Distribution of Tropical Diseases in Africa. 467 
and acute pains in the head and eyes, the muscles and joints ; 
there is swelling of the joints, and the pains are apt to shift 
suddenly from one limb or joint to another; the throat and 
mouth are often affected, as well as the sub-maxillary glands; 
the sensorium is often much disturbed, and active, violent 
delirium is not uncommon. The disease is very infectious, 
and attacks persons of every age and sex. It may remit, 
and is liable to relapse. Some authorities consider that 
dengue is intimately connected with relapsing fever. Dr 
Christie thought that it was related to cholera, Although 
the complications of dengue are very troublesome, yet the 
prognosis is favourable. Deaths usually occur from syncope 
in children, in the aged, and in the debilitated. Summer 
and early autumn are the seasons when dengue is most 
prevalent. All epidemics have occurred during the hottest 
weather. It does not appear that the amount of moisture 
in the air has anything to do with its production. 
The onset of the disease is sudden. After suffering from 
severe rigors, the patient’s temperature runs up to 103° or 
104° F. Headache, pains in the joints, and nausea are 
prominent symptoms. The patient is sleepless and restless. 
Enlargement of the lymphatic glands is noticed. There may 
be epistasis, salivation, diarrhcea, or dysentery. Hepatic 
derangements are sometimes seen. Women may suffer 
from uterine hemorrhage, and if pregnant are hable to mis- 
carry. ‘The first eruption, which appears on the third day, 
resembles that of scarlet fever, the throat being likewise 
affected. After two or three days the fever subsides, and the 
rash disappears, but after an interval of from 24 to 36 hours 
the fever returns, accompanied by a secondary rash re- 
sembling measles. 
With regard to prophylactic treatment, no drug is of any 
service, but overcrowding and faulty sanitation appear to 
favour the spread of the disease. The greatest care should 
be taken in thoroughly disinfecting all fomites, for contagion 
may persist a long time, and the dead should be carefully 
disposed of. 
General Treatment.—Castor-oil, or some warm carminative 
aperient should be given at the onset of the disease, violent 
