77 
boneache is suggestive of dengue. Zipf ( 1896, p. 65) reports backache. According 
to Maxey (1899, p. 435) the bones and muscles soon begin to ache, and on the second 
day the patient feels sick enough to take to his bed; he already feels very Aveak and 
depressed, and the pains in the back and in the joints and muscles of the extremities 
are becoming quite severe; accompanying the bronchial cough there may or may not 
be some pain in the lungs. 
Montana . — At the onset there may be intense soreness seemingly of the entire 
muscles of the body (McCullough, 1902, p. 226). According to Gwinn (1902) there 
may be general aching and soreness of the whole body. Patients while conscious 
usually complain most bitterly of general aching and soreness, and prefer to be moved 
as little as possible, especially after the disease has progressed a few days. Sometimes 
the pain is referred to as being more in the head, in other cases the back, while in 
others it does not seem to predominate at any single point. Wilson and Chowning 
(1902a, p. 132; 1903a, p. 62; 1904a, p. 37) state that the onset is accompanied by a 
severe aching in the bones and muscles, with pain in the back and joints. The 
patient is usually very weak (1903a, p. 45). In case 109 there was no stiffness of the 
neck or back, though some pain was present on pressure over the spinal processes of 
the vertebrae, especially those in the dorso-lumbar region. They also report (1904a, 
p. 37) that cases Xos. 94, 96, 97, 115, 116, 117, 119, and 120 give a history of soreness 
about the tick bite, and pains radiating therefrom which continued until the initial 
chill, but (1902a, p. 133; 1903a, p. 63; 1904a, p. 38) except at the onset the disease 
is remarkable for its freedom from pain. Anderson (1903a, p. 507; 1903c, p. 21) 
reports for the onset some pain in the back and head and soreness of the muscles 
and bones. He states (1903c, pp. 21, 23) that the pain in the head and back is 
usually severe daring the first week, while the soreness of the limbs causes a sensation 
as if the limbs were in a vise, and causes the patient to change position frecjuently. 
The soreness of the muscles is often very severe in mild cases and lasts mitil recovery. 
Anderson (1903c, p. 16) records pains in head, back, and upper and lower limbs 
and soreness of muscles in all parts of the body for case 90; (p. 26) case 116 was 
bitten by tick under the arm on April 13, and the chill on April 19 was followed by 
aching pains; the wound and axillary glands were sore and swollen on Ai:)ril 13, 
soreness was less marked after a few days, but still present; it became much worse 
on April 19, with shooting pains radiating from the axilla, through the shoulder, 
down the arm and side of the body; aching pains in the back followed the severe 
chill and extended over the whole body; (p. 27) case 118 complained of aching pains 
in the back and limbs; (p. 29) case 119 experienced soreness from the wound made 
by the tick bite; pain and swelling was present, extending down the side of the 
head behind the ear to right side of neck; (p. 29) case 120 had pain in back and 
limbs on day preceding removal of ticks, the pains continued the next day; (p. 36) 
case 121 had pain in bones and joints, and (pp. 34, 37) backache on May 10, severe 
pain in back and limbs on May 14, backache and soreness of muscles of legs and 
arms on May 17, no pain in head or back on May 23. Anderson (1903c, p. 40) 
advises Dover’s powders or morphine sulphate to relieve the pain. Gates (1905, pp. 
111-113) states that iu his case 11 the headache was followed by severe aching of all 
of the skeletal muscles, especially severe in the calves of the legs; case 14 complained 
of pains in the tibite, intense backache, pains in ankles and knee joints, and great 
muscular soreness, including muscles of eye; case 15 complained of general muscular 
soreness, severe headache and backache, and great exhaustion; case 16 complained 
(fi aching in limbs and back. 
Ill 1901, case 1 complained of ‘‘general body aching;” case 2 had 
some pain in back and head, and complained of general soreness after 
appearance of the eruption; case 3 complained of backache; case I 
complained of suprascapular and lumbar pains, and later of pains in 
