SIGNIFICANCE OF STEGOMYIA FASCIATA IN WEST AFRICA. 257 



I think, not only from the evidence of the wide distribution of the Stegomi/ia, 

 but also from the evidence of Hospital Case Books and the experience 

 of English, French and German medical authorities, that a very con- 

 siderable proportion of the death-rate may, with a high degree of probability, 

 be ascribed to yellow fever ; that, in fact, the disease has been often over- 

 looked. In other words, when the yellow fever cases are taken out, the 

 malaria death-rate on the Coast is not unlike the malaria death-rate of all 

 other malarial countries ; and it seems probable that the deadly reputation 

 of West Africa has to a large extent been due to mistaken diagnosis, to 

 neglect of fumigation after cases of yellow fever, and above all, to the 

 absence of any attempt to reduce the vast numbers of the Stegomyia. 

 Therefore, if West African development is to proceed in security, it is necessary 

 to lose no time in organising methods to combat this mosquito. 

 I arrange these measures as follows : — 



Measure I. 



The first step is to organise the medical and sanitary forces, and also 

 citizen volunteers, to make a systematic raid on all breeding places, . as 

 follows : — 



1. The removal and burial of all tins, bottles, calabashes, broken crocks, 



etc., capable of holding water. 



2. The clearing of all bush from yards and waste places, and from the 



immediate vicinity of towns and villages. 

 .3. The setting apart in all towns of regular cleaning-up days, when all 

 the inhabitants should be urged to assist in getting rid of water- 

 holding rubbish. 

 4. The institution of popular lectures ; the instruction to school children ; 

 the exhibition of diagrams and notices in all public places ; and the 

 co-operation of ministers of religion and all public bodies in the great 

 work of exterminating the Stegomyia pest. 

 If action is taken under the above heads a great deal can be accomplished 

 at a comparatively small expense. But for its success, it means that, 

 to commence with, the medical officers will require themselves to set an 

 example in the matter of cleaning up, and that they will have to act as 

 sanitary ins|iectors and labourers. It will also mean that more sanitary 

 inspectors will require to be trained, and that more refuse carts will have 

 to be obtained. Above all, it means that the work must be sustained and 

 not spasmodic, in two or three weeks everything tends to relapse into the 

 status (/no ante and the bush is as bad as ever. Therefore, provision must be 

 made for regular daily cleaning-up work and inspection. 



Measure II. 



The next point is to abolish or screen all accumulations of stagnant water ; 



