Registered with the Registrar of Newspapers for India under R.N.I 53640/91

Vol. XXVIII No. 17, December 16-31, 2018

Dengue – once reported on

Anantanarayanan Raman

I wish to alert Indian doctors and medical microbiologists about a paper by one H. R. Oswald, M.D. (Surgeon, Mysore Commission) entitled Notes of a case of ‘scarlatina rheumatica’ or ‘dengue’ published in the Madras Quarterly Journal of Medical Science (1867, 11, 158160; freely available in the Internet, edited by William Nathan Chipperfield, Acting Physician, Madras General Hospital & Professor of Medicine and Clinical Medicine, Madras Medical College). This 3-page article by Oswald fascinated me, because this is the first formal article which uses the term ‘dengue’ in India.

I searched for the origins of this mosquito-borne disease (Aedes aegypti). Dengue is Central African in origin. The term dengue (Spanish) has evolved from the Swahili term ka-dinga-pepo, particularly from the middle fragment dinga. The dengue fever spread to South America with the indentured labour from Africa moving to South America in the early decades of the 18th Century. William Robert Smart, a physician attached to the British Royal Navy, in an article Scarlatina rheumatica vel arthritica: break-bone fever, or dengue published in the Transactions of the London Epidemiological Society (1862-1866, 2, 317-335) in the introductory section spells dengue as denguè (the second ‘e’ with a grave accent), which will read as deng-ga (The ‘a’ at the end will read as a short vowel; vel, Latin word for ‘or’.)

Philadelphia (U.S.A.) suffered a major breakout of dengue in 1780, which resurged in the Caribbean island nations and some parts of southern-eastern U.S.A. in different decades of the 19th Century. The breakbone fever referred so because of muscular and joint pains (myalgia and arthralgia), was first recorded and reported in Philadelphia by Benjamin Rush (Rush, B., An account of the bilious remitting fever as it appeared in Philadelphia in the summer and autumn of the year 1780, Medical Inquiries and Observations, 11, facsimile reprint available in the American Journal of Medicine, 1951, 11, 546-550 [ 0002-9343(51)90035-6]; Rush, B, Accounts of Epidemic Diseases and Chronic Diseases, 17791789, 1805, 1, pages 119120). It is this breakbone fever, which got later renamed as dengue across the world.

It entered India rather Madras from the Dutch East Indies (Indonesian island) via passengers from Burma in the mid-19th Century. When I searched for papers on the historical breakouts of dengue fever in India, I was inundated in them. Almost all of them, curiously, indicate that ‘dengue’ was first reported in Madras in 1780, although none provides the original citation. In other words, dengue was not known, in its truest sense, in India until the mid-19th Century. What needs to be factored here is that many of the different types of infectious diseases, including malaria, were known and were broadly referred as ‘fevers’ (jwara, the paper by P. V. Prasad on jwara as known in ancient India offers an interesting read; see Bulletin of the Indian Institute for History of Medicine, Hyderabad, 2001, 31, 103-125) until the 19th Century. The dengue-inducing virus was characterised using serological methods in Japan in 1943.

On reflective thinking, I reject the claim of dengue (or a like illness) as reported first in Madras in 1780. The earliest official recording of ‘dengue’ also referred as scarlatiana rheumatica (which could also mean chikungunya, a variant of dengue fever) in India occurs only in the report of Henry Oswald (1867) belonging to the Mysore Commission (see the first paragraph in this letter).

Two sidebars to this story.

1. Henry Robert Oswald (1827-1892), a Scottish physician, worked for the Mysore Commission, after his stint as an Assistant Surgeon, Madras Medical Establishment, Trichinopoly. Oswald rose in ranks as the Surgeon General of India in later years.

2. In spite of dengue’s infamous popularity in Madras, what always pains me is the erroneous way dengue is said by many, including doctors and TV news readers. They say this word as deng-gu, whereas Standard English dictionaries with pronunciation keys (e.g., indicate this term has to be said as den-ghee. Of course, we may think that we need to say things as people understand them. At the same time, we need to realise that we cannot be perpetuating errors.

In none of scientific articles from India on dengue, have I ever seen the citation of a classic paper by three American surgeons, John Siler, Milton Hall, and Parker Hitchens, working in Manila in the 1920s, which is a shame. Their paper Dengue, its history, epidemiology, mechanism of transmission, etiology, clinical manifestations, immunity, and prevention, published in the Philippine Journal of Science (1926, 29, 1-304), is a comprehensive monograph which cannot be overlooked by anyone interested in this subject.

Drs. Sanjay Pai (Medical Pathologist, Bangalore) and P. K. Rajagopalan (Malariologist, Madras) vetted this letter.

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