NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
391
concluded.
General's Letter No. 1323 of 17 th April last, &c.—concluded.
Cost of
Wines and
Spirits.
Cost of
Bazar
Medicines.
Cost of
House Rent
(if any).
Miscella-
neous. i .
e . ,
clo
t h i n g , f u r n i t u r e , & c .
Total
E x p e n d i t u r e .
N u m b e r o f s i c k t r e a t e d .
Average
cost per
patient.
Rs. a. p. Rs. a. p. Rs. a. p.
Rs. a. p.
Rs. a. p.
Rs. a. p.
57 12 0 122 14 8
. . .
8 15 9 1,180 8 0
475
2 7 9
11 4 0
33 5 5
. . .
91 8 8
858 12 8
269
3 3 0
3 0 0
29 1 2
. . .
. . . 434 4 3
53
1 2 7
3 10 0
4 14 5
. . .
24 8 0
545 10 9
296
1 13 5
. . .
61 10 4
. . .
70 4 4 1,413 0 11
463 3 0 10
14 8 0 165 1 10
. . .
107 8 0 5,611 5 9 9,645 0 9 4
44 0 0 467 14 4
96 0
0 200 13 3 2,771 3 6 14,225
0 3 1
. . .
159 5 0 . . .
. . .
1,726 9 4 1,898
0 14 7
. . .
90 5 0
. . .
46 11 0 1,651 5 10 2,676
0 9 10
3 0 0 110 11 7
. . .
43 3 6 1,882 8 11 6,206 0 4 10
. . .
108 4 3
. . .
108 12 2 1,311 9 8 2,001
0 10 6
2 10 0
90 2 8 275 0 0 290 5 11 1,947 12 7 4,646
0 6 8
18 0 0
41 5 4
. . .
114 12 1 1,487 14 6 3,056
0 7 9
. . .
122 8 9
. . .
92 12 5 6,543 1 0 7,009 0 14 10
7 8 0 147 0 1
30 0 0
. . . 1,161 12 9 2,148 0 8 7
27 11 0 222 4 11
24 0 0
. . . 1,471 10 7 10,917
0 2 1
18 12 0 22 1 0
60 0 0
128 9 1 1,682 10 1 3,654 0 7 4
7 0 0
40 7 0
. . .
69 0 9 1,338 3 0 2,701
0 7 11
6 8 0 48 12 2
60 0 0
48 14 8 1,926 2 2 4,142 0 7 5
11 14 0 160 12 8
50 8 0
. . . 1,709 5 11 6,307
0 4
47 4 0 181 15 5 268 0 0
101 11 6 3,924 14 10 4,497 0 4
. . .
14 7 1
50 0 0
59 13 2 1,178 7 11 1,195
0 15 9
. . .
49 0 0
. . .
124 8 2 2,773 7 2 4,552 0 9 9
49 MD
++392
INDEX.
PARAS.
Introduction, places visited . . .
1
Medical History of past year—
Absence of Cholera . . .
2
Small-pox ; Measles . . .
3
Unusual amount of sickness—causes three-fold . . .
4
Cause 1, heavy rain . . .
5
Cause 2, inundations . . .
6
Cause 3, dengue . . .
7
Working of Medical Institutions. . .
8
Lunatic Asylum . . .
9, 10, 11, 12, 13, 14, 15
Ditto out of Asylum . . .
16
Civil Hospitals in general . . .
17, 18
Civil Hospital, Kurrachee
19, 20, 21
Water-supply ditto . . .
22
Civil Hospital, Kotri . . .
23
Ditto Haidarabad, and water-supply . . .
24, 25, 26
Ditto Shikarpur . . .
27
Recommendation for its abolishment . . .
28
Civil Hospital, Sakkhar . . .
29, 30
Police Hospitals . . .
31
Dispensaries ; payment system . . .
32
Ditto in-door patients . . .
33
D i t t o
o u t - d o o r d i t t o . . .
34, 35
Ditto operations . . .
36
Dispensary at Kurrachee . . .
37, 38 . 39
Ditto Manora . . .
40
Ditto
Keti
.
.
.
41
Ditto Tatta . . .
42, 43, 44
Ditto
Jharrak.
.
.
45
Ditto Mirpur Batora . . .
46, 47
Ditto
Sihwan
.
.
.
48
Ditto
Mehur
.
.
.
49
Ditto Larkhana . . .
50
Ditto Shikarpur . . .
51
Ditto Jacobabad . . .
52, 53
Ditto Sakkhar . ..
54, 55
Ditto
Rohri
.
.
.
56
Ditto Tarusha . . .
57
Ditto Alharka Tanda . . .
58
Ditto
Halla
.
.
.
5 9
Ditto Mahomed Khan's Tanda . . .
60
393
PARAS.
Dispensaries in Thar and Parkar . . .
61
Dispensary at Umarkot . . .
62, 63
Khelat Agency
64, 65, 66
Review of work at Dispensaries . . .
67
Jails in Sudder Towns . . .
68, 69, 70
Jail at Kurrachee . . .
71
Ditto
Haidarabad . . .
72
Ditto ditto Water-supply . . .
73
Jail,
Shikarpur
.
.
.
74
Do.
Bukkur
.
.
.
75
Do.
Umarkot
.
.
.
76
Do. Narra Canal . . .
77
Subordinate Jails, Tatta . . .
78
Ditto ditto Sihwan . . .
79
Ditto ditto Mirpur Batora . . .
80
Ditto ditto Mahomed Khan's Tanda . . .
81
Ditto ditto Alharka Tanda . . .
82
Ditto ditto Tarusha
. . . 83
Ditto ditto Halla . . .
84
Ditto ditto Mehur . . .
85
Ditto ditto Larkhana . . .
86
Ditto ditto Mirpurkass . . .
87
Ditto ditto Kipra . . .
88
Ditto ditto Miti . . .
89
Working of Subordinate Jails . . . 90
Conservancy in Sind . . .
91
Scheme for protecting water-supply . . .
92
Controlling exuberant vegetation, &c. . . .
93
Filling up superfluous water-courses at Jacobabad . . .
94
Vaccination at Civil Hospitals . . .
95
Ditto Dispensaries . . .
96
Difficulty attending it . . .
97
Proposal to attach Native Medical Pupils to Dispensaries to
help in the matter—refused by Government . . .
98
Re-vaccination ; remarks on . . .
99
Animal Vaccination; remarks on . . . 100
Meteorology of the Province . . . 101
Ditto ditto for Kurrachee Collectorate . . . 102
Ditto ditto Haidarabad ditto . . . 103
Ditto ditto Shikarpur
ditto . . . 104
Ditto ditto at Jacobabad . . . 105
Ditto ditto in Thur and Parkur . . . 106
Exact cost of medical institutions in Sind not ascertainable,
owing to certain returns called for not having bean fur-
nished
.
.
. 107
394
Annual Report of the Civil and Police Hospitals, Dispensaries, Jails,
and Lunatic Asylum in the Province of Sind, for the Official Year
1872-73, by J. R. Miller, M.D., Deputy inspector General of
Hospitals, Sind District.
During the past season I have visited every town at which an hos
-pital or dispensary is maintained, with the exception of Nagar Par
-kar. To have undertaken the journey to this extreme point of the
Thar and Parkar district would have occupied more time than I could
well spare. I had, moreover, when at Umarkot, met with an acci
-dent which rendered it unadvisable for me to extend my tour further
than was absolutely necessary.
2. The medical history of the past year, as it has affected the
health of the people throughout Sind, presents some unusual features
which I will briefly notice. It is admitted on all hands that the year
under report has been an unhealthy one. Cholera, I am glad to say,
has not visited us, although fears at one time existed that it might
do so. In the months of July and August last, it prevailed to a con
-siderable extent in the Punjab, and was gradually extending to La--
hore and in the direction of Mooltan; and it was not unreasonable
therefore to suppose that eventually it might find its way down the
Indus to Haidarabad and Lower Sind, in the same manner as it tra
- v e l l e d i n 1 8 6 9 . B y d i r e c t i o n o f t h e C o m m i s s i o n e r i n S i n d I p l a c e d
myself in communication with the principal medical officer at Mooltan,
with the view of receiving early intimation of any out-break of epi
-demic cholera that might take place in that neighbourhood. In an-
ticipation of its appearance, the medical officer in charge of Sakkhar
was instructed to board every boat or steamer arriving from up-stream,
and in the event of cholera or doubtful cases existing among them,
at once to land and segregate in the hospital set apart for the pur
- p o s e a l l p e r s o n s s o a f f e c t e d . O t h e r p r e c a u t i o n a r y m e a s u r e s , s u c h a s
fumigating and thoroughly cleansing all infected vessels, and destroy
- i n g a l l b e d d i n g a n d c l o t h i n g i m p r e g n a t e d w i t h t h e f o m i t e s o f t h e
disease, were ordered to be carefully carried out before allowing the
vessels to proceed on their downward voyage. Intelligence reached
me that a few cases only of the disease had appeared at Mooltan, but
that no tendency was observed to its-spreading or assuming an epi
- d e m i c f o r m . S h o r t l y a f t e r w a r d s t h e d i s e a s e w a s r e p o r t e d t o h a v e
disappeared altogether, taking a north-westerly course.
3. Small-pox has been prevalent in several places, but to no great
extent. Nothing approaching an epidemic form of the disease has
been noticed: and every year, as the benefits of vaccination become
more widely disseminated among the people, the less likelihood is
there of this terrible scourge assuming formidable proportions, or to
any appreciable extent affecting the mortality of the population. The
395
few cases which have been brought to my knowledge as coming under
treatment, have been chiefly at Kurrachee and Manora, but no casualty
has occurred. Measles again have been more generally distributed,
but still not coming under the denomination of an epidemic. The
largest number of cases treated at any single hospital were 16, and
this was at the Kurrachee Civil Hospital. No deaths from this disease
have been reported to me ; nor is it one where, except when compli-
cated with other affections or occurring in young and debilitated
children, a fatal termination is often witnessed.
4. While therefore neither cholera, small-pox, nor other diseases
in an epidemic form have decimated the people, yet during the past
year they have suffered in other ways from an unusual amount of
sickness ; and with, I understand, a somewhat corresponding increase
of mortality in places at a distance from medical aid. This increase
in the amount of sickness is referable to certain causes which are not
far to seek. They are three-fold : (1) a rainfall of unusual quantity
and over a large extent of country ; (2) the inundation of the river
Indus, to which must be added the bursting of several bunds in the
upper provinces ; and (3) the invasion of dengue fever.
5. With regard to the first : Sind, as is well known, has no mon-
soon. it is not visited as are other parts of India by regularly re-
curring periodical rains. What does fall, is regarded more as a mat-
ter belonging to the chapter of accidents than as an event to be ex-
pected and longed for. The amount of rain which fell in 1871 may
be regarded as a fair average of what usually falls in Sind. I note
below the quantities registered for that year at some of the principal
towns in the province, and contrast them with the amount measured
at these places for the past year :—
1871.
In Cts.
1872.
In. Cts.
Kurrachee ...... ...
0 50
8 20
Haidarabad ...... ...
2 98
8 63
Jacobabad ...... ...
1 31
6 78
Sihwan
...
...
0 40
7 95
Shikarpur ...
...
...
1 70
3 22
Sakkhar...
...
...
1 50
5 77
The above may be taken as a fair sample of what has fallen
t h r o u g h - o u t t h e d i s t r i c t s , f o r e v e r y p a r t o f S i n d h a s b e e n v i s i t e d m o r e o r l e s s
and at some places to a much larger extent. At Miti, in the Thur,
I found upwards of 14 inches had been registered. An amount of
rain like this, however, is a blessing not unattended with several draw-
backs; for in a nearly flat country where the surface is not favour-
able to drainage, and is, moreover, in many parts below the level of
the river, which is characteristic of some of the richest alluvial
tracts in Sind—it is surprising how an inch or two of rain—and one
396
inch be it remembered represents 10,000 tons of water to an acre
will in a short time submerge a large extent of country. Without a
natural fall, this remains until absorbed or evaporated; and if ad
-
ditional rain happens to fall at intervals, this drying up is arrested;
the soil becomes thoroughly saturated; low forms of minute vege
-
table and animal life are abundantly developed; and the hot autumnal
sun acting upon a large amount of moist surface charged with these
conditions—malaria, proportionate to the activity and extent of the
agencies at work, will be generated throughout the district.
6. The second factor, and the one mainly responsible for the in
-
crease of sickness in the province, has been the inundation of the
river Indus, which was greatly aggravated by the giving way in
several places of some of the larger canal bunds. The river began
to rise in May and rapidly increased. In July it burst over the
country above Kusmore; and towards the end of the month the
amount of water which made its appearance in the neighbourhood of
Jacobabad, seriously alarmed the inhabitants for the safety of the
station. Shortly afterwards, the whole country round was in flood;
communication with Shikarpur and Sakkhar was entirely cut off ex
-
cept by boat, and continued so for nearly three months. It was a
considerable time before this large body of water disappeared, ab
-
sorption and evaporation being the only means of disposing of it. In
the middle of December, when I passed up from Shikarpur, a por
-
tion of the road was impracticable, and much of the land also on
either side was under water, for the most part stagnant and offensive
and containing numbers of dead fish in a state of decomposition. In
Haidarabad also the unusual high state of the river did not fail to
exercise an injurious effect upon the inhabitants. The low laud sur
-
rounding the plateau, and especially that portion situated to the west
of the fort, which every autumn is more or less marshy, was entirely
submerged; and there being in this locality a naturally large amount
of vegetation, an immense mass of decomposing organic matter was
left on the surface after the subsidence of the water, which proved a
fertile source of malarious disease. The Thur and Parkur districts
suffered likewise severely from the inundation of the Indus, which
poured over the country above Sakkhar. This was further increased
by the overflowing of the Narra, and the giving way of some of the
bunds connected with it. Large tracts of country between Umarkot
and Haidarabad were thus rendered impassable, and the people in the
plains and around Umarkot suffered severely from fever and diarrhœa.
Malaria has in consequence been generated to an enormous extent
throughout Sind. And during the past year—especially its latter
part—the climate has unfortunately been such as to favor its develop
-
ment and activity. Cold is supposed either to kill, or keep in abey
-
ance this poison, or to brace the nervous system with some special
power to withstand its effects. But last year, the usual cold which
397
prevails in November and December—particularly in Upper Sind
—
was absent. The latter portion of the year was unusually mild; the
sun's power considerable; and the winds being light and variable,
and even at times scarcely perceptible, the circumstances were all
specially favourable for the production of malaria, as also its reception
by those whose impaired health or low state of vital energy, render
-
ed them predisposed to its effects. Diarrhœa also and dysentery,
have been very prevalent; and these complaints are greatly in
-
fluenced by the same causes which produce a heavy fever-season.
In summer, a rise of mean temperature above the average, especially
when attended with heavy rain and abundant moisture, increases the
number of cases of and the mortality from abdominal affections.
In the cold months again, a similar tendency is noticeable in connec
-
tion with the organs of respiration. And we shall find that the fall
of mean temperature below the average which occurred in the early
part of January, increased the sickness and mortality from thoracic
affections.
7. The last element which has contributed to increase the
sickness to an unusual extent during the year under review has been
dengue fever. This disease was imported into Kurrachee from
Bombay during the monsoon, most probably by one of the steamers.
It began to show itself in the native town about the beginning of
July, and shortly afterwards some cases presented themselves for
treatment at the civil hospital and dispensary. After this, it rapidly
spread through the town, attacking fully one-third of the people.
Comparatively few of those suffering from the disease applied for
medical aid, it being soon discovered that although painful it was
unattended with danger. In the course of a month from its appear
-
ance at Kurrachee, it broke out at Kotri and Haidarabad. In the
latter city but few houses escaped, and from first to last, i . e ., from
August to December, upwards of two-thirds of the people had suffered
from it. The disease being of a contagious nature was transported
by boats and steamers up and down the river. Both at Tatta and
Keti people suffered from it. At Sakkhar also it was prevalent, but
at the town of Rohri exactly opposite, and with constant communi
-
cation going on between the two, no cases had presented themselves
at the dispensary; nor upon inquiry could I learn that the disease
had been recognized in the town. Shikarpur and Jacobabad were
unaffected; and so far as I could ascertain, the disease did not ap
-
pear to have visited towns at any distance from the river. By the
end of December the disease took its departure, and during its visi
-
tation only one case that I know of terminated fatally.
8. Having thus reviewed the causes which during the past year
have been mainly instrumental in largely increasing the sickness of
the population throughout Sind, I go on to mention the working of
the various medical institutions in the province.
398
9. Lunatic Asylum .—In the end of September last, Dr. Holmes
-
ted, Civil Surgeon at Haidarabad, was appointed Superintendent in
the room of the Sub-Assistant Surgeon who hitherto had held that
post. The change is a satisfactory one. On the 1st April 1872 there
remained 100 lunatics—85 males and 15 females; and of these 13
were criminals. During the past year 34 males, of whom 5 were
criminals, and 9 females have been admitted, making with those re
-
maining a total of 143 under treatment: 30 have been discharged
either cured, or so greatly improved that it was considered prudent
to intrust them to the care of their friends. The deaths have
amounted to 17. This gives a percentage of mortality to treated of
1 1 . 1 , w h i c h i s a n i m p r o v e m e n t o n t h e p r e v i o u s y e a r , w h e n i t r e a c h e d
13.2. Of the deaths, 5 occurred in weak and debilitated patients
shortly after their admission. The other casualties resulted from
chronic diarrhœa and dysentery, and which in some measure are
traceable to the unusual rain-fall and the inundation of the river af
-
fecting the site on which the asylum is built. The chief diseases
were the two just mentioned and malarious fevers It is somewhat
remarkable that while dengue, was rife in the town, and most of
the warders and the hospital assistant suffered from it, not a single
lunatic was attacked.
10. Having in my last year's report expressed an unfavorable
opinion as regards the site of the asylum, I need not here repeat the
objections I then advanced against it; nor would I again recur to the
subject, except to mention that I do not think the Commissioner in
Sind and myself are quite agreed as to the exact position of the
other site I should have recommended. When at Haidarabad in
January last, I again examined the spot I had in view. It is a large
open piece of ground bounded on the east by the new Foolaile.
I did not observe on it any building or shrine such as the Commis
-
sioner refers to in paragraph 25 of his letter No. 679, of 15th June
1872. The extent of the ground, its elevated and retired position,
and the vicinity of the Foolaile, the water of which never fails, all
seemed to point to this as the most suitable place for a lunatic asylum
in the neighbourhood of Haidarabad.
11. By Government Resolution dated 23d December last the sum
of Rs. 5,548 has been sanctioned to build two additional wards inside
the present empty walled enclosure. I trust the plan I recommend
-
ed last year will be followed, and in place of erecting pucka tiled
buildings similar to the ones already there, they will be made of sun
-
dried bricks and covered with flat roofs. Dr. Holmested considers
the fly-roof detrimental to the health of the patients, and I agree
with him. The cost of these also would be much less; a consider
-
able balance would be available, and this would admit of the enclo
-
sure wall being carried out a little, so as to include within it a well,
to which a bath-room is proposed to be attached.
399
12. The additional warders, 6 male and 1 female, which were
sanctioned last year as a temporary measure, have proved very useful,
and the comfort and security of the inmates have been greatly in
-creased in consequence. The resolution sanctioning this arrange
- m e n t l i m i t s i t , h o w e v e r , t o o n e y e a r , w h i c h e x p i r e s o n t h e 2 0 t h J u l y
next. But the necessity for it is so obvious, that it is to be hoped
Government will continue it in permanence ; or at least until the ad-
ditional wards have been built for the refractory and dangerous luna
-tics, and a fair trial given of how far under these altered circum
- s t a n c e s t h e e x t r a h a n d s c o u l d w i t h p r o p r i e t y b e d i s p e n s e d w i t h .
13. None of the wells have as yet been covered in. To one of
them has been fixed a couple of pumps which supply, in the first
instance, a covered-in bath, the water from which is afterwards dis
-tributed to the garden. The sleeping blocks in the wards and hos
- p i t a l h a d n o t b e e n r e m o v e d a t t h e d a t e o f m y i n s p e c t i n g t h e a s y l u m
in January last. The suggestions recommended in last year's report
in regard to matters of conservancy and sanitary arrangements are
still a desideratum, and will be very beneficial when carried out.
14. The general management of the inmates is conducted on wise
and humane principles. Medicines, restraint, or coercion are seldom
resorted to in the treatment of the special maladies on account of
which they have been admitted. Not infrequently the patients have
been ill-used and half starved before being received into the asylum ;
and greater and more rapid improvement is observed to follow their
being fed, clothed, and treated with kindness and forbearance, than
by the administration of a variety of drugs, which often increase the
nervous and mental affections they are intended to alleviate.
Dangerous or refractory persons and those subject to periodical fits
of excitement are kept as much as possible by themselves; and even
to them forbearance and kindness are not omitted ; while others
again who show signs of improvement and are quiet and tractable,
a r e e n c o u r a g e d t o e n g a g e i n g a r d e n w o r k o r o t h e r l i g h tlabour.
15. The average cost of each lunatic for the past year, deducting
the income derived from their united labour, has been Rs. 72-5-7.
16. The number of lunatics who have come under the notice of
Medical Officers and subordinates in the province during the past
official year has amounted to 44. Of these 19 were received at the
civil hospital, Kurrachee. Out of this number, 1 was a European who
was sent to the asylum in Bombay. Other 10 were transferred to
the asylum at Haidarabad ; 6 were consigned to the care of their
friends, and 2 were discharged as sane. At the Kurrachee Jail there
was 1 case. He was sent to the Haidarabad asylum. There were
two cases treated at the dispensary ; one of whom was given over to
his friends ; the other, who up to the date of his admission with
acute mania had been employed as a peon in a merchant's office, died
50 M D