570 ANNUAL, REPORT SMITHSONIAN INSTITUTION, 19 3 



lem of acclimatization will not be solved. No one can read of the 

 wonderful progress that has been made in the fight against yellow 

 fever, malaria, hookworm, and dysentery, without looking to the 

 future with high hope of a continuing and eventually a complete 

 conquest. The work of General Gorgas at Panama, in reducing 

 the death rates from 40 per thousand to 7.5, a year or so later, is 

 certainly an object lesson in successful prophylaxis. It is one of 

 many " monuments of victory," as these splendid achievements in the 

 war on tropical disease, in Panama, in Cuba, in the Philippines, and 

 elsewhere, have well been called. It has been estim.ated that in the 

 Malay States, over 30,000 lives were saved by the introduction of 

 an adequate drainage system. Fifty years ago the death rate in 

 Jamaica averaged over 50 per thousand. It has now been reduced 

 to nearly that in our own cities. A brilliant group of medical men — 

 heroes, all of them, and several of them martyrs to medical science — 

 has accomplished almost incredible results. The areas ravaged by 

 some diseases have been limited. " Quinine, kerosene and mosquito 

 netting" have accomplished wonders. The future certainly looks 

 bright. Many diseases associated, directly or indirectly, with trop- 

 ical heat and moisture can now be effectively guarded against by 

 the intelligent and persistent observance of simple rules of living. 

 Medical science already knows, fully or partially, the best methods 

 of controlling and preventing such diseases as plague, cholera, yellow 

 fever, typhus, malaria, sleeping sickness. As a recent medical writer 

 has put it, the question of how far to apply this knowledge in a 

 practical way is now very largely one of expense and of incentive. 

 In this discussion certain facts seem to stand out in the mind of a 

 layman. Tropical diseases are still, and will for generations remain, 

 a very serious handicap to white settlement of the Tropics. Medical 

 men will doubtless be the first to agree that a great deal of slow, 

 patient scientific research must still be accomplished before the fight 

 against the widely extended strongholds of many tropical diseases 

 can be successfully carried through. Sanitary campaigns, on a vast 

 scale, must be undertaken. These are immensely expensive, perhaps 

 for generations to come prohibitively expensive. And they may also 

 be very difficult because of the ignorance and opposition of the 

 natives. To quote, " Those who are not actively engaged in the war 

 against tropical disease are not given to exuberant optimism con- 

 cerning the outlook, but are preparing for a conquest ' which must 

 be sustained with method and tenacity ' for years to come." The 

 brilliant work accomplished in Cuba, in Panama and elsewhere, in 

 the fight against yellow fever, involved a very large expenditure of 

 money. The area was limited. There was strong military or 

 civilian compulsory authority behind it. If one looks at the extent 

 of the wet Tropics on any map of the world's climates, the impos- 



