44 L. Rogers — Special Bepori on Fever in Dinajpur Dlst. [SupplL 



The tab] eon the previous page shows a very similar class of cases to those 

 in that of the malarial series, and also a very great variation in the duration 

 of the disease. Thus in cases 6 and 8 the fever had only lasted one month 

 and no marked cachexia was present, although the spleen in both cases 

 was very large for such a duration of fever, being down to the navel. 

 In No. 8 the temperature was 100'2 at the time the spleeu puncture was 

 performed, and the slides contained the largest number of bodies met 

 with in any case in the Dinajpur district. In both series of cases 

 darkening of the skin was a marked feature of the majority, and in 

 some instances the patients or their relatives volunteered the statement 

 that the skin had become darker recently. In nearly all of both series 

 there was distinct and often extreme wasting, the face and limbs being 

 very thin, and contrasting with the large abdomens, presented the typi- 

 cal picture of the condition always known as " Malarial Cachexia, " but 

 this remark is equally applicable to those which showed only malarial 

 parasites as to those which presented the new bodies recently described. 

 In short, these examinations throw no light on the very difficult ques- 

 tion of the differentiation of the malarial cases from those which are 

 presumably due to the new bodies, admitting for the present that they 

 are parasites, as they appear to be. It is of course possible that all 

 these chronic cases may be due to the new bodies, and the presence of 

 malarial parasites in some of them was an accidental complication. It 

 appears to be more likely, however, that the new bodies are a form of 

 protozoa very closely allied to the malarial parasites, and producing a 

 very similar train of symptoms, but with a greater tendency to produce 

 rapid cachexial state, and with a greater resistance to the action of 

 quinine in ordinary doses. In view of the above results it is clear 

 that the differentiation of the two forms by purely clinical means apart 

 from spleen puncture will be a matter of extreme difficulty and will 

 require a study of a much larger series of cases than the present one. 

 The fact that one-third of these cases showed the new parasite is 

 sufficient to prove that it is present in a large proportion of these chro- 

 nic fevers. On the other hand, in no less than half the cases neither 

 malarial parasites nor the new bodies could be found even by spleen 

 puncture, although all but two of the patients gave a history of fever 

 continuing for a long time up to the date of examination, and chiefly 

 occurring at night or in the evening. It is clear, then, that no more 

 can be said than that the new parasite-like bodies can be found by 

 spleen puncture in a number of chronic fever cases with large spleen 



larger proportion of this class of cases, nearly every case of so-called ** Malarial 

 Cachexia" having shown the new parasites in the spleen, while they could not be 

 found after deaths from other diseases. 



