NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
( iii )
Average operations per man.
7. The average number of persons operated on by each vaccinator
exceeds that of the preceding year by 95. This
appears to me to be a good test of the amount of
work done; and, as I said in my last report, I think this, with the number of
successful operations per man, is the best test of the efficient working of the
Department. Regarding the latter I shall have more to say in detail here-
after. Suffice it to say, for the present, that the quality of the work has been as
good as heretofore ; and, taking into consideration the altered system of regis-
tration, the percentage of success met with, has been up to that of former
years. The number of operations per man, for the past three years, is
shown below, and, as will be seen, the past compares not unfavourably with
the previous years, especially so when we consider the large number of young,
and therefore less experienced, vaccinators employed since 1st August 1871—
1870-71
1871-72
1872-73
1,508
1,411
1,506
Expenditure
8. The expenditure for the past exceeds that of the preceding year
by 26,336: the total expenditure amounting to
Rs. 2,10,795 against Rs. 1,84,459. This increase
is due (1) to the establishment having been complete throughout the year,
whereas in 1871-72 it was incomplete; the reorganization having taken effect
from the 1st of August of that year ; (2) to the whole of the postage having
been debited to the Department ; (3) to the entertainment of an Assistant
Superintendent of Vaccination for the Kolhápur State and its dependencies ;
(4) to increase in the number of vaccinators and peons ; (5) to the pay of the
Aden and Sakkhar municipal vaccinators, included in this report, having been
unavoidably omitted from the report of the previous year.
9. The following table shows the expenditure according to the sources
from which it is derived, as well as the increase and decrease under each head.
It shows an increase in all of them, but principally in Local Funds :—
Establishments.
Imperial... ... ...
Local Fund... ... ...
Municipal... ... ...
Native Chiefs'... ... ...
Total ...
Total
Expenditure.
Rs.
99,881
59,189
15,929
35,796
2,10,795
Compared with the
preceding year.
Increase.
Rs.
4,185
17,979
744
3,428
26,336
Decrease.
......
.......
......
......
......
( iv )
10. The total sanctioned expenditure was Rs. 2,32,511. Of this
Rs. 2,10,795 have been expended. The expenditure is, therefore, Rs. 21,716
within the sanctioned amount.
Average cost of each suc-
cessful operation.
11. Taking the Presidency as a whole, but excluding the operations done
at dispensaries, and by Army Medical Officers,
for which no special expenditure is incurred, the
average cost of each successful operation is
annas 6—8 or 7 pies—equal to 7/8ths of a penny—more than that of the preced-
ing year. The average cost, according to establishments, is shown in the
following figures, and these as compared with the previous year:—
Local Fund ................
Municipal ..................
Native States..............
1871-72.
As.
3
4
3
p.
0
8
7
...............
...............
...............
1872-73.
As.
3
5
3
p.
3
10
5
There has thus been a small decrease in cost in the Native States, and
a small increase in Local Funds and Municipalities. Considering that the
operations performed in the year 1871-72, by the municipal establishment,
were nearly double the number performed in the year 1870-71, I am not
surprised at the increased cost under this head ; for I do not think it is possi-
ble always to maintain the high standard, in point of numbers, shown last
year.
Sex.
12. The remarks which follow, regarding sex, caste, and age, refer to
primary vaccinations only : the particulars regarding these in re-vaccinations
not being available. Of the total number of persons vaccinated 301,006 were
males and 267,502 were females, or respectively
52.9 and 47.1 per cent. Compared with the pre-
ceding year this shows an increase of 1 per cent. in females.
Caste.
13. In the matter of caste, except a small decrease in Musalmáns and
a corresponding increase in Hindús, the percent-
age of each caste is almost the same as in the
previous year. The number of Musalmáns per cent. vaccinated in Native
States is only half that vaccinated in British Territory.
Age.
14. In the report of last year I stated that, with a vaccinator, some-
times two, in each táluká, I anticipated, in a
year or two, a gradual increase in the number of
operations on infants, and I am happy to say that the returns of this year
show a not inconsderable increase in this respect. The following shows the
( v )
number of operations on infants, under one year of age, for the past five
years:—
1868
1869-70
1870-71
1871-72
1872-73
177,276
175,596
157,671
174,522
198,484
With the large extension of vaccination, during the past two years, the
proportion of children under, to those above, one year has been somewhat dis-
turbed—affected unfavourably. But this will soon right itself again, and the
proportion per cent. under one year of age will soon increase. The percentage
for the year under report is 36.8, or 2.3 per cent. over that of the preceding
year.
15. During the past year measures were taken to bring this important
matter prominently to the notice of Superintendents, their Assistants, the
vaccinators, and the people. But these were taken too late to effect, very per-
ceptibly, the returns of the year under report. I, however, anticipate a steady
increase in the returns of future years. Hitherto, in some Circles at least,
vaccinators have not sufficiently availed themselves of the birth registers as
a means of assisting them to find the whereabouts of young children. Our
great difficulty has always been, not so much the active opposition of the peo-
ple, as their apathy, and the difficulty of ascertaining the whereabouts of un-
protected children. Birth registers now, however, exist in every village, and
this difficulty ought not to be experienced any longer. I have, therefore, di-
rected that a vaccinator, before leaving a village, should invariably call over the
name of every child entered in the register since his last visit, and, with the
assistance of the village officers, to endeavour to persuade parents to have their
children vaccinated. If this is strictly, judiciously, and zealously carried out,
the result will, I think, be a large increase in the number of infants vaccinated.
Percentage of success
in Primary Vaccination.
16. In former years, until the middle of 1871-72, the percentage of
success was calculated on the result of the final
operation on each individual. No matter how
often the operation was performed, the result
of the last operation only was recorded. Since the middle of 1871-72, how-
ever, agreeably to the orders of the Government of India, the result of every
operation has been registered, and the consequence has been a large addition
to the number of unsuccessful operations. The percentage of success is now
therefore, calculated on the number of operations performed, instead of, as
formerly, on the number of persons operated on. As a consequence of
this alteration in the method of registration, the percentage of success appears
a little lower than formerly ; but the decrease is only apparent, not real. Re-
gistered according to the old method, the percentage would have been 95.8
( vi )
or 1 per cent. more than the average for the past five years. Calculated by
the new method, the percentage of success for the past year is 94.6 or 1 per-
cent. less than last year.
17. I have shown, I think satisfactorily, that the success attained in
the past year has been quite up to that of former years. I may also add
that I think the results recorded are more exact; accounted for by closer and
more frequent inspection, ensuring better lymph and consequently better
work.
Percentage of Population
vaccinated.
81. It may be interesting here to record that 510,582 persons were pri-
marily vaccinated with success, i.e., 2.67 per
cent. of the total population are reported to have
received protection.
19. Having shown the general results of the year's operations, I now
proceed to exhibit the results of the working according to Circles and esta-
blishments. The following shows the total number of persons vaccinated in
each Circle, the increase and decrease as compared with the preceding year,
and the percentage of the population operated on:—
1. Central
Circle
2. Southern
do
3. Western
do
4. Northern
do
5. Sindh
do
6. Káthiáwád do
7. Rewá Kánthá do
8. Presidency
do
9. Barodá
do
10. Kutch
do
11. Aden Municipality....
Total ...
Total
Number of
Persons
vaccinated.
1,18,387
73,533
71,963
93,738
78,314
75,625
19,275
16,415
29,661
2,232
684
5,79,827
Deduct Decrease ...
Total Increase* ...
Compared with the
preceding year.
Increase.
7,410
4,542
5,404
10,292
......
5,933
......
958
6,170
......
238
40,947
1,837
39,110
Decrease.
.......
.......
.......
......
956
......
671
......
......
210
......
1,837
Percentage
of the Popula-
tion operated
on.
2.29
1.60
2.67
2.51
3.71
4.19
2.76
2.25
.......
1.49
3.54
2.67
* Exclusive of the Army.
( vii )
This table shows an increase in the number vaccinated in all Circles
except those of Sindh, Rewá Kánthá and Kutch. In these exceptions the de-
crease is small. Had Dr. Williams been in charge throughout the year I feel
certain that, as far as the Sindh Circle is concerned, the result would have been
otherwise. The supervision during the first half of the year was, I think,
somewhat lax, and to this I attribute the decrease. The Northern Circle
shows the largest increase, but it scarcely makes up for the very large decrease
shown in the preceding year. Next in order comes the Central Circle, which
has steadily progressed for several years, and close upon it follow the Barodá
Káthiáwád, and Western Circles.
In the last column of the above table I have shown the percentage of the
population vaccinated, and, as will be seen, in three of them, it exceeds the
estimated number of births. In this respect the Káthiáwád returns are very
high. No doubt this is due to arrears of work, but I do not see how such figures
can be maintained for more than a few years. If the population is correctly
given, and the proportion of births to population is the same as in Europe,
there must be a decrease in the number vaccinated, two or three years hence,
if not earlier, in the Sindh and Káthiáwád Circles. With regard to the per-
centages of the Central, Western, Northern, Rewá Kánthá, and Presidency
Circles, they appear to be slightly within the estimated number of births. So
also with the Southern Circle. The latter Circle is behind all the others ; why
I am unable to say. But the fact remains. The number vaccinated is only
half the number of births. I feel sure that there is nothing existing in the
shape of extraordinary opposition or unusual indifference to vaccination, to
prevent a larger amount of work being done, and during the past few months
I have been endeavouring to effect a change in this respect. Some of the
men, nearly one-half of them, I am sorry to say, are indolent, and will re-
quire the most watchful, intelligent, and strict supervision, to bring them into
regular and active working order. I trust that Mr. Raby will effect something
towards this end during the current year.
20. The highest Circle average number of operations per man is that
of the Káthiáwád Circle, with 2,289 operations. The lowest, that of the
Southern Circle, with 1,094 operations.
Percentage of success at-
tained in Circles.
21. The average percentage of success attained in Circles and in Dis-
pensaries is shown in the following table, and,
if compared with that of the previous year, it
will be seen that in a few of them the percent-
ages are slightly lower, due entirely to the new method of registration
noticed in para 16:—
( viii )
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Central Circle... ...
Southern
do. ... ...
Western
do. ... ...
Northern
do. ... ...
Sindh
do. ... ...
Káthiáwád
do
Rewá Kánthá do. ... ...
Presidency
do. ... ...
Barodá
do. ... ...
Kutch
do. ... ...
Aden
do. ... ...
Dispensaries ... ...
Primary
Vaccination.
94.3
91.6
94.0
95.5
97.2
96.0
96.9
89.0
92.9
94.3
71.6
91.1
Average
94.6
...
...
...
...
...
...
...
...
...
...
...
...
Re-vaccination.
69.5
59.9
66.8
76.9
69.3
71.6
77.9
44.1
91.5
88.8
...
54.3
Aver-
age
66.9
22. For purposes of comparison it may be well here to add a table show-
ing the percentage of success, as recorded by the vaccinators, for primary and
re-vaccinations combined, and that ascertained from actual inspection by the
Superintendent of each Circle. The following table shows this comparison
omitting those Circles in which no inspection work is done by the Superin-
tendents :—
Circle.
Central ... ... ...
Southern... ... ...
Western... ... ...
Northern... ... ...
Sindh ... ... ...
Káthiáwád... ... ...
Rewá Kánthá... ... ...
Total ... ...
Percentage of success
recorded by
Vaccinators.
91.1
95.2
94.0
95.2
97.8
95.0
95.8
95.0
Percentage of success
ascertained on actual
inspection by
Superintendents.
93.9
73.7
96.4
97.3
98.1
92.1
98.8
94.7
The percentage of success given in the second column of this table, is the
percentage of success recorded by the vaccinators for the children inspected
by the Superintendents—not the percentage of success in the total vaccina-
ted during the year—and includes all vaccinations, whether primary or secon-
dary. It will be seen, in all, except the Southern and Káthiáwád Circles, the
percentage of success, as ascertained from actual inspection by the Superin-
tendents and their Assistants, is greater than that recorded by the vaccinators.
This is accounted for by the calculation, in the former case, being made from
( ix )
the number of persons vaccinated, and in the latter from the number of opera-
tions performed, i.e., the former by the old and the latter by the new method
explained in para 16. Why the percentage, as ascertained by the Superin-
tendents, should have been lower in the Southern and Káthiáwád Circles, I am
unable to explain. The difference is not great in case of Káthiáwád, but in
the Southern Circle it amounts to 21.5 per cent. This shows a far from
satisfactory state of affairs. An enquiry is being instituted into the matter.
It may not improbably be due to want of correctness in the inspection reports
of the Assistant Superintendents, two of whom were found unfit for appoint-
ment permanently, and were remanded to their former duties.
As far as the other Circles are concerned, they are, I think, satisfactory.
Local Fund Vaccina-
tion.
23. There is a very satisfactory increase under this head. As there are
now only two vaccinators paid from the Imperial
Funds, I. shall, in consideration of the opera-
tions performed under this head, join these with
those performed under Local Funds. The number vaccinated by these two men
is 3,465, and that by the Local Funds Establishment 317,516 = 320,981, an in-
crease over the preceding year of 10,969 persons. The following shows the
increase and decrease in each Circle as compared with the preceding year:—
Increase.
Central Circle
Western do. ......
Northern do.
...
Deduct Decrease.......
Total Increase..
12,569
1,895
2,454
16,918
5,949
10,969
Decrease.
Southern Circle .........
Sindh do .........
Káthiáwád
do
269
1,325
2 723
1 632
5,949
The greatest increase in any Circle occurs in the Central Circle. It is
more than equal to the total increase, and though due in part to the reorga-
nized establishment having been maintained complete throughout the year,
yet it must partly be ascribed to the careful, and intelligent supervision of
Dr. Robb. The increase in the Western Circle is satisfactory, and is probably
due to closer and more frequent inspection. The decrease in the Káthiáwád
Circle is due, solely, to the removal of all the Government vaccinators, except
one for Rájkot and neighbourhood, in the middle of 1871-72. That of the
Sindh Circle I can account for only by the want of tact and care exercised
by Dr. Keith in the first half of the year. Since Dr. Williams resumed
charge in November much more work has been done. The decrease in the
Rewá Kánthá Circle, considering that there are only five vaccinators, is large.
It is ascribed by Dr. Haliday to the great prevalence of " fever and dengue "
amongst the vaccinators and the people generally.
2 vac
( x )
24. The appointment of an itinerant vaccinator to each táluká was a
grand improvement, and its influence will soon be felt, especially in the
Deccan, where the establishment has always been particularly weak. The
advantages of having a vaccinator permanently in each Táluká, or Rural
Registration Circle, appear to me to be these—(a) villages are visited more
frequently ; (b) the vaccinator being always in one táluká becomes per-
sonally acquainted with the subordinate Government officials, the village
officers, and the people; (c) in outbreaks of small-pox there is always a vacci-
nator on the spot to take immediate measures for stamping out the disease ;
(d) when vaccine lymph fails in one táluká, it is easily renewed by lymph
from the neighbouring vaccinators.
Municipal Vaccination.
25. The number of vaccinators employed under municipalities, at the
end of the year, was the same as at the end of the
preceding year—one was abolished at Kotrí in
Sindh Circle and one was appointed at Aden.
The number of persons vaccinated in the past year was 57,554 against
60,676 in the year preceding,—a decrease of 3,122. This cannot be considered
unsatisfactory. On the contrary I think, considering the difficulties the men
have to contend with (they being employed principally in large towns where
vaccination generally proceeds less smoothly), and that the report of the year
1871-72 showed an increase of no less than 24,180 operations over the pre-
vious year, the work exhibited is very creditable to the establishment. That
it is satisfactory when compared with the previous years will be seen from the
following statement showing the average number of operations per man
performed in the past five years :—
1868
1869-70
1870-71
1871-72
1872-73
764
769
715
1,189
1,129
26. In the following table the increase and decrease according to Circles
is shown :—
Increase.
Northern Circle .........
Sindh do. ............
Presidency do ............
Aden Municipality ..............
1,045
252
958
238
2,493
Decrease.
Central Circle ............
Southern do. ............
Western do. ............
Deduct Increase...
Total Decrease...
4,271
391
953
5,615
2,493
3,122
( xi )
The only decrease worthy of notice is that of the Central Circle, which is
due to the abolition of the appointments in the tálukás of Mán, Khatáo and
Koregám of the Sitárá Collectorate and of Sángolá in the Sholápur Zilhá.
These abolitions, which were noticed in the report of last year, were car-
ried out in the middle of 1871-72, and consequently the returus for the first
half of the year were included in the statement of that year. Against these
municipalities there is nothing shown in this year's statement.
27. Against these reductions there is a slight set off in the shape of a
vaccinator appointed to some towns of the Juner Táluká, Puna Zilhá. The
towns in question are Náráyangáon and Utur, towns in which the strongest op-
position exists and always has existed to vaccination. In 1867, with the assist-
ance of Mr. Claude Bell, C. S., in charge of the district, I made an endeavour
to overcome this opposition, and we partially succeeded. But time appears
to have blunted the people's sense of responsiblity in the matter, for they
are reported to be as passively obstructive as ever. The man appointed per-
formed 286 operations only; but what can be expected of a man who receives
only Rs. 8 per mensem ? To overcome the prejudices of the inhabitants of
Náráyangáon and neighbourhood, the services of a man of considerable experi-
ence, energy, tact and perseverance are necessary. I need scarcely say that per-
fection is not likely to be obtained on Rs. 8 per mensem. The pay was fixed
without reference to this Department.
28. The increases shown in the Northern and Presidency Circles are
very satisfactory, but I find it difficult to assign the cause. In the latter case
it is, perhaps, due to the prevalence of small-pox; no less than 1,637 persons
having died from that disease during the past official year.
Hitherto the method of registering vaccine operations in the city of
Bombay according to Registration Circles, as ordered by the Government of
India, has not been carried out. I, therefore, directed the Local Superinten-
dent of Vaccination to have this done for the year under report and future
years. A reference to Statement No. I will show that this has been done, and
that it is a great improvement in the old method of merely showing the total
of the whole Circle.
Vaccination in Native States.
29. Vaccination has made very good progress in Native States during
the past year. With the same number of vaccina-
tors at work, the returns show an increase of
27,627 over the previous year. The following table shows the increase and
decrease according to Circles. As will be seen, there is an increase in all the
( xii )
Circles except two, i.e., the Central and Sindh Circles, in which the decrease
is very small indeed :—
Increase.
Southern Circle............
Western
do
Northern
do
Káthiáwád do. ...........
Rewá Kánthá do
Baroda
do
Kutch do..........
Deduct Decrease
Total Increase...
3,056
3,703
5,480
8,845
939
6,170
226
28,419
792
27,627
Decrease.
Central Circle......
Sindh
do
553
239
792
Considering that in 1871-72 the increase under this head was 16,730 and
that the increase this year is 27,627—equal to 44,357 in two years—I think 1
am justified in reporting the results attained in Native States as very satis-
factory. The Circle which shows the largest increase is that of Káthiáwád
—the Circle in which the largest number of Native States' vaccinators are em-
ployed. In the returns of this Circle for last year, also, there was a large in-
crease shown, but the returns of that year were clouded with a large number
of false names. Those of this year compare very favourably in this respect.
Dr. Butler resumed charge of the Circle in June last, and since then his know-
ledge of the men, of the language, and of the people, united with energy and
tact, has had a considerable influence for good. Since he resumed charge, the
insertion of false names has gradually died out, so much so that during the
last four months of the year not a single false name was detected by Dr. Butler
and his Assistants. Dr. Butler attributes this result to the discontinuance
of the system of fining and dismissing men if their monthly returns, in point
of numbers, did not reach the very high standard fixed by Dr. Blanc, and
noticed unfavourably in para. 24 of my last year's report.
30. The Kutch Circle is superintended by the Medical Officer in charge
of the Bhúj Dispensary. The operations carried on do not appear, to me,
satisfactory. To what this is due it is difficult to say, but I think the esta-
blishment wants organization. Nine men performed 1,932 operations, or
little more than the average number of operations performed by one man in
British Territory. The annual average per man is 215, giving a monthly
average of only 18 operations per man. I need not say that, with such a
small number of operations, it is impossible that good work can be done