NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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the various classes of dispensaries, and in the year under report 177,966
patients underwent treatment, 150,934 were cured or relieved, 24,481
absented, with 80 deaths, giving a ratio of 0 . 004 per cent. of deaths
to treated.
6. In the Bombay Marine, at the dockyard dispensary, 3,848
cases were treated with 9 deaths, or 0.23 per cent. to treated.
The above points are brought out in the following form, and in
the accompanying table marked B, the chief diseases are entered:—
In-patients.
European
Sick .
T r e a t e d .
.
Died.
P e r c e n t . o f d e a t h s t o t r e a t e d .
Native
Sick.
T r e a t e d .
Died.
P e r c e n t . o f d e a t h s t o t r e a t e d .
Civil Hospital ... 1,635
50
3 . 05 Civil Hospital ... 7,966
964 12.10
Jail
„
...
79
2
2 . 53 Jail
„
... 1,366
37
2.71
Police „
...
N o n e .
Police
„
... 2,026
28
1.38
Lunatic Asylum...
38 ...
...
Lunatic Asylum...
252
11
4.36
Dispensaries
...
N o n e .
Dispensaries
...
402
37
9.18
Bombay Marine ...
193
1
0 . 51 Bombay Marine ...
589
2 0.33
Total... 1,945
5 3
2. 72
Total... 12,601 1,079
8.56
Out-patients.
European
Sick.
T r e a t e d . Died.
P e r c e n t . o f d e a t h s t o t r e a t e d .
Native
Sick.
T r e a t e d .
Died.
P e r c e n t . o f d e a t h s t o t r e a t e d .
Civil Hospital ...
None
. .
Civil Hospital ....
..
None
..
Jail
„
...
. . None
..
Jail
„
..
..
None
..
Police „
...
. . None
. .
Police
„
. .
..
None
..
Lunatic Asylum ...
. . None
..
Lunatic Asylum. .
..
None
..
Dispensaries
... 168
..
..
Dispensaries
..
. 177996
80
0.004
Bombay Marine ...
. . None
..
Bombay Marine .. . 3,468
9
0.23
Total...
1 6 8
. .
..
Total. . 181844
89
0.048
A short analysis of the above table shows, firstly, that the death
rate for sick Europeans treated as in-patients in all hospitals, is on
the whole 2 . 72, while for the Native sick treated as in-patients in all
hospitals the death rate ön the whole is 8.56.
In European in-door sick in civil, jail, and Bombay Marine hos-
pitals the percentage of death to treated runs from 3 . 05 in the first
to 2.53 and 0 . 51 in the two last. In the in-door treated of Natives
in civil, jail, police, lunatic asylum, and Bombay Marine, it varied
64
from 12.10 in civil, 9.18 in dispensaries, to 0.33 in the ship hospitals,
Bombay Marine.
The general ratio as regards Europeans does not call for remark
at present, but it is different as regards the Native in-patients treated
and died, under the hospital headings given above. It will be observed
that in those classes of Natives amongst whom sickness is early noticed,
such as in jails, police, ships, and lunatic asylum, the death rate
assumes a moderate character, according, doubtless, to the celerity
with which disease is brought under treatment ; but, when the results
of treatment in civil hospitals and amongst the in-patients of dis-
pensaries is examined, and a total death rate of 12 and 9 per cent.
presents itself, we naturally consider and endeavour to ascertain why
this is. The consideration does not take long, for the observations
of all Civil Medical Officers on the fatal cases occuring in their hos-
pitals and dispensaries go to show, that a number of those admitted
are admitted only to die : sent in either by the authorities to whom
they are a burden, or seeking, themselves, the last shelter open to the
distressed. In no hospitals in this Division is this more apparent
than in the Jamsetjee Jejeebhoy, civil hospitals, Tanna, Karwar,
and Surat, where the ratio of deaths to treated are 15.06 per cent.,
19.48 per cent., 16 per cent, and 8 per cent.
It is also to be remembered that Native sick will, generally, try every
remedy within reach before they will resort to the last resource,
namely, the Hospitals attended by European medical men. The un-
suspecting credulity of a sick Native, too, is proverbial, and he will
allow many a pretender to experiment on him before he awakens to
the fact, that the last chance for his recovery lies in the hospital,
which he frequently seeks too late.
These are chief causes of the largeness of the mortality ratio in civil
Native hospitals, and to only one does there appear to be a possibility
of the application of any remedy. In large towns the local authori-
ties should have their poor asylums, and medical attendants, no
where more requisite than in Bombay, where those, for whom
shelter, diet, and attendance, more than medical treatment are re-
quired, could be provided for, and so relieve Government from some
of the heavy cost that it is at in supporting hospitals in the perform-
ance of one of their present functions, viz., that of poor asylums,
and by timely relief of this kind, do much to prevent those diseases
which destitution undoubtedly produces.
In small towns and villages, local authorities should be induced to
come more liberally forward to support those who would then seek
the shelter of the institutions (dispensaries), which observation of
the requirements of their poorer countrymen has led them to assist
in the establishment of—as it is, the dispensary cannot afford to diet
the sick who might be otherwise induced to seek early treatment
and be benefited by it.
From the returns of civil hospitals and dispensaries no correct
inferences can be drawn as to the ratio of sick to population ; but in
65
jails, police, and ships, where the strength and total sick are recorded,
and where sickness is soon observed, a ratio of diseases is attainable,
and taking them as classes, the result obtained is, as below
tabulated :—
Europeans.
Strength. Treated. Died.
Ratio of
Treated to
Strength.
Deaths
to
Strength.
Deaths
to
Treated.
Jails ... ... ... ...
105
79
2
75.23
1 . 8 0
2.53
Police... ... ... ...
6 ......
...
. . .
. . . ......
Bombay Marine ...
62
193
1
311
1.61
0.51
Natives.
Strength. Treated. Died.
Ratio of
Treated to
Strength.
Deaths
to
Strength.
Deaths
to
Treated.
Jails ... ... ... ... 1,481 1,366 37
92.23
2.49
2.71
Police ... ... ... 3,533 2,026 28
57.34
0.79
1.38
Bombay Marine ...
272
589
2
216.5
0.73
0.33
It will be observed from this table that amongst Natives in jails,
police, and marine, the death rate is highest in the jail hospitals ;
while the sickness ratio is highest in the marine. This small death
rate may, to a certain extent, be in consequence of the police and
marine being composed of more selected lives, though,[illegible]it is possible,
with a more careful police sick registration, it would be found that
the ratios shown for them would be somewhat increased.
It will be unnecessary, in analyzing the returns accompanying the
report, to allude to all the diseases which have occurred during the
year ; of the chief diseases, however, which are particularly marked
as affecting the people and influencing the mortality, the accompany-
ing tables will afford a clear view.
From the above Table F it appears that, as regards European per-
sons seeking relief as in-patients in Civil Hospitals, the greatest
number suffered from the class of fevers, for which 429 were treated
with a mortality of 7, giving a ratio of 1.63 to treated. Next approach-
ing in numbers are diseases of the stomach and intestines : 255
patients from this class of disease were under treatment, and 14 died;
a rate of 5.49 to treated.. Skin diseases were frequent without any
deaths. Next in frequency were diseases of the heart and lungs,
from which 124 suffered, and 16 died, giving a rate of 12.90 per
cent to treated. The chief of these deaths resulted from disease of
66
the lungs ; rheumatism gave 1 death; syphilis 1; diseases of the
liver gave 61 cases and 7 deaths ; a percentage of deaths to treated
of 11.47.
With reference to Native in-patients of civil hospitals, and their
diseases, it is found that out of a total of 7,966, the large number of
1,281, or 16.08 per cent., received treatment for fevers, and that 111
of these died, giving a ratio of deaths to treated of 8.66 ; of these
fevers 1,128, with 93 deaths, were malarial, 8.24 per cent. of deaths to
treated. Almost the same course in frequency of disease; but with
greater mortality, as amongst in-door European sick, occurs in Natives.
Of diseases of the stomach and intestines 1,036 cases sought relief
and 262 died, giving a ratio of 25.30 per cent. of deaths to treated ;
skin diseases were frequent, 80, with 1 death.
There were 336 diseases of the heart and lungs, and 66 deaths, or
18 per cent. to treated.
Diseases of the liver were 123, with 27 deaths, or 21.90 to treated.
Syphilitic disease gave rise to 767 cases and 20 deaths, or 2.6 per
cent. to treated.
Cholera was not prevalent, but of 26 cases brought under treatment,
there were 12 deaths, or a ratio of 46.15 per cent.
The remaining deaths occurring in Civil Hospitals arose chiefly
from debility, ulcers, nervous system, injuries, other local diseases,
poisons, other general diseases, &c.
In Jail Hospitals, only two of which at the Presidency have
European prisoners, the European sick have been very few. From
the diseases in the above table two deaths only took place: from
malarial fever 1, and disease of liver 1.
The Native sick of Jails have followed much the same course in
frequency of disease as in civil hospitals. There were 465 cases of
fever and 5 deaths, or 1.07 to treated. Diseases of the stomach and
intestines gave 226 and 13 deaths, or 5.75 to treated.
Diseases of the liver gave 5 cases and 2 deaths, or 40 per cent.
Diseases of the heart and lungs gave 50 cases and 6 deaths, or
12 per cent. to treated ; there were 27 cases of rheumatism, 20 of
syphilis, 33 of eye disease, and 86 of skin disease, with no deaths. In
Police sick no Europeans came under treatment in hospitals. In
Natives treated in police hospitals, the same course or sequence in
frequency as in civil hospitals and jails is observed. First are fevers,
of which 1,057 cases were treated in hospital, with a mortality of 7, a
death rate of 0.66 to treated. Considering the duties of the police,
and the fact that these are often carried on in most malarious dis-
tricts, it is surprising that the treated are not more, and that the
death rate from malarial fever should be so small.
Of diseases of the stomach and intestines there were 284 treated
and 8 died ; the ratio of deaths to treated is 2.81. There were 79
67
cases of rheumatism with no deaths; 53 of syphilis with 1 death; 67
diseases of the heart and lungs, with 5 deaths; giving a ratio of 7.46
to treated. Disease of the liver gave 8 cases and 2 deaths, or 25 per
cent. to treated.
The records of the ship hospitals of the Bombay Marine show that
much the same sequence of disease occurs both in Europeans and
Natives.
In Europeans 52 cases of fevers were treated, with no deaths; 33
cases of diseases of stomach and intestines occurred, with no deaths;
27 of rheumatism, no deaths; 15 of disease of heart and lungs and
1 death; or 6.66 per cent. to treated. Diseases of the liver caused 8
cases without death. There were 5 cases of syphilis, 5 eye diseases,
and 4 of skin diseases without death.
In Natives—204 cases of fever were treated without deaths, 73
cases of diseases of stomach and intestines, with 1 death, 1.36 to treat-
ed. There were 37 cases of diseases of heart and lungs, with 1
death, or 2.70 per cent to treated. Diseases of liver 3,74 cases of
rheumatism, 11 cases of syphilis, 23 diseases of the eye, and 20 of
skin disease, none of which caused death.
The dispensary returns of in-door patients show that a total of 402
cases were treated and 37 died, thus giving on the whole a death rate
of 9.18. As the class of patients admitted into dispensary wards is
very much the same as that admitted into civil hospitals, it will not
be without interest to compare the mortality in the several diseases
which the returns point out as particularly influencing the health of
the people. These are—
Fevers.
Diseases of the stomach and intestines.
Disease of skin.
Disease of the heart and lungs.
Disease of the liver.
Disease of the eye.
Rheumatism.
Syphilis.
Of fevers 63 cases were treated in-door, 7 died, giving a percentage
of 11.11. In civil hospitals the death rate was 8.66 in this class.
In diseases of the stomach and intestines there were 64 cases
treated and 12 deaths, giving a ratio of 18.75. In civil hospitals
the death rate in this class was 10.36.
Diseases of the heart and lungs gave 17 cases and 1 death, yield-
ing a ratio of 5.88 to treated, while in civil hospitals the death rate
in this class was 18.
In diseases of the liver there were 9 cases treated and 2 deaths,
giving a rate of 22.22. The death rate in this class in civil hospitals
is 21.9. Of the other diseases mentioned no deaths resulted.
Turning from the records of sick who have resorted to hospitals
and dispensaries as in-patients, from which it is seen that the chief
68
diseases affecting the health and mortality of the people, judged of
from them, are derived from the classes of—
Fevers,
Diseases of eye,
Diseases of stomach, &c,
, , l i v e r ,
, , s k i n ,
Rheumatism, and
,, heart and lungs,
Syphilis,
to the detail of dispensary out-door practice, the following general
results are obtained.
There were 181,844 cases treated in dispensaries as out-patients;
the dispensaries are 34 in number, and thus, on an average, there
may be said to be 5,348 cases to each dispensary. The Dockyard
Dispensary is included in this.
Under the same headings of disease as have been already taken
for hospitals, the same sequence as to classes and numbers of disease
is kept up in dispensaries ; the mortality, however, reported being
very small.
There were 43,513 cases of fevers treated at dispensaries, giving
a ratio to total diseases of 23.92 per cent.; of these fevers, were erup-
tive 63, and 2 deaths, 3.17 per cent.; 2,809 were of continued fever,
with no deaths ; and 40,641 and 12 deaths were due to malarial fever
or ague ; giving a ratio of 22.24 to all diseases, and 0.092 deaths to
treated.
The diseases next in frequency, seeking out-door relief, were from
affections of the stomach and intestines. They number 41,170 and
23 deaths, and give a ratio to total number treated of 22.68, the
deaths were 0.05 to the treated of these diseases.
Skin diseases gave a large number for dispensary treatment,
amounting to 24,171, or a percentage of 13.57. There were no deaths
from skin diseases. Diseases of the heart and lungs, in consequence
of their frequency, next call for attention ; they amounted to 13,602,
giving a percentage on the whole of 7.42. Of this class of disease
there were 13 deaths, 0.09 per cent. to treated.
Eye diseases were somewhat numerous, 10,760 being treated ;
there were no deaths, the ratio of these diseases to the total treated
is 5.91.
Rheumatism was not so prolific a source of disease seeking relief
as might have been expected. 7,644 cases were treated, with no
deaths, yielding a percentage to all cases of 4.20. Syphilis gave
2,156 cases, and no deaths, 1.21 to all treated. There were 768
cases of disease of the liver, and 2 deaths recorded; the ratio of treat-
ed of this disease to total treated is only 0.43. Cholera occurred in
only 18 cases, from which 6 deaths are reported, or 33.33 per cent. to
treated. The deaths in civil hospitals being at the rate of 46.15.
The other diseases treated in dispensaries occurring in smaller
numbers were of general or local classes.
69
The ratio of deaths to treated cannot be considered in any way re-
liable, as in the general treatment of out-door sick a very large
number absent themselves; some being cured of their little ailments
do not return to inform the medical attendant, others take medicines
for a time, and, not getting the quick relief they probably anticipated,
or impatient, do not continue, and, if their cases are serious, perhaps
eventually die, there is no doubt that there are many of this class.
In dispensary practice the results of treatment must often be ex-
tremely doubtful, especially when patients seek aid from considerable
distances. The fact must not in any way detract from the large
amount of good institutions of this kind are able to dispense, and
I fully believe that, were every village of a thousand inhabitants
supplied with a small dispensary with a few useful medicines, more
good would be done than by the erection of one or two in a large,
extensive taluka.
I advocate most strongly the multiplication of village dispensaries
in districts, with Hospital Assistants, and one or two larger with Sub-
Assistant Surgeons of good attainments, wherein patients could be
treated and counsel sought at times of need; as to seek institutions
miles distant from their homes for the less important diseases, puts
families to so much inconvenience that, as it is well known, they
hesitate to repeat their visits.
I need only point out the number of absented shown in dispensary
returns* as going far to prove this state-
ment. A scheme of this kind, could it be
carried out, might have the effect of reducing very considerably in-
deed the cost of the extremely expensive Vaccination Establishment,
as each Hospital Assistant could conduct the vaccination of the vil-
lages, and only in large towns would extra vaccinators be required.
To this subject more attention is necessary than can be afforded
now, and I only offer these remarks as suggestions which might sub-
sequently be considered, and, if carried out, eventually do far more
for the salus populi than the present system can possibly perform.
The tables accompanying this report will, I trust, help to illustrate
the medical and surgical statistics of the Presidency Division for
1871-72.
CIVIL HOSPITALS.
European General Hospital, Bombay.
At my annual inspection of the European General Hospital I found
the buildings and offices in as good order as care, and annual and
minor repairs enabled them to be kept. The sick were most care-
fully attended to.
The hospital itself has been the subject of so many reports, gene-
rally of unfavourable character, that it is unnecessary almost to repeat
that it is a simple make-shift for a hospital for European sick, in a
city like Bombay.
9 M D
* Shown in Table D.
70
For years past, and each year, it has been hoped by all persons
interested in the subject, and they are many, that arrangements
would have been ere this completed for the long-promised erection
of a new European General Hospital, to take the place of the present:
an old military hospital of times gone by, and a converted barrack
with its out-houses, forming together a rambling, disconnected series
of buildings, unsuited really for the purposes to which they are put
on all points, save that of position.
Fortunately for the inmates, in this respect it possess a good aspect
and fair ventilation. Most of the surroundings of the hospital are
highly objectionable, as stated by my predecessors, and the whole
arrangements only bearable, under consideration of their temporary
character, pending the erection of a new hospital. This new hos-
pital was actually commenced in 1863, when the foundations were
laid on the part of the Esplanade fronting the main road leading into
the Native town from the Fort ; this situation was, however, aban-
doned, plans and sites have since then undergone various changes ;
it is now still hoped it will be commenced at an early date, the site
selected being, it is supposed, near the old Cooperage on the Esplanade.
In my inspection I did not see much that could be remedied in re-
ference to the hospital. Two subjects, however, called for particular
attention : one was the state of the laboratory, which should be
removed from its present position, and the place it now occupies
should be converted into a waiting room.
The other, the great need for a day-room for those patients who
now use the windward verandah, in close proximity to the beds,
for smoking, reading, talking, &c., to the serious inconvenience and
hurt of those patients for whom quiet is so necessary. I think a tem-
porary day-room, for patients not required to be at rest all day,
should be provided.
It would be vain to recommend any serious alterations which would
involve much expenditure without making anything complete ;
to arrange for such defects as should clearly be attended to, is all
that can be done.
The additions or alterations which have been made during the year
* For 11 months.
are noted in the annual report of Dr. Butler,
the Acting Surgeon of the Hosnital.* Since
that report a sanction has been received to the opening of an obstetric
ward for European women—a want which was pointed out by my
predecessor, and one which is probably much felt amongst European
families without the necessary means of commanding the attendance
so requisite on such occasions. Arrangements are being considered
so as to carry out the design with as little delay as possible.
The alteration in the residence room of the Apprentices, of whom,
by a recent Government Resolution, 18 have been ordered to be
attached to this hospital, has been most useful and prudent. The
places they were compelled to reside in before were most unsatisfac-
tory in a social as well as sanitary sense.
71
It appears that there was a smaller number of cases treated in the
year under report than in the previous year ; this may probably be
ascribed to decreased trade in the port, to the deportation of desti-
tute Europeans, to the establishment of the Government Workhouse,
and, to a certain extent, to the Contagious Diseases Act, as the ad-
missions for venereal disease were more than a half less than in the
previous year.
The total number of cases treated in the European General Hospi-
tal was 1,162, of which 70 remained from the previous year and 1,092
were fresh admissions ; there were, of these, 1,048 discharged, 49
died, 62 remained, 3 transferred.
The ratio of deaths to treated was 4.21, being larger than in the
preceding year, but considerably less than in previous years.
In Dr. Butler's report, accompanying, there are some interesting
remarks on hepatic abscess, with a table showing the amount of
urea excreted in that disease, and the effect of the administration of
chloride of ammonium on this excretion. Dr. Joynt's treatment of
delirium tremens by strychnine and nitric acid is pronounced favour-
ably on.
I append a table of the chief diseases treated in this hospital
during the year, and of the mortality occurring from them :—
Fevers. Rheuma tism. Syphilis.
Diseases
of the
Eye.
Diseases
of the
Heart
and
Lungs.
Diseases
of the
Stomach
and In-
testines.
Diseases of the
Liver.
Diseases
of the
Skin.
T. D. T. D. T. D. T. D. T. D. T. D. T. D. T. D.
European General Hospital 189 6 71 1 80 1 7 .. 84 15 182 13 46 6 52 ..
Fevers have given the largest number of cases for treatment; next
to these dysentery and diseases of the intestines. Diseases of the
kidneys were more numerous than before, all some form of Bright's
disease.
The discipline of the hospital has been very favourably reported on.
Some Assistant Surgeons, on joining, have been attached to the
hospital. Assistant Surgeon Arnott, M.D., has taken the place of
Mr. Dymock, appointed Principal Medical Storekeeper, and Surgeon
Asher was attached, while on general duty, on his return from
England, at his own request.
The subordinate establishment 1st class have all conducted them-
selves to the Surgeon's satisfaction, and Dr. Butler brings to notice
the care and attention evinced by Mr. Apothecary Hudson and
Assistant Apothecary Maloney.
The Apprentices are stated to have conducted themselves very
well, and their paying, themselves, for schooling every evening, shows
an earnest desire to improve.