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MALARIA ON THE BURMA ROAD
315
A
THE LANCET LONDON:SATURDAY, NARCFI 8, 1941
MALARIA ON THE BURMA ROAD THE opening of great channels of commerce overland
in the tropics and the subtropics during the last 80 years has shown that the difficulties to be overcome are not only political, economic and engineering but also medical. Two papers by ROBERTSON! on the China-Burma highway illustrate this fact, and a new instalment of the history of the road which he began in our columns two years ago.2 The proposal to connect Burma and China by road dates from 1860, but it was not until the outbreak of war between Japan and China in 1937, and the closure to China of the Pacific coast, that the urgent need for a motor road connecting China with the ports on the Irrawaddy River was fully appreciated and its construction undertaken. In spite of great engineering difficulties, lack of modern mechanical aids to construction and loss of many lives during the work, Chinese perseverance achieved a passable road by early 1939. In its central section it has to negotiate two great river canyons, each some 6000 ft. deep, set in a plateau 9000-10,000 ft. above sea-level. It descends the sides of each canyon by a series of hairpin bends flanked by precipices on one side and precipitous cliffs on the other, until at about 3000 ft. above sea-level it crosses the rivers by suspension bridges. At its western or Burma end the road descends by gradual stages to the notorious swampy valleys of the Chinese Shan State, known for centuries as malarial death-traps. The local Chinese migrate from them to the mountains at the onset of the rainy season when malaria is most rife. Owing to the rapid construction of the road its drainage is inadequate, and in the- wet season torrents wash it away and landslides block it. At places the carriageway is a soft crumbling ledge in the face of the cliffs, and trucks are liable to crash through into the ravine below ; accidents and delays are common in these difficult stretches. Convoys of transport lorries may be held up for days on end, often in remote places, and the personnel have to sleep in the wagons, short of food and unprotected from mosquitoes. An army of drivers is continually passing from one end of the road to the other ; labour has been mobilised and brought to the spot to deal with the repair and upkeep of the road ; and the local Chinese, instead of migrating to the hills in the malarious season, stay in their villages to supply the market needs of the new influx of population. Depots for motor trucks, fuel, repair shops and ammunition-supplies have been constructed on sites chosen
provide
1. Robertson, R. C. Chin. med. J. 1940, 57, 57; Trans. R. Soc. trop. Med. Hyg. January, 1941, p. 311. 2. Lancet, 1939, 2, 108.
preliminary survey over the western end of the road
showed that malignant tertian, simple tertian and quartan malaria were all prevalent, but that the first greatly predominated in the low-lying plains, while in the upper plains of high altitude simple tertian was the prevailing infection. But it is evident that the improvement in communication may lead to changes in the predominance of the various infections in the near future. Six anopheline mosquitoes have been inculpated as vectors of the infections, and of these the most important is Anopheles minimus, an insect so tiny that it can penetrate the few mosquito-nets at present in use along the road. The nets are inadequate in design, of unsuitable mesh, and in a bad state of repair. Quinine prophylaxis has been instituted for all workers in the transport system, but its issue has proved difficult for administrative reasons ; and quinine prophylaxis is at best only a palliative in such a situation. The population of the surrounding districts consists not of a single racial group but of several different types ; these include primitive tribes eking out a pastoral existence and avoiding contact with the Chinese, the agricultural Shan people whose language and customs again differ entirely from those of the Chinese, the immigrant Chinese settlers, and the floating Chinese population brought in as a result of the construction of the road. Investigation of malaria problems among the local inhabitants, parthe more primitive, is difficult ; the people inaccessible, conservative and resent interference,
ticularly are
aiid differences of language constitute a formidable barrier. There are tested principles, however, which it would be a mistake to ignore, including the error of allowing the new population to adopt the domiciliary habits of a malarious and partially immune population. Existing villages ought to be avoided, the new depots and camps should be erected on suitable sites away from swamps, and the buildings must be properly screened with netting against the entry of mosquitoes at night. Breeding-places of the principal vectors, especially A. minimus, must be attacked by drainage, oiling and Paris green. Adequate mosquito nets of suitable design and mesh must be provided, their intelligent use enforced, and health education of the whole population begun. Dr. ROBERTSON points out the great opportunity for a wise and far-sighted policy on the part of authority, and the steady toll of ill health and loss of life which will follow This a vital need in China’s highway, already supplying resistance to Japanese aggression, will increase in value for commerce when the present troubles are If proper steps are taken now, when the road over. is young, it will become a safe highway from Burma to China.
neglect.
CANCER AND PRECANCER OF THE
STOMACH
twenty-five
is AT least one grown person out of killed by gastric carcinoma, yet we are in no position to attack the disease ; our war is one of defence. The stomach is secretly invaded before-and we cannot say how long before-the patient gets a warning sign. Our intelligence service depends on radiology, gastroscopy and gastric analysis ; surgery is at present our only effective weapon. But if we can improve our tactical use of the knowledge we have we may gain ground even during this time of ignorance of causes. To do this we need full information about
A
THE LANCET LONDON:SATURDAY, NARCFI 8, 1941
MALARIA ON THE BURMA ROAD THE opening of great channels of commerce overland
in the tropics and the subtropics during the last 80 years has shown that the difficulties to be overcome are not only political, economic and engineering but also medical. Two papers by ROBERTSON! on the China-Burma highway illustrate this fact, and a new instalment of the history of the road which he began in our columns two years ago.2 The proposal to connect Burma and China by road dates from 1860, but it was not until the outbreak of war between Japan and China in 1937, and the closure to China of the Pacific coast, that the urgent need for a motor road connecting China with the ports on the Irrawaddy River was fully appreciated and its construction undertaken. In spite of great engineering difficulties, lack of modern mechanical aids to construction and loss of many lives during the work, Chinese perseverance achieved a passable road by early 1939. In its central section it has to negotiate two great river canyons, each some 6000 ft. deep, set in a plateau 9000-10,000 ft. above sea-level. It descends the sides of each canyon by a series of hairpin bends flanked by precipices on one side and precipitous cliffs on the other, until at about 3000 ft. above sea-level it crosses the rivers by suspension bridges. At its western or Burma end the road descends by gradual stages to the notorious swampy valleys of the Chinese Shan State, known for centuries as malarial death-traps. The local Chinese migrate from them to the mountains at the onset of the rainy season when malaria is most rife. Owing to the rapid construction of the road its drainage is inadequate, and in the- wet season torrents wash it away and landslides block it. At places the carriageway is a soft crumbling ledge in the face of the cliffs, and trucks are liable to crash through into the ravine below ; accidents and delays are common in these difficult stretches. Convoys of transport lorries may be held up for days on end, often in remote places, and the personnel have to sleep in the wagons, short of food and unprotected from mosquitoes. An army of drivers is continually passing from one end of the road to the other ; labour has been mobilised and brought to the spot to deal with the repair and upkeep of the road ; and the local Chinese, instead of migrating to the hills in the malarious season, stay in their villages to supply the market needs of the new influx of population. Depots for motor trucks, fuel, repair shops and ammunition-supplies have been constructed on sites chosen
provide
1. Robertson, R. C. Chin. med. J. 1940, 57, 57; Trans. R. Soc. trop. Med. Hyg. January, 1941, p. 311. 2. Lancet, 1939, 2, 108.
preliminary survey over the western end of the road
showed that malignant tertian, simple tertian and quartan malaria were all prevalent, but that the first greatly predominated in the low-lying plains, while in the upper plains of high altitude simple tertian was the prevailing infection. But it is evident that the improvement in communication may lead to changes in the predominance of the various infections in the near future. Six anopheline mosquitoes have been inculpated as vectors of the infections, and of these the most important is Anopheles minimus, an insect so tiny that it can penetrate the few mosquito-nets at present in use along the road. The nets are inadequate in design, of unsuitable mesh, and in a bad state of repair. Quinine prophylaxis has been instituted for all workers in the transport system, but its issue has proved difficult for administrative reasons ; and quinine prophylaxis is at best only a palliative in such a situation. The population of the surrounding districts consists not of a single racial group but of several different types ; these include primitive tribes eking out a pastoral existence and avoiding contact with the Chinese, the agricultural Shan people whose language and customs again differ entirely from those of the Chinese, the immigrant Chinese settlers, and the floating Chinese population brought in as a result of the construction of the road. Investigation of malaria problems among the local inhabitants, parthe more primitive, is difficult ; the people inaccessible, conservative and resent interference,
ticularly are
aiid differences of language constitute a formidable barrier. There are tested principles, however, which it would be a mistake to ignore, including the error of allowing the new population to adopt the domiciliary habits of a malarious and partially immune population. Existing villages ought to be avoided, the new depots and camps should be erected on suitable sites away from swamps, and the buildings must be properly screened with netting against the entry of mosquitoes at night. Breeding-places of the principal vectors, especially A. minimus, must be attacked by drainage, oiling and Paris green. Adequate mosquito nets of suitable design and mesh must be provided, their intelligent use enforced, and health education of the whole population begun. Dr. ROBERTSON points out the great opportunity for a wise and far-sighted policy on the part of authority, and the steady toll of ill health and loss of life which will follow This a vital need in China’s highway, already supplying resistance to Japanese aggression, will increase in value for commerce when the present troubles are If proper steps are taken now, when the road over. is young, it will become a safe highway from Burma to China.
neglect.
CANCER AND PRECANCER OF THE
STOMACH
twenty-five
is AT least one grown person out of killed by gastric carcinoma, yet we are in no position to attack the disease ; our war is one of defence. The stomach is secretly invaded before-and we cannot say how long before-the patient gets a warning sign. Our intelligence service depends on radiology, gastroscopy and gastric analysis ; surgery is at present our only effective weapon. But if we can improve our tactical use of the knowledge we have we may gain ground even during this time of ignorance of causes. To do this we need full information about