﻿138 ASHBURX AND CRAIG. 



In a few cases the onset is so gradual and its manifestations so mild 

 that it may not be noticed at all. Case 8 of our experimental series, 

 who also had an sestivo-autunmal malarial infection, is a case in point. 

 The incubation period in this case and the date of the eruption indicate 

 that he had had dengue for about four clays, while a blood examination 

 showed that his chill and high fever of November 25 were of malarial 

 origin. 



Fever. — Fever is in practically all cases present from the beginning, 

 and in the majority it reaches its maximum within twenty-four hours. 

 This primary rise may exceptionally be to 40.5° C. (105° F.), or even 

 41° C. (106° F.), usually it reaches to about 39.7° C. (103.5° F.). 

 In a minority of cases the ascent is gradual (see Case 2) . 



By the end of twenty-four hours the temperature has usually fallen 

 1° C. (2° F.) or more, and the period of intermission has begun. In 

 some cases this drop in temperature is delayed until the beginning of the 

 third day. quite exceptionally the same high point may be reached on 

 four or five successive days (see Case 9). 



However, in the typical case the temperature has fallen as stated at 

 the end of twenty-four hours. The fall may carry it to normal, or 

 only as low as 37.8° C. (100° F.), 38.3° C. (101° F.), or 38.9° C. 

 (102° F.). There it remains, usually until the fifth day. when it again 

 rises to almost as high a point as its early maximum. On the sixth day 

 there is generally a sudden fall, by crisis, to normal, and the disease is 

 ended. Critical discharges do not, in our observation, usually attend 

 this fall in temperature, though profuse perspiration may occur. 



When the chart is "typical" it is very characteristic of the disease, 

 and enables one to pronounce a correct diagnosis at sight. Often it 

 is not typical. The sharp rise on the first day and another on the fifth 

 or sixth day, occur sufficiently often, however, to make the temperature 

 chart at least as characteristic as in many other diseases in which much 

 diagnostic significance is attached to it, as in typhoid fever. 



Guiteras and Cartaya (7) protest against the description of the 

 disease as one characterized by two febrile paroxysms, and contend that 

 the fever is one attack, usually lasting six days, and only exceptionally 

 subsides to normal before the sixth day. We agree with them in this, 

 though we see no more objection to speaking of two paroxysms in this 

 disease, when the temperature does go to normal between them, than in 

 speaking of paroxysms in malaria under similar conditions. 



The variations of this "typical" temperature record are manifold, 

 as is shown in very many charts in our possession. However, in the 

 majority of instances the type may be recognized even through the 

 variations. 



Hyperpyrexia, causing dangerous symptoms, is mentioned as a rare 

 occurrence. We have not observed it. 



