NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
REPORT
ON
VACCINATION THROUGHOUT THE BOMBAY
PRESIDENCY AND SIND,
FOR THE YEAR 1864.
No. 555 OF 1865.
From the PRINCIPAL INSPECTOR GENERAL, Medical Department,
To the SECRETARY to GOVERNMENT, General Department.
SIR,—I have the honour to submit to His Excellency the Governor in
Council the Annual Report on Vaccination for 1864. It consists—
1st—of a brief statement of the general working of the department during
the year;
2ndly.—of extracts from the reports by the Superintendents of Vaccination
and by Civil Surgeons; and
3rdly.—of tabulated figured results.
2. Two changes took place among the Superintendents during the year.
Assistant Surgeon Turnbull was nominated to fill the vacancy caused by
the transfer of Dr. Beatty to another appointment; and Assistant Surgeon
Fleming succeeded Assistant Surgeon Adey, who vacated his post by
remaining in Europe beyond the period at which, in accordance with the
Regulations, he could retain it.
3. At the close of the year the Superintendents were as follows :—
Northern Circle—Assistant Surgeon Dick, M.D.
Central
do.
„
„
Turnbull, M.D.
Southern
do.
„
„
Plumptre.
Sind
do.
„
„
Pinkerton, M.D.
Kattiawar do.
„
„
Butler, M.D.
Rewa Kanta do.
„
„
Fleming.
Presidency do. Sub-Assistant Surgeon Anunta Chundroba.
( iv )
4. In the report for 1863, I alluded to three important measures
recently sanctioned by Government for increasing the efficiency of the
department, viz:
1st.—The admission of native vaccinators to the privilege of pension;
2ndly.—The establishment of a separate body of peons to assist in collect-
ing children for vaccination, and for subsequent inspection; and
3rdly.—The grant of an increased allowance for remunerating native
parents for allowing their children to be conveyed from village to village,
for the purpose of ensuring vaccine lymph being transmitted direct from
arm to arm.
5. In concluding that report I expressed an opinion that these measures
could not fail to prove highly beneficial to the cause of vaccination, that they
would be fully appreciated by the Superintendents and their establishments,
and that they would be responded to on their parts by increased exertions,
leading to far greater results than had ever yet been shown.
6. I am happy to state that these anticipations have been fully realized; for
while the total number of vaccinations during 1863 was 267,995, the number
for the past year was 332,894,* being a very marked increase of 64,899.
7. This increase was not confined to any limited number of districts, but,
with the sole exception of the Rewa Kanta, was diffused throughout every
part of the Presidency. It does very great credit to the Superintendents
and their establishments. It demonstrates in the clearest manner how zea-
lously and earnestly each and all must have been working during the year.
8. Where all have done so well, it seems almost invidious to point out
which circle, in particular, has made the greatest advance. Nevertheless it
is desirable to record briefly the relative results ; and an examination of the
different returns shows the following extent of increase in the five larger
circles:—
Central Circle . . . . . . . . . . .
Northern do. . . . . . . . . . . .
Southern do. . . . . . . . . . . .
Sind do. . . . . . . . . . . .
Kattiawar do. . . . . . . . . . . .
22,000
21,000
12,000
7,000
5,500
9. There was also a marked increase under the Civil Surgeons at Ahmedabad,
Surat, Kaira, Nuggur, Belgaum, and Rutnagherry; under the Sub-Assistant
Surgeon at Nassick, and under the municipal vaccinators at Hooblee and
* Not including about 3,000 persons vaccinated at the expense of several Municipal Com-
missions in the Sattara districts.
( v )
Kotree ; but there was a considerable falling off under the Civil Surgeons at
Sattara, Kolapoor, Kurrachee, and Hydrabad.
10. About 8 per cent. of the operations proved either unsuccessful or
doubtful. Thus out of the 332,894 vaccinations, 306,525 were reported as
successful. That the returns received by the Superintendents from their
native vaccinators, on this and other points, are in the main correct, there is
good reason to believe ; and certainly the most strenuous efforts are made by
the Superintendents to test their accuracy by personal inspection and by other
means. Instances of falsification, however, are occasionally met with. It
should, therefore, be understood that the figures are to be regarded,
not in the light of perfect accuracy, but merely as an approximation to it.
Two such instances occurred during the year, viz. one in the Central and one
in the Southern Circle. In each case the vaccinator was dismissed the service.
11. As some 200 vaccinators, however, are employed under the Superin-
tendents, and as only these two were detected in making false returns, it seems
reasonable to conclude that the practice is by no means common. On this
point Dr. Pinkerton states very pointedly that he travelled during the year
in every district in Sind, that he examined the work of 14 vaccinators, and
inspected upwards of 10,000 children, yet failed to detect a single instance of
false registers. He then adds, " if falsification existed I should certainly have
detected it."
12. Dr. Butler makes a very similar remark. He states that he travelled
over the greater part of Kattiawar, and examined the work of 19 vaccinators,
yet " did not find a single false return."
13. With regard to sex—
180,200 were males, and
152,694 were females.
14. The castes were as follows :—
Hindoos . . . . . . . . . . . .
Mussulmans . . . . . . . . . . .
Christians . . . . . . . . . . .
Parsees . . . . . . . . . . .
Other castes . . . . . . . . . . .
250,764
64 007
1,715
922
15,486
15. Of the total number of operations, 223,343 were performed in persons
above one year of age, and 109,551 in those below it.
16. In the last report I made a few remarks on the great importance of
vaccination being attended to during infancy, inasmuch as, when properly
performed thus early in life, it affords a far greater security from small-pox
( vi )
than when resorted to at a later age. The result of the accumulated expe-
rience of Europe all points in this direction ; and as still further confirmatory
of the correctness of this view, I may mention that it was recently stated in a
medical periodical that, at an interview which a deputation of the Epidemio-
logical Society in London had a few months ago with the President of the
Privy Council, it was urged by the members of the deputation that " if every
body was thoroughly well vaccinated in early infancy, small-pox might be
nearly banished from our death registers".
17. I would, therefore, again urge upon the Superintendents of the Central
and Southern Circles,—in which the prejudices of the people against early
vaccination are much stronger than elsewhere,—to increase their endeavours
to overcome these prejudices, and to redouble their efforts to make parents
comprehend its paramount advantages.
18. Why these prejudices should be so much stronger in the Deccan and
Southern Mahratta Country than in Gujerat and Sind, it would be difficult
to explain ; but that such is the fact there is no doubt. The returns from the
Deccan, for instance, show that only 11 per cent. of the vaccinations were
in children under one year of age, while those from the Superintendent in
Gujerat give 48 per cent.
19. The returns from some of the Civil Surgeons in that province show a
still higher per-centage. Thus, Broach gives 61, Kaira 75, and Ahmedabad 76
per cent. So far, the result is encouraging; and Dr. Wyllie, who, as Civil Sur-
geon at Ahmedabad, has for a long period taken great interest in the subject,
mentions that since 1858 every year's experience has shown a large and growing
increase in the proportion of vaccinations under one year of age,—a fact,
he adds, " of some significancy, not only as confirmatory of the advance of
popular appreciation, but as illustrative of the success that has attended the
working of the department."
20. At one or two places in Sind the per-centage was equally high, and
under the Civil Surgeon at Shikarpoor it even rose to 94, for while only 69
operations were performed in persons above one year of age, no less than 1,259
were in children below it. Dr. Ffolliott, the Civil Surgeon, accounts for this
by stating that the whole population of Shikarpoor, under ten years of age, is
protected by vaccination, and that the operations were almost limited to chil-
dren born within the year. The 69 persons above one year of age were chief-
ly Patans, who came of their own accord from the Kaffila Serai to be vacci-
nated. Shikarpoor is probably better protected against small-pox than any
other town throughout the Presidency, and as a proof of the great advan-
tage of this unceasing attention to vaccination during early life it may be men-
tioned that not a single case of small-pox has occurred there for a long period.
( vii )
21. Proofs, however, of the immunity afforded by vaccination, properly
performed, may be met with everywhere. One of the most signal of all is
perhaps to be found in the fact,—mentioned a few months ago in a medical
periodical,—that during the last 28 years not a single nurse or servant in the
small-pox hospital in London ever caught the disease, though of course
exposed to its influence in its most virulent forms.
22. At the commencement of the year small-pox prevailed to a considerable
extent at Kurrachee as well as in two towns in Kattiawar, and, somewhat
later in the season, in Bombay itself and in parts of Canara; but it does not
appear to have prevailed as an epidemic, or in a severe, form elsewhere.
In many places throughout the Presidency, however, it was occasionally met
with in a mild form. Thus during the earlier months of the year it appeared
in some of the Kaira districts, and Dr. Dick says it would no doubt have been
very prevalent, and have caused a large mortality, if most of the villages had not
been carefully gone over by the vaccinators a few months previously. Towards
the close of the year it was also met with at Hooblee, and in some of the Bel-
gaum, Kalludghee, and Rutnagherry districts. Wherever it did make its
appearance, active measures were immediately taken by the Superintendents
to arrest its progress, by vaccinating the unprotected as rapidly as possible.
23. The extent of mortality from small-pox throughout the Presidency
cannot be computed, owing to the want of registration, but in Bombay itself
the number of deaths from this cause in 1863 was 1,113. They were consider-
ably above the average, the disease having been peculiarly fatal. Viewed in the
abstract, this extent of mortality may seem large, but, when contrasted with the
state of matters in some parts of Europe during the same year, I do not think
we shall find much reason for being dissatisfied, or see much cause for appre-
hension, particularly on bearing in mind that whilst in most parts of Europe
vaccination is compulsory by law, in India it is not.
24. In illustration I would point to London, which has always taken the
lead in devising plans for rendering vaccination more effective, and which
boasts of having erected a statue in honour of Jenner, its great discoverer.
Vaccination has been compulsory in England since 1854, yet small-pox not
unfrequently prevails as an epidemic, and in 1863 the deaths from this disease
amounted to 2,012 in London alone.
25. The mischievous practice of inoculation, though gradually disappear-
ing, is still occasionally met with. It not only does immense harm by perpe-
tuating and spreading small-pox, but it also causes great mortality. I have
been told by a former Superintendent of Vaccination that on one occasion he
distinctly and personally traced 35 deaths to this cause.
( viii )
26. The Superintendent in Sind, in his report for last year, mentions that
when he went into the hills lying between Kurrachee and the Khan of Khelat's
territory towards the Hubb River, he saw a number of children who had recently
been inoculated, and on making enquiries he ascertained that at least two inocu-
lators had been at work in that direction. He further states that the practice
resulted in conveying small-pox into Kurrachee, and was the direct cause in
producing the epidemic which prevailed in that town at the close of 1863.
He adds that as soon as the disease took its terrible hold on Kurrachee, the
inoculators went off, but he could not ascertain where they lived.
27. The Superintendent also ascertained that in the Meerpoor Sacra
Kardarate, small-pox was kept up during the hot season by an inoculator
named Shah Meer, a fukkeer. He saw the man's work in several villages, and
states that as soon as the man ceased to inoculate, the disease ceased also.
The circumstance was immediately reported to the Deputy Collector at Jerruck,
who appears to have taken prompt measures with the view of stopping the
practice.
28. Again. The Superintendent of the Central Circle mentions that reports
had reached him of the existence of inoculators in the Tanna districts, and that
in each case he had requested the magistrate to enquire into the matter, and
to take proceedings against them, under the impression that paragraphs 269
and 270 of the Indian Penal Code gave him the requisite power. The magis-
trate, however, replied that he had no power to do so. As differences of opinion
appear to exist on this point, I would venture to suggest whether a reference
might not be made to the law officers of Government,—the statements just
made in paragraphs 25 and 26, relative to the fatal consequences of inoculation,
being borne in mind.
29. The character of the vaccine lymph has been well reported on by
nearly every Civil Surgeon and Superintendent throughout the Presidency.
In each instance in which there appeared to be the slightest tendency to dete-
rioration, fresh matter was obtained and introduced. There was a good deal
of interchange of lymph between different medical officers, and with the best
results. Thus the Superintendent of the Southern Circle obtained an excellent
supply from Dr. Mills at Kolapoor, and as the vesicles produced therefrom
were exceedingly satisfactory, he provided Dr. Bell at Kulludghee, Mr.
Hanson at Vingorla, and several other medical officers. The Superintendent
remarks that it is a great advantage to himself to have lymph thus maintained
at different stations under the immediate superintendence of medical officers,
as it enables his vaccinators to obtain a supply from sources on which reliance
can be placed, in the event of their own failing or deteriorating.
( ix )
30. In some places, however, it appears at times to be impossible to keep
up a supply of matter so as to be always ready for use ; but this need not
excite any feeling of surprise, inasmuch as the same complaint is occasion-
ally made in different parts of Europe.
In illustration of my remark, I
may mention that for a considerable time, last year, lymph could not be main-
tained at Aden, and vaccination was in consequence suspended. Unhappily
too, and for some reason unknown, as recently reported by the Civil Surgeon,
the supply annually sent to that station direct from the National Vaccine
Institution, failed to be received. At the Presidency itself it is sometimes
exceedingly difficult to keep up a sufficient supply, and the difficulty is the
greater in consequence of the strong dislike on the part of native parents to
have the vesicles of their vaccinated children interfered with.
31. In the report for 1862 I mentioned that, for the purpose of guarding
against the inconvenience resulting from this cause, Dr. Peet had entered
into an arrangement with the National Vaccine Establishment, London, and
the Royal Dispensary, Edinburgh, with the view of ensuring the receipt of
periodical supplies. For a time the plan succeeded, but the requirements at
home appear to have become so great that both these sources failed, and
Dr. Husband, the Superintendent of the latter depôt, reported that the demand
in Scotland exceeded his capability of meeting it.
32. Dr. Plumptre, of the Southern Circle, alludes to the subject in his
recent report, and urges the importance of obtaining lymph from Europe.
He points out that thus " there would be a continuous supply of fresh matter
coming into the country, and the fear which has been expressed that the
prophylactic in the course of years in a hot climate wears itself out, and ceases
to possess its special properties, would be removed."
33. Without entering on the disputed question whether unrenewed lymph
would or would not lose its properties in this country in the course of time,
there can be no doubt that it is an object of importance to guard against its
possible degeneration by obtaining occasional supplies from fresh sources.
For this, as well as for other reasons, it seems most desirable that some
arrangement should be made, if possible, to carry out more effectually than
hitherto the proposal originally made by Dr. Peet, and now renewed by
Dr. Plumptre.
34. Dr. Plumptre seems to think that an arrangement might be made for
securing a quarterly supply. Bearing in mind, however, that the result of the
general experience of India proves that lymph, obtained from Europe, more
frequently fails than succeeds, and believing, as I do, that this loss of its
properties is attributable to the injurious effects of heat during its passage
2 vac
( x )
from Egypt, and its subsequent transmission to out stations by post, I am
inclined to think that the most effective plan would be to procure only one
supply annually, and that during the coldest season of the year. It might be
sent from England in November, so as to arrive here in December. By this
arrangement we should secure the opportunity of distributing the lymph,
wherever required, during the height of the cold season, and consequently of
guarding as much as possible against the injurious effects of heat in transit.
35. For the purpose of carrying out this plan effectually I would invoke the
aid of Government. I would venture to suggest that the Secretary of State for
India be moved to communicate with the National Vaccine Establishment in
London, with the view of obtaining, and of forwarding, an annual supply
during the month specified. I would also suggest that the Secretary of State
be further moved to request the Directors of the Peninsular and Oriental
Company to allow the lymph to be kept in the ice-house of their steamers
during the passage from Suez, as was proposed by Government in paragraph
15 of the Resolution passed on the report for 1862. The lymph ought to be
forwarded solely in vaccination tubes, a very small number being sent to Aden,
and a larger supply to Bombay.
36. In the last report it was mentioned that the plan of vaccination by
municipalities, suggested by me in 1863, and approved of by Government, had
been commenced by Dr. Plumptre in the Sattara zilla, with the hearty co-oper-
ation of Mr. Chapman, at that time the Collector. Several municipal towns
were grouped together into a " division," to which was appointed a vaccina-
tor on a salary of 15 rupees a month, and six such divisions were formed. I
attached much importance to the commencement of this plan, as it promised
to identify local municipal bodies with efforts to render the protective system
of vaccination more extended, efficient, and complete.
37. Dr. Plumptre is not altogether satisfied with the result, which he states
has disappointed him. The Deputy Inspector General of his Division, how-
ever, does not participate in this feeling of disappointment, and sees no sufficient
reason for being dissatisfied, merely because the expectations entertained have
not been realized to their full extent. In the view thus expressed by Dr.
Glasse I fully concur. The scheme, indeed, is so completely in its infancy that
it would be premature to hazard an opinion as to its ultimate success. The
result at present is, at all events, so far encouraging that nearly 3,000 people
have been vaccinated by these six men.
38. In commencing the system, Dr. Plumptre stated that, beyond requiring
a monthly return from each of the vaccinators, and examining the quality of
the lymph, he should in no way interfere with its working, which ought to
( xi )
be left in the hands of the municipality which defrayed the expense. The
returns, however, appeared to the Superintendent to be so very small, that he
proposed to the Collector that a minimum amount of work to be done by
each vaccinator should be fixed, and that if he failed to do this, he should
receive a salary of only 10 rupees instead of 15.
39. The Collector, however, did not approve of this suggestion, and pro-
posed instead that the Superintendent should take upon himself the entire
control of the vaccinators in the way of punishing by fine. The Superin-
tendent objected to this, and, I think, on well-based grounds. His main
argument is thus stated:— " If the Municipal Commissions are to be
regarded as holding a position analogous to Parochial Boards in England,—
and in that light I view them,—to begin a work by taking all independence
of action and control from their hands, is the very way to promote apathy
and indifference in the discharge of their duties."
40. The position thus taken is not only sound in itself, but is in strict
accordance with the view expressed in paragraph 9 of the Resolution passed
by Government on the report for 1862. It is there urged that municipalities
should employ a vaccinator, "in whose labours, and in checking whose returns,
the Municipal Commissioners should be induced to interest themselves."
41. Great credit is due to Dr. Plumptre for the active interest he has
taken in the subject of municipal vaccination. In addition to what he has
effected in the Sattara Districts, he addressed communications to the Collectors
of all the zillas in his circle, respecting the capability and probability of the
municipalities, in their respective districts, employing a vaccinator at their
own expense.
42. It appears from the replies that there is no Municipal Commission
in the Rutnagherry Collectorate, and that no precise date could be definitely
fixed by the Collector of Canara at which any municipality in that zilla
would be in a. position to maintain a vaccinator, although hopes were held out
that three or four would do so before very long. It further appears that the
municipality of Gokak is the only one in the Belgaum Collectorate which
could afford to make even a temporary arrangement, but that three municipal-
ities in the Dharwar Collectorate, two conjointly, and the third singly,
would maintain permanent vaccinators.
43.
In other parts of the Presidency municipal vaccination has not made
much progress. It is, however, so sound in principle that it is to be hoped
that efforts will be made to introduce it wherever it can be done, and I trust
the other Superintendents, in communication with the civil authorities, will
exert themselves to do so. In the meantime I am happy to say that, owing