# Gódávari/Chapter 9

CHAPTER IX.
PUBLIC HEALTH.
Prevalent Diseases—Malaria; in the Agency—In the uplands—In the delta—Cholera—Small-pox—Other diseases—Sanitation. Medical Institutions—Public hospitals and dispensaries— Mission institutions—Institutions in Cocanada—Rajahmundry hospital
The most noticeable of the diseases which afflict the district is malaria. This is worst in the Agency. The Gháts there are densely wooded and the valleys are filled with a tangle of damp jungle, so that during the rains the country is eminently suited to the propagation of the malaria-bearing mosquito. Beyond the Gháts, the lower parts of Bhadráchalam appear to be equally malarious, the villages along the valley of the Saveri river and those lying between it and the Rékapalle hills being the worst parts of the taluk.
Even the Koyas, who have resided for untold generations in the Agency, are not immune to malaria. The disease is said to be chronic among them, and its effects are particularly noticeable in the case of the children. People from the plains suffer far more severely, however; and from the earliest times up to the present day the country has retained a most unenviable reputation for its unhealthiness. The Board of Revenue referred to its 'putrid fever' as far back as 1794; and of the party of 25 men who were recently engaged in inspecting the forests of Rekapalle preparatory to the preparation of the working-plan for their exploitation, almost all subsequently suffered from low fever of a malignant and lingering type, several were dangerously ill, and as many as one-fourth died. It is characteristic of this malaria that it does not as a rule show itself when the victim is in the hill country, but appears in all its virulence as soon as he descends to the plains. One explanation of this fact avers that the system is braced to resist the disease by the cooler air of the hills, but as soon as the patient reaches the hotter plains becomes relaxed, and allows the latent malaria to obtain the upper hand. The agency malaria is generally said to be more prevalent in the cold than in the hot weather, but no season of the year is free from it. ​The upland taluks adjoining the Agency also suffer, though to a much less extent, from malarial fever. In 1869-70, before the advent of the theory that all malaria is conveyed by the anopheles mosquito, elaborate enquiries were made as to the prevalence and causes of the disease in these parts of the district, and the Sanitary Commissioner arrived at the conclusion that the fever in the plains was due to the northerly winds which sweep over the malarious forests of the hill tracts. He pointed out that the taluks which were most open to breezes from the sea had the least fever, while those which were most exposed to wind blowing across unhealthy jungles had the highest ratios of sickness and death from malaria.
The question had also been raised at that time whether the great increase of irrigation under the recently-constructed anicut was in any way responsible for the insalubrity of the district. It was known that in some places (the Punjab, for example) irrigation was invariably accompanied by malaria. Enquiries were therefore directed at the same time to the elucidation of this point. The conclusion arrived at was that the irrigation had had no effect upon the prevalence of malaria. The result of five years' registration of vital statistics 'demonstrates in a very clear manner that the intensity of fever in any taluk has no relation to the extent of irrigation of the land, but is solely due to its geographical position and its exposure to malarious winds during the north-east monsoon.' The irrigated taluks were in fact found to suffer in very varying degrees. For five years the death-rate in Rámachandrapuram taluk had been 11.9 per thousand, while in Amalápuram and Narasapur it was 6.5 and 4.6 per thousand respectively. The difference was attributed entirely to the position of the taluks, the former being exposed to winds from the north, while the latter are swept by sea-breezes.1 Theories regarding the dissemination of malaria have doubtless changed since those days, and vital statistics in rural areas are seldom sufficiently accurate to afford a firm foundation for debatable propositions; but the fact remains that the delta taluks (unlike irrigated areas in some places in this Presidency — the valley of the Tungabhadra, for example) are not greatly subject to malaria and are, in fact, the part of the district in which it is least prevalent.
Cholera, however, is endemic throughout the delta. It is chiefly conveyed from place to place along the lines of communication, that is, by the movement of persons affected with ​it, and by the irrigation channels, which are used for drinking purposes. At times the disease has broken out in a very serious manner. In 1892 as many as 13,600 persons died of it in the Gódávari district as then constituted, and in 1878, 1879 and 1889 its victims numbered between nine and ten thousand. But such visitations have been rare; and, though in nearly every one of the last 35 years cholera has claimed some victims, the number of these has, as a rule, been less than that even in less populous districts. It exceeded one thousand in 17 of the 32 years between 1871 and 1902 inclusive, but on only four occasions was it higher than in any other district.
The ravages of small-pox have on the whole been less serious than those of cholera, but on more than one occasion they have been very grave. In 1878 over l8,000 persons died of the disease in the district as then constituted, and in 1884 over 11,300. In six of the 32 years between 1871 and 1902 more deaths occurred from small-pox in this district than in any other; in fifteen of these years the mortality exceeded one thousand; and in only one year did it fall below one hundred.
A serious epidemic of the disease broke out in the delta taluks and the Tuni division in 1900, and after that compulsory vaccination was extended to a number of the unions. It is now in force in the municipalities of Rajahmundry and Cocanada and the unions of Dowlaishweram, Amalápuram, Kottapéta, Peddápuram, Rámachandrapuram, Pithápuram and Tuni.
Certain other less virulent diseases are common in Gódávari. Dysentery and diarrhœa are frequent, but perhaps not more so than elsewhere. Elephantiasis and hydrocele are also prevalent, and the town of Peddápuram has a bad name for the former. Guinea-worm is rare. A few cases of black-water fever have occurred in the Bhadráchalam taluk. A peculiarity of the district is the prevalence of beri-beri, the Telugu name for which is ubbu vayuvu. Though endemic in many localities, it is frequently epidemic, and it is commonest along the coast. It is said to confine its attacks to males and to be most frequent among the middle-aged.
A good deal has been done in the municipalities to improve sanitation, and with satisfactory results. In rural villages, as in other districts, matters are still backward and even the state of the unions leaves much to be desired. The difficulties are greatest in the delta, where the pressure of cultivation leaves little waste land round the village sites and the population is thickest. Drinking-water is also usually ​obtained there from the irrigation canals, which are liable to pollution. The water-works recently constructed in Cocanada municipality are referred to in Chapter XIV.
The public medical institutions in the district comprise seven hospitals and seventeen dispensaries. Of these, two hospitals and a dispensary are maintained by the municipalities, and the rest by the local boards. Statistics regarding all of them will be found in the separate Appendix to this volume.
Besides the above, the missions maintain several medical institutions. The American Lutheran Mission at Rajahmundry keeps up a dispensary for women and children in which some 3,000 cases are treated annually. Connected with the dispensary is a small hospital, and the erection of a larger one has been resolved upon. The Canadian Baptist Mission manages, and in part maintains, the Kellock Home for lepers at Rámachandrapuram, which was founded in 1899 by the liberality of Mrs. Kellock, the widow of Dr. Kellock, a Canadian Baptist. At the end of 1904 the patients attending it numbered 94. It contains three large wards for men and a smaller one for women, and is owned, and largely supported, by the Mission to Lepers in the East. At a distance of a mile from it, is the Phillips Memorial Home for the untainted children of the lepers, which was erected from the subscriptions of the children attending Sunday schools in Great Britain in memory of the first Secretary of the Indian Sunday School Union. The Canadian Baptist Mission also has a dispensary at Rámachandrapuram, and is erecting at Pithápuram a hospital to contain 21 beds.
The medical institutions in Cocanada town comprise a hospital, a branch dispensary and a dispensary for women and children.
The first of these is situated in the suburb of Jagannáthapuram. It was founded in 1856 and has 32 beds for male, and 14 for female, patients; in the out-patient department is a room with six beds set apart for Europeans. The main block is well ventilated and lighted; but there are no caste, or special contagious, wards. The hospital is jointly maintained from Provincial, local, and municipal funds. It is in charge of a Commissioned Medical Officer aided by an Assistant Surgeon and two hospital assistants, and is under the general control of the municipal council.
The branch dispensary in the same town was founded in 1888 and is maintained by the municipality. It treats over 20,000 patients annually. The building, was erected in memory of M.R.Ry. Kommireddi Narasinga Rao by his son. ​The dispensary for women and children at Cocanada was established in 1895 and the attendance is over 11,000 annually. Its expenditure is nearly all met from local funds and it is under the control of the District Board.
The Rajahmundry hospital has been in existence since 1854. It contains twenty beds for men and twelve for women. The attendance is larger than that at any other medical institution in the district, and compares favourably with the figures for most of the mufassal institutions in the Presidency. Its expenditure is met from municipal and local funds; it possesses an invested capital of Rs. 5,560; is under the general control of the municipality; and is managed by a Civil Surgeon and two hospital assistants.