mosquito eradication schemes

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local medical and panel committees which haveso long and so smoothly discharged similar though,less extensive duties : they will have no statutorilyprovided funds from which to pay the expenses oftheir officers or members. Under the National HealthInsurance Acts, a sum of up to 2d. per patient per yearcould be levied from the practitioner’s remunerationto provide a fund from which the expenses of thecommittee could be met. The new Act makes no such

provision, and it will therefore be necessary for thelocal medical committees to obtain the consent oftheir constituent practitioners to a voluntary levyfrom their remuneration to meet these expenses,which now, owing to increased duties probably involv-ing more frequent meetings (to say nothing of risingoffice and travelling costs), may well be higher thanin the past. Any- such levy-needing, as it does,to be deducted at source by the executive council-would probably have to be arranged by a voluntarilysigned request sent by each practitioner to the clerkof the council. In other words, each doctor wouldhave to " contract in ’’ to pay this levy ; for it isdoubtful whether the council would be able, or ifable willing, to agree to the alternative of makingthe levy universally except where the practitionercontracted out " of paying it.This financial problem will doubtless be one of the

first of the domestic difficulties the local medicalcommittees will need to solve. In view of the con-siderable services, and the protection, they willbe giving their constituents, they may fairly expectevery practitioner to be willing to pay his share.

That the practitioner should be effectively repre-sented is a necessity for the health of the newscheme.

Mosquito Eradication SchemesTHE remarkably successful campaign against the

mosquito Anopheles gambice, the African malariavector, directed by F. L. SOPER and D. BRUCEWILSON in Brazil a few years ago, was of more thanimmediate or local value, for it encouraged similarattempts elsewhere. The " control " of mosquitovectors of disease, as previously practised, consistedmerely in keeping the numbers of dangerous speciesbelow the critical level; but now for the first time

complete extermination from an area was shown tobe a practical possibility-in the particular circum-stances. It will be remembered that in BrazilA. gambiœ was an invader from tropical Africa ; inEgypt in 1943 the eradication scheme was alsodirected against an invader (the same species) fromthe Sudan ; in Cyprus and Sardinia, however, whereeradication operations are now proceeding, the malariavectors are indigenous. The disadvantage of havingto deal with well-established species may to someextent be offset by the fact that these places areislands, and the present workers have an advantageover the pioneers in possessing the synthetic insecticideD.D.T., which is cheaper and less laborious to applythan paris green or oil, though these substances maystill have to be used under some conditions.In contrast with the earlier control methods, which

were more leisurely, total eradication involves some-thing like a blitzkrieg, where every detail is thoughtout beforehand and a start is made only when all

possible preparations are completed. Once begun, thework is carried on at tremendous pressure, continu-ously and unrelentingly to its final conclusion. Themental and physical strain, on administration andworkers alike, is heavy, and many difficulties and

complications, some seeming deceptively trivial atfirst sight, have to be overcome at short notice.A thorough knowledge of local anopheline mosquitoesand their habits is of course essential. The whole-hearted cooperation of the local authorities must besecured, so that once they have been persuaded thatthe total eradication of malaria vectors has a reason-able chance of ultimate success there will be no lackof funds ; for the initial capital outlay is compara-tively large. Plans must be made for the campaignto be continued for two, three, or more seasons.Experience in Greece and Cyprus has shown that thepopulation, though they may not be particularlyinterested in eradicating mosquitoes and malaria,their old familiar enemies, may be won over afterthe campaign has started when they see the effectof the D.D.T. treatment on flies, bugs, and other insectpests, and notice the consequent reduction in suchdiseases as typhoid and dysentery. (Precautions havehad to be taken to protect bees and silkworms.)Those employed in the campaign must discard anyideas they have previously held about mosquitocontrol and must become eradication-minded. The

checking and counter-checking of each other’s work,which forms a necessary part of the scheme, mustbe undertaken in good faith by everybody, withoutany mistrust or ill-feeling. A large number of forms,records, and instructions are involved, and the

irritating but vital necessity for the punctual renderingof negative returns has to be impressed on everyworker. There will inevitably be some desertions toless hazardous jobs, some siokness and neglect; andthe organisation must be ready to act at once on suchoccasions. The actual operators will find their dutiesoften dirty, tiresome, and strenuous ; in Cyprus, ithas been found worth while to issue them withoveralls, soap, boots, &c. Equipment should be

simple, reliable, and strong but not heavy, for

operators commonly spend long periods away in

rough country ; it should also be easily replaced andrepaired, and should be designed to save the operatorsfrom too much stooping, which will lead to backacheand the consequent missing of breeding-places whichare difficult to reach. Special measures must betaken against the reintroduction of vector speciesby ships and aircraft and the transport of mosquitoesby vehicles from one zone to another. Each newplace attacked will provide a fresh crop of localproblems.The campaign in Cyprus is now about to enter

its third and perhaps final season. Here the chief

anophelines are A. sacharovi, A. 8UPerpietus, andA. claviger.

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The Karpas peninsula was apparentlycleared in the first season and the middle of the islandin the second. The Sardinia campaign began in 1947after a preliminary survey, made the year before,had shown that the main vector was A. labranchiœ.These projects are being keenly watched by adminis-trators as well as epidemiologists in all the malarialcountries, and it is to be hoped that similar schemeswill soon be in operation in places like Mauritius,Zanzibar, and the West Indies.