1904.] L. Rogers — Special Report on Fever in Vivojpur List. 45 



in the Dinajpur district, and that no distinction can at present be made 

 out between the symptoms seen in these cases and in those due to repeat- 

 ed attacks of malaria in which malignant tertian parasites were found. ^ 



With regard to the nature of the bodies found in the former cases 

 .there is little to be said ; for in view of the fact that such authorities as 

 Laveran, Ross and Manson are at complete variance as to the classifica- 

 tion of them, it is useless to add one more to the opinions already ex- 

 pressed with regard to their nature. I will only say that nothing like 

 a trypanosome was ever seen in any of the cases, either in the periphe- 

 ral blood or in that drawn direct from the spleen during life. 1 hope 

 to be able to submit coloured drawings and specimens to high English 

 authorities on protozoa very shortly in the hope that they will be able 

 to throw some light on the question, but in all probability some of the 

 stages of the parasite have still to be discovered. The form most frequent- 

 ly seen is a small oval body slightly longer than it is broad, measuring 

 about one-third the diameter of a red blood corpuscle in its longest axis. 

 It has two nuclei, one of which is small and often rod-shaped and stains 

 deeply, while the other is rounded, considerably larger, but more feebly 

 stained. They are free in the blood from the spleen and in most of the 

 cases are scantily met with, but in exceptional instances, and usually in 

 cases which showed an actual fever at the time the blood was taken, 

 they may be very numerous, a number of them being seen in some 

 fields. In addition to this common form small groups of similar bodies 

 are met with clumped together so as to very closely resemble a quartan 

 sporulating body, some of them being in the act of breaking up. A still 

 earlier stage is sometimes seen in which pairs of unequal sized neuclei 

 are grouped within a single cell, but no separation into the small bodies 

 is yet to be distinguished. These last bodies are somewhat larger than 

 the largest of the simple forms, and appear to be formed by a subdivi- 

 sion of the nuclei of the largest full-grown small forms. I have not 

 been able to detect these bodies in the peripheral circulation by exami- 

 nations of ordinary blood films, but this would not exclude the possibi- 

 lity of their being present in small numbers there. They may be found 

 within the polynuclear white corpuscles, and be thus undergoing degene- 

 ration, which is of interest in connection with the very great reduc- 

 tion of the total leucocytes, and especially of the polynuclears in these 

 chronic fevers which I have previously pointed out. 



Kala-dukh and Kala-azar. 

 In accordance with my instructions to visit the Kala-dukh area of 



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

 the blood changes. Trans, of the Medical Ghir. Soc, 1903, and Lancet, Volume 1, 1903. 



