June 3. 1909] 



NA TURE 



417 



subject, was made by the Americans in Havana — I mean 

 the discovery that yellow fever, the scourge of tropical 

 America, is also carried by mosquitoes of the kind called 

 Stcgomyia. With the Americans, however, there was no 

 delay in turning this fact to practical account, and under 

 General Wood and Colonel Gorgas they got rid of the 

 disease from that large city in a few months. Since then 

 Colonel Gorgas has been conducting the magnificent 

 sanitary work of the Americans in the Panama Canal zone — 

 work the success of which is too well known to require 

 illustration by figures, but which has enabled the Americans 

 to do what the French, before the date of these discoveries, 

 failed in doing, namely, to continue the construction of 

 the canal. It is not too much to say that the canal is 

 being made with the microscope. Colonel Gorgas has re- 

 peatedly stated that the measure upon which he principally 

 relies, against both yellow fever and malaria, is the general 

 reduction of mosquitoes. 



For three years my original proposals to remove malaria 

 by this means had not been thoroughly and formally applied 

 by any Government, but I have now to record the first 

 classical successes obtained by it in Ismailia and in the 

 Federated Malay States. The former is a town founded 

 by Ferdinand de Lesseps on the Suez Canal. For many 

 years it had suffered extremely from malaria, the cases 

 amounting ultimately to about 2000 a year among a small 

 population. In 1902 I was asked by Prince Auguste 

 d'.Arenberg to advise on the matter, and my advice was 

 acted upon loyally and intelligently by his officers in the 

 town. The result was that the cases fell to 214 next year 

 and to ninety in 1904, and that since then there has been 

 no endemic malaria in the town at all. while mosquitoes 

 of all kinds have been practically banished from it. The 

 work in the two small towns of Klang and Port Swetten- 

 ham, in the Federated Malay States, was begun about the 

 same time, chiefly by Dr. Malcolm Watson under the 

 orders of the Government and of Dr. E. A. O. Travers, 

 and has been equally successful. No one who has studied 

 the facts published with regard to both these campaigns 

 can for a moment deny the success obtained. 



Since, then excellent campaigns on similar lines have 

 been conducted at Durban. Hong Kong, Khartoum, Candia, 

 and St. Lucia. Most striking has been the anti-mosquito 

 work conducted at Port Said under the orders of Sir Horace 

 Pinching, recently head of the Egyptian Sanitary Service, 

 by my brother, Mr. E. H. Ross. The town has been so 

 completely cleared of mosquitoes that, as at Ismailia, the 

 ladies no longer use mosquito nets for their children. I 

 may add that I have just recently visited both localities, 

 and was able to verify this statement by conversations with 

 a number of people. Fuller accounts of some of these 

 campaigns will be found in a paper by me published in 

 the LniiccI of September 28, 1907. Excellent and extensive 

 work has been done for many years in Algeria by Drs. 

 Edmond and Etienne Sergent (Aniiales de I'InstUut Pasteur, 

 1909) by all methods, and by Drs. Savas and Kardamatis 

 and the Greek Anti-malaria League (Annals of Tropical 

 Medicine and Parasitology, Liverpool, June, 1908). The 

 Italian work is published in the Atti della Societa per gli 

 stiidi della Malaria, and Dr. Laveran gives much informa- 

 tion on the subject in his last book on malaria, " Du 

 Paludisme, " 1907. 



Two years ago I was asked by the Government of 

 Mauritius to advise regarding mal.Tria in that ancient 

 island colony. The War Office associated Major C. E. P. 

 Fowler, R.-^.M.C, with me, and after three months' 

 studies, warmly assisted by the Governor, the officials, the 

 planters, and everyone, we drew up our scheme for a 

 general campaign against the disease. There is no doubt' 

 that this scheme will be followed when the present financial 

 situation is rectified, but in the meantime I hope and trust 

 that our reports, which were written with great care, and 

 have been published bv the Colonial Office and the War 

 Office respectively, will prove of value in other parts of 

 the tropics. 



When I left India in 1899 I hoped that that great 

 dependencv of the British Crown, with its powerful Govern- 

 ■nient and well-appointed medical and sanitary services, 

 would lead the way against malaria, a disease which 

 causes untold sickness, and possibly some millions of 

 deaths, annually in the country: but though many local 



\o. 2066, vol. 80J 



campaigns have been started by individual medical men, 

 and though there has been a steady fall in the malaria 

 rate of the army, I can find no evidence of a generalised 

 effort against the disease. Less than three months ago I 

 attended the Medical Congress at Bombay, largely for the 

 purpose of inquiring into the reason for this, and concluded 

 that though many capable officers, both of the Indian 

 Medical Service and of the Royal Army Medical Corps, 

 had done their best, yet the necessary leadership and 

 organisation were wanting in India as in West Africa. 

 .\n ill-judged and ill-conducted experiment at Mian Mir has 

 done much to paralyse all efforts in this direction, and I 

 gathered that anti-malarial campaigns were not popular 

 among certain officials. Neither the Indian Government 

 nor the medical services can be congratulated on the result. 



Some years ago the Secretary of State for the Colonies 

 issued a circular to the Governors of Crown Colonies ask- 

 ing for information as to what had been done in each 

 against malaria and other mosquito-borne diseases, and 

 statements on the matter from twenty-one colonies were 

 published in the Report of the ."Advisory Committee of the 

 Tropical Diseases Research Fund for 1907. I have criti- 

 cised these statements in detail elsewhere. Only those 

 furnished by seven colonies, namely. Southern Rhodesia, 

 Papua, Mauritius, British Central Africa, Gambia, Ceylon, 

 and Southern Nigeria, showed evidence of any real interest 

 in the matter. Those from Bahamas, Barbadoes, Jamaica, 

 and St. Kitts-Nevis showed, to my mind, nothing but 

 neglect of public duty, while those from Northern Nigeria, 

 St. Lucia, British Honduras, Grenada, Somaliland, Straits 

 Settlements, and Sierra Leone gave no decisive evidence 

 of the reverse. 



For a number of years I have had very good opportuni- 

 ties of learning the truth as to what is really being done 

 in manv of these and other dependencies. It may gener- 

 ally be summed up in two words — very little. Festering 

 pools which might have been cleared years ago for a few 

 shillings or pounds are left in the heart of important towns 

 to poison all around them ; quinine prophylaxis is neglected, 

 and house-screening forgotten. No efforts are made even 

 to estimate the local distribution of the disease, much less 

 to organise any serious efforts against it, although it may 

 be causing, perhaps, half the sickness in the place. 



Want of funds is always an excuse which is urged — and 

 is always a false excuse. Much can be done at almost no 

 expense ; and the men who have actually carried out the 

 work successfully in Panama, Ismailia, the Federated 

 Malay States, and Italy have expressly declared the cheap- 

 ness of it. Many a town could be kept clear of malaria 

 for the amount, 'say, of the salary of a single European 

 official. I estimate that a sixth of the medical and sanitary 

 budget should generally suffice to reduce a disease which 

 often causes half the sickness ; but instead of doing really 

 useful work which would benefit everyone, the authorities 

 too often fritter away their funds on trifling schemes. _ I 

 maintain that the health of the people has the first claim 

 on the public purse. 



Another excuse is that the possibility of preventing 

 malaria has not been proved, but when one questions the 

 sceptics one generally finds that they have not troubled 

 to studv the literature. 



The fact is that the neglect of which I complain is due 

 to quite other causes. I do not think that, as a rule, the 

 blame is to be attached to the rank and file of the medical 

 profession in the tropics. Men on the clinical side gener- 

 ally have enough to do with their hospitals and medical 

 practice, while those on the sanitary side frequently com- 

 plain that their recommendations are not seriously attended 

 to. The immediate responsibility lies with the heads of the 

 sanitary services of the colonies— men who are specially 

 paid to organise such work. Now, though many capable 

 individuals are to be found in such medical services, there 

 is always a percentage of men, in them as in other services, 

 who, to be frank, are not at all capable— men who from 

 the date of receiving their medical qualifications take no 

 further real interest in their work, read no literature, 

 undergo no further courses of instruction, undertake no 

 scientific researches, and make no additions to our know- 

 ledge either of medicine or of sanitation, and yet who 

 manage to obtain the highest medical or sanitary appoint- 

 ments, either bv seniority or by the well-known arts of 



