3
13. I am not inclined to trust implicitly to the District returns of Vaccination
unless well assured that the Medical Officers make many and careful test
examinations of cases and registers. The value of the several returns as well
as the character of the work done, vary I consider in proportion to the interest
taken in the operation by the Civil Medical Officers, and in former reports I have
expressed my opinion that the Civil Surgeon's duties should not be confined to
the Sadar station and outlying dispensaries, but that he should be considered
the health officer of his district, making himself familiar with its physical and
hygienic features, and endeavouring to study the peculiarities, and to counteract
the ravages of epidemics on other spots than the Civil station. In a large pro-
portion of the other districts in these Provinces the services of the Civil
Surgeons can at times be spared from the Sadar stations quite as well as those of
the Medical Officers from Betul and Chhindwara.
14. There are few epidemics that can be more directly controlled than one
of small-pox. Instances do occur in which small-pox follows good vaccination, in
the same way that the disease occassionaly visits the same person a second time,
but these cases are quite exceptional and rarely occur save in the course of severe
epidemics and amongst a community to a great extent unprotected.
A child well vaccinated may be considered as protected from small-pox
up to the age of puberty, and successful re-vaccination after that age usually confers
immunity for the remainder of a life.
As small-pox is undoubtedly propagated by contagion or infection, every
unprotected person is a source of danger to the community of which he is an
unit, and a corollary to this is that with a fixed number of individuals, the more
they are protected the less is the danger of the disease attacking the others.
15. Compulsory vaccination has been again and again strongly recom-
mended by different officers, but is considered unsuitable for India in its present
condition.
In these Provinces another plan has been adopted and where properly
carried out, has been very successful.
Over and over again it has been shown that there is little or no real
objection to the operation on the score of religion, that it only requires some
tact on the part of the operator, the influence of some leading man or even the
gift of one or two annas to the parent of a child to overcome the strongest
opposition. This would not be the case if religious prejudices were involved.
16. The principle upon which the plan alluded to is founded is, that when
gratuitous vaccination has been offered and brought to the very doors of an in-
dividual or a community is still available, but has been and is refused, then this
individual or community, is to be prevented as much as possible from becoming a
source of danger to others. With this view such an individual if attacked by
small-pox is to be removed from the interior of a town or village, placed with his
attendants in a chapar outside the abadi (the best position for his recovery) and
prevented holding intercourse with the inhabitants of the neighbourhood generally
until quite well. In the case of a bazar, town or village in which several cases
have appeared, the periodical bazar or market is temporarily closed to guard
as much as possible against the disease being carried by visitors to neighbouring
villages. At the same time a Vaccinator is sent to the spot prepared to
vaccinate all comers.
17. One of the results is that instead of the Vaccinator having to go
from house to house getting single patients with extreme difficulty, individuals
come forward or bring their children in crowds to escape the inconvenience of
removal from their houses, and the village officials or headmen use their
enormous influence to get all protected in order that the bazar may be re opened
with the least delay or the small-pox encampment rendered no longer necessary.