Bleeding was the universal remedy at that time, and in 181(), Dr. Skey, (|UOted by Hexxan, remarked that it did not often happen that the blood of patients suffering from the Malta summer febricula had a buffy appearance ; he noted it once only in "28 cases. Also, in 1822, Lightbody noticed that the buffy coat was absent during the summer, in the sandfly season, but that it was observed in the autunm, when yellow fever was prevalent at Malta There is generally an initial leucocytosis in yellow fever.
The Army Medical Reports date from 1817, and the Statistical Eeports on the Health of the Navy from 18H0. We meet with excellent clinical pictures of sandfly fever in these volumes, and we learn how widely prevalent it was during the summer months throughout the whole Mediterranean area, including Gibraltar, Malta, the Ionian Islands, Greece, Cyprus, Crete, Asia Minor, and Egypt.
In 1905, Taussig' contributed a masterly article to the Wiener kUnische Wochenachrift on the short fever which breaks out every summer among the Austrian troops stationed on the Adriatic coast in Bosnia and Herzegovina. He adduced epidemiological evidence that the phlebotomus, a figure of which he gave, should be regarded "as the agent in the transmission of the disease. Our Indian investigators were thus forestalled, though McCarrison stated in a paper on a kindred ailment in Chitral, which he had studied in 1903 and 1904, inserted in the Indian Medical Gazette of 1906, " with regard to suctorial insects, sand- flies are those most likely to be implicated. Their appearance corresponds in a striking way with the appearance of the disease, and the fact that they are not found where the disease does not prevail may be more than a coincidence. Experiments in my hands have, however, failed to throw any light on this point. The very great difficulties in working with sandflics may be responsible for this lack of result." And further on, "the use of sandfl} and mosquito-proof curtains is also essential, as much for the sake of comfort as for the pr)ssil)le protection which may be afforded against the disease." Fooks, writing in the Indian Medical Gazette of 1908 and 1910 of an outbreak of about 100 cases of a similar fever in 1899, at Landi Kotal, a frontier post west of Peshawar, stated that he thought that sandflies were the means of conveying the infection, since there were no mosquitoes, but the sandflies were abundant. Hi^ opinion was confirmed by a study of another epidemic at Sialkot in 1907
