﻿144 ASHBURN AXD CRAIG. 



the mortality was relatively greater in females than in males, and was 

 highest at the extremes of life ; patients under 5 years of age contributing 

 37.6 per cent of all deaths, those over 60 years 35.5 per cent. 



We have seen no deaths, and have heard of none during the epidemic 

 we have studied. The disease does its harm from a military standpoint 

 by disabling such large numbers of men at one time. When 600 men out 

 of 1,000 or 1.200 are disabled for a period of at least a week each, the 

 work of the command must, of course, suffer. 



V. DIAGNOSIS. 



As indicated in the consideration of the symptoms, the diagnosis of 

 dengue will often not be made except in the presence of an epidmic, in 

 which case the tendency would probably be to call any painful affection 

 of sudden onset "dengue." 



The fairly characteristic temperature chart, the sudden onset, severe 

 pain, flushed face, the coated tongue, the eruption, and the leucopenia and 

 lymphocytosis, unite to make the ordinary case easy of diagnosis, especially 

 in the presence of an'epidemic. 



Care is required, under various conditions, in differentiating dengue 

 from yellow fever, malaria, influenza, scarlet fever, measles, syphilis, 

 tonsilitis, rheumatism, smallpox, and meningitis. 



Yellow fever. — The differential diagnosis between yellow fever and 

 dengue is probably the most important we have to consider, as the two 

 diseases occur side by side in America, and mistaken diagnosis might lead 

 to the gravest consequences, as a supposed dengue case is not apt to be 

 so carefully guarded from mosquitoes as is a known one of yellow fever. 



Guiteras and Cartaya, experienced in both diseases, say that the most 

 valuable differential signs are the slower pulse, the jaundice and the 

 haematemesis in yellow fever. Xone of these are apt to occur in dengue. 

 Add to this the greater liability to albuminuria in yellow fever, the 

 character of the prevailing epidemic, the mortality, the absence of the 

 eruption and probably the blood examination, which in yellow fever does 

 not show the characteristic leucopenia and lymphocytosis of dengue, and 

 in the great majority of cases the diagnosis will be clear. Nevertheless, 

 it would be the part of wisdom in all doubtful cases to act as though the 

 disease were yellow fever. 



Malaria. — The history and the microscope will usually make an early 

 differentiation possible. In case they do not do so, quinine will do little 

 harm. 



Influenza. — The geographical and seasonal distribution of the two dis- 

 eases do not correspond. Dengue occurs only with the mosquitoes, in- 

 fluenza where mosquitoes are absent and oftenest in cold weather. In- 

 fluenza is usually accompanied by catarrhal symptoms, dengue rarely so, 

 and then only accidentally. Dengue usually shows an eruption of a 



