42 L. Rogers — Special Report on Fever in Dinajpur List. [Suppit. 



in tlie district even in the dry season, but it is not possible to deduce 

 accurately the relative prevalence of each from tbe few cases found at 

 this time of the year. 



A more important question to solve was whether the Leishman- 

 Donovan bodies could be found in chronic fevers in this district, and, if 

 so, the frequency of their prevalence and how to differentiate from ordi- 

 nary chronic malaria. Dina.jpur was an especially interestiug place in 

 which to examine this question, for, as I showed in my report on Kala- 

 azar, that epidemic took its origin in a very severe outbreak of fever in 

 the Dinajpur and Rangpur districts in the early seventies owing to a 

 succession of very unhealthy years on account of deficient rainfall. 'J'he 

 brief description as yet published by Donovan^ pointed to a close 

 resemblance between his cases and Kala-azar, aud he has recently sug- 

 gested that they may be the same disease. For purposes of searching 

 for this new parasite it is necessary to do a spleen puncture, as they 

 have not yet been found in the peripheral circulation. This little 

 operation is without danger if properly done, but it necessitates being 

 able to examine the cases in a hospital and careful antiseptic precau- 

 tions. For over a month a careful watch was kept for suitable cases 

 in the Dinajpur in-door dispensary, but no such case presented itself. 

 On discussing the question with Captain Megaw (to whom I am very 

 greatly indebted for much help throughout my investigation both in get- 

 ting me cases aud in helping in the microscopical examination of some 

 of the slides) he informed me that he had seen a number of such cases 

 at one place only, and that was Ranisankail in the north-west part of 

 the district. When at this place on the village enquiry a number of 

 such cases were met with in the villages around, and they came to the 

 dispensary, which was themost popular one in the district, and by means 

 of ansethetising the surface of the skin with an ethyl chloride spray, 

 spleen puncture was readily performed, even in children, in a painless 

 manner and without the slightest difficulty, on the part of the patients, 

 except in so far that some without fever were disappointed at not being 

 submitted to the new treatment. On a subsequent occasion a second 

 sories were done at the same dispensary, every case with any consider- 

 able enlargement of the spleen and recent fever being taken without 

 any selection, the histories of the cases being also carefully recorded. 

 These cases taken as a whole were exactly those wMiich have always 

 been considered to be '^Malarial Cachexia," some of tliem presenting 

 as great enlargement of the spleen and liver, accompanied by general 

 wasting and darkening of the skin, as seen in typical cases of Kala-azar 



i Donovan, Indian Medical Gu:ettc, December 1903, 



