The first thing for a parent to remember is that the degree of fever is no indication of the severity of an illness. Some minor illnesses, such as Roselle infantum, can be accompanied by a very high fever, whereas some very serious diseases, such as certain cases of diphtheria, may only have a low fever. The illness of a child should be judged more on the way he acts than the degree of fever.

A child’s temperature should be taken by rectum with a rectal thermometer until he is between six and even years of age. The rectal temperature is approx­imately one degree higher than the mouth temperature. Generally, the rectal temperature varies between 99 0 and 100 0 . It should be known, however, that a child’s temperature fluctuates during the day, usually being higher in the late day and evening.

Occasionally, at the end of an infection the temperature may drop as low as 97 0. This is no cause for concern as long as the child acts well. It will usually return to normal within 24 hours.

Not infrequently when children recover from an infection they may, for a period of a few weeks, run a low grade fever after activity. This has been called “action temperature.” It is of no significance. It may readily be diagnosed by letting a child rest for 45 minutes and retaking the temperature. If it is only action temperature it will almost always return to normal after rest.

Treatment of Fever

If the fever is high or if it is making a child uncomfortable, efforts should be made to lower it. Aspirin can be given in tablets and by suppository. There is also a preparation like aspirin available in liquid form. The usual dosage would be one-half of a children’s 114 grain tablet for infants under six months of age; one tablet (114 grains) for children six months to two years of age; two tablets (2% grains) for two and three years of age; three tablets for children of four; and four tablets (five grains) for those five years and older. Aspirin suppositories should be given in the same dosages. Suppositories are of particular value when children are vomiting or when there is marked refusal to take medication by mouth. The preparations in liquid form will have an indication as to the amount that will equal the dosage of children’s aspirin tablets (114 grains) .

A warning must be given that an overdose of aspirin may be extremely dangerous to a child. Most of these preparations for children are flavored so as to make them attractive and acceptable. Too often, children, thinking them candy, will take large amounts with serious consequences. It follows that aspirin should be kept entirely out of reach of children.

Other ways of reducing the temperature when the fever is very high (over 104 0 F.) are by alcohol sponge or by cool enemas.

An alcohol sponge is given by sponging a small part of the body at one time (about a six inch square). Pat the area gently with a sponge or soft cloth dipped in rubbing alcohol, then gently pat the area with a dry cloth. Then go to another area using the same procedure and continue on over most of the body. In this way the evaporation of the alcohol on the surface of the body takes down the fever and usually comforts the child at the same time. Most of the child’s body can be kept lightly covered during this procedure.

The cool enema is usually very effective in reducing fever. Cold water is used with only the chill taken off. Bicarbonate of soda (one teaspoon to eight ounces of water) should be added to the water to make it more soothing internally. The amount given should be about four ounces to an infant, eight ounces for a child from one to three years of age, and one pint for children over the age of three. The contents of the enema should be inserted and the buttocks held together for at least three minutes to cool the body.

An epidural abscess is a collection of pus in the space between the skull or spinal bones and the dura mater, which is the outermost of the three meninges, or membranes that cover the brain and spinal cord. The pus is usually due to a bacterial infection. As the pus collects it exerts pressure on the nerve tissue. In rare cases, toxins, or harmful chemicals that are produced by bacteria, may cause damage to the dura mater.

What are The Symptoms?

An abscess on the spinal cord can cause loss of muscular power in the legs and numbness of the entire lower part of the body. An abscess in the brain may have the same symptoms as a stroke, causing weakness down one side of the body or difficulty with speech. The onset of stroke like symptoms is seldom rapid; they usually appear gradually over several hours. In addition, you will probably have general symptoms caused by the infection, such as fever, confusion, and perhaps delirium or convulsions.

What are The Risks?

Epidural abscesses are extremely rare, because the infections that used to cause them can now be treated with antibiotics. Such infections include acute infection of the middle ear and sinusitis.

What Should be Done?

If you suspect that you have an abscess, consult your physician, who will probably consider the history of previous infection, and may order diagnostic tests. Among them may be blood tests to identify the invading bacteria, a skull X-ray, and perhaps an electroencephalogram (EEG). Arteriography, a CAT scan of the brain, and an examination of the spinal cord (myelography) may also be required for a diagnosis.

What is The Treatment?

To combat infection, your physician will probably prescribe an antibiotic. In some cases, however, this will not solve the problem, and surgery will be necessary. The surgeon makes an opening in the skull or in the vertebral bone through which pus can be removed. After such an operation, antibiotic treatment is continued. If the original cause of infection is also dealt with, you have a good chance of full recovery.

Meningitis is an inflammation of the meninges, which are membranous coverings of the brain and spinal cord. There are three meninges. First, there is the outside membrane, the dura mater, which adheres to your skull. Next is the middle layer, the arachnoid. Finally, there is the innermost membrane, the pia mater, which adheres to the brain. The cause of infection of these membranes is usually an invasion by either bacteria or viruses. There are a number of ways that infection can reach the meninges. For example, infectious agents may spread through the bloodstream from some other part of the body, such as the lungs, where there is an infection. They can also spread to the brain from an infected ear or infected sinuses, through the cavities in the bones of the skull. Or if you have a head injury involving a fractured skull, this provides an easy entry for infection. There are many forms and degrees of meningitis. Much depends on the type of bacterium or virus that causes the disease.

What areThe Symptoms?

Fever, headache, nausea and vomiting, a stiff neck, and photophobia (inability to tolerate bright light) usually develop over the course of a few hours. An occasional additional symptom is a deep red or purplish skin rash. If the infection continues to proceed unchecked, you become drowsy and you may eventually lose consciousness.

The symptoms of meningitis may be less obvious in infants and young children. For a full discussion on the differences, read the article on meningitis in babies and children.

What are The Risks?

Meningitis is an uncommon illness in this country. The most common form, a viral infection, spreads from person to person through the air. It therefore tends to occur in epidemics, as do many viral illnesses, often in winter when people are in close contact in doors. Bacterial meningitis may also occur in epidemics, but sporadic cases of this form are more commonly seen.

The sooner treatment of bacterial meningitis is started, the better the results. Untreated bacterial meningitis may well be fatal. With appropriate treatment, most people recover completely, but a few are left with permanent damage including deafness, blindness, and/or mental deterioration. Babies and elderly people are most in danger of either failing to recover or of being left with lasting residual damage. The reason for this may be that these people have relatively weak powers of resistance.

Viral meningitis tends to be a less severe illness than the bacterial type. In most cases there is full recovery with no after effects.

What Should be Done?

If you or anyone in your family develops symptoms of meningitis, particularly a combination of severe headache, stiff neck, and photophobia, consult your physician without delay. A tentative diagnosis of meningitis can be confirmed by an examination of a sample of cerebrospinal fluid, the liquid that bathes your central nervous system. This sample will be taken in a hospital. If the sample, which is obtained by a lumbar puncture , looks cloudy and contains pus cells, the meninges are probably infected. Further tests of the liquid sample should be able to identify the infectious agent, and this will help your physician to plan treatment aimed at combating the particular organism involved.

What is The Treatment?

You will have to remain in the hospital until the meningeal infection has cleared up. If the infection is bacterial, you will be given large doses of antibiotics, which may be dripped through a tube directly into a vein. This may be necessary for as long as two weeks. Since most viruses are not harmed by antibiotics, these drugs are not generally used for a case of viral meningitis. You can expect to be fully recovered in two to three weeks, depending on the severity of the attack.

While you are in the hospital, you will be made as comfortable as possible. Bed rest in a darkened room, plenty of liquids, and possibly drugs to lower your temperature and ease the pain of headaches will help your body overcome the infection.