30.

     OTHER CONDITIONS LIKELY TO BE THE CAUSE OF BLACK-WATER FEVER.—
If it were not for malaria, the Duars, for a tropical country, should be un-
usually salubrious. There is a cool season lasting several months and the hot
season is, on account of the heavy monsoon, much cooler and less trying than it:
is in Calcutta, Bombay, and Madras. The Europeans live an open and healthy
life, and are not unduly exposed to fatigue or hardship. Diet is com-
paratively good; and not lacking so. far as we can see in any essential
particulars. Yet Europeans in the Duars die from Black-water Fever,
whilst those in Calcutta and the plain's of India, broadly speaking,
do not. In what respect are the conditions different? If diet were at fault
the disease should be as common on the healthy gardens of Assam as
among the planters of the Duars; nor should Black-water Fever occur among the
babus, who do not modify their diet with a change of district. If exposure to
the sun be a cause, the disease should not appear as it does among babus
engaged entirely in office work. That the mere moisture of the atmosphere unac-
companied as it is by great heat should produce such an effect is inconceivable.

     We append a letter in the form of a diary, received from a plan-
ter who was simply asked for particulars regarding his Black-water Fever.
attacks :

     Arrived in India December 1894. Age 21.

1894-95. South Sylhet—

     Constant attacks of malaria. Treatment 60 grains of quinine daily during attacks.
No quinine taken between intervals of attack. No sign of anything approaching
Black-water Fever.

1895-96. Alipur-Duars—

     Constant attacks of malaria. Treatment daily doses of quinine 15 to 30 grains during
and subequent to attacks. No quinine between intervals. No sign of any.
thing approaching Black-water Fever. Constipation general throughout the year
and weight reduced from 12-5 to 11 stone.

1896-97. Alipur-Duars—

     Constant attacks of malaria. Treatment 15 to 30 grains quinine daily during and sub-sequent to attacks.
No quinine in intervals. Malarial attacks culminated in
June in bad attack of Black-water Fever. The disease raged for 10 days and as life
was despaired of I was carried to railway terminus and taken to Darjeeling.
Began to recover rapidly and returned to garden six weeks later. Weight 10 stone.

     Quinine was taken in small lots of 10 to 30 grains on odd days just before the attack as,
I felt " seedy." Was treated for liver, dosed with mercury and black draught, and