NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
6
definite arrangement for appointing Local Fund Vaccinators has been come to in any
of the other zillahs, but the matter is under consideration.
Dispensary Vaccination.
15. The number of vaccinations performed by Subordinates in charge of Dis-
pensaries has not been so great as might have been
expected. This is easily accounted for, when we
consider that they only vaccinate those who voluntarily present themselves at the
Dispensary, and that in many instances it is difficult for them to keep up a continuous
supply of lymph. In order to remedy this, I would beg to suggest for the favourable
consideration of the Inspector General, that either the apprentice or medical pupil
attached to the Dispensary be directed to vaccinate through the town one day in every
week. By this means, not only would a fresh supply of lymph be kept up, but the
apprentice or pupil would, be acquiring knowledge of a subject, which, although con-
sidered simple, and almost below notice, is often very imperfectly known by many of
the young subordinates.
Small-pox.
16. Small-pox has prevailed, more or less, in every talooka of this Circle, except
one ; but the disease only assumed an epidemic form
in the talookas of Indee and Shindghee, in the
collectorate of Kulladghee.
Statistics of Small-pox during the year 1869 in the Central Circle of Vaccination.
Collectorate or
Native State.
Ahmednuggur......
Poona
Nassick
Khandeish
Kulladghee
Sholapore
Peint State
Aukulcote
Total 1869......
Total 1868 ......
Total number of
cases of Small-pox
during the year
1869.
2,972
3,790
2,510
4,954
5,161
2,548
8
Of the total
number were
vaccinated
In In-
fancy.
13
50
80
28
144
15
...
Not received.
21,943
47,234
330
390
In after
life.
79
94
183
276
387
74
...
1,093
1,458
Of these died of
small-pox who
were vaccinated.
In In-
fancy.
1
2
2
8
...
1
...
14
16
In after
life.
2
16
13
52
22
8
...
113
101
Of the total number
were unprotected
2,880
3,646
2,247
4,650
4,630
2,459
8
20,520
45,388
Of these died of
Small-pox
313
238
251
563
866
299
...
2,530
4,314
Total deaths from
Small-pox out of
the total number
of cases.
316
256
266
623
888
308
...
2,657
4,431
The totals of 1868 have been entered for comparison, and the contrast is very
favourable ; the more so, as owing to the change of date for submitting this report,
1 have been enabled to include in the above table the returns from every talooka
7
Deaths from Small-pox.
Each Talooka should have a
Vaccinator.
within the Circle, except two ; whereas the total for the year 1868 only shows about
two-thirds of the actual number of cases which occurred. Of the total number of
cases 93.5 per centum were unprotected, and 6.48 had been previously vaccinated.
Of the former there died 12.3 per cent. (a very small death rate), and of the latter
8.9 per centum. Of the 6.48 protected, and afterwards affected with small-pox, 1.5
were vaccinated in infancy and 4.9 in after life ; of the former there died 4.2, and of
the latter 10.2 per centum. Thus it appears that infantile vaccination is nearly two and
a half times a better prophylactic than vaccination in after life. In detail, I do not place
very much reliance upon these returns, more especially with reference to the number
of cases occurring after vaccination. During my tour I on several occasions tested
the correctness of the returns for 1868. As statements of the total number of cases
of small-pox, they are not very far from correct. As to the numbers entered as
previously vaccinated, I discovered some grievous mistakes. As instances, I may
mention the returns from the villages of Ankola and Wakharrie, in the Nassick Zillah ;
the returns from the former showed that 58 cases of small-pox had occurred during
1868, and that all of them had been previously vaccinated. Upon careful inquiry I
found this to be altogether incorrect. Only one child had been previously vaccinated.
The same was the case with the return from Wakharrie. The deaths from small-pox
during 1869 were 2,657, as compared with 4,431
for 1868. Is there no remedy for this terrible loss
of life among the young? I do not advocate compulsory vaccination for the present,
because I am of opinion that such a law would entail serious hardships on a large
mass of the population. Let all other means be fairly tried first, so as to give the
natives an opportunity of appreciating the advantages
of vaccination. The only means of doing this is
by having a Vaccinator for each talooka, so that he
might be continually moving among the people, and, as it were, teaching them.
Area and Population.
17. The following table will show the area and
population of the different Collectorates and Native
States in the Central Circle :—
Collectorate or Native State.
Poona..........................................................
Ahmednuggur
Khandeish
Nassick.....................................................
Sholapore..................................................
Kulladghee................................................
Native States. Peint.................................
Aukulcote
Total
Area in square
miles.
4,272
5,375
9,471
10,077
6,951
11,495
960
420
49,021
Population.
646,114
638,904
861,208
616,399
568,180
707,816
26,167
61,000
4,125,788
11
could get a few children collected for inspection. On the 31st March I reached the
Rahooree Talooka, Zillah Ahmednuggur, having during the last fourteen months
travelled over the greater part of the six zillahs included in the Central Circle. During
1869-70 I have visited 314 villages, examined 14,013 vaccinated children, and travelled
1,506 miles.
Can Syphilis be transmitted by
vaccination ?
19. The possible transmission of syphilis by
vaccination has engaged my attention; but I have
seen nothing worthy of remark.
Assistance from Revenue Officers.
20. The Revenue Officers and their Assistants have given me great assistance.
It is mainly through the interest taken by these
Officers in vaccination that matters go on so smoothly.
Cost.
21. Detailed statements of the expenditure of vaccination in each talooka sepa-
rately, and of the monthly returns, are appended; also
a statement showing the results of vaccination during
1869-70, as compared with the five previous years.
SOUTHERN CIRCLE.
Superintendent.—Assistant
Surgeon J. RABY.
Establishment.—Twenty-two
Vaccinators under Government, twenty-three under
Native Chiefs, twelve under Municipalities, six paid by Local Funds, and eleven
Dispensaries.
Population, 4,158,989. Total cost, Rs. 22,485. Average cost of each successful
vaccination, 5 annas and 10 pies.
Establishment.
Government
...
Native Chiefs ...
Municipalities ...
Dispensaries ...
Local Funds ...
Years.
1868
1869-70
1868
1869-70
1868
1869-70
1868
1869-70
1868
1869-70
Total
Vaccinated
23,962
28,499
20,400
22,572
9,463
9,368
175
1,418
......
3,843
Compared with the
preceding year.
Increase.
......
4,537
......
2,172
......
......
......
1,243
......
3,843
Decrease.
......
......
......
......
......
95
......
......
......
......
Success-
fully Vac-
cinated.
22,744
27,178
19,594
21,715
9,095
8,653
138
1,178
......
3,624
Percentage
of Success
excluding
Unknown.
......
97.1
......
97.3
......
94.8
......
86.7
......
97.3
13
Percentage of Success.
4. The smallest percentage of success is shown by the Dispensaries, and this
rather diminishes at first sight the percentage of
the aggregate.
Age and Sex.
5. The percentages of age and sex are :—
Above 1 year 47,493, or 72.3 per centum.
Under „
Males
Females.....
18,207, or 27.7
35,352, or 53.8
30,347, or 46.2
„
„
„
Cause of Increase.
6. The increase in the vaccinations during the year is partially accounted for
by the introduction of Local Fund Vaccinators for
the last seven months of the year, their operations
being 3,624. The Dispensaries also exhibit a slightly larger return than last year,
but still not as much as, I think, they might show with a little more exertion and
energy on their part.
Dispensaries.
7. Concerning the Dispensaries there is little to be said, as they are not under
my control in any way. But, in fairness to them,
it should be stated that they vaccinate only those
who voluntarily attend at the Dispensary for the purpose. As natives seldom come
forward spontaneously with their children, the comparative smallness of the numbers
vaccinated is sufficiently accounted for. In addition, there is no Peon or other person
attached to the Dispensary for collecting children.
Local Funds' Vaccinators.
8. During the year Local Funds' Vaccinators were entertained through the exer-
tions of Mr. Robertson, the Acting Collector of
Dharwar. I addressed the Collectors of Belgaum,
Sattara, and North Canara, respecting the entertainment of such Vaccinators in parts
of their collectorates, but was informed that extra Vaccinators were considered unne-
cessary. With this opinion, in the case of the Belgaum and Canara Collectorates (the
latter more particularly), I beg to dissent. I have lately visited the Canara Zillah,
and seen many villages where a Vaccinator has not been for many years, because there
is no Vaccinator to send to them. Small-pox is frequent in the district. The talookas
are large; villages, it is true, are mostly small, but widely scattered, in jungly places,
where access to them is difficult. A Vaccinator, to work throughout a talooka where
there are so many hamlets (they cannot be termed villages), loses a great deal of
time in travelling, and his returns not infrequently must be small. There are four
talookas without a single Vaccinator. I am of opinion that a Vaccinator should be
entertained for each talooka, or, at any rate, two Vaccinators for the four talookas ; and
in this collectorate especially, batta ought to be granted to all itinerant Vaccinators.
A common coolie in this zillah receives five and six annas a day, and provisions of all
kinds are very dear.
16
Ranehbednore, and Koade, of the Dharwar Collectorate ; in some of these talookas
vaccination had never been previously performed, and consequently the natives being,
to a certain extent, unfamiliar with the operations, opposed the Vaccinators much.
In fact, in some places, the Vaccinator could get no subjects for operation. The Local
Fund Vaccinators of Kamdgee and Ranehbednore were working with such bad lymph
that I at once suspended the latter Vaccinator for a month, and directed him to pro-
ceed to the Sub-Assistant Surgeon in charge of the Hooblee Dispensary (which was
the nearest) to learn his duties, and when certified to be proficient I would re-employ
him. He could not accompany me for the purpose of being taught, as I was moving
too frequently. I fined him a month's pay for his great carelessness and inattention.
From the Dharwar District I crossed into Canara, and first inspected the work of
General No. 251, whose lymph was very good; also examined the work of the Sircy
Vaccinator, as before stated. From thence I travelled through the talookas of Compta,
Honore, Ancolah, Karwar, and Yellapoor, inspecting the work of the Vaccinators and
Dispensaries ; but, as a rule, I could get. very few collected for inspection.
13. During the year 1869-70 I have inspected 6,172 cases of vaccination ; but
in no case have I witnessed syphilis conveyed by the use of vaccine lymph.
WESTERN CIRCLE.
Superintendent.—Assistant Surgeon H. J. BLANC, M.D.
Establishment.—Fifteen Vaccinators under Government, two under Native States,
and three under Municipalities.
Population, 1,644,869. Total cost, Rs. 12,670-2-4. Average cost of each
successful vaccination, 4 annas and 8 pies.
Establishment.
Government .....
Natives States ...
Municipalities ...
Dispensaries .....
Years.
1868
1869-70
1868
1869-70
1868
1869-70
1868
1869-70
Total
Vaccinated
32,342
35,904
5,381
8,021
410
1,168
1,566
1,678
Compared with the
preceding year.
Increase.
......
3,562
......
2,640
......
758
......
172
Decrease.
......
......
......
......
......
......
......
......
Success-
fully Vac-
cinated.
31,442
34,752
5,083
7,476
391
1,096
1,299
1,368
Percentage
of Success,
excluding
Unknown.
......
96.7
......
93.2
......
92.2
......
84.3
Increase.
The above tabular statement shows a total of 45,093 vaccinations performed
during the year 1869-70, being an increase on the
preceding year of 6,960, not including Dispensaries.
17
However satisfactory this result may appear, it is not one that should per se be considered
of much value ; indeed, we should be guarded against giving too much importance to
a mere increase.
Quality of Vaccination rather
than quantity desirable.
2. I fear that in this country quality in vaccination is too much sacrificed to
quantity.
Every return relates more or less pro-
minently to quantity, and in an annual report the
appearance of the vesicles and cicatrices, the real effi-
ciency of the Vaccinators, the protection afforded by good and typical vesicles, the
selection of proper cases, &c., cannot be brought so prominently to notice as the mere
number of vaccinations performed. To a " decrease " a sense of blame is attached, and
praise bestowed when an increase has occurred. When a decrease takes place, hopes
are expressed that an increase will follow a more energetic supervision on the part of
the Superintendent. In my humble opinion, this inference is not consistent with facts,
and the influence of the Superintendent, as far as quantity is concerned, must, for the
following reasons, be somewhat limited : —
(a) Sickness among the Vaccinators ; changes due to the necessity of remov-
ing from their work and sending Vaccinators to places where small-pox has
broken out; suspension and dismissal of Vaccinators for bad conduct, &c, are all
causes tending to produce a decrease, and beyond the control of the Superin-
tendent.
(b) The stay of the Superintendent in a given locality is so very short
that it cannot lead to any practical results as far as quantity is concerned.
(c) The energy and ability of the Vaccinator, and the disposition of the
people among whom he works, are the principal causes of increase and decrease
in the number of vaccinations performed.
The Annual Return for 1869-70 bears out this opinion. It will be observed that
the increase is partly due to the Native States, which have not during the present year
been visited by the Superintendent; also, that during the four months of most active
superintendence—November to April—the monthly returns show a considerable
decrease on the monsoon months, during which no active superintendence is possible.
But if the influence of the Superintendent on quantity is very limited, if existing
at all, his importance as to the quality of the vaccinations performed is very con-
siderable.
Charging of Tubes by Vaccinators.
3. Only a few of the Vaccinators in my Circle can fill a capillary tube well. I
directed them all to send me every month three
tubes each, so that I might always form an idea of
the lymph they use. Few of these tubes are properly filled : some have a large vacuum
in the centre, and burnt lymph at each end ; others are full of air, the bullæ and
lymph, very prettily alternating ; some contain only a little clotted blood ; and most of
them, as a rule, are worthless.
3 v s