Junk 1907.] 



408 



Miscellaneous. 



of brandy). Eucalyptus oil has lately been highly spoken of, I have myself found 

 a strongly carminative mixture containing liq. hydrarg. perchlor, a most useful 

 mixture. Colomel acted well in the Krian epidemic, gr. 1 every hour, but I consider 

 it requires careful watching. Haffkine's cholera vaccine should be given a trial, 

 it has been well spoken of. Quarantine infected houses, lines, and towns. 



The most satisfactory method of dealing with infected houses is of course 

 to burn them ; if impracticable, then disinfect them thoroughly with 1'500 corrosive 

 sublimate. During the Pahang epidemic the D. O. (Mr. Mason) and I burnt every 

 house in which a case occurred which was within two miles of Raub town, and 1 

 believe that action had much to do with the fact that Raub remained clear. All 

 excreta must be either burnt or buried. Contacts must be also isolated, and they 

 should all be given some acid and mixture thrice daily in order to keep the 

 stomach acid. 



Measures to be taken upon the Outbreak of Cholera, Plague, or 

 Small-pox.— 1. Form bearer, burial, and sanitary companies, equip with stretchers, 

 etc, treat all as contacts, their clothes and hands to be carefully rinsed in 1 in 500 

 corrosive twice daily and after contact. 



2. On the discovery of a case, bearer company will remove patient to 

 hospital, medical officer will remain to see the kuchie opened to the sunlight, and 

 the room either completely limewashed or scrubbed with 1 in 500 corrosive sublimate. 



3. When the washing gang are started the names of the contacts should be 

 taken, they should be sent to the contact shed. Frequent roll calls of contacts are 

 essential. 



4. During the progress of 2 and 3 above, the patient's clothes may be burnt, 

 all his utensils destroyed or boiled. 



5. If the disease shows any tendency to spread, tubs of 1 in 500 corrosive, 

 1 to each 50 coolies must be set up and the clothes of every one in the lines steeped 

 therein for 12 hours. 



6. All utensils of all coolies must be boiled. 



7. All wells must be closed, and a sound, fresh water supply arranged for 

 (this in the case of cholera only). 



8. All coolies must rinse their hands in a solution of 1 in 1,000 corrosive 

 before meals. 



9. Change the bathing places if possible. 



10. Limewash or corrosive wash all benches in the kuchies. 



11. In the case of small-pox universal vaccination. 



12. In the case of plague, plague vaccination and disinfection as above. 



Dengue. — This disease is an exceedingly sudden, and extremely infectious 

 fever, it is marked by severe pain in the bones and joints, a rash usually appears, 

 but in this country is rather fickle in its appearance, in the early stage of the fever 

 it occurs as a simple redness of the general body surface, which is hard to demon- 

 strate on dark skins. The pain in the joints and bones is frequently very serious> 

 and the disease has hence acquired the name of " break-bone " fever. It almost 

 invariably occurs in epidemic form, and rapidly spreads, it may be " seen coming ' 

 and advances from the neighbouring towns rapidly, when it has once declared itself. 



After the primary fever a short interval of calm or freedom from fever 

 occurs, and patients may even feel fit to go to work, but the secondary fever then 

 breaks out, and a rash the true rash of dengue shows up, this commences on the 

 palms and backs of the hands, is best seen on the back of the body to which it 

 quickly spreads. It consists of slightly elevated, circular, reddish brown spots. 



