Dengue Fever in Penang

two colonies of B. coli on one of the slope agar tubes, no other organism was found. Pericardiunm.-There were evidences of a slight plastic pericarditis, a few flakes of fibrin being adherent to the heart muscle. This condition was not diagnosed during life, and it was entirely owing to the restrictions placed on the necropsy by the parents that none of the fi aid could be properly collected and examined. It is, however, quite permissible to reason that in all probability the condition was pneumonic in origin. Heart.-The right cavity was in a state of slight dilatation, and otherwise the whole organ was perfectly healthy. The valves were absolutely sound, and there was no evidence whatever of any existent endocarditis; and it is, further, a significant fact that no infarcts of any kind were met with in any of the internal organs examined. Elbow-joint.-No sign of inflammation, swelling, or other abnormality was visible. However, I aspirated the joint with a sterile needle, and withdrew a few drops of practically clear fluid containing a small number of floating flocculi. Coverslips made direct from the fluid presented a few capsulated Gram-staining hastate cocci, but cultures both in blood broth and on blood agar remained sterile. I have, however, no doubt in my mind that the organisms were no other than genuine pneumococci. Middle Ear.-During the child's stay in the hospital no discharge or ear trouble ever manifeited itself. At the necropsy. however I introduced in the middle ear on each side a sterile pipette, but entirely failed to withdrawn even one drop of fluid. This is interesting, for on inquiry the mother stated that before the child's admission a discharge from its ears had been noticed for some time. This of course may or may not be true, but for the period during which the child was under treatment in the hospital no ear trouble was ever observed, though on several occasions it was searched for unsuccessfully. In conclusion it may be interesting to trace out in tabular form the time and nature of the various sequential infections: Bacteriological Report. Original pneumonia ... ... March 7-12 ... Diplococcus pneumoniae Left elbow-joint ... ... ... March I7-I8-... I Empyema ... . .. ... ... March 24 ... .. BloocL examined ... . .. ... April 20 ... Cerebro-spinal fluid examined April 24 ... ,, Death ... ... ... ... ... April 28 Necropsy .April 3o Lung squeezing ... ... ... ... ... Diplococcus pneumoniae Elbow-oint ... ... ...