Report of the Medical Officer of Health / Municipality of Colombo.

  • Colombo (Sri Lanka). Public Health Department
Date:
[1929]
Catalogue details

Licence: Public Domain Mark

Credit: Report of the Medical Officer of Health / Municipality of Colombo. Source: Wellcome Collection.

    42/70 page 24
    (5) Soil-Fingers-Moulh. This is an important mode of infection in Colombo. Experiments have shown that although there is no multiplication of the organisms in the soil they may persist there under favourable conditions for from 74 days to months. Tenement compounds in Colombo are badly abused by children and even by adults and soil pollution is great except in the Ijetter residential districts. This is due to— {a) Absence of latrine accommodation. {b) Inadequate latrine accommodation. (c) Latrines not being within easy reach. id) Latrines being unsuitable in type for young children. (e) Dirty habits of the people. Children playing on such polluted grounds readily convey infection to their mouths or bring the infection on their feet to their homes and then indirectly through fingers to food and mouth, vide Statement (a) for incidence among children 0 to 10 years of age. Soil pollution due to lack of drainage is also seen in the unsewered lanes of South Colombo. Every house has to deal with its sullage containing latrine washings, &c., by means of a sump which Foon becomes a veritable cesspit. In the Wall street and Dematagoda areas especially soil pollution is extremely bad and accounts for the high incidence of typhoid in these areas. Typhoid bacilli have been shown to survive in fseces for from 15 to 80 days or longer so that in places where the ground is systematically polluted and condition of moisture, temperature, &c., are favourable the danger of infection by this mode is very great. C.—Future Preventive Measures. We have seen from section B above that the chief sources of infection are from carriers and from cases diagnosed and notified late in the course of the disease, and the commonest modes of transmisson are by indirect infection through, in their order of importance, (1) fingers-food- mouth, (2) flies-food-mouth, (3) soil-fingers-food-mouth, and less commonly (4) water-mouth or water-food-mouth. In regard to the problem of carriers this Department is not in a position to do anything very much. Without a bacteriological examination of very large numbers of people it would not be possible to detect all unsuspected carriers in the city. In cases that have been hospitalized convalescents might of course be detained until four negative stool examinations have been done, but in cases treated in jiatient’s home by private practitioners the difficulty of getting material for bacteriological examination is very great as people show great reluctance to give specimens of urine or foeces. In these cases it is the duty of those who have gone through an attack to observe scrupulous cleanliness in their personal habits and to take the greatest care in the disposal of their excreta. They should also not engage in any trade or business connected with the handling or cooking of food especially in establishments catering to the public. It would be an excellent thing if in all such establishments employees were required to produce a certificate that they are not typhoid carriers. In regard to the large numbers of cases diagnosed and notified late, the practice of a large numlser of people, especially the class who are chiefly affected, of resorting to quack and other unscientific methods of treatment renders early and correct diagnosis impossible. Where cases are seen from the beginning of the illness private medical practitioners might assist this Department to a greater extent by availing themselves early of the available laboratory aid in diagnosis without actually waiting for the development of the classical syndrome of typhoid. Diagnosis is possible in large numbers of cases even in the first week of the disease by means of blood cultures. Early correct diagnosis is essential if we are to prevent those secondary cases due to direct or indirect infection through fingers to mouth or fingers to food to mouth. Early correct diagnosis would also enable this Department to hospitalize a larger number of cases and thereby ])revent the occurrence of secondary contact cases. From the point of view of the patient himself ( I refer to the poorer classes of the population ) treatment in a properly equipped hospital gives him a greater chance of recovery than in a small crowded house without proper nursing. For instance, among the 173 cases treated in hospital last year there were 52 deaths or 30‘5 per cent, fatal cases and among the G4 cases treated in patient’s own home there were 28 deaths or 43‘8 per cent, fatal cases. The unreasonable and largely groundless prejudice against hospital treatment operates detrimentally to the patient’s own interests. We must look to time and education to overcome these prejudices. Next, in regard to practical measures that might be adopted l)y Council we have seen in the section dealing with the incidence of typhoid by wards that the disease recurs year after year in certain well defined areas such as chiefly Dematagoda road and Wall street. The remedy is also obvious. The Dematagoda area must be roaded and sewered so that it would be possible to scavenge the area properly and to abolish the pail latrines and substitute water closets and proper drainage. In the Wall street area a sewer between Wall street and Blomendahl road is needed in order to drain the premises and dispose of the excreta satisfactorily. In addition to these two sewers which are urgently needed the objective towards which efforts should be directed is the early complete sewerage of the town and abolition of the pail latrines. The danger from fly infection and soil pollution would then be removed to a very large extent. Diagram IV. shows the influence of proper disposal of excreta upon the incidence of typhoid fever in the city. Last year, for instance, there were 141 cases of typhoid fever in premises with pail latrine and 93 in pi-emises with water closets.
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