_Onset and Fever Chart._—The disease commences in a rather indefinite manner, often with gastro-intestinal symptoms or possibly daily rigors. The fever chart is that of a remittent fever with rather marked oscillations and in particular a double rise in the 24 hours, which Rogers regards as characteristic. The absence of a high continued fever and this double daily rise assist in differentiating typhoid. Waves of fever separated by apyrexial periods often simulate the fever chart of Malta fever. _The Spleen, Liver and Lymphatic Glands._—The splenic enlargement, which may reach the umbilicus by the third month, is the most characteristic clinical sign of kala-azar. The diagnosis was formerly made by spleen puncture but owing to many fatalities the liver puncture is to be preferred, although the results of such exploratory examinations are often negative, the liver being involved to a less extent than the spleen and rarely showing appreciable enlargement before the third month. It is during the pyrexial periods that the spleen and liver enlarge. Cochran has brought forward the importance of examining smears from excised lymph glands for the parasites and others have shown that gland puncture is of value. The glands in the infantile type of the disease often do not show enlargement. _The Blood._—Marked anaemia is only found in the later stages and the color index is about normal. The number of red cells rarely falls below 2,000,000. Leucopenia is characteristically marked, this having been below 2000 in 62% of Rogers’ cases. This authority considers the finding of 1 white to 1000 red cells, in a case of fever, very significant of kala-azar. There is also an increase in the large mononuclear percentage which would aid in differentiating typhoid. The coagulability of the blood is decreased and this may be a factor in the fatal results which at times follow spleen puncture. Parasites are found in the peripheral circulation in about 80% of cases, after prolonged search, and may be phagocytized by either large mononuclears or polymorphonuclears. Patton found parasites in the peripheral blood in the examination of a single slide in 42 out of 84 cases and with three slides in 25 of those not showing parasites with the first slide. By repeated examinations up to the seventeenth slide, he got positive results in all 84 cases. The Sudan commission found that the alkalinity of the serum of their patients was diminished. Rogers has noted an acidosis in unfavorable cases of kala-azar while those showing improvement only showed slight or no acidosis. _Respiratory and Circulatory Systems._—There is very little that is constant, the lungs being quite normal in 90% of Rogers’ cases. The pulse rate is rather variable, although usually accelerated. Diagnosis