viii
REPORT.
Self-supporting vaccination has on the whole been so far demonstrated as possible in
Lower Bengal as to give some assurance of ultimate success; but it must be regulated and
supervised closely. It seems also a necessary preliminary to introduce the practice and form
the habit of vaccination by a special establishment, and it is doubtful whether the plan will
be entirely successful in any area, until inoculation has been rendered penal. I am however
opposed to sweeping changes, and in favor of gradual developments.
31. Extending the Metropolitan system to other circles.—This question was raised in
Bengal Government letter No. 2653, dated 6th August 1870, and was very carefully considered
in the correspondence forwarded from my office with letter No. 92, dated 2nd May 1871, in
which the subject was thoroughly discussed. It is unnecessary here to recapitulate the grounds
on which the conclusions acquiesced in by Government rested, namely, that, setting difficulties
owing to the prejudices of the people aside, there are difficulties, depending on the large area
which these circles embrace, and the necessity of attending to reported outbreaks of small-pox,
in the way of introducing the Metropolitan circle system into the Ranchee and Darjeeling
circles without material increase of establishment and expenditure.
The best principles on which operations should be conducted, derived from a close study
of the manner in which they are conducted in the different circles, have been in the letter
quoted summarised as follows :—
I.—Definite areas or a definite number of villages adjoining one another should be at
the commencement of the season selected, and fixed on for vaccine operations, and these should
be exhausted, if possible, before new ground is taken up. Yearly maps might show the areas
exhausted. Such areas might be in circles or lines, according as the intention is to vaccinate
a limited area thoroughly, or to spread a knowledge of vaccination over a district.
II.—The aim should be to vaccinate all, but time should not be lost in vain endeavours
to overcome strong scruples or prejudices. An estimate might be formed of the degree of
protection afforded as Dr. Powell has endeavoured to give.
III.—For convenience of supervision the members of gangs should be kept as close to
each other as possible; but I cannot see the necessity of two trained men working together in
the same village, unless they take a separate section of it. A learner should be associated
with an experienced man, until he is fit for independent action.
IV.—Head vaccinators should see every case at or about the time of maturation. A
weekly inspection of each vaccinator's work is, I consider, sufficient; and a head vaccinator to
a gang of seven men is the proper proportion.
V.—The frequency of visits by the Superintendent will depend on the efficiency of the
Deputy Superintendent. With thoroughly reliable Deputy Superintendents, one visit a year
to each gang should be enough.
VI.—Two sets of registers should be used, one for deposit with the head man of the
village, and the other for departmental use.
VII.—Arm-to-arm vaccination should be adopted in every case if practicable.
The strict observance of these principles will depend on the circumstances of the circle;
but they should be always held in view. In the metropolitan circles they are entirely
realized; in the others, with a smaller staff to a larger area, and many disturbing causes,
imperfectly. The suggestion contained in paragraph 19 would permit of a limited introduction
of the thorough Metropolitan system, while education in vaccination would still be diffused
by the flying parties.
32. Instruction in vaccination at the Medical College.—In February 1870 Surgeon Cutcliffe,
Civil Surgeon of Dacca, represented that native doctors were practically ignorant of vaccination,
and that thus the prophylactic, from improper performance of the operation, got into disrepute