ftbe
3'iMan fll>efcical (B.^ette dftftv? JI)ears Hgo
BENGAL MEDICAL INSTITUTIONS
(From the Indian Medical Gazette, Vol. 34,
1899,
p.
331)
We have already in our July issue made reference to Colonel Hendley's report on the Medical Institutions of Calcutta, but were then
only able to give a few figures and facts from the report without comment. We now propose to touch upon many interesting points omitted from our previous notice, and, in addition, to refer to Colonel Hendley's report on the
Sept., 1949] ^lofussil Dispensarios ending
1898.
FIFTY YEARS AGO for the triennial
period
So much has been written of plague in Calcutta hat we need not follow Colonel Hendley here, eyond pointing out that the ' first case ' was Ported as such on the 17th April, 1898, when p ?}onel Hendley, Major Dyson and Dr. Cook \?sited the house in which it had occurred and agnosed the case as true plague. On the vexed 9uestion of the causes of the increased mortality n Calcutta, Colonel Hendley is making extensive nquiries. This is obviously a matter which eannot be wisely settled off-hand, and Colonel endley points to the absence of sufficient Meteorological and climatic data, and to the ?n-submission to his office of a more minute nd more scientific classification of disease than ? afforded by the ordinary mortality returns, s regards Howrah, Colonel Hendley is not Prepared to accept the suggestion of the Sanitary ommissioner of Bengal that the higher death ates of recent years has been due to the absence a proper water-supply. This has, however, een remedied, and Howrah is now in possession amP^e Altered water-supply; but that this w necessarily involve an improvement in the umber of deaths and amount of recorded sickess, recent Punjab experience forbids us to be 00 sanguine." Overcrowding in the insanitary Ustis of a city like Calcutta does not make for health though as Colonel Hendley lows in the case of the Peabody Trust in ?ndon, the evil effects of overcrowding can be greatly diminished by attention to general The question why the general ealth has not improved is one which must be urther examined before any authoritative hswer can be given. Meantime we are glad ,? note that in Colonel Hendley's opinion the ncreased mortality was not due to plague. The gures for the various institutions in Calcutta ave been already given in our former notice, hat the plague scare was accountable for a fallng off in the attendance at the hospitals is to understand. We agree with Colonel that the sickness in the Police Force endley j to a large extent, due to the fact that men. tint themselves in the matter of food to save loney. This is a universal experience with .egard to men of the sepoy class; it is the same (n the Army, and very often increased allowances .Ior dearness of provisions' only means remittances to their homes. We are g ad to notice that orders have been received r?m Government to carry' out many reforms the Presidency General Hospital. Colonel endley has specially given his attention to minor reforms and improvements which, lough neither showy nor costly, yet add much o the comfort and well-being of the patients in le hospitals. This, we may remark, is a ?iaracteristic of all Colonel Hendley's work. ne amount of good that can be done in this Wet way is incalculable, and we shall have ,
lfn
^proved
^nitation.
^creased
?
jhany
419
further to refer to it when we treat of the report Colonel Hendley is on Mofussil Hospitals. opposed to the new regulations about recording surgical operations, but we defer any remarks upon this subject till his special report on the subject is to hand. The remarks upon the vast amount of clinical material in the Campbell Hospital are very interesting. The Superintendent of that institution, being also Police Surgeon to Calcutta, and having an immense amount of medicolegal work, is simply unable to find time to avail himself fully of the for teaching purposes splendid clinical material in this hospital. ' Moreoverwrites Colonel ' Hendley, in this hospital are to be found the most wonderfully instructive cases of chronic disease perhaps in the whole world; but notwithstanding there are some able Assistant Surgeons it is to a great extent thrown away. Here even such a man as Charcot would have found opportunities of studying much that was new in reference to the nervous system. It is lamentable that such a field should be wasted.', especially, we may add, as so little has been written on nervous diseases in India. Colonel Hendley concludes this valuable and exceptionally interesting report with the following remark : 'Although there is room for improvement, I am quite convinced that the institutions are most useful and afford a large amount of medical relief not only to the town and suburbs, but to persons who come for treatment from distant places. The medical officers in nearly all cases have enormous charges which are almost beyond their powers. The results that have been obtained are, therefore, the more Colonel Hendley then worthy of commendation adds a word of tribute to the memory of tliat most valued officer, the late Major J. F. Evans, i.m.s., a tribute which all who knew John Fenton Evans will heartily endorse. We must now turn to Colonel Hendley's Triennial Report on the working of the Charitable Dispensaries of Bengal for 1896-9798. The first thing to be noticed is a gratifying increases in the number of dispensaries; no less than 14 were opened in one district (Bakergunge) during the period under review. Another means of bringing medical aid to the people was adopted in the same district, and is noted with approval by Colonel Hehdley; this is done by entrusting simple medicine chests to the village headmen for distribution in times of need. We are glad to read of the freforms in the position and prospects of the Assistant Surgeons : a new grade on Rs. 300 a month has been created, and unemployed pay has been abolished?a source of much grumbling. in entire sympathy with Colonel in his desire to keep in the hands of the Administrative Medical Officer the question of the qualifications and fitness of all medical subordinates appointed to the charge of and unless this is done, dispensaries; hospitals We
are
Hendley
420
THE INDIAN MEDICAL GAZETTE
too often the
appointment of the medical officer of a new dispensary becomes a matter of pure and simple favoritism or nepotism. To ask that local bodies shall pay a fixed sum towards the medical officer's pay is certainly only fair and reasonable. Before it often happened that a good man had to be got rid of, because he had been promoted, and the local authority could not afford the extra pay which accompanied the promotion, a system obviously wrong from every point of view. As all who have been inspected by Colonel Hendley know his inspections are thorough and eminently practical, and he has insisted upon the same thoroughness on the part of Civil Surgeons when visiting their outlying dispensaries. We are glad to note that Colonel Hendley can report an improvement in the interest. taken in the charitable hospitals by municipalities and other local bodies. In our experience we have found that the system of contributing towards the maintenance of on the part of the public is certainly hospitals ' fitful \ In one district, we remember, a contributor telling us that he would gladly subscribe more, only that for every rupee he subscribed, the municipality would give so much the less, that is, the local hospitals did not benefit in direct proportion to the amount raised by special subscription for them : the more the subcriptions, the less has to be provided for hospitals in the Municipal Budget. Wo find that no less than 2,879,545 persons were treated in the hospitals of Bengal (excluding Calcutta) in the year 1898; but this figure, enormous as it'lis, is not yet up to the numbers which attend similar institutions in the North-West Provinces In Bengal, there are still 331 or the Punjab. square miles for every dispensary, a figure which, however, is better than that of any other province except Madras. Colonel Hendley, while admitting that in Bengal the lower rate of attendance is partly due to the enormous number of practitioners of all sorts and conditions,?indeed they are as plentiful as the lawyers,?yet thinks that the low standard of accommodation and want of comforts in the public hospitals has much to say on this question. It is in this direction, we venture to say, that Colonel Hendley's tours of inspection will do most good. It is his insisting upon minor and, as we said above numerous inexpensive, improvements and changes that have done already much for the greater comfort of patients attending hospital. His words on this point should be quoted entire :? '
In nine cases out of ten, it is not so much to want of money as to want of persistence and ingenuity that the bad condition of our hospitals is to be attributed. A good surgeon, who is possessed of tact, skill and enthusiasm, as a rule, will soon be able to indoctrinate others with some of his zeal, and, at all events, be able to make a number of small improvements which will add to the popularity of his dispensary and
[Sept.,
1949
increase the comfort of the people under his
It does not take much money to put up few pictures in a ward; to whitewash the lower panes of a window so as to prevent passers-by from looking into the room; to make care. a
a
pathway
across a swampy
compound
to
erect
screens, so that women may be seen in privacy! to cleanse walls and floors; nor does it lower the Hospital Assistant's dignity or even his influence to be courteous to all and polite to women or kind to children It these
is, as we have said, the insistence upon points that has already marked Colonel Hendley's regime as characteristic. We are glad to note an increase in the number of operations performed; the average for tlie
past three
years is close upon 30,000 more than for the preceding triennium. The usual explanation that Bengalis are more averse to operations than the inhabitants of other provinces we do not believe in, and Colonel Hendley is inclined rather to ascribe it to a lack of attention on the part of the medical subordinates to this branch of their work. In the list of surgical operations done by Civil Surgeons, Major T. R. Macdonald, i.m.s., at Chapra and Berhampur, heads the list; next come Lieut.-Colonel Tomes (now retired) and Lieut.-Colonel R. Macrae at Gaya and Dacca. Though the personal equation goes for much in this matter, yet it will be noted that certain towns are almost always ahead of the others. Another satisfactory feature of the Report is the steady rise in the attendance of women at these dispensaries. There are many other points in these interesting reports in which we intend to comment upon in later issues. Enough has been written to show the strong personal interest Colonel Hendley has taken in the working of the charitable dispensaries and in the hospital of Bengal and in Calcutta and .the amount of good work which is being done by medical officers and their subordinates throughout the Province of Bengal.
3'iMan fll>efcical (B.^ette dftftv? JI)ears Hgo
BENGAL MEDICAL INSTITUTIONS
(From the Indian Medical Gazette, Vol. 34,
1899,
p.
331)
We have already in our July issue made reference to Colonel Hendley's report on the Medical Institutions of Calcutta, but were then
only able to give a few figures and facts from the report without comment. We now propose to touch upon many interesting points omitted from our previous notice, and, in addition, to refer to Colonel Hendley's report on the
Sept., 1949] ^lofussil Dispensarios ending
1898.
FIFTY YEARS AGO for the triennial
period
So much has been written of plague in Calcutta hat we need not follow Colonel Hendley here, eyond pointing out that the ' first case ' was Ported as such on the 17th April, 1898, when p ?}onel Hendley, Major Dyson and Dr. Cook \?sited the house in which it had occurred and agnosed the case as true plague. On the vexed 9uestion of the causes of the increased mortality n Calcutta, Colonel Hendley is making extensive nquiries. This is obviously a matter which eannot be wisely settled off-hand, and Colonel endley points to the absence of sufficient Meteorological and climatic data, and to the ?n-submission to his office of a more minute nd more scientific classification of disease than ? afforded by the ordinary mortality returns, s regards Howrah, Colonel Hendley is not Prepared to accept the suggestion of the Sanitary ommissioner of Bengal that the higher death ates of recent years has been due to the absence a proper water-supply. This has, however, een remedied, and Howrah is now in possession amP^e Altered water-supply; but that this w necessarily involve an improvement in the umber of deaths and amount of recorded sickess, recent Punjab experience forbids us to be 00 sanguine." Overcrowding in the insanitary Ustis of a city like Calcutta does not make for health though as Colonel Hendley lows in the case of the Peabody Trust in ?ndon, the evil effects of overcrowding can be greatly diminished by attention to general The question why the general ealth has not improved is one which must be urther examined before any authoritative hswer can be given. Meantime we are glad ,? note that in Colonel Hendley's opinion the ncreased mortality was not due to plague. The gures for the various institutions in Calcutta ave been already given in our former notice, hat the plague scare was accountable for a fallng off in the attendance at the hospitals is to understand. We agree with Colonel that the sickness in the Police Force endley j to a large extent, due to the fact that men. tint themselves in the matter of food to save loney. This is a universal experience with .egard to men of the sepoy class; it is the same (n the Army, and very often increased allowances .Ior dearness of provisions' only means remittances to their homes. We are g ad to notice that orders have been received r?m Government to carry' out many reforms the Presidency General Hospital. Colonel endley has specially given his attention to minor reforms and improvements which, lough neither showy nor costly, yet add much o the comfort and well-being of the patients in le hospitals. This, we may remark, is a ?iaracteristic of all Colonel Hendley's work. ne amount of good that can be done in this Wet way is incalculable, and we shall have ,
lfn
^proved
^nitation.
^creased
?
jhany
419
further to refer to it when we treat of the report Colonel Hendley is on Mofussil Hospitals. opposed to the new regulations about recording surgical operations, but we defer any remarks upon this subject till his special report on the subject is to hand. The remarks upon the vast amount of clinical material in the Campbell Hospital are very interesting. The Superintendent of that institution, being also Police Surgeon to Calcutta, and having an immense amount of medicolegal work, is simply unable to find time to avail himself fully of the for teaching purposes splendid clinical material in this hospital. ' Moreoverwrites Colonel ' Hendley, in this hospital are to be found the most wonderfully instructive cases of chronic disease perhaps in the whole world; but notwithstanding there are some able Assistant Surgeons it is to a great extent thrown away. Here even such a man as Charcot would have found opportunities of studying much that was new in reference to the nervous system. It is lamentable that such a field should be wasted.', especially, we may add, as so little has been written on nervous diseases in India. Colonel Hendley concludes this valuable and exceptionally interesting report with the following remark : 'Although there is room for improvement, I am quite convinced that the institutions are most useful and afford a large amount of medical relief not only to the town and suburbs, but to persons who come for treatment from distant places. The medical officers in nearly all cases have enormous charges which are almost beyond their powers. The results that have been obtained are, therefore, the more Colonel Hendley then worthy of commendation adds a word of tribute to the memory of tliat most valued officer, the late Major J. F. Evans, i.m.s., a tribute which all who knew John Fenton Evans will heartily endorse. We must now turn to Colonel Hendley's Triennial Report on the working of the Charitable Dispensaries of Bengal for 1896-9798. The first thing to be noticed is a gratifying increases in the number of dispensaries; no less than 14 were opened in one district (Bakergunge) during the period under review. Another means of bringing medical aid to the people was adopted in the same district, and is noted with approval by Colonel Hehdley; this is done by entrusting simple medicine chests to the village headmen for distribution in times of need. We are glad to read of the freforms in the position and prospects of the Assistant Surgeons : a new grade on Rs. 300 a month has been created, and unemployed pay has been abolished?a source of much grumbling. in entire sympathy with Colonel in his desire to keep in the hands of the Administrative Medical Officer the question of the qualifications and fitness of all medical subordinates appointed to the charge of and unless this is done, dispensaries; hospitals We
are
Hendley
420
THE INDIAN MEDICAL GAZETTE
too often the
appointment of the medical officer of a new dispensary becomes a matter of pure and simple favoritism or nepotism. To ask that local bodies shall pay a fixed sum towards the medical officer's pay is certainly only fair and reasonable. Before it often happened that a good man had to be got rid of, because he had been promoted, and the local authority could not afford the extra pay which accompanied the promotion, a system obviously wrong from every point of view. As all who have been inspected by Colonel Hendley know his inspections are thorough and eminently practical, and he has insisted upon the same thoroughness on the part of Civil Surgeons when visiting their outlying dispensaries. We are glad to note that Colonel Hendley can report an improvement in the interest. taken in the charitable hospitals by municipalities and other local bodies. In our experience we have found that the system of contributing towards the maintenance of on the part of the public is certainly hospitals ' fitful \ In one district, we remember, a contributor telling us that he would gladly subscribe more, only that for every rupee he subscribed, the municipality would give so much the less, that is, the local hospitals did not benefit in direct proportion to the amount raised by special subscription for them : the more the subcriptions, the less has to be provided for hospitals in the Municipal Budget. Wo find that no less than 2,879,545 persons were treated in the hospitals of Bengal (excluding Calcutta) in the year 1898; but this figure, enormous as it'lis, is not yet up to the numbers which attend similar institutions in the North-West Provinces In Bengal, there are still 331 or the Punjab. square miles for every dispensary, a figure which, however, is better than that of any other province except Madras. Colonel Hendley, while admitting that in Bengal the lower rate of attendance is partly due to the enormous number of practitioners of all sorts and conditions,?indeed they are as plentiful as the lawyers,?yet thinks that the low standard of accommodation and want of comforts in the public hospitals has much to say on this question. It is in this direction, we venture to say, that Colonel Hendley's tours of inspection will do most good. It is his insisting upon minor and, as we said above numerous inexpensive, improvements and changes that have done already much for the greater comfort of patients attending hospital. His words on this point should be quoted entire :? '
In nine cases out of ten, it is not so much to want of money as to want of persistence and ingenuity that the bad condition of our hospitals is to be attributed. A good surgeon, who is possessed of tact, skill and enthusiasm, as a rule, will soon be able to indoctrinate others with some of his zeal, and, at all events, be able to make a number of small improvements which will add to the popularity of his dispensary and
[Sept.,
1949
increase the comfort of the people under his
It does not take much money to put up few pictures in a ward; to whitewash the lower panes of a window so as to prevent passers-by from looking into the room; to make care. a
a
pathway
across a swampy
compound
to
erect
screens, so that women may be seen in privacy! to cleanse walls and floors; nor does it lower the Hospital Assistant's dignity or even his influence to be courteous to all and polite to women or kind to children It these
is, as we have said, the insistence upon points that has already marked Colonel Hendley's regime as characteristic. We are glad to note an increase in the number of operations performed; the average for tlie
past three
years is close upon 30,000 more than for the preceding triennium. The usual explanation that Bengalis are more averse to operations than the inhabitants of other provinces we do not believe in, and Colonel Hendley is inclined rather to ascribe it to a lack of attention on the part of the medical subordinates to this branch of their work. In the list of surgical operations done by Civil Surgeons, Major T. R. Macdonald, i.m.s., at Chapra and Berhampur, heads the list; next come Lieut.-Colonel Tomes (now retired) and Lieut.-Colonel R. Macrae at Gaya and Dacca. Though the personal equation goes for much in this matter, yet it will be noted that certain towns are almost always ahead of the others. Another satisfactory feature of the Report is the steady rise in the attendance of women at these dispensaries. There are many other points in these interesting reports in which we intend to comment upon in later issues. Enough has been written to show the strong personal interest Colonel Hendley has taken in the working of the charitable dispensaries and in the hospital of Bengal and in Calcutta and .the amount of good work which is being done by medical officers and their subordinates throughout the Province of Bengal.
