NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
6
Date.
March 13 ...
35 ...
16 ...
17 ...
18 ...
19 ...
20 ...
22 ...
23 ...
24 ...
25 ...
26 ...
27 ...
29 ...
30 ..
31 ...
April 1 ...
2 ...
3 ...
5 ...
6 ...
7 ...
8 ...
9 ...
10 ...
12 ...
13 ...
14 ....
15 ....
Houses
Dis-
infected.
14
46
49
65
75
81
50
168
56
86
103
72
101
74
81
54
37
42
54
44
43
9
27
36
27
29
16
18
24
Remarks.
} .
} Two
disinfecting
} divisions of 10 par-
} ties each.
}
}
Found 2 cases and one
corpse. Increased to
three divisions of 10
parties each.
Found one corpse.
Two divisions.
One division..
Date.
April 16 ...
17 ...
19 ...
20 ...
2:1
...
22 ...
23 ...
24 ...
26 ...
27 ...
28 ..
29 ...
30 ...
May 1 ...
3 ..
4 ...
5 ...
6 ...
7 ....
8 ...
10 ...
11 ...
12 ...
13 ...
14 ...
15 ...
17 ...
18 ...
19 ...
Houses
Dis-
infected.
21
28
48
18
12
12
14
10
16
20
12
9
9
12
11
7
12
6
7
4
7
7
7
5
1
4
4
Nil.
Nil.
Remarks.
One case found.
Two parties only.
Estimate of Disinfectants expended in the Plague Operations from March 13th to May 20th,
1897, including City, Cantonment, Segregation Camp, Hospitals and Suburban Municipa-
lity.
Name. of Disinfectant.
Lime, quick
„ chloride
Perchloride o£ mercury...
Manganese, di-oxide
Acid, hydrochloric
,, sulphuric
„ carbolic
Permanganate of potassium
Sodium, chloride
Other disinfectants used in
Quantity used.
Tons.
49 15/20
10 5/20
"
20
Lbs.
1,185
„
480
Jars.
12 1/4
17
Drams. 89
Lbs.
10
„
284
hospitals not inc
REMARKS.
= 5 gallons each.
luded.
7
Contents of Lime-washing Carts.
Articles.
Lime-washing tubs ...
Pails, zinc ...
Brashes, lime- washing
„
paint ...
Brooms, sweeping ...
Ladders, bamboo ...
Paint, red ...
Pickaxes
Shovel
Acid, carbolic ...
Kerosine
Lime, quick
„ chloride ...
Flag, white
Box for acid
...
...
...
...
Lbs.
...
...
Bottle
,,
Cwt.
Lbs.
...
...
Number.
1
4
4
1
4
2
2
1
1
1
1
2
28
1
1
Remarks.
Half band'.
10 feet long.
For antiseptic lotion.
Distinguishing flag.
Diary of Houses Lime-wasJied by Military Parties.
Date.
March 13
15 ...
16 ...
17 ...
18 ...
19 ...
20 ...
22 ...
23 ...
24 ...
25 ...
26 ...
27 ...
29 ...
30 ...
31 ...
April 1 ...
2 ...
3 ...
5 ...
6 ...
7 ...
8 ...
9 ...
10 ..
12 ...
13 ...
14 ...
Houses
Lime-
washed.
15
35,10
34
50
35
46
32
49
59
88
132
122
96
92
85
95
70
108
186
110
102
103
95
68
61
79
54
Remarks.
With cases of plague
and plague corpses
found by lime-wash-
ers.
1 corpse found.
)
)
) Two divisions.
) 1 corpse found.
)
Three divisions.
1 case, 2 corpses.
1 corpse.
1 case.
1 case, 1 corpse.
1 corpse.
2 cases and 1 corpse.
1 corpse.
1 case.
1 case.
1 corpse.
Date.
April 15 ...
16 ...
17 ...
19 ...
20 ...
21 ...
22 ...
23 ...
24 ...
26 ...
27 ...
28 ...
29 ...
30 ...
May 1 ...
3 ...
4 ...
5 ...
6 ...
7 ...
8 ...
10 ...
11 ...
12 ...
13 ...
14 ...
15 ...
17 ...
18 ...
19 ...
Houses
Lime-
washed.
38
44
24
42
43
63
69
70
47
42
84
20
29
19
22
17
17
11
11
11
9
10
31
22
25
30
25
22
13
10
Remarks.
1 case.
1 case, 1 corpse.
1 case.
1 corpse.
One division.
Scheme of Lime-wasMng Parties.
Parties.
10 ... ... ...
Officers.
1
British
Troops.
10
Sappers.
10
Native
Infantry.
20
Carts.
10
Flag.
White.
B 1215. POONA JUNE 1897. Drawn & Litho:Govt. Photozinco, Office, Poona 1898
W.W.O. Beveridge
B 1215. POONA JUNE 1897. Drawn & Litho: Govt. Photozinco, Office, Poona 1898 W.W.O. Beveridge
12
DEATHS FrOM PLAGUE IN THE SEGREGATION CAMP.
Day of Segregation on which the death occurred.
Day.
Number of deaths
1st.
1
2nd.
1
3rd.
2
4th.
2
6th.
1
6th.
0
Total.
7
It will be seen that 50 per cent. of the cases occurred on the 3rd, 4th and
5th day of segregation.
Lieutenant P. Owen Lewis, in whose hands under my supervision the work
of segregating the probably infected inmates of houses fell, carried out this duty
with the utmost zeal and discretion. Without him, and the assistance rendered
by the sepoys under his command, the work in connection with my inspection of
the dead would have been difficult indeed.
In conclusion, it may be allowed that the measures adopted in Poona to
suppress the plague have been eminently successful ; for although more than a
month has elapsed since the withdrawal of the troops, there has been practically
little or no plague, and since the 16th of June, when an imported case was
discovered, no further cases have occurred in spite of a varied condition of
climate.
It is impossible to over-estimate the value of the work performed by the
troops and without their aid, aid that could only be rendered by a disciplined
body of men, with a keen sense of their duty, unapproachable by bribes and
untiring in their efforts, no success could have been attained. Every officer and
man engaged in the operations performed his duties with unceasing zeal
displaying the greatest tact, fortitude and patience in the midst of most trying
circumstances. Mr. M. K. Kumthekar, the Municipal Secretary, was always of
the greatest assistance and rendered valuable aid in matters relating to the
Segregation Camp and the work now in progress, viz., the examination of the
dead in Poona.
Dr. Benjamin Soloman, who worked with me before the search parties were
introduced, has given the greatest assistance both then and while working under
the Plague Committee. A large proportion of the cases of plague discovered
were due to his unceasing efforts and vigilance. Dr. Anant Bhawanishankar has
also shown considerable zeal and given able assistance in assisting to carry out
the work of inspecting the dead on the withdrawal of the search parties.
W. W. O. BEVERIDGE, M.B.,
Surgeon-Captain, A. M. S.
0 0
I N D I A N M E D I C A L R E V I E W
3 95 h
IP
IP/QB.3.
AN
INDIAN MEDICAL REVIEW
BY
M a j o r - G e n e r a l E . W . C . B R A D F I E L D , C . I . E . , O . B . E . ,
K.H.S., I.M.S.,
Director-General, Indian Medical Service.
1938.
PUBLISHED BY THE MANAGER OF PUBLICATIONS, DELHI.
PRINTED BY THE MANAGER, GOVERNMENT OF INDIA PRESS, NEW DELHI,
1938.
Introduction.
The Provinces and States of India publish annual records of the
activities of their Medical and Public Health Departments, which, in so
far as they relate to the incidence of disease, vital and health statistics, are
summarised in the Annual Report of the Public Health Commissioner
with the Government of India. If this Review of the medical organisa--
tions of all-India reproduces information contained in the latter report,
it is because the Medical and Health Departments are both concerned
with the same problems which affect the health of India. Major-General
Sir John Megaw between 1931 and 1933 published several papers con--
cerning medical administration in India, while Sir Cuthbert Sprawson,
in 1935, wrote a valuable note on the medical schools. These have been
consulted in compiling this Review, while my thanks are also due to the
Administrative Officers of Provinces, to Dr. A. G. Young, Editor of the
Journal of the Christian Medical Association of India, and others who have
supplied material for its publication. The preparation and analysis of
the statistics has been done under the supervision of Mr. Khushi Ram,
Superintendent of the Medical Section of my office, and I also gratefully
acknowledge the help of Major A. N. Chopra, I.M.S., in reviewing and
correcting proofs. The views expressed on the statistics and information
collected are purely personal.
E. W. C. B.
AN INDIAN MEDICAL REVIEW.
TABLE OF CONTENTS.
PAGE.
I.- GENERAL.
1. Administrative Organisation.
1
2. Medical Profession
2
3. Medical Services
3
II.- HOSPITALS AND DISPENSARIES.
1. Advisory Committees for Hospitals
5
2. Average area and population served by each hospital or dispensary
7
3. Expenditure on medical relief
8
4. Rules regulating Grants-in-aid to hospitals and dispensaries
8
5. Fees charged from non-indigent patients
11
6. Buildings
1 2
7. Nursing Homes
1 6
8. X-Ray and Radium Facilities
1 6
9. Beds for maternity cases and number of labour cases
18
10. Honorary Medical Officers
19
11. Post-graduate training for Assistant and Sub-Assistant Surgeons
26
12. Mental Hospitals and Psychiatric Clinics
2 8
13. Medical Inspection of School Children
3 0
14. Effects of Earthquakes in Bihar and Baluchistan and progress thereafter
32
15.
16. Rural Medical Relief
34
17. Mission Medical Activities
46
18. Railway Medical Departments
47
III.- CO-ORDINATION BETWEEN GOVERNMENT MEDICAL AND PUBLIC
HEALTH DEPARTMENTS
49
IV. - TUBERCULOSIS
52
V.-MEDICAL EDUCATION AND REGISTRATION.
1. Medical Colleges
61
2. Medical Schools
92
3. Military Medical Students (I. M. D.)
153
4. Medical Education of Women
154
5. Medical Council of India
156
6. Provincial Medical Councils
162
VI.- NURSING IN INDIA.
1. Historical
169
2. Status of Nurses
173
3. Registration of Nurses
174
(ii)
CHAPTER
VI.—NURSING. IN INDIA.—contd .
PAGE.
4. Training and Examination . . .
181
5. Conditions for approved Training Institutions for Nurses and Midwives in
the Bombay Presidency . . .
182
6. Salaries of Nurses in various provinces . . .
183
VII.—MATERNITY.
1. Maternity . . .
184
2. Facilities for training . . .
187
3. Research on Maternal Mortality and Morbidity . . .
188
4. Maternity Homes of Bombay . . .
190
VIII.—MEDICAL RESEARCH IN INDIA.
1. Medical Research in India . . .
192
2. Medical Research Department . . .
194
3. Indian Research Fund Association . . .
195
4. The Indian Journal of Medical Research and Indian Medical Research
Memoirs . . .
198
5. Summary of Research work carried out on special subjects . . .
198
Malaria . . .
198
Cholera . . .
201
Plague . . .
203
Kala-azar . . .
205
Leprosy . . .
208
Rabies and Anti-rabic treatment . . .
211
Nutrition Research . . .
212
G e n e r a l P r o t o z o o l o g y . . .
213
Medical Entomology . . .
215
Helminthological Research . . .
218
Snake Venoms . . .
220
Pharmacology including Indigenous Drugs . . .
220
Cancer . . .
224
6. History and Activities of important Institutions connected with Medical
Research in India . . .
226
(i) Central Research Institute, Kasauli . . .
226
(ii) School of Tropical Medicine, Calcutta . . .
228
(iii) All-India Institute of Hygiene and Public Health, Calcutta . . .
231
(iv) Haffkine Institute, Bombay . . .
235
(v) Pasteur Institute of India, Kasauli . . .
238
(vi) Pasteur Institute of Southern India, Coonoor . . .
239
(Vii) The King Edward VII Memorial Pasteur Institute and Medical Re
-
search Institute, Shillong . . .
241
IX.—MEDICO-LEGAL WORK AND IMPERIAL SEROLOGICAL DEPARTMENT. . . .
243
X.—PHARMACY AND DRUGS CONTROL.
1 . Methods of Control . . .
246
2. Pharmacists . . .
250
3 . Quinine . . .
253
4. Medical Stores Department . . .
255
(iii)
CHAPTER
PAGE.
XI. —MEDICAL AND OTHER COGNATE SOCIETIES.
1. Indian Red Cross Society . . .
257
2. St. John Ambulance Association (Indian Council) and the St. John Ambu
-lance Brigade Overseas (Empire of India) . . .
261
3. Countess of Dufferin's Fund (Women's Medical Service) . .
264
4. British Empire Leprosy Relief Association (Indian Council) . . .
269
5. Lady Minto's Indian Nursing Association . . .
272
6. Lady Ampthill Nurses Institute and the South Indian Nursing Associa
-tion . . .
273
7. International Health Division of the Rockefeller Foundation in India . . .
274
8. King George Thanksgiving (Anti-Tuberculosis) Fund . . .
276
9. Trained Nurses' Association of India . . .
278
APPENDICES —
I. Statistics regarding hospitals and dispensaries in British India . . .
281
II. Statistics regarding Mission Medical Institutions in India . . .
583
III. Statistics regarding hospitals and dispensaries under the control or super
-vision of the Political Department . . .
631
IV. Statistics regarding hospitals and dispensaries under the control or super
-vision of the External Affairs Department . . .
635
V. Report on the Work of the Lhasa Medical Mission (1936-37) by Captain
W. S. Morgan, I.M.S. . . .
641
INDEX . . .
645
CHAPTER I.
General.
1. ADMINISTRATIVE ORGANISATION.
An account of the history of the medical and health organisation in
India will be found in Section VI of the " Souvenir", 1927 (which
includes a short note on the indigenous systems), edited by Colonel (now
Sir) Richard Christophers, and in Section II of Major General Sir J. D.
Graham's " Health Organisation in British India",, 1927.
2. The general constitutional position under the Government of India
Act, 1935, is that while public health and hospitals and dispensaries are
p r o v i n c i a l l e g i s l a t i v e s u b j e c t s , t h e C e n t r a l G o v e r n m e n t h a s r e s p o n s i b i l i t i e s
for medical research, port quarantine, higher medical education, and for
medical and health affairs of areas under its direct administrative control.
The Director General, Indian Medical Service, is the principal medical
adviser to the Government of India in the Department of Education,
Health and Lands. He is also the head of the Indian Medical Service
and the Indian Medical Department (Military Assistant and Sub-Assistant
Surgeons) and controls the Medical Store Depots, a brief account of which
is included in Chapter X of this book. He is assisted by a Deputy
Director General, an Assistant Director General, and, in matters relating
to public health and research, by the Public Health Commissioner, who
is the technical adviser to the Government of India in public health
matters. The Public Health staff also includes a Deputy Public Health
Commissioner and a Statistical Officer.
3. In the Presidencies of Bombay, Madras and Bengal, the medical
services are administered by Surgeons General, while the corresponding
position is held by the Inspectors General of Civil Hospitals in other
provinces, except the two newly created provinces of Sind and Orissa
where the heads of the medical departments are designated as Director
of Health Services and Inspector General of Prisons and Director of
Health and Inspector General-of Prisons, respectively. The chief admi
-
nistrative medical head is the medical adviser to the local Government
in all provincial medical matters.
4. Provinces are divided into divisions, each of which consists of several
districts, the average population of which may roughly be taken as one
million. Each district has a headquarters for all Government depart
-
ments, one of which is the 'medical' presided over by a Civil Surgeon.
Besides managing the headquarters hospitals ( i.e ., Civil and Police
Hospitals, etc.), he controls in his area several branch hospitals and
numerous dispensaries staffed by officers of the Provincial and Subordi
-
nate Medical Services; his work is largely in the hospital, though much
of it is administrative. The responsibility of the Civil Surgeon for public
4
2
health varies in the different provinces of India, and while in all there
is a Director of Public Health, it is only Madras, Bengal, United Provinces,
Punjab, Bihar and Orissa that public health has been placed under the
control of whole time District Public Health Officers.
5 . I n M a d r a s t h e r e i s a C h i e f L e p r o s y O f f i c e r , w h i l e G r o u p L e p r o s y
Officers are in charge of several adjacent districts and, according to Sir
Frank Connor's note on the Madras Medical Department, it has been
proposed to increase their number so as to allow of each heavily infected
district being provided with a separate Leprosy Officer.
6 . P r o p a g a n d a a n d s u r v e y i n r e g a r d t o L e p r o s y h a v e n e c e s s i t a t e d t h e
appointment of a Leprosy Officer each in Bengal and the Punjab. In the
Central Provinces there are three Sub-Assistant Health Officers for the
purpose.
7. The appointment of special officers for Tuberculosis is under con
-
sideration in the various provinces. Bihar has given lead in the matter
by appointing one officer of the rank of Assistant Director of Public Health
on the staff of the Inspector General of Civil Hospitals.
2. MEDICAL PROFESSION.
It is estimated that there are 35,000—40,000 qualified doctors now
practising in India, and, although a proportion of 1 doctor to roughly
10,000 of the population would appear to be very inadequate, it is a
fact that unemployment has become a serious problem among the younger
members. of the profession. Careful enquiries, however, show that in
many towns the proportion is as high as 1 to 1,000 and that it is the
disinclination of members of an educated profession to settle in rural
areas which is responsible for this apparent overcrowding, a problem
which is not confined to India but common to all agricultural countries.
A doctor who has had a long, expensive and scientific education is very
unwilling to choose a career in a remote country district where there are
few amenities, no educated society, no education facilities for his family,
and, in India, on account of the poverty of the people, few fees to be
earned. Better communications, better roads and mechanical transport
are changing the conditions of medical practice as rapidly as they are
influencing other aspects of Indian life, and in many areas the doctor
with initiative is able to exploit the countryside from his urban residence.
The question of inducing doctors by the provision of subsidies or other
plans in rural areas is receiving the attention of provincial medical depart
-
ments, and the methods employed and recommended are described in
detail in Section 16 "Rural Medical Relief" of Chapter II. The position,
to quote the "Statesman",* is that "The villages offer the practice and
the experience. They do not offer the fees nor the opportunity of dis
-
cussing difficulties with other doctors, nor the opportunity of keeping in
touch with what is done in hospitals. For the young doctor, who is
not troubled about the need of earning an income commensurate with the
length and cost of his education, who has something of a missionary
*Delhi edition, dated the 1st May, 1938.
3
spirit and has no particular yearning for the company of his own kind,
the village is an admirable place to work in if he can bring himself to
forgo the close contacts and associations by which alone he can steadily
become more proficient in his calling. Not many, we must infer, are so
endowed. The doctor who does work in the villages is quite likely to
find that, after all his years of study, a charm or a line of ancient verse
is regarded as a more reliable help in time of trouble. It is a difficult
situation not to be put right by good advice alone".
2 . I t i s o n l y i n p r o v i n c e s w h e r e a C o u n c i l o f M e d i c a l R e g i s t r a t i o n e x i s t s
that it is possible to give the number of doctors registered and these are
as follows:—
Madras . . .
6,085
Bombay . . .
6,378
Bengal . . .
9 , 0 1 9
United Provinces . . .
3,041
Punjab . . .
4,558
Bihar . . .
3,045
Assam . . .
1,166
3 . T h e n u m b e r o f m i s s i o n a r y d o c t o r s w o r k i n g i n I n d i a , a c c o r d i n g t o
the estimate given in the May 1937 issue of the Journal of the Christian
Medical Association of India, Burma and Ceylon, is 740.
3. MEDICAL SERVICES.
British.
Indian.
Total.
(a) I. M. S. Officers (as on 1st April 1938)—
In civil employ . . .
196
115
311
In military employ . . .
207
149
356
Grand Total . . .
403
264
667
(b ) R. A. M. C. Officers (as on 1st April 1938)—
. . .
. . .
275
Civil.
Military.
Total.
( c ) Indian Medical Department (as on 1st April 1938)—
Military Assistant Surgeons . . .
105
381
486
Military Sub-Assistant Surgeons . . .
85
6 0
685
A 2
4
Madras
225
530
Bombay
69
360
Bengal
171
287
United Provinces
134
345
Punjab
167
551
Bihar
100
83
Central Provinces
69
310
Assam
40
194
Sind
96
Orissa
29
95
North-West Frontier Province
20
106
Delhi
10
31
Ajmer Merwara
2
13
Baluchistan
4
40
Europeans.
Indians.
Superior medical personnel
33
52
Subordinate medical personnel
8
1,718
Total
41
1,770
(f) Doctors employed in Public Health Duties (as on 1st April 1938)-
Madras
1 0 0
Bombay
36
Bengal
4 1 3
United Provinces
180
Punjab
109
Bihar
36
Central Provinces
74
Assam
130
Sind
11
Orissa.
23
North-West Frontier Province
12
(Whole time)
3
(Part-time).
Delhi
17
(Whole time).
8
(Part-time).
Ajmer Merwara
2
Coorg
2
5
CHAPTER II.
Hospitals and Dispensaries.
1. ADVISORY COMMITTEES FOR HOSPITALS.
Advisory Committees for hospitals are now a feature of medical admi
-
nistration in all provinces, though their scope and composition varies,
and except in Delhi Province they do not exist in the Centrally Admi
-
nistered Areas.
The principal function of these Committees is to keep the head of the
provincial medical department and the local Government informed of
the needs of the hospitals as viewed by the public and they aim at
maintaining touch with the Medical Department on the one hand and
the public on the other. They enquire into the working of the instit
u -
tions and advise on all matters connected with the welfare of the
hospital, the comfort and well-being of the patients and in some cases
management and control of accounts. These Committees have no execu-
tive authority, for the entire supervision and management of the institu-
tion and its establishment are in the hands of the Medical Officer in
charge of the hospital subject to the control of the Provincial Admi-
nistrative Medical Officer.
2. In a note on the Madras Medical Department, Major-General Sir
Frank Connor writes "The reports received on the working of these
Advisory Committees during my term of office show, with few exceptions,
that these committees have not been working satisfactorily. The District
Medical Officers complain that it is difficult at many meetings to get a
quorum. General apathy is one reason for this state of affairs, but
another important reason is the failure of the administration to carry
out the majority of the recommendations made by them; this results very
naturally in their losing interest. The reason for this failure is, in the
majority of cases, the inadequacy of finance made available by Govern-
ment.
"An improvement in the working of Advisory Committees in the City
of Madras is noticeable. Non -official members have been taking greater.
interest in ascertaining the requirements of hospitals, with the result that
many useful suggestions have been made and accepted by the Surgeon-
General. It is to be hoped that this improvement will extend to mofussil
areas and that more money will soon be available to activate proposals
for improvements made by Advisory Committees."
3. The Visiting Committees for State institutions in Bengal are
appointed by Government and consist of officials as well as non-officials.
The Managing Committees for private hospitals are appointed with the
sanction of the Commissioner of the Division and consist of non-officials
except for the District Magistrate or Sub-Divisional Officer and Civil
Surgeon who are ex-officio members.