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CHAPTER XXIV.

VITAL STATISTICS.

health

THE vital statistics of India1 are derived from five chief Five sources. Of these, the first or European army consists of sources of foreigners under special medical conditions, and subject to returns. the disturbing influence of 'invaliding.' The second, or native army; the third, or jail population; and the fourth, or police; are all composed of natives, but of natives under special conditions as regards food, discipline, or labour. It is dangerous to generalize from returns thus obtained, with regard to the

1 The literature of Indian health statistics and medical aid may be divided into eight chief classes :-(1) Separate treatises by a series of medical observers, dating from the latter part of the 18th century and continuing up to the present time. (2) Official special reports of the Medical Boards of Bengal, Madras, and Bombay on the great outbreak of cholera in 1817; the Medico-Topographical Reports (1825-40) of the chief stations of the Madras Presidency, by the Medical Board of that Presidency. (3) The Transactions of the Medical Physical Society of Calcutta (1823-39), and of Bombay (1837-76); the Indian Annals of Medical Science (Calcutta) (from 1853-80); other medical journals at different periods in the three Presidencies. (4) Reports on the Medical Education of the Natives of India, commencing with vernacular medical schools in Calcutta and Bombay (1820-30), developing (1835-57) into the medical colleges of Bengal, Madras, and Bombay, and extending into medical schools at Haidarábád (Deccan), Nágpur, Agra, Lahore, Balrampur (Oudh), Patná, Dacca, Poona, Ahmedábád. (5) Reports on Vital Statistics by the various Medical Boards, Medical Departments, and Inspectors-General of Hospitals; since 1827 these assume a prominent place. (6) The Annual Reports of the Sanitary Commissioner with the Government of India, since 1874, and of the Sanitary Commissioners to the local Governments; the Annual Reports of the Inspectors-General of Jails, of the Inspectors-General of Police, and of the health officers to municipal bodies in the various Presidencies and Provinces. (7) Reports by special Committees or Commissions, such as those on the Bardwán fever, on the cattle-plague in Bengal, the Orissa famine of 1866, the Madras famine of 1878, etc. (8) Annual Reports of the public hospitals, dispensaries, and other medical charities. I have been unable to test all the dates in this footnote; but reproduce some of them, unverified, from a memorandum supplied to me by Dr. Morehead, formerly of Bombay.

untrustworthy.

For that

health statistics of the ordinary population of India.
population, however, a system of registration exists, and this
system forms the fifth source of our data on the subject.

Registra- In certain Provinces, registration is carried out with some
tion of
degree of efficiency. But the natives shrink from publicity
general
population. touching the details of their life. They could only be forced
Why to give uniform and absolutely trustworthy returns of births,
deaths, marriages, sex, and age by a stringent legislation, and
a costly administrative mechanism, from which the Govern-
ment wisely abstains. In municipalities, however, registration
furnishes a fairly accurate account of the vital statistics of the
urban population. For the rural Districts, special areas have
in some Provinces been selected for statistical supervision.

The
Census.

Sources of error.

Death-rate in India.

Average duration of life.

The Census operations, conducted under special legislation, will furnish a general picture of the Indian people every ten years. But the complete details have, up to the present time of writing, been obtained only for the Census of 1871. The chief results of the Census of 1881 are given at page 67.

In treating of the public health of India, therefore, three points must always be borne in mind. The data are obtained either, first, from limited classes under special medical conditions; or second, from limited areas under special statistical supervision; or third, from a general system of registration spread over the whole country, but which has hitherto failed to yield trustworthy results. General averages from such sources, struck for the entire population, can only be accepted as estimates based upon the best information at present available. Subject to the above remarks, it may be stated that the evidence goes to show an annual death-rate of 3257 per thousand in India. During the famine of 1877-78, the deathrate in Madras was ascertained to be equal to an annual rate of 532 per thousand. In 1877, the death-rate among the European troops in India was 12'71 per thousand, being the lowest recorded; in the native army, 13:38 per thousand; in the public jails, 61.95 per thousand, rising to 176 per thousand in the Madras prisons, which were flooded by the faminestricken population. The returns of births, as given hereafter for each Province, are too untrustworthy to allow of an attempt to calculate the birth-rate for the whole country. The average duration of life in India is, on slender foundation, estimated at 30 years. Instead of attempting generalizations, which, although interesting to the speculative statist, might mislead the actuary and be perverted into an unsound basis for induction, I shall confine myself to the returns as furnished for the separate

Provinces; together with the health statistics of the European troops, the native army, and the jail population. The following paragraphs are condensed from the Report of the Sanitary Commissioner with the Government of India, for 1877.

statistics

In Bengal, the system of collecting statistics over selected Vital areas has been abolished, and an attempt is being made to of Bengal. obtain returns equally from the whole Province. The registration of deaths in 1877 showed a ratio of 17.96 per mille (varying in different Districts from 36 down to 8), which, according to the Sanitary Commissioner, 'must be very much. under the truth.' The mortality in towns (where the registration is less incomplete) is returned at 32'49, compared with 17.39 in the rural circles. Of the total death-rate, 20 ̊24 was among males, and only 1569 among females, 'a discrepancy which must be due in the main to defective registration.' The registered number of deaths in 1876 was 16:41, and in 1875, 1001 per mille. The following figures show the causes of the deaths registered in 1877 :-Cholera, 2:58 per mille; small-pox, 013; fevers, 11.85; bowel complaints, o'98; injuries, o'34; all other causes, 2.05 per mille. The birth-rate, which averaged 10:20 for the whole Province, varied, according to the returns, from 35 in Patná to only 6 in Bardwán and Bákarganj Districts. The male births are returned as exceeding the female births in the proportion of 118 to 100. Excess of births over deaths in Bengal Presidency in 1877, population. An Act, passed in 1873, for the compulsory registration of births and deaths was in force in 92 towns of Bengal in 1877

0'07 per thousand of the

of Madras.

In the Madras Presidency, both births and deaths were Vital much affected in 1877 by the famine which desolated that statistics part of the country, and registration was conducted under special difficulties. Though many defects are consequently apparent, the Sanitary Commissioner is of opinion that the relative intensity of the famine in different circles is fairly represented by the mortuary registration.' The registered death-rate was 53'2 per mille; and in Madras city the rate was 116.7 per thousand (see article MADRAS PRESIDENCY, Imp. Gaz. vol. vi. pp. 137, 138). Among males, the ratio is given as 584, and among females 48'06, which points to imperfections in the record of female deaths.' The following figures show the causes under which the deaths of 1877 in Madras were classified in the Sanitary Commissioner's Report:Cholera, 122 per mille; small-pox, 3'02; fevers, 16'06; bowel complaints, 4'5; injuries, o'5; all other causes, 16.8 per mille.

1

Vital

statistics

The number of registered deaths in 1876 was 23:34, and in
1875, 211 per mille. The famine resulted in a marked reduc-
tion in the birth-rate, the ratio for 1877 being only 16'3, or less
than that of 1876 by more than 5 per mille. For every 100
female births, 107 male births were registered. In the nine
Districts where the famine was most severe, the birth-rate was
only 12, whereas in the eight where the people suffered less
the rate was 20 per mille. Excess of deaths over births in
Madras Presidency in 1877, according to the above figures,
36.9 per 1000 of the population. The registration of births
and deaths was not compulsory in Madras in 1877.

In the Bombay Presidency, famine affected the death-rate in 1877, and the year was also more than usually unhealthy, of Bombay. cholera and small-pox being both epidemic. The mortality,

North

according to the returns, was at the rate of 38.76 per mille,
varying in different Districts from a maximum of 101 to a
minimum of only 8. The deaths among males were returned
at 4132, and among females at 36'01 per 1000. In the
famine-stricken Districts the mortality was 55'09, compared
with 2571 per mille in 1876. The following figures show
the causes of the deaths registered in 1877-Cholera, 3'53;
small-pox, 169; fevers, 20'79; bowel complaints, 372;
injuries, o*46; all other causes, 8'55 per mille. The deaths
registered in 1876 were 21.81, and in 1875, 22:47 per 1000.
Besides the causes already referred to as affecting the figures
for 1877, the Sanitary Commissioner states that increased
attention was paid to registration during the year. The birth-
rate in the Bombay Presidency in 1877 was 19:26 per mille
(varying from 29 to 6), or 2'09 per mille less than the ratio for
1876-'a result which is for the most part ascribed to the
effects of famine; but also, in great measure, to neglect in
registration.' For every 100 female births, III male births
were registered. Excess of deaths over births in Bombay
Presidency, 19'54 per 1000 of the population.

The North-Western Provinces and Oudh together returned Western a death-rate in 1877 of 1967 per mille, varying from 29 to 12. and Oudh. For Oudh alone, the ratio was 17'1; and for the North-Western

Provinces

Provinces alone, 2016. The mortality in the towns of the
amalgamated Province was 29'43, compared with 18.99 in the
rural circles; and of the total death-rate, 2106 was among
males, and 1812 among females. The registered number of
deaths in 1876 was 21'94 per mille, and in 1875, 1996. The
following figures show the causes of the deaths registered in
1877-Cholera, o'74; small-pox, o'84; fevers, 13'45; bowel

The

complaints, 198; injuries, o:46; all other causes, 2:20. registration of births was in 1877 confined to the municipalities in the North-Western Provinces and Oudh, but since then it has been carried on throughout the Province. The average birth-rate registered in the municipalities in 1877 was 39'22 per mille, varying from 70 at Orai to 14 at Dehra. Excess of births over deaths per 1000 of the population, 10°27.

of the

In the Punjab, the death-rate for 1877 is recorded as 20 Vital per mille, and the same rate applies to both males and females statistics taken separately. The District average varies from 27 per Punjab. mille in Lahore to 8 in Kohát on the frontier. In the towns, the mean mortality was 33, varying between a maximum of 52 (in the town of Delhi) and a minimum of 12 (in Kohát). The registered number of deaths in the Punjab in 1876 was 28'42, and in 1875, 25'7 per mille. The year 1877 was remarkably healthy, and unusually free from epidemics. The following figures show the causes for the deaths registered :-Cholera, o'001; small-pox, 0.70; fevers, 12'54; bowel complaints, 101; injuries, o 29; all other causes, 5'52 per mille. In 1877, births were registered only in the municipal towns of the Punjab, and the results showed a birth-rate of 31.86 per mille; number of males to every 100 females, III. Excess of births over deaths per 1000 of the population, 5.

statistics

In the Central Provinces, the recorded death-rate in 1877 Vital was 23.91 per mille, varying from 38 in Mandla to only 18 in of the Nágpur District. Among males the death-rate was 25'66, and Central among females, 22.11. In the towns, the ratio was 35.86 Provinces. per mille. The registered number of deaths in the Central Provinces in 1876 was 30:38, and in 1875, 26'32 per mille. The following figures show the causes of the deaths recorded in 1877-Cholera, 0:46; small-pox, 0'37; fevers, 17.70; bowel complaints, 2.01; injuries, o'48; all other causes, 2.89. Births were in 1877 registered throughout the Central Provinces, the ratio being 39 26 per 1000 of the population; varying from a maximum of 45 in Bilaspur to a minimum of 31 in Nágpur. The number of male births recorded was 111 for every 100 female births. Excess of registered births over deaths in the Central Provinces in 1877, 15'35 per 1000 of the population.

of Berar

In Berar, the Sanitary Commissioner describes the regis- Vital tration as more accurate, and he does not attribute the high statistics death-rate for 1877 (28.1 per mille) to exceptional unhealthiness, but rather to more careful registration. In the towns alone the mortality was returned at 314 per mille. The registered number of deaths in Berar in 1876 was 319, and

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