“‘In former reports I have mentioned the extreme ignorance displayed by native “hukeems” or “vaids” of surgical principles. As a rule, all surgical disease is either wrongly treated, or let alone until treatment is unavailable by these uneducated practitioners. Their errors of omission and commission are not so easily ascertained in their medical, as in their surgical, practice. But in the latter, there is a glaring ignorance, not only from things requisite not being attempted, but from things unnecessary being performed, leading to the serious injury and often to the death of the patient. Thus, during my last tour, I saw at one village, an open scrofulous sore of the neck with the carotid artery isolated, and apparently on the point of giving way. At another village I witnessed an advanced cancer rapidly killing a man. In another place a woman had remained for days with a dislocated jaw, which was easily put in situ. Other forms of dislocation and fracture neglected are almost daily sights. At Bikaneer I amputated the leg of a man who eight months before fell from a camel; the bones of the leg protruding through the skin of the heel, and the foot being driven half-way up the front of the leg, in which position it had been permitted to heal! At the same place a woman was rapidly sinking from the results of extensive sinus of the breast, following abscess, and which only required free incisions for the restoration of health. I also saw a man dying of strangulated hernia, without the slightest idea of or attempt at relief on the part of the native practitioners. And so on, throughout almost the whole range of surgery, I have from time to time witnessed the most lamentable results from the malpractices, or from the absence of practice on the part of the Native Doctors.’

“As mentioned in the above extract, the errors of omission and commission are not so easily ascertained in medical as in surgical cases. But the great majority of those stricken by disease, such as inflammations and fevers, derived as little benefit from medicine as did the Romans when, according to Pliny, physicians were banished from the Imperial City during many years. For few indeed of the higher class and comparatively better educated ‘hukeems’ or ‘vaids’ would minister to the poor who were unable to pay their fees; and of the populations of India the great majority are and always were poor. Steeped in continually augmenting superstition and ignorance, if the poor received medical aid at all, it was from the hands of the equally ignorant and superstitious village ‘Kabiraj,’ who, unlike their more noble Aryan predecessors, did not even ‘draw physic from the fields,’ although they may have used a charm, such as a peacock’s feather tied round the affected part! If the poor got well, they got well; and as most diseases have a tendency to terminate in health, many did recover. If a fatal termination resulted, it was attributed to nusseeb or destiny, or the gods were blamed. Insane persons, if harmless, were allowed to ramble about the streets; if violent, they were chained in the most convenient place. The jails of the Native States were also in an unparalleled unsanitary condition, for no medical aid whatever was provided; as Coleridge said of Coldbath Fields, these jails might have given His Satanic Majesty a hint for improving Hades. Fatalism combined with ignorance, and a consequent utter unbelief in any measures of sanitation, resulted in the absence of all measures of precaution during epidemics of contagious disease. During the prevalence of small-pox, children might be seen by scores, in every stage of the disease, playing or lying about the streets. During an epidemic of cholera, not one precautionary measure was ever adopted—except by the wild Bheels, who invariably moved, leaving their villages for a time for the open jungle; thus forestalling the most approved method of preventing cholera adopted for British troops, viz., marching away from the infected area.

“Not only were there no hospitals proper, or contagious hospitals, or asylums for the insane, but neither were there any asylums for lepers. Regarding the latter, difference of opinion would appear to have existed among scientific investigators, then as now, as to whether leprosy is a contagious disease or not. Then as now, in some parts of the country, lepers were permitted to live among the people; in other localities they were thrust out from the towns or villages, generally forming a little colony on the adjoining plain. This expulsion of lepers from the towns and villages, then as now, was not so much the result of fear of contagion, as the Brahminical dread of contact with impurity. Then as now, these outcasts lived miserably in mud or grass huts, obtaining food by begging. When tired of life, or when being old or disabled their relatives were tired of keeping them, they often submitted to ‘sumajh’ or burial alive. But they more frequently threatened to perform ‘sumajh’ with the view of extracting alms from the charitable, who were induced to believe that the death of the leper would be credited to them, unless they bought off the sacrifice. ‘Sumajh,’ or leper burial alive, has been practised comparatively recently in more than one of the Native States.

“The Native principalities are now much more advanced in most respects than they were only a few years back. By coming into contact with the progressive civilization of adjoining British districts, the Governments of Native States were forced to advance; for they felt their existence would be imperilled. And this advance was most materially assisted by the successful endeavours made by the Indian Government to secure the better education of the young Indian princes and nobles. The Imperial Government also, and especially under Lord Mayo, enunciated care for the sick as one of the most urgent duties of the feudatory rulers of India. Owing to such measures, aided by the personal influence of the Political, and the assistance of the Medical Officers attached to the Native Courts, a hospital or dispensary has, amongst other features of civilization, been established at every large capital; while in some States ramifications of such central establishments have rendered the people almost as well off, in the matter of medical relief, as those in British territory. As it will not be necessary to refer again, except incidentally, to the Native States, I may here remark that all the medical institutions are supported at the cost of the Durbar or Government of each State. They are, as a rule, superintended by the European Medical Officer attached to the Political Residency, aided by native assistants.

“Although the recent condition of the Native States represents what formerly prevailed all over Hindustan, it must not be understood that the people were devoid of charity; only the charity of the well-to-do classes did not take the form of medical relief. In the absence of a qualified medical profession recognised by the State, the confidence felt in the physic of the ‘vaids’ and ‘hukeems’ was something akin to the faith of Byron, who without any such excuse designated medicine as ‘the destructive art of healing.’ Moreover, the organization of hospitals was not understood, and the necessary discipline of such establishments was foreign to the habits and ideas of the people. The poor (who now throng the hospitals of India), having had no experience of the advantages of such institutions, would probably not have resorted thereto had hospitals and dispensaries been opened under native control. So suspicious were the people on the first opening of a hospital in one of the Native States, that sweetmeats, of which they are very fond, were ordered to be given daily to each patient, as an encouragement to attend! So in former times the charitable preferred spending their money in sinking wells, in constructing serais or rest-houses for travellers, in endowing temples, and in feeding the poor, particularly Brahmins. In this manner, enormous sums have been disbursed and are still expended, especially in food for the destitute. This laudable charity of the Indians, although often confined to their own caste people, and to occasions of family festival, is one of the reasons why it has never been thought necessary to establish any system of poor-law relief in British India. Of late years native charity has been often directed towards building and endowing medical institutions, and many Indian gentlemen have given most liberally for such purposes.”