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.
6/74 page 24
![There is every reason to believe that when the Legislature has granted the legal powers required (1) to compel householders to abolish their insanitary latrines and sewage-carrying open drains, (2) to control the erection of new buildings, and improve the state of the existing ones, and (3) to enforce segregation of advanced cases of phthisis, there will be a great further improvement in the death-rate of Colombo, which, although already one of the healthiest of the large towns in the tropical East, should become far more so than it is at present. 4.—Population. The estimated mean total population in 1912 was 227,062, the distribution of which by race, age, sex, and ward is given in the Appendix. The ward in which there is the greatest congestion of population is St. Paul’s, with an average density of 189'4 persons per acre. The eastward extension has the lowest density, viz., 7-1 per acre. The density for the town, as a whole, is 32' 9 per acre. These densities are reckoned upon the area available for building, and not upon the total acreage. 5.—Births. The total number of births registered in Colombo during 1912 was 5,195, representing a birth-rate of 22' 9 per 1,000, which is slightly below the average. It is quite certain, however, that the recorded birth-rate is not a true measure of the fertility of the population, and that many births of children of Colombo parents escape registration in the town owing to the custom which prevails amongst the indigenous races whereby prospective mothers migrate prior to confinement to the homes of their parents. The extent to which this custom must affect the recorded birth-rate may be surmised from the fact that at the Census, out of a total female population of 81,599 enumerated in the town, of whom about half were at child-bearing ages, 13,697 gave their place of birth as the Colombo District, i. e., outside the town, from which one may fairly deduce that the homes of the parents of many thousands of Colombo women are still in these extra-urban districts, and that therefore there must be a great deal of migration to these districts for confinement purposes. In fact it is common knowledge that this is so. Children born under these circumstances would naturally be registered in these extra urban districts prior to their being brought into Colombo by their mothers, and consequently the record of their births is lost to the Colombo statistics. On the other hand, only a relatively very minute proportion of the women enumerated in the adjoining extra-urban districts gave their place of birth as the Municipality, viz., only 2,391 out of a total female population of 298,453, so that there is probably very little compensating migration from country to town for confinement purposes. This has an important bearing upon the infant death-rate of Colombo for the following reason. The infant death-rate represents the total number of recorded infant deaths stated as a proportion per 1,000 of the births recorded during the year. Therefore, even if the number of infant deaths were to remain constant from year to year, a decrease in the number of births recorded, due to the migration referred to above, would give a higher death-rate and vice versa, from which it will be seen that the migration for confinement purposes and consequent loss of birth registration to Colombo must result in the production of a fallaciously high infant death-rate in Colombo. It is of course assumed that such of these children as survive until the mothers’ return to Colombo are brought here, and should they die in Colombo their deaths are registered here. As the infant death-rate is generally accepted as the best test of the sanitary condition of any place, it is important that the true rate should be known ; but this cannot be ascertained unless steps are taken to ensure that all children born of Colombo parents in extra-urban districts, and who are subsequently brought into Colombo before they are a year old, are registered in Colombo, and that, on the other hand, all children born in Colombo of non-resident parents, and who are removed from the town before they are a year old, are excluded from the Colombo registers. How this can best be effected is a matter which should be referred to the Registrar-General for consideration. 6.—Deaths : General. Total deaths registered, 6,636; crude death-rate, 29 ’2 per 1,000; average crude death-rate for ten previous years, 33'0 per 1,000 ; death-rate corrected for hospital deaths, 26'8 ; death-rate further corrected for age and sex, 31 • 5. (a) Correction for Hospital Deaths. The hospitals in Colombo attract a large number of sick persons, not only from the town, but also from all parts of the Island, especially from the adjoining rural districts. During 1912 there were 542 deaths amongst these non-residents in the hospitals, and it is the deduction on this account which reduces the death- rate from 29 *2 to 26'8. The rates of the individual races are very differently affected by this correction, the most extreme example being in the case of the Europeans. Out of a total of 64 European death records in Colombo during 1912, 27, i.e., 42 per cent., were non-residents of the town, who came here sick and died in the hospitals, their death-rate being reduced by this correction from 20*3 to 11*8 per 1,000. On the other hand, a large proportion of the Europeans who are taken seriously ill go home to Europe, if they are well enough to travel and can afford the expense. Unfortunately there is no record of the number of such, or of the number who die out of Colombo, so that the compensating correction cannot be made, and the true European death-rate cannot be ascertained. The race next to the Europeans, which is most affected by the correction for hospital deaths, is the Sinhalese, whose death-rate is thus reduced from 32*0 to 27*7. This is mainly due to the great use which the large suburban Sinhalese population make of the Colombo hospitals. The correction is least in the case of the Moors and the Malays, neither of whom appear to make much use of the hospitals. They are both very conservative races and cling tenaciously to their established customs. In addition to the death-rates of non-residents which occur in hospitals, a number occur in the town generally in the case of persons who have come sick from the rural districts in search of medical advice, or in order to be with relations, or for other reasons. As an off-set, however, against the increase of the Colombo deaths caused in this manner, a number of town residents leave the town when sick and die in the rural districts. There is no record of such in either case, so that it is not possible to make corrections ; but it is not improbable that they more or less balance each other, so that the death-rate may not be materially affected one way or the other. Ward Rates.—Not only are the general and the race death-rates affected by hospital deaths, but the ward death-rates are also seriously disturbed, there having been no fewer than 952 deaths of town residents in the hospitals during 1912. The most extreme example of this is the Pettah Ward, the death-rate of which, when corrected for deaths of Pettah residents which occurred in the hospitals, is raised in respect of 1912 from 9-7 to 38*1 per 1,000. This is an extraordinary correction, and is probably to be explained by the fact that the term “ Pettah ” is very generally used to indicate a wider area than the registration district so called. It is especially used in this wider sense by the large vagrant population, most of whom are destitute Tamils, to indicate not only the Pettah proper, but also the adjoining parts of St. Paul’s and San Sebastian Wards. As the majority of these vagrants go when sick to the hospital, and as they undoubtedly have normally a very high rate of mortality, the result is that the‘Pettah death-rate is made to appear fallaciously high by this- [ 308 ]](https://iiif.wellcomecollection.org/image/b31753371_0006.jp2/full/800%2C/0/default.jpg)
