﻿ETIOLOGY OF DENGUE FEVER. 14.*! 



comfort in the prsecordium or of a sense of suffocation, and one man 

 had an attack of syncope while eating. In none of these cases were we 

 able to discover any sign of heart, lung, or pericardial lesion. Not even 

 the cardiac rhythm was disturbed during any of our examinations. 



However, the frequency of complaint, and the fact that one man 

 actually fainted, show that the circulation is often disturbed in this 

 disease, and this disturbance prompts us to join with other writers in 

 pointing out the necessity for guarding against accidents from such a 

 cause. 



Hcemorrhages. — Several writers speak of the tendency to haemorrhages, 

 and Guiteras and Cartaya, whose cases were many of them sent to the 

 hospital as yellow fever suspects, noted it in almost a fifth of the cases 

 they studied. We did not observe haemorrhages in any instance, if we 

 except the small capillary ruptures described as an occasional feature of 

 the eruption. 



The possibility of the occurrence of haemorrhages from other parts 

 should be kept in mind, especially in yellow fever countries, for though 

 Guiteras and Cartaya observed none from the stomach or bowels, other 

 writers say they may occur. 



Lymphatic glands. — It is stated by some observers that the lymphatic 

 glands show an enlargement during this disease. This observation we 

 can not confirm, as we saw no lymphatic enlargements except in cases 

 which had shown them prior to the onset of dengue, or who developed 

 inguinal adenitis from coexisting venereal disease. 



Blood. — The results of the examination of the blood have already been 

 considered. 



Urine. — Guiteras and Cartaya state that albumen may often be found 

 in the urine if very delicate tests are used, they detecting it in 41 per cent 

 of their cases. We have never seen any symptoms referable to the urinary 

 system except in a few men who had a coexisting gonorrhoea, and we 

 therefore did not have the urine examined in many instances. We had 

 eight urines examined, and they were all normal but one. However, our 

 experience indicates that in some epidemics the condition of the urine 

 gives more valuable information for a differential diagnosis between 

 dengue and yellow fever than Guiteras and Cartaya thought. 



Convalescence. — Many writers state that convalescence is often pro- 

 longed and tedious, and apt to be protracted by such complications as 

 boils, joint affections, muscular pains, or weakness in the knees. In all of 

 our cases convalescence has been prompt, practically all patients expressing 

 a desire to return to duty as soon as the temperature fell. 



Mortality. — All observers agree in saying that the mortality in dengue 

 is so low as to be almost nothing. During the Australian epidemic 

 94 deaths occurred from the disease in Brisbane. The Eobertson com- 

 mittee estimated that this represented about one death in 1,000 cases; 



