THE ANTI—MALARIA PROGRAM IN NORTH AMERICA 
369 
schools and universities through boards of 
education, and frequent lectures through¬ 
out the malarious portions of the state. 
The malarial unit also teachers the district 
and county health organizations the best 
methods of malaria control. 
In all of these state activities the 
U. S. Public Health Service has cooperated 
and has even secured inter-departmental 
cooperation in federal activities. It has 
arranged with the Division of Soil Ero¬ 
sion Control and with the Rehabilitation 
Administration to supply all of their 
field workers with necessary instructions 
whereby malaria control may be secured 
at soil erosion control dams and recrea¬ 
tional ponds. The Service protects our 
seaports from introduction, by airplane, of 
new anopheline species by requiring that 
all planes from other countries accomplish 
disinsectization at the last port of call be¬ 
fore entry. Through the Tennessee Valley 
Authority the government is developing 
one entire drainage basin with malaria 
control built into the original plans. 
In Mexico the state governments are be¬ 
coming stronger and, responding to efforts 
of the central administration, are building 
up their own control work, but as yet have 
no fully organized units. Cuba and Puerto 
Rico, in cooperation with the Rockefeller 
Foundation, have a well-rounded plan 
similar to that of the United States. Dur¬ 
ing the few years that Haiti was under the 
administration of the United States Navy, 
study and control of anophelines com¬ 
menced at Port au Prince and other towns. 
In the smaller republics and islands the 
whole program of control is under the 
central governments. Research and con¬ 
trol units have been established in coopera¬ 
tion with the Rockefeller Foundation, but, 
as yet, are understaffed. They have made 
notable studies of their anopheline fauna. 
They attempt to control epidemic death 
rates by treatment and they practice anoph¬ 
eline control in some population centers 
where malaria is especially severe. No rural 
work is done except by the oil and fruit 
companies, for as yet no republic-wide or 
island-wide plan has been adopted. The 
U. S. Public Health Service plan, which has 
become established in our southern states, 
may be adapted easily to any other re¬ 
public. Our state boards of health, which 
have grown phenomenally in the last 23 
years through the establishment of hun¬ 
dreds of county health departments and 
the strengthening of the special divisions 
of the central administrations, have demon¬ 
strated the efficacy of. mobile well-trained 
malaria units. 
Every republic of North America is 
engaged in some research on malaria. 
Since Brazil is now suffering from an inva¬ 
sion of A. gambiae, we should amplify our 
study of airplane disinsectization, for 
North America can well do without this 
highly androphylic species. We need iron¬ 
clad legislation for control of new and 
established impoundments in the eastern 
half of the continent and for better plan¬ 
ning and supervision of irrigation projects 
in the western and tropical part. 
In the field of chemotherapy, we need to 
develop a true causal prophylactic so that 
people may visit or even live in an area 
where anopheline control is, as yet, impos¬ 
sible. We need to discover a drug which 
not only cures the clinical attack but steril¬ 
izes the patient and so prevents chronic 
malaria and suppresses gametocyte produc¬ 
tion, thus reducing the sporozoite rate in 
the mosquito. For this purpose our re¬ 
searches should open up the almost un¬ 
known field of the exo-erythrocytic phase 
of the plasmodium in the human host. 
For testing such chemicals, sporozoite 
malaria is necessary. In experimental work 
there is a great paucity of sporozoite-in¬ 
duced malaria. Blood-inoculation malaria 
is the favorite as it is easy to maintain and 
tends to produce a standardized type of 
infection, whereas sporozoite-induced ma¬ 
laria, both in man and birds is variable in 
intensity and uncertain of duration. The 
individualistic character of sporozoite in¬ 
fection should not be an irritation but a 
very desirable characteristic, as this ma¬ 
laria most nearly simulates natural infec¬ 
tion. The average laboratory worker fi n ds 
it more difficult to use and the results less 
