INFOKARA RESEARCH ISSN NO: 1021-9056 Travancore Government and Public Health 1. Sindhu Thomas, Ph.D. Scholar, Dept. of History, Bharathidasan University, Tiruchirappalli, Tamil Nadu. 2. Dr. Y. Srinivasa Rao, Assistant Professor, Department of History, Bharathidasan University, Tiruchirappalli, Tamil Nadu. Abstract In independent India, health services have definitely made remarkable progress. As a result, the average expectation of life span has increased more them three times. Travancore can be said to have made the transition from a society with high growth rate, high death rate and high infant mortality rate. From 19th century onwards the changes took place with moderate population growth rate, low crude death rate and relatively low infant mortality. There are many socio-economic conditions unique to Travancore, which have been postulated to this health model possible. This especially is the high female literacy, socio-cultural re- awakening in the nineteenth century, introduction of western system of medicine, the advent of missionaries and the patronization of the kings of erstwhile Travancore princely state. So the Travancore state contributed for the partial success of public health efforts in India as a whole and made Kerala a unique model. This paper is mainly focussing on the initiatives and efforts of Travancore State Government that has taken for its progress in the public health care. Key Words: Public Health, Trivandrum, Kerala Women, Vaccination. Introduction The public health activities of the Travancore state dates back to the first decade of the Volume 8 Issue 11 2019 1857 http://infokara.com/ INFOKARA RESEARCH ISSN NO: 1021-9056 19th century. The introduction of vaccination so early as 1813 within a few years after its discovery by Edward Jenner, laid the foundation of preventive medicine in the state. The starting of the European system of medical aid in the country during the reign of Her Highness Gowri Lekshmi Bai, in the year 1811 preceded the starting of vaccination only by a couple of years. She opened a Charity dispensary in 1816 in Thycaud to give free supply of medicine to the poor and the needy. It was under the aegis of the curative system, and as a part and parcel thereof that the branch of preventive medicine in the state had its inception. Among the Indian states, it is the role of a pioneer that Travancore has played in the realm of modern medicine, public health and sanitation. It was with the introduction of vaccination the regular efforts of public health care started in Travancore. Travancore society in the earlier periods was confronted with a lot of communicable diseases which shook the Travancore society and led to the increase of death rate. The year 1895 has recorded the highest figure in the death rate being 19.52 per mile. In 1896 and the following year the ratio fell to 15.01 and 15.72 respectively and 13.63 in 1898. After 1898 the figures began to improve on account of the unusually severe prevalence of cholera and small-pox. The prevalent-diseases in Travancore were fever, Cholera, and small pox among the epidemics and ulcers anaemia, dropsy, diarrhoea, leprosy, elephantiasis, scabies, yaws or farang worms and dysentery among the sporadic find which led to innumerable deaths in Travancore. 1 In order to prevent the spreading of this type of diseases the Travancore Government adopted several measures. Vaccination Department In 1865 a separate Vaccination Department was established and the government adopted several measures for ensuring health and the public health institution in the state crystallized itself.2This department was put in charge of a medical officer with required qualifications Volume 8 Issue 11 2019 1858 http://infokara.com/ INFOKARA RESEARCH ISSN NO: 1021-9056 followed in Europe who was designated as Superintendent of Vaccination and placed under the orders of the Durbar physician. Durbar physician was an ordinary official in the Indian medical service. His period of service was five years. The main duty entrusted on him was to treat the kings and the palace members and he was in charge of the Civil Medical Department. His staff consisted of a Head vaccinator and twenty seven vaccinators in five grades. The long established policy of the government had been to see the proper medical aid is placed within the reach of all classes of people. Accordingly free medical aid and a free supply of medicines were available to the public in all medical institutions maintained by the Government. The government had come for passing a Regulation to make vaccination compulsory in the rural areas according to the needs of the localities. In the Madras province, it had been made compulsory in several rural areas and had slowly been extended, and in Mysore a regulation was shaped in the Legislative Council. In Travancore, compulsory registration of births and deaths has been introduced for it is easy to keep the un protected register in all registering offices. As a first step it should be made compulsory in all police conservancy towns and one or two taluks backward in vaccination should be taken up first.3 The administration of the medical department continued to be vested in the Administrative Board Medical Services till the close of August 1932.From which date the post of Darbar 4 Physician was restored. The Darbar Physician was made the sole head of the Medical Department responsible for the entire administration and he was designated as ‘Durbar 5 Physician and superintendent General Hospital. The Superintendent of vaccination had to supervise the work of the vaccinators, inspect the out-station hospitals and suggest measures for the improvement of sanitation. This step marked the first stage in the progress of public health work in the state. The superintendent of vaccination functioned as the sole Inspecting officer up to the end of 1889 and two Inspectors were appointed in addition to assist him. A Volume 8 Issue 11 2019 1859 http://infokara.com/ INFOKARA RESEARCH ISSN NO: 1021-9056 Vaccine Depot was established in 1886 for the preparation and distribution of vaccine lymph.6 Primary Health Centre The Primary Health Centre forms the base of the integrated structure of medical services in the rural areas. The primary health centres and sub centres provide basic medical care to the community through multi-purpose health workers. It lays stress on the preventive, promotive public health and rehabilitative aspects of health care and points to the need of establishing comprehensive primary health care service to reach the population in the remotest areas of the country, the need to view health and human development as a vital component of overall integrated socio-economic development, decentralized system of health care delivery with the maximum community and individual self reliance and participation.7 During the first five year plan a policy was sought to be implemented to control and eradicate communicable diseases and to provide curative and preventive health service in the rural areas through the establishment of a Primary Health Centre in each community development block. The health staff of each centre consisted of one Health Inspector, one peon and one midwife working under the medical officer of the centre. One important general trend in modern medicine was to switch on emphasis from curative to preventive medicine. The realization was that more individual curative care would not improve general health standards.8 A more community minded and preventive approach was required needs of their affiliated teaching hospitals increased. The Health Survey and Development committee of 1946, Bhore committee recommended that a three tier system of primary, secondary and tertiary levels should be developed with a well-built referral system and that the poor should be given free medical care. 9 Primary Health centre is a multi-purpose unit established at the peripheral level to render medical Volume 8 Issue 11 2019 1860 http://infokara.com/ INFOKARA RESEARCH ISSN NO: 1021-9056 services to the community. There was one primary Health centre for every 100 villages.10The main services provided were medical relief, maternity and child health care, family planning, school health, health education and control of communicable diseases. In Travancore to achieve the target envisaged in the first year plan twenty dispensaries in rural areas of medical department were transferred to the Public Department towards the end of 1955. The actual transfer was effected on 1 April 1956 but these centres continued to function mainly as dispensaries since it took several months to sanction the MCH staff and other health staff required to these Health units. For the same reason these Health units could not function as effective agencies for providing curative and preventive health services to the people of the localities concerned. In addition to the new twenty dispensaries transferred from the Medical Department three more Health units were created during the period. Of the eight old Health units Karunagappally was upgraded into a Secondary Health Centre. With the wide net work of primary health centres, community health centres, health sub centres, mini health centres and mobile health services the aim of the government was to reach the goal of health for all even in the remotest areas and in the de-linked areas. Towards this commitment, the government provided better medical aid and health care facilities qualitatively and quantitatively. Primary health centre was the pivotal centre, where from all activities relating to preventive, promotive and curative health care of the rural population radiate.11 The Travancore Government implemented several innovative measures for the improvement of maternal and child welfare programmes in the state. Women and Public Health In the absence of purdah (seclusion) and because of high status, women in Travancore were educated and allowed to circulate in an environment under western influence.