NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
28
12. MENTAL HOSPITALS AND PSYCHIATRIC CLINICS.
There are 17 Mental Hospitals in British India distributed as follows:—
Province.
Where situated.
Sanctioned
accommo-
dation
available.
Madras Presidency . . .
Madras . . .
744
Waltair . . .
124
Calicut . . .
286
Bombay Presidency . . .
Thana . . .
318
Ratnagiri . . .
176
Yervada . . .
817
Dharwar . . .
171
Ahmedabad . . .
167
United Provinces . . .
Agra . . .
826
Bareilly . . .
402
B e n a r e s . . .
373
Punjab . . .
Lahore . . .
1008
B i h a r —
For Europeans . . .
Ranchi . . .
250
For Indians . . .
Kanke . . .
1286
Central Provinces . . .
N a g p u r . . .
470
Assam . . .
Tezpur . . .
690
Sind . . .
Hyderabad . . .
317
The Province of Bengal has arrangements by which its mentally defect
-ive patients are admitted to the Mental Hospitals in Bihar.
2. In the Mysore State there is a Mental Hospital at Bangalore, which
has accommodation for 183 males and 67 females. In the year 1936, 289
males and 162 females were treated as in-patients in this hospital.
3. There is no separate mental hospital in Hyderabad State. A small
lunatic asylum exists, which is housed inside the Central Jail at Hyderabad
and is in charge of a specialist with D.P.M. qualification. This asylum
has accommodation. for 175 males and 50 females, while the number of
patients actually confined during 1936 were 432 males and 141 females. A
scheme for the construction of an up-to-date mental hospital has been
sanctioned and the construction work is to be started shortly.
4. Accommodation and overcrowding.—In the 17 mental hospitals in
British India there is accommodation for 8,425 patients, but the number
of patients actually confined in the hospitals in 1936 was 11,792 (8,930
males and 2,862 females). There was overcrowding in almost all the
hospitals, but it was more acute in Madras, Bombay and, the United
Provinces.
37
inevitably restrict the amount of treatment he is able to give. The dis-
pensary doctor cannot be used as a sanitary inspector, though there are
certain public health duties which he can easily undertake, for instance
early detection and report of epidemic diseases, noting the relative
incidence of the various communicable diseases, detection of villages in
which vaccination is badly needed, reporting to the District Health Officer
gross insanitary defects and cases of malnutrition among his patients
and their family and propaganda for the improvement of health. The
aim, on the whole, should be co-operation directed towards the greatest
good of the people rather than rigid separation into compartments, since
all efforts are directed towards the same objective of better health and
less sickness.
8. The organisation of an efficient Rural Nursing Service is as impor-
tant and necessary as the provision of doctors, and though the number of
trained women available is still very inadequate, the profession is, if
slowly, becoming more popular among educated Indians. In the United
Provinces qualified midwives and nurses agreeable to settle down in rural
areas are paid a subsidy of Rs. 100 per annum. In the Bombay Presidency
the Government have sanctioned, as a part of the rural medical relief
programme, a scheme providing for an increase in the number of qualified
nurses and midwives attached to local board dispensaries. The Madras
Government pay a subsidy of Rs. 300-400 p. a. to midwives working
in rural areas. In the Delhi Province there are five maternity and child
welfare centres in rural areas each in charge of a midwife or a nurse.
9. The various schemes for providing additional rural medical relief
have been briefly narrated in the following paragraphs.
10. Madras. —In Madras Presidency additional rural medical relief
is afforded through subsidised medical practitioners. All persons or mem-
bers of families whose monthly income does not exceed Rs. 30 are entitled
to free treatment and free supply of medicine at the dispensary. In other
cases the medical practitioner is entitled to charge reasonable fees.
The District Boards can also utilise the services of medical practitioners.
in charge of subsidised rural dispensaries for the furtherance of public
health work such as inoculation, verification of vaccination, births and
deaths, the control of epidemic diseases, etc., on payment of an honora-
rium of Rs. 15 per mensem from the District Board funds, such work being
done under the guidance of District Health Officers.
Besides medical graduates and licentiates, candidates who have
acquired the diploma in medicine of the Government Indian Medical
School, Madras, are also eligible for appointment to subsidised rural
dispensaries. When Licentiates in Indian Medicine are posted to rural
dispensaries they become automatically converted into Ayurvedic, Siddha
or Unani dispensaries.
The Madras Government pay a subsidy of Rs. 300- 400 per annum
to midwives who visit pregnant women at their houses and attend on
labour cases in rural areas. For attending on labour cases outside their
vi l l a ge s , i . e . , mor e t ha n one mi l e , t he y a r e pa i d f or by t he Ta l uk Boa r d
Re. 1 for every non-paying case of labour.
Sir Frank Connor, in his note on the Madras Medical Department has
noted as follows :—
"One of the most useful measures of medical relief adopted by Govern-
ment during recent years is the scheme promulgated in their Order No.
1522 P. H., dated 27th October, 1924. There are about 447 such subsidis-
ed dispensaries working in this Presidency at present. The Surgeon
General has recommended further extension of this system and has for-
warded to Government a list of places in rural areas in which medical aid
is urgently required. It is hoped that funds will soon be available to
open dispensaries in these areas and also for those rural dispensaries
which have been sanctioned, but to which medical practitioners have not
as yet been appointed."
11. Bombay.—In 1936 the local Government introduced a scheme for
subsidising allopathic medical practitioners in certain selected districts on
the condition that they practise in rural areas. It has recently been decided
to extend this scheme so as to have about 200 centres and to subsidise, for
some of the new centres to be opened, Ayurvedic and Unani practitioners.
who may get themselves registered under the new legislation to be enacted
for the registration of practitioners of the Indian systems of medicine.
Under the scheme each allopathic subsidised practitioner will ordinarily
be in. charge of three or four villages easily accessible by road, or rail
and will visit them on definite days of the week. He will receivé Rs. 50
a month plus a fixed travelling allowance of Rs. 25 p.m., in addition to
an annual grant of Rs. 350 for medicines and instruments. The Ayurvedic
and Unani practitioners will receive Rs. 30 p.m. each plus a fixed travelling
allowance of Rs. 15 p.m. each and an annual allotment of Rs. 150 for
medicines. The Surgeon General will submit detailed proposals to the
Government of Bombay in regard to the opening of the 200 new centres
after consulting the District Local Boards, who have to bear one-fifth of
the cost, the remaining four-fifths being borne by the Government. The
ultimate annual cost of the proposals indicated above is estimated to be
Rs. 1,63,500.
As part of the programme of medical relief in rural areas the local
Government has also introduced a scheme providing for an increase in
the number of qualified nurses and midwives attached to local board dis-
pensaries. Under this scheme Government pays each district local board
in the Presidency, excepting the Bombay Suburban District Local Board,
a subsidy equivalent to 33⅓ per cent. of the cost of nurses or midwives
actually maintained, subjected to a maximum of 3, in addition to those
who were already in employment at the time of the introduction of the
scheme. Each nurse or midwife employed under the scheme receives
Rs. 50 p.m. as pay plus a house rent allowance of Rs. 10 p.m.
39
Government has also sanctioned as a part of their rural programme
the opening of six tuberculosis clinics at the Civil Hospitals at Ahmedabad,
Surat, Poona, Sholapur, Nasik and Belgaum, at a total annual cost
of Rs. 14,680. Each clinic is to be in charge of an Honorary Medical.
Officer acquainted with the modern methods of treatment and prevention
of tuberculosis on Rs. 50 p.m. each. A nurse attached to each clinic,
is to be paid Rs. 100 p. m. plus a house rent allowance of Rs. 15 p. m.,
half of which is to be met by the Red Cross Society.
12 Bengal.—No scheme for the employment of subsidised medical
practitioners in rural areas has been adopted in Bengal.
The Local Government, in pursuance of their scheme of rural re-cons
-truction financed from the Government of India grant sanctioned in
1935, a sum of Rs. 1,66,220 for the establishment of 139 Union Board
Dispensaries in the 24 districts of Bengal, on the condition that the annual
recurring expenditure, which was estimated at Rs. 850 per dispensary,
is met by contributions from the District and Union Boards concerned,
supplemented by a small fee of one anna on each new patient and 3 pies
en each old patient. The scheme is generally appreciated by the rural
people, but difficulties have been experienced in obtaining funds to meet
the recurring cost of maintenance, as some District Boards are unwilling
to contribute their share, while others are not solvent enough to do
so.
It is considered that medical relief in rural areas in the province is
yet inadequate and that every Union Board or a group of villages, where
there is no Union Board, should have a dispensary of its own in the
charge of a qualified medical man.
There are at present 1,102 hospitals and dispen-saries in the rural areas.
Besides there are reported to be 2,117 qualified private medical practitioners
settled in these areas, thus making a total of 3,219 doctors in all.
13.
United Provinces. —Additional medical relief in rural areas in this
province is provided through subsidised medical practitioners.
A scheme for the subsidisation of qualified midwives and nurses
agreeable to settling down in rural areas is also under trial. Such midwives
and nurses are paid a subsidy of Rs. 100 per annum.
14.
Punjab.—The Government of the Punjab decided in 1925 to open
375 new village dispensaries in order to provide adequate facilities for
medical aid in rural areas. Of these 360 have already been opened and
the opening of the remaining 15 has been postponed on account of paucity
of funds.
The Local Government provided funds for the buildings of the dispen
-saries and the quarters for sub-assistant surgeons and dispensers and it
also met the cost of initial equipment. It pays an annual grant of
Rs. 2,500 for the maintenance of each dispensary.
40
The medical officers in charge of these dispensaries are engaged by
District Boards on a five-year contract, but for the purposes of discipline,
leave and transfer they are under the control of the Civil Surgeons and
the Inspector General of Civil Hospitals. The scale of pay sanctioned for
them is Rs. 70-4-130, Rs. 150, after 20 years' service and Rs. 175
after 26 years' service, but it is open to District Boards to vary this scale
if they can obtain men at cheaper rates.
An experiment has been introduced in October 1937 whereby the Rural
Dispensary Doctors in the districts of Lahore, Gujrati, Montgomery,
Hoshiarpur and Karnal are placed under the district medical officer of
health, with a view to encourage preventive propaganda side by side
with curative work. The mere fact that the dispensary doctor is treating
the sick in the village, makes his advice regarding general health work more
readily acceptable. The medical officers in charge of Rural Dispensaries
are required to tour at least twice a week in the area within four miles
from the dispensary and are paid a fixed Travelling Allowance of Rs. 10
p. m
As an experiment two rural dispensaries in each of the four districts
in the Punjab have been converted into subsidised dispensaries.
15. Central Provinces and Berar. —There are 164 rural dispensaries in
addition to 43 travelling dispensaries, the latter being under the control
of the Director of Public Health. The officer incharge of the travelling
dispensary has the licentiate qualification and is designated as "Sub-
Assistant Health Officer" and in addition to the sanitary and health duties,
he affords relief to the people on the curative side also. Dispensary treat-
ment is often beyond the reach of the rural masses, and for more than 3
months during the rainy season many villages are cut off during the most
unhealthy part of the year when malaria and bowel diseases are at their
climax.
In 1936 as a part of the Rural Reconstruction scheme, a sum of
Rs. 15,000 was allotted for rural medical relief out of the funds allotted
for the purpose by the Government of India. A further sum of Rs. one
lakh has been allotted from the same source in 1937 and it is proposed
to start shortly 30 more cheap plan dispensaries for rural areas. The prin-
cipal difficulty is that of finding funds for meeting the recurring expenditure
involved in the maintenance of these dispensaries.
•
The scheme of subsidised dispensaries was tried on a limited scale,
but had to be abandoned as it did not prove a success.
16. Bihar.—Medical relief in rural areas in this province is practically
confined to District, Sub-divisional and District Board dispensaries, a very
few private practitioners and indigenous doctors, vaids, hakims etc.
Various efforts were made in the past to induce doctors to settle in the
villages and small towns by giving them a subsidy but it has not proved
a success.
41
17. Assam.—The rural dispensaries in Assam are mostly in the charge
of Sub-Assistant Surgeons, who serve within a radius of 10 miles from
each dispensary. The Local Boards have also employed medical graduates
in certain selected rural dispensaries.
A scheme for the appointment of subsidised medical practitioners in
rural areas not served by any dispensary has very recently been adopted.
18. Orissa.—The facilities available at present for rural medical relief
in this province are not adequate, there being on an average, only one
medical institution for every 43,859 of population. There are eight subsi-
dised rural dispensaries in the Ganjam and Koraput districts and ten
in the districts of North Orissa. The Local Government have under consi-
deration a scheme to subsidise, besides Allopaths, practitioners of the
Homoeopathic, Ayurvedic and Unani systems, who agree to settle down
in villages.
Under the new scheme the Medical Officer in charge of the Rural Dis-
pensary is, in addition to providing medical relief, entrusted with the work
of developing rural sanitation in the village where the dispensary is situated
and its immediate surroundings, the cultivation of a sanitary and a civic
consciousness and formation of minor health unions, etc. He is also expect-
ed to look after the general well-being of school children, anti-malarial
work in the circumscribed areas, organisation of Health and Baby Week
celebrations, Maternity and Child Welfare work, assistance in the collec-
tion of vital statistics and in the vaccination work of the Health staff
as far as possible. In other words, the dispensary doctor is to assume the
role of a "health guardian" of the villagers and to afford the necessary
guidance and instruction to the uneducated population within his limited
area. This does not absolve the Health Officer and his staff from their
responsibility for their legitimate duties, on the preventive side of medicine,
nor is it intended to amalgamate the Medical and Public Health Depart-
ments, but the aim is only to secure proper liaison and co-operation
between the officers and staff of the two departments.
19. Sind.— The Government of Sind have introduced, with effect from
1st October 1937, a scheme for providing medical relief in rural areas,
which aims at the employment of five subsidised medical practitioners
in each district.
The subsidised medical practitioner is under an obligation to do inocula-
tion or vaccination work or such other duty as may be entrusted to him
by the Civil Surgeon or Medical Officer or the President of the District Local
Board in times of epidemics. Such duties are to be performed free of
charge provided that the persons to be inoculated visit the dispensary.
If the whole-time services of the Medical Officer are required in times of
severe epidemics, he will be paid the same remuneration as an Epidemic
Officer.
42
20. Delhi.—There are six District Board or Municipal rural dispensaries
in the Delhi Province. The aim is to provide a dispensary within 5 miles
of every village in the Province. There is in addition, King George V
Travelling Dispensary which works among 262 villages not served by fixed
dispensaries and stays for about a fortnight at each suitable centre. The
Travelling Dispensary is in the charge of a Sub-Assistant Surgeon who
has a ward orderly to assist him. The Sub-Assistant Surgeon treats
ordinary patients and encourages the seriously ill ones to go to hospital.
In addition, he also does propaganda work in connection with public health
and prevention of diseases. The doctors in charge of the fixed dispensaries
are also required to do public health work and to inspect school children
in their areas.
There are five Maternity and Child Welfare centres in the rural areas
of Delhi, each in the charge of a midwife or a nurse, who works under the
Chief Health Officer.
There is no scheme for the employment of subsidised medical practi-
tioners.
21. North-West Frontier Province.— Medical aid in rural areas in this
province is at present provided in the following manner :—
(a) By establishing fixed rural dispensaries in selected villages, the
population of which is comparatively large and which are
surrounded by a number of thickly populated villages.
(b) By subsidising private medical practitioners in selected -villages,
At present 16 such practitioners are subsidised in different
villages. Medical relief is being provided to 16 villages in.
this way.
(c) By placing doctors attached to existing hospitals in visiting
medical charge of villages nearby. These visits are restrict-
ed to once or twice a week. About 40 villages are being
catered for in this way.
(d) By a travelling dispensary in a motor-lorry. This dispensary
is a complete unit consisting of a doctor, two compounders.
and menial staff. There are at present two such dispensaries,
one in Peshawar district and the other in Hazara district.
A tour programme for the whole district is drawn up in con-
sultation with the Deputy Commissi oner of the district and
circulated in advance to enable the villagers concerned to
know when the moving dispensary would visit their village.
22. Baluchistan.—There are no arrangements for rural medical relief
in Baluchistan, nor does the system of subsidised practitioners obtain.
Arrangements are, however, being made for the Sub-Assistant Surgeon in
civil dispensaries to visit villages nearby. In the malarious season free
distribution of quinine is made by the Revenue Staff.
43
23. Ajmer-Merwara.—Rural medical relief in Ajmer-Merwara hardly
exists, but plans are under consideration for putting up dispensaries
at Pushkar, Ramsar and Sarwar. A scheme for the employment of sub-
sidised practitioners in two villages is also being considered.
Rural Medical Relief. (Excluding District Headquarters).
Subsidized Rural Practitioners.
Name
of
Province.
Pay.
Annual grant for
drugs and
instruments.
Controlling
authority.
Method of
appointment of
practitioners.
Duties
Method of Finance,
Government grant,
local effort, etc.
Remarks.
Touring or
area.
Health
1
2
3
4
5
6
7
8
9
a . Graduates Rs.
600 p. a., L. M.
Ps. Rs. 500 p.a.
Rs. 360 p. a.. Surgeon Ge-
neral.
Practitioners ap
pointed in consulta
tion with D. M. Os.
with approval of
the S. G.
Within a
radius of 5
miles.
Yes, on pay
ment of Rs.
15 p. m.
Subsidy paid from
Provincial funds.
In exceptional
cases local body
pays in addition
50 per cent.of Gov
ernment Subsidy.
419 rural medical
practitioners at
work.
Bombay
Rs. 50 p.m. pl
us Rs. 25 p. m.
fixed Travel
ling Allowance.
Such amount as
may be fixed
by Government
from time to
time subject to
a minimum of
Rs. 350 p. a
President D. L.
B. and C. S. of
the District.
Selected by the Pre-
sident, D. L. B. and
C. S. of the District
subject to final
approval of the
Surgeon General.
3 or 4 village
Not definitely
prescribed so
far.
Half to be borne by
the D. L. B. and
half by Govern-
meat.
So far only 5 dis
pensaries have been
opened in the Dis
tricts of (1) Ahmed
nagar,(2) Nasik,
(3) West Khandesh,
(4) Bclgaum, and
(5) Ratnagiri.
No scheme for Subsidized Medical Practitioners in force.
Bengal
United Pro
vinces.
Graduates Rs.
1,000 p.a.;
Licentiates Rs.
600 p. a.; an
additional sum
of Rs. 100 p. a.
is also given
for engaging a
midwife.
Rs. 360 p. a.
Inspector General
of Civil Hospi
tals.
By local Boards in
consultation with
the Civil Surgeon
of the District.
Subsidy as shown
under "pay" is
paid by Govern
ment and Annual
grant for drugs and
instruments is paid
by the local Board.
28 medical practi
tioners at work.
Punjab
Graduates or
Licentiates Rs
. 600 p. a.
Rs. 500. Inspector Ge
neral of Civil
Hospitals.
Registered Medical
Practitioners ap
pointed.
No touring .
District Boards
given grants-in-aid.
8 subsidized dis
pensaries function
ing for which Gov
ernment pay the
subsidy, 1 for which
D. B. pays
Central Pro
vinces.
Bihar
Subsidized practitioners scheme tried but proved a failure.
Rs. 25
Annual grant
not fixed.
The doctor is
given free qui
nine and has
to provide
medicine him
self
District Board. No order on the subj
ect.
The doctor is
inspect local schools
lantern lectures
and to treat
cases of malaria.
engages in
practice. required to
to give
to students
free acute
He
free private
District Board f
lnance the Dispen
sary.
There are only five
subsidized medical
practitioners in one
district at present.
44
Assam
Rs. 25 p. m.
Rs. 150
Civil Surgeon
Registered Medical
practitioners to be
appointed.
Radius of 5
miles.
Yes, Epidemic
duty, if re
¬quired.
Financed by Gov
¬ernment.
27 subsidized medical
practitioners to be
engaged.
Sind
Rs. 50 p. m.
Rs. 400
President, Dis
¬trict Local
Board.
Appointed by the
President, D. L. B.,
in consultation with
the Civil Surgeon
and subject to the
approval of the
Director of Health
Services and Ins
¬pector General of
Prisons.
Yes
Government grant. 40 rural medical
practitioners were to
be appointed. This
scheme has proved
unpopular.
Orissa
L. M. Ps. Rs. 35
p. (North
Orissa). Rs.
500 to Rs. 600
p. a. (in South
Orissa).
Rs. 300
Director of
Health and In
¬spector General
of Prisons,
Orissa through
C. Ss. and
Chairman of
District Boards.
Registered Medical
practitioners by
selection.
Area
Yes
Subsidy is paid by
Government and
medicines and ins
¬truments are paid
for by Local
Boards.
In addition to eight
subsidized rural dis-
pensaries, in South
Orissa, 4 more such
dispensaries have
since been sanction
¬ed by Government
for North Orissa
which will function
from the next finan
¬cial year. In the
case of these 4
dispensaries, Gov
¬ernment will con-
tribute half of the
monthly subsidy
and the other half
plus the cost of
medicines (Rs. 300)
will be paid by the
Local body, con
¬cerned.
Delhi
North-West
Frontier
Province
Rs. 35p. m. plus
Rs. 5 p. m.
fixed Travel¬
ling Allowance.
Rs. 200
I. G. C. H.,
N. W. F. P.
By selection
Radius of 5
miles.
No
Except for 3 places
where local effort
is made to main
¬tain the subsidized
dispensaries, the
expenditure in all
other cases is
wholly defrayed
by Government.
There are 16 subs
i¬dized medical prac-
titioners at work, 7
of whom have also
been appointed
Medical Inspectors
of Local Schools on
payment of a further
subsidy of Rs. 10
p. m. each.
Baluchistan.
Ajmer-Mer¬
wara
A scheme for medical
relief through the
agency of subsidized
medical practi
¬tioners is under con
¬ i d e r a t i o n .
45