Administration report / Public Health Department, Colombo Municipality.
- Colombo (Sri Lanka). Public Health Department
- Date:
- [1920]
Licence: Public Domain Mark
Credit: Administration report / Public Health Department, Colombo Municipality. Source: Wellcome Collection.
24/78 page 5
![In all cases where home isolation is permitted, a special bucket is provided for the excreta of the patient, which is disinfectetl under the supervision of the Sub-Inspector in charge of the case, who visits daily or as often as the circumstances of the case require. Disinfectants are sup¬ plied free of charge and the relatives in attendance upon the patient are instructed in their use and in other preventive measures in accordance with the Departmental repilations on the subject. In the cases where the general sanitary condition of the infected premises is not satisfactory, the Public Health Department cleansing gang is at once sent in to clean up the compound, disinfect the latrines, &c. The source of the water supply and the milk supply is enquired into and recorded. Enquiries are also made as to whether there are or previously have been any other cases of ill-ness in the house or in the immediate neighbourhood. The following general measures are also adopted. The Sanitary Inspectors have instructions to pay special attention to the state of all dry-earth latrines as these are regarded as being a fruitful source of infection. Milk sampling is carried on all over the town with a view of detecting and checking adulteration which as is recorded in Sec¬ tion 74, has been on the increase during the last few years, and was particularly prevalent in 1920. A great barrier to tlie carrying out of preventive work is the existence of Enteric “carriers'’ which although undoubtedly numerous can seldom be detected, and can only be verified by a bacteriological examination'the carrying out of which is frequently attended with great difficulties and may be altogether impossible as the consent of the individual concerned is necessary. Another l)arrier to the carrying out of preventive measures is raised by the neglect on the part of some of those who are legally responsible for the notification of cases. That such neglect does exist and to a very considerable extent, is practically proved as previously stated by the high case mortality amongst the cases which are notified. It is probable that this form of neglect occurs most commojily amongst Vedaralas, and includes a considerable proportion of mild, non-fatal but none the less highly infectious cases. Id- Plag'Ue. (a)—Eecrudesence and chatKjc in type of the disease. After an interval of fully two years during which the number of Plague cases remained so low as to be almost negligible, the disease broke out again with unusual severity during the last quarter of 19I9, this recrudesence being associated, as was explained in the report for that year, with the failure of the Indian lace supplies, and the consequent importation of large quantities of other kinds of grain which, instead of going into the Government Granaries as in the case of rice, was stored in the rat infested godowns in the town. During the first few weeks of 1920 the increased incidence of the disease was maintained, but with the onset of the hot weather, it as usual declined, although there was a slight but ominous increase of both rat and human Plague during the off-season in June and July which, taken in conjunction with the flea index and an apparent increase in the rat population enabled Dr. Hirst to predict a recrudesence of the disease which occurred towards the end of the year. The total number of cases reported during the year was 239, as against 89 in 1919, 4 of the cases in 1920 having been admitted to Hospital from districts outside the town. 223 or 94 9 per cent of the cases proved fatal. 93 cases were of the purely septicaemic type, all of which as usual died, while 142 or 59 per cent were bubonic, of which 130 or 9P5 per cent died. This is the first year since Plague appeared in Colombo that the bubonic cases have ex¬ ceeded the septiccBinic in number, in which connection Dr. Hirst reports there is evidence that the type of rat Plague also is becoming more bubonic and proportionately less septica3mic in character. This observation, if confirmed by exact methods of investigation which Dr. Hirst proposes to undertake, has an important bearing upon the methods employed in the diagnosis of rat Plague, since as Dr. Hirst says the microscopic examination will become less reliable as an index to rat plague, and a factor of correction deduced from the naked eye appearances will need to be introduced. It is also important in connection with the spread of the disease, for as Dr. Hirst has elsewhere pointed out the septicsemic Plague of Colombo is entirely different both bacteriologically and clinically from the bubonic Plague of Bombay. He has estimated that the number of bacilli in the blood of a septicsemic case may reach 100 million per c. c., whereas in the blood of bubonic cases the Indian experts have estimated that only 5 bacilli per cubic centimeter would be an ordinary In these proportions therefore the risk of transmitting Plague from a septiciemic human means of a flea would be roughly 20 million times as great as in an ordinary bubonic case. The significance of these facts, and of the fact that Colombo has hitherto been the only place in the woi-ld in which, so far as published records show, the far more dangerous septicaimic type has predominated over the bubonic type in point of numbers, does not appear to be generally realised even in Colombo. (b) Plague in relation to age and. sex.—( Bee statements 24 and 2j ). In Colombo, the \lctims of Plague have for the most part been well irourished young adults, males being attacked far more fre<]uently than females in proportioii to their respective populations. Very young children and old people have been comparatively seldom attacked. Thus in 1920, as statement 24 annexed shows, much the highest rate of incidence occurred between the ages of 15 and 20 y^ears, while coniparatively few were attacked below 10 or above 50 years of age. The rate of incidence amongst males was 1’36 per 1,000 of the male population, whereas the rate amongst females was only 0’33 per 1,000 of their population. The experience in India, as recorded by Major Norman White, agrees with Ceylon as I’egards the age distribution of the cases, but differs markedly as regards the sex distribution in that the late of incidence in India is slightly higher amongst females than amongst males. Major White suggests that infants and young children in India appear to enjo,y a certain degree ol immunity ; but it seems probable that in Colombo the differences in incidence as regards both age and sex, may be better explained b}’ differences in tlje degree of exposure to infection. figure, case by Thus the high incidetice amongst young adult males as compared with females, very’ young children and dM people may be explained by the differences which exist in the habits of these classes, e.speciallj’^ at night when fleas are most active and most infections probably occur. In Colombo, j'bt holes are generally’ most numerous in the cooking place, which in tenement houses, where most, of the Plague cases occur, is situated, as a rule, in an enclosed or partiall}’ enclosed verandah adjoining the door, and it is the usual custom here for the young adult males to sleep in](https://iiif.wellcomecollection.org/image/b31753516_0024.jp2/full/800%2C/0/default.jpg)
