4i6 



NATURE 



[June 3, 1Q09. 



foundly modifieS the history of mankind by doing more 

 than anything else to hamper the work of civilisation in 

 the tropics. Only those who have studied tjie disease from 

 house to house, from village to village, can form any true 

 notion of the total effect which it must produce throughout 

 the world. 



Next let us recall briefly the various methods which we 

 possess for preventing and reducing the disease. The 

 oldest of these — known to us since the time of the Romans 

 —is drainage of the soil. The reason why it succeeds 

 became quite obvious after 1898— because it tends to re- 

 move the terrestrial pools and marshes in which the 

 Anophelines, that is, the family of mosquito which carry 

 malaria, breed ; but the new discoveries not only explained 

 the old method, but also rendered it more simple, cheap, 

 and yet precise, by showing us exactly what waters!' 

 namely, those in which the larva; of the Anophelines 

 actually occur, arc to be drained awav, or filled up, or 

 otherwise treated. But science has given us other methods 

 as well. Thus we have known for a long time that 

 quinine is a preventive as well as a cure — that if, for 

 example, a body of men are given quinine with regularity 

 they will suffer less from fever in consequence. Still 

 further, the old saying that the use of mosqidto-nets at 

 night will keep off malaria was now fully justified, not 

 because the nets exclude any aerial poison, but simply 

 because they exclude the infecting insects. This simple 

 precaution can, moreover, be extended by protecting all the 

 windows of a house by wire-gaiioc , as' already frequently 

 done in the southern ' States of America. Punkas and 

 electric fans also serve to keep away the insects ; and, 

 lastly, segregation of Europeans from native quarters, as 

 used so largely in India, will help to keep them from 

 mosquitoes infected by native children (who suffer so fre- 

 quently from the disease). It was thus apparent that if 

 the inhabitants of malarious countries could be persuaded 

 to protect themselves by mosquito nets or quinine, or if the 

 Governments of such countries could be persuaded to 

 undertake suitable drainage and other measures against 

 mosquitoes, much improvement in the public health was 

 likely to accrue. 



But hovif precisely was such persuasion to be under- 

 taken? Of course, I do not allude to utterly barbarous 

 peoples, to areas far beyond the influence of 'civilisation, 

 which are happily shrinking in magnitude every day. I 

 allude to independent or dependent S'tates professing them- 

 selves civilised, and to the numerous colonies of the great 

 civilised nations. Here we already possess the requisite 

 machinery. Such States or colonies are administered by 

 governors and councils, and for the most part possess 

 medical and sanitary departments controlled by well-paid 

 officials, whose special duty it is to attend to such affairs. 

 Many dependencies, moreover, such as some of these of 

 Britain, are placed under the central Government of the 

 nation concerned, and can be influenced bv it. It might 

 be supposed, then, that at the period referred to all such 

 administrations would have gladly interested themselves 

 in the prevention of a disease which produces so much 

 mischief, and of which the cause had been so clearly 

 elucidated ; that they would at once have set about collect- 

 ing preliminary information, and commencing at least some 

 experimental trials. So far as I can see, there is no real 

 reason why this was not done everywhere nearly ten years 

 ago. 



Unfortunately, though science may provide us with facts, 

 humanity is slow to credit them, 'and still more slow to 

 fake advantage of them. History is full of examples of 

 this. For instance, years elapsed before the discovery of 

 Jenner was fully utilised — it is not fully utilised even 'yet. 

 .Another instance, closely connected with malaria, is that of 

 filariasis, a parasitic disease of which elephantiasis is one 

 manifestation. More than thirty years ago very good 

 evidence was given to show that it is carried by mosqui- 

 loes, and, considering the horrible and widespread deformi- 

 ties which it produces, one would have thought that strong 

 efforts would have quickly been made to- control it by 

 reducing the carrying agents. So far as I can ascertain, 

 however, scarcely anything has yet been even ' attempted 

 against it. No one has interested himself seriously in the 

 nrutr-r, and consequendy nothing has been done. 



It w.ns therefore early apparent to me that, though the 



NO. 2066, vol.. Sol 



machinery for extensive anti-malarial work' existed in many, 

 countries, yet it would not easily be got, to work unless, 

 someone could be found who would devote himself to the. 

 task — neither a pleasant nor a profitable one — of urging 

 it forward, and I felt that the duty devolved on myself, 

 in the absence of others, as regards British territory. 

 Happily, .■\ngelo Cell! and Robert Koch occupied them- 

 selves similarly as regards Italy and Germany, and the 

 creation of the Schools of Tropical Medicine in Liverpool 

 and London in 1S99 did much to popularise the recent dis- 

 coveries. At my inaugural lecture the same year, at the, 

 former institution, I described my proposals for the pre- 

 vention of malaria by mosquito reduction, and a few months 

 later, accompanied by Dr. H. E. Annett and .Mr. E. E. 

 .Austen, I left England for Sierra Leone in order to perfect 

 the details. 



Sierra Leone is a small British colony long notorious for 

 its extreme unhealthiness. We determined rapidly the 

 malaria-bearing species of .Anophelines there, and their 

 breeding places and habits, and ili' \\ ii|i :i series of pro- 

 posals for their reduction. These Ihm ^in, ,• become the 

 basis of similar work elsewhere; Inil. simplr as they were, 

 we could not get the local authorities to understand them 

 or act upon them. Two years later I again — twice — visited 

 the colony, and, assisted by Dr. Logan Taylor and a sum' 

 of money presented to me for ' the purpose by a private 

 gentleman, attempted to give an object-lesson on the sub- 

 ject. Though the result was successful at the time, we 

 again failed in inducing the authorities to take up the 

 work properly ; and I can obtain no adequate information 

 as to what has been done there during the last seven years,' 

 and may perhaps be excused for not wishing to inquire. • . 



In the meantime, the Liverpool School of Tropical' 

 Medicine and the Royal Society had sent a series of ex- 

 peditions to West Africa, which did much good work there.' 

 -As a consequence. Sir William MacGregor, Governor of 

 Lagos, and one of the most enlightened of British adminis- 

 trators, took up the task in that colony with great intelli- 

 gence and energy, but, . unfortunately, was shortly forced 

 to leave by ill-health — a serious blow to anti-malarial work 

 throughout the world. From that time, though much 

 appears to have been done by energetic individuals in West 

 Africa, and though, to judge from popular statements, 

 public health has been decidedly improved there, yet the 

 official reports and returns are too inadequate to enable 

 us to form any trustworthy opinion of the results. The 

 recent statements of Prof. Simpson on the subject' are not 

 encouraging; and to my mind, judging from many facts; 

 known to me,' the sanitary administration of the West 

 African colonies has been generally wanting in leadership^ 

 and organisation, and the campaign against malaria_ has 

 been constantly thwarted by administrative indifference' and 

 professional jealousy. . * . 



Turning elsewhere, I must now mention with great 

 pleasure the early and successful campaign of Koch at 

 Stephensort, in New Guinea.' The method .of Koch .does, 

 not depend on mosquito reduction, but on the detection' 

 and treatment of cases of malaria by quinine, until' they 

 cease to spread the disease among their healthy neighbours. 

 It is allied to the similar method used in other diseases, 

 has been successfully followed in the German colonies and 

 in Italy, and will always be a valuable weapon in the anti- 

 malarial armoury. The great work of Colli and the Italian 

 Anti-malaria Society, commenced early in 1899, has been 

 based on the same, but also on a wider, principle of dis-' 

 tribution of quinine, togelher with mechanical protection 

 from niosquilo bites. Working onward step by step against 

 political and local indifference, they have gradualjy made, 

 during the last ten years, a great reduction in the amount 

 of the disease throughout Italy. .An independent witness — 

 Prof. Osier — has recently written as follows to the Times :■ — 

 " In Prof. Celli's lecture-room hangs the mortality chart 

 of Italy for the past twenty years. In 1887 malaria ranked 

 with tuberculosis, pneumonia, and the intestinal disorders 

 of children as one of the great infections, killing in that 

 year 21,033 Persons. The chart shows a gradual reduc- 

 tion in the death-rate, and in 1906 only 4871 persons died 

 of the disease, and in 1907, 4160." I should be unable to 

 hang a similar chart for British possessions in my lecture- 

 room . 



In 1900-1 a great discovr-rv, closely connected with our 



