authorities work hand in glove with the various organizations equipped to do executive work along definite educational lines. It is essential that co-operative assistance be secured from the medical profession, the school authorities, the clergy, the public press, the sociological workers, including women's clubs, civic clubs, Boards of Trade, philanthropic agencies, charitable organizations, church organizations, child welfare clubs, little mothers' clubs, and a thousand and one kindred societies. The efficient public health officer, with one hand upon the executive side of his work, with the other hand constantly cultivates the assistance and invites the co-operation of these valuable organizations in such a way that health teaching is carried into the home of every citizen. These organizations can do as much, in some instances more, in protecting life and health than can the health officer and his staff. The teaching of the health officer may reach the ears of a goodly number of citizens, but with the assistance and co-operation of the numerous members of each of these associated organizations, the teaching can be increased many hundred fold and may be carried into the homes in the community in a way that will count in life and health.

Probably no stronger argument could be produced in favor of a Board of Health than that of securing the constant cooperation of the various allied organizations that can do so much in public health work; and an executive officer who not only can secure their assistance, but who is so fully alive to the needs of the municipality which he represents that he may apportion much of the work to these various societies and outline or suggest new lines of effort for these valuable agencies to take up.

The little scheme of organization herewith submitted gives a fairly graphic demonstration of the ties that should exist between the local executive officer and his various administrative branches of work on the one hand, and co-operative association with the various agencies always ready to work at his elbow, bound to him by close ties of friendship and with the strongest desire to be helpful in making the community better, happier and healthier.

MALARIAL FEVERS.

BY DR. CHARLES T. C. NURSE.

READ APRIL 24, 1912.

Malarial fever was recognized in the days of Hippocrates as early as 460 B. C.; but from that time until 1880 the etiology appears to have been obscure. Prior to 1880 the causation of malaria was considered to be the effect of an infection or intoxication resulting from the miasma or foul air of marshes, swamps and damp soils; hence the name of "malaria", which means foul air.

In 1879 Klebs and Tomasi Crudeli isolated a bacillus from marshy soils, which they termed the bacillus malariae and claimed that it was the cause of malarial fevers; but their investigations were not confirmed by other scientists along this line.

However, in 1880 Laveran discovered the haematozoon or plasmodium malariae occurring in the blood of individuals suffering from the so-called miasmatic fever, his observations were later confirmed by Marchiafava and Celli of Italy and Councilman of this country. A little later Major Ronald Ross in India discovered the presence of the malarial plasmodium of Laveran in the bodies of a certain genus of mosquitoes, namely anopheles. The third link in this interesting investigation was supplied by Manson of England, who carried out a series of experiments in the Roman Campagna in Italy and demonstrated without a doubt that the plasmodium malariae was transmitted to man by the bite of an infected mosquito. It is somewhat interesting to mention in this connection, however, a curious fact mentioned in the Lancet of 1905, that Sir Henry Blake, Governor of Ceylon, while making an investigation into the incidence of malaria in that island, was surprised to find in the medical works of Carata Susruta and other ancient Singalese writers of the sixth century, mention of the fact that there were sixty-seven varieties of mosquitoes and four kinds of fevers caused by the bites of mosquitoes, so that after all it seems that the mosquito-malarial theory was known 1400 years ago.

There are three accepted forms of malarial fever corresponding to the three types of malarial organisms which have been described.

I.

Tertian fever produced by the tertian malarial organism; this parasite is the largest in size, almost as large as a red blood cell, its cycle of sporulation occupies forty-eight hours, hence the periodicity of its paroxysms would be every third day.

2. Quartan fever produced by an organism which is slightly smaller than the Tertian parasite and differs in certain morphological characteristics; its cycle of sporulation occupies seventy-two hours, this parasite would produce a paroxysm every fourth day.

The Quotidian fever is not considered to be produced by a separate organism, but may be produced by a double infection of the Tertian or a triple infection of the Quartan.

3. Aestivo-autumnal or remittent fever, is produced by a parasite which is smaller than either of the foregoing, its cycle of sporulation is uncertain, but is about forty-eight hours; unlike the other varieties, sporulation does not take place in the general blood stream but only in the spleen and bone-marrow. It does not seem to produce any typical brood formation, but sporulation appears to be continuous, so that it produces a fever which is remittent in character.

SYMPTOMS.

Malaria is manifested in the individual by a paroxysm which is repeated every twenty-four, forty-eight or seventytwo hours, according to the variety of the invading parasite. The paroxysm consists of three stages:

First. Chill or cold stage.

Second. Hot stage.

Third. Sweating stage.

The first stage or chill is ushered in by headache and pains in the limbs, severe shivering of the entire body, with chattering of the teeth, the face and tips of the fingers are cyanotic, vomiting, vertigo and dizziness are usually present; the skin feels cold to touch but the temperature in the axilla is found