. The treatment of disease : a manual of practical medicine . esystem. The paroxysm may be preceded by prodromal symptoms such as indefi- MALARIAL PEVERS. 69 nite malaise, yawning, headache, or nausea. Prodromata may be whollyabsent. The paroxysm consists of three stages, the chill, the fever, and thesweat. Tlie chill lasts from one-half to two hours; it usually occurs late inthe morning and almost never at night. Its onset is usually gradual, begin-ing with chilly feelings of increasing intensity until the body shivers withcold and the teeth chatter. Hot water bottles and numerous blankets wi
. The treatment of disease : a manual of practical medicine . esystem. The paroxysm may be preceded by prodromal symptoms such as indefi- MALARIAL PEVERS. 69 nite malaise, yawning, headache, or nausea. Prodromata may be whollyabsent. The paroxysm consists of three stages, the chill, the fever, and thesweat. Tlie chill lasts from one-half to two hours; it usually occurs late inthe morning and almost never at night. Its onset is usually gradual, begin-ing with chilly feelings of increasing intensity until the body shivers withcold and the teeth chatter. Hot water bottles and numerous blankets willnot keep the patient comfortable; the face is pinched and pale; the lips areblue, and the patient is apparently very cold; yet, at the same time, the bodytemperature is elevated even to 105° or 106° F. (° or ° C). Thereis severe frontal headache and nausea, and vomiting may be present. Thepulse is rapid, tense, and small. The urine is pale, increased in amount, andof low specific gravity, but before this stage it may have been dark colored and. Fig. -Clinical chart of tertian malarial fever. heavy. At the end of the stage of chill tho. febrile stage begins. This is char-acterized by flushing of the face, a hot and dry skin, coated tongue, greatthirst, severe headache, and pain in the back and limbs; the pulse is full,bounding and rapid and active delirium may be present. The temperaturemay be but little higher than during the cold stage, and at times the maximummay be reached at the termination of the chill. The stage of fever lastsfrom thirty minutes to four or five hours, and is, at the end of this time,followed by the stage of sweating. All the symptoms now subside and thereis profuse perspiration beginning on the face and gradually involving theskin of the whole body, and the patient falls asleep to awake later feelingperfectly well. This stage lasts one-half to two or three hours. The sweat-ing may at times be very slight. yo THE INFECTIOUS DISEASES. The dura
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