TEMPERATURE AND PULSE 27 



curve. In a few cases the defervescence took place by a con- 

 tinuous fall within twenty-four hours or less. Others showed a 

 gradual lysis without any distinct remission .or other sign of 

 outspoken improvement on any single day. Still in going over 

 our series of charts and records it seems to us that most cases 

 represent only variations in rather than contradiction of this 

 curve suggested as the normal. After defervescence with sub- 

 sidence of typhus symptoms most cases showed continuously 

 normal or subnormal temperatures; others, however, had eve- 

 ning rises for some days without notable febrile symptoms, prob- 

 ably from persisting bronchitis. In certain severe cases, and 

 notably in those cases passing from delirium into stupor ending 

 in death, the elevation of temperature was conspicuously slight. 

 It deserves emphasis that in typhus fever, more than in any 

 other acute infectious disease, the temperature may bear little 

 relation to the severity of the general symptoms. Among the 

 fatal cases there were several instances of terminal hyper- 

 pyrexia. 



The pulse curve through the febrile course of many of our 

 cases was characterized by great variability of rate. Certain 

 cases day after day would show rises and falls as great as be- 

 tween 80 and 140 (Temperature charts 2 and 4). These varia- 

 tions followed the temperature curve or were dissociated from 

 variations in temperature. They were rather apparently asso- 

 ciated with increases or remissions in the delirium. In cases 

 with a more constant pulse rate the pulse was rapid in propor- 

 tion to the temperature, in contrast to typhoid fever. Dicro- 

 tism, however, was not infrequent. In severe cases with cold 

 cyanotic extremities the radial pulse often could not be counted 

 for days. With the onset of a complicating pneumonia the ac- 

 celeration and weakening of the pulse accompanied the appear- 

 ance of pneumonic dyspnoea (Temperature chart 3). With 

 defervescence and beginning convalescence the pulse curve 

 followed a striking downward course, the slowing often being 

 clearly evident from the first remission of temperature in anti- 

 cipation of the final disappearance of fever. Bradycardia of 

 convalescence was sometimes marked. 



