LITTLE EVIDENCE EXISTS TO THROW LIGHT UPON THE SANITARY CONDITION OF BOMBAY during the period preceding its cession to the English Crown by the Portuguese. Heitor da Silveira named it the " Island of the Good Life," which he would scarcely have done, if the climate had proved very deleterious, while Fryer in 1673 spoke of the country people and Portu­guese in old days living to a good old age, which he believed to be largely due to their temperate habits. But subsequent to the cession and up till the close of the first decade of the eighteenth century, the island acquired an evil reputation and the mortality, particularly among the English, rose to an alarming figure.

More fatal than all was a disease known as mordi-sheen to the Portuguese, which appears to have been choleraic in nature. Throughout the entire period between 1670 and 1710 there are continual references in official records to the great unhealthiness of the island, and on more than one occasion the Company's servants asked to be excused on this account from serving in Bombay. Moreover circumstances were not improved by the fact that the island was often destitute of a physician and that the consignments of medicines, which were spasmodically sent out by the Court of Directors, often proved to be bad.

Various reasons for the unhealthiness of the climate were put forward by the Company's representatives in Bombay. Writing in 1671 to the Court of Directors, they opined that it was due to the habit of manuring the cocoa-nut palms with putrid fish, while in 1673 Aungier remarked in his report that after the first intermission of the rains in May or June and after their total ceasing in October the air and water are unwholesome by reason of the crude pestiferous vapours exhaled by the violent heat of the sun into the air and vermin created in the wells and tanks which renders those months most sickly to the inhabitants and especially to Europeans. One of the chief reasons was doubtless the gradual silting up of the creeks which divided Bombay into a group of islets. At high tide the sea swept through the breaches, overflowed the major portion of the island, and laid a pestilential deposit highly productive of malaria; added to such natural causes was the dissolute life led by the majority of Europeans at this epoch.

Between 1690 and 1708 circumstances were aggravated by a violent epidemic of plague which helped to justify the dictum that in Bombay " two monsoons were the age of a man ".

The excessive mortality caused the greatest anxiety to the Court of Directors, who endeavoured to afford temporary relief to their factors by the despatch of medicines and Surgeons from home. They also advised the Bombay Council to issue orders prohibiting the " buckshawing " of the toddy trees in the Mahim and Worli woods, to allow the free per­flation of the western breeze, to stop the breaches, to burn continual fires and to put chalk in the drinking water. Accordingly in 1708 fish manure was universally prohibited, dry manuring being permitted up to 1766, when it was discovered that the indulgence was turned to bad uses, and this practice also was discontinued; while by 1720 a dam had been con­structed across the Great Breach at Mahalakshmi, and a considerable area of marshy ground had been drained. This gradual reclamation of land from the inroads of the sea coupled with better medical attendance and a more temperate style of living introduced a considerable change for the better, and by the middle of the 18th century, Bombay had not only lost entirely her former reputation for insalubriety but was even accounted a tolerably healthy station.

However, the sanitary condition of Bombay was far from perfect. In 1757, there was a serious epidemic among the labourers employed on the fortifications, which necessitated the appointment " of a country doctor, " whose medicine, it is satisfactory to note, met with great success; while little or no attention was paid by the inhabitants to the advice and orders of the special officer, styled ' Scavenger', who was appointed about this date to supervise the cleansing of streets. In fact, according to a consultation of the 18th November 1757, the town had become so dirty that the Bombay Government decided to appoint a member of the Board tq the office of Scavenger and to defray the cost of a sufficient number of labourers and scavenging carts by a tax upon the towns people. The mortality, at this date, was also high. At the close of the eighteenth century the mortality was about 500 per month.

At the beginning of the nineteenth century it appears from statistics of deaths collected by the Police that the average annual mortality varied between 4,000 and 8,000, this figure rising in 1804 to 26,000 in consequence of the great famine in the Konkan and the resultant immigration of a very large number of famishing and moribund people. The most common causes of death were fever and liver complaints.

In 1812 a definite attempt to secure the better conservancy of the town was made by the passing of Rule, Ordinance and Regulation I, which empowered the Justices of the Peace to check nuisances on roads and thoroughfares and make structural improvements in the streets of the town.

A further step forward was taken in 1845 when a Board of Conser­vancy was established to supervise sanitary and other measures for the improvement of the public health; but the activities of the board were somewhat curtailed by the fact that they were not vested with legal authority to check nuisances. In consequence Act XIV of 1856 was promulgated which gave the necessary legal status to the board, and bye-laws under it were framed. Two years later the board had fallen into considerable disrepute, in consequence largely of the venality of its inferior servants, and a new body corporate, composed of three Municipal Commissioners, was appointed to supervise the conservancy of the town. Finally on the 1st July 1865, the 'triumvirate' of Municipal Commissioners was superseded by a new Municipality, which was charged with the entire control of the urban administration, the executive power and responsibility being vested in a Municipal Commissioner appointed by Government for a limited term of years.

The municipal administration has put in good amount of efforts in improving the general sanitary conditions. The diseases like plague, cholera, which once took a heavy death toll, have been much reduced. Regular supply of water, construction of drainage, more careful scavenging of streets and roads, removal of offensive trades and introduction of compulsory vaccination have severally contributed towards counter­acting the high mortality. With the increase in hospitals and dispen­saries more staff is available to look after the principal diseases, especially epidemic diseases which once played a havoc in Bombay.

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BIRTHS AND DEATHS

The registration of vital statistics which was performed by the police from 1850 to 1867 was since then entrusted to the health department of the Corporation. For this purpose, at present, Greater Bombay is divided into 80 districts each under a medical officer who acts as district registrar of births and deaths. These districts are further divided into sections.

Since 1920 the total births in Bombay city showed a steady increase whereas total number of deaths fell rapidly. This might be due to the increase in medical facilities and public consciousness to avail of the same. The following statement shows the births and deaths in the period from 1921 to 1951, registered in Bombay city :—

	1921	1931	1941	1951
Total Population	11,75,914	11,61,383	14,89,883	23,25,945
Area (Sq.miles)	23.54	24.19	26.18	26.18
Births-
Males	9,979	14,084	20,638	33,721
Females	9,146	13,120	19,316	31,958
Total	19,125	27,204	37,954	65,676
Birth rate per 1000	16.3	23.4	26.8	28.2
Deaths—
Males	N.A.	13,494	16,946	18,473
Females	N.A.	11,611	14,150	15,368
Total	53,609	25,105	31,096	33,841
Death rate per 1000	45.5	21.6	20.9	14.5

As a result of the merger of the Bombay Suburban District into Bombay city, the city limits were extended to Dahisar on Western Railway and Mulund on Central Railway in February 1957. This was naturally accompanied by an increase in births also. The following statement shows the position for 1961 and 1971:—

	1961	1971
Total Population	41,52,056	59,68,546
Area	437.71 Sq.km	437.71 Sq.km
Births-
Males	59,625	86,150
Females	56,712	78,143
Total	1,16,337	1,64,293
Birth rate per 1000	28.2	27.5
Deaths-
Males	24,312	33,945
Females	18,805	23,300
Total	43,117	57,245
Death rate per 1000	10.4	9.6

Of 1,16,337 births registered in 1961, 74,706 births took place in city, 32,216 in suburbs and 9,415 in extended suburbs. In 1971 there was an increase in births which were put at 164,293 of which 78,941 were in city, 59,610 in suburbs and 25,742 in extended suburbs.

Statistics of month-wise births and deaths registered in Greater Bombay since 1961 for a few years are shown in Table No. 1, while ward-wise births and deaths are given in Table No. 2. Deaths according to ages are shown in Table No. 3. An interesting statistics of certification of causes of deaths is shown in Table No. 4.

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INFANT MORTALITY

Infant mortality is divided into two groups : (1) neo-natal deaths, i.e. deaths under 4 weeks and (2) post-natal, i.e., deaths under 12 months but at four or above weeks. Generally causes of infant mortality in case of neo-natal deaths are prematurity, congenital malformation and birth injuries; while diarrhoea and enteritis, small-pox are causes of post-natal mortality. Commendable work has been done to prevent high mortality of infants due to availability of services of medical personnel, specialist services, family planning and other allied social services. Due to spread of education there is also a considerable awareness among people to avail of the medical facilities.

Deaths among infants under one year in Bombay in 1921, 1931, 1941 and 1951 are shown below:—

	1921	1931	1941	1951
Infant Deaths	12,751	7,401	8,445	9,746
Rate per 1000	668	272	211	N.A

In 1961 there were 11,150 infant deaths which showed an 1971. The area-wise deaths are shown below:—

Year	City	Suburbs	Extended Suburbs	Total
1961	8,452	2,192	506	11,150
1971	6,627	4,529	1,817	12,973

In 1980 there were 13,633 infant deaths.
As regards neo-natal deaths the following statement shows the position since 1961 for a few years:—

Year	Births	Neo-natal Deaths	Death Rate
1961	1,16,337	5,087	43.7
1963	1,31,831	5,788	43.6
1965	1,42,781	6,740	47.2
1968	1,55,880	7,029	44.8
1971	1,64,293	7,445	45.9
1973	1,80,409	8,030	44.5
1975	1,80,018	7,452	41.4

During 1979 there were 8,440 deaths, the death rate being 41.4.

Table No. 5 shows infant deaths due to principal causes, while infant deaths by age group are shown in table No. 6. From table No. 5 it can be seen that diseases of respiratory system, congenital malformation, diseases of early infancy and diarrhoea and enteritis caused heavy morta­lity. Small-pox, malaria, fever which once were responsible for heavy mortality are now under control.

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DISEASES

The details of some of the principal infectious and communicable diseases in Bombay are given below :—

Small-pox.—The disease is highly infectious. Deaths due to small-pox in the past were very high. One of the main reasons for occurrence of heavy incidence was a high floating population in city which remained unvaccinated. More and more areas were added to city jurisdiction which naturally resulted in delay in establishing proper and effective health services in newly added areas. However the Corporation took a serious note of it and organised systematic vaccination campaign and arranged treatment of small-pox cases. The national small-pox eradication programme was launched in 1962 with the object of covering a large number of people in age group of 1-14 years with special attention to labour class and migratory people. As a result of this the mortality incidence has gone down as can be seen from the following figures:—

Area	Year	Attacks	Deaths	Rate
Bombay City	1921	N.A.	406	N.A.
	1931	N.A.	31	N.A.
	1935	N.A.	1,248	N.A.
	1941	2,325	1,293	0.8
	1945	603	235	0.1
	1951	1,803	314	0.1
	1955	166	44	0.0
Greater Bombay	1961	3,868	1,615	0.4
	1965	3,202	1,323	0.3
	1971	Nil	Nil	Nil
	1975	N.A.	N.A.	N.A.

The disease was epidemic during 1942, 1944, 1954, 1957 and 1958 while it was sporadic in rest of years since 1941.

Cholera : Recently Greater Bombay remained free from this disease. In Bombay city during 1921, 1931, 1935, 1941, 1945 and 1951 there were 70, 80, 13, 7, 30 and 1 deaths, respectively.

Preventive measures such as anti-cholera inoculations, disinfection of well water, destruction of over ripe and rotten fruits and unwholesome articles of food exposed to contamination are carried out regularly. During 1971, 9,20,668 persons were inoculated against cholera.

Malaria : It is classified as an infectious disease caused by the sporo-zoa parasite carried from man to man and transmitted by the bite of mosquito. The deaths have now practically been reduced due to implementation of the National Malaria Eradication Programme which was started in 1962-63. Potential breeding places such as wells, overhead tanks, mill tanks, storm water entrances and drains are checked regularly for detection and destruction of mosquitoes. Regular efforts of application of insecticides are adequately supported by aerial spraying of larvicides over creeks and grass lands. Under the programme, Greater Bombay has been divided into city, western suburbs and central suburbs. Under active surveillance enquiries of fever cases are made while under passive surveillance blood smears from fever cases attending hospitals and dis­pensaries are collected and examined in the Municipal Laboratory at Parel. The work done under this programme during 1975 was as under :—

Particulars	Fever cased detected	Persons treated	Blood Smears
			Collected	Examined	Found positive
Active	53,434	53,434	55,942	55,942	382
Passive	2,81,098	2,81,098	2,81,098	2,81,098	2,296
Mass	1,56,472	1,56,472	1,56,472	1,56,472	65

As regards death toll in Bombay City and Greater Bombay area the following figures give the position since 1921:-

Area	Year	Deaths
Bombay City	1921	545
	1931	131
	1935	97
	1941	88
	1945	96
	1951	59
	1955	6
Greater Bombay	1961	1
	1965	Nil
	1971	Nil

 

Tuberculosis: It was once a dreaded disease because of the general belief that practically no cure was feasible, the patient having almost no option but to await death. Statistics of deaths due  to tuberculosis in Bombay City are given below:—

Year	1921	1931	1941	1945	1951	1955
Deaths	1,566	1,929	1,692	1,981	2,525	1,934

Industrialisation and urbanisation are the main causes for the spread of this disease. Mortality since 1961 in Greater Bombay is on an increase as can be seen from the following figures:—

Year	Deaths from
	Pulmonary	Other form	Total	Males	Females	Death Rate
1961	2,184	762	2,946	1,905	1,041	N.A
1965	3,371	838	4,209	2,750	1,459	0.9
1971	5,673	66	6,339	4,344	1,995	1.0
1975	7,555	860	8,415	6,005	2,410	1.2

During 1979 there were 8,756 deaths including 2,374 females. Efforts such as establishment of hospitals and clinics, BCG vaccination, supply of anti-TB drugs are undertaken to check the heavy mortality due to this disease, llie All-India T.B. Association has also done significant work in this field.

Leprosy: It is the most dreadful disease and even today those who suffer from leprosy at once become outcastes. However deaths on this account are not heavy as there were 73 deaths occurred in 1931, 21 in 1935, 65 in 1941, 76 in 1951, and 61 in 1955 in Bombay City.

The Greater Bombay Leprosy Control Scheme aims at control of leprosy through survey, education and treatment.
Table No. 7 shows total deaths due to various other causes since 1921 for a few years.

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MEDICAL FACILITIES

As early as 1668 the unhealthiness of the climate impressed upon the East India Company's servants in Bombay the prime need of a hospital. The Commissioners, writing to Surat in October of that year, stated that many of the soldiers were ill, and that medicines were urgently needed. But, notwithstanding the high mortality, no definite steps towards establishing a proper " hospital for sick English, " were taken until Gerald Aungier had assumed the reins of Government; and it was really due to his forcible representations that in 1675 the Court of Directors formally sanctioned the erection of a hospital. The Bombay authorities thereupon set about finding a suitable site, and informed the Directors that they estimated the cost of a building, capable of accommodating fifty or sixty patients.

In 1676 the Court of Directors despatched Dr. Wilson from England as first Physician, in the hope that he would prove " a great benefit and happiness to the Island ". It appears, however, that the proposed building was never erected, and that instead a new Court of Judicature was built in the bazaar, while the old Court situated on the Esplanade to the south­east of the present Cooperage was transformed into a hospital in 1677.

This hospital, the first ever known in Bombay, was in use until some little time prior to the year 1733, when a new building was erected near the Marine yard, nearly opposite the Great Western Hotel. The cost of completing it was defrayed by the imposition of a half per cent duty on trade. From 1740 onwards it was inspected weekly by a Board composed of the Land Paymaster, the Marine Paymaster and the Commandant of the Station, and seems to have been the chief resort for sick persons in both military and civil employ until the beginning of the nineteenth century, when the pressing need of more space in the Marine yard for the accommodation of workmen and materials forced Government to consider the desirability of choosing a new site.

In addition to this general hospital in the Fort, there were at the close of the eighteenth century a hospital for native troops on the Esplanade and a convalescent home on Old Woman's Island (Colaba).

The year 1824 witnessed the final relinquishment of the Marine yard hospital in favour of a new building erected in Hornby road for the use both of the garrison and the European civil population. The site had been occupied by a gun carriage factory, which was removed to Colaba about 1820. This hospital continued to be used until 1860, when the medical authorities condemned it, and Government determined to sell it with the land on which it stood, and devote the sale-proceeds to the erection of a new hospital on the Cooperage.

In consequence, interest in the matter languished until 1876, when the temporary huts in Fort George were relinquished in favour of a building known as the Officers' Quarters which had previously been used partly as the residence of the House Surgeon and partly as a convalescent, and contagious ward, and no definite step towards the construction of a proper hospital was taken until 1886, when, on the initiative of Lord Reay and Sir M. Melvill, plans were prepared and culminated in the laying of the foundation-stone of the present St. George's Hospital in 1889.
Apparently little was done towards providing State aid to the native population prior to the opening of the nineteenth century. Captain Hall, who visited Bombay shortly after the great famine of 1802-04, records that " several great sheds were erected as hospitals on the smooth greens­ward lying just beyond the foot of the glacis and reaching nearly across the Esplanade in front of the northern line of the fortifications. Numerous surgeons, some military and some belonging to the civil establishment, were called in from various out-stations and placed in charge of these and other infirmaries." (Fragments of Voyages (1832),64.) About 1809 a kind of Native General Hospital was in existence, which treated daily about 20 patients and was supported solely by Government. The inmates were chiefly paupers sent in by the police. In 1834, in pursuance of resolutions adopted at a public meeting, the Bombay Native Dispensary was opened in buildings granted rent-free by Government; and a few private dispensaries, notably one opened in Girgaum road in 1846, commenced to afford medical aid to the native population. The popularising of medical institutions and European remedies was largely the work of the Committee of the Native Dispensary, formed in 1836. By 1866 Bombay contained the Jamsetji Jijibhoy Hospital, including an Obstetric Hospital, and an Eye Dispensary, which was closed on the completion of the Sir Cowasji Jehangir Ophthalmic Hospital in that year, a Police Hospital, the Byculla Schools Hospital, and the Royal Indian Marine Dockyard Dispensary; while in 1874 the Jehangir Nasarwanji Wadia Dispensary at Mahim, opened several years before, was formally recognised by Government for a grant-in-aid, and the Gokuldas Tejpal Native General Hospital was opened for the benefit of native patients resident in areas distant from the J. J. Hospital. About this date the Native Dispensary opened a branch at Colaba, which was shortly afterwards abolished. This indirectly led to the opening of a branch in Khetwadi in 1877, which subsequently became the Nasarwanji Petit Charitable Dispensary. This was followed a decade later by a movement to afford medical relief to native women, who aversed treatment by male doctors, and in 1885 the Bombay Committee of the Medical Fund for the Women of India opened a temporary hospital for in-door patients at Khetwadi, the out-door patients being treated at the Jafar Suleman Dispensary for women and children, which was opened near the Crawford Market in the next year. In the following year (1886) the Pestanji Hormasji Cama Hospital was opened, whereupon the Khet­wadi hospital was closed, and its inmates were removed to the former institution. The year 1890 witnessed the opening of the Bomanji Edalji Albless Obstetric Hospital. In 1890 the Acworth Leper Asylum at Matunga was opened, and in 1892 the Obstetric wards of the Jamsetji Jijibhoy Hospital were replaced by the Bai Motlibai Wadia Hospital and the Sir Dinsha Maneckji Petit Hospital, and an out-door department for both these hospitals was provided by the Dwarkadas Lallubhai Dispensary for women and children.

As compared to other urban areas of the State, better medical facilities are available in Greater Bombay through a network of medical institu­tions controlled by the Government, the Bombay Municipal Corporation and charitable trusts. These hospitals are well equipped and are well known in the country. A steady growth of public and  public-aided hospitals and dispensaries in Bombay can be seen from the following statistics:—

	Year
Particulars	1920	1930	1940	1950	1960
General   hospitals   and dispensaries.	21	30	38	51	74
Hospitals and dispensaries for females.	7	7	8	7	13

During 1960 these 74 general hospitals provided 4,528 beds, including 1,630 beds reserved for females. In addition, thirteen hospitals and dispensaries for females provided for 500 beds. The respective number of beds for the Bombay Division was 6,284 and 548, respectively. During 1975 there were as many as 191 hospitals and 284 dispensaries with a total bed strength of 19,526 and 27, respectively. The details are as under:—

 

Management	Hospitals		Dispensaries
	No.	Beds	No.	Beds
State Government	18	4,691	12	17
Central Government	8	1,477	128
Municipal Corporation	23	7,187	2	10
Others	142	6,171	142
Total	191	19,526	284	27

Various hospitals provide teaching facilities for medical students for university degrees in surgery and preventive medicines. These are B. Y. L. Nair Hospital, Bombay Central; KEM Hospital, Parel; Sir J. J. Memorial Group of Hospitals, Byculia and Lokmanya Tilak Municipal Hospital, Sion. The courses leading to the degree or diploma in ayurvedic system of medicine are conducted in the M.A. Podar Hospital, Worli; Smt. Kamaladevi Gauridutta Mittal Punarvasu Ayurvedic Mahavidyalaya, Charni Road and Ayurvedic Hospital, Sion. Instructions in homoeopathy are given by the Government Homoeopathic Hospital, Irla.

In Bombay there are some specialised hospitals. Mention amongst them may be made of Tata Memorial Cancer Hospital for cancer patients, Acworth Leprosy Hospital for leprosy patients, Kasturba Hospital for infectious diseases and Group of T.B. Hospitals for tuberculosis patients. Other specialised institutions are Eye Hospital and ENT Hospital, both managed by the Municipal Corporation. Likewise there are special hospitals for females and children. These are B. J. Wadia Hospital, Parel; Children's Orthopaedic Hospital, Haji Ali; and Cama and Albless Hospital, Fort. Considering the area-wise distribution of these hospitals, it is noticed that there is a heavy concentration in Parel and Fort areas. However the needs of suburbs and extended suburbs are met by recently established hospitals managed by private bodies and some established by the Municipal Corporation.

Apart from hospitals managed by the Government, Municipal Corporation and Private Bodies there are some hospitals in Greater Bombay which are exclusively meant for the employees of the Railways, the Police, the Navy, the Bombay Port Trust and hospitals started under the Employees State Insurance Scheme.

State Government Hospitals
The State Government manages the St. George's Hospital, Fort ; J. J. Group of Hospitals, Byculla ; G. T. Hospital; Cama and Albless Hospital, Fort; M. A. Podar Hospital, Worli; Government Homoeopathic Hospital, Irla ; and Police Hospitals at Nagpada and Naigaum. The details of some of these hospitals are given below :—

St. George's Hospital: The foundation stone of this hospital was laid in February 1889 and the building was completed in 1892. Formerly it was known as the European General Hospital meant for treatment of sick Europeans. In the beginning it provided 130 beds. During the course of time the activities of the hospitals were expanded and at present it is one of the biggest hospitals in Greater Bombay having 467 beds. In the following statement is given the total number of patients treated and bed capacity:—

Year	Patients treated		Beds
	Indoor	Outdoor	Males	Females
1920	3,585	1,432	141	101
1930	3,000	3,036	131	89
1940	3,658	9,824	102	83
1950	5,307	22,911	138	83
1960	4,999	25,022	308	121
1980	1,61,330	3,19,400	467

During 1977 there were 34 doctors and 838 nurses working in the hospital.

Sir J. J. Hospital : The foundation stone of the Sir J. J. Group of Hospitals, Byculla, was laid in 1843 and the building was erected at the joint expenses of the East India Company and Sir Jamshetjee Jijibhoy Batliwala and the hospital was formally opened in 1845. In 1961 a new building was constructed. It consisted in the beginning of 18 wards with 237 beds. Today it is a premier Government hospital in the State, and renders medical aid in almost all types of specialised treatment. In 1977 there were 1,292 beds.

The following statement gives the statistics of patients treated with bed strength since 1920 for a few years:—

Year	Patients treated		Beds
	Indoor	Outdoor	Males	Females
1920	7,833	34,440	228	68
1930	8,971	44,278	287	92
1940	9,877	50,503	249	116
1950	14,557	1,17,323	353	125
1960	5,366	44,278	332	146
1970	34,574	6,98,769	606	544
1980	5,18,272	9,70,931	1314

The J. J. Group of Hospitals consists of two other hospitals, viz., B. J. Hospital for Children and Sir C. J. Opthalmic Hospital. All these hospitals are situated in one compound. Attached to the hospital is a full-fledged medical college, the famous Grant Medical College,(For details see Chapters 2 and 15.) conducting courses leading to degree and post-graduate degree in medicine and surgery. The hospital and college received immense encouragement from enlightened Indians like Jagannath Shankarshet and Bhau Daji Lad, the latter being one of its first medical graduates.

G. T. Hospital : The Gokuldas Tejpal Hospital owes its existence to an outcry raised in 1868 for a second hospital for Indian nationals. The construction of the building was commenced in 1870 with the munificent donation from Gokuldas Tejpal and was finally completed in 1874. In the beginning it had 120 beds.    The same increased to 521 in 1980.

In what follows are given the statistics regarding the patients treated since 1920 with number of beds :—

	Patients treated		Beds
Year	Indoor	Outdoor	Males	Females
1920	4,388	12,274	100	20
1930	5,182	20,725	180	20
1940	5,141	34,559	100	36
1950	7,789	53,898	156	76
1960	4,311	26,297	230	100
1980	1,75,200	2,42,300	521

There were 13 doctors and 167 nurses working in the hospital during 1977.

Cama and Albless Hospital : The Pestanji H. Cama Hospital for Women and Children with which are connected the B. E. Albless Obstetric Hospital and J. S. Dispensary originated in a movement commenced in 1882 to afford medical assistance to Indian women. In the following year Shri P. H. Cama offered a donation for creation of a hospital and Government granted a suitable land on Esplanade for hospital known as the Cama Hospital. The foundation stone of the hospital was laid in 1883 and the hospital was opened in 1886. In 1886 the dispensary was attached to the hospital and Albless Obstetric Hospital in 1890. These three wings now form one hospital financed and managed by Government.

In the following are given the statistics of patients treated since 1930 for a few years :—

	Patients treated		Beds
Year	Indoor	Outdoor	Females
1930	5,087		150
1940	6,059		155
1950	8,132	40,632	155
1960	3,703	14,597	163
1980	96,000	78,000	367

Besides, there are two Government hospitals, one homoeopathic situated at Irla and the other ayurvedic, viz., M. A. Podar Ayurvedic Hospital situated at Worli. The hospitals for the police personnel are situated at Naigaum and Nagpada.

Employees' State Insurance Scheme : The Employees' State Insurance Scheme was passed by Parliament in 1948. It covers industrial workers of all non-seasonal factories using power and employing more than 20 workers. Workers drawing pay upto Rs. 1,000 per month are covered under this scheme. The medical facilities are provided by the State Government, and include outdoor patient treatment, specialist examination, hospitalisation, maternity benefits and ambulance service. Hospitalisation facilities are extended to the insured persons through five hospitals situated at Parel, Worli, Andheri, Kandivli and Mulund. The details of the four hospitals for 1980 are shown in the following statement :—

Name of Hospital	No. of beds	No. of patients treated 1980		No. of doctors	No. of nurses
		Indoor	Outdoor
1.ESIS Hospital,Worli.	550	12,000	15,500	64	161
2.ESIS Hospital,Andheri.	650	18,000	40,000	80	193
3.ESIS Hospital,Mulund.	650	20,060	1,63,700	98	156
4.ESIS Hospital,Kandivli.	300	1,800	2500	47	83

Municipal Hospitals : The Bombay Municipal Corporation is the biggest local authority in India providing six major hospitals for its populace. These are the K.E.M. Hospital, Parel; B.Y.L. Nair Hospital, Bombay Central; L.T.M. General Hospital, Sion; Kasturba Hospital, Jacob Circle; Group of T.B. Hospitals, Sewri; and Sheth A. J. B. Municipal E.N.T. Hospital, Fort. Of these hospitals, the first three provide facilities for medical education. The details of these institutions are given below :

K. E. M. Hospital: The King Edward Memorial Hospital, Parel, was started in 1926, the building being constructed at a cost of Rs. 43,86,000. The bed strength of the hospital during 1930 was 354 including 145 beds for females. This strength increased to 1,595 in 1980.

There are a number of departments, the major being pathology, bacteriology, pharmacology, surgery, medicine, preventive and social medicine, radiology, orthopaedic, neurology, cardiology, gynaecology and obstetrics. Besides, the hospital also runs a leprosy clinic conducted under the Greater Bombay Leprosy Control Scheme, a diabetic clinic, a family planning centre, a school clinic and a blood bank. The following statement shows the position regarding patients treated, beds, etc., during a few years from 1951 :—

	Patients treated		Beds
Year	Indoor	Outdoor
1951	19,148	1,56,888	510
1961	38,197	2,66,879	756
1971	60,079	3,78,015	1,450
1980	55,380	3,69,568	1,595

The Seth Gordhandas Sundardas Medical College is attached to the hospital. It admits 160 students every year.

B. Y. L. Nair Hospital : The management of this hospital was taken over by the Bombay Municipality in 1946.

The large central clinical laboratory, blood bank, full-fledged X-ray department, eye bank, school health clinic, medical check-up centre function in the hospital. The statistics of patients treated and number of beds are shown in the following statement :—

	Patients treated		Beds
Year	Indoor	Outdoor
1951	10,036	62,973	250
1961	22,506	1,32,204	336
1971	32,964	2,49,329	713
1980	45,070	10,22,050	830

The Topiwala National Medical College and Nair Hospital Dental College are attached to this hospital.

L.T.M. General Hospital: The Lokmanya Tilak Municipal General Hospital, Sion, formerly known as the Indian Military Hospital and popularly known as the Sion Hospital was taken over by the Corporation in 1946, and in the following year, the Dharavi Municipal Group of Hospitals was started there with 50 beds. In 1958 the hospital was renamed as the Lokmanya Tilak Municipal General Hospital.

It is now a full-fledged hospital with 783 beds including 306 for females in 1977.

Various kinds of facilities and specialised sections such as clinical laboratory, blood bank, child welfare centre, post-natal clinic, check-up centre, family planning centre, eye bank etc. have been provided at this hospital. Under the paying patient's scheme, which was started in 1951, 50 beds have been provided for poor patients. Ten beds are reserved for B.E.S.T. workers.

In regard to patients treated the following statement shows the statistical position for a few years since 1951 :—

	Patients treated		Beds
Year	Indoor	Outdoor
1951	9,426	51,431	300
1961	25,566	1,51,850	370
1971	44,646	2,53,010	50
1980	52,713	2,97,009	984

The Lokmanya Tilak Municipal Medical College attached to the hospital was started in 1964. During 1976-77 the strength of the college was 315.

The strength of medical personnel in the hospital comprised of 266 doctors and 522 nurses in 1977.

Kasturba Hospital : The Kasturba Hospital situated on the Sane Guruji Marg, formerly known as the City Fever Hospital which was opened in 1892, is maintained for admission and treatment of all cases suffering from infectious diseases. It also imparts instruction to undergraduates and post-graduates and to student nurses.

The paying bed scheme was introduced in 1965. In 1977 total number of beds available for patients was 680. The hospital has paediatric wards, pathology laboratory and X-ray department, clinical laboratory and welfare centre.   In the following is given the statistics of admissions and the number of beds in the hospital :—

Year	Total admissions	Beds
1951	6,726	314
1961	25,073	314
1971	31,749	680

During 1977, total number of indoor patients treated was 18,092 as against 11,304 outdoor patients. The medical and nursing staff numbered 50 and 201, respectively.

E.N.T. Hospital : The Ear, Nose and Throat Hospital situated near the Hutatma Chowk was opened in 1962. It is a specialised hospital rendering medical and surgical treatment to patients suffering from ear, nose and throat diseases. It provides facilities of radiological and sample pathological investigations, operation theatre, and endiology clinic. During 1980 the bed strength of this hospital was 100.

Group of T. B. Hospitals : The Group of T. B. Hospitals, Sewri, was established in 1948 by amalgamating the Maratha Hospital, the Turner Sanatorium and the R. P. T. B. Hospital. Facilities such as out patients department, X-ray, operation theatre and laboratory are available in the hospital. The bed strength during 1980 was put at 1,330. Clinical teaching in tuberculosis is imparted to undergraduate medical students of G. S. Medical College, L. T. M. Medical College and D. P. H. students of the Bombay University.

In the following is given the number of patients treated in the hospital since 1955 for a few years :—

	1955	1960	1965	1970	1980
In-patients	2,260	2,339	5,934	N.A	11,538
Beds	348	458	800	830	1,330

Besides the present bed strength of 1,330 provided in the hospital, 350 beds are hired from private hospitals for tuberculosis patients by the Corporation. The four T. B. clinics situated at Princess Street, Foras Road, Dadar and Khar serve as diagnostic centres for pulmonary tuberculosis patients and treatment centres. These centres also serve as out­patient departments for admission to the Group of T. B. Hospitals, Sewri or Sarvodaya Hospital, Ghatkopar.

Besides the above hospitals,  the Municipal Corporation conducts the following other general hospitals :—

Ward No.	Name of hospital	Location	Bed strength (1977)
H	K. B. Bhabha Hospital	Bandra	165
H	Municipal General Hospital	Santa Cruz	104
K	Dr. R.N.Cooper Municipal General	Vile Parle	520
L	H.K.Bhabha Hospital	Kurla	178
M	D.M.Mehta hospital	Chembur	70
N	S. V. C. Gandhi and M. A. Vora	Ghatkopar	516
P	Haji Bapu General Hospital	Malad	110
R	H.B.Municipal general Hospital	Borivali	300
T	S.M.T. Agarwal Muncipal General	Mulund (W)	128
	Muncipal General Hospital	Mulund (E)	100

The Corporation has also reserved beds in the hospitals managed by charitable trusts. The number of beds reserved are : 20 beds in S. B. C. J. General Hospital, Santa Cruz ; 16 beds in Holy Spirit Hospital, Andheri (E); 600 beds in Sarvodaya Hospital, Ghatkopar (W) ; and 50 beds in S. K. Patil Arogyadham, Malad, thus making a total of 7,209 beds in 1977 in all municipal hospitals.

Trusts Hospitals : Medical needs of people of Greater Bombay are also met with by the big private hospitals. These hospitals are mostly run by the trusts. The details of some of these hospitals are given below :

Acworth Leprosy Hospital : The hospital situated at Wadala was established in 1890 to mitigate the nuisance caused by vagrant leprosy patients infesting the streets and public places in Bombay and to provide a shelter to these patients. The present hospital started functioning as Homeless Leper Asylum, Matunga by the initiative and untiring efforts of late Mr. H. A. Acworth, the then Municipal Commissioner of Bombay. In 1904 the name of the hospital was changed to Acworth Leper Asylum and in 1956 it was again changed to Acworth Leprosy Hospital. The expenditure is shared by the Government and the Corporation in the proportion of number of the non-Bombay domiciled and Bombay domiciled patients, respectively.

Total cases of leprosy treated in the hospital since 1970 are shown below:—

	1970	1973	1976
Indoor	872	820	720
Outdoor	13,746	16,224	19,340

The hospital provided, in 1976, 500 beds, 342 for males and 158 for females. The staff working in the hospital included 17 doctors during 1976.

Teaching facilities for the medical graduates in leprosy are provided by the hospital.

The hospital provides various types of occupations of supervisory, skilled and unskilled nature for the in-patients who are paid monthly wages.

Greater Bombay Leprosy Control Scheme : This scheme financed by the Municipal Corporation, the Government and the Gandhi Memorial Leprosy Foundation in equal share came into existence in 1955 with the aim and objective to control leprosy in Greater Bombay through survey, education and treatment. Upto 1959 it was under the control of the Municipal Corporation and now works under the control and management of Acworth Leprosy Hospital. During 1977 there were 9 clinics in Greater Bombay working under this scheme.

B. J. Wadia Hospital for Children : This hospital situated at Parel was opened in 1929 at the cost of Rs. 16,67,150 of which Municipal Corporation contributed Rs. 7,00,000. Today it is managed by a board of management.

In the beginning it had 126 beds which increased to 250 beds in 1976. There are medical, surgical, orthopaedic, plastic surgery, X-ray, pathology, social service, orthopaedic appliances, physiotherapy and occupational therapy departments in the hospital. A child welfare centre, a well baby clinic, a skin bank as well as a burns research unit are also run by the hospital. A child guidance centre controlled by the Tata Institute of Social Sciences was started in this hospital in 1948. In what follows are given the statistics of patients treated since 1930 :—

	1930	1940	1950	1960	1970
Beds	126	135	135	174	250
Patients treated—
Indoor	926	2,417	2,684	3,833	5,666
Outdoor	9,166	50,474	80,744	1,20,261	65,655

During 1976, 6,535 in-patients and 65,663 out-patients were treated in the hospital.

The hospital had received recognition by the Royal College of Surgeons of London for F. R. C. S. in 1948, by the Royal College of Physicians of London for D. C. H. in 1947, and by the Bombay University for post-graduate courses in 1943. In 1964 it was included in the Bombay paediatric project sponsored by the UNICEF.

Bhatia General Hospital : This hospital situated at Tardeo, was started in 1932 by some industrialists. Originally it was meant for the Bhatia community only, but with the passage of time it was opened to all sections of population.

The hospital runs at present departments like surgical, medical, pathology, radiology, gynaec, ENT, paediatric and dermatological, besides an operation theatre. In the beginning it had only 25 beds which increased to 125 in 1973. During 1971 it treated 4,016 patients as against 4,218 patients, in 1976. The strength of doctors and nurses in 1976 was 11 and 45, respectively.

Bombay Hospital : Realising the difficulties of sick and suffering patients coming from upcountry in obtaining admission in private and public hospitals, Mr. R. D. Birla, the well-known industrialist, donated a large sum and amalgamated the P. A. Singhania Hindu Hospital Trust and the Marwadi Medical Relief Society to form a new trust, viz., the Bombay Hospital Trust which constructed in 1950 a new hospital with the help of donations.

The hospital, situated near Metro Cinema theatre, had in the beginning a bed capacity of 280 which increased to 625 in 1976. Of these 293 beds were paying beds. The number ofpatients treated during 1967, 1971 and 1976 are shown below :—

	1967	1971	1976
Beds	415	402	625
Patients treated-
Indoor	10,399	9,105	16,402
Outdoor	94,872	93,947	1,30,364

The hospital has as many as 26 departments such as medicine, cardiology, surgery, ENT, obstetrics and gynaecology, out-patients, casualty, etc. Besides there are five operation theatres, a family planning centre, and an intensive cardiac care unit. The medical research centre with 200 beds was opened in 1972. The hospital also carries out laboratory investigations and provides for highly specialised medical and surgical treatmenti. It is one of the best equipped hospitals in Bombay enjoying national reputation.

The Bombay University has recognised nine units of this hospital for post-graduate studies.

During 1976 there were 97 honoraries working in the hospital, whereas resident medical doctors and nurses numbered 87 and 304, respectively.

Children's Orthopaedic Hospital : To provide orthopaedic and physiotherapy treatment for patients afflicted with poliomyelitis and other forms of crippling conditions, the Society for Rehabilitation of Crippled Children started a clinic in 1947. With the expansion in its activities a new building was constructed in 1950. It now provides treatment to children suffering from orthopaedic diseases and poliomyelitis upto 17 years of age.

Today the hospital is equipped with an operation theatre, physiotherapy, occupational therapy, medical social work, X-ray, psychology and psychiatry departments. A cerebral palsy unit was established in 1963 with assistance from the Department of Health, Education and Welfare of the U. S. A. The hospital provides training facilities to medical graduates. The work done by the hospital is shown below for a few years :—

	1965	1969	1973	1976
Cases seen—
Indoor and outdoor	1,648	1,193	1,196	1,535
Patients admitted	333	348	373	409
Operations performed	516	596	559	680

The number of physio-therapists and occupational therapists working in the hospital in 1976 was nine and seven, respectively.

Holy Spirit Hospital : The Holy Spirit Hospital, Andheri, was started in 1966. It is a general hospital with bed strength of 100 serving a popu­lation spread over Andheri and Jogeshvari areas.

The hospital has regular wards such as medical, surgical, gynaecology, paediatric, opthalmic, orthopaedic, ENT, etc. In the following is given the number of patients treated in the hospital since 1971 for a few years :—

	1971	1973	1975
Indoor patients	1,661	2,298	2,488
Outdoor patients
Free	6,824	8,223	94,591
paying	19,421	23,710	N.A

During 1976, 2,746 indoor and 97,363 outdoor patients were treated. The hospital staff includes 5 resident doctors and 39 nurses.

Harkisondas Narottumdas Hospital : Sir Harkisondas Narottumdas Hospital, popularly known as the Harkisondas Hospital at Girgaum, was established in 1925 with the help of donations from Sir Harkisondas Narottumdas. Started with 40 beds it is, at present, one of the biggest trust hospitals with 351 beds in 1976 at its disposal.

There are well equipped departments such as pathology, medicine, surgery, orthopaedic, neurology, opthalmology, dental, gynaecology, operation theatre, X-ray, family planning, intensive cardiac care unit, out-patients unit, blood bank, nutritions, artificial kidney unit, etc. It provides teaching facilities for housemen and registrars and also runs a college for nurses. Recently it has been recognised for post-graduate and Ph.D. courses by the University of Bombay.

Today the hospital employs nearly 750 hands including 15 medical officers and 40 residential staff. In the following is shown the work done by the hospital since 1971 for a few years :—

	1971	1973	1975
Patients treated—
Indoor	8,692	8,973	9,114
Outdoor	6,282	8,918	13,424

Jaslok Hospital : The Jaslok Hospital, managed by the Jasoti Lokumal and Mulchand Charities Trust, was established at Cumballa Hill in 1973. It has various departments such as medicine, surgery, ENT, opthalmology, cardiology, dental, gynaecology, obstetrics, etc. The out-patient depart­ment has a referal system similar to a system followed by the Mayo Clinic in the U. S. A. It has provided the latest form of radiotherapy and chemotherapy for treatment of cancer. There is one multi-patient artificial kidney unit in addition to an intensive care unit, the largest unit in the country. It is one of the best equipped hospitals with a reputation all over India.

Upto 1974, 6,219 and 3,306 outdoor and indoor patients were treated in the hospital.

During 1976, 16,402 indoor and 1,30,364 outdoor patients were treated in the hospital. During the same period there were 625 beds, of which no charges were levied for 332 beds. The number of doctors and nurses working in the hospital was 188 and 304.

Nanavati Hospital : This hospital was opened in 1950 at Vile Parle with a bed capacity of 50. Various departments like pathology, X-ray, casualty, ayurvedic, occupational therapy, etc. have been provided in the hospital. A casualty section works round the clock in this hospital for the western suburbs people. Besides, there is a family planning section, an immunisation section and a diagnostic centre, the last being for the benefit of workers under the Employees State Insurance Scheme.

The hospital is recognised by the Bombay University for post-graduate teaching of general medicine, gynaecology and obstetrics, and by the College of Physicians and Surgeons for FCPS in medicine and general surgery, diploma in family planning, etc. It is also recognised by the Maharashtra Nursing Council for training of nurses.

In the following is given information regarding patients treated in the hospital for a few years :—

	1952-60	1965	1970
Indoor cases	34,319	7,363	10,354
Outdoor cases	4,11,286	74,429	91,770

Tata Memorial Hospital : The Tata Memorial Hospital, Parel, was established in 1941 by the trustees of the Sir Dorabji Tata Trust, Bombay, with the object of treating cancer and allied diseases. In 1957 the hospital was given as a national gift to the Government of India, and was placed under the control of the Ministry of Health, and subsequently it was transferred to the Department of Atomic Energy. The radiation medicine centre, a wing of the atomic energy was housed in the Tata Memorial Centre to facilitate treatment of cancer patients. The Indian Cancer Research Centre was established in 1952, and during 1967 this unit was amalgamated with the Tata Memorial Hospital. Now this hospital and the Cancer Research Centre form the two units of the Tata Memorial Centre, which has done pioneering work in the diagnosis and treatment of cancer. Its work in this field is unparalleled in India.
The activities of the hospital are classified as service (patient care), education (professional and public) and research.

(1) Patient Care : The patients treated, both indoor and outdoor, number of surgical operations performed, etc. are shown in the following statement for a few years since 1941 :—

Year	No.of new patients seen	No.of cancer cases	No.of admissions	No.of surgical operations
1941-45	12,219	6,686	5,183	4,227
1951-55	29,249	14,138	8,341	7,880
1961-65	51,571	27,092	10,754	17,522
1970-71	14,229	N.A	3,062	10,388
1975-76	15,145	N.A	5,030	8,942

During 1976-77 there were 5,344 admissions. From 100 beds in the beginning the bed strength increased to 210 in 1976. No fee is charged for 68 per cent of the total beds.

The routine activities of the hospital are undertaken in nine departments including department of social service and rehabilitation. There is also a blood bank.

(2) Education : The hospital staff actively participates in seminars, meetings conducted in medical institutions both within the country and abroad. Members of the staff are recognised teachers of the Bombay University and conduct regular courses of lectures for post-graduate students. The strength of the staff of the hospital in the beginning was 120 which rose to 186 including 74 doctors in 1976.

(3) Research : The hospital closely collaborates in research activities with the Cancer Research Institute. Clinical research studies in the methods of treatment to improve survival rate have been pursued ; immunological studies in oral cancer have been initiated and retrospective case control studies of cancer of oesophagus and cancer of female breast have been undertaken to study the role of certain suspected factors. It has been recognised by the Bombay University as a teaching centre for post­graduate students for M.Sc. and Ph.D. degrees.

Shushrusha Citizen's Co-operative Hospital : The principle of co­operation was practised by some of the doctors and they established the Shushrusha Hospital at Dadar in 1964. It is managed by a board of directors, and its membership includes doctors and non-doctors.

The hospital is a modern institution and caters to the needs of people and provides facilities such as consultation, treatment, medical and surgical facilities, laboratory and X-ray and other special investigations. It also runs a drug store where medicines are sold at reasonable rates. It also runs a maternity home at Vikhroli.

The work done by the hospital and the maternity home, for a few years, is shown below :—

Particulars	Year
	1971-72	1973-74
Main Hospital:
Consultations	5,171	6,159
Admissions	2,233	2,354
Operations	1,247	1,394
Vikhroli Unit
Registration	503	560
Admissions	626	634
Operations	170	170
Deliveries	437	536

Central Government Health Scheme: To provide medical relief to the employees belonging to the Central Government and their families staying in Bombay, the Government of India started a scheme in 1963 by opening six dispensaries in South Bombay. During 1974 this strength increased to 15 in addition to one specialists' out-patient department to cover 36,000 Central Government servants residing south of Andheri and Ghatkopar.

These dispensaries were located at Ballard Estate, Bandra, Byculla, Churchgate, Colaba, Ghatkopar, Juhu, Koliwada, Mahim, Malabar Hill, Opera House, Peddar Road, Santa Cruz, Wadala and Worli. Facilities for consultation and free supply of medicines are provided by these dispensaries. A specialists' centre provides consultation by specialists and is equipped with facilities such as X-ray, laboratory, minor operation theatre. Other cases requiring further treatment are referred to the State Government hospitals, the Bombay Hospital, the Nanavati Hospital and the Shushrusha Hospital. Beneficiaries are not required to spend money for the services received by them.

During 1974 there were 55 medical officers and 275 class III and IV staff employed in these dispensaries and specialists' centre. Expenditure incurred under the scheme per family per year came to about Rs. 140. During 1973-74 the total expenditure was to the tune of Rs. 45 lakhs. During the same period 8,29,174 patients were treated.

BARC Hospital : From 1965 to 1975 the Bhabha Atomic Research Centre Hospital was located in the premises of the J. J. Hospital, Byculla. In 1976 the BARC Hospital at Deonar was commissioned with five wards and a bed strength of 110. The hospital has 12 departments. The details of patients treated are given in the following":—

Year	Patients treated
	Indoor	Outdoor
1967	1,250	14,134
1970	1,675	21,932
1973	1,930	22,401
1976	3,905	33,051

This hospital caters to the needs of about 15,000 employees of the Department of Atomic Energy.

There are also hospitals run by some of the Government organisations like the Railways, the Navy and the Bombay Port Trust for the benefit of their employees. The Central Railway runs a hospital situated at Byculla which was started in 1926. During 1977 the bed strength was 315. The other railway hospital managed by the Western Railway is known as the Jagjivan Ram Hospital located at Bombay Central. A hospital was started in 1964 by the Indian Navy at Powai. Amongst semi-Government organisations providing medical facilities for their employees mention may be made of the Bombay Port Trust, which provides a hospital with 160 beds. This hospital was started in 1968 and is located at Wadala (E).

Haffkine Institute for Training, Research and Testing : The Institute is one of the oldest and leading medical research institutes in India and had its origin in 1896 when plague broke out in epidemic form in Bombay.

It has made important contributions in the field of medical research such as studies in the epidemiology of plague, standardisation of plague and cholera vaccine, development of lyophilised polyvalent antivenin against common poisonous snakes in India, etc. It has also made contribution towards the development of technology of production of biologicals.

This Institute, controlled by the Government of Maharashtra, has recently been converted into an autonomous body. Haffkine Institute for Training, Research and Testing is the successor organisation of the former institute. The present organisation was registered under the Societies Registration Act, 1860, and started functioning as an independent body from September 1975.

The institute is entrusted with the work such as to study, investigate and improve the means of preventing and curing communicable diseases of man and animals, to conduct research on vital problems of medical field, to provide education in preventive and curative medicines to the medical personnel, to examine clinical specimens, to undertake testing of drugs, to advise various authorities in preventing the infectious diseases, etc.

Researches at this institute are carried out in bacteriology, immunology, chemotherapy, virology, biochemistry, chemical pathology, pharmacology, zoonosis and immuno-haematology. It is affiliated to the Universities of Bombay, Pune, Baroda, Nagpur, Marathwada and Konkan Krishi Vidyapith for the post-graduate teaching and research in medical sciences. During 1976, 134 seats were provided for post-graduate studies. For certificate courses in bioassay and drug analysis it admits 32 students every year. It is also recognised by the University Grants Commission. Scientists of other institutes and industries are provided short term training. In respect of testing, clinico-pathological, histo-pathological and biochemical tests are carried out at this institute. A mobile van for collecting blood from patients suspected to be suffering from typhoid fever within limits of Greater Bombay has been in operation. Samples received from private pharmaceutical companies are tested on payment.

This Institute is recognised as a reference and training centre by the World Health Organisation. A library of the institute is the oldest medical library in India having 18,000 volumes and 200 periodicals.

Dispensaries : For the benefit of the citizens of this metropolis the Municipal Corporation has set up a net work of free dispensaries. These dispensaries have proved very useful fo rtreatment of minor ailments. In recent years there has been over-crowding at the out-patient departments of the municipal general hospitals, making it difficult to medical staff to pay proper attention to each patient. The overcrowding at ,the out-patient departments is due to attendance of large number of patients requiring only dispensary treatment. With a view to relieving the general hospitals of heavy load of patients, the Corporation has upgraded some of its dispensaries by providing facilities of screening and routine laboratory investigations.

There is a steady increase in the number of free dispensaries in Bombay. During 1920, there were only 12 dispensaries which treated 77,963 new cases. This, however, increased considerably since then as can be seen from the following statement :—

Year	No of Dispensaries	New cases treated
1931	13	87,814
1941	16	1,98,350
1951	24	2,55,835
1961	27 + 1 mobile dispensary	6,03,278
1971	80 +15 mobile dispensaries	27,10,545

During 1977 there was as many as 124 dispensaries,their ward wise break-up was as follows:-

Ward	A	B	C	D	E	F/S	F/N	G/N	G/S
Dispensaries	5	5	5	5	12	7	6	11	7
Ward	H		K	L	M	N	P	R	T
Dispensaries	11		9	6	8	7	12	6	2

Of 124 dispensaries, ayurvedic and unani dispensaries numbered two each and were situated in G-North ward and B ward, respectively.

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FAMILY WELFARE

Maternity and child health, school health, family planning are the important activities carried out by the Corporation through its medical institutions. In the following is given a brief description of these services:

Maternity and Child Health : It is primarily intended to stop the wastage of human power and to build up future generation. As the maternity and child health service has unique position it occupies an important place in health care of the community. The Municipal Corporation renders maternity and child health services through its maternity homes and child welfare centres. Through these institutions domiciliary care is rendered to impart health education, and health propaganda is carried out amongst mothers. During natal period, mothers are explained importance of family planning. Milk is supplied free to needy and poor expectant and nursing mothers. Arrangement for B.C.G. vaccination,and immunisation is also made in the maternity homes.

The Corporation has started a number of maternity homes for the poor people who are unable to avail of the facilities offered by private hospitals. There were three maternity homes in 1921 in Bombay city which increased to 19 in 1971 in addition to the maternity wards provided in four municipal hospitals. The number of maternity and child welfare centres was 34. The total number of maternity beds increased from 134 in 1931 to 875 in 1971. In 1979 there were 22 maternity homes, 9 maternity wards and 39 maternity and child welfare centres. The scheduled strength of mater­nity beds was 1376. Paediatric centres were conducted at seven maternity homes during 1977 with a view to providing a service to community in which effective and comprehensive paediatric care can be given outside hospital by promoting good growth and development ; providing immunisation facilities ; reducing load of hospitals ; and providing field and educational experience to doctors, nurses and allied workers.

In the following is shown the work done by all institutions both public and private, doing maternity work, for a few years since 1931:—

Year	No. of institutions	Beds	Confinements
1931	50	N.A.	18,237
1941	104	1,475	34,763
1951	N.A.	N.A.	N.A.
1961	195	2,775	80,995
1971	364	6,029	1,60,747
1979	445	19,358	1,97,926

The ward-wise number of all types of maternity homes during 1979 was as follows:—

Ward	A	B	C	D	E	F/n	F/s	G/N
Maternity Homes	17 G/S	7 K/E	8 K/W	52 H/E	17 H/W	29 L	13 M	33 N
	13 p	29 R	27 T	12	31	9	22	18
	39	31	29

School Health : Medical inspection of children studying in municipal schools is carried out by the health department of the Corporation. Parents and guardians of inmates are interviewed and are explained necessity of getting their wards investigated and treated. During 1971 there were six school clinics, and these were functioning at L.T.M.G. Hospital, Sion; K.E.M. Hospital, Parel; B.Y.L. Nair Hospital, Bombay Central; H.B.M.G. Hospital, Borivali; Nair Dental College, and Lions' Juhu Dental Clinic. Minor ailments are treated in the municipal dispen­saries and those requiring further treatment are referred to the hospitals. Ailing children attending school clinics are provided milk.

The child welfare centre attached to the J. J. Group of Hospitals, established under the WHO Nursing Education Project, assists the municipal inspection branch in health programme. Assistance is also rendered by the mobile health unit in medical examination of children.

Family Planning : In Bombay efforts to provide family planning services were made as early as in 1925 when Prof. R. D. Karve opened the first birth control clinic in the city. In 1945 the Bombay Municipal Corporation passed a resolution to establish free family planning clinics, and the first two clinics were opened in 1947 at Dadar and Girgaum. In 1949 the Family Planning Association of India was established in Bombay and in 1952 it opened a family planning centre to provide family planning services to city population. In 1957 the Government of India established the Family Planning Training and Research Centre in Bombay. This Institute aimed at offering training to family planning workers. In 1952 a large number of clinics were opened because of impetus given to the family planning movement in city by holding International Planned Parenthood Conference in Bombay during that year.

During 1960 there were as many as 53 clinics in Bombay of which 38 were working in city area. Of 53 clinics doing family planning work, 29 were managed by the Bombay Municipal Corporation, 12 by voluntary organisations, 7 by the Central Government and 5 by the Family Planning Association of India. The total number increased to 62 in 1977, of which 52 were managed by the Municipal Corporation. During the period 1960-1977, 6,20,519 operations were performed by these 62 centres. The strength of staff employed was 367.

The Municipal Corporation has created a separate wing to look after the family planning programme in Greater Bombay. The family welfare unit situated at Parel was established in 1967, and has under its control 52 family planning centres spread over the area of Greater Bombay manned by a staff numbering 217. The work done by the wing in Greater Bombay since 1967 is shown below:—

Year	Sterilisation
	Vasectomy	Tubectomy	Total
1967-68	53,193	11,215	64,408
1969-70	25,474	15,850	41,324
1971-72	23,927	19,405	43,332
1973-74	54,548	22,127	76,675
1975-76	25,473	25,904	51,377

During 1976-77, 78,707 operations were performed including 40,782 vasectomy operations.

The family planning programme launched by the Corporation is unique in the sense that it has jumped from the lowest rung of family planning ladder to the top by means of courageous and active implementation of novel and unorthodox ideas. Opening of numerous information-cum-nirodh distribution centres at railway stations and in crowded localities have facilitated tremendous increase in the distribution of nirodh (contraceptives) and spreading the message of small family norm in every nook and corner of the city.

The Family Planning Hospital established in 1971 was the first of its kind in the World. It is a specialised, centralised institution for total family planning care.

Ambulance Services : The Municipal Corporation of Greater Bombay provides ambulance services for removing cases of maternity and street accidents and infectious diseases to the hospitals, the last one on payment within Greater Bombay area. These services are provided by the Fire Brigade, Byculla and Ambulance Garage, Sane Guruji Marg. An ambulance is also attached to the K. B. Bhabha Hospital, Bandra; Dr. D. N. Cooper Hospital, Juhu; H. K. Bhabha Hospital, Kurla ; Municipal General Hospital, Ghatkopar; S. H. B. Municipal Hospital, Borivli ; MAA Hospital, Chembur; and Municipal Maternity Homes, Mulund, Mahim, Bhandup and Malad.

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PUBLIC HEALTH ORGANISATION

The medical and public health activities in Greater Bombay are entirely carried out by the Municipal Corporation of Greater Bombay. The subject of public health is dealt with by the Corporation and hence the Department of Public Health of the State Government has a little voice in this subject. The controlling authority of public health services is the Executive Health Officer who is responsible to the Municipal Commissioner. The Deputy Executive Health Officer and the Assistant Executive Health Officer with other staff help the Executive Health Officer in his day-to-day work. The public health committee, one of the special committees of the Corporation, gives guidelines to the public health department in order to carry out effectively the public health activities in Greater Bombay area.

The staff in the State Government hospitals works under the control of the Director of Health Services. Bombay.

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BLOOD BANKS

A movement of voluntary blood donation in India was started in 1954 on an experimental basis at the St. Georges' Hospital, Bombay. A trust known as the St. Georges' Hospital Voluntary Blood Donation Service was registered in 1955. However it was wound up in 1968 and since then the blood donation service at the St. Georges' Hospital is managed by the Government. St. Georges' Hospital blood bank was declared a regional bank in 1965.

In Bombay there are as many as 22 blood banks working under the control of the Federation of Bombay Blood Banks. The list of these blood banks and transfusion centres is given below:—

Name of blood bank	Management
St. Georges' Hospital	Government
Cama and Albless Hospital	"
Gokuldas Tejpal Hospital	"
Lokmanya Tilak Municipal General Hospital	Municipal Corporation
B.Y.L. Nair Hospital	"
Dr. R. N. Cooper Hospital	"
Rajawadi Municipal Hospital	"
Haffkine Institute	Government
Indian Red Cross	Red Cross
Jaslok Hospital	Charitable Trust
Harkisondas Hospital	"
Bombay Hospital	"
Breach Candy Hospital	"
Ma sina Hospital	"
Nanavati Hospital	"
Sarvodaya Hospital	"
Saifee Hospital	"
B. D. Petit Hospital	"
St. Elizabeth Hospital	"
Tata Memorial Hospital	"
Wacha Hospital	"
Tata Blood Bank (J. J. Hospital)	Government

 

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TABLES

TABLE No.1
BIRTHS AND DEATHS BY MONTHS

Year	Births/ Deaths	Months												Total
		Jan.	Feb.	Mar.	Apr.	May	June	July	Aug.	Sept.	Oct.	Nov.	Dec.
1961	Births	7,670	7,434	7,066	8,736	8,789	9,403	9,812	9,384	10,895	11,592	11,840	13,716	1,16,337
	Deaths	4,133	4,820	4,587	3,937	3,292	3,151	3,195	3,378	3,217	3,125	3,050	3,232	43,117
1963	Births	9,211	8,221	9,084	9,991	10,454	9,276	11,292	9,938	12,963	13,172	13,152	15,077	1,31,831
	Deaths	3,051	2,631	2,982	3,263	3,561	3,139	5,919	3,783	3,818	3,665	3,348	3,490	40,650
1965	Births	9,203	9,858	10,720	9,779	10,297	10,419	11,258	11,521	13,879	13,325	16,133	16,389	1,42,781
	Deaths	4,014	4,523	5,442	4,955	4,248	4,381	4,844	4,628	4,884	4,169	4,132	4,203	54,223
1968	Births	9,334	10,925	7,375	13,145	12,368	11,885	12,755	12,355	15,327	14,552	16,951	19,906	1,56,880
	Deaths	4,000	4,273	3,353	4,003	4,256	3,666	4,533	4,294	4,828	4,654	4,119	4,460	50,439
1971	Births	10,210	10,206	8,842	10,666	11,790	12,194	14,866	12,949	14,841	14,690	19,027	24,012	1,64,293
	Deaths	4,427	4,849	4,702	4,438	4,647	4,385	5,001	4,928	5,094	4,955	4,845	5,472	57,245
1973	Births	12,362	11,237	11,749	12,536	13,256	14,559	13,035	13,159	15,737	17,005	21,080	24,424	1,80,409
	Deaths	4,689	5,160	5,482	5,120	4,818	5,076	4,713	5,107	5,396	5,547	5,525	5,298	61,931
1975	Births	11,488	10,638	9,867	12,090	14,469	13,850	14,366	15,577	16,224	18,246	18,592	24,611	1,80,118
	Deaths	5,584	5,045	4,968	6,449	6,449	5,043	5,067	5,866	5,815	5,282	4,979	6,041	65,234
1979	Births	12,887	12,395	12,095	12,103	14,497	16,980	15,193	16,972	20,085	19,632	18,559	31,847	2,04,595
	Deaths	5,406	5,556	5,549	5,116	5,831	6,055	6,239	6,697	6,987	5,802	5,805	6,959	72,002

 

TABLE No. 2
Births and Deaths by Wards

Wards	1965				1971		1979
	Births		Deaths		Births	Deaths	Births	Deaths
A	4,990		2,095		4,987	2,219	5,339	2,645
B-1	1,600		736		1,490	574	1,132	564
B-2	3,330		1,206		3,159	1,202	2,772	1,138
C-3	3,747		1,574		3,217	1,298	2,704	1,072
C-1	3,910		1,810		3,175	1,530	2,576	1,932
D	8,522		3,826		8,345	3,638	8,899	4,426
E-1	8,164		4,258		7,860	4,093	7,452	3,832
E-3	6,281		3,155		6,319	2,594	4,504	2,023
F-S	12,402		4,631		11,718	4,237	11,014	4,926
F-N	5,873		2,756		6,810	2,737	9,583	4,323
G-N	10,034		4,994		10,311	4,386	12,502	5,184
G-S	10,794		4,262		11,550	3,854	12,768	4,131
H	13,614		4,551		14,340	4,763	17,619	5,654
K	12,602		3,809		16,334	4,879	21,743	6,948
L M		12,500		4496	8,721 9,268	2,611 2,708	11,636 15,077	3,616 4,368
N	10,154		3,022		10,647	3,079	14,772	4,108
P	7,214		1,553		10,398	2,579	15,174	3,919
R	4,054		670		6,638	1,937	12,586	3,589
T	2,996		821		8,706	2,327	14,753	3,468
Total	1,42,781		54,223		1,64,293	57,245	2,04595	72,002

TABLE NO.3
DEATHS ACCORDING TO AGE

Year	Sex	Age periods								Total
		Under one year	1— 4 years	5 — 14 years	15 — 24 years	25— 44 years	45 — 64 years	65 — 74 years	75 and above
1965	Male	7,291	3,796	1,381	1,818	4,817	6,300	2,735	2,554	30,755
	Female	6,448	4,229	1,313	1,314	2,763	2,607	1,767	3,027	23,468
	Total	13,739	8,025	2,694	3,115	7,580	8,907	4,502	5,561	54,223
1971	Male	6,929	3,033	1,219	1,804	5,981	8,289	3,568	3,122	33,945
	Female	6,044	3,356	1,048	1,200	2,756	3,086	2,191	3,619	23,300
	Total	12,973	6,389	2,267	3,004	8,737	11,375	5,759	6,741	57,245
1975	Male	7,411	3,158	1,381	2,139	6,654	9,530	4,093	3,600	37,966
	Female	6,736	3,688	1,105	1,572	3,077	3,655	2,391	4,213	26,487
	Total	14,147	6,846	2,486	3,711	9,731	13,185	6,484	7,813	64,403
1979	Male	8,158	2,752	1,262	2,441	8,044	11,743	4,817	4,366	43,583
	Female	6,920	3,250	1,072	1,615	3,220	4,363	3,050	4,839	28,419
	Total	15,078	5,992	2,334	4,056	11,364	16,106	3,867	9,205	72,002

TABLE NO.4
CERTIFICATION OF CAUSES OF DEATHS, BOMBAY CITY

Particulars	Year
	1931	1936	1941	1946	1951	1956	1961
Total deaths	25,105	N.A	31,096	41,264	33,841	27,759	32,506
Verified by District Registrar	N.A	N.A	N.A	25,004	17,318	11,273	12,420
Certificates of causes of deaths received from -
(1) Medical officers of hospitals	4,213	6,286	7,260	9,142	9,946	7,922	8,808
(2) Private medical practitioners	3,484	3,636	4,106	4,264	4,135	5,115	6,886
(3) Hakims and vaidyas	10	9	76	16	119	22	36
(4) Commissioner of Police	128	200	152	342	432	392	339
(5)Coroner of Bombay	621	940	1,175	2,496	1,891	3,035	4,017
Total	8,456	11,071	12,769	16,260	16,523	16,486	20,086
Percentage of total certificates received to total mortality	27.3	36.9	41.5	39.8	48.8	59.4	61.7

TABLE NO.5
INFANT MORTALITY BY PRINCIPAL CAUSES

Causes of death	Year
	1961	1963	1965	1968	1971	1973	1975	1978
Poliomyelitis	5	7	6	36	25	2	13	21
Small-pox	259	21	229	8
Measles	51	21	196	22	38	40	50	11
Malaria fever
Diarrhoea and Gastroenteritis	1,097	1,125	1,636	1,560	1,637	1,615	1,713	1,810
Dysentery	40	39	40	55	61	70	44	53
Congenital malformation and diseases of early infancy.	4,893	5,608	5,877	5,188	5,267	5,487	5,768	6,156
Diseases of respiratory system	3,543	2,140	4,151	3,140	3,144	3,717	3,701	2,671
Convulsions	83	35	27	48	43	22	1
All causes	11,150	10,677	13,739	12,602	12,973	13,976	13,767	13,512

TABLE No. 6
INFANT MORTALITY BY AGE PERIOD

Age Period	Year
	1961	1963	1965	1968	1971	1973	1976	1979
Under 1 week	3,366	3,702	4,424	4,621	5,113	5,292	5,305	5,450
1 to 4 weeks	1,721	2,086	2,316	2,408	2,432	2,788	2,724	3,030
4 weeks to 6 months	3,177	2,768	3,955	3,269	3,305	3,548	4,301	4,026
6 months to 12 months	2,886	2,121	3,044	2,304	2,123	2,398	1,817	2,572
Total	11,150	10,677	13,739	12,602	12,973	13,976	14,147	15,078

TABLE No. 7
DEATHS DUE TO CAUSES

Area	Year	Measles	Influenza	Enteric fevers	Diarrhoea,enteritis and dysentery	Respiratory diseases	Diphtheria	Total deaths
Bombay City	1921	201	1,389	152	4,957	21,982	N.A.	53,609
	1931	45	130	186	1,295	9,096	25	25,105
	1935	264	72	232	1,235	10,642	28	29,289
	1941	199	44	554	1,374	10,186	70	31,096
	1945	160	32	616	N.A.	13,771	N.A.	40,215
	1951	96	6	262	1,156	8,784	90	33,841
	1955	60	3	211	1,423	5,418	171	28,108
Greater Bombay	1961	150	23	132	2,041	9,940	181	43,117
	1965	580	14	42	3,924	10,601	102	54,223
	1971	194		47	3,737	10,730	97	57,245
	1975	285		49	3,946	11,646		65,234
	1979	90		79	4,657	10,571		72,002

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