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dc.contributor.authorSmith, A. F.en
dc.date.accessioned2019-02-15T14:22:20Z
dc.date.available2019-02-15T14:22:20Z
dc.date.issued1926
dc.identifier.urihttp://hdl.handle.net/1842/33993
dc.description.abstracten
dc.description.abstractHaving reached the last milestone in a journey which if it has had its ups and downs as all journeys must, has been one of undisguised pleasure practically all the way, we would fain survey our handiwork for a second ere the curtain falls on its last chapter. One of the many impressions which is perhaps common to all those who would essay to write a thesis is that this effort into which he has put so much time and attention, somehow seems to lack a central idea, and following on this, comes the thought that several if not all of the subjects have been dealt with very superficially. To these and many more less complimentary emotions we would plead guilty. Yet the answer to those denizens of Doubting Castle is fairly obvious. An alternative heading for the thesis might have been "An analysis of 982 cataract case sheets". The central idea in such an undertaking is the analysis itself and the individual results achieved thereby. We were, I think, more than usually fortunate in that our analysis yielded us not only individual results, but in the shape of the conclusion given here, a deduction of no small value. To the charge that we have dealt with the various sections in a somewhat superficial manner, we, while agreeing, would enquire if it were possible to do aught else with the material we had to review. The macroscopic appearance of a tissue is always necessary before we can have the microscopic finding, and it was the macroscopic vi-ew of the cataract question in one of India*a provinces we were trying to give. With this explanation, we will proceed to the deductions derived from the findings in the various sections. Each of the parts of this thesis, though separate and distinct in itself, also goes to form a whole. In the formation of this whole, there are one or two sections which stand out more clearly than the others; we refer especially to the pages on 'etiology* and 'couching', for it is from them we wish to draw the conclusions which form one of the uniting threads of the preceding pages. It will be remembered we gave the total number of cataracts extracted annually in Bihar as somewhere around 4,500 - Bamdah 1400, the other hospitals 5100 - an arresting total, and one being increased annually, but still capable of much improvement. 4,500 then is the number operated on each year; what is the number not done? This question, like many another asked in those pages, is impossible of solution, but also like many another problem raised here, we feel that a partial solution is better than none, and perhaps will have sufficient in it of surprise to stimulate further interest and research in the matter. Under etiology, it will be recalled, we estimated that If cataract occurred among the six million Semi- Hinduised aboriginees and cowherds in the same proportions as among the other castes, then over 2000 cataract extractions which should have been done every year, remained undone. The women we estimated as compared with the men had 900 cataracts not done which ought to have been operated on. The Couchers were calculated to do 1400 - 2400 cases per annum, and here I think we may well take the latter figure considering the ultra conservative estimate we have made in the two preceding cases. Our total then of cataract cases not done - or worse - comes to 5300 per annum as compared with the 4,500 done, i.e. the Province of Bihar has a cataract bill, potential and real, of at least 9800 yearly; in all probability the real figures are two or more times this amount, but for our purpose the figure given will suffice without further correction. The facilities for the treatment of all those patients seem excellent on paper. Hospitals there are in comparative abundance, - government, mission, railway, etc., but when we come to look at them in more detail we find that practically without exception they are general in nature; in fact in the whole of this vast province of over 20,000,000 souls there is not a single hospital devoted exclusively to eye patients and yet surely nov/here else could we find so much justification for the establishment of special ophthalmic institutions. If then we are dissatisfied with the existing re/gime, our dissatisfaction if it is to be of any use at all, must spur us on to a little constructive effort, that- being so what type of hospital are we going to build to answer India's needs in matters ophthalmic. The general hospital is, I think, out of the question, the need for these is probably as great as for eye hospitals, but with such abundant material to hand, combining the two seems a great waste of men, money and - most important of all - efficiency. The next alternative, an eye hospital, run, as far as possible, on altogether Western lines might be ideal, but its cost would be prohibitive, more especially as in all probability several such institutions would be needed to satisfy the requirements of an area so extensive as that with which we are dealing. We arrive then, by a process of exclusion at a hospital modelled on the lines of that at Bamdah, wher we find, not so much a hospital as a caravanserai, a place where the blind of all castes foregather for treatment, where we would have central modern operating theatres with their attendant ante-rooms, surrounded b long blocks of single roomed apartments, to each of which a patient and his friends would be allocated, the friends to do the cooking, the surgeon the treating - and within reason, I think, it will be agreed that the less a cataract is treated after operation the better and the patient the waiting in hope. In addition ther would be several general wards for those who required less immobilisation than cataract patients after operation. Such a type of hospital is of course somewhat obnoxious to the perhaps over-civilized taste of the average European surgeon, but we have to remember that India is not Europe, that if our first principles are correct then the application of those principles must surely change in the changing countries; that it matters little whether the hospital or the patient provide the bed clothes, so long as the patient is content to remain in bed when he is told - and here we have to bear it in mind that practically all Indians when travelling carry their bedding with them, since hotels as we know them here, are very few and far between, so that to bury an eye patient between snow white sheets is a kindness which he neither understand nor appreciates, and it can hardly be said to be necessary. The thought which at once assails us is that sepsis under the conditions above outlined would be rampant; the strange thing is that it is not; in the last 500 cases operated on at Bamdah during the cold season there were only 2 cases of suppuration; the bugbear of the operator was not sepsis but prolapse of iris which was very frequent, being about 15%; that this however is not an inherent defect of the system is proved by the figures from Shikarpur where doing some 1300 extractions per annum, they have a prolapse rate averaging 3%, yet the hospital regime at the hospital there is very similar to that in operation at Bamdah. So much then for the defects, possible and real, of the system; what are its advantages? Firstly, and pre-eminently, it is cheap; this is essential for success in a land where 8d a day is deemed a good wage for a labourer. Secondly, it suits the patients, since coming to hospital does not mean separation from their family it also prevents them being filched of their money by unscrupulous attendants and compounders, who are all too frequent in a land where bribery is rife, and where the traditions of both doctors and nurses are hardly on the same level as in our own country. Thirdly, this type of hospital closely resembles the ancient Hindu houses of healing, and therefore at a time like the present, is of value in that it excite no racial prejudice against it. Fourthly, it is extremely popular. This is obviously a fact of considerable importance as no matter how good a hospital may be, if it does not meet the public favour then the good it does is a mere shadow of what it otherwise would do; this is especially applicable to India with its prejudices against all things Western. As proving the popularity of this type of hospital, we have only to look at the numbers of operations performed in the few which are in existence, to realise this. Shikarpur does some 1300 extractions in about 7 weeks, in the cold season. Bamdah does 1400 per annum as compared with 97 for the 6 government hospitals and dispensaries of Monghyr in the same time. Hazaribagh, a neighbouring district, contains 2 mission hospitals run on similar lines to Bamdah; they between them do some 400 extractions per annum as compared with 22 for the government hospitals and dispensaries of the province. The 195 extractions per annum of the SantalParganas are made up as follows Government institutions . . . 79 Benagaria (a mission hospital run on similar lines to Bamdah) . . . 116 These differences between the figures for the government and the mission hospitals are rather striking; the government hospitals have the advantage in many ways, in numbers, in resources of men and money, yet they obviously are not reaching the people as they might; we have outlined some of the reasons why; another is that the biggest and finest government hospitals are built in large towns, whereas 90% of IndiaTs inhabitants are country born and bred, and as the statistics given -under etiology prove, less than one-sixth of the inhabitants of the villages ever visit their principal towns. In Europe we rightly build our best hospitals in our biggest towns, in India on the other hand if we would get patients we ought to build our hospitals in the country, preferably in a small country town. Enough has been said in those few preceding pages to give a somewhat sketchy idea as to what we - think would constitute an ideal eye hospital from the Indian point of view. We do not propose to give a more detailed account, for the present at any rate - as such a procedure would not be In keeping with the general tenor of this thesis, which has all along been to take a broad rather than a deep view of the problems with which the cataract operator in India has to grapple daily. One word more, however, we would say on this subject and that is in connection with the problem of how best to popularise such hospitals once they were built. The best solution here, we feel, would be travelling dispensaries in charge of experienced subassistant surgeons. Their duties would be (1) To treat minor eye diseases, conjunctivitis, trachoma, corneal ulcers, etc. (2) To give ’refresher’ courses to the village head man, school teacher, etc. in the a. b. c. of the treatment of the commoner ailments of the eye. (3) To diagnose cataracts, glaucomas, etc., and send them to hospital for operation. In addition,to supply all the patients whom he sent to hospital with a free railway pass from the nearest station to the hospital; a somewhat necessary piece of practical philanthrophy if we would do the maximum amount of good in a land where poverty holds such sway. Such then are a few of the lessons learned from our analysis; if the reader has derived as much pleasure from the perusal of these observations as we have in compiling them; the writer of this thesis will be more than satisfied.en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2019 Block 22en
dc.relation.isreferencedbyen
dc.titleSome observations on cataract and cataract patients in Bihar, Indiaen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


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