장음표시 사용
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sudden rise There is an advance fro l0.8ll ora5.865 followed by a regula descent. The law of l 900 o quinin hardi seem tohave produced an chanse belare 190q, when the mortalit is 8.q65. but the downwar curve ecomes more marked rom ea to ear, reachin the figure of 2.045 in l9lq. The war, for man rectSonS, resulte in B increas which. in the influeneta ear, produce li,q87 deaths, ut in 192 the curve hadalmos resumed the pre-war levet with 2.27 deallis. Ital fori years ago forme one immense focus of malaria: at present the oscialifinfected zones on*ic py bout one-thirci of the tota supersicies. The compris a par of the Lombardian lain. Emilia, and the coas of Venetia, as far a Istria this norther regionis the ne here the cases are mildest o the contrary the Mediterranea coas and the out o Italy the Adriati plain of the Abrueteti and the Molis an Apulia, then the coasis o Calabria, as mel a the whole of Sicily, and above ait Sardinia are trichen with malaria in a grave form. At What cost has his resul been chievedyThe profit on the sale os quinine fro 19084 1923 were in round figures 2 militon ire of whicli more then II millio have so farbeen eoote to the struisse in the formis direct expenses o Subsidies to the associations participatins in the delance work To this there must be adde the expenses of the province and the colonies Rome has a malaria udse of millio per earin the associations
In addition here must e ut down o the debit side the sumsappropriate by the Ministr o Public orks for ork of sereat bonistrations hic in fixi years represent more than Ag milliata. I may be sal that durin the last twent years the State has expende for the reclamationis marshy solis particularly in the province of enice and Rome and for humanionification, that is, anti- malaria defence in an a sum hicli annuali may be estimate atl7l million ire.
I Seems that we a sum a follows the resulis of our obServationSandisu data a to the causes and conditions os malaria in Italy, as et a the method used, advised by the sanitar administrationan malaria specialist in the strussi against this grave infection: l. tal found itfel unde the mos favourabie seographical and climati conditions for the occurene of malaria:
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2. It was a matteris necessit to Italy, in te of the smali extentos iis furface sultabie or agriculture and the frowth of iis population, toclook or land for intensive cultivatio at the expense of iis marshes: 3. The anti-malaria legislatio takin iis inspiration rom scientificdiscoveries introduced hygien into the great work of reclamationis marsh solis: ut it is bove ali the la o State quinine, hich. by allo in os a liberal distributio of this produci for treaiment and prophylaxis, resulte in an indisputabie reductionis the reservoi of
q. The immense e r of the Governmen and the charitable associations has reduce to one-thir the declare malaria area of the peninsula an has in particular resulte in a note orthy decreas inmortalit and morbiditY:5. fill the means used in Italy the greates importance is attachedio rea bonification it it hydraulic agricultura an hysienicconditions but in orde tot effective it musti accompanted formion time by an aggregate os caresuli supervise measures: 6. Human bonitication that is the definitive cur of the patientand temporar quinine prophylaxis of the exposed individual certaini constitutes liat ali Italia malaria specialisis conside a theessentia potnt of the strussie: 7. Mechanica protectio and the destructio of insed infecisare mons the mali measure mos reccommende by the fame scientisis:
8. Anti arva meastares are sesul, bove ali in the immediate enuirons os inhabited places thei application is a questionis circum-Stance and place: 9. Finalty biolostica protectioni farm animal appears in certain localities to sive such resulis suo justiis further investigation: 10. The reclamation D country anci ita retur toraealth cannothe done in a Gy. It is the resulis of tensili agricultural work includin large scale reclamation , of the constant modificationis the soli soras to utilis ali the Suriace mater, the prosperit os land-owners and thei labourers, the more comfortabie installationis thei dwellinus, thei belle hystene in hori. of the welibein the secure andalso of thei senera education ali of them conditions hic placethem in an excellent posture os defence.
I may be sal that in thecias resori, it is the weII-beino of the population hich resulta in the transformation ansciisappea rance of
malaria. Presse Medicate, Paris. 1 nov. l92q. No. 93 p. 951 - 1953
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HYGIENE IN NATIONAL O UNIVERSA ECONOMY 57 HYGIENE IN ALLIANCEMITH NATIONALAN UNIVERSA ECONOMY
PRO F. DR REI NE MULLER COLOGNE
Ordinar Professor o Hysiene an Bacteriolosy
l muniversa economy, malaria has umio his Ay, presente the principat obstacle to the conques of the tropic by European civilisation It was frequent ii us a late a 90 ears ago in Aix-la-Chapelle Iulich. revenbroich. Duisburs citio appear in Russi again a a concomitant of the disturbe orderis affairs upinio the far North. includin even Archangel. In India. ut of 325 millio inhabitant a least 100 millio tali sic wit it every ear. severa millio of them dyins Thus in l917. in India more than imillio death fro laver ere reported in hic malaria played achie part Theseopte horare unde the courge of this itines maybe assume at 800 million But e remo longe powertes againStit. e no the cause the prologoon hicli destroy the lood corpuscle, e have for 25 ear known the carryin vehicle the Anopheles ever mosquito moreover e no have a reatly good remed for the disease Already the tropic have lost much of their terror They aremo longe the grave of the European, a Batavia Wasonce Alled. It almos seem a thous no the Unite States in particular destre to utilis the bases create by science or a socia fightins organisAtionis a reat scale against malaria There in the subtropica Southern States there are stili id stretches of territorY.bisse than Germany in hic agriculture and economi conditionsare very backward. In the Mississippi setilements malaria, hi marshfeVer frightens the settier a a in spite of the enormous stret heso exceedinsi fertile soli. Theraealth pioneers of the Rockefelle Foundatio SicyectrS Goundertook o ho in severa places that malaria canae eradicated, even in the very midstis plague-strichen enuirons as in the district
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58 HYGIENE IN NATIONAL O UNIVERSA ECONOMY
this in spite of the fac that in the environs the laver continued toras in the fame old way And what was the cost of this restorationis the transallantic Hamburuhers In the first year 19 17 l doliar q5 cenis per head of the population, and in the folio ins years only 42 cenis. 69 cents. 8 cenis. 63 cenis. Tahin an veras of 35 lowns it was found that is the strusule had Once been sotns in Hown at a cost offlighil more hanci dolia per head forin year, only 25 cenis more per head were required to make the resulis permanent an kee thelowns practicali laee rom malaria. The economic justificatio of this fish is clearly evident Theexpense Alone per annum per head of the population, for malaria formeri exceededra doliars, par Domini the unpleasaniness, and danser of sichness. And that is precisely what the Rockefelle Commission ante to how in these regions that to kee healthycis much cheaper thanaein ill and that it is possibi to remain healthy, even in those ho regions.
Erom the Commemmoration speech on the thir foundation ceremon of the Universit os Colosne 1923, p. 12-l33.
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UEBER RIEGSMALARIA LECTURE OF THE DIVISION FOR TROPICA MEDICINEO THE GERMAN COLONIA CONGRESSO THE im D 18in SEPTEMBER. 1924
DURING the worid a the extensionis the scene os operationScreate the conditions for disseminationis malaria both in thearm an in the civi population Thus it was that in the German Army, cases of malaria reache the hishest figures, partfrom exuat diseases there ere recorde in the rst year of war0-35'Ibo, in the secon year -32 4 in ne hird yea 6 2 4 and in the Murth year 13 7 M. The speakerratio si means os curves that the maximum number of increases occurred belween Iulrand October. but that the annua curves how a second apex in April to Iune. In reton armis the morbidit and mortalit from malaria asmuch reater than in the German. O the Enulisti Salonilia front, accordin to Phear the cases in l9l6 and 19 17 were about 333 d. in ali three ear tosether 1053 o. The malaria mortalit was in
it wasmearly 9 times es than amon the French. O in to the retur os uerm carrier malaria again preAd Strongi Amon the home civilians accordin to the communication
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The wides dissemination o malaria howeve occurre a a resultos the civit,ar an famine in Russia, here, accordin to Muhlens. it extended a farras Archanget.
The speaher then deal in delati,it possibi sequelae of malaria in sociar a the are likel to affect the questionis injur due tomilitary Service pernicious anctemia leucaemict Polystobulia cacheXy.skin diseases in spleni tumour' i os opinio that a permanent chroni tumour of the spleen hould noti cur after energetic reat-ment rupture of the spleen did not occur during the war. wellinso the liver tuns symptoms, hear SymptOmS. kidne affections dis- eases affectin the nervous System, hic lalter in particular played
great part under a conditionS. Fro the therapeuti standpoint, in a malaria, the inchona
The question o quinine resistenc is ostreat importance Thespeaker distinguishes threelinds l. occasioned by the parasites takinsu thei preferentia abod in interna capillar regions 2 that dueto endosenou quinine resistence of certai races of parasites 3 that conSequentipon absence of powers of immunit in the patient Thelalter formio doubi occurred most frequently in war malaria Therapeuticatly the resistent war malaria was stili Mund tot most favour- abi influenced by the combinationis pomerfui quinine plus neoSal
Finalty the speaker sumsi his a experiences to the effect that malaria in spite of the heau sacrifices it entailed both durinu the last mort war an since, an e combate wit considerable success. sive eners and the se of the right means. Durin the discussion A. Pleh says: The clinica peculiarities of war malaria culminate in the obstinac with hic it osten resisis quinine trectiment. The actionis quinine nodoubi consists of a stimulus
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itself Accordin0 to the biological law of Arnes-Schultete smali stimuli. assist large ne inhibit Ver large ne paralySe Ver large doses o quinine mouid therelare, to a the least, iei no aduantase Acondition precedent in ach AS is a certain capacit for reactionis the organism, hicli is undoubtedi in par conditione by psychic factors. Is his is lachin the the larges quinine doses are ineffectiveor are even unlavourabie in thei action. Under his headin comethe greater par of the refractor cases of war malaria. Claus Schillino Accordinaeto observations o service men, mnlctrindies ut after about 3 years Malaria in German has ather fallenoff than increased sine the war. y the instructions of Ouo-Berlin. Schillin also states as early a l906 Muli potnted out that by the carryins ut o quinine prophylaxis in the German ExpeditionaryForce in China the occurrence of ne cases,as stillied to the folio insyear. A like observation a made by Otto a the Narocet Lahe: two division which were in that resion in the previous yearaad, in the prins of 19l more cases than ne hichaad newl arrived whil on the other hand in a division transportexto the west, in region re hom malaria, in the prins of 19 17 more cases of malaria occurred than in l916 in the East. Fulleborn Without quinine prophylaxis durins the world war, in
heavily infected malaria regions practi altral German men On Service would have been unfit for service a terras littiaeas 2 or 3 weeks owins tomataria, o that it,ould have been necessary thous ulterly impoSS-ible entiret to replace repeatedi the me in ac malaria SectSon. What waeshould have had to expect rom the warda troops, without quini ne prophylaxis udsins accordininto the anticipaled course of the annua epidemic is absolutet monstrous. Quinine prophylaxis HS an absolute militar necessit and in formations here it was notin lyprescribed, ut carri out unde Stron controI, notini Bmons Sbut also in the Entente troops it was found thoroughi effective. It istrue that there is no formis quinine prophylaxis,hicli can with certaint prevent malaria. neither the periodic illi large quinine doses nor the ait with smalle doses, whicli present man aduantase in militar prBCtice.
A resard the origination o quin me proos races of malariapctrasites the theor of selectio suggest itself against thisio everthere is the fac that in Italy here quinine prophylax has fordecade been applied amon the populationis the mos extenSive scale nothininis heard of such malaria races hic have become proos against quinine Thous the occurence of such a race of parasites S
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no disputed the reason for the frequent fallure os quinine in the war, both in therapeutic and prophylacticareatment Mas osten the had conditionis nutritionis the men Undoubtedishoweve many of the apparent quinine-proos ' malaria cases Dilest mis me quinine pre- scribe at ali particulari a Molis reporis had sol about a to the injur occasioned by quinine for instance, impotence resultins .
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ON THE DOGMA OF PREVENTIVE QUIN INE 63ON HE INTANGIBILIT OF THE DOGMA OFFREVEN TIVE QUIN INE AND ON THE CAMOUFLAGE OFMALARIA BY THIS MEAS IRE OFFROPHYLAXIS,DE LINTANGIBILITE DUD MEDELA QUININE PREVENTIVE ET DUCAMOUFLAGE DU PALUDISME PAR CETTE MESURE DE PROPHYLAXIE
Physician to the Militar Hospitals
o Belsrade, preserve his me against malaria infectio hydistributin quinquinario them, the questionis quinine administration for reventive purposes has been constantly under discussion. Advocate by ome, decrie by thers, it has been everthelessapplied ii fair resularit in the co se of remote expeditions and in ursosSession Overseas, hut with some diversity of result so thata definitive formula accepted by ait hygienisis has not yet been established Nevertheless, a me ill endeavou to prove by a numbero observations made in the ward of the Hospital of Saint-Iean at Beyrouth, the questio mistitie solve to the satisfactionis everybody, provide there is clear understandin a to the object in te and the necessar doses to attaincit. I pernicious attach are toleprevente an malaria mortalit reduced the neceSsar quinine prophylaxis ill ork wonders. I malaria infection is tot avoided, quinine, in the doses hic the organism ill stand without injury, cannotio thermis than reduce the number of sufferer an renderthe ourse of the lines more favourabie, ut it,ill also create thedanser of maskin the firs attacks thus pultin the clinica sense of the medica manes a severe teSt. In the course of the las Syria summer the ne usi ended, whicli extend homJune to the end of October 8 malaria sufferer enteredou depariment Amon this number there ere 3 cases of rst malaria attacks observe in soldier comin fro France. ho had
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6 O THE DOGMA OF PREVENTIVE QUIN INE
hospital orde the word malaria ' or probabie malaria ' 38 othersarrive unde various headins and thei malaria, id have escapedattention ere it no that ever case of laver no explaine by a sussicient organi lesion or no consonant Wit the ther symptomsobserved was Systematicali submitte to heckin by lood est. wit these patient it ould indeed have been dissiculi to ascertain clinicatly the existence of malaria, a the symptoms observefand thethermi curve di no in an way potnt to the right diagnosis The
tts different phases di no exhibit the characteristic eatures hichare senerali so clear and wel defined it ein oni possibi toidentis one of the pathosnomoni element of hicli it is usuallymade p. and in moSt casecheat, Sitiverins and weatins heins inferr-ed rather than observed the heat was limite to a se fit o simple
thos profuse perspirations hic balli the patient and flood the bed. wit thes features the attach. thus masked by the tonin do neffect o quinine jus ascit id the announcement of stistit astricdisorder and above allat suggested the ovibrea of that famous threedays laver hic is very common in Syria and the diasnosis of hichi unfortunately, every day, with regrettabi thoughtlessness, made. instea of malaria. hich lalter out be broush out learly by atria treaiment fallin positive hematologica examination, even in thoSe numerous cases in hic preventive quinin has expelle thehematoetoon rom the periphera circulation. The oori definedSymptOms jus enumerated areio Such a to potn to a specia formo hematoetoon Those of our patienis the lesse numbercit is true. ho, o in to indolence of the person in command of uniis, oro in to lac o persona conviction, had evade the reventive quinine reaiment hic is compulsor in the East. had presented afirs typica invasion it perfecti classica attack of laver Butother again classe a perfecti reliable and weliminde men of hom, asked the truth wit the objectis scientificisnqui , and who had resulari taken every da 50 t 80 centifram os quinine hydrochloride had nevertheles contracte malaria an exhibite a
perfecti typical evolution. Quinine, a many observers have potntedou before us thereiare. oes no always revent malaria an forthcti reason many practitioners who have not been putin thei suard.