6 
1832), as well as a second survey of the 
same state later conducted by J. M. Smith 
(1860). Dr. Garrish (1879) relates that a 
system of drainage was installed to im¬ 
prove the healthfulness of the unnamed 
town of his residence, on one of the tribu¬ 
taries of the White River in Indiana, which 
resulted in the diminution of ague to in¬ 
significant incidence. Continued interest 
in the subject is shown by a symposium 
on drainage and public health that was 
held at one of the meetings of the Amer¬ 
ican Medical Association, which largely fills 
the volume of transactions for 1874. To 
this Kedzie (1874) contributes a statement 
that in 1857 the State of Michigan adopted 
legislation to encourage the drainage of 
swamps, marshes and lowlands, and esti¬ 
mated that in the 20 years preceding his 
report, no less than 20,000 miles of ditches 
had been dug. The motive, of course, was 
agricultural reclamation, yet a profound 
effect on health was noted. He stated that 
as drainage became more perfect, a diminu¬ 
tion of malarial diseases was observed, and 
that the fevers did not yield as readily to 
antipaludic remedies, there being observed 
an increase of the continued fevers and a 
diminution of the intermittents. 
With the discovery of the transmission 
of the parasite by anopheline mosquitoes, 
drainage as a means of preventing malaria 
was removed from the field of empirical 
sanitary procedures, and developed a sig¬ 
nificance of its own, i.e., a means for the 
elimination of anopheline breeding places. 
In conjunction there also developed, as a 
natural corollary, practices to prevent 
anopheline breeding. The earliest applica¬ 
tion of drainage for malarial control with 
this orientation was effected during the 
American occupation of Cuba subsequent 
to 1900. This early demonstration of the 
practical value of the discovery of Ross 
was directed by Col. W. C. Gorgas, assisted 
by J. A. LePrince (LePrince and Oren- 
stein 1916), providing an apprenticeship 
for their later effective control of yellow 
fever and malaria in the Canal Zone (Gor¬ 
gas, 1910; 1915). 
The immediate effect of this discovery 
and of the later demonstrations in Havana 
and Panama was practically nil on the con¬ 
tinental United States. Perhaps the most 
distinctive project of an antimalarial char¬ 
acter was the program executed on Staten 
Island between 1901 and 1910 by A. H. 
Doty (Howard et al. 1912b), health officer 
of the port of New York. In addition a 
small amount of isolated work was exe¬ 
cuted in widely scattered localities by local 
initiative, which was doubtless productive 
of much good; but even at this early date 
these steps tended to exhibit the character¬ 
istic of a general attack on all mosquitoes, 
a trend which continued until compara¬ 
tively recent years and has undoubtedly 
retarded the control of malaria. 
Finally, however, the Panama demon¬ 
strations commenced to bear fruit in the 
United States, and R. H. von Ezdorf and 
H. R. Carter of the Public Health Service, 
the latter a close associate of Gorgas, in¬ 
itiated field studies of malaria in the south 
in 1912 and 1913. These early studies re¬ 
sulted in practical demonstrations of anti- 
malarial measures at Roanoke Rapids, N. C., 
and Electric Mills, Miss, (von Ezdorf 
1916), which really initiated serious ma¬ 
larial control work in the South. 
A decided impetus was given to interest 
in malarial control by the program exe¬ 
cuted in extra cantonment zones during 
1917 and 1918 while the United States was 
engaged in the first World War. This 
program, executed by the Public Health 
Service, extended to 43 areas in 15 states, 
over a total area of about 1,200 square 
miles. Apart from its immediate objective, 
the work had a significant demonstration 
value and also resulted in the technical 
training of a large personnel, several of 
whom are still at work in this field. 
As previously intimated, many commu¬ 
nities have simultaneously prosecuted a 
program devised for the control of both 
yellow fever and malaria, or of one or the 
other coupled with measures directed 
against one or more of the noxious species 
of local mosquitoes. Considering the dif¬ 
ferences in the breeding places chosen by 
different species of mosquitoes, projects 
