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.

    31/124 (page 25)
    3. —Social :— Purdah.—We have seen in the section dealing with incidence by race and sex that the Muslim communities practising purdah have a high death-rate and that the females of these two communities suffer very much more than the males. This is undoubtedly due to the practice of keeping women secluded in their homes without exercise and the opportunities of enjoying the life-giving fresh air of the out-of-doors. In this respect it is the middle class who are the greatest sufferers. The poorer classes are compelled to go out and work in the open air and the richer classes have the advantage of private gardens, but the females of this community as a whole have less freedom and opportunities of going out and therefore spend most of their time indoors engaged in sedentary work which conduces to softness, obesity, and weakness of the body. 4. —Economic :— (1) Low Wages and High Price of Food.—We have seen that faulty feeding is the cause of malnutrition and weakening of the constitution. Low wages and high prices of foods, particularly milk, eggs, meat, ghee, &c., naturally lead to consumption of insufficient food or articles low in food values. In the early years of life milk and other nutritious foods are necessary for growth and health, but the poorer classes cannot afford these and many of them suffer from underfeeding which renders their bodies susceptible to infection and disease. (2) Low Wages and High Rents.—Owing to the inadequacy of suitable dwellings for the working classes and the high rents demanded for what is available many of the labouring classes live crowded together in dwellings which, owinglto the demand in the past when there were no building regulations, had been divided and sub-divided and added to so as to render them utterly unfit for human habitation by reason of the lack of light and ventilation and means of drainage, &c. This overcrowding of persons and buildings naturally led to obstruction to light and free circulation of air, fouling of the soil, vitiation of the air inside and outside, and increased and greater personal contact. When cases of pulmonary tuberculosis occurred in such dwellings and the sick were not segregated but allowed to sleep with the healthy in a common room, a dark corner of which was used for voiding the expectoration, infection was easily spread from the sick to the healthy. Among the conditions which are responsible for the high incidence of the disease housing conditions of the people are the most important. It was in the close ill-ventilated overcrowded tenement-dwellings of the slums that pulmonary tuberculosis was born and bred and disseminated. ,5.—Environmental :— (1) Climate.—The prevalence of tuberculosis in any area depends chiefly upon the degree of infection present, but climate has a certain effect upon the general health. According as the climate of a place is bracing or enervating the health of the people is said to be generally good or bad. A dry climate with a low mean temperature is generally admitted to be the most healthy and comfortable, and conversely a very humid climate with a high mean temperature as unhealthy and uncomfortable. The climate of Colombo combining as it does a high mean humidity of 80 per cent, with a high mean temperature of 80'5 is one that is not conducive to the maintenance of vigorous health or to the treatment of pulmonary tuberculosis which requires a dry climate, low mean temperature, and small rainfall. (2) Urbanization.—Tuberculosis is much more prevalent in cities than in villages, and in cities it is in direct proportion to the density of population, congestion of dwellings and overcrowding of dwellings, presence of factories, slums, dust, &c. Colombo, the largest city in the Island, has the highest incidence. (3) Atmosphere.—A dusty atmosphere is injurious to health, but from the point of view of pulmonary tuberculosis the nature of the dust is important. Dust ” plays two roles : it may injure the delicate lung tissue or it may act as a vehicle for the transmission of disease germs. Ordinary soft dust as from gravelled roads, plumbago, coal, &c., does not injure the lung tissue but dust from metalled roads containing hard sharp particles does injure the lung tissue. We have seen in one of the preceding sections location of the disease is often determined by some local weakness or injury and an injured lung may easily become the starting point of tuberculosis of the lungs. As a matter of fact pulmonary tuberculosis is fairly common among stone cutters, &c., in Western countries, but statistics are not available here to show what effect such occupation has upon the incidence of the disease. Dust may also act as a vehicle for conveying the germ. Dr. Soparkar s experiments would show that the danger of infection from tuberculosis sputum deposited in open spaces such as public streets exposed to the sun is not so great as when the sputum is deposited inside buildings where the effect of sunlight is not felt. Street dust would therefore appear to be less dangerous than the dust of factories, workshops, public buildings, conveyances, dwelling houses, &c. (4) Dampness of Soil.—Dampness of soil and consequent dampness of dwellings is admittedly bad for one’s health. Owing to the high le\el of sub-soil water, high rainfall, inadequate drainage in some areas, and general absence of damp-proof courses, ^’dampness” is a common feature of most houses, paiticulailv ot those cheaply built ones occupied by the poorer classes. Continuous exposure to dampness predisposes one to respiratory diseases such as coughs and colds, &c., which lower the vitality and weaken the lungs.