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464
MALARIA


and A. costales (Africa). In colour Anopheles is usually brownish or slaty, but sometimes buff, and the thorax frequently has a dark stripe on each side. The wings in nearly all species have a dappled or speckled appearance, owing to the occurrence of blotches on the front margin and to the arrangement of the scales covering' the veins in alternating light and dark patches (Austen). The genus with which Anopheles is most likely to be confounded is Culex, which is the commonest of all mosquitoes, has a world-wide distribution, and is generally a greedy blood-sucker. A distinctive feature is the position assumed in resting; Culex has a humpbacked attitude, while in Anopheles the proboscis, head and body are in a straight line, and in many species inclined at an angle to the wall, the tail sticking outwards. In the female of Culex the palpi are much shorter than the proboscis; in Anopheles they are of the same length. The wings in Culex have not the same dappled appearance. Anopheles is also a more slender insect, with a smaller head, narrower body and thinner legs. There are further differences in the other stages of life. Mosquitoes go through four phases: (1) ovum, (2) larva, (3) nympha, (4) complete insect. The ova of Anopheles are tiny black rod-shaped objects, which are deposited on the water of natural puddles, ponds, or slowly moving streams, by preference those which are well supplied with vegetation; they float, singly or attached to other objects or clustered together in patterns. They can live in brackish and even in sea water. The larva has no breathing-tube, and floats horizontally at the surface, except when feeding; it does not frequent sewage or foul water. The ova of Culex, on the other hand, are deposited in any stagnant water, including cesspools, drains, cisterns, or water collected in any vessel; they float in boat-shaped masses on the surface. The larva has a breathing-tube, and floats head downwards; when disturbed it wriggles to the bottom (Christy). Some observers maintain that Anopheles does not “ sing,” like the common mosquito, and its bite is much less irritating. Only the females suck blood; the act is believed to be necessary for fertilization and reproduction. Anopheles rarely bites by day, and then only in dark places. In the daytime “ the gorged females rest motionless on the walls and ceilings of rooms, choosing always the darkest situations for this purpose ” (Austen). In temperate climates the impregnated females hibernate during the winter in houses, cellars, stables, the trunks of trees, &c., coming out to lay their eggs in the spring. The four phases are passed in thirty days in a favourable season, and consequently there are ordinarily four or five generations from April to September (Celli).

The most important question raised by the mosquito parasitic theory of malaria is that of prevention. This may be considered under two heads: (1) individual prophylaxis; (2) administrative prevention on a large scale.

(1) In the first place, common sense suggests the avoidance, in malarious countries, of unhealthy situations, and particularly Pro-
phylaxis.
the neighbourhood of stagnant water. Among elements of unhealthiness is next to be reckoned the proximity of native villages, the inhabitants of which are infected. In the tropics “ no European house should be located nearer to a native village than half a mile ” (Manson), and, since children are almost universally infected, “ the presence of young natives in the house should be absolutely interdicted ” (Manson). When unhealthy situations cannot be avoided, they may be rendered more healthy by destroying the breeding-grounds of mosquitoes in the neighbourhood. All puddles and collections of water should be filled in or drained; as a temporary expedient they may be treated with petroleum, which prevents the development of the larvae. When a place cannot be kept free from mosquitoes the house may be protected, as in the experiments in Italy, by wire gauze at the doors and windows. The arrangement used for the entrance is a wire cage with double doors. Failing such protection mosquito curtains should be used. Mosquitoes in the house may be destroyed by the fumes of burning sulphur or tobacco smoke. According to the experiments of Celli and Casagrandi, these are the most effective culicides; when used in sufficient quantity they kill mosquitoes in one minute. The same authorities recommend a powder, composed of larvicide (an aniline substance), chrysanthemum flowers, and Valerian root, to be burnt in bedrooms. Anointing the skin with strong-smelling substances is of little use in the open air, but more effective in the house; turpentine appears to be the best. Exposure at night should be avoided. All these prophylactic measures are directed against mosquitoes. There remains the question of protection against the parasite. Chills are recognized as predisposing both to primary infection and to relapses, and malnutrition is also believed to increase susceptibility; both should therefore be avoided. Then a certain amount of immunity may be acquired by the systematic use of quinine. Manson recommends five to ten grains once or twice a week; Ross recommends the same quantity every day before breakfast. There is some evidence that arsenic has a prophylactic effect. An experiment made on the railway staff at Bovino, a highly malarious district on the Adriatic, gave a striking result. The number of persons was 78, and they were divided into two equal groups of 39 each. One group was treated with arsenic, and of these 36 escaped altogether, while three had mild attacks; the remaining 39 who were not treated, all had fever. In a more extended experiment on 657 railway-men 402 escaped. This was in 1889; but in spite of the encouraging results the use of arsenic does not appear to have made any further progress. Experiments in immunizing by sero-therapeutic methods have not as yet met with success.

(2) Much attention has been directed in scientific circles to the possibility of “ stamping out ” epidemic malaria by administrative measures. The problem is oneAdminis-
trative
Measures.
of great practical importance, especially to the British Empire. There are no data for estimating the damage inflicted by malaria in the British colonies. It is, indeed, quite incalculable. In Italy the annual mortality from this cause averages 15,000, which is estimated to represent two million cases of sickness and a consequent loss of several million francs. In British tropical possessions the bill is incomparably heavier. There is not only the heavy toll in life and health exacted from Europeans, but the virtual closing of enormous tracts of productive country which would otherwise afford scope for British enterprise. The “ deadly ” climates, to which so much dread attaches, generally mean malaria, and the mastery of this disease would be equivalent to the addition of vast and valuable areas to the empire. The problem, therefore, is eminently one for the statesman and administrator. A solution may be sought in several directions, suggested by the facts already explained. The existence of the parasite is maintained by a vicious interchange between its alternate hosts, mosquitoes and man, each infecting the other. If the cycle be broken at any point the parasite must die out, assuming that it has no other origin or mode of existence. The most effective step would obviously be the extermination of the Anopheles mosquito. A great deal may be done towards this end by suppressing their breeding-places, which means the drying of the ground. It is a question for the engineer, and may require different methods in different circumstances. Put comprehensively, it involves the control of the subsoil and surface waters by drainage, the regulation of rivers and floods, suitable agriculture, the clearing of forests or jungles, which tend to increase the rainfall and keep the ground swampy.

The city of Rome is an example of what can be done by drainage; situated in the midst of malaria, it is itself quite healthy. Recent reports also show us how much may be done in infected districts. At Ismailia malaria was reduced from 1551 cases in 1902 to 37 cases in 1905. The cost of operations amounted to an initial expenditure of 6.25 francs, and an annual expenditure of about 2.3 francs per head of the population. “ The results are due to mosquito reduction together with cinchonization." The following is a tabulated