HISTORICAL BACKGROUND
 

THE GROWTH OF PUBLIC HEALTH AND MEDICAL FACILITIES in the country is a development of recent origin. However, this is not true of Nagpur district, where the pioneering work began as early as the sixties of the last century. The Mayo Hospital was started in 1867 and the Murray Hospital in 1896 gave a lead and today the district has a numher of well-known institutions for medical relief, public health and research. This however does not mean that the populace was disease-conscious and easily availed of the medical facilities. The disease was rarely ever ascribed to some physiological disorder. Many a time it was ascribed to some outside evil influence which was propitiated by some sacrifice. It was only with the spread of western education that conservatism and orthodoxy were replaced by reason and rational outlook. The vaidyas, vaidus, hakims and similar persons dominated the field of medical profession till quite recently. The vaidyas used to give treatment according to the Ayurvcdic system of medicine. Their knowledge represented a combination of what they inherited from their forefathers and the practical experience they acquired in course of their medical practice. The system of diagnosis by vaidus and hakims did not essentially differ from the Ayurvedic system of medicine. However, the psychological influence which, these created was more important. The vaidus moved from place to place and had a good knowledge of rare herbs with rich medicinal properties. In the absence of specialised veterinary practitioners, they occasionally treated the live-stock. The modern and up-to-date maternity facilities were conspicuous by their absence and very often the practical personal experience of the elderly ladies in the joint families proved highly useful to the young expectant mothers.

 
 
HOSPITALS AND DISPENSARIES

(Socio-Economic Review and District Statistical Abstract of Nagpur District, 1958-59.)

In Nagpur district there were 12 hospitals in 1958 with 1,307 beds. In the same year these hospitals treated 7,89,176 patients of whom 41,507 were in-door and 7,47,602 out-door patients. The allopathic dispensaries in the same year numbered 21. The number of doctors was 173, of whom 152 were in urban areas and 21 in rural. There were 370 nurses in the district.

 

DISEASES

 

DISEASES COMMON TO THE DISTRICT

Malaria, filaria, leprosy, tuberculosis, respiratory diseases, dysentery, diarrhoea and epidemic diseases like smallpox and cholera are noted to exist in the district. There are special units for the control of malaria, filaria, tuberculosis and leprosy.The public health department co-operates with the local bodies in the control of epidemic diseases through the primary health centres, health assistants, sanitary inspectors and sanitary squads.

The following table gives the number of deaths due to chief diseases in Nagpur district from 1956 to 1960 : —

Year

(1)

Cholera

(2)

Smallpox

(3)

Plague

(4)

Fevers

(5)

Respiratory Diseases
(6)
Dysentery
and diarrhoea
(7)
1956
..
151
..
13,434
2,167
1,145
1957
608
91
..
9,434
3,254
3,528
1958
242
277
..
10,182
4,967
2,452
1959
1
93
..
8,998
3,503
1,998
1960
..
119
..
8,772
3,920
3,412

 
MEDICAL ORGANISATION
 
The medical organisation in the district is essentially a hospital organisation designed to render medical relief to the general population.

The Civil Surgeon, Nagpur, is the administrative head of the medical organisation of the district. He is directly subordinate to the Deputy Director of Medical Services, Vidarbha Region, Nagpur. He is in charge of the medical arrangements of the Mayo Hospital. In addition, he is required to take active part in the public health matters affecting the district in collaboration with the District Health Officer. Prior to the implementation of the Zilla Parishads and Panchayat Samitis Act of 1961 the supervision of the tahsil dispensaries, hospitals (including civil and cottage hospitals and other big Government hospitals), subsidised medical practitioners' centres, rural medical relief centres and public medical relief and sanction of grant-in-aid to private charitable institutions like hospitals, maternity homes, dispensaries, etc., vested in the Civil Surgeon. . Such institutions and schemes with their staff and the budgetary provision on their account have now been transferred to the Zilla Parishad. The Civil Surgeon is, however, authorised (i) to inspect the concerned institutions or schemes periodically and (ii) to give such guidance, assistance or advice as the institutions may consider necessary. The institutions under management of local bodies are supervised by a Dispensary Committee.

Mayo Hospital

The Mayo Hospital is the main Government Hospital at Nagpur. The other Government Hospitals are: the Medical College and Hospital ; T.B. Control and Training Centre; the Daga Memorial Hospital for Women and Children; the Mental Hospital and the Police Hospital. Besides, a number of Government-aided dispensaries are scattered throughout the district.The Mayo Hospital situated in the heart of the Nagpur City was established in 1867. Originally a single-storeyed building it has now developed considerably with the donations from various charitable trusts like the Lady Dufferin Fund. It now has a number of buildings spread over 18.211 hectares (45 acres). It accommodates about 500 patients and has arrangements for X-ray, electrocardiograph, diathermy apparatus, etc. The outpatient department has separate blocks for medical, surgical, dental, ear, nose, throat, eye, gynaec and obstetric cases and a minor operation theatre. Besides, it has a six-bed leprosy ward, a sub-centre of the T.B. Control and Training Centre. The anti-rabic centre for Nagpur district is also located in the Hospital. The hospital has blood transfusion service and a training centre for nurses since 1927.

In 1960, the indoor patients at the Mayo Hospital numbered 13,609 and outdoor patients 1,84,991. The expenditure was Rs. 10,21,034 and receipts were Rs. 1,24,492. The Hospital has an Advisory Committee attached to it and is composed of the Collector as the Chairman, the Civil Surgeon as the Secretary and 13 other members. The Committee helps in the management of the Hospital and keeps the authorities informed about the public needs.

Employees’ State Insurance

The Employees' State Insurance Scheme is in force in Nagpur since 1954. The total number of persons insured was 32,884 till December 1960. The medical officers working as insurance medical officers under the scheme are medical graduates (17) and licentiates (5). Ambulance service is provided in Nagpur City for the transport of patients. Beds are provided for insured persons at the Government Hospitals and at some of the private hospitals. The Employees' State Insurance Corporation and the Stale Government have constructed a ward of 25 beds at the Mayo Hospital for treatment of T.B. cases. Persons registered under Employees' Insurance scheme requiring specialised medical treatment are sent to the Medical College Hospital and the Mayo Hospital, Nagpur. The scheme is supervised by the Administrative Medical Officer, Employees' State Insurance Scheme, Vidarbha Region, Nagpur. The Medical Board consisting of the Civil Surgeon, Nagpur, the Professor of Surgery and the Professor of Plastic Surgery, Medical College, Nagpur, examines cases of industrial accidents in Nagpur and Hinganghat. The local committees discuss the local problems and refer complaints to the Corporation. In 1960, the expenditure on dispensary unit was Rs. 5,05,945 shared between the State Government and the Employees' State Insurance Corporation in the proportion of 1:3. The scheme for the extension of medical relief to the families of the workers coming under the Employees' Insurance Scheme has also been sanctioned. When implemented it will cover about l,20,.000 persons, which approximates nearly one-fifth of the city's present population.

T.B. Control and Training Centre

The Tuberculosis Control and Training Centre was started in 1952 as a wing of the Medical College with 50 beds. The bed strength has been gradually raised to 150. It is a joint enter-prise of the Government of India, the World Health Organisation and the State Government, The World Health Organisation provided an international team of experts, radiological and laboratory apparatus, reference literature, etc. For want of sufficient hospital accommodation the Centre has a domiciliary treatment section with an efficient home-visiting service. The X-ray unit is very helpful in locating the patient's trouble. The Social Welfare Department provides training in some light jobs suitable to the convalescents. The Centre has a children's ward with 30 beds. The Centre conducts laboratory and X-ray technicians' courses and home visitors' training courses in collaboration with the Medical College, Nagpur. The expenditure of the Centre in 1960 amounted to Rs. 1,56,586.

Daga Memorial Hospital

The Daga Memorial Hospital was started only as a women's wing attached to the Mayo Hospital. The present hospital building was constructed out of a donation of Rs. 3,35,000 received from the late Sir Bisesar Das in memory of his late father Sir Kasturchand Daga in 1928 and was named as the Daga Memorial Hospital. Since 1956 it is under the management of the State Government. It has at present 151 beds, a separate paediatric unit, a family planning centre and an out-patient ward with a pre-natal and post-natal clinic. The hospital is under the supervision of a Class I Medical Officer of the Maharashtra Medical Service. It has arrangement for the training of nurses. The indoor patients treated at the hospital in 1960 numbered 8,336 and the outdoor patients 16,740.

Mental Hospital

The Mental Hospital, Nagpur, waft started in 1884. It. was originally known as the Lunatic Asylum. Several additions and alterations were made Thereafter and the hospital was renamed as the Mental Hospital. The hospital is supervised by a Medical Superintendent, who is a Class I Officer. It accommodates about 610 in-patients. The out-patient department was started in 1959.

Rural Medical Aid

Various hospitals and dispensaries under the Zilla Parishad and the municipalities are at Umrer, Ramtek, Katol, Khapa, Kamptee, Kondhali, Mowad, Mohpa, Dhanla, Jalalkheda, Pipla-keolaram, Navegaonkhairi, Parseoni, Kuhi, Mouda, Deolapar, Kalmeshwar and Bhiwapur. There is a mission dispensary at Dhapewada and three mine-hospitals-cum-dispensaries at Mansar, Kandri and Gumgaon. Of the 46 ayurvedic dispensaries maintained by municipalities and the Zilla Parishad, 14 receive grant-in-aid. The five primary health centres are at Kuhi (Salwa, Mandhal, Titur) ; Kalmeshwar (Kohli, Uperwahi, Gondkhari); Mouda (Aroli, Tarsa, Govari); Badhegaon (Rajegaon, Nauda, Bina) and Bhiwapur (Kargaon, Salesari, Nand}( The sub-centres are given in brackets.). The health-unit at Saoner is attached to the Medical College, Nagpur, and nurses and internees are sent there for training.

 
 
PUBLIC HEALTH ORGANISATION
 

The public health of the district is looked after by the Public Health department of the State, local bodies, i.e., municipalities, Zilla Parishad and panchayat samitis.

The head of the Public Health department at the State level is the Director of Public Health, with headquarters at Poona. For public health purposes the State of Maharashtra is divided into four divisions, each division being in charge of a Deputy Director of the Public Health Services. The district of Nagpur is under the Nagpur Division. The District Health Officer, Nagpur, represents the district for all public health matters except for malaria and filaria which arc under officers appointed for the specific purposes. The District Health Officer and all subordinate staff under him are now transferred to the Zilla Parishad. He organises measures for public sanitation and hygiene; sanitation at fairs and festivals; investigates the causes, origin and spread of diseases, both epidemic and endemic and adopts preventive measures to control diseases, like cholera, smallpox, plague, guineaworm and enteric infections. He inspects and advises municipalities, panchayat samitis and other village authorities about health, sanitation, drainage and water-supply ; inspects centres for child and maternity welfare, family planning and leprosy and looks to industrial and school hygiene ; recommends the issue of licences for cinema theatres and other places of public amusement, inspects sites for school buildings, factories, burial grounds, village extensions, etc., and gives opinion on their suitability from the point of view of public health. He also carries out health education with the help of his subordinate staff. The District Health Officer is helped by a number of officers and other subordinate staff in the execution of the various health schemes.

Primary Health Centres

The Medical Officers in charge of the primary health centres are responsible for rendering preventive as well as curative help to the population covered by the centre. The primary health centres in the district are located at Kalmeshwar, Narkhed, Mouda, Kuhi, Borkhedi, Badegaon and Bhiwapur. Besides the scheme for starting primary health centres at Katol, Ramtek, Parseoni, Umrer, Kamptee and Hingna is under way.

Control of Epidemics

Medical officers

The main duty of the Epidemic Medical Officer is to control epidemics and in non-epidemic times to adopt measures for prevention of epidemics. He has also to render medical aid in rural areas.

Health Assistants

Every tahsil of the district has a Health Assistant. He adopts preventive and curative measures in infected areas, renders medical aid at fairs, festivals, etc., checks the work of the vaccinators and also vital statistics. He also performs the duty of the Medical Officer in charge of the Primary Health Centre when he is on tour.

Sanitary Inspector

A Sanitary Inspector is placed at each tahsil. He is responsible for all public health matters in his charge including assistance in controlling epidemics. He inspects the vaccinators' work regularly so as to improve the standard of vaccination. He is also entrusted with the sanitation of the areas in his charge.

Control of Epidemics

Vaccinators

Local Bodies

The main duty of the vaccinators is to vaccinate the population in their charge. They also assist in anti-epidemic measures and sanitation of the villages.

The Nagpur Municipal Corporation has a Health Officer and three Assistant Health Officers to look after the public health of the city. The District Health Officer advises the other ten municipalities in the district in public health matters since they do not have a Health Officer of their own.

The Zilla Parishad and the panchayat Samitis look after the public health of the non-municipal areas of the district. Each tahsil has an Assistant Superintendent of Vaccination and three to four vaccinators. Villages which have a panchayat of their own look after the sanitation and public health of the village. The District Health Officer renders technical advice to the panchayat secretaries whenever required.

Malaria Organisation

The Malaria Organisation of the Maharashtra State with its headquarters at Nagpur works under the National Malaria Eradication Unit. The eradication of malaria in Nagpur and Wardha districts (excluding the Nagpur Corporation area) is the responsibility of this organisation. The organisation is also entrusted with the control of filariasis.

The Malaria Officer who is a class II Officer guides the spraying and surveillance activities throughout the area under his jurisdiction. He also carries out survey (only for children and infants) for assessment of results. The Assistant Unit Officer assists the Malaria Officer in his work.

Nagpur district is divided into three sub-units, viz., Nagpur, Ramtek and Saoner, each in charge of a Malaria Inspector (Senior Malaria Inspector in case of Nagpur sub-unit) with requisite staff under him. They carry out the spraying operations in their areas and during non-spraying season help the Malaria Officer in carrying out the survey and examination of blood smears. They also supervise the surveillance work done by the Surveillance Inspectors, and help the Malaria Officer in carrying out epidemiological investigations both parasitological and entomological. They keep a watch over the nomadic groups in their area and maintain proper records and accounts of materials given to them.

The Technicians are class III officers and examine the blood smears collected during the survey. The Surveillance Inspectors are also class III officers appointed specially for the active surveillance work which consists in the detection of malaria cases and the treatment of every positive case by administering the drug (primaquin) for five successive days and helping the Malaria Officer in investigations and in deciding the nature of the infection. There are 36 Surveillance Inspectors in the Nagpur Division and 12 under the Nagpur Municipal Corporation.

For the assessment of results villages are surveyed and child and infant blood smears and blood smears from fever cases and passive cases are collected and examined from time to time. One hundred and fifty-seven villages were visited for child blood survey and 80 villages were visited for the infant malaria survey during 1960-61. Of the 1,235 infant smears none was found positive for malaria parasites. Of the 3,300 child blood smears examined none was found positive for malaria.

National Filaria Control Programme

The National Filaria Control Unit, Nagpur, has jurisdiction only over the Saoner and Katol tahsils of the Nagpur district. It works under the control of the Filaria Officer who is a class II Officer. He is entrusted with the annual filaria parasitological survey and with administering suitable dose of diethyl carbamazine tablets. He is helped in his duties by the Research Officer.

The Assistant Entomologist is a Class II Officer. He carries out all entomological investigations. He advises the Filaria Officer as regards the anti-larval work carried out in the breeding areas.

The Filaria Inspectors are Class III Officers who supervise the anti-larval measures and help the Filaria Officer and the Research Officer in carrying out the Filaria survey and in doing mass therapy.

The Filaria control work in Nagpur City is done by the Municipal Corporation under the technical guidance and supervision of the Deputy Director of Public Health (Malaria and Filaria). The Corporation receives Government assistance in the form of larvicide and drugs.

B.C.G. Work

The special B.C.G. Unit for Nagpur Division has its headquarters at Nagpur. It is entrusted to Supervising Medical Officer, B.C.G. Nagpur, who works under the supervision and guidance of the Assistant Director of Public Health, B.C.G., Vaccination and T.B. Control Programme, Poona. The four B.C.G. Teams under this unit are headed by a Team Leader. The four teams have 25 technicians in all and other requisite staff and equipment to carry on their work. The teams have so far covered whole of the Nagpur Division except the districts of Bhandara and Chanda where work is in progress. In Nagpur district 2,09,569 persons were vaccinated during 1953—59 and 5,68,114 persons were tested.

The Health Unit at Saoner also functions as a training centre for various categories of personnel required for public health programme. The Health Unit has- all the necessary equipment, a well-developed museum and a library.

Tuberculosis

The Tuberculosis Control Programme has been launched by the Medical Department under the T.B. Control and Training Unit, Nagpur. Besides the Nagpur Main Centre, there are sub-centres at the Mayo Hospital, Nagpur; Saoner Health Unit; Bhiwapur Primary Health Centre and Ramtek Hospital, a health-visitor being stationed at each sub-centre.


Epidemics

In urban areas it is the statutory duty of the municipalities to provide special medical aid and accommodation to the sick in times of epidemic diseases, and also to prevent such outbreak. In rural areas it is the duty of the Zilla Parishad. The Public Health Department co-operates with the local bodies in the control of epidemics through primary health centres, Health Assistants, Sanitary Inspectors and sanitary squads.

The main season for the outbreak of cholera is the rainy season, but occasionally summer also, when there is scarcity of water. The infection takes place through rivers and water sources. The sanitary staff undertakes disinfection of water well in advance. In times of epidemics, the Epidemic Medical Officers, Health Assistants and the sanitary staff take preventive measures like segregation and treatment of cases. In case of smallpox, the disease is brought under control by vaccination and revaccination done every year. There has been no incidence of plague in the district during the last ten years.

Leprosy

Leprosy is an endemic disease in the district. The Assistant Leprosy Officer, Nagpur, is in charge of Nagpur and Marathwada Divisions. He works directly under the Special Leprosy Officer, Maharashtra State, stationed at Nagpur. The Leprosy Centre at Umrer works under the National Leprosy Control Scheme. The Centre has under it 258 villages divided in four sub-centres each with a non-medical assistant. Their main duty is survey and treatment. Propaganda and education also form part of their duty.

Survey, Education and Treatment Units have been set up at Katol, Mouda, Narkhed and Saoner under the Bombay Leprosy Plan. Each works under a Leprosy Technician. Two Leprosy clinics are located one each at Nagpur and Parseoni. A six-bed temporary hospitalisation ward has been built within the premises of the Mayo Hospital. Nagpur. The Leprosy Training Centre at the Medical College, Nagpur, affords training in leprosy work to the medical graduates. In the out-patient department attached to this Centre 2,500 patients so far have been diagnosed and treated.

Fairs

The following fairs managed by the Government and local bodies are held every year in Nagpur district: —

Name of the Fair

(1)

Time

(2)

Number of pilgrims

(3)

Managed by Government—
Ramtek (Kartik)
5 days
5,000
Ramtek (Ramnavami)
3 days
20,000
Managed by Local Bodies-
Dhapewada Fair (Ashadhi Ekadashi)
3 days
7,000
Hati Fair
5 days
3,000
Bela Fair
6 days
4,000
Ambhora Fair
3 days
8,000

The respective local bodies organise the sanitary arrangements at the fairs under the supervision of the Public Health department.

Famine Relief

When famine and scarcity conditions are declared, the District Health Officer under the general orders of the Collector arranges medical aid and sanitary facilities.

Health Propaganda

Health propaganda is done by all the health staff by use of posters, pamphlets and with the audio-visual equipment. Seminars, group discussions and cinema shows arc also held.

School Hygiene

The Dispensary Medical Officers undertake medical examination of school children wherever such dispensaries exist. At other places the staff of the Public Health Department undertakes this work.

Vital Statiastics

Compilation of vital statistics is done by the staff attached to the office of the District Health Officer. Reports regarding births and deaths are received from the municipalities and from each police station which in turn receives them from the village kotwals once a week or fortnight. The checking of registration of births and deaths is done by the staff of the Public Health, the Police and the Revenue departments.

Family Planning

In the context of our rapidly growing population and poor economic conditions, birth rate ought to be reduced if the standard of living of the community is to be raised and the health and happiness of the families is to be ensured. To achieve this goal, rural family planning centres arc opened in conjunction with the primary health centres and maternal and child health centres at Kalmeshwar, Narkhed, Mouda, Kuhi, Katol and Soner. Urban centres are run by voluntary organisations and local bodies with Government grants. The mobile family planning unit has its headquarters at Nagpur. The Family Planning Officer at the Directorate level in Poona co-ordinates and guides all family planning activities in the State.

Public Health Institute, Nagpur

The Public Health Institute at Nagpur was started in 1959 to train personnel for the Public Health department. It provides training facilities for para-medical personnel and orientation training for departmental candidates. For the post-graduate course the Institute is affiliated to the Nagpur University.

Vaccine Institute, Nagpur

The Vaccine Institute, Nagpur, manufactures smallpox lymph and cholera vaccine.

Bureau of Health Education

A Bureau of Health Education is established under the Assistant Director. Public Health, to undertake the training of pre-service and in-service personnel. It also conducts cinema shows in rural areas on various subjects relating to public health and exhibits models at cattle-shows, etc.

Health Schools

The Health School at Nagpur under a Lady Superintendent conducts courses for health visitors. Practical training is imparted at Sadar Maternity and Child Health Centre, Saoner Health Unit and Daga Hospital.

Mobile Hospital Unit, Nagpur

During times of epidemics, the staff of the Mobile Hospital Unit undertakes isolation and treatment of infectious cases by opening temporary hospitals. During normal times it undertakes opening up of medical camps at places where no medical facilities are available.