NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
72
Dr. Joynt, who returned from England and took charge on the 31st
March 1872, does not add anything to Dr. Butler's report.
The operations performed during the year have been amputation,
forearm 1, of finger 4 = 5. In thus reviewing the report of the
Acting Surgeon of the hospital, I regret that there are so few sub-
jects of importance to bring to notice.
Jamsetjee Jejeebhoy Hospital.
Founded in 1845, and opened in May of that year, at the joint ex-
pense of Sir Jamsetjee Jejeebhoy, Bart., and Government.
In reviewing the annual report of the Jamsetjee Jejeebhoy Hos-
pital, it appears advisable to correct, or rather alter, the table with
which it is commenced as, including the sick treated in the Cowasjee
Jehangeer Opthalmic Hospital., it would convey an erroneous impres-
sion of the admissions, &c., of the Jamsetjee Jejeebhoy Hospital
per se. This is alluded to by the Acting First Physician in a subse-
quent sentence, where he says, as regards the treated, "this number
includes 519 patients treated in the Cowasjee Jehangeer Hospital ;
* * the ratio of mortality will be increased by excluding the Opthal-
mic Hospital sick, as no deaths occurred." The table will therefore
stand as follows, understanding it as simply a statistical table of
sickness, having no reference to diets, medicines, &c., supplied by
the Jamsetjee Jejeebhoy Hospital to the Opthalmic Hospital as well
as to its own particular patients, for which purpose the table given
by the First Physician would answer :—
Remained
...
. . .
...
...
... 341
Admitted
...
. . .
...
. . .
. . .
_5,309
Total ...
...
. . .
. . .
. . .
. . .
5,650
Discharged ...
...
. .
...
. . .
4,421
Died ...
...
. . .
. . .
. . .
. . . 851
Remaining ...
. . .
...
...
. . . 378
Daily average number of sick
. . .
. . .
377.21
Ratio of deaths to treated ...
...
... 15.06
The total number of treated therefore was 5,650, and out of these
628 were cases of malarial fever (ague), with a mortality of 24 or
3.82 per cent. to treated.
The ratio of deaths to treated in the following diseases was :—
Remittent fever
...
...
...
. . .
28.77
Small-pox ... ...
...
...
. . .
12.29
Diseases of stomach and intestines
. . .
24.03
Diseases of heart and lungs, the chief of
which were disease of lungs
...
...
18.01
Venereal disease
...
...
...
... 3.88
Rheumatism, acute and chronic ...
... 1.02
Diseases of the skin ...
...
...
... 8.27
On leprosy, as treated in the Hospital for Incurables, under the
charge of Sub-Assistant Surgeon S. Arjoon, there are some interest-
ing remarks. Reviewing the treatment throughout the year, it ap-
73
pears that the chaulmoogra ( Ch. Odorata v. Gynocardia Odarata v.
Hydrocarpus odoratus) oil keeps its place in the estimation of the
officer who conducts the treatment ; he considers it as first in efficacy.
Dr. Beauperthuy's remedy has been tried, not exactly as advised by
Dr. Bakewell ; as used, however, it has failed, and it is difficult to
understand how, unaided by constitutional treatment, it could do
otherwise in its simple action as a local stimulant. The remarks
concerning this disease appear to me to be very worthy of record.
I would also commend to notice the notes on abscesses of the
liver and the statement of the Acting First Physician that urea is,
contrary to the observations of Dr. Parkes, formed in the urine of
patients labouring under hepatic abscess. This accords with the
experiments made in the European General Hospital by Dr. Butler,
to which attention has already been drawn.
The table and remarks on cases of tetanus too are interesting and
important, if not satisfactory, as regards results which are as follows :—
Treated. Discharged
wel l .
Discharged
recovering.
Discharged in
a dying state. Died. Remained
Idiopathic tetanus ...22
6
4
3
9
0
Traumatic ...
...34
3
1
8
20
2
The report of the Senior Surgeon is, I regret to observe, short, as
much of great surgical interest has come under his notice.
The sanitary state of the surgical wards is very satisfactory. The
list of operations performed tends to bring this out clearly : out of
the number which remained at the end of the last year after under-
going operation, and those admitted and operated on in the year
under report, viz., 408, 5 remained, 389 were discharged, and 14 died,
giving a ratio to operated of 3.43 per cent.
Of some of the major operations performed, I take from the
hospital return them following results:—
Admitted. Discharged. Remaining. Died.
Amputation of Arm
...
5
3
2
. . .
, , F o r e - a r m . . .
3
3
. . .
. . .
,,
Hand ...
1
1
...
...
,,
Thigh
...
4
1
2
1
,,
Leg...
9
9
. . .
. . .
, , F o o t . .
. . .
1
...
...
1
Lithotomy ...
...
... 19
18
. . .
1
Lithrotrity ...
...
. . .
6
6
. . .
. . .
Lithectasy ...
...
. . .
1
1
. . .
. . .
Amputation of knee . . .
2
2
. . .
. . .
Strangulated hernia
...
3
1
...
2
Amputation of shoulder ...
1
...
. . .
1
Delegation of ulnar artery ...
1
1
. . .
. . .
Trephining ...
...
. . .
1
. . .
1
. . .
Resection of shoulder joint ...
1
...
...
1
Vesico-vaginal fistula
. . .
5
5
. . .
. . .
Splitting stricture, Holts ...
2
2
...
. . .
Tapping hydrocele...
... 169
169
. . .
. . .
Fistula in ano
...
... 10
10
. . .
. . .
74
A large number of poison cases were treated, 257, during the
year.
To the 3rd Physician's table of these and remarks I would draw
attention as well worthy of record.
The Obstetric Institution, under the charge of Surgeon Major
Ward, has been of much service during the year. 90 labours occurred
in hospital, of which 29 were natural with no deaths to mothers, and
31 were difficult, preternatural, complex or premature. Of these,
3 women only died; the results to children were that out of 59 natural
labour cases, 6 children died; of the others, 25 died. Dr. Ward's
remarks and the state of some cases, when brought to hospital,
especially shown in one case of preternatural labour, simply point
out how terrible the treatment of labours, beyond the common, is,
when undertaken by Native midwives. To educate the class of
midwives, or women undertaking such duties, who attend the poor
in their labours, presents great difficulties; but as medical practi-
tioners increase, it will gradually become known that "doctors" are
able to assist in difficult cases, and these women should be made to
understand that a "doctor" should be called in. Punishment, if
there is any legal, should be brought to bear on these persons, when
such a result attends their work as is pointed out in Dr. Ward's
report.
At my visits to the J. J. Hospital, and at my inspection, I was
fully satisfied with the hospital and its general management, with
the exception of the system relating to stores, that is to say, the
bedding, clothing, dead stock, articles of diet, &c.
These are all placed under the charge of one man, called a first
class purveyor, on Rs. 45 per month, the 1st Physician of the Hos-
pital being considered responsible for the whole.
The 1st Physician of this large hospital, recollecting that he is
also the head of a division of the Educational Department, in the
duties of which a considerable portion of his time is occupied,
should, I venture to suggest, be freed from this charge; indeed none
of the medical staff should be in any way connected with it.
In military hospitals the surgeon is freed from all responsibility,
except for the articles as drawn from the purveyor, and for those ac-
tually under use in the hospital. The Commissariat is the provider, on
whom the purveyor indents for his daily supplies, and under which
department he is, the medical officer making requisitions on him.
It is widely different in these large civil hospitals, for, since
Circular Order No. 3 of 1871-72 from the Commissary General, the
medical officer indents and procures, his supplies, he then becomes
responsible for all; the store is a hospital store under the physi-
cian, not a Commissariat store under the Commissariat and their
servants.
Such trust must be placed in the purveyor in the case of the
J. J. Hospital by the 1st Physician, as is quite incompatible with
75
the pay and position of the man, and though this system has still for
the present to be carried on, I am of opinion that it should be
changed.
There should be a storekeeper to the hospital, who should be in-
dependent of all officers, except the 1st Physician, having rules laid
down for his guidance, which the 1st Physician would see carried out,
and report any occurrences requiring notice to the Deputy In-
spector General.
This officer, the storekeeper, should purchase the articles required,
either by contract or in such manner as would be most serviceable
to the interests of the hospital and Government, under the sanction
of the Deputy Inspector General, and samples of all articles of bed-
ding, clothing, furniture, food, &c., to be procured, should be sub-
mitted to a Committee of hospital officers for approval ; everything
belonging to the hospital should be placed in his charge, and the
servants, such as cooks, dhobies, and others connected with the
supply of the hospital, should be placed under him, always in every-
thing subject to the 1st Physician's control and the authority of the
Deputy Inspector General. There should be a Committee as often
as the 1st Physician might consider it advisable or when asked for
by the storekeeper.
The storekeeper should have a first class purveyor under him
with the usual servants.
With some such arrangements, only sketched here, the result
would, without doubt, be satisfactory to Government : if the Inspector
General agrees with me the subject may at once be taken up.
The store room is an ill-ventilated place, quite insufficiently light-
ed; it should be lighted with gas.
The male dispensary has no waiting room sufficient for the accom-
modation of the patients, and altogether is ill adapted to the
purpose it has to fulfil, particularly is it ill suited in the rainy and
cold seasons, when shelter to sick is so desirable, nay so really needed.
The servants' houses, or rather the wreched huts, where only a part
of them reside, are so inferior and in every way so objectionable as
to call for early attention. They have been reported on frequently, but
the proposals to place them on ground which would have to be pur-
chased, and so rid the hospital compound of the nuisance, have not
been attended to. I would now propose that the requirements for
attending the dispensary and re-arranging the out-houses should be
submitted to Government, with a request that a committee should be
formed to investigate them and report on what it is really necessary
to be done. There can be only one opinion as to the necessity of
some arrangement being made for the out-houses to enable all the
servants to reside on the premises, and at the same time to have some
little regard paid to sanitary laws.
The light buildings for cholera and small-pox which have proved
of much utility, abut on the large cattle ground, between which and
them there is a wall which is much lower than it ought to be and
76
very ruinous; to heighten this appears to be necessary. The reports
of the establishments have been favourable throughout the year.
In submitting the annual report and that for three months, I would
beg to state that there are some points in them that might bear being
published in the transactions of the Bombay Medical and Physical
Society.
It should be added here that my predecessor adverted to the dis-
pensary for making up medicines, and in his remarks I perfectly
agree, and consider the subject is one very worthy of the attention
of the Inspector General for recommendation for alteration, if it can
be satisfactorily arranged for.
The dispensary is in excellent order, but not being all in one place,
direct supervision cannot be carried out.
Surgeon Major Hunter, 1st Physician to the hospital, proceeded to
Europe and delivered over charge of the J. J. Hospital on the 20th
October 1871 to Surgeon J. H. Sylvester. Surgeon Stedman pro-
ceeded on furlough on the 10th May, his place of 2nd Physician being
taken by Surgeon Cook, who joined on the 2nd June 1871.
The 2nd Surgeon to the hospital, Assistant Surgeon Knapp,
proceeded on sick leave on the 18th February, and was relieved by
Surgeon G. Y. Hunter on the 18th April 1871.
Cowasjee Jehangier Opthatmic Hospital.
The Cowasjee Jehangier Opthalmic Hospital continues to main-
tain its position as a most beneficial and successful charity. Its use-
fulness to all classes of the people of Bombay cannot be too highly
considered ; as an institution it reached a high position under Mr.
Sylvester, and under Dr. Maconachie I trust it will continue to re-
tain it.
The old grievance of the Cowasjee Jehangier Opthalmic Hospital
still remains—the settlement by Government of its independence of
the Jamsetjee Jejeebhoy Hospital, with which it is at present con-
nected as regards matters of supply only.
The whole question rests on the subject of out-houses being built
for the Opthalmic Hospital, for which purpose Rs. 5,000 was offered
by Mr. Cowasjee Jehangier Readymoney, C.S.I.
The out-houses are for the purposes of cooking the diets of 40 in-
patients, which now have to be brought a great distance from the
cook-houses of the J. J. Hospital, and it is frequently complained
that the food is cold and extremely disagreeable to the patients.
They are also for the purpose of residence of the servants who now
live anywhere. Medicines are also obtained from the J. J. Hospital
for the Opthalmic Hospital, while the absurd anomaly exists of the
medicines for the Opthalmic Dispensary being issued from a stock
in the Opthalmic Hospital.
The dead stock too is all under the J. J. Hospital, and the respon-
sibility of all articles of dead stock, diet, &c., of a separate hospital
entailed solely on the 1st Physician J. J. Hospital.
77
The hospital has one great additional fault, which I cannot too
strongly urge on the consideration of the Inspector General, and that
is the absence of quarters for the hospital assistant. At night and
when absent for meals, &c., there is no responsible person present
beyond Native medical pupils and, as these are also without quarters,
they may be absent likewise.
For the out-houses there is ground sufficient close to the hospital,
for quarters for the Assistant and pupils none that, as far as I can
see, is available.
My own impression is that the male dispensary and vaccination
buildings, which are as ill fitted as they can be for their purposes,
should be handed over to the Opthalmic Hospital, and a new dispen-
sary and vaccination offices be built in some equally accessible parts
of the grounds of the Jamsetjee Jeejeebhoy Hospital.
The number of patients that remained last year was 37: there were
admitted 482, total treated 519 ; of these 491 were discharged, 28 re-
mained. The chief diseases treated were :—
Hard cataract
Keratitis ...
. . .
...
Chronic Opthalmic.
Conjunctivitis ...
... Choroiditis.
Opacity
Ulcer of cornea
Staphyloma
There were 565 operations performed, the chief of these were :—
Operation for extraction of cataractous lens ...
... 86
,, trichiasis ... ... ...
...
... 86
,, extraction of foreign bodies
. . .
. . . 92
,,
fistula lachrymalis and lachrymal obstruction 5 8
,, puncture of globe ... ...
. . .
...
artificial pupil
...
...
. . .
... 38
,, tumour of eyelids ... ...
. . .
... 35
,, iridectomy ... ...
. . .
... 32
,,
pterygium...
...
. . .
. . .
. . . 2 5
,,
excisision of eyeball
...
. . .
... 18
,,
s t a p h y l o m a
. . .
. . .
...
... 12
,,
entropium ...
...
. . .
...
. . . 11
The Opthahnic Hospital was under the medical charge of Surgeon
J. H. Sylvester up to 20th January, when Assistant Surgeon Maco-
nachie, who was appointed Acting Opthalmic Surgeon, relieved him.
But as Surgeon Sylvester had taken over the appointment of Acting
1st Physician J. J. Hospital on the 20th October 1871, several
medical officers on general duty at the Presidency did duty at the
Opthalmic Hospital and, in a measure, held charge till the arrival of
Dr. Maconachie.
Byculla Central Schools.
These schools are well situated, open, and airy, having Christ
Church in front and between them the garden and play grounds,
10 M D
78
which are of considerable extent. Opposite the main church en-
trance to the N. W. is the hospital, which is an upper-storied build-
ing, with offices and dwelling rooms for matrons, &c., below.
There is a set of rooms for the boys' hospital, and a set for the
girls. The arrangements are very good. On the boys' side there are
two large and one small room, with ample cubical measurement and
with space for about 40 cots.
When I paid my inspection visit measles prevailed ; the wards
were chiefly occupied by boys suffering from the disease.
The health of the boys has been, with the exception of this attack,
good. 60 cases of simple fever were treated, 60 discharged cured.
Measles, 24 were treated and discharged well. Conjunctivitis, 35
treated, 35 discharged well. Surgeon Partridge, in medical charge,
points out that the most of these cases are purposely induced, by
insertion of lime, &c. This disease is entirely confined to the boys !
14 cases of bronchitis were treated, and 14 discharged. 5 cases of
dysentery in boys admitted, and 5 cured.
Scabies has, I regret to observe, been frequent; 11 remained, 57
were admitted, and 67 discharged ; no remarks have been made as to
the cause of this disease.
Girls' Hospital.— There is space, and much the same kind of
accommodation as in the boys' side, for 30 beds. The arrangements
were good, except in the latrines, where there is much room for im-
provement.
Some of the chief diseases were as follows :—
Remained. Admitted. Discharged. Remained.
Measles
...
. . .
...
17
17
. . .
Febricula ...
...
1
69
69
1
Remittent fever
...
. . .
2
2
. . .
Bronchitis ...
...
. . .
8
8
8
The diseases occurring in the girls' hospital do not require me to
remark on, except one case of leprosy, which has been long under
treatment ; treatment not mentioned. There seems to have been
little or no amelioration of the disease.
I went over the two schools, visited the dormitories, cook-rooms,
play-grounds, lavatories, latrines, &c., and was generally satisfied
with the order prevailing in each part.
There was one death from extensive sloughing of the pharynx.
Surgeon Partridge reports favourably on the attendance, which is
entirely supplied at the expense of the Educational Society.
Lock Hospital.
Concerning the arrangements for the establishment and mainte-
nance of the Lock Hospital, Bombay, I am officially unacquainted, as
there are no records concerning them in the Deputy Inspector Gene-
ral's Office.
79
It appears that the rules for the management and inspection of
this hospital were sanctioned early in September 1870, the establish-
ment was entertained and the Lock Hospital then commenced to re-
ceive its patients.
During the year, from 1st April 1871 to 31st March 1872, the
average daily number of prostitutes in hospital under treatment was
101, the total treated during the year being 700; of these there were
410 in hospital for actual contagious disease, the remainder, 289,
from diseases incidental to prostitutes' occupation, such as ulceration
of os uteri, &c.
Previous to its being closed I had twice inspected the hospital and
was satisfied that the treatment of the sick was attended to, and that
the patients were, generally, by no means disinclined to be taken care
of in their ailments.
The hospital is to be closed on the 31st March. This is of course a
matter of much regret: such an institution would have gradually be-
come of the utmost service in such a populous and mercantile city.
Looking at the establishment of this hospital only as a tentative
measure, it was not allowed to remain long enough to disclose its
faults, to remedy shortcomings, or enable suggestions for alteration
or improvements to be made. There is no doubt it did good to a
certain extent, the amount of which might perhaps be not at first
appreciable, owing to the short existence of the hospital.
The cases admitted, however, clearly shew that venereal disease
prevails to a considerable extent in the city of Bombay, as might be
expected; the number received during the year can only be looked
upon as a small portion of the diseased.
It is a pity, indeed, that the Lock Hospital, Bombay, has been so
soon abandoned.
The deaths occuring in the hospital were chiefly from dysentery
and diarrhœa accompanying contagious diseases.
Surgeon Partridge's report alludes to the good done and to the
increasing willingness of the women to be treated and cured of their
diseases.
Ratnagiri.
I have little to report on this hospital, which combines under its
roof—Civil, Police and Dispensary.
The chief point to notice in reviewing the report of the Civil Sur-
geon is that of increase of number of treated—it is 18 only.
Dr. Joynt notices the antipathy of the Natives of the place to
hospital treatment, this being the case, even so small an increase
is important, especially if the patients have sought the hospital
themselves for treatment; the deaths too have been in less ratio to
treated.
In the present year the ratio was 4.8, in the previous year it was
about 15 per cent.
80
The report beyond this does not require comment. At my in-
spection I found the hospital in good order in every way.
The dispensary and police hospital are separately reported on.
Carwar.
The Civil Hospital is a mere shed which, on the early re-
establishment of the place, was put up at the spot near to where
work-people and others were most located. The town has now ex-
tended entirely in the contrary direction and, being only in proxi-
mity to the travellers' bungalow, and to a few of the houses of the
residents, the present civil hospital is, as regards situation, entirely
misplaced. In other points, it is almost needless to repeat from for-
mer reports, it does not fulfil the requirements ; but this need not be
dwelt on now, as it is understood a design for a new hospital has
been prepared and a site selected to the south of the Kalee Nuddee,
on the northern portion of the sandy plain, on which the town is
extending on the south and east.
The new jail is to be also built in this position.
A review of the Civil Surgeon's return and report shews that the
climate of Carwar, as regards temperature, is much as that of Bom-
bay. The greatest temperature, registered by the Civil Surgeon be-
ing 92º in May and June, and the lowest 69º. The rain-fall is
considerable, having during last season, which gave scanty registra-
tion over the whole Presidency, been 79 inches 94 cents.
The total number treated during the year as in-patients was 106 ;
of these 7 remained from the preceding year, 99 were fresh admis-
sions, 17 died and 2 remained ; 16 per cent. of deaths to treated.
There were more treated than in the preceding year.
The largest number of admissions of disease was from fever, giv-
ing 22 per cent. on the whole; these were almost all complicated with
diseased spleen and dropsy : no deaths occured.
Many persons much exposed to malarious influence do not shew it
in attacks of fever, but in general malaise and debility.
Dysentery gave ten cases, all of long standing ; there were four
deaths.
At my inspection I found everything in order, the subordinate
establishment attentive and favorably reported on.
The report of the Civil Surgeon is meagre and affords nothing
novel to bring under review : there are no particular points to bring
to the notice of the Inspector General.
Tanna.
The chief point to notice in the annual report of the Civil Surgeon
at Tanna, is the statement concerning the admission of cases of
dysentery and diarrhœa. There were 33 of these and " most of
them admitted in a most debilitated state from fever, scurvy or star-
vation, necessarily the mortality must be large."