The depression, mental and physical, is altogether out of proportion to the lack of seriousness of the disease.
Malaise and anorexia are marked. Constipation is the rule at first.
About the third or fourth day the temperature drops to normal or about that and remains so lowered for from twelve hours to three days. At this time the patient feels much better and views his affection in a less serious light. After this variable intermission the temperature rises to possibly a greater height than primarily, although as a rule it is less marked. This interval, or intermission, separating two periods of fever gives us a chart designated “saddle-back.” There may be only one rise of fever.
This second febrile attack is attended with pains and possibly greater depression than the first accession. It is usually, however, of shorter duration and during this period the terminal rash appears. This is the most characteristic feature of the disease. It generally manifests itself about the dorsal surface of hands and feet advancing up forearms and legs. Later on it may involve all extremities, face and trunk. The eruption is much like that of measles but lacks the dusky red appearance of the measles rash. It may however be punctiform and thus resemble the rash of scarlet fever.
With the appearance of the terminal rash we may have crises such as profuse sweating or marked diarrhoea or epistaxis.
The desquamation is furfuraceous in character and may be attended by marked itching.
In some patients (European) there is a rosy carmine flush of palms of hands and soles of feet. Some authorities have reported glandular enlargements in dengue.
Fig. 137.—Temperature charts of dengue and dengue-like fevers.