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Handung Kuru. These are long sticks made of some preparation of Sandal wood, which when burnt give off a white smoke with a not unpleasant odour, and is sup- posed to drive away mosquitoes.
Kata Kumanjal. This is an olco-resin, which is burnt for the same purpose.
I need hardly say that the people have great faith in these methods of ridding themselves of mosquitoes.
Hindoos, Buddhists and Mohammedans are peculiarly open to mosquito infection because they attend all-night services in their temples and because they wear but slight amount of clothing.
Class III-These people do not protect themselves in any way. They are more or less naked and their children are quite naked.
Natives do not protect themselves by rubbing their bodies with any ointments, odours or anything of that nature.
IV. The Cultivation of Rice.
Rice is extensively grown in Ceylon and, as is well known, requires a quantity of water.
The fields are banked by the low mud banks and are artificially inundated with water which slowly flows over the fields and is then allowed to settle.
It gradually gets absorbed into the earth, leaving little pools of water in which I have found Anopheles larvae (Figures 11 and 12.)
Nor would these rice fields be improved by the continuous submersion system, for this is in use in parts of Italy and the anopheles larvæ have been found to flourish in its slowly flowing waters.
It might be said that the cultivation of rice is "a trade harmful to public health." So far as I know there is no legislation with regard to rice fields and the building
of houses, but in Italy a law of 1866 says:-
The cultivation of rice is permitted at the distances from the blocks of houses -and under the conditions prescribed in the interest of the public health by
special regulations.
The Province of Cronona [? Cremona] published regulations:-
Rice fields must be distant from a town, village or house of inhabitants:
3 Kilometres-more than 10,000.
3,000 Metres--10,000
2,000 Metres-10,000-3,000
1,000 Metres-3,000-300
400 Metres-300-30
200 Metres-30-1
As regards Ceylon it appears to me to be almost impossible to regulate rice cultiva- tion, but new houses could be prevented from being built low down near rice fields, and should only be allowed at a distance therefrom and at an elevation above them.
V.—Swamps.
Ceylon appears to me to be as much the land of swamps as West Africa is. Every- where in the valleys which I have seen there are swamps, and the nooks and corners of these swamps must be quite as good a place for the anopheles larvæ to live in as the swamps of Africa.
It appears to me to be impossible to get away from swamps, and, what is practi- cally the same, rice fields, in Ceylon.
The difference between West Africa and Ceylon may possibly be the scarcity of the parasite in Ceylon in the anopheles.
VI.-The Education of the People with regard to the Causation and
Prevention of Malaria.
The people and even the educated people here seem to believe implicitly that malaria is due to drinking bad water, perhaps because typhoid and malaria are not always distinguished by them.
A very simple pamphlet in Sinhalese illustrated by simple but accurate wood cuts of the leading features of the disease and its prophylaxis might be given to the Head- men, and perhaps very simple lectures in the vernacular or in English illustrated by lantern slides might be given at a few of the principal towns of Ceylon.
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The best way to educate the people is to begin in the schools. In certain schools instruction is given in sanitation, and if in this class a little simple instruction was given as how the mosquito by biting people produced malaria, good results might ensue.
VII-The Governmental, Medical and Apothecary Services with regard to Malaria.
I would suggest that from time to time a doctor at an out-station who was not conversant with modern methods of research in Malaria should be encouraged to come for two weeks to the Medical College in order to study these methods.
The Apothecaries.-These people are often sent alone to remote stations at times of an outbreak of Malaria.
I therefore suggest that they should be taught during their course of study in the Ceylon Medical College how to take blood films and how to recognise Anopheles and its larvae, and how to apply the methods which ought to be adopted in villages, &c., to diminish the epidemic.
A very simple pamphlet of directions concerning the methods of making blood films, &c., might be given to medical men and apothecaries.
PART III.-The Prevention.
I. Introductory.
The prevention of malaria from a practical point of view appears to me to resolve itself into two great divisions.
(a) The prevention of infection of man by the anopheles. (b) The prevention of the infection of the anopheles by man.
And it is under these two heads that I propose to discuss it.
The principal points of interest about Ceylon with regard to malaria are these:-
1. Ceylon is an island.
2.--The malaria is only epidemic in certain localities, therefore at first sight it
would seem to be easy to deal with it, but
3.—Malaria is constantly being introduced into Ceylon by the coolies from
India.
Now these coolies are most necessary for the trade of Ceylon and no means could be taken to exclude in any way those carrying the parasite.
But I feel sure that a great deal could be done in a space of time, say for examplė 10 years, to diminish the disease.
I do not think that rapid methods will be nearly so effective as gradual well con- sidered steps.
My belief is that the best systematic method of preventing malaria is to prevent the anopheles from getting the malarial germ into its body.
II.-Prevention of the Infection of Man by the Anopheles.
The various means of prevention of the infection of man by the anopheles may be divided into two classes.
(a) Those applied to the mosquito and its larvæ.
(b) Those applied to man.
A.-Those applied to the Mosquito and its Larvae.
These may be sub-divided again into two Classes:-
1. Those applied against the life of the larvae. 2.-Those applied against the life of the mosquito.
1. Those applied against the life of the larvae.
These may be classified into:-
(A) The prevention of the formation of pools of water suitable for the life of the
larvae.
(B) The destruction of the larvae.
(A) The prevention of the formation of pools of water suitable for the life of the larvae: --
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Under this head come all schemes associated with:-
1. The prevention of the inundations from rivers, lakes, &c.
2. The drainage of swamps, &c.
3. The removal of ground water.
4. The removal of small pools.