metabolically very costly to have a
Speaker 3: fever because of what all of the other things that
Speaker 3: come along with it. But on top of that, at
Speaker 3: a certain point, the heat alone damages ourselves. So we
Speaker 3: see both cellular and tissue level and then even like
Speaker 3: organ level damage as a result of that increase in
Speaker 3: body temperature as a result of fever.
Speaker 2: And so it.
Speaker 3: Makes sense then that there are usually these mechanisms in place,
Speaker 3: these kind of negative feedback loops that kick in over
Speaker 3: certain temperatures in order to keep our fevers from getting
Speaker 3: too high. But you're right, there are situations in which
Speaker 3: those fail, and there's a few ways to think about
Speaker 3: that depending on what the cause of fever was. If
Speaker 3: it is something like accepsis or an overwhelming infection, then
Speaker 3: a fever that is getting so incredibly high that it's
Speaker 3: causing things like brain damage or other organ damage is
Speaker 3: a sign that the damage has already begun, and so
Speaker 3: your body can no longer regulate that fever cycle, if
Speaker 3: that makes sense. And the same thing is true if
Speaker 3: it's a cause like a TBI, like a traumatic brain injury,
Speaker 3: where you've just you've disrupted the ability to do that
Speaker 3: temperature regulation period.
Speaker 1: Why when you have a fever do you feel cold?
Speaker 2: Oh, that's a really good that's a really good question.
Speaker 3: From what I read, It's because your body is trying
Speaker 3: to raise its temperature, and so it's doing that by
Speaker 3: things like vasoconstriction in your extremities in order to funnel
Speaker 3: the heat into your core. So you're going to feel cold.
Speaker 3: It's also then behaviorally going to cause you to put
Speaker 3: on layers, which is going to help you raise your
Speaker 3: body temperature.
Speaker 2: How cool is that?
Speaker 3: Huh yeah, yeah, so it's not. I think what's interesting
Speaker 3: too is a lot of times people are like, oh,
Speaker 3: if you have a fever.
Speaker 2: You should try and cool your body down.
Speaker 3: You should put on cold you know, put a cold
Speaker 3: cloth on, et cetera. But that is going to fight
Speaker 3: against what your body is trying to do, so then
Speaker 3: it will actually probably cause you to shiver more, which
Speaker 3: is the way that you're trying to generate heat. Shivering
Speaker 3: is trying to generate heat. So it kind of like
Speaker 3: works against yourself to do those mechanisms. It doesn't mean
Speaker 3: they're harmful necessarily, but right, it's interesting.
Speaker 1: But then also like, okay, maybe this is just I'm
Speaker 1: thinking of I don't know, the Secret Garden or something. Okay,
Speaker 1: is it like ice bath when the fever is out
Speaker 1: of control really high, where you can sort of like
Speaker 1: overwhelm externally your body to the point where it brings
Speaker 1: the temperature down. Sounds and it looked from the movie
Speaker 1: Secret Garden really painful.
Speaker 3: Yeah, I don't know that in a fever situation an
Speaker 3: ice bath would be the way to lower your temperature.
Speaker 3: In a hyperthermia like situation, something like that, yes, potentially, okay, right,
Speaker 3: like it like because your body got overheated externally.
Speaker 1: Like heat stroke type of thing.
Speaker 2: Exactly heat stroke type of thing, but this was not that.
Speaker 2: But no, I think I.
Speaker 3: Think we have better ways than an ice bath to right,
Speaker 3: they didn't in the Secret Garden, but we do today.
Speaker 2: Okay, good to Yeah, don't do an ice bath. Not
Speaker 2: to tell you what to do. This is not medical advice,
Speaker 2: but yeah, that is kind of that. That is the fever.
Speaker 2: That's the fevers.
Speaker 1: That's it.
Speaker 2: That's what I have. Did you have more questions?
Speaker 3: I have a lot more things I could talk about,
Speaker 3: but that was what I really wanted to get across.
Speaker 1: Yeah, okay, so talk to me about the when fevers
Speaker 1: get out of control? Why does it cause certain types
Speaker 1: of responses like convulsions, seizures.
Speaker 3: Like seizures, Okay, seizures we don't febrow seizures we don't
Speaker 3: fully understand. Like, okay, straight up, Febrow seizures.
Speaker 2: Are most common in young kids.
Speaker 3: They're not impossible to happen in older individuals as well
Speaker 3: and in adults, but they're most common in young kids.
Speaker 3: And you don't have to have a high fever to
Speaker 3: have a febrow seizure. Like, it's not necessarily a function
Speaker 3: of how high the temperature is, and it's not indicative
Speaker 3: of damage. Really, what we think is going on is
Speaker 3: that the same cytokines that are inducing fever also can
Speaker 3: result in increases in excitatory neurotransmitters and decreases in the
Speaker 3: inhibitory neurotransmitters, increases in glutamine, decreases in GABBA, and so
Speaker 3: that those things together can result in seizures, right, Okay,
Speaker 3: So it's not necessarily a result of the temperature, it's
Speaker 3: a result of the other parts of the inflammatory response
Speaker 3: that are doing the same thing. Why is it more
Speaker 3: common in kids? I don't fully know, But is it
Speaker 3: because like their brains and neurotransmitters are just not all
Speaker 3: online the way that adults are.
Speaker 1: Okay, probably that question about treatment, Like, so obviously you
Speaker 1: know we've covered a couple on the podcast before. Yeah, aspirin,
Speaker 1: acetaminifin slash paracetamol. We have to do, ibiprofen we do
Speaker 1: someday someday, and probably something else. Am I forgetting something?
Speaker 2: Those are really that I know about, which is.
Speaker 1: Kind of interesting. I guess quinine, which we've already talked about.
Speaker 1: But this kind of goes along with the whole like
Speaker 1: evolutionary meta in type of thing which I like very
Speaker 1: briefly touch on in my section in terms of just
Speaker 1: like mentioning that there is this conversation sometimes that that
Speaker 1: springs up about when to treat a fever and are
Speaker 1: we being are we fighting against our millions of years
Speaker 1: of evolution leading to this response that is in many
Speaker 1: ways good for us or protective potentially? Yeah, potentially, So like, yeah,
Speaker 1: is there sort of are there guidelines for this or
Speaker 1: is this not really I don't know, Yeah.
Speaker 2: It's such a good question.
Speaker 3: There's not guidelines for it, at least not for like
Speaker 3: normal people living their normal lives. There are you know,
Speaker 3: guidelines for like ICUs where there's you know, consensus of
Speaker 3: this is when you should investigate versus treat a new
Speaker 3: fever in the ICU type setting because that's where we
Speaker 3: have like the most data.
Speaker 2: But really there's.
Speaker 3: There's not a ton of clinical evidence one way or
Speaker 3: the other to say like, oh, we should be treating
Speaker 3: fevers because the fevers are detrimental on their own, or
Speaker 3: there's not data saying like we should let fevers run
Speaker 3: their course because treating a fever causes more problems than
Speaker 3: letting it run its course. We don't have the data
Speaker 3: to say that one way or the other.
Speaker 1: And I feel like I mean, I guess you could
Speaker 1: probably design studies that would not be entirely unethical to
Speaker 1: do this, you know.
Speaker 2: What I mean, you could.
Speaker 3: I think that part of the problem is just that
Speaker 3: it's so the medicines that we use, like acetaminifin and
Speaker 3: yboprofen are just so common and so generally safe and
Speaker 3: well tolerated.
Speaker 2: And fevers suck, man, they do.
Speaker 3: They feel crappy, and so I think that that is
Speaker 3: why they're just so common to be used. But I
Speaker 3: do think that what to know that a fever has
Speaker 3: even the potential to help, like, is a sign that
Speaker 3: our body's immune system is doing what it is supposed
Speaker 3: to do and is trying to fight off this infection
Speaker 3: if it is a result from an infection, right, like
Speaker 3: assuming that it's you have a fever because you have
Speaker 3: an infection. What I think that can provide is just
Speaker 3: like a peace of mind that like there is no
Speaker 3: data saying we have to treat a fever if you
Speaker 3: are not uncomfortable from it, or if you're sleeping through it,
Speaker 3: or like whatever the situation is, you don't have to
Speaker 3: treat it, right, And I think that that like we
Speaker 3: don't have data that says you have to treat a
Speaker 3: fever in order to prevent harm, even if it gets
Speaker 3: pretty high.
Speaker 2: Quite honestly, is.
Speaker 1: This is this my moment to tell you about my
Speaker 1: high fever that went untreated? Yes, Okay. So I was
Speaker 1: a freshman at the University of Kentucky in too zosand
Speaker 1: and five. It was my first semester. I was living
Speaker 1: in Donovan Hall with my roommate Megan, and it was
Speaker 1: like really just pretty early on and I got sick,
Speaker 1: you know, like achy, I don't even know, sore throat probably,
Speaker 1: And I don't remember much of the week, and I
Speaker 1: missed class a few days in a row, and I
Speaker 1: was it was the first time living on my like
Speaker 1: living on my own quote unquote, and I just laid
Speaker 1: on my top bunk four days covered in blankets, freezing.
Speaker 1: Couldn't even watch Gilmore Girls, which I watched religiously at
Speaker 1: the time.
Speaker 2: I do.
Speaker 1: I remember like vaguely seeing like the intro and then
Speaker 1: just passing back out and then on. I feel like
Speaker 1: it was Thursday or Friday. In the afternoon, my roommate
Speaker 1: came back from class and she was like, I am
Speaker 1: really worried about you. This is bad, Like you have
Speaker 1: not moved. Have you eaten anything? Have you had anything
Speaker 1: to drink? And I was just like could not take
Speaker 1: care of myself because I was used to my mom
Speaker 1: taking care of me, and I did. We didn't have
Speaker 1: a thermometer, we didn't have any sort of tile and
Speaker 1: all I'd beprofen anything to like relieve fevers. Yeah, of
Speaker 1: course not. So then I walked like the half a
Speaker 1: block with my roommate. My roommate was like, we're going
Speaker 1: to Campus Health right now, and I remember almost passing
Speaker 1: out on the walk.
Speaker 2: Oh my god.
Speaker 1: And I get in. This is such a longer story
Speaker 1: than I intended it to be. Get into the doctor's office.
Speaker 1: They see me right away, and the doctor she takes
Speaker 1: my temperature with an electronic thermometer and looks at it
Speaker 1: and then leaves the room. And then she comes back
Speaker 1: again and takes my temperature again, looks at it, leaves
Speaker 1: the room and comes back with a mercury thermometer and
Speaker 1: takes my temperature. And I'm just like laying like I
Speaker 1: can't even form sentences. And she is like, Okay, uh,
Speaker 1: we're gonna you probably have strep throat. We'll test you
Speaker 1: to make sure. But I'm going to give you antibiotics anyway,
Speaker 1: and you need to take tailan al or something. She's like, I,
Speaker 1: your fever is one hundred and five point five. I
Speaker 1: didn't believe it. This is why she took my temperature
Speaker 1: with the mercury thermometer because she's like, it must be malfunctioning.
Speaker 2: Yeah, that's something's wrong with the electronics. Yeah.
Speaker 1: And so then she was like sent me back to
Speaker 1: my dorm with instructions to do all that and over,
Speaker 1: and she called the ers like during the night to
Speaker 1: see if I had checked in because she.
Speaker 2: Was like, I was really so worried.
Speaker 1: She's like, I felt bad about sending you back. And
Speaker 1: then by the next day I was fine. It was
Speaker 1: like ninety seven point six.
Speaker 2: Gotta love antibiotics.
Speaker 1: Huh, antibiotics. I know. That's my fever story. It's a
Speaker 1: good fever story. Thanks. One hundred and five point five
Speaker 1: never want to one is just.
Speaker 2: Below what I said. The physiologic set point.
Speaker 1: Was right, listen, I push at your take to the
Speaker 1: limit one more time. Never again though.
Speaker 2: Yeah.
Speaker 3: Yeah, it's also I feel like that also like brings
Speaker 3: up the interesting point of like treating a fever alone
Speaker 3: versus like, if you're giving antibiotics, you're treating the fever
Speaker 3: because you're treating the infection which is causing the fever. Right,
Speaker 3: So yeah, but just like straight antipyretics are like not
Speaker 3: doing that, right, They're just bringing down the fever. So
Speaker 3: it's interesting, it is.
Speaker 1: It's interesting. I feel like I'm going to have more
Speaker 1: questions for you as we go on.
Speaker 3: Oh that sounds great, So Aaron, tell me how did
Speaker 3: we learn I'm not going to say, like what is temperature,
Speaker 3: but like, oh god, yeah, how did we start to
Speaker 3: measure it?
Speaker 2: Tell me about the thermometer. I'm thrilled.
Speaker 1: Thermommy, Okay, let's take a break and then I'll get started. Okay, well, Aaron, Aaron,
Speaker 1: the history of fever. This is not what I told
Speaker 1: you that I was going to research initially, not what
Speaker 1: we were like, Oh, we'll do this episode on thermometers
Speaker 1: and it'll be medical invention, really cool and like that
Speaker 1: is really cool and really interesting. Yeah, and I thought, okay,
Speaker 1: I started out reading and being like how did we
Speaker 1: even begin to conceptualize temperature? And then to create this
Speaker 1: tool to measure it? We needed fixed points, like because
Speaker 1: you can't just like how do you know what ninety
Speaker 1: degrees is?
Speaker 2: Yeah?
Speaker 1: Right, like right exactly, So like what is this set?
Speaker 1: You know these different fixed points and then there's like
Speaker 1: the whole standardization thing all of that, So like how
Speaker 1: do you do that across the world?
Speaker 2: I mean, we still don't, right celsia's fahrenheit kil then.
Speaker 1: Right, but but we can we can like communicate among
Speaker 1: those like we can like what do you call it, calculranslate, translate.
Speaker 2: Yeah that's not the right word, but yeah, what is it?
Speaker 1: It doesn't matter. Convert, convert, thank you. I was like
Speaker 1: calculate translate somewhere in there. But yeah, I mean, like
Speaker 1: how do you standardize that those temperatures? Like and so
Speaker 1: even if you're talking about the freezing point of water
Speaker 1: or the boiling point of water, there is down the
Speaker 1: rabbit hole. Turns out boiling is not as simple as
Speaker 1: you would think it would be because it's like there
Speaker 1: were entire decades of arguments about like, no water is
Speaker 1: boiling when it looks like this, No water is boiling
Speaker 1: when it looks like this, And then you can superheat
Speaker 1: water so that it actually is higher than one hundred
Speaker 1: degrees celsius, which is the boiling point of water, but
Speaker 1: then like, at what point does it turn into steam?
Speaker 2: Is it still we well? And like what atmosphere are
Speaker 2: you at?
Speaker 1: Right elevation in Denver? It boils lower, like at a
Speaker 1: lower temperature. So I quickly was like, this is not
Speaker 1: for me. I am not equipped to do this, but
Speaker 1: I do you know, I wrote this whole intro thing
Speaker 1: where I was like, it's so amazing that we have
Speaker 1: these thermometers because because like and it is really cool,
Speaker 1: Like what what was life like before we had standardized measurements?
Speaker 1: Like nowadays I can be like Aaron, what's the temperature
Speaker 1: in San Diego? How much does your dog weigh? Can
Speaker 1: you send me that recipe for espresso fudge cheesecake so
Speaker 1: I can see if I have enough cream cheese to
Speaker 1: make it?
Speaker 2: Sure can three bricks.
Speaker 1: But we can understand and relate to one another and
Speaker 1: the world around us because we have those standardized units.
Speaker 1: You can say to me, oh, it takes two cups
Speaker 1: of cream cheese, which that sounds like an awful lot,
Speaker 1: but maybe that's okay. Well, instead of like I don't know,
Speaker 1: two scoopfuls of this bowl that I have in my house.
Speaker 1: How much does your dog way, I don't know, kind
Speaker 1: of heavy, but I can lift him like that. It's
Speaker 1: like that kind of thing, right, Yeah. And so before
Speaker 1: it would be like, oh, the castle is three days
Speaker 1: by horseback, and like what kind of horse do you have?
Speaker 2: Is it fast broken foot? Yeah?
Speaker 1: Is it carrying something? Like? Are you dragging something?
Speaker 2: Yeah?
Speaker 1: Exactly exactly. And so these standardized units are really because
Speaker 1: they help us navigate the world and also really important
Speaker 1: in science of course, like we can it's so crucial
Speaker 1: for us to be able to replicate scientific studies being
Speaker 1: like zero point five mills whatever.
Speaker 2: Yeah, but then.
Speaker 1: You know the boiling and superheating. I was like, this
Speaker 1: is I can't. I can't do this. I'm out of
Speaker 1: my depth. So then I went back to the drawing
Speaker 1: board and I was like, okay, what about like the
Speaker 1: medical use of thermometers. When did we decide that we
Speaker 1: needed to use those? And then that kind of led
Speaker 1: me down into what are fevers and the history of
Speaker 1: fever from capital f fever to fever the symptom, and
Speaker 1: I wanted to kind of like take this approach by
Speaker 1: looking at like what did fever mean to someone in
Speaker 1: to Hippocrates at all? What did fever mean to someone
Speaker 1: in the seventeen hundreds, What did fever mean to someone
Speaker 1: in the early nineteen hundred. It's like those things are
Speaker 1: very different. And then I want to kind of incorporate
Speaker 1: the use of the thermometer in clinical medicine. Love it,
Speaker 1: That's what I did. Okay, I love it so long intro.
Speaker 1: But if fever started out at least as far as
Speaker 1: we can tell, as a cluster of symptoms, kind of
Speaker 1: as a disease in its own right, or as a
Speaker 1: frequently uncountered state of being like it wasn't. It wasn't
Speaker 1: something that was like super rare. And I will say
Speaker 1: that if you want like a very full, comprehensive history
Speaker 1: of fever and all of its metaphors. The book that
Speaker 1: I used for this is called More Than Hot, A
Speaker 1: Short History of Fever. It's by Christopher Hamlin. And yeah,
Speaker 1: there's a lot more information that I ever anticipated in there. So,
Speaker 1: But in ancient Greece and Rome, fevers were, like I said,
Speaker 1: kind of this state of being broad on often by
Speaker 1: external fact, is not necessarily tied to specific disease, Like
Speaker 1: working out too hard when it's hot outside could lead
Speaker 1: to a fever. You're overheating. Your body might feel like
Speaker 1: warm to the touch, and your sweat is cooling you down.
Speaker 1: And so then if you stop working out, that could
Speaker 1: lead to chills. Sure. Sure, And then there were fevers
Speaker 1: associated with epidemics of what we now know to be
Speaker 1: infectious diseases. Those were kind of more on the periphery
Speaker 1: of things, like they happened, but they weren't as much
Speaker 1: of an everyday part of life as something like this,
Speaker 1: you know, exerting yourself fever.
Speaker 2: I guess interesting.
Speaker 1: Soushruda So, the ancient Indian medical scholar from around the
Speaker 1: seven hundreds BCE, described fever as the quote unquote lord
Speaker 1: of ailment, king of all bodily distempers, inasmuch as it
Speaker 1: can affect the whole organism at one time quote and
Speaker 1: I have a lot of quotes, an indispensable condition under
Speaker 1: which a creature can come into being or depart from
Speaker 1: this life. I think that's kind of interesting. Yeah, I
Speaker 1: don't want to give the impression that fevers were not
Speaker 1: indistinguishable in ancient times, because they were. People did recognize
Speaker 1: that certain fevers followed certain patterns, like malaria, for instance.
Speaker 1: So there were many ancient medical texts from China and
Speaker 1: India and Greece that like characterize malaria or other fevers
Speaker 1: that seem to follow this like every three days or
Speaker 1: every you know. However, it is this pattern or those
Speaker 1: fevers that tend to appear during certain times of year,
Speaker 1: or those that appear after wounds, like putrid fevers, And
Speaker 1: the prognosis was different for each of these different kinds
Speaker 1: of fevers. But the fever was the disease, do you
Speaker 1: know what I mean? Like it was a putrid fever.
Speaker 1: It wasn't like, oh, that fever is really high because
Speaker 1: he has a wound and that wound is clearly infected. No,
Speaker 1: it was like that he had full seed state of
Speaker 1: being capital f Yeah, and those make sense, Like I
Speaker 1: feel like those that characterization makes sense to us today.
Speaker 1: But what I think is a little bit more challenging
Speaker 1: to grapple with, at least in terms of what we
Speaker 1: know now, is something like this passage from the Hippocratic text,
Speaker 1: which kind of brings into question, like, wait, what is
Speaker 1: favor quote? Favors? Some are pungent to the touch, some gentle,
Speaker 1: Some are not pungent but increasing, some are sharp but
Speaker 1: decreasing to the touch. Some are straightway burning hot, and
Speaker 1: some are faint throughout, some dry, some salty, some with blisters,
Speaker 1: dreadful to see, some damp to the touch, some are red,
Speaker 1: some livid, some yellow, and so on. End quote.
Speaker 3: It's almost like they're just using the word fever to
Speaker 3: mean infection, right or am I am I missing it?
Speaker 1: Yes? No, I think I don't think you're missing it.
Speaker 1: But I also don't know, Like I feel like what
Speaker 1: we're having a hard time doing is like putting that
Speaker 1: in our current framework of understanding of disease, and it's
Speaker 1: hard to make parallels with that, and so it is
Speaker 1: it is sort of like infection but also fevers. Like
Speaker 1: when we think of fevers today, they're an indicator. It's
Speaker 1: like it's like a in your car and check engine
Speaker 1: like going on, Like there's something that might be a
Speaker 1: miss here, and we're not super concerned about the fevers themselves.
Speaker 1: It's more about like the overall infection, but for the
Speaker 1: most part, we have a strategy with how to handle it.
Speaker 1: And this was less so like fevers were much more
Speaker 1: a morphous I don't know. It's really hard to wrap
Speaker 1: my head around. And I think that at least the
Speaker 1: impression that I get was that distinguishing which type of
Speaker 1: fever that someone had. It was important in understanding like
Speaker 1: the natural history or possible treatments for a disease, but
Speaker 1: it was less important, at least in ancient Greece and China,
Speaker 1: than understanding the process of fevers, because then you have
Speaker 1: to add on this layer of like the humors and
Speaker 1: humoral theory of disease and balancing out the humors and
Speaker 1: how much moisture is in your body or whatever, because okay,
Speaker 1: you can have putrid fever or you could have bilious
Speaker 1: fever or something like that, and those could be caused
Speaker 1: by totally different infections and they could look totally different
Speaker 1: on the surface, but you would still treat them to
Speaker 1: balance out the humors. And then the fever schedule also
Speaker 1: mattered great deal and was kept track of, like if
Speaker 1: someone felt bad on the fourth and seventh day with
Speaker 1: good days in between, they would probably die. It was
Speaker 1: almost like here's your prognosis based on when your fever peaks.
Speaker 1: And this also lasted like well into the eighteen hundreds.
Speaker 1: It's interesting, and this was in theory supposed to help
Speaker 1: with intervention, as in like the physician would time their
Speaker 1: visits to be with the patient during those more critical
Speaker 1: periods and providing treatment or maybe a spell throwback to
Speaker 1: abercadabra and malaria. But in terms of treatment, if we're
Speaker 1: going with the humoral theory of disease, different fevers caused
Speaker 1: by different imbalances of the humors, which are blood, flem,
Speaker 1: black bile, yellow bile. Most of the time it was
Speaker 1: excess of one humor, and so how do you get
Speaker 1: rid of a humor, Well, if you have too much blood,
Speaker 1: you bleed them. And bleeding really was like a primary
Speaker 1: treatment for fevers for hundreds of years. And this also
Speaker 1: sometimes applied to the prevention of fever, which was dependent
Speaker 1: upon the cause, which was dependent largely upon the patients themselves.
Speaker 1: So if the cause was something like, oh, you have
Speaker 1: too much phlegm, then maybe you should hold off on
Speaker 1: eating this thing or over indulging in this way, that
Speaker 1: kind of thing, and that also in turn had very
Speaker 1: personalized to the person's like social status and class, all
Speaker 1: of that kind of thing just the normal thing that
Speaker 1: we expect to see. But I also think it's really
Speaker 1: interesting because this framework of disease that was highly individualized
Speaker 1: in this way Oh, it's your overwork that caused this
Speaker 1: humor to increase, and this is what you need to do.
Speaker 1: All of that was challenged when epidemic fevers appeared. But
Speaker 1: then those there's always an explanation. Those could be explained
Speaker 1: away by society at large. Is bad and you're all
Speaker 1: being punished for what you've done. Now go into your
Speaker 1: room and think about your decisions, or like the bad
Speaker 1: winds blow into town. Whatever. So the concept of fever,
Speaker 1: or the umbrella term of fever, I think, is kind
Speaker 1: of hard to get a handle on, even if you're
Speaker 1: just looking at one time period like antiquity, it was
Speaker 1: recognized to be elevated body temperature, but it was also
Speaker 1: fever with a capital F. Like a collection of symptoms.
Speaker 1: It could be brought on by everyday events or seasonal contagions.
Speaker 1: It could be cyclical or follow a totally different schedule.
Speaker 1: It could represent a horrible, deadly disease or just be
Speaker 1: a symptom of a more mild one. It was caused
Speaker 1: by an imbalance in the humors or too little moisture
Speaker 1: in the body, or over exertion or over indulgence. Was
Speaker 1: anything everything, all of it, all of it, and Over
Speaker 1: the centuries, these different definitions of fever kind of ebbed
Speaker 1: and flowed. Some became more popular, it fell out of
Speaker 1: favor that sort of thing, And as society and science changed,
Speaker 1: so did the meaning of fever. So we've already seen
Speaker 1: this a bit, with the onset of fever thought to
Speaker 1: be caused by like various personality types or lifestyle habits
Speaker 1: or larger societal issues. But beginning in the eighteenth century,
Speaker 1: fever in the quote unquote Western world became less about
Speaker 1: disease and even more a state of mind. It's hard
Speaker 1: from our twenty first century vantage point, at least for
Speaker 1: me to understand like again, what this fever then shifted into.
Speaker 1: So let me give you a couple of examples and
Speaker 1: quotes of like some of the range of things that
Speaker 1: a fever could be. This is from the eighteenth century.
Speaker 3: Oh.
Speaker 1: The first one is about someone who isolated herself quote,
Speaker 1: resolved never to think, speak, answer, or hear. She is
Speaker 1: quite wearied with saying good night and good morning, and
Speaker 1: has almost every day a touch of fever, which a
Speaker 1: little rest always carries off end quote. So is that malaise, fatigue,
Speaker 1: elevated temperature, something else, entirely all.
Speaker 2: Three like touch a fever.
Speaker 1: And then there's this about somebody else's fever quote at
Speaker 1: the point of death of a violent fever he got
Speaker 1: with swallowing two glasses of brandy upon a debauch of
Speaker 1: wine end quote. So like, was he really hungover? So
Speaker 1: he was he was had a violent fever from drinking
Speaker 1: a lot of brandy and wine.
Speaker 2: Right, I mean that would make me feel crappy?
Speaker 1: Right?
Speaker 2: Does that mean like body aches and vomiting. It's so interesting.
Speaker 3: I never thought about it because, like I just always
Speaker 3: assume when I've read old timey things, if they say
Speaker 3: the word fever, they mean what we mean fever.
Speaker 1: Yeah, nope, nope, nope. And during this period, like the
Speaker 1: seventeen hundreds the early eighteen hundreds, fevers seem strongly tied
Speaker 1: to the brain, either brought on by too much mental
Speaker 1: work or intense emotions, or directly affecting the mind, like
Speaker 1: someone's fever causing quote a lowness of spirits and falling
Speaker 1: away that alarm everyone end quote. And I think that
Speaker 1: this is also really interesting because there is a term.
Speaker 1: I didn't really get into this too much, but like
Speaker 1: brain fever is a thing that pops up a lot
Speaker 1: in Victorian literature, I guess, like the Bronte Sisters, Charles Dickens,
Speaker 1: like Pip in Great Expectations gets brain fever at one point,
Speaker 1: Catherine from Wuthering Heights gets brain fever, dies of brain fever. Spoilers,
Speaker 1: you're allowed to spoiler. There's statute of limitations. But there
Speaker 1: you know, Elizabeth Gaskill, there were someone who had a
Speaker 1: fever in one of her books, like there is brain
Speaker 1: fever was like a trope almost in literature from this time,
Speaker 1: where it was like this emotional shock brought on this
Speaker 1: fever that could then be very like physical manifestation of
Speaker 1: an emotional shock.
Speaker 3: It wasn't mensis, I mean, or maybe it was like
Speaker 3: it very well could be, who knows.
Speaker 2: Wow, Okay, I do.
Speaker 1: Think it's really interesting to use like popular literature as
Speaker 1: a lens through which, like people every day people saw
Speaker 1: like medical understanding from that, like contemporary medical understanding. Anyway, Sorry,
Speaker 1: that's our next book club. Yes there probably is a
Speaker 1: book like that. Yeah, okay. But also the meaning of
Speaker 1: fever had to do with your social standing, right, So
Speaker 1: those who are living in poverty fell victim to contagious
Speaker 1: fevers transmitted through unsanitary living conditions or like working too hard,
Speaker 1: the strenuous physical work, and it was seen as like
Speaker 1: a societal problem or personal shortcomings, and especially it was
Speaker 1: like clean it up so that the contagion doesn't affect
Speaker 1: the rich, and whereas the origin of the upper classes
Speaker 1: fevers seemed to be much more refined, like too much
Speaker 1: thinking over indulgence in rich food or wine or whatever.
Speaker 1: But this brain fever, which I already mentioned, was very
Speaker 1: different than like bilius or putrid fever, or remitting fever
Speaker 1: or Tertian fever. And so it was understood that fevers
Speaker 1: could be caused by many different things, in that there
Speaker 1: were many different types of fevers, and there began to
Speaker 1: be I think a dawning recognition that maybe fever as
Speaker 1: a symptom was at the core one mechanism, one thing
Speaker 1: with degrees of severity and a basis in the nervous
Speaker 1: system and vascular system malfunctioning. And so fever as a
Speaker 1: symptom what I mean by that is, well, it's a
Speaker 1: little unclear, but like mostly temperature. Yeah. But the question
Speaker 1: then became, like how do you measure how severe a
Speaker 1: fever is? Like how dangerous it is and so since
Speaker 1: since ancient times, physicians had recognized that fever was associated
Speaker 1: with the body being warmer to the touch than normal,
Speaker 1: and sometimes they also observed that the pulse was elevated.
Speaker 1: One of the earliest pulse measurements was made in the
Speaker 1: third century BCE. Okay, Aaron, how do you measure a pulse?
Speaker 1: You just count it against what the like, what is
Speaker 1: the what is the unit of pulse? Right?
Speaker 2: Beats, beats, per minutent?
Speaker 1: But how do you measure a minute? If you don't
Speaker 1: have a watch, then have clocks, so the whole clocks sundial.
Speaker 1: In this third century BCE, Heropholus used a water clock.
Speaker 1: I'm not sure how it worked, but it was like
Speaker 1: presumably you could measure against this, like how many drops
Speaker 1: of water? How long it took?
Speaker 2: Yeah, like a sand timer thingy.
Speaker 3: But yeah, yeah, I didn't think about that.
Speaker 1: Oh, clocks are because and then you could use like
Speaker 1: pendulum clocks type of thing. But you couldn't use those
Speaker 1: on ships for navigation because there was right, it's so interesting. Yeah, anyway,
Speaker 1: I'm not even gonna get so.
Speaker 2: Deep just to be able to measure a fever.
Speaker 1: Uh, huh. And so in general, although these two characteristics
Speaker 1: of fever, body temperature and pulse rate had been recognized
Speaker 1: since ancient times, there wasn't a whole lot of effort
Speaker 1: made to quantify them, at least until around the seventeen hundreds. So, okay,
Speaker 1: we talked about pol right. It was in the sixteen
Speaker 1: nineties that watches with second hands were introduced.
Speaker 2: Sixteen nineties.
Speaker 1: Wow.
Speaker 3: Yeah, I don't know how to feel about that. It
Speaker 3: feels very early somehow, But I guess I've never thought
Speaker 3: about when watches were invented.
Speaker 1: I know the stuff we take for granted. I'm curiously,
Speaker 1: I'm telling.
Speaker 3: You talking to each other on the freaking airwaves, Internet,
Speaker 3: the world Wide Web.
Speaker 2: Worldwide Web. When has a watch invented? Wow? Sixteen ninety
Speaker 2: with second hands? Okay?
Speaker 1: I mean so before then there were other like clocks
Speaker 1: or ways of measuring time, but they weren't widely available
Speaker 1: or or widely recognized to be useful in medicine. And
Speaker 1: so in seventeen oh seven, Sir John Floyd wrote about
Speaker 1: his observations of pulse rate measured against a watch. Quote,
Speaker 1: our life consists in the circulation of blood, and that
Speaker 1: running too fast or slow produces most of our diseases.
Speaker 1: The physician's business is to regulate the circulation and to
Speaker 1: keep it in a moderate degree. I don't know how
Speaker 1: he expected to do that, but that was that was
Speaker 1: his job, his job. And so with the introduction of
Speaker 1: the sixty second watch, pulse rate kind of took center
Speaker 1: stage in terms of diagnosing a fever by the seventeenth century.
Speaker 1: So it was like a fever was not temperature, it
Speaker 1: was pulse rate.
Speaker 2: Right, Okay, that's interesting, Yeah.
Speaker 1: But pulse rate is not ideal for this. Like your
Speaker 1: pulse can rapidly change if you're active, if you get stressed,
Speaker 1: it can go up or down without a corresponding change
Speaker 1: in body temperature. So it became apparent that like pulses
Speaker 1: could not be relied upon for like every sort of diagnosis.
Speaker 1: If only there was something that could quantify something like
Speaker 1: body heat. Right, And the thing is, by the seventeen hundreds,
Speaker 1: thermometers had already been developed. So I love this. This.
Speaker 1: This is a quote by Thomas Willis from sixteen ninety
Speaker 1: two about using pulse to diagnose fever. It's about pulse. Quote. First,
Speaker 1: we consult the pulse as a thermometer constituted by nature
Speaker 1: for measuring the heat kindled in a fever end quote.
Speaker 3: So they had the word thermometer, and they have the thermometers,
Speaker 3: but they're like the pulse.
Speaker 1: Thecuse the thermometer. It is a nature's thermometer. Isn't that amazing?
Speaker 2: That is fascinating.
Speaker 1: Yeah, So clearly people knew what thermometers were by this point.
Speaker 1: What kept them from being used in a medical set?
Speaker 1: So the broader history of thermometers, like I said, is
Speaker 1: too much for me to get into, but I do
Speaker 1: want to focus on, like when they were first used medically.
Speaker 1: So people had been toying around with measuring temperature for centuries,
Speaker 1: but most histories put Galileo's invention of the thermoscope around
Speaker 1: fifteen ninety five as the first major advance in measuring
Speaker 1: temperature since ancient times.
Speaker 3: Wow.
Speaker 2: Yeah, yeah, fifteen ninety.
Speaker 3: That is a lot earlier than I thought, Aaron, I
Speaker 3: don't know anything about history. We've done this for so long,
Speaker 3: and this blows my mind, Like, Oh, it's embarrassing.
Speaker 1: It's not, it's like, I mean, it's really hard to
Speaker 1: put this in in context. Yeah, I don't know. Yeah,
Speaker 1: I also don't know how the thermoscope worked so and
Speaker 1: how different it was to thermometers. But but in the
Speaker 1: decades that followed, people did try to use various thermometers
Speaker 1: or thermometer like instruments to measure human body temperature, so
Speaker 1: like somebody would be holding the bulb end of a
Speaker 1: thermometer in their hands or popping it in their mouth.
Speaker 1: But these methods and the measurements produced were pretty crude
Speaker 1: and certainly not fine enough to make any meaningful connection
Speaker 1: between fever severity or even establishing a baseline, like I
Speaker 1: feel like, especially when we're talking about fever being one
Speaker 1: hundred point no one hundred and one excuse me, one
Speaker 1: hundred point.
Speaker 2: Four hundred point four one on one I here in
Speaker 2: the ICU.
Speaker 1: Okay, Okay, but like that's not very far off from
Speaker 1: some of the extreme temperatures that you could measure from
Speaker 1: just like air to ground.
Speaker 2: Totally whatever water go to Arizona, Yeah.
Speaker 1: Exactly, And so there really needed to be a lot
Speaker 1: more work done to establish a baseline and create instruments
Speaker 1: that had more fine where you could actually like measure
Speaker 1: more finely. So in seventeen fourteen, Gabriel fahrenheit like, guess
Speaker 1: what he did one he was the one, the chosen one.
Speaker 1: He invented the mercury thermometer. I don't know anything else
Speaker 1: about him, so I don't know if he was indeed
Speaker 1: the chosen one. But seventeen fourteen, right, mercury thermometer. And
Speaker 1: despite how revolutionary this tool could have been has been
Speaker 1: for medicine, some people did point that out, it didn't
Speaker 1: really take off very quickly. So some people, like the
Speaker 1: Austrian physician Anton de Haan, took extensive measurements of both
Speaker 1: temperature impulse of people of varying ages with varying health
Speaker 1: throughout the day. He changes in temperature or pulse after
Speaker 1: activity or certain drugs. He was a firm believer that
Speaker 1: the physician's hand for assessing fever would no longer suffice
Speaker 1: thermometer only from here on out. But he scattered his
Speaker 1: observations that he had made these tons of observations throughout
Speaker 1: a massive treatise that he published in the second half
Speaker 1: of the seventeen hundreds, and so it was just like
Speaker 1: way too long for anyone to actually make any sense
Speaker 1: of So what kind of just skipped? Yeah, And I
Speaker 1: think that it is still it's from this vantage point
Speaker 1: it is a little bit baffling to be like, here's
Speaker 1: this obvious tool that could be so helpful. How do
Speaker 1: you not see it? It is literally a part of
Speaker 1: every physician interaction pretty much, or like go to a
Speaker 1: doctor's office, you're going to get your temperature taken. But
Speaker 1: I think that we have to keep in mind a
Speaker 1: few things. So it wasn't that people didn't care about
Speaker 1: quantifying previously subjective things like that was very much in
Speaker 1: style in this time. In the mid sixteen hundreds, the
Speaker 1: Royal Society stated that they want to bring quote all
Speaker 1: things as near the mathematical plainness as they can end
Speaker 1: quote butt and kind of considered was considered to be
Speaker 1: separate from science at this point in history. From the
Speaker 1: seventeen hundreds into the eighteen hundreds, I've seen it described
Speaker 1: as science wanting to use these new measuring devices to
Speaker 1: better understand the world around them, whereas medicine was more
Speaker 1: concerned with a cure, with testing therapies on fever rather
Speaker 1: than understanding and characterizing fever. So you have people like
Speaker 1: Benjamin Franklin, like very much like scientists observing that human
Speaker 1: body temperature stayed the same despite the weather outside, but
Speaker 1: not necessarily measuring the body temperature, you know, in someone
Speaker 1: who had a smallpox or plague or something like that
Speaker 1: yellow fever. Plus it was harder to conduct experiments on
Speaker 1: the mechanism of fever than on possible treatments. The other
Speaker 1: major factor in this delay was in the thermometers themselves,
Speaker 1: which still had a long way to go in terms
Speaker 1: of standardization or quality control. So people would get recordings
Speaker 1: of one hundred and eighteen degrees fahrenheit like body temperature
Speaker 1: recordings of one hundred and eighteen hundred and twenty two,
Speaker 1: and the person would be like, I'm okay, Like I'm
Speaker 1: just chilling. I don't know, I don't know, I don't
Speaker 1: know what I did. So so you can imagine being
Speaker 1: a physician looking at this reading and going this person
Speaker 1: shouldn't be alive if this thermometer is right. So like,
Speaker 1: this thing is useless. I'm not going to use it anymore.
Speaker 1: And so thermometer accuracy did get better, and in eighteen
Speaker 1: thirty five, the mean body temp of a healthy adult
Speaker 1: was established to be ninety eight point six. The last
Speaker 1: bit of the recipe is just preconceived notions. If you
Speaker 1: think you knew how fevers worked or even what a
Speaker 1: fever was, then you're going to be less likely to
Speaker 1: investigate whether you were right, Like we just take this
Speaker 1: knowledge for granted, and we're like, yeah, of course it's that.
Speaker 1: Of course this fever is caused by X, Y and z.
Speaker 1: We don't need to measure the body temperature because it's
Speaker 1: the pulse rate. Or we don't need to measure the
Speaker 1: body temperature because I took a full patient history and
Speaker 1: they seem to have brain fever.
Speaker 2: Yeah.
Speaker 1: And so it took until around the mid eighteen hundreds
Speaker 1: for enough curiosity or doubt or need or knowledge to
Speaker 1: emerge to get people to reconsider how fevers worked and
Speaker 1: conclude that body temperature is actually a much better clinical
Speaker 1: guide for fevers than pulse. And it was then quickly
Speaker 1: integrated across medical practice. So, for instance, before the mid
Speaker 1: nineteenth century, patient records at mass General included pulse and
Speaker 1: respiratory rates, but only some of them had those, like,
Speaker 1: not all patients had these things, no other quantitative metric
Speaker 1: at all. By the eighteen eighties, though, you've got daily
Speaker 1: pulse temperature and respiratory rate being charted. The thermometer was
Speaker 1: here to stay, and the knowledge that it generated was
Speaker 1: exponentially increased by all of the other scientific achievements or
Speaker 1: advancements happening during the eighteen hundreds, the laws of thermodynamics,
Speaker 1: discoveries of antipyretics, germ theory showing that different fevers could
Speaker 1: be caused by different pathogens. Comparing temperature and pulse between
Speaker 1: typhus and typhoid, for instance, even before germ theory was
Speaker 1: able to distinguish between the two, just looking at temperature
Speaker 1: and pulse could say that's typhoid, that's typhus.
Speaker 3: Because of the pulse temperature dysregulation that happened in typhoid
Speaker 3: took our episode.
Speaker 2: Uh, it's really thrilling.
Speaker 1: And so all of this helped to transform fever capital
Speaker 1: f the disease in to fever the symptom, from the
Speaker 1: whole diagnosis to just a data point. It was a
Speaker 1: huge shift in how diseases were perceived and managed. The
Speaker 1: individual personality or lifestyle habits like overwork or a troubled mind,
Speaker 1: particularly among the wealthy, we're no longer seen to be
Speaker 1: the leading cause of fever. I was trying to think
Speaker 1: of what the opposite of a silver lining is is
Speaker 1: just like the gray cloud across the sun. I think, So, okay,
Speaker 1: that's what this is. Thermometers began to show that what
Speaker 1: a patient felt might not be fact. So you know
Speaker 1: how like we talked about when you're shivering and you're like, no,
Speaker 1: I'm really cold, I'm piling the blankets on, doctors could
Speaker 1: take your temperature and be like, you're not cold, you're hot.
Speaker 1: You don't understand what you're feeling. Oh dear, yeah, I mean.
Speaker 1: And so this is one of the less extreme examples.
Speaker 1: But the author of this book, Christopher Hamlin, wrote this
Speaker 1: little quote that I really enjoyed, where he said, for
Speaker 1: a patient quote a century earlier, fever or feverishness would
Speaker 1: have referred to a state of feeling akin to a
Speaker 1: modern mood disorder. One expected a physician to assess its
Speaker 1: type and probably course, and then suggest the best response,
Speaker 1: not sanction its existence. End quote. So all in all,
Speaker 1: obviously temperatures or thermometers were an incredibly valuable thing, and
Speaker 1: if we only had ways to objectively measure many other things,
Speaker 1: I feel like we could really advance treatment and care
Speaker 1: for people. But what we see happening with temperature and thermometer.
Speaker 1: In the twentieth century. The late the late eighteen hundreds
Speaker 1: and into the twentieth century is the trivialization and domestication
Speaker 1: of fever. Medications became available to bring a fever down,
Speaker 1: and most households began to have a mercury thermometer at
Speaker 1: home and these medications, so if someone had a fever,
Speaker 1: you just took care of it at home, or you
Speaker 1: monitored it at home until it got worse, whereas in
Speaker 1: the past you would probably have a doctor to make
Speaker 1: a house visitor. You would take someone to a doctor.
Speaker 1: But the story of the fever isn't over. It's almost over. It.
Speaker 1: Don't worry about it. Because once capital f fever became
Speaker 1: lowercase fever, people began to wonder why this response existed,
Speaker 1: kind of like what we talked about, and whether it
Speaker 1: could be beneficial. And so fever as a response to
Speaker 1: infection was found to be super widespread across the animal kingdom,
Speaker 1: and so some researchers took this friend not foe idea
Speaker 1: and ran with it, maybe a little too far, developing
Speaker 1: something called fever therapy cabinets in the early twentieth century,
Speaker 1: where they would treat infections like syphilis that did not
Speaker 1: include fevers. By locking someone's body in a cabinet with
Speaker 1: just their head poking out, and they would crank up
Speaker 1: the heat until their body temperature got to like one
Speaker 1: of six one o seven.
Speaker 2: Which is not a fever, that's just hyperther yah.
Speaker 1: Yeah, yeah, great idea called fever therapy. Aaron, get with
Speaker 1: the program, I am objecked. Would you like this next program? Because,
Speaker 1: oh dear, I think I've mentioned this before. In nineteen
Speaker 1: twenty seven, the Nobel Prize for Physiology or Medicine was
Speaker 1: awarded to Julius Wagner Jareg, who treated cases of neurosyphilis
Speaker 1: by infecting his patients with the malaria parasite. A malaria parasite.
Speaker 2: You got a Nobel prize for that?
Speaker 1: Uh huh. I should have checked to see whether it worked.
Speaker 1: I assume it did.
Speaker 2: Yeah, I would assume you get the Nobel price for it.
Speaker 1: Yeah. It's kind of interesting anyway. And so this debate,
Speaker 1: you know, is fever friend is it foe? Is it
Speaker 1: like the casual acquaintance that you met that one time
Speaker 1: and you don't really ever think about and it's just
Speaker 1: kind of like there in the background. I feel like
Speaker 1: that debate is still going on, like we about but yeah,
Speaker 1: I mean I think, like I said, I think that
Speaker 1: the thermometer, it was really one of those things where
Speaker 1: I was like, if only we could measure pain in
Speaker 1: this way, because once we develop the thermometer and we're
Speaker 1: able to use it in clinical medicine, then we could
Speaker 1: much better test things like does quinine actually bring down
Speaker 1: your fever? You know, does aspirin bring down your fever?
Speaker 1: How does it bring it down? How when should we
Speaker 1: administer it? What are the different courses of these things?
Speaker 1: Just like because I think we're always down on quantifying
Speaker 1: symptoms and being like, oh, objective symptoms are or objective
Speaker 1: signs of a disease are leaned on very heavily by
Speaker 1: modern medicine at the cost of the whole person and
Speaker 1: like the other things that they're experiencing that are harder
Speaker 1: to describe, right, And I think that's valid. But I
Speaker 1: also think that like would be beneficial to have all
Speaker 1: of the things.
Speaker 2: I know, Yeah, yeah, I agree.
Speaker 1: So there's a lot more to learn about fevers, and
Speaker 1: especially by like the evolutionary side of fevers, if you
Speaker 1: want to go into that, and like evolutionary medicine. It
Speaker 1: is an interesting field. When you mentioned something about Iron yeah,
Speaker 1: Iron City shows, I was like, we're going to have
Speaker 1: to do hemochromatosis.
Speaker 2: Oh, it's on our list.
Speaker 3: I think it's like, like I really in the season season?
Speaker 3: Oh sweet, Yeah, it's already like on our schedule. Perfect.
Speaker 3: I should check our schedule.
Speaker 1: And if you would like to check our sources, you can.
Speaker 1: Let's do it, Okay, I already mentioned mine. What is it?
Speaker 1: A Short History of fever more than Hot? A Short
Speaker 1: History of Fever by Christopher Hamlin. I have a bunch
Speaker 1: of other papers too that I'll post up there.
Speaker 3: I had just a few papers that I used for
Speaker 3: this episode. Actually one if you want really fun deep dives,
Speaker 3: I have some really really fun ones. This one was
Speaker 3: called the physiology of Mammalian temperature homeostasis. And I already
Speaker 3: have like three other pages of notes that we didn't
Speaker 3: even get into about like bears and hibernation and blubber
Speaker 3: and like we it does make you want to do
Speaker 3: a whole episode on temperature homeostasies, But tell us if
Speaker 3: that sounds too boring listeners, because like I could go
Speaker 3: off and then I.
Speaker 2: Also have a couple on like.
Speaker 3: There was one by Walter at All from twenty sixteen
Speaker 3: that was a pathophysiological Basis and Consequences of fever That
Speaker 3: was a really good primer on fevers and a few more.
Speaker 2: We'll post the links for all of our sources from
Speaker 2: this episode and all of our episodes on our website,
Speaker 2: this podcast will Kill You dot com under the episodes tap.
Speaker 1: We will thank you to Bloodmobile for providing the music
Speaker 1: for this episode and all of our episodes.
Speaker 2: Thank you to Tom and Leanna for the wonderful audio.
Speaker 1: Mixing, Thank you too, exactly right, and thank you to
Speaker 1: you listeners.
Speaker 2: We had a lot of fun with this episode.
Speaker 1: Yes, I actually really loved this me too.
Speaker 2: It was super fun.
Speaker 1: And a big thank you as always to our wondrous,
Speaker 1: wondrously generous patrons. We appreciate your support so very much.
Speaker 2: Thank you, thank you, thank you.
Speaker 1: I've been recording so many of these book club outros
Speaker 1: that I forget. Oh yeah, wash your hands
Speaker 2: You feel the animals