FEVER AND FEVEBS. 531 



to remain until shortly before the return of another paroxysm. Th< uuru 



in some fevers is nuu-h higher than in others. I-W example, in an ordinary case 

 of measles it seldom rises above 103, but in wail.t f,-\-r it may reach l'i . 

 or nearly 105 on the first day. When tin- temperature in any fever reaches 

 105 the case is serious, and if it remains long above 106 the patient i> in inim 

 peril. Until within the last few years a continued temperature of 107 always 

 proved fatal; but nowadays, by the use of the cold bath, we not unfn -ju ntly 

 succeed in reducing the fever and saving the life of the patient. 



Fever is almost always accompanied by an increase in the rapidity of the 

 heart's action, and consequently by quickening of the pulse. It is * .; n laid down 

 as a rule that a rise of one degree in the temperature of the body correspoii< 

 an increase of ten beats of the pulse in the minute, and this is, in the main, correct. 

 In some fevers the pulse nearly always becomes very rapid. Thus, in scarlet fever 

 it is often remarkably frequent. In this disease it may rise in the case of children 

 to 160 on the first day of the illness. In typhoid fever a pulse of 130 is of 

 serious import, and in typhus fever death almost always ensues when it exceeds 

 150. 



A harsh, dry, burning heat of the skin is one of the symptoms of fever. A 

 moist skin seldom gives the same sensation of extreme heat as is experienced when 

 the skin is dry. In rheumatic fever or acute rheumatism the whole of the body is 

 often bathed in perspiration, even when the patient's temperature is three or four 

 degrees above the normal. 



Headache is sometimes present in fever, but not always. In most cases it' is felt 

 in the region of the forehead ; in fact, headache, unless dependent on some disease 

 of the head itself, is nearly always frontal. It is a common accompaniment of i\i 

 hot stage of ague, and is usually very intense in small-pox and typhus fever, : 

 particularly in the latter disease. 



Fever is often accompanied by pain, sometimes confined to one particular part 

 of the body, but frequently not localised. In many fevers pain in the back is 

 common, and in small-pox it is one of the most prominent of the early symptoms. 



Confusion of ideas, or even distinct delirium, is not an uncommon result of fever. 

 Frequently it shows itself at night only, or it may be perceived that the patient 

 wanders a little on awaking from disturbed sleep. In typhus fever it is very common* 

 particularly between the fourth and the eighth days. In this disease it varies very 

 much in character, and may be active and maniacal, or low and muttering. Much 

 active excitement is not very common, but extreme degrees of it are occasionally 

 seen, the patient praying, bawling, or blaspheming, according to his habitual turn 

 of mind. Very commonly the patient lies talking quietly to himself about matters 

 which interested him at the time of his seizure, or on subjects suggested by what is 

 going on, or what he supposes to be going on, around him. Sometimes in his delirium 

 the patient may labour under the delusion that an attempt is being made to poison 

 him, and acting upon this impression he may positively refuse to take nourishment 

 of any kind. Patients will often tell you after their recovery that the period of 

 delirium was to them a time of utter confusion, not only as regards time, and 

 place, and people, but even respecting personal identity. Occasionally the patient 



