town, tliat the real basis
are on which these dispensaries gratuitous supply of medicine and advice. If, for example, a trial could be given to a different system, by subsidising the Baids and Hakimjees with a fixed salary, residence, and pure and free drugs, while the Hospital-Assistants were sent to make a living from the people, to buy, sell, and visit on fees, there might possibly be a more correct, if greatly reduced, appreciation of the value which the people place on our medical science. As a matter of fact, it is ill-suited to the conditions of their lives, to their poverty, their exposure, and their daily necessities. But this is a subject too general to be pursued on this occasion. Sir John Stracliey has ordered that as much as possible the branch dispensaries, and especially the distant ones which escapo inspection for long periods, shall be closed; that the independent charges, hitherto looked upon as such prizes by Hospital-Assistants, shall be exceptional; and that it shall in future, be the endeavour of the medical administration to keep dispensaries under assistant-surgeons only, who arc fitted for the duties by a much superior education and training. He has also ordered that the dispensaries in which the conditions for Government support are not fulfilled, by a local contribution of a moiety of the expenses, shall, after two years' grace, be closed; and at the present time the Inspector-General of civil hospitals is engaged in collecting monthly returns with a view to ascertain more clearly the financial support,, accorded to each of them. In these measures of the Local Government wc cordially The aim is to maintain the character and position concur. of the medical profession, as well as to save the expense of
worked is
POOR-HOUSES
OR HOSPITALS P
of tlie North-Western Provinces are, at
The dispensaries present, undergoing a critical inquiry as to their real value Sir to the people for whose benefit they were established. John Strachey, as Lieutenant-Governor, took a very different view from that of his predecessors, for in future, quality, and not quantity, shall bo the standard of merit. For many years past, these institutions, in their several varieties of Sudder, Branch, Municipal, &c., have sprung up in each important town; their rise being chiefly prompted the progress of ideas which were understood to command sympathy of those in authority. A jshort ex-
by
the favourable
perience," however, has shown, that, in a great many instances, they were not really required; and it is important to note, as an instance of real opinion, that such mushroom growths met with the same fate as similar projects in more civilized countries. They drooped and failed, notwithstanding the prestige of their establishment, and the common people ceased to subscribe simply because the dispensaries were not wnnted. Sir John Strachey, in his review of Dr. W. "Walker's annual report of the dispensaries of the North-Western Provinces for 1875, very clearly hits the blot on their foundation. The Hospital-Assistants, to whom many of the branch dispensaries have been entrusted, have not come well through the trial. Originally of second-rate abilities and education, these subordinates have
subsided into
absolute
inefficiency They
niente of rural duties.
removed to the dolce
attention long ago, and not have been of a civil ruler. For a long time, each
left to the sagacity medical subordinate who has been appointed to these charges, has considered increased attendance to be the infallible proof of his
popularity,
the
"
and of the enduring nature of his medical
thing
on
inspection
numbers" in the books and to maintain the
regarding back ground,
"
cases."
visits is to show discrcet silence
altogether left remarked by people
It has been
but none the less
a
At the
system
have
engaged professidhal
instruction ; and the first
institutions which
when
far always looked forward, during their military service, to that happy time when, relieved from control except a nominal inspection twice a year, tlicy could collect their Lares and Penates around them, have a few servants to prepare sundry stock recipes, and, beyond a couple of hours' lazy attendance on out-patients, have all the rest of the day to their private pleasures and amusements. The result is, that English medical science has become degraded and worthless in the eyes of the common people; they have preferred to be treated by their own national physicians ; and it is extremely doubtful if even our surgery, which has hitherto stood us in good stead, has not also been brought into disrepute. If it has not, the credit it enjoys is mostly due to the marvellous cures still effected under the skilful treatment of a few, and to the village talk which greets the cured sufferer on his return home. \Ye are very glad that this matter has been taken up so vigorously by the Lieutenant-Governor. It should have
a
same
which are
discusscd at the
.
are
not necessary. are other features in the
time there
dispensary
kept out of sight, but which may well be present moment when the welfare of the
whole, and the existence of many, are at stake. In one sense the dispensaries are, by the act of Government, placed in a false position; there are duties laid down as incumbent on the staff, which arc improper to any hospital economy ; and it is very possible that under this alien charge, much of the coldness and want of sympathy manifested by the people, originate. Wo speak now of the admission, as house patients of those destitutes, more fitted for a relief-refuge than a to the dispensary for food, who carried are hospital, and medical treatment, simply becausc there is no shelter, poor-law and no poor-house. The dispensaries are made to do this duty, and they do it in obedience to orders, but at the expense of their popularity and at the peril of their This class of destitute sick is supplied other sick patients. in several ways ; many of them are professional beggars, worn out; many are religious mendicant s ; some are houseless and disgraced ; some are labourers on the tramp ; some are pilgrims who have fallen by the way. It is not of much importance to explain whence they come, but their condition, when they are carried in by the Police and laid at the dispensary gates, is generally very uniform. They are often entirely naked; if they have any clothes these are filthy and disgusting to a degree; their persons arc emaciated; their
in the
hair crowded with insect life ; their habits to the last extent
of the
degraded
and
insensible to improvement.
Some
may
lie
Maech 1.
PENSIONS AND DEFERRED ANNUITIES.
1877.]
suffering from an incurable dysentery or diarrhoea?tlie result of long exposure, of food which has been given when stale and cold, of raw cereals often distributed by a bunniah in charity and when diseased unwholesome?anaemia, pneumonia, any or all of these conditions accompany the unfortunate half-starved wretch on admission. Of course, those who are
really
ill
require medicine
cases
are
admitted into
well
as
food, but then when such
as
there
hospital
a
to be separate have no doubt
ought
provided for them. We dispensaries the best that can be shaved and washed, their clothes
accommodation that in many that new
they
are
medical comforts
know in how many
But
provided.
are
removed and
that the best food
and
supplied;
ones
done is done ;
we
possible
half of this is
dispensaries only
and
should be glad to
done,
and in
how many more nothing whatever is done, and where the moribunds find little else but shelter and that of the poorest. And even
when the best has been done the mischief is not averted.
How is it
possible
that
poverty, have known to be house
patients
mity,
of home
6ense
a
where such
It is not
close to them.
people who,
the
only
as w
even
in this land of
comfort,
endure
can
mere
proxi-
that may be excused when oneself is also sick ; it being in the same room, and having to
even
is the real nuisance of
up with the sights, the smells, and the atrociously filthy habits. A well-ordered hospital should take a pride in the
put
and of
purer than
absence of such
things,
but, in such
sense, it would not be venturesome to assert
a
that there is not
being
even
a
home ;
well-ordered
hospital in India. mortality among this class is fearful, and lias a marked deterring influence on those who might gladly become house patients with benefit. For the purpose of this article we have ascertained that in one small dispensary in the North-Western Provinces putting up 12 beds, there were, in 1874, 26 destitute patients admitted, and 12 deaths ; in 1875, And
again,
a
the
25, and 9 deaths ?
;
in 1876, 28, and 13 deaths.
In the whole of the
vinces there
were
of the North-Western Pro-
in?
1871 1872 1873 1874 1875
...
dispensaries
...
...
...
...
...
The deaths are not
296")
520 932
J
J-
Destitute House Patients.
| 962J
1,002
separately shown, but a
;
the
and it is
invidious distinctions. the' condition- already who is
tree
Thereupon
One man is brought to-day in described, and to-morrow, another notoriously a professional beggar. Times are
hard with him, and lie has determined that it will be comfortable;, to pass, the ; winter as
a
he lies down under
the sunny side of a wall, and complains to the first person of position that passes, or to all who will listen to him, a
or
that he has
nothing to eat and has just been discharged from dispensary. On the'other hand, if the charitable" part of the institution is freely given, there are numbers to avail themselves of it. Not only will beggars gladly make it their home, but private families in distant villages will hear of the good thing going on, and bring their relatives, incurably bed-, ridden, to be cared for in the hospital. "
the
Now, it is not contended for such as has been and
pictured, is half-starved, destitute,
die uncared for. ment
arc
to be
a
moment that real distress,
disregarded by (Government,
and homeless
Par from it!
ones are
to be left to"
The sentiments of Govern^
well known that the poor shall not be allowed to
starve, and, whether
on a
scale of
thousands, hundreds,
or
teii&,
this must be averted. Bnt
we
do contend, very reasonably, that the necessity of a not be shirked by putting the burden of it
poor-law should on dispensaries. and simple, as
It is not a
a
duty
which
part of the medical
ought to remain, pure profession. And since
the Government of the North-West em Provinces has admitted the
failing popularity of dispensaries, and called for an inquiry as to the falling off in their support by the people more directly concerned in their maintenance, it seems that the inquiry should first and foremost have been directed to the reasons why support has been withdrawn. It has, perhaps a little too readily, been assumed that it results from dissatisfaction with Western medicine as practised by subordinates of inferior education.
No doubt, this has been
a
very serious
only one. Sir Jolui Stracliey may close the branch dispensaries, but it is more than likely that the decay will spread soon to the sudder dispendefect; at the
same
time it is not the
saries also ; and matters will not
assume
a
healthy
tone until
profession has been left free to its proper duties, and the care of the poor and destitute made a distinct branch
figures given likely that these guess provide by no mean# represent the whole truth. The Medical staff, very naturally, shrink from admitting more than is absolutely necessary. There are hundreds in remote, villages that cannot be got within the radius of hospital relief; there are many hundreds more who ought to get relief sooner, and, as the terrible mortality shows, fail to receive it till it is too late. All this points to a very serious defect in the Civil Administration,^ initio. It is not fair that dispensaries, and the medical profession at large, should have this duty of a Parish relief wholly put upon them; and, as long as it is so, of the hospital must involve the charge many other
applies
told to go about his business.
the medical
above may at least
.
arranges to be picked up by the Police and carried thither as:" adestitute." He is admitted, and after a week's observation
have described may bo
shrinking from
175
house patient.
.He
accordingly
as
it is in every other civilized
country.
are on which these dispensaries gratuitous supply of medicine and advice. If, for example, a trial could be given to a different system, by subsidising the Baids and Hakimjees with a fixed salary, residence, and pure and free drugs, while the Hospital-Assistants were sent to make a living from the people, to buy, sell, and visit on fees, there might possibly be a more correct, if greatly reduced, appreciation of the value which the people place on our medical science. As a matter of fact, it is ill-suited to the conditions of their lives, to their poverty, their exposure, and their daily necessities. But this is a subject too general to be pursued on this occasion. Sir John Stracliey has ordered that as much as possible the branch dispensaries, and especially the distant ones which escapo inspection for long periods, shall be closed; that the independent charges, hitherto looked upon as such prizes by Hospital-Assistants, shall be exceptional; and that it shall in future, be the endeavour of the medical administration to keep dispensaries under assistant-surgeons only, who arc fitted for the duties by a much superior education and training. He has also ordered that the dispensaries in which the conditions for Government support are not fulfilled, by a local contribution of a moiety of the expenses, shall, after two years' grace, be closed; and at the present time the Inspector-General of civil hospitals is engaged in collecting monthly returns with a view to ascertain more clearly the financial support,, accorded to each of them. In these measures of the Local Government wc cordially The aim is to maintain the character and position concur. of the medical profession, as well as to save the expense of
worked is
POOR-HOUSES
OR HOSPITALS P
of tlie North-Western Provinces are, at
The dispensaries present, undergoing a critical inquiry as to their real value Sir to the people for whose benefit they were established. John Strachey, as Lieutenant-Governor, took a very different view from that of his predecessors, for in future, quality, and not quantity, shall bo the standard of merit. For many years past, these institutions, in their several varieties of Sudder, Branch, Municipal, &c., have sprung up in each important town; their rise being chiefly prompted the progress of ideas which were understood to command sympathy of those in authority. A jshort ex-
by
the favourable
perience," however, has shown, that, in a great many instances, they were not really required; and it is important to note, as an instance of real opinion, that such mushroom growths met with the same fate as similar projects in more civilized countries. They drooped and failed, notwithstanding the prestige of their establishment, and the common people ceased to subscribe simply because the dispensaries were not wnnted. Sir John Strachey, in his review of Dr. W. "Walker's annual report of the dispensaries of the North-Western Provinces for 1875, very clearly hits the blot on their foundation. The Hospital-Assistants, to whom many of the branch dispensaries have been entrusted, have not come well through the trial. Originally of second-rate abilities and education, these subordinates have
subsided into
absolute
inefficiency They
niente of rural duties.
removed to the dolce
attention long ago, and not have been of a civil ruler. For a long time, each
left to the sagacity medical subordinate who has been appointed to these charges, has considered increased attendance to be the infallible proof of his
popularity,
the
"
and of the enduring nature of his medical
thing
on
inspection
numbers" in the books and to maintain the
regarding back ground,
"
cases."
visits is to show discrcet silence
altogether left remarked by people
It has been
but none the less
a
At the
system
have
engaged professidhal
instruction ; and the first
institutions which
when
far always looked forward, during their military service, to that happy time when, relieved from control except a nominal inspection twice a year, tlicy could collect their Lares and Penates around them, have a few servants to prepare sundry stock recipes, and, beyond a couple of hours' lazy attendance on out-patients, have all the rest of the day to their private pleasures and amusements. The result is, that English medical science has become degraded and worthless in the eyes of the common people; they have preferred to be treated by their own national physicians ; and it is extremely doubtful if even our surgery, which has hitherto stood us in good stead, has not also been brought into disrepute. If it has not, the credit it enjoys is mostly due to the marvellous cures still effected under the skilful treatment of a few, and to the village talk which greets the cured sufferer on his return home. \Ye are very glad that this matter has been taken up so vigorously by the Lieutenant-Governor. It should have
a
same
which are
discusscd at the
.
are
not necessary. are other features in the
time there
dispensary
kept out of sight, but which may well be present moment when the welfare of the
whole, and the existence of many, are at stake. In one sense the dispensaries are, by the act of Government, placed in a false position; there are duties laid down as incumbent on the staff, which arc improper to any hospital economy ; and it is very possible that under this alien charge, much of the coldness and want of sympathy manifested by the people, originate. Wo speak now of the admission, as house patients of those destitutes, more fitted for a relief-refuge than a to the dispensary for food, who carried are hospital, and medical treatment, simply becausc there is no shelter, poor-law and no poor-house. The dispensaries are made to do this duty, and they do it in obedience to orders, but at the expense of their popularity and at the peril of their This class of destitute sick is supplied other sick patients. in several ways ; many of them are professional beggars, worn out; many are religious mendicant s ; some are houseless and disgraced ; some are labourers on the tramp ; some are pilgrims who have fallen by the way. It is not of much importance to explain whence they come, but their condition, when they are carried in by the Police and laid at the dispensary gates, is generally very uniform. They are often entirely naked; if they have any clothes these are filthy and disgusting to a degree; their persons arc emaciated; their
in the
hair crowded with insect life ; their habits to the last extent
of the
degraded
and
insensible to improvement.
Some
may
lie
Maech 1.
PENSIONS AND DEFERRED ANNUITIES.
1877.]
suffering from an incurable dysentery or diarrhoea?tlie result of long exposure, of food which has been given when stale and cold, of raw cereals often distributed by a bunniah in charity and when diseased unwholesome?anaemia, pneumonia, any or all of these conditions accompany the unfortunate half-starved wretch on admission. Of course, those who are
really
ill
require medicine
cases
are
admitted into
well
as
food, but then when such
as
there
hospital
a
to be separate have no doubt
ought
provided for them. We dispensaries the best that can be shaved and washed, their clothes
accommodation that in many that new
they
are
medical comforts
know in how many
But
provided.
are
removed and
that the best food
and
supplied;
ones
done is done ;
we
possible
half of this is
dispensaries only
and
should be glad to
done,
and in
how many more nothing whatever is done, and where the moribunds find little else but shelter and that of the poorest. And even
when the best has been done the mischief is not averted.
How is it
possible
that
poverty, have known to be house
patients
mity,
of home
6ense
a
where such
It is not
close to them.
people who,
the
only
as w
even
in this land of
comfort,
endure
can
mere
proxi-
that may be excused when oneself is also sick ; it being in the same room, and having to
even
is the real nuisance of
up with the sights, the smells, and the atrociously filthy habits. A well-ordered hospital should take a pride in the
put
and of
purer than
absence of such
things,
but, in such
sense, it would not be venturesome to assert
a
that there is not
being
even
a
home ;
well-ordered
hospital in India. mortality among this class is fearful, and lias a marked deterring influence on those who might gladly become house patients with benefit. For the purpose of this article we have ascertained that in one small dispensary in the North-Western Provinces putting up 12 beds, there were, in 1874, 26 destitute patients admitted, and 12 deaths ; in 1875, And
again,
a
the
25, and 9 deaths ?
;
in 1876, 28, and 13 deaths.
In the whole of the
vinces there
were
of the North-Western Pro-
in?
1871 1872 1873 1874 1875
...
dispensaries
...
...
...
...
...
The deaths are not
296")
520 932
J
J-
Destitute House Patients.
| 962J
1,002
separately shown, but a
;
the
and it is
invidious distinctions. the' condition- already who is
tree
Thereupon
One man is brought to-day in described, and to-morrow, another notoriously a professional beggar. Times are
hard with him, and lie has determined that it will be comfortable;, to pass, the ; winter as
a
he lies down under
the sunny side of a wall, and complains to the first person of position that passes, or to all who will listen to him, a
or
that he has
nothing to eat and has just been discharged from dispensary. On the'other hand, if the charitable" part of the institution is freely given, there are numbers to avail themselves of it. Not only will beggars gladly make it their home, but private families in distant villages will hear of the good thing going on, and bring their relatives, incurably bed-, ridden, to be cared for in the hospital. "
the
Now, it is not contended for such as has been and
pictured, is half-starved, destitute,
die uncared for. ment
arc
to be
a
moment that real distress,
disregarded by (Government,
and homeless
Par from it!
ones are
to be left to"
The sentiments of Govern^
well known that the poor shall not be allowed to
starve, and, whether
on a
scale of
thousands, hundreds,
or
teii&,
this must be averted. Bnt
we
do contend, very reasonably, that the necessity of a not be shirked by putting the burden of it
poor-law should on dispensaries. and simple, as
It is not a
a
duty
which
part of the medical
ought to remain, pure profession. And since
the Government of the North-West em Provinces has admitted the
failing popularity of dispensaries, and called for an inquiry as to the falling off in their support by the people more directly concerned in their maintenance, it seems that the inquiry should first and foremost have been directed to the reasons why support has been withdrawn. It has, perhaps a little too readily, been assumed that it results from dissatisfaction with Western medicine as practised by subordinates of inferior education.
No doubt, this has been
a
very serious
only one. Sir Jolui Stracliey may close the branch dispensaries, but it is more than likely that the decay will spread soon to the sudder dispendefect; at the
same
time it is not the
saries also ; and matters will not
assume
a
healthy
tone until
profession has been left free to its proper duties, and the care of the poor and destitute made a distinct branch
figures given likely that these guess provide by no mean# represent the whole truth. The Medical staff, very naturally, shrink from admitting more than is absolutely necessary. There are hundreds in remote, villages that cannot be got within the radius of hospital relief; there are many hundreds more who ought to get relief sooner, and, as the terrible mortality shows, fail to receive it till it is too late. All this points to a very serious defect in the Civil Administration,^ initio. It is not fair that dispensaries, and the medical profession at large, should have this duty of a Parish relief wholly put upon them; and, as long as it is so, of the hospital must involve the charge many other
applies
told to go about his business.
the medical
above may at least
.
arranges to be picked up by the Police and carried thither as:" adestitute." He is admitted, and after a week's observation
have described may bo
shrinking from
175
house patient.
.He
accordingly
as
it is in every other civilized
country.
