womeu living under jail conditions, not doing hard out-door labour or exposed to rain and storm. But the ventilation diflSculty is insuper- able unless a very much larger amount of cubic space is provided — a larger amount than one could justly recommend.
We are left, then, with mosquito brigades, prophylactic quinine and general sanitation, and it is to these that we must look as means of checking malaria. I have endeavoured to shew that the two former have already had some good effect. It is not unreasonable to hope that as experience is gained in the working of the mosquite brigades, better results may be hoped for. The prophylactic issue did do good, and, I think, not only by diminishing the admissions, but over the whole Settlement by lessening the periods of detention in hospital. This opinion is supported by the various medical officers in charge of the Settlement hospitals, especially in the female jail ( q. v. ).
For general sanitation we must rely largely on the executive officers in immediate charge of the convicts. It is to their interest to have a low sick rate, for the fewer men they have in hospital the more easily can remunerative work be undertaken.
In conclusion I advocate the following mea- sures as the most suitable for the checking of malaria:
1. The retention and, when necessary, ex- pansion of the existing mosquito brigades. The expert trained part of each gang should be per- manent and not available for other work. The coolies, drain makers, &c., may of courae be taken on and off as required, but the Petty Officer of the gang who knows what a mosquito larva is like, who can recognise culex eggs and knows the usual hiding and breeding places of the insects should be a fixture.
2. The general administration of quinine throughout the Settlement in prophylactic doses.
3. The establishment in the outlying and unhealthy stations of branch dispensaries sup- plied with quinine and simple remedies. This plan was tried last year with much success, both in the treatment of malaria and also of dysen- tery. It at times enabled us to get hold of patients earlier than we otherwise should have done and to save invaluable time in treatment.
So far we are hampered by want of an ade- quate Medical and Compounder staff, but it is hoped that more assistance will soon be avail- able.
4. The provision of drying rooms or drying frames at every station, and as a corollary the issue of extra clothing.
I do not regard the drying room as a panacea for all evils, but I am sure that giving a man dry clothes to sleep in and a good, hot, well- cooked meal, when he comes home from work, will enable him much more successfully to fight against malaria and other climatic diseases.
5. The restriction of such Unhealthy forms of labour as firewood cutting, swamp work, &c., to the narrowest limits, and the granting to men so employed of a small extra food ration. I re- gard the proposed substitution of coal for fire- wood as a most valuable idea, and one which cannot but have a good effect on the general health.
6. The continual stimulation of local public interest in the health of the convicts. One would like to see competition between stations as to which should have the lowest sick and death-rates and whose malarial admissions should be fewest.
I should like to add a few remarks on the cli- nical characters of the malaria as locally ob- served, and on the various methods of treatment in use.
Owing to the nomenclature adopted by the Royal College of Physicians, we are obliged to define our malaria cases as remittent or inter- mittent fever. This is a most unsatisfactory classification ; many cases are remittent (in the sense that the temperature does not touch normal) for the first two or three days and then assume an intermittent type for a longer period. Such a case may recover and be returned under either heading according to the ideas of the Medical Officer in charge of the case. On the other hand, such a case may die after a stay of some weeks in hospital, during the latter part of which stay the temperature may have been normal, intermittent or even subnormal at times.* Yet that case may reasonably be shown as remittent fever by one man and as intermittent fever by another.
In the Port Blair returns " remittent fever" may be taken to mean a severe type of malarial fever, and all cases dying from remittent fever are considered as malarial.
These ' remittent' cases occur in all parts of the Settlement, but especially in the less cleared areas like the Wimberley Qanj and Viper Sub- Pivision. 148 cases with 48 deaths were thus returned in 1902.
Many of the cases are rapidly fatal, the patients often being brought to hospital in a dying condition. Three or four days is a very common period for the patient to survive, and delirium and coma are frequent before death. Hyperpyrexia is not common, though in one fatal case a temperature of 110* was noted, and in another non-fatal case one of lOT*.
The men attacked are often old malarial sub- jects who have many previous admissions for the disease; one patient had 24 previous admissions recorded, others had 15, 12, 10, and so on.
Malarial parasites are occasionally but not often found. As is well known in these perni- cious cases, parasites are often absent from the peripheral circulation.
Ou' post-mortem examination, the outstanding features are the general congestion of the organs, especially of the brain and its membranes, the
