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THE RECENT ANTL MALARIA CAMPAIGN i59
The campais against malaria in Moroc si in l922 includes prophylax applied to colonisation medicat advice oblisator forcoloniat concerning the choice of a Site, hygieni measures e resetilement importance of Smali anti-larvat wor after the completionos these me ures , prophylax applied to the natives, State-quinine
whic has been sive since Iul l 922, but whicli cosis a lotis moneyand which should neverthelessae distribute profusely, in orde toroot ut the virus reservolrs, the final aim os anti-malarial orkὶ: prophylax Amongst the arm os occupation where prophylacticquinine has been applied thoroushi since 9l7, and whicli ho sa considerable decreas in the malaria morbidity not illistandinscertain lapses in the application.
hospitat. In French Morocco admission to hospital for malaria per 1000
was 2q. 6. The writer are convince of the value os preventive quinine.
In Aloeria si prophylacti quinin ima dati dos of 0. uram ahensor 5 month in the ea in the hilis and 7 monilis o the coast, andat the ear round at Halia amissued ,3.500 persons in l921 4000 in 1922 and 10.000 in 1923. mali anti-larva measures, OSquito sauete complete the hygieni measures It is held that grave attacks have been preMented cachexia lessene an mortalit considerablydiminished. In Aloeria My likewiseras in Mor co β' anti-malaria mor consisted in hygieni mensures, drainase or and smali anti-larva work, butalways combined wit quinine distribution. In Palestines after the war the Depariment of Public Healthtook up the cammis against the principat diseases, in the sirs place
The American Iewis Hadassali Medicat Orsanisation illi plentyo materia and well-schoole personne cooperate&with the State.
The starte mitti the mos important drainas morks in different Places, erosene applicatio an contro os ater-celis. In his way the Succeede in marin the owns almos completet laee of malaria. In the count an villases it a not so eas to destroymalaria altosether. In addition quinin was sive gratis and the population was instructe in his matteris much a possibi by popularillustrate pamphteis.
whil in Ierusalem si there,ere in l918 stilici lydeat cases hom
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160 HE RECENT ANTI MALARIA CAMPAIGN
malaria, his number dropped in l922 tori This was a result of the work of the above mentione organisation. I seems that in Palestine sanitation-wor has done a tot of good.
The anti-malaria committe reporta: ββ
In certain districis, o ever. and in ali towns the diminutiono malaria a chiefl due to the measures ahen to dea with thedisesse This a particularly the case in the Iezreel alley whereth extensive drainase orks ad rought about a mos strikinstat in the incidence of primar malaria amon the Settiers . It is notice that the fittin os pumps to water supplies is ne fthe standard sanita Measures used in Palestine. It willi interestinuto know whether these are amentire success. Experiene in the tropi shows that unles the become the private properi os an individualthe domo last very long the reaiment received at themand of the public ver rapidi render them selem. Ita opinio concernins prophylacti quinin is notis favorabie.while reaiment of carrier is an important element in malaria contro it cannoti employed in Palestine a the sole me ure be-
cause of the lac of a homogeneous population when ontra portionos the population canae effectivel trealed the fifh against the parasit is incomplete an is a bestini os limited valve. β' Quinine prophylaxy was useful in reducins malaria morbidi Hurins the perio os relativel lo cincidence Durins the epidemi period. even double the usual irain dos was no effective in preventing
In the fame a Bytae and de Moysi repore: Durins an exploratio of the centra histiland of ei Guinea
Amongst the antasonisis of quinine prophylaxy. Miselar β' must bementioned Treatins an epidemicis malaria in aream in Phoenicia ted him to the folio in conclusionS:
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Is prophylacti quinine reduces the number os cases, it has noprophylacti value, Vie ed rom a publicaealthioin os levi itincreases the numberis latent serm-cctrriers, who Sprea the diseasean also the number of chroni cases of malaria, hicli are very resistent to quinine we mctyras indeed whether B serm-carrier. camoussased by quinine, is no more anserous han a sufferer unde observation, and finalty whether prophylacti quinine does no posses more dra backs than advantases . Lmense μ' is practicali of the fame opinion. Quite os a contrar opinion, ho ever, is Maj. Trabauci, the writeros an artici reproduced unde the titie: De rintanoibilite dii Gomede a quin in preventio et u amouβεις dia paludiam par cette mesure de prophylaxi. V p. 63ὶ. Comparins this furtheo it the publication of Ulabem anci Lacare
o the importance of prophylacti quinine, e observe ho diametricali opposed the opinion about the value of this measure stili are. Preventive quin in treaiment of troopS. The objectis this measure is by means of the regula absorptionos quinine, to provide an environment unlavourable to the devel-opment of the hematoetoa introducedunt the blood of man. The method has been severet attached Therefore it is necess
Afier the reat experience of three ear stay, in Macedonia, of the bisues expeditionar force hicli ever existed the valueo preventive quinine reaimentishould n longe in ou vie iecontested above alia doctors. Detractor o preventive quinine reaiment ut formar the followins, mons other usual arguments against the method: l. That it is inoperative. his is a mere assertion hich mahes ali comment superfluous and whicli oes no even posses thevalue Da hypothesis: 2. That it is injurious by iis direct effect o the organism. It
predisposition to emostobinuri bilious laver. The experienceo three ear dispose of this opinion in Macedonia. 3. That it is injurious indirecti in the sense that it reduces thehemAtΟZo resistent to quinine, o b causin habituatio of the organis the result of hic is that the ordinar doses ould have to e exceede when a therapeuti effect is tot obtained. This is a meret imaginative vie whicli is no based on an pre-
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in favour of the iram dose two ears ago, have ecome BdUΟ-cates of smalle doses Duram for instance . heca e the have perceived that these doses ere sussicient. Exacti the oppositeshould have taken place is the above allegation ere true. q. That it transform the clinica complex o symptoms of malaria by hadins os o masking the habitua reactions of the organism. O in to this fac it is Sald malaria readit passes un- perceived and lead the patient direct to anaemia and cache . This alter argument alis to the round for the follo inureasons in therars place the figure of evacuation to the sanitary formations in respectis malaria decreased progressivel every year in the arm of the East. his contributed reatly to the
maintenance of effectives. Furthermore, XAminctiion for serm-carrier during the period
Ianuary-Ausust 918. carried ut o l. 500 soldier in vario regiment or unitS, AVe ct positive percentas of hic proves that thei number is no considerable Al that could then esupposed is that the allege malaria patient With masked symp- tom have se or no emetoetoa sametes in thei peripherialblood: ut to a this is to agre to the incontestabie collective efficac of the method the number of carrier os ametes einstess, the hances of contamination re es and the conditionis health of the troops as a whole hows the effect a great for ardstride is made in the reductio of the reservol o militar virus which very ea spread farther and farther mons the troopS. On what calthe allegations of the detractor of preventive quin-ine reaimentie based in a senerat wayΤl O arguments by analogy hic can have nothins more hanthe value of a hypothesis. 2. O arguments created for the purposes of the cause: a. In orde to cloa refrettabi ignorance by the retentious assirmationis a persona conviction: b. o sive an excuse to idienes hecause the application o pre-
Ventive quinin trectiment requires constant vigilance an action:
C. To evade punishment by helterin negligenc unde theauthorit os a theory: d. o avoid suspicioni lac o foresistit hen the necessarystock of quinine has no been provided in time. 3. O medicat-philosophica theories ithout scientific clinicalor experimenta basis.
The appearance of these theories is always tot anticipate in
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a count ,here the sun HVours imaginative exaltation They existed in Macedonia but to the honour of the Medicat Corpsiecit said. thei advocates ere rare wemeedio dweli longe on this potnt. The est that an e sal of these purei imaginative vie swhich. like weeds, must neverte resardes illi contempt but whichshould receive caresul attention in orde to lea them Way, is that the are based on persona statistic whicli are osten justextensive enough to ut into a ridiculous isti the person ho. vie in themas holi reliable has putrio hasty an interpreta
Furthermore suc statistics, prepare ami the almnes of auniti a formation posses a value the scope of hich should notu beYon the limit within hic the were determined. It is impossibi to argue about the question os preventive quin-ine reaiment usi a Deel an easti as ne argues on a philo sophical question. One eed to have institute the method on a large scale, checked iis executio an observe iis immediate an remote effect in orde to form an idea of iis duantas es an drawbacks. Moaut howed that in the hospital depariments here quinine administere per os for curative purposes, was ineffective, thereason a that it is notuaken. f this fraudus difficult to preventi a hospital it is much more difficult in the casei preventive quinin treaiment in a unit,here the individual escape stili more the direct actio of the doctor Besore invetshin against themethod i is herefore indispensabierio mali sure ther is than by the simple assertio of the parties concerned that the orders sive have been stricti carried out. In matters of epidemiolos amid a id population, here it is destre to determine the efficac os a measure of senerat prophyl- HXy, ne must suar against an hypothesis, an preconceived idea The epidemiologist,ill socion ascit is necessary, confine
himself to the ole. Omewhat prosai perhaps ut ver fertile in useful information. of searchin for and examinins facts He illso ab ut a good deat wil se a much asine can or himself. illno allo himself to e influenced by the opinion whicli others il not ait o sprea out before him o prove that the Uknow the question he wil se everythin o the spol and for that pur-POs it is necessar that he houldi thorouultly at home in his bufiness, that he should knowlow to see . The motio offertilionis insulari true in his particular case: The eyes canini See that hic one knows and one oni knows that whic one alWays
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has in indV. In orde to no . one mus have learn and this kin os prophylax is a specialitY. a crast ' hic is learn likeothers by practis and not rom manualS.when the epidemiologist has collected ali the necessar informa tion o the spol, he he has studie ali the elements of practica application, hen in a word, he has sathered an assemblaseos facts in sufficient number observe a lensili an subjecte to Severe criticism, then only, illaeie in a positio an entilled topronounce an opinion to hicli faith may be siven . In Italy the classi malaria-country. State quinine cis distributed,
The preventive measures against malaria comprise 'δ l. compulso notification 2 regulationi furface ater: . certain adaptions of
malaria mensures. An compulsor measures are carried out bypersuasio throus voluntar societies Red Cross). it State id. The et result has been a fali in the death caused by malaria, hom
In Tuscany ' a condition existed defineffas paludism and anopheles ithout malaria , up to 19l8. The experiences of theseopte tedio thei ready acceptance of quinine prophylax an treaiment in 192 and 923. The maximum incidence in the lalter ea was qcases in Manandiu 2 cases in November, and non in December. It is advised that these anti-malaria measures hould e continued. In thecisland of Corsica' after severat unsuccesssu endectu urS, the followin method for fightin the mosquito a propoSed: resulatio of the rivers and drainas of marshes. ex to this asystematicali imposed reaiment of the population it quinine, by
officiali schooled an controited distributors . In the province of taceres Spain ' in 1922 the number of ne lyinfected cases of malaria has been inferior to half the correspondinsnumber for the revious year. The tota number o laver cases decreased in aries defree 22 and lqὶ The endemi save in Talay- uela a number hic was in proportio a thir of that in the spice culture. In the adjoinins areas of Talamela the number os cases hassiishil decreased a result hicli is the more remarhable, hecauseoni therapeuti means have been sed an above alliemus thepopulation is very unstabie. Mention is made here of 2388 cases of malaria, the quantit os quinine used was ql,372irams.
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Plate XXI ITALY moto Pros. r. B. Gosio, Roma Splenomesalia in 'o in consequence of malaria Pase 6q