240 



NATURE 



[August 25, 1910 



expensive ; but as compared with the worlc and ex- 

 pense involved in outbreaks such as at one time or 

 another have attacked our north European ports, the 

 work and expense involved are absolutely trifling. 



All this, of course, is exceedingly reassuring, but 

 we have, on the other hand, as the outcome of our 

 knowledge of the life-history of the cholera bacillus 

 and its relation to the human subject, a fact which, 

 disregarded, mav be a source of great danger, though, 

 knowing of its existence, precautionary measures may 

 be taken which may render it harriiless. Of io8 

 patients, presumably "contact patients," or patients 

 who had recovered, examined at Rotterdam in 1909, 

 nearly 4 per cent, were found to be bacilli-carriers, 

 corresponding to the so-called typhoid-carriers which, 

 only recently recognised, seem to play such an impor- 

 tant part in the dissemination of the typhoid fever 

 germ. The cholera bacillus was found in these 

 carriers for periods of from five to twelve days after 

 they came under observation. It is pointed out that, 

 this being the case, out of more than 100 people leaving 

 a cholera-infected port four (approximately), according 

 to the above statistics, may carry these germs for 

 twelve days, so that any port within twelve days' 

 distance at which these carriers land might be in- 

 fected bv cholera. How far this observation accords 

 with the experience of port officials it is impossible to 

 say at present, but no doubt the matter will be care- 

 fully gone into now that attention has been directed 

 to it. 



A very interesting outcome of the curative treat- 

 ment of the cases of cholera that occurred in the 

 Rotterdam outbreak is that, although the epidemic 

 death-rate in Holland during 1909 was about 45 per 

 cent., the death-rate in the municipal hospitals, where 

 special treatment was carried out, was only 13 per 

 cent. Here the doctors resorted to the hvpodermic 

 injection of a normal saline solution, sometimes in 

 quantities of several quarts a day, the effect of this 

 mild saline solution, as pointed out by the Times cor- 

 respondent, being not only a replacing of the moisture 

 which the system loses as the result of the extreme 

 watery diarrhcea, but " a direct stimulation of 

 the heart and also an indirect stimulation of 

 the heart by diluting the blood and thus reducing 

 friction." 



The whole treatment, both preventive and curative, 

 of cholera is the outcome of modern methods of medi- 

 cal research, a fact that may be commended to those 

 who, either through prejudice or ignorance, or both, 

 would limit the study of bacteriology and experimental 

 medicine to the field the bounds of which are those of 

 their own narrow vision. 



MALARIA PROPHYLAXIS IN INDIAN 



A 



PROBLEM of Imperial magnitude." "Epi- 

 demics of smallpox, cholera, and plague are 

 grievous afflictions, but neither singlv nor even col- 

 lectively are they responsible for so much economic 

 inefficiency, and what is worse, actual human misery, 

 as the recurrent scourge of malaria." These words 

 of the Viceroy and the Lieutenant-Governor of the 

 Punjab respectively impress us with the magnitude 

 and seriousness of the problem that the conference 

 had to consider. If we attempt to translate these 

 words into figures, we are met with difficulties, owing 

 to the fact that the registrar of deaths in India is 

 often the ignorant village chowkidar, but as a rough 

 approximation, it may be assumed *^hat the mean 



* Proceedings of the Imperial Malaria Conference held at Simla in 

 October, 1909. Pp. vi + 107. (Simla : Government Central Branch Press, 

 1910.) 



NO. 2130, VOL. 84] 



death-rate is about 5 per 1000, i.e. over a million. 

 deaths annually throughout the country as a whole ; 

 whereas in the jails, owing to the care with which 

 prisoners are treated, the mean death-rate from, 

 malaria is only i per 1000. 



But even if the figures for the country as a whol"^ 

 be correct, an analysis of them does not reveal where 

 the real mischief lies. If we assume, for example, 

 that we know the malarial death-rate of a particular 

 town or district the figures available still do not 

 show us whether, as not uncommonly is the case, 

 some parts of the town or district may not be quite 

 free from malaria. It is evident, then, if prophylactic 

 measures are to be applied economically and' from 

 financial considerations, this is a prime necessity : one 

 of the first and most important steps must be to 

 determine accurately what areas are malarial, or are 

 so to such an extent as materially to affect the whole 

 of the inhabitants ; for it is obviously unnecessary 

 to apply prophylactic measures to those areas which 

 do not need them ; but unfortunately there appears- 

 to be evidence that this has already been done, not 

 to mention the " fatuous " instance recorded of oiling 

 drains, under instructions, where minute examination 

 showed that no anopheline larvae existed. But on the 

 other hand, there is already work waiting to be done. 

 What is the nature of this work, and how is it to- 

 be done? 



It is these questions that mainly occupied the atten- 

 tion of the delegates to the conference. It was pointed 

 out that a multitude of different conditions exist in 

 India, but that small villages surrounded by swamps 

 are in the enormous majority, and again it was stated 

 that the mitigation of malaria in India is chiefly 

 the problem of its mitigation in small villages. For 

 scattered populations, small villages, and rural areas 

 we have the opinion of Major Ross quoted that we 

 must generally fall back upon quinine, yet, -rightly, 

 the conference put mosquito destruction in the fore- 

 front of its policy, for no doubt — and this is also 

 Ross's opinion — this is the fundamental method; the 

 question is, to what extent is it financially pos- 

 sible ? 



The resolutions of the conference on this point are 

 expressed in an apparently contradictory sentence. 

 They state " that it will not be possible to protect 

 rural areas by any scheme of drainage which is finan- 

 cially practicable, but it has been found that in some 

 highly malarious tracts the level of subsoil water has 

 been materially lowered with great permanent benefit 

 by drainage operations, the cost of which was not 

 prohibitive." This question of drainage was discussed 

 at length by the conference, and very contradictory 

 views were expressed, not only as to its practicability 

 owing to expense, but as to its benefit, evidence being 

 adduced to show that even in well-drained areas there 

 had, in some cases, been no reduction in malaria. 



It is a somewhat discouraging fact that no instance 

 of a drainage scheme with successful result was put 

 before the conference, but that already many un- 

 recorded failures have occurred. It seems to us a 

 matter of importance, then, to inquire into the cause of 

 these failures, so as to ascertain if anvthing was left 

 undone that could now be better done. Ill thought- 

 out schemes are not uncommon. We ourselves know 

 of a case where a large, shallow tidal area of water, 

 quite free from anophelines, was converted into an 

 ideal breeding-ground by partial filling with earth 

 and by the consequent formation of many hundreds 

 of pools. The danger, too, was pointed out of drain- 

 ing a permanently flooded area, wherebv a compara- 

 tively healthv was converted into an unhealthy tract, 

 with numerous pools in the rainy season. .Some 

 difference of opinion was expressed as to the effect 



