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VACCINATION IN BENGAL.
IT has been suggested to me that a short account of the system of vaccination in Bengal
would be interesting and instructive, not only to medical men generally and others in Bengal
and other provinces in India, but also to people in England, who take an interest in Indian
subjects.
2. To persons unacquainted with the practical working of vaccination in a province like
Bengal, it seems an easy matter to inaugurate and carry on a complete and successful system
of protection from small-pox, but the difficulty of doing so in Bengal is great, as will be at
once apparent when the area, population, and conflicting interests of the people of these
provinces are taken into consideration. Any system to be successful in Bengal must there-
fore be simple, effective, moderate in cost, and suited to the requirements of the various
classes of the people. Bengal is the largest of the Indian provinces: it has an area of 151,543
square miles, which is equal to that of the United Kingdom, with the addition of a second
Scotland; whilst the population of 71,346,987 is about that of the whole of the United States
of America in 1890, together with Mexico. There are 47 districts in Bengal, each covering
an average area of 3,224 square miles and containing an average population of 1,503,520
inhabitants, which is greater than the average population of the districts of other provinces
and three times greater than the average population of the Punjab districts, which is 673,124,
although the average district area in the Punjab, viz. 3,570 square miles, is about the same
as that of Bengal, which is 3,224 square miles. Then, too, the villages in Bengal are more
scattered than they are in other parts of India. The supervision of vaccination in Bengal is
thus especially difficult, and it is necessary to employ a larger number of workers than in
other provinces in proportion to the population.
3. The system of work in Bengal is as follows :—The department is under the general
control of the Sanitary Commissioner of the province, who is assisted by three Deputy
Sanitary Commissioners, who are covenanted members of the Indian Medical Service. The
district is the unit of administration, and the Civil Surgeon of it is the responsible executive
officer, the entire district staff being under his supervision and control. He works in
consultation with the District Magistrate, and is assisted in the matter of inspections by
Assistant Surgeons and Civil Hospital Assistants, the latter of whom also vaccinate in the
immediate neighbourhood of their dispensaries, as well as at the dispensaries which are
vaccination centres for free vaccination. There is also a Government Inspector of Vaccina-
tion in each district, who is the right-hand man of the Civil Surgeon in all matters relating
to vaccination, and a Government Sub-Inspector for each subdivision. The principal duty of
these officers is to be continually on the move, checking the work of the vaccinator. The
Inspector also every now and again applies a test to the work of the Sub-Inspectors. An
Inspector's pay ranges from Rs. 30 to Rs. 40 a month, and a Sub-Inspector gets Rs. 25
a month. Both are allowed the travelling allowance admissible under the Civil Service
Regulations to officers of their class. The Inspectors are appointed by the Sanitary Commis-
sioner from amongst the Sub-Inspectors who are recruited from the rank and file of
vaccinators on the nomination of the Civil Surgeon, who makes his selection from amongst
the most intelligent and deserving men specially noted for their tact in dealing with local
prejudices. Occasionally, outsiders are appointed, when it seems desirable, in the interests of
the public service, to appoint them.
4. The actual work of vaccination in Bengal (except in municipal areas, where vaccina-
tion is compulsory and is performed free by vaccinators paid by the municipal authorities) is
performed by licensed vaccinators, who are authorized to charge 2 annas for every successful
case. Their work lies in the rural areas of the province. The selection and appointment of
these men is left to the discretion of the Civil Surgeon, who selects them from amongst men
of good caste and character, preference being given to those who can read and write. It is
necessary before a man can obtain a license to practise vaccination (which has to be signed by
the Civil Surgeon and countersigned by the Magistrate of the district) that he shall have
undergone systematic training in vaccination for at least three months under the instruction
of the Civil Surgeon, or an Assistant Surgeon, or a Civil Hospital Assistant, or an Inspector
or Sub-Inspector of Vaccination, and the Civil Surgeon is expected to satisfy himself by
personal examination that the candidate understands all the details of true vaccination, and is
in other respects qualified for the appointment he seeks. Licensed vaccinators are not, strictly
speaking, Government servants, but they are allowed certain privileges which the latter enjoy,
and the grant of a license to practise vaccination entails on them the duty of submitting to
the supervision of the Government Inspectors, furnishing the returns prescribed by Govern-
ment, and depositing a security of Rs. 10 in the nearest Post Office Savings Bank as a
guarantee of thier good behaviour, and also in order to secure Government against loss on
account of the Government property in their possession, such as lancets, stationery, forms, &c.,
with which they are provided free of cost. Each licensed vaccinator is assigned a definite
area of country which he is expected to maintain properly vaccinated; the area allotted to
each vaccinator covers an average of about 60 square miles and contains a population of about
24,000 inhabitants.
5. As a rule these vaccinators work in a satisfactory manner; their homes are usually
situated somewhere within their beats; they are an intelligent body of men, and are well