64! L* RogerB—Special Report on Fever in Dinajpur Bist. [Supplt. 



malaria, but was also effective in preventing the infection of any of the 

 adults in the same lines, although these latter took no quinine whatever, 

 because adults are infected by mosquitoes which have first derived the 

 infection from children as a rule. I have also shown in an earlier part 

 of this report that the main death-rate from acute malaria is among 

 children during the few months of the rainy season and immediately 

 afterwards. If these could be adequately treated with quinine as soon 

 as they developed fever (for its prophylactic distribution to children in 

 villages is as yet beyond the region of practical policy), not only would 

 the main source of death-rate from malaria be stopped, but at the same 

 time there would be much less infection among adults, and fever deaths 

 from chronic malaria and from other diseases such as pneumonia, dysen- 

 tery and phthisis, which so often attack those debilitated by previous 

 malaria. 



In discussing this important question we must first consider how 

 far the present agencies for the distribution of quinine meet the necessi- 

 ties of the case. They are the dispensaries, private practitioners and 

 the post-offices. That the dispensaries effect great good by the treat- 

 ment of fevers with quinine was abundantly evident throughout my 

 inquiry, for in every place where there was a flourishing dispensary the 

 spleen-rate was considerably lower than it was in the neighbouring 

 villages, the differences being much greater than could be accounted 

 for by the position of the dispensary village on a slightly higher and 

 more healthy site in some instances. The difference was most marked 

 among the children of the more intelligent classes, for it was particular- 

 ly marked among the childi'en attending the larger schools. The most 

 striking example met with was that of a school at Churaman which stood 

 next to the dispensary, for among 31 children only two had any enlarge- 

 ment of the organ, or 6 per cent., by far the lowest rate met with in the 

 district. In this instance I ascertained from both the School Master 

 and the Hospital Assistant that the boys were regularly sent to the 

 dispensary from the school when they were found to be getting fever. 

 In Balughat a very similai.^ state of affairs was found. As it was not 

 uncommon for about one-third of the children attending the school to 

 be down with fever at one time in the rainy season, it is clear that they 

 must, most of them, have been treated during the year. The Civil Sur- 

 geon, Captain Megaw, I.M.S., had been struck by this fact before my 

 arrival in the district, and my own experience amply confirms his. The 

 range of such a dispensary unfortunately is seldom more than two or 

 three miles, or five at the outside, so that the quinine distribution of 

 seven dispensaries among the one-and-a-half million persons in the 

 district of Dinajpur is scarcely more than a grain in an extensive sandy 



