Report on the prevention of malaria in Cyprus / by Sir Ronald Ross ; presented to both Houses of Parliament by command of His Majesty.

  • Ross, Ronald, Sir, 1857-1932.
Date:
1914
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Licence: In copyright

Credit: Report on the prevention of malaria in Cyprus / by Sir Ronald Ross ; presented to both Houses of Parliament by command of His Majesty. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    many of the children as they could in them. rlhe children so examined were divided into four classes, namely: (1) Those without enlargement of the spleen; (2) Those with small enlargement; (3) Those with medium enlargement; (4) Those with great enlargement. For reasons given by me in my book, I class the enlargements of the spleen so found under the numbers 1, 3, 6, and 9, because these numbers are likely to give roughly the comparative sizes of the organs with no enlargement, and small, medium, and great enlargement respectively. Of course, different medical officers are likely to differ considerably as to what exactly they consider to be a small, medium, or large spleen; but, nevertheless, for a large public health census of this nature, the figures are suffi- ciently accurate to give us a very good test as to the amount of malaria which is present, and which indeed has been present for some time past, in a given area. The proportion of all the children with any enlargement of the spleen at all is called the spleen-rate. Another ratio, which I call the average spleen, is obtained as follows. The number of children with no enlarge- ment is added to three times the number of children with small enlargement, to six times the number of children with a medium enlargement, and to nine times the number of children with a great enlargement; and the total so obtained is divided by the total number of children examined. Obviously this figmre gives the average size of the spleen for all the children concerned, according to the principles mentioned above. There is always a certain amount of observational and also statistical error in all such estimates; and these can be taken into account if we please. But we are not seeking here an absolutely exact measurement, but only one which gives approximately the degree of prevalence of the disease in Cyprus. The simple spleen-rate is the most free from observational error; but even this is subject to a considerable amount of it— a point which I now understand more strongly than before. This arises from the difficulty of saying whether a spleen which is just palpable under the ribs is really a pathological enlarge- ment at all, especially in the case of very young children. It has been stated that the spleen of healthy infants is often palpable, and the question arises whether it is not sometimes palpable also in the case of slightly older children. This question cannot be fully answered without making a similar study of a large number of children in non-malarious countries. I propose to undertake the work shortly in England, but cannot possibly complete, it in time for this report. On the whole, I think that Dr. Patrick and myself accepted as enlarged spleens those which I should hardly have accepted as such in India or Mauritius—a circum- stance which tends to increase the spleen-rate of Cyprus in comparison with those countries. But I do not think that this point will make any really great difference in the total figures obtained. Dr. Cleveland’s results are as follows:—Out of 9,178 children examined in Cyprus 2T82 per cent, were found to have enlarged