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Malaria control through anti-mosquito measures in Italy
107
CORRESPONDENCE. MALARIA C O N T R O L T H R O U G H A N T I - M O S Q U I T O IN ITALY.
MEASURES
To the Editor, TRANSACTIONS Of' the Royal Society of Tropical Medicine and Hygiene. SIR, I regret that I was not able to be present when Dr. L. W. HACKETTread his paper to the Society on the 21st February, 1929, v but I saw the draft of it in advance and think that it showed a genuine desire on the part of the author to further anti-malaria work in Italy and elsewhere. It is the study of a practical man who tries to fit his measures to his opportunities, and who is to be greatly complimented on undertaking a task the necessity for which is not always clear to the people of these islands who are so fortunate as to live in a country where malaria is very scarce ; I wish him every success in the future. But I was not so greatly impressed with the discussion which followed. I doubt whether the work of Dr. LOGAN TAYLOR and myself in Freetown was quite correctly described. We went there only with the view of giving an object-lesson on mosquito control, and discontinued the work when our funds were exhausted, and when it became clear that there was much opposition towards our effort and indeed towards the whole mosquito theory of malaria, which at that time was scarcely credited in British Colonies. Moreover the work of GORGAS in Havana was then progressing satisfactorily. Still further I did not feel myself called upon to spend more time than I did for work which was not properly mine as a teacher of tropical medicine in Liverpool. But we did a great deal with our money. Dr. C. W. DANIELS, Superintendent of the London School of Tropical Medicine, reported favourably on our efforts so far as they had been carried out. T h e work was really a part of the duties of the local authorities and might have been commenced several years previously. These TRANSACTIONS,Vol. xxii, p. 477.
108
CORRESPONDENCE.
'The expense of it, omitting necessary salaries (I took none), was by no means great, and amounted only to a little over £1,000 for more than a year's work, and for a town of over 30,000 inhabitants. The question of what are cheap or what are expensive measures is a comparative one, and depends principally on the question of what is the cost of the disease. Counting invalidings, sick-leave, treatment, drugs, etc., the cost of the disease was at that time probably much greater than the sum expended by us ; yet this item in the balance-sheet seems to be entirely omitted from the said discussion. This is a mistake frequently made. Our administrators often cavil at a few pounds spent on the prevention of disease when they do not hesitate to spend hundreds of pounds on the consequences of disease. Yet a wise sanitarian regards such a balance-sheet as his first duty. There was no blow to practical anti-malaria work in this expedition of ours as stated, but there was a serious blow to practical sanitary administration. A correct b u t sufficiently ample account of this affair is given in my little book Studies on Malaria, 1928. W h e n we talk of cheap anti-malarial measures and compare them with each other, we often forget that whether paraffin or Paris green be used is not of m u c h consequence in our expenditure ; what cost money are chiefly (1) capable administration, and (2) labour for distribution or works. It may cost just as much to distribute Paris green as to distribute paraffin. Probably each has its proper application ; and both are only minor measures in towns. Another doubtful point in the discussion seems to be that regarding Mian Mir, which in my opinion was a futile experiment badly conducted and proving nothing at all to a scientific mind (see m y paper in the Lancet, 5th November, 1910), e A third questionable point concerns the efficacy of plasmoquine. Before this can be looked upon as a sound substitute for quinine, it must be shown to be not only equal in value to quinine, but its superior (see B.M.J., 2nd July, 1921). No one in this discussion seems to have thought of the mathematical studies of KARL PEARSON and myself on Random Migration. Probably few doctors are even such humble mathematicians as 'myself, but I wish they were so, for probably malaria-control would in that case have been more easily understood and might have advanced further in the thirty years during which it has been talked about, if not really tried. Dr. HACKETT himself has replied to most of the other points which arose in the discussion. Yours faithfully, RONALD ROSS,
Director in Chief, Ross Institute and Hospital for Tropical Diseases. Putney Heath, London, S.W.15. 2nd May, 1929. e I shall be glad to send an off-print on application.
CORRESPONDENCE. MALARIA C O N T R O L T H R O U G H A N T I - M O S Q U I T O IN ITALY.
MEASURES
To the Editor, TRANSACTIONS Of' the Royal Society of Tropical Medicine and Hygiene. SIR, I regret that I was not able to be present when Dr. L. W. HACKETTread his paper to the Society on the 21st February, 1929, v but I saw the draft of it in advance and think that it showed a genuine desire on the part of the author to further anti-malaria work in Italy and elsewhere. It is the study of a practical man who tries to fit his measures to his opportunities, and who is to be greatly complimented on undertaking a task the necessity for which is not always clear to the people of these islands who are so fortunate as to live in a country where malaria is very scarce ; I wish him every success in the future. But I was not so greatly impressed with the discussion which followed. I doubt whether the work of Dr. LOGAN TAYLOR and myself in Freetown was quite correctly described. We went there only with the view of giving an object-lesson on mosquito control, and discontinued the work when our funds were exhausted, and when it became clear that there was much opposition towards our effort and indeed towards the whole mosquito theory of malaria, which at that time was scarcely credited in British Colonies. Moreover the work of GORGAS in Havana was then progressing satisfactorily. Still further I did not feel myself called upon to spend more time than I did for work which was not properly mine as a teacher of tropical medicine in Liverpool. But we did a great deal with our money. Dr. C. W. DANIELS, Superintendent of the London School of Tropical Medicine, reported favourably on our efforts so far as they had been carried out. T h e work was really a part of the duties of the local authorities and might have been commenced several years previously. These TRANSACTIONS,Vol. xxii, p. 477.
108
CORRESPONDENCE.
'The expense of it, omitting necessary salaries (I took none), was by no means great, and amounted only to a little over £1,000 for more than a year's work, and for a town of over 30,000 inhabitants. The question of what are cheap or what are expensive measures is a comparative one, and depends principally on the question of what is the cost of the disease. Counting invalidings, sick-leave, treatment, drugs, etc., the cost of the disease was at that time probably much greater than the sum expended by us ; yet this item in the balance-sheet seems to be entirely omitted from the said discussion. This is a mistake frequently made. Our administrators often cavil at a few pounds spent on the prevention of disease when they do not hesitate to spend hundreds of pounds on the consequences of disease. Yet a wise sanitarian regards such a balance-sheet as his first duty. There was no blow to practical anti-malaria work in this expedition of ours as stated, but there was a serious blow to practical sanitary administration. A correct b u t sufficiently ample account of this affair is given in my little book Studies on Malaria, 1928. W h e n we talk of cheap anti-malarial measures and compare them with each other, we often forget that whether paraffin or Paris green be used is not of m u c h consequence in our expenditure ; what cost money are chiefly (1) capable administration, and (2) labour for distribution or works. It may cost just as much to distribute Paris green as to distribute paraffin. Probably each has its proper application ; and both are only minor measures in towns. Another doubtful point in the discussion seems to be that regarding Mian Mir, which in my opinion was a futile experiment badly conducted and proving nothing at all to a scientific mind (see m y paper in the Lancet, 5th November, 1910), e A third questionable point concerns the efficacy of plasmoquine. Before this can be looked upon as a sound substitute for quinine, it must be shown to be not only equal in value to quinine, but its superior (see B.M.J., 2nd July, 1921). No one in this discussion seems to have thought of the mathematical studies of KARL PEARSON and myself on Random Migration. Probably few doctors are even such humble mathematicians as 'myself, but I wish they were so, for probably malaria-control would in that case have been more easily understood and might have advanced further in the thirty years during which it has been talked about, if not really tried. Dr. HACKETT himself has replied to most of the other points which arose in the discussion. Yours faithfully, RONALD ROSS,
Director in Chief, Ross Institute and Hospital for Tropical Diseases. Putney Heath, London, S.W.15. 2nd May, 1929. e I shall be glad to send an off-print on application.