கவனிக்க: இந்த மின்னூலைத் தனிப்பட்ட வாசிப்பு, உசாத்துணைத் தேவைகளுக்கு மட்டுமே பயன்படுத்தலாம். வேறு பயன்பாடுகளுக்கு ஆசிரியரின்/பதிப்புரிமையாளரின் அனுமதி பெறப்பட வேண்டும்.
இது கூகிள் எழுத்துணரியால் தானியக்கமாக உருவாக்கப்பட்ட கோப்பு. இந்த மின்னூல் மெய்ப்புப் பார்க்கப்படவில்லை.
இந்தப் படைப்பின் நூலகப் பக்கத்தினை பார்வையிட பின்வரும் இணைப்புக்குச் செல்லவும்: Journal of the Ceylon Public Health Association 1961.12

Page 1
Communicable Diseases
JOUF
THE CEYLON |
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(Successor to Tr Society of Medical Offi
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VOLUME II
DECEMI

Number.
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JOURN
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(Successor to Transa Society of Medical Officers
b3H 2
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VOLUME II ()
DECEMBEI

IAL
JBLIC HEALTH
TION
ctions of the of Health, Ceylon.)
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R 1961

Page 6
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Page 7
CONTENTS
Editorial
Presidential Address
The Pattern of Communicable Diseases
in Ceylon
An Intestinal Parasitic Survey of an
Apparently Healthy Population in Ceylon
A Review of the Problem and Control
of Malaria in Ceylon
A Review of the Problem of Filariasis
in Ceylon
The Fight Against Tuberculosis
in Ceylon
Venereal Diseases and Treponematoses
in Ceylon
Leprosy Control in Ceylon
.Journal

Page
by Dr. V. NADARAJAH, L.R.C.P., & s.
(Edin.), L.R.F.P. & s. (Glas.), D. T.M. & H. (Lond.), D.P.H. (Eng.) From the Presidential addressed delivered to Ceylon Public Health Association
... 5
by P. ARUMA NAYAGAM, L.M.S., (Cey.)
M.P.H. (Mich.) Epidemiologist, Department of Health Ceylon ... 23
by V. SIVALIMGAM, M.R.C.P. (Edin.);
D.T M. AND H. (Eng.), L.M.S. (Cey.) Professor of Parasitology, Faculty of Medicine, University of Ceylon. 32
by T. VISVALINGAM, L.M.S. (Cey.), D.P.
H. (Lond.) Superintendent, Anti
Malaria Campaign, Ceylon.
..,
43
by M. H. M. ABDULCADER, L.M.S.
(Cey,) D.P.H. (Lond.) D.T.M. & H., (Eng.), F.S.s. Superintendent, Anti-Filariasis Campaign, Ceylon 101
by W. K. HANDY, T. B. SUBASINGHE,
B.A. (Cey.), and J. R. WILSON, M.D. (Lond.), M.R.C.P. (Lond.). Superintendent, Tuberculosis Campaign, Department of
Health Ceylon
.. 127
by Mrs. E. D. C. PEREIRA, L.M.S.
(Cey.), M.P.H. (JOHN HOPKINS UNIVERSITY). Superintendent, Venereal Diseases Campaign, Department of Health Ceylon... 149
by P. J. DE FONSEKA, L.M.S. (Cey.),
M.P.H. (Harvard), Superintendent, Leprosy Campaign, Department of Health, Ceylon ... 157
... 171

Page 8
... ਤੇ ॥


Page 9
V. NADARAJAH, L.R & s. (Glas.), D.T.M. & E
Presiden

C.P. & s. (Edin.), L.R.F.P. H. (Eng.), D.P.H. (Eng.). it 1961.

Page 10
..-1,


Page 11
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Page 12
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Page 13
JOURNAL OF THI
HEALTH A
VOL. II. (New Series)
EDIT THIS special number of the Ceylon Publi
the vital problem of communicable o hands that this problem is not so serious as presence was clouded and masked by the m emerging as significant challenges to the heal
It is therefore not surprising that, w cholera, with the appearance of small-pox on and with the virtual extinction of the one-t reckoned menace in the form of a group of these diseases are Tuberculosis, Filariasis, th are termed as “ pyrexias of unknown origin seem to flit in- and out of the health pictur fectious hepatitis, etc.
To combat these problems, special cas but most of these campaigns, however, coul owing to the country's long pre-occupation like Cholera, Plague, Small-pox and Malaria all out crusade against the new menaces.
In regard to Tuberculosis, for instanc lenge although of course we are seeing this nised efforts are being made to fight it with tional and domiciliary treatment and rehabil
Filariasis threatens perenially, a popi South Western coastal belt. The Campaign
Typhoid group of fevers are not ir undertaken as a routine activity in the Publ such as hookworm and round worm infestat illnesses take a heavy toll of the young both sizeable danger which has to be grappled wit

3 CEYLON PUBLIC SSOCIATION
DECEMBER. 1961.
DR I A L
c Health Journal aims to focus attention on iseases. Although it will be agreed on all it was in the pre-war era, yet diseases whose ore ravaging diseases of yesteryears are now th services.
rith the complete elimination of plague and ly in sporadie spells introduced from abroad, ime killer scourge, Malaria, a hitherto lightly
diseases is now claiming attention. Among e bowel diseases, Venereal Diseases, and what ’, not to mention other disease problems that e from time to time such as poliomylitis, in
npaigns have been in existence for sometime, d not get into full stride to hit their targets with the veritable killer diseases of the past, -. Now the time seems ripe for going on an
e we have yet to get a firm grip on this chalenemy in clearer focus than before and orga
modern techniques of case detection, instituitation.
alation of 14 millions living in a 400 sq. mile
against this disease has been intensified.
frequent although preventive measures are ic Health Programme. Other bowel diseases, ions are widespread and the gastro-intestinal in morbidity and mortality and constitute a

Page 14
Special campaigns have been establish Diseases. The activities of these campaigns case of other diseases coming under the purt
A recent advance, in the war against of the Epidemiological unit to study the p investigations and formulate measures to cor to not received specialised attention. This unknown origin”, Reckettsial diseases, Lep outbreaks of Influenza and other such dise attention. This unit works in close associat tory services, the Medical Statistics section,
municable diseases.
So important is this fight to-day that reorganised in order to concentrate heavily
municable diseases, improving environmental
We commend to all readers of this I attention towards combating communicable Ceylon Health Services has won internatio spectacular results achieved in several fields efforts, we pave the way for the conquest o the nation and thus demonstrate that we are
To build a healthy nation is indeed a which, must be marshalled all the forces at o

ed to fight ailments like leprosy and Venereal are discussed in this special number as in the view of other specialised campaigns.
communicable diseases is the establishment attern of communicable diseases, undertake trol communicable diseases that have hither
unit is devoting attention to " pyrexias of etospirosis, infective hepatitis, poliomyelitisf cases which hitherto received no specialised ion with the preventive, curative and laboraand specialised campaigns dealing with com
the work of the public health staff has been on the three vital needs of controlling comsanitation and imparting health education.
publication the pressing need to pay greater
diseases in this country. The work of the nal encomiums from time to time for the -. It would be most fitting, if, by our own f the communicable diseases that now stalk
worthy of this praise.
in objective worth striving for, and towards ir command.

Page 15
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Page 16
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Page 17
HISTORY OF DEVELOPMENT OF
COLOMBO MUN
BY
DR. V. NADARAJAH, L.R.C.P. & s. (
1 D.T.M. & H. (Lond.), (From the Presidential address delivered at
sir
ES #TËSa a
THE PRE-MUNICIPAL COUNCIL
PERIOD In tracing the history of a public health service it is necessary to discuss the history of the community itself, because the health services only reflect the community's attempt to meet its health needs. When we consider Colombo, we find that its history dates back to the ancient past, but for the purpose of this discussion, it is sufficient to trace it to the Pre-Portuguese times. Long before the arrival of the Portuguese in Colombo in 1505, Colombo was a busy port from which Muslims, descendants of seafaring Arabs, exported to countries in the West, valuable products • found in abundance in the Island, chief among them being elephants, cinnamon and coconuts. By this time Colombo, then called Kolomba or Kolomtota, had grown in importance after Kotte had become the Seat of Government of the King. The trade of the Island was entirely in the hands of the Muslims, who had established a thriving Colony in Colombo, and also friendly relations with the King of Kotte. They had built vast godowns and storehouses in which goods were stored pending shipment. The population, too, at that time was largely Muslim and they had established a mosque, a cemetery and other 12 amenities required for their observances. The township lay on the bank of a rivulet, an outlet of the Kelani river, which entered the sea near modern Pettah. At the mouth of the rivulet was the anchorage for ships.
th
no he
es
co
ex
When the Portuguese accidentally touched at Colombo, they found that it not only provided them with safe anchorage from unfriendly winds and rough seas, but also a possible Colony, which would make for the expansion of their trade. So they soon settled down in Colombo while carry- th ing out intermittent warfare with the m

I
HEALTH SERVICES IN THE ICIPALITY
Edin.), L.R.F.P. & s. (Glas.), D.P.H. (Eng.).
Ceylon Public Health Association)
nhalese Kings, who were supported by the uslims. After their final victory in 1588, e Portuguese started to introduce their ws and customs. Colombo was declared
Royal City for the Portuguese with a namber of elected members, judges and Jerman for its civil administration, and a aptain for its Military Government. By is time the original boundaries had conderably expanded and included such burbs as Mutwal and San Sebastian.
After the Portuguese had been in occupaon of Colombo for a hundred years, the utch cast their eyes on Ceylon and sought ade opportunities with the Sinhalese ings. At first they did not lay much nportance on the capture of Colombo, but
1656, the Portuguese were defeated and se flag of the Dutch flew over Colombo. or the purpose of administration the utch divided their territories into three Commanderies one of which was blombo. The Commandery of Colombo cluded Fort and the Old Town and was nder the immediate command of the overnor who resided in Colombo.
From the Dutch, Colombo passed into he hands of the British on 16th February,
96. Soon after the British occupation, blombo was ravaged by Smallpox causing a Feat deal of alarm. Governor North took nergetic steps to fight the disease and a ospital was opened. The British unampered by war, set about vigorously to stablish a stable Government and peaceful onditions. They also made Colombo the apital, and it was from here that they xtended their influence throughout the hole Island until it became a British plony. During the one and half centuries e British rule, Colombo became not only ne chief port of Ceylon, but also one of the Fost famous in the world. The City itself

Page 18
6 HISTORY OF DEVELOPMENT OF HEA)
underwent a complete mentamorphos Most of the Portuguese Forts and Dut bastians and moats have disappeared, at except for the narrow streets which rema in the Fort, Pettah and certain parts
Colombo, few traces remain of Portugue
· and Dutch Colombo.
The Western system of medicine w introduced to Ceylon evidently with t) advent of the Portuguese. This syste developed gradually until the Briti occupation in Ceylon towards the end the 18th century. Since then it has unde gone rapid evolution. It will be seen th it was introduced chiefly to safeguard tl health of military personnel.
When one examines the development health services in the United Kingdom ar those of Colombo, there is seen a gre similarity not only in the pattern of dev lopment, but also in the kind of problen from which such development ensued.
Public health conditions in Englan especially in towns and industrial area were very poor even up to the year 184 Privies were inadequate and insanitary water supplies were inadequate and defe tive; houses and streets were filthy; an the rooms were ill-lighted and ill-ventilate Leprosy was rampant and Plague, Choler Smallpox, Typhus and Typhoid and oth infectious diseases ravaged the counti repeatedly in violent epidemics, only cea ing for want of fresh material.
Modern public health methods in th: country are founded upon the recognitio by Chadwick, Simon and Farr and other the effect of environment upon health, an upon the discoveries of Pasteur and Koch
In England the first Sanitary Act w passed at Cambridge in 1388, and from tl time of the Poor Law, Officers who duties were to supervise the cleanliness public places and streets, have functione rather haphazardly. It was not till t} Public Health Act of 1848 which provido a central authority, the General Board Health, that the appointment of the for runner of the present Sanitary Inspector

LTH SERVICES IN COLOMBO MUNICIPALITY
is. namely Inspectors of Nuisance, became a ch legal requirement.
in
Section 37 of the Public Health Act of
1848 states — “ Local Boards of Health se shall from time to time appoint fit and
proper persons to be Inspectors of Nuisan
ces." Briefly they were to superintend the as duties of the scavenging, to detect and ne
abate nuisances, to inquire into complaints m on water supply, to detect breaches of
regulations dealing with cleanliness, and to take legal action to punish offenders. Under this Act, provisions were made for the appointment of “ Medical Officers of Health." These appointments created the
machinery through the agency of which improvements could be carried out. A
series of subsequent Acts resulted in the
modern Public Health Department of at England with its several categories of
Workers.
er
at
je
of
d
e
ԴՏ
HEALTH CONDITIONS OF COLOMBO DURING THE PRE-MUNICIPAL ERA
7Co in
What, then, were the corresponding health conditions in Colombo that existed during this period which necessitated similar development ? For this information one has to turn to Military Despatches of the time, which, are hard to find.
KY P
The Despatches deal mainly with the Military Sanitation of Colombo, much of which is equally applicable to Civil Sanitation. Further, specific reference has been made to the insanitary conditions prevailing in the country surrounding the barracks.
it
n
S
In 1864, Colombo, according to a Despatch from the Right Honourable Secretary of State to His Honour Major General O'Brien, commanding the Forces in Ceylon,
consisted of the For't and the surrounding is country which was “ flat and under valuLe able cultivation." It was intersected by ie water courses and there was some irrigated of land about three miles distant, which was d said to affect the “ healthiness of the
troops."
The Despatch records, at some length, - the sanitary conditions as they existed in }, 1864.

Page 19
HISTORY OF DEVELOPMENT OF HEALTH
" Drainage.--The Fort is drained by a system of underground and surface drains, running on both sides of the streets and from the barracks. They are usually 18 inch barrel drains, constructed in the time of the Dutch occupation. There is no information as to the state of these drains, except that some of them open into the Fort ditch, and most of them into the canal which traverses the Fort close behind most of the barracks. Their outlets are only a few yards from the barracks. The water in the ditch and canal is more or less stagnant, and deposits much mud. It will be previewed that such a system of drainage is radically bad. There is every probability that these drains are mere cesspits. They have very little fall, and there is no current of water through them.’”
C 05 05
a
“It appears there is neither house nor barrack drainage in the proper sense of the term. Cesspits are provided for most of the privies and urinals. They are usually I from 24 to 5 feet deep, and from 25 to 4 feet square. One of these cesspits is only a 3 feet beyond the verandah of one of the barracks. One is within 10 feet of the hospital, one cesspit is within 11 feet of a well, the water of which cannot be used except for Washing; other cesspits are from 7 yards to 27 yards distant from wells.”
IN V V
1
“Water Supply.–It has been already stated that the elevation of the station is from 12 to 18 feet above the sea level.
Water is found at a depth of from 7} to 24 feet below the surface in the rainy season, and a depth of from 11 to 28 feet in the dry season (according to the elevation of the surface) and hence the fresh water in some wells must be drawn from below the level of the sea. The source of the water must either be infiltrated from the Fort ditch, or from the canal (both of which, as has been shown, receive the Fort drainage), or from rain-fall absorbed by the ground of these sources contribute their quota to supply the wells ; and the privy and urinal drainage in any case is a tributary to the water supply."
“The wells supply drinking water for the troops. Rainfall is also collected but is only used for washing. The water for

SERVICES IN COLOMBO MUNICIPALITY
ise is therefore shallow well water, all the ources for the supply of which are more or ess in danger of being tainted.”
“ The water is raised and distributed for ise by pumps, buckets, earthen vessels
nd barrells."
In dealing with the morbidity and the nortality reports, the Despatch records :-
" In the statistical reports on sickness ind mortality in the Army (1841) the nnual mortality over 17 years is given at 1.9 per 1,000 strength from all causes, nd of this very high rate 21 per 1,000 was lue to dysentry.”
" Cholera likewise contributes its. quota of mortality. This is given at 5:8 per
,000 strength in the statistical returns."
The conditions in the “ Bazaar" by no neans seemed to have been better than in iny other part of Colombo for "the drainLge of the Bazaar and Pettah '" was " by open drains.”
"Sanitary state of the Bazaar etc.—The drainage of the Bazaar and Pettah is by open drains, in many parts giving off noxious effluvia. Ventilation is defective. Latrines in some houses too are near the wells. Water not always of good quality." There are no regular sanitary regulations." Cleansing inefficient " Local Board of Health might show more activity”. No Inspector of Nuisances. Dung heaps and cesspits are seen within the compound of native houses. " Several of the inhabitants of the Fort keep carriages, and chey have neither sufficient space nor care Por cleanliness to prevent the accumulation of filth.”
Thus it will be observed, appalling environmental conditions coupled with major and recurrent epidemics of Smallpox and cholera were causing great damage to the health of the people. The European popuation was not immune to the effects of these conditions. The Colonial rulers were deeply concerned about the high mortality and morbidity, particularly among the
military personnel.

Page 20
HISTORY OF DEVELOPMENT OF HEAL
Of the major infectious diseases, Small pox appears to have been introduced t Colombo and its suburbs very early in the British period, for it is recorded tha vaccination overseers were appointed a early as 1802 ; only a few years afte Edward Jenner had discovered that th cowpox virus gave protection against Small pox. Further, there is sufficient evidenc to indicate that Smallpox was endemic.
Cholera first occurred in Colombo i 1819, and since then epidemics have bee almost an annual feature. Incidence C the disease in certain years was as high a 93•04 per thousand population with 35. deaths. The Civil Medical Departmen was established in 1859, and the only typ of public health work that engaged thei attention was the control of communicabl diseases.
LOCAL HEALTH BOARD FOR
COLOMBO
The first serious attempt to deal with th existing health problems was the establish ment of the Local Health Board of Colomb under the provisions of the Nuisance Ordi nance No. 15 of 1862, just as similar con dition in certain Towns of England resulte in the Public Health Act of 1848 whic provided for the " Local Boards of Health in that country. This development is, i all respects, similar in both countries excep in point of time.
The Local Board of Health, Colombo consisted of two or more members ar pointed by the Governor, with the Govern ment Agent, Western Province, Hon. M: Charles P. Layard as Chairman. Th Board was empowered to frame By-Law: under the Nuisance Ordinance of 186 which the Board immediately pursuec These By-Laws which were published i 1862, were the first to be enacted by an Local Authority of any kind in Ceylon, an to receive the approval of the Governmen In the main they provided for the ( inspection of public or private premise with a view to detecting cases of infectio disease (ii) abatement of nuisances, sanit tion of public and private premises, an

-TH SERVICES IN COLOMBO MUNICIPALITY
- legal proceedings against persons who vioo lated the requirements of the By-Laws.
n
X
D T CD E O C
These By-Laws framed by the Board of Health of Colombo, resulted in the creation
of the machinery, the “Inspector of Nuie sance", through the agency of whom the
provisions of the By-Laws could be implemented just as the Local Boards of Health of England resulted in the appointment of " Inspectors of Nuisance" in that country. This again is a similarity in development between Colombo and England, and, what is more, the functions of the Inspectors of Nuisance in Colombo were identical with those in England.“ Inspectors of Nuisance, it will be observed was the forerunner of the Public Health Inspector in this country just as it was in England.
n
S un pont 4 U
t
Important as these measures were, they do not seem to have effected any appreciable change in the health of Colombo, for it is recorded that "there are no regular sanitary regulations," “ Cleansing inefficient;" ventilation is defective, water not always of good quality and that
“ Local Board of Health might show more o activity.
d MUNICIPAL COUNCIL MOOTED
Thus it will be seen that neither the n newly constituted Board of Health, 1862, et nor the Civil Medical Department with its
limited resources, could cater to the health needs of Colombo, which were numerous and complex. It was for these reasons, and the need to give the local people responsibility for the management of basic and civic amenities which do not require the intervention of a central authority, that
Sir Hercules Robinson stated in the Des2 patch forwarding Ordinance No. 17 of 1865
entitled "An Ordinance for establishing n Municipal Councils in this Island, to the
Rt. Hon. Edward Cordwell, M.P. that:
e
d
“ Owing to the absence of Municipal institution in this Colony, a great many duties devolved on the Central Government, which were entirely beyond their
province, and the necessity of some Local d Agency for undertaking these duties,

Page 21
HISTORY OF DEVELOPMENT OF HEALTH
especially during the prevalence of epide
mic disease, has been felt long before my assumption of the Government, and was forcibly impressed on me by the filthy condition in which I found some of the principal towns after my arrival here. I trust that this measure would have the effect of remedying these defects, and that it will lead to the introduction of various local improvements which are much needed.”
From this point onwards, it is necessary to consider, though briefly, the development of Local Government in Ceylon, especially Municipal Councils for the creation of which the filthy conditions and epidemic diseases in Colombo were greatly responsible.
LOCAL GOVERNMENT IN
CEYLON
Ancient Period.--The development of Local Government in Ceylon itself dates back to ancient times, although what pattern exists today is largely a modern one dating back to the latter half of the 19th century.
After the proclamation of 1818, however, the Village Council or Gansabha ceased to receive recognition, but in 1856, Sir Henry
Ward realising the usefulness of this system which had taken root in the life of the rural population, resuscitated the Council to some extent. But of the legislation of this period, the most important was the Ordinance establishing Municipal Councils, of Colombo and Kandy in 1866.
Subsequently Ordinance No. 2 of 1871, Small Towns Sanitary Ordinance No. 18 of 1892 and the Ordinance No. 13 of 1898 resulted in the revival of the Village Councils, and the constitution of Sanitary Boards and Local Boards respectively. These Ordinances are an indication of the desire on the part of the Government to associate the people in the task of administration of Local areas on a democratic basis up to a point. But the first far-reaching changes were made as a result of the recommendations of the Local Government Service Commission of 1916, which resulted

SERVICES IN COLOMBO MUNICIPALITY
in the Local Government Ordinance of 1920. It provided for a fairly complete scheme of Local Government and a central authority, the Local Government Board to exercise general supervision and control over them. Local Government was further developed consequent on the recommendations of the select committee on Local Government, 1928, and those of the Donoughmore Commission relating to Local Government, 1928.
Municipalities. Subsequent legislation altered the constitution of Municipal Councils, and later on they came to be administered under the Municipal Councils Ordinance No. 6 of 1910. There was no serious constitutional change except that the number of wards was increased to ten. From 1917 to 1935, a series of amendments were made to this Ordinance. In April 1936, the Municipality of Colombo was given a new constitution under the Colombo Municipal Council (Constitution) Ordinance No. 60 of 1935. The Law governing Municipal Councils was embodied in the Municipal Councils Ordinance, Chapter 193 and the Colombo Municipal Council (Constitution) Ordinance, Chapter 194. In 1947 these Ordinances were finally consolidated, and the present Municipal Council Ordinance No. 29 of 1947 was enacted.
THE MUNICIPAL COUNCIL
PERIOD
In the preceeding section an attempt was made to state the health problems that stimulated the institution of Municipal Council of Colombo. It is now necessary to trace the Manner in which the Council attempted to solve these problems. In passing it may be restated that these health problems were largely problems associated with insanitary environment as the disposal of excreta, and of refuse, water supply, housing, pure Food supplies, control of insect vectors and cleanliness, public and personal. Added to this is the problem of infectious diseases, arising, as it does,
mainly, if not solely, from these very insanitary conditions. However, it is not surprising because this sort of pattern

Page 22
10
HISTORY OF DEVELOPMENT OF HEA
emerges when one analyses the develop ment of any health service, be it here i Ceylon, or in any European community It can therefore be considered a universe stage of development.
Let us, first, examine how some of th main provisions of the Municipal Counci Ordinance No. 17 of 1865, in so far a health matters are concerned have bee
met.
This would, in effect, provide a histor of the development of health services i Colombo.
This development can be divided int two major periods :-
(i) An initial period of developmen
from 1866-1902, which is charac terized by an absence of a centra public health organization, and distinct division of responsibility.
And
(ii) The Post-Public Health Depart
ment period from 1903 onward which was a period of consolida tion of the activities of the forme period and of further development
In view of the extremely unsatisfactor conditions discussed in the early part o this paper, the Municipal Council, imme diately after it was constituted, engage itself in such sanitary improvements a
were desired. The responsibility for suc improvements, however, was not vested i a central organization such as the ones w know of today, but in several departments most important of which were the Cor servancy Department, Police Departmen and the Inspection Department. Executir power for sanitary functions was vested i the Sanitary and Police Committees, one ( the five coinmittees contemplated in th By-Laws of 1866, the other committee being Law, Public Works, Finance an general business.
The question of the appointment of Municipal Health Officer had on severa occasions been pressed on the attention a

LTH SERVICES IN COLOMBO MUNICIPALITY
- the Council by the Sanitary Committee, n chiefly on account of the prevalence of
Smallpox, but the Governor to whom the suggestion had been made turned it down on the ground that “ so long as the Government Medical Department was responsible
for the medical services of the town, the s appointment of a Municipal Health Officer s would be undesirable !One of the Official
members of the Council always was a representative of the Civil Medical Department from whom the Council received such guidance and directions, to the extent that their other multifarious public duties and
more or less extensive private practice could permit.
n
a
A precedent for the non-appointment of a health officer had been furnished by the t Madras Corporation whose Commissioners - reported that — "Looking to the financial Il position of the Municipality and to the fact
that the Commissioners are already put in possession of all necessary information in regard to subjects which would come within the province of a special Sanitary Officer, the Commissioners were of opinion that the appointment of such an officer is un
desirable."
r Departments responsible for health
work. Thus health work in the Colombo Municipal Area continued to be carried out
jointly by the Municipal Council and the of Civil Medical Department, the latter having
responsibility for the control of communicable diseases.
t
The Municipal share of the responsibility n
was carried out by the Municipal Inspection e Department, who received direction directly
from the Council and the Sanitary Com
mittee. Special measures of sanitary re
form have generally been enforced without se trouble, the interference of the Bench of n Magistrates having been invoked where of necessary. Strict surveillance had been e kept over articles of food, but it was con
sidered that it would be ineffectual until “ supervision can be so centralised as to render the sale or exposure for sale of whatever is unwholesome and had a matter of ready and easy detection. This was
the thinking behind the initiation of market of construction early in the Municipal era.
On

Page 23
HISTORY OF DEVELOPMENT OF HEALTH
Early Sanitary Measures.--The Muni- S cipal Conservancy Organization was orga- T nized in 1867 and was worked by Municipal I Inspectors, the necessary “ appliances and transport having been provided by the Council. However, scavenging had been entrusted to a contractor. Conservancy laws had also been framed and the prosecution for the violation of these laws, or the enforcement of special sanitary measures were entrusted to the Municipal Inspectors. The Conservancy Department, in 1871, was amalgamated with the Public
Works Department for reasons of economy. The night soil was transported in covered carts to the Hultsdorf Mills, where it was so treated as to form “ compost and ultimately despatched to the Coffee estates as manure.
}
Within the first three years of its existence, the Council had commenced, or was actively pursuing such measures as the provision of slaughter houses and their supervision, slaughter of animals outside Municipal limits and their subsequent transport to Colombo, and registration of animals slaughtered ; the supervision of burial grounds in populous parts of the City; provision and maintenance of public latrines ; provision of public markets and their supervision ; registration of dangerous and offensive trades; and provision of a safe water supply; By-Laws where necessary had also been framed.
Control of Infectious Diseases. The Council, was also actively concerned about epidemics, especially those of Cholera and Smallpox. It is recorded that — every possible precaution was adopted to interpose a check to the spread of the disease, cholera. Cleanliness was strictly enforced in private premises and all buildings of public resort such as markets, boutiques, etc. and houses which were more or less crowded were ordered to be limewashed while the scavenging contractor was closely kept to his engagement in regard to the conservancy of public thoroughfares and drains. A supply of cholera medicine, obtained from the Civil Medical Officer, was entrusted to the Inspectors for distribution. The evacuation of all Cholera patients were ordered to be buried, and the

SERVICES IN COLOMBO MUNICIPALITY
| 11
oiled clothes and bedding to be burnt. No grave was allowed to be used which was 1ot at least six feet deep and a quantity of quick lime was ordered to be put in to the coffin of every case of interment. The Police co-operated with the Municipal Dfficers.”
The position with regard to Smallpox vas no better. Epidemic followed epidemic ind it is reported that the statistics at the lisposal of the Council were “ so defective, Doth as to the monthly proportion of cases ind the rate of mortality within the various livisions that the figures are altogether omitted as unreliable.
The Law relating to compulsory Vaccination had been “ neglected " until the pccurrence of the very evil it intended to counteract appeared and reappeared resulting in major epidemics. In Ireland as n Ceylon, vaccination had been compulsory ior nearly the same period, since 1864, but the results had been widely different in the two countries. The principal Civil Medical Dfficer, under whom the vaccination department of the time functioned recognized the need for reorganization of same.
The difficulty of recruiting competent vaccinators was considerable, but in Colombo, this was overcome by the payment of a premium for every successful case of vaccination that was performed by Ehe several Medical Practitioners in the Town. As the years passed the vaccinacion department was reformed, and the vork was performed with increasing efficiency.
In addition to Cholera and Smallpox, Typhoid Fever was more or less prevalent especially in Pettah where " the cause could easily be traced to the want of a proper system of sewage — drainage." Large numbers of cases of “ intermittent Pever” were also on record.
The need for quarantine regulations also engaged the attention of the Council especially on the arrival of the Ship “ Westporough in Colombo in 1864, from Mauritius having cases of fever on board.

Page 24
12
HISTORY OF DEVELOPMENT OF HEA
However, the Governor, to whom submi sions were made by the Council, took ov this responsibility from the Council.
APPOINTMENT OF THE
SANITARY OFFICER
The appointment of, in 1875, the Sanitai Officer, fore-runner of the Medical Offic of Health, is an important land mark in t development of health services, not only i Colombo but in the whole country.
The distinction of being the first Sanita Officer, in effect, the first Medical Officer Health, in this country, was held by t late Dr. Simon de Melho Aserappa, Doctor of Medicine of the University Edinburgh. Prior to his appointment, was a private Medical Practitioner, Colombo. The year he was appointed there occurred a most wide-spread epidem of Cholera in Colombo. The epidemic fir started in Bankshall Street and later sprea to Pettah, Kotahena, Grandpass and b yond Municipal Limits. The disease w introduced and reintroduced. A total 721 cases were recorded of which 421 58.3% succumed to the disease. S Charles P. Layard, Government Agent, W.) who was also the Chairman of the Municip Council, reported that "the duration { the disease was, however, only shortene in Colombo by extraordinary measur adopted by the Municipal Council and b the laudable exertion of Government an Municipal Medical Officers, who, bot during its prevalence and on its recurren at a later period in a sporadic form, worke harmoniously and successfully together. However, the Sanitary Officer was no solely responsible for the control of in fectious diseases in Colombo, for the Princ pal Civil Medical Officer reports that t} Assistant Colonial Surgeon, Mr. Carver was placed in charge of Cholera duty i Colombo.
Council assumes responsibility fo infectious disease. The harmonius reli tions between the officers of the Civ Medical Department and the Municip: Council do not seem to have lasted lon because in 1876, the Principal Civil Medic

LTH SERVICES IN COLOMBO MUNICIPALITY
S
Officer reported that : “ I must here mener
tion that in consequence of some difference that existed between the Medical Officer appointed by this Department to report cases of Cholera and other infectious diseases occuring in Colombo, and the Sanitary Officer of the Municipal Council, the Council requested that the former be withdrawn,
and the duty delegated to their own er
officer." ne
Thus we find the Municipal Council entrusted with entire responsibility for the two major problems of the time, control of communicable diseases and environmental
sanitation. ne
Functions of the Sanitary Officer.-- of The Sanitary Officer was responsible to the
Chairman of the Municipal Council for the control of communicable diseases and other public health functions. He supervised the control of infectious diseases, adulteration of food, control of bakeries, and other food handling establishments, meat stalls and markets. He was empowered to authorize prosecution by Municipal Inspectors for the contravention of By-Laws. Vaccination though handled by a separate Department under the Principal Civil Medical Officer,
was supervised by the Sanitary Officer al within the Municipal limits.
a
де n
11
O
Dr. Aserappa had been required to submit quarterly reports on health and sanitation of the City, besides others on special problems as and when such problems arose.
ze
The Sanitary Officer was assisted in these functions by Ward Inspectors. Conservancy and scavenging work was also supervised by him, although the latter was carried out by private contractors.
ne
IN
From time to time he made recommendations to the Council regarding various health matters. Of these one of the most far reaching was his recommendation to introduce a public service for night soil (1888) the disposal of which, hitherto was the responsibility of the individual owner of property, a practice which was attended by grave danger to health. The same year, he carried out an experiment in
OR

Page 25
HISTORY OF DEVELOPMENT OF HEALTH S
C
incinerating night soil, and proved to the C satisfaction of the Chairman, that his method was cheap, simple and hygienic. However, this practice was discontinued later on.
C
Dr. Aserappa was succeeded in 1891 by Dr. John B. Drieberg.
On the retirement of Dr. Drieberg in 1901, his designation, Sanitary Officer changed to that of Medical Officer of Health and his Department the Public Health Department. The “Health Department" which during the later years was entrusted with the responsibility of conservancy now became the Conservancy Branch of the Public Health Department and its Manager, the Superintendent of Conservancy.
EVOLUTION OF THE OFFICE OF SANITARY INSPECTOR IN THE MUNICIPALITY
It will be recalled that the By-laws of the Board of Health framed in 1862, under the Nuisance Ordinance of that year, provided for the appointment of Inspectors of Nuisance. These Inspectors were succeeded by others with similar responsibility when the Municipal Council was constituted in 1866. However, they came to be now known as Municipal Inspectors instead of “ Inspectors of Nuisance. The former designation itself is suggestive of the assumption of wider functions as compared with those of the Inspectors of Nuisance. The designation underwent further change, under the Sanitary Officer, and they came to be known as Ward Inspectors. The responsibility of the office now being restricted to particular problems of a specific ward. In 1900 however, these officers came to be designated Sanitary Inspectors.
Functions of Inspectors.--The responsibility of these officers, though restricted at the beginning in so far as they were related to health work, was widened with the passage of years. At first they were mainly confined to abatement of nuisances, and prosecution for keeping filthy premises. Later

ERVICES IN COLOMBO MUNICIPALITY 13
n these functions were extended to include etection, transport to I.D.H. and control f communicable diseases, (In 1883, one aspector is reported to have contracted mallpox in the discharge of his duties and ied, his widow later on receiving Rs. 700/- s compensation), visiting of permises with accinator for the purpose of vaccination gainst Smallpox by the latter, reporting f insanitary and overcrowded buildings nd others.
However, these were not the only unctions of the Inspectors. They were \lso engaged on other Municipal work which had no relationship whatever to nealth work. In 1894, the Special Committee on Sanitation reported to the Chairman that the Municipal Inspectors were not performing actual duties required of them n such fields as scavenging, sanitary premises, administration of food, overcrowding of dwellings, inspection of bakeries, meat stalls, etc. Therefore the Committee recommended that these officers should be relieved of other functions so they will have
more time for health work.
Recruitment of Sub-Inspectors.--The recruitment of Sub-Inspectors was commenced in 1896, the new officers having major responsibility for the control of Infectious diseases.
Consequent on the recommendations of the Bubonic Plague Commission of 1896, each Ward Inspector was given twenty four rat traps, and a reward of five cents per rat caught, which was considered sufficient to meet the wages of coolies and other expenses. Rats caught were destroyed by drowning in the presence of the Senior Inspector and another officer who was not in the inspectorate.
The following extract sums up the functions of the inspectors :-
“ The Sanitary Inspectors of the various wards have hitherto been the slaves of every department. They did duty for the Works Department in reporting of breaches of building By-laws and for the Revenue and Secretary's Departments in preparing

Page 26
14
HISTORY OF DEVELOPMENT OF HEA
lists of Councillors and voters, in pecting licensed vehicles, prosecutir for the recovery of dog tax, ei forcing warrants for vehicles an animal tax, and for water rate an other miscellaneous duties. In fa their duties were almost as gener as those of village headmen.”
The Medical Officer of Health pointe out the disadvantages of this system, an of the divided control which it involver and by means of reorganization of tł
Works Department, and the creation of cadre of revenue inspectors, the Sanitar Inspectors were released for their legitima duties.
DISPOSAL OF EXCRETA
Disposal of excreta was one of the fir problems that the Council had to face..] will be recalled that until 1898, each hous holder was at liberty to dispose of the night soil in any manner he wished.
But in 1888, the Council voted a sum Rs. 5,500/- for the purchase of night-so carts and buckets, but the organization a regular conservancy service was pos poned, pending the results of an exper
ment at incineration of night soil carrie out by the Sanitary Officer, Dr. Aserapp: Later Dr. Aserappa recommended a publ service for night soil and incineration ( night soil.
In the year 1891, Dr. Drieberg, Actin Sanitary Officer, recommended a carriag system for night soil as the Council we encouraging the construction of dry eart latrines in the City. The following yea however, the practice of burying night so in convenient spots, and the incineration night soil hitherto carried out near publ latrines were abandoned as these we causing certain nuisances.
Six years later (1898) a new Departmer called the Health Department was org nized with a Manager in charge. He wa not responsible to the Sanitary Officer,

LTH SERVICES IN COLOMBO MUNICIPALITY
S
n
id
ct
Public Latrines.--The construction of ig public latrines engaged the attention of the
Municipal Council from very early times.
In 1867 a model public latrine was conid structed at St. John's on an experimental
basis which had “ proved successful ’’. Thereafter the Councilerected latrines at St. Thomas, St. Sebastian, Beira, Kew Road, Madampitiya and at Bankshall. The Government Agent W.P. also refers to two public latrines, one in Sea Street and the other in Mutwal.
In 1888 a Sub-Committee of the Municipal Council recommended the erection of more public latrines with attached “ bathing jhats at the following places — Beira, Pettah Railway Station, St. Sebastian above Lock Gate, Sutherland Road, Vauxhall Street, Hunupitiya Nos. 1 and 2, Polwatte and Galle Face Church.
st
The Commission of Enquiry into the state of sanitation in Colombo has recorded, in 1890, that all these latrines were of the
dry earth type.
Incineration of night soil had been carried out until 1892 when it was abandoned as it was said to have caused certain nuisances.
SE A
• T
SCAVENGING
d
In 1873 scavenging of the City was done by a contractor paid by the Municipality. The contractor was using only 30 carts and this was highly inadequate. Every year tenders were called for and the work was given on contract. When there was a change of the contractors the coolies were assigned to the succeeding contractor.
609
In 1882 M.C. was divided into two areas il for the purpose of scavenging and separate of tenders for the two areas were called. Le Only one tender had been received and
accepted. Work in the other area was, therefore, attended by the Municipal Works
Department.
st
2- In 1891 the Superintendent of Works, s Mr. R. Skelton recommended that the
entire work of scavenging in the City should

Page 27
HISTORY OF DEVELOPMENT OF HEALTH SE
be placed in charge of the Works Department. This recommendation was accepted.
Co
DRAINAGE
Use
do
Although the question of drainage was mooted as early as in 1867, it was in 1888 that a Sub-Committee of the Municipal Council recommended “ a scheme of drainage for Polwatte, side drains on trunk bo roads, deep drainage for Cinnamon Gardens we and drainage for Kotahena and Kochchi
un kade," and in 1891 on the recommendation
the of the Sanitary Officer, side pavements mi were introduced and along with them, an filt improved system of drains.
wa
pal sto
ado
Con
Further progress relating to sewage was made in 1892 when the sewers were laid in
ma
rec Chatham Street and Hospital Street.
mi In 1900 Governor Sir J. West Ridgeway
mi
est appointed a Commission to go into the question of providing the City with an adequate system of drainage with the least cost. The Commissioners, except one, agreed that the whole City should have a drainage system and the modified scheme put up by Mr. Manseigh was carried out in stages.
wa In 1903, Mr. R. E. Tickel took charge of
mi the work along with Mr. A. F. Churchill of
an the Local P.W.D. as his Assistant, and the
inc duplication of the water main which was essential for the successful carrying out of the scheme, was taken in hand. In the same year the necessary organization was Gri set up and next year, sanction was granted 18 for the revised scheme. Municipal Council, at this stage, decided to acquire private
poj land for the laying of pipes and rain water drains in the harbour districts, was com a pleted and formerly handed over to the mi Municipal Council on 30-9-1910.
wa
inc
firs
13t
40
of cos
During the next few years work was extended to other places such as Grandpass, Dematagoda, Maradana, Slave Island, Polwatte, Cinnamon Gardens and the drainage for the City of Colombo was completed and put into operation in April 1913.
tha
Rs for

ERVICES IN COLOMBO MUNICIPALITY
| 15
WATER SUPPLY
Immediately after the passing of the municipal Councils Ordinance of 1865, a emmission was appointed to report on e water supply and drainage of the Town. ne Commission reported that the water ed by a majority was utterly unfit for
mestic use.
Although various proposals for a pipe rne water supply were submitted (bet-en 1862 - 65) nothing tangible took place til this Commission recommended that e Kelani river be tapped at a point 10 les from the sea and that the water be cered, stored in tanks and distributed.
The population of Colombo was estisted at 60,000 and the Commission commended 25 gallons per head or 1; llion gallons of water per day as the nimum requirement. The cost had been imated at Rs. 180,000/- per annum. It s also recommended that the MuniciCity should put in supply pipes, and one
p lock to each house. The report was ppted and approved by the Legislative
uncil in December, 1866.
However, a provisional scheme for a ter supply had previously been subtted by the Colombo Gas and Water Co. d by Mr. Dawson. The Company also luded a scheme for drainage.
These papers had been referred to Mr. Ellinton in 1867 for report, and in June P1, by which time the population had creased to 100,284 excluding a floating pulation of 10,000 as enumerated at the et census. Mr. Grillinton recommended scheme which would have provided 3 llion gallons for all purposes. His scheme s to take water from the river at the Eh road mile from Colombo and to lay
miles of street pipes at an estimated cost Rs. 1,741,120/- and an annual working st of Rs. 99,600/-. It was also proposed at the Municipality should guarantee . 104,460/- to the Gas Co. for 20 years - the public stand posts.

Page 28
16 HISTORY OF DEVELOPMENT OF HEA)
No action was taken on this report, ani Mr. R. A. Sparkes made a further repor in 1873.
Under this scheme it was proposed t pump water from Kelani river at th Kelani Temple, store it in Cinnamo Gardens, and pump it into town pipes But in June 1873 Sir Gregory refers to Mi Bateman, who sent Mr. Burnett to Ceyloi in December for the purpose of investiga tion. After five months Mr. Burnett sub
mitted 2 schemes.
However, when everything had been prepared, during 1878-1879, the Govern ment decided to abandon the Kelani schem and adopt the Labugama scheme. Th work on this scheme commenced in Jun 1882, and in September 1885, a temporary supply of water was brought to Colomb by the main pipe. But unfortunately du to some defects, the Service Tank a
Maligakande failed in October 1885, an again in December 1886 and Februari 1887.
Further work on the project was under taken under the instructions of Sir Joh Fowler in December 1888, and this wa completed in October 1889, after which i was working under full pressure yielding the maximum supply.
In June 1887 the first public stand pos was installed and by the end of 1889, ther were 664 stand posts, 1,414 private con nections, 28 trade and 43 garden supplies
When this project reached this stage o development, it was suggested that th supply should be increased by duplicating the mains from Labugama. The imple mentation of this suggestion resulted in th present sewage system of Colombo. Ther was difference of opinion between the Government and the Municipal Council n doubt, but on 18th October 1901, Sir Wes Ridgeway declared in the Legislative Council, “ I rejoice that the importan question of an increased water supply for the improvement of sanitation of Colombe is now practically settled.'"

-TH SERVICES IN COLOMBO MUNICIPALITY
The Government undertook to construct the duplication of the main, and the Council to take complete responsibility for future expenditure. In 1904 the Government handed over the water works to the Council.
HOUSING
Records of the early period of the Municipal Council which are fragmentary in most cases, do not provide sufficient data to make a correct assessment of the early state of housing in Colombo. But in 1891 Dr. Drieberg, the Sanitary Officer, reported
that in many parts of the city " the poor e are herded together in little huts with e little or no light and air." He recome mended the acquisition of “ Hettiwatte to
house dislodged persons from recent floods."
1
Overcrowding was made an offence under the quarantine and prevention of diseases Ordinance of 1897 and notices were issued to people to abate overcrowding. Further the Council framed By-Laws under section 485 (1) and (V) of the Ordinance No. 3 of 1895 in respect of lodging houses and in 1898 no new house was allowed to be constructed unless a dry earth lartine was provided.
T P
UN
FOOD SUPPLY
B
Markets. Soon after the institution of the Council, it was felt that the erection of publie markets was a crying need as a striet surveillance over articles of food could not be kept until it was centralised by the provision of markets. For this purpose markets were not only erected or
otherwise provided by the Council, but ; also By-laws were framed to control them.
Licensed trades and dangerous and offensive trades.--By-laws have been enacted during the various times for the control of Bakeries, Eating Houses, etc. and the requirements of these laws were enforced by Municipal Inspectors. Prosecution for various offences under these By-laws is on record, but it is doubtful whether the principles behind these were correctly comprehended.

Page 29
HISTORY OF DEVELOPMENT OF HEALTH S
CONTROL OF COMMUNICABLE
DISEASES
CD 3
Immigration and quarantine.“ Immigration Dr. W. R. Kynsey reported " is intimately connected with the coffee industry, and the material progress of the colony. It is equally connected with and I am sorry to state, and answerable for the introduction and dissemination of no small amount of such infectious diseases as Cholera and Smallpox through out the Island.
A. O 9. O O
The labour supply of this Island, at the time came from South India and there were four routes of entry :
1. Tuticorin to Colombo.
2. Pamben and Devipatam in India
to Vankalai, Pesalai and Mannar in Ceylon.
3. India-Kalpitiya, Kurunegala.
4. India-Negombo.
In 1876, it is recorded, that as many as 60,089 persons arrived in Colombo. It is no wonder, therefore, that the origin of the outbreak of every epidemic of Smallpox and Cholera had been traced to India.
at
n:
CE
Therefore the Principal Civil Medical Officer, who was responsible for all quarantine measures established a temporary quarantine (cooly) station beyond Kelaniya. Coolies were subjected to strict inspection on arrival in Colombo and those actually sick were removed to hospital. Dr. Kynsey had also recognised the need for a permanent Infectious Disease Hospital.
w
at
Cholera and Smallpox.--Cholera and
18 Smallpox which had become major epidemic H diseases in Colombo prior to the Municipal of era continued to enjoy the same position after the institution of the Council. In 1876, Dr. Kynsey, reporting on these epidemics wrote "Our hospitals are full
with patients from South India and our streets are full of beggars from the same source.'"
tr
re
W

ERVICES IN COLOMBO MUNICIPALITY 17
Other Infectious Diseases.--Infectious isease in Colombo was not confined to major ones, for epidemics of typoid fevers, nfluenza, chickenpox, and others are on ecord. Occurrence of such outbreaks is ot surprising under the unsatisfactory nvironmental conditions of the time.
Plague.--It will be observed that plague ccurred in Bombay in 1896, after a lapse f nearly two centuries, but Ceylon enpyed immunity from plague for 18 years fter this. In the year 1896, Governor of Ceylon, Sir West Ridgeway who viewed the ituation in Bombay with great alarm ppointed a Commission to advise the Government on the measures that were eeded to prevent the entry of plague inte eylon.
CEMETERIES
The Council in 1869 recommended to the Government that it did not intend to ncourage opening of new places of burial. "he Government was in agreement with nese views and in 1892, in response to an ppeal from the Government, the Muniipal Council expressed their willingness to ake upon themselves the control and managements of the two general Cemeteries t Kanatte and Madampitiya.
In December 1890 the Cemeteries Ordiance was enacted and in 1897 all the emeteries were closed except Kanatte and Tadampitiya.
ASSESSMENT OF HEALTH
To summarise the state of sanitation and ater supply of Colombo, during the first Cunicipal period 1886-1902, I cannot do ny better than quote from a Review of ae Administration of the affairs of Ceylon 396 to 1903 by His Excellency the Right Conourable Sir West Ridgeway, Governor e Ceylon.
“When I assumed charge of the adminisration of the colony in February, 1896, I ealised the necessity of promptly dealing ith the urgent questions affecting the elfare of Colombo, and therefore of eylon, namely the deficient and precarious

Page 30
18 HISTORY OF DEVELOPMENT OF HE
water supply and the grave insanitary co dition of the City. The prosperity Ceylon is dependent on the prosperity Colombo practically its only seaport,... The water supply of Colombo was excellent quality, but very deficient quantity. Not only was the drainage ve unsatisfactory, consisting as it did most of surface drains in a very defective co dition, which by discharging largely in harbour and the lake rendered both the bodies of water liable to pollution... Few questions during my term of offi have called for such care and attention the question of the sanitation of Colombo
“I come now to the question of plagi It is a matter for lively congratulation al of profound thankfulness that the fortuna Island has remained wholly immune fro the ravages of the terrible scourge.”
Thus we find ourselves after years pioneering and foresighted effort, still co fronted with problems of environment sanitation and of communicable disease.
PUBLIC HEALTH UNDER MEDICAL OFFICER OF HEALTH
It may be stated that the latter half the 19th century was a period of develo
ment of health sérvices which was chara terised by an absence of a central pub! health organization and a distinct divisi of responsibility. The health problems the time were those of environment sanitation and of communicable diseas By 1902 the Council had established t. Public Health Department and had desi nated the former Sanitary Officer as t. Medical Officer of Health. Dr. Marsh Phillip was appointed to this post and I holds the distinction of being the fir Medical Officer of Health in Ceylon.. TI Department, he organised, is also the fir Health Department in this country ar therefore he may rightly be called t father of Public Health in Ceylon.
Dr. Phillip's was a most difficult tas A trained staff of Inspectors and clerks ar a store of information which could only | accumulated by such a staff were not ava able to him in order to direct his activitie

LTH SERVICES IN COLOMBO MUNICIPALITY
гу
se
ce
as 32
ce. nd
- His was merely an unchartered voyage on of the high seas. The first step which he
found necessary upon taking charge of the .. Public Health Department was the orgaof nization of a definite system of inspecting in
and reporting and of record keeping. It was found that a considerable part of the Inspectors’ time was occupied in attending to duties, such as revision of voters' list, the licensing of rickshaws and carriages and the whole of the revenue work of the Council which had no connection with sanitary work. They were, " the handymen of the Council o being styled Municipal Inspectors instead of Sanitary Inspectors. They had no definite hours for inspection, nor were their inspections carried out in
accordance with any system there being no te
routine inspection of premises. For the most part, their work was confined to visiting in connection with complaints received from householders and to a small extent to the control of infectious diseases, the notification at the time being most defective. Under these conditions, there was very little sanitary inspection being done, and such it was it could not be checked, as one never knew where an Inspector might be or what he may be doing at any given time of the day. It was therefore, arranged that Sanitary Inspectors should be relieved of revenue work by the appointment of Revenue Officers.
m
n
of
C
ic
Instructions were issued to Sanitary at Inspectors prescribing the hours of work
and the nature of the work. Routine daily e.
inspection of premises was instituted, hours were set apart for routine inspection and
for work in connection with papers and for ne attendance at the office. Forms were Il drafted for reporting the results of routine 1e inspection, and of inspection of dairies, st
laundries, etc. and for recording the
results of inquiries into infectious diseases. st
When the more urgent matter of inquiring into the methods in force and devising and introducing improved methods had been got in hand, attention was directed to the systematic theoretical teaching of the Inspectors. A course of lectures, accompanied by practical demonstrations, was undertaken by the Assistant Medical Officer of Health for this purpose. This
I.
d ie |-

Page 31
HISTORY OF DEVELOPMENT OF HEALTH S
was the earliest method of training Sanitary { Inspectors in this country.
Control of Communicable Diseases.-- Commencing from 1903, a series of steps were taken to control communicable diseases. For the first time (1906) a study of the relative importance of each disease as a cause of death so that the sanitary policy of the department could be directed on the most effective lines was undertaken. This survey revealed that enteric fever was the principal cause of death in the city and therefore four Sanitary Sub-Inspectors were appointed to deal with the disease. As a further measure an Enteric Hospital was established at Kanatte (1909).
During the early years of the country, it was feared that plague, which had occurred in Bombay would spread to Ceylon. By 1914, when plague actually occurred in Colombo, an Anti-plague organization was already in operation, and this resulted in effective control measures being adopted.
By this time Cholera and Smallpox were on the decline as a result of the action that had been taken to control these diseases. The establishment of the Bacteriological Laboratory in 1911, the first of its kind in Ceylon, was another notable advance, because this institution in no small measure, assisted the control of infectious disease. It may also be mentioned that it was in this institution that Dr. Fibian Hirst carried out his original research into the trans
mission of plague which, later on, resulted in the control of the disease in Colombo and elsewhere.
The establishemnt of the Ambulance Station (1908) and the Disinfection Station (1906) are noteworthy.
CO
The control of flies, mosquitoes and other pests had also received the attention of the Department, measures against these insects and pests having been taken as early as in 1910.
N
Maternal and Child Health.--Immediately he had secured such measures as were necessary to deal with the problems of

ERVICES IN COLOMBO MUNICIPALTIY
19
environmental sanitation and of communicable disease, and had also established the machinery to ensure the continuity of these measures, he directed his attention to personal health services. Apart from being the first Medical Officer of Health in Ceylon, and thereby the first head of the Public
Health Service, Dr. Phillip was the first in this country to set up a maternal and child nealth service manned by medical officers, public health nursing service and midwifery service, having himself trained the nurses and midwives, as he had the Sanitary Inspectors before. He was also the first to set up a Bacteriological Laboratory, an Ambulance Station, a Disinfecting Station, a Food Inspectorate, a Pest Control Bureau, and Infectious Disease Hospital, General Cemeteries and many other public health nnovations. A perusal of Dr. Phillip's reports, annual and periodical will convince one, of his capacity to plan, organise and implement programmes and above all his enthusiasm and devotion to duty.
His work can hardly be excellent even today.
During the year 1906, the Maternal and Child Health Branch of the Department was inaugurated, with the appointment of
midwives for work among poorer classes of the City. This was followed by the appointment of two health visitors in 1913). In 1924 a lady Medical Officer was appointed to be in charge of the programme and two years later (1926) child welfare centres were established where various clinics were started. By this time, the -taff consisted of one Medical Officer, 13 nealth visitors and 8 midwives.
By 1928 action had been taken to train ll midwives in the City. The majority of chem were untrained and steps were taken to see that those who refused to be trained gradually disappeared from the City. This vas made possible by placing all the Midvives in the City under the supervision of che Medical Officer Child Welfare. The irst Municipal Maternity Home was opened n 1935 and the distribution of milk foods, vhere this was indicated, started in 1937. In service ' training of health visitors and nidwives was undertaken in 1938, following

Page 32
20
HISTORY OF DEVELOPMENT OF HE
the appointment of a Superintendent Publ Health Nurse who was later on sent 1 England for Public Health training.
The maternal and child health servic was reorganised in 1953 and now include public health nursing, domicilliary mic wifery service and maternity homes an ante-natal infant and pre-school clinic The present staff consists of five medici officers, 18 matrons, 26 public health nurse 61 midwives and other staff.
Municipal Dispensaries. The firs Municipal Dispensary was established a Slave Island in 1906 and was soon followe by two others at St. Pauls’ and Ne Bazaar. Each dispensary was manned b a Medical Officer, Apothecary and Orderl and other minor staff. By 1939, ther were seven Municipal Dispensaries. Thes institutions were so successful that b 1957, the number of dispensaries wa increased to 17. The staff of each dispen sary was strengthened by the appointmen of a lady clerk. In the same year, th work of these dispensaries was co-ordinate with that of the O.P.D., General Hospital.
Health Education.--The origin of healt) education in Colombo or even in Ceylon
may be traced to the appointment of th first two health visitors in 1911. Dr Phillip urging the appointment of thes officers had stressed the need for healt teaching, specially in the poorer quarters o Colombo. The next stage was reached when in 1938, Dr. Aserappa, recommende the appointment of a Medical Officer o Health with special training in healt! education for full time responsibility fo health education. His recommendation was accepted by the Council, but the office appointed in 1940, did not reach his expecta tions. This officer left this post in 194 to accept a higher post in Council's service upon which the post was suppressed. Th post was restored in 1953 and a smal health education unit was established The staff was increased in 1955 by th appointment of supporting personnel. Bu the work of this unit had increased to suc) proportions, the appointment of additiona staff became necessary. The staff nov

ALTH SERVICES IN COLOMBO MUNICIPALITY
- consists of :
Health Education Officer 3 Assistant Health Education Officers Publicity Officer Officer-in-Charge of H.E.M.P.U. Artist Photographer Exhibition Assistant Clerk Projectionist Peon Driver and Labourer
- 0 D. O. O
>
Food Sanitation.---A series of steps had been taken to ensure a clean food supply for Colombo. These include the provision of slaughter houses, legislation for the control of food handling establishments and of dairies, a network of Municipal markets and a machinery to exercise supervision over them, namely a staff of food Inspectors. The appointment of a food Inspector was urged by Dr. Phillip as early as in 1909, but it was not till 1928 the first food Inspector was appointed. Another food Inspector was appointed the following year.
^ d)
In 1949, following the Food and Drugs Act, two more officers were appointed. As this number became inadequate three Sanitary Inspectors were sent to England for training as Food Inspectors in 1954, followed by 4 others in 1955. By the year 1957, the number of Food Inspectors in the department was 7.
* 1)
CONCLUSION
f In this paper, an attempt was made to 1 trace the important land marks in the
development of health services in the 1 Colombo Municipality. Colombo became a
populous City mainly on account of its situation as a port of call, and consequently a trade centre. It is quite natural that health problems should arise where there is concentration of population, and so was it with Colombo. Colombo was not prepared, at that time even to meet the basic needs of the community in such matters as housing, water, clean food, sanitary arrangements and disease prevention. And in consequence, thousands died on account of the ravages of Cholera and Smallpox

Page 33
HISTORY OF DEVELOPMENT OF HEALTH SI
R
apart from other diseases and disabilities S arising from insanitary environments. This M is exactly what happened during the In- 1
dustrial Revolution when thousands of people flocked to the centres of industry in ei England, attracted by the prospects of better life, when of course, these centres were least prepared to accommodate them. Just as England developed the necessary C
machinery to deal with the situation presented, so has Colombo attempted to do so. The first step in this direction was the a institution of the Local Board of Health of Colombo in 1862. This was totally inadequate, considering the magnitude of the c. contemporary problem ; something more a than that was necessary and this was met by the institution of the Colombo Municipal b Council in 1866. This Council attempted to improve the environment and to control communicable diseases through the agency of Inspectors of Nuisance at first, and later, the Sanitary Officer, and also by the provision of public services for scavenging and conservancy. They were poorly organised and in consequence much progress had not been made. But greater progress was 0
made consequent on the provision of a safe water supply and of drainage in the closing years of the 19th century ; nevertheless one still found oneself confronted with the same problems one set out to solve.
P
+ +
d
C
2X T T .=
ti
In 1902, a new era in public health ford Colombo, and for the whole country for that matter, dawned, when the first publie ir
Health Department under Dr. Marshall Phillip came into existence. He developed h a comprehensive health programme much m in advance of his time, even providing for te personal health services, at a time whenti public health was so young in this country. is

ERVICES IN COLOMBO MUNICIPALITY
| 21
o when the sanitary branch of the Civil edical Department was ushered in, in 913, there was an organised public health astem in Colombo, which could have been mulated and built upon. So it might astly be said that here in Colombo was ublic health born, fathered by such Lustrious men as Marshall Phillip and - V. Aserappa.
But the story does not end there. What: bout the future ?
We have long past the stage of communiable disease, of environmental sanitation nd even of personal health services. But ne solution of a problem always leaves ehind another. It was Nimkoff the amous German Sociologist who invented ne term “ cultural lag " to describe this henomena. We have achieved much, and his has again resulted in problems for us, nose resulting from social mobility, urbaniation and the consequent deterioration in ne family structure, besides others prouced by civilised living and the tempo of ur times. Today communicable diseases o not take such heavy toll of life in olombo ; but cardiovascular diseases, ancer and others do. Added to this is the roblem of mental health now almost nocking at our door. In short our morbiity and mortality pattern has assumed a Vestern trend. But man cannot accept efeat. He must accept the challenge. .daptability to changing conditions is iherent in human nature. But the tradional items of equipment in our public ealth armoury are grossly inadequate to leet current problems. Therefore, we have ) seek help elsewhere. It is not prevenve medicine that is required now; what
required is social medicine.

Page 34
S:M
The Physicians' Forn
SMA
CARBOHYDRATES SMA
the ph
1habiTnish ਹੈ ਤੇ
fat in . in cor
PROTEIN
SMA amour of the
VITAMINS &
MINERALS
SMA
of Vit correc of a h
the truest alternative
Over a century of service
Soie Agents: LEWIS BROWN & CON
( RAL

HA
mula For Optimum Nutrition
contains only Lactose aysiologic sugar of MOTHER'S BREAST MILK.
SMA is closely similar both mposition, and proportion to MOTHER'S BREAST MILK.
provides the physiologic at of protein requirements
infant as in MOTHER'S BREAST MILK.
provides the full quantity amins & Minerals in t balance similar to that Lealthy MOTHER'S BREAST MILK.
to mother's breast milk
yeth
e lo medicine founded in 1860.
MPANY LIMITED, P. O. Box 85, Colombo.,
DE MARK

Page 35
THE PATTERN OF COMMUNIC.
BY P. ARUMANAYAGAM, L.M.S. (
Epidemiologist, Departme
INTRODUCTION A dramatic change in the pattern of communicable diseases seen in the Western countries was mainly due to scientific, economic and social advances. In the United States of America, in 1900, ten leading causes of deaths included five infectious diseases but at present there is only one. With similar changes taking place in Ceylon in the field of Public Health and in the social and economic fields, the pattern of communicable diseases too has shown remarkable changes in the country during the last twenty five years.
The problem of major infectious dis
eases : When the British occupied Ceylon in the early part of the nineteenth century they had to deal with serious outbreaks of smallpox and cholera and special attention was paid to the control of these two diseases.
TABLE
Year
Cases
Deaths
167
25
135 124 711 409
21 21 108
67
-CO A
1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961
344 25
- || - || 1 - || ||
19
29

23
ABLE DISEASES IN CEYLON
Cey.), M.P.H. (MICHIGAN). Branoides nt of Health, Ceylon. Door de
Emallpox :
Smallpox was a major public health prolem in the country up to 1951. The two ables given below show the incidence of he disease.
TABLE I.
Date
Total cases
Annual average
1877-1880 1881-1890 1891-1900 1901-1910 1911-1920 1921-1930 1931-1940 1941-1950 1951-1960
8,423 11,607
3,091 3,434 1,557
842
645 1,561
420
2,106 1,161
309 343 156 84 65 156
42
II.
Fatality
Population
Rale
in thousands
15:0 100.0 15.8 16.9 15:2 16.4
25.0
__
14:0)
8.0 50.0
5,972 6,044 6,044 6,161 6,308 6,516 6,719 6,903 7,109 7,321 7,544 7,742 7,940 8,155 8,385 8,589 8,929 9,165 9,388 9,625
9,896 10,030
1111
36.8
6:9
18.1

Page 36
24
THE PATTERN OF COMMU
Table I shows that the annual averag number of cases which was 2,106 for ti period 1877-1880 and 1,161 for the te year period 1881 to 1890, showed a marke reduction and for the next ten year perio 1891 to 1900, it was 309. This could I attributed to the Vaccination Ordinance 1886 which made vaccination compulso in the country. From this time onwar the number of cases of smallpox diminishe and the annual average number of cas for the period 1951 to 1960 was 42. Fro time to time the country has been free smallpox and it has been so during tl
years 1955, 1956, 1959 and 1960.
Cholera has not occurred and could be said to have
TAJ
Period
Cases
.8
08
1841-1850 1851-1860 1861-1870 1871-1880 1881-1890 1891-1900 1901-1910 1911-1920 1921-1930 1931-1940 1941-1950 1951-1960
16,869 35,811 30,324 36,756 3,868 6,127 1,718 1,104 424
94. 242
19
Plague :
The first human and rat cases of plagi were introduced into Ceylon in 1914 ini Sea Street, Colombo, where rice shipmen from India were stored. The incidence plague by five year periods from 1914 given below and the graph annexed shev the decline of the disease in the countı and its total eradication,

NICABLE DISEASES IN CEYLON
De
ge Cholera :
en The first known outbreak of cholera in en Ceylon during the British period was in ed 1818 when an outbreak was reported at od Mathagal a village in Jaffna where 25 cases
with 2 deaths occurred. The disease spread from here to Point Pedro and Jaffna town and another virulent outbreak of 40 cases occurred again at Mathagal, Jaffna (Kelaart
—1952). Cholera has been reported in Ceylon during the Dutch period as well. Cases of cholera occurred in various parts of Ceylon during various periods. All the
infections were traced to the neighbouring he continent, India. The incidence of cholera,
by ten year periods is given below. in the country since 1953 linolnil e been eradicated.
2
BLE III.
Deaths
Annual Average
of cases
10,296 24,254 18,523 19,960 2,452 3,765 1,064
763 280
79 164 14
1,686 3,581 3,032 3,675 386 612 171 110 42
| bm og
24 1.9
TABLE IV. Decline in incidence of Plague (Ceylon)
by five year periods
Period in years
10
Average number
of cases (annually)
XS
269
207
84
VS
62
1914–1918 1919-1923 1924-1928 1929-1933 1934–1938 1939-1943 1944-1948 1949-1953 1954-to date
38
Nil
Nil Nil
Nil

Page 37
THE PATTERN OF COMMUNICA
229
DECLINE IN PLAGUE
1914 - 1953 (BY FIS
444
1
300
250
& & & & &
200
150
100
50
1914-18. 1919-23. 1924-28. 1929-33.
din Til

BLE DISEASES IN CEYLON
25
INCIDENCE (CEYLON) VE YEAR PERIODS)
447
1934-38, 1939-43, 1944-48. 1949-53.

Page 38
aneste
26
TABLE V.
INCIDENCE OF DIARRHOEAL DISEASES
THE PATTERN OF COMMUN
1957
Treat.
Deaths
1958
Treat. Deaths
1959
Treat.
Deaths
1960
Treat.
Deaths
Bacilloary dysentery
2,833
132
2,117
104
1,566
87
2,137

UIUspecimeu Iorus OI aysentery
5,669
102
7,736
569
5,558
86
2,020
20
Amoebiasis without mention of liver abscess
5,502
45
6,079
52
6,412
27
10,567
61
Gastro-enteritis and colitis
64,614
2,518
66,653
1,747
59,186
1,939
59,008
1,924
Acute or choleraie diarrhoea
2,099
70
1,796
104.
1,905
100
2,020
20
CABLE DISEASES IN CEYLON
Acute infantile diarrhoea
1,440
58
2,492
122
3,374
80
4,122
112
Chronic enteritis and ulcerative colitis
2,520
182
2,667
148
3.477
100
3,078
94

Page 39
THE PATTERN OF COMMUNICAB
8ž 8
. From the figures given above for small- D pox, cholera and plague, it is evident that plague and cholera have been eradicated from the country as no cases have occurred since 1938 and 1953. Smallpox is under control and outbreaks take place from time to time due to Ceylon being in close proxi
mity to smallpox endemic areas. With strict quarantine measures, with efficient vaccination programmes both primary and secondary and with the eradication programme that is being put into effect in India, smallpox could also be eradicated from Ceylon.
"an 3.5
In considering the pattern of communicable diseases, the problem of malaria should also be considered briefly. Malaria which was one of the biggest public health problem is now in the eradication phase. The annual number of cases which used to be in the region of a million before 1948 has fallen to 110 cases in 1961.
co
sp
Di
co
ha
Till recent times, the problem of infectious diseases was the problem of four major acute killing diseases mentioned above viz., malaria, smallpox, cholera and plague. Malaria was the most common among these and this accounted for a large amount of morbidity and mortality. The Department of Health Services till 1959 gave priority to the study and control of these diseases..
of
als
са tio he
ag
tin bre
The problem of “ minor "" infectious
In diseases : In this group of minor infectious diseases, special attention is given to the problem
be of enteric diseases and typhoid fever
ap and other salmonella infections appear
օս to be the most important problem. Typhoid fever is endemic all over the country. According to official information
Tr received from notifications and hospital
w records, approximately four to five
cas thousand cases come to notice annually.
A On the basis of studies conducted by the sch Epidemiological unit of the Department of Health Services, it was estimated that in
att Ceylon 15,000 to 20,000 cases of typhoid
inf occur annually. As regards other Salmonella infections not much is known about these.
no
UL
dis
inc

E DISEASES IN CEYLON
27
senteries and Diarrhoeas :
These are very common in Ceylon but e exact incidence is not known as notificions have been poor. With respect to cillary dysentery, from available inforation, it seems that Flexner dysentery is evalent although Sonne and other types o occur. Amoebic dysentery and amoebic patitis account for a large number of spital admissions. A large number of ses are reported as gastro-enteritis among e population and this accounts for a ge amount of morbidity. Table V ves the number of cases of dysenteries d diarrhoeas that are treated in medical stitutions in the island.
phtheria, whooping cough and
tetanus :
The incidence of diphtheria, whooping ugh and tetanus is becoming greater and ecial attention is being paid to these. phtheria in Ceylon is still a disease of the e-school child unlike in most Western untries where the pattern of diphtheria s been changing. A correct assessment
the incidence of whooping cough has 10 not been made as a large number of ses are treated by Ayurvedic practiiners. Tetanus too is becoming a public alth problem especially in predominantly ricultural areas.
fectious Hepatitis :
Very recently, infectious hepatitis has come a disease problem. The disease pears to be endemic in certain areas and tbreaks have occurred from time to ne. One of the most important outak was the one at a Teachers aining College at Uyanwatte, Kandy ere a water borne outbreak of 30 ses was reported in 1956 (Perera 1957). minor outbreak took place in a boarding 1ool at Kandy in 1959. The outbreak at anwatte brought this disease to the ention of the Health authorities and ectious hepatitis was made a notifiable ease in 1956. Table VI. gives the idence as seen in hospital admission and tified cases.

Page 40
28
THE PATTERN OF COMMUT
assotsia bisaolota T
INFECTIOUS HEI
et degree |
Hospital cases of 1
i nov |
1956 1957 1958 1959 1960 1961
2717 2288 1749 2297 2378 2932
Poliomyelitis :
Acute anterior poliomyelitis was not considered a major public health problem.
With the improvement in sanitation, and the fall in infant mortality rate, the problem of poliomyelitis may become important. At present, poliomyelitis is ende
mic in the Island though during 1952, and 1957 the number of cases showed an increase during certain months of the year. The age group that is affected is the age group under 3 years. Though the disease is endemic at present the “ epidemic evolution" of the disease will have to be watched carefully. The new pattern of poliomyelitis that may emerge and the role of Coxsackie and Echo group of viruses will also have to be kept in mind.
Pyrexias of unknown origin :
A very common diagnoses in dispensaries, outpatient departments and hospitals are “ Influenza ?”. “ Pyrexias of unknown origin” and simple continued fever. In some institutions up to 80% of cases of acute febrile illnesses are given these diagnoses. With a view to understand the diagnostic composition of this group, investigations of a preliminary nature revealed the prevalence of leptospirosis, brucellosis, typhus group of fever and arbor virus infections.
(a) Leptospirosis :
Clinical cases of leptospirosis have been reported recently in the General Hospital, Colombo and leptospira have been isolated from the blood of rats caught in the

ICABLE DISEASES IN CEYLON
ABLE VI. solrod atomladi ne
ATITIS IN CEYLON MOD
Hepatitis
Notified cases of Hepatitis
| hasta
285 647 830 828 1123 2832
Colombo Port area. Serological surveys carried out revealed that the following types were found. L. icterohaemorrhagia, canicola, australis, mautumnalis, medanensis, pomona, pyrogenes, saxkoebing, zwolfii, sentot, hebdomadis, and bangkiang. The final typing is awaited with interest.
(b) Rickettsial diseases : or
1. Murine typhus
The first two cases of murine typhus were reported by C. F. Fernando in 1938, one from Nuwara Eliya and another from Colombo. Preliminary studies made revealed that Murine typhus is prevalent in the up-country bazaar towns like Kandy, Gampola and Nawalapitiya. These were plague infected towns once. A few cases are being seen in Colombo as well.
2. Scrub typhus : la lo maldos
The first two cases of scrub typhus were reported by Wijerama in 1938, and in 1944 during World War II, when a division of 3,000 East African troops were stationed at Embilipitiya in the Ratnapura District, about 756 cases occurred after jungle training. (Lewthwaite 195!). This brought the disease into prominence in the country.
Cases of scrub typhus are seen in Colombo and its suburbs like Kotte, Mt. Lavinia and in certain areas of Ratnapura.
(c) Arthropod borne viruses and res
piratory viruses : Evidence of arbor virus infections and respiratory virus infections is available from reports of preliminary serological surveys

Page 41
THE PATTERN OF COMMUNICA
carried out by the Epidemiological unit of the Department of Health Services. When laboratory facilities are available for a routine diagnosis of these diseases and when clinicians become aware of the problem, more information on these will be available. The prevalence of antibodies for dengue, Japanese B encephalitis and other group B arbor viruses was shown in certain sera examined by the Virus Research Centre, Poona from patients treated at the Children's Hospital, Colombo.
Discussion :
The progress of public health in a country is assessed to a great extent by the achievements in the field of communicable diseases control. The Island of Ceylon is in very close proximity to the sub-continents of India and Pakistan where there are still an enormous reservoir of cases of smallpox, cholera and plague. Owing to strict quarantine measures, cholera and plague have been eradicated and smallpox kept under control though there is daily communication between the two countries. Malaria was one of the major problems and after the great malaria epidemic in 1935 which accounted for 47,326 deaths, the health authorities gave high priority to the control of malaria by organising public health work all over the Island. The result of malaria control especially after the advent of D.D.T. has been the colonisation of large areas of land which were depopulated due to malaria. At present malaria is in the eradication phase. The era where priority was given to the control of killing diseases like smallpox, cholera, plague and malaria could be considered as the first phase in the development of communicable diseases control in the country. The second phase is the realisation of the role of environmental sanitation as a causative factor for the large group of enteric diseases among whom the predominant and the most important one is the enterie group of fevers. Diphtheria, whooping cough and poliomyelitis should also be considered as diseases of importance which accounts for a very high morbidity. This is the phase

BLE DISEASES IN CEYLON
( 29
in which Ceylon is at present. With the control of these, newer diseases will come to the foreground, diseases like leptospirosis, other zoonoses and viral and rickettsial diseases. In the group of viral diseases, the arthropod borne virus inEfections will very soon assume an important place. The importance of acute anterior poliomyelitis in this changing pattern should also be considered. In addition to the changing pattern of diseases, the changing epidemiological pattern of certain diseases like diphtheria and poliomyelitis will also have to receive attention.
Conclusion :
William Farr, Statistician to the Registrar General of U.K. in his annual letter stated in 1873. “ The infectious diseases replace each other and when one is rooted out it is apt to be replaced by others which ravage the human race indifferently whenever the conditions of healthy life are wanting. They have this property in common with weeds and other forms of life—as one species recedes another advances". When one looks upon the changing pattern of communicable diseases in various countries, how killing diseases gave way to enteric and respiratory diseases and how these are giving way at present due to the advancement in public health, environmental sanitation and immunisation programmes to a large spectra of viral and rickettsial diseases, Farrs statement appears very prophetic. This will be equally true n Ceylon as well. Physicians and public nealth workers should become aware of these rapid changes taking place in the ield of communicable diseases.
SUMMARY:
In the pattern of communicable diseases, plague and cholera have been eradicated.
Malaria is in the process of eradication and smallpox is under control. Enteric discases especially typhoid fever, diphtheria, whooping cough and tetanus are responsible for a large amount of morbidity.

Page 42
30
THE PATTERN OF COMME
Poliomyelitis too will become an importa problem. Attention has to be paid newer diseases like leptospirosis, other zo noses, viral and rickettsial diseases, esp cially to arthropod borne viral enceph litidies.
REF
1. ADMINISTRATION REPORT OF THE DIRECTE
1960.
2. DE SILVA, DR. DAVID MONTAGUE (1956).
Publication Bureau, Colombo, Ceylon.
3. FALISEVAC, J. AND ARUMANAY AGAM, P. (
XVIII-11.
4. KELAART, NOEL (1952).-The Ceylon Medi 5. LEWATHWAITE, R. (1951),—Rickettsial fer
fectious fevers, London. 6. PERERA, P. A. D. (1957).--Tr. Society of 7. SPITTEL, F. C. (1956).—Tr. Society of Med

NICABLE DISEASES IN CEYLON
ACKNOWLEDGEMENTS
The Author’s thanks are due to the
Director of Health Services for granting me a- permission to publish this paper and to
Mr. J. S. Perera for secretarial assistance.
ERENCES
R OF HEALTH SERVICES-COLOMBO, CEYLON 1957,1959,
—Health Progress in Ceylon: A Survey—Government
1959), Tr. Society of Med. Officers of Health, Ceylon,
cal Journal, 1-28.
pers, in H. STANLEY BANKS : Modern Practice in In
Med. Officers of Health, Ceylon, XVII-17. . Officers of Health, Ceylon, XVI-25.

Page 43
- Seven nev
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Page 44
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Page 45
AN INTESTINAL PARASITIC S
HEALTHY POPULAT
BY
V. SIVALINGAM, M.R.C.P. (Edin.) ; D.T.
Professor of Parasitology, Faculty of
The survey was conducted over a period of 6 years (1946-1952).
The individuals examined were those who had come for anti-rabies inoculations to the Pasteur Institute, Colombo. As the inoculations were done daily in the mornings, it was the practice to detain in the Institute all persons from distant places as they were not in a position to come daily from their homes for receiving the inoculations.
w
TABLE
INTESTINAL INFECTIONS TR
Amoebiasis Without Liver
Abscess
Amoebiasis With Liver Abscess
Pro.
Year
Dys
Treated
Deaths
Treated
Deaths
| Treated
1951
1953
3734
68
1086
12
527
1955
4717
52
1488
36
139
1957
5502
* 45
1461
21
290
1959
6412
27
1701
36
154
Very early in the investigation, it became bl obvious that these persons were infected by tr other intestinal parasites also, and thus all di the infections found during the examinations were registered.
st
Method :
Since the primary object was the establishment of the “Amoebic Carrier '' pro- ol
be to

33
URVEY OF AN APPARENTLY ION IN CEYLON
E. AND H. (Eng.); L.M.S. (Ceylon).
Medicine, University of Ceylon.
The original intention was to determine ne " Amoebic Carrier ” problem among an pparently healthy population. No work 1 this subject had been undertaken itherto, and an investigation appeared to e important as amoebiasis was widely resent in Ceylon. The Annual Reports of ne Director of Health Services indicated a ide prevalence of this infection. Table I adicates the numbers treated in the Ospitals for amoebiasis and other intestinal arasites over a few years.
1.
EATED IN HOSPITALS
Cher
tozoal entery
Ancylostomiasis
Other Diseases
ases Due to Helminths
Deaths
Treated
Deaths
Treated
Deaths
15110
288
12695
612
14077
185
22761
1205
16113
178
38551
1723
1. E o a
19019
118
50615
1582
20947
67
49132
1130
em, examinations for the presence of ophozoites and cysts were carried out in rect saline smears, iodine smears and by lture methods. A concentration techque with CuSO4 solution for cysts was arted, but was abandoned as it could not ! carried out satisfactorily in our laboraries. The other parasitic infections were served in the direct saline smears only.

Page 46
34
AN INTESTINAL PARASITIC SUR
POPULATI
The stay of the persons for completin the course of anti-rabies inoculations varie between 7 days and 21 days - and th number of faecal samples from them varie between 1 and 7.
The number of persons comprising mer women and children totalled 1,251.
The number of specimens secured fron them for examination was 5,019.
The persons came from the area which i indicated in Map 1.
The cases are a true random sampling as no human persons were responsible, but they were the victims of biting dogs.
The intestinal parasites found and the extent of their prevalence are shown in Table II.

VEY OF AN APPARENTLY HEALTHY ON IN CEYLON
TABLE II.
and
INTESTINAL PARASITES FOUND
IN THE SURVEY
NUMBER EXAMINED 1,251
% POSITIVE FOR PARASITES 90
*22 26
6
Hoy
Ertamoeba histolytica Entamoeba coli Iodamoeba butchlii Endolimax nana Giardia lamblia Trichomonas intestinalis
Ascaris lệmbricoides Necator americanus. Trichuris trichiura Enterobius vermicularis Hymenolepis diminuta
49 45
0:1
It will be seen that as many as eleven species of parasites have been found, some markedly much commoner than others. Entamoeba histolytica, and Entamoeba coli are the commoner protozoal infections ; and the helminthic infections were due to Ascaris lumbricoides, Necator americanus and Trichuris trichiura.
Table III shows the extent of combination of any two of these commoner parasites.
TABLE III.
ANALYSIS OF CASES HARBOURING COMBINATIONS
OF Two PARASITES
NUMBER EXAMINED–1,251
Number Positive Positive
Combinations
11
E.histolytica+E.coli E.histolytica + A.lumbricoides E.histolyticat necator E.histolytica FT.trichiura Ascaris-FTrichuris
140 118 113
98 338
78 | 26
It is worthwhile to note how frequently E. histolytica is mixed up with other common intestinal parasites. But the most outstanding combination is that of the Round worm and Whip worm which reached the high figure of 26 per cent.

Page 47
AN INTESTINAL PARASITIC SURVEY
POPULATION
PLATE
* 3 Ascaris lumbricoides 1. Unsegmented Ascaris ovum in fresh stools 3. Advanced segmentation

35
E OF AN APPARENTLY HEALTHY
IN CEYLON
I.
Phase contrast 2. Segmentation has commenced 4. Larva inside the egg shell

Page 48
36
AN INTESTINAL PARASITIC SURVE
POPULATION
PLATE
Trichuris trichiura 1. Trichuris ovum unsegmented in fresh stools 3. More advanced segmentation

EY OF AN APPARENTLY HEALTHY - IN CEYLON E II.
Phase contrast 2. 3 cell segmentation 4. Larva developed and inside the egg shell

Page 49
AN INTESTINAL PARASITIC SURVEY
POPULATION 1
TABLE IV.
Numbers of Persons with 8
OR MORE PARASITES
NUMBER EXAMINED-1,251
Number Positive for 3 or
more Parasites
428
% Positive
34
In Table IV, the number of persons harbouring 3 or more parasites are shown. The figure of 34 per cent should make all medical men realise how our people in this surveyed area are riddled with intestinal parasites ; and I am of the view that these findings are representative of the state of affairs in other parts of the island.
YN YR
In this investigation it was not possible to show the infections by different age groups, on account of the smallness of each group. But a gross differentiation between children (ages 12 and under) and adults (over 12 years of age) has been possible thus enabling to bring out the salient features of two important modes of acquiring parasitic infection, namely, by ingestion of the infective stage of the parasite or by the entry by penetration of skin of the infective stage into man by its own efforts. Typical and widely prevalent parasites belonging to these groups respectively are the Round worm and the Hookworm.
CO W -
Y +
Table V shows the results
dU P
TABLE V.
ANALYSIS OF CHILDREN : (12 YEARS AND UNDER)
Infected
Number examined
309 Number Infected with Ascaris 179 Number Infected with Necator 123
58
| 40
ANALYSIS OF ADULTS
(OVER 12 YEARS OF AGE)
Number Examined
942 Number Infected with Ascaris 429 Number Infected with Necator 439
45
a o c+ +
46

OF AN APPARENTLY HEALTHY EN CEYLON
In these series 309 children were examined. Infestation with the Round Norm amounted to 58% and infestation with Hookworm was 40%.
Among 942 adults who comprised the series of the survey, the respective infection rates were 45% and 46%.
It is seen that children had a larger percentage of Ascaris infection than adults, while there was no significant difference in che rates in respect of hookworm infections. This result is as is to be expected ; for children, by their habit of playing on ground, which well may have been faecally polluted and by putting their contaminated ingers into their mouth or picking up dropped sweets and eating them though polluted with soil material, a habit absent n adults, become a ready and easy risk to acquire the infection.
There will be no difference in Hookworm nfections as both classes of persons walk about equally freely on likely polluted grounds, and the infective larva enters by penetrating the skin of feet. This larva is
he third stage larva.
Plate I shows the development of the scaris ovum and the stage it must reach in he soil before it could become infective to Luman beings.
These are phase-contrast photo-microraphs and it will be noted that the live arva is contained within the two coats of he egg. The larva is well protected to rithstand adverse conditions of temerature and environment by these coats.
Similar development is necessary for nfection with Whipworm.
Plate II are phase-contrast photo-microraphs and shows this development.
On the other hand, in Hookworm infecons, the infective stage larva escapes into ne soil and remains alive until it gets any pportunity to enter man by piercing the rin when he walks about bare-footed.

Page 50
38
AN INTESTINAL PARASITIC SUI
POPULATI
The Department of Health Servic conducts regularly Island-wide treatment i school children and village population fi hookworm infection. In this campaig stools are sent for ova and for hookwor; ova counts to the Medical Research Inst tute, Colombo, before and after treatmer of these persons. The hookworm ova al counted according to Stoll's technique, an
Willis's salt floatation method is employe for the detection of the presence of Ascari and Trichuris ova, and for hookworm ov when the faeces sent was of insufficien quantities for Stoll's count. No examina tion was made for the presence of intestina protozoa or for helminthic ova that will no float by Willis's technique. The analysi presented here is from data when the write was at the Medical Research Institute an are from persons, before treatment, in th same areas as in my principal survey, an comprises all ages from 5 to 60 years an is shown in Table VI. The number o persons dealt with is 3,111.
TABLE VI.
ANCYLOSTOMIASIS CAMPAIGN, 1953
HOOKWORM, ROUNDWORM AND WHIPWORM
SURVEY — (ALL AGES)
NUMBER EXAMINED—8,111
O/
Number Positive
Positive
N. americanus
1870
60
A. lumbricoides
1403
45
T. trichiura
748
24
A comparison of the results given i Table II and Table VI shows a somewha greater prevalence of hookworm infection as revealed by the Ancylostomiasis Cam paign, while the Round worm infections are same in both, while a distinctly greate Trichuris infection is shown in the mair survey. However both surveys reveal the very high incidence of parasitism by these helminths in the population of the area under consideration.

VEY OF AN APPARENTLY HEALTHY ON IN CEYLON
ES A survey on the same lines was done on of another group of persons. These were the er newly enrolled pupil nurses of the Nurses n Training School, Colombo, November 1955
—January 1956.
The findings are shown in Table VII.
TABLE VII.
SURVEY – PUPIL NURSES NURSES' TRAINING SCHOOL, COLOMBO.
NOVEMBER 1955 — JANUARY 1956
NUMBER EXAMINED—254 % PosITIVE FOR PARASITES 38
5.5
2
OP 1 P - C
E.histolytica E.coli I.butschlii
E.nana G.lamblia A.lumbricoides N.americanus T.trichiura E.vermicularis
2:8 2.4 8
9:5 0:4
The very low prevalence of every one of the parasites is striking. This group comes from a better economically placed class of persons who have better hygienic living conditions and consequently are less at risk to exposure to infections by intestinal parasites.
Another survey was made on a group of persons with a superior economical status. They comprised a group of students of the University of Ceylon, Colombo, admitted in the years 1958 to 1961. The number of students examined was 1, 737.
Table VIII gives the results.
TABLE VIII.
SURVEY – UNIVERSITY OF CEYLON STUDENTS,
COLOMBO. ADMITTED 1958 - 1961 NUMBER EXAMINED-1,737 % POSITIVE FOR PARASITES 42
E.histolytica E.coli 1.butschlii Endolimax nana G.lamblia T.intestinalis A.lumbricoides N.americanus T.trichiura E.vermicularis
1.5 3.0 0:0 0:0 3.0 0:0 3:0 3.0 3.0 0-0

Page 51
AN INTESTINAL PARASITIC SURVEY
POPULATION IN
Here again the very low incidence of E intestinal parasitism is striking.
E3 2.
Discussion :
E. histolytica ranks among the most pathogenic of man's intestinal parasites. “ Carriers" are the sources for the spread of amoebiasis ; and the determination of presence of “ Carriers" in a population has been conducted in several parts of the world particularly in U.S.A. In Ceylon no one has so far investigated the “ Carrier state and the survey reported in this paper is therefore the first on this subject. It is seen that 22% of persons who lived in the area indicated in Map I were “ Carriers ". Since the other parts of Ceylon are not different from this area in factors of hygiene, it will not be wrong to suggest that one-fifth of our people are infected
with E. histolytica.
ËSE E S
5 2.AK
R.
Recently, amoebae, the trophozoites of which conform to the morphology of E. histolytica and which give rise to tetranucleate cysts, have been separated into a large race and a small race, basing this separation on the size of the cyst, size of 10u being taken as the line of demarcation, the small race being non-pathogenic.
th ho
It has not been able to make this distinction, as at the time of this survey, this view had not been fully confirmed.
na
th
Karunaratne (1941) in his detailed survey of the literature on the pathology of amoe
see bic hepatitis, gives the world-wide distribution of the amoebic carrier state. He ex states that Boeck (1923) found a carrier rate of 4·1 per cent in U.S.A., Dobell in
be the United Kingdom a rate of 7-10 per cent, Bach (1932) a rate of 5.7% in Germany; Acton (1918) in India a rate of 20%; Brug (1920) found 16% in Java for
isl the indigenous people and 21 % for (cl Europeans; and Dunbar and Stephens
ar (1930) give a carrier rate of 21:9 for Indians in Madras. From these figures, it is seen that the 22% rate for our area comes top.
ag
WC
th. th
Of the other intestinal protozoa, E. coli is present even at a higher level than in

39
OF AN APPARENTLY HEALTHY
CEYLON
histolytica, but being non-pathogenic, til effects from its prevalence are absent.
The next for consideration are the helinthic infections. The extensive paracization by the three worms A. lumbriides, N. americanus and T. trichiura is oteworthy, namely 49 per cent, 45 per
nt and 42 per cent respectively.
Jayewardene (1957) has made a study of arasitic Infection in school children during e period October 1953 to October 1955. ne examination was from two groups, hool children 2 to 14+ years of age in crious parts of Colombo, and the other, ildren from the rural schools from all ris of Ceylon and who were dealt with
the Ancylostomiasis Campaign. Table E shows the results she obtained.
is seen that her survey showed a high cidence for hookworm infection of 72.5% r the rural school children and only 3% r the Colombo school children. The pund worm and the Whip worm infections owed approximately equal prevalence in ch of the groups. Sa
When compared with my surveys, Tables and IX, the Round worm infection and e Whip worm infections are equal, but the ok worm infection is much higher, mely 72•5% against 45% of my findings.
Also other interesting data obtained are n by a comparison of the results given in bles VI and IX. Both are results of aminations of specimens of stools sent by e Ancylostomiasis campaign officers fore treatment.
Jayewardene's figures are for children of es 2 to 14+ and coming from the whole and, whereas my figures are for all ages hildren and adults) and drawn from the pas of my survey. The great similarity
the percentages of infection is noterthy. This is a strong support for the !w expressed earlier, that we may accept at the intestinal parasitic infections of } whole of Ceylon would resemble those the area of my survey.

Page 52
40
AN INTESTINAL PARASITIC SUR
POPULATIO
TA
PARASITIC INFECTIO
(JAYEWAI
COLOMBO SCHOOLS CHILDREN
Number Examined
559
19
No. Positive for Hookworm
% Positive
293
No. Positive for Roundworm
% Positive
=
52
ART No. Positive for Whipworm
196
% Positive,
35
Conclusions :
1. Results of the intestinal parasite
survey of an apparently healthy population of an area of Ceylon are given. Attention is drawn to the heavy parasitic infection in them. The numerous protozoal and helminthic parasites found and their extent are listed. Attention is drawn to the fact that Ascaris infection is predominantly one of children,
3.
REFE
1. KARUNARATNE, W. A. E. (1941). The Path
of the Pathogenic Role of the Entamoe
XXXVIII, p. 1.
2. JAYEWARDENE, L. G. (1957). A study of Pa
Vol. IV (New Series), p. 99.

FEY OF AN APPARENTLY HEALTHY
N IN CEYLON
BLE IX.
IN SCHOOL CHILDREN
DENE, 1957)
RURAL SCHOOLS CHILDREN
Number Examined
804
No. Positive for Hookworm
583
% Positive
72.5
No. Positive for Roundworm
400
% Positive
50
No. Positive for Whipworm
214
% Positive
E
26.6
5. Trichuris infection is a frequent com
panion of Ascaris infection.
6. Hookworm infection is equally pre
valent among adults and children.
Parasitologically speaking, our country is primitive in the practice of Public Health Sanitation.
It is time that a very serious view is taken of the parasitic infections of the intestines and vigorous measures are launched against them.
RENCES
blogy of Amoebic Hepatitis including a Consideration ha histolytica. J. Cey. Br. Brit. Med. Ass., Vol.
rasitic Infection in School Children. Cey. Med. Jour.
al al

Page 53
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Page 54
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Page 55
A REVIEW OF THE PROBLI
MALARIA IN
BY
T. VISVALINGAM, L.M.S. (( Superintendent, Anti-Malaria
The Physiography and CI
Cli
Physiography :
clin The island of Ceylon is situated between 5° 55' and 9° 50' North latitude, and 790 42' and 81° 53' East latitude, in the Indian Ocean close to the southern extremity of India.
litt
hu It is 25,332 sq. miles in area with the greatest length of 270 miles from North to South, and 140 miles across at the widest Te part.
flat
LICIN 1811, Val
The south central portion is mountainous,
sta reaching up to high altitudes with the high
ye: est mountain rising to 8,292 ft. above mean ten "sea level. The hill country roughly covers hil
one-fifth of the area, of which, about 1,200
yei sq. miles are above the limit of the malarious altitude of 2,500 ft. The hilly portion F gradually slopes on all sides to constitute fai the flat coastal plains of the southern half, and the vast extent of the northern plains
nal covering more than half the length of the ten country.
in
tug Numerous rivers and streams radiate
tuo from the central hills to provide abundant alt and continuous water supply to the south 6,1
western and southern parts of the island while a long period of drought prevails each year in the northern, eastern and South Re eastern plains. The lower northern, north Central, north western and eastern plains have a network of tanks and irrigation
sin channels. A few of these tanks are fed by rivers while a large majority of them collect vai rainwater for irrigation purposes in the dry mo zone. The principal rivers flowing through the wet and intermediate zones that are
Fel associated with Malaria outbreaks, and their terminal points are, the Maha Oya at the
the North of Negombo, Deduru Oya at Chilaw,
du Mahaweli Ganga at Trincomalee, Kelani
70 Ganga at North of Colombo, and Nilwala Ganga at Matara.
lat
mil
fro
hur
sid

43
EM AND CONTROL OF
CYELON
Cey.), D.P.H. (Lond.) Campaign, Ceylon.
imatic Conditions
Map 1 shows the contours, rivers and natic zones.
imatic Conditions :
The climate is essentially Tropical with cle seasonal variations in temperature and
midity.
mperature :
The variation in temperature at any one tion is little marked throughout the ar. Considerable differences exist between nperatures of the flat country and the | country at different altitudes. The mean arly temperature is about 81° F in the | country and a fall in temperature of 1° for every 300 ft. rise in altitude holds rly well throughout the country. The riations between the diurnal and noctur
temperatures are small. The mean yearly nperature variations of some hill stations one year were -- Kandy-—1,654 ft. alti-75: 1 le —-76 4° F., Badulla —2,225 ft. altile 73 7o F., Diyatalawa -4,129 ft. itude 68, 2° F., and Nuwara Eliya — KG.) 88 ft. altitude 59 2° F.
lative Humidity :
The relative humidity is generally high ce no part of the island is more than 70 es from the sea. The average humidity ies but little from month to month. The nthly mean relative humidity varies m 60% to 95% throughout the year. pruary and March are months of highest nidity in the wet zone and along most of
coastal regions. The relative humidity ting the South West monsoon is well over
% in these regions and at nights is conerably higher. Even in dry areas the re
ve humidity rarely falls below 60%.

Page 56
44
A REVIEW OF THE PROBLEM AN
MAF
CONTOU
0
MEDIATE
JZ
A N T E R ME
W E AT

ID CONTROL OF MALARIA IN CEYLON
- |
RS AND CLIMATIC ZONES
LL
KEY
USEA LEVEL TO 500 FEET
500 - 1000 il" anlagt
TIIULIL 1000 - 3000 #
S22
A BOVE 3 O 0 CNN
utilus on linnollisena
) 5 golia
A ANUL
de la

Page 57
A REVIEW OF THE PROBLEM AND CON
The temperature and relative humidity A seldom threaten the existence of Anopheline D mosquitoes or their capacity to develop D malaria parasite generally except at high
ai altitudes.
om S > Go E.S
Rainfall and Climatic Zones :
The rainfall is associated with the two monsoons. The South West monsoon prevails from May to September and the North East monsoon from November to March. The inter-monsoonal months are marked by heavy rainfall which continues during the early months of the monsoons. For the study of Malaria epidemiology, the country has been divided into 3 climatic zones based on the rainfall during the South West monsoon.
te
O 27
The rainfall during the South West monsoon is more than 40 inches in the Wet Zone, 20 to 40 inches in the Intermediate Zone and less than 20 inches in the Dry Zone. The Wet Zone which is the South
West quadrant is 3,992 sq. miles in area. The Intermediate Zone which is a narrow band shaped area between the Wet and Dry Zones is 2,284 sq. miles in extent. The rest of the island is the vast Dry Zone, mostly flat country which is 19,055 sq. miles in area. The annual rainfall figures in the three zones respectively are — over 100 inches reaching 200 inches in some places, between 75 and 100 inches and less than 75 inches.
The rainy season, in the Dry Zone is from end of October to January in the North East monsoon, and in the Wet Zone between April and June and from October to January in both monsoons. The rainy season in the Intermediate Zone follows the pattern of the Wet Zone with less rainfall.
Map 2 shows the annual average rainfall for 30 years in the different parts of the country. Table 1 shows the average monthly rainfall in selected stations in the 3 climatic zones for the period 1911-40.*
Population and Economic Conditions
For administrative purposes the country is divided in to 9 provinces which are further sub-divided into 21 Districts. Recently
As co
*Reproduced from Indian Journal of malariology
- 5, 1st March, 1951.

TROL OF MALARIA IN CEYLON
45
nuradhapura, Batticaloa and Badulla istricts have each been divided into 2 istricts. Provincial and District divisions ce shown in Map 4.
The population of the country which was 565,954 at the census of 1901, had increasI to 6,657,339 at the census of 1946 the ear when the national malaria control procamme by the application of DDT comvenced, and further increased to 10,167,000 - 1961 (estimated mid year population).
The annual population details from 1934 - 1961 are given in Table XIV.
The table below gives the population, mount of increase and percent increase of opulation at each of the census undertaken
nce 1901 to 1946, and for the year 1961.
TABLE II
POPULATION, AMOUNT OF INCREASES, AND
PERCENT INCREASE 1901-1961
ear of Population Amount of Per Cent Pnsus
Increase Increase
1901
3,565,,954 558,165 18.6
(since 1891)
1911
4,106,350 540,396 15.2 1921
4,498,605 392,255 9.6 1931
5.306,871 808,266 18.0 1946
6,657,339 1,350,468
25.4 1961
sidyear Estinated) 10,167,000 3,509,661 52.7
The percent increase of population which as 25.4 for 15 years before 1946 had more lan doubled during the 15 years since 1946 though the birth rate had not shown ppreciable fluctuations during these years. he birth rates (per 1,000 population) were, 1.4 in 1931, 38.4 in 1946 and 36.6 in 1960. he increase in population is mainly due to Le steep decline in the crude death rate Ibsequent to 1946. The crude death rates hich were, 22.9 in 1931, 20.3 in 1946 had eadily declined by 1960 to 8,6.

Page 58
46
A REVIEW OF THE PROBLEM A
MAP 2

ND CONTROL OF MALARIA IN CEYLON
ANNUAL AVERAGE RAINFALL
1911 - 1940,
KEY
25 - 50 INCHESolli
75 -100 11
100 - 125 in
125 - 1 50 rubiiba * 150 - 200
> 200 uning
Somo
pirmone /nn moitlane
awa lori Dominus

Page 59
A REVIEW OF THE PROBLEM AND CI
Map 3 shows the natural increase of population —1901-1930 (by Districts). The natural increase had been very low or in negative figures in the hyperendemic dry zone area as compared to healthy areas of the South Western quadrant and the hill country above the malaria elevation. The natural increase of population in the epidemic intermediate zone is placed between the malaria free wet zone and hyperendemic dry zone.
Map 4 shows the crude densities of population by Districts, in 1931 when malaria was the biggest public health problem, in 1946 when the national malaria control programme by the application of DDT commenced, and in 1960 when malaria had ceased to be a problem. The areas in sq. miles and the densities of population by districts and provinces for the 3 years are given in Table III.
In addition to the natural increase there has been steady influx of population into the hyperendemic dry zone after malaria has been progressively brought under control since 1946.
Ceylon is mainly an agricultural country producing chiefly Tea, Rubber and Coconut. Rice which is the staple diet of the country is produced to meet roughly 50% of the local requirements. Rice production has been stepped up considerably after malaria was brought under control in the rice producing dry zone area, as a result of which the local rice production which was 246,000tons in 1946, increased to 630,000 tons in 1961 with the opening up of large acreages. of land in the previously hyperendemic areas. The total acreage cultivated which
was 927,078 in 1946 when the national, malaria control scheme was inaugurated. had increased to 1,411,700 acres by 1960, subsequent to the control of malaria.
Anopheline Fauna and the Vector
Species
Chalmers A.J. (1905) published the results of his investigations in Ceylon identifying 10 Anopheline species. James S.P. and Gunasekera S.T. (1913) incriminated A. culicificies as the vector in Ceylon after detect

ONTROL OF MALARIA IN CEYLON
47
ing one gland infection from dissections done in Talaimannår. Carter H.F. (1928) confirmed this after finding gut and gland infections in many A. culicifacies which were dissected. Senior White R. (1920) recorded in some detail the breeding habits and seasonal incidence of 8 Anopheline species including A. culicifacies. Carter H.F. (1927) who had done pioneer work, comprehensively reported on the bionomics of Anopheline species in Ceylon.
The following 20 species of Anopheline mosquitoes have been recorded in Ceylon:-
Local Vector
1. A. (Myzomyia) culicifacies GILES,
1901.
Vectors outside Ceylon
2. A. (M.) maculatus THEOBALD, 1901. 3. A. (M.) aconitus DONITZ, 1902. 4. A. (M.) annularis VAN DER WULP,
1884. | 5. A. (Anopheles) barbirostris VAN DER
WULP, 1884. 6. A. (A.) hyrcanus var. nigerrimus
GILES, 1900. 7. A. (M.) leucosphyrus DONITZ, 1901. 8. A. (M.) tessellatus THEOBLAD, 1901. 9. A. (M.) varuna IYENGAR, 1924.
Probably of no Practical Importance
10. A. (A.) aitkeni JAMES, 1903. 11. A. (A.) annandalei var. interruptus
PURI, 1929. 12. A. (A.) gigas var. refutans ALCOCK,
1913. 13. A. (A.) insuloeflorum SWELL. and
SWELL., 1920. . A. (M.) jamesi THEOBALD, 1901. 15. A. (M.) karwari JAMES, 1903.
A. (M.) pallidus THEOBALD, 1901. A. (A.) pseudobarbirostris LUDLOW,
1902. 18. A. (M.) ramsayi COVELL, 1927. 19. A. (M.) subpictus GRASSI, 1899. 20. A. (M.) vagus DÖNITZ, 1902.

Page 60
48
A REVIEW OF THE PROBLEM AN
МАР 3
i di
NAT
unutar 0 a
O AT
(+ 8 3 2
49 9
+13. 31
(+ 14
| +12
* 15. 5
+ 14.2
+ 17. o
+ 16.6

ID CONTROL OF MALARIA IN CEYLON
URAL INCREASE IN POPULATION
BV DISTRICTS 1901 - 1930.
= +10 AND OVER
= to + 10 de
MIMO = - 10 To od uslu
IIIIII+ 8 9
A illalled
+ 9 3//
AD MUTANT 10 bot
Ailərigon

Page 61
A REVIEW OF THE PROBLEM AND CON
MAP 4
CRUDE DI
355 425 589
13
15
32
39
46 83
21 O 263 434
72. 2 69
| 533
II O 2
| 489 625 884
Ll5611 (2.533 3-060
1988
275 409

TROL OF MALARIA IN CEYLON
49
ENSITIES OF POPULATION
31, 1946, 1960.
19401960
},
92

Page 62
50
A REVIEW OF THE PROBLEM AT
A. culicifacies the vector in Ceylon :
A. culicifacies is a small inconspicuou mosquito brown in colour with wings les conspicuously spotted than other anophe line species and with narrowly banded pulp and dark brown unbanded tarsi. It's resting position resembles more that of culicine mosquito. It is essentially a dry zoni species, where it is extensively prevalent ir the jungle covered plains and villages. It', prevalence however diminishes as altitude increases, and becomes a rare species above 2,000 ft. elevation, and is hardly founc above 2,500 ft. It is also a rare species in the intermediate epidemic zone which it invader from the dry zone during times of drough when breeding conditions are favourable It is hardly prevalent in the wet zone which accounts for the relative freedom of this area from malaria. It breeds equally well ir the jungles away from human habitation feeding on wild animals as in the villages o the dry zone where it is domestic in habit: and feeds freely on human beings and domestic animals. Mohan Rao and Ariyaratnam had reported (personal communica tion) that precipiten tests carried out in 1961 on blood meals of A. culicifacies
collected in dwellings, had shown that 32% 'fed on human host and 48% fed on bovine
host.
A. culicifacies enters houses in the evenings and is active specially from dusk to 9 or 10 p.m. and again towards dawn. I rests in dwellings after the blood meal Dwellings of primitive construction such as cadjan huts or wattle and daub structures thatched with cadjan or straw, provide them with excellent shelters.
A. culicifacies breeds in clean stagnani or slow moving waters. The preferentia breeding places are:
(i) Sand and rock pools in beds o
rivers and streams, (ii) Wells of all types, (iii) Brick and quarry pits and coconut
trenches, (iv) Burrow pits, irrigation channels
and seepage waters,

ID CONTROL OF MALARIA IN CEYLON
(v) Rainwater collections,
(vi) Rice fields particularly fallow and
up to quarter growth.
Its prevalence increases seasonally in the
dry and intermediate zones. It is more pree valent in the dry zone during the rainy
season and soon after, in the months from 1 November to March. It invades the inter
mediate zone during drought. Rain flushes the rivers and streams and tends to keep the breeding down to a minimum. Infection rates of 4.8% to 20.6% had been reported by Carther H.F. (1927) during different
months of the year, with the highest rates in the months of December, January and February.
M
Recent investigations by Mohan Rao and Ariyaratnam had shown that 16 years of
residual spraying of houses with DDT in f Ceylon had not caused the development of
resistence in A. culicifacies, to DDT. They had reported (personal communication) L.C. 50 of DDT to A. culicifacies as 0.395% in an unsprayed area and 0.4% in a sprayed area.
Historical references :
How long malaria had existed in Ceylon is a matter of conjecture. Probably the disease was prevalent for centuries. The earliest record of its existence is seen in a map published in 1638 by the Dutch. The area of the old kingdom of Yala in the Southern Province is marked with the statement, “this was depopulated and deserted 300 years ago by fever sickness". The North Central Province was marked as “depopulated by sickness”. Queyroz writing in 1687, alludes to the ancient court of Anuradhapura as being "abandoned on account of protracted pestilence’’ (Perera, 1930). Knox (1681) writing an account of his captivity in Ceylon, had referred to the exceptional prevalence of fever in a town 30 miles North of Kandy. In 1765, the Dutch had reported' of sickness that was raging in Kandy and at Some outposts (from letter dated 6th April, 1765, in Journal Roy. As. Soc. Ceylon 1901). Reference is made in the Dutch minutes of Council of Friday June, 1, 1787, to fever prevailing in general among inhabitants of

Page 63
A REVIEW OF THE PROBLEM AND CC
the Colombo Disawany (area extending from Chilaw to the Walawa river in Matara). The Mudaliyars and Chiefs were requested to issue paddy to the needy in the area to be returned later. Reference is also made to a p similar sickness prevailing in the Galle Korale and the Matara Disawany.
O * O
A
Davy (1821) referred to districts of the interior of Ceylon as being "suddenly de- z solated by endemic fever", while Marshall (1846) observed that endemic fever was one of the prevailing diseases in Ceylon both among the immigrants from Europe and the indigenous inhabitants.
Hirsch (1883) referred to Ceylon as one of the Head quarters of severe remittent and pernicious malaria fever.
E ñ in .= O = 2
Nicholls (1921) attributed the decline of o ancient civilization from the beginning of 13th century to the introduction of malaria from India.
The Distribution and Prevalence of
Malaria :
0只。
al
The Distribution of malaria in Ceylon depended greatly on the extent to which in conditions were favourable for the production of A. culicifacies, the vector species. The temperature and humidity are favourable for breeding and propagation of A. culicifacies and transmission of malaria fr perennially throughout the country except m at high altitudes. The country may be divided into 4 Regions based on the epide- A miology of malaria. (1) Areas free from Malaria. (2) Areas of Epidemic outbreaks. (3). Areas of Epidemic exacerbations. (4) Areas of hyperendemic Malaria.
Areas free from Malaria:
The only areas that were free from malaria when the disease was widespread were the north western portion of the Jaffna peninsula in the dry zone, hill country above altitudes of 2,500 ft. and parts of Kalutara and Galle Districts in the wet zone. Why the north western portion of the Jaffna peninsula was free from malaria where conditions
M were favourable for transmission, with m vector densities increasing seasonally, can in
CC
SC
O

NTROL OF MALARIA IN CEYLON
51
nly be explained by the area being more a eveloped than the rest of the peninsula. he absence of malaria transmission in the ther two areas was due to extremely rare revalence of the vector species.
areas of Epidemic Outbreaks :
Epidemic outbreaks occurred in the wet pne and the adjacent parts of the intermediate zone which areas, under normal onditions, were free from A. culicifacies reeding and transmission of malaria. Some f the principal rivers from the central hills ow through the intermediate and wet pnes out into the western and southern pas. When these rivers and streams were in pate and flowed swiftly due to regular ainfall in their catchment areas, the breedag of A. culicifacies was scarce. Epidemics ccurred only in times of drought when the _vers and streams formed pools, facilitating rolific breeding of the vector species. The reas where epidemic outbreaks occurred Tere the Districts of Colombo, Negombo nd Kegalle and parts of the Districts of Calutara, Kurunegala, Kandy, Ratnapura, -alle, and Nuwara Eliya. Periodic Regional utbreaks of a severe nature occurred, once 13 to 5 years, causing extreme suffering nd high mortalities, particularly among he age groups of either extremes, as the eople had no immunity for the disease or ne immunity level was low on account of eedom from malaria during the inter-epidelic periods.
reas of Epidemic Exacerbations :
These are the meso-endemic areas of the - termediate zone and the adjacent parts of Le dry zone comprising, the Southern parts
Chilaw, Kurunegala and Matale Districts, le valleys of Kandy and Nuwara Eliya istricts and parts of the Districts of atnapura, Matara and Hambantota.
There are two fever seasons in these areas ving rise to 2 small peaks annually, rresponding with inter-monsoon and monon rains. Seasonal increases in malaria cur during April and reach the peak in ay in association with the Southwest onsoon, while the second rise commences
November and reaches the zenith in

Page 64
52
A REVIEW OF THE PROBLEM A
December/January in association with th Northeast monsoon. In times of Regioni epidemics in the wet and intermediate zone the epidemic extended into these mest endemic areas.
Areas of Hyperendemic Malaria :
The rest of the dry zone area whic comprises about 3/4ths of the country wa subject to 'hyper-endemic malaria. Thes areas are the Northern, North Central an Eastern provinces, greater portion of th North Western, and the lower Uv provinces, and parts of the districts C Matale, Hambantota, Ratnapura an Kandy. Malaria was holo-endemic in severa localised areas in the vast hyperendemi zone. One large wave of seasonal increase in incidence occurred annually in this are: during the North East monsoon whicl brings the bulk of the rainfall to the area The seasonal rise starts in November reache the peak in December/January and sub sides to pre-seasonal level by March in the following year.
Epidemics of Malaria before 1900 :
The Civil Medical Department was created in 1858 and in 1867 the earliest avail able report of the Department made re ference to unusual prevalence of fever in the Eastern Province and in the West among coolies working in building bridges over rivers with drying beds. It was reported that malaria fever had prostrated them and in the case of Deduru Oya the work had to be abandoned. The cause was attributed to unhealthy emanations from river beds.
In 1868, it was reported that fever was extremely prevalent throughout the thickly populated portions of the island.
The next reference was made to an outbreak in 1877, which is said to have occurred in the areas drained by Kelan Ganga and Kalu Ganga, after the floods subsided in May and continued till November. Extensive outbreaks were reported in Negombo and Kegalle, in Kurunegala and Puttalam districts and in Avissawella and Ratnapura. The epidemic was attributed to the decomposition of organic matter left exposed to sun after the floods.

AD CONTROL OF MALARIA IN CEYLON
eIn 1880, outbreaks of fever were reported 1 in Negombo, Ratnapura, Kurunegala, and
in parts of Kandy and Matale districts towards the end of the year after heavy rains of the North East monsoon. In Kalutara, intermittent fever in Pasdum Korale from March to October was attributed to Mclearing of jungle for cultivating Coffee.
Dh
In 1884, malaria in epidemic form was reported to have occurred in Negombo district and villages of Ratnapura, Kegalle, Puttalam and Kurunegala districts. Increased prevalence of malaria was also reported between Matale and Anuradhapura and in the Eastern province.
f
In 1887, an epidemic occurred in the Western and North Western Provinces and about a dozen itinerating Medical Officers were reported to have been sent to the fever stricken areas. Extensive outbreaks also occurred in Galle, and the epidemic in the Northern Province continued till March, 1888.
In 1889, there were severe epidemies in Batticaloa and Jaffna. In Jaffna 14 Medical 5 Officers were employed for house-to-house
visits and 6,035 cases and 37 - deaths were - registered. A large number of cases were ! also reported from Uva where there was
immense distress.
In 1891, wide spread outbreaks had occurred during different parts of the year in all the provinces of the island. Medical Officers were sent to the affected areas on special duty. An outbreak that started in the last quarter of 1892 in the Western, North Western and Sabaragamuwa Provinces subsided only during the 3rd quarter of the following year. The outbreak was attributed to continued drought followed by rain.
In 1894, epidemies occurred in Negombo and Jarela areas and in villages bordering on Kelani Valley. Severe outbreaks occurred in Sabaragamuwa province attributed to opening of tea estates in new lands. The Principal Civil Medical Officer reported “mortality caused by malaria fevers and their sequelae is enormous and I fear is increasing yearly’’.

Page 65
A REVIEW OF THE PROBLEM AND CO
In 1895, outbreaks occurred in the ir Western province, and the outbreaks in al Galle and Matara districts were the most virulent. The cause was attributed to disturbance of soil when cutting the railway from Galle to Matara.
. ET 3 T 5
In 1898, one of the severest epidemics known in the area occurred in Jaffna district. There was severe distress and high mortality. Matale and Kurunegala also suffered from severe epidemics following prolonged drought. Malaria was generally prevalent at many places during this year. The epidemic in Jaffna continued till March 1899, and again there was recrudescence in
November. Severe malaria was also reported in Trincomalee and other parts of the m Eastern province.
2 2 2
Epidemics of Malaria after 1900 :
mK
a 2.5
of
In this century epidemics of malaria had occurred in 1906, 1911, 1914, 1919, 1923, 1928/29, 1934/35, 1939/40, 1943 and 1945/46. The 1906 epidemic occurred, following a long period of drought. Percy (1906) had stated that, a widespread outbreak of malaria occurred from April to September affecting the whole island except af the Northern Province. He said that in pr some parts of the country there was scarcely
W an inhabitant who had not suffered from the
pr disease and that there was very great
m distress. The areas most seriously affected were Matara, Hambantota, Veyangoda,
en Hanwella, the Kelani Valley, Matale, Teldeniya, Buttala, Monoragala, a large portion of North Western province and nearly the whole of the Sabaragamuwa
an province. Sessional paper No. XL of 1906
W was published on the epidemic. There was
er an increase of 36,679 deaths in 1906 as compared to the average annual deaths for the previous 6 years.
TE
pr pa
ер
Fe
th
m.
In 1911 an epidemic occurred from May to August after the break of the South-West re
monsoon following a prolonged drought. Parts of the Western, Sabaragamuwa and
th Central provinces were affected. 23,675
m more malaria cases were treated during the year. In Kegalle about 50% of the entire lo population was prostrated causing distress and numerous deaths. There was an di

NTROL OF MALARIA IN CEYLON
53
crease of 33,033 deaths in 1911, over the nual average for the previous 10 years.
The 1914 epidemic affected mostly the astern and Uva provinces. In the Eastern ovince, there were 41,037 more cases of alaria than in the previous year. The ak of mortality was in January, when ere were 4,410 deaths than in the prepus year.
In 1919, the high death rate was mainly te to pandemic influenza which caused pproximately 67,000 deaths. There is vidence of outbreak of malaria also during is year in the months of January and ebruary but the actual death rate due to alaria could not be ascertained separately.
The 1923 epidemic occurred in Trincoalee and Kegalle districts. The outbreak in egalle district was attributed to prolonged Fought followed by insufficient rains and so due to the large pilgrim crowd visiting nuradhapura. In 1923 there was an crease of 15,071 deaths over the number
deaths in the previous year.
The 1928/29 epidemic began early in 1928 fecting the North Western and Uva ovinces, and lower Kelani Valley in estern, and Kegalle in Sabaragamuwa ovinces. Later in the year a severe epideic occurred in Matale district and ambara Valley of Kandy district. At the d of the year the epidemic extended to Ingalle and Hambantota in the Southern ovince. Severe epidemics were also rerted in 1929, in Northern, North-Central d Eastern provinces. Later in the year, estern, Sabaragamuwa, Central and South1 provinces were also affected. The idemic in some areas reached the peak in bruary, 1930. This is reported as one of e severest and most wide spread epidemics.
In 1934/35 came the worst epidemic on :ord. It affected an area of 5,800 sq. les of the most thickly populated parts of e country with a population of 3-1 llions. The areas affected were the whole the Western and Sabragamuwa provinces, ver parts of the North Western and rater portions of Kandy and Matale tricts. Between October 1934 and April

Page 66
54
A REVIEW OF THE PROBLEM A
0-5
DE 40-60
0510
0O 1032
Edo-4o
OVER 6
40 -
zo -40
20 - 40
8102015-VO
5 - 10
5-10
O - 5
5

ND CONTROL OF MALARİA İN CEYLON
MAP 5
SPLEEN RATES
1921-1922
KEY KEY
0 - 5 R 5 - 10
10- 20 20-40 | 40-60 EoVER 60
20 - 40
60
20-'40
40 - 6o

Page 67
A REVIEW OF THE PROBLEM AND CO
1935, 1.5 million contracted the disease and S roughly 80,000 died during the 7 months.
al
This epidemic had far reaching effects in tl that the Government decided to commission cɛ an expert to study the problem of malaria epidemics in Ceylon with particular reference to the 1934/35 epidemic and make recommendations to prevent such national calamities.
Colonel C.A. Gill, I.M.S. who was given the commission, submitted his report Sessional paper XXIII—1935. The result was the inauguration of the malaria control and health scheme of 1937 and the extension of anti-malaria measures and health activities into the Rural areas for the first time.
The 1939/40 epidemic commenced in April Ti 1939, following poor rainfall in February and March. This epidemic which was not so severe, affected Colombo district north of Colombo Town, Negombo, Kurunegala, Kandy and Matale districts and parts of Sabaragamuwa and Southern provinces. The number of clinical cases of malaria increased in 1939 by 455,327 in the epidemic zone and by 1,157,716 in the whole country, above the number of cases in 1938. The
en increase in clinical cases in 1940 was even greater. The malaria deaths increased by 5,261 in by 1939 and 4,391 in 1940 over the number of deaths in 1938.
5.E.SB
re
The 1943 epidemic was also a spring epidemic which commenced in the month of April, following a period of poor rainfall. It was a milder epidemic with limited distribution in the area affected by the 1939/40 epidemic, except that the Southern province was not affected.
dr
m
ar
m
The last of the epidemics occurred in M 1945/46 and affected the wet and intermediate zones of the Kegalle, Kandy and Kurunegala districts. As malaria control measures by the use of DDT had already been instituted, the effect of the epidemic was localised and it was quickly brought under control. The clinical cases, in the epidemic zone increased by 12,457, and in
* the island increased by 867,471 in 1945, and the malaria figures continued to remain high during 1946,
(atuuteng . Gffeeh Leems the generalised llaw many penne slede."
**

NTROL OF MALARIA IN CEYLON
55
pleen Surveys :
To establish the endemicity of malaria in e country systematic spleen surveys were rried out.
pleen Survey—1921/22 :
The first comprehensive island wide spleen ad parasite survey was undertaken from ly, 1921 to July, 1922. Mainly children in wns and villages were examined by random mpling and male adults were included in e sparsely populated areas. The survey as carried out after a period of malaria aiscence during the inter epidemic inrval.
The results of the survey are given in able IV*
According to the results of the survey the demicity of malaria varied considerably
the different parts of the country. The ariations of endemic malaria are expressed
spleen rates, and mapped out in a some hat arbitrary way in Map 5**.
The following classification is made in the demic distribution of malaria from the sults of the spleen survey.
rates
ypoendemic areas (Spleen | 10%) :
wet 2
These areas are generally parts of the termediate zone, the Northern and South estern parts of Jaffna peninsula in the y zone, and hill country above 500 etres (1,500 ft.) elevation. Within these eas are parts that are generally free from alaria.
eso-endemic areas (Spleen rates
%-50%) :
These are the remaining areas of the interediate zone and the adjacent parts of the y zone, the coastal areas of the Eastern pvince and the hill country below 500
tres elevation. Leproduced Table 9 of the sessional paper VII --
by Carter et al (1927). Reproduced Map 6 of the sessional paper VII ----
by Carter et al (1927).

Page 68
56
A REVIEW OF THE PROBLEM
Hyper-endemic areas (Spleen rates 51%-75%) :
This constitutes the remaining vast are: of the dry zone.
Holo-endemic areas (Spleen rates abovi 75%) :
These are isolated areas within the hyper endemic Zone. Spleen rates of 70 to 1009 have been recorded in Northern, Nortl Central, Eastern, Uva and Central province by Carter et al. (1927).
Spleen Survey—1936-1941:
The next island wide spleen and parasiti survey was carried out in 1936 and this wa repeated annually until 1941. The annua survey confined to school children wa carried out only at schools in the country The results of the annual spleen survey from 1936 to 1941 are given in Table V.
The high spleen rates of 1936 and 1937 show the influence the great epidemic o 1934/35 had in increasing the spleen rates The island spleen rate which was 13.5% ir the 1921/22 survey had increased to 30.6% in 1936 soon after the great epidemic, and gradually declined to 28.4%, 21.2%, 18,2% respectively in successive years. The spleer rates of Western, Sabaragamuwa, North
Western and Central provinces which were affected by the great epidemic were mucl higher than the rates of the unaffected areas. The spleen rates in certain district of North Western, Uva, Sabaragamuwa an Southern provinces affected by the 1939/40 epidemic and also the spleen rate of the hyper-endemic North Central province hac increased in the 1940 March survey, al though the island's average spleen rat showed reduction in this year.
Spleen Surveys 1946–1955 :
The results of the island wide spleei surveys from 1946 to 1955 are given by districts in Table. VI. The rapid decline i spleen rates in the entire island from 194 when the national malaria control pro gramme by residual spraying of DDT t. dwellings was inagurated, corresponds t

AND CONTROL OF MALARIA IN CEYLON
the steep decline in epidemic and endemic malaria throughout the country. The island spleen rate which stood at 11.8% in - September, 1946 had declined to 0.2% by March, 1955. The highest spleen rate in 1955 was 1.4% for the Hambantota district. The spleen rate of Mannar district was 0.6% while all other districts had registered lower rates.
The spleen rates at the March survey a carried out in the hyper-endemic area after
the seasonal rise in malaria was always higher than the rates in the September survey which followed the dry months of low malaria incidence.
en The annual spleen survey was suspended s | as of no significance after 1955 when the
island spleen rate had declined to 0.2%.
Parasite Surveys Earlier Surveys :
The earliest island wide malaria parasite - survey was conducted in 1921/22 by Carter
et al. The results are given in Table IV. 5,040 blood smears taken from school children of all areas were examined and the overall slide positivity rate was 13.5%. The parasite rates in the wet and intermediate zones and at elevations above 1,000 metres were low in the inter-epidemic period when the survey was carried out. High parasite rates were registered in the hyper-endemic areas. The parasite rate of the North
Western portion of Jaffna peninsula was lower than that of the rest of the peninsula.
The species distribution of malaria parasites is given in Table VII*.
The species distribution in 1,751 positive blood smears was, P. vivax—57.7%, P. malariae 33.7% and P. falciparum10.1%. In the Uva hyper-endemic area, P. malariae predominated, in the North Central and North Western hyper-endemic areas, the prevalence of P. vivax and P. malariae was almost equal, while in all other areas P. vivax predominated. P. falciparum was the least prevalent species in all areas.
* Reproduced from sessional paper VII — by
Carter et al (1927).

Page 69
A REVIEW OF THE PROBLEM AND CO
in
In the earlier parasite surveys of a limited nature, James and Gunasekera (1913) found w in Mannar island that out of 42 positives, pa P. malariae-71%, P. vivax—18% and P. falciparum —10%Subsequently in Jaffna peninsula they found, P. malariae 73% and P. vivax_26%. During 1922 epidemic at Mahara prison, in 31 blood smears examined, 51.5% were P. vivax and 48.5% P. falciparum.
P;
co
dr
SU
In:
19
Bahr found in the North Western province that in 45 positive blood smears the distribution was, P. malariae—68.8%, P. vivax26.7% and P. falciparum—6.7%. He also found at Tangalle in the Southern province that in 19 positive blood films the distribution was, P. malariae—57% and P. falciparum—41%.
fo 5. ра an
th
19
To ascertain the seasonal distribution of parasite species, blood smears taken at 5 selected stations—Anuradhapura, Jaffna, Trincomalee, Kurunegala and Badulla restricted to hospital patients, showed that P. malariae predominated until P. vivax took the lead during the last four months of the year in areas of heavy rainfall during the North East monsoon. P. falciparum maintained a steady low prevalence throughout. (Carter et al. 1927).
pr
Ce sin of
During epidemic of 1934/35 :
an.
10,215 positive smears were examined
rep during 4 months, from November 1934, of the great epidemic, and the species distribu
co tion was, P. vivax—60.2%, P. falciparum
ov 38.5% and P. malariae-1.1%. This distribution disagreed with the species distribution, in blood smears examined at the bil General Hospital, Colombo alone, which was P. falciparum 67.2%, P. vivax—32.7%
doi and no infections with P. malariae.
P. The species distribution, in 516 positive/ api blood smears taken from 2,703 apparently healthy children in the districts of Colombo,
Pa Kalutara, Kegalle, Kurunegala and Kandy which were affected by the epidemic was, P. vivax --70%, P. falciparum—29% and
cor P. malariae 1%. The slide positivity rate fro was 19.1%.
rat
rel:

NTROL OF MALARIA IN CEYLON
57
During epidemics, P. malariae prevalence as least but this species predominated articularly in the endemic areas during ter-epidemic periods. In epidemics and mes of seasonal rise of malaria, P. vivax Fedominated. P. falciparum was more -mmon in the epidemic zone than in the -y zone.
arasite Survey 1938-1941:
The results of the island wide parasite rvey annually carried out in schools dury February and March for 4 years from 38 are given in Table VIII.
The average island parasite rates for the ur years from 1938 were 4. %, 5.1%, 3% and 3.7% respectively. The island rasite rate in the 1921/22 survey was 13.5 d the parasite rate in the area affected by e 1934/35 epidemic was 19.1%. The 39/40 epidemic had influenced the rise in rasite rates in the Western and Sabbaramuwa provinces in 1939 and the rise ntinued in the Sabbaragamuwa province 1940 also. There was a general decline in e parasite rates in 1941.
Carter et al. (1927) stated that the low evalence of P. falciparum malaria in ylon is a matter of considerable interest ice in many tropical countries this form
parasite preponderated.
Sivalingam and Rustomjee (1941) ported the predominence of P. malariae
February and March throughout the untry, and the prevalence of P. vivaxer P. falciparum in the wet zone.
Sivalingam (1943) ascribed the responsiity for epidemic outbreaks, to P. vivax A P. falciparum, the latter playing a minant part. He further states that the ative high prevelence of P. malariae and falciparum would serve to indicate an proaching outbreak.
rasite Surveys 1946-1954
The results of the annual parasite survey aducted at schools are given by districts
m 1946 to 1954 in Table IX. The parasite ce in the March survey conducted at the

Page 70
58
A REVIEW OF THE PROBLEM ANI
end of the period of seasonal rise in malaria, was always higher than the rates in the September survey. The island parasite rate which was 3.6% in 1946 when the national
malaria control programme using DDT was
• started, steadily declined to reach 0.07% by 1954 the last year when the survey was conducted. The parasite rate in 1954, was zero in 14 out of 22 districts, one district registered 1.8% and rates for the remaining districts were less than 0.5%. The annual parasite survey of school children was not conducted after 1954 when surveillance operations were instituted and blood smears
were taken in mass surveys and fever surveys in epidemic and endemic areas.
Infant Parasite Survey:
Infant parasite surveys were carried out from 1951 to 1955 and later in 1959 and 1960. Blood smears were taken and examined, from all infants (under 1 yr.) attending the child welfare clinics throughout the island during one month. In 1959, infants attending medical institutions for treatment were also included in the survey. In 1960 the survey was further extended by requesting Surveillance Officers to take blood films in their home visits. The results of the survey are given in Table X. Very few infants were found infected. In 1959, one out of 9,419 infants examined was positive, and in 1960 none was found infected out of 27,281 infants examined.
Malaria Morbidity and Mortality
Malaria Morbidity :
Malaria was the most prevalent disease until it was brought under control by the National Malaria Control Programme, using DDT for residual spraying, which was in augurated in 1946. A large percentage o patients treated at hospitals and dispen saries were for malaria. Table XI shows that annually 26.7% to 52.5% of patients who visited medical institutions during the year 1910 to 1923 were treated for malaria.
A study of attendances at certain representative hospitals shows that th percentages of mean annual malaria morbi dity to total attendance for the years 1910

D CONTROL OF MALARIA IN CEYLON
to 1923 were over 50 in 3 districts, 40 to 50 in 6 districts and 20 to 40 in 8 districts. The
lowest percentage was 7.2 in respect of 9 1 hospitals in the Nuwara Eliya district which
is a healthy hilly area.
= Table XII gives the percentage of
inpatients and outpatients annually treated for malaria over a period of ten years from 1924. 11.1% to 19.7% inpatients and 31.4% to 45.2% outpatients were annually treated for malaria over the ten year period.
Table XIII gives the malaria morbidity by districts from 1950 to 1961. Five years of National Malaria Control Programme by residual application of insecticides had reduced the annual malaria cases from approximately 2.7 million in a population of 6.7 millions in 1946, to 0.6 million in 1950. The rapid decline of malaria over the years is evident from the detection of only
110 cases in 1961. The 110 cases were detecte ed in 14 districts while there were no cases E in 8 districts.
Table XIV gives the population and malaria morbidity rates (per 1,000 population) for the years 1934 to 1961. The increase (of malaria cases in 1959 was due to intensify-N ing the search for cases by organising surveillance activities after launching the Malaria Eradication Programme in November, 1958.
Malaria Mortality:
Deaths from malaria had been under estimated when the disease was widely prevalent. As in the case of malaria morbidity, many malaria deaths had been classified under deaths from "pyrexias.
High malaria mortality was greatly responsible for the slow rate of increase in population until malaria was brought under control, despite the high birth rate of the country. During epidemic years the mortality rates rose steeply. In the 1934/35 epidemic the number of deaths during the 6
months of the epidemic exceeded the mean average deaths for the previous four years by 177 % in the affected areas and by 39% in the other areas,

Page 71
A REVIEW OF THE PROBLEM AND CO
of
in
Table XIV gives the population, and malaria mortality rates (per million population) by years from 1934 to 1961. The annual
i de malaria mortality rates varied between 770 and 8,439 up to 1946 before malaria was
19 brought under control. Subsequent to 1946 when malaria incidence steadily declined, the malaria mortality too declined rapidly to reach one death in 1958. Since 1959 there re
were no deaths from malaria.
pe
паа еу
Vital Statistics1901-1960:
Vital Statistics in so far as they relate to crude birth rate, crude death rate and infant death rate and the influence of malaria on them are briefly discussed.
Table XV gives the crude birth rate, crude death rate and infant death rate by years from 1901 to 1960, and in Table XVI by these statistics are given by decennial periods. The figures indicate, less conspicuous fluctuations in the birth rate, and a Pi declining trend in the crude, death rate
marked by sharp increases in times of epidemics. The crude death rate had fluctuated according to the severity of the
Al epidemics. The 1906 and 1911, malaria
(1 epidemics were responsible for approxi
mately 37,000 and 33,000 deaths res- an pectively and this was reflected by corresponding increases in the crude death rates. Similar increases in crude death rates were registered in epidemic years, 1914, 1919, 1923, 1928/29, 1934/35, 1939, 1943
ed and 1945/46. The crude death rate for 1919 sharply rose due to approximately 67,000
more deaths on account of pandemic in- fu fluenza and malaria. The highest death rate ep of 36.6 was registered in 1935 as a result of ou the great malaria epidemic of 1934/35.
sti
tic
The curve of infant mortality rate ac conformed closely to the crude death rate to ou illustrate that infants suffered severely due to malaria and mortality among them was high.
Scarcely less conspicuous than the sharp rises in the mortality rates was the decline in birth rates during epidemics and in years immediately following each sharp rise in
mortality rates. This is a characteristic feature of malaria epidemics upon the in fecundity of the population.
KE 33S
fo

ATROL OF MALARIA IN CEYLON
59
With the steady and progressive decline malaria year by year since 1946, the crude ath rate and infant death rate correspondgly declined to reach the lowest level in 60 with the crude death rate being 8.6 d the infant death rate being 57. In the me year the number of malaria cases tected was 422 which is the lowest corded up to that time.
alaria Control Measures :
The activities for the control of malaria, n be categorized as events of two distinct riods. The pre-DDT era which is the riod before 1946, and the DDT era which mmenced in 1946 with the inauguration the National Malaria Control Programme - residual application of DDT.
re-DDT era:
Chalmers A.J. (1905) was the first to ince interest in the problem of malaria. len Perry (1908) and Marcus Fernando 910) are others who took interest and
mulated early attention to investigate d study the problem.
On the recommendation of a Committee pointed by the Government, the first iti-Malaria Campaign centre was establish
at Kurunegala in 1911 under the direcon and control of Dr. S. T. Gunasekera. iring the 22 months this Campaign centre nctioned, important entomological and idemiological investigations were carried
t.
The early interest was not maintained on count of the first World War which broke t in 1914.
In 1921, with the appointment of . H. F. Carter as the first Malariologist, e study of the problem of malaria was vived. A report on Malaria and Anopheline osquitoes of Ceylon by H. F. Carter was blished as Sessional Paper VII of 1927. vo full time Medical Officers assisted . H. F. Carter in carrying out the restigations and obtaining information
the report.

Page 72
60
A REVIEW OF THE PROBLEM AN
TAI
VITAL STATISTICS (RATES PER
PERIOD
BIRTH ᎡᎪᎢᎬ
1901-10
38.1
1911-20
37.9
1921-30
39:8
1931 40
36 · 4
1941-50
38 - 6
1951-60
37:8
In 1922 and 1923 Anti-Malaria Campaig centres were established at Mahara prisor Anuradhapura and Trincomalee. Malari control measures were instituted at Mahar following a severe epidemic among prisoner: The Campaign at Anuradhapura an Trincomalee was directed by the Malari logist and operations were carried out b special Medical Officers, Entomologica Assistants, Overseers and Labourers.
In 1925, a Malaria Advisory Committe was formed with the Colonial Secretary E Chairman, including several unofficia members of the Legislative Council an representatives of various Government D partments, to advise on the future polic and planning, and for co-ordinating malar Control work. On this Committee's recon
mendation, an executive branch under tł Superintendent of the Anti-Malaria Can paign, and a research branch under th Medical Entomologist were established an a Sanitary Engineer with experience i malaria control work was also appointed.
In 1927, a Departmental Committee o Malaria was formed with the Assistan Director of Sanitary Services as Chairmaj and the members were Mr. H. F. Carte Medical Entomologist, Dr. K. J. Rustomje Superintendent, Anti-Malaria Campaign an Mr. H. N. Worth, Malaria Engineer who als acted as Sanitary Engineer. This Committ

ID CONTROL OF MALARIA IN CEYLON
BLE XVI
THOUSAND) BY DECENNIAL PERIODS
90 1-6 0
DEATH
RATE
INFANTMORTALITY
RATE
28.8
180
30 - 6
196
26-5
182
23.
171
17:5
116
10-4
69
n met periodically, reviewed the programme 1, and progress of work, and planned future
a activities.
D
5. More Campaign centres were established,
at Chilaw and Kurunegala in 1928, at Puttalam and Badulla in 1930, and at Maho in 1931. Malaria control work was commenced at a number of other railway stations in the malarious areas.
ee Control of Malaria in Estates :
al In 1926, the Ceylon Estate Proprietary d Planters' Association inaugurated a Malaria 2
Control Scheme for their estates and y Dr. H. C. Ross (a brother of Sir Ronald Ross) ia was appointed the first Malariologist,
7
seconded by the Ross Institute of Tropical Hygiene, London. The control of malaria in
the estates was of importance as the estate ne population constituted 1/9th of the total
population, the prosperity of the country was closely bound with the productivity of the estates and the Government had a
special responsibility to look after the health n of a large immigrant population.
1
n
The estates made their own arrangements r, for organising a scheme for Anti-Malaria
measures in estates that subscribed to the scheme. Lieut-Colonel W. W. Clemesha,
I.M.S. (retd.) who succeeded Dr. H. C. Ross, ce organised measures for the control of mos

Page 73
A REVIEW OF THE PROBLEM AND co
quito, and provided preventive treatment a by using quinine and other anti-malarial drugs.
Nature of work done :
The anti-malaria measures were mainly confined to campaign centres established in urban areas, important railway stations, and at Mahara prison. Only anti-larval measures were carried out to reduce the mosquito densities. Gangs of labourers were engaged to attend to minor works at the campaign centres such as, construction and maintenance of drains in order to prevent water stagnation, and filling and draining of low lying areas and burrow pits. Major work was undertaken in some campaign centres such as the construction of Halpanela at Anuradhapura. Other Anti-Malaria measures taken were oiling of Anopheline breeding places that could not be eliminated or permanently improved, introduction of larvivorous fish into breeding places such as
wells, tanks and rain water collections, and dusting of Parisgreen mixed with soapstone powder to certain types of breeding places. Nurseries were maintained to breed small varieties of fish like, “millions?' (Lebistes reticulatus) and the indigenous variety “Haplachilus lineatus’, which were periodically introduced into potential breeding f: places. Water collections were sprayed with I oil mixture (kerosine 1 part and fuel oil 4 i parts).
|
t.
Prison labour was utilised in some centres t for anti-malaria work. The following labour fi force was used at Anuradhapura in 1925.
Prison labour
— 42 convicts Oiling Brigade
5 coolies and 1 s
Kangany Maintenance Brigade - 20 coolies and 1
Kangany Halpan-ela Force
average of 100 coolies and
4 e Kanganies.
The staff at each campaign centre work- f ing under the direction of the Malariologist, o
was a Medical Officer, Entomological r Assistants, Overseers, Kanganies and labour force. The Medical Officer who was in im
mediate charge, controlled and supervised n

NTROL OF MALARIA IN CEYLON
61
1 works in his area. He maintained close sociation with local authorities and prorietors.
rug Prophylaxis : Systematic distribution of quinine was rganised during the period of seasonal rise - malaria in hyper-endemic areas. It was pped that at least during the first two months of the rainy season with the onset E the North-east monsoon sufficiently high ercentage of the people would have taken uinine regularly to ensure definite reducon in the parasite rate and relapses. At nuradhapura, two Apothecaries were asgned the duty of weekly distribution of uinine to school children, and to houseolders by house-to-house visits. Quinine ards were maintained at houses to keep ecords. The two Apothecaries made regular isits to 1,800 houses in Anuradhapura own from October 1923 to March 1924. imilar measures for quinine prophylaxis nd treatment were organised at other ampaign centres under the direction of Provincial Surgeons.
n times of Epidemics :
Intensive measures were taken in times of pidemics to provide special treatment scilities and medical comforts. The Medical Department opened up treatment centres 1 groups of affected villages and provided reatment within easy access. During the 934/35 epidemic, 690 new treatment cenres were opened in the affected area to inction in addition to 38 hospitals and 80 entral dispensaries that existed in the area. 36 estates threw open their dispensaries for ne treatment of villagers using free drugs upplied by the Government. Additional saff was temporarily employed and even medical students and apothecary students rere mobilised for service. 33,000 lbs. of uinine were issued in six months of the pidemic. Arrangements were made through he Government Agents who were the Proincial Administrative Heads, to provide pod, and medical comforts to patients and ther householders who required help. Rice, milkfoods and other food products were istributed free of charge and transport scilities were arranged for patients to the earest hospitals and treatment centres.

Page 74
62
A REVIEW OF THE PROBLEM AT
Voluntary organisations came forward t give assistance in providing treatmer facilities and medical comforts. Ant mosquito measures were undertaken t control breeding. Unemployed village
were given relief by providing minor work such as filling low lying areas. Breeding i rivers and streams were controlled b weekly oiling of water pools in drying rive beds. During the 1934/35 epidemic 12 unit of labour gangs operated to oil Maha Oyɛ Kelani Ganga, Mahaweli Ganga and Dedur Oya and their tributaries, the basins ( which were affected by the epidemic, unt the rivers were flushed by rain. River oilin operations were carried out under th direction of Assistant Sanitary Engineers Sanitary Inspectors carried out intelligenc service to keep in touch with conditions i villages and inform the Medical Director o developing situations.
Aftermath of 1934/35 Epidemic :
The disastrous epidemic of 1934/35 re volutionised the Malaria Control and Healt Services in the country. Loss of lives an suffering unprecedented in living memory made the Government decide on taking a possible measures to avert similar catas tropies, in the future.
Colonel C. A. Gill, I.M.S., was commission ed to investigate epidemics in Ceylon wit particular reference to the 1934/35 epidemi and make recommendations for formulatin the anti-malaria policy for the country. Hi report was published as Sessional Pape XXIII—1935. The principles of ant malaria policy enunciated included th eradication of the malaria vector species reduction of the number of human carriers alleviation of economic stress, and improv ing the hygienic conditions in order to reduc the spread of communicable diseases, an raise the resistence of the people. The repor stressed that anti-malaria measures canno be separated from other sanitary measures The storm water drainage scheme for ex ample was not only to control malaria bu also to reduce the incidence of othe common communicable diseases. He re commended that malaria control shoul come under the perview of the Public Healt

AD CONTROL OF MALARIA IN CEYLON
O Department and Institution of Antiat Malaria measures must rest primarily with 1- the Health Officer and the Local authorities.
n DC
N
g
The result of this report was the inauguration of a new Malaria Control and Health Scheme in 1937. It provided for the carrying
out of malaria control measures as part of er an intensive general health scheme based on Es the principles of Health Unit activities. The
country was divided into 105 Health Unit areas and Field Medical Officers, more Sanitary Inspectors and Rural Midwives were appointed. For the first time malaria control and general health activities were
extended into the rural areas. Anti-Malaria 5. measures were undertaken in the land se development, colonisation and irrigation n schemes which were hitherto not making of headway due to malaria. Medical Officers of
Health, Field Medical Officers and Sanitary Inspectors were given a comprehensive course of training in malariology as part of their routine health training scheme. For this purpose a Malaria Field Training Centre
was established at Kurunegala in 1939. In h
the new scheme, no less importance was stressed on the development of the Maternity and Child Welfare and School Health Services of the country. Field Medical Officers appointed on the basis of one for every 40,000 population were in charge of the malaria control and health schemes in the rural areas while the Medical Officer of Health functioned in the urban areas. Sanitary Inspectors and Field Midwives were appointed on the basis of one for 8,000 and 4,000 population respectively. .
S.
g
S
E
},
|-
New Scheme of Malaria Control Activities :
The malaria control activities were intensified and expanded to cover rural areas. The Field Medical Officers carried out preliminary malaria and health surveys to
assess the problems in their areas and pret. pare long term and short term programmes t of work.
Oiling of rivers and streams as anti-malaria measure was placed on a permanent footing in epidemic areas. Streams in estates which were more than 10 ft. in width were taken
over by the Department for emergency h oiling.

Page 75
A REVIEW OF THE PROBLEM AND CON
lar
st
54 malaria observations stations were established in the epidemic zone and month
ye ly examinations were carried out by Entomological Assistants for Anopheline prevalence. The programme at each station spread over 6 days and consisted of house examinations, night trapping of mosquitoes
of in cattle baited traps, and examination of rivers and village breeding places for lervae.
in About .325 subsidiary observation sites were strategically established along rivers and streams in the epidemic zone and Sanitary Inspectors carried out fortnightly larval surveys. The examination for larvae
were carried out weekly in times of drought. E When the breeding of vector species was detected, emergency river oiling was ordered at weekly intervals until rains flushed the streams. Gangs of labourers sprayed "Malariol’’ a larvicide, supervised by Overseers.
M Automatically working syphons were installed in epidemiologically important streams to produce intermittent agitation and destroy the larvae. Many other naturalistic methods were adopted to control the
lo breeding of anopheline.
be Regular oiling of potential breeding places were also carried out at the campaign centres. Gangs of labourers were engaged
m for maintenance work in order to reduce anopeline breeding.
TI
co
ev
sit
tw
th
Se th
sp
M.
Every Sanitary Inspector maintained his m fish nursery and periodically introduced off larvivorous fish into wells and other breeding places.
(1
Quinine centres were established in the endemic zone to make Quinine mixture easily available for patients. The Sanitary Inspectors visited these centres periodically and supplied the mixture to maintain stocks.
Spraying of pyrethrum extract :
Spray killing of adult mosquitoes resting in houses was undertaken from 1939 on an organised basis. Pyrethrum extract in the form of pyrocide 20 was used for space spraying on 2 days every week, Owing to

STROL OF MALARIA IN CEYLON
63
ck of adequate supplies during the early ears of the war, the spraying was limited
selected areas where agricultural and lonization schemes were in progress. This secticide was used on a wide basis in the aha Oya basin and upper catchment areas the Deduru Oya which were affected by e 1943 epidemic. In 1944 when adequate pplies became available imagocidal sprayo was extended to 48 rural malaria control ntres. As this insecticide had no residual tion the high cost of frequent spraying evented its use on an extensive scale.
valuation of results :
Under the reorganised scheme of malaria ntrol, the progress was continuously aluated. An island wide spleen and parace survey was organised and carried out Fice a year at schools from 1938. The arch survey was carried out at the end of e fever season in the endemic areas and e results were compared with those of the ptember survey which was at the end of e dry season when malaria incidence was w. Owing to the second World War the leen and parasite survey was suspended tween the years 1942 and 1945.
Records of malaria morbidity and ortality statistics were maintained by - Health Officers in respect of their areas. ne Medical Officers of Health, Field edical Officers and Sanitary Inspectors aintained the following records in their ices.
- Malaria Register in five parts, namely:-
(a) Weekly total attendance, Fever
attendance, Fever Index and Malaria attendance by Medical Institutions.
(6) Weekly malaria cases and malaria
deaths by villages.
(c)
Records of results of larval surveys by Sanitary Inspectors at Subsidiary observation sites.
(d) Monthly expenditure on Malaria
Control Work,

Page 76
64
A REVIEW OF THE PROBLEM A
(e) Work done by the Health Office
(2) A graph chart was maintained at a
Medical and Public Health Institution to show weekly the total attendanc fever attendance and malaria atter dance at Medical Institutions an Health areas.
Malaria Education Activities :
The Health Officers and Sanitary II spectors gave talks on malaria in their visil to schools and at clinics. Posters and liter: ture on malaria were printed and distribute to the people in order to disseminate knov ledge on malaria. Sanitary Inspectors gav group talks in villages, on malaria.
Island wide "Malaria Week Celebrations were inaugurated in 1937 and annuall carried out in order to make the gener public conscious of the malaria problem an to educate them in their duties to reduce th problem. Since malaria was brought und control the nomanclature had been change to "Health Week Celebration’’ subsequently
In spite of all these activities on a organised basis, epidemics continued t occur although in less severe form, in 1939 40, 1943 and in 1945/46, until DDT cam into use. There is little doubt that tł control measures adopted under the ne scheme had reduced the problem of malari and the severity of epidemics during thes years.
D. D. T. ERA
National Malaria Control Programme
When nearly four-fifths of the countr was subject to endemic malaria and a larg portion of the thickly populated balanc area had severe regional epidemics period cally, the control measures so far adopte could only give some relief to reduce th severity of the epidemics while the mai problem of malaria remained unabted.
The advent of DDT in 1945, the first of series of residual insecticides, revolutionise malaria control in this country as in man other countries. 1945 was an epidemic yea and the availability of a limited quantit

ND CONTROL OF MALARIA IN CEYLON
r. of DDT through the courtesy of the Army
Services was the beginning of a Campaign
which made this the last of the epidemics in as the country.
After preliminary trials carried out confirming the efficacy of this insecticide as a potent killer of the local malaria vector, a comprehensive scheme was submitted in September, 1945 for the National Control of Malaria and accepted by the Government.
The aim of the scheme was to rapidly a- bring malaria under control and help the
development and progress of the country - and improve the health of the people.
25
It was envisaged to give complete coverage in residual spraying of DDT to all areas subject to malaria and carry out the spray
ing operations with high degree of efficiency al so that malaria transmission may be inter
d rupted as quickly as possible.
er Malaria Control Units :
The scheme was inaugurated in the first
week of November, 1945, by the establishn ment of two malaria control mobile units at O Anuradhapura and Kekirawa in the North | Central Province which was one of the worst le affected areas.
w In 1947, 31 Truck Units, 6 Jeep Units and a 37 Walking Units functioned to spray DDT te to every dwelling in the entire area subject
to malaria. The entire dry zone except the North Western portion of the Jaffna peninsula, the entire intermediate zone except Colombo and the suburbs, parts of the wet zone subject to epidemie malaria and the hill country below the malaria elevation of
2,500 ft. were sprayed. Map VI shows the ve
areas of operation of 28 Truck Units, 16
Jeep Units and 18 Walking Units which d functioned in 1950.
i
n 585,000 houses in the malarious areas
were sprayed with 5% DDT in Kerosene
Solution in cycles of 6 weeks. The dosage of a DDT was 1. gm/sq. metre. This dosage was
obtained by dissolving 7 ozs. of technical y DDT in one gallon of Kerosene and sprayring at the rate of one gallon solution to 2,000
y sq. ft. surface.

Page 77
A REVIEW OF THE PROBLEM AND CON
MAP 6
DISTRIBUTIO
IV

TROL OF MALARIA IN CEYLON
65
as)
OF MALARIA CONTROL UNITS
1950.
KEY
TRUCK UNITS 28
JEEP UNITS 16
WALKING UNITS 18
HEALTHY AREA
|27|
-XIV
XY

Page 78
| 66
A REVIEW OF THE PROBLEM
From 1948, Benzene hexachloride we table powder (Gammexane P 520) was als used after its portency was tested by pr liminary trials. The dosage of gama isom BHC was .12 gm/sq. metre. This dosage w: obtained by suspending 3/4 lb of Gan
mexane P 520 in 1 gallon of water ar spraying at the rate of 1 gallon suspensi to 2,000 sq. ft. surface. The DDT Kerosen solution was changed to DDT emulsio prepared by dissolving technical DDT Zylene and adding Triton X-100 as emu cifier. The emulsion had the advantage i that it is non-inflammable and could ! transported to the field as 40% concentra and diluted with water on the spot an sprayed as a 5% DDT emulsion thus redu ing the number of porters necessary f transport.
Later, the DDT emulsion was changed DDT watery suspension which made tl transport less difficult. One lb. of 75% DD wettable powder suspended in 3 gallons water which is the capacity of the four Oal Knapsack Sprayer that is used, sprayed : the rate of one gallon per 2,000 sq. 1 surface gave a dosage of .5 gm/sq. metr DDT wettable powder made the operatic less expensive in many ways. Each spra
man is able to carry all his requirements insecticide and no porter or helper w: necessary.
As malaria was brought under control t} interval of spraying was extended from
weeks to 2 months and later to 3 month At present areas on the banks of rivers ar streams, developing areas, chena cultivatic areas and villages on the outskirts of jungle where malaria potential is high, are spray at intervals of 3 months while the develop areas and settled villages are sprayed intervals of 6 months.
Truck Units :
These are large mobile spraying units wit 9 to 15 spraymen in each unit with a Publ Health Inspector (new designation for Sanitary Inspector) in charge and 2 to Overseers to assist him in supervision, that one Supervisor will supervise the wo1 of 3 spraymen. A large truck or super Jee and a driver are provided for transport

AND CONTROL OF MALARIA ÎN CEYLON
t- each unit. These units operate in areas S0
accessible by large vehicles.
er Jeep Units :
AS
One Driver Overseer, one Overseer and ad 6 spraymen comprise this unit. The Driver on Overseer drives the Jeep as well as super
vises work. The Jeep Unit operates in reon
mote areas that are accessible only by Jeep and not by a larger vehicle.
ne
N
Walking Units :
ge
te
C
A Walking Unit comprises an Overseer to supervise and 3 or 4 spraymen. These units operate in very remote areas that are not approachable by vehicles, or in urban areas where it is redundant to use vehicles, for transport.
le
- In experience it was found that walking -T units in remote areas were more expensive of and difficult to inspect. The 37 Walking Is Units which operated in 1947, were gradualat ly disbanded and ultimately their entire Et. programme of work was assigned to mobile
units which camped out in these remote areas and carried out the spraying operations.
-e.
51
as Technique of Spraying:
as.
Dn
es,
Each spraying unit is assigned areas for ne 3 or 6 monthly cycles of spraying at the 6 rate of an average of 20 houses to be sprayed
by each sprayman per day. The unit sprays according to an approved advance programme prepared for a cycle. No deviations
are allowed without approval. The sprayed man and the supervisor have to sign the ed householder's card maintained at each
house, after the spraying had been satisfactorily done. Each superivsor visits an average of 60 houses per day. The entire roof, inner walls, eaves and hangings of every shelter is sprayed.
at hoge
th
The malaria control units submit the following progress reports of work:
SO
Weekly progress reports, Monthly progress reports, and Daily running chart of vehicle.

Page 79
A REVIEW OF THE PROBLEM AND CON
Vigilance Units :
Vigilance Units were established soon after the Control Units started functioning in the endemic and epidemic areas. Each unit was manned by an Entomological Assistant and Field Attendant who travelled on motor cycle. Emphasis was laid on entomological investigations for testing the potency and efficient application of insecticides. Routine entomological investigations were carried out at, 39 stations in the dry zone, 25 stations in the intermediate zone and 3 stations in the wet zone. As the methods of surveillance had changed subsequently with the interruption of malaria transmission, the Entomological Assistants were replaced by trained Public Health Inspectors and the Field Attendants by labourers trained in residual spraying.
(c
The number of Vigilance Units were increased in order to strengthen surveillance activities in areas from where the control units were withdrawn commencing from 1951.
The displaced supervisors and some spraymen were appointed to the new Vigilance Units.
The following were the duties of the Vigilance Units :
a. Examination of 15 houses per day for ap
Anopheline adults by hand catch and fro spray catch methods. Later the number of houses examined per day was increased to 20. After hand catching was done in 5 houses, spray catch- mi ing was carried out in all 20 houses. Fixed houses were examined in the
( epidemic area but in the endemic area random selected houses were examined.
(2
Rivers and streams and potential village breeding places in the vicinity of houses examined were surveyed for ( anopheline larvae.
The entomological collections were daily despatched to the central laboratory of the Campaign for identification.
W

TROL OF MALARIA IN CEYLON
67
-) Examination of 108 subsidiary obser
vations sites (S.O. Sites) in the epidemic zone in order to check the fortnightly routine examinations for anopheline larvae carried out by Range Public Health Inspectors.
The Range Public Health Inspectors spent half a day on the examination at each fixed station, and forwarded the collections to the central laboratory.
) Checking the efficiency of spraying by, inspecting for adequate insecticidal deposits, questioning the inmates of houses and by checking the entries made in the householder cards by the spraymen and supervisors.
2) Detection of new chenas and new
dwellings and making arrangements to get them sprayed by the control units.
) Detection of reservoirs of infection by
taking blood smears from suspected and fever cases.
f) Carrying out epidemiological investiga
tions and domiciliary treatment of referred cases of malaria.
E) Carrying out mass fever surveys in
relation to referred malaria cases.
The Vigilance Unit worked according to an proved fortnightly programme, to deviate
m which prior approval was obtained.
The following progress reports were subtted:
E) Investigation reports of positive cases
were submitted as soon as investigation and treatment were completed.
) Weekly progress report of work.
) Weekly report of defects detected in
spraying.
) Monthly progress report. ork done by Vigilance Units 1950 ;

Page 80
68
A REVIEW OF THE PROBLE
Anopheline Investigations :
18,105 houses in the dry zone, 13 houses in the intermediate zone and 1 houses in the wet zone were examined the hand catch method, and 322 A. cu facies were detected in the dry zone.
16,496 houses in the dry zone, 13 houses in the intermediate zone and 1 houses in the wet zone were. examined spray catch method, and A. culicifa adults, 487 in the dry zone and 7 in the zone were detected.
Blood filming work:
4,184 blood smears were taken f suspected cases and fever cases and
were positive for malaria parasites givir positivity rate of 8.6%.
Examination of subsidiary observat sites (S.O. Sites—1950) :
Range Public Health Inspectors car out fortnightly examinations at fixed S sites, 44 in the wet zone, 58 in the in mediate zone and 6 in the dry zone, detected 7 A. culicifacies larvae on occasions in the dry zone and none in other 2 zones.
Clinical cases of Malaria—1950 :
Blood smears were taken from 3, clinically diagnosed cases of malaria
Medical Institutions and 162 were for positive for malaria parasites giving a pos vity rate of 4.8%.
Investigations of A. culicifacies Jungles--1949/50 :
Investigations for the first time w carried out to determine the prevalence : breeding status of A. culicifacies in jung away from human habitation. Two par led by Medical Officers camped out in jungles of North Central, Southern and I provinces and carried out the investigatio A, culicifacies adults and larvae were

M AND CONTROL OF MALARIA IN CEYLON
tected in jungles at distances as much as 6
miles away from the nearest dwellings. This 369
proved that A. culicifacies the vector is as 995 much a jungle species feeding on wild
animals as it is a domestic species haunting lici- human habitats feeding on human blood.
by
361
ion
105 Interruption of Residual Spraying : 995 by
Encouraged by the elimination of the cies vector species in the wet zone, its scarcity wet in the intermediate zone and the absence of
transmission in both zones, interruption of spraying was first contemplated in 1951. During this year, the truck unit at Matara
was withdrawn and interruption of spraying rom
commenced in the epidemic area sprayed by
this unit. In 1952 the truck units at ng a
Negombo and Kandy were withdrawn and interruption of spraying was extended to include the epidemic areas sprayed by these 2 units. Three walking units that operated in 3 inslands in the dry zone off the Jaffna peninsula were also withdrawn. In 1954, six Truck Units, one Jeep Unit and 2 Walking
Units were withdrawn, interrupting residual 5.0.
spraying in the entire epidemic area and in
the islands off the Jaffna peninsula in the and dry zone. This was possible in view of the
interruption of transmission in the entire epidemic zone, parts of the endemic zone, and steep decline in malaria morbidity in 1953 and 1954. 269,024 malaria cases in 1952, had declined to 91,650 in 1953 and 29,650 in 1954. Another inducement for
the interruption of spraying was the report461
ing of increasing number of vectors of other at
countries developing resistence to insectiind
eides. In Greece one vector was reported to have developed resistence to insecticides in 1951 but by 1954 four other vectors had
developed resistence in other countries.
ried
ter
| 2 the
siti
ind
in
The subject of the development of resistence was discussed at the malaria
conference in Bagiuo, Philippines, in ere
November, 1954. After this conference it
was thought prudent to limit the use of DDT gles
in order to deter the development of resistties ence, and apply it sparingly, restricting it to the
areas of transmission. From February, 1955 Tva spraying was interrupted in the entire ns. epidemic area and in the urban areas and de- settled villages of the endemic area,

Page 81
A REVIEW OF THE PROBLEM AND
Emergency spraying units-—1955:
15 emergency Jeep units were set up and staffed by 15 driver Overseers and 15 Overseers to supervise 90 spraymen. These units were stationed, 4 in the Eastern province, 2 each in the North Central, Uva, North Western, Southern and Northern Provinces and one in Sabaragamuwa province.
The emergency spraying units sprayed only work sites in the developing areas Land development and colonization schemes under 2 years old, chena cultivation areas and foci areas. The interval of spraying was 3 months and 6 months depending on the transmission potential of the area.
Surveillance operations :
The Public Health Inspectors and Overseers displaced from the disbanded spraying units were utilised to man the newly established vigilance units and vigilance subunits in the spray interrupted areas.
Vigilance Units in Epidemic Areas :
9 Vigilance Units functioned in the epidemic area. These units concentrated more on entomological investigations as before, for the early detection of the appearance of the vector species in the intermediate and wet zones. The Vigilance unit officers also took blood smears from fever cases wherever they visited and at selected medical institutions. They investigated clinical and confirmed cases notified and administered treatment by domiciliary visits. As transmission had been interrupted in the area the cases were few and invariably infection was imported.
Vigilance Units in Endemic Area:
The ten Vigilance Units that functioned before were increased to 24 to intensify surveillance in the endemic area as spraying had been withdrawn from the larger portion of the area. Some of these Vigilance Units were provided with Jeeps, and Spray men instead of Field Attendants in order to carry out emergency spraying immediately on

CONTROL OF MALARIA IN CEYLON
69
detection of new chenas and new dwellings in jungle areas without wasting time in notifying the emergency malaria control units to undertake the spraying.
Some of the duties of these units were revised in order to strengthen surveillance activities in spray interrupted areas while other duties were performed as before. The full course of treatment was administered to cases by 3 domiciliary visits. Infective reservoirs were visited once a month and blood smears were taken from all fever cases. The Vigilance Unit officer supervised and inspected the Vigilance Sub-Units and submitted inspection reports. Each Vigilance Sub-Unit was inspected once a month as a routine.
Vigilance Sub-Units :
56 Vigilance Sub-Units were established, using the Overseers displaced following the
withdrawal of spraying units. These Overseers took blood smears from fever cases that attended medical institutions. 256 medical institutions in the endemic area were devided into 56 groups and each sub-unit Overseer visited 2 to 4 medical institutions in rotation and took blood smears for 1 to 2 weeks at each institution
depending on the attendance and the endemicity of malaria.
The names and addresses of fever cases including absentee fever cases were despatched to the central laboratory with the blood smears taken. The parasitologically positive cases were referred to the Vigilance Units for investigation, treatment and follow up action. He also visited the absentee fever cases at their homes and took
blood smears.
Positive Malaria Cases—1955-1961:
Table XVII gives the results of parasitological examination of blood smears by
months from 1955 to 1961. This table shows the monthly parasite positivity trend since large scale interruption of residual spraying was started in the endemic area in February, 1955.

Page 82
70
A REVIEW OF THE PROBLEM
103,725 blood smears were taken and th slide positivity rate was 3.7% in 1955 afte the expansion of the surveillance mec hanism, as compared to 8,727 blood smear taken with slide positivity rate of 13.7% in 1954 when the whole of the endemic are: was under coverage of residual spraying The slide positivity rate in 1954 was high a the blood films were mainly taken fron clinically diagnosed cases of malaria a medical institutions.
From October 1955, there was an increasi in the positive blood smears and in 1956 th number of positive slides was 6,994 giving i slide positivity rate of 5.8% as compared to 3,795 positive slides and slide positivity rat of 3•7% in 1955. In January 1957 when the peak was reached with 2,407 positives, i was decided to restart residual spraying in the spray interrupted endemic areas. Al though the number of positive slides declin ed in subsequent months the year endec
with 6,811 positives out of 105,957 blood smears examined, giving a slide positivity rate of 6.4%. 1,037 blood smears were positive out of 63,866 blood smears examin ed in 1958, and the slide positivity rate hac declined to 1.6%. The number of blood smears taken in 1958 had declined as the personnel engaged in surveillance activities were reverted to supervise in the re-estab lished spraying units.
18 Super Jeep Units and 13 Jeep Unit functioned in 1958 when total coverage ir residual spraying was again given to the endemic area while spraying remained interrupted in the whole of the epidemi area. The retrenched spraymen were re employed to man these re-established units
Controversy over interruption o spraying:
The wisdom of the large scale withdrawa of spraying in 1955 had raised some con troversy. Factors that yeighed in favour o the decision were the increasing number o vector species that developed resistence to insecticides in other countries, and afte 9 years of continuous spraying a beginning had to be made to extend the successfu interruption of spraying in the epidemi area, into parts of the endemic area where

AND CONTROL OF MALARIA IN CEYLON
transmission had been interrupted. The necessary precautions were taken to establish emergency spraying units and to
organise a system of surveillance for early a detection of positive cases.
. Whether there was an appreciable increase s in malaria after the interruption of spraying a is a doubtful matter. The only evidence of
increase of malaria was the increase in the number of microscopically positive cases in 1956 and 1957 which would not have been
detected had not more Vigilance Units been e established and blood smears taken in such a large numbers as never done before. The D
numbers of blood smears taken were 121,280 in 1956 and 105,957 in 1957, as compared to 4,049 in 1953 and 8,727 in 1954 which were the highest numbers taken since 1946.
The situation was closely watched since - interruption of spraying was extended into a the endemic area and prompt action was
taken to restart spraying when malaria I apparantly increased, and as a result the
number of malaria cases declined from 10,442 in 1957 to 1,037 in 1958.
Malaria Eradication :
Until recent times the aim of most countries subject to malaria was the control of the disease as eradication looked an impracticable proposition bristling with insurmountable difficulties. Malaria control means the reduction of the disease to a degree where it is no longer a major public health problem. This implies that the programme is unending and application of control measures have to be continuous, involving recurrent expenditure.
Malaria eradication means the ending of the transmission of the disease and the elimination of the reservoir of infective cases, by a campaign limited in time and carried to such a degree of perfection that when it comes to an end there is no resumption of transmission or re-establishment of endemicity of malaria. The old concept of malaria eradication implying vector eradication which has been achieved in a few countries by attacking both larvae and adult mosquitoes cannot be applied as a universal mechanism. The present concept of malaria

Page 83
A REVIEW OF THE PROBLEM AND CON
eradication is one of elemination of the malaria parasites from infected persons, and when this is achieved the vector anopheline still persists but there is no infective reservoir or transmission of the disease.
The eardication of malaria brings everlasting benefits which outweigh the cost and inconveniences. The money spent may be considered as capital investment and not as perpetually recurring expenditure. The gain is immense in terms of increased expectation of life, health and well being of the people, social and economic development and prosperity of the country.
Eighth World Health Assembly—1955 :
The eighth World Health Assembly held in May, 1955, having considered that the ultimate goal of Malaria Control Programme should be the eradication of the disease, passed a resolution requesting the Governments to intensify the programmes so that eradication may be achieved before the potential danger of the development of re sistance in the Anopheline vectors to insecticides may materialise.
The Director General of the WHO was authorised to establish a Malaria Eradication Special Account, and utilise this fund to assist countries to carry through their eradication programmes.
In pursuance of the resolution passed, a number of countries intensified and expanded their programmes with the object of eradicating malaria.
Five Year Malaria Eradication Programme :
In 1956 proposals were submitted for the eradication of malaria from the country and accepted by the Government. The five year eradication programme was to cost Rs. 18,250,000/- towards which the International Co-operation Administration of the U.S.A. agreed to make a generous contribution of U.S. $ 1,238,840 for the purchase of off-shore supplies such as motor vehicles, insecticides, equipment and anti-malaria
drugs.
2 207 274, 20
5 ym from 1984

ATROL OF MALARIA IN CEYLON
71
The necessary staff was recruited and equipment purchased, and the malaria eradication programme was ceremoniously inaugurated on 2nd December, 1958 by the Prime Minister of the country accepting the gift of a fleet of 43 Jeeps from the United States Operation Mission in Ceylon.
- In 1960, the Ceylon Government signed a second agreement with the International Co-operation Administration of the U.S.A. and another agreement with the WHO for additional financial assistance in local currency, to intensify the surveillance activities of the programme. The overall revised cost of the five year eradication programme was estimated at Rs. 26,000, 000/- towards which I.C.A. made further substantive contribution, and the WHO agreed to provide Rs. 200,000/- each year according to availability of funds. The
WHO also assists the programme in an advisory capacity.
Organisation and Administration :
The organisation and administrative set up for the malaria eradication programme are shown in the chart annexed.
The Anti-Malaria Campaign is a decentralised Unit of the Department of Health Services, coming directly under the Director of Health Services and the Deputy Director of the Public Health Services. The laboratory section comes under the Deputy Director, Laboratory Services. The Superintendent of the Campaign is given the right to carry out the Internal Administration independently and take decisions in disciplinary matters within certain limits. A Deputy Superintendent, two Medical Officers and an Administrative Secretary are provided to assist in technical and administrative functions.
The staff of the Campaign, which comprised 162 in 1945, increased to 898 in 1948 when the National Malaria Control Programme was in full swing, decreased to 506 in 1956 when large scale interruption of spraying was effected, had increased to 1,232 by 1962 when the malaria eradication programme was fully implemented.
5. & 1 -tumu nu.

Page 84
12
ADMINISTRATION CHART, ANTI -- MALARIA CAMPAIGN
MINISTRY OF HEALTH
DIRECTOR OF HEALTH SERVICES/
|DEPUTY DIRECTOR OF LABORATORY
SERVICES
JDEPUTY DIRECTOR OF PUBLIC HEALTH SERVICES
| SUPERINTENDENT, ANTI-MALARIA CAMPAIGN |
A REVIEW OF THE PROBLEM ANI
|DEPUTY SUPERINTENDENT, ANTI-MALARIA CAMPAIGN |
| ENTOMOLOGIST
MEOICAL OFFICER (1/
MEDICAL OFFICERU)
SECRETARY
FIELD
ENTOMOLOGICAL LABORATORY
PARASITOLOGICAL
LABORATORY
| HEALTH ROUCATOR
TRANSPORT
WORKSHOP
OFFICE
PUBLIC HEALTH
INSPECTOR (HEADQUARTER
STORES
ENTOMOLOGICAL ASSISTANTS
LIBERARY
ARTIST

ENTOMOLOGICAL OVERSEERS ENTOMOLOGICAL FIELD ATTENDANTS
MUSEUM
STUREKEEPER
CLERKS
LABOURERS
HEAD QUARTER
LABOURERS
BUKATUKY TEGNOLOGISTS LABORATORY SUB- ASSISTANTS LABORATORY OVERSEERS LABORATORY ORDERLIES LABORATORY LABOURERS
TLABORATORY TECHNOLOGISTS LABORATORY SUB-ASSISTANTS
MICROSCOPISTS LABORATORY ORDERLIES LABORATORY LABOURERS
TRANSPORT FOREMAN
CLERKS
MECHANICS
DRIVERS WORKSHOP LABOURERS
CLERKS
STENOGRAPHER
TVPISTS
PEONS
OFFICE
LABOURERS
NORTHERN REGION
CONTROL OF MALARIA IN CEYLON
CENTRAL REGION
SOUTHERN REGION
EASTERN REGION
OFFICER-IN-CHARGE |PUBLIC HEALTH INSPECTOR, ANTI-MALARIA CAMPAIGN
MALARIA CONTROL UNITS
VIGILANCE UNITS VIGILANCE UNIT SUPERVISORS
VIGILANCE SUB-UNITS (FIELD) VIGILANCE SUB-UNTS (INSTITUTIONS)
OFFICER -IN-CHARGE | PUBLIC HEALTH INSPECTOR, ANTI-KALARIA CAMPAIGN
MALARIA CONTROL UNITS
VIGILANCS UNITS VIGILANCE SUB-UNIT SUPERSOAS VIGILANCE SUB-UNIT (ESIO) YIQILAKE SU-UBT ( INSTITUTIONS)
OFFICER - IN - CHARGE PUBLIC HEALTH INSPECTOR, ANTI-MALARIA CAMPAIGN MALARIA CONTROL UNITS
VIGILANCE UNITS VIGILANCE SUB- UNIT SUPERVISORS VIGILANCE SUB-UNIT (FIELD) VIGILANCS SUB-UNIT (INSTITUTIONS)
OFFICER-IN-CHARGE PUBLIC HEALTH INSPECTOR, ANTI-MALARIA CAMPAIGN.
MALARIA CONTROL UNITS
VIGILANCE UNITS VIGILANCE UNIT SUPERVISORS VIGILANCE SUB-Uair (FIELD) VIGILANCE SUB-UNIT CONSTITUTIONS)
AAAA
Sup
SUO

Page 85
A REVIEW OF THE PROBLEM AND CO
Regional Divisions :
SI
Se
0
The malarious area of the country has been divided into four regions-Northern Region with Regional Office at Anuradhapura, Central Region with Regional Office at Kurunegala, Eastern Region with Regional Office at Batticaloa, and Southern Region with Regional Office at Tangalle. The Central and Southern Regions are subdivided into epidemic and endemic areas, while the Northern and Eastern Regions are entirely endemic areas. The malaria free area of the wet zone has been excluded from the Regional Divisions and is looked after from the Head Quarters. Map 7 shows the a Regional Divisions and Table XVIII gives e the area in sq. miles, population, Medical I Institutions, Anti-Malaria Campaign units and number of houses under residual spraying, by Regional Divisions and Sub
divisions.
Head Quarters, Colombo :
Ce aj
The organisation is centralised at the Head Quarters in Colombo, where the Superintendent of the Campaign, his principal technical and administrative u assistants, and a large section of the office staff are functioning. The central laboratory si for parasitological examination, the main in supply store, vehicle and equipment repairs and maintenance workshop, technical evaluation section, accounting and paying section and health education section are attached to the central office.
m
re . The planning and despatching of technical and administrative directives are conducted from the Head Quarters and the execution of field operations are meticulously carried out by the Field Units under the guidance and supervision of the Regional Officers and their assistants. There is great measure of coordination through the departmental institutions of the Medical and Public Health Sections.
E 5.5
Regional Officers :
The four Regional Offices are in the charge of four Regional Officers, who are Senior Public Health Inspectors counting several years experience in anti-malaria activities. re

NTROL OF MALARIA IN CEYLON
73
hey are assisted by 7 Senior Public Health aspectors in their administrative and apervisory functions appointed at the rate E two for each large Region and one for the
astern Region which is the smallest.
The Regional Office is manned by the -fficer-in-charge of the Region, one of his enior assistants and other office staff. The ther senior assistant is centrally stationed a the other half of the bigger Regions.
Residual Spraying of Insecticides :
Residual spraying is an activity of the ttack phase which is the 2nd phase of the radication programme. 37 Malaria Control Units are operatng to residually spray very dewllng in the endemic area in cycles E3 to 4 months or 6 months according to ialaria potential. The dosage of DDT prayed is .5 grm. per sq. metre in areas prayed at 3 to 4 monthly cycles and 1. gm er sq. metre in areas sprayed at longer atervals. No residual spraying is underaken in the epidemic area.
The distribution of the malaria control nits which comprise 13 Super Jeep Units nd 24 Jeep Units and the number of houses prayed are given by Regional Sub-divisions, - Table XVIII.
390,233 houses are regularly sprayed and ne total coverage of the endemic area will ontinue until cessation of malaria transmission and the emptying of the parasite eservoirs have been realised.
nterruption of Spraying :
The criteria for the interruption of sprayng are the cessation of transmission, infant arasite rate reaching zero, and the case acidence declining to less than 0.5 per 1,000 opulation, in and around the area where aterruption is contemplated. Although this as been reached in many sizable areas and a the country as a whole, it is proposed to roceed cautiously with the interruption of praying in view of a few isolated residual pci yet remaining in the remote parts and ne potential danger of the vector species afiltrating from the vast jungle areas and e-establishing endermicity.

Page 86
74
A REVIEW OF THE PROBLEM A
It is proposed to commence the strategic withdrawal of spraying in 1963 according to the pre-determined plan starting with Urban Areas and settled villages where fully established surveillance operations had shown absence of indigenous cases for over one year. This interruption of spraying will be extended by stages to the periphery where screening of jungles by barrier spraying will be undertaken in order to prevent the infiltration of the vector species into spray interrupted areas. The surveillance operations will be re-inforced to maximum strength in the spray interrupted endemic area. The barrier spraying will be continued until all residual foci are emptied and no cases occur for one year.
Protective spraying will be undertaken in areas where entomological surveillance reveals vector prevalence in potentially dangerous densities.
Surveillance Operations :
Surveillance operations constitute the consolidation phase of the eradication programme. It is started during the terminal stages of the spraying operations and developed so that when the time comes to interrupt spraying after transmission has been stopped, a fully developed surveillance organisation will suffice to maintain the progress towards reaching eradication. The surveillance programme is designed to discover evidence of any continuation of transmission or importation of infection, to establish its nature and causes, to eliminate residual foci, to prevent and radically cure all indigenous or imported malaria infections in man as would threaten the resumption of transmission or delay the realisation of eradication and finally to substantiate that eradication has been achieved
Epidemiological surveillance is concernec with the search for, and investigation o malaria infections and entomological sur veillance concerns the investigations ir relation to vectorial species, required by the eradication programme,

ND CONTROL OF MALARIA IN CEYLON
El Objectives of Surveillance :
The important objectives of epidemiological surveillance are :---
(a) To detect cases by utilizing all
possible means suitable for local conditions.
(6) To classify the cases as indigenous,
imported, intruduced, induced and
relapsing.
(c)
To establish where, when and how the infection was probably contracted.
To establish the actual or probable source and mode of infection.
To investigate how far the spread of infection had taken place.
(S)
To determine the cause if transmission is persisting.
(g)
To prove the absence of malaria cases and the establishment of eradication.
The objectives of entomological surveillance are :-
(a) To determine the extent to which the
vector species and other anopheline species prevail in the eradication area.
(6)
To follow the changes in densities of vector species and other Anopheline species in relation to the eradication activities.
(C) To determine the efficiency of
residual spraying by the build up of the densities of the vector species and other Anopheline species by continuous observations, and regulate the dosage, method of application and interval of application of insecticide or even change the insecticide if necessary.
(d)
To recognise the possible role of secondary vectors,

Page 87
A REVIEW OF THE PROBLEM AND C
(e)
To note the reappearance of vector species in areas from where they have disappeared particularly during favourable seasons and under favourable conditions.
To confirm eradication of the vector species wherever this had occurred.
To test periodically the susceptibility status of the vector species to insecticides.
(h) To watch for possible changes in the
behaviour and habits of the vector species in order to regulate the spraying operations suitably.
To check the duration of activity of residual insecticide deposits.
Techniques of Surveillance :
The techniques of surveillance have been developed for :-
(a) detection of cases by active and
passive mechanism of case detection.
(6)
providing ensured treatment for radical cure, and follow up of cases until infections have been eli
minated.
(c)
carrying out epidemiological investigations to detect other cases from known cases.
n o em 02
(d)
entomological investigations to determine the entomological factors responsible for the transmission of
malaria.
Vigilance Units, and Vigilance Sub-Units for active and passive case detection, have been established for surveillance activities.
The distribution of Vigilance Units, Vigilance Sub-Units at Medical institutions for passive surveillance and in the field for active surveillance, are given by Regional r Sub-divisions in Table XVIII.

ONTROL OF MALARIA IN CEYLON
Vigilance Units :
The stations of the 36 Vigilance Units that operate are shown in Map 7. Some of the duties of the Vigilance Units have been revised in the light of the Malaria Eradication Programme. The Vigilance Unit officer gets the house of the positive case and the cluster of neighbouring houses sprayed when he visits for investigation. He carries out a mass blood survey in the whole village and within half mile radius of the positive case. The immediate contacts n the infected house and all fever cases in the area of mass blood survey are given the 3 day course of 4 aminoquinoline treatment, ind followed by 8 aminoquinoline treatment f the blood examination reveals infection.
All clincial and confirmed cases are treated py daily domiciliary visits. The P. falciparum infected cases are visited 7 days and other positive cases are visited 16 days.
Every registered malaria case is kept under observation by follow up blood filmng for 2 years before it is declared free of Y nfection.
The Vigilance Unit officer carries out active surveillance by monthly visits in areas not covered by active surveillance agents. He works one day in a month with each active surveillance agent, checks his vork and guides him in his activities. He arries out mass blood surveys once in 6 nonths in conjunction with the active urveillance agents in areas where positive ases were detected within 2 years.
Two days in a week are devoted for ntomological investigations. One day is Levoted for hand catch and spray catch in 5 cheduled houses and larval survey in the ricinity, and the 2nd day is devoted for andom examination for Anopheline adults nd larvae on similar lines.
The surveillance officer maintains a case egister which gives full particulars of action aken with regard to every case in his area.

Page 88
76
A REVIEW OF THE PROBLEM
M AP 7
00
N O R T H E R N
C E N T R A L
R E G
rin |

AND CONTROL OF MALARIA IN CEYLON
VIGILANCE UNITS - A 36 VIGILANCE SUB-UNIT. 46 SUPERVISORS
2n_
S 0 N
A S T E R N
R E G | 0 N
! O \N
u T H E R N R E G I o N

Page 89
A REVIEW OF THE PROBLEM AND CC
Vigilance Sub-Units (Institutions) :
r
ܟܘ ܒܕ
fo
130 Vigilance Sub-Units have been established for taking blood smears from fever cases attending the larger Medical Institutions in the endemic and epidemic areas. The distribution of these passive surveillance agents is shown in Map 8. At the other Medical Institutions where it has been possible to make local arrangements, blood smears are taken by the staff of the Institution. Map 9 shows the distribution of Hospitals and Central Dispensaries in epidemic and endemic areas. Blood smears are taken from cases having fever or giving history of fever during the previous one month. The blood smears are forwarded to the Central Laboratory by post. On days the passive surveillance agent is absent, arrangements are made by the Institution to take blood smears. When a positive case is detected at an institution, investigations are carried out to determine how the case escaped the screening by the active surveillance agent of the area. In a country where the hospital service is well established with the institutions not so far apart, and people are hospital minded as in Ceylon, a large proposition of cases are detected by passive surveillance and further cases can be detected by epidemiological investigations carried out in relation to known cases.
ܕ ܐ
日文
Vigilance Sub-Units (Field) :
e o
g
231 Vigilance Sub-Units have been established for taking blood smears from fever cases by active surveillance method. The distribution of the Vigilance Sub-Units, agents, giving total coverage to the endemic area is shown in Map 8. These active surveillance agents who use push cycles for travelling, operate within 10 miles radius, follow an approved programme and visit about 1,500 to 2,500 houses at intervals of 4 or 6 weeks. All houses and inmates are a registered in the Fever register and blood smears are taken by domiciliary visits from all cases having fever or giving history of fever since the last visit. These are despatched to the Central Laboratory and the positive cases are immediately notified to the Vigilance Unit for follow up work.
4
a.

INTROL OF MALARIA IN CEYLON
77
Regulation for Notification and Treatnent of Malaria :
The mosquito-borne diseases (Prevention) egulations published under the Quarantine nd Prevention of Diseases Ordinance chapter 173) requires the notification of nalaria within 24 hours by all medical ractitioners, and by persons who know or ave reasonable cause to believe that they re suffering from the disease. Provision Iso has been made under these regulations or taking of blood smears and treatment of ersons suffering from or believed to suffer rom the disease.
laboratory Service :
Parasitological laboratory and entomopgical laboratory are attached to the AntiTalaria Campaign. The parasitological aboratory is supervised by a Medical Officer. An average of 65 Microscopists xamine, 65 blood smears per head per day. l'here is provision to increase the number of Licroscopists according to the inflow of lood smears taken in the field.
| Thick and thin blood smears are taken on he same slide, using one slide for each person. The thick smear only is stained with Giemsa stain and examined. The thin Im of a positive slide is stained with Leishman stain and examined.
The entomological laboratory is in charge f an Entomologist. All entomological ollections are forwarded daily to this aboratory from all parts of the country by -Ost.
The Entomologist and his team carry out he necessary entomological investigations i relation to the Malaria Eradication Pro- . ramme.
Treatment and Follow up of Cases :
Clinical and confirmed cases of malaria re given full course of treatment for radical ure. All cases are taken charge of by the Pigilance Unit officers who follow them from he Medical Institutions to their homes and eep them under surveillance for 2 years. The treatment, at the institution is done by he Medical Officer and at the home is dministered by the Vigilance Unit officer.

Page 90
- 18
A REVIEW OF THE PROBLEM
DISTRIBI
novo nome
SS
LOS
bo
N O R T H E R N
R
|CENTRAL
O0
REGIO
sa Yon
| lo

AND CONTROL OF MALARIA ÎN CEYLON
MAP 8
UTION OF VIGILANCE SUB-UNITS
KEY *O FIELD
O INSTITUTIONS
231
130
CS
ON
STERN
+ N
REG
slo U THE RN REGION

Page 91
A REVIEW OF THE PROBLEM AND CON
MAP 9
MEDICAL IN: AND END
N O R T WE R N P R E GIO
Anuradhapuro :
CENTRAL
RE G 10
- Kurunggala
CP e ed a
COLOMBO -
I SO U
Tang

TROL OF MALARIA. IN CEYLON
79
STITUTIONS IN THE EPIDEMIC DEMIC AREAS BY REGIONAL
DIVISIONS
HOSPITAL
- 216 - DISPENSARY - 263
VEL Batticaloa
EASTERN REGION )
TYERN REGION
alla

Page 92
80
A REVIEW OF THE PROBLEM
The standard treatment for adults is 60 mgms. (base) Camaquin on the ist da 400 mgms. on each of the next 2 days f all infections, followed by 15 mgms. (bas Primaquine daily for 14 days in P. viva and P. malariae infections and for 5 day for P. falciparum infections. Children al given proportionate dosages.
The blood examination is repeated i monthly intervals after completing trea ment until 3 consequetively taken bloo smears are negative for malaria parasite The blood examination is then repeate after 3 months and thereafter at interva of 6 months until 2 years had elapsed.
The full course of treatment is repeate if at any time the blood smear is parasi
positive.
Supervision :
Success of the malaria eradicatio programme depends in no small measure o the efficient supervision and constant chec in order to get every member of the eradic: tion team to perform his duties efficientl and correctly. The programme has bee planned to check every activity systemat cally, correct defects, and give guidance i order to prevent repetition of defects.
The spraying operations are supervise by Supervisors who visit every house an sign the house-holder's card maintaine after inspection. The Vigilance Unit office inspects houses, corrects defects by repea ing the spraying wherever necessary, an reports defects so that action may be take against the sprayman and the superviso who have defaulted. Similarly the work o each active and passive surveillance ager is inspected and checked by Vigilance Sul Unit Supervisors once a week. 46 Vigilanc Sub-Unit Supervisors have been appointe for each to supervise at the rate of 6 Activ Surveillance Agents. The distribution these Supervisors are shown in Map 7. TI Vigilance Unit officer supervises and in spects the work of the active and passiv surveillance agents and Vigilance Sub-Un Supervisors. The Senior Public Healt Inspector inspects the work of the Vigilanc Units, spraying units, Vigilance Sub-Un

AND CONTROL OF MALARIA IN CEYLON
0 Supervisors and Vigilance Sub-Units once in 1, 3 months in half the Region in his charge.
The Officer-in-Charge of the Region X inspects all units in his region once in 3
months. Three Medical officers itinerate from the Head Quarters once in 6 weeks and inspect the units in their respective areas.
In two circuits each Medical officer at covers his assigned area. The Superint- tendent of the Campaign itinerates once in d 6 weeks and covers the island once in 6
months. Every supervising officer submits inspection notes indicating, the defects noted, corrections made, and the recommendations after each inspection. Follow up action is pursued until all defects are
corrected and recommendations implementte
ed.
ܪܼܲܢ
Evaluation and Assessment :
The eradication programme requires on continuous evaluation of results from the en beginning to the end of the programme. Ek Data are continuously collected and analysa- ed in order to assess the progress. The
review of the programme from phase to n -
phase depends on the results obtained by i- the evaluation process.
n.
The data are collected by means of standard forms to be filled in and returned by d the different operational units and evalua
tion and assessment are done at the Regional Office for the Region, and at the Head Quarters for the whole programme.
B 2.
Criteria for. Confirmation of Eradication :
it
)-
ve
Malaria may be assumed to have been eradicated when adequate surveillance operations have not revealed any evidence
of transmission or residual endemicity, desd pite careful search during 3 consecutive re years, at least in the last two of which no of
specific general measures of Anopheline Le control or other measures which might.
obscure the presence of residual foci have re been instituted.
|-
- The surveillance operations should have e been adequate, and efficiently executed. it At least 10% of the population should have

Page 93
A REVIEW OF THE PROBLEM AND có
been microscopically examined for parasit- N aemia since the detection of the last
us indigenous case and no positives detected
other than the proven relapse cases.
TI
th
na
It is desirable to obtain a certificate of eradication from the W.H.O. to confirm the reaching of eradication. If W.H.O. is ha informed giving timely notice, she will
ce consider sending an evaluation team to m study the reports and data collected during
W the last 3 years, make their own assessment and report, before the certificate of eradication is issued.
UGU址m
Maintenance Phase :
The phase of maintenance will begin when the criteria of eradication have been met, and eradication declared achieved. The maintenance phase will last as long as malaria lasts in the world and there is reasonable chance of the introduction of infection. Epidemiologically a territory from which malaria has been eradicated will be classified as formally or potentially endemic area.
A S.
m
10
po
to
The specialised malaria eradication campaign should be absorbed into the General Public Health Services so that the phase of maintenance will become part of the activities of the Public Health Services. Advantage should be taken to employ as
many of the trained staff as necessary for the maintenance phase activities. Malaria should be included in the list of non-endemic diseases but should remain a notifiable disease. The imported or introduced cases should be handled as a routine activity by the Department of Health.
Adequate quarantine measures should be taken to prevent the introduction of infecttion from outside by the infected vector or infected person.
tt so 이 tweased 1
Expenditure :
The annual expenditure on Anti-Malaria Campaign for years 1934 to 1961 are given 1! in Table XIX. The population in the
malarious areas, the expenditure and per capita cost of protected population, in local currency are shown. The annual expenditure had increased from 1946, when the fr

TROL OF MALARIA IN CEYLON
81
utional Malaria Control Programme by the e of residual insecticides was inaugurated. Lere has been further increase in expendire since 1958 when the implementation of e Malaria Eradication Programme began. Le per capita cost had declined since the tional control programme started, and d fluctuated between 0.48 cents and 0.79 nts in local currency, since the impleentation of the eradication programme is initiated in 1958.
The population protected declined in 54 due to partial withdrawal of spraying. nce the establishment of more Vigilance nits from 1955, taking up more areas in e epidemic zone, the population protected s been increasing.
rogress of Malaria Eradication :
The success of the National Malaria ontrol Programme by the use of residual secticides that began in 1946 can be assess
from the trend of morbidity and mortay rates given in Table XIV. The malaria orbidity rate of 403 per thousand populaon and mortality rate of 1,873 per million opulation in 1946, had both been reduced
0.1 by 1958. The epidemic areas were eed of transmission and the parasite rervoirs in the endemic areas were depleted
a few residual foci confined to develop ental areas in the jungles and their outirts, and chenas (shifting cultivation eas in jungles).
An attempt had been made to accelerate e elimination of malaria by converting ce control programme to eradication pro-amme in 1958. The satisfactory progress
the eradication programme is reflected in ne figures given in Tables XIV and XVII hich show the rapidly declining trend of ses although the number of blood smears camined had progressively increased. 1,596 Eses detected from 305,740 blood smears camined in 1959, had declined to 422 cases etected from 396,933 smears examined in P60, and to 110 cases detected from 768,309 ood smears examined in 1961. The alaria morbidity rate per thousand opulation had declined during the 3 years pm 0.15 to 0.01 while there were no deaths om malaria during this period.

Page 94
82
A REVIEW OF THE PROBLEM.
TAE
EXPENDITURE ON ANTI-I
Year
Population protected
1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961
52863 53319 53538 54308 55240 58025 58033 59533 60378 60633 64358 207900 1200000 1988000 2605800 2664000 2668000 2842500 3100000 3000000 2400000 5679822 5814063 5427 400 5487000 6131269 6268533 6405797
There has been further reduction in the number of positive cases detected during the first six months of 1962. 28 positive cases were detected in the six months o 1962 as compared to 75 positive cases de tected during the corresponding period ir 1961.
The parasite reservoirs are rapidly empty. ing and the prospects of early elimination of the remaining few foci look indeed hope fully bright.
Summary:
1. The physiography and the climatic conditions of the country are discussed. The hilly areas roughly constitute one-fifth of the country, of which about 1,200 sq. miles are above the malarious altitude. Numerous rivers and streams radiating from

AND CONTROL OF MALARIA IN CEYLON
LE XIX
IALARIA CAMPAIGN 1934-61
Expenditure in Cost per capita
rupees*
rupees and cents
53653. 55532. 76356. 70035. 180987. 143645 138868. 122500 · 117880. 121252. 184349.
· 301556. 1707902. 2427978. 3995233. 2907566 · 2688657. 2887741. 3283931: 3517734. 2400000 1860414. 2194113. 2555408. 4350511. 2993440. 3642452. 4210382.
1:05 1:04 1:43 1:29 3.45 2.48 2.36 2:07 1:95 1.99 2. 86 1.45 1.42 1:22 1.53 1:08 1:00 1-02 106 1:17 1.00 (034 0-37 ) · 47 0.79 0 · 48 0.58 0-65
| U. S. $ = Rs. 4.75
the central hills are the chief source of water supply to areas through which they traverse. Some of these rivers are closely associated
with epidemic outbreaks of malaria.
The temperature and relative humidity favour perenneal transmission of malaria.
The country is divided into three climatic zones based on the rainfall during the South
West monsoon. The rainfall has an abiding influence on epidemic and endemic malaria.
2. The density of population varies from area to area depending on the prevalence of malaria. The population increase was rapid after 1946 when malaria was progressively brought under control. There was a steady influx of population into the previously hyper-endemic areas which were avoided by the people before malaria was brought under. control.

Page 95
A REVIEW OF THE PROBLEM AND CI
3. Ceylon is an agricultural country 1 mainly producing tea, rubber and coconut. e Local rice production increased rapidly since 1946 as it became possible to open
more lands for rice cultivation after the g incidence of malaria had declined.
do 3 ora
4. The Anopheline species in the country C are listed. Anopheles culicifacies is the only vector increminated. The habits of the vector species in relation to transmission of malaria are described. 16 years of residual application of DDT has not caused the development of resistence in the vector species.
5. The historical aspect of malaria in the country has been discussed. Records of the prevalence of malaria is available from 1638.
6. The distribution of malaria is discussed. The country has been divided into four distinctive areas based on the epidemiology of malaria. The seasonal prevalence and variations in the intensity of the disease are described in relation to the four areas.
7. References have been made to epidemics of malaria before 1900. The earliest reference to increased prevalence of malaria dates back to 1867. The epidemics in subsequent years are dealt with.
h
8. Epidemics of malaria since 1900 are discussed. Epidemics had occurred once in 3 to 5 years since 1906, up to 1946 when the National Malaria Control Programme by the use of DDT was inaugurated to deter the outbreaks of epidemics in subsequent
years.
S
The biggest epidemic was in 1934/35, which took a heavy toll of 80,000 lives in 7 months.
9. The spleen surveys carried out since the first comprehensive survey was undertaken in 1921/22, are discussed. The endemicity of malaria in the various parts of the country are described, based on the spleen rates among school children.
Spleen surveys of school children were not undertaken since 1955 after the island's a spleen rate had declined to 0.2%.

DNTROL OF MALARIA IN CEYLON
83
0. The parasite surveys, since the arliest island wide survey was undertaken a 1921/22 are considered. Parasite survey was undertaken among school children to-ether with the spleen survey. The parasite ates rapidly declined since 1946. Since 954, when the parasite rate in school hildren had declined to 0.07% and a sur-eillance programme was inaugurated, parasite surveys of school children were not
ndertaken. 1. Infant parasite survey was inaugurated n 1951 and carried out up to 1960 when no nfants were found infected out of 27,281
xamined.
2. Malaria morbidity and mortality tatistics and the influence of malaria on the -ital statistics of the country from 1901 to 960, are discussed. With the control of nalaria since 1946, the crude death rate and nfant death rate have rapidly declined.
3. The activities for the control of nalaria in the pre-DDT era, and subsequent o the introduction of DDT for residual praying in 1946, are described. Measures aken in times of epidemics and during the nter-epidemic period are dealt with.
The disasterous epidemic of 1934/35 evolutionised the malaria control and Health Services. A new malaria control and lealth scheme was inaugurated in 1937 and or the first time control measures and lealth activities were extended into the ural areas. The activities of the new cheme are described.
4. The organisation and activities of the National Malaria Control Scheme by using DDT that was inaugurated in 1946 are lescribed in detail. Spectacular results in educing the incidence of malaria were chieved by this control scheme.
5. Encouraged by these results, the National Malaria Eradication Programme vas inaugurated in November, 1958. The organisation and activities of the eradication orogramme are discussed. Efficient superision, continuous evaluation of results and onstant review of activities are described Is important ingredients for the success of he programme.

Page 96
84
A REVIEW OF THE PROBLEM
16. The criteria for the confirmation ( eradication of malaria are described. WH has decided to issue a certificate confirmir. the eradication achieved by a country aft investigations have been carried out by i own evaluation team, at the request of t} country that claims to have eradicate malaria.
17. The annual expenditure on the Ant Malaria Campaign from 1934 to 1961 an the per capita cost are given.
18. The progress of malaria eradicatio scheme and the prospects of eradication a discussed.
19. The report is illustrated by maps am tables which are annexed.
REF
(1) BAHR P. H. (1913). Sessional Paper XXXII (2) BRIERCLIFFE R. (1935). Sessional Paper XX (3) CHALMERS A. J. (1905). Spol. Zeyl., 11, pp. (4) CARTER H. F. assisted by K. J. RUSTOMJEE a
Govt. Press, Colombo. (5) DAVY, JOHN (1821). An account of the Inter (6) FERNANDO H. M. (1910). Prevention of ma
B.M.A. (7) GUNASEKERA S. T. (1913). Sessional Paper (8) GILL C. A. (1935). Sessional Paper XXIII, (9) HIRSCH A. (1883). Hand Book of Geographi
London. (10) JAMES S. P. and GUNASEKERA S. T. (1913). (11) KNOx ROBERT (1681). A Historical Relation (12) MARSHALL H. (1846). Ceylon—A general des (13) NICHOLLS L. (1921). Indian Med. Gaz., Vol. (14) PERRY A. (1906). Malaria Fever in the L
Ceylon. (15) PERERA FATHER S. G. (1930). Translation
quest of Ceylon”, Colombo. (16) RAJENDRAM S., ABDUL CADER M. H. M. and (17) RAJENDRAM S. and JAYEWICKREME S. H. (19 (18) SENIOR WHITE R. (1920). Indian Jour. Med (19) SıVALINGAM V. and RUSTOMJEE K. J. (1941). (20) SIVALIN GAM V. (1943). J. Mal. Inst. Ind., 5, (21) Wld. Hlth. Org. techn. Rep. Ser. (1957) 123. (22) Wld. Hlth. Org. techn. Rep. Ser. (1959) 162. (23) Wid. Hlth. Org. techn. Rep. Ser. (1961) 205.
Sein 1913 la laguna s
Apolk

AND CONTROL OF MALARIA IN CEYLON
ACKNOWLEDGEMENT
O
ts
The Author's thanks Drs. F. A. Wicker
remasinghe and S. Ramanathan, Medical Officers, Mr. Ivor Muruguppillai, Publicity Officer, for correcting the script, Mr. A. Tennekoon, Health Educator and Mr. M. D. A. Fernando, Public Health Ins
pector, for collecting the data for the i- tables and maps, Mr. K. E. T. Chandrasena,
the artist for preparing the maps and ta
Messrs. T. Balasubramaniam and A. G. Canjemanathan for typing the script.
ID
re
He is also indebted to the Permanent Secretary, Ministry of Health, and Director
of Health Services, for granting permission id to publish the article.
ERENCES
, Govt. Press, Colombo. III, Govt. Press, Colombo. 165-178. and E. T. SARAVANAMUTTU, (1927). Sessional Paper VII,
rior of Ceylon and its inhabitants, London. laria in Ceylon. Publication of the Ceylon Branch of the
XXXVII, Govt. Press, Colombo. Govt. Press, Colombo. cal and Historical Pathology translated by C. CREIGHTON,
Sessional Paper XXXIV, Govt. Press, Colombo. n of the Land of Ceylon in East Indies, London. scription of the Island and its inhabitants, London.
56, pp. 121-130. ow Country, Sessional Paper XL. Govt. Record Office,
of Fernao De Queyroz. “The Temporal and Spiritual con
VISVALINGAM T. (1950). Nature, 166, p. 486. 51). Indian Journal of Malariology 5, 1. - Res. 8, pp. 304-325.
J. Mal. Inst. Ind., 4, 2, pp. 155-173. pp. 261-265.

Page 97
TABLE I
AVERAGE MONTHLY RAINFALL IN INCHES IN SELECTED STATIONS IN THE THREE ZONES--1911-40
Zone
Station
Height above mean sea-level
feet
Total
January
February
March
September
November
December
A REVIEW OF THE PROBLEM
August
April
May
October
June
July
Dry
(Anuradhapura Trincomalee /
Batticaloa 3 Puttalam
Chilaw | Hambantota
300 5-81 1.71
4- 12
30 8:27 2.68
2.32
20 12·88 4. 24
3.49
10 | 3. 41 1.41
3. 10 10 3:11 1. 44 4: 22 60 x 400 148 3.40
6. 45
2.16
2.29
489
6.11
3.83
3:57 | 0:73
1-37
1-65
3:23 0.91 1: 68
3:59
1.75
0.93 1 - 04 1.96
3.75 1.43
0-69
7:10 3:24
177 1.47
4:31
2.112.05 1.48
3. 80
3.47
2.35
1:55
3.00
2.74
9.68 1069 7. 54 57.12 9.58 13:95 12.98 64.82 7:24 13.82 17:04 69.03 7.42 1009
5. 59 44:27
9.50 1022
4:40 55.58
| 4.79 7.53
5.61 43.33

( Negombo
Polgahawela * Intermediate j Kurunegala
Matale
Kandy
| Tangalle
10
240
380
1,210
1,610
70
3.00 1.96 5:30 1:45 5:10 2.00
8:20 2.59 6-30 228 3.05 1: 60
4.91 8-14 10.79 684
3.95
2-95
6.87 10.05 9.87 10:18
6-85
5.56
6.31 990 7.51 6-75 3. 92
3-58
4: 45 6: 82 6-39 6 - 29 5:05
4:15
5:84 | 6.48
7:58 8 · 82 7:31
5:71
3.98 4.38 7.44
491 389 3:15
5.28 11-95 12.78
4.98 77 · 53
6-63 16.42 14.87
6.54 100 - 59
5.56 14.89 12:42
6.76 84.70
5:21 1196 11:38
8. 69 81.18
6.48 10.50 10.97
8:39 86.66
4:55
5-947-54 508 55.51
ONTROL OF MALARIA IN CEYLON
Wet
(Avissawela
Ratnapura
Kalutara,
* Galle
| Kegalle
| Hatton"
100
7-05 5.53 10.15 14.55 21.55 17.61 11:49 9.48 13.40 20.31 19:28
130
10-39 11:53 20.95 1856 12.80 11.34 14.51 17.98 14:77
10 4.83 3:53 6.51 12.45 17-68
9 · 277.29 5:11 9:23 14.07 15:43
70 3.84 3.29. 5:28 8.75 12.69
8.43 6.39
6:11 8-80 12.03 11.97
650 4.66 2.79 7. 98 9.62 10:25 11:28
7:47
5.90 7.98 16.62 12.99
4,1404. 47 2.65
6.56 9.07 14.75 21:41 21:39 1550 13.46 13.80 10-99
9. 49 159.89 9:14 153.52 7:11 112.51 7-81 94.39 7.48 105.02 5.96 140.01
- FJERITERIILIEI
* Average for 19 years
85

Page 98
TABLE III
98
DENSITY OF POPULATION BY DISTRICTS AND PROVINCES--1931, 1946 & 1960
PROVINCES
AND
DISTRICTS
CLIMATIC
ZONE
1931
AREA IN SQ. MILES POPULATION DENSITY POPUT
1 9 4 6
1960
POP
VSITY
SQ. MILES AREA IN POPULATION DENSITY POPULATION DENSITY POPULATION DENSITY
875,488
1,561
1,420,332
2,533
Colombo
Negombo
Kalutara
5608
247.5
625-8
1,714,000
334,000
618,000
3,060
1,352
988
363,785
577
456,572
731
WESTERN
Galle
Matara
Hambantota
1,434-1
652.3
481.3
1,012-8
1,239,273
363,553
283,292
124,359
864
557
588
122
1,876,904
459,785
351,947
149,686
1,308
705
731
147
2,666,000
626,000
520,000
255,000
1,859
960
1,081
251
A REVIEW OF THE PROBLEM
W. I.
I. D.
648
SOUTHERN Ratnapura W. I. D. Kegalle
W. I.
2,146 · 4
1,250.5
642-0
771,204
263,801
314,567
359
210
489
961,418
343,620
401,762
448
275
625
1,401,000
510,000
568,000
408
884
SABARAGAMUWA
1.892.5
578.868
305
745.382
393
1078.000
569

Kurunegala
Chilaw
Puttalam
I. D.
I. D.
D.
1,843-8
262.3
909.9
397,239
114,640
35,087
210
440
38
485,042
139,764
43,083
263
533
801,000
204,000
76,000
434
778
83
46
181
NORTH WESTERN
Kandy
W. I. D.
Matale
I. D. Nuwara Eliya W. I. D.
3,016-0
913.8
902.4
473.9
546,966
587,916
129,697
235,775
642
143
497
667,919
711,449
155,720
268,121
221
778
172
565
1,081,000
1,007,000
243,000
378,000
358
1,102
269
796
CENTRAL
Jaffna Vavuniya D. Mannar
2,290-1
998-6
1,466.5
964-2
953,388
355,425
18,312
25,137
D.
416
(355
13
23
1,135,290
424,788
23,246
31,538
495
425
15
32
1,628,000
588,000
47,000
54,000
1,261
589
AND CONTROL OF MALARIA IN CEYLON
32
D.
56
3,429.3
4,0085
398,874
97,365
116
.24
479,572
139,534
139
34
689,000
231,000
200
57
NORTHERN Anuradhapura D. NORTH CENTRAL. Batticaloa D. Trincomalee D.
2,792.1
1,0480
174,929
37,492
64
203,186
75,926
72
72
357,000
109,000
127
104
35
55
121
EASTERN
Badulla
UVA
3,8401
3,277 · 1
212,421
303,243
279,112
372,238
72
113
D.
466,00
578,000
92
176
W : Wet zone
D: Dry zone
I, Intermediate zone

Page 99
TABLE IV
ENDEMIC PREVALENCE OF MALARIA-SPLEEN AND PARASITE RATES--1921/22 SURVEY
S P L E E N
B L 0 0 D
Province
Children
examined
Number
Positive
Spleen
Rate
Children
examined
Number
Positive
Parasite
Ratc
Western
18,414
254
1-4
1,068
25
2.3
Southern --
A REVIEW OF THE PROBLEM AND CO
5,052
197
3.7
125
0.8
(a) Wet zone (over 75 in. rainfall) (b) Dry zone (less than 75 in. rain
fall)
1,387
370
26.5
134
14
10-5
Sabaragamuwa
4,437
451
10:2
267
30
11:2
Central
(a) Below 500 metres (b) 500-1,000 metres
813
3,443
152
242
32
18.7
7 0
144
154
22.2
7:1

(c) Over 1,000 metres
744
1:1
10
Uva---
(a) Below 500 metres (b) 500-1,000 metres (c) Over 1,000 metres
245
1,116
448
138
96
56-3
8-6
1:8
22
308
30
43
18:2
14.0
3-3
8
--
Northern---
NTROL OF MALARIA IN CEYLON
(a) North & North-west portions of
peninsula (6) Elsewhere
W
4,176
3,232
359
1,034
8:6
32.0
306
342
43
59
14.0--
17:3
North Central North-Western Eastern
1,807
5,785
5,273
955
2,084
1,288
52.7
36.2
24.4
601
754
775
176
114
131
28.8
. 152
16:9
Totals.
56,372
7,636
13.6
5,040
684
13.5
87

Page 100
Ferm end timij ee LG 4
al of 343
88
TABLE V
37 - 4
DISTRIBUTION OF SPLEEN RATES (FEBRUARY-MARCH) 1936-41
END
6T
PROVINCE
21 22
1936
1937
1938
1939.
1940
19 41
No. Eæd. S.R No. Cæd. S.R No. Eæd. S.R NO. Eæd. S.R No. Eæd. S.R No. Eæd. S.R
Western
|- A.
62,901
10·0 31,487 8.4 33,102
3.8 34,016 3.9 31,806 3.1 33,395
- 2.7
A REVIEW OF THE PROBLEM AN
0.5 | 7
1.9 29
Sabaragamuwa
Jo.
14,367
47.6 15,508
27:5 15,613
16.4 15,572 9.5 14,375 14.8 15,476 11.5
03.07
Southern (a) Wet zone (6) Intermediate zone
(C) Dry zone (H) Central ta) below 500 metres
9,016
5,186
782
2.4
307
A 61 - 1
8,834
6,713
882
6.3
42.6
63.5
8,624
6,468
1,006
2.1
24.5
47.9
9,344
6,145
1,029
4.1 8,595 23.8 6,342
53.1
886
2.9
33.6
56.0
7,823
5,890
852
4-0
50.4
59.9
2 ..5
0:4 -3
A 4.82139.6 13
38 :7
1..T
10.779
30.9 8.842
32.5 8.956
20.8 7.564 -- 19:1

11.2
(b) 500-1,000 metres (c) Over 1,000 metres
..
2,964
1,419
| 45.99.554
4.0 4.9 1,744
21.7 11,052
3.0
2,685
19.0 11,682
3.2
2,425
10.7 10,866 |2.12,034
7.7
1.1
9,993
2, 304
10.3
3.7
E・S2・
20, 0,7
b13
6 「、3
Uva(a) below 500 metres (H) (b) 500-1,000 metres (c) Over 1,000 metres
76
1,263
1,771
1,857
79.2
|- 26.3
1.7
2.054
1.165
|1,477
| 45.6
|2,382
15.9
1,302
3.0 30 1,665
48.3
14.4
3.1
2,228
887
|1,720
38.2
6.0
| 1,741
1,198
|1,241
41.0
2.073
14.5
1,088
1.3
| 1,417
| 47.2
14.5
1.4
226
..3
4.1
Northern(a) North) & North-Western
portions of peninsula (b) Elsewhere
2. 。
6,810
3, 213
AD CONTROL OF MALARIA IN CEYLON
13.3), 7,558 58.25,888
|1.8
47.8
8,454
6,347
2.2
2.7
7,53
6,531
22
31.7
5.394
5,614
12, 5,2354 | 19.65,001
| 0,3
0.3
22.5
|量讀
42.+
(H)
3.
(H)2,7
| (H) 36.2
81 383+49
North-Central
3,766
| 77.6 3,838
71.6
3, 952
64.7
4,09!)
57.5
2, 209
70.5
2,989
76.6
、I.)
North-Western
24,399
| 55.4 24,255
51.0 23,713
37.6 26,159
30.7 24,974
36.0 25,671
32.4
ܐ ܙ ܕܐ ܐ܂
Eastern
810.4
(II)
9,70445.48,851 49.8 9,665, 43.7 10,14848.79,112 28.89,743
Totals || 161,230 (30.6 138,42528.4 144,873212 148,504 18.2 134,875
17.9 137,133
(I)-Hyper endlemic area No:Exd: Number Examined S. R: Spleen Rates
18.4
||

Page 101
D eta 9 communia 4 Me,
344 45 -
A6 -
و با ماری ۱ / 24
194
Le nti 'm2. cne . T. Via y durf an 149.
TABLE VI
DDT
SPLEEN RATES BY DISTRICTS — 1946-55
Sept. March March March March March March 1949 i 1950 1951 1952
1953 1954
1955
0:2
| 0:3
0.25
| 0-1
Sept. March Sept. 2 March Sept. March
Man DIᏚᎢᎡICᎢᏚ .
· 1946 | 1947
1947 1948
Ma
1948 1949
38
SP Colombo E 3-...2.9 2.62.3
0.8 1:2
1:0 (0:7
Negombo O.Kalutara 1/6 10....2.2 0.6 0-3
0-3 0:2 0.05
(0-01
15. OKandy 8.9 714.1 846
3-6 2:2 1.6 1.4 1:2
1:1
52. Matale 33.o 367.34 104 /
15:0 12.4
8:9 5:1
2.6.
163 Nuwara Eliya 8.4 7 A. 10. 15.2
9-1 1-8 2:2 1.5
2.7
2. Galle 2. A 2.5.245 2.5
(-5 0:3 0.4 0.01
0:3
9. a Matara 616...30.7 12:192
7.3 2.6 0.6
0.5
//3 Hambantota 158.4 673.692 52.2 / 47.4
27.) 30.0 12.4
9.7
9. Jaffna 1842. 49 4-32-3
2.1 1:1 0-6
1.2.
77, Vavuniya 66.7 53.2.68.6 65.3 522
32. 9. 23.5
16. ()
9.1.
LL
A REVIEW OF THE PROBLEM AND CO.
0:0
0-6
2.3
2.5
- 0:3
0.5
3.1.
0:3
4.0
0:0
(0-5
2-1
2:1
0.3
0.5
3-05
0:3
4.9
' 0-03
| 0-05
1:0
0.08
0:2
0:03
0:02
0:1
0:0
0.4
0:1
0:1
(0.03
0-3
0.4
0:2
2:2
0-03
0:3
0-0
0:0
0:0
0.8
(0:29= (0:02
2.5.
1:0
1:0
0-5
0.6
0.02
0.7
|0.7
1-5-
1.5
(0-2
0:03
2. ()-
0.6
0-01
0-0
0-02
0-3-
0:0
0-3
0:1
0:0
1:4 +
0:2
0:09

3. "7 MUHIT 3'02"...SC6 22.5V 33.7
ITT T2.)
TU
4:3 04 0* 0* 44 07 04
/**
UV
a 23Batticaloa 461 229.3.32'S 20.9v 16.7
13:1
9.4 6:9 3:8 3:6
1.7 | 1:5.
2-1 1:1 |0.7
0:3
404Trincomalee 17, 7271.. 2.82 15.9 21:9
21:2. 15:2
9:8 11:6 8-6 1-9 1.5 0:0
0:0
4.3 Kurunegala 34.8 | 421.1. ke/ 33.2
(): 2
0:0
30:8 23 -(0- 15.9 9.4 7:8. 5:8 3.7 1:7 1:2 1:2 0-5
0.5%
64, 2Puttalam 46 10 485.3e.o 46-1
31.7 24-5- 17:5
8:0 4-5 3-6 3.9 2.3 4:2 1.4 0-7
0:0
20. Chilaw 2757/8.9.121 4 6-2
6-3 4-7 4:1 4:0 2.4. 1:6 2:0 0:08 0) 0.02 0:04
0:1
647 Anuradhapura 57S 70.3. 76.6 38.5
36.9 27:1- 18.5 126
7:1, 5.3 3.4 1:9 - 0-9 0:2 0:2
0 4
- Tamankaduwa --- ... -
0-0
0:0
2b. O Badulla 20. a 25. 26.6163,
9:6 8.0 7:8 5:3 4·1 3. 4 3:5 4:0 2.5 0-9 0:5
0:3
14. Ratnapura 1/5//.. 1718 79
8-7 4-9 2.9 2.3 1:0 (07 0.25 0:1 0 6 0:1 0.02
()3
174, Kegalle :) 17:3. 1j9.9
4-0 4:3 2.9 1:7 1:1 0-9 0 · 6 0: 16
(0-08 | 0-1
0.4
0:3 2/ L CEYLON 18.2 771.2.78.4 118 10.3 7:6 5.8 3.5 2.7 18 1:2 (0:8 (0:6 (0:3 (0:3 (0:2
NTROL OF MALARIA IN CEYLON
Y4 plen. Alte at ku San Carrus A e ky de este nos for The teks Al Art Musland was die het har kanske at E IL Pe pa Patru w kiky s bedre, ma le - tas at ater indre
| EP, Irty no pue) ao nu infantu afdelaar w sw 16 ulan) | Aplemrat ka dielned or 2

Page 102
Tartu 0.
Tur (1927)
90
TABLE VII
PROPORTIONAL DISTRIBUTION OF MALARIA PARASITES -- 1921/22 SURVEY
Province
Films
examined
Films
Positive
estis
Benign
Tertian
(Per Cent)
(P.0)
Quartan
(Per Cent)
(P.m)
Subtertian
(Per Cent)
(P.f)
Western
1,607
51
84.3
11:8
5.9*
Southern --
(a) Wet zone (Over 75" rainfall) (6) Dry zone (less than 75" rainfall) Sabaragamuwa
A REVIEW OF THE PROBLEM AN
33
275
179
329
17
63.6
76.5
69.4
27.3
17.6
20.4
9.1
5.9
10-2
49
Central -- (a) Below 500 metres (b) 500-1,000 metres (c) Over 1,000 metres
47
180
216
10
57.4
72:3
36.2
22 - 2
6.4
· 18
5.5

Uva - (a) Below 500 metres (b) 500-1,000 metres (C) Over 1,000 metres
11
79
1,038
30
253
27.3
61.0
54.5
26.9
18:3
13.8
Northern — (a) North & North-west portions of
peninsula (b) Elsewhere
1,390
656
282
123
58.5
61:8
32.6
30-8
9.2
7:3
D CONTROL OF MALARIA IN CEYLON.
North-Central North-Western Eastern
1.448
2,025
1,798
353
283
230
500 M
47 -7
65:3
45.0
42.4
35 - 2
10-8
10.2
9.5
Total
11,260
1,751
57:7
33-7
10:1
*In considering these results it will be noted that the percentages given do not, in cases where mixed infections occur, total exactly to 100; this is due to the fact that each species of parasite is treated separately in regard to the number of infected cases observed.
P.y
Plasmodium vivax
P.m
Plasmodium malariae
P.f
Plasmodium falciparum
L

Page 103
TABLE VIII
MALARIA PARASITE SURVEYS (FEBRUARY-MARCH) 1938-41
1938
1939
1940
- 1941
Province
No. of
children
examined
P.R.
No. of
children
examined
P.R
No. of
children
examined
P.R
No. of
children
examined
P.R
Western
2,682
0.6
3,473
1.4
3,396
0-8
3,588
0.6
Sabaragamuwa
1,806
1-5
1,728
4.8
1,657
5.3
1,850
3.9
A REVIEW OF THE PROBLEM AND COM
Southern —
(a) Wet zone (6) Intermediate zone (c) Dry zone
885
660
109
0-8
14:2
9:2
988
740
160
1:3
8.9
11:9
977
663
141
1.8
7.2
15-6
876.
632
113
3.9
3.0
2.4
-Central -
(a) below 500 metres (b) 500-1,000 metres
942
1,323
5.8
3:6
1,712
1,526
6-0
2:1
1,568
1,191
5.0
5.0
2:1
0.8
767
1,213
991
2.5
204
oso

(C) UVET 1,000 metres
10
24 OF
2024
UU
201
Nva — (a) below 500 metres (6) 500-1,000 metres (c) over 1,000 metres
285
169
141
10 - 2
5:3
0:4
710
288
420
5.4
0:3
1:4
656
346
269
7.5
3:1
1.9
126
138
137
7.1
2:2
1.5
Northern - : (a) North & North-Western portions of the
peninsula (6) Elsewhere
NTROL OF MALARIA IN CEYLON
625
517
0-5
4-8
368
2,006
0:0
4.2
251
1,821
0.8
3.6
Unsurveyed
– do
- do
North-Central North Western
465
2,895
8.2
7.5
1,374
2,802
11.4
7.5
920
2,650
11-3
5.9
2,756
5.6
Eastern
964
8.1.
3,111
8.1
3,138
13.5
Unsurveyed
Total ...
14,653
4-5
21-690
| 5:1
19,906
5.6
12,427
3.7
The figures in the number examined column refer to those examined for malaria parasites
91

Page 104
کی A ها بر این بار ای به نام ( عمراہ آیا اس میں با
ویر5/ ميل / C T VIA 17 ، لا ما في المياه بهار
92
DO T
'TABLE IX
PARASITE RATES BY DISTRICTS - 1946-54
Sept.
1947
March
1948
March
1949
March
1950
March
1951
March
1952
March
1953
March
1954
0.5 + + Colombo
()·1
(0-04
A REVIEW OF THE PROBLEM AN
0:0
0:0
0:0
0:0
0:0
MAN MAN
38 39
DISTRICTS mal Mad Sept.
40 A) 1946
0: 9.613
Negombo
O, 6 > | Kalutara
O. A. 0.70:7
2* 2 2.3 Kandy
23. 272.3
1014 lo•3 Matale
5... 68 5:0
57 1. I N'Eliya
2R.). 20-9
2. Galle
!.. 607
Matara
o'/. 114 43
20.7 12. | Hambantota
101.7.445 36
0:0
0:0
0:3
(0.7
() -7
0:2
(02
0-9
0:0
0:1
0.5
0.4
0-0
0-0
0-7
(0-0
0:2
0.5
0:2
0-0
0-0
0:2
0-0
0.04
(0:0)
0:0
0-0
0:0
0.2
00
0.05
0:2
0:0
0:0
0:0
0.0
0:0
0:0
0:1
0:0
0-9
0-0
0.0
0:0
0-0
0:0
() - 2
0:0
(0-0
0:0
0:1
0:4
0:0
0:0
0.0
0:0
7 || 6.5

| 5.2.2 Jaffna 8. ol 1013 Vavuniya 318 · 1 Mannar 8. 8. A Batticaloa 7.9 6'7 Trincomalee 8, 28,3 Kurunegala 16.3 7. o Puttalam 2 ) 812 Chilaw
82
Anuradhapura Tamankaduwa
Badulla
6:7
Ratnapura
Kegalle
29.. NS 0-5 5'... NS0-8 b'%. NS 7-8
NS 5:1
Ns 0-3
6.7 10:1 6* 7. 23 5.0 22.! 8, 667
NS 3-6
minio
3.S| 2-2
4.8
0. a 3:3
() - 4
(0-0
2:0
1-8
0-6
2:6
1:1
0.5
2.7
0:1
1.5
1:2
2:2
1:2
1:6
1:7
0-6
1:8
0:0
0:0
0:3
, 1:0)
(0:0
(0:6
()·()
()·1
() - 8
(0:05
0:0
(0-0
0-6
() - 4
() - 6
() - 5
0()
0:1
0:0
0:3
(0:0)
1:3
0:2
0:3
0:3
(): ()
0 - 4
0-0
0:0
0 - 0
1-6-
(): ()
0-2
() - ()
0:0
(0-5
0:05
(): (
()(
(0.5
0:0
0:2
0:3
0-0
05
0:0
0-0
(0:0
0:2
0:2
0:03
1:8.
0:0
0:0
0:0
0:3
0:1
0-0)
12. dy
7,9
3.
() -6
1:1
0-9
1:2
D CONTROL OF MALARIA IN CEYLON
(0:9
() - 1
(0:2
(0-1
(0:0
(): ()
0:2
0:1
0:2
0:08
0:0
().2
0:15
(0:0
0-8
0:0
0-0)
/3 32
4.57 ) CEYLON
56.3.7 3.6
0-9
0-6
* 0:2
0:13
(0-16
0:14
0:09
0:07

Page 105
TABLE VIII
MALARIA PARASITE SURVEYS (FEBRUARY-MARCH) 1938-41
1938
1939
1940
* 1 9 41
Province
No. of
children
examined
P.R
No. of
children
examined
P.R
No. of
children
examined
P.Ꭱ
No. of
children
examined
P.R
Western
2,682
0.6
3,473
1.4
3,396
0.8
3,588
0.6
Sabaragamuwa
1,806
1.5
1,728
4.8
1,657
5.3
1,850
3.9
A REVIEW OF THÉ PROBLEM AND CON
Southern — (a) Wet zone (6) Intermediate zone (C) Dry zone
885
660
109
0.8
14:2
9.2
988
740
160
1.3
8.9
11:9
977
663
141
1.8
7.2
15:6
876
632
113
3.9
3.0
2.4
Central -- (a) below 500 metres (6) 500-1,000 metres
5-0
942
1,323
5:8
3:6
1,712
1,526
904
6.0
2:1
1,568
1,191
262
2:1
0.8
767
1,213
931
5.0
2.5
0.0
1 OF

(C) Uver 1,000 Helles
TO
OF
10:2
Nva —
(a) below 500 metres ; (6) 500-1,000 metres
(c) over 1,000 metres
285
169
141
710
288
420
5:3
0.4
5.4
0:3
1.4
656
346
269
7-5
3.1
1.9
126
138
7.1
2:2
137
1:5
Northern — : (a) North & North-Western portions of the
peninsula (6) Elsewhere
ATROL OF MALARIA IN CEYLON
625
517
0.5
4.8
368
2,006
0:0
4:2
251
1,821
0.8
3.6
Unsurveyed
- do
North-Central North Western
465
2,895
8.2
7.5
1,374
2,802
11:4
7:5
920
2,650
113
5.9
2,756
- do -
5.6
Eastern
964
8-1
3,111
8·1
3,138
13.5
Unsurveyed
Total ...I
14,653
4-5
21-690
5:1
19,906
5.6
| 12,427
3.7
The figures in the number examined column refer to those examined for malaria parasites
91

Page 106
marki Ali ar tu) i peresa Juus ad use 5 mal
the adult + ile A. M. chT. Vis v clusa ). S.
92
TABLE IX
PARASITE RATES BY DISTRICTS -- 1946-54
Sept.
1947
March
1948
March
1949
March
1950
March
1951
March
1952
March
1953
March
1954
A REVIEW OF THE PROBLEM AN
0:1
0-04
0:0
0:0
(0
() - ()
0-0
0:0
YM ay | MAL
38 | 39
DISTRICTS mam ad Sept.
40 A) 1946
0.5 + + Colombo
0:9. O61.3
Negombo 06 · 1 Kalutara
O. A. 0.70:7
2.3 Kandy
213. 2.72.3
10.4 3 Matale
5.... 68
5-0
1.1 N'Eliya
28. 2
0-9
2. Galle
(07
O.
| 4:3
107 12, 8 Hambantota
701.7.1536
L
2. 2.
0-)
0:0
0:1
0:0
0-3
0-7
0-7
0-2
0:2
0-9
0:0
0:1
(0-5
0.4
0:0
0-0
(0:0)
0:2
0-5
0:2
0:0
0:0
0:2
(0-0
0.04
0-0
0:0
0-0
0:0
0:2
0: ()
0.05
0:2
0()
(0-0
0 - 0
0:0
() - 0
0:0
0-0
0:2
0.()
0 - ()
0:0
0-0
0:1
0.4
0-0
0:0
0:0
0:0
57.
(): ()
(0
0:0
0:0
7. Il 6.5 Matara
"1.. -
o'.. - G

(0-1
(): ()
1:5
Ms/
14
»57.242 Jalna g, ol 10.3 Vavuniya 318 e 1 Mannar 8.) 8-A Batticaloa 79 b'7 Trincomalee
, a 83 Kurunegala 16.3 7. o| Puttalam 2.) 324 Chilaw
Anuradhapura Tamankaduwa
Badulla |-st b'7 Ratnapura
Pri godkimi:Ndim :
NS 0.5
NS| 0-8
7-8
Ns 5:1
Ns 0-3
6.7 10:1
213| 5:0
8:6 6:7
WS 3.6
() - 4
0:0
2:0
1:8
0-6
2.6
1:1
0.5
2.7
1-2
2.2
1-2
1-6
1-7
0-6
1.8
(0-0
(0-0
().3
| 1:0
(): 0
() -6
() - ()
() - 1
() - 8
0:05
(): ()
(0:0)
0.6
0.4
() -6
() - 5
() - ()
0:1
()-3
(): ()
1.3.
() - 2
0-3
() -3
0·()
() - 4
(0-0)
(0:0)
() :)
1.6 -
(0:0
(0-2
0:0
0:0
(0-5
0:05
()- ()
0- ()
0.5
0: ()
0:2
0:3
0:0
0.5
0:0
0-0
0:0
0:2
0:2
0:03
1:8 -
0:0
0:0
() ·0
0:3
0:1
0:0
82/ /)
79 3.2
5!.. 3.s 2:2 91. 8.1 4.8 2.8.. 0.9
3:3
1:1
0-9
1:2
/31 32 Kegalle
0-9
0:1
0:2
0:6
0:2
(0:1
D CONTROL OF MALARIA IN CEYLON
(0:1
0.)
(): ()
0:2
0-08
(0-
0:2
0.15
0:8
0-0
(0-0)
0:
4.5 57) CEYLON
5.6.3.7 3·6
0-9
0-6
0-2
0:13
(). 16
(0:14
0:09
0:07

Page 107
TABLE X
INFANT PARASITE RATES BY DISTRICTS
1951-55,1959-60
DISTRICTS
July:1951 Jan:1952 Sept:1952 Jar:1953 Sept:1953 Jar:1954 Sept:1954 Jar:1955 NMar:1959 NMay 1960 End. P.R Eed. P.R End. P.R Eed. P.R End. P.R Ead, P.R Eed. P.R End. P.R Erd. P.R Eed. P.R
A REVIEW OF THE PROBLEM AND CO
|-
Colombo
Negombo
Matale
Kandy
Nuwara Eliya
Matara
Hambantota Jaffna
| 三三二
| 116 0.01630.0,
163.0.0 103 0.0 146 0.0 193 0.0 253 0.0 293 0.0 259 0.0 410 0.0
18 0.071 0.0 120 0.0 122 00 233 0.9 230 0.0 1570.0 194 0.0 233 00 244 0.0574 0.01, 293 0.0 419 0.0 42900 577 0.0 4910.0 423 0.2446 0.0 232 0.0 171 0.0699 0.01,544 0.0 6 0.032 0.0 18 0.0 54 0.036 0.050 0.0
2280.01560.0 367 0.0 315 0.0 460 0.0 511 0.0 715 0.0 812 0.0 467 0.0 398 0.0 551 0.0236 0.0 185 0.0 2010.0 1999.0305 00 263 0.0 210 0.0 230 1.3 172 0.0386 0.0 1,869 0.0. 47 .042 0.0 164 0.0710.02110 10900 2000.096 0.0586 0.014960)

Mannar
Vavuniya
Batticaloa
Trincomalee Kurunegala Puttalam
Chilaw
Anuradhapura Tamankaduwa
Badulla
Ratnapura
Kegalle
則WBSBm的W-3的船
mwmus则仍叫%叫M
109 0.078 00910-097 0.0 136 00 107 0.0 88 0.0 15300 2590.0818 0.0 103 0.0 105 0.0 124 0.0 63 0.0 94 00 101 0.078 0.0.59 0.0 290 0.0 845 0.0 169 0.0 144.0.0 243 0.0 236 0.4 277 0.4 111 0.0 289 0.3224 0.0 682 0.03,681 00
13 0.0 10 0.088 0.0 49 0.0 103 0.092 0.0 58 0.088 0.0 250 0.0.732 0.0 991 0-01.064 0.01,400 0.01.414 0.11,0610.0 922 0.0 841 0.0 847 0.01,459 0.05,525 0.0
67 0.0 29 0.0 44 0.0 29 0.0 67 1.5 78 0.0 89 0.0 35 0.0 3410.0 841 0.0 415 0.0 475 0.0 428 0.0 442 0.0 440 0.0 459 0.0 430 0.0 304 0.0 412 0.0 532 0.0 108 0.0 121 0.0 130 0.0 143 0.0.146 1.4 104 0.9 86 0.0 78 0.01,053 0.02,475 0.0
38 0.062 0.0 42 0.0 146 0.0170 0.0 910.079 1.3106 0.0 106 0.92 134 07 128 00 218 0.0 203 0.0 268.
0.37 2552 0.0 |147 0.0 255 - 0.4347 0.0 320 0.0 419 00 286 0.0 418 0.0 500 0.4,779 0.01,321 0.0 4.35 0.0 422 0.0 732 0.0 60 0.0 755 0.0 601 0.0 814 0.0 593 00 327 0.0961 0.0
NTROL OF MALARIA IN CEYLON
TOTAL. 3,955 0.04,026 0.053,506 0.07 5,3680.07 5, 718 0.15,2150.065,3420.07 4,746 0.049,4190.01 27,281 0.0
Exd:Examined
公主
P.R: Parasite Rate
93

Page 108
94
A REVIEW OF THE PROBLEM AT
TA
MALARIA ATTENDANCE A
YEAR
TOTAL CASES
1910/1911
1,680,989
1911/1912
2,004,610
1912/1913
1,498,950
1914
1,723,866
1915
1,305,348
1916
1,562,731
1917
1,301,197
1918
1,308,513
1919
1,633,086
1920
1,643,398
1921
2,282,602
1922
2,533,657
1923
2,860,981
ΤΑ)
TOTAL INPATIENTS & OUTI
TREATED FOR
IN PATIEN
YEAR
TOTAL NUMBER
PER TRE
М
1924
176,787
1925
188,354
1926
205,529
1927
200,770
1928
224,850
1929
210,547
1930
208,464
1931
191,864
1932
207,922
1933
207,028

D CONTROL OF MALARIA ÎN CEYLON
BLE XI
T HOSPITALS & DISPENSARIES 910-23
MALARIA
CASES
MALARIA MORBI
DITY RATE PER CENT
515,590 -
30 -6
869,369
43.3
787,987
52.5
772,364
44.7
485,082
37:2
682,919
43-6
348,728
26.7
367,854
28 · 2
616,172
37.9
505,370
30:8
916, 152
40:1
986,187
39.0
1,227,747
42.9 %
BLE XII
PATIENTS AND THE PERCENTAGES
MALARIA—1924-33
ITS
O U T PA TI E N T S
CENTAGE ATED FOR ALARIA
TOTAL NUMBER
PERCENTAGE TREATED FOR A
MALARIA
15:2
2,497,122
12:0
2,360,468
14:2
2,864,733
12.5
2,759,403
37.0 923 927 33:3 786 O 13 36 · 9 10 57074 31.4 666 45|| 44.2 1539 309 44•6 | 6174 63 45.2 1,722 720 38.2 1,418 863
19.7
3,482,691
17.8
3,626,606
44.6
18.0
3,810,010
14.4
3,714,348
15:7
3,965,209
38:0 | 506 776 31.8238
11:1
3,765,231
31:8 | 129 333

Page 109
TABLE XIII
MALARIA MORBIDITY BY DISTRICTS
19 5 0-6 1
Name of
Districts
Climatic
Zone
1950 1951 1952 1953 1954 1955 1956 1957 1958 19591960
1961
A REVIEW OF THE PROBLEM AND CO.
60,803 41,015 30,599
3,969
791
289
44
25
5
A
O
0
()
11
Colombo
Negombo
Kalutara
Kandy
Matale
Nuwara ‘Eliya
Galle
Matara
Hambantota
105
822
48
146
136
121
1,179
336
21
19,065 16.051 10,546 34,110 20,855
12,831
30,316 26,421
13,383
6,694 6,096
2,282
13,313 8,007
2,719
23,962 14,017
7,003 27,947 21,425 14,312
W, I & Ꭰ
I Ꮂ Ꭰ
W, I & D
W
W & I
I & D
734.
2,105
7,207
1,104
1,530
3,014
4,988
276
477
2,114
358
537
1,136
1,742
49
193
721
49
53
135
1,120
SO PO w Noo o
N - N
0
3
0
26
304
18
106
10

275
70
11
52
72
65
30
79
43
AAA AAA
64
Jaffna
Vavuniya
Mannar
Trincomalee Batticaloa
Badulla Anuradhapura Tamankaduwa Ratnapura
Kegalle
Kurunegala
Puttalam
Chilaw
56
29,566 | 16,418
8,280
9,523 5,554
3,877
8,748 4,227
2,103
12,846
4,847
2,502
59,541 53,929
41,907
21,290 13,810
9,879 58,531 39,794 13,935
5,954
27.738 22,645
9,138
20,382 16,555
7,418
110,036
83,537 49,265
36,307 32,897 11,009
10,082
2,113
1,217
414
954
13,638
6,174
5,837
2,241
3,334
1.288
18,153
9,359
2,607
408
224
52
294
5,877
1,871
828
1,047
1,996
120
5,680
2,861
961
258
168
55
149
3,440
653
735
782
1,216
11
660
419
32
124
279
66
213
2,210
615
689
614
170
12
840
47
33
317
252
427
134
2,151
236
2,043
1,341
14
10
1,937
346
245
43
206
187
153
88
91
65
75
4
- p op i
W, I & D
w & I
I & D
NTROL OF MALARIA IN CEYLON
59
8
128
81
| 0
D
135
208
33
I & Ꭰ .
- 3
CEYLON
610,781 448,100 269,024 91,990 29,650 11,191
7,906 10,442 1,037 1,596
422
110
I: Intermediate zone
W: Wet zone D: Dry zone
95

Page 110
. Pas la nom aleneum, Dili pod
96 96
A REVIEW OF THE PROBLEM A
TA
POPULATION, MALARIA MOR
N O
x
No 170 YEAR
ESTIMATED POPULATION
NO. 01 CASES
1934
5,415,516
2,333,94
1935
5,551,623
5,459,53
1936
5,631,000
2,947,53
1937
5,712,000
2,308,97
5,810,000
2,053,07
5,897,000
3,210,79
5,951,000
3,413,61
6,178,000 WV
3,220,36
6,179,000 m
3,225,47
6,296,000 N/
2,141,32
6,442,000 NA
1,672,47
6,650,000 WV 2,539,94
6,854,000
2,768,38
7,037,000 V
1,459,88
7,244,000
775,27
53 16 93 6 17 b 1938 / 383 4 & 109 5-86 1939 : 8120 | 34 O 43. O 1940
3659 176 4 3/: 1941 21 6 6 4 84 228 1942 /4 80- y. O 23 27. 1943 - 1784 2033 17.6 1944
S-I O 4 /3-74 og 1945 2. SS- / 574 2215 1946 5746 704 419 1947 3196 229: 772 1948 | 290 4 2 3 4 81 e 1949
3 4 a. 1 1950 | 2203 139 b. 3 1951 28S2 / 75 1952 4 o 4 9 1 69289 1953
8 727 19:13:7 1954 10 78 387 4
1955 2o 07 L 7139
1956 597
1957 16 Riau, I M.E P - 1958 44 294 63
3257 40 / 590 to 5 2 1959
7,455,000 Y
727,76
7,678,000 v
610,78
7,876,000 V
448,10
8,074,000
269,02
8,290,000 /
91,99
8,520,000
29,65
8,723,000 /
(11,19
8,929,000 v
7,90
9,165,000 V OPo 10,44
(9,360,000 9 384
1,03 9,585,000 96 251,59 9,611,000 9E94 42 10,167,000 10 / 68 11
1960
e 3 0.7 120/1961 479 28
os 2 06 1961-62 7 817
TL koo 7 1465
Souis
DP)
JUMAA
SAAR
* Pos Ces 65
G - C. .

ND CONTROL OF MALARIA IN CEYLON
BLE XIV
IBIDITY & MORTALITY RATES—1934-61
ORBIDITY
MORTALITY P. RATE PER NO. OF RATE PER
THOUSAND
DEATHS MILLION
5
430
2,332
419
983
47,326
8,439 )
9
523
7,613
1,352
404
4,408
770
19 v
353
4,778
820
OI
54.4
10,039
1,697
8 V
573
9,169
1,536
10.
521
7,132
1,180
522
5,143
851
9.
340
6,765
1,098 S
8 /
259
5,604
888
381
8,539
1,310
403
12,587
1,873
207
4,562
661
107
3,349
471
97
2,403
328
79
1,903
252
56
1,599
206
33
1,049
132
11
722
89
3.47
447
53
268
31
1.7317 1:25 6 3 FG0, 0:79
- 2
144
16
P A
0.8
2 94 9 (1:12 7 X 3 S*" 0:1 6*
0:15
0:1
2 X 427 10:04
0.01
V AHL fransual"
( num -

Page 111
A REVIEW OF THE PROBLEM AND
TABL
VITAL STATISTICS (RATES
YE.AR
BIRTH RATE
1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911¥ 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926
1927
1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945: 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960
37 ·5 38.5 40 · ( 38.5 38 -7 36-5 33.6 41: () 37.5 39-0 38 - 0 33-3 38 · 6 38 · 1 37 ·(0) 39 - 0 40 · 1 39:2 36 · 365 407 39.1 38 -7 37.5 39 · 9 42. 41 () 41 · 9 38:3 39: () 37.4 37 :) 38 · (6 37:2 34.4 34:1 37:8 35.9 36 ·(0 35:8 36.5 36.7 40 -6 37:1 36.7 38 · 4 39 · 4 40:6 39.9 39-7 39.8 38:8 38:7 35.7 37.3 36 · 4 36 · 5 35.8 36.9 36 -6
1901 – 10 19 17 - 20
- 30 3/ - to 41 - 6 47. Le G
38. 37: 9 39 · 8 364 37: 6

CONTROL OF MALARIA IN CEYLON
97
E XV
PER THOUSAND)—1901-60
DEATH RATE
INFANT MOR
TALITY RATE
185
189 213
26 · 1
27.6
170 27-5
173 25.9
164 24:9
174 27.7
176 35-1-37 000 Mal diell, 198 33.7
186 30.1 31 - 0
202 27-3
176 34.8- 33 000
218 32.4
215 28.4 32:2 25:2
171 26.8
184 24.7
174 31 · 9
188 37:6
223 29.6
182 31:2
192 27-5
188 30 - 3
212 25:8
186 24:3
172 28-3
174 22 - 6
160 26 -0
177
187 25.4
175 22:1
158 20.5
162 21-2
157 22:9.
173 366
203 21:8
166 21:7
158 21:0
161 21:8
166 20 - 6
149 18.8
129 18.6
120 21:4
132 21 -3
135 22:0
140 20:3
141 14.3
101 13:2
92 12.6
87 12.4 12.7 11.8 10-7
71 10:2 10:8
71 9.8
67 10-1
68 9.7
64 9-1
58 8-6
78
72
57
IED 19 6
286 36.6 26.5 230 204
/7 13 3
93

Page 112
1950
SA I A Star p i flere
died
36 |
86
TABLE XVII
EXAMINATION OF BLOOD SMEARS BY MONTHS, 1955-1961
YEAR
- TOTAL JAN FEB - MARAPR MAY JUNE JULY AUG SEPT OCT NOV DEC POD VED
103,725
3,795
3.7
2.5
5-7
(No: Examd. 1,450
9,585 9,474 6,396 9,070 8,956
9,983 10,591 8,456
9,777 9,325 10,662
1955 No: Pos.
244 514 342 165 182 235 182 195 215 214 472
612
| Positivity rate % 1.6
5.9 3.6 2.5 2:0 2.6 1:8 1.8
2.9
5-06 (No: Examd. -- 10,389 10,4429, 263 - 6,96110,901 - 14,415 11,471 1,099 10,263 11,557 11,705 12,814 1956 No: Pos.
374 in 277 446
- 164 2 311 264
557
510 510 792 1568 908
is 1,822
| Positivity rate % 3-6
2.6 48 2.4
2.9 | 18
4.9 5.04 7:7 49
7:8
14:2
(No: Examd. 3,727 10,365 10,912 6,437
7,110 7,744 8.842
9.486 7.458
7.297 10.718
REVIEW OF THE PROBLEM
121,280
6,994
5-8
105 957

443
392
5.5
433
5.6
5:01
284
3.0
166
2-2
173
2.4
163
1.5
126
2-1
6,81
6:4
- 5,598
1957 No : Pos.
2,4071,132
706
386
( Positivity rate % 17.5 10.9
6.5
6.0
(No: Examd.
4,872. a 6,182
3,532
1958 & No: Pos.
208 105 91
22
| Positivity rate % 3.7
2.25 1.5
(0.6
(No : Examd. 10,911
11,362
19,079 14,646
1959 No: Pos.
288 136 140
44
| Positivity rate % 2.6
1:2 0.8
0:3
4,065 - 3,130 -43 - 19
1:106
4,862 e 4,216 - 4,275 - 5,385PF 6,71111,038 3633 - 81 89 153
E 157
0-7 * (0:8
2.3
1.4
63,866
1,037
1-6
3 A 4 8 A 9
* A * * * 9.1 108. .
28,854 32,114
52
0:2
0:3
80
33,032 33,210
154
185
0.4
0.5
94
24,154 33,021 29,545
95
159
0:3 0-2
0-5
34,812
169
0.4
305,740
1,596
0.52
(No: Examd. 36,349
36,877 39,605
1960 No : Pos.
-149
I 63 73
| Positivity rate % 0.4
202.0.2
I AND CONTROL OF MALARIA IN CEYLON
50,444
15
50,099
52,667
18
0.01% 0.03
48,032
12
- 0.02
57,043
10
(0-01
22,524 - 72,647-73,090 - 57,556 == 230 31
14
- 0.03 - 0.02
0 - 4
0-02
596,933
442
0-07
0-03
( No: Examd. 69,474 79,632 1961 & No: Pos.
19 | Positivity rate % () 02
0-01
67,290
66,320
20
13
0-02
| 0.01
67,766
68,567 49,897 57,216 56,894 10
11
0-008 | 0.01 001
0.01
61,089 70,030
72,132
12
0-01
0: 004 0.001
786,307
110
0.01
Abbreviations : No: Examd.
No : Pos.
— Number Examined
Number Positive

Page 113
TABLE XVIII
THE REGIONAL DIVISION & SUB DIVISIONS — AREA, POPULATION, MEDICAL INSTITUTIONS, AMC UNITS & No. OF HOUSES SPRAYED
Area in Popula- Health Medical Vigilance M.C V.S.U.V.S.UU. V.S. UU. No. of Sq. Miles
tion Areas InstituUnits Units. Super
(Institu(Field)
houses
tions
Ꭷsors tions)
sprayed
A REVIEW OF THE PROBLEM AND CON
Northern Region (Endemic)
8,485
1,124,100 15
123
10
16
42
91
147,266
Super
Jeep 6
Jeep 8
Eastern Region (Endemic).
2,792
352,730
36
5
5
20
48
46,726
Super
Jeep 1
Jeep 4

Central Epidemic
1,658
2,535,840
16
15
E 8 -a.
Super
Jeep 3
Jeep 8
Central Endemic
3,211
1,006,190
8
36
71
134,444
Southern Epidemic
1,020
608,550
- 3
U
Super
Jeep 3
Jeep 4
8
TROL OF MALARIA IN CEYLON
Southern Endemic
4,417
880,280
4
37 U
16 16
42
61,797
TOTAL ...
21,583
6,507,690 43 325
36
37
125 44 125 267
267
390,233
M.C. -- Malaria Control V.S.U. -- Vigilance Sub-Unit
R 678 - e a Zone (12 = 29-84) 18 90s - em 2 sal na 2 SE 3
| 66

Page 114
100
A REVIEW OF THE PROB
令ME
sy
GG
S29
可R
十个十十七
十十十十十. 入十十++十十 \++++++十个土 }++++十十十十十+ i+++++++++ +++
年十+
了十
++*
十f\
+4。
外十
十七十
f十
十+ \++++++++++
片十+
Dumcansh。

LEM OF FILARIASIS IN CEYLON API
ANNUAL RAINFALL
CEYLON Scale 1/2,000,000
2s2
20 25 ins - 50 ins.
] 50 ins - 75 ins. 4+H
| 75 ins - 100 ins. Over 100 inches.
(GAS
乎个人 44平十十
(+十十一十十一十土十, 片十大于十个十十十+十, *十十十个十++++++ \十大十十+++++十+ + 十十十十十一十十++++
++++++++++++
++++ーム++++ 十十 +,
Drawn and Printed by Survey Dopt., Ceylon

Page 115
A REVIEW OF THE PROBLEM (
BY M. H. M. ABDULCADER, L.M.S. (Cey.), D.P.E
Superintendent, Anti-Fila
• Department of Healt
lon
Cen
giv clin
ref
Ceylon is a pear shaped island situated 2. in the Indian Ocean, separated from the Southern tip of India by Gulf of Mannar and Palk Strait, the width of the sea at its fes narrowest point being about 20 miles ; it sis lies between parallels 5° 55' and 9° 51'
North latitude and the meridians of 79° err 43' and 81° 53' East longitude. Its greatest
to distance between North to South is 270 miles and from East to West 140 miles and it has an area of 25,481 sq. miles. From
(6t the point of view of surface features the country can be divided into a central hilly region (the highest point being Pidurutalagala which is 8,292 ft. above sea level) and the surrounding plain which divides itself into Northern, South Western ka and South Eastern plains. Climatically, oro the hilly region is much cooler than the
cia plains ; the temperature of the hill country follows more or less the contour-the average being about 77°F at 1,000 ft. and about 60°F at 6,000 ft. In the Northern plains the average is about 80°-83°F whereas it is about 80°-81 °F in the South Western and South Eastern plains. The relative humidity is well over 70% in the plains for most part of the year. Excepting for the South Western portion the Island which receives rainfall during both the monsoons
– North East and South West the rest of the country (70%) receives its rain only
be during the North East monsoon which lasts from October to April. The country
Bu can thus be divided into a wet zone (annual
уе: rainfall over 100") intermediate zone
as (annual rainfall between 75”-100") dry thi zone (annual rainfall between 50-75"). and
wh arid zone (annual rainfall between 25"-50"). The South Western and Southern regions ap of the country are watered by several
thr rivers which have a perennial supply of water whereas the rest of the plains especially the Northern region suffers from a fol. drought during the dry season—the only reservoirs of water supply being large tanks and these too go dry in cases of extreme drought.
Pit
of
Cer

101
OF FILARIASIS IN CEYLON
. (Lond.), D.T.M. & H., (Eng.), F.S.S. riasis Campaign, h, Ceylon.
History:
There is no doubt that the late manitation of filariasis, especially elephantia
of the legs, was too well known in India ig before Celsus (1st Century B.C.) oneously used the word “ elephantiasis' indicate leprosy. Two famous Indian Physicians-Charaka h Century B.C.) and Susruta (5th ntury B.C.) have described the disease, ring an accurate description of the nical manifestations of the disease.
Vinaya Pitaka–Maha wagga Pali Mahandakang, which contains the rules of lination of Buddhist priests, as enunted by Buddha (623-543 B.C.) makes erence to elephantiasis as follows:--
“Nă Bikkặvẽ Seepadee Pabbãjệthăbbā " which means : “ Priests, do not admit into priesthood, those suffering from filariasis ”. Again the Wessantara Jataka story said to have been related by Buddha refers to Jujaka, who was suffering from elephantiasis of one leg.
It is very probable that people in Ceylon came aware of the Jataka stories and the takas soon after the introduction of ddhism into the country about 2,269 ars ago ; there is no definite information to whether the disease had existed in s country from very early times or ether it had been introduced as a result trade and invasions by foreigners. It pears as if the disease had found its way Fough the port of Galle.
Reference to the disease is made in the lowing medical literature produced in
vlon.
Sarartha Sangrahaya written in sanskrit by King Buddhadasa of Ceylon in 339 A.D.

Page 116
102
A REVIEW OF THE PROBLEM
M.
|
Em adsl ali i danas nind tansah disintesitula 1 noite
- boli desOSE
talaninya dibuliformet owl
line.rad Did
} ).loin bil to moitati | ( Emal salira Hatar
Biogiriya Ni /**
t| WISEt birtwaddad Tigt insin mitt git Li gv (i bija relatatis. Tetts |al oli loodhotak
gelane
Induruwa' O
Telwattas Boossa o
Galle Habaraduwane .
Weligama

OF FILARIASIS IN CEYLON P 2
CEYLON Scale:
1/2,000,000 Prevalence of Filariasis
(1937-1939) B. malayi areas - , 1 IM ni Il dit !
et al metalo W. bancrofti areas
(
Z
OTS \ i 1997 ogasters
Toppur
loitario 10
նոս
-Tunt
oletas
silwerd OL Lainis
a Embilipitiya Svislavir
Walasmulla
Weeraketiya
O
Hungama
mE
ага
DUNCAN
Drawn and Rrinted by Survey Dept., Ceylon

Page 117
A REVIEW OF THE PROBLEM
2. Besajja Manjusa written in Pali by
Principal of Five Colleges in 1200 A.D.
Yogaratnakara written in Sinhalese by Poet Vidu in 1665 A.D.
Yogarnavaya—an abridgement of Sarartha Sangrahaya with a translation of its important sanskrit verses into Sinhalese by Principal of Mayarapada Pirivena in 1818.
The earliest scientific information regarding the disease is to be found in the Ceylon Administration report of . 1879 wherein Ondaatje, has reported the incidence of one case of elephantiasis in the Kandy hospital and 2 cases in the Matale hospital. In the administration report for 1892, Kynsey, has recorded one case of Filaria Sanguinis Hominis at the Matara hospital.
3. Previous Surveys:
Bahr, (now Sir Philip Manson Bahr) carried out a filariasis survey of the Island in 1914. He reported the prevalence of bancroftian filariasis in Ambalantota, Hambantota, Tangalle, Illekmulla, Matara, Galle and Induruwa (in Southern Province), Kurunegala, Hiripitiya and Puttalam (in North Western Province) and Mutur and Toppur (in Eastern Province). He examined 1,824 blood samples from 1,308 persons and found microfilaraemia (W. bancrofti in 43 persons (2-3%). The rates varied from 1:8 (Illekmulla) to 26.6 (Toppur). Clinical manifestations were detected in 57 persons—47 cases of elephantiasis, 7 cases of hydrocele, one case of lymph scrotum and 2 cases of chyluria.
He also noticed cases with enlargement of epitrochlear or inguinal glands without obvious signs of filariasis but 7•5% of these cases had microfilariae in their blood.
Carter, carried out a survey in Toppur (in 1933) with the main object of deter
mining the insect vector. He dissected 1,313 mosquitoes of which 77% were
Mansonioides ; infection with W. malayi (now Brugia malayi) was found in 37 female

OF FILARIASIS IN CEYLON
103
Mansonioides--17 M (M) annulifera and 20 M (M) indiana and M(M) uniformis. He also examined 172 thick blood smears, 128 adults (over 12 yrs.) and 44 children 12 yrs. and under) collected after 9 p.m. and found microfilaraemia in 44 blood smears from adults (34 - 4%) and 11 smears From children (25-0%). The species idencified was B. malayi. He also came across 29 - cases with elephantiasis of the extremities; there were no cases of genital involve
ment.
Sweet, and Dirckze, carried out a “ rapid filariasis survey of the Southern Province in 1925 (Results published in 1934). They found several foci of infection in Galle Town, Galle, Matara and Hambantota Districts (vide appendix i for details).
The highest microfilaria rates were recorded in Palathera. (31-4) Wiraketiya (278) Walasmulla (20-8) Kahawatta (11:3) Patiyawella (10-0) all in West Girawa Pattu of Hambantota District. Species identification was not done by these
observers.
Dassanayake, carried out an extensive survey of the whole island for a period of two years commencing 1st April, 1937. This, survey revealed endemic foci in Southern, North Western, Eastern,
Western and North Central Provinces of Ceylon-(vide appendix ii for details). He reported rather high microfilaria rates in Wanni Hatpattu (54 · 2) Yatikaha Korale North (48 -0) Kiniyama Korale (46-3) Baladora Korale (44-5) Tissawa Korale (440) Giratalana Korale (40-3) Karandapattu Korale (38 · 2) of Kurunegala District and moderate rates in Tammankaduwa Palata (17 · 2) of Anuradhapura District, Kottiyar Pattu (16:9) of Trincomalee District and Pitigal Korale North (11-6) of Chilaw District. He examined a total of 10,989 blood films, out of which 1,716 were positive for microfilariae-1684-B. malayi and 32 W. bancrofti. V. bancrofti infection was confined to Galle and Matara Towns. Broadly speaking the bancroftian type was prevalent in urban areas (Galle and Matara) and the malayi type in rural areas.

Page 118
104
A REVIEW OF THE PI
**, TRA TUTTE
Bingiriya
Negombo
Kotte
Ja-Ela
Kolonnawa
Dehiwala Moratuwa Panadura
Kalutara
Beruwala O Induruwa
Ambalangodai
Telwatta
]Boossa
Galle
Weligama

ROBLEM OF FI LARIASIS IN CEYLON
MAP 3
22S
CEYLON Scale: 1/2,000,000 Prevalence of Filariasis
(1947) W. bancrofti areas B. malayi areas
Areas where control
work was done W. bancrofti areas
| B. malayi areas E
·Toppur
Hatamuna,
da Embilipitiya.
Kirana
Walasmulla
Hungaina
Matara
DUNCAN,
Drawn and Printed by Survey Dept., Ceylon.

Page 119
A REVIEW OF THE PROBLEM (
S
By this time it was established that B. malayi was transmitted by M (M) annulifera, M(M) uniformis and M(M) indiana and that these species of mosquitoes were found in association with Pistia stratiotes 4 found in abundance in large irrigation 1 tanks and channels.
Based on the findings of this survey I Dassanayake, recommended a scheme of C Pistia clearance which unfortunately could t not be implemented owing to the i outbreak of World War II in September, 1939.
Soon after the termination of the war, many cases of lymphangitis, lymphadenitis and filarial infection were reported in the South Western Coastal belt of Ceylon. This resulted in the inauguration of a separate campaign on 24th October, 1947, for the control of filariasis in the Island.
Rapid Surveys carried out in 1947 brought to light a number of foci on the South Western coastal belt ; the infection in the urban areas in the coastal belt was of the bancroftiae variety whereas the malayi variety was found in the rural areas in this belt and in other foci already detected in 1937-39 by Dassanayake.
A study of the history of filarial infection in Ceylon presents two problems :
1. Conflict between the findings of
Bahr, on the one hand and Carter, and Dassanayake, on the other regarding species diagnosis.
and 2. The reason for the sudden and
wide prevalence of bancroftian filariasis in the South Western Coastal area. . . . .
The former problem is easy of solution ; b W. malayi (now Brugia malayi) as a separate a species was differentiated by Brug, in u 1927 and it is obvious that Bahr, had P attributed the infection in Ceylon to to the only species known at that time viz. O W. bancrofti. The latter problem is rather S

F FILARIASIS IN CEYLON
105
Puzzling and has to await further investigaions before arriving at a reasonable plution.
. Past Problems and Remedial neasures
The distribution of filariasis as deternined by Dassanayake, in his survey carried out in 1937-39 and the distri
ution of the disease in 1947 are given n maps 2 and 3 respectively.
It would be seen that the problem nmediately prior to the commencement of he Campaign consisted of:-
(a) Brugia malayi infection prevalent
in rural areas especially those situated close to irrigation tanks and channels where Pistia stratiotes was found in abundance. The chief centres of malayi infection were : Walasmulla, Weeraketiya, Induruwa, Bingiriya, Wariyapola, Toppur and Unawatuna, and villages around these centres. The population in these villages amounted to 118,701 and were distributed in an area of about 380 sq. miles.
(6) Wuchereria bancrofti infection along
the South Western Coastal border of Ceylon, especially in urban areas. The principal centres in this belt were : Matara, Weligama, Galle, Ambalangoda, Beruwela, Kalutara, Panadura, Moratuwa, Dehiwela, Kotte, Kolonnawa, Wattala- Mabole-Peliy a g o d a, Negombo and the neighbouring areas. The population at risk was about 1.5 million and the area involved was about 400 sq. miles.
With a view to dealing with these pro.ems, the Department of Health created special campaign in 1947 and placed it nder the control of the Deputy Director, ublic Health Services. The staff attached
· the Anti-Filariasis Campaign consisted
2 doctors one of whom functioned as the iperintendent in charge of the Campaign,

Page 120
106
A REVIEW OF THE PROBLE
20 Public Health Inspectors, 6 laboratory technologists and Assistants, clerical staff nurse, overseers and labourers.
The control measures adopted variec with the type of infection. In the case o Brugia malayi infection, emphasis was laic on the removal and destruction of Pistic stratiotes, case detection, treatment with Diethylcarbamažine and follow up till the cases of microfilaraemia were freed o infection. Manual removal of Pistia at two monthly intervals was carried out foi several years ; as this was found to be
1949
1950
1951
1952
Walasmulla
10:6 6:8 2.5
2.9
Weeraketiya
1.3 1.5
3.6
1.6
ruwa
3.7
2:0
2:1
1:2
Bingiriya
Wariyapola
1:3
3.5
3:8
1.5
7-0 3-6 34 1.5
Toppur
18.09.1 5:8 (0:9
Unawatuna
Survey Not Do
It is generally accepted that infection due to B. malayi has been brought unde control. This conclusion is fortified by th results of a survey carried out in July 1961, in Baladora korale of Dewamedi Hat pattu in Kurunegala District. Dassa nayake, carried out a survey in Balador: kor a le in 1937 and reported a higl incidence of filariasis due to B. malayi
He examined 563 persons and detected 50 clinical cases (8.8%); out of 173 bloo films examined microfilaraemia was founc in 77 cases (44 · 5%). In 1961 July, 89! persons out of a total population of 1,131 (79%) were examined for clinical mani festations and microfilaraemia. All the 895 blood films were negative for micro filariae and clinical manifestations (ele phantiasis over 15 years duration) were detected in only 10 cases. There was no evidence whatsoever of recent transmis. sion. It is possible that the infection has

'M OF FILARIASIS IN CEYLON
expensive and unsatisfactory, weedicides especially " Phenoxylene " 30 (sodium salt of methyl chlorophenoxy acetic acid) was used in a dilution of 1-2 fluid ounces in one imperial gallon of water with one ounce of Teepol as a wetting agent and applied at
the rate of 36 gallons to an acre. The I results were very satisfactory and conse
quently the control units in all malayi areas were withdrawn on 18-4-57 i.e., after 4 years of weedicidal control. The microfilaria rates in respect of these areas is given below.
P
ERRED RECEP
1953
1954
1955
1956
1957
1958
5:2
004 0-4 0: 84 0-08 Survey
not
done 0-9
0:04
Survey not done
1-0 1-5
0.4
0.23 0·13 Survey
not
done 0.5
| 0:3
Survey not done
0.5
| 0.4
Survey not done
1:1 1:3
Survey not done
one
2.6
1:8 not done 0:83
1 receded, in other malayi areas as well, r further investigations will have to be made e before a definite pronouncement could be I made regarding the status of B. malayi
infection in Ceylon.
In the case of infection due to W. bancrofti the measures adopted consisted o: case finding by night blood examinations treatment with diethylcarbamazine and
follow up and use of larvicides such as 1 D.D.T., B.H.C. and Malathion mixed in
diesel oil to deal with the insect vector. The results achieved have not been encouraging, probably because of the many gaps in the programme of vector and parasitological control and consequently bancroftian filariasis continues to be the problem of the present. The table given
below shows the position regarding micro- filaraemia in the various centres during the
past years :

Page 121
A REVIEW OF THE PROBLEM (
МАР
07
A E Negombo
che Kolonnawa
Ja-Ela , Kotte Dehiwala Moratuwa A Panadura
E Kalutara
Beruwala
E Ambalangoda
Galle
Weligama
Matar

DF FILARIASIS IN CEYLON
107
CEYLON Scale: / 2,000,000
Prevalence of Filariasis
(1962) W. bancrofti areas Areas where control
work is done
DUNCAN Drawn and Printed by Survey Dept., Ceylon

Page 122
108
A REVIEW OF THE PROB
Negombo
Ja-Ela
Kolonnawa
Kotte
Dehiwala
Moratuwa
1949
8:0
4:2
6.7
2.7
4.4
1950
13-6
8.5
Not done
4·2
1951
9:8
5.2
7-5
1.7
1952
NOT DONE
6.5
6-6
5.9
5.9 1:7
1953
3.6 1:5 5.4 5:1 1:4
1954
2.4
| 6.6 3-6 0:6
1955 2.2
3:2
| 1:2
1:9 2.3 0-3
1956 1:8
1.7 1:2
2.3 1-4 1.7
1957 0.9
3.7 1:3
2:3 2:3 0:1
1958 0.8
3.0
| 2.5
0.4
1959 10 4.809 2.2 2-6 2-3
1960 1:54.2 2.9 2.9 4-2 1-6
1961 1.6 5.9 3.8
3.2 3.0 1.9
From the above it would be seen tha there has been a slight change in the tren since 1960. This is due to the fact that new system of blood surveys and recor keeping has been introduced from 1960 It must be remembered that the rates ar not based on either longitudinal surveys ( each of the areas year after year or o random sampling. The staff available car not possibly cover the entire area in a year; it will take two or more years t cover each area. Hence the figures ar not strictly comparable. They only furnis an idea regarding the degree of micro nlaraemia in each area, and also some ide as to whether violent changes are occurrin either for the better or worse.
5. Present Problems and Remedla
Measures :
It is clear that the present problem ( filariasis in Ceylon is localised and confine to a coastal belt about 130 miles long an

LEM OF FILARIASIS IN CEYLON
Panadura
Kalutara
Beruwela
Anibalangoda
Weligama
Galle
Matara
2:2
3.2
3.8
9:7
112
3.4
| 7:2
6:7
7-6
8.2 12.4
7:8
Not done Separately
Not done Separately
2.9
4-1 68 37 6.5
5.4
2.1
2.7
2.4
5.9
3:0
1:9
3:7
3:1
5:3
4:7 2.6
| 1:3 0:5 4.2 2-1 2.4
2.9
2.0 Not done 0.9 3.2 0·9 1:8
1:6 (0:7 3.9 1:1 6·2 2.8 2.5
1:8 (0.4 1.8 1:7 4.5 2.0 2.3
2-3 2-2 2-6 2-0 6:2. 3-8
4.0
2-3 2-3 69 2.5 7.2 3.4 7•0
1.8 1.42.8 3.2 56 1-6 5.5
t 2 to 4 miles broad totalling about 400 sq. d miles in extent with a population between a 14 to 2 million, the largest bulk being
centred in the urban areas. The infection D. is of low grade not exceeding 5% and the e causal agent is almost entirely W. bancrofti.
The methods of attack are more or less the same as in the past except for refinement
in techniques. The activities carried out n at present are confined to certain selected O areas in the bancroftian endemic belt and e they consist of :--
20
(1) Investigation :
(a) Parasitological and
(6) Entomological. (2) Control :-
(a) Parasite control and (6) Vector Control and
(3) Health Education.
a I-A Parasitological Investigation :

Page 123
A REVIEW OF THE PROBLEM
This is carried out in the 13 urban areas in the endemic belt. Details observed in carrying out this work could be summarised as follows:--
(a) A tentative programme of work to
cover up the entire area is prepared by the Public Health Inspector, Anti-Filariasis Campaign on the basis of about 25 blood films per working hour, three working hours per night and three working nights per week. The area is surveyed systematically from one end to the other, ward by
ward.
(6) A monthly advance programme of
night blood surveys based on the tentative advance programme is prepared in a printed form, (Monthly Advance Programmes of Night Blood Surveys) and submitted to the Superintendent, Anti-Filariasis Campaign by the 25th of each month for approval.
(c) In addition to the Health Educa
tion work carried out by the Health Education Section attached to the Anti-Filariasis Campaign, the Public Health Inspector, AntiFilariasis Campaign visits in the morning each house taken up for night blood survey and explains the purpose of the survey and solicits their co-operation. A propaganda leaflet is also handed over to the chief occupant of each house. The Public Health Inspector, Anti-Filariasis Campaign makes use of this visit to record the names of all occupants of the house in a printed form (Night Blood Examination Schedule) in duplicate.
(d) On visiting a house for the night
blood survey the Public Health Inspector, Anti-Filariasis Campaign calls out the names of occupants one by one and commences preparing blood films in the order in which the names are written in the schedule. As far as

OF FILARIASIS IN CEYLON
109
possible 20 cubic mm. of blood are obtained from each person and spread into an oval }" x }".
(e) The name is checked against the
Night Blood Examination Schedule and the correct number is then marked on the slide with a grease pencil. If any of the occupants of the house are out at the time of the survey an entry to this effect is made against his name.
(S) The slides and the schedules in
duplicate are posted to the Superintendent, Anti-Filariasis Campaign on the following day.
(g) At the end of each week a list of
absentees is prepared and when a sufficient number of persons are available under any particular street or ward the Public Health Inspector, Anti-Filariasis Campaign selects a suitable central spot for blood filming the absentees.
(h) On receipt of Night Blood Exami
nation Schedules and blood films in the laboratory of the AntiFilariasis Campaign, the slides are checked with the schedules, the schedules are assigned a laboratory reference number, the slides are stained with J.S.B. stain and examined for microfilariae. All positives detected are indicated in the schedules, giving the species and the number of microfilariae. The schedules are then handed over to the statistical section of the Campaign where central register number will be assigned to each positive case. In the case of post treatment Blood Examination Schedules, information relating to post treatment blood examination of cases and contacts is recorded in the Field Treatment Card maintained for each case of microfilaraemia ; the schedules are then returned the original to the Medical Statistician of the Department of Health for purposes of

Page 124
110
A REVIEW OF THE PROBL)
statistical analysis and the duplicate to the Public Health Inspector, Anti-Filariasis Campaign
who pursues action regarding treatment of positive cases and their contacts.
I-B Entomological Investigations :
These investigations are carried out on tentative advance programmes and
monthly advance programmes by Entomological Assistants and Field Attendants. Collections of adult mosquitoes are made in dwellings, surrounding vegetation, and sheds (cattle shed, firewood shed, etc.) and traps. Printed transmission labels Health 1113a (vide appendix iii) and 1113b (vide appendix iv) accompany Barraud's cage containing mosquito collections.
Whenever infections are detected mosquito collections are repeated and special night blood surveys are also done for the purpose of correlating the findings.
Larval surveys are also undertaken with a view to determining the efficiency of the larvicide used and also to locate any gaps in the Anti-larval programme.
II-A Parasite Control :
The Public Health Inspectors, AntiFilariasis Campaign will normally first know that a blood film has been found to be positive on receiving back one copy of the Night Blood Examination Schedule Action to be taken depends on whether this is the first time an individual has been found to be microfilaria positive (new case) or whether he is already a known case (old case).
On receipt of a Night Blood Examina. tion Schedule containing a new case the Public Health Inspector, Anti-Filariasis Campaign responsible gives the case a reference number of his own in a pink card (Field Treatment Card for a Microfilaria case).
At the first visit to the patient (i.e. within 10 days of receipt of Night Blood Examination Schedule from the Superin tendent, Anti-Filariasis Campaign,) the

EM OF FILARIASIS IN CEYLON
Public Health Inspector, Anti-Filariasis Campaign prepares two copies of the Field Treatment Card, filling in all the relevant sections of the card.
Treatment and follow up :
Having filled up these particulars, the Public Health Inspector, Anti-Filariasis Campaign issues drugs for the first week of treatment of the cases and the prophylactic treatment of contacts if the latter have been blood tested earlier along with the case. If not, steps are taken to blood test the contacts. A record of the date of blood testing the contacts and the dates of commencement of treatment of both case and contacts will be made in the appropriate cages in the card. The result of the blood test of contacts too will be recorded when it is received.
Treatment of a case of microfi
laraemia :
While issuing drugs for treatment of a case of microfilaraemia, the Public Health Inspector, Anti-Filariasis Campaign impresses on the patient the need for adequate and regular treatment until he or she is rendered free of microfilaria.
Treatment of adults (over 12 years) consists of 2x 50 mg. tablets of Diethylcarbamazine taken three times a day about 15 minutes after each of the morning, noon and night meals for a continuous period of 21 days i.e., a total of 126 tablets. In the case of children between the ages of 5-12 years, half the above dosage is given. In the case of those below 5 years reference should be made to the Superintendent, Anti-Filariasis Campaign.
Treatment of contacts :
Treatment of contacts of either clinical or microfilaria cases is to be commenced only after they are blood filmed. The treatment consists of the same dosage as
the case but the duration is limited to one e week, i.e., a total of 42 tablets only.

Page 125
A REVIEW OF THE PROBLEM
Visits for treatment and follow up
work could be summarised as follows:
*1st day—Patient is contacted, advice given and tablets for one week's treatment given to patients. Treatment of each of the contacts depends upon whether they have been blood filmed or not.
*3rd day--Patient is contacted to see if there are any reactions such as fever, headache, nausea, vomiting, diarrhoea, abdominal pain, dizziness, loss of sleep, loss of apetite and swelling of testicle or any other parts of the body.
*8th day--Patient is visited, a check up. is made if the tablets already issued have been taken and a further weeks treatment is given.
*15th day—Patient is visited and action. as on the 8th day is repeated.
*22nd day—Patient is visited again, check made on treatment given, and records completed in the Field Treatment Card.
Follow up work:
First post-treatment night blood examination of cases and contacts is done between the 10th and 40th day after completion of treatment. Subsequent night blood examination is at intervals of 6 months from the 1st post-treatment night blood examination. A case which has been continuously negative for microfilaria for a period of 2 years since the completion of treatment is considered "Freed".
Clinical cases :
Overt cases of filariasis are only recognisable as a result of clinical diagnosis made by a doctor, normally following a visit by the patient to one of the campaign clinics. The usual routine is that at the first visit blood is taken for laboratory examination and the clinical examination is conducted on the second.

OF FILARIASIS IN CEYLON
111
New cases for the year 1960 and onwards are recorded in a new yellow card (Filariasis clinic--treatment and record card). As. in the case of microfilaria positives, two copies of the card are completed, one to be retained locally and the other to be sent to the Superintendent, Anti-Filariasis Campaign. At the same time one copy of the new yellow contact card—contact record for a case of filariasis—is completed in respect of the name and address of the primary patient, the clinic attended and the stage of disease of the primary patient and passed to the Public Health Inspector, Anti-Filariasis Campaign in whose area the patient resides. For the present contact observation is maintained only for those cases residing in the Public Health Inspector, Anti-Filariasis Campaign area.
The Public Health Inspector, Anti
Filariasis Campaign is responsible for :
(i) Visiting the patient's home and re
cording details of contacts.
(ii) Blood filming the contacts.
(iii) Issuing prophylactic treatment.
(iv) Blood filming the contacts soon
after prophylactic treatment and at half-yearly intervals.
(v) Transferring any microfilaria posi
tive cases to the register of microfilaria cases and taking all action required for microfilaria positive cases.
(vi) Maintaining a separate file of con
tact records together with a separate case and surveillance indexes as in the case of microfilaria cases.
(vii) Ensuring that action is taken when
a case changes address.
The Medical Officer in charge of the
clinic is responsible for :
(i) Ensuring that details such as clinic og register number, i central register i 2A number, full name and address and

Page 126
112
A REVIEW OF THE PROBLE
previous residence of patient, dat of birth, year of onset of clinica symptoms, dates of first clinic visi and full examination, age, sex Public Health Inspector, Anti Filariasis Campaign area, town village, Medical Officer of Health Officer-in-charge, Health Office are: and results of blood examination are entered by the Public Health Ins pector, Anti-Filariasis Campaign or duty at the clinic.
(ii) Himself completing stage of disease
at first detection, findings at first full clinical examination, record o treatment and progress after treat
ment. In completing the form the following points are observed by the
Medical Officer.
(a) the appropriate cage under each and
every item is filled by entering a tick
(6) for purposes of uniformity, it is
decided to define lymphangitis as those cases where transient signs such as inflammation of lymph vessels and glands associated with slight swelling and redness are observed. When the swelling has become permanent, ther it could be classified as lymphoe dema. If the lymphoedema is con fined only to the ankle, or foot 01 both, a note to this effect could be made in the space for special notes o comments.
Such records as annual file, action file case index and surveillance index assist in the follow up. Details regarding the records maintained are given in “ Filariasis Records in Ceylon "-Indian Journal o Malariology 14, 4th December 1960 pp 521-543.
II-B Vector control:
One of the proven methods of attack against such insect-borne diseases as Filari asis, Malaria, etc., has been the elimination of the vectors responsible for the trans
mission of these diseases. Entomologica investigations carried out so far have con firmed the fact that Culex fatigans is

IM OF FILARIASIS IN CEYLON
2
the only vector of Filariasis in the Urban
areas of Ceylon. It is therefore important t that Culex fatigans is eliminated ; in view of
the fact that the insect vector (C. fatigans) does not generally rest on walls or roof and majority of them rest in hangings such as clothes, etc. and under furniture, spraying
of residual insecticides does not appear 2 to be of much value. Under the circums
tances there is no alternative other than to depend on larval control.
Larval Control:
AS 3
E
To achieve a reasonable measure of success in larval control it is necessary that
all breeding places of C. fatigans are either e eliminated or treated with the appropriate e larvicides.
Elimination of breeding places :
(1) One of the chief breeding places of
Culex fatigans is the catch-pit at tached to latrines. These could be eliminated by converting these latrines to water-seal type. It is absolutely essential that the lid covering the pit is hermatically sealed ; otherwise there will be profuse breeding of mosquitoes and it will be a case of the remedy being worse than the disease. There is a State Aided Scheme whereby a sum of Rs. 60/- is paid to the householder for conversion of the catch-pit latrine to water-seal type. The same subsidy is also payable for demolition of a catch-pit latrine and erection of water-seal type in its place. Under the aided scheme of latrine conversion which commenced in October 1956 a total of 7,757 latrines have been converted to water-seal type by the end of December 1961. There are still about 17,243 awaiting con
version.
(2) Another common breeding place that
could be eliminated is the burrow pit, quarry pit, etc. A list of such breeding places is prepared and a register maintained under the following headings:

Page 127
A REVIEW OF THE PROBLEM O
Serial Number, Type of Breeding place, Location, Cubic capacity, How dealt with, Amount of work done by months.
Under normal circumstances all Saturdays are utilised for permanently dealing with breeding places of this nature.
02 - o
Treatment of breeding places :
fa
These are of two varieties :
(i) Permanent breeding places that
could not be eliminated by the
methods described above.
(ii) Temporary breeding places.
The permanent breeding places that could not be eliminated have to be treated with larvicides. These breeding places could be grouped under :-
(i) Breeding places which are NOT used
by human beings or animals for tl drinking, washing or bathing e.g., catch-pits, husk-pits, drains, etc. These are treated with a suitable larvicide issued by the Superintendent, Anti-Filariasis Campaign (e.g.,
Malathion in heavy diesel oil).
zo op 5 O DO R PP
(ii) Breeding places which are used by
human beings or animals e.g., tanks, ponds, kohila pits, certain canals and channels. These are treated with B.H.C. dust or any other larvicide issued by the Superintendent, AntiFilariasis Campaign from time to time.
A list of the breeding places that have to be treated with larvicides is prepared and a register maintained under the following headings.
O po. O 2 P <
Section, Sub-section, Name of Street, Assessment No. Type of breeding place, d How dealt with.
A summary of the breeding places is also given in pencil on the first few pages of ti each of these registers referred to above.

F FILARIASIS IN CEYLON
113
'emporary breeding places:
These consist of empty tins, pots, spent pconuts, unripe coconuts (komba), stumps f trees such as bamboos, vessels used for uring arecanuts, tree holes, gutters out of lignment, water storage tanks, receptacles ept under legs of meat safes, aquaria etc.
In preparing the programme of larval ontrol due consideration was paid to the bllowing factors :
(a) Total extent of the area involved.
(6) The number of breeding places to
be treated.
(C) Walking distance involved.
The area to be controlled is divided into sections. The size of each section is etermined by the three factors already eferred to and hence they need not be of qual size. The larvicidal programme in ach section is completed in a day so that ne 5 sections are completed in 5 days Iondays to Fridays. Each section is urther divided into convenient units which puld be handled by a labourer working
hours a day. Each such unit is called a UB-SECTION and the sub-section is permanently assigned to a particular labourer nd. overseer so that the labourer and the verseer are jointly responsible to the Iedical Officer of Health through the Public Health Inspector, Anti-Filariasis ampaign for work in each sub-section. "hus the minimum labour strength required
arrived at.
It has to be emphasised that under ormal circumstances Mondays, Tuesdays, Wednesdays, Thursdays and Fridays are evoted for dealing with breeding places nd that Saturdays are devoted for dealing rith permanent breeding places. Under xceptional circumstances (absenteeism, inLement weather or Public Holidays) Saturays are devoted for work that could not e completed during the week.
A programme of larvicidal work indicang the sections and sub-sections assigned o each labourer on each day of the week

Page 128
114
A REVIEW OF THE PROBL
(Monday to Friday) is submitted to th Superintendent, Anti-Filariasis Campaig for his approval.
Control of Adult Mosquitoes :
This is done on a restricted scale, almos on an experimental basis. The areas takei up for work consist of the Municipal Counci area of Dehiwela-Mt.Lavinia, Ratmalan: Airport area and a portion of the U.C. are: Matara. The insecticide used is a mixtur of B.H.C. or Malathion or any other insec ticide dissolved in light diesoline an applied through fogging machines. Th programme of work is so arranged tha each house is fogged at intervals of one t two weeks ; this necessarily involve dividing the area into sections and sub sections as in the case of the larvicida programme, the only difference being tha all 6 working days are devoted for the only purpose of fogging of houses.
The chief difficulties associated with th implementation of the programme of worl are the following:
(a) Recruitment of Public Health
Staff. The Public Health Inspector attached to the Campaign are drawi from the general cadre of Publi Health Inspectors ; officers are no keen to join the Campaign as they ar called upon to work at night withou any additional remuneration.
(6) Night Blood
Surveys. Som persons do not wish to get thei blood tested as they do not suffe any symptoms.
(C) Treatment. Quite a few cases o
microfilaraemia are reluctant to tak treatment in the absence of signs an symptoms, more so if they develoj any reactions.
(d) Breeding Places. Some house
holders do not co-operate in th disposal of empty containers whic are a source of prolific breeding o C. fatigans.

EM OF FILARIASIS IN CEYLON
(e) Local authorities. Although there.
are legal provisions to compel persons to submit themselves to night blood surveys, treatment of cases of microfilaraemia, disposal of breeding places of mosquitoes, it has not been possible to induce local authorities to serve legal notices on offenders and pursue legal action. Under the circumstances the only alternative presented is Health Education.
2 (8) Health Education :
|
a Intensive health education programmes 2 lasting about one week are carried out in t all urban centres where control work is O carried out. The programme of work conS sists of talks and discussions in the schools
in the mornings and talks and discussions
with community groups in the afternoons followed by film shows. Radio talks, exhibitions and lecture demonstrations are arranged frequently for the benefit of
members of the public, departmental officers, medical students, apothecary
students, public health learners and K buddhist priests. Publicity material con
taining information regarding the disease and its control is distributed to the public through the various control units.
1 6. Future:
ст со т (ә Руа
Any programme for the future will have to be directed towards :
با به (م
10 ---
(a) intensification of Health Education
procedures so that the public and the local authorities will become aware of the crippling nature of the disease
and its effect on the community. (b) intensification of control measures in
the entire endemic belt, especially
the urban areas. (c) the installation of proper sewerage
and water schemes in the towns • immediately to the North and South .
of Colombo.
(d) assessment of the present status of
B. malayi infection in the Island and if necessary carry out mopping up operations,

Page 129
A REVIEW OF THE PROBLEM OF
7. Summary:
ar
m
նԸ
W οι CC
Ceylon lies just below the tip of India and has an area of 25,481 sq. miles ; it has a hilly central area the highest point being 8,292 ft. above sea level. The rest of the area is more or less flat. The average temperature in the hill country varies from 60° to, 77°F and in the plains it is from 80° —83°F. The relative humidity in the plains is over 70% for most part of the year. The South Western portion receives rainfall during the South West and North East monsoons and the rest of the country during the North East monsoon ; the annual rainfall varies from 25 to over 100 inches.
Im
UT
са er
n
There is historical evidence that the disease has been known in this country for over 2,500 yearsThe first survey done was in 1914 by Bahr, ; subsequent surveys carried out by Carter (1933) Dassanayake, ( 1937 - 1939 ) .described respectively the transmitting agent and the prevalence ra and distribution of filarial infection in Ceylon. Dassanayake, found that Brugia malayi was the predominant type and that W. bancrofti infection was confined to Galle and Matara Towns only. No control was undertaken owing to the outbreak of World War II. in 1939.
Soon after the termination of the war cases of lymphangitis lymphadenitis and filarial infection were reported in the South
Western Coastal border of the Island. The causal agent was W. bancrofti.
to Dassanayake, instituted control measures
A which consisted of Pistia removal manually ge
REFEREN
BAHR, P. H. (1914). An epidemiological study of fila BERRIEDALE KEITH, A. (1928). A history of Sanskrit BUDDHADATTA MAHA THERA, REV. (1922). Buddhaw:
pitaka Press. CARTER, H. F. (1933). Medical Entomology-Filariasis
and Sanitary Services, Ceylon for 1932–pp. C. 84-C. CASTELLANI, A. AND CHALMERS (1913). Manual of Tr
sity Series London. Baillere, Tindall and Cox 8, He CUMSTON CHARLES GREEN (1926). An introduction to
Paul, Trench, Trubner and Co., Ltd., New York Alfa

- FILARIASIS IN CEYLON
115
ed thereafter destruction by the use of nenoxylene 30, case finding and treatent with diethylcarbamazine and follow o for a period of 2 years. The results ere very satisfactory. A survey carried ut in 1961 in a focus of malayi infection enfirmed the findings of Dassanayake.
The present problem continues to be fection due to W. bancrofti in the South estern Coastal belt. Case finding treatent with Diethylcarbamazine and follow
in addition to anti-larval measures are rried out. The results are not very couraging. Before making a final propuncement it is necessary to give these ethods a proper trial by intensification of Le methods in at least the urban areas.
Acknowledgements :
My thanks are due to Dr. W. A. Karunatne, Director of Health Services, Ceylon r permission to publish this note. I am so grateful to Dr. P. Rajasingham, eputy Director (Public Health Services) r his encouragement and helpful advice.
would also wish to thank Mr. R. B. issanayake of the College of Indigenous edicine, Messrs. L. de Fonseka and . B. C. Fernando of the National Museum ibrary and Messrs. U. A. Perera and . P. W. Abeysuriya, Health Educator, ublic Health Inspectors attached to the nti-Filariasis Campaign for their assistice in connection with references to terature. My grateful thanks are also due
• Mrs. D. Fernando for typing and Mr. . G. E. de Silva for having assisted
nerally in getting up this paper.
CES
iriasis in Ceylon. Parasitology, vii pp. 128-134. literature p. 514–Clarendon Press Oxford. ansa Atuwawa—p. 106. Hewawitharana Thri
5. Administration Report of Director of Medical
86 Ceylon Government Press, Colombo. ppical Medicine p. 1123 second edition-Univer
nrietta Street, Covent Garden. the history of medicine--p. 51. London Kegan, ted A. Kaoff.

Page 130
116
A REVIEW OF THE PROB
DASSANAYAKE, W. L. P. (1939). Filariasis Su DASSANAYAKE, W. L. P. AND CHOw, C. Y. (19
of herbicides. Annals of Trop. Medicine an DHAMMAKUGALA THERA, THE VENERABLE AM
Part I p. 226. Buddha Jayanti Tripitaka S KYNSEY, W. R. (1892). Ceylon Administrat
p. A53. NICHOLAS, C. W. AND PARANAVITANA, S. (196
versity Press. ONDAATJE, W. C. (1879). Ceylon Administra SHAMBUNATHA PANDYA SASTRI AYURVEDACHA
Sri Saraswathy Pusthakalaya Chowk-Kant SILVA, S. F. DE (1954). A Regional Geograph SILVA, W. A. DE (1913-1914). The Medical H
Asiatic Society Vol. xxii, pp. 34-45. SWEET, W. C. AND DIRCKZE, H. A. (1934).
Ceylon J. of Science (D) Vol. iii. PT. 3—pp. TENNENT, JAMES EMERSON (1859). Ceylon V
Roberts. VAMAN KESHEO DATAR VAIDYA BHUSHAN (19
Press, Bombay. VANDERSTRAATEN, J. L. (1885-1886). A brie
Asiatic Society (Ceylon) Vol. ix. pp. 306-336
A SUMMARY OF FINDINGS BY S
Serial
No.
Place
No. of persons examined
Galle Town
605
Galle District
1193
v om
| Matara District
566
Hambantota District
. 1007
Total
3371

LEM OF FILARIASIS IN CEYLON
rvey Ceylon (Unpublished report). 54). The control of Pistia stratiotes in Ceylon by means a Parasitologyvol. 48 No. 2, pp. 129-134. BA LAN GODA (1957). Vinaya Pitaka Mahawagga Pali priesVol. iii. ion Reports—Part IV. Miscellaneous--Medical Reports
-). A concise history of Ceylon, Colombo. Ceylon Uni
tion Report-Appendix No. 2 p. 225C.
RI, AYURVEDAL ANKARA (1952). Susruta Samhita p. 224 Pur—India.
y of Ceylon. The Colombo Apothecaries' Company, Ltd. Estory of the Sinhalese--J. of Ceylon Branch of the Royal
A filariasis survey of the Southern Province of Ceylon. 1777-182. olume I. p. 505 London-Longman Greene Longman and
22). Charaka Samhita pp. 160 and 480. Nirnaya Sagar
ef sketch of the Medical History of Ceylon J. of Royal
PENDIX I.
WEET, W. C. AND DIRCKZE, H. A. (1925)
Microfilariae in night
blood specimens
Elephantiasis
Number
Percent
Number
Percent
5-8 + 0.6
19
1.6 + 0·2
10
1.2 + 0.8
0.8 + 0·2 0.5 + 0:2
1.4 + 0:3
101 |
10.0 + 0:6
22
2.2 + 0-3
163
4:8 + 0:3
42
1:3 + 0:1

Page 131
APPENDIX II.
A SUMMARY OF FINDINGS BY DASSANAYAKE W. L. P. (1937 - 39)
Serial
No.
Place pelo Place
No. of
persons
examined
Microfilaraemia
No.
Percentage
Positive
Positive
Species
Clinical Manifestations
No.
Percentage
Positive
Positive
I. Southern Province
5922
437
7.4
O 405
1334
16:3
B.malayi
W.bancrofti
32
A. Galle District:
3272
241
7:4
623
27.4
B.malayi.
W.bancrofti
218
23
(a) Galle Four Gravets
1862
188
10- ()
140
466
B.malayi
165 W.bancrofti 23
A REVIEW OF THE PROBLEM
347
12
3.5
76
11:0
292
1:3
B.malayi only
• B.malayi only
B.malayi only
145
(b) Talpe Pattura (C) Wellaboda Pattu (d) Bentota Walallawiti Korale (e) Hinidum Pattu
15.5
771
37
4-8
251
36.7
DONE
5.9
NOT
var
TDOT
.1

INUI
TOUTVILY
(1) ՆդlgaՍՆԱa LavՆԱ B. Matara District :
1253
42
3.4
33
365
9.4
9
B.malayi
W.bancrofti
B.malayi
W.bancrofti
(a) Matara Four Gravets
683
36
5.3
29
68
36.7
OF FILARIASIS IN CELON
(b) Wellaboda Pattu
101
2.9
22
3.9
B.malayi
W.bancrofti
E NOT
DONE
14
4:2
NOT
DONE
17
3.5
469
(06
B.malayi only
134
17:3
NOT
DONE
10
3. ()
(c) Morawak Korale (d) Gangaboda Pattu (e) Weligam Korale
(f) Kandaboda Pattu C. Hambantota District :
(a) Magam Pattu (b) Giruwa Pattu East (e) Giruna Pattu West
1397
154
11:02
446
37:2
193
1:0
B.malayi only
B.malayi only
B.malayi only
17
12.8
23
5.7
78
21:7
405
799
129
16 · 1
B.malayi only
356
18.7
117

Page 132
Serial
118
No.
Place
No. of
persons
.examined
Microfilaraemia
No. Percentage Positive
Positive
Species
Clinical Manifestation
No.
Percentage
Positive
Positive
II. North Western Province
3871
1153
29.8
576
10.1
B.malayi only
B.malayi only
3092
1086
35.1
472
12.1
104
0-0
0-9
A. Kurunegala District:
(a) Weudawili Hatpattu (b) Dambadeni Hatpattu (c) Dewamedi Hatpattu i. Walgampattu Korale
227
0
0-9
1713
722
232
48.8
42.1
DONE
NOT
61
ii. Medagandahayi Korale
NOT
DONE
A REVIEW OF THE PROB.
iii. Baladora Korale
173
77
44-5
iv. Giratalana Korale
884
356
40:3
B.malayi only
B.malayi only
B.malayi only
82
48.8
v. Tissawa Korale
656
289
44.0
66

NOT
DONE
14
NOT
DONE
vi. A ngomu Korale vii. Dewamedi Korale (d) Katugampola Hatpattu
i. Medaketiya Korale ii. Yatikaha Korale South
776
344
44-3
B.malayi only
196
17.8
ΝΟΤ
DONE
EM OP FILÁRIALIS IN CEYLON
NOT
DONE
279
134
48.0
251
96
38 · 2
iii. Yatikaha Korale North iv. Karandapattu Korale v. Kiniyama Korale vi. Yagam Pattu Korale vii. Katugampola Korale
B.malayi only
Bmalayi only
B.malayi only
17.8
246
114
46:3
! co - 3 8 N e en
NOT
DONE
NOT
DONE
viii. Meda Pattu Korale West and East
NOT
DONE
24
13
54.2
4.7
(e) Wanni Hatpattu (f) Hiriyala Hatpattu
B.malayi only
B.malayi only
248
2.8
10
. 10
2.4

Page 133
Serial
No.
Place
No. of
persons
examined
Microfilaraemia
No.
Percentage
Positive
Positive
Species
Clinical Manifestations
No.
Percentage
Positive
Positive
B. Chilaw District :
708
67
9.4
B.malayi only
90
8.2
(a) Pitigal Korale North
577
67
11.6
B.malayi only
20-8
131
* 0-0
3.0
(b) Pitigal Korale South C. Puttalam District :
71
0
0:0
4.3
0 O 7 %
12
0-0
7:2
(a) Demala Hatpattu (b) Puttalam Pattu
(C) Kalpitiya Pattu
43
0:0
6.7
16
0
0:0
1-2
A REVIEW OF THE PROBLEM O
III. Eastern Province
1063
111
10.4
202
9.1
B.malayi only
B.malayi only
A.
428
0-9
36
2-1
Batticaloa District :
(a) Panama Pattu (b) Akkarai Pattu
37
0
0-0
10.2
50
0:0
3
1:6

(c) Nintavur Pattu
35
0
0:0
0.4
N =
(a) Sammanturai Pattu
NOT
DONE
*
0.8
177
0-0
3
1:1
129
3:1
22
6:3
635
F FILARIASIS IN CEYLON
107
166
(e) Manmunai Pattu
(f) Eravur-koralai Pattu B. Trincomalee District :
(a) Koddiyar Pattu IV. North Central Province A. Anuradhapura District
4.5
16.9
16-9
635
107
166
B.malayi only
B.malayi only
B.malayi only
B.malayi only
B.malayi only
B.malayi only
52.9
133
15
11.3
58
5.4
133
15
11:3
58
5.4
(a) Tammankaduwa Palata
87
15
17:2
38
* 48.0
(b) Nuwaragam Palata
46
0:0
2.2
Athanasius
th
NOT
0-8
(c) Hurulu Palata (d) Kalagam Palata
DONE
DONE
ON 9
ΝΟΤ
4.)
6[I

Page 134
120
Serial
No.
Place
No. of
peᎢ ᎦᏣns
examined
Microfilat aemia
NO.
Percentage
Positive
Positive
Species
Clinical Manifestations No.
Percentage
Positive
Positive
V.
Western Province
NOT
65
0.4
VI.
Sa baragamuwa Province
NOT
DONE
DONE
DONE
23
0.4
* VII.
Central Province
ΝΟΤ
10
0:1
VIII.
Northern Province
NOT
DONE
0:1
A REVIEW OF THE PROB
IX.
Uva Province
NOT
DONE
0:0
Summary by Provinces
5922
437
Southern Province
7.4
B.malayi
405
1334
6-3

W.bancrofti 32
II.
3871
1153
29.8
B.malayi 1153
577
I0-1
North Western Province Eastern Province
III.
1063
111
10.4
B.malayi 111
202
9-1
IV.
133
! 15
11:3
B.malayi
| 15
58
6.0
North Central Province
Western Province
V.
NOT
DONE
65
0.4
ELEM OF FILARIASIS IN CEYLON
VI.
Sabaragamuwa Province
ΝΟΤ
DONE
23
0.4
VII.
Central Province
ΝΟΤ
DONE
10
0:1
VIII.
Northern Province
NOT
DONE
4.
0:1
IX.
Uva Province
NOT
DONE
0:0
10989
1710
15.6
2273
4.0

Page 135
A REVIEW OF THE PROBLEM OF F
Appendix iv.
Transmission Label for Adı
1. Station :
8. Time trap operating : from
4. Descriptionof location of trap:
5. Nature of Trap---
Cattle baited
Light
Others
6. Total No. of mosquitoes trapped : 7. Nature of this collection --
Site
All culicines
1. Animals
2. Trap sheet
3. Surrounding Vegetation
Date :.

ILARIASIS IN CEYLON
121
ult Mosquitoes Trapped
2. Date of Collection :
to :
C. fatigans only
All Anophelines
Initials of Entomological Assistant,
Anti-Filariasis Čampaign.

Page 136
IDENTIFICATION AND DISSECTION
122
No. RECEIVED
SITE OF INFECTION
Species
ALIVE
Number
| Total Dissected Infected
DEAD
M F
Head
THORAX
Abdomen
Malpighian
tubules
M | F
Π
I.
III III
C. fatigans
A.
obturbans
A REVIEW OF THE PROBI

Other culicines
A. hyrcanus
A. subpictus
EM OF FILARIASIS IN CEYLON
Other anophelines
Date :...
Initials of Medical Laboratory Technologist.

Page 137
A REVIEW OF THE PROBL
Appendix iii.
Transmission Label for
1. Station : 3. No. of premises examined : 5. Nature of this collection :
Site
Number Examined
1. Dwellings 2. Surroundings
Sheds 3. Surroundings
Vegetation 4. Others (specify) ...
6. Assessment Numbers positive for C. f:
All culicines
7. No. of mosquitoes
collected
8. Resting places of C. fatigans (Dwelling
Site
(a)
1. Roof
Temporary (Cadjar
Permanent (tile, as 2. Walls
(a) Temporary (Cadjar (6) Permanent (stone,
(i) Smooth surface
(ii) Uneven surface 3. Hangings
(a) Clothes
(b) Hangings from ro0 4. Furniture
(a) Table, chairs, &c.
(6) Other articles 5. Surroundings—(a) Cattle/goat sheds
(6) Other sheds (firewe (c) Vegetation
Date :

EM OF FILARIASIS IN CEYLON
123
Adult Mosquitoes Collected
2. Date of collection : 4. Time actually spent on
this collection :
No. Positive
Culicines
C. fatigans only All Anophelines
tigans :
C. fatigans only
All Anophelines
gs and surroundings).
Male
Female
1, iluk, straw, &c.) bestos) 1, iluk, &c.)
brick)
f
pod, &c.)
[P. T. O.
Initials of Entomological Assistant,
Anti- Filariasis Campaign.

Page 138
IDENTIFICATION AND DISSECTION
124
No. RECEIVED
SITE OF INFECTION
Species
ALIVE
DEAD
Number | Total Dissected|Infected He ad
III
THORAX
Abdomen
Malpighian
tubules
M | F
MI F
Ι Ι Π Ι ΠΙ
C. fatigans
A. obturbans
A REVIEW OF THE PROBLEM
Other culicines

A. hyrcanus
A. subpictus
OF FILARIASIS IN CEYLON
Other anophelines
Date :.....
Initials of Medical Laboratory Technologist.

Page 139
A new mi anti-hype
Serpasil-Esidrex
combining
the anti-h and brady
with
the potent anti-hyper
Smoother
Marked po Fewer side Easing of s
Each table 0.15 mg. Se Bottles of :
СІВ
Sole Importers & Distributors for Ceylon :- A. BAUR & CO., LTD. P. O. Box 11, Colombo.

lestone in ertensive therapy
***
ypertensive, tranquillising, cardiac action of Serpasil
- sali-diuretic and
tensive action of Esidrex
control of blood pressure otentiation e effects salt-free diets
t contains erpasil® +10 mg. Esidrex 30, 100, and 500
A

Page 140
A #
THIS FIERI VASSA
a rich source of protein
Each 30 Gm (approximately 1 ounc 42TIKSESSER.
UDR - Adult Minimum Daily Re. quirement
The need for these substances in human nutrition has not been established
Potency established prior to the addition of other ingredients,
An ad GEVRAL PROTEIN, GEVRAL and G
Lysine for appetite stimulation, a. *Registered Trademark
non-inhibitory intrinsic fact **Trademark
exclusive to augment vitamin |
LEDERLE LABORATORIES Cyanamid International A Division
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in. a highly palatable form o
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VITAMIN-MINERAL' PROTEIN SUPPLEMENI
Lederle The elderly (as well as the very young) are particularly prone to suffer from protein deficiency. Others requiring protein supple, mentation are individuals on a restricted diet, food faddists, convalescent, debilitated and post-operative patients.
GEVRAL PROTEIN Lederler provides protein plus all the known vitamins and minerals in a pleasant tasteless powder that may be mixed with liquid or dry foods, hot or cold It has a low salt content, and can be given to patients on low salt diets.
Two other nutritional standouts that complete the famous Lederle "Geriatric Trio": *
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Lederle An established preparation containing 14 vitamins and 11 minerals, in a well-balanced formula. In capsule form.
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Page 141
THE FIGHT AGAINST TUBI
BY
| W. K. H. Chief Public Health Inspector,
T. B. SUBASINGHI Medical Records Officer, T
AND J. R. WILSON, M.D. (Londo Superintendent, Tuberculosis Campaiga
History:
During the first decade of the 20th Century there was much public agitation and clamour for effective steps by the Government to arrest the spread of Tuberculosis in Ceylon. The demand was made not only by the “ Natives " but also by the European residents as Tuberculosis was no respector of races, and it was claiming its annual quota of lives from every section of the community at an increasing rate (Table I). The rate of mortality from Tuberculosis was as high as 44 per 10,000 population in 1909 in the city of Colombo. The corresponding figure at present is only 3·9.
Tuberculous Diseases Commission of
1910:
In response to the demands made by the public, and also encouraged by the generous offers made by the publis spirited citizens like the Hon’able Mr. J. N. Cambell, M.L.C., Mr. A. J. R. de Soysa and Mr. A. E. de Silva, a Tuberculous Diseases Commission was appointed in 1910 by the then Governor, Sir Henry Macallum to inquire into and report on the following:
(1) The extent to which Tuberculous
diseases prevail in the Island, and the alleged increase of such diseases.
(2) The means by which such diseases
are disseminated in Ceylon.
(3) The districts of the Island and the
classes or sections of the population in which such diseases are particularly prevalent.
09 E O

127
ERCULOSIS IN CEYLON
ANDY - Tuberculosis Campaign. E, B.A. (Ceylon) Puberculosis Campaign
n), M.R.C.P. (London). 1, Department of Health, Ceylon.
(4) The most appropriate measures to be
taken --
(i) for treatment and cure of
persons already affected ; (ii) for preventing the dissemina
tion of such diseases. (5) The advisability and practicability of
introducing a system of compulsory notification, and the persons, if any, upon, whom the duty of notifying Tuberculous diseases should be imposed.
(6) The expedience and practicability of
enforcing the segregation of affected persons, and the extent to which, and the means whereby, such segregation should be enforced.
(7) The establishment of sanatoria for
the treatment of such diseases, and the most favourable localities for their establishment, and the scale upon which they should be constructed.
(8) The estimated cost of carrying out
any system of sanatoria, or any other remedial or prophylactic measures which may be recommended.
(9) The extent to which the general
public may be expected to contribute towards the cost of the measures recommended.
The appointment of this Commission is ne First landmark in the history of Tuberulosis in Ceylon. The action of the Governor, no doubt, would have also been nfluenced by similar public agitation and overnmental action against Tuberculosis,

Page 142
128
TABLE 1.
CITY OF COLOMBO
RATE OF DEATH FROM TUBERCULOSIS PER 10,000 POPULATION IN EACH RACE
1899 - 1909
Year
All Races
Europeans
Burghers
Sinhalese
Tamils
Moors
Malays
Others
THE FIGHT AGAIN
1899
25.7
19:5
23.5
29.2
24.8
20-4
29.9
18.2
1900
28.7
19.1
32.3
29.5
25.2
27.2
22 A.

1901
33.5
37.4
36-0
30-7
25.5
26.5
31:0
39.0
1902
31.0
110
27.1
35-0
30.9
26-0
30.4
23.6
1903
341
28.8
28.2
38.3
26.5
34.7
29.8
46.2
1904
37 -6
24.7
41.8
41:9
28.6
36.6
39.6
41:2
ST TUBERCULOSIS IN CEYLON
1905
37.9
242
27.9
43:8
31.0
34.6
49.0
46.4
1906
44.7
23.7
38•7
48.8
44.7
38-0
40·1
53.4
1907
41:8
13.3
29.7
46.0
36.2
40-0
58.9
64.0
1908
40:2
22.8
32.1
45.3
35.0
38.0
44.3
45.6
1909
44.1
28.7
30-7
45.9
44.8
38.8
34-8
44.7

Page 143
THE FIGHT AGAINST TUBER
taking place in other parts of the world, particularly in England, at this time. It was in 1908 that the British Government made regulations, for the first time, compelling poor-law hospital medical officers to notify pulmonary Tuberculosis found among cases under their care. The first dispensary for Tuberculosis was established in England, in 1909, at Paddington, although the world's first Tuberculosis dispensary had been established by Sir Robert Phillip, in Edinburgh, 22 years earlier.
h
H E A
h
The Tuberculous. Diseases Commission took only four months to prepare its report which was submitted to the Government on 6th June, 1910 (Sessional Paper XIX of 1910). The recommendations made by the Commission were so far-reaching and comprehensive that anyone who examines them will feel that if those recommendations were seriously and honestly implemented at that time, the problem of Tuberculosis would not have been with us today. Some of the recommendations made by the Commission
were as follows:
(e)
(f)
(a) Compulsory Notification (6) The segregation of the sick from the
healthy. The establishment of a dispensary for out-door treatment in large centres where the disease is prevalent. The establishment of hospitals, sanatoria, etc. The education of the people in the prevention of phthisis. The establishment of an Anti-Tuberculosis Society, with branches in every important centre. Improved sanitation, improved dwellings and the prevention of of over-crowding. Provision for free examination of
sputum, etc. (i) The prohibition of expectoration in
public places. (3) The inspection of schools and T
children in schools. The inspection of factories. The roads and streets not to be by swept without being first watered.
(h)

CULOSIS IN CEYLON
129
(m) The prohibition of persons obviously
suffering from phthisis from working
in factories and offices. (n) The discontinuance of the use of
coir rugs as spitoons. (o)
The provision of special places in parks where poor people suffering from the disease can receive open air treatment during the day.
It is, however, observed that the implementation of the recommendations was andicapped, initially by the outbreak of he First World War in 1914, and later on y Malaria taking the first place of importnce as a Public Health problem. It is mainly for these reasons, that the fight gainst Tuberculosis has not made much eadway during the 30 year period from 910-1940. Some of the measures taken y the Government to control the spread f the disease during this period were as ollows:
(3)
(1) Pulmonary Tuberculosis was declared
as a notifiable disease in 1910 (not
compulsory). (2) Spitting in public places and public
conveyances was made a punishable offence in 1910. An Ordinance to amend the law relating to the housing of the people and to provide for the improvement
of towns was passed in 1915. (4) The Anti-Tuberculosis Institute was
established in 1916. (5) Ragama Hospital for advanced cases
was opened in 1917. (6) Kandana Sanatorium was opened in
1919. (7) A full time Inspector to deal with
insanitary buildings was appointed in
1925. (8) The Notification of deaths from
Tuberculosis was made compulsory in
1925. (9) A Sanatorium at Kankesanturai was
opened in 1930.
uberculosis Committee of 1943 :
In the early forties, when it was realised y the Government that the control, and ae eradication of malaria was a possibility,

Page 144
130
THE FIGHT AGAINST
the attention was again diverted to Tube culosis. The initiative taken by i Governor, Sir Andrew Caldecotte in whi ping up public support for an effecti drive against T.B., contributed to success in no small measure. One han cap that was noted was the shortage qualified personnel to undertake this wo and therefore, a batch of Medical Office was sent abroad for training in Tubero losis in 1942. A Tuberculosis Committ
· was appointed by the Minister of Health 1943 to report on the measures that shou be adopted for the control of T.B. Ceylon, and to submit detailed recomme dations regarding the formation of a Tube culosis Association. This Committee whi had the opportunity of consulting ev eminent Tuberculosis Officers like Dr. P.
Benjamin, the present Advisor on Tube culosis to the Government of India, su
mitted its report to the Government on 7 October, 1944. (S.P. III of 1945). A outcome of the recommendations made ! this Committee was the appointment of Superintendent to organize the conti
measures on the basis of a Campaign. rapid development of the Anti-Tubero losis Movement is seen from then onwar
Anti-Tuberculosis Campaign :
With the control of malaria, Tubero losis became the most serious medical a socio-economic problem in the country a therefore, in 1949, the Government to over the full responsibility and all expe diture, for the control of T.B. in the Islar The Ceylon National Association for t Prevention of Tuberculosis was also form in the same yesr. The Government bei aware of its heavy responsibility soug advice and assistance from all possil quarters including International Agenci
With the assistance of the Joint Enterpri and later on, of the WHO and t UNICEF, a BCG Campaign was organiz in 1949. Even locally there was genero public support forthcoming for an intensi drive against T.B. The Mayor of Ga donated Rs. 100,000 for the construction a T.B. Clinic at Galle, while the CNA) undertook the construction of a childre ward at Welisara Chest Hospital. T

TUBERCULOSIS IN CEYLON
er- Ceylon Turf Club gifted to the CNAPT the he entire proceeds of one of its Race Meets.
.
of
rk
erS
-ee
ve
Another important landmark in the its history of the T.B. Campaign was the li- report on the “ Thoracic Services of Ceylon
with special reference to Pulmonary T.B.” submitted by Dr. Donald Barlow who made
a survey of the Tuberculosis situation in -- Ceylon in 1952 at the invitation of the
Government. As a result of this report it in
was possible for the Government to solicit further support at International level. At
the request of the Government, an Advisor en
on Tuberculosis, Dr. R. T. Neubauer was er
assigned to Ceylon by the WHO for two
years from 1954. The gifts offered by the en
Australian Government under the Colombo
Plan for Anti-Tuberculosis activities in er
Ceylon exceeded Rs. 5,000,000. Seven out b- of the nine Provincial Chest Clinics were th built and equipped entirely with this
money.
ld in
ch
V.
J
A
cu
Is.
U
a
A sudden increase in the number of rol notifications received by the Medical
Officers of Health was noticed in 1953. The increase was by more than 100%; from 2,146 in 1952 to 4,610 in 1953. As only 1,962 beds were available to accommodate the T.B. patients at that time, it was felt that a special type of officer would be required to supervise the large number of patients who would be under ambulatory or domicilliary treatment. Hence a decision was taken to set up a Health Visitors Service and the first batch of Health Visitors were trained in 1954. A few years later, when more and more beds were available for T.B. patients, and when it was noticed that T.B. patients were scattered all over the Island and not concentrated in particular areas, arrangements were made for the range Public Health Inspector himself to supervise the T.B. cases in his area, and the Health Visitors Service was abolished.
se,
d
US
ve
Neubauer-Wilson Report on Reorgale
nisation of T.B. Control in Ceylon of
In the year 1954, the Tuberculosis control
programme received new impetus and the ne activities of the Campaign increased by

Page 145
THE FIGHT AGAINST TUBEI
SE
ini
leaps and bounds thereafter. The AntiT.B. Campaign became a Decentralized in Unit of the Department in 1955. This new arrangement was responsible for the rapid expansion of the Campaign at that time as it enabled the Superintendent to take quick decisions and actions on his own authority and responsibility. The then Minister of Health, Mr. E. A. Nugawela was so enthusiastic and keen on expanding
th the service that he did everything possible to place the Anti-T.B. Campaign on a sound footing. It can be said that the “Report on Reorganization of T.B. Control in Ceylon " submitted by Dr. R. T. Neubauer and Dr. J. R. Wilson was the in foundation on which the Campaign was
di: built up since 1954. Steps were taken to
vo extend the T.B. control work, which were
th hitherto confined to Colombo and its suburbs, to the Provinces, by opening up Chest Clinics in all the Provincial Capitals. The establishment at Welisara of a school for the training of T.B. nurses, with assistance from Australia and Canada, was one of the most far-sighted projects that were ever undertaken. As a result of this venture
with so much talk about shortage of nurses in General Hospitals no such shortage is experienced in any of the Chest Hospitals.
The diagnostic facilities were improved sp by purchasing a large number of new X-ray and Screening Plants. While the facilities for laboratory examinations were provided in all the Chest Hospitals, a Central Tuberculosis Laboratory with modern equipment and trained personnel was established at
Welisara to undertake any type of pathological and bacteriological tests for the Campaign. A Pulmonary and X-ray Function Block was also established at
Welisara at a cost of Rs. 500,000.
The training programme of the Campaign had two aspects. The first aspect was a short term programme to get as many officers as possible trained in the basic treatment of Tuberculosis, with the least possible delay. The second was a long-term programme to get the officers qualified in the treatment of chest diseases, and the other ancilliary services like Radiography, Bacteriology, Pathology, Aneasthesiology and Thoracic Surgery.
po
ye
PE
*Sin:2
on
10

CULOSIS IN CEYLON
131
With the help of this well planned traing programme it has now become possible r the Campaign to man all sections of its ork with its own officers. The X-ray epartment is run by a Radiologist and e Central Laboratory is under the charge
a Pathologist assisted by a Bacterioyist. Medical Officers qualified in T.B. e in charge of all Chest Institutions and e total number of Medical Officers who ve obtained post graduate qualifications T.B. exceeds thirty (i.e.) more than half e Campaign's cadre of Doctors.
A Rehabilitation Centre was established 1957 at Talagolla to train patients whose sease has been arrested, in some suitable cations, to enable them to supplement eir income when they get back to their
mes. In 1953, the Government voted 5. 3,000,000 to give financial assistance
T.B. patients who need such assistance. ne amount set apart for this purpose creased from year to year and now it is arly rupees ten million. About 16,000 -tients are given financial assistance every ar, and from the inception of this Scheme
• to the end of the financial year 1960/61, pre than rupees fifty million have been ent on this account.
The extension of the diagnostic facilities the provinces helped in the discovery of large number of cases which were hitherto known. Through an intensive proamme of health education and propanda it was possible to remove the stigma tached to this disease from the minds of e people, to a large extent. It was made sy for the people to meet the T.B. ecialist, closer to their homes, by mobiing the services of the Specialist through net Work of Branch Clinics conducted ce or twice in the week. .
Opinion is divided as to the advisability
conducting Branch Clinics in Hospitals iere diagnostic facilities are not available. cperience has shown that the success of a anch Clinic depends entirely on the ctor who conducts it. In underdeveped countries like Ceylon where the ancial resources do not permit the

Page 146
132
THE FIGHT AGAINST
establishment of more than a few Cho Clinics, with the facilities for diagnosis, is only through the Branch Clinics that t service could be taken to the people. is also interesting to note that in all t reports written on the control of T.B. Ceylon, the establishment of Branch Clini has been recommended.
B.C.G. Campaign-Three Year Plan : : The B.C.G. Campaign which was I organized and intensified in May, 195 reached its target of tuberculin testing,
million of the population, by the end 1958. In 1959 the B.C.G. Campaign w also brought under the direct control of tl Superintendent, T.B. Campaign. The wo
was decentralized and the Campaign w. reorganized on a planned basis. A pla was prepared to cover all the schools in tl Island within a period of three years fro October, 1959.
Inspite of the fact that the progress the B.C.G. Campaign under the Three Yes Plan was handicapped due to reaso1 beyond its control the indications are the the Campaign will achieve its objective b the end of September, 1962. Up to th end of 1961, a total of 987,603 scho children had been mantoux tested unde this plan and 587,357 of them had bee given the B.C.G. Vaccination. More tha half the population have been given th mantoux test from the inception of th B.C.G. Campaign in 1949, and the numbe of persons who were B.C.G. Vaccinated nearly one quarter of the population.
Central Tuberculosis Register :
The organization of a Central Tuberci losis Register in 1958 was another lan
mark in the Anti-Tuberculosis Campaign i Ceylon. This Register functions as tł nucleus of a records and statistics un which supplies all the information relatin to Tuberculosis for administrative an planning purposes. In order to make tł notifications pass through the Central T.I Register and also to ensure that ever notified case is investigated, the Regul: tions made under the Quarantine and Pre vention of Diseases Ordinance were amer

- TUBERCULOSIS IN CEYLON
ics
S
est ded in 1959, to make the Superintendent,
it T.B. Campaign, the " Proper Authority he for the purpose of notifying Tuberculosis, he It for the whole Island. he
A uniform recording and reporting system has been introduced in all the Chest Institutions. Statistics relating to all aspects of work done in these institutions are collected quarterly and tabulated. The Central Tuberculosis Register is kept up to date by removing the cases who have died, on information received from the Registrar General. In order to ensure that accurate
and reliable statistics are supplied by the as
institutions, the officers who are dealing ne
with this subject in Clinics and Hospitals
are given training courses periodically. as
The development of the Anti-T.B. Campaign at such a rapid speed was possible mainly because of the assistance received from International Agencies and countries like Australia, Canada, Japan and U.K. These Agencies and countries offered assistance generously, on many occasions, to expand the activities of the T.B. Campaign. It could be stated with all sincerity that but for this help the Campaign could not have achieved its present status.
B
an
m
of
1S
Pr
En
EPIDEMIOLOGY
Is
There had been no definite information ne regarding the extent of Tuberculosis in
Ceylon until a random sample survey was carried out by the WHO in 1956. The information available till then was limited to the number of cases treated at Chest Clinics and Hospitals and therefore, was inconclusive, as it was possible for a patient to appear in more than one clinic register or none at all. The system of notification
too was so unreliable that it was impossible ae to gauge the extent of the Tuberculosis proit blem by either the number of notifications
received by the Medical Officers of Health d or the number of investigations done.
N
3. The Government had estimated the y number of cases in Ceylon to be about
50,000 but the estimate of Dr. Donald
Barlow was as much as 200,000. The 1
authorities of the T.B. Campaign, however,
a

Page 147
THE FIGHT AGAINST TUBEF
had arrived at a prevalence rate of 1% for ar the adult male working population in T
Colombo on the basis of some Mass Mini
aj ature Radiography examinations carried H out in 1952. In the belief that the prevalence of T.B. in Colombo was higher than in any other place in the country, this rate was considered to be the highest that could be expected in the land on a geographical va basis.
sh
th
ar
National T.B. Survey of 1956 :
S/
th
One of the main objectives of the National T.B. Survey of 1956 was to estimate the number of Pulmonary Tuberculosis cases in Ceylon. The Survey was limited to the population above the 10 years of age. The report of the Survey Team was made available to the Government in 1957. According to the findings of the Survey, the estimated number of Pulmonary Tuberculosis cases in Ceylon was 62,800 with unhealed pathology and to 34,700 with healed disease. Of the 62,800 unhealed cases 36,400 or 58 per cent were
males. (Table 2). The prevalence rate in T respect of unhealed pathology was found to m vary with age but this variation was not
се statistically significant. The rate appeared to be at a minimum between the ages 15 to 31 years, but as much as 35% of all unhealed cases were estimated to be above the age of 45 years. No significant difference was noted in the trends for males and lis females but the rate of prevalence was co high among the elderly females.
no
re
W
as
þe
nl
As regards the geographical distribution, re the over-whelming importance of the rural th sector was brought out by the Survey. It
was reported that of the 62,800 unhealed cases 51,300 or 81.7 per cent were from the rural areas. The total number of cases in of the urban sector was reported to be 4,700. The Survey finding was that in Ceylon the prevalence of Tuberculosis “was high among older persons, particularly females and specially in the rural areas ”.
ye The relationship between Tuberculosis and occupations was studied in the Pilot Survey which preceded the Sample Survey. It was revealed that the incidence was high th

:CULOSIS IN CEYLON
133
nong farmers and agricultural workers. he rate of incidence among students ppeared to be lower than the average rate. ousehold workers, mainly women, also 1owed a slightly higher rate of incidence aan the general population.
The Survey estimate of the rate of prealence was 1% for unhealed pathology nd 055% for healed pathology for the opulation above 10 years of age.
Iorbidity :
There are two ways of assessing the uberculosis morbidity in a country, viz., rough sample Surveys and through comalsory notifications. If it is done proerly the first method may be called the ore efficient. The efficiency of the second ethod depends on the knowledge and till of the medical officers who diagnose se cases and their sense of responsibility - notify all diagnosed cases.
With the organization of the Central uberculosis Register it became possible to Lake the notifications pass through a entral body and keep an accurate record e all the notified cases. It was also posble to minimise the number of duplicate otifications. An analysis of the cases gistered in the Central T.B. Register ould thus be able to throw some more ght on the problem of Tuberculosis in this
untry.
During the year 1959, 8,161 cases were gistered in the Central Register. Of zem, 5,396 or 66% were males. As much : 43.8 per cent of the cases were found to e in the age group 25-44 years. The umber of cases who were under 15 years Page were only 347 or 4.2 per cent. It as observed that there were more female atients than male patients in the lower ge groups but in the higher age groups the
verse was the case. For example, only 3 per cent of the males were below 25 ears of age whereas 21 per cent of the
males were below that age. On the other and when 45 per cent of the males are Dove 45 years of age only 31 per cent of
e females are above that age.

Page 148
Age Group
Population
Number Examined
TOTAL
T. B. Cases
Rate per
1000 Examined
Estimated Number of
Cases
Rate per
1000 Population
Population
Number Examined
ESTIMATED NUMBER OF CASES WITH UNHEALED PATHOLOGY
NATIONAL TUBERCULOSIS SURVEY -- 1956
TABLE 2.
T.B. Cases
Rate per
1000 Examined
MALES
Estimated Number of
Cases
Rate per
1000 Population
Population
Number Examined
T.B. Cases
Rate per
1000 Examined
FEMALES
Estimated Number of Cases Rate per
1000 Population
L LSNIVOV LHDII IHL
FET

10 -
14 ...
1049700
2675
25
9:34
9200
8:76554500
1932
15
10:78
5700 |
10:28
495100
1283
7:80
3500
7.07
1519600
3916
21
5:36
8300
5:46
70800
1986
13
6:55
5500
7:14
748800
1930
8
4:15
2800
3.74
གྱི > ། ། ་ | | |
1325000
3361
. 。 ་ མ བྱ
7• 44
9400
7:00
677900
1742
6:32
3900
5:75
647200
1619
14
8,65
5500
8, 50
UBERCULOSIS İN CEYLON
2656
33
12:05
11900
11:50
567100
1462
19
13:00
7200
12.0
467800
1194
13
10:90
4700
10:05
- 44 ...
1034900
45 - 64 ... 1118500
65 & Over | 2020200
2837
46
16:22
17800
15:92
638500
1601
29
18:11
10900
17.23
480000
1236
17
13:75
6900
14:38
28:01
666
16
24:02
6200
28:83
153100
389
23:32
3200 10:90
107100
277
25.27
3000
Not
known
114
8.77
58
56
17 : 86
Total
...།
| 6307900 16225 [166 { 10:23, 62800 9:96 3361900[ 8630 | 96 11:12, 36400, 10:862946000 | 7595, 70
9:22 ]26400 | 8:96

Page 149
Fig.1
CENTRAL TUBERCULOSIS REGISTER PERCENTAGE DISTRIBUTION OF CASES REGISTERED
IN 1959, 1960 & 1961.
NNN
* A * * *
THE FIGHT AGAINST TUBER
TA 65

PER CEN
un 6 u
a lul
CULOSIS IN CEYLON
0-A
5-124
15-24
45-64
65 & OVER
25-44
AGE GROUPS
135

Page 150
136
THE FIGHT AGAINST
This same pattern was again brought o in the registrations of 1960 and 1961. ! 1961, 8,411 cases were registered in t! Central Register and of them 3,565 or 42 per cent were in the age group 25-44 yeai A high rate of incidence among you females than males is spot-lighted { having 31.4 per cent of the female patien below 25 years of age as against only 17 per cent of males in that age group. noticeable increase in the number of cas under 15 years of age is seen in 1961 (Fi I). It is not possible to adduce any reasol for this increase without a thorough invest gation but it may be due to the T.B. contr work done in schools during 1960 and 19t under the B.C.G. Campaign-3 Year Pla: The B.C.G. Teams had been issued wit specific instructions to refer any hig reactors to tuberculin among students the Chest Clinic for further investigation.
As regards the geographical distributio of cases a large majority of the cases foun are residents of the Western Provinc For example, 45 per cent of the cas registered in 1961 are from Western Pr vince as against only 2 per cent from eac of the North Central and Uva Province The low rate of detection in the Uva Pr vince could be easily explained as due i lack of facilities for detection in the are rather than due to any lack of disease.
An examination of the detections mac at Chest Clinics during 1961 shows that the males who call at these clinics 4:3 p cent are ultimately diagnosed as Tuberc losis as against 3.2 per cent of the female The rate of detection is lowest in the as group 5-14 years. There is hardly an difference between the sexes in the ag group 0-4 but in the age group 5-14 an 15-24 the rate of detection of patien among females is noticeably higher tha among males. (Table 3).
According to the Case Registers mai tained at Chest Institutions about 40,00 T.B. Cases have been taking treatmer during 1961. The number of T.B. patien treated in hospitals is nearly 10,000 p year.

TUBERCULOSIS IN CEYLON
at Mortality:
n
The Tuberculosis Death Rate lost its 4 importance as an indicator- of prevalence
with the introduction of anti-biotics in the
Treatment of Tuberculosis. In the olden y days when the treatment for Tuberculosis ts was limited to “ fresh air and good food"
it was calculated that there would be 10 A. T.B. patients for every T.B. death. But es
now the number of T.B. Deaths per year
has decreased to such an extent that it has as only an academic value. The rate of death i- from Pulmonary Tuberculosis decreased by
more than 75% from 1947 to 1960. (Table 4).
7
2.
According to the figures for 1956, Ceylon -h shows the lowest death rate for T.B. in
Asia (Except for Jews in Israel). It is even lower than in many countries in Europe, viz., Germany, Austria, Belgium, France, Portugal and even Switzerland.
Of the 1,898 T.B. Deaths that occured in 1958, 1,094 were males and 804 were females. Showing the same pattern as in morbidity, more deaths of females than males have occured in the lower age groups, particularly in the age group 15-34 years, whereas the male deaths have far outnumbered the female deaths in the higher age groups specially from 50 years onwards.
D
jo
The percentage of T.B. deaths to total deaths has decreased by more than 33% from 1952 to 1958. The age specific rate of T.B. Deaths increases from the lower ages to the higher ages but in the case of females the rise is very rapid at the beginning. (Fig. II A & B).
e
Tuberculosis Infection :
|-
The rate of Tuberculosis infection, discovered through mass tuberculin testing, could be a valuable indicator to the prevalence of disease if the tuberculin indurations observed are “ natural” reactions.
In Ceylon, as a B.C.G. Campaign was in t operation from 1949, a large number of S
people have been vaccinated with B.C.G. and therefore, the number of positive reactors in any group of people does not
0

Page 151
TABLE 3.
EXAMINATIONS AND DETECTIONS AT CHEST CLINICS — 1961.
TOTAL
MALES
FEMALES
First
Visits
Examined
Age Group
Rate per
Pulmonar Y
T.B.
Diagnosed
Rate per
1000
Examined
First
Visits
Examined
Pulmonary
T.B.
Diagnosed
Rate per
1000.
Examined
First
Visits
Examined
Pulmonary
T.B.
Diagnosed
1000
THE FIGHT AGAINST TUBER
Examined
8961
130
14.51
4713
CO
14: 64
4248
61
14:36
0 — 4
5 -- 14
20931
202
13:95
10977
136
12.39
9954
156
15. 67

37691
851
22.58
22013
456
20 72
15078
395
**
2519
| |
61183
2770
45:27
36119
1738
48 · 12
25064
1032
41:18
45
-- 64
30908
1879
60-80
18039
1358
75.28
12869
521
40.48
CULOSIS IN CEYLON
65 & Over
7320
468
63:93
4363
365
83. 66
2957
103
34.83
TOTAL
166694
6390
38 - 27
96224
4122
42 · 84
70770
2268
32.05
SPECIBEN
137

Page 152
1948
1947
Year
7109
6903
Population (Thousands)
2316
2106
No. of T.B. Noti
fications received by the “Proper
Authority"
10014
7814
T. B. of Resp : System
No. Treated in Hospts.
10928
8682
T. B. of All Forms
0-33
0-31
Rate of Notifications per 1000 Population
1-41
1-13
T. B. of Resp : System
per 1000 Population No. Treated in Hosp.
TUBERCULOSIS MORBIDITY AND MORTALITY -- 1947 to 1960
TABLE 4.
All T.B.
1-54
1-26
3771
T. B. of Resp :
3510
wəpsis
4073
3842
All T. B.
Number of Deaths
2111
1955
No. Died in Hospitals
52-1
49-9
T.B. of Resp : System
100,000 Population.
Death rate per
56-2
54-6
All T. B.
THE FIGHT AGAINST
138

10646
949
11960
7321
0-24
785
1-46
1-63
2000
386%
519
4136
bj=5
11513
2817
1950
12900
7544
0-31
1-53
1-71
1737
3694
48-1
56-7
4350
13797
སྔ742
1908
15598
1951
0-25
1-78
2-02
45-6
9589
3881
49-3
1809
13025
2146
1952
7940
14812
0- 27
1-64
1-87
1572
3046
2808
348
37-7
TUBERCULOSIS IN CEYLON
1953
8155
12378
4610
13562
0-57
1-52
1-66
2202
26-6
2410
29-1
126]
10416
8385
1954
3986
11427
0-48
1-24
1-36
1976
20-7
1761
1098
23-2
དེ ན རྫ བྱ
416
10897
1955
12120
8589
0-48
1-27
1-41
1667
980
1874
21
19-1
5211
8929
11119
1956
12352
0-57
1-26
1-38
1372
1698
15-4
19-0
943
1957
4836
11740
12992
9165
0-59
1-28
1-42
1654
20-5
875
1880
18-0
12546
1958
8705
9388
13601
0-93
1-34
1-45
19-2
931
1709
1899
20-2
8321
11197
1959
12314
9651
0-86
1-16
1-28
891
1566
1841
16-3
19-1
11701
10395
10076
12784
1960
1-03
1-16
1-27
833
1619
1234
12-5
16-4

Page 153
DE ATH RATE PER 1000 POPULATION
- v w p in a w OD 0
2.0
2.5
0-4
5-9
10-14
15 - 19
20-24
25-29
& S A 18
AGE GR
Fig. II A
THE FIGHT AGAINST TUBEE
BY AGE AN TUBERCULOSIS
O SORTER
30-34
GEO4

it-08
PUPS
ALES EMALES
OD 45-49
50-54
D SEX - 1952. B DEATH RATES
RCULOSIS IN CEYLON
55-59
60-64
65-69
70-74
6L-G2'
808
OVER
139

Page 154
140
RATE OF DEATH PER 1000 POPULATION
mas N ON COA O
2.0
2.5
0-4
5-9
10-14
15-19
BY AGE A TUBERCULOS
THE FIGHT AGAINST
20-24
25-29

TUBERCULOSIS IN CEYLON
SIS DEATH RATES
ND SEX * 1953.
. MALES De FEMALES
A PO
35-39
40-44
5- 49
50-54
6G-SS
60-64
69-99
70-74
GLN
80 %
WE
GE GROUPS
Fig. II B

Page 155
THE FIGHT AGAINST TUBER
BCG CUPA 3 YEAR PL
al THE PERCENTAGE OF
BY AGE GROUPS
SI JNINOS
BEDANEGA
10% 20% 30% 40% so%
PERCEN:

CULOSIS IN CEYLON
141
Fig.111
UGN /
N
NEGATIVE REACTORS AND SHOVINCES
Oo-6 yes. N7-14 yks
Is roVER
60%. 75%% 0% toeg FAGE.

Page 156
142
THE FIGHT AGAINS
give any indication as to the rate o “ natural infection " in that group Another difficulty in assessing the rate o prevalence through tuberculin testing i Ceylon is the presence of non-specifi tuberculin sensitivity as in other tropica countries.
When a B.C.G. Assessment Survey wa carried out by a WHO Team in 1959, ai attempt was made to find out the rate o natural tuberculin sensitivity in Ceylon b selecting a few groups without B.C.G Vaccinated persons. This study shower that 3 per cent of the children in the ag group 0-4 had a reaction of more thai 10 mm. The number of positive reactor in the age group 5-9 was 10•5 per cent an in the age group 15-19 as much as 51: per cent. An analysis of the figure obtained from schools under the B.C.G Three Year Plan shows that in the ag group under 7 years there were 90 · 4 pe cent showing a reaction of less than 9 mm The number of negative reactors in the ag group 7-14 years was 72•3%. (Fig. III).
ORGANIZATION
The Government has taken the ful responsibility for organizing the Campaigi against Tuberculosis in Ceylon. Even the voluntary organizations like the Ceylor National Association for the Prevention o Tuberculosis and the National Anti-T.B Association (Moratuwa) are given financia assistance by the Government.
The Anti-T.B. Campaign, which is decentralized Unit of the Department, i administered and directed by a Superin tendent who is responsible to the Deputy Director of Medical Services. The annua expenditure of the Campaign is between and 10 million rupees. The total number of officers working in the T.B. Campaign as at the end of the year 1961, was 1,658 of whom 53 were Medical Officers and 284 were nurses. The Campaign has 6 Chesi Hospitals with 2,002 beds and one Rehabi litation Centre with accommodation for 80 patients. In addition to the facilities available in these institutions, there are 1,377 beds in T.B. wards attached to 22

T TUBERCULOSIS IN CEYLON
f General Hospitals, 155 beds in T.B. Wards . at Mental Hospital, Angoda, and 20 beds f in T.B. Wards at Leprosy Hospital, 1 Hendala giving a total bed strength of = 3,634 beds.
The number of chest clinics belonging to the Campaign is 11, and 9 of them are s Provincial Chest Clinics. In addition, there 1 are 44 Branch Clinics conducted in Governf ment Hospitals. Diagnostic facilities are
available in all the chest clinics and some of the Branch Clinics.
The aim of the Anti-T.B. Campaign is 1 the control of Tuberculosis in Ceylon with s eradication as the ultimate goal. With a a view to reach its goal as early as possible
the Campaign does its utmost to prevent s the spread of the disease by finding cases
and treating them. To a person who e examines the control programme of the r Campaign, it would appear that there is a
strong bias towards treatment; this is because we consider treatment as a public health measure. The emphasis on isolation has, however, been relaxed with the advent of the importance of the Anti-T.B. drugs.
In the attainment of the objectives of the 2 Campaign the following activities are
carried out :-
f
(a) Case Finding and Mass Miniature
Radiography. (6) Case Supervision. (C) Contact Examination. (d) B.C.G. Vaccination. (e) Health Education. (f) Financial Assistance. (g) Treatment. (h) Rehabilitation. (i) Records and Statistics.
va
Most of the activities are organized at Provincial level by the Medical Officers in charge of the Provincial Chest Clinics. There are only four M.M.R. Mobile Units available for the Campaign, and they are attached to four Provincial Clinics. Not very many cases are detected by these Units. The rate of detection among the persons X-rayed by the M.M.R. Units is

Page 157
THE FIGHT AGAINST TUBEI
about 1 or 2 per 1,000. Nearly 98 per il cent of the cases diagnosed in any year are detected at chest clinics.
1
The supervision of cases who are under C Ambulatory Treatment is done by the si Public Health Inspector of the area. When n a case is notified for the first time, the Public Health Inspector visits the patient's n residence for a full investigation. He b directs the contacts to the clinic for examination and gives advice on sputum disposal, etc. If the patient is in need of financial assistance, he helps him to get the assist'ance as well. Thereafter, the P.H.I. visits the patient regularly to make sure that the patient is following the medical advice already given at the clinic.
E Q + P
A D
The contacts are examined at the Chest E Clinic at regular intervals. The rate of detection of cases among contacts is about 1 1:4 per cent. An increase in the numbers of contacts examined per year is seen from the time that this work was entrusted to the local Public Health Inspector.
| r
h E
The B.C.G. Campaign is now confined to n the schools under the B.C.G. 3 Year Plan. A B.C.G. Team is attached to each Provincial Chest Clinic to carry out the work in the area. The work done by the B.C.G. Teams is assessed constantly by a B.C.G. Assessment Team attached to the Head Quarters. The B.C.G. Vaccination is given to negative reactors in some Chest Clinics where tuberculin tests are done for diagnostic purposes.
Hon s
op .
The Health Education activities are organized by a trained Health Educator
e attached to the Office of the Superintendent. The education of the school children t on T.B., is generally done by the B.C.G. S. Teams. Exhibitions, lectures, demonstrations, seminars, film shows and in-service training programmes are some of the activities carried out regularly by this section.
- + + +
H -
Even though the Financial Assistance Scheme is administered by the Department of Social Services, it depends entirely on 2 the T.B. Campaign for its proper function
in

RCULOSIS IN CEYLON
143
ng as the assistance is given only to those Fho are medically certified as Tuberculous. The right to issue medical certificates for his purpose is given only to the Medical Officers of the Campaign in order to make ure that these patients report for treatment regularly. There are, of course, some patients who misuse this money but a great majority of the patients have immensely -enefitted by this Scheme, which has even ncouraged persons to come to the clinics or examination hoping that they will be iagnosed as T.B. to be eligible for assistnce.
Once diagnosed as T.B., the patients are ither kept under Hospital Treatment or ambulatory Treatment. The Domiciliary Treatment which was tried out at Colombo, Kandy and Galle did not show any fruitful esults, and therefore, was discontinued in 959. The patients who show a positive putum are hospitalized as a matter of outine, and discharged after sputum conFersion. The average length of stay in Lospital per patient is about three months. Every province is provided with a sufficient Lumber of beds for T.B. patients either in Chest Hospitals or in General Hospitals with T.B. Wards. The children who are uffering from T.B. are treated at Children's Wards at Kandana or Welisara. n addition to the normal Anti-T.B. drugs - wide variety of other drugs are also used n the treatment of the T.B. patients. The cases who have developed some resist-nce to T.B. drugs are being discovered -ut not in large numbers.
The question of the rehabilitation of the X-patients has not been answered so far. The Campaign has done its best to give a raining in a suitable vocation to at least ome of them in its only Rehabilitation Centre at Talagolla. There is a Rehabiliation Officer who is in charge of the raining programmes at this Centre. The raining is given in one or more of the ollowing vocations :-Tailoring, Needlework, Weaving, Carpentry, Stenography, Pypewriting, Poultry Farming and Gardenng. During the five years of its existence, 60 patients have gone through the full ourse of training at this institution. It is

Page 158
144
THE FIGHT AGAINST 1
however, realised that this Scheme is no substitute for the need of a comprehensive programme to rehabilitate and resettle al the T.B. patients once they are cured. I is not possible for the Campaign to undertake such a task in this stage of its develop
ment and under the present employment situation in the country. The Campaign has, on many occasions, appealed to the voluntary organizations to take a greatei interest in the question of rehabilitation o
T.B. patients as the Government is unable to provide any satisfactory solution at the
moment.
The importance of statistics in the field of Tuberculosis control has been realised and therefore, every endeavour is made to see that accurate and up to date records are kept in the chest institutions. The medical records and statistics relating to Tuberculosis are handled by the Records and Statistics Unit which maintains the Central Tuberculosis Register.
EVALUATION
Inspite of the fact that the problem of Tuberculosis in Ceylon is not so grave as ir
many other countries in Asia, Tuberculosis is yet a major public health problem in this country. It has not lost its place of importance for the last 15-20 years. Even though some light has been thrown on the extent of the problem by sample surveys and morbidity studies, no information whatsoever is available on many vita questions. For example, the extent to which the environmental and economic factors influence the spread of Tuberculosis in Ceylon is not known. The position is the same even with other factors, such as nutrition, housing, industrialization and urbanisation, which normally influence the epidemiology of Tuberculosis in under developed countries.
The death rate from T.B. however, keeps on decreasing and it is likely that it wil reach the same level as in more advanced countries in the West in a few years time The T.B. Death Rate per 100,000 population in 1956 in Ceylon was 19 as against

TUBERCULOSIS IN CEYLON
O 15.6 in Scotland, 12 in England, 10.2 in
Norway, 9.6 in Sweden, 8-4 in U.S.A., 7-8 in Canada and 5-1 in Denmark. The Death Rate in Ceylon had a further decrease to 16.4 in 1960.
It should be interesting to know as to why the death rate from T.B. in Ceylon is reaching the Western standards before any other country in Asia. As far as the other conditions in these countries are concerned there is hardly any difference. They are all underdeveloped, and pressed with problems such as housing, employment, nutrition, over-population etc. Yet Ceylon has been able to bring down its death rate from T.B. more rapidly than any of the other countries. This achievement could be attributed to nothing but the efficiency of treatment. In Ceylon, the patients have been treated with a wide variety of T.B. drugs, which are not available in many countries in the East. This procedure is already showing its results as far as deaths are concerned, and if it succeeds in bringing down the rate of incidence in time to come it will prove that T.B. could be controlled in underdeveloped countries, even under adverse conditions, by a well organized system of treatment with effective T.B. drugs. The Campaign spends about rupees three million on drugs every year.
It is also observed that a large majority of the cases who die of Tuberculosis now belong to the older age groups. For example, in 1952 only 47 per cent of the patients who died of T.B. were above 40 years of age but in 1958 the percentage had risen to 60.
There has been an increase in the rate of detection during the recent past. The number of cases registered in the Central Tuberculosis Register has been more than 8,000 per year for the last three years. It may be that all these cases are not entirely new cases as even old cases are registered in the Central Register when notified on transfer from one institution to another. However, it can be said that at least 70-80 per cent of the registrants are new cases detected in the year of registration. This

Page 159
THE FIGHT AGAINST TUBER
w:
does not mean that they have all con- ca tracted the disease during that year, and
рі therefore this rate cannot be taken as the rate of incidence. The rate of detection will continue to be the same or even in
m crease for some time to come as it is likely that more and more cases will be detected with any possible expansion of case finding activities.
3$ 2.
cu
ex
Another redeeming feature in the problem of T.B. in Ceylon is that the number of cases detected with a positive sputum is
w. very small. Most of the cases are detected la fairly early. More than 50 per cent of the cases detected have only pulmonary patho
an logy, on one or both sides, without even
sp suspicion of the presence of any cavities.
w: Among the patients detected at the National T.B. Survey of 1956 there were as much as 75% with pulmonary pathology
G without any cavities. In 141 cases with
th unhealed pathology, sputum was examined at this Survey and 22 of them had positive results giving a rate of 15.6 per cent. The Survey Team concluded that the bacteriological results found here were almost fa similar to those found at the Japanese Survey of 1954.
ar
NE
It is, however interesting to note that
or some information obtained by analysing the cases registered in the Central Tuberculosis Register contradicts the findings of the National T.B. Survey. For example, the Survey revealed that the disease is at a
minimum between the ages 15-34 years. But a large majority of the cases registered in the Central Register appear to be from
th this age group. Another Survey Finding
pr was that the prevalence of T.B. among
in elderly females was higher than among
ас elderly males. This again is contradicted by the Central Register which shows a very high rate of detection among elderly males. Even though the conclusion of the Survey Team was that the disease “ is high among older persons, particularly females and specially in rural areas " the Central Register shows that T.B. in Ceylon is a disease among “ young females and elderly at
males". The prevalence of disease in id rural areas is fairly high, no doubt, but it er.
22 =

CULOSIS IN CEYLON
145
n be questioned whether the difference in revalence in rural and urban sectors is so
de as to estimate the presence of such a rge number of cases among the rural asses.
As far as the activities of the Anti-T.B. ampaign are concerned it can be said that
e facilities are now available for any erson in Ceylon to make sure that he is ee from Tuberculosis by getting himself -rayed at any Government Institution here X-ray facilities are available. Simirly, for any person suffering from Tuberlosis, full range of treatment is available ad they can get admitted to any of the ecialised institutions without having to ait for it. In addition to the diagnostic caminations and treatment done free of narge, financial assistance is given by the overnment to supplement the income of ceir families, during the period when they
e disabled due to Tuberculosis.
It cannot, by any means, be said that the cilities available now are sufficient to ght against this scourge in Ceylon and ring it under control. Improvements are ecessary in every field of activity. Case nding programmes, for example, are poorly ganized due to lack of sufficient number
M.M.R. Units. There are not enough agnostic facilities in many Branch Clinics. he contact examination programme is also andicapped due to the fact that contacts om remote areas find it difficult to visit Le clinic for examination. Enough transort facilities are not available to bring em to the clinics. If these facilities are -ovided or improved, the control of T.B.
Ceylon is not something that cannot be chieved.
Ceylon has only a little over 10,000,000 opulation, it has distinct boundaries, the te of literacy is fairly high and there is no sistence from the people for any type of edical examination. Even the remotest llage is approachable. All these favourele conditions suggest that Ceylon is eally suited to carry out a Tuberculosis adication plan.

Page 160
146
THE FIGHT AGAINST
ACKNOWLEDGEMENTS
Our thanks are due to Mr. V. S. Ratn singham, Statistical Officer, for his assis ance in the preparation of the statistic tables and Mr. K. P. E. Fernando, Typi for his help in arranging and typing tł paper. We are extremely grateful to M
ВІВІІ
ELEMENTS OF VITAL STATISTICs by B. BENJA
REPORT OF THE TUBERCULOSIS DISEASES Com
REPORT OF THE TUBERCULOSIS Committee of
FINAL REPORT of Reorganization of Tuberculo
J. R. WILSON. (WHO Publication SEA/T.
REPORT ON THE NATIONAL TUBERCULOSIS SUI
cation SEA/T.B./8 Part I of 19-7-1957).
ASSIGNMENT REPORT on B.C.G. Assessment in
T.B./23 of 4-12-1959).
ADMINISTRATION REPORTS of the Director of I
ANNUAL EPIDEMIOLOGICAL and VITAL STATIS
A SCHEME FOR PREVENTION AND CONTROL
M. ALMEIDA.
comorro irina al snel

TUBERCULOSIS IN CEYLON
8
W. Clement Fernando, Secretary of the T.B. Campaign for his valuable advice and
assistance in preparing this paper. Mr. st
Fernando has been associated with the
ist
T.B. Campaign from its very inception and
therefore he was able to enlighten us on the Ir. activities of the Campaign from its infancy.
zis
BIOGRAPHY
MINE.
mission of 1910 (Sessional Paper XIX of 1910).
1943 (Sessional Paper III of 1945). psis Control in Ceylon by DR. R. T. NEUBAUER and Dr.
B./2 of 16-2-1956).
RVEY of Ceylon by DR. JAMES DEENY (WHO Publi
a Ceylon by DR. K. L. HITZE (WHO Publication SEA/
Health Services.
TICS, 1956.
OF TUBERCULOSIs in the city of Colombo by DR.

Page 161
Doctors Recomn 'Codis' Both doctors an
Both doctors an value of codein Today, it is Cod
Because, tak solution, togethe cetin in fine sus
Because the less likelihood o and quickly at pain-reliever.
Composition. Phenacet. B.P. 4
FOR DISPENSING ONLY Cortant to be supplied to the hit on pretion or Supplied the Purda Tan salah > under
CODIS IS RECKITT &
Agen

nend
d nurses have long been aware of the Le compounds for the relief of pain. is specifically that they prefer. Why? en in water, Codis provides aspirin in er with codeine phosphate, with phena
pension. pension. aspirin in Codis is soluble, there is far f stomach upset. Easily administered psorbed, Codis is a highly efficient
JWTCDC 5924
CODIS
Each Codis tablet contains : Acid. Acetylsalicyl. B. P. 4 gr.. gr., Codein. Phosph. B.P. o. 125 gr., Calc. Carb. B.P. 1.2 gr..
Acid. Cit. B.P. (exsic.) 0.4 gr ADVERTISED TO THE MEDICAL PROFESSION ONLY 2 COLMAN OF CEYLON LTD., COLOMBO 1. as: E. B. CREASY & COMPANY LIMITED
55/57, Queen St., Colombo 1,

Page 162
more
Uses
gon
This rem has pro balanceepilepsy in still o
. . .
e 0 0 °
new case! PRI
PREME Where fi daily do menstru
se e se
rew ule!
OBESIT Without the weig to retain
e e o . . .
TOXEM
now use!
DIAMOx treatmen of pregn
DIAM
·LEDERLE LABORATORIES DIVISION AMERICAN C
MILLERS LT

Acetazolamide Lederle
narkable and versatile oral diuretic ved its ability to control the body's fluid —in cardiac edema, in glaucoma, in . Now DIAMQx has been approved ther conditions:
• O • • • • • • • • • •
O ® ® @ 0 .
NSTRUAL TENSION uid retention is a problem, a single se beginning 5-10 days before ation markedly alleviates symptoms.
= • • • • • • • • • • • • • • • • @ $ e o o o ® @ ¢ ®
affecting appetite, DIAMOx helps control ht of the obese patient who tends
water.
- % e o • •
• • • • • • • • •
IA and EDEMA of PREGNANCY serves as adjunctive therapy in the at of gross or occult edema in toxemia ancy.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
COX in tablets of 250 mg.
in vials of 500 mg.
-anamid çOMPANY PEARL RIVER, NEW YORK
D., Sole Agents for Ceylon.

Page 163
VENEREAL DISEASES AND TREP
BY
MRS. E. D. C. PEREIRA, L.M.S. (Cey.), M Superintendent Venereal Diseases Can
Ceylon.
I. History of the Diseases :
tic
Se
CO
as:
th
1. Venereal Diseases have been recognized as a major problem in Ceylon for many years past. It is interesting to note that the Government of Ceylon has enactad
we regulations with a view to the control of venereal diseases. The Vagrants' Ordi
an nance No. 4 of 1841, the Contagious Diseases Ordinance No. 17 of 1867 and the Brothels Ordinance No. 5 of 1889 have been passed for this purpose. The Contagious tra Diseases Ordinance required the registration and examination of all prostitutes.
Ve There have been three Lock Hospitals in
or Colombo, Kandy and Galle solely for the treatment of women suffering from venereal infections. A lady doctor has been in Ve charge of the Lock Hospital in Colombo in pa 1896.1. Although these ordinances have been in existence for many years, the data in the medical administrative reports show that the problem of V.D. in Ceylon has been widespread.
Pr
th A fresh impetus to anti-V.D. work in
UI Ceylon was given in May, 1920, with the
wa arrival of the Venereal Disease Commission appointed by Mr. Winston Churchill, the then Secretary of State for Colonies.
Of The Commission ac established the
Co “ National Council for Combating Venereal Diseases ?” affiliated to its counterpart in Britain. oil
vit
reg
all
W
co]
The Council recommended that venereal disease control be taken on the following lines :
ad Ge Ce of thi res
1. Establish venereal disease treat.
ment facilities for all people.
PH
2. Enlighten the public by a wide
spread educational campaign.
3. Enforce compulsory notification.

ONEMATOSES IN CEYLON
149
.P.H. (JOHN HOPKINS UNIVERSITY). npaign, Department of Health,
In agreement with these recommendains the Government established the
lowing:
1. In 1921 free venereal disease clinics :re organized at the Port of Colombo for amen, at the Branch Hospital for women d children, and at the General Hospital, lombo for men.
2. In 1938 a medical officer was specially sined in the Clinical and Serological work sociated with Venereal Diseases. A nereal Disease Control Programme was ganized and venereal disease clinics were tablished in all hospitals and dispensaries roughout Ceylon. During this year the nereal Disease Ordinance No. 27 was ssed by the Government whereby only gistered medical practitioners were owed to treat venereal diseases.
In 1939 the Venereal Disease Control ogramme for Ceylon was placed under e control of a well qualified surgeon. ander his able guidance V.D. control work es intensified by the Department.
At the request of the Government of ylon to the South East Asia Regional fice of the World Health Organisation, a nsultant was made available by the
H.O. to the Government of Ceylon to aluate the venereal disease control acti. cies and recommend such revisions in the atrol procedures as might be deemed visable. In November, 1949, Professor orge Leiby, V.D. Consultant visited ylon. He recommended the expansion the venereal disease control facilities in ree phases, within the limit of available
ources :
nase I.
(a) A V.D. control team to be sent by
W.H.O. to amplify the V.D. control section in the Department.

Page 164
150 1500
VENEREAL DISEASES A
(6) To develop a pre-natal syph
control and congenital syphilis co trol programme.
(C) To create facilities to treat patiei
with infectious syphilis.
(d) To establish a treatment cont
group.
Phase II.
Enlarge the scope of the control p gramme of phase I with emphasis on :-
(a) Contact Investigation of the co
tacts of infectious syphilis. (6) Health Education with the follo
ing objectives :-
1.
Education of responsible citize in V.D. control and seek the operation of public organizations
Education of the afflicted pati regarding his disease, treatme follow-up and epidemiology.
3. Professional education. Der
Phase III.
General expansion of the V.D. Cont Programme so as to ultimately embrace aspects of the medical management of the venereal diseases.
In July, 1951, a V.D. Control Team w sent by the W.H.O.
* 2. The chief objectives of the W.H. V.D. Project for Ceylon were :-
(i) To establish a Model Venereal D
eases Clinic in Colombo which wo serve as :--
(a) The chief clinic of Ceylon.
(6) The training centre for me
cal and para-medical staff.
(ii) To develop a full venereal diseg * service with trained staff in t
major outstations.

ND TREPONEMATOSES ÎN CEYLON
Gilis
on
(iii) To establish the Serological Testing
for expectant mothers as a routine, and thus to control congenital syphilis.
ats
(iv) To train local staff in a simple sero
logical testing so as to provide such facilities in the main outstations.
rol
(V) To develop the diagnosis and treatol ment facilities for seafarers in the der Port of Colombo.
ro
on
All the objectives of the W.H.O. V.D. project were achieved by the Anti-V.D. Campaign within a short period of five years after the W.H.O. V.D. team was withdrawn at the end of 1953 when it was considered that the National Staff were fully able to continue the V.D. project in Ceylon without the presence of the International Team.
-W-
ens 20
ent
nt,
LAt the request of the Government of Ceylon W.H.O. sent a short-term consultant in November, 1958, to assess the progress of the Anti-V.D. Campaign. The Assessment Report concluded that "the A.V.D. Campaign has made solid progress and that initial improvement stimulated by the W.H.O. team during 1951-1953 has been extended by national staff during the past five years. While progress towards the chief objective varies, a good start has been made in all five and some have already been achieved."
rol
all
all
vas
In January, 1960, training of medical and para-medical personnel commenced to upgrade the treatment facilities afforded to V.D. patients at institutions where fulltime V.D. clinics do not function. This training is still being continued as the officers are transferred frequently from their stations.
is.
ald
O II. Organization and Control Pro
gramme :
di
The Anti-V.D. Campaign was inaugurated in April, 1952, with the appointment of the Superintendent in charge of the Campaign under the Administrative Control of the Director of Health Services through his deputies. In addition to the
ase
che

Page 165
VENEREAL DISEASES AND TREPC
V.D. control programme the Superintendent is in charge of the eradication of Yaws act (Parangi) from the endemic areas within a reasonable period of time.
cal
Пnc
W
na
The present organisation consists of:-
est
ful (i) Central V.D. Clinic, Colombo which
also serves as the Headquarters of the Campaign and training centre for lis
medical and para-medical staff.
of
po (ii) Nine full time Central V.D. Clinics
an staffed by trained full time personnel
blo vii ., Kandy (Katugastota), Jaffna,
me Galle, Kurunegala, Badulla, Anu
cor radhapura, Negombo, Ratnapura and
Horana.
III
des
we
bu
(iii) Six peripheral clinics which are con
ducted at institutions 15-20 miles from each central clinic. These clinics are conducted by the staff at each central V.D. clinic – two
sessions a week either A.M. or P.M. (iv) Part-time V.D. clinics conducted by
trained medical and para-medical personnel.
Th
Co va. gat
pai
(TE
inf реа th rap rer
196
The activities of the campaign are centred round chiefly in the search of early infections and bringing them to treatment early. This is being achieved by the services available at the full time V.D. clinics. Diagnosis, treatment, investigation and follow-up of " contacts and defaulters” and education of the V.D. patient in the community are the other main activities carried out at a V.D. clinic.
no
col
dai
pro
haj
196 ove
Every new case diagnosed for V.D. at full-time V.D. clinics is interviewed by the Public Health Inspector attached to the respective clinic and relevant information obtained about his contacts. Every effort is then made with the assistance of the patient to trace and bring to treatment these contacts.
no1 the car str ser
the
pei dei
sy!
Routine blood testing of various groups of population continues to be undertaken by the Campaign.
bu It alo

ONEMATOSES IN CEYLON
151
Prevention of congenital syphilis is being nieved by protecting the pregnant others. Routine ante-natal blood test is cried out at ante-natal clinics in Colombo omen's Hospitals and Municipal antetal clinics. This procedure has been cablished at all provincial hospitals where l-time V.D. clinics are conducted.
Ultimate elimination of congenital syphi
will naturally depend on the prevention acquired infection of the child bearing pulation and the availability of good te-natal care. Therefore, ante-natal pod testing and expansion and improveent of the V.D. control programme are
mplementary.
I. Prevalence and Epidemiology:
It is not possible to give the exact incince of V.D. in Ceylon. The diseases re made notifiable in Colombo in 1954, t so far no cases have yet been notified. Ley are still not notifiable outside lombo. However, some idea of the prelence of these diseases here can be thered from the records of attendance of tients at the V.D. clinics over the years. able I). The attendance of cases of Cectious syphilis in Colombo reached a ak of 1526 in 1949. Thereafter, with e introduction of penicillin, the figures pidly declined to 244 in 1954 and then nained approximately at that level up to 30. Unfortunately, this levelling-off does t indicate successful control. On the atrary, one felt that there was a constant nger of the disease occurring in epidemic oportions. This, in fact, is what has ppened -for the unpublished figures for 31 show an increase of almost a 100% er those of 1960. In the case of gorrhoea there has been a steady rise over e years. Part of the rise in gonorrhoea a be accounted for by the appearance of ains of gonococci which have become less asitive to penicillin. The treponeme, on e other hand, remains as susceptible to nicillin as before. The increased incince of gonorrhoea and of infectious philis is being experienced not only by us, t also by many other Western countries.
merely goes to show that potent drugs one cannot control V.D. Other measures

Page 166
152
VENEREAL DISEASES AN
e.g., contact investigation, public educati etc., on a very intensive scale are necess for success.
The outstation figures do not show appreciable change during recent yei One should not assume, on this accou that V.D. is no longer a problem the The probable explanation is that peo in the outstations are more conscious of stigma attached to V.D. than are tł fellow citizens in Colombo. They, the fore seek treatment outside the full-ti
V.D. clinics.
An analysis of new cases at the Colon Clinic according to employment shows highest attendance amongst labourers y form approximately 40% of early syph and 30% of gonorrhoea. (Table II).
As in most other countries, prostitu and casual acquaintances form the ma source of infection. Stringent measu against prostitution are therefore essent for proper control of V.D.
According to our figures there is a grea incidence of both syphilis and gonorrh among males, the sex ratio being appro
mately 6:1 in the case of syphilis and 10 in the case of gonorrhoea in favour of mal The main reasons for this difference are the greater reluctance of females to atte V.D. clinics and, (2) the fact that sympto in the female are generally milder than

D TREPONEMATOSES IN CEYLON
ion, ary
the male, so much so that many are not even aware of their infection.
ere.
Unlike Western countries we do not yet an have a teenage problem. The commonest ars.
age-group involved here is the 20 - 24 ant, group. (Table III). -ple IV. Evaluation : the neir
The unpublished figures of 1961 alerts ere
one to the increasing incidence of infectious eme
venereal diseases in Colombo District and its suburbs. The problem in the out
stations is not revealed by the figures at abo
Government clinics for various reasons.
the who Lilis
Many patients stop treatment as soon as open lesions heal in spite of individual education and advice.
tes
The personnel available for the Anti-jor Venereal Diseases Campaign is strictly
res limited and certainly inadequate.
tial
ter
Until it becomes obvious that the Campaign is effecting a significant reduction in the number of primary, secondary and
early latent syphilis, the reservoir of xi- infection will continue to expand!
pea
0:1
(1)
les.
The co-operation and assistance of an
educated general public together with that end
of the kind and enthusiastic“ V.D. ms
worker" will ultimately achieve the goal in of V.D, control,

Page 167
VENEREAL DISEASES AND TRE
.TABLE N
ANALYSIS OF NEW CASES RE
19.
Classification
29
Syphilis Si-Sero Negative Primary S2-Sero Positive Primary S3-Secondary
167
99
S4-Latent — Early
132
Late
497
32
= & 1
S5-Neurosyphilis S6-Cardiovascular S7-Other Late Syphilis S8-Congenital Early (Under 2 years)
Late (Over 2 years) Parangi (Yaws) Early (with papules) Late
14
3
25
Gonorrhoea
1307
Presumptive Gonorrhoea
325
Non. Gon. Urethritis/Cervicitis/Vaginitis
540
Chancroid
566
14
Lympho Granuloma Venereum Granuloma Inguinale
Other Venereal
132
Non Venereal
2835
Total ... 6822
C – V.D. Clinics, Colombo.
O — Outstation — Full-time a

PONEMATOSES IN CEYLON
153
. I.
GISTERED - 1958 - 1960
1959
1960
02 C o C 0
71 71 1475
75
14
41
93
64
91
92
139
49
71
38
95
69
98
125
94
77
617
567
699
520
678
30 53 15 41 13 30
53
15
41
13
8
17
15
]]
55
28
23
11
24
34 34 103 41 131
103
131
68
18 2
19
13
194
45
170
52
189
1088
1486
1049
1917
1045
263
407
203
470
218
718 679 568 737 478
718
679
568
737
478
366
578
351
489
335
N
65
154
119
151
110
14879
3261 17588 3112 19235
18601 7663 21231 8039 22709
id Branch V.D. Clinics.

Page 168
154
VENEREAL DISEASES AND
TABL
DISTRIBUTION OF CASES BY OCCUPATION -
V. D. C., Port,
Occupations
S1, S2, S3,
Teachers
Clerks
Domestic Servants
Canvassers
Unemployed
Cultivators
Labourers
Students
Peons
Drivers
Mechanics
Traders
| Tor - E -- + T + - w co X E 5 en S - E - F |
Police and Prison Personnel
Seamen
Military Personnel
Tailors
Laundry workers
Carpenters
Businessmen
Food Handlers
Bus Conductors
Masons
Lawyers
Priests
Total
228

TREPONEMATOSES IN CEYLON
F No. II,
- MALE SECTION CENTRAL y. D, CLINI¢ AND Cou0MB0 - 1960
Syphilis
Gonorrhoea
34 Early
Late $Cong$
མ་ཚང་མས་
164
18
12
68
56
106
19
32
155
521
46
35
244
164
177
༑ ༑ ། ༧ ༈ ༑ ལ། -- , , - ། །
229
| | | | | } { | | | | | | | | | ག ་ པ ། ། ༈ །
19
20
ཚ ལ གློ ན ་ མོ ང ཥཱ
24
20
18
28
46
37?
1828

Page 169
TABLE NO. III.
DISTRIBUTION OF CASES BY AGE GROUPS – SYPHILIS, GONORRHOEA, PRESUMPTIVE GONORRHOEA --CENTRAL V. D. CLINIC, COLOMBO
AND V. D. CLINIC, PORT, COLOMBO -- 1960.
VENEREAL DISEASES AND TR
0-2 2-9 10-14 15-19 20-24 25-29 30-34 35-39 40-49 50-59 Over Total yrs. yrs. yrs. yrs. yrs. yrs.
yrs. yrs.
yrs. 60 yrs.
yrs.
Syphilis -- Early
3 11 42 100 89 56 32 267 3 369
18 59
89 132
96
117 — 1 1859 87 89 132 96 117 599
Synhilis Late
599

Syphilis–Congenital
Gonorrhoea
| cu un
114
13 4 5 7 13 37
37 31 13 16
136
4 1 136
3 - 3 2 103
103 572 653 312
127 | 127 114 25 3 1917
1917
3 54
189 110 64
37 354 189 110 64 37 12 1 – 470
470
Presumptive Gonorrhoea
54
12
EPONEMATOSES IN CEYLON
Total
7 11
23
213
916
942
532
301
289
133
124
3491
| wo erit
155

Page 170
Sturdy and Straighton Cow & Gate
All babies love easy-to-digest Cow & Gate—the food that doctors choose for their own children. Surely this is proof that Cow & Gate is the
finest food in the
world to-day. Insist on Cow & Gate for YOUR baby!
FOOTOROAA
LO -disi
Mi fod
S49 3
COWEG
The FOOD of

Misi
FATE MUUS
ROYAL BABIES

Page 171
LEPROSY CONTRO
BY
P. J. DE FONSEKA, L.M.S. (C
Superintendent, Lepi Department of Health,
History of Leprosy:
H
St
A
Leprosy is old as man himself and ranks with Syphilis and Trachoma as one of the oldest diseases known to mankind. The Word “ Leprosy '" as used in ancient times included not only Hansen's Disease but also Psoriasis, Eczema and other skin diseases of a scaly nature. The earliest
M references to Leprosy are found in the , ch Egyptian Papyrus (B.C. 1,500), Vedas of India, Upanishads of Persia, Chinese writings dating to time of Confucius as well as M in the Bible (Leviticus Chapter XIII to
XIV).
The earliest authentic record of the disease in Ceylon dates to the Dutch Period. In the Minutes of the Dutch Council of Colombo dated 10th March, 1685The Chief Physician reported “ several cases in the hospital ”. A house to house inspection was carried out as a preliminary
measure.
Le
ра
In 1692 the Dutch Governor took steps to segregate cases of Leprosy—a building was completed in 1708 and patients were segregated at the Asylum at Hendala. An inscribed monogram giving this year and incorporated in one of the buildings is seen to this day at the Hendala Hospital.
ga
Le
In 1815 Dr. Joseph Sansoni was in charge
ce of the Hendala “ Leper Asylum" as it was. Of then called.
In 1868 the Medical Administration of th the hospital changed from the Military to an the Civil Medical Department.
Dı
Sis In 1874 the Norwegian Scientist Hansen
ра discovered the Mycobacterium leprae—also called “ Hansen's Bacillus after him. This important event is significant in that (E it replaced the then predominant theory of Pe

157
L IN CEYLON
ey.), M.P.H. (Harvard), *osy Campaign,
Colombo, Ceylon.
ereditary transmission of the disease by ne more accepted and hopeful one of fection. This discovery changed the whole ncept of the Epidemiology of the disease.
In 1887 when Rev. Fr. Neut Rector of . Xavier's College Bombay visited the sylum there were 187 patients and Dr. eier was the Superintendent who was in arge for 25 years.
In 1889 the death of Father Damien of -olokai who became a leper for the lepers Fought about an awakening of the coniousness of the people all over the world
the existence of the problem of leprosy. s a result
(1) the Damien Institute in England was
established for the Study of Leprosy; (2) An inquiry into the state of leprosy
in India and the other countries was instituted.
egislation in Ceylon :
In 1901 the Leper Ordinance No. 4 was Ssed providing for the compulsory segretioncare and treatment of cases of eprosy. The Ordinance empowered the overnor to demand notification of every se of Leprosy, insist on examination and
necessary compulsory segregation on rtification by two Government Medical
ficers.
In 1909 Dr. R. Pestonje—also a Major in e C.L.I. was appointed Superintendent Ld was in charge for over 20 years. uring this period in 1914 the Franciscan sters took over the nursing of the Leprosy -tients.
The Leprosy Hospital at Mantivu astern Province) was opened during Dr. estonje's period.

Page 172
158
LEPROSY CONT
In 1925 Dr. Pestonje went to India fo special study of the disease and when returned introduced better methods treatment with injections of Hydnocarp Oil.
In 1930 the seriousness of the Lepro problem in Ceylon was first recognised Dr. R. Briercliffe the Director of Medi and Sanitary Services. He invited I R. G. Cochrane the Secretary of the Briti Empire Leprosy Relief Association to vi Ceylon in 1933 and 1936 and submit 1 reports on the problem and the steps to taken to tackle the problem in Ceylon. a result two Medical Officers were select and sent to India for a course of Trainin When the two officers returned after trai ing they adopted the following measures f the control of the disease :
(2)
(1) A preliminary survey of known cas
of Leprosy in the two institutions
Hendala and Mantivu. A survey of the whole island—(t took several years to complete) find out the nature, frequency ar
distribution of the problem. (3) Compilation of Leprosy Case Registe
(a) for the whole island (6) by provinces (c) by Health areas (d) Registers of Public Healt
Inspectors. (4) A Central Office at Maradana f
maintenance of records and statisti
and for survey work. (5) Facilities for outdoor treatment
cases in Colombo and endemic areas (6) Training of personnel. (7) Educative propaganda.
The span of control is as follows :-
Superintenden
Institutions :
1. L. H. Hendala 2. L, H. Mantivu 3. Department of Health Colony
Uragasmanhandiya.

ROL IN CEYLON
- a The survey of the island when completed he revealed that Leprosy was more prevalent of along the Western, Southern and Eastern
Coastal belts in Ceylon. The distribution
was widespread—and endemic areas were sy spotty and confined to small villages.
us
Dy
cal
The organisation for the Control of Dr. Leprosy was set on a firm footing with two sh sections—
(1) Institutions (2) Field
lis
is
with the Central Office at Maradana acting as a co-ordinating centre between the institutions and field.
nor
The Central Office at Maradana also functioned as a diagnostic Centre where
weekly clinics were conducted regularly for outdoor cases from Colombo and suburbs.
es
at
is
to
nd
In 1951 the W.H.O. sent a Consultant to report on the Leprosy Problem - and as a result a W.H.O. Senior Leprosy Officer came to Ceylon and worked in the Campaign from 1954-1957. An Occupational Therapist was also here for 2 years from 1955-57 as part of the W.H.O. project.
er.
Dr
In 1952 a Department of Health Colony th
of 103 acres extent was opened up at Uragasmanhandiya 5 miles off Kosgoda in
the Southern Province, comprising of both cs high and paddy land with 12 twin cottages
for able bodied leprosy patients. of
In 1954 the Leprosy Campaign started functioning as a separate de-centralised unit.
},
t Leprosy Campaign
Field : Central Office and Clinic
Colombo

Page 173
LEPROSY CONTROL
C
As a result of the W.H.O. Project, number of Medical Officers, Public Health Inspectors, and Laboratory Technologists were trained International Fellowships and at Government expense.
. L.
II. PREVALENCE AND
PREVALENCE TABLE : -- TOTAL
BY AGE-GROUPS, SE
Age-Group
Lepromatous Males
Females
0 - 4
6 - 9
o N o
10 - 14
18
15 - 19
34
18
20 - 29
217
63
30 - 39
G = =
361
72
40 - 49
304
49
**
50 - 59
215
43
60 - 69
110
24
70 +
29
11
Total
1,292
288
Prevalence--Table : Total Cases in Agegroups, (Ceylon 1961) by Sex and Type.
The prevalence rate in the two sexes males and females was 2.8: 1. This ratio was most marked in the Lepromatous type
—the ratio being 4: 1, whilst in the nonlepromatous type the ratio was 2:1.
The Western Province heads the list with 2,008 cases, of which 831 were lepromatous. Of the 2,008 cases in the Western Province 542 cases were from the Colombo Municipality.
A study of the spread of the disease in ep several countries reveal that—
(1) the Leprosy bacillus is poor at pro
ducing disease because
(a) it is a low pathogen ;

IN CEYLON
159
In 1960 the W.H.O. sent a short term onsultant to assess the problem again on te work done after the completion of the eprosy project from 1954-57.
EPIDEMIOLOGY:
CASES IN CEYLON 1961 K AND TYPE.
Non-Lepromatous Males
Females
Total
38
25
86
68
51
143
61
34
147
241
100
621
343
131
907
298
135
786
256
121
635
152
84
370
62
30
132 3,818
1,522
716
(b) it has to enter the body through
a break in skin or mucous
membrane of nose ;
(c) once it enters the tissues it
takes a long time to break down the resistance of the invaded host ;
(d) there must be a break in con
tinuity of skin or mucous membrane for the bacillus to get out of the invaded host.
nese factors are borne out by the main idemiological features of the disease.
(1) Selective nature--people in stress
groups affected-those living under conditions of overcrowding in close and prolonged contact, chiefly children, being more susceptible.

Page 174
160
LEPROSY co
(2) Spotty distribution—cases occurin
round known cases or households i clusters or foci.
(3) The association of the infective o
open case discharging bacilli in th spread of the disease.
TOTAL LEPROSY CASES
Province :
Lepromatou Males
F.
WESTERN
675
SOUTHERN
180
NORTHERN
74
EASTERN
80
CENTRAL
59
SABARAGAMUWA
110
UVA
43
NORTH-CENTRA
17
NORTH-WESTERN ..
54
Total ...
1,292
TOTAL CONTACTS OF LEPRO
CASES U
Province :
Lepromatov Over 15 U
WESTERN
2,043
SOUTHER
559
NORTHERN
147
EASTERN
162
CENTRAL
162
SABARAGAMUWA
355
UVA
158
NORTH-CENTRAL ...
29
NORTH-WESTERN...
150
Total ... 3,765

TROL IN CEYLON
g Leprosy is a disease of the crowded home ;
and more insanitary and more crowded the home conditions in which people live on a poor subsistence level with lack of proper nutrition, the more the chances of spread once the infectious agent is present.
BY PROVINCES, SEX AND TYPE
Non-Lepromatous Males Females
Total
emales
156
769
408
2,008
39
232
121
572
10
53
18
155
13
112
34
239
15
80
195
* * *
28
131
322
65
23
140
18
41
| 16
62
14
146
288
1,522
716
3,818
IMATOUS AND NON-LEPROMATOUS
NDER 15 AND OVER 15.
LS
Non-Lepromatous ider 16 Over 15 Under 15
Total
919
2,550
1,315
6,827
234
858
411
2,062
73
149
110
479
127
278
221
788
85
241
107
595
226
646
309
1,336
89
240
142
629
22
37
43
131
[08
135
91
484
383
5,134
2,749
13,531

Page 175
LEPROSY CONTROL
It is not realistie to compare the degree of communicability of leprosy with that of acute exanthemata such as measles and chicken pox which are acute diseases of short duration. Leprosy is a chronic disease of long duration and because an, open case unless recognised early and adequatley treated remains communicable for a long period, the disease is able to spread to a susceptible individual who is living in close contact.
The disease process is dynamic-never static moving in one direction or other. The nature, frequency and distribution varies at different places at different times. Given the ideal conditions for spread such as cases discharging bacili living with susceptible groups-like childern, in close contact especially in overcrowded and insanitary homes—the disease can spread in a village or community.
It is not always possible to trace every case or to recognise the disease in the very early stages and often by the time an open case is detected he would have infected several other people living with him. These factors have to be kept in mind in the investigation of cases and contacts.
However every attempt is made
(a) To detect source of original infection
by
(1) questioning
(2) study of records
(3) looking into disease pattern in
area.
(6) To discover other possible cases of
the disease ;
(e) To take measures to prevent spread
from source of infection ;
(d) To minimise effects of disease on the
cases by proper treatment.
Three factors are involved in disease pro
duction :

IN CEYLON
161
) The human host:
(a) Resistance, natural or acquired, of
the host plus the host-parasite relationship. As long as there is equilibrium between host and parasite no manifest disease is evident—but once equilibrium is upset--clinical disease ensues. The earliest clinical lesion is a hypopigmented patch (single or multiple) non-anaesthetic, no bacilli on routine examination. The other signs are (1) Hypopigmented patches
—usually anaesthetic ; thickened infiltrated areas of skin, usually nonanaesthetic and generally positive for
M. leprae ; thickening of ear lobes. (2) Areas of anaesthesia along distribution of thickened nerves like Ulnar, Peroneal and their branches. (3) Presence of bacilli from skin lesions (dermis) or mucous membrane of nose by routine or biopsy examination.
(6) Age-young more susceptible.
(C) Sex-males more affected than
females ratio 2 : 1.
(d) Race–In certain races the Lepro
matous (severe) type of the disease is more frequent—such as in AngloIndians, Burmese and Chinese.
1) Agent of disease :
(a) The lepra bacillus is a low pathogen.
The nature and source of infection in the community important--Household contact—a high degree of com
municability.
(6) Community dosage :
(i) direct relationship to the re
sevoir of infection-—i.e., the number of cases discharging bacilli ;
(ii) fomites—articles used by highly
infectious cases--bed, room, towels, etc.

Page 176
162
LEPROSY CON
There should be effective contact betwee human being and lepra bacillus.
(C) Efficacy of the reservoir :
The manner of extrusion of bacillit outside world—by contact
(i) skin or mucous membrane wher
ulcers are present ;
(ii) using infected articles ;
(iii) by droplet infection from nos
and throat--possible in ver advanced cases ;
(iv) the period during which th
reservoir is effective.
Infective cases remain communicable fo long periods. Therefore disease produce
Is----
(1) Chronic
(2) Many sequelae
(3) long period of convalescence.
(3) Environment :
(a) Physical. A moist hot climat
helps to spread the disease.
(6) Biological. The community dos
sage governs--nature, frequenc and extent of disease.
(C) Social. (1) Food habitsdepend o
knowledge of food, health, avai lability of food and economy.
(2) Level of Education—knowledge o
health and pattern of behaviour o individuals.
(3) Economic status—governs livin
conditions, occupational hazards stress, etc.
III. Organisation and Control Pro
gramme :
Organisational Chart in page 92.

TROL IN CEYLON
a The Control Programme :
The control programme can be broadly divided into 3 phases with main emphasis on prevention :
(1) Prevention.
(2) Treatment.
(3) Rehabilitation.
(1) Prevention :
d
As leprosy is both a preventable and curable disease it is only logical to give more emphasis to the preventive aspect. From the epidemiological concepts it is evident that the host and parasite are equally balanced and the only factor which favours the spread of the disease is the long period of communicability of the open case discharging bacilli. This long period of communicability can be reduced by earlyregular and adequate chemotherapy and the balance in favour of the bacillus which is essential for its survival and transmission of disease be turned in favour of the human host and against the bacillus. This treatment by chemotherapeutic drugs like D.D.S. and D.P.T. play a vital role in the
Control Programme by reducing the degree e of communicability of the infective case
year by year and .by preventing the noninfective case from becoming infective or open.
Therefore every case in hospital or field is provided with facilities for treatment at n the Special Institutions, local health office
or a Special Leprosy Clinics and for those who cannot be reached–Domiciliary Treatment by Public Health Inspectors.
of (2) Surveys :
Case Finding Programme :
60
A variety of data is necessary to define and locate the problem and assure sound planning for better control measures. Therefore periodical visits to known households of Leprosy and also neighbouring households are necessary to check on known cases and to find out new cases.

Page 177
LEPROSY CONTROL
Therefore in order to obtain information the following procedures are carried out---
(a) Maintenance of Leprosy Case Re
gister—where every known leprosy case is recorded.
(6) Conduct special surveys in all the Health areas of the island with the
M assistance of the health officers and their Public Health Inspectors. This a is done every year as far as financial
provision and time permit.
BO C As o m 29
(c) Bring the records maintained at
Health Offices up to date.
(d) Maintenance of continuing records of b
patients—
(i) in Survey Cards.
(ii) P.H.I. Register.
Un o
(iii) In treatment record at treat
ment clinics.
(e) Contact examination is given special
emphasis during surveys and they are advised to get themselves checked up at the—(1) Home
(2) Health Office. (3) Nearest local hospital.
Children are given pointed attention.
(f) Endemic foci with large number of
infective cases given special emphasis.
(g) Contracts divided into two catego
ries
Contacts of Infectious cases.
Contacts of non-infectious cases.
All contacts receive CARE MILK.
Contacts of infective cases--Prophy- M lactic D.D.S.
Children B.C.G. Vaccination.

IN CEYLON
163
Worm treatment.
Cod Liver Oil.
B) Health Education :
It is more and more recognised that a vell informed and educated public is one f the best guarantees for the success of n effective control programme. Most of ne human problems as we meet today will ontinue as problems unless the individuals nd groups see for themselves the need to hange their ways and adopt a more coperative approach towards the control measures which are ultimately for the enefit of the individual and community.
Therefore health education is threaded in very activity-Propaganda---Treatment--- urvey.
(a) A leaflet “ Facts about Leprosy " in
three languages is widely distributed to leprosy patients--their families and general public.
(6) A Booklet “ Information about Le
prosy > has been distributed to
medical personnel.
(C) Cyclostyled circulars(14 in all) have
been given to all Health OfficersPublic Health Inspectors and paramedical personnel to assist them to recognise and treat cases.
(d) A well rounded programme of pro
fessional education to Medical Paramedical personnel both at Postgraduate, graduate and Student level.
(e) The Departmental Manual in three
sections Laboratory, Medical and Public Health Services contain all information for guidance of depart
mental personnel.
The aim of Health Education at all levelsIedical-Paramedical and general public
is :
(1) to understand people ;

Page 178
164
LEPROSY co1
(2) to communicate facts of disea
according to degree of knowled; required ;
(3) to break down attitudes ar
barriers ;
(4) to get people to actively partic
pate in control measures.
It is only by changed outlook on the pa of Medical, paramedical personnel an general public that Leprosy can be ult mately controlled even to the point { eradication.
Legislation :
(1) The Leprosy Ordinance No. 4 (
1901 is not enforced. Infectiv patients are induced to enter inst tutions-no compulsion is used it is against all Modern Concepts.
(2) The Quarantine and Prevention {
Disease Ordinance 1957 require that infective Leprosy cases shoul report for treatment and get the contacts examined periodically.
Treatment :
The treatment given in the three inst tutions Hendala-Mantivu-Uragaha is judicious combination of all forms therapy depending on the needs an facilities available.
(1) Chemotherapy.
(2) Physiotherapy.
(3) Occupational Therapy.
(4) Surgery---reconstructive.
The treatment is designed to minimis the effects of the disease and prevei further disability. The drugs at our di posal do not directly attack the bacillusthey are mainly bacteriostatic in action an hence they take a long period of time i break down the bacilli in the body an render them inactive. Therefore trea ment has to be continued for some tim

NTROL IN CEYLON
se even after the active signs have disge appeared. During this period of treatment
the morale of the patient has to be kept up
by occupational therapy and physiotherapy ed and psychotherapy.
1- J;
Most of the patients have some type of disability such as anaesthesia—deformity. and ulcers and they receive special atten
tion not only in the institutions but also rt in the field by :-
(1) Education of the patient about
disease ;
(2) Oil exercises and massage for anaes
thetic hands;
(3) Prevention and treatment of ulcers
bysponge rubber, Metatarsal bars,
Moulded shoes ;
f
(4) Issue of splints : Coconut shell splints
to swollen hand. Finger splints to contracting fingers. Corrective splints of plaster of Paris or bataliya.
2 T =
III. Rehabilitation :
Leprosy unrecognised and not adequai- tely treated often bring about disfiguring a features—such as foot drop, claw hand, of depressed nose-facial paresis—ocular
lesions—lagophthalmos, blindness. Today it is recognised that most of this deformity is preventable and correctible. The fear. and prejudice for the disease in the minds of the general public is mainly caused by the disfiguring features associated with leprosy. Most of the leprosy deformity could be prevented and even if present corrected by recent advances in Reconstructive Surgery aided by physiotherapy and the leprosy patient rendered inactive of the disease by chemotherapy could be sent back to his family and job from isolation in an institution. This gives hope and courage to the patient who begins to have a new life so that the rehabilitation programme begins with the diagnosis of the disease and ends only with the restoration · of the individual to his job and family. Leprosy patients who are recommended by
U S

Page 179
LEPROSY CONTROL
a panel of Medical Officers as fit for discharge receive an allowance of Rs. 50/- per le month from the Department of Social Services. This allowance enables patients who are unable to obtain full employment to exist with casual work.
Evaluation :
U O O UN
(1) Over 10 years ago in a Presidential address to the Medical Officers of Health it was mentioned that leprosy affected the lives of about 4,000 patients and 16,000 dependents. At that time the Ceylon population was approximately 6 to 7 p
million.
t og 8
(2) Today we have almost the same number of patients with a population of 10,000,000.
e = e o
(3) Leprosy is a slowly spreading disease with a low incidence, spotty distribution and a trend which taken over a number of years is static or downward. On account of the low rate of transmission and long te incubation period a reduction in trans
mission due to effective control measures fi will not be reflected for some time in the annual attack rate.
REFERI
(1) DE SIMON, D. S._Transactions of the Society of I
1945.
(2) DOULL, J. A.—Control of Leprosy--Annals of the
1951.
(3) American Journal of Public Health, Vol. 41 No.
tion 1950).
(4) HANSEN's Disease (Leprosy)—Leonard Wood Men

IN CEYLON
165
(4) Ceylon being an island with a limited prosy problem-fine public health set p-chain of hospitals and dispensaries and lealth Offices with range public health nspectors-nurses, midwives scattered very few miles, has the ideal conditions or the Control of Leprosy even to the point ! Eradication if every available person is lucated and coopted to help in the Control cheme.
(5) The most potent weapon for reducing kposure to infection is the education of the atient and his family along with the eneral public assisted by regular chemoherapy for affected persons—thus reducing ne degree of infectiousness year by year nd the raising of economic levels with mphasis on better housing —better diet nd better living conditions, and this įtensive effort should be continued until 1ccess is achieved. It is only when the
dividual and the group realise the need or co-operation with the activities to proect him and the community from disease nd its effects, that leprosy can be successally controlled to the end point of transmission.
ENCES
Medical Officers of Health. Presidential Address
New York Academy of Science Vol. 54 Article 1
B (Official Statement of American P. H. Associa
morial Publication.

Page 180
166
Prevalence Total Cases
Incidence
New Cases
Year
N.
Mortality
Deaths
N.
1961
3818
1580
2238
307
134
173
73**
S =
1960
3635
1481
2154
347
154
193
89**
1959
3457
1382
2075
329
136
193
46**
N
LEPROSY CONT
1958
3224
1246
1978
308
107
201
33*
1957
2685
1022
1663
358
126.
232
28*

1956*
2154
775
1379
475
121
354
35*
1955
4052
316
111
205
38*
ROL IN CEYLON
1954
3774
265
102
163
36* *
1953
3545
278
113
165
45* 2*
1952
3312
213
91
122
67**
1951
3166
233
107
126
34**
** Field and Institution. * Institution (Field not available). † Compilation of New Leprosy Register.

Page 181
ORGANIZATIONAL CHARTANTI-LEPROSY CAMPAIGN
DIRECTOR OF HEALTH SERVICES
Deputy Director Deputy Director
Deputy Director
(Medical) (Public Health)
(Laboratories)
Divisional Superintendents of
Health.
SUPERINTENDENT - ANTI-LEPROSY CAMPAIGN
(Organisation and Direction)
Divisional Superintendents of
Health.
(2) Field Set-up.
(1) Leprosy Institutions (Treatment ; Prevention ; Rehabilition; Health Education ; Welfare.)
Hospitals. Dispensaries. Health Offices. School Medical
Officer.
Public Health
Inspectors. Public Health
Nurses
Hospitals. Dispensaries. Health Offices. School Medical
Officer. . Public Health
Inspectors. Public Health
LEPROSY CONTROL
L H. Hendala (W.P.) L. H. Mantivu (E.P.) Uragaha Colony (S.P.) Central Clinic (W.P.) Bed strength - 737 Bed strength = 289. Bed strength -- 126.
Health Education.
M. O. in-charge. M.O. in-charge. Apothecary i/c.
Survey.
Medical Officers. 2 Anothecaries. Attendants.
Special Leprosy

Other Grades.
Other Para-Medical
Personnel. Leprosy Clinics attached to Health Offices, Dispensaries and Hospitals. Domiciliary treat
ment.
Religious Nursing
Sisters.
Attendants. Other Grades.
2 Apothecaries. 1 Physiotherapist 1 Occupational
Therapisit. 2 Laboratory Techs. Religious Nursing
Sisters.
Nurses.
Attendants. Other Grades.
Clinics conducted by Officers of Leprosy Campaign. Organisation of and
periodic visits to Leprosy Clinics attached to Health Offices, Dispensaries
and Hospitals. Training of Personnel. Medical Officer. 4 Apothecaries. 3 P.H. II.
1 Nurse. 1 Laboratory Tech. Other Grades.
Nurses. Other Para-Medical
Personnel. Leprosy Clinics
attached to Health Offices, Dispensaries
and Hospitals. Domiciliary treat
ment.
IN CEYLON
I EPROSY CONTROL IN CO-ORDINATION WITH ENTIRE HEALTH SET-UP.
167

Page 182
168
PRE VALENCE AND INCIDENCE OF LEPROSY
1951 - 1961.
TOTAL
CASES
4052
4 000 .
3818
NEW CASES
DETECTED
3774
3635
3545
3457
3312
3224
3166
TER. were tak actually REGIST ALL IS the refigures
3 0 0 0.
LEPROSY CONT
* The
2685

FROL IN CEYLON
comparatively low for 1956 is due to compilation of the SLAND LEPROSY "ER. Only cases seen during the year en into the REĠIS
20ɛ
1961
347
O 961
167£
6961
308!
89 61
1358
1961
2134
916
996
265
bg6!
1278
€961
MESATERARTENIMIENTRAL
1213
ZSSI
tasi
000 €
1 000 .

Page 183
LEPROSY CONTROL
Point Pedro
Vevertiturai
KoyOSOJaffna.
Kay18
LEPROSY HC
CLINICS AT
HE.
Jaffna
Talai mannar
O Manner
Yakolla
Chilaw O
Okuliyapitlya
OPolgohawela
O Kodugannawa
O Pitipane
OGampola
Negombo o Ja Ela lo
Hendala COLOMBO
Deraniyagala ODikoya
Gampaha
Kirindiweig Dompe
OP adukka OHomagama Kesbewa
Ehaliyagoda
Horang
Moratuwa
Ponadura o
Sapumaikanda Estate
o Ratnapura 08alan
Kalutora o
Okolonne
Induruwao Ambalangoda
O Baddegama
Okatugod Akuressa
Gallo-o. Katuwana
WeligamaONOMatara

IN CEYLON
169
OSPITALS AND TREATMENT MEDICAL INSTITUTIONS AND ALTH OFFICES
KEY
LEPROSY HOSPITALS MEDICAL INSTITUTIONS - HEALTH OFFICES
oratticaloa
*Mantivu
Kaការាទី
Dombona
O Amperi
Ekeriyankumburo.
O Badulla
Dambagolia
Siycqបង Bandarawela O Moneragala
goda
O Hambantota

Page 184
170
LEPROSY CO
LEPF
KREIRA
3 GOL
KOLEM
/ N O R T H E
84
7
P R O V T N C E
Fascis
N O R T H-C E T
19
2a
P R
IN O R T - W E S T E R N
70
75
P R O VINCE
сE
PRO
| WESTERN Handale
0642 patients
138
184
\PROVINCE
SAB ARAGOI
83| II77
PRO VI
Urggaha 24 patients SOUTH ER N
21C
35:

NTROL IN CEYLON
ROSY CASES AND INSTITUTIONS
BY PROVINCES
Arti
KEY
conta suita
mitte
CASES
2ir
INSTITUTIONS
N
and s
arran
The
year the p the jo
>rdtif
V T R A L
HIC
ulie
Adve
O VINCE
are ki
93
Decen
Office
146 E A STERN
74 121
163 potiente
Mantivu - PROVINCE
TR A L
INCE
U v A
52
88 PA O VIN C E
MU W A'***
N. CE :
PROVINCE

Page 185
THE JO U
Articles for Publication :
The Journal of the Ceylon Public Healt] contains all papers read before the Association di suitable articles is also invited for considerati
mittee. Only articles that have reached the req
Articles for publication should be type w and sent in duplicate to reach the Hony. Secreta
References to the literature should be arranged alphabetically according to the first au The following order may be followed—author year of publication in parenthesis, title of the the paper is published and abbreviated (underli the journal in arabic numerals, add the first pag
di Ing idibo di
When reference is made to a book, the or or authors' name with initials, title of on has been published, the place of publ Jlication. If page numbers are available thes
Advertisements : .
Rates for advertisements are available wit are kindly requested to notify the Honorary Se December of each year. Communications may Office of the Superintendent, Anti-Malaria Camp

171
R N A L
Association is published annually and uring the year. The submission of other on for publication by the editorial com
uired standard will be published.
ritten (double spacing) on foolscap paper ury before the 31st December.
compiled at the end of the article, thor, under the heading “ References ?”. Ps name or names followed by initials,
paper, the name of the journal in which ined to indicate italics), volume No, of
e number.
e following order may be adopted the
the book, the edition if more than one ication, publisher's name and date of se are added.
Eh the Honorary Secretary. Advertisers cretary, of their requirements before 31st be addressed to the Honorary Secretary, aign, Torrington Square, Colombo 7.

Page 186
Only
has THE
BU
BY APPOIT
DAILININGRIHELINSIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
TOTO HER My vFACTS
MY NE YA
BIS INFECTA."
THE
POWERFUL DI
*FUL DISINFECTAM"|
FOR HOMELAND GARDEN
UMAINIUIIIIIIIIIIIIIIIIBIBIBITIS
Not To BI TA
31/

milites
WARNING
y genuine JEYES' FLUID
the sign of JEYES and E RISING SUN on its
label.
Y ONLY GENUINE
JEYES' FLUID
Trade Inquiries to :-
JONES & Co., Ltd.,
P. O. BOX 261,
COLOMBO.