mum, and the evening temperature the minimum, the condition is said to be one of "inverse temperature."

Inverse temperature not infrequently occurs in acute tuberculous affections. It is of rather rare occurrence in typhoid fever. What is the significance of a sudden fall of temperature?

A sudden fall of temperature may be part of the usual phenomena of a disease, as in intermittent fever; or it may indicate termination by crisis, as in pneumonia; or when it is not part of the usual course, and is not brought about by obvious loss of blood (as by venesection or menstruation), by drugs or cold applications, or other extraneous influence, it may indicate the development of albuminuria, or the occurrence of internal hemorrhage.

What is subnormal temperature?

A temperature lower than 97.3° F. (36.25° C.) is considered subnormal.

The temperature may be subnormal in influenza and in acute yellow atrophy of the liver as part of the essential course of the disease.

Subnormal temperature occurs, usually associated with profuse perspiration, at periods of critical recovery, as in pneumonia. There is simultaneous decrease in the frequency of pulse and of respiration and improvement in the general condition and sensations of the patient. In many acute diseases that terminate by lysis, such as typhoid fever, the temperature falls below the normal with the setting in of convalescence.

A subnormal temperature develops abruptly in conditions of collapse. It is then associated with sudden failure of the heart, as indicated by a feeble, rapid and irregular pulse, a fluttering and feeble cardiac impulse, pallor, coldness of the skin, with or without sweating, faintness or syncope, and profound prostration and weakness. The pulse becomes feebler, less rapid, and may finally cease. If recovery take place, the temperature again rises; or, if the termination be fatal, the temperature may rise post mortem.

The temperature becomes subnormal in some cases of severe hemorrhage, and at times, temporarily or persistently, in chronic

wasting diseases, such as pulmonary tuberculosis and carcinoma, in chronic Bright's disease and in some diseases of the brain.

What is an essential fever?

An idiopathic or essential fever is one in which the pyrexia and its concomitants do not result secondarily from an anatomical lesion, but arise primarily from the action of a specific poison or a similar cause. Essential fevers may or may not present invariable lesions as a part of their phenomena.

What is a symptomatic fever?

A symptomatic or deuteropathic fever is one that arises secondarily as the result of irritation, intoxication or perverted function, caused by disease or injury of a special organ or tissue. The causative lesion is the essential element; the fever is but one of the symptoms.

What is a specific fever?

A specific fever is an essential fever due to a specific pathogenetic agent. Typhoid fever and yellow fever are examples of specific fevers.

What is a continued fever?

A continued fever is one in which the temperature pursues an uninterrupted course, without sudden variation from beginning to end. The diurnal range will not exceed 1.8° F. (1°C.). The first rise may be sudden or gradual; there may be steady maintenance of a maximum, or continuous increase; there may be gradual or sudden final defervescence; but there is not a decided fall and a renewed rise during the progress of the case.

What is a remittent fever?

A remittent fever is one the course of which is interrupted once or repeatedly by a marked decline in temperature, not reaching the normal, and followed by renewed exacerbation. The daily difference wil exceed 1° C. (1.8° F.).

What is an intermittent fever?

An intermittent fever is one in the course of which a complete intermission takes place once or repeatedly; that is to say, in

the progress of the case the temperature becomes normal (or even subnormal), remains normal for an appreciable time, of greater or less duration, and subsequently rises to about its previous level. The maximum may be high.

Simple Continued Fever.

What is the clinical course of simple continued fever?

Simple continued fever, ephemeral fever or febricula is a nonspecific fever, sometimes apparently idiopathic, but often symptomatic of digestive aberration or of some local irritation. It may be caused by error in diet, by fatigue, anxiety, shock, unusual mental or physical exertion, exposure to cold and damp to a foul atmosphere, or to the sun.

The disease sets in with a feeling of indisposition, which is followed by chilliness, fever, with heated skin, headache, thirst, anorexia and pain in the back and limbs. The pulse is accelerated. The tongue is coated. There is usually constipation, less frequently diarrhea. The urine is scanty and high-colored. The pyrexia is slight or moderate; the diurnal variations are small, the rise rapid, the fall gradual or by critical defervescence, with profuse sweating or watery diarrhea. The duration is commonly less than a week. It may be less than twenty-four hours. Recovery is invariable and convalescence is rapid.

Graver forms of the affection, induced by the graver causes, may be attended with considerable depression, and running a more protracted course, in duration from ten to fourteen days, may simulate typhoid fever. Especially is this resemblance marked in cases of septic intoxication.

What is ardent fever?

Ardent Fever,

Ardent fever is a non-specific, continued fever, occurring in hot countries, in which the ordinary symptoms of febricula are exaggerated. The temperature reaches or exceeds 103° F.; there is throbbing of the temporal arteries, with severe headache and

even delirium. The symptoms resemble those of an inflammatory fever, so that the utmost care must be observed to avoid error in diagnosis.

Thermic Fever-Insolation-Sunstroke.

What is thermic fever?

Thermic ferer, or sunstroke, results from exposure to extreme heat. The heat may be excessive and the exposure brief, or the heat may be less intense and the exposure prolonged. The condition is described with affections of the nervous system.

Catarrhal Fever-Influenza,

What is catarrhal fever?

Catarrhal fever, epidemic catarrh, influenza or la grippe, now commonly called "grip" in the United States, is an infectious, possibly contagious disease, belonging to the group of specific, essential, continued fevers, that occurs epidemically, endemically or pandemically, more rarely sporadically, and exhibits a protean capability of variation in its symptoms.

There are four prominent varieties: (1) the catarrhal, in which the predominant features are those of catarrhal inflammation of the respiratory tract; (2) the thoracic, in which, with or without the ordinary catarrhal manifestations, there are symptoms of profound involvement of the thoracic viscera; (3) the abdominal or gastro-intestinal, in which disturbances of the digestive tract. are most marked; (4) the nervous or cerebral, in which neural phenomena attract attention, and in which, as in the abdominal variety, the clinical course of typhoid fever is often closely simulated. Much greater refinement in subdivision might be made, as the symptoms of two or more types are frequently associated in one case. Some epidemics are characterized by greater or even exclusive prevalence of one or two types; but in other epidemics, half a dozen patients in one household may exhibit six varieties of the disease.

What is the clinical course of influenza?

The invasion of influenza is commonly sudden, sometimes with a chill, usually with more or less irritation or inflammation of the mucous membranes of the nose and throat, often associated with catarrhal conjunctivitis and blepharitis (pink-eye). There is always a feeling of lassitude, passing into unaccountable depression, physical and mental, great soreness in the back and limbs, aching of the muscles, more or less stiffness of the neck, cutaneous hyperesthesia, headache, dyspnea and anorexia.

The temperature is decidedly irregular; it may rise high; it is often subnormal for more or less protracted periods, and is subject to extreme fluctuations. The pulse is not much accelerated; it ordinarily is weak, the heart sharing in the general depression. The tongue is coated; the bowels are often constipated; the urine is scanty and high-colored, or profuse and light-colored. The skin is hot and dry and very sensitive to the touch. Sometimes there are irregular perspirations.

In the catarrhal type, sneezing, coryza, watering of the eyes, odynphagia, painful respiration and a dry, harassing, irritative cough are early and prominent symptoms. The difficulty and distress in breathing are out of all proportion to the phenomena elicited by auscultation and percussion. Later, the cough becomes freer, and associated with expectoration of a thick, glairy mucus, sometimes blood-streaked or discolored; the nasal discharge becomes thicker and even purulent and hemorrhagic. With recovery, profuse, watery diarrhea occurs. In some cases,

symptoms of tonsillitis or of catarrhal pharyngitis are the earliest, those of laryngitis and of bronchitis following. Coryza may be a late manifestation. In some cases, there is a peculiar edematoid condition of the tonsil, uvula and neighboring structures that has been termed "solid edema," as puncture gives exit not to serum, but to a sanious, stringy, lymphoid material. Suppurative otitis media, preceded by excruciating earache and usually affecting both ears in succession, may be the only manifestation in the upper air-tract. This otitis is quite common in children and usually runs through a household.

In the thoracic type, pleuritis, pericarditis, endocarditis, pneumonia―catarrhal, croupous or hemorrhagic-or edematous or