Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 6 (7).djvu/5

 TRANSACTIONS OF THE SOCIETY OF TROPICAL MEDICINE AND HYGIENE. JUNE. 1913. Volume VI. No. 7. Proceedings of a Meeting of the Society on Friday, May 16th, 1918, Sir K. HAVELOCK CHARLES, G.V.C.O., Vice-President, in the Chair. PHLEBOTOMUS FEVER AND DENGUE. By Lieut.-Col. C. BIRT, R.A.M.C.

After an incubation period of from four to seven days, phlebotomus or sandfly fever is ushered in with violent headache, chiefly confined to the forehead and back of the eyes ; pains in the calves of the legs ; discomfort in the epigastrium ; and stift'ness of most of the muscles of the body : the face is deeply flushed and the features are swollen ; the conjunctivae are injected ; vomiting occurs in a quarter of the attacks, and diarrhoea almost as frequently, but constipation is noted in the majority of instances ; the temperature rises rapidly to 101° F. to 103° F., and falls gradually to the normal level on the third or fourth day ; the pulse remains slow throughout the illness ; leucopenia, with a relative decrease in the polynuclears, is an almost constant sign ; there is considerable debility during convalescence ; in an epidemic, more than 90 per cent, of the cases are first attacks, hence a high degree of immunity is afforded after recovery.

This fever is accurately described in Pym's Bulam Fever, in W. Burnett's A Practical Account of Mediterranean Fever, and in J. Hennan's Medical Topography, which were published between the years 1814 and 1830. So exact were the observations of these early physicians that the absence of leucocytosis did not escape them.