Statement by Dr. Ray Lyman Wilbur

DR. WILBUR: This country paid an enormous price for introducing the African into the southern states. Part of that price was the introduction of the hook worm and malaria and other tropical diseases into the southern part of the United States. Part of the price we paid for finding the gold in California was introducing malaria into our beautiful valleys, and one of our problems is to get rid of that malaria.

It seems a pity that right here in California, with the civilization that we have, with the knowledge that we have of malaria and its relationship to the mosquito, we tolerate it the way we do, when this committee's report shows that it is merely a matter of dollars and cents to get rid of the whole problem. We could eliminate the carriers we have, we could destroy the mosquitos that infect individuals, and we could protect the workers coming to the malarial communities in the future.

In other words, this is a problem that can be solved. Compared to tuberculosis it is a very simple problem. Of course, there are many difficulties in it. One of the things that makes me most hopeful about the solution of this problem is the value that we place on water here in California. When I was a boy in Southern California, irrigating ditches were made of dirt; but they found that that was too expensive. that it paid them to put in concrete and pipe it under the ground, in order to get rid of as much evaporation and waste as they could, so that they could plant more oranges and make the different lands there more productive.

Now, if we could create-and I think we will eventually-in the malarial parts of California where there is irrigation, that type of conducting ditch, a large part of this problem would disappear at once. It is the dirt ditch, it is the pool, it is the little eddy, and the corner where the water collects, where these mosquitos breed.

I had a chance, a summer or so ago, to go over a number of these large California ranches in the malarial districts. The waste of water to one coming from Southern California where water was considered worth while, seemed considerable, and along with that waste there was a multiplication of these breeding places. It is very expensive for these ranches to put in a large water system, but I think the need for economy of water will compel many of the large ranch holders to do that. Certainly it will come about in communities where water is of value, and it can be introduced in those communities where the government is taking an interest in the distribution of water. That one thing done, a great step forward will have been taken.

Not only have we the problem of the mosquito, but we have the problem of the carrier. Of course, it was the carrier that brought us the different kinds of malarial parasite. Dr. Ebright has shown how our immigrant laborers, and some of our present citizens, brought in this infection from different parts of the world, and it is those carriers that we keep introducing and redistributing throughout California that make a large part of our problem.

In Italy it was found that the malarial problem was too great to be settled by any engineering scheme or any drainage proposition, so that it was largely settled by the administration of quinine in sufficient quantities to kill the malarial parasite in the whole population. We could introduce such a system here in California. We could introduce that system in every big ranch in California without great difficulty. We could at least see that quinine is sold, instead of these various patent medicines that cost a good deal more than ordinary quinine, anè I think our State Board of Health should try to protect the health of the population in malarial districts in that regard.

If we should see that every one employed on each of the large ranches in California is given enough quinine to be quite sure that the parasites have been killed within them, and then if we watch and see that the laborers that come out to that ranch are not carriers, we will settle a large part of the more difficult aspects of the problem at once.

We must find out which mosquitos to attack, and then we must attack them. We must also make a study of carriers, and when carriers are discovered, they must be treated; and we must ask those who own and control the large ranches in these districts to co-operate in bringing about the extermination of the malarial parasites in the bodies of their laborers. When this is done a large part of our problem is covered.

The trouble is this: We look on malaria-take the population as a whole as we do on hives. It is annoying; it disappears before long, and we do not pay much attention to the cause. We do not pay much attention to the cause of the hives. We do not study the cause of the malarial problem or it would not go the way it does.

I am sure that Professor Herms will give you an idea of what can be accomplished in local communities, where his work has been carefully introduced and where there has been an education of all the members of the community. If information that is in the hands of the medical profession and of the health officers was also in the hands of all of the citizens, you would be surprised what a change there would be in this world in its relationship to disease. The whole thing would be made over. Your points of view in regard to diseases would no longer be those of toleration; they would be those of obliteration of the

disease. You would not be thinking of what you personally suffer, but how long it would be before the human race obliterates that disease. When malaria can be practically obliterated and kept obliterated, and it is only a matter of dollars and cents, why can we not all join together to bring about that result? (Applause.)

Remarks by President Hodghead

THE PRESIDENT: It is rather unfortunate that we have not many thousand people here to hear these reports and comments on this important subject, rather than the number that we have tonight; but the reports of this meeting will be published and sent to all of our members and the libraries of the state, and will reach a great many persons and ought to be productive of great good.

The next topic that will be discussed this evening will be the field work on malaria in California, by Professor William B. Herms. Over in Berkeley when a fly bites us, why, we telephone for Professor Herms; and if we allow conditions to exist there which attract flies, Professor Herms telephones to us. In that way we keep up a complete system of co-operation. He is professor of parasitology of the University of California, is the consulting adviser of the State Board of Health, and is undertaking the field work in the Sacramento valley for the prevention of this disease. His remarks will be illustrated by lantern slides.

Methods of Malaria Control

PROFESSOR HERMS: It goes without saying that I am very much gratified this evening that after nearly eight years of almost single-handed work against what I early believed to be one of the most important economic problems the State of California has had to meet, namely malaria, that there is now behind the work not only the State Board of Health, but also the leading business men, and that this evening the Commonwealth Club is listening to the knock at the door and is willing to participate in the attempt to control malaria, and to drive it out of the bounds of our beautiful state.

Perhaps some of you remember a paper which the speaker read at one of the luncheons about six years ago, entitled "Protecting California's health resources through the control of disease bearing insects." I still maintain the position taken at that time, namely that there are many localities in California where malaria is virtually the only blight, and these include some of our most fruitful and beautiful portions of the state, made almost unhabitable for the white man, and now having been largely turned over to the Oriental, who apparently can get along, tolerably well at least, though infected with malaria.

I maintain that successful malaria control in California is approximately synonymous with mosquito control. This I have maintained. from the beginning, and in this I believe all must agree who have carefully studied the situation. Certain other matters are involved, such as quinine prophylaxis and treatment, which Dr. Ebright has already mentioned, and which will again be referred to later.

Kinds of Mosquitos in California

Two or three things are fundamental in our effort to control malaria. If it is correct, that successful malaria control and mosquito control are virtually synonymous, then there are two things which must be done to begin with. First, a very careful mosquito survey of California must be carried out. The breeding habits, life history and geographical distribution of all our species must be known. The better equipped we are in this respect the better able will we be to control malaria.

My travels have taken me into practically every county repeatedly during the last few years with the result that a collection of several hundred mosquitos has accumulated in my laboratory upon which a certain estimate can be based as to the kinds of mosquitos occurring in the state. There are, however, many localities which have not been studied carefully or have not been touched at all. I am very glad that the State

Board of Health has authorized such a survey to be made during the coming summer. At least a good beginning will be made.

A preliminary survey of the state with regard to mosquitos has revealed several species of anopheline mosquitos, which fact puts us face to face with the question "which of these anopheline mosquitos are carriers of malaria and which are not?"-a matter not so difficult to ascertain under proper conditions.

The systematic relationship of our anopheline species is at present in a somewhat chaotic condition, but I believe that when all is cleared up it will be found that Anopheles quadrimaculatus is the most dangerous mosquito in California.

The second thing necessary is a careful malaria survey to ascertain the distribution and occurrence of the various species of malaria parasites (Plasmodia) existing within the bounds of California. This may have an important bearing on control due to probable differences in the treatment of carriers particularly.

As far as our limited knowledge goes it is evident that the most widespread and abundant type of malaria occurring in California is the tertian, extending from the northern Sacramento to the southern San Joaquin valley. We have also considerable aestivo-autumnal malaria in the northern Sacramento valley, extending possibly as far down, in certain foci, as the lower San Joaquin valley, and there are at least one or two foci of quartan malaria in the upper Sacramento valley.

Waging a Mosquito Campaign

It is necessary to know which of the anophelines are the carriers of the various types of malaria in order to combat the disease with greatest efficiency. To the layman it makes not a particle of difference whether we are dealing with Anopheles occidentalis, Anopheles quadrimaculatus, Anopheles punctipennis or the ordinary Culicine mosquito. It is necessary, then, that the crusade be directed against mosquitos in general, hence it becomes a mosquito control campaign.

Education is the basis of all our work; this involves public lectures, distribution of literature, use of exhibits and extensive publicity. Some of the lantern slides which I shall show shortly will illustrate the educational features. It is a set of slides which I usually take with me to illustrate lectures on malaria mosquito control.

To successfully conduct a mosquito campaign ample financial assistance is necessary, as well as an efficient organization under expert ieadership. At the meeting of this Club above referred to the speaker emphasized his conviction that the State of California by special act ought to set aside not less than $200,000 to be used in the control of