A leaf from history: Health sector in Kashmir in 1800’s.
Adapted from Lawrence’s ‘The valley of Kashmir’
“The state has always done its best to afford medical help to the people and maintains one excellent hospital in Srinagar and six dispensaries, three of which are situated in the districts. The following table shows the extent to which the people availed themselves of State help in the normal year 1891-92
Total number of in-door patients: 615
Total number of out-door patients: 122,960
Total: 123,575
2,188 surgical operations were performed, of which 283 were major operations. Eight cases of double amputation of legs were performed, in Srinagar for gangrene after frostbite, all of which ended in recovery. In a country like Kashmir, where travellers are liable to frostbite on the passes and where mountain accidents and injuries from wild beasts are frequent, the Srinagar hospital is a great boon. It us noted that general diseases form fully 25 per cent of the surgical cases. Of the diseases treated in the state hospital and dispensaries the following are the most common: fevers, syphilitic diseases, rheumatic affections, nervous system diseases, eye diseases, respiratory diseases, dyspepsias, diseases of digestive system, connective tissue and skin diseases. It is interesting to compare the working of the splendid Medical Mission.
‘Kashmir Medical Mission, 1893. (These figures are about the average of last five years)
‘Hospital Srinagar, eighty beds —
In-patients: 853
Out-patients: 8,688
Total visits: 20, 606
‘Temporary winter branch; two months only —
New patients: 1,469
Total: 2,022
‘Villages, number of days’ work ninety —
Number of patient seen: 5167
Surgical operations —
Major: 503
Minor: 2086
‘Average income Rs. 10,000 from voluntary sources’
‘Villager have apparently great faith in European medicine, e.g. at Hanjipore, Tahsil Deosar, 2,500 patients came for treatment in eight days and at the opposite end of the valley, e.g. Trahgam, the number have been equally great. But in the city and larger towns, Kashmiris usually resort to their own Hakims, in the first instance, for ordinary medical (non-surgical) diseases and only consult Europeans for surgical complaints, or when inextremis. With regard to reoterparts such as Dras, Kargil, the Wardwan and Skardu, the conditions seem similar to those of Kashmir villages.
The census gives no figures showing the number of leper or lunatics in Kashmir. It appears that in 1891–92 and in 1892–93, 260 lepers were treated. From an inquiry made in 1890 it seems that there were 133 lepers in the valley. A large number of lepers are to be found in the nomad herdsmen who visits Kashmir in the summer. The state has shown great liberty in dealing with leprosy and there is state leper hospital which is under the charge of the Kashmir Medical Mission. In 1892–93, 146 lunatics were treated at the asylum connected with the Srinagar gaol. This is an asylum in the English sense, but is a place where medicinal treatment for insomnia and attacks of intense excitement is given. Dr. Mitra Rai Bahadur estimates the number of lunatics at 250 and he notices that they are chiefly Hindus. It is unfortunate that we possess no statistics regarding lunacy, nut my frequent tours through every village in the valley have acquainted me with the sad fact that lunatics are common. Some are lunatics from their birth, some have gone mad from excessive use of charras: others have have lost their senses through some calamity. The lunatics are harmless people and are well treated by the villagers. I have discussed the question of establishing a lunatic asylum, but the villager think that captivity would do more harm than good. They regard them much as the Swiss regard the cretins. Suicide is very rare in the valley, but I have known cases which, in unscientific language, might be styled death from a broken heart. The Kashmiris are a nervous people and cannot stand sudden and great misfortunes. They are very demonstrative and when overtaken by calamity gesticulate in so frenzied manner that one wonders that their mind regains its balance. Compared with the ordinary Kashmiri, the natives of India would seem cool and phlegmatic.
Goiter is common. In 1891–92, 520 cases were treated.
Blindness is very frequent and is chiefly caused by smallpox. The number of deaf persons is also great, but we have no statistics of the subject of these infirmities.
It is only of late years that the Kashmiris have begun to recognise the benefits of the western system of treatment and the growing belief in the efficacy of the European methods is due to the devotion and the skill of the medical missionaries of Kashmir. Even now the mass of the people believe in their own doctors, many of whom are men of considerable ability and experience. There are 300 Hakims or doctors in Kashmir and as a rule the profession is hereditary. There system is based on the Greek system of medicine and I have known cases in which some of my subordinates have derived great benefits from the skill of Kashmiri Hakim. Once, when I was in great anxiety, a deputation of Kashmiris begged me to allow a wee known Hakim to treat my son. They urged that this Hakim had never failed to cure the disease. The Hakims have a considerable knowledge of herbs and there herb collectors are the shepherds, who spend the summer on the high mountains where the most valued plant are found. The Hakim charges a wealthy patient 8 annas a visit, but he makes some money by compounding medicines. He does not dabble in surgery. He will mark with a pen the vein which is to be opened, but a barber must be called into operate. There are over 1900 barbers in the valley. If leeches are to be applied a special man is sent for. Such simples as the Hakim does not obtain from the shepherds are bought from the druggist, of whom there are 159 in Kashmir. The Hakim never attends midwifery cases; special women, of whom there are 74, dispose off these cases. Besides the professional Hakim, there are many ‘wise women’ in the villages who have considerable knowledge of the properties of herbs and it is a remarkable fact that nearly every peasant seems to know something about the medicinal powers of plant. The sovereign remedy of the Hakims for all very serious cases is the ‘chob-i-chin’ (similax china), a kind of root brought from China and administered internally. Inoculation for small pox, so common in Astor and elsewhere, is unknown in Kashmir, save to the Gujjars of the mountains and apparently the only help in small pox is the reading of the Quran by a Pir. The people believe greatly in the efficacy of amulets given by Pirs. They cure all diseases. The amulet is either fastened on the right arm, neck or turban, or is put in water and the water and ink of the writing drunk by the patient, is burnt and the smoke inhaled by the sick man. The Kashmiris believe that this inhalation brings dreams and the dreams must be told to the peer, who at once knows what is to be done. The chief principle in the treatment of Pir fraternity is that illness is caused by evil spirits (jin) and that a talisman suitably prepared, with the name of patients mother on it, will drive out any evil.”
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