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

Colombo (Sri Lanka). Public Health Department

Date:: [1911]

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

9/74 page 27

$milk being used nowadays amongst the more ignorant classes here, that personally I should be glad to seo every but the very highest grade condensed milks excluded from Colombo. A system of depots for distributing certified milk to mothers of infants would be a very useful measure, but there are many practical difficulties in the way of carrying out such a scheme. The following table shows the distribution of the infant mortality in the various wards :— Fort t- 1901-1910. 211 Average. _A_ 1911. 300 1912. 100 Petah 407 279 390 San Sebastian 387 372 329 St. Paul’s 440 509 337 Kotahena 366 295 304 New Bazaar 410 382 441 Maradana 332 370 324 Slave Island 368 325 364 Ivollupitiya 258 249 260 East Extension . . -■ 374 217 Wellawatta . . - — 267 The consistently high mortality in St. Paul’s, New Bazaar, and San Sebastian, and to a less extent in Slave Island, is an illustration of the maxim that the best test of the sanitary condition of a place is its infant death-rate. San Sebastian, however, shows a distinct improvement, whereas Slave Island does not. New Bazaar shows a distinct set back, and now heads the list. No averages are available for the Eastward Extension and Wellawatta. As regards prevention of infant mortality, this is closely associated with the housing conditions referred to in the first section of this report ; but a good deal might be done to improve matters by an extension of the health visitor system in connection with dispensaries. The poor people require to be educated, and the best way to do so is to send trained female visitors amongst them. 10.—Pulmonary Diseases. Under this heading are included phthisis, pneumonia, and bronchitis. Deaths, 1,821 ; crude rate, 8*01; corrected rate, 7 -49 ; average crude rate for previous ten years, 8*11; decrease, 0*10 per 1,000. The only races which showed improvement were the Europeans, the Tamils, and the Moors. The corrected rate quoted in this and subsequent paragraphs means the rate corrected for the deaths of non-residents in the hospitals. (a) Phthisis.—Deaths, 713 ; crude rate, 3‘14 ; corrected rate, 2*82 ; average crude rate, 3 * 48 ; decrease, 0*34 per 1,000. Every race except the Malays and Others shows an improvement. The Malay rate, on the contrary, shows the large increase of 1*21 per 1,000. The Europeans show the greatest improvement, viz., P66, but this is misleading for, as previously stated, comparatively few phthisis-stricken Europeans remain in Ceylon. They are generally sent home, and such of their deaths as occur there are lost to the Colombo statistics. They are such a small population, however, that their statistical variations do not materially affect the general rates. The improvement in the death-rate from phthisis amongst the general population, which began in 1910, has since been maintained, the 1912 rate being, with the exception of 1910 which was practically the same, the lowest recorded for nine years. In this connection it may be recalled that regular visitation and disinfection of phthisis-infected houses was first commenced in July, 1909. The details in regard to this disease are given in the statements in the Appendix. (b) Pneumonia.—Deaths, 886; crude rate, 3-90; corrected rate, 3-70; average crude rate, 3-40; increase, 0‘50 per 1,000. The high level at which the pneumonia death-rate keeps is an indication of the destruction of life, which is going on as the result of a large section of the population being compelled to live in overcrowded and therefore unhealthy areas and dwellings, and which the Council’s staff is powerless to improve owing in the first place to the absence of legal powers, and, in the second place, to the great difficulty and cost involved in the improve¬ ment of such areas. Exclusive of the mixed class of aliens included under the heading of Others the race which as usual suffered most from “ pneumonia ” was the Tamils. The Europeans suffered comparatively little from this disease, as they live for the most part in the more sanitary quarters of the town and seldom adopt the unhealthy custom of shutting up their bedroom windows at night. Every race except the Europeans had a death-rate from pneumonia in excess of the average, the greatest increase being observed in the cases of the Others and the Malays. (c) Bronchitis.—Deaths, 222; crude rate, 0-97; corrected rate, 0'97; average crude rate, 1-23; decrease, 0-97. It is possible that a considerable proportion of the mortality ascribed to bronchitis is in reality due to the more specific causes of phthisis and pneumonia. 11.—Diarrhceal Diseases. Deaths, 927 ; crude rate, 4-05 ; corrected rate, 3-65 ; average rate, 5*76; decrease, 1 -71 per 1,000. This group includes diarrhoea, enteritis, and dysentery, the two former of which are considered below under one heading and include also the various forms of colitis, as there is no proper line of demarcation between them. The death-rate from this group of diseases in 1912 was the lowest on record {vide diagram in Appendix). Every race participated in the improvement, the most marked being the case of the Europeans, whose rate corrected for deaths of non-residents was only 0*95. The Moors and Others showed the least improvement. (а) Diarrhoea and Enteritis.—Deaths, 655 ; crude rate, 2*85; corrected rate, 2*58; average crude rate, 3*79 ; decrease, 0*94 per 1,000. Every race showed a marked improvement in the mortality from this cause, the greatest improvement being in the case of Burghers. (б) Dysentery.—Deaths, 272 ; crude rate, 1*20; corrected rate, 1*07; average, 1-97; decrease, 0*77 per 1,000. Every race except the Others showed improvement. The Europeans had, for them, the extraordinarily low corrected rate of 0*32 per 1,000, only one European resident of Colombo having died of this disease during the year. [ 311 ]$

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

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