September, 1890
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THE .4 usIralian Medical yournal SEPTEMBER 15, 1890. Irtitits. REPORT ON INDIAN HOSPITALS. (Continued.) By Wm. GARDNER, M.D. C.M. Glas. Lecturer on Surgery, Adelaide University ; Sen. Surgeon to Adelaide Hospital. GENERAL CONCLUSIONS. Construction of Hospitals. Most of the hospitals I visited are well built and well situated. 'The wards are lofty and well ventilated, and in many of them the use of tiles and cement is replacing the wooden floors and plaster of the older buildings, with corresponding advantage to the patients and the general appearance. In all the army hospitals, and in some of the civil hospitals, punkahs and mosquito curtains are supplied, which in most parts of India, are absolutely necessary to comfort. We, in Australia, might well follow this example during the summer months. As far as my limited observation goes, sanitary matters are more carefully attended to in the army, than in the civil hospitals ; but allowance must be made for the greater assistance and the smaller amount of actual hospital work done in the former. The ideal hospital for all but the large cities of India is, as pointed out to me by Surgeon-Major Hendley of Jeypore, a central administration block, with cottage hospitals scattered about the grounds, each with a nurse in charge, so that caste prejudices may be respected as far as possible. Statistics. I cannot too highly eulogize the annual returns of the hospitals, issued by the surgeons-general of the various presidencies. They are all drawn up on one plan, and the results can thus be very readily compared. Similar returns should also be forthcoming from all hospitals and dispensaries in connection with the Dufferin Fund, and until this be done, it will be impossible to form any conception of the value of their work, as distinguished from its amount. VoL. XII. No. 9. BB 386 Australian Medical Journal. SEPT. 15, 1890 Infectious or Contagious Diseases. Leprogy, Small - pox. Cholera Central Provinces 720 96 237 Madras Presidency 4,367 250 15,783. Hyderabad Assigned Districts 284 8 92 Bombay Presidency 1,656 741 7,833 Bengal Presidency 2,787 50 4,839 Punjaub 952 339 3,033 10,766 1,484 31,817 Extracted from annual returns. With such large numbers returned under these headings in one year, it is abundantly evident that infectious hospitals are urgently required in the large towns, where diseases, such as cholera and small-pox, can be carefully treated in large numbers, and an accurate study made of both diseases. We might thus look hopefully forward to the time when both diseases would be at least reduced to a minimum. In saying this, I have not forgotten that excellent work of this kind has been done by Indian practitioners, but much remains to be accomplished. The 10,766 cases of leprosy do not, as all Indian practitioners admit, at all adequately represent the number of the population affected, for many cases do not apply for hospital relief. Very little provision is made for their treatment, and one of the burning questions of the day for the Government of India is how to segregate, in comfortable quarters, such vast numbers and prevent them from mixing at all with the general population. The experi- ment, if tried at all, must be done legally, and the retirement must be compulsory. The medical men and nurses who are sent to the settlement must retire there for life, as in the case of the lamented Father Damien. Will medical men and nurses (such as Sister Gertrude) be found coming foward ? I think so. The scheme is vast, and the difficulties in the way of its being carried out are great ; but the results to be expected are such as to stimulate the efforts of every well-wisher to India. Cataract Operations and Spectacles. The following is the list of Cataract operations in India for 1888 :— Bengal Presidency 582 Bombay 283 Punjaub 2,660 Hyderabad Assigned Districts 6 Madras Presidency 744 Central Provinces 114 4,389 SEPT. 15, 1890 Report on Indian Hospitals. 387 Surgeon-General Pinkerton, in his report on the civil hospitals and dispensaries of the Bombay Presidency draws attention to the urgent need that exists for some provision to enable poor persons, who have been operated on for cataract, to obtain spectacles. When the number of cataract operations is considered, it will be at once seen how urgently some such provision is needed. Nursing. Necessarily, from their enormous requirements in this respect, the nursing in India is, as far as one could judge from limited observation, behind that standard which is attained in other parts of the Empire. Every effort, however, is being put forth to obtain well-trained nurses from English hospitals, so that they may train up native women who will, in time, do the greater part of the work. Evidence collected from civil surgeons in various parts of India goes to show that native women are capable of being trained so as to become highly competent nurses. They are very even- tempered, and possess the delicate touch in the highest possible degree. I have been informed that they are wanting in self- reliance ; but I believe that even this invaluable requisite in a nurse will be shown to be acquired by a higher standard of training. It is not to be expected that there could be self-reliance without complete training. Were it so, I should feel disposed to apply another term to this faculty. To what extent have the sexes in India availed themselves of the Hospitals ? The object of this question is to show in the answer the general effect of the " Purdah " system on the attendance of the female sex at the hospitals. In explanation, I may state that nearly all the women belonging to the higher classes in India are kept behind the " Purdah " or curtain, i.e., they are not allowed to be seen by any man except their husbands. The great aim then of every man who becomes rich is to " Purdah " his wives. Many women who apply at the hospitals, as I was informed, pretend to be "Purdah" women, and are really not so. Their object is to make themselves appear higher in the social scale than they really are, and it is this fact which vitiates all calculations as to how far treatment by female medical aid has reached the women of this class. The objection to their treatment by men, comes from the male side, and not from the women themselves, who would, I am told, gladly submit to anything necessary for their good. I know of one BB 2 388 Australian Medical Journal. SEPT. 15, 1890 Rajah, who has had a liberal education in Scotland, who takes his wife about with him wherever he goes, and it may be that this may become general as education spreads its influence over the people. On the other hand, I have heard objections made to female medical aid being brought to the Zenana, that women would be much more likely to assist in the plots which are continually going on where women are collected together and have no occupation. Personally, I think this objection will fall to the ground if the central committee of the Dufferin Fund select only well qualified and high-class women, they will then exert their influence only for good. I am, however, decidedly of opinion that the influence of a higher education will do more than anything else to break down the " Purdah " system, and possibly also to abolish polygamy. Leaving children out of the question, and considering the in-patients in the hospitals of the various presidencies only, there was a daily average in— Bombay Presidency of 1429 men to 334 women. Madras Presidency of ••• 1302 623 Hyderabad Assigned Districts of 71 4 fl Punjaub of •• • 1169 244 1) Bengal Presidency of 874 3, 237 Central Provinces of 269 /9 59 or 3.4 men to every woman. This at least proves that the women of the lower orders avail themselves of hospital treatment in very fair proportion to the number of men, and there is not such a great disparity as might have been expected under the existing conditions. Differences between Indian and Australian Surgery. An essential difference between the natives of India and Australia is, that though they suffer more from shock, yet traumatic fever is infinitely less marked amongst them, which is probably due to their diet being principally a vegetable one, and to the absence of alcoholic stimulants. One of the most noticeable features, viz., the delay in having operations for deformity performed, is due to the reluctance of the natives to submit to a surgical operation, unless life is rendered a burden to them by reason of pain. To take an illustrative example : In 1888, Surgeon-Major Hendley operated successfully on five adults for hare-lip, an operation which, in European countries, is done as soon as possible 389 SEPT. 15, 1890 Report on Indian Hospitals. after birth. This shows, however, that gradually the native mind is becoming educated up to the beneficial results to be derived from good surgery. Abdominal operations for the same reason are rarely done, with the exception of ovariotomy, of which in 1888, there were only twenty-one performed, the remainder would only permit the tumour to be tapped. As the disease is very frequent, there is a great future for this operation in India. So far, Dr. Harvey, of Calcutta (Eden Hospital), has performed the greatest number done by any one operator. Operations on the kidney (one of the causes for which, viz.