MALARIA IN GREECE — ROSS, 701 



the locality, we could attribute the enlargement in these children only 

 to malaria. This diagnosis has been fully confirmed by subsequent 

 examinations of the blood films, which showed that the parasites ex- 

 isted in at least 17 of the 62 children at the time when the films were 

 made. Of these, 5 had an appreciable enlargement of the spleen, so 

 that this number must be added to the number of spleen cases in 

 order to arrive at the total yielding evidences of infection. Hence, 

 out of the total 62 children, no less than 40 were certainly infected — 

 a ratio of them of 64,5 per cent. This is, of course, the lower limit 

 of the ratio, because it is quite possible, and indeed very likely, that 

 the parasites were overlooked in some of the films. Such a ratio was 

 unexpectedly high for any European country, and is almost equal to 

 any that has been found in Indian or African children. 



I may add that in many of the children the splenic tumor was 

 very great, reaching almost to the crest of the ilium. This is im- 

 portant, in view of statements recently made in India to the effect 

 that great splenic tumor is probably due to kala-azar, rather than 

 to malaria. The former disease is apparently not present in Greece, 

 the Leishmania donovani parasite never having been discovered there. 

 Moreover, the Grecian cases were markedly different from the cases 

 of kala-azar studied by me in Assam, in 1898, for the purposes of an 

 official report. In not a single one of the former did we note any 

 enlargement of the liver, so commonly seen in kala-azar; there was 

 not the constant fever of kala-azar, the expression of the face was the 

 unconcerned expression of malaria rather than the hopeless look of 

 the deadly eastern disease ; and lastly, the death rate was far too small 

 for the latter. Nevertheless, the splenic enlargement in a few of these 

 cases of pure malaria was, I think, as great as anything I saw in 

 kala-azar. Of course, many of the children were shockingly anaemic 

 and emaciated — not in any way, I was informed, from lack of food, 

 nor, apparently, from the great prevalence of other diseases. The 

 work was clearly that of the spirit of the marsh. 



The next thing to do was to find the source of the malaria, or 

 rather its carrying agents, the local Anophelines. As I have said, the 

 Kopaik Plain is now drained and cultivated over its whole extent; 

 but numerous small streams enter it from the surrounding hills, 

 traverse it, and discharge into the main channels of drainage. These 

 streams are swollen torrents in the winter, but in the summer often 

 become trickles of water with occasional marshy borders here and 

 there. Several such streams enter the basin near Moulki ; but at that 

 season (May to Jime) we could find no Anopheline larvae in them, 

 though some have been found subsequently, as we conjectured would 

 happen with the advance of the dry season. But in addition to these 

 streamlets there exists a long series of shallow pools suitable for the 

 larva3 in the '" borrow pits " made by the engineers who constructed 



