epidemics, the disease terminates with the fading of the eruption; appetite and strength gradually return, and the patient, after a few days of debility, feels well again. Bradycardia may persist for a time.
The rheumatoid pains.— With most, their troubles do not end so soon. For days or weeks some muscle, tendon, or joint is the seat of the peculiar pains, which may become so severe as to send their victim back to bed again. Sometimes, three or four weeks after all apparent trace of the disease has vanished, a joint or a muscle will be suddenly disabled by an attack of this description. This may occur in patients who, during the acute stage, suffered little or no pain. A finger or toe, or a joint of a finger or of a toe, may alone suffer. Of all the joints, perhaps the knee is most frequently affected; but wrists or shoulders are often attacked, and their associated muscles may even undergo considerable atrophy from enforced disuse. The soles of the feet, too, and the tarsal articulations are favourite sites.
The pains of dengue— those occurring during the initial fever as well as those that may be regarded as sequelæ— are difficult to locate with precision; the joints or muscles affected may be percussed, pressed, or moved with impunity. Du Brun locates those associated with the knee in the thigh muscles, which, he says, are painful on deep pressure.
The pains are worst usually on getting out of bed in the morning, and on moving the affected part after it has been at rest for some time; they are relieved somewhat by rest and warmth. Passive movements are, as stated, not painful, but any resistance to the movement of the limb may cause acute suffering. When a muscle is affected the pain is accompanied by a sense of powerlessness.
Other complications and sequelœ—. Convalescence may be very much delayed by the persistence of these pains; also by anorexia, by general debility, mental depression, sleeplessness, evanescent feverish attacks, by boils, urticarial, lichenoid, and papular eruptions, and by troublesome pruritus. Among sequelæ and complications may be mentioned enlarge-
