INTERMITTENT FEVER. 677 



the spleen, etc., can be referred to collateral fluxion to the organs impli- 

 cated in these symptoms. At all events, as we have before said, col- 

 lateral fluxion to the spleen is not the sole cause of enlargement of 

 that organ. The cold stage lasts from half an hour to three hours ; in 

 the first paroxysms, it is usually shorter and less severe than subse- 

 quently ; and its intensity and duration generally decrease again if the 

 disease last a long time. The hot stage does not begin suddenly, but 

 gradually ; at first the chill is only interrupted by temporary flashes 

 of heat, and a permanent feeling of warmth only comes on by de- 

 grees. The headache becomes more severe ; the patients grow rest- 

 less, and not unfrequently slightly delirious or somewhat stupid ; the 

 feeling of oppression on the chest increases, while the breathing almost 

 always becomes deeper, freer, and slower. Thirst is greatly increased. 

 The appearance of the patient changes. The size of the body ap- 

 parently increases, the color returns to the skin, the pale, livid look, 

 the goose-flesh, the cyanotic hue of the lips and ends of the fingers 

 disappear ; the face becomes flushed, and herpetic vesicles often come 

 out on the lips ; the previously small pulse grows full and strong, the 

 carotids throb, the urine becomes more saturated, and the enlarge- 

 ment of the spleen increases. In the hot stage, the bodily temperature 

 is increased at the periphery also ; at the commencement of this stage, 

 the temperature of the blood reaches its highest point, and remains 

 there till toward its termination, when it gradually begins to fall. All 

 these symptoms show that the spasm in the muscles of the skin and 

 vessels has disappeared and given place to a subparalytic state. The 

 relaxation of the cutaneous tissue and of the walls of the vessels suf- 

 ficiently explains the increased entrance of blood into the previously 

 bloodless tissues, and their consequently increased color and warmth. 

 The severe headache, the oppression of the chest, which are often 

 accompanied by catarrhal symptoms, and finally the continued enlarge- 

 ment of the spleen, render it very probable that the arteries of the 

 brain, bronchi, and spleen, are in the same condition as those of the 

 periphery. The duration of the hot stage varies ; sometimes it is only 

 a few hours, in severe cases the dry heat continues six, eight, or even 

 twelve hours before a pleasant perspiration breaks out on the skin. 

 The sweating stage begins with moisture in the armpits and on the fore- 

 head ; but soon the perspiration, at first moderate, but later very copi- 

 ous, extends all over the body. The patients feel greatly relieved, the 

 headache remits and gradually disappears, the mind becomes clear, the 

 oppression passes off, the depth and frequence of the respiration be- 

 come normal, the thirst is less annoying, the pulse is full, soft, and 

 less frequent. The dark urine generally deposits rich sediments of 

 urates ; this depends on the great concentration resulting from the loss 



