The usual premonitory symptoms are headache, loss of appetite, a feeling of general depression and aching of limbs. These symptoms may either be mild or may appear at once in very aggravated form; violent headache being usually of an acute dull character, accompanied by throbbing in the temples, giddiness, sleeplessness, palpitation, a feeling of oppression of the chest, even mental delusion may appear on the first day. The look of the patient is anxious, pale and cyanosed. The expression of the face resembles that of a man who has had no sleep for two or three nights but is being overpowered with the fatigue consequent to it. These symptoms are usually ushered in with a rise in the temperature. Well-marked rigor is usually not seen, but a slight shiver or chillness is complained of. Pulse is full, bounding and rapid—130 or more per minute. Respiration is difficult and accelerated even to 40 or 50 per minute. Skin is dry and hot, face puffed, conjunctivæ congested. Sense of hearing is dull. Speech is thick and faltering. Tongue is dry and coated with greyish white or dark brown heavy fur. Violent thirst is present. Sometimes Patchiæ appear on the skin. In a few hours, or a few days after the appearance of the first symptoms, a swollen gland appears either in the neck or axilla or groin. The gland most commonly affected is one or some of the femoral chain. An inguinal, axillary or a cervical gland may also be affected. A number of glands may swell at one time or glands in all the above situations may be felt painful and swollen. The glands of the neck are most frequently attacked in children. Pains in the lower part of the abdomen and along the spine indicate affection of internal lymphatic glands. In some cases the first symptom noticed is a swollen and painful gland, but fever soon manifests itself. The glandular enlargement may antedate, coincide with, or follow the rise in temperature. Sometimes only pain in the gland is complained of, but no swelling is observed. The temperature rises gradually and goes up to 104°, 105° or 106° F. In some cases a temperature of 108° was observed. There may be a marked morning fall and an evening exacerbation, which is a favourable sign, or the temperature may remain high persistently. All the above symptoms become soon aggravated when the second stage or stage of acute development of the disease appears. Brain symptoms show themselves. Lowson noticed four distinct type of brain symptoms—(1) comatose, when the patient lies paralysed, mind and body; (2) wildly delirious, when the patient struggles and fights and still retains a fair command of rational speech; (3) apathetic, when he lies perfectly quiet but is drowsy; (4) convulsive, which condition occurs when there is inflammation of the meninges or hæmorrhage in the brain.