﻿94 ASHBURX AND CRAIG. 



I. INTRODUCTION. 



Having been instructed by the Surgeon-General of the Army to in- 

 vestigate the cause of dengue and to determine the possibility of the 

 transmission of the disease by mosquitoes, we undertook the experiments 

 to be detailed below when the opportunity was afforded us by the occur- 

 rence of the disease in epidemic form at Fort William McKinley, Province 

 of Kizal, Luzon, P. I., 5 miles out of Manila, 



The incidental investigation of available literature on the subject in- 

 dicated to our minds that a brief discussion of all the features and phases 

 of the disease would not be out of place, as there are discrepancies to be 

 reconciled and certain doubts to be settled, some of which may possibly 

 be ended by our conclusions, while on the other hand some points on 

 which our experiments leave us in doubt seem to be strengthened by the 

 history of the disease as recorded in the literature. 



The literature has not been nearly as accessible to us as we could 

 wish, and several articles, both old and new, which we desired to consult, 

 were not available. 



The first question that merits discussion in the consideration of this 

 disease concerns its existence as a disease entity. At times the question 

 of identity with influenza has been raised. 



However, in our opinion, the study of the writings of those men who 

 have had experience with dengue should promptly and finally settle the 

 question. The agreement in the descriptions from 1827 and 1828, when 

 Dickson, Squaer, Osgood, Dumaresq and others wrote of the disease, down 

 to the latest articles accessible, such as those of Guiteras and Cartaya, is 

 remarkable, while the almost simultaneous appearance from opposite sides 

 of the world of two reports agreeing so closely throughout as do those of 

 the Australian committee and of Guiteras and Cartaya, is even more 

 striking, and the clinical picture drawn from these writings from almost 

 a century of literature and from every part of the tropical and sub- 

 tropical world is quite distinct and unique. It has very little in common 

 with the picture of influenza, and many points of difference, and in our 

 opinion it would be only the exceptional case that would give rise to 

 confusion. 



II. EPIDEMIOLOGY. 



1. HISTORY. 



The written history of dengue extends back clearly as far as 1827, while it 

 is quite probable that it was recognized and described much earlier: By Hush (1), 

 in 1780, as "bilious remittent fever;" by Boylon, in Java, in 1779, while 

 Thomas (3), speaks of Pazzio describing an epidemic in Seville, in 1764-68, which 

 was traced to Africa. Dickson's (2) writings, however, first brought the question 

 into prominence, at least with Americans, and his observations and descriptions 

 are applicable to the disease as it occurs to-day. 



The number of writers, from the earliest down to the present, who have 

 likened the disease, in its causation and spread, to yellow fever, is very striking. 



