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valuable information regarding the causation, nature and treatment of insanity,
which Mr. Birch has very clearly set forth.
The medical officers who have been entrusted with the superintendence
of these institutions have managed them with humanity and diligence, and
there does not exist a better illustration of the benignity of British rule in
India than the contrast which the present state and treatment of lunatics
affords with their conditions and usage in times past.
3. The records of vaccination during the year ending 31st March 1874
exhibit satisfactory and encouraging results. The agency employed was larger,
and the amount of work done more considerable. The cost to the State of
vaccination was higher, but in relation to the outturn of work lower than in
any preceding year. Still, notwithstanding much and steadily increasing pro-
gress, the amount of vaccination accomplished falls far short of the require-
ments of the population, and the protection against small-pox conferred in this
manner does not amount to more than one-third of what it ought to be. It is
not surprising, therefore, to find that this disease continues to prevail in all the
provinces of the presidency, and to cause a very considerable mortality. In
the year 1873-74, small-pox was widely and severely prevalent. Quite apart
from the amount of protection against it enjoyed by a population, the disease,
from causes at present unknown, is apt to recur epidemically in cycles of a few
years. The year under report appears to have been an epidemic one for small-
pox, more particularly in the Punjab and North-Western Provinces. Even in
Europe, where vaccination, enforced by law, is all but universal, small-pox
is apt to break out and spread periodically. Its incidence and mortality are, of
course, lower; but the experience of well protected countries must needs be
repeated with more disastrous consequences in worse protected or unprotected
countries. The problem of efficiently vaccinating India is one of serious diffi-
culty, both on account of the great cost of the measure and the peculiar poli-
tical and social circumstances of the country. Many questions intimately
affecting this problem, e. g., the feeling of the people, the prevalence of the
practice of inoculation, the employment of ex-inoculators in vaccination, the
employment of female vaccinators, the establishing of self-supporting vacci-
nation, are intelligently discussed in this section. Up to this point vaccination
has been introduced among an unwilling and often hostile people by State
agencies, working, without legal sanction, under the authority and with the
moral support of Government: the ultimate aim must be universal self-sup-
porting vaccination, and this end must either be attained by the spontane-
ous motion of the people or the compulsory effect of law. The goal cannot
be reached for many years, but it is right to keep it clearly in view, and to sub-
ordinate every effort to its attainment.
4. Charitable hospitals and dispensaries, concerning which Part III con-
tains full and interesting details, continue to multiply. The number of institu-
tions of this descriptions in operation in 1873 exceeded that of the previous
year by 58, and this is but a step in a progress of which every succeeding
year gives evidence. The number of the sick resorting for relief to dispen-
saries is yearly undergoing a corresponding increase. There can be no question
whatever regarding the great and growing appreciation of these institutions
by the people, and the amount of good which they accomplish. The dispensary
movement has now acquired such root in India that the question now is, not
how to promote it, but how to relieve the State of the heavy burden which
these charitable institutions impose on the public revenues, and to transfer it
to local resources. Some progress is being made in this direction by entrust-
ing the care and support of dispensaries to municipal corporations. As the
latter become more habituated to develope and control local resources, this
policy can, doubtless, be more extensively put in practice, and it is one which
recommends itself strongly on every ground. Although the year under report
was not remarkable for any unusual sickness, with the exception of the epidemic
prevalence of small-pox, to which I have referred, there is always in every part
of India a sufficiency of disease to give full employment to dispensaries were
they multiplied ten-fold. The efforts which have been made to educate native
medical practitioners, hakims and others, in order to enable them to treat disease
rationally and successfully, have not been attended with much benefit. These
men are quite ignorant of anatomy and pathology, and it is impossible without