Dyscntcry or bloody diarrhea is recorded only five times. Therc were known cpidemics of dysentery in Duĉ in 1880 and in Alcxandrovsk in 1887, but the church records show a total of eight deaths due to this illness during the ten- year period. Old correspondence and reports often mention dysentery, which in former days was probably as common as scurvy. Convicts, soldiers and foreigners suffered from it and there are further indications that suggest it was caused by the vile food and the abominable living condi- tions.7
There was no case of Asiatic cholera on Sakhalin. I observed erysipelas and military hospital gangrene myself, and apparently both these illnesses are not infectious in the local infirmaries. There was no whooping cough in 1889. Intermittent fever was recorded 428 times, more than half of the cases occurring in the Alexandrovsk district. The report names the causes as the warmth of the habitations, which lack sufficient fresh air, contamination of the soil near habitations, work in localities which undergo periodic flooding, and the construction of settlements in such locali- ties. All of these unhealthy conditions do exist; nevertheless the island does not give the impression of being a malarial location. During my visit to the island I never saw anyone suffering from malaria and I do not recall even one settle- ment where men complained of this disease. It is possible that many of the recorded examples were contracted when they were still in Russia and they arrived on the island with an already enlarged spleen.
Death from malignant anthrax was mentioned only once in the church records. Neither glanders nor hydro- phobia has been observed on the island.
Diseases of the respiratory organs cause one-third of the deaths, tuberculosis in particular being responsible for 1 5 percent. The church records only contain data on Chris- tians, bur if we added the number of Moslems who die from tuberculosis there would be an impressive percentage. In any case, adults on Sakhalin are susceptible to tubercu- losis to a high degree. Here it is a most frequent and most dangerous disease. Deaths occur most often in December, when it is extremely cold on Sakhalin, and in March and April. The lowest incidence of death is in September and October. Herewith is a breakdown of deaths from tubercu- losis by ages:
From o to 20 years of age
3%
From 20 to 25 years of age
6%
From 2 5 to 3 5 years of age
43%
From 35 to 45 rears of age
27%
From 4 5 to 55 years of age
12%
From 55 to 65 years of age
6%
From 65 to 76 years of age
2%
Consequently, those in the 25-35 and 35-45 age brack- ets, workers in the prime of life,8 are most subject to the peril of dying from tuberculosis. The majority of those who died of tuberculosis are convicts ( 66 percent). This predominance of working-age convicts gives us the right to conclude that the significant mortality from tuberculosis in the penal colony is produced by the adverse living condi- tions in the prison wards and the oppressivcncss of penal labor, which exacts more cnergy from the worker than prison farc can give him. Thc raw climate, all the depri- vations suffcrcd during work, escapcs, and imprisonment in cclls, thc turbulcnt lifc in thc prison wards, thc insuffi- cicncy of fats in thc food, longing for thc homcland—these arc thc causcs of Sakhalin tuberculosis.
Syphilis was rccordcd in 246 cascs, with five deaths. All of thesc, as statcd in thc rcport, wcre old syphilitics in sccondary and tertiary stagcs of thc discasc. Thc syphilitics whom I saw wcrc pathctic. 'licsc ncglccted, chronic cascs indicated a complctc lack of medical inspection, which in cffcct should have bccn ideally thorough in view of the scant convict population. Thus in Rykovskoye I saw a Jew with syphilitic consumption. Hc had not bcen treated for a long timc and was slowly wasting away whilc his family impaticntly awaited his dcath. And this occurrcd about half a vcrst from thc hospital. Thc church records indicate I 3 dcaths from syphilis.fl
Thcrc werc 27 I cascs of scurvy recordcd in 1889, with 6 dcaths. Thc church records show 19 deaths from scurvy. Somc twcnty to twcnty-fivc years ago this discase was incomparably more prcvalcnt on the island than within thc past dccade, and many soldiers and prisoners pcrished from it. Somc of thc old writers who favored the founding of thc penal colony on thc island completely denied the existcncc of scurvy, whilc thcy simultancously praised wild garlic as a marvelous preventivc of scurvy. They wrote that the people storcd hundreds of poods of this preventive for the winter. The scurvy which raged on the Tatar shore would scarcely have spared Sakhalin, where living condi- tions at the posts were hardly any better. At present this disease is most frequently imported by prisoners arriving on the ships of the Voluntary Fleet. This is also stated in the medical reports. The district commander and the prison doctor in Alexandrovsk told me that on May 2, 1890, the Petersburg landed 500 prisoners, 100 of whom were suffer- ing from scurvy; 5 i of these were put into the infirmary and the clinic by the doctor. One of these sufferers from scurvy, a Ukrainian from Poltava whom I found in bed in the infirmary, told me he had contracted scurvy in the Kharkov central prison.10
Of the common illnesses due to the bad diet I espe- cially recall marasmus, from which people of working age, not old people, die on Sakhalin. One died at 27, another at 30, others at 35, 43, 46, 47, 48 years of age. Could it be a priest's or a medical assistant's slip of the pen when "senile marasmus" is recorded as the cause of 4 5 deaths of people who were still young and had not yet reached the age of sixty? The average life expectancy of the Russian penal convict is not yet known, but judging by appearance, peo- ple in Sakhalin age and grow senile very early in life, and in the majority of cases a forty-year-old convict or settler is already an old man.
The exiles do not usually request treatment at the in- firmary for nervous disorders. Thus, only 16 cases11 of neuralgia and convulsions were recorded in 1889. Obvi- ously only those who are ill with nervous disorders who have come on foot or in some conveyance to the infirmary are treated. Meningitis, apoplexy and paralysis caused 24 cases, with io deaths; epilepsy is recorded in 3 i cases, and mental aberrations in 25. As I stated previously, people with mental illnesses are not treated in a separate instiru- tion on Sakhalin. During my visit to the Korsakov settle- ment a mental case was found living among syphilitics, and I was told that another became infected with syphilis. Others living in freedom worked together with healthy persons. They were cohabitants, they escaped and were put on trial. I personally met a number of insane persons in the posts and settlements.
I recall that in Due a former soldier constantly talked about the oceans of air and sea, his daughter Nadezhda and the Persian Shah, and of his killing the Kristovosdvizhensky church deacon. One day in my presence in Vladimirovka a certain Vetr'akov, who had spent five years in penal servi- tude, approached thc settlement inspector, Mr. Y., with a stupid and idiotic expression and extended his hand in a friendly manncr. "Arc you greeting me?" said the aston- ished inspector. It appeared that Vet^'akov had come to ask if he could have a carpenters ax from the government warehouse. ''I'll build myself a shack and later I'll build a hut," he said. He had long been recognized as a lunatic, had been examined by a physician and found to be a para- noiac. I asked his fathcrs name. He answered, "I don't know." Nevertheless they ga\e him an ax.