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Medical Administration.
No. 1087.
GENERAL DEPARTMENT,
BOMBAY CASTLE, 15TH APRIL 1874.
Letter from the Surgeon General, Indian Medical Department, No. 3094,
dated the 4th October 1873, forwarding with remarks the Annual
Administration and Progress Report of his Department for 1872-73.
RESOLUTION.—This Report is very bulky, and is so much encumbered
with tables and other matters of detail, as to render it doubtful, in the
opinion of His Excellency the Governor in Council, whether others
than those whose duty may compel then to master its contents, will
be found willing to encounter the labour of extracting from it the
information really valuable to the world at large. It cannot but be
matter of regret to the Government, that the pains bestowed on the
preparation of the Report, as well as the good work to which it
relates, should thus remain comparatively unnoticed. And they there
-
fore desire that the system to which this disadvantage is attributable,
should in future years be altered.
2. The greatly increased extension of medical aid in various ways
which has taken place throughout the country of late years, together
with the imperative demands which Government now makes for
accurate and elaborate statistics, as well as for minute details of the
working of all Departments, (all of which are a natural sequence
of the progressive improvements in administration which are made
every year,) have made the subject too large a one to be disposed of
in one report as heretofore. The financial position of the Department,
which has this year for the first time been brought prominently to
notice, has materially added to the mass of information to be compiled
and digested. The consequence has been that, as might have been
expected, the principal features have not been clearly brought out,
and it is not distinctly shown what officers have done conspicuously
well, or who have done the reverse.
3. To remedy this in future, the plan must be adopted which
already obtains in other Presidencies. The report on Lunatics and
Lunatic Asylums must be submitted separately; so must that on
Civil Hospitals (including Police and Jail Hospitals); so must that
on Dispensaries. The report on vaccination already is separate; and,
if the other subjects be dealt with in a similar way, they will all
receive much fuller and more accurate treatment than they do at
present. The most important thing to be remembered is, that all
statistical tables should be uniform. The reports should be framed
all on one model, so as to show the comparative results of each
institution, and enable the Surgeon General to gather the general
1 u
2
results into his own report. The latter should be, as far as possible,
in a narrative style, eschewing tabular statements in the text as far
as possible. In this manner the year's results under each head will
be clearly brought home both to Government and to the reader,
and good working and bad working will be clearly seen.
4. The Surgeon General is requested to issue the necessary
instructions to his Deputies, to ensure this being carried out. It will
be as well to consult the reports from other parts of India, so as to
have the benefit of others' experience in laying down the frame-work
of various reports; but this is a matter of detail which Government
will leave entirely to Dr. Thom. There is one point to which they
would invite his special attention, which is, that purely professional
details should appear separate from those relating to administration;
for instance, the list of the various surgical operations performed
in a hospital or group of hospitals would come under the latter
category, the detailed description of a certain specially difficult and
successfully performed operation would come in the former. Such
details had always be best grouped together in one place towards the
end of the report. They will be there more accessible to professional
men. Similarly, special experiments as to the treatment of disease,
such as cholera, hydrophobia, or the like, should find a place by them
-selves.
5. At present only the reports of Deputy Surgeons General are
sent up to Government. In the case of lunatic asylums, however, the
original reports of the Superintendents should also be sent in future.
Any specially good reports from Civil Surgeons or Officers in charge
of dispensaries, might in addition be forwarded with the general
reports on those institutions
.
6. Government hope that one benefit of the division of the
Medical Report into three, will be seen in the transmission of them
to Government at an early date. The Surgeon General should have
them printed at the Central Press, and one complete copy sent for
Government to review. The remaining copies of the report will
afterwards be bound up together with the Resolution of Government
and published
.
7. Government will now turn to the consideration of the details
of the Report for 1872-73 at present under review.
LUNATIC ASYLUMS.
8. Colaba Asylum.—In this institution 55 Europeans including
Indo-Europeans, and 308 Natives, were treated. Of Europeans, 42
were sent to England, 4 only, or 9·5 per cent., were wholly cured, 2
were discharged not cured, 1 was discharged partially cured, and 6
remained. Government have recently had their attention prominent
-ly drawn to the fact that, amongst those sent to England during
1872, there were some congenital lunatics who have no chance of
recovery anywhere. The great expense which has been caused the
State, in paying for their passage and maintaining them in expensive
asylums in England, was therefore wholly unnecessary. Of Natives,
48, or 15·5 per cent., were cured, 12 discharged to friends, 22 or 7·1
per cent. died, and 226 remained. Of the 55 Europeans, 53 were
males and 2 females, the average daily strength being 3 males and
2 females. One male only was a re-admission. Of the 308 Natives,
253 were males and 55 were females, 6 males and 2 females being
re-admissions. The average daily number was 181 males and 42
females.
9. The new wards that have been built have materially added to
the accommodation, though Dr. Niven still complains of overcrowd
-ing. The Deputy Surgeon General at the same time points out that,
taking the last 23 years, the average daily number of Natives in the
asylum was 210, or only 13 less than in the year under report; and
that the general statistics do not show any marked increase in the
number of insane of late years. Until, therefore, Government are in
a position to build a new asylum, of which there does not appear at
present any near prospect, all that can be done is to see that the addi
-tions that have been made are utilized to their utmost. At the same
time, it is most disappointing to learn that, in the opinion of so able
and experienced an officer as Dr. Johnstone, the new wings are badly
arranged and ill-finished. This should be brought to the notice of
the Public Works Department
.
10. There is no question but that another airing court is urgently
required for this asylum, and it has been entered by the Public Works
Department in next year's budget. An estimate should also be
made for the other improvements suggested by the Deputy Surgeon
General at page 261 of the report. The attention of Dr. Nive
n should be drawn to the desire expressed in the Resolution on last
year's report, that gardens should be formed, if possible, in the yards,
and Government hope that this will not be lost sight of. They do
not expect it to be profitable. A beginning has, they understand,
already been made.
11. It is satisfactory to learn that attempts have been made to
separate the lunatics according to their behaviour, or according to
the nature of the mental disease from which they suffer.
12. The tables attached to the report show that not only in this,
but in all the asylums, the classification of the forms and the causes
of insanity, as well the caste and sex of the lunatics, is receiving
attention. The rates per cent. of known causes is at present only
small, ranging from 13·3 per cent. at Dharwar and 17·0 per cent.
amongst Europeans at Colaba, to 60·83 (not 0·87 as erroneously
stated in the printed report) at Haidarabad, and 62·1 at Ahmedabad.
All Magistrates and Officers sending lunatics to asylums, should again
be warned to be most particular in sending the history of all lunatics,
as far as it can be discovered, with them to the asylum. When the
percentage of known causes becomes higher, it will be possible to
expand the tables, so as to show the various relations which sex and
caste bear to the different causes and forms of insanity. Most of
the European lunatics at Colaba being soldiers, Government would
have thought particulars as to the cause of insanity in these cases
4
would have been more accurately known than in any other class of
patients. The reverse, however, is the case.
13. In future years tables, like those which Dr. Niven appears to
supply for Colaba, but which have not been printed with the report,
should be furnished with the report of each asylum. One should
also be given classifying the lunatics according to their length of
residency in the asylum. The Surgeon General should be asked to
revise all the tables, so as to give the fullest details possible as to
sex, race, caste, age, disease, mortality, &c.
14. Indo-Europeans and mixed races should, in future, in prepar
-ing statistics, be separately shown; under Europeans, if they are
treated as Europeans, otherwise under Natives.
15. The question as to the necessity of sending the ordinary
papers with soldier insanes has been disposed of in Government
Resolution No. 2451, dated the 12th July last.
16. The employment of patients appears to have had attention
paid to it. It is useless to expect too much in this respect. Govern
-ment, however, would be glad to learn that some of the more tractable
of those who have been for some time in the asylum have been taught
some regular simple kind of work. They are under the impression
that, with the exception of epileptics, idiots, and those suffering from
acute mania, a good deal of useful work could be obtained from a
large proportion of the patients.
17.
Poona Asylum.—There were 74 insanes under treatment.
The number cured was 6 or 8·1 per cent., 8 or 10·8 per cent. died,
and 60 remained. There were 18 new admissions. The number of
re-admissions is not stated, for either this or the three next asylums.
18. The bad management of this asylum has recently been brought
prominently to the notice of the Surgeon General, and need not be
further noticed here.
19.
Dharwar Asylum. —The number treated amounts to 30, of
which 11 where fresh admissions. Deaths were 3 in number, or 10
per cent.; the same number were cured, and 24 remained.
20. Government are glad to learn that the lunatics were employed
to a considerable extent in gardening.
21.
Ahmedabad Asylum .—There were 132 cases under treatment,
45 being fresh admissions. There were 17 cures or 12·8 per cent.,
4 were transferred to their friends, 3 or only 2·2 per cent. died, and
108 remained at the end of the year.
22. There were 51·2 lunatics daily employed in labour. Govern
-ment have great satisfaction in noticing Dr. Wyllie's strenuous and
successful labours in this direction, and trust that his example will
be followed by other Superintendents as well as circumstances
permit.
23. It is not stated who sanctioned the purchase of a field by Dr.
Wyllie. The Public Works Department will be asked to have plans
and estimates made for a new female ward to this asylum, as recom
-mended by the Deputy Surgeon General.
5
2 4 . C o w a s j e e J e h a n g h e e r A s y l u m , H a i d a r a b a d . - - A t t h i s a s y l u m
143 have been treated, of whom 43 were admitted during the year.
The number cured or discharged improved was 30 or 20·9 per cent.
D e a t h s a m o u n t e d t o 1 7 o r 1 1 · 8 ; o f t h e s e 1 2 a r e , i n t h e D e p u t y S u r - g e o n G e n e r a l ' s o p i n i o n , t r a c e a b l e t o t h e u n u s u a l r a i n f a l l , a n d t h e a n n u a l i n u n d a t i o n a f f e c t i n g t h e s i t e o f t h e a s y l u m . C a r e s h o u l d b e
taken to notice, in the report which will soon be due, the effect which
the site and the inundation have had in 1873-74 on the health of
the patients; and suggestions should be made with a view to obviat
- i n g a n y r e m e d i a b l e e v i l . I n a r e c e n t M e m o r a n d u m r e c e i v e d f r o m
the Army Sanitary Commission, the necessity for improvements of
this Institution has been strongly enforced. And His Excellency
in Council has no doubt that the subject will receive all proper
attention from Dr. Holmstead, with whose general management
His Excellency the Governor had reason to be much pleased on
his recent visit.
2 5 . N o d e t a i l s h a v e b e e n g i v e n o f t h e w o r k p e r f o r m e d b y t h e
patients, and on this point full information should be given in the
next report.
Criminal Lunatics.
26. These were as follows:—
Males.
Females.
Colaba
2 0
1
Poona
9
...
Dharwar
1
...
Ahmedabad
1 7
1
Haidarabad
1 9
...
Total
6 6
2
1. No classification of the crimes which these have committed is
given. This should be done in future.
2.
The accommodation at Poona and Dharwar is not, in the
opinion of Government, suitable for criminal lunatics, and such as
may be at present in those asylums should be transferred to Colaba.
There is no probability at present of a General Lunatic Asylum being
built at Poona
.
3.
It appears that out of 742 lunatics under treatment in
all five asylums, the cause of insanity is set down in 189 cases, or
25·47 per cent., to intoxicating liquors and drugs. If it be possi
-ble, the nature of these drugs should be specified in future reports;
such information will be valuable, as helping to decide how far opium
and ganja conduce to insanity. The mode of cure adopted in such
cases should also be reported on
.
4.
The erection of a small lunatic asylum at Kolhapur reflects
credit on the administration of that State.
5.
Five escapes are recorded from the Colaba Asylum, but it
is not stated whether there were any from the other four. Govern
-
6
ment presume Dr. Niven has taken measures to prevent similar escap
-es in future, and that the warders under whose charge the lunatics
were have been called to account.
32. It appears that, besides those in lunatic asylums, no less
than 303 insanes were treated in Jail, Police, and Civil Hospitals.
Except that there are lunatics kept at Satara, and that the old Civil
Hospital at Dhulia is mentioned as one place where insanes were
accommodated, and that the insanity of many is doubtful, nothing
more can be learnt on the subject of these lunatics from the report.
Government desire that detailed reports about them should, in
future, accompany the General Lunacy Report.
33. This is the first year in which the finance of medical institu
-tions has been treated of. It is unreasonable to expect that the
tables would be perfect to commence with, and those now sub
-mitted require a little explanation. For instance, in Column 1 of
Table No. 4, the average daily number of European patients at Colaba
is put down at 10·3, but in para. 15 page 124, the average is said to
have been 3 males and 2 females. If this last figure is correct, then
the average cost of each lunatic must be double what it is stated to be
in column 6 of the tabular statement. As it is, the cost as calculated
for a daily number of 10·3, viz., Rs. 371-1-6, is not apparently accurate.
The average daily number of Natives is also according to the table
217·8, according to the Deputy Surgeon General 223. Again, it is not
understood where the pay of the Superintendent of the Colaba Asy
-lum appears. It is presumed it has been divided rateably between
the "Establishment under Europeans and Natives," though this is
doubtful. The sum put down as the pay of the Establishment of
the Haidarabad Asylum is undoubtedly wrong. According to the
table given by the Deputy Surgeon General, it came to Rs. 5,855,
while that compiled in the Surgeon General's Office shows only Rs.
2,755.
34. Government trust, therefore, that an endeavour will be made
to have these tables compiled with greater correctness in the coming
year. It will be well to divide cost of Establishment into: 1st, Eu
ro-pean Superintendence; 2nd, Subordinate Medical Establishment;
and 3rd, Servants and Others. The income derived from lunatics'
labour should also be divided into cash receipts and estimated value
of labour. Other miscellaneous receipts, if any, should also be
taken credit for.
35. It is hardly worth while commenting on figures the accuracy
of which cannot be depended on. It may, however, be noted that
the difference between the cost of dieting at different places is most
startling, and this is an item in which there is probably little or no
error. At Bombay the cost of dieting a Native lunatic is Rs. 123-7-0
per annum, or Rs. 10-5-5 a month. This is far too high. At Poona,
it is Rs. 69-5-10, or Rs. 5-12-5 a month. At Haidarabad in Sind, on
the other hand, the cost is only Rs. 33-5-6, or Rs. 2-12-5 per month.
Government request that Dr. Thom will have these figures carefully
looked into, and, if they are correct, to ascertain whether no economy,
especially in Bombay, is feasible.
7
JAIL HOSPITALS.
36. The following Table shows the Sickness and Mortality in
Jails:—
Strength.
Treated.
Died.
Presidency Division
1,838
1,546
40
Poona Division
3,430
2,772
68
N o r t h e r n D i v i s i o n 1 , 1 6 1
1,584
30
Sind Division
1,926
2,029
104
8,355
7,931
242
According to the Jail Report the figures were for the Calendar
year 1872—
Strength.
Treated.
Deaths.
6,450
6,717
196
37. As the sickness and mortality in jails is fully treated of in
the Jail Report, statistics on these subjects need not be given in
the Civil Surgeons' Reports in future. The only remarks required
on Jail Hospitals are those of the Deputy Surgeon General who
inspected them, with the addition of anything calling for special
mention which is not included in the Jail Report.
38. The figures under this head seem, as was noticed last year,
susceptible of great improvement. Those in the Northern and Sind
Division show that the number of treated exceeded the strength; and,
when the returns of single jails are examined, it is found that in many
cases the number of the first is more than twice or thrice the latter.
This anomaly is probably due to each individual case of treatment
(including the treatment of the same prisoners on several occasions)
being calculated in making up the total of persons treated, while the
average daily strength is taken as the basis on which to calculate the
percentage of sick. It is evident, however, that this is quite
misleading, and that the total number of separate individuals confined
in the jails, whether for a long or short time, should have been taken
when ascertaining the proportion that have been sick,—that the
percentages of treated and deaths recorded should have been on the
actual number of prisoners, as well as on the average strength,—and
that every re-admission of the same prisoner to hospital should have
been separately counted.
10
4 9 . T h e r e m a i n i n g h o s p i t a l s o f t h i s P r e s i d e n c y D i v i s i o n d o n o t
call for lengthy detailed notice. Great care has been taken by Dr.
Johnstone, the Deputy Surgeon General, in inspecting them, and
Government are glad to acknowledge his zeal and energy.
5 0 . I t i s t o b e r e g r e t t e d t h a t t h e r e p o r t o f t h e S u r a t H o s p i t a l i n
particular should not reflect credit on the officer in charge. All
Civil Surgeons should be given distinctly to understand that they,
and not their subordinates, are responsible for the correctness of the
books and the whole management of their hospitals. At Surat, as
well as other places, the paucity of surgical operations argues a want
of interest, which is not creditable, especially when compared with
the results achieved by officers like Drs. Bainbridge and Holmstead.
POONA DIVISION.
Sassoon Civil Hospital.
51. At this institution 1,919 in-patients were treated, as well as
11,564 out-patients. The cost was Rs. 44,506. The annual report
on this institution has already been reviewed by Government. It
should be included in the general report in future.
52. It is satisfactory to learn that the management of the other
Civil Hospitals in the Poona Division was good and economica
.
53. The want of quarters for a Hospital Assistant at Sholapur,
a new ward and dead-house at the Sassoon Hospital, of a new
Civil Hospital at Kaladgi, and of additions to the Satara Hospital,
should be brought to the notice of the Public Works Department,
as well as the remarks that have been recorded as to the delay in
commencing the new Civil Hospital at Dharwar.
NORTHERN DIVISION
.
54. As already noticed, the Deputy Surgeon General in the
Northern Division visited very few civil medical institutions, having
confined his tour to the Ahmedabad and Kaira Collectorates. Go
-vernment hope t hat , i n t he offi ci al year whi ch has j ust cl osed, i t wi l l be
found that he has been able to afford as much attention to the Civil
Department as the other Deputy Surgeons General, without detriment
to his military duties. Government have to remark that some por
-t i on of Dr. Turner' s report are of somewhat t oo conversat i onal
character.
55. The Hut t eesi ng and Premabhaee Hospi t al has an endowment
of Rs. 62,000, but the column in the financial statement shows a
blank where interest should appear. The accommodation and esta
-blishment at this hospital are stated to be insufficient. Any rea
-sonabl e proposal s for remedyi ng thi s, showi ng preci sel y how
matters stand at present and what extra expenditure is wanted, will
receive full consideration. Government are afraid there is no hope
of building an extra ward for some time to come.
56. The number of persons treated at thi s hospi tal was 2, 263,
plus 7,371, or 9,634 altogether, as against 20,030 in 1871-72. The
8
39. There are general complaints made of the overcrowding in
jails. This is a matter which has been noticed in the Annual Jail
Report. It is, however, out of the question to suppose that funds are
available to carry out a tithe of the additions that might be recom-
mended on purely scientific principles. Government agree with
Dr. Maitland's remarks that " while calculating the capacity of a jail,
"little or no allowance seems to be made for the healthiness or
" otherwise of the climate in which they are situated ; in other words,
" no difference in cubic capacity is allowed for the good or bad
climate influences surrounding them." In specially bad cases, such
as that noticed by Dr. Miller at Umarkot, the Superintendents of
Jails should make a separate recommendation to the Inspector Gene-
ral of Prisons on the subject ; but the absence of epidemic, as well
as the fact that deaths are almost always attributable to causes
wholly unconnected with the jails where they occur, and the low
rate of mortality, show that the jails are, as a rule, sufficiently large
and healthy.
40. This part of the report hardly calls for further remarks, but the
attention of the Inspector General of Prisons should be called to it.
The inspection of the jails by the Deputy Surgeons General has been
thoroughly carried out in all divisions except in the Northern Divi-
sion, and Government anticipate very good results from this being
done annually. The recommendation made at page 38 of the Surgeon
General's Report relating to incurable prisoners should be transferred
to the Judicial Department for disposal, and the Public Works
Department should be asked to make immediate arrangements to
improve the state of the Tarusha and Hala Jails brought to notice
by the Deputy Surgeon General in Sind (pages 424-425 of the
Report). The suggestions made by Dr. Turner, as to the fettering and
clothing of prisoners, should also be transferred to the Judicial
Department for consideration.
POLICE HOSPITALS.
41. The following Table is given of the Sickness and Mortality
of Police :—
Strength.
Treated.
Died.
Presidency Circle...
3,692
2,620
26
Poona Division
...
...
7,581
2,968
30
Northern Division
1,817
1,513
14
Sind...
...
...
1,760
2,669
47