NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
408
totally inadequate arrangements which at present exist for the re
-
ception and treatment of patients. By the last census a total of 1,826
persons, of whom about 80 are Europeans, come under the care of
the Apothecary at Manora; besides, during the fair season, or in the
presence of an epidemic, his having to attend and visit various ships
and native craft coming into the port. There being no accom
-
modation for in-door patients, all are classed as out-door, and have
amounted to 745 against 639 for the previous year. Of the total
treated, 92 were Europeans, one of whom, a child, died. The ratio
of treated to the strength above noted is 40.7 per cent., which is 8.5
more than for last year, and is due to the general unhealthiness of the
season and the presence of dengue. A Goorgah was sanctioned and
entertained from the 1st September last, the menial work of the dis
-
pensary having been previously performed by the Apothecary's
private servant. The expenses of this dispensary for the past year
amounted to Rs. 1,634; for the previous one to Rs. 1,565.
41. On visiting Keti I found no progress had been made towards
building either a dispensary or quarters for the medical subordinate.
As a temporary arrangement, the iron dhurmsalla is used, as the hut
formerly provided for the purpose was greatly injured during the
rains of last year. 1,529 patients were treated against 1,397 for the
previous year. In addition to an increase of malarious diseases,
there were 65 cases of dengue, and a large preponderance of affections
of the lungs and bowels, caused by the heavy rains and the inunda
-
tion of the river flooding the low-lying land around Keti. I was
greatly dissatisfied with the result of my inspection of this dispensary.
1st Class Hospital Assistant P. A. De'Crastos (No. 283) in medical
charge, had greatly neglected his duties. He was ignorant or pro
-
fessed to be so of the prevalence of small-pox in the town, but which
according to the kotwal's statement had been twice reported to him.
He had performed no vaccination previous to June last, and little or
none since, stating as his reason the impossibility of obtaining
children. His instruments were disgracefully dirty, and the medicines
not cared for and in a disorderly state. The records also were badly
kept and in many instances incomplete; and as regards accounts he
had none to show me. Altogether his dispensary was the worst
conducted in the province. Mr. De'Crastos has proved himself to
-
tally unfitted for an independent charge, and at my recommendation
he has been removed to general duty at Muscat. A good Hospital
Assistant has been sent in his place, who has already brought matters
into a more satisfactory condition.
42. There is every prospect before long of an excellent dispensary
being built at Tatta in the room of the present inconvenient and
unsuitable one. The plans which were submitted to me last year
have been slightly altered at my suggestion, so as to embrace the
requirements recommended in the new rules. The new building with
409
the necessary out-houses are to cost Rs. 3,600. A wealthy native
lady at Tatta has consented to give Rs. 2,500 towards it, and the
Municipality are expected to make up the remainder of the sum.
When at Tatta I approved of a site which is well raised, just outside
the town near the mooktyarkar's kutcherry, and conveniently placed
for the inhabitants; so I trust that in a few more months this much
needed building will be well advanced towards completion. In the
meantime, the present one is being used as well as it can; and in
place of the miserable house a quarter of a mile distant inside the
town in which the in-door patients were treated hitherto, a temporary
shed has been erected near the present dispensary.
43. The patients treated have numbered 6,426, being an increase
of 314 from the previous year. Only 21 of these have been in
-door. This class is scarcely ever drawn from the inhabitants of the
town, which circumstance, as also their small number, no doubt
arises from the hitherto wretched accommodation provided for them.
44. In my last year's report para. 29 a I referred to the importance
of Tatta being always provided with a good and efficient medical
officer of rank and qualifications not less than those of an rssistant
apothecary, and the desirability, therefore, of retaining the services
of the present Apothecary Mr. Sylvester. This warrant officer has
represented that he receives no extra allowance for the duties which
he performs at Tatta, and which are given at almost every other
dispensary in the province. On a reference to the Collector it was
stated that the municipality contribute Rs. 60 a month for Mr. Syl
-vester's services. But it does not appear that the apothecary is in
any way benefitted by this allowance, which is probably credited to
Government. He merely receives Rs. 180 per month (Rs. 150 pay
and Rs. 30 Staff allowance) and which amount he would draw where
-ever employed in the Civil or Military Department. The duties at Tatta
are often onerous, and will become more so on the new dispensary
being built. A man of the Apothecary's class also is quite isolated
at such a place, and while there he forfeits all the advantages of
society and education for his children which a larger town would
afford. I think, therefore, that if the services of an apothecary are
desired to be retained for the Tatta dispensary, some provision should
be made for placing him on a footing similar to that of other men
of his class in Sind.
45. At Jharrak the health of the population has been fair. It
quite escaped dengue; and the returns from the dispensary show
that the people did not suffer to any great extent from the general
unhealthiness prevailing elsewhere. There is an increase of forty
-two persons treated as compared with the previous year. Upwards
of one-third of these were cases of malarious fever; disease of the
410
bowels and lung affections were likewise prevalent. The Hospital
Assistant in charge is a careful steady man and performs his duties
creditably.
46. Owing to several changes which have taken place
during the past year in the medical subordinates in charge
of the dispensary at Mirpur Batora, it has not been so satis
-factorily conducted as was formerly the case. In August last
the Native Apothecary who had been there a considerable time and
had suffered for some years from a chronic form of leprosy, had to
go away. The Apothecary sent to relieve him soon fell sick and
after five months had to leave, necessitating another one being sent
in his place. The evil effects of these changes are shown by a falling
off in the numbers treated during the past year, which in the out
-door patients amount to 200. Under other circumstances this
would not have been the case. Admissions would have been numer
-ous, as the country around Mirpur Batora has been extremely
unhealthy. Dengue, moreover, prevailed to some extent in the town
and surrounding district, and sixty-six cases of this disease were
treated. A larger number of cases of syphilis, chiefly in its second
-ary and tertiary forms—have presented themselves at this than at
any other dispensary in Sind. The disease appears to be very pre
-valent in these parts. Both sexes are tainted with it, and their
offspring suffer proportionally. Affections of the eye likewise are
more than usually common here, particularly among the children,
which is accounted for by the dirty habits of the people. The most
singular feature in the returns of this dispensary is the number of
cases of snake-bite, amounting to seventeen. This is double the
number recorded at any other hospital. As none of these proved
fatal, and the records afford little information concerning symptoms
or the description of snakes said to have bitten these persons, it is
more than probable that half of them were not cases of snake-bite.
47. Hitherto the dispensary at Mirpur Batora has been in charge
of an apothecary; but I think the requirements of the place would
be sufficiently met by appointing an hospital assistant in his place
. The town is not an important one; it is not on the high road; is
seldom visited by Europeans; and the Government officials are few
in number. Moreover the municipality having last year decided
that the local allowance formerly paid to the apothecary could no
longer be continued, it is hopeless to expect that, in future, a man of
this class will, in such an out-of-the-way place, be satisfied with the
bare pay of his rank and take a proper interest in his work. For
these reasons, I would recommend an hospital assistant being put
in charge.
48. With regard to the dispensary at Sihwan, I think there is
room, not only for considerable improvement and extension in the
411
work performed there, but also in effecting a considerable saving to
Government, and that without risking in the least the amount of
benefit this institution is capable of affording. Sihwan was made
into a "civil station" by order of the Government of India, dated
29th June 1868; and by rule 28 of G. G. O. No. 392 of 17th idem.
Mr. Cooke, the Apothecary at present in charge, draws a monthly
salary of Rs. 350. On visiting Sihwan in the course of my inspec--
tion tours, and especially on this last occasion, I have not been
favorably impressed with either the amount or importance of the
work performed by Mr. Cooke. During the past year, with the
exception of four dislocations reduced, no operation of importance
has been performed, and the total number of persons vaccinated
has been only 105, while for the previous year there were but
thirty-five. With upwards of 4,000 persons in the town and
45,000 in the talooka, these are but poor results. The Hindoos
generally are, I know, averse to vaccination, and especially object to
having lymph taken from their children's arms; but persuasion,
tact, and perseverance, will go a great way in overcoming their
scruples. The order by the Government of India constituting
Sihwan a "civil station," was on the ground of its being one of
much importance requiring a fully qualified Medical officer; but
hitherto the results have not, I think, justified the opinion. At any
rate Mr. Cooke has not made it apparent; and indeed, from various
circumstances which have come to my knowledge, I do not think the
present Apothecary is appreciated by the people, or is himself parti-
cularly well suited to them, or the kind of work they require. From
what I could learn, the natives would be better pleased to have the
services of a good 1st Class Hospital Assistant; but in contempla--
tion of the works in connection with the Indus Valley Railway which
are to be carried out near this town, this would scarcely be a suffi-
cient arrangement. The medical requirements of the place however,
after removing Sihwan from the list of civil stations, and transfer--
ring the present expensive apothecary elsewhere, would be ade--
quately provided for by appointing in his stead another of the same
class on the ordinary salary of his rank with the addition of Rupees
30 a month from the Local Funds. The in-door patients have fallen
off to exactly half the number, 60, treated in 1871-72; and of this
number 20 or two-thirds were the result of injuries. The casualties
amounted to 4, giving a mortality of 12.9 per cent to cases treated.
The out-door patients however show an increase of nearly 1,000, or a
total of 4,538. Malarious fevers have numbered 1,564; diseases of
the lungs, 230; affections of the stomach and intestines, 731; and
of the liver and spleen 76. Nine cases of fracture and 4 disloca--
tions have been treated; but of operations there have been none.
49. No changes have been effected at the dispensary at Mehur
since I visited it in 1871-72, though they are greatly needed. It has
412
however, I hear, been determined to make several improvements in
the building shortly, so as to admit of better ventilation. The com--
pound also is to be enlarged; the present dead house and privy
removed, and others erected further away from the main building.
For the past year the in-door patients have not been so numerous as
for the previous one. These number only 40 against 68; and the
mortality also has been higher, 5.0 being the death-rate per cent to
treated for this last year compared with 2.9 for 1871-72. An
increase of 909 is shown in the number of the out-door patients,
bringing up the whole number treated of this class to 3,188. The
population of the town is returned at 2,500; but as there are various
villages in the immediate neighbourhood who take advantage of the
dispensary, I trust now that an active and efficient hospital assist--
ant has been sent there lately in the room of the former one, who
had not been as energetic as he might have been, a larger field for
usefulness will be opened at this place.
50. At the Larkhana Dispensary there has been a total of 6,607
patients treated during the past year, which is an increase of 152
compared with that of the preceding one. The daily average has
been 54.6 of those attending as out-door. The in-door patients are
one in excess of 1871-72; the mortality considerably less, being 9.8
against 14.0 recorded for the previous oear. The prevailing dis--
eases have been those most generally met with in other parts of the
province. But affections of the eye, chiefly catarrhal inflammation,
have been more numerous here than were observed at any other
dispensary in Sind, numbering 1,769 out of 6,607, the total treated.
Ulcers were numerous, furnishing many cases of the true "Sind
sore." Considering the importance of this town, numbering 7,234
souls, and the populous condition of the surrounding country, a much
wider development of the benefits of an institution of this kind
would be obtainable if the dispensary was worthy of the town, and
of the work which it might be expected to perform. In my last
year's report, paragraph 30, I brought to notice the miserable con-
-dition of the present dispensary, and which no amount of repairs
could change or render otherwise than it has always been, a reproach
to Larkhana. From what the Commissioner in Sind mentioned in
the 15th paragraph of his letter No. 679, dated 15th June 1872,
I had hoped, on the occasion of my late tour, to have found a new
dispensary ready, and on the site I had previously approved of; but
I am sorry to say matters were precisely in the state I had last
seen them. On enquiry I learn that there was a difficulty about
funds; and, moreover, that the Deputy Collector was in favour of
a site different from the one I had selected, which however did not
meet with the approval of the Municipality. Within the last two
months I have received from the Collector of Shikarpur plans for
a new dispensary, which I returned after suggesting sundry improve-
413
ments. As these would involve but little extra cost, I trust that
sanction has been accorded, and I would earnestly hope that the site
which, after inspecting all the others proposed, I selected as by
far the most suitable in every way, may not be departed from.
51. I have to report more favourably of the working of the dis--
pensary at Shikarpur for the past year than I was able to do for the
previous one. The in-door patients have been 96 against 53 for
1871-72. The rate of mortality however has been nearly double, or
17.7 compared with 9.4 for the preceding year. The out-door patients
have been also more numerous, 6,261 against the previous 5,945.
When speaking of the civil and police hospital at this town, I have
in a measure anticipated the suggestion I have to offer with respect
to an alteration in the constitution of this dispensary. With a new
ward attached to it for the Police, the civil surgeon would daily have
to visit it; and as on the proposed abolition of the civil hospital, he
would be relieved from his present attendance there, he should, I
think, be put in charge of the dispensary with an hospital assistant
and Medical Pupil under him, which would thus save Government
the expense of maintaining an Apothecary on Rs. 180 a month. By
this arrangement I have no doubt that, with a population of some
50,000, which Shikarpur and the villages withius a radius of 6 to 8
miles are said to contain, the attendance would be largely increased;
and a number likewise of important operations would be performed,
which would favourably contrast with—as at present—the complete
absence of anything in this direction worthy of notice. The diseases
of most frequent occurrence were pretty much the same as those
noticed elsewhere. Seven cases of snake-bite are noted, none of them
were fatal; and as the only symptoms present were those of extreme
fright, it is to be inferred the snakes were harmless. Among the
many ulcer cases which have presented themselves at this dispensary,
the Apothecary mentions numerous instances of obstinate sloughing
ulcer, or in other words—"Sind sore."
52. During the past year there were treated at the dispensary at
Jacobabad 4,935 persons against 3,355 for the previous one: and
this number would have been considerably augmented but for the
absence of the usual advent of Kafilas, which for the past year were
extremely limited, owing to the disturbances in the Khan's domi
- n i o n s . F r o m t h e r e m a r k s m a d e i n t h e e a r l i e r p o r t i o n o f t h i s r e p o r t
on the state of the country around Jacobabad caused by the rains
and inundation, it will occasion no surprise to learn that malarious
fever to an unusual extent has prevailed at this station; and such has
been the case: 2,447 patients, or almost half of the total number
treated at the dispensary, have been cases of ague. Dr. Byramjee,
the medical officer in charge, reports that the type of fever prevailing
during the past year has been a bad one, and presenting itself in a
form the most obstinate he has witnessed. Diseases of the respira-
414
tory organs—owing to the mildness of the season—have not been so
frequent, nor have the symptoms been so severe as in former years;
still there have been 7 deaths out of 22 cases. The in-door patients
have numbered 187, which is 46 fewer than in the previous year.
The mortality also has been high; which is however only what has
been observed generally throughout the province for the past year.
This has amounted to 15.5 per cent. to treated against 11.6 for 1871-72.
The characteristic ulcer of this part of Sind has been of frequent
occurrence, and its usual obstinate character and resistance to reme-
dies has been well noticed. Among the operations, have been 17 for
extraction of stone; of these 4 terminated fatally.
53. I was glad to find, when visiting Jacobabad last cold season,
that the vexed question of a site for the new dispensary or hospital
had been definitely settled; and, considering all things, the position
is a good one, being in a fairly open spot and conveniently situated
for the requirements of the people who resort to it. The space allot
- t e d t o i t i s s o m e w h a t c o n f i n e d ; a n d i t i s r a t h e r c r a m p e d b y a r o a d
running close on its eastern flank, but which, as it is a bye-road and
little frequented, might with great advantage be included in the hos
-pital compound. The buildings were in progress, and when complet-
ed will no doubt largely increase the amount of medical relief which
has been dispensed hitherto to the people in and around Jacobabad,
as also to persons coming from adjoining States, British and Foreign.
And by means of a large and well conducted Hospital as this one
will be, the political and other advantages in connection with such an
establishment will be widely felt.
54. The Charitable Dispensary at Sakkhar, as I noticed in my last
report, though conveniently situated for the people, is far too small,
badly ventilated, and hemmed in by surrounding buildings, and is
moreover incapable of extension. I learnt, however, that the muni
- c i p a l i t y h a v e n e a r l y d e c i d e d t o b u i l d a n e w o n e , b u t w e r e h e s i t a t i n g
in respect to a site. When on the spot, therefore, I visited several
sites which had been proposed and were pointed out to me by
Honorary Assistant Surgeon Leahy. One of these possessed such
superior advantages to any of the others, that I recommended its
selection. The only difficulty in obtaining this spot, is, that an old
and empty mess-house stands upon it, and for which the owner asks
an exhorbitant sum. But in a matter of such importance, this
ought not to be allowed to stand in the way. The Improvement Act
gives the Municipality the power of taking over the ground at a valu-
-ation, which, I trust, they will avail themselves of, and without unne-
cessary delay commence the new dispensary.
55. The number of in-door patients treated at this dispensary is
higher than that of any similar institution in Sind; and it is much to
be desired therefore that a building of greatly increased accommo
- d a t i o n t o t h e p r e s e n t o n e s h o u l d b e s p e e d i l y e r e c t e d . T h i s c l a s s f o r
416
patients, or 96 for the past year against 62 for the previous one, have
been treated; and the death-rate, which was 3.2 in 1871-72, is for this
year only 1.0. Nearly three-fifths of the whole cases treated were
those of malarious fever. After these, in point of frequency, come
diseases of the eye (conjunctivitis), affections of the digestive organs
and spleen, boils and ulcers. Three cases of snake-bite are recorded: 2
of these were caused by a snake called "Loondie," the other by a
"Nag." They were treated with "Richardson's antidote" and
recovered. Six " capital" operations were performed, 4 of them
being for stone; but on enquiry I found that these were undertaken
by Dr. Holmested when he came to inspect the dispensary in June
last; and another, a case of amputation, was performed by the former
hospital assistant, who is now in the Civil Hospital, Haidarabad.
58. As is the case in most of the other dispensaries, there has
been a slight decrease in the number of in-door patients at the
Alharka Tanda one, and an increase likewise in the death-rate
—
the latter having been 9.2 against 7.4 for the preceding year. The
out-door patients, as is observed elsewhere, have been more nume
-
rous—634 being the number in excess of last year. And this
increase is due to the prevalence of fever, diseases of the eye, and
cutaneous affections. These last hold the second place in point of
frequency in this taluka; and among the ulcers have been witnessed
many cases of the true "Sind sore," as evidenced by their large,
sloughing character, with raised indurated edges, and their deter
-
mined resistance to treatment. Mr. Wight, the Apothecary in charge,
has again shown himself successful in surgical operations, especially
for stone in the bladder. The cases of this disease operated on were
not in persons belonging to the taluka, but coming from various
parts of Sind, and even from the neighbourhood of Haidarabad; and
this shows the confidence he enjoys, that, with Haidarabad only 23
miles distant, where Dr. Holmested's success in lithotomy is widely
known, 25 cases should have presented themselves for operation;
and further it is highly creditable to him that out of these he should
have lost only 3.
59. On the occasion of my visiting Halla I had reason to be much
dissatisfied with the hospital assistant in charge of the dispensary.
Not only were his records incomplete and in confusion, but his
work has been very unsatisfactory. After such a sickly season, he
ought to have had a good return of patients, whereas there was a falling
off of 82 compared with the previous year. Complaints were made
to me that he was inattentive and careless, and was frequently absent,
and that he even sent away persons applying for relief. In conse
-
quence of this many people were forced to seek assistance from
M r .
Strachan, the Superintendent of Cotton Experiments at Suhara, who
does a great deal of good in administering simple remedies among the