From: riggs@descartes.tec.army.mil (Bill Riggs)
Newsgroups: sci.skeptic
Subject: Re: Well known scientifc facts
Date: 29 Sep 92 01:35:57 GMT
Followup-To: sci.skeptic
Organization: LNK Corporation, Riverdale, MD

In article <1992Sep28.163456.1@fnalo.fnal.gov> rhatcher@fnalo.fnal.gov writes:

>I'm tired of this thread, so I thought I'd type in the blurb in this week's
>"Science News" (Sept 26, 1992: Vol 142, Number 13, page 196) completely
>without permission (typo's mine).  I suggest individuals interested in
>*further* details visit the library for the complete JAMA article.
>
>[title] Body temperature: Don't look for 98.6 ^oF
>
>In 1868, Carl Wunderlich published a seminal paper on body temperature in
>25,000 adults. His more than 1 million measurements indicated that while
>temperatures of healthy individuals varied, they averaged 98.6 ^oF 
>(37 ^oC). Texts on fever still cite Wunderlich's study, one of the few
>to investigate normal temperatures, and accept as dogma the 98.6 ^oF
>average-body-temperature figure, notes Philip A. Mackowiak at the
>University of Maryland School of Medicin in Baltimore. However, his new
>data suggest the average should be 98.2 ^oF.
>
>Mackowiak's group measured oral body temperature digitally up to four
>times daily for three consecutive days in 148 volunteers.  The healthy
>men and women ranged in age from 18 to 40.
>
>Like Wunderlich, Mackowiak's team found that normal temperatures vary
>between individuals (by as much as 4.8 ^oF) and even within individuals
>over the course of a day (by up to 1.09 ^oF). However, the Baltimore group
>found that 98.6 ^oF "was not the overal mean temperature, the mean 
>temperature of any of the time periods studied, the median temperature,
>or the single most frequent temperature recorded".  Indeed, they report
>in the Sept. 23/30 _Journal_of_the_American_Medical_Association, 98.6 ^oF
>accounted for just 8 percent of their 700 readings.
>
>Maximum normal temperatures varied from a 6 a.m. low of 98.9 ^oF to a
>4 p.m. high of 99.9 ^oF. Though age did not appear to influence readings
>in this group, women tended to be about 0.3 ^oF warmer than men, and
>blacks about 0.1 ^oF warmer than whites. Mackowiak's team also observed a
>2.44-beats-per-minute increase in heart rate with each 1 ^oF rise in
>body temperature.
>
>Mackowiak described Wunderlich's data collection as awesome, noting that 
>thermometers then took 15 to 20 minutes to obtain temperatures and had
>to be read while still in place -- the armpit.  Today, however, physicians
>eschew such underarm readings because of their unreliability.
>       -J. Raloff
>   
	
	Being the father of 3 small girls, I was a bit concerned by this
particular piece of information when it was broadcast on the NBC Sunday
Morning News program yesterday. For one thing, the NBC program did not
go into sufficient detail to explain the consequences of the reults, merely
making what I consider to have been a rash and irresponsible statement that
a (hypothetical) person should not be considered to be running a fever until
it gets up to 100.4 degrees Fahrenheit. (This statement made in the
flippant context that a kid who is trying to get out of going to school
now loses his/her ability to cheat the system by artificially warming
the thermometer.) Clearly, it is possible to be quite sick with a "low"
temperature, just as much as doing fine with a temperature of 100 degrees.

	Now I suppose that one approach to take is to measure one's 
children's temperature when it is normal, with enough trials to come up
with a good solid mean temperature. Of course, with very young children,
the standard temperature-taking technique IS the unacceptable "underarm"
method, but in field testing, one often does the best one can with what
one has.

	Is this better than nothing ? I'm really not sure...98.6 was both
good and bad for mothers' peace of mind, no matter how unacceptably derived.
Many of us Dads have caught the dickens for not rushing the kids off
to the emergency room when the thermometer hit 99 - assuming other symptoms
were turning unfavorable - my four-year-olds last bout with intestinal flu 
comes to mind - Amanda hit 100, and it was all I could do to keep my wife
from climbing the walls - a few hours later, her (my daughter's, that is)
temperature came down into the "normal" range, and my phlegmatic decision
making style was redeemed, at least for once. (In fairness to my wife, Amanda
really WAS very sick - she threw up three times that evening - and had her
temperature NOT gone down, it is likely that off to the ER she would have
gone, instead my kid just had a really lousy night of it.)

	My suspicion is that the abandonment of 98.6 may be a victory
for scientific precision, but is pretty worthless where our suboptimal
decision making processes are concerned. But perhaps more disconcerting
is the potential for both unjustly blaming parents, or maybe even worse,
an excuse for parental negligence when things go awry, and the wrong 
decision gets made. Under such circumstances, sticking with 98.6 seems
as solid as sticking with the Ten Commandments, even when the facts bearing
on the problem would seem to suggest otherwise.

	
	Bill R.


	"My opinions do not represent those of my employer or any
government agency."
-- 
Bill R.
Newsgroups: sci.skeptic