Mosquito or man? : The conquest of the tropical world

s<-

-

I

s*

0

MOSQUITO OR MAN ?

OTHER WORKS BY THE SAME AUTHOR

A TEXT-BOOK OF MORBID HISTOLOGY, 1892
ANTI-MALARIA MEASURES AT ISMAILIA, 1904

REPORT ON THE SANITATION AND ANTI-
MALARIA MEASURES IN BATHURST,
CONAKRY AND FREETOWN, 1905

YELLOW FEVER PROPHYLAXIS IN NEW
ORLEANS, 1905

REPORT ON YELLOW FEVER OUTBREAK,
BRITISH HONDURAS, 1905

HEALTH PROGRESS AND ORGANISATION IN
THE WEST INDIES. In the Press.

§§

•§ *

^

.MOSQUITO OR MAN?'

t* — |

THE CONQUEST OF THE TROPICAL WORLD

BY SIR RUBERT W. BOYCE, M.B., F.R.S.

HOLT PROFESSOR OF PATHOLOGY, UNIVERSITY OF LIVERPOOL J DEAN OF THE LIVERPOOL SCHOOL

OF TROPICAL MEDICINE; COMMANDER OF THE ORDER OF LEOPOLD n. ; FELLOW OF UNIVERSITY
COLLEGE, LONDON; ONE OF THE PUBLIC ANALYSTS FOR THE CITY OF LIVERPOOL

WITH ILLUSTRATIONS

" Stagnation, the great enemy of life "

LONDON
JOHN MURRAY, ALBEMARLE STREET, W.

1909

Pi

PRINTED BY

HAZELL, WATSON AND VINEY, LD.,
LONDON AND AYLESBDEY.

TO

HER ROYAL HIGHNESS PRINCESS CHRISTIAN OF
SCHLESWIG-HOLSTEIN

HONORARY PRESIDENT OF THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE
WHOSE GRACIOUS SYMPATHY AND ENCOURAGEMENT

HAVE DONE MUCH
TO PROMOTE MEDICAL ORGANISATION

IN THE TROPICS
THIS SMALL WORK IS RESPECTFULLY DEDICATED BY THE AUTHOR

PREFACE

I HAVE purposely selected the title " Mosquito or
Man ? " or, " Conquest of the Tropical World " for this
small volume. I have endeavoured in it to epitomise
the Tropical Medical movement, which, initiated in
this country by the sympathetic encouragement of
the then Secretary of State for the Colonies —
Mr. Joseph Chamberlain — and energetically supported
by the liberality of Sir Alfred Jones, K.C.M.G., and
merchants interested in the health progress of tropical
countries, has now spread all over the civilised world.
From whatever standpoint the movement is regarded,
the reader cannot fail to be impressed with the
immense success which has been obtained.

Large numbers of better-equipped medical men
have been sent to the tropics, vast quantities of up-
to-date literature, dealing with tropical diseases, have
been distributed ; the public are being steadily educated
to understand that it is by no means an impossible task
to make the tropics healthy. In the field of scientific

research some of the most important discoveries of

vii

viii PREFACE

century have been made — discoveries not only brilliant
in themselves scientifically, but, on account of their
eminently practical bearing, of immense importance to
the prevention of suffering. The movement moreover
has demonstrated time and time again the heroic
devotion of those who embark upon it. Many have
lost their lives and many have been injured. It can
truly be said that no movement of modern times has
called forth such devotion and such enthusiasm.
Finally, if results are looked for, it can be said without
exaggeration that the tropical world is to-day being
steadily and surely conquered. The narration of the
numerous campaigns against the mosquito which I have
here recorded is signal proof of this. The campaigns
show that the three great insect-carried scourges of the
tropics — the greatest enemies that mankind has ever
had to contend with, namely Malaria, Yellow Fever and
Sleeping Sickness — are now fully in hand and giving
way, and with their conquest disappears the awful and
grinding depression which seems to have gripped our
forefathers. Now the situation is full of hope. The
mosquito is no longer a nightmare ; it can be got rid of.
The tropical world is unfolding once again to the
pioneers of commerce, who now do not dread the
unseen hand of death as did of old the Spanish Con-
quistadores of Columbus and Cortes. The British
public has and must always have a paramount interest
in this practical conquest, which is destined to add a

PREFACE ix

vast slice of the globe, of undreamt-of productiveness,
to their dominions and activities, and as a contribution
to the history of the conquest this small volume is
launched by one who has been privileged to take a
humble part in the movement and in not a few of
its successful campaigns.

UNIVERSITY OF LIVERPOOL,
July, 1909

CONTENTS

PART I

CHAPTER I

PAGE

FOUNDATION OF THE TROPICAL MEDICINE MOVEMENT IN

ENGLAND 1

CHAPTER II

GROWTH OF GENERAL AND APPLIED SANITATION IN THE

TROPICS 12

CHAPTER III

Mi ASM, TRADITION, AND PREJUDICE . . . . .17

CHAPTER IV

THE FORERUNNERS OF THE DISCOVERIES OF THE MOSQUITO

ORIGIN OF DISEASES 22

CHAPTER V

FlLARIA AND THE MOSQUITO : MANSON^S DISCOVERY . . 32

CHAPTER VI

THE DISCOVERY OF THE PARASITE OF MALARIA IN THE BLOOD
OF MAN BY LAVERAN, AND OF ITS FURTHER DEVELOP-
MENT AND PASSAGE THROUGH THE MOSQUITO BY RoSS . 38

xii CONTENTS

CHAPTER VII

PACK

THE PLAN OF CAMPAIGN AGAINST THE MOSQUITO . . 49

CHAPTER VIII

SUMMARY OF THE ANTIMALARIAL CAMPAIGNS . . . 61

CHAPTER IX

NOTES ON THE RELATIONSHIP OF PLANTATIONS AND BOTANIC

GARDENS TO THE MOSQUITO QUESTION . . . .92

CHAPTER X

YELLOW FEVER — DR. BEAUPERTHUY ON TRADITION IN MEDI-
CINE AND HIS VIEW OF THE MODE OF TRANSMISSION OF

YELLOW FEVER. HARRISON AND MOXLEY ON THE NATURE

OF THE VIRUS OF YELLOW FEVER .... 97

CHAPTER XI

HISTORICAL SURVEY OF YELLOW FEVER: ITS DESTRUCTIVE
SPREAD AND MORTALITY DURING THE SEVENTEENTH AND
EIGHTEENTH CENTURIES Ill

CHAPTER XII

DISCOVERY OF THE MODE OF TRANSMISSION OF YELLOW FEVER,

AND PLAN OF CAMPAIGN AGAINST THE MOSQUITO . .126

CHAPTER XIII

THE BREEDING PLACES OF STEGOMYIA. STEGOMYIA SURVEY

AND INDEX . . . 146

CHAPTER XIV

THE YELLOW FEVER CAMPAIGNS IN HAVANA, CUBA, NEW
ORLEANS, HONDURAS, Rio JANEIRO, SANTOS, PANAMA
CANAL ZONE, THE WEST INDIES, THE AMAZON . .153

CONTENTS xiii

PART II
CHAPTER XV

PAGE

SLEEPING SICKNESS ; FLIES AND DISEASE . . . .194

CHAPTER XVI

ANKYLOSTOMIASIS : DIRT CONTAMINATION . . . .210

CHAPTER XVII

MALTA FEVER AND GOATS' MILK 215

CHAPTER XVIII

THE RISE AND FALL OF DISEASE, PLAGUE, TICK FEVER,

LEPROSY AND TUBERCULOSIS ...... 220

APPENDIX

(1) ORDINANCES, REGULATIONS, AND BYE-LAWS RELATING TO

STAGNANT WATER, MOSQUITO LARV.E, YELLOW FEVER,
RATS, ETC 231

(2) TROPICAL EXPEDITIONS AND COMMISSIONS OF THE ROYAL

SOCIETY, THE COLONIAL OFFICE, AND THE SCHOOLS OF
TROPICAL MEDICINE OF LONDON AND LIVERPOOL . . 257

INDEX 261

LIST OF ILLUSTRATIONS

no. IA. " WIGGLE- WAGGLE," LARVA OF STEGOMYIA CALOPUS ^ „
„ IB. STEGOMYIA OALOPUS £>} **»***"

FIO. PAOINQ PAGE

2. A WELL-CONSTRUCTED DRAIN AND STANDPIPE, THE AGENTS

WHICH HAVE CAUSED THE DIMINUTION OF MOSQUITOS, TRINIDAD . 12

3. A WELL-MADE ROAD WITH CONCRETE SlDE-DRAINS, TRINIDAD . 14

4. A LARGE CONCRETE DRAIN TO CARRY OFF STORM WATER, TRINIDAD 16
6. A SO-CALLED YELLOW FEVER HOUSE, BARBADOS . . .18

6. CULEX. ATTITUDE AT BEST (AFTER Ross). ONE OF THE CARRIERS

OF FILARIA 34

7. ANOPHELES MOSQUITO. OBSERVE SPOTTED WINGS ... 38

8. RAFTS OF EGGS OF AN ANOPHELINE FLOATING ON WATER . . 38

9. CHARACTERISTIC ATTITUDE OF AN ANOPHELINE, THE MOSQUITO

WHICH TRANSMITS MALARIA 40

10. ANOPHELINE BREEDING POOLS, AFTER RAIN, SIERRA LEONE . 42

11. ANOPHELINE BREEDING POOLS, SIERRA LEONE .... 42

12. STREET IN BELIZE SHOWING GRASS- GROWN AND WATER-HOLDING

SIDE-DRAIN. ANOPHELINE BREEDING PLACE .... 44

13. STREET IN BELIZE SHOWING GRASS-GROWN AND WATER-HOLDING

SIDE-DRAIN. TYPICAL BREEDING PLACE OF ANOPHELINES . 46

14. WATER-LOGGED ANOPHELINE BREEDING LAND, BELIZE ... 62

15. HOUSE STANDING IN STAGNANT WATER, BELIZE. OBSERVE

WATER-BARRELS AND CANOE 66

16. ROAD POOLS, VILLAGE, WEST AFRICA. BREEDING PLACES OF

ANOPHELINES 76

17. ANOPHELINE BREEDING POOLS, SIERRA LEONE . . . .76

18. ROADSIDE DITCH CONTAINING STAGNANT WATER, BREEDING

ANOPHELINES. WEST AFRICA 78

19. ROAD POOLS, WEST AFRICA 78

xv

xvi LIST OF ILLUSTRATIONS

no. FACING PAGE

20. SAMAN TREE COVERED WITH WATER-HOLDING MOSQUITO-BREEDING

EPIPHYTES (BROMELIACE^E), TRINIDAD 92

21. Too MUCH BUSH, GEORGETOWN, DEMERARA. THE EFFECT is TO

OBSCURE SUNLIGHT AND FRESH AIR 94

22. COLLECTING CRAB-HOLE MOSQUITOS, BRIDGETOWN, BARBADOS . 96

23. A PROPERLY SCREENED CISTERN, NEW ORLEANS .... 126

24. A PROPERLY SCREENED WATER-BARREL ON PLANTATION DIA-

MOND, BRITISH GUIANA 130

25. A TEMPORARY SCREENED WARD IN ST. LUCY'S ALMSHOUSE, BAR-

BADOS. OBSERVE THE DOUBLE DOORS 138

26. PAPER-SCREENING AN ARCHWAY PREVIOUS TO FUMIGATION, NEW

ORLEANS . 140

27 & 28. PAPERING OUTHOUSES PREVIOUS TO SULPHUR FUMIGATION,

NEW ORLEANS 142

29. A Row OF WATER-BARRELS AND KEROSENE TINS, TYPICAL BREED-

ING PLACES OF THE STEGOMYIA, BELIZE 146

30. A COOLIE " RANGE," SHOWING THE WATER-BARRELS — THEY ARE

AT.T. SCREENED — SUGAR PLANTATION DIAMOND, DEMERARA . 148
31 & 32. EXAMPLES OF POSTERS DURING NEW ORLEANS YELLOW

FEVER EPIDEMIC, 1905 160

33. AN OILING AND CISTERN-SCREENING GANG, NEW ORLEANS, 1905 . 166

34. SCREENING GANG AT WORK. SCREENING THE WATER CISTERNS,

NEW ORLEANS, 1905 166

35. THE ANTIMOSQUITO BRIGADE, BRIDGETOWN, BARBADOS, 1909 . 186

36. THE RUBBISH-CART BRIGADE, BRIDGETOWN, BARBADOS, 1909 . 188

37. COLLECTION OF ODD WATER RECEPTACLES, THE WORK OF A FEW

DAYS. BRIDGETOWN, BARBADOS 190

38. CULEX FATIGANS (MALE AND FEMALE) ..*... 192

39. GLOSSINA PALPALIS, THE CARRIER OF SLEEPING SICKNESS . .196

40. GLOSSINA FUSCA, IN RESTING POSITION 196

41. NATURAL SIZE OF TSETSE FLY 196

42. MASS OF FLY LARVJE IN STABLE MANURE. (NATURAL SIZE) . 204

43. PLAGUE FLEA (LCEMOPSYLLA CHEOPIS, Roths.). (GREATLY EN-

LARGED) 220

44 ORNITHODOROS MOUBATA, THE INTERMEDIARY HOST OF THE
PARASITE WHICH CONVEYS AFRICAN RELAPSING FEVER.
(NATURAL SIZE) 220

Mosquito or Man?

PART I
CHAPTER I

FOUNDATION OF THE TROPICAL MEDICINE
MOVEMENT IN ENGLAND

UNDOUBTEDLY it is to the genius of Pasteur and to
his discoveries in Bacteriology and Epidemiology
that we must ascribe the foundation of the present
investigations in animal Parasitology and their applica-
tion to the cure and prevention of tropical diseases.
The genius of Pasteur lay in its comprehensive grasp,
in its faculty of being equally able to direct scientific
research to the advantage of both commerce and indus-
try, as well as to the alleviation of suffering. In effect,
the great movement which he initiated and the great
store of thought which he called into existence in the
seventies has proved to be one of the great sources of
supply associated for all time with the cause of humanity
and the world's progress.

The advent of the experimental method so closely
identified with Pasteur and his school pushed traditional
medicine to one side and allowed scope for a freer and

1

2 TROPICAL MEDICINE MOVEMENT IN ENGLAND

more comprehensive treatment of disease. This is
abundantly proved by the nature and range of the in-
vestigations which he himself undertook and stimulated
others to take up, and also by the type of investigators
which he attracted to Paris. It mattered not whether
the disease to be investigated was confined to man or
to animals.

He demonstrated that equally brilliant, equally use-
ful and beneficial results would accrue from the study
of either. The investigators, drawn from all parts of
the world with whom he surrounded himself, displayed
the same comprehensive spirit in the treatment of their
special lines of research ; this is notably seen, for example,
in Metchnikoffs handling of the subject of inflamma-
tion and infection. Nor were the researches of the
great Institute associated with his name only intended
for his countrymen, for when he had discovered the
cure of Rabies, to Paris repaired the afflicted of all
nations in order to be subjected to his treatment. Then
there came the period when other countries established
similar Institutes of their own, in order that the same
spirit of investigation, with the same beneficial results,
might be planted in their midst.

Moreover Pasteur had always at hand trained men
ready to proceed to investigate on the spot diseases
which afflicted tropical countries. His pupils spread
far afield, and, fired with the enthusiasm and spirit of
their master, they were not slow in reaping a rich
harvest in a hitherto almost unknown field of research.
Thus, we find Laveran working at Malaria in North
Africa ; Yersin with Plague in the Far East, followed

PASTEUR'S WORK 3

later by Haffkine in India. Roux and a group of
colleagues investigated Cholera in Egypt, and in the
present successful movement in the field of animal
Parasitology and Epidemiology we can clearly see
the direct continuation and amplification of the like
comprehensive method of treatment, the same de-
termination to extend the field of medical research
and to give the benefits of these researches to less
favoured peoples, — just as much to the coloured man
as to the white, whether in temperate or tropical zones,
and thereby to extend the benefits of civilisation and
commercial prosperity.

Just as Louis Pasteur and his disciples, Lord Lister
and Koch, gave a new insight into the cause and means
of prevention of the infectious diseases, and freed the
world in consequence of many of its most devastating
scourges, so tropical medicine, in carrying us still further
afield, has shown us how to combat other and vastly
more devastating classes of disease, such as Malaria,
Yellow Fever, Plague, Malta Fever, Sleeping Sickness,
and Tropical Anaemia. In these diseases it is now only
a question of efficient administration and organisation in
order to bring about their total abolition. The result
is a triumph of the advancement of medical knowledge,
and it is not too much to say that the twentieth
century will be known in the annals of medicine by
the immense progress which medical science has made
into the causes and prevention of tropical diseases,
discoveries which show clearly the role of insect life
in the transmission of disease, and, in consequence, the
most effective way of stopping disease.

4 TROPICAL MEDICINE MOVEMENT IN ENGLAND

But not only has the study of tropical diseases
conferred an increased benefit upon the science of
medicine, it has given new and undreamt-of advantages
to commerce, to civilisation, and to administration in
tropical countries. To-day we receive regular reports
from all parts of the tropical world showing what is
being accomplished — the new areas and territories
wrested from decay and handed over to civilisation.
We are furnished with regular monthly reports from
the Panama Canal zone, Cuba, the Philippines, and
from a host of other places, just as if they were as
old-established as Manchester or Liverpool, and had
always known what a medical officer and his elaborate
staff were.

But not only has tropical medicine added new
territories to civilisation, it has quite recently taken
a speculative turn, and, in the light of what is taking
place in Africa to-day, surveys what may have occurred
in America and in Europe in past ages. Recently
Major Ross, Mr. Jones, and Dr. Withington have
brought forward evidence to show that Malaria in
Greece may have taken no small share in helping to
wipe out the old Greek civilisation. What may not
have occurred in other countries also ? It is even
surmised, and not without reason, that the tsetse fly
has either cleared the white man out of Africa or kept
him out, the fly having proved, until recent times,
unconquerable.

Again, in its far-reaching and world-wide investiga-
tions, tropical medicine has directed our attention more
and more to the role which insects play in the trans-

INSECTS AND DISEASE 5

mission of disease, and, naturally, this role is
not confined to the tropics, our own familiar housefly,
flea, bug, etc., being equally dangerous in their
spheres. It has also, thanks to our knowledge of
the blood in malaria and sleeping sickness, drawn
our attention to the striking fact that not every
one harbouring parasites shows obvious symptoms
of the disease ; that there are, in fact, quite as
many ambulatory reservoirs, or apparently healthy
carriers of these diseases, as there are well-recognisable
cases.

I have said that the foundations of tropical medicine
were laid upon those upon which Bacteriology itself
had been reared, but the commencement of the
movement which had for its immediate end the
building up of the great subject of Tropical Medicine
in our midst, would not perhaps yet have made a
start had it not been for the practical and far-seeing
Minister who was in 1898 at the head of the Colonial
Office, the Right Hon. Joseph Chamberlain.

The following is proof of this, and the history of
the movement recorded here is of great interest,
because it shows how the layman sees the practical
advantage which can be gained by the study of a
subject before even those devoting their lives to it
can shake off tradition and branch out anew.

Already in October 1897, Sir Patrick Manson in an
address to the students assembled in St. George's
Hospital, London, had urged the necessity for special
education in tropical medicine in the medical schools of
this country.

6 TROPICAL MEDICINE MOVEMENT IN ENGLAND

Mr. Chamberlain, in a Report dated May 1903 upon
the subject of Tropical Medicine, wrote that —

" It was largely through the interest taken in this matter
by Dr. Manson that my attention was more definitely
directed to the importance of scientific inquiry into
the causes of malaria, and of special education in
tropical medicine for the medical officers of the Crown
Colonies."

He then went on to state that—

" In pursuance of the second of these two objects it was
clearly advisable (a) that a special training school in
tropical medicine should be established, where officers,
newly appointed to the medical services of the Colonies
and Protectorates, might be given systematic instruction
with special facilities for clinical study, before leaving
England to take up their appointments, and where
doctors already in the service might, when on leave,
have opportunities of bringing their professional know-
ledge up to date ; (b) that all the leading medical
schools in the United Kingdom should be invited to
give greater prominence than hitherto in their schemes
of study, to tropical medicine.

" (c) That the medical reports periodically sent from
the tropical Colonies and Protectorates should be recast
on one uniform type, designed to throw light on the
diseases which are prevalent in tropical countries, and
to indicate the methods likely to be most successful in
preventing or curing such disease."

Previously, on March 11, 1898, Mr. Chamberlain
had addressed a circular letter to the General Medical

MR. CHAMBERLAINS ACTION 7

Council and the leading medical schools of the United
Kingdom pointing out —

" The importance of ensuring that all medical officers
selected for appointment in the tropics should enter
on their careers with the expert knowledge requisite for
dealing with such diseases as are prevalent in tropical
climates, and that it was very desirable that, before
undergoing such special training, the future medical
officers of the Colonies should be given facilities in the
various medical schools for obtaining some preliminary
knowledge of the subject." ..." I would be prepared,"
he added, " to give preference, in filling up medical
appointments in the Colonies, to those candidates who
could show that they had studied this branch of
medicine, especially if some certificate or diploma to
that effect were forthcoming."

As the result of this letter the General Medical
Council replied as follows :

" That, while the Council is not prepared to re-
commend that tropical medicine should be made an
obligatory subject of the medical curriculum, it deems
it highly advisable, in the public interest, that arrange-
ments should forthwith be made by the Government for
the special instruction in tropical medicine, hygiene, and
climatology of duly qualified medical practitioners, who
are selected for the Colonial medical service, or who
otherwise propose to practise in tropical countries."

Two great ports in Great Britain having medical
facilities also replied favourably, and proceeded at once
to found schools of tropical medicine.

8 TROPICAL MEDICINE MOVEMENT IN ENGLAND

In the autumn of 1898 the London and Liverpool
Schools were founded, so that commendable promptitude
was taken in these two cities to give practical effect to
Mr. Chamberlain's wishes.

The founder of the Liverpool School was Sir Alfred
Jones, K.C.M.G., who then became the first chairman
of the school. By thus placing at the head of tropical
medicine in Liverpool a great and distinguished busi-
ness man having large interests in the tropics, the
school was at once drawn into close relationship with
the mercantile community of Liverpool, especially with
that portion more directly interested in the trade
of our tropical possessions. The interest in the local
movement was, however, not confined to the mercantile
community ; the late Earl Derby and the Countess of
Derby, the Duke of Northumberland, Earl Cromer,
and many others took a keen interest in the movement.
Expeditions were organised and dispatched to all parts
of the tropical world to study the diseases on the spot,
a necessity which Mr. Chamberlain had already insisted
upon. The gain of this has been, that not only has our
knowledge of the diseases been immensely increased,
but the way has been pointed out of preventing their
spreading or suppressing them altogether.

Both schools entered into friendly rivalry with one
another in equipping and sending out investigators, and
both at the same time started courses of instruction for
medical officers proceeding to the tropics. Nor were
the services of the schools confined to British pos-
sessions ; they were freely consulted by foreign Govern-
ments, and, thanks to the fact that Sir Patrick Manson,

EXPEDITIONS TO THE TROPICS 9

K.C.M.G., was the head of the London School, and
Major Ross, C.B., the Professor of Tropical Medicine
in the Liverpool School, the keenest intellects from
all over the world were attracted both to Liverpool
and to London for the purpose of study and research.

In the Appendix will be seen the number of expedi-
tions dispatched under the auspices of the Colonial
Office, the Royal Society, and the London and Liver-
pool Schools respectively. Of course these investiga-
tions into tropical diseases could not be carried out
without very considerable risk. Indeed several of the
investigators have sacrificed their lives in this endeavour
to advance the cause of medicine and humanity. The
Liverpool School of Tropical Medicine has lost two
brilliant investigators, Dr. Walter Myers, who died of
yellow fever whilst investigating that disease at Para,
and Dr. Everett Dutton, who died of relapsing fever in
Central Africa whilst investigating sleeping sickness.
The London School lost the son of Sir Patrick Manson
— a young medical man of great promise who died
through accident whilst on an expedition. He had
previously submitted himself to be inoculated by in-
fected malaria mosquitos and had contracted the disease,
thus proving in his own person conclusively what Ross
had previously proved in birds, that the infected
Anopheles was the carrier of the parasite of malaria.

Mr. Chamberlain did not rest satisfied with seeing
the foundation of these schools, for in a letter to Lord
Lister he states : "I am not satisfied to rest at this
point, and wish to invite the co-operation of the Royal
Society in taking further steps."

10 TROPICAL MEDICINE MOVEMENT IN ENGLAND

He went on to suggest that a thorough investiga-
tion should be undertaken by scientific experts
on the spot, into " the origin, the transmission, and
the possible prevention and remedies of tropical
diseases, especially of such deadly forms of sickness
as the malarial and blackwater fevers prevalent on the
West African Coast," and that the inquirers should
be appointed by and take instructions from the Royal
Society. The Royal Society immediately appointed
a small committee as proposed, and dispatched, in
1898, an expedition to investigate malaria upon the
lines of Major Ross's discoveries.

This committee has continued its work, and has
embraced the investigation of other tropical diseases
(see Appendix). The foundation of the Schools of
Tropical Medicine, and the increased importance
attached to tropical research by the Royal Society,
soon began to react both at home and abroad. Under
the guidance of Sir David Bruce many investigations
were set on foot in the Army Medical Department,
which have resulted in most fruitful work, especially
that of Sir Charles Leishman. Abroad, the question
of establishing tropical schools was soon taken up, and
tropical schools were established at Hamburg, Paris,
and Bordeaux.

In the United States also, pari passu with this
development, increased attention was directed to tropical
medicine, and Washington has become the head centre
of tropical entomology and parasitology.

Finally, India and the Colonies have realised the
necessity of doing something, and great progress has

EXPANSION OF MOVEMENT 11

been made in the way of establishing laboratories under
the direction of experts for the study of the diseases
peculiar to the particular colony. Quite recently a
Tropical School has been founded in Australia, under
the directorship of Dr. Anton Breinl; splendid work
has also been accomplished by the Wellcome Research
Laboratories at Khartoum, under Dr. Balfour.

I will in the following pages bring forward the
bed-rock facts upon which 1 base my assertion that
in the study of tropical medicine — that is to say, by
the study of a wider medicine as distinguished from
the parochial, local, or older form — nations possess a
force which above all others can wrest vast provinces
from the sway of the insect pests which, though minute
in size, yet in their aggregate mass have defied and
hurled back man when he has ventured into their
domain, or completely wiped out those who tried to
gain a foothold. The narrative would appear more
like a fairy tale were it not based upon easily accessible
reports and figures.

CHAPTER II

GROWTH OF GENERAL AND APPLIED SANITATION IN
THE TROPICS

BEFORE proceeding to describe in detail the fight
against the mosquito, I will in the following chapters
deal with those factors which prepared the way for
the successful anti-mosquito campaign of to-day.

In the first place, I deal in this chapter with the
growth of general sanitation. It stands to reason that
our tropical possessions have not stood still as regards
general sanitary progress. Just as hygiene and sanitation
have made great strides in the older countries, and
better means of water supply and sewage disposal have
been devised, as well as regulations formulated for
dealing with the construction of more healthy houses,
town planning, slaughter houses, isolation hospitals,
milk and food supply, and the numerous other improve-
ments which are naturally grouped under sanitary
reforms, so in the tropics steady progress has also
been made. There are in many colonies building
regulations, excellent isolation and general hospitals,
nursing arrangements, slaughter houses, arrangements
for scavenging, sewage and night soil disposal, storm

12

FlG. 2.— A WELL-CONSTRUCTED DRAIN AND STANDPIPE, THE AGENTS
WHICH HAVE CAUSED THE DIMINUTION OF MOSQUITOS, TRINIDAD.

DRAINAGE AND WATER SUPPLY 13

water drainage, water supply, etc. The result has been,
as in Europe, that many of the tropical towns are vastly
more healthy than fifty years ago. By the segregation
of infectious diseases there has been a very great
saving in life. Cases of leprosy are now housed in
excellent lazarettos, and are removed from the possi-
bility of communicating that disease to others ; so
also with smallpox and other diseases.

The growth and extension of tropical towns has,
of course, brought with it the drainage of the soil and
the swamp lands which usually existed in the earlier
days of colonisation. The necessity for providing for
the removal of storm water, and therefore the necessity
of making properly macadamised roads, with suitable
surfaces and concrete side drains, have freed many
towns of the puddles which formerly were the rule in
the rainy reason, and which are still to be found in
outlying villages or in the small towns of backward
colonies where hygiene has made little progress.
Therefore, with the improved drainage there has been
a progressive diminution of the breeding places of
mosquitos, and, in consequence, mosquitos are becom-
ing less numerous in the towns.

Another most important factor which has tended
in the same direction has been the introduction of
pipe-borne water to the houses and to stand-pipes
along the roads. This has naturally brought about
the closing of the old-time wells, the common cause
of typhoid, dysentery, and cholera in the 'fifties in all
tropical towns. One can say that with the introduction
oj pipe-borne water cholera has vanished, and that a

14 GROWTH OF SANITATION IN THE TROPICS

great diminution took place in the cases of typhoid
and dysentery. But further, with the comfort of a
constant water supply either in the house or close at
hand by the roadside, the necessity for storing water
in cisterns was abolished. In consequence, the storage
of rain-water is not now the absolute necessity it was
before the introduction of pipe water. It is true that
the inhabitants of cities still collect it for washing
purposes, but this will disappear in time. Now in the
old days it was the storage of rain-water in the wooden
vats or in the innumerable barrels which furnished the
ideal breeding grounds of the house mosquitos. There-
fore to the new water supplies must be ascribed the
remarkable diminution of yellow fever throughout the
West Indies — that is, when we compare to-day with
the condition of affairs fifty years ago. But this is a
matter to which I will again refer in detail. The
significance of the relationship of the diminution of
yellow fever to the introduction of pipe-borne water
is due entirely to the fact that there has been of
necessity a diminution of the common breeding places
of the house mosquito — the Stegomyia calopus — the
sole carrier of yellow fever.

Again, with the inculcation of the principles of
cleanliness, and with the appointment of sanitary
inspectors to see that yards and gardens are kept clean,
there has been a very general cleaning up of the larger
towns, so that now there are fewer odd tins and bottles
for water to collect in. This, again, has still further
reduced the breeding places of domestic mosquitos.

Therefore it is not to be wondered at that in many

APPLIED SANITATION 15

of the larger towns in the tropical and subtropical
countries there has been a very real diminution of
mosquito-carried diseases. For instance, New Orleans
was once notorious for its malaria. Endemic malaria
now no longer exists in the town. The malaria-carrying
mosquito has been driven further and further out, until
to-day he only survives along the fringes of the marsh
lands outside the city.

But whilst to general sanitation we must ascribe
increased healthiness and a diminution of death and
sickness rates and of malaria, nevertheless there is one
disease — namely, yellow fever — which persisted, in spite
of sanitary reform carried out on the general lines such
as are employed in Europe. The town of Rio de
Janeiro was an example of this. In spite of the fact that
Rio had made immense strides in general sanitation, as
disclosed by the annual health returns furnished regu-
larly by the medical officer of health, nevertheless it
soon became apparent that there was one disease which
did not disappear, in spite of the general hygiene — this
disease was yellow fever. It was not until special
sanitary measures were specifically directed to it that
the disease was stopped. Small-pox has furnished a
similar example. By means of isolation and general
sanitation and disinfection small-pox can be decreased.
But the specific method of attack is vaccination. Then,
given this specific method of prophylaxis, coupled with
provision for isolation and general sanitary reform,
the disease disappears. So with yellow fever, general
sanitary reform, coupled with the only direct form
of attack known to medical science— namely, the

16 GROWTH OF SANITATION IN THE TROPICS

destruction of the yellow fever mosquito, — and yellow
fever disappears in toto. So that by the term " applied
hygiene," I wish the reader to understand the adoption
of measures specifically directed to the destruction of
those insects or parasites which are directly concerned
with spreading infectious diseases, and to bear in mind
that the measures necessary against one disease are not
necessarily those suitable for other diseases. That, in
other words, each disease, like malaria, yellow fever,
Malta fever, sleeping sickness, ankylostomiasis, etc., etc.,
requires the application of its own special prophylactic
measures.

In subsequent chapters I will deal in detail with
these specific measures, and will be able to show the
astonishing improvement in tropical sanitation which
has taken place as the result of specially applied
hygienic measures, results, moreover, which would in
all probability have never been achieved if reliance
had been placed solely on general sanitation.

CHAPTER III

MIASM, TBADITION AND PREJUDICE

IT is only those who have been practically engaged
in anti-malarial and anti-yellow fever prophylaxis who
have any idea of the depth to which the old doctrine
of the miasmatic origin of these diseases has sunk into
the minds of men.

On account of this deep-seated belief in man, the
pioneer finds it far more easy to overthrow the strong-
holds of the disease-carrying mosquito than to over-
throw this deep-seated prejudice, which begets apathy
and indifference, characteristic of the tropical countries
where these diseases are so prevalent. I suppose it
is not to be wondered at, considering in the first place
the enormous mass of literature which has been written
upon the so-called deadly miasm, the veritable night-
mare of the tropics, which surrounds you on all sides,
which you encounter at its worst in the cool eventide
or early morning. It was especially bad over the
marsh and in the mangrove swamp, and if any colony
was so foolhardy as to engage in dredging the harbour
or the river bar or in constructing a new road, or so
rash as to disturb an old and disused cemetery, then the

17 2

18 MIASM, TRADITION AND PREJUDICE

wise men of the colony foretold that an epidemic
would without fail arise in consequence ; of course,
in those days it often did, but as we shall see, not from
the miasm but from causes now as clearly proven as the
law of gravitation.

By the word " miasm " is implied an exhalation
or emanation from the soil, especially that of warm,
moist climates where there must always be an abund-
ance of decaying vegetable humus. In the name
" Malaria," or bad air, given to one of the largest groups
of miasmatic diseases, we see clearly what was implied
by miasm, and we can also understand why people were
so frightened at disturbing the soil. As tropical
countries must, owing to the luxuriance of vegetation,
have always a vast amount of fermenting vegetable
matter, it was clear then that miasm came to be
regarded as the necessary evil of tropical countries, and
thus it came about that this nightmare theory of
disease was accepted as inevitable — it did not matter,
every one had to suffer alike from it ; they had to
get the "acclimatisation fever," and then they were
" salted" and regarded as immune. Malaria and yellow
fever were the " diseases of the new-comers " ; after
an apprenticeship to the tropics they would recover.
The miasm was not peculiar to swamps or churchyards
or mud- banks ; it could equally well be incubated on
board ship, from bilge water, ballast, and certain forms
of cargo. Learned works were written, in which the
kinds of cargo are specified which are most prone to
engender deadly miasm.

So bad has this nightmare been at times, that

p. 18]

FlG 5. A SO-CALLED YELLOW FEVER HOUSE, BARBADOS.

YELLOW FEVER HOUSES 19

granite sets and gravel ballast have been consigned to
the deep, lest an epidemic should break out were they
landed. It is almost impossible to realise to-day the
incubus which this nightmare has been upon the world's
progress. In the old days, the young man, be he
soldier, sailor, or young merchant, went to what was
known as the " white man's grave." The result was that
in many instances only the wilder ones who could not
succeed at home went to what was regarded as almost
certain death ; and indeed it often was, when one
recollects, as shown in the mortality statistics of fifty
years ago, that amongst the British garrisons 69 per
cent, was not an infrequent mortality rate 1

Further, the nightmare even spread to houses and
barracks, and men spoke of " yellow fever houses " with
bated breath, just as children do of haunted houses.
It does seem strange that in this the twentieth century
similar superstitions still survive ; nevertheless they do,
as those whose duty it is to teach the present-day
methods of health preservation only too well know. I
reproduce a picture of a so-called yellow fever house.
It was supposed that if any one was so foolhardy as
to sleep in one, yellow fever was certain to result. No
words of mine could describe the loss of life and goods
and the curtailment of civilisation which this night-
mare of the tropics has brought about.

But is there any foundation for this belief, which
has so deeply grafted itself upon mankind ? None
whatever. The damp vapour or the small quantity of
marsh gas or sulphuretted hydrogen which could come
from a tropical marsh is absolutely unable to give

20 MIASM, TRADITION AND PREJUDICE

diseases like malaria and yellow fever. Could they do
so we would naturally expect yellow fever and malaria
in colder climes where there are certainly marshes and
offensive smells, but where, nevertheless, there is no
malaria nor yellow fever.

At the present time the world is seeing the spectacle
of the refutation of the miasm nightmare in the
Isthmus of Panama. Here there are some 48,000
workmen employed digging the canal in what was
formerly a notorious yellow-fever and malarial country.
Notwithstanding this and the fact that the graves of
the 50,000 workmen who perished of these very
diseases in the time of De Lesseps must have been
turned up over and over again, no cases of yellow
fever have occurred there during the last three years,
and malaria has been reduced to a very low figure,
so that the total death rate compares favourably with
any town in Europe. Surely mankind does not want
stronger proof. Yes, certain individuals do. I know
of more than one learned medical man, judge, and
prosperous merchant who still argue in favour of the
nightmare — miasm.

With the knowledge which we possess to-day we
can of course understand why the marsh should have
been regarded with dread. It is, however, not on
account of any miasm, but because disease-carrying
mosquitos bred there, — two very different things.
Experiments were already made, as we shall see when
we deal with the subject of yellow fever, to ascertain
by inoculation whether the soil of graves in which
patients who had died of yellow fever had been buried

MOSQUITO VERSUS MIASM 21

was infectious or not. These observations showed that
yellow fever could not be communicated in that way.

We are wiser now that we have the true facts
before us ; but we must freely confess that the medical
men of those days must have been both puzzled and
awestruck to find strong men struck down by the
fever at the rate of 69 per cent. It was not from
want of good food or water, or accommodation.
No, they were struck down by some unseen hand,
and medicine said that that hand was the miasm. To-
day we know it to be the mosquito ; and whereas
formerly, acting on the miasm theory, not one life was
ever saved, to-day, armed with the new knowledge,
we visit the miasmatic countries with the same feeling
of security that we do when we pay a visit to the
Continent. But did no one in the days gone by stand
forth and try to stem the tide of prejudice and tradi-
tion ? Were there philosophers who saw something
dangerous in the common mosquito ? Yes, there were
such, as I will endeavour to show in the next
chapter.

CHAPTER IV

THE FORERUNNERS OF THE DISCOVERIES OF THE
MOSQUITO ORIGIN OF DISEASES

IT is the rule that all great movements and discoveries
are heralded in by premonitory signs. In other words,
there are always " John the Baptists " who go before.
It is so with the discovery of mosquito-borne diseases.
In the last chapter I traced the theories that were held
about malaria and yellow fever, how malaria or marsh
fevers and yellow fever were attributed to miasms.
In this chapter I wish to record the opinions of those
who doubted this view, and thereby demonstrated
how far ahead of their time they really were. Viewed
in the light of what we know to-day, they were true
prophets. There appears strong evidence that the
danger of flies and mosquitos was known in very early
times. Thus Sir Henry Blake, in speaking at a banquet
in connection with the Liverpool School of Tropical
Medicine in 1908, mentioned how, when he was
Governor of Ceylon, he had been shown a medical work
written fourteen hundred years ago, in which the
mosquito was stated to be a carrier of disease, and
malaria was described as being transmitted by flies

22

DR. BEAUPERTHUY 23

or mosquitos. It will also be remembered that Hero-
dotus spoke of winged serpents. Beauperthuy argues
that this term is very applicable to mosquitos, whose
poisonous bite he compares in its effects on the human
body to that of the serpent's bite. The use of
mechanical protection against mosquitos also appears
to be a very ancient practice, the means adopted
consisting of either smearing the exposed parts with
pungent fats and oils, or more commonly by the use of
netting ; this is seen in the use of our common word
" canopy " (KCOVCOIJ/ = gnat).

Not until the nineteenth century, however, do we
find medical men directing their attention to the
mosquito, the common biting insect of the tropics.
We read that in 1848 Dr. Nott, of Mobile, Alabama,
published a work on yellow fever in which he upholds
the mosquito origin of yellow fever, and also surmises
that the mosquito of the lowlands may be the origin
of malarial fever. But it is Dr. Beauperthuy whom we
must regard as the father of the doctrine of insect-
borne disease.

" Louis Daniel Beauperthuy, Docteur en Medecine
des Facultes de Paris et de Caracas, naturaliste fra^ais
et micrographe," was born in Guadeloupe in 1803,
studied medicine in Paris, and graduated with dis-
tinction. He was a medical man with a very strong
biological trend, and was devoted to the use of the
microscope. In order to study a disease he would
follow it up, no matter in what country it broke out.
It was thus with yellow fever ; wherever an epidemic
of it occurred in the West Indian group, he set off to

24 THE MOSQUITO ORIGIN OF DISEASES

study it on the spot. We thus find him at Cumana
in Venezuela, where a virulent epidemic had broken
out. In Cumana he appears to have been made a
health officer by the then Government, and in 1853
we find him contributing a paper to the Gaceta Official
de Cumand, in which he says :

" To the work I undertook I brought the knowledge
gained during fourteen years' microscopic observation of
the blood and secretions in every type of fever. These
observations were of great service to me in recognising
the cause of yellow fever and the fitting methods of
combating this terrible malady. With regard to my
investigations on the aetiology of yellow fever, I must
abstain for the present from making them public.
They form a part of a prolonged study, the results of
which are facts so novel, and so far removed from all
hitherto accepted doctrines, that I ought not to publish
them without adducing fuller evidence in support.
Moreover, I am sending to the Academic des Sciences
de Paris a communication which contains a summary
of the observations I have made up to the present,
the object of which is to secure the priority of my
discoveries concerning the cause of fevers in general.

" The affection known as yellow fever, or black
vomit, is due to the same cause as that producing
intermittent fever.

" Yellow fever is in no way to be regarded as a
contagious disease.

" The disease develops itself under conditions which
favour the development of mosquitos.

" The mosquito plunges its proboscis into the
skin . . . and introduces a poison which has properties
akin to that of snake venom. It softens the red blood

BEAUPERTHUY'S OBSERVATIONS 25

corpuscles, causes their rupture . . . and facilitates the
mixing of the colouring matter with the serum.

" The agents of this yellow-fever infection are of a
considerable number of species, not all being of equally
lethal character. The zancudo bobo with legs striped
with white, may be regarded as more or less the house-
haunting kind.

" Remittent, intermittent, and pernicious fevers,
just like yellow fever, have as their cause an animal
or vegeto-animal virus, the introduction of which into
the human body is brought about by inoculation.

" Intermittent fevers are grave in proportion to the
prevalence of mosquitos, and disappear or lose much
of their severity in places which, by reason of their
elevation, have few of these insects.

" The expression * Winged Snakes ' employed by
Herodotus is peculiarly applicable to the mosquito,
and the result of its bite on the human organism.

" Marshes do not communicate to the atmosphere
anything more than humidity, and the small amount
of hydrogen they give off does not cause in man the
slightest indisposition in equatorial and inter-tropical
regions renowned for their unhealthiness. Nor is it
the putrescence of the water that makes it unhealthy, but
the presence of mosquitos."

Readers will agree that perhaps never in the history
of medicine has such a carefully-thought-out prognosti-
cation received such remarkable scientific confirmation.
Beauperthuy made other communications both to the
Gaceta Oficial de Cumand and to the Academic des
Sciences.

He studied, amongst other diseases, Leprosy. For

26 THE MOSQUITO ORIGIN OF DISEASES

this purpose, acting upon his usual plan of investigation,
he removed into British Guiana, and it was whilst
engaged upon this study that he died at the Penal
Settlement, Mosaruni River, British Guiana.

The inscription on his tomb, for which I am in-
debted to the courtesy of Professor Harrison of
Demerara, reads as follows :

LOUIS DANIEL BEAUPERTHUY,

M.D., OF PARIS,

Born at Guadeloupe,

Died Sept. 3, 1871,

Aged 64 years.

After his death his papers were collected together
and published in book form by his brother, Pierre
Daniel Beauperthuy, at Bordeaux in the year 1891.
I am indebted to Dr. de Vertheuil, of Trinidad, for
having placed in my hands a copy of this work. It
is written in French.

In my opinion, Beauperthuy wished to publish a
treatise on insect-borne diseases. There is little doubt
also that he regarded the mosquito or " tipulaire " as
the cause of very many diseases. Where he failed in
his argument was to account for the source of the
virus with which the mosquito infected man. He
believed that the mosquito introduced some poison
into man which it obtained from the decomposing
matter on which it fed (matieres pelagiques], or
perhaps from decomposing phosphorescent animal sub-
stances, as fish. In support of this he mentions that

BLAIITS OBSERVATIONS 27

M. Magendie demonstrated that a few drops of putrid
fish inoculated into animals produce very severe intoxi-
cation. Then he says, " N'est-ce pas, en effet, une
instillation de poisson en putrefaction cfue versent ces
insectes sous la peau et dans le tissu cellulaire de
1'homme ? "

Thus Beauperthuy was clear as to the transmitting
agent, but fell into error in supposing that the poison
was taken from extraneous decomposing matter, and
not from the infected man. In other words, he
believed that the poison was telluric, that it did not,
however, come off in the form of a gas or miasm,
but was carried and inoculated into man through the
instrumentality of a mosquito.

Another investigator of high repute, and also of
British Guiana, viz. Surgeon- General Daniel Blair,
writes in 1852, in his "Report on the First Eighteen
Months of the Fourth Yellow Fever Epidemic of
British Guiana," that —

" it would appear from the observation of the present
epidemic that though, as is well established, a certain
high average temperature is required for the generation
and continued existence of the efficient cause of yellow
fever, it has not its genesis from any known combina-
tion of meteorological elements, and may appear at
a time when they are highly favourable to general
health and comfort ; that the laws of its diffusion differ
from those of gases ; that it is impelled by atmospheric
currents, but seems to possess some power of spon-
taneous motion ; that though intense energy of vegeta-
tive power characterised the seasons antecedent to and

28 THE MOSQUITO ORIGIN OF DISEASES

during the epidemic invasion, its shifting lines of infec-
tion and gyratory movements suggest to the imagination
the attributes of insect life"

Then in still more recent times we find King * in 1882
tabulating the facts in support of the mosquito origin
of malarial disease, showing how the word "Miasm"
can in all cases be replaced by the word " Mosquito."

Again, later, the name of Dr. Charles Finlay2 is
linked up with the mosquito origin of yellow fever. He
did much to direct the recent researches on yellow fever
to the Stegomyia as the transmitting agent in that
disease.

Working in a totally different direction, in a direc-
tion which had already been followed up and was well
known to the scientific world, namely, the relationship
of the lower animals to man in the transmission of
human disease, conclusions were arrived at which
demonstrated that it was possible that even a small
insect like the mosquito could act as an intermediate
host or carrier of disease organisms.

It had already been proved that improperly cooked
meat containing the encysted larvae of the Trichina
spiralis was capable of producing a very severe disease
in man known as Trichiniasis. Thanks to the re-
searches of Virchow and others this disease, which at
one time caused considerable mortality, was finally
banished by instituting a proper system of meat inspec-

1 King. " Mosquitoes and Malaria/' The Popular Science Monthly, New
York, 1883.

* Finlay, "El mosquito hypoteticamente considerado como agente de
transmisidn de la fibre amarilla," Havana, 1881.

TRANSMISSION OF DISEASE FROM ANIMALS 29

tion. The main points in connection with trichiniasis
are : —

1. The persistence in a living form of the larvae
of the parasite for considerable periods in the flesh
of the affected animals, like swine.

2. When such meat is ingested the larvee are
liberated in the intestines and then commence to
multiply and migrate, and the disturbance produced
in the body of man by their activity gives rise to
the symptoms characteristic of trichiniasis, such as
fever, etc., etc.

3. The pig infected man, man infected the rat, and
the rat infected the pig.

During the same period our knowledge of the
other intestinal-worm diseases advanced, and the re-
lationship of the phases of the parasites living in the
animal to those living in man was worked out. For
example, Tcenia echinococcus inhabits the dog, the dog
infects man through the eggs of the taenia infecting
the food of man ; the eggs, when swallowed, develop
in man into the scolex or hydatid phase, and there are
many more examples.

The next great step was made when the relationship
of the guinea worm to man, and to the minute
crustacean Cyclops was demonstrated by Fedschenko
and Leuckart. It was proved that the larvas of the
mature guinea worm upon reaching water were taken
up by the cy clops. Now if water containing these
infected cyclops was consumed by man, the parasites
were liberated in the stomach of man and from thence
migrated to the subcutaneous tissues where the adult

30 THE MOSQUITO ORIGIN OF DISEASES

stage was passed, and so the cycle repeated itself:
man— cy clops— man.

A further step was made when, about 1883, it was
shown that the intermediate host of the blood parasite
Filaria was the female mosquito, and the suggestion
made that man might become infected through the
bite of that insect. To Sir Patrick Manson we owe
most of our knowledge upon this point. By this time
observers all over the world were beginning to inquire :
How is a disease like malaria carried and spread ?
The parasite was known, but how did it enter man ? I
need hardly remind the reader of the shelves of books
which have been written containing all kinds of fantastic
theories. They nearly all centred on the deadly miasm
— the malaria or bad pestilential air which, as we have
seen, was supposed to arise, carrying the parasites and
infecting every one coming in contact with the vapour.
There were others, however, as we have seen, who held
that possibly the ubiquitous gnats or mosquitos might
have some share in the transmission : for instance,
observers like Beauperthuy, King, Finlay, etc.

Indeed, with the perfection of our knowledge of
the nature of infectious diseases, it was becoming
clearer every day that the " domestic " insects which
infested and pestered man and animals, such as fleas,
bugs, ticks, gnats, and flies, could act as disseminators
of disease. Already, in the case of red-water in cattle,
observers in the States had demonstrated how that
disease was carried from animal to animal by the tick,
which acted as host and carrier.

However, returning to the diseases of man, it was

THE MOSQUITO AND MALARIA 31

left to Major Ross to demonstrate in a most convincing
manner that the mosquito was the cause of the spread
of malaria. Thus a situation which at one time appeared
hopeless is now, on the contrary, full of hope, and the
tropics are rapidly becoming possible for Europeans.

Ross showed, as we shall see presently, that when
anopheline mosquitos, not all mosquitos, sucked blood
from a person suffering from malaria, that the parasites
which they sucked up in their meal of blood developed
in their stomach, and, after certain developmental
stages, reached the salivary glands, from whence they
were transmitted to man again.

In other words, the anopheline plays the part of
intermediate host, just like the dog does in some forms
of tapeworm disease, and the cyclops in the case of
the guinea-worm disease. It is most important to
recollect this, for it proves that the mosquito is
necessary to the complete life-cycle of the malarial
parasite, and that the former does not merely mechani-
cally carry the parasite from man to man like the
common house-fly does. The latter picks up on its
body or mouth parts the infected material, and trans-
fers it on to the first object it alights upon. We can
state the case for the mosquito thus :

For the complete life-cycle of the malaria parasite,
the special mosquito — the anopheline — is as necessary
as man. The date when the parasite was discovered
in the blood of man, and how Ross proved that it
passed part of its life-cycle in the body of the anopheline,
will be set forth in a subsequent chapter.

CHAPTER V

FILARIA AND THE MOSQUITO
HANSON'S DISCOVERY

UNDER the term " Filar iasis " are grouped several
diseased states of the body which have received different
names, according to their leading features, such, for
example, as " Fever and Ague," " Chyluria," " Elephan-
tiasis," " Barbados Leg," " Rose," etc. These morbid
conditions are due to the presence of a worm which
in its immature or larval form is known as Microfilaria
Bancrofti, and in its adult form as Filaria Bancrofti.

The larval form was first discovered by Demarquay
in 1863, and in 1872 Lewis of India found that it was
very frequently present in the blood of Indian natives.
To Bancroft belongs the credit of having discovered
the adult form.

The parasite, and therefore the morbid conditions
which it gives rise to, are widely distributed over the
globe. It is abundant in China and India, the per-
centage reaching as high as 50 per cent, in the former
country. It is found in the South Sea Islands, and
has been observed in the Southern States of the United
States, and also in Southern Europe. It is therefore

32

THE FILARIA SANGUINIS HOMINIS 33

a very widespread condition, and is of very special
interest because mosquitos which had previously
sucked the blood of persons harbouring the larval
forms were found later to contain them in a further
state of development, man thus acting as the definitive
host and the mosquito as the intermediary host. The
discovery of this inter-relationship paved the way, as
we shall see, to the discovery of the mode of the
transference of the virus of malaria and yellow fever.
Therefore, as very great interest attaches to this
discovery, I reproduce here the account which its
discoverer, Sir Patrick Manson, gave early this year
(1909) at a meeting of the Authors' Club. He said :

" Let me go back to my early years of tropical
experience. I was then in the island of Formosa. I
took a great interest in the diseases of the people. One
disease had a special fascination for me — Elephantiasis.
I puzzled over what might be the cause of this disease,
but without finding a satisfactory solution. Later I
went to Amoy, a large town on the coast of China,
where I saw many more cases and many more forms
of the same disease. Still I failed to find an ex-
planation.

" In 1874 I came to London, and there for the first
time I heard that Timothy Lewis, who had done so
much in the study of tropical diseases, had discovered
that in the blood of a proportion of the inhabitants in
certain districts of India there was to be found an
organism which he called the Filaria sanguinis hominis.
This is a microscopic animalcule, eel-shaped, and
enclosed in a loose sac, or sheath, within which it
wriggles about in the blood very actively. It is some-

3

34 FILARIA AND THE MOSQUITO

times present in enormous numbers — hundreds in every
drop of blood. These parasites Lewis had found in
more than one instance in association with elephantiasis
or elephantoid diseases. On my return to China in
1876 I endeavoured to ascertain if these parasites
occurred also in China. I discovered that they were
present in some districts in 10 per cent, of the popula-
tion ; in other districts they were present in 50 per
cent. ; while in other places they were not found at
all. One thing was certain — that this little organism
was not a mature animal. It showed no evidence of
growth while in the blood, or of any organs such as
would lead one to suppose that it was capable of
reproducing itself. The inference was therefore that
it was the young of some other animal. For this I
searched many times, and at last found such to be the
case, although my discovery had been anticipated by
Bancroft, and by Lewis himself.

" The parental worm was quite a big animal, from
about 3 in. to 4 in. in length, of a thickness of a strand
of fishing-gut. It lay in the lymphatic vessels. But
between this mature animal and its young, actively
wriggling progeny in the blood no intermediate form
could be discovered. The problem naturally suggested
itself — How does this parasite contrive to pass from
one human being to another ?

" Now it occurred to me that if it could not pass
by virtue of its own effort from one human body to
another, and if such a passage were necessary, as it
obviously is, some other agent must intervene, and that
that other agent must be one which is capable of
piercing the skin of the human body, and also one
which absorbed the blood of the human body, and
with the blood the little wriggling parasite which it

FIG. 0.-

-ATTITUDE AT REST (AFTER ROSS).
CARRIERS OF FILARIA.

ONE OF THE

MANSON'S EXPERIMENT 35

contains. Such translation was, in my opinion, a first
and necessary step for the parasite to take when it
would quit one human body and get into another.
Now, the agent which occurred to me as being the
most likely to effect the necessary step in the translation
of the filar ia was the mosquito."

Manson's suspicion that the mosquito was the
transmitting agent was soon strengthened by the dis-
covery that the filariee increased in the blood during
the night — this fact he discovered himself after the
examination of the blood of 1,000 Chinamen whilst
in Amoy. He argued, was this great development of
the parasite in the blood during the night in any way
an adaptation to the nocturnal habits of the mosquito ?
Stimulated, as he says, by this further coincidence, he
determined to make a practical test — just as, later, Ross
did in the case of malaria, and Reed, Carroll, Agra-
monte and Lazear in the case of yellow fever. For
this purpose Manson placed a Chinaman who had the
parasites in his blood under a mosquito net with hungry
mosquitos. The latter took their usual meal of blood,
and then Manson set about dissecting them.

" I shall not easily forget the first mosquito I
dissected so charged. I tore off its abdomen, and by
rolling a pen-holder from the free end of the abdomen
to the severed end, I succeeded in expressing the blood
the stomach contained. Placing this under the micro-
scope, I was gratified to find that, so far from killing
the filaria, the digestive juices of the mosquito seemed
to have stimulated it to fresh activity."

36 MANSOX'S DISCOVERY

Having thus proved that the filariae were taken
up by the mosquito in its meal of blood and that they
were not killed, he next set to work to find out whether
they underwent any changes in the body of the
mosquito ; this he succeeded in doing.

Manson observed that when the human blood
entered the stomach of the mosquito, it became
thickened in consequence of the water which it con-
tained becoming absorbed. The filariae which found
themselves imprisoned in the stomach of the mosquito
became actively motile. After a series of patient
dissections Manson was able to trace them through the
stomach wall into the abdominal cavity, and then into
the thoracic muscles of the mosquito. More than that,
"I ascertained," adds Manson, "that during the
passage the little parasite increased enormously in size.
From measuring about Tjy^ of an inch in length it grew
to about y^ of an inch, and it was now just visible to
the naked eye. It developed a mouth, an alimentary
canal. Manifestly, it was on the road to a new human
host."

When this state of development was reached in the
mosquito, Manson supposed that the latter in all proba-
bility died, and that the developed filaria escaped into
and infected the drinking water. He supposed that
the infected drinking water infected man. Later,
however, he succeeded in tracing the filaria a further
stage in the mosquito. From the thoracic muscles
he found that the parasite wandered towards the pro-
boscis of the insect, and could be found in the sheath
of that organ, where it remained to await an opportunity

CULEX AND FILARIASIS 31

to escape. And this was in all probability given it
when the mosquito sought a fresh victim to get its
meal of blood. During this act it is supposed that
the parasite escapes into the tissues of the victim.
From these observations it seems highly probable that
filaria disease is transmitted from a person in whose
blood the parasites are present by the intermediate
host, the mosquito, which in its turn infects man
when it bites him. Man harbouring the parasite is the
reservoir, the mosquito is the carrier. It will be ob-
served that the carrier is the " mosquito " — often a
species of Culcx. But this function does not appear
to be limited, as is malaria, to the Anophelines, or,
as in yellow fever, to the Stegomyia, probably several
species of mosquito being able to act as hosts. But as
in the case of malarial parasites, so in the case of the
filaria, the parasite passes part of its existence in man
and part in the mosquito ; both man and the mosquito
are necessary for the complete development of the
parasite.

Therefore, if the mosquito is destroyed, the life-
cycle of the parasite is destroyed and the disease must
of necessity cease. This constitutes, as we said in a
former chapter, the fundamental principle of prophylaxis
in all the mosquito-borne diseases.

CHAPTER VI

THE DISCOVERY OF THE PARASITE OF MALARIA IN
THE BLOOD OF MAN BY LAVERAN, AND OF ITS
FURTHER DEVELOPMENT AND PASSAGE THROUGH
THE MOSQUITO BY ROSS

HAVING in the preceding chapters traced how men's
minds were gradually being turned to the possible
danger of the mosquito in relationship to disease, and
thus in some measure preparing the way to the great
discovery of Ross that one particular genus of mosquito
could alone communicate malaria from man to man,
I will in this chapter refer first to the discovery of the
malarial parasite in the blood of man by Laveran and
others, and then I will deal fully with the discovery
of Ross.

Whilst, as we have already seen in the preceding
pages, the marsh fevers or malaria were attributed
to emanations or miasms from swamps, investigators
following other lines had searched the blood of man
by means of the microscope to try to find something
in the blood-stream — some organism to which the very
characteristic febrile symptoms of malaria might be
definitely ascribed. This quest was but natural, and

38

[R. Xeiostead, del.
FlG. 7. ANOPHELES MOSQUITO. OBSERVE SPOTTED WINGS.

FlG. 8. BAFTS OF EGGS OF AN ANOPHELINE FLOATING ON WATER.

P. 38

LAVERAN'S DISCOVERY 39

in conformity with the spirit of investigation of the
age. It had already, in the hands of the bacterio-
logists, led to the discovery of the anthrax bacillus
as the cause of the disease anthrax, the tubercle
bacillus as the cause of tuberculosis, the typhoid
bacillus as the cause of typhoid fever, the cholera
bacillus as the cause of cholera, etc. Considerations
like these no doubt stimulated one of Pasteur's dis-
ciples to patiently investigate the blood of patients
suffering from malaria, for Laveran succeeded in 1880
in discovering the parasite in the blood of all cases
of malaria. His researches were published in his
well-known work " La Paludisme," a work based
upon extensive observations made in Algeria. After
these observations, which were soon confirmed by dis-
tinguished observers all over the world, there remained
no possible doubt that the only cause of the disease
known as malarial fever was a microscopic parasite
which multiplied in enormous numbers in the blood of
the infected patient. Then, as invariably happens,
it was soon proved that related organisms could be
found in numerous species of animals ; in other words,
that this parasite was a widely distributed blood
parasite both in the blood of man and animals.

This discovery was an immense advance. The para-
site which caused all the characteristic symptoms was
now seen, and for the first time described and classified.
But whence did it come ? How did it get into the
blood of men ? Did it gain access to the body of
man in some finely divided form in miasm or vapours
from the marsh ? You will recollect that Dr. Beau-

40 DISCOVERY OF THE PARASITE OF MALARIA

perthuy imagined that the marsh mosquito absorbed
some telluric poison derived from decaying animal or
vegetable matter, and in its bite communicated this
poison to man. Laveran's discovery showed at once
that the virus was not a poison or ptomaine such as
would be obtained from decaying matter, but was
indeed a comparatively highly organised living body,
actively motile, at certain stages in the blood. Then
the great question arose in men's minds, how did
Laveran's parasite get into the blood ? My colleague
— Professor Major Ross — answered the question, and
we can with truth say that, side by side with the
discovery of the bacterial origin of the infective
diseases by Pasteur, this will remain one of the
epoch-making discoveries in medical science, which
will prevent an immense amount of suffering through
sickness and death and will advance civilisation and
commerce in hitherto almost inaccessible regions in
a manner previously undreamt of. The discovery was
only made in 1897, and consisted in Ross being able
to infect certain mosquitos, the Anophelince, with the
malarial parasite. And then, as if by magic, the true
story of malarial infection, about which countless
books had been written containing an equal number
of hypotheses, theories, warnings, and surmises, was
made as clear as daylight. A water-breeding mosquito
sucked, not decomposed vegetable or animal matter
at the marsh, but the blood of a man suffering from
malaria, and in which there were parasites in abundance.
The parasites sucked in with the meal of blood
underwent further development in the mosquito, i.e.

FlG. 9.— CHARACTERISTIC ATTITUDE OF AN ANOPHELINE (AFTER BOSS).
THE MOSQUITO WHICH TRANSMITS MALARIA.

I'- 40]

ROSS'S DISCOVERY 41

infected the mosquito ; and then when the infected
mosquito, which had now become the carrier, bit
man, it infected him.

As the history of this epoch-making discovery is
of great scientific and practical interest, J cannot do
better than give it in Professor Ross's own words.

Professor Ross had returned to his regimental
duties in India ; before setting out, however, he had
a conversation with Dr. Manson (now Sir Patrick
Manson) on the best method of experiment to test
whether, as in the case of the Filaria Bcuicrofti dis-
covered in the mosquito by Manson, a mosquito might
likewise act as host to the malarial parasite. Ross says :

" We agreed that the proper course would be to
select patients whose blood was rich in gametocytes
(the name now given to those forms of the parasite
of which some produce motile filaments), and to
attempt to trace in the tissues of these insects the
development of the said motile filaments which we
thought were flagellate spores. In fact it was pro-
posed that I should adopt exactly the procedure
employed by Manson in regard to Filaria Bancrofti."

After innumerable failures to find anything definite
in the bodies of the mosquitos which he examined for
the purpose of trying to trace out the further life
history of Laveran's parasites in the mosquito, Ross,
being now at Secunderabad (1907), says:

" I commenced work by making a careful survey
of the various kinds of mosquitos which were to be
found in the officers' quarters, in the regimental

42 DISCOVERY OF THE PARASITE OF MALARIA

hospital, and in the numerous little houses of the
native soldiers which constituted the barracks, or
' lines,' as they were called. I found, first, the insects
with which I was familiar during my previous studies
here in 1895, namely, (a) several species of brindled
mosquito, and (b) two species of grey mosquito. But
at the same time I was astonished at observing that the
whole place was overrun by swarms of (c) a small and
delicate variety of mosquito which were at once
observed to rest with the body-axis at an angle to
the wall, and which had spotted wings. In fact they
were evidently of the same genus (though not of the
same species) as the mosquito which had been previously
found in the Sigur Ghat — a genus, or perhaps family,
quite distinct from those of the grey and brindled
mosquitos with which I had hitherto been working.

" In the spotted- winged mosquito which I now found
at Secunderabad I noticed at once the general difference
of shape, the peculiar attitude of the insects when at
rest, the marks on the wings, and the appearance of
the eggs (as seen within the body of the female when
dissected) ; but the larvae could not be studied until
later. The adults were very delicate, pale brown
creatures, which by common consent seemed scarcely
to bite man, though they were numerous enough to
have caused much irritation had they done so. They
swarmed in my own quarters, but seldom bit me.
They abounded also in the houses of the other officers
of the regiment who, with their families, had remained
quite free from malarial fever. Consequently I was
not disposed to think that they had anything to do
with the disease. On the other hand, the grey mos-
quitos swarmed in the barracks, but were much less
numerous in the officers' quarters' (situated some

[Logan-Taylor.
FlG. 10. ANOPHELINE BREEDING POOLS, AFTER RAIN, SIERRA LEONE.

FlG. 11. ANOPHELINE BREEDING POOLS, SIERRA LEONE.

[Logan-Taylor.

ROSS'S EXPERIMENTS WITH ANOPHELINES 43

hundreds of yards to leeward of the barracks). Suspicion
therefore first attached to the latter variety.

" I determined, however, not to be swayed by such
considerations, but to make a most complete and
exhaustive test of all the varieties which I could
procure — even at the cost of repeating much of my
old negative work, during which, laborious as it was,
I may have overlooked the object I was in search of.
A number of natives were employed to collect larvae
from far and wide round the barracks. These larvae
were kept in separate bottles, and when the adult
insects appeared they were released within mosquito
nets in which the patients were placed. The insects
were applied sometimes during the day in a darkened
room, and were sometimes fed at night. After
feeding, the gorged insects were collected in small
bottles containing a little water, and were kept for
several days before being dissected. The procedure
was therefore the same as before. But now, in order to
ensure at least definite negative results, redoubled care
was taken ; almost every cell was examined, even the
integument and legs were not neglected ; the evacua-
tions of the insects found in the bottles, and the
contents of the intestine, were scrupulously searched ;
at the end of the first examination staining reagents
were often run through the preparation and it was
searched again with care. The work, which was
continued from 8 a.m. to 3 or 4 p.m., with a short
interval for breakfast, was most exhausting, and so
blinding that I could scarcely see afterwards, and the
difficulty was increased by the fact that my microscope
was almost worn out, the screws being rusted with
sweat from my hands and forehead, and my only
remaining eye-piece being cracked, while swarms of

44 DISCOVERY OF THE PARASITE OF MALARIA

flies persecuted me at their pleasure as I sat with both
hands engaged at the instrument. As the year had
been almost rainless (it was the first year of plague
and famine) the heat was almost intolerable, and a
punkah could not be used for fear of injuring the
delicate dissections. Fortunately my invaluable oil-
immersion object-glass remained good.

" Towards the middle of August I had exhaustively
searched numerous grey mosquitos, and a few brindled
ones. The results were absolutely negative ; the
insects contained nothing whatever."

He, however, continued dissecting, and finally he
says :

" On August 20th I had two remaining insects,
both living. Both had been fed on the 16th instant.
I had much work to do with other mosquitos, and
was not able to attend to these until late in the
afternoon, when my sight had become very fatigued.
The seventh dappled- winged mosquito was then success-
fully dissected. Every cell was searched, and to my
intense disappointment nothing whatever was found,
until I came to the insect's stomach. Here, however,
just as I was about to abandon the examination, I saw
a very delicate circular cell, apparently lying amongst
the ordinary cells of the organ, and scarcely distinguish-
able from them. Almost instinctively I felt that
here was something new. On looking further, another
and another similar object presented itself. I now
focussed the lens carefully on one of these, and found
that it contained a few minute granules of some black
substance, exactly like the pigment of the parasite of
malaria. I counted altogether twelve of these cells in

THE PARASITE OF MALARIA IN THE MOSQUITO 45

the insect, but was so tired with work, and had been
so often disappointed before, that I did not at the
moment recognise the value of the observation. After
mounting the preparation I went home and slept for
nearly an hour. On waking, my first thought was that
the problem was solved, and so it was."

Then Ross proceeds to add :

" The mind long engaged with a single problem
often acquires a kind of prophetic insight, apparently
stronger than reason, which tells the truth, though the
actual arguments may look feeble enough when put
upon paper. Such an insight is mainly based, I sup-
pose, on a concentration of small probabilities, each of
which may have little weight of itself ; but in this case,
at all events, the insight was there, and spoke the
truth."

Up to this point Ross had proved that the parasite
of malaria (Laveran's corpuscles), when sucked into the
stomach of mosquitos in a meal of blood after the
mosquito had bitten a person with malaria, underwent
further development.

" I had traced," he says, " the development of the
pigmented cells up to their maturity and subsequent
rupture and discharge of their contents into the body
cavity of the grey mosquitos. I could not see at the
moment what happened to these contents, yet upon
this point depended the vastly important question of
the root of infection in malaria. ..."

" Hitherto my mosquitos had been dissected in
water or a weak solution of salt, and I had had no time
for methodical staining. A strong salt solution was

46 DISCOVERY OF THE PARASITE OF MALARIA

now used, and the secret was revealed. The contents
of the mature pigment ed cells did not consist of clear
fluid, but of a multitude of delicate, thread-like bodies,
which, on the rupture of the parent cell, were poured
into the body cavity of the insect. They were evi-
dently spores."

Further on in his narrative he shows how the spores
here described enter the salivary gland of the mosquito.

" The exact route of infection of this great disease,
which annually slays its millions of human beings, and
keeps whole continents in darkness, was revealed.1
These minute spores enter the salivary gland of the
mosquitos, and pass with its poisonous saliva directly
into the blood of man. Never in our dreams had we
imagined so wonderful a tale as this."

Finally Ross, in order to make a crucial test of the
accuracy of his observations, in 1898 infected twenty-
two out of twenty-eight healthy sparrows by mosquitos
previously fed on diseased sparrows.

In 1900 Manson infected two gentlemen in London
by mosquitos brought from Italy. They were infected
in Italy by allowing them to suck up a meal of blood
from a man suffering from malaria. One of the gentle-
men who submitted himself to be bitten in England by
these infected mosquitos was Hanson's own son. As the
result of the bite the latter contracted tertian malaria
and the parasites were found in his blood. The first
attack was followed by recurrences. This experiment
demonstrated that a person could contract malaria in

1 Ronald Ross, " Researches on Malaria," London, 1905, pp. 32, 33,
and 34.

PROOF OF THE MOSQUITO DOCTRINE 47

London where endemic malaria does not exist, provided
that he was bitten by infected mosquitos. Ross had
now therefore worked out the whole story. The mos-
quito was the carrier of malaria from man to man.
Malaria had no connection with miasms. The reason
why malaria was associated with marshes and water
was simply that mosquitos bred there.

With these facts proved, it was clear that in order
to prevent malaria, it was necessary to protect man
from the infected mosquito and also to wage war
against it. Now this latter would have been a stupen-
dous task if it meant that war was to be waged against
all mosquitos. Here, however, direct scientific observa-
tion proved to Ross that the only species of mosquito
which could become infected belonged to a single group,
the Anophelinse. So that the question of extermina-
tion only affected that group. In consequence a
whole army of reseachers were set to work and it
was soon demonstrated that the anophelines preferred to
breed in small collections of water — those with a natural
earth bottom, such as small pools and patches of water
of all descriptions, margins of streams and lakes, and
odd receptacles coated with humus ; therefore the
problem of extermination was reduced in magnitude.

The workers in the field of malarial research soon
brought to light another very important fact, i.e.
that, as demonstrated by Christophers and Stephens
and Koch, a very large number of people, including
children, harboured the parasite of malaria in their
blood without showing obvious symptoms of malaria.
In other words, that these people acted as the reservoirs

48 DISCOVERY OF THE PARASITE OF MALARIA

of the virus — the comparatively " healthy reservoirs "
attracting very little attention by the general absence
of symptoms and going about their daily avocations
much as usual. The people most infected in this way
were the indigenous population of the district. There-
fore the indigenous population who were reservoirs
of disease became the source of infection for the
anophelines breeding in the small collections of water
close by, and the new-comer arriving in the infected
zone very soon found himself struck down by malarial
fever as if by magic. Of course he was bitten by the
innumerable infected anophelines which had themselves
contracted the disease from the almost symptomless but
deeply infected native population around.

The extent of the infection amongst the native
or indigenous population is very great, viz. 80-90 per
cent. In black populations the black are the reser-
voirs. In Algeria, Sergent has shown that it is the
native Arab tribes. With the knowledge of the fore-
going facts, the lines of defence are clear.

1. Measures to avoid the reservoirs (man) — Segre-
gation.

2. Measures to avoid the anophelines (choice of
locality, screening houses, anti-larval measures).

3. Measures to exterminate the anophelines by :

(a) Use of natural enemies of larvae.

(b) Use of culicides, oils, etc.

(c) Drainage, etc.

(d) Enforcement of penalties.

(e) Education.

4. Measures to kill the parasite in the blood of
infected man (quinisation).

CHAPTER VII

THE PLAN OF CAMPAIGN AGAINST THE MOSQUITO

IN this chapter I will deal with the practical applica-
tion of the facts learnt in the preceding pages ; in other
words, with prophylaxis. I will then proceed to give a
short history of what has been accomplished since the
great discovery was published.

As stated, the lines of defence and offence against
malaria are :

1. Measures to avoid the human reservoirs :

(a) By means of segregation.

(b) By screening with nets those suffering from

malaria.

2. Measures to avoid the anophelines :

(a} By choice of suitable locality when possible.

(b) Screening houses (windows and verandahs).

(c) Sleeping under mosquito nets.

3. Measures to exterminate the anophelines :

(a) Use of the natural enemies of mosquitos.

(b) Use of culicides as oil.

(c) By drainage and scavenging to get rid of

breeding places.

(d) Enforcement of penalties for harbouring

larvae or keeping stagnant water.
(e} By educational methods.

49 4

50 PLAN OF CAMPAIGN AGAINST THE MOSQUITO

Those accustomed to take part in anti-malarial and
anti-yellow fever operations are accustomed to hear
many objections against doing anything. Some will
argue, what is the good of trying to do such an im-
possible task as exterminating mosquitos ? The people
who argue thus are generally those who live in large
swampy countries and in countries about or below sea-
level, where there is always a great abundance of water
and very frequently enormous numbers of mosquitos.
The answer to these objectors is that in the first place
the war is against one particular group of mosquito,
the anophelines, which are, moreover, very selective
breeders and not found in the middle of lagoons and
rivers but only along the margins. In the second
place, that as lagoons, canals, large trenches, rivers,
and deep marshes are usually plentifully stocked with
fish, larvas are not present. For example, Barbados
is an island which appears to be entirely free from
anophelines, yet scattered throughout the island there
are numerous ponds ; these are, however, plenti-
fully stocked with minute fish, and so no larvae can
exist.

The very first thing, therefore, to be done in an
anti-malarial war is to make an accurate survey under
the guidance of an entomologist in order to accurately
locate the breeding places of the enemy, and thus to
avoid dissipating energy by attacking useless places, and
by so doing anticipate defeat. A mosquito survey is
therefore first made, and it is surprising when this is
done how comparatively localised will the breeding-
places be found to be. Others will argue that the

SEGREGATION 51

nature of their occupation necessarily exposes them
to infection on all sides. The answer to this is the risk
of infection can be greatly diminished by the use of in-
telligence and the carrying out at any rate of some (if it
is not possible to carry out all) of the precautions which
modern discoveries have placed in our hands. If health
is worth preserving, then it is business to diminish risks
or to take no risks at all. This is absolutely feasible,
and has succeeded on innumerable occasions ; just as the
" don't care " policy has meant prolonged sickness or
even death.

1. Measures to avoid the human reservoirs. — It
having been incontestably proved that the indigenous
inhabitants of tropical countries nearly all harbour in
their blood the parasites of malaria, and that they
have to a great degree become accustomed or inured
to their presence, so that they can go about their
daily work with little inconvenience, it stands to
reason, given the presence of the anopheles mosquito,
that the new-comer would be running an unnecessary
risk did he not try to avoid living in close quarters
with the infected. The new arrival is in no sense
immunised in the same degree as the indigenous
inhabitant, and by taking risks he puts himself at a
very great disadvantage compared to the native.
Curiously enough, precisely the same argument holds
good with the locally and partially immunised native
himself, for it is well known that the native of one
country who is through long infection more or less
immune to the malaria of his native land, yet readily
succumbs to an invasion of the malarial parasites of

52 PLAN OF CAMPAIGN AGAINST THE MOSQUITO

another malarial country, in this respect in no wise
differing from the rawest new arrival from Europe.

It were wise, therefore, if Europeans would adopt
the plan of living as much as possible away from the
reservoirs. It is often argued that this is not a
humane procedure, but, from what I have said above,
why should the unacclimatised new-comer put himself
at a disadvantage by assuming that he is as resistant
as the native who has had the malarial parasites in
his blood from childhood, and has in consequence
acquired a certain degree of immunity ?

Persons suffering from malarial fever in the house
or hospital should be screened in order to prevent the
anopheles from becoming infected and passing the
disease on to others.

2. Measures to avoid the anophetines. — If in the
founding of new towns and residences it is possible
to select alternative sites, then let that site be chosen
which is furthest from any possible breeding grounds,
on soil where the rain-water will not puddle and
where the water, either by reason of the nature of
the soil or the slopes, disappears rapidly. Very often,
however, new-comers have to take the houses built
in the old days before attention was paid to mosquitos,
houses very often which are infected with mosquitos.
Under these circumstances it is very advisable to
screen the verandahs and windows with copper-wire
gauze. This has now been done with the very greatest
comfort in many of the more advanced towns through-
out the tropical and subtropical world. With such
a protection one can live in security, and surely the

STUDY OF ENTOMOLOGY 53

gain to health for the inmates is worth the outlay.
Under any circumstances it is now recognised in
every civilised community that a mosquito net to
sleep under is as essential as the bath in the morning.
Time was when it was supposed to be effeminate to
use a net, and what countless lives and shattered con-
stitutions have resulted in consequence ! The net now is
as essential to a man or woman as any article of attire.

3. With regard to the measures to exterminate
the anophelines, a very large subject is opened up. It
is in the first place the measure which strikes at the
root of prevention, and it is the procedure, as first
pointed out by Ross, that we must all aim at. Get
rid of the breeding places of the enemy. And the
very first thing to do is to locate them. Here the
entomologist is necessary to point out where they are,
and it surely is a sign of the progress of tropical
sanitation that the services of entomologists are being
made use of far more frequently than formerly. The
closer study of the life history of the mosquito has
indicated to us that man has most powerful allies to
help him carry on his war in the form of the natural
enemies of mosquitos. All living things have their
natural enemies, and mosquitos are no exception. They
have their enemies whilst on the wing, such as dragon-
flies and birds, but they are most vulnerable in the
larval stage whilst in water. Here they form the
natural food of fish and of certain water insects. It
is now, therefore, the rule to stock ornamental ponds,
lily-tubs, canals, trenches, etc., with fish — larger fish
like the gold fish for the larger collections of water,

54 PLAN OF CAMPAIGN AGAINST THE MOSQUITO

little fish, like the useful " millions " of Barbados, for
the smaller collections of water. Whilst in Barbados
recently I had abundant opportunity of seeing the
great utility of fish in killing larvae.

Immunity of Barbados from Malaria. — A most
interesting fact in connection with Barbados is the
immunity of the island from malaria. This is due
to the fact that the " anopheles " mosquito does not
exist in the island 1 ; indeed it was the reason why the
medical men of the island had at once believed Major
Ross's theory of the relationship of malaria to the
" anopheles," because they well knew that malaria did
not exist in the island and also that the " anopheles "
had not been found. This fact has stimulated several
observers to ascertain why the " anopheles " mosquito
does not breed in Barbados. It led to a discussion,
and many interesting facts were brought out, — first
of all the complete immunity of Barbados from the
" anopheles," whilst the other West Indian islands are
plagued with it. Mr. C. Kendrick Gibbons, who has
resided for many years in Barbados, propounded the
interesting theory that this might be due to the
presence in the swamps and ponds of Barbados of
a tiny fish which exists in such teeming numbers as
to earn the name of " millions," whose staple diet is
the larvse of mosquitos.

The "million," or Girardinus pceciloides, belongs
to a group of fish known as "top minnows," small
carnivorous fish which swim and feed near the surface
of the water upon insect life. They are most com-

1 According to local authorities.

55

monly found in water too shallow for larger fish.
They chiefly feed on the eggs, larva* and pupae of
mosquitos. They multiply very rapidly, are oviparous
in captivity ; in water tanks, reservoirs, fountains,
and lily-tubs they thrive and multiply, and through-
out the island they are largely used for these receptacles
both in town and on estates to reduce the annoyance
from mosquitos. I have examined some sixty re-
ceptacles containing " millions," and I can testify to
their absolute use in killing the larvae of the Stegomyia.
In one house I examined twenty-seven lily- tubs con-
taining millions, and in no instance were larva? present.
In another case I examined twenty-five barrels
containing aquatic plants, and in no case were larvae
present ; but they were present in a dirty stream in
the vicinity. My experience has been similar with
lily ponds, where I have failed to detect larva?. These
observations have been fully proved, and the " millions "
shown to be the natural enemy of the mosquito in
Barbados, by a series of experiments undertaken by
Dr. H. A. Ballou, on the staff of the Imperial
Department of Agriculture in Barbados, who, by
keeping these minute fish under observation in the
laboratory, has proved that they eat the eggs, larvae,
and pupa? of both Culex and Stegomyia. So successful
have these experiments been that the Imperial Depart-
ment of Agriculture is introducing them into other
mosquito -plagued islands. But Mr. Gibbons's ex-
planation was criticised because, in spite of the fact
of no " anopheles," nevertheless Culex and Stegomyia
were abundant. If the fish theory were correct, then

56 PLAN OF CAMPAIGN AGAINST THE MOSQUITO

these mosquitos, they argued, should also have been
destroyed.

The explanation is very simple : the breeding places
of Culex, Stegomyia, and " Anopheles " are usually
quite different. Just as amongst the higher animals
some dwell in caves, others burrow in the earth, and
others again live in the forest, so with the different
species of mosquitos, the Culex prefers dirty gutters
and drains, the Stegomyia wrooden barrels and small
receptacles of all kinds, the Anophelines pools, the
margins of marshes, lakes, rivers, ponds, and small
receptacles coated with a lining of humus. Fish will
not be found in the dirty gutters or in drains, nor
yet in the water-barrels and small receptacles. So
Culex and Stegomyia under these circumstances are
not molested, but the larvae of the Anophelines are
exposed to the fish. That this is the explanation
I had a further proof in Barbados ; I found that
amongst the natives there was a very common practice
of keeping one or two small gold fish in the drinking-
water barrel. Now, wherever I found this to be the
case I never found the Stegomyia larva? present ;
where these fish were absent the larva? were invariably
present. When I asked the native residents why they
kept fish in their drinking-water barrels, they always
replied that they had been taught to do so by either
their parents or grandparents, and for this reason: if
a maliciously inclined neighbour poisoned the water,
the gold fish would die, turn up and float on the
surface, and they could see at once that the water
was poisoned ; then they would pour out the contents

PREDACEOUS LARV^ hi

and burn the barrel. It is thus that a very primitive
custom has now become of practical value, for we
encouraged these humble folk always to keep a fish
in their barrel — that is, if it1 were necessary for them
to have a barrel at all.

In Trinidad I also found in certain of the coolie
" ranges " on sugar plantations, that it was a common
practice to keep a fish in the drinking-water barrel,
but they would not inform me why they did so.

Besides fish, other enemies or auxiliaries have been
described. The water boatman, Notonecta, has been
shown by Branch and Patterson of St. Vincent, amongst
others, to suck dry the larvae of mosquitos. Similarly,
it is supposed that the water spider helps also in the
work by continually harassing the larvae when they
come to the surface to breathe. A most satisfactory
circumstance amongst larvae is the cannibalistic ten-
dencies of many of them. The observations of Dr.
Urich of Trinidad and others demonstrate that the
larvae of Megarhinus trinidadensis and M. superbus
and Sabethes undosus are predaceous and feed upon
other larvae. In other words, there appears to be
a bitter struggle for existence amongst larvae when
they find themselves at close quarters. All these are
observations well worthy of further study, for it is
evident that man possesses most powerful allies in
the natural enemies of the mosquito which may do
much to help him to keep under the mosquito
pest.

The common artificial culicide is kerosene oil ; a
small quantity is poured on the surface of the water

58 PLAN OF CAMPAIGN AGAINST THE MOSQUITO

to form a film, which then prevents the larvae from
coming to the surface to breathe. It is usual to
employ this method for cisterns which are difficult of
screening with wire gauze.

The method of larvae destruction which strikes
at the root of the problem is, of course, drainage, i.e.
getting rid altogether of the water in which the larvae
develop. Drainage is carried out in many ways.

Road drainage. — Roads should be constructed with
proper falls, free from puddles, with side drains of
concrete or stone, which must be kept scrupulously
clean, so that it is impossible for water to stagnate in
them.

Streams and rivulets in valleys, gullies, and cuttings
should be trained so that the edges are sharp, the
simplest way being to concrete them.

River canals and pond banks must be cut sharply,
so that there are no small bays where water can rest.
Regular flushing of drains should be insisted upon.
Yards ought to be constructed with proper falls to
the street drain.

There is an immense field for successful antimosquito
work in drainage. The guiding principle being to
prevent storm water or water from any source remain-
ing stagnant in pools or in any receptacles.

Great attention must be paid to drains to see that
they do not sag, also to house gutters for the same
reason, also to the water-holding plants, like the
B?~omeliacece or wild pines. It is not easy at first
to appreciate the large water-holding capacity of the
wild pine. In the Port of Spain — Trinidad — my

attention was drawn to them, for the authorities have
adopted the plan of cleaning the trees of these epiphytes.
One Saman tree wrhich was cleaned up for this reason
yielded twenty-six cartloads of epiphytes. The total
weight of these was 3*62 tons. As each plant may
hold from ten to twenty ounces of water, the total
volume of water represented by 3'62 tons of plants
must be very great indeed ; the water in this Saman
tree was probably equivalent to a good-sized pond,
capable of fostering a very large number of larva?.

Educational propagandism. — As part of any anti-
mosquito campaign, the education of public opinion
must take a very prominent share. In my experience
in the tropics, I can state that the public is being
educated to appreciate the danger of mosquitos and
other insect pests, and therefore to organise to get rid
of them. This state of feeling has been produced by
the increased number of public lectures given by medical
men and teachers, and by the distribution of pamphlets,
and by the press in many cases giving increased promi-
nence to all work on mosquito destruction. Primers
on hygiene including antimosquito measures are used
in the schools. Pupil teachers, police officers, and those
who wish to qualify for sanitary inspectorships are now
being trained in mosquito destruction. Further, by
means of small handbills and posters, the poorer
classes are being trained to fully appreciate the danger
of harbouring mosquito larvje.

But, as is well known, education is very well in
its way, but unless it is occasionally backed up by the
strong arm of the law, little progress would, in the long

run, be made. It is now, at any rate in the West
Indian Colonies, becoming the rule to inflict penalties
if, after due warning from the Sanitary Inspectors, the
people have not got rid of stagnant water, or water in
which larvas are found. The beneficial effect of this
salutary punishment is beginning already to tell, and
will in time completely change the health conditions of
our tropical possessions. It is most satisfactory to
record that, in spite of its novelty, the law is not
resented ; all classes see the wisdom of the measure.

Quinisation. — By this is understood the systematic
taking of quinine in order to destroy or reduce the
number of parasites in the blood, and so to modify,
ward off or prevent the attack of the disease. It is un-
questionably a most wise safeguard. It has been used
as an auxiliary preventive with great success in many
places, and in British Guiana the Government dispense
it at the post offices to the labourers ; and it is sought
after and does good.

CHAPTER VIII

SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

IN his " Researches on Malaria " Ross very truly
remarks that "malarial fever is important not only
because of the misery which it inflicts upon mankind,
but because of the serious opposition which it has
always given to the march of civilisation in the tropics.
Unlike many diseases, it is essentially endemic, a local
malady, and one which unfortunately haunts more
especially the fertile, well-watered, and luxuriant tracts
— precisely those which are of the greatest value to
man. There it strikes down not only the indigenous
barbaric population, but, with still greater certainty, the
pioneers of civilisation — the planter, the trader, the
missionary, and the soldier. It is therefore the principal
and gigantic ally of Barbarism. No wild deserts, no
savage races, no geographical difficulties have proved so
inimical to civilisation as this disease. We may also say
that it has withheld an entire continent from humanity
—the immense and fertile tracts of Africa ; what we
call the Dark Continent should be called the Malarious
Continent ; and for centuries the successive waves of
civilisation which have flooded and fertilised Europe

Gl

62 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

and America have broken themselves in vain upon its
deadly shores."

We cannot obtain accurate figures to give us some
indication of the mortality and sickness rate amongst
the populations of Africa. We can, however, agree
with Ross that Africa is to-day what it is as compared
to Europe because of its malaria-bearing mosquito.
But we can well imagine that such figures would be
gigantic if for a moment we consider what malaria does
in India. Here we have available data, and they show
that there were 4,919,591 deaths recorded under the
word Fever in 1900, the vast bulk of which was no
doubt of malarial origin. Taking next the military
population, out of a total force of 305,927 in 1900,
there were 102,640 cases admitted into hospital suffer-
ing from malaria.1

Figures like these give the world some idea of the
magnitude and importance of antimalarial mosquito
warfare ; they are figures only exceeded by the mortality
which was common in the 'fifties in the West Indies
from yellow fever, when the mortality sometimes
reached 69 per cent, amongst the soldiers I No wonder,
then, that antimosquito work is attracting increased at-
tention all over the world. The method of attack is
simple and the victory to be gained is overwhelming, as
the following narrative of campaigns abundantly proves.2

Historically, the first antimalarial work was under-

1 Ross, " Researches on Malaria," 1905

1 For further information about the organisation of antimosquito work
consult " Mosquito Brigades and How to Organise Them," by Ronald Ross,
C.B., F.R.S., 1902.

FIRST ANTIMALARIAL CAMPAIGNS 63

taken by Ross when in India, and subsequently in
Sierra Leone. He organised mosquito brigades to do
away with the breeding places of the anophelines, to
drain the land, or oil the pools, — not every patch of
water, however. The rivers and the lakes and large
collections of water were for the most part free from
larvae ; these latter were to be found in the small
collections of water, — pools by the roadway, pockets
of water in unnoticed and waste places, ditches,
margins of marshes, etc.

ANTIMALARIAL CAMPAIGNS IN EUROPE
THE CAMPAIGN AGAINST MALARIA IN ITALY

In Italy malaria is a disease of the entire population
where the conditions exist for the propagation of the
malaria- carriers — the anophelines. In addition to the
agricultural population, the great sufferers are railway
employees stationed in marshy districts, and in mili-
tary outposts placed under similar conditions.

In 1905 Grassi proved the efficacy of mechanical
protection against the anopheles in one of the most
malarial areas near Salerno.

In a letter written in March 1909 to The Times,
Professor Osier, in testifying to the value of the work
of the Italian Society for the Study of Malaria in
suppressing that fever, mentions how in 1887 malaria
ranked with tuberculosis, pneumonia, and the intestinal
disorders of children as one of the great infections,
killing in that year 21,033 persons. In 1902 an
organised campaign was started, the measures adopted

64 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

being chiefly systematic screening of the houses and
the free distribution of quinine ; at the same time, by
the spreading of a better system of land cultivation, the
breeding area of the anophelines was curtailed. The
result, according to Osier, has been that the annual
mortality of about 10,000 has been reduced to about
4,000, whilst in the army and amongst the officials
there has been a similar diminution as a result of
vigorous action.

THE ANTIMALARIAL CAMPAIGN IN GREECE

In May of 1906 Major Ross was asked by a British
company owning large tracts of land in Greece to
proceed there to advise 'upon the best means of pre-
venting malaria, which was seriously interfering with
the work and prosperity of the company. Ross's visit
stimulated the work of the Grecian Antimalarial Society,
with the result of forming a co-operation between
medical men and officials to undertake strenuous
measures against anophelines, such as drainage, screen-
ing, etc. — with what success the following statement
shows :

Within the last year, 1908, the Liverpool School
of Tropical Medicine has been informed by the Grecian
League against Malaria that their efforts have had
wonderful results in the plain of Marathon, which used
to be a hot-bed of fever. In 1906, 90 per cent, of the
cases of sickness were due to malaria. In 1907, after
the first efforts of the League, the malaria cases fell to
47 per cent, of all cases of sickness. During last
summer, however, usually the most intensely malarious

ANTIMOSQUITO CAMPAIGN IN ISMAILIA 65

season, the sickness due to malaria fell to only 2 per
cent, of the total amount of sickness at Marathon.

This triumph is possibly more important to humanity
than the results of a twenty-mile foot race, and Major
Ross adds : " The best kind of international race is
that in which nations compete to benefit humanity."
Such a race has been carried on most successfully by
the Grecian Antimalarial League in Marathon.

ANTIMALARIAL CAMPAIGNS IN EGYPT
THE ANTIMOSQUITO CAMPAIGN IN ISMAILIA

The town was founded in 1862, and contains 8,000
inhabitants. It is conjectured that malaria was intro-
duced by the Italian workmen who were employed
upon the canal construction, and who brought the
malaria parasites from Italy with them.

In 1877 malaria fever broke out with great in-
tensity and gained in volume until in 1886 it was
computed that every inhabitant suffered from the
disease. After many fruitless efforts to get rid of
the disease., the Canal Company, having been made
aware of the new views of the way in which malaria
is carried, invited Major Ross in 1901 to advise upon
antimalarial measures.

An anopheles survey was first made, and it was
ascertained that larvae were present in every pool
and puddle formed in the cultivated land near the
town, in the irrigation and drainage canals, and in
deposits of water formed by infiltration from the

5

66 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

fresh-water canal. No larvse were found in the reeds
or water-plants along the shore of the canal. The
breeding places of the anopheles having been deter-
mined, the Canal Company laid down a definite
programme of extirpation by improved drainage and
flushing of all small waterways ; large water basins
were dried, smaller ones were filled in with earth or
sand, drainage canals were deepened and kept free
of reeds and water-plants, and regularly sluiced. The
result has" been that the larvae have been driven out
of the large area operated upon. To still further
complete the wrork, a house-to-house visitation was
made, and house drains and sinks oiled and collections
of stagnant water removed. These measures have
brought about a remarkable disappearance of mosquitos
and flies of all kinds, whilst anopheline larva* have
been exterminated in an area which surrounds the
town at a distance of some 1,800 metres from the
outlying houses. Since 1905 no case of malaria has
been reported in Ismailia.

On February 7, 1904, sixteen months after my
colleague Ross's visit, I was invited by the courteous
Chairman of the Company, Prince d'Arenberg, to
visit the town and see for myself the steps they had
taken to form what the Directorate hoped very
shortly would become a sanatorium and a healthy
inland sea-bathing resort for the Cairenes, out of what
was, until two years ago, a mosquito-plagued town
and a nest of malaria.

In the old days, previous to the antimalarial
measures, the carefully planted town and well-placed

ANTIMOSQUITO BRIGADES 67

hospital did not, however, prevent malaria, and mos-
quitos infested both the houses and the hospital.
Indeed, it was found that mosquitos were more
abundant in the European quarter than in the
irregular, dirtier native quarters. This is now readily
explained by the fact that there were far less breeding
places in the Arab quarter, where there were none
of the garden drains, water-closets, and fountains
abundant in the European town. Button, in his
" Report of the Malaria Expedition to the Gambia
in 1902," has called attention to a similar condition in
Bathurst.

Following Ross's directions, in 1901 two anti-
mosquito brigades were formed, one, the " Drains
Brigade," composed of five natives and one European
in charge, whose duty it was to keep all drains clear.
The other, the " Petroleum Brigade," consisting of
four natives in charge of a European, was told off to
add petroleum to all collections of water which could
not be removed at once. In addition to forming
these brigades, the Company undertook extensive
drain-clearing operations and the filling in of a con-
siderable area of waste marshland with sand.

THE METHODS OF MOSQUITO EXTERMINATION — WORK OF THE
" BRIGADES "

In company with Prince d'Arenberg, Sir John
Hardy, Mr. William Johnston of Liverpool, M. Duelle-
nec, the Consulting Engineer, M. Doyen the Estate
Manager, and under the special guidance of M. Tillier,
chief of the Transport Service and a keen zoologist,

68 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

I made a tour of inspection. We first visited some
agricultural land plentifully supplied with the irrigating
channels characteristic of Egypt. The water in these
is supplied from the sweet-water canal, and, as it
stands at a higher level, there is considerable fall,
circulation can be maintained, and a good head of
water can be readily obtained for flushing purposes.
Once a week the " Drains Brigade " pays it a visit,
cleanses the drains by sending down an extra flood
of water, and removes any weeds or accumulations of
sand. Constant supervision is necessary to keep the
irrigating and drainage channels free from obstruction,
as the banks are of sand, and weeds grow rapidly.
The least stagnation affords a nidus for the mosquito.
The large sweet-water canal does not appear to
harbour larva?, the fish to a great extent preventing
this. I particularly inquired whether larvae were ever
observed in the sea-water canal. I did so because
I was surprised to find fresh-water grasses and other
fresh-water plants growing along the margin of the
canal. The riparian growth of the vegetation is
naturally encouraged by the Canal Company, as it
is a valuable aid in binding together the otherwise
shifting sand of the sides of the canal. No larvae
have hitherto been observed amongst the plant growth.
We next drove to an opposite part of the town, where
the authorities had nearly completed the filling in with
sand of a considerable strip of low-lying marshy land.
This will in future ensure the prevention of the
formation of any pockets of stagnant water.

THE PETROLEUM BRIGADE 69

MOSQUITO PREVENTION AT ISMAILIA

We next proceeded to the examination of the
system of mosquito-prevention adopted in the town
itself, M. Tillier taking his own house and garden as a
typical example of the others in the European quarter.
Once a week the " Petroleum Brigade " visits the
houses and pours a mixture consisting of equal parts of
crude and ordinary petroleum into all collections of
drains and waste water which do not soak away during
the course of the day. Petroleum is poured into the
water-closets and into the puits pcrdus or sunken pits,
which receive the bathroom and kitchen waste. The
garden fountain is emptied, and if any water still
remains in it which cannot be removed, petroleum
is added ; it is refilled after twelve hours. Similarly,
the stable drains, washing troughs and all receptacles
containing waste water are flushed or emptied or
petroleum added. The essence of the procedure being
to either empty and cleanse and then renew all water
receptacles, or to add petroleum when this cannot
be done. But nothing must be overlooked, as it has
now been abundantly proved that the mosquito breeds
in most unexpected places, and intelligent direction
is therefore absolutely necessary ; for this reason, the
company have found that it is essential that the brigades
have at their head Europeans. The work must not be
left to the native alone. Naturally here more especi-
ally the co-operation of the householder is all-
important ; time after time it has been pointed out
in the malarial reports of the Liverpool Committee

70 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

that the cause of mosquitos in the residential house
or in the hospital is due to the drinking-water cistern
or to some equally simple and preventable source.
This, too, may be the case in places where little effort
is made by the European, because of the apparent
hopelessness of being able to drain some large marsh
somewhere in his locality. The power of prevention
which lies in the hands of every householder in a
mosquito-plagued town cannot be emphasised suffi-
ciently, and it is very gratifying to learn that about
this time at Cairo, Lord Cromer and the residents
around him commenced amongst themselves a local
antimosquito campaign. The willingness of the private
individual to assist in the work is a guarantee to the
public authority — whether a company or a government
— of the earnestness of the movement, and encourages
them to undertake their share of the larger work of
directing and co-ordinating operations, draining, etc.
During our numerous drives through the town we
encountered only one example of Culex, the species of
which we could not identify, and during the night
I slept without mosquito curtains. In M. Tillier's
words, there are no more mosquitos in Ismailia than are
to be met with in Paris. On the other hand, at Port
Said, and at the other stations in the vicinity, there
is an abundance of mosquito life, and every traveller to
Egypt in the winter soon realises this fact.

" Since 1905 we have succeeded," writes Prince
d'Arenberg, in a letter written to Major Ross from
Ismailia and dated May 1909, "at small expense in

RESULTS 71

abolishing malaria, and this too without having recourse
to complicated measures, but by adopting measures
so simple that they can be applied in any country. It
is further worthy of note that the improved drainage
has increased the yield of the cultivated areas.

Out of 280 children 15 years old examined for en-
larged spleens in 1909, only one showed enlargement !
Antimalarial operations commenced in 1901.
In 1903 there were 214 cases of malaria.
,, 1904 ,, ,, 9U ,, ,, ,,
1905

there were no new cases of malaria and

1906
1907
1908

but 4 recurrent old cases."

These facts also show the great saving in money
which the Canal Company must have experienced
because of less sickness, loss of time, and expenditure
on hospitals and additional labour.

ANTIMOSQUITO WORK AT PORT SAID

In May 1906 Dr. E. H. Ross, brother of
Major Ross,1 commenced antimosquito and antimalarial
measures ; these were rendered necessary by the mos-
quito nuisance which existed in Port Said, and to
which I have already referred, also by the occurrence
of endemic malaria, and above all owing to the
example of Ismailia. It was argued that what could be
done in the latter place could also be done at Port
Said. The first mosquito brigade consisted of five
men who made a house-to-house inspection to ferret

1 "The Prevention of Fever on the Suez Canal/' by E. H. Ross
Cairo, 1909,

72 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

out all breeding places, that is to say, all collections
of stagnant water, and when these were located, to
remove them where possible, and if not possible then
to oil them. This work was first of all tried over
one section of the town in order to demonstrate what
could be done ; for as one would expect, there were
numerous people who argued, what was the use of
doing anything ? The results of the test proved so
satisfactory that the other districts of the town asked
that the antimosquito measures should be extended
to them. The total result has been to effect a
substantial reduction in the number of mosquitos ;
and as the breeding places of the anopheles were also
raided, there is every reason to believe that malaria
will also be reduced. Naturally it is yet too soon to
measure the reduction.

THE ANTIMALARIAL CAMPAIGN IN KHARTOUM

In 1904 Dr. Balfour commenced antimosquito opera-
tions in Khartoum and vicinity. He organised anti-
mosquito brigades to examine all breeding places, water
receptacles, and pools, and then organised measures
for drainage, oiling, etc. As the result of five years'
work Khartoum is declared almost mosquito-free, and
primary cases of malaria are exceedingly rare.

ANTIMALARIAL CAMPAIGNS IN AFRICA
THE ANTIMALARIAL CAMPAIGNS IN ALGERIA

The Doctors Sergent describe in very interesting
detail the methods and results of their plan of campaign
against malaria in Algeria.

ALGERIA 73

DISTRIBUTION OF AN~OPHELINES

They in the first place show, as Christophers,
Stephens, and Koch have shown in West Africa, in
the case of the black races, that in Algeria the
human carriers of the disease, or the reservoirs, are
the Arabs, who harbour the malarial parasites in their
blood without showing any pronounced symptoms of
malarial fever. From this fact they reason that the
danger of infection is in direct relationship to the
number of indigenous inhabitants.

With regard to the distribution of the insect
carriers — the anophelines — they rightly insist that the
larva* are not found in the lakes or in the rivers ;
that they are, in fact, strictly confined to the edges.
They also lay stress upon the fact that careful
cultivation of the land diminishes the breeding places,
giving as examples the amelioration of malaria which
has followed vine plantation, due entirely to the fact
that for the proper cultivation of the vine it is
essential that there be no stagnant water. In a sub-
sequent chapter it will be observed that the same im-
provement has occurred in connection with the tobacco
plantations in Sumatra, where the most careful irriga-
tion is necessary to produce the best leaf. In this way
the carefully irrigated plantations contrast markedly
with the improperly drained areas around, and are free
from malaria. This clearance of malaria following on
careful irrigation is also seen to a considerable extent
in tea, cocoa and coffee plantations ; but the reverse
has also happened where the irrigation has been less

74 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

perfect and the water allowed to pool, as has occurred
in connection with some banana plantations. In these
cases the careless planting of the banana trees has
brought about, it is stated, an increase of malaria.

With regard to preventive measures, the authors
have cited the prejudice which has to be overcome
in the first instance. Much of this, they point out,
comes of the fact that the older residents cannot
understand that it is one special group of mosquitos —
the anophelines — which are the carriers of the disease.
They are bitten by harmless mosquitos and wonder
why they do not get malaria, and reason in conse-
quence that they are either proof against malaria or
that mosquitos are not the transmitters of the disease.
Or they travel and stay in intensely malarial places,
but owing to the fact that they are to a considerable
degree immune to the irritating action of the bites
of mosquitos generally, they don't feel the bites of
the anophelines which are present ; they become in-
fected with malaria, but affirm that they were not
bitten.

Segregation. — The authors also discuss the marked
difficulties of segregation, the colonists being obliged to
live close to their workmen. On the other hand, they
point out how rational and justifiable it is to protect
the susceptible new-comer from the danger of close
dwelling with those who, although harbouring the
parasites, are not inconvenienced by the disease, but
nevertheless are capable of communicating the disease,
a disease which will have a disastrous effect upon the
new-comer.

RESULTS OF CAMPAIGN, ALGERIA 75

Quinisation. — Systematic treatment with quinine of
infants and adults has had a very beneficial effect.

MEASURES DIRECTED AGAINST THE MOSQUITO CARRIERS

1. Antilarval measures. — These consist in improved
drainage : deepening shallow drains and making the
margins sharp-cut, and removing weeds ; also oiling.

2. Measures against the adult mosquito carriers. —
The systematic use of mosquito nets, and the screening
of houses.

To sum up. The Algerian antimalarial campaigns
were commenced in 1902, and consisted in :

1. Spreading the knowledge of the way in which
malaria was propagated.

2. Giving a practical demonstration upon a suitable
scale of the markedly beneficial effects of antimosquito
measures in reducing malarial fever, for this purpose
choosing a place in a particularly malarial district and
subjecting it to the well-recognised antimosquito treat-
ment, viz. oiling and drainage and enforcing nets and
screening, and treating the dwellers in the area chosen
systematically with quinine. The result of these
measures has been the almost total disappearance of
anophelines in the treated area as compared with the
untreated district around, and the very marked diminu-
tion of cases of malaria amongst the Europeans
employed in the selected area as compared with those
living in the non-treated areas. Thus, in one experi-
ment, no case of malaria was reported amongst the
seventy-one European inhabitants, whilst twenty-seven
Europeans outside the area contracted the disease.

76 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

Again, in 1906, of sixty- two Europeans residing
in seven stations where antimosquito measures were
enforced, four cases of malaria were reported as against
thirty-five cases in 1904, when no precautions were
taken.

THE ANTIMALARIAL CAMPAIGNS IN WEST AFRICA

The first campaign was started in Sierra Leone ;
indeed, it was the first expedition1 sent out by the
Liverpool School of Tropical Medicine to put to a
practical test, as suggested by Ross himself, the dis-
coveries which he had made during the years 1895-
1898, as we have already seen in the preceding chapters.
This was the first occasion on which a free hand was
given to Ross to test the results of doing away with
the breeding places of the anophelines. Sierra Leone
was selected because of its unsavoury reputation for
being the " white man's grave," and also for the fact
that it presented great natural difficulties in carrying
out antimosquito war ; these difficulties were the very
heavy rainfall and the nature of the soil. The expedi-
tion, which consisted of Major Ross and Dr. Logan
Taylor, arrived in Freetown in July 1901, and Major
Ross directed operations against all kinds of mosquitos.
Thirty-two men were engaged under the direction of
headmen, and they were furnished with carts and
utensils. The force was divided into two gangs : one a
Culex gang, composed of six men, to collect all broken
bottles, tins, and odd receptacles of all kinds from the

1 Previous expeditions had been sent out to confirm the accuracy of
Major Ross's observations (see Appendix).

[Logan-Taylor.
FlG. 16. ROAD POOLS, VILLAGE, WEST AFRICA. BREEDING PLACES OF ANOPHELINES,

p. 76]

FlG. 17. ANOPHELINE BREEDING POOLS, SIERRA LEONE.

[Logan-Taylor.

ANTIMALARIAL WORK, WEST AFRICA 77

compounds ; secondly, an anopheles gang, to drain
pools and depressions in back yards and streets. The
members of the gangs instructed the householders upon
the danger of harbouring larvae. The drains were
kept brushed out. The result of the cleaning up and
drainage was an observable diminution in the number
of mosquitos.

Dr. Logan Taylor, as the result of a second and
independent visit, drew up a report upon the sanitary
condition of Cape Coast Town.

The late Dr. Dutton in 1902 visited the Gambia,
and reported upon its antimosquito measures.

Lieut.-Col. Giles was also sent out by the Liver-
pool School, and reported upon antimalarial measures
in Sekondi, the Goldfields, and Kumassi, and there
have been many more expeditions of a similar nature
(see Appendix).

In 1904 I also visited, in conjunction with Drs.
Evans and Clarke,1 Freetown, Bathurst, and Conakry
in the French Guinea, and reported upon the sanitation
and antimalarial measures then in force. We found
that the inhabitants had commenced to put into practice
the teachings of the previous expeditions, and that they
realised it was possible to protect themselves from the
anophelines by adopting the precautions taught by
Ross. We found that mosquito nets were more gener-
ally used, the water cisterns screened, and the drains
better looked after. In other words, there was a
distinct improvement over the condition reported by

" Report of the Sanitation and Antimalarial Measures in Practice in
Bathurst, Conakry, and Freetown," February 1905.

78 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

previous expeditions. This improving state of affairs
has been kept up all along the West Coast. I have
just received (June 1909) the following communication
from Mr. H. Cottrell, the Chairman of the African
Association, upon the present state of malaria amongst
the employees of the Association.

In 1904, out of 96 employees 2 died and 5 were
invalided. In 1905, out of 91 employees 1 died and
3 were invalided. In 1906, out of 94 employees 1 died
and 5 were invalided. In 1907, out of 98 employees
1 died and 9 were invalided. In 1908, out of 98 there
were no deaths and 4 were invalided. The employees
carry on their work in 35 different places over the
Gold Coast and Southern Nigeria. Mr. Cottrell adds :

" You will no doubt find in these figures satisfaction
with the result of the efforts of the School of Tropical
Medicine in improving the conditions of life in West
Africa, particularly so when I tell you that out of the
5 deaths recorded over the 5 years given, 3 of such
deaths were not due to the climate."

The Secretary of the Liverpool School of Tropical
Medicine has this month (July) received the following
letter from the Secretary of the African Association :

" I beg to hand you herewith cheque for £50, being
a supplementary Grant made to your School by the
Shareholders of this Company at their meeting on the
1st inst., in recognition of the fact that 1908 was the
first year in the history of the Company in which
there had not been a death in the whole of our Coast
Staff."

FlG. 18. BOADSIDE DITCH CONTAINING STAGNANT WATER, BREEDING ANOPHELINES.

WEST AFRICA.

p. 78]

FlG. 19. ROAD POOLS, WEST AFRICA.

PROGRESS IN WEST AFRICA 79

In reply to special inquiries made by Sir Alfred
Jones, Chairman of the Liverpool School, the manager
of important gold mines on the Gold Coast states that,
during the five years which he has spent in that Colony,
there has been a marked improvement in the health
of European residents. This he attributes largely to
the work of the Liverpool School in stamping out
mosquitos and encouraging better sanitation, but it is
also due in great measure to the sending out of a better
and more temperate class of men.

Surely the result of the West African campaigns
has been a net gain of life and money.

Further eloquent testimony as to the practical
result of this African campaign has been given by
Dr. Johnston, who has thirty years' experience in
Jamaica, who purposely visited our school to bear
testimony to the value of our teaching in the prevention
of malaria. He himself had first thought that the
prevention of malaria by the destruction of the
mosquito, as taught by our school, would be a hopeless
task ; but a very large and practical experience, chiefly
amongst the natives, had overwhelmingly convinced
him of the practicability and efficacy of the measures
put forward by Ross and his school. In his own
experience, it has reduced the mortality amongst the
native soldiers of the West Indian Regiments serving
on the West Coast of Africa some 75 per cent. The
preventive measures were not only of use to white
trading officials and officers, but also of immense
advantage to the natives themselves.

80 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

CAMPAIGN ON THE ISTHMIAN CANAL ZONE

•

PANAMA

Panama, like Havana, has now become an object-
lesson in prophylaxis to the rest of the world. Until
recently the mosquito absolutely foiled the attempts
of man to construct the canal. The French tried it,
with a loss which has been estimated at 50,000 men.
Anopheles and Stegomyia wrere more than a match
for man. But thanks to researches in tropical medicine,
their breeding grounds were disclosed and their slaughter
commenced, and regular monthly reports tell us with
what marvellous success. Both Sir Frederick Treves
and Sir Harry Johnston have already made it the text
of very inspiring addresses.

In 1904 the United States took over the administra-
tion of the Canal Zone and appointed a commission, and
they set to wrork in grim earnest. A chief sanitary
officer was appointed, with a splendid staff of 2,000 men
under him.

The following figures show the great decrease in the
malarial death rate since 1906 :

Year Deaths

1906 . 821

1907 .... 424

1908 .... 282

or 1'34 per thousand

That is, the death rate from malaria in the Canal Zone,
in spite of the enormous increase in the labourers, is
only one-third of the death rate three years ago.

ORGANISATION AND ADMINISTRATION 81

This great antimalarial work has been accomplished
chiefly by drainage and trimming the margins of all
lakes and swamps of all weeds amongst which the larvae
shelter. Superficial ditches are concreted, deep ones
are kept free of weeds. No animals are allowed near
the margins of the ditches or marshes, so as to avoid
making the small foot puddles which cattle invariably
make. Where possible sulphate of copper, crude
petroleum, and other culicides are also employed.
Bush-cutting is regarded as second only in importance
to drainage, and with this I thoroughly agree. To
enforce and carry out these antimalarial measures in
the forty-five miles' strip along the line of the canal,
the strip has been divided into seven districts. Each
district is in charge of an inspector, whilst a chief
inspector is over all. The chief has on his staff a man
acquainted with the life-history of the mosquito, another
who is an expert in tilling and drainage, also a general
inspector ; these men keep in touch with the district
inspectors, and act as teachers. Each district inspector
has a gang of twenty-five to thirty men, who trench
and cut bush, also carpenters for looking after screening ;
lastly two quinine dispensers. The medical officer of
each district reports monthly all cases of malaria to
the central office, and if the number of cases go up
in a district there is an immediate inquiry to know
why.

THE ANTIMALARIAL CAMPAIGN IN COLON

Colon is a town of 15,000 inhabitants, built on
an island just above sea-level, and many of the houses,

6

82 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

as in similar low-lying countries, viz. Honduras and
British Guiana, are built upon piles, and in the wet
season swamps abound, and of course innumerable
mosquitos. The bush was first cut away for half a
mile to the back of the town ; the cleared swampy area
was then canalised and small superficial drains led into
the larger channels ; with the fall of the tide the fresh
water runs out, and the incoming tide brings in sea
water. I recommended precisely the same system
in British Honduras. All barrels and cisterns were
rigorously inspected. Result— Colon is to-day almost
free from every kind of mosquito. In addition, how-
ever, the houses of employees are screened with wire
gauze ; mosquito nets are used, although the necessity
for these precautions has practically ceased ; quinine is
also taken.

ANTIMOSQUITO CAMPAIGN IN RIO DE JANEIRO

The City of Rio de Janeiro furnishes us with
regular monthly returns which disclose a marvellous
improvement in mosquito-carried diseases, such as
yellow fever and malaria. The city has undergone
a complete transformation in this respect.

Similarly favourable reports come from HAVANA
and from many other towns in South America.

In BRITISH HONDURAS the antimosquito war, which
I commenced in 1905, more particularly directed
against the stegomyia, has had its effect in reducing
the numbers of mosquitos of all kinds and directing
attention to protecting against the anophelines. In the

ANTIMALARIAL CAMPAIGNS, WEST INDIES 83

survey which I then made of Belize I pointed out the
breeding grounds of anophelines, and how by improved
street and road drainage, and by levelling up the sub-
merged compounds, by canalisation, and by removal of
all odd receptacles, and the rigid screening of all water
cisterns, it would be possible to banish yellow fever and
greatly diminish or banish malaria. The result of put-
ting into practice these measures has been a marked
improvement in mosquito-borne diseases.

ANTIMALARIAL CAMPAIGNS IN THE WEST INDIES

We have already, in the chapter upon General
Sanitation, seen the progress which the West Indies
have made in reducing mosquito-borne diseases, brought
about, as it was there shown, by pipe-borne water
supplies, drainage, and building extension. In this
place I wish to draw attention, however, to the specific
means which have been set on foot to substantially
reduce malaria throughout the group. For it is a fact
that malaria is still the cause of a very large proportion
of sickness in the islands. In those islands in which
there is a well-equipped official medical organisation
much has been done. The medical officers are as alive
as any one to the importance of destroying the breeding
grounds of the anophelines, and it has been in this
connection that the entomologists have rendered great
service by indicating the breeding places. The use
of the mosquito net is very general ; a few houses are
wire-netted, and in BRITISH GUIANA quinine is on
sale at the post offices. The Surgeon- General of that

84 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

Colony writes me as follows concerning the sale of
quinine :

" As one result of the Mortality Commission, ar-
rangements have been made for the sale of quinine
at the district post offices, so as to place it within reach
of the poorer classes. The drug is retailed at the rate
of two cents for thirty grains, and meets with a ready
sale. It is only intended for the benefit of the people ;
and in order to prevent, as far as possible, its purchase
and subsequent resale at a profit, the quantity which
can be sold to any one person at a time has been
limited to 180 grains. Later on, as a further pre-
caution, the supplies for this purpose were ordered
in tablets coloured pink and stamped with the
letters E.G."1

Regulations have also been passed making it com-
pulsory on district boards to properly drain the roads
in their respective districts.

Regulations have been passed making it compulsory
to screen all water-vats. Lectures are given and health
primers used in the schools ; circulars and diagrams are
distributed to householders, police stations and public
places, drawing attention to the prevention of malaria
by the destruction of mosquitos. Similar measures
have been taken in Trinidad.

ST. LUCIA

As further evidence of the thoroughness of the
movement in the West Indies, I reproduce here a
circular letter which the Administrator of St. Lucia,

1 For Regulations see Appendix.

ST. LUCIA AND ANTIGUA 85

then Mr. Cork, issued in 1905 to the medical officers
throughout the island :

" Being desirous of obtaining reliable information as
to the prevalence of mosquito-borne diseases in this
Colony, I shall feel very much obliged if you will be
so good as to favour me with a return showing the
number and description of such diseases which may
come under your notice, either in your public capacity
or in your private practice during the past twelve
months. If convenient to you to add particulars of
any other preventable disease which may be prevalent
I shall be much obliged."

This letter had a very salutary effect. It showed
that the administration was fully alive to the im-
portance of antimosquito measures ; it also showed,
by the replies received, to what extent the medical
officers had kept in touch with modern developments in
epidemiology and mosquito-borne diseases ; and thirdly
it demonstrated where weak spots existed in sanitary
administration in St. Lucia, in respect of these im-
portant diseases, and where in consequence the medical
machinery required augmentation.

ANTIGUA

In the year 1904 active antimosquito measures
were adopted in the Colony of Antigua — on a small
scale, it is true, but nevertheless something. The first
brigade was formed under the chairmanship of Sir
Courtney Knowles, who was subsequently succeeded
by Sir B. Sweet Escott. The first executive officer
was Oliver Nugent, magistrate of Antigua. The

86 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

brigade work was chiefly directed against the anopheles ;
the oiling of all pools was undertaken, and the people
were warned of the danger of keeping stagnant water,
and crab holes were filled up. To this enterprise the
public subscribed at the rate of one shilling each, and
the Government gave a small subsidy. The work of
the brigade has now been taken over by the City
Board of the town of St. John's. Small as was this
movement, it was a step in the right direction and
ought to be followed by other colonies.

ANTIMALARIAL WORK IN JAMAICA

In a recent (1908-9) malarial survey of Jamaica,1
undertaken by Dr. Prout, C.M.G., on behalf of the
Liverpool School of Tropical Medicine, it is stated
that although something has been accomplished in the
shape of antimosquito measures, yet the work done
is not equal to that accomplished in other places.
Prout calculates the death rate from malaria in the
period of ten years 1898-1907 to have been 4*4
per cent. He states, moreover, that the deaths due
to malaria in 1907 were 4,094, and the total deaths
from that disease in ten years 34,695. According to
this authority one-fifth of the total death rate in the
island is due to malaria. This of course should not
be, considering that malaria can be so comparatively
easily grappled with. In analysing the hospital re-
turns, Prout states that one-half of the cases admitted
into hospital are malarial, and he estimates the actual

1 Twenty-first Expedition of the Liverpool School of Tropical Medicine,
Malaria, Jamaica, 1908-9.

JAMAICA AND NASSAU 87

cost of these cases to the Colony at £6,300. Amongst
the coolies he states that 50 per cent, of the illness
is also due to malaria, which he estimates is equivalent
to a loss of 16 '9 days out of the 100 working days
of each Coolie labourer.

To remedy this state of affairs Dr. Prout proposes
to make it a punishable offence to harbour larvae on
premises (this is now the case, as we shall see, in
many of the West Indian islands) ; that all wells,
tanks, and barrels should be screened ; that all gutters
in towns should be cemented, as is the case in
Trinidad ; that all margins of rivers be kept free of
grass and weeds ; that drainage operations should
be undertaken bit by bit but systematically ; that
mosquito nets should be invariably employed and
houses screened where desirable. He also recommends
the daily use of quinine by those exposed to infection,
and the application of kerosene oil to all breeding
places which cannot be drained.

The report also emphasises the importance to the
Colony of the services of an entomologist. In Jamaica,
as in some of the other colonies where there is no
official entomologist, a doctor or clergyman or other
enthusiast has volunteered his services, to the great
good, as I can testify, of the Colony.

ANTIMOSQU1TO WORK, NASSAU, BAHAMAS

Measures were started in 1905 by, the Board of
Health. Regulations dealing with stagnant water were
passed (see Appendix). Quinine was distributed and
screening enforced.

88 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

THE ANTIMALARIAL MEASURES IX MAURITIUS

In 1907 Major Ross was sent, at the instance of
the Colonial Office, to Mauritius to report upon
measures for the prevention of malaria. The report
is a very complete one, dealing very fully with the
history of malaria, and then with the distribution of
malaria in Mauritius, and finally with his recommenda-
tions for the prevention of the spread of the disease.
These include the formation of mosquito brigades, the
appointment of a malarial authority, drainage operations,
screening, quinisation ; also a measure to make it a
punishable offence to harbour mosquito and other
larvae OH premises. For the guidance of other colonies
I reproduce it in the Appendix with the other anti-
larval measures.

SANITARY AND ANTIMOSQUITO MEASURES IN THE
PHILIPPINES

The loss of Spain's tropical possessions is partly
attributable to her failure to cope successfully with
disease. Ignorance of the laws of health destroyed
the health and lives of 100,000 Spanish soldiers in
Cuba in three years. Complete change took place
under American administration (1903), and the death
rate amongst the troops in Cuba and Porto Rico was
reduced to 672 per thousand, or practically the same
as at home.

In July 1901 military government in the Philippines
was formally instituted. The officers responsible for
the health administration were in the first instance

THE PHILIPPINES AND BRAZIL 89

men recruited from the Army Medical Service, and
later, in 1905, men of the United States Marine
Hospital Service were employed ; all, therefore, were
especially conversant with this class of work.

The result of general sanitary prophylaxis is seen
by comparing the death rate amongst the troops in
the year 1906 with that obtaining in 1899.

In 1899 the death rate from malaria was 1'23
and the admissions . . . 705*49

In 1906 the death rate was . . . 0'55
and the admissions .... 304 '20
With regard to the health of the civil population
of the Philippines, the death rate in Manilla has
been reduced from 40 '99 per mille to 30 or below
in 1908 ; figures which compare well with the rest
of the world.

(From a paper by Dr. Washburn upon " Health Conditions in the
Philippines," September 1908, Philippine Journal of Science.)

THE ANTIMALARIAL CAMPAIGN IN RIO AND OTHER
PARTS OF BRAZIL, 1903

Just as a most vigorous policy of extermination
has been adopted against yellow fever, and with
results that the Republic is justly proud of, so,
stimulated by this success, a vigorous war has been
declared against the anophelines. Rio has always had
a bad reputation as regards malaria, but not so bad
as usually depicted.

In 1900 there were 1,019 deaths
„ 1901 „ „ 932 „
„ 1902 1,217 „

90 SUMMARY OF THE ANTIMALARIAL CAMPAIGNS

In 1903 war on the anophelines was declared, and
there was an immediate fall to 772 deaths.

In 1904 there were 433 deaths

„ 1905 „ „ 295 „

„ 1906 „ „ 266 „

„ 1907 „ „ 239 „

Encouraging enough results for a comparatively
small outlay — and from all parts of the civilised world
where antimalarial measures are adopted, similar results
are recorded.

ANTIMALARIAL CAMPAIGNS IN THE EAST INDIES

ANTIMALARIAL CAMPAIGN IN KLANG AND PORT
SWETTENHAM

Taking Travers and Watson's figures for Port
Swettenham and Klang in the Federated Malay
States, we find that at Port Swettenham the area to
be dealt with was about 110 acres, low-lying and
swampy. In 1901 draining and filling-in operations
were undertaken.

In Klang, the area affected covered 332 acres,
swampy and bush : drainage and clearing effected.

Results in Klang and Port Swettenham : Deaths
due to malaria in 1901, 368 ; in 1905, 45. In sur-
rounding districts where no measures were taken the
corresponding figures are 266 deaths in 1901 and
351 in 1905.

In 1901 Government employees at both places
numbered 176, and the number of days' leave granted
for malarial sickness totalled 1,026. In 1904 the em-
ployees numbered 281, and the number of days' leave

HONG KONG AND THE UNITED STATES 91

was 71, and in 1905, 30. Surely a considerable saving in
money, not to mention lives and broken constitutions.

ANTIMALARIAL CAMPAIGN IN HONG KONG

What do we learn from Hong Kong ? — Population,
377,850; white, 10,835 — heavy rainfall, numerous
breeding places of anophelines. Operations commenced
by Dr. Thomson in 1901 ; works carried out, efficient
training and drainage, netting, oiling, and quinine.

Results : In 1901 admissions in the two principal
hospitals for malaria were 1,294, and deaths 132. In
1905 admissions 419, deaths 54. Amongst the police,
in 1901, 44 per cent.; in J905, 12J per cent. Total
deaths in Colony in 1901, 574 ; in 1905, 285.

ANTIMALARIAL MEASURES IN THE UNITED STATES

Dr. A. Woldert, in a small pamphlet entitled
" Malarial Fever and its Expense to the People of
Texas," has calculated from an examination of various
official records that the loss in money caused by
malarial sickness upon three railway systems amounted
to 133,810 dollars a year ; and calculating upon the
same basis, viz. that one person in twelve is affected
with malaria in Texas, he reckons the total loss to
the State as 5,333,320 dollars a year. He gives these
figures to support the necessity for a vigorous anti-
malarial campaign.

Dr. A. H. Doty of New York has rendered excel-
lent service by directing attention to the extermination
of the mosquito on the Atlantic side of America,
where already much has been done by the American
Mosquito Extermination Society of New York.

CHAPTER IX

NOTES OX THE RELATIONSHIP OF PLANTATIONS AND
BOTANIC GARDENS TO THE MOSQUITO QUESTION

MANY interesting facts in connection with malaria have
been brought to light by observations conducted by
medical officers charged with the supervision of the
health of labourers employed upon large estates.

Tobacco Plantations. — Dr. Kuenen, on a visit to
Liverpool in 1909, told us how in his district malaria
had been reduced by drainage. Dr. Kuenen, who is
Director of Pathology at Medan, Sumatra, has the
medical care of the workers upon a large tobacco
estate. The whole of the coast of Sumatra is notorious
for its bad forms of malaria. When, forty years ago,
the first tobacco planters went to Sumatra, they found
a big marshy jungle and many swamps, and they
suffered much from malaria. As the plantations grew,
drainage operations were very carefully undertaken, for
it was found that the finest kinds of tobacco could only
be grown as the result of very careful drainage, and the
suitable drying of the soil ; in consequence, the swamps
had disappeared, and they were now as free from
malaria on the plantations as Holland itself. Malaria

92

PLANTATIONS AND MALARIA 93

cases were only encountered as the coast line was
approached ; it had disappeared from the plantations
now spreading over the interior of the island. They
were thus able to compare side by side the effect
of drainage in stopping malaria, and to see per-
sisting malaria as bad as in the old days in those
districts where there was no tobacco planting, and,
in consequence, where no drainage had been under-
taken.

Cocoa Plantations. — In Grenada it has been found
by the medical men that a material decrease in the
number of cases of malaria has resulted from the re-
placement of sugar cane by cocoa plantations. It is
necessary for the efficient cultivation of cocoa that the
soil should be thoroughly drained, and for this purpose
the plantations are intersected by very numerous
drainage channels leading from the high grounds to
a main channel at the lowest part of the estate. By
these means, water never puddles or remains stagnant.
Careful cultivation, including drainage undertaken as
we have seen in the case of Ismailia, leads both to the
increased production of icrops and to a diminution of
the cases of malaria.

In the case of the sugar-cane fields in British
Guiana, intersected as they are by numerous trenches
and canals, the anophelines are kept under by the
presence of fish, and by flushing.

In the rice fields, although for the most part sub-
merged, small fish appear to be the chief means of
keeping in check the production of the anophelines.

Dr. Sergent states that grape-vine planting in

94 CULTIVATION AND THE MOSQUITO QUESTION

Algeria, necessitating careful drainage, has diminished
malaria.

Botanic gardens are very frequently the preserves of
the mosquito, for on them ornamental ponds and fountains
and innumerable tubs and water-barrels are the rule,
and unless these are stocked with small fish they are a
fertile source of mosquitos. As previously pointed out,
trees and plants may aid to an enormous degree in the
production of mosquitos. Tree mosquitos have been
conveniently grouped by Dr. Urich in Trinidad into
the " rot hole," " bamboo," and " wild pine " groups.
Old trees are often honeycombed with decay holes, and
in these water collects and mosquitos lay their eggs.
When bamboo cane is cut down it is very common
for the workmen to leave an internode, in which one
or more pints of water can collect and act precisely
as a miniature pond. I have already referred to the
" wild pine " (Bromeliaceoe} which infest trees in enor-
mous numbers, and in the aggregate hold up a great
quantity of water. There are in addition numerous
other small water-holding plants, such as the Aroideas,
which in towns, if allowed to grow up in neglected
places, give rise to a mosquito nuisance in a very short
time. Therefore more attention should be given to
the question of the care of bush and plants in tropical
towns than is usually done at the present time. Bush
should be rigorously cut down around towns, and on
no account should it be allowed to increase in yards
and gardens as is almost invariably the case. Not only
does bush hold up water, but it also gives excellent
cover to mosquitos and enables them to progress from

BUSH CLEARING 95

point to point. Bush also is one of the chief agents
in keeping out fresh air in towns, where fresh air is
above all things necessary ; it also forms cover for
plague rats and their fleas. By some it is argued that
bush helps evaporation. The contrary is the case ; the
admission of more air and light would accomplish far
more. Plant cultivation in towns also leads to various
devices for keeping them moist or protected from
ants, and these devices in their turn lead to the breed-
ing of mosquitos. Thus, flower-pot saucers are a very
common breeding place of the stegomyia, and so are
the antiformicas with which rare plants are protected
from the inroads of the umbrella ants. I have found
larvse in them in very numerous instances. And whilst
on the subject I would like to draw attention to the
very numerous occasions upon which I have found
mosquito larvae, usually those of stegomyia, in glass
vases used either for holding cut flowers or, more
frequently, for propagating cuttings of the Croton plant ;
the reason is, of course, that either the water is not
changed often enough, or when the water is changed,
the larva? and eggs cling to the roots when the old
water is thrown away, and when the fresh water is
added the larva? are as vigorous as ever. Upon one
occasion I found a swarm of stegomyia larva? breeding
in a pool that had formed between the buttresses
of an old silk-cotton tree. Another not very obvious
site for the fostering of mosquito larvse are the small
pools which are found amongst the rocks of a rock-
bound coast. These, in many instances, come close
up to human habitations, as in St. Vincent, and in

96 CULTIVATION AND THE MOSQUITO QUESTION

such cases the domestic mosquito, like the stegomyia,
may breed in them. These pockets should be either
filled in with concrete or so chiselled that water can-
not remain in them. In many of the more low-lying
swampy coasts crab-holes occur in enormous numbers
in the sandy soil, and in them are bred vast numbers
of mosquitos. In fact they constitute the chief
nuisance in those houses which are situated near
the sea.

CHAPTER X

YELLOW FEVER

DR. BEAUPERTHUY OX TRADITION IN MEDICINE, AND HIS
VIEW ON THE MODE OF TRANSMISSION OF YELLOW
FEVER — HARRISON AND MOXLY ON THE NATURE
OF THE VIRUS OF YELLOW FEVER

IN introducing the subject of malaria I have already
alluded to the opinions of certain men of great
distinction in the medical world who, long before the
scientific proof of the relationship of the mosquito to
disease, had come to the conclusion that yellow fever
was carried by a mosquito. There was, for instance,
Surgeon- General Blair, the great authority on yellow
fever, who stated in connection with that disease that
"its shifting lines of infection and gyratory movements
suggest to the imagination the attributes of insect life ";
and then there was the other great naturalist-physician,
Dr. Louis Daniel Beauperthuy, who in no uncertain
manner pinned his belief on the power of insects to
transmit diseases, and even went so far as to accuse
the " Zancudo bobo " (the stegomyia), the domestic
mosquito, as being the carrier of yellow fever. He
was right, but men did not know it ; and as his writings

J)7 7

98 BEAUPERTHUY ON TRADITION IN MEDICINE

have now a very real interest I have reproduced in the
following pages his observations taken from the volume
of collected papers issued by his brother after his death
in 1871. I have left them all in the original French.
Then we come to the modern period (1881) to Dr.
Charles Finlay. He also had spotted the stegomyia,
and his observations proved of the greatest assistance
in directing researches to this insect. Finlay presented
his paper, showing that the mosquito carried the infection
from man to man, before the Academy of Sciences of
Havana in 1881. Beauperthuy, it will be remembered,
also believed that it was the domestic mosquito, but
held that its virus was telluric in origin.

There are two parts of Beauperthuy's writings here
reproduced to which I wish to direct the reader's special
attention. One part is that in which he refers to the
hampering effect of tradition in our great profession.
He points out in the history of the disease known as
Scabies the number of centuries it took medical men
before they would confess that scabies was a parasitic
affection, and that, too, in spite of the fact that the
" poor negro " had recognised its parasitic origin. The
other paragraph to which I would direct special attention
is that dealing with the common fly.

TRADITION IN MEDICINE

" The profession said," writes Beauperthuy, that "La
gale, la peste, se propageaient, par les inoculations
miasmatiques par contact immediat ou par les vetements
ou autres objets touches par les galeux, par les
pestiferes ; ces memes objets pouvaient, apres un

MOSQUITO THE MIASM 99

certain laps de temps plus ou moins long, occasionner,
par leur contact sur des corps sains, la contagion
miasmatique. Telles furent les ingenieuses creations
que les homines de 1'art imaginerent a une epoque peu
avancee de la medecine pour expliquer des phenomenes
dont la cause echappait a leur investigation. Presque
toutes ces donnees regissent encore la science actuelle,
a Fexception des miasmes contagieux de la gale, qu'il
fallut enfin efFacer de 1'ancien tableau etiologique, pour
lui substituer . . . quoi ? Un insecte, un acarien.
Linne, Arenzoar et d'autres medecins avaient signale
la sarcopte de la gale comme 'producteur de cette
maladie. Le culte voue aux opinions adoptees et
consacrees par le temps avait conserve les anciens
errements. II a fallu trois siecles pour arriver a etablir
un fait aussi facile a verifier et a faire connaitre la
veritable cause d'une affection aussi elementaire que la
gale. Grace a Gales, la gale fut enfin effacee du
tableau des maladies vesiculeuses pour ouvrir la serie
des maladies parasitaires, pour etablir a grandpeine une
verite que savaient les negres de nos colonies, les
indigenes de toute FAmerique du Sud, le vulgaire de
tous les pays. Ceux qui voulaient avoir plus de genie
que la nature, ignoraient seuls ce fait trivial.

THE MOSQUITO is THE MIASM.

" L 'absence d'insectes tipulaires pendant 1'hiver
explique pourquoi dans cette saison le voisinage des
marais cesse d'etre dangereux. Les marais immenses
du Nord de 1'Europe ne sont point malsains par la
meme raison. Les marais ne communiquent a 1'atmo-
sphere que de 1'humidite, et la faible quantite de gaz
hydrogene carbone qu'ils exhalent ne produit chez
rhomme aucune indisposition dans les regions dqua-

100 BEAUPERTHUY ON TRADITION IN MEDICINE

toriales et intertropicales reputees pour leur insalubritd.
Ce n'est pas seulement la corruption des eaux qui les
rend insalubres, mais la presence des tipulaires.

" Pendant la saison de la secheresse, defavorable aux
tipulaires, les fievres cessent au Senegal, dans les plaines
de 1'Apure, de Caracas et de la Guyane. Elles sevirent
pendant la saison des pluies, qui est celle de la produc-
tion des tipulaires. Les affections qu'elles occasionnent
prennent plus de gravite lorsque les tipulaires pulluknt
dans les eaux stagnantes et corrompues.

" Arenzoar avait fait connaitre, depuis trois siecles,
1'acarus qui produit la gale ; il en avait indique' la
provenance. Linne signala de nouveau 1'existence de
Tacarus scabiei aux medecins ; mais 1'existence de
1'acarus genait les theories regnantes. A quoi bon
admettre une verite nouvelle, isolee, qui menace de
renverser tout un systeme medical merveilleusement
invente et repondant a presque toutes les necessites, un
peu plus ou un peu moins, de la science ? Pourquoi
deranger tout un edifice intellectuel pour y introduire
une innovation degradante pour Tart et dangereuse pour
les dogmes enseignes par le maitre et soutenus par
d'innombrables disciples ? "

Tradition said :

" Les emanations marecageuse s se repandent avee
plus d'energie le soir que dans le reste de la journee.
C'est aussi a ces heures que les insectes tipuliferes sont
plus actifs. Les habitants des pays marecageux sont
moins exposes que les etrangers a con tract er la fievre
intermittente. Comme si les emanations marecageuses
se\iraient avec moins d'energie sur les organes soumis
habituellement a leur influence, que sur ceux qui la
ressentent pour la premiere fois.

FLIES AND DISEASE 101

THE RELATIONSHIP OF THE FLY TO DISEASE — MOUCHES

" La mouche commune et autres petits dipteres qui
s'attachent aux ulceres, aux substances excrementitielles
et putrides, sont sujets au parasitisme des acariens : c'est
un fait d'une grande generalite. Les mouches com-
munes qui s'attachent avec une tenacite si incommode
aux levres et aux orifices du nez, sont des insectes
malades, comme 1'atteste leur etat de maigreur: elles
cherchent leur soulagement en deposant les germes
de leur affection sur les teguments, a 1'origine des
membranes muqueuses. Apres avoir presse ces insectes
entre deux verres de maniere a leur oter la vie, on les
soumet, apres trois ou quatre jours dans ces climats, a
1'observation microscopique : on ne tarde pas a aperce-
voir des acarus adultes qui s'echappent de leurs cavites
abdominales et se fixent aux organes exterieurs. Ces
observations sont faciles a faire et ne demandent qu'un
peu de soin.

How FLIES CARRY DISEASE

" Les acariens se transportent sur 1'enveloppe tegu-
mentaire de 1'homme et des ahimaux par locomotion ;
mais cette voie est le moins ordinaire. Ce sont les
mouches domestiques, auxquelles ils s'attachent, qui
leur servent le plus habituellement de vehicule. Ces
dipteres, attires par les matieres en decomposition sur
lesquelles vivent les acariens, sont frequemment envahis
par eux et les transportent, soit sur l'homme, soit sur
les objets qui Fentourent. On reconnait les mouches
atteintes de ces parasites a leur apparence maladive,
a leur importunite et a 1'obstination qu 'elles mettent a
se poser au pourtour des ouvertures des membranes
muqueuses de l'homme et des animaux. Elles trans-

102 BEAUPERTHUY ON TRADITION IN MEDICINE

portent sur ces orifices les acariens qui les tourmentent
et s'en debarrassent au prejudice du nouvel note qui les
recoit. La presence de ces insectes sur les levres et au
bord des narines occasionne une vive demangeaison
et des boutons vcsiculeux, semblables a des boutons
de gale, dont Feruption s'accompagne d'une reaction
febrile ephemere. Ces eruptions phyctenoides partielles
sont connues sous les noms cFherpes labiaKs, praeputiaMs,
nasalis, etc.

How MALARIA, YELLOW FEVEII, ETC., ARE CARRIED

" Les fievres intermittentes, remittentes et perni-
cieuses, ainsi que la fievre jaune, le cholera morbus
et les accidents causes par les serpents et autres animaux
venimeux, reconnaissent pour cause un virus animal on
vegeto-animal dont 1'introduction dans 1'organisme
humain se fait par voie d'inoculation. Les fluides ou
virus inocules determinent, apres une periode d'incuba-
tion plus ou moins longue, des symptomes nerveux
dans le principe et plus tard une infection putride
du sang et des autres fluides de 1'economie, portant
le trouble dans la circulation, la respiration, la digestion
et toutes les autres fonctions.

" Les fievres intermittentes sont graves en raison
du developpement des insectes tipulaires, et ces fievres
cessent d'exister ou perdent beaucoup de leur intensite
dans les forets qui par suite de leur altitude nourrissent
peu de ces insectes, quelles que soient les masses de
matieres vegetales qui y subissent la decomposition
putride.

" Les Indiens, pour se garantir des fievres, font usage
de certains preservatifs, et, lorsqu'ils habitent leurs
vallees malsaines, de brasiers allumes a 1'entree de leurs
cabanes pendant la nuit. Ce moyen est tres efficace

THE WINGED SERPENTS 103

pour chasser les insectes tipulaires. Us le negligent
lorsqu'ils voyagent dans d'autres localites.

" De tous les moyens en usage pour se preserver
de Faction enervante occasionnee par les piqures des
insectes tipulaires, le plus efficace est celui qu'emploient
les Indiens, consistant a se frotter la peau avec des
substances huileuses. II est vrai que leur peau reste
sans defense contre 1'introduction de 1'aiguillon de ces
insectes ; mais le contact d'une substance grasse dans
Finterieur du tube capillaire qui sert a Finoculation du
venin, suffit pour obstruer ce conduit et s'opposer a
1'instillation du virus secrete par les glandes salivaires
de 1'insecte : la piqure alors perd toutes ses proprietes
deleteres et se reduit a une simple incommodite qui
n'a rien de prejudicial e pour la sante et n'altere en rien
la composition du sang.

" L'expression de serpents ailes employee par Hero-
dote est fort applicable aux insectes tipulaires et a
Faction de leurs piqures sur Feconomie humaine. Tant
il est vrai de dire que la verite apparaissait aux anciens
j usque dans les fables.

" La fievre jaune atteignit un degre de malignite
peu commim. L 'epidemic s'etendit sur les Indiens
comme sur les Europeens, sans distinction de classes.
Les negres eux-memes ne furent pas exemptes. Elle
atteignait depuis les enfants de quatre ans jusqu'aux
hommes de Fage le plus avance ; M. Manuel Artiz,
vieillard presque centenaire, fut attaque du typhus
amaril. Je lui assurai qu'il accomplirait le siecle, et
j'eus le bonheur de lui tenir parole.

" Dans la mission que j'avais a remplir, j'apportais
le fruit de quatorze annees d'observations faites au
microscope sur les alterations du sang et des autres

104 BEAUPERTHUY ON TRADITION IN MEDICINE

fluides de Feconomie animale dans les fievres de tous
les types.

" Ces observations, faites dans les regions equi-
noxiales et intertropicales, me furent d'un grand secours
pour reconnaitre la cause de la fievre jaune, et les moyens
propres a combattre cette terrible maladie. Quant a
mes travaux sur 1'etiologie de la fievre jaune, je m'abstien-
drai pour le moment de les livrer a la publicite. Mes
recherches a cet egard font partie d'un grand travail,
dont les resultats ofFrent des faits tellement nouveaux,
et si eloigne's des doctrines re9ues, que je ne dois pas
les presenter a la publicite sans apporter a leur appui
les demonstrations les plus evidentes. Du reste,
j'envoie a 1' Academic des Sciences de Paris une lettre
scellee qui renferme le resume des observations que
j'ai faites jusqu'ici et dont le but est de m'assurer a
toute eventualite la priorite de mes decouvertes sur la
cause des fievres en general. Quant a la methode
curative que j'ai employee et qui a egalement reussie sur
les Europeens et sur les indigenes atteints de la fievre
jaune, je ne crains pas de la publier. Ces faits sont
faciles a observer et tout medecin intelligent et de
bonne foi qui usera, sans restriction, de mes preceptes
centre le typhus amaril, obtiendra les resultats que j'ai
obtenus moi-meme.

" On ne peut considerer la fievre jaune comme une
affection contagieuse. Les causes de cette maladie
se developpent dans des conditions climateriques leur
permettant de s'etendre a la fois ou successivement sur
plusieurs localites. Ces conditions sont : 1'elevation
de la temperature, 1'humidite, le voisinage des cours
d'eau, les lagunes, le peu d'elevation du sol au-dessus
du niveau de la mer. Ces conditions sont celles qui
favorisent le developpement des insectes tipulaires.

THE "ZANCUDO BOBO" 105

" Les tipules introduisent dans la peau leur sucoir,
compose d'un aiguillon canalise piquant et de deux
scies laterales ; ils instillent dans la plaie une liqueur
venimeuse qui a des proprietes identiques a celles du
venin des serpents a crochets. II ramollit les globules
du sang, determine la rupture de leurs membranes te'gu-
mentaires, dissout la partie parenchymateuse, facilite le
melange de la matiere colorante avec le serum. Cette
action est en quelque sorte instantanee, comme le
demontre 1'examen microscopique, puisque le sang
absorbe par ces insectes, au moment meme de la succion,
ne presente pas de globules. Cette action dissolvante
parait faciliter le passage du fluide sanguin dans le
conduit capillaire du sucoir. Si 1'insecte est interrompu
dans 1'operation de la succion, tout le venin reste dans
la plaie et produit une plus vive demangeaison que
lorsqu'iine grande partie du fluide venimeux est repompee
avec le sang. On attribue sans motif le prurit a la
rupture de 1'aiguillon ; cet aiguillon est une substance
cornee elastiqtie, dont je n'ai jamais observe la rupture
dans mes nombreuses observations.

" Les agents de cette infection presentent un grand
nombre de varietes qui ne sont pas toutes nuisibles au
meme degre. La variete zancudo bobo, a pattes rayees
de blanc, est en quelque sorte 1'espece domestique. Elle
est la plus commune et sa piqure est inoffensive com-
parativement a celle des autres especes. Le puyon est
le plus gros et le plus venimeux ; il produit une gale ;
son aiguillon est bifurque a son extremite ; sa piqure,
dans les cas les plus favorables, oil le venin n'est pas
absorbe dans 1'economie, determine une irritation locale
qui presente la forme d'un bouton prurigineux sem-
blable au scabies purulent, mais nullement contagieux.
C'est surtout les enfants qu'il attaque. L'etendue du

106 BEAUPERTHUY ON TRADITION IN MEDICINE

foyer de la suppuration rend difficile les recherches qui
tendent a decouvrir 1'existence du sarcopte dans ces
vesicules.

" Que sont les matieres pelagiques dont les tipulaires
se nourrissent, sinon des substances animales phospho-
rescentes comme la chair des poissons ? Qu'y a-t-il
d'etrange que 1'instillation dans le corps de 1'homme
de ces substances a 1'etat putride produise des desordres
tres graves ? M. Magendie n'a-t-il pas prouve que
quelques gouttes d'eau de poisson pourri, introduites
dans le sang des animaux, determinaient en peu d'heures
des symptomes analogues a ceux du typhus et la fievre
jaune ? N'est-ce pas, en effet, une instillation de
poisson en putrefaction que versent ces insectes sous la
peau et dans le tissu cellulaire de 1'homme ?

" Les animalcules de la fievre jaune se meuvent
dans toutes les directions, remontant le courant, .et
sont doues d'un mouvement de giration de droite a
gauche et de gauche a droite. Une tres petite
quantite de sulfate de quinine melangee avec le liquide,
paralyse instantanement 1'action des animalcules. Ils
sont entraines par le cours du liquide sans manifester
aucun mouvement."

(Cet article a etc public dans la Gazette officiel/e de Cumand, le 23 mai
1854, no. 57.)

WAS YELLOW FEVER CONTAGIOUS OR NOT ?

Just as in the case of malaria so in the case of
yellow fever, much controversy and speculation took
place as to whether the disease could be passed on
from man to man, either by contact or through the
secretions, or through the clothes. So two schools
arose in the eighteenth century, the contagionists and

CONTAGIOUS OR NOT CONTAGIOUS? 107

the non-contagionists. It was chiefly with a view of
getting information upon this vexed subject that the
1852 Commission was appointed, and upon its findings
the quarantine laws of the period re yellow fever
were modified where necessary. As a result of their
deliberations the Committee reported as follows :

" That epidemics are preceded by individual and
sporadic cases, which cases likewise occur in seasons
when no epidemics prevail. That epidemics are very
often local, and limited to one part of a town. That
epidemics do not spread by gradual progression, but
often skip over certain adjacent districts. That in an
epidemic the most rigid seclusion affords no protection.
That great success attends removal to a non-infected
locality. That the exciting cause, whatever it is, is
local and endemic. That the means of protection
from Yellow Fever are not quarantine restrictions and
sanitary cordons but sanitary works and operations
having for their object the removal of the several
localising conditions.

(Signed] " SHAFTESBURY,

"EowiN CHADWICK,
"T. SOUTHWOOD SMITH.

" WHITEHALL, 7 April 18,52."

They therefore were decided that yellow fever was
not contagious. Blair held the same view strongly.
He went so far as to inoculate the conjunctiva of
healthy persons with the mucus taken from the con-
junctiva of persons suffering from yellow fever — in no
instance was yellow fever contracted. He mentions
numerous cases where nurses had become smeared
with the black vomit of patients and suffered no ill

108 BEAUPERTHUY ON TRADITION IN MEDICINE

effect, also numerous cases in which the wives of
yellow fever patients slept in the same bed, or cases
in which a patient, through lack of space, was placed
in the cot newly vacated by a yellow fever case
that had died. In no instance was yellow fever
contracted.

In 1793 Dr. Firth of Philadelphia inoculated his
arm with the blood taken from a yellow fever patient.
He also drank some of the black vomit. No ill effect
followed. According to Professor Harrison,1 a Dr. May
dropped some black vomit into his eyes and did not
get the fever. Since that period all these experiments,
with many more besides, have been re-made, with the
like negative effect, showing that the secretions, the
bedding, and the clothes did not convey infection.
But how, then, was the infection conveyed ? Beau-
perthuy, as we have seen, tried to explain it, and
succeeded half way— the mosquito conveyed the virus,
but he failed to observe that the mosquito got its
virus from infected man. He supposed that it obtained
it from decomposing matter. Just as Ross furnished
the clue in the case of the anophelines, so Reed, Carroll,
Agramonte, and Lazear solved the question in the
case of the stegomyia. Beauperthuy's contention that
the mosquito obtained its poison from the soil fitted
in with the views then firmly held of the local origin
of the disease. It was noted over and over again how
the disease clung to certain places and houses. With
the view of throwing light upon the local origin of the
disease, more especially in the case of graveyards which

1 Loc, cit.

HARRISON AND MOXLY 109

had been used to bury yellow fever cases, Professor
Harrison, now of British Guiana, and Mr. Sutton
Moxly, Chaplain of the Forces, both then in Barbados,
undertook a series of experiments to test by inoculation
in the lower animals whether the mould of yellow fever
graves was infective or not. The experiments were
also an answer to observations made by Dr. Freire of
Rio, to the effect that the soil from burials spread the
disease. Harrison and Moxly's experiments showed
that so far as small animals were concerned the soil
was non-infectious.

The most interesting observation of these two early
investigators was the following pregnant statement :

" The theory that we believe, in view of all the
apparently contradictory facts of the case, to be the
most reasonable, and that, if not generally accepted
now, will be when the history of the disease is
thoroughly known, and when the apparently contra-
dictory facts are compared, and given each their due
weight, is that yellow fever is a highly contagious
disease, but that the germs, whatever they may be,
require some time and suitable opportunity for their
development before they can reproduce themselves in
another body ; and that thus the disease is not at least
generally communicable from a sick person to another
who may be in ever so close proximity to him.'

Surely this is an extraordinary coincidence — Beau-
perthuy certain that it was a mosquito that trans-
ferred the poison, Harrison equally convinced that that
poison required some time and suitable opportunity
to develop itself outside the body before it could infect.

110 BEAUPERTHUY ON TRADITION IN MEDICINE

Yes ! British Guiana can compete on equal terms
with Cuba for the honour of having paved the way
to the epoch-making discovery, and all honour to the
great clinician and the young professor and his clerical
companion who, with the simplest instruments, got so
near the truth. L. H. R. Carter, of the Marine
Hospital Service, had also drawn attention to the
curious " extrinsic " period of incubation of yellow
fever, that is to say, to the remarkable fact that an
interval existed between infected and secondary cases —
the interval being, as we now know, the latent period
which the virus passes in the stegomyia. It is clear
that Harrison and Carter were both thinking alike.

CHAPTER XI

HISTORICAL SURVEY OF YELLOW FEVER. ITS DESTRUC-
TIVE SPREAD AXD MORTALITY DURING THE SEVEN-
TEENTH TO EIGHTEENTH CENTURIES

FASCINATING as is the study of malaria, both historically
and scientifically, nevertheless that of yellow fever is
even still more so, as I shall endeavour to show.

Whilst we read how malaria dogged the footsteps
of our forces in the Netherlands, so yellow fever was
the disease in the days of the buccaneers, and later
of our regular troops at a period in our history when
we were engaged in conquering in the West Indies
and on the Spanish Main, which time and time again
swept our pioneers and soldiers away just as so many
flies. Before we had ventured into these waters the
terror of yellow fever was well known to the Spanish,
Portuguese, French, and Dutch settlers ; it was recog-
nised as the " disease of the Conqnistadores"

How often, in wandering through the West Indies,
one meets with an obelisk or an isolated tombstone or
a disused churchyard, all telling how our own con-
quistadores, our own soldiers, met their death, not
at the hands of a warlike enemy, but, as we now

in

112 HISTORICAL SURVEY OF YELLOW FEVER

know, vanquished by the sting of an insignificant
insect ; and thousands so perished, as the following
official narratives attest.

Blair, in an account of the yellow fever epidemic
of Georgetown, 1850, quotes as follows from the Report
of the Medical Inspector of the West Indian Command
for the years 1837-41.

"About the end of August fever began to appear
amongst the non-commissioned officers and privates :
out of 32 attacked, 15 died. Intermittent fever was
at the same time very prevalent : 1,435 cases came
under treatment.

" In Trinidad, in May 1838, fever occurred among
the troops at St. James's and St. Joseph's : 15 died
out of 109 treated. A draft of young Irishmen, just
then arrived, suffered most.

" In Dominica this year (1837), out of 65 cases of
yellow fever admitted into the hospital, 21 died. Nearly
all the officers had the disease and died. In this
epidemic, hemorrhage from the gums and throat was
common ; black vomit set in about thirteen hours
before death.

" In Trinidad, 1837, at St. Joseph's, 19 men of the
detachment there died of fever.

" Grenada about the same time was severely visited
by fever.

" At Port Frederick, out of 14 men of the Royal
Artillery 11 were attacked, of whom C died. At
Richmond Hill, out of 207 of the 70th Regiment,
61 were attacked, 14 died. Fever raged amongst the
civil population, both white and black ; even the ac-
climatised by no means escaped ; the crews of the
shipping suffered severely.

MORTALITY IN WEST INDIES 113

" In Barbados, 1837-8, in November and December,
yellow fever prevailed amongst the inhabitants of
Bridgetown and proved very fatal. The troops then
were healthy. In the beginning of January, 1839, the
disease appeared in the 52nd Regiment, which in the
November preceding had arrived from Gibraltar ; of
37 admitted into hospital G died. The officers of the
regiment suffered in a greater proportion. Of 10 attacked
3 died ; 12 was the whole number in barracks. It
is remarkable that every individual who had any duty
to perform requiring his presence in the orderly room,
which was in the officers' barracks (previously con-
sidered healthy), was attacked with fever ; and also
that few escaped who occupied the adjoining lower
rooms ; thus, of 24 persons connected with this part
of the building, only 2 females and 4 young children
escaped the disease. The building was vacated, the
floor taken up — nothing offensive was found under-
neath.

" In the quarter ending June 30th there was an
average of 39 deaths out of every 123 cases. The
inhabitants at the time were reported healthy, as also
the seamen and the troops in Berbice and at the out-
stations. The weather was described as particularly
fine. •

" In St. Vincent, in the same quarter, yellow fever
was very destructive amongst the troops ; out of 310
(the total strength of the white troops) 241 cases
occurred, 54 died ; out of 18 officers, the whole in the
garrison, 9 were attacked, 4 died.

" In St. Lucia, from the middle of August to the
end of September, the troops at Morne Fortune suffered
from fever ; out of 134 white troops 93 were attacked,
20 died. The inhabitants suffered even more ; amongst

8

114 HISTORICAL SURVEY OF YELLOW FEVER

them the disease appeared in the early part of July.
The weather was unusually dry and hot. About the
same time fever was severe and destructive amongst
the inhabitants of St. John's, Antigua. The troops
in the island escaped the disease.

" In the quarter ending December 31, 1839, fever
prevailed amongst the troops in Barbados ; it was fatal,
and obtained chiefly in the brick barracks. It first
appeared amongst the respectable inhabitants in the
early part of October, and about the end of the
month became prevalent in the garrison. The hospital
sergeant and orderlies of the 52nd Regiment were
amongst the first taken ill ; then the families of the
married men ; then the troops in the barracks. The
disease broke out amongst the troops on the ships,
and even in Trinidad (March 1846) fever prevailed ;
402 cases occurred, 13 died.

" In Tobago, during the same quarter (1846), 62
were attacked with fever out of 71, 8 died.

" In St. Kitts, out of 8 attacked 4 died.

"In the same year 7 fatal cases of fever occurred
amongst the troops in Berbice, 5 in Trinidad, 24 in
St. Kitts, out of 90 attacked.

"In the following quarter (1840), at St. Kitts, there
were 10 deaths from fever out of a garrison of 33
attacked ; the civil inhabitants suffered as well as the
troops. During the twelve months ending March 31,
the deaths from fever at Brimstone Hill, St. Kitts, were
49, which was a large proportion of the garrison."

Again, in the year 1847, during a severe epidemic in
Georgetown, Demerara, Surgeon-General Blair wrote :

" Within the trenches aquatic larvae and exuviae
abounded, and over them clouds of mosquitos and

SIXTY-NINE PER CENT. MORTALITY 115

sandflies. Such was the condition of the neighbour-
hood of the Military Grounds during the epidemic.
These particulars were noted by me more especially
in 1840, in consequence of a reference being made to
me by His Excellency the Governor, with a view to
reply to a dispatch from the Right Hon. the Secretary
at War regarding the question why in a few months
69 per cent, of all the white troops had perished. In
close proximity and to leeward of the marsh stood the
Military Hospital. It is said that almost every case
admitted to this hospital during the epidemic became
yellow fever, no matter what the ailment on admission ;
and it ultimately became such a terror to the soldiers
that the utmost difficulty was experienced in persuading
them to enter it when sick."

And again we read :

" Fergusson tells us how the troops at St. Domingo,
after disembarking, one and all suffered. At the com-
mencement of the epidemic a census was taken of the
inhabitants, and they and the newly arrived soldiers
totalled equal numbers at the conclusion of the epidemic.
1,500 soldiers — that is, the original complement of the
men — had perished. No wonder we read about a general
who lost his reason when he saw, in spite of all his
efforts for their wellbeing, his men struck down by
hundreds by invisible bullets. In the words of Blair,
so persistently did yellow fever dog the footsteps of the
early European pioneers, whether on plunder or con-
quest bent, that it seemed as if the European carried
something upon his person which, coming in contact
with the tropical atmosphere, lit up a conflagration.
The moment, wrote Prescott, a town is founded, or a

116 HISTORICAL SURVEY OF YELLOW FEVER

commercial centre created, it is certain to cause the
explosion of the latent malignity of the poison in
the air."

No wonder, then, that around such a disease, magic
and mystery were freely invoked to account for it.
Yes, and little wonder that to-day may still be found
surviving some old practitioners of medicine who
cannot shake the juju off and will take you to see
a " yellow fever house " — a house haunted with the
yellow fever pestilential miasm of former generations,
and in which, if you reside, you will surely get yellow
fever !

Just as in the case of malaria, so in this disease :
miasms — the chemical reactions arising from the union of
salt water with fresh — were considered an ideal explana-
tion, for it fitted in with appearances. Our tropical
seaports were attacked by yellow fever, and in these
tropical seaports it invariably happened that the in-
coming salt-water tides met with the outflowing fresh
water of the tropical river or the water of the lagoon ;
and it was to that natural phenomenon that wise men
attributed a chemical reaction and the engendering of
a " fibrilifying influence." The " fibrilifying influence "
was described as a terrestrial poison which a high atmo-
spheric heat generates amongst the newly arrived.
The frequent outbreak of yellow fever on board ships
led to a host of theories which are amongst the most
absurd of the modern period of the history of medicine,
only finding their parallel away back in the days of
alchemy and witchcraft. The outbreaks on board ship

YELLOW FEVER AND SHIPS 117

were described as spontaneous. The cargo was blamed ;
it might have been green logs from Sierra Leone or
logwood from Honduras. But the majority of authori-
ties laid the blame to ballast, especially shingles, gravel,
mud or sand. The ballast was more often than not
wet when put in, or made so by the drippings from
the fresh-water tanks stored on board. The pestiferous
emanations from bilge water, mixed with the ballast
in all the forms in which it was encountered in the
days of sailing ships, were supposed to be the chief
cause, and very numerous examples of this are given
in the "Report on Yellow Fever," General Board of
Health, London, 1852. Quite recently Dr. Manning
of Barbados has reviewed a considerable number of
these instances to support the view which he shares,
and which, as we now see, were the views of the
school of miasms, fibrilifying influences, concatena-
tions, in the days before science had given us the true
explanation. The persistence of views like these to-day
shows in a very marked degree how hard it is to kill
tradition and superstition in our profession. The
explanation of all these so-called "spontaneous" out-
breaks on board ship has been admirably given by
Dr. Le Bceuf and by other American writers of the
past few years. A little thought will show at once
that yellow fever has almost disappeared from ships
since wooden vessels were replaced by iron steamships.
In the old days before a steam condensing plant, fresh
water was carried in numerous casks which were more
often than not leaky, the fresh water was taken in at
the ports of call, and no doubt contained innumerable

118 HISTORICAL SURVEY OF YELLOW FEVER

stegomyia larva? and eggs which developed during the
voyage into the winged insect. The ship then became
like a house in a yellow fever town ; the particular
species of mosquito — the stegomyia — was there. All
then that was necessary to light up an epidemic on
board was that a labourer or some one from shore
suffering from the disease should come aboard, or that
a member of the ship's crew should go ashore and
contract the disease. Soon after the ship would sail
and he would naturally develop the disease, and pre-
sently every mosquito in the whole ship would become
infected ; and then most of the crew would be down
with yellow fever. There is no necessity to search for
a miasm nor to ask us to discover a sea mosquito, as
Dr. Manning suggests, for an explanation of this now
well-known fact. That the stegomyia can and does
develop in fresh water on shipboard in warm latitudes
as easily as it can ashore is now well known, and if it
can transmit yellow fever ashore, it certainly can do so
on board ship, which is to all intents and purposes a float-
ing house. But no, in spite of all these explanations,
tradition and yellow fever houses andjnju still cling.

Although yellow fever and malaria have been
usually bracketed close to one another (and as we now
know there was a reason for so doing, for they are both
mosquito-carried), yet Blair recognised the very great
difference which existed between malaria and yellow
fever from the point of view of aetiology, for he states :

" It is remarkable that some of the most destructive
outbreaks of yellow fever have occurred amongst the

THE CONQUISTADORES AND YELLOW FEVER 119

troops at stations where intermittent fever is almost
unknown as indigenous : for instance, Brimstone Hill in
St. Kitts ; Fort Charlotte in St. Vincent ; St. Ann in
Barbados ; and vice versa, those colonies in which ague
are most common have been least frequently visited
by yellow fever — e.g. Demerara and Berbice."

The reason for this difference is now quite clear. The
life-story of the anopheles and the stegomyia is quite
different ; the one is an earth-pool breeder, the other
a domestic drinking-water-barrel or odd drinking-water-
receptacle breeder. The one therefore is much depend-
ent upon the rains or upon permanent springs and
marshes, the other chiefly dependent upon the hand of
man, who provides the receptacle and fills it with
the drinking water necessary for the use of his house-
hold.

Histoj'y. — There is every reason for supposing that
yellow fever is one of the very old diseases of mankind
in the New World. It is stated that it was known to
the Aztecs under the name of matlazahualt, and accord-
ing to Humboldt it existed as early as the eleventh
century.

Amongst old Spanish writers who refer to this
disease may be mentioned Oviedo, who in his " Historia
General de las Indias " describes the great mortality
among the followers of Columbus in 1494. This mor-
tality he attributes to the humidity of St. Domingo,
but in every probability it was yellow fever. So
bad were the reports which reached Spain, that
Ferdinand V. had to send out 300 convicts to the
island as there were no volunteers.

120 HISTORICAL SURVEY OF YELLOW FEVER

Columbus in 1498, in writing to the King of Spain
upon the sickness of his men, attributed their illness
to " peculiarities in the air and water " in the new land.
No doubt the peculiarity was the mosquito.

In the sixteenth century yellow fever is said to have
decimated the Mexicans. But the first authentic
history of an epidemic of yellow fever was furnished by
Jean Terreyra de Rosa at Olinda in Brazil in the year
1687.

Fere Dutertre, 1635, appears to have been the first
to furnish details of the symptoms and progress of the
disease in the West Indies. He regarded it as a new
disease.

Pere Labat, whose name is well known in connec-
tion with yellow fever, found on landing in Martinique
in the year 1649, the disease raging in the island, the
monks of the religious order stationed there being
severely afflicted. The learned father stated that the
disease was called " the Maladie de Siam," because
in Martinique they supposed that it was imported from
Siam by the ship Oriflamme. As, however, this ship
called at Brazilian ports on the voyage, it is much more
probable that either the crew became infected there
or that infected mosquitos wrere carried away. Accord-
ing to Bancroft the disease existed in St. Domingo in
1731. Old writers upon yellow fever frequently refer
to the West Coast of Africa as being the original
source of the disease.1

Thus Dr. Chisholm believed that yellow fever was

1 Dr. Le Bceuf, in interesting notes on "History of Yellow Fever,"
published in the New Orleans Medical and Surgical Jcuinal, 1C05.

BULAM FEVER 121

first introduced into the AVest Indies in 1793, when
Grenada became infected from the remarkable ship
Hankcy, which had come from Bulam in West Africa.
On account of this supposed origin of yellow fever it is
sometimes called Bulam fever. Evidence, however,
points the other way,- — that in fact it was a very preva-
lent disease in the New World, stretching from Mexico
down through Central America to Brazil. Brazil appears,
then, to have been the centre from which it radiated out
to the West Indies. As I have stated before, the early
Conquistadores suffered from it, the Latin races of the
Old World being therefore the first to make its acquaint-
ance during the time they were occupied in pushing
civilisation into the then newly discovered continent.

In Cuba yellow fever was probably known as the
Pest or Epidemic of Havana as early as 1620. The
first authentic description of the black vomit in
Havana was furnished by Dr. Thomas Romay in the
year 1761.

In the beginning of the eighteenth century the
disease, from its appearance in various parts of Spanish
America under the name of vomito prieto, attracted
much attention, and it is particularly referred to by the
historian Ulloa, who resided for some years in that
country. The word pricto appears to be the Portuguese
or nearly obsolete Spanish term for black. In Spanish
the word negro is now universally substituted. A
small pamphlet of sixty-two pages by a Dr. Gastel-
bondo, written at Carthagena (S.A.) in 1753 and
printed at Madrid in 1755, was probably the first work
cxprofesso on the black vomit as it appeared in South

122 HISTORICAL SURVEY OF YELLOW FEVER

America. He gives his experience of the disease during
forty years. He says on the title page that he is about
to write about a disease of frequent occurrence in that
part of the world, mentions change of climate and mode
of living among some of the causes of the disease in
new-comers, and says that the natives of Carthagena,
Vera Cruz, etc., were not subject to attacks of the true
black vomit fever, though liable to the " Chapetonada,"
a disease resembling it in some respects.

From its home in Central and South America we
find yellow fever carried into other latitudes along the
trade routes or by the returning soldiers. Time was
when Baltimore, Philadelphia, Boston, and the Southern
States of Mississippi, Louisiana, Tennessee were ravaged
by yellow fever ; this was the period when there was
an extensive and unguarded trade intercourse with the
West Indies and Central America. A mortality of
50 to 60 per cent, of the population was often recorded
in those days.

" It seems strange," writes Gilkrest, referring to the
epidemic at Cadiz, " that writers should have over-
looked the remarkable epidemics at that place in the
years 1730, 1731, and 1736, recorded by different
authorities, the two first being very particularly noticed
by Villalba in his curious work ' Epidemilogia Espanola.'
It seems equally extraordinary that those writers should
have overlooked the black vomit epidemic which pre-
vailed in Spain previous to those of Cadiz and Malaga."

Race Susceptibility. — The Latin races are perhaps
those which are considered to be the most liable to

RACIAL PREDISPOSITION 123

yellow fever. Thus in British Guiana Dr. Walbridge
gave it as his opinion that the most predisposed were
the Norwegians, Danes, Germans, and Portuguese, the
latter being so greatly predisposed that their emigration
from Madeira was prohibited for a time. One of the
reasons why the Latin races are regarded as more
susceptible comes no doubt from the fact that these
races inhabit the yellow fever zones. They were the
first settlers and were the first to suffer. But in the
days when large bodies of British troops were stationed
in the West Indies, they suffered to a terrible extent,
as we have already seen. There may, however, be
some reason for the Latin races appearing to suffer
more than the other races, and that is this : in my
experience I have obtained the impression that in the
houses, yards, and gardens kept by the Portuguese,
Spanish or French, there are more water-containers of
all kinds for storing the drinking water and washing
water for the clothes, water for the poultry and
domestic animals. The houses of the Latin people
appear to me always to have more children, domestic
animals, chickens, etc., about than the houses of the
natives or those of the English residents. So, therefore,
the question may be simply that of providing the
largest number of breeding places, and, reasoning from
the analogy of fleas and rats, this seems to be the
simplest explanation.

The black race has been said to enjoy a remarkable
immunity. This is, however, far from the case. The
greatest observers have pointed out how time and time
again they suffer equally with the white races ; the

124 HISTORICAL SURVEY OF YELLOW FEVER

most recent epidemic in Barbados is an example of
this. Examples are also cited by Blair and in the
1852 Commission's Report.

From the earliest times yellow fever has been
described as the disease of the unacclirnatised, the
disease of the new arrival ; for that very reason it was
thought that as every new arrival must sooner or later
get it, the sooner it was got over the better, and with
this kind of reasoning the native inhabitants folded
their arms and did nothing. It was the young soldiers
and merchants who suffered in the old days, and to-day
in many parts of the world, as in the Amazon, it is the
young merchants who fall to the disease.

The explanation is that the native, be he black or
white, has no natural immunity, but he has acquired
immunity through having had an attack of the disease,
most probably in childhood. He survives, and is in conse-
quence immune. When, therefore, a case of yellow fever
is imported into a district and infects the stegomyias,
those who succumb are naturally the non-immunes,
that is, the new arrivals. But let it be now observed
that with the increase of sanitation and the diminution
of mosquitos, brought about as described in a previous
chapter, yellow fever has become rarer in the yellow
fever zone of the wrorld. This means that the immunising
process which used to occur in the old days no longer
takes place now, and every year adds to the number
of native non-immunes ; they no longer get the oppor-
tunity of acquiring the disease. In other words, the
black has now become as susceptible as the latest white
arrival to yellow fever. This is, at any rate, my

PERIODICITY 125

interpretation of why the native Barbadian is suffering
from yellow fever equally with the new arrivals.

Periodicity. — This has been referred to by many
writers, and it is often stated that in the case of
Barbados the island is visited at intervals of thirteen
years. Here again the coincidence is probably de-
pendent upon the creation of a larger susceptible
population during the interval of freedom from disease,
the immunes having diminished in the meantime
through natural causes, as by death.

CHAPTER XII

DISCOVERY OF THE MODE OF TRANSMISSION OF YELLOW
FEVER AND PLAN OF CAMPAIGN AGAINST THE MOSQUITO

YELLOW FEVER
SCIENTIFIC FACTS RECORDED IN CONNECTION WITH YELLOW FEVER

YELLOW fever is an exceedingly good example of a
disease in which, although up to date the actual
parasite or agent which produces the disease has not
been conclusively demonstrated as in the case of
malaria, sleeping sickness, Malta fever, tuberculosis,
and numerous other infectious diseases, nevertheless
certain other facts in connection with the disease
have been so convincingly proved that from the
administrative side, that is from the prophylaxis
point of view, there is not the trace of a doubt as to
how the disease can be prevented or what are the
conditions which make it quite impossible for it to
spread.

The prevention of yellow fever is one of the most
brilliant triumphs of modern prophylaxis. The founda-
tion of exact yellow fever prophylaxis was laid in
June 1900 by Army Surgeons Reed, Carroll, Agra-

126

FlG. 23. A PROPERLY SCREENED CISTERN, NEW ORLEANS.

p. 126]

FINLAY AND CARTER 127

monte, and Lazear, who were sent to Cuba to study
yellow fever. In Havana these observers found that
already Dr. C. J. Finlay had, as early as 1881,
enunciated the theory in no uncertain manner of the
propagation of yellow fever by the mosquito ; and,
influenced both by this fact and, as they state, also
by the brilliant work of Ross and the Italian observers
in connection with the propagation of malaria by the
mosquito, as well as by certain observations of Carter,
they determined to experimentally investigate this
line of research. The results obtained by them were
most conclusive. In the same year the Liverpool
School of Tropical Medicine dispatched Drs. Walter
Myers and Durham to study the disease at Para ;
France followed immediately (late in 1901) with an
expedition composed of Drs. Marchoux, Salimbini,
and Simond, which made Rio its headquarters. In
1903 a yellow fever working party composed of
Rosenau, Beyer, Parker, Pothier, and Francis was
sent by the Public Health and Marine Hospital
Service to study the transmission of yellow fever at
Vera Cruz. Lastly, in 1905 the Liverpool School
of Tropical Medicine established for a second time a
Yellow Fever Laboratory at Para under the direction
of Dr. Thomas, assisted by Dr. Breinl. The conclusions
arrived at by these commissions, as well as by Dr.
Guiteras in Havana and Drs. Lutz, Ribas, Barreto
de Barros, and Rodriques in Brazil, have all fully
confirmed the original observations of Reed, Agramonte,
Carroll, and Lazear, and have proved that the Stegomyia
calopus is the sole transmitter of the disease. The

128 MODE OF TRANSMISSION OF YELLOW FEVER

enthusiasm and devotion of this army of workers are
shown by the fact that a very large number of the
workers suffered themselves from the disease, and
that Walter Myers and Lazear succumbed. Reed,
one of the most brilliant of this group, unfortunately
died at Washington from appendicitis in 1902, hardly
before he had had time to witness the beneficial results
of his remarkable labours. For although no observer
succeeded in microscopically demonstrating the parasite,
whatever it may be, they proved firstly, as others had
done, that neither the vomit nor the clothes of the
patient were infective ; they further proved (and this
was new) that the blood of the patient only contained
the virus five days after having been infected ; and
that if then the patient was bitten by one particular
species of mosquito — viz. the Stegomyia calopus, and by
that species alone — that then after a latent period of
three days the stegomyia became itself infected and
was capable of transmitting the disease to man. I
know of no parallel in the history of medical science
of discoveries which appear at first sight so incredible
and as to which, were it not for the equally marvellous
success which has followed acting upon them, we
might be excused for retaining some measure of
sceptical reserve.

The new doctrine swept away as if by magic the
traditional views, which filled very many volumes,
as to the nature and origin and prevention of yellow
jack. Yellow fever has, as we have seen, been attri-
buted to droughts and to floods, to the pestilential
" mangrove swamp," to high temperatures, to fcecal

PREJUDICE AGAINST EXCAVATING 129

matters, to combinations and concatenations of atmo-
spheric circumstances, to stone ballast, hundreds of
tons of which have been disinfected or thrown into
the sea — theories every one of which have raised
bitter controversies and have been the cause during
epidemics of the loss of much valuable time. Even
to-day there exists in many parts a very deep-rooted
prejudice against excavations and dredgings during
certain seasons, notably in the summer months, and
works of this nature, in spite of their importance
and urgency in preserving the health of the com-
munity, are deferred for an old tradition, and that,
too, after Havana and the Isthmian Canal Zone
have proved the absurdity of it. It demonstrates,
however, that the newer facts are not yet fully accepted
by a section of the public, and that those measures
against yellow fever which have now been proved to
be the only ones of avail, are not fully adopted. It is
hardly necessary to add that in consequence valuable
time is lost, and lives and commerce sacrificed.

When it is remembered that the Stegomyia calopus
is present throughout the year, and that in consequence
a town in the tropics in the yellow fever zone may
be as liable to infection in the autumn as in the
summer, or in the spring, it is obvious that if the
excavated or dredged material contained some poison
which inoculated the stegomyia or infected man, it
would be as effective in the autumn as in the summer
or spring, and dredging or excavations would be
equally harmful at any time of the year ; it would
be impossible to say, as has been said, when " digging

9

130 MODE OF TRANSMISSION OP YELLOW FEVER

operations might be safely commenced." But there
is no scientific evidence whatever, as we have seen,
to show that dredged or excavated material is infective,
and the prejudice does not appear to me to be shared
by the natives. Dredging operations have been blamed
as the cause of the outbreak in Belize, but the fact
is lost sight of that at the same time the fever had
declared itself in the surrounding Republics, and that
dredging has been carried on over and over again
without any epidemic occurring. I lay stress on this
clinging to past beliefs because I am convinced that
a great deal of harm is done even at the present time,
and that the necessity for active preventive measures is
unfortunately not fully realised.

Without a clear and precise knowledge of the
method of transmission it is impossible for any authority
to effectively prevent or check a disease like yellow
fever, in which scientific precision, thoroughness, and
immediate action are essential.

DIFFICULTIES OF COMBATING THE DISEASE IN THE PAST

It can be readily understood from the preceding
remarks how hopeless and ineffective were the measures
of prevention used in the past, and that, too, in spite
of the fact that in the more recent periods Listerian
principles of disinfection were applied, carbolic acid
and perchloride of mercury being freely used as dis-
infectants. For instance, although Major Gorgas had,
previous to the advent of Reed, Carroll, Agramonte,
and Lazear, made a vast change in the sanitary con-
dition of Havana, yellow fever was, nevertheless, not

SPECIFIC PROPHYLAXIS 131

affected ; it only ceased after employing methods directed
against the mosquito, viz. fumigation, screening, and
destroying the breeding places of the larva? . In Belize,
during the recent (1905) epidemic, cases of yellow
fever occurred amongst the best-cared -for class of
people living in the best residential houses, where
the sanitary arrangements were excellent.

In the past, from want of knowledge of the true
method of transmission, rigorous house quarantine
was enforced in the epidemic of 1878 in New Orleans,
and vast quantities of disinfectant were used, clothing
and baggage were disinfected or destroyed, but nothing
but the frost — a natural means of preventing the
activity and breeding of the mosquito — stopped the
fever. Ships have been "turned away with the dying
on board, or subjected for long periods to quarantine,
thousands of tons of harmless stone ballast have been
thrown overboard or disinfected, lest they should spread
contagion.

The flood of new light which was thrown upon
the nature of yellow fever soon began to have its
effect. The first great application of the new principle
of prevention of yellow fever was made at Havana
in 1901 by Major Gorgas, under the very able
administration of General Wood. The result was a
complete success ; it has become historic, and con-
stitutes the example to every town in the yellow
fever zone of the truth of the doctrine of the mosquito
transmission and the practicability of its application.
The example has been followed, under Dr. Cruz in
Rio, and Dr. Liceaga in Mexico ; great improvements

132 MODE OF TRANSMISSION OF YELLOW FEVER

have been brought about, but an immense amount
of work still remains to be done. A new stimulus
has, however, now been furnished by the successful
campaign of 1905 in New Orleans, and now in the
Canal Zone, and it is to be hoped that a great deal
of the opposition and apathy still to be met with will
soon give place to hearty co-operation and determina-
tion to rid yellow fever countries of a pest which
causes so much suffering and cripples commerce.

THE INFECTED STEGOMYIA CALOPUS

A knowledge of the following facts is necessary
to understand the application of the prophylactic
measures which are now employed. The yellow fever
patient is only capable of infecting the stegomyia
during the first few days of the onset of the disease ;
the period usually given is the first three days, although
the French authorities extend the infective period.
The yellow fever cadaver after the first three days
of illness is non-infectious ; in consequence the
separate burial ground for yellow fever cases is need-
lessly harsh, quite unnecessary, and unscientific. At
no late stage can the yellow fever patient or the
cadaver infect man directly. In common with many
other non-immunes I was almost daily in the Yellow
Fever Emergency Hospital examining patients and
assisting at post-mortems, but no case of infection ever
occurred amongst us. The well-screened Emergency
Hospital, although crowded with patients and extremely
hot, was, nevertheless, one of the safest places in New

THE EXTRINSIC INCUBATION PERIOD 133

Orleans, because the stegomyia was effectively shut
out. No case of direct transmission from the patient
to man has ever been recorded. The only means is
through the mosquito, as Ross has proved in the case
of malaria.

When the stegomyia has taken a meal of blood
from a patient in the infective stage, it is not at
once capable of transmitting by its bite the virus to
a healthy individual. A very definite number of days
must elapse before the mosquito is itself infective, and
capable of transmitting the virus ; approximately this
period is twelve days.

Therefore, at the termination of the period of
incubation in the mosquito, fresh cases of infection
may be expected to occur in those living in a house
in which the mosquitos were not destroyed.

The symptoms of disease will also not declare
themselves in man at once, for, as just seen in the
case of the mosquito, an incubation period is also
necessary in the case of man, and the period is usually
five days. Consequently an interval of a little over
two weeks usually occurs before secondary cases
manifest themselves.

1. Man suffering from yellow fever after the fifth
day is the reservoir.

2. From this reservoir one species of mosquito,
the Stegomyia calopus, becomes infected and after the
tenth day becomes the insect carrier or transmitting
agent of the disease.

134 MODE OF TRANSMISSION OF YELLOW FEVER

3. The reservoirs and the carriers are both necessary
for the spread of the disease.

4. Method of attack.

(a) Prevent entry of reservoirs (quarantine

measures, etc.).

(b) Exterminate the carrier (anti-adult mos-

quito measures, screening, fumigation,
etc., anti -larval measures, control of
water supply, oiling, drainage).

RATIONALE OF THE CHIEF PREVENTIVE
MEASURES

I. To DIMINISH AND CONTROL THE RESERVOIRS, I.E. TO PREVENT
MAN SUFFERING FROM THE DlSEASE BECOMING A DlSSEMINATOR OF
THE DISEASE.

1. Early notification and diagnosis necessary in
order to isolate the reservoirs as soon as possible.

Careful inquiry into the origin of the numerous
epidemics all over the yellow fever zone proves con-
clusively that yellow fever has usually gained a firm
foothold before the first cases are notified.

In some Central American ports this will prove for
a considerable time to come a perpetual source of
danger, for the inhabitants of these districts are likely
to be more indifferent to the disease, and therefore to
be less careful about notification. No doubt this is
also the reason why it is laid such stress upon in
the opening articles of the Washington Convention of
1905. Commercial reasons, it is alleged, may some-
times operate to hold back notification, but the numer-
ous bitter lessons have shown that the risk of the losses

EARLY NOTIFICATION 135

brought about by allowing the fever to gain a head
is too great. In a modern city swarming with the
stegomyia a concealed case must sooner or later make
itself manifest, and by the time it does so the total
volume of mosquito infection will be so great that
serious disaster is inevitable. Commercial and civic
authorities now commence to realise this, so that the
danger from suppression of the facts is diminishing.
More often the loss of time in early notification is due
to the fact either that cases of the disease are present
amongst the indigenous inhabitants, or that it breaks
out amongst a particular colony of labourers in a town
or district (such as amongst the Sicilians and Italians in
New Orleans in the year 1905, who do not readily seek
medical advice and are often exceedingly suspicious), or
that early cases are not recognised. In districts where
malaria takes a pernicious form, or where dengue is
common, the difficulties of diagnosis must be greatly
increased, and experience under these circumstances
will be of great value. On the other hand, some other
epidemic may have preceded the yellow fever, and
cases which were in reality yellow fever may have been
placed to the credit of the former.

In large cities, as mentioned in the previous chapter,
a clue that something unusual is happening may be
afforded by analysis of the weekly death returns. A
sudden rise in the number of deaths recorded from
malaria in a month, at a season of the year when
malaria has not occurred in previous years, would be
a very suspicious element. In small towns, however,
such indication would probably be too slight to be

136 MODE OF TRANSMISSION OF YELLOW FEVER

of practical value in putting a community upon its
guard.

Where the practitioners themselves have had the
advantage of previous experience in the disease there is
a greater chance of early notification. But I venture
to suggest that experience gained of yellow fever or any
other disease twenty or fourteen years previously is not
so valuable as experience of the disease acquired since
our knowledge of the disease has been very greatly in-
creased. For this reason 1 urge that it would be wise for
one or more of the Government medical officers of any
colony to be sent, as occasion arises, to study any
particular disease affecting the prosperity of the colony,
to some place where the particular disease is common.
This is one of the chief reasons why the medical officers
of the Marine Hospital Service are of such practical
service to the United States.

Of supreme importance also is the necessity of
obtaining a post-mortem examination of the first
suspicious death. The post-mortem findings are char-
acteristic, and do not need microscopic confirmation.

The notification of yellow fever is rightly regarded
as a very serious matter, and a young practitioner will
undoubtedly hesitate before he declares. If he has
notified, and the case does not turn out to be yellow
fever as he supposed, he regards his diagnostic power
as open to criticism, both by other doctors and by the
patient. If he is dealing with a genuine case, and
he hesitates till too late, no fumigation is undertaken
to kill the infected mosquitos at the outset, and in the
meantime contagion is spread — to make itself felt some

EARLY PREVENTIVE MEASURES 137

twelve days afterwards in the same house or in the
vicinity. The situation is unquestionably difficult, and
it can only be got over by friendly inter-reliance
amongst the medical men themselves, and by the
encouragement given by the Senior Medical Officer to
his juniors not to hesitate to express their difficulties
to him nor to think that thereby they suffer in his
estimation as careful observers. I am convinced that
this is very necessary, as there is evidence that this
spirit is not always present.

2. General screening of the reservoirs by the use
of an Isolation Hospital.

This is a most useful measure because amongst the
poor or careless it is very difficult to maintain efficient
control without the employment of much elaborate
machinery and a considerable expenditure of money.

3. Isolation by screening the Reservoir.

A great deal can be done in the direction of pre-
venting the spread of the disease by screening the
patient, and so preventing the mosquitos from becoming
infected and spreading the disease.

Both with regard to the isolation of the patient and
the application of fumigation there is a great want of
precision. It is useless for any one to apply these two
cardinal preventive measures unless they understand
the role of the mosquito in the dissemination of the
disease. The infected mosquitos have to be destroyed
both in the house of the patient and often in the
adjoining blocks, and the patient must be so placed
that no mosquitos can gain access to him. Those who
are familiar with the habits of mosquitos know that it

138 MODE OF TRANSMISSION OF YELLOW FEVER

is not an easy task to bring about their thorough
destruction in living-houses, and that fumigation must
be applied with absolute thoroughness to all parts of
the house, closets, and outhouses ; and that to do this
the house, closets, and outhouses must be so completely
sealed that a mosquito cannot get away through any
chink. Again, those familiar with mosquitos know
that it is very difficult to keep them out of screened
rooms, unless the screening is well done and the doors
are of the proper kind. It is only by the rigid applica-
tion of these two methods that an epidemic can be
stamped out quickly. In the hands of good men,
experience has taught that both these measures can
be applied with scientific precision.

I recommend that both the screening and fumiga-
tion in cases of fever be carried out under the direct
supervision of the medical officer of health and by
his staff.

The staff of the medical officer should, without
delay, be instructed how to seal a room, how to fumi-
gate, and how to test the efficiency of the fumigation.
The methods at present in vogue for fumigating and
disinfecting for diphtheria, scarlet fever, etc., will
not do.

A supply of the necessary materials for screening,
including laths and frames, paper strips, fumigators,
and fumigating material should be kept in the health
office for emergency purposes, arid the health officer
should know where he can immediately procure addi-
tional supplies. Simple rules for the guidance of the
men should be drawn up.

SCREENING 139

In my judgment, in view of the fact that mosquito-
borne diseases cause more sickness and mortality in the
tropics than those arising from any other cause, it is
not too much to expect that sanitary inspectors and
others attached to health offices in the tropics should
be taught the precautions to take against them. This
is, however, frequently omitted, and instead they are
taught principles of European sanitation, which are
inadequate to deal with malaria or yellow fever.

Screening the Patient and Room. — In either doubtful
or well-marked cases the patient is to be at once placed
under bars in charge of a nurse, and the room screened.
The entrance to the room is to be through double doors
(air-lock) provided for the purpose, the original door, if
there was one, having been removed. The portable
screens and doors used for the purpose may be made
with wire gauze or bobinette, the standard gauge of
eighteen meshes to the inch either way being used.
Employing mosquito nets alone, or, as at Belize,
portable screened chambers, is not sufficient — the pre-
sumption being that, as the majority of infected
mosquitos are in the patient's room, it is essential
that both their egress from the chamber and the
entrance of fresh ones be prevented.

If screening cannot be carried out in the patient's
room, or there is reason to believe that the double doors
will be left open or the screens to the windows inter-
fered with, then, without hesitation, the patient should
be removed in the screened ambulance to the isolation
hospital, otherwise the patient becomes a source of
infection in the district.

140 MODE OF TRANSMISSION OF YELLOW FEVER

II. To EXTERMINATE THE CARRIEBS

Sealing and Fumigating. — Preparation for fumiga-
tion should have started with the screening. Not only
the sick chamber, but very possibly also other rooms in
the house harbour infected specimens of the stegomyia.
The rule of procedure should, however, be absolute,
and that is that the entire house must be fumigated,
with the exception of the patient's room, which is
screened. Incomplete and imperfect fumigation are
the principal reasons of not being able more promptly
to suppress yellow fever.

Houses and huts in tropical countries have usually
innumerable large and small openings in roof and sides,
and it is contended that it would be difficult to seal
them, or halls, stores, or markets without elaborate and
expensive wooden framing. As a matter of fact, and
proved in numerous instances in tropical countries, an
intelligent workman can, in an incredibly short time,
paper over a whole archway, hall, or even court.
By the use of a few supporting laths, and with stout
and thin paper, the very large openings can be com-
pletely sealed. The stout paper necessary for covering
large openings can usually be procured locally and at
once. Paper cut in rolls, three inches wide, is exceed-
ingly useful for pasting along the cracks, but it would
be required to be ordered and to be kept in stock. In
an emergency, however, strips of newspaper could
readily be cut. Although it is recommended to seal
the rooms from the inside, I think there is an advantage
in sealing windows, etc., from the outside in order not

FlG. 26. PAPER-SCREENING AN ARCHWAY PREVIOUS TO

FUMIGATION, NEW ORLEANS,
p. 140]

FUMIGATION 141

to disturb any mosquitos which may be present. If
there are any fireplaces or other holes they will require
to be sealed from the inside. The doorway is left
open till the last to introduce the fumigating materials
and to light up ; when this has been done the door is
brought to and sealed, and the time noted in a book
kept for the purpose. The medical officer or the chief
superintendent should personally examine to see that
the sealing is carried out effectively. A small open
chink admitting light is sufficient to attract mosquitos
to it ; then they make their escape. Halls, water-
closets, or outhouses must not be forgotten.

Considerable objection amongst the poorer classes is
usually taken to the disturbance of their homes and their
displacement by the fumigation. Afa excuse, other than
severe illness in a room, should be taken as exempting
any part of the house from fumigation, except the sick
room, which should be fumigated as soon as possible.

After the allotted time necessary to thoroughly
complete the fumigation is up, the doors are opened
and the floors swept. Some of the mosquitos may only
be stupefied, and it is necessary that they be all burnt
or otherwise destroyed.

After the patient is convalescent, or after death, the
patient's room is to be fumigated.

Materials and Apparatus to be used in Fumigation,
and precautions to be taken. — No guesses at the amount
of material to be used are to be made, but the room
should be carefully measured and materials proportioned
to cubic capacity as follows (small closets and wardrobes
to be opened) :

142 MODE OF TRANSMISSION OF YELLOW FEVER

Pyrethrum Powder. — 3 Ib. to 1,000 cubic ft. applied
for three hours, and it is better that the 3 Ib. be
divided amongst three pots than that all the powder
be put in one pot. The pots to be placed in pans
containing a little water. Pyrethrum powder is
used for rooms close to the sick patient, as the fumes
which might escape from sulphur fumigation are
irritating.

Pyrethrum powder is also used in cases where
brass-work, pianos, telephones, instruments, etc., are
present.

Sulphur. — 2 Ib. to 1,000 cubic ft. The pots
containing the sulphur are to be placed in pans con-
taining 1 in. of water. The sulphur is to be started
by alcohol, and care must be taken to see that it is
well alight. Duration, three hours. Brass-work and
instruments are liable to injury ; they should, therefore,
be removed.

Camphor and Carbolic Acid. — The mixture consists
of equal parts camphor and crystallised carbolic acid
dissolved by gentle heat. It is an exceedingly good
fumigator, does not injure furniture, clothes, or brass-
work ; the odour is pleasant and smells of camphor,
A room has a refreshing smell after its use.

Four ounces are vaporised per 1,000 cubic ft. for
two hours ; the material is placed in an open pan
placed over a spirit or petroleum lamp, white vapour
is given off.

To test the efficiency of the fumigation, it is very
useful to enclose some twenty or more mosquitos in
a cigar or other small box covered on one side with

GENERAL FUMIGATION 143

muslin. The box is placed on the floor, and the
mosquitos should be dead at the end of the fumigation.
They should be kept, however, to see if they revive.

Avoid risk of setting fire to the premises by using
care and foresight.

Fumigation of Adjacent Houses and General Fumi-
gation.— It is most important that the houses in the
vicinity of the house in which a case of yellow fever is
declared should be fumigated at once. Powers are
often sought by the authority to compel owners or
occupiers of houses, building lots, outhouses, and
premises situate within 100 yards of the infected house
or premises, to destroy all mosquitos, larvae, pupse, etc.
I am strongly of opinion that this is not sufficient.
The householder cannot, as a rule, carry out fumiga-
tion as described above. It can only be carried out
effectively by the proper staff, which should be that
of the medical officer of health. The result of the
householder carrying out fumigation is that the
majority of the mosquitos are not killed, that cases
of yellow fever occur in the so-called fumigated houses,
and that the method is brought into disrepute. I do
not think that the authorities always realise the
necessity of issuing stringent directions for the destruc-
tion of the yellow fever mosquito. The following
notice, for instance, is of little practical use:

" Inside of houses care should be taken to destroy
mosquitos as much as possible, especially if there are
any cases of fever in the neighbourhood. This may
be done by burning either insect powder or tobacco

144 MODE OF TRANSMISSION OF YELLOW FEVER

leaf freely in the room after closing the doors and
windows ; afterwards sweeping the ceilings, walls, and
floors, and destroying the sweepings (which will contain
dead and stunned mosquitos) by fire."

This paragraph is of very little use to the house-
holder, and it certainly will not bring about the
effective destruction of mosquitos ; on the contrary, a
sense of false security may ensue. Those who have
worked with culicides know that the quantities of
materials to be used must be specified, the sealing must
be complete, and the exposure a definite time ; that a
little practice is necessary, and that tobacco leaves are
not used because it is exceedingly difficult to fire them,
that special apparatus is necessary, and that the smell
penetrates everything. I therefore recommend that
the district authorities be given powers to execute
fumigation in the houses surrounding the infected
house, and that the distance be not specified, but that
this be left to the discretion of the authority acting on
the advice of the medical officer.

Whilst I am of opinion that the fumigation of an
infected house and the houses surrounding should be
carried out by the health authorities, I think that the
inhabitants of the town should be encouraged to
fumigate their houses in a systematic and scientific
manner, and not to rely on carrying a little insect
powder alight on a shovel through the rooms, which
is as effective as the old native plan, still adopted in
some places, of lighting bonfires in the streets. For
that end I think that it would be of advantage if the

STEGOMYIA CALOPUS 145

District Board would undertake for a nominal fee the
fumigation of houses when they were applied to. If
the camphor-carbolic compound is used, householders
would be distinct gainers, as moths and objectionable
vermin would be killed, and there would be no damage
to furniture or clothes by either smell, smoke, smuts
or corrosion.

10

CHAPTER XIII

THE BREEDING PLACES OF STEGOMYIA. STEGOMYIA
SURVEY AND INDEX

THE STEGOMYIA CALOPUS

THIS mosquito, which has been conclusively demon-
strated to be the sole transmitter of yellow fever, is
a very characteristic and familiar one throughout the
yellow fever zone. It is surmised, however, that it
was originally imported into the Southern United
States from the tropics through the medium of com-
mercial intercourse. It is common on the coast towns
along the Gulf, the Caribbean Sea, and on the Atlantic
coast of tropical and subtropical countries. It is,
therefore, a mosquito of the seaports, and this is one
of the reasons why it is so essential to eradicate it,
especially in view of the continual opening of new
ports throughout the tropics. It is capable of flourish-
ing over a wide area, and Dr. Howard of Washington
states from collected observations that the species can
flourish wherever the sum of the mean daily tempera-
ture above 6° C. (43° F.) throughout the year does
not fall below 10,000° C. It is not by any means
exclusively confined to the coast line, observations

146

HABITS OF STEGOMYIA 147

showing that in places where it is capable of surviving
the winter it readily spreads into the interior, follow-
ing the trade routes, whether rail or river. It has
already, it is stated, reached an altitude of 4,200 feet
in Mexico (yellow fever working party Report), and,
as shown by the great outbreak of yellow fever in
the interior of Guatemala and Spanish Honduras in
1905, it has well established itself along the Puerto
Barrios and Puerto Cortez railroads.

It is essentially a domestic mosquito, and, there-
fore, a mosquito of cities. Whilst the malaria-bearing
Anophelines are usually confined to the outskirts of
large cities, having been gradually driven away from
the centre of the towns owing to the building up of
inhabited blocks, and to drainage, the stegomyia, on
the contrary, seeks the central and more crowded
parts of the city — the places, in fact, where it finds
the necessary and innumerable water receptacles in
the closest proximity to the dwelling houses. The
knowledge of this characteristic is of the utmost
importance in all epidemics. It is, indeed, a cistern-
breeding mosquito, and is often known on this account
as the " cistern mosquito." It is found in abundance,
therefore, in those places where rain-water is collected
and stored for domestic purposes ; no wonder, then,
that it was present in New Orleans, with its sixty to
seventy thousand water-vats.

The mosquito is readily recognised by the white
bands upon the legs and abdomen, the lyre-shaped
pattern in white on the back of the thorax. It is
due to the presence of these bands and spots that

148 THE BREEDING PLACES OF STEGOMYIA

this black-and-white mosquito is often called the "Tiger
Mosquito." The females only suck blood, and they
appear to attack man both during the day and at
night. Between 4 p.m. and midnight is stated by
some to be their most active period. For this reason
it is necessary to take precautions against them at
night as well as by day. The stegomyia is subject to
seasonal variations, cold being the great factor in
stopping biting activity and breeding. Below 75° F.
development is retarded, and the eggs kept at a
temperature of 68° F. do not hatch. It is for this
reason that the onset of cold weather in New Orleans
soon put an end to yellow fever, and that the city
is said to enjoy a natural immunity from December
to May. Too much stress must not be laid upon this,
however, as the fact remains that the mosquito readily
survives through the winter. The distribution and
history of this mosquito in towns during these months
require close investigation. Each female lays between
twenty and seventy-five eggs on the surface of the
water ; these are minute, black, and cigar-shaped ; they
are very resistant, and have been kept in a dry state
for periods varying between ten and twenty days, and
freezing does not destroy their fertility. The eggs
are therefore a ready means of tiding over the cold
weather. Under suitable conditions of temperature
the eggs hatch out, according to different observers,
in from ten hours to three days. The result is the
well-known " wiggle waggle," or " wiggle tails," the
larval stage of the mosquito. The larvae are very
active and very sensitive, and very rapidly disappear

RESISTANCE OF THE LARVAE AND EGGS 149

from the surface of the water in the cistern if the
least disturbance occurs. For this reason the water
barrel or vat must be approached gently if one is
desirous of obtaining specimens and examining them,
otherwise they wriggle very rapidly to the bottom.
Another point has also to be borne in mind, and
that is, that they cling to the sides of the receptacle
and hide in the crevices, so that it is by no means
easy to get rid of them. Simply emptying the water
out of the receptacle will not suffice ; a very thorough
rinsing and cleansing is necessary. The duration of
the larval period is from six and a half to eight days
normally ; but, of course, they may remain in the
larval stage for a much longer period ; for instance,
I brought some specimens alive to Liverpool which
I collected at Puerto Barrios in Guatemala, on
October 26. They were kept in a large test-tube
either in my pocket or in my living room, and they
were exposed to great variations of temperature, the
cold increasing as I travelled from New Orleans to
New York, and from New York across the Atlantic
to Liverpool. The journey occupied twenty-five days,
and they were only supplied with clean water. The
larval stage is succeeded by the pupa stage, which
lasts two days or under, and from the pupa arises
the image or winged mosquito.

Dr. Francis of the United States Marine Hospital
Service reported, on March 25, 1907, upon many
interesting points in connection with the life cycle of
Stegomyia calopus, as observed in Mobile. Amongst
them he mentions that larvae were never found breeding

150 THE BREEDING PLACES OF STEGOMYIA

in the unpaved street gutters or ponds, or in fact in
any natural earth-bottoms, but were always in artificial
water-containers. The eggs may retain their vitality
when kept dry for six and a half months. In my
experience in searching for stegomyia larvae — and it
is now considerable — I have invariably found the rain-
water barrel the seat of election for breeding purposes.
Given an old wooden barrel, just coated with a green
slime, and " worms " will almost invariably be found.
So expert did my men become in detecting likely
breeding places that they frequently affirmed that
worms must be in a barrel from its appearance ; yet
a cursory examination of the water failed to reveal
their presence. When, however, the water was poured
out to all but a teacupful at the bottom, and this was
well agitated, invariably the worms were found. This
property of disappearing to the bottom of the recep-
tacle and hiding in the chinks between the staves and
in the groove at the bottom is very characteristic.
After barrels come washing- tubs, olive jars, and then
every form of water receptacle. I have found them
in the blacksmith's shop in his cooling barrel or tank,
and in logs. It can be stated that, wherever in or
around a house water stagnates, there the larvae will
be found. Their presence is a positive test of stagnant
water. In the living and bed rooms they are frequently
found in receptacles for holding flowers, and in which
the water is imperfectly removed ; very frequently,
indeed, in vessels in which a cutting of a croton plant
is placed in order to make it take root. In my opinion
the essential point is that the stagnant water be in or

STEGOMYIA SURVEY 151

around the house — that is, in the yard or garden. One
does not encounter them breeding, at any rate in
large numbers, away from man ; they are as domestic
as the flea, bug, and cat. In a few instances I have
found them in drains in the houses, mixed with culex
larvae. In these cases the water was dirty. This latter
point recalls the statement often made that larvae purify
water, and that they are useful in the drinking-water
butts because they will remove pathogenic organisms
should any gain access. For this reason certain
municipal authorities have not been so active in their
destruction as they might otherwise have been. We
have no evidence whatever that they do remove
pathogenic germs ; their natural food is green algae
and diatoms. But from the practical point of view,
we know the danger of stegomyia larvae and how surely
yellow fever will spread wherever these larvae are, that
it is hardly practical to keep these larvae for any sup-
posed good they may do when we know the positive
disaster they bring about.

Stegomyia Survey. — In every town I have visited
for the purpose of strengthening or drawing up
measures against fellow fever, it has been my invariable
rule to visit either all the houses or to take repre-
sentative blocks, and go through each house, garden,
and yard systematically. In these tours I am accom-
panied by the sanitary inspectors and one or more
medical officers. We are armed with white enamelled
iron spoons, with which we can rapidly take a sample
of water and see if larvae are present. I examined
all water, drinking and washing, inside or outside the

152 THE BREEDING PLACES OF STEGOMYIA

house, and whether contained in cisterns, barrels,
buckets, tubs, tins, goblets, vases, " monkeys," " destil-
ladores," wells, antiformicas, broken bottles, etc. If
larvae are found for the first time, the householder is
handed a printed slip setting forth the danger of having
larvae, and the penalty for the same. If after previous
warning they are found, the householder is summoned.

In the West Indian Islands the percentage of
stegomyia breeding places in the towns and large
villages has varied from 4 to 10 per cent. Our aim
is to reduce it to zero.

NOTE. — The stegomyia is often described as the mosquito of seaports, but
it must always be remembered that it is by no means limited to them. It is
simply more abundant in seaports, because there are more people crowded
together there ; but let the labourers of the population migrate into the
mountains with their paraphernalia and innumerable receptacles for holding
water, and stegomyia will go as certainly as do the flea, the dog, the cat,
and all the other domestic animals and insects which follow man along his
paths, be they by rail or over sea.

THE YELLOW FEVER CAMPAIGNS IN (1) HAVANA, CUBA;
(2) NEW ORLEANS; (3) HONDURAS; (4) RIO ; SANTOS ;
(5) CANAL ZONE ; (6) WEST INDIES ; AMAZON

THE ANTI- YELLOW FEVER CAMPAIGN IN
HAVANA, 1900

THIS will always remain one of the first and one of
the greatest examples of what has been done to stamp
out a disease by concerted intelligent action and using
the latest and most modern weapons. When the
American Government took over the administration
of Cuba, one of the first things to be done was to
make Havana a livable place. Hitherto it had been
a notoriously unhealthy place, the natural home of
most pestilences, and with a corresponding mortality.
Thus we know that between the years 1853-1900 there
perished in the city of Havana alone 35,952 persons
of yellow fever. This is equivalent to 754 a year,
64 a month, or to 2 deaths a day. And now, after
General Woods, Colonel Gorgas, Guiteras, Finlay and
their other distinguished colleagues, to whom we have
had occasion to refer, took the situation firmly in hand
and organised a thoroughly efficient sanitary adminis-

153

154 THE YELLOW FEVER CAMPAIGNS

tration and a special raid upon the breeding places of
the stegomyia, the death rate for Cuba has come down
to between 11-17 pro mille ! It must never be for-
gotten that it was in Cuba that the crucial and famous
test was made that only by the stegomyia could the
poison of yellow fever be transmitted. This test was
made, as we have already seen in a preceding chapter,
by Reed, Carroll, Agramonte, and Lazear. Yellow
fever has now been checked and annihilated. Thus
in 1907 only one case of yellow fever is reported in
Havana, and the general death rate is 17 pro mille.
It can be with truth said to-day, as stated in the
current number of the " Bulletin of Public Health
and Charities of Cuba," that during the three years
between 1905-9 there was only a total of 359 cases
of yellow fever throughout the whole republic, and
during that same period only 40 deaths in Havana ;
whereas in the days of old there were thousands of
cases.

On the date upon which this new Bulletin was
issued (April of this year), the republic was declared
free from small-pox, yellow fever, and bubonic plague.
This is the result of the use of modern weapons — a
complete triumph for civilisation.

THE YELLOW FEVER CAMPAIGN, NEW ORLEANS,

1905

This having been my first campaign in which I was
present as a volunteer, I will trace the steps by which
the fever was overcome, for that purpose reproducing
the proclamations which were issued in their chrono-

ORGANISATION OF THE CITY 155

logical order. They will always act as a guide in the
case of a yellow fever outbreak. New Orleans at the
time had an estimated population of 325,000 of mixed
nationalities. There was a large Italian and Sicilian
labour population housed in the oldest and dirtiest part
of the town, and amongst them yellow fever broke out.
It was clear that before the citizens recognised that
they had yellow fever in their city, that disease had
gained a firm foothold unperceived. Then, when the
seriousness of the situation was realised, the first step
was to organise the resources of the city to combat the
disease, and the following manifesto was issued by the
Health Authority and Advisory Committee.

Step I

An emergency exists in our city to-day which
demands the attention of every individual, with the
view to limiting and preventing the spread of epidemic
disease. It has been scientifically proved that the
mosquito is the only means of the transmission of
yellow fever, and measures should be especially directed
against them. It is especially urged by the undersigned
that the following simple directions be followed by the
householders of this city for the summer months : —

1. Empty all unused receptacles of water. Allow
no stagnant water on the premises.

2. Screen cisterns, after placing a small quantity of
insurance oil (a teacupful in each cistern) on the surface
of the water.

3. Place a small quantity of insurance oil in cess-
pools or privy vaults.

156 THE YELLOW FEVER CAMPAIGNS

4. Sleep under mosquito nets.

5. Screen doors and windows wherever possible with
fine screen wire.

Step*.— APPEAL FOR CIVIC CO-OPERATION

On Monday, July 24, a Proclamation was issued,
signed by the Mayor, and concurred in by the Medical
Authorities, setting forth the situation and calling upon
the citizens to co-operate with the Health Authorities
in stamping out the fever. It runs as follows ;—

THE MOSQUITO CAMPAIGN

PROCLAMATION

MAYORALTY OF NEW ORLEANS,

CITY HALL, July 24, 1905

To THE PEOPLE OF NEW ORLEANS : —

The health situation in this city is serious, but
not alarming. Because of this situation, quarantine
has been declared against New Orleans by several
States and Cities. It is proper that the actual facts be
recognised and dealt with resolutely and calmly.

It is authoritatively stated by eminent sanitarians
that within recent years visitations of yellow fever,
more widely spread than that which is in our city,
have been successfully met and absolutely suppressed
by methods whose potency has been demonstrated by
ascertained results, and the application of which is
simple. Those methods are now adopted by our own
State and City Health Authorities, with the volunteer
assistance of the United States Marine Hospital
Service, and the Orleans Parish Medical Society of
this parish. To the perfect and speedy success of the

OBEDIENCE TO AUTHORITY 157

measures to be followed, the co-operation of every
householder is necessary. That given, the people may
confidently expect a speedy release from the trying
conditions in which they are now placed, and from
apprehension of its recurrence in the future.

I, therefore, as Mayor, urge all citizens and house-
holders to render cordial and ready obedience to the
instructions which may from time to time be given by
the Health Authorities, and to render every aid within
their power to those Authorities in the earnest efforts
which they are now making, and in which they will
persist for the absolute stamping out of this infection.
Those instructions are not difficult of performance ;
they are easily to be understood, and can be followed
with but little expense. Since the consensus of sanitary
and medical opinion of to-day is that the infection
of yellow fever is transmitted, or can be transmitted,
only by means of the sting of the insect known as the
" cistern mosquito," the following advice recently given
by Dr. Kohnke, the City's Health Officer ; by Dr.
Souchon, President of the State Board of Health ; Dr.
White, Surgeon of the U.S. Marine Hospital Service,
and an Advisory Committee of the Orleans Parish
Medical Society, should be willingly and implicitly
obeyed by every householder in this city.

1. To keep empty all unused receptacles of water
in every house, and allow no stagnant water on any
premises.

2. To screen all cisterns after placing a small
quantity of insurance oil (a teacupful in each cistern) on
the surface of the water.

3. To place a small quantity of insurance oil in
cesspools or privy vaults.

4. Sleep under mosquito nets.

158 THE YELLOW FEVER CAMPAIGNS

5. Wherever practicable, screen doors and windows
with wire screens of close mesh.

The foregoing advice may from time to time be
given by the Health Authorities with more particularity.
Whatever emanates from them must be accepted as
given for the good of the city and the preservation
of every individual of its population, and should be
respected and followed to the letter.

I repeat, upon the information of those qualified
from actual investigation and scientific knowledge to
speak upon this subject, that the situation in our city
is not alarming, and that if it is treated by our people
earnestly and intelligently, that this situation will soon
be eliminated and demonstration will be made to the
world that for the future the infection of yellow fever
can have no permanent lodgment within the borders
of the City of New Orleans.

Step 3.— APPEAL FOR EARLY NOTIFICATION

ISSUED BY THE HEALTH AUTHORITIES AND ADVISORY COMMITTEE

July 24, 1905

DEAR DOCTOR,

We want to specially urge you to report all
your cases of fever — malarial, typhoid fever or fever
of any kind — during this summer, to the City Board of
Health. It is absolutely essential to the checking of
the spread of yellow fever in our city that all cases
of fever should be promptly and conscientiously re-
ported. Our patients, the public and the surrounding
communities, will naturally look to our profession in
this great emergency, and the responsibility rests in
a great measure with us to check this condition, or
at least to limit its too extensive spread. It is a
well-known and scientifically proven dogma that the

EARLY NOTIFICATION 159

mosquito theory is to be accepted as a fact ; then we
must exert ourselves to the utmost to destroy the mos-
quito, the only host of transmission of yellow fever.
Let us, then, make a consistent campaign against it,
educate our patients regarding this situation and the
danger of it, and direct them to place patients im-
mediately under netting pending action of the Board of
Health. Neither your patient nor the household will
be subjected to the obnoxious house quarantine of
several years ago.

Above all things, report your cases promptly, to
permit us to check any further foci of infection.

Even if you are not positive that the mosquito is
the only source of transmission of yellow fever, give
your city the benefit of the doubt in this important and
vital matter.

Step 4.— APPEAL FOR IMMEDIATE SCREENING OF
ALL SUSPICIOUS CASES AND FOR FUMIGATION

ISSUED BY THE ADVISORY COMMITTEE

ORLEANS PARISH MEDICAL SOCIETY,

NEW ORLEANS, LA.

DEAR DOCTOR,

In an earnest attempt to work in harmony
with the plan of procedure adopted by the Health
Authority and the U.S. Public Health and Marine
Hospital Service, now being enforced in a general
inspection of our entire city, we want to suggest to
you, as your Advisory Committee acting with these
bodies, that you report at once any case of fever in your
practice remotely suspicious of being yellow fever. If
you want to do your city the greatest good in this hour
of trial, immediately constitute yourself as a Health
Officer for the premises of the sick you are called to

160 THE YELLOW FEVER CAMPAIGNS

attend. Even before the regular Sanitary Inspector of
the Board reaches the house, place the patient at once
under a mosquito bar, pending further proceedings.
Also order at once another room fumigated with
sulphur — 2 Ib. to the 1,000 cubic feet — and then
thoroughly screen it. If it cannot be done in a perfect
manner, at least order all the openings screened with
either cheese cloth or other light material, well packed
so as to allow no mosquitos in the room. Keep only
one door free, covering all the transoms in the same
manner. On entering the door beat the air thoroughly
with a cloth before opening. When the room is
prepared, remove the patient to it, fumigating the room
just vacated in the same manner.

After the first three days of the fever the Stegomyia
fasdata cannot be infected from that patient, but we
must be careful to keep the room well closed until the
final fumigation or destruction of any mosquitos which
might have remained in the room. Look to the general
hygiene of the house, inquire whether the cisterns or
any other open receptacles of standing water about the
premises have been properly oiled or screened. Act
in this manner regardless of the work which will be
done by the constituted authorities, for your own
personal good and for the greatest good of your city.
In other words, Doctor, take every possible precaution
to protect all of your fever cases from being bitten
by mosquitos during the first three days of fever.

Our interest in this entire matter is the same as
yours, and we must work for the same purpose. The
part to be played by our profession is an extremely
important one ; the faith and trust of the entire com-
munity is placed on our shoulders, and we must fully
deserve the confidence reposed in us.

EDUCATION OF THE PUBLIC 161

Step 5.— APPEAL FOR AN EDUCATIONAL CAMPAIGN

ISSUED BY THE ADVISORY COMMITTEE

Another circular is issued on the 24th, directed
to the Board of Health, pointing out the necessity
of a campaign of education, and urging the im-
portance of asking the clergy to especially disseminate
knowledge from the pulpit in the matter of yellow
fever. The circular then proceeds to give useful
information in case of infection and finally appeals
for united action in a general warfare against the
stegomyia.

NEW ORLEANS,

July 24, 1905

GENTLEMEN,

The condition existing at present is one that
calls for the most strenuous, prompt and vigorous
measures capable of institution. In view of the absence
of the necessity for obnoxious local or house quarantine,
the co-operation of physician and householder should
be a matter of comparatively easy solution. A cam-
paign of education should be boldly inaugurated. The
clergyman, during his rounds and from his pulpit,
should be a valuable agent in the dissemination of this
knowledge. The Advisory Committee of the Orleans
Parish Medical Society begs to recommend that the
following measures be instituted at once, with the view
of stamping out the few foci of infection of yellow fever
which now exist in our city.

Cases of fever of any character developing in the
infected area may be regarded as suspicious, and the
patient immediately protected from mosquitos. The
house, cisterns, yards, drains, gutters, cesspools and

11

162 THE YELLOW FEVER CAMPAIGNS

vaults should be carefully inspected, and no breeding
spots for mosquitos should be overlooked.

The gutters and streets must not be neglected.

If the case proves to be one of yellow fever, the
house must be screened and the rooms in the house
other than the one occupied by the patient must be
fumigated, to destroy all mosquitos in them. When
the case ends, either by recovery or death, the room
occupied by the patient must be fumigated, for the
same reason.

The success of these procedures will largely depend
upon the promptness and earnestness with which
mosquitos are prevented from coming in contact with
the patient and the destruction of all mosquitos in the
room after the patient is cured or dies.

The new foci of infection must be diligently sought
and drastic measures adopted for stamping them out.
It is only through the proper conciliatory education
of the physician and the layman, and through their
sincere co-operation, that anything can be accomplished.

For the vast portion of the city not infected, we
recommend that a sufficiently large force of men be
immediately organised to place oil in all unscreened
cisterns, or other breeding places of mosquitos, and
distribute circulars amongst householders enlisting their
co-operation.

All gutters should either be flushed or oiled.

An active, vigorous and persistent warfare on
mosquitos should, in our opinion, be immediately
instituted from one end of the city to the other, as
in this way localities now healthy may be kept so, even
though foci of infection be introduced. We believe
that the sanitary regeneration of this city depends
entirely upon prompt and vigorous action on your part.

A WARNING 163

With the profoundest assurance of our heartiest
co-operation with you in any movement to better
the sanitary conditions of the city.

Step 6.— A WARNING TO BEWARE OF THE DANGER
OF OVERLOOKING THE LESS OBVIOUS BREEDING
PLACES OF THE STEGOMYIA

A very useful and practical notice is also sent
out by the Advisory Committee directing attention to
the importance of not overlooking possible receptacles
of water in the house, as pitchers, flower-pots, etc.
It reads as follows : —

ORLEANS PARISH MEDICAL SOCIETY,

NEW ORLEANS, LA.

We desire to call your special attention to the
wrigglers seen inside of the residences of people.
Probably the public in the fight against the mosquito
have directed all their efforts against the cisterns and
the barrels or the outside containers. Still a source
of great danger also exists inside of the bedrooms in
the water-pitchers, in the dining-room, or in the
conservatory in the water-pots, vases or pots of plants.
A frequent error and a great menace is the habit which
some householders have of only partly emptying a
water-pitcher, and though it is refilled daily it is never
emptied entirely, leaving always one-half pint or so
for the larvae to develop. Any physician in his daily
rounds can see this illustrated by inspecting the various
water-pitchers in the bedrooms.

On this same line we beg to again call your atten-
tion to the accumulation of water in the urns in the
cemeteries as well as in the sagged gutters of the
house drains, which are a great source of mosquito
breeding after rain.

164 THE YELLOW FEVER CAMPAIGNS

Step 7.— APPEAL FOR A MORE SKILLED MEDICAL
BODY TO CONDUCT THE CAMPAIGN

On August 4, the fever still making headway in
spite of all local efforts, the Advisory Board takes
very decided action. It candidly expresses the opinion
that it has not confidence in the efficacy of the work
performed up to date ; that this work must be absolutely
perfect in its working to be efficient, and that to accom-
plish the desired reorganisation it is necessary to call
in the assistance of the Public Health and Marine
Hospital Service of the United States.

NEW ORLEANS,

Augmt 4, 1905

CITY BOARD OF HEALTH.

GENTLEMEN,

As there has appeared a new case in the
Frye focus, which has been in existence since Monday,
while we had been told that the instructions previously
agreed upon in the management of all maturing foci
had been rigidly carried out, and especially so in this
case. As we are not satisfied that the fumigation
performed by the City Board of Health has been
absolutely effective, we feel, as we have shared some
of the responsibility of this work, that it is a matter
of too great importance to be kept on in this unorganised
and unsystematic manner. This is the first serious
visitation of yellow fever in this country since the
mosquito has been recognised as the only mode of
transmission, and we are unwilling to support the
City Board of Health in what we consider an ineffective
service.

DANGER OF MILD CASES 165

Step 8.— LETTER WARNING MEDICAL MEN NOT TO
OVERLOOK THE MILD TYPE OF YELLOW FEVER
WHICH MAY BE FOUND IN THE NATIVE BORN

NEW ORLEANS, LA.,

August 17, 1905

DEAR DOCTOR,

In the consistent campaign we are now waging
throughout the city against the fever, we want to enlist
your hearty assistance.

You have shown up to now a uniform activity, and
if some of the work already accomplished begins to
show some little improvement, we feel it is greatly
due to your co-operation. This, though, is a crucial
moment, and you must keep up reporting all your cases
with unfailing promptness. The native born will un-
doubtedly begin to be affected, and will show the lightest
and mildest types of the disease; it is specially with
regard to these that we wish to warn you, for it is as
important to the success of the work being done by the
U.S.P.H. and Marine Hospital Service, that the mild
cases be reported as well as the marked cases. These
must be screened as carefully as others.

One stegomyia infected, in the first three days from
such a case, can produce a number of serious and even
fatal cases. The means employed are being systematised
and rendered less objectionable daily by the service, so
let us endure a little inconvenience for the welfare
of all.

Beware of the so-called immunisation or acclimatisa-
tion fever, and report these cases as promptly and
rigidly as if they were perfectly characteristic, so that
the authorities will be able to give them the same

SAN IT All Y THE ATMEN T.

166 THE YELLOW FEVER CAMPAIGNS

Step 9.— APPEAL TO HOUSEHOLDERS TO DELAY
"MOVING DAY11 ON ACCOUNT OF DANGER OF
SPREADING INFECTION

In view of the near approach of " Moving Day "
(October 1) the undersigned deem it their duty to
direct your attention to the danger likely to attend
a general moving of tenants from house to house.

Persons moving from infected localities may later
develop the fever in uninfected neighbourhoods, thereby
developing new foci. Others now residing in uninfected
houses may contract the disease by removing into
houses where mild cases of fever may have occurred
and recovered without medical attention, and conse-
quently escaping fumigation. Non-immunes coming
into such houses will almost inevitably contract yellow
fever, thereby adding to our present troubles.

We do therefore urge the importance of taking such
steps as may be necessary to delay the general movement
for at least thirty days.

ADVISORY COMMITTEE, O.P.M.S.

Step 10.— DANGER OF REMOVAL OF TEMPORARY
CISTERN SCREENS

NEW ORLEANS, LA.,

September 13, 1905

There being a pretty general understanding in the
community that the cheese-cloth screens over cisterns
have to be removed by October 1, and the regular
18-mesh to the inch wire screen substituted by that
date, we believe that a number of persons are now
having this change done to the great danger of a
general liberation of all mosquitos imprisoned or bred
from the pupa? in the cisterns. We cannot afford, in

PROTECT THE WATER 167

the final fight of checking yellow fever in our midst,
to neglect so important a matter as this, so we strongly
urge that the change from cheese cloth to wire, if not
legally postponed until Dec. 1, shall be by having the
wire screens placed over the cheese cloth without
removing the latter.

ADVISORY COMMITTEE, O.P.M.S.

Public opinion having been educated, the City
Authority feels now strong enough to bring in an
ordinance to compel landlords to screen all vats.

Step 11.— A WATER-CISTERN SCREENING
ORDINANCE

MAYORALTY OF NEW ORLEANS,

CITY HALL, August 2, 1905

NO. 3196 NEW COUNCIL SERIES

AN ORDINANCE, prescribing the manner in which
water liable to breed mosquitos shall be stored within
the limits of the City of New Orleans.

Section 1. — Be it ordained by the Council of the
City of New Orleans that no water liable to breed
mosquitos shall be stored within the limits of the city,
except under the following conditions.

Section 2. — Water kept in cisterns, tanks, barrels,
buckets, or other containers for a period longer than
one week shall be protected from mosquitos in the
following manner : Cisterns shall be covered with oil
by the property owner or agent thereof within forty-
eight hours after the promulgation of this ordinance
and provided with a cover of wood or metal ; all
openings in the top or within 6 ft. of the top larger
than Y^ in. to be screened with netting of not less than
18-mesh, or cheese cloth or other suitable material by

168 THE YELLOW FEVER CAMPAIGNS

the property owner or agent thereof within forty-eight
hours after the promulgation of this ordinance, provided
that after the first day of October 1905, all property
owners shall be required to screen cisterns with wire
netting of the proper size mesh as required by the
Board of Health in such a manner as to prevent the
entrance of mosquitos.

Section 3. — Tanks or barrels or similar containers to
be constructed in the manner provided for cisterns, or
in some other manner satisfactory to the Board of
Health.

Section 4. — Buckets containing water for longer
than one week (such as fire buckets in cotton presses),
and other similar containers of stagnant water, shall be
covered in such a manner as to prevent the entrance
of mosquitos.

Section 5. — Water in ponds, pools, or basins, in
public or private parks, places of resort or residence, or
in depressions, or excavations made for any purpose,
shall be stocked with mosquito-destroying fish, or
covered with protective netting, or shall be drained off
at least once every week, or shall be covered with
coal oil in a manner satisfactory to the Board of
Health, by the owner or agent thereof within forty-
eight hours after the promulgation of this ordinance.

Section 6. — The Board of Health may, in its dis-
cretion whenever deemed necessary, treat stagnant
water by applying oil to its surface in such a manner
as to destroy mosquitos.

Section 7. — The penalty for violations of this
ordinance or any section thereof shall be a fine of
not more than twenty-five dollars, or imprisonment
for not more than thirty days, or both, and failure to
comply with any provision shall be considered a

"CLEAN UP" CLUBS 169

separate offence for each day of its continuance after
the proper notification by the Board of Health.

Adopted by the Council of the City of New
Orleans.

Step 12.— A DAY APPOINTED TO "CLEAN UP"
IN THE CITY

The following is an appeal to the citizens to
" clean up," and it again should be copied by all
towns in the Yellow Fever zone.

THE MAYOR'S PROCLAMATION

It has come to be recognised as an indispensable
necessity for the eradication of disease, and for the
proper safeguarding of our public health, that our
city should be thoroughly cleaned. Our patriotic
citizens are unanimous in the sentiment and have
generously come forward to aid and assist in such
a movement.

The Executive Committee which was named to
consider and take action upon the thorough cleans-
ing of the city, recommended that Wednesday,
August 9, 1905, be observed as general cleaning-up
day. To that end, and to promote the more expeditious
handling of the accumulations of dirt, it has been
recommended that all householders begin the work
of cleaning their premises Monday, and continue the
same Tuesday, in order that the refuse and pilings
will be ready and convenient for removal Wednesday,
" General Cleaning-up Day."

It has been earnestly and urgently recommended
that all merchants and business men assist in this
work by closing their respective establishments on

170 THE YELLOW FEVER CAMPAIGNS

that day, so that they and their employees may assist
in the .task. There have been many patriotic offers
of carts, wagons, teams and drays, and all contrac-
tors who are engaged in work of public improvement
are urged to contribute their teams to aid in this
laudable undertaking of removing trash and pilings.
The details of this work will be planned and prepared
under the direction and control of the Commissioner
of Public Works, to whom the tender of carts, teams,
etc., must be made as soon as possible in order that
the full programme may be perfected and made
public not later than Tuesday morning.

In furtherance of this great object, I do hereby
call upon every taxpayer and householder to extend
every assistance towards the effective performance of
the work, and urging that all merchants and business
men close their respective establishments on that day,
I do hereby proclaim Wednesday, August 9, 1905,
to be " General Cleaning-up Day."

Witness my hand and seal of office, affixed this
fourth day of August, A.D. 1905.

MARTIN BEHRMAN,

Mayor.

Step 13.— APPEAL TO THE CLERGY

FROM THE CITIZENS1 VOLUNTEER WARD ORGANISATION

NEW ORLEANS, LA.,

July 29, 1905

To THE REVEREND CLERGY :

The influence of the Reverend Clergy is such,
and their loyalty and public spirit have been so often
demonstrated, that we venture to ask your co-opera-
tion with the Citizens' Volunteer Organisations in
the present emergency.

United action produces the surest results.

CLERGY TAKE ACTION 171

We beg to ask that you will speak to your con-
gregations on Sunday, July 30, or at the earliest
date thereafter convenient to yourself, in behalf of
the work now being carried on by the Health
Authorities of the city.

We ask that you will urge them, whether they
believe in the " mosquito theory " or not, that they
will give their hearty assistance to the authorities who
are attempting to stamp out the mosquito, as at least
one source of infection. Urge upon them the patriotic
duty of allowing cisterns to be oiled and screened ;
cesspools to be treated with disinfectants, etc.

Many householders (a small minority, but still
enough to work mischief) refuse permission to the
oilers and screeners to do the work. This refusal
nullifies to a great extent the work accomplished on
the premises of willing householders. In previous
visitations of the fever we have been fighting in the
dark, striking at an unknown enemy coming from a
mysterious source.

The consensus of scientific opinion fixes upon the
mosquito as the agent of transmission of the Yellow
Fever.

The enemy therefore is in sight. So far as your
power extends, then, we beg of you to use it for the
spread of information concerning the mosquito theory,
and to use your influence with your congregations
to hold up the hands of the constituted Health
Authorities.

This office will gladly receive suggestions and will
give all possible assistance to the Ward Organisations.

It is proposed to have two cleaning-up days,
by proclamation of the Mayor, although this has not
at this writing been definitely decided.

172

The daily newspapers will announce it when deter-
mined. We will ask you to bring this matter also to
the attention of your congregations.

Step 14.— REQUEST TO THE HOUSEHOLDERS OF

THE WARD TO OBSERVE A GENERAL

FUMIGATION DAY

NEW ORLEANS, LA.,

September I, 1905

Saturday, September 2, and Sunday, September 3,
have been suggested and agreed upon as GENERAL
FUMIGATION DAYS, between the hours of 10 a.m. and
12 a.m., for the purpose of destroying mosquitos,
which are recognised as the medium of communica-
tion of yellow fever, and we make the following
suggestions as to the manner of fumigating :— •

1. Close all outside openings, such as doors and
windows, and make the house (or room) to be fumi-
gated as tight as possible, by closing or stopping the
fireplace and other openings with paper pasted over
them.

2. Pianos should be removed from the rooms to be
fumigated.

3. Place an iron vessel, flat skillet preferred, in pan
or tub with about one inch of water in it ; place roll
of sulphur or flower of sulphur (two pounds to each
ordinary-sized room to be fumigated) in the skillet ;
pour over it a small quantity of alcohol, about two
tablespoonfuls to the pound, and set fire to same.

4. Keep the house, or rooms, closed for two hours
after lighting the sulphur.

Those who prefer to do so may use pyrethrum
powder (insect powder) instead of sulphur. Where
this is used the rooms should be swept after the

HOW TO FUMIGATE 173

fumigation and the mosquitos so gathered up should
be burned, as pyrethrum powder merely stuns the
mosquito. The amount of pyrethrum to be used is
one pound to each ordinary-sized room.

It having been decided to call in experts to advise
upon the situation and if possible to expedite the
campaign, the special yellow fever experts arrived
and took charge of the situation, and the campaign
was carried out with renewed energy and precision.
It consisted in : —

1. Discovering every case of yellow fever and
isolating it.

2. Killing aid stegomyias.

3. General warfare against all mosquitos, except
swamp.

4. Ensuring that each Ward was fully equipped with
its forces of inspectors, oilers, screeners, fumigators and
others as wanted, and that there was an adequate number
of men.

Each Ward Office was in telephonic communication
with the Central Office.

Under the Marine Hospital Surgeon in each Ward
were placed one or more medical assistants, young local
medical men, chosen on account of their local know-
ledge and ability, and a staff of workmen, varying
from 28 to 128.

Each Ward Centre was furnished with a supply
of-

Fumigating Materials. — Sulphur, pyrethrum, pots

174 THE YELLOW FEVER CAMPAIGNS

for fumigating, paper, paste, laths and all accessories
for sealing.

Screening Materials. — Bobinette and sheeting, wire,
portable wire-screened doors, ladders, nails, hammers
and all accessories.

Oiling Materials. — Oil and oil cans, ladders, scythes
for cutting rank grass, carts.

A map of the district was kept at each office and
the progress of the cases, the number of cisterns
oiled, and of houses fumigated were recorded with
dates. The various gangs, whether inspectors, oilers,
screeners or fumigators, left the Ward Offices early
in the morning for their appointed tasks, or at such
time as they were particularly required. A practitioner
might report a case to the Central Office or directly
to the Ward Office in which the case occurred. If
in the former manner, the Central Office telephoned
to the Ward Officer concerned. As the result of
the call, a screening and fumigating gang (see
illustration) would be dispatched, the patient's room
would be screened and the rest of the house fumi-
gated, or the patient would be removed in the
ambulance (see illustration) to the Emergency Hospital,
and the house fumigated. Depending upon circum-
stances, the surrounding blocks would also be fumigated,
and from the tenth to the thirtieth day of the
occurrence of the case the Medical Inspector would
visit the house every day to locate any secondary cases.

The work of the Central Office consisted in
directing the work of the Wards, receiving reports
of cases, preparing and issuing reports and instruc-

STRENGTH OF THE GANGS 175

tions, and in generally organising. For these purposes
a large clerical staff, as well as a statistical department
and accountants' office, were necessary. All cases of
fever had to be notified to this office, and it was
in constant receipt of innumerable complaints and
questions. Every morning either Dr. White or Dr.
Richardson made an inspection tour of the districts.
It was soon found necessary, in order to check
unnecessary expenditure, to establish a purveyor's office.
This was placed in the charge of Dr. Perkins and a
staff of about twelve assistants. Each Ward was
required to send in a requisition to this department
for the material it wanted, which, if not in stock,
was promptly obtained. In this way waste was
avoided, and by purchasing supplies beforehand in
the cheapest markets, considerable saving was effected.
The office was most carefully organised and every-
thing was reduced to a very precise system.

TOTAL NUMBER EMPLOYED IN THE CAMPAIGN

Total number of men, inspectors, oilers,

screeners, etc .910

Special Fumigating Division . .156
Special Investigating Division . .105
Purveyor's Department . . . 32

1,203

The total Medical Staff was fifty, of which twenty
were Marine Hospital Service surgeons.

BOARDS OF CONSULTING EXPERTS

A body of twenty-three experienced medical men
were chosen amongst the various Wards, who were

176 THE YELLOW FEVER CAMPAIGNS

available at any time for consultation upon difficult
or suspicious cases.

During the first few days after the Marine Hos-
pital Service was officially placed in charge of the
campaign, Dr. White was busy meeting the Presidents
of the Ward organisations, placing his own officers
in charge of the Wards, instructing them in their
duties, and holding daily conferences with the various
representative bodies.

On August 11 he met the Presidents of the
Ward Organisations and agreed upon the following
general plans : —

That the work of the Ward Organisation must
be carried on as strenuously in the future as in the
past.

That there should be a " mosquito-killing day "
throughout the city once a week, when the entire
population should make an effort to kill by fumiga-
tion the mosquitos in their houses.

That all street gutters should be flushed out once
a week.

That every Ward undertake a complete minute
inspection of all cisterns in its territory to see that
they are perfectly screened.

That as an extra precaution the oilings of all
cisterns be continued.

That only oil of at least 150 flash test be used,
so as not to render water unpleasant.

That all physicians and every one else in the city
report to headquarters every suspicious case they
might learn of.

RESULTS 177

The experts then issued a series of directions
upon : —

1. The formation of oiling, screening, inspecting
and salting squads.

2. Upon hourly reporting to headquarters.

3. Upon how to fumigate.

4. Necessity of reporting suspicious cases.

5. Necessity of systematic sanitary surveys.

6. That there is only one Authority in the city.

7. Warning against quack remedies.

All these directions emphasised those which had
already been issued by the local authorities.

Result of Campaign. — Yellow fever broke out in
an unprepared densely populated city (New Orleans)
in July. By August 12 the fever was at its height,
numbering on that day 105 cases. In the meantime
the prophylactic measures, including early notification,
isolation, fumigation, screening, and protection of the
water supplies, had begun to take effect, for in three
weeks from the notification of the first case the
number of fresh cases ceased increasing and it was
clear the fever was in hand. The infected stegomyias
on the wing had been killed and would no longer
carry infection, and a fresh supply of stegomyias
was rendered impossible owing to the fact that all
cisterns had been screened. Thus an outbreak which
in previous years would have developed into the usual
awful epidemic was in a few weeks at a comparatively
small cost completely stopped, and that in the face of
a dense population, open drains, and a sultry summer.

178 THE YELLOW FEVER CAMPAIGNS

ANTI- YELLOW FEVER MEASURES IN BRITISH
HONDURAS AND IN THE ADJACENT CENTRAL
AMERICAN REPUBLICS

In the summer of 1905, whilst I was then taking
part in the yellow fever campaign in New Orleans, I
was asked by the Colonial Office to proceed to Belize
to investigate an outbreak of yellow fever there, and
to report upon measures to stamp it out and prevent
its reappearance.

I gladly availed myself of the opportunity, and
commenced investigations on September 17, 1905.

My first care was to ascertain to what extent the
epidemic had gained a foothold, or, in other words,
the total number and distribution of the human
carriers. I was soon satisfied that the officially re-
ported cases did not represent the total cases — that, in
other words, a considerable number of " suspects "
should have been added to the list. At the same
time I hastened to ascertain the extent and distribu-
tion in the town of the insect carriers. I made at
once a stegomyia survey, organising for that purpose
small search parties to ascertain accurately the breed-
ing places of the stegomyia, and so determine the
numerical strength of the insect. To this end we
made a house-to-house investigation and examined
1,342 barrels containing water, many hundreds of kero-
sene tins, 489 large wooden water- vats, 271 iron water-
tanks, 91 wells, and very many other likely places, such
as disused canoes, ditches, pools, crab-holes, etc. This
examination revealed the presence of the stegomyia

STEGOMYIA SURVEY 179

breeding grounds in 50 per cent, of the houses and
yards. The water most favoured by the mosquito for
her eggs was the clean water for domestic use stored
in the cisterns, barrels, tins, and odd receptacles men-
tioned above, and not the water of the pools, ditches,
marshes, or crab-holes. This survey proved at once
that the insect carriers were everywhere to hand in
and around the houses, and that therefore the ideal
conditions for the spread of the disease were present.

As a result I reported upon the absolute necessity
of exercising a vigilant supervision over the water
supply of the town — that is to say, removing and
destroying all odd water receptacles and encouraging
the use of proper screened domestic and public cisterns.

I am glad to say that the work commenced by
me in 1905 has borne fruit, for by a report of the
United States medical officer, dated March 27, 1907,
it is stated that in Belize much is being done to render
the town as sanitary as possible. The tanks are care-
fully screened, and unscreened water-barrels and other
breeding places of stegomyia have been removed from
most of the premises. Two sanitary inspectors are
constantly employed to examine into and report upon
the proper carrying out of the regulations bearing on
these points. Then the streets are kept clean, and
work is constantly progressing towards eliminating
the breeding-places of mosquitos ; mosquitos are not
constantly present in great numbers ; and since
the screening and cleaning ordinance has been syste-
matically carried out, the number of stegomyia has
been reduced to a very marked extent. Nor has it

180 THE YELLOW FEVER CAMPAIGNS

been necessary since my visit to quarantine on account
of yellow fever any ship leaving the port of Belize, and
this has meant a very considerable saving of money,
not to mention loss of lives.

In further confirmation of the efficiency of this
campaign, the Hon. Wilfred Collet, Colonial Secretary,
British Honduras, writes me that in 1907 an epidemic
of dengue fever broke out in the Colony. Naturally a
disease like dengue caused a very considerable amount
of uneasiness, on account of its close resemblance to
yellow fever, and as a result the Marine Hospital
Service of the United States made a most searching
inquiry. Their representatives, however, reported that
there were no stegomyia to be found, and the disease
could not be yellow fever ! The result was that the
United States authorities at once permitted the usual
trade facilities between the Southern States and Belize.
No ship was detained, and the commerce of the port
was not interfered with. In 1908, after a very close
season, the water-vats warped and the staves opened,
as not infrequently happens ; the result was that the
stegomyia began to appear again. The authorities,
however, immediately instituted a vigorous screening
campaign, which was followed by a disappearance of
the stegomyia in two months' time.

SPANISH HONDURAS
PUERTO CORTES -ANTIMOSQUITO WORK

We may take this small fruit port as a further
example of other similar ones where the work of

ANTJMOSQUITO MEASURES 181

warfare against mosquitos has begun to be carried on
with considerable vigour in Central America. The
population of the town numbers about 2,400. The
existence of yellow fever would close down the con-
siderable trade which is done in the exportation of
fruit to the United States, hence the necessity for
war against the stegomyia ; and in July 1907 the
United States medical officer reported that the authori-
ties had oiled all water-containers — viz. 113 cisterns,
167 barrels, and 26 wells, and that all surface pools
were either drained or oiled thoroughly. Result that
stegomyia was reported not numerous.

ANTI- YELLOW FEVER CAMPAIGN IN THE
CANAL ZONE

This campaign was pushed forward with great
vigour from the moment that the Isthmian Canal
Commissioners took over the health administration of
the Zone.

The plan of campaign lay in rigorously prohibiting
the keeping of stagnant water, and in screening, house-
to-house inspection, and the infliction of fines if larvas
were discovered. As the result, yellow fever has been
banished. Colonel Gorgas, under whose able direction
these successful operations have been carried out, writes
in his 1908 Report that " it is now more than three
years since a case of yellow fever has developed in the
Isthmus, the last case occurring in November 1905.
The health and sick rates will compare favourably
with most parts of the United States." Surely a most
successful campaign.

182 THE YELLOW FEVER CAMPAIGNS

THE ANTI-YELLOW FEVER CAMPAIGN IN RIO
JANEIRO AND SANTOS, 1903

In a very delightful tract entitled " Comment on
assainit un Pays " J — or the extinction of yellow fever
in Rio — will be found the results obtained to-day by
the vigorous war against the stegomyia which has
been waged since 1903.

Brazil has usually been regarded as the home of
yellow fever. We have already seen how, in the
remarkable wanderings of the famous ship Hankey,
bound from Siam to the Antilles, there was an account
of her putting into some port in Brazil, and how
from that fact we concluded that the so-called
" maladie de Siam " should be more appropriately
called " maladie de Bresil." On the other hand,
those of Brazil blame the Antilles for the introduction
of the disease in the seventeenth century. But,
however that may be, fresh doses of the infection
came at successive intervals as trade grew. Great
epidemics resulted in consequence. Thus we read
of great outbreaks in 1850, 1851, 1852. In 1899
the mortality from the disease was 35,557. This
great death rate was just at the time when Brazil
was expanding, just when large numbers of young
men, labourers and clerks, had been attracted from
the Old World to the new country — " conquistadores "
of commerce — it was amongst the new-comers that
the mortality was so high, just as of yore. It also
became evident about the year 1883 that yellow

By Rangel Pestana.

THE CAMPAIGN IN BRAZIL 183

fever could no longer be regarded as a seaport disease,
for it went into the interior and up into the hills.
The situation had about this time become exceedingly
serious ; Brazil had gained a bad name for itself—
a white man's grave, " Tombeau des etrangers," a
place where yellow jack was endemic. Therefore
the Government set to work, offered prizes and en-
couraged investigators, but alas, all in vain. Thus
in 1891 there were 4,456 deaths, 4,312 deaths in 1894,
4,852 deaths in 1898, and so on, mounting up until
it could be said that at the end of thirteen years the
capital had lost 28,078 victims from yellow jack. Since
1850 this disease has cut off 58,335 lives.

The time of the deliverance of Brazil from this
scourge was, however, approaching. It came from
the moment Reed, Carroll, Agramonte, and Lazear
risked their lives to prove the new doctrine. This
done, the Havana theory was taken up con amore,
and with such enthusiasm that four gentlemen of
Rio, Domingo Pereira Vaz, Oscar Marques Moreira,
Januario Fiori, and Andre Ramos, together with
Dr. Emilio Ribas, submitted also to be bitten by
infected mosquitos. The results were, as at Havana,
a complete demonstration of the stegomyia doctrine.
Furthermore, numerous other experiments were made,
and all proved the one thing, — that yellow fever could
only be transmitted by one particular mosquito, the
stegomyia.

The result was a vigorous antistegomyia policy
under Dr. Oswaldo Cruz, and the pushing aside of
all doubters. Antimosquito brigades were formed.

184 THE YELLOW FEVER CAMPAIGNS

One brigade consisted of 1,500 men to wage relentless
war upon all the breeding places of the stegomyia.
All stagnant water was upset, all useless receptacles
removed to the dust tip, and houses scaled to clear
the gutters. A rapidly moving column was organised
to deal instantly with any house in which infected
mosquitos might be ; they were attacked at once
with sulphur and pyrethrum.

Thus it came about that between the years 1903-
1906, a period when everything, according to the old
doctrines, should have engendered yellow fever — viz.
open putrefying drains, mud dredging, moisture, a close
fcetid atmosphere — in fact, a period of the old-time
concatenation of circumstances when miasm ought to
be distilled and deal death all around, passed in perfect
safety ; more emigrants than ever arrived, but no yellow
fever. A total of 948 deaths in 1904 showed that
ignorance had been at last conquered, and that never
again could there be room for doubt. And for once
the strong arm of the law felt it had reason on its
side ; it did not hesitate to punish those who trans-
gressed and were found harbouring the enemy— the
stegomyia larvae.

As evidence of the earnestness of the people we
read that in 1909 153,670 breeding places of larvae
were destroyed, 850,575 odd water receptacles
examined, as well as 44,343 reservoirs and 604,283
water- containers overhauled ; as many as 814,650 sinks
and 718,154 water-closets oiled ; 2,545 cartloads of
tins and odd receptacles were removed from yards.
For fumigation 1,242 kilos of pyrethrum and 28,603

RIO AND SANTOS 185

kilos of sulphur were used. And this brought it about
that in the summer of 1909, in spite of the arrival of
some 45,219 new-comers, the word went forth that
yellow fever no longer existed in Rio. Can any one
in his right mind, after a demonstration like this,
afford to doubt and thwart the efforts of those who
believe ?

As with Rio, so with Santos : once the white man's
death trap, it has now become a veritable " santos " or
health resort. Yet in the harbours of Rio and Santos
ships once rotted and fell to pieces for want of crews —
all had died of the accursed disease ; and to-day no
one fears, and no ship rots.

ANTI- YELLOW FEVER CAMPAIGN ON THE AMAZON l

Since April 1905, when the Liverpool School of
Tropical Medicine dispatched a commission consisting
of Drs. Thomas and Breinl, a great deal has been
done to disseminate the knowledge of the danger of
the stegomyia amongst the merchants trading at
Iquitos, Para, Manos, etc. The mission has received
the warm support of the trading firms, and it is hoped
that under Dr. Thomas a still greater amelioration of
the health conditions will be brought about, and yellow
fever banished. In 1905 Dr. Thomas published in
Spanish a useful Report upon the Public Health of
Iquitos. He found the Stegomyia calopm present every-
where in water-barrels and odd receptacles throughout

1 The first yellow fever expedition sent out by the school was in 1900, and
consisted of Drs. Durham and Walter Myers. The latter investigator con-
tracted and died from the disease

186 THE YELLOW FEVER CAMPAIGNS

the town. He drew up recommendations urging com-
pulsory screening, removal of odd receptacles, and
cleansing of yards.

THE ANTI-YELLOW FEVER OPERATIONS IN THE
BRITISH WEST INDIES, 1906-1909

It was to be expected that these ancient Colonies
would follow the brilliant examples set them by Cuba
and on the Spanish Main by the Isthmian Canal
Zone, and endeavour to put their house in order so
as to be able to withstand yellow fever and banish
malaria. I have referred in a preceding chapter to
the awful mortality which yellow fever produced in
the 'fifties, a mortality so great that to-day we cannot
realise it. In those days the West Indies were regarded
as the home of yellow fever, the islands where it was
endemic. The adjacent American Continent regarded
the islands as the source of all their epidemics. When
discussing the march of general sanitation we showed
how both the yellow fever and malaria abated before
the modern weapons of drainage and water supplies.
Abated, however, only to a certain degree, just as in
Rio and in many other parts of the world. The really
significant change did not occur until the newest
weapons of medical science were unerringly directed
against the specific enemies — the stegomyia in the case
of yellow fever and the anophelines in the case of
malaria. Then, and only then, were these diseases
brought under absolute control.

I wish in this narrative to state what those islands
which I have already visited have accomplished : how

HOUSE INSPECTING 187

far their methods are modern, whether they are still
hampered by prejudice and tradition, or are willing to
embrace the modern method.

In the first place I will begin by giving my methods
of procedure when I arrive in a colony.

1. I establish an office or headquarters, or secre-
tarial department, where the plan of campaign is drawn
up with the assistance of the local medical and health
authorities.

2. The mornings are devoted to a house-to-house
examination of the locality in order to determine
precisely the number of breeding places of the
stegomyia, in the case of yellow fever. I invariably
make the house-to-house inspection with the district
medical officers and all the sanitary inspectors available,
together with the chairman and others of the Sanitary
Boards of the district in which I am working. The
more who accompany me on these inspections the
better, for they all learn the methods and their signifi-
cance. When we enter a house with a yard and garden,
every water-container is carefully examined and the
results entered in the Special Inspection Book. Nothing
is neglected : the water receptacles for the chickens —
the " Cafe de Poule "-—the water for the dog or other
animals, the drinking-water barrels, the washing-tubs,
and the innumerable odds and ends, are all carefully ex-
amined for the larvae of the stegomyia. By this means
a correct estimate of the percentage of the breeding
places is worked out, and the efficacy of the work
accomplished by the medical authority in charge
gauged.

188 THE YELLOW FEVER CAMPAIGNS

Whilst making these investigations, ample oppor-
tunity is afforded of talking with the householders and
of explaining to them the significance of the visit and
the necessity for the removal of all stagnant water
in and out of doors. An estimate is at the same time
made of the general cleanliness of the interior and
exterior of the house, and if there are any broken bottles
or odd tins about the yard, the householder is ad-
monished to remove them at once. For this special
purpose we are frequently accompanied by the dust
contractor and his carts.

To sum up the results of my house-to-house inspec-
tions in the West Indies, I examined —

525 yards in Bridgetown, Barbados,
48 „ „ Georgetown, Demerara,

211 „ „ in Port of Spain, Trinidad,
72 „ „ in Castries, St. Lucia,
98 „ „ in Kingston, Grenada,

125 „ „ in St. Vincent.

In these yards I found and examined a total of
2,292 water receptacles ; these included 574 buckets,
425 barrels, 695 tubs, 392 jars, 114 large tins and
cans, 92 vats, also an innumerable number of odd
receptacles such as broken bottles and pitchers, small
tins, conch shells, calabashes, flower vases, saucers, lily
tubs, etc. etc. When mosquito larvae were found,
they were those of the Stegomyia calopus.

Nature of the Water-containers. — Each Colony had
for the most part its own peculiarities in the way of
water-containers. Wherever barrels were used for

PIPE-BORNE WATER is9

the storage of water, as in straggling districts and
small villages, larvae were always most abundant. In
Castries and in other Colonies which were formerly
under French rule, the large old-fashioned jars were
the great offenders. In George Town, Demerara,
vats predominate. In Port of Spain, Trinidad, the
antiformicas, as 1 have previously explained, are a
source of danger.

It was abundantly evident from my visits that
in all these six Colonies measures had been taken to
abate the stegomyia breeding nuisance. First and
foremost, a pipe-borne water supply is now the rule,
but it wants further extension. Secondly, the town
councils have been fairly active in removing all odds
and ends from yards likely to contain water. Thirdly,
in all these Colonies health clauses have been inserted
dealing specifically with the stagnant-water nuisance —
the presence of larvae being taken as proof of this.
Fines are inflicted regularly for infringement of these
bylaws. Screening is compulsory in some places.
Fourthly, in many places an active antimosquito pro-
paganda has been set on foot and the people have been
educated. Fifthly, both the medical officers and the
sanitary inspectors have in many places been trained
either in tropical diseases at the Tropical Schools in
England, or, as in the case of the sanitary inspectors,
they have been trained to recognise and differentiate
the various mosquito larvae arid to realise their
significance. In addition to these antilarval measures,
the health authorities have also clauses to deal with the
fumigation of houses in which yellow fever has occurred,

190

the screening of patients, and early notification. Had
these West Indian Colonies not already commenced to
make these reforms that brought them into line with
Cuba and the Canal Zone, there can be little doubt
that they would have been visited by epidemics of
yellow fever which in former days were, as we have
seen, the rule. The best test of this is the recent
epidemic in Barbados. This epidemic has been kept
under ; it was practically stamped out in May in the
chief port, Bridgetown, whereas in former days it would
have gone on gaining in force and virulence. The fever
persisted longer in the straggling isolated country
parishes around because the machinery for carrying out
thorough fumigation was not so complete as in the
chief town. One of the West India Islands has been
very severely visited by yellow fever, viz. the French
Colony of Martinique, and in this island we have
evidence that antilarval measures had not been
vigorously pushed. Yet, in spite of the fact that
yellow fever was raging in Martinique, the adjacent
island of St. Lucia remained absolutely secure owing
entirely to the wise antilarval measures and sharp
look-out taken by the Governor and his officers.
It proves conclusively that yellow fever need never
again be a source of alarm to the West Indies as
of old, provided that anti-larval measures are pushed.
Again, a source of great danger to the West
Indian group is Venezuela, the remaining stronghold
of yellow fever. But, again, the adjacent Colony of
Trinidad, with its up-to-date antimosquito measures,
need have little to fear. In this respect the " Liver-

THE STEGOMYIA RATE 191

pool" of the West Indies (Port of Spain) has as
little to dread as the Liverpool of Lancashire.
Nevertheless, no Colony can afford to take risks, and
as rigid an inspection of all arrivals from Venezuela
must be made as the Isthmian Canal authorities enforce
in the case of arrivals into their territory. In other
words, each Colony must see that all its defences are
perfect. In the present day, with our knowledge of
how yellow fever is carried, its presence in any Colony
is rightly regarded as a disgrace, and as showing that
the Colony is as yet in the barbarous stage, and possesses
no medical organisation worthy of the name. Yellow
fever is not to-day regarded as the inevitable penalty
of our desire to go to tropical lands ; it is to-day the
penalty of ignorance and superstition.

Finally, as the result of my investigation of the
numerical strength of the breeding places of the
stegomyia, I found the rate was not high, varying from
4 to 10 per cent.1 But this percentage must be
reduced to zero. In the Appendix will be found
collected together those health clauses of the various
Colonies which I visited which deal with anti-yellow
fever and antimalarial warfare ; they are useful as a
guide to other Colonies which may not have yet come
into line. These measures, and the numerous penalties
which" followed their systematic enforcement, constitute
the most eloquent testimony which we possess of the

1 In a letter which I have received as I go to press from Dr. Hudson of
Barbados, there is the gratifying statement that "The first fortnightly
returns of mosquito destruction in the parishes shows that only 0'45 per
cent, of the houses inspected were found to be harbouring larvae." This is
a remarkably good result.

192

earnestness of this great health campaign in the West
Indian Colonies.

Thus in Trinidad there have been 29 prosecutions
from March to April of 1909 ; 98 in St. Lucia from
1907-9 ; 99 in Barbados during April and May of
1909 ; and the fines have ranged from Is. to 40s.

DENGUE OR DANDY FEVER

This is a tropical fever of wide distribution, occur-
ring in the West Indies, Syria, the Far East, India,
Australasia, Central and South America. In the
present day it owes a considerable amount of its im-
portance to the fact that, together with influenza, it
is liable to be confused with yellow fever. Like the
latter fever, it appears to follow the trade routes and
to burst out without warning into considerable-sized
epidemics of an essentially local character. Indeed, in
its mode of extension and its tendency to keep to the
coast line, it resembles an insect-borne disease, and
evidence is accumulating in favour of this view. Thus
Dr. H. Graham of Beyrouth has brought forward
reasons which show that dengue fever is spread by
the Culeoc fatigans. This observer states that he was
able to infect (1901) healthy persons by the bite of
infected mosquitos, that is, mosquitos which had bitten
patients suffering from the disease.

Dr. Strong of Manilla likewise (1909) states that
recent studies in Manilla point to the Culex fatigans as
the transmitting agent, and I have received a note
from the Hon. W. Collett, Colonial Secretary, British

p. 192]

MALE. FEMALE.

FlG. 38. CULEX FATIGANS.

DENGUE FEVER AND CULEX 193

Honduras, concerning an outbreak of dengue fever in
that Colony, in which he states :

" An epidemic of dengue broke out in the middle
of the year 1907, and P.M.O. Harrison estimated that
45 per cent, of the population suffered. A few who
had previously had yellow fever contracted the disease,
so that evidently yellow fever does not protect. It was
noted that wherever dengue fever occurred the Culeoc
fatigans was also found. Mr. Collett had the culex
in his own house, and his youngest child contracted the
disease ; both himself and Mrs. Collett, however,
escaped, as they had had the disease in Fiji in 1885."

13

PART II
CHAPTER XV

SLEEPING SICKNESS, FLIES, AND DISEASE

TRYPANOSOMIASIS (SLEEPING SICKNESS)

THIS morbid condition, better known in one of its forms
in man as sleeping sickness, belongs to that group
of diseases, including malaria, filariasis, and tick fever,
which are caused by minute animal parasites living
in the blood stream of the body. Like, also, many of
the other tropical diseases, it attacks a wide range of
the animal kingdom. I have had occasion to refer to
this significant fact before. We will have noted that
these diseases are not peculiar to man alone ; man is
simply liable to them just as are other species of the
animal kingdom.

Naturally, when man is affected in epidemic form,
our attention is at once directed to the disease, and
investigations made and the cause discovered. It was
thus with sleeping sickness. The trypanosome, as the
small blood parasite which causes the disease is called,
was discovered in 1902, but long before that date

194

TRYPANOSOMA GAMBIENSE 195

(1869) it had already been known as a blood parasite
in many of the lower animals. In 1901 Dr. Dutton,
of the Liverpool School, whilst investigating tropical
diseases in the Gambia Colony, discovered the parasite
in the blood of a patient, exhibiting no unusual symp-
toms, under the care of Dr. Forde, and he named it the
Trypanosorna gambiense ; and then, in the year 1902, the
world was made aware by Bruce and Castellani of
the fact that the mysterious and deadly disease which
was rapidly spreading over Central Africa — Sleeping
Sickness — was due to the same parasite. Since then the
disease has been subjected to numerous investigations
(see Appendix), and international action has been taken
to endeavour to limit its ravages and if possible stamp it
out. It would appear that the disease has only attained
its present prominence in Africa comparatively recently,
coincident with the opening up of Africa to develop-
ment, consequently necessitating the formation of trade
routes and the movement of large bodies of natives from
point to point. The disease, if it existed amongst the
natives in earlier times, remained confined to circum-
scribed areas ; in opening up trade, however, the
disease diffused itself, and is still doing so, until it is
said to extend over some million square miles. The
spread of this disease has wiped out entire communities,
large districts have been depopulated in the Congo,
200,000 of the inhabitants of the Uganda Protectorate
are believed to have perished.

The question naturally arises, How does the disease
spread ? Is it by contact, by water and food, or by
insects ? Knowing as much as we now do about the

196 SLEEPING SICKNESS, FLIES, AND DISEASE

spread of tropical diseases, we are not surprised to
learn that this disease is spread by the agency of an
insect. This time a fly — the well-known tsetse fly.
Bruce had previously proved that the fly disease of
horses and cattle known as Nagana in Africa was
communicated from animal to animal by the bite of
a species of fly (Glossina -morsitans) ; he concluded,
moreover, that the transference was mechanical — that
is to say that, unlike the case of the malarial parasite
where the anophelines play the part of intermediary
hosts, the fly simply became mechanically infected by
the parasite adhering to the mouth parts, so that when
it bit a healthy animal it transferred to the wound
the adherent parasites, in a manner somewhat analo-
gous to the way in which the domestic house-fly
carries infection on its body. The mode of infection
having been shown in Nagana, it was not long before
it was determined that an allied species of fly (Glossitia
palpalis] was probably the agent which transmitted
sleeping sickness.

There was here, as in the case of yellow (ever
and malaria, the most significant fact that sleeping
sickness was found only in districts where the fly was
found. No tsetse, no sleeping sickness : just as no
anophelines, no malaria ; no stegomyia, no yellow fever.

In the West Indies, where although there are
many species of biting flies there is no tsetse, sleeping
sickness has not occurred.

The next great question then arose, Was the
transference of infection mechanical ? Or, as in
malaria and yellow fever, did the fly act as host ?

[Photo by Dr. W. H. Graham.
FlG. 39. GLOSSINA PALPALIS, THE CARRIER OF SLEEPING

SICKNESS. Enlarged Four Times.
Block lent by S. S. Bureau.

FlG. 41. NATURAL SIZE OF

TSETSE FLY.

[Photo by Dr. W. M. <*ranam.
FlG. 40. GLOSSINA FUSCA, IN RESTING POSITION.

Enlarged about Three Times.

Block lent by S. S. Bureau,
p. 196]

PLAN OF CAMPAIGN 197

Did, in other words, the parasite pass part of its life
cycle in the fly, as did the malaria parasite in the
mosquito ? The answer, as furnished by the experi-
ments of Kleine and Bruce, point to the con-
clusion that, much as in the case of yellow fever virus
in the stegomyia, a latent period exists in the fly
during which period it is not infectious, but that
after the period of latency, the fly becomes again
infectious. In the case of the Sleeping Sickness
parasites the latent period appears to be from 14 to
21 days. These observations point to the fact that
the fly acts as a true host to the trypanosome just
as the anophelines do to the parasite of malaria ; in
other words, the fly appears necessary to the propa-
gation of the disease.

Plan of Campaign. — Having proved that the tsetse
fly is the carrier of sleeping sickness, and proved more-
over, as it would appear from the most recent
observations, that it is only one species, the Glossina
/Hi/jHilis, that can act as host to the trypanosome,
we have the key of the plan of preventing the disease
altogether, viz. by exterminating the carrier, precisely
as in the plan of campaign against malaria, yellow
fever, and plague.

The tsetse fly, like the common house fly and
like the mosquito, has its two phases — the adult winged
form and the larval form. It can be attacked at both
stages, whichever is most practical or most convenient.

In the first place, observations have shown that
the breeding place of the fly is the strip of ground
bush along the rivers ; a strip about 30 yards wide

198 SLEEPING SICKNESS, FLIES, AND DISEASE

extending from the river-bank is the usual breeding
zone ; breeding appears not to extend to any marked
degree beyond this distance.

The larval or pupa stage evidently requires a certain
amount of humidity and shade, and requires to be
protected from the direct sun-rays, and hence the
fly chooses the damp shaded humus of the bush in
which to deposit her pupae. Therefore, as a first step
in prophylaxis, it is necessary to destroy the ground
bush, to burn it for a depth of about 30 yards from
the river-bank.

It is not necessary to cut down forests any more
than it is necessary to drain lakes and run rivers dry
in antimalarial operations. All that is essential is to
go for the chief breeding grounds around man and to
let the forests take care of themselves.

The reason is precisely similar to that which we
fully discussed under malaria and yellow fever. We
cannot attempt the impossible, and it is totally un-
necessary ; the object is to protect man in his villages
and towns and camps and along his trade routes, and
this can be done. It is, as we have so often emphasised,
a question of protecting man against his innumerable
insect surroundings. In practice this has been found
to be perfectly feasible, as easy as preventing the
keeping of stagnant water in and around houses in
yellow fever countries or getting rid of pools and
anopheline breeding grounds around the houses in
malaria countries, or destroying cover for rats in
seaport towns.

What is therefore now done is to burn the ground

SLEEPING SICKNESS PROPHYLAXIS 199

bush along the margins of rivers and ponds and around
encampments and villages, and to keep the roads clear.
The sun's heat has a most detrimental effect on the
fly and prevents them breeding in such situations.
Further, as in the case of the mosquito, the natural
enemies of the fly are to be encouraged. These consist
of both the enemies of the adult fly and those of
the pupa?, and amongst them are described certain
birds, wasps, spiders, ants, and fungi. The collection
and destruction of the pupas have also been advocated.
The drainage of pools in the vicinity of camps and
villages is also of use.

The destruction of wild animals which the fly
may use for sucking blood, such as the crocodile, is
also advocated.

Having disposed of the method of attack as
regards the breeding grounds of the fly, let us examine
what can be done against the adult insect. In this
connection a series of regulations have been adopted
as follows :—

Protect the body as much as possible from un-
necessary exposure to the bite of the fly —

(a) by wearing plenty of suitable clothing (white),

(b) by systematic use of nets,

(c) by screening the living-rooms,

(d) by choosing for the sites of houses and encamp-

ments places free from flies,

(e) avoiding fly-infected routes.

In all these rational and practical measures, the
lines followed are those which we have seen accomplish
so much in malaria and yellow fever. And as in the

200 SLEEPING SICKNESS, FLIES, AND DISEASE

case of yellow fever, so here a great deal can be done
by rational quarantine administration. Natives coming
from infected districts should not be allowed to freely
travel into non-infected districts. They must be sub-
jected to most careful medical inspection to ascertain
whether they have the parasite in their blood or not,
and those who have must be detained and isolated
in properly screened hospitals. The principle of segre-
gation should also be adopted where possible. The
healthy should live at a distance from the villages
or the huts of those who may be suspected to have
the parasites.

Lastly, as in malaria, an endeavour can be made
to kill the parasites in the blood. In malaria use is
made of quinine, in sleeping sickness the great drug
is arsenic in some form or other ; therefore arsenisation
is a great curative and prophylactic measure of
defence, and is having good results. According to
authorities like Koch and Manson, arsenic in the
form of atoxyl is as efficacious in early cases of
sleeping sickness as quinine is in malaria.

Upon these lines of attack a great anti-sleeping
sickness campaign has been undertaken by all the
nations possessing Central African colonies.

In order to direct the operations of the campaign
in British Africa, a National Bureau has been established
in London, and at these headquarters regular monthly
reports are issued and reports collected from all
sleeping sickness districts, maps are made and issued
showing the progress of the disease and the districts
pf the fly. The Bureau, which has been established

RESULTS OF CAMPAIGN 201

under the auspices of the Colonial Office, has already
done excellent service, and the system might well be
copied in the case of the other tropical diseases.

Although it is early yet to speak of the results
of the anti-sleeping sickness measures, there is no
question that much good work has been already done
and very many lives saved ; they serve as indications
of what can be done. The following Report received
from the Governor of Uganda shows clearly that
improvement is taking place :

RESULT OF ANTI-SLEEPING SICKNESS MEASURES

IN UGANDA

(FnoM Manchester Guardian, JUNE 25, 1909)

The Governor of Uganda in his Report for 1907-8
to the Earl of Crewe (Secretary for the Colonies) is
able to report that the measures taken during the
past three years to stamp out sleeping sickness are
proving effectual. During 1907 the deaths in the
Kingdom of Buganda numbered less than 4,000, and
in 1908 they fell to 1,700. It is believed (the Governor
says) that for the whole Protectorate the deaths
during the past twelve years have not exceeded 2,500.
No Europeans have been infected since 1906. Prac-
tically the whole of the population of the fly-infested
shores of Lake Victoria have been removed to districts
inland, where the tsetse does not exist, and it is
believed that there can now be but few cases of fresh
infection so far as the mainland is concerned. Steps
are in progress for the complete depopulation of the
.islands in the Lake. It was feared that this would
prove a most difficult matter, but the native Govern-
ment is now showing such confidence in the efficacy

202 SLEEPING SICKNESS, FLIES, AND DISEASE

of the measures for the suppression of the sickness
that the request for final action has come from them.
About 21,000 souls will have to be moved, and
arrangements are being made to locate them on
vacant lands in Chagwe and in other districts of the
mainland. The realisation of this project will put the
finishing touch to the whole scheme.

The pestilent tsetse fly will still infest the shores
of the great Lake, but it will find no more victims
on which to play its malevolent part. Sleeping sick-
ness has ceased to be the dominant scourge of this
territory, and the disease has now been reduced to a
merely sporadic scale. Continued vigilance, however,
is essential, and the recrudescence of sleeping sickness
can only be averted by the consistent and vigorous
maintenance of those preventive measures which have
already proved efficacious. The four segregation
camps, in which several thousands of sufferers are
still located, are in full working order, and though
no effective curative treatment has yet been discovered,
the lives of many of the patients are being consider-
ably prolonged. The measures taken to drive away
the tsetse flies from the neighbourhood of Entebbe
and of other important points on the Lake shore,
from which the population could not be removed,
have proved successful, and those places may now be
considered perfectly safe, so far as sleeping sickness
is concerned.

The Principal Medical Officer, A. D. P. Hodges,
furnishes the following satisfactory statement from
Uganda : —

" I think that the continued and progressive
decrease in the death rate, which is apparent in the

RESULTS OF CAMPAIGN

203

returns from individual counties as well as in the
totals, is scarcely likely to have been artificially con-
trived or to be a mere coincidence. I, therefore,
regard it as a true decrease and as decidedly satisfac-
tory and encouraging ; for, even though the actual
figures may be inexact, the rate of decrease shown is
in all probability substantially a true one.

" It will be noticed that the decrease on the main-
land has been much greater in 1907 and 1908 than in
1905 and 1906, while the difference between these two
periods is much less marked in the case of the islands.

" This decrease must be attributed to the preventive
measures which were begun in 1906 on the main-
land, and they have produced a fall in the death-
rate from 3,585 in 1906, to 1,419 in 1907."

" Making full allowance for other causes, unless we
are to place no reliance at all on the Chiefs' returns,
the conclusion can scarcely be avoided, in my opinion,
that the preventive measures which have been applied
are producing results so satisfactory as to warrant
their continuance wherever practicable and their ex-
tension wherever this is possible."

DEATHS FROM SLEEPING SICKNESS IN BUGANDA

KINGDOM

Year.

Mainland.

Islands.

Totals.

Mainland.

Islands.

Totals.

1905

1900

4,500
3,515

3,503
1,719

8,003
5,304

!• 8,085

5,222

13,307

1907

1,419

1,992

3,407

]

\ 1,965

3,1G5

5,130

1908

550

1,173

1,723

J

10,054

8,387

18,437

—

-

18,437

204 SLEEPING SICKNESS, FLIES, AND DISEASE

THE SEPTIC FLY (MusoA DOMESTICA)

The awakening of interest in insects as carriers of
disease by the study of the tropical diseases malaria,
yellow fever, and plague and tsetse fly disease, has
been chiefly instrumental in drawing our attention
to the danger of the common house fly. Recently
Howard of Washington has proposed to substitute
the name "typhoid fly" instead of house fly. He is
indeed justified in doing so, for there is overwhelming
proof that the house fly is one of the important
carriers of that disease. It has been more especially
during military campaigns that evidence to this effect
on a vast scale has been forthcoming, but in the
case of villages and towns we have abundant evidence
also of the activity of the fly in spreading typhoid.
Inasmuch, however, as the common fly is equally
able to transmit cholera, tuberculosis, and the various
intestinal bacteria associated with the diarrhoea pre-
valent in towns in summer time, I think the term
" Septic Fly " would be more appropriate.

It has for long been believed that the fly can
carry disease germs, that it is a mechanical carrier.
Every one must have observed that the fly is a filth-
eater. What dust-bin, what garbage, exists without
the fly ? We become aware that something is wrong
or rotten, by the presence of flies. We must have
all experienced the dread with which we have seen
the common fly in the sick-room. Wherever there
is rotting, fermentation, or decay, or, in other words,
animal or vegetable offal or excreta of any kind,

p. 204]

FIG. 42. — MASS or FLY LARVAE IN STABLE MANURE. (Natural Size.)

[R. Newslead.

DANGERS OF THE HOUSE FLY 205

there the fly must be. Why ? Because as the water-
barrel is to the larva of the stegomyia and the
earth-pool to the larva? of the anophelines, so is putrid,
fermenting material to the larvae or maggots of the
fly. The fly breeds there, deposits its eggs there,
and they hatch out into the well-known maggots.
It is not surprising, then, that the natural breeding
grounds being filthy material, the fly should carry
on its body some of this filth to the sugar basin,
the entree dish, or the milk in the bowl in the pantry.
Unquestionably the fly can and does contaminate our
food supplies, and by landing on the face around
the eyes and mouth it may directly inoculate disease
germs. Beauperthuy long ago directed attention to
this. The presence of flies in a house means that
filth is close at hand — not miles away, but, in all
probability, close outside the kitchen window in the
dust-bin, or in the adjacent stables, or in the highly
manured garden soil around the house.

We must have often observed by the sea foreshore
the prevalence of flies especially where the foreshore
is used as a dumping ground for garbage. Yet town
councils have wondered why their apparently beauti-
fully situated seaside resorts should still have cases
of typhoid and other intestinal fevers. There is no
wonder when we realise that the fly is the common
carrier. The fly has now been proved experimentally
to be a carrier in the case of cholera, typhoid, tubercle,
and no doubt of the germs of summer diarrhoea. In
Egypt the dissemination of the common ophthalmia
present amongst the poor people is also largely due to

206 SLEEPING SICKNESS, FLIES, AND DISEASE

the fly ; for we have no doubt seen in that country
the eyes of children rendered black by swarms of
them. The relationship of the fly to leprosy has
often been commented upon, and in my own ex-
perience I have on many occasions been struck by
the great abundance of flies swarming around the
patients.

Plan of Campaign. — Knowing the danger of the fly,
the next step is to get rid of it. As far as I am aware,
the first Corporation to move in this direction was that
of the City of Liverpool. In December 1906 the
Medical Officer of Health of this city, Dr. Hope,
instructed Mr. Newstead of the Liverpool School of
Tropical Medicine to undertake a minute inquiry into
the breeding places of the fly throughout the city. A
report was drawn up by Mr. Newstead which has
served as a model for many other corporations in this
and other countries. The chief strongholds of the fly
were found to be manure-heaps in connection with
stables and shippons, and ashpits of all kinds. Mr.
Newstead found that 25 per cent of ashpits were
infected with larvae. Other breeding places were all
odd collections of fermenting material, vegetable or
animal, accumulations of manure at the wharves, bed-
ding for poultry, pigs, etc. Mr. Newstead lays stress
upon the selective affinity which flies have for human
dejecta for feeding purposes, and in this propensity lies
of course the great danger of the house fly. It cannot
be too clearly understood.

As the results of this investigation Mr. Newstead
recommends the following plan of warfare :

PLAN OF CAMPAIGN 207

1. That stable manure and spent hops should not
be allowed to accumulate in the middensteads during
the months of May to October inclusive, for a period of
more than seven days.

2. All middensteads should be thoroughly emptied
and carefully swept at the period stated in 1.

The present system of partly emptying such recep-
tacles should in all cases be discontinued.

The walls of middensteads should also be cemented
over, or, failing this, the brickwork should be sound and
well pointed.

3. That all ashpits should be emptied, during
the summer months, at intervals of not more than
ten days.

4. That the most strenuous efforts should be made
to prevent children defecating in the courts and
passages ; or that the parents should be compelled
to remove such matter immediately ; and defecation
in stable middens should be strictly forbidden. The
danger lies in the overwhelming attraction which such
fecal matter has for house flies, which latter may after-
wards come into direct contact with man or his food-
stuffs. They may, as Veeder puts it, "in a very
few minutes . . . load themselves with dejections from
a typhoid or dysenteric patient, not as yet sick enough
to be in hospital or under observation, and carry the
poison so taken up into the very midst of the food and
water ready for use at the next meal. There is no long
roundabout process involved."

5. Ashpit refuse, which in any way tends to fermen-
tation, such as bedding, straw, old rags, paper, waste
vegetables, dirty bedding from the " hutches " of pet
animals, etc., should, if possible, be disposed of by
the tenants, preferably by incineration, or be placed

208 SLEEPING SICKNESS, FLIES, AND DISEASE

in a separate receptacle so that no fermentation can
take place. If such precautions were adopted by house-
holders, relatively few house flies would breed in the
ashpits, and the present system of emptying such
places at longer intervals than, say, four to six weeks,
might be continued.

6. The application of Paris green (poison) at the
rate of two ounces to one gallon of water to either
stable manure or ashpit refuse will destroy 99 per
cent, of the larva?. Possibly a smaller percentage
of Paris green might be employed with equally good
results.

One per cent, of crude atoxyl in water kills 100 per
cent, of fly larva?.

The application of either of these substances might,
however, lead to serious complications, and it is very
doubtful whether they could be employed with safety.
Paris green, at the rate of one to two ounces to twenty
gallons of water, is used largely as an insecticide for fruit
pests. It does no harm to vegetation when applied in
small quantities ; but cattle might be tempted to eat
the dirty straw in manure which had been treated with
this substance, and the results might prove fatal if large
quantities were eaten.

7. The use of sun-blinds in all shops containing food
which attracts flies would, in my opinion, largely reduce
the number of flies in such places during hot weather.
Small fruiterers' and confectioners' shops, as a rule, are
not shaded by sun-blinds, and in their absence flies
literally swarm on the articles exposed for sale.

The rules laid down by the Merchants' Associations
Committee on pollution of the waters of New York are
as follows :

209

RULES FOR DEALING WITH THE FLY NUISANCE

Keep the flies away from the sick, especially those
ill with contagious diseases. Kill every fly that strays
into the sick-room. His body is covered with disease
germs.

Do not allow decaying material of any sort to
accumulate on or near your premises.

All refuse which tends in any way to fermentation,
such as bedding, straw, paper waste, and vegetable
matter, should be disposed of or covered with lime or
kerosene oil.

Screen all food.

Keep all receptacles for garbage carefully covered,
and the cans cleaned or sprinkled with oil or lime.

Keep all stable manure in vault or pit, screened
or sprinkled with lime, oil, or other cheap preparation.

Cover food after a meal ; burn or bury all table
refuse.

Screen all food exposed for sale.

Screen all windows and doors, especially the kitchen
and dining-room.

Don't forget, if you see flies, their breeding place
is in near-by filth. It may be behind the door, under
the table or in the cuspidor.

If there is no dirt and filth there will be no flies.

If there is a nuisance in the neighbourhood write at
once to the Health Department.

14

CHAPTER XVI

ANKYLOSTOMIASIS I DIRT CONTAMINATION

ANKYLOSTOMIASIS

THIS is a disease which, like so many of the others
which we have described in the preceding pages, teaches
a very instructive lesson. It is the disease par ex-
cellence of workmen and labourers, which breaks out
frequently amongst them when they are working and
living under insanitary conditions, or rather, not under
strict sanitary discipline. Masses of men when left
to themselves, away from the intelligent eye of the
sanitary officer, revert to the primitive conditions of less
civilised nations, or to the condition of our ancestors.
In other words, they surely tend to contaminate their
surroundings, to " foul their nest," to pollute their
houses, villages, water supplies, etc. We know from
history how frequently this occurred in the movements
of armies in the Middle Ages. It was the frightful
mortality from these causes which brought into exist
ence the study of hygiene.

So with ankylostomiasis. This disease has been
known for a very considerable time under different
names. In Egypt there was a well-marked condition

210

TROPICAL ANAEMIA 211

of profound anaemia, which occurred amongst the
labouring population, and was known as Egyptian
chlorosis. During the construction of the St. Gothard
tunnel there broke out an intense anaemia amongst the
workmen, which received the name of Tunnel Anaemia.
In more recent times severe loss was caused by its ex-
tensive prevalence under the name of Miners' Anaemia
in the coal mines of Westphalia ; and still jnore recently
Professor Haldane has given prominence to it by
making accurate observations upon its presence and
cause in Cornish mines. In the tropics, under the
name Tropical Anaemia, it produces a very great
sickness and death rate amongst the labouring classes ;
this is notably so in India and Ceylon, and to a certain
extent amongst the coolie labourers employed in the
West Indies. The disease is therefore widely distri-
buted over the globe. Its leading feature is profound
anaemia, and the consequences of anaemia — i.e. loss of
working capacity and invaliding ; it is therefore the
labour-paralysing disease, and it has in consequence
received great attention from scientific observers all
over the world, and we are now reaping to the full
the benefits of their discoveries. Observers found that,
whether the disease was called " tropical," " miner " or
" tunnel " araemia, " Egyptian chlorosis " or " earth-
eater's disease," " grounditch " or " hook-worm disease,"
the cause was one and the same, a small intestinal
parasite, the Aiikijlostomwri duodcnalc, which inhabited
the intestines in very large numbers and led to a
considerable loss of blood in consequence. The eggs
of the adult worms were passed in the excreta,

ANKYLOSTOMIASIS : DIRT CONTAMINATION

and the latter, either not being carefully removed or
disinfected, contaminated the water and food supplies
of the workmen, or else the abode and ground around
the dwellings and villages ; it was shown especially by
Loos of Cairo that not only could infection take place
by means of infected water and food, but that the
young worms which had hatched out from the eggs
passed in the excreta, in the cane or other plantations
surrounding the houses, were capable of penetrating
the skin of the barefooted workmen and children and
induce the disease. The method of prevention, the
plan of campaign, was also made clear from these
observations. Obviously the first thing is to prevent
the disease spreading by insisting upon the proper
treatment of the excreta of the workmen by erecting
suitable latrine accommodation, rigorously preventing
the pollution of the ground and plantations, etc., around
the villages and houses and camps ; careful treatment
of those suffering from the disease in hospitals and at
dispensaries where some intestinal vermifuge and dis-
infectant of approved efficacy can be obtained. By
the use of these drugs the worms are expelled from the
intestines and the sufferer rendered non-infectious—just
as, in the case of malaria, quinine is employed to kill
the parasites in the circulation. By the combination
of these wise measures splendid results have been
obtained in different parts of the world, and tropical
anaemia, like yellow fever and leprosy, will be steadily
driven back. In the West Indies the disease is
receiving very careful attention ; the labourers and
their families are, in the first place, very carefully

PROPHYLAXIS 213

housed and medically cared for ; they have good
hospitals, where they are promptly treated, and regu-
lations have been framed for their protection. The
following extract from a circular issued by C. J. Cox,
Colomal Secretary, British Guiana, shows that good
work is being done :

" I am directed by the Governor to inform you that
in connection with the efforts which have been made
by the Government to stamp out Ankylostome infection
among East Indian immigrants, it has been found that
upon those sugar estates where suitable latrine accom-
modation has been provided, and where efforts have
been made to prevent the resident population from
defalcating elsewhere, there has been a marked im-
provement in health conditions."

But it is to the Philippines under American rule
that we must turn for examples of the most extensive
safeguarding measures.

THE CAMPAIGN AGAINST ANKYLOSTOMIASIS OR
UNCINARIASIS IN PORTO RICO

The permanent commission appointed by the United
States to study and institute measures for the prevention
and cure of anaemia in Porto Rico has recently issued
a report.

" The campaign commenced in 1906-7 ; 35 stations
for treatment were established in the island, and a
total number of 89,233 patients were treated. The
population of the island is 800,000, scattered over an
area of 3,306 square miles. It was calculated that

214 ANKYLOSTOMIASIS: DIRT CONTAMINATION

90 per cent, of the population harboured the parasite.
To cany out the prophylactic and curative campaign
the island was divided into three zones, each under
the control of a commissioner. Numerous ' Anaemia
Stations ' were formed in each district. The diagnosis
of each case was made accurately by the use of the
microscope. An active educational propaganda was
instituted, and the people taught the nature of the
disease and how it was contracted ; stress was laid
upon the necessity of using only privies, and that on
no account must the people defecate on the ground ;
the people were also exhorted to wear shoes. The
treatment consisted in the use of thymol and beta
naphthol. The total number of people treated amounted
to 89,233 ; of this number 43 per cent, were cured, and
in 16 per cent, the conditions were improved."

It is especially to be noted that the campaign against
the ankylostome has a most marked effect in reducing
the general death rate. Dr. Heiser, Chief Quarantine
Officer for the Philippine Islands, lays great stress upon
this aspect of the campaign, and I fully agree. Given
a man or woman or child suffering, say, from tuber-
culosis or other disease, the chances of recovery are
immensely decreased if the anaemic condition produced
by ankylostomes is also present. If a low mortality
rate is desired, then war must be pressed against these
parasites.

CHAPTER XVII

MALTA FEVER

Malta Fever. — A bacterial parasitic disease com-
municated to man chiefly by the milk of goats suffering
from this bacterial disease. The germ is a minute
micrococcus.

This disease is an excellent example of the principle
underlying every previous chapter, and that is the
danger of the domestic animal as a source of disease.
We have shown that it is the domestic or man-loving
mosquito which is to be feared, and which is the very
fertile source of spreading diseases. As it is with
insects, so with the mammals. From the cow man may
be infected with tuberculosis, anthrax, and perhaps
scarlet fever, from the horse man may acquire glanders,
from the pig trichinosis, and so on. Invariably the
higher animals associated with man are liable to suffer
from diseases which are also harmful to man, and
therefore which they communicate to man by the milk,
flesh, or excreta. Malta fever is an exquisite example
of this principle. It cannot be too strenuously insisted
upon that the domestic economic animals like cattle,
swine, and sheep and poultry require hygienic super-

215

216 MALTA FEVER

vision equally with man. Forgetfulness of this principle
has over and over again led to the spreading of
disease in man. The question can be grappled with
in many ways. It can be dealt with as Sir David
Bruce dealt with the goats which he found to be the
source of the fever in Malta, by either banishing them
or their products from man altogether ; or, as in the
case of diseased swine, by a most rigorous inspection
of the swine flesh as is done in Germany ; or, as in the
case of the cow, by a most searching examination for
the presence of tubercle in the animal. When it can
be carried out, the most effective way is the method
employed in the case of Malta fever. It resembles more
closely the method used against the mosquito.

But whilst the economic domestic animals are a
source of danger to man, it must never be forgotten
that the domestic pets of man are also a fertile source
of disease. For instance, man may be infected with
glanders from the horse, but it is more especially
against the dog and cat that man must be on his
guard. For example, in Iceland the dog is a very
necessary help to the Esquimaux for draught purposes,
therefore the dogs are numerous and live close to him,
in or around the house. A frequent disorder of these
dogs is tape-worm disease ; but, living in such close
contact with their employer, man, it is not to be
wondered at that man should share the disease with
the dogs. It thus comes about that the adult tape-
worm phase of this disease is passed in the dog, and
the cystic or hydatid phase in man. Similarly with
rabies : where dogs are abundant and neglected, there

DANGERS OF DOMESTIC ANIMALS 217

also rabies in man may be expected. The lesson to
be learnt from the foregoing facts is that the fewer the
domestic pets in and around the dwellings of man the
better ; because it stands to reason that, difficult as it
is to maintain the health and cleanliness of man, it
must necessarily be far more so in the case of cats and
dogs, whose wanderings in dirty places can no more
be prevented than those of the common fly.

Geographical Distribution. — Malta fever has a wide
distribution, producing much suffering and loss of time.
It occurs in the islands of the Mediterranean, Italy,
Greece, Turkey, Palestine, North Coast of Africa, Cape
Colony, Orange River Colony, Arabia, India, China,
Philippine Islands, Fiji Islands, North America, West
Indies, and South America, etc.

Discovery of Virus and Carrier. — This disease
remained a mystery until its nature and significance
were worked out by Sir David Bruce, F.R.S., in Malta.
In the following account of the results achieved I follow
closely the account given by the discoverer of the
disease and the author of the simple but absolutely
effective prophylactic measures. The virus consists of
a small coccus, and is therefore not of the nature of
an animal parasite, but belongs to the bacterial group.

Distribution of the Disease in Malta. — The popula-
tion of the island is about 200,000. The garrison
averages about 8,000 troops ; in addition there is a
considerable sailor population. Bruce states that almost
every native of Malta suffers at one time or another
from the disease.

He remarks, " Amongst our troops in the past up

218 MALTA FEVER

to 1905 the average yearly incidence was 37*6 per
thousand. In the year 1905 as many as 403 officers
and men were invalided home, and in previous years
the numbers were also uniformly high. The average
stay of the soldiers and sailors in hospital in Malta
was 90 days, and say a further 120 days' stay in
hospital when invalided home ; therefore on an average
624 soldiers and sailors were in hospital 120 days
each, making up a total of 74,880 days of illness."
Bruce adds, " What the amount of personal suffering
and loss to the State this sickness and invaliding
entailed it is impossible to estimate, but the mere
pecuniary loss must have been very considerable."

Discovery of the Virus. — This was found by Bruce
to be a micrococcus — the Micrococcus melitensis. Its
presence is demonstrable in all persons suffering from
the fever.

Discovery of the Source of Infection. — Suspicion
fastened upon the goats, which were very plentiful
and were the source of the milk supply. Examina-
tion of these animals revealed the fact that 50 per
cent, of them contained the parasite, although appearing
to be perfectly healthy, and in 10 per cent, of them
the milk contained the micrococcus. Here then was
a magnificent example of so-called " healthy carriers "
of the disease, in this case in the animal.

As happened in the case of other infectious pro-
cesses in man, so here an accidental infection in man
gave the final proof. In 1905 a steamer sailing to
the States shipped 65 goats from Malta; their milk
was consumed by the captain and many of the crew,

PLAN OF CAMPAIGN 219

with the result that an epidemic of Malta fever broke
out on the ship, and every one who drank this milk
contracted the disease.

Plan of Campaign. — Preventive measures com-
menced in June 1906. First the goat's milk was
banished from the hospitals and regiments ; then it
was forbidden, and in Gibraltar the goats were them-
selves got rid of.

Results. — The prophylactic measures commenced
in July 1906, and almost immediately a diminution
of the disease occurred. Thus for the months of
July, August, and September 1905 there were 258
cases ; for the same months of 1906 there were only
26 cases.

In the Naval Hospital in Malta, a model institution
in every respect previous to the stopping of the
goats' milk, nearly every patient suffered from the
disease ; after stopping the supply of milk not a single
case occurred.

From Gibraltar MAJOR HORROCKS reports the dis-
appearance of Malta fever simultaneously with the
disappearance of the Maltese goats.

CHAPTER VIII

THE RISE AND FALL OF DISEASE. — PLAGUE, TICK
FEVER, LEPROSY AND TUBERCLE

RELAPSING FEVER (SPIRILLOSIS) AND PLAGUE

Plague. — The term " vermin fevers " might not
inappropriately be given to the two diseases known
respectively as relapsing fever and plague — two diseases
as widely distributed over the globe as the vermin
which have been proved to take a large share in their
transmission. In their very wide distribution over the
temperate and tropical zones they differ from yellow
fever, malaria, and sleeping sickness, the insect carriers
of which diseases flourish more vigorously in warm
climates.

It is therefore not surprising that both these
fevers have a world-wide distribution, as world-wide
as the crawling and lively insects associated with
them, namely, ticks and possibly bugs in the case
of relapsing fever, and fleas in the case of plague.
Nor is it surprising to find that both these diseases
are being confined to diminishing areas of the globe.
Time was when probably both had a far wider dis-
tribution than they have to-day. We know that

220

&*

i. § 1

THE HOME OF PLAGUE 221

Europe was in the Middle Ages and even in later
times devastated by epidemics of the plague or black
death, the pestilence which wiped out entire populations
and which we have every reason to believe was
plague. To-day, the homes of plague have to be
sought in the East and in India, to a less extent
in Egypt ; and it also bursts out sporadically in those
parts of the world having intercourse with the East
and which are not on the alert and are dirty, viz.
the Pacific coast of the United States of America,
and Australia, the Pacific seaboard of Central and
South America, Mauritius, Madagascar, South- West
Africa, South Africa, then finally the larger seaports
in Europe.

If every now and then a few sporadic cases are
found in Liverpool or Glasgow, or London, they are
not feared, for they cannot spread, as the conditions
for their spreading are not at hand ; formerly they
were, but now they have ceased to exist. Of course
this is not the case in all parts of the world. Those
places which have not come into line with these
cities as regards modern hygiene are, as Europe was
in the Middle Ages, still vulnerable. If we inquire
into the reasons why plague has to so large a degree
disappeared from countries where once it was pre-
valent, and why to-day it is being confined to narrower
areas, we must first recall what we have already
learnt about malaria and yellow fever. We have seen
how these diseases have steadily fallen back before
improved water supplies and drainage — that is, before
the destruction of the agents, the mosquitos, which

THE RISE AND FALL OF DISEASE

propagate these diseases. Similarly with plague, the
forces which have led to its extinction and curtailment
are those grouped under Sanitary Reform— improved
ways of living, less overcrowding, refuse removal
and destruction, sewering and water supplies, better
food, hospitals for the isolation of suspected cases,
strict sanitary control by means of medical officers and
sanitary inspectors ; these are the weapons of civilisation
which have steadily driven back the agencies at work
in transmitting plague. Now let us inquire what
these agencies are. Plague is a disease caused by a
bacillus, that is to say by a bacterial parasite or virus,
and belongs to the class of diseases which also em-
braces typhoid, cholera, tubercle, leprosy. Like all
the bacterial diseases, it may be transmitted in various
ways, such as by direct contact, by contaminated food
and clothing. But there is one special way by which
we know it is spread, and that is why we discuss it
here, namely by means of an insect, — in this case the
flea. It has been shown by several observers, notably
in 1906 by the investigations of the Plague Com-
mission in India, that especially the rat flea, Pulex
cheopis, acts as the carrier. It appears that when the
flea takes up a meal of infected blood from a person
suffering from plague, the bacilli are not killed in
the body of the flea ; it has been shown that they
even multiply ; when the infected flea bites a rat or
a healthy human being it transmits the virus. The
rat flea, it would appear therefore, is the chief trans-
mitting agent, and this explains why the rat in common
with man is the greatest sufferer from plague.

DERATISATION 223

Epidemics of plague amongst rats often precede those
in man, and dead and sick rats have always been
regarded with the gravest suspicion in countries
liable to plague. These observations therefore teach
us that the rat and the particular flea which infests
it are the agents which must be regarded as largely
responsible for the spread of this disease. And, just
as in the case of the mosquito-borne diseases special
sanitary measures — the attack, in other words — must be
directed against them, so in plague in all anti-plague
measures a special war must be waged against the rat.
Anti-rat measures are enforced; steps are taken in all
epidemics to exterminate them both on ships and
in towns. Indeed as a precautionary measure in those
places where plague is liable to be introduced, the
rats are systematically examined throughout the year,
as in Liverpool, to try to detect at the earliest
possible stage an acutely or chronically infected rat.
The rats on ships coming from ports where plague is
known to exist are of course subjected to very special
bacteriological scrutiny ; and as a further precaution
means are adopted to prevent the rats from such ships
getting on shore. By these means, if plague is
discovered in the rat the sanitary authority is fore-
warned, and is able to take effective steps before the
disease has attacked man. Again, just as in the case
of yellow fever and malaria the essential part of the
plan of campaign is to exterminate the anophelines and
the stegomyia, so, in the case of plague, the root of
prophylaxis is to exterminate the rat, and with it, its
own special flea which is the carrier. We see now,

THE RISE AND FALL OP DISEASE

moreover, how improved sanitation, better housing,
prevention of overcrowding, sewering, and destruction
of filth will diminish the natural hunting grounds of the
rat, and therefore of its flea, and will in consequence
lessen the chance of spreading the disease ; and this is
why plague has died out in places where hygiene is
good and survives where there still exist overcrowding,
squalor, and dirt.

TICK FEVER

This is the second of the diseases communicated by
vermin. The name is of comparatively recent intro-
duction, but the disease in some form has been known
for many years. The relationship of ticks to the
propagation of disease has been worked out most
carefully in animals. Investigations by Drs. Smith,
Kilborne, and Stiles in the United States showed
that Texas cattle fever or red-water was spread
from animal to animal by the bites of the ticks with
which they were often covered. A tick bites an
infected animal, and by so doing infects itself. In
the case of the female tick the infection is passed
on to the offspring, which, being infected, are capable
of transmitting the virus to healthy beasts, and so the
disease is spread.

As so often happens, that which occurs in the
lower animals finds its parallel in man. And in effect,
in 1904, two sets of investigators working indepen-
dently in Africa proved that the well-known spirillum
of relapsing fever, the parasite which sets up this
disease in man, was transmitted from man to man by

TICK FEVER 225

the bite of a tick, the Ornithodoros moubata, the disease
induced receiving in consequence the name of Tick
Fever.

Two of the investigators who had been sent out
by the Liverpool School, Drs. Dutton and Todd,
proved the further interesting facts, namely, that the
parasite taken up by the parent tick in its meal of
blood could pass into the egg and larva ; in other
words, could pass into the blood, — facts which Pasteur
had shown to occur in the case of silkworm disease.
The infected silkworm moth transmitted to the egg,
and these to the worms which developed from them,
the virus of that disease. So with these ticks. As the
result of biting a man harbouring the parasite, they
infected themselves and their offspring, thus producing
a miniature epidemic amongst themselves and their
offspring ; and presumably these infected or diseased
ticks are capable of communicating the parasite to
man when they attack him. It was whilst engaged
upon this research that Dr. Dutton lost his life by
accidentally becoming infected with the disease.

It thus having been established that fleas can infect
man with plague, and that ticks transmit the parasites
of relapsing fever, it is not unreasonable to suppose
that other crawling vermin can also take their part
in the propagation of disease ; hence the great import-
ance of measures to ensure the cleanliness of the
people, as, for example, by the anti-verminous Act.
Insects that can pass from person to person are
highly dangerous, and every endeavour should be made
to get rid of them. Further, as we have evidence

15

226 THE RISE AND FALL OF DISEASE

that relapsing fever was once, like plague, a disease
widely spread over the temperate as well as over the
tropical zones, and as we know that it still persists
in those districts where there is still overcrowding,
so we must naturally come to the conclusion that
this disease is dying out as the result of civilisation
and its attendant sanitary reforms. It is, like plague
and yellow fever, being chased out of the world or
confined to smaller and smaller areas. What has been
accomplished in the case of relapsing fever and plague
should encourage man to redouble his energies to
finally stamp out yellow fever, malaria, and plague,
more especially now, as there is no excuse for their
existence seeing that we know precisely how to attack
them. In addition to the methods of general sanita-
tion, we have now specific weapons, and the world
should not rest content until these diseases are
absolutely eradicated.

These are not theoretical considerations ; they are
eminently practical, as the history of the rise and fall
of disease has proved to us. To recapitulate, we
stated how only fifty years ago the mortality from
yellow fever in the West Indies reached 69 per cent,
amongst our garrisons. Plague was once the pestilence
of Europe. Cholera once swept over Europe and
many parts of the world. Small-pox was once much
more deadly and common ; so common, in fact, that
it was regarded as the right thing to get it and
have done with it, just as often the planter to-day
regards malaria. Clearly the victory is on our side,
and we must push it home.

PARASITE OR MAN? 227

A very fascinating object-lesson is furnished by the
struggle between man and disease, and it is this. We
are apt to regard the virus or germs of disease as a
dead chemical and poisonous substance, a substance
which having been introduced into our system will
have to run itself out, during which process we may
or may not survive. The study of the tropical
diseases reveals to us the fact that the causes of the
diseases are organised living elements — we term them
parasites — which are struggling for an existence in
our bodies and those of animals ; like all other species
of living matter, they only want to live. When
man, however, finds out that this living is done at
his expense, in the shape of loss of health and very
often death, he bestirs himself against these competi-
tors. He has to adopt every means in his power to
ward them off, for he is now aware that these living
parasites in his blood or intestines are equally strug-
gling to survive in our bodies, and when we use one
method of defence they in their turn harden them-
selves to withstand it. This is seen, for example, in
the gradually increasing resistance which the parasites
of malaria and sleeping sickness offer respectively to
quinine and arsenic. When these drugs are first ad-
ministered they are much more efficacious, that is to
say, they kill more parasites ; later the parasites develop
natural resisting powers and are less affected. The
struggle therefore resolves itself into a deliberate contest
for supremacy in the animal kingdom between the
highest and the lowest representatives. This considera-
tion should still further fortify us to continue the fight.

228 THE RISE AND FALL OF DISEASE

LEPROSY AND TUBERCULOSIS

Just as tick fever or plague teaches us a very signifi-
cant lesson as regards the rise and fall of disease in
the history of mankind, so to-day the bacterial diseases
known by the respective names of leprosy and tuber-
culosis also give us very much cause for reflection.

Leprosy is a very widely distributed disease. It
can still be seen in its most flourishing condition in
the tropics, but it is by no means limited to the
warmer latitudes ; there is much of it still in the north
of Europe. And we must all be familiar with the
fact that formerly it was not only very prevalent in
Europe, but even in this country. The precise manner
in which it is transmitted from person to person is not
known. Numerous theories to account for its spread
have been from time to time propounded, but they
are none of them satisfactory. Beauperthuy, who
had a very considerable experience of the disease,
regarded the insect vermin Sar copies scabeii as taking
a very leading share in its transmission ; he also
viewed with suspicion the house fly. It is a fact
that the sarcoptes is very frequently associated with
leprosy ; and, just as in the case of the tick- and
flea-carried diseases, there may be some intimate
relationship. But the great lesson which leprosy
teaches us is the magnificent results which sanitation
and the skilled care of the sick can bring about.
The leper no longer roams about or is allowed to
rot in some disused hut little better than a dog-
kennel. He is taken and cared for in beautifully

THE DECREASE OF LEPROSY 229

kept hospitals and lazarettos, where he is well fed
and his existence made tolerable ; and those of
us who have seen him in these institutions will, I
am sure, agree that a great debt of gratitude is due
to those devoted nurses and to the sisterhoods who
devote their lives to his care : they are helping in
an unmistakable way to make the world healthier,
and it is one of the great reasons why this terrible
disease is becoming less.

While leprosy is diminishing, an allied disease, often
called the white man's plague, appears to be spreading
in the tropical world. The cause is probably not very
far to seek. We know that the wild animals are not
prone to this disease, but the domestic animals are.
Similarly, we have reason to believe that the wild man
is less prone than the civilised man to contract the
disease. When, however, with the extension of com-
merce, the native races begin to copy more and more
our ways of living, they render themselves equally
liable to our diseases. We have already pointed out
how the domestic animals share with us diseases in
common. The native, instead of living as of old in his
freer and less crowded state, comes into the larger
villages and towns to seek work ; overcrowding in con-
sequence results, too many live huddled together in one
room and with hardly any ventilation. The consequence
is that if tubercle is once introduced, it tends to spread
and to infect the floors and walls of the living rooms.
No wonder then that the question of tuberculosis is
giving much cause for anxiety in some of our tropical
possessions, for no doubt history will repeat itself, and,

230 THE RISE AND FALL OF DISEASE

just as we have witnessed the spread of consumption in
this country and have taken energetic measures to stop
it, so with tropical countries and with crowded popula-
tions the disease will spread and most energetic measures
will have to be adopted to stem it. Tuberculosis is not
the only white man's disease which shows signs of in-
crease ; there are also others. Thus we are brought face
to face with the curious fact that whilst man is steadily
stamping out certain diseases which for the most part
interfere with his commerce, there are a few diseases
associated more especially with his comparatively luxuri-
ous way of living which are not kept under and are
especially apt to spread quickly amongst the native races
who come in contact with us and copy our methods.

APPENDIX

ANTILARVAL AND DRAINAGE REGULATIONS, ORDI-
NANCES, AND BYE-LAWS, RAT AND PLAGUE
REGULATIONS, IN TRINIDAD, BRITISH GUIANA,
BARBADOS, ST. VINCENT, ST. LUCIA, GRENADA,
NASSAU, MAURITIUS, SIERRA LEONE, SAN FRANCISCO

EXPEDITIONS AND COMMISSIONS SENT TO THE TROPICS
BY THE ROYAL SOCIETY AND THE LIVERPOOL AND
LONDON SCHOOLS OF TROPICAL MEDICINE

IN March 1907 Regulations were made under Section 8 of
Ordinance 188 to deal with yellow fever by screening patients,
fumigation, etc., and by prohibiting the keeping of stagnant
water, unless properly protected. It runs as follows :

(«) No water shall be stored (except in small quantities
for drinking purposes) unless efficiently protected against
mosquitos by the following method :

All tanks, barrels, etc., for storing water shall have
all openings except the draw-off opening covered with
wire-gauze (18 mesh to the inch), or with a piece of cheese
cloth or fine mosquito netting, and all fountains, pools,
ponds, antiformicas or excavations made for any purpose
whatever, in public or private property, which may
contain water, shall be kept stocked with mosquito-
destroying fish, or shall be kept covered with a film of
petroleum oil.

(6) The occupier or owner of any premises shall keep such
premises free of stagnant water, liable to breed mosquitos,
231

ANTIMOSQUITO LAWS

and the presence of mosquito larvae in any collection
of water, wherever situated, shall be sufficient evidence
that such water is stagnant.

(c) The occupier or owner of any premises shall keep his
premises free of all articles (bottles whole or broken, old
tins, boxes, conch shell, etc.) which may retain water
and so become the breeding places of mosquitos.

(d) All watery cess-pits shall be disinfected or oiled and
all catch-pits cleaned out at least once a week.

(e) All eaves-gutters and down-pipes shall be maintained
in good repair and free of obstruction so as to allow the
ready passage of water from the roofs of houses.

(f) The Medical Officer of Health or any person authorised by
him in writing shall have authority to enter any premises
at any time between the hours of 6 a.m. and 8 p.m. for
the purpose of seeing that these regulations are carried
out.

6. Any person failing to comply with these regulations shall
be guilty of an offence arid be liable to a fine not exceeding
twenty pounds.

In the new draft Ordinance for 1909 provisions similar to the
above are inserted for dealing with the breeding places of
mosquitos.

In March 1909 a leaflet was widely distributed by the
Surgeon-General repeating these clauses and emphasising the dP20
penalty. Action was taken and many fines inflicted.

On January 16, 1908, additional regulations were passed
dealing with " Contacts,1' and a Report published as follows :

The regulations of the 22nd March and 6th April, 1907,
were revised, provisions for dealing with " Contacts " were added
and the whole were consolidated — passed by the Governor in
Council on the 16th January, 1908, and published in the Royal
Gazette.

In each case of yellow fever occurring in Port-of-Spain a large
area surrounding the infected house was promptly defined and
every house and yard within such area was rapidly subjected to
a rigid inspection and cleansing, special attention being devoted
to actual and potential breeding places of mosquitos.

A portable and readily adaptable apparatus for screening
yellow fever patients was devised and used when required. Isola-
tion was maintained in each case at the patient's residence. The

ANTIMOSQUITO LAWS 233

number of these was reduced as circumstances permitted, and
they were dispensed with altogether for a short period, four being
re-employed between 1st January and 7th March.

The numbers were gradually reduced and the brigade was
disbanded towards the end of November 1907. It was again
brought into operation on the 6th January, and has since been
employed in reduced number. Every building in which a case ol
yellow fever occurred was thoroughly fumigated — including all
outbuildings within the same curtilage, and adjacent premises
when necessary ; twenty-nine premises were dealt with, including
the convents of St. Joseph and Holy Name.

ST. LUCIA

Shortly after his arrival in 1905 Administrator P. Cork directed
the attention of the Sanitary Officers to the importance of the
destruction of the breeding places of mosquitos in towns and
villages, and gave special instructions to the police on the subject.

In November 1905 the Administrator, P. Cork, wrote to the
Inspector of Prisons.

A circular was also directed by the Administrator in November
1905 to all Medical Officers.

A Police Order, dated November 1905, was also issued :

CIRCULAR TO MEDICAL OFFICERS

GOVERNMENT OFFICE

November 25, 1905

Being desirous of obtaining reliable information as to the
prevalence of mosquito-borne diseases in this Colony, I shah1 feel
very much obliged if you will be so good as to favour me with a
return showing the number and description of such disease which
may have come under your notice either hi your public capacity
or in your private practice during the past twelve months.

2. If convenient to you to add particulars of any other
preventible disease which may be prevalent I shall be much
obliged.

THE FOLLOWING USEFUL NOTICE HAS RECENTLY BEEN
ISSUED TO HOUSEHOLDERS IN ST. LUCIA

1. In the general interest of the public health and particularly
to prevent the introduction and spread of yellow fever which

234 ANTIMOSQUITO LAWS

would most seriously affect the trade of the island, every house-
holder is invited to co-operate with the Health Authorities in the
destruction of mosquitos.

2. It is by mosquitos that both yellow fever and the ordinary
malarial fever are carried and spread.

3. Mosquitos can only breed in stagnant water, therefore you
are requested to see that —

(a) Any tanks or jars or other water receptacles in your yard
are screened according to the Board of Health Regulations,
to prevent mosquitos getting into the water to breed.

N.B. — The Health Authorities will be prepared to examine
premises and give advice as to the proper way of screening, etc.
In Castries a specimen of such screening can be seen at the Police
Station.

(6) All wells are filled up.

N.B. — Well water in Castries is most unwholesome.

(c) That none of the following articles are kept lying about
your yard or lots :

i. Bottles : whole or broken,
ii. Tins,

iii. Broken pieces of earthenware,
iv. Coco-nuts,
v. Calabashes,
or any other thing capable of holding water.

(d) That all hollows in the ground about your yards or
adjacent premises are filled up to the level, so that water
may not collect in them.

(e) That water kept in —

i. Washing-tubs,
ii. Flower vases,
iii. Chickens' drinking vessels

is changed very frequently and the vessels kept free from
moss, because the green moss found in such vessels harbours
the mosquito larvae and keeps them alive while the water
is being changed.
Issued by advice of the Medical Board.

H. A. SMALLWOOD,

Acting Colonial Secretary.
July 7, 1909.

GRENADA

Under the Public Health Ordinances 1902 and 1905, regula-
tions were made April 24, 1907, to deal with yellow fever from

ANTIMOSQUITO LAWS 235

the point of view of reporting suspects, fumigation and antilarval
measures. It runs as follows : —

YELLOW FEVER

1. A Medical Officer upon becoming aware or on suspecting
that any person in his district is suffering from Yellow Fever shall,
if he has not already done so, visit such person without delay and
report the facts to the Local Sanitary Authority of his district,
as well as to the General Board of Health through Colonial
Secretary as required by section 4 of Ordinance No. 13 of 1905.

2. Where the patient is found or suspected on such visit to
be suffering from Yellow Fever the Medical Officer shall forthwith
cause him to be placed under a mosquito net, and may direct him
to be isolated in an apartment or building so screened as to
effectually prevent the access of mosquitos thereto, and it shall be
the duty of the occupier of such premises to carefully cause such
screens to be kept closed.

3. Where the patient aforesaid is ordered by the proper
authority to be removed to an Isolation Station or Hospital, he
shall only be so removed in an ambulance or vehicle which is
effectually screened against mosquitos, and it shall be the duty
of the person in charge of such ambulance or vehicle to see that
such screen is not opened unnecessarily. Any such Isolation Station
or Hospital shall be so screened as to effectually prevent the access
of mosquitos thereto.

4. Where any house or building or any part thereof in which
any case of Yellow Fever or suspected case of Yellow Fever has
occurred is ordered to be cleansed and disinfected (under the
authority of section 8 of Ordinance No. 13 of 1905) such operation
shall include its fumigation to the satisfaction of the Medical
Officer and so as to effectually destroy any mosquitos therein.

5. Immediately upon any case of Yellow Fever being reported
in any place in a district, the Local Sanitary Authority shall cause
regular house-to-house visitation to be made in the vicinity of
such place to ascertain whether any other cases of fever have
occurred ; and the district Medical Officer shall assist the Local
Sanitary Authority and its inspectors in such visitation, and they
are hereby empowered to strictly enforce the following measures
for the eradication of mosquitos in such place and its neighbour-
hood :

(«) No water shall be stored (except in small quantities for
drinking purposes) unless efficiently protected against
mosquitos by the following method :

All tanks, barrels, etc., for storing water shall have all

236 ANTIMOSQUITO LAWS

openings except the draw-off opening covered with wire
gauze (18 mesh to the inch), or with a piece of cheese cloth,
and all fountains, pools, ponds, or excavations, made for
any purpose whatever, in public or private property, which
may contain water, shall be kept stocked with mosquito-
destroying fish, or shall be kept covered with a film of
petroleum.

(&) The occupier or owner of any premises shall keep such
premises free of stagnant water, liable to breed mosquitos,
and the presence of mosquito larvae in any collection of
water, wherever situated, shall be sufficient evidence that
such water is stagnant.

(c) The occupier or owner of any premises shall keep his
premises free of all articles (bottles whole or broken, old
tins, boxes, conch shells, &c.) which may contain water and
so become the breeding places of mosquitos, including
broken bottles on walls.

(d) All watery cess-pits shall be disinfected or oiled and all
catch-pits cleaned out at least once a week.

(e) All eaves-gutters and down-pipes shall be maintained in
good repair and free of obstruction so as to allow the ready
passage of water from the roofs of houses.

(f) The District Medical Officer or any person authorised by
him in writing shall have authority to enter any premises
at any time between the hours of 6 a.m. and 8 p.m. for the
purpose of seeing that these Regulations are carried out.

On August 30, 1907, a further notice was issued entitled :
REGULATION FOR THE PREVENTION OF YELLOW FEVER

The Regulation No. 4, passed by the General Board of Health,
on April 24, 1907, is hereby rescinded, and the following regula-
tion is made in its place.

4. Where any house or building or any part thereof is, in
consequence of the occurrence of any case of Yellow Fever, or
suspected case of Yellow Fever, ordered to be cleansed and dis-
infected (under the authority of section 8 of Ordinance No. 13 of
1905) such operation shall include its fumigation to the satis-
faction of the Medical Officer, and so as to effectually destroy any
mosquitos therein, as well as the fumigation in like manner of
such of the houses or buildings in the immediate neighbourhood
thereof, as the said Medical Officer may certify in writing to be

ANTIMOSQUITO LAWS 237

necessary with a view to the destruction of possibly infected
mosquitos.

Approved and passed by the General Board of Health this
30th day of August, 1907.

Since my visit (May 1909) most useful regulations dealing with
mosquito larvae have been passed, as follows :

PUBLIC HEALTH ORDINANCES, 1902 AND 1905

REGULATIONS FOR DECLARING THE BREEDING PLACES OF MOS-
QUITOS, IN AND ABOUT HUMAN HABITATIONS, TO BE STATUTORY

NUISANCES

Under and by virtue of sections 11 and 23 of the Public
Health Ordinance 1902, the General Board of Health hereby
declares the following matters to be deemed nuisances liable at
all times to be dealt with summarily under the provisions of the
said Ordinance :

1. Any accumulation of any stagnant water in any town or in
or about any human habitation, which accumulation results from
want of proper care or from want of repair to any construction or
defective construction.

2. Any articles or receptacles or any construction holding
stagnant water, not being a receptacle or construction designed
and used for the storage of water.

3. Any receptacle or construction, designed and used for the
storage of water, which is not either —

(i) cleared or emptied daily, or

(ii) effectively screened, from the access thereto by mosquitos,
with wire-gauze (18 mesh, at least, to the inch) or, in the
case of receptacles kept in the house, with a covering of
cheese cloth, or

(iii) stocked with mosquito-destroying fish, or

(iv) covered with a film of oil.

4. Any pond or pit containing water, situate in a town, or
within 150 yards of a human habitation, which is not stocked with
mosquito-destroying fish or covered with a film of oil.

5. Any receptacle used for storing water, which receptacle may
have been condemned as unnecessary under notice in writing of
the local sanitary authority served or left on any premises in
pursuance of the provisions of any Regulations made under the
authority of section 20 of Ordinance No. 13 of 1905.

And it is hereby declared that any collection of water shall for

238 ANTIMOSQUITO LAWS

the purposes of these Regulations be regarded as " stagnant
water " if the same contains mosquito larvae or if the same has
been left undisturbed for a period exceeding 18 hours.

Made by the General Board of Health this 21st day of June,
1909.

By order of the Board,

T. T. DYER.
Clerk to General Board of Health.

Also a most useful Ordinance for the destruction of rats :

THE RATS ORDINANCE, 1909
REGULATIONS FOR THE DESTRUCTION OF RATS, ETC., ON VESSELS

1. Any Medical Officer, on becoming aware or upon suspecting
that any vessel lying within any waters of the Colony is infested
with rats or other vermin, is hereby empowered to strictly enforce
the adoption of such measures as may in his discretion be deemed
most efficacious for the purposes of exterminating the said rats
or vermin and of preventing such rats or vermin passing from such
vessel to the shore or from the shore to such vessel. Such measures
may include the following :

(«) Require the owner, master or person in charge of the
vessel, when at any mooring or when loading or unloading
cargo at any port within the Colony, to use rat-guards of
a pattern approved by the said Officer on every rope, cable
or such-like communication passing between such vessel
and the shore or between the vessel and any lighter or
barge or other vessel, or between the vessel and its buoys
or anchors or the mooring.

(Z>) Require the owner, master or person in charge to generally
abate all insanitary conditions where they exist, and to
effectually remove or burn all rubbish and deposits on the
vessel likely to harbour rats or vermin.

(c) Whenever it shall appear to the Medical Officer that the
rats or vermin can only be exterminated by cleansing and
disinfection in a specified manner, the Medical Officer
may, by notice in writing, either require the owner, master
or person in charge of the vessel to cleanse and disinfect
or fumigate the same accordingly, or may inform such
owner, master or person that it is the intention of the
Medical Officer to conduct such cleansing and disinfection
or fumigation at a time to be specified in the notice.

2. Where the owner, master or person in charge of such vessel

ANTIMOSQUITO LAWS 239

fails to comply with any requirements made under these Regula-
tions, or is, from poverty or otherwise, unable to effectually carry
out such requirements, the Medical Officer may cause the requisite
measures to be taken forthwith, and the expenses thereby incurred
may, at the discretion of the General Board of Health, be either
defrayed from General Revenue, or be recovered wholly, or in
part, from such owner, master, or person.

3. It shall be the duty of all Port, Revenue, and Police
Officers to assist the Medical Officers in enforcing the provision
of, and preventing any infringement of, these Regulations.

4. Any person acting in violation of these Regulations, either
by way of refusing to obey any requisition or instruction, made or
given hereunder, or by obstructing in any way the due execution
of these Regulations, renders himself liable to a fine not exceeding
twenty pounds.

Made by the Governor in Council this 21st day of June, 1909.

T. T. DYER.

Clerk of Council.

ST. VINCENT

The Public Health Act of 1865 naturally contained no anti-
mosquito regulations.

Therefore an ordinance (No. 3, 1901) was passed to repeal it,
and under this ordinance Regulations were made in 1907 to
deal according to modern methods with yellow fever and mosquitos
as follows :

THE PUBLIC HEALTH ORDINANCE, 1901

REGULATIONS MADE BY THE GOVERNOR IN COUNCIL UNDER THE
AUTHORITY OF SECTION 20

1. When disinfection of any house or premises is ordered or
effected under Regulations 8-11 of the Public Health Regula-
tions of the 16th March, 1903, such disinfection may include
fumigation to the satisfaction of the Government Medical Officer
so as to effectually destroy any mosquitos therein.

2. The provisions contained in Regulations 14 and 15 of the
Public Health Regulations of the 16th March, 1903, as to isolation
and removal of persons suffering from infectious or contagious
disease shall, notwithstanding anything contained in the Public
Health Regulations of the 23rd July, 1903, apply where any

240 ANTIMOSQUITO LAWS

Government Medical Officer suspects that any person is or may be
suffering from Yellow Fever.

3. The occupier of any premises in any town, or in case of
their being no person in occupation, the owner thereof, shall keep
the premises free from stagnant water likely to breed mosquitos.
and the presence of mosquito larvae in any collection of water shall
be sufficient evidence that such water is stagnant ; and he shall
also keep the premises free from tins, bottles, whole or broken
(including broken bottles on walls), tubs, barrels, odd receptacles,
broken crockery, etc., kept or left in a position likely to accumu-
late and retain water and so become breeding places for mosquitos.

4. Immediately upon any case of Yellow Fever or suspected
Yellow Fever being reported, the Local Authority or Local
Authorities for the district or districts in or near to which the
case has occurred shall make or cause to be made regular house-to-
house visitation in their district in the vicinity of such place
to ascertain whether any other cases of fever have occurred, and
the Government Medical Officer of the district shall assist the
Local Authority by examining any person the Local Authority
may require, and the Local Authority shall see that, in any town,
the provisions of the last preceding Regulation have been, and
are, observed, and shall also have power and authority to order
and direct the owner or occupier of any premises in the neighbour-
hood of which any such case has occurred, and whether the
premises be, or be not in any town, for a period of not exceeding
three months from such order and direction :

(a) To comply with the requirements of the last preceding
Regulation.

(b) To cover ail openings except the draw-off opening in
tanks, barrels, etc., used for storing water, with wire-gauze
(not less than in 18 mesh to the inch), or with a piece of
cheese cloth.

(c) To either cover and keep covered with a film of kerosene
oil, or draw off and keep drawn off, or fill up, all pools,
ponds or excavations made for any purpose, which may
contain water.

(d) To disinfect in manner directed, or to oil once a week any
watery cess-pit, and to flush out or clean at least once a
week any drain, or gutter.

(e) To repair and free from obstruction any eaves-gutters and
down-pipes and to keep the same repaired and freed from
obstruction so as to allow the free passage of water from
the roofs of houses.

All persons shall comply with the orders or directions of the

ANTIMOSQUITO LAWS 241

Local Authority, or of any inspector authorised by them in
writing, in respect of any of the above matters.

5. The Local Authority or any person authorised in writing
by the Local Authority is hereby empowered to enter any premises
at any time between the hours of 6 a.m. and 6 p.m. for the
purpose of enforcing the provisions of these Regulations.

Made by the Governor in Council this 8th day of May, 1907.

V. F. DRAYTON,
Acting Clerk of Council.

N.B. — By the provisions of Section 21 of the Public Health
Ordinance 1901, any person who —

1. Violates these regulations : or

2. Refuses or neglects to obey the same ; or

3. Resists, opposes, or obstructs the lawful execution thereof,
— is liable to a penalty not exceeding twenty pounds or to
imprisonment with or without hard labour for any period not
exceeding six months.

This year (1909) a new Bill is being prepared, to be called
the Public Health Ordinance 1909, containing provisions against
stagnant water and mosquito larvae. Provision is made for
bringing water under proper control and supervision, etc.

BRITISH GUIANA

The old Public Health Act not containing any reference to
antimosquito measures, special bye-laws were enacted.

In 1905 a bye-law for the cleansing of tanks without, however,
special reference to larvae, was issued.

In 1907 bye-laws relating to the screening of vats, etc., as a
preventive against mosquitos were promulgated under the title
" Mosquito Prevention Bye- Laws, 1907," as follows :

BYE-LAWS RELATING TO THE SCREENING OF VATS, ETC.,
AS A PREVENTIVE AGAINST MOSQUITOS

1. These bye-laws may be cited as the Mosquito Prevention
Bye-Laws, 1907.

2. All vats, tanks, or other vessels shall be screened with
mosquito-proof wire-netting or other suitable material so as to
prevent the entrance into or exit of mosquitos from such vats or
tanks or other vessels.

16

242 ANTIMOSQUITO LAWS

3. The inlet and overflow pipes into such vats, tanks or other
vessels shall be placed in such positions or screened in such a
manner as to prevent the entrance into or exit from the same of
mosquitos.

4. All buckets or other vessels containing water for fire-
extinguishing or other purposes shall be emptied and cleansed at
least once a week.

5. The work of screening the vats, tanks, and all such other
vessels shall be done by the owners of the properties on which
they are situated, and all vats, tanks, or other vessels shall be
screened within three months from the date of the coming into
force of these bye-laws.

6. Any person contravening any of these bye-laws shall be
guilty of an offence, and on summary conviction, be liable to a
penalty not exceeding ten dollars.

Made by the Mayor and Town Council of Georgetown under
Section 179 of the Local Government Ordinance, 1907,
and confirmed by the Governor and Court of Policy on
the second day of September, 1907.

These do not appear, owing to considerable prejudice, to have
been enforced. I had, however, the opportunity of discussing
them with the Mayor and Town Council, with the result as
follows :

PUBLIC NOTICE

VAT SCREENING

THE Mayor and Town Council having directed that the Vat
Screening Regulations of 1907 are in future to be rigidly enforced,
and the Sanitary Inspectors of the several Wards having been
instructed to notify property owners and householders accordingly,
public notice is hereby given that all persons failing by the 15th
July next to comply with such Regulations in respect to the
efficient screening of tanks, vats, barrels, and other vessels used
for the storage of water, will be proceeded against as the law
directs.

Advice as to the best methods of screening to be adopted will
be given when required on application at my office.
By order of the Mayor and Town Council.

LUKE M. HILL,

Town Superintendent.
TOWN HALL, GEORGETOWN,
June 8, 1909.

ANTIMOSQUITO LAWS 243

VAT SCREENING IN GEORGETOWN

Sir, — In reference to your paragraph in this morning's issue
about vat screening in Georgetown, I may mention for the in-
formation of the public that many hundred vats have already been
screened, notwithstanding your statement that only " a compara-
tively small number " have been so treated.

It may be of some interest to those property owners still in
default to know that the following general order to Town Over-
seers was issued by me on Thursday :

" As the days of grace allowed for vat screening expire to-day,
I shall be glad if the overseers will make out a return of all
vats screened and unscreened in their respective districts with
a view of instituting some prosecutions of recalcitrant owners and
occupiers, as an example to others ; and to show that it is intended
to enforce the vat screening regulations.

" I expect these returns to be made from personal inspections
of the storage vessels, and not from casual inquiries made from
the householders." — I am, sir, etc.,

LUKE M. HILL,

Town Superintendent.
TOWN HALL,
July 16, 1909.

By Ordinance 13, 1907, stress had been laid upon the necessity
of drainage. The bye-Laws are as follows :

DRAINAGE BYE-LAWS

FOR THE CITY OF GEORGETOWN, IN THE COUNTY OF I3EMERARA,
COLONY OF BRITISH GUIANA, WITH RKSPECT TO THE DRAIN-
AGE OF LOTS

MEMORANDUM

THE PUBLIC HEALTH ORDINANCE, 1878 (NOW LOCAL
GOVERNMENT ORDINANCE No. 13, 1907), ENACTS :

23. (174, new Ordinance 13, 1907.) The owner or, when
required by the local authority, the occupier of every lot of land
situate in a Town or Village district shall effectually drain the lot,
and for that purpose shall :

1. Make such dams and drains on the lot as may be necessary
for effectually draining the lot ;

2. Fill up all irregularities in the surface of the lot ; and

3. Adjust the surface thereof, and if necessary raise the level
of the surface thereof, in such a manner —

244 ANTIMOSQUITO LAWS

(a) That the water received on the lot may flow into the

drains without obstruction ;
(6) That no water can remain on any portion of the

surface of the lot other than the drains ; and
(f) That the surface of the lot does not remain swampy :
Provided that where the swampy state of any lot in any such
district is occasioned by the main drains into which the drains of
the lot discharge not having a sufficient outfall- or a sufficient
capacity to carry off all the water discharged into them, the
owner or occupier of the lot shall not be liable under this section
to raise the level of the surface of the lot if the level of such
surface is as high as the average height of the level of the land
surrounding such a lot for a distance of twenty roods ; and

Provided that any owner may, with the consent of the local
authority of the district in which the lot is situate, have a pond
on the lot.

24. (175, new Ordinance 13, of 1907.) Every local authority
may make bye-laws :

1. For regulating the number, position, length, and width of
all drains, the materials of which they are to be constructed,
the mode of their construction, and the main drains into
which they are to discharge ;

2. For imposing on the owner of the lot, or on the occupier,
or on each occupier of the lot or of any building thereon,
the duty of keeping the drains on or adjoining the lot
clean and wholesome and free from obstruction ;

3. For determining in what cases there is to be one drain
common to two adjoining lots and how the expense of the
same is to be divided between the owners or occupiers of
such lots ; and such bye-laws may apply to the whole or any
specified part of the district of such local authority.

26. (New Ordinance 176.) Where any lot within a town or
village district is not effectually drained . . . the local authority
shall, by a written notice, require in the first case the owner or
occupier of the lot or of any building on the lot, and in the
second case the owner or occupier of the land or of the dwelling-
house thereon, or if there be more than one of such owners or
occupiers, then any one or more of such owners or occupiers, to
perform within a reasonable time to be specified in the notice all
or any of the obligations imposed by this Ordinance on the owner
or occupier for effectually draining the lot or portion of the land.

If any owner or occupier fails to perform any act required by
such notice to be performed he shaU be liable to a penalty not
exceeding twenty-four dollars, and to a further penalty not ex-

ANTIMOSQUITO LAWS 245

feeding three dollars for each day during which such failure shall
continue after the expiration of the time specified in the notice.

Where the notice is not complied with (and notwithstanding
proceedings may have been or are about to be instituted for the
recovery of the penalty for non-compliance therewith) the local
authority may, after the expiration of the time specified in the
notice, do the work required, and may recover in a summary
manner the expenses incurred by them in so doing from the owner
or occupier of the lot in the first case, and in the second case from
the owner or occupier of the land or the dwelling-house thereon,
or may by order declare the same to be private improvement
expenses.

Any expense incurred by the occupier of any lot or building in
complying with any notice under this section may be recovered by
him from the owner of the lot or of the land on which the building
is erected, unless the necessity for the work required by the said
notice to be performed was rendered necessary by the act of the
occupier, or unless it has been otherwise agreed between the owner
and occupier.

AS TO DRAINAGE.

1. Every lot exceeding fifty feet in width shall have not less
than two drains, and every lot under and not up to fifty feet in
width shall have at least one drain.

2. Each such drain shall be so placed :

(a) That the centre thereof shall not be less than two feet from
the nearest boundary line of the lot unless the Town
Superintendent, the circumstances being exceptional, shall
give permission in writing to place any such drain nearer
to such boundary line ;

(6) That such drains shall run clear from and outside of all
buildings on the lot in a straight line without any bend or
angle unless the Town Superintendent, the circumstances
being exceptional, shall give permission in writing to place
any such bend or angle in any such drain ;

(c) That the tops of the sides of such drain shall be below
the level of the surface of the lot and that the said sides
shall be pierced at intervals of not less than ten feet with
holes of not less than one square inch in area, and being
not less than two inches above the level of the bottom of
the drain ;

(d) That the bottom of such drain shall at the upper end or
highest level thereof have a depth of not less than six
inches, and shall have a fall towards the point of discharge
of not less than two inches in every one hundred feet ;

246 ANTIMOSQUITO LAWS

(c) That such drain shall discharge into the main drain in rear
of the lot in all cases where such back drainage is pro-
vided ; in all other cases, into the nearest main drain
provided by the local authority for the reception of the
lot-drainage of the district, and every question as to which
is such nearest main drain shall be determined by the
Town Superintendent.

3. Each such drain shall run through the lot from end to end
or from side to side as may be necessary, having reference to the
position of the main drain unless the Town Superintendent, the
circumstances being exceptional, shall give permission in writing to
construct any such drain for a shorter distance.

4. Each such drain shall have an internal width of not less
than nine inches at the top and six at the bottom.

5. Each such drain shall be constructed of stone, brick, con-
crete, hardwood, or other suitable material, and in such manner as
the Town Superintendent shall approve.

6. The drains on or adjoining any lot shall be kept clean and
wholesome, and free from obstruction by the parties hereinafter
named :

(a) The owner or, where there are more than one, each owner

of the lot.
(6) The occupier of the lot or, where there are more occupiers

than one, by each occupier,
(c) The occupier of any building on the lot.

7. The owner or owners of two adjoining lots may, having
first obtained the permission in writing of the Town Superin-
tendent, construct one drain common to such two adjoining lots.

8. Every such common drain shall be of not less than one and
a half times the width required by these bye-laws for the drain of a
single lot.

9. The expense of constructing any such common drain shall
be divided between, and be payable in equal proportions by the
owners of the lots drained thereby unless the Town Authority
shall otherwise order in cases where the special circumstances show
that one owner ought justly to pay more than the other.

10. If in the opinion of the Town Superintendent it is
necessary for the efficient drainage of a lot that the drainage shall
pass through or over an adjoining lot, the drains carrying off such
drainage shall whenever practicable be made to pass through the
side drains of the said adjoining lot hereinbefore provided for,
and, if not so practicable, then such drainage shall be carried
across such adjoining lot by means of a tunnel or covered drain
of sufficient capacity constructed to the satisfaction of the Town

ANTIMOSQUITO LAWS 247

Superintendent as regards position, size and material, and the
expense of constructing such tunnel or covered drain and of
replacing the surface earth shall be borne wholly by the owner
or owners of the lot from which the drainage comes.

11. If the Town Superintendent certifies that on the coming
into operation of these bye-laws any lot is or was sufficiently
drained, these bye-laws shall not be taken or held to require the
construction of new drains on such lot, unless the drainage of the
lot subsequently becomes defective or insufficient.

12. Efficient subsoil drainage, to the satisfaction of the Town
Superintendent, may be permitted in lieu of the drains described
in Bye-laws 2, 3 and 4.

13. The owner of any lot feeling aggrieved by the action of
the Town Superintendent in any manner by these Bye-laws left to
his decision may appeal to the Town Authority, whose decision
shall be final.

14. Every person who shall offend against any of these bye-laws
shall be liable for every such offence to a penalty of twenty-four
dollars, and in the case of a continuing offence to a further penalty
of three dollars for each day after written notice of the offence
from the Town Authority :

Provided nevertheless that the magistrate, before whom any
complaint may be made or any proceedings may be taken in
respect of any such offence, may, if he think fit, adjudge the
payment as a penalty of any sum less than the full amount of the
penalty imposed by this bye-law.

BARBADOS

The Public Health Act of 1898, Section 8, contained some
up-to-date regulations for the destruction of mosquitos. Good
as they were, they were not, unfortunately, rigorously enforced.

2. The occupier or owner of any premises shall keep such
premises free of stagnant water, liable to breed mosquitos, and the
presence of mosquito larvae in any collection of water, wherever
situated, shall be sufficient evidence that such water is stagnant.
All tanks, fountains, pools, ponds, or excavations made for any
purpose whatever, in public or private property, which may
contain water, shall be kept stocked with mosquito-destroying
fish, or shall be kept covered with a film of petroleum oil.

3. The occupier or owner of any premises shall keep his
premises free of all articles (bottles whole or broken, old tins,
boxes, conch shells, etc.) which may retain water and so become
the breeding places of mosquitos.

248 ANTIMOSQUITO LAWS

4. All cess-pits which retain water shall be disinfected or oiled
except they be efficiently covered and trapped.

5. All gutters and down-pipes shall be maintained in good
repair and free of obstruction so as to prevent the accumulation
of water therein and to allow the ready passage of water from the
roofs of houses.

6. All Inspectors of Health shall have authority to enter any
premises at any time between the hours of 7 a.m. to 6 p.m. for
the purpose of seeing that these Regulations are carried out, and
may pour oil or cause oil to be poured on the surface of water
contained in any receptacle in or on such premises.

Made by the General Board of Health this 22nd day of
February, 1909.

President.

Confirmed by the Governor in Executive Committee this
day of February, 1909.

Colonial Secretary.

When the epidemic broke out a manifesto was issued by the
President of the Board of Health, Dr. Chandler, to Commissioners
and Inspectors of Health, etc. :

SIR,

Yellow Fever is spreading in various parts of the Island.

There are two points whose importance you probably realise
already but which cannot be too frequently impressed on every
Commissioner of Health and every Inspector of Health in view of
the grave danger resulting from a want of their proper con-
sideration.

1. It is during the first three days of illness that the Yellow
Fever patient infects mosquitos, and every such patient who
remains unscreened from mosquitos during the whole or a material
part of these three days if bitten by Stegomyia mosquitos, which
abound in Barbados, makes his place of abode the centre of a new
Yellow Fever infected district.

Our recent experience has clearly demonstrated that in many
cases it is difficult for the attendant medical practitioner to
diagnose Yellow Fever in the earlier stage of the disease.

The returns made of the cases that have occurred during the
present epidemic show that a large number of cases have only been
seen for the first time by a medical man after the expiration of
the first three days of the disease. With this result of the present
state of things its continuation can only mean the spread of the
epidemic.

ANTIMOSQUITO LAWS 249

To prevent this spread steps must be taken to ensure as far
as possible that every Yellow Fever patient be screened from
rnosquitos during the first three days of his illness.

To effect this every person suffering from fever of any sort
should as a matter of precaution be screened from mosquitos
as soon as possible after the development of fever. Patients of
the labouring classes are not in ordinary circumstances seen by a
medical man until some time after the occurrence of fever.

To cope with the existing situation there must be a daily
house-to-house inquiry as to the health of inmates not likely to
summon a medical man on the first appearance of illness, prompt
attendance by a medical man at the public expense on every
person having fever of any sort, and proper arrangements for
immediately carrying out at the public expense every direction by
a medical man to screen a patient from mosquitos.

2. The destruction of the largest possible number of mosquitos
which have had the opportunity of coming into contact with a
Yellow Fever patient is most essential.

A mosquito infected with Yellow Fever can live and infect
persons with that disease for many months.

In the returns made to the Board of Health by Sanitary
Inspectors they invariably report that they have " disinfected and
fumigated," and the result of inquiries made show that in many
cases these words correctly describe the order of procedure
adopted.

Some Inspectors in their use of disinfectant do everything
possible to chase the mosquitos out of the infected premises, and
having done this more or less effectively then proceed to close up
the premises and fumigate for the destruction of mosquitos.

One can scarcely imagine any mode of procedure which would
tend more to the spread of the epidemic.

Similar directions were placarded in all prominent places
throughout the town and many districts.

At the same time also a large number of handbilk were printed
warning householders against the danger of keeping stagnant
water, and the penalties for the same.

IMPORTANT NOTICE

Extract from Bye-Laivs made by the Commissioners of
Health for the Parish of St. Michael for the City

2. The occupiers of all houses, stores, warehouses, or other
premises within the limits of the city shall daily have swept and

250 ANTIMOSQUITO LAWS

cleaned the yards and enclosures thereof, the streets, pavements
and gutters in front of and around the same, as far as the centre
of the streets, some time before the hour of eight every morning ;
and shall collect the sweepings and rubbish, with other refuse
matter on their premises, in a box or some other receptacle, to be
placed ready to hand on the premises for removal by the
scavengers' carts. And where such premises are not occupied, it
shall be the duty of the owners to have the streets, pavements
and gutters daily swept and cleansed, and the rubbish removed or
deposited as aforesaid for removal by the carts.

Extract from Bye-Laws for Suburbs of Bridgetown

No. 4. The owners or occupiers of all houses or other premises
throughout the city and suburbs are required at all times to keep
such premises in every respect clean and free from offensive matter
and rubbish of every kind ; and the occupiers or owners of all
houses, stores, or other premises within the suburbs shall have
swept and cleaned the yards and enclosures thereof, and gutters in
front of, and around, the said premises.

Extract from the General Board of Health Rides, %£nd February r,
1909, confirmed by the Governor in Executive Committee on
February 26, and proclaimed in the Official Gazette on
March 1, 1909

2. The occupier or owner of any premises shall keep such
premises free of stagnant water, liable to breed mosquitos, and
the presence of mosquito larvae, in any collection of water,
wherever situated, shall be sufficient evidence that such water is
stagnant. All tanks, fountains, pools, ponds, or excavations made
for any purpose whatever, in public or private property, which
may contain water, shall be kept stocked with mosquito-destroying
fish, or shall be kept covered with a film of petroleum oil.

3. The occupier or owner of any premises shall keep his
premises free of articles (bottles whole or broken, old tins, boxes,
conch shells, etc.) which may retain water and so become the
breeding place of mosquitos.

4. All cess-pits which retain water shall be disinfected or oiled
except they be efficiently covered and trapped.

5. All gutters and down-pipes shall be maintained in good
repair and free of obstruction so as to prevent the accumulation of
water therein and to allow the ready passage of water from the
roofs of houses.

6. All Inspectors of Health shall have authority to enter any

ANTIMOSQUITO LAWS 251

premises at any time between the hours of 7 a.m. to 6 p.m. for
the purpose of seeing that these Regulations are carried out, and
may pour oil or cause oil to be poured on the surface of water
contained in any receptacle in or on such premises.

Penalty for infringement of Bye-Laws of the Commissioners of
Health, a sum not exceeding £5.

Penalty for infringement of Rules of the General Board of
Health, a sum not exceeding <£°10, to be recovered before a Police
Magistrate.

By order,

S. E. BREWSTEE,
Inspector of Health, No. 2 District.

THE BAHAMAS, NASSAU

Measures were first taken in 1905 by the Board of Health
against mosquito-borne diseases. In 1906 the authorities circu-
lated my pamphlet upon the prevention of Yellow Fever and
imported wire-gauze for distribution. In 1907 the following
useful antilarval regulations were drawn up and circularised, and
quinine was distributed at cost price and free of cost to the poor.

BOARD OF HEALTH ACT, 1872
RULES AND REGULATIONS, OCTOBER 1907

1. The owner or person in control of any cistern, vat, tank,
barrel, bucket, or other vessel used for the storage of water shall
within such time as may be specified by notice protect the same
from mosquitos in the following manner, that is to say :

i. Cisterns, tanks, vats, and barrels shall be provided with
covers of wood or metal, and all openings other than the
delivery exit shall be screened with netting,
ii. Buckets and similar or other retainers shall be protected
in the same way as cisterns, or in some other manner
approved by the Board.

iii. Owners and occupiers of premises on which there is any
water in wells, ponds, pools or basins, or in depressions or
excavations made for any purpose, or which by any means
have occurred, and in which mosquitos can breed, shall
within such time as may be specified by notice protect the
same from mosquitos in the following manner, that is
to say —
(1) Stock them with mosquito-destroying fish ;

252 ANTIMOSQUITO LAWS

(2) Or cover them with protective netting ;

(3) Or drain them off at least once a week ;

(4) Or cover them with oil at least once every week : or fill
them up.

(5) Or (in case of wells) provide them with a pump and
mosquito-proof cover to the satisfaction of the Board.

3. All empty and open tins shall be kept in such a position as
to prevent mosquitos breeding in them, and all odd receptacles,
such as jars, broken crockery, condensed milk tins and other
rubbish which form receptacles for water shall be removed and
buried. All doreys, pit-pans and boats, in use or discarded, must
be kept free of fresh water.

PENALTIES

4. Any person committing a breach of any of these Rules and
Regulations shall be liable on summary conviction to a penalty of
£2, and on a second conviction to a penalty not exceeding £5
or to imprisonment with or without hard labour not exceeding
30 days.

NOTICE

5. " Notice " shall mean a written notice addressed by a person
authorised in that behalf by the Board to the occupier or the owner
of any premises, or water receptacle, and every such notice shall
be deemed to have been duly served by delivering the same or a
duplicate thereof to some person on the premises, or if there is no
person on the premises who can be so served, by fixing the same
on some conspicuous part of the premises, or in the case of a
water receptacle as aforesaid by fixing the same on the water
receptacle in respect of which such notice is issued.

J. BENSON ALBURY, M.D.,

Chairman of Board of Health.

MAURITIUS. PROPOSED ANTILARVAL AND
DRAINAGE MEASURES, 1908

ORDINANCE NO. OF 1908

1. In this Ordinance " owner," " occupier," " premises,"
"sanitary authority" shall have the same meaning as in Ordinance
No. 32 of 1894-5.

2. The following paragraph is added to Article 29 of
Ordinance 32 of 1894-5.

All collections of water, sewage, rubbish, refuse, ordure, or

ANTIMOSQUITO LAWS 253

other fluid or solid substances, and all other conditions which
permit, or facilitate, or are likely to permit or facilitate, the
breeding or multiplication of animal or vegetable parasites of men
or domestic- animals, or of insects or other agents which are known
to carry such parasites, or which may otherwise cause or facilitate
the infection of men or domestic animals by such parasites.

3. (a) Notwithstanding the above provisions or any of the

provisions of Ordinances No. 32 of 1894-5, 21 of 1903,
12 of 1889, 31 and 32 of 1895—

It shall be lawful for any Sanitary Authority or any
person deputed by him in writing to take immediate steps
to destroy mosquito larva? on any premises where they
may be found, and to take such action as may be necessary
to render any pools or accumulations of water unfit to be
breeding places for mosquitos.

(b) The persons so deputed shall have a right to enter any
premises, dwelling-houses excepted, between the hours of
six in the morning and six in the afternoon.

(c) When such pools or accumulations of water lie on premises
under the charge of a public body or corporation they
shall not be dealt with as above provided, unless due
warning has been given in writing to such public body or
corporation, and no action has within reasonable delay,
not to be less than 24 hours, been taken by them. In such
cases the expenditure incurred shall be borne by such
public body or corporation.

(d) Any owner or occupier who shall object to pools and
collections of water on his premises being dealt with as
above provided shall within 24 hours submit his reasons to
the Sanitary Authority, who, after inquiry, shall order such
action to be taken as he shall consider necessary to meet
the provisions of this Ordinance. Should the objections
be rejected the measures originally ordered shall be carried
out at the expense of the said owner or occupier.

4. It shall not lie lawful for any owner or occupier to allow
mosquitos to breed on his premises or to allow the presence on
.such premises of any receptacles in which water is kept or may
collect unless such receptacles are properly protected from access
of mosquitos, or unless the water they may contain is treated in
such a way as to prevent the breeding therein of mosquitos, nor
shall such owner or occupier allow on his premises any conditions
which may, in any way, be favourable to the breeding of mosquitos.

5. Trees on all premises shall be at all times kept freely
lopped to the satisfaction of the Sanitary Authority by the owner

254 ANTIMOSQUITO LAWS

or occupier, and no trees shall be allowed to grow within ten feet
from any dwelling-house. The Sanitary Authority may, in
writing, direct the said owner or occupier to carry out the above
provision within a reasonable delay, not to l)e less than 48 hours,
and, in case of non-compliance, the trees shall be lopped or cut
down at the expense of the owner or occupier.1

6. It shall be lawful for the Director of the Health Department
to make such regulations as may be necessary to carry out the
provisions of this Ordinance.

7. It shall be lawful for the Director of the Health Depart-
ment, in any case when the owner or occupier of any premises is
liable for the expense of any measures carried out on his premises,
to relieve such owner or occupier from the said expense, if, after
inquiry, the Director is satisfied that such owner or occupier is not
in a position to incur such expense. In such cases the expendi-
ture shall be borne by Government.

8. Any person acting in breach of Articles 4 and 5, or of the
regulations made under Article 6, shall be liable to a fine not
exceeding Rs. 100.

9. Expenses incurred by the Sanitary Authority under para-
graphs (c) and (d) of Article 3, and under Article 5, shall be
dealt with in the manner provided by Articles 52 and 53 of
Ordinance No. 32 of 1894-5.

10. This Ordinance may be cited as the Malaria Prevention
Ordinance.

WEST AFRICA

In the year 1905 clauses were inserted by Dr. Prout, C.M.G.,
in the Public Health Ordinance of Sierra Leone dealing with
mosquito larvae, and it was made a nuisance under this Ordinance
(1905) to have any collection of water in any well, pool, channel,
barrel, tub, bucket or any other vessel, and found by the Sanitary
Authority to contain mosquito larvae.

Under clause 4, paragraph (d) it states :

When mosquito larvae are found in any collection of water, or
in any well or pool, channel, barrel, tub, bucket, or in any other
vessel, the Sanitary Authority may themselves abate the same,
and may do what is necessary to prevent the recurrence thereof.

1 Some specific provision ought to be made to enable tbe Sanitary
Authority to fill up with concrete, or otherwise to treat, holes and hollows
in trees which breed, or are likely to breed, mosquitos ; and also to compel
owners to cut insanitary undergrowth (see particularly addendum 3).

R. Ross.

ANTIMOSQUITO LAWS 255

PENALTIES

Where a notice has been served on a person under this
section (4) —

Where mosquito larvae are found in any collection of water
or in any well or pool, channel, barrel, tub, bucket, or any
other vessel, within ten days from the service of such notice on
any such person in respect of any such collection of water, well,
pool, channel, barrel, tub, bucket or other vessel, he shall be
liable to a fine not exceeding ten pounds for each offence, whether
any such nuisance order as in this Ordinance mentioned is or
is not made upon him.

Under Section 31 dealing with provisions as to water, it is
stated :

Every person who shall keep an any premises any collection
of water in any well, barrel, tub, bucket or other vessel intended
for the storage of water without providing them with covers
so constructed as to prevent the ingress of mosquitos into the
same, shall be liable to a fine not exceeding twenty shillings. If a
person shall fail to comply with the provisions of this section,
he shall, after notice received from the Sanitary Authority to
comply therewith, be liable to a further fine not exceeding
seventy shillings a day during his default.

THE ANTIPLAGUE CAMPAIGN IN SAN FRANCISCO

There has just been issued an account of the eradication of
plague in San Francisco. It is a very excellent and stimulating
account of what has been accomplished, and it should serve to
stimulate this country to wake up to do likewise for India.

As was the case during the 1905 yellow fever outbreak, so
in San Francisco one of the first steps was the organisation of
a Citizens' Health Committee to combat the plague which had
burst out again in 1909. This committee organised in all the
useful directions, and at the end of six weeks reported as follows :

42,460 premises inspected,
334 premises disinfected,
171 dangerous houses destroyed,
54 buildings condemned,

17,564 nuisances abated,

56,994 rats trapped or poisoned.

256 ANTIMOSQUITO LAWS

The committee had enlisted the sympathy of the entire popu-
lation. One hundred meetings had taken place ; a vast quantity
of literature had been distributed ; numerous improvement clubs
had been organised throughout the city. With regard to the
support given by the clergy, the Report states :

Rat destruction, cleanliness and sanitary doctrine in general
were preached in the churches and sabbath schools for several
months. A general meeting of the clergy of ah1 denominations was
held in the Chamber of Commerce to advance the sanitary crusade.

The Report further remarks :

Before San Francisco could get rid of plague it had to
go to school and study zoology, bacteriology and fleas. The
whole community had to learn about plague as a disease and
an epidemic — that plague zcas a rat disease.

Again, the Report adds :

Fleas shun the sunlight and the air. They deposit their eggs
in rat-nests and the rats hatch them out with the warmth of their
bodies and then give the young fleas free transportation wherever
they go. Sulphur fumes will kill them, so that fumigation has
been found effective.

Ordinances were passed by the Mayor and Council of San
Francisco :

(a) Dealing with the collecting of garbage.

(b) The suitable construction of all stables, which were
further sources of rat breeding.

(c) The proper flooring of markets and yards and basements.

(d) The keeping of animals and fowls.

(e) The suppression of insanitary buildings and many other
matters.

The Report makes some ugly comparisons between what has
been accomplished in San Francisco with what is occurring in
India to-day. It says in 1896 the plague reached Bombay and is
still there. It has spread all over India, and in the face of
modern medical skill it has claimed over five and a quarter
million victims. In 1904, the year the first epidemic was sup-
pressed in San Francisco, it killed over a million people in the
Indian Empire, destroying in a single week over 76,000 lives — a
number equal to the British Army in India !

LIST OF COMMISSIONS AND EXPEDI-
TIONS SENT TO THE TROPICS TO
STUDY TROPICAL DISEASES

ROYAL SOCIETY

INVESTIGATIONS INTO TROPICAL DISEASES CARRIED OUT UNDER THE
DIRECTION OF COMMITTEES OF THE ROYAL SOCIETY

TSETSE FLY. — No expedition sent out, but investigations
carried on in Natal by Surgeon-Major (now Colonel Sir David)
Bruce more or less independently of the Committee, and by Dr.
W. H. F. Blandford, Dr. Kanthack, and Dr. H. E. Durham in
London under the direction of the Committee, in 1896 and
1897.

MALARIA AND BLACKWATER FEVER. — Dr. C. W. Daniels, Dr.
J. W. W. Stephens, and S. R. Christophers, M.B., sent to British
Central Africa in 1898. Daniels also to East Africa and Stephens
and Christophers to West Coast. Stephens and Christophers sent
to India in 1901 to carry out researches on Blackwater and
Malaria : returned to England in 1 902 ; work on Malaria con-
tinued by Captain James, I.M.S.

SLEEPING SICKNESS. — Dr. G. C. Low, Dr. C. Christy, Dr. A.
Castellani, sent to Uganda in June 1902. In 1903, Colonel
Bruce and Dr. Nabarro joined the Commission. In 1904-5 the
work of the Commission was conducted by Captain Grieg and
Lieutenant Gray, R.A.M.C. In 1908 Colonel Sir David Bruce
again left for Uganda in September, accompanied by Captains
A. E. Hammerton and H. R. Bateman, R.A.M.C. This Com-
mission is still in Uganda.

257 17

258 LIST OF COMMISSIONS

MEDITERRANEAN FEVER. — The first Commission was sent out
in 1904, and consisted of Major Horrocks, R.A.M.C., Staff
Surgeon Shaw, R.N., and Dr. Zanmet, under Colonel Bruce,
R.A.M.C. In 1905 the Commission consisted of Staff Surgeon
Shaw, R.N., Dr. Kennedy, R.A.M.C., Major Horrocks, R.A.M.C.,
and Lieut.-Colonel Davies, R.A.M.C., under Colonel Bruce. In
1906, the members of the Commission under Colonel Bruce were
Major McCulloch, R.A.M.C., Major Weir, R.A.M.C., and Major
McNaught, R.A.M.C., Staff Surgeon Clayton, and Dr. Eyre.

The brilliant work of these Commissions is published in a
series of Reports issued by the Royal Society.

LIVERPOOL SCHOOL OF TROPICAL MEDICINE

The following is a complete list of the Expeditions sent out
to the Tropics from the commencement of the School to the
end of 1908 :—

THE FIRST (MALARIAL) EXPEDITION : Major Ronald Ross,
C.B., F.R.S., Dr. H. E. Annett, Mr. E. E. Austen (of the British
Museum), and Dr. Van Neck (of Belgium), despatched to Sierra
Leone in the summer of 1899.

THE SECOND (MALARIAL) EXPEDITION : Dr. R. Fielding Ould,
despatched to the Gold Coast and Lagos in the winter of 1899.

THE THIRD (MALARIAL) EXPEDITION : Dr. H. E. Annett,
Dr. J. Dutton, and Dr. Elliot, despatched to Northern and Southern
Nigeria in the spring of 1900.

THE FOURTH (YELLOW FEVER) EXPEDITION : Dr. H. E. Durham
and the late Dr. Walter Myers, despatched to Cuba, and to Para,
Brazil, in the summer of 1900.

THE FIFTH (SANITATION) EXPEDITION : Major Ronald Ross,
C.B., F.R.S., and Dr. Logan Taylor, despatched to Sierra Leone in
the early summer of 1901.

THE SIXTH (TRYPANOSOMIASIS) EXPEDITION : Dr. J. E. Dutton,
despatched to the Gambia in the autumn of 1901.

THE SEVENTH (MALARIAL) EXPEDITION : Dr. C. Balfour Stewart,
despatched to the Gold Coast in November 1901.

THE EIGHTH (SANITATION) EXPEDITION : Major Ross, despatched
to Sierra Leone on February 22, 1902.

THE NINTH (MALARIAL) EXPEDITION : Major Ross accompanied
by Sir William MacGregor, K.C.M.G., the Governor of Lagos,
despatched to Ismailia, September 11, 1902.

LIST OF COMMISSIONS 259

THE TENTH (TRYPANOSOMIASIS) EXPEDITION : Dr. J. E. Dutton
and Dr. J. L. Todd, despatched to the Gambia and French
Senegal on September 21, 1902. This Expedition received great
assistance from M. Roume, Governor-General of French West
Africa, and all the French officials with whom they came in contact.
Two valuable Reports in connection with the Expedition have been
issued by the School.

THE ELEVENTH (SANITATION) EXPEDITION : Dr. M. Logan
Taylor, despatched to the Gold Coast from Sierra Leone on
October 11, 19U2. This Expedition was sent to the Gold Coast
in consequence of unsatisfactory rumours as to the health of
that district. The services of Dr. Taylor were utilised by the
Governor of the Colony, and his recommendations for improving
the sanitary conditions of Cape Coast Castle carried out with
most successful results.

THE TWELFTH (TRYPANOSOMIASIS) EXPEDITION: Dr. J. E.
Dutton, Dr. J. L. Todd, and Dr. C. Christy, despatched to the
Congo Free State on September 23, 1903. This Expedition gives
promise of being the most important Expedition sent out by the
School since the Expedition in 1899, which discovered the presence
of the Anopheles Mosquito in West Africa. It was sent out as
a result of representations made to the School by H.M. the King
of the Belgians, who made the Expedition possible by granting
a handsome donation towards its expenses.

THE THIRTEENTH EXPEDITION : Professor Rubert Boyce, M.B.,
F.R.S., Dr. Arthur Evans, M.R.C.S., and Dr. Herbert H. Clarke,
M.A., B.C. (Cantab.), were despatched to Bathurst, Conakry and
Freetown on November 14, 1904, to report on the Sanitation and
Antimalarial Measures in practice at the towns visited. The
members of the Expedition have drawn up a valuable Report,
which has been issued by the School.

THE FOURTEENTH EXPEDITION : Lieut.-Col. G. M. Giles,
M.B., F.R.S., Indian Medical Service (Rtd.), and Dr. R. Ernest
McConnell, M.D. (Canada), despatched to the Gold Coast on
December 31, 1904. Unfortunately, Col. Giles had to return to
England on February 8, 1905, through illness. Dr. McConnell
remained for several months on the Coast to carry on the work of
the Expedition.

The Thirteenth and Fourteenth Expeditions were sent to West
Africa in appreciation of Sir William MacGregor"s great services
to health and sanitation in West Africa.

THE FIFTEENTH (YELLOW FEVER) EXPEDITION : Dr. H. Wol-
ferstan Thomas and Dr. Anton Breinl, despatched to the Amazon
in April 1905. Both members of the Expedition contracted yellow

260 LIST OF COMMISSIONS

fever and Dr. Breinl had to be invalided home. Dr. Thomas is
still carrying on the work of the Expedition.

THE SIXTEENTH (YELLOW FEVER) EXPEDITION : Professor Boyce,
F.R.S., despatched to New Orleans in August 1905 to observe
the work of the United States Medical Authorities in dealing with
the outbreak of yellow fever there. Professor Boyce subsequently
visited British Honduras at the special request of the Colonial
Office, to make a report on the conditions existing in that Colony
with reference to a recent outbreak of Yellow Fever.

THE SEVENTEENTH (MALARIAL) EXPEDITION: Professor Ross,
C.B., despatched to Lake Copias, in Greece, on May 20, 1906, at
the request of the Lake Copias Company.

THE EIGHTEENTH (SLEEPING SICKNESS) EXPEDITION : Dr. Allan
Kinghorn, M.B., and Mr. R. E. Montgomery, M.R.C.V.S.,despatched
to Rhodesia and British Central Africa on May 5, 1907.

THE NINETEENTH (BLACKWATER FEVER) EXPEDITION : Dr. J. O.
Wakelin Barratt, M.D., D.Sc. (Lond.), and Dr. W. Yorke, M.D.,
despatched to Nyassaland on August 14, 1907.

THE TWENTIETH EXPEDITION : Professor Ronald Ross, C.B.,
despatched to Mauritius on October 28, 1907.

THE TWENTY-FIRST EXPEDITION : R. Newstead, M.Sc., A.L.S.,
F.E:S., Dr. W. T. Prout, M.B., C.M.G., and Dr. Alan Hanley,
M.D., C.M.G., despatched to Jamaica on November 14, 1908.

EXPEDITIONS ORGANISED BY THE LONDON
SCHOOL OF TROPICAL MEDICINE

1900. MALARIA. — Drs. Sambon and Low practically demon-
strated that in the Roman Campagna, Malaria could not be
acquired without the mosquito.

1902. FILARIASIS. — Dr. Low went to the West Indies to
study Filariasis and the relationship of Mosquitos to disease.

1902. SLEEPING SICKNESS. — Drs. Low and Castellani members
of the Royal Society's Commission in Uganda.

1902. BERI-BERI. Dr. Durham went to Christmas Island
to investigate this disease and afterwards proceeded to Singapore
and the Malay States.

1905. Dr. Leiper : investigations upon the Guinea Worm,
West Africa.

1907. Dr. Wenyon : investigations in Egypt and the Soudan.

1908. Professor Simpson : Plague investigations in West
Africa for Colonial Office.

INDEX

Acclimatisation Fever, 18

Africa, Antimalarial Campaign, 72-9

Agramonte, 127

Algeria, Antimalarial Campaign, 72-5

Amazon, Yellow Fever Campaign, 185

Anaemia, Miners', 211

— Tropical, 210-14

— Tunnel, 211
Ankylostomiasis, 210, 213-4

— and Porto Rico, 213

— Prophylaxis, 213
Ankyloatomum duodenale, 211
Anopheline Mosquitos, 31
Breeding Places, 56

Measures against, 52, 53, 56-7

Natural Enemies of, 53

Antigua, Antimalarial Campaign, 85

— and Yellow Fever, 114
Antilarval Regulations, Ordinances,

and Bye-laws, 231 (Appendix)
Arsenisation, 200
Atoxyl and Sleeping Sickness, 200
Australia, 11

Balfour, Dr. (Antimosquito work), 72
Bancroft, Dr., 120
Barbados, 119

— Antilarval Bye-laws, 249-50

— and Malaria, 50, 54-5

— and Yellow Fever, 113
Barretto de Barros, 127
Bathurst, 77
Beauperthuy, Dr., 23, 25, 228

— and Flies, 101

— and Itch, 99

— and Malaria, 102

— and Stegomyia, 97

— and Tradition, 97

Beauperthuy on Transmission of
Yellow Fever, 97-110

— and Yellow Fever, 102
Belize, 83, 130-1
Beyer, 127

Blair, Surgeon-General, 27, 97, 107
Blake, Sir Harry, 23, 25
Botanic Gardens and Malaria, 92-3
Branch, Dr. (St. Vincent), 57
Brazil, 89-90

— and Yellow Fever, 120

— Yellow Fever Campaign, 182-5
Breinl, Anton, 127

British Guiana, 82-3, 1 10

and Ankylostomiasis, 213

Drainage Bye-laws, 243-7

Screening Bye- laws, 241-3

British Honduras, 82

Yellow Fever Campaign,

178-80

Bromeliacece, 58, 94
Bruce, Sir David, 10, 195, 216-8
Bulam Fever, 121
Bush-clearing, 94-5

Campaigns — Antimalarial :
Africa, 72-9
Algeria, 72-5
Antigua, 85
Brazil, 89-90
British Honduras, 82-3
Colon, 81
East Indies, 90-1
Europe, 62
Greece, 64
Hong Kong, 91
India, 63

261

INDEX

Campaigns — Antimalarial : (contd.)

Ismailia, 65

Isthmian Canal Zone, 80-1

Italy, 63

Jamaica, 86

Khartoum, 72

Klang, 90

Mauritius, 88

Nassau, 87

Panama, 81

Philippines, 88-9

Rio de Janeiro, 82

Sierra Leone, 64, 76

St. Lucia, 84-5

United States, 91

West Africa, 79

West Indies, 83, 87
Campaign, Plan of, 49
Campaigns, Antimalarial, 61-5, 72,

75-6, 79-91
Camphor, 142
Canopy, 23
Carbolic Acid, 142
Carroll (Army Surgeon), 126
Carter, L. H. B., Dr. (Marine Hos-
pital Service), 110, 127
Castellani, 195
Chamberlain, Rt. Hon. Joseph, M.P.,

5, 7, 9

Chisholm, Dr., 120
Cholera, 3, 13, 226
Christophers, Captain, 47, 73
Clarke, H. H., 77
Cocoa Plantations, 93
Collet, Hon. Wilfred, 180, 192-3
Columbus, 119-20
Conakry, 77
Cottrell, H. (African Association),

78

Crab, Crab-holes, and Mosquitos, 96
Cromer, Earl of, 8, 70
Cruz, Oswaldo, 131, 183
Cuba, 127

— and Yellow Fever, 121

— Yellow Fever Campaign, 153-4
Culex Fatigans and Dengue Fever,

193

Culex and Filariasis, 37
Culicides, 57

Cultivation and Mosquitos, 92-6
Cyclops, 29

Dandy Fever, 192-3

d'Arenberg, Prince, 66

De Lesseps, 20

Demarquay, 32

Dengue or Dandy Fever, 192-3

and Culex, 192-3

Deratisation and Plague, 223
Derby, Earl of, 8

— Countess of, 8

Dirt Contamination, 210, 214
Doty, Dr. A. H. (New York), 91
Drainage, 13, 58

— Regulations and Ordinances, 231
(Appendix)

Durham, H. E., 127
Dutertre, Pere, 120
Dutton, J. Everett, 9, 67, 195, 225

East Indies, Antimalarial Campaigns

of, 89-90
Education, 161
Egyptian Chlorosis, 211
Elephantiasis,
Entomology, Study of, 53
Epiphytes, 59
Evans, Dr. Arthur, 77
Expeditions :

Liverpool Tropical School, 288,
259

London Tropical School, 260

Royal Society, 257

Fedschenko, 29
Fergusson, 115
Fever, Acclimatisation, 18

— Dengue or Dandy, 192-3

— Malaria, 38-48

— Yellow, 107-92
Filaria, 30

— and Culex, 37

— and Mosquitos, 32

— Bancrofti, 32
Findlay, Sir Charles, 28

and Stegomyia, 98

Firth (Philadelphia), 108
Flies and Beauperthuy, 101

INDEX

263

Flies and Disease, 194-209

Forde, Dr. (Bathurst), 195

Francis, 127, 149

Freetown, 77

Freire (Rio), 109

French Guinea, 77

Fumigation, 131, 140-5, 159, 172-4

— Materials for, 142

Gastelbondo, Dr., 121
Georgetown, Yellow Fever, 114
Gibbons, 54
Gilchrist, Dr., 122
Giles, Lieut.-Col., 77
Girardinus pceciloides, 54
Glossina palpalis, 196

— morsitans, 196
Gold Coast, 79
Gorgas, Major, 130-1
Grassi, 63

Grecian Antimalarial Society, 64
Grenada, Antilarval Regulations,
237 (Appendix)

— Anti-rat Ordinance, 238-9 (Ap-
pendix)

— Cocoa Plantations, 93
Ground-Itch, 211
Guatemala, Yellow Fever, 147
Guinea Worm, 29
Guiteras, 127

Haffkine, 3
Haldane, Prof., 211
Harrison, Prof. (Demerara), 26, 82,
98, 109

— on Extrinsic Incubation, 108, 133
Havana, 82, 98, 127, 131

— and Yellow Fever, 121

— Yellow Fever Campaign, 153-4
Herodotus, 23

Hodges, A. D. P., 202

Hook-worm Disease, 211

House Flies, 204-9

House Fly, Breeding Places of, 205

Dangers of, 205

Plan of Campaign, 206-7

Regulations against, 207-9

Howard (Washington), 146
Humboldt, 119

Ismailia, Antimalarial Campaign, 65

— Cultivations, 93
Isthmian Canal Zone, 80-1

Yellow Fever Campaign, 181

Italy, Antimalarial Campaign, 63
Itch and Beauperthuy, 99

Jamaica, Antimalarial Campaign, 86
Johnston (Jamaica), 79
Johnston, Sir Harry, 80
Jones, Sir Alfred L., K.C.M.G., 8

Khartoum, Laboratories of, 11

— and Malaria, 72

— Antimalarial Campaign, 72
King, 28

Klang, Antimalarial Campaign, 72
Kleine, 197
Koch, 3, 4, 7, 73
Kuenen, 92

Labat, Pere, 120

Larva?, destruction of, 131

Laveran, 2, 38-9

Lazear (Army Surgeon), 127

LeBoeuf, Dr., 117, 120

Leprosy, 228-30

Leuckart, 29

Lewis, 32

Liceaga (Mexico), 131

Lister, Rt. Hon. Lord, 3, 9

Liverpool School of Tropical Medi-
cine Expeditions, 258-9

Logan laylor, 76

London School of Tropical Medicine
Expeditions, 260

Lutz, 127

Maladie de Siam, 120
Malaria and Beauperthuy, 102

— and Barbados, 50

— and Botanic Gardens, 92-3
Malaria Campaigns, 61-91 :

Africa, 72, 79
Algeria, 72, 75
Antigua, 85
Brazil, 89-90
British Honduras, 82-3
Colon, 81

264

INDEX

Malaria Campaigns (contd.)

East Indies, 90-1

Egypt, 65

Europe, 63

Greece, 64

Hong Kong, 91

India, 62-3

Ismailia, 65

Isthmian Canal Zone, 80-1

Italy, 63

Jamaica, 86

Khartoum, 72

Klang, 90

Mauritius, 88

Nassau, 87

Panama, 80

Philippines, 88-9

Port Said, 71

Port Swettenham, 90

Bio, 82

Sierra Leone, 63

West Africa, 76, 79

West Indies, 83, 87

United States, 91
Malaria and Manson, 41

— and Plantations, 92-4

— and Boss, 61-2

— and Suez Canal Co., 65-71
Malta Fever, 215-9

Campaign, 219

Virus, 218

Manson, Sir Patrick, 5, 8, 30

— and Filaria, 32-4

— and Malaria, 41

— Experiments of, 46
Manson, Dr. P. Thorburn, 9, 46
Marchoux, Dr., 127
Martinique and Yellow Fever, 120
Mauritius, Antimalarial Campaign,

88

— proposed Antilarval and Drainage
Begulations, 253-4

May, Dr., 108

Medan, 92

Mexico and Yellow Fever, 120

Miasms, 17

Micrococcus melitensis, 218

Microfilaria Bancroft!, 32

Millions, 54

Miner's Anaemia, 211
Mosquito Brigades, 68-9
Mosquitos and Cultivation, 92-.,

— and Dengue Fever, 192-3

— and Filaria, 32

— and Malaria, 22

— and Miasm, 99

— and Trees, 94

— and Yellow Fever,

— Doctrine, 47

— Enemies of, 49, 55

— Nets, 49

— Penalties against, 49

— Survey, 50
Moxly, Bev., 109
Myers, Walter, 9, 127

Nagana, 196

Nassau, Antilarval Begulations,
251-2

— Antimalarial Campaigns, 87
New Orleans, 15, 131-2

Water-screening Ordinance,

167-8

Yellow Fever Campaign, 155-

79

Northumberland, Duke of, 8
Notification, early, 134, 158
Nott, Dr., 23

Ordinance, Water-screening, New
Orleans, 167-8

Ordinances, Antilarval, 231 (Ap-
pendix)

Ornithodoros moubata, 225

Osier, Prof., 63

Oviedo, 119

Panama, Antimalarial Campaign,

80

Parker, 127
Pasteur, 3

Patterson (St. Vincent), 57
Penalties, 69
Philippines and Ankylostomiasis,

213

• — Antimalarial Campaign, 88-9
Pines, wild, water-holding, 58

INDEX

265

Pipe- borne water, 13, 189
Plague, 220, 223

— and the Flea, 222

— and the Rat, 222-3

— Campaign in San Francisco, 255-6

— Deratisation, 223
Plantations and Malaria, 92-4
Porto Rico and Ankylostomiasis,

213
Port Said, Antimalarial Campaign,

71

Port Swettenham, 90
Pothier, 127
Predaceous Larvse, 57
Prejudice, 17
Propagandism, 59
Prophylaxis, Malaria, 49-60
- Yellow Fever, 131, 133, 160
Prout, 86, 254-5

Puerto Barrios, Yellow Fever, 147
Puerto Cortez, Yellow Fever, 147
Pulex cheopis, 223
Pyrethrum, 142

Quinisation, 60, 75

Reed (Army Surgeon), 126
Relapsing Fever, 220
Ribas, 127
Rice Plantations, 93
Rio de Janeiro, 15

Antimalarial Campaign, 82, 89-

90

Yellow Fever Campaign, 182-5

Rodriques, 127
Romayn, Dr. Thomas, 121
Rosenau, 127
Ross, Major, 9, 31

— and Anophelines, 40

— Experiments of, 43, 45-6

— Dr. E. H., 71

— on Malaria, 61-2
Roux, 3

Royal Society, 10

Tropical Expeditions, 257

Salimbini, 127
Saman Trees, 59

Sarcoptes scabeii, 228

Screening, 49, 131, 137, 139, 159,

167-8

Sealing, 140-2
Segregation, 49, 51, 74
Septic Fly, 204-9
Siam, Maladie de, 120
Sierra Leone, Antilarval Clauses,

254

Simond, 127
Sleeping Sickness, 194-220

and Atoxyl, 200

Campaign, Uganda, 201-3

National Bureau, 200

Prophylaxis, 199-203

Spain and Yellow Fever, 122
Spanish Honduras, Yellow Fever,

147

Spirillosis, 220
St. Domingo, 119-20

and Yellow Fever, 115

St. Lucia and Yellow Fever, 113

Antilarval Regulations, 233

St. Vincent, Antilarval Regulations.

239-41

— and Yellow Fever, 95, 113,

119
Stegomyia, Breeding Places, 56, 95,

146-52, 163

— Description of, 147-8

— Habits of, 147
- Index, 152, 191

— in relation to Water Supply, 14

— Larvse and Eggs of, 149-51

— proved carrier of Yellow Fever, 14,
126, 128

— Survey, 146-52

— when Infected, 132

Stephens, J. W. W. (Liverpool, 47),

73

Sugar-cane Plantations, 93
Sulphur, 142
Sumatra, 92
Suez Canal Co. and Malaria, 65,

71

Thomas, H. Wolferston, 127, 185
Thomson (Hong Kong), 91
Tick Fever, 224-5

266

INDEX

Tobacco Plantations, 92
Tobago and Yellow Fever, 114
Todd, Prof. J. L. (Montreal), 225
Tccnia echinococcus, 29
Tradition, 17
Travers, 90
Trichina spiralis, 28
Trichinosis, 28
Terreyra de Rosa, 120
Trinidad and Yellow Fever, 112

— Antilarval Regulations, 231-2
(Appendix)

Tree-Mosquitos, 93-4
Treves, Sir Frederick, 80
Tropical Anaemia, 210-14

— Entomology, 10

— Medicine Movement, 2

— Schools, 8, 11, 257

Expeditions, 9, 257

Trypanosoma gambiense, 19t>
Trypanosomiasis, 194-203
Tuberculosis, 228-30
Tunnel Anaemia, 211

Uganda, Sleeping Sickness Cam-
paign, 201-3
Uncinariasis, 213
United States, 91

and Yellow Fever, 122

Urich (Trinidad), 57

Vine Plantations, 93
Virchow, 28
Vomito prieto, 121
• — negro, 121

Walbridge, Dr. (British Guiana), 123
Washington, 10
Water-holding Plants, 58, 94
Water Supply, 13
Watson, Dr., 90
Wellcome Laboratories, 11
West Africa, Antimalarial Cam-
paigns, 79
West Indies Water Supply, 14

Yellow Fever Campaign, 18 6-92

Westphalia, 211

Woldert, Dr. A. (U.S.A.), 91

Wood, General, 131

Yellow Fever, 107-92

— and Ballast, 117

— and Beauperthuy, 102
and Cargoes, 117

1852 Commission on, 107

and Conquistadoros, 111

and Dredging, 129

and Early Settlers, 111

and Excavating, 129

and Periodicity, 125

and Race Predisposition, 123-4

and Stegomyia, 126, 128

and the Clergy, 170-1

and Water Supply, 14

Contagious or not, 1 06

Extrinsic Incubation period,

133

False Doctrines, 116-18

Historical Survey, 1 1 1-25

Houses, 19

Immunity, 124

Inoculation Experiments, 108

Mild case of, 165

Prophylaxis, 131-52

Ships, 117-8

Susceptibility, 123-4

Transmission, 126-7

Yellow Fever Campaigns, 153-92 :

Amazon, 185

Brazil, 182-5

British Honduras, 178-80

Cuba, 153-4

Havana, 153-4

Isthmian Canal Zone, 181

New Orleans, 155, 179

Rio de Janeiro, 182-5

Santos, 182-3

West Indies, 186-92
Yellow Fever in Antigua, 114

Barbados, 113

Brazil, 120

Bulam, 121

Cuba, 121

Demerara, 114—15

Dominica, 112

Georgetown, 114

Guatemala, 147

INDEX

267

Yellow Fever in Havana, 121, 131

Martinique, 120

Mexico, 120

— Puerto Barrios, 147, 180-1

Puerto Cortez, 147, 180-1

St. Domingo, 115, 120

St. Kitts, 114

St. Lucia, 113

Yellow Fever in St. Vincent; 113

Siam, 120

Spain, 122

Spanish Honduras, 147, 180-1

United States, 122

Trinidad, 112

West Indies, 111-25

Yersin, 2

Printed by Hazell, WaUon & Viney, Ld., London and AyUibury.

I

.,• .

.r

Boyce, Rubert W
Mosquito or man?

WC680
B?89m
1909

MEDICAL SCIENCES LIBRARY

. • ••--.,-•

- - .-

-

.

'

•

e

'

:

'

•

"
-

'

&

-

-

•

'

•

• . • ' - .

-

•

- •

'

- - ' '

' . - -

..

Uj