MEASLES, SCARLET FEVER, MUMPS, DENGUE FEVER, ETC. 931 



DENGUE FEVER 



Dengue fever is of sanitary importance because it spreads rapidly, 

 occurs epidemically and may lead to a very high sick rate, though 

 it rarely kills. It is tropical in its distribution, but has occurred 

 epidemically in the sub-tropical countries. Southern and Eastern 

 Europe have had small epidemics and an occasional sporadic dis- 

 tribution of cases. 



The onset is sudden and begins with severe pains throughout the 

 body, weakness and chilliness. There is conjunctival injection and 

 there may be gastro-intestinal symptoms. The temperature rises to 

 103 or 104 and with this there is headache and the pains in the 

 back and legs increase. The pain seems to be largely localized in 

 the muscles. The fever persists usually for about three days when 

 it drops considerably, and remains down for two or three days when 

 it rises again. Usually at this time there is a rash on the hands 

 which spreads to the arms, trunk and legs. Castellani and Chalmers 23 

 describe this as a "measly" eruption in most cases, though in others 

 it may resemble that of scarlet fever. After the second febrile attack, 

 convalescence is usually rapid. The mortality of the disease is 

 negligible. 



In 1903 Graham, 24 working in Syria, made blood examinations 

 on a large number of cases of Dengue and described protozoa-like 

 organisms within the red blood cells. He believed that the disease 

 was transmitted by the ordinary mosquito, Culex fatigans. The 

 geographical distribution of this mosquito corresponds fairly well with 

 that of the disease. In one case he produced the disease in man 

 by the subcutaneous injection of a suspension of salivary glands 

 of infected mosquitoes. He produced the diseases by bites of the 

 mosquitoes that had fed on Dengue patients. In 1906 Bancroft 

 produced typical attacks in two volunteers by the bites of Stegomya 

 fasciata which had been allowed to feed on Dengue patients on the 

 second day of the disease. Of considerable importance are the ex- 

 periments of Ash burn and Craig 25 of the United States Army which 

 were carried out in the Philippine Islands in 1907. These inves- 



M Castellani and Chalmers, Textbook of Tropical Medicine, W. Wood & 'Co., 

 Now York. 



"(irahatn, Jour. Trop. Mod., 6, 1903, 209. 



25 Ashburn and Craig, quoted from Craig, Jour. A. M. A., 75, 1920, 1171. 



