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·PALUDISM- No 3 July 1911 CONTENTS РАСв THE DEATH OF LICUTE ANT COLONEL J T W LESLIE, CIE, IMS Facing EDITORIAL RECORD t IO A NOTE ON SOME ON THE MCASURES THAT HAVE BEEN TALEX TO MALE QUININE AVAILABLE TO THE POOR IN INDIA ON THE SELECTION Or UNIT AREAS FOR RECORDING DATA CONCERNING MALARIA IN INDIA 15 24 THE EFFECT OY E DEVIC MALARIA UPOV THE BIRTH AND DEATH Rite BY MAJOR WH KENRICK, I MS INFECTION AMONG TROOPS AND NATIVE CHILDREN AT DELFI BY LIEUTENANT COLONCL IRADIE, INS MALARIA IN THE SEYPORE HILL TRACT AND ADJOINING COAST LAND BY MAJOR EL PERRY IMS THE RELATION OF THE ENDEMIC INDEX TO THC SPLEEN INDEX IN EPIDEMIC AREAS OF THE PUNJAB BY MAJOR EL PERRY, I HIS AIDS TO THE IDENTIFICATION OF CULICIDAC OTHER TIIAY ANOPIIALES, WITH SPECIAL REFERFNCE TO INDIAN Species BY MAJORS R CHRISTOPHERS IMS A MANDY METHOD OF COLLECTI GADULT ANOPHELES By LIEUTENANT COLO\ELJ R ADIE, IMS A SYSTEM OF MOUNTING EVASINING AND PRESERVING MOSQUITOES CENTRAL MALARIA BUREAU 38 40 55 57 ·PAGE 62 63 63 64 64 64 64 67 ნა 65 66 NOTES ON MOSQUITOES 1-A method of heeping adult anopheles alire with cut feeding them on blood ( R Adie) II -11 liston in the Punjab (E 4 Perry J R. Adie, F Smith, C Bureau) III —P Jeyporiensis (CL Perry C M Bureau) IV-P gigas in Assam Hills (McCombie Young) psimlensis (G:11) V-A turkhudt at altitude of 6,000 feet (Gill, Acton, Christophers) Note regarding P nurser and P nigrifasciatus from Quetta VI -Reduction of palpal bands in N maculatus and N maculipalpis (Adie Gill, Krishna Rao) VII - Larva of Ne fowlers (WY H henrick) VIII --le oillmori a proved malaria carrier in sature REVISED AND NE\V DESCRIPTIONS OF INDIAN ANOPHELES- 1-Egg of il lestone (Revised) 11 –Egg of N maculatus (nen) III -- Larva and Nymph of C halli (new) IV - Larva and Nymph of Ne rollmont (new) 4N INVESTIGATION INTO THE PREVALENCE OF WALA AZAR IN A PART OF UPPER ASSAM by S R CHRISTOPHERS MALARIOMETRY 1-Obser latrons upon graphs of the spleen rate and erera, e spicen by S R Christophers RECENT LITERATURL- The anopheles fauna of Tonkin The pfluence of temperature upon the bitog of mo quitoes On the collection and preservation of in ects Description of a new genus of anopheles from Ceylon Some enumerafite studies on Valarial Fever Malarial parasites resistant to quiaine Treatment of Valaria by 606 hala Azar and 606 Arsenophenylglyzine to Blackwater Fever bernation of mosquitoes by means of the esg 67 67 69 72 87 103 108 109 rog IJO 114 116 119 119 119 ·ME PAGE IO 12I 131 124 Some methods of destroying mosquitoes A new anopheline from the Federated Malay States 120 Anopheles in the Transy..al 120 Habits of anopheles in relation to screening of houses Endemic index at Tonkin Malaria among Mecca pilgrims The effect of strichaine on malarial parasites 133 Malaria on the Ivory Coast 123 The value of the Splenic Index 124 Quartan Malaria in Germany Quartan Malaria anl its parasite, Panama Clinical studies of malaria at Ancon, Panama 125 The duration of malarial infection 135 Malarial pigment in the urine 126 Recurrences in malaria 1.6 Campaign against malaria in Sicily 127 A case of Blackwater rever 127 On hemoglobin metabolism in malarial icver 128 A method of cultivatiog hala izar parasites 129 LIST OF PLATES PLATCI - Vap of India to illustrate subdivisions to face page 16 PLATCI --To illustrate the scale structure of Cult cida to face page yo PLATC III - To illustrate methods of mounting and collecting mo to face page 57 PLITE IV-Larya and esos of anopheles to face page 66 PLATF V -Charts to illustrate Vajor Christophers paper on graphs to face page 96 PLATT VI —* Veecella forler: and Leslieonyta Laensorhynchoides to face page 130 These mos101tes e e eser edc pa sad (s of Paludis

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·.....* 49 The Central Committee for the study of malaria in India record with profound regret the death, on the 27th March 1911, of their late President, Lieutenant Colonel J T W Leslie, CIE, IMS For more than fourteen years Lieutenant Colonel Leslie, first as Secretary to the Sanitary Commis sioner with the Government of India, afterwards as Sanitary Commissioner, laboured with untırıng zeal and industry to advance the cause of public health in this country He was a man in whom the qualifications of great administrative ability, sound judgment and unrivalled knowledge of the sanuary needs of India were combined with technical attainments of a high order and a wide scientific outlook He always held that research is the foundation of sanitary progress and in this connection the Bacteriological Department the Organi sation for the Study of Malaria, and the Indian Research I und are examples of the fruits of his labours He possessed remarkable powers of critical analysis and of realısıng at once the true significance of problems and results, and although his official duties were arduous he always found time to keep abreast of the most recent scientific work During the periods of his leave to Europe it was his practice to study in one or other of the continental laboratories, and he was intimately acquainted with the work and writings of German and French specialists His interest in protozoolog, led him, when he was last on leave in Germany to undertake and almost complete the serious task of translating into Lnglish Professor Doficins umque treatise on that subject Vlen of affairs sought his advice, and no research worher ever consulted him without obtaining valuable suggestions and that sympathetic and heenly interested encouragement which is an endunng stimulus to continucd effort His untimely death is a loss not only to India which he served so faithfully and sell, but to the world of scientists to whom at heart he belonged 1.-:... .

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·EDITORIAL RECORD In the last week of January 1911 one of the members of our Committee had an opportunity of placing on record the view that the progress of public health in this country might be greatly advanced by the establishment of a special fund to be devoted to research in Lonnection ith sanitation The idea met with the approval of the Government of India and a sum of five lakhs of rupees was set aside as an Indon Research Fund The primary object of the fund is to assist the policy which for some years has been followed in India of making a direct attach upon certain of the more inportant epidemic diseases Resmarch is the starting point and basis of this policy, for it has been shown not only in other countries but in India, that when the actual sourcls and modes of conveyance of infection have been exactly ascertamed the measures which can be adopted are often far more simple and are always incomprrably more effectie than those recommended in the absence of this detailed knowledge The organisation proposed for carrying out the objects of the Fund is an Association consisting of permanent and temporary members, the control and manage ment being ested in a Govert ing Body of which certain members will be apponited to act as a Scientilic Advisory Board through which proposals in connection with the scientific objects of the Association m!l bu submitted The proposals approved by the Governing Bods will be carried into effect with the aid of Worhing Committees, of which the Central Committee for the study of malaria will be one It is hoped also to form committees to organise and carry on study in regard to (1) medical entomology, (2) vital statistics and the mot general problems of disease, (3) cholera, (4) plague , (5) p oblems of practical sanitation and especially the preparation of schemes for model tonns and other measures by which the efficacy of sanitation is demonstrated to the public.

·The manner in which the Central Malaria Committee propose to utilise any allotment from the fund is indicated in the following report of a meeting held on the 24th May 1911 Present The Hon'ble Surgeon General C P Lukis, CSI, President IMS, Lieutenant Colonel Sir D Semple, Kt Major S R Christophers, IMS Major S P James, IM S, Secretary The President desired that the Committee should place on record a resolution expressing their deep regret at the death of Lieutenant Colonel J T W Leslie, CIE, INS The resolution is printed to face the first page of the present number of these transactions The Secretary read a summary of the work done since the last meeting and from this the following notes containing information not already published in No 2 of Paludism have been extracted Classes of instruction at Amritsar -A third class of instruction was held at the Malaria Laboratory, Amritsar, from the 15th March until the end of April 1911 The members of the class were three officers of the Royal Army Medical Corps, four of the Indian Medical Service, two Military Assis tant Surgeons, sıx Cıvıl Assistant Surgeons, tho Sub Assistant Surgeons and a Medical Officer of Health from the Mysore State The Central Malaria Bureau --The collection of Indian anopheles, in so far as examples of the different species are concerned, is practically complete A specimen of P gigas from Assam has been received from Captain McCombie Young, IMS, a large number of Pleyocriensis from ·3 Jes pore have been added to the collection by Major Perry, IMS, and a large number of Challı from Assam by Alajor Christophers Further specimens of the new anopheles A barianensis caught at Simla and Murrec have been recensed from Captain Gill, IMS, and Assistant Surgeon Quich, as well as further specimens of the new species Psimlensis which is found to occur at hasauli, Murree etc Numerous specimens of N james have been sent by Dr Bently from Bombay and some niore specimens of the rarer species such as Ne indica, A turhhuds, etc, by Colonel Adte, I AIS, Major henrich, I MS, Captain Cill IMS, and others As regards Culıcıdae the follorrin, have been added since the publication of the last number of PALUDISN Theobaldia spathipalpes Stepongia gebelansis Pseudotheobaldia nivertaeniata Ho.cardına himalayana hingia annandaler Desmoden fusca Chrysoconops Pygmeus apıcalis Acdeomyra squammipenna Leisteria apicalis Sonamomyia inornata Stegomyia albolatcralis Alclanoconion juxtapallid: Cups IV alba Ficalba minima 31 Of larva cating fish the collection has received specimens of Haplochilus from various parts of Burra sent by Major Lalor IMS specimens of llaplochilus (another species) and Anabas scandens from Bombay sent by Dr Bentley of Ophiocephalus obtained from Amntsar and othe species some of which hase been experimented with as regards larva eating kabits and others not Major Gage INS has kindly identi fied a number of the commoner aquatic plants which have teen placed in the collection ·The thanks of the Committee are due to the following contributors to the collection Major W H Kenrick, I NIS (many consignments), Major N P O Gorman Lalor, IMS (many consignments of mos quitoes, larva eating fish, etc), Major CB Harrison, Dr UN Brahmachari, Major F Smith, R AMC,DSO (many consignments), Sanitary Commissioner, Madras (many con signments), Captain H 1 Acton, IN S, Major S P James, IMS (Types and type examples), Captain IV A Justice, IMS, Lieutenant Colonel G W king IMS (an extensive collection of Burmese anophelines and culıcınes), Lieutenant Colonel Castor, IMS, Dr CH Nolan, Cul Surgeon, Prome Dr E J Murphy, Cul Surgeon, Maubin, De PA McCarthy, Cowl Surgeon Henzada, Prof N Annandale (named specimens of culicidae), Lieutenant Colonel CA Johnston IMS, Lieutenant Colonel T W Stenart, IMS, Lieutenant R Mckie, IMS, Assistant Surgeon F Quick, Lieutenant Colonel ] R Adie IMS (many consignments), Captain ; D Graham, IMS (type examples of UP anopheles), Dr C A Bentley (mosquitoes, larva eating fish, blood films, etc), Captain C A GLIMS (many consign ments), Captain TC McCombie Young, I MS, Captain E FLL Estrange, RAMC, Assistant to the DM and So, Nellore, Officer Commanding Bellary, Captain HC Bronn, IMS, Mr R Des edathan, Alajor E }Hassard (several consignments), Captain A B Fry, IN S, Major McKechnie, IMS, S M O Lucknon, Major E Wilkinson, IMS, Captain G Fowler, 1 MS, Major RJ Clements, RAMC, D. R keelan, Assistant Surgeon A N Quiche Lieutenant Colonel R H Penton, RAMC, Major [ L Perry, IMS (several hundred anopheles, blood films, etc), Captain F A Barher, IM S, Captain R Tate, RAMC, Captain ] H Horton, IM S, Major L F Smith, RANC Publications --The second number of PALUDISM was pub lished in January and many encouraging comments upon its ·5 uselulness hare appeared in medical journals and have been Tecencd in private communications I he member of appli cants for copies of the publication contmues to increase and It has therefore been decided that in future 750 copies instead of 600 must be printed A new edition of James and Liston's monograph of the anopheline mosquitoes of India, which is largely the work of one of the members of our Committee has recently been published The complete report on malaria in the Punjab by Major Christophers has just been issued as No 46 of the Scientific Memoirs by Officers of the Sanitary and Medical Depart ments of the Government of India It can be obtained from the Superintendent, Government Printing, India, Calcutta Field work --Major E L Perry, IMS, is continuing his investigations into the causes underlying variations 112 malarial endemicity in the Jeypore Agency of the Madras Presidency It is too soon to expect definite results at present but as was anticipated, Major Perry reports that the conditions are very suitable for the line of investiga. tion pursued It is conjectured that the increased endemicity in the hill tracts 15 parily a question of greater prevalence of anopheles and partly of greater poverty and inferior diet among the aboriginal hill tribes than among the people of the plains In the plains, however, Major Perry has found Very curious variations of malanal intensity and it is hoped some important additions to knowledge will accrue if the causes of such variations can be ascertained An ad entersins report by Major Perry is published in this number Work of the Provincial Organisations - The progress of the establishment and prork of these organisations was fully reported in No 2 of PALUDISV Since the issue of that number Dr C A Bentley, having finished his investigations into malana in Bombay city, has joined his res appointment ·6 of Special Malaria Officer in Eastern Bengal and Assam and in this province the organisation for malarja insestigation is now complete It is on a larger scale than in any other pro vince and excluding the salary of the special malaria officer the cost during the first year is estimated to be nearly 40,000 rupees The staff includes I special clerk for the investigation of existing vital statistics 3 Assistant Surgeons for test enquiries into the stal statistics of selected areas 1 Sub Assistant Surgeon 13 Sub Aanstant Surgeons } 1 laboratory attendant I tour clerk coolies for the Field laboratory and the Travelling laboratory I sweeper Boatmen 1 Assistant Surgeon for the six Quinine Demons 6 Sub Assistant Surgeons tration Camps which will be established 7 Compounders 1 Assistant Surgeon extra establishment 4 Sub Assistant Surgeons The Governments of Madras and Burma have also sub mitted detailed proposals which include the appointment of special malana officers so that with the exception of the Bom. bay Presidency every chief province gill shortly have an officer those sole duty is in connexion with the investigation and prevention of malaria The following subjects were then discussed Arrangements for future classes at Amritsar -It spas pointed out that the method by which the members of the ·7 first three classes liad been celected does not give every officer who is seriously anxious to study malaria an opportunity of joining one of the classes The Committee therefore decided that for future classes the method of selection should be similar to that now practised for the classes in bactenology at the Central Research Institute A list of applicants will be kept and classes will be held at such inters als as may be rendered necessary by the number of candida es Utilisation of A hoped for allot mert from the Indian Research Fund -The follosing were considered to be the proposals which should be submitted for the approval of the Governing Body of the Indian Research Fund (1) The pretention of malaria among troops --(a) It was decided that in consultation with the Principal Medical Officer His Majesty s Forces in India, cxperiments should be made on a considerable cale for the protection of the troops in a malarious station from the bites of mosquitoes Up to the present this method of preventing malaria has recensed very little attention in India In order that it might be ade qualely investigated the officers possessed of the requisite tcclinical knowledge and administrative experience would be necessary The Committee thought that Captain Hodgson INS who has just joined the Bacteriological Department from the appointment of Health Officer Simla should be one of the officers and that the Principal Medical Officer should be asked to lend the services of another (6) A second investigation which the progress of knonledge shons to be urgent is a scarching enquiry into the efficacy of quinine prophylaxis among troops Several thousand pounds of quinine are expended annually for prophylactic pur poses among troops in India, but the measure has not yielded such good results as nerc espected and the possibility that this may be due not to defective arrangements for administration, but to some other as yet unknown cause, is eminently a ·8 subject deserving close enquiry One orker would be suffi. cient for this investigation (2) Thic institution of malarıometric investigations In malaria Norh the need for quantitative values has become very urgent It has, for example, become absolutely neces sary to arrise at sone method of measuring the amount of malaria in communities more accurately than can be done by the methods now in use It is necessary to knory more about the relation of numbers of anopheles to the pre valence of parasites and many other points of great importance A commencement has already been made, and one article upon the subject is published in the present number of these trans actions, but such studies require the worker's whole time, and an investigator placed on special malarıa duty cannot usually afford to neglect what seem to be more pressing investigations ade quately to pursue this kind of work Certain determinations for pracucal use bave, honeter, become almost essential to any further progress, and for this reason the Committee think it is Sery desirable to have at least one vorher who can devote his whole time to the deselopment of malariometric methods and their application to the study of Indian malaria (3) Enquiry mnto the bronon's of anopheles - This en. quiry, mentioned in the first number of PALUDISY, has not yet been taken up It is hoped that with the funds that may be made available it will be possible to secu e the services of an entomological specialist to deal with it (4) Engurry into educationnl fropaganda -It is hoped that it yll be possible, by Xorking in consultation with local Goy ernments, to investigate the value of and the best way of carry ing out certain proposed educational methods, including the establishment of Quinine Demonstration Camps, the rendenng mosquito proof of rest houses in malarious localities, and other practical assistance in the spread of knowledge regarding prophylaxis ·9 In connexion with these proposals the problem of obtaining workers was discussed and it was decided that the Governing Body of the Indian Research Fund should be asked to approve an endeavour to obtain from England an entomologist for the bionomical investigation and a worker recommended by Major Ross for the malariometric enquiry The necessity for a good library of malaria literature at the Central Malaria Bureau was also brought forward, and it was decided to ask for 2 preliminary grant of Rs 500 for this object The Committce desire to direct attention to the following publications which were received too late for review in this number They will be noticed in some detail in our next issue The pre cntion of Baların in the Federated Malay Stałes, by Malcolm Watson, MD, with a preface by Sir Ronald Ross Published at the Liverpool School of Tropical Medi cine Price severt shillings and 18 pence The causes and Prevention of Ilalaria in Bombay, by CA Bentley,MD (Final Report) Published by the Gover. ment of Bombay Malarsa in the Punjab by S R Christophers, Scientific Memoirs by officers of the Medical and Sanitary Departments of the Government of India, No 46 ·10 A NOTE ON SOME OF THE MEASURES THAT HAVE BEEN TAKEN TO MAKE QUININE AVAILABLE TO THE POOR IN INDIA It is not more than half a century since the Government of India, being desirous that the people of this country should be able to obtain an efficient remedy for malaria at the lowest possible cost and being apprehensive of the extermination from their native forests in South America of the quinine yielding cinchona trees, decided to take effectual steps to procure seed and plants of the medicinal cinchonas and to cultivate them on the Nilgirı Hills and in British Sikkım The well con sidered measures to this end taken from 1858 to 1863 sere entirely successful, and they were followed as soon as possible by the liberal distribution of seed and seedlings from the Govern ment plantations to all applicants, with the result that in a fer years thousands of acres on the hill ranges of Southern India and Ceylon were covered with cinchona trees About the same time the Dutch Government carried out a similar policy in Malaya, large tracts of land in Java being planted by official agency and private enterprise The ultimate results of the action taken by the Indian and Dutch authorities were to bring about a great fall in the price of quinine throughout the world and to render practicable the policy of making the drug available even to the poorest peasants in malarious countries In India the first preparation manufactured on a large scale from the bark of the Government plantations was cinchona febrifuge, which, at a time when the price of quinine some times rose as high as sixteen shillings an ounce and was on an average eight shillings and four pence an ounce, was freely offered to the Indian public at an unchanging rate of only one rupee an ounce Oser 120,000 pounds of this preparation Bere disposed of between 1874 and 1894 Although this substitute for quinine nas valuable it was clear that so long as a good commercial process for the manufacture of pure quinine was knojn only to certain pritate firms, a great and permanent cheapening of the price of that drug was hardly to ·be expected The discovery by the officers at the plantation in Sikkım of an entirely new process for manufacturing pure sulphate of quinine was therefore an event of great importance, and in order to present a monopoly in the manufacture of the drug and to complete the efforts towards bringing about a permanent reduction of price, the Government of India in March 1888 published to the world the details of their process From 1887 to 1894 the amount of sulphate of quinine made at the Sihkim factory and distributed to the medical depots, hospitals and charitable dispensaries all over the country was 29,761 pounds, and the amount supplied from both factories for use in various parts of India dunng each of the last ten y cars is shorn in the follosing table- TABLE I I Loty 300-07 981-01 16.1930-os 005-00 000.07 97-09.09 14. P (1 dae do'p od Po od p d 00 9773 9 I. 4855 098 73 90 6 43 f der 8 Pet & Pound 111315.78 15 957 19.3.80 7149 3033761 That 31 g 3 7711 » 031334 703033 564 1394 The great benefits thich have accrued to this country and to the whole s orld from the cinchona enterprise of the Govern ment of India, although seldom mentioned, are untersally recog mised, and to India also belongs the credit of being the first tropical country in which an endeavour was made to mitigate malaria among the poor by the plan of selling single doses of quinine for the smallest coin in gencral daily use among the people This scheme 135 gradually introduced in various prorinces during 1890 to 1894, the Post Office being the chief agency for the sale of the "pice pachets," shich contaired at first five grains of pure quinire laler seien grains, and in one or two provinces ten grains The following table indicates ·10 A NOTE ON SOME OF THE MEASURES THAT HAVE BEEN TAKEN TO MAKE QUININE AVAILABLE TO THE POOR IN INDIA It is not more than half a century since the Government of India, being desirous that the people of this country should be able to obtain an efficient remedy for malaria at the lowest possible cost and being apprehensive of the extermination from their native forests in South America of the quinine yielding cinchona trees, decided to take effectual steps to procure seed and plants of the medicinal cinchonas and to cultivate them on the Nilgiri Hills and in British Sikkım The hell con sidered measures to th end taken from 1858 to 1863 sere entirely successful, and they were followed as soon as possible by the liberal distribution of seed and seedlings from the Govern ment plantations to all applicants, with the result tirat in a fety years thousands of acres on the hill ranges of Southern India and Ceylon were covered with cinchona trees About the same time the Dutch Government carried out a similar policy in Malaya, large tracts of land in Java being planted by official agency and private enterprise The ultimate results of the action taken by the Indian and Dutch authorities were to bring about a great fall price of quinine throughout the world and to render practicable the policy of making the drug available even to the poorest peasants malarious countries In India the first preparation manufactured on a large scale from the back of the Government plantations was cinchona febrifuge, which, at a time when the price of quinine some times rose as high as sixteen shillings an ounce and nas on an average eight shillings and four pence an ounce, as freely offered to the Indian public at an unchanging rate of only one rupee an ounce Oier 120,000 pounds of this preparation nere disposed of between 1874 and 1894 Although this substitute for quinine as valuable it was clear that so long as a good commercial process for the manufacture of pure quinine was known only to certain private firms, a great and permanent cheapening of the price of that drug was hardly to in the ·11 be cxpected The discosery by the officers at the plantation in Sikhim of an entirely new process for manufacturing pure sulphate of quinine was therefore an event of great importance, and in order to prevent a monopoly in the manufacture of the drug and to complete the efforts towards bringing about a permanent reduction of price the Government of India in March 1888 published to the world the details of their process From 1887 to 1894 the amount of sulphate of quinine made at the Sikkim factory and distributed to the medical depots, hospitals and charitable dispensaries all over the country was 29 761 pounds, and the amount supplied from both factories for use in various parts of India during each of the last ten years is shown in the following table TABLE 1 Tattory 200-01001-01-03 190304 304-05.00 105.01 07-08. Bologi & Po A Penn 1P du. P 8 P AP JP date 4 ada 1 00 9793 OS 1,03 14865 10,133 *5.1605713525 13.1 DO 185 319 94 10 es 11 645 4,53 13 055 787 Madu 9 JIT 1705 3134103439 350 34904 The great benefits which have accrued to this country and to the whole world from the cinchona enterprise of thc Goiern ment of India, although seldom mentioned are un crsally recog nised, and to India also belongs the credit of being the first tropical country in which an endeavour tas made to mitigate malaria among the poor by the plan of selling single doses of quinine for the smallest coin in general daily use among the people This scheme was gradually introduced in various prorinces during 1890 to 1894, the Post Omce being the chief agency for the salc of the "pice pachets," which contained at first fisc grains of pure quinine, later seven grains and in one or tro provinces ten grains The following table indicates ·12 approximately the amount of quinine sold in pice packets at Post offices during certain years from 1895 to 1910 - TABLE II Postal circia 1895 96 1900 ol 1903-03 1904-05 190647 1908-09 1907-10 3Ьs ?bs Ibs Ibs Ibs Ibs lbs 01119 3025 Si 1303 72 107477 2114 65 46 81 1631 59 1137 71 1338 86 49 01 1987 0 174408 7367 51 583 51 614 13 1375 43 1297 47 > 1896 37 708 73 430 69 $6 30 1 79 208 36 6149 638 0 Bengal Madras Bombay Wasted Provaces Punjab Cental Pronaces Rajputana Eastern Bengal 816 27 814 54 28 37 105 99 55 51 87 82 502 190 83 1136 99 691 58 114 5563 522 53 96 308 0 78 84 333 09 373 76 413 80 1875 71 os 790 2 43437 370 35 6715 1166 34 го бо 426 38 Assam 5725 Burma 663 97 39 307 76 T 444 191 83 241 48 242 03 Total 7470 17 3954 41 5037 3 69633 7403 35 7548 57 7705 15 Clearly in all provinces there is still room for a great ex tension of the system, but the figures do not include the amount of quinine sold in pice packets by district officers, village schoolmasters, vaccinators and other non postal agents who in different provinces have been enlisted in this cause Next, at should be noted that the obligation to provide quinine gratuitously especially during epidemic years, has not been neglected, and that of late years in addition to the large amounts supplied without charge at the numerous hospitals and dispensaries in India, the practice has been adopted of deputing hospital assistants and others to distribute the drug freely in malarious areas In the United Provinces in 1908 more than 7,000 pounds of quinine were distributed gra tuitously in the affected districts and in the Punjab about 6 000 pounds were distributed by a central agency and large quanto ties by various local bodies and organisations in Bengal in ·13 1909 nineteen civil hospital assistants were specially deputed to distribute quinine gratuitously in 35 of the most unhealthy thanas In the Punjab during the same year 424 pounds of quinine were distributed gratuitously by 13 municipalities and 2,113 pounds by 24 district boards, large quantities of quinine were also distributed gratuitously in the North West Frontier Province Finally, attention may be drawn to the fact that it has always been the policy of the Government of India to encour age the production and importation of quinine as much as possible and to abstain from entering into competition rith private enterprise in regard to the sale of the drug in bulk in this connexion the following table, which shows the amount of quinine imported into British India during cach of the last ten years, may be given TABLE INI 200 or 1 01-07 1902-03 303 + 204 51905-01 1900r07 1903 1 050) 19orto IL tus 16 lbs bs tes Ibs 1ds. br 61.913 43 299 6037 $ $5363049639 371 137 83 077 So 020 120 113 The total consumption of quinine in India may be ascer tained by adding these figures to thosc already ghcn in Table I, and it is of interest to place the results alongside those for Italy TADLE IV Total consumplion of quimine 190001171-03 1903-03 1903651901-05 170 1206-07-03 1903-07 1,070 the 1ts Ibt thing دلم $104,650 $ging 2934 1903 103 150 155 1ty 6.1 111.3735 74 137 ·It will be seen that the consumption of quinine in India 15 increasing steadily and that the rate of increase compares favourably with the rate of increase in Italy The further measures which are now being taken in seve ral provinces for bringing quinine within reach of the poor in India will be the subject of subsequent notes (SP)] ·15 OF ON THE SELECTION UNIT AREAS FOR RECORDING DATA CONCERNING MALARIA IN INDIA (IV:th map of India ) Much thought and enquiry have been devoted to an attempt to form subdivisions of India, which, being homogeneous in regard to malarial conditions, as far as me I now then, are suitable as units for recording on broad lines certain data concerning maların in India The attempt has resulted in an arrangement which is practically identical sith that already in use by the Indian Meteorological Department, the names, position and extent of the areas being shown on the accompanying map which has been reproduced from one of those in use by the Metcorolo fical Department The present note is intended to draw atten tion to the main features of the plan of subdivision shown on the map and to indicate the suitability of the divisions for rc cording information about maları The subdivision at first sight may seem too detuled, but it must be remembered that on an average each of these sub divisions is many thousand iniles in extent and that it is not likely that wny larger division will give us the homogeneity ve desire Again, it may be thought that the subdivisions ac so large as to lack this quality of homogeneity, but it is safe to say that though we hnok 3 good deal regarding malaria in many of them, in regard to others there is scarcely a single obsenation, so that for the present the question of further sub division liardly arises In selecting our units for malana work, it is desirable that within certain limits re should be guided by the following considerations (a) Large differences of geograplıcal position such as may influence the distribution of species of anopheles (6) Physical chanctors ·16 (c) Rainfall and climatic conditions generally (d) Economic features, notably the nature of the staple food crop (e) Marked racial characters It is also Iery important to make the boundaries of the subdivisions correspond with boundaries of provinces, the limits of districts, and so on, the object of course being that we may more readily make use of vital statistics and other information collected according to administrative areas Geographical India has been divided from a broad and general point of view into three main geographical areas * The Himalaya, or abode of snow, the Middle Land, or Madhyadesa, and the southern table land of the Deccan To these must be added Baluchistan and Burma Physical features --The most convenient guide to the physical features of India is the course of the 1,000 feet contour line Starting from near the sea coast at Chittagong to end near Karachi on the west the 1,000 feet contour line can be follon ed, first, to the north, separating the highlands of Burma from the plains of Middle India, then to the north West in a line of some tho thousand miles, separating of the Himalaya, and finally, to the south, delimiting the eastern border of Baluchistan South of the plains of Madhyades? we again meet with altitudes of over 1,000 feet, and ne can fol low a second line which, starting on the east near the mouths of the Mahanadı, extends across India to end near Surat on the vest In its course this line separates Middle india from the Deccan The first line in its passage along the foot of the Himalayas shons scarcely any irregularities of importance, nor does it as a rule pass to any extent up any of the river valleys The second line is not so regular, and we have to Report on the Ceague of ladis 1901, Page 1

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·17 notice cspecially a disturbance due to the valleys of the Chamba and Betwa south of Agra, and those of the Narbada and Tapti east of Surat The two lines ne have follored with the coast line at the mouths of the Ganges and Indus form the boundaries of what we have so far called Viddle Inlia This is a vast alluval plain of remartably uniform character extending in a broad belt from the borders of Baluchistan to those of Burma Upon it live nearly half the inhabitants of India To the south of the second line lie, the Deccan To cxamine this more closely lle may again follow the 1,000 feet contour line Passing along the sest of the Indian Peninsular, this line, for all practical purposes coincides with the sea const On the east again it hugs the sad coast is far south as the Godavcry river But from this poi t to the extreme south of India there is a comparatively broad rup of plain, land Here too as in the case of the Chumbal rover the valleys of the Malanadı Godarcot his na Due in! Cruier cluse large disturbances in the fme and of the He shall have to tahe notice The strip of plain refers d to though on a much smaller scale than the sast plain of huddi India is with its tributary valleys, the second most extenu va ca of plains land in India The remaining portion of the Dictin consists for the most part, of land of moderate cluvat on by no m-ans entirely abouc the influence of malvia and sometimes es en characters ed by a peculiar intensity of this disca i The chef components of these Deccan Uplands arc (a) the Malu platciu and Irasallı range, which perhrps tre should rot cicept to the sake of uniformity, lave included on the Occcan, (2) the Picnman and Muhal Thills, (c) Chota lampu ſo in or a ro turn plateau () what we may call the judoc Ill Tnct forming an isolated platcau inlard from 1:23 apatum, (i) the basalt ·18 plateau of the Bombay Ghats, the gneissic plateau of the south portion of the Peninsular In this last division only are there areas of any size (Nilgiris, Anaimalis, Pulnis) above the influence of malaria Rainfall — The total annual rainfall of India has a very definite distribution The most striking features are (a) An area of deficiency in the north west, which we may map out by following the limit of an annual fall of under 20 inches (6) Two areas of very heavy rainfall-one over Eastern Bengal and Assam, and the other a narrow strip in which the rainfall is 75 inches or over along the western coast (c) An area of more moderate rainfall over Bengal and the north east of the Deccan (50 to 75 inches), extending over much of the United Provinces (40 to 50 inches) (d) A broad belt extending from north to south, in which the rainfall is between 20 and 40 inches Staple food crop-For reasons which have become very evident in the course of recent researches, consideration must be given to the main economical features of the different For the present it is not proposed to do more than draw attention to three types of areas, which may be called respectively Rice, Wheat, and Millet areas Without entering into the reasons for such definitions, we may define a rice area as one in which rice forms over 25 per cent of the total cropped area, a wheat area as one in which rice forms less than 25 per cent and heat or maize forms over 25 per cent of the total cropped area, and a millet area as one in thich neither wheat nor rice forms 25 per cent of the total cropped area and in which Bajra or yowar is the staple food Roughly speaking areas ·19 nice cultivation on any scale commences rather abruptly at a line which, corresponding with the limit of 30 inches total annual rainfall, starts at the Himalayas about the centre of the United Provinces and passes in a semi circular streep across India to Surat There is a large tract, honever, not included within this limit thich omres its origin to irrigation from the Indus (Sind) Wheat areas are confined to the parts exclud ed by the semi circular rice line referred to (Punjab, western halt of United Provinces northern portion Central Provinces) Millet areas take the place of wheat here the soul is poor and of rice areas where irrigation or rainfall is insufficient for this latter crop Raco-Of race we need say comparately little The most important features from our present point of view are the following (a) Races inhabiting the plains of Northern India from the Indus almost to Calcutta for the most part living m compact villages of mud built houses (6) The races of lower Bengal and the rice countnes to the cast living for the most part in small scattered hamlets of bamboo built houses (c) The aboriginal races of Chota Nagpur, Central India, and other parts of the Deccan (d) The Marathas of the No th nest Deccan (e) The Dravidian races of Southern India Natural divisions as defined by Sir Johr Cllict-Beforc guing our final clasification of arms some mention must be made of what may be called the authorised natural divisions of India These mere drann up by Sir John Elliot in 1901 and are as follons -(1) Baluchistan (2) Acrth llest Dry Area, comprising the plain of the Indus ard including Sind, the ·22 f (9) Bihar Rice forms 60 per cent of total cropped area, Total annual rainfall 50 to 75 (6) Bengal inches Deltaic region Rice forms 80 per cent or over of total cropped area Bengalı race (5) Eastern Bengal Annual flooding of large tracts Total annual tarafall over 75 taches Rice 80 per cent or over Bengalı or alled races i 14 a)* Assam Brahmaputra valley (20) Gujarat Pecular geographical position and physical features III --DECCAN MOSTLY OVER 1,000 FEET BASALT (DECCAN TRAP) AND GNEISSES 50 inches A-Total annual rainfall underſ (32 a)* Madras South East Carranc plain Tanjore, Coimbatore, etc (32 b)* Madras Hills Nilgiris Pulne, etc Eastern Plaid under 1,000 feet (34 s)* Madras Coast North Portion of the area south of the Godavery Godavery, histna and Nellore districts River Valley Plazas for the mot part under 1,000 feet (25) Orissa. Contaias much fiat land Valley of 1) Rich nie rada meteoro le the eartas further ·# Central lodian Plateau (19) Rajputana East (21) Central India West (na) Central India East • East Satpuras (Plateau) (24) Ceatral Prorroces West Wheat area (98) Hyderabad North (Vative State, contains upper portion of Godavery valley) Native (29) Hyderabad South State * Deccan (Plateau) (27) Bombay Deccan Receives more rain than rest of the platcat (33) Madras Deccan Cuddapah, hurnool etc (30) Alysore (Native State) South India B.Total annual rainfall go to 75 inches Chota Nagpur Plateru (8) Chota Nagpur Aboriginal races Rice arca. Jeypore Hill Tract 134V) Madras Coast North Arca nos being investigated ith reference to study of endemic malaria. Rirer valley pluins for Mopart (35) Central Provinces Eas' under 1,000 feet. Contains valleys of Goda icry and Mabanado (25) honlao C-Total annual rainfall over Bombay Presidency 75 inches (31) Valabar 'ladras Presideer 11 -BURUA (S.RC) • mica tre those el Sl Joe Etoilehen! Dirts jou of Ish ·24 THE EFFECT OF ENDEMIC MALARIA UPON THE BIRTH AND DEATH RATE BY WH KENRICK, Special Malaria Officer, Central Provinces In both its endemic and epidemic forms malaria has a very marked effect upon the birth rate In the case of epidemic malaria, a great reduction occurs in the total number of births in the year following the epidemic This reduction begins in the month of March or April, 10 nine months after the commencement of the fever season, and is greatest in June or July, the ninth month after the epidemic is at its height Corresponding with the subsidence of the epidemic, the birth rate gradually recovers and may even exceed the normal These features are well shonn by the figures given belon which represent the births in two areas in the Punjab and in the Damoh District of the Central Provinces for the year 1909 following the severe epidemic conditions of 1908 For the district of Damoh, which is a portion of the Central Provinces subject to epidemic malaria, are gnen also the births during the five normal or but slightly affected years 1904 1908, those for 1903 following moderate epidemic conditions, and those for 1901 following the famine year 1900 ·Ametsar Delhi Daroh 1709 1997 1901 1904 1,08 1993 1901 1,90 1.550 1 350 50 January rebruary Aya ch JOO 1 700 Soo 800 500 450 Syo In 3 DOO 53 Apr1 3 50 3,200 900 کیرا 1 00 wy 70 1 400 1100 1 I TOO 400 500 30 1 000 500 1.000 Bo 550 1 350 goo (5) July Au $ NO 1,500 1 Goa 73 100 90 so pember 1 300 no ico I too Oc.ober 100 3 800 1 950 (o 1 930 750 ovember . 600 3100 1 2 13 10o 50 December 3 700 $oo Note F e panation of the t ms ender cand epul me mal in the mea of the word healthy hyper ndem cla ve metrora d m by th Centra! Com ee given PALLDIMIR !! A heal by eas the dfionis wh the sleen raam E cheas not ab ro Opt mod at ly dea neach the ri el bet a to a 27 per ce tab ghly ndemce 13 in which the ra LETY 1 and so per cent und a hype eodmiot arta u onom which the rate is ever so percent Endemic malaria, on the other hand may haic, as will be shown no effect upon the yearly rate, tlıc birth rate for the year in lughly endemic areas in the Central Provinces being as high as that in healthy arcas It lras a marked effect, however, on the monthly distnbution rate To shon the absence of effect upon the total birth rate, I 511c the the bath rates of two groups of villages in which the amount of malar as determined by actual measurement The first group which I shall call' healthy uillages com priscs 34 villages in the plains of Balaghat disinct, fusing a combired population of 19054 and 2 spleen rate, as shown lelon, of 4 per cent ·26 Spleen rate of 34" healthy " villages (Lalburra and neigh bourhood)- No of children examined Class I spleen to umbilicus C] ss II Hand breadth Cla s III Two to three fingers Class IV Palpable Claus V Megabre 737 3 3 6 18 697 Total percentage with enlarged spleen, 4 per cent The second group, which I shall call " Hyper endemic" villages, consists of 33 villages having a combined population of 10,825 and an average spleen rate as shonn below of 80 per cent Spleen rate of 33 "Hyper endemic" villages (Chichgarh, Pallandur, Bijagarh, etc )- No of chideen examined Class I spleen to umbilicus Cla s11 Class III Splee Spleen two Hand breadth to three fing is Class IV Splee Palpable C'ass V Negat ve 840 3 173 37 217 165 per cent Total percentage with enlarged spleen, 80 The following table contrasting the birth rate of these two groups for a period of three years shows that endemic malaria, even in a hyper endemic tract, has not had any the total birth rate per mille of population living effect upon Spl en rte Brate B th rate Porth rate, 9903 1909 2910 43 S4 Healthy villages populat ca 18064 49 *S 80% 42 33 Hyper-endem c villages populat on so $25 18 ·27 Monthly distribution rale. Though endemic malaria docs rot influence (so far as observations have gone) the total birth rate, it has a marked effect upon the monthly distribution of births If the monthly birth curse of a healthy area for a series of normal years is drasn, it is seen that the births are ferest in number during the early months of the year and greatest duning the autumn months, the curre reaching its maximum in October or November This feature of the curve is p actically constant, provided abnormal years, such as those charactersed by epidemics scarcity, etc, are ercluded It is well shown in the series given below thich gives the births in certain non malarious parts of the Central Provinces Arerago births for the seven yearly period 1903 1909 10 certaia non malanous thanas of the Central Provırces Aarun Ilacta Daraghat Lakbal 770 $70 Vo 710 January February i ca 610 7. $ 630 $ 750 50 Ap 810 200 RO . $50 190 750 Juro 710 $20 €40 710 00 570 200 1039 Jaty Arrust September Q+aber November 1 boo too 9. 970 1030 1 230 po 1.100 1 to 100 850 Decembe 942 çou 730 Tlic probable reason for this distribution is that the carly part of the year, being the most her!'hy and at the same time the period of the han est when the physical and maectual con dition of the people is at its best, is the period most fasourabla for conception ·28 In a malarious locality on the contrary the early months of the year are those in which the results of fever are most evident In every hyper endemic area visited the people were unanimous in saying that the worst time for fewer is the cold weather, vis from December to March And here, just as happens in epidemic malaria, a period of increased fever prevalence seems to be a period of comparative sterility, for the rise in the birth curve, which should normally occur in the autumn, is postponed for three or four months and takes place instead during March, April or May In malarious areas, then, the period after the end of the feser season, 22. June and July, is the most favourable for conception Tle character of the birth curse in malarious areas is well shown in the following table, which gives the average monthly births for a number of hy per endemic areas Average births for the seven yearly period 1903 1909 in certain hyper endemic thangs of the Central Provinces Rupsar Bura Baihar Cbichga b 280 Janue y 430 400 210 Tebay 20 400 440 220 March 250 440 460 250 400 60 60 310 330 April May June 750 C20 O 310 640 Coo 350 20 630 50 770 320 610 570 990 August September 310 550 550 700 270 SIO SIO Octobc Novembr 350 450 bo 7.30 Doceraber 360 410 0 The lower the degree of endemicity of any place the more closely does the birth curie approximate to that of "healthy" areas ·Lfect of ondentie n alarte on tl: de 3th ra't-In hyper erdemic as contracted with healthy arers, there is an increase in the total death rate It is al o noticeable that in hyper endemic villages there is a proportionately greater mortality among infants and children 2 to 3 years old During the course of my investigations (cold weather), I saw many children suffering i om lever, and on more than ore occasion I saw a fatal termination to an uncomplicated attack of malaria in a child The history of such a case is as follons An apparently realthy chuld has an attack of ſeverlasting seven or eight dass in November or December The child is then quite sell for (no or three sechs until another bout of feser superencs followed by another apyrexral period The relapses now occur at more frequent intervals and with greater severity As quining is practically unknown to these people unless the child acquires a certain degree of immuniti death occurs, very often with cereb al compliations In ore such case which came to my notice a mell nourished child had been unconscious for four days with high temperature and consul There was no enlargement of the spleen but blood films tahen half an hour before death showed an average of 23 quartan parasites (large and small) per microscopic field huist crescents rerc on an average 3 per 100 fields sions Dcaths of children in malarious arcas constitute from 55 to 65 per cent of the total mortality thich is very rearly doub's the percen age found in non malarious localtics In the village retums practically crery death is asenbed to fcyer F om personal enquiry into the causes of 300 deaths in hype endumic cent is I find that in nearly half the deaths the cause of dcath is correctly returned for i inic in the case of adults this diagnosis of fevce is mostly wrong, in the case of children It is most often right ·30 If malaria causes death in an adult, it is generally indirectly 4 frequent cause of death among adults in hyper endemic areas is cirrhosis of the liver with oedema Another common cause is some lung complication superiening upon an attack of malarial fever With children it is the intensity of the parasitic invasion that kills, and most of the deaths are correctly ascribed to "ferer The extent to which a high degree of endemic malaria affects the death rate can be gathered from the following figures which contrast the death rate in the 34 healthy villages previously mentioned with that in the 33 hyper endemic wl lages 1903 1909 1910 Spleen rato 4 per cent 24 2 33 34 healthy villages Pop 18 064 33 hyper-endem c villages Pop 10 SS 3 h ghly endemic vllag Pop 502 80 39 32 44 30 29 28 40 In the last entry in the table is given the death rate per mille per annum of three highly endemic villages having a combined population of 5,022 and a spleer rate of 36 per cent In none of these villages was there plague or cholera during the years given From the facts stated, it is reasonable to assume that malaria in hyder endemic form causes in the Central Provinces an increa e of frem 10 to 15 per mille in the death rate Curses giving the monthly deaths in malarious localities shon that the smallest number of deaths takes place as a rule in July, whilst the largest number occurs at the end of the rains and during the cold treather ·37 Cfect of enderle Yalarıı or tkt natural increase of populattor - While the total population of the Central Prov inces has increased considerably during the last decade, it is mainly in the pon malarious locrkties that this iscrease has occurred On her hold the hyper endemic sullages show a Fery slight increase whilc vcry many shout a decrcase ·32 INFECTION AMONG TROOPS AND NATIVE CHILDREN AT DELHI BY J RADIE, Special Malaria Officer, Punjab The following notes throw some light on the amount of malaria among troops, especially the extent to which latent and concealed malaria may preyarl By a case of concealed malaria is meant one in which a soldier, though ill, does not report sich, either on account of some pecuniary loss he may suffer or from a high sense of duty The figures relate to British troops living in the Fort at Delhi and native children living either within the Fort or in the immediate neighbourhood (Daryagan) Delhi Fort is notoriously unhealthy and both the British troops within the Fort and the Native infantry at Daryaganj are heavily infect cd each year with malaria The feser season in this part of India being at its height in October and November, the figures for British troops probably represent the highest degree of infection for the year 1910, those for the children taken at the end of September represent the condition of affairs at or near the commencement of the fever season British troops-In order to get as complete material as possible for my estimation, I took advantage of a quinine parade which was being held at the Station Hospital by Major Brown and Captain Brown, RAMC, to both of whom my thanks are due On 11th November 1910, in the morning, all in hospital or actually engaged in duties being paraded, I took a film from each In all 160 films were taken and of them to sere accidentally spoilt The remaining 150 were very carefully examined by me and the parasites recorded by a convenient method for indicating approximately the numerical prevalence men not ·33 Examining in most cases 100 fields, 38 of the 150 or -53 per cent shoned parasites Gisen in extended form the results were as follons the numerator being the number of Gelds cxamincd and the denominator the parasites found 7 90 199 *** 10 161 162 210 100 TTTT tou ya 72 18 J > > 10 air Notas - Crescents. Aty dla igeant Tertian Ellog? Der Senga Tetta & Of the 38 szfcctions 33 were therefore malignant tertan and 24 of these were crescent bearing cases Only 5 mere benign terisan Considering only those cases in which Bactes were actually found in 100 fields nearly a quarter of the men actually carry ing on their duties satu gamele carriers more complete examination had been made it is almost certain that a larger proportion of infected men and crescent carriers could hase been sitos lla As a demonstration of the extent to which snadequate $amplus may affect malaria determinations I may note that - In the 1st group of 30 (lms es37 nal these were 3. tons or lo per ckz.hu and ot 36 N N PA 6 N In the whole community (159 lis) there were or as Anopheles at the time were abundant especially prossi af cafetfanics Hly barbirostris and Vs rigerrits a fult girnsus c pickerm. Ac tupfenst and it reprlos Mere present, but not abundants Matr-e children on the 26th September, 53 Glas front the children of followers living in the Fort sell were takea ·34 BI 3 ET 1 The percentage showing infection in the examination of 100 fields iras 434 Guen 111 extenso, the finds were as follows s O BE B & B & *GITÁTY 15 Вт 5. BT, It will be noted that in this case there were 12 benign tertian infections to jo malignant tertian infections and one case in which both types of parasite were present 3 1 On 12th January 1911, eighteen children of the same com munity were examined, six, or 33 per cent , shored parasites At Daryaganj (adjoining the Port to the south) 24 children of the 33rd Punjabı sepoys were examined Para sites were found in 19 or 37 5 per cent Given in detail the results follous , eum , OD SE BILO, BTC Tere as too BI 1 It is necessary perhaps to say that both the British troops and the children of the followers were under prophylactic quinine treatment--the former by means of quinine parades, the latter through the agency of a Sub Assistant Surgeon To what extent the 45 grains weekly were actually consumed by the individual soldier or how far the apparent failure of quinine to prevent the occurrence of parasite in the blood represents real inefficacy of the drug, I am not prepared in the absence of investigation to say ·35 MILARIA IV THC JOY PORC AILI TRACT AVD ADJOINING COIST LIND sapitim flarbour EL PERRI On Special Duty Ohsen rtions nicre commenced in January on the coast at Vizagapiram In the main part of lizagapılan for 11 the spleen rate was found to be only per cent A focus of SCHLIC mala horcier nas lourd on it far side of the Vizi The near sult of the harbour was also affected though is a lesser derrce the curden e of the prmalenco of mularza disappearing itry rapidly 7 the main part of the kan nas approach d Anopheks Bere found breeding abundantly througnout the residential portions of Haltar (Cura, en quarter al lizzapłam) 11 th a delle paris of V123, param and in the surrounding villages At Dimlipatum 18 miles furthar hlon,, th cost the spioon Falc wasio children buti, eramud without any of enlargement of the splen bring 6099 ered a great deal of water about and anoph Is were found bereit ce The 15 ing freely The following specks of anoplinle, urmahen inatin Coast Tract ff cutest cics i futiririsus X Am rosss, le sirpkem 1 dly nigerrin us In 1 cbruary work as commenced on this ſerpo e Malcru (3000 feet) wherr malın is reported to bow sery scienu Thc spleen rate was to inid to lc 75 per cent blood spccincy Mere obezined from 15 sill?, ca inolohich not at an 3) stude of 3 000 feet and it i alt ude oi 2000 (cct above «or lcrct The total number eram Bed as 351 Oi tiesc only nere taken inom persons oic 15 Luts ot ·36 majority were from the children of aboriginal races (Parasas, Gadabas, and Doms), who so far as is known have occupied these regions from very remote times The time within which the films were collected ras from 11th February to soth April of the 351 specimens 287 shoned malaria parasites gring an endemic index of 61 per cent Of the total number examined 29 per cent had rings (diagnosis not certain but mainly quartan), 16 per cent undoubted quartan, 13 undoubted benign tertian, and 3 per cent crescents In 14 cases benign tertian and quartan were found, in three cases benign tertian and crescents, in three cases crescents and quartan, and in one case crescents, benign tertian and quartan Every specimen was searched for ten minutes, the results in regard to the numerical value of the infections being as shewn in the table Nol Number of parasites s en in tea minutes ito 5 6 to 15 16 to 30 Orer 30 Number of cases 134 104 Øs 23 25 In order of frequency, the types of parasite present sere, as already mentioned, quartan, benign tertian and malignant tertian Quartan is also the most active fever, at any rate during the spring months when these examinations were carried out The latter point is evidenced by the fact that when a quartan infection is found, the parasites are present in considerable numbers and sexual forms are frequent It is also evidenced by the fact that at this season of the year primary infections among new comers are usually quartan Wherever search has been made abundant breeding places of anopheles have been found, and in all the villages visited ·37 adult anopheles have bear collecled So far, the following species are been found in this trict - Guloriferies / Instoni P 10) forlensis fuft, nous N t/ cobald: Mracula Falpis, N'y rosni, all these has been present from the begins sing of observall07s with the exception of Nysiomycom) 1a ross which at first could not be found but has since ap feared and become abundantly pooralent In March and again in Maj a series of dissections of aropheles, mainly culcafacies were made On both occas sions at least a hunira glands prere examined but with no On both occasions the meather was very dry. and on the latter occasion the maximum day temperature tas 98"! in the shade pithe results Most ample assistance has been sendered to the trork of investigaton by the Special Assistant Agent and the officers in the Je; porc Agency ·38 THE RELATION OF THE E,DEMIC INDCX TO THE SPLENIC INDEY IN CPIDFMIC AREAS OF THE PUNJAB BY EL PERRY, On special duty On page 44 of PALUDISM No I for July 1910 is a table detailing the endemic and splenic indices of some villages near the Chenab River in the Gujrat District The figures were ascertained shortly after the great epidemic of the autumn of 1903 In April 1910 these villages were again visited and blood specimens obtained from 78 children For these 78 children the splenic and endemic indices were respec trvelv 59 per cent and 27 per cent On referring to the above mentioned table it is evident that since June 1909 the endemic index has decreased in greater degree than the splenic index Moreover in the films from infected children the parasites were far less numerous than at the previous examination The relation of crescents to other parasites at the two periods is most important In December 1908 at the decline of the epidemic, when the endemic index nas 75 per cent cres cents were present in 25 per cent of the total nuinber of children examined At this time benign tertain sporonts were far more frequently met with than crescents in June 1909 at the dry est and least malarious part of the year the endemic index for the same community was 71 per cert and crescents were present in 17 per cent of the total number of children examined April 1910 the figures were respectively 27 per cent and 6 per cent On this occasion out of the 78 bloods examined only to were found to contain benign tertian speronts and 70 benign tertian schizonts were seen In the community therefore as in the individual the malignant tertian parasite dies harder than the benign tertian ·55 A HANDY METHOD OF COLLECTING ADULT ANOPHELES BY J RADIE, Special Malaria Officer, Punjab (With plate) The usual method of collecting adult anopheles for dis section is to transfer them one by one as they are caught in test tubes to a large bottle or jar the mouth of which is either plugged with wool or is coscred with a paper cap in which a hole has been cut Much time is occupied in this procedure in making the mosquitoes fly from the tube into the bottle and, unless one is very careful pieces of trool are apt to fall into the jar, the paper cap to become torn, and so on The follow ing method has many advantages and is free from the above Inentioned defects Outfit -The following only are required 1-A lamp glass prepared as shown in the diagram Over onc end is stretched tight and tied in post tion a piece of rubber shcet in which a slit just large cnough to admit the end of the tube you are going to use for catching the mosquitoes has been cut A short length of old bicycle tyre scrics admirably for this purpose (fig A) II-A tcst tube in the bottom of which three or four holes huic been dnlled with the aid of a menting diamond, or a test tube the bottom of which has been rcmoi cd, or a suitable length of glass tubing Over the end of which a picce of musln has been tied (Fig BB) ·38 THE RELATION OF THE EVDEMIC INDEX TO THE SPLENIC INDEX IN EPIDEMIC AREAS OF THE FUNJAB BY EL PERRY, On special duty On page 44 of PALUDISN No I for July 1910 is a table detailing the endemic and splenic indices of some villages near the Chenab River in the Gujrat District 7 he figures Frere ascertained shortly afte the great epidemic of the autumn of 1903 In April 1910 these villages were again visited and blood specimens obtained from 78 children For these 78 children the splenic and endemic indices were respec tively 59 per cent and 27 per cent On referring to the above mentioned table it is evident that since June 1909 the endemic index has decreased in greater degree than the splenic inder Moreover, in the films from infected children the parasites sere far less numerous than at the pressous examination The relation of crescents to other parasites at the two periods is most important In December 1908 at the decline of the epidemic, when the endemic index nas 75 per cent, crus cents were present in 25 per cent of the total number of children evainined At this time benign tertain sporonts were far more frequently met with than crescents in June 1909 at the dry est and least malarious part of the year the endemic index for the same community was 71 per cert and crescents lere present in 17 per cent of the total number of children examined In April 1910 the figures were respectively 27 per cent and 6 per cent On this occasion out of the 78 bloods examined only tro were found to contain benign tertian sporonts and 70 benign tertian schizonts were seen In the community therefore as in the indıyıdual the malignant tertian parasite dies harder than the benign tertian ·55 A HANDY METHOD OF COLLECTING ADULT ANOPHELES BY JR ADIE, Special Malaria Officer, Punjab (With plate) The usual method of collecting adult anopheles for dis section is to transfer them one by one as they are caught in test tubes to a large bottle or jar the mouth of which is either plugged with wool or is covered with a paper cap in which a hole has been cut Much time is occupied in this procedure in making the mosquitoes fly from the tube into the bottle and, unless one is very careful pieces of wool are apt to fall into the 17, the paper cap to become torn and so on The follow ing method has many advantages and is free from the above mentioned defects Outfit -The following only are required 1-A lamp glass prepared as shonn in the diagram Over one end is stretched tight and tied in posi tion a piece of rubber sheet in shich a slit just large enough to admit the end of the tube you are going to use for catching the mosquitoes has been cut A short length of old bicycle tyre serves admirably for this purpose (Fig A) II -A test tube in the bottom of which three or four holes have been drilled with the aid of a wnting diamond, or a test tube the bottom of which has been removed or a suitable length of glass tubing over the end of which a piece of muslin has been tied (Fig BB) ·Plate 11 I System of mounting etc CM Bureau head removed by slanting Cut A Cork slide D B с wedge shaped piece cut out of cork Cork sheet { cork of lube, Cork sheet Tube 3 x 1 por Bottom holding cork in place Cardboard Box COYK SHË ET HU Lid' G Adie's apparatus for collecting adults II slit Lamp Class A Muslin Rubber Sheet (old tyre) slit Perforations B Muslin ·57 A SYSTEM OF MOUNTING, ELAMINING, AND PRESERVING MOSQUITOES Central Malaria Bureau (11 th plate) In dealing with different kinds of material at the Bureau some extension of the method of "mounting mosquitoes " as ordinarily understood has been found necessary The basis of the mounting system is the use of a fine pin from which the head has been removed by an oblique cut with a sharp pair of scissors The object of making the cut obliquely is that by this means the pin is made sharp enough at the head end to penetrate cork etc readily A pin truncated by a transverse cut can be pushed into cork but not readily and it easily falls out, a pin with an obliquely cut end engages the cork wh ease and certainty The full system at present adopted is as follows 1 -Mounting mosquitoes as dried specimens --(a) If a trell arranged specimen is desired, the method of preliminary mounting on a card is still employed, as this enables the legs and abdomen to be hept in good position The arrangement, however in this case is not necessarily final and, there being no head to the pin the specimen can at any time be with drawn, pin and all from the card the presence of which of course entirely precludes any examination of the ventral surface of mosquito When employing his method the usual procedure is adopted (oide Instructions to Col lectors), but the precaution is talen to drive the point of the pin about the eighth of an inch through the back of the dorsum by pressing against a smooth cork surface It has generally been taught that a card circle should be used, but a square is much more readily cut, and so far as is knonn there is no particular advantage in a circle ·58 Cimens (6) The above, which is the method of mounting ordina nly taught, is used orly because it makes good museum spe Ordinarily it is sufficient merely to impale the mosquito nith a fine headless pin without any cardboard at all (Vide Fig B) In this case after the mosquito has been transfixed and the point of the pin made to project a little beyond the back of the thorax, the thicker end of the pin IS drven into a small strip of cork (Fig E) or a block of pith (Fig D) or stuck, along with similarly mounted mosquitoes, on a piece of cork sheeting (Fig G) 11 -Examination of dried specimens-If a specimen has been mounted on a card, it is, as a rule, left in this condi tion until it becomes necessary to examine it It is then re moved from the card and treated in the same way as speci mens mounted simply on a pin For examination of a mos quito under the microscope one may use a sheet of cork moved over the stage of the microscope by the fingers, or more conveniently a small strip of cork about the size of a slide which is placed between the arms of the mechanical stage and moved about as though it were a slide, or still better per haps an oblong strip of corh a' by 1" placed upon a glass slide which is then manipulated by means of the mechanical stage In all these cases, however, it is difficult to arrange the mos quito suitably for examination from certain points of vier One of the most convenient of all methods of examination is to use a stout cork (the corh of a 3' by ' specimen tube) which is placed upon a slide and manipulated with the mechanical stage For examination of the dorsal or entral surface the upper surface of the cork is used, for lateral and certain other viens the pin of the mosquito is stuck at ranous angles into the sides of the cork (Fig C) III -Remounting after examination — It is obvious that a specimen after examination is easily remounted either singls on a pith block (Fig D) or on a corh strip (Fig E) or along uith other specimens in store tubes (Fig F) ·59 IV --Preservation of mounted specimens- (a) Permanent preservation of a single spe imen -Esther on its original card or on a pith block the large pin of the spe cimen is driven into the inner side of the cork of a specimen tube 3" by 1" Before doing so horever, a wedge shaped piece is cut out of the cork as shewn (Fig F) The name or catalogue numher is then written on the outside of the cork and the tube is placed over calcium chloride in a dessicator for three or four days in practice a jar is used capable of holding say a couple of dozen tubes and specimens are allowed to accumulate in this until it is full After the most recently added tubes have remained for the required time in the dessicator all are removed and at once sealed with paraffin, the hole in the cork being first lightly plugged with a little pledget of wool to enable the paraffin to close the opening Each tube is then rolled in a small square of wool which is tied on with a short length of tape 1 he number on the cori can always be seen without removing the tube from the wool and the specimens can be handled with the greatest freedom without any danger whatever of jars or knocls which are a feruile source of damage when storeboxes or unprotected tubes are used (0) Permanent preservation of numbers of mosquitoes. When it is not desired to give a whole tube to a single specimen a tube is prepared as shown in rig r A strip of thick cork sheet is cut 2 by or slightly less A Hedge shaped piece is cut out of this near one end and by means of 1 stout pin the stap is fixed to the inner surface of the corh of the speci men tube (from which a wedge has been cut as before) near a portion of its circumference (Fig F) As many specimens as convenient are now pinned on to the strip by sticking the sharpened head end of the pins into the cosh strip The outer surface of the cork of the tube being labelled and the tube placed in the dessicator for a period, this is finally sealed and wrapped in wool ·60 Treated in this manner mosquitoes are for all practical purposes permanent preparations When the tube is opened to allow of the specimen being examined microscopically and the mosquito is being replaced the plug of paraffin and wool is removed and the specimen left for a period in the dessicator jar This, if done as a routine, is no trouble, since a jar is always kept at hand in which tubes can be placed until one has leisure to reseal them V-Despatch of specimens - The preceding method of mounting is very convenient for the despatch of specimens If two or three mosquitoes only are being sent they can be stuch directly into the cork of a specimen tube or twenty or so can be put up on a cork strip in a tube on the "telegraph pole" system (Fig F) Dealing with larger numbers it is con venient to use a cardboard box into the lid of which a piece of cork sheet has been fitted On closing the box the cork will be held firmly in position so that no further fixation is required (Fig G) It is very easy to mount mosquitoes in this way without any trouble about card discs, etc, and a hundred may easily be put up at a sitting A hundred mosquitoes can be pached 80 put up, in a single quarter plate photographic slide box o in five or six tubes VI -Manipulation of dried unmounted specimens --Many specimens are received at the Bureau loosely packed in wool When it is desired to examine such in detail or to preserve them they are placed for an hour in a moist chamber Alter this they can be transfixed with a fine headless pin and of course at once examined or mounted in any way desired Vll.Permanent potash preparations Whenever possi ble, in addition to dried specimens of a species, balsam mounted potash specimens are prepared It is often a good plan •These and some further points of technique will be given la future numbers of * PALVO19 ·61 only to do in the ficld the necessary boiling in 10 per cent potash and ubsequent washing and to preserie the specimens in 70 per cent alcohol for future mounting VIII-Larval and nymphal stages – The larval and nym phalskins of adults which are actually presarved and catalogued in the collection are alone emploved for descriptive work Fortunately it is found that such skins make even better pre parations than the actual larva or nymph ·62 NOTES ON MOSQUITOES 1-Arethod of keeping adult anopheles alive without feed ing them on blood --Lieutenant Colonel I RAdie, / MS- Under ordinary circumstances all anopheles caught and kept in tubes or bottles die in at most two or three days if not fed on blood By a very simple procedure I have been able to heep anopheles adults alive without feeding them on blood for as long as three weeks In an ordinary jar or lamp glass conta!ning anopheles are placed (a) a dried date wrapped in a small piece of muslin, (6) a small fragment of set sponge, (c) a twig of some green need the end of which is stuck into a hole in the sponge In a jar so prepared anopheles live for a long time If examples are required for dissection a clean jar is placed upside down over the mouth the muslın is removed, the lower jar covered with a cloth to render it comparatively dark and a few taps made with the lower jar on the table The anopheles will fly upivards into the fresh jar II - listons in the Punjab - Perry, Adie, Smith, C M Bureau For many years it was not supposed that M listons occurred so far to the west as the Punjab It was not found at Mian Mır by the Royal Society's Commission nor is it mentioned by Adie in his list of species taken at Ferozepore In 1910 Perry among numbers of a culcifacies caught at Kuthala near Gujrat found specimens which resembled listons sing markings, and some of these seen by James were thought definitely to be 11 listone One or two more speci mens sere taken at the foot of the hills near Kalka listone has also been received on several occasions among anopheles sent by Major Smith, RAM C, from Rawal Pındı • Adie (1905) refers to specimens in his collection (4 Astiatilirluutoni) taken in Kashmir in their ·63 At Amritsar during 1909 10 this species was not encoun tered, though many hundreds of anopheles were examined It was very surprising therefore in the spring (early part of April) of 1911 to find it in large numbers on the outshirts of Amritsar Altogether more than two hundred specimens were taken at various times during April in a particular neigh bourhood and stray specimens were found in other parts of Amritsar That this appearance of a spec es hitherto thought to have been absent was not the result of its having been confused in the past with Af culicifacies is shown by the examination of a large batch of anopheles caught at various times at Amritsar and preserved at the Bureau Also the specimens nere at once recognised as something quite new by the collector A comparison of specimens taken in Calcutta with those taken at Amritsar and at Rawal Pindi shows no differences in markings or structure In the Amritsar specimens the attitude was seen to be that of an ordinary anopheles and not that of 4 culicifacies III --P jeyportensis (James) --Perry C M Bureau A large number of this species from the Jeypore Hills has been sent by Major Perry I MS, to the Bureau So far practically ro specimens have been available for study since the species was first taken in the Jeypore Hills, and there was a good deal of uncertainty in respect to details of scale Structure, etc The specimens now sent shey it to be a very distinct Pyretophorus and the scales on the thorax though narrower than those on the thorar of N fuliginosus, for example, are much more distinctly true scales than the thoracic scales of a listonı or A turkhud: Being snony white they are also very conspicuous under the microscope The legs are very distinctly banded at the tarsal joints, but the bands though quite distinct are narrow is darher than 21 culıcıfacies or 11 listons and the narrow The mosquito ·64 very clear tarsal banding at once distinguishes it If y culicifacies shows banding it lacks the distinctness of that of P je poriensis IV-P gigas 14 Assani hills (VcCombie Young) P Simlensis Murree (Gill) -A specimen of P gigas caught ac Shillong (4.900 ft) in May was recented from Captain McCombie Young, I MS It shows no bands on the palps and so resembles the typical P gigas of the Nilgiris A series of specimens of Psimlensis from Murree and another series bred out from larva taken at Kasault all showed sell marhed and in some cases very conspicuous bands on the palps V-A turkhudt at altitude of 6,000 feet (Gill, Acton, Christophers) A turkhudı has generally been ſound breeding in shallon pools in connection with river beds (Jumna at Delhi, river Beas, nullahs near Nagpur, etc) In August 19 o one of us found this species breeding freely in pools in a small stream below Kasul at a height of about 4,000 feet Since then (June 1911) specimens have been bred out at Murree (7 000 feet) and caught in bungalows at Kasauli (6,000 feet) A turkhuat is therefore to be looked upon as a species occurring at considerable altitudes in the Punjab hills The thoracic scales in the specimens caught at Kasauli are similar to those of A turkhud: caught at Beas There is no reason therefore to believe these mosquitoes to be P nigrofasciatus a species tahen near Quetta at a considerable altitude (5,000 feet or more), unless P nigrifascialus, as suggested by James, is only A turkhud: * V-Reduction of palpal bands 111 N maculatus N maculipalpis (Adie, Gill, Krishna Rao) --Adie notes that in N maculatus caught in the Kangra Valley the two terminal palpal bands in some cases coalesce to form a single broad Captain G I Davys LAS das recently sent a valuable collection of anepheles t ken at Quetta It i clades many specimens of P **?301 and a few ? mirrifar als Both these species are qu te disti ct from turkhudi and cl arly belong to the genus Pyret us A new description of these will be given in the dext Qumber of these traosactions (S.PJ) ·65 terminal white band In such specimens the sing markings are lighter in colour and marked somess hat differently from the norma! Gill and Krishna Rao find similar blending of the terminal bands in a certain proportion of the same species caught in the Ravi near Pathankot Adie also records N maculipalpıs as shoring the same reduction of bands on the palps but without much change in the wing marlings VII -Larva of Ne fowlerı (Kenrick) -The larva resem bles that of N fuliginosus, but the median frontal hairs are more branched There is no branched hair on the antennae The median and external frontal hairs are branched, there is no posterior pair of hairs There are no palmate hairs on the thorax or on the first abdominal segment The second seg ment carries undeveloped palmate hairs Well deseloped palmate hairs are present on the 3rd to 7th segments The filament is half the length of the stem of the leaflet and ends abruptly at the base of the leaflet The larvæ are found in ricefields, in borrot pits and in tanks, as well as in leal age and overflow water from these when near ricefields They are not found in flowing water and prefer water with seeds and grass The species is one of the commonest anophelines in the Central Provinces at certain times of the year (cold weather) and is pre eminently the ricefield species VIII -Ne willmori a proved malaria carrier 112 satire Sporozoites have been found by Mrs J R Adie in the salivary glands of Nc willmore caught in the hangra valley A communication is promised for the next number of this publication ·66 REVISED AND NEJV DESCRIPTIONS OF INDIAN ANOPHELES Indian species egg, laria (IV1th plate) The monograph of the anopheles of India by James and Liston forms a complete reyision of the adult stages of the But in a number of the species the and nymph still remain undescribed, and in others the descrip tions of the immature stages require revision or more detailed treatment There are also a fer species in which, owing to want of material, the description of the adult stage has still to be revised, eg P nigrifasciatus, P nursez etc This will be done in the present section as material becomes available Only descriptions will be utilised in which the actual adult insect, being preserved in the Bureau, is available for study at any time In the case of eggs both the adult laying them and the eggs themselves will be preserved and catalogued In the case of the larva and nymph, the skins mounted in balsam will be kept along with their respective mature insects It is intended by these precautions to avoid the error which is so apt to occur of an immature stage of one species being described as that of another 1 Egg of a listor (CM Bureau) -Four gravid female de listoni (No 347 Mus Cat) caught at Amritsar were allowed to oviposit All laid eggs of the following description (No 348 Mus Cat) - Type 1 -Floats do not touch rim of upper surface Upper surface narrow, separated into tão areas each of which 18 surrounded by a narror frill (Vide Plate) Lower surface shagreened, un ornamented Floats long, occupying more than half the length of the cgg, about 20 crinkles

·Plate 11
2
1
6
5
Ch halli
10
7
Ne willmori
9
13
14 stort
N maculatus

·68 from papillæ close to the hase of the median hairs There. are two small posterior hairs (Vide Plate ) The mental plate is bluntly conical in shape and bears ſine rounded teeth The maxillæ carry a branched hair thich arises from the outside near the apex and carries at its termination the following structures, two thick spines, a small foliate plate, a small fat process carrying two thin spines The mandibles carry four large curied spines, a mass of similar but smaller spines, and a comb lying below the mandı bular teeth The mandibular teeth are blunt pointed and about fite in number The hairs arising from the thorax are similar to those of other anopheles laria but are small and niperfectly developed The abdominal lateral hairs are also rather delicate and short There are the usual double oar shaped hairs on the first two segments and a single oar shaped hair on the third seg ment The rest of the lateral hairs are simple Palmate hairs are carried on the 3--7 segments They are of moderate size measuring in the adult larva 12mm in one larva in which they were counted the leaflets born by the different segments proceeding from the 3rd to the 7th was 11, 16, 16, 14, 12 The hur on the oth segment is often rather small and inconspicuous The greatest breadth of the leaflet is about one sixth the total length including the filament The leafiet ends in a series of rather pointed teeth usually about three on each side of the Glament These lead up gradually to a short pointed filament From the most basally placed "jag" to the point of the filament is about one sisth of the total length of the leaflet The sprcle comb carries three large smooth processes and about e ght smaller spines cartung fine teeth ·69 The hairs arising from the ninth segment are rather short and poorly developed A feature which serves to distinguish the larva of this species from that of all previously described ones is the extreme shortness of the external frontal hairs The nymph resembles in general appearance that of other anopheles The air trumpets are of the shape usual in ano pheles They measure 45 mm from origin to terminal margin The first abdominal segment carries a pair of large fan shaped hairs The hairs on the succeeding segments are very small and feeble Lateral spines are present on the 4-7 segment, but are small and ill developed. That on the 7th segment is, bowever, of medium size The anal flaps measure 8mm They are fringed with minute hairs The above descriptions are from cast skins of No 160 (1), (11), and (III), Mus Cat The farvæ were found abundantly in Golaghat in January in small muddy pools resembling the breeding places of Nm rosse and in footprints of cattle At the time of the year they were caught this species next to 11g ngerrinius and N fuliginosus was the commonest anopheles IVLarda and 123 mph of Ne willmori (C M Bureau) - The larvae have no distinguishing feature to the naked eye The head markings are generally a dark V shaped mark with a spot in front of this There may be a bar in front of this again and to small spots near the eyes The antenna have the usual characters branched lateral hair The spines covering the body of the Gatenna are rather well des eloped The basal hair is branched and about as long as the antenna There is no ·70 The frontal hairs are simple The median pair arise about half their length from one another and the external ones about half as far again external to this The external hairs are somewhat shorter than the median There are two rather well developed posterior hairs which reach fornard as far as the base of the median hairs The mental plate is blunty conical and carries 9-10 rounded teeth The mandibles and maxillae do not differ appreciably from those of C hallı described above The thorax and abdomen carry the usual hairs Rudimentary palmate hairs are present on the second segment, well developed ones on the 3-y segments They are of moderate size, measuring in the adult larva 12mm In one larva in which the leaflets were counted they numbered on the different segments proceeding from the 3rd to the 7th segment 14, 13, 14, 15, 10 The leaflets at their broadest part measure slightly more than one sixth of their- total length, including the filament They terminate in a series of steps about three on each side of the filament These lead up gradually to a short pointed filament From the most basally situated step to the point of the filament is about one fifth the total length of the leadet The spiracle comb carries four large processes one of which carries fine teeth and about nine smaller spines with fine teeth The nymph resembles in general appearance that of other anopheles The air trumpets are of the shape usual in ano pheles They measure 47mm They are fringed with short hairs The first abdominal segment carries a pair of large fan shaped hairs The succeeding three segments carry on the dorsum respectively, an outer simple and inner branched hair, two branched hairs and a simple hair, two branched hairs ·The three penultinate segments carry each a pair of long inner simple hairs and a pair of outer branched hairs In addition to these hairs the 3rd to the 7th segments carry dark coloured stout spines which increase in size as one passes backwards On the last segment this spine is represented by a dark stout branched hair The anal flaps measure 8mm and are fringed with minute hairs The larval and nymphal description is from the cast skin of No 375 Mus Cat The larvæ and nymphs of Ne will mort are remarkable for their poner of remaining at the bottom of the small rochy or stony pools in which they are found ·70 The frontal hairs are simple The median pair arise about half their length from one another and the external ones about half as far again external to this The external hairs are somewhat shorter than the median There are two rather well developed posterior hairs yhich reach forward as far as the base of the median hairs The mental plate is blunty conical and carries 9-10 rounded teeth The mandibles and maxillæ do not differ appreciably from those of C halli described above The thorax and abdomen carry the usual hairs Rudimentary palmate hairs are present on the second segment, well developed ones on the 3--7 segments They are of moderate size, measuring in the adult larva 12mm In one larva in which the leaflets were counted they numbered on the different segments proceeding from the 3rd to the 7th segment 14,13 14, 15, 10 The leaflets at their broadest part measure slightly more than one sixth of their total length, including the filament They terminate in a series of steps about three on each side of the filament These lead up gradually to a short pointed fila- From the most basally situated step to the point of the filament is about one fifth the total length of the leaflet The spiracle comb carries four large processes one of which carnes fine teeth and about nine smaller spines with fine teeth ment The nymph resembles in general appearance that of other anopheles The air trumpets are of the shape usual in ano pheles They measure 47mm They are fringed with short hairs The first abdominal segment carries a pair of large fan shaped hairs The succeeding three segments carry on the dorsum respectively, an outer simple and inner branched hair, two branched hairs and a simple hair, tso branched hairs ·71 The three penultimate segments carry each a pair of long inner simple hairs and a pair of outer branched hairs addition to these hairs the 3rd to the 7th segments carry dark coloured stout spines which increase in size as one passes backwards On the last segment this spine is represented by a dark stout branched hair The anal flaps measure 8mm and are fringed sith minute hairs The larval and nymphal description is from the cast skin of No 375 Mus Cat The larvz and nymphs of Ne willmort are remarkable for their power of remaining at the bottom of the small rochy of stony pools in which they are found ·72 AN INVESTIGATION INTO THC PREVALENCE or KALA AZAR IN A PART OF UPPER ASSAM SR CHRISTOPHERS The name kala asar was first applied to a peculiarly Fatal fever which had been present for some time in the Garo Hills, a tract of comparatively low hills lying to the south of the Brahmaputra at the losser end of the Assam Valley In 1882 when investigated by McNaught, Civil Surgeon of Tura, the disease seems to have been unknown in other parts of Assam But a little later what was evidently the same disease became prevalent in the Goalpara District lying to the north of the Garo Hills, and in the course of years successively attached Kamrup, the adjoining district on the north bank of the river, and Gauhatı, the district lying opposite to Kamrup on the south of the river In each case after lasting a certain number of years the epidemic conditions declined and the districts sere in turn abandoned by the disease In 1889 at the time of Ross's investigations into kala apar, this disease, though it had died out, in epidemic form at least, from Goalpara, was present in Nongong and had spread to Mongaldai and Tezpur Kala azar had therefore extended in the course of some twelve years in successive steps about half way up the Assam Valley Since 1889, a period of twenty years, no known further extension of the disease in epigemic form has taken place But quite recently Captain Morison, IMS, Civil Surgeon of Sıbsagar, has drawn attention to the occurrence of what he believed to be kala asar in certain villages in Golaghat, a sub division of Sibsagar adjoining Nongong It was on account of the importance of this announcement that the present investigation was carried out ·73 The facts known at the time of my visit Bere as follows - Captain Morison, IMS, had recorded a number of cases scen by him in the villages of Khumtai, Melamara and Habic hoa, which, from their history and other clinical evidence, he believed to be kala asar he also showed that a considerable number of deaths from what appeared to be this disease had already occurred in these yıllages Captain McCombie Young IMS, who later visited the area, similarly records ms opmion that the cases referred to were kala asar and was able to make an autopsy on a patient who died whilst he was in the neighbourhood Vide case i At first cases were reported only from the Khumtaz mausa which lies to the west of the sub division But during the course of Captain Morison s and Captain Young's invests gations some further cases were repoited from a village in the Naharani mausa which is situated in the extreme eastern portion of the sub division 1 hese cases, seen by Captain Young, were also pronounced on clinical grounds to be undoubted kala asar There were thus three sillages-hhumta. Melamara, and Ilabichoa-n the l humtai mausa and one village-Dumjoonain the Naharani mausa suspected to be infected with kala azar My on investigations were commenced at Khumtat A camp was arranged on the outshirts of this village and a care ful house to house examination inade Altogether within the boundaries of the village there 105 houses which, as is usual in this part of Assam, sere very scattered, the vyhole village stretched about two miles from north to south and about a mile from east to west Fifty one houses, forming the north and south extremities of the village, were occupied by ex tea garden coolies im migrants from other parts of India Among these only three suspected cases were found In one of these (case 7) spleen puncture showed no leishmania parasites ·74 The central portion of the village consisted of 54 houses occupied by native Assamese (ahoms) In 19 of these houses one or more cases, suspected to be kala asar, fere found The spleen blood was esamined in 11 cases In three cases in which the clinical diagnosis was doubtful the result was negative Three cases thought to be kala asar also yielded negative results The remaining 5 cases shoned leishmania parasites It will be seen, therefore, that in this village among the native Assamese kala azar was very prevalent At Melamara, a few miles from Khumtar, only tivo suspect ed cases were discovered as the result of house to house examination In neither of these cases did splenic puncture show leishmania parasites At Habichoa, a mile or no further distant, house to house examination yielded 6 cases which pere thought to be kala The splenic blood was examined in five cases, all of which showed parasites At Dumjooria all the reported cases had been found in a portion of the village consisting of about a score of houses In this small group of houses no less than sıx infected families were found Four cases were examined by splenic puncture, all of which shoned parasites Thus, in each of the reported centres, except perhaps Melamara, there could be no doubt as to the existence of kala asar Distribution of hala azar in Golaghat asar Though cases had been reported from only four yıllages, it was not at all certain that infection was limited to these In order to ascertain the prevalence of kala asar in the district generally, a house to house examination is made in as many Villages as possible, the spleens of the innates being pal pated with a vier to detecting cases of the disease ·75 In the villages Basagaon Sapenokoboa, and Lukhurahhnea near the Nongong border 259 ullage people were examined The only suspected case of kala agar was a boy in a Kayah's shop who had a very large spleen and a history of fever Moderate enlargement of the spleen (malaria) was present in 77 per cent of the children of these villages tahen collectively In the same neighbourhood Captain Morison made a spleen census among over 300 coolies on tea gardens There were a number of very large spleens reaching to the umbilicus , but tlie general spleen rate was very high (84 per cent ), and Captain Morison was of opinion that none of these were cases of kala asar Further east at Dangaon 103 village people were examined In two cases the spleen reached to the umbilicus At Mohaligaon 67 people were examined and no very large spleens encountered At Kolakua, a village of ex tea garden coolies, one girl sith a very large spleen was seen and this may have been a case of kala asar In all these villages the general spleen rate was high At Saporialgaon, a small village in the same neighbourhood, only 36 people were encountered in a house to house examina tion, but of these four hed spleuns reaching to the umbilicus and five possessed spleens almost as large The general spleen rate (18 children only) was 66 per cent Under the circumstances of our sasit it was not possible to perform splenic puncture, but there seemed reason to suspect that this village was a focus of kala azar On a garden in this neighbourhood Captain Morison found among 87 children 5 muth spleens which reached to the umbilicus Again it was doubtful if any of these yere kala asar (Vide remarks gren later on certain types of sery large spleen) Still further cast beyond the mer Dunsını the infected khumtat Habichoa area is approached At Bungaon, eight miles from Khumtal, 130 people perc cumined The spleen 1 ·76 rate was low, being only 23 per cent Sıx adults, all long settled ex garden cookies, showed enlarged spleens reaching to the umbilicus In all of these there was a very long history and in only two was there any sign of general ill health The most suspicious of these cases was examined by splenic puncture, but no parasites were found In the neighbourhood of Golaghat tonn lying to the south of the Khumtai area 167 people were examined in two cases the spleen reached to the umbilicus though the general spleen rate as low (20 per cent) A case (case IV) coming from a village four miles outside Golaghat was thought to be kala azar, but splenic puncture yielded only malaria parasites (quartan) and another case (case II) svith a large spleen com ing from another part of the district also shored quartan para sites, Proceeding again easttards towards the heavily populated sub division of Jorhat, a number of villages were examined At Gujagania 323 people were examined In three cases the spleen reached to the umbilicus in one of these the spleen was punctured, but no parasites were found The general spleen rate was low, being 19 per cent At Dumjoona infec tion was found to be practically confined to the group of houses we had previously examined Excluding the focus 124 people were examined No cases in which the spleen reached to the umbilicus were seen, but one case with a some what smaller spleen was suspected to be kala agar At Baltipuria (Mussalmangaon), where, as ne shall see, kala azar is stated to have been at one time epidemic, 96 people were examined, but no very large spleens were found At Dergaon 181 people were examined, but no suspicious cases were found At Dodara Ahom 115 people were examined and one child was found with a spleen reaching to the umbilicus (doubtful if kala asar) In all these villages the spleen rate was re marhably low, the percentage tahen collectnely being 15, whilst at Dumjooria it was only 4 ·77 These results show that kala azar is not generally pre valent, but occurs chiefly in the form of foci They show also that the distribution of kala azar is in no way related to that of malaria Considerable difficulty was felt in arriving at a diagnosis in what may have been sporadic cases of kalı asar Cases of very large spleen in ex garden coolses seré also a source of difficulty on the whole, experience gained by splenic puncture showed that the following types of very large spleen might be distinguished (1) Large spleens yielding lets)manna on puncture (2) Large spleens in xhich no parasites are found even when many splenic cells are included in the blood drawn from the spleen Nevertheless not infrequently in these cases the history and clinical evidence very strongly suggest kala asar (Vide cases \II, VIII, XIV and WWII) It is possible that at certain stages of the disease parasites are greatly reduced in numbers or that they are absent from portions of the spleen (3) Very large spleens exactly resembling leishmania spleens, but there is usually a very long history and the patient, though he may be anemic, is well nourished and may even be robust The frequency of this condition among the immigrant coolie populalion from certain localities, eg Arrah, is very notable A very similar condition is common in the Punjab and is drawn attention to by Ferguson and Day in Egypt (Vide cases II, V, VI, XXIV) (4) Very large spleens associated rith mari ed anæmia and often with a considerable amount of edema of the face To superficial examination these cases often Simulate kala asar very closely, but on puncture they yield only malaria parasites (Vide cases II, IV) * See also Set ntific Vemo rs Vew Scrits No 19 Kolo osar, Salutis and Walanal Cachexia by SP James and ascites ·78 History of kala azar in the focus at Khumtar serted portion The first deaths from kala agar in Khumtai are stated to have occurred in or about 1900 At this time there existed a portion of the village, now quite deserted, to the north of the present centre The village as it now stands consists in fact partly of houses which once formed part of the original village and partly of houses of more recent construction built by families who at various times had moved out of the now de Until quite recently (1909) there was no history of kala azar among any of the families living in the old standing houses But no less than eleven out of fifteen families in the newer houses shon cases or have a history of kala asar Some families moved away from the old village site fifteen or sixteen years ago, these have no history of kala asar Others who moved anay in 1904, in 1907, and at the final exodus in 1908 have shown infection The origin of most of the infection in the village can therefore be traced definitely to the old deserted village site, and it seems pro bable that the disease originated as stated some time prior to 1904 Old maps and records have enabled this portion of the village to be reconstructed It consisted of 23 houses rather closely aggregated The first cases are stated to have occurred in 1900 in a family living in a house (No 587) situated in the centre of the group By 1908 the disease had shown itself in eight more families living in the area Four families who had been free from the disease in the area have also since developed kala azar in their ner homes Thus small houses formed then a veritable focus resembling that described at Dumjoonia The first cases of kala azar in Khumta, not traceable to this focus in the old village occurred in house 957 here three deaths took place during the years 1909 1910. Up to group of ·79 date one other death has occurred 19 the house next to this and five out of seven houses forming a small group around it shox certain suspected cases of the disease This then forms another focus quite recently started As regards the origin of the first cases in Khumtar, the Lillagers state that on at least two occasions vis twelve and five years ago respectively, people fleeing from Nongong settled in the village and to these the presence of the disease 19 ascribed At Habichoa the first case among the villagers is stated to have been in a youth called Nagıram About two and a half years ago Nagram died after about six months illness with large spleen and constant fever Debt another member took all of the same disease and died about six months ago after four months illness Bhadai wift of Debi then got sich and died in December 1909 after suffering for about five months A girl aged & was also stated to bre ben sich sth the same disease and to have been on the point of death, but to have recosered She non showy no sign of kola avar Another inmate, Katri aged 16 tool all with the same disease in April 1910 He now has a spleen reaching to the umbili cus is emaciated, feeble and anemic (case \VII) The wife of another brother died in November 1910 and the hus band is case VIII Infection has therefore actively progressed in this family, hich yielded tuo of our cases The other cases seen gave no past history of cases of kala azar in the family As at Khumtar the disease is said to have been brought by people from Mongong Il hether this is so or not it is impossible to say In any case the appearance of the disease in Habichoa seems to be of a more recent date than was the case in Khumtai ·80 At Dumjooria it is stated that sonte eight years ago a severe epidemic of kala acay broke out in a neighbouring village called Mussalmangaon (portion of the village Baltipuria), as a result of which nearly half the people there died and many others left the village The Mussalmans who first suffered are said to have traded in cattle with Nougong and it is suspected that they made a business of buying up cheaply the cattle of those who had died from kala asar The first to contract the disease in Dumjooria was a man called Tuai, who is believed by the villagers to have become infected from sleeping in the same hut at the silkworm rearing time with one of the Vussalmans from Mussalmangaon Tuai was related to the household in shich the disease next occurred (house 312) Since then almost all the horses 112 this cluster of huls i ave become infected forming the focus already mentioned It is interesting to find that at Mussalmangaon where so severe an epidemic is said to have occurred 110 indication of the disease is now to be found Summary aid Conclusions Knla asar is present in Golaghat at the edge of or at little beyond the limits of the area affected by the great kala agir epidemic of Nongong The disease is not diffused generally over the district, but is in the form of small foci A remarl able feature of these foci is the large proportion of infected persons At Mussalmangaon a selere epidemic of the disease seems to have disappeared and left no trace At Melamara and Habi choa the disease does not seem to be very active At hum tai and in the Dumjooria focus the transniission of infection is, or has been until quite recently, in active progress Without a much more extended enquiry it is not possible to gauge with certainty the significance of these small foci or ·81 to say whether they represent the commencement of the spread of epidemic conditions, the slowly dying embers of past epidemic conditions, or a state of endemic prevalence of kala asar which may be of wide occurrence in certain tracts of India I desire to acknowledge the kind help I received whilst carrying on the investigation from Captain Morison, IMS, Civil Surgeon of Sibsagar, who personally assisted in the house to house examinations, the results of which are recorded paper It is also due to Captain Morison to state that many of the splepy puncture, were made by him in this Cases Casc 1 -Adult roman, Habichoa autopsy made by Captain Young IMS, smears sent to kasau'r showed no parasites, but sections of a piece of spleen tissue kindly given to me by Captain Houng shosed scanty parasites collected here and there in the large cells characteristic of infection by Leishmania Case II -Adult man, ex garden coolic from near Kamar band Ali, 4 miles east of Golaghat Spleen approaching umbili cus, marked anæmia, and cedema of right leg below the knee Spleen punctured 5th January 1911 Fairly numerous quartan parasites No Leishmania Case III -Boy aged 9 Bengal Came with his family to Golaghat town from Nadia in Lower Bengal about 5 years ago Has then healthy Began to suffer from fever and spleen about a year ago Spleen to umbilicus large and massive, liver enlarged, emaciation mushed, anemia con siderable Spleen punctured 6th January 1911 ( cashmanta present ·82 Case IV --Boy aged 8 Native Assamese from Naragaon, about two miles from Golaghat History of persistent fever, spleen nearly to umbilicus, finid in abdomen and adema of eyelids and face, marked anæmia, no noticeable wasting Spleen punctured 11th January 1911 Large rings (quar tan) No Leishmania Case V -Adult man Native Assamese Seen in jail, but came a few days ago from Kakolekigaon near Habichos Spleen nearly to umbilicus , large and massie Long history Spleen punctured 12th January 1911 No Leishmana or malarial parasites Case VI --Adult man aged 20 Living in house 32, Khumtai Case reported as kala azar Came three years ago from Arrah district (near Patna) After living some months in Khu ntai had quartan fever, which lasted for about SIX months Recovered from this, but lately has been suffer ing from fever of a continuous type and lo said to be darken ing in colour Spleen a hand's breadth Some anæmia Spleen punctured 13th January 1911 No Leishmanra or malaria parasites Case VII -Adult man Ahom (Native Assamese), Khumtal Living in house 3 Spleen a hand's breadth Man otherwise healthy Spleen punctured 12th January 1911 No Leiskmania or malaria parasites Case VIII--Boy (Garra) aged 9 years Ahom Khum tas Living in house i Spleen a hand's breadth Slight Emaciation doubtful Spleen punctured 13th January 1911 Very numerous Lesshmania anæmia ·83 Case IX Boy (Terok) aged 7 Ahom Khumtar Living in house 16 Spleen nearly to umbilicus , very tumid Anze mia marked Slight emaciation Brother aged 6 has spleen to unbilicus, anæmta and cedema with ascites Spleen punctured 13th January 1911 Very numerous Leishmania Case X – Youth (Petua) Ahom Khumtai Living in house 27 Spleen to umbilicus History of continuous fever No distinct emaciation or anæmia Reported as a case of kala Spleen punctured 13th Janua y 1911 Numerous Leish mania house 53 Case 11 –Adult (Robi) Ahom Khumtai Living in Three months' history of illness Has lived for four years in Khumtai in the same house but previously lived at Habichoa Spleen to umbilicus, massive Anæma Rather thin Spleen punctured 15th January 1911 mania Numerous Leish cus kala asar Case XII -Boy (Marun) aged 5 years Ahom khum tai Living in housc 26 Since birth spleen nearly to umbili Four of the family have died in the last two years from Father and mother both have hand's breadth spleens One brother has spleen nearly reaching the umbilicus (case XIII) and another a spleen four fingers' breadth Spleen punctured 15th January 1911 No Leishmania Case VIII -Boy (Nalia) aged 7 Brother of case XII Spleen nearly to umbilicus Spleen punctured 16th January 1911 No Leishmania ·84 Case XIV --Youth aged 18 (Mulua) Ahom Living in house 37 Spleen a hand's breadth Otherwise appears healthy, but reported as a case of kala agar Spleen punctured 16th January 1911 No Leishmania Case TV-Adult man (Runghai) Native Assamese Melamara Spleen hand's breadth Doubtful case Spleen punctured 17th January 1911 No Leishmania Case YVI — Boy (Boghu) aged 12 Native Assamese Melamara Spleen hand's breadth Doubtful case Spleen punctured 17th January 1911 No Leishmania Case XVII -Youth (Kotia) aged 16 Native Assamese Habichoa Spleer to umbilicus and massive Liver const derably below costal margin Emaciation Spleen punctured 18th January 1911 Leishmania pre sent Case XVIII Adult man (Tonka) Native Assamese Habichoa Brother of case XVII Spleen to umbilicus, liver mell belon costal margin Advanced case Spleen punctured 18th January 1911 Leishmania pre sent Native Assamese Case XIX -Adult man (Bhalola) Habichoa Spleen *o umbilicus Spleen punctured 18th January 1911 sent Leishmania pre Case XX -Adult man (Sobai) Natre Assamese Ha bichoa Spleen to umbilicus Emaciated Eight months' history of illness ·85 Spleen punctured 18th January 1911 Leishman a Very numerous Has since died (February 5th) Case XI -Adult woman (Pahı) Native Assamese Habichoa Spleen to umbilicus Liver below costal margin Spleen punctured 18th January 1911 sent Leishmania pre Case XVII —Adult (Manik) Native Assamese hum tal Living in house 23 Spleen a hands breadth, but bulky Man otherwise healthy Spleen punctured 19th January 1911 No Loishmania Case YXIII -Boy (Taheram) aged 10 Ahom khum ta! Living in house 28 Spleen punctured 19th January 1911 No Leishmania Case XXIV Adult Only likely case seen in the examination of some 350 people at the village of Gujagania gaon Spleen to umbilicus Long history and man was otherwise healthy Spleen punctured 23rd January 1911 No Leishmania Case XXV -Boy aged 14 Native Assamese Dum jooria Living in house 265 Spleen to umbilicus Emacia tion extreme Spleen punctured 23rd January 1911 Leishmania pre sent Case XXVI ---Boy aged 13 Native Assamese Dum j00118 Living in house 276 A Spleen a hand's breadth Emaciation extreme

·86
Spleen punctured 23rd January 1911
Leishmania pre
sent
Case XXVII -Adult Native Assamese
Living in house 333 Spleen to umbilicus
marked
Dumjooria
Emaciation
Spleen punctured 23rd January 1911
sent
Leishmania pre
Dum
Case XXVIII Boy aged 10 Native Assamese
jooria Spleen to umbilicus Emaciation distinct
Spleen punctured 23rd January 1911
sent
Leishmania pre
Case XXIX -Boy aged 12 Ex garden coolie Spleen
when first seen (January 11th) to umbilicus When seen
about a month later spleen a hand's breadth Some emacia
tion Five years history of enlarged spleen States does not
now get fever
Spleen punctured 5th February 1913 No Leishmiania

·87 MALARIOMETRY OBSERVATIONS UPON GRAPHS OF THE SPLEEN RATE AND THE AVERAGE SPLEEN BV SR CHRISTOPHERS (W*h plate) The spleen rate, being the percentage of children in any community showing enlargenent of the spleen takes no direct cognisance of the size of this organ But the size of the enlarged spleen is important and cannot be neglected as an indication of the amount or intensity of malaria For this reason the Central Committee have recommended that the spleen rate be given as an extended form by placing the results of paipation in five classes according as the spleen is (1) not palpable, (2) palpable or one finger s breadth below the costal margm, (3) two to three fingers breadth below the costal margin (4) four fingers breadth or a hand s breadth below (s) still larger te reaching to the umbilicus or filling the abdomen Major Ross employs for the same purpose four classes only and these are based upon an es imate of the polu»e of the spleen The first includes children in hom the spleen is not palpable In the second class the volume of the spleca is calculated to be about three times in the third class ${x times and in the fourth class mine times the volume of the normal spleen in practice the size of the spleen is estimated as a slightly enlarged, moderately enlarged or greatly enlarged spleen For reasons that will be cleares later, I believe Major Ross's fourth class to be identical with the Committee's lourth and fifth classes combined, and that the other three classes are the same in both cases It is evident that both methods lease a great deal to the observer's personal equation, but for the present at any rate, there are practical difficulties which prevent the employment hy of any more precise method There is also reason to believe * ·88 that estimations by these rough and ready methods are not, Bithin the limits of the standard employed, so inaccurate as one might think It has been my own experience that a spleen placed in one class by one observer will usually be placed in the same class by any other observer who may be on the spot Weightesi spleen rate It is obvious that if one knew the relative value of the different classes as regards malaria, a weighted average based on such knowledge could be given Major Ross on the basis of volume has weighted his classes respectively 1, 3, 6, 9, and terms the weighted average so obtained "the average spleen Similarly by omitting the class of normal spleens valued at 1, he obtains what he terms " the average enlarged spleen Quite arbitrarıly, for a purpose which ll be clear later, I have made weighted averages, using the values 1, 2, 3, 4, 5 for the classes I to V respectively In future I shall designate these results, respectively, Average Spleen (Ross), Average Spleen (SRC), Average Enlarged Spleen (Ross) and Average Enlarged Spleen (SRC) As I shall show later, it does not matter hon one weights the spleens provided the weighting is itself regular Ross states that there is a relation between the spleen rate and the average spleen This is a fact which everyone who has examined a number of different communities must acknowledge But it is necessary to see to what extent this In a relation holds good and exactly what the relation is recent publication* I gave a series representing the proportion of the different classes of spleen in communities grouped in the order of their spleen rate In this series (about 3 000 in number) there is apparent a peculiar effect, resembling that Malatia ia the Punjab Sc Memoirs by Oficers of the Medical and Soetary Departemet To 46 ·89 of a sliding scale, which first dresy my attention to a very peculiar property of the spleen rate This series was the result of examinations made by myself, and the standard of measurement was, I believe, fairly consistent throughout, but for obvious reasons I have been anxious to make use of greater numbers and of data collected independently In Major Ross's Report on Malaria in Mauritrus are given, in tabular form, the results of spleen censuses by nearly a score of different medical men, amounting in all to about 30 000 children examined Thes! Mauritius figures include four groups, a group consisting of about 19 000 examinations of children on Sugar Estates made by Drs Tennant, Menage, De la Roche, Lesur Chauvin Guerin Senneville, Ulcoq, Harel, Leclezio, Clarence, Bour, and Vinson a group consist ing of about 6,coo examinations made on children in schools by Drs Keisler, Masson, Castel and a few (about 400) by Ross and Fowler, a group consisting of about 5 000 examina tions made on children in various localities (about 4 000 by Dr Milne and about 1 ooo by Ross and Fowler and a small group of about 800 examinations made by Ross and Fowler in which, honever, the data for obtaining the average spleen are not given) Of these the most important for our purpose is the first group consisting of craminations of children on Sugar Es tates It is not only the nunbers that make this series very valuablu, but also the probability, since they deal with coolie labour and conditions where large numbers of children can be Sery readily obtained, that the detailed entries represent for the most part homogeneous communities an important point as we shall see later The examination of school children is less raluable, since Pre do not know to what extent admixture of different com muntits has taken place The fourth group is interesting in ·90 that 3,900 of the examinations are by one observer, Dr Milne. The remaining 1,000 or so examinations contain only three examinations of over 100 children and do not require separate notice IVe can then study the folloning series of examinations 3,134 Punjab children by myself 18,909 Mauritius Estates children by various medical men 6,188 Mauritius school children 3,907 miscellaneous children by Dr Milne I shall term these respectively Punjab series, Mauritius Estate series, Mauritius schools, and Mauritius Milne series With these preliminary remarks, which seem necessary to a proper understanding of what folloirs, I shall proceed to the results of a study of graphs of the different values mentioned above For the sake of brexity, I shall employ symbols as follows average spleen rate (Ross)<A (Ross), average spleen rate (SRC=A(SRC), average enlarged spleen Ae (Ross) and Me ( SRC) respectively I shall also indicate the spleen rate by the symbol S Graphs of the Spicen Rate and Average Spleen Plotting the points for S and A (SRC) in the Punjab series, they are found to fall verv close to a straight line which passes through the field in a diagonal' direction and thich represents the simple linear function A=02 S+1 Taking my own class IV and V as together equal to Ross's class IV and weighting the Punjab series with the values 1,3,6,9 (Ross's method), the points fall close to another diagonal line representing the function A=05S+I ·91 I shall not explain the diagram which accompanies this article * Along the left edge of the paper wc have 100 div sions (ordinates) corresponding to the percentages of the spleen rate, the mark 100 being at the top left hand corner Along the base, and also marhed on the upper margin, are divisions (abscissæ) 1, 2, 3, etc, representing the values of the average splee 1 or the average enlarged spleen, as the case may be, in terms of normal spleen The first line representing A(S R C) starts one division to the right of the left bottom comer (origin) and strikes the upper margin of the field at 3 (0) The second line representing A (Ross) starts from the same point (which we shall in future call P) and strikes the upper margin of the field at about 6 (this point will in future be called 9) Plotting the values S and A (Ross) for Mauritius estates the points fall with extraordinary regularity about a straight line passing in a diagonal direction and corresponding to the function A= 043 y +ı This line is evidently identical, or practically so, with the line previously given by the Punjab figures plotted by Ross's method of neighting It starts from the point P and passes a little to the left of Q (it actually cuts the upper margin of the field at about 5 29 (9) Weighting the Mauritius estate figures so as to obtain A ( SRC), se, multiplying the classes by 1, 2 3 etc, instead of 1, 3, 6, etc, and neglecting the small class V, the graph corresponds to that previously found for the Punjab series on my system of weighting Both the Punjab and Mauritius figures therefore follow the same functions, depending simply on the way in which the spleers are weighted eighted by my method they plot out along PQ, weighted by Ross's method they plot out along PO Starting from the same point P it will also be observed A hurtber contt but on deaing roch more fully oth the sob; ct and accom Pac ediby detaied and accurate charts will be publisted lo oor # xt nember ·This series 92 that the tiyo lines behave very similarly, except that for every space passed over by one (S R C) two spaces are passed over by the other (Ross) In the Punjab series the number of points that can be plotted is limited by the smallness of the numbers, but in the Mauritius estate series there are nearly a hundred entries, of which 66 refer to numbers of children over 100 therefore enables one to follow very closely the distribution of the plottings As stated, the points for this series lie closely grouped along a line passing from P to about 5 25 on the upper margin It was noticed, honever, that above and below 50 per cent the line was at a slightly different inclination and that a slightly curved line made a somewhat better fit, especially as it included the extreme upper values which were otherwise about 5 out This line will be referred to later as pg The Mauntius school series followed almost exactly the line PQ The line pq was ewdently in this case not so good a fit Mauritius Milne series plotted out with remarkable regularity along a line passing from P to a point beyond (about 75 P9"), but this line was a very distinctly curved one Plotting the points for S and Ae (which latter it wil bo remembered is the "average enlarged spleen" obtained by omitting negative children and only averaging actually enlarged spleen), very distinct linear graphs were obtained, but of a quite different character to those just now described Ae (SR C) for the Punjab series gives a line commencing at and ending above at 3 4e (Ross) commences below at 4 and ends above at 6 These lines correspond respectively to functions of Ae=01 5+2 and Ae= 02 S +4 The Alau ritius estates series follow almost identical lines depending * It has since been ascertained that graphs for d are always slightly curred those for Ad always linear ·93 upon whether the spleen values are estimated by (Ross) or (S R C) Heighting The Mauritius Milne series, Thich was peculiar in having a distinctly curved graph for A, shosed for Ae a linear graph re sembling those for the other Ae series, except that the upper end of the line passed more to the right, cutting the upper margin about 7 The graphs for de are much less diagonal than the othersin fact they surprise one at first by the way in which they pass almost directly up and down the field Significance of the Graphs for A and Ae That the graphs should be those of linear functions is peculiar and need not be further remarhed upon for the present It is first necessary to know what they signify in regard to actual facts connected with the spleen rate It will be observed that both the graphs for A start from the point P and not from the extreme corner (origin) This is because normal spleens being counted as the graphs at o per cent spleen rate are at I, noto Again, both my own and Rosss method of weighting results in graphs which are obviously related by a very simple function The graphs simply follow then the no tation ne have employed This must mean some extraordinarily regular relation between the spleen rate and the amount of enlargement of the organ, and this appears lo make it immalersal what alues ze gite for light ing so long as these are themselves in regular sequence. Whether Ross's method or the one adopted for the nonce by me, be used, the values arrived at can be conierted from one to the other with a stroke of the pen For the time 1 ·94 4 in the He may consider the graphs of A as showing that the "spleet; rate" and the "average spleen" are so closely related that they can be predicted one from the other To this subject we shall reſer later The graphs for Ae do not pass through P, but in each case they pass through either Oor O' They pass through 0 and because at 100 per cent A and Ae are the same, there are no negative children to be considered The small angle of the graphs for Ae signifies that the spleen composition, using this term to express the proportion of the different sized spleens at any particular percentage, does not vary very much The average size of enlarged spleens at o per cent spleen rate (supposing a theoretical case) would be 2 in the ( SRC) notation and (Ross) notation, it has only reached 3 and 6 respectively by the time 100 per cent is reached This stability of the spleen composition (even allowing as we shall see for the small number of groups that can be used to designate spleens of different sizes) is a very important character of the spleen rate It will be further dealt with in a later section, but before this is done it will be convenient to examine what I have defined above as the Splcen Composition The Spleen Composition If the proportion of different sized spleens at different percentages are studied, it will be found that in communities having a spleen rate below about 50 per cent the number of class II spleens is generally greater than that of class III, and that of class III than that of class IV But above about 60 per cent the proportional prevalence changes, so that class III spleen are now most numerous As joo per cent is approached there is a still further shifting of the centre of gravity, so to speak, towards class IV, but this class neser in my experience becomes sufficiently numerous actually to become the most prevalent ·95 If a large number of observations are plotted it soon becomes apparent that there is a law determining in a homo geneous community the splen composition for any given value of the spleen rate The proportions of the different classes in fact give what is evidently a rough picture of a frequency distribution for enlarged spleens of a quite regular nature Il percentages be marhed off as ordinates and divisions 1, 2, 3 etc, as abscissae, these latter may be alloned to indicate our classes as follows The first division will indicate the limit of normal spleen, the mark 3 the position of the mean of Rosss class II (valued at 3) The mark 6 will be the mean of Ross's class III (valued at 6) and the mark at 9 the mean of his fourth class valueu at 9 My fifth class, always comparatively small, will coine one may suppose at in It upon this scale, which gives an approximation to actual conditions, the spleen composition of a community having a spleen rate of say 80 per cent be plotted the resulting curve will be in form of a mound with its hy hest point at 6 and its concavity directed downwards At a spleen rate of about бо per cent this curre may give place to an almost straight diagonal line and at lover values of the spleen rate the curve has its concavity directed upnards Dealing with such a small number of classes as three or four, it is however evident that we get a very imperfect idea as to the nature of the real frequency curie Fortunately in the Punjab series the original observations were recorded in hine classes, and with this additional information it is possible to ascertain much more clearly shat the actual cune is Plotting the spleen composition as recorded in these nine classes it is seen that the change in the shape of the cuno previously referred to is more apparent than real The mode ·96 5 does not change from its position (about 3d along the base line) and the only change which takes place in the curve is an increased skewness as the loner values of spleen rate are approached The change compared to what one might have expected is quite inconsiderable Below 30 per cent it is difficult to follow the spleen com position as it becomes increasingly difficult to get sufficient data, and the possible effect of immigration from more malarious places and consequent interference with the natural spleen composition becomes increasingly great We knom, honever, from the graphs, supposing these to hold good so low down in the scale, that the average spleen at o per cent is (theoretically) 4, whereas it might, had all the spleens been within the limits of class II, have been 3 By a simple cal culation therefore, which we need not give here, it can be shown that the average of 4 necessitates a proportion of 66 per cent class II and 33 per cent class III, supposing there to be no spleens of still larger size The important point is that even at the very commencement of the appearance of enlarged spleens there should theoretically be a considerable proportion of the larger class spleens This is borne out by an examination of the observations giving low spleen rates among the Mauritius series Thus, between the spleen rates of 5 per cent and 15 per cent there are 3,494 children, and among these the spleen composition is 50 per cent, 36 per cent and 16 per cent for the classes II, III, and IV The spleen composition is therefore not noticeably different to what it is much higher up the scale The most striking feature of the spleen composition is therefore its comparative fixity There is, however, a pro gressive change moderate in degree as we pass from low to higher spleen rates, which ensures, so far as one can judge with the data at hand, a fixed composition for each spleet rate Though imperfectly worked out, there would appear ·97 may to be at the root of the spleen composition a general lar dependent on the fact that there is an almost fixed distribution curve for different sizes of spleen One consideration perhaps requires mention as its omis sion may lead to error This is that in calculating the spleen composition for a percentage one must not deal sith a mixture of communities under different conditions as regards malaria Thus, of 100 children from a community having a spleen rate ol go per cent were mixed with too children from a com munity with a spleen rate of o per cent, it is obvious that we should get a resulting spleen rate of 45 per cent but a spleen composition for a community at 90 per cent spleen rate This be a matter of practical importance, since a marhed discrepancy between the calculated composition and the actual may lead one to suspect this mixture Thus one might surmise that certain estates which in the Mauritius figures show a spleen rate of only about 40 per cent., but a composition corresponding to 75 per cent, contained mixed labour or were subject to much immigration either from healthier or more malarious localıtıcs Final conclusions regarding the nature of the spleen rate We can now summarise what we have learnt regarding the nature of the spleen rate We know that theoretically it 19 not necessary to determine the average spleen or the average enlarged spleen because oking to some underlying principle connected with the nature of the spleen rate these values are fixed for any given spleen percentage Also we know that if we do wish to make a spleen average it does not matter that standard of weighting se usc provided this is in itself regular The results are in terms of whatever standard me choose to employ We have reason to suppose that as soon as any enlarged spleens are present at all there is a spleen composition very similar to the spleen composition at ico per cent spleen rate ·98 The composition differs in fact only in that there is a comparatively small incremental change We can measure this increment as well as the effect due to what we may call the fundamental spleen composition At 100 per cent spleen rate Ae (Ross) is roughly 6, and by a well known property of the average the spleens of a hundred members of the communiy would reigh, in terms of a normal spleen, 600 Similarly at 0 (Ae being as shown on the graph 4) the spleens of a hundred members of the community would Heigh 400 This means that the fundamental spleen compo sition which is there from the beginning (as it nere) is responsible for 400, whilst the remaining 200 which has de veloped as a result of passing from o per cent to 100 per cent IS increment The increment ne may liken to a wedge land along the upper margin of a rectangle representing a populatron As the rectangle is encroached upon more and more by something which he may consider the presence of enlarged spleen, more and more of the wedge will be included Let us suppose that the encroachment has gone on to the extent of one half of the rectangle passing from right to left (this would represent 50 per cent enlarged spleens), then the thin end of the wedge sould be included up to one half its length With 80 per cent epleen rate se should have covered four fifths of the rectangle and four fifths of the wedge This increment can be calculated by simple graphical methods from the graph of Ae the amount of the 200 total increment for any given percentage of spleen rate (proportionate to the amount of wedge included) being on SxS Attempting to arrie by first principles at the essential nature of what has been discussed,' It seemed to me that the following conception as to the nature of the average spleen was of value The nature of the theory will be best demon strated by working out a specific instance ·99 Let us suppose the spleen rate to be 80 teps of the reasoning will be as follows - per cent Th There will be in a community of 100 pcople, 20 having normal spleens valued at I These twenty people will contribute to the total spleen composition in terms of a normal spleen There will be 80 people who having enlarged spleens must at any rate have their funda mental spleen enlargement. These will contribute 20 80 X 400 or 320 TOO 468 There is, however, the sacrement to go with this and being for 80 per cent this will be 03 X 80 X 80 or 128 The total mass of spleen in the community of 100 people will therefore be And the average spleen will be This is close to but rot cractly upon the line Spleen rates of 70% 60%, 50 etc, work out as 4 o8, 352, 3, 232, 208, etc, these being close to but not exactly on the line 468 From the above a formula can be deduced as follows 100 A=(100S) + (5 x 400) 100 + (02 S x S) or A=0.SPS + 100 TOO or A ( 02SH) (OIS + 1) If a curve be plotted from this function 1 will be found to fit the Mauritius estates graph very closely It was found to be in fact the line 99 ·100 As this hypothesis seems to reduce the facts regarding the spleen rate to very simple ones (the nature of the incre ment is still under study) the above formula may be considered for the time at any rate the function for the average spleen (Ross) On the same reasoning the average enlarged spleen yould be Ae= 45 + 02 S2 -= 02 S + 4 $ This, if plotted, gres a line lying along the previously described graph for de Practical applscation of the facts ascertained regarding the nature of the Spleen Rate That the spleen average can be calculated from the spleen rate is important in several ways is important because except for some special purpose it will probably be found unnecessary to take the trouble to record the size of the spleen and it is of importance because it gives us the opportunity to ascertain the meaning and significance of variations which occur in nature For instance when Major Ross at consider able trouble calculates the average spleen for Mauritius as 54, we could (given the spleen rate) say that the probable rate for this (34 i per cent ) sas on the straight graph 2 56 On the line pq it is 2 25, but this figure for a whole Island is not strictly an average spleen for this particular percentage, because it is obtained from a great admixture of communities But though these results make it reasonable to suppose that eventually re can in measuring malana quite disregard the size of the spleen, they also make it very desirable to investi gate for the time in more and more detail the different spleen values 5 ·101 To calculate the spleen average (Ross) from the spleen rate we may employ the formula for P9 re, (02 S+1) (or S+:) For use mith actuals te may put this formula in the form A= * +1 ŕ to Where n=the number of children with spleens and N the total number examined An interesting point may conclusion be brought forward, namely, what happens after the 100 per cent spleen rate limit has been rerched? This does not often happen in nature, and in the whole of the Mauntius figures there is only one example of an examination yielding 100 per cent spleen rate (spleen composition not given) lo my own series, I have one examination of 41 children from an extraordinarily malarious village who gave 100 per cent The values were A (Ross) =Ae (Ross)=6 5. A (SRC)=39 The calculated maxima are 6 and 3, but it must be remembered that our measure of percentages gives out at 100 per cent, whereas there is nothing to prevent a further increase of malarial intensity But by going back to the percentage from the aserage spleen we get the value 107 per cent We can thus continue our scale if necessary beyond the apparent limit of 100 per cent As the Mauritius series on which the above has been chiefly based are available elsen here, it is necessary only to five part of the data utilsed The most important are the following records of the nine classes of spleen rate from the Punjab senes The unchanging position of the mode is nell shown ·Spleep Janasi Delhi (un h althy wa ds ) Ova Bb ra v llages. OVER 90 + Actuals + co Pe centage CO 00 Palwal o Am tsar Hljare CO Bhera T WD O So-90 Amr tsat 1910 N Act als a Percentage proportio The figu es sa beavy type show them de of the que ce curve Dhatir N Guralı Nurpur 00 03-0! Actuals N Percentage propotion Mian Mr N 01-09 A Perceolage Gugrat y llages Percentage proportion Dbarema Blatua! 0-60, 2 e La 40-56 Actuals Us N Percentage proport om Nathuwala Gujrat towo hot momon UNDIR 40 Actuals | Percentage proportion TOI ·103 RECENT LITERATURE Mathis et Leger Paludisnic et Anophélınes dans la vallée de la Rivière claire de TugendQuang à Haglang Bull de la Soc de Path Exot T III No 9 page 6,2 Mathis et Leger La faune anophéltenne du Tonkın Bull de La Soc Med Chir de l'Indochine 13 November 1910 Mathis et Leger La faune anopheliènne du Tonkın dans ses rapports avec l'endemie palustre Ioid 8 January, 1911 from the western border of Baluchistan to the eastern limit of Burmah embraces nearly 40 degrees of longitude of about one ninth of the circumference of the globe It is to be expected therelore that oser and above differences due to varied physical and meteorological conditions lie should, in pas sing from the wcstern to the eastern extremities of the Indian Empire, meet with differences in the anopheline fauna due to the geographical distribution of different species In the Western portions of North India, N111 ross: A1 culicifacies N fuliginosus, Ne stephenst and C pulcherrima are the common species Less frequent species are My nigerrimus, Mly barbirostris N maculipalpis A furkhud: On or near the foot of the hills are found Ne villmort N maculatus, both very common, and rarely 11 liston At a higher level P! lindesayı Pi sımlensis and A barsanensis are met with In the United Provinces the fauna is not perceptibig different In Bengal, horcier, some changes occur Nm still at certain seasons the most common anopheles but N fuliginosus is most in cvidence throughout the y car il lesions is 1 common and in some parts the commonest aropheline al culicifacies is rare if present at all M1 niger Tin us is a common mosquito, and at the foot of the hills, in addition to the species already mentioncd as hill sprcies, N cobald: is found C Pulelenino, so far as is known, 15 not found so far east In Castern Bergal and Assam TOS51 15 ·104 In Burma prepon 111gerrinus is a very common species, and with N fuliginosus forms the bulk of specimens of anopheles sent to the Bureau from this province In Sylhet and Assam a common species Ck halli, not so far recorded from any other part of India, is met with derance of NI nigerrimus, to judge by collections sent to the Bureau, is again very marked 1 listone is still very common in soine localities at any rate The most marhed change that has come about in passing into Burmah is the appearance of a new species Nm ludlowz which resembles Nu rosse but has speckled legs True Nm rossi, however, still occurs as well as Ne stephensz These sery briefly are the chief features of the distribution of Anopheles as far as we know them in a broad belt across India from the Punjab to Burmah, and the foregoing remarks are our reason for considering in some detail the results of the excellent sorh of Mathis and Leger on the anophelines of Tonkin, a country which touches the eastern border of Burma and is about the same latitude as Calcutta Altogether Mathis and Leger have examined 8,625 anopheles caught in various parts of Tonkin In the Delta comprising the regions near Hanoi and the coast 3.383 anopheles were examined The commone.t species was Aly sinensis pseudo pictus (Wied) (60 per cent ), the next most common mas Nm rossz (33 per cent) N punctulatus (Donitz) formed 5 per cent of the whole and the remaining species which com prised P superpictus (Grassi) Aly barbirostıs, il tessalata (Theobald 1901), and it albırosiris, (Theobald) were each under i per cent N fuliginosus formed only 05 per cent In the Noyenne Region 461 anopheles were examined The species found and their relative prevalence as much as in the Delta, Mly sinensis eudopictus forming s9 per cent, Nm rossi 26 per cent, N penciulatus (Donitz) 11 per cent, and N fuliginosus only 5 per cent )

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·105 The district of haute Tonka vas examined in October in addition to species found in the Delta M and L found one new Alysonyra and five new species of Nyssorhynchus, namely, Il christophers: (liston2) Ne stephens: N phillipinensis, N james: Ne willmore, and a species resembling N mas teri Considering the haute Tonkın as a whole the 4,781 anopheles examined sere as follows - My pseudopictus 41 per cent, N fuliginosus 29 per cent, No rossi & per cent, N punctulatus 6 per cent, N masteri 4 per cent, My barbirostris 2 per cent and the remaining species under i per cent There are a number of points we may remark upon The species Mly sinensis pseudopicius (Wied) of the authors is evidently A1 S11101SIS (Wied)== !1 11gerrimus (James and Liston) of India and Burma Excluding Aly minutus and Mly 12gcrrimus (Giles) as doubtful species, there remain in the of species of llysorhynchus having banded palps and none of the tarsal segmerts white the following described pecies between shich there is, as will be seen, very little dis tinction - group Wing fringe with one pale spot Mly sinensis \Vied mann Wing fringe unspotted Wing with two yellos costal spots Aly vanus (Theobald) Wing without prominent spots 11y pseudopictus (Grassi) Indian specimens of Mly sinensis (Wied) show great varia tion in the wings, and such differences as those given above unsupported by other adequate differences must be of httle value It is interesting to note that there is no Alyzorhynchus at all described from the New World As in Burmah this species in Tonkin is evidently a dominant one

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·105 The district of haute Torku: pas examined in October In addition to species found in the Delta M and L found one new Mysomyia and fire new species of vyssorhyrchus namely, 4 christophers: (lestoni) le stephens N phillipistensis N james: Ne illmori, and a species resembling N mas der: Considering the haute Tonéin as a whole, the 4 781 anopheles examined we e as follows My pseudopictus 41 per cent N fuligiosus 29 per cent, Nm rosso & per cent, N punctulatus 6 por cent, N munstert 4 per cent, Mly barb rostris 3 per cent and the remaining species under i per cent There are a number of points ne may remark upon The species My sinensis pseudopictus (Wied) of the authors is evidently I SINENSIS (\Vied) = nsgerrimus (James and Liston) of India and Burma Excluding dly mindus and al rigorrimus (Giles) as doubtful species there reman in group of species of Aly orlynchus having banded palps and none of the tarsal segments shite the folloring described paces between which there is as #ill be seen, very little dis 112ction the Wing fringe with one pale spot Mly sinensis Wied mann Wing fringe unspotted Hling with two yellow costal spots ay anus (Theobald) Wing sithout propment spots als psendopictus (Grassi) Indian specimens of aly sinensis (Wied) show great varsa tion in the wings, and such differences as those given above unsupported by other adequate differences must be of little Falue It is interesting to note that there is no Ny-orhynchur at all described from the New World As in Burmah this species in Tonkın is evidently a dominant one.

·106 The next most striking feature of the anopheline fauna of Tonkin to the Indian sorher is the abundance of the species N functulatus (Donuz) which formed 511 per cent of all catches This species is given by Theobald as identical with his A tesselatum and later as a Cellia (C punctulota (Donits) If this is the species described by Mathis and Leger, it is not recorded at all from India It is difficult to feel much certainty about a species described under so many synonyms and finally only mentioned as a Cellia without any detailed description in the possession of eye spots and in the tips of the last tarsal segment being white, the species resem bles Ch halle (James), but sing markings and palps differ greatly The presence of al albırostris, the species like N masterı and N philipinensis, which are species not recorded from India, is also important, though it should not be forgotten that N phillipinensis is extremely close to N fuliginosus the presence of four palpal bands, in view of the frequency of this variation in India, being of little specific importance The existence of Nm rosst and A1 barbırostris might be expected, as these species are recorded from Malay, etc Ne stephense, Ne willmori, and N janese are evidently common to India and Tonkın Ne stephens, has been recorded also from the Phillipines, but Tonkin is the furthest eastern locality from which the two latter species have been recorded In regard to the relation of the anopheline fauna to malaria, the authors believe that shilst N christophers (listoni) N fulig 1110545, Ne stephens and 11 barbirostris are species transmitting malaria in nature, they are of opinion that in Ton hın Nm rosss, M1 albirostris dy pseudopictus, N punciula tus and N maculatus are not concerned in the spread of malaria A most important point is the doubt thrown on My pseudogectus (sinensis) as a carrier of malana in nature ·107 In their last note the authors give a synoptic table of the anopheles of Tonkin on the lines of James and Liston's table for Indian species Tonkın being so close to Burmah it is probable that workers in Burmah sll find it necessary to include the extra species mentioned above in their list of possible anophelines, and an indication of the position of these species in the Indian table may therefore be found of use Addition to James and Liston's table for Burmah- A–Wings unspotted No additions B Wings spotted 1 Palpı unbanded No additions 2 Palp with 4 white bands (including shite apex) 1 tessellata (Theobald) Celha punctulata (?) of Theobald, Vol IV, page 109, and Vol V, page 71 N punctulatus (Donitz) Wings much spotted None of hind tarsal segments pure white Eye spots on thorax N masters (?) Given as having 4 palpal bands The chief point noted by Thea bald for this species is that it is lihe stephenst, but has the terminal half of the proboscos (not palps) pale N phillipinensis Probably N fuliginosus with 4 bands on palps 3 Palpı with 3 white bands (including white apex) Tip of palps black No additions Tip of palps white ·108 (a) One or more hind tarsal segments pure white No additions (6) Tarsal joints banded but no segments pure white M albirostris Legs not speckled Terminal ball of the proboscis pale Tuo terminal bands on palps broad (In Nm rossi the second band 15 a narrow one) superpicius Near P jeyponensis but wong fringe upspotted (c) Tarsal joints unbanded No additions Howlett --The influence of temperature upon the boting of mosquitoes Parasitology, December 1910 The author has experimented with a view to find out what influences induce mosquitoes to "bite" Smell in the case of S scutellaris and C fatigans evidently played little or no part since they were not attracted by sweat, blood, etc Mio tion, form, and colour cannot be very important, as mosquitoes bite persons at rest and in the dark Very striking results were obtained, honeser, when the effect of temperature was tried Female S scutellaris and C fatigans enclosed 10 7 gauze bag were attracted by and attached a test tube filled with warm water and held near the bag No effect vas pro duced when the tube was filled with cold water, nor sere males attracted by the warm tube When the test tube tras held so that consection currents did not reach the mosquitoes they were much less actively stimulated The effect of radiant heat was therefore not so much concerned as Farm air currents set up by the heated body The same result in greater or lesser degree was obtained bath Nm rossi, N fult S ginosus, N scataphagoides, S gubernatoris and S thomsont did not react, but also could not be induced to feed on a bare arm The conclusions drawn by the author are (a) that sugens ·tog the bite of a mosquito is a reaction to the stimulus provided by a hot surface, (6) that the mosquito is attracted to the hot surface mainly by the warm air rising from it, (c) that the strength of the reaction may within certain limits be proportional to the excess of temperature of the warm surface over that of the surrounding air On this last conclusion Hon lett raises the interesting question whether mosquitoes bite when the air temperature is abose that of the body Howlett-On the collection and preservation of insects -- Ibid, page 485 Howlett recommends for insect store boxes the use of paraffin with 5 per cent napthalın melted and poured in a thin layer (1) over cork carpet (Suberit) previously painted white with a quicl drying enamel (Paripan) For collecting nets he uses Swiss Bolting silk For closing tubes or bottles containing formalın solution Howlett recommends a plug of plasticine pushed down until the liquid spurts up through a pinhole shich is made for the purpose and afterwards obliter ated by a wipe of the tumb Newstead and Carter - Description of a 110v genus and three new species of anopheizre mosqustous -Ann of Trop Med and Parasitology Vol IV No 3 page 377 The species Dactylomyra ceylonica is as its name signifies, from Ceylon The character on which the genus is founded is the presence of a pair of distinct and very pronounced tuber cles projecting obliquely from the prothoracic region The figure given suggests that these are the prothoracic lobes (Patagia), which in that case would appear to be very promi nent in this species The author places it near anopheles but up to the present that genus has not contained any brilliantly spotted species and the half white sciled proboscis, the broadly banded palps, the speci led legs and the many spotted wung veins bring it very close to Neomycomyia punctulata (James and Liston) ·110 The other species are Py cardamatısı and C cincta, the former from Athens, the latter from West Africa Ross and Thomson-Some enumerative studies on Mala rial Feder Annals of Trop Med and Parasitology Volume IV, No 3, page 267 Thomson A research into the production, life and death of crescents in malignant tertian malaria en treated and an treated cases by an enumeratize method Ibid. Vol V, No 1, page 57 These two papers represent a series of studies upon cases in which the enumerative method of Ross has been employed, the first being more or less preliminary in nature The results shon the great importance of this method of research, but it is surprising to see that the well known cycle of asexual para sites followed some days later by crescents is apparently put forward in the first paper as a new discovery And in this connexion it seems fair to drau attention to the work in India of Buchanan,* who, in 1902, published an account of the relation of the sexual forms (crescents) to the asexual cycle in malignant tertian feyer That crescents are not present during the early stage of an attacl, but appear many days later-often not until the feser has abated- Tyas, of course, known before Buchanan's paper was writ ten, but the interest of his work was that he investigated the subject very closely by means of counts In ail he described 14 cases in which daily counts sere made of differ ent forms of the parasıte during periods up to a month, and, See traosactions of the Malaria Conference held at Nagpur 1n Jacoary 190 page 33 ·til (just as is described in the more recent papers) the counts showed that the summit of the crescent curve occurs with con siderable regularity about ten days after that of the asexual forms associated with the fever The work had 1 further in terest, in that, in addition to counts of total crescents, the number of crescents which on any particular day became "spheres " was recorded It is well known that not all cres cents seen in the peripheral blood are equally prone to 'flagel late" and that while some retain their original form, others, in cluding those which eventually "flagellate," become spherical Major Buchanan showed by his counts that the extent to which crescents become spheres and in the case of male crescents, the number that "flagellate' depends upon the period at which the blood is drawn When crescents first appear in the peripheral blood they are apparently immature for only a few become spheres or flagellate later on 1 larger and larger number exhibit these changes And just as crescents reach a iniximum about ten days after the greatest prevalence of asexual forms, so the spheres are most numerous to or three days later still This relation was made very clear in the charts which Major Buchanan published and the charts also show that this observer although seldom quoted, has some claim to having employed a useful enumerative method a good many years ago The most important points brought out in the first paper by Ross and Thomson a e the decided correlation between the number of asexual parasites and the degree of fever, the non disappearance of as exual parasites in the interval between relapses, and the fact that a certain number (some hundreds per c mm) of parasites are necessary before fever is pro The authors lay stress upon the second point and are not in favour of Schaudinns theory of the causation of relapses by parthenogenesis such a theory being considered by them unnecessary and unsupported by their own results Some important observations in relation to crescents given in this duced ·112 paper are (a) that by no mean“ every asexual rise is followed by a sexual one, (6) that the number of crescents never er ceeded 5 per cert of asexual forms found in the generation (hypothetically) producing them The first statement opens up a particularly important subject in regard to the epidemi ology of malaria, and in she list of investigations proposed in PALUDISM will be seen one suggesting research upon the mflu ences, Thich, under different conditions of infection, etc, deter mine the output of gametes The researches upon crescents are more fully des eloped in the wecond paper by Thomson, which is one of the most impar tant contributions to the study of malaria made within recent years In all 42 cases of malignant tertian were studied in regard to the output of crescents 74 per cent of the cases showed crescents at some time or other , 26 per cent did not shew crescents at any time whilst they were under observation The number produced varied very greutly, some paroxysms being followed by as many as 7,000 per cm, Whilst in others the num ber was much smaller A very important relation between the number of crescents produced and the severity of the attack is noted by Thomson In eleyen acute cases in which the number of a sexual parasites has over 50,000 per om the percentage which produced crescents was 375, and taking the total numbers there was ore crescent to 535 asexual parasites In eleven sub acute cases the percentage which produced cres cents was 69 and there was one crescent to Si asexual parasites In twenty six mild chronic cases the percentage producing crescents was 69 and there fas one crescent to 52 asexual forms The mild and chronic cases had therefore a crescent producing power more than ten times greater than the very acute cases * See also the emark on pre 489 of an a ticle by Captain Smallmo RAM C, in the Journal of the Royal Army jedical Corps May 1912 ·113 Investigating when crescents are produced, the author finds that after a single paroxysm of fever there is a simple crescent curve reaching a maximum ten days after the maximum of asexual forms When the paro ysms of fever are more con tinuous, the crescent curve becomes drawn out into plateau form In one case in xíhich the patient had nine successive daily paroxysms of fever there were nine daily outbursts of crescents each occurring on the tenth day after the corre sponding fever paroxysms The author concludes therefore that each brood of crescents arises from a brood of asexual forms and that they tal e ten days for development Since very fer immature crescents were seen in these cases, Thomson thinks that the crescents undergo development in the internal organs, and that when fully grown they appear suddenly in the blood The prolonged continuance of crescents is not due to their long life but to the production of nen forms by surviving asexual parasites Quinine was found not to begin to act on crescents until it had been given for ten daysma very strong reason for believing that it does not act directly, but indirectly upon the asexual parasites which produce them Thomson believes that crescents are produced as an effect of the appearance of immunity in the host, and gives Seven reasons for this, viz , (1) the observations referred to above in which mild and chronic cases gave rise in a greater proportion of cases to crescents and to relatively greater number of these, (2) that paroxysms occurring early in the disease tend to produce less crescents than those which occur later, (3) patients who have had previous attachs develop more crescents than those suffering from first attachs, (4) that fewer crescents were produced in the case of young patients, (5) that a losy percentage of hæmoglobin is associated with a smaller output of crescents than a high percentage, the latter probably indicating according to Thomson a greater power to develop immunity, (6) that crescent production was greater in cases with enlargement of the spleen than in cases in which 1 ·114 there was no enlargement, (7) that the number of crescents varied directly with the number of leucocytes Having regard to this relation bet een crescents and im munity the author draws attention to the possible evil effect of small doses of quinine and relers to one of the cases in which quinine in small doses appeared to stimulate the forma tion of crescents Neiva -Formacao de racas do hæmatosoaria do impalud 35910 resistante a quinina Mem do InstOSIY Cruz, Vol II, fasc 1, April 1910 Reference in Bull de l'Inst, Pasteur, Vol VIII, No 20, 30th October 1910, page 894 Nocht and Werner-Bcobachtungen über relative Chinin resistens aus Brasilien Deut Med Woch, 25th August 1910, page 1557 In connection with a large engineering undertaking in which some 3,000 workmen were employed, a campaign was carried on against malaria by Chagas and Nena As the country was very swampy and intensely malarious, the only means of controlling the disease considered feasible was the prophy lactic use of quinine As a result of the measures, it was found that the workmen themselves sho were compelled to take quinine suffered but slightly, whereas the families of the workmen who refused to be treated were decimated by malaria The chief interest, honeter, of Neiva's results lies in the fact that they led him to believe that under certain circumstances strains of parasites could be developed, as a result of treating a community with quinine, which were resis tant to quinine The facts on which Neisa bases his conclu sions are as follons From February to September quinine prophylaxis on the whole was satisfactory and demonstrated a marked difference betireen the formen themselves and their families But in spite of this a certain number of men who were cahing quinine (5 gramme every third day) ·115 developed attacks of fever In October therefora the ame dose Bas given every other day This for a time was effectile and stopped all attaci s among men at work But in November malanta began to attack even men taking this amount and it was necessary to give the same dose daily in order to present attachs Without entering into the question as to the possibility of quinine resistant strains of parasite being formed in the way suggested by Neiva and Werner, one cannot help considering their interpretation of I envas experiences somewhat open to Criticism It has been the cxperience of those in India who have had to deal with Luropeans living 19 malarious districts that though a man after a time develapes an immunity (tolerance) to malaria of a certain severity he succumbs of the intensity of the infection he is exposed to for any reason is increased also that in order to meet a greater degree of malarial infec tion quite apart from any specific quinine resisting property of the parasite, it is necessary to increase the prophylactic dose of quinine Similarly, it is necessary to increase the dose where an increased ainount of exposure or fatigue is to be counteracted In the camp to which Neiva refers there was a rather Curious state of affairs , namely, worl men treated prophylactı cally with quinine and their families suffering sevcrely from There was no reason in fact why the amount of infection presailing should not have gone on increasing stendi ly as the work pogressed, and it would be quite in accord ance with experience (the workmen being subjected to more and more intense infection) for the amount of quinine at first effective to be insufficient later Again it is to bc noted that the prophylactic doses used at first were extremely small Even the highest dosage mala 13 ·116 employed (77 grains a day) is only very little above what experience in India has shown to be the least that in a mala rious tract could be expected to be effective Europeans liv ing in certain very malarious districts in India who practice personal prophylaxis tale 5 grains daily for years without the least evil effect, so that 73 grains a day is by no means a large dosage The difficulty in preventing relapses referred to by Werner has again to be carefully distinguished from difficulty in curing attacks, long standing cases of malaria may be resistant to treatment owing to some relation between the parasite and the tissues The possibility of the existence of strains of parasite resistant to quinine is a most important one that requires the most careful investigation and Neiva's observations, if not conclusive, are very suggestire The treatment of Malaria with 606 Nocht and Werner-Beobachtungen uber relative Chenin resistens ber Malaria aus Brasilien Deut Med Woch, 25th August 1910, No 34, page 1557 Werner-Das Ehrlich Hala Atlel 600 ber Malaria Deut Med Woch, 1910, 29th September, No 39, page 1792 Nicolle and Conseil Action du 606 sur le Paludisme Bull de la Soc Path Exot Vol III, No 10, page 708 Iversen Discussion at Konigsberg Deut Aled Woch, 1910, 13th October Werner - Uber die Behandlung der Alalar ta mit Ehrlich Hata 606 and uber Chinenresisten: bez Malaria Arch 1 Schiffs u Trop Hyg XV, No 5, 1911, page 141 ·117 The use of arsenical compounds in malara has been frequently tried In 1903 a number of communications were made on the use of Arrhenal, and later in 1907 and 1908, when Atoxyl was being extensively used in the treatment of try panosomiasis Koch and others found that this drug lad some effect upon the malaria parasite But beyond the fact that arsenic had not only a tonic and blood restoring effect but also some slight specific action on the parasite, no practical Tesult accrued in the treatment of malana In regard to treatment with 606 however there seeins Teason to believe that it mill take its place as one of the recognised effective means of controlling malaria when for some reason or another the usual methods of treatment with quinine are not applicable The early trials of 606 by Nocht and Werner gave consi derable promise, and the later more detailed observations of Nicolle and Conseil and of Werner have given us a very con siderable knon ledge of the action of this drug in malaria Werner's first cases were treated with intramuscular injec tion of the drug in alhalıne olution (method of Alt and Iversen), later intravenous injection and the combined method stere used He was able to say, as a result of these experiments that 606 acted much more effectively upon simple tertian than it did upon the tropical parasite A single dose administered by intramuscular or subcutaneous injection or the use of the combined method caused the schizonts and gametes of simple tertian malaria to disappear from the peripheral blood within from 12 to 48 hours In infections with the tropical parasite homever 606 was effective only in half the cases Nico'le and Conseil examined only six cases, but these were observed very closely and lept under observation for ·118 considerable periods They used small doses 3 to 4 gramme and had no accidents They came to the conclusion that the effect of 606 was very manifest and that its action was very rapid, producing immediate amelioratior of symptoms, a fall in the temperature, and 1 rapid reduction of the number of para sites in the peripheral blood But the action was in their experience neither durable nor complete, for though the parasites were greatly reduced in number, it was alnays possible to demonstrate, their presence if the examination was sufficiently searching, and whilst the temperature remained low for some days after the injection there was eventually in every case a relapse Nicolle and Conseil also noted that whilst the simple tertian large forms were very susceptible to the action of 606 the small rings rere less so and crescents not at all A still further contribution to the subject was made by Werner, who carefully s'udied the effect of 605 on the parasite in 7 cases His results with simple tertian were very satis factory, the temperature falling and the parasites disappearing usually within 24 hours and often within 12 hours Nor in these cises was there any recurn of intection whilst they were under obscrvation Werner's results with malignant tertian show houtver very clearly that in regard to tht forin of parasite there is not much to be expected from treatment with 606 In most cases there was a reduction in the number of parasites, but these did not entirely disappear in others no effect at all was produced Crescents were unaffected, and in txo cases the use of 606 did not present the appearance in dve course of crescents following upon an infection of trop cal rings The use of 606 in malaria would seem to be reserved for cases which are sery resistant to quinine or require an urgent melioration of symptoms ·119 Nicolle and Conor Applicatson d: 606 an traıiment du kala Asar Bull de la Soc Trop Exot T III, No 10, Decem ber 1910, page 717 Nicolle and Conor inoculated a dog by intraperitoneal injection with a strain of Leishmania which had for number of generations caused fatal results in dogs Nineteen days after inoculation the spleen was punctu ed and the presence of Leishmanta ascertained ; and 57 days after the injection the spleen nas again punctured and numerous parasites found Three days later the animal received intramuscularly? gramme of 606 Four days after the injection three effective punctures shon ed no parasites the same result was obtained on the 7th, Toth, and 14th day Post mortem the spleen was enlarged, but no parasites were to be found Shrodzlı - Arsenophenylglycine ber Hamoglobinurie Arch f Schiffs u Trop Hyst LIVE 2. 1910, page 707 Treated a case of Blackwater with arsenophenylglyzine The day after the administration there was no haemoglobin in the urine and the temperature fell Cazeneuve -L'hivernation des moustiques dans la Chue du Nord Bull de la Soc Path Erot, Table III, No 3 March 1910 page 155 Annett and Dutton have described the hibernation of adult anopheles , Galli Valerio and Narbel also James and Wright have described the hibernation of larva Caze neuve brings forward facts to show that in very extreme climates the preservation of the species may depend upon the eggs in May and October the climate of North China is hot and moist (27° to 23° C) and mosquitoes breed freely In December and January it may descend to a minimum of 32°C After the first of November C failed to find either adults or living larvæ To ascertain whether living eggs were ·120 present, the author removed blocks of ice from the frozen marsh water and kept these in flashs at a temperature of 6° C Six weeks later various forms of life were seen, amongst which were 8 anopheles larız, six of which died and tno of which even tually reached the adult stage The thaw appeared from the 15th March to 1st April On the 19th of April numerous anopheles larvæ, many of shich hatched out here captured Legendre -Sur la destruction des moustiques adultes a l'aide du filet a pap llons Bell de la Soc Path Isot T III, July 1910, page 457 Legendre Sur la destruction des culicines a l'arde dos gite prege Ibid, page 455 The author uses a net for capturing adults and employs artificial breeding places as traps for the destruction of mos quitoes in his hospital Malcolm Watson -A neu anopheline from the Federal cd Alalay States Annals of Trop Med and Parasit, Vol IV, No 2, page 251 Watson records a new anopheline, 11 aurirostris, from the Malay States It is a small bronn species with unband ed legs differing from previously described unbanded legged myzomyias in having four shite bands on the palps and the apical half of the proboscis golden scaled Gough-On a collection of Anopheles made at Onderste poort in the autumn of 1909 Report of the Govern Vetern Bacter for 1908 1909, Transvaal The species presiously knorn in the Transvaal niere P costalis, 11 funesta, both common forms in Tropical Africa, Panereus Parshalm P aureosquammiger, alg mauri franus (near dy paludis a common Tropical African form), N pretoriensis N maculipalpis (this is Theobald's maculi palpis differing slightly from James and Liston's maculpalgıs which Theobald calls N audiensis) and squamosa The ·121 author also records Nm ross the geographical distribution of which is usually considered as not extending so far Test To this list Gough adds all rhodesiensis N natalensis, 2 variety of 11 prelorı 12515 AI rufipes and two new species, C argentcolobata and C pretoriensis Isthmian Canal Commission Report of the Department of Sanitation for September 1910 Ref Jour R A MC, December 1910 Some remarks on habits of anopheles in connection with screened buildings Anopheles which have been hiding during the day in the protected rooms mahe numerous attempts to leave about 6 PM Mathis and Leger Bull de la Soc Path Exot, 1909. page 577 Mathis and Leger-Le paludisme au Tonkin Index endı mique pendant la saison frasche Ibsd T III, No 7, 13th July 1910, page 465 In the months of October 1909 (cold season) to March 1910 (hot season) inclusive, the anthors have examined the blood of 2,133 children of ages from one month to 15 years, 1 697 being under 5 years of age Great differences were found in the endemic indices of different areas On the coast land and Delta the index was very low, being practically o per cent In the valley of the Riviere Rouge the rate was higher, 12 per cent, whilst in the valley of the Riviere Claire and Riviere Noire it was very high, being 22 per cent and 29 per cent respectively In the North West Frontier district the rate was low-4 per cent Beineen the rate in the cold season and that in the hot season there was not much difference Talen collectively, the rate nas 7 33 per cent in the hot weather and 583 per cent in the cold ·122 The spleen rates are not given, but it is possible that the coast area would come under the definition of a healthy area (spleen rate under 5 per cent ), whilst it is pretty certain that the valleys of the Riviere Claire and Rsdiere Noire would be included as hyper endemic (over 50 per cent) Vide note on page 25 ) Analysing the results with reference to age, Mathis and Leger found that among children of 1 month to 5 years 5 83 were infected and among children 5–15 years 665 per cent Thereis thus no distinct difference in the parasite rate at different ages The matter is an important one as, if this here not the case, grave difficulties would be introduced in obtaining an index, it being obvious that if infection varied greatly with age, one's result in any given case would be dependent very largely on the proportion of children of different ages in the sample In regard to the type of parasite present at different ages, the authors found that in infants under 1 year the percen tage proportion of the different parasites was simple tertian 50 per cent, malignant tertian 333 per cent and quartan 166 per cent Taking children in two groups, namely, those of from 1 month to 5 years of age and those of from 5–15 years, the percentage of simple tertian was seen to diminish with age from 52 4 per cent in the first group to 13 per cent in the second Quartan was about the same in the cold sveather in the two groups, but malignant tertian was twice as frequent in the second group, 77 6 per cent as it was among the younger children, 303 During the hot weather both groups had an equal proportion of malignant tertian (30 per cent), but the proportion of quartan was doubled for children under 5 Among indigenous adults admitted to hospital on account of fever Mathis and Leger found the proportions for simple tertian, quartan, and malignant tertian to be in the cold TIeather 8 per cent, 11 per cent and 79 per cent respectively, and in the hot weather 15 per cent, 25 per cent and 58 per ·123 ceat respectively Thus there is always a great preponder of malignant tertian among indigenous adults suffering fr fever Calvocoressi - Die malaria inter den lekka pole Zeit fur Hyg f 1, 28th October 1910 The author has examined Mekka pilgrims as they pass station at Tor in the Red Sea He has met with many ca of malana, mostly relapses The proportion of the differ parasites has been malignant tertian 71 9 per cent, simple tian 24 per cent, quartan 35 per cent, and mixed inaligr tertian 3 per cent Janni Policlinico Rome December 1910, Ref 3 Amer Med Assoc , 21st January 1911, page 231 Janni has examined over 2,000 temporary or permar inhabitants of endımıc foci of malaria He found parasite 53 of 146 persons free from the slightest indication of mala disease (vide PALUDISY, No 2, page 111 ) When no para: were found at a first examination Janni administered a th peutic dose of strichnine In many cases within 30 tc minutes parasites appeared in the peripheral blood Sorel Le paludisme a la cote d'Ivoirc Bull de la S Path Erot IV, No 2, page 108 Sorel has investigated the endemic index on the le coast The total number of cluidren examined wa 988 the percentage infected 45 In children from 1-5 years of age the parasites were fo in 56 per cent , in children 15 years of age in 38 per ce and in children over 15 years in 43 per cent The most quent parasites found were quartan and malignant tertu simple tertian was rather rare In one locality conditions - unfavourable to the breeding of anopheles and the au believes that such as were present Kere largely imported ·124 Trincas - Il valore del l'indice splenomegalico nel Pepidem sologia della malaria Policlinico Sezione pratica Fasc 27 1 Ref in Arch f Schiff u Trop Hyg XV 9 Trincas has studied the splenic index in 309 children in its relation to age, sex, economic condition of the parents, dietary and type of fever present He concludes that splenic enlarge ment is most frequent and greatest at the age of 1-5 years, in the female, in the poor, and in the badly nounshed The type of fever most concerned is given as quotidian, possibly a clinical definition He believes that the significance of splenic enlargement is chronicity of infection, and thinks that the intensity of epidemic condition has nothing to do with the amount of splenic enlargement Muhlens-Uber einheimische Malaria quartana Deut Med Woch 43, 1910, page 1948 States that quartan is very rare in NW Germany, but records two cases the origin of which was obscure W M James Quartan malaria and its parasite --Pro ceedings of the Canal Zone Med Soc, Vol III, April September 1910 A record and description of the quartan parasite --James states that quartan parasites are not commonly encountered in the Canal Zone Typical quartan paroxysms of ferer even in cases showing the parasite are scarcely ever seen In addition to a minute description of the schizonts, the author gives some valuable information regarding quartan gametes As quartan is a form of malaria very liable to relapses, the author has studied the question of parthenogenesis In both tertian and quartan all the forms described by Schaudion were seen, but only when asexual forms there also present All degrees of atypical sporulation between a normal segment ing form and the so called segmenting macrogamete were also ·125 seen, but the author found it impossible to say whether 'parthenogenetic " forms were atypical schizonts or sporulat ing macrogametes James describes a peculiar form of the parasite which is distinct from either the schizont or the gamete Brem Clinical studies of malaria in the White Race - Archives of Internal Medicine Chicago Ref Jour Amer Med Assoc In the l'hite Fever Wards of Ancon Hospital during 1903 and 1906 out of a total of 1,300 patients 1,107 were admitted for malaria In 705 or 637 per cent of these parasites ere found, the proportion of the different species being aestivo autumnal 63 4 per cent , tertain 32 9 per cent No quartan parasites Bere encountered Mixed infections were found in 3 7 per cent of cases showing parasites Three systems of quinine administration (curative) were tested vis , (1) 30 grains daily in three doses of ro grs at 68, and 10 AM , () from 30 to 40 grains given in 5 grain doses every four hours , (3) 20 grains daily in two doses of lo grains The febrile period was approximately equal under systems (1) and (2), it was much longer under system (3) Of the three methods the first was on the whole preferred LOR --The duration of infection of malaria - Jour of Trop Med, 15th November 1910, page 342 The author records the history of W, the second volun teer, bitten by infected anopheles brought from Italy by Los and Sambon The initial attack was in September 1900 There were several relapses in the course of the next two years and parasites (benign tertian) were found at the time of a relapse in 1903 Lom refers also to the case of PM, the other volunteer, who had an attack nine months after the initial attack, though this tras followed by three months' quinine treatment and calls attention to the difficulty of determining the recovery rate in untreated cases ·126 Urriola --Ref Lancet, 28th January 1911, page a 52 Urriola states that malarial infection can be ascertained even when parasites are not found in the blood by the detec tion of malarial pigment in the urine A sample of unne carefully collected is centrifugalised and the sediment ex amined The pigment may occur in clusters or in hyaline casts, etc Prolonged search is sometimes required The possibility of the detection of malarial pigment under the circumstances seems rather doubtful, but the correctness of the contention might easily be put to the test in severe cases of undoubted malaria Deaderick - Recurrences 112 malarsa Bull de la Soc Path Exot T III, No 8, October 1910, page 498 Sums up briefly different views as to the causes of long relapses The theories to explain the phenomenon of long relapses are given as three-(1) feeble schizogonic reproduc tion in the spleen and elsewhere, (2) intracorpuscular con jugation with the formation of a zygote stage or resting body, (3) pasthenogenesis The author inclines to the last theory We may draw attention in this connection to the work of James at Panama (vide reference in present number of this journal), in which he refers to the impossibility of deciding with certainty between ordinary or atypical sporulation and sporulating "gametes” It should not be forgotten that ordinary sporulating benign tertian parasites often show some delay in the splitting up of the chromatin, and experience teaches one to be rather careful in making a confident diag nosis of such forms The impression gathered from a number of references to gametes is that more experience would have caused the writer to define his diagnostic signs more care fully If one tahes as a definition of a macrogamete merely what one considers to be a full grown form in which the chromatın does not show signs of division, one will have ample opportunity of seeing such associated with sporulation ·127 Donzello --Campaign against Malaria in Sicily Policlinic Rome, February 1911 Reference Jour Amer Med Assoc, April 1911, page 1013 As people in the selected area were debilitated from repeated infections, the campaign was kept up throughout the winter in the hope of effecting a permanent cure In spite of this, malaria recurred in s 7 per cent The general condition of the people was, however, much better than it had been and the spleens were materially reduced in size Preventive treat ment in the preceding summer was given to 33,387 people, six grains being given every second day No cases of pernicious malaria occurred whilst only 26 per cent among the agricul turists and 13 per cent among miners had attacks There was no mortality The results were thrown into bright relief by contrast with the prevalence of fever among the people outside the treated area Ross, Thomson and Simpson -A case of Blackwater fever followed by a peculiar relapse without haemoglobinuria or detectable plasmodia Ann of Trop Med and Paras stology, Vol IV, No 3, page 307 The authors record a case of blackwater fever in which the attack supervened whilst a daily count of parasites was in progress No parasites were seen during the blackwater or during a second attack of fever following this, but unasso ciated with baemaglobinuria, nor were any other forms of parasite seen As previously noted by Christophers and Bentley, the amount of haemoglobin passed calculated in terms of actual blood represented is very small But the authors' conclusion that haemoglobinuria is a small overflow of the freed haemoglobin which the liver has not been able to deal with is rather misleading and scarcely does justice to recent researches on this disease Both Christophers and Bentley and Barrett and York show distinctly that haemoglobinuria occurs as a consequence of the existence of even a trace of ·126 Urriola --Rel Lancet, 28th January 1913, page 2 53 Urriola states that malarial infection can be ascertained even when parasites are not found in the blood by the detec tion of malarial pigment in the urine A sample of urine carefully collected is centrifugalised and the sediment ex amined The pigment may occur in clusters or in hyaline casts, etc Prolonged search is sometimes required The possibility of the detection of malarial pigment under the circumstances seems rather doubtful, but the correctness of the contention might easily be put to the test in severe cases of undoubted malaria Deaderick --Recurrences in malaria Bull de la Soc Path Exot T III, No 8, October 1910, page 498 Sums up briefly different views as to the causes of long relapses The theories to explain the phenomenon of long relapses are given as three-(1) feeble schizogonic reproduc tron in the spleen and elsewhere, (2) intracorpuscular con jugation with the formation of a zygote stage or resting body, (3) parthenogenesis The author inclines to the last theory We may draw attention in this connection to the work of James at Panama (vide reference in present number of this journal), in which he refers to the impossibility of deciding with certainty bettyeen ordinary or atypical sporulation and sporulating "gametes" It should not be forgotten that ordinary sporulating benign tertian parasites often show some delay in the splitting up of the chromatin, and cxperience teaches one to be rather careful in making a confident diag nosis of such forms The impression gathered from a number of references to gametes is that more experience would have caused the writer to define his diagnostic signs more care fully If one tahes as a definition of a macrogamete, merely what one considers to be a full grown form in which the chromatın does not show signs of division, one will have ample opportunity of seeing such associated with sporulation ·127 Donzello --Campaign against Malaria in Sicily Policlinic Rome February 1911 Reference Jour Amer Med Assoc, April 1911, page 1013 As people in the selected area were debilitated from repeated infections, the campaign has kept up throughout the winter in the hope of effecting a permanent cure In spite of this malaria recurred in 5 7 per cent The general condition of the people was, however, much better than it had been and the spleens were materially reduced in size Preventive treat ment in the preceding summer was given to 33,387 people, six grains being given every second day No cases of pernicious malaria occurred whilst only 26 per cent among the agricul turists and 13 per cent among miners had attacks There was no mortality The results were thrown into bright relief by contrast with the prevalence of fever among the people outside the treated area Ross, Thomson and Simpson - A case of Blackwater fever followed by a peculiar relapse without haemoglobinuria or detectable plasmodia Ann of Trop Med and Paras itology, Vol IV, No 3, page 307 The authors record a case of black water fever in which the attack superi ened whilst a daily count of parasites was in progress No parasites were seen during the blacknater or during a second attack of fever following this, but unasso ciated with haemaglobinuria, nor were any other forms of parasite seen As previously noted by Chnstophers and Bentley, the amount of haemoglobin passed calculated in terms of actual blood represented is very small But the authors' conclusion that haemoglobinuria is a small overflow of the freed haemoglobin shich the liver has not been able to deal with is rather misleading and scarcely does justice to recent researches on this disease Both Christophers and Bentley and Barrett and York show distinctly that haemoglobinuria occurs as a consequence of the existence of even a trace of ·128 free haemoglobin in the blood It is not, as was formerly supposed (and as the wording of the authors' conclusion would seem to indicate), only when a great excess of haemoglobin 19 present that haemoglobinura occurs, (vide the next article) Simpson-On Haemoglobin metabolism 19 Malarial Fever Ann of Trop Med and Parasitology, Vol IV, No 3, page 313 The author draws attention to the importance of estimat ing the faecal urobilin as well as that present in the urine if one wishes to arrive at the total output of this derivatne of haemoglobin The method employed to estimate the urinary urobilin was to determine the dilution at which the spectrum of urobilin just became invisible when the solution was ex amined in a layer 15 mm thick This was then compared with standardised solutions of pure urobilin In the case of faeces the urobilin was extracted by shaking with large amounts of water acidulated with sulphuric acid After exposure to day light for some time the amount of urobilin was then estimated by the same method as that employed for urine In cases of simple tertian malaria the author finds no increase of urobilin excretion beyond that to be expected from the amount of febrile disturbance present In malignant tertian the urobilin excreted is much in excess of this In Blackwater fever the amount, considering both urine and faeces, is enormous and equal in the particular case examined to the equivalent of the total blood haemoglobin in stating that the normal channels are capable of dealing with free haemoglobin, the author says that a severe strain, equal to 25 per cent of the total circulat ing haemoglobin, can be sustained without causing haemoglobinuria This must surely be an error, for Barrett and York give up to only 25 per cent of the red cells or a mere trace of haemoglobinaemia This latter determination is in fact tantamount to saying that a very slight degree of solution of the red cells in the peripheral blood leads to haemoglobin ·199 aemja-a conclusion in accord with actual observations on Blackwater fever cases in which haemoglobinaemia however slight, is associated with haemoglobinuria Manceaux Sur la technique de culture des Leishmania Bull Soc Path Exot Vol IV, P 286 The following medium for the cultivation of Leishmania is recommended Distilled water 900 grammes Agar agar 14 Sodium chloride 6 Rabbits blood i part to 3 parts of agar agar The following is the method of preparing the medium Macerate the agar agar in a cristalliser containing distilled water After five or six hours change the water and after 24 hours drain it off Then to the melted agır agar add sufficient distilled water to make the weight 914 grammes Then add 6 grammes of sodum chloride Dissolve, filter and pour from 3 to 5 cc into each test tube Sterilise Remelt the medium and after allowing it to cool to 53°C to 55°C add the required quantity of rabbit's blood obtained aseptically from the heart incline the tubes and the next day test their sterility by incu bation The parasites develop best at a temperature of 20 to ga°C C Accr + In OGOP Sale - SC-918-11-CAC

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