early in November by a general aggravation of the severity and virulence of the disease. Bad forms of remittent fever were now observed, and severe affections of the spleen and chest became more common. Head complications were also frequent. The parts of the district mainly involved were those already indicated; the eastern and north-western portions still remaining comparatively free. During the fortnight ending 7th November there was an increase of 2,455 in the average daily attendance, which in the week ending 14th November amounted to 8,611 cases. During December acute sickness abated; but dysentery, chronic fever, spleen, dropsy, and cancrum oris-sequelæ of acute fever-were very prevalent.

Remedial measures in Burdwan.

Four Assistant Surgeons, sixteen Sub-Assistant Surgeons, and seventy-three Native Doctors, were deputed to Burdwan during the year in addition to those at work at its commencement. Eighty new dispensaries were opened, making a total of 105, which were in operation in different localities throughout the year. Dispensaries were, however, closed and opened according to the circumstances and requirements of different localities. The largest number opened at one time was 56 in December. The number of cases treated amounted to 1,275,035. Depôts for the distribution of food and clothing were opened throughout the district; 33 of these were organised, and 105,748 persons received relief from them, the total amount of money expended in this way being Rs. 5,630. Advances were made from the treasury on account of food and clothing to the amount of Rs. 22,049. No unusual outbreak of disease occurred in this district, and no relief measures were required. The Civil Surgeon reported that fever was severe in pergunnah Bishenpore in November. He visited the locality and found only the usual autumnal fever and its sequelae. According to the Civil Surgeon of Burdwan the inhabitants of that part of the Bancoorah district which was during the year attached to the Burdwan district suffered severely from the prevailing fever.

Bancoorah.

Beerbhoom.

This district has a reputation for comparative salubrity. The unusual prevalence of fever first attracted notice in 1870, when it was reported to be more than ordinarily severe in the south-east of the district bordering on Burdwan. This is a densely populated alluvial tract situated between the rivers More and Adjye. Sickness subsided as the hot weather approached, and from April to September 1871 the district was healthy. In October fever again broke out in the same tract of country, and appeared also in villages further to the north-west. It subsided in March 1872. In July 1872 the disease again broke out in the old ground, and invaded new localities to the north and west. The mortality on the whole was very great. It is observed by the Magistrate that the low flesh-eating castes, who in previous years had escaped the epidemic, were this year carried off in numbers. Seventeen dispensaries were opened before the close of the year, and 16,301 cases treated in them. Appropriate medicines were distributed through the agency of the police and intelligent natives. Two food depôts were opened in the district.

In 1869 fever resembling the Burdwan fever prevailed in Chunderkonah and Ghattal, which Midnapore. then belonged to the Hooghly district. In 1870 an unusually severe outbreak of the usual autumnal fever prevailed in and around Tumlook and Gurbetta. In 1871 fever of a fatal type broke out at Nowadah and Daspore, having apparently spread from Jehanabad via Ghattal. It was recognised to be the same severe type of disease which was devastating Hooghly and Burdwan. The disease again broke out in December 1872, prevailing severely in thannahs Chunderkonah, Ghattal, Debra, and Daspore, a low alluvial tract lying between the Selye and Cossye rivers, and causing great mortality. Six Native Doctors were deputed to treat the sick, and 24,007 cases were treated by them.

Abatement of fever during the spring

and summer of 1873.-Increase in the autumn.

Fever of the exceptionally severe type above described has prevailed in this district annually since Hooghly. the year 1864. During the cold season, 1871-72, the disease prevailed severely in several parts of the district, more particularly to the west. It subsided as the warm weather advanced, and again broke out in July. The localities mainly affected were Bansberia, Khanacool, Dhuniakhally. Seven special dispensaries were opened, in which were treated 62,289 cases. An epidemic of remittent fever causing much mortality prevailed in many parts of the Serampore sub-division from July 1872 to January 1873. Since the close of the year 1872 fever has gradually abated in the districts of the Burdwan division, and the special dispensaries which had been established for the relief of the sick were closed in Hooghly, as the weather became warmer, and greatly reduced in number in Burdwan and Beerbhoom. Much sickness of a chronic nature, consequent on the acute fever of the preceding season, remained, and the dispensaries which were not closed had abundant applicants for relief. There was a slight aggravation of fever in Burdwan as the rains set in, but no real or general increase of sickness occurred until towards the end of September, when from all the districts reports came that the disease was again beginning to manifest itself. The rainfall of 1873 has been very scanty, the total fall having amounted to more than 20 inches less than the average in Burdwan, and the rainy season came to an unusually early close. The increase of fever has been progressive during October and up to the present month (November 1873), and relief measures have been again set on foot in all the affected tracts. But it is still far below what it has been in past years.

In Beerbhoom and Midnapore those portions of the district which were attacked in 1872 have again commenced to suffer. In Burdwan the disease has been observed to be more severe to the south and west, and to have spread beyond the limits of 1872 to the westward. In Hooghly the worst outbreak has been in the neighbourhood of Serampore. Beerbhoom and Midnapore seem to be suffering as severely as in 1872, and more so than in years previous to that. An attempt has been made to utilize the services of "village compounders," a class of practitioners who have gained what knowledge they possess

of disease and its treatment in our dispensaries, for the purpose of treating the sick under strict and systematic supervision. It was hoped thus to provide permanently for groups of villages a Native Doctor competent to treat ordinary diseases, such as ague, dysentery, and diarrhoea, as well as a more skilled subordinate supervising circle of compounders, whose services might be commanded in more difficult or serious cases. The scheme has, however, so far not succeeded well. Hitherto the severe fever which has been prevailing in these districts of the Presidency and Malarious fever attributed by some to filth and overgrown jungle. Burdwan divisions during the last ten years has been unanimously considered to be an aggravated form of malarious fever. Several theories have been held as to the cause of the special virulence of its type. Dr. Elliot and the special Commission appointed some years ago were inclined to attribute this to insanitary conditions, filth, overgrown jungle, &c. This idea has been exploded, because the fever has been found to maintain no constant relation to the degree of filth, &c. The Hon'ble Baboo Degumber Mitter has strenuously maintained that the special virulence is due to By others to obstructed drainage. obstructed drainage. His data have been called in question by others, and though obstructed drainage cannot be otherwise than pernicious, it is by no means certain that every instance of outbreak of this fever coincides with, or follows the construction of, a road, railway, or embankment. The opposite has indeed been pointed out both by Engineers and Civilians.

Another view attributes the special severity of type of the fever to natural deltaic changes, unequal subBy others to natural deltaic changes. sidence or elevation of the Gangetic delta or spontaneous siltings of water-courses. The gradual progress of the disease westward is claimed as a strong evidence in favour of this view. Colonel Haig, in an able note on the causation of the Burdwan and Hooghly fever, endeavoured to prove that the exceptional severity of type was due to The over-population theory. over-population and destitution, to a weakened vital stamina or power of resisting disease-causes which are ever rife in these districts. This subject is now under very careful inquiry by a special agency.

More recently still the medical officers serving in Burdwan have been describing cases of typhus and The typhus theory. typhoid fever, and some have gone so far as to say that one or other of these fevers constitutes the real epidemic, and that its existence accounts for the exceptional severity of type and mortality. The attention of medical officers has been strongly directed to the importance of very carefully determining the type of the fever. They have been furnished with clinical thermometers, and regular observations are being taken under the supervision of the Surgeon-General. Meteorological observations are also being regularly recorded, but nothing has come out of them yet; except that there appears to be a direct relation between the humidity of the season and amount of rainfall and the amount of fever; though in the height of the rains, and while the land remains partially or wholly

The fungus theory.

covered with water, fever is comparatively in abeyance. Observations have been made in America, France, Italy, and the Mauritius which go to shew that periodic fevers are due to a microscopic plant of the alg class. It has not been found possible as yet to verify this hypothesis in India. In order to make satisfactory observations, a highly skilled observer, furnished with suitable appliances, would have to make prolonged experiments under varying circumstances. Attention has hitherto been so strongly concentrated on devising and applying relief measures, that all the medical officers whose services could be obtained have been employed in supervising the work of the subordinate executive. Government has not, however, lost sight of the importance of systematic scientific observations regarding the exact nature and causation of this terrible malady; and if the agents and appliances can be made available, an inquiry will be initiated for the purpose of obtaining more precise knowledge than we have hitherto possessed.

The Lieutenant-Governor has expressed the opinion that whatever the origin or character of the fever, it marches from place to place by some kind of communication and progression. Places which it has invaded and held for years have been gradually abandoned by it and become healthy again, while it advances over other tracts hitherto healthy, marching onwards by a gradual progress. So much at least seems certain.

Fever did not attract special attention in any of the central districts during the past year. The Civil Surgeon Fever in other districts. of Moorshedabad distinctly states that the Burdwan fever has not extended to that district. In Maldah and Rungpore the habitual autumnal fever is reported to have presented a severer type than usual. Malarious fever was unusually prevalent and severe in all the districts of Orissa; this was associated with a heavier rainfall than usual. The only district of Eastern Bengal in which a specially bad form of fever prevailed was Backergunge. The Civil Surgeon describes an outbreak of remittent fever, which raged in the district from June to January and affected the prisoners in the Burrisal jail in the former month. The disease was very fatal in consequence of frequently occurring lung complications. In Assam no unusual prevalence or fatality is reported, except from Kamroop, where the seasonal malarious fever is said to have been worse than ordinary. Many cases assumed a remittent form, and proved rapidly fatal.

In Behar, Cooch Behar, and Chota Nagpore, the autumnal fever prevailed as usual, but nowhere except at Purneah did it attract very special notice. The district of Purneah is a notoriously malarious tract, and suffered much from a virulent form of malarious fever in September. Special measures were adopted to relieve the sick.

The very peculiar fever or disease known as dengue commenced to DENGUE FEVER. attract notice in Calcutta towards the Its wide prevalence. end of 1871. The disease continued to prevail during the cold weather, and increased rapidly as the hot weather advanced. It continued to rage epidemically during the hot weather and rains, and few escaped its attack. Very few deaths

were caused by it, though the symptoms, violent fever and racking pains, were exceedingly severe during the few days of acute suffering; and the attack was apt to be followed by prolonged debility and rheumatic or neuralgic affections. Cases of relapse were also not unfrequent. The epidemic subsided towards the close of the rains. Cases began to occur in Howrah and Hooghly in December 1871, but the disease did not spread to the suburbs or surrounding district till March and April. All the suburbs of Calcutta were visited, and the epidemic extended all over the district of 24-Pergunnahs. It arrived at different localities at different times, and could always be traced to importation. The outbreak generally lasted for about three months from the date of the first to that of the last case. The epidemic was carried to different parts of the province, and followed the great routes of human intercourse.

It appeared along the East Indian line of railway, and was carried to Eastern Bengal by the Eastern Bengal Railway and the steamers plying to Dacca, Cachar, and Assam. It also spread to Midnapore and Orissa along the Grand Trunk Road. Following the disease along these great routes, we find that it appeared early in the year at Serampore, Hooghly, and Chinsurah, and gradually spread throughout the surrounding district; it broke out in Burdwan in April and invaded the whole district, prevailing most generally and severely in July, August, and September. The reports of the inspecting medical officers of epidemic dispensaries show that few localities escaped, and that the sufferings of dengue were superadded to the more serious sickness caused by the local fever. It appeared in Raneegunge in May and continued to prevail during the two following months. The disease reached Moorshedabad in April, and spread into spread into the district, prevailing from April to September. It was carried across the Ganges to Rajshahye in July, and a limited number of cases occurred, but the disease did not spread into the district. Bhaugulpore was leniently visited in June. In the same month Maldah was attacked, and cases continued to occur till November. The disease was imported into Monghyr from Calcutta about the middle of April, and spread far and wide. It disappeared in August. Jamalpore suffered much during the same period. It broke out in Patna in June and spread to Bankipore, Dinapore, and many parts of the district, lasting till August. In August dengue broke out in Gya, and continued to rage till November. Most of the inhabitants were seized, and the disease visited many parts of the district. It ceased in November. It prevailed in Chuprah from August till December. This district was not much affected. It broke out in Arrah in August, and in Buxar in July.

To the east of Calcutta dengue spread to many parts of Jessore and Nuddea in June and July. It broke out in Dacca in June and continued to prevail till November. Its importation from Calcutta was clearly proved, and many parts of the district suffered. It appeared in Sylhet in August, lasting till October. The only station on the Assam route affected was Goalparah, where a few cases occurred among the European residents in May. Along the south-western route the disease spread to Midnapore, Balasore, Pooree, and Cuttack. It broke out in Midnapore in July, in Balasore in the same month, in Pooree in