1248 



DENGUE AND ALLIED FEVERS 



Fig. 630. — Typical Temperature Chart 

 OF Dengue Fever. 



being at times replaced by the opposite extreme of pallor. Jaundice, 

 if it occurs, is rare. Haemorrhages are rare, and will be mentioned 

 as a complication. The changes in the blood have been carefully 

 worked out by Ashburn and Craig. The erythrocytes are usually 

 normal in appearance and number, but a few poikilocytes may be 

 seen, while the haemoglobin and colour-index are also normal. 



Leucopenia is so constant 

 as to be of diagnostic im- 

 portance, varying from 

 4,860 to 1,200, the aver- 

 age being 3,800 per cubic 

 millimetre. The leuco- 

 cytes are normal in 

 appearance, but there is 

 an increase of the large 

 mononuclears and eosin- 

 ophiles, and a decrease 

 in the polymorphonuclear 

 leucocytes. The urine 

 appears to be usually 

 quite normal, except that it is high-coloured, but may contain 

 a minute trace of albumen, and in severe cases Guiteras says the 

 diazo-reaction can be obtained. 



Intermission. — On the third day the temperature usually falls, 

 but rarely reaches to normal. This fallmay be accompanied by the 

 usual signs of a crisis — ^namely, profuse^perspiration, the passage of 

 much urine, violent diarrhoea, and 

 bleeding from the nose — ^but in many 

 cases these signs may be absent . The 

 patient now feels better, except for 

 slight pains, and a genuine intermis- 

 sion in the disease is established. In 

 other cases, however, this inter- 

 mission may be entirely wanting, 

 and the temperature may only remit, 

 remaining at 100° to 102° F. 



Second Attack. — ^The intermission 

 or — generally — ^remission lasts until 

 the fifth day of the illness, when the 

 temperature rises to some point 

 usually below 103° F., and at the 

 same time a rash appears on the palms and backs of the hands, 

 and rapidly spreads to the arms, the trunk, and the legs. This 

 rash may be of two types — a measly eruption of small, circular, 

 dark red maculo-papules, which almost entirely disappear on 

 pressure, or a scarlatiniform eruption of close-set bright red points, 

 which may coalesce and form large red patches. Eruptions inter- 

 mediate in appearance between these two types may, however, be 

 present, and occasionally only an abortive, or no eruption at all occurs. 



Fig. 631. — The Atypical Tem- 

 perature Chart of Dengue 

 Fever. 



