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is seen that malaria has increased in the districis hicli ere on ly
In a se districis only was the incidence in l92 simila to that ofl913. e.9. wester Districi, Central Asricultura District Northern Caucasus, Crimea white Russia. In om districis the number of cases per l0 000 inhabitanis as
In ali the ther districis the incidence of malaria is much hisherthanaefore the wHr.
Monthly fluctuations in I92 . The figures for the sirs Mur monilis of l92 are hisher thanuhose for the correspondin monilis in l923. From Iune the figures homadecline and are below thos of 1923. The decreas besan in Norther Caucasia in Iune, o the Middie Volsa in April. o the Lower Volsa in Februar and in the NorthEastern districis in Ianuary. In the districis here an increas in malaria was observed in 192q. i.e. in the Ukraine, the Urais and Siberia, the increas silo edatselfin Ianuar and continue throughout the ear. The maximum number os cases in l922 occurred in September inl923 in Iune and in l92 in May which was the monili os maximum prevalence before the war. Only three Governments form an exception to this rute, .e. SHmnrn, T saritzy an Astrakhan. In Samara there ere two AXimum periods, ne in a and the other in September. In the greater parto Siberia the maximum occurre in Iune and in t o GovernmentS,i.e. Alta and Novo-Nikolayevsh in May. In the trulli Republicthe maximum occurred in Iune Norther Caucasus had two maximum periods in Manand Ausust the autumn maximum heingiuisher hanthat in the pring. The Trans-Caucasian Republic also had two maxima, .e. in Hyand September. Fornas of malaris. The return Dom malaria stations for 192 sho in histi frequencyof the tropica form throushout the entire Country. In Siberia the constitute&0.54 9. 3 per cent of the other formS,
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152 HE RECENT ANTI-MALARIAL CAMPAIGN
in the Uraim per centi in the Centra Industria districtra per centi Mosco Government 7 per centi, aetan per centi Saratoss26 per centi, in certain districis a much a 50 percent in Volsa districti 7 per centi Vladikavkas and Dashesta 22 per centi, Trans-Caucasia and Armenia 56 per cent. The quarta form is only reporteliso the Volsa district Northern Caucasus and Trans-Caucasia It has not been observesto any great extent in ther districis. The monilii curve of the various form os malaria hows that theincreas o plasmodium vivax occurs in Marcii an April it a maximum in May It then remainsin the fame levet atri constantly unti September. The tropica form increases in Iul and Ausust, illi a maximum in September. The quarta form is irregulari distributed illi a maximum rom September o IanuHry. The decline in malaria inciden e correspondsuo a lowered gravityo the clinica forms. The malignant form observe in 1923 in Norther Russi and the Volga district id not appea in l92q. Onthe ther and malignant form mere observe in districis here malaria increased in l92q. especiali in the Urais and Siberia. Mortalit has diminished. The hishest mortalit occurred in Siberia
and Norther Caucasus, here it was estimate atra per centi, in Astrahitan ali per centi, an in Trans-Caucasia atri per Cent.
Notist tiri. Notificationis malaria cases a belle carrie out in l92 than in l923 as a result of the wor done by the malaria stations the distributioni quinine and propaganda The fac that the figures for
an improvement in the system os resistration. At cases, o ever, have o been reported. Notificatio is stili defective in the country districis Specialisis conside that the ratios
M. Dobreitae consider that the actua number of malaria BSeSwouldae obtained by doublin the number of reporte cases whichwould sive bout te million for the firs te months of 192q. The decline in the incidence of malaria may be attributed o variouS factors periodicit of the epidemic, improvement in the economicsituation and particulari in nourishment the drynes of the Summer, an measures of control. The fac that the maximum potnt of the
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epidemi occurre in a may be considere a a favourabie sisn
The se-sroups mos subjectu attach were seo 20 to 50 ears.correspondin to the workin age, an a considerable number of chroni cases stili exist The anopheles is common throushout thewhole o Russia. and the tropica formo the problem is increased by the fac that famine eisns in certain districis It is obvious, there- fore, that continued efforis are necessar is malaria is tot reducedio ita pre-war leve in Russia . The perfecti correct argument that the destructio of the mos quilo ould bring bout the disappearance of malaria, fave is in the besinnins to the vie that it actualty out be possibie by this meanS. to eradicate the disease, and the magnificent resulis obtained by the reclamationis the Panam Cana gone eeme to prove this.
This method was applied thoroughly, speciali in the nitea
States, here the cost is no obstacle, and the population readilycooperate in ensor in measures hic are likel to e os ueneralbenefit. Numerous publications describe the different courses hic were adopted As a typical one, sive here the descriptionis a campaisnin Illinois. 3 Some interestin particular resardin a campais against themataria mosquito initiate an carrie out by ensineers at thelow of Carbondale, Illinois were sive in a paper recenti read
decreased the amount of malaria. Although the economi Savinsfro decrease sichnes and death rom malaria is Domitherdiseases hic may have attache person weahened by malaria - HS Ot he Rid, generali taken into consideration in drainase projecis the result shouldie included amon the benefit resultins fro drainage. In Some cases the economi savinifrom decreasedilines liad. he added exceeded the direct cost of the drainase ork. Vita statistic for Iackso County in hicli Carbondale is Siluated. ho the occurrence of rom 2700 to 3000 cases of malaria annualty Assumin that the economiclos is L 20 per case, the tota los in that one count is omes 50.000 tori 60.000 annually. The L 20 per case which includes doctor' bilis medicines
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and os in productive earnins by the patienis, is considere hyMr FersuSon tolera conservative amount. Even o the figures
indicate that the count could et assor to spen a large sum yearly in eliminatins mosquilo-breedin placeS. In the pringi l 922 the municipat authorities of Carbondalearrange to undertake complete contro of the malaria mosquito in an area includin the own itself and a district extendin i mile
tar ensineers to plan an supervis the work. his campaisn was ver successsu in controilin no Only the malaria mosquito ut also the ther ind whicli are meret a uisance due to their
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ticali perfeci contro ha been obtaine by the heiulit of the mos-quit season. The tota cost of the ork includin that done by
the rati analso the ensineer' time and expenses, was about A 850. Ι resulte in the revention o a leas 200 cases of malaria. andalso relieved the mosquito nuisance. Estimatins an economic losso L 20 for each case a note above, the ne SAVins RS at least 3l50. o more than the entire cost of the permanent,or and the seasona mor of inspectio an treaiment. mali expenditure in succeedin years ill develo greater economic HVinss. r. Perguso states that the resulis ere o apparent a toclea thelown to repare for continuin the wor this ear, hil aneighbourins cit is planning to initiate simila contro of the
Concerning the beneficia resulis of drainase i is reporte thalat Care Blanci*' it has been possibi to mahe an area of 20square miles of lo lyin coasta land practicali Dee rom malariab drainasse. hil in the ala States δ' Si Malmis acton has observed excellent result by a system os subsol drainase The
R.M.M. Mansthoeminoto' reporis ho . illi simple mensures of drainase combined illi quinine reaiment in period os acute ut-brecths malaria cases in the jihea plain a notorious malaria focus in Iava decreased considerably. He estimates the costin about 50cents Dutch currency lypence per head of the population, anda repor from British India' mentions that a te estate lyin in the Easter Himalayas at bout 3000 feet altitude, illi porous Oil,
consistin os decomposed granite was drained and the Stream resti lated. his a followed by reductio of the malaria rate. I Seems, nevertheless, that even drainase does no sive the fame good resulis everYwhere. Thus a repor concernins Benga AaYS'':
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156 HE RECENT ANTI-MALARIA CAMPAIGN
Alons it drainas other measures accordin to locat conditions
now been orbidden by the Commissaria o Public Health. o land
we have hardi besu the great campais against malarictaei Different places require different method os attach in method successsul in one place may aggravate the diseas in another place. we do not know hy one species of Anopheles is a carrier fmalaria, and another, hardinio be distinguished rom it, is not. In America the rs expectatio that drainage ould bring the destred resulis, has no been realiSed. Ichy notes the spectacula tali in malaria folio ins the initiationo contro mor in Alabama. and the liope fit speed extermina tion hicli followed No comes the discourasin discovery that nothin of the kind has ensued and the realisationis the disconcert- in magnitude of the subjeci. Follo in this Le Prince howed that major drainas does not necessarii reduce the prevalence of malaria. DOwIino ,riteS: Theoreticalty it is extremel eas to prevent the sprea os malaria and the eradicatio of the breedin places of thes Opheles practicalty it is very dissicuit . Concernin the siluatio in Panamaε weaea that any relaxation
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o viqilance in the anal Zone means increased malaria incidence. Colon was at that time l920hbeins annoYed by swarms of Anophetes attributable to a s ammtwo miles way, alf of this distance heinucovered by open wnter. we can. thereiare, quite underStand that beSides Sanitary measures, quinine reaiment has been trie to secure the destre result Thewell-known C.-G. Bass, εδ ithout enterin into a discussion con- cerning the fundamenta merit os both methods, hinks that for thepresent in the United States, attention houldie concentraledin therational reaimentis Germ-carrierS. In limited areas anti-larvat measure sive excellent resulis, as doesalso quinine reaiment of the reservol os virus. The dissiculties arise hemit is ought to put down malaria in B VAS country. Further Bas notes that durin thecias is years in them S. Anti-larva measures have been applied ora furface of about 5, 180square hilometres But the malaria-infested area of them S. exceedshal a million sq. k.m. The amount of money required to tali up this or is enormous compare to this rationat quinine reaiment de
with reuard to this Bass3 said: ILali cases of malaria were trealedclinicali by prope doses durins a least two monilis, ill recoVery. malaria ould n longeriem problem . A the Internationa Congressis tropica medicine at ingston inl92ε Bas εἶ potnted emphaticalty to the necessit os a sussiciently longafter-treaiment of ali cases of malaria, hicli come unde medicat controi nolint for clinical reasons, but also because it resulis, through decreas of the prologoa in a real lowering of the number of infected Anopheles we recommend thereiare the senerat adoption os a routine method whichae had tried. Fulleborn Hamburs reporis that a systematica treaimentis allserm-carrier combined illi that of the apparenti healthyihildren, in GermAn malaria areas has sive excellent resulis besides it is easti applicabie in schoois, The fac that the authorities in them S. domo hesitate to car through evenali most drasti measures, is illustraled by the folio inscommunication:
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about 30 malariat cases hasbeen reporteland the prospectis reachinuthe revious year' tota seemed likely when nocles than 300 cases occurred in one lumber mill During the summe monilis follo ins thetrectiment, however no further case of malaria a discoVered, and Simila good reporis ere received homother districis here this eight weeks treaiment was applied .we are notriold ho the enforcement of this ukas was controlled, nor sin illins citigens reatly lest the to n. Accordininto his principiethe mos efficacious method for amanti-malaria campals wouldie todepopulate a country. his ouldiu an enda malaria oncessor ali, but ascis evident measures like these cannoti considered seriously. But it is clea that every here in the las few years besides hygieni mensures an extensive Se of quinin is recommended.
Concernins Suriname, Bonne 7 writes: In a routine a 1 reate Iavanese ni durins laver, and som day after ards. It is clea that such a quinine reaiment isno ideat, ut unde the particula circumstances it was themostpractical, and malaria disappeared almost in two ectrS. This oes no mea that the population ad hecome normalafain the spleen enlargement for instance eremo sone and the possibilit os infection for the Anophetes a no icthen a By. but absence rom or through malaria was inconsiderabie.
In an account of the malaria in Madapascar Clotiarδε is nothopeia concernin anti-larva measures. The main dissiculi is un- doubtedi the lose proximit betwee padd land and habitations. He considers that quinin therapnis more lihelyrio sive good resulis init canae pushed visorouSty. Experiences are the fame in Morocco and Alperia. Obelle an Halaue ' fin prophylacti quinine of very recti utilit is properi taken unde SuperviSion.