Page:Tropical Diseases.djvu/339

XV] rigor; sometimes a deep flushing of the face is the first sign of the disease. However introduced, fever rapidly increases. The head and eyeballs ache excessively, and some limb or joint, or even the whole body, is racked with peculiar stiff, rheumatic-like pains, which, as the patient soon discovers, are very much aggravated by movement. The loins are the seat of great discomfort, amounting in some cases to actual pain; the face particularly the lower part of the forehead, round the eyes, and over the malar bones may become suffused a deep purple; and often the skin over part or the whole of the body, and all visible mucous surfaces, are more or less flushed, that of the mouth and throat being sore from congestion and perhaps from small superficial erosions. The eyes are usually much injected; very often the whole face is bloated and swollen. This congested erythematous state of the skin constitutes the so-called initial eruption.

These symptoms becoming in severe cases rapidly intensified, the patient, in a few hours, is completely prostrated. His pulse has risen to 120 or over; his temperature to 103° F., in some cases to 105°, or even to 106°. He is unable to move owing to the intense headache, the severe pain in limbs and loins, and the profound sense of febrile prostration. From time to time the skin may be moistened by an abortive perspiration, but for the most part it is hot and dry. Gastric oppression is apt to be urgent, and vomiting may occur. Gradually the tongue acquires a moist, creamy fur which, as the fever progresses, tends to become dry and yellow.

Defervescence.— In this condition the patient may continue from one to three or four days, the fever declining somewhat after the first day. In the vast majority of cases this, the first and most acute stage, is abruptly terminated about the end of the second day by crisis of diaphoresis, diarrhœa, diuresis, or epistaxis. When epistaxis occurs the relief to the headache is great and immediate. On the occurrence of crisis the erythematous condition of the skin, if it has not already disappeared, rapidly subsides. In