NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
ANNUAL ADMINISTRATION
AND
PROGRESS REPORT
OF THE
INDIAN MEDICAL DEPARTMENT, BOBMAY,
FOR THE YEAR 1871-72.
PREFATORY.
1. The proceedings of Government in the General Department,
No. 2441, of 2nd September 1871, brought to notice certain defects
in the preparation of the Administration Reports of the various
departments.
2. It was anticipated that, as it is obviously of importance that
statistical tables should be uniform, and uniformly adopted, the
Government would, perhaps, supply tables suitable for all depart-
ments, to be prescribed by the Statistical Committee referred to in
the proceedings above quoted.
3. No tables have been received, and it has been my effort, in
adopting tables, to make them represent the amount and kind of
information that seemed of importance, but which may not be so
considered by the Statistical Committee.
4. Being thus without any guide as to what information might
be most desired, I have endeavoured to bring out the civil work of
the department during the year with some detail, having already
submitted the medical history of the Native Army.
5. I propose describing
—
(1) The Lunatic Asylums,
(2) Civil Hospitals and Dispensaries,
(3) Police Hospitals,
(4) Jail Hospitals,
of each division or circle of medical superintendence, gathered
from the annual reports of Administrative Officers and of Civil
Surgeons, &c., and to give a summary of the aggregate results of the
work of the department.
6. The reports of Deputy Inspectors General of Hospitals I for-
ward in original, Sind excepted, as Government may desire to see a
more detailed account of the work of the department than can be
attempted in this report.
1 M D
LUNATIC ASYLUMS.
Colaba Lunatic Asylum
.
Europeans as well as natives are accommodated in this asylum,
the average daily number of the former during the year being 10 and
of the latter 208.
Europeans. —There were in the asylum on the 1st April 1871
24 males and 1 female, and 13 males have been admitted during the
year, the total number treated being 38; of this number, 2 recovered
and 33 invalided to Europe. There were no deaths.
Of the forms of insanity, 22 were cases of mania, 8 of melancholia,
4 of dementia, 1 of paralysis, 1 of amentia, 2 of amentia with
epilepsy.
O f the causes of insanity, 16 were not ascertainable, 3 exposure to
sun, 6 drink, 2 cranial injury, 2 hereditary, 2 climate, 3 moral
c auses, 3 physical, and 1 is ascribed to "old age."
The asylum is a convenient place in which to receive insanes from
all parts of India prior to embarkation in the troop-ships; and
European soldiers are under care for so short a time comparatively,
and other Europeans, owing to the want of sufficient accommodation,
are placed under such disadvantageous circumstances, that they also
are sent to Europe after a short stay in the asylum. So that the
statistics of Europeans are not of so much value as they would be
were the cases watched to the end.
Natives.—There were 200 native insanes—160 males and 40 fe-
males—on the 1st April 1871, and 52 have been admitted during the
year—42 males and 10 females—making the total number treated 252.
Of these, 22 recovered, 2 made over to friends improved, 3 made
over not improved, and 11 died.
There remained in the asylum on the 31st March 1872 214 native
insanes.
Of the forms of insanity 149 were cases of mania, 2 mania and
epilepsy, 1 with paralysis, 1 puerperal, 29 cases of melancholia, 34 of
dementia, 7 dementia with epilepsy, 6 dementia with paralysis, 18
amentia, 5 epilepsy and imbecility.
Of the cures 18 were cases of mania, 3 of melancholia, 1 dementia,
1 amentia.
The Superintendent remarks on these cases "most, if not all, of
t h e m w e r e f o r t h e t i m e c u r e s " ; b u t t h e t e n d e n c y o f i n s a n i t y t o
re-
lapse, a n d t h e d e t e r i o r a t i n g i n f l u e n c e o f t h e h o m e r u l e t o w h i c h t o o
o f t e n c o n v a l e s c i n g i n s a n e s a r e s u b j e c t e d , r e n d e r a p e r m a n e n t
r e -
covery very doubtful.
This is marked in 9 cases which have been re-admitted during t he
year.
4
158 cases were treated for bodily disease, the principal affections
being febricula, bronchitis, disease of the stomach and digestive
organs, and debility.
Causes of Insanity .—One of the principal causes has been excess in
ganja.
The Superintendent remarks that, in examining the register of
the asylum during the last 8 years, of 646 patients admitted, 76 or
11.7 per cent. were cases which are recorded as resulting from the
use and abuse of the different preparations of " Cannabis Indica"; of
these 76 cases, 30 are still in the asylum, 6 of them being " re-admis-
sions." But it must be difficult in a large number of cases to trace
the disease to its cause with anything like scientific exactness. Many
of the patients are police cases found in the streets and with no pre-
vious history whatever. The medical officer who examines these
cases probably knows nothing of the language of the patients, nothing
of their family history, and it is plainly impossible that he should be
able to ascribe the disease to its true cause. Probably, in the majo-
rity of the cases received into the asylum, a clue to the cause of the
disease can only be obtained as the result of experience and induction
after the patient has been for some time under observation. The
question of the cost of patients in this asylum has received a good
deal of attention.
According to the calculations of the Superintendent, in which the
cost of labour is, I think, excessive, the cost per head per annum is
Rs. 371-14-7, or Rs. 30-15-8 per mensem. There is no asylum in Ben-
gal so circumstanced as to permit a fair comparison of its expenditure
with that of Colaba.
But at Madras there is no separate asylum for Europeans, and the
expenditure of the Madras asylum compares very favourably with
that at Colaba
—
Monthly.
Rs. a. p.
Rs. a. p.
Colaba ... .... . . . 371 14 7 ... 30 15 8
Madras ... ... . . . 322 13 0 ... 26 14 5 12/12
Difference ...
49 1 7
So that an insane, it would seem, can be maintained on 4 rupees
per mensem less in Madras than in Bombay. The cost per mensem
of European and Anglo-Indian insanes at Bhowanipore, as given in
the Bengal Medical Report for 1870, is as follows:—1868, Rs. 29;
1869, Rs. 23-5-4; 1870, Rs. 21; showing a progressive decrease.
The Superintendent remarks on the management of the asylum :—
" The medical and moral treatment of the patients has been conduct-
ed on principles described in former reports. The overcrowded
state of the asylum precludes a possibility of classification, and in
the same ratio produces difficulty of management. For it is an ad-
mitted fact, that if the space usually allotted to insane patients be
diminished, that they in the same ratio become quarrelsome and
5
difficult to govern. It is only by the most watchful and careful
supervision that they are prevented from injuring each other. Vari-
ous expedients have been adopted, and with gratifying results, to
counterbalance the monotony of asylum life, to divest it of a prison
character and appearance, and to restore dormant faculties, suitable
occupation being the principal agent employed. During the year
there has been a deficient supply of Vehar water, which suddenly
ceased on the 29th of April, and the asylum was supplied, on daily
requisition, by the Commissariat from that date until the 24th of
June.
" The supply of this water forms a considerable item in the expenses
of the asylum."
The Deputy Inspector General reports :—" At my visits to the
asylum, and at my annual inspection, I have found in all matters
the greatest order prevailing ; the attendants were always among
the patients, and, as far as I could observe, kindness and patient
attendance were given. There have been no complaints during the
year : the management reflects much credit on the Superintendent."
The general health of the patients has been good.
A committee appointed by Government to examine and report
upon various sites, with a view to the selection of one for the new
lunatic asylum, has been at work ; but its proceedings had not ter-
minated at the end of the year under report.
During the year two new wings have been sanctioned for the
further and better accommodation of male and female lunatics, the want
of which had become very pressing indeed. The building was com-
menced at the close of the year.
Lunatic Asylum, Ahmadabad, in charge of Dr. Wyllie, Civil Surgeon.
In this asylum 116 patients, natives only, have been under treat-
ment during the year, and of these 15 were discharged, and 12 were
transferred to friends, and 5 died, giving a percentage of 5.7 to
average strength and of 4.3 to number treated.
Classes treated.— 97 were males, 19 females. Of the males 54
belonged to the industrious classes, agriculturists, handicraftsmen,
clerks, and traders ; the remainder, vagrant mendicants, having no
settled home or pursuits.
Criminal Insanes. —Of these there are 15 : one of them, a deaf
mute, perfectly sane, and frequently recommended by the visitors for
discharge. Dr. Wyllie reports he has lately been taught weaving,
and is fit to earn his livelihood.
Classification. —The construction of the asylum provides for the
complete classification of the inmates, a point of the utmost importance
and not universal in our asylums.
6
Causes of Insanity.—Dr. Wyllie reports : "The patients' certi-
ficates are invariably silent on this subject, and friends, in the few
cases in which they appear, are rarely able or willing to throw any
light on the matter. The information obtainable is thus almost re-
stricted to the results of observation in respect of habits, associations,
and avowed addictions, as disclosed whilst under treatment. It is,
however, beyond doubt that the abuse of ganja is by far the most fre-
quent cause of insanity as witnessed here, and the more particularly
among the wandering mendicant class, and others of aboriginal blood.
" There are at least 18 of the patients now in the asylum whose con-
dition may fairly be ascribed to the excessive smoking of this drug.
" Other cases, such as religious zeal, commercial losses, debauchery,
grief, domestic unhappiness, and social misfortune are also represent-
ed among the cases.
" Observation leads me to add that the prognosis would, as a rule,
be more favourable in primary cases resulting from ganja than in
those depending on emotional causes."
Management continues to be the same as detailed in former re-
ports. Dr. Wyllie adds : " Its primary aim is to diffuse, as far as
possible, a spirit of cheerful contentment among the inmates as the
most rational basis of cure. No mechanical means of restraint have
at any time been used, nor is there any padded room."
Employment.—After stating that gardening and the cultivation and
improvement of the asylum grounds, which extend to some 20 bee-
gahs, are almost the only forms of employment pursued, Dr. Wyllie
continues : " I have repeatedly on former occasions borne testimony
to the value of this healthful and pleasurable pursuit as a means of
averting the recurrence of excitement, and of its influence in pro-
moting recovery. I would here mention that all the cures among
the males during the year, as well as the different cases in which im-
provement has resulted, have been confined to such patients as have
been daily engaged on 'out-door work.' " This is an important state-
ment by one of the most experienced officers in the department, and I
trust it will attract the attention of Government to the necessity of
providing sufficient space for the occupation of all insanes capable of
being so employed in the health-restoring pursuits of gardening and
gentle out-door labour.
General Health has been satisfactory throughout the year ; no in-
stance of epidemic disease.
Buildings and Accommodation.—The buildings and out-offices are in
excellent order.
The northern wing has been enlarged to the extent of 12 cells—a
work only now completed—a corresponding extension on the southern
side having been made in 1869-70.
The accommodation is now equal to more than 100 patients, and
consists of 57 separate cells, 5 rooms on the associated principle,
the convalescent ward capable of receiving 24 patients, and the
7
keeper's room available for the few who are employed in the service
of the asylum, or who only may be awaiting the arrival of friends to
leave it for good.
The Acting Deputy Inspector General remarks that of all the
public charities at Ahmadabad, the lunatic asylum holds the first
p lace for completeness and efficiency. It is the only asylum within
a radius of 300 miles. He can add nothing to Dr. Wyllie's report.
I have tabulated the most important points of information, as to
t h
e
asylum, in the appendix, so that an easy comparison may be
made with other asylums of the Presidency.
Sir Cowasjee Jehangeer's Lunatic Asylum, Haidarabad.
The location of the asylum has been changed from Larkhana to
Haidarabad during the year. The insanes left Larkhana, 31st August
1871—those in good health on foot, those in delicate health in country
carts—in charge of the asylum servants and an escort of 16 police.
They reached Phooloo Bunder, about seven miles from Larkhana,
on the same evening, and on the following morning left in a steamer
for their destination, where they arrived safe on the 3rd September
1871, and occupied the new buildings on the same day.
The Deputy Inspector General of Hospitals reports unfavourably of
the site of the new asylum, from the want of privacy and retirement,
and from its insalubrity.
There have been 4 escapes from the premises at Haidarabad. It
seems very necessary that the enclosure to the asylum buildings
should be secure. At present the Deputy Inspector General reports
that the hedge which surrounds the grounds is so ragged and broken
down as to admit in numerous places of persons passing either
in or out.
The change has not so far influenced the health of the insanes
favourably.
Of the 18 deaths during the year, 16 have occurred in the new
asylum during the last 7 months of the year, two deaths only having
taken place in the previous 5 months at Larkhana.
Of the 136 insanes (116 males, 20 females) under treatment
during the year, 18 were made over to their friends, and 18 died—
100 remaining at the end of the year.
The deaths, 18 in number, were due to the following causes:—
Dysentery............ 9
Bronchitis............ 1
Anœmia............ 3
Scurvy ............... 2
Rheumatism .........1
Epilepsy ........... 1
Diarrhœa ............ 1
and formed a percentage of 18.5 to average strength, and of 13.2 to
number treated.
8
Lunatic Asylum, Poona.
There were 76 patients under treatment during the year. 14
were discharged cured and 2 died. Of the deaths one (male) resulted
from chronic diarrhœa and general debility ; the other (female), up-
wards of 60 years of age, died of old age and general debility.
The most frequent form of insanity in this asylum is mania. In many
cases the only assignable cause for the disease was a previous attack
of fever. In some instances, however, both the acute and chronic
forms of mania were traceable to eating or smoking ganja or
bhang.
Two rooms attached to the male ward have had suitable padding
affixed to their walls, and thus additional and useful accommodation
has been added to the building. The Superintendent of the asylum
points out how much the want of employment is felt. He says :
"The question was formerly considered at the suggestion of Govern-
ment as to whether the establishment of workshops for the patients,
similar to the system in Bombay, could be carried out with any hope
of the plan proving remunerative. It was then decided that, with
the accommodation and present establishment, the amount of hand
work of any description which could be turned out would not in all
probability cover the expenses."
Some garden work is suggested for the male convalescents, and
grinding corn as a fit occupation for female insanes. The general
health of the patients has been good. No infectious disease, nor
epidemic of any kind, appeared among them.
The Deputy Inspector General reports : "Before the Sassoon
Hospital was opened, this asylum was an adjunct of the Civil Hospital.
Since that period some improvements have taken place, and there
is much less overcrowding than formerly. But the accommoda-
tion is still defective. It consists of 2 long wards which divide the
criminal from the ordinary lunatics and two small padded rooms.
" The female portion of the building is much on the same plan and
scale, viz., one ward for the sick and one for ordinary insanes. In
a building of this kind no attempt can be made to classify and
treat patients according to the phase of the malady under which
they may be suffering, nor can measures be adopted to separate a
convalescent patient from the noisy chattering crowd which surrounds
him. To effect the change necessary in the management of the
asylum, two additional wards would be required, one to be used as a
day room, the other for the reception of the quiet and more rational
patients. This latter ward may be obtained at a small cost by simply
dividing the present long ward in which the ordinary patients are
confined."
The water supply is reported to be insufficient.
Lunatic Asylum, Dharwar.
The total number of inmates of the asylum during the year has
been 24; of these, 6 were new admissions. 5 insanes have been
discharged—2 cured and 3 handed over to their friends. No death
has occurred during the year. One criminal lunatic was transferred
from the Dharwar Jail to the asylum by order of Government, and
is the only criminal lunatic in the asylum.
Of the 24 patients, 21 are cases of mania and one dementia (idiotcy).
The Superintendent states that the majority of the cases are of long
standing, and hold out no hope of permanent recovery ; but, as a
rule, the patients are not violent, with the exception of two or three,
who are subject to periodical paroxysms of acute mania.
There is a great want of further accommodation at this asylum, to
meet which some temporary arrangements have been made. A padded
room for refractory patients is also required. The only source of
occupation and amusement for the patients is the garden, in which
all who are able and willing are daily employed, with great benefit
to their bodily health. The Deputy Inspector General reports that
the plan of the Dharwar Asylum is good, but it is on too limited a
scale, and its proximity to the civil hospital is objectionable.
2 M D
10
PRESIDENCY DIVISION AND BOMBAY MARINE.
CIVIL HOSPITALS.
European General Hospital.
Total treated 1,162, died 49—4.21 per cent., which is larger than
the death rate of the preceding year, but considerably less than that
of previous years before 1870-71.
There has been a falling off in the numbers treated at the hospital,
which may be accounted for, 1st, by the establishment of the Go-
vernment workhouse, and, 2nd, by the smaller number of sailors ad-
mitted. The number of ships in the harbour has been less, and they
stay a much shorter time than formerly. Moreover, there is a pre-
ponderance of steamers, which do not carry so many hands as sailing
vessels.
It is noticeable that phthisis is the most fatal of the diseases
treated at this hospital, as was the case in the preceding year.
The explanation given by the Surgeon to the hospital is: "That
many of these patients come from Europe suffering from the disease."
The facilities for getting to Bombay now are so great that many
come in the hope that the warm climate will be beneficial to them,
and soon find their way to the European General Hospital. Of
those who did not come out from Europe with the disease, the greater
number stated that they first became ill in Bombay. Some of them
have been born and bred in the country.
The principal diseases treated are as follows:—
Eruptive-fever ...
...
Total treated.
Died.
Per cent.
...
40
3
...
Malarious „ ...
...
... 149
3
. . .
Rheumatism ...
...
...
71
1
. . .
Syphilitic affection
...
...
80
1
. . .
Scorbutic ,,
...
...
16
. . .
. . .
Disease of nervous system
...
28
2
...
Do. of heart
. . .
...
11
3
...
Do. of lungs
. . .
...
73
12
16.4
Poison
. . . ...
...
. . .
4 7
. . .
...
Diarrhœa
...
..._
. . .
42
5
11.9
Dysentery
...
...
...
72
4
5.5
Others ...
...
...
...
68
4
...
Disease of the liver ...
. . . 46
6
13
There has been no death from delirium tremens. One case of
malignant cholera treated with successful result.
Jamsetjee Jejeebhoy Hospital .
Excluding the Ophthalmic Hospital, which will be treated as a
separate institution, the total treated were 5,650, died 851 or 15.06
per cent. of treated, which is a much smaller death rate than that of
the preceding year.
11
The principal diseases treated were:—
Total treated. Died. Per cent.
Small-pox
. . . ... ... 147
15
10.2
Malarious fever ...
. . . ... 817
87
10.1
Cholera . . .
. . .
. . .
... 26
12
46.
Others of this class ...
. . . 7
2
. . .
Rheumatism ... ... ... 202
2
...
Syphilitic affection ... ... 309
12
...
Scorbutic
. . .
. . . ... 105
12
. . .
Dropsies ... ... ...
. . .
26
8
...
Others ... . . .
... ... 448
152
33.7
Nervous system
. . .
... 251
57
22.7
Insanity ...
. . . ... . . .
15
1
...
Heart ... ... . . .
. . .
32
6
...
Lungs ...
. . . ... ... 301
54
17.9
Diarrhœa
...
. . .
... 196
41
20.9
Dysentery
... ... ... 436
162
37.1
Others ... ... ... ... 283
27
...
Liver ... . . .
... ... 119
24
...
Abscess ... ... ... ... 101
5
...
Ulcer ... ... ... ... 185
18
...
Affection of the surface
... 510
35
. . .
Old age . . .
... ... ... 133
52
...
Poisons ...
... ... ... 239
19
...
Injuries . . .
...
... ... 537
46
. . .
Amongst the diseases which have attracted a very large share of
the highest official, as well as public, notice, is "leprosy." The
English Government had deputed a physician well fitted for the task
(Dr. Gavin Milroy) to inquire into the plan of treatment adopted by
Dr. Beauperthuy, which was reported to be very successful. But it
is now understood from Dr. Milroy's experience that a specific cure
for the disease has yet to be discovered, and the experience of this
hospital, as detailed in the valuable report of the 1st Physician,
points to the same conclusion. Many remedies have been tried, in-
cluding those said to be specially efficacious—chaulmogra, oil of
cashew nut, carbolic acid, &c., an improvement has been effected,
but it has never been permanent. Sooner or later the disease
returns. The medical report of the Jejeebhoy Hospital is unusually
interesting this year, and the experience related as to leprosy, hepatic
abscess (29 cases), and tetanus (20 cases) is worthy of permanent
record. The mortality from dysentery, 37 per hundred of the
treated, is great, as is that from diarrhœa, 20 per cent. There is a
striking contrast between the experience of this hospital and that of
the European General Hospital as to the fatality of these two
diseases—
Death rate
to treated.
J. J. Hospital ............... Dysentery ... 37.1 Diarrhœa ... 20.9
European General Hospital Do.
... 5.5
do. ... 11.9