NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
18
Method of inserting Lymph.
4. Some Vaccinators make from ten to twelve punctures on one arm and none
on the other (I once counted as many as nineteen
vesicles on one arm), generally quite close to one
another. Some make only one puncture ; some, very properly, three or four on each
arm, but they are made on a line,—a practice long ago abandoned for the triangular¬
shaped punctures recommended by Marson, Ceely, and others.
Ignorance of Vaccinators.
5. The ignorance of the Vaccinators is greatly to be deplored, and, until reme-
died, vaccinations will not attain in this country the
high position it is justly entitled to. To vaccinate from
inferior vesicles, to vaccinate children suffering from fever or skin diseases, or those
in general bad health, should not be tolerated. By far would I prefer a decrease
to the indiscriminate vaccination, as at present performed ; not only the first re-
quisite is good lymph taken from typical vesicles, but on a par the selection of the
vaccinifer should be deemed imperative : vaccination should never be performed on a
subject considered, temporarily or permanently, unfit to receive its beneficial influence.
6. Having made these remarks, I must add, lest my meaning be misunderstood,
that I would myself prefer a large number of vaccinations to a small one, provided
always that quality was not sacrificed to quantity.
No result can be more satisfac-
tory than a large increase of good vaccination ; but an increase, merely an increase,
leaving the vaccinated but imperfectly protected or unprotected, is certainly more to
be deplored than encouraged.
Percentage of Success.
7. I am also under the impression that the percentage of success given by the
Vaccinators is greatly exaggerated. I am not in a
position to give, in support of my opinion, any large
statistics, but from what I have seen I would place the percentage of success far
below 99 or 96, as given for the last two years.
General progress.
8. General progress of Vaccination.—I do not believe that vaccination is unpopular
in the Western Circle; in my opinion, it is simply
not well understood. My remarks will refer to the
Tanna Collectorate, the only portion of my Circle that I have been able to visit. To
be able to form an idea of the progress of vaccination in that populous district, it is
necessary that we should consider separately the rural population and the inhabitants
of the towns or large villages. In the northern portion of the Tanna Collectorate, if
we accept as a division the Bombay and Baroda Railway, we find to the eastward of
this line a succession of jungles, in which are scattered numerous small villages. The
inhabitants of this district are the most miserable and uncivilized looking beings I have
ever seen. Barely clad, dirty in their persons, badly fed, all suffering or cachectic
from the effects of malarious diseases, and ignorant beyond conception. Amongst
these people vaccination has made good progress. To the westward of this same line
we find small towns,—Bassein, Mahim, Kelwe, Seergaum, &c.,—or large villages,
—Manickpoor, Sopara, &c. These towns and villages are principally inhabited by
20
tried in this country. I would also suggest that for good lymph we should pay the
parents a sufficient amount to induce them to allow lymph to be taken from their
children, say one rupee; few, I believe, would refuse the gratuity; and as such agency
is only required in towns, the total expense on that score would not be considerable,
and should be borne by the towns themselves.
10. In order to ascertain, as far as lay in my power, the progress of vaccination
in those parts of my Circle that I visited, 1 examined the children of the different
schools, and obtained the following result:—
Name of Town.
Bandora ................
Cheechum ............
Tarrapoor .............
Callian .................
Bhewndy .............
Total .......
Vaccinated.
118
20
18
24
10
190
Protected
by
Small-pox.
18
53
84
43
49
247
Protected
by
Inoculation.
......
75
20
1
1
97
Unprotected.
91
27
......
28
14
160
According to this tabular statement, the percentage of vaccinated is 37.7. But
these numbers are much too small for any correct inference to be drawn from them.
State of Lymph.
11. The state of lymph throughout the year.—A priori, I believe that human-
ized lymph, handled by unqualified men, must
quickly degenerate. During my tour I have taken
notes of the qualities of the vesicles and cicatrices I saw, and the result is not favour-
able ; but as my experience in this country is limited, it is not impossible that I may
have been unfortunate, and have only examined localities in which the results are less
favourable than elsewhere. A good vesicle is one that offers a marked central depression,
is pearly, hard, raised above the skin, and gives on the eighth day lymph perfectly
limped and of a certain consistency; from the ninth to eleventh day a well marked
areola surrounds the vesicles in dark skins, felt, if not seen. A bad vesicle (I do not
mean a spurious one) presents no, or very little, marked central depression: it is
globular, small or large, contains a large quantity of serous lymph, breaks on the
slighest pressure, the lymph turbid on the eighth day, the areola often absent, and
this frequently followed by an unhealthy sore ; a good cicatrix is circular, below the
level of the skin, and well pitted; a bad cicatrix is superficial, without pitting, and often
very indistinct; " indifferent," applied to vesicles and cicatrices, implies that they are
neither very good nor yet bad. I thought it advisable before giving the following
tabular statement, showing the result of my inspection, that the value of the terms I
use should be clearly explained :—
21
Vesicles ..........
Cicatrices ........
Total
Good.
36
119
155
Indifferent.
186
194
380
Bad.
180
390
570
Unhealthy
Sores.
138
138
The percentage of good vesicles is only 9.3, and of good cicatrices 15.3. If we
take the total of good and indifferent of both vesicles and cicatrices, we have the per
centage of successful cases 45.6. I believe that on a larger scale this percentage
would be found to be low. Since the end of the official year I have met with better
results ; still 97 or 96 per cent is too high. Something between 45 and 97, say 70 per
cent., is, I believe, a fair estimate of successful vaccination in this Circle. When
speaking of my tour I will have occasion to mention the steps taken when the l ymph
used by a Vaccinator was found to be bad or indifferent.
Conduct of Vaccinators.
12. The most steady men, or those who have done the most work during the
year, are—Assistant Vaccinator Ballo Chalkar (Ge-
neral No. 157), Assistant Vaccinator Gunputrao
Harryba (General No. 220), Assistant Vaccinator Govind Ballal (General No. 125).
Assistant Vaccinator Ballaje Chawun (General No. 130), and Apprentice Vaccinator
Hurry Ramchunder (General No. 266). To these I beg to suggest that a gratuity of
a month's pay be granted.
Constant supply of good Lymph.
13. A constant supply of good lymph is the first desideratum. The question
of degeneration of vaccine lymph may in Europe be
a question open to discussion ; here, it is generally
admitted. At the same time, I am not prepared to endorse the opinion that vaccine
lymph must necessarily degenerate quicker in India than in more temperate climes.
If vaccination in this country were in the hands of able men,—if our Vaccinators were
only well acquainted with their work,—we would keep our lymph in as good condition
as at home, although in many instances, as Marson states, " the cicatrices would not
be so good as formerly ;" as we are at present situated the best lymph must quickly
degenerate.
Animal vaccination established.
14. Since I have been able, with the valuable assistance of the Superintendent
General, to establish animal vaccination in Bombay,
(where it has since its introduction been successfully
practised by the able Local Superintendent, Anunta Chandroba, and the funds for its
maintenance during one year supplied by that philanthropic gentleman, Mr. Cowasjee
Jehanjeer Readymoney,) the question of lymph is much altered; and I trust that the
system will have a sufficiently fair trial for its merits to be generally acknowledged, and
for Government to be induced to take it under its patronage, Should animal vaccina-
22
Renewal of Lymph from Heifers.
tion be continued, and its practice extended to other cities, India will be in possession
of as good vaccine lymph as can be obtained from England itself.
15. On two occasions I inoculated heifers in my Circle, and thereby renewed
the lymph in several talookas. I experienced no
difficulty whatsoever in procuring heifers, and, far
from meeting with any opposition, great anxiety was shown by all to be vaccinated
from that pure supply.
16. I propose making during the year a series of experiments with dried lymph
on ivory points, and liquid lymph in tubes, or preserved between plates of glass.
If, as I believe, points are found to give a higher percentage of success, they should
on this score alone be preferred. Points being so much easier to charge than
tubes to fill, the Vaccinator could always carry with him a large supply of lymph,
and, once taught how to use them, would obtain very fair results. At present
the Vaccinators have frequently to put up with bad lymph, as it is not the child
presenting the best vesicles that can always be conveyed to another village, but
the one whose parents are willing to go. One point can only be used for one super-
ficial incision, and the bad practice of vaccinating a large number of children from an
inadequate supply of lymph would then be obviated.
Animal Vaccine a good and pure
source of Lymp.
17. I believe that we have now the means of keeping up a good supply of vaccine
lymph ; but unless the same advantage is extended
to the Vaccinators themselves, all our efforts will be
made in vain. I supplied on one occasion some very
good lymph to the Sub-Assistant Surgeon in charge of one of the Callian Dispensaries,
and with it he vaccinated three children ; in two (I saw them on the eleventh day) he
obtained beautiful vesicles ; in the third, vesicles were very indifferent, almost spurious.
To my astonishment he had taken lymph from these bad vesicles for vaccinating other
children ; the result was unsuccessful, and he lost his supply. If Sub-Assistant Sur-
geons, who are supposed to know better, cannot distinguish between good and bad
vesicles, what are we to expect from the generality of our Vaccinators.
Supernumerary Vaccinators de-
sirable.
18. Two or three supernumeraries should always be attached to the Superin-
tendent's Office, and thoroughly trained in every
detail of their work, before they are employed as Vac-
cinators. The want of properly trained men, always
at the disposal of the Superintendent, is a want I have greatly felt. Having had to
make lately several appointments under the Local Funds, I had no alternative but
to appoint men whom I could get, and who were in some respects not well suited
for the work. I kept them all for some time near me, allowing them to draw part of
their pay ; but they had studied under our Vaccinators, and it is well known how
much more difficult it is to "unteach" than to "teach." These supernumeraries (who
should receive pay at the rate of from ten rupees to fourteen per mensem), after a
few mouths' training, would be of the greatest use. They would be always at hand,
23
and ready to fill up temporary vacancies, and, through their agency, in time we would
have really good Vaccinators—men that could be depended on.
An English Writer in Superin-
tendent's Office desirable.
and ready to fill up temporary vacancies, and, through their agency, in time we would
have really good Vaccinators—men that could be depended on.
19. I would now venture to make a few remarks on our own position. The
amount of office work that falls upon us is very con-
siderable, and an English Writer would considerably
relieve the Superintendent from the mere clerical
part of his work. The Marathi correspondence is most voluminous, and for this also
no Writer is allowed ; the Vaccinator on tour with the Superintendent does the verna-
cular writing. This not only deprives the Circle of the services of a Vaccinator, but,
as the pay this man receives is quite inadequate to meet his own expenses and keep
his family at home, he is discontented, and only anxious to leave a post where his
services meet with no adequate remuneration. I therefore beg to suggest that an English
Writer be sanctioned to the Superintendent ; but should this expense not be admissible
for the present, that, at least, the Vaccinator employed as a Carcoon be granted a some-
what better pay, say Rs. 30 per mensem, and, when on tour, sufficient travelling
allowance to allow him to keep a tattoo.
Small-pox.
20. No returns of small-pox have been received this year from the Collector of
Rutnagherry ; but the Collector, at my request, has
been good enough to direct the Mamlutdars in his
collectorate to supply them to me from the beginning of the official year 1869-70,
with the exception of two talookas, Mahim and Mahar. I have received all the returns
of small-pox for the other two collectorates :—
Unprotected.
Cases of Small-pox.
2,891
Deaths from Small-pox.
330
Vaccinated.
Cases of postvaccinal
Small-pox.
1,586
Deaths from postvaccinal
Small-pox.
28
From this tabular statement we gather—
(a) A very large proportion of postvaccinal small-pox, 35.2 per cent.
(b) A very low rate of mortality ; being for the unvaccinated. at the rate of 11.4,
and for the vaccinated at the rate of 1.7 per cent.
Evidently no weight can be attached to these returns. Whenever outbreaks of
small-pox have been reported to me in talookas where no Vaccinator was at work,
one was immediately ordered to proceed to that locality, and urged to vaccinate and
re-vaccinate all the inhabitants of the villages in which the disease had appeared. But
for many reasons the changes that are thus occasioned are much to be regretted, and
would not be necessary if the Superintendent had by him some supernumeraries, among
whom the best trained could be then advantageously employed.
26
indifferent. I supplied him with fresh lymph, and directed him to abandon the lymph
he was working with.
24. During the year, with the exception of the Native States of Johar and Sawunt
Warree, the whole of the Western Circle has been visited by Mr. Cody, Acting
Superintendent, or myself. Some talookas have been visited twice. On one occasion
I was only a day's march from Johar, and would have inspected the work of the
Vaccinator employed there, had he not been absent, without leave, at the time.
Aid received from Civil Autho-
rities.
25. On all occasions I have received every assistance possible from the Civil
Authorities,. and beg to record my best thanks for
the kind manner with which they have, one and all,
given to this Establishment their valuable support.
No care of communicated Sy-
philis met with.
26. During my tour I have examined upwards
of four thousand children, and have not met with
a case of transmitted syphilis.
27. The following report was handed to me by Assistant Surgeon Cody. It is
for the period he held the charge of this Circle:—
Remarks by Assistant Surgeon Cody.
General progress.
During the year under report the progress of vaccination in this Circle has been,
on the whole, very favourable. In the collectorates
of Rutnagherry and Colaba the progress has been
most marked as regards the number of operations and their success. I have examined
during my tour nearly every talooka in the two collectorates, and can testify, from
personal observation, to the great spread of vaccination amongst the people. They
seem to thoroughly appreciate the advantages to be derived from the prophylactic,
and the almost complete protection it gives them from small-pox. This is well
illustrated by the great anxiety they express to get their children vaccinated whenever
small-pox makes its appearance amongst them. During my tour through the Rutna-
gherry Collectorate, I encamped one day near a village where two or three cases of
small-pox had just occurred ; and the people, as soon as they learned I was the Devi
doctor, brought every unprotected child in the village to me voluntarily to be vacci-
nated ; fortunately I had a good supply of lymph with me, and was able in consequence
to take advantage of the panic that had seized them, and get all the children
vaccinated. I returned again to the village after eight days to see the results, and
was glad to find them in nearly all cases satisfactory, and, further, that the small-pox
cases were doing well, and that no new ones had occurred. I could plainly see that
implicit faith in vaccination was completely established here at least, and that, for the
future, there would be little trouble in inducing the villagers to accept it. With these
few preliminary remarks, I will proceed to give a report of my tour of inspections.
Tour.
2. In January I examined the work of Apprentice Vaccinator Koondajee Mukund-
row, who was working in the talookas of Callian and
Bhewndy, Tanna Collectorate. I saw a good deal of
30
Vaccination in Native States.
6. Of the two Native States in this Circle I can only speak from the returns I
received. In both instances vaccination seems to
be in a most satisfactory condition.
Vaccination at Dispensaries.
7. Of the Dispensaries, generally speaking the returns were by no means satis-
factory. There are two or three in which the
Medical Subordinates and others in charge of Dispen-
saries seem to make every effort to vaccinate ; but I must say the larger proportion
have during the time I acted as Superintendent shown any thing but a strong desire for
its spread, or efforts to induce it to become popular
NORTHERN CIRCLE.
Superintendent.—MUNCHERJEE
BYRAMJEE COLAH, M.D.
Establishment.—Thirty two Vaccinators under Government, thirteen under
Native Chiefs, two * under Municipalities, and twenty-three Dispensaries.
Population, 2,671,228. Total cost, Rs. 18,928. Average cost of each successful
case of vaccination, 3 annas and 4 pies.
Establishment.
Government ...........
Native Chiefs
Municipal ............
Dispensaries
Years.
1868
1869-70
1868
1869-70
1868
1869-70
1868
1869-70
Total
Vaccinated
71,203
70,273
23,080
22,734
2,175
†2,827
200
2,669
Compared with the
preceding year.
Increase.
......
......
......
......
......
652
......
2,469
Decrease.
......
930
......
346
......
......
......
......
Success-
fully
Vaccinated
......
65,228
......
20,964
......
2,721
......
2,235
Percentage
of Success,
excluding
those
Unknown.
......
96.9
......
95.8
......
97.6
......
88.3
Change of year for report.
The last annual returns and report were for the calendar year 1868 ; the present
ones are for the official year, commencing from 1st
April 1869, and ending on 31st March 1870.
General progress.
2. Vaccination has been carried on satisfactorily throughout the period under
report. A large number of operations were per-
formed during the first three months of 1869,
whilst comparatively less work was done during the corresponding months of 1870 ;
consequently I had anticipated a large decrease. Taking the actual results, however,
* Two in Ahmedabad omitted.
† Work of Ahmedabad omitted.
31
the decrease is found to be very slight, viz. 930 in the Government and 346 in the
Native States' establishment; whilst, on the other hand, there is an increase of 652 in the
work performed by the Municipal Vaccinators. Vaccination at the Dispensaries was
only systematically carried on during the year under report. I do not take into
calculation, therefore, the work of this establishment, but, taking only the other three
establishments together, the actual decrease is only 624.
Total vaccinated.
Percentage of Success.
3. The total number of operations performed by the four establishments
during the past twelve months is 98,503. Of these
91,118 were successful cases. Excluding from the
calculation the unknown cases, and taking only the
successful and unsuccessful cases, the percentage of
success comes to 96.4.
Sex, Age, and Caste.
4. The result, as regards sex, age, and caste, is
shown below :—
Arranged according to sex, there were
„
„
„
„
„
„
„
„
„
„
„
„
„
„
„
„
„
age
„
caste
„
„
„
„
„
„
„
„
„
„
„
„
52,684 males,
or 53.4
45,819 females,
or 46.5
63,041 under 1 year, or 63.9
35,462 above 1 year, or 36.0
83,768 Hindoos,
or 85.0
8,057 Mussulmans, or 8.17
120 Parsees
or .12
19 Christians.
6,539 other caste, or 6.6
per cent.
„
„
„
„
„
„
„
Cost.
5. The following table shows the cost of vaccination in each of the establish-
ments separately, as well as the cost of each vacci
nation :—
Establishments.
Government ......................
Native States ......................
Municipal ......................
Dispensaries ......................
Total ..........
Total
Vaccinated.
70,273
22,734
2,827
2,669
98,503
Total Cost.
Rs.
15,436
3,072
420
a.
3
0
0
p.
8
0
0
......
18,928 3 8
Cost of each
Vaccination.
Rs.
0
0
0
a.
3
2
2
p.
6
2
0
......
0 3 0
State of Lymph.
6. The lymph in use throughout the year has been on the whole good. Five
supplies of English lymph were received ; of these
only one failed entirely, and the rest have been more
or less successful, and I have brought the lymph into use in many parts of this Circle.
32
I also endeavoured, about the close of the year, to introduce animal vaccine lymph ;
two supplies of it were from the Local Superintendent of Vaccination, Presidency
Circle; and I have been just partially successful in establishing vaccination with it.
Use of Tubes.
7. Supplies of lymph in capillary tubes were
sent to the undermentioned Officers:—
Local Superintendent of Vaccination, Presidency Circle ...........
Medical Officer in charge Aboo Sanitarium ..............
Superintendent of Vaccination, Kattiawar Circle
Civil Surgeon, Kaira—a lymph child .......................
Superintendent General of Vaccination and Dispensaries, Rajpootana
Hospital Assistants in charge of various Dispensaries in this Circle...
Total .........
No of Tables.
121
11
10
2
21
50
218
As a rule, no information as regards the result of the use of the lymph is received
from the recipients of such supplies.
Small-pox.
8. The period under report has been comparatively a happy one as regards the
almost entire absence of small-pox. But soon after
the last monsoon, malarious fever prevailed to
an unusual extent during the best part of the working season, viz. from October
1869 to January 1870. The prevalence of the fever was very general. Our Vac-
cinators enjoyed no immunity from it. Many were laid up. Some succeeded in just
keeping up their lymph, whilst others had actually to stop work. It was also difficult
to carry on work among the people during such sickness. The returns of these
months consequently show less work.
Vaccination introduced
into
Dhurrumpoor.
9. In paragraphs 19 and 20 of last report, mention was made of the non-exist-
ence of vaccination in the Native States of Dhurrum-
poor and Bansda. During the year under report
vaccination has been introduced into Dhurrumpoor.
Through the exertions of Mr. T. C. Hope, the Agent to the Governor for these States,
the Dhurrumpoor Durbar consented to entertain a Vaccinator at an annual cost of
Rs. 270. No time was lost in making arrangements for sending one. Since Novem-
ber last, vaccination has been carried on in Dhurrumpoor, and up to the end of last
month twenty villages have been vaccinated and 1,107 operations performed. As
the Native State of Bansda is a small one, I hope to succeed in making arrangements
for entrusting its vaccination to the Dhurrumpoor Vaccinator.
Revision of Pay.
10. Consequent upon the stoppage of grain compensation, the Vaccinators and
Peons were receiving very low rates of pay, and
were much dissatisfied when I submitted my last
report. Since April last, a revision of the whole establishment has been effected.