NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
218
The intestinal parasite, the ascaris lumbricoides, prevails among
the children under 10 years of age. Santonine is the stand-by; there
were 400 cases of this disease.
Diseases of the chest are not very common—66 were treated, 2 of
phthisis; a case of cirrhosis of the liver and extensive ascites was
reported. Gonorrhœa and its complications gave 21 cases. Of cuta
- n e o u s d i s e a s e , 4 3 c a s e s w e r e t r e a t e d .
Snakebites only presented 3 cases, each reported to have been in
-flicted by the Phoorsa, one of the commonest, if not the commonest,
of the venomous kind. These cases were treated with tinct: ferri:
perchloridi and tincture iodi—2 recovered, 1 died.
There was no cholera. 42 cases of injuries were treated, of which
3 were homicidal. 33 minor operations were performed.
The 3rd Class Hospital Assistant Vittul Bhickajee, General No. 866,
was educated in the Grant Medical College. As far as I have been able
to observe, his behaviour while in charge of the dispensary has been
good, and he shows a desire to improve.
Vaccination has not been mentioned, but there were 106 cases suc
-cessfully performed during the year.
No explanation has been given of the cause of the decrease in at
- t e n d a n c e ; i t i s , p r o b a b l y , o w i n g t o t h e y e a r b e i n g h e a l t h i e r .
No native medical pupil is employed here.
DOCKYARD DISPENSARY.
Natives.
23. At this dispensary for the treatment of the employés of Her
Majesty's Dockyard, there were 2,141 received medical aid during the
year 1872-73 against 3,848 of the preceding year; a decrease in the
strength of the men employed occurred during the year owing to
slackness of work; this will partly account for less sickness, as also
will the separation of Europeans from the return; last year all were
included in one return.
38 remained and there were 2,103 fresh admissions; 791 were
Hindoos, 763 Mussulmans, 443 Parsees, and 143 Christians. 2,092
were, cured or relieved, 24 absented, none are entered as died, and
25 remained.
Under general diseases, Division A, 574 received medical aid; of
these 484 had ague, the remainder were cases of febricula, chicken
-pox, and dengue. In Division B, 201 attended, suffering from kinds
of rheumatism, anœmia, a few cases of syphilis, and beriberi.
Of local diseases there were 1,178; brow ague in nervous affections
gave 32 cases; a few diseases of the eye and ear were treated; bron
-chitis and catarrh in the respiratory; dysentery, diarrhæa, constipation
colic, and dyspepsia in the digestive system were frequent. Of go
- n o r r h œ a a n d i t s c o m p l i c a t i o n s 1 9 c a s e s w e r e t r e a t e d . D i s e a s e s o f t h e
cellular tissue and the cutaneous system were chiefly scabies, boils,
u l c e r s , a b s c e s s e s , a n d p s o r i a s i s . T h e r e w e r e 2 8 7 i n j u r i e s r e c e i v e d ,
267 of which were contusions, more or less severe, sustained at work
— o n e d i s l o c a t i o n o f t h e j a w , 2 f r a c t u r e s o f t h e a r m , a n d 1 0 w o u n d s .
72 minor operations were performed.
The dispensary is under the medical charge of the Marine Surgeon
(3rd Presidency Surgeon) who has under him an apothecary who
daily attends the dispensary, and remains in the Dockyard for acci
- d e n t s a n d e m e r g e n c i e s . T h e r e i s a l s o a n a t i v e m e d i c a l p u p i l a t t a c h e d .
Medicines and instruments are provided from the Medical Stores,
and the Presidency Surgeon sends his prescriptions to the dispensary
for Government servants, to whom he gives attendance, who live in
t h e v i c i n i t y . B e y o n d t h e s e t h e r e i s n o e s t a b l i s h m e n t ; c l e a n i n g t h e
dispensary is performed by a dockyard servant. The medicines and
instruments and books were in good order and the establishment was
well reported on throughout the year.
DISPENSARIES ATTACHED TO POLITICAL RESIDENCIES.
Bushire.
1 . A t t a c h e d t o t h e R e s i d e n c y t h e r e i s a c i v i l o r r e s i d e n c y s u r g e o n ,
a n d a n a p o t h e c a r y ; t h e f o r m e r i s n o t a l w a y s a t B u s h i r e , a s h e
accompanies H. B. M.'s Resident when required, the latter remains on
the occasions of the surgeon's absence, in medical charge. Assistant
Surgeon Waters, a Civil Surgeon, has forwarded the annual return of
the dispensay operations for the year 1 871-72, the first, as far as I
am aware, that has been submitted; with it he has also sent an
annual report, which I would ask might be presented to the Medical
and Physical Society.
2. On this report I will not therefore dwell here to any extent.
I would, however, point out that prior to Mr. Waters assuming medi
-cal charge of the British Residency in Bushire, he states the dispe
n - s a r y b e l o n g i n g t o t h e e s t a b l i s h m e n t , w a s o n l y o p e n o n c e , o c c a s i o n a l l y
twice, a week, and sometimes closed for three months together; for
instance, during an epidemic, or when the whole or nearly so of the
s t a f f h a p p e n e d t o b e r e m o v e d f r o m t h e t o w n : u n d e r t h e c i r c u m s t a n c e s
hardly any particulars of value were recorded, medicine was issued
when required, and no particulars or memoranda kept. The system
of record-keeping has however now commenced; at the end of the
year the civil surgeon hopes to be in a position to draw up a full
meteorological report from the text of observations now being made,
and his present, dispensary return shows how much professional
work has been performed by him, and, in his absence, by the apothe
- c a r y , d u r i n g t h e y e a r .
220
3. There remained 76 patients at the end of 1871-72, and, accord
-ing to the return, the number of admissions was 1,960, making a total
of 2,036; 14 or these were Christians and 2,022 Mussulmans—981
were males, 842 females, and 213 children. The average daily sick
was 35. There were 1,661 cured or relieved, 305 absented, no deaths
are recorded, and 70 remained. Under general diseases, Division
A, 658 were treated, all for ague. Under B. 282, chiefly of rheuma
- t i s m , 7 5 o f s y p h i l i t i c d i s e a s e , t h e r e m a i n d e r o f s c u r v y , a n œ m i a ,
scrofula, and dropsy. No cases of phthisis presented. Under
local disease there were 18 affections of the nerves; of which 16
were brow ague. Eye disease gave 320 cases. Diseases of the re
- s p i r a t o r y s y s t e m w e r e c o n f i n e d t o b r o n c h i t i s ; o f w h i c h t h e r e w e r e 8 0 .
Of the digestive system, affections of the teeth, stomach, intestines,
liver, and spleen were the most prominent; dyspepsia occurred in
72, dysentery, diarrhœa, colic, enteritis, and hernia gave 112,
splenitis 14; of gonorrhœa there were 27, all in males; of gynœceial
disease there were 34. Of the cutaneous system, ulcers were the
commonest, numbering 173 of poison or poisoned wounds, there were
none. Of gener al and l ocal i nj ur i es t her e wer e 10 bur ns, and 15
others—wounds, contusions, dislocations, fractures: 80 operations
—25 major 55 minor were perfomed.
4. The lithotomy and lithotrity operations were quite successful as
well as the other operations. The establishment of a small hospital
would be of incalculable benefit to those on whom it might be
necessary to perform surgical operations, and the increase of appli
- c a n t s f o r a i d w o u l d , D r . W a t e r s c o n s i d e r s , b e b e y o n d c o n c e p t i o n .
Apothecary Ahmed Khan is highly spoken of; while he was on
leave his place was taken by Assistant Apothecary Stephens whose
deportment was by no means satisfactory. This is not the first time
that this warrant officer has been reported on unfavourably; he is now
under the British Medical .Department and time, experience, and
dis-cipline will, probably, alter a somewhat rough manner.
Muscat.
5. I believe that Muscat has not, before the visit paid to it in
December 1872, been looked upon as a part of the inspection
work of a Deputy Inspector General of Hospitals. In a medical
point of view there was little to observe. The civil surgeon attach
- e d t o t h e R e s i d e n c y f i n d s , h o w e v e r , a g o o d d e a l o f e m p l o y m e n t .
There is a hospital assistant also attached and a peon. Assistant
Surgeon Jayakar holds a dispensary in his own house, as there is no
provision for a place to receive and attend to the sick: here, too, all
the instruments and appliances are kept. No returns, as far as I can
make out, used to be sent, and correspondence was confined to matters
connected with pay or medicines. The instruments were all in the
worst order and must all be changed. The ice machine was, appa-
221
rently, unworkable; the medicines were few but in good order.
Mr. Jayakar appears to be well thought of, and is consulted largely
by the moneyed classes, trading Hindus and Mussulmans, "Bunyas,"
and "Khojas." In the year 1872-73 there were treated at the civil
surgeon's house 1,417 cases; of these seven remained from the
previous year and 1,410 were fresh admissions. 1,248 were Mussul
-
mans, 96 Hindus, 71 Christians, 2 Parsees. There were cured or
relieved 1,178, absented 208, died 9, remained 22. The average daily
number of sick was 37.
6. Under general diseases, Division A, there were 437 treated; of
which 398 were ague, 22 of remittent fever. Under Division B, 239
cases came for relief, chiefly for chronic rheumatism, anœmia,
scurvy, and phthisis pulmonalis. Phthisis is prevalent amongst the
Khoja community. Under local diseases, there were seven cases of
paralysis, 20 of neuralgia and pleurodynia. Of eye diseases there
were 91; 19 of ear disease; of diseases of the respiratory system
106 cases were treated. Diseases of the digestive system gave 305
cases, the chief of which were from dyspepsia, dysentery, diarrhœa,
constipation, cirrhosis, hypertrophy of the spleen. There were 26
admissions from gonorrhœa. Diseases of locomotion were 12; of the
cellular tissue and the cutaneous 108, the great majority of which
were ulcers. General injuries by burns and scalds were only three,
and there were only 11 cases of local injuries, five of which were
islocotions—three of the shoulder, one of the elbow, and one of the
patella; one contusion, two homicidal wounds, and the remainder
accidental. The operations were 18 chiefly minor. The Resident
agreed with me as to the utility of the establishment of a small
hospital and dispensary.
THE PAYMENT SYSTEM.
1. In November 1871 Government, in the General Department,
issued revised rules, for general information, in supersession of exist
-
ing rules for charitable dispensaries. In Articles 20, 21, and 22 it was
therein laid down that subscribers to dispensaries and well-to-do
persons not subscribing, should pay for medical advice and medicines
received at the dispensaries, and that the indigent poor only were to
receive the same gratuitously.
2. In Resolution of Government No. 597, dated 6th February 1872,
letters from the Inspector General, Indian Medical Department and
Accountant General, having been considered, it was decided, supposing
the surmise of Government to be correct, viz., that it was only in
respect of some of the older dispensaries, established under the rules
of 1857 and 1861, that special stipulations with the municipality,
community, or person by whom these institutions were founded (for
the gratuitous supply of medicines to all applicants), may be supposed
222
to exist, there will be no difficulty in applying the new rules to the
dispensaries opened under the orders of August 1867. Every such
stipulation, Government decided must be observed, until the found-
ers or their representatives agree to the introduction of the new-
system, and, consequently, the proposals were approved, that is, that
the payment system should not be enforced in the old dispensaries.
This Resolution of Government also approved of a fixed tariff for
medicines, at the same time stating that the charges should be extreme-
ly moderate. The charges recommended by Dr. Wright were 1½ anna
for each pill or powder, and 3 annas for each ounce of fluid medicine,
mixture, draught, liniment, or lotion.
3. In reply to a series of questions put by the Collector of
Dharwar, Resolution No. 660, dated 9th February, was issued, in
which Government resolved that the subscriptions of "one rupee and
upwards" were to be annual, but that well-to-do non-subscribers
will have to pay for medical advice, the fees not to belong to the
medical officer in charge of the dispensary. Government servants
were exempted from the rule of compulsory payment.
4. In Resolution. No. 1308, dated 20th March. 1872, Government
decided that the fee for advice to a non-subscriber at a dispensary
should be four annas, and on the 8th July 1872 Resolution No. 2834,
General Department, was issued, which very clearly propounded the
objects had in view in establishing the payment system, and laid
down the scale for medicines at decreased, and certainly most reason-
able rates for persons of the description required to pay. In para-
graph 3 of this Resolution, Government also decided that any
municipality or community, which, in addition to its fair share of
contribution to a particular hospital or dispensary, undertakes to
pay the entire cost of medicines, supplied by Government, may, if it
thinks fit, authorize the gratuitous distribution of medicines to all
persons applying; otherwise the regulations now promulgated should
b e e n f o r c e d i n a l l h o s p i t a l s o r d i s p e n s a r i e s t o w h i c h t h e n e w s y s t e m
applies, i. e., to those established after August 1867.
5. The payment system, thus arranged for, was commenced in
the month of March 1872, in the marginally
noted dispensaries in the Presidency Division
of medical superintendence, and during my
tour of inspection in the latter end of 1871 and
b e g i n n i n g o f 1 8 7 2 , I ma d e i t a d i s t i n c t p a r t o f
my duty, while at each place, to instruct each
medical subordinate in charge, each mamlutdar,
mahalkerry, or police fozdar, and such better
class people as I could meet with, on the mean
-
ing of the rules and who should pay, and on
leaving each dispensary I felt sure it was, so far, distinctly under-
Kamte. Pen.
Bardoli.
Mandvi.
Pardi. _Anklesar.
Hansot. Elao. Chickli
Panwel.
B a s s i e n .
K e l v i - M a h i m .
223
stood, that not only the poor but also those in a better position but
still not exactly well-to-do, were one and all to receive advice and
medicine gratis. I also asked that the information should be imparted
to all.
6. It appears now, with the light of the year's experience thrown
on the subject, that the system was extremely distasteful to the well-
to-do, more in some places than others, and the discontent of these
persons quickly reflected itself upon the poor with whom they came
in contact, who, listening to gossip, ignorant and unenquiring, easily
believed that they also were required to pay for their medicines. It
was not the cue of those interested in the matter to disabuse the poor
of this idea, and hence, for a time, in some dispensaries, the number
of admissions and attendance fell considerably. In addition to this
the civil authorities in some places did not consider the system a
correct one, their reasons I do not know. Further, I cannot help
thinking the system was not popular with the medical subordinates
in charge, as it, perhaps, a little interfered with their interests.
7. I tabulate the average daily sick at such dispensaries, as the
payment rules were adopted in, for periods anterior to the system,
and subsequent to it; I also tabulate the sick of dispensaries where
medicine is given gratuitously. From these tables I am led to assume
that admissions fell from want of clear, comprehensive, and sufficient
-
ly widespread instructions having been given; I am also led to this
conclusion from the fact that when the Collector of Surat summarily
put a stop to the system in certain dispensaries, he ordered the
occurrence to be notified by "bhatake" over the places. It cannot, I
think, be supposed that the falling off in attendance, which at first
took place, was all amongst the well-to-do; for instance, it is hardly
likely in a place like Bardoli, where the daily attendance fell from 23
to 5, that 18 were well-to-do, and that 5 represented the poor; nor
can it be supposed that the poor sympathized with the rich and stay
-
ed away. Again, it is not likely at a place like Mandvi, where the daily
attendance fell from 38 to 16, that 22 were well-to-do and 16 repre
-
sented the poor, Were such the c ase the conclusion to arrive at would
b e , t h a t t h e u t i l i t y o f c h a r i t a b l e d i s p e n s a r i e s i s c h i e f l y e x p e n d e d o n
the families of the well-to-do in the towns in which they are located.
2nd. The tables I think show, notwithstanding the evident
want of proper information, that gradually persons appeared to
become acquainted with the real circumstances, and the attendance
rose again.
3rd. The same tables point out that at dispensaries where the
payment system is adopted, wherever there is a medical officer in
whom confidence is placed, it is well attended, receives a moderate
number of subscribers, and payment for medicines but few fees.
224
4th. In some of the dispensaries under the payment system the
attendance is quite as much as at dispensaries where the gratuitous
issue of medicines is carried out.
8. Out of the dispensaries in which the system was inaugurated,
it has been permitted by Government that the gratuitous issue of
medicines, to all persons applying, should be re-habiltated in 5,
n a m e l y —
Kamte in Canara.
Chickli,
P a r d i
Bar doli,
Mandvi.
At the Kamte Dispensary the attendance fell in the first and
only month in which the system was allowed to exist, though not
considerably, while in this short time, no less than Rs. 80 were paid
by subscribers, and for medcines, subsequently, the money was re
-
turned; here, if anywhere, the system should have been continued,
as fair receipts would have, being paid to the credit of the dispensary
(I believe this is correct), relieved the municipality by so much of
dispensary expenditure for the ensuing year.
In Kamte, and in the other abovementioned dispensaries, it has
been settled that the whole cost of medicines is to be paid for by the
municipalities or local funds in addition to their fair share of contribu
-
tion to them. The dispensaries in the Surat Collectorate had besides a
claim to gratuitous issue, as "stipulations" ( vide Collector's report)
had been made with some subscribers; these dispensaries were
established by Resolution No. 714, of the 19th March 1869, when the
payment system was not even in petto.
9. I venture to repeat that had measures been taken, in the first
instance, to make the people understand the meaning and the object
of the rules, we should not have seen the falling off of the first few
months, which has affected the whole year's returns, nor should we,
perhaps, have observed more than a little ill-will towards the system;
much payment at first was not to be looked for.
Should the payment system be continued, even now a careful pub
-
licity should be given in the vernacular, so that errors many have
imbibed, and which I have no doubt still linger, may be cleared
away.
10. With the above remarks I submit a table showing the monthly
receipts at each dispensary where payments were received; in some
places the proceeds are more than at others; the cause of this, I
Surat.
225
think, mainly depends on the medical officer who, if he is really
efficient will be willingly consulted; if the contrary, patients will stay
away; much again will rest upon the character of the people and the
number of well-to-do in the vicinity of dispensaries. Parsees will
willingly consult, and understand that they should pay; a Hindoo or a
M u s s u l m a n w i l l w a i t u n t i l s i c k n e s s b e c o m e s s e v e r e b e f o r e a p p l y i n g .
I found, and this appears from the accounts to have been general, that
subscribers frequently received their advice and medicine for their
rupee; I also found in one dispensary that Bombay prescriptions
were sent to be made up, and that seidlitz powders were occasionally
sent for; this corrective being apparently known to some natives in
the districts.
11. It is well known to me that sub-assistant surgeons and hos
-
pital assistants add to their pay by receiving fees from the well-to
-
do for visiting at their houses; this of course is quite correct. But I feel
convinced that to people so visited medicines are sent from the dis
-
pensaries and are never paid for. From Rs. 100 to Rs. 300 are in
this way made in the year. Should new rules be under preparation
this fact should engage attention, and also that the advice fee at dis
-
pensaries should be, in my opinion, reduced.
12. There is one point more to touch upon, and that is, when a
municipality or community resolves to pay the whole cost of bills for
medicines, in addition to its fair share of the general expenditure of
a dispensary, to enable it to declare a gratuitous issue to the well
-
to-do.
13. To show how this may affect a municipality or Government,
I will suppose a case. A dispensary is established to which Govern
-
ment gives a grant-in-aid of Rs. 600 and the municipality Rs. 600;
dissatisfied with the obligation of paying for their advice and medi
-
cines the municipality or community resolve that gratuitous issue of
medicines shall be the rule, and, consequently, they pay the bill of
English medicine; this bill amounts to Rs. 300, the total expenditure
being, I will say, 900 Rs.
The amount for medicine, generously paid by the municipality and
deducted from the total, leaves 600 Rs. as the remaining expenditure,
t h
e h a l f o f w h i c h t h e G o v e r n m e n t w i l l , I p r e s u m e , p a y a s i t s f a i r s h a r e ,
the other moiety will have to be paid by the municipality, which will
thus disburse Rs. 600, i.e ., medicine 300, the remaining half 300. In
this dispensary, had the payment system not been stopped, the muni
-
c i p a l i t y o r c o m m u n i t y w o u l d h a v e p a i d R s . 4 5 0 o n l y , h a l f o f t h e
Whole expenditure; Government would have paid the other half
R s . 4 5 0 ; t h e m u n i c i p a l i t y o r c o m m u n i t y w o u l d t h u s h a v e s a v e d