Fever. 1 73 



duration in wliich tlicre is alternation of notable depression and 

 exacerbations of temperature it is spoken of as an ainphibolic sfai^e. 

 Tlie slow and Ji^radual type of defervescence is called lysis or rcsn- 

 liilinn. The decline of fever is believed to be due to the tornialion 

 somewhere in the or^-anism (bone marrow, spleen, liver, etc.) 

 during the febrile process of a large quantity of protective sub- 

 stances and to the destruction of the pyrogenetic substances present 

 in the system from the time when these protectives become predomi- 

 nant. Should the blood become rapidly filled with i)rotective sub- 

 stances from the sites of antitoxine j^iroductiou or with |)hagocytic 

 elements from hyperleucocytosis, the change in the case comes on 

 suddenly (crisis) in the first, or gradually (lysis) in the second 

 instance. The termination of the fever, at which time the normal 

 temperature again prevails or merely trifling variations continue, 

 brings back the appetite ; the pulse recovers its softness and even- 

 ness ; the functions of all the organs proceed as before the attack : 

 and there persist for a tiiue only weakness and general debility. 

 This is known as the period of convalescence. In case, however, 

 the febrile disease go on to an unfavorable termination, and there 

 appear irregular fluctuations in the temperature curve, a sudden 

 rise far above nonual or a subnormal depression, with signs of 

 impending death, we are then dealing with what is known as the 

 premortal [nioribund] stage [cf. p. 95]. 



When the stages above mentioned succeed each other in the 

 order indicated the course of the fever is said to be regular or 

 typical: if there be variations, it is said to be irregular or atypical. 



If in this regular course, a fever should continue for only a few 

 hours or for a day, the whole process ending within this time, it is 

 described as an ephemeral fever. A fever of one or more weeks' 

 duration with a temperature curve showing daily an evening rise 

 and a morning fall comparable to those of the nonual body tem- 

 perature, but at a level above that of the nonual internal tempera- 

 ture, is said to be a continued fever: where the depressions and 

 exacerbations are more pronounced it is called discontinuous or 

 remittent. When the variations in temperature are so great that 

 between the times of high temperature accession, which take place 

 periodically (febrile paroxysms) Ahe^e occur periods of absence of 

 fever (apyre.via). the fever is said to be of an intermittent or 

 recurrent type. 



Metabolism in Fever. 'J'he causes of fever are known to give 

 rise as a rule to increased destruction of the albuminates, esseti- 



