9
against it. In the city of Nagpore the better classes very generally adopt,—some
sects as the Lohars and Teylees avoid it; but the mass of the people bring` their
children readily to the Dispensaries, and this year a number of children, particu-
larly boys of 7 and 8 years of age, have been brought for vaccination.
36. It is, however, rather singular that the returns of the vaccine esta-
blishment for the last three years should show a large excess of females over
males, while the proportion of the two sexes in the population is just the
reverse in the infant population, the males largely exceeding the females. In
a European population this fact might be taken to indicate that the parents
were more anxious to protect the girls from disfigurement than the boys, but
here, I fear, it must be taken to indicate a lingering dislike to the operation
among a portion of the population, that in answer to the demands of the
vaccine department for children, the girls are offered first and the boys
kept back.
37. In order to reduce expenditure, the separate appointment of Superin-
tendent General of Vaccination has been abolished, and the supervision of
vaccine operations made over to the Sanitary Commissioner, but as the Central
Provinces contain a population of 9 millions scattered over an area of 120,000
square miles, the Sanitary Commissioner cannot effect more than a general
superintendence of vaccine operations. It will be his duty to see that vaccine
operations are fairly started at the commencement of each season, and to dis-
tribute lymph to the medical Officers of the several districts, to train and
appoint Native Superintendents of Vaccination, and to inspect as far as possible
the work done in different parts of the Province; but the work of extending
vaccine operations must, I think, be carried on by district establishments, under
the supervision of District Medical Officers. This may appear a retrograde
step, but the withdrawal of the one European Superintendent must be taken
as an indication that the Government is not disposed to incur the expenditure
necessary for the further extension in these Proviuces of vaccination under
immediate supervision by European Medical Officers, and it becomes a necessity
to fall back upon district establishments.
38. Sumbulpore affords an instance of what may be done under the
supervision of District Medical Officer, the circumstances there are no doubt
peculiar, but I believe that under proper organization, much good work may be
done in all districts by local establishments. The information that the Census
gave us regarding the population, and now the registration of births and deaths,
affords better means than formerly existed of checking returns, of ascertaining
the amount of work done, and of the effect of vaccination on the prevalence
of small-pox. In these Provinces each district is now divided for purposes of
registration into circles, and each circle is sub-divided into smaller circles con-
taining from 20 to 100 villages ; lists of these villages, with the population of
each, are kept at each station-house; and besides the Monthly Returns of births
and deaths when small-pox is prevalent, Weekly Returns of the number of
cases occurring in each village are sent in. We have then the means of
estimating the number of children in each circle, and as our registration of
births improves, we shall be able to tell how many subjects for vaccination each
village should furnish annually, and by the small-pox returns we have the
surest test of the quality of the work done. With these checks it appears to
me that an efficient system of District vaccination might be organized.
39. A district might be divided for vaccination into circles, coinciding
with Registration circles, each circle containing from 100 to 150 villages and a
population of from 40,000 to 50,000. To each of these circles one vaccinator
would be permanently appointed; he would be held responsible for the state of
vaccination within the circle and would not be moved except on urgent neces-
sity. In Districts where means are available for bringing several such circles