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Its onset is characterized by a second marked but gradually developed defervescence.

Even in the later stages, until defervescence occurs, heat elimination is inadequate to get rid of the heat produced.

After the high fever and severe cephalic and lumbar pains of this stage there may follow, in the case of varioloid, a complete defervescence and the appearance of a very copious exanthem.

The absence of marked defervescence is the most characteristic difference between variola in its eruptive stage and typhus, typhoid, and relapsing fevers.

In other cases, more commonly those of a grave character, there is failure of this defervescence, the febrile symptoms continuing or even increasing in severity.