21l TRANSACTIONS OF THE ROYAL-SoCIETY OF TROI'ICAL MEDICINE AND HYGIENE.
F I R S T R E P O R T E D CASES OF D E N G U E FEVER I N BRITISH GUIANA. BY
E. COCHRANE, M.B., CH.B., D.P.H.
On 1st February, 1933, Miss A. reported the occurrence of a rash on her arms and legs. When questioned, she stated that she had been ill for some days but that the rash had made its appearance only that morning. She was advised to go off duty and her case was referred to Dr. BETTEN¢OURT-GOMES, Senior Physician to the Public Hospital, Georgetown. He arranged to pay a visit and kindly invited me to accompany him. On examination, the legs and arms were seen to be thickly covered with a slightly-raised morbilliform rash : it had commenced to fade. There were a few scattered patches over the back and abdomen. The temperature was 99.0 ° F. and the pulse 56 (her normal pulse was 80 to 85). A blood count showed marked leucopenia : white blood corpuscles, 2,400 ; polymorphs, 30 per cent. ; eosinophils, 2 per cent. ; small lymphocytes, 66 per cent. ; large mononuclears, 2 per cent. Miss A. was of English nationality, single, aged 27 years and had been resident in the Colony eighteen months. She was living at the time with Mr. and Mrs. B. The history of the illness was as follows : 27th January.--Bad frontal headache, aching pain in the back, temperature 102 ° F. 28th January.--Pain in back more intense, headache worse and eyeballs very tender on palpation. Marked nausea but no vomiting, complete anorexia, temperature 99"6 ° F. 29th January.--Bad night, pain all over, especially in the knees and back. The slightest movement of the eyes caused acute pain, temperature 99.2 ° F. 30th January.--Improvement noticed, temperature 98-4 ° F. 31stJanuary.--Improvement maintained, temperature 98.4 ° F. 1st February.--In the morning felt much better but noticed the rash. Towards noon began to feel ill again and by the afternoon had a recurrence of nausea, headache and body pains. Temperature 99 ° F., and pulse 56. Up to this date she had not sought medical aid and had only taken her temperature at night and had omitted to record her pulse.
FIRST REPORTED CASES OF DENGUE FEVER IN BRITISH GUIANA.
2nd February.--Rash practically gone, headache and pains much less severe; vomited once. Temperature 99 ° F., pulse 48. 3rd February.--Rash disappeared, slight headache, great muscular weakness and marked cardiac overaction on the slightest exertion. Temperature 98.4 ° F., pulse 56. Her subsequent recovery was uneventful but very slow. It was noticed that the house was infested with Aedes argenteus, and the patient reported that her host, Mr. B., was suffering from a similar train of symptoms. In his case, the rash was strongly marked, the limbs being densely covered with a raised angry red eruption. Her hostess, Mrs. B., was in good health, but gave an unmistakable history of a similar attack two years previously which fully accounted for her immunity. I had no hesitation in diagnosing these cases as dengue fever especially after previous experience of the disease while in Malaya. Further enquiries revealed three more cases, unfortunately, already convalescent, amongst Europeans in the same residential area. Undoubtedly other cases would have come to light about this time, but the occurrence of an influenza epidemic masked the diagnosis. Six weeks later, a household of three Europeans, adults, one male and two females, who had taken up residence close to the house of the above-reported cases a fortnight previously, contracted the disease. CONNOR (1924), stated that dengue fever had been prevalent in Dutch Guiana in recent years, and foretold its spread in the near future to Demerara. It is noteworthy that it was the same residential area that contributed the highest attack rate in the yellow fever epidemic of 1885. I trust that the publication of this article will serve not only as a record of the existence of dengue fever, but also as an aid to the diagnosis of sporadic cases that undoubtedly occur from time to time. I have to thank Dr. J. A. HENDERSON, Surgeon-General, for permission to publish this article. REFERENCE. CONNOa, M.E.
(1924). Report of Combined Court of British Guiana, No. 24, p. 4.