Proceedings of Seventh Annual Meeting 117 



tremely interesting and suggestive observations. The observation 

 is made that, ''The Board aims at the extermination of Anopheles 

 mosquitoes in all thickly populated centres, and wherever economical- 

 ly possible in rural areas, and wishes to effect a reduction in mos- 

 quitoes generally." It is therefore considered desirable that "local 

 authorities should make every effort to secure the willing coopera- 

 tion of inhabitants with regard to measures against malaria in par- 

 ticular and mosquito-breeding in general." This, in brief, is our 

 own problem, and it is precisely in this direction that the efforts of 

 the National Malaria Committee have been most disappointing. The 

 anticipated cooperation by a multitude of interests directly affected 

 by mosquito control has not been forthcoming. In localities in which 

 mosquitoes, on account of topography and defective drainage, are 

 excessively common, a malaria bureau is practically the only success- 

 ful solution. No better illustration of useful efforts in this field and 

 by these methods could be had than in the results obtained by the 

 Malaria Advisory Board of the Federated Malay States, and the 

 Malaria Bureau of the Punjab and of the Central Provinces of 

 India. I may in this connection call attention to the following in- 

 teresting observation in the report of the Malaria Advisory Board 

 of the Federated Malay States for 191 8: 



It would appear that severe malaria has occurred at times when but few 

 anophelines or little anopheline breeding was evident, and that little malaria 

 has been apparent at times when anophelines were numerous. Breeding places 

 which at times harbor an abundance of anopheline larvae, at other times af- 

 ford barely any. The further study of species is therefore essential. The 

 endemic factors, if it be possible to consider them apart from these affecting 

 mosquitoes, also require more attention. While persons of poor vitality and 

 with a low standard of feeding are more susceptible to malaria than others, 

 examples are by no means rare of persons of sound vitality and a good stand- 

 ard of living being badly affected. 



The preceding observations suggest the importance of the malaria 

 problem to all the elements of the community, rich as well as poor, 

 and intelligent as well as ignorant, for malaria is not, like tubercu- 

 losis, a disease primarily of poverty and ignorance, but an affliction 

 which concerns every element of the population, and every age, 

 although, naturally, to a varying degree. In the Federated Malay 

 States, as the result of sustained efforts, the malaria death-rate has 

 been reduced from 11 per 1,000 in 1908 to 3 per 1,000 in 19 18, and 

 the case rate among the native police force has been reduced from 



