515 
4. Nervous symptoms.—In addition to the headaches, reference is made 
to other nervous manifestations such as insomnia and, particularly, 
depression during convalescence. This depression in our patients when 
we were assuring them that they were well of the disease, impressed us 
as a most striking symptom. In no disease, other than influenza, have 
I seen it so marked. 
5. Lhe eruption—The initial eruption usually is reported to have 
been simply a blotchy flushing of the face and neck which disappeared 
rapidly. The terminal rash was present, or rather observed, in only 
about 50 per cent of the cases. It was stated to have been more like 
the rotheln or measles rash than scarlatiniform in character. This 
report refers to its predilection for the extensor surfaces of the elbows 
and knees and also to a carmine-pink suffusion of the palms and soles, 
which was regarded as being extremely characteristic. 
In our cases the most striking feature of the eruption has appeared 
to be its early and marked appearance about the wrists, on which it 
was more abundant on the dorsal than on the flexor surfaces. I com- 
monly describe it as the bracelet rash, having a wide, dorsal outline and 
a narrower ring of eruption underneath. We have frequently noted the 
rash on the palms of the hands, but it has seemed to resemble the 
erythematous syphilide of the palms more than what should be termed 
a suffusion. In only one of the cases was there an entire absence of 
secondary eruption; the patient being a Chinaman in whom the other 
symptoms and the differential count were quite characteristic. Stedman 
states that he has invariably failed to find the rash in dengue cases 
among the Chinese. 
The symptoms described in connection with changes in the tongue, 
lymphatic glands, alimentary canal, renal and respiratory systems were 
so varied that little weight could be attached to them. 
It is stated that early in the epidemic discussed in the above-mentioned 
report many of the cases were diagnosed as influenza and that in the 
absence of an exanthem in a patient presenting the symptoms of fever, 
muscular pains and great depression, the best means of diagnosing 
dengue was found to be in the almost entire absence of respiratory 
symptoms. It has certainly appeared to me in many respects greatly to 
resemble influenza. 
Shortly after commencing my investigations as to variations in the 
percentages of the various leucocytes, I was greatly interested in reading 
a paragraph of an article by Surgeon D. N. Carpenter of the United 
States Navy * in which the author stated that he had found a most 
characteristic diminution of the polymorphonuclears and a corresponding 
increase in the small lymphocytes in the blood of dengue patients. This 
at once attracted my attention, inasmuch as up to that time I had almost 
*Carpenter, D. N.: Journ. Am. Med. Asso. (1905), 45, 982. 
