KALA-AZAR 



155 



Wasting, anaemia, and debility are early symptoms of the 

 disease, and sometimes darkening of the skin is observed 

 at this stage. 



Headache sometimes accompanies the fever, but there 

 is very little, if any, digestive disturbance ; the tongue 

 remains clean, and the appetite good, except in cases 

 where high fever has persisted for some time. The first 

 stage usually lasts about a month, but the duration may 

 vary from ten days to two months. 



It is followed, either directly or after an interval of 

 apparent health, by a stage in which low fever persists 

 for weeks or, more frequently, for months. Sometimes 



FIG. 47. Kala-azar. Undulating type. 



the course of this secondary fever is very irregular. It is 

 rarely high, though there may be occasional attacks of 

 high fever, lasting for some days, while, on the other 

 hand, there may be days or weeks of apyrexia (fig. 47). 

 In some cases the course of the fever may be remarkably 

 regular, the temperature rising and falling to exactly similar 

 points at the same hours day after day for weeks. Fre- 

 quently also the course of the temperature chart shows, 

 a double daily rise and fall. The fever at this stage often 

 causes but little discomfort, and but for profuse sweating 

 the patient may be unaware that he has any. Sweating, 

 especially at night, may, however, occur without any rise 

 in the temperature. 



