NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
46
17. MISSION MEDICAL ACTIVITIES.
Medical Missions have played an important part in medical relief and
particularly so in Mofussil areas. The first regular medical missions
are said to be those founded and supported by the citizens of the United
States in Southern India in 1830-40.
Particulars regarding mission institutions in India (excluding Burma and
Ceylon) run and aided by different Missions are given in the tables contained
in Appendix II. It will be observed that 182 hospitals, 111 dispensaries,
54 leper asylums and 9 sanatoria were functioning during the year 1936.
These figures do not represent all the institutions but stand only for those
which responded to the questionnaire issued by the Christian Medical
Association of India, Burma and Ceylon. Hospitals with 10 or more
beds for in-patients have been classed as hospitals and those with less
than this number have been put under dispensaries. There were institu
-
tions that did not supply figures.
These collected figures show that of a total yearly expenditure of
approximately Rs. 47.62 lakhs by Missions on Medical work a sum of
Rs. 20.42 lakhs is found by fees and gifts from patients, Rs. 6.43 lakhs
from Government and Municipal grants and Rs. 20.77 lakhs from private
mission funds.
Table showing particulars regarding Mission Medical Institutions.
Particulars.
Hospitals.
182.
Dispensaries.
111.
Asylums.
54.
Sanatoria.
9.
Number of Beds— . . .
11,254
229
3,896
800
Doctors—
Foreign . . .
219
27
14*
8
National . . .
276
38
30
16
Nurses—
Foreign . . .
237
26
11
9
National . . .
693
35
11
42
Student . . .
1,551
16
. . .
. . .
Midwives—
Qualified . . .
42
5
. . .
. . .
Student . . .
209
67
. . .
. . .
C o m p o u n d e r s —
Qualified . . .
242
57
44
6
Student . . .
128
2
. . .
. . .
In-patients . . .
2,05,288
2,635
11,344
1,650
* Includes 4 visiting doctors.
Particulars.
Hospitals,
182.
Dispensaries,
111.
Asylums,
54.
Sanatoria,
9.
Out-patients—
Individuals treated
. . .
16,87,054
2,68,434
8,180
3,756
X-Ray Installations
. . .
24
1
. . .
3
Operations—
Major
. . .
36,881
840
437
. . .
Minor
. . .
1,38,432
7,513
2,391
. . .
Combined
. . .
3,545
. . .
. . .
1,160
Obstetrical Cases
. . .
22,672
601
. . .
. . .
Fees and Gifts from Patients . . . Rs.17,83,079
Rs. 51,846
. . . Rs. 2,07,822
Grants—
Government
. . . Rs. 1,35,118
Rs. 15,242 Rs. 3,94,419
Rs 91,758
Municipal
. . .
Rs. 5,830
Rs. 1,160
. . .
. . .
Total Current Expenses . . . Rs. 35,58,276 Rs. 2,77,062 Rs. 6,00,320 Rs. 3,27,025
18. RAILWAY MEDICAL DEPARTMENTS.
Almost all the principal railways in India maintain their own Medical
Department. The following table represents facts and figures in regard to
the medical and nursing personnel employed by the various Railways and
the number of hospitals and dispensaries maintained by them.
Europeans.
Indians.
Europeans.
Indians.
Assam Bengal
3
2
46
9
7
88
17
Bengal and North Western
3
28
11
5
75
10
Rohilkhand and Kumaon
1
8
3
1
20
5
Bengal Nagpur
4
3
1
178
20
5
182
48
Eastern Bengal
1
5
61
13
14
238
26
2 A. M. 0.
East Indian
2
9
238
36
8
252
56
1 A. M. 0.
Great Indian Peninsula
3
10
162
31
7
196
30
Madras and Southern Mahratta
3
3
64
10
4
116
33
North Western
5
3
3
116
18
11
235
60
South Indian
2
3
4
634
5
5
86
25
H. E. II. Nizam's State
3
1
29
7
3
132
5
Bombay, Baroda and Central India
4
4
154
14
11
168
35
Total
33
52
8
1,718
182
81
1,788
350
49
CHAPTER III.
Co-ordination between Government Medical and Public Health
Departments.
The activities of those responsible for medical relief and prevention
of disease are so closely inter-related that it is impossible to draw any
sharp line of distinction between them, and the necessity for co-ordinating
their activities is now fully recognised. No apology is therefore required
for a brief reference to this subject which has attracted the attention of
both administrations and of authorities concerned with medical education.
The Central Board of Health at its first meeting passed a special resolu-
tion which stressed the need for co-operation between Medical and Public
Health Departments, and recognising the important position which pre-
vention occupies in every phase of medical practice, both the Medical
Council of India and the General Medical Council of Great Britain recom-
mend that "throughout the whole period of study the attention of the
student should be directed to the importance of the preventive aspects
of medicine".
2. In most countries all branches of medicine are administered by one
Health Ministry with separate higher directing staffs, and India is in
fact peculiar in the extent to which in some areas the activities of medical
and public health departments have been separated, or in a few cases even
divorced from each other. For this result the history of the development
of modern medicine in India is partly responsible, while the magnitude of
their tasks, the limited facilities available, and the need for expanding the
efforts of both require concentration to a large extent on their own affairs.
The inadequacy of existing arrangements has been outlined both in this
Review and in the annual reports of the Public Health Commissioner.
*Sir John Megaw in 1933 wrote:
"There are historical reasons for the 'diarchy' which exists
in the medical and public health departments. In
the early days of the development of modern medicine
in India disease prevention was scarcely attempted except
in the case of vaccination against small-pox. The view
which held the field at that time was that the people had
not yet been educated up to the necessity for preventive
medicine and that any attempt to enforce unpopular public
•
health measures would do more harm than good. Medical
effort was therefore concentrated on the establishment of
hospitals and dispensaries for the treatment of the sick. When
public health began to receive its due share of attention the
physicians and surgeons were already strongly entrenched so
that public health workers found it difficult to awaken any
enthusiasm for preventive medicine amongst the
administra-tive medical officers who were interested in their own speciali-
•
ties. It was therefore necessary for the public health workers
to put up a vigorous fight to secure autonomy and, generally
speaking, the result has been an undesirable cleavage between
medical relief and public health.
• • •
* Some
points connected with Medical Administration in India.
50
"The position is now very different. The prevention of disease has
come to be universally recognized as being the chief aim of
medical work and most of the administrative medical officers
are now enthusiastic advocates of disease prevention; indeed
some of them have been specialists in public health for the
greater part of their previous service. All of them state
that they are prepared to co-operate with the Directors of
Public Health and to insist on a similar co-operation on the
part of the members of their staff. This combination of
effort does not mean the swallowing up of one department by
another, nor does it imply the elimination of the principle of
division of labour. It does mean that whenever it is in the
interests of efficiency and economy, the medical man ought to
engage both in medical relief and public health work and
that ever increasing emphasis must be laid on disease preven-
tion."
3. Opening a discussion on the organisation of Health Departments
at the first meeting of the Central Advisory Board of Health on the 23rd
June 1937 the Public Health Commissioner (Colonel Russell) drew attention
to the need for co-ordination in the following words:—
"I think it will be admitted on all hands that a Public Health
Department has a number of functions which are distinct
from those of Medical Department and that these functions
are best performed by trained health officers who can give them
their full time. It is unnecessary here to give a detailed
list of these functions, but I may mention as illustrations the
collection of vital statistics, the control of epidemics and the
planning of water supplies, of drainage schemes and of con-
servancy arrangements. These and others of the kind can
only be properly carried out by officers of a Public Health
Department, who can spend a large proportion of their time
on inspection tours and who can go on tour at once when an
emergency arises. I do not wish to elaborate this point
further as I hope that it is generally agreed that every town
of any size and every district requires a trained health officer
if the standard of environmental hygiene is to be steadily
raised and if progress in general public health is to be made.
On the other hand, there are certain subjects, such as tuber-
culosis and maternity and child welfare, in which the Public
Health and the Medical Departments are mutually concerned
and in regard to which there must be co-operation and co-ordi-
nation of effort. For this kind of subject the Civil Surgeon and
the Medical Officer of Health should be closely associated,
working together in a common cause, and unless that associa-
tion is achieved, in one way or another, progress in preventive
medicine must be correspondingly retarded".
4. Other speakers also drew attention to this aspect of health adminis-
tration and the meeting unanimously adopted the two following important
resolutions:—
(i) "The Board desires to bring to the notice of all Governments,
Provincial Medical Councils and the Medical Council of India
51
the necessity for improvement in the teaching of hygiene and
public health as part of the Medical Colleges and Schools
curricula for medical qualifications and registrations".
(ii) "In order to promote co-ordinated effort in preventive medicine
between the Medical and Public Health Departments, the
Board recommends the establishment of Central Health
Board (or Committee) at the headquarters of each province and
of a Health Bureau (or Committee) in each district."
5. While a satisfactory degree of liaison exists between the Directors
of Medical and Public Health Departments, it is in the district, in the
sphere of the Civil Surgeon and the District Health Officer that health
presents its most important problems and where there is the greatest
need for co-operation. Separate higher directing staffs technically qualified,
co-ordinated by an administrative head, are essential for efficiency, but when
we come down to the smaller district unit, such as the village dispensary,
it is certain that India can never afford to maintain two experts for each
small centre of her population.
6. While, therefore, the ideal is unattainable for financial and other
reasons, the most promising line to follow is that of the District Health
Bureau recommended and outlined by the Central Health Board, on which
the Civil Surgeon and the public health expert of equal standing can
co-ordinate all their activities. Further the dispensary doctor must be
brought more intimately into the local health picture and his usefulness
increased by improving the teaching of hygiene and public health in medical
schools and colleges. In their knowledge of the people and the confidence
in them, gained by frequent contact, the civil surgeon and the dispensary
doctor are valuable assets which should be made full use of.
52
CHAPTER IV.
Tuberculosis.
Details of the extent to which tuberculosis is prevalent in India will
be found in the Public Health Commissioner's reports, but the extent
of the problem and the inadequacy of the efforts which have so far been
made to meet it necessitate a short reference.
2. Unfortunately the available data are inadequate, and our chief
evidence regarding its widespread incidence comes from Dr. Lankester's
report in 1920; a note by General Megaw based upon reports collected
from medical officers and others throughout India; the figures collected
from limited surveys in different areas, and conclusions which have been
reached in the Public Health Commissioner's reports.
3. Dr. Lankester, who carried out an inquiry into the causes, preval-
ence and possible measures for prevention of tuberculosis in India from
July 1914 to June 1916 observed in his report which was published in
1920:—
"To sum up: the impression left upon the mind after careful
inquiry, with comparison of such statistics as are available,
is that many large areas in India, which 40 years ago were
practically "virgin soil" to tuberculosis, have now become to
a considerable extent infected; that phthisis has been for
generations, probably centuries, a common disease of the
larger cities, yet even in these there has been considerable
actual increase during the last 40 years; that while in smaller
towns and in the village districts it was formerly compara-
tively rare or even absent, yet in these during a similar period
the disease has made its appearance and spread widely. The
increase has been most marked in connection with those
centres which have shown the greatest commercial and
educational development, and in the village districts
which have been linked up with them by direct lines of communi-
cation."
4. Major-General Sir John Megaw in 1933 estimated that there were
probably two million cases of tuberculosis in India. His conclusions
were: —
"Tuberculosis is evidently very widespread throughout the villages
of India but is specially serious in Bengal, Madras, the Punjab
and Bihar and Orissa. Pulmonary tuberculosis seems to be
much more common than extra-pulmonary except in the
United Provinces and Bombay. The low incidence in the
Central Provinces is remarkable and is perhaps associated
with the sparse distribution of the population and with defec-
tive means of communication.
"Tuberculosis is well known to be exceedingly prevalent in the
cities and large towns but little is known as to its incidence
in rural areas. The evidence of the dispensary doctors goes
to show that the disease is very widely disseminated through-
out India. From other sources of information it seems likely
•
57
(vii) Treatment .—As far as possible it should treat tuberculosis patients
attending the clinic, advise them as regards home treatment and, where
possible, arrange for sanatorium treatment and other benefits.
The provision of facilities for open air and solarium treatment for a
limited period of the day for patients or contacts attending the clinic is an
activity well within its scope.
Table showing number of clinics and beds for tuberculosis patients in India.
Province.
Name of
Anti-Tuberculosis
Association
in the
Province.
No. of T. B.
Dispensaries
and Clinics.
Tuberculosis Sanatoria.
No. of
Beds.
No. of beds
reserved in
General
Hospitals for
T. B. patients.
Special
T. B. Officers
if any.
Name of Sanatorium.
Designation of Managing
Body.
Madras
Anti-Tuberculosis
Sub-Committee,
Madras Presidency
Branch, Indian Red
Cross Society.
9
1. Government T. B. Hospital,
Royapettah.
Madras Government
8 0
About 157
2. Government T. B. Sanatorium,
Tambaram.
Madras Government
40
3. Union Mission T. B. Sana-
torium, Madnapalli, District
Chittoor.
Union Mission
250
4. Visrantipuram T. B. Sanato-
rium, Rajahmundary, Goda-
vary District.
U. L. Mission
50
5. T. B. Sanatorium, Perundurai,
Coimbatore District.
6. Shakuntala Memorial T. B.
Sanatorium, Guntur.
Bombay
Anti-Tuberculosis
Sub-Committee,
Indian Red. Cross
Society, Bombay.
9
1. Turner Sanatorium, Bhai Wada
Hill, Parel, Bombay.
Bombay Municipality
40
About 129
2. The Hindu Sanatorium, Karla
40
3. Bel-Air Sanatorium, Dalkeith,
Panchgani.
Trust managed by a
Committee.
140
4. Hill-side Sanatorium, Vengurla
35
5. Sir William Wanless T. B.
Sanatorium, Miraj.
131
6. Maharashtra T. B. Sanatorium,
Panchooti, Nasik.
Poona Anath Vidyarthi
Griha Society.
10
7. Dr. Bahadurjee Memorial Sana-
torium, Deolali.
Private Concern
17
8
T. B. Sanatorium, General
Hospital, Hukeri Road, Bel-
gaum.
The Karnatak Health
Institute.
20
Bengal.
Tuberculosis Asso
ciation, Bengal,
Calcutta.
7
1. T. B. Hospital and Sena
torium, Jadabpur.
Calcutta Medical Aid and
Research Society.
120
About 175. There is a p
roposal to appoi
nt special
2. Lowis Jubilee Sanatorium,
Darjeeling.
Managing Committee.
8
Anti-T. B. 0
fficer.
3. Kurseong Sanatorium. Calcutta Medical Aid and
Research Society.
20
United Provinces. Anti-Tuberculosis
League, Lucknow.
3
1. K. E. VII Sanatorium, Bhowali,
Naini Tal.
K. E. VII Memorial
Consumptive Sanato
rium Trust.
140
A few beds in.
certain hospi
tals.
2. Hillcrust Sanatorium, Jeole
Kote, Gethia, Naini Tal.
A private concern.
30
3. The Sanatorium, Almora. Run by Dr. Miss E. C.
Cousins.
35
4. Sri Mangla Prasad Sana
torium, Sarnath, Benares.
Mangla Prasad Trust.
12
5. T. B. Hospital, K. G. Medical
College, Lucknow.
44
6. T. B. Hospital, Allahabad.
12
7. Karella Bagh Sanatorium. A private institution run
by donations.
Punjab .
Anti-Tuberculosis
sub -Committee,
Punjab Provincial
Branch.
4
1. King Edward Sanatorium,
Dharampore.
Consumptives’ Home
Society, Bombay.
92
2. Lady Irwin Sanatorium,
Sanawar.
Pubjab Union Mission .
58
3. Jubilee (Mohd. Hussain) Sane
torium, Samli.
Board under Chairman
ship of Commissioner,
Rawalpindi Division.
74
4. S. G. Tuberculosis Hospital,
Model Town, Lahore.
S. G. Memorial Hospital
Trust.
28
5. Krishan Bhagwan Sanatorium,
Multan.
K. B. Sanatorium So
ciety.
35
6. McGuire T. B. Sanatorium,
Dharamsala.
Dharamsala Municipality
7
7. Memorial Mission Hospital,
Ludhiana.
Mission.
18
8. R. B. Amar Nath T. R. Insti
tute and T. W. Wards in
Mayo Hospital, Lahore.
74
9. K. G. Jubilee Memorial T. B.
Hospital, Rawalpindi.
32
V59
Province.
Name of
Anti-Tuberculosis
Association
in the
Province.
No. of T. B
. Dispensaries
and Clinics.
Tuberculosis Sanatoria.
No. of
Beds.
No. of beds
reserved in
General
hospital for
T. B. patients.
Special
T. B. Officers
if any.
60
Name of Sanatorium.
Designation of Managing
Body.
Central Provinces &
Berar.
Anti-Tuberculosis
Committee, Indian
Red Cross Society,
Nagpur.
4
Pendra Road Sanatorium
Union Board of 11
Missions.
100
29
Bihar
Anti-Tuberculosis
sub-Committee,
Bihar Provincial
Branch.
16
Clinics are to
be opened.
Itki Sanatorium, Ranchi
Bihar Government
128
About 38
One Provincial
Specialist in
charge Itki
Sanatorium and
one specia IT. B.
Officer of the
rank of A. D.
P. H. for tour
-ing.
Assam
Anti-Tuberculosis
sub-Committee,
Assam Provincial
Branch.
1
There is a proposal to open a
Sanatorium with the money
received from the Silver
Jubilee Fund.
North-West Frontier
Province.
. . . . . .
3 4
1. 10 beds are reserved for N.-W.
F. P. in Samli Sanatorium.
......
10
44
2. Dadar Sanatorium unde
r construction.
......
64 beds
when
opened.
Sind
Indian Red Cross
Society, Sind Pro
-vincial Branch.
3
Parpati Awatsing Sanatorium,
Jherrach, Karachi District.
Run by charitable funds
20
Orissa
. . . . . .
. . .
2 beds are reserved in Itki Sana
-torium, Ranchi.
Bihar Government
2
1
Delhi
Anti-Tuberculosis
sub-Committee,
Delhi Provincial
Branch.
2
Silver Jubilee Tuberculosis Hospi
-tal, Kingsway, Delhi.
Delhi Municipality
93
. . .
Baluchistan
There are no anti-tuberculosis activities in Baluchistan for the present.
Ajmer-Merwara (Raj
-putana).
Anti-Tuberculosis
Committee, Ajmer-
Merwara, Ajmer.
1
1 Mary Wilson Sanatorium, Tila
-unia.
American Methodist
Mission.
80 for
women.
30
2 Madar Sanatorium
Ditto
40 for
men.
Tota l
...
77
39
2,165
603
61
CHAPTER. V.
•
Medical Education and Registration.
1. MEDICAL COLLEGES.
Medical Colleges built at Government expense were established at
Calcutta and Madras in 1835 while half the initial cost of the Bombay
College built ten years later was defrayed by the friends of Sir Robert
Grant after whom the new institution was named. Although numerous
schools sprang up to provide training for a subordinate class of medical
officers (hospital assistants and sub-assistant surgeons), except for Lahore
(1860), it was not until 1906 that the need for more teaching of a Univer-
sity standard was recognised. The example of Lucknow (1911) was
followed by other centres and there are now 10 University medical
colleges, including one exclusively for women, established in India. At
first the Colleges, which were used almost entirely to train medical men
for Government service, granted their own diplomas but Calcutta became
affiliated to a University in 1857 and was followed soon after by Madras,
Bombay and Lahore.
2. The connection of Indian Medical Colleges with the General Medical
Council of the United - Kingdom began in 1892 when that Council accepted
Indian degrees as being of sufficient standard to be placed on the British
Medical Register. After the War the General Medical Council, who were
dissatisfied with the reports received concerning the teaching of midwifery,
deputed Sir Norman Walker to inspect and report on the standard of
medical education in India. Inspection of standards of recognised qualifi-
cations is one of the duties imposed upon the General Medical Council
and Sir Norman Walker's visit was followed by an all round improvement
in medical education. Some colleges were unable to attain to the required
standard and when India was unable to accept their proposals for regular
inspection the General Medical Council were compelled to withdraw-
recognition from Indian degrees. This state of affairs existed from 1924
to 1933 when the Indian Medical Council Act, 1933, passed by the
Central Legislature came into force. By this Act responsibility for the
maintenance of a uniform minimum standard of higher medical qualifi-
cations for the whole of British India was entrusted to the Medical Council
of India who were given necessary powers to inspect courses of instruction
and examinations and to recommend to the Governor-General in Council
the medical qualifications which should be included in the Schedules to
the Act. In accordance with the powers conferred upon it the Council
has in 1934, 1935 and 1936 carried out detailed inspections of all the-
Indian Medical Colleges and their examinations and as a result the medical
qualifications of all the Universities except those of the Andhra Univer-
sity have now been placed on the First Schedule of the Act. As a result
of two careful and detailed inspections of the Vizagapatam Medical
62
College the Medical Council of India at their meeting held in August. 1937
decided that
"Andhra University be informed that pending the provision of
proper facilities for all teaching for the M. B. B. S. degree
the Council is unable to recommend to the Governor-General
in Council the inclusion on the First Schedule of the qualifi-
cations of the Andhra University."
3. The Medical Council of India has also framed a series of recom-
mendations for professional education. These recommendations now
govern the requirements and standards of University medical education in
India and except in a few minor details are already being followed closely
by the recognised Medical Colleges. These recommendations are repro-
duced below:—
I. General.
No candidate should be allowed to begin the medical curriculum proper
until:—
(i) He has attained the age of 17 years, or will attain that age
during the first term of the curriculum
.
(ii)
He has passed an examination in Mathematics at least of the
matriculation standard, and in General Education, including
modern English, of the intermediate standard.
(iii) He has passed, preferably as part of the Intermediate exami-
nation, including practical tests in each subject; an exami-
nation or examinations in the following subjects to the extent
indicated:—
(a) Chemistry; the elementary principles of general and physical
chemistry, and of the chemical combination of elements,
including carbon;
(b) Physics; the elementary mechanics of solids and fluids, and the
elements of heat, light, sound, electricity and magnetism;
(c) Biology; the fundamental facts of vegetable and animal
structure, life-history and function, and an introduction
to the study of embryology.
N.B .—These subjects should be treated, in general, with special reference to their
applications in the subsequent work of the student.
II. The Medical Curriculum
With regard to the course of study and the examinations which persons
desirous of qualifying for the medical profession shall go through in order
that they may become possessed of the knowledge and skill requisite for
the efficient practice of medicine. surgery and midwifery, the Council
recommends as follows :
- -
1. That every student should undergo a period of certified study
extending over not less than five academic years between the date of