(BREAKBONE FEVER)
=Definition.=—An acute infectious disease; characterized by a double
febrile paroxysm, severe pains in the muscles and joints and sometimes
a skin eruption.
=Etiology.=—It is a disease of tropical and subtropical regions.
Unhygienic conditions predispose to an attack. During an epidemic a
single attack is the rule. The disease spreads from place to place
along the lines of travel, attacking both sexes, and all ages. It
occurs in epidemics, practically affecting every one. The specific germ
has never been isolated as it is probably ultra-microscopic but there
is no doubt but that it is carried by the mosquito _Culex fatigans_.
=Symptoms.=—The incubation period lasts about four days. The onset is
abrupt with a slight chill, headache, and extreme pain in the joints
and muscles, of a boring or breaking character. The joints become red,
swollen and painful. The fever rises gradually to 103 or 106 degrees
F., or over. The pulse is rapid and full and the respirations are
much quickened. The face is flushed, the tongue coated, the appetite
is lost, and slight nausea occurs. “Black vomit,” similar to that of
yellow fever, has been observed in this disease. Hemorrhages from
various organs may occur and the lymphatic glands are swollen. The
urine is scanty and the bowels constipated. Febrile albuminuria and
delirium are rare.
At the end of three or four days the temperature falls and there is
a period of remission; the patient is free from pain, but profoundly
prostrated. During this time the eruption generally appears, but is
never constant in character. After a remission of two or three days,
the symptoms reappear and a second febrile paroxysm sets in. This is
usually milder and shorter than the first, lasting two or three days,
when convalescence begins. The duration is, according to medical
writers, from seven to ten days, and convalescence slow. Death seldom
occurs, so practically no pathological changes have been recorded. By
osteopathic treatment, E. B. Ligon has been able to confine the attack
to four or five days duration; this is confirmed by the experience of
N. Chapman.
=Diagnosis.=—During an epidemic the disease attacks all classes alike,
and the distinct remission renders the diagnosis comparatively easy. An
occasional case might be mistaken for acute rheumatism, but the absence
of any glandular swelling or eruption, while the pain is more closely
limited to the joints, will aid in the diagnosis. Care has to be taken
that yellow fever is not mistaken for dengue.
=Treatment.=—The indications of the treatment are to maintain the
patient’s strength and to treat the leading symptoms as they arise.
The severity of an attack can probably be lessened at the start by
strong and thorough treatment of the suboccipital, upper dorsal, lower
dorsal and lower lumbar regions, respectively, so as to control the
large vascular areas by means of the vasomotor nerves of the cranial
region, of the lungs, of the splanchnic region, and of the lower limbs,
thus equalizing the entire vascular system. Elimination should be
pushed and the excretory organs stimulated. Ligon has observed that the
cervical and lumbar regions are especially tender on the second day
and the lower dorsal region on the third day. The most severe symptoms
disappeared within a few hours after treatment and the attack was
markedly shortened.
The high fever may be treated by the usual methods and by the external
application of cold water. The pain is to be controlled, according to
the region affected, by a correction of parts impinging upon the nerve
tissues and by strong inhibition. The entire spinal region should be
kept constantly in a relaxed condition, as far as muscular contractions
are concerned. Particularly should the treatment be extensive along the
spine during prostration. N. Chapman, in addition to the osteopathic
treatment, has the patient drink considerable hot water; also employs
the hot bath. The treatment frequently shortened the attack. During the
entire attack of the disease, the patient should be kept in bed and a
carefully regulated diet administered. Relapses are not infrequent. A
suitable change of air may hasten convalescence.