NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
298
Ahmadnagar. —During the year an upper ward has been built to
t he ci vi l hospi t al at Ahmadnagar for t he accommodat i on of t he si ck
of the Police. The former police hospital was situated outside the
city, and at some distance from the civil hospital. The present ar
-
rangement is not only more convenient, but will be found more eco
-
nomical, as no separate establishment is now required for the police.
Satara.—It is more than 6 years ago that the large ward built by
the late Rajah of Satara for the reception of the civil patients, fell
to the ground, but nothing has been done since that date towards its
re-construction.
As the daily average number of sick treated of this class is always
high, much inconvenience has been experienced in accommodating
them in the remaining ward of the hospital without overcrowding.
On the late inspection the patients were found to be sadly over
-
crowded.
Better accommodation, as before stated, is also much required at
the hospital for lunatics.
Sholapur.—This hospital is quite sufficient to contain the daily
average number of sick treated. But proper quarters for the hos
-
pital assistant are urgently required.
Dharwar.—No further steps have been taken since last report
towards the erection of the new civil hospital at Dharwar.
As this scheme is one intimately connected with the question of
increased accommodation for our lunatics, as I attempted to explain
when writing on that subject, I sincerely trust that Government will
see the urgent necessity which exists for this hospital.
Plans have been submitted and approved, an eligible site chosen,
and money sanctioned for the building ; but the cause of delay in
commencing the work has not been communicated to this depart
-
ment.
The Administration Report of Dispensaries attached to Civil Hos
-
pitals for the year 1872-73 in the Poona Division and Southern
Maratha Circle.
Although the general return submitted for dispensaries attached
to civil hospitals show that the people, generally, have fairly availed
themselves of the advantages to be derived from these institutions,
nevertheless they exhibit, as compared with the
previous year, a falling off in attendance of
2,442 persons. I am unable to account for
this decrease.
It certainly is not attributable to any feeling of fear or distrust,
engendered by the promulgation of the new dispensary rules regard
-
ing payment of fees, for they are in no way applicable to these
dispensaries.
General attendance
at civil dispensaries.
The total number of persons treated during
the past official year was 53,290; of these,
57 died.
With a death-rate of only 1 per thousand, it must be supposed
that very few of the cases treated were of a serious character, and
further that the mortality recorded cannot be taken as an approxi
-
mation of actual results.
As regards the prevailing diseases, the present return exhibits
no deviation from those received from other civil charges. Fevers
and diseases of the stomach and intestines furnishing 43 per cent. of
the total cases treated. Dysentery and diar
-
rhœa, however, it is observed form an unusually
small proportion. The former giving only 1,009 cases and three
deaths, and the latter 2,080 with two deaths.
At the dispensaries of Belgaum, Satara, and Dhúlía thirty-two
cases of cholera were treated, of which 20 or
62 per cent. proved fatal.
The persons attacked, it is presumed, were not brought to the dis
-
pensaries for treatment, but must have been attended to at their
own houses by the civil surgeons or their medical subordinates.
On my annual inspection of civil hospitals, attention was especi
-
ally directed to the management of these dis
-
pensaries and to the manner in which the duties
are carried out, and I am able to state they were found to be well
and economically worked, and that I was quite satisfied with the
way in which medical officers in charge conducted their duties.
There is no doubt but that these institutions have proved a great
boon to the people generally, and that they are freely resorted to by
all classes, is fully borne out by the returns submitted.
The Annual Administration Report of Criminal Jails in the Poona
D i v i s i o n f o r t h e y e a r
1 8 7 2 - 7 3 .
The ten criminal jails in the Poona Division have been inspected
during the year, and in all of them the sanitary
and other arrangements carried out by jail
authorities, were found very satisfactory.
It is to this circumstance, I am of opinion, that the good health of
the convicts generally is to be attributed, as also their comparative
immunity from cholera and other epidemic diseases, so prevalent in
the various towns and districts in this Division, during the period
under report.
3 9 M D
Sickness and morta
-lity.
Prevailing diseases.
Epedemic cholera.
Result of inspection.
Sanitary state of jails.
300
The average strength of the prisoners in the above jails during
the year was as follows :—
Europeans . . .
3
Average strength of
prisoners.
Native males . . . 3,244
Do. females . . . 183
3,430
Of these 2,645 passed through the hospitals, 68 died, and there
remained under treatment, on the 31st of March, 61.
The percentage of sick treated to strength during the year
is 80.7 and deaths to treated 2.4. As regards
general sickness this return contrasts favourably
with the previous year, in which the percentage of cases treated to
strength rose to 90.1, but with a death-rate of only 3—a decrease of
more than 1 per cent.
The greatest mortality has occurred in the Dharwar Jail, the per-
centage of deaths to treated being 8.2. This high death-rate is
ascribed to the accidental occurrence of severe cases of disease
affecting men somewhat advanced in life, and not to any
special insanitary influences in the jail itself ; and, certainly, the
returns submitted bear out this explanation, for the percentage of
cases treated to strength is only 46.1.
It is a subject for congratulation to know that although cholera
was very rife for several months together in
the immediate vicinity of many of the jails, it
gained admittance into only two, and that to a very limited extent.
At the Poona City Jail in the month of July 2 cases were admitted,
one of which proved fatal. At Yerrowda one fatal case occurred.
Thus, only 3 cases and 2 deaths from this disease have taken place
during the year.
Malarious fever.—Under the head of malarious fever the admis-
sions to hospital were 1,111 with 3 deaths or 40 per cent. of the
total treated. Included among these, however, are 27 cases of dengue
fever, admitted in the Poona and Satara Jails.
Diseases of the Stomach and I ntestine.—Diarrhœa and dysentery
prevailed in the jails to a greater extent in this than in the previous
year. From the former there were 136 admissions and 10 deatls,
and the admissions from dysentery were 169, of which 8 proved
fatal.
But bowel complaints were also very prevalent among the free
population during the months of June, July, and August ; and, in all
probability, were due to the impurity of the water obtained for drink-
ing purposes owing to the drying up of tanks and wells prior to
the monsoons, which after heavy rains again filled, and the water
Sickness and mortality.
Malignant cholera.
301
taking up all the filth which had accumulated in them, was no doubt
largely used with all its suspended impurities.
Diseases of the Respiratory System.—Ever since the Yerrowda Jail
was established, it has been observed that diseases of the respiratory
system have been proportionately greater in this jail than in any
other in the division. No doubt the locality in which the jail is situ
-ated has something to do with this, for it is very high and much
exposed to the east and north-easterly winds which prevail during
the cold season. But the convicts transferred from jails on the
coast and other low lying situations, being unaccustomed to the
dryness of the Deccan climate, are more especially liable than others
to pulmonary affections.
During the last year the number of admissions to hospital from
pneumonia and bronchitic affections was 95, 13 of these or nearly 14
per cent. proved fatal. The admissions to the Yerrowda Jail were
59 or nearly two-thirds of the total treated.
Filaria Medinensis .—Before closing this brief medical history of
the jail hospitals, allusion must be made to the frequency of guinea
- w o r m a m o n g s t t h e p r i s o n e r s . F r o m t h i s t e d i o u s a n d t r o u b l e s o m e
complaint 222 cases have been under treatment during the year.
The reports submitted, however, show that, in the majority of in
- s a n c e s , t h i s d i s e a s e w a s c o n t r a c t e d p r i o r t o t h e p r i s o n e r ' s a d m i s s i o n
to jail; consequently, water of the wells and tanks used by the pri
- s o n e r s a r e , i n a l l p r o b a b i l i t y , f r e e f r o m t h e g e r m s o f t h e d i s e a s e .
Transfer of Prisoners.—The injudicious selection of convicts trans
- f e r r e d f r o m o t h e r j a i l s t o Y e r r o w d a , i s a s u b j e c t w h i c h h a s a g a i n b e e n
brought to notice. It is stated that out of 585 prisoners sent to the
Yerrowda Jail during the year, 16 were constitutionally unfit for the
labour and exposure prisoners undergo in the central jail.
As the same rule applies to convicts transferred to the above
jail, as to prisoners selected by civil surgeons for "subsidiary road
labour jails," the attention of medical officers must be again directed
to this subject.
Overcrowding in the Jails. —Taking the extent of space allowed to
each prisoner in jail at 648 cubic feet, very few of the jails in this
division can be said to be free from overcrowding. But, whilst calculat
- i n g i n t h i s w a y t h e c a p a c i t y o f a j a i l , l i t t l e o r n o a l l o w a n c e s e e m s t o
have been made for the healthiness or otherwise of the climate in
which they are situated ; in other words, no difference in cubic capa-
city is allowed for the good or bad climate influences surrounding
them. And it is only in this way, I think, we can account for the
freedom from sickness in those jails which are made to contain, per
- h a p s , a t h i r d m o r e t h a n t h e e s t i m a t e d n u m b e r .
302
Judging from the returns received from the several jails in this
division, I think it is evident, that the pre
-sent prison accommodation is on very much
too limited a scale to meet the requirements
of our convict population.
Yerrowda Central Jail now contains 400 prisoners above its esti
-mated capacity, and the total number of convicts in the jails for
which no adequate provision has been made is 796.
Annual Progress Report of Police Hospitals in the Poona Division
for the year 1872-73.
Jail accommodation insuf-
ficient.
The returns received from the police hospitals for the past year,
though on the whole favourable, considering
the work the Police are called upon to per
-form, are not so satisfactory as those sub
-mitted for the preceding year, exhibiting as they do, with a large
reduction of strength, a greater amount of sickness and mortality.
The average strength of the Police in this division during the year
was 6,113. Of these 2,867 were treated in
the hospitals and 30 died. The percentage,
therefore, of sick to strength was 46.9 and deaths to treated 1 per
cent.
If the above statement is to be relied upon, it shows that the
Police, as a body, have been very healthy during the year, notwith
-standing the sickness which has been so general throughout the dis
-tricts. But I am inclined to think that many instances occurred of
policemen when sick being allowed to remain in their lines
without medical treatment, and that some men even died at the out
-posts, and, consequently, are not brought on the returns.
Cholera .—The returns show only 7 admissions from this disease
with a mortality of 5. As most of these cases were brought to the
hospitals in the collapsed state of the disease, this fatality is not s
u r - p r i s i n g .
Malarious Fever.—Admissions from fever, of the intermittent and
remittent type, constituted 40 per cent. of the total sick treated, but
of these only 5 cases terminated fatally.
The Police in the districts of North Kanara have as usual suffered
very much from ague. For out of a strength
of 312 men, doing duty at the 5 outposts
in those jungles, 275 or 88 per cent. have
been under treatment for that disease.
The bad accommodation provided for these men no doubt has
contributed in some measure to augment the
prevailing sickness, and to render the men
more susceptible to recurrent attacks of fever.
General health of the po
-lice force.
Sickness and mortality.
Sickness of Police in North
Kanara.
Causes of sickness.
Diseases of the Stomach and Intestine .—The number of cases
treated in the hospital from these diseases, bears, I am afraid, but a
proportion to the actual number who have suffered from these com
- p l a i n t s d u r i n g t h e y e a r , j u d g i n g f r o m r e t u r n s r e c e i v e d f r o m o t h e r
hospitals.
The admissions from diarrhœa were 68 with 1 death, and from
dysentery only 62 and 2 deaths. This gives a percentage of strength
to treated of only 1.
Diseases of the Respiratory System .—With exception of cholera,
pulmonary affections have been the most fatal of all other diseases
treated. This is owing, in all probability, to the great exposure the
men of the Police undergo, and in all vicissitudes of weather. The
number of admissions was 96, of these 9 or nearly 10 per cent. died.
Police Hospitals. —All the police hospitals in this division, with
exception of those in North Canara, have been inspected during the
past year. At a few stations, such as Dhurrumgaum and Kolhapur,
separate hospitals are established for the sick of the Police, but in
others they are treated in wards attached to the civil hospitals; and
I take this opportunity of stating I had every reason to be satisfied
with their neatness and order and of the manner in which the medical
officers appeared to conduct their duties.
Police Lines .—The police lines, as a rule, are very fairly built and
afford sufficient accommodation for the average number of men oc
-cupying them. They were all found clean, and their sanitary condi
-tion was satisfactory.
Dhurrumgaum Lines. — A t
Dhurrumgaum the lines though substan
-tially built might be greatly improved by introducing more light and
ventilation to the huts. At present the only light and air admis
-sible is by the door, a defect which has been already pointed out. The
interior of the huts also require lime-washing.
Latrine accommodation is also much required; at present, the in
-
habitants of the lines resort to the fields,
more than half a mile distant, which of course
is very inconvenient, even in the day time.
At night it is supposed that women and children only go to places
within the lines; for it is reported that the effluvia arising from this
cause, early in the morning, is very great. Latrines, therefore, if only
for the families of the above corps, should be erected without delay.
The lines at Belgaum were condemned, and money sanctioned for
building new lines five years ago, but up to this time nothing has been
done towards this desirable object. The condition of the present
lines is bad, and they are not sufficiently extensive to contain half
of the men usually present at head-quarters in the monsoon.
Latrine accommodation
required.
304
The accommdatioon provided for the Police in Kanara jungles, as
before mentioned, is, as a rule, very bad, and
is one source of the great amount of sickness
which has prevailed and still prevails amongst
them. For, it may be observed, it is in these districts that the men
of the Police require better shelter and more wholesome dwellings
than in any other. At Supa and Sirsi the lines are good, but at
Moondegod it was observed that the police quarter consisted of a
house capable of containing, perhaps, a large family, but in which the
whole detachment of some 40 men were located.
No. 111/M OF 1873.
FROM
THE DEPUTY INSPECTOR GENERAL, P. D. A.,
To
THE SECRETARY TO THE INSPECTOR GENERAL,
Indian Medical Department.
Mahableshwar, 1st June 1873.
SIR,—In compliance with instructions conveyed in your letter No
244, dated 23rd January, I have the honour
to submit a statement of expenditure in
-
curred for the maintenance of patients in the civil hospitals and
lunatic asylums in the Division, and to point out how far and
in what direction, I consider a saving could be effected, without
in any way impairing the usefulness or efficiency of those institutions.
Before, however, I enter upon this subject, I must allude to the Reso
-
lution of Government No. 157, marginally noted in your letter under
reply, wherein Government seem to be under the impression that
various dietaries are in the use in the civil hospitals and dispen
-
saries—of course this is a mistake. It is true that the cost of main
-
tenance differ much in different hospitals, and for reasons hereafter
to be explained, but the dietary in use is the same in all Civil Hos
-
pitals and lunatic asylums; and it is that laid down in the Medical
Code, Section 7, page 78.
At dispensaries in-door patients are seldom admitted. But when
they are, the expenses incurred for dieting are either borne by the
municipality or the patients subsist themselves.
After careful consideration of the subject of dieting patients in our
civil hospitals and lunatic asylums, I have
come to the conclusion that, in the majority
of them, the expenditure is much greater
than need be; and this is quite irrespective
of the price of grain ruling at the localities in Which they are situat
-
ed.
Defective state of police
lines in North Kanara.
General observations.
Dieting of patients in
civil hospitals and luna
-
tic asylums.
305
In some civil hospitals the average cost of daily diets is one-third
more than at others; and that, too, at sta
-
tions where the market prices of the articles in
use are actually cheaper.
In order to form a correct idea of the subject, a statement has been
prepared (vide C I), showing the average price of each article dur
-
ing the past year, in the several collectorates, and the cost of diet
-
ing patients at the various civil hospitals in this Division.
Why this difference should exist I am unable to say—probably, in
some instances, unfavourable contracts have
been accepted by the civil surgeons in charge;
or there being no contracts, the grain dealers have charged what
prices they pleased.
The Sassoon General Hospital and the Lunatic Asylum at Poona
are supplied by the Commissariat Department;
consequently, all articles furnished greatly
exceed that for which they might be procured
by contract. This circumstance was pointed out in a report submit
-
ted last year, and the civil surgeon brings the subject to notice in
his annual report.
The cost of dieting convicts in our jails is considerably less than
in our civil hospitals and lunatic asylums;
notwithstanding the Dietary Table for convicts
on hard labour is equally liberal, and might,
as stated by Dr. Beatty, be accepted as the basis for carrying out
any alterations in the ordinary diet table before alluded to.
The most expensive articles of food in the present dietary, viz.
ghee, rice, and mutton, are just those to which the majority of peo
-
ple resorting to our civil hospitals are unac
-
customed; because, from their poverty, they are
unable to procure them. I, therefore, think that
some modification, with a view to economy, might be made in the
diet table in use in civil hospitals and lunatic asylums, and that,
too, without detriment to the inmates.
Bajree, wheat, or juwaree flour, might very well be substituted for
rice; and mutton, as an article in the ordinary diet, be given only
twice a week. Ghee I would retain.
The scale of reduced diet should remain as at present.
In trying to introduce more economy in the management of our
civil hospitals and asylums, the subject of fuel is one which has not
to be lost sight of. Firewood, though in some parts of the country
The difference in cost
of diets at different hos
-
pitals.
Causes of difference.
Cost of difference ex
-
plained.
Cost of diets in hos
-
pitals and jails compar
-
ed.
Modification in dietary
proposed.
306
rather expensive, it has been thought advisable to retain, as the sub
-
stitute for it—cowdung cakes, now used in all our jails—will
n o t
answer very well in hospitals for heating water, preparing poultices,
&c. Besides, I am informed, it requires less time and labour to pre
-
pare food with wood than with the native fuel.
If these alterations were made, no doubt, the cost of maintaining
pauper patients and lunatics would be considerably less than at pre
-
sent. But even keeping to the present dietary, I am confident that
by limiting the daily expenditure of each civil hospital and asy
-
lum to a fixed rate per man, the sum depending of course on the
part of the country in which the hospital is situated, a considerable
reduction in the annual outlay might be effected.
This plan answers very well at Nasik, where the daily allowance
to each patient admitted to hospital is only two annas.
To bring the subject more clearly into view, reference is requested
to Statement C 2, in which the daily, monthly, and annual cost for
each patient, in various civil hospitals, is exhibited; also the saving
which might be effected if the above plan be regularly carried out.
Clothing.—The annual cost for clothing in our civil institutions
has always been considered too large, and it is in this direction also,
I think, more economy might be exercised than at present.
In the Sassoon Hospital and Lunatic Asylum at Poona, it is supplied
by the Commissariat Department, and, of course, is more expensive
than if obtained elsewhere.
The expenditure for clothing in the former hospital during the
past year was 800 Rs ., and in the asylum for the year 1871
Rs. 1,860. But the clothing having lasted two years the sum
expended annually is Rs. 930, showing an average cost of Rs. 15-8-0
per man per annum. This might be reduced one-half if the clothing
was procured direct from the bazar.
In the asylum at Dharwar each patient was clothed for Rs. 8-8-0
—a rate which approximates to the one I propose to fix for the Poona
Asylum. The table marked C. 2 in the appendices, will show the
annual. cost of clothing in each civil hospital and lunatic asylum in
the Division, and the reduction which, I think, might be effected.
Expenditure of Medicines.—The expenditure of medicines and medi
-
cal and surgical appliances is no doubt large, and appears to be in
-
creasing, especially in civil hospitals and dispensaries. But as this
is a subject which is now under the consideration of the Inspector
General, it will be unnecessary for me to state in detail what measures
307
in my opinion should be adopted with a view to check this undue
expenditure.
The causes which have led to this increase, I think, may be traced
partly to expensive preparations now too
much in use in hospitals when cheaper and
as efficacious articles might be employed;
and, also, to the undue accumulation of drugs in store, which, in course
of time, deteriorate and are condemned.
The expensive surgical instruments supplied by Government to
charitable dispensaries on their first establishment, I am of opinion,
are quite unnecessary. A few instruments of the simplest kind is all
that hospital assistants need, and should sub-assistant surgeons at
any time require more, they can be obtained from the civil hospital.
probable causes of increased
expenditure.
40 M D