as 
. 
514 
than is seen in vacuolation as it is ordinarily observed; furthermore, 
on several occasions I have been sure that I have seen movement, both 
amceboid and locomotor. Absence of staining reactions and constant 
watching have made me believe that I was simply observing vacuolar 
distortion from contraction of the red-cell stroma. I feel sure that 
an observer who has not repeatedly examined and carefully studied 
the unstained malarial parasite would in all probability mistake these 
vacuolations for Plasmodwm malarie. 
While convinced of the great value of a differential count in the 
diagnosis of dengue yet, from practically negative findings in two 
undoubted cases of the disease, I should assign to it simply the place of 
a striking symptom and would not consider it to be a pathognomonic sign. 
For this reason it would seem advisable briefly to consider those symp- 
toms which, in my opinion, are the most characteristic. 
A valuable analysis of the symptomatology of the disease is to be found 
in the “Report of the Dengue Epidemic in Brisbane in 1905,” * and in 
presenting my views as to the value of the various symptoms, I think 
I could not do better than briefly to discuss certain paragraphs in this 
report. Taking the symptoms in detail we have: 
1. Onset.—This is stated to be sudden. This has been our experience, 
however, without any case of abrupt onset. There was always a period 
of several hours separating perfect health from manifestations of the 
disease. There was nothing approaching the case described by Martialis 
where one member of a family, who had up to that time escaped the 
disease, was seized in the midst of a pantomime in which he was 
mimicking the sufferings of the others. 
2. Temperature.—This is stated to have ranged between 39° and 39.5° 
C. and most rarely reaching 40° or 40.6° C., it generally persisted as an 
initial rise during two or three days, and after a remission which, as a 
rule, lasted only for a few hours, it was followed by a terminal one con- 
tinuing for one or two days and falling by crisis. 
This has been exactly our experience with the fever, except that at 
times no remission was observed. Again, the fall by crisis almost always 
seemed to coincide with the maximum manifestations of the eruptions. 
3. Pains.—In the report it is noted that post-orbital or frontal head- 
aches were almost always present; that the eyeballs were generally tender 
to pressure and that lumbar pain was almost as common as the headaches. 
In addition, many patients complained of pains in the calves of the legs 
and in the regions adjacent to the joints but never in the joints. Our 
experience has been that, if we except the pains in the head and eyeballs, 
there has not as a rule been marked suffering, the patient experiencing 
more malaise than actual pain. Many of the cases have complained of 
a feeling as if sand were in the eyes. 
2 Journ. Trop. Med. (1905), 8, 355. 
