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MALARIA IN CEYLON

THE LANCET

LONDON: SATURDAY, JANUARY 19, 1935

MALARIA IN CEYLON.-LEFT-HANDEDNESS AND STAMMER

NEWS of a great malaria epidemic in Ceylon,with half a million cases and a heavy mortality,may seem at first surprising. The island hasnever had the name of being unhealthy ; no one

has ever called it a " white man’s grave " ; indeed,it was chosen for reasons of salubrity as a placeto which prisoners were sent by the British Govern-ment during the South African War. To most

people Ceylon is a beautiful, fertile, and prosperousisland, an important tea-growing country, whoseinhabitants, well known in our inns of court andmedical schools, are obviously an intellectualrace and heirs of an ancient culture. Its buriedcities are sometimes mentioned but are seldomregarded as anything more than an additionaland picturesque attraction to tourists.

Generally speaking these impressions are correct,but there is a grim background, not merely in thepresent epidemic but in the grip which malariahas maintained on a large part of Ceylon for someeight centuries. The healthy, flourishing partsof the land are the south and west lowlands andthe central mountain mass ; they receive the fullforce of the south-west monsoon, their rainfall

ranges from 40 to 100 in. a year, and their popula-tion, of some 400 people per square mile, lives

largely on little gardens surrounded by fruit treesand flowering shrubs, cultivating the rice fields.In strong contrast to these are the north and eastparts of the island. They too were once tropicalgardens ; there were great cities, and a greatirrigation system, some of whose tanks are as largeas the largest reservoirs of the Metropolitan WaterBoard. To-day the ruins of these cities are buriedin jungle ; their inhabitants are the leopard, thewild pig, the tiger, and the elephant ; the greatirrigation system remains, but the tanks are

silent except for the call of the water-birds. Onlyin small patches here and there is the landcultivated. In place of an educated and prosperouspeople, a few miserable wretches, half-starvedand sodden with malaria, cling to a fretted threadof life. So it has been since the Tamils fromsouthern India drove the Sinhalese out of theircities and fields into the central mountains aboutthe twelfth century. After the invaders left,the remnant of the inhabitants returned to theirhomes, but they were unable to recreate their

prosperity-were able indeed to do little but dieof the malaria now firmly established in the land.In the centuries that followed the Sinhalese haveover and over again tried to colonise these areas,and failed. In Africa and India are to be foundlarge numbers of people who can tolerate the

malaria parasite sufficiently to live in places noless malarial than this part of Ceylon ; but perhapsit has taken them many thousands of years to

acquire this tolerance. Be that as it may, 800

years have not given the Sinhalese a correspondingresistance. Nor does the European attempt tocultivate this area ; for him too the land is

practically uninhabitable : it would be a whiteman’s grave were he to do so. And just becausemalaria reigns unchallenged, the land is jungle-bound. It is as if it did not exist, and men forgethow near the enemy is to their gates. But fromtime to time there is a drought in the south, andthe drought conditions of the north are reproducedin other parts of the island. What exactly happensis not fully known, but malaria then spreadssouth and west, even up the slopes of the mountainsfor 2000 or 3000 ft., and death follows in its wake.For want of water to irrigate the fields, and wantof strength to till and harvest the land, the cropsfail and famine follows sickness.

Malaria in Ceylon is a major problem-themajor problem of the country. If it is to beovercome an organisation must be created whichwill study its every aspect, and on the factsdiscovered build a system for preventing thedisease. The British Government have given thepeople of Ceylon a large measure of self-govern-ment, and we may be sure that if Ceylon asks forhelp it will be given freely. In no better waycould the Ceylonese prove their fitness for rule,and love of their native country, than by workingto deliver it from this pestilence.

LEFT-HANDEDNESS AND STAMMER

A MEMORANDUM concerning left-handed children,recently issued by the London County CouncilEducation Committee, advises that some attempt-should be made, for practical reasons, to encourageall children to use the right hand, but points outthat pressure, especially by punishment or ridicule,may produce a harmful degree of emotionaldisturbance resulting in nervous symptoms, includ-ing stammering. This authoritative warningshould settle a problem that has vexed manyteachers who, in accordance with modern tenden-cies, had begun to ask whether a left-handed childmight not, after all, be given the right to followhis own habit.The undoubted relationship of corrected left-

handedness and stammering is capable of two

explanations which at first sight appear mutuallyexclusive-one physiological, the other psycholo-gical. The physiological explanation was presentedin our pages last year by Dr. CHARLES J.MACALISTER,l who follows the general belief thatthe cerebral speech centre is left-sided in right-handed people and the opposite in left-handers,this belief being based upon observed results ofcerebral disease. It is, however, not always true,and he cites MOUTIER as finding that the rulesometimes fails both in right- and left-handedsubjects. Of right-handers with the speech centreapparently upon the same side MOUTIER makes

1 Left-handedness, THE LANCET, 1934, i., 1151-1153.