PUBLIC RECORD OFFICE
Reference :-
C.O._885
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23 PUBLIC RECORD OFFICE, LONDON
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issue good Government quinine at a low price, thus practically telling the people to save themselves if they can; and it actually makes a profit from such sales, but I doubt whether this is sufficient to make more than a very partial reduction of the malaria. For example, in the village of Moulki in Greece, which I examined in 1906 before such sale of quinine, and again this year after my visit to Cyprus, 1 found that the spleen-rate had fallen from 55 per cent. to 28 per cent. ; but here in addition to the quinine the breeding pools round the village had been kept carefully oiled by a British company, so that the reduction cannot all be fairly attributed to the quinine. Moreover, such reduction is often more apparent than real; the people get slightly less fever and less enlargement of the spleen, but large numbers of them still remain infected and sickly. Probably a thorough quinine treatment can only be carried out by an extremely large staff of doctors and dispensers residing more or less permanently in each group of villages, examining the inhabitants very fre- quently, and insisting upon their taking the drug properly. In the end this would be much more expensive than mosquito reduction, especially if we remember that the salary of a single medical man is often as great as the payment of from twenty to fifty of such workmen as are usually employed in treating breed- ing waters. And, as the villages could never support such an expense, most of it would in the end fall on Government.
As already stated, the cost of mosquito reduction falls almost entirely upon the Government; but this has the advantage that it enables Government to do the work almost without reference to the public because the large majority of breeding pools and anophelines occur in the roads and the fields and not in private premises. Moreover, no rational person objects to the reduction of mosquitoes, which saves him much annoyance as well as much sickness; while the reduction of every species of mosquitoes besides anophelines tends to reduce other maladies. This method has also the very great advantage that it compels the authorities to keep a strict sanitary watch upon the whole of the area under them.
The vost and applicability of all the measures depends also upon other circumstances, namely:-
(1) The existence of a capable sanitary department;
(2) The state of education of the local sanitary and medical
officers;
(3) The intelligence and education of the people.
Where all these are unsatisfactory, as in most parts of the world, the auti-malarial measures are much more difficult.
12. The Suitability of Cyprus for a large Anti-Malaria Cam- paign.—I must remark in the first place that something has already been done in Cyprus to educate the people. Excellent instructions, published by Dr. Williamson, have been issued and widely circulated in the suitable languages, and a good primer of hygiene by the Chief Medical Officer printed in 1909. Arrangements have also been made to enable the muktars to give quinine on furnishing certain statements regarding the necessity of doing so. Hence, during my visit I found that the people of
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Cyprus were already quite cognisant of the fact that mosquitoes carried malaria-though, of course, they do not always believe it. Moreover, I must confess that I found them to adopt an extremely intelligent attitude on the question-much more so than I have always found even amongst English people in various parts of the world. We always conversed with the priests and school- masters and others in the villages as much as time would allow, and found them quite ready to help any strong lead in the direction of malaria prevention.
It is now recognised that special instruction in tropical medicine and sanitation is almost indispensable for medical practice in warm countries. The Chief Medical Officer of Cyprus holds the Cambridge diploma, and, as already stated, Dr. Williamson obtained the Liverpool one. Several other Medical Officers of Cyprus have attended the schools; but I am informed that the majority have not done so, and indeed find a difficulty in doing so, because the teaching in England is in a language which they do not speak.
Regarding a sanitary department, I must confess that Cyprus can scarcely claim to have one at present. It is true that the Medical Officers are held to have sanitary as well as medical duties, but this is not nearly sufficient. A busy medical man who is superintending, or actually carrying out, clinical work cannot possibly carry out the sauitury work of a large district as well. There must be sufficient numbers of sanitary inspectors, a good Public Health Act, sufficient funds for sanitary work, and, above all, a sufficient labour force for such work throughout the towns and villages. Sanitary work demands brain, eyes, and hands; but at present Cyprus possesses only the brains-that is, the capacity to do sanitary work, if only the proper inspectors and the proper labour could be provided.
Coming now to the question: which of the possible measure is most applicable to Cyprus, we must consider the following points:As stated in Section 10, the breeding of anophelines in Cyprus practically lasts only during the months of April and Moreover, May, and occurs in comparatively small waters. except in a few small, abolutely flat areas, the ground is much sloped in a manner which renders drainage easier. Both these circumstances together are strongly in favour of mosquito reduc- tion for the Island. In fact, after having examined many parts of India and West Africa, the Panama Canal zone, Egypt, Mauritius and Greece, as well as Cyprus, I think that the only country which lends itself better to mosquito reduction than Cyprus is Ismailia, in Egypt, and perhaps one or two very arid tracts in India. The absence of rainfall during the warm months of the year is a most valuable asset. Things are quite different in Panama or Sierra Leone, for example, where there are torrential If, therefore, rains during the whole of the breeding season, mosquitoes can be reduced in such places as this the process should be much easier in Cyprus.
On the other hand, quinine distribution is just as difficult in Cyprus as it is anywhere else, this difficulty depending upon the natural unwillingness of the people in Cyprus and elsewhere to take an unpleasant medicine for the rest of their lives.
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