1250 



DENGUE AND ALLIED FEVERS 



Reinfections. — ^These are not uncommon, and each attack may be 

 quite typical, being associated with the rash. 



Diagnosis. — ^This is based on the sudden onset with extremely 

 severe muscular pain, the remission or intermission in the course 

 of the fever on the third or fourth day, the rash generally appearing 

 on the third to the sixth day. The diseases most likely to be mistaken 

 for dengue are yellow fever, malaria, influenza, scarlet fever, measles, 

 rheumatic fever, smallpox, tonsillitis, typhus, and pappataci fever. 



Yellow fever is recognized by its slower pulse, jaundice, albumen in 

 the urine, and hsematemesis ; malaria by its blood parasites ; influenza 

 by the absence, as a rule, of any eruptions and the presence of catar- 

 rhal symptoms; scarlet fever hy the presence of the sore throat with 

 enlarged cervical glands; measles by the catarrhal symptoms and 

 the absence of the severe pains; rheumatic fever by the swelling 

 of the joints; smallpox may be with difficulty recognized until the 

 eruption comes out ; and tonsillitis may be recognized by examining 

 the throat. In the tropics, where enteric is frequently atypical and 

 often begins suddenly, there may be difficulty during the first few 

 days in distinguishing the two diseases. The very severe pains 

 are, however, rare in enteric, and the course of the fever will clear 

 the diagnosis. From typhus it may be diagnosed by the leucopenia. 

 From pappataci fever it may be distinguished by the presence of the 

 rash and the frequent rise of the temperature on the fourth to fifth 

 day. 



Prognosis. — ^This is quite good, as the mortality is usually nil, but 

 in Australia it caused i death in i,ooo cases, principally in those 

 under five and over sixty years of age. 



Treatment.— No rational treatment can be given, as we do not 

 know what the nature of the cause will prove to be. Symptoms 

 must, however, be relieved. The fever and headache may be com- 

 bated with cool sponging and cool applications; the pains by 

 hypodermic injections of morphia or doses of Dover's powder; this 

 will also relieve the nervous symptoms, which otherwise will require 

 bromides. Antipyrin, phenacetin, and aspirin, may be administered 

 with care, and the bowels should be opened by calomel. The diet 

 must be low, and stimulants should not be given. 



Prophylaxis. — Protection against mosquitoes, as described under 

 Malaria, excluding, of course, quinine prophylaxis, is the correct 

 method of preventing the disease. 



SEVEN DAYS' FEVER. 



Remarks. — In our opinion the seven days' fever is dengue or a variety of 

 it. We have come to this conclusion after having had the opportunity of 

 studying epidemics of dengue and of the so-called seven days' fever in various 

 countries. 



History. — This disease was described by Rogers in 1905-08 as a sporadic 

 fever of Indian seaport towns. It is probably identical with Crombie's simple 

 continued fever, and, according to many observers, including ourselves, is a 

 form of dengue. 



