From the diaries of Dr Smith...

From the diaries of Dr Smith...

HISTORY

From the diaries of  Dr Smith...

MEDICAL HISTORY A section of the Bowring Hospital, where once stood the Hospital for                 Soldiers, Peons and Paupers. Right: An  extract from Dr Smith’s diary.  Photo courtesy: Wellcome Library, London.  Below: NIMHANS, which owes its existence to Dr Smith. (File photo)

While Sir Mark Cubbon’s contribution to Bangalore is well known, few are aware of the contributions of his personal physician, Dr Charles Irving Smith, to the development of mental health services in Bangalore, which can be traced back to more than 150 years ago.

Dr Charles Irving Smith, the medical officer at the Hospital for Soldiers, Peons and Paupers in the Bangalore Cantonment was born in Bangalore to Lt Michael Smith, perhaps one of the first English births after the Army moved here from the then Seringapatanam in 1809. He was probably sent back to Britain to study, and after becoming a licentiate doctor, he joined the East India Company and came back to India in 1831, and was involved in the battle of Coorg in 1833. He was appointed Surgeon to the Mysore Commission under General Mark Cubbon and held this appointment till 1853.

During his tenure, he also held the appointment of superintendent of the cattle in Mysore district, where he spent the large part of his working life. He was appointed as Inspector-General of Hospitals in 1862 and retired in 1865 after a stint in Rangoon, moved back to England and died in Bath in 1871, but his son Henry Hammond Smith (b 1850) continued to work as a doctor in Bangalore, and returned to England in 1878 (just before Mysore was handed back to the Maharaja) and died in 1924 in London. 

Father and son maintained a detailed account of their medical work in Bangalore, and this provides an insight into the social and medical history of the city in mid-nineteenth century, as well as a connection to the medical institutions that exist to this day. The case book is replete with information not only on cases of tetanus, fractures, obstructed labour, infectious diseases and causes of death in the soldiers and civilians, but also of insanity and mania. There are also several other details, including meteorological information, as well as lists of plants and trees of Mysore. 

The origins of NIMHANS

Dr  Smith made it quite apparent that a separate facility for treating the insane was needed, and created a separate ward for the insane in 1838. He also added another ward for women in 1839. As Dr Smith noted, he was able to convince Mark Cubbon to build a separate facility for the mentally ill in 1847/1848. Thus the Lunatic Asylum of Bangalore was created. Unlike most other asylums, however, the one in Bangalore began as a General Hospital Unit to provide more specialised care for mental disorders.

Prominent causes of these disorders were paralysis of the insane, peculiar infections that were then unrecognised (but later came to be known as tapeworm or syphilitic lesions of the brain), delirium caused by excessive drinking and intemperate habits. Dr Smith conducted autopsies on many patients, especially British soldiers, who died, and tried to develop correlates between the brain changes and the symptoms of insanity. It was therefore no accident that a neuro-centre and a de-addiction centre were established as logical additions to the successor to the Asylum established by Dr Smith, though a century and a half later. 

 Dr Smith was not averse to trying Indian home remedies, and records that he cured Mark Cubbon of rheumatism by giving him lime juice with a little black pepper. He was also convinced of the ‘blood purifying’ action of tender coconut water. Other contemporary issues also come up, as he observed that “diabetes is a common disorder, but chiefly attacks Brahmins and rich Indians, who seldom seek aid from this hospital.”

He notes ruefully that his clientele was derived mainly from the poorer sections, the affluent preferring the native healers. But it becomes quite apparent that the English doctor was popular. His case book includes 23,000 patient-visits, at a time when the total population on Bangalore was just over one lakh, so almost a fourth of the total population consulted him!

Observations about administration

Local differences also excite comment. Bellary was then, perhaps seen to be a particularly lawless place. Gang robberies with murder were rare in Bangalore, with only one case in 1848-1850, while Bellary had a rate of 12 in 1850, five in 1849 and seven in 1848, thus showing that crime had fallen to a greater extent in Bangalore than in Bellary (which was under a different administration). He was a great believer in direct rule by the British, and observed that the surplus revenue of Mysore had increased from Rs 55 lakh in 1833, to Rs 80 lakh in 1849 (more than 5.5 lakh pounds, now worth 1.20 billion pounds in GDP terms, per year).

However, part of this money was invested back in public good, as seen by a layout on building 1,597 miles of roads in Mysore at a cost of Rs 18,57,299 in 1851. Mark Cubbon has often been complimented for achieving this with a personal staff of only four Europeans, at a total salary of 10,000 pounds/year.

Dr Smith was particularly happy with the fact that the increase in revenue had been accomplished without a single farmer becoming bankrupt or having to sell his lands!
Events far away also get a mention in his diary. Since regiments from the Bengal Army were posted to Bangalore (having participated in the defeat of Tipu Sultan), some of these were thought to be at risk of being influenced by events in Calcutta and Awadh in the summer of 1857.

Two cavalry companies and 24 of infantry were disarmed, while three infantry companies were disbanded entirely as a precaution. However, 53 companies remained ‘faithful’ and thus no great problem was seen in Bangalore. 

The diaries thus provide a unique resource of the history of medicine, and society, in India, especially southern India. An open-minded and helpful doctor, working in a richer country to make his fortune (Mysore was richer than most parts of England at that time), tries to help as best as he can, and develops an interest in a wide range of social and economic issues over and above his medical duties. It also reveals that enthusiasm with which Western medicine was taken up by all classes, and especially the poor, for whom this was probably the first time that a modern medical service was being delivered with no strings attached. 

The Lunatic Asylum has been moved several times, from the Cantonment, to what is now the State Bank of Mysore, and then in 1935 to the campus that is now the NIMHANS, while the Hospital for Peons and Paupers was replaced by a civil hospital, and then the Bowring Hospital towards the end of the 19th century.

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