INDIAN RAILWAY MEDIC A L SERVICE ASSOCIATION, Special Mention: Pages from EASTERN RAILWAY History of East Indian S P E C I A L Medinews Railway….. P O I N T S O F INTEREST: VOLUME 1 ISSUE 001 NOVEMBER 2012

 Message from the General Manager, E Rly History of Eastern Railway  Forward by the Chief Patron, CMD/E Rly The East Indian Railway (EIR) Company by separating the Eastern  Introductory was incorporated in 1845 to connect East Railway's Danapur, Dhanbad and Mughals Editorial by with Delhi. The first train ran here arai divisions from it. Presently, it MD/BRSH between Howrah and Hooghly on 15 comprises four divisions. August 1854. The management of the East Indian Railway was taken over by the INSIDE THIS British Indian government on 1 Jan 1925. ISSUE: The Eastern Railway was formed on 14 April 1952 by amalgamating three lower divisions of the East Indian Railway: Brief History of 4 Howrah, Asansol and Danapur, the the Medical entire Nagpur Railway (BNR) and Department the division of the Services and 10 erstwhile Bengal Railway. On 1 Facilities in Aug 1955, some portions of BNR were B.R.Singh Hosp separated from Eastern Railway and became the South Eastern Railway. Three New Koilaghat, the present day Cardiac Bypass 13 more divisions: Dhanbad, Mughalsarai Headquarters of Medical Department, Surgery in E Eastern Railway Eastern Railway Railway and Malda were formed later. Till 30 September 2002 ER consisted seven The Story of 16 divisions. On 1 October 2002 a new zone, Hyperbaric the East Central Railway was carved out Oxygen

It is only a Fish 17 Bone! Focus on B. R Singh Hospital, Sealdah

Dying mother 19 Website: brsingh-irms.org.com saved B R Singh Hospital ,established in 1934 ,was named after Baba Ramrick Frequenty 20 Asked Singh, the first Indian Agent of the Questions: and acting GM of the B. R. Singh Hospital, E Rly, Sealdah. then Eastern Bengal Railway in Pre- Independence Era. certifying their fitness. . Later it was It was a Health Unit just besides the converted to a hospital with 36 beds. then to serve Now it is one of the best equipped the employees mostly of the Traffic Railway hospitals in India. Deptt. of Railways of Eastern Region

Dr.S.S. Rathaur, Chief Medical Director & Addl. Comm, SJAB, Eastern Railway & Chief Patron 14, Strand Road,!2th Floor, New Koilaghat Building, 700001

MESSAGE

The idea of publishing a quarterly "Medinews" for railway beneficiaries of Eastern Railways was in my mind for quite some time as I often noticed that most of our clients are not aware of the kind of medical facilities available in different hospitals of Eastern Railways. This quarterly publication will contain reports on various procedures being done and the infrastructural up gradation taking place in the medical field over this zone.

I am extremely happy to see this dream turning into a reality. The kind of moral support by our General Manager and the technical help by Controller of Stores in getting the issues printed in printing press of Eastern Railways are worth praise.

I hope the "Medinews" will find a place in the hearts of its readers and will fulfill the purpose of its publication.

I wish the Editorial board a grand success.

.

(Dr.S.S. Rathaur)

Editorial:

Dr.A.K.Singh,

Medical Director, BR Singh Hospital

Sealdah, Eastern Railway

Kolkata 700014

Adjudged as “Best Hospital" in Eastern Railway for 2010-11 and also a "Baby Friendly hospital",

this hospital was also a major contributor in winning of overall "Comprehensive Health care At the outset, I would like to thank everyone Shield" of Railway Board 2010-11. involved in initiating the concept of a B R Singh Hospital with 465 beds continues to newsletter –"Medinews" and for their provide high quality services- preventive, unrelenting encouragement and support in promotive and curative to nearly 6.8 lakh bringing out its inaugural issue. beneficiaries. This is one of the few tertiary New concepts and innovative techniques are care hospitals where specialists are available being discovered regularly. It is amazing how round the clock, something not seen in some of the Medical Department of Eastern Railway the top corporate hospitals. under the dynamic leadership of CMD-E Rly has In order to update the medical knowledge, kept pace with the latest developments in the Annual Scientific conferences and CME field of Medicine. This Newsletter is an attempt Programmes are being held every year since to highlight a few of the services the medical 1971 starting with a symposium on 'Recent profession has been providing to the Railway advances in Myocardial infarction' as the first beneficiaries relentlessly along with highlights topic delivered by Dr J C Banerjee of Kolkata. of some activities of the Medical department, practical advice on some common diseases and Let us work together for the success of this guidelines to healthy life etc. Newsletter to be published quarterly

The focus of the first issue of the Newsletter is on the Eastern Railway's zonal hospital, B R Singh Hospital

(Dr.A.K.Singh)

Pages from History of East Indian Railways Compiled by Dr S.S.Rathaur CMD-Eastern Railways

First Indian CMO of East India Railway: In 1945 he was appointed Professor of Islamic History and Culture in Calcutta University while retaining the chair of Public Health and Hygiene, which he had held since 1931.

He served as an adviser to the Simon Commission and was a member of the Bengal Legislative Council of which he Lt. Col. Dr. Hassan Suhrawardy, D.Sc., was Deputy President from 1923 to 1925. M.D., D.P.H., F.R.C.S. (1884 – 18 Sep 1946) As Chief Medical and Health Officer (1932-37) of the East Indian Railway he Life and family founded the railway's ambulance and Lt. Col. Dr. Hassan Suhrawardy was the nursing division. first Indian Chief Medical and Health Officer (1932-37) of the East Indian Knighthood

Railway & a noted Surgeon, politician It was while he was Vice-Chancellor and and public servant in India. Dean of the Faculty of Medicine that he Suhrawardy was married to Sahibzada received his knighthood immediately after Shahbanu Begum and had one son and he had saved the life of Sir Stanley one daughter; Hassan Masud Suhrawardy Jackson from an attempt by Bina Das, a (1903–1963) and Shaista Suhrawardy female student who attempted to shoot Ikramullah. He is the grandfather of Salma Jackson in the Senate House of Sobhan, Naz Ikramullah and Princess the University of Calcutta in February, Sarvath of Jordan. 1932.

Career His distinguished career in medicine and in the public service was crowned in 1939 Suhrawardy was the First Muslim Vice- by his appointment to succeed Sir Abdul Chancellor of Calcutta University (1930– Qadir as Adviser to the Secretary of State 1934) and the second Muslim from the for India. He retired from that post in 1944, sub-continent to become a Fellow of the Royal College of Surgeons of He was active in the Muslim League, England. renouncing his knighthood a month before his death in August 1946.

***************

First CMO-Bengal-Assam Railways Compiled by Dr.S.S. Rathaur CMD-Eastern Railways (From Wikipedia) Dr.Pares Chandra Datta University College, London for Born-1892 three months. He became FRCS, Died-1963 Edinburgh in 1920. Background and education After the completion of his studies, He was born in Silchar in Assam. he was commissioned in the Indian His family owned substantial tracts Medical Service as a Captain. After of land in Lakhai, presently in returning to India following a long , for several centuries. gap, he went as the Surgeon to His His father was a Senior Government Britannic Majesty's Consul Pleader who shifted to Silchar in the General in Meshed (now Meshad) in latter half of the 19th. Century, and Persia. Later he was also a Honorary eventually moved into Vakilpatty, a Surgeon (Eye, Ear and Throat) at the locality in Silchar. After studying in Campbell, Calcutta. the Government High School, He joined the Eastern Bengal Silchar, he joined Presidency Railways (EBR), in 1925 and was College, Calcutta. Later he joined appointed as District Medical Calcutta Medical College, ranking Officer of Kancharapara in first class second in the University, Bengal. In 1930 he travelled to before proceeding to England for Edinburgh on a 13-month study higher studies. leave, where he completed his Career Diploma in Public Health (DPH). He became a Member of the Royal After returning to the same post in College of Surgeons (MRCS), Kancharapara, he was transferred to London and in 1916 a Fellow of the Calcutta and appointed to the newly Royal College of Surgeons (FRCS), created post of District Medical London. He was also a Member of Officer, Sealdah in 1933. the Royal College of Physicians The EBR authorities had decided to (MRCP), London. In 1917 he was build their own self-contained appointed as House Surgeon at the hospital for the treatment of their Royal Infirmary in Oldham. Later in officers and staff. On January 1, the same year he was appointed as 1942 he was appointed as the First- the Second House Surgeon. He Chief Medical Officer of the newly joined the Royal Infirmary in 1918 constituted Bengal Assam Railway and was appointed as an Assistant and was given the responsibility of Demonstrator of Anatomy at running the new B.R. Singh

Memorial Hospital in Sealdah. As 1948 he joined the West Bengal a member of the newly constituted Government's Health Directorate as Bengal Assam Railway, he, like all Deputy Director (Supervision). He other officers and staff of the finally retired in 1953 after holding railways, was embodied in the various posts including the Director Defence of India Corps which came of Health Services WB. under army rules and regulations. He retired from the railways on 14 ******************* August 1947. After retirement, in **

LIST of CMOs and CMDs, New Koilaghat, Eastern Railway, Kolkata.

CMO: CMD: R.G. Griffith, 1893-1901 Dr.K.P.Pathak Nov 1991-Oct 1993 J Stewart Brooke 1901-1912 Dr.D.K.Das Oct 1993-Jan1999 E.W.N.Guinness 1912-1917 Dr. G. Hariharan Nov 1999-May 2000 Sir Harry Waters 1917-1924 Dr.N.Ghosh May 2000-Sep 2000 A.K.H.Pollock 1924-1931 Dr.A.Sen Oct 2000-Nov 2000 R.V.Clayton 1931-1932 Dr.G.Subramanium Nov 2000-Mar 2003 Sir H Suhrawardy 1932-1937 Dr.S.B.Sarkar Apr 2003-Apr 2003 Dr.S.E.R.Laborda 1937-1938 Dr.T.S.Wasnik Apr 2003-Mar 2004 Dr.S.C Chatterjee 1938-1940 Dr.S.B.Sarkar Apr 2004-Mar 2005 Dr.S.E.R.Laborda 1940-1946 Dr.S.C Das Apr 2005-Jan 2006 Dr.S.S.Kent 1946-1952 Dr. J Chattopadhyay Feb 06-Nov 06 Dr.P.N.Gokhale 1952-1954 Dr. A Buxy Nov 2006 ( one day) Dr.A.S.Arora 1954-1955 Dr.S.Ghosal Nov 2006-Jul 2007 Dr. N N Goyel 1955-1956 Dr. Nagarathnam Jul 2007-Feb 2008 Dr. A.L.Laksminarayan 1956-58 Dr. D.P Singh Mar 2008-Sep 2008 Dr.M.M Suri 1958-1961 Dr.N.Parashivamurthy Sep 08-Oct 10 Dr.S S Verma 1961-1967 Dr.S.S.Rathaur Oct 2010- Dr,J R Gaddeock 1967-1971 Dr.H S Chaudhuri May 71-Sep 71 Dr.J R Gaddeock Sep 1971-1973 Dr.S W Correa 1973-1977 Dr.J M Ghosh 1977-1986 Dr. M S Ghosh Feb 86-May 86 Dr. J.M.Ghosh May 86-May 86 Dr.M.S.Ghosh Jun 86-Aug 86 Dr.Y.P.Kohli Aug 86-Sep 91 Dr.D.K Das Oct 91-Nov 91

Superintendent (CMS) or Medical Eastern Railway Superintendent (MS)-in-charge in divisional, sub-divisional and Medical Department workshop hospitals.

The Medical Department, in keeping with pattern of Medical & Health services on Indian Railways provides comprehensive health care through a close-knit organization. The beneficiaries numbering 6.2 lakh include serving & retired railway employees and their dependents and certain other categories of staff such as contractor's labour, vendors, licensed porters etc.

The Indian Railway Medical Service (IRMS) is an organized Group 'A' service IRMS Doctors in a Health Camp of the Government of India. The officers of this service are responsible for providing comprehensive health care to the railway Doctor-Patient beneficiaries. Ratio in Eastern Organization Railways The cadre is headed by a Director General,

Railway Health Service (DG-RHS) of the rank of Secretary to the Government of Total Beneficiaries = 681708 India. Total Doctors = 346  At the Railway board level, the DG- RHS is assisted by Executive Doctor-patient ratio Director Health (General), Executive Director Health India- 1: 2000 (Planning), Director-Health & Family welfare, Director-Industrial E.Rly- 1:1970 Health and other officers.

 At the Zonal level, the medical services are headed by a Chief

Medical Director (CMD) who is the administrative head of the entire zone. The CMD is assisted by 4 Addl Chief Medical Directors (ACMD). At the divisional level, the department is headed by a Medical Director (MD) in zonal hospital & Chief Medical

7 Distribution of Doctors and beneficiaries

Division/ Retired IRMS Visiting WS Employee Employees Doctors CMP Residents Consultant G.Total SDAH 29987 21911 71 3 49 12 135 HWH 29540 10184 43 2 3 2 50 LLH 9305 4196 16 0 0 3 19 KPA 11219 5846 21 2 2 3 28 JMP 12741 2818 21 8 0 0 29 MLDT 8993 1865 17 3 0 2 22 HQ 6125 3 7 0 0 0 7 ASN 12356 4109 28 7 2 4 41 UDL 5560 2354 7 3 0 0 10 Metro 3900 982 4 1 0 0 5 Total 129726 54268 235 29 56 26 346 No. of beneficiaries 129726x4 54268X3 G.Total =518904 =162804 681708 Hospital Statistics- B. R. Singh Hospital-2011

Sanctioned Bed-Strength: 465

Average daily IPD admission: 43

Average daily OPD attendance: 1694

Total Indoor admissions: 15564 OPD Wing, BRSH/SDAH Bed Occupancy Ratio: 85%

Special Surgery: 599

Major Surgery: 3038

Minor Surgery: 3234

Total Surgery: 6871

Hospital deliveries: 640 Operation in progress, OT-2, BRSH/SDAH Sterilizations: 390

8 consisting of chest piece with two History of the sides, one of which is used for the respiratory system, the other for the Stethoscope: cardiovascular system. The Rappaport-Sprague was later made Dr. Subhashish Das, by Hewlett-Packard. The ACHD/BRSH/SDAH Rappaport-Sprague model stethoscope was heavy and short 18-24" (46–61 cm) with an antiquated appearance and was finally abandoned. o Several other minor refinements were made to stethoscopes, until in the early 1960's Dr. David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics. o The stethoscope was invented in o In 1999, Richard Deslauriers France in 1816 by René Laennec at patented the first external noise the Necker-Enfants Malades reducing stethoscope, the DRG Hospital, Paris. It consisted of a Puretone. It featured two parallel wooden tube and was monaural. His lumens containing two steel coils device was similar to the common which dissipated infiltrating noise ear trumpet. as inaudible heat energy. o In 1840, Golding Bird described it with a single earpiece. o In 1851, Irish physician Arthur Leared invented a binaural stethoscope. o In 1852 George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since.

Two types of Stethoscope are used nowadays, the common and widely used Acoustic type and the Electronic type.

o Rappaport and Sprague designed a new stethoscope in the 1940's

9 Medical Services & facilities in B.R.Singh Hospital-Sealdah BR Singh hospital is 465 bedded tertiary care Super-Speciality hospital and zonal hospital of Eastern Railways established in 1934. It has specialist doctors in all the major disciplines to serve the Railway beneficiaries BR Singh hospital is the second such hospital to have advanced Cardiac The Emergency department runs centre in Indian Railways and the only 24X7. Well equipped casualty hospital to have modern Burn unit with department run by efficient and Hyperbaric Oxygen therapy in Eastern senior medical professionals, is India & IR capable of handling all sorts of OPD and Special Clinics in various emergencies. Specialist doctors are specialities, separate OPD facility for available round the clock in all the retired employees and their dependents major disciplines along with house are run daily on week days from 9 am surgeons and post graduate to 4:30 pm. trainees of the respective Regular classes, case discussions, departments. journal clubs and CME programmes are held in each discipline for house Health Units under Sealdah surgeons & DNB students. Division: 14 A library with recent edition of books Ranaghat main, Ranaghat and journals along with high speed (CRE), , Krishnapur, internet connection is available wherein Bongaon, Barasat, Sonarpur, live classes are conducted by IGNOU Chitpur, Dakhindari, for DNB students via satellite in the library. Regular CME programme for all Kamardanga, Narkeldanga, doctors are held once in a Gholsapur, Fairlie Place & week Koilaghat.

Lock Up Dispensaries: 7 Beldanga, Krishnanagar, Shantipur, Barrackpur, BudgeBudge, Judges Court & New Alipur. Health Fair,

10 SPECIAL CLINICS: ADMINISTRATIVE At B R Singh Hospital MEETINGS &

 Cardiology Mon-Fri 2 PM INITIATIVES:  Diabetic Thurs 2 PM  Endocrinology Wed 2 PM To maintain a high standard of  Neurology Mon Wed 2 PM Medical Services the following  Hepatology Thurs 2 PM administrative initiatives have  Rheumatology Wed 2 PM been taken:  Nephrology Mon &Wed 2 PM  Pulmonology Tue &Thu 2 PM • Hospital Management Meeting:  Infertility Wed 2PM once/month  Cancer Screening Mon 2 PM • Internal Audit Meeting: once/week  Oncology Tues 2 PM • Hospital Visiting Committee Meeting:  HRT Thu 2 PM twice/year  Urology Wed 9 AM • Hosp Infection Control committee  Pain clinic Mon 3 PM meeting: once/month  Thoracic Surg. Wed 2 PM • Review of Medicine expenditure:  Movem't Disorder Thur 11AM once/week • Review of Budget Expenditure: once/month • Review of PWP and M&P : once/month • Coordination Meeting with DRM & BO's: as & when required • In-service Training of Group C & Group D staff

Baby Show, BRSH Auditorium.

Above: Centrally AC Ward, BRSH/SDAH

Left: Executive Health Check-up for PHODS, Belvedere Park Club, Feb 2012

11 RECENT FACILITIES COMING INNOVATIONS in UP SHORTLY IN BRSH: B R Singh Hospital  G+5 Super Speciality Building with Modern Seamless OT Complex • 6 bedded Emergency Room with all  CT Scan and MRI Modern emergency equipments  3rd Lift in the OPD commissioned on 10th Aug 2011  New 3 Storey Central Medical Stores • Multipurpose Health Drive Camps  Provision of dormitory for patient's Total of 64 Health camps held all attendants over the Sealdah Division & 2570  Revamping of centralized Medical beneficiaries examined gas Pipeline & Manifold System • Executive Health Check-up for  Installation of Liquid Medical Officers Oxygen Plant • Total of 25 Blood Donation camps organized & 925 units of blood collected • Healthy Baby shows once a year Indoor Patient Feedback Form • School Health Programmes • Involvement of ERWWO and Scouts and Guides in health activities • AIDS Awareness Programme • Hospital Cornea Retrieval Programme (HCRP) with Disha Eye hospital. >100 eye donations performed by Railway patients to Disha Eye Hospital • Opening of Counseling Centre at BRSH/SDAH on 09/5/12 for HIV AIDS, De-addiction, Family Planning & Adolescent Sexual Health (Conducted by Family Planning Association of India, a premier NGO) • Modified Early Warning Scoring (MEW Score) introduced in Casualty and all critical care units for Serious Indoor patients for better Triage and treatment from Apr 2011 • Feed back form introduced for Indoor Patients from 15th Aug 2011

• Diagnostic Centre at Panchanantala started on 14th.Jan 2011 as desired by the MR

12 said Dr S.S. Rathaur, Chief Medical Cardiac Bypass Director-Eastern Railway.

Surgery in B R Singh Cardiac surgery in railway hospitals first Hospital started in the 1970s at Perambur. It took nearly 40 years for the railways, which has over 13 lakh employees, to set up such Dr.Munna Das facilities at another hospital. While plans DMO/Card/BRSH/SDAH were made to conduct cardiac surgeries in

Mumbai (Western Railway) and Delhi An Advanced cardiac Seamless CTVS OT (Northern Railway), the hospital in Kolkata in B.R.Singh Hospital was inaugurated by took the lead. then Honorable Minister of Railways Ms SOME OF FIRSTS IN BR SINGH Mamata Banerjee on 30th.Jan'2011. The HOSPITAL: centre is headed by Dr Alok Mazumdar with able assistance of team comprising of o First Cardiac Resynchronization Cardiothoracic Surgeon Dr Therapy done on 30th May2011. H.K.DasMahapatra & Dr Abhijit Santra, o First coronary angiography done on Cardiologists Dr Basudeb Bhattacharya & 1st June 2011. Dr Munna Das, Cardiac Anaesthesiologist o First Automated Implantable Dr Chayan Bhattacharya along with five Cardiac Defibrillator implanted on 23rd senior residents, House physicians and June 2011 dedicated forty nurses & other paramedics o First Balloon Mitral Valvuloplasty for24 hrs manning of the ICCU, CTVS ITU done on 6th July 2011. & Semi ICCU. The unit became fully o First diagnostic & therapeutic operational in April 2011. Electrophysiological study done on 30th July 2011. B R Singh Hospital Sealdah is now the o First coronary angioplasty done on second railway hospital in the country to 21st November 2011 conduct cardiac surgeries after. It also o First Coronary Bypass Surgery done became the first hospital in Kolkata to on 17th May, 2012. conduct cardiac surgery in a state-of-the-art o First Atrial Septal Defect (Hole in modular operation theatre. According to the heart) repaired on 6th. Sept 2012 doctors, there is only one other hospital (private) in the city that has a modular OT, but it is not used for cardiac surgeries.

"A modular OT has stainless steel walls that have no sharp bends or joints. This allows a bacteria-free atmosphere and the risks of infection are reduced considerably. There is laminar flow of air through a filter and cameras are fitted on the lights above the operating table to record the procedure. It costs between Rs 60 to 75 lakh just to set up the OT. The equipment cost is extra," Coronary Angiography in progress

13 In-house Non-Surgical Number of procedures done till date from inception of this centre: Treatment of Carpal

• Coronary Angiography : 340 Tunnel Syndrome

• PTCA/STENTING : 119 Carpal tunnel syndrome (CTS) is an • B M V : 11 entrapment median neuropathy, causing paresthesia, pain, numbness, and other • Pacemaker Implant : 368 symptoms in the distribution of the median • C R T Implant : 4 nerve due to its compression at the wrist in the carpal tunnel. The main symptom of • I C D Implant : 3 CTS is intermittent numbness of the thumb, • Peripherals : 14 index, middle and radial half of the ring • E P S/ R F A : 34 finger. The numbness often occurs at night; with the hypothesis that the wrists are held • C A B G : 11 flexed during sleep Pain in carpal tunnel syndrome is primarily so intense that it

wakes one from sleep. The only Dr.H.K.Das Mahapatra, a reputed Cardio- thoracic Surgeon of Kolkata and his team scientifically established disease modifying of doctors along with Dr.Chayan treatment is surgery to cut the transverse Bhattacharjee, DMO/Anaes /BRSH carpal ligament. conducted the first Coronary Bypass Surgery on 17th.May'12 in a case of Triple At B R Singh Hospital, Dr Sarbani Vessel Disease of Shri Khudiram Maity, 56 Sengupta ACHD/ Physician and yrs, male, Com Clk and he was discharged Rheumatologist is injecting Long-acting subsequently in a stable condition. Triamcinolone in patients of Carpal Tunnel Syndrome which is a unique recommended treatment of the said condition instead of surgery. She has treated 86 patients with this non-surgical method with great success. It is highly effective treatment but very few centres have this expertise in India. She is also doing regular therapeutic and diagnostic joint aspiration. She has also started a SLE (Systemic Lupus Erythomatosus) clinic in BRSH for better management of SLE patients which is Coronary Bypass Surgery in progress multisystem disorder

14 discovered, through an elegant experiment, that botulinum toxin blocks neuromuscular transmission through decreased acetylcholine release. In the late 1960s Alan Scott, M.D., a San Francisco ophthalmologist, and Edward Schantz were the first to work on a standardized botulinum toxin preparation for therapeutic purposes for eye muscle disorders. Since then BOTOX has been used for various therapeutic purposes. Dr Bhaskar Ghosh ACHD/Neurology runs Botulinum Toxin injection clinic and there are 173 patients who get Botulinum Dr Sarbani Sengupta ACHD-Physician & Toxin injection at a regular interval. This Rheumatologist injecting Long-acting is a highly specialized technique. It is the Triamcinolone in a patient of Carpal only treatment of many medical conditions Tunnel Syndrome associated with over activity and abnormal contractions of muscles and also stiffness in

cerebral palsy and after stroke. It is also BOTOX does MAGIC injected in drooling saliva, chronic headache (Migraine). Only few Movement Disorder specialists inject this drug in India How a DEADLY TOXIN that and this form of treatment is available only can kill a person is used to cure in Super specialty teaching institutes. symptoms…. BRSH is one of the only few centres in India where this drug is injected in all indications by a single neurologist and BRSH is pioneer in India in this field. Dr Ghosh has published several papers on use of this drug in various disorders and trained several neurologists how to inject the drug. Dr Ghosh also runs a Movement Disorders Clinic in BRSH, which is the only clinic in Indian Railways. Most of the patients attending the clinic are difficult to control Parkinson‟s disease and Essential Tremor. Dr Ghosh also runs an Epilepsy clinic for better management of Epilepsy Patients.

In 1897, Emile van Ermengem found that ********* the producer of the botulin toxin was a bacterium, which he named Clostridium botulinum. In 1928, P. Tessmer Snipe and Hermann Sommer for the first time purified the toxin. In 1949, Arnold Burgen's group

15  Venous /arterial insufficiency. The Story of  Pressure ulcers Hyperbaric Oxygen  Tubercular infections.  Infections of bone in Indian Railways:  Gas gangrene. A new approach to treat Non-  Infection of soft tissue of limb with healing Ulcers. antibiotic resistant strains. and many more Dr Chayan Bhattacharyya,

DMO-Anaesthesia (In charge HBOT) /-

How Hyper baric Oxygen Helps?

In almost all the cases cause of non-healing

is reduced supply of blood and oxygen to

the tissue involved. In pressurized A Four Bedded Modern Burn Unit was chambers when we provide oxygen at high announced in the Railway Budget for pressure of 2 to 2 .5 atmospheres absolute year 2009-10 by the then Hon‟ble (ATA), the oxygen dissolved in plasma Railway Minister, Ms.Mamata Banerjee reaches each & every cell in the body and

initiates neovascularization & healing. Railway Board had sanctioned the 4

bedded Modern Burn Unit with provisions for Hyperbaric Oxygen Therapy vide Pink Book 567 in the year 2009-10 with a cost of Rs.4,24,00,000

Non Healing ulcers are very nagging problems both for patients and the treating doctors. Often they are associated with foul BEFORE HBOT smelling discharge, disfigurement leading to mental depression of the sufferer and care givers. Patients often get distanced themselves from society and even from their family members. Common Causes: Non-healing ulcers are most commonly associated with

 Diabetes mellitus. AFTER 10 SITTING OF HBOT

16

Is HBOT is associated with risk? Hoarseness of Voice: No, it is not associated with any major risk, but sometimes patient may feel pain in the An unusual case ears & may have fear of closed space(claustrophobia). For that we do pre Dr.Debasish Guha procedural ENT check up, Eye check up Sr.DMO (SG)/ENT and checking up of vital parameters. B.R.Singh Hospital

What are other conditions in which A female aged around 52 years, and HBOT can be used ? housewife by Profession, presented with a  Acute Sensory Neural Hearing loss. history of hoarseness of voice for last one month. She was a known case of Diabetes  Carbon monoxide poisoning mellitus and Hypertension with  Cyanide poisoning Hypothyroidism. She was on Oral  Cerebral Palsy. Hypoglycemic, Antihypertensive and  Radiation Necrosis. Thyroxin therapy.  Osteomyelitis (infection of bone) She didn‟t give any definite history of  Cerebral Stroke. sudden onset of hoarseness of voice. On Indirect Laryngoscopy,  Soft tissue infections & Leukokeratosis was noted. Fibre optic Gas gangrene etc Laryngoscopy was done, and a nodular swelling at the junction of anterior 1/3rd and Conclusion: Post 2/3rd of both Vocal cords (Lt>Rt) with HBOT, a new therapy in railways will Leukokeratosis Right cord was obtained. benefit lots of patients without any Both cords were found mobile. associated increased risk. As the patient was initially reluctant to ******* undergo Microlaryngoscopy or any sort of Surgery, she was at first treated with Oral

Prednisolone, with careful monitoring of Blood Sugar level, along with advice for Voice rest, etc. Repeat test for Serum TSH was done to detect the latest level. Since the symptoms didn‟t subside at all, the patient and her husband were counseled to give consent for Microlaryngoscopy under GA. Per operatively, when the Vocal cords were visualized under Microscope using 400 mm lens, the Leukokeratotic lesion that was diagnosed clinically and by Fibre optic Laryngoscopy, was found to be nothing but a partially impregnated “Fish Bone” in the Right Vocal cord near the Anterior Commissure which was removed.. No Vocal cord nodules were seen.

17 Within a few days Post operatively, the Voice of the Patient returned to normal. Quinine at Rescue Peroperative Pictures of removal of the Fish Bone were shown to convince the Dr. B. Ghatak, ACMS/ASN patient and her relatives regarding the cause of hoarseness of voice in this particular Quinine was the first effective treatment for case. malaria caused by Plasmodium falciparum, appearing in therapeutics in the 17th Pre operative Fibre Optic Laryngoscopic century. It was first used to treat malaria in Pictures: Rome in 1631. The form of quinine most effective in treating malaria was found by Charles Marie de La Condamine in 1737. Quinine was isolated and named in 1820 by French researchers Pierre Joseph Pelletier and Joseph Bienaimé Caventou. The name was derived from the original Quechua (Inca) word for the cinchona tree bark. It Per-operative Pictures (taken by Mobile remained the antimalarial drug of choice Phone from T.V.Monitor): until the 1940s, when other drugs with less unpleasant side effects replaced it. Since then, many effective antimalarials have been introduced, although quinine is still used to treat the disease. One elderly patient was admitted in June, 2011 in the Divisional Railway Hospital, Asansol in unconscious state. He had history of fever for 7 days for which he took medicines from Private doctors where it was provisionally diagnosed as a case of ?? liver abscess, Initially antibiotic ceftriaxone was started. As patient‟s level of consciousness deteriorated initially provisional diagnosis Though, in the literature, „ Fish Bone of cerebrovascular disease / metabolic Larynx‟ is an emergency, and it may encephalopathy was made. Further compromise the airway and the patient has investigations revealed .blood pressure of extreme discomfort, but fortunately, in this 120/90 mm of Hg.and peripheral blood case the patient had no such emergency, smear done showed MP P.falciparum. and her only complaint was hoarseness of Optimal test for malaria was positive, blood voice. urea was 118mg%, and serum creatinine was 2.62 mg%. CT scan done shows evidence of Gliotic area in left frontal region, & Periventricular hypo density suggestive of ischaemic demyelination.. Chloroquine and Artemether were started & continued for 24 hours..

18 Artemether failed to reduce fever and moreover the level of consciousness A Precious Life deteriorated gradually.

Without delay injection Quinine Saved: dihydrochloride I.V. was started and with Dying Mother each doses of I.V. QUNINE the patient’s united with her level of consciousness improved rapidly, without any side effects. Patient was also newborn child getting IV Epsolin along with adequate IV Dr.C S Lee, ACHD/Gyn/BRSH/SDAH fluids and antibiotics. Other causes of coma Dr S Das ACHD/Rad/BRSH/SDAH were excluded as renal function also rapidly returned to normal. 2 years post Caesarian section patient was admitted on 23/7/12 at 2:30 am Diagnosis –Cerebral malaria, acute renal with LUCS done on 22/07/12 at 11am. She failure, anemia. was referred from a private hospital in a Cerebral malaria carries a mortality of state of shock after a bout of vomiting. At around 30 to 50 %. the time of admission she was having However after 15 days of hospital stay tachycardia, low BP and was shifted to ICU patient was discharged in a stable and urgently and managed conservatively. Hb% ambulatory condition. There was no was 7 gm% Urgent bedside USG done neurodeficit at the time of discharge. showed collection in peritoneal cavity and in pelvis on right side with clots found just Patient shortly after admission anterior to uterus near midline (? Rectus sheath hematoma). As gradually her condition deteriorated, she was taken for emergency laparotomy. On laparotomy, huge amount of intra- peritoneal bleeding and clots were found which were removed from above and below the the rectus sheath. There was no active bleeding. Intra abdominal drain was inserted and a corrugated drain was put under rectus After recovery sheath.

Patient was managed for 3 days in ICU with occasional INR, LFT and routine blood tests during which she was transfused 5 units of blood and 4 units of FFP. There was no PPH. Patient was shifted to maternity ward and was managed conservatively. Patient‟s condition improved gradually and drains were removed after 10 days. Patient was discharged with no complaints in a healthy state on 07/08/12. ***********

19 or causing you to “wet” yourself, you From the Doctor’s should talk to your doctor to find out the cause.

Desk: What are the different types of cough? Cough may be of three types, depending on how long the cough has lasts: acute (cough less than 3 weeks), sub-acute (cough 3-8 weeks), or chronic (cough longer than 8 weeks). What is the most common cause of acute cough? The main cause of acute cough is common

cold. A cough following a common cold

FREQUENTLY may last as long as two or three weeks.

ASKED QUESTIONS What are the causes for cough lasting 3-8

ABOUT COUGH weeks?

Dr Angira Dasgupta A cough that lasts for 3-8 weeks is often

Sr.DMO/BRSH/SDAH caused by a cold or other lung infection that

lasts longer than normal for example

tuberculosis. A cough that lasts 3-8 weeks Why do people cough? may go away by itself but it may also need Coughing has a purpose. It is the way our treatment. body keeps away unwanted stuff from When do I seek medical advice? getting into your lungs. Coughing helps You should seek medical advice if 1) you clear extra mucus from your airways (small are coughing up blood 2) you are short of tubes in your lungs). It is therefore a breath 3) you are losing weight 4) you are manifestation of various diseases. coughing up coloured mucus 5) your cough

has changed over time 6) you have a fever What are the common causes for cough? 7)you are a current or ex-smoker Any condition that causes extra mucus like What are the causes for a chronic (8 smoking, a cold, a lung infection or a lung weeks or longer) cough? disease, like asthma or COPD can cause A chronic cough is not a disease in itself. It cough. is usually a sign of an underlying disease. Cough may also be caused by a condition Some of the most common causes of not related to your lungs, such as heartburn, chronic cough include: post-nasal drip some medications, or throat irritants (for syndrome, (when mucus drips down your example, dust, pollution, chemicals in your throat from the back of your nose), workplace or home). something at home or work that is irritating How do I know if my cough is normal or your nose or airway, allergies, asthma, not? smoking, for chronic obstructive It is normal to cough occasionally. pulmonary disease or COPD, acid reflux Coughing with a cold, flu or allergies is (sometimes called gastro-esophageal reflux normal. disease or GERD), some high blood Coughing is not normal if there is pressure medications or a combination of associated blood or thick mucus. If your these causes. Tuberculosis is a common cough makes you very tired, or light- cause for chronic cough in our country. headed, or causing chest or stomach pain,

20 I quit smoking; but why do I still have a cough? Medical Equipment Smokers and former smokers are at risk of developing COPD. COPD is short for Watch: chronic obstructive pulmonary disease – the new name for emphysema and chronic Roche MODULAR P800 ANALYTICS bronchitis. A cough that has lasted a long SWA time is a symptom of COPD. A simple breathing test called spirometry is used to diagnose COPD. I have asthma; why do I still cough? If you are coughing a lot, it could be a sign that your asthma is not as well controlled as it could be. Can I just take cough medicine to make my cough go away? Unless your doctor recommends it, don‟t use over-the-counter cough medicine. They won‟t treat your cough; they‟ll just hide the symptoms. Once your doctor determines What? what is causing the cough with the help of Equipment Used for automated tests such as (spirometry, chest X-ray, Biochemistry analysis, Blood sputum tests) he or she can treat the cause. Sugar, LFT, Lipid profile etc Can you have more than one cause of cough? Where?

Yes, you can have more than one cause of Pathology department, B R cough. In fact you can have two or three Singh Hospital. causes at the same time. This is why it is Since When? important to work with your doctor to find 6th.Dec, 2011 the causes Output: 800 test/hour

BR Singh Hospital is proud to announce the launch of this system in our Pathology Laboratory bringing uncompromised quality and world-class diagnostic testing to the Eastern Railways fraternity. The Roche Modular P800 is the star of the modular analytics Serum Work Area family. P800 is a State-of –the -art equipment and offers unique features in terms of flexibility where the system can be tailored to suit the customer requirement, thereby reducing the sample volume requirements with the

21 possibility of combining the Clinical chemistry and Immunology testing onto Did You Know? a single system. Hospital Waste The system has an exhaustive menu of more than 160 parameters providing Management at comprehensive testing on a single platform. The enhanced Intelligent B R Singh Hospital. Process Management (e.IPM) prioritizes sample movement thereby optimizing sample turnaround time. The A variety of waste material is produced Super STAT mode on the modular daily in the wards, OT and OPD which is ensures top priority for critically scientifically disposed. Each hospital emergency samples thereby relieving should develop a proper system for lab personnel follow up on STAT collection, storage and disposal of hospital sample processing. waste (Railway Boards letter No.96/11/ With a throughput of 800 tests per hour 2-2/1 dated 23.4.97) the segregation of the system ensures a smooth workflow. hospital waste at source in different Modularity ensures the flexibility of categories, hazardous and nonhazardous increasing the throughput by changing and collection in readily identifiable colour the setup on-site with up to 27 different coded containers is meticulously followed. system combinations. .

Installed on Reagent Rental Basis System: Capacity: 800 analysis /hour, ie, 1600 tests in 2 hours, as compared to previously 200 tests/hour and even before that, semi automatic at 40 tests/hour.

At B R Singh Hospital, not only the color code is followed for waste disposal, colored baskets (blue and yellow) are provided in each ward instead of colored plastics used in most of the Govt and Corporate Hospitals.

22 Colour Type of Containers Waste Coding Category Yellow Plastic bag 1,2,3,6 Human Anatomical Waste (human tissues, organs, body parts) Animal Waste & tissues, organs, Body parts carcasses, bleeding parts, fluid, blood and experimental animals .Microbiology & Biotechnology waste (wastes from laboratory cultures, stocks) Red Disinfected Container/ 3,6,7 Solid Waste (Items contaminated with Plastic bag blood and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood) Blue/ Plastic bag/puncture proof 4,7 Solid Waste (waste generated from White container disposable items other than the waste translucent sharps such as tubing, catheters, intravenous sets etc.) Black Plastic bag 5,9,10 Discarded Medicines and Cytotoxic drugs (Solid) Incineration Ash Chemical Waste

Forth-coming The Board of Editors,

Programme ahead.. Comprising of

o 42nd Annual Scientific Seminar &  Dr. Munna Das, DMO/BRSH CM E Programme & All India  Dr.C. Bhattacharya, DMO/BRSH Annal Conference of Indian  Dr. A Dasgupta, Sr.DMO/BRSH Railway Ophthalmic Association---  Dr. D Guha, Sr DMO/BRSH 7th,8th and 9th December,2012,  Dr. Subhashish Das, BRSH/SDAH ACHD/BRSH

IN the NEXT ISSUE: Sincerely thank: o Know your Hospital: Focus on  Dr. Shyam Sunder, CS1/BRSH Divisional Hospital, Howrah  Dr. Rupa Mitra, MS/SDAH o Alternative Employment on Medical Grounds  Dr.A Dutta,ACHD/Admn/BRSH o From the Doctor‟s Desk:  Dr. G Dasgupta, ACHD/BRSH Hyperacidity and Dyspepsia  Dr. B.N Dhar, ACHD/BRSH o Diet Watch  Dr. A Sett, Dy CMD/KKK o Interesting Orthopedic Cases o Medical Equipment : DR For their efforts in bringing out this o And many more… magazine

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