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

  • Colombo (Sri Lanka). Public Health Department
Date:
[1911]
Catalogue details

Licence: Public Domain Mark

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

    8/74 page 26
    During 1912 pneumonia caused 13'8 per cent, of the total deaths in Colombo, phthisis caused 10 • 5 per cent., diarrhoea and enteritis 9-6 per cent., dysentery 4-0 per cent., bronchitis 3• 6 per cent., and enteric fever 3 • 5 per cent. Europeans as usual suffered most from enteric fever, which, although less than half the average, was still responsible for 13-5 per cent, of their total deaths. Their next greatest cause of death was diarrhoea, which caused 5 * 4 per cent. As usual, comparatively few of their deaths were caused by pulmonary diseases ; but their statistics in this respect are not trustworthy, as most Europeans who are attacked by phthisis go to Europe ; and there is no record of the number of such or of their deaths. The European pneumonia rate is however comparatively low, and that is a disease which operates too rapidly to permit of those who are stricken escaping from the Island. It may therefore be that their true phthisis rate is also genuinely low, compared with other races. It is a significant fact that about a quarter of the total recorded European deaths are usually due to diseases, the infection of which gains entrance with their food supply. This is probably in a large measure due to their being more susceptible to these diseases than are other races ; but, on the other hand, one knows from what one has seen that there is an extraordinary lack of supervision over the kitchen in many of the bachelor establishments, and it is young bachelors who suffer most. There is therefore every reason why Europeans should exercise strictest precautions in all matters connected with their food supply, and the main¬ tenance of their health in a condition which will enable them to resist attacks by these food borne diseases. Tamils, in addition to suffering more severely in 1912 from pneumonia, had a higher mortality than . any other race from diarrhoeal diseases. This is no doubt due to the fact that more poverty exists among them, and they live, as a class, under more unfavourable conditions than any other race. They had as usual a relatively low mortality from enteric fever, which is probably due to most of them having already had the disease during their childhood in India, where enteric fever is said to be exceedingly prevalent. The Moors, like the Tamils in Colombo, had as usual a low death-rate from enteric, but whether the same explanation holds good in their case is doubtful. It may be that many of their children suffer from this disease in a mild form which thus escapes recognition and notification, or they may have a certain degree of natural immunity to the disease. On the other hand, their religion requires them to be more particular about the source and preparation of their food than any other race, and this may and probably does confer a certain amount of protection upon them. The Malays, who are much less strict Muhammadans, had as usual a higher fever rate (probably mostly enteric) than any other race except Europeans; but it is satisfactory to note that, like the Europeans, they showed a great improvement in this respect in 1912. The principal cause of deaths amongst both the Burghers and the Sinhalese was as usual pulmonary diseases, chief amongst which was pneumonia. In considering these principal causes of deaths one must be careful to avoid making the mistake of assuming that because a certain disease is the principal cause of deaths amongst one race, whereas it is not the principal cause in another race, that therefore the first race suffered more than the second race from that disease. Such may be, but is not by any means necessarily the case. Take the case of pneumonia as an example : although 12-3 per cent, of the total Burgher deaths and only 11 • 9 per cent, of the total Moor deaths were due to this cause, the Moors never¬ theless suffered more severely from this disease in proportion to their population than did the Burghers, or whereas 3 • 07 per 1,000 of the Moors died of pneumonia only 2 • 81 per 1,000 of the Burghers died of this disease. The rates for each race expressed as a percentage of their total deaths are only of value as a means of expressing which disease each race has suffered most from during the particular period dealt with, and must not be used for comparing the mortality amongst different races or even amongst the same race at different periods of time, or in different localities. They are very useful rates, but their legitimate uses are strictly limited as stated above. 9.—Infant Mortality. Deaths, 1,554 ; death-rate per 1,000 recorded births, 299 ; average rate for the preceding ten years, 333 ; decrease, 34 per 1,000. That the true infant mortality in Colombo is probably a good deal lower than it appears from the statistics had already been explained in section 5. The following table shows the average infant death-rate for each race since 1908, and also the rates for the years 1911 and 1912. Separate race-rates are not available prior to 1908. Average. Europeans Burghers Sinhalese Tamils Moors Malays Others 1908-11. 1911. 1912. 159 182 22 200 218 186 290 286 284 436 413 381 410 423 382 304 291 289 441 408 354 A large proportion of the Tamils, Moors, and Others being poor are compelled to live in densely crowded, unhealthy areas, such as exist in St. Paul’s, New Bazaar, and San Sebastian, their infants being thus exposed to conditions which are always associated with a high rate of mortality. Many of the mothers are moreover ignorant and careless, and especially in the case of the Tamils, many of them have to work when they should be attending to their children. In the case of the Moors it is largely a case of mishandling of the infants, many of whom are injured by hand feeding instead of breast feeding. Sanitary dwellings for the poor are very urgently required in Colombo, and until this undoubtedly very difficult problem is solved there can be little material improvement in the infant death-rate. This is a matter which was dealt with at some length in the 1911 report. The principal causes of infant deaths expressed as a rate per 1,000 recorded births amongst the population generally were as follows :—Convulsions (91), debility (45), diarrhoeal diseases (37), pneumonia (34). The Moors, Tamils, and Malays each had a very high infant death-rate from “ convulsions,” which is a sure indication of improper feeding, most of these deaths being no doubt the result of digestive troubles. It is most unfortunate in this connection that the use of condensed milk, much of which is quite unsuitable for infants, appears to be rapidly spreading amongst the poorer classes, who have not got the education necessary to warn them against the dangers to their children entailed by this form of feeding. Breast-feeding is said to be rapidly being displaced, especially among the Moors, by hand-feeding, and as condensed milks are being imported in enormous and yearly increasing quantities, and are being assiduously thrust before the public, much of it is taking the place of breast milk or fresh cow’s milk to the great detriment and loss of life of the infants. One way of dealing with this evil—and I strongly recommend it—would be to put an importation tax upon condensed milk sufficient to make it more costly than fresh cow’s milk, and to absolutely prohibit the sale of such as has instructions for dilution upon the label which, if carried out, would reduce the quality to below the Colombo standard. The proposed Food and Drugs Act will provide for the carrying out of the second but not the first of these proposals. So harmful are the conditions under which one sees condensed [ 310 ]
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