10 



done practically nothing to lessen the incidence of infection. With 

 sufficient labour it would not be impossible to keep a certain area free 

 from mosquitos, provided that the work extended far enough, as the 

 mosquitos in Macedonia will travel a mile or more. But even in the 

 districts that were less difficult to deal with, the mosquitos could not 

 be eradicated, and it would have probably been better to concentrate 

 energy on direct protective measures. Of these, quinine prophylaxis 

 was tried, but although it may have protected a small number of 

 individuals, it failed to prevent infection in thousands of cases, and it 

 is questionable whether it is worth while on so vast a scale. The daily 

 administration of quinine, however, undoubtedly prevented relapses in 

 infected men. The third measure adopted was to protect the men 

 from bites. For this purpose head nets and gloves, though of limited 

 use, were distinctly advantageous in certain places. Repellents of 

 various kinds were generally employed, but their effectiveness depended 

 apparently more on the grease used than on the other ingredients, 

 and they therefore required frequent application. 



Consequently it is thought that better results might have been 

 obtained had the money been spent on the erection of mosquito proof 

 huts and hospital wards, the issuing of a constant supply of 

 mosquito nets, etc., rather than on anti-mosquito measures and 

 quinine prophylaxis. 



The occurrence of malaria in 1919, after the armistice, in Salonika, 

 Constantinople, ports on the Black Sea and the Caucasus is also 

 reviewed. A. maculipennis and A. superpictus both occurred in the 

 vicinity of Batoum, but it is thought that anti-mosquito work carried 

 out in this district under peace conditions should give good results. 

 Along the railway line from Tiflis to Baku, A. maculipennis, A. hyr- 

 canus (sinensis) and Ae'des {Ochlerotatns) caspius (dorsalis) were taken. 

 The Caucasus is a highly malarious country, and there are probably 

 areas that are nearly, if not quite, as bad as some of the worst districts 

 of Macedonia. The Anophelines of primary importance are A. macidi- 

 pennis and A. superpictus. A. hifnrcatus is probably of little account 

 as a malaria carrier, for it is comparatively rare, as is also /I. algeriensis. 



In Macedonia the females of A. maculipennis and A. superpictus 

 hibernate in any sheltered spot. From April onwards the adults 

 become numerous, and breed rapidly in the streams and marshes 

 until November. Even in Macedonia, where the winter is very severe, 

 hibernation as applied to Anophelines is a relative term. They may 

 take a meal of blood during the winter in warm stables, but in colder 

 ones they remain inactive. 



Experiments indicate that as regards infectibility with P. praecox 

 and P. vivax, A. maculipennis and A. superpictus are practically 

 the same. The earliest date on which an infected A. maculipennis 

 was found was 11th May in Macedonia. Individuals of A. super- 

 pictus taken during the winter months were found with oocysts on the 

 stomach. Experiments here described show that under certain 

 conditions the carriage of malaria through the winter by hibernating 

 mosquitos is a possibility. 



The clinical aspect of the disease, including an explanation of the late 

 appearance of malignant tertian and the severity of Macedonian 

 malaria, is briefly discussed. 



The development of the malarial parasite in Macedonian Anophelines 

 and the technique employed are described. 



