﻿ETIOLOGY OF DENGUE FEVER. lo7 



IV. SYMPTOMATOLOGY. 



Tt is of cardinal importance in considering the symptoms and diagnosis 

 of dengue to bear in mind the fact that it presents, in different epidemics 

 and in different individuals in the same epidemic, a variety of clinical 

 pictures ; and that, while there is what may be called typical dengue, 

 there are many variations from the type, and there is no one symptom 

 that can be said to be pathognomonic, or even constant, if we except 

 fever. We do not state positively that even fever is constant, but we 

 are unable to satisfy ourselves that a given case is dengue unless it shows 

 some fever, particularly at the onset. This doubtless accounts for the 

 different descriptions of the disease that have been written. We agree 

 with Guiteras and Cartaya in the belief that many cases can not be 

 properly diagnosed except in the presence of an epidemic. We like- 

 wise agree with them that it is illogical to differentiate subtypes of 

 the disease according to the dominant symptom, so we shall content 

 ourselves with outlining the typical attack, and commenting on the 

 usual symptoms. In doing this we will use the plan of the writers 

 mentioned, whose observations and descriptions we consider accurate, 

 clear and well balanced. 



Invasion. — This is usually rather sudden, and, exceptionally in our 

 experience, may be so sudden that the patient has to sit or lie down, 

 being unable to continue the employment in which he is engaged. One 

 patient was a sentry on post at the time he was attacked, and so sudden 

 and severe was the onset that he had to call for relief. However, many 

 cases have a gradual onset, and it was not uncommon for men to 

 report sick with a history of having felt ill for a day or two, or even 

 three. The onset is usually manifested by pain in the loins, often also 

 in the legs, with headache and fever. Frequently the sensation is one of 

 extreme weariness, rather than of pain. Chilliness is at times, but not 

 usually, complained of. The appetite is nearly always impaired, and 

 vomiting or diarrhoea are occasional features. 



Catarrhal symptoms, such as coryza or bronchitis, are not present, unless 

 as a complication, and are usually due to preexisting causes. Sore throat 

 is described as common in some epidemics. We observed it in very few 

 cases, and consider it rare. The skin is usually much injected, especially 

 over the head and neck. Injection of the conjunctiva and lachrymation 

 are common signs; photophobia is uncommon. We have not seen jaun- 

 dice of either skin or mucous membranes. The early injection of the 

 skin is described by some authors as the primary eruption. We agree 

 with Guiteras and Cartaya in thinking that this term should not be ap- 

 plied to it. There is, in practically all cases, but one eruption, and it 

 appears later, if at all. We have seen one case in which two eruptions 

 appeared, but it was the rare exception which only served to emphasize 

 the rule. 



