148 
Malaria in Ceylon 
instance being at a quiescent stage, ready to break out when conditions 
again became favourable. The gametocyte cell was the one most 
frequently encountered. 
The quartan parasite (Appendix III) predominated, an experience 
which tallies with the recent work of Major Christophers, I.M.S., in the 
Andamans. 
Malignant or sub-tertian crescents were only found three times. 
All three species of malaria parasite—the quartan, tertian, and sub¬ 
tertian—were represented. It is of great interest to note that malaria 
parasites were found in the blood of 15 children, in whom no concomitant 
enlargement of the spleen could he detected. 
Results of systematic treatment with Quinine. Special enquiries were 
made during this investigation with regard to the effect of regular treat¬ 
ment with quinine. On the whole, the children impressed me as being 
a remarkably healthy set, well-fed, mentally alert, with sleek and glossy 
skins, presenting in this respect a contrast to the anaemic, ill-kept, 
rough-skinned village children met with in malarious districts in the 
Southern Province. 
It was found that a very small proportion of the children had been 
regularly treated with quinine—only 43 out of the total number exa¬ 
mined had been so treated ; the spleen rate amongst those treated was 
60‘4 per cent., and the parasite rate 13'9 per cent., as against a spleen 
rate of 33’8 per cent, and a parasite rate of 9'9 per cent, amongst those 
who had had no treatment at all. It must be understood that these 
figures do not represent the real efficacy of quinine treatment; only the 
cachectic, anaemic children attend the Town Hall for systematic quinine 
administration, and it is just amongst these that a higher spleen rate 
is to be expected. Indeed, a considerable improvement in the spleen 
rate has been effected by systematic treatment, as I understand that- 
on commencing treatment every one of these children had enlarged 
spleens. 
The greatest difficulty with which Gunasekara has to contend is 
to convince the parents of the children of the necessity for systematic 
treatment after the one attack of fever has ended. The schools are 
obviously the places where systematic daily administration of quinine 
pills shoidd be undertaken. In winning over the teachers to his views, 
Gunasekara, by the exhibition of much tact, has been particularly success¬ 
ful. I understand that this difficulty is greatly magnified, in so far that 
only 50 per cent, of the children of Kurunegala town regularly attend 
school. 
