MAINE

the population of the state in 1920 was 768,014, in 1910 742,371, an increase of only 3:5 %, as compared with 14:9% for the united states in the same period and 6-9% for maine in the previous decade. there was a significant in- crease in urban population. the proportion living in places of 2,500 of more was 33°5% in 1900, 35°3% in i1g10, and 39%% in 1920. in ro10 the rural pepulation was 480,123; in 1920, 468,445. the only one of the 16 counties showing a marked in- crease in rural population was aroostook, which is one of the richest farming regions of new england. the principal cities of the state, with their population of 1920 and 1910 and rate of increase, were as follows:— ; i city 1920 1910 | per cent portland 69,272 58,571 18-3 lewiston 31,79! 26,247 21-1 bangor 25,978 24,803 4:7 biddeford 18,008 17,079 5°4 auburn 16,985 15,064 12-8 bath 14,731 9,396 56-8 augusta 14,114 13,211 6-8 waterville . 13.351 11,458 16-5 agriculture —in maine there were in 1920, 48,227 farms, val- ued with equipment at $250,000,000. although the number of farms has decreased since roto, the value of farm land has greatly increased; and in certain fields such as poultry there have been 7790 gains. the poultry co-operative marketing is being successfully conducted; and in other branches of agriculture newer methods of marketing are making up for decreased acreage. maine’s potato crop in 1924 totalled 41,475,000 bushels. fifty-five per cent of all certified seed potatoes in the united states was grown in maine in 1924. figures for that year show 305 bu. of potatoes per ac.; 42 bu. of corn; 26 bu. of wheat; 37 bu. of oats. one of the chief agricultural industries is the production of sweet corn for canning. in 1924, 38,030 tons of corn were cut. lately canned green peas are coming into equal popularity. in wash- ington county blueberry production is one of the staple industries. maine’s annual blueberry crop is valued at a million dollars. hay still leads other crops: 1,432,000 tons in 1924 as against 1,326,289 tons in t919. maine has a very low percentage of mortgaged farms; in 1924, 67:5% were free from mortgage in- debtedness as against the national average of 52%. ninety-six per cent of maine farms are owned by men who operate them. it is estimated that about one-third of the people living in maine are engaged in, or are supported by, agriculture. but over one-half of the foodstuffs come from outside the borders of the state— a situation that has led to efforts encouraging the use of markets and the development in maine of agricultural independence. forestry and lumber —during the past few years much atten- tion has been given to afforestation. nearly three-fourths the area of the state, 15,000,000 ac., is forest land. very recently attention has been called to the abundance of hard wood in the maine forests, a fact that had been overlooked in the unparalleled consumption of pulp wood. the total stand of timber, spruce and fir is estimated at 25,500,000,000 {t.; pine, 5,060,000,000 ft.; cedar, 2,780,000,c00 ft.; hemlock, 880,000,000 ft.; hardwoods, 5,000,000,000 feet. the annual cut of lumber is approximately 1,000,000,000 feet. figured on the basis of population maine’s forest lands amounted in 1925 to 19°5 ac. per capita, a ratio ex- ceeding those of all other states east of the rockies, except florida. | shipbuilding and fisheries —the shipbuilding industry was stimulated during the world war to a remarkable activity, which, however, subsided in the years immediately following. bath, the chief shipbuilding city, attained, during the height of this boom, to a population of 15,000. manufactures —in total value of products, paper and wood pulp manufacturing ranks first among maine industries; cotton goods are second; boots and shoes third; and woollen goods fourth, followed by lumber and timber products. maine leads all the states in the production of wood pulp; and old town leads the country in the manufacture of canoes. there is still much un- developed water-power; the u.s. geological survey credits maine rivers with a potential maximum of 1,300,000 electrical horse- power, of which 700,000 is undeveloped. the state still refuses to allow the exportation out of the state of water-power; but there are indications that this policy does not meet with as much popular support as it did a few years ago. administration and finance.—since toro there have been adopted 13 amendments to the state constitution, the total number of amendments numbering 47 in 1925. of amend- ments adopted since 1920 the two most important provided for a bond issue of $3,000,000 fora bonus to maine soldiers and sailors in the world war, and for voting by mail. maine is fast becoming the summer playground of the country. it has been conservatively estimated that nearly a million tourists visit maine annually; and the summer visitors furnish an im- portant element in the business life of the state. there are 165 summer camps for boys and girls, with an attendance exceeding 7,500. the recreational advantages of the state were emphasised in 1925 by gov. brewster in his inaugural address; and an elaborate programme of publicity, based upon the examples of california and florida, was undertaken under the auspices of the state and with funds provided in part by appropriations granted by the state. education.—during the decade 1915-25 much progress was made, particularly in the rural schools. a well-arranged pro- gramme providing for school buildings of modern construction maironis was being carried out in cities and towns; and in rural cum- munities the old-fashioned type of isolated, single school build- ings was giving way to consolidated buildings, transportation being furnished to pupils from remote homes. in 1925 the total enrolment of pupils was 163,106, as against 154,604 in 1920; 132,853 were enrolled in the elementary schools, and 30,253 in the high schools and academies. of the farm populatien of high- school ages, 49°3°% was enrolled in high schools, as compared with 42-3% of the non-farm population. maine claims to have the highest percentage in the country of farm boys and girls attending high schools. the state dept. of education also put into operation a well-devised plan for the gradual elimination of illiteracy through evening schools and adult classes. there were about 1,400 students in the six normal schools, and about 3,300 students in the state university and bates, bowdoin and colby colleges. history—in t1o11, for the first time since the civil war, maine had a democratic governor, frederick w. plaisted, and two democratic senators, charles f. johnson, of waterville, and obadiah gardner, of rockland. in 1912 woodrow wilson won the electoral vote of maine by reason of the split in the republican ranks. but in 1916 the split was healed and maine in every election thereafter ran true to form as a republican state. the consolidation of various newspapers with other changes in ownership left the minority party practically with no press. the chief contests consequently were in the primaries for the republican nominations. in 1924 the choice for governor between frank farrington, of augusta, and ralph o. brewster, of portland, was so close that for some weeks the result was in doubt, a recount held by the governor and council finally giving the nomination to the latter. in view of federal legislation on prohibition and woman suffrage it is interesting to recall that in sept. 1911 the state of neal dow (q.v.) voted to retain the pro- hibitory amendment to the constitution by the extraordinarily close vote of 60,853 to 60,095; and in sept. 1917, ina referendum, woman suffrage was overwhelmingly defeated, 38,858 voting “no ”’ and 20,604 voting ‘* yes.” in 1924 the ku klux klan was a very active factor in politics and one of the most discussed issues in the state campaign. the agitation, however, largely subsided following the election of brewster as governor in sept. 1924. governors since rotr: frederick w. plaisted (dem.), 1011; william t. haines (rep.), 1913; oakley c. curtis (dem.), 1915; carl e. milliken (rep.), 1917; frederic h. parkhurst (rep.), 1921; percival p. baxter (acting) (rep.), 1921-3, elected 1923-5; ralph o. brewster (rep.), 1925- ck cy mis) maironis, (1862- ), lithuanian poet, whose real name was jonas maciulas, was born in 1862 at pasandvaris, in the kaunas (kovno) district. after leaving the kaunas high school, maironis continued his studies at the university of kiev and the kaunas seminary. on graduating from the lat- ter, he entered the st. petersburg (leningrad) theological academy, where he took the m.a. degree. he was for 15 years a professor in the academy and received his d.d. for a scholarly work entitled de justitia et jure. in 1909 he was appointed rec- tor of the kaunas seminary. he became in 1922 a professor and deacon of the theological faculty of the kaunas university which he helped to found, and in 1923 was appointed professor. maironis began to write at an early age. his prose, flistory of lithuania, went into four editions. as a poet he excels alike in dramatic, epic and lyrical composition. his song of spring, a collection of songs, elegies, sonnets, ballads and satires also ran into several editions. many of his songs have been set to music and are sung all over lithuania. his famous poem young lithuania describes the national re-birth; our sufferings is a poem descriptive of the lithuanian national ripening and con- quest of independence; his afagdalen of raseiniai castigates the national vices, while his polish poem zxzad biruty appeals to the polonised lithuanian nobility. his dramatic works include where is salvation? the death of kestutis, and vytautas with the crusaders, the two last being historical plays of the 14th century. maironis also translated the rigveda into lithuanian. malaria malaria (see 17.461)—malaria had long been recognised as a disease of world-wide incidence and the cause of a higher sickness and death-rate than any other disease. the finding of malarial parasites in the blood cell by laveran at constantine in 1880, the demonstration of the life cycles of the quartan and tertian species of parasite by golgi in 1885, and of the subtertian fever species by marchiafava and celli, and the discovery that the disease is transmitted through the agency of mosquitoes first from bird to bird by ronald ross in india 1897-9, and later from man to man, in conjunction with the investigations and teachings of patrick manson and other pioneers, were important factors in a great stimulus to the study of tropical diseases, both of men and of animals in general, and the whole of tropical sanitation was powerfully affected. parasites —malaria is due to small protozoa or animal para- sites which pass an asexual stage in man, living and developing in the red blood cells, dividing into young forms or fresh broods in two or three days’ time and producing some male and female forms (gametocytes), which are drawn with the blood into the stomach of the female mosquito, and there conjugate and com- plete a sexual cycle. an odcyst forms from the female gamete and in this a swarm of young sporozoites develop and, becoming free in the body cavity, pass to the salivary glands, whence they are injected at the bite of the mosquito and begin again the asexual stage in man. the parasites—malaria parasites are’ of three species: plasmodium falciparum, p. vivax and p. malariae, the causal organisms of ‘‘ subtertian,” tertian and quartan fevers respec- tively. following the teaching of laveran, asmall body of workers believed that there was but one species, a theory of unity, and on the other hand certain investigators, because of minute differences between examples of the same species, concluded there were even further species and gave names to them. how- ever, as professor marchoux pointed out in a thorough review of the question at the first international malaria congress held at rome in oct. 1924, experimental research generally tended to support the idea of plurality and existence of the three species abovenamed. this was supported by the difference and practically constant periods of evolution of each, the transmission of the same species to healthy subjects, the specificity of culture of the parasites of each of the three species in vitro, and by epidemio- logical studies. symptomology.—in malaria symptomology nothing of funda- mental importance has been discovered in recent years. there has been advance on our knowledge of the cause and treatment of blackwater fever or haemoglobinuria, the serious nature of which has called forth many investigations, especially in the particular and heavily infected regions where it occurs. some investigators hold that this condition may arise not only in infections with p. falctparum, but occasionally with p. vivax and exceptionally with p. malariae. the association of an unknown virus with the malarial parasite has been considered as the cause. j. thomson’s work in rhodesia in 1923-4 gave strong evidence in favour of p. falciparum as the causal organism of all local cases and possibly elsewhere. he showed that p. falctparum can almost always be found in the blood; and that cases had been liv- ing in a district heavily infected by p. falciparum. he found one case after five months and another after 40 years’ residence; he noted its occurrence only in people who had hadattacks of malaria, though possibly unrecognised as such at the time, and had taken their quinine inadequately in amount and over an insufficient period of time. a similar observation was made in the cases which developed blackwater fever on their way home, or after they had left an endemic area even for some time. the finding of the other species of parasite, both of which tend more to chronicity and are readily found in the blood stream, may when present be, in thomson’s view, but an indication of a mixed infection. | diagnosis.—in the diagnosis of malaria in endemic localities the estimate of inhabitants infected is based on the percentage rate of an enlarged spleen or of a positive blood finding amongst a proportion of the population. for the latter, the examinations 174 of a thick and a thin film of blood are made. in the absence of the parasite an estimate of the relative number of large mono- nuclear (endothelial) cells to other white cells in the blood may be made in certain cases, but the evidence obtained is not con- clusive. an increase above the basic figure of 15 % endothelial cells of the total white cells was taken by stevens and christopher as indicative of actual or recent malaria in europeans living in the tropics. blood cell counts made at some time prior and sub- sequent to the finding of the malarial parasite did not show the presence of a constant relative increase of endothelial cells, nor was this a constant factor in latent malaria, even when the clinical diagnosis was obvious and the most reliable factor, an enlarged spleen, present. with regard to the finding of the parasite in the blood in these cases of “ latent malaria in england ” it must be remembered that but asmall drop is taken and that parasites are not easily found except at the period of a relapse. the clinical signs of latent malaria most commonly found are, in order of fre- quency, an enlarged spleen, anaemia, functional disorders of the heart and enlargement of the liver. the tendency to chronicity and febrile relapses in malarial infections is very marked. distribution.—malaria is a world-wide disease with endemic foci in all countries. it is most prevalent and extremely common in the tropics with the native population and high infection rate, constant heat, moisture and water for the breeding of the anoph- eline mosquito and requisite temperature for the development of the sexual stage of the parasite therein. as the poles are approached, the foci of endemicity gradually become less. for the development of the parasite in the mosquito an adequate temperature is necessary. on an average the three forms, p. malariae, p. vivax and p. falciparum, take 14, 11 and 6 days, respectively, the time varying with the temperature. in sub- tropical countries, malarial outbreaks follow the rainy seasons, when opportunities arise for the breeding of the mosquitoes. nor- way and sweden are examples of countries wherein anopheles are present but malaria absent. in great britain malaria was formerly not very uncommon, but became rare until the return of many infected troops. related to the presence of these carriers there were 235 indigenous cases in england in 1917, the number falling to four in 1924, thus corresponding with the cure of the malarial carriers. there exist in england three species of anophelinae in which the parasites may develop and be transmitted from man to man, but with treatment of infected cases from abroad there is now practically an absence of the human carrier of the parasites, or at least of parasites with sufficiently numerous sexual forms in the blood, a minimum of 12 per cu. mm. of blood being considered necessary for development in the mosquito. climatic conditions, partic- ularly temperature and humidity, influence the endemic prev- alence of malaria. a mean daily temperature exceeding 60° f. is necessary for its propagation for the full development of the parasite in the mosquito, p. falciparum requiring a very high temperature; p. malariae completing its cycle at a low one, and p. wivax over a wide range of low to high. this explains the seasonal incidence of the three types of malaria, the relatively high incidence of p. falciparum, the most malignant parasite, and the large number of infected inhabitants and high death-rate in the tropics and subtropics, and its rarity in indigenous cases in temperate climes, the presence of the endemic foci of p. malariae in the cooler hill country in the tropics and subtropics and the universal distribution of p. vivax though p. falciparum is the most malignant and spreads most rapidly when anophelism is intense, because of its greater output of gametes in the blood, it does not tend to such chro- nicity in the absence of reinfection as do the other two forms. in the absence of reinfection p. malariae, by far the rarest form, is, however, the most resistant and p. vivax holds an intermediate place. of 28,270 blood examinations made in england at one laboratory on cases of malaria contracted during the war, 777 were found positive, and of these p. vivax numbered 759, p. falciparum 14, p. malariae 4. there wasa marked falling off as the time in england jengthened, and it was rare to find the parasite after the quarterly period of 12 to 15 months. seven 7/2 cases were found after 30 months all with p. vivax, one in a double insection with p. malariae after 39 months, and one case after 51, and another after 59 months; p. falciparum was found after three months in a double infection with p. vivax at the 11th month, once alone at the 12th month, and once in a triple infection at the 14th month. the third of the four cases of p. ma- lariae had also been home a long time, namely, 16 months. in none of this extensive series was the parasite ever found after five years at home. it is not uncommon to hear a person settled in a non-infective country for many years accusing a temporary febrile attack or period of lassitude as a return of malaria which he once contracted abroad. proof of this seems wanting. though malaria has been transferred directly from man to man, the parasites infecting man have not been made to infect any animal. entomologists have furthered their investigations into the bionomics and classification of mosquitoes and the determina- tion of the species of anopheles that carry malarial parasites. s. p. james and dale have recently reported that quinine, quinidine and cinchonine possessed the same curative properties for all forms of malaria, and without difference in their toxicity save for the greater cardiac depressant action of quinidine. fletcher at kuala lumpur has made a careful series of obser- vations on this point. prophylaxis and treatment.—the treatment of malaria is inti- mately bound up with prophylaxis. particular reference may, how- ever, be made to the recent therapeutic use of horse serum in the treatment of that severe form of malaria, blackwater fever, wherein this serum appears to inhibit the action of an auto- haemolysin and its destruction of red blood cells in the body. many clinicians strongly advocate in tropical regions intra- muscular and intravenous injections of the bihydrochloride of quinine in serious cases, and injections do act quickly in severe, malignant, remittent and comatose cases, but in ordinary cases oral administration of the sulphate has been satisfactory. in acute attacks it must be borne in mind that 24 hours or more may elapse before the good effects of quinine become manifest. the classical successes in the reduction of malaria at ismailia, hongkong, havana and elsewhere have encouraged similar work in other localities, but there are few such examples as the long continued labours of malcolm watson in the federated malay states and the brilliant sanitary victory of general gorgas and the americans over both malaria and yellow fever at panama. the work of darling, bass and others in southern united states and in the islands must also be mentioned. the method of mosquito reduction against malaria, first suggested and tried under ross in freetown, sierra leone, in 1899, has not been followed as widely as anticipated, and local authorities too often dislike spending money on sanitation and hamper practical efforts of sanitarians by the attitude that it is better to prevent malaria by quinine or by the use of mosquito-nets, measures which are impractical in an uneducated native com- munity. local conditions must alw ays determine the most suitable mode of prophylaxis, and it is important, as etienne sergent points out, to have several methods of control which may well be combined and include with specific measures an educational propaganda. obviously there must be action to eliminate infection from all carriers of the parasite: in other words, to prevent the mosquito becoming infected, to destroy the species of anopheles in which the parasite may develop, and to prevent their biting and inoculating the parasite into the blood of man. good results have attended well-applied efforts of this kind. better health results and there are real economic returns for expenditure. the native must be looked after and enjoined to adopt some sanitary methods until he is taught to share in systematised efforts to protect and cure himself of malaria as of other endemic diseases. measures to rid carriers of the parasite are most difficult to put into practice. there is no settled or fixed dosage, or time of administration, of the specific remedy, quinine or other of the cinchona bark extracts. acute attacks respond readily to quinine; each dose makes a reduction in the number of parasites, and this reduction occurs every day, until finally none of the malaria parasites is left. treatment must be continued for a long time. i-mpirically three months appear to be enough, but there are obstinate cases. standard treatment.—for some years a standard line of treat- ment to procure disinfestation has been adopted by bass in america and by ronald ross and his colleagues in great britain, and the former has been recently introduced by j. thomson in rhodesia. the two former vary slightly. ross gives 30 grains of quinine daily during the attack and for three days after, followed by to grains daily, just before or after breakfast, for three months; bass ceases after two months. success has attended these standard treatments, and it is well for administrative pur- poses that a standard be adopted in each country. it will not cure all cases, but the exceptions appear rare and when detected can be specially treated. stevens found arsenic, after initial doses of quinine, of great value in helping to eradicate the para- site. together with quinine or other drug therapy, the important factor of building up and maintaining the general health, so as to assist the natural forces of the body to eliminate the malarial parasite, must not be forgotten. regarding the value of quinine prophylaxis amongst carriers, the results obtained at the malaria centres and camps during the war showed that any dosage under a total of 60 grains weekly proved insufficient for an adult male. other salts of quinine, of hydrochloride and bihydrochloride, affect the digestion less and seem to be as satisfactory. the tannate has been much used in italy, especially for prophylaxis among children. the daily small dose is more easily and therefore more certainly taken by patients (out of hospital) than larger occasional doses which cause some dyspepsia and headache and are therefore fre- quently postponed. children can be given a larger proportion by body weight than adults, say, twice as much. sir ronald ross has always felt that, to be effective, quinine should be con- tinued in 10 grain doses daily for three months after a subject has left a malarial country. quinine prophylaxis has been of value on particular occasions, such as in tiding a body of troops over a critical period of fighting or passing through a heavily infected area, in that it has kept off attacks of malaria during that time. bodies of troops in salonika who were given quinine daily remained free as long as they were taking it, but went down with malaria as soon as they stopped it, showing they were infected in spite of it. not all people bear quinine continued over a long period well and they may show symptoms of quininism. occasionally an individual is hypersensitive to quinine and may show symptoms even following an initial dose. on the first appearance of quininism the drug should be stopped for a time, or arsenical treatment substituted. in the hypersensitive case some begin with very small doses to desensitise the patient. certain inves- tigators in the tropics consider that it is more difficult to elimi- nate the parasite by quinine therapy in cases that have been tak- ing quinine consistently and who have become infected in spite of it. the cost of quinine and of its supervised administration has frequently rendered quinine prophylaxis impracticable in certain endemic areas. quinine prophylaxis should be supported by measures to pre- vent mosquito bites as far as practicable. in endemic areas and where there are many carriers the infection rate of the mosquito may be very high and frequent reinfection may occur. the second measure of prophylaxis, 7.e., the reduction of anophcline mosquitoes and the prevention of bites, has received more gencral application. this is difficult and costly, but it results in a lessened sickness and death-rate from malaria, and in profit from the expenditure incurred. in subtropical regions or where mosquitoes hibernate in dark places in rooms of homes, cellars, stables, outhouses and such places, oftenattaching themsclves tocobwebs, they should system- atically be killed directly or by fumigation. the breeding place of the mosquitoes is any still water on which they lay their eggs, and to kill the larvae and pupal forms through which they pass in development is the object in view. much can be done by the filling in of small pools, cattle foot-marks, draining of malay states, federated marshes, clearing out of long grass and reeds from the sides of streams, the conversion of still to running water when in large masses, the clearing away of all cans and unnecessary water containers and the covering by gauze of cisterns and tanks and the like around the homes. a female mosquito lays about 250 eggs at one time and seven to 10 days bring them to maturity. the young aquatic forms may be destroyed by larvicides such as kerosene, waste oil, cresol or “ paris green,” which, when mixed with roo parts of dust (1 c.c. of the mixture to 10 sq. metres of water) and blown on to the water, distributed by the winds or dropped from acroplancs, kills the anopheline larva forms and does not injure the fish or the animals that drink therefrom. valuable agents against larvae and pupac are the surface-feed- ing minnows, gambusia, stickleback and perch. anopheline mosquitoes do not attack until sunset, when one may remain as far as possible indoors in houses, bungalows and huts protected by close-mesh wire or netted windows and double doors; a bed or head net should cover any exposed part of the body during sleep. in the early evening the wearing of puttees by men and a paper lining under the stockings of women pre- vents bites on the legs. coolie lines should be placed when possible a mile from the breeding places of the anopheles, though this does not mcan that the mosquitoes cannot tly much farther. there is little danger to be anticipated from breeding places over a mile distant, if the mosquitoes have opportunities of feeding close at hand (i.c.; from other mammals), and if the intervening space be raised, wind-swept and clear of all shrubs and trees. the knowledge that the mosquito will attack man or animal in its thirst for blood has raised certain questions regard- ing the preservation of game, but up to the present no practical studies on any extensive scale have been made. use in psychiatry—following the observation of wagner jauregg in vienna in 1917, that certain chronic conditions showed improvement alter malarial attacks, the therapeutic use of malaria in psychiatry has been extensively applied in many countries. many cases of general paralysis have benefited, some sufficiently to be able to return to family and social life. time must be given to determine the permanency or otherwise of the amelioration. its use in other cases of cerebrospinal syphilis and also in such mental diseases as dementia praccox, confusional insanity and encephalitis icthargica is under consideration. the parasite uscd is the p. vivax and it appears more satisfactory to inoculate the patient by an experimentally infected mosquito than-by infection with blood from a case of malaria. thereby all risks of other infection are avoided, a wise precaution, espe- cially in an endemic region where other species of the parasite occur. infected cases are allowed to have 6 to 10 febrile attacks of malaria and are then given quinine which in these experimen- tal cases readily cures the attacks. : war malaria.—the following were the british war office figures of the number of cases admitted to hospital in four of the fighting areas during the war: mesopotamia: 1916, 680; 1917, 744; 1918, 10,202. salonika: 1916, 31,059; 1917, 71,413; 1918, 59,087. east africa: 1917, 58,236; 1918, 20,015. egypt: 1916, 1,423; 1917, 8,480; 1918, 30,241. until the war spread to the eastern fronts british armies suffered little from tropical diseases. in the summer of 1916 an epidemic of malaria occurred among the troops on the salonika front; and con- tinued until the end of the war. , following the outbreak of malaria at salonika, sir alfred keogh, the director-general, army medical services, early in 1917 appointed a special malaria hospital in each command in the united king- dom, for the express purpose of finding a permanent cure if possible, and of treating the thousands of men who were being returned home sick with malaria from the eastern fronts, sir ronald ross being also appointed consultant in malaria at the war office. the fact that moderate doses of quinine will control actual attacks within a few days was fully verified, and with very few exceptions. almost every form of treatment that had ever been suggested —enormous doses of quinine reaching 100 grains per diem; smaller doses continued for three weeks or more; additional medication with arsenic and other drugs; continuous doses lasting for a month, and various kinds of interrupted dosage—all proved uncertain, vhirty grains of quinine, continued every day for three weeks, proved a failure. intramus- cular injections and even intravenous injections did no better. men who were presumed to be cured relapsed again after returning to duty; a large proportion of those infected with malaria became 7%3 almost useless for further service. numerous nostrums advocated for malaria proved valueless, the only exceptions being one or two arsenical preparations, which, however, were no better than ordinary quinine, now, in all these attempts, treatment had seldom been continued for more than one month and rarely or never for more than two months —owing, of course, to military exigencies. it was decided to deal with the large numbers of discharged soldiers by a longer period of treatment. in 1918 two whole divisions, full of malaria, had been brought from salonika to france and were there subjected to a longer course of treatment preparatory to their being sent again into the firing-line, the regiments arrived in an extremcly bad condition, were all placed in camps in the dicppe region, and the men were given 15 grains of quinine in solution once daily for a fortnight, fol- lowed by 10 grains of quinine in solution daily for 2} months more. the course, designed and carried out by col. j. dalrymple, had marvellous results, almost the whole of the two divisions being found ft for the front at the end of the three months. about the same time large malaria concentration-camps were established in england, where cases were given similar treatment, but for shorter periods: and it was found generally that: (1) doses of less than io grains daily did not suffice to prevent relapses even while they were being taken; (2) doses of ro grains daily did so suffice, except in about 6% of the cases, most of whom, however, relapsed during the first days of the treatment; (3) 15 grains a day reduced the relapses still further, but only to about 4 or 5 °%. the long-continued treatment of malaria was now proved to be satisfactory, and was extended to pensioners also. in one london clinic alone nearly 30,000 pensioners have been treated in this way. the results have been admirable, and probably very few men who have taken the treatment properly have returned. but the 10 grains of quinine must be taken religiously every day, and it is well to asso- ciate this with or follow it by a course of arsenic. quinidine replaced the quinine in a small number of these cases. good food and care in building up the general health are important factors in overcoming malarial infections. empirically, three months appear to be enough, but in obstinate cases four months might be better. there are rare individuals who are hypersensitive to quinine or who may be desen- sitised prior to the introduction of the standard dosage. even long courses of treatment will not necessarily cure people who are subject to reinfection during treatment; and it is even possible that they are not so elfective during the first six months or the first year of infec- tion as they are later. the results described above were obtained among returned cases in britain. other salts of quinine besides the sulphate were tried. the hydrochloride and bihydrochloride affect the digestion less and seemed to be as satisfactory. the prevention of malaria on the battle-front was always difficult and sometimes impossible. mosquito-reduction in the face of enemy fire is impracticable; quinine prophylaxis was under such conditions disappointing; and the armies were obliged to fall back upon mos- quito-nets and mosquito-proof tents and bivouac shelters—which were carefully designed by the british war office. better results were obtained at the bases of operations, especially in palestine; and a very successful campaign of mosquito-reduction was carried out by col. j. c. robertson at taranto in southern italy. bretrogcrariy.—p. armand-delille, p. abrami, g. paisseau and hf. lemaire, malaria in macedonia, ed. by sir ronald ross (1918); war office, observations of malaria by medical officers of the army, h{.nls.o. (1919); m. watson and others, the prevention of malaria in the federated malay states (1921); sir r. ross, memoirs: with a full account of the great malaria problem and its solution (1923). (r. ro.; w. b.-a.)