NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
26
THIRD SPECIAL REPORT ON THE
the National Vaccine Establishment, he found that the failures were only
one in 170. In a foot-note it is stated that in 1863, Mr. Marson failed
only three times out of 1,479 vaccinations ; and that both Mr. Marson
and Mr. Sheppard have each vaccinated 2,000 times without a failure.
As regards success, whatever can be done in England can be done
in Bengal; and with careful training, I have no doubt that for three
months of the year, if only the work of the best trained vaccinators were
taken into the calculation, very soon a higher percentage of success may
be reached, than has ever been recorded in Europe. The men are most
expert, the virus is most perfect, and the climate is all that could be
desired ; and under these circumstances, failure ought to be a difficulty,
and success an unfailing result. Of course when the work of the entire
department, extending over the whole season, is embraced in the cal-
culation, allowance will always require to be made for some unskilled
operators, or careless vaccinators, while possibly a few failures may be
occasioned by climate.
Besides the high rate of percentage of successful cases, which
seemed to exceed that of previous seasons, there was a much more
marked and noticeable feature of the vaccinations of the last season, in
the fact, that owing to departmental rules having been more strictly
enforced, a greater uniformity in the results was observable.
Most of these improvements depended on greater nicety in little
points. As regards the protection to the individual afforded by the
vaccination, such a change for the better can have no influence. Pro-
bably even with regard to communities the advantages in themselves
might be insignificant. From thepoint of view of departmental efficiency
however such a change is no slight gain. It points to the vaccinators.
having been better in hand; it bears evidence to the controlling power
having been more successfully employed; and it shews that the various
elements of which the establishment consists, can be guided in a given
direction more efficiently. Individual marks of care may constitute
trifles in themselves, but the sum of such trifles goes far to make the
difference between a perfect and a slovenly method of conducting the
operations. When I see such trifles have been attended to, I have less
hesitation in feeling sure that more important matters have not been
overlooked.
Explanation of
success.
31. Careful insertion of the virus below the cuticle, and little niceties
of manipulation, probably assist a little in leading to this success.
Selection of the individuals to operate on, may, perhaps, also exercise a
PRESIDENCY VACCINE DEPARTMENT.
27
certain amount of influence on the result. I might besides dilate on the
advantages of attending to many other precautions which, though small
in themselves, may be more or less important when spread over large
numbers. Were I to do so, it would only serve to lead to erroneous
conclusions, as the explanation is to be found mainly in the following
three points, to which I attach a value in the order in which they are
placed. (1.) All of these vaccinations have been practised from arm
to arm. (2.) The supply of virus has been practically unlimited, and
its selection entrusted to only the most competent persons. (3.) No
man has been allowed to vaccinate largely till he has shewn himself
expert.
With regard to the last two points I shall add nothing more, but
will now make a few observations in regard to the importance of arm
to arm vaccination. If there is one thing of which I am more convinced
than of another, with regard to public vaccination in India, it is
of the fact, that if even a remote approach to perfection is aimed at, it
can only be reached through arm to arm vaccination. Preserved lymph,
crusts, and other contrivances for avoiding arm to arm vaccination, to
my mind constitute only so many agencies for making failure more easy.
Under many circumstances such are the only available means for
commencing vaccination; but when one perfect vesicle has been
procured, to continue to vaccinate with crusts, or lymph preserved in
any way, is to court failure.
Every one of the cases vaccinated in the Mofussil have this year
been performed from arm to arm. Of course each of the Superin-
tendents, as well as myself, was aware that such was practically true,
but in case a single crust or tube or other means had been used,
unknown to us, the vaccinators were asked the question and deny that
on even a single occasion was this the case. This is only an instance
of a right principle having been carried too far. If the practice of
arm to arm vaccination is universally carried out, a few exceptions to
the rule, if judiciously allowed, would not materially affect the results,
and serve somewhat to render vaccination on such a large scale rather
more easy. In after years, when the people have been drilled into the
necessity of complying with the exigencies of arm to arm vaccination,
the vaccinators may be safely trusted to employ stored lymph to help
them on any emergency, and the knowledge of the superior efficacy
of fresh lymph, will prevent them from abusing the privilege. For
the present I consider that the Superintendents can hardly be too
28
THIRD SPECIAL REPORT, &C.
strict in enforcing compliance with the rule of operating direct from
the vaccine vesicle.
It involves difficulty and entails a slight expense, but the result
attained is cheaply bought. If the people are once shewn it is not
a necessity, they will give much trouble in after years; but once having
learned that such is the custom, each year makes it more easy to
get them to conform to it. Such a mode of working provides for success
a dozen of years hence, and half an hour occupied in arguing the point
with a refractory villager is not time badly spent.
Conclusion.
32. As an Appendix to the third special report on the Presidency
vaccine establishment, I forward the following reports :—
1st. On the " stamping out" of small-pox in Calcutta.
2nd. On the out-break of small-pox at Sankerberiah, Thannah
Sultanpore, suddenly " stamped out" by extensive vaccine operations.
3rd. On the subject of "stamping out" small-pox epidemics, occur-
ring within a certain distance of Calcutta, by means of a moveable
vaccine establishment.
These three reports are for the Government of Bengal, and I
have to request that they may be forwarded.
In conclusion I have to solicit the cordial co-operation of the head
of the medical department in supporting my recommendations, in
the case of any reference being made by the Bengal Government.
Any personal difference of opinion, on trivial matters of arrangement,
serves so far to complicate, any final action which the Government
may choose to take, as to interfere materially with the success of any
scheme, however carefully prepared, and however certain originally
to attain its end.
REPORT
OF THE
DARJEELING CIRCLE OF VACCINATION
FOR 1867-68.
BY
T. MATHEW, M. B.,
SUPERINTENDENT, VACCINE CIRCLE.
REPORT
OF THE
DARJEELING CIRCLE OF VACCINATION
FOR 1867-68.
From DR. T. MATHEW, M. B. Supdt., Darjeeling Vaccination Circle, to the
Secretary, Inspector-General, Indian Medical Department, Lower Provinces,
dated 28th April 1868.
I HAVE the honour to submit the returns of vaccination for the
districts comprised in the Darjeeling circle for the season 1867-68.
2. In the subjoined table, the total operations for 1867-68 are
contrasted with those for 1866-67, and an increase, for the present season
over the last, is shown of 12.673 successful cases, and of 13.313, of
all vaccinations, checked and verified throughout, on the system
described in my first report:—
Season.
1866-67 ...
1867-68 ...
Increase ...
Successful.
9,998
22,661
12,673
Unsuc-
cessful.
1,360
1,702
342
Doubtful.
606
818
212
Unknown.
171
257
86
Total.
12,125
25,438
13,313
Percentage
Successful.
82
89
3. In comparing the work of both seasons, it has to be remembered,
that many difficulties and delays, first in training the vaccinators, and
afterwards in establishing them in their districts, which were met
with in the first season, had not to be encountered again; but, keeping
this difference fully in mind, I cannot doubt that a very satisfactory
progress has been made, and I feel much more hopeful now, than when
1
2
DARJEELING CIRCLE
I submitted my first report, of seeing vaccination, at no distant date,
established upon as firm a basis in the circle as that it stands upon in
the North-West.
4.The success which has attended this season's operations must
be ascribed in no small degree to the fact of my having been provided,
through the courtesy of the Superintendent General of Vaccination, North-
Western Provinces, with competent Native Superintendents. On my
making known to him that I had failed to find qualified men in Bengal,
Dr. Pearson was good enough to select from his staff three of his most
trustworthy and experienced vaccinators to fill these appointments,
and they proved a very valuable acquisition. Thoroughly trained in
the working of the system which has proved so successful in the North-
West, and which it has been my endeavour from the first to imitate,
they proved most useful, not only in guiding the vaccinators, and in
verifying their work before and after my visit to their districts, but in
placing the boon offered to the people in the clearest way before them.
Objections too to vaccinations, founded on religious and caste scruples,
which natives would naturally hesitate to acknowledge to an European,
they freely disclosed to one of themselves, and in demonstrating how
groundless such objections were, the Superintendents were of the
greatest assistance to me.
5. The establishment of vaccinators remains the same in point of
strength as it was last year. The few vacancies that existed at the
commencement of the season were filled up by inoculators, and the
new men have worked very fairly; but, of the originally entertained
vaccinators of this class, several had to be dismissed, in the course of
the season, for irregularities that could not be over-looked, and my
experience of them did not induce me, when filling up their places, to
look for inoculators to the exclusion of all other candidates. I found
that inoculators, as a rule, worked less steadily than others, that few
men, with any pretensions to respectability, belonged to their body, and
that, unless an inoculator be placed as a vaccinator in the very place he
had formerly practised inoculation, (and this can be very seldom done)
he does not seem to possess any special influence with the people by
reason of his previous occupation. Of the twenty-six vaccinators of my
Plain's establishment at the commencement of the season, sixteen were
formerly inoculators, and of these I found it necessary to part with four.
The remaining twelve have done satisfactorily.
6. In addition to the districts named in my first report, vaccin-
ators were placed, this season, in the Western Dooars; but, unless an
OF VACCINATION.
3
increase to the establishment be granted, it would not, in my opinion, be
wise to take up the as-yet unoccupied districts of Maldah and Pubna.
In fact, the- number of districts in which vaccine operations can be
successfully undertaken, must be determined by the number of Native
Superintendents, and I have but three at my disposal. A district as
large as Dinagepore or Rungpore is quite as much as one Native Super-
intendent can manage, if he is to be held responsible for the genuiness
of the work of the vaccinators under him. After placing a Native
Superintendent in charge of each of these districts, I had but one left
to supervise Rajshahye and Bogra, so that, if I had taken a few vaccin-
ators from any of the districts named, and placed them in Maldah and
Pubnah, I could not have provided for their supervision beyond my
own passing inspection, and this would have been quite inadequate.
The Darjeeling Terai and the Western Dooars were assigned to the
Deputy Superintendent. Sub-Assistant-Surgeon Nil-Moni Chowderee;
as he was new to the work, I did not wish to give him a larger tract of
country than he could easily manage, he is active and energetic, and
promises to be a very efficient officer.
7. Considerable inconvenience and loss of time having been ex-
perienced last year in paying vaccinators directly—in more than one
instance, avaccinator having spent a fifth of his working time in going
to the sudder station to receive his salary and in returning to his post—
the sanction of the Inspector-General of Police was asked for and
obtained to my attaching each vaccinator, for the purpose of his receiv-
ing his salary only, to a Thannah. By this plan, the vaccinators' pay,
sent by me to the District Superintendent, is forwarded by him, together
with the pay of his own establishment, to such Thannahs as the vaccin-
ators may be stationed at, and the latter are paid without loss of time.
The adoption of this arrangement led to a re-distribution of the vaccin-
ators of each district at the commencement of the season, and no less
than seventeen of them were placed at stations where vaccination had
not been before practised.
8. Some little delay was, in consequence, to be apprehended in
getting the vaccinators to work, but it proved very trifling, and at every
place selected, except one, they found immediate employment among the
people. It will not, of course, be understood, that the majority of the
population anywhere availed themselves of the vaccinator's services, or
that he ever got full work, but the numbers, compared with those of last
year, are far from unsatisfactory.
4
DARJEELING CIRCLE
9. In obedience to paragraph 12 of the Lieutenant-Governor's
Resolution, dated 24th July, 1867, the district officers were solicited to
aid in any way in their power the Native Superintendents and vaccin-
ators, and the latter were accordingly furnished with sealed perwannas
by the Magistrates, recommending them to the people; the objects for
which vaccinators were sent among them, were also proclaimed at the
larger Hauts in the vicinity of which the vaccinators were stationed. In
addition to these means for securing the good-will of the people, every
necessary explanation was given by myself in the course of my tour,
and by the Native Superintendents in their respective districts. It
needs scarcely be added, that nothing like compulsion was ever
attempted.
10. Further, the Magistrates were asked, that no opportunity
might be lost of showing the people the value of the boon offered them,
to communicate with the Native Superintendents, should the break-out
of small-pox be reported in any part of their districts, and the latter
were directed, immediately upon the receipt of such communication, to
proceed with one or more vaccinators to the place indicated. It is rather
remarkable that no cases of small-pox were reported, and that I myself—
and it was the same last year—could hear of no small-pox in the line of
country through which I travelled.
11. Perhaps, in consequence of this immunity, I heard or saw
very little of the practice of inoculation, and as I noticed before, the
inoculators, as a rule, shrank from practising or even showing themselves
in the localities occupied by vaccinators. At one place, Singra, in the
North of Rajshahye, they succeeded for a time in prejudicing the people
against vaccination; but in others, Boda for example, in Rungpore, and
Raneesunkail, in Dinagepore, I found some of the inhabitants hostile
to the inoculators, in consequence of loss of life caused by their oper-
ations. I am, as I stated last year, disposed to believe, that inoculation
is less regularly practised in these districts now than formerly, and that
unless there happen to be an epidemic of small-pox among them, the
bulk of the population is rather unwilling than otherwise to have
recourse to it.
12. As I gave, in my first report, as complete an account as it was
in my power to furnish, of the feelings of the people on the question of
vaccination, I need not again enter into the subject, it will suffice to say,
that, though it is too early to hope that these feelings have undergone
any material change, I had very much less difficulty with the people
OF VACCINATION.
5
this season, than I had the season before, and that it occurred to me but
once during the present season, (it happened often during the last) to
arrive at a place and find the vaccinator absolutely idle. It is true, that
my staff of vaccinators was more experienced this season, and that I
had the assistance of Native Superintendents of great energy and intelli-
gence ; but making every allowance for these important aids, I am still
encouraged by all that I have seen, to believe, that vaccination has, by
its own merits, already taken some hold upon the minds of those of the
people amongst whom it has been practised.
13. The system of check by village register, described in my first
report, was maintained throughout. Every vaccinator's diary was re-
peatedly examined, and its figures compared with those in the village
record, by the Native Superintendent to whose district he belonged.
The vaccinators' papers were also inspected by myself in the course of
my tour, and I feel very confident as to the genuineness of the num-
bers returned under the heading " total vaccinated." But one vaccinator
was discovered by me to have made entries of operations in his diary,
which did not tally with the village register, and he was at once dis-
missed. I found, however, in the papers of several vaccinators, a less
serious irregularity, the return as successful of doubtful cases. This
occurred from mere carelessness, and was not done with an intent to
mislead, as in all such instances, the totals of operations in the village
records were accurate. It was sufficient, in such cases, to warn the
vaccinators against a repetition of their negligence.
14. The season's work commenced in November in the Darjeeling
Terai, where I had arranged for my being joined by the Native Super-
intendents on their arrival from Rohilcund; it was necessary that I
should see them together to settle how the districts were to be distri-
buted among them. Some slight delay occurred before they could be
sent to their destinations, as I was not quite satisfied with the lymph
supplies I had collected during the rainy season at Darjeeling. How-
ever, the first operations made in the Terai resulted in a genuine vesicle.
Supplies of lymph were sent to the more distant vaccinators in the
Rajshahye and Bogra districts by post, and the Native Superintendents
ordered to proceed to their posts with as little delay as possible.
15. Leaving a vaccinator at work in the Terai, I went on to
Julpigoree, the Deputy Superintendent remaining with me for a short
time, as he had had no previous experience in conducting vaccine
operations.
6
DARJEELING CIRCLE
16. Three vaccinators were placed in the Western Dooars, at
Mynogoree, Julpigoree, and Buxa. At the first-named place, a very
active vaccinator commenced work in the last week in November.
I visited the place a week after he began, and was gratified to see that
he had established a good vesicle, and to find that the people made no
difficulty about accepting his services in sufficient numbers for a begin-
ning, vaccination never having been practised there before. During
the season, he made an average of 300 successful vaccinations per
month, and on my again inspecting his work and his records in March,
I found that he had been very accurate and painstaking.
17. At Julpigoree, where vaccination had been commenced last
season, and had made some way, I placed a man who had previously
practised there. I saw him well to work before I left, the people being
by no means ill-disposed towards vaccination: he worked pretty steadily
for a couple of months, but then became careless and idle; and, on my
return I found his papers full of inaccuracies, and the quantity of work
he was doing, trifling—the Deputy Superintendent, besides reporting
unfavourably upon him. This vaccinator has been dismissed.
18. A vaccinator of some experience was sent to Buxa early in
December. He was followed by the Deputy Superintendent, whom I
instructed to engage, if possible, a native, or resident of the place, to be
trained, and ultimately employed as a vaccinator. This he succeeded
in doing, and also in getting some of the few residents of the
place to submit to the operation. On the Deputy Superintendent's
departure, the vaccinator, although he had been told that he should
not be detained at Buxa after the newly engaged man could be trusted
to work alone, absconded without warning, and the Deputy Superinten-
dent on his return collected, with some difficulty, from the village papers
the returns of the little work that had been done. He then, by my
instructions, appointed the Nepalese resident of the place, whom he had
taught how to vaccinate, to the post. This vaccinator made but forty-
four vaccinations in January, and fifteen in February; and on my return
to the Western Dooars in March, when I proposed visiting Buxa, the
Deputy Superintendent reported that the man had ceased work.
19. The population of Buxa is so scanty, consisting only, outside
the cantonment, of a few hundred Nepalese immigrants, whom I know
by experience to be the most prejudiced of any class of natives against
vaccination, that there is really no occupation for a vaccinator at the
place, and my establishment being so limited that I can afford but
OF VACCINATION.
7
three vaccinators to the Western Dooars. I should be glad of the sanc-
tion of the Commissioner, upon whose application I was directed to
place a vaccinator at Buxa, for my removing him to some more populous
locality in the district.
20. From the Western Dooars, I marched to Boda, which place I
reached on the 14th December; vaccination never having been practised
there before, I was pleased to find the vaccinator, who had been recently
placed at Boda by the Native Superintendent of the Rungpore district,
in very fair work. He had made 114 vaccinations, the majority of
which I inspected, from the first of the month with scarcely a failure
among them. The people told me that they had no dread of vaccina¬
tion except for its novelty, and several of them expressed a great
dislike to inoculators. This vaccinator made an average of nearly 300
successful vaccinations per month during the season.
21. I next crossed to Nischintipore, to commence the inspection
of the work in the Dinagepore district, leaving the rest of the Rungpore
vaccinators to be visited later. Seven vaccinators, all of them originally
inoculators, were placed in this district; I had at first proposed to
appoint three of this number to Maldah, but I found that one Native
Superintendent could not undertake the two districts.
22. The vaccinators were placed at the following Thannahs:—
Nischintapore, Raneesunkail, Beergunge, Hubbra, Gungarampore, Nawab-
gunge and Hemtabad, all, except the first named, never before having
been visited by a vaccinator. It was in this district, Nischintipore
excepted, that I found so much difficulty in getting vaccination,
even to a small extent, established in my first season. The Native
Superintendent had placed a vaccinator at Nischintipore in the last
week in November, the people being as well disposed as I found
them the year before; but, scarcely had the former turned his back
than the vaccinator left the place for some days, and on the Native
Superintendent's return to meet me there, he found that, entirely
from the vaccinator's negligence, scarcely anything had been done.
Misconduct of this kind could not be tolerated; and, on my
arrival, the vaccinator was dismissed, and another man appointed. The
vesicle here was very good, but the cases, at the time of my inspection
were few in number.
23. I next visited Raneesunkail, where the vaccinator had already
met with some success. He had commenced early in December, and I