Translated from the popular Refuat HaShabbat, this invaluable guide covers all aspects of the halachos of medical care on Shabbos: categories of illnesses; guidelines for caring for adults, children, the elderly, and expectant and nursing mothers; the laws of taking medication and performing common treatments; and much more!
Fever, Hypothermia, and Measuring Temperature
Almost everyone experiences abnormal temperature, for different reasons and in varying degrees. A change in body temperature may indicate a life-threatening illness or may be fleeting and benign. Fever may aid the body to overcome an infection, but it may also cause dehydration, heart failure, delirium, or convulsions.
Our Sages decreed (Avodah Zarah 28a) that abnormal temperature is dangerous and that Shabbos may be desecrated for its evaluation and treatment. The Shulchan Aruch (Orach Chaim 328:7) states: "One may desecrate Shabbos for every wound...and for anyone who has a high fever or fever with chills..." (see also Mishnah Berurah and commentaries of Acharonim there).
In this chapter, we will clarify:
a. General causes of change in body temperature
b. What temperature level constitutes danger
c. The permissible way to measure temperature on Shabbos
Causes of Abnormal Temperature
Changes in body temperature are generally caused by one or more of the following:
a. Infection or inflammation in any part of the body
b. External or environmental factors, such as dehydration, food poisoning, poisonous gas, animal bites, or insect bites or stings
c. Heat-induced illness, such as heatstroke
d. Cold-induced illness (hypothermia)
e. Unknown causes in infants less than three months old
f. Other causes, such as tumors, drug reactions, neurological disorders, metabolic disorders, or endocrine (thyroid) disorders
Infectious or Inflammatory Diseases
1. Infections caused by various bacteria or viruses may be destructive, life-threatening, or harmless. Even though an infection is not life-threatening, it may require treatment.
2. The immune system is comprised of white blood cells and antibodies capable of fighting infectious invaders of the body. Sometimes the immune system alone can eradicate the invader, but sometimes it requires external help, such as antibiotics or incision and drainage.
3. In determining treatment, the location of the bacteria is essential, for two reasons:
a. If the bacterial infection is in the brain or another sensitive organ, it is life-threatening and requires immediate treatment.
b. The type of antibiotic and its administration (intravenous, oral, or injection) depends on the location of the bacterial infection, the symptoms, and the offending organism.
4. When the body is invaded by bacteria, its temperature rises or lowers (usually proportionally to the danger) along with other symptoms that assist in identifying the location of the bacterial infection. Therefore, any information on the patient's condition is important in determining the severity of his condition.
5. The following are symptoms that indicate the severity of the patient's condition:
a. Fever accompanied only by vomiting may be indicative of a life-threatening illness (possibly meningitis) and requires emergency medical treatment.
b. Fever accompanied by vomiting and diarrhea is less worrisome. This depends on the patient's appearance. If the patient looks sick, immediate treatment is required. If he looks healthy, there is no concern of immediate danger.
c. Some fevers that are not associated with any symptoms may resolve without treatment. However, a fever of unknown etiology that continues for more than twenty-four hours and, in particular, if accompanied by signs of dehydration, requires medical attention.
d. Fever of known etiology (such as an ear infection, pneumonia, bronchitis, hepatitis, urinary tract infection, erysipelas) that is already being treated by a doctor, may be of lesser concern. The medications prescribed for these illnesses may be taken on Shabbos.