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spleen; and the average size of the spleen of these children was 178 times the normal size. These are fairly high figures, but by no means excessive. For example, in Mauritius in 1908 the spleen rate of 31,000 children was 341 per cent.; whereas the average spleen was 2.54 times the normal size. From these figures we can infer with a very high degree of probability that the Cyprian malaria is much less in amount than the Mauritian malaria.
It will be seen from Dr. Cleveland's census (Appendix VI.) that the rates differ largely according to district and also accord- ing to localities. They are the highest in the Larnaca and Limassol districts and lowest in the Nicosia district. In several of the villages the spleen-rate reaches 100 per cent, of the children actually examined, and the average spleen reaches more than five times the normal size. Some of the figures, however, show certain discrepancies which suggest that the rates were not taken quite accurately a thing which is not to be wondered at in this first attempt at a general spleen census, Major Christopher, I.M.S., has shown the existence of a mathematical law governing the two rates, namely, that the average size of spleen bears a constant ratio to the spleen-rate. Exceptions to this law are found occasionally in the tables of Appendices V. and VI., suggesting that there has been some error. But these details will doubtless be rectified on a subsequent trial. In the meantime, the tables given form an extremely useful evidence of the amount of malaria, not only throughout the Island or in each district, but, what is still more important, in each village examined.
Appendix V. contains some spleen-rates obtained by myself in association with Dr. Cleveland, Dr. Patrick, and Mr. Francis. My examinations were made at random in various parts of the Island, mostly in the schools. They show a spleen-rate of 25:4 per cent. and an average spleen of 167. These figures agree fairly closely with Dr. Cleveland's, but, of course, I examined nuch fewer children (1,016), so that the statistical error is very much greater.
The enlargement of the spleen recorded in these figures may be taken with certainty to be almost entirely due to malaria. No kala-azar has yet been found in the Island; and nothing which I saw there led me to suppose that it was present. My investiga- tions of kala-azar made in Assam in 1898 furnished me with a very clear clinical picture in that terrible disease. The children which I saw both in Mauritius and in Cyprus did not accord with that clinical picture.. But, what is more definite, the death rate among the children in these countries does not suggest the presence of kala-azar in any way. Of course, a very small pro- portion of the enlarged spleens may be due to some other causes than malaria; but this proportion is certain to be always so small that it cannot affect the total figures to any appreciable extent.
The general appearance of the children and the villagers in Cyprus did not lead me to suppose that the malaria there is intense as a general rule. At a few spots with high spleen-rates both the children and the people looked nickly, but as a rule they appeared much more robust than the Indian population of Mauritius, or indeed than the Greek population of Moulki, in
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Greece, or than many villages which I examined years ago in India.
On the whole, therefore, I conclude that the mularin of Cyprus
is of medium degree. It is much less intense as a whole than that of Mauritius or than that of many isolated localities, even in Cyprus. On the other hand, a general spleen-rate of over 20 per cent. is by no means to be ignored.
We must remember that these spleen-rates were taken at quite the least malarious time of the year, that is just before the com mencement of the malaria season of 1913. I have no doubt that at the end of the present year there will be a very much larger spleen-rate throughout the Island. We must remember that the Mauritian spleen-rates were taken in the middle of the malaria season of that Island.
Another point to be remembered is that the amount of malaria varies from year to year. During epidemic years, as clearly shown in parts of India, it may reach twice and thrice the intensity that it reaches in non-epidemic years. Last year was by no means an epidemic year in Cyprus, so that the figures now given may be taken to represent a very normal state of affairs. Lastly, there are facts to suggest that malaria tends to increase in many localities with increasing civilization, irrigation, and so on. A spleen-rate of 20 per cent. must always, therefore, be lobked upon as a public danger, as we never know what it may not develop into at a later date.
It is known from many researches in various parts of the workl that the disease has a great influence upon the total death-rate, apart from the actual deaths directly due to it, which can be put down as amounting nearly to about 0'5 per cent. of the total cases. Thus, wherever the spleen-rate is high the death-rate is high. It is not possible at present to determine exactly the influence exerted by malaria upon the total death-rate in Cyprus, because the death registration is not sufficiently exact to give the figures; but by analogy we must infer that it is considerable. that it causes a large infantile mortality, and that it tends thus to keep down the population, and, therefore, the prosperity, of the whole Island. When the sanitary organization proposed by me has been in working for some time the exact figures will doubtless emerge from the statistics, and Government will be better able to calculate the mischief caused by the disease.
8. Mosquito Breeding during March to April.-As stated in Section 2, one of my principal reasons for visiting Cyprus so early in the year was to ascertain the exact date when the anophelines commenced to breed there. For a week after my arrival I failed to find any anopheline larve anywhere, even in a small but very suitable marsh just outside the walls of Nicosia, in the gardens at Larnaca, in the Government farm at Athalassa, and in certain waters at Kythrea; and it was not until the 27th March that we discovered. larvæ in the first mentioned marsh. Other waters at Deftera, Dikomo, Ortakq, and in the Kerynia district, though suitable, proved negative; as also the waters in the large Mesaoria reservoirs examined by us on the 2nd and 3rd April. But we found considerable numbers of large anopheline larvæ in the village marsh.at Akhyritou on the 3rd April and, next
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