NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
35
SUMMARY.
Having thus examined the work of each medical circle, I now
come to summarize the collected results of the year and to make
such observations and suggestions as seem to be required and in the
order previously noted.
1.—LUNATIC ASYLUMS.
There are five. Table No. 6 shows that there has been a decrease
of 57 in the total number treated in all asylums in 1871-72, as com-
pared with 1870-71. The decrease is very large in the Colaba asylum
(66), whilst in the Poona and Dharwar asylums the decrease has
been 9.
In the Ahmadabad asylum there was an increase of 1, and in that
of Sind of 17.
There is a large number of insanes, not in any asylum, who figure
in the annual returns of civil hospitals and dispensaries. The
gross number is 354, with 6 deaths. Many of these have doubtless
been subsequently provided for in asylums, but the number is so un-
expectedly large, that I have directed careful enquiries to be made
with the object of obtaining exact information as to the number of
insanes, known to be such, who are not at present in any asylum,
with all necessary particulars of their state and condition. Credit is
due to the medical officers concerned for the good management of
these important institutions during the year. The asylum at Ahmada-
bad, under the care of Dr. Wyllie, is especially noticeable for the
excellent system which prevails in it. Many of the patients are use-
fully and profitably employed in out-door work and it has been found
possible to maintain order and quiet without the use of painful modes
of restraint, or even of a padded room. In the asylums generally,
the physical health of the patients has been good, and the number of
deaths, though excessive in the Sind asylum, has on the whole been
less than during any of the preceding five years.
2.—CIVIL HOSPITALS.
There are 33 of these institutions altogether, one of them being
located at the head quarters of each Collectorate.
The general usefulness and high character of these hospitals have
been well maintained during the year.
There has been a decrease in the numbers treated in the Mofussil
civil hospitals of 348, and in those of the Presidency city of 122.
The death rate of the J. J . Hospital is the highest, 15.06, and, exclud-
ing Aden, which has only one civil hospital, the lowest death rate is that
of the Northern Divison, 6.38 per cent. of treated. The lowest death
rate in figures is that of the European General Hospital, 4.21, from
which it would seem that Europeans and Eurasians resist disease
better than Natives; but it is not possible to institute a comparison.
36
It is a part of the civilized habits of the European to come readily
to a hospital when help is necessary, whilst the Native in many
cases only comes when all other means of maintaining the struggle
of life have failed. The reports of civil hospitals all agree that the
class of persons which contributes most largely to the mortality of
the hospitals, is the wandering mendicant class or poor travellers,
picked up by the police and sent to the hospital. It is not the best
arrangement to have these poor people, often very dirty and repulsive,
received into the same ward with the regular patients of a civil
hospital.
But, practically, there is no other arrangement in most of our
civil stations.
The most prevalent diseases have been fever, diseases of the lungs,
and affections of the surface ; and the most fatal, diarrhœa and
dysentery.
The expense of civil hospitals is almost entirely borne by the State
and is very considerable. A proposal to introduce the payment
system, now applicable to some dispensaries, has been received with
very general disfavor by the revenue authorities.
As the objection appears to be chiefly to the personal character of
the proposed measure, the well-to-do individual being called upon to
pay for what he requires at the hospital, and as there are indications
that the same amount of objection would not be felt if the relief
to Government were effected by a grant from local municipal cor-
p orations, so that the individual might have free advice and medicine
as heretofore ; it is, I venture to think, worth the consideration of
Government whether some principle of this kind might not be gene-
rally adopted to lessen the expense of our civil hospitals.
At the Presidency, there is a powerful municipality, with a large
annual revenue, and there is also a large pauper population. It
would be thought that some provision would have been made by the
Bench of Justices for the relief of the sick poor ; it is a fact, I believe,
that up to this time no portion of the civic income has been applied
to the maintenance and support of the hospitals of this city.
I find from the Report of the Bengal Medical Department for
1870, that in Calcutta there is what is called "The Municipal Pauper
Hospital," a large building originally constructed for a municipal
market, but which fulfills the purposes of a hospital admirably. Sup-
plies are obtained by public contract, and the dietary is liberal.
The expenses of this institution, which was opened in 1867, are
entirely sustained by the Justices of the Peace for the town of Cal-
cutta.
It cannot be right that the expense of keeping up all our civil
hospitals should fall upon the State, and here is an instance, in the
metropolitan city, where the Justices, to their infinite credit, main-
tained during the year 1870, 3,427 in-patients in this hospital with-
out help from Government.
Calcutta, 1870.
Bombay, 1871-72.
37
Besides this, there is a Municipal Police Hospital, the strength of
the Calcutta Police being 3,000. Total treated 2,019.
To compare the amount of medical relief for in-patients in the two
cities :—
In-patients.
In-patients.
Medical College Hospital... 4,526 J. J. Hospital
...
... 5,650
General Hospital...
... 2,551 Cowasjee Jehangier
Ophthalmic Hospital ...
519
Native Hospital and
D i s p e n s a r i e s . . . .
1,400 European General Hospital. 1,162
3,727
Pauper Hospital ...
...
Total... 7,331
Total...
1 2 , 2 0 4
So that there is a regularly organized plan of relief of nearly 5,000
sick in Calcutta above the number provided for in Bombay, and the
largest part of this excess is due to the liberal action of the Calcutta
Bench of Justices.
There is a large hospital now being completed, the Goculdass Tej-
pall Hospital, the whole working expenses of which will fall upon
Government. It appears at least opportune to enquire, whether the
sick poor, for whose especial relief our hospitals are mainly
employed, have not a claim on the Bombay Municipality at least as
great as that which has been so handsomely acknowledged and met
in Calcutta.
It is a pleasant duty to bring to the notice of Government the
names of officers whose resources and skill have been prominently
exhibited during the year.
Dr. Carter of Satara, Dr. Holmsted, Haidarabad, Sind, Dr. Bain-
bridge of Dhulia, and Dr. A. H. Hughes, General Duty N. D. A.,
have each and all by their zeal and talents contributed to maintain
the reputation of the Bombay Medical Service.
The last mentioned young officer has given evidence of much pro-
mise. He has successfully attempted an operation (ovariotomy) not
hitherto performed in this Presidency to the best of my knowledge,
and has also brought to a successful issue a case of aneurism requir-
ing ligature of a main artery, and subsequent careful surgical treat-
ment, besides being a successful lithotomist.
DISPENSARIES.
Four new dispensaries have been opened during the year under the
new rules of 1871, viz., at Akalkot, Athni, Bijapur, and Islampur.
Including these, there have been 121 dispensaries in operation, of
which 30 are attached to civil hospitals, 30 are wholly supported by
Government, 1 is self-supporting (Nausari), and 60 are called chari-
table dispensaries. Of these last, a few are either altogether, or in
great part, supported by Native States, the remainder being estab-
38
lished under some one of the different rules now in force regarding
dispensaries. There are 4 sets of rules applicable to the dispen-
saries in this Presidency :—
(1). 1857. Government contribution restricted to pay of Sub-
Assistant Surgeon, 2 Native medical pupils, and allowance
of 17 Rs. per month for contingencies.
(2). 1861. Government contribution limited to pay of Sub-
Assistant Surgeon, and 2 Native medical pupils, and no
contingent allowance.
(3). 1867. "Grant-in-aid Rules." Government pay a fixed grant.
(4). 1871. Government contribute a fixed grant according to
population. Payment system, for advice and medicine,
introduced and made applicable only to dispensaries esta-
blished under rules of 1867, and subsequently.
Although these last rules were promulgated in November 1871,
they were not generally understood or acted upon during the year
under report. Enough was seen of their reception, however, to make
it plain that they would not be popular, nor can this be matter of
surprise.
Gratuitous advice and medicine have been so long the rule, that a
change of system was sure to be received with lukewarm approbation.
The principle at stake is so unassailable—the payment, namely by
the rich and well-to-do, for advice and medicine, the poor (with a
most liberal interpretation of the limits of the class) being as hereto-
fore provided for, as well as all the servants of Government—that it
may be safely left to time and the operation of natural influences to
do all that is necessary.
European medicine and surgery, and more especially the latter,
are rising in public estimation, and will continue to rise. There are
a few more people every year who would prefer to go to the civil
hospital or dispensary to have a cataract or a stone extracted, even
if they had something to pay, than trust themselves to unscientific
hakeems : and so with the diseases which medicine can do so much
to relieve, as fever and the other common diseases of the country.
And, doubtless, the number of the intelligent few would be more
rapidly increased if it were possible to secure a better educated class
of men, and men with stronger professional sympathies and tastes,
for the charge of dispensaries.
Government has sanctioned, at a considerable increase of the
annual charges on account of these institutions, that they shall all
be visited twice a year by the Civil Surgeon of the district in which
they are situated, and it may fairly be anticipated that the exertions
of these officers will be followed by a commensurate improvement
in the character and work of the dispensaries and of the subordi-
nates in charge.
39
The classes of medical officers and subordinates in charge of
dispensaries are as follows:—
19 Sub-Assistant Surgeons.
1 Honorary Assistant Surgeon.
6 Apothecaries.
2 Assistant Apothecaries.
63 Hospital Assistants.
The large majority being Sub-Assistant Surgeons and Hospital
Assistants.
As to Sub-Assistant Surgeons, Government has provided that
they should be an educated class, and that they should give proof of
having kept up their professional knowledge by passing an examina-
tion for promotion.
But in spite of all such precautions, there can be no doubt that,
under our present system, these officers become less zealous, and
give proofs of individual talent and professional success in a shorter
measure than might fairly be expected of them. One remedy is to
refuse an entrance to all men who do not pass out of the Grant
College as 1st class after the university standard. Another and less
easy remedy would be to have the power to change the position of
these officers. They, many of them, have remained so long at
dispensaries, that their removal seems a harsher measure than ad-
ministrative officers generally like to carry out, and so they are
allowed to remain until their professional shrewdness and activity
suffer almost irreparably. The remedy for this will be to remove
junior officers of this class more frequently, and to place those of
them who require an infusion of fresh energy with Civil Surgeons
on general duty. It has been the custom hitherto to attach these
officers to the J. J. Hospital when no independent charge is avail-
able for them, but they will now be sent anywhere on general duty,—
that is, as a general rule, to any civil hospital where they can be
usefully and advantageously employed.
Five Sub-Assistant Surgeons have been admitted into the depart-
ment during the year, of whom only one is noted as being of the 1st
class according to the university standard.
Hospital Assistants.
The largest number of dispensaries are in the independent charge
of Hospital Assistants.
These men have all been educated in the vernacular class of the
Grant Medical College; but the general experience of administrative
officers is, that, as a class, they are not sufficiently educated and in-
telligent for the thoroughly efficient discharge of the important du-
ties which fall upon them as dispensary medical officers. One cause
of inefficiency has been the poor knowledge of English they possess.
All the returns and reports from dispensaries are written in English,
and there has been some improvement in this respect in the students
who have more recently passed out of the Grant College. But cer-
40
tainly, if the real value of these men were to be tested by their
knowledge of English, many of them now in independent charge
would have to be removed. But this has never been the desire of
Government, so far as I have been able to gather from office records.
Had it been so, teaching medicine and surgery through the medium
of the Mahratti language would never have been attempted, but
the instruction would have been imparted in English. It is clear
then, that, in estimating the value of these men, a high amount of
excellence as regards this point cannot be expected.
But what are the essential qualifications for the independent charge
of a dispensary ? Some of the principal are character, conduct, pro-
fessional knowledge, and ability to make this knowledge not only
available, but desired by the townspeople when sick. As to character
and conduct, considering the class to be a very large one, complaints
are singularly few. So that it would seem that given these two
cardinal points, and a man may still be inefficient. We have, then, to
inquire into his knowledge of his profession; and here there is a
difficulty to commence with, that all his professional knowledge has
been acquired through one of the vernaculars, not always the man's
own, whilst the examining officers who visit the dispensary can only
converse in English, which is the dispensary officer's weak point, so
that the real value of the man as to professional knowledge has prac-
tically to be judged from unreliable data.
But there is one test which is infallible, and that is his ability to
make his knowledge (which from circumstances may not be tho-
roughly or even fairly tested by visiting and inspecting officers)
not only available, but desired by the townspeople when sick.
At present the last is the only true test of the value of these men
as regards the Native public of the dispensary towns, and judged
in this way, very many of them are wanting.
Indeed, it may be said that most of the men fail to make them-
selves popular.
They certainly possess a degree of knowledge of medicine and
surgery which would be of advantage to any neighbourhood, as
compared with the unskilful and barbarous practice of Native ha-
keems. But the qualities are wanting which would enable them to
take strong ground, except in very rare instances ; and when a man
is found to possess such qualities, he is generally good enough to be
able to look forward to promotion out of the class altogether.
But these Hospital Assistants are useful servants of Government;
indeed, it is not too much to say that their services are at present
indispensable. The hope is, that closer supervision will gradually fit
them for a further and more intelligent discharge of these important
duties which devolve upon them.
The work at the dispensaries during the year has every where in-
creased, compared with that of the previous year : the aggregate in-
crease in the number of patients according to Table No. 5 being
89.387.
41
Of the diseases treated, there is great uniformity in the returns
from the dispensaries in all parts of the Presidency.
Slight differences there are, but nothing to affect the general con-
clusion, viz., that malarious fever, skin diseases, and various affections
of the surface—boils, abcesses, &c., &c,—and diseases of the stomach
and intestines, contribute 70 per cent. of the total treated. The
following table gives the ratio per cent. of the treated under the
class of disease noted to the total treated
:—
,
M a l a r i o u s F e v e r .
S k i n D i s e a s e a n d A f f e c t i o n o f t h e S u r f a c e .
D i s e a s e o f t h e L u n g s .
R h e u m a t i c A f f e c t i o n .
Disease of the Stomach and Intestines.
Diarrhœa Disentery.
Others of this
cass.
21 .07
28.03
5.84:
3.93
2.64
1-96
1 4 . 4 1
Small-pox.. 336 cases treated and 13 died, or 3 . 8 per cent.
Cholera ... 146,, 45
„ or 30 . 8
„
Syphilis ...8,062
,,
2 deaths.
Gonorrhœa.8,310
,,
no death.
The numbers treated are of value as pointing to the comparative
prevalence of any class of disease, but the number of deaths is of no
statistical use. The figures do not show the actual mortali ty from
any disease in dispensary practice, but the known mortality, which is
a very different thing.
So many thousands of patients in the year, many of them with
serious and even incurable maladies, attend the dispensary for a time
and then " absent " themselves and are subsequently not heard of.
VACCINATION.
There has been an improvement observable in the care and atten-
tion paid to vaccination in some of the dispensaries.
But popular prejudices still abound, and notably so in the Canara
districts.
In North Canara, the Deputy Inspector General of Hospitals re-
ports that there is active opposition to the introduction of vaccina-
tion, although small-pox is endemic there. He relates that at Sircy,
just before his arrival on tour of inspection, the great biennial feast
of Mordi had been held in honour of the goddess Devi, This feast
lasted 8 days, during which many thousands of people had collected to
witness the ceremonies, which terminated in the slaughter of 9
bullocks and 1,000 sheep and 2,000 cocks. This district would seem
to be scarcely so enlightened as most other parts of the Presidency
in the matter of small-pox and vaccination. Many of the dispen-
saries have been complained of as not possessing the amount and
42
kind of accommodation necessary. Probably, as municipalities and
local fund committees grow richer, they will become more liberal,
and the dispensaries to which they are so closely allied, will, after a
time, afford a guage of the general prosperity and progress of the
district, as well as of the liberality and intelligence of the district
officials.
POLICE.
The strength of the force in the Presidency during the year has
been 14,339 ; nearly half this number have passed through the
hospital. 6,855 have been treated, 88 died, or 1.2 per cent.
It will be seen that the men suffer principally from malarious
fever ; and, considering the nature of their duties requiring them to
move about at all seasons in the districts, this is not to be wondered
at. They are also in the way of duty exposed to "injuries. " There
have been 283 cases and 2 deaths under this head.
From the various returns and reports it would appear that the
police generally have been healthy, and of the 33 cases of small-pox
and 3 cases of cholera recorded, not one was fatal.
JAILS.
The sanitary condition of the jails in this Presidency, and the
general health of the prisoners, have both been good.
Fewer men have passed through the hospital than in the preceding
year, the decrease being 617.
The jails have been very free from epidemic disease. 21 cases
of small-pox have been treated, with no death : so that the disease
was of a very modified character, the result of vaccination and re-
vaccination whenever deemed necessary.
Two cases of cholera have been treated—the jail population
amounting to nearly 8,000 individuals.
The average death rate has been 2.67 per cent. of the number
treated, and 2.65 per cent. of the strength.
Many of the jails have a very low death rate, but a few, notably
one or two in Sind, having a correspondingly high rate ; the average
is still considerable.
Fever and affections of the surface of the body have been the pre-
vailing diseases, the death rate from fever being 1.2 per cent. of the
treated.
TABLE No. 1.
COMPARISON of the General Results at the several Lunatic Asylums for the Year 1871-72.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
D a i l y A v e r a g e S t r e n g t h
o f t h e I n m a t e s .
R e m a i n e d , 1 s t A p r i l
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 .
R e - a d m i t t e d . Total.
D i s c h a r g e d c u r e d .
I m p r o v e d a n d r e t u r n -
e d t o f r i e n d s .
E s c a p e d u n r e c o v e r e d
I n s a n e s .
Died.
R e m a i n e d , 3 1 s t M a r c h
1 8 7 2 .
R a t i o p e r c e n t . o f c u r e s
a nd t r a ns f e r s t o
t ot al t r eat ed.
R a t i o p e r c e n t . o f M o r -
t a l i t y t o t o t a l
t r eat ed.
R a t i o p e r c e n t . o f M o r -
t al i t y t o Dai l y
A v e r a g e S t r e n g t h .
G r o s s y e a r l y c o s t f o r e a c h p a t i e n t .
A v e r a g e n u m b e r p e r
c e n t . o f t h e m e a n
D a i l y S t r e n g t h e m -
p l o y e d d a i l y t h e r e -
a b o u t t h e y e a r .
Rs. a. p.
Colaba ....
Europeans
10.7
25
13 ..
38
2 33 to Europe. ....
..
3
5.26 ..
..
..
..
Natives
208.38
200
52 .. 252 22
5
1 11
214
10.7
4.3
5.2 425 12 7
35.09
Poona
55.9
56
16 ..
72 14 ..
. . . . 2
56
19.5
2.7
3.5 141 10 9 None.
Dharwar
18.0
18
6 ..
24
2
3
....
..
19
20.8 ..
..
87 8 4
38.8
Ahmadabad
87.3
90
26 ..
116 15 12
. . . .
5
84
23.2
4.3
5.7 98 5 6
65.5
Haidarabad, Sind
97.0
93
43
. . 136
. .
18
4 18
100
13.2 13.2 18.5 77 12 6
15.4
43
TABLE No. 2.
SHOWING the Forms of Insanity of the Total Treated.
A m e n t i a .
D o . C . E p i l e p s y .
M a n i a .
D o . C . E p i l e p s y .
P u e r p e r a l .
D e m e n t i a .
D o . C . E p i l e p s y .
P a r a l y s i s .
M o n o m a n i a .
M e l a n c h o l i a .
S u r d o - m u t e .
T O T A L .
Colaba .. ..
. .
..
..
. .
..
18
3
149
5
1
34
7
6
..
29
..
252
Poona
..
..
..
..
..
..
1
..
67
..
..
. .
..
. .
3
1
. .
72
Dharwar ..
..
..
..
..
..
..
23
..
..
..
1
..
..
..
. .
. .
24
Ahmadabad ..
..
..
..
..
..
15
1
69
6
..
17
1
..
3
3
1
116
Haidarabad, Sind ..
..
..
..
..
..
..
89
. .
..
46
. .
..
. .
1
..
136
Total ..
..
34
27
374
11
1
98
8
6
6
34
1
600
44
TABLE No. 3.
SHOWING the causes of Insanity among the Total Treated during the Year.
Name.
I n t o x i c a t i n g D r u g s L i q u o r s .
Social Causes.
S e x u a l C a u s e s .
E p i l o p t i c I n s a n i t y .
T r a m n a t i c , i n c l u d i n g F e v e r s .
H e r e d i t a r y . C o n g e n i t a l .
U n k n w o n .
T o t a l T r e a t e d .
R a t i o p e r c e n t . o f k n o w n C a u s e s .
Colaba ...........................
Causes tabulated as to admissions only: abuse of Ganja the principal.
45
Poona ...........................
" In some instances " mania traceable to eating and smoking Ganja and Bhang.
Dh arwar ........................
Not mentioned in report of Superintendent.
Ahmadabad .....................
18 from Ganja, other causes mentioned, no numbers tabulated.
Haidarabad, Sind ............
Not mentioned in report of the Sub-Assistant Surgeon in charge.