Page:Tropical Diseases.djvu/252

214 remarkable degree, in harmony with the fluctuations of the fever. Then comes a period of apyrexia and general improvement, to be followed once more by fever and splenic and hepatic enlargement, and perhaps tenderness. In this way spells of fever and apyrexia recur for months, absolutely unchecked by quinine, until finally a low form of fever, rarely over 102° F., becomes more or less persistent. Profuse sweats are common during remissions at all stages of the fever; rigor is rare. Pains in the limbs often suggest rheumatism. When the disease is thoroughly established emaciation and anaemia become noticeable, and, together with the enlargement of the liver and spleen, cause the patient to present a typical appearance. Œdema of the legs, sometimes circumscribed œdemas, or even ascites may now be present. In many the skin acquires an extraordinary earthy-grey colour; the hair is apt to become dull, dry, and brittle, and may fall out; petechiæ, in the axillæ especially, are not unusual; epistaxis and bleeding from the gums are common. This condition of chronic fever, enlargement of spleen and liver, emaciation and anæmia, may continue for months, or even one or two years, until improvement sets in, or more usually—— 96 per cent, of cases (Rogers), 150 recoveries in 2,000 cases (Price), 24 in 100 cases (Lignos)—— until the patient is cut off by intercurrent disease, especially dysentery (90 per cent.), occasionally phthisis, pneumonia, cancrum oris, or asthenia.

According to Rogers, the degree of anæmia, in uncomplicated cases, is usually only a moderate one, the number of red corpuscles being not infrequently over 4,000,000, and, as a rule, over 2,500,000 even in advanced cases. The most remarkable change in the blood is the great and constant reduction in the number of leucocytes. Instead of there being 1 white to about 625 red, as in a normal subject, the proportion is commonly from 1 to 2,000 to 1 to 4,000, and may be lower still. The reduction is most marked amongst the polynuclear variety; the lymphocytes and large mononuclear leucocytes, although greatly reduced in