DENGUE IN INDO-CHINA. 29 



The third category includes 5 attenuated fevers, in which the tempera- 

 ture did not rise to 39°, such as for example in cases numbered 6, 39, and 

 48; these were fevers associated with malaria, hepatitis, etc. 



Anorexia persists during the evolution of the disease, the tongue is 

 covered with a deep and brownish coating, the breath is foul. We 

 noticed only a few cases of nausea and vomiting was never seen. As a 

 rule there was constij)ation, liut no abdominal pain. Only two patients 

 suffering from malaria had an enlargement of the spleen and another with 

 a long career in the Tropics suffered from hepatitis and his chart was 

 modified by this fact. iSTone of the cases suffered disturbances in the 

 respiratory organs. No albumin was found in the urines which were 

 analyzed. In only one case did we have mild delirium, the temperature 

 at that time being 40°. 4 C. 



The majority of the patients were depressed and tired, but their ap- 

 pearance did not give the impression of a serious illness. The con- 

 valescence was always rapid. 



It is important to state that there were no relapses in our epidemic. 

 In about ten cases we observed a slight desquamation on the arms, 

 mostly in places where there was already ]3rickly heat; but this also 

 appeared on men who did not contract dengue. 



Many writers agree in saying that dengue is extremely benign. This 

 does not seem to be the rule in the Indo-Chinese epidemics and especially 

 not in Saigon where the death rate was 2.12 per cent. We had two fatal 

 cases, death being du.e in both instances to disturbances of the circula- 

 tion. A lesion of the myocardium was present in one; it was revealed 

 by the movements of the heart, which became at the same time weak 

 and accelerated, by the enlargement of the cardiac area on percussion, 

 and finally by the presence of embryocardia. A systolic murmur was 

 heard at the apex of the heart in the second case. Bulbar disturbances, 

 which affected the heart, also appeared at the same time. 



DIAGNOSIS. 



The differential diagnosis of dengue offers some difficulties; it may be 

 confounded with certain other diseases, so that the distinctions on which 

 we based our diagnosis are given below. 



( 1 ) The temperature chart, the absence of liaematozoa, and the inefficacy of 

 quinine permit us to exclude malaria. 



(2) The symptoms have no analogy with typhoid fever, moreover our numer- 

 ous serum reactions were negative. 



(3) Influenza would have been accompanied by catarrh and respiratory 

 troubles. 



(4) We have already given reasons for dismissing spirillum fever by a study 

 of the temperature charts, and it is also true that spirilla would have been 

 discovered in the blood. 



