장음표시 사용
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it depend on entiret different factor the natur of hich, canmeret sues at whether the malaria mill continue, ill increas ordecline This hypothesis hicli in turn contain nothin ne hwould
explain why, in generat, and again mihiS ourney, sonitile was observ-ed of the useful effect of the many measures for destructionis larvae an mosquiloes, which, Saw or hear of To his howeve it mustat onceis added that in many cases the natur of the statistic didnotallo os ascertainins a good result whic may have been obtained, and in sociar a concern the measures against the larvae, the richcatches of fullirown mosquiloes in the houses o stabies round about but o frequently rendered clea the inadequac of these mensures. cannot here enter upo a descriptio of the breedin places and the Calches of mosquiloes in houses and stabies hicli, Mund and performed nor Sum P the meaSures against larvae an adult infecis. hicli ere hown us either in realit ori paper. Sussice it here toremar that the oni anti-larva measure hicli reali promised anything ood was that in the ars territor against the lokvas seepas 26 and that not hecause of the perfectioni the method buto in to the peculia natur of the land. One laeis convinced that torasti malaria exclusivel by means of the fullest possibi tracin and reaiment of the sufferer and health parasite carriers, ouldae equivalent to figlitin typhus onthe fame basis inhich would therefore sorio benefit not the sufferersalone but, o in to reductionis the likelthood of infection the publichealthieneralty without the other mensures usuali considered neceSS-a . Such combatin os malaria is thereiare incomplete and also dis- resard ali discoveries made in his depariment since 898. The measures hicli must e taken o eve are so expensive or toexpres it better precisely the so-called Vsmal measures his thenaret do any good, and the are of so litile seneralisse, remo Specta lisediat leastris one excludes the bis drainages, hic are not generalty
include amon the measures against malaria in iis prope sense that the cannot e compared, o instance, it improvement of thedrinkins ater, suppi or the removinsi faeceS. Thus there is a certain tendencycloi some hat more caresul hansereViouSi in mensures against mosquiloes an above ali against
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q6 IOURNE OF THE MALARIA COMMISSION
of the countries visite by us a clearly achere, excepi perhaps in Italy wil become the prevalent opinion, cannot et e Stated. Nex to this negative there is omethin positive the place par excellence here infection rom A. maculipennis occur is the dwellinuhouse the likelthood of malaria infectio is greater: l. In proportio a there are more eopte livinxit it: 2. The lonser the hous offers the anopheles the opportunit ofremainins undisturbed. The chiesioin thereiare is notino many anopheles there are in
inio a house bucho man remain there, and this number dependsmore o the natur of the hous than on therars mentioned factor. As resard therarsi potnt, it ecam clearly evident in the stilluncompletestand reclaimed in the Piave territorn province of Venetia where amon the labourer residins in Sheds, much more malaria occurre than in the land long since reclaimed. et the number ofanopheles found in those two territorie in houses o stabies hewe no appreciable difference. In this connection, mindioesiachio the barrac camps of the refusees around Salonika, hich, o insto the densit of thei aggregation, o that reason alone, OS Certaini contribute to the great extensionis malaria This is entirelyin agreement therefore it another phenomenon observe in urcountry, amely that in houses resided in by bis families there areosten Mund more infected anopheles than in those,ith smali families. Unde these circumstances labourer barracks it mistitie imagined that fauete protectio acquire Special value, as we a cit applied in thesea uround of Chaturka with good resulis i .e many anophetes in thesisSty, adjoinins butione in the barracksin. The secon potnt an e understood but is stili no more than a hypothesis, ascit canini be proved by findin infecte mosquiloes in ome kind of houses and thei absene or carcet in thers. EX- perience resardin the occurrence of malaria houses' does indeed potnt to the suggestio that one hous offers more chance of infectionthan another, ut e have not et much positive knowledse,ithresard to such chance and in relation to the character an installationis the house. Notwithstandins these lacunae the vie is thus arrive a - and in his connection, the nam o Cotonet Iames musti mentione in therars place -- considering the malaria question housing questio an attachin primar importance to the remova of Anopheles in dwellinus, no wit the objectis reducin the number of mosquiloes, butaecause in dwelling there is the reater hanc of
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catchin infected mosquiloes AS i mellanown Such measures have been applied in and around Amsterdamin the basis of considerations simila in principie. The Same applies to India Schusners malaria combatin in Grea Mandallingi. Needies to say the are ni ofvalue i the malaria carrier is a mosquito hicli is in the habit offuckin blood in the hous and unde favourable circumstances re maining therein for a long time.
There is nothins reatly ne dorus to be concluded Do the foresoing. Yet specia emphasis mustinc more he laid o certai potnis In the rs place this that it is unjustrio ard Dutch doctor tosa that in this countrymothin is done against malaria, as was aidi 1920 and helare, prior to the commencement of the great mosquito campaisns what ther countries endeavourto introducemith difficulty.what the potn to illi pride an organisation to brins quinine real l within the reach of ali, that organisation, posses thanks to theco-Οperationis doctors, medicat State supervision, sichiund and the wholesale quinine trade Thanks to that co-operation a severe epidemi
l per cent of malaria ithout the relapses of the fame yeari, passedove the populationis orth-Holland without occasionins grave orpermanent injury what, mish have expected without that quiet
I at an time the decision hould e arrive at that in North-Holland without radicat alterations in the hydraulic conditions the genera fisti asainst mosquiloes a conductedis to no i not orth the expense, his ould no mean as has been asserted that we hould sive itis an sit down illi folde hands. ut that weshould confine ursetve to perfectin the old an trie system findividua malaria Bulitini also perfectinxit the introductioni So- calle cheaper quinine n the initiative of the forme Inspectoris North-Hollan and Utrecht. Professor Dr Alclershos in conjunctionwit the Amsterdam Quinine actor is an example of this . his
Another potnt of emphasis is the importance asinopheles in houseso the basis of what has been aidis pase q6. In conjunction iththis the endeavours of the Red and white Crossio induce inhabitants by propaganda to star the fiftit musti consideredis of the ulmost
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48 IOURNE OF THE MALARIA COMMISSION
I is further clear o the basis of what has been sat above that in ur malaria area Such an organisatio for the distributionis quin-ine a that of the Italian Red Cros in the Pontine Marshes oris the Commune of Rome in the Auro Romano wouldie superfluous weare reali much etter of But is the drainins of the Zuyderaeereali reaches the stas that groups of polderboys ' emain there da an nisiit, in an area not et in the regula posSeSSion ofour doctors, and later on durin therars few ears of bringin thene ly on land unde cultivation, then a regulation suci, a that of
in in the parasitologica investigation elare ensasin the men, hic is flareat importanc in an area hitherio uninhabited might certainlyae considere&with a vie M adoption Os courseri do notmea a flavis imitation, ut adoption illi utilisatio of the many data collecte in the course of these ears the great value of whichas proos of what canae achieved and what cannot wili perhapsinlythen be realised but then certainly.
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QUIN INE AN MALARIA PROPHYLAXIS 49 METHOD OF ADMINISTRATION OF QUIN INE. PARTICULARLY wΙTH A VIE TO MALARIA PROPHYLAXIS ON A LARGE SCALE
THE usual method os administration os quinin are per S in
In a brie discussion of the mos destrabie mode of administerins quinin the distinctio musti made belween the reaiment of individua cases and the fightin os malaria o a large scale for instance, when it is a questionis controilin endemi malaria in a particular
while in individua treaiment the doctor ill consider hichmethod is the mos destrabie in the particular case, extensive malaria prophylaxis and contro can, by iis nature, he effected by means of asenera planini and there musti taken into account an verasestandar dose, a mode os administration hic is accepted without justifie aversio an simplicit a resard theaeepin and takins of the drus, it a vie , mons other things, o costis transpori and
Is e conside what are the advantases and disaduantases attend- in the different modes of administration e may, in the firs place, puti record that the common opinionis almost at writer on his subjec is that dissolve quinin administere per os provides themost rapi and ut quinine effeci. At the fame time this method is ope to great objections no Suc ces has sociar been achieved in correctin the intenset bitter asteos a Solution, and consequently many patienis, and children in particular, have a violent aversion to this method. I frequently sive riset obstinate vomitin and it is difficult os application in comatose conditions in hic condition rapid absorption is o essentiat.
These difficulties are done away with for the most part when quininei sive in pilis o cachet o tableis Pili ho ever must e laeshbecause they dry rapidi and absorption in the intestinat canat is then
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50 QUIN INE AN MALARIA PROPHYLAXIS
ver inadequale Cachet ar fairi expensive the tablet, providedit is made in Such manne that itireah umin a se seconds is there- fore testin the mode tot selected for administration peris. As resards intramuscula injectionisither of quinine alone or quinine combine with urethane, hic injections are osti made dee in the nates there is Some differen eis opinion Accordin to Some riters it always produces abscesses and necrosis in the long run Othersasain extol this method and appini readily On perusing the literatureo the subjec the impression is nevertheles gaine that in many cases the abceSSe Occurrins are tote attributed to insufficient asepsis an fauit technique hen injectins and it is no tot wondered atthat repeated injections os concentraled quinin solutions at the fame potnt finali resul in necrosis this lies in the natur of the actionis quinine n the ProtoplaSm. But the view that in a particular case a single injectionis quinine in the nates is contra-indicated by reason of the anser of necrosiso abscesse Hypectr to me rons and there are a number of writers who are of the Same opinion I myset have repeatedi sive Such
injections and haVe neve Seen an complication.
For ome time itised tot potnted out a for instancei Boreland mire in l923 that intramuscula injections ould cause tetanus
o rende the latent tetanus infectio acute But this to is no contradicted in ther quHrterS.
Intravenou trectiment i reserve for severe attach in hic it is absolutet indicated, o conve a quantit os quinine direct into thebloo circulation As a regula treaiment iti no means teld any belle resul than an other mode os administration. hile it has considerable disaduantases. Thrombo-phlebitis cinctionism . As state above the doctor reatins a malaria case illinave todetermine hic method he wil Appi in that particular case. In the malaria prophylaxi on a large scale ho ever e re con- fronte&with an entiret different propoSition. Needies to a there cantem question here of the applicationos injectioni an kind whatever. Each quinin injectio requires strict sepsis an caresul technique the hance of infectio appears to e much reater than for instance, it morphine injections. Therefore is malaria is tot controited in a lesse or greater region injections Aremo tot considered.
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QUININE AN MALARIA PROPHYLAXIS i
There remain administration by the mouth. For the reason state above the administration o dissolved quinin is though not impossibie, almost uiside the limits of feasibility. The bitter aste and the vomitin are serious dissiculties, and unles the solution is prepare o the spo the conveyance of the necessar quantit of Solution occasion unnecessar trouble. Cachet are to dear and therefore pilis o tablet are test. O these the tablet deserve preferen e in ever reSPeci, the are eas of transpori, occupwlitti space, remat in sood condition indefinitely is properi packe and ostio much more than quinin inpowder form. The dosas is the simplest imaginable this also appliesto pilis .
Malaria controi on a large scale is mos eastly and cheaply effected by an administrationis quinin in table form. The therapeuti effectis no inferior to that of ther modes of administration capable of application in his caSe.
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52 MALARIA IN ITALYMALARIA IN ITALY
THE ANTI MALARIA FIGHT: TS METHODS IT RESULTS LA MALARIA EN ITALI E LUT TE ANTIPALUDIQUE: SE PROCEDES SE RESULTAT Si
Member of the Health Committe of the Leaque of Nations
SUCH is the descriptio sive acie years ago by an Italian
writer of the fatal regions of the Pontine Marshes This sombre picture as applicabie to any the marsh areas oscitaly. To-da matters have chansed True i is that the entire malarialsurface of the Peninsula has not et been improved. ut persistent
work and efforis have profoundi modihed the siluation. This a the fac recorde by the Commission hic ha been instructed by the Health Committe of the Leasue o Nations tostud malaria in Eastern Europe and Italy we sive here a Summaryo the conclusion of the repor concerninscitat presente to the September l92q session of the Health Committe of Geneva. The extent an importance of malaria laver in Ital constitute ita sociat problem of therars rank. The question is dominate by two factors in the rs place e have the orograph and the climatemhic have create sultabie conditions for the appearance and per sistence of the infection, and on the other hand the necessit os eti- in rid of the marshes the cause of the liness, transformin them, boni*ing them so that the mistit furnis sustenance to a numerouSpopulation. To this tas the Government, ensineers, agriculturisis and doctorS have devote themselves an it is impossibi to ver estimate the progress achieve in the trusule against this infectio by the scien tisis of the counirnwho studie malaria.
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vated, ut o urea lensili traversin the whole of the res of the Peninsula an occupyin more than hal of iis ursace suc is theueouraphical formation os Italy An exceedinstrabundant river system. more than 300 river an torrent descendinifrom these heiuliis onthe other hand have, in the lowsaris, create a very fertile alluvialsoli, hic to ard the seashores, formaeau deposit os fertilisinu
ulations of dunes in formin an obstacle to the normal outflow of the waters marshes and pond without number ere forme pretiywel everYwhere and particulari nea the estuaries Thessio climate and stagnant,ater are the mos favourabie conditions for the multiplicationis mosquiloes Ital was marked out as ct prent malaria.
She has been o in ali times. Some paris of her soli neverthelessadmitted of hein worked improved, reclaimed the historica politica event of hic Italy has so osten been the scene in forme times, caused the wor to e bandoned plain formeri fertile eredeserted and hecam marshes: men fled to the hilis. The rapi increas of the population in the last centur sit hasalmost doubie in fift years concurrently ith the reconquest ofunit and salaty le to pace bein sought forin hicli ne generations isti setile an find thei sustenance. It was proposed todrain the marshe with the idea that malaria infection Ouidie sotri os a the fame time. The hygieni result a good in certain regionS, es so or lower in others but rom the agricultura potnto vie the effect was such that the State thoush itfel in utybound folio in the example se by the Magistrato alle Acque ' of the ancient Republic o Venice, to sive reater extenSion to the works of greationisi timor redemption of marshlands Thecla s
was tot carrie out but it was perceived that here,as norasreement etween hydraulic improvemenis and the improvement offarmers, and above ali that malaria far romtein extinguished ostenextende alon the artificiali create drainas channeis. DiscoVeries resardin the parasite and the transmittin inSectS, modifie both the means os combatin the diseas and the methodSemploYed by the wnin or reclaiminitand-owner o ASSO intiΟnS.
The law of 900 create the Institutis of State quinine HS curcttiVe an preventive remed placed within reach of all. Thecla solo 90 l. 902 l 90 and l 907 complete this orsanisation. Malarict
a considere a a professiona diseas for compulsor declaration
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the tand-owne was compelle to look after and salasvard his orkmen, o indemniis the familWin caseis deat is it had occurrediminuto ac of precautions Ormi in the one osciallideclared infected. Finalty ali the prosit of the sale of the quinine prepared by the State
were tot reserved for the more energetic continuance of the strussie.
The State ein unable in spite os iis large sanitar stas and iis Ver complete equisement, to undertake lone the delance of the territor against malaria, calle in the id os charitable associations.suc a the ResCross, the Autonomous Institute of Venetia themtiona Institute Dr the Pontine Marshes thebationa Associationfor the outh etc. I grante them ver his subsidies and placed
scientisis, bacteriolosist an inspector at thei disposai. Thus there,ere create in the whole of the infected regions. 1200 permnnenti temporary ut-patient depariments in addition to 2.000 out patient depariment consultation surgeries of a generat character normali existins quinine citatributis StationS, ambulances, Sanitary
medica services in hicli the children, hil receivin education. are Milyareatefinith quinine, antiamalaria schools where the methods
laboratories for the examinationis the blood laboratories for researchi connection it mosquiloes commission for the stud of mali bonification smal measures for the destructionis larvae, etαὶ.One of the ast important legislative enaciment is the decree of therat ' December 1923. modi*in the Italia sanitar organisationand co-ordinatin ali measures and ali orks effected by the various Ministries, in orde that the Directionis Hysten may exerciseritSright o supervision thereover: his means a linkinsiman hygienicco-operation in the work of reclamation. It is no longe possibi for marsh drainas tot carriefout without the subsequent measures require for the disappearance of the mallponds and the outflow of smali stream an remova o grassaeins provide for The associations and omners of improve land mustavoid an cause hic may aggravate the sanitar siluation by reasono the had drainas of the Suriace HierS.