By Jamellah Bayley
This article is the second in a two-part series that examines the health conditions in British Guiana during the 1890s. Part one gave a brief overview of the general conditions in the colony including economic and living conditions as both had implications for the health of residents. This second installment focuses on the health conditions and health facilities in British Guiana.
The colony had five public hospitals:- Georgetown, New Amsterdam, Suddie, Bartica and Morawhanna including Arakara Ward and Bariman Ward. Additionally there were ninety one estate hospitals in 1892, reduced to eighty two during the same year. There was a further reduction to sixty eight by 1894/95.
The hospitals suffered from overcrowding. In 1894, Georgetown hospital had seven hundred beds and eight hundred and sixty four patients. The Suddie hospital had only fifty beds and it was too small to cater for the sick poor of the county of Essequibo. Care was taken to admit only serious suitable hospital cases. Those suffering from chronic and incurable diseases which were not urgent and also trivial cases and cases of destitution were refused.
In many instances patients were treated and released without being cured. At Georgetown in 1894, 9,200 persons were treated, 1,177 died and 4,413 were released without being cured; at Suddie 1,071 patients were discharged only 256 were cured.
The nursing staff was insufficient and untrained. At Georgetown hospital in 1890 the staff included:
Source: Guyana National Archives, Medical Box 1
The authorities were of the opinion that the sacredness of the duty of nursing had not been understood amongst those employed. An incident at the Georgetown hospital occurred where the head nurse and one under nurse were found sleeping at about 1:30 am. The Surgeon General report noted that thanks to the vigilance of the medical officer these delinquents were discovered and dismissed.
Prior to the 1890s, night nurses were given a meal in addition to ration allowance of $3 a month. This was done to prevent the introduction of contraband. However in order to save money night nurses’ meals were discontinued. They were permitted to bring their own food which had to be subjected to inspection by the gateman. Refusal or anything deemed misconduct saw them being punished.
Plans were made to start a Nursing Home and School to train ‘respectable mature women’ as hospital nurses and nurse midwives in 1894. The school was started in 1896 with sixty five probationers. They were trained by carrying out the ordinary duties of the wards under the supervision of the Matron and her assistant. Lectures of a simple nature were given by the Matron and special teaching was given in the general wards and Maternity ward by the Medical Officer.
After six months of training in Midwifery, they were given Nurse Midwife Certificates to deal with simple or natural labour. These certificates were designed so that they could not be used as license to practice midwifery. Each was marked across in red “This certificate does not entitle the holder to practice midwifery …..”
At the public hospitals there were rooms for paying patients and non-paying patients. Additionally there were separate wards for ‘coolies’ and ‘creoles’. The arrangement in the public hospitals was a ward was set apart for the coolie immigrants. They were to be looked after by their fellow countrymen and women. It was hoped to have a staff of entire ‘coolie’ nurses in ‘coolie’ wards.
An Out-patient Regulation was passed on 18th December, 1894. It required poor persons to bring a Ticket of Recommendation from a responsible individual such as a member of government, certifying that they were at the moment, fit subjects for free treatment. No such ticket meant no treatment except for serious accident cases. This implies that a number of sick persons could not seek medical treatment, since the ticket required signatures of what the authorities deemed a respectable individual. Implication being if no such person was available a sick person went unattended.
The Out-patient Regulation was an addition to the ‘Pauper’ and ‘Poverty’ certificates already in the colony. A ‘Pauper’ certificate was given to those who were destitute and unable to pay anything for medicine or treatment. While a ‘Poverty’ certificate was given to persons such as servants, porters, labourers and those in reduced circumstances who while unable to pay for private medical advice and medicine are not destitute.
The former was valid for a month and the latter for a fortnight. They had to be notarised by persons such as Justices of Peace, Ministers of religion, chairman of village councils or immigrant agents. So every fortnight or every month the poor, hardworking people had to take time off to seek out such a person to issue them with a certificate. All this red tape just to receive what in the end amounted to second rate medical care. The holders of these certificates could only go to the dispensaries situated in the district in which they lived. This had repercussions for a certificate holder who migrated either to the city or another village. It meant they had to go back to their home village for treatment in case of illness. Further, the Medical Officers were not compelled to give medicines to certificate holders. ‘Pauper’ was treated gratuitously and given free medicine. ‘Poverty’ certificate holders on the other hand had to pay 12 cents to the Medical Officer for attendance on each visit and to pay each time a like sum for the medicines ordered.
Medical Officers made house calls. If required to visit a ‘Poverty’ certificate holder, that patient had to pre-pay 18 cents for each visit. The ‘Pauper’ was given a ticket for free admission into hospital. In the 1890s, those who could not pay for medical treatment were at the mercy of the medical profession who refused to treat them if they did not have a ticket or if the ticket had expired. Those who had the financial resources got better care. Arguably the same obtains in many of today’s health facilities as those who cannot afford to pay for medical treatment have to spend hours waiting to be attended to regardless of their emergency. Today’s poor therefore often experience similar treatment without the ‘poverty’ and ‘pauper’ certificates.
The tickets were seen as a way of reducing the number of outpatients, saving the colony expenses and removing ‘pauperising influence’ upon the lower class. It was believed by the authorities that many feigned illnesses in order to secure free meals and shelter within the walls of the hospitals – thus the reference to ‘removal of pauperising influence.’
In the 1890s many diseases were prevalent, some at epidemic levels. Among the diseases were influenza, yellow fever, malaria fever, diarrhoea, dysentery, Bright’s disease, anemia, pneumonia, bowel complaints, chest infections and tuberculosis. An influenza epidemic started in 1890 with 12,229 cases at the public hospitals. 1,689 persons died and it was not taken under control until about 1895/96. Malaria fever was prevalent mostly among the East Indian immigrants on the estates. In 1893, there were as many as 79,703 reported cases on the estates. In 1892 the mortality rate among immigrants was 25.2 per 1,000. Indentured women had higher mortality than men. This was blamed by the colonial health authorities on their inferior mental and physical conditions due to the lower classes from which they came and their often advanced age.
Pneumonia and tuberculosis caused the most deaths in 1894/95 as some 38% of total deaths were attributed to these two diseases. In Bartica high mortality rates were blamed on the conditions of the patients when they were received. The patients were mostly from the gold fields and usually arrived at the hospital in deplorable conditions, having travelled great distances. One report mentioned a man with a fractured spine who travelled for five days in an open boat, shooting several falls. Both the medicines and foods taken along on gold expeditions were often inadequate and insufficient.
Infant mortality was high due to the poor conditions of the women in relation to their squalid living conditions, poor diets and hard work they had to perform. At Georgetown in 1890 there were 121 deliveries, of this twenty four were still births, and nineteen aborted. The influence of syphilis and malaria disease interfered with the normal course of natural labour as did the lack of skilled nurses during and after labour. In 1894 in Georgetown there were 551 infant deaths under one year old, 42 in New Amsterdam, 207 in the county of Berbice, 572 in the county of Demerara and 206 in the county of Essequibo.
In that same year there were 1584 still births among the different ethnic groups, highest occurring among the Blacks and East Indians. Infant deaths were ascribed to pneumonia, asthma, whooping cough, worms, malnutrition, starvation, diarrhoea among others.
Several measures were implemented to improve the state of health in the colony. The first step was to improve living conditions and water supply. The main sources of water were rain and trenches or creeks. Proper tanks, vats and cisterns were constructed on hospitals and on estates. New trenches were dug and fenced and efforts were made to keep cattle away. Some estates even installed systems for running water and adopted filtration methods for river water, such as Enmore and Taymouth. Additionally, new dwellings were constructed and ventilation improved on older estates.
To combat malaria fever it was advised that water should be boiled, food cooked and a dose of arsenic or quinine taken. These measures were to be tried particularly on newly arrived immigrants on estates in malaria localities. Some were even given a dose of arsenic or quinine before going to the estate.
The Vaccination Ordinance was amended on 6th January 1894. As a result the control of vaccination, formerly in the hands of the Registrar General of Births and Deaths, was taken over by the Medical Department. Vaccination officers assisted Medical Officers in carrying out vaccinations, collecting children and prosecuting parents or guardians who evaded the law. At estate hospitals, the dispenser performed this duty and in villages and other places the Registrar of Death and Births assisted the Government Medical Officer. A regular supply of human and calf lymph was received with every mail from the Crown Agents and was distributed among Government Medical Officers. As a result, between 5thMarch 1894 and 31st March 1895, 6,490 vaccinations were given and in 1896 – 1897 10,338 were given.