March 31, 1927 — Council Chamber, Madras Legislative Council, Madras, India
Sir, I heartily second the motion. I need not repeat here that the idea of Children’s Hospital has been long before our minds. Every time mention was made of the terrible death rate of infants in our Presidency, the necessity for a special hospital for children was felt very acutely indeed, both by the medical as well as the lay public. Again as every one of you is aware after the visit of His Royal Highness the Prince of Wales, wee thought that this long expected boon was going to be given to this province, but soon after, came the disappointment that the money collected for the purpose has been diverted, as explained to you last time, in the Press Communique, dated 30th March 1926, Local Self-government Department (P.H.), to the construction of a tuberculosis ward for our children and a few beds in other hospitals thus allotting to our children a secondary place, in spite of the great and very urgent need that existed for a separate hospital for them.
No doubt, sir, there are few beds in the General Hospital, a few in the Women and Children Hospital. I may tell you, Sir, even though it is called Women and Children Hospital, the children are few in number having only 24 beds as compared with their total population, and take a secondary place. No special attention is given to them. There is no specialist in charge of the children, no special equipment in that hospital for children such as a milk modifying laboratory or the Physio-Therapeutic department, nor are there any specially qualified nurses to look after them. Dr. Hutchinson, an eminent physician of London, when talking about the clinical examination of children, gives the student the following advice: “The method of examining and handling a sick child does not come to you by intuition, and the man who starts for the first time to study the diseases of children is like a traveller in a foreign country. He hears a strange language spoken which he does not understand: at all events, if the language is not absolutely strange, it is spoken with a foreign accent; for, the physical signs of disease are often different in children from what they are in grown up people and so the students have to devote special attention to their interpretation,’ moreover as the child is unable to describe to the doctor the nature of the suffering, the students have to develop their power of observation very much indeed.”
Again in the handling and examination of children one has to learn gentleness and tact which will come only with care, experience, practice and above all, training under competent teachers.
As that learned doctor again says, the subject of diseases of children is one which is apt to be neglected in General Hospital for more than one reason. The first reason is that adult patients are so very numerous, their claims on the staff are so very pressing that there is very little time left for special teaching in the children’s wards. It has its explanation in this further fact that the teaching in the General Hospital is directed generally to the requirements of qualifying examinations and no demand is made at the ordinary qualifying examinations for a special knowledge of the diseases of children, the consequence of which is that many men and women, when they qualify themselves know almost nothing of the commonest ailments of Infancy. So when going out into practice, you are not much better informed than the mother or the nurse as to the diseases you have got to deal with. And still you will find that in any large general practice children make up a great part and perhaps the greater part of the patients, and the serious nature of the disease will be brought home to you by a study of the deathrates; whereas the adult mortality is 4 per 1000, the infantile mortality is 150 per 1000, which is not creditable to our profession (this was the condition prevailing m England before 1911.)
Since then many changes have taken place. The great business of child reform began. Hospitals were built for sick children. Infant welfare centres and milk depots were established. Further, a knowledge of the diseases of children and treatment was introduced as a compulsory subject in the medical curriculum of students and both in the out-patients and in the in-patients wards, special provision was made to give practical instruction on this subject to students qualifying for examinations, extending in some hospitals to three months and in some even six months’ course. The result has been an immense saving of life, and a steady improvement in the health and the physique of the child as reported by no less a man than Sir George Newman, the Medical Officer in the Ministry of Health. Now, I ask, how much more appropriate are the above remarks of Dr. Hutchinson made before the year 1911, to us here who record a mortality of 300 per 1000? How much more energetic we should be in this business of child reform with a death-rate like 300 per 1000 — a figure that astounds the civilized world?
Again Dr. Holt, the great American Physician, an authority on diseases of children says in his book: “Therapeutics in infancy consists in something more than a graduated dosage of drugs. Many therapeutic means which are valuable in adults are useless in children, and many others which are of little value in adults are extremely useful in children.” Showing that child’s study is entirely a different one from that of the adult.
Again, without the help of a special hospital and special equipment for children, study and research into ailments of our children and also teaching the students on that subject is not possible. In the English hospitals and in the English books much prominence is given to rickets, scurvy, rheumatic affections of childhood, diseases peculiar to cold countries which are rather rare here. It will do us, Indian students, not much good to devote too much time to such diseases. Here in the tropics, we have to tackle other problems such as a typical forms of malaria, kala-azar, dysentery, tropical jaundice, etc. I may tell you here that signs and symptoms of malaria in children are not the same as those in adults. There is then prevalent among the Brahmin children a certain diseased condition of the liver called in Tamil [?] infantile tropical. The aetiology and cure have not been found yet even though many of our children succumb to this every year. I have listened, to many a sad and pathetic tale from mothers who have narrated to me with tears in their eyes how they have been losing their children one after the other from this dire disease. In the West they have found remedies for rickets, scurvy, rheumatism, diphtheria and smallpox, through persistent research and study. What was possible there will be possible for us here also. If we only take the trouble of studying and analysing a large number of such children, very soon we may strike at the root cause. As we are, we are indifferent to such sad occurrences amongst us, and the vast amount of human suffering which they involve.
Again, regarding the diet of our children, we are simply copying the West. The present method of scientific feeding in the absence of mother s milk is this — diluted and sterilised cow s milk, supplemented with sugar, cream, fruit juice, etc. Is it possible for poor mothers of our country to carry out the above instructions? If we want to live as a nation should we not find a diet for our infants suitable to our climate and conditions of life here? As it is, the practitioners very often prescribe the tinned foods for infants in the place of human milk or diluted cow’s milk without any of the above mentioned necessary adjuncts to make it a complete food. I can only point out to the house that such an ignorance and indifference on our part is not at all excusable when the whole civilized world is tackling this problem of infant welfare most seriously and earnestly and has achieved very many tangible results.
Indian children have suffered much and are still suffering for want of a separate hospital. Can anybody in this House conceive of a better, wiser and more useful form of medical relief viewed from the human, from the scientific and from the nation’s standpoint than the one proposed in this motion, to give relief to our innocent young, the speechless and helpless millions of India who are to be the future bulwarks of the State?
I have heard hon. Members of this House complaining about the large amount of money that is spent on hospitals, on the doctors and drugs. My answer is, so long as we ignore the preventive aspects of medicine, so long as we are blind to the immediate needs of the nation,, we are bound to suffer, our money, our leisure and our energy are bound to go to waste. To prevent unnecessary human suffering, disability, disfigurement, and avoidable mortality of infants and at the same time to save our money and labour, I would most earnestly beseech you to direct your attention to the preventive side of medicine and lay the foundation of a healthy life by replacing quack treatment of our infants and children with up-to-date scientific treatment and by looking after the health of school boys and girls with properly conducted medical Inspection.
Sir, much infantile mortality is preventible. In England the infant mortality in 1901 was 128 per 1000; in 1924 only 69. The amazing decline was due to preventive medicine. As we are, we cannot but admit that the majority of us are under-developed and undernourished, are unable to bear the stress and strain of modern life as is revealed by our mortality returns (for Europe 4 per 1000, for India 42 per 1000) by our average age of living (20 for an Indian and 50 for an European) and by our capacity to work.
No doubt there may be other contributory causes — social and economical, but one of the main causes if not the chief cause, in my opinion, is the negligent and indifferent treatment given to our children — our boys and girls. Because, in my experience, the rural child even though starved, keeps better health than the over-fed children of the well-to do classes. So we cannot attribute all our ill-health and disease to poverty and premature motherhood, because most of our children when born have a healthy appearance. In a few days or months they develop a sickly look as a result of mismanagement or improper and„ unscientific methods of feeding in the absence of breast milk. No wonder that such ill-nourished children readily fall a prey to all kinds of infantile ailments, especially in the absence of rational treatment.
Again the general physique of our children is low. When I landed in India after my recent visit to the West, the difference in the appearance of our children as compared with that of the European child was very poignantly brought home to me, the anaemic, pale, sallow cheeks of the majority of our children as contrasted with the rosy fleshy cheeks of the European ones, the thin wasted limbs of ours as compared with the muscular, round limbs of the Western children, their cheerful and happy expressions with the melancholy and dejected looks of our children. True, the racial and climatic differences may be seen in contour, and colour but need not be in health and vigour which are not the monopoly of any one race or climate.
In the face of what civilised nations have been doing towards the solution of the problems of infantile mortality and morbidity, we in India, have to admit that we have been guilty of very great injustice towards the treatment of our children. Now in England and Wales, there is abundant provision for the care and treatment of children and enormous facilities exist for carrying on research and experiments. There are more than half a dozen special children hospitals in the city of London alone in addition to children’s wards in every big general hospitals. Many of the maternity and child-welfare centres have a few beds for children ailing from digestive troubles where mothers are kept and taught the art of looking after their infants. There are children’s homes where they are admitted for minor ailments, day nurseries where the poor mothers leave their children when they go out for their work. There are a number of nursery schools for children below the age of 5 besides convalescent homes for weak children and foundling hospitals and orphanages. As the result of such wide, well-thought out organizations and centres of health the infant mortality within the last few years has come down to 69 per 1000. So, look at the frantic and co-ordinate efforts of other nations to save the child’s life.
In the face of such honest attempts on the part of other nations and such authoritative views as expressed by such eminent experienced and practical physicians like Dr. Robert Hutchinson, Dr. Holt, Sir George Newman for special hospitals for children and for special teaching of students on the subject are we justified in tolerating this kind of indifferent treatment to our children, the future citizens of the State, on whose health and welfare depends the prosperity and progress of the country? When we are also conscious of the fact that ‘there is np more promising field of medicine than the prevention of diseases in children only those who can fathom the depth and intensity of a mother’s love for her ailing infant, can adequately realize what it means to the mother to see her helpless infant suffer, on whom her life-happiness centres, what it is to see that spark of life being extinguished for ever for want of proper care and treatment. What sacrifice would such a mother not undergo if she is only convinced that the remedy is near at hand? The Indian mother who will fast for days together and who will undertake arduous journeys to beget a child, who will forego all her wealth, leisure and her pleasures for its sake, would she not admit her child into a hospital if she is only sure of good treatment and its certain recovery? I leave it to the hon. Members to judge.
Child’s study being a different one from that of the adult, I feel convinced that it should be developed as a separate science and art, and be given an important place in the medical curriculum of students, as any other subject like ophthalmology. Midwifery and Gyneacology can not be made a secondary thing as it is being done now by alloting a few beds for children in the several hospitals.
Source: My Experience as a Legislator, by Dr. Mrs. S. Muthulakshmi (Madras: Durrent Thought Press) 1930, pp. 38-46.