anopheline mosquito, ponds from breaks in irrigation ditches, log flumes, patches of water left by overflowed rivers, water standing in tin cans are all favorable places.

Destroying the Mosquito

The solution of the malaria problem in any district therefore depends upon the destruction of the anopheline mosquito. This can only be accomplished by the control of the mosquito breeding places. The control of breeding places involves permanent and temporary work, and may be carried out by several methods, depending upon local conditions. Drainage wherever possible is in the nature of a permanent measure; the cleaning up of grass, brush and vegetable growth from the sides of rivers, canals, ditches, etc., prevents the breeding of mosquitos in slack water places; the keeping in proper repair of flumes and water courses, such as irrigation ditches, to prevent the formation of standing pools is of great importance. The cleaning up of garbage heaps where empty cans and other receptacles can retain rain-water is necessary.

Where permanent treatment is not possible, temporary measures may be considered supplementary to permanent work, and one of the most important is oil. The oil to be used should be of such a character as to spread a thin film which remains upon the surface of the water as long as possible. Oil should be applied wherever wrigglers are found. The time of repetition of the use of oil depends upon several factors; as a rule, twelve days in summer, and under cooler conditions varying intervals up to three weeks. Where oil is impracticable, as, for instance, in the tule lands, the use of top minnow and other mosquitofeeding fish should be considered. It may be possible that the problem of irrigation in the rice fields may be met by the use of such fish.

House protection is necessary and can be rendered efficient by the drainage of all pools, marshes and wet lands near the house, the cleaning up of banks of springs so as to allow free access to the banks for destroying larvae, and the use of oil upon ponds which are undrainable, preventing the access of the anopheline mosquito to man by the removal of brush and tall trees about the house in which the mosquito may rest during the day. The anopheline mosquito does not live in the sunlight nor does it travel far from the breeding place. The furthest distance that the mosquito has been known to travel is two miles where a bright electric light or wind has enabled her to increase her normal sphere of activity which is one-fourth to one-half a mile. House screening is of value if properly carried out. Nothing larger than the best one millimeter mesh screen should be used, as the screening of windows

and doors should be done in such a way as not only to prevent the ingress of the insects while they are closed, but also to prevent their entering the house whenever a door is open.

Anti-Malaria Campaigns

Crusades against malaria in California may be said to have begun with the activities of Professor William B. Herms, University of California, who conducted five campaigns as follows: two in Placer county (Penryn and Roseville), one in Butte county (Oroville), one in Tehama county (Los Molinos), and one in Kern county (Bakersfield). beginning with the year 1909. Unfortunately these crusades did not cover all of the malaria infected districts of the state. Marked results were obtained for a time, but the chief criticism lies, however, in the fact that sufficient funds were not provided to insure permanency in these operations with the result that as soon as public interest diminished, as it necessarily will, sanitary conditions comparatively soon relapsed to a great degree into their previous state. The work of Professor Herms, however, has had very important results from an educational standpoint in its application to administrative measures. It was demonstrated that public education as carried on by lectures, lantern-slide exhibitions, the co-operation of public school children by means of competitions, essays, lectures and similar means. were of emphatic importance in creating a public sentiment which rendered acceptable the sanitary regulations necessary, and insured intelligent cooperation of the community and of the press. It was found that in all instances any adverse sentiment was easily overcome, that by a plain exposition of the entire problem most valuable assistance resulted upon the part of the newspapers, and that when remedial measures were instituted and regulations imposed, universal co-operation ensued, and the work was followed by very satisfactory results. The ultimate conclusion to be drawn is that permanency and completeness of results could best be obtained by the formation of a permanent organization for the control of the situation, and centralization to as great an extent as possible.

Mosquito-Control Districts

The legal machinery existing today which can best be used for the control of the malarial problem is the recent law providing for the establishment of mosquito control districts, and the organization of the State Board of Health. The State Board of Health has at its command a consulting parasitologist who is the professor of parasitology of the University of California; the executive secretary of the board,

who is an expert epidemiologist; also the director and several bacteriologists of the department of communicable diseases, as well as a small staff of field inspectors, which unfortunately is limited. In the national forest reserves, through the courtesy of the district forester, all forest rangers are being invested with the powers of inspectors of the State Board of Health, and although this arrangement has been in effect only about two months its advantages have been seen. For example, in a certain town, a forest ranger finding an important mosquito-breeding place which as a source of mosquitos was causing considerable annoyance in the town, reported the situation to the Sacramento office, and received the necessary instructions by which, with a small amount of work, he himself remedied the trouble.

The policy which has been adopted by the Board of Health is that its chief office must be at the present time advisory on account of lack of field men, and that it shall send into the affected regions available experts who shall carry on a campaign of education and encourage the organization of mosquito control districts. The actual work of controlling mosquitos rests with each community and the success of efforts in this direction will depend upon the amount of public interest that can be brought to bear in the matter. There is no doubt that if the counties in the Sacramento and San Joaquin valleys could through the action of their various communities establish themselves entirely as mosquito control districts malaria would be reduced in California eighty per cent. in a comparatively short time. The difficulties under the existing scheme for malaria control lie in the cumbersomeness of the scheme, and also in the fact that it is rather difficult to establish control districts over all the territory necessary. If the State Board of Health had sufficient funds, which, at the present time is not the case, to employ field men who would be under the control of its central office, and who could be detailed to work in whatever part of the State it might be found desirable, there is no doubt that malaria could be controlled in the State of California in a comparatively short time. Quoting from Dr. Herms:

"The average cost of protection, giving to each field agent an area of ten square miles to cover, which is possible with some assistance, is about seventy-five cents per day per square mile. At this rate the cost of an average crusade covering an area of ten square miles is about $16,000 for one season, covering a period of eight months. Estimating the cost of quinine and doctors' bills at $20 per family, with not more than one hundred families within the ten-square-mile area (a low average), plus twenty-five per cent. reduction in earning capacity per family with an average income of $800, gives a total loss of $22,000. Ordinar

ily it is possible to reduce the total amount of malaria by at least fifty per cent. in one season. At this rate there is a saving of $9,400 in ten square miles."

Your committee estimates that the malarial situation should under a centralized organization be under complete control certainly within three years and that the cost of the work should decrease very fast after the first year's work. Undoubtedly by the end of two years there would remain very little to be done. Under circumstances existing at present, however, every encouragement should be offered for the establishment of local control districts and it is gratifying to be able to state that some six or eight such districts are in process of formation at the present time. The State Board of Health has taken the initiative toward stimulating interest in the formation of control districts wherever possible, particularly where activities in this direction were not already evident, the worst districts receiving the first attention. The State Board of Health sends its experts to make inspections and to give advice in mosquito eradication whenever requests are made, and whenever in its judgment work should be undertaken against the mosquito. At the regular meeting this month, the State Board of Health ordered a mosquito control survey of the entire Sacramento valley, which will be carried out by Professor Herms, the consulting parasitologist, with the assistance of others from the University of California. The object of this survey will be to determine the varieties of mosquitos throughout the Sacramento valley, and to determine which types are the ones which are the carriers of the malaria parasite. In the Philippines considerable time and money was expended uselessly in destroying mosquitos which were found later to have nothing to do with malaria; and while it is granted that all mosquitos are a pest, it is more important from the standpoint of public health that concentration of effort should be directed to those places where malarial mosquitos breed. During this survey work, an educational campaign will also be carried on, and the formation of mosquito control districts will be encouraged.

Conclusions

In conclusion it may be said that as far as the existing legal machinery is concerned the work of mosquito control in California is well under way and the coming year will determine to what degree the arrangement can be made efficient. The mosquito season is about to begin and it is important that educational work and field work be carried on as fast as possible within the next few months. If a satisfactory diminution of malaria does not result within the next eight months, and if satisfactory local machinery of a sufficiently permanent nature shall

not have been established, it will be necessary to conclude that the mosquito control district law is a failure. The plan employed by the State Board of Health since the first of December, 1915, for the eradication of rabies in Modoc county has proven a success and the same system could be used against malaria. At the beginning of the work against rabies in early December, the county was divided into seventeen districts, each in charge of a field inspector with several supervising inspectors and a chief inspector. With this organization very rapid and satisfactory work was accomplished, to such an extent that by another month the men will probably be withdrawn.

Your committee therefore takes the liberty to recommend:

First, that mosquito control districts be formed which shall cover all malaria infected areas in California and that this be done as rapidly as possible.

Second, that if by the end of the year 1916 this plan be found ineffectual or unsatisfactory, the Legislature should appropriate funds to be used by the State Board of Health to employ a sufficient number of inspectors to undertake the field work of malaria extermination under the present authority of the State Board of Health.

Respectfully submitted,

GEORGE E. EBRIGHT,

Chairman.

Remarks by President Hodghead

THE PRESIDENT: I had expected to ask Dr. Wilbur, at the close of the reading of the formal papers, to summarize the discussion, but the doctor has to attend another meeting during the evening, and I will ask him at this time to give his views on the subject, and to comment on the committee's report.

As I stated, Dr. Wilbur is the general chairman of this section of the Commonwealth Club on the health of the state. The next most responsible position which he occupies is that of president of the Stanford university. When he recently assumed the duties of that office, we asked him if they would interfere with his work as chairman of this committee, and he said not at all, he would go on with the work. I will now ask Dr. Wilbur to speak generally on the administrative work of public officers in preventing the spread of malaria, and incidentally to make such comments as he may desire on the subject of the committee's report.