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Dysentery.-Most adults dying from malaria exhibit the most intense
anæmia, œdema of the face and ankles or more or less general dropsy
and a form of terminal dysentery. Dysentery in such a connection can
not rightly be considered as the real cause of death, though it is fre-
quently returned as such.
Abortion.-Pregnant women are particularly liable to abort as a
result of acute attacks of fever or as the result of the intensely anæmic
condition that we have described. In the latter case large numbers of
women abort or die before or immediately after childbirth, and even
when the child is born at full time it is small and ill-developed, and very
frequently it is beyond the powers of the mother to nourish it. The ex-
traordinary number of abortions under such conditions has given rise
to the impression that criminal abortion is frequent, an idea but little
supported by actual observation.
General apathy.-We have not infrequently heard it said that
"laziness " is responsible for many coolies not working and that this
in turn makes them sick and anæmic. This is an inversion of the
real facts. A marked feature of the chronic malarial subject is a
characteristic apathy, and it is easy to understand that when, as is very
frequently the case, the percentage of hæmoglobin falls to below 25 per
cent. of the normal the subject becomes apathetic, unwilling to work,
and there commences the vicious cycle that often ends in death.
General unrest and movement of the population.-Where, as in the
Duars, malaria is intense, family bereavement and constant ill-health,
interference with means of livelihood and resulting hardship to depend-
ents, together with a host of other effects resulting indirectly from the
same cause lead to a constant state of shifting in the population.
Movement from garden to garden in the Duars is extraordinarily fre-
quent and seems to be due to a state of unrest produced by a want of the
sense of well-being.
THE EFFECTS OF MALARIA.
In the Duars we see exemplified all the effects of intense malaria.
These may be briefly summarised:-
(a) An abnormally high death-rate and a diminished birth-rate,
not only preventing the natural increase of the population,
1 SC D