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which attention should be turned, and the proposed organization will then be able to study their local conditions.

10. Relations between Malaria and Breeding Surface in Cyprus. That such a relation exists has, been known to the world since the time of Empedocles of Sicily, that is, since 500 B.C.

The relation was worked out numerically by Major Fowler and myself in Mauritius in 1908 in the Clairfond marsh, where we showed definitely that the spleen-rate of the villagers diminishes decisively and rapidly the further the people live from the pools of water. Subsequently Major Robertson, 1.M.S., made some excellent similar studies in India showing how the disease diminishes directly with the distance from the breeding area. My observations in Cyprus simply confirm the same law. Wherever the malaria rate is high, there we may expect a large local breeding surface.

It will of course be understood that by breeding surface I do not mean any water or even any stagnant water. I mean water which breeds the local carriers. Here as elsewhere that water is generally more or less stagnaut, and generally contains a certain amount of fiue, green, floculent water weed and other shelter for the larve, and is not open to fish, or subject to quick desiccation or scouring out.. A place may possess much water and even much stagnant water, without possessing much breeding. surface. For instance, at Kythrea there is very much water, but, as I have said, not much breeding surface (Section 9 (1)).

Wells occur all over the Island and may or may not be asso- ciated with high spleen-rates. I think that the explanation is that they supply only a few anophelines as a ruly, perhaps enough to cause a low spleen-rate of something up to 10 per cent. Where the spleen-rate rises above this, I have always found some additional breeding surface in the close neighbourhood. This is important, because the wells are often very troublesome to deal with. More exact information will be obtained upon this point in the course of future studies; but I think that the broad lines can be accepted as pretty certain. I should add here that malaria has now been studied so much that I have been able to construct a mathematical equation containing most of the factors im- plicated in the spread of it-this equation has been accepted by good mathematicians and enables us very definitely to allot its proper quantitive force to each separate factor (Prevention of Malaria, Second Edition). I may therefore now proceed, without further analysis, to proposals for prevention.

III. THE PREVENTION OF MALARIA IN CYPRUS.

11. Methods which may be used.—These are:-

(1) The use of mosquito nets, wire gauze to windows, culici- fuges, &c. This is chiefly applicable to public buildings, such as barracks, prisons, railway stations, hospitals, &c.; but it is very difficult to apply to the mass of the people, especially in poor villages, where the houses are often so constructed that it would be more expensive to apply wire gauze to them than to rebuild them entirely. Mosquito nets will seldom be employed by the poor, and culicifuges are never very satsfactory.

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(2) Quinine. If every case of malaria is treated completely with quinine, the malaria parasites throughout a locality will be destroyed, and the mosquitoes will therefore be innocuous however numerous they may be. But a complete quinine treatment re- quires for an adult an administration of something like five hundred grains of quinine altogether, given in varying doses ordered by medical inen and taken with the utmost regularity. The method has now been tried all through Italy, Greece, and in many parts of America and India, and the results have often proved disappointing because of the difficulty of getting people to take the drug properly. This difficulty is experienced even with soldiers and much more, therefore, with the poor populace, especially the children (who are the principal carriers of malaria). (3) Mosquito Reduction.-This consist principally in draining away the breeding waters of anophelines, or in so treating them that the larvæ are killed. The destruction of the winged insects has also been advocated. The method can only be done properly by the local Public Health authorities, who have to find the money for the treatment of the breeding waters. The cost varies largely according to the nature and the amount of the local breeding surface.

The advantages and disadvantages of these several methods have now been discussed throughout the world during the last fifteen years. Probably each method by itself would completely stamp out malaria if it could only be absolutely thoroughly employed-which is seldom, if ever the case. It generally happens, therefore, that we employ two or more of the methods partially and simultaneously. In Panama all the methods have been employed together with the greatest possible success; but in most localities those methods which are easiest under the local circumstances are those which have been selected. The question is what are the best arrangements which will cost the least money and cause the greatest reduction of malaria; and I understand that it is my principal duty to advise upon this point for Cyprus.

All the methods have their defects and their advantages. Mosquito nets and wire gauze are most suitable for public institu- tions and for the wealthier and more intelligent inhabitants. They should always be recommended; but, as already stated, it will be almost impossible to enforce them upon the general populace.

Quinine will never be taken in sufficient doses by the general population; and D. Thomson, working under my direction, suggests that an insufficient dosage is likely if anything to increase the sexual forms of the parasite, that is, those which are engaged in their transmission. Many recent disappointments with this method have occurred; for instance, I may refer to the remarks of the Director-General of the Indian Medical Service, at the last meeting of the General Malaria Committee of India, held at Madras on the 18th November, 1912, in which he mentions these disappointments. On the other hand, the method lays the responsibility of malaria reduction almost entirely on the people themselves, and thus saves the authorities much trouble. For example, the Government of Greece has done little more thau