378 DISEASES OF UNCERTAIN .ETIOLOGY 



In some cases ihe lemperature remits only to ioo° or 102° F., and 

 the symptoms abate only. 



Terminal fever and eruption. This occurs about the fifth day, 



temperature rises tO' 102° or 103° F., the pains return and are severe, a 



rash appears on the palms and the backs of the hands, elbows and 



knees, rapidly spreading to the trunk and legs. This rash may be : — 



(i) A measly eruption, small circular dusky patches. 



(2) A scarlatiniform eruption, numerous bright red, small 

 papules forming larger patchy areas. 



(3) A mixed type or abortive only. 



The eruption lasts two to eight days followed by a furfuraceous des- 

 quamation lasting two or three weeks. 



The second temperature falls by crisis about the sixth day. 



The pains may come back again at intervals for weeks afterwards. 



Convalescence may be C]uick and permanent or protracted and com- 

 plicated. 



The seven-day fever of Rogers is held by some to be a varietv of 

 Dengue. 



The mortality is almost nil (o'l per cent). 



SEQUELS AND COMPLICATIONS. 



Relapses are not uncommon. 

 Pains in the joints and muscles. 

 Hcemorrhage from any of the mucous membranes. 

 Hyperpyrexia is rare, so also are pleurisy, pericarditis, orchitis, 

 endocarditis and meningitis. 



DIAGNOSIS. 



Look for sudden onset, severe muscular pain, intermission on the 

 third day, and rash on the fifth or sixth day. 



Yellow fever has its low pulse with a high fever, jaundice and 

 haematemesis. 



Influenza has catarrhal symptoms, and rash is absent. 



Scarlet fever has sore throat and enlarged cervical glands. 



Measles has catarrhal symptoms, but no severe muscular pains. 



Rheumatic fever has swollen joints. 



Small-pox will be difficult until the eruption is seen. 



Early enteric cases are not easy to distinguish; the cause of the 

 fever will decide it. 



TREATMENT. 



It is useless to attempt to cut the fever short. 

 Cool applications to the forehead for headache. 

 Dover's powder or morphia for the pain. 



