Leonard Woolf on Distributing Quinine in a Malaria Epidemic Ceylon – 1909 and Samuel Baker on Endemic Diseases and their Causes Ceylon – 1854

Sometime ago there was a severe outbreak of fever in some villages in West Giruwa pattu and as the only course open to me I appointed paid distributors: but I stopped it almost immediately as they are useless. I asked that if similar cases occurred again a special dispenser might be sent but was informed that this was impossible. I urged that it was a mere waste of quinine and time to give the powders to headmen or daily paid distributors for distribution. In the first place the people don’t take it and in the second it is quite unfair to expect an unpaid headman to spend the time required for a house to house visitation – which must after all be the only way of doing any good – besides all his other duties. As for distribution at dispensaries, people in the majority of cases only go to dispensaries when they are already ill. Both the D.M.O. [District Medical Officer] Tangalle, Dr Cooke and the Mudaliyar were agreed that it is only from a man of the class of a dispenser going round from house to house, that the people will really take the quinine as a prophylactic: they will only take it from a man they can call a ‘Doctor’. I do not think it is an exaggeration to say that the whole amount of money spent in quinine distribution in this District has been wasted not for anyone’s fault but because the system is wrong: and I imagine that the money would have paid for at least one dispenser who working regularly in one small area might have done much good. I was pleased to find this view has high authority in Prof. Ross.

Leonard Woolf is too well known to need any introduction. His unsuccessful effort at rationalising government policies comes from The Hambantota Diaries 1908-1911: Records of a Colonial Administator, reprinted Sri Lanka, 1962, p.110. This quote is preceded by a letter to The Times from Ronald Ross, Professor of Tropical Medicine, on the importance and difficulties of distributing quinine – which must be gratis – and the need to back it up with rigorous control of mosquitoes and their breeding grounds.

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It may no doubt appear very enticing to the lovers of such things, to hear of the gorgeous colours and prodigious size of butterflies, moths and beetles; the varieties of reptiles, the flying foxes, the gigantic crocodiles; the countless species of waterfowl &c; but one very serious fact is apt to escape the observation of the general reader, that wherever insect and reptile life is most abundant, so sure is that locality full of malaria and disease.

Ceylon does not condescend to second-class diseases: there is no such thing as influenza; hooping-cough, measles, scarlatina, &c are rarely, if ever, heard of; we ring the changes on four first-class ailments – four scourges, which alternately ascend the throne of pestilence and annually reduce the circle of our friends – cholera, dysentery, small-pox and fever. This year (1854) there has been some dispute as to the routine of succession; they have all accordingly raged at one time.

The cause of infection in disease has long been a subject of controversy among medical men; but there can be little doubt that, whatever is the origin of the disease, the same is the element of infection. The question is, therefore, reduced to the prime cause of the disease itself. A theory that animalcules are the cause of the various contagious and infectious disorders has created much discussion; and though the opinion is not generally entertained by the faculty, the idea is so feasible, and so many rational arguments can be brought forward in its support, that I cannot help touching a topic so generally interesting.

Baker goes on to discuss various kinds of disease-producing organisms, particularly microscopic, and their relationship with climate.

Now, if some are discernible with the naked eye, and others are detected in such varying sizes, that some can only just be distinguished by the most powerful lens, is it not rational to conclude, that the smallest discernible to human intelligence is but the medium of a countless race? That millions of others still exist, which are too minute for any observation?

Observe the particular quarters of a city which suffer most severely during the prevalence of an epidemic. In all dirty narrow streets, where the inhabitants are naturally of a low uncleanly class, the cases will be tenfold. Thus, filth is admitted to have at least the power of attracting disease, and we know that it not only attracts, but generates animalcules; therefore, filth, insects and disease are ever seen to be closely linked together.

He discusses the advantages of fumigation and continues:

The great purifier of Nature is a violent wind, which usually terminates an epidemic immediately; this would naturally carry before it all insect life with which the atmosphere might be impregnated, and the disease disappears at the same moment……Every person is aware that unwholesome air is quite as poisonous to the human system as impure water….

Samuel Baker’s theories may not be entirely correct, but his idea that there were disease-carrying organisms too small to be seen by any microscope available at the time was ahead of the general opinion of the day. He was an extremely remarkable and energetic character. After building bridges and railways in what is now Eastern Europe, he spent a number of years in Ceylon (Sri Lanka), where he founded Nuwara Eliya as an agricultural settlement and hill-station. After the death of his first wife, he returned to Eastern Europe and there effected the dramatic and romantic rescue of a Hungarian Christian slave girl, destined for the Pasha of Vidin. They married and she accompanied him on his journeys of exploration in Africa. At the request of the Khedive Ismail, Baker led expeditions to the south – to the area where the janajaweed are still operating – to suppress the slave trade, something in which they naturally felt a personal interest. He tells the story in Ismailia (1874) and Pat Shipman in The Stolen Woman (2004) gives and excellent account of Florence Baker’s part in his adventures.

The quotation given above is from:

Samuel W. Baker, Eight Years in Ceylon, 1855, reprinted Sri Lanka, 1983 pp.123-5.

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