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GNATS OR MOSQUITOES — CHAPTEE VIII 



a distinction which, it must be admitted, it would be very 

 difficult to make in practice, the diagnosis between the 

 various forms of pyrexial disturbance, that in India and 

 elsewhere in the tropics are grouped together as " fever," 

 has hitherto been made in a very loose way. 



No statistics as to malaria can be considered to be exact 

 and definite in which the diagnosis is not based on the 

 ascertained presence of the parasite in the blood, and as yet 

 such statistics on any considerable scale are entirely want- 

 ing. No doubt in the majority of cases the symptomatic 

 diagnosis of malaria is perfectly correct, but we are only 

 now commencing to differentiate exactly between remittent, 

 malarial, typhoid, and Malta fevers, and on the other hand 

 there can be no doubt that numbers of cases of transient 

 pyrexia, due really to digestive disturbance giving rise to 

 the absorption of toxic materials from the bowel, and to 

 various other causes, are returned as malaria. Such cases 

 are very common in the dry, hot season, and in a large 

 proportion of them certainly, the most careful examination 

 fails to demonstrate parasites in the blood. 



A certain number of course are really malarial, but are 

 recurrent attacks which, as far as my limited experience 

 extends, appear in this part of India to be usually charac- 

 terised by the presence of the small, round, unpigmented 

 forms unaccompanied by crescents in the peripheral blood. 



In spite, however, of these sources of fallacy the figures 

 at our disposal are really sufficiently conclusive for all but 

 the most exacting. 



Taking the returns of intermittent fever as the least 

 open to diagnostic errors, we find that the last available 

 report of the Sanitary Commissioner with the Government 

 of India shows that in the European army the monthly 

 admissions were as follows : — 



