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list of the cases. The population of Ismailia is about 6000.

  Year     1900     1901     1902[1]   1903     1904     1905  
  Cases of Malaria   2250   1900   1584   214   90   37[2]

Klang and Port Swettenham are contiguous towns in the Federated Malay States, having a population of 4000 and a rainfall of 100 in. a year. At Klang the expenditure has been £3100, with an annual expenditure of £270, devoted to clearing and draining 332 acres. At Port Swettenham £7000, with an annual upkeep of £240, has been devoted to treating 110 acres. In Hong-Kong similar measures were carried out, with the result that the hospital admissions for malaria diminished from 1294 in 1901, the year when operations were begun, to 419 in 1905.

Klang and Port Swettenham.
  Year     1900     1901[1]   1902     1903     1904     1905  
  Cases of Malaria   510   610    199   69   32   23  

A systematic campaign for the destruction of breeding-places has been inaugurated in the British West African colonies, with encouraging results. The planting of eucalyptus trees is out of favour at present, but it appears to have been successful in Portugal, not from any prophylactic virtues in the plant, but through the great absorption of moisture by its deep roots, which tends to dry the subsoil. Treating the breeding-ponds with petroleum or similar preparations seems to be hardly applicable on a large scale, and in any case can only be a temporary expedient. H. Ziemann advocates the destruction of mosquito larvae by the growing of such plants as the water-pest (Anacharis alsinatrum) which covers the surface of the water and suffocates larvae and nymphae. Short of suppressing mosquitoes, the parasitic cycle may theoretically be broken by preventing them from giving the infection to man or taking it from him. The means of accomplishing the former have been already pointed out, but they are obviously difficult to carry out on a large scale, particularly in native communities. It is one thing to protect individuals from mosquito bites, another to prevent the propagation of the parasite in a whole community. Perhaps the converse is more feasible in some circumstances—that is to say, preventing mosquitoes from having access to malarial persons, and so propagating the parasite in themselves. It could be carried out where the infected persons are few, by isolating and protecting them, but not where many are infected, as in native villages. Koch has suggested that the disinfection of malarial persons by quinine would have the desired effect, but other authorities of greater experience do not consider it practicable. In spite of the difficulties, however, there is no doubt that a great deal can be done to reduce, if not stamp out, malaria by the methods indicated, which should be applied according to circumstances. An encouraging example is afforded by the remarkable fact that malaria, which was once rife in certain districts of England, has now died out, although the Anopheles maculipennis mosquito still exists there. The parasitic cycle has been broken, and the insect is no longer infected. The suggested causes are (1) reduction of insects by drainage, (2) reduced population, (3) the use of quinine. Sir Patrick Manson has suggested that the problem of stamping out malaria may be assisted by the discovery of some at present unknown factors. He has pointed out that certain areas and certain islands are entirely free from the disease, while neighbouring areas and islands are devastated. This immunity is apparently not due to the absence of favourable conditions, but rather to the presence of some inimical factor which prevents the development of the parasite. If this factor could be discovered it might be applied to the suppression of the disease in malarious localities.

A few other points may be noted. The pathological changes in malaria are due to the deposition of melanin and the detritus of red corpuscles and haemoglobin, and to the congregation of parasites in certain sites (Ross). In chronic cases the eventual effects are anaemia, melanosis, enlargement of the spleen and liver, and general cachexia. Apparently the parasites may remain quiescent in the blood for years and may cause relapses by fresh sporulation. Recent discoveries have done little or nothing for treatment. Quinine still remains the one specific. In serious cases it should not be given in solid form, but in solution by the stomach, rectum, or—better—hypodermically (Manson). According to Ross, it should be given promptly, in sufficient doses (up to 30 grains), and should be continued for months. Euquinine is by some preferred to quinine, but it is more expensive. Nucleogen and Aristochin have also been recommended instead of quinine. The nature of immunity is not known. Some persons are naturally absolutely immune (Celli), but this is rare; immunity is also sometimes acquired by infection, but as a rule persons once infected are more predisposed than others. Races inhabiting malarious districts acquire a certain degree of resistance, no doubt through natural selection. Children are much more susceptible than adults.

Malaria in the Lower Vertebrates.—Birds are subject to malaria, which is caused by blood parasites akin to those in man and having a similar life-history. Two species, affecting different kinds of birds, have been identified. Their alternate hosts are mosquitoes of the Culex genus. Oxen, sheep, dogs, monkeys, bats, and probably horses also suffer from similar parasitic diseases. In the case of oxen the alternate host of the parasite is a special tick (Smith and Kilborne). In the other animals several parasites have been described by different observers, but the alternate hosts are not known.

Authorities.—Celli, Malaria; Christy, Mosquitoes and Malaria; Manson, Tropical Diseases; Allbutt’s System of Medicine; Ross, “Malaria,” Quain’s Dictionary of Medicine, 3rd ed.; The Practitioner, March, 1901 (Malaria Number); Lancet (Sept. 29, 1907); British Medical Journal (Oct. 19, 1907); Indian Medical Gazette (February 1908).  (A. Sl.; H. L. H.) 

MALATIA (Malatieh or Aspuzu) the chief town of a sanjak of the same name in the Mamuret el-Aziz vilayet of Asia Minor, and a military station on the Samsun-Sivas-Diarbekr road, altitude 2900 ft., situated about 10 m. S.W. of the junction of the Tokhma Su (med. Kubakīb) with the Euphrates, near the south end of a fertile plain, and at the northern foot of the Taurus. Pop. about 30,000, including, besides many Armenian Christians, bodies of Kurds and “Kizilbash.” It is a wholly modern place, rebuilt since the earthquake of 1893, contains fine public buildings, and is noted for its fruit orchards. There are Protestant (American) and Roman Catholic missions, and an Armenian Catholic archbishop has his seat here. Eskishehr or Old Malatia (Melitene), 5 m. N.E. and 3 m. from the great medieval bridge (Kirkgeuz) over the Tokhma Su, is said to owe its present desolation largely to its occupation by Hafiz Pasha as his headquarters in 1838 before his advance to fight the disastrous battle of Nizib with the Egyptian, Ibrahim. But it has still many inhabitants and large gardens and many ruinous mosques, baths, &c., relics of Mansur’s city. It was the residence of von Moltke for some months, while attached to Hafiz’s army. The earliest site was possibly Arslan Tepe about 2 m. south of Eskishehr were two “Hittite” stelae, representing hunting scenes, now in the Constantinople and Paris museums, were found in 1894.

In the time of Strabo (xii. 537) there was no town in the district of Melitene, which was reckoned part of Cappadocia. Under Titus the place became the permanent station of the 12th (“Thundering”) legion; Trajan raised it to a city. Lying in a very fertile country at the crossing point of important routes, including the Persian “Royal Road,” and two imperial military highways from Caesarea and along the Euphrates bank, it grew in size and importance, and was the capital of Armenia Minor or Secunda. Justinian, who completed the walls commenced by Anastasius, made it the capital of Armenia Tertia; it was then a very great place (Procop., De aed.,

iii. 4). The town was burnt by Chosroes on his retreat after his

  1. 1.0 1.1 Drainage works begun.
  2. Nearly all were relapses of previous infection.