NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
(
v
)
I may at once say, there can be no doubt but that the increase is mainly
due to the reorganization of 1871 having increased the number of vacci-
nators and given to the department a most useful class of men, viz., the
assistant superintendents, who constantly see that the vaccinators do their
duty well.
Excess of operations over
the number of persons prima-
rily vaccinated.
6. There were 7,733 operations more than the number of persons
primarily vaccinated : that is to say, the vaccine
operation was performed that number of times
on persons who had been unsuccessfully operated
on at least once before.
Sex, caste, age and result.
7. The particulars as to sex, caste, and age are not recorded in
revaccination cases nor in secondary operations ;
there is thus the exact number of persons pri-
marily vaccinated shown in the columns for sex, caste, and age under
the heading of primary vaccination; but in the columns for result, both under
primary vaccinations and revaccinations, secondary operations are entered,
thus there are more operations than there are persons : this excess of opera-
tions is shown in a foot-note to the Statements No. I. and V. and also for the
native troops in No. VI.; but I am unable to give a similar foot-note for
British troops, as I get a return which only shows the successful cases ; and
for it I am indebted to the courtesy of Surgeon-Major Codrington, Secretary
to the Surgeon-General, Bombay Command.
Percentage of sex.
8. There were, exclusive of the European army returns, 329,865 males
and 294,831 females primarily vaccinated. The
proportion of the sexes in every hundred persons
is therefore 52.8 and 47.2 respectively. The disparity is greatest in Bombay
city where the males are 55 per cent. and it is lowest in the Western circle
where they are 50.3. There has been a gradual decline in the excess of males
over females during the past six years, with the exception of 1871-72. In
1866 the males exceeded females by 10 in every 100 persons, last year they
exceeded by 5.6. This decrease in the disparity of the sexes is due to the super-
intendents and their assistants impressing on the vaccinators that errors in
respect to the sexes will be punished as severly as any other errors arising from
carelessness.
Castes.
9. As regards castes, exclusive of the European and native armies' re-
turns, and taking the figures in Statements No. I.
and V., there were christians 3,281, hindús
454,915, musalmáns 114,745, pársis 1,216, and
other castes 44,874, or percentages of .53, 73.49, 18.53, .19 and 7.25 respec-
tively. I am unable to say whether these percentages bear any close relation
to the number of each caste in the general population, but there has not been
much difference in these percentages for several years back.
Age.
10. There has been a considerable annual increase in the number of in-
fantile vaccinations during the past six years with
the exception of 1870-71, but the percentage has
rather fallen ; the following figures are for six
years in civil life, viz. :—
( vi )
Years.
1868
1869-70
1870-71
1871-72
1872-73
1873-74
Infantile
vaccinations.
177,276
191,221
157,671
174,522
198,484
235,543
Percentages.
41.1
41.8
36.3
34.5
36.8
38.0
Although there has been a very great increase in the number of infan-
tile vaccinations since 1868, still it is evident that there has been a
greater among children above one year old. This is doubtless due to
the vaccinators endeavouring to leave as few unprotected behind them
as possible. In a population of twenty-four and a half millions, it is
probable that there are 678,462 children annually available for vaccina-
tion ; but it takes the vaccinator, on an average, about two years to go
over his charge, so that this reduces the infantile children to half the above
sum : and again, in many parts of this presidency mothers strongly
object to have children vaccinated under six months old, so that, in point
of fact, it is really all but impossible to vaccinate within a year of birth,
much more than a third of the available children. I think if we can
reach 41 or 42 per cent. it will be doing very well. In Bombay city the
percentage of infantile vaccination is as high as 65.3 and in Eastern Gujaráth
circle it is 44.5, whereas in the Southern circle it is only 25.0 : which
is a very strong indication that more vaccinators are required there.
Percentage of success.
11. The percentage of success is, exclusive of the British army return,
94.8 in primary vaccine operations and 65.7 in
revaccinations. The success in primary vacci-
nations is 0.2 higher than last year, but it is not as high as it ought
to be. If vaccinators would vaccinate always from arm-to-arm and
with good lymph the success ought to be 99 per cent.; but unfortu-
nately they cannot always get a child, to go from one village to another,
with vesicles on the arms, and so they are often obliged to start work
in villages from tube or glass-lymph, and as a matter of course there
are always many of the first series unsuccessful. This matters all the
more, that many parents object to a second operation after failure, though
they willingly submitted their children to the first operation. The per-
centage of success in revaccinations, I consider, is too high. It is difficult
to fix an arbitrary standard of success in revaccinations, and most medical
men even record differently ; thus one will register a success even though
the vaccine vesicle has run its course to a pustule in 5 days; another
considers that all the typical manifestations must be observed. I cannot
believe that 65.7 per cent. of the revaccinations ran a perfect course, though
there may have been more or less success in that number. The percentage of
success varies a good deal in the different establishments as shown below :—
1st.
2nd.
3rd.
4th.
5th.
6th.
2 Government vaccinators obtained
48 Municipal
do.
do.
202 Local fund
do.
do.
125 Native States
do.
do.
In Dispensary returns
In Native Army
Primary
Vaccinations.
92.4
92.9
95.2
95.0
91.5
90.9
Revaccinations
42.8
64.0
73.6
70.1
63.1
48.2
( vii )
The local fund vaccinators again stand highest and the native states
are close on them. The success in dispensaries is low and it is still
lower in the native army. This is- a matter of surprise to me ; but I cannot
explain it, unless it be produced by there being few comparatively to vacci-
nate and so good lymph cannot always be maintained in regiments. The
following figures show the success in Statement No. 1, by circles. It will be
observed that the success is highest in the Sindh circle in primary vaccination
and lowest in the Presidency and Southern circles—Aden and dispensaries
excluded :—
1.
2.
3.
4.
5.
6.
7.
8.
9.
Presidency Circle...............
Central do ...............
Southern do ...............
Western do ...............
Eastern Gujaráth Circle ...... .
Western Gujaráth do ............
Sindh Circle ....................
Barodá do
Kutch do
Aden
Dispensaries ........................
Primary
Vaccination.
87.9
95.8
92.9
93.7
94.8
95.6
97.5
93.5
93.9
80.0
91.5
Average
94.9.
Revaccination.
53.5
63.0
61.0
67.5
65.9
66.4
77.1
86.4
57.1
60.4
63.1
Average
68.2.
The method of calculating the percentage is liable to the objection that one
person may reckon as two unsuccessful cases—for instance in Statement
No. 1. there are 28,678 unsuccessful operations recorded, and of these 7,171
were operations on persons who had been at least once unsuccessful, but I
cannot say how many of these 7,171 were twice unsuccessful, or how many of
them were successful on the second operation. Our method of reckoning
the percentage of success is that, the total of operations (not persons) is
taken, and from it the number of operations whose result is " unknown "is
deducted, and the remainder is then considered the total on which the per-
centage of success is calculated. For all practical purposes this is a good
enough method, but it is not absolutely correct. Exclusive of the British
army but including the native army returns there were 567,153 successful
primary operations, 30,724 unsuccessful, and in 34,552 the result was un-
known—of the unsuccessful only 7,733 were operated on more than once. It
is certainly to be regretted that so few of the unsuccessful are vaccinated
a second time: but there is some reason to believe that many of the un-
successful operations occur in people who have had mild small-pox or been
more or less successfully vaccinated previously. Surgeon Cody makes some
remarks on this subject in his report. He says, " I think a good deal of
this low rate is to be attributed to the failures which occur amongst persons
who ought rather to appear in the revaccination columns than in the pri-
mary, &c."—vide para. 7, page 27.
Quality of lymph.
12. The lymph in use throughout the whole year has been reported on
by all the superintendents of circles as good.
There have been a few exceptions to this general
rule particularly in the Eastern Gujaráth circle, where Dr. Colá says the
lymph deteriorates in the rains, and he appears to think it does so on
( ix )
Whence
received.
England.
Vaccine circle in
which tested.
Presidency
Central
Southern
Western
Eastern Gujarath ...
Western do. ...
Sindh ... ... ...
Total......
Presidency ... ...
Central
Southern
Western
Eastern Gujarath ..
Western do....
Sindh
Baroda
Kutch .........
Total
......
Grand Total
Number of
Tubes tested.
3
4
4
4
3
3
3
24
3
3
3
3
3
3
3
2
2
25
49
Children oper-
ated on.
3
5
12
...
3
3
4
30
4
3
4
3
3
4
3
4
1
29
59
Insertions.
14
24
58
...
13
18
24
151
20
14
24
14
12
24
18
...
10
136
287
Resulting vesi-
cles.
3
4
6
...
...
5
...
18
13
6
8
1
...
5
5
1
...
39
57
Character
of
vesicles.
Excellent.
Successful.
Small.
.........
.........
Successful
.........
Good.
Excellent.
Small
Good.
.........
Small
No remark
Successful
REMARKS.
Failed in 2 children.
In 4 of the 5 children successful.
Most of the vesicles small.
Tubes broken in the post.
Total failure.
In one of the 3 children failed.
Total failure.
Successful in all children.
Successful in all children.
Lymph good.
Total failure.
Lymph good.
Successful only in 1 child.
Successful in one child from
which a good supply of lymph
was obtamed.
From one tube a calf was success
fully
inoculated but total
failure in child with the other
tube.
I am unable to give any reason for this English lymph being less
successful than usual.
Lymph sent to Africa.
14.
Lymph was sent to the late Dr. Livingston by the mail of 7th
October
1872, but what became of it 1 am
unable to say. In February last, lymph was sent
2 vac
(
x
)
to the civil surgeon of Zanzibar. Supplies were repeatedly sent to officers
in the Central Provinces and in short it was given to all applicants.
Animal vaccination.
15. The practice of animal vaccination has been carried on in Bom-
bay nearly the whole year and for a portion
of the year in Poona and Bhooj and it will
shortly be begun at Barsee. Dr. Williams does not say in his report
whether it was continued at Sukkur or not. In Bombay cow-lymph is
much esteemed and has overcome one great obstacle to vaccination and
that was the unwillingness of parents to allow lymph to be taken from
children's visicles.
Population.
16. In 1871 I estimated the population of this Presidency with its
subordinate native states at 21,000,000 : but the
census which was taken in 1871 shows that my
estimate was considerably under the real number. I am indebted to Dr.
Lumsdaine for a " proof copy " of populations and areas which enables me
now to form a correct judgment as to the progress of vaccination in
every district; previously, I never could do more than hazard an opinion.
Statement No. I. shows a population of 24,362,409 to which must be added
about 123,220 for the military stations : this makes a total of 24,485,629,
and if we add the civil population of the military stations of Mhow,
Nímach and Nasirábád, from which we receive vaccination returns, the
population in which we carry on vaccination, must be in round numbers about
24,500,000.
Birth-rate taken at 30 per
mille.
17. In the British territory of this Presidency there are now birth
and death registers kept by village officers, but, it
is perfectly certain that the registrars do not
register anything like all the births. Hitherto
I have usually reckoned the birth-rate at 30 per mille but I feel very
great doubt about this being high enough. There is only one country
in Europe, France, which has a lower birth-rate than 30 per mille. The
most recent information which I can obtain shows that—
In England the birth-rate is 35.1 per mille.
„ France
„ Belgium
„ Prussia
„ Italy
„ Russia
„
„
„
„
„
26.3
32.9
38.4
37.1
49.0
„
„
„
„
„
As far as the above figures can afford any indication of what the birth-
rate may be in India, France should be excluded from consideration, for
there is a very general belief among statists and physiologists that the birth-
rate in France is kept down intentionally. In a conversation which I
had with the distinguished Professor Virchow in Berlin he stated that he
had no doubt of this. Well, in taking an average of the remainder in
the above group of nations the birth-rate is 38.5. Russia stands by far the
highest; and in respect to the practice of early marriages is more like India
than any of the other countries. I think it is very probable that the birth-
rate in Bombay Presidency is really about or over 33.3per mille— but taking
( xi )
There should be 678,462 children an-
nually available for vaccination.
the lower number of 30 per mille there should be in a population of
24,500,000 about 735,000 births per annum and if a thirteenth be deducted
for still-born and those who die and get small-pox before the vaccinator
can reach them, there should be 678,462
available for vaccination annually or only
52,544 more than were primarily vaccina-
ted in the year under report ; so it will
be observed that the annual increase in primary vaccinations cannot go
on at the rate of the last few years, but a steady increase of revaccinations
may be reasonably expected : and doubtless the annual increment to popula-
tion will give a corresponding increase of births and consequently of vaccina-
tions.
Great increase in the number vaccina-
ted annually in the last 20 years.
18. The increase in the number an-
nually vaccinated and revaccinated is very
marked in the last six years as the follow-
ing figures show :—
In 1853-54 the vaccinations numbered
„ 1863
do.
do.
„ 1868
do.
do.
„ 1873-74
do.
do.
206,110
267,995
426,258
652,223
In twenty years the vaccine operations have more than
tripled
and in the year under report, the number of persons primarily vaccinated
was 625,818—I include in this number the 1,122 successful cases in the
British army—this is only 52,544, less than the available number of
678,462, so the primary vaccinations have reached fully 9-10 ths of the
number of children that may be considered annually available for a
series of years.
19. Although we have in the past year primarily vaccinated 25.5
per mille of population and 23.1 success-
fully—which may be considered satisfac-
tory—still a glance at the figures shows
how very unequal is the rate per mille in
the different districts. The successful primary vaccination is as high as 4.21
per cent. of population in the Sindh circle and as low as 0.46 in Kutch,
where vaccination is still very backward; but I am happy to say that Major
Goodfellow, the political agent at Bhuj, is interesting himself in the subject
and he hopes soon to put vaccination on a better footing in H. H. the Ráo's
dominion. It is also to be regretted that it is so low in the Presidency,
Southern and Barodá circles.
The rate per mille of population prima-
rily vaccinated is 25.5.
The percentage of primary successful
vaccination in relation to the number of
population.
20. The following table shows the number of persons successfully
vaccinated primarily in relation to the
number of population in each circle, and
it shows the absolute degree of protection
given to the children in the year 1873-74.
I have excluded revaccinations because they afford no indication of the extent
of protection among children.
( xii )
Circles.
1. Presidency ......
2. Central
3. Southern .........
4. Western .........
5. Eastern Gujarath ...
6. Western Gujarath
7. Sindh
8. Baroda .........
9. Kutch
Aden .........
Native army .........
Total......
Total number of
persons primarily
vaccinated suc-
cessfully.
8,665
108,268
82,048
63,879
76,891
97,813
96,920
24,328
2,269
818
5,245
567,153
Populations.
644,405
4,828,850
4,757,127
3,070,259
3,112,490
3,142,153
2,300,711
2,000,225
486,900
19,289
109,697
24,472,106
Percentage of popula-
tion primarily vac-
cinated successfully
during the year
1873-74.
1.34
2.24
1.72
2.08
2.47
3.11
4.21
1.21
0.46
4.24
4.78
2.31
The British army figures are excluded from the above table as they do not
show the vaccinations and revaccinations separately, and the return shows no-
thing but successful.
Revaccination.
21. The Surgeon General, Indian Medical Department, in his letter No
3216 dated 13th September 1872 called the atten-
tion of all the Deputy Surgeons General to the fol-
lowing remarks which appeared in the " Madras Monthly Journal of Medical
Science " for September 1872, regarding the results of revaccinations by the
Surgeon of the Sappers and Miners in Bangalore:—"In 108 vaccinations
" of sepoys who had marks of previous small-pox, 84 were successful; in 98
" who had good marks of previous vaccination, 77 proved successful; and of
" 67 men who had marks both of small-pox and previous vaccination 44
" were successfully revaccinated. These remarks are contrary to ordinary
" belief, to say the least of it, and we are glad to know that the Inspector
" General (Madras) has ordered a repetition by others of the experiment."
The Deputy Surgeons General communicated with Dr. Turnbull (then
acting Superintendent General of Vaccination) as to the best method of carry-
ing out revaccinations in regiments and jails and he suggested that the fol-
lowing points should be carefully attended to :—
1st. Persons who bear distinct marks of vaccination or small-pox should
alone be considered as revaccinated when operated on.
2nd. In revaccinating, lymph from good primary vesicles only should
be used, and lymph from broken vesicles or vesicles, with an inflamed areola
should never be used.
( xiii )
3rd. The revaccinations should be performed by the surgeon of the re-
giment or by a competent vaccinator.
4th. The result should be recorded by the medical officer of the regi-
ment or jail himself.
How far these instructions have been carried out I am unable to say, but
I can say that the results were not always recorded by the medical officers
themselves but sometimes entrusted to their subordinates. I have received only
the returns of the operations in most cases without any report stating that these
simple rules were observed or not. The reports from Deputy Surgeons Gene-
ral Maitland and Johnstone are so interesting that I have added them to this
report along with two special reports on revaccinations in Rajkot and Kár-
wár jails by Surgeon Major Sexton and Surgeon Goldsmith. In the past year
there were 2,585 revaccinations in the native army of which 1,182 were suc-
cessful, 1,266 unsuccessful and in 137 cases the result was unknown. The
percentage of success was 48.2. In the whole presidency there were 26,693
revaccinations, of which 14,894 were successful, 7,748 unsuccessful and in
4,051 the result was not ascertained. The percentage of success was 65.7.
I would observe here that the army percentage of success is probably the
more correct. I have in para. 11 pointed out how difficult it is to place a
true value on the percentage of success as recorded by different persons in
revaccinations.
Cost.
22. The expenditure in 1873-74 was Rs. 2,16,076-8-4 or an increase
of Rs. 5,281-7-5 over the preceding year which was
caused by 1st the circumstance that for eight months
of the year there were no acting officers drawing
less than the full pay of the superior appointments and 2nd by the number
of assistant superintendents and clerks having been increased since the
1st November. A still further increase of expenditure will occur in future
from the second cause. The following figures show the sums expended
by each establishment:—
Establishments.
Imperial ...................................................
Municipal
Local Fund
Native Chiefs
Total
Total expen
diture
Rs.
1,05,198
15,659
59,158
36,059
2,16,076
a.
11
12
0
15
8
p.
9
7
6
6
4
Deduct decrease
Rs
Net increase
Rs.
Compared with the preced-
ing year.
Increase.
Rs.
5,317
...
...
263
5,581
299
5,281
a.
9
...
...
8
1
10
7
p.
6
...
...
4
10
5
5
Decrease.
Rs.
...
268
30
...
299
a.
...
11
14
...
10
p.
...
9
8
...
5
( xiv )
The decrease in the municipal establishment was caused by the
abolition of the vaccinators already mentioned in para. 4. The cost of
each successful vaccination varies a good deal in the different establish-
ments as shown below :—
Municipal........................
Local Fund .....................
Native States..................
1873-74
As.
5
2
3
p.
2
10
3
1872-73
As.
5
3
3
p.
10
3
5
The two Government vaccinators (civil) are excluded from the above
calculation because their cost cannot be separated from the administration
charges, and the expenditure on account of administration and superin-
tendence is also excluded here. There has been a decrease in the cost
of each successful case of 8 pies in municipal, 9 pies in local funds and
2 pies in native states. Taking the whole expenditure into account the
cost of each successful vaccination was 6 annas and 2 pies or 8 pies less
than in the preceding year.
The cost of each successful vaccination in a circle is considerably
influenced by the pay of the superintendent which, of course, depends
on rank and is beyond my control : I will therefore show below the
cost of each successful vaccination after excluding the pay of the super-
intendent from the total cost in each circle, and after excluding the 4
army vaccinators altogether from consideration :—
Name of
Circle.
1. Presidency
2.Central.....................
3. Southern
4.Western..................
5. Eastern Gujarath...
6. Western
do. ...
7. Sindh
8. Baroda.................
9. Kutch
Aden .......................
Superintendent.
Mr. Ananta Chandroba
Drs. Robb, Turnbull and
Gordon.
Mr. Raby
Mr. Cody
Dr. Cola
Drs. Butler and Blom-
field.
Dr. Williams
Dr. Seward
Mr. Dorabji Hormasji ...
Drs. James and Hay ...
Total......
Success-
fully vacci-
nated and
re-vacci-
nated.
9,897
105,591
80,974
62,446
74,851
97,810
98,908
24,678
2,273
876
558,304
Total cost ex-
cluding pay
of Superin-
tendent.
Rs.
6,476
26,631
24,874
20,650
20,691
23,221
25,338
7,085
2,319
504
157,792
a.
1
0
15
5
6
10
4
1
11
0
9
p.
9
10
2
11
2
4
11
0
10
0
11
Average
cost of
each suc-
cessful vac-
cination.
Rs.
0
0
0
0
0
0
0
0
1
0
0
a.
10
4
4
5
4
3
4
4
0
9
4
p.
5
0
1
3
5
9
1
7
3
2
6
Number
of vacci
nators.
11
65
68
49
46
52
50
23
11
2
377