.

Reliable lymph points should always be used. Clean the skin near the
insertion of the deltoid muscle on the arm, and with a clean (sterile)
knife or ivory point, a few scratches are made, deep enough to allow a
slight flow of liquid, but no bleeding. The vaccine virus moistened, if
dried on a point, is rubbed into the wound and allowed to dry. A piece of
sterile gauze, or a "shield," is used as a dressing. This shield can be
bought at any drug store. One vaccination may give immunity for ten to
twelve years, but it is better to be vaccinated every six years at least.

DENGUE. Break-bone Fever, Dandy Fever.--This is an acute infectious
disease characterized by pains in the joints and muscles, fever, an
initial reddish swollen eruption and a terminal eruption of variable type.
It occurs in the tropical regions and the warmer portions of the temperate
zone. The disease appears in epidemics, rapidly attacking many persons.

[INFECTIOUS DISEASES 209]

Symptoms.--Incubation lasts from three to five days without any special
symptoms. The onset is marked with chilly feelings, an active fever with
temperature gradually rising. There is severe pain in the muscles and in
the joints which become red and swollen. There is intense pain in the
eyeballs, head, back and extremities. Face looks flushed, eyes are sunken,
the skin looks flushed and mucous membrane looks red. This is the
beginning rash. The high fever falls quickly after three or four days,
sometimes with sweating, diarrhea or nose bleed. The patient feels stiff
and sore then, but comparatively well. A slight fever returns after two to
four days, although this sometimes remains absent. Pains and eruptions,
like scarlet fever or hives, appear. An attack usually lasts seven to
eight days. Convalescence is often long and slow, with stiffness and pain
in the joints and muscles and great weakness. A relapse may return within
two weeks.

PHYSICIANS' TREATMENT for Dengue.--An anti-plague serum is sometimes used,
though with doubtful results. The pain is controlled by doses of morphine
of one-eighth to one-fourth of a grain every four or five hours. Hyoscin,
one hundredth of a grain, is also given for the pain. The high temperature
can be relieved by cold and tepid sponging. Tonics are given during the
convalescence and continued for some time.

CEREBRO-SPINAL MENINGITIS.--This is an acute infectious disease. It comes
in epidemics, when there are many cases, or appears here