Soorjoo Coomar Goodeve Chuckerbutty Part 3

Final part of the article

He felt the great need of determining the average duration of life in this country and recommended concrete measures for registration of births and marriages.20 He reverted to this subject again in 1867 when he published a paper entitled 'A Clinical
Retrospect of Hospital Experience of Civil Medical Cases' dealing with a total of 7,125 indoor patients, 6,662 in the Medical College Hospital and 811 in Chitpore and Baitaconnah Hospitals and the 5,839 out-patients referred to in the earlier report.21 The average mortality in the three hospitals was 24.4 per cent and in the Medical College Hospital alone 22.7 per cent. He noted that for the four years commencing in 1850, the gross mortality rate was 16.45 per cent and for the similar period commencing in 1860, the rate was 25.32 per cent. The major causes of death were cholera, dysentery, smallpox, phthisis, remittent fever and intermittent fever. The death rates were as follows: cholera 46.6, dysentery 30.26, smallpox 39.21, phthisis 45.3 per cent. He found that in some diseases the ratio of mortality to admissions was higher in the latter four-year period. He felt that there was a 'change of type in the constitution of diseases in India'-an idea he sought to prove by other data as well. This view had been put forward by some workers in Europe and it had many supporters and opponents. His colleague Dr. Ewart was one who did not believe in this theory.
During 1864-65, Goodeve Chuckerbutty was placed in charge of smallpox hospitals in Calcutta. Temporary hospitals used to be built or residential buildings hired for this purpose during epidemic outbreaks. He gave a detailed account of the Chitpore hospital, its administration and of the patients admitted; those relating to the latter being of epidemiological interest.22 The final case mortality figures were 20.8 per cent and 23.9 per cent for female and male Europeans and 41.8 per cent and 58.5 per cent in male and female Indians respectively. Of the unprotected cases, about 53 per cent died; once vaccinated or inoculated (variolation) showed a mortality of 25-30 per cent. Of the few cases having second attacks of smallpox, 7.8 per cent died.
As for the practice of acquiring or building some sort of temporary hospitals to accommodate smallpox cases, Goodeve Chuckerbutty recommended that a permanent hospital should be built for cholera and smallpox cases. Subsequently Cholera and Smallpox Wards of the Campbell Medical School Hospital continued to accommodate most of such cases for many decades until the building and inauguration of the present Infectious Diseases Hospital of Calcutta.
In 1865, the paper 'Cases Illustrative of the Pathology of Dysentery' was published.23 During a period of fourteen months, 280 cases of dysentery had been admitted under his care into the Medical College Hospital. Of these ninety-one patients died (case mortality 32.5 per cent); 189 were discharged cured and post-mortem examination was done in thirty-eight cases. Apart from the clinical classification of the cases, the morbid changes encountered were described in great detail. From his descriptions, it appears that majority of cases belonged to what was recognized about four decades later as bacillary dysentery; but there was a fair number of cases of fulminating amoebic dysentery some with liver abscess. Besides these, there were a few cases ofintestinal tuberculosis, uraemic dysentery, tape-worm infection with dysenteric symptoms, scurvy, etc.
The lesions described as mamillated ulcers, circular ulcers, rodent ulcer, carbuncular lesions, submucous abscess with small mucous membrane lesion and perforating ulcers, were very probably due to acute amoebic dysentery. Though Goodeve
Chuckerbutty was aware of Annesley's work, he did not adhere to the latter's broad
classification of dysenteries into acute uncomplicated and hepatic dysentery. As was
the fashion with some of the workers of this period, Goodeve Chuckerbutty described
his own observations without any attempt at comparison with the findings of previous
writers.
He delivered a lecture on the pathology of hepatic abscess24 before the Bengal branch of the British Medical Association in 1867. He postulated that there was coagulation of blood in the small vessels in the intestines in dysentery; thrombi from branches of mesenteric veins were carried into the portal vein and thus to the liver causing blockage of small branches supplying hepatic lobules which became pale
and soft and ultimately small and large abscesses were formed. This concept was possibly an extension of that of Budd who in 1845 laid stress on the fact that metastatic infarcts might follow ulceration or gangrene of the intestine and from that Budd evolved the theory that in tropical countries, the endemic prevalence of abscess of the liver was causally related with dysentery that was likewise endemic in these regions. Budd's concept was not accepted by many European workers and even up to the beginning of the present century, Duncan of the London School of Hygiene
and Tropical Medicine regarded liver abscess and dysentery as unrelated.25
His paper 'Cholera, Its Symptoms, Clinical History, Pathology, Diagnosis, Prognosis,
Treatment and Prophylaxis' was published in 1867.26 In this paper only his own experiences were recorded and no 'second-hand material' was included by him. The description of the clinical features in this paper is excellent. As regards the cholera stools, he was of the view that 'they seem to consist of the ordinary secretion from the mucous lining of the intestines more or less diluted with water'. He discussed the question of cholera being due to a poison and analogous to the virus of smallpox and measles which must run its course and be eliminated in its own time. He did not agree with this view regarding the aetiology of cholera. Like many other earlier writers, he felt that the disease arose from a peculiar condition of the atmosphere which caused catarrh of the alimentary tract.
Post-mortem examination was done in sixty-three fatal cases under his care; fifty-two of these were primary and in the rest cholera developed in the course of
other diseases (intercurrent). Of the primary cases twenty-six and twenty-three died
during the second and the third stages of cholera. His description of the morbid changes in the three stages of cholera was more or less similar to that of many writers in India and elsewhere, who had encountered cholera since 1817. He described
appearances similar to that of Bright's disease in a few of his cases and in several
others he found what was held to be the evidence of desquamation of the epithelium
of the uriniferous tubules, viz. expulsion of milky fluid on pressure upon the pyramids of the kidneys.
The treatment followed in his cases was described in detail. Opium and astringents formed the sheet anchor of treatment in the first and the second stages and calomel
was used to 'allay gastric irritation'. In the second stage, he employed stimulants
but felt that medicines might have to be discontinued, only cold drinks or ice or
bland fluids being given. Injections of warm saline solutions had during this period gone out of use and this measure and blood transfusions were deprecated. For suppression of urine in the third stage, dry cupping and diuretics were employed and for uraemic coma attempts were made to promote elimination by means of purgatives, e.g. castor oil.
During the period of four years from 1860, 47.9 per cent of cholera cases admitted
under his care in the Medical College Hospital, died. He was of the opinion that mortality at the commencement of an epidemic was as high as 75 per cent and it
came down to about 25 per cent towards the end of the outbreak. The mortality rate
of his cases compares favourably with that of Wall who lost 70 per cent of his cases
in Calcutta; and the rate varied between 60-80 per cent till the introduction of treatment with intravenous hypertonic saline infusions by Rogers in 1908 09.27 For
prophylaxis, he recommended good sanitary laws on board ships and along caravans
and recommended cleanliness as an effective measure of control.
Goodeve Chuckerbutty held very decided views on the spread of education among
the people of India. Some idea about his opinions may be had from his introductory
lecture at the commencement of the thirty-sixth session of the Medical College of
Bengal.28 After describing the curriculum the newly-admitted medical students would have to master, he discussed the question of national education in India. Oriental classical education including mastery of Sanskrit or Arabic, Vernacular education, and English education available in the country at the time were considered.
The alumni of centres of Sanskrit learning had been described by Macaulay
as 'utterly useless for all worldy business' and Arabic was felt to be unsuited for
popular education, the knowledge of this language was required only for its intrinsic
merit. He mentioned that 'oriental mania' died out after the vigorous administration
of Lord Bentinck. At the time, the teaching was poor in the vernacular schools. He
was of the opinion that the grand principle should be to teach European knowledge
in a popular and vernacular dress. As for English education, he felt that it was very
useful for working anywhere and the language was a treasury of European civilization.
It was expensive; but he felt that the rich should be made to pay education fees for
the spread of English education among their countrymen. He laid great emphasis on
the importance of education of Indian women and of the lower classes. He dealt
with this subject more than once before the meetings of the Bethune Society and
other learned bodies of Calcutta.
Goodeve Chuckerbutty's scientific writings reflect the state of medical science
particularly as it obtained during the third quarter of the nineteenth century. Past
was the age of Twining and the generation of European surgeons of the East India
Company who practised massive and repeated venesections, leeching, drastic purgatives, mercury in large doses till salivation and soreness of the gums were induced along with a regime of near starvation. The earlier attempts to treat cholera by parenteral replacement by saline solutions of the fluid lost, had not generally succeeded, and no attempts had been made to improve this rational mode of therapy.
The treatment of malaria, particularly the dreaded terai fever had immensely improved
by Hare's reintroduction of heavy dosage of quinine in this condition. employed, and except for Balantidium coli (Malmsten, 1857), the protozoan parasites affecting man and causing many major diseases in India, e.g. malaria, kala-azar and amoebic dysentery, were yet undiscovered. In spite of the fact that newer concepts of pathology were being evolved in Europe and other Western countries and microscopes
were available in Calcutta, there was little enthusiasm among the local European teachers of pathology to employ microscopy in their investigations. Only as late as 1869-70, did Timothy R. Lewis examine the cholera stools with the microscope
and describe diverse elements found in it including some amoebae, the significance
of which was not clear to the investigators. It is against this background, that the contributions of Goodeve Chuckerbutty should be assessed.
His description of the clinical features of and the morbid changes (as seen by the
naked eye) in the major diseases-dysentery and cholera are examples of meticulous
attention to all variations seen and their presentation in detail after suitable classification.
The causative agents of these diseases being entirely unknown, there was
little alternative to recording one's observations. His concept about the development
of liver abscess following dysentery was rational though not entirely original.
As for typhus fever, Goodeve Chuckerbutty was probably the first to recognize that
the disease did occur in India, though Megaw, who himself suffered from it and diagnosed the condition on clinical grounds alone, is credited with this.29 He was one of the early workers in India who recognized that rheumatic heart disease occurred among Indians, a fact that was not generally accepted by most European authorities of this period.
Surgeon Major S. C. Goodeve Chuckerbutty died on 29 September 1874, at
Kensington, London, where he had gone on furlough. He had been in indifferent
health for some time, suffering from severe asthmatic attacks and a dilated heart
was suspected. The change to England during summer had apparently done him
good; but the autumn proved too much for his chest condition. At the time of his
death, he was barely forty-eight years old.'5
Personally, he was described as 'possessed of an intelligent countenance, mild
pleasant expression and general manner'. His photograph and portrait in colour
bear this out. He was much respected by his countrymen, colleagues and fellow
officers as well as his students and in his honour a ward in the Medical College
Hospital, where he spent the major part of his years of professional activity, was named after him.
REFERENCES
1. CHucKERBur, S. C. G., Med. Times Gaz., 1852, N.S. 5, 406.
2. CRAwFoRD, D. G., Roll of the Indian Medical Service, 1615-1930, London, Thacker,
1930, p. 148.
3. MYrRA, S. C., Saral Bangla Abhidhan [A Dictionary of Bengali Language], 7th ed.,
Calcutta, 1936.
4. Med. Times Gaz., 1855, i, 173.
190
S. C. Goodeve Chuckerbutty
5. SEN, A. N., Swargiya Dina Nath Sener Jibani o Tatkaler Purba Banga [Biogaphy of
the late Dina Nath Sen and an account of contemporary East Bengal], Calcutta,
published by the author, 1948, vol. 1, p. 15; vol. 2, p. 400.
6. UKIL, A. C., The Centenary of the Medical College, Bengal, Calcutta, Statesman Press,
1935.
7. GHOSH, S. K., Calcutta med. J., 1934, 28, 514. (This paper is based on an article by
Mahendra Lal Sarkar, M.D., D.L., published in 1897, and freely reproduced from
the same.)
8. Lancet, 1846, U, 138.
9. CORNELUS, E. H., personal communication, 1969.
10. Lancet, 1847, Ui, 188.
11. Lancet, 1849, , 625.
12. WESENCRAFT, A. H., personal communication, 1969.
13. Lancet, 1855, i, 424.
14. CRAWFORD, D. G., History ofthe Indian Medical Service, 1600-1913, London, Thacker,
1914, vol. 1, p. 504.
15. MACLEOD, K., Ind. med. Gaz., 1874, 9, 330.
16. Ind. med. Gaz., 1868, 3, 113.
17. SEN, B. C., Calcutta med. J., 1907, 1, 193.
18. CHucKmBury, S. C. G., Med. Times Gaz., 1853, N.S. 6, i, 564.
19. Idem., Ind. Ann. med. Sci., 1865, 18, 122.
20. Idem., ibid., 1857, 7, 179.
21. Idem., ibid., 1867, 21, 96.
22. Idem., ibid., 1866, 20, 337.
23. Idem., ibid., 1865, 19, 90.
24. Idem., Ind. med. Gaz., 1867, 2, 222.
25. ScoTr, H. S., A History of Tropical Medicine, London, Arnold, 1939, vol. 2, p. 827.
26. CHucKERsBTuwy, S. C. G., Ind. Ann. med. Sci., 1867, 11, 61.
27. SEN Gup'rA, P. C., J. Ind. med. Ass., 1969, 53, 88.
28. CHucKEBuwrry, S. C. G., Ind. Ann. med. Sci., 1870, 27, 58.
29. NAPIER, L. E., Principles and Practice of Tropical Medicine, Calcutta, Thacker Spink,
1943, vol. 1, p. 280.
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