GENERAL REPORT.
xix
A vaccine inspector
best plan, and a little of this kind of inspection is a great deal better than a
great deal of the cursory or superficial kind. In districts where many con-
verted inoculators are employed, there should be at least one vaccine inspector
of the grade and pay (Rs. 20 and 16 ) of a native superintendent who should
assist the men in establishing and maintaining a good vesicle, and supervise
and verify their work. The Civil Surgeon should, however, occasionally
inspect and satisfy himself regarding the quantity and quality of the work.
Converted inoculators should also be provided, I think, with such stationery
and forms as they may require for rendering the simple statistics required of
them. It would also be well, could a subsistence allowance be given these
men during the period of their tuition. The two last-mentioned matters could,
no doubt in most cases, be arranged locally.
Centralizing vacci-
nation.
63. Centralizing Vaccination.—Towards the close of 1871, Commissioners
were called upon by Government for reports on the subject of centralizing
and concentrating vaccine operations, so that they might be more systematic
and exhaustive. Their replies were forwarded to this office for review in
August 1872. I was not able to reply till January 1873, when I offered some
remarks on the general question, and promised to return to the subject when
submitting the Reports for 1872-73. The remarks which I then made were
as follows:—
" * * * * The question has now come to be—Is it possible to render
vaccine operations throughout the province more systematic and effective by
concentration ?
The circumstances of
localities vary,
" 4. It is difficult to dispose of the question thus stated briefly or generally,
for the circumstances of different divisions and districts vary greatly, and
the subject cannot be dealt with practically without going into details. The re-
ports of Commissioners are moreover very unequal according to the amount
of attention and thought which each may have devoted to the subject, and
the condition and progress of vaccination in their divisions. Thus the Com-
missioner of the Presidency division, within whose experience lies the very
excellent and successful work performed in Calcutta and the Metropolitan
circles, contemplates vaccination from a different point of view from the
Commissioners of Orissa or Assam, where vaccination has as yet hardly found
a footing, and the circumstances of the case are so entirely different.
Systematic exhaus-
tive vaccination
gencrally approv-
ed.
" 5. The opinions elicited are on the whole, favorable to the views regard-
ing which reports were requested, and the majority of the Commissioners agree
in denouncing scattered, desultory, imperfectly supervised work, and recom-
mending exhaustive vaccination under proper supervision and control within
a manageable area. There can be no doubt that the cause and progress of
vaccination suffer most materially through the careless and ineffective work of
ignorant, unskilled, and unsupervised operators, and that the only way of
commending the benefits of the practice to the people is, to ensure that the
protection from small-pox shall be as complete as it is possible to make it, by
including all the members of a community and making certain that the opera-
tion in each case is successful and really protective. This a very broad ex-
perience shows can only be done by a very close and constant supervision.
The Civil Surgeon of Chittagong remarks that " the object of vaccination
being to protect the individual vaccinated from small-pox, an equal amount of
good is done whether a given number of cases is vaccinated in a circumscribed
area, or whether the same number of cases is scattered over the length and
breadth of the district." This is to a certain extent true; but as a mattter
of experience, it is essential for successful results that the operations of native
vaccinators should be watched, and it is also an object to secure, for the pur-
pose of commending the practice of vaccination to the people, the spectacle of
a community which has been properly vaccinated enjoying a comparative or
absolute immunity from the scourge of small-pox.