nets for soldiers when on the march is almost impossible,
crowded as they are together in small tents, but for the officer
it is quite a simple matter to carry a small bell-shaped net
and sling it up from the tent wall or branch of a tree at night.
On shooting-trips during the malarious season a net should
invariably be carried. It is very light and easily packed, if
the supporting ring is hinged to fold over.

(5). The administration of quinine. — This drug must be



6i] QUININE 615

employed for the soldier as for the general population, namely,
to (a) cut short the actual attack, (d) prevent relapses, (c)
prevent the infected acting as reservoirs and potential spreaders
of the parasite, (d) act as a prophylactic agent.

(a) The various methods of administering quinine as a
curative agent will be dealt with in other sections,
so that further reference to this point will not be
made. The treatment of the soldier differs in no
way from that of a man in civil life, and army
medical officers have now a free choice of any
method which they may select.
(3) It may be taken for granted that, if a patient has
been infected with the malarial parasite and suffered
from an attack of fever thereby, it will require a
period of probably three, certainly two months
continuous and rigid treatment, before the parasite
is rendered more or less inactive. To say that it
is destroyed is not possible, however energetic the
treatment may be.

The failures of quinine to prevent so-called
relapses are not generally failures in the true sense,
as the recrudescence of the attacks is in the larg-e
majority of such cases due to a re-infection. This
is the reason why it is so extremely difficult to cure
a patient when he still continues to reside in a
malarious locality. Within the last few years the
importance of the after-treatment of all soldiers
affected with malaria has been appreciated by
army medical officers, and nowadays every care is
taken to carry on continuous treatment over a period
of several months and to record results.

It may be presumed that the blood of every
suspicious case of fever now admitted to a military
hospital will be examined for the malarial parasite,



6i6 PREVENTION OF MALARIA AMONG TROOPS [Sect.

and that the diagnosis of malaria will never be
made unless a positive result is found. When a
malarial patient is discharged from hospital, some
such scheme as the following may be employed.
The man is given a paper, telling him on what
days he must attend for doses of quinine. A
duplicate of this order is kept by one of the
hospital staff, whose duty it is to give the paper,
note the dates of attendances, and report any
failure to do so.

The raison d'etre of continued treatment should
always be briefly and reasonably explained to the
patient, in order that he may grasp the importance
of taking quinine regularly, not only for his own
sake but in the interest of his comrades. The
treatment must be enforced ; but as a general rule
there is not much difficulty in making a soldier
who has once had an attack of malaria realise
that it will be to his benefit to continue treatment.
Every facility must be given to him for obtaining
the necessary doses.

There is some variance of opinion as to the
best method of giving the drug. For soldiers the
most suitable plan is perhaps the administration of
lo or 15 grains of the sulphate or its equivalent
on two successive days every week or on three
successive days every ten days over a period of
three months. During this time the blood should
occasionally be examined for the presence of para-
sites and the treatment modified if necessary.
{c) To prevent the infected acting as reservoirs of the
parasite : Treatment for this object is in reality
bound up with that mentioned for the prevention
of relapses. If the latter do not occur, it is
improbable that many or in fact any gametes are



6i] QUININE 617

circulating in the patient's blood. Similar lines
of giving quinine can therefore be recommended.
{d) As a prophylactic agent : On the use of quinine for
this object there is a considerable diversity of
opinion, and the latest military reports are not by
any means favourable to any definite conclusions of
the benefit ensuing from its administration, (A.M.D.
Report, 1908, India.)

However, there has been undoubted evidence of
beneficial action exerted by its use, and it is therefore
the duty of the medical officer in charge of troops to
administer the drug whenever malarial conditions are
widely prevalent. It must always be remembered
that positive results, as the outcome of quinine in
prophylactic dosage, are most difficult to estimate.
Negative results are declared only too vividly ; and
a few of the latter as facts far outweigh any estima-
tions of the former as theories. In considering the
results, it should be also brought to mind that a large
proportion of the cases admitted to hospital, probably
more than 50% in some stations, are relapses, and
that the administration of quinine may greatly lessen
the number of such relapses, quite apart from any
action in preventing fresh infections.

The difficulties encountered in carrying out an
efficient prophylactic issue are very great. The
soldier is extremely suspicious, when forced by order
to undergo such a dosage, and will often do every-
thing in his power to evade it. Considerable tact
must always be employed in order to win over his
confidence. In any case the drug must be taken by
order, and in the presence of the medical officer or
other reliable person. An issue to volunteers only
soon resolves itself into a farce.

The drug may be given in solution, or in the



6i8 PREVENTION OF MALARIA AMONG TROOPS [Sect.

form of pills or tabloids. Solution has the advantage
that it is always at hand and easily made up, but
the taste is of course extremely disagreeable to most
people. Pills are convenient, but take some time
to make, and do not keep well under conditions of
heat or moisture. Tabloids are really the most
useful form, and given as a preventative only, they
are unlikely to pass through the intestine unchanged.
The uncoated form should be used. As regards
this, there is a note in the A.M.D. Report, 1908, to
the following effect. " As is usual the men disliked
the quinine parades, and many adopted every means
they could to avoid swallowing the dose ; tabloids of
quinine were found unsuitable, since many men kept
them in their mouths until the parade was dismissed,
and then threw them away. Hence, quinine in
solution was administered, and each man had to
shout out his regimental number immediately after-
wards to prove that the dose had been swallowed."

The above is one typical instance of resentment at com-
pulsory treatment, and points out how extremely difficult it
must be to rely entirely on the results of quinine prophylaxis
under military conditions.

As regards the dose, there is some difference of opinion.
A daily administration of 5 grains cannot be recommended for
soldiers, owing to the trouble it involves in the parading, etc.,
of the men. In India during 1908, where in 53 out of 58
plains stations quinine was given as a prophylactic during the
malarious season, in the majority of the cases 10 to 15 grains
were used on two consecutive days in each week. This seems
to be as good a method as can be recommended.

One most important point not yet referred to is the instruc-
tion of the soldier and others in the causation and spread of
malaria.



6i] INSTRUCTION 619

All such instruction should be given in a way which will
appeal to the imagination, and the language used should be
couched in the most popular style. Short descriptions of
lantern slides are the very best means of imparting elementary
knowledge of this kind. Each medical officer appointed to a
division or district as an expert on malaria should be provided
with a set of lantern slides and suitable lantern, and give short
demonstrations in each station throughout his district. A full
but elementary understanding of the cause of malaria and the
role of the mosquito in its spread, will explain to the soldier the
reason of many precautions which he may have failed to under-
stand and thereby neglected.

It will be found that the men are ready enough to receive
such instruction, and become greatly interested in the subject,
provided that the facts are placed in a simple and straight-
forward manner before them.



^'












2. THE CAUSK Ul' llIK MALARIA A.\I().\(,ST TH1-: TK(JU1'S IN Till-; lU'TS.

This stream was situated at a distance of 400 yards, and formed a most favourable
breeding-ground for /-". coslalis.




3- ANoi'iiEi.iNK hkki-:i)1n(;-(;k()i;.\I) in a coi.oniai, cantoxment (Mal-ritil-s).




(The Latanier, near Port Louis, Mauritius— the river of Paul and \'irginia. — R. Ross.




5. TIIK SAME FINISHKI).

This stood intact after several floods.



*â–  't *' ^ c \



ADDENDA
62. Sugfgrested Terminologry for the Phenomena of Cyto-

gfenesis. — Several such terminologies have been proposed, among
others by myself. That of F. Schaudinn is now extensively used, but
has the defect of attempting to limit the word spore to the first genera-
tion of daughter cells proceeding from the zygote, and the word schist
only to subsequent generations. His merozoites are in fact spores, his
spores merozoites : his spores are really produced by his schizogony and
his schizonts by his sporogony. I think therefore that a more general
system, in which each root is invariably used in a strictly defined sense,
may still be proposed for consideration, briefly, as follows : —

Schist =^z. division of the centrosome and nucleus only.

Clast = a. division of centrosome, nucleus and cytoplasm only.

Mere = 2L division of the whole cell.

Spore = z. mere when more than two meres are produced at a time.

Protoschists or protoclasts are the first schists or clasts produced in the

dividing cell, z.w^ protomeres ox protospores the first meres or spores

(starting with the zygote).
Deutero- and trito-^ etc., for succeeding generations.
Gametes = the sexual elements. Microgamete = sperm, macrogamete =

oon.
Zygosis — conjugation, and zygote = the resulting body.
— g^^y = production by — e.g., parthenogeny, sporogeny.
— genesis = production of- — e.g., spermatogenesis.
— -//aj/i- = making of — e.g., gametoplasis.
— phase = p\i2ise or cycle — e.g., gamophase (sexual cycle), agamophase

(asexual cycle), schistophase, merophase, zygophase, etc.
— cyte = di cell destined to produce — e.g., gametocyte.
— phore = z. body actually producing — e.g., sporophore (sporulating

body), spermatophore (flagellate body).
— cyst^z. capsule containing — e.g., oocyst, clastocyst,

621



622 NOTES ON THE MALARIA-BEARING ANOPHELINES [Sect.

— id=3i body connected with, or belonging to, the phase of — e.g., merid,
sporid, gametid. Also haematid (red corpuscle), leukid (white
corpuscle), micrid (blood plate), etc.

Descriptions should, I think, commence with the definite starting-
point of the zygote. Thus I should describe the general cytogenesis
(or biogenesis) of Plasmodium briefly as follows : —

Zygosis occurs in the stomach of the mosquito. The zygote pene-
trates into the stomach wall ; and after a short schistophase produces
about eight to twelve protoclasts which, continuing schistogenesis,
produce a large number of deuteroclasts. These, escaping from the
cyst, become protospores ; which pass by route of the insect's salivary
glands into the vertebrate blood, where each penetrates a haematid.
Here the sporid, after another schistophase, produces six to thirty
deuterospores, the sporophase being thus continued indefinitely. The
gamophase commences (by stages not yet clearly seen) in the vertebrate
blood. The oocyst has one oon, and the spermatocyte, say, four to six
sperms ; but gametophoresis and zygosis do not occur until the blood
is ingested by another Culicid.^

63. Notes on the Malaria - bearing- Anophelines. — This
section ought to have been placed in Chapter III, but has been
relegated to the Addenda for the following reasons. Many works on
malaria and on mosquitos give lists of the malaria-bearing Anophelines,
but mostly without exact references to the literature in which the
incriminating evidence was published. Hence early in 1910 I directed
Mr W. R. Drawz, our Malaria Bibliographer (Tropical Diseases'
Research Fund), to collect all the data which he could find ; but the
work could not be completed in time for the earlier chapters of this
book ; and he reports that even now, after several months' close search,
some references have probably been overlooked. I am also much
indebted to Mr R. Newstead and Dr J. W. W. Stephens, of the
Liverpool School of Tropical Medicine, for their valuable assistance.

(i) So far as we can find, the following is a complete list of the
Anophelines which have been mentioned in various books and papers
as being capable of carrying malaria : —

(Note. — Only synonyms in small type.)

A?topheles albimatia, Theobald (1901), vide

Cellia albimana, (Wiedemann) (1821).
Anopheles albimana, Wied., xnde

Cellia albimatia, (Wiedemann) (1821).

^ I am indebted to Professors Myres and Postgate, University of Liverpool, for
advice regarding the Greek roots.



63] ADDENDA 623

Anopheles albimanus, R. D., vide

Cellia argyrotarsis^ (Robin-Desv.) (1827).
Anopheles albitarsis, Arribalzagia (1901), vide

Cellia argyrotarsis^ (Robin-Desv.) (1827).

Anopheles algeriensis, Theobald (1903).
Anopheles annulipes, Walker (1850), vide

Nyssorhynchus annulipes, (Walker) (1850).

Aitopheles arabiensis, Patton (1905).

Anopheles barbirostris. Van der Wulp (1884), vide
Myzorhynchiis barbirostris, {yzxi der Wulp).

Anopheles bifurcatus, (Linn.) (1758).

Anopheles bifurcatus, Meigen (1804), vide

Anopheles maculipennis, Meigen (18 18).
Anopheles chaudoyei. Billet {is not a spec), vide

Pyretophorus chaudoyei, Theobald (1903).
Anopheles claviger, Fabr. (1805), vide

Anopheles maculipennis, Meigen (18 18).
Anopheles claviger, Meigen (1804), vide

Anopheles bifurcatus, (Linn.) (1758).

Anopheles cohaesus, Donne.

Anopheles costalis, Loew (1866), vide

Pyretophorus costalis, (Loew) (1866).

Anopheles crucians, Wiedemann (1828).

Anopheles culicifacies, Giles (1901), vide

Myzomyia culicifacies, (Giles) ($ non ^) (1901).

Anopheles farauti, Laveran (1902). (Doubtful species.)

Anopheles forniosaensis, Tsuzuki (1902) (? Genus Anopheles).
Anopheles fuliginosus, Giles (1900), vide

Nyssorhynchus fuliginosus, (Giles) (1900).
Anopheles funesta, Giles (1900), vide

Myzomyia funesta, (Giles) (1900).
Anopheles funesta var. subuvibrosa, Theobald (1900), vide

Myzomyia funesta, (Giles) (1900).
Anopheles fujiesta var. umbrosa, Theobald (1900), vide

Myzotnyia funesta, (Giles) (1900).
Anopheles gambiae, Giles (1902), vide

Pyretophorus costalis, (Loew) (1866).
Anopheles grabhantii, Theobald (1901), vide

Cycloleppteron grabhamii, (Theobald) (1903).



624 NOTES ON THE MALARIA-BEARING ANOPHELINES [Sect.

Anopheles gracilis, Donitz (1902), vide

Pyretophorus cos talis, (Loew) (1866).
Anopheles jamesii. Listen (non Theobald) (1901), vide

Nyssorhynchus fuliginosus, (Giles) (1900).
Anopheles jesoensis, Tsuzuki (1902), vide

Myzorhynchus sinensis, (Wiedemann) (1828).
Anopheles kawari, James-Liston (1901), vide

Nyssorhynchus kawari, James-Theobald (1901).
Ajtopheles kochii, Donitz (1901), vide

Cellia kochii, (Donitz) (1901).
Anopheles kumasii, Chalmers (1900), vide

Mysojuyia funesta, (Giles) (1900).
Anopheles leucopus, Donitz (1901), vide

Nyssorhynchus fuliginosus, (Giles) (1900).
Anopheles listoni, Giles (1901) (? ^ only), vide

Myzoinyia ctdicifacies, (Giles) ( $ non (J) (1901).
Anopheles listoni, Liston, vide

Myzomyia listoni, Liston (non Giles) (1901).
Anopheles lutzii, Theobald (1901), vide

Myzomyia lutzii, Theobald (1905).
Anopheles maciilipalpis, Giles (1902), vide

Nyssorhynchus inacidipalpis (Giles) (1902).

Anopheles maculipennis, Meigen (18 18).

Anopheles martini, Laveran (1902).

Anopheles metaboles, (Theobald) (1902), vide

Nyssorhynchus stephensi, (Liston) (1901).
Anopheles musivus, Skuse (1888), vide

Nyssorhynchus annulipes, (Walker) (1850).
Anopheles paludis, Theobald, vide

Myzorhynchics paludis, (Theobald) (1900).
Anopheles pharoefisis, Theobald (1901), vide

Cellia pharoetisis, (Theobald) (1901).
? Anopheles picius, M'Donald, vide

Myzomyia hispaniola, Theobald (1903).

Anopheles pseiidopunctipennis, Theobald (1901).
Anopheles punctipennis, Say (1823).

Anopheles pursati, Laveran (1902).

Anopheles quadrimaculatus, Say (1824), vide

Anopheles jnaculipennis, Meigen (18 18).
Anopheles rossii, Giles (1899), vide

Myzomyia rossii, (Giles) (1899).



63] ADDENDA 625

Anopheles sinensis^ Wiedemann (1828), vide

Myzorhytichus sinensis, (Wiedemann) (1828).

Anopheles stephensi. Listen, vide

Nyssorhynchus siephensi, (Listen) (1901).

? Anopheles superpictus, Grassi, vide

Pyretophorus superpictus, (Grassi) (1900).

Anopheles tarsimaculata, Goeldi (1905) (not Anopheles).
Anopheles theobaldi, Giles, vide

Nyssorhynchus theobaldi, (Giles) (1901).

Anopheles treacheri, (? Daniels 1909).

Anopheles trifurcatus, Fabricius (? date), vide

Anopheles bifurcatus, (Linn.) (1758).
Anopheles turkhudi, Listen, vide

Myzomyia turkhudi, (Listen) (1901),
Anopheles vagus, Donitz (1902), vide

Myzomyia rossii, (Giles) (1899).
Anopheles villosus, Reb.-Des. (1827), vide

Anopheles bifurcatus, (Linn.) (1758).

Anopheles vincenti, Laveran (1901).

Anopheles walkeri, Theebald (1901), vide
Anopheles bifurcatus, (Linn.) (1758).

Arribalzagia maculipes, Theobald (1903).

Cellia albimana, (Wiedemann) (1821).

Cellia albipes, Theebald (1903), vide

Cellia albimana, (Wiedemann) (1821).

Cellia argyrotarsis, (Rob.-Des.) (1827).

Cellia kochii, Donitz (1901).

Cellia pharoensis (Theobald) (1901).

Culex bifurcatus, Meigen (1804), vide

Anopheles niaculipennis, Meigen (18 18).
Culex hyemalis. Fitch, vide

Anopheles punctipennis, Say (1823).

Cycloleppteron grabhamii, Theobald (1903).

Cycloleppteron mediopunctalus, (Lutz M.S.), Theobald.

Myzomyia christophersi, Theobald (1902), vide

Myzomyia listoni, Listen (non Giles) (1901).

2 R



626 NOTES ON THE MALARIA-BEARING ANOPHELINES [Sect.

Myzomyia culicifacies, (Giles) ( % non ^ ) (1901).
Myzomyiafluviatilis, Christophers M.S. (1901), vide
Myzomyia listoni, Liston (non Giles) (1901).

Myzomyia funesta, (Giles) (1900).

Myzomyia kispaniola, Theobald (1903).
Myzomyia indica, Theobald (1901), vide

Myzomyia culicifacies, (Giles) ( $ non $) (1901).

Myzomyia listoni, Liston (non Giles) (1901).

Myzomyia ludlowi, Theobald (1903).

Myzomyia lutzii, Theobald (1905).

Myzomyia nili, Theobald (1904).

Myzomyia rossii, (Giles) (1899).

Myzomyia turkhudi, (Liston) (1901).

Myzorhynchus barbirostris, (Van der Wulp).

Myzorhynchus coustani, (Laveran) (1902),

Myzorhynchus mauritianus, (Grandpre) (1900).

Myzorhynchus paludis, (Theobald) (1900).

Myzorhynchus paludis var. similis, Theobald (1901), vide

Myzorhynchus mauritianus, (Grandpre) (1900).
Myzorhynchus pictus, Ficalbi (1899), vide

Myzorhynchus pseudopictus, (Grassi) (1899).

Myzorhynchus pseudopictus, (Grassi) (1899).

Myzorhynchus sinensis, (Wiedemann) (1828).
Myzorhynchus tenebrosus, Donitz (1902), vide

Myzorhynchus mauritianus, (Grandpre) (1900).

Myzorhynchus umbrosus, Theobald (1903),

Myzorhynchus ziemanni. Von Griinberg (1902).

Nyssorhynchus annulipes, (Walker) (1850).

Nyssorhynchus fuliginosus, (Giles) (1900).

Nyssorhynchus kawari, James-Theobald (1901).



63] ADDENDA 627

Nyssorhynchus maadipalpis, (Giles) (1902).

Nyssorhynchus maadipalpis var. indiensis, Theobald (1903), vide
Nyssorhynchus maculipalpis, (Giles) (1902).

Nyssorhynchus maculatus, (Theobald) (1900).

Nyssorhynchus stephensi, (Listen) (1901).

Nyssorhynchus theobaldi, (Giles) (1901).

Nyssorhynchus willmori, James (Theobald) (1904).

Pyretophorus ardensis, Theobald (1905).

Pyretophorus chaudoyei, Theobald (1903).

Pyretophorus costalis, (Loew) (1866).

Pyretophorus costalis var. melas^ Theobald (1903), vide
Pyretophorus costalis^ (Loew) (1866).

Pyretophorus Jeyporensis, Theobald (1903).

Pyretophorus myzomyifacies, Theobald (1907).

Pyretophorus sergenti, Theobald (1907).

Pyretophorus superpictus, (Grassi) (1900).

Stethomyia fragilis^ (Theobald) vide

Anopheles treachtri^ (? Daniels) (1909).

Stethoinyia nimba, Theobald.

(2) I now add some notes on the species regarding which we have
succeeded in finding some incriminating evidence. That evidence
is of three degrees of value : — {a) experimental proof that certain
individuals of a species are capable of developing all the stages
of any or all the species of the human PIas?nodia, or of causing
infection in man, or of both ; (b) proof that a species may contain
some of the stages of the parasites (zygotes) ; and {c) apparent correla-
tion between the numbers of a species and the local prevalence of
malaria. Here (b) is not conclusive because, though the zygotes may
develop to a certain degree in an insect, it does not follow that they
come to maturity ; and {c) is not worth much because, as we showed
in the case of Myzorhynchus mauritianus, a species may abound in a
malarious locality, although the disease is really being spread by quite
another one. Lastly, even {a) proves only that the variety concerned



628 NOTES ON THE MALARIA-BEARING ANOPHELINES [Sect.

in the experiments is culpable, because, for instance, we failed in
infecting English A. maculipennts, which certainly carry in most other
places. The reader should also note that the breeding-waters selected
by larvae in some places need not necessarily be the same as those
selected by the same larvae elsewhere.

Anopheles algeriensis. — Ed. and Et. Sergent state that they found
protospores in the salivary glands of the two individuals examined by
them [1905]. They also state that a violent epidemic of malaria
occurred in the villages of Thiers in Algeria, where it was not
possible to find any other Anopheline except this one. Occurs in
Algeria, and the Sergents say that it haunts les collines saheliennes^
and the plains of the littoral.

Anopheles arabiensis. — Apparently incriminated by W. S. Patton
[1905]. Literature not available. Protospores found in it. Distribu-
tion : Arabia and Aden. See Stephens and Christophers [1907,
p. 156].

Anopheles bifurcatus. — There are two species of Anophelines under
the name of claviger, A. maculipennts Fabr. and A. bifurcatus Linn.
Both appear to have been incriminated by the Italians by cultivation of
the parasites in all their stages, and also by inoculation of healthy
persons (see section 17, cases 2, 3, 4) ; but it is not always clear which
species is referred to. We gather that A. maculipennis is the one
concerned in the experimental inoculations, and generally in the cultiva-
tions. But Bignami and Bastianelli also incriminated bifurcatus by
cultivation. Grassi says [1901] that he found it much more difficult
to work with bifurcatus than with maculipennis, owing to the small size
of the former, but found zygotes in thirteen out of sixteen insects, and
adds (page 121, German edition) that parasites were found in bifurcatus
and maculipennis in the Maccarese district. Jansc6 also [1904, 1905
and 1908] gives experiments with A. claviger without stating which
claviger he referred to ; but we gather that he was referring to maculi-
pennis. Probably bifurcatus can be safely claimed as a carrier.

It is generally distributed over Europe and North America. In
England it is certainly the commonest of the three Anophelines, the
other species being maculipettnis and nigripes. Grassi states that it
occurs in forests and breeds in small collections of fresh water such as
wells and in rot holes in trees ; that it occurs seldom in houses and
stables, and that when one is bitten in forests it is generally by this
species. It bites more quickly than A. claviger, and in the daytime,



63] ADDENDA 629

and enters habitations at night. Newstead says that it is the
commonest Anopheline in the New Forest in England, where the
larvae occur in large numbers in the shallow pools and in the cattle
footprints. In the marshes of Cheshire it is also abundant, occurring
chiefly in shallow, terrestrial waters, sometimes in company with the
larvae of Culex.

Anopheles formosaensis. — The generic position of this species has
not yet been definitely fixed. Incriminated by J. Tsuzuki [1902], who