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Editor,—I read with interest the paper by Purssel,1 and I am in agreement with his conclusion that tepid sponging offers little advantage over the administration of paracetamol alone in most cases. I would go as far as saying that tepid sponging offers no advantage in the vast majority of cases. We no longer use fans and sponging, but remove some clothing (keeping a vest or a light T-shirt) during the phase of defervescence and sweating. We have not experienced any disadvantages with this current practice.
There are important points to mention that are missing in this paper. Why is there a need to lower the body temperature with tepid sponging even further than can be achieved with paracetamol? When we “treat” fever vigorously by combining an antipyretic drug with physical methods, we are giving the impression to parents, students, junior doctors, and others, that fever is harmful and the antipyresis is beneficial. The scientific evidence does not support this practice. It is the underlying disease, not the fever, which we should be concerned about. The presence of fever could well be of benefit to the infected host through the activation of the immune system. Several clinical studies have shown the beneficial effects of fever,2 even high fever over 40°C,3 and the harmful effects of the antipyresis.4 We prescribe antipyretics because of prevailing concepts among physicians, parental expectation, and because children may show improvement in their level of activity and alertness.5
Physical methods have an important indication in cases of hyperthermia, such as heat stroke, where antipyretics are ineffective. Hyperthermia can also complicate febrile illness (vigorous muscular contractions in a child with febrile convulsion) and physical treatment may be of benefit.
Several issues remain unresolved. Which diseases are likely to benefit from the presence of fever, so that minimal interference is indicated? What degree of fever is harmful and thus ought to be lowered? Finally, does antipyresis have any effect on the clinical course of infectious diseases?
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