153
452. The observations relating to the malaria-carrying anophelines present
on the island shew that, though the Municipality was justified in attempting
to combat maiaria by measures directed against mosquitoes, until Major
Liston's discovery of the fact that N. stephensi was the carrier responsible for
the spread of most of the infection, the attack could not be concentrated upon
the most dangerous agent of transmission ; and in the absence of proper legal
powers, sufficiently generous financial assistance, and the co-operation of the
wealthy and educated classes of the community, the efforts of the sanitary
authorities could effect only a slight mitigation of the disease.
453. In a previous report it was pointed out that, in India generally the
prevention of malaria was usually a question of mitigation of the disease, but
that in Bombay there was good reason to believe that the adoption of adequate
measures would bring about the complete eradication of autochthonous malaria
from the greater part of the island. It is generally recognized that the existence
of endemic malaria is the prime cause oí epidemic malaria, and so long as
endemic malaria remains uncontrolled, epidemics are likely to occur, whenever
conditions become favourable for such manifestation of the disease.
454. To prevent epidemic malaria therefore it is necessary to control
endemic malaria ; and the eradication of endemic malaria from Bombay must
be aimed at (1) because as far as natural obstacles are concerned it "should be
easy of accomplishment, and (2) because until malaria has been properly
controlled liability to the occurrence of epidemic outbreak of the disease
will continue.
455. In the body of the report minor measures of prevention, such as the
use of mosquito nets, punkahs and fans are not discussed. They are largely
personal matters which have little bearing upon the public prophylaxis of
malaria.
456. Education also, although of great value, is not likely by itself to
effect very much. Among the poor it is useless to talk of mosquito nets and
ordinary measures of personal prevention, but they may be taught the value of
quinine as a remedy for malaria and trained to make use of it for the relief of
the disease. As a class the poor have little power to stop the spread of the malaria,
because they cannot control the breeding places of dangerous anopheles, and it is
therefore not of much use urging them to pour kerosine on water or to attempt
similar measures ; but among the educated and the wealthy, the property-owners
and tax-payers, those who have a voice in the Municipal administration and who
possess the power to eradicate malaria from the City, education regarding the
prevention of malaria by public measures is needed, for the responsibility rests
with them.
457. The use of quinine, though often of supreme importance where
the mitigation of the disease is all that can be attempted, becomes of secondary
importance in Bombay; and though the popularization of the remedy, its wide-
spread distribution and the encouragement of its use in the treatment of existing
infections are likely to be of great value, the taking of doses for the prevention
of fever is seen at once to be a measure useful possibly for large employers of
labour, among troops and prisoners and for private persons, but not adapted
for large uncontrolled populations.
458. The conclusions that have been reached regarding the public
measures of malaria prevention for Bombay are as follows :—•
(1) The measures should be directed against mosquitoes, but the suppres-
sion or reduction of the species of anopheles that carry the disease must
first be aimed at.
(2) The measures must be so contrived and directed as to bring about not
merely a mitigation of the disease but the eradication of autochthonous
malaria from the City.
(3) The more rapidly the measures are carried into effect the greater will
be the certainty of their complete success.
B 136—39