NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
417
poor in his district. In vaccination also he had done next to nothing
having vaccinated only six children in nine months. I have recom
-
mended the Inspector General to remove him.
60. While the number of in-door patients at Mahomed Khan's.
Tanda Dispensary has not varied for the past year, nor the death rate
increased, remaining at 1.8 per cent. to treated, a diminution in the
attendance of out-door patients to the extent of 51 persons has occur
-
red. The population of this town, however, is small, and its state of
health is more favorably reported of than that of other districts.
After fevers the most common diseases have been those of the diges
-
tive and respiratory systems; also affections of the skin
.
61. With reference to the dispensaries in the Thur and Parkur
-
District and the state of health of the people residing there, it is to be
noticed that that part of the country was visited last year by heavy
inundation from the Indus, which invaded the country some 20 miles
above Sakkhar. The Narra also overflowed, and burst some of its
bunds. The consequence of all this was, that a vast extent of country
lying between the Haidarabad and Umarkot Districts was completely
under water. This slowly dried up, and was followed by great sick-
ness among the inhabitants. In the upper portion of the Thur and
Parkur District, fever was particularly abundant; affections of the
lungs and bowels in a moderate degree. In the lower, fevers were
not so prevalent, but diseases of the respiratory and abdominal organs
assumed greater importance. At Nuggur Parkur the attendance at
the Dispensary has been nearly doubled, the numbers being 2,920
against 1,684 for the previous year. But at the Dispensaries at
Miti and Kipra, it is somewhat remarkable that, instead of there
being an increase of patients as might have been expected, there is a
falling off, and which is most marked at Miti. Here it has amount
-
ed to 215, while at Kipra the decrease has been 55. At the former
t o w n , t h e p o p u l a t i o n b e i n g r e t u r n e d a t 5 , 0 0 0 p e r s o n s , t h e a v e r a g e
daily attendance has been 13.11. At the latter the daily average of
the sick has numbered 30.8 out of a population estimated at 1,849.
62. The Umarkot Dispensary is the largest and most important
in this part of Sind. The population according to the census of 1872
amounts to 3,579 souls. Of this number 2,936 are Hindoos. The
attendance at the dispensary has been within one of that for the pre
-
vious year, and the daily average has been 48.6. There has been a
great decrease in the number of the in-door patients; nearly two
-
t h i r d s l e s s ; b u t t h e m o r t a l i t y i s n e a r l y t h e s a m e , h a v i n g b e e n 7 . 8
against 7.0 for 1871-72. The great diminution of in-door patients is
explained by the circumstance that during the previous year people
flocked into Umarkot from the surrounding country in a starving con
-
dition, and the in-patients for that year were chiefly composed of
t h e s e . B u t f o r t h e y e a r u n d e r r e p o r t , w h i l e U m a r k o t i t s e l f w a s u n -
418
healthy, and some of the people even leaving it for change, the Thur
was comparatively healthy. The inhabitants were not, as in former
years, under the necessity of moving in search of the necessaries of
life, and consequently very few came to Umarkot. The in-door
patients, therefore, were almost entirely confined to people of the town
and neighbourhood, which accounts for their small number, only 51.
Out of the total treated, 4,235, more than one-half, or 2,476, were
cases of malarions fever. This disease prevailed more or less through
-
out the year, but was particularly severe from September to Decem
-
ber. Dysentery likewise prevailed to a considerable extent; and
although the climate was the chief predisposing cause, yet unwhole
-
some food, heat, and malaria told severely on the poorer classes and
rendered them especially liable to this disease. Abscess and ulcers
likewise have held a prominent place in the diseases affecting the peo
-
ple at Umarkot. The subjects of these affections were mostly poor
people of the labouring classes, who are much exposed to inclemen
-
cies of weather, are dirty in their habits, and their diet coarse and
often scanty.
63. Last year I reported that the new dispensary at Umarkot was
almost finished, and would be ready for occupation in a month. I
regret to say, however, that this expectation has not been fulfilled.
When I last saw it in March 1872, there needed but a cook-room,
dead-house, and some other minor details to be completed; and yet
in the succeeding 11 months, no progress had been made beyond
raising the walls of the cook-room, and a portion of those of the dead
-
house, and putting a wall round the compound; which last might
have been delayed until the more necessary parts had been finished.
This delay is the more to be regretted as the present old dispensary
is very unsuitable, and in-door patients have to be accommodated in
a shed at some distance. The Police, it is true, had been lately re
-
moved to a ward in the new building, but this arrangement was very
inconvenient, as all medicines and other articles required for their
treatment had to be carried backwards and forwards from one dis
-
pensary to the other. I trust it is only necessary to bring this mat
-
ter to notice, to insure the whole premises being completed without
further loss of time.
64. An account of the Khelat Agency will, before closing the his
-
tory of the dispensaries, be appropriately entered here, as it presents
many of the features of these institutions, though possessing no fixed
locality and being based on a different footing. It affords medical
aid to the Political Agent, his establishment, and military escort;
also to numerous persons who apply for relief at the various stations
visited by the Agency. The total number of cases treated was 4,286
against 3,435 for the previous year. Many of these patients were
Affghans, either belonging to one of His Highness the Khan's Regi
-
ments, or pilgrims en-route to Mecca; also from the districts of Sa-
419
rawak and Peshim several people came for treatment. The majority
however were Brahooees or Beloochees. Malarious fevers have not
affected the people in these parts so much as it has the residents of
Sind proper. It is described as usually of a mild tertian type, and
was most prevalent in the plains about Gundara and Bagh. Syphilis
primary and secondary gave comparatively few admissions. This
disease appears not to be of frequent occurrence in this country, but
is generally contracted on the frontier. The severe punishment which
follows adultery in Beloochistan—both man and woman being killed
— h a s a m o s t s a l u t a r y e f f e c t i n p r e v e n t i n g a n d c h e c k i n g t h e s p r e a d o f
this disease. Affections of the eyes and respiratory system were
pretty numerous; while those of the abdominal organs furnished the
largest class of disease coming under observation, and of which diar
-rhœa and dysentery were the most numerous and important. Diseases
of the skin, as might be expected, were of frequent occurrence. In
-juries also were numerous. Many of the cases, chiefly the gun-shot
wounds, were of some standing, and came from different parts of Be
-loochistan. Some of these were sepoys belonging to the Khan; others
were Affghan merchants and their followers, who were wounded by
the Brahooees and Murrees in the Bolan pass in 1871-72. Owing to
the disturbed state of affairs at Khelat, and the uncertainty of the
Political Agent's movements no operations of importance could be
undertaken.
65. In addition to the diseases above mentioned, small-pox was
present more or less at Khelat and also in Cutchee. Dr. Bowman
attempted to introduce vaccination, but the results were unsatisfac
-tory. Inoculation is extensively practised throughout Beloochistan
by native hakeems, and no doubt this gives to the disease a perma
-nence which it would not otherwise have. It does not appear that
many obstacles would be encountered in the way of inducing the
people to replace inoculation by vaccination; but without a staff of
vaccinators there would be much difficulty in keeping up the supply
of lymph, owing to the nomadic habits of the people.
66. The medical relief afforded by Dr. Bowman to the several
people who come across his path during his journeys in Beloochis
-tan, is at once varied and extensive, and forms a valuable and im
-portant feature in connection with the mission at Khelat; and Dr.
Bowman deserves great credit for the readiness he has shown in ad
-mitting the people to the benefits at his disposal, and the excellent
manner in which he conducts his work.
67. On review of the working of the dispensaries for the year
under report as above detailed, I think, there is sufficient evidence to
show that, taking one with another the work has been satisfactory;
and that the aggregate increase of 7,811 patients gives a fair indica
-tion of the increasing estimation in which these institutions are held
420
by the people. It was reasonable to expect that an unhealthy year
like the past one, would swell the returns from all medical charities,
but it is an encouraging sign and one giving promise of good things
to come, that, while in 1871-72—a healthy year it is true—there was
a total of 100,909 persons treated in the civil hospitals and dispensa
-ries in Sind, we should have for the past official year in the same in
-stitutions, an aggregate of 112,553 patients, giving an excess of
11,644 persons for the year under notice
.
68. From the table (Appendix F) of the large jails it will be
seen that the average strength of the prisoners for the past official
year has been 153 less than in 1871-72; that the numbers treated
have been fewer by 540; that the ratio of deaths to strength is a
little higher, being 5.4 against 5.2 for the previous year; and that
the percentage of deaths to treated is likewise in advance of that
formerly noted, viz. 5.1 as compared with 4.2 for 1871-72.
69. Last year the Shikarpur Jail recorded the highest rate of
mortality of any in Sind, being 8.1 per cent. to strength and 10.3 to
numbers treated; while the one at Haidarabad gave the lowest or
2.3 of deaths to strength and 3.5 of deaths to treated. For the year
under report there is a great change for the better at Shikarpur.
The ratio of deaths to strength has been reduced to 5.7. On the
other hand, the one at Haidarabad tops the list, showing 7.3 and 8.6,
respectively, as the rate per cent. of deaths to strength and deaths to
treated. The jail at Bukkur returns the same ratio as Haidarabad
in the matter of deaths to strength, but only 3.0 of deaths to treated.
At Karrachee again, the mortality figures the least of any, being at the
rate of 3.4 per cent. to strength, which is considerably lower than it
stood in 1871-72 when it was 5.8. The gang of convicts at the Narra
Canal shows favourably, considering the past trying year. Their
death-rate per cent. to strength is 3.8 compared with 3.0 for 1871-72;
but, as might be expected, the ratio of mortality to treated, viz. 5.4
was higher than it stood in the preceding year when it was only 2.1.
In the Umarkot Jail the percentage of deaths to strength and of
deaths to treated are double of those for 1871-72, being, respectively,
6.2 and 2.2 against 3.3 and 1.2 for the previous year.
70. On referring to the satistics given in Government Resolution
No. 850, dated 15th February 1873, founded on the annual report
of the jails in the Bombay Presidency, submitted by the Inspector
General of Prisons, it will be found that the rate of mortality for the
jails in Sind for the year, antecedent to the one under report, does
not correspond with what is there stated; but this discrepancy is
easily explained by noting that the report of the Inspector General
of Prisons is for the calendar year of 1871, whereas the figures I sub
-mitted were for the official year 1871-72.
421
71. With regard to the jails themselves, I have a few remarks to
make. As observed in my previous report, the one at Karrachee, owing
to the lowness of its position is always more or less damp. It be
-comes excessively so after heavy rain, and which is greatly increased
on the occasion of spring tides. The evil of this is especially felt in
the sleeping pendalls. The Superintending Engineer in Sind has
expressed his opinion that raising the floors of these one foot will not
prevent the damp from below rising up, and that nothing short of
spreading a layer of asphalt on a three-inch bed of concrete will in
-sure a dry surface for the prisoners to lie down on. This he says
will cost Rs. 3,200 for the 10 pendalls. In anticipation of a scheme
which last year the Commissioner in Sind informed me was under
consideration, in consequence of the town increasing rapidly round
the jail and the enhanced value of the land it occupies, of removing it
altogether to a higher and drier position, it would hardly be worth
while to incur this expense if the arrangement is likely to be soon
carried out. And the more especially as the past year which was one
of the wettest experienced for several years, has not effected the
health of the prisoners. This has been pretty good; nor were there
any particular symptoms in their complaints which could fairly be
attributed to the conditions under which they live. The mortality
was caused chiefly by fevers, dysentery, and diarrhœa; but most of
the cases occurred in old and debilitated subjects; and as a rule the men
leave the jail in better physical condition than they enter it. The
"dry-earth" conservancy is the only system followed; no deodorizer
but this is used, and it is found to be quite effectual in combating all
offensive effluviæ. The night-soil is carted away twice a day to a dis
-tance of 2 miles, where it is buried.
72. There has been no overcrowding in the Haidarabad Jail, nor
are there any causes at work in it—unless it is the bad water, to which
the large mortality for the past year can be traced; neither can the
unhealthiness of the season be debited with it, as this would have
similarly affected all the other jails. The chief causes of death were
diarrhœa, dysentery, chest affections, and fevers, attacking prisoners
with previously diseased organs. Many of the casualties occurred
during the hot months in patients who were at the time ill in hospital,
and who died suddenly, and which was attributed to the great heat
affecting them in their diseased and enfeebled condition. The same
system of conservancy as was reported on last year, is maintained, and
with equally satisfactory results. A new latrine on a larger scale and
on the same principle as the former one has been built by the
prisoners. The night-soil is daily buried outside and all nuisance is
avoided.
73. The water-supply is still in the same deplorably bad state as
reported last year. My suggestion of passing the water through iron
tanks half filled with charcoal and coarse sand has not been adopted.
422
The Superintendent, Dr. Holmested, mentions having lately received
a grant of Rs. 200 from the Inspector General of Prisons, which
he proposes to expend in procuring a quantity of the patent magnetic
carbide from England, and construct a large filter, which he calculates
will purify 300 gallons of water daily. This to a certain extent will
be beneficial, but at best will prove but a very poor substitute for a
plentiful supply of water direct from the river. I have already, when
noticing this subject in connection with the civil hospital at
Haidarabad, endeavoured to point out some of the evils resulting
from the scarcity and bad quality of the water-supply; and, as it is a
question of great importance, I trust, I may be excused if I again
draw attention to the matter. It is one which every year forces
itself more prominently into notice, and must continue to do so, until
—of the three fundamental elements absolutely necessary to the carry
-ing out any sound system of sanitation, viz., pure water, pure air, and
good food—this one is supplied. It is encouraging therefore to learn
that at last a scheme is about to be introduced by the municipality
for bringing water into the town direct from the Indus; and when
this is accomplished, there will be then nothing wanting to perfect
present arrangements in connection with the jail.
74. Nearly one-half of the deaths occurring in the Shikarpur Jail
were occasioned by malarious fever. This was either complicated with
disease of other organs, such as pneumonia, congestion of the liver, or
kidney disease; or the subjects were those with broken down consti
-tutions. From diarrhœa and dysentery—a frequent cause of death
among prisoners—there has been a remarkable exemption. Three
cases only of the latter and 23 of the former with but 1 casualty, are
all that have occurred under these heads. Pleuro-pneumonia is a
common disease in Upper Sind, and is usually attended with a high
rate of mortality. The prisoners in this jail have not escaped their
share of affections of this kind. 25 cases of lung disease are recorded,
of which one-third proved fatal. On the whole, however, the prisoners
have been healthy. The barrack used last year as an hospital is still
retained as such. A new hospital is being constructed, which when
completed will be very suitable. The jailor is greatly to be praised
for the admirable manner in which he carries out the conservancy of
the jail. No water is allowed to be taken inside the latrine, solids
and fluids are kept separate, and over the former, dry sifted silt is
thrown on each occasion by the prisoners; and the whole is after
-wards removed to a distance and buried in trenches. The system
leaves nothing to be desired.
75. The general health of the prisoners at Bukkur has not been
very satisfactory for the past year. The strength is two-thirds less
than for 1871-72. Prevailing diseases were, after malarious fevers,
pneumonia, and diarrhœa. The casualties have nearly all arisen from
lung disease due to sudden and extreme variations of temperatur e
423
acting on previously debilitated subjects. Nearly all the prisoners in
this jail are employed in out-door labour, and as a good portion of
their work consists in excavating silt from canal beds, they appear
specially liable to malarious influences and pulmonary affections
. The ventilation of the barracks has been lately much improved by
piercing the walls close under the roof with windows at suitable
intervals. The latrine which was recommended to be Constructed
has not yet been built, and the conservancy arrangements are still
very inefficient and unsatisfactory
.
76. The average strength of prisoners in the Umarkot Jail has
been somewhat higher for the past year than for the preceding one.
It has been 144 against 130; and yet I regret to have to report that
nothing whatever has been done to increase the sleeping accommoda
-tion. The remarks I made on this matter in para. 48 of my previous
report may be repeated word for word in the present one, and with
this addition, that as the strength for the past year has been great-
er, and seven inches and fifty cents of rain fell in three months, when,
of course, the prisoners could not sleep in the open court, all the evils
I then brought to notice with respect to their terribly overcrowded
Condition at night, have been intensified. On theoretical grounds it
would be natural to expect from this state of things an exceptionally
high death-rate; but although it is double that of the previous year—
6.2—it cannot be termed for Sind excessively high. The sickness
however has been very considerable, fevers and dysentery having
been extremely prevalent, and causing the percentage of treated
to strength to reach the high figure of 275.0 which is Considerably
above that of any jail in Sind. There is no attempt made in this jail
to use the "dry-earth system." The latrines are merely small en-
closures, cleaned twice a day, and are common to the police quartered
inside the fort as well as to the prisoners
.
77. The strength of the prisoners stationed at the Narra Canal
was greatly in excess of that for the previous year, being 437 against
294. And although the floods from the Indus were unusually high,
and everything favourable in that low-lying district to induce much
disease, the report for the past year must be considered satisfactory
. The percentage of treated to strength 71.6 as compared with 140.1
for 1871-72 stands in very favourable contrast. And the death-rate,
considering the severity of the past season, is far from excessive. It
is 3.8 per cent to strength, while for the preceding year it was 3.0.
The disease attended with the highest mortality was pneumonia;
next in order came fevers; after which followed sunstroke. All the
prisoners belonging to this jail are daily told off for out-door work,
such as digging canals, clearing jungle, and the like. They live in
rude huts constructed from the mater ials around them; and their
quarters are removed as often as the sphere of their labours is chang
-ed. Meanwhile the men are well fed and clothed; their labour though
5 3 M D
424
regular, is not excessive; and this kind of life, even when pursued
in an unhealthy district, gives results much more favourable than
might be expected. In not a few instances however the health breaks
down, not from the work or mode of living, but from climatic influen
-ces acting upon some latent organic defect. In these Cases the men
are sent away to some permanent jail for change and treatment.
78. My inspection of the small subordinate jails enables me to re
-
port on them in generally favorable terms. The one at Tatta was
clean, sufficiently large, well ventilated, and suitable.
79. At Sihwan, an attempt has been made by piercing the wall
with two windows, to remedy the original blunders at the time of
construction, and which I pointed out in the last year's report. But
the benefit in the matter of ventilation is not apparent; and the ac
-commodation is as limited and confined as ever. Nothing short of
throwing down the wall at the rear, including more ground, and
substituting strong palisades for the one in front, will effect any real
improvement in this jail, or render it otherwise than the hottest in
Sind.
80. At Mirpur Batora, there are two wards, which are ventilated
through the roof. They were clean and in good repair. Prisoners are
seldom detained over a week or ten days.
81. The disposition of the wards, ventilation, and Other matters
in connection with the jail at Mahomed Khan's Tanda were previously
reported on, and there is no change in these respects to notice this
year. The jail was in good repair, but the prisoners were not equa
l - l y d i s t r i b u t e d t h r o u g h t h e d i f f e r e n t w a r d s . I f o u n d s o m e 1 2 o r 1 4
huddled together at one end of a ward, the rest of it being useless
i n c
onsequence of their having stopped about the water from a large
earthen pot, placed for drinking. The other ward of similar size con
-tained only 4 prisoners and one small ward was empty. A more
judicious distribution of the inmates would be beneficial. There had
been but little sickness among them for the year.
82. Two small wards have been lately added to the jail at Alhar
-ka Tanda; they are ventilated from the roof, are provided with small
open courts, and are sufficient for the accommodation of 2 to 3
prisoners. The premises were clean and in good state of repair.
83. In last year's report I took occasion to notice that the ward
in the male portion of the jail at Taroosha, termed the "murderer's
ward" was totally unprovided with any means of ventilation, the
doors being solid, and the walls destitute of windows or ventilators
of any kind. At the date of my visit—1st January last—nothing had
been done; but I was informed that preparations were going on to
put in the windows, but that the doors which I recommended should
be replaced with iron bars, were to remain, and iron-barred fanlights