22
survival of the least susceptible, the disease is always in an active condition in
the case of the children, whose spleens are the reservoirs which keep up the
supply of the infection, and carry it on from one fever season to the next.
The diminution of the size of those semi-liquid reservoirs should therefore he
the chief aim of our anti-malarial measures, for if one cannot protect the
children from the mosquitos the obvious thing to do is to protect the mosquitos
from, the children. Repeated individual attention to each child with an enlarged
spleen is what is necessary ; such children are only indirectly infectious, but for
practical purposes they should be regarded as if they were directly infectious,
and should be looked upon as an immediate source of danger to their neigh-
bours, rich or poor.
The only way to keep up this constant attention to the state of the
children's spleens is by means of a Travelling Dispensary. It is not suggested
that Salsette should merely be one of the 26 tálukas of the Presidency to which
one of the existing travelling dispensaries is sent during the fever season, but
that Salsette should have an itinerant Dispensary of its own, worked on special
lines., and financed independently of Provincial or of Local .Funds. The endow-
ment of such an institution by a private individual, or by the trustees of a
charitable fund, would be of benefit not merely to the inhabitants of one town,
as in the case of a stationary dispensary, but to the whole of the people of the
island who are out of reach of the existing hospitals and dispensaries ; moreover,
as a preventive institution, its object would be to protect those who are well
besides treating those who are actually sick, and so to help the island to become
a healthier place for Bombay people to come and live in, To be of any real
service the work would have to be carried on the whole year round as each
individual spleen would need repeated and systematic attention, and it would
accordingly be advisable to provide a caravan for the purpose, in which the
Assistant or Sub-Assistant Surgeon in charge could comfortably live even in
the monsoon months. One compartment of this would be fitted up as a surgery,
and a considerable stock of medicines could be kept in it. The caravan would
be drawn by a yoke of bullocks. Two peons would be required. One would
accompany the doctor on his visits to villages off the road, and carry the haver-
sack he would take with him; the other would stay behind to look after the
caravan. If the doctor wished to take any members of his family with him in
the dry weather a small tent could be added to the equipment.
Salsette is fortunate in having its interior encircled by a made road,
so that the dispensary could actually circumambulate the island. Experience
would show what time was required in order to work the villages once properly,
and the period of a perigrination would be fixed. Each time the caravan came
round its boots would be inspected and its stock made up, by the Civil
Surgeon, Thána, or by the Medical Officer of Banclra Hospital, who would have
to satisfy himself that the work done was not being confined to a -mere distribu-
tion of medicinesj but that the individual children, whose names were entered
in the registers as having been found to have enlarged spleen, were being
attended to on each round, and sufficient medicines left for their treatment.
The name of the dispensary, including that of the person whose
memory it was desired to perpetuate by the gift of it } could be inscribed on the
sides of the caravan.
PREVENTION IN NEW BUILDING AREAS.—If the investiga-
tion on which this report is based shows that certain of Mr. Mead's original
suggestions are not such as can be earned out it should be remembered that
Mr, Mead in his report was the first to suggest a malariologieal investigation in
Salsette in connection with the town-planning he advocated,
Before individual areas are considered it may be well to lay down
certain principles which should be adopted where building is being sanctioned.
In the first place the leaving of any excavation which can hold water, in
connection with the building of houses, should be prohibited by by-law. "Wells,
again, are very prolific breeding-places of mosquitos and they are not needed,
in places that have a pipe-water-supply. Their construction, should not be
sanctioned in such places. Legal powers to order the closing of wells after the
introduction of a water-supply would be advantageous ; they need not be made