Pathology
As death almost never occurs from the disease there is nothing to note other than the marked leucopenia.
Symptomatology
After a period of incubation of from four to fifteen days the disease manifests itself with striking suddenness, in fact the patient can generally recall almost the hour of the onset.
The temperature rapidly rises and in a few hours reaches a maximum of from 102° to 105°F. Associated with this primary fever we have frequently a blotchy congestion of the face—the so-called initial rash.
We also have intense headaches, principally supraorbital and postorbital. The pulse rate is slightly accelerated at first but soon becomes slow and may fall to 50 from the fourth to fifth day.
There is no involvement of the joints, and the so-called joint pains are really pains of the muscular insertions about the joints.
The backache of dengue is usually a well marked feature. Pain on motion of the eyeballs is a prominent symptom—it is a deep soreness.
Insomnia, characterized by frequent dropping off to sleep to be awakened immediately by disturbing dreams, is often noted.