TROPICAL MEDICINE AND HYGIENE 



considerable height, and after several hours falling several 

 degrees, the fall being accompanied by profuse perspira- 

 tions. These febrile attacks recur daily. At first the 

 type is remittent, but may soon become intermittent, the 

 daily range of temperature being considerable, varying 

 between 97 and 103 F. (fig. 46). 



FIG. 45. Kala-azar. Simulating typhoid. 



FIG. 46. Kala-azar. Later showing intermittent type. 



The rise of temperature usually occurs in the evening, 

 but not uncommonly there is a double or, even a treble 

 rise and fall in the twenty-four hours. Sometimes there 

 are short periods of apyrexia, followed by further out- 

 bursts of fever. 



After the fever has lasted a short time, the spleen 

 becomes enlarged and tender; enlargement and ten- 

 derness of the liver also occur, but are less marked. 



