ment of the lymphatic glands (particularly the superficial cervical), orchitis, possibly endocarditis and pericarditis, hyperpyrexia, purpura, and hæmorrhages from the mouth, nose, bowel, and uterus. Miscarriage is rare. The urine sometimes contains a trace of albumin, but true nephritis does not occur.
Variability of epidemic type.— Judging from the published descriptions, there is considerable variety in the symptoms of this disease in different places and in different epidemics. Some authors mention swelling and redness of one or more joints as a common and prominent symptom; others refer to metastasis of the pains, enlargement of submaxillary glands, orchitis, mental depression, hæmorrhages, and so forth, as being frequently present. However this may be, the essential symptoms in well-marked cases are the same practically everywhere, and in all epidemics; these are, suddenness of the rise of temperature, an initial stage of skin congestion, limb and joint pains, and a terminal rubeoloid eruption.
Relapses are not uncommon in dengue, and second and even third attacks during the same epidemic have been recorded. As a rule, however, susceptibility to the disease is exhausted by one attack. According to Hare, in a recent Australian epidemic the immunity acquired by an attack did not persist beyond one year.
Mortality.— In uncomplicated dengue the mortality may be said to be almost nil (O.l per cent., Hare), In the case of very young children, convulsions and delirium may occur and cause anxiety; and in the aged and infirm, and in those suffering from chronic exhausting disease, an attack of dengue may prove a serious complication. Charles describes a pernicious form which, though rare, was very much dreaded in Calcutta. In these cases the lungs became œdematous, and the patient, growing drowsy and cyanotic, rapidly passed into a comatose condition with a tendency to hyperpyrexia, and died. Some writers state that the gravity of any given case is in direct proportion to the abundance of the eruption; others deny this.
