Armstrong – Table of Contents

dengue in September 1922 (1). While there he became ill with the disease. In the review
that he wrote (7), he did not describe his illness, but his publication included a typical
temperature chart of a patient with dengue fever identified with the initials “C. A.” On
returning to his laboratory, Armstrong was unable to pass dengue fever from the blood of
patients to experimental animals including guinea pigs, rabbits, white rats or Rhesus
monkeys. After the conclusion of the epidemic, the State Health Officer of Louisiana, and
the President of the Munroe Board of Health thanked the Hygienic Laboratory (1) for
assigning Armstrong to “investigate dengue fever.”
Dengue (3, 8) is an acute arbovirus infection—a term used to describe any virus
transmitted by an insect (arthropod) to vertebrates—that presents chiefly with fever,
malaise, enlarged lymph glands and rash. Epidemics occur worldwide over large areas of
the tropics and subtropics including the Pacific Basin, Southeast Asia and Africa.
Outbreaks recurred in the Caribbean region including Puerto Rico and the United States
Virgin Islands in 1969. Indigenous infections were recognized in the Continental United
States in 1980 but they have not recurred recently.
Dengue viruses are members of the Flaviviridae (Flavi virus family). Genetically,
they are single stranded non-segmented RNA viruses. They occur in 4 distinct
serogroups, types 1 through 4. The Flavi viruses include yellow fever and Saint Louis
encephalitis. Dengue virus is transmitted from person to person primarily through Aedes
aegypti mosquitoes, although other species of Aedes are involved in Asia and the Pacific
areas.
Dr. Benjamin Rush (8) wrote the first clinical report of dengue based on personal
observations in 1789. He termed the illness “break bone fever” to describe the prominent