26 CLINICAL OBSERVATIONS 



such variations that description and analysis are .difficult 

 (Temperature charts 1, 2, 3, and 4). Some cases would show 

 continuous high temperatures with less other evidence of seri- 

 ous illness than would be expected. Other cases would present 

 the gravest clinical picture, often ending in death, with only 

 moderate temperatures. From a general survey of our charts, 

 however, impressions are gained which may be summarized as 

 follows. Through the obscuring confusion of variations it is 

 thought that a normal curve of temperature for uncomplicated 

 typhus ending in recovery can be made out, represented by a 

 continuously elevated temperature in the neighborhood of 

 103F., with or without slight to moderate remissions, most 

 commonly in the morning, and returns to the higher level in the 

 afternoon; this fever continuing at a fairly constant average 

 height, or showing a slight downward tendency in the second 

 week, until most commonly on the morning of the llth or 12th 

 day a marked remission of temperature, almost or quite to 

 normal, occurs accompanied by a distinct improvement in the 

 general condition. The temperature rises in the next afternoon, 

 and on the following day the remission and evening rise are 

 repeated. But a third remission, occurring forty-eight hours 

 after the first, very commonly marks the beginning of per- 

 manently normal temperature, although still another evening 

 rise may appear. We suspect that it is the conspicuous im- 

 provement in the general condition, often accompanying the 

 first remission, which has led to the common teaching that 

 typhus fever is a disease which terminates by crisis. As the 

 curve of the temperature shows, the defervescence of typhus 

 fever is better described as rapid lysis (Temperature charts 1 

 and 2). The chart described above, it must be admitted, is so 

 subject to variations that fully typical instances are the excep- 

 tion. Many of our cases during their course had occasional un- 

 accountable marked remissions in single readings of tempera- 

 ture without corresponding improvement. Others ran a more 

 or less regularly remittent temperature throughout the later 

 part of their course somewhat simulating the later stages of 

 typhoid fever. Others ran an absolutely irregular temperature 



