culminating in the more pronounced phenomena of a fully developed ague.
Cold stage.—— When rigor sets in, the feeling of cold spreads all over the body, becoming so intense that the teeth chatter and the patient shivers and shakes from head to foot. He seeks to cover himself with all the wraps he can lay hands on. Vomiting may become distressing. The features are pinched, the fingers are shrivelled, the skin is blue and cold-looking and may exhibit the condition known as " goose-skin " (cutis anserina). But the feeling of cold is entirely subjective; if the temperature be taken, it is found to be already several degrees above normal and to be rapidly mounting. In young children it is not at all unusual to have a convulsive seizure at this stage a fact that has to be borne in mind, as it is very apt to lead to ideas of epilepsy.
Hot stage.—— After a time the shivering gradually abates, giving place to, or alternating with, waves of warmth and, before long, to persisting feelings of intense heat and febrile distress. The wraps, which before were so eagerly hugged, are now tossed off; the face becomes flushed; the pulse is rapid, full, and bounding; headache may be intense; vomiting frequent; respiration hurried; the skin dry and burning, the thermometer mounting to 104°, 105°, 106° F., or even higher.
Sweating stage.—— After one or more hours of acute distress the patient breaks out into a profuse perspiration, the sweat literally running off him and saturating his clothes and bedding. With the appearance of diaphoresis the fever rapidly declines; headache, vomiting, thirst, and febrile distress giving place to a feeling of relief and tranquillity. By the time the sweating has ceased the patient may feel quite well; a little languid, perhaps, but able to go about his usual occupation. The bodily temperature is now often subnormal, and may remain so until the approach of the next fit, one, two, or three days later.
Duration of the fit.—— The duration of an ague fit and of its constituent stages is very variable. On an average it may be put at six to ten hours, the
