LEISHMA NIA SIS—KA LA -A ZA R 



59 



SYMPTOMS. 



Onset is often by rigor, which may recur daily. 



Initial fever is irregular, high, intermittent (jr continuous, showing 

 a double remission daily on a four-hourly chart. 



Vomiting is not infrequent. 



Less frequently there are gastro-intestinal disturbances, or in some 

 instances the onset is insidious. 



Secondary low fever is chronic in its course, continues from two to 

 six weeks, then gradually declines. The spleen and liver enlarge, may 

 be painful and tender. Then there is an apyrexial period, or a very 

 mild fever. Profuse sweats are common. Rigors are now rare. 

 Apyrexia and pyrexia mav now alternate. The anaemia increases. 



Cachexia is now manifest. There are : asthenia, wasting of muscle 

 with protrusion of abdomen. The ribs show, the extremities are thin, 



Kala-azar. Undulating type. 



cheeks sunken, nose sharp and ankles puffy. There may be oedema 

 of the legs and ascites. 



The skin becomes an earthy grey colour. 



The hair becomes dull, dry, brittle, and may fall out. 



Epistaxis and bleeding from the gums are not uncommon. 



The spleen may nearly reach the pelvis, but the liver is not so much 

 enlarged. 



Diarrhoea and dysenteric attacks are common. 



Haemorrhages may occur from anywhere — nose, gums, stomach, 

 bowels, or under the skin. 



There may be a papular eruption about the thighs. Ulcers may 

 form. 



TERMINATION. 



The disease goes on for months or years, average twelve to eighteen 

 months. 4 per cent, improve slowly, 96 per cent, die of asthenia or 

 some intercurrent disease (Rogers). 



