1904f.j L. Rogers — Special Beport on Fever in Dinajfur Dist, 33 



T}ie seasonal distribution of the diffeient diseases sliown in this 

 table are just what might have been expected, and thus indirectly con- 

 firm the general accuracy of the diagnosis arrived at. The most strikitig 

 figures are those classed as acute malaria, the diagnosis of which was 

 largely a matter of exclusion of other likely kinds of fever, and the fact 

 that the very great majority of the cases occur in the height of the 

 malarial season strongly supports the substantial accuracy of the data 

 obtained, and also show that the time of the enquiries was the minimum 

 malaria fever season, a fact which is in agreement with the returns of 

 cases treated at the dispensaries of the district. Again, in the case of 

 pneumonia the majority of the cases occur in the cold weather months, 

 when the temperature falls to 30°F., the early mornings being both cold 

 and misty. The cases classed as chronic malaria are more uniformly 

 distributed, yet the largest numbers occur in the latter part of the 

 malarial season, while an examination of the duration of these cases 

 shows that the great majority of deaths from chronic fevers of from 

 one to three months' duration occurred during the late autumn and early 

 cold weather months, being thus doubtless mostly of malarial origin ; 

 while on the other hand most of the cases of very long duration, namely, 

 six months or a year and more, died during the months of from March 

 to July and most frequently in the hot weather season. Most of these 

 latter were probably cases of the cachexial type of fever in which 

 Leishman-Donovans bodies are found. 



The prevalence of the cases classed as enteric in the dry months in 

 the greatest numbers, and the nearly complete absence of them in the 

 wet malarial season is also in accordance with the distribution of en- 

 teric fever in Calcutta, as I have shown in a previous paper.i 



The great frequency of deaths in infants of a few days old during 

 the malarial autumnal months has already been pointed out and dis- 

 cussed. Diarrhoea cases were most frequent in the hot season among 

 children of under one year. 



In the table on the next page, again the most striking and impor- 

 tant figures relate to acute malaria, for it appears that three-quarters of 

 the fatal cases under this heading occurred in children under ten years 

 of age ; and as it is now known that the infection of malaria is also spread 

 mainly through children, it is clear that any measure which will appre- 

 ciably lower the amount of malaria in children will have a most marked 

 effect in reducing the death-rate from this disease. In the case of chronic 

 malaria, too, a large proportion of the shorter and most definitely mala- 

 rial cases also occurred among the children, while the majority of cases 



1 The differentiation of the continued and remittent fevers of the tropics by the 

 blood changes. Trans, of the Medical Chir. Soc, 1903 and Lancet, Voluuae 1, 1903. 



J. 11. 5 



