292 The Philippine Journal of Science i9is 



but in a bullet-swept country, dotted with water-filled shell 

 holes, or in places still more favorable to the development of 

 Anopheles there is little opportunity to control malaria through 

 the eradication of mosquitoes. Recourse must be had to quinine 

 prophylaxis — the efficacy of which in all cases is open to doubt — 

 or to the elimination of carriers of the parasite. As suggested 

 in a previous paragraph, much can be done in the home country 

 to minimize the danger, before the troops leave for the front. 4 



The formidable problem presented by malaria on the battle 

 line and at the base has been well borne in on the military 

 surgeons of all countries during the present struggle. The 

 protean nature of the disease itself is perfectly familiar to every 

 physician. Carles (4) places malaria in the same class with en- 

 tamoebiasis and syphilis, as a disease eminently chronic and 

 characterized by frequent revivals of manifestations, which re- 

 quires persistent treatment over years, as is the case with 

 syphilis and entamoebiasis. He considers every man suffering 

 from grave malarial infection disqualified for duty for a period 

 of from six months to a year. In such cases every return to 

 a fatiguing occupation brings about a new exacerbation and a 

 general decline in health as a consequence. 



Gill (12) has recently made an interesting inquiry into malaria 

 as it exists in the Indian army. In his opinion the greater part 

 of the sickness in the native Indian army is attributable, either 

 directly or indirectly, to malaria. In the Punjab, for instance, 

 one of the great recruiting grounds, the recruits come from a 

 population that is widely infected every year, and in some years 

 grossly infected. Examination of the men in the ranks as well 

 as of the recruits has shown that a large proportion of them, 



4 The problem of prophylaxis against malaria in tropical countries 

 presents difficulties that are not met in most temperate climates. The 

 importance of the elimination of the anopheline mosquito is by no means 

 to be discounted, for it is of incalculable value in communities peopled 

 by persons of intelligence and having a well-organized health service. 

 But in sections of a tropical country, to which a health service has not 

 been extended, the problem is different. In such places the eradication 

 of breeding places of the mosquito, except under the most favorable natural 

 conditions, is virtually an impossibility. No aid in the carrying out of 

 antimosquito work can be expected from semicivilized populations. Unless 

 it is possible to enforce what virtually amounts to military discipline, 

 the systematic use of quinine as a prophylactic cannot be carried out. 

 The screening of houses or even of beds cannot even be dreamed of. Of 

 all the health problems met in such communities, malaria is by far the 

 most formidable. The eradication of malaria under these circumstances, 

 still remains a laboratory problem and will so remain until means are 

 discovered for killing the gametocyte in the human body. 



