Synonyms.—Break-bone Fever; Dandy Fever; Broken-wing Fever.

The fanciful and grotesque names which have been used in naming the disease prove its variable character.

From the intense character of the pain, it received the most common and suitable term, break-bone fever; while the peculiar gait of the patient, owing to stiffness of the joints, gave him a grotesque appearance; hence he appeared like a "dandy," dengue being a Spanish corruption, no doubt, of dandy.

Definition.—An acute, specific, infectious fever, occurring epidemically in tropical and subtropical climates, and characterized by two severe paroxysms of fever, separated by an intermission, great muscular and arthritic pains, and attended usually by an eruption.

History.—Brylon was the first to recognize and describe the disease, which occurred as an epidemic in Java in 1779, and which he termed articular fever. In 1780 it appeared in Philadelphia, and was accurately described by Benjamin Rush. From 1824 to 1828 it prevailed at intervals in India, the West Indies, and Spain. It has occurred at intervals in our Southern States and along the Gulf Coast, the last visitation being in 1897. While usually confined to the South, it has occurred as far north as Philadelphia, New York, and Boston.

Etiology.—The nature of the infection or contagion is not yet known, though McLaughlin, of Texas, has isolated and cultivated a micrococcus which he believes is responsible for the disease, That it is infectious is shown by the rapidity with which it spreads when once it invades a section.

Thus, in 1885, within a few weeks, sixteen thousand out of a population of twenty-two thousand, in Austin, Texas, were stricken. Neither age, sex, race, nor position exert any influence in staying the disease, all classes suffering alike.

Pathology.—As few cases prove fatal, but little opportunity has ever been given to study its pathological character. There has been found infiltration of the tissues about the joints, somewhat resembling rheumatism, but not enough is known to speak definitely of the morbid anatomy of the disease.

Symptoms.—After an incubating period of from three to four days, in which there are few, if any, prodromal symptoms, the disease is ushered in with a chill in the adult, and quite frequently by convulsions in children. There is a rapid rise in the temperature, the fever registering 104°, 105°, or 106° at the end of the first twenty-four or forty-eight hours. The pulse and respiration are quickened in proportion to the elevation of the temperature; the face is flushed, eyes injected, tongue coated, and there is nausea and sometimes vomiting. The pain in head, back, and limbs is of an intense character; the patient's complaint is as though his back and limbs would break; hence the term break-bone fever.

The joints are red, slightly swollen, and stiff; there is also general muscular soreness. Although the temperature is extremely high, there is rarely delirium or unconsciousness to relieve the excruciating pain. The lymphatics become painful and swollen. There may be diarrhea, though the bowels are usually quiet; the urine is scanty, though non-albuminous.

The primary fever lasts from three to five days, during which time a rash, varying in character, appears, though not in all cases. It may be scarlatinal, rubeolar, herpetic, papular, etc., and is usually followed by desquamation. This primary fever is followed by an intermission of two or three days, attended by great relief, though there is soreness and stiff ness of the joints, the patient exhibiting the peculiar gait already mentioned. In some cases the temperature becomes subnormal, while in others there is only a remission.

In from two to five days a secondary fever occurs, whereupon all the symptoms of the primary fever are reenacted, though usually in a less aggravated form. This secondary fever is of shorter duration, lasting only two or three days. It is also attended by the same rash as the primary.

Although the duration of the fever is only from seven to ten days, convalescence is apt to be slow and quite protracted. The prostration that follows a severe attack is very marked, the patient being unable to do severe mental or physical work for weeks.

Diagnosis.—When prevailing as an epidemic, and especially when it is of a severe type, there is but little difficulty in establishing a diagnosis. The sudden onset, high temperature, excruciating pain in muscles and joints, and the appearance of the eruption, leave but little doubt. In sporadic cases it may be mistaken for inflammatory rheumatism, but a careful study will soon show the distinguishing features of each.

Another disease likely to be confused with dengue is la grippe. The onset, the marked myalgia, are similar in each, but there the similarity ends.

Prognosis.—It is rare for a case to end fatally, only those of advanced age or persons of feeble vitality succumbing to its influence.

Treatment.—The disease being self-limited, the object of our treatment will be to reduce the febrile state, allay the intense pain, and render the patient as comfortable as possible. Rest in bed should be emphasized, and the diet should be fluid in character; milk and rich broths being best suited to sustain the patient's strength.

For the high fever, use the wet-sheet pack, assisted by veratrum, if the pulse be full and strong, and combined with gelsemium where there is great nervous irritation.

For the myalgia, macrotys, rhamnus Californica, and bryonia will be used, and for the lymphatic involvement phytolacca will be the remedy.

Jaborandi may be useful during the active stage of the fever.

Of course, quinia will be used if the patient resides in a malarial section and if periodicity exists.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.