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PUBLIC RECORD OFFICE

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23 PUBLIC RECORD OFFICE, LONDON

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Island. His experiences, called "A Report on Malaria in Cyprus," and dated the 3rd April, 1903, were published in a Colonial Report and re-published in The Selections from Colonial Medical Reports," clated July, 1904, No: 27. This forms an admirable monograph on the whole subject of malaria in Cyprus. The author begins with some remarks on the mosquitoes of Cyprus especially the Anopheles maculipennis. He states that in the months of January and February there were a few culicines In March a but no anophelines, and no larva of either group. very few anophelines towards the end of the mouth. In April a few anophelines and more plentiful culicines. In May a great majority of anophelines over culicines. In June and July, the same as for May. In August, fewer mosquitoes, but culicines and anophelines both common. In September, October, November still fewer mosquitoes, and culicines and anophelines present in about equal numbers. In December, a few culicines and extremely few anophelines. Thus he found anophelines commonest in May, June and July, and absent in December, January and February. He observed also that anophelines do not seem to bite much until May is well advanced; but he states that he found no anopheline larvæ until the beginning of May, and not after the beginning of November; but in the next sentence he remarks that the auophelines begin to hatch out in the end of March or in April-which scarcely agrees with his previous state- ment. The insects hibernate from November in houses and stables. He found the larva in newly-made shallow wells; in borrow pits; and in clean puddles. But they were absent in certain reservoirs near the Kouklia marsh; in the ordinary deep wells sunk for the domestic water supply of villages; in small receptacles; in large channels; in domestic water tanks containing fish; and in the salt lakes. Other details given by him agree with the usual observations. Regarding the effect of rain, he remarks that rain falling during the winter gradually evaporates and is absorbed during the heat of the summer; but if there are late spring rains (end of March, April and May) then there is a longer time for the existence of pools suitable for the breeding of mosquitoes, and, in effect, these pools will be found swarming with mosquito larvæ later on. He adds that heavy rain in the end of October and November will have an excellent effect in scouring out the pools, while the temperature, being below that required for the breeding of mosquitoes, does not allow of these pools again becoming, for that year, a breeding place. He gives an excellent table showing the cases of malaria admitted to the Larnaca Hospital during the twenty years 1882-1901. These numbered 10,076, or about five hundred a year on an average. The distribution of cases shows that they were fewest in February and March, and most numerous in August, when they were more than five times as numerous as in March. This is the common monthly distribution of malaria in the south of Europe. He also gives an excellent chart comparing the malaria prevalence with the rain- fall and the temperature. He notes the great resemblance of the Cyprus statistics with those of Italy; and observes that the period of greatest malarial incidence is also the one during which the temperature is over 70° Fahrenheit. He again emphasises the

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effect of the spring and autumn rains on malaria, the former causing it and the latter checking it. Dr. Williamson's figures are so large that I think his results must be accepted as being statistically sound. Coming to the microscopic examination of the blood, he succeeded in finding the parasites of malaria in 470 out of 503 cases which were diagnosed as being due to malaria; so that he actually succeeded in detecting the parasites in 94-4 per cent. of his cases--a very good result. The different species of parasites found by him in these cases were as follows:-

Per cent.

Tertian

48-47

Quartan

8:03

Estivo Autumnal (malignant)

43.50

100.00

He also gives a table showing the seasonal prevalence of each species, from which it appears that the cases of tertian commence first in July and those of malignant later in September, whereas the quartan enses do not show so much variation (possibly owing to their small numbers). Passing on to the study of the pre- vention of malaria he repeats the principles generally laid down. He corresponded with me on the subject and quotes a passage from one of my letters-though of course, as I had not seen the Island at that time I could only form my opinion very in- sufficiently from the data. Partly as the result of my letter he concluded that mosquito reduction was not much called for; but he emphasised the usefulness of fish as the destroyers of larvæ and the utility of mosquito nets and of quinine and malaria education. He also urged that every encouragement should be given to the Muktars of the villages to dispense small doses of For the treatment by quinine he quinine to the villagers. advocates a dosage which would now be thought to be too small and not sufficiently continued. His monograph is one of the best ones written at that time on the subject; but, of course, sub- sequent investigations have modified some of the smaller details since then.

On my arrival in Cyprus in March, 1913, Dr. Cleveland, the Chief Medical Officer, showed me some excellent preparations of malaria blood, made by him so that it is evident that the medical staff of the Island have been fully able to use this method of diagnosis.

On 19th January, 1909, a Commission which was appointed to enquire into the working of the irrigation reservoirs in the Mesaoria submitted its report to the Chief Secretary of Govern- ment. It appears that the large irrigation reservoirs which had been made since 1897 in the eastern part of the Mesaoria bad called for investigation, partly on agricultural grounds and partly because some of the neighbouring villagers complained that they increased the malaria. The Commission, of which Dr. G. A. Williamson was a member, carefully considered the latter question in detail; concluded that the reservoirs did not have much effect; and suggested various remedies. They also