I cannot even discuss the cases of mental disorders, of thc onset of progressive paralysis and the like, where a greatcr or lesser specialized diagnosis is required. All these people arc working and arc considered healthy. Some arrive here alrcady ill or thcy bring the germination of illnesses with them. Thus the church records describe convict Goro- dov as having died from progressive paralysis. He had been sentenced for premeditated murder, which he had probably committed after having already been stricken with the dis- case. There are many on thc island whose sufferings every day and every hour offer a sufficient reason for a weak man with broken nervcs to go insanc.12
There were 1 ,76o cases of gastrointestinal disorder re- corded in 1889. In ten years 338 died; of these 66 percent were children. July and August arc the most dangerous months—a third of the total of children's deaths occur in those months. Adults also die most frequently from gastro- intestinal disorders in August. This is probably because August is the month of the migratory fish runs and they gorge themselves on fish. Gastric catarrh is a common ill- ness. Natives of the Caucasus always complain that their "heart hurts," and vomit after eating rye bread and prison cabbage soup.
Cases of female illnesses were infrequent in 1889. Only 105 were recorded. There are almost no healthy women in the colony. One of the commissions which inquired into the provisioning of convicts—the director of the medical department was one of those who sat on the commission— declared inter alia that "about 70 percent of the convict women suffer from chronic female illnesses." Sometimes there was not one single healthy woman in a group of female prisoners arriving on the island.
The most prevalent eye disease is conjunctivitis. Its epidemic form is not contagious among foreigners.13 I can say nothing about more severe eye afflictions because all disorders of the eye are included in the figure of 2 i i cases. In the huts I saw people who had only one eye, with cata- racts, completely blind. I also saw blind children.
There were i ,2 i 7 persons who requested medical aid for traumatic injuries, for dislocations, fractures, contusions and all types of wounds. All these injuries were suffered at work, in a variety of unfortunate accidents, in escapes (shotgun wounds) and in fights. This group contains four infirmary cases of women who had been beaten by their cohabitants.14 Rigor was recorded in 290 cases.
In ten years there were I70 cases of unnatural death amid the Orthodox population. Of this number 20 were sentenced to death by hanging, 2 were hanged by unknown persons, 27 committed suicide—in Northern Sakhalin they shot themselves ( 1 shot himself on sentry duty), and in Southern Sakhalin they poisoned themselves with wolfs- bane. Many were drowned, frozen to death, crushed by trees; one was torn to bits by a bear. In addition to such causes of death as stroke, heart attack, apoplexy, general paralysis of the body, etc., the church records show 17 cases of "sudden death." More than half of these were between the ages of 22 to 40, and only i was over 50.
This is all that I can say about morbidity in the penal colony. Despite the exceptionally weak development of infectious diseases, I still cannot fail to acknowledge their significance on the basis of the above figures. There were i 1,309 patients requesting medical aid in 1889. During the summer most of the convicts work and live at a consider- able distance from the prison and even in the prison a medical assistant is assigned only to large groups. Since the majority of the settlers cannot walk or ride to the in- firmary becausc of the great distances and the terrible weather, this figure applies chiefly to that portion of the population which lives close to the medical stations at the posts.
According to data in the report, there were 194 deaths in 1889, or 12.5 pcrcent, for every thousand persons. This percentage might serve as the basis for a magnificent illu- sion and suggest that Sakhalin is thc hcalthicst place in thc world. Howcver, it is ncccssary to wcigh the following facts. Under ordinary conditions half of the deceascd are usually childrcn, and somewhat Icss than a quartcr are thc agcd. But therc arc vcry fcw children on Sakhalin and there are almost no agcd, so that in actuality thc coefficicnt of 12.5 pcrcent rcfers only to those of working age. Since it is shown to bc lowcr than the facts warrant, and since it was calculatcd in rclation to a population of 15,^^, thc death ratc is at least half again as large as that indicatcd hcre.
At present Sakhalin has three medical centcrs, one in each district: in Alexandrovsk, Rykovskoye and Korsakov. Hospitals arc called district infirmaries in thc old-fashioned way, and thosc huts or wards wherc paticnts with minor illncsscs are treatcd are callcd clinics. Each district is as- signcd one physician, and all mcdical mattcrs arc headed by thc director of the mcdical dcpartmcnt, a physician. The military havc thcir own infirmarics and doctors, and the military doctors oftcn substitute temporarily for prison doctors. During my visit, because of thc absence of the di- rector of the medical departmcnt, who had left to attend a prison cxhibition, while the prison doctor had taken a leavc of absence, the military doctor was in charge of the Alcxandrovsk infirmary. During my presence in Due the military doctor substituted for the prison doctor during the executions. The local infirmaries are guided by civilian hos- pital rcgulations and are supported by prison funds.
I will say a few words about the Alexandrovsk in- firmary. It consists of several buildings resembling bar- racks,15 with 180 beds. When I approached the infirmary, the new barracks with their heavy round logs glistened in the sun and exuded a coniferous odor. In the dispensary everything was new, everything was shiny and there was even a bust of Botkin1(i sculptured by a convict from a pho- tograph. "It's not a very good likeness," said the medical assistam, glancing at the bust. As usual there were large boxes of medicinal bark and roots, from which a good half had already been dispensed. As I proceeded farther inta the barracks, I found the floor between the two rows of beds has been covered with fir twigs. The beds were of wood. On one lay a convict from Due with his throat cut. The wound is over half a vershok long, dry and gaping. You can hear the air escaping. The patient complains that he had been hit by a falling tree which injured his side. He requested admittance to the surgery, but was refused by a medical assistant. Feeling deeply insulted, he attempted suicide—he cut his throat. There is no bandage on his neck; the wound is left to heal itself. Some three to four arshins to the right of this patient is a Chinese with gangrene, to the left a convict with erysipelas. In the corner lies another with erysipelas. . . . The dressings of the surgical patients are filthy; the marine cord is suspicious, looking exactly as though it has been walked on. The medical assistant and the infirmary workers are undisciplined, do not understand questions, and look unpleasant. A convict called Sozin, who had been a medical assistant when he was free, is the only one who obviously knows the proper regimen in a Russian hospital, and it seems to me that he is the only person in the entire hospital staff who will not offend the god Aes- culapius by his attitude toward his duties.