VI] DISTRIBUTION AND SYMPTOMS 45 



researches of Doerr, Franz, and Taussig, clearly demonstrated 

 the nature of this disease and its mode of transmission. 



Some authors, especially the French, regard Pappataci Fever 

 as merely a form of dengue, but the febrile symptoms are rather 

 different in the two cases and therefore, for the present, it seems 

 advisable to consider them distinct. 



Distribution. Pappataci Fever occurs in various parts of 

 Italy and is especially prevalent in Dalmatia, Istria, Herze- 

 govina and various other parts of Austria-Hungary, and has 

 also been recorded from Portugal. It is said to occur in 

 Asia Minor, the Balkan Peninsula, North Africa and the 

 Sudan. The majority of the islands in the Mediterranean 

 seem to be liable to outbreaks, for the disease has been recorded 

 from Corsica, Sicily, Malta, Crete and Cyprus, and probably 

 occurs in most, if not all the islands of the Greek Archipelago. 

 According to Robinson and Blackham the "Seven-Day Fever" 

 of the Peshawur valley is also a variety of Sand-Fly Fever and 

 is carried by Phlebotomus. In other parts of India, epidemics 

 probably due to this infection have been observed, but the 

 symptoms in many cases closely approximate those of dengue. 

 The disease is said to occur in China. 



Symptomatology. In view of the fact that this disease has 

 only recently been distinguished, a short account of the symp- 

 toms is included. 



Different outbreaks shew considerable variations in the 

 symptoms. The onset of the disease is usually sudden, with 

 febrile symptoms, headache and pains, especially in the extremi- 

 ties. The fever continues for one or two days and usually 

 disappears on the third, fourth, or fifth day, but in some 

 cases may persist as long as seven days. During the attack 

 nervous symptoms are very pronounced ; headache, usually 

 frontal, is constantly present and pains in the back, loins and 

 lower extremities occur in the majority of cases. Muscle pains 

 are frequently present, being chiefly located in the intercostal 

 and lumbar muscles, and the muscles of the calves. On the 

 other hand the joints are very seldom affected and this con- 

 stitutes one of the means of distinguishing this disease from 

 dengue. 



