9 



instituted, the investigations of which covered a wide field. The 

 results have been collected and will appear in a series of five papers. 



Wenyox (C. M.). The Incidence and Aetiology of Malaria in 

 Macedonia.—//. R.A.M.C, London, xxxvii, nos, 2, 3, 4 & 5, 

 August, September, October & November 1921, pp. 83-108 

 172-192, 264-277 & 352-365, 20 figs., 5 plates. 



An account is given of the malaria epidemic in the Salonika army 

 in Macedonia, and the topography of the country and the remedial 

 measures undertaken are described. Every spot along the line was 

 heavily infested with mosquitos, Anopheles maculipennis being the 

 prevalent species in the valleys, while A. superpictns proved to be 

 essentially a hill stream species and was found all over the high land. 

 During 1916 over 4,000 cases of malaria occurred on the lines of com- 

 munication, and in all over 30,000 cases were recorded for the year. 

 The native inhabitants undoubtedly constituted the foci of infection 

 in the first place, and a very high percentage of the troops still har- 

 boured parasites in their blood during the winter. Infection with 

 Plasmodium vivax may persist throughout the winter, but P. praecox 

 {falciparum) tends to disappear spontaneously or as a result of 

 quinine. 



The measures undertaken included drainage of swamps, clearing of 

 streams, destruction of larvae and adults, and the use of mosquito nets, 

 repellents, prophylactic quinine, etc. As many of the troops as possible 

 were camped on the high land. The complete extermination of mos- 

 quitos from the vast area involved was impossible under war conditions ; 

 under peace conditions the drainage would require the expenditure 

 of millions of pounds, and even then it is doubtful if anything very 

 satisfactory could be accomplished in less than five or more years of 

 continuous work. During the war much of the drainage and clearing 

 work could only be carried on at night, and there was enough untouched 

 breeding ground beyond the fine to infect the whole army. The men 

 could only be satisfactorily protected by the contrivances used to prevent 

 their being bitten by mosquitos. Except in certain localities anti- 

 mosquito work could only be done in patches, and in most cases the 

 effect was lost owing to the surrounding untreated areas. For the year 

 1917 over 70,000 cases of malaria were recorded. This large figure may 

 be partly explained by the unrestricted submarine warfare having 

 prevented the usual embarkation of severe cases. In 1918 a 

 similar state of affairs occurred. A scheme was therefore devised 

 whereby all troops in and out of hospital were inspected, and badly 

 infected men were evacuated by the overland route via Taranto. 

 This resulted in a great reduction of the numbers admitted 

 into hospital. The malaria incidence in 1918 was, however, seriously 

 affected by an outbreak of influenza, resulting in an inevitable confusion 

 of diagnosis, as it was difficult to decide which was the primary disease. 

 Of over 100 autopsies performed on cases diagnosed as influenzal 

 pneumonia, 83 per cent, showed previous malarial infection, proving 

 to what a large extent the army of Macedonia had become infected. 



It is very difficult to estimate the relative effect of the various anti- 

 malaria measures adopted when the number of mosquitos attacking 

 an individual amounts to hundreds, if not thousands ; the reduction 

 of a small portion of these will not lessen his chances of infection. 

 It would thus appear that the clearing measures undertaken can have 



