GENERAL REPORT.
xiii
Failure of carly
lymph supply.
satisfactory circumstance, however, that 3,299 of the cases which he saw had
been vaccinated only in one point. The number of points should never be less
than two, and it is even advantageous to insert lymph in three or four points,
for it is well known that the degree of protection from small-pox which vacci-
nation confers is directly proportionate to the number of successful points.
Dr. Wood's attention will be drawn to this matter and a sounder practice
enjoined. Some difficulty appears to have been experienced in setting up a
good vesicle at the beginning of the season. This appears to have been an
almost universal occurrence, and constituted a serious drawback to the success of
the season's work. Dr. Charles has some useful remarks in his report on this
subject, and offers a suggestion on which I have already commented. He will
be again addressed with a view, if possible, to devising means to remedy a
defect in establishing vaccination which is of a very serious character.
Dr. Wood found the labor of ascertaining to what extent the people are pro-
tected from small-pox so great that he only examined 44 individuals and then
abandoned the attempt in despair. I cannot concede that the simple process of
finding out whether so many persons in a community or among a certain portion
of a community have been vaccinated, inoculated, had small-pox, or remain
unprotected, is a matter involving much difficulty or fatigue, and this circum-
stance does not bespeak much energy or interest in his work on the part of the
superintendent.
Small-pox
43. It is satisfactory to find that small-pox has not prevailed severely or
extensively during the year. The Sub-division Palamow of Lohurdugga where
inoculation still lingers, appears to have been most seriously visited; but even
here the Sub-Assistant Surgeon's report goes to show that many other
eruptive disease went to swell the numbers registered under the head of
small-pox. In the districts of Singbhoom and Maunbhoom the prevalence
of small-pox appears to have been trivial.
Work done by ex-
moculators.
Areas ofpractice.
The question of fees.
44. Dr. Wood's report gives a summary of the work of ex-inoculators
in the different districts, and the reports submitted by Messrs. Manook and
Wilson which are given in extenso in the " Abstracts of Reports of Civil
Surgeons," detail the results of the season in the districts of Singbhoom and
Maunbhoom. In these districts the Civil Surgeons appear to take a warm
interest in the movement and to take pains in instructing the men, in assigning
to them their fields of labor, and in supervising and verifying their work. Mr.
Wilson examined 6,156 out of 8,458 cases, and Mr. Manook 1,578 out of 8,358,
and it is satisfactory to find that in the former case the ratio of successful
cases was found to be 86.5 per cent., and in the latter 70. These are not
high rates, but considering the operators they cannot be considered disap-
pointing. In the districts of Hazareebaugh and Loharduggah the proceedings
of the ex-inoculators do not appear to have been supervised either by the
superintendent of vaccination or by the civil surgeon. I certainly agree
with Dr. Wood in his opinion with regard to the necessity of supervision, and
think that a vaccine inspector should be appointed for each district. I am
of opinion, however, that both the superintendent and the civil surgeons of
Hazareebaugh and Ranchee ought to supervise and verify the work of ex-
inoculators as much as their regular engagements permit. Two circumstances
appear to hinder the satisfactory development of this scheme, namely (a) the
advisability of permitting the instructed inoculators to settle down in their
former fields of practice, and ( b) the question of fees. The civil surgeons of
Singbhoom and Maunbhoom are quite alive to the defects entailed by the areas
of practice of different men not being continuous. This is a fault which time
will remedy, and the evil of leaving a certain tract of country without a vacci-
nator for a time seems less than the evil of taking a man away from a place
where he is known and has influence, and placing him among strangers. As
regards the question of fees, this also leads to imperfect vaccination, the
demands of the inoculators being beyond the ability or willingness of the