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(b) More British institutes for research in the Tropics, say, at least two others, so that each great group of Tropical colonies might have the required facilities.
6. The eastern group of Tropical Colonies is already well supplied by the Research Institute at Kwala Lumpur, and the provision of laboratories with good bacteriologists in Ceylon, Singapore and Hong Kong.
In Africa there is no corresponding Institute, nor is there in the West Indies. Such Institutes need not be so costly as the one provided by the Federated Malay States, and the expenses would be considerably reduced if at the places chosen ice and gas were procurable.
-7. The financial difficulties are not great for the eastern group, as these Colonies contribute to the Teaching Schools, and have, in addition, founded, main- tained and endowed the Research Institute and Laboratories. In West Africa, now that the West African Medical Services are amalgamated, a Central Research Institute, say at Sekondi or Lagos, would be easily arranged, and as the diseases to be studied are in the main the same as those in Uganda, East Africa and Central Africa, a contribution to the cost could be fairly claimed from these Protectorates.
In the group including the West Indies. Trinidad or British Guiana would be the best place for such an Institute, as the material is abundant. The financial difficulties could, be surmounted by contributions from the various Colonies aided, if necessary, from Imperial funds or by contributions from a central fund.
8. Many difficulties would be avoided if the authorities at the Colonial Office could see their way to the formation of a special Colonial or Imperial Service for the work of such institutes, paid either from a general fund or by contributions from a group of Colonies. The members of this would then, wherever stationed or employed, retain continuity of service, whilst a wider and more practical experience would be gained by the members of this service. Such a service could be recruited from members of the Medical Services of the Colonies, directly from the Schools of Tropical Medicine or elsewhere, and members of the service might, if necessary. be lent to the teaching staff of a school, and paid by that school or employed in the rare cases where an expedition or commission was really required. Members of such a service would, for administrative purposes, be necessarily considered 'as belonging to the service of the Colony in which they were employed.
9. As these tropical teaching schools, research institutes and expeditions are of general service the funds should be in part, Imperial. In the case of the Army and Navy the funds are provided by the British Government. In the case of the Colonies they must, I presume, necessarily be provided mainly by the Colonies, and the expenditure would be regulated by the Colonial Office. A central fund would probably be necessary to subsidise the tropical schools in proportion to the numbers regularly attending to pay for the rare expeditions which may still be required: to subsidise an institute or laboratory when sufficient funds cannot be raised locally: to pay, if the plan adopted for the R.A.M.C. Advisory Board is followed, the members of the Advisory Board.
10. If more advice is required than that of the Medical Adviser to the Colonies, an Advisory Board or Committee is suggested. I venture to point out that in an Advisory Board on medical subjects the majority should be medical men, and in the suggested board only two of the members out of a minimum of five, or more probably seven, are necessarily medical men, and that nó provision is made for the representa- tion of the Medical Services of the Colonies. Such a constitution of an Advisory Board is in marked contrast to the Advisory Board for the R.A.M.C., and to what is usual in Advisory Boards on other professional matters. A Sanitary Engineer would be a most valuable additional member.
I may add that the plans suggested are more in accordance with the practice in India and in the Army, and with that which is being adopted by America in Cuba and Manila.
The Resident-General,
Federated Malay States.
I have, &c..
C. W. DANIELs, Director, Institute for Medical Research, Federated Malay States.
SIR,
"
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BRITISH MEDICAL JOURNAL," June 6, 1903.
The Extermination of Mosquitoes in Sierra Leone.
HAVING been absent on a tour in the Protectorate for some weeks, my atten- tion has only recently been drawn to an annotation the "British Medical Journal' of January 17th, entitled, "The Extermination of the Mosquitoes in Sierra Leone," and as the report from which the extracts were made has, as usual, been sent to the lay papers, and contains one or two misleading statements, I trust you will give this correction the same publicity.
Dr. Taylor states that "since the men of the expedition stopped clearing up yards and emptying out the water containing Culex larvæ, no one else has taken up the work; that, in fact, the rubbish is beginning to accumulate as before; several Europeans were complaining to me of being much annoyed by Culex and Stegomyia," and that "this means that unless the Government and the school will keep on the work, the money the school has spent on it will be almost thrown away.' These statements are so inaccurate that I beg to protest against them.
The removal of refuse from the town is carried on now, as it has been for some years, by the sanitary department of the municipality. The town is divided into six districts, which are under the charge of a sergeant, and assistant sergeant, and eight sanitary constables, who regularly visit every yard in the town, and serve notices on all whose yards are found in an insanitary condition. When the notices are not complied with within a certain number of days, summonses are taken out against the defaulters, and, I may remark, that in 1902, while the Liverpool Expedi- tion was actually at work, it was found necessary to issue 4,155 notices. Especial notice is given to the removal of tin pans and other receptacles capable of breeding larvæ, and any vessels containing larvæ are at once emptied. In a new Sanitary Bill, which will be introduced shortly, a clause will be inserted making provision for the compulsory covering of all vessels containing water, and making it a punish- able offence to have vessels containing larvæ in the yard, which, I trust, will become law.
}
At present the law places upon the householder the duty of keeping his yard clean and depositing all rubbish in shoots on the shore or in dustbins, from which it is removed by the sanitary carts, and hundreds of loads are removed monthly in this way.
The native is by no means easy to deal with, and as the Liverpool Expedi- tion actually sent labourers into the yards to clean them, naturally they were very pleased to have the work done free of expense, and the result has been that in several instances lately there has been some difficulty in getting the work done, owing to this very fact. No doubt dirty yards will be found in town at any time, as in any English town, but this is due to the rapid accumulation of rubbish, which always takes place in a tropical country, owing to luxuriant vegetation, &c. (a fact which Dr. Taylor appears to have overlooked), but I venture to state that Freetown at the present moment will compare very favourably from a sanitary point of view with the great majority of tropical towns. Just now, well on in the dry season, the town is practically both Anopheles and Culex free, but within the next three months, when the rains begin, I will undertake to demonstrate the presence of Anopheles in any part of the town, and this will continue to be the case until the system of permanent surface drainage, which I advocated so long ago as 1896, and which is now being carried out by His Excellency the Governor, Sir Charles King-Harman, is completed.
The East Coast of Africa owes a great debt of gratitude to Major Ross and to the Liverpool School of Tropical Medicine for the energy which they have thrówn into the campaign against malaria, and which has resulted in attention being drawn to the need of sustained efforts and the necessity for the expenditure of money for sanitary purposes, but, as regards the actual improvement which is said to have been effected in Freetown, up to the present, as shown by the native death-rate and the fever-rate in Europeans, the results are imperceptible, and it is only to be expected that it should be so. In a city with the physical configuration of Freetown, and an annual rainfall of about 160 inches, the inprovement in the health of the town is not to be effected in eighteen months by scratching a few shallow mud drains, oiling a few puddles, or removing a few empty tin pans, but by the system of permanent surface drainage to which I have referred, and by attention to the general sanita- tion of the city, such as the closure of cesspits, &c. Dr. Taylor would be surprised if he were to hear the outspoken comments of the Europeans and the medical profes-