THE EARLY DIAGNOSIS OF EPIDEMIC HEMORRHAGIC FEVER—EXPERIENCES IN THE FORWARD ECHELONS OF THE MEDICAL SERVICE

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Abstract
A disease new to the military and to western civilization is discussed from a standpoint of early clinical diagnosis. The symptoms and signs of the disease of unknown etiology are given in table form according to their frequency in 50 consecutive patients, which will emphasize the acute, non-specific, infectious nature of this disease in its early stages. Typically the patient comes in during the first 24 hrs. of illness complaining of chills, fever, nausea, vomiting and generalized myalgia, especially in the muscles of the lumbodorsal area. His temp. is 102[degree]-103[degree], the W.B.C. 10-12,000/mm3 and in addition to the findings present in any URI, there is peri-orbital edema, abdominal tenderness which might simulate disease of the liver, gall bladder, stomach or appendix. During the next 2 days his fever remits and petechiae appear in the conjunctiva, the chest or forearms and the urinalysis shows an abrupt albuminuria with or without microscopic abnormalities. Early diagnosis can best be made on the 2d or 3d day of illness; however, during the period of the study, 31 patients were evacuated with one of 8 other diagnoses but were subsequently confirmed EHF patients. In view of the high mortality rate, the grave complications and the special facilities required for care, the importance of early diagnosis is obvious.

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