A two-hourly chart is shown.in Plate XXIX., and it also illustrates how the margin may be used for entering the directions of the doctor to the nurse. This is a portion of an actual chart in a case of typhoid fever fatal because of haemorrhage.
To understand how the mere graphic record of the course of the fever may help greatly to identify the disease, a chart of the progress in a typical case of typhus (Fig. 201), and another of typhoid or enteric (Fig. 202), are placed near to one another. That of typhus shows a fever rising rapidly to about its maxi mum, oscillating there a little; and abruptly coming to an end between the twelfth and four teenth days, and illustrates the phenomenon of crisis so far as the temperature goes.
Compare this chart with a typical case of typhoid. Note how the temperature mounts by steps, so to speak, each succeeding evening of the first six days being considerably higher, a slight drop occurring each morning, so that by stages the temperature rises for the first week. Note how, during the second week, the temperature maintains an average level, a marked oscillation occurring between morning and evening each day. At the beginning of the third week a descent begins, but like the ascent it is gradual, but in larger oscillations, the morning sion and the evening increase being still marked.
This illustrates termination by lysis.
As a contrast to both of these, the chart in a case of blood-poisoning (Plate XXVT.) is introduced. This chart shows the variations of some parts hourly—during six days of the disease. Thus on the 15th Novem ber, at three in the afternoon, the temperature was and barely three hours later it 105°, in less than four hours after it had fallen nearly to normal. Day after day this process goes on ; between 2 a.m. and 8 p.m. on the 17th two such rushes occurred. This is highly sig nificant of some source in the body, whence, periodically, organisms or their morbid pro ducts gain entrance to the blood. For each of these rushes of temperature was announced by a rigor, some so severe that the patient's bed shook, his teeth rattled, his skin became livid, and his extremities cold as death. During all this time the most patient and vigorous treat ment availed only to secure the patient a degree of comfort, but nothing was potent enough essentially to alter the fever's own course, To the experienced eye a glance at Figs. 201 and 202 is enough to suggest the nature of the disease. In the case of typhoid the three first days are sufficient to suggest it before the full development of the other symptoms would permit one to name the disease.