Chapter IV

Imperial Reluctance: State Initiatives

.. The Government of India has been so busy with the administration that it has not

had much time or attention for anything else. Public health has been allowed to

develop by itself or to stagnate, though every now and then immediate urgency or

twinges of conscience have resulted in spasmodic action. But the "ultimate

principles" of sound advance in public health have either not been studied, or they

have been mostly ignored and set aside. India has lacked an Edwin Chadwick or a

John Simon."1

In 1927 talking about the need for Public Health Policy in India an anonymous

author wrote the above lines in the Indian Medical gazette in 192 7. Public

Health policy in India was clearly not developed before 1920s and the impact

of Western medicine upon Indians' ideas, life-styles, and experiences were

very limited at least before 1914.2 The role of state in the organization of

public health was a modern concept introduced in India through the contacts

with the west. The comprehensive conception of what a community health

service should undertake has led to the development of modem health

administration, in which the State assumed almost the entire responsibility for

providing medical relief to the country and it alone had the power for

legislation. State was thus responsible for the establishment and maintenance of

the different organizations required for providing the community with health

protection on the wide basis. Though there were few private practitioners it was

beyond the capacity of individuals or of groups to take up the major task of

health administration of the entire population. Hospitals, dispensaries and other

adjuncts and the necessary personnel to run them were provided by state. The

early efforts of health administration were directed to the alleviation of

suffering and to the r~habilitation of the sick and the idea of prevention came

later. 3

I Anonymous Author, 'The Need for Public Health Policy in India', Indian Medical Ga::ette. Octobt"r 1927. p. 576. 2 David Arnold, Colonising the Body, OUP, New Delhi, 1993, p. 244. 3 Sir R.N. Chopra, ·organization of Public Health and Medical Services in India', Indian Medical Gazette, January 1941, p. 55.

126

For a long time there was no organised effort to introduce a public health

policy in India and the Public Health Department was primarily intended to

supervise and control the sanitary administration and devise measures to

prevent and control the diseases which often visited the towns and villages in

epidemics such as cholera, small pox, plague, malaria, dysentery etc. There

were no energetic advocates of public health laws in India like in England

where Sir Edwin Chadwick and Sir John Simon campaigned for better sanitary

measures. 4 The role of state in public health policy in India changed after

World War-I with the passing of Government oflndia Act of 1919.5 From 1919

the Public Health Departments, · both under the Central and Provincial

Governments, have been re-organised and schemes have been formulated to

tackle the Health problems. Health Department became not only an advisory

body to the Government but also for the self-governing bodies and other

institutions and it also extend its helping hands whenever such advice and help

was sought for. 6 During the same time period in the medical front the

administrative and technological limits of western medicine have become

apparent and there was a growing realisation that much of the ill-health of the

colonial world was almost intractably bound up with problems of poverty and

nutrition. There was a shift from curative to preventive medicine, from

epidemic diseases to endemic ill-health and under nourishment during inter war

period. Hmvever, the scale of problem revealed was too great for most colonial

administrators to contemplate tackling in any comprehensive way. 7

The role of state in the promotion of maternal health care system in India is

studied in this chapter. Some of the questions which will be addressed in this

chapter are as follows. What was the public health policy of India from 1920s?

4 Sir Edwin Chadwick (1800-1890) was the Secretary of Poor Law Commissioner and he propositioned that po\'erty and sickness were linked and to eradicate diseases it was necessary to eradicate poverty. He was the architect behind the enactment of the public health Act of 1848 and the acceptance of the principle that the state was responsible for the health of the people. Sir john Simon (1816-1904) was responsible m0re than any other for the sanitary reforms in England.

5 By 1921 India was a continent of 1,805,332 square miles, inhabited by 318,942.118 inhabitants, belonging to populations differing profoundly in race, language and culture as well as in habits and religion. 90 percent, of the total population - the 286,467,204 inhabitants who li\'e in the 685,665 villages of India. (Editorial, Indian Medical Journal, December 1931, p. 623)

6 Editorial, Indian .'dedical Journal, November 1931, p. 567.

7 David Arnold, Imperial Medicine and Indigenous Societies, Manchester University Pres~. 1988, p. 2.

127

How was the administration of maternal health care system and what were the

devises of the state in this? How far state was able to succeed in its efforts and

what was the reach ofthe state provided medical relief to women in India? Was

the maternal health care system in India a benevolent gesture of the state? The

chapter first traces briefly the beginning of public health policy in India and

then studies the development of the medical administration from 1920. It traces

the development ofthe health organisation under the Government of India Acts

of 1919 and 1935 and how the central and provincial medical administration

was co-ordinated with the creation of Central Advisory Health Board. Focusing

on the theme of the present thesis the state sponsored maternal health

programme administered by Dufferin Fund i.e. Women's Medical Services is

studied. Besides this major scheme the functioning of the government

hospitals, dispensaries and meternal and child welfare centres (MCW) in

Punjab, United Provinces and Delhi are also analysed.

State and Public Health

"The state of health conditions of a country or a province depends largely on

the meteorological features, character of population, their occupation, mass

literacy, economic prosperity of the people and the extent to which organized

efforts are under taken by the Government and public institutions to mitigate

the human suffering."8 State has a major role in promotion of public health and

the British government in India tried to introduce public health schemes.

Western medicine came to India in the wake of colonialism and as early as

1664, hospitals· were opened by the East India Company for treatment of

servants of the Company. Ho'lpitals were provided for Indians towards the end

of eighteenth century. The first moffusil hospital was opened at Dacca in 1804

and by 1840 there were a dozen hospitals for Indians in various large towns

besides the presidencies.9 Under East India Company Public Health

Administration began with the creation of a Hospital Board in Bengal

presidency in 1786 for direct superintendence of military hospitals in the

8 Dr. Prakash Chandra, 'Public Health Conditions in U.P".lndian Medical Ga=ctte. December 1933, p. 725

9 John Megaw, 'Medicine and Public Health', in Sir Edward Blunt (ed.), Soci.:.-1 Sen·ice in India, London, 1938,pp. 184-85.

128

Presidency. In 1796 new medical boards were constituted in all the three

presidencies and they controlled all the medical affairs, both civil and military,

in the presidencies. 10 In 1858 with the transfer of power from East India

Company to the crown these medical boards were reorganised and a Director

General of Medical Department was appointed for each of the presidencies.

On the recommendation of the Royal Army Sanitary Commission of 1863 three

Sanitary Boards were appointed in 1864 for improving the sanitary conditions

of the towns and villages in the three presidencies. In 1867 Sanitary Inspector

Generals (afterwards re-designated as Sanitary Commissioners) were

appointed. All the sanitary works were handled by in the Public branch of

Ho!lle Department until a separate sanitary branch was created in 1868. In 1873

a separate medical branch was created in the Home Department to deai with all

medical affairs. In 1880 civil and military medical administration was

separated and all medical matters of Government of India (GOI) were placed

under a Surgeon General and in .1896 he was also designated as Dir~ctor

General, Indian Medical Services (DG, IMS) with the formation of Indian

Medical Services. In 1914 the office of the sanitarj commissioner with GOI

was amalgamated with that ofDG, IMS.

Public Department (I 764)

~ Home Department (I 843)

~ Education Department (19IO)

Education and Heath Department (I92I)

~ Education, Health and Lands Department (1923)

~ ~ ~ Education Department (I 945) Health Department (I 945) Agricultural Department (I 945)

~ Ministry of Health ( 1947)

10 TLe Hospital Board of 1786 consisted of the Physician General, the chief surgeon and the head surgeon. The Medical Board comprised the surgeon general, the physician general and the inspector of the hospitals.

129

Ministry of Health

Under Government of India Act 1919 reforms the Imperial and Provincial

Councils were to be enlarged and a new system of dyarchy was to be

introduced. As per the dyarchy the Viceroy would retain control of areas such

as Defence, Foreign Affairs and Communications and the Government

responsible for the Provincial Council would control Health and Education.

The former were the 'reserved list' whereas the latter 'transfered lists'. Medical

administration including hospitals, dispensaries and asylum and provision for

medical education, Public health and Sanitation and vital statistics became

provincial subjects. However matters connected with policy decision and co­

ordination over these subjects remained with GOI and continued to be dealt in

the Home Department till these were transferred on 51h August 1921 to the

Education and Health Department. In 1923 this became the Department of

Education, Health and Lands and the 'Medical Branch' and 'Sanitary Branch'

were merged together in this. 11

The Government of India Act of 1935 confirmed the transfer of the

responsibility for local Medical and Public Health Administration to the

Provincial Government in 1919. Under the Reforms introduced by this Act the

distribution of health functions between the Centre and the Provinces has

remained practically unaltered. At the same time a larger measure of autonomy

has been granted to the Provinces than in the Government oflndia Act of 1919.

II By this the subjects of Medical branch i.e. administration ufCMS, Development of medical Science (including medical Colleges and Schools), Chemical examiners, civil lunatics and administration of lunatic asylums, Medical Regi.>tration Acts, Collection vital statistics, administration of pasture institute and Edward VII tuberculosis institute, along with subjects of Sanitary Branch i.e. Sanitary Commissioner, Sanitation and its improvements, sanitation in Haj pilgrimage control of malaria, plague etc., came under the Health Branch. In 1933, Local selfGovernm~nt Branch, which was dealing with functions like control of municipalities and Municipal local- bearers, the municipal Acts- framing and amendments, charitable and religious endowments, contributions from provincial to municipal funds and vice versa, loans received by municipal councils from Govt. or from other sources, town planning, village panchayats, pilgrim taxes, etc. as well taken over by the Health Branch. Department of Health was hence forth given the responsibility of dealing with subjects like medical relief; Public Health and Sanitation, Medical Research, Nutrition, medical profession, pharmaceutical profession, drug standards, medical store depots, cinchona products and quinine substitutes, resettlement of demobilized medical and auxiliary medical personnel and also miscellaneous matters like burial grounds, inns and inn keepers, pilgrimage in India !tc. On 2 August 1946 registration of births and deaths and matters relating to lunatic asylums, which were being dealt within the Home Department were transferred to Department of Health.

130

This resulted in the provincial legislatures and provincial governments being

more in control over the development of internal health policy and its

implementation. The ministers to the legislatures were anxious to promote the

growth of education, medical relief and preventive he<.lth measures as far as

funds permitted. Public Health officers were recruited in all the provinces and

the organization of such services became the marked feature in a number of

provmces.

There was no body for coordinating the health activities of the Centre and the

Provinces and to rectifY this defect in the constitutional position in June 1937

the GOI established the Central Advisory Board of Health (CABH). This Board

was under the chairmanship of the Member-in-Charge of Health in the

Viceroy's Executive Council and consisted as members the Health Ministers in

the provinces and the representatives from a certain number of Indian States. A

women member was also generally nominated by the GOI. Board has no

executive powers and provided only advice, consultation and cooperation with

regard to public health questions. On 151 September 1945 in the interest of the

Department of Education, Health and Land, this Department was and a separate

Department of Health was constituted. 12 On 291h August 194 7 Department of

Health was designated as Ministry of Health.

On the technical side the Member in charge of the Health Department had two

advisers, the Director General (DG), Indian Medical Service (IMS) and the

Public Health Commissioner with the GOI. The DG, IMS advised the GOI on

all questions of a medical nature and the administration of the Indian Medical

Services. The Public Health Commissioner with the GOI in addition to his

main duties acts as Staff Officer on public health matters to the DG, IMS. He

was also the adviser to the GOI on all public health matters and was also

responsible for the consolidation and issue of vital statistical returns for British

India as a whole and for an annual report to the Government of India on the

health of the country. 13 Apart from the technical advice they place at the

12 Directory of National Archives of India, p. 124.

13 Bhore Committee Report 1946, p. 32.

131

disposal of the Central Government and of the Provincial Governments, if so

desired by the latter, they also assisted in promoting the activities of a number

of organizations. 14

Organization of the Public Health Department

Two things which were inherent in the health policy of British government

after 1919 were the separation of preventive health care system and curative

health care systein and the devolution of power between centre and state lead to

more responsibilities to the states but more power were vested with the centre.

This separation of preventive from curative medicine continued in each

presidency. Most provinces had created a separate 'department' for preventive

medicine with an independent budget and functioned under an officer

designated as the 'Director of Public Health Department'. 15 He was assisted by

various ru;sistant directors of public health and in larger towns sanitary

inspector or heath officers were appointed. Generally there was lack of co­

operation and consequently of co-ordination in many parts of India between the

official medical and public health departments. This was a problem peculiar to

India for it neither existed in western countries nor in the dominions and

colonies, where the separation ofthe official health services into 'curative' and

'preventive' has never been effected.

'Surgeon-General' and 'Director of Public Health' were the two titles largely

responsible for the confusion of functions pertaining to the two departments

and the consequent overlapping, duplication and wastage of their resources.

Another factor contributing to this confusion has been the absence of orders

14 Both the Director General and the Public Health Commissioner were closely associated with the promotion of r.1edical research in India. The former was the administrative head of the Medical Research Department maintained by the GOI, while the latter was mainly responsible for its actual administration 'under the control of the Director General. In the Indian Research Fund Association, which is the largest body concerned with the promotion of medical research in India both were members of the governing body of the association. In addition to these duties, the two officers participated in the health activities of a number of volunta~ organizations, either as chairman or as members. These organi~tions include the Indian Red Cross Society. the Tuberculosis Association of India and the !ndiar. Councils of the St. John's Ambulance Association. In addition, these officers were also members of certain committees concerned with the dir.::ction of special fields of health activity such as the Central Committee of the Pasteur Institut:: of India, the Governing body of the School of Tropical 1'1edicine, Calcutta, and the Countess oi Dufferin 's Fund.

15 Prior to 1922 the Director of Public Health was known as Sanitar: Commissioner.

132

laying down the exact policy and scope of work for each department. While the

specialists in preventive medicine argued that those who had not taken a

diploma in public health could not appreciate the requirements and scope of

their work, the clinicians held that public health personnel were so fully

occupied with environmental hygiene that it lost all touch with clinical work

and was, therefore, not the proper agency for the administration of medical

relief. This lack of understanding between the two official departments led to

the development of 'exclusion' instead of a sense of co-operation. 16

In many branches of health activity the curative and ·preventive aspects could

not be separated without lowering the efficiency of the service to the people.

Co-ordination between the medical and public health departments was perhaps

more vital in the field of maternity and child welfare (MCW) than in any other

of medical and public health work. Maternity and child welfare organization

could not be built up on satisfactory lines without including in it the service of

health visitors and midwives. Besides this basic services, the facilities for

diagnosis and treatment required in respect of many forms of maternal ill health

and for the institutional care of difficult cases of childbearing were also

required. So when public health depanment proceeded to interest itself in

individuals rather than communities overlapping began to nppear in maternity

and child welfare work.

Generally the level of efficiency of health administration by local bodies was

low. Although there had been quantitative expansion of public health activity in

the provinces since 1921, the quality of work suffered from the weak control of

the local government over the local bodies as well as limited resources.

Commenting on the weak position of the provincial governments the Simon

Commission (1930) stated that "The result of the legislative and administrative

action taken in accordance with the scheme of the reform was, in effect, to

deprive the new ministers of Local Self Government of powers which were

essentials if they were to perform their tasks successfully ...... we have heard

the criticism that the only effective powers passed by provincial government,

namely those of suspension and dissolution, have left the ministers powerless

16 Chopra, 'Organization of Public Health and Medical Services in India', in Indian Medical Ga::ette, January 1941, p. 55.

133

in the face of misconduct calling for less drastic treatment, and we think that

this criticism is well founded." 17

In majority of the cases he financial resources of these bodies were insufficient

to maintain adequate services staffed with well qualified personnel. The

executive power was generally vested in an elected Chairman who often found

himself powerless to enforce the law against vested interests in the absence of a

public opinion~ The Provincial Director of Public health could only give advice

to the Chairman but could not ensure that such advice would be carried out

even where it was urgently required in the public interest, as in the case of

measures to control epidemics.

"The Public Health Department being the transferred subject under the Minister is said

to be a starving department, and particularly when it is not paying but a spending

concern, it is natural that all big and comprehensive schemes costing an initial outlay of

big sums will be shelved for 'want of funds' but when in the western countries the

State is primarily responsible for the health of the people committed to its charge, the

Government of this country can ill-afford to remain inactive as mere spectators any

longer and to allow the ravages of the preventable diseases to work havoc and

decimate villages." 18

On the whole it can be said that there was no definite public health Policy in

India till 1920s. "In Indian public health administration there has been no

continuity of policy, no long views, but a series of abrupt actions, dictated

sometimes by the feeling that something had to be done, sometimes by the

view that the people were not ready, and sometimes by fears lest one

department should acquire too much control and too much independence."19

Often it was felt that measures adopted with success in a country like England

or America were not applicable in India, which stood on a different footing in

respect of tradition, culture, climate, religious faiths, civilization, habit and

social and economic conditions of the people. "It is, therefore, necessary to

! 7 J.B. Grant, The Health of India, 1943, p. 12. 18 Editorial, Indian Medical Jou"nal, November 1931, p. 568. 19 Anonymous Author 'The need for Public Health Policy in India' Indian Medical Ga=we, October 1927, p. 576.

134

proceed with caution and pursue a policy on which may not bring about any

disastrous effect upon the people for whose well-being it is inaugurated.2°

Co-operation of the indigenous elite was sought to overcome these suspicions

and for the decimation of western public health system in India. The more

established colonial power became (or the more it fell back upon the support of

'traditional' elites and social groups in the face of mounting nationalist

opposition) the more reluctant it was to undertake a wholesale medical

interventionism that might undermine an already precarious status quo.21

Maternal Health Care

Every society expects women to go through the process of child birth and

society considers as its duty to find ways and means to minimize the risk

entailed in such a process. Everj endeavour was made to lessen the mortality of

the mother during child birth. There was no reliable statistics yet it was

estimated in 1936 that the number of women dying every year during child

birth was nearly one and half lakhs and the inclusion of the deaths due to

abortion would swell the number more. While an epidemic disease assuming

these proportions demanded and received attention from local authorities health

departments and the public too, the deaths of women from preventable causes

did not receive the same attention.

"The explanation may be partly that the facts are not known sufficiently, partly because

mortality from child-bearing does not occur in epidemic form, but it must also be due

to the too commonly held view that it is inevitable that some women must die during

child-birth. 'Some women' in each aiea naturally become thousands when applied to

the whole oflndia."22

The death rate for the age period, 15 to 40, was as usual higher among females

than among males, and the cause is ascribable to the greater risk of death to

which women are exposed during child-bearing ages, the rates being 10.7 for

males and 12.4 for females. Considering deaths by communities the rates for

20 Editorial, Indian Medical Journal, November 1931, p. 568. 21 [bid 20 22 Abstract from Annual Report of Public Health Commissioner with GOI 1933, Indian Medical Ga::ette, March 1936, p. 170.

135

i:he whole of British India are 28 for Hindus, 24.2 for Mohammedans, and 17.5

for Christians and thhe provincial figures for 1931 were as foliO\vs:

Hindu Mohammedans Christians

North-west of Province 15 21 14

Punjab 29 27 25

Delhi 33 25 10

United Prevince 26 29 5

Bihar and Orissa 27. 23 17

Bengal 23 24 14

C. Province 34 32 -Bombay 28 17 14

Madras 34 22 19

Coorg 22 27 -

Assam 18 20 18

Burma 21 15 14

Ajmer-Miwara 31 27 3

(Source: Indian Medical Gazette, May 1937, p. 324)

The births in India in 1921 were 7, 774,776 therefore the maternal deaths-taking

the death rate as 14 per 1000 births- would be 108,852. The maternal mortality

rate remained unaltered year after year and very slow progress was made in

reducing it. "A country which has met with signal success in combating the

general and the infant death rate, which has spent money freely and has passed

several enactments for the greater protection of women in child birth, has yet

done little to reduce the maternal mortality. What hope then can there be for

India, where every distressing condition endured by mothers in England is

magnified a hundred fold?"23

Often the detail figures for the maternal death rates for the province were not

accurate, and those of the rural areas were quite incomplete. Though most of

the facts were thus unreliable and. it was noted by the Public Health

Commissioner in his report that "They are incompleLe as they stand, but serve

23 Miss M.l. Balfour 'Maternal Mortality: A comment on the report on maternal mortality d,tring childbirth in England by Dr. Janet Campbell of the ministry of health, with a reference to maternal mortality in India' -Indian Medical Gazette, December 1924, p. 621.

136

to indicate the volume of work which is now being done in this department, the

increased of its ramifications and the enormous field yet to be overtaken. The

movement is in its infancy in India, but the conditions crying for amelioration

are only too potent to all; and the tedious reiterations of statistics many of

which are inaccurate serves all the more to focus on these urgent problems the

attention of all who think. " 24

Reducing maternal mortality included both preventive and curative care. While

the preventive care steps included long term plans like ways and means of

advancing the age of motherhood to a suitable period when a woman is more

capable of easily bearing a child, providing adequate nourishment for the

expectant mother, providing adequate medical aid for the expectant mother,

limiting the number of children, opening MCW centres etc. Of these,

concentration was on the antenatal work as it is the best single measure that

would produce the maximum benefit to the expectant_ mother. On the other

hand the curative care included providing the infrastructure like opening up of

women's wards in the hospitals and dispensaries, women's hospitals etc. Both

of these steps undertaken by the state for the promotion of the health care of

women in India. In the present chapter, the initiatives of state through WMS,

contribution to philanthropic organisations, Working of MCW scheme are

studied. The areas of Delhi Punjab and United Provinces are further studied in

detail for the understanding of the working of maternal health care system as

provided by the state.

(i) Women's Medical Services

The Women's Medical Services was found m the year 1914 and was

maintained by the Countess of Dufferin 's Fund (CDF) by means of a subsidy

received from the GOI. The maximum subsidy of Rs.3,70,000 was paid

annually to the CDF for the maintenance of WMS25 Most of the hospitals were

maintained by the native states, local governments, local bodies and private

persons of corporations and CDF provided trained doctors to run these

24 Annual Report of Public Health Commissioner with GOI 1924, p. 26. 25 NAI, File no I 0-69 'A' Medical May 19~ I

137

hospitals. The CDF, along with the GOI maintained a service of qualified

medical women and sent individuals to the institutions which most require

them. A medical woman, who was Secretary to the CDF, was Chief Medical

Officer of the Service.26 The Secretary had a personal assistant who was a

highly trained medical woman to assist her in her duties. But the Secretary had

no official status as such which would enable her to deal more effectively with

Provincial and Local Health Departments. She had no ready access to sources

of information which were available with the Government of India regarding

Maternity and Child Welfare or allied subjects in the Indian provinces and

States and in other countries through the Public Health Department of the

League of Nations.

In 1926 WMS 44 qualified medical officers attended 7289 maternity cases and

treated 30456 inpatients and 384242.27 In 1927 and about 400 women doctors

with registrable qualification were working in India. Of this 42 were in WMS

and 15 in junior branch of that service ar.d its training reserve; about 90 unde::.­

provincial governments and in local fund hospitals; about 150 under different

missionary societies and some I 00 in private practice. 28 In 1929, 42 medical

women were employed together with 7 in the Training Reserve. 29 But the

doctors working with WMS often faced many problems.

"In many hospitals doctors are fighting a difficult game, having to work in \\Tetchedly

constructed, ~apidly deteriorating buildings with poor equipments and an inefficient

staff. The struggle to make both ends meet is a constant anxiety and adds enormously

to the heavy responsibility entailed in the cadre and treatment of patients in

considerable climatic difficulties and often great loneliness."30

26 The Chief Medical Officer, Women's Medical Service, and Secretary of the Countess of Dufferin's fund, was ex-officio Secretary of the Lady Chelmsford All-India League for Maternity and child Welfare and of the Victoria Memorial Scholarships Fund. These were charitable funds raised by the wives of former viceroys for assistance of Maternity and Child Welfare work and improving the conditions of childbirth. 27 Annual Report of the Public Health Commissioner with GOI 1926. p. 217. 28 Abstract from the Annual Report uf CDF for 1928, Indian Medical Ga::ette, September 1929, p. 537.

29 20 of these were in charge of hospitals in different Provinces of British India, 6 were in charge of hospitals in Government of India areas, 8 were employed as professors or lecturers at the Lady Harding Meuical College, Delhi, 3 were appointed as l~ctures in medical schools or assistar.ts in the larger hospitals, while 5 formed a leave or sickness reserve.

30 Abstract from the Annual Report of CDF 1928, Indian Medical Ga::ette, September 1929, p. 537.

138

On 12 March 1929 a deputation of WMS went to Her Excellency Lady Irwin

and presented a memorandum on the need for the extension of medical aid by

women in India, but it had little out come. 31

Financial constrain was another problem faced by CDF in maintaining WMS.

The grant-in-aid from the Imperial Government was supplemented by large

donations by Indian privies and merchants who realized the need of

maintaining the WMS. But when medicine was transferred to provinces in

1919 it faced lot of problems. The Imperial Government clearly felt that they

could do no more for it than they were doing already; while the provincial

government were always faced with severe shortage of funds.

31 NAI, File no. 24 Health Deposits September 1929, EHL Department Some of the suggestions forwarded in the application were as follows.

• The increase of the Women's Medical Service to allow of experienced medical women being appointed to the five larger Provinces to inspect and report on all work done by women in medical institutions aided by government.

• To allow also of the appomtment of additional medical women to the larger women's hospital in the Provinces. This would enable a better standard of work to be done, would make it possible to open Branch Dispensaries in villages and to u11dertake some touring in the districts.

• An increase in the Training Reserve of the Women's Medical Service to allow women medical graduates trained in India to spend a year or two after graduation in a good women's hospital to gain practical experience.

• The formation of a senior grade for the Women's Medical Service, carrying a higher rate of salary to which the best of the personnel would be promoted by selection for filling expert posts.

• The organization of post graduat~ courses for medical women in obstetrics, gynaecology, maternity and child welfare !lnd tropical diseases.

• The appointment of a medical women to the office of the Commissioner for Public Health with the Government of India, who would be in touch with Maternity and Child Welfare Department throughout India, would act as a Bureau of information linking the different Departments with each other and with other nations. She would stimulate and co-ordinate the work and think 0ut methods of prevention suited to the peculiar conditions of the country.

• The appointment of medical women to the office of the Directors of Public Health in at least the five largest provinces, to organize and develop Maternity and Child Welfare work in the manner best suited to the Provinces. Attention would be directed to the medical inspection of school girls and women studP.nts and to the organization of welfare work among women industrial workers, and to the supervision of midwives and dais.

• The development of the grant-in-aid system from Provincia! Revenues to approved schemes of Maternity and Child Welfare.

• The provision by Government of training facilities for medical women to enable them to take up preventive work in India with a full understanding of its purpose, of its difficulties and the ways in which these m~y be overcome. Also the provision of training schools for Heal!h Visitors.

• The appoin.ment of at least one woman to all commissions appointed to enquire into the condition of the people. Where questions of health or welfare are concerned a medical woman should be appointed.

139

"The WMS in India may be no one's child; neither a legitimate object upon ~.~ohich

imperial revenues may be expended-since medicine is a transferred subject; or a matter

of much interest to provincial government who are trying their best to economise. Yet

it is an organization in being and one which is almost certain to expand to limits almost

equivalent to those ofthe general civil medical organization for lndia."32

There was hardly any subject more vital than the supplying of medical aid to

the women of India by well qualified women doctor and it was a matter of

necessity to maintain this Cadre. Yet it has been left out totally to be run by a

voluntary organisation and government refused to take any sort of

responsibility besides providing a fixed amount evecy year. It also continually

refused to extend any more financial help than the. fixed grant given to it

annually.33

WMS and Provinces

Provinces could recruit highly skilled women doctors from \VMS. The

Governments of Bombay, Madras and the United Provinces each employed

first class medical women in charge of the hospitals at Bombay, Madras and

Agra, respectively. The medical women at Agra acted as Principal of the

Women's Medical School and as well as the Superintendent of Medical Aid in

the United Provinces. However, the scale of relief for the province was

notoriously uneven. "Even where it is most generous, it does not pretend to be

commiserating with actual needs. It is the only agency that can step in and give

assistance where local efforts-official or non-official needs to be supplemented

or is non-existent"34 The limited number of the cadre did not allow of any one

being appointed to organize MCW work or to assist in the provincial

32 Abstract from the Annual Report ofthe CDF, Indian Medical Ga::ette, September 1929, p. 536.

33 For example in 1922 when CDF requested for extra grant, the Deputy Secretary to GOI, Department of Education and Health replied "Although the countess of Dufferin's Fund receiYes a luge subsidy from Central funds, the Government of India understand that it supplies lady doctors to many hospitals, e.g., local fund hospitals, hospitals in Indian States and ~ven purely provincial hospitals- to which they will not in future, under the Reforms scheme, make any grants from Central revenues. If, therefore. the Association should find any necessity for increasing their resources for the maintenance of the Women's Medical Service, it would not be unreasonable, in the opinion of the Government of India. to expect them to appi~' for pecuniary assistance to local Governments, local bodies, etc.. which employ their staff." NAI, File No 3-5 'B' March 1922 34 NAI, File no. 60-1134-H EHL Department

140

administration of women's hospitals. It allowed for three or four doctors only

being lent to each Province.

In 1924 it was observed that while a portion of the expenditures incurred on

appointments under the direct control of the local government in Governor's

provinces was recovered, no such recovery is made on the account of

appointments of the local bodies situated in those provinces. The Auditor

General objected to the pay of salaries to WMS officers serving in provincial

government hospitals, for then this particular grant to CDF would be regarded

as contribution by the central government towards a provincial object.35 CDF

maintained a service of qualified medical women and lent individuals to

institutions which most require them and was the only organized body capable

of providing such facilities. The continuance of its activities depended almost

entirely on the continuance of Government grant.

The Deputy Secretary of Department of Education, Health, and Lands in his

letter of 5th December 1924 to the Secretary of State noted "Neither local

governments and local bodies nor private persons or corporation would be in a

positions to carry on the work of the Association if, as a result of the

withdrawal of the financial assistance now given us to it, the Assistants were to

terminate its activities. Such a step would involve a great set back to the

welfare of the women of India and the matter has to be treated as possessing an

All India importance. "36 It was argued that the institutions to which these grants

were made did not belong to any particular province and had an all India

interest in their operations.

However, in the peculiar social conditions prevailing in the country the

provision of women doctors to minister to the medical needs of women was a

matter of primary importance and this justified the continuance of the grant.

The Governments of India with the concurrence of the Auditor G~neral has

therefore decided to continue to make these payments from central revenues.

The secretary of state approved this by the legislation, subject to the condition

35 NAI, File no. 5 Health 'A' January 1925 EHL Department

36 NAI, File no. 1-5 Health 'A' January 1925 EHL Department

141

that in future no officers of the WMS were to serve local government except in

return for full payment of salary including contribution to Provincial fund. Late

in October 1926 it was decided to continue the grant but that no addition should

be made to the list of such contributors. 37 This requirement that WMS o.llicers

serving under local governments must be paid for entirely by that Government

has resulted in loss to the Punjab of WMS officer who acted as Assistant to

Inspector Gene.ral of civil hospitals. Due to financial reasons several provinces

continued to enter the plea of a financial non possums and in these cases the

WMS had no option but to provide officers free of ch~rge or the women of the

locality concerned had to do without a doctor.38

The WMS officers also occupied many teaching and specialist post. One of the

most pressing needs of India in the sphere of medical aid to women was the

provision of an adequate supply of qualified women doctors. It was for this

reason that the proportion of WMS officers engaged in teaching institutions

was very high. Out of a cadre of 44 officers 13 were continually employed in

teaching at the LHMC, the Agra Ivfedical School, and in Madras. Students after

qualifying from these institutes had at least a year's experience of medical

supervision in hospitals staffed by 1st class medical women belonging to WMS.

Women Sub-Assistant-Surgeons from Agra were being posted to Agra,

Cawnpore, Allahabad, Banaras, or Lucknow under officers of WMS. "The

Association finds itself more and more committed to a policy of recruiting for

the service women who have specialized in the various branches of medicine

and Surgery. This high proportion of specialists is a heavy handicap on the

general usefulness of the WMS; but the Association looks upon the training of

Indian medical women as of the highest importance and as one of its greatest

responsibilities. "39

37 NAI, File no. 114-115 Health 'B' October 1927 EHL Department

38 NAI, tile no. 60-1/34-H EHL Department

39 NAI, File no. 114-115 Health 'B' October 1927 EHL Department

1~2

Training Reserve of WMS

Association has started the training of practitioners by forming a trammg

reserve of 8 officers for the WMS from 1924. The idea was to enlist two

promising young students each year soon after their taking degree and to give

them employment involving higher training for 4 years before taking them

finally into the WMS. First year they will work as clinical cssistant, for the

second year as ·resident medical officers, for the third in charge of small

hospitals, whilst in the fourth they will go to Europe for a post graduate course.

Since 1924 32 members have been admitted of which 12 were still in the

training reserve, 3 were temporary and 8 in WMS. In 1934 the raining reserve

had 43 doctors of whom 24 were Indian domicile and 19-non Asiatic domicile

doctors.

WMS was thus maintained by a voluntary organisation and government was

clearly reluctant to take direct responsibility of the women's health care. There

was always great pressure on WMS for supplying more doctors but the

numbers were limited. The study also shows that out of the total \VMS doctors

nearly one fourth were at Delhi teaching at Lady Hardinge Medical School.

(II) Philanthropic Organisations

Major work of organising Women's Health Care in India was under taken by

the philontrophic organisation, some f them were started by the Vicerines. Due '

to their dose association with the government these organisations were able to

get grant-in-aid from government. In this section these organisations are also

briefly studied. At the instance of Countess of Dufferin the National

Association for Supplying medical Aid to the Women of India or the Dufferin

Fund was established in 1885 mainly with the object of bringing out medical

women from England for employment in the local fund hospitals. The income

from the Countess of Dufterin Fund was spent on the grants to the provincial

Dufferin branches and to various hospitals and other institutions. It also gave

£cholarship to the women students pursuing studies in medicine in different

medical colleges and schools in India. By 1888 the GOI was supervising the

143

work of the Association and providing employment for women graduates. The

pay of these posts was, however, small owing to this and with the absence of

pension and official status the appointments failed to attract women of ability

in the numbers required. In 1909 an appeal for assistance was made to the GOI

and eventually in 1913 an Annual grant-in-aid was given to the National

Association for Supplying Female Aid to women of India to enable it to

constitute a Women's Medical Service to be under its sole administration and

control.

Besides WMS the following organizations have been carried out their activities

from the Dufferin Fund Offices: The opening of a Training School for Health

Visitors 1918, Foundation of the Lady Chelmsford League for Maternity and

child Welfare 1920, All-India Maternity Exhibition 1920, Opening of a

quarterly Journal for Maternity and Child Welfare 1921, All-India Baby Week

1924, All-India Conference of Health Workers 192 7, All India Conference on

Maternity and Child Welfare at Delhi in 192 7. The organising secretaries of all

these movements were members of WMS.

The governing bodies of the four different organisations i.e. Women's Medical

Services for India, Victoria Memorial Scholarship, the Lady Reading Women

of India Fund and the Lady Chelmsford All India League, were co-ordinated

and a centralised board of control was established in 1923. All of four have

originated at different times but their scope of work largely covered the same

ground. 40 The work chiefly carried out by Victoria Memorial Scholarship was

the training of dais at numerous centres throughout India and then subsequent

examination. There was a difference of opinion to whether it was better to train

the indigenous dias or to import properly trained midwives into the different

centres of the population. Good teachers for the former class of pupil were

scarce and health visitors who were only partly trained themselves do not make

good teachers.41

40 Abstract from the Annual Report ofCDFI923, Indian Medical Ga=elle, December 1924, p. 639. 41 Abstract from the Annual Report ofC;)F 1928, Indian Medical Ga::ette, September 1929, p. 537.

144

Lady Chelmsford All India League for MCW consisted chiefly of running

Health Schools, training of dais at different MCW centres and propaganda.

From very small beginning in 1918 the organization has later spread widely all

over India. The provincial governments of tLe Punjab, Bengal and of other

provinces made contributions which render such schools nearly self­

supporting. The Lady Reading Health School at Delhi was the most important

of these schools. The students who passed out of this school were working at

different centres scattered throughout India. A new school was opened in

Lucknow in 1923. The work at different centres was mainly concerned with the

training of dais and the organization of health wealth.42 It also brought out a

quarterly journal 'Maternity and Child Welfare in India'.

The Lady Reading Women of India Fund came into existence in January 1922

and had 3 main objectives- the provision of a hosi:el for the nursing staff of the

Lady Harcinge hospital at Delhi; the provision of a first class hospital for

Indian Nursing Association with the intention of raising the status and standard

of training for Indian nurses and provision of a first class hospital for Indian

women and children at Simla. In February 1923 the hostel was inaugurated by

Her Excellency the Countess of Reading which had accommodation for 70

nurses.43

Although these organisations were philanthropic in nature they were dependent

on GOI for funds for successfully carrying out their work. Any reduction of

Grant directly affected the working. CDF was greatly dependent on GOI for

maintaining the WMS. An annual subvention of Rs.1.5 was paid to the central

committee of CDF from 1913 to 1919 and later on a further subsidy of

Rs.2.5lakhs was sanctioned. Subsequent to this there have been 2/3 occasions

when the committee came up for additional subYention which was rejected.

Orders were issued promulgating that the amount of the subvention was fixed

at Rs.370000 and that the GOI did not concern themselves with the question of

pay etc of the WMS and that the Association would have to make their own

arrangements. 44

42 Ibid 43 Abstract from the Annual Report of CDF 1924, Indian Medical Ga::ette, December 1924 , p. 670.

44 NAI, File no. 10-69 medical 'A' May 1921

145

In 1932 as a retrenchment measure the GOI reduced the grant to the CDF from

Rs. 370000 to Rs.344300. The work of the service has been cramped for years

and due to the uncertainty the CDF could recruit only 'temporary' officers

which was an unsatisfactory step and make shift arrangement. This

arrangement failed to provide proper standard or efficiency. Dr. M.V. Webb,

C.M.O, WMS/ Secretary Dufferin Fund wrote to Deputy Secretary of India in

January 1934 appealing for the restoration of Funds.

"In this connection, it seems desirable to remind the Government of India that an

amount equal to the whole of the unreduced grant is required merely for the pay e:..."'ld

allowance including Provident Fund contribution and passage. money of the cadre of

medical officers. In the recent past the council have fortunate!) had other res(lurces

from which to meet the other essential expenditure required for the maintenance e:...1d

administration of the WMS. But these resources are slender and largely fortuito~s

and if the grant from the Government of India is not restored in full to the figure at

which it formerly stood, definite and considerable curtailment of the activities of L"'le

WMS is inevitable in the future. One of the institutions which would in that event re affected would be the LHMC, for which the Government of India have a spec:al

concern and responsibility."45

The council earnestly prayed that the grant for the maintenance of the WMS for

India may be restored in fu11 as the reduction has lead to closing down ')[relief

or the curtailment of the relief to be afforded in many of the existing centres. In

a letter dated 11.1.33 to the Deputy Secretary of the CDF further noted "The

council consider that a distinction may fairly be drawn between their own and

other classes of work which have had to be restricted owing to retrenchment.

In many cases with the restriction of funds, work. can be resumed at t.~e point

where it was left off. Their own case is different Diminution in the number of

patients due to inability to provide relief, will result in Joss of ground and loss

of life, which cannot be recovered at once with the advent of better

times ............ such loss cannot be averted if financial stringency necessitates

continued curtailment of work, reduction of cadre and closing down of some

hospitals. "46

45 NAI, File no. 50-21 34-H EHL Department

46 NAI, File no. 30-2/i2-H EHL Department

I.f6

The Junior Women's Medical Services supported by the Government of India

grant was directly affected. In 1931 then~ were 6 numbers and in 1934 only 3.

As long as cut remained it was not possible to expand the training reserve of

works to balance the los.:; from non recruited to the Junior Branch. In a reply to

the CMO, WMS the Deputy Secretary note on 20.09.1934 that "On the merits

of the case it is undoubtedly desirable that the grant should be restored to its

original figures; since I do not think there can be any doubt that India receives

good value for the money." Yet Government defended the reduction saying

that the cut was generally 10% but for CDF it was less. and was not ofthe fixed

%. The Fund was restored to its original amount only in 1937 on the condition

that it would send WMS officer to run the MCW section at the AIIHPH at

Calcutta.

"The amount required to restore to its former figure the annual grant to the

National Association for supplying medical Aid by women to women of India

is Rs.25700, which Rs.l7000/-would be spent during next financial year on the

maintenance of the Maternity and Child Welfare section at the All India

Institute of Hygiene and Public Health, Calcutta. The balance will be utilized

for meeting a part of the increased expenditure generally. For instances a sum

of Rs.5846 is required for normal increments to officers on the permanent

cadre of the WMS and a sum of Rs.12900 is needed for the employment of 2

extra temporary officers owing to the unexpected illness of 2 officers in

addition to the number normally on leave throughout the years. In regard to the

latter it may be stated that an officer has to be posted from the 1st April, 1935 to

the newly constructed Dufferin hospital at Shillong and arrangements have to

be made to provide for the hospital at Lucknow a highly qualified and

experienced officer, who in addition to her own work, assists in the teaching of

midwifery and gynaecology to the students of the Lucknow University.47

Many of the private efforts for the promotion of the maternity and child welfare

in India were dependent on the Government funds for their functioning. The

Countess of Dufferin Fund was the largest of these organisations and the effect

47 NAI, File no. 32-9/35-H EHL Department

147

of the reduction in the government funds largely affected the work of the

council. On the other hand there were few contributions from the public too.

The financial conditions of the Dufferin Hospitals as a whole was not

satisfactory as so many were having a precarious existence ow!ng to lack of

endowments and local support although their works was being more and more

appreciated by the patients who came in increasing numbers. "It is to be

regretted that the public still seem slow to realize the fact that medical relief, all

to modem western methods is expensive and if they wish to obtain the services

of highly qualified and experienced doctors such as WMS officers and take the

treatment required they must be willing to contribute something towards the

expenses in proportion to their resources. ,,4g

It was often found that many middle and better class patients insisted on

occupying free beds in the general wards though paying rooms were available.

Most of the hospital commitlee were not willing to give the medical officer in

charge authority to refuse admission to free beds to such patients and in fact,

often encouraged the practice with the result that the hospitals were in a

chronic state of financial distress. "Modem India, like other countries needs to

assimilate the fact that it can only afford free medical treatment to the really

poor, and the generate public must make a change in their attitude towards

medical relief and be taught not to except free advice and treatment unless they

are really proper. Only when this comes about will the hospitals be placed on a

satisfactory basis. '.49

(iii) Civil Hospitals or Dispensaries

Civil hospitals and dispensaries were run by the government to provide medical

relief to the people. There were very few civil hospitals run exclusively for

women as Dufferin Hospitals were functioning. The women doctors working in

the civil hospitals were usually of the sub-assistant surgeon grade and their

preliminary education and medical training were for a shorter period than that

required for a university degree. They work under the male civil or Assistant

48 Abstract from the Annual Report of the CDF 1939,/ndian Medical Ga=ette, September 1940.

49 Ib;d

148

Surgeon and he was not consulted by women. The male doctors often failed to

organise or direct effectively the work concerning childbirth and its

complications often due to the difficulties in most medical schools as to

practical train::tg in midwifery for men. The women assistant or sub-assistant

surgeon had often no other woman but a midwife (perhaps a poorly trained

one) to assist her or to anaesthetize the patient. Hence the relief of the women

was often very ·inefficient.

There was always shortage of women doctors in most of the hospitals and

dispensaries. "In the beginning there were only 24 wotnen doctors practicing in

whole of India and Burma; now after 50 years later 26 qualified women doctors

are working in zenana hospitals of Delhi and New Delhi alone". By 1935 the

Association of Medical Women in India had about 300 members and there

were approximately 700 registered women doctors in India. 50 Yet this number

was too small compared to the requirememnt in the country.

Educated women in the towns were availing the services of these hospitals and

dispensaries. "Indian women are using to some extent their former prejudice

against entering hospitals for confinement. Hospitals staffed by women exist in

all the big towns now, which was not the case 30 years ago and the more

educated are willing to avail themselves of the care and skill met with in these

hospitals. "51 Medical relief by women was almost entire I:/ confined to the cities

and large numbers of women in small towns and villages were debarred from

medical relief in their special troubles. They were dependent on the indigenous

dais. The first step towards ensuring that skilled service was available for all

confinements was emphasising on the training of these indigenous dais and

midwives and this did not fulfil the emergency needs or the treatment of

abnormal cases. For cases of complicated pregnancy and labour and for patient

with unsuitable home conditions maternity beds in hospitals were needed. The

total number of special beds recorded in 1935 \Vas 3,162 only.

50 Abstract from the Annual Report of the CDF 1935, Indian Medical Ga=ette, September 1936, p. 557.

51 Annual Report of Public Health Commissioner with GO! 1927, p. 75.

149

These hospitals accommodation was totally inadequate to meet the demand and

the hospitals for women were all over crowded and under staffed. There were

still a large number of women who would die rather than enter a general

hospital a still large number who would prefer to be atten~ed by a member of

their own sex for their confinements and for special diseases of women. The

local authorities were unable to give proper financial support to the hospitals

under their administration. 52

(iv) Maternity and Child Welfare Centres

Hospitals and Dispensaries mostly helped women in the child birth and other

immediate medical needs. However, MCW centres were opened to provide

prenatal care or preventive centres. Secondly there were very few hospitals and

the demand for maternity homes for the middle classes was increasing.

Municipalities were pressed to provide and maintain institutions. While

Maternity hospitals and homes were more expensive to equip, to staff and to

run MCW centres were much cheaper. MCW centres are mostly run by

voluntary organisations which sometimes received a small grant from

Government.

MCW movement in India has received great impetus due to the assiduous

efforts of the Countess of Reading. "it may be said that the outstanding need of

the maternity and child-welfare service in India to-day is expert medical

control, developing, coordinating and directing all efforts, voluntary and

official towards the one common goal of robust individual health and racial

improvement."53 There was slow but definite progress and MCW work did

penetrate in to the public consciousness in the different provinces. "The

movement has come to stay. It must develop before great progress in reducing

the infantile mortality can be expected and it is for Indians themselves to

promote and carry forward this development process if they wish to participate

in the results on a scale commensurate with the impact of the subject. "54 The

52 Abstract from the Annual Report of the CDF 1938, Indian Medical Ga::ette, January ! 940.

53 Abstract of Annual Report of Public Health Commissioner with GOI 1935, Indian Medical Ga::ette, April 1938, p. 248.

54 Annual Report of Public Health Commissioner with GO! 1927, p. I 06.

!50

number of welfare centres in England and Wales in 1934 was 2,884; the

number in India was 684, of which North-West Frontier Province had 2, the

Punjab 96, Delhi 26, United provinces 166 excluding 13 sub centres, Bihar and

Orissa 23, Bt:nga141, Central Provinces 57, Bombay 81, Madras 153, Coorg 1,

Assam 3 and Burma 22.55 The United Provinces heads the list in number but

many of these are in charge of poorly-trained and untrained welfare workers.

In some cases medical women were employed to supervise centres but the

payment given was usually poor and did not attract experienced workers. There

was no general system of Government's aid, no systematic inspection and this

lead to the preventive principle to be forgotten and for the centre to degenerate

in to a third class dispensary. 56

Training of Midwives and Dais

For centuries the work of attending women at child birth has been performed

by a special class of women who learn the methods of midwifery from their

seniors; usually their mothers or mother-in-law. These methods were not based

on modern knowledge of anatomy, physiology or surgery, but are entirely

empirical. There was PO knowledge of asepsis or antisepsis and therefore no

conception of the need for cleanliness and non interference. Yet she was the

only help available in the villages for women during child birth. Approximately

nine times as many children were born in villages as in towns in India. Normal

cases mostly recovered but there were often cases of morbidity due to bad

midwifery and subsequent lack of nursing care. In abnormal cases the patient

rarely survived, sometimes undelivered, of sepsis or shock. If there were

hospitals near by they were taken there but usually too late. Rural women's

needs have been altogether neglected in most of the plans and this voblem of

maternity work in rural cases has never been addressed with the vigour it

deserved. The training of dais and midwives was a very important component

ofthe maternity welfare work.

55 Abstract from Annual Report of Public Health Commissioner with GOt 1934, lnaian ,;redical Ga=ette, July 1937, p. 449.

56 NAt, File no. 24 Healtl-: Deposits September 1929 EHL Department

!51

Training ofthe dais in hospital was in those days the only method visualized by

those who wished to see them instructed and this was a very daunting task. 57

An impetus to this work was given in 1902 by the formation of the Victoria

Memorial Scholarship Fund. This was a movemen~ set on foot by Lady Curzon

who collected money for training of indigenous dais as a memorial to the late

Queen Victoria. The money provided by this fund, yielding an income of rather

more than Rs. 40,000 yearly, enabled the training of dais to be undertaken on

much larger scale throughout India. The work, however, proceeded very slowly

and there were many obstacles to overcome. 58 The agencies which undertook

the training of the dais were doctors attached to hospitals; either mission or

state-aided, voluntary societies; and health visitors. This system was ideal

because it afforded the dai opportunity of acquiring experience in ante-natal

work and in domiciliary as well as institutional methods of midwifery. 59

All doctors who have had experience of the work were convinced that it is not

sufficient mereiy to train the dais. Supervision of their work subsequently was

necessary to prevent their lapsing into the old methods. It was for the most part

non-existent and could not be supplied due to need of greater funds and

personnel.

"During the last 20 years, large numbers have been trained in hospitals eLc. But owing

to the fact that the training in many cases has been unpractical in its nature and that the

women (often illiterate) are quite unsupervised, their after work leaves much to be

desired. For the improvement of the conditions of childbirth in India are needed­

training and supervision of the work of indigenous dais; better training and supen·ision

of work of trained midwives; and improvement of obstetric standard of doctors t.rainec!

in India, men and women but especially women whose life work it forms. At present

the medical regulations at the University only require six cases to be conducted before

a degree in midwifery is obtained." 60

57 The dais feared to come for training as it would interfere with their practice owing to the necessary absence from home and they were not at all convinced that their patients w~uld appreciate their service more if they secured diplomas, nor pay them more highly. The most successful plan in &awing a good number of indigenous dais into classes for instruction was giving payment. The conditions attached to the payments were regular attendance, general good condu..;t, reporting of their cases. calling of the teacher in all difficulties.

58 Annual Report of the Public Health Commissioner with GOI 1927, p. 75. 59 The older methods of public health officers, sub-assistant surgeons and midwives instructing dais was later on replaced by the establishment of training centres run in conjunction wi:h a maternity hospital or home and having an infant-welfare centre attached.

60 Abstract from the Annual Report of the CDF 1919, Indian Medical Gazette. Februar::· 1921, p. 72.

152

Most of the provinces, however, lacked a definite policy in regard to the

training, registration and control of the dais, midwives and nurses. Punjab was

an outstanding exception where the training of dai was vigorously prosecuted

and -:rained dais were registered under the Punjab Nurses and Midwives Act,

1932. This act prohibited untrained dais from practicing and was enforced by

the local authority or failing it by the provincial Government whenever the

local situation warranted this step. 61 In 1933 there were 3923 trained dais in

India and only 2187 trained midwives.

Similarly the need for some organization of the training and work of midwives

in India was great. The training of midwives, other than indigenous dais, was

carried out at almost all big hospitals. These midwives worked mostly in the

towns and a good portion of them sought paid posts or were engaged in private

practice. As a rule they charged much higher fees than even the trained

indigenous dais. Those in paid posts were in the employment of local

authorities such as municipalities where their services are available to the poor.

Control and inspection of the work of qualified midwives varied greatly from

no inspection at all to detailed control by officers of the medical and public

health departments and voluntary societies. Registration of midwives was not

achieved in India for a long time. In Punjab there was a central midwives

Board which examined midwives and dais; awarded diplomas and kept a

register of those who were certificated. In the United Provinces the State

Medical faculty acted in a similar manner. In other places examinations were

conducted and certificates issued by hospitals undertaking the training of

midwives. 62

However legislation regulating the training and registration of midwives was

passed in eight provinces by 1938.63 Apart from the scarcity of training schools

and of trained midwives a serious handicap existed in the lack of supervision of

the midwives and their practice. These midwIves were supervised by health

61 Abstract from with GOI of Public Health Commissioner 1934, Indian Medical Ga=ette, July 1937, p. 449.

62 Annual Report Public Health Commissioner with GOI 1927, p. 75.

63 Abstract from Annual Report of Public Health Commissi.:mer with GOI 1935, Indian Medical Ga=ette, April 1938, p. 248.

153

visitors. The health visitor was the most important single unit in the maternity

and child-welfare services and the success or failure ofMCW centres depended

on her personality, knowledge and skill. A rough computation of the number of

health visitors working in India was about three htmdred i.e. less than one per

million of the population in some centres. Nurses and midwives were often

employed as health visitors. The provinces which employed the greatest

number of health visitors were the Punjab, the Central Provinces and Delhi.

The two former provinces have had health schools which were financed by the

provincial government concerned. In 1934 there wer~ only fi\·e health schools

in India.

Punjab

The estimated population of Punjab in 1923 was 20,685,024 and it usually had

a high birth rate and natural increase of population. "A serious feature of the

position, however, is the excess of males over femal~s; this calls urgently for

an extension of very considerable volume of MCW work which is already

carried out in the province. "64 There were hospitals dispensaries and MCW

centres all over Punjab to take care of maternal health care of the women in

Punjab. MCW centres were extended and a great deal of useful work was done

by the Public Health School in this regard. "In addition attempts were made by

the delivery of lectures and the distribution of leaflets and pamphlets to

disseminate amongst the masses knowledge of the value of the hygienic living.

The importance of propaganda in Public Health matter cannot be too strongly

emphasized. "65

MCW Work in Punjab

Most of the hospitals were situated in the district head quarters or the tehsil

head quarters and large number of women in rural area depended on MCW

centres for there medical needs. The MCW centres were run by a qualified

64 Abstract from Annual Report of Public Health Commissioner of Punj.d> 19:8, Indian Medical Ga::ette , Maich 1930, p. 176. 65 Abstract from Annual Report on the Public Health Administration of the Pun_;.:J for 1925, Indian Medical Gazette, 1927 February, pp. 116-117.

154

Health Visitor and medical facilities were provided for women before, during

and after confinement. Her duties were to visit mothers after confinements, to

supervise as many as confinement cases of dais as possiule; to train dais for the

indigenous dais examination and to attend the Baby Clinic.

The chief and most important duty of the Health visitor was the training and

in~pection of the midwives and dais. Refresher courses were held at most of the

centres for dais in order to prevent any deterioration in their knowledge or

standard of work. The public health inspectors carried on the inspection of the

work of health visitors in the MCW centres. Some times the Principal of the

Punjab Health School inspected all local centres and conducted departmental

propaganda. As the work of the inspectress of health visitors and health centres

increased, government sanctioned the post of an assistant inspectress in 1935.

In Punjab there were 64 centres by the end of the 1934 and these centres were

financed by local bodies, the Lady Chelmsford League, the Red Cross Society

and independent local committees. Year after year efforts were made to expand

the MCW activities. In 1926 arrangements were made by the Local Bodies to

afford medical relief for women by doctors of their own sex at new places like

Gojra and Jaranwala in the Lyallpur District, Batala, Gurdaspur District and

Sheikhupura. Similar arrangements were in progress at Dera Ghazi Khan and

Chiniot, District Jhang where wome'l sub-assistant surgeons were to be

appointed. 66 By 193 7 the number of MCW centres increased to 76 67 and by

1939 it was 102 .

.In 1923 about 16 local bodies employed qualified lady health visitors and most

of them had opened MCW centres. The local Health Committees have recruited

28 and 19 more health visitors in 1926 and 1927 respcstively. The demand for

these medical personnel was so great that they were posted to MCW centres

immediately after their training. However, there was often shortage of health

visitors also and in 1934 two centres had to be closed as there was no one to

66 Note 0:1 the Annual Statement of the D:spensaries and Charitable Instituti0ns ofthe Punjab 1923, p. 6. 67 Abstract from the Annual Report on the Public Health Administration of Punjab for the year 1935, Indian Medical Ga=ette, October 1937, p. 645.

155

run them. "Lack of funds and uncertainly as to the altitude of government in

respect of grants-in-aid prevented more rapid expansion of MCW work, though

public opinion was acutely alive to its importance. "68

Training of Dais ·

The progress in training of the dais was rather slow as the conservation,

prejudice and ignorance of the people stood in the way. The trained dais were

also very reluctant to leave their houses to take up services in other districts.

However, steps were taken for regularisation of the trained dais. The proposal

for the compulsory registration of dais was considered by standing committee

on Public health of the Punjab legislative councils in 1924 but was dropped as

the number of d~is was not considered sufficient to · warrant such an

enactment. 69 But the same was achieved by 1930s and the registration of dais

under the Nurses registration Act has also made progress. A number of local

bodies have also made by-laws under the Act forbidding the practice of

unregistered dais. 70

The grant from the Victoria Memorial Scholarship Fund has been promised for

training of dais during the year 1924 to 9 additional centres of Ambala,

Jagadhari, Rewari, Fazilks, Narowal, Jhelum, Jhang, Mianwali and

Montgomerywala (District Lyallpur).71 A sum ofRs.60,000 was provided from

the government of India in 1938 for rural construction tu be spent on

scholarship to encourage women from rural areas to be trained as dais and

nurse-dais. 72 The number of women who qualified in 1934 was 50 for the

diploma in midwives, 43 for the nurse dais certificate. and 200 for the

indigenous Dais certificate of the Punjab Central midwives board. 73 The

68 Annual Report of Public Health Commissioner with GOI 1927, p. 88. 69 Note on the Annual Statement of the Dispensaries and Charitable Institutions of the Punjab 1924, p. 7. 70 Abstract from the Annual Report of the Public Health Administration of Punjab for the year 1935, Indian Medical Gazette, 1937 October, p. 645. 71 Note on the Annual Statement of the Dispensaries and Charitable Institutions of the Punjab 1923, p. 6. 72 A Report on the working of Hospitals and Dispensaries in the Punjab 1938. 73 Abstract from the Report on the Working of Hospitals and Dispensaries in the Punjab for the Triennium 1932 to 1934, Indian Medical Gazette, 1936 May, p. 30!.

156

number of dais under training at various health centres in 1935 was 1758 and

350 passed the examination for indigenous dais. 74

233 women qualified for Indigenous Dais Certificate, 66 for Nurse Dais

Certificate and 45 for Diploma in Maternity in 1936.75 The number of qualified

midwives showed a steady increase. During the triennium of 1935-37 there

were 127 midwives, 189 nurse dais and 1056 trained dais qualified themselves

for the diploma and certificate of the Punjab central midwives Board. 76 The

number of dais under training increased to 2593 and certificate after

completion of training were obtained by 627 dais in 1939 as compared with

563 in 193 7. 77 There was always shortage of female medical workers and the

dearth of women dispensers was acute. Besides the scholarships sanctioned by

Government for the training of women dispensers some of the Local Bodies

have also endowed scholarships, but candidates were not forthcoming to take

them. 78

Hospitals and Dispensaries

Many hospitals and dispensaries were opened in Punjab to cater to the needs of

women. Besides the women's wards L'1 the general hospitals there were special

hospitals run by women doctors. There were 7 assistant surgeons in the

women's branch ofthe Punjab Civil Medical Service and the provincial cadre

of women sub-assistant surgeons has also been made in 1939.79

In Punjab there was one dispensary serving an average population of 33,043 in

147 sq miles. The Punjab Government in 1924 considered a scheme for the

expansion of medical relief under which it proposed to provide one dispensary

per 100 sq. miles and one dispensary per 3000 of population. It planned ~o

74 Abstract Annual Report on the Public Health Administration of Punjab for the year 1935, Indian Medical Ga=ette, 1937 October, p. 645. 75 Abstract of the Annual Report on the Working of Hospital and Dispensaries in the Punjab for the year 1936, Indian Medical Ga=t:tte, July 1938, p. 443-444. 76 Abstract from Annual Report on Working of Hospital and Dispensaries in Punjab, 1935-37, Indian Medical Ga=ette, February 1940, p. 126. Abstract Annua! Report on the Public Health Administration of Punjab for the year 1939, lnc!ian Medical Gazette, 1941 August, p. ,l96. 78 Note on the Annual Statement of tf)e Dispensaries and Charitable Institutions of the Punjab 1923

79 Abstract frum the Report on the Working of Hospitals and Dispensaries in the Punjab for the year 1939, Indian Medical Gazette, September 1941. p. 573.

157

open 70 new dispensaries by January 1926 which were to be in charge of Sub

Assistant Surgeons recruited by district board on a five year contract. 80 A very

considerable increase in the number of dispensaries was to be made to ac.r..ieve

the ideal of OJ.1e dispensary for every 100 sq. miles. The local bodies had

limited funds and these ideals could not be realized. Often due to the financial

stringency there was consolidation rather than expansion of hospitals and

dispensaries in Punjab. By the end of 1934, 360 rural dispensaries were

established and at 4 7 places hospitals and dispensaries were provincialised.

Again due to lack of funds for the maintenance of hospitals the government

could not proceed with its programme of provincialzing 66 more districts and

tehsil head quarter hospitals and dispensaries. Provincializing of hospitals has

saved many hospitals from untimely closure. For example, the Lady Aitchi5on

hospital \Vas the only hospital in Lahore and one of very few in the province

where medical attendance for women was provided entirely by qualified lady

doctors. It was in great demand yet was on the verge of closure when the

government took it over and saved it.

Number of indoor-outdoor patients according to class and sex treated in the

state Public, local fund and private aided dispensaries of the Punjab - 1924. 81

Male Female Boys Girl.s

Europeans/ Foreigner 1,423 1,906 547 517

Hindu 12,62,441 5,14,997 4,35,573 3,01,539

Muslim 13,00,778 7,22,374 5,90,343 1,29,791

Others 1,29,791 85,386 64,694 53,227

Total- 59,35,079

The above table clearly shows that the number of Hindu and Muslim women

who were treated at hospitals and dispensaries was less than half the number of

the men. At the same time the number of European and other foreign women

was higher than the men of same community.

80 Note on the Annual Statement of the Dispensaries and Charitable Institutions of the Punjab: I 9:24. p. 2.

81 Ibid

158

Number of Hos~itals in Punjab at the end of 1923

State Public 23 State Special

i. Police 31 ii. Forest and survey- 3 iii. Canal 86 iv. Others 14

Local Fund 355 Private Aided 31 Private Non-Aided 8 Railway 53 Total 610 (Source: Annual Statement on the Dispensaries and Charitable Institutions of the Punjab: 1923, p. 53)

Number of Hospitals and Dispensaries in Punjab

Year Number Rural Urban

1923 626 - -1924 640 - -

1936 961 687 274

1937 968 693 279

1938 974 697 277

1946 1064 778 287

Women's Hospitals and Wards

In Punjab there were 34 female hospitals and dispensaries which treated about

11884 women patients in 1923. In 1926 a special scheme was inaugurated for

providing medical aid to women by lady doctors in separate hospitals at each

district head quarter and special female sections in the general hospital at each

tehsil head quarter. Separate women's hospitals were to be under a woman

doctor, while the women's wards in the general wards had \vomen Sub

Assistant Surgeon. This Scheme could not be completed even after 10 years. In

1938 one District head quarter i.e. Jhelum and 54 tehsil head quarters haJ no

women doctors i.e. abo:.It 2/3 of the tehsil headquarter hospitals and

159

dispensaries had no-arrangement for the treatment of wo:nen patients by

doctors of their own sex. 82

By the end of I 934 there were 85 women's institutes (50 women's hospitals

and 35 women wards) in all of this 25 were maintained by Government, 32 by

local bodies and 28 by missionary societies. In 194 7 this increased to I 06 and

there were 345 maternity beds. There was always an inadequate provision for

proper female ·medical aid and it was rarely given the due consideration in any

scheme of expansion. "But the achievement of this ideal is still remote; for

financial reasons. The other limiting factor was the insufficient supply of

Punjab women doctors."83 Annexure -V table shows that the Female hospitals

and dispensaries in Punjab were run by the local fund or by the missionaries.

The statistics of the Lady Willington Hospital, Lahore show that these women

speciality hospitals were very popular and were in great demand. It also

fulfilled the important function of providing clinical material for the training of

students at the King Edward Medical College in practical midwifery and

Gynaecology.84 The Lady Willingdon Hospital, Lahore continued to work at

full pressure and many gynaecological cases had to be refused for want of

accommodation. Proposal was put up for providing accommodation for 116

more beds.

The extent to which women were availing themselves of this facilities is shown

by the number of women patients at hospital and dispensaries which rise from

1131632 (110672 out-patients + 24907 in-patients) in 1924 to 3326355

(3249818 out-patients + 76537 in-patients) in 1934. These figures refer to

women patients treated at ordinary hospitals as well as at women's hospital or

wards where lady doctors were available. The number of beds for ;vomen has

risen from 223 5 (912 at exclusive female hospitals and dispensaries) in 1924 to

82 Abstract from the Report on the Working of Hospitals and Dispensaries in the Punjab for the Triennium 1935-37, Indian Medical Gazette, February 1940, p 126. 83 Abstract from Annual Report on the working of Hospitals and Dispensaries in the Pun.;ab 1938, Indian Medical Gazette, July 1940, p. 444. 84 Abstract from the Report on the Working of Hospitals and Dispensaries in the Punjab for the Triennium 1932 to 1934, Indian Medical Gazette, May 1936, p. 301.

160

4024 in 1935.85 There was definitely a growing demand for women's hospitals

and this has brought to the forefront the problem of making adequate provision

for female medical aid io meet the growing demand. "The year shows a

remarkable increase in the number of women patients, both indoor and outdoor.

Thanks to the combined efforts of Medical, Public Health education and Rural

Reconstruction Department and Indian Red Cross society, there are signs of a

general awakening in the public who have begun to realize the necessity of the

proper medical aid for their women folk. "86

Village Nurse Scheme

Many schemes were introduced in Punjab aiming at the welfare of the women

and the reduction of infantile mortality but these activities were mostly

confined to the large towns and cities where all facilities existed for the

women. Rural dispensaries catering to men and women fell hopelessly short of

the provision that was rightly expected for the women. Local bodies were not

in a position to finance any large undertaking and due to financial stringency

Government also could not provide adequate assistance and funds.

It was in the middle ofthe year 1925 that an attempt was made by G. McGuire,

I.M.S Civil Surgeon, Kamal, Punjab with the assistance of his wife and in the

face of great deal of ridicule, to provide some help for the women in the

villages by adding to the number of qualified nurses in the district. According

to this scheme a body of nurses and nurse-dais trained in midwifery and paid

for by Government was to be maintained in every district with at least a nurse

in each and every dispensary. Great enthusiasm was shown by the public, who

came forward in numbers of their own accord asking for the services of trained

nurses. The District Boa;ds were prevailed upon to pass a resolution providing

a nurse in every dispensary if subscriptions of Rs. 1 ,500 were raised by the

people of the area. This scheme supplemented to a much felt want in the rural

areas, as it was not possible to provide for trained lady doctors. Nurses and

85 Review of the Report on the working of Hospitals and Dispensaries in the Punjab 1935 , Indian Medical Gazette, January 1937, p. 61. 86 Abstract of the Report on the Working of Hospital and Dispensaries in the Punjab for the year 1936, Indian Medical Gazette, July 1938, p. 443.

161

nurse-dais trained in midwifery played an important part in reducing puerperal

fever. There were 22 nurses in a district instead of the prior number of 2. It is

not intended that these nurses should take the place of lady doctors and even

though these nurses would fail to be useful in obstructed delivery, thousands of

women whose labour was normal and who die from puerperal fever through

sheer neglect and want of ordinary aseptic precautions at the hands of the

ignorant untrained indigenous dai, were saved. 87

Delhi

According to 1931 census the population of Delhi was 6,36,246 and the death

rate of females in the age group of 10 to 50 was 12.16 compared to 7.6 of the

males of the same age group per mile of the population. The total P.xpenditure

on MCW work in Delhi 1931 was about Rs. 70,692 which was about 5% of the

total expenditure incurred on account of public health. 88 The first of the MCW

centre was started in Delhi city in 1915. By 1931 there were 24 MC\V centres

of which 19 are in the urban areas and 5 in the rural areas (including the

notified areas of Shahdara, Mehrauli, and Najafgarh) of which onlv 2 were

actually located in the villages of Bawana and Nangloi. At all these centres a

mother card was kept and every effort was made to follow up the case from the

antenatal period to at least ten days of delivery. In these centre classes for

indigenous dais were also held twice a week and e.t:forts were made to wean of

these dais from their ignorance of elementary laws of hygienic and crude

methods as far as possible. Almost all these centres are popular and well

patronized.

Another very significant function of the health unit at Najafgarh was the

facility it offered for the training of students; medical or lay, and the fullest

advantages has been taken of this facility throughout the year. The Medical

Officer of health also fulfilled the very important function of teaching the pupil

teachers at the normal training school at Najafgarh. She taught all that was

practical and important in hygiene and suitable as applied to Indian villages'

87 G. McGuire, 'Hints ot Village Nurse Scheme', Indian Medical Ga=Ptte, February 1929, pp. 95-99.

88 Public Health Report for Delhi Province 1931, p. 31.

162

conditions, t0 school, their environment and to school children. 89 Students from

Lady Reading Health School and Lady Irwin College attended specially

arranged course lasting over a week during which period they had the fullest

opportunity of studying at first hand life of the villagers, the duties and

functions of the skilled workers appointed to assist them, the organization of

the health unit and the value or co-ordinated social services. Day tour was also

arranged for the senior students from the LHMC.

The organization of the centre varied according to the size and locality. In all

the municipality areas MCW work was carried out under supervision of their

respective health officers and the expenditure in the large municipalities was

entirely financed by the local authorities themselves. The Assistant Director of

Public Health with the help ofLady Health Visitor in charge of the main MCW

centre in New Delhi also supervised the work of the welfare centres in the rural

areas. Delhi was the only province, besides Madras, where women doctors

were recruited for organising the MCW centres both in urban and rural areas. 90

The MCW staff usually consisted of 2 European Health Visitors under whom

were 2 Indian Lady Health Visitors and 2 trained dais. Under the re-organised

MCW schemes each of the 4 municipal centres was provided with the one

senior Lady Health Visitor, Junior Lady Health Visitors and 2 dais.

Th~ smallest centre was in charge of a nurse dais and was attended at least once

a week in the urban areas by the lady doctor. During the intervening period in

the week the nurse dais followed up the instructions of the doctor and devoted

her time in home visiting in the locality. These home visiting were very

significant for only by visiting the home of the patients some of the worst kinds

of ignorance and prejudices were successfully overcome. More over during

such visits friendly advice as to proper feeding for the mother and the child,

sick nursing, clothing, ventilation, drainage and home economics was given.

Such work was more efficiently done by the Lady Health Visitors but due to

shortage of funds it could not be taken up extensively. The 2 trained dais

89 Abstract from the Annual Public Health Report of Dei hi province 1939, Indian Medical Ga=ette , May 1941, p. 314.

90 Bhore Committee Report 1946, p. 65.

163

working under Lady Health Visitors paid 3,349 visits. The Indian Health

Visitor paid 96I new visits and attended I09 midwifery cases, visiting 480

houses which were gynaecological cases. 69 dais were under training in I923.91

·~n I927 the number of dais increased to 95 including 4I trained and 54 under

training. 2 out of the 3 dais who appeared at the Punjab Centre midwives Board

Examination passed. 92

The total number of home visits made for different reasons were 92707 for

Urban areas (New Delhi, Delhi city and notified area Civil lines, Delhi) and

I7444 for rural areas for the year I93I as compared to 90572 and I7752

respectively in I930. Total number of attendance at the clinics in the urban area

was I99765 while the number in the rural areas was 8580 during I93I and

166I25 and 9049 for I930.93 Number of confinements in the health centre had

rose from I004 in I938 to I2I8 in I939. Attendance at the clinic rose sharply

from 26310 to 35505 and home visits rose form 3II92 to 31880. The rural

areas served by the centres has been considerably widened and whereas in

I938, the staff of the three centres at Narela, Nangloi and Meharuli dealt only

with 548 cases of confinement in 1939 they deal with twice that number i.e.

1088.94

More rural centres were required but financial stringency had hampered the

expansion of the work in rural areas and as a result Nangoli centre closed in

I93I. Voluntary Organisations or private individuals often contributed towards

the maintenance of the centres at Shahdara, Raj pur, Dhakka, and Meh.rauli. In

1939 a MCW centre was built at Jangpura with the donation given by

Marchioness of Willing don.

In I918 at Delhi 22 new dispensaries were opened of thi::; 8 were state special,

II sponsored by local fund, 2 were private and one was of railways. 95 The

Victoria Zenana Hospital was one of the famous hospitals for women in Delhi.

91 Annual Report of Public Healtll Commissioner with 0011923, p. 106. 92 Annual Report of Public Health Commissioner with GOI 1927, p. 94.

93 Public Health Report For Delhi Province 1931, p. 31. 94 Abstract from the Annual Public Health Report of Delhi province 1939, fr,riian Medical Gazette, May 1941, p. 314. 95 Report on the Administration of Delhi province 1918-1919.

164

It was run by the Dufferin Fund and it received grant-in-aid from Red Cross

Society, Delhi Muncipal Committee and Delhi Administration.96 Many patients

came to this hospital and there was always over crowding. "This increase in

maternity work is particularly encouraging as it shows that women have at last

realized the advantages of hospital care and treatment. At times the rush of

maternal cases has been so great that less urgent cases have had to be refused

admission and there is the danger of losing our medical and general work

unless the committee takes early steps to build the long-talked of Maternity

Block" 97

United Provinces

In United Provinces both ~he District Public Heath staff and the Local Health

staff were both provincialised and were under the control of the Director of

Public Health. It also had a Board of Health for the provinces which besides

being an advisory body, allotted funds for the sanitary purposes. The services

of District Medical Officers of Health and Assistant Medical Officers of Health

were provincialised and unified with the services of municipal Medical

Officers of Health. The provincialised Public Health Services has been formed

into two Distinct classes for Class I and those of with an Indian Licence into

Public Health of Class II.98 According to the 1921 census the population of

United Provinces was about 45,375,787.99 There were 632 hospitals and

dispensaries in 1923 and this later rose to 844 hospitals and dispensaries. Of

these 388 was in urban areas, each institution serving a population of 17, 668

and 456 in rural areas, each institution serving a population of 105,626. The

average number of villages served by a single medical institution was 224 and

a single dol'tor catered to the medical needs of about 13,586 people. And it was

the lowest provision for rural population in India. "It seems fairly certain that

96 NAI File no.S0-11139-H 97 Annual Report of the CDF 1932, p. 23.

98 Abstract from the Annual Report of the Director of Public Health qf United provinces and Oudh 1927, Indian Medical Ga=ette, p. 98.

99 Indian Medical Ga::ette, July 1929, P .409.

165

an appreciable proportion of those living in rural areas may, throughout their

lives, receive no medical aid from either a hospital or a dispensary." 100

During 1925, 1926, and 1927 deaths reported from child birth were 1405, 1817

and 1518 respectively. A member of the Women's Medical Service was

appointed as Superintendent of Medical Aid to Women in the United Provinces

since 1922. She organized preventive work in addition to the inspection of

hospitals. She has greatly increased the number of Maternity and Child Welfare

Centres and the training of midwives and dais. "She organizes and attends

Baby Week Celebrations give lectures, personally checks the work of the many

Health Centres she has started. All this is work of the greatest value in a

country like India, which could not be done by male workers. No other medical

woman is employed by any provincial Government to organize Maternity and

Child Welfare." 101

Jn 1935 the number of medical women employed on the preventive work in

municipalities and other local bodies was 18 and the number of health visitors

with diplomas in the municipalities was 10. The number of midwives employed

was 203. One medical woman (LMP) and 2 Delhi trained health visitors

worked in the Provincial Training Centre, Lucknow. One medical woman

(MBBS) and two Lucknow trained health visitors worked in the health unit of

Pratapgarh. 102 "The urgent need for incr~ased medical aid in the rural areas is

being more and more stressed on every hand and it is satisfactory to note a

scheme for an ambulance service has been inaugurated in United Provinces." 103

MCWCentres

At MCW centres maternity work and the treatment of mother and infants were

done. The midwives paid house visits daily discovered expectant mothers and

gave them elementary lessons on hygienic conditions and on care of the baby.

Expenses were met from the publicity funds, public donations and municipal

100 Bhore Committee Report 1946 ,p. 37. 101 NAI, File no. 24 Health Deposits September 1929 EHL Department 102 Abstract from the Annual Report of the Director of Public Health of United provinces and Oudh 1935, Indian Medical Gazette, February 1937, p. 126. 103 Abstract from the Annual Report of the CDF 1938, Indian Medical Ga=el/e, January 1940, p. 57.

166

contributions. The U.P branch of the Lady Chelmsford league in co-operation

with the provincial branch of the Indian Red Cross society controls the child­

welfare work and has opened many centres in cities and some small towns.

These centres have played an important part in the propagation of antenatal and

post natal knowledge in the expectant mothers. 104 In addition to health care

work regular classes were held for indigenous dais where lectures were given at

these centres. TP,e training of probationer dais and midwives was also carried

out at these centres which were recognized by the United Provinces State

Medical Faculty.105 Sometimes these midwives were .sent for health visitors

training to the Lady Reading School at Delhi.

In 1926 MCW work was carried out in 22 districts with 27 MCW and this

increased 'i:o 33 in 1927. By 1935 there were 223 MCW centres (114 rural and

I 09 urban) but all were run by the Red Cross Society. 106 The organisation of

these MCW centres varied according to the place and availability of the fund. ·

Some centres were having just a dai and sometimes they were having even a

qualified women doctor. A modified health Unit was introduced in 9 districts in

1935 in connection with rural development work and it had a health visitor, six

midwives and six trained dais.

Five midwives supervised by 2 health Visitors were employed in Lucknow

MCW centre. The number of labour cases conducted by these was 3 70 and of

expect mothers seen was 452. The training of the probationary midwives was

carried out at the Provincial Training Centre situated at Lucknow in

domiciliary midwifery and house visiting. By 1927 there were 6 MCW centres

in Lucknow. At Allahabad midwives have beeP- appointed in different localities

to visit the homes of expected mothers and to attend to confinement cases. The

duty order was to explain to the public the measures to be adopted in order to

combat the high infantile mortality. 2 sub-assistant surgeons have been

104 Dr. Prakash Chandra, 'Public Health Conditions in U.P', in Indian Medical Gazette, December 1933, p. 727. I 05 Abstract from the Annual Report of the Director of Public Health of United provinces and Oudh 1927, p. 34. I 06 Abstract from the Annual Report of the Director of Public Health of United provinces and Oudh 1935, Indian Medical Gazette, February 1937, p. 126.

167

appointed to supervise the work of these midwives and train the probationary

midwives. Four probations midwives were said to be under training here in

1925. Efforts to improve the standard of indigenous dais are also being made

by 2 resident midwives and the Health visitors for these provinces whose

headquarters were at Allahabad. In 1924 these midwives gave lectures to 42

dais and held about 49 classes with an average attendance of 6. The Allahabad

scheme was fmanced by the Red Cross Society, the provincial league the

municipality and by subscriptions donations and fees earned by the staff

maintained its success and popularity.

Cawnpore had five centres, two of which were financed and managed by the

British India Corporation was for the workers of Cooper Allen and woollen

Mills; two were run by the municipality and one privately. Only 26 cases of

confinements were attended by three centres. 107 At Jhansi two centres were

opened in November 1925. The Maternity staff of these two centres made 600

home visits and conducted 50 cases through dais that year. The centre at

Dehradun was established in December 1924. The midwives paid 10 tol5

house visits daily. Expenses for this centre were met from the publicity funds,

public donations and municipal contributions. Lectures were given to dais in 51

classes. The MCW centres at Pilibhit, Muzaffamagar, Bahraich, Gonda etc

were small and there was just a resident midwife who worked under the

municipality. She made house visits, attended normal labour cases free of

charge and sometimes held classes for dais. The centre a~ Muttra had a

maternity Nurse and at this centre lectures were given to indigenous dais and

women in their own homes.

The local government sanctioned Rs.l 0, 000 for the improvement and Rs.6000

for the training of dais and Rs.l 0, 000 for the purchase of models for the

opening of fresh centres and for propaganda work in 1924. The Victoria

Memorial Scholarship Fund also sanctioned Rs.3300 grant and these were

spent in helping the centres at Jhansi, Bijnor, Gorakhpur, Cawnpore,

107 Annual Report of the Public Health Commissioner with the GOI 1925, p. 18.

168

Saharanpur, Fatehpur, Bareily. 108 The local government increased their grant

from Rs.26,000 to Rs.50,000 in 1926 it also distributed Rs.36,000 as

preliminary gift to the branches already in existence only to encourage them. 109

The local government grant during year 1927-28 was increased from Rs.50,000

to Rs.59,600. A sum of Rs.3300 from the Victoria Memorial Scholarship fund

was given for the improvement of indigenous dais. In 1935 a sum of

Rs.1 ,00,000 was sanctioned from the silver jubilee fund for the building of a

health school in Lucknow for the training ofthe health visitors and midwives.

Midwife and Dai Training

Sanction was accorded to the training of 6 midwives at the Dufferin Hospitals

at Allahabad, Benares and Lucknow, 4 at Cawnpore, 2 each at remaining

places and 4 at Women's School and Hospital at Agra in 1923 itself. In all

there were 36 probations midwives have been under training that year. Of these

whole 6 were discharged or left, being unsuitable and 14 passed out. The

remaining 16 were still under training. The scheme for the training of midwives

was introduced later at the Dufferin and Women's Hospitals at Gorakhpur,

Fyzabad, Meerut, Aligarh, Moradabad, Allahabad, Bareily, Benares, Cawnpore

and Agra. Government made a grant of Rs.6000 for this training in 1925. 48

midwives were enrolled, of whom only 10 passed, 11 left, 7 failed and 20 were

still in training that year. At Cawnpore in 1925 facility for midwifery training

was conducted at the MCW Centre, Dufferin and Mission Hospitals, but these

institutions only trained workers for their own needs. Indigenous dais were

given lectures in special classes held for training them in modem methods of

doing their work. Sometimes demonstrations on . cleanliness and aseptic

1~ethods were also given to indigenous dais at the bedside of cases. In 1923

there were also centre for improvement of indigenous dais at Lucknow, Agra,

Allahabad, Meerut, and Gonda. At each centre a resident midwife was working

in connection with this scheme. At Shajahanpur indigenous dais were trained

by the Sub Assistant Surgeon in charge of the Dufferih's Hospital.

I 08 Annual Report ofthe Public Health Commissioner with the GOI 1924, p. 18. 109 Abstract from the Annual Report of Public Health Commissioner with GO! for 1926, Indian Medical Ga=ette, March 1929, p. 168.

169

A serious effort was made in 1935 to train dais through out the province,

especially in 25 MCW centres, where medical women or health visitors were

employed and in areas under the ten health units in the province. At Pratapgarh

a special health unit was established in 1931 as a model scheme and it was

funded by Rockefeller foundation. 110 600 dais were trained during 1937 at this

centre.

Due to financial reasons MCW centres were sometimes closed. In 1926 the

Muzzaffarnagar centre was closed. Where as the centre at Almora had to be

closed, as it did no useful work. The centre at Gazipur, in spite of public

opposition, frequent changes of chairman and financial stringency, did continue

showing progress. The centre at Meerut was discontinued in August 1925. The

MCW centres were always struggling to survive due to financial and other

reasons which directly effected their futtctioning. The number of Maternity

cases attended by these trained staffwas often very less. At Allahabad in 1925

out of 6118 births recorded 1526 maternity cases were attended by the MCW

staff. Similarly the following year, out of 6445 registered births the MCW staff

attended only 2000. At Benaras out of 10,245 births recorded in 1927 only 666

were attended by maternity staff. At Lucknow the number of births in the

maternity wards was 8147, of which the maternity staff attended 1698 cases

only. III

Women's Hospitals

Most of the women's hospitals and dispensaries in the United Provinces were

run by the Countess of Dufferin's Fund Association. (See Annexure-VI)

Government run female hospitals were very few. During retrenchment when

government introduced cut in the the grant to CDF, there were major changes

in the provincial cadres also. The effect was felt in the maintenance of the

IIO Abstract from the Seventieth Annual Report of the o:rector of Public Health of the United Provinces 1937, Indian Medical Gazette, May 1939, p. 316. Ill Annual Report ofthe Public Health Commissioner with GO: 1927, p. 84.

170

Dufferin hospitals in United Provinces. The following were the changes

introduced in I 932 in the United Provinces to make up for the deficit budget. 112

1. One post of first class medical women was abolished.

2. At Bijnor, Mirzapur and Gazipur Sub- assistant Surgeons were appointed in

place of assistant surgeon.

3. A universal cut of I 0 per cent was made in the pay of all employees of the

provincial Dufferin Fund in place of Graded cuts

4. Further increments in the pay ofFirst class medical.women were stopped.

5.The clerks in the offices of the secretary and the honorary Treasurer,

provincial committee, Countess of Dufferin's Fund, U.P., Allahabad, were

deprived of increase in pay due to them.

6. The rate of uniform aJiowance to Anglo-Indian and Indian Staff Nurses was

cut down to half the former amount.

7. The number of Dufferin Fund scholarships at the Women's Medical School,

Agra, was reduced to half.

8. The amounts provided m the budget estimates against the heads

"Superintendent's T.A., Gratuities and Bonus" and "Contribution to Local

Branches" were cut down

All these steps have directly affected the functioning of Hospitals, Dispensaries

and MCW centres. The direct effect was ·the lose of the only first class medical

woman of United Province. She was the only person who organised MCW

work in the province she also was the principal of the Agra Girls Medical

School. The functioning of these had a major set back.

Dr. S. H. Commissariat SMO, WMS, Superintendent Medical Aid to Women,

U.P; inspected 27 Dufferin Hospitals and 51 women's hospitals between

January and October 31, 1932. Basing on her report the provincial Committee

112 Ibid

171

of the Countess of Dufferin's Fund, U.P., passed the following resolutions to

improve the functioning ofhospitals and dispensaries: 113

(1) That half the number of Dufferin Fund Scholars admitted in future to the

Women's Medical School, Agra, should be bona-fide residents of these

provinces.

(2) That in order to encourage Indian lady students to study in Europe, half the

number of posts for First Class Medical Women should be reserved for

Indian Women, i.e., for women other than European and Anglo-Indian.

(3) That four per cent of the cadre be First Class Medical Women.

(4) That the appointment of 2 Indian Nurses on Rs. 40-5-50 p.m., as pay and

Rs. 2-8-0 p.m. as uniform allowance, and 4 probationer nurse on a stipend

of Rs. 12 p.m., each to the Dufferin Hospital, Lucknow, a:1d of 4

probationer nurses on a stipend ofRs. 12 p.m., each to other larger Dufferin

Hospitals in place of 2 junior staff nurses on Rs. 50 p.m. as pay and Rs. 30

p.m as board allowance, and 2 probationer nurses on a stipend of Rs. 20

p.m. each paid out of the Government grant ofRs. 2,400 be sanctioned.

(5) That a woman Sub-assistant Surgeon, who has passed the membership

examination of the State Medical Faculty, U.P., be exempted from one of

the grade examinations required to be taken under the Dufferin Fund rules

113 Annual Report ofCDF 1932, p. 39-41.

172