1904.] L. Rogers — Special Report on Fever in Dinojpur Bist, 41 



for much of the death-rate returned as chronic fevers in my tables, al- 

 though some of them fall under the head of pneumonia and dysentery, 

 as these diseases often attack people debilitated by prolonged fever and 

 prove the actual cause of their deaths. 



The above four circles are those with the highest fever death-rates 

 and the uniformity with which they show a marked relationship between 

 a high ground water-level and high spleen and fever death-rates, a re- 

 lationship which I have repeatedly pointed out in previous reports and 

 papers, 1 is the most striking and important point brought oat by this 

 part of the inquiry. 



PART II.— THE NATURE AND ETIOLOaY AND PROPHY- 

 LAXIS OF THE FEVERS IN DINAJPUR. 



The Varieties of Fever met with. 



It has already been mentioned in the first part of this report tliat 

 the enquiry was carried out in the minimal fever season, and that the 

 village enquiry occupied the major part of my time. Nevertheless, a 

 few cases of fever were met with attending the Dinajpur dispensary, the 

 blood of which was examined for malarial parasites, while on two occa- 

 sions a number of chronic fevers in the most feverish part of the district 

 were examined by means of spleen puncture for the recently described 

 parasite-like bodies found last year in chronic fevers by Leisliman and 

 Donovan, and more recently in a case from Sylhet by Manson and Low. 



Firstly, with regard to the kinds of malaria met with, the common- 

 est variety was the malignant tertian form just as it is in Calcutta and 

 most parts of India. One case of benign tertian was also found in 

 Dinajpur. During the village enquiry a history of quartan fever was 

 obtained in a number of cases in the circle a few miles to the east of the 

 town, and these cases were usually of a chronic nature, terminating fatal- 

 ly after several months of fever. During my last visit to Ranisankail a 

 patient came to the hospital with a history of fever of the quartan type, 

 and having suffei'ed from an attack two days before. An examination of 

 his blood showed typical quartan parasites, some just beginning to 

 sporulate, which would correspond with his statement. These cases are 

 probably much more common in the rainy season, and are of interest in 

 connection with the finding of A. Listoni in the district to be mentioned 

 presently, for in the Duars the Malarial Commisson found quartan fever 

 to be the commonest type and to be also associated with the same 

 species of anopheles. All three varieties of malaria were thus met with 



1 The relationship of the level of the ground water-level to the incidence and 

 seasonal distribution of malarial fevers in India. Lancet, March 12th, 189b. 

 J. II. 6 



