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

  • Colombo (Sri Lanka). Public Health Department.
Date:
[1930]
Catalogue details

Licence: Public Domain Mark

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

    23/124 (page 17)
    XIV.—Tuberculosis. Tuberculosis is the greatest and most difficult public health problem in every civilized -country of the world. It is a problem not only to the sanitarian and the social worker but owing to its intimate and inseparable association with economic and social factors such as industrialism, wages, unemployment, poverty, housing, &c., it has become a national problem of the greatest importance and complexity to the State. In spite of the great strides taken in the West in matters of sanitation and public health, the disease has not been completely wiped out yet but still continues to levy a terrible toll of lives, being more deadly and expensive in its effect than war. Sanitary progress alone has not been sufficient to attack it. The social and economic factors with which it is connected have also to be taken into account in dealing with this problem if we are to make more rapid progress in fighting it. The disease is of world-wide prevalence ; between the years 1918 to 1927 it has been estimated that 40 millions have died of tuberculosis in the various countries of the world. In India over 6 millions are said to be affected by the disease and that over a million die annually. An astounding price to pay for the infringement of Nature’s simple laws. For wherever man has departed from the natural and simple ways of life and has created for himself an artificial environment tuberculosis has arisen as the avenger to exact full payment. In every city and town of the civilized world where there is industrialism, crowding together of human beings, sweated labour, low wages, unemployment, alcholism, poverty, bad housing, &c., tuberculosis thrives and spreads and from the cities the surrounding villages become gradually infected. If in countries where great progress and reforms have been made in the sanitary, social, economic, and educational spheres the disease is still regarded as a scourge, what devastation must it cause in countries where such reforms are still in the primitive stages or not so advanced ! The disease being ordinarily one of fairly long duration, its victims drop off one by one unnoticed and its ravages do not strike the imagination as do the more rapidly opei’ating epidemic diseases such as cholera, smallpox, or plague, which though more dreaded actually cause less destruction, less suffering, and less expense. Owing to this fact neither the State nor the people treat the problem of tuberculosis as a matter of urgent and prime importance and one that should be fought with all the resources and means at their command. The Registrar-General’s reports show that in the five years from 1925-1930 there were 17,902 deaths in the Island and 3,302 deaths in Colombo, and if we follow the general rule of reckoning the incidence at the rate of 10 cases to every death then during this period there must have been approximately 179,020 cases in the Island and 33,020 cases in Colombo, a state of affairs that should claim greater interest and attention from everyone interested in the welfare of the Island. The disease of tuberculosis, so called because of the little swellings or “tubercles” seen in the affected parts of the body, was known to the Chinese as early as the sixth century and was generally regarded until 50 years ago as a sort of inherited taint which led to gradual decay and death. This belief is still current; the disinclination to notify the existence of the disease in a family being due to the fear that the whole family might be regarded as subject to degeneration and that the stigma so attached might work detrimentally specially in the matrimonial market ! Its infectious nature was definitely proved only when the causal agent, the tubercle bacillus, was discovered by Koch in 1881. The disease has been proved to depend upon the presence of this organism or germ which is found in all cases of tuberculosis in whatever part of the body the disease exists. Nearly every part of the body except the voluntary muscles are liable to attack, but the commonest seat is the lungs where it is called pulmonary tuberculosis or phthisis pulmonalis and in popular language “ consumption.” The healthy human body has the power of destroying the vitality of the bacillus when introduced in small numbers, but where the infecting dose is great or the exposure to infection is prolonged and one’s resisting powers are lowered in various ways, which will be dealt with later, the germ finds a suitable soil, gains a footing, and begins to propagate itself producing various morbid changes according to its location. The tubercle bacillus is found in enormous numbers in the sputum of patients suffering from advanced disease of the lungs. It has been estimated that the expectoration voided in 24 hours by a patient in such a stage may contain as many as 4 billion germs ! The germs are also found in the discharges from ulcerated glands, in the urine in case of diseased kidneys, in the foeces in intestinal tubercle, &c., but from the point of view of the spread of infection the sputum in the pulmonary form of the disease is the main source of infection. The germ possesses considerable powers of resistance to external influences such as light, temperature, and dessication, and it is this property that makes it so dangerous. It cannot however live and retain its vitality indefinitely under unfavourable conditions. It needs passage through the human body for rejuvenation and renewal of vitality. It has been found by experiment that the dried spittle of a patient retains its virulence for from six to eight weeks while in moist dark places it may retain its virulence and be capable of reproducing the disease even after six months. Boiling or exposure to bright sunlight or strong disinfectants rapidly kills it. From the point of view of prevention the following observations made by Dr. Soparkar of Bombay are interesting :— * (1) Bacilli in sputum exposed to direct sunlight were alive for G hours but were dead after 8 hours. (2) In sputum exposed to diffused daylight they were alive for 6 days but were dead after 8 days. (3) In sputum kept in darkness, even when completely dessicated they were found alive and virulent for 309 days (10 months). (4) From decomposing sputum bacilli were isolated after 20 days but not after 26 days. (5) A pellet of sputum became sufficiently dried to be reduced to dust in 3 to 4 hours in direct sunlight and 3 to 4 days in diffused daylight. (6) It was easier to reduce to dust sputum dried on dusty surfaces than on glazed surfaces. * “ Vitality of tubercle bacilli outside the body.” Indian Journal of Medical Research, 1917.