PRESIDENTIAL ADDRESS IN PUBLIC HEALTH. By Surgeon-Lt.-Col. W. G.
King,
D. P. H.
O.NT first being informed that the Health Section of this Congress had done me the honour of electing me President, I necessarily felt doubt as to whether I ought to accept so responsible a position for which I cannot help feeling I am ill-fitted. I, however, understand that our Bengal brethren, with whom the happy idea of the holding this Congress originated, have, as far as possible, reserved for their visitors all posts of importance. It is thus I find myself possessed of the pleasure of being the first President?let us sanitarians say whilst at a safe distance from enthusiasts in other branches of our glorious profession?of the most important section of the first Indian Medical Congress. Allow me gentlemen, to thank you sincerely for the honour afforded me, and, if I may be permitted to so regard it, the Presidency in which I have the
privilege to serve. Although this is
the first Medical Congress in this country, it is doubtless not the first time that wise heads have been shaken in the discussion of matters sanitary. The laws of Mariu could not have seen the light, unless there had existed in ancient India a section of the educated classes who regarded sanitation as of so great moment that, to bring it home to the masses, it was desirable to weld its laws with their religion. None but men possessed of strong sanitary instincts would have considered it necessary to render it illegal that filth should be brought near them, or would have taken care that those following noxious trades, and the " great unwashed generally should not approach them. It is true these sanitary Jaws are known as "rules of caste," but neither their origin nor intention can be mistaken. Were the most recent refinement of scientific research? the bacteriologist?to have it all his own way, I verily believe we should find ourselves bound down by rules as rigid as those of caste; none but men who on penalty of excommunication from the Guild were in the habit of completely washing their bodies and clothing a certain number of times daily, and who would undergo special purification and. a stage of segregation if by force of circumstances brought in contact "
Jan.
1895.]
be permitted to prepare food for We should find it necessary to purify ourus. selves carefully after our chins had been handled by the barber, or we had attended a funeral; we should all be bound to prevent saliva, excrement, blood and other defiling matter reaching our public water-sources ; we should regard sunlight and the living earth" as the great purifiers. Laws such as these must in their day have been of vast benefit to the members of the Guilds which were called upon to live in the midst of an alien and, apparently, not over-cleanly race. The Hindoos, however, by no means possessed a monopoly of a belief in sanitary laws. Mahomedans brought with them the dicta that " cleanliness is the key to heaven," and that the man life of is but the second to the preservation of command of God." In this matter they did not halt at mere theory, as witness the magnificant infiltration galleries, and the distribution of enormous volumes of pure water in pipes under pressure in Aurangabad, Ahtnednugger, Burhanpur, and other localities. In proof of the fact that these works, designed by the Sanitary Engineer of the period before cast-iron pipes had been dreamt of, have fulfilled their function, I may mention that the city of Aurangabad?although the protection of its water-supply is by no means perfect according to modern notions? has, during the 300 years of their existence, been remarkably free from cholera. Indeed, it frequently occurred that, whilst the neighbouring British Cantonment suffered severely, the city of Aurangabad, within a mile of it, remained fairly free. The reason for this comparative immunity being self-evident, in that in the one case a much-defiled stream is the watersource, in the other a partially-protected supply from a good origin. The enlightened Government of H. H. the Nizam sanctioned the opening of water-works for the cantonment. It is a curious commentary upon the principles pursued in these ancient sanitary engineering works that Mr. Marrett?the able Engineer for the modern works?has also drawn his supply from infiltration galleries, the data as to the yield of which he was aided in calculating by an examination of those formed three centuries ago by Malik Umber and Aurangzebe. But, it has been with Hindoos and Maliomedans alike, as it has been with the Jews the other instance where hygienic laws had been knitted to religion?the letter of the law has been fulfiled, but the spirit has been forgotten ; thus, alas, the India of to-day is a by-word amongst the nations as to neglect of sanitation, and is regarded as the home of that muchdreaded pest?cholera. Hence it is in this country, there exists an enormous field for the labours of that modern branch of the medical profession which we recognize as sanitation.
with
15
INDIAN MEDICAL CONGRESS.
unkindly microbes, would our drinking vessels or
handle
"
"
?
Well may the qualifying terra of modern be applied to this science of the West, when compared with the rules of caste of the East with which there is so much akin. The great cholera scare in Great Britain of 1849 pointed to the necessity of concerted public action where grave epidemics were feared; the waste of human life and hardships to which our troops were subjected in the Crimea, taught the public the necessity of attending to the warning voice of Hygiene. As you all know, the outcome of this movement was a demand that our soldiers, when called upon to risk their lives for their country in fair fight, should not be condemned to die by disease born of tilth and engendered by ignorance. This was responded to by the appointment of a Royal Commission, and the founding of the Array Medical School at Chatham and, subsequently, Netley. When quiet times succeeded the troublous days of the Indian Mutiny, officers trained in these schools at the feet of that noble and learned man, the late Professor Parkes, could not fail to be imbued with his unselfish spirit, and thus whilst, on the one hand, they toiled in the various civil stations to which they were attached to start medical institutions, on the other, they did not forget their dutjr as sanitarians. They formed Sanitary Committees whose constant representations to the authoi'ities as to the conditions of the civil populations resulted in the birth of Municipalities and Local Fund Boards, charged with the sanitary administration of urban and rural areas, respectively. Under their pare, also, rose great medical schools, which have afforded training to the important class of private medical practitioners which now shares with the Indian Medical Service the responsibilities of medical and sanitary work in this country, whom we have the pleasure in this Congress of welcoming as valued colleagues capable of aiding us with their experience and advice in the common object of sanitary reform. These advances were made but slowly, but, during the last 15 years, the progress of hygiene has been in geometrical proportion. Investigations in the various sciences which go to make l^giene are now pressed forward wtih feverish haste, and we no longer wait till the experimenter has settled with his publishers as to a book to see the light perhaps a year after completion of his work; we demand that intelligence shall be sent us by wire, and brook no delay in being told that Koch has discovered the bacillus of tubercle ; Klein the streptococcus of scarlatina ; Pasteur an inoculation against rabies, and Haffkine against cholera; that Hankin has demonstrated a new tox-albumin, and Simpson the true origin of vaccine lymph ; that Manson has taught us to dread the mosquito, and Cunningham to think less unkindly of the comma bacillus; that the lucid pen of Hart l
?
?
?
16
INDIAN MEDICAL GAZETTE.
has stirred the length and breadth of the civilized world in demanding better sanitary care of the home of cholera;" and that Miss Florence Nightingale preserves intact her sympathy with sanitary advance in this country. The Royal Commission of 1863, to which India is so greatly indebted for its awakening into sanitary activity, declared that the mortality of the European soldier was equivalent to 69 per 1,000 amongst the men and 31 per 1,000 amongst the officers; while in 1860-61 in jails for native prisoners the mortality was 67'0 per mille. I need not trouble you with a statement of what the mortality was amongst the civil native population, as our registration statistics were at that time and are up to date, far too defective to enable trustworthy figures In accordance with the advice to be furnished. tendered by the Royal Commission, advising bodies were, in 1864, attached to each Government in the form of Sanitaiy Commissions. In 1866 these were replaced by single officers? Sanitary Commissioners. Under their advice, radical improvements were made in dietaries, in the buildings, and precautionary methods pursued in barracks and jails. The deathrate of the Europeau soldier is now about 12 per mille from all causes, and that of our native prisoners about 29 per mille. These results are undoubtedly highly satisfactory, and can be ascribed to no other cause than the placing of the populations concerned under improved hygienic conditions. In regard to jails, although here and there minor insanitary conditions still exist, it may fairly be said that, as to diet, labour, and dwelling accommodation, the native prisoner is well off. I do not believe the same can be said so fully either ofthe British soldier or Native sepoj'. The period of progress inaugurated in 1864 has not been continuously maintained. Typhoid fever claims far too many victims for it to be imagined that the surroundings of the British soldier are free from reproach. I do not forget that Thomas Atkins has his own little ideas of what is good for his internal economy, and imbibes without thought of its origin, vile "cool drinks" prepared for him in the bazars; but, we cannot well regard this?albeit preventible cause?as sufficiently explaining our losses. In the matter of food-supply, which demands the special knowledge not of the medical man only, but also of the chemist and analyst, our Army authorities have become impatient of control or suggestion by the medical profession, and we find the modern tendency is to attempt to educate military officers to do the work of the sanitarian; so that, except at the expenditure of much representation and the risk of considerable opprobrium, it is impossible for the medical officer to reject that which the combatant officer officially responsible for food inspection has "
[Jan.
1895.
already passed. It is highly desirable that military officers should possess the training indicated, just as it is also desirable that medical officers should have sufficient military training to defend the wounded or themselves in desperate positions, as they have so often managed to
do without possessing that advantage. But, whilst I would demand that in action the lives of soldiers should be entrusted to professional combatants, it seems but meet that all matters affecting health should be under as complete control by the sanitarian, as the exigencies of military service would permit. Recent reports by officers of the Army Medical Staff have shown that the dry-earth method of night-soil disposal in certain cantonments is far from above suspicion. Nor, in the more grave matter of water-supply, have our cantonments, in the generation that has elapsed since the appointment of the Royal Commission, been placed in completely satisfactory condition. In two at least of our important military stations in the Madras Presidency, the water-supply is such as to leave little room for doubt that, however much the soldier is himself to blame in contracting typhoid by his gustatory peculiarities in the midst of the bad hygienic conditions of native bazars, there is ample room for his contracting the disease nearer his barracks. In Bangalore, the troops are provided with water from a tank which is supplied by an open channel that passes through a native bazar, but is duly kept clean by means of sweepers, be it noted, are considered whose services, necessary. Forming part of the wall of the supply channel is the main sewer from the This sewer is ingeniously arranged same area. with storm water? so that when over-charged brought thither by open drains which are destined normally to receive the sewage from native houses?relief is obtained by discharge into the water-supply channel, and thus into the tank. We are consoled by the statement of the Engineer authorities in charge that overflow only occurs about five times per annum ! Again, in Madras the so-called Seven Wells water is supplied to the British troops. " bad " by the This water has been pronounced a sanitary whilst Madras Chemical Examiner, that collections shows enormous of survey rubbish containing fsecal matter deposited by the Municipality, sewage farms, and graveyards, are within the same sub-soil sheet as the source. Both in Bangalore and in Madras the British troops have suffered from typhoid fever. They are said to be valued at ?100 per "
"
man.
But there is one class of disease to which the British soldier is subject, which, in the plenitude of the wisdom of Exeter Hall it has been determined, prevention shall not be exercised. In India during 1892, there were inefficient for
-Jan.
INDIAN MEDICAL CONGRESS.
1895.]
the year 27,000 men, or 410 per mille of the average strength, by reason of admission to hospital for venereal disease : find 208 were invalided from this class of disease during the year. Yet, by the repeal of certain ?clauses of the C. D. Act, the hand of Governat the instance of a ment has been stayed narrow-minded section of the British public. In the name of morality, in the name of Christianity, the erring bachelor has been dealt with on the serve-you-right" policy?possible only of adoption by minds devoid of the power of recognizing in what true humanity exists. To what punishment would not these purists condemn the man who, having warned his child that if he played with fire he would burn himself, complacently saw it commit the act of disobedience and be literally done to death ; }'et, the polic}' of non-interference entails present suffering in our fellowmen and their companions in immorality from a disease that may be transmitted to a wife and the innocent infants of a future union. I know of no law of God or man that can give countenance to a policy so cruel. The only possible excuse that can be offered for the leaders of this movement is that they hoped that fear of acquiring disease would act as a deterrent. In this they have exhibited gross ignorance of the laws of Nature; not the biggest scare-crows ever made?and the soldier is aware that the dangers are real enough ?would quench human passion. Neither can it be pleaded that the measure protects women from falling. On the opposite, a system of supervision prevents many from subjecting themselves to degradation so manifest, and must often have saved those from final ruin whose wings have been singed. In mj^ opinion, the result of the repeal of the law has been to extend the circle of immorality, and to bring within the area women who might otherwise have escaped. Nothing short of the moral training that would demand that mankind be "temperate in all things" can afford the result arrived at, and it is to this end, combined with endeavours to make gymnastics and all manly exercises receive far more encouragement than at present at the hands of the authorities, all efforts should tend. The sanitary conditions under which the native troops serve are certainly much superior to those of the average civil native population, and undoubtedly, the small mortality, and especially their comparative freedom from smallpox and cholera, exhibit the results of the supervision exercised. But, in respect to native followers, there can, I think, be little doubt that defects exist. An army wasteful of its transport animals must suffer seriously in the long run, to say nothing of the enormously increased cost to the country employing them. The last Afghan war seems to have taught the necessity for care in '-this particular, and officers and men now receive certain
periods during
"
o
o
training
as
to
before little
see
any
17
loading
thought
and unloading tliat was of. But I have failed to
precautionary
measures
suggested,
or
result of the loss of life amongst native followers which occurred in the various expeditions of late 3'ears in Burma. I cannot here take up your time with details, but I would ask those who have interest in these questions to balance the diet, fuel allowance, and shelter provided for followers, against the work expected of them as weight-carriers 011 lengthy marches, and compare these data with those applicable to native combatants employed side by side with them, and ascertain for themselves whether there does not exist some physiological error which in part accounted for the invaliding and death-rate of that useful class of men. In my humble opinion; these matters should have been carefully sifted, and the medical and sanitary experience gained from our little campaigns in Burma should have been made available for possible heavier struggles in the future. In the case of troops and jails, it is but demanded that the sanitarian should convince the ruling authorities as to the necessity for action, for the latter to find funds and issue orders. With the civil population,the problem is,however, much more complex. It embraces questions as to the sanitary discipline of 212 millions of people inhabiting the most diverse climates, speaking different languages, possessed of different customs I and, above all, bound hand and foot by prejudices which they are but too apt to confuse with instincts. religious Undoubtedly, the foundation of all sanitary efforts must be the existence of suitable laws to support the sanitary executive. Since 1863, we have seen passed laws under which Municipalities and Local Fund Bodies have sprung into existence ; these, in their infancy, were largely controlled by Government officials, but of late 37ears, under the Local SelfGovernment movement, have been placed in the hands of representative native gentlemen. In the case of the Madras Presidency, the Act dealing with the rural tracts has already, since its inception in 1871, undergone one revision, and is now being remodelled by Government. The same is to be said of the District Municipalities Act. For the large Town of Madras, revision of the special Act applicable has also been accomplished. These alterations were largely prompted by the necessity for increased sanitary procedure. In regard to fairs and festivals, increasingly stringent regulations have had some influence in diminishing the appalling loss of life, which the insanitary conditions under which most of them used to take place brought about; but, on this point, much remains to be done. Careful records of factors affecting the health of populations, as to the progress of epidemics, and sanitary subjects generally, may be reckoned by the lakh. Attempts to ameliorate
adopted,
as a
INDIAN MEDICAL GAZETTE.
18
conditions by petty expenditure, and the giving of advice have also everywhere been made in our rural tracts and minor towns. The Yaccination Department has not been idle, and has. made its influence felt upon mortality distinctly; but 110 one has yet been able to convince the Government of India that the employment of a poorly-educated and ill-paid vaccination staff throughout the country is incompatible with the attainment of full results. In rejecting a scheme for employing medical subordinates in the Madras Yaccination Department in 1868, the Government of India informed that of Madras that, the duties" of vaccinators "are purely mechanical," and the rates of pay proposed "are needlessly high from a desire to attract men of education and respectability such as are not required, inasmuch as they would be more expensive agency than is requisite for the purely mechanical duties of vaccinators." During the last 6^ years in the Madras Presidency 201,394 deaths were registered from the preventible disease of small-pox. Taking into account the probable number of survivals from these attacks at 643 per cent., it is calculated that? without taking into account the capitalized value of lives?there must have resulted during sickness and upon funeral ceremonies an unproductive expenditure of 51 lakhs of rupees, if it be presumed that the persons attacked occupied 110 higher position than the cooly gaining Rs. 5 per month. But in the practical application of sanitation, outside the limits of the capitals of the various Governments, our advance has been but little. Unfortunately for the country, it was possible for those responsible for. this absence of progress to shelter themselves behind a motto that was so frequently applied to the Sanitary Department that it became a part of the sanitary creed of the day. There were, it was repeatedly stated, prejudices to overcome; therefore festina lente, be the guiding principle. The phrase must saved much labour, and it became the business of no one to enquire whether these prejudices really were of so serious a nature as to clash with the people's more deeply-seated and legitimate opinions of religion, and?it saved money. Year after year, it was pointed out that if the principles evolved from the investigations of the sanitarian were to be given effect to, speci-
existing
"
ally trained Engineers
to
execute
sanitary
schemes, in consultation with Sanitary Commissioners, were requisite. At last the Secretary of State acted upon these recommendations, and the majority of local Governments are now provided with Sanitary Boards having a Sanitary Engineer as a member. Further, the important principle that Government must aid sanitary advance by direct allotment of funds has now been conceded, and local Governments are responding to the call; in the Madras
[Jan.
1895.
the Government lias, since 1890, in of free grants to Municipalities, given the sum of Rs. 13,05,850, besides advancing loans upon veiy favourable interest to Municipalities for drainage and water-works. 1888? the date of the Secretary of State's Despatch on these subjects?may well be reckoned a new era in the sanitation of India. Since this period we have seen the North-West Provinces busy in the revision of its sanitary laws, especially with reference to the accommodation of pilgrims; a Village Sanitation Bill has been essayed in Bombay ; and Bengal, under that ardent sanitarian Sir Charles Elliott, has excogitated large drainage schemes that, aided by legal measures, are directed against the greatest cause of mortality in this country?malaria : these are measures of the most practical nature which must be far-reaching in their life-saving results. We have seen a well-known bacteriologist appointed at Agra, and to the Sanitary Commissioner with the Government of India a special assistant for bacteriological enquiry has been attached. Methods of intercommunication between presidencies and between neighbouring districts as to movements of epidemics, have been successfully organized. In numbers of the large towns drainage and water-supply works are in actual But, it would be folly to consider progress. there have been made efforts commensurate with the great work cf life-saving before us. Although, as I have shown, it has been possible within the last few years to throw off something of the glamour of that thread-worn proverb, there is still enough of the old spirit of festinu lente prevailing to clog the wheels of progress, and to limit the fuel, the consumption of which makes the machinery exhibit its full value ; I refer to that useful article?money. Schemes for sanitary improvements are still built toilfulljr, yet in hope, are launched upon seas of unbelief, and are wrecked upon the shores of finance. In short, sanitary advance is constantly frustrated by the cry no funds." In this great assembly of sanitarians representing opinions from all parts of India and of Europe, we may well be permitted to ask without being taxed with captiousness, or, in the case of those occupying official positions, insubordination, whether it really be that no funds are available, or that Government has not yet arrived at a sufficient grade of faith in sanitation to devote to it its fair share of funds. I maintain that sanitation neither receives its fair share of funds, nor that place in the Government of the country it
Presidency the
manner
"
merits.
I have had no time to enter into statistics on this subject in other presidencies, but taking the case of Madras, I find that from Provincial funds the average amount spent directly upon sanitation during the last five years was, Rs. 44,660 or 0.15 per cent, of the total fuuds?
Jan.
1895.]
INDIAN MEDICAL CONGRESS.
This expenditure is for a Sanitary Commissioner aided by a single Deputy, who also, under the former officer, is in charge of the Vaccination Department plus an office staff. This represents the total staff devoted solely to sanitary purposes and paid from Provincial funds, for the care of about 36,000,000 people and an area of country about 141,180 square miles. But for education daring the same period, it was found necessary to allow an average of Rs. 12,21,230 per annum, or 4'1 per cent, of the total funds. It is further noteworthy that, whilst expenditure on the sanitary staff, remained practically at the same figure, for education it lias year by year steadily increased, so that although in 1883-84, Rs. 9,52,778 was thought sufficient, in 1892-^3, Rs. 14,06,352 This sum represents the pay was demanded. of a Director of Education who gets a salary of Rs. 2,000?2,250 per month, has a suitable office staff plus an admirable staff of Assistants in the form of Inspectors, Assistant Inspectors and Sub-Assistant Inspectors, male and female. In this statement of expenditure from Provincial funds, no account is taken of grants for buildings for educational purposes, which, in the Presidency Town alone cost Rs. 13,34,355. The Government lias remained so convinced as to the necessity for this outlay, that it has felt it desirable, in the interests of economy, to issue its orders from an ancient building, which is a cross between a barrack and the office of a commercial firm?affording a decided contrast to the magnificent educational buildings such as the Presidency College, the Senate Hall, and Law College which are in its proximity. Even were the provincial grants to Municipalities I have mentioned taken into account, the percentage from Provincial funds for sanitary works and sanitary staff would amount to 0*57 against 4T for education excluding grants for works and buildings. Nor does the Educational Department cease its demand for money only from Provincial funds. It duly asks and receives its share from Municipal and Local Funds. I find that, in 1893, the Educational Department spent from Provincial and Local Funds Rs. 21,32,281 against Rs. 7,88,000 devoted to sanitation, or a proportion of 5'4 per cent, against 2"0 per cent, of the total funds. On combining the figures for Provincial Funds, Local Funds and Municipalities, it is found that education consumes 5'5 per cent, against 3'0 per cent, for sanitation. As far as it has been possible to effect this from the data available, this sum represents net expenditure. The amount spent in sanitation represents the maintenance charges for conservancy staff and the upkeep of plant for a population of 36,000,000. There are doubtless other departments which also recei ve more than their fair share of available funds, and thus tend to render sanitary
19
but I have utilized this the Educational Department of Madras has long been subject to the well-merited criticism of over-production, whilst like Oliver Twist it for ever demands more. In the Madras Presidency, notwithstanding the" popular opinion outside our limits that we are benighted," the land is flooded with B. A.'s and Vakeels; or, in other words, with educated men. The best evidence of over production is the market value of any article, and I may state that the finding of employment of any sort for University graduates is so difficult that they willingly accept posts on pay little better than that of a good class of domestic servants, whilst with Vakeels the earning of a living in strict accordance with legal ethics is becoming increasingly difficult, notwithstanding the extraordinary fondness of the people for litigation. But it may be said that education is the best ally that hygiene could have, and but paves the way for sanitary advance. Well, I have carefully watched results, and have attempted to believe that this is so ; but I am driven to the conclusion that this theory must be accepted with reserve. Whilst, doubtless, education lias given to us in every part of the country consistent and earnest advocates of sanitation, in a large number of cases practice and theory do not go hand-iuhand. The average educated man will not scruple in the morning to proceed to the riverside or tank and perform there his complete toilet, using water, that he sees is undergoing contamination within a stone's throw by his male and female brethren; although, in the evening, he will fully grasp the refined hygienic details of the evil results of earl}'' marriage, and will give his vote at crowded meetings as to the abolition of the nautch girl. Not only has the Educational Department been guilcy of over-production in the higher branches, but they have committed the fatal error of neglecting sufficiently to advance female education. It has apparently been forgotten how powerful and obstinate an advocate the female part of the population is of various superstitious This neglect has rendered it almost imcustoms. possible for educated natives to carry into their every-day life the practice of sanitation, of which they have duly learnt the theory. In the mental culture of women I, therefore, think lies a far more legitimate field for the spending of public money than in the over-production of Yakeels and B.A's. But, irrespective of this great impediment, it is manifest that large as the number of educated men is, their influence upon the masses can be but small; where this can best be felt is almost solely in the large towns?the rural population representing the bulk of the people being practically beyond their sphere of influence. This mistake is beginning to dawn upon the public, and the Madras Government is now doing its best to favour primary and technical education?just advance
instance,
impossible; as
INDIAN MEDICAL GAZETTE.
20
[Jan.
1895.
no public praise, but at the attaining where their predecessors' efforts should have at securing of the ample reward?even in a greater measure commenced. This form of education which will which our brethren engaged in medicine raise the status of the lower classes and assist in?for and surgery are willing to toil by night and by the developing long-neglected natural resources the pleasure of being the instrument, in of the country doubtless will effectually aid day; God's hands, of relieving suffering and saving sanitary advance, and, were it to be understood life. For the sanitarian is reserved the joy not that the new scheme is to be pushed forward by the solitary weakly patient day by day of retrenching the useless expenditure upon over- seeing strength to resist the onslaught of death, production in the higher classes of education, the gather but of saving lives that may be counted by thousmovement would have the full sympathy of for him is reserved the happiness of seeinothose interested in sanitation. But there is every ands; where before the unkempt street Arab revelled in reason to believe that the changes incurred will filth appear a new generation in the full vigour form increased increments against funds that of health, and where disease, poverty and vice might otherwise be available for sanitation. If to find instead temperance, hapto hasten slowly" has been the principle enun- reigned supreme, and wealth enthroned Here is true phipiness, ciated for the guidance of the Sanitary Departto those who have felt this pleasure " the people die not slowly, therefore be lanthrophy ; ment, can be no wonder that the ancient there religions philanthropic and hasten their education" has of nations having little else in common, were been that unconsciously acted upon as regards united in finding a place for hygiene ; for its first the Educational Department. is respect for the rights of our neighbours. dictate In speaking thus, it must not be imagined that thus that hygiene claims a fraternity It is I would prefer not to see the country overrun from which neither Christian, Hindu, Sikh nor with highly-educated men. Provided these genSocialist nor Autocrat, can with a tlemen could get a living satisfactorily to them- Mussulman, clear conscience hold himself aloof. Under the is a distinct factor in the selves, their existence banner of hygiene, we are capable of knitting advance ot' the country; whilst socially their every race and creed, because we labour together mental culture makes acceptable comrades and for no selfish purpose?we endeavour to secure to who would otherwise be of friends men, incapable man God's greatest blessing?health : we labour of exchanging an idea with their fellow-beings to preserve His most precious gift?life. of the West; but I certainly think the time has come to consider, in view of over-production and the more pressing claims of the population upon Government f?>r the preservation of health and decency, whether the higher class of education should not be secured by those desiring this luxury otherwise than at the hands of an elaborate department receiving pay and pensions from Government. I need not say we do not grudge our fellow-officials of the Educational Department the success which has attended their efforts, to persuade Government to give them of the sinews of war. so large a proportion The Sanitary Department has just as great opportunities to plead the cause of sanitation as they have possessed as to education ; they have succeeded where we have failed. It is obviously to remedy this state of affairs that we must exert ourselves. If we believe in the enormous importance of hygiene in the saving of human life and suffering, we as a body and as individuals will not rest until we see this country provided with and a correctly-organized a better share of funds Health Public Department, capable of investigating and dealing with the causes of disease, and methods of expensupervising and controlling the diture upon sanitation. In undertaking to secure these ends, we may well consider it our duty to press forward at the risk of being regarded by the public as mere faddists," and men possessed of not the slightest comprehension of what the demands upon the State are. This, however, we can well afford to brook. We aim "
"
King,
D. P. H.
O.NT first being informed that the Health Section of this Congress had done me the honour of electing me President, I necessarily felt doubt as to whether I ought to accept so responsible a position for which I cannot help feeling I am ill-fitted. I, however, understand that our Bengal brethren, with whom the happy idea of the holding this Congress originated, have, as far as possible, reserved for their visitors all posts of importance. It is thus I find myself possessed of the pleasure of being the first President?let us sanitarians say whilst at a safe distance from enthusiasts in other branches of our glorious profession?of the most important section of the first Indian Medical Congress. Allow me gentlemen, to thank you sincerely for the honour afforded me, and, if I may be permitted to so regard it, the Presidency in which I have the
privilege to serve. Although this is
the first Medical Congress in this country, it is doubtless not the first time that wise heads have been shaken in the discussion of matters sanitary. The laws of Mariu could not have seen the light, unless there had existed in ancient India a section of the educated classes who regarded sanitation as of so great moment that, to bring it home to the masses, it was desirable to weld its laws with their religion. None but men possessed of strong sanitary instincts would have considered it necessary to render it illegal that filth should be brought near them, or would have taken care that those following noxious trades, and the " great unwashed generally should not approach them. It is true these sanitary Jaws are known as "rules of caste," but neither their origin nor intention can be mistaken. Were the most recent refinement of scientific research? the bacteriologist?to have it all his own way, I verily believe we should find ourselves bound down by rules as rigid as those of caste; none but men who on penalty of excommunication from the Guild were in the habit of completely washing their bodies and clothing a certain number of times daily, and who would undergo special purification and. a stage of segregation if by force of circumstances brought in contact "
Jan.
1895.]
be permitted to prepare food for We should find it necessary to purify ourus. selves carefully after our chins had been handled by the barber, or we had attended a funeral; we should all be bound to prevent saliva, excrement, blood and other defiling matter reaching our public water-sources ; we should regard sunlight and the living earth" as the great purifiers. Laws such as these must in their day have been of vast benefit to the members of the Guilds which were called upon to live in the midst of an alien and, apparently, not over-cleanly race. The Hindoos, however, by no means possessed a monopoly of a belief in sanitary laws. Mahomedans brought with them the dicta that " cleanliness is the key to heaven," and that the man life of is but the second to the preservation of command of God." In this matter they did not halt at mere theory, as witness the magnificant infiltration galleries, and the distribution of enormous volumes of pure water in pipes under pressure in Aurangabad, Ahtnednugger, Burhanpur, and other localities. In proof of the fact that these works, designed by the Sanitary Engineer of the period before cast-iron pipes had been dreamt of, have fulfilled their function, I may mention that the city of Aurangabad?although the protection of its water-supply is by no means perfect according to modern notions? has, during the 300 years of their existence, been remarkably free from cholera. Indeed, it frequently occurred that, whilst the neighbouring British Cantonment suffered severely, the city of Aurangabad, within a mile of it, remained fairly free. The reason for this comparative immunity being self-evident, in that in the one case a much-defiled stream is the watersource, in the other a partially-protected supply from a good origin. The enlightened Government of H. H. the Nizam sanctioned the opening of water-works for the cantonment. It is a curious commentary upon the principles pursued in these ancient sanitary engineering works that Mr. Marrett?the able Engineer for the modern works?has also drawn his supply from infiltration galleries, the data as to the yield of which he was aided in calculating by an examination of those formed three centuries ago by Malik Umber and Aurangzebe. But, it has been with Hindoos and Maliomedans alike, as it has been with the Jews the other instance where hygienic laws had been knitted to religion?the letter of the law has been fulfiled, but the spirit has been forgotten ; thus, alas, the India of to-day is a by-word amongst the nations as to neglect of sanitation, and is regarded as the home of that muchdreaded pest?cholera. Hence it is in this country, there exists an enormous field for the labours of that modern branch of the medical profession which we recognize as sanitation.
with
15
INDIAN MEDICAL CONGRESS.
unkindly microbes, would our drinking vessels or
handle
"
"
?
Well may the qualifying terra of modern be applied to this science of the West, when compared with the rules of caste of the East with which there is so much akin. The great cholera scare in Great Britain of 1849 pointed to the necessity of concerted public action where grave epidemics were feared; the waste of human life and hardships to which our troops were subjected in the Crimea, taught the public the necessity of attending to the warning voice of Hygiene. As you all know, the outcome of this movement was a demand that our soldiers, when called upon to risk their lives for their country in fair fight, should not be condemned to die by disease born of tilth and engendered by ignorance. This was responded to by the appointment of a Royal Commission, and the founding of the Array Medical School at Chatham and, subsequently, Netley. When quiet times succeeded the troublous days of the Indian Mutiny, officers trained in these schools at the feet of that noble and learned man, the late Professor Parkes, could not fail to be imbued with his unselfish spirit, and thus whilst, on the one hand, they toiled in the various civil stations to which they were attached to start medical institutions, on the other, they did not forget their dutjr as sanitarians. They formed Sanitary Committees whose constant representations to the authoi'ities as to the conditions of the civil populations resulted in the birth of Municipalities and Local Fund Boards, charged with the sanitary administration of urban and rural areas, respectively. Under their pare, also, rose great medical schools, which have afforded training to the important class of private medical practitioners which now shares with the Indian Medical Service the responsibilities of medical and sanitary work in this country, whom we have the pleasure in this Congress of welcoming as valued colleagues capable of aiding us with their experience and advice in the common object of sanitary reform. These advances were made but slowly, but, during the last 15 years, the progress of hygiene has been in geometrical proportion. Investigations in the various sciences which go to make l^giene are now pressed forward wtih feverish haste, and we no longer wait till the experimenter has settled with his publishers as to a book to see the light perhaps a year after completion of his work; we demand that intelligence shall be sent us by wire, and brook no delay in being told that Koch has discovered the bacillus of tubercle ; Klein the streptococcus of scarlatina ; Pasteur an inoculation against rabies, and Haffkine against cholera; that Hankin has demonstrated a new tox-albumin, and Simpson the true origin of vaccine lymph ; that Manson has taught us to dread the mosquito, and Cunningham to think less unkindly of the comma bacillus; that the lucid pen of Hart l
?
?
?
16
INDIAN MEDICAL GAZETTE.
has stirred the length and breadth of the civilized world in demanding better sanitary care of the home of cholera;" and that Miss Florence Nightingale preserves intact her sympathy with sanitary advance in this country. The Royal Commission of 1863, to which India is so greatly indebted for its awakening into sanitary activity, declared that the mortality of the European soldier was equivalent to 69 per 1,000 amongst the men and 31 per 1,000 amongst the officers; while in 1860-61 in jails for native prisoners the mortality was 67'0 per mille. I need not trouble you with a statement of what the mortality was amongst the civil native population, as our registration statistics were at that time and are up to date, far too defective to enable trustworthy figures In accordance with the advice to be furnished. tendered by the Royal Commission, advising bodies were, in 1864, attached to each Government in the form of Sanitaiy Commissions. In 1866 these were replaced by single officers? Sanitary Commissioners. Under their advice, radical improvements were made in dietaries, in the buildings, and precautionary methods pursued in barracks and jails. The deathrate of the Europeau soldier is now about 12 per mille from all causes, and that of our native prisoners about 29 per mille. These results are undoubtedly highly satisfactory, and can be ascribed to no other cause than the placing of the populations concerned under improved hygienic conditions. In regard to jails, although here and there minor insanitary conditions still exist, it may fairly be said that, as to diet, labour, and dwelling accommodation, the native prisoner is well off. I do not believe the same can be said so fully either ofthe British soldier or Native sepoj'. The period of progress inaugurated in 1864 has not been continuously maintained. Typhoid fever claims far too many victims for it to be imagined that the surroundings of the British soldier are free from reproach. I do not forget that Thomas Atkins has his own little ideas of what is good for his internal economy, and imbibes without thought of its origin, vile "cool drinks" prepared for him in the bazars; but, we cannot well regard this?albeit preventible cause?as sufficiently explaining our losses. In the matter of food-supply, which demands the special knowledge not of the medical man only, but also of the chemist and analyst, our Army authorities have become impatient of control or suggestion by the medical profession, and we find the modern tendency is to attempt to educate military officers to do the work of the sanitarian; so that, except at the expenditure of much representation and the risk of considerable opprobrium, it is impossible for the medical officer to reject that which the combatant officer officially responsible for food inspection has "
[Jan.
1895.
already passed. It is highly desirable that military officers should possess the training indicated, just as it is also desirable that medical officers should have sufficient military training to defend the wounded or themselves in desperate positions, as they have so often managed to
do without possessing that advantage. But, whilst I would demand that in action the lives of soldiers should be entrusted to professional combatants, it seems but meet that all matters affecting health should be under as complete control by the sanitarian, as the exigencies of military service would permit. Recent reports by officers of the Army Medical Staff have shown that the dry-earth method of night-soil disposal in certain cantonments is far from above suspicion. Nor, in the more grave matter of water-supply, have our cantonments, in the generation that has elapsed since the appointment of the Royal Commission, been placed in completely satisfactory condition. In two at least of our important military stations in the Madras Presidency, the water-supply is such as to leave little room for doubt that, however much the soldier is himself to blame in contracting typhoid by his gustatory peculiarities in the midst of the bad hygienic conditions of native bazars, there is ample room for his contracting the disease nearer his barracks. In Bangalore, the troops are provided with water from a tank which is supplied by an open channel that passes through a native bazar, but is duly kept clean by means of sweepers, be it noted, are considered whose services, necessary. Forming part of the wall of the supply channel is the main sewer from the This sewer is ingeniously arranged same area. with storm water? so that when over-charged brought thither by open drains which are destined normally to receive the sewage from native houses?relief is obtained by discharge into the water-supply channel, and thus into the tank. We are consoled by the statement of the Engineer authorities in charge that overflow only occurs about five times per annum ! Again, in Madras the so-called Seven Wells water is supplied to the British troops. " bad " by the This water has been pronounced a sanitary whilst Madras Chemical Examiner, that collections shows enormous of survey rubbish containing fsecal matter deposited by the Municipality, sewage farms, and graveyards, are within the same sub-soil sheet as the source. Both in Bangalore and in Madras the British troops have suffered from typhoid fever. They are said to be valued at ?100 per "
"
man.
But there is one class of disease to which the British soldier is subject, which, in the plenitude of the wisdom of Exeter Hall it has been determined, prevention shall not be exercised. In India during 1892, there were inefficient for
-Jan.
INDIAN MEDICAL CONGRESS.
1895.]
the year 27,000 men, or 410 per mille of the average strength, by reason of admission to hospital for venereal disease : find 208 were invalided from this class of disease during the year. Yet, by the repeal of certain ?clauses of the C. D. Act, the hand of Governat the instance of a ment has been stayed narrow-minded section of the British public. In the name of morality, in the name of Christianity, the erring bachelor has been dealt with on the serve-you-right" policy?possible only of adoption by minds devoid of the power of recognizing in what true humanity exists. To what punishment would not these purists condemn the man who, having warned his child that if he played with fire he would burn himself, complacently saw it commit the act of disobedience and be literally done to death ; }'et, the polic}' of non-interference entails present suffering in our fellowmen and their companions in immorality from a disease that may be transmitted to a wife and the innocent infants of a future union. I know of no law of God or man that can give countenance to a policy so cruel. The only possible excuse that can be offered for the leaders of this movement is that they hoped that fear of acquiring disease would act as a deterrent. In this they have exhibited gross ignorance of the laws of Nature; not the biggest scare-crows ever made?and the soldier is aware that the dangers are real enough ?would quench human passion. Neither can it be pleaded that the measure protects women from falling. On the opposite, a system of supervision prevents many from subjecting themselves to degradation so manifest, and must often have saved those from final ruin whose wings have been singed. In mj^ opinion, the result of the repeal of the law has been to extend the circle of immorality, and to bring within the area women who might otherwise have escaped. Nothing short of the moral training that would demand that mankind be "temperate in all things" can afford the result arrived at, and it is to this end, combined with endeavours to make gymnastics and all manly exercises receive far more encouragement than at present at the hands of the authorities, all efforts should tend. The sanitary conditions under which the native troops serve are certainly much superior to those of the average civil native population, and undoubtedly, the small mortality, and especially their comparative freedom from smallpox and cholera, exhibit the results of the supervision exercised. But, in respect to native followers, there can, I think, be little doubt that defects exist. An army wasteful of its transport animals must suffer seriously in the long run, to say nothing of the enormously increased cost to the country employing them. The last Afghan war seems to have taught the necessity for care in '-this particular, and officers and men now receive certain
periods during
"
o
o
training
as
to
before little
see
any
17
loading
thought
and unloading tliat was of. But I have failed to
precautionary
measures
suggested,
or
result of the loss of life amongst native followers which occurred in the various expeditions of late 3'ears in Burma. I cannot here take up your time with details, but I would ask those who have interest in these questions to balance the diet, fuel allowance, and shelter provided for followers, against the work expected of them as weight-carriers 011 lengthy marches, and compare these data with those applicable to native combatants employed side by side with them, and ascertain for themselves whether there does not exist some physiological error which in part accounted for the invaliding and death-rate of that useful class of men. In my humble opinion; these matters should have been carefully sifted, and the medical and sanitary experience gained from our little campaigns in Burma should have been made available for possible heavier struggles in the future. In the case of troops and jails, it is but demanded that the sanitarian should convince the ruling authorities as to the necessity for action, for the latter to find funds and issue orders. With the civil population,the problem is,however, much more complex. It embraces questions as to the sanitary discipline of 212 millions of people inhabiting the most diverse climates, speaking different languages, possessed of different customs I and, above all, bound hand and foot by prejudices which they are but too apt to confuse with instincts. religious Undoubtedly, the foundation of all sanitary efforts must be the existence of suitable laws to support the sanitary executive. Since 1863, we have seen passed laws under which Municipalities and Local Fund Bodies have sprung into existence ; these, in their infancy, were largely controlled by Government officials, but of late 37ears, under the Local SelfGovernment movement, have been placed in the hands of representative native gentlemen. In the case of the Madras Presidency, the Act dealing with the rural tracts has already, since its inception in 1871, undergone one revision, and is now being remodelled by Government. The same is to be said of the District Municipalities Act. For the large Town of Madras, revision of the special Act applicable has also been accomplished. These alterations were largely prompted by the necessity for increased sanitary procedure. In regard to fairs and festivals, increasingly stringent regulations have had some influence in diminishing the appalling loss of life, which the insanitary conditions under which most of them used to take place brought about; but, on this point, much remains to be done. Careful records of factors affecting the health of populations, as to the progress of epidemics, and sanitary subjects generally, may be reckoned by the lakh. Attempts to ameliorate
adopted,
as a
INDIAN MEDICAL GAZETTE.
18
conditions by petty expenditure, and the giving of advice have also everywhere been made in our rural tracts and minor towns. The Yaccination Department has not been idle, and has. made its influence felt upon mortality distinctly; but 110 one has yet been able to convince the Government of India that the employment of a poorly-educated and ill-paid vaccination staff throughout the country is incompatible with the attainment of full results. In rejecting a scheme for employing medical subordinates in the Madras Yaccination Department in 1868, the Government of India informed that of Madras that, the duties" of vaccinators "are purely mechanical," and the rates of pay proposed "are needlessly high from a desire to attract men of education and respectability such as are not required, inasmuch as they would be more expensive agency than is requisite for the purely mechanical duties of vaccinators." During the last 6^ years in the Madras Presidency 201,394 deaths were registered from the preventible disease of small-pox. Taking into account the probable number of survivals from these attacks at 643 per cent., it is calculated that? without taking into account the capitalized value of lives?there must have resulted during sickness and upon funeral ceremonies an unproductive expenditure of 51 lakhs of rupees, if it be presumed that the persons attacked occupied 110 higher position than the cooly gaining Rs. 5 per month. But in the practical application of sanitation, outside the limits of the capitals of the various Governments, our advance has been but little. Unfortunately for the country, it was possible for those responsible for. this absence of progress to shelter themselves behind a motto that was so frequently applied to the Sanitary Department that it became a part of the sanitary creed of the day. There were, it was repeatedly stated, prejudices to overcome; therefore festina lente, be the guiding principle. The phrase must saved much labour, and it became the business of no one to enquire whether these prejudices really were of so serious a nature as to clash with the people's more deeply-seated and legitimate opinions of religion, and?it saved money. Year after year, it was pointed out that if the principles evolved from the investigations of the sanitarian were to be given effect to, speci-
existing
"
ally trained Engineers
to
execute
sanitary
schemes, in consultation with Sanitary Commissioners, were requisite. At last the Secretary of State acted upon these recommendations, and the majority of local Governments are now provided with Sanitary Boards having a Sanitary Engineer as a member. Further, the important principle that Government must aid sanitary advance by direct allotment of funds has now been conceded, and local Governments are responding to the call; in the Madras
[Jan.
1895.
the Government lias, since 1890, in of free grants to Municipalities, given the sum of Rs. 13,05,850, besides advancing loans upon veiy favourable interest to Municipalities for drainage and water-works. 1888? the date of the Secretary of State's Despatch on these subjects?may well be reckoned a new era in the sanitation of India. Since this period we have seen the North-West Provinces busy in the revision of its sanitary laws, especially with reference to the accommodation of pilgrims; a Village Sanitation Bill has been essayed in Bombay ; and Bengal, under that ardent sanitarian Sir Charles Elliott, has excogitated large drainage schemes that, aided by legal measures, are directed against the greatest cause of mortality in this country?malaria : these are measures of the most practical nature which must be far-reaching in their life-saving results. We have seen a well-known bacteriologist appointed at Agra, and to the Sanitary Commissioner with the Government of India a special assistant for bacteriological enquiry has been attached. Methods of intercommunication between presidencies and between neighbouring districts as to movements of epidemics, have been successfully organized. In numbers of the large towns drainage and water-supply works are in actual But, it would be folly to consider progress. there have been made efforts commensurate with the great work cf life-saving before us. Although, as I have shown, it has been possible within the last few years to throw off something of the glamour of that thread-worn proverb, there is still enough of the old spirit of festinu lente prevailing to clog the wheels of progress, and to limit the fuel, the consumption of which makes the machinery exhibit its full value ; I refer to that useful article?money. Schemes for sanitary improvements are still built toilfulljr, yet in hope, are launched upon seas of unbelief, and are wrecked upon the shores of finance. In short, sanitary advance is constantly frustrated by the cry no funds." In this great assembly of sanitarians representing opinions from all parts of India and of Europe, we may well be permitted to ask without being taxed with captiousness, or, in the case of those occupying official positions, insubordination, whether it really be that no funds are available, or that Government has not yet arrived at a sufficient grade of faith in sanitation to devote to it its fair share of funds. I maintain that sanitation neither receives its fair share of funds, nor that place in the Government of the country it
Presidency the
manner
"
merits.
I have had no time to enter into statistics on this subject in other presidencies, but taking the case of Madras, I find that from Provincial funds the average amount spent directly upon sanitation during the last five years was, Rs. 44,660 or 0.15 per cent, of the total fuuds?
Jan.
1895.]
INDIAN MEDICAL CONGRESS.
This expenditure is for a Sanitary Commissioner aided by a single Deputy, who also, under the former officer, is in charge of the Vaccination Department plus an office staff. This represents the total staff devoted solely to sanitary purposes and paid from Provincial funds, for the care of about 36,000,000 people and an area of country about 141,180 square miles. But for education daring the same period, it was found necessary to allow an average of Rs. 12,21,230 per annum, or 4'1 per cent, of the total funds. It is further noteworthy that, whilst expenditure on the sanitary staff, remained practically at the same figure, for education it lias year by year steadily increased, so that although in 1883-84, Rs. 9,52,778 was thought sufficient, in 1892-^3, Rs. 14,06,352 This sum represents the pay was demanded. of a Director of Education who gets a salary of Rs. 2,000?2,250 per month, has a suitable office staff plus an admirable staff of Assistants in the form of Inspectors, Assistant Inspectors and Sub-Assistant Inspectors, male and female. In this statement of expenditure from Provincial funds, no account is taken of grants for buildings for educational purposes, which, in the Presidency Town alone cost Rs. 13,34,355. The Government lias remained so convinced as to the necessity for this outlay, that it has felt it desirable, in the interests of economy, to issue its orders from an ancient building, which is a cross between a barrack and the office of a commercial firm?affording a decided contrast to the magnificent educational buildings such as the Presidency College, the Senate Hall, and Law College which are in its proximity. Even were the provincial grants to Municipalities I have mentioned taken into account, the percentage from Provincial funds for sanitary works and sanitary staff would amount to 0*57 against 4T for education excluding grants for works and buildings. Nor does the Educational Department cease its demand for money only from Provincial funds. It duly asks and receives its share from Municipal and Local Funds. I find that, in 1893, the Educational Department spent from Provincial and Local Funds Rs. 21,32,281 against Rs. 7,88,000 devoted to sanitation, or a proportion of 5'4 per cent, against 2"0 per cent, of the total funds. On combining the figures for Provincial Funds, Local Funds and Municipalities, it is found that education consumes 5'5 per cent, against 3'0 per cent, for sanitation. As far as it has been possible to effect this from the data available, this sum represents net expenditure. The amount spent in sanitation represents the maintenance charges for conservancy staff and the upkeep of plant for a population of 36,000,000. There are doubtless other departments which also recei ve more than their fair share of available funds, and thus tend to render sanitary
19
but I have utilized this the Educational Department of Madras has long been subject to the well-merited criticism of over-production, whilst like Oliver Twist it for ever demands more. In the Madras Presidency, notwithstanding the" popular opinion outside our limits that we are benighted," the land is flooded with B. A.'s and Vakeels; or, in other words, with educated men. The best evidence of over production is the market value of any article, and I may state that the finding of employment of any sort for University graduates is so difficult that they willingly accept posts on pay little better than that of a good class of domestic servants, whilst with Vakeels the earning of a living in strict accordance with legal ethics is becoming increasingly difficult, notwithstanding the extraordinary fondness of the people for litigation. But it may be said that education is the best ally that hygiene could have, and but paves the way for sanitary advance. Well, I have carefully watched results, and have attempted to believe that this is so ; but I am driven to the conclusion that this theory must be accepted with reserve. Whilst, doubtless, education lias given to us in every part of the country consistent and earnest advocates of sanitation, in a large number of cases practice and theory do not go hand-iuhand. The average educated man will not scruple in the morning to proceed to the riverside or tank and perform there his complete toilet, using water, that he sees is undergoing contamination within a stone's throw by his male and female brethren; although, in the evening, he will fully grasp the refined hygienic details of the evil results of earl}'' marriage, and will give his vote at crowded meetings as to the abolition of the nautch girl. Not only has the Educational Department been guilcy of over-production in the higher branches, but they have committed the fatal error of neglecting sufficiently to advance female education. It has apparently been forgotten how powerful and obstinate an advocate the female part of the population is of various superstitious This neglect has rendered it almost imcustoms. possible for educated natives to carry into their every-day life the practice of sanitation, of which they have duly learnt the theory. In the mental culture of women I, therefore, think lies a far more legitimate field for the spending of public money than in the over-production of Yakeels and B.A's. But, irrespective of this great impediment, it is manifest that large as the number of educated men is, their influence upon the masses can be but small; where this can best be felt is almost solely in the large towns?the rural population representing the bulk of the people being practically beyond their sphere of influence. This mistake is beginning to dawn upon the public, and the Madras Government is now doing its best to favour primary and technical education?just advance
instance,
impossible; as
INDIAN MEDICAL GAZETTE.
20
[Jan.
1895.
no public praise, but at the attaining where their predecessors' efforts should have at securing of the ample reward?even in a greater measure commenced. This form of education which will which our brethren engaged in medicine raise the status of the lower classes and assist in?for and surgery are willing to toil by night and by the developing long-neglected natural resources the pleasure of being the instrument, in of the country doubtless will effectually aid day; God's hands, of relieving suffering and saving sanitary advance, and, were it to be understood life. For the sanitarian is reserved the joy not that the new scheme is to be pushed forward by the solitary weakly patient day by day of retrenching the useless expenditure upon over- seeing strength to resist the onslaught of death, production in the higher classes of education, the gather but of saving lives that may be counted by thousmovement would have the full sympathy of for him is reserved the happiness of seeinothose interested in sanitation. But there is every ands; where before the unkempt street Arab revelled in reason to believe that the changes incurred will filth appear a new generation in the full vigour form increased increments against funds that of health, and where disease, poverty and vice might otherwise be available for sanitation. If to find instead temperance, hapto hasten slowly" has been the principle enun- reigned supreme, and wealth enthroned Here is true phipiness, ciated for the guidance of the Sanitary Departto those who have felt this pleasure " the people die not slowly, therefore be lanthrophy ; ment, can be no wonder that the ancient there religions philanthropic and hasten their education" has of nations having little else in common, were been that unconsciously acted upon as regards united in finding a place for hygiene ; for its first the Educational Department. is respect for the rights of our neighbours. dictate In speaking thus, it must not be imagined that thus that hygiene claims a fraternity It is I would prefer not to see the country overrun from which neither Christian, Hindu, Sikh nor with highly-educated men. Provided these genSocialist nor Autocrat, can with a tlemen could get a living satisfactorily to them- Mussulman, clear conscience hold himself aloof. Under the is a distinct factor in the selves, their existence banner of hygiene, we are capable of knitting advance ot' the country; whilst socially their every race and creed, because we labour together mental culture makes acceptable comrades and for no selfish purpose?we endeavour to secure to who would otherwise be of friends men, incapable man God's greatest blessing?health : we labour of exchanging an idea with their fellow-beings to preserve His most precious gift?life. of the West; but I certainly think the time has come to consider, in view of over-production and the more pressing claims of the population upon Government f?>r the preservation of health and decency, whether the higher class of education should not be secured by those desiring this luxury otherwise than at the hands of an elaborate department receiving pay and pensions from Government. I need not say we do not grudge our fellow-officials of the Educational Department the success which has attended their efforts, to persuade Government to give them of the sinews of war. so large a proportion The Sanitary Department has just as great opportunities to plead the cause of sanitation as they have possessed as to education ; they have succeeded where we have failed. It is obviously to remedy this state of affairs that we must exert ourselves. If we believe in the enormous importance of hygiene in the saving of human life and suffering, we as a body and as individuals will not rest until we see this country provided with and a correctly-organized a better share of funds Health Public Department, capable of investigating and dealing with the causes of disease, and methods of expensupervising and controlling the diture upon sanitation. In undertaking to secure these ends, we may well consider it our duty to press forward at the risk of being regarded by the public as mere faddists," and men possessed of not the slightest comprehension of what the demands upon the State are. This, however, we can well afford to brook. We aim "
"
