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IOURNE OE THE MALARIA COMMISSION Il
Erivan Tissis and Bokhara, hic are chiefl for scientis research. trainin os doctor an auxiliar stas for combatins malaria, but also do service a malaria stations mitti clini an poticlinici. b. Sections for malaria in lyexistins bacteriologica laboratories
chiefly investigation . c. t malaria stations Plates X O ID in l923. his ea thereare more distribute unequali ove the territor of the Union forinstanc in European Russia that is, id European Russia ithout the orde States kraine. hite Russi and the Caucasus 52. Ukratne alone l3 now 7ὶ Siberia it Centra Asia 10 etc. Each
station has a policlinic, a laborator an propctganda muSeum. Plate XIIJ To eac station there are attache Pto 2 somelimes more doctors, 1 to 2 assistants and minor staff. In addition to examinationand reaiment of the sufferers, ho atten or are fought ut Seeabove the station ensases in the hsh against larvae an adult ano pheles and chiefl in propaganda. Plate XIIIJ Sometimes a par of the counirnis studie and assisted by means of delachments . Most Sintion mere ni opened in the ourse of l922 or 923. The cosis the amounti estimate of hic are notanown to me)are horne: a By the Commissaria o Public Health of the Union, amelysor: l. the quipment of malaria stations and payment of their principat stafi 2 that portionis the quinine hicli is distributed laeeo charge. b. y the loca services in respect os l. the maintenance of the stations 2 the remainder of the quinine: . the smal sanitation . In Bulparia also there is a separate malaria service, regulate by
the lavi of the 3' Apri 19l9. The directio is in the hand of the
Malaria Inspectorate ' standininunde the Generat Directoris Public Health in the Homeministry consistins of a doctor, a civil-ensineerandis Zoolosist Iis spher of operation consists of the districis declared infected with malaria in each of hic clyto 60 villases are siluate. In ac district there is a medica inspector it an office an a laboratorY o blood examination, it one or more miScroScΟPiStS. In ac villas there is a quinine distributor. ho also akes bio stides a so-calle VFeldscher . something like the Dutch Eas IndiesnctiiVe-BSSisinni, ut noti a fame levet os development and notifies the malaria cases also the necessar drivers and labourers for thesanitation orks an voluntar assistance, at lyleus per day, suta a Schoolmasters, priest and Student S. The tas of the medica inspector is to examine the lood stides comin in to maintain supervision ove the bis ork of reclamation,
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32 IOURNE OF THE MALARIA COMMISSION
whic are at for ut of the fund at the disposa of the Malaria
Inspectorate and the mali ork of reclamation whichire pald forby the lando ners He also maintain supervision ove the distributiono quinine laee o chars to veryonei, ver the fixin os fauete protectioniat the expense of the Inspectorate, communes or emplOyerS , and the constructionis houses only permitted after the opinionis the Inspectorate is ought within villases an town districis oni after permission of theiod in question is securedi. The similarit wit the Serbia system and the contrast,it the Russian system therefore lies in the fac that the medica inspector maintains Some connection illi ait the villases in his district thoughthis connectio in Serbia is loSer. The expenses for malaria fightins in so far a theriare borne by the State are covered by the malaria fundV unde the administrationis the Inspectorate. It no amounts t 7 million leus an consist of
the iel os a capital of 3 millio an a yearly contributionis 50.000levs. both supplied by the State. Also ' of the communal and
10 . of the deparimenta revenues in the region declare infected illi malaria, ali revenues rom reclaimed land forci Lyears save insociar a carrie outi private persons, in hic cas the pas tothe lalter and the proceed of fines imposed in respectis offences
against malaria legislation. For the est this does not quite correctly reproduce the expenses, hecause the civil-ensineer of the inspectorate had an extraordinar credit of ll millions for the purpos of executing orks ouiside the malaria fund Moreove the expenses of the quinine
monopoly this ear 20 million leus are not included. In Greeh Macedonia the combatin os malaria hic is there
carried out chiefly by means of medicamenis coincides it the generalmedica provisio for the refusees in the owns and of the entire population in the country, and thereiare present nothins remarkablefrom the potnt of vie is malariolosy. Provision is made ho eversor future requirements by training the auxilliar stas for the larvat. mosquito and quinine-squads in t orichoolsit Salonika and at Athens. Eac squad. of hicli there are twent intended for Macedonia, and te Already in operation, consist os a clites student of medicine) whoearn 50 drachmas a male nurse earnins ydrachmas and 5 to 10 labourer each of hom earn 30 drachmas per day Administrativelythenare unde the deparimenta physicia in hos area the workand thenare supervised for the entire country by 3 medicat inspectors. Their tas is the eekins ut an treaimentis sufferers in Summer, the executio of smali sanitation ork in inter the fumigationo houses. In one district we a 2 squad to 40.30 inhabitant in
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l50 villasses Lars scale sanitation is tote lest to private initiative. This scarcet organised Service of malaria sistitin is unde a commission of delegates fro- Ministries Health, Public orks Auriculture and Finance an is unde the supervision of the Ministr ofo Public Health. The udset millio drachmas 30 ha been applied for).
In Mumani there has been oni loca malaria controlaitherio and exclusivel by medicamenis It is not intende eithe to establislia specia service, the deparimenta doctors ho no have themanasement remni the mcers ho execute the centrat orders withthe counir doctor unde them, horare here mostly State ossicialsi. In orderio evereto salina hetter insistit into the spreadis malaria theso-called flyinsirisades ' illi organised assisted by 1 stationa laboratories including the University laboratories of Bucharest, Iassyand Clujὶ and 12 lyins laboratories Each flyinu brisad consist o ldoctor an student of medicine in thei last year of stud sit is
intended to compellat student of medicine, after completionis their studies t so throus one year's practical or in one of the branches of the State service of Public Healthin Their tas consist in seekinsout sufferers, ahin blood stides, resistering the spleni index ofchildre u to their 6th ear, collectins Dentomological materialan particular resarding the reedin places of anopheles, heir occurrence in houses, the occurrence of malaria houses, meteorologyan seolos of the infecte areas, economi conditions of the population and number of inhabitanis. The area of eachirisad comprises about 2000 inhabitanis Is his plan cani carriefout Roumania may come to e ne of the est informed countries in the worid in thematter of malaria Statisti S. In Italy malaria fightin is, as resard the State, not incorporaledinto ne service and evenietonssuo different Ministries for instance, as resard drainase, it betons to the Ministry of Public orks and BS resard the quinin monopoly the Ministry of Finance. In additiontoo the State leaves a great deal to private an communal initiative, so that considerable decentralisation occurs. In orde therefore toavoi excessive delati here, I mustaeep very much to the surtace of thingS. The State by means of the quinin monopoly and the supplyins os quinine re os charse or at auo frice, is immediatet enfased in figlitin malaria It extend this influencea legat enacimenis, hicli compei doctor to notis malaria cases and unde cerisin circumSictn-ceS, Orce commune or private employers in the reston declared tobe malaria infested, o distribute quinine re os charse A prominent
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int of vie in his connectio is that malaria is considere as a professiona disease. In his matte the State iself does the folio ins: i. t promotes the judicious use of quinine by means of the existingmedicat organisation provinciai and sub-prefectura doctors, medici condotti . in the communes, wit thei hospitalsin by posts for quinine
distribution long the oad and by 200 policlinic for malaria Sufferers. Plate XIVi.
2. I undertakes the care of the personne of the State ratiways and the nrmy. no Ont HS resarci quinin Supply, ut also by sauete protectio an measures against breedin places both of hich. or
ponds an in the ne cla . ali bonifications ' mode obligator on
3. I provides for the training of the necessar auxiliar staff in fluhtin malaria by the school a Nettuno, here every year 54 6 courses of 2 to 3 weeks are held. The establishment cost q0.000 Lire an maintenance cost 10.000 Themisher stafho ever do the workas a by-employmeni and resides at Rome the wholeris accommodated in a portionis a militar bulldins.
q. It assisls by means os subsidies granted unde certain conditions. in renderin sultabie or agriculture and residen e lakes lagoons and marshes, and works Such a afforestationis mountains, regulationis ater ourses, etc., hich may be of Service for the fame purpose. In
part it carries ut these ork itself. I have atready potnted out thalit ma seem torus Ather strans that this houldie classified in particula unde the figlitin os malaria, but that this standpoint is quite defensibi is oninit is no considered as an anti-larva mensure. O the specia bodies to hic the State transfer a portionis itatas I ma mention: A. In the province of Venetia. l. The Magistrato per te acque , hic supplies directive instructions for the reclamation or carrie out by private odies the
2. The Istituto autonomo percia lotta contra la malaria ' Theobjectis this bodycis malaria fightinui druss with q2 ambulances it doctor policlinic somelimes a smali sic wardi. 22 dispensaries for quinine distribution). 2 stations for malaria radio-therapy andrachildrens sanatoria in the mountains, forchildrem it chroni malaria. Also combatin by means of drainas and measures against larvae and finalty by improvement of the water Supply in the existingaeclaim-ed lands. I do not know ho large the entire population is mons inhic this bodyMorks in the environs of S' Dona diliave there mere
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moto Italian ea Cress Malaria Contro Depariment
Surve ma of the Anti-malaria service of the Re Cross. Pontine Marshes
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IOURNE OF THE MALARIA COMMISSION 35
7 ambulances illi doctors, student and 9 male nurses toral.700 inhabitanis But this mas a Severet infeste reston.
B. The Italian Red Cros Works in various paris of Italy. Plate Vibu above ali in the Pontine Marshes SicilY and Sardinia The chies
inor asain is the distributionis quinin unde medica Supervision. For that purpos the have: 1. The ambulances ' it dispensary, policlinic, smali sichward forsevere cases an a stas consistin os a doctor, ho sives his entire time an receives 200 Lire per monthin, 3 male nurses, Gemale nurse 1 river cari 2 horses and the necessar druss. The costsare 6.000 Lire per monili There are Sof them in the Pontine Marshes.
each of hich also has the medica chars of 3 school for their
account in hic the co-operate it the Lisa contrari'analfabetismo ' and ac covers an area it a radius of q0 kilometres, whichthe doctor traverses entiretnies to 5 ays. 2. The ambulatory service in the resion where there are more doctors of homine at a remunerationis 300 to 400 Lire per monili sive a partis his time to the maintenance of a policlinic. The onlywhole time stas is a district nurse an a househeeper cost 2000 Lire per month. There are bout 80 of these in various paris of the
3. The motor ambulances , in principie the fame as the ambulances, but everythininca be loadeston amotor-carand cantherefore hereadilyconveyed here mos required There area in Sardinia The cost 50.000 Lire per nnum.
q. The Childrens Sanatoria. of hichahere area Pontine Marshesin. 5. A station or radio-therapyis malaria Pais system in themountains Segete adjoining the fame mctrSheS. In ali here are thus treate per ea 60.000 malaria sufferer Withl000as o quinine i Puram per patient compare it this the 90 grams per head of the population used in Greecessor prophylaxis alone).C. The Commune of Rome has in the Agro Romano, 33 sanitarystations ' o whicli a doctor is attached who maintain a regula poli- clini an together it the district nurses attache to the station, travel through the environs o horse bicycle or motor- cle andalso visits schools There is telephonic communication with the Umiod'Isiene for speed helpin a mali sic ward an establishment for ursent ursica measures an a dispensary. Eac station an dealwith fuli 2000 inhabitanis. In addition to this there are 1 Vpuntiaussiliari di profilassi V each with a prosilassator', a quinine distributorandis number of signatatori Vcior feekins ut sufferers hora notcome themselves for reaiment. Finalty there are stations in the mo--
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36 IOURNE OF THE MALARIA COMMISSION
inins in the environs for reaiment of the mountain dwellers, whowor in the lain in the summer an contraci malaria there Forchildre sufferinifrom chroni malaria there is a sanatorium in Rome. In om stations particulari Ostia a good ea is done for thedestructionis larvae and mosquiloes This entire orsanisatio costsevery year boutra million Lire 400.000 for quinin and 600.000 forthe stationSi. As resard cosis it may furtheri faid that the subsidies to various dies hic co-operate in the fifh against malaria amount annuallyto an averas of 2.5 millio Lire the cost and subsidies for great and smali bonifications ' are bout 16 million in 1900 to 1920 before that timeonis million . The ne proceeci hom the quinin monopolyon the other hand amount to aboutra millio per ear. 3. Extent of malaria. Most communications Agreed in this that toward the en of the wHr, Rictrict was in proces of increasin an in 1922 or 1923 had reached iis climax excepi in theukraine here it was greater in 192qὶ, and was no declining or at leastiore a les serious character Asto a decline there canini hera question he weano ino much malaria there was and ho much there is no . Andis, alwaychadio take astur basis the resulta os examinationis patienis,ho reported themSelves to malaria stations the particular prior to 1922 werebasedon locat data hic could noti checked in any wayhwe reatly do nothnow any here exacti ho much malaria there AS, and only Sresard a se places how much there is no . It would ake me too facto discus here the various defecis inherent in the statistic received by us They did not allow of formin a justidea of the influence of the various measures o the ourse of theepidemic thecies So a an epidemi recrudescence AS in queStiono the every here endemi malaria: and experience hows that Suchrecrudescen e again diSappea after a time. The me ures ahen may promote Such disappearance, the domo causerit. In Dalmatia the organisation a suchis to enabi the epidemicdoctor to come into contact illi the entire population. et themataria position a no wellanown, ecause at the station onlytha portio of the population hic attended was examined whichcaused the figures to turn out to hish. Only in Marina Trosi and Met ovi was a great portionis the population examined. In Marina Kars area the percentas of parasite-carrier. subsequently referred