was a wet year, fever was prevalent amongst the native popula-
tion, and, in consequence, the figure again rose, in spite of all
efforts to diminish it.
INDIA.
APPROXIMATE STRENGTH OF BRITISH TROOPS, 70,000.
Malarial Incidence.
Year.
Admissions.
Deaths.
Invalids,
1898.
28,382
50
485
1899.
16,579
36
246
1 900.
19,445
62
190
1901.
18,217
35
418
1902.
15,367
45
245
1903.
17,037
35
244
1904.
12,112
23
259
1905.
7,947
10
126
1906.
12,601
22
136
1907.
10,662
15
274
1908.
16,763
35
62
6i] STATISTICS 603
It should be noted that since 1903 a large number of men,
averaging from 4,000 to 5,000 each year, are treated in barracks.
Amongst the native army of India malaria is also very
prevalent. During the last ten years the average strength of
these troops has been 124,523, of whom 34,074 have been each
year admitted to hospital, to say nothing of those treated in
barracks and not coming on the returns.
Having thus briefly outlined the incidence of malaria at
some of the various stations of British troops, there is now to
be considered what means of prevention can best be employed
to counteract such serious losses. In the first place, it must
be presumed, when formulating any means of prevention, that
readers are believers in the part played by the mosquito in the
transference, spread and maintenance of the malarial parasite,
and have absolute faith in the formula of " No mosquitos, no
malaria." It would appear mere waste of words to make such
a statement at the present day, were it not that experience
has shown how even now there are people, including members
of the medical profession, who still retain doubts of the mosquito
being the sole carrier of the malarial parasite. All recom-
mendations here made will be based entirely on the proved
facts of malarial transference by the aid of certain varieties
of Anophelines.
In formulating the measures of prevention most applicable
to troops, it must always be remembered that the soldier cannot
be thought of in his position as a unit only ; there also has
to be taken into consideration the inhabitant of the country
in which the soldier is residing. It may be stated, as a general
axiom, that if the native suffers from a certain disease, it will
almost necessarily follow that, unless extraordinary precautions
are taken, the soldier will inevitably suffer from a like com-
plaint. The soldier is largely dependent for his health on
that of the community around him.
Therefore it comes to this in many cases, that to check
malaria amongst the troops it will be necessary at the same
6o4 PREVENTION OF MALARIA AMONG TROOPS [Sect.
time to lessen it amongst the surrounding inhabitants. Thus
the question can be seen to be a much wider one than would
at first appear.
Preventive measures may be divided into : —
1. General measures of prevention.
2. Personal measures of prevention.
I. The general measures of prevention are such as will
be undertaken by the State, Local Government, or Community
at large. As a rule they involve a considerable expenditure
of capital, as well as a large amount of thought, trouble and
probable legislation by those in power. For these reasons
obvious means of cutting short malarial incidence have been
on more than one occasion allowed to lapse, or only very in-
adequately provided for by Local Government officials. Failure
must necessarily follow ; and though the authorities may
endeavour to make a scape-goat of the means recommended,
the blame lies entirely at their own door.
In other instances financial considerations alone must block
the way to improvement ; and in certain of our colonies it is
a question for serious debate whether the necessary funds should
not be provided temporarily by the Imperial Exchequer. It
is heart-breaking to look on the results of malarial havoc,
knowing at the same time that this could be controlled, were
power and money employed to the best advantage ; and yet
neither can be obtained.
These general measures can be dealt with but briefly in
this section, but reference must be made to them as affecting
the population surrounding the troops, on whose health the
latter are so largely dependent.
At the present time there are two schools of opinion. One
relies mainly on the destruction of the larval mosquito ; the
other, believing that such a desideratum is without the range
of possibility, affirm that quinine dosage forms the mainstay
of prevention.
The first school, relying chiefly on larval destruction, looks
6i] MEASURES 605
upon quinine as a valuable aid certainly, but not to be placed
upon the same footing as the destruction of the primary agent,
except in certain cases where larval destruction is almost hope-
less. The second school base their preventive measures primarily
on quinine dosage, and hold that if the malarial parasite is
prevented from remaining in the human blood-stream by the
administration of quinine, then it is impossible for the mosquito
to become infected.
In every country where malaria is present there is some
diversity of opinion on which of these methods chief reliance
should be placed. This matter will be dealt with fully in
other sections, so that no further reference will be made to
it here, save to mention, as a general statement, that in the
majority of our possessions larval destruction is the one of
primary importance and trial.
A. The General Measures may therefore be cited as
follows : —
(i) Larval destruction.
(2) Segregation of the soldier.
(3) General quinine treatment.
(i). Larval destruction, under this heading, means the
elimination of all spots where the Anophelines may find a home
or a suitable breeding-place, from which it can reach barracks,
cantonments or other sites where troops may be quartered.
The question at once arises : What is the probable or possible
flight of one of these insects? A reply of fact and not of
theory it is impossible to furnish. Some years ago many
authorities would have judged the probable limit of flight at
a few hundred yards, but facts have arisen since then, showing
that mosquitos under favourable climatic conditions can and
will travel several thousands of yards from their breeding-place
to their feeding-ground. To lay down a precise distance of
safety is quite impossible, but a reasonable limit, within which
no breeding-spot should be allowed around barracks, may be
6o6 PREVENTION OF MALARIA AMONG TROOPS [Sect.
quoted at 2,000 yards or thereabouts. Now many of our
barracks abroad are built on small plots of ground belonging
to the War Department, but the land closely adjoining may
be quite without their jurisdiction ; the consequence being that
the Military Authorities have no power to enforce the abate-
ment of evils existing on the ground of neighbouring tenants.
At the present day no barracks should be built in the
tropics or sub-tropics on ground which does not include the
control of an area of 2,000 yards' radius from it as the centre
of a circle. Unless this plan is carried out the troops occupy-
ing the barracks must of necessity be exposed to all dangers
arising from a neglected condition of the surrounding area, as
well as the risk of being infected with other diseases from
which the inhabitants living on this ground may be suffering.
Many examples of barracks situated in this faulty position
might be quoted from our Colonial garrisons.
When the State or War Department owns or controls
the land around barracks, it is incumbent upon them to place
this ground in such a condition that it shall not act as a
breeding-spot for mosquitos.
If such a land is not their property, and is forming a favour-
able source of origin for Anophelines, it is essential that the
ground should be purchased, in order to gain complete control
over it. The purchase may involve great expense, but this
would probably soon be covered by the saving effected in the
improved sick-rate of the troops.
(2). Segregation of the soldier. — This has been referred to
under the previous heading. It may be stated fairly con-
clusively that the wider the separation of the soldier from the
native inhabitants the better will be his health. The barracks
that have been carelessly placed in the midst of native towns,
or that have become encroached upon and surrounded by
native houses, will show a far heavier incidence of disease than
barracks standing in isolated positions. The reservoir of the
malarial parasite is to be found chiefly in the children of the
6i] CANTONMENTS 607
native inhabitants. An infected village with a high spleen
rate amongst its children will contaminate any camp or settle-
ment within a wide distance of its site. Such a condition of
things exists in numbers of our garrisons abroad.
Take the case of so many of our Indian stations. The
barracks may have originally been placed at a reasonable
distance from the native town, but a bazaar has been allowed
to grow up alongside them for the use of servants and others
serving on or trading with the troops. Many of these Sudder
Bazaars contain several thousands of inhabitants. Malaria or
any other disease from which they may suffer must inevitably
spread to the troops.
Again, within the Indian cantonment, until quite recently
the native was allowed to grow any sort of crop, and to do
practically whatever he wished with the ground rented. The
consequence was, and still is, in some places, that rice fields
existed within quite a short distance of barracks, to say nothing
of other crops requiring an abundance of moisture, which so
generally means neglected ditches and the formation of small
marshes. The outcry against the continuance of such a state
of things has often been raised, but is invariably met by the
answer that if such crops are done away with, the cantonment
funds would disappear and financial ruin ensue. It is the duty
of the State to insist on an abatement of such dangers; and if
in any case its continuance cannot be stopped, then the troops
should be moved and the station evacuated. Until the State
can appreciate the enormous losses involved by the sickness of
our soldiers from malaria and its sequelae, it is almost hopeless
to expect works to be taken in hand, which must appear to the
authorities to involve a large expenditure of capital without any
evident financial return.
(3). General quinine treatment. — By this is meant quinine
treatment of the general population of the country in districts
around the location of troops. This lies outside the measures
to be undertaken by the Military Authority, who would only
6o8 PREVENTION OF MALARIA AMONG TROOPS [Sect.
be in a position to advise and not insist on such a campaign
of defence. It would mean action on the lines of the Italian
school, and will be fully dealt with in another section. The
military forces would benefit very greatly, as the chief source
of their contamination, namely, the native children, would be
brought under treatment, and their capability of spreading the
parasite by acting as reservoirs materially lessened.
B. Personal Meastires of prevention must now be considered.
These are such as can be carried out by units themselves and
will involve no great initial expense, as is so often the case with
the general measures.
The various means employed may be enumerated as
follows : —
(i) The attack on Anopheline larvae in their breeding spots.
(2) The defence against the adult Anopheline.
(3) The segregation of malarial patients, and their protec-
tion from the Anopheline mosquito.
(4) Segregation from the native.
(5) The administration of quinine.
(i). It is one of the first duties of an officer commanding
a barrack or cantonment to see that the same is kept in a
clean and sanitary condition. It must also be the duty of
this officer to see that the place under his control in a malarious
country is in such a state that mosquitos will be unable to find
any breeding spots on its area. If he does not himself under-
stand or appreciate the hygienic importance of this order,
he must be compelled to do so by a higher authority, and
be made to accept the advice of experts who have made a
special study of the subject.
The attack on mosquito larvae can best be carried out
by the formation of " mosquito brigades," or " working gangs,"
consisting of men especially trained to such work. These
men may be either soldiers or natives of the country. It
6i] MOSQUITO REDUCTION 609
is not considered that the former are suitable for these duties.
Soldiers are wont to despise such employment, and think it
beneath their dignity to carry it out. In addition, there is
always the likelihood of their being continually changed and
taken for other duties, just at a time perhaps when their services
are most urgently required.
It must also be borne in mind that the heaviest work will
come just at the most trying season of the year, when the
weather is intensely hot and perhaps saturated with moisture.
In a tropical country soldiers should certainly not be employed.
It remains, then, to rely on the native. It has been found
in practice that, if the proper class of native is selected, he is
capable of being trained very efficiently to the work ; but
of course he will always need the supervision of Europeans.
The number of these men required v/ill vary in accordance
with the size and conditions of the barracks, cantonment or
War Department ground. Experience has shown that it is
better to divide up the men into separate units or working
gangs, rather than have a number of men engaged indis-
criminately. A convenient working gang would consist of
a head man with two or three underlings. The head men
should be selected for their special aptitude in the work and
should receive more instruction than their underlings, in order
that they in their turn may be able to impart the information
received. All the men employed must be given a general
insight into the causation of malaria and be taught the life
history of the mosquito. They must know the different species,
both of the larvae and adults, together with their habits. They
must also receive a course of instruction in the best means of
dealing with casual water, in ditching and rough draining.
These men should be under the direct control of the medical
or other officer appointed in charge of malarial work, and
he will be responsible for their instruction.
Different ways of working the gangs can be arranged as
best suits the individual place. For instance, the station may be
2Q
6io PREVENTION OF MALARIA AMONG TROOPS [Sect.
divided up into six different areas, and a gang made responsible
for each ; or gangs can be employed on one of these areas for a
day in each week. Again a gang may be appointed to each
regiment or unit, and a man, preferably a N.C.O., made respon-
sible for its working. The general duties of these gangs will be
shortly as follows : — The exploring and examining of all ground
around the barracks or cantonment ; the collection of all tins,
pots, pans, or other rubbish capable of holding water ; the
cutting and removal of all waste vegetation, brushwood
and scrub ; the clearing and grading of ditches, the filling
up of holes and hollows, the draining away of casual water
and small marshes ; the examination of water-tanks, water-
butts, wells and cess-pools ; the search for plants and holes
in trees retaining water ; the treating with paraffin-oil, tar or
other larvicide of all water that cannot be disposed of or
properly protected.
It is advisable that attention should be paid, not only to
the Anopheline larvae, but also to those of Culex and Stegomyia,
as the destruction of the two latter, which are usually the more
domestic species and therefore more in evidence as nuisances,
will show the inhabitants of the station that something is being
done. Besides, in many places, these mosquitos are a veritable
pest, the Stegomyia by day and the Culex by night, and their
destruction is worth some outlay, if only to obtain increased
comfort.
When dealing with these larvicidal operations, the question
of the station or cantonment irrigation is certain to arise. Where
a canal supply is in force, as in many parts of India, it is well-
nigh impossible to act efficiently on the Anopheline larvae,
unless such irrigation is stopped. The main canal, as it passes
through the cantonment, is broken up into numberless small
channels for the distribution of the water. These generally
become little better than rough and neglected gutters, over-
grown with vegetation, and allowing the water to stagnate.
Small patches of marsh or water-logged soil are often formed
6i] MECHANICAL PROTECTION 6ii
by the side of these channels from leaking or overflowing of
their banks. These will form ideal breeding spots for most
varieties of the Anophelines. On the other hand, it has to be
recognised that if irrigation is cut off, the cantonment will be
turned into a desert. Irrigation from wells is by no means so
objectionable. The supply of water is limited by the labour
necessary to raise it from the well, and therefore only a
sufficient quantity to irrigate the crops themselves is drawn.
Water seldom stands wasting in channels or sides, so that
the Anophelines have little opportunity of finding any breeding
pools.
A medical officer should be detailed for each station or
cantonment to look after all malaria work, and he should be
placed in charge of all the working gangs to direct and super-
vise their operations.
At the headquarters of each district or province a medical
officer possessing special knowledge on the subject of malaria
should be appointed. It should be his duty to travel from
place to place, to supervise the work being carried on, and to
advise as to future procedures. All reports on malaria from
the out-stations should be submitted to him, in order that he
may collect the various details, and be in a position to form
a reliable opinion on the efficiency or otherwise of the different
measures of prevention.
(2). The defence against the adult Anopheline. — The means
at disposal are mosquito-proof houses and mosquito-curtains.
In Europe, or even in a sub-tropical climate it is easy to
lay down rules and carry them out as regards the use of the
above means. The matter resolves itself into one only of
expense for their provision. In the tropics the situation is
far different. Here the most prominent question is : Will the
troops or others make use of such means if they be provided?
or even it may be asked : Can they be allowed to do so .? To
those who have experienced hot weathers on the plains of India
this point is one that is only too vividly appreciated. To
6i2 PREVENTION OF MALARIA AMONG TROOPS [Sect.
expect any one to remain under a mosquito-net during the day
or night-time of the hot weather, or even to remain in a room,
the windows of which are blocked by wire -gauze netting, is
scarcely reasonable. Existence would be unbearable, and in
all probability sacrificed to an attack of heat apoplexy. Un-
fortunately the use of mosquito - curtain and punka is incom-
patible, at least for the soldier. Mosquito - proof rooms and
powerful electric punkas or fans might be borne. In many
parts of India, for five or even six months of the year, punkas
are a necessity of existence, and therefore curtains cannot be
made use of It is impossible to lay down definite rules in
regard to this question. In each district or station the various
points will have to be taken into consideration in a common-
sense manner, and corresponding recommendations made.
Mosquito - curtains should undoubtedly be provided for all
soldiers in a malarious locality, and they should be made
to use them if the climatic conditions permit. The form of
curtain varies. The bell pattern is the cheaper, more easily
managed and hung, but does not allow the same air-space
within it. This appears a minor point in the sub-tropics, but
is soon appreciated under tropical conditions. The old pattern
square shape is now again being used on this account, but
the obstruction to ventilation and air movement becomes very
great when each bed in a barrack room is fitted with these
curtains. Men must always be instructed in the best method
of hanging them, otherwise they are worse than none at all,
and act simply as traps. In many cases it has been found
that although curtains are provided, the men are not in the
habit of using them when on guard or attached duty, and
consequently become infected. The provision of wire-gauze
for all doors, windows and ventilators in a barrack - room is
one of theoretical excellence, but one of great practical
difficulty. The expense, both initial and recurring, is of some
magnitude, and constant watch must be kept on the proper
fitting and closing of the openings ; otherwise the soldier is
6i] SEGREGATION 613
sure to remove what he will consider are useless obstructions
to the breeze.
In certain isolated and dangerous positions, where a small
number of men are on duty, the employment of this method
is undoubtedly a sound one, but as a general preventive
measure it has not been taken up for our garrisons.
As regards the destruction of the adult mosquito but little
can be done. The majority of the Anophelines are night
feeders, and as a general rule will leave a room before day-
light. There are some varieties, however, which will remain
a certain time after engorgement, and can be found in the
dark corners of rooms. Various means have been devised for
killing off these insects by fumigation, such as the burning
of sulphur, formalin or other chemicals. These methods are
of but little use in the tropics, where it is most difficult to
render a room in any way fume-tight. The safest procedure
consists of the regular sweeping out of all dark corners, removal
of unnecessary hangings, and thorough cleanliness. Many
so-called specifics have been brought forward, purporting to
ward off the attacks of mosquitos when smeared on the skin,
such as soaps, ointments, oils, etc. Some of these are excellent,
whilst their virtue lasts, but the latter is very evanescent, and
few of them are found to be efficient for more than about half
an hour.
(3). The segregation of malarial patients and their protection
from Anophelines. — This is a most important matter and one
that has been much neglected up till very recently. It was
customary to place patients suffering from malaria in any
ward with other patients not yet infected, no provision being
made or even thought of to prevent infection being carried
from one to the other. In consequence, many men who were
in hospital for some trivial complaint became infected with
the parasite during their detention. At the present day
it is understood that a patient suffering from malaria is a
danger to his non-infected neighbour, and he should, therefore.
6i4 PREVENTION OF MALARIA AMONG TROOPS [Sect.
be placed in a separate ward, and provided with curtains, or
if these cannot be borne, then the ward must be rendered
impervious to the entrance of the mosquito. In any station
where malaria is prevalent, these precautions are essential.
A ward containing malarial patients unprotected from the
attacks of the Anopheline carrier, is a grave potential danger
to the surrounding community, and should not for one moment
be tolerated.
(4). Segregation from the native. — The importance of this has
been referred to previously under general measures of preven-
tion, when insistence was laid on the advantages to be derived
in separating soldiers entirely from the native houses and
population around. It must not be forgotten that the soldier
may still easily contract the disease by visiting places or
towns, where malaria is rife amongst the inhabitants, and it
is very necessary to do everything in one's power to prevent
such excursions, more especially after dark.
When troops attend camps of exercise or are on the march
through a malarious country, the encampments should always
be placed as far as possible from any native village or from
any spots where infected mosquitos are likely to be prevalent.
The same advice can be given as regards shooting-trips, on
which the officer often, and the soldier occasionally, proceed.
Native guides will always try to induce a party to pitch their
encampment in close proximity to a village or water of some
kind, for obvious reasons of supply. This should not be
allowed, but the very opposite plan adopted. The use of