Eebicfos,

FIFTEENTH ANNUAL REPORT OF THE SA- NITARY COMMISSIONER FOR MADRAS, FOR 1877, WLTH APPENDICES. In our issue for October last we reviewed at some length Surgeon-Major W. R. Cornish's report for the year 1876,. We were enabled to draw therefrom a picture of the early causes, features and effects of the great famine, of whose complete development the present volume contains a full and interesting narrative. The whole story cannot as yet be told, and until the census of 1881 has placed in the Sanitary Commissioner's hands detailed returns of the population of the affected tracts, the account cannot be closed, nor the total loss of life debitable to this great disaster finally declared. Meantime the record under review displays clearly a large mass of facts and ex- periences of a profoundly interesting description, and February 1, 1879.] HEVIICWS. 57

we shall endeavour to chronicle them in a condensed subsistence upon miscellaneous pickings of leaves, fruits for the benefit of our readers. shape and roots in the jungles, or dependence on public relief. A The meteorological peculiarities of the year are thus section of the " lar^e agricultural classes summed The of the sun's beat habitually up ls?, intensity during receive wages in grain, and when crops failed and the months of the a storm on scarcity- early year ; 2nd, cyclonic came, the small landholders were to leave 20th in the south-eastern coast districts a compelled May, giving their labourers to their own resources and husband plentiful, and in the neighbourhood of Madras a copious, their stores for themselves and their families. The of rain a south-western mon- downpour ; 3rd, delayed two means which relief came were " by private with breaks" so that in of enterprise soon, pi-olonged many and Government agency, and a very of the districts on the rains the large importation depending early early food stuffs took place in both these ways and undoubted- either failed or were on account crops greatly delayed ly saved a very substantial proportion of the of the deficient a and suffering moisture; 4th, very copious population from death ; but the from rainfall in and following passage general September October, continuing Mr. Cornish's report (p. 9) enunciates what we believe on to the usual season of the north-east monsoon ; to be a profound truth "When the common food of a violent storms and floods in the southern dis- 5th, people ranges from four to six times its normal tricts of and Madura the north- price, Tanjore, Tinnevelly during and when the poorer classes have a difficulty in pro- east monsoon with or failure of the partial complete viding enough food at ordinary rates, it is very certain rains in the coast north-east districts north of Nellore." that mere subsistence is a task too difficult for those who As with or. even the fall compared 1876, 1875, aggregate have no reserves of money or property, and that those was The numbers in good. are,?1875, 37 inches 56 days, least fitted to maintain the struggle for existence must 28 in and 48 It was 1876, 42, 1877, in 65. the distribu- die in large numbers. A humane and thoughtful ad- tion that was at and the lack of rain at the fault, proper ministration of a famine tract may do incalculable time the famine in those districts in which it aggravated good in helping the population to pass through so or induced it in districts which had already existed, terrible an ordeal, but to save an entire population in 1876. To the former the escaped category belong stricken by famine is beyond the power any districts of of Bellary, Kurnool, Cuddapah, Nellore, Salem, Government on earth. If it were to get at the North- (Joimbatore ami possible Arcot, Chiugleput, Madras, Madura; people before the pangs of starvation had laid hold of to the latter, South Arcot, Trichinopoly, Tinnevelly and the them, the task of them alive and in health The districts which fall keeping Neilgheris. escaped altogether would be one of superhuman but, as a matter into three those on the west coast difficulty; classes, namely, 1st, of fact, it is quite beyond the power of administra- which any received and appropriated all the moisture brought tion to reach all the and to afford them needful the south-west monsoon?South Canara and Malabar people by ; aid, before they are mortally smitten with that most those on the east coast obtained rain from the 2nd, which fatal of all diseases?chronic privation of food." This north-east and Goda- monsoon?Ganjam, Vizagapatam section of the report is also illustrated tables and and is by very ; 3rd, those in which cultivation systemati- diagrams, and in the latter, tracings of the death rates on a cally carried regular scheme of irrigation?Kistna are into instructive relation with those of en- and brought Tanjore. Thus the amount and distribution of water hanced prices of food stuffs. the whole cause climax explain of the food famine whose The two most conspicuous statistical results of the was reached in and when the south-west July August famine among the general population are a diminished monsoon failed to over Ghats. carry moisture the Western birth rate and an enhanced death rate. Of the former The famine-stricken area measured about 84,000 square we have already treated in a special article. The latter miles covered a of by population nearly twenty exhibits a startling increase over previous years; for a balance of miles and a millions, leaving 55,000 square whereas the results of registration during the preceding population of The contains 11^-millions exempt. report 11 years gave an average of 50,589-5 deaths detailed tables full the rain- (1866-76) giving particulars regarding among a population of 26i millions, or very nearly 19 fall of each district and a series of diagrams illustrating per 1,000, the deaths in 1877 were or its incidence in certain tracts. A of registered 1,556,312 typical subject pro- 3 times the average of previous years in a population found interest is touched the re- upon, namely, periodical of about 29 millions ; the exact ratio being 53'2 per mille. currence of and their on droughts dependence cyclical This rate, owing to the disturbing effects of the famine, variations in the amount of sun with heat, coincidently no doubt fell far short of the truth, and this is rendered an abundance or of sun Some observa- paucity spots. probable by the disparity between the registered morta- tions Mr. the Government are by Pogson, Astronomer, lity of males and females, the rate for the former being which direct sun heat as quoted, indicate that the 58*4 and for the latter 48*06. Infants and old people measured a sun's thermometer was by rays' considerably succumbed in than adults, the rate above the unusual in larger proportions average, droughts Africa, California, for infants (under 6 years) 57*9 ; for children Northern Australia and Natal are alluded being China, to, (7 to 12 years) 31*6 ; adults to 50 years) 39*6, and and a recurrence of India (18 drought in Southern between old 50 86'3 against mean rates the 1887 and 1889 is considered Mr. to people (over years) years by Pogson of 8-1, 12*2 and 611 during the previous four be more than 28-1, probable. years. Hindus also perished in larger relative number If in the statistics of rainfall we a index possess good than the rates being 54*2 and 38 8 respective- and measure of the cause of the statistics Mahomedans, famine, showing ly. The total loss of population due to the famine is the prices of food constitute a of its grains gauge gravi- more discussed in a special paper drawn up and the results of birth and death of its elaborately ty, registration Mr. Cornish for the Statistical of London, in effects. The of no to by Society prices food-grains were, doubt, which the results of a census taken in 1878 of some extent affected and disturbed and January by importation certain areas, where famine did and did not prevail, are gratuitous but on the whole reflect distribution, they exhibited. Making allowance for the natural increment the fluctuations of the and to some accurately distress, of which is estimated at 1 cent per an- extent of population per the prospects and of the sufferers. The as hopes num, the Commissioner puts down 3j millions cost of was in the famine districts from four to Sanitary grain the result of checked increase and actual mortality, and six times as as it to be. It reached a climax great oughr surmises that before the birth rate recovers its normal e4 the were in^AugurOi September? when early sowings standard the loss caused by the famine will amount to ruined rain. When rain came in Itydeficient September 4 million lives. The results of the census were that on and October the and continued to decline to prices fell, comparing the numerations of 1871 and 1878 in non- tlie end of the The attained it year. figures put quite famine areas an increase of 6-l per cent was found to the of the of the lower classes beyond power majority have taken place, while in famine areas a decrease of 15 to and there was left but a purchase, nothing precarious per cent had occurred, and in the district of Salem, which 58 THE INDIAN MEDICAL GAZETTE. [February 1, 1879.

was selected as a typical famine district, a decrease of the hot and dry months the disease exhibited no excess of 20 7 cent. can per This subject however be more pro.- prevalence, but after the cyclone of May and still more fitably discussed when the figures for 1878 have been after the rain of September and October the death published and the census of 1881 taken. rate rose rapidly. The districts of Kurnool, Cuddapah, The famine districts, as might have been anticipated, Salem, North Arcot and Neilgheries exhibit the highest exhibit much higher rates than those in which no famine rates, and as a rule the famine districts suffered more existed. Thus Madras gives a rate of 119-4, Kurnool than the famine-free. It is also noteworthy that the hea- 93*9, Bellary 92*6, Salem 90'1, while Ganjam, Vizagapatam viest mortality occurred sometime after the climax and Godavery show only 17*04, 17'4 and 20*6 ; Ivistna of the famine had over. The reduced condition < passed and Tanjore 252 and 37'4, and South Janara and Mala- of the people and the insanitary circumstances under bar 33*4 and 22 0. On the important question, how the which they lived expjain the great mortality which people died, the report gives abundant and most interest- occurred, when seasonal and local conditions deter- ing information. In the first place cholera, which broke mined the development of the fever poison. Bowel out in 1875 and prevailed extensively in 1876, committed complaints were to a considerable extent confounded terrible ravages in 1877. The total number of deaths with cholera, more especially the peculiar famine flux registered under this head was 357,430, or 12'2 per mille which was so common and proved so fatal. The against a mean rate of 0*8 per loOO for the 5 preceding number of deaths registered under this head was years. The subject is treated in great detail in the report 133,366 against 37,886 the mean of the 5 preceding years, excellent a and illustrated by tables and carefully or 4 5 per mille against 1*3. Here again the famine devised and executed map. It is shown that cholera districts exhibited a decided pre-eminence, giving a rate has always gained head in years of exceptional drought of 6'4 against 1-4 for the non-famine districts. The and scarcity, and that the disease was worst in districts mortality caused by injuries was also in excess. Suicides most On where famine prevailed longest and severely. numbered 2,57.t against an average of 1,969, and there the other hand it is stated that there was no relation be- was an excess of accidents explained to some extent by tween the intensity of famine and the intensity of cholera. the injuries sustained in pulling carts. Deaths " " grain Our food pressure was most severe in July and August, from other causes" were doubled, and here also the but the cholera intensity was at its maximum in January famine districts render a rate of 21*8 per 1,000 against and February, when a large number of the persons attack- 8-5 in the others. The classification employed in register- not the ed had undergone gradual decline of health from ing deaths is extremely crude, and gives a very imperfect chronic starvation." It is clear, therefore, that while the view of the causes to which mortality was really due. effects of the disease were aggravated by the conditions Air. ('ornish has, however, appended to his report a paper " prevalent in the Madras Presidency in 1876 and 1877, it on the sanitary and medical aspects of the famine," in obeyed those seasonal influences which have so material which the physical effects of starvation on the tissues, a power over its propagation and continuance. Attain- organs and functions of the body are discussed at some ing a maximum in December 1876 and January and length, and a mass of most valuable information founded Fenruary 1877, it declined in the hot months, rose on observation is given, as to how life is impaired and again in July and August, fell in September and destroyed by famine. To this subject we propose to October and abated towards the close of the year, except draw attention in a future number. in the northern districts when the normal rain was While the sanitary history of the general population scanty. It would thus seem that the first check was of Madras in 1877 is a tale of distress, disease' and given by the intense heat of the hot months and mortality, it is satisfactory to notice that the bodies of that a partial recrudescence in the moisture of July British troops stationed in that Presidency maintained a and August was quenched by the heavy rains of high standard of health. The number admitted into hos- and Some must September October. credit also be given pital was 1172-2 per mille, the daily sick 58-7, the deaths to the tendency of all epidemics to wane after having 17-2 and the invaliding 46-2. These figures contrast favor- visited a population and attacked all the susceptible. ably with previous years ; 64 cases and 22 deaths were By way of explaining the exceptional intensity of the attributed to typhoid fever, and 35 cases and 19 deaths states that " all the disease, the Sanitary Commissioner to cholera. This latter result is considered very favor- conditions of rural bad feed- that the disease so normal insanitary life, viz., able, seeing prevailed severely every- ing, bad'housing, bad conservancy and bad water were where and no special precautions were taken to avoid it. the famine distress the to The intensified by forcing people native army had 832-2 admissions per 1,000, 28'8 herd together in works and centres of relief.-' The facts daily sick and 13 deaths. The mortality was above he to those of the occasion also, points out, give support the average of past years; 99 cases and 1 death were who connect cholera with the consumption of foul water. due to small-pox, and 190 cases and 8(J deaths to cholera. show that the disease The tables and maps prevailed The sepoys appear therefore to have suffered to some at one time or other in of varying degrees intensity extent from the unhealthy conditions so rife among throughout the whole presidency. The deaths from small- their countrymen. The and pox numbered 88,321. prevalence mortality The statistics of the jail population were affected by of the disease were than at time within the greater any the famine in a very marked manner, 12,242 persons re- Commissioner's of the The Sanitary experience country. mained in confinement at the close of 1876, 2,274 were and their promiscuous herding of the people carelessness liberated on the 1st of January on the occasion of the and indifference as regards avoiding palpable sources of Queen's assumption of the title of Empress of India, and infection he causes of ex- were, thinks, the principal the yet the population increased to 24,081 at the close of the cessive of the disease. The seasonal fluctua- prevalence year. 70,779 persons were incarcerated during the year. tions of the were not so marked as usual- It epidemic The admissions into hospital were 971 *3 per 1,000 and the lias been noticed that is a constant attendant small-pox deaths 175*4 por mille. Famine stimulated crime, on in and is the largely scarcity India, always aggravated by and many "committed offences with the sole of find- of life to object abnormal conditions which famine gives rise. ing refuge and food in the State was with redoubled and jails." Overcrowding Vaccination prosecuted energy, and bad sanitation were and the miserable con- its beneficial influence was well marked when it could inevitable, dition in which a majority of the were admitted be carried out The of prisoners effectively. number deaths attri- fully accounts for the terrible death-rate. In famine buted to "fever" was about twice as as in large any area the death rate was 215*7 and in other districts 68'3. since was the previous year registration commenced, In the Coimbatore district jail the death rate reached ratio 16-0 per 7 6 for the 5 being 1,000 against previous the rate of in the Chittoor it was The of the disease was appalling 657-2, jail years. type malarious, and no 536-5, in Bellary 3190, in Kurnool 307-0 and in Madura 300. relapsing or other continued fever was observed. During The central jails which receive only long-term prisoners, February 1, 1879.] MEDICAL NEWS. 59

had a rate of only 87*3 against 220-2 for district jails. And under-trial prisoners died at the rate of 189*3 against 173*5 for convicts. The principal causes of death were diarrhoea 50*1 per mille, dysentery 32-1, cholera 25-7, dropsy 5*8 and anaemia 2'0. The condition of those im- prisoned during the year was one of grave physical depression and disease, and prison observations and statis- tics fully confirm the evidence obtained elsewhere regarding the terrible effects of the distress on the popu- lation of the Madras presidency. We have left many interesting and important topics in this admirable report untouched. The sketch which we have endeavoured to draw from it of the general phenomena and effects of the famine, may, however, serve to indicate how valuable and complete a record of this disastrous event Surgeon- Major Cornish has compiled.