282 Timehri. 
The great increase in malarial fever is at the time of rice reaping ; we see the 
increase commencing in these settlements about two or three months before 
the cutting, and when the rice cutting is on we have also the people from the 
healthy part of the estates going into the rice-fields ; working excessively they 
lower their natural resistance, often being in the field day and night as well, 
and thus they give every opportunity for infection ; our hospital charts show 
at the rice-cutting season a general marked running up of cages. 
When the rice is cut there is no shade, and the land either dries up or is 
flooded, therefore the anopheles lose their breeding places and diminish 
greatly, although of course the previous generations do not die off at once, the 
people other than those living about the rice-fields have left and we finda 
rapid fall in the fever rate. 
The old creole saying, “ July, you may die ; August, you must ; September, 
remember ; October, all over ;” expresses from experience the unhealthy times 
in years gone by, but now circumstances have altered ; true in these first three 
months we often get some increase of sickness, the weather is hot, dry and close 
and gives rise to irregular (not malarial) fevers, bilious attacks, etc., and drying 
up of the swamps independent of rice-fields may favour the facilities for ano- 
pheles breeding in suitable localities and so there may be some increase of 
malarial fever. We find now, however, that the maximum rise of malarial fever 
cases does not occur in these three months, August the bad month is often with 
us a healthy one, July usually healthy. In 1908 and 1909 the maximum rise 
was in September and October when the rice was reaped ; in 1910 the rice was 
reaped later than usual in October and November, these months then showed 
the maximum rise of fever. The old theory was that the absence of trade winds 
from July to September, and correspondingly depressing weather, was the 
cause of the increased sickness ; it cannot now be connected with trade winds, 
which are present in October and November and usually more or less in Sep- 
tember. The increase of fever about the time of rice-cutting, the occurrence of 
a great increase of malaria on an estate where new rice-fields have been put in, 
and the observation that settlements in the rice-fields are specially affected 
with malaria, are facts too strong to prove other than that malaria is con- 
nected with the rice cultivation. 
In taking in new fields, when the work is done before the surface of the land is 
covered with water, levelling, etc., pools may be formed or exist, and if there is 
shade would be good breeding places for the anopheles ; this may explain the 
occurrence of malarial outbreaks which occasionally occur at that time. 
I give figures of cases admitted to the hospital on one estate, and in dealing 
with these figures we must take into consideration the fact that, when the rice 
reaping is on, , the free people will not come to hospital unless they have bad fever, 
especially if quinine is being distributed generally, which not only prevents 
the occurrence of fever in many people but reduces the severity of an attack, 
If even a daily dose only be taken, they will remain at home, take the quinine, 
and do some work if possible ; after the reaping is over they come much more 
