NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
No. 415 of 1872.
FROM
THE DEPUTY INSPECTOR GENERAL OF HOSPITALS,
Indian Medical Department, Sind District ;
To
THE COMMISSIONER IN SIND,
Kurrachee.
Kurrachee, 21st May 1872.
SIR,
I do myself the honour to forward, for your information, the follow
-ing report embracing the medical history of the various civil hospitals,
dispensaries, and jails throughout the Province of Sind for the
official year 1871-72 ; also that of the Cowasjee Jehangeer Lunatic
Asylum at Giddu-ka-Tanda ; the health of the prisoners and police,
and the amount of vaccination, with results carried out at the above
institutions, and which is quite distinct from the work under
-taken by the Vaccination Department.
Since the receipt of last year's administrative report, the civil
hospitals and dispensaries in this province have been neither increas
-ed nor diminished. They are as follows
:—
Civil hospitals.
5
Dispensaries, Government and Charitable 23
The police in Collectorate towns are received into the former,
those scattered throughout the districts are treated at the latter.
Prisoners, again, have their own hospitals in the several large Zillah
jails at Kurrachee, Haidarabad, Bukkur, Shikarpur, and the Mitrow
Canal, while those confined in the subsidiary ones receive medical
aid from the Hospital Subordinates in charge of the dispensaries at
those places.
During my late tour I have personally inspected all the hospitals
and dispensaries in the province, with the exception of the ones
at Nagar Parkar, Mittee, and Khetty. These three I was unable
to visit owing, first, to the interruption in my tour occasioned by
having to send in my annual military report in the beginning of
February, hitherto never called for previous to the termination of
circuit ; and, secondly, in consequence of the advanced period of the
season, which would have necessitated my absence from head quar
-ters to an unusual length, and interfered with the preparation of my
annual papers.
I have to report with pleasure that, with a few exceptions, the
working at the various hospitals and dispensaries has been satis
-factory. The medical officers and subordinates for the most part
have displayed zeal, diligence, and a due appreciation of the respon-
20 8
sibilities of their duties and position, and have endeavoured faithfully
to discharge these to the best of their abilities. In some instances,
which I will mention further on; this has been most marked, and I
shall have much pleasure, when speaking of the separate changes, in
bringing the names of these individuals to your notice.
5. In stating the results of the medical practice in the civil
establishments of this province, I will Content myself with merely
giving you a general statement of the sickness and mortality as wit-
nessed at them, believing that you neither require nor would appreciate
a more scientific arrangement necessitating, as it would, my introduc-
- i n g p r o f e s s i o n a l a n d t e c h n i c a l t e r m s .
6. The numbers treated therefore in the several hospitals and
dispensaries for the past official year are of two classes, in-door and
out-door. I will first of all enumerate the former with their results,
beginning with the civil hospitals, and following with the dispen-
saries. It must be borne in mind, however, that the police are not
included in the in-door patients of civil hospitals, but are returned
separately; but this is not the case elsewhere, as the regulations
have not as yet provided for their seperation in dispensaries, though
this will be done in future. At present they are included under the
general head of in-patients at these institutions.
Civil Hospitals.
R e m a i n e d o n 3 1 s t
M a r c h 1 8 7 1 .
Ad mi t t e d d u r i n g
t he year.
Total.
Cured.
D i e d .
R e m a i n i n g o n 3 1 s t
M a r c h 1 8 7 2 .
P e r c e n t a g e o f D e a t h s
t o Tr e a t e d.
I n - d o o r P a t i e n t s .
Kurrachee
19
423
442
352
66
24 14.9
Kotri
15
315
330
290
19
21
5.7
Haidarabad
51
646
697
619
44
34
6.3
Shikarpur
4
176
180
158
14
8
7.7
Sakkhar
11
208
219
203
9
7
4.1
Total
1 0 0
1,768 1,868 1,622 152
94
8.1
3 Police Hospitals
31 1,206 1,237 1,174
28
35
2.2
209
Di spensari es.
R e m a i n e d o n 3 1 s t
Ma r c h 1 8 7 1 .
A d m i t t e d d u r i n g
t h e y e a r .
T o t a l .
C u r e d .
D i e d .
R e m a i n i n g o n 3 1 s t
M a r c h 1 8 7 2 . P e r c e n t a g e o f D e a t h s
t o Tr eat ed.
I n - d o o r p a t i e n t s .
Kurrachee
1
4 0
4 1
3 2
7
2
1 7 . 0
Tatta
1
2 3
2 4
1 8
5
1
2 0 . 8
Mirpur Batora
1
4 5
4 6
4 0
5
1
1 0 . 8
Khetty
. . .
2 5
2 5
2 5
. . .
. . .
. . .
Jharak
. . .
1 3
1 3
1 2
. . .
1
. . .
Sihwan
. . .
6 0
6 0
5 9
. . .
1
. . .
Tarusha
. . .
6 2
6 2
5 3
2
7
3 . 2
Halla
1
3 4
3 5
3 3
. . .
2
. . .
Alhar-ka-Tanda
2
7 9
8 1
7 2
6
3
7 . 4
Mahomed Khan's Tanda
3
1 5 4
1 5 7
1 5 0
3
4
1 . 9
Umarkot
1 3
1 2 8
1 4 1
1 2 8
1 0
3
7 . 0
Nagar Parkar
4
6 2
6 6
6 5
1
. . .
1 . 5
Kippra
3
4 8
5 1
4 6
3
2
3 . 6
Mittee
. . .
6
6
5
1
. . .
1 6 . 6
Jacobabad
2 1
2 0 2
2 2 3
1 8 0
2 6
1 7
1 1 . 6
Shikarpur
. . .
5 3
5 3
4 6
5
2
9 . 4
Sakkhar
6
2 5 2
2 5 8
2 1 4
2 7
1 7
1 0 . 4
Rohri
1 0
1 6 2
1 7 2
1 6 3
5
4
2 . 9
Larkhana
1
4 9
5 0
4 3
7
. . .
1 4 . 0
Mehur
3
6 5
6 8
6 1
2
5
2 . 9
Total
7 0
1 , 5 6 2
1 , 6 3 2
1 , 4 4 5
1 1 5
7 2
7 . 0
7. Preserving the same order, I
will now give the numbers treated
as out-patients at the various civil hospitals and dispensaries in Sind;
but in place of showing any deaths from among these, I Will instead
note the number who have absented themselves. This omission of
deaths is very necessary, for although the mortality is of course con-
siderable, yet the information on this point, which can be brought- to
book in the dispensary records, is extremely limited, Owing to the
irregular and spasmodic attendance of this class, to the fluctuating
state of the population, to the applicants for relief frequently being
travellers, or others coming from a distant village for advice and
medicine, there are hundreds; perhaps thousands, who subsequently
die, and who ought, strictly speaking, to appear on the casualty list
of the different dispensaries which helped them in their distress. But
this is of course impossible, and to record, therefore, the few deaths
occurring in the village or town in which the dispensary is situated,
as a set off against the thousands who have been treated, as I have
noticed frequently to be done, without having the power of taking
cognisance of the many who pass on to die elsewhere, and to attempt
to draw a ratio per cent. of deaths to treated from such erroneous
premises, is to arrive at deductions as untrustworthy as they are illogical.
210
Civil Hospitals.
R e m a i n e d .
A d m i t t e d .
T o t a l .
C u r e d .
A b s e n t e d .
R e m a i n i n g .
O u t - d o o r P a t i e n t s .
Kurrachee
...
...
97
6,639 6,736 6,599
46
91
Kotri
...
...
57
2,234 2,291 2,221
4
66
Haidarabad ...
...
78 14,259 14,337 13,401
813
123
Shikarpur
...
...
20
1,427 1,147 1,408
32
7
Sakkhar
...
...
23
1,747 1,770 1,313 438
19
Total
......
275 26,306 26,581 24,942 1,333
306
Dispensaries.
R e m a i n e d .
A d m i t t e d .
T o t a l .
C u r e d .
A b s e n t e d .
R e m a i n i n g .
O u t - d o o r P a t i e n t s .
Kurrachee ...............
123 12,268 12,391 8,537 3,770
84
Manora .................
14
625
639
618
4
17
Khetty ...................
19
1,378 1,397 1,340
12
45
Tatta .........................
67
6,021 6,088 5,615 338
135
Mirpur Batora ...............
107
4,367 4,474 4,189
182
103
Jharak ..........................
15
1,068 1,083 1,045
22
16
Boola Khan's Tanda ...
19
967
986
965
2
19
Sihwan ..........................
49
3,510 3,559 3,430
93
36
Mahomed Khan's Tanda
41
1,575 1,616 1,557
39
20
Umarkot ........................
44
4,051 4,095 3,637
403
55
Nagar Parkar ...............
16
1,602 1,618 1,553
27
38
Mitte
e .........................
14
2,225 2,239 1,828 398
13
Ki ppr a . . . . . . . . . . . . . . .
16
1,792 1,808 1,764
22
22
Alhar-ka-Tanda .............
19
1,618 1,637 1,545
77
15
Halla .....................
15
1,363 1,378 1,368
...
10
Tarusha ..................
34
1,794 1,828 1,683
121
24
Jacobabad ...............
26
3,106 3,132 2,976
131
25
Shikarpur ..................
21
5,924 5,945 5,695
197
53
Sakkhar ....................
52
2,639 2,691 2,138 481
72
Panjab Flotilla, Sakkhar
17
880
897
884
2
11
Rohri ...........................
25
2,619 2,644 2,406
212
26
Larkhana ...............
48
6,356 6,404 6,210
148
46
Mehur ...............
24
2,255 2,279 2,179
78
22
Lunatic Asylum ......
93
43
136
18 * 18
100
* Died.
Total ... 918 70,046 70,964 63,180 6,777 1,007
211
8. By comparison with the number of in-door and out-door pa-
tients treated in these same hospitals and dispensaries for the previous
official year, which will be found in the administrative report for
-warded you by my predecessor, it will be seen that there is an
increase of some 4,332 patients ; and when it is remembered that the
past year has been an exceptionally healthy one, specially in the
matter of malarious fevers, it will be admitted that the appreciation
in which these establishments are regarded by the people, and the
growing tendency there exists to take advantage of their benefits, are
well marked, and constitute an encouraging feature as to the benefi
-cial results these institutions are conferring upon the inhabitants at
large.
9. It would be erroneous, however, to attempt to gather from
these returns any idea of the healthiness of the people throughout
the province, or of the amount of mortality which has prevailed dur-
ing the past year.
10. It is pleasant to have to record that Sind has been entirely
free from cholera, though this disease has prevailed to a consider-
able extent in the Persian Gulf and adjoining countries, nor has any
form of epidemic disease visited the country. Small-pox has been
reported here and there, and it certainly has been witnessed in a
few isolated cases ; but beyond these it is extremely doubtful whether
the disease reported as small-pox was in reality such. Consi-
dering the highly contagious nature of this malady, it is far more
probable that the affection was the comparatively harmless one called
chicken-pox, which has here and there been prevalent, and which
is not infrequently mistaken for the other disease in its modified
form. Measles have prevailed to some extent in Kurrachee, at
Manora, lately at Haidarabad, and in a few of the smaller towns in
Sind ; but it has been so partial as hardly to deserve the name of
"epidemic," and the mortality from this affection, sq far as I have
heard, has been insignificant. Hooping-cough also has been witnessed
to a slight extent, but this complaint was confined chiefly to
Manora, and for a few months among the Parsees at Kurrachee. It
was noticed also lately at Haidarabad. The affection has proved
mild and tractable. But fever—malarious fever—annually lays
low its victims by hundreds, and although in the course of
time, through the increasing knowledge of the proper remedies, and
the facilities afforded to the people of obtaining them, the mor
-tality from this cause will be every year becoming less. Yet so long
as in a burning climate, such as Sind, a flat alluvial country border-
ing on a large river like the Indus, and in many places below its
level, is subject to annual inundations, is intersected by countless
water-courses which receive all manner of impurities, and these
slowly dry up ; malaria, with all its attendant evils, will hardly ever
be absent, and, under certain circumstances, will exist in a highly
exalted and dangerous condition.
11. In addition to the constant presence of this poison, under
-mining by its depressing and debilitating effects the constitution of
212
the people, they are likewise exposed to the extremes of great heat
and cold ; and this not only during what may be termed the normal
periods of the year, viz., summer and winter, but at other times also,
and that suddenly, and within the 24 hours. I allude specially to
the cold season. At this time during the day the sun's rays elevate
the thermometer often to 100º, while during the night, and
particularly towards morning, when the system is peculiarly
susceptible to climatic influences, the temperature is fre
-quently at the freezing point, and even below it, These sudden
changes do not take place without their injurious effects being
occasionally felt by the well-fed, well-clothed, and comfortably
-housed portion of the community ; but they act with tenfold greater
energy on the ill-fed, poorly clad, and insufficiently protected classes.
Hence it is not surprising that a very considerable mortality is
known to have occurred in many of the smaller towns and hamlets
throughout Sind, the residents of which have had little or no medi-
cal assistance from dispensaries in the neighbourhood. This morta-
lity has been particularly observed during the cold season, and its
explanation is not difficult. The malaria poison induces a vitiated
condition of the system, the prominent symptom, in the absence of
fever, being a low state of vital energy. This renders the individual
peculiarly susceptible of atmospheric changes ; and under these cir
-cumstances, without the greatest circumspection, imflammation of the
lungs and their investing membranes are a frequent occurrence.
The disease generally comes on suddenly, and. in such cases, debilita
-ted by the causes I have already mentioned, recovery in the absence
of judicious treatment is seldom witnessed. It would be quite
out of place to term this disease "epidemic," however common it
may be. The more correct expression would be to call it "endemic,"
born and bred in the soil, just as fever is, and developed in indivi
-duals already prepared for its reception through climatic influen
-ces acting on their depraved constitutions and faulty modes of living.
It would be equally incorrect to consider this mortality in any way
infectious or dependent upon a special contagion. From what I have
said it will hardly be necessary for me to stop to combat this opinion,
which, I am aware, has in some quarters been advanced. I merely
notice it to pronounce emphatically against it.
12. A number of deaths likewise have occurred in various parts
of the Province from affections of the bowels, chiefly diarrhœa and
dysentery. In this matter, another element added to those already
spoken of, has its part—I mean the great impurity of the drinking
-water which, owing to the extreme drought experienced last year
throughout the whole of Sind, has caused all the supplies used
for domestic purposes to become more or less obnoxious from
contamination.
In commenting on the maladies which peculiarly affect the health
of the natives in the Province, I must not omit to mention one which
is observed more frequently here than in other parts of this side of
India. I allude to stone in the bladder. Various explanations have
214
the Police hospitals situated at head quarters would be valuable to
these ends were the mon individually the same; but while the
average strength is subject to little variation, constant changes
are occurring in the persons. Only healthy men are sent away on
out-post duty; sickly ones are frequently returned. These rapidly
help to increase the sick roll, are at length cured or die, and give
place to others, perhaps, similarly circumstanced, It is easy to see
how imperfect must be statistics based upon returns which are them-
selves the offspring of error, but which the system initiates and
helps to keep up.
16. The following table shows the average strength of the pri-
soners in the large jails in the province during the past official
year, their admissions and deaths, the ratios per cent. of treated to
strength, of deaths to strength, and of deaths to treated:-
St r e ngt h.
Remai ned.
Admi t t ed.
Total.
Cured.
Di ed.
Remai ni ng.
Percentage of
T r e a t e d
t o
S t r e n g t h . Deaths to
Strength. Deat hs t o
Tr eat ed.
Kurrachee
343
6
347
353
323 20
10 102.7 6.4
5.9
Haidarabad
521
12
323
335
305 12
18
64.2 2.2
3.5
Shikarpur
550
14
420
434
379 45
10
78.9 8.1 10.3
Bukkur
241
27
608
635
595 18
22 263.4 7.4
2.8
Narra Canal
294 27
385
412
391
9
12 140.1 3.4
2.1
Umarkot
130
4
396
400
386
5
9 307.6 3.8
1.2
Total
2,079 90 2,479 2,569 2,379 109
81 123.5 5.2
4.2
17. Striking out for the moment the returns from the Shikar
- p u r j a i l , i t w i l l b e s e e n t h a t t h e m o r t a l i t y h a s b e e n g r e a t , b e i n g a t
the rate of 42 per 1,000, which stands in very unfavourable contrast
with the published returns of the death rates in Indian jails, vide
Madras Report for 1870, where they are stated as 26.5 per 1,000; but
when the mortality in the Shikarpur jail, which is as high as 80
per 1,000 is added to the others in Sind, the comparison is still more
startling, and brings the total death rate of prisoners in this pro-
vince up to 52 per 1,000, which is enormous, being double the rate of
Indian jails in general. The explanation of this high rate of morta-
lity in the last named jail is not to be accounted for by the severity
of the climate, by any exceptional state of the prisoners' health, or
peculiarity in the jail itself, or method of the treatment; but simply
to the fact that all the healthy, able-bodied men are constantly
being transferred to other jails, while only the feeble, the sickly,
and aged prisoners are retained at Shikarpur.
18. When remarking in the earlier portion of this report that the
working of the various hospitals and dispensaries throughout Sind
had for the most part been satisfactory, I left it to be inferred that,
217
24. The Kurrachee Dispensary, supported by the Municipality, has
done fairly. The admissions have been fewer by about 3,000 than
was the case in the previous year. This is attributed to the com--
parative healthiness of the past year ; but I think also something
may be owing to the fact of the Sub-Assistant Surgeon living in camp,
and not, as a rule, visiting the dispensary in the evening. But now
that the new rules require dispensaries to be attended morning and
evening by the medical officer in charge, his living so far away is
very inconvenient. He states that no suitable house can be found
in the neighbourhood, and with the view of removing this objection,
I think the Municipality should be moved to build quartes for the Sub
-Assistant Surgeon near the dispensary.
25. As regards Tatta great improvement in the present dispen--
sary arrangement is called for. More than half of the dispensary is
appropriated as the residence of the apothecary, there being no suit--
able house where he and his family can live ; and the evil of this is
that the in-patients are treated in a miserable place in the town at
least 1/4th of a mile distant. Either a house ought to be built for the
apothecary, and the present building given up entirely for dispensary
use, or a new dispensary erected.
26. Matters at Khetty are, however, infinitely worse. The dispen--
sary there is merely a hut built of mats ; and as this is rather an
important place, with a rich municipality, who only lately have con--
structed a large iron dhurmsalla, it is a matter of surprise that they
should show such apathy and indifference in a much more important
matter, viz., the erection of a good substantial dispensary.
27. The dispensary at Sihwan is located in an old mosque in the
town. The accommodation is sufficient, but the situation is objec--
tionable, it being close to the market, surrounded by houses, and dis--
tant at least 1/4th of a mile from the apothecary's quarters. It has been
proposed to transfer the dispensary to the school-house, which is
commodious and well situated in an open quarter of the town, not
far from the River Arrol. It is conveniently placed for the inhabit
-ants, and is also close to the apothecary's house ; and a still
further recommendation is the presence of several large trees, the
shade of which would at all seasons be most acceptable to the patients
visiting the dispensary. As the mosque and out-buildings now used
as the dispensary would make an excellent and convenient school--
house, I strongly recommend the transfer being effected.
28. The Halla Dispensary is what formerly was the District Jail.
The space is greater than is ever likely to be required for hospital
purposes, but commodious as it is, I found in it two evils, the one
was the absence of ventilation, and which could be supplied at small
cost. A few loop holes under the roof, or a small window here and
there, Would answer the purpose. The other is not so easily reme-
-died. The wards are on a level with the ground, and in heavy rain,
or after a high flood in the Indus, the floors, which are of mud, par--
take of the general dampness around.
219
medical aid on the person in charge of the dispensary, there being
no other experienced medical officer nearer than at Kotri. On
all these grounds, therefore, and remembering also that Tatta, with
the surrounding neighbourhood, is at all times rather an unhealthy
locality, I would urge no change being made in the rank of the
medical subordinate stationed there.
30. I was greatly surprised on visiting Larkhana, to find that
a large and important town such as this possessed the worst
dispensary in all Sind. Situated near the edge of a large canal,
it ought to have been raised on a plinth. In place of this it seems
purposely to have been sunk below the surface, for on entering
the building the floor descends for nearly a foot. The dispensary
is constantly damp, the earthern floors dark and sodden looking,
and the walls in every direction have the plaster falling off up
to fully 4 feet from the ground. To make matters worse, the
construction of the building is so faulty, consisting of 3 narrow, low
-roofed corridors, that ventilation is nearly impossible ; neither doors
nor windows exist at the two ends, and those at the sides are so
low and narrow as to be nearly useless. Little or no space inside is
available for conveniently placing the cots; altogether the place, owing
to its darkness, damp, and close, mouldy smell, reminded me of a
charnel-house fitted more for the reception of the dead than the cure
of the living. The Mooktyarkar, who is also Secretary to the Muni
-cipality, informed me that it was all, but decided to build a new dis
-pensary, and he showed me several spots which were available for the
purpose. One of these was in every way so much superior to the
others, that I begged he would state my views on the matter to the
municipality. The site I selected is not far from the present dispen
-sary, on a fine, open piece of ground, shaded by several large trees,
conveniently placed for the town, and some 80 yards distant from
the canal. I particularly impressed upon the Mooktyarkar the ne
-cessity of raising the new building on a suitable plinth and protecting
it with verandahs on the south and west sides.
31. I can report favourably of the dispensary at Tarusha only
from the end of September last, when it came under the charge of an
excellent hospital assistant, who was formerly at the civil hospital,
Haidarabad. For some months previous to that it had been sadly
neglected by the medical subordinate who was there ; but since he
was removed the attendance has greatly increased.
32. Although the population of Mehur is small, containing only
some 2,500 souls, the attendance at the dispensary has amounted
to 2,279. A good portion of these, however, is contributed by the people
of the neighbouring villages, who readily come in for medicines and
advice. The dispensary itself is a poor place. It has existed for the last
22 years, and is a small irregular building in a very confined com
-pound. The accommodation hitherto has been found sufficient, but
the ventilation is most imperfect, and the premises require consider-
able repair.