xiv
REPORT.
Darjeeling circle.
Dangers of the
practice.
Chota Nagpore.
In the districts comprised in the Darjeeling circle the practice is very general,
and Dr. Lidderdale records valuable observations, showing its pernicious effect.
In one instance 2 deaths had occurred among 25 persons inoculated. It is clear
that the operation is not so universally or exhaustively performed in the selected
villages as some writers would have us suppose, and it is equally clear that the
strict precautions against infection which have been described are not always
adopted. The disease does spread by infection and causes sickness and mortal-
ity besides the direct effect. It is evidently a most dangerous weapon to handle,
and its practitioners are obviously not so cautious or careful as they ought to be.
Inoculation appears to have been very nearly suppressed in the Chota Nagpore
division, and it is very satisfactory to note that small-pox has been corre-
spondingly less severe and frequent. This may be fairly put forward as an
evidence of the advantage of suppressing this noxious practice, even if means
are wanting to vaccinate the people exhaustively. It amounts to the removal
of a cause by which small-pox is maintained and spread.
Other districts.
Loss of life which
must be caused
by the practice
under the most
favorable
cir-
cumstances.
In all the districts of Eastern Bengal and Assam, Behar and Orissa, inocu-
lation is the universal practice. Many of the civil surgeons attribute outbreaks
of small-pox to it, and in some instances the result of inoculation has been fatal.
There can be no doubt that even under the most favorable circumstances—in a
good and healthy season, at a suitable time, with a skilful operator, and with
the strictest precautions, loss of time and life is caused by inoculation. Even
accepting the most favorable estimate of 2 deaths per 1,000 operated on, the
protection of 60 million people would be achieved at a sacrifice of 120,000 lives.
This is the most favorable aspect in which the matter can be viewed. When,
however, as must often happen, the season is unfavorable, the virus too
virulent, the operator unskilful, or precautions against infection are not taken,
the mischief due to this pernicious practice must be very material.
More exact infor-
mation regard-
ing it desnable
Dr. Wise urges very truly that the proceedings of inoculators ought to be
carefully watched and noted. Our knowledge regarding inoculation, its risks
and mortality, is very slender and unsatisfactory; and civil surgeons would
render a most important service by accumulating facts founded on personal
observation regarding this subject, which affects so deeply the well-being and
lives of so immense a multitude of human beings.
Small-pox in Cal-
cutta ,
in surrounding dis-
tricts ,
in the Darjeeling
circle,
in the Chota Nag-
pore division
Inoculation as a
cause of small-
pox outbreaks
Control of small-
pox.
46. Small-pox.—The remarkable immunity which Calcutta enjoyed from
small-pox during 1871-72, is clearly brought out in Dr. Charles' report. This
result may fairly be laid to the credit of the suppression of inoculation and
assiduous practice of vaccination. The districts around Calcutta were not so
fortunate. Dr. Powell mentions 27 outbreaks in his report. The majority of
them were caused by inoculation. Dr. Lidderdale describes the prevalence of
the disease in the districts of Rungpore, Dinagepore, Bograh, and Rajshahye,
and was able generally to trace it to inoculation. In the Chota Nagpore divi-
sion small-pox prevailed during the year in the Palamow sub-division of the
Lohardugga district. It does not seem to have been severe, and in many
instances the disease reported was chicken-pox. The Commissioner states that
since inoculation was prohibited, small-pox has been less frequent and severe in
this division. In the remaining districts of the province the reports of medical
officers show that sporadic or limited outbreaks occurred in most of them, but
not to any remarkable extent in any. Many of these outbreaks are said to have
been due to inoculation, and there can be no doubt that this practice, perilous at
best, does, when carelessly practised, cause much avoidable sickness and mor-
tality. So long as the people look upon small-pox as a mark of divine favor,
the disease must prevail and spread among them, and the expedient of volun-
tarily inducing it must continue popular. It is curious to note that in the
Khasi Hills the inhabitants voluntarily seek protection, by the process of
natural infection, for the young. The power of controlling small-pox in rural
villages is very slender. Vaccinating the unprotected is the best expedient,
and this should always if possible be attempted. Good results have in many