NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
13
39. In the Nagpur and Wardha districts there appears to be very deci-
ded passive resistance to vaccination on the part of the people in many vil-
lages.
In Chanda the work of the vaccinators is reported as not satisfactory.
The Civil Surgeon, Mandla, attributes the prevalence of the disease to non-
protection of the people from an insufficient staff of vaccinators.
40. With a view to trace what relation exists between the state of protec-
tion by vaccination and the prevalence of small-pox, I have in the table
printed below placed opposite each district of the Province the position it
occupies (1) according to the state of protection enjoyed by the people as
judged by the proportion of the population said to have been successfully
vaccinated in the previous 5 years, and (2) according to the death rate from
small-pox in 1885-86.
District.
Bhandara ... ...
Raipur ... ...
Chanda ... ...
Hoshangabad ... ...
Betul ... ...
Nagpur ... ...
Balaghat ... ...
Jubbulpore ... ...
Damoh ... ...
Bilaspur ... ...
Saugor ... ...
Narsinghpur ... ...
Wardha ... ...
Chhindwara ... ...
Seoni ... ...
Nimar ... ...
Sambalpur ... ...
Mandla
... ...
Position in scale of
protection No. 1
worst No. 18 best
protected districts,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Position in seale of
small-pox death
rate No 1 sightest,
No. 18 severest death
rate.
1
12
4
18
5
2
8
15
7
13
10
9
3
16
11
17
14
6
The position in the 2 scales occupied by several of the districts shows a dis-
tinct relation between the state of protection enjoyed by the population and the
death rate from small-pox, but there are several districts in which no such
relation is found to exist.
In the case of the districts of Wardha and Mandla the high position they
occupy both as to protection and small-pox mortality indicates that either the
vaccine operations returned as successful are really not so, or that while a large
part of the population is well protected parts of the district escape vaccination
altogether, and the reports of the Civil Surgeons of these districts show that
parts of the districts do escape vaccination, in the Wardha district, because of
the oppssition of the people in towns and large villages and in the Mandla dis-
trict, because the vaccination staff is so small that only half of each circle can
be worked over during the year. But from what I saw of the work in this dis¬
15
41. The inspection in the district of Nagpur was carried out by the Assis-
tant to the Civil Surgeon and that in the Jubbulpore district by an Assistant
Surgeon specially deputed for this work.
42. In his Review of the Report on the Vaccine operations in the Central
Provinces for the year 1884-85 the Chief Commissioner laid down that not less
than about one month or more than 6 weeks is ordinarily a suitable period for
the Civil Surgeon to be on tour.
43. The only Civil Surgeons who spent much less than a month on tour
are those of Bhandara, Saugor and Sambalpur. There was a change of Civil
Surgeon at Bhandara during the inspection season which no doubt partly offers
a satisfactory explanation of the very short period spent in camp, but as the
present Civil Surgeon took charge early in January I think he should have
done much more inspection work.
The short period spent by the Civil Surgeon, Sambalpur, on tour is accounted
for by his having been placed in medical charge of the wing of the Regiment
in the early part of the season and by illness later on.
It is particularly unfortunate that he was able to do so little inspection
work, as last year the Civil Surgeon was on tour only 9 days, while the suspen-
sion of the Native Superintendent and the detection of grave irregularities by
Vaccinators made it especially desirable that the Civil Surgeon should have
seen as much of the work as possible.
Of the 23 days spent on tour 9 were devoted to inspection of the work in
the Rerakole Feudatory State in which there is only 1 vaccinator.
The Civil Surgeon, Hoshangabad, was detained in the station by work at
the dispensary. Mr. Thipthorpe, Civil Surgeon, Wardha, had to return from
the district on account of a case of serious illness and to give evidence in Court.
The Civil Surgeon, Raipur, met with an accident which prevented his being
out for long in March.
The number of days entered as spent on tour by the Civil Surgeons, Nar¬
singhpur and Balaghat, and by the Assistant Surgeon at Jubbulpore include
those devoted to the special inspection of the sanitary state of villagas in which
cholera had appeared.
44. The Civil Surgeon, Sambalpur, visited on an average less than two
villages, and the Civil Surgeons, Bhandara and Chanda, less than 3 villages, each
of the days they were on tour. The number of villages visited by the Civil
Surgeons of Hoshangabad and Wardha was also small.
45. The Civil Surgeon of Sambalpur saw only 0.9 per cent of the persons
vaccinated by the district staff or practically none, and the percentage seen by
the Civil Surgeons, Bhandara, Chanda, Hoshangabad, Raipur and Bilaspur are
smaller than is desirable: but in the cases of Raipur and Bilaspur the total
number of vaccinated persons inspected by the Civil Surgeon is not small, the
small proportion seen being due to the large number of Vaccine operations
performed in those districts.
16
The area of these 2 districts and the vaccination staff employed in them
are so large that for the proper inspection of the work the Civil Surgeons should
be on tour during a longer period than is necessary in other districts.
The Civil Surgeons, Nimar and Mandla, saw nearly half of the total number
of persons vaccinated.
46. The proportion of vaccinated persons inspected by the Native Super-
intendents of Chanda, Betul and Nagpur is very low.
The Native Superintendent of Nimar saw nearly all the vaccinated persons
as already noticed.
47. The Civil Surgeons and Native Superintendents return the same ratio
of successful cases for the Province, and their percentage (92) is practically
the same as it was last year; the ratio returned by vaccinators is 1 per cent
lower than it was in the previous year.
48. The inspection, by Native Superintendents, of the Vaccinators' work in
the Feudatory States and Zamindaries of the Raipur, Bilaspur and part of the
Sambalpur districts was on a more satisfactory footing in the year under report
than in any previous year, as 2 Native Superintendents were (as sanctioned by
the Chief Commissioner in his letter No. 4499-224 of 21st November 1885)
appointed specially for this work; but as these men did not join their appoint-
ments till the end of January and beginning of February and were new, in
great part, to their districts, the amount of inspection done by them is compa¬
ratively small.
49. I had an opportunity of seeing the work in the Nandgaon, Khaira¬
garh and Kawardha States and in the Pandaria Zamindari during the past
working season, and there can be no doubt that it was not and has not been
satisfactory.
I also saw a considerable number of vaccine operations in the Betul,
Chhindwara, Balaghat, Raipur, Bilaspur and Mandla districts.
I did not find the names of unvaccinated persons entered as vaccinated in
any village forms. In several of the circles in the Raipur district the village
forms had not been given to the Kotwar, the names of the persons vaccinated
had not been entered, and in many the vaccinators had not re-visited the villa-
ges to record the results. The work of the previous, as well as the present year,
I also found in several instances bad, and altogether my inspection of the work
in this district led me to the conclusion that the vaccinators were badly super-
vised and had been so for some years, and thus allowed to get into a careless
unsatisfactory way of doing their work both clerical and vaccination. I saw
some indifferent and bad work in the Bilaspur district also. No doubt these
two districts with the Zamindaries and some of the Feudatory States have
hitherto been more than 1 Native Superintendent could thoroughly supervise,
but this is not a sufficient excuse for the state of the work in the Raipur
district.
In Chhindwara and Balaghat the work I saw was with few exceptions
good.
17
In Betul I saw comparatively few vaccinated persons, but in several villa-
ges the forms were not to be found.
50. The high ratio of success returned by vaccinators is due to (1) doubtful
cases being entered as successful, (2) the repetition of the operation on persons
already unsuccessfully operated on without recording any result till a success-
ful one is found.
51. I also saw enough to convince me that vaccinators are not sufficiently
careful in the selection of the lymph they use or in the children they vaccinate.
DISTRICT VACCINATION.
The following is a precis of the reports submitted by Civil Surgeons:—
52. Saugor.—Vaccination was kept up at Head-quarters throughout the
non-working season with the exception of about 4 weeks at the close of the rains,
but lymph had been stored in tubes and with this work was recommenced.
In October 10 tubes of English lymph were received from the Sanitary Com-
missioner's office and gave successful results in 9 out of 10 children vaccinated
with it.
The Vaccinators were at their stations with a supply of lymph by the end
of October. The total number of operations performed was 112 more than in
1884-85. There were only 215 re-vaccination operations. The Civil Surgeon
is of opinion that the average of work by the Vaccinators in the City and Can-
tonment and in the district is not as much as it might and should have been.
The Civil Surgeon only took charge of the medical duties of the district in
November, and the inspection work (which was carried out by him this season
in place of by the Assistant to Civil Surgeon as formerly) was rather small in
consequence: he was on tour 23 days, and reports that he found little to be
desired as regards the vaccination of children born since the close of last
vaccinating season, but that the vaccinators' work in former years was bad as
is proved by the large number of persons found marked by small-pox. The
Civil Surgeon thinks that the staff is insufficient and should be increased by 2
Vaccinators for the district. The Native Superintendent is well reported of.
2 vaccinators, Nundkishore (1st class) and Ramchunder (2nd class), are men-
tioned as having done specially good work and 2 are unfavourably reported of.
DISPENSARY VACCINATION.
The Hospital Assistant attached to the Main and Sadar bazaar dispen-
saries did not (under recent instructions) vaccinate during the past season.
SMALL POX.
There were 67 deaths in the district and 4 in the town reported from this
disease.
53. Damoh.—The supply of lymph was kept up in the Head-quarters
town and neighbouring villages during the non-working season. The English
18
lymph proved unsuccessful. 3 Vaccinators were employed on cholera duty at
the beginning of the season so that they did not begin vaccinating till the 8th,
20th and 22nd November respectively: notwithstanding this there was an
increase of 106 in the number of operations. The ratio of success returned by
the vaccinators is lower than it was last year, the difference being due to more
accurate recording of results.
The Civil Surgeon was 40 days on tour and found the percentage of success
to be 83.72.
No falsification of the returns was detected. The Native Superintendent
was 143 days on tour and inspected 7,817 children. The Civil Surgeon reports
that he was not as energetic as he should have been.
The attitude of the people in general is one of indifference, the higher
and more wealthy still showing some opposition.
DISPENSARY VACCINATION.
The Hospital Assistants did more work than in any previous year: the
increase took place at all the dispensaries, but was most marked at the main
dispensary. The vaccination by the Hospital Assistants at Damoh and Hatta
is to be confined to the limits of the Municipal town.
SMALL-POX.
There were 665 cases as compared with 1,113 in the previous year; but the
Civil Surgeon found on personal inspection that cases of chicken-pox are
reported as those of small-pox.
54. Jubbulpore.—The number of operations by the Vaccine department
is 5,905 below that of the previous season, the decrease being due partly to less
work having been done by the old vaccinators and partly to 4 of the men being
new, to replace 1 died, 1 dismissed and 2 resigned. The Vaccinator who died
was a great loss to the staff : 6 Vaccinators are reported as having worked well,
and 4 badly.
The percentage of success as given by the Vaccinators is 93.3, by the Assis-
tant Surgeon who inspected the work as 90.55, and by the Native Superinten-
dent as 84.60, the last named ratio being that accepted by the Civil Surgeon as
most correct.
The Native Superintendent was 151 days on tour, visited 1,033 villages, and
inspected 11,565 children. The Civil Surgeon's report on him is somewhat more
favourable than it was last year.
The Assistant Surgeon who was deputed to inspect the work spent 88 days
in camp, inspected 412 villages, and saw 3,449 children; his inspections were
largely among the hilly and jungly parts of the district; he examined the work
in all the circles.
The Assistant Surgeon reports that opposition to vaccination is growing
weaker year by year; the people in some villages have began to appreciate the
value of vaccination, and with a little persuasion can be induced to have their
children vaccinated.
19
DISPENSARY VACCINATION.
The number of operations performed by Hospital Assistants is 1,330 less
than that of the previous season. This is, the Civil Surgeon thinks, partly due to
the areas of the Murwara and Sehora Hospital Assistants' work having been
reduced and partly to the Hospital Assistants not considering vaccination so
distinctly a part of their work. The Medical Officer of the city branch took
leave and those of the Main and Sehora dispensaries were changed. The falling
off may be partly due to this.
SMALL-POX.
Only 3 deaths were reported as having occurred from this disease, and the
Assistant Surgeon could not in any of the villages hear of a vaccinated child
having died of the disease.
55. Narsinghpur.—The lymph became inert at the end of June, but work
was recommenced at the end of September from lymph stored in tubes: and from
this aided by 10 tubes of English lymph, which all proved good, the vaccina-
tors were supplied and commenced work on the 1st November: 1 Municipal
Vaccinator was employed for the towns of Narsinghpur, Gadarwara and Chhind¬
wara, the Hospital Assistants being relieved of this duty.
There was a falling off of 657 in the District vaccination and of 48 in the
Town vaccination, the decrease being due, the Civil Surgeon thinks, partly to the
hindrance the work sustained by the heavy rain in December and partly to
sickness among the staff.
The Vaccinators report the ratio of success as 99.64 including unknown
cases while the Civil Surgeon states it at 94.16 and the Native Superintendent
at 93.89. The Civil Surgeon was 57 days on tour, he saw each of the circles
and inspected 4,245 children.
The Native Superintendent visited each circle 2 or 3 times besides taking
the work of a sick vaccinator ; he is well reported of.
The Civil Surgeon reports that the large majority of the people are indif-
ferent in respect to vaccination, that the better educated appreciate it and com-
pare the immunity from small-pox now enjoyed with what was the case in
former years, but that the Brahmins are still strongly opposed to it, especially
at Birman. The Civil Surgeon thinks that there should be a " reserve" vaccin-
ator to take the place of any one falling sick.
SMALL-POX.
144 cases of and 70 deaths from small-pox were reported during the year.
56. Hoshangabad.—The supply of lymph was kept up during the non-
working season at Head-quarters.
During the non-working season vaccinators were also employed on cholera
duty, and two in assisting the Civil Surgeon to test the accuracy of the vital
statistics of the town of Hoshangabad. The Vaccination circles were re-cast
during the non-working season, as it appeared that the distribution of work had
been unequal.
20
The Civil Surgeon directed the Vaccinators to work in a regular order so
that he might know if any portion of the district remained unprotected at the
close of the season, and he found that rather less than a third of the people had
not had vaccination carried out among them: this he attributes to the large size
and population of the circles and the great difficulty in getting hold of the
people in March as they are then all occupied in their fields. There was an
increase of 314 in the number of operations, but the increase is entirely in re-
vaccinations, there being a decrease of 669 in the number of primary operations.
Re-vaccination rose from 224 to 1,207, but the greater part of the operations
were performed on children of from 3 to 9 years of age.
The Native Superintendent was on tour 125 days, visited 487 villages,
inspected 7,135 vaccinated children, and returns the percentage of success as
93.72. he is well reported of.
The Civil Surgeon was in camp only 29 days, he visited 109 villages, saw
1,300 vaccinated children, and gives the percentage of success as 94: dispensary
work detained him in the station.
The attitude of the people is the same as it was last year.
DISPENSARY VACCINATION.
Vaccination by Hospital Assistants was confined to the limits of the towns
in which the dispensaries are situated. This has caused a falling off in the
numbers vaccinated, especially by the Hospital Assistant of the Sohagpur dis¬
pensary, who used in previous years to vaccinate in villages far distant from his
dispensary.
SMALL-POX.
The police returned 213 cases of small-pox (with 1 death) in 122 of which
vaccination was said to have been performed.
The Civil Surgeon feels sure from enquiries which he has made that many
cases of this disease are not reported.
57. Nimar.—The Vaccinators remained in their circles and kept up the
supply of lymph during the non-working season. Birth registers were institu-
ted in the towns of Khandwa, Mandhatta, Burhanpur and Pandhana, and by
these it was hoped, all children born during the year could be traced, certifi-
cates of successful vaccination were also issued to the parents of children suc-
cessfully vaccinated in Khandwa and Burhanpur where Municipal Bye-laws
render vaccination compulsory. A system of making a vaccination census in
each village, introduced by Doctor Cullen, was fairly completely carried out and
is said to ensure as nearly complete protection of the people as is possible under
existing circumstances. The total number of primary operations is less by 822,
but that of re-vaccination is larger by 278.
The ratio of success for primary operations claimed by vaccinators is 97.10
per cent. The decrease in the number of operations is attributed to idling on
the part of 3 vaccinators and the illness of one. Again this year the number of
children under 1 year vaccinated exceeds the number alive according to the
police returns : the Civil Surgeon remarks that this shows that not only was the
registration of births incomplete but that very few children of this age can have
been left unprotected.
21
Of the 303 re-vaccination operations, 32.67 per cent proved successful, and
care was taken that as far as possible only cases of real re-vaccinations were
entered as such.
The Civil Surgeon spent 44 days in camp, visited 230 villages and inspected
4,821 vaccinated persons: he returns the percentage of success as 85.1 instead of
97.10 claimed by the vaccinators.
This difference was due chiefly to the occurrence of a large number of cases
in which although the vesicles were doubtfully developed the result had been
entered as successful. In a good many cases he found the results had been
entered without proper inspection by the vaccinators, but in only very few had
unsuccessful cases been entered as successful. The registers were found correct,
and in the villages which the Civil Surgeon visited he found most of the chil-
dren under 10 years of age vaccinated.
The Native Superintendent spent 160 days on tour, visited 542 villages, and
inspected 11,242 vaccinated persons; he is very favourably reported of by the
Civil Surgeon.
The bulk of the people accept vaccination if not with intelligent or great
good will at least as an established custom, but members of the Borah, Bun¬
niah and other exclusive classes do all in their power to conceal and protect their
children when Vaccinators are in the neighbourhood: there has not been any
instance of pronounced opposition.
The Civil Surgeon acknowledges the assistance afforded by the Malguzars
of Rustumpur, Songir and Mundi.
DISPENSARY VACCINATION.
There was a falling off in the number of operations performed by Hospital
Assistants, the numbers being 372 as compared with 413 in the previous season.
This decrease is due to the Medical Officer of the Khandwa and Burhanpur
dispensaries having been relieved of Vaccination work entirely and to the area
of work for those at the other dispensaries having been confined to the limits of
their towns.
SMALL-POX.
Can scarcely be said to have appeared in this district: one case occurred in
the town of Khandwa in the person of a girl who had apparently acquired the
disease while on a visit to Holkar's territory. No death from the disease was
reported. The Civil Surgeon remarks that " Dr. Cullen's continued efforts have
" familiarized the people with vaccination so that it is now generally accepted.
" The result is that small-pox has ceased to be an important factor in the mor¬
" tality of the district."
58. Betul. —Vaccination was kept up till the beginning of September when
the lymph became inactive. The English lymph did not yield quite satisfac-
tory results, but a supply was obtained from Khandwa and Chhindwara, and
by the end of October each Vaccinator had a supply sufficient to commence
work with.
The number of primary operations was 126 less than that of the previous
season, and under the head of re-vaccination there was a decrease of no less than
22
1,622 operations: this is due to a stop having been put to the practice of re-
turning as re-vaccinations, cases in which the operation had been repeated in
consequence of previous failure.
The vaccinators return their percentage of success as 95.63 or 2.29 less than
that of the previous season, the difference being due to more care in recording
the results.
The Civil Surgeon was on tour 41 days and saw the work of each Vaccin-
ator. He inspected 2,801 vaccinated children and found the percentage of
success 96.35, and can only account for his finding the ratio of success higher
than that returned by the Vaccinators themselves by supposing that unsuccess-
-ul cases were not brought forward.
The Officiating Native Superintendent and 1 Vaccinator are unfavourably
reported of.
DISPENSARY VACCINATION.
Hospital Assistants performed 396 primary operations or 32 less than they
did last year.
SMALL-POX.
Was prevalent in a number of villages. The cases seen by the Civil Sur-
geon being chiefly in adults and unprotected children of from 5 to 12 years of
age. In the cases of several vaccinated children who were said to have had the
disease the Civil Surgeon could not find any trace of it.
59. Chhindwara.—Vaccination was maintained throughout the year at
Chhindwara and Lodhikhera by the Hospital Assistants and the English lymph
proved successful.
There was a large decrease in the number of operations performed, due in a
great measure to failure to do his work by one of the Vaccinators sent to the
Jaghirs and partly to the unusual prevalence of fever. The decrease was chiefly
in primary operations, the numbers being in primary 1,489 and in re-vaccina-
tion 228.
The percentage of success claimed by the Vaccinators is in primary opera¬
tion 99.89 and in re-vaccination 81.16.
The Native Superintendent was on tour 172 days and is well reported of.
The percentage of success in primary operations was as under:
By Vaccinators ... ...
„ Native Superintendent ...
„ Civil Surgeon ... ...
99.89
93.22
91.09
DISPENSARY VACCINATION.
The Hospital Assistants at Chhindwara did more work than in the previ-
ous year, viz., 153 primary and 81 re-vaccination operations, while the Medical
Officer at Lodhikhera performed 31 more primary but 161 fewer re-vaccination
operations.