The temperature of the skin, however, is not the only indication of fever. It is accompanied simultaneously by accelerated action of the pulse, up to 120 beats per minute, and even more; also by increased thirst and, as an indication of very intense affection, extreme exhaustion and lassitude. The increased excretion becomes manifest through dark and strong-smelling urine and, especially at the time when the fever begins to abate, through intense perspiration.
In the beginning of fever the change alternating between chills and abnormal heat is very characteristic; frequently, and especially in severe attacks, it begins with shivers. The patient suddenly feels an intense chill, so that he commences to shake all over, his teeth chatter and he grasps whatever covering he can for warmth. Suddenly, following this, a rapid increase of temperature occurs, and the patient begins to complain of intense heat. In other cases patients complain of feeling very cold, while their skin indicates a marked degree of warmth.
With higher degrees of temperature, the fever may induce a loss of consciousness. The patient becomes delirious, loses urinary and fecal control and displays the signs of total collapse.
Fever, as I have already indicated, is a kind of physical revolution, a state of excitation which, differing so widely as to cause, character and degree, cannot be judged according to any fixed rule. The temperature of a patient we may read from the thermometer; but the real nature of the fever we do not learn until we consider his constitution, his innate faculties and the strength to which his various organs have attained. For this purpose we must take into consideration not only the physical attributes, but also the quality of the senses and of the mind, since these items are of the utmost importance in determining the tenacity, i.e., the power of resistance of the patient.
From this point of view it will be understood that people possessing a calm and phlegmatic temperament, will not attain to high degrees of fever, except in cases of very serious complications, while nervous people may quickly reach very considerable degrees of temperature. Children and younger people are more inclined to high fever, since their organs are still immature. This explains why simple inflammations, which are not general throughout the body, or frequent indigestion, which in itself does not figure as a dangerous illness, will in the case of children appear under the gravest symptoms. It follows, therefore, how necessary it is to discriminate closely and decide accordingly between severe symptoms of fever as manifested by people of calm temperament, and similar cases when manifested by people of nervous temperament.