CHAPTER XVI
MEDICAL AND PUBLIC HEALTH SERVICES
| Medical Facilities in Early Times The ancient system of medicine obtaining in the district appears to have been derived mainly from the Ayurveda, which literally means the science of life. It is largely based on hygiene, regulation of diet and mentions numerous herbal drugs in addition to extracts derived from animal and mineral products. The Ayurveda elaborately classifies various diseases and adopts a diagnostic approach. References to post-mortem examination are found in Kautilya's Arthashastra which amply serves to illustrate the progress made in this field even in the third century before Christ. Practitioners of this system, known as Ayurvedaeharyas or vaids, were well known in the region comprising the present district in the past, the services rendered being free, or, in most cases, on a very nominal fee for the common people. Important and costly medicines were usually prepared by the vaids themselves under their direct supervision. Common drugs and herbs, as prescribed by the vaids were sold by local shopkeepers, commonly known as pansaris. With the establishment of Muslim rule in the country, the Unani system of medicine based mostly on the Greek system was Introduced in the district. The physicians and the surgeons of this system are respectively known as hakims and the jarrahs (surgeon barbers). The allopathic system of medicine was introduced in the district in the nineteenth century. Hospitals and dispensaries were opened in the district and these were put later on, under the control of the district board, while the civil surgeon looked after their administration with the help of the other doctors. The first allopathic medical institution in the district was built in 1856, in a fine open space in the central square of the city. Later on a new building was constructed in 1869 and, at present, it is the largest medical institution of the district In 1900, a separate female dispensary was built in the city. Three branch dispensaries were opened at Auraiya, Phaphund and Bidhuna in 1874. 1875 and 1904 respectively. Dispensaries were also opened at Jaswantnagar and Lakhna in 1873 and 1900, but were closed in 1878 and 1904 respectively. Besides these, four special dispensaries were opened and were attached to police lines, lower Ganges canal divisions of Etawah and Bhognipur branch and the Railways. After Independence the government opened numerous hospitals and dispensaries at different places in the district and in 1974 there were 27 allopathic hospitals and 25 dispensaries, two homeopathic dispensaries, and 29 Ayurvedic dispensaries. AT.B. Hospital at Etawah and T.B. Clinic in Etawah city were opened in 1952 and 1965 respectively. The hospital has 30 beds for men and women each. The E. S. I. Dispensary was opened in the city in 1972. A large number of primary health centres and maternity centres have also been opened. Vital Statistics An examination of the vital statistics of the district since the last decade of the last century till recent years reveals that the birth-rate (per thousand) has been higher than the death-rate (per thousand). However, there have been greater fluctuations in the death-rate than in the birth-rate although both have declined considerably. During the decade from 1891 to 1900 the number of births averaged 29,459 or 40.34 per thousand. In 1902, it rose to 48.16 per 1,000 and till 1904 it remained same with slight fluctuations. In 1906, it come down to 34.99 and in 1909, it fell to 30.41 per thousand. In 1913 it again rose to 48.46 and in 1916, there was a slight rise to 49.83 per thousand. During 1921-30, 1931-40 and 1941-50 the average birth-rates were 35.2, 38.7 and 28.0 respectively. Between 1941, and 1950, the maximum birth-rate per thousand was 37.4 in 1941 while the minimum was 23.7 in 1943. During the fifties the maximum births were 27,734 in 1954 and the minimum were 14,054 in 1956. Between 1891, and 1900 the annual mortality averaged 23.075 with a resultant rate of 31.71 per thousand, but during the seven years from 1901 to 1907 it had risen to 29,944 or 37.11 per thousand, This increase was for the most part due to plague, which first visited the district in 1903 and claimed an average of 2,554 victims every year ; while in 1906 the mortality rate rose to the unprecedented figure of 46.45 per thousand due to famine following on the severe frosts of the previous year. In 1908, there was a further rise in the mortality rate and it came to 59.43 but in the next two years the per thousand rate came down to 38. In 1913, there was again a rise and rate was 43.50 per thousand but till 1919. there was a tendency of a fall in the death-rate. The average rates of death during 1921-30, 1931-40, and 1941-50 were 26.5, 22.7 and 19.4 respectively. During the period from 1941 to 1950, the highest death-rate was 25.2 in 1944 and the lowest was 14.6 in 1948. During the fifties the maximum deaths were 18,378 in 1954 and the minimum were 7,731 in 1955. The following statement gives the total number of births and deaths between 1968 and 1973 :
Infant Mortality The rate of mortality among children below one year in age was quite alarming till 1942. From 1943 to 1950 the figures of infant deaths were about 4,000 every year. Between 1951 to 1960 the maximum infant mortality was 4,836 in 1960 while the minimum was 2,247 in 1959. The position has vastly improved in recent years, the figures being as follows :
Common Diseases Diseases which commonly caused deaths were epidemics such as cholera, smallpox and plague or fever, bowel disorders and respiratory troubles. Epidemics have, however, been largely controlled, but fevers still claim the highest percentage of the total number of deaths in the district. Fever—The term fever has wide connotation. It includes not only such diseases as malaria and typhoid but also covers many unidentified diseases of which fever is only a symptom. Malarial fever was undoubtedly prevalent in the district as elsewhere, but the -term was, as a rule, made to include all cases in which fever was a prominent symptom of the disease, without necessarily being the cause of death. Intermittent and remittent fevers are endemic in the district, and they are most in evidence after the close of the rains and attack all classes. From 1818 to 1900 fever claimed lives for more than 81 per cent of the total mortality, while from 1901 to 1907, 73.11 per cent had. on the average, been attributed to this cause. Fever did not appear to assume the proportions of a violent epidemic, the number of deaths due to it being generally fairly constant : but in dry and healthy years it was normally less fatal in its effects than in years of heavy rainfall. In the first decade of the present century the worst epidemic occured in 1908 and took 41,453 lives. Though there was a declining trend but the number of deaths were 26,138 and 23,155 in 1909 and 1910 respectively. This trend continued in the next decade also and the highest number of deaths were 22,887 in 1911. In 1921, there was a slight increase in the figures of deaths and it came to 23,507 and in 1931 the number came down to 14,335. Between 1941, and 1950, the highest number of mortality from fever was 18,801 in 1944 and the lowest number was 10,871 in 1948. Again between 1951 and 1960 the maximum number of deaths from fever came down to 9,681 in 1960 and the minimum to 2,398 in 1956, With the improvement of medical and health services, deaths from fever have declined as the following indicates :
Dysentery and Diarrhoea—These diseases occur in the form of bowel and stomach complaints. The incidence is attributed mostly to insanitary conditions and unsatisfactory arrangements for drinking water. Sometimes dysentery is the result of malarial fever also. With the strict enforcement of sanitary measures such as disinfecting and cleaning of wells and drinking water sources, the incidence of these diseases has lowered. In the last decade of the last century the highest number of deaths from bowel complaints was 453 in 1897 and lowest was 121 in 1900. During 1901 to 1910 the highest mortality was 394 in 1906 and in the next decade it was 235 in 1911. During 1941 to 1950 the maximum figure was 429 in 1943 while the minimum was 168 in 1950, and in the fifties the highest mortality was 745 in 1957 and the lowest was: 367 in 1951. The number of deaths due to bowel disorders from 1969 to 1973 is given below :
Respiratory Diseases—These diseases generally lead to temporary or permanent, infirmities and in a few cases they hasten death. In 1941, 716 persons died from these diseases in this district, and the figure rose to 875 in 1944, the maximum in this decade. In the fifties the number of deaths increased, and in 1957 the mortality was 1,188 rising to 1,970 in 1960. The mortality figures from 1968 to 1973 were as below :
Epidemics Smallpox, cholera and plague took a heavy toll of lives in the district till the enforcement of the vaccination Act of 1880 which made primary vaccination compulsory while the Epidemic Diseased Act of 1897 empowered the district magistrate to remove patients to hospitals, segregate them, disinfect the dwellings and. to evacuate infected houses and localities etc. Smallpox— Smallpox is a formidable disease which takes many lives whenever it visits the area, and sometimes assumes the form of an epidemic. It has been estimated that smallpox must have been prevalent for more than 1.500 years in UP The mortality rate of district Etawah for the period 1877 to 1954 was 0.16 to 030 per cent. On the basis of studies made by Rogers, it was discovered that there was a close relationship between absolute humidity and the prevalence of the disease , a low absolute humidity favours the disease and high one checks it Studies conducted in the field by Murty revealed the existence of a close relationship between the prevalence of this disease and variations in the intensities of ultra violet radiations at different tunes of the year at varying altitudes. The disease is generally found to be on the decline after the onset of the monsoon, owing to high intensity of ultravilot radiations of sunlight which restrict the transmission of infection. Though smallpox is never entirely absent in the district, its ravages have minimised, especially after the enforcement of the Act making vaccination compulory for the children in urban areas. From 1877 to 1890 the average mortality from it amounted to 855 annually, five severe having occured in 1878, 1883. 1885. 1889 and 1890. Be ween 189 and 1900 the average number of deaths from this disease was 192 which between 1901 and 1907 fell to 152. In the second decade of this century the maximum number of deaths from small-pox was 440 in 1913 and in the fifth decade the highest incidence of this epidemic was 376 in 1950. Between 1951 to 1960 the maximum loss of lives was 563 in 1951. Now only few case-, are reported in the district and there has been appreciable decrease during last ten years since the launching of the National Small pox Eradication Programme. Cholera— This disease mostly occurs in a single annual wave which usually appears in March-April, suddenly increases in May and reaches its peak in June. Fairs and festivals are the starting points for these epidemics and additional impetus is provided by heavy feastings in marriages mostly taking place during summers The worst epidemic of cholera was seen in 1887, when it carried off 3,946 victims. It again visited the district in 1894 and 1906 when 2,520 and 1,107 fatal cases were reported respectively. Between 1911 and 1920, it took the form of epidemic twice in 1913 and 1915 when the number of deaths reported were 1,364 and 763 respectively. Subsequent visitation of cholera were not severe upto 1943. It reappeared in 1944, 1948 and 1949 took 793 797 and 509 lives respectively. Between 1951 and 1960 it broke out only in 1957, claiming 318 lives. After 1960, only stray cases were reported. Plague—The out of break of plague, a formidable disease, was first recorded in the State in the district Kumaon in 1834-35 According to the local traditions of that region the disease was seen in 1823 in the person of the Rawal of the famous temple of Kedarnath in the snowy range, who, with the Brahmins associated with him, was smitten with it. It was believed to be a consequence of some ceremonial omission in the performance of temple rites. Till the end of the 19th century the identification of the disease as plague depended on clinical observation. The seasonal incidence of plague is very uniform, the highest incidence occurs in the months of February to April. The high temperature of May and June, brings about a dramatic decline and the humid monsoon months are free. In mid-winter in the month of December the seasonal curve begins to rise. Plague made an appearance in the district m 1903, when 1,493 persons died and it revisited with double severity in 1904 and 1905 when the mortality figures were 3,926 and 4,817 respectively. The year 1907 again saw the revages of plague which took 2,058 lives. The epidemic reappeared in the district in 1910, 1911 and 1913 and 2,635, 4,361 and 2,003 fatal cases were reported. Till 1945 only stray cases occurred in the district and in 1946, 1947 and 1948, 34. 32 and 14 cases were reported respectively. In the fifties, sixties and seventies no case was reported upto 31-3-75. Other Diseases Insanity, myopia, cataract, deafness, leprosy and tuberculosis are some other diseases which have been prevalent in the district since long. Efforts were made by the government in all the Five-year Plans to improve environmental conditions and health of the people and these have helped to decrease the incidence of these diseases. The number of T. B. cases treated in the district in 1959-60 was 2,127. There is, however, no special arrangement for the treatment of leprosy. An eye hospital exists.
Prior to 1948 there were separate departments for medical and public health activities but were amalgamated in that year under a directorate for better cohesion and control over the allopathic, Ayurvedic and the Unani institutions and services. In July, 1961, a separate, directorate was established at Lucknow for the development and effective supervision of Ayurvedic and Unani institutions and services. Local administration of these institutions however, remained in the charge of the district medical officer of health, now designated deputy chief medical officer (Health). Formerly the civil surgeon and the district medical officer of health respectively headed the medical and public health organisation in the district. In July 1973, the departments of medical and public health were again reorganised in the State, abolishing the posts of the civil surgeon and the district medical officer of health. In the district from the same year, under the new set-up, a chief medical officer has been appointed who heads the entire medical, public health, and family planning set-up in the district. He is assisted by three deputy chief medical officers. In urban circle at the district headquarters superintendent of the District Hospital (Male) and the Women Hospital are controlling body of medical health and family planning activities in their respective institutions. The whole supervisory type of health and family planning activities are under the control of chief medical officer. At the district headquarters the municipal medical officer of health is responsible for public health activities. The rural area has been divided amongst the three deputy chief medical officers for all medical, health and family planning work. The public health centres in the rural areas are equally distributed to the deputy chief medical officers. The rural State dispensaries fall under the primary health centres and are also under the deputy chief medical officer concerned. At the level of primary health centre, a medical officer is over-all in charge of the medical, health and family planning activities. The medical officer is assisted by another medical officer in family planning and maternity and child welfare centres. An idea of the public health activities undertaken in the district in the Third Five-year Plan (1962 to 1966) can be had from the following table :
Hospitals There are nine State hospitals for men including district hospital, Etawah and three womens' hospitals, besides a railway, a police and a Jail hospital. There is also a childrens' hospital, a T.B. hospital and an Eye hospital in Etawah city. The district board runs 9 hospitals including one for women. The district hospital, Etawah is located near Kotwali in an old building. It has 75 beds and the hospital is equipped with X-ray plant, blood bank and a pathological laboratory. A dental clinic is also attached with this hospital. Womens' hospital, Etawah, located near refugee market has 17 beds. The childrens' hospital, Etawah, was established in 1971 with "only 4 beds, and it now has 28 beds. It is located near exhibition ground. The T.B. hospital, Etawah is also located near exhibition ground and has 60 beds. This hospital has X-ray plant and pathological laboratory. The following statement gives an idea of the location, staff provided, number of beds and the patients treated in the hospitals in 1974.
Dispensaries Allopathic—A statement giving details about the staff, beds and the number or patients treated at the allopathic dispensaries in the district is given below :
Ayurvedic dispensaries— There are twenty nine Ayurvedic dispensaries. 18 run by Zila Parishad and 11 by the State, in the district. The State Ayurvedic dispensaries are under the control of the deputy chief medical officer (Health). Each dispensary has one vaid incharge. The following statement gives the location of dispensaries :
Homeopathic dispansaries — There are two homeopathic dispensaries, located at Kukaoli and Barauna Kalan, each named by a doctor and other staff. Primary Health Centres In order to extend medical facilities and improve health standards of the rural population, the government has established primary health centres in every development block of the district. There were 15 such centres in 1974. Each centre is manned by a medical officer, who is assisted by Para-medical and health staff consisting of pharmacists, health inspectors, health visitor, smallpox inspectors and supervisors, and family planning workers. Each centre generally has a four beded ward for in-door patients. At the district level the deputy chief medical officer (health) controls their functioning. The following statement gives the location and year of establishment of these centres :
Maternity and Child Welfare Maternity and child welfare activities in the district, as elsewhere in the State, have come a long way since the days of the untrained dai and the village paediatrician. Lack of facilities for anti-natal and post-natal care contributed largely towards higher incidence of mortality among women and children till the late forties of this century. Since 1958, the government embarked upon a policy to establish several maternity and child welfare centres in the district. They numbered 14 in 1974, attended by midwives and trained dais. Three subcentres are also attached to each such centre, and they are looked after by dais. Since 1973, a new scheme of prophylaxis of pregnant women and children against nutritional anaemia and other common diseases has been taken up. These centres have been equipped with aids and devices to educate ladies in planned parent-hood. Family planinng literature and contraceptives are also made available free of cost to the couples. The following statement gives the location of maternity and child welfare centres and subcentres :
There is an auxiliary nurses and midwives training centre, with 101 seats established in 1969 in Etawah city with a two-year training course. Each trainee is given a stipend of Rs 75 per month during the training period. The desirous entrants should have passed the eight class. There is also provision for the training of dais at each maternity centre. The period of training varies from six to nine months and each trainee is given a stipend. The trainees are required to be just literate. Vaccination—The deputy chief medical officer is in-charge of the work of vaccination in the district. He is assisted by sanitary inspectors and a team of vaccinators. The work of vaccination has been intensified since 1963, when the national smallpox eradication scheme was launched. Though the vaccination Act of 1880 was enforced in the district from its inception, it could not be implemented fully due to lack of co-operation by the public. Under this Act vaccination is not compulsory in rural areas except for short periods during the outbreak of epidemics. Mothers are advised during the post-natal period to have the child vaccinated as early as possible after the child is two or three months old. In 1973, the number of persons vaccinated were 58,563. In 1972 one B.C.G. team was posted at T.B. Hospital, Etawah. It gives testing and vaccination facilities. In 1974, 1304 cases were tested and 32,950 persons were vaccinated. Prevention of Food and Drug Adulteration The government public analyst, analyses the samples taken by the sanitary inspectors. Suitable action is taken against offenders under the prevention of Food Adulteration Act, 1954. The deputy chief medical officer is the licencing authoritv for food establishments and drug stores in the district, He is assisted by a drug inspector in his task to check the adulteration of drugs. They are further required to ensure the observance of Indian Drugs Act, 1940, and Drug Rules of 1945 by the retailers, wholesale dealers, and manufacturing concerns. In 1974, the officers collected 167 samples, out of which 77 were found adulterated. As many as 70 cases were prosecuted out of which 68 were convicted. National Malaria Eradication Programme The national malaria eradication programme was launched in the district in 1958-59 and the district was categorised in two parts, hyper-endemic areas and hypo-endemic areas. The hyper-endemic urea of the district was covered by the National Malaria Eradication programme unit. Etawah and the remaining area of the district, was categorised as hypo-endemic and was covered by National Malaria Eradication Programme units of Mainpuri and Kanpur Under the National Malaria Eradication Programme each unit has to pass through four phases viz., preparatory, attack, consolidation and maintenance. The preparatory phase was not actually launched as the national malaria control programme was already in operation in the district. In the next phase only spray operations are carried out in all the roofed structures twice a year from May to September. In 1960-61 surveillance procedures were launched in the district and were carried out concurrently with Dray operations. House-visitors visited all houses twice a month in search of fever cases, the blood slides of fever cases detected were collected and a presumptive treatment administered. The attack phase remained in operation in the district from 1958 to 1964, when some parts of the district entered into the consolidation phase and in 1965 the entire district was covered under this phase. In the maintenance phase the national malaria eradication programme became part of the district health scheme and is now under the overall charge of the chief medical officer, who is incharge of all the public health activities in the district. The deputy chief medical officer assisted by his staff has been looking after the programme of malaria eradication since the start of surveillance work. The incidence of malaria is given in the following statement:
Family Planning The family planning scheme was introduced in the district somewhere at the end of the fifties or the beginning of the sixties but a separate office under the district family planning officer was established only in 1965. when concrete steps were taken to implement the programmes of family planning. At present there is a mobile unit under the control of a lady doctor, who offers suitable help and guidance to the interested people and performs tubectomy operations and inserts loops, etc. The deputy chief medical officer (family planning) is in overall charge of such operations. Medical officers incharge of primary health centres also perform vasectomy operations. Continued efforts are being made to
popularise the small family through films, placards, posters and by personal contacts. The
achievement in family planning work in recent years is given
Indian Red Cross Society There is a branch of Indian Red Cross Society in the district, with the district magistrate as its ex-officio president. The chief medical officer is vice president and the deputy chief medical officer (health), the ex-officio honorary secretary. This society runs one maternity child welfare centre at Sahar. It also provides relief to people in times of natural calamities. Funds are raised by enrolling members or collecting subscriptions and donations. A sum of Rs 1,638 was spent in 1974-75 by the society on welfare activities in the district. |
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