NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
220
33. There is an excellent dispensary at Shikarpur, the popula
-tion of which, and the surrounding villages, is very considerable;
and although it possesses, among other advantages, the services of
a good apothecary, yet the attendance is not so great as one would na
-turally expect considering the importance of the place. The numbers
treated for the year have amounted only to 5,998, and no surgical
operations of consequence have been performed. The apothecary is
well reported of, but he can hardly have succeeded in gaining the
confidence of the people, or the result would, I think, be different.
I trust, however, before next year to have a more encouraging
account.
34. The people who resort to the dispensary at Sakkhar are those
residing there, and also the inhabitants of old Sakkhar, nearly a mile
distant. It is working satisfactorily, the daily average of in-patients,
being 14.2, and of the out-door ones 31.3. The compound in which this
dispensary stands is extremely small and much encroached upon by
houses in the rear. It would be desirable if one or two of these tene
-ments were purchased, and the space added to the dispensary, as at
present the latrine is close to it, and quarters also are much needed
for the hospital establishment.
35. The Government dispensary at Rohri has apparently done
fairly during the past year. In addition to the townspeople,
travellers take advantage of it, and the inhabitants of the surround--
ing villages have also shown a readiness to come in for medicine and
advice. It is under the care of a steady, tolerably well-informed
medical subordinate, who has been at Rohri now for some years, and
the people are gradually taking to him.
36. The dispensary established at Sakkhar for the use of the
Punjab Flotilla has been well conducted by the hospital assistant in
charge, and under the able superintendence of Honorary Assistant
Surgeon Leahy. Besides native workmen, there have been some 30
Europeans and their families resident there ; also all those passing
up and down on board the steamers. A small dispensary, therefore,
efficiently conducted was much needed, and has thoroughly answered.
The Flotilla has been abolished from 1st of April 1872, and with it
the dispensary also.
37. The dispensary at Jacobabad is peculiar, both from its posi
-tion on the frontier and the class of people who obtain relief at it.
Owing to its situation being in the direct line to Shikarpur and
Sakkhar from Khandahar and the northward, large kafilas and
numerous travellers are continually passing through the village,
where they halt for a longer or shorter period. This class furnishes
a considerable portion of the applicants for medical relief. There are
also large numbers of migratory tribes who come down from the hills in
the cold season to feed their cattle in the surrounding plains. Subjects
likewise of the Khan of Khelat, Murrees, Boogties, and inhabitants
of Affghanistan are annually treated in this dispensary ; and many
of these come thus far for the express purpose of subjecting them
-selves to treatment for diseases which they have found their own
225
tion, therefore, the peculiar circumstances under which this jail is
maintained, the vicissitudes of climate and the description of dwell-
ings the prisoners live in, it is satisfactory to find that their health
has been remarkably good, and the mortality, compared with preced-
ing years, considerably less. Indeed, the ratio per cent. of deaths to
strength—3.4—stands but second on the list of jails, Haidaradad
being the only one showing a lower death rate ; a great deal of the
improvement thus manifested in all that pertains to the health and
well-being of the prisoners in this jail, is due to the exertions and
intelligence of the present medical officer, Sub-Assistant Surgeon
Shaik Abdool Kurim, who was appointed to this charge some 8
months ago, and who conducts his duties with zeal and ability.
50. To avoid being tedious, I must withhold some observations I
intended to have made on the smaller jails. These had reference
chiefly to the defective ventilation which is painfully apparent in
many of them. But I cannot help mentioning one or two instances
which stand out from the rest, and demand a special notice.
51. The space allotted to the prisoners in the District Jail at
Sihwan is 188 feet by 51, and the surrounding wall is not less than
14 feet high. Within this is a shed divided into 3 compartments, two
for males, and one for females. Now, as Sihwan has the reputation of
being very hot, it follows that, with the above arrangements, this
jail, for several months of the year, must resemble a fiery oven. No air
can circulate in a space 188 feet by 51, surrounded by a wall 14
feet high, and which in addition is blocked up by the sheds in
which the prisoners are confined. But it is not easy to remedy
the evils resulting from such arrangements short of pulling
half the place down, but in hopes of neutralizing them to some
extent, it would be very desirable to have surrounding walls pierced
every here and there, with iron-grated windows, and admit the air
inside as much as possible.
52. In the Tarusha District Jail I would desire to draw your
attention to the condition of what is termed the “murderers’ cell.”
It is a good sized ward, some 15 feet square, but has neither window
nor ventilator, and as the door is solid, the entrance of either light
or air is an impossibility. This has surely been an oversight, and is
one calling for immediate remedy, as in its present condition it is
quite unsuited for the incarceration of human beings.
53. It is a pity to see a good jail, such as the district one at
Larkhana, converted into a bad one by the neglect of a slight
amount of sanitary knowledge, or the withholding of the few rupees
necessary to carry this into effect. There are three wards, one of
them being for women. In the largest of these, 25 by 24 feet, I
found the prisoners to the number of 11, but I was told sometimes
as many as 30 are confined in it. Even with the former number it
was close and foul smelling, and on looking round I could see
neither windows nor apertures of any kind. Ventilation was out of
the question. The air in fact was never changed, and if the place
228
56. The above remarks, though written with special reference
to the station of Jacobabad, are equally applicable to all other places
where, as is observable at Tarusha, Mehur, and partially so at
Larkhana, vegetation has been allowed to run riot and to exceed the
bounds dictated by prudence and a due concern for the health of
the community.
57. At the zillah towns vaccinators have been kept up by the
municipalities, and are attached to the civil hospitals, where their
work is supervised by the civil surgeons. This has answered well,
and as many as 7,826 cases of primary vaccination have been per-
formed at these hospitals during the past year. I was sorry to find,
however, when inspecting the hospital at Kotri, that the Munici-
pality had lately discontinued their vaccinator on account of the
expense. In a place like Kotri, through which so many people are
constantly passing and repassing, this is greathy to be regretted,
and I would trust the Municipality may be called upon to reconsider
the matter.
58. Vaccination likewise is practised at the several dispensaries
throughout the country, but I regret being obliged to record that
not much has been accomplished in this direction. Three of these
have made no returns, and excluding the ones at Kurrachee, Shikar-
pur, and Sakkhar, which are under municipalities, I observe that
the total of operations amounts to only 1,977 cases. Various rea-
sons are put forward to account for the meagreness of their returns,
the principal one being the extreme unwillingness of the people,
first of all to produce their children, and secondly, to allow of
lymph being taken from their children’s arms for the benefit of
others. From what I have heard, I believe there is a good deal of
truth in this, especially as regards the latter part ; and I have been
told by several of the assistants that in some cases so great is the
objection to having the lymph removed, that the parents will them-
selves destroy the vesicles, or even go the length of leaving the
place for a few days. The hospital assistants likewise complain
that, as a rule, they get little or no assistance from the Mooktyar-
kars or other local authorities in obtaining children, and without
whose earnest co-operation and countenance they find it nearly
hopeless to carry on vaccination. From this cause the lymph not
infrequently dies out, and it is not always readily re-established.
Another way in which it is lost, and perhaps at a time when the
results are encouraging, is by the hospital assistant being suddenly
summoned to a distance to give his evidence before a magistrate in
a criminal case. This has so frequently been urged as a reason for
the small amount of vaccination shown at some dispensaries, that I
am recommending to the Inspector General to increase the number
of native medical pupils, so as to enable me to place one at every
dispensary at which there is only an hospital assistant. If this is
carried out, there ought soon to be no more complaints of the failure
of the lymph owing to the temporary absence of the assistant.
229
59. It now only remains for me to make a few observations on
the new Lunatic Asylum at Giddu-ka-Tanda, and on the first
occasion of reporting upon this institution since its occupation, it is
necessary to give a short account of the buildings in which the
inmates are located. This naturally divides itself into two heads—
the site and the various buildings erected thereon.
60. The site is an alluvial tract of land,some 18 acres in extent,
almost level; the slope, if any, tending towards the Indus, from
which it is about half a mile distant. Its western side is partly
skirted by the village of Giddu-ka-Tanda, and beyond that by the
river. On the north it is bounded by the public road leading
from the ferry to the town and camp. The south faces the open
country, while towards the east there lies at a distance of from one
to two miles an extensive surface of low ground, which during the
inundation is flooded; but drying up about the end of September or
beginning of October generates a vast amount of malaria, which, as
the prevailing wind at that period of the year blows from the east,
cannot fail to be carried right through the asylum. The site has the
advantage of 4 wells affording a never-failing supply of good water.
It possesses also the remains of a garden in which orange, guava,
and other fruit trees have been reared. I cannot say how far these
considerations acted upon those whose opinions were sought for
when selecting a suitable situation for the lunatic asylum, but so
far as my judgment and experience go, I regard them as com-
paratively of little moment, when weighed against the many other
important matters requiring grave deliberation before finally coming
to a conclusion upon a question which, when decided on and carried
into effect, may influence for good or for evil, the health and comfort
of thousands of human beings for many years to come.
61. In the description I have given of the present site, the objec
- tions I have to urge against it may be anticipated. These are brief-
ly summed up in, 1st, its want of privacy and retirement, and, 2nd,
its insalubrity of position.
62. One of the first and most essential requisites in a lunatic
asylum is quiet and retirement—a situation which shall ensure, on
the one hand, that idlers and passers by cannot by their noise or
curiosity cause distraction and annoyance to the inmates; and, on the
other, that the public, in their daily avocations, are not exposed to
painful and disgusting sights or sounds in consequence of the
proximity of the asylum to public thoroughfares or other places of
resort.
63. If these are essential, which I think will be generally ad
- m i t t e d , i t r e q u i r e s l i t t l e a r g u m e n t t o p r o v e t h a t b o t h h a v e b e e n
ignored. Neither quiet, nor privacy, nor absence of intrusion from
outside can be the lot of the inmates of this asylum, seeing that
first of all 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 ; and, secondly, that on its west side, and stretching
for some distance in a north-west direction, lies the village of Giddu,
29 M D
230
and but small acquaintance with native villages is necessary to
understand the noise, especially at some seasons, which will find
its way from here into the asylum. Then, again, there is its north-
ern boundary, i.e. , a public road, the greatest thoroughfare probably
near Haidarabad, along which traffic and passengers to and from the
ferry are constantly passing. Lunatics, as is well known, are utter
-ly lost to all sense of decency, and thus become extremely filthy and
demoralised in their habits ; but even were this not the case, surely
in 18 acres of ground some spot more distant than a few yards from
this road, might have been found equally suitable for the erection of
two of the largest privies required for the use of the asylum ! Although
this question of decency does not exactly affect the lunatics, yet some
might say that the public who use this road, and particularly the
European portion of it, have a right to protest against their feelings
being thus needlessly outraged, as they must be every time they pass
the asylum.
64. The second and by far the most serious objection, that is as
concerns the health of the lunatics and others residing on the premises,
is the malaria to which they are exposed for nearly six months
of e ve r y ye a r . On t he I ndus s ubs i di ng t he r e i s l e f t a n e xt e ns i ve
surface on both banks, with its burden of organic matter which
speedily becomes decomposed under a hot October sun, and then on
the other side, between the asylum and the fort, there is the large
extent of marsh generating abundant malaria as it slowly dries up,
and being carried towards the asylum by the wind which at that
season sets towards it.
65. With regard to the first named objection a good deal might be
done to mitigate the evils I have described. The village Giddn,
it is true, cannot be removed, but special Police regulations might
be enforced to control noise, and to direct marriage and other
festivities to be celebrated outside or at the farthest end of the town.
A wall all round the grounds I do not think at all necessary, but
even if it were proposed to remove the privies, which is not, I believe,
contemplated, I would strongly recommend a wall not less than 8 feet
high being built on this side between the asylum and the public road,
carried on its north-west corner, and even continued for a few yards on
the west side, so as to exclude, as much as possible, all distracting
elements arising from the village and people outside, and at the
same time hide much that is most offensive to the public passing
by.
66. The last objection which I have raised against the site, viz.,
its insalubrity from the large amount of malaria flowing towards
it, especially from the east, is not so easily dealt with, and must
always remain, in greater or less degree, an evil whose injurious
effects will be painfully apparent. The only plan which promises
to be of any avail in lessening this is to plant successive rows of
thick-growing trees all along the east side of the ground, which, as
has been proved, will act as a screen, and intercept a considerable
amount of malaria which otherwise would pass over the asylum.
231
67. Previous to the present ground being finally decided on,. I
understand that another piece was offered for the consideration of
the committee. I went to see it. The site is on the new Foolaili
;on both banks there is a large tract of land, either of which might
have been obtained for the purpose had the decision of the committee
favoured either the one side or other, the following requisites would
have been secured :
—
1. Retirement. It is a mile or so distant from the town, free
from proximity to buildings or public roads.
2. Good and abundant water direct from the Foolaili.
3. A moderate fair soil up to 20 acres or more.
4. Great facility for making gardens.
5. Easy accessibility to Haidarabad.
67. A dry and elevated position far removed from all sources of
local malaria; and I may add, lastly, that the price of this land
would, I believe, have been very considerably less than that paid for
the site at Giddu.
63. Having mentioned all that seems to me necessary regarding
the objections to the situation of the asylum, I will now proceed
to the second head of my subject, and give some account of the
buildings which in the aggregate go by the name of the Cowasjee
Jehangeer Lunatic Asylum.
69. The total number of these is 42, and they are scattered near
- l y a l l o v e r t h e g r o u n d s . T h e p r i n c i p a l o n e s a r e e i g h t b a r r a c k s o r
wards for males, 1 barrack for females, 1 casual ward for Europeans,
1 high-walled enclosure, containing a barrack for criminal lunatics,
1 hospital, 3 work or exercise sheds, and the Superintendent’s house.
The remainder of the buildings consist of 6 privies, a large office,
and a multiplicity of detached cook-rooms, guard-rooms, padded cells,
and servants’ quarters.
70. The barracks for the males are all on one plan. They are
single-tiled buildings, with fly roof, and raised on a 1½ foot plinth.
The walls are 18 inches thick and only 13 feet high, and the
dimensions inside are 36 feet long by 13 broad. There are no
windows, but each have 6 doors, 2½ feet wide. A verandah runs
round each, 6 feet 10 inches wide, the posts of which are 9 feet high.
In 7 of these wards the doors are solid, but a few small holes
h ave been drilled through their lower part. In the other ward
there are in addition iron-barred doors. In every ward are to be
found 12 solid built blocks, each 6 feet by 2½, for the men to sleep on.
71. The single barrack which I have minutely described will
answer as a description for the others, and, indeed, may be regarded
as a fair sample of the style and class of work adopted in all the re-
maining structures.
72. In the course of my tour, I have travelled over various parts
o f S i n d . I k n o w s o m e t h i n g o f i t s g e n e r a l c l i m a t e t h e o r e t i c a l l y ,
practically, and from the accounts of those who have inhabited
different portions of the country for years. I have likewise carefully
232
examined the style and construction of many of its buildings as
designed by Government, municipalities, private individuals, and
Natives, and which have been constructed for the double purpose of
excluding the heat in summer and the cold in winter. But when I
look at these barracks, I cannot help feeling that, had they been
purposely designed to catch and retain the heat during the day, and
admit the cold and draughts at night, there would be no room for
complaint that they had not fulfilled their purpose to the utmost.
73. Such buildings may be found to answer in a more equable
climate than Sind, Kurrachee excepted, and where a considerable
amount of humidity in the atmosphere is more or less present ; but
in a country like this, where in the cold weather the thermometer
sometimes sinks below the freezing point, and in the hot rises in the
sun’s rays sometimes to 175°, they are the worst that could be
devised.
74. The type of building best adapted in Sind to resist the great
and sudden changes of temperature so characteristic of it, is one with
cutcha walls, not less than 2½ feet thick, and having a height of 20
feet. The roof, solid and thick, of beaten earth, and at the top of
the walls, just under the roof, a few clerestory windows to open and
shut at pleasure. This provides for ample ventilation, and by shut
-ting them, as occasion and prudence direct, both heat and cold can be
excluded.
75. It is sufficient merely to point out a few of the principal
features in the barracks under notice, to see that neither of these
ends can be attained. To begin, the verandahs are barely 7 feet
wide and the supporting posts 9 feet high. By this arrangement
the sun’s rays, except for an hour or two, in the middle of the day
beat full upon the walls and in at the open doors. The walls again
are much too thin ; a thickness of only 18 inches allows of the heat
passing through them. They are also too low ; the heated tiles are
brought into too close a proximity with the inmates, and lastly the
fly roof gives free ingress to the hot external air. In fact, the whole
place in the hot season becomes little better than a furnace, and
when it is remembered the class of people who are thus exposed to
this high temperature, it will be admitted that they are placed in
anything but favourable circumstances for promoting their recovery
or even maintaining their health. In the winter months, again, they
shiver with cold, not only does it strike through the tiles, but die
cold air streams down by the wide openings in the fly roof. The
sleeping blocks also should be removed ; they occupy a great deal
of space, and the floor of the ward being raised a foot and a-half
from the ground, there is no necessity for them ; the people would
be just as comfortable sleeping on the floor.
76. The female ward, which is similar in all respects to the one
just described, is not used. The Superintendent informs me that it
is so far away as to be practically useless in consequence of there
being but one matron who cannot always be present. The women
are therefore accommodated in one of the male wards ; and, worse