Report of the Principal Civil Medical Officer and Inspector-General of Hospitals / [Ceylon].

  • Ceylon. Civil Medical Department.
Date:
[1914]
Catalogue details

Licence: Public Domain Mark

Credit: Report of the Principal Civil Medical Officer and Inspector-General of Hospitals / [Ceylon]. Source: Wellcome Collection.

    6/72 (page 4)
    10. Plague.—On January 25, 1914, a Coast Moor, aged 16, was found dead in 65, Sea street, Colombo, and bacteriological examination confirmed the death as due to septicoemic plague. It proved difficult to trace the source of infection, but by a process of elimination of other possible sources it was presumed to have been India. From this focus the disease spread over many parts of Colombo, and at the end of the period 437 definite cases with 401 deaths occurred. In Sea street alone 23 cases occurred, in Kochchikade 42, Maradana (2nd Division) 43, and it extended to such remote parts of the town as Grandpass, Pettah, Slave Island, St. Sebastian, Maligakanda, (outside Municipal limits, 11 cases). Of the total number of cases, 26 occurred outside Colombo, 6 of which occurred in Peliyagoda. Cases occurring in Kandy, Maskeliya, Jaffna, Talaimannar, Karawanella, Avissawella, and Kurunegala were all Colombo residents, and of the others most were found dead, and were probably connected with the Colombo outbreak. The disease, in the first instance, was of the septicsemic type, and was therefore only definitely capable of detection by bacteriological examination, and a fatal result occurred so quickly that in such cases the diagnosis could only be made with certainty on post-mortem examination, as the patients died before clinical symptoms could manifest themselves. Later the disease assumed a milder type, and both bubonic and pneumonic cases became more common than septicsemic, and it was among the milder cases that recoveries took place. The occurrence of the disease caused something of a panic among the Chetty and cooly classes, and considerable numbers migrated to India in the belief that a universal preventive inoculation would be instituted. The spread of the disease was very largely due to the difficulty attending the detection of cases, which were moved about from house to house with the object of escaping the vigilance of the sanitary inspectors of the Municipality. Cases attempted to escape out of Colombo even by motor car, and when detected heavy fines were imposed on those abetting such removal. In connection with the outbreak an anti-rat campaign was organized and carried out by Dr. Milne, Junior Sanitary Officer of the Department, who was lent to the Municipality of Colombo for the purpose. A large number of the rats were examined bacteriologically, and as the campaign progressed, the percentage of rat infection, which was at no time large, perceptibly diminished ; but sporadic cases of the disease were still occurring. It is to be noted that the disease was confined to the poorer classes, who inhabit overcrowded and congested areas. 11. Cholera.—The total number of cases which occurred during the period was 55, of which 28 died ; 14 of these with 4 deaths occurred in the Western Province—a relic of the outbreak in Colombo towards the end of the pre\dous year; and of these, 12 occurred in the village of Peliyagoda. The infection from this village was carried to Galle, where an outbreak occurred in the suburb of Gintota in January, which resulted in 19 cases with 14 deaths. One case occurred on Dikwella estate, Kegalla, in which the source of infection could not be traced. The remaining 21 cases with 10 deaths occurred in the Central Province, the infection being taken to Silverkande estate from Mandapam (the kangany of the gang died there) by a gang of new coohes ; 4 cases with 1 death occurred. The adjoining estate, Brookside, was infected (6 cases with 4 deaths), and a Sinhalese who was watching contacts there escaped to his village, Kumbalgamuwa, and 10 cases with 5 deaths occurred there. The last case occurred in a chauffeur to a visiting agent, who had a meal on Brookside the day before the outbreak and developed the disease immediately on arrival at Annefield estate, Dikoya, two days later. In addition to the above, 8 cases with 3 deaths occurred in Mandapam Camp. There were no infected vessels. 12. Smallpox.—409 cases occurred during the period with 103 deaths, as compared with 6 cases and 1 death during the previous period. Of these deaths, 60 occurred in persons on which were no or very faint vaccination marks, and the remainmg 43 in persons who had good marks. Of the 306 recoveries, 208 occurred in persons who had good vaccination marks. The principal outbreak was centred in Colombo, where 270 cases with 68 deaths occurred. Of these deaths, 3 Indians and 2 Tamils only took place, which is a testimony to the efficacy of vaccination performed on that class prior to their arrival in Ceylon. The first case in Colombo occurred in March in a Malay from Rangoon, and subsequently all the members of a Sinhalese family fell victims, as the case was concealed, and was only discovered when some of those attacked were convalescent. A few isolated cases followed, and the disease seemed to disappear from Colombo, but later appeared in Kalutara, where, among others, the medical officer succumbed to the disease. The disease returned to Colombo in July through the medium of a carter from Kalutara who was infected there, and moved about in concealment from house to house until finally run to earth in Armour street, Colombo. The result was that a severe epidemic followed, and cases were still occurring at the end of the period. 83 cases with 23 deaths occurred in the Province of Uva, the source of infection being a Coast cooly who arrived on Nahavilla estate, where 12 cases occurred, including the medical officer attending. A month later the disease appeared in Passara, and from there spread to Lunugala, Bibile, Kataragama, and Monaragala; at the same time 24 cases with 8 deaths occurred in the Southern Province, the infection being traced from Badulla to Hambantota, and spreading to Tangalla, Matara, and Ambalangoda. One case from the Colombo outbreak was detected in the Northern Province, and one of unknown origin in the Province of Sabaragamuwa. Thirteen cases occurred in the Eastern Province, the source of infection being traced to Bibile (Uva) and Hambantota (Southern Province). Finally, 17 cases with 4 deaths occurred in the Central Province, and in only 1 case was there infection from the Colombo outbreak. 13. Enteric Fever.—243 cases with 67 deaths were treated in hospitals in the Island, as compared with 834 cases in the previous period. 181 cases were also reported from dispensaries. 101 of the hospital cases were treated in the General Hospital, Colombo, with 29 deaths, and 17 w’ere seen at the outdoor dispensary. 64 cases with 14 deaths were treated in the Central Province hospitals, and 26 cases with 3 deaths in the Southern Province, and cases occurred in all the other Provinces. Nevertheless, the number of cases shows a marked diminution from those occurring in the previous period. 14. Dysentery.—3,435 cases with 859 deaths occurred in the hospitals in the Island, and 19,406 were treated in dispensaries. This shows a slight comparative decrease of the incidence of the disease, but while great success is experienced in the treatment of the amoebic type of the disease, success in treat¬ ment is not so marked in other types, which is not surprising, in view of the varied types and causative agents occurring in the disease. The study of this disease has been recognized to such a degree of para¬ mount importance in tropical countries as to engage the principal attention of research workers in these countries. The dividing line between this disease and the symptom diarrhoea without specific cause is difficult to demarcate, and m every consideration clinically the two are to some extent bracketed. With