Alter the disease has run its course, which m typical cases is in six to seven days, the stage of convalescence is reached. This is, even after a mild attack, just as in influenza, frequently prolonged by long continued debility and loss of strength, bodily and mental prostration, insomnia, continuance of gastric disturbances, and often delayed by the persistent itching which accompanies the desquamation. The patients are anemic, have lost flesh, and, according to the Smyrna medical report, "give the impression as if they could recover only with difficulty from a severe prolonged illness." Sandwith and von During call attention to marked loss of weight of many dengue patients, in spite of the brevity of their illness (compare the analogous condition in influenza, p. 667). "There is no disease," says de Brun, "which after so brief a duration shows such a debility as dengue." Influenza, at any rate, does the same.
These are, without exception, unusual.
In the first place, certain hemorrhages must be mentioned, which, remind us of a similar condition in influenza. While, on the one hand, Skottowe never saw hemorrhages, yet in both the earlier epidemics, also at Smyrna in 1889, they were not quite uncommon, and they were also noticed in Constantinople from time to time. We may mention hemorrhages from the nose, gums, larynx, hematuria, hemorrhages from the bowel, and especially from the stomach. Hematemesis was frequently noted in the epidemic in Madras (1872), sometimes in a pernicious form.
A case of fatal hemorrhage from the stomach is mentioned by Mordtmann. Menorrhagia and metrorrhagia were occasionally seen, but premature births, which especially characterized influenza, were exceedingly rare.
Sequelae relating to the nervous system are obstinate neuralgias, especially of the trigeminus. Hyperesthesias and anesthesias do not play the part in dengue that they do in influenza. Meningitis as a complication, severe "cerebral disturbances, epilepsy, paralyses, paraplegia of the lower extremities, were very uncommon. Sandwith mentions but one case of fatal coma.
The cases of endocarditis and pericarditis observed by de Brun are unquestionably due to mixed infections. Pneumonia and pleurisy practically never occur.
Affections of the eye, apart from conjunctivitis, are exceedingly rare. Keratitis and iritis are mentioned.
Of diseases of the ear, but one case is mentioned: "Bleeding from the ear without otitis."
As sequela? relating to the joints, long continued stiffness must be mentioned.