Medical Department
INTRODUCTORY

                                ONE of the peculiarities of administration in India is the extent to which the provision of medical aid for the people rests on the shoulders of the Government. In a healthy community the sphere of Government action outside certain recognised spheres tends always to contract; in one which is feeble or unsound it tends always to expand. Judged from this standpoint there are few if any countries which show such a miserable lack of robustness as India. Normally Government action is limited to the management of only such affairs as cannot be conducted by local or private enterprise either at all or with sufficient efficiency and organised power. Foreign affairs and the maintenance of national defence, legislation and the administration of justice and maintenance of order, the imposition and raising of the revenues necessary for public administration comprised under the old theory of politics the main sphere of Government. In our own times all matters of public or national concern are held to be a fit province for Government action; but chiefly in the way of assistance, general regulation or the maintenance of a certain standard of efficiency or public morality. Government for instance assists national trade and industry by a bureau of statistics and information, protects it by tariffs, regulates it by seeing fair play in essential matters between employers and employed or by enactments regulating navigation. Similarly it may exercise a watch and light general control over all forms of local self-government. In one sphere especially State action is being everywhere more and more imperatively called for, in all civilised nations; it has become an axiom of modern politics that the provision of universal education is the duty of the State. Yet even here the necessity is rather a result of the circumstances of modem national life than a permanent principle. The action of certain nations driven by their comparative weakness to find a counteracting force to the superior individual energy of other nations in

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the universal education of the community by the State and the success with which they have used this lever to raise themselves to preeminence in commerce and politics has made it an essential condition of self-preservation to all civilised countries. Without universal education a nation nowadays is self-condemned to stagnation and decay. But it is conceivable that when all the great nations stand on an equal level in this respect, the grip of the State on education may again relax and the duty of Education will again gradually devolve on local and private effort, the State confining itself to its fundamental duty in all matters of public concern, assistance, general regulation and the maintenance of a high standard. Even now a large element of private and voluntary enterprise is a healthy element in the provision of education, as necessary for variety, life and progress as State control for generality and a high standard of efficiency.

                There are at least two departments of medical activity in which the State may claim a predominating voice, Sanitation  and Medical Education. But the peculiar circumstances of this country have enforced it to take up a third burden which in wealthier, better-educated or more advantageously circumstanced countries is undertaken by individual enterprise and private charity, the provision of medical assistance. The utmost that could usually be expected of the Government in this line would be the establishment of State Hospitals in large towns where there existed a large and congested mass of poverty. But in India the State provides not only these but covers the land with skilled medical help and dispensaries, bringing assistance to the doors of the people gratis or at a nominal price. The reason of this state of things does not lie altogether in the poverty or helplessness of the people.

                Previous to the British rule medicine was practised in India as in Europe by a class of skilled physicians using their knowledge as a means of independent livelihood. The princes and nobles of the land might maintain a family Hakim or Vaidya, but there was no idea and probably no great necessity of providing State or charitable help in any systematic shape to the mass of the population. The fees of the local physicians were not beyond the means of an ordinary income, and the great mass of

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the people living healthy open-air lives and observing rules of life which the experience of generations had established as suitable to the climate, enjoyed greater immunity than in these days from ordinary diseases and trusted more with justification to the vigour of their natural constitutions for recovery when attacked. The great epidemics which sanitation and prophylactic measures combat with so large a measure of success, were regarded, in India as in mediaeval Europe, as divine visitations borne with terror perhaps, but without any idea of organised resistance.
                With the British rule came a marked change. There was in this country an ancient and indigenous system of medicine, which had shared the fate of the other Hindu arts and sciences both in the comparatively high degree of scientific knowledge and intelligent practice it had reached in astonishingly early times and in the premature blight which had subsequently come over it. In surgery, in pharmacy and in sanitation its knowledge was sound and masterly; it conducted successfully surgical operations which would have been far beyond contemporary science in Europe; it had amassed a pharmacopoeia from indigenous drugs, which, however imperfect, was possessed of considerable merit and efficacy; and its rules of sanitation were exhaustive, sound and in consonance with the scientific opinion of today. Its theory of the human body was, it is true, rather in agreement with ancient opinion than the more enlightened modern ideas, but its practical science was superior to its theory. Upon this promising science as upon almost everything else in India there fell a curse of stationariness and decay. Its practice became mechanical; its science fell into desuetude; the old authorities couched in the learned tongue came to be repeated by rote; its pharmacopoeia was ministered without intelligence or original research and analysis and therefore with only a fitful efficacy; surgical knowledge ceased to exist except in a rudimentary form, and sanitary rules once invested with a religious sanction came to be flagrantly violated in the daily practice of the people. Mahomedan medicine, a mediaeval science based on the Greek, did not tend to correct this state of things; it only added another imperfect system to the existing one. To a country thus circumstanced, Western civilisation came with a medical science which, recovered

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from its old stagnation, was making immense strides, with a vastly superior pharmacy, an ever bolder and more subtle surgery and organised and living grasp of sanitation.

             When the British Government finally established itself throughout the country, its enlightened and benevolent instincts left only one course open to it. The epidemics which yearly devastated filthy and insanitary towns and villages must be in some measure combated. A population scattered through the country in innumerable small villages without any means of adequate medical assistance, must be familiarised with the more advanced science of the West. But there was no body of men in the country itself who could replace as an independent profession the old Vaidyas, Kavirajas and Hakims by the application of the new science, nor could the Government wait for the necessarily far-off time when such a class, in sufficiently large proportions, could be elaborated. The necessary consequence was the development of the Indian Medical Service one of the most beneficent institutions of the British rule; and with this development came, as an obvious corollary, the establishment of Government dispensaries all over the country. One of the latest minor developments in this line, the action by which small quantities of quinine are sold at the Government Post Offices as a remedy for malarious fever, is a characteristic instance alike of the curiously paternal nature of the British rule and of the unique state of things prevailing in this country. Of this state of things great poverty is a necessary feature, otherwise Government assistance might be gradually replaced by the class of professional men with diplomas from the Indian Universities who are now to be met with in increasing numbers in every considerable town. But such men have small chance of success in the rural districts among a population too poor to pay for efficient medical assistance. The great bulk of the population must for long depend upon the gratuitous assistance which the Government has placed at their doors.

                  In Baroda the old system prevailed almost until the year of my accession. At that time the only public provision of medical aid on modern lines was one hospital at Baroda under the Residency Surgeon, two small military hospitals in Kathiawar and

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three dispensaries in various parts of the State. At the same time a number of Vaidyas and Hakims, about 25 in all, were maintained by the State for the benefit of the Troops, the prisoners in the jail and the State officials. These had their charges in a manner farmed out to them, for they were expected in lieu of a regular remuneration to provide drugs and other medical necessaries from their own resources. One State Hakim drew the immense salary of Rs.5000 a month; the others, though not so fortunate, had certain advantages within their grasp. These physicians were attached to different Departments and in some cases the same man held charges in two, three or more departments, thus drawing a multi fold salary and farming out each branch of his work to someone else at perhaps a third of the stipend attached to it. These easy and profitable posts descended in practice from father to son, and often had privileges attached to them of considerable pecuniary value. The medical expenditure on their salaries amounted to about £20,000, and their privileges to at 1east 10,000 more. In 1876-77 this system was swept away, the whole staff being pensioned off for an aggregate sum of Rs.545 per month and a regular Medical Department instituted. Dr. Cody, a medical officer of the British service, was appointed Chief Medical Officer and 4 hospitals and 9 dispensaries were opened in Baroda, Nowsari, Sidhpur, Kadi, Pattan and other important places in the territory. These were added to in successive years and in 1880-81 there existed 11 hospitals, 23 Dispensaries and one Veterinary Hospital. A Vaccination Department had been organised under the supervision of the Residency Surgeon several years before and this under the new regime was greatly strengthened; 3 inspectors, 31 vaccinators, 6 probationers and 34 peons formed the staff. The strength of the regular Department numbered besides the Chief Medical Officer, 10 Medical Officers, 46 Hospital Assistants and 34 Medical pupils; the Veterinary Hospital was in the charge of a Surgeon and one veterinary pupil; a midwife was also maintained by the State for the city of Baroda. During the five years from 1875-1880, Rs.858,550-5-6 had been expended by the State on its Medical Department.

               The work done up to this date could only suffice for the most urgent and immediate needs of the principal towns of the Raj.

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The twenty years from 1880 to 1900 have accordingly been devoted not only to expansion on the lines already laid down, but to the inception of larger work in the sphere of Sanitation and the introduction of improved methods and organisation in the Department. Of the 35 institutions already existing, several have been discontinued owing to the cessation of the special need for which they were created; for instance the military dispensaries at Deesa and Manekwada came to a natural end with the cessation of the contingents there stationed. On the other hand, 24 new institutions have been established, 20 dispensaries, 2 veterinary dispensaries, and one Lunatic and one Leper Asylum, raising the total number to 54. Most of the towns of the Raj which are at all considerable have therefore been provided with these facilities for medical assistance.
                It has not been found necessary to increase the number of, Hospitals, the provision already made being sufficient for the present and liberal in proportion to the extent and needs of the territory. In the city of Baroda itself there are as many as three Hospitals. The oldest, once known as the State Hospital, dates back to the times of the Maharaja Ganpatrao and was from its inception till 1881 under the supervision of the Residency Surgeon. So long as there was a lack of- qualified medical talent in the country, such an arrangement was no doubt advisable and necessary, but by this time the conditions which necessitated it had ceased to operate, and after assuming powers I appointed Dr. R. H. Nanavati to be in charge of the Hospital; it has since been under the management of different State Medical Officers. The housing and accommodation had ceased to be sufficient for what was intended to be the first Hospital in the State; accordingly in 1882-83 the old building was pulled down and a new one erected in its place, the Hospital being temporarily transferred elsewhere. The new building is a fine red brick building just outside the city, graceful in architecture and sufficient in accommodation. It is now called the Countess of Dufferin Hospital as a compliment to a lady whose name will always be remembered in India in association with high benevolence, active sympathy with suffering and an earnest desire to ameliorate the condition of Indian women. Another and smaller building was added to the

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Hospital in 1898-1899 for the accommodation of women of respectable families and styled the Victoria Jubilee Ward and a final addition for the use of patients from the army, called the Sayajirao Military Ward, completed the building as it now stands. The hospital is well equipped with instruments and appliances; in 1893-1894 Rs.5000 worth of instruments were ordered out from England and in 1900 after visiting the Paris Exhibition I sent many of the latest scientific appliances from Europe to be kept for use in this Hospital. Besides the Medical Officer in charge who daily visits the Hospital and the Hospital Assistants working under him, there is a House Surgeon in constant attendance upon the sick and, since 1899 a Lady Doctor with a nurse to assist her, in charge of the Victoria Jubilee Ward. A Lady Doctor was first appointed in 1893 at the Jumllabai Hospital to attend to female out-patients; but the appointment has, I believe, benefited the public of the city more widely than the sphere of her purely official duties would indicate, as many families are glad to secure skilled female assistance for their ladies when it is available. There is a greater field in India than in other countries for the services of female physicians and nurses, but the supply is insignificant. The abundant provision of trained nurses is a great element in the comfort and efficiency of hospitals in Europe. The State has made some attempt to supply the need of nurses for women in sickness by sending four female students to the Cama Hospital in Bombay to learn midwifery and nursing; two of these returned after passing their final examination in 1887-1888 and were appointed to the State Hospital and the Jumnabai Hospital. The other two also were entertained in the State service in the next year. A regular midwife has also been maintained whose duty it is to attend cases of childbirth in the city.

                Of the other hospitals in Baroda the Jumnabai Hospital named after H.H. the Maharani Jumnabai is confined to out- cases; it was originally a dispensary afterwards turned into a Hospital, by attaching a girls' school building in the vicinity as a ward. For in-cases the accommodation in the Dufferin Hospital is sufficient and the site healthier, accordingly since 1899 the admission of in-patients into the Jumnabai Hospital has been discontinued. The Sayajirao Military Hospital was, as its name

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implies, meant not for the use of the general public but for the Army, of which by far the larger part is stationed at the capital; originally built to accommodate 40 people, it was increased as necessity arose by two further wards. In 1899, it was amalgamated with the State Hospital by the addition of the Sayaji Military Ward to that building and placed under the same supervision. In spite of the superior development and scientific accuracy of Western medicine, a great portion of the people of this country still cling to their belief in the old systems, and it has been thought advisable to make a certain concession to their preferences. Two Hakims have been appointed by the State to treat cases at the Hospitals in which patients might express a greater confidence in the Mahomedan system of treatment and the State Balvaid was attached to the Countess of Dufferin Hospital in 1899-1900 for the benefit of those who preferred the Ayurvedic treatment.
                The city of Baroda has therefore been amply supplied with medical facilities; nor have the districts been neglected. There are Hospitals in the chief town of each Division, the large division of Kadi having two to its share; besides this several of the district dispensaries are in all essential respects hospitals, admit- ting in- and out- patients as well as dispensing medical aid to out-patients and being placed under the supervision of an Assistant Civil Surgeon, notably Mehsana, Petlad, Dabhoi and Visnagar. There are also Assistant Civil Surgeons at Sidhpur, Anusuya and Dwarka. This large development of medical aid in the districts has taken place mainly since 1887.The regular strength. of the Medical Establishment numbered, in 1899,21 Medical Officers, 62 Hospital Assistants and 75 medical pupils, besides the Hakims, Balvaid, midwife and nurses already mentioned.

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