NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
4
15. The number of births registered in the Province in 1873 yielded a
birth rate of a little over 30 per 1,000 of the population ; this is undoubtedly
much below the truth, and we must have some other standard whereby we may
estimate the relative value of the work of vaccination. According to the Census
of 1872 the number of children living under 1 year of age amounted to 51 per
1,000 of the total population. As about 15 per cent of the children die before
they reach the age of 1 year, if we took the Census for our guide in estimat-
ing the annual birth rate, we should have to put it at about 60 per 1,000 of the
population, or nearly double the average birth rate of European countries. One
hesitates to accept this enormous birth rate as correct, more especially as it would
show our efforts to make vaccination keep pace with the births to be more
inadequate even than we imagined them to be, but I have shown elsewhere that
our vital statistics to a considerable extent support the figures of the Census,
and even the statistics of vaccination in Sambalpur and the hill districts ap-
parently indicate that the birth rate is very high. For the present, however, and
until we can get more accurate statistics, it will be better to use the birth rate of
England, 36 per 1,000, as a standard for comparison.
16. Taking 36 per 1,000 as the birth rate, the proportion of children under
1 year old vaccinated per cent of estimated births in the districts given in
Table I, compares very favourably with the rates obtained in other Provinces, as
will be shown presently.
17. As, however, a large proportion of the children vaccinated in this
country are above 1 year old, the number of infants vaccinated is not a correct
measure of the efficiency of vaccination, and we must take the proportion of suc-
cessful operations per 1,000 of the population for the purpose of estimating the
extent to which protection has been conferred by the annual work. Assuming the
birth rate to be 36 per 1,000, and reducing this by a sixth to meet the mortality
among young children, 30 operations per 1,000 of the population would be the
rate which it would be necessary to keep up annually in order to exclude small-
pox from a district.
18. The following table shows the rates obtained in 1873-74 in the three
Satpura districts occupied by the Provincial Establishment of these Provinces,
compared with the rates obtained in 1872-73 in the best vaccinated districts of
Bombay and of the North West Provinces :—
TABLE II.
Province.
Central Provinces ...
North-West Provinces. ...
Bombay
District
Satpura Districts ...
Kumaon
...
Rohilkhund Circle ...
Kathiawar Circle ...
Sindh ...
Population.
921,881
726,334
5,791,603
1,782,062
2,179,671
Successful vaccina-
tion per 1,000 of
population.
41.4
51.8
11.1
38.9
32.1
Infants vaccinated
per cent of esti-
mated births.*
57.7
45.5
10.0
41.2
45.2
* Births estimated at 36 per 1,000 of population.
6
TABLE III.—(Contd.)
No
8
9
10
11
12
13
14
15
10
Districts.
Chanda ...
Hoshangabad.
Sagar ...
Balaghat ...
Mandla ...
Bilaspur ...
Narsinghpur.
Wardha ...
Damoh ...
Total.
Rs
363
350
260
383
128
469
234
333
198
A
0
0
0
0
0
0
4
0
0
P.
0
0
0
0
0
0
0
0
0
Cost of each successful case.
R.
0
0
0
0
0
0
0
0
0
A.
1
1
1
3
1
2
2
3
5
P.
6½
9 1/3
2
6½
7 ¼
7
7 ¾
9 ¾
10
Number of vaccinators.
4
4
2
4
1
4
4
3
2
Number of persons vaccina¬
ted by each vaccinator.
1,518
974
1,741
1,006
901
822
53
575
404
Number of successful cases
3,794
3,151
3,543
1,727
1,236
2,887
1,418
1,392
543
Successful per cent of opera-
tions.
74.87
87.89
75.67
87.39
76.91
88.95
71.97
83.55
71.26
Infants vaccinated per cent
of estimated births.
6.74
20.38
10.36
1.75
10.00
8.50
6.85
4.04
5.52
Successful cases per 1,000
or population.
9.34
7.15
6.71
6.15
5.80
5.78
4.17
3.92
2. 01
23. Sambalpur, as in former years, shows results which at first sight seem
scarcely credible, but several officers have vouched for the general correctness of
the Statements, and as now for a period of seven years small-pox has obtained
no footing in the district, I believe the results may fairly be taken as a measure
of the slight trouble and cost to the State with which vaccination may be carried
on when the prejudices of the people against it have been overcome and they
have learnt to seek the protection it affords. But here again we meet with
evidence of the high rate of vaccination which it is necessary to keep up in order
to protect the people from small-pox. A strong movement among the people
of Sambalpur induced the Government in 1867 to sanction a special Vaccine
Establishment for the district; in the two following years the average number of
successful vaccinations amounted to 95 per 1,000 of the population, and this work
may be supposed to have cleared off all accumulation of unvaccinated persons.
The special establishment was then withdrawn, and the district left to carry on
the work without aid from Government; nevertheless the average number of
successful operations during the last 4 years has exceeded 40 per 1,000 of the
population.
Operations were performed during the season in 237 villages, of which 33 lay
in the Chanderpur Zamindari. Mr. Harrison personally inspected the work in
224 villages.
24. Jabalpur. - The number of operations exceeded by more than 50 per
cent the operations of the previous year. A great proportion of the operations
were performed in the Town and Station of Jabalpur. I inspected a large
number of these cases in December, and found the work very good.
Besides the immediate neighbourhood of the Town and Station, where the
work was done by the Hospital Assistant and passed Medical pupils, Dr. Rice
formed six other central stations in the district, all readily accessible by the
main roads and railroads, and to each of these a vaccinator was appointed, and
their work was inspected by Dr. Rice himself or the Hospital Assistant in
charge of the different dispensaries. Dr. Rice reports that year by year the
opposition to the operation is growing weaker.
12
TABLE IV.
Province.
Bombay ..
Punjab ..
†Central Provinces ...
Berar ..
North-West Provinces ..
Madras
..
Oudh ...
Expended on vacci-
nation.
Rs.
2,10,795
58,873
19,922
14,881
94,166
87,679
11,076
Number of success-
ful vaccinations.
5,04,762
3,29,590
1,12,702
33,734
3,32,478
2,49,698
14,576
Success per cent of
total operations.
94.8
93.00
89.9
82.6
88.1
90.4
79.7
Infants
vaccinated
per cent of esti-
mated births.*
26.0
15.6
17.3
9.5
8.6
3.0
1.2
Successful cases per
1,000 of popula-
tion.
23.8
17.9
15.0
15.4
10.7
8.0
1.3
Average cost of each
successful case.
6.8
2.10
1.12
7.0
4.6
5.10
8.3
Successful cases by
each vaccinator.
1,330
1,478
1,162
685
918
653
265
45. These Provinces occupy a favourable position in the Table IV. as
regards the amount of work done, and in the Sanitary report for 1873, where
I have entered fully into the question regarding the amount of protection
against small-pox conferred on the people by the work of vaccination, I have
shown that in this respect also the Central Provinces compare favourably with
other Provinces, especially those districts in which the Provincial Establishment
has worked, and the district of Sambalpur.
46. When, however, we come to compare the work accomplished in any
of the Provinces with what is required to ensure the safety of the people against
the ravages of epidemic small-pox, we find that it is altogether insufficient, even
if we estimate the requirements according to the English birth rate, but far
more so if we accept the evidence I have aduced to the high birth rate of this
country.
47. To extend vaccination in these Provinces to the extent of protecting
any large portion of the population, it will be necessary to pursue a far more
definite plan of operations, for hitherto with the exception of the districts in which
the small Provincial Establishment has worked, operations have been carried on
in a very unsystematic manner.
48. I do not, however, for the present advocate an extension of the special
department. In the other Provinces large special departments have been in
operation for many years, but judging by the statistics of small-pox of the last
5 years, in no Province has the work of vaccination produced any marked effect
in diminishing the periodical mortality from small pox. Within limited areas,
as in Kumaon in the North West Provinces, and Sambalpur in these Provinces,
the people have been efficiently protected; but in no Province taken as a whole
has an approach been made to the amount of vaccination which is apparently
necessary for the protection of the people against small-pox ; in fact, to effect any
thing like suppression of small-pox it would I believe be necessary to double
* Estimated at 36 per 1,000 of population.
† A third of the salary of the Sanitary Commissioner has been added.
13
even the largest Provincial Establishment now in operation, and the cost of a
department organized on a plan sufficiently comprehensive to include the whole
of these Provinces would be more than the finances could bear.
For instance, the Bombay Establishment, which includes the Native States
under the Presidency within the sphere of its operations, and is spread over an
area of 205,000 square miles, containing a population of twenty-one millions,
consists of a Superintendent General, 10 Medical Officers as Superintendents, 27
Native Superintendents, 373 Vaccinators, and some 400 Peons ; the whole
costing upwards of two lakhs of rupees. To place this Province, which com-
prises 114,000 square miles, and contains a population of nine millions, on an equal
footing with Bombay, we should require an establishment consisting of at least 5
Medical Officers as Superintendents, 19 Native Superintendents (or one for each
district), 200 Vaccinators, and an equal number of Peons. Nor with this establish-
ment (supposing the Bombay establishment to be now producing its maximum
of results) could we count upon bringing up the vaccination of the Provinces to
much more than half the rate that is required for the protection of the people.
For these Provinces, where the populous circles are separated by wide tracts
of waste, a large Vaccination Establishment, with a number of Medical Officers em-
ployed specially as Superintendents, is not suitable even if funds were available.
Much of the time of the Superintendents would be lost in travelling from dis-
trict to district.
49. The great obstacle to the extension of vaccination everywhere is the
difficulty of providing for supervision by trustworthy Officers, and as this difficulty
is increased in these Provinces, where the population is more sparse than elsewhere,
it is all the more necessary to utilize existing agencies as far as practicable, and
the work will I believe be best carried on by an Establishment in each district
under the control and direction of the Civil Medical officers. The experience of
this system which has been gained in the districts of Chhindwara, Seoni and
Betul, has so far answered well, and there is no reason why the system should not
be extended to at least 16 of the 19 districts into which the Province is divided.
It may not be possible to bring whole districts under operation at once, in fact
we have neither the funds nor (and this perhaps is the greater difficulty) the
men, but in every district a portion might be taken up in which the vaccinators
might be trained to the work, and the people enlightened as to its benefits ; and
when this portion has been thoroughly protected, and as means become available,
the circle might be extended. The chief point to be insisted on is, that whatever
portion of a district may be selected as the field for operation, the work shall be
continued year after year in that field, so that when an epidemic spreads over the
country the immunity of the vaccinated circle may be evident.
I have the honor to be,
Sir,
Your most obedient Servant,
S. C. TOWNSEND,
Sanitary Commissioner,
Central Provinces.
P y-29 -239-290
Appendix I.
From Mr. A. G. Price, Civil Medical Officer, Chhindwara, to the Sanitary Com-
missioner, Central Provinces, Nagpur,—dated Chhindwara, 19 th May 1874
I have the honor to forward the Annual Returns and Report on Vac-
cination in this district during the year 1873-74.
After the close of last season's operations, children were brought weekly
to the Dispensary and vaccinated under my immediate supervision " arm to
arm," a supply of good lymph being thus kept up throughout the hot and rainy
seasons up to the beginning of November, when operations were extended to the
several Registration Circles. The results for these months are as follows:—
Months.
May
1873
June
„
July
„
August
„
September „
October
„
Total ..
No. of Operations.
26
25
32
15
22
179
299
Successful
25
25
30
10
20
178
288
Unsuccessful.
1
...
...
...
...
...
1
Doubtful.
...
...
2
5
2
1
10
On the 8th January I received two tubes of English lymph from you, and
vaccinated two children; of these one was successful.
Towards the end of October operations were extended in the villages sur-
rounding Chhindwara in the direction of the several Registration Circles above the
ghats, and by the 1st week of November all these circles were supplied with
fresh lymph obtained from "arm to arm" vaccination.
The Vaccinators whose circles are below the ghats, filled tubes and points
themselves at Chhindwara, and proceeded without delay to their respective posts,
and were enabled to obtain good results without any difficulty.
There was no change in the disposition of the Vaccinators from former
years, that is, they all worked in the circles to which they were originally posted
on joining their appointments in 1870, new men taking up the posts vacated by
those promoted and transferred to other districts. By this means the Vaccinators
(the older ones) have become well acquainted with nearly every man in their
circles, and in a great majority of cases have been able to exert a favourable in-
fluence in inducing people to bring up their children for vaccination, as the results
of the season's operations show, compared with that of the two previous years.
20
The efficacy of vaccinating oxen to prevent cow-pox, and its proved efficacy
in England, has been constantly told to the people, who seemed ready enough
to accept of the prophylactic if any one could be got to vaccinate for them. In
two villages I inoculated two calves on their udders from human lymph ; in one
the operation proved a failure, in the other some febrile action was reported as
well as some special local effects, but as I did not see the animal afterwards, I
doubt if any specific or reliable result was obtained. I purpose next season to
make a few more extended trials at Chhindwara where the results can be daily
watched and noted, both with variolous matter (if procurable) and with vaccine
lymph.
I was again enabled to send three Vaccinators to the Jaghirs of Harrai,
Partabgarh (Pagara), and Sonpur, owing to the work in some of the Circles
having been completed before the end of the season ; but as they went later than
last year, and no new ground having been broken, there is a decrease in the
number of operations over last year. I would now recommend that three men
be specially posted to the Jaghirs in future, who could then carry on their
operations from the beginning of the season, and thus do a large amount of good
work. Seven men are now quite sufficient for the district, four above and three
below the ghats.
The total number vaccinated during the year, compared with last year, has
been as follows.—
Years.
1872-73 ...
1873-74 ...
District.
Primary.
9,312
10,399
Secondary.
...
557
Jaghirs.
Primary
2,483
1,284
Secondary.
...
...
Total.
11,795
12,240
Showing an increase of 1,640 operations (Primary and Secondary) in the
district ; while there is a decrease of 1,199 in the Jaghirs, occasioned principally,
as already stated, from the late date on which work commenced there. Taken
together, there is an increase over last year of 445 cases.
Of the total number vaccinated during the year, the results are as follows:—
Results
Successful ... ...
Unsuccessful and doubtful ...
Unknown ... ...
Total ...
Primary.
Number of
operations.
11,143
376
164
11,683
Per cent.
95.37
3.22
1.41
100.00
Secondary.
Number of
operations.
258
260
39
557
Per cent.
46.31
46.68
7.01
100.00
21
There is an increase of over 2 per cent in the successful cases, as compared
with last year, owing I believe to greater diligence on the part of the Vac-
cinators in searching out those who did not come up to show the results of the
operation, as well as to vaccinating again cases of failure until success was
obtained. In former years such cases were noted as " unsuccessful" and if re-
operated upon, were placed under the head of " secondary" vaccination.
The secondary vaccinations performed during the year are all cases of
former successful operations in children from 4 to 14 years, who had one or more
permanent marks. And the results compare very favourably with those given
in the General Annual Report for 1872-73, showing as they do a great number
of well protected children from primary vaccination. Most of these cases were
selected by me in the Chhindwara, Jhilmillee, and Umreth Circles, during my
tour through those Circles, and the results were carefully noted.
The following table shows the ages of those vaccinated during the year in
the district:—
Ages at the time of vaccination.
12 months and under ...
1 to 3 years
3 to 6
do. ...
6 to 8
do. ...
8 to 10 do. ...
10 to 12 do. ...
12 to 14 do. ...
14 to 16 do. ...
16 to 18 do. ...
18 to 20 do. ...
Over 20 years ...
Total ...
Primary
vaccination.
7,120
2,177
890
79
60
56
4
10
1
...
2
10,399
The number of registered births in the district during the year as obtain-
ed from the Police Office is 9,031, and the number of deaths under one year, in-
clusive of those born dead, are reported as amounting to 1,570, leaving an approxi-
mate available balance for vaccination of 7,461, of which number 7,120 have been
vaccinated or 95.43 per cent of the registered births. This is exclusive of the
Jaghirs, as they are not under registration.
X. x. 29 243 290
22
As compared with the number of children under one year given in the
Census Report for 1872, viz. 16,781, the number of registered births for the
past year, viz. 9,031, seems small. It may be that in the Census Returns the
Jaghirs are included, in which case the great difference in the numbers will be
somewhat explained. But apart from this, I have frequently had brought up for
vaccination in Chhindwara, children whose births are not noted in the Register
of births kept up at the Dispensary; and if at Chhindwara births are not fully
registered, it is equally certain that the same thing happens in other large towns
of the district, more especially among the wealthier class of Sahocars and land-
owners. In small villages I have seldom found any discrepancy in the numbers
vaccinated and the numbers proved to have been born during the year.
Assuming that the Census figures are correct, they give 53 births per
1,000 of population. while the district number of births is only 28 per 1,000 ; that
is, dividing the number of births registered (exclusive of Jaghirs) by the total
population of the district inclusive of Jaghirs. If, however, the number of births
in the Jaghirs could be ascertained, there would, I think, be an increase of about
8 per 1,000, making the total birth rate to about 36 per 1,000 of population.
In the Annual Report of the Sanitary Commissioner for 1870, the birth
rate in England is stated to be 35.85 per 1,000, while in Durham it reached as
high as 41.81 per 1,000 living, so that registration in this district may be consi-
dered very fair, although still rather below the average of what might reasonably
be expected.
The total number vaccinated (primary) in reference to Caste Statement
No. I. shows the following results : —
CASTES
Christians (of all denominations) ...
Hindus
..
Buddhists and Jains
191,669
574
Mohammadans ... ... ...
Hill Tribes .. .. ..
Total ...
Population.
105
192,243
9,747
114,000
316,0,95
Number vaccin-
ated (primary)
2
6,417
208
5,056
11,683
Percent-
age.
1.90
3.33
2.07
4.43
11.73
or, in other words, Christians show the least, while the wild Gonds show best of
all. This may be explained by the fact that nearly all the Christian children
have already been vaccinated.
The cost of the season's operations has been as follows :—
Pay of Native Superintendent and 10 Vaccinators
Travelling allowance to Civil Medical Officer
Carriage of Tents
Rs.
Rs.
Rs.
Total ...
847-0-0
463-0-0
143-0-0
1,453-0-0
Or 2 annas ½ pie for each successful cases (primary and secondary.)
23
The conduct of the establishment during the season has, on the whole,
been very good.
Native Superintendent Chhitoo Ram has continued active and diligent.
He was constantly moving about from circle to circle, supervising the work from
village to village. I consider him well deserving of promotion.
Vaccinator Bhowany Pershad, 2nd (Chhindwara Circle), has vaccinated
during the year 2,004 cases. He is a very successful Vaccinator, and has worked
throughout the year very diligently. All his work has been " arm to arm."
Vaccinator Mahomed Abbas (Mokher, Bichhowa, Khamarpani, and
Sonpur Circles) has done very good work indeed ; all his cases are " arm to arm,"
and I am much pleased with his zeal and diligence. He has vaccinated during
the season 1,405 cases.
Vaccinator Noor Alli (Chand Circle). This man was appointed at the
beginning of the season in room of Nadir Khan, promoted to another district.
Generally his work was very good, and principally " arm to arm." In some few
instances of failure, I found that he had chosen imperfect vesicles, and that the
abrasions were not deep enough to ensure a complete inoculation. The Native
Superintendent was directed to stay in his Circle and to teach him how to select
his vesicles, and when to use the lymph. I have no doubt that he will make a
successful Vaccinator. He has vaccinated during the season 864 cases.
Vaccinator Bhowany Pershad, 1st. (Ghaurie Circle). This Vaccinator
vaccinates very well indeed " arm to arm," and his registers and village lists were
always found correct. But he is not as energetic and diligent as he might be, and
has only vaccinated 973 cases in his Circles (Chauraie and Sankh).
Vaccinator Golam Hosain (Singori and Bhutoria Circles). This man's
work in the Singori Circle was good, but it could have been better. In the
Bhutoria Circle it could not have been better. It was all " arm to arm", and his
promptness in proceeding to the village of Bindrai on the outbreak of small-pox,
and vaccinating over 40 children, thus checking the spread of the disease, is worthy
of commendation.
Your letter No. 425, dated
24th November 1873.
Vaccinator Roshun Lall (Pandurna and Rajnah Circles). This man
has done even better work than formerly, and he has vacci-
nated " arm to arm" more frequently. Where this was
not done, unsuccessful and doubtful cases occurred.
I
would recommend that his fine be remitted. He has vaccinated during the season
1,112 cases.
Vaccinator Amir Khan (Tehgaon, Mohgaon and Tekari Circles). This
Vaccinator has not done so well as he might and could have done, I think, in the
way of " arm to arm" vaccination, and the desire to vaccinate large numbers
instead of vaccinating well, seems to be his great aim. He has vaccinated during
the season 1,013 cases. Few of his cases had more than 4 marks or vesicles, most
of them not more than 2, and some few only 1. I noticed this when he was in
the Khamarpani Circle, and the excuse given was that the villages were far apart,
and he was obliged to vaccinate from crusts and points; but another Vaccinator
found no difficulty in vaccinating "arm to arm" in this Circle (Mahomed Abbas),
and has done it well too.