NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
139
There was no case of sickness, one or two of the officers and met
were stiff from the effects of the fever, but all were more or less at
work. Further directions for disinfection were given.
The circumstances were favorable. No sickness was on board. No
case had occurred since the 15th, and none of the men shipped be-
tween the 12th and 18th had been attacked, therefore the Quarter
Master General was informed that "the present favourable circum-
stances continuing, the 24th of January might be directed as the day
of embarkation for the Native Troops proceeding to Aden."
On this day a fresh admission was reported, and the embarkation
was postponed sine die. Subsequently it was found necessary to
send the steamer on the 29th to Butcher's Island, as more men be-
came affected, to remove the officers and crew to the Island, and to
empty the steamer of her stores and cargo: she was then most
tho-roughly and completely disinfected, the cushions and linings removed
and burnt, and the vessel for a fortnight or more left free.
The men on the island were, with one or two exceptions of the
disease, all well : they were regularly bathed, their clothing exposed
daily to the sun, boiled and disinfected according to its character,
and blankets, pillows, upholstery, which it was found impossible to
arrange for, and in which no doubt the infective power remained,
were burnt.
The steamer was again docked on the 24th February, undocked
on the 28th, and. as since the 6th February no fresh cases of the
disease had appeared, she was again reported fit for employment,
and employed early in March : since then there have been no fresh
eases on board.
It is necessary to state that the earliest knowledge of "dengue" at
Aden, was in the last fortnight of June 1871, and even then it was
not clearly recognized.
T h e Ma r i t n e S u r g e o n wa s a g a i n d i r e c t e d t o p r o c e e d o n b o a r d , a n d
report to the Quarter Master General whether the vessel was, in his
Opinion, in a fit state to receive on bond Native Troops for Aden on
the 12th. This officer now recognized the disease affecting the
crew as "dengue" and considered that troops should not be embark-
ed until disinfecting precautions had been taken.
The precautions recommended by the Marine Surgeon were not
carried out in their entirety.
On the 18th I returned to Bombay, and on the 19th inspected the
ship. She had been thoroughly vetilated, fumigated, and half of the
crew allowed each night to go on shore; the crew had not been
changed as recommended.
140
The cases of the dengue on board the Dalhousie presented no
peculiar features distinct from the now well-known characters of the
disease. The Assistant Apothecary has given a very fair description
of it. It would not have received such prominent attention here, only
that the mis-statement of the Garrison Surgeon, Cananore, called
for correction : this correction it would, perhaps, be advisable to have
published.
T. B. JOHNSTONE, M.D.,
Deputy Inspector General of Hospitals,
P.D. and Bombay Marine
.
Bombay, 15th April 1872.
ANNUAL PROGRESS REPORT
OF
C I V I L H O S P I T A L S , D I S P E N S A R I E S , & c . ,
IN THE
POONA DIVISION
FOR THE YE AR 1871-72.
The Poona Circle of medical administration is a very extensive one.
It includes nine collectorates, to the principal or Sudder station of
which a civil hospital is attached, consequently the present reports
will embrace the
operations of nine civil surgeons.
These nine civil hospitals, with their civil dispensaries, and 26
charitable dispensaries, dispersed over a vast area of country, have
been established for the purpose of affording. medical aid and relief
to about 7,000,000 of the civil population.
During my tour of inspection, which commenced in the begining
of December and terminated at the end of March last, I visited
every civil station in this division, and am happy in being able
again to record my entire satisfaction with the manner in which the
several medical officers in charge of these establishments have con-
ducted their duties ; as the state of each hospital has already been
commented on in my annual inspection reports, I shall not further
allude to the subject here.
Before commencing my report on the sickness and mortality which
has occurred in the hospitals and dispensaries during the past year,
I propose making a few brief remarks on the meteorological and
sanitary condition of the Deccan and Southern Maratha Circle gene-
rally, as drawn -from the various observations submitted.
The monsoon of 1871 must be considered an exceptional one.
The rainfall was not only one of the scantiest on record, but it
came at irregular and unseasonable periods.
This circumstance, no doubt, accounts in a great measure for the
high mean temperature experienced throughout the year, and the
sickness which has very generally prevailed.
Ozone.—The presence of ozone in the air was observable during
the first 7 months of the official year, that is, from April to October.
In the 5 remaining months no trace of it was detectable, and this
is worthy of note, for it was observed that in these latter month
s,
1 8 MD
142
the mortality in the hospitals was greatest, with a decrease in the
general sickness, and that the reverse obtained in those months in
which ozone was present.
Sickness and Mortality.—During the year 1871-72, 4,603 persons
received medical treatment in the hospitals in this division, and
there died in the same from a 1 causes 315, or 12 per cent. of the
total sick treated.
I will now proceed to notice a few of the principal diseases which
have been treated in those hospitals, detailing results, and then
pass on to the subject of injuries and capital operations performed
by the different surgeons in charge.
Fever.—Fever, especially of a malarious character, always bears a
large proportion to the total sick treated ; but the present returns
show that the rate of admissions from this cause to the whole sick
treated, is not so proportionately great, as it is in European and
Native military hospitals.
The number of cases treated is 674, of these 27, or 4 per cent., died.
The majority of these fatal cases were complicated with other
affections.
In the treatment of fever, distinctly intermittent, the introduction
of quinine into the system by the hypodermic process is one very
highly spoken of by medical officers in charge of the larger hospitals.
It is a practice now extensively pursued, and it would appear with
the same uniform success.
Dr. Beatty, in his report, mentions having treated 57 cases of fever
in this manner, and with the following results :
—
The average number of injections was 2, the average quantity of
q u i n i n e 8 1 / 2 g r a i n s , a n d t h e n u mb e r o f d a y s t o e f f e c t a c u r e wa s o n
average 10.
For reasons stated in the report it will never be a popular remedy
in consequence of the pain experienced at the time, and for several
days subsequent to the operations, and perhaps in private practice
seldom be permitted.
In our civil and military hospitals the great advantages held out,
are the saving of time and of expense in the consumption of
quinine.
In none of the cases treated did abscess occur.
Diseases of the Stomach and Bowels.—Diseases of the stomach and
bowels, though less prevalent than fevers, have proved far more fatal.
Diarrhœa.
—The admissions from this cause were 186 ; of these 72
died, giving a high percentage of 38. More than one-half of the
cases were treated in the Sassoon Hospital, and, as is usually the case,
the majority of sufferers were of the indigent class seeking the shelter
of a hospital when all hope of cure was passed.
The same remarks may apply to the admissions to hospital from
dysentery.
1 43
Dysentery.— From this cause the admissions to hospital are com-
p a r a ' t i v e l y f e w , o n l y 1 2 5 , b u t t h e n u m b e r o f d e a t h s w a s 3 8 , o r 3 0 p e r
cent. of the total sick treated.
Diseases of the Liver.—Diseases of the liver give only 48 cases
with 10 deaths, one-half of them were treated in the Sassoon Hospi-
tal; of these 9 were the subject of hepatic abscess, 6 of which recover-
ed, and 3 .died. In one case the abscess.was opened, but the man.
eventually sunk from exhaustion.
In the treatment of hepatitis, and in properly selected cases, Dr.
Beatty speaks highly of the value of the chloride of ammonium given
in 20 grain doses.
Diseases of the Lungs .—The number of admissions under this head
is 229, and deaths 39, or 17 per cent. The cases treated were prin-
cipally bronchitis in the chronic form, but the mortality was due
chiefly to pneumonia.
Cholera.—Cholera was not prevalent during the period under review,
except in the Collectorates of Khandesh and Satara, where it made its
appearance in the months of November and December 1871, and in
February 1872. The returns appended to Dr, Carter's interesting re-
port on the subject, show that altogether 293 persons were attacked, of
which 203 applied for medical aid ; 112 of these recovered and 92
died. The number of persons who received no medical treatment
is 89, and recoveries and deaths are pretty equal, 44 against 45,
showing that medicines and medical care have some effect towards
saving of life.
The whole report on this subject, annexed to Dr. Carter's annual
report on the civil hospital, is interesting and suggestive.
The number of admissions to hospital from cholera is few, only 10
with the small mortality of 3.
Small- pox.— Small-pox in the months of February a'nd March was
pretty general throughout the districts, and the number of admissions
to hospital was 40, of these two unprotected cases proved fatal.
I shall now enter upon the surgical practice of these hospitals, and
in doing so, I must preface my observations on the subject by saying
that few hospitals, I think, in this country can -produce a greater
number of more interesting cases treated, or perhaps show more suc-
cessful results of the more formidable operations which have been
undertaken for their relief, than is exhibited in these reports and
returns.
Under the head of injuries 433 cases have been received into the
hospital, and not a few of them have been of a very serious nature.
The deaths recorded are 19, or 4 per cent. of the whole number
treated.
One interesting case of a very extensive injury inflicted on a boy
admitted into the civil hospital of Belgaum may here be mentioned,
i llustrative, as Dr. Sylvester remarks, of the reparative power observ -
ed in children.
144
The boy was 12 years of age, and in an attempt to rob him of a
few ornaments worn about his person, he sustained the following
injuries :—A compound fracture of the skull situated on the inferior or
posterior aspect of the head but without depression of bone. A frac-
ture of right radius, at its middle third, with 12 incised wounds, ex-
tending over the head, neck, back, and upper extremities. One of
which laid open the left wrist-joint. The edges of the wounds were
brought together by sutures and plaster, and afterwards dressed
with carbolic oil. The lad made an excellent recovery, and without
a bad symptom was discharged from hospital.
The whole of the surgical practice of this hospital is interesting,
and the report submitted by Surgeon Major Sylvester is deserving
of notice and commendation.
Of the capital operations that have been performed, amputations
and operations for the removal of stone may be mentioned.
Lithotomy has been performed no less than 42 times during the
past year, and with an almost unprecedented success. Of the cases
recorded death followed in only two. A very instructive and
interesting table of 20 cases operated on is appended to Dr.
Bainbridge's report on the civil hospital, Dhulia, all of which were
successful. He states that of the 63 operations undertaken by him
since his arrival in the country, he has only lost one patient. His
largest stone extracted during the last year weighed no less than 3
ozs., 3 drs., 15 grs. In Dr. Beatty's unsuccessful case the stone
(oxylate of lime) weighed 3 ozs. 95 grs. Owing to the ruggedness of
its surface, some difficulty was experienced in extracting it. The
patient was an old man, long suffering from abscess of the bladder
and uretra. He survived the operation 9 days, and sunk from
disease and exhaustion.
Amputation .—From serious injuries received or for malignant
disease affecting the leg and knee, amputation of the thigh was
found necessary in six (6) cases, but on the whole with rather an
unfavourable result, as 3, or one-half, proved fatal.
Amputation below the knee-joint was performed twice, both cases
did well. Of the arm, 5 operations, all successful.
An interesting case of excision of the elbow-joint, under Dr.
Sylvester's care, unfortunately terminated fatally. Large collections
of the matter subsequently formed, necessitating the removal of the
arm, but the patient, an elderly female, died from exhaustion.
A case of excision of the superior maxilla by Dr. Bainbridge may
here be mentioned. It was undertaken in consequence of an osteo-
sarcomatous tumour, the size of a small orange, which had formed on
this bone, with deep attachments.
The subject of the case was a boy about 12 years of age, and to
whom chloroform was administered very carefully and in the usual
way. During the operation it was necessary to stop several times
owing to stertorous breathing and oppressed respiration.
145
Death from Chloroform.— The tumour had been taken away, and
the operator was proceeding to remove small portions which remained
deeply attached, when failure of the pulse and respiration were
suddenly observed. Artificial respiration, by Sylvester's method, was
immediately resorted to, but without success.
The cause of death is ascribed to shock, aided by the passage of
blood into the bronchi.
Dr. Beatty submits the photograph of a man on whom he operated
for the purpose of restoring a portion of the cheek, lost by ulceration.
Several of these rhinaplastic operations have been performed, and
with success. The two which occurred at Belgum were for the
restoration of the nose, cut off by jealous husbands, who, I trust, not
only received a proper punishment due to their barbarity, but on
return from prison would have the mortification of meeting their
wives looking, if possible, handsome than ever.
Vaccination has been carried on at the dispensaries attached to
civil hospitals, and will be separately treated of in my report on civil
dispensaries.
JAILS.
During my annual tour of inspection, I took the oportunity of
visiting and inspecting every jail in this division, and I have much
satisfaction in being able to state that the sanitary arrangements
carried out in these establishments were sound and judicious. I was
also much pleased with the healthy appearance of the convicts gene-
rally and their personal cleanliness.
The system of conservancy maintained was likewise very good,
circumnstances which have all tended no doubt to preserve the
health and lessen the death rate of our prison population.
In the Poona Division, including the Southern Maratha Circle,
there are ten criminal jails. The average aggregate strength of pri-
soners during the past year was 3,089, of these 2,602 passed through
the hospitals, 43 died, and there remained still under treatment on
the 1st April 69.
The ratio of admissions to hospital to strength was rather high, 90
per cent., but the death rate only 1.3. Although, as before stated, the
number of admissions to hospital, compared with the strength, is
somewhat large, yet, perhaps, it is not greater than might be ex-
pected, when we consider that the population of these jails is a float-
ing one, and that convicts admitted to hospital are not unfrequently
suffering from diseases contracted prior to their incarceration.
Again, convicts are sometimes transferred from a jail adjacent to
their native place, to one far remote and situated in a climate foreign
and inimical to their habits and constitution.
This circumstance has been forcibly brought to notice in Surgeon
Major Wiehe's report on the Yerowda Jail.
The great sickness and mortality, however, which occurred in that
jail in the years 1866-67, 1867-68, is in a great measure attributable
146
to the fact of the convicts having been confined in tents, during all
seasons of the year for two years, and to the neglect of sanitary
arrangements.
Fevers of a paroxysmal character contribute by far the largest
share to the total of admission to jail hospitals. Next in numerical
order are skin diseases; these two classes of disease form more than
one-half of the total number treated
From the former there were 1,102 admissions and 4 deaths. The
latter gives 571 and deaths 4.
Rheumatic affections, syphilitic or otherwise, were by no means
uncommon, and returns show from these causes 110 admissions and
1 death.
Diseases of the stomach and bowels have not been prevalent
during the year. The total treated is 277, with 9 deaths. From
diarrhœa 113 cases came under treament, 4 of which proved fatal.
Three of these latter took place in the Dharwar Jail. Dysentery
gives 79 treated and 3 deaths. Under the head of "other diseases"
of this class, of which colic bears the largest proportion, there
were 83 admissions, with a mortality of 2. One of these was rather
an interesting case of intus-susception of the bowels.
It has been remarked that diseases of the lungs were more or
less prevalent in Yerowda Jail during the months of December,
January, and February, and attributed to extreme diurnal ranges of
temperature existing in those months. The total admissions under
this head is 141, with 4 deaths; of these 79 cases occurred in the
above jail, 2 of which proved fatal.
The greatest proportionate mortality arose from causes over which
the Physician has little or no control. Under the head of old age and
debility 46 persons sought the shelter of the hospital, and out of
these 9 died. Six of the fatal cases took place at the Yerowda Jail,
and is commented on by Dr. Wiehe in his report. No doubt the
practice of transferring old and worn-out men to the Central Jail,
where the work is chiefly extramural and laborious, is reprehen-
sible, especially after the stringent orders that have been from time
to time issued on the subject.
Cholera has not visited the jails in an epidemic form during the
period under review, only two cases have occurred One fatal case
occurred. at Yerowda Jail, and the other took place at Dhulia.
This man recovered.
The jails in this division have been, as a rule, remarkably free
from epidemic diseases for some years past. A circumstance no
doubt in a great measure due to the strict system of conservancy
which at present obtains, and to the sound practical sanitary rules
laid down for the guidance of subordinate jail authorities.
In illustration of these remarks I need only point to the Dhulia
Jail in Khandesh. This jail, 10 years ago, was one proverbially un-
healthy. Its percentages of treated to strength ranged from 115 to
160, and the death rate of its prisoners from 3 to 6 per cent.
14 7
Since the year 1869,but taking out 1868, which was an unusually
sickly one, though with a small mortality, the treated to strength
varied from 109 to 90, and the mortality from 1 . 5 to 0. 7. In 1870
there was no death.
The report submitted from Dhulia Jail is worthy of a careful
perusal. It has evidently been drawn up with care and reflection,
and credit is due to Dr. Bainbridge for the same.
The report from Yerowda Jail is likewise to be commended. Dr.
Wiehe is an officer who has had great experience in the management
and superintendence of jails, and his remarks, whether affecting
discipline or medical treatment, all bear the stamp of practical sagacity.
POLICE HOSPITALS.
The average strength of the Police Force during the past year in
this division was 7,111, of these 2,448 have been under treatment,
and 17 died.
It has often been the subject of remark that this body of men, al-
though obliged to undergo at times great fatigue, and exposed, as
they are, to all vicissitudes of climate, is, as a rule, a remarkably
healthy one.
One reason no doubt for their immunity from disease is that the
men who compose this force are usually enlisted from that part of
the country in which they are called upon to serve, and seldom or
ever leave it.
When on my inspection tour I was able to visit and inspect
every police hospital in the division, and take this opportunity of
stating that I had every reason to be satisfied with the order and
neatness, and also of the manner in which the medical officers
conducted their duties.
At a few stations, such as Dharmgaon, a separate and complete
hospital exists, but in others the police are treated in the same ward
as the civil patients.
Whilst reporting favourably on the hospitals, I cannot say much
in favour of some of the police lines, such as at Belgaum and others.
The lines at Belgaum are very indifferent and have been repeatedly
reported on, but nothing is done. The districts in which the
police sepoy requires perhaps better shelter and more wholesome
dwellings is Kanara, but here, however, the men are worse off than
elsewhere.
I was particularly impressed with this fact when at Mondegode,
where, in a large delapidated house, capable of accommodating per-
haps a good-sized family, I found the whole detachment located
some 35 or 40 men. The place was portioned off into small spaces,
just sufficient for a man to lie down in, and the whole aspect of the
place bore more the appearance of a rabbit warren than a police
barrack.
As before stated, the proportion of sick to the total strength of
the Police Force is usually small.
During the past year it is only 34 . 4 percent., which is consider
- ably less than the rates exhibited for the native military and other