Report of the Medical Officer of Health / Municipality of Colombo.
- Colombo (Sri Lanka). Public Health Department
- Date:
- [1911]
Licence: Public Domain Mark
Credit: Report of the Medical Officer of Health / Municipality of Colombo. Source: Wellcome Collection.
4/74 page 22
![improvement (see diagram)—an improvement which it is interesting to note coincides with the adoption in 1909 of disinfection of phthisis-infected houses. Whether this improvement is the direct result of this measure it is of course too early to say, and whether it will be maintained is very doubtful, unless legal powers are granted to enforce the important preventive measures of isolation of infected cases and the improvement of the housing conditions. The vital statistics, therefore, although of late satisfactory so far as they go in respect of phthisis, clearly indicate the necessity in respect of pulmonary diseases generally, for the granting of legal powers to control the erection of new buildings, to improve existing buildings, and to enforce isolation of advanced cases of phthisis, if any very material or permanent improvement is to be secured. It should be remembered that these pulmonary diseases are responsible for a very large proportion (nearly a third) of the total deaths in Colombo, and that, therefore, until a check has been put upon them it is unlikely that there will be any very material improvement in the general death-rate ; on the contrary, as the erection of insanitary dwellings continues to go on apace, and the town is becoming more and^more congested, one might fairly expect the general death-rate to have gone on rising. That it has not done so of late years is due to the fact that the death-rates from most of the other principal causes have been steadily decreasing for a number of years, notwithstanding the persistence of many adverse conditions. The other principal causes of deaths referred to are the “ diarrhoeal ” and the “fever” groups of diseases, which, although they also are to some extent associated with insanitary housing conditions, are more particularly associated with filth conditions, and therefore afford a better indication of the state of the town in regard to ordinary sanitary matters, such as municipal and domestic cleansing, in respect of which one has not infrequently seen it publicly stated that practically no improvement has been effected. Upon what grounds such statements are based it is difficult to understand ; they are certainly not supported by the facts disclosed by the vital statistics, nor are they in accordance with the experience of those who are in the best position to judge of such matters. As an illustration of this improvement, take the case of the “ diarrhoea” group of diseases, under which heading are included dysentery, diarrhoea, and enteritis, all of which are essentially “ filth diseases.” Decrease of Diarrhoeal Diseases.—A glance at the statistics and diagrams annexed shows that the mortality from this group, although it had been steadily rising up till 1906, has since then been steadily decreasing, the lowest rate on record having been reached in the year now under review. Decrease cf Fevers.—So also in the case of the “ fever ” group (most of which is probably enteric), the mortality from this group has for a considerable number of years been more or less steadily decreasing, the lowest death-rate on record having been reached in the year now under review. The improvement in the mortality from these causes has, as stated, gone on notwithstanding the persistence, and indeed progressive* increase of many powerfully adverse conditions, to which reference will now be made. Adverse Conditions.—It is well known that the incidence of diseases, such as diarrhoea, enteritis, dysentery, and enteric fever, is very closely associated with the manner in which the waste of the population is dealt with, i.e., the night-soil, the sewage, and the other domestic and trade rubbish. It is also closely associated with the food supply as regards its liability to contamination. Bucket Latrines.—What then are the conditions in respect of these in Colombo ? First, as regards the night-soil, the great bulk of this is still dealt with in so-called dry-earth latrines the vast majority of which, especially in the poorer and more crowded parts of the town, are kept and always will be kept in a most insanitary condition. They are not in reality dry-earth latrines at all, for the reason that the coir dust supplied as a covering is seldom used by the people, in spite of innumerable warnings and even prosecutions on that account. These latrines, therefore, form a very great source of danger as regards the diseases mentioned, and as the population has been very rapidly increasing so has the amount of, and therefore the possible danger associated with, this class of waste been increasing. The actual danger from this source is, however, in a measure dependant upon the manner in which the work of removal is done, and this has undoubtedly been improved since the contract system was abolished and the work was taken in hand by the Works Engineer at the end of 1910. By far the greater part of the danger is, however* associated with the manner in which the householders themselves perform their duty in using the covering supplied, and in maintaining their latrines in a cleanly condition, and in these respects there has been little improvement. There is, under the conditions which obtain here, obviously no proper solution of this problem, except the adoption of the water-carriage system, and the immediate removal of this class of waste in a cleanly manner, and although many millions of rupees have already been spent for this purpose in sewering the town, practically no benefit has as yet been derived from this work by the town at large, owing to the lack of legal powers to compel householders to adopt this system. Drainage.—The same remarks apply to the disposal of the liquid waste, i.e., the sewage. In spite of the great growth of the population, and the increase in the water supply, and the consequently great increase in the output of sewage, it is for the most part still disposed of by turning it either direct on to the ground in close proximity to the dwellings, or into open and frequently unbuilt drains, many of which serve no purpose beyond conducting it from the house where it is produced to some other spot,’ which is often adjacent to other houses where it creates a nuisance and is a source of constant complaint from the residents and of trouble to the Council’s staff. Here again there is obviously no proper remedy except to compel the house-owners to connect their drains to the under-ground sewers, and this as stated there is no legal power to enforce. It is expected that such powers will before long be granted; but that does not alter the fact that, until the underground system has actually replaced these bucket latrines and sewage-carrying open drains we have in Colombo a state of affairs which has been becoming progressively more favourable to the incidence of filth diseases pari passu with the growth of the population. Disposal of Rubbish.—Next take the case of domestic and trade refuse : the only point to which reference need be made in the present connection is that although matters have been greatly improved, it is still unsatis¬ factory in that the destructor at Mansergh avenue is insufficient for the rapidly growing needs of the town, and there are still a number of insanitary fly-breeding tips either within or in close proximity to the town. Food Supply.—Lastly, take the case of the food supply as an instance of the adverse conditions which exist here. It stands to reason that as the infection of all these filth diseases must gain access by the alimentary canal, the purity of the food supply is of the first importance. Apart from the obvious risk of infection by flies to which food is exposed in houses surrounded by insanitary bucket latrines, and sewage-carrying open drains, the conditions under which it is exposed in the public markets are very unsatisfactory, as these markets are for the most part hopelessly out of date, and cannot be maintained in a sanitary condition. Public Markets.—Why should not our markets be put into an up-to-date condition ? It is not for the want of money derived from that source, for, as the annual statements of revenue and expenditure show, only a fraction of the revenue derived from public markets has in the past been expended upon them, the balance having apparently been utilized for other purposes. During 1912, for example, although a revenue of Rs. 52,081'05 was derived from public markets, only some Rs. 30,243*93 in all was expended upon them, including salaries of staff, maintenance, and an unusually large amount for construction work. During the last three years the aggregate revenue from markets has exceeded the aggregate expenditure by Rs. 46,607. This [ 306 ]](https://iiif.wellcomecollection.org/image/b31753371_0004.jp2/full/800%2C/0/default.jpg)
