Bull. Ind. Inst. Hist. Med. Vol. XX pp. 123 to 139 GROWTH OF THE HOSPITAL SYSTEM IN HYDERABAD- HISTORICAL AND DEMOGRAPHIC ASPECTS: 1880's-1950's AIJAZ-UR-REHMAN* ABSTRACT Health service institutions of the past and thair transformation over the years, serve to explain the state of the present health-care system, particularly when the original institutions survive in some form or other to fulfill the same primary functions. With their persistence. they may affect the 'health-attitudes' of generations and orientations of the population towards a specific system of health care. This paper provides a descriptive outline of the rise and growth of health services in the capital city of the Niz arns State from the late 19th Century to middle of the 20th Century. The discussion is conducted in terms of institutions (hospitals/dispensaries) existing in each decade, their bed capacity and staff, as well as their utilisation in context of the prevalent demographic situation, health conditions and needs of the popu'ation. Conspicuous among the limitations, is the exclusion of political aspects and economic constraints of welfare. Delimitation of the period (1880's-1950's) has been convenienced by the avai labilitv of demographic data ,from the 1881 Census onwards) and coincidental with the period of svstematisation of health services in the State. Some problems relating to historiography and variance in reporting of figures from discrete sources are alr o briefly discussed. During the Outb Shahi period in describes the Darus-Shifa as a "very Hvderabad, the Unani and Ayurvedic important building of public utility .. Medical systems were popular and unique in the whole range of secular also promoted by the rulers, About architecture in the Deccan". Its the late 16th Century, the'Darus- construction is estimated to have Shifa ' (literally 'House of Cures') was started circa 1595, From a chronicle built, only the structure of which of the reign of Muhammed Outb Shah, remains to date, Sherwani (1972), it is known that "nearly 400 patients" { * Department of Sociology, Osmania University, Hyderabad-500007. 124 Bull. Ind. Inst. Hist. Med. Vo/. XX could be accommodated for treatment About 1880, the organisation of o S in-patients. T!;}8institution langui- the State medical department was shed i.nd came to be defunct with the entrusted to the 'Residency Surgeon' fall of Hyderabad-Golconda to the Moghal emperor Aurangzeb in the who was assisted by a staff of late 17th Century. surgeons. He was primarily placed incharge of attending to the Resident n.e 19th Century in Hyderabad and his staff through the institution saw the introduction of the "Western" of the 'Residency Hospital' but was system of medicine. The contribution edditionallv made Director of the of the Nizam along with the profes- State's Health and Medical Organise- sional expertise of British doctors, tion. (Imperial Gazetteer of India, issued in a system of health-care, Provincial Series, Hyderabad State, the embodiment of which was the Mirza Mehdy Khan, Calcutta 1909). hosoital. Voluntary and 'missionary hospitals were also known then. and In 1881, the population of Hvd- some institutions like the DichpaJly erabad (only) was 1,23,675; including Leprosy Hospital were already the suburbs and Secunderabad functioning towards the end of the cantonment it was 3,67.417 (Census 19th Century. of India, 1891). In 1844, the Hyderabad Medical During the early 1880's, the School came to be established to medical staff under the Director of keep up a supply of medical profes- the State Medical and Public Health sionals to the state and private service, Department consisted of 15 medical who otherwise had to be attracted surgeons, 7 hospital assistants, 24 from the schools of England, Madras, compounders and 11 vaccinators. In Bombay or elsewhere. The course addition there was an unspecified was "approximately" the same as the number of diploma nurses. Between "Licentiate in Medicine and Surgery" 1881-85,6 hospitals and dispensaries (L M. & S) of the Madras University. are reported to have been functioning Administration records indicate that in the city and suburbs and 48 examinations were supervised by a dispensaries in the districts (Imperial Board of (British) Medical Officers Gazetteer, 1909: 79·80). from the King Edward Memorial Hospital at Secunderabad and later Among these 3 were major in- from the Madras Medical College or patient hospitals in Hyderabad which the Grant Medical College of Bombay. were run by the State's medical (Administration Report of the Resi- department apart from those managed dent at Hyderabad 1871-72, Sir by the British Residency (viz. the King Charles Saunders). Edward Memorial Hospital at Secun- Growth of Hospitals in Hyderabad-Aijaz-ur-Rehman 125 derabad and the Residency Hospital following representation (Walker, at Sultan Bazar. The KEM Hospital 1907)_ The Residency Hospital, was originally established for the likewise, was meant for the Resident's British contingent stationed at Secun- derabad but accepted emergency office and domestic staff. The British cases of local civilians and also managed hospitals served as models started a regular ward for them for the state's public hospitals. TABLE- I In-patient admissions in three city Hospitals 1894-1898 SI. Hospital 1894-95 1895-96 1896-97 1897-98 No. 1. Afzalgunj 1,341 1.450 1,299 1,175 2. Central Police 231 206 257 177 3. Chanchalguda Jail 180 229 198 216 4. Suburbs and Dispensaries 416 290 369 291 Total 2,168 2,175 2,123 , ,859 Source Annual Administration Reports of the Nizam's State - 1903. (Courtesy A.P. State Archives). In 1891, the population of the period (1880-1950). While 'hospital' twin cities and suburbs was 415,039 connotes a permanent, relatively large (Census 1891). In 1901, it rose to unit with in-patient beds, 'dispen- 448.466 (Census 1901). saries' were nodal out-patient centres located in suburbs where medical In this decade, the 3 major advice and medicines were dispensed. hospitals run by the state, viz. the Some of the latter had provision for Afzalgunj Hospital, the Central Police a small number of in-patient beds on Hospital and the Chanchalguda Jail a non-regular basis (as per demand). Hospital, accounted for over 75% of The size of the Afzalgunj hospital can the in-patient admissions in the be approximated to be the largest, city (Administration Report. 1903). treating (over a period of 4 years, Suburban dispensaries with provision 1894-98). 63% of an annual average for a few beds tended to the remainder 2,080 cases. cases (Hyderabad and suburbs only). The terms 'hospital' and 'dispensary' However, inspite of steady growth are found in nearly all reports of the of population in the city in this decade, 126 Bull. Ind. Inst. Hist. Med. Vol. XX hospital admission figures for these had dropped to 1,859 from 2,173 in years suggest an irregular tend in 1895-96, it again soared to 2,589 in utilisation. While in 1897-98, the 1899-1900. Admn, Reports, 1894-98; total number of in-patient admissions 1898-1903, Hyderabad State). TABLE- " Year-wise in-patient admissions in Hyderabad City Hospitals 51. Total number of in-patients admissions Years No. in city hospitals 1. 1894-95 2,168 2. 1895-96 2,173 3. 1896-97 2,123 4. 1897-98 1,859 5. 1898-99 2,058 6. 1899-1900 2,589 7. 1900-01 2.209 8. 1901-02 2,683 Source Administration Reports. 1894-98: 1898-1903 (Courtesy A P. State Archives). The administration report of It may be reasonable to assume 1894-98 attempts to explain this that a number of citizens patronised irregular trend as the misuse of other institutions like the hospital in Secunderabad and private services hospitals. Perhaps the particu lar offered by physicians, Hakims and social class (religious mendicants and Vaids. As early as 1888. there is lurnpen elements) using the hospitals, recorded evidence to indicate the discouraged the best efforts of doctors existence of private hospital services and inhibited the middle and upper class patients who began to ragard in Hyderabad The Residency sur- them as places of 'disrepute ', High geon's report mentions "the opening hospital mortality rates may have of a temporary hospital for women been instrumental in their being and children" at Dr. (Miss) White's viewed as 'houses of despair'. It own expense, " ... pending the carry- would also be relevant to note the high incidence of epidemic diseases ing out of a proposal for a Jubilee like plague and cholera prevailing at commemoration hospital" . the time. (Dr. Lawries Report, 1888), Growth of Hospitals in Hyderabad-Aijaz-ur-Rehman 127 From the first three decades of hospitals survived into the latter half the 20th century also, there is periodic of the 20th century Owing to floods, reference to the existence of "some subsequent draught and exigent private hospitals" in Hyderabad. medical conditions arising from these calamities, there appears to be a In fact, some private hospitals positive relation between feed back had been included in enumeration in obtaining from vital statistics and the medical department's annual the growth and inputs to health reports during the 1920s (Report of services since the 2nd decade of the the Medical Department 1922-23). 20th ce ntury. In an earlier administration report for the year 1912-13, (5:58), there is In 1901, the population of Hyd- explicit recognition of the existence erabad and Secunderabad including of "private medical institutions" to suburbs was 4.48,465. During the which there was a spill - over of period 1906-10, the total number of patients from the public hospitals. city public hopit als and dispensaries The Statistical Year Book for 1350F had increased to 12 from 6 since the (1940-41) of the Hyderabad state end of the century, With the inception enumerates "22 Government ar.d of the Victoria Zenana Hospital in non-government hospitals".