NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
SMALL-POX, &C.
5
successful, thirty-one doubtful, and twenty-one failures. I beg to be al-
lowed to lay great stress on this amount of success, and to point it out as
deserving the careful consideration of the Government. It exhibts an
amount of perfection beyond which excellence in vaccination can scarcely
be attained to. This subject will again be alluded to in a later paragraph.
Inspection by
the Superinten-
dent of Vaccina-
tion.
16. As is usual in the working of this department, all the villages
in which vaccination was practised, were visited by one of the Superin-
tendents of Vaccination. The distance from the places in which he was
already engaged was so great that he could not follow the standing rule, of
seeing every vaccination while it was in progress; but he carefully inspected
every case that had been vaccinated which could be procured, and in this way
saw five thousand five hundred and seventy-four individuals who had been
vaccinated. In all seventy-two per cent. of the total numbers vaccinated.
This want of correspondence between the numbers vaccinated and cases in-
spected is an apparent and not a real difference. In every large inspection the
numbers fall short of the reported cases; some are away in the fields; some
have gone to neighbouring villages on business or pleasure; children have
gone to play at a short distance; some of the women from other causes are
not visible at the time of the inspection; and so, from one cause or
another, a considerable deficiency results at such inspections. It would
be possible to go again and again, till every case had been inspected;
but in working, this is found to be impossible, as to return, it may be
miles, to inspect a dozen of cases which have evaded inspection, involves
that a hundred cases requiring inspection are not overtaken. Speak-
ing generally, the number of cases left uninspected at Sankiberiah,
may be stated as being far too high to be sanctioned by any system
professing to ensure to all, that protection from small-pox, which vaccina-
tion is capable of supplying. In the present instance, the large propor-
tion inspected may be considered highly satisfactory, and such a high
percentage could not have been attained to, unless the population had
been unusually willing to follow the directions of the vaccinators, in stay-
ing at home during the day on which the Superintendent was to inspect
their villages.
The Superinten-
dent deputed to
Sankiberiah.
17. No special Superintendent being available for this work,
Baboo Jadub Chunder Ghose, Graduate of the Bengal Medical College
and Superintendent of the Southern Division of the Town of Calcutta,
was directed to proceed to Sankiberiah and inspect the cases there. He
reports that the people have thorough confidence in vaccination, that they
bear testimony to the kindness and attention of the vaccinators who have
6
OUTBREAK OF
worked among them, and are most grateful for the assistance which the
Government sent them during the outbreak. He had opportunities of
seeing vaccination during every day of its progress, and pronounces
the vesicles to have been typically perfect; to. have run the exact course
which is known to be normal; the areola in appearance and course to
have been strictly perfect; and the cicatrices of the less recent cases, to
have been deep, well defined, and presenting characters which are said to
belong only to perfect vaccination.
Reliable nature
of above report.
18. In estimating the value of the circumstances above reported,
every thing depends on the trustworthiness of the Government
servants reporting. It seems superfluous for me to point out, that the
report on the cases actually inspected by the Medical man deputed
for the purpose, must be received as literally and strictly true. He has
been in Medical charge of civil stations for ten years in the Punjab,
for seven years of this time, as an extra Assistant Commissioner, he
also exercised judicial functions both in civil and criminal suits. On
very many occasions he has received the thanks of Government for
his services, and I am glad to avail myself of this opportunity of again
pointing him out as one of the very best of the graduates of the
Medical College serving the Bengal Government, and in bringing it
prominently to notice that on this, as on every other occasion, his
duties have been discharged in an efficient and energetic manner and are
worthy of acknowledgment. With regard to the Head Vaccinator
Romanath Ghosal, he was specially selected for this duty, as it was
evident from the first that very much would require to be left to his
truthfulness and honesty, as many of the vaccinations could not be
inspected during their course. It is quite at variance with every tradi-
tion of this department to place any reliance on the reports of vacci-
nators till they have been verified by the Superintendents; but in this
individual instance, there seems no reason to question the correctness of
the returns, and every possible enquiry was made to test their accuracy.
Reports were received, week by week, of the amount of work done, and
of the quality of the vaccinations of the week before.
Amount of suc-
cessful cases not
overstated.
19. Exception may be taken to the great proportion of successful
cases, and the small proportion of failures, as no such success is reported
in other parts of the plains of India. On this point, though I did not
see one of the cases, I can speak with the utmost confidence. At the
season of the year when these vaccinations were made, this success (if
the vaccinators attend to the rules and precautions laid down for them) is
SMALL-POX, &C.
7
not exceptional among carefully trained men. The main figures corre-
spond exactly; the decimal figures only vary to a slight extent, from the
results of vaccinations, which have been minutely and carefully watched,
as well by the Superintendent General as by the Superintendents of
Vaccination. Such an absolute and exact correspondence of the results,
as can be traced month by month, between these vaccinations which were
not seen, and the vaccinations by many such batches of vaccinators,
the results of which could be verified, affords strong corroborative evidence
of the truth of the statements regarding the numbers operated on.
The nominal cost
of these Vaccina-
tions.
20. The nominal cost to Government of these vaccinations has
been Rs. 258-6-9. This sum comprises Rs. 181-10-9, the pay of the
vaccinators, Rs. 59-4, the travelling expenses of the Superintendent,
Rs. 17-8 contingent charges, comprising carriage hire, reward for the
child who accompanied the vaccinators, &c. This can only be looked
on as a nominal and not a real cost. Although it includes every
extra expense incurred for these Sankiberiah vaccinations, nothing
has been placed to this account as a share of the salary of the Super-
intendent General; in the same way, no part of the pay of the Super-
intendent who inspected the cases has been debited in this account.
The mere pay of the vaccinators is in the same way a defective item.
The results obtained could not have been secured by sending down
untrained men; vaccinators from the permanent establishment were
temporarily detached from it. The difference between the value of
work which they would have overtaken had they remained at their own
posts, and of that performed by the untrained men by whom their places
were filled, would have to be added to this account to make it any-
thing more than a nominal charge.
Nominal cost of
each Vaccina-
tion.
21. In consequence of the extensive frauds which are constantly
perpetrated by vaccinators in making false returns, it is absolutely
necessary, in estimating the cost of any particular vaccinations, to make
all calculations on the number of cases which have been inspected by a
Medical man. Of these cases five thousand five hundred and seventy-four
have been so inspected, the cost, as already stated, having been Rs. 258-6-9.
The price, therefore, of each vaccination, which has been inspected, has
been less than nine pie. So a fraction more than a penny for each has
been paid by Government on account of vaccinations, for which it has
the guarantee of a Medical man, not only that they have been actually
performed, but that they have been of a perfect character; this cheapness,
though a bonâ fide occurrence, is exceptional, and the explanation
of this has been detailed in the previous paragraph.
REPORT
ON THE
STAMPING OUT OF
SMALL-POX EPIDEMICS,
OCCURRING WITHIN A CERTAIN DISTANCE OF CALCUTTA,
BY MEANS OF A
MOVEABLE VACCINE ESTABLISHMENT.
BY
T. EDMONDSTON CHARLES, M.D.,M.R.C.P. LOND.,
SUPERINTENDENT GENERAL OF VACCINATION.
INDEX.
Small-pox epidemics in the neighbourhood of Calcutta
...
...
...
...
...
Proposed Vaccine Establishment only sufficient to overtake work near Calcutta ... ...
Establishment sanctioned for definite work ... ... ... ... ... ...
Additional provision to be made for stamping out epidemics
...
...
...
...
Argument why present establishment should not be thus employed
...
...
...
Unsafe nature of the arrangement
...
...
...
...
...
...
...
...
Unfavorable impression produced on the population
...
...
...
...
...
Distasteful to the Vaccinators
...
...
...
...
...
...
...
...
Proposal for a moveable Vaccine Establishment
...
...
...
...
...
...
Stamping out of Small-pox ... ... ... ... ... ... ... ... ...
Cost of each Vaccination performed by such an establishment
...
...
...
...
True estimate of the results attained at Sankiberiah
...
...
...
...
...
Economy of proposed arrangement
...
...
...
...
...
...
...
...
PARA.
1
2
3
4
5
6
7
8
9
10
11
12
13
REPORT
ON THE
STAMPING OUT OF SMALL-POX EPIDEMICS,
OCCURRING WITHIN A CERTAIN DISTANCE OF CALCUTTA,
BY MEANS OF A
MOVEABLE VACCINE ESTABLISHMENT.
Small-pox
epidemics in the
neighbourhood
of Calcutta.
1. In connection with a report dated September 1868, on an
epidemic of small-pox at Sankiberiah and the neighbourhood, which was
put a stop to by vaccination, I have the honor to solicit the attention
of His Honor the Lieutenant Governor to the subject of dealing with
small-pox epidemics in the districts of Bengal not far removed from
Calcutta.
Proposed Vaccine
Establishment
only sufficient to
overtake work
near Calcutta.
2. Should the scheme for the vaccination of the Presidency districts,
contained in my second Special Report on the Presidency Vacci-
nation Department, dated 23rd October 1867, receive the sanction of
the Government, the need for at once dealing with small-pox epidemics'
in the neighbourhood of Calcutta will be met. In the outlying portions
of these districts, and even in places within fifty miles of Calcutta,
where the means of inter-communication are very imperfect, it will be
impossible with the small establishment asked for, to deal satisfactorily
with any epidemics which may occur.
Establishment
sanctioned for
definite work.
3. Within the area of the proposed circles very large numbers of
people will be vaccinated, and year by year successive tracts of country
will be brought under the influence of vaccination. For reasons stated
in the report alluded to, those places most closely connected with the
metropolis will be first overtaken, and so for very many years, the
operations of the establishment will be confined to within a comparatively
short distance of Calcutta. As also stated before, it is not contemplated
that with the establishment asked for, all the country included within
2
THE STAMPING OUT OF
the Presidency districts will ever be overtaken. The working power
represented in the provisions of this scheme being altogether incom-
mensurate with the magnitude of such an undertaking.
Additional
provision to be
made for
stamping out
epidemics.
4. Under these circumstances, if it is the intention of the Govern-
ment, that when small-pox epidemics arise, measures shall be taken
by means of vaccination, to arrest their progress, it is absolutely neces-
sary that some provision should be made to enable such intentions to
be carried out. The necessity exists equally with regard to Jessore
or other places so close to Calcutta that a Vaccine Establishment can
on occasion be deputed to them, and in the case of those portions of the
Presidency districts which cannot be dealt with by any establishment
for which sanction is likely to be obtained at present.
Argument why
present estab-
lishment should
not be thus
employed.
5. Having a readymade Vaccine Establishment for a certain work,
there is at all times a tendency to indent largely upon it for duties quite
beyond its sphere, where the services of a vaccinator seem temporarily called
for. The extreme facility of the arrangement, requiring only an imperative
order from either the head of the Medical Department or from the Govern-
ment, renders it tempting to such a degree, as to be dangerous to the efficient
working of any Vaccine Establishment. To cheapen the price of each
vaccination with a fixed establishment, or, in other words, to furnish the
maximum of return for the money at the disposal of the Superintendent
General of Vaccination, it is essential that the vaccinators should work
continuously in the same neighbourhood. Months are required to make
an impression on any given point, and the result must be judged of by
the season's work, and not by what can be shown for the early months of
the vaccinating season. The call for vaccinators to deal with small-
pox year by year, comes at the very time, when, departmentally speaking,
the services of a vaccinator are worth many times as much as his monthly
salary ; and it is most unfair to the department to insist on its parting
with its vaccinators at that precise part of a short vaccinating season,
on which it depends for being able by a high annual average, to make up
for the unavoidably low monthly ratio of the rest of the year. Were no
simple remedy at hand, such an argument would not deserve much
weight ; but as the difficulty can be easily obviated, it clearly merits full
consideration.
Unsafe nature
of the arrange-
ment.
6. Much more important reasons, however, lead me to urge the
matter strongly on the Government. The experience of half a century
has shown, that a system of public vaccination to be so safe as to
SMALL-POX EPIDEMICS.
3
warrant the Government in pressing it on the people, absolutely
demands that almost every case shall be personally inspected by a
Medical man. Such a system has actually been in force in Calcutta since
1853, and I conceive it to be my duty to point out that in this year the
Superintendent General has been made to deviate from it. No argument
of temporary necessity can justify a departure from so imperative a rule.
To be able to supervise the number of vaccinations required of him, the
Superintendent must live in the midst of his men. If he is forced
to leave them to go and look after a batch of vaccinators working in a
small-pox epidemic, he necessarily must neglect his legitimate duties. It
seems a very problematical advantage, to leave hundreds of vaccinations
uninspected in one part of the country to overtake the inspection of not
a tenth of the number in another.
Unfavorable
impression
produced on the
population.
7. The impression produced on the people of any place from which
vaccinators are removed, is a most unfavorable one. At the time when
they have made up their minds to accept vaccination, the opportunity is
denied them. A sense of uncertainty connected with being vaccinated
is fixed on their minds, and they use this as a strong argument when
refusing to accept vaccination. The above is not only my own experience,
but it has also been pointed out in forcible language in the general
records of vaccination in India.
Distasteful to
the Vaccinator.
8. To the vaccinators themselves it is equally distasteful, and
proves a serious obstacle to retaining the services of the best men. No
individual from the neighbourhood of Calcutta will accept service on ten
rupees a month, if he is subjected to the chance of being sent on the
shortest notice, to a distance from his home, at any time that necessity
seems to call for such a measure. It is evident that to secure men per-
manently, the service must be made popular to them. A vaccinator of
some years' service, and of known character, is of such value to the
department that every endeavour is made to meet his legitimate wishes.
In ways which it is not necessary to detail, a small number of vaccina-
tors can be from year to year kept available for such service, but they
must constitute a separate body, distinct from the other establishment,
the men of which latter must feel safe from the liability to such irregular
duties.
Proposal for a
moveable
Vaccine
Establishment.
9. In my letter No. 13, dated 11th October 1867, addressed to the
Commissioner of the Presidency Division (which is already before the
Government), I have (in from paras. 6 to 10 inclusive) pointed out that
4
THE STAMPING OUT OF
the cheapest and best way of meeting the difficulty of dealing with
small-pox epidemics which do not occur near any place where regular
bodies of vaccinators are working, consists in having a " Moveable
Vaccine Establishment," attached to the " Presidency Vaccine Establish-
ment." Such a corps would be always available to work in the actual
sphere of all small-pox epidemics within a certain distance from Calcutta;
such limit being fixed at 50, a 100, or a 150 miles according to the local
facilities for transit. The strength proposed for this moveable esta-
blishment was a small one. Three head vaccinators on Rs. 15 a month
each, and 18 vaccinators on Rs. 10 a month, being considered sufficient
as a permanent establishment. When not employed where there was
small-pox, these men would not remain idle, but would be scattered
among the various gangs of vaccinators belonging to the Presidency
establishment, and be employed in extending the ordinary vaccine opera-
tions. The total annual cost of such permanent establishment would be
Rs. 2,700. Other incidental expenses would be incurred each time they
were deputed to deal with small-pox. The salary of a Sub-Assistant
Surgeon to supervise their working would come under this head; the
travelling expenses of the vaccinators; their batta when on such service;
the pay of temporary vaccinators to assist the permanent establishment
when the work was found too great for them, and certain contingent
charges; would also require to be considered as items extra to the per-
manent fixed cost of the establishment.
Stamping out of
Small-pox.
10. I have gone into considerable detail in the report on the
Sankiberiah epidemic for the purpose of showing the Government
how certainly and how quickly, small-pox epidemics can be " stamped
out" by the operations of such a moveable establishment. I have
on various occasions brought this matter forward, and detailed how
the Vaccine Establishment have abruptly arrested epidemics existing
round them, so that the Government are now in a position to take action
in the matter. It is no longer on a mere assertion or assumption of
what may be done that such arrangements are called for, but on the
actual experience of what has successfully been done in the past.
Cost of each
vaccination per-
formed by such
an establish-
ment.
11. Some years ago I pointed out that the probable average
cost of a vaccination in the country districts of Bengal, when each case
was supervised by a Medical man, might be estimated at four annas.
It is on this estimate, and not on the low nominal cost of the Sanki-
beriah vaccinations, that the cost of each vaccination performed by such a
moveable establishment must be judged of. Even with such a standard,
SMALL-POX EPIDEMICS.
5
there is no room for doubt that not only is such a plan as that brought
forward the most perfect way of dealing with such epidemics, but that it
is at the same time the cheapest. As far as I know, no other measures
which might be suggested could compete with this in point of economy.
True estimate of
the results
attained at San-
kiberiah.
12. In estimating the results attained by the body of vaccinators
deputed to Sankiberiah, it requires a certain knowledge of the laws of
small-pox to arrive at just conclusions. By merely looking at the number
of deaths which occurred over so many previous months, the most erroneous
estimate of the amount of good attained would be formed. During the
first seven months during which small-pox was present, the season of
the year is so unfavorable to the spread of the disease that it is never
epidemic. The power of propagation being at its minimum, small-pox
simply existed from month to month; but in obedience to natural laws,
it was unable to attack large numbers. During the next three months
the season was still such that the spread was necessarily tardy and the
original focus did little more than extend to a number of different centres,
and thus become ready to burst out into an epidemic, during the season
when such outbreak is to be looked for. It was during February, March,
and April that such an augmentation of small-pox was to be expected
as to constitute a calamity, and the mortality would then doubtless have
been very great indeed. By this time the vaccinators had been at work,
and the small-pox was stamped out entirely, just as it was ready to assume
epidemic form and virulence. The saving of life must not be estimated
by tens, as perhaps the previous progress of the disease might at first
sight seem to suggest, but by hundreds, as indicated by a correct
understanding of the natural climatic laws which govern the diffusion
of small-pox in Bengal.
Economy of
proposed
arrangement.
13. When a sacrifice of life requiring to be calculated by the
hundred is at stake, it requires but little apology for treating the subject
at length. The expenditure which I have indicated is a small one,
whether looked on as a whole, or considered from the point of view of the
cost of rescuing an individual from the chance of death during an epi-
demic visitation. I trust that the proposal for a Moveable Vaccine
Establishment will meet with the approval of Government, and that it
may be in full working order on the 1st October of this year.
(RESOLUTION.)
MEDICAL.
Fort William, the 23rd January 1869.
READ a letter No. 528, dated 3rd November 1868, from the
Inspector-General of Hospitals, Lower Provinces, forwarding
the report on vaccination proceedings in Bengal for 1867-68.
This is the first report which embraces the whole of the
vaccine operations conducted in the Lower Provinces, and no
doubt the bringing together of reports which used formerly to
be submitted separately has contributed to the delay in laying
this report before Government. It is hoped that in future the
report will be ready much earlier.
2. The Lieutenant-Governor thinks that it is clearly esta-
blished that the system of carrying on vaccination by men
attached to the Charitable Dispensaries, and working indepen-
dently of the Superintendents of Vaccination, is not calculated
to produce any satisfactory or reliable results. It is impossible
under that system to secure proper and effective supervision,
and indeed it depends entirely upon the inclination of the Civil
Medical Officer of the Station whether any supervision at all is
exercised, and whether this important duty is not set aside in
favor of some more congenial and possibly pressing duty. The
minimum distance for which Medical Officers in charge of Civil
Stations can draw travelling allowance has been reduced from
five to three miles, with the special object of affording facilities
for inspecting vaccine operations. It is hoped, however, that
the circle system will, before long, cover the whole of the
Lower Provinces, and bring the whole of this important duty
into the hands of a properly organized and trained department
relieved of all other duties.