A merchant from Bombay arrives in Karachi and stays at an inn. He has the Plague. A 16-year-old cook working at the inn gets infected from the merchant guest. The teen is diagnosed on December 8, 1896, the first case of the Third Plague (the bubonic plague or Black Death) documented in Karachi. 

Entering the New Year, there is mayhem in the city, with the plague rapidly spreading and an extremely high mortality rate. The authorities respond with stringent public health measures and make provisions for the healthcare for citizens. Civil Hospital Karachi becomes the Plague hospital and a tertiary care centre. 

But how did the hospital become trusted to deal with such a crisis? We can find out by going even further back in time…

It is 1839. The British come to Karachi. Their forces are stationed at the Eidgah Maidan. To cater to their medical needs, a dispensary is established on Mission Road in the Ranchore Line quarter. However, as the facilities develop, the British forces move to the cantonments and the dispensary gets transferred to civilians.

The dispensary grows and, in 1854, the first block of the hospital — which is still the central portion today — is built at a cost of 6,878 rupees. Civil Hospital arrives!  Come 1859, the newly established Scinde Railway Company builds further additions. Civil Hospital becomes one of the first British institutions in Sindh.

Civil Hospital Karachi was one of the first British institutions in Sindh and a shining example of a well-maintained and state-of-the-art medical establishment that played its part in times of epidemics. A Dow Medical College alum accesses never-seen-before records about the long history of the hospital…

In 1876, A.W. Hughes records the earlier history of the Civil Hospital in The Gazetteer of Sindh. He describes that the Civil Hospital is situated in the Ranchore Lines municipal quarter, facing west from Mission Road. It has a large upper-storey building with two wings. There are six lower wards and one upper-storey ward to house 75 beds.

In 1880, the Imperial Government of India establishes 1,200 public hospitals and dispensaries. Civil Hospital Karachi is one of them. The hospital is directly under the control of the Civil Surgeon of Karachi. The Matron has a significant role in the management. The hospital’s clinical activity and expenditures show that it dealt with the cholera epidemics in 1865, 1867 and 1869 and the smallpox epidemics in 1866, 1868 and 1870. 

A report by the Navy Surgeon-General in 1883 describes two wings of the hospital with a capacity of 70 beds. About 100 major operations were carried out there each year. The average cost per day for each patient was three annas, and the average expense of treating each case admitted was 2 ¼ rupees.

So, did the ‘memsaab’ share the same facility with locals? The official correspondence letters indicate that there was racial segregation; the ward on the first floor was reserved for the Europeans.

During the current Covid-19 pandemic, hospitals and wards have been allocated by the Sindh Government. Similarly, R. Giles, the Collector of Karachi, mentions in his report of 1887 that plague patients were taken to Civil Hospital: “A Plague hospital was therefore necessary and the adjacent NJV Government High School was made available for ordinary patients, the civil hospital being reserved for Plague cases.”  

The Civil Surgeon was Lt Col James McCloghry. Surgeon-Lieutenants Niblock and Cornwall were deputed and reported for duty on February 12, 1887. Nurses were supplied by the Karachi Convent. Sister Heriberta, with the approval of the Reverend, responded without hesitation. Also commended was Miss Horne who returned to the hospital after recovering from the Plague, assisted by the two Misses Carey of the Zenana Mission. The sisters occupied the European wards and lived there for several months. By 1898, the hospital already had a capacity of 250 beds.

Expansion and Funds

The Plague provided an opportunity for Civil Hospital Karachi to expand. Funds were regularly raised from external sources such as the Karachi Port Trust, Persian Gulf Telegraphs and North Western Railways. In 1900, extension was envisaged and financial assistance was sought from donors for developing a ward for European officials of higher stature. It coincided with Queen Victoria’s jubilee.

On October 27, 1900, the Viceroy of India, Lord Curzon, and Lady Curzon arrived to lay the foundation of the Diamond Jubilee Wing; its construction was funded by various private donors and the Government of Bombay, and Lord Curzon announced a personal donation of 500 rupees.

Today, you can see the result of major rebuilding, which was undertaken in the early 20th century. Most of the present hospital blocks were completed in 1905, costing 572,649 rupees. The hospital, composed of seven blocks, formed one of the most impressive groups of buildings in the city. 

The Diamond Jubilee Block consisted of the Nurses Quarters providing accommodation for 27 nurses. Next to it, at the left of the main entrance was a dispensary, the foundation stone of which was laid by Lady Muir Mackenzie in 1904. This is where outpatients were attended to and new patients registered for admission. 

In front of the Nurses Quarters was the central or surgical block, which contained the Civil Surgeon’s room, the examination room and six wards (four for men, one for women and a small spare ward). The six wards on the upper storey were for Europeans. The operation theatre was attached to this block, on the ground floor. 

The medical block stood to the right of the central block. On the ground floor, it accommodated non-paying wards: two for Muslims, one for women, one for high-caste Hindus and two for low-caste Hindus. All six wards upstairs were for paying Indians. 

To the left of the central block was the Police Block which had two wards on each of the two floors. The Septic Block was located behind these blocks. It accommodated a special operating room and 20 wards. The seventh block comprised a mortuary, a psychiatry facility — four ‘wards for the insane under observation’ — quarters for the house surgeon, kitchens and outhouses.

The range of splendid buildings was built on modern lines and CHK was a thoroughly well-equipped hospital supplied with every necessary convenience.

We have become acutely aware of the need for ventilators during the current Covid-19 pandemic. Early ventilators took the form of ‘iron lungs’. These were first installed in Civil Hospital in 1940, under the auspices of Civil Surgeon Lt Col B.F. Eminson, who was also the President of the British Medical Association, Sindh branch. The ‘iron lungs’ were an innovation for the time, having been introduced in the US in 1928. The global shortage of modern ventilators has generated interest by some organisations to develop new versions of the iron lungs again. 

With time came more progress. The eye unit was added in the 1920s, the Seth Goverdhandas Motilal Mohatta Eye Hospital, named after Rai Bahadur Goverdhandas Motilal Mohatta, who contributed 70,000 rupees for it. The building was towards the front, facing Mission Road.

CONTROVERSIES

The hospital was not free from controversy. In the 1900s, the Civil Surgeon was assisted by a house surgeon, three sub-assistant surgeons and three compounders. A Civil Hospital Aid and Nursing Association Committee exercised a general overview of the hospital. When Lt Col Stephen, Civil Surgeon, took charge of the hospital in April 1919, Civil Hospital was the only place in Karachi with first-class, up-to-date equipment, including X-ray machines. Major operations were undertaken only here. The hospital provided free services, including food and medicine, to the poor but for the rest, the payment tiers were linked to their level of income.

In 1923, Dr Rochiram A. Amesur alleged that the Civil Surgeon had embezzled funds. The media, particularly ‘Sind Observer’, demanded an inquiry into those charges. Dr Paranjpye, the minister of public health, established an inquiry committee, which cleared the Civil Surgeon of any wrongdoing. However, Dr Amesur disagreed with the outcome of the inquiry and published the evidence against the Civil Surgeon. He contented that the Civil Surgeon was well connected and that the enquiry was not held properly. Lt Col L. P. Stephen was held in high esteem in government circles.

The nursing staff was provided by the Nursing Association. The government contributed half of the expenses, whereas the other half was raised through public and semi-public bodies. Since the separation of Sindh from Bombay in 1936, CHK was recognised for training nurses, but still governed by the Bombay Provincial Nurses Council and a separate council for Sindh was proposed.

When riots broke out in the city in March 1935, a mob was confronted by the Matron, Daisy Munro, who dispersed it single-handedly. The following year, three sergeants and 30 constables were called in when a hundred protesters raided the hospital, objecting to the post-mortem of a road accident victim.

In 1941, the Indian Medical Council aimed to introduce a uniform standard of medical education. With the untiring efforts of Dr Holmsted, the existing medical school in Hyderabad was upgraded to a degree college, affiliated to the University of Bombay. However, the inspecting committee found that the staffing was inadequate and the hospital facilities meagre. The university threatened to cancel its temporary recognition in 1944, unless the college were moved to Karachi.

The minister of health, Dr Hermandas Wadhwani, made elaborate plans and transferred the college from Hyderabad to Karachi on December 31, 1945. It was temporarily housed in the NJV High School Building on Mission Road. Meanwhile, Sir Hugh Dow, then Governor of Sindh, laid down the foundation stone of the relocated medical college. Dow Medical College, as it was renamed, started functioning in the new building in November 1946. Civil Hospital Karachi was designated as the affiliated teaching hospital of the Dow Medical College, providing further impetus to its rise in importance. 

During World War II, the responsibility for medical supply in the Karachi-Bombay military sector was assumed by the 181st General (Military) Hospital in Malir, a sub-depot. When the war was over, a host of its equipment was acquired by Civil Hospital Karachi.

By 1947, Civil Hospital Karachi was a well-equipped and a full-fledged teaching hospital, offering the best facilities to the public. That is the medical institution we inherited in 1947.

The writer is a consultant physician based in Essex, UK

Published in Dawn, EOS, July 19th, 2020