Armstrong – Table of Contents

musculo-skeletal pain characteristic of the infection. The viral etiology and mosquito
transmission were established in the first two decades of the 20th century. During World
War II, Albert Sabin (8) described the multiple serological types. The severe form called
“dengue hemorrhagic fever” was described in the early 1950s; it is an important epidemic
disease in Southeast Asia.
In his short autobiographical summary (9), Armstrong lists dengue as one of the
infectious diseases that he contracted during his professional career, but he did not
specify the occasion or the time of his possible exposure in his review. His manuscript (7)
was a comprehensive and up-to-date review of knowledge about dengue in 1923. The
manuscript covered definition of the disease, its importance, geographic distribution and
previously reported epidemics. He described the etiology as a filterable organism in the
blood stream, shown to be transmitted by mosquitoes as demonstrated in volunteers. He
described how the epidemiology of the disease was influenced by climate, age, sex,
diffusion in susceptible populations, economic status, crowding, epidemic case
chronology (epidemic curve) and incubation period.
Armstrong provided a detailed account of symptoms and physical signs including
the onset, primary rash, body pains, fever, secondary rash, gastro-intestinal and genito-
urinary features, pulse, lymph gland involvement, joint manifestations and nervous
system involvement; he listed the characteristic laboratory changes in the counts of red
and white blood cells. He also enumerated associated complications involving the eye,
hemorrhagic tendencies, cardiovascular system complications, relapses and delayed
recovery. He discussed factors in the prognosis for recovery, the approach to diagnosis
and differential diagnosis, and symptomatic treatment to relieve discomfort.