30 ' VASSAL AND BROCKET. 



(5) Scarlet fever is accompanied by sore throat with glandular swelling, 

 continued fever, and an eruption, none of which symptoms was present in our 

 cases. 



(6) Typhus fever, without eruption, might be confused with dengjie, but 

 only at the beginning of the illness. Later, the extreme prostration, high fever 

 lasting for 10 or 12 days, and the terminal crisis in no way resemble our disease. 



Even now, after the latest discoveries which, though important, have 

 not revealed the cause of the disease and its specific lesions, the diagnosis 

 still is often difficult. Formerly the confusion was so great that dengue 

 was known by twenty-one different names in French and nineteen in 

 English. 



The eruption is a great help in the diagnosis of dengue, but to always 

 expect this symptom may lead to many errors. Certain writers have 

 preferred to call an epidemic of dengue, influenza or malaria, rather 

 than admit that dengue exists without eraption. De Brun, on the 

 contrarjr, writes "the skin eruption is inconstant," and later "dengue 

 distinguishes itself (from scarlet fever and measles) by the contingency 

 of its eruption, which not only may not exist, but also presents the 

 greatest variability in its aspect and in its time of appearance." Cotho- 

 lendy states as follows : "Some medical men affirm that eruption some- 

 times fails," and Martialis adds, "the eruption is not always regular 

 and constant." 



What are the relations between the different epidemics of dengue in 

 Indo-China? The epidemic of 1907 on the Manche was certainly related 

 to that of 1906, since three persons having had the first were immune 

 against the second, although the 1906 epidemic had its origin in Tonkin 

 and that of 1907 in Cochin-China, as we have already stated. Ei-uptions 

 were present in the first, but not in the second epidemic. Consequent^, 

 in Indo-China, dengue can exist either with or without eruption. The 

 inconstancy of the eruption, the relative malignancy, and the very diver- 

 gent susceptibility of Annamese and Europeans might be mentioned as 

 distinguishing the dengue of Indo-China from other known forms of 

 dengue. New experimental investigations will doubtless bring forward 

 facts which will emphasize these arguments or render them void. 



TREATMENT. 



(1) Medicinal. — Anorexia and coated tongue require laxatives. The 

 patient should then be given a light diet. In the iisual course of the 

 disease there is no other general indication for treatment. There are no 

 si^ecific remedies and the different symptoms should be treated by ordinary 

 medication. If tlie hyperpyrexia should become alarming, cold baths 

 should be given. Iced compresses relieve the headache. In malignant 

 forms, hj'podcrmic injections of caffein and cold baths are recommended. 



(2) Prophylactic. — Preventive measures should be directed against 



