NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
PRESIDENCY VACCINE DEPARTMENT.
17
constitute a permanent part of the establishment. In paras. three and
four of this report, it was stated—" they have proved themselves of
great use in supervising the work of the vaccinators placed under them,
and the consequence has been, not only that the results of the operations
have been more uniform, and departmental rules more strictly carried
out, but departures from a very high standard of excellency in the
character of the virus, have been more rare than during former seasons.
As bearing on the question of increased departmental efficiency, I may
mention that several instances have been brought to my notice of quite
young vaccinators working hard and well, and exerting themselves to
attract favourable notice, professedly with the object of pointing
themselves out as worthy of promotion to the new grade in the event
of a vacancy occurring."
It is to the appointment of these head vaccinators that I attribute
the improvement in the character of the vaccinations, to be alluded
to presently. When they become habituated to the work, and gain
a little experience in handling the vaccinators under them, I have every
confidence that the expense of the grade will be more than counter-
balanced, by increased control over the operators, enabling a larger
amount of work to be overtaken. These head vaccinators, by superin-
tending the daily routine duties of the vaccinators, and by being on
the spot to check any irregularities which may occur, will enable the
Superintendents to look after a larger number of vaccinators than they
could otherwise control; and thus by rendering it possible for them to
overtake the inspection of a larger number of cases, will, it is trusted,
tend also to cheapen the cost of each inspected case. My attention has
been directed to a curious fact in the working of the head vaccinators
by the two senior Superintendents. They believe that those of the
grade, who have been old inoculators, have not taken the same pains to
instruct those under them, as the others have done; and attribute this,
to a desire not to make the secrets of their craft available to outsiders.
If this be the case, it merits attention, and will call for special arrange-
ments in organizing the gangs to work under them. It is hoped they
will yield, and change their tactics, when they find that they are judged
as members of this grade, not on their own qualifications, but by the
success with which they can make the vaccinators work.
Vaccinators.
24. Up to the 1st of January forty vaccinators were employed
in the district. Since that date, owing to the Municipality having
provided vaccinators in Calcutta, fifty-seven men have been available
for work in the neighbourhood. Some of these vaccinators are now
c
18
THIRD SPECIAL REPORT ON THE
well trained, others give promise of turning out well, and I have no
doubt that the majority of them will prove nearly as good workers as
can be secured for the wages allowed them. It must not be supposed
that these vaccinators have been trained to the degree of excellence
that the quality of the work done, might fairly lead one to suppose.
The fact is, that many of the vaccinators have performed but few
vaccinations; while they were in a state of pupilage, they have been
employed in assisting others, who could ensure a larger percentage of
success by operating dexterously; and even when they have by degrees
shewn that they had acquired the manual trick, which enabled
them to avoid failure, each vesicle, from which they were to take their
virus, has been selected for them. By management of this sort, the
bad effects on the minds of the population, resulting on their seeing
constant failures, has been avoided. It is no empty boast to be able to
say, the people have yet to learn that a vaccination performed by the
department can fail.
A fondness for attracting inoculators into the vaccine establish-
ment, is a partiality inherited from a long line of my predecessors. It
has been a source of constant disappointment that, as the department
increased, the majority of the new vaccinators could not be recruited
from among the old inoculators. The demand not being a gradual one,
and the necessity for at once procuring new men being a sudden emer-
gency, which left little room for choice in the matter, the constitution
of the establishment is very different from what I should have preferred,
had selection been possible.
Baboo Jadub Chunder Ghose has been more successful than the
other Superintendents in procuring the services of inoculators, but
even under his superintendence the number are few when compared
to what they should be. The bad character, and intolerance of
discipline, of many of the old inoculators, which has led to their
discharge even after they have been entertained, has doubtless had
some influence in reducing the proportion they bear to the others. By
filling up vacancies as they occur, with as many inoculators as can
be persuaded to turn vaccinators, it may still be hoped that many
more of this class will join the establishment than have lately done,
and that the old associations of the department may be in a measure
restored.
Lists have been prepared of the vaccinators, in which each of their
qualifications and tendencies is noted; as the peculiarities of the head
PRESIDENCY VACCINE DEPARTMENT.
19
vaccinators are also recorded, the various gangs can now be put together,
with regard to their special qualifications.
The idle or negligent, though thoroughly trained, can be made to
work under a severe task-master, while the less able, though more willing
vaccinators, can be placed under a careful head vaccinator, even should
he be deficient in firmness. The skilled operator can be made to work
with the man cunning in persuasion, so that the defects of one can
be counter-balanced by the strong points of the other. Again the
energetic leader of a gang who brooks no refusal, may be employed
where his fault will not be liable to run him into mischief, while the
more cautious though less pushing head vaccinator, may have his
defect made one of less consequence, by being trusted to keep his gang
out of collision with a population ready to resent over-zeal on the part
of the vaccinators.
Positions in
which the vacci-
nators worked.
25. The vaccinators under the superintendence of Baboo Jadub
Chunder Ghose, commenced work in three gangs at the following places:—
No. one at Behala, No. two at Rajpore, No. three at Burra Sahib's Hât, all
within the sudder Thannah of Tallygunge. Gang number one, was
subsequently sent to protect some villages in the Bistopore Thannah, in
the neighbourhood of some others which had been previously vaccinated.
They remained for two months trying to persuade the people to accept
their services, but owing to cholera being then epidemic in the place,
they met with comparatively little success. An attempt was then made
to vaccinate some villages in the Barripore Thannah, similarly situated
with regard to other protected villages. Cholera appeared here also;
and urging besides, their having suffered much from the cyclone,
these villagers too refused to receive vaccination this year. The gang
had again to change ground and proceeded to Baraset in the Bankipore
Thannah, where they began work in March. Gang number two also,
was sent to protect some villages in the Barripore Thannah; when
these were finished, they too were sent to work in the Bankipore
Thannah, where vaccination had never been practised. Gang number
three, in the end of December, was sent to work at Ooloobaria in the
Thannah of the same name.
The vaccinators under Baboo Buddynath Brummo, worked along
the East India Railway, between the Boinchee and Sactyghur stations.
Further details will be given in the words of the Baboo's own report as
an example of working under the Calcutta system.
20
THIRD SPECIAL REPORT ON THE
Baboo Sreenath Mookerjee's vaccinators commenced work in three
divisions, No. one at Kooshteah, No. two in the Nawabgunge Thannah, No.
three in the Dhuniakallee Thannah. Owing to the cyclone and inundation,
the first gang, after having completed all arrangements, and prepared a
full supply of virus to enable them to carry on the work actively, had
to be withdrawn, or more correctly withdrew themselves, when it was
found impossible to vaccinate in that neighbourhood. They were sent
to the Biddabatty Thannah, but with this exception no further changes
took place, the vaccinations being extended uniformly from these
centres. In the month of February a fourth gang was sent to work in the
Kudumbagachee Thannah. The gangs working in the Thannahs of
Dhuniakallee and Nawabgunge, laboured under great disadvantages in
consequence of fever prevailing extensively.
Example
shewing mode
of working
26. No circumstances occurred requiring that the gangs, working
under Baboo Buddynath Brummo, should be changed from one position
to another. His report will therefore now be introduced. In spite of
the vaccinators working under great difficulties, it shews very distinctly
the advantages of working the men in gangs, and pushing steadily over
a given tract of country, and will give a fair idea of what can be done
by steadily pursuing this system.
" Vaccination in the Mofussil.
" In October last, twelve vaccinators left Calcutta with virus to com-
mence vaccine operations in the Mofussil. They commenced work in
three Divisions on both sides of the Railway between Boinchee and
Sactyghur, making Mymaree, Cossypore and Corrundah their head-
quarters. Within two weeks the vaccine operations were fairly established
in the three divisions, and would have rapidly extended, had not fever
prevailed epidemically in the villages, and amongst the vaccinators,
to an unusual extent at the time. During November and December
last, almost all the vaccinators suffered severely from repeated attacks of
fever one after another. The three head vaccinators with three others
were obliged to be absent from their Divisions on sick leave from four
to twenty weeks. Extra men were sent to act in their places. This
unfortunate occurrence greatly interfered with the progress of the
vaccine operations, and caused the falling-off in the number of vacci-
nations in the Mofussil. At the close of the season, the line of vaccine
operations extended to about sixteen miles from east to west, and
twelve miles from north to south. The number of villages in which
vaccine operations were carried on amounted to one hundred and sixty-
two.
PRESIDENCY VACCINE DEPARTMENT.
21
Result of Primary Vaccination.
Successful ... ... ... ... ...
Partial ... ... ... ... ...
Failed ... ... ... ... ...
Total.
Number Inspected ... ... ... ... ...
16,528
8
110
16,646
13,329 "
Numbers
vaccinated.
27. As regards the numbers vaccinated, the Superintendents report
as follows:—Baboo Jadub Chunder Ghose 28,633. Baboo Buddynath
Brummo 16,646. Baboo Sreenath Mookerjee 27,657. In the case of
the two first, I believe the numbers may be accepted as correct, as the
Superintendents are so fully alive to the necessity for checking the
statements of the vaccinators, and from long practice can exercise such a
control over them, that the opportunity for fraud is reduced to a minimum.
With regard to the third Superintendent, this being his first year, I am
not sure that the vaccinators could not impose on him. The Baboo
himself has confidence in the substantial correctness of the figures
reported, and attaches much importance to his having checked the
vaccinators, by having been in the custom of calling out names from
the nominal register, and never having found any names entered, for
which he could not find representatives in the village.
Of the numbers vaccinated, the following have been reported as
having been inspected by the respective Superintendents:—
Baboo Jadub Chunder Ghose ... ... ...
Baboo Buddynath Brummo ... ... ...
Baboo Sreenauth Mookerjee ... ... ...
22,986
13,329
23,200
The two former I accept as correct to the letter, the latter is
possibly an approximation to the result attained.
I am well aware that very large numbers have been inspected by
Baboo Sreenath Mookerjee, but knowing the positions in which the work
lay, and the great difficulties in the way, I am unwilling to state
confidently that there can be no mistake in his statement.
Considering the large numbers inspected by the Superintendents,
while being fully alive to the absolute untrustworthiness of the vacci-
nators' reports in themselves, I believe that there are no grounds for
discrediting that they are virtually correct, as in the case of two of
the Superintendents, I consider the check to be as effective as could
possibly be attained.
22
THIRD SPECIAL REPORT ON THE
Falling of
when compared
with the previ-
ous season.
28. In the annual return for 1867, the actual numbers stated to
have been vaccinated show a falling-off of two thousand five hundred
and seventy for the previous year. For the present this deficiency
may be explained by the cyclone desolating the places where the vacci-
nators worked, and preventing the people from being able to take
vaccinations. Had it not been for this, the out-turn of work would
doubtless have been greater than in the previous year. Quite inde-
pendently of this explanation, there is another which has also to be
considered before a correct estimate can be formed. During the
previous year, thousands of famished persons from Orissa had been vacci-
nated; and before I returned from England large numbers of such
vaccinations had found their way into the monthly returns. On my
arrival I found this to constitute such a disturbing element in the
returns, as to falsify them for all purposes of true comparison; and
eliminated 4,570 such vaccinations from the columns of the first
monthly return which I signed, not putting such work to the credit
of the establishment, and only making a marginal note of the fact.
Taking this into consideration in spite of a slight decrease in
actual numbers, the work of the year may be considered more satis-
factory than that of the previous one; success in the early months of
the year making up for deficiencies in the later months.
In the same way, as regards the annual return for 1868, we may still
hope that the deficiencies of the beginning of the year, may be nearly
counter-balanced by the increased success in the later months, should
no unforeseen calamity interfere to prevent such a result. So far for
the out-turn of work as calculated by the year.
When looked at as a season's work, that under consideration con-
trasts most unfavorably with that of the preceding season. As already
stated the work in the end of the year, was all but put a stop to, by the
ruin and desolation, in which this part of Bengal was involved by the
cyclone as well as by pestilence which prevented the people from
accepting the services of the vaccinators.
These causes (especially fever) also interfered seriously with the
work in the early months of 1868. Besides the unfavorable effect on
the persons among whom they worked, whole gangs of vaccinators
were disorganized by repeated attacks of fever. Many of the vaccina-
tors requiring to be sent away to their homes on leave. Week by week
the falling-off in the numbers was commented on, and week
after week brought nothing but continued reports of imperfect success.
PRESIDENCY VACCINE DEPARTMENT.
23
The Superintendents did all that energy could effect, but no marked
improvement was apparent till February, when the very fair number of
27,046 vaccinations during the month was reached. Even this must
only be taken as good, after making allowances for the sickness of the
vaccinators, and the state of distress the people had recently been in.
In March again, the numbers diminished; and here is the first period
of the want of success under review, in which I think the establish-
ment failed me, in making as great an effort to retrieve lost ground as
could have been made. Had I had no other occupation, I think that
at least one-half more work would have been done in this month. Of
course I may be unjust to the establishment in making this supposition,
but after having studied the circumstances most carefully, such is the
judgment I have arrived at.
During the month of March vaccination round Calcutta requires
to be conducted with great care on account of the heat. As soon as the
vesicles begin to cause irritation, all extensive operations require to be
put a stop to. Possibly every year the numbers may be liable to very
great variation, but this year they are much lower than the actual state of
the season warranted. The dilemma in which the department is placed
is this :—to show a large return of work, the vaccinators are required to
strain their energies to the utmost during this month, as the people are
more ready, then from old false associations, to receive their services,
than at most other times; while this is the case, the danger of making
the people hostile to the practise is great, ( owing to the tendency to
inflammatory irritation and the consequent suffering produced) and
requires that this fact should regulate the amount of work.
It matters nothing to a vaccinator whether he does much or little
work during this month, and as certainly as he is entrusted with the
power of regulating his work, so surely does he take advantage of the
loop-hole to escape from hard work and becomes less busy. The defici-
ency is much greater than it at first sight appears, as the establishment
has been much larger and better trained than during the last season.
Proposal to
keep back part
of the pay of
the younger vac
cinators.
29. In my first special report the intention was stated that as
soon as a permanent establishment was sanctioned, a part of the
vaccinators' pay, during the hot months, was to be kept back, and either
refunded to those who worked well during the next cold season, or dis-
bursed to those who shewed themselves to be specially deserving. Of
course, in the case of the older vaccinators, such an arrangement cannot
be attempted on account of the discontent it would occasion. In the
24
THIRD SPECIAL REPORT ON THE
case of the new vaccinators, it will be in part put into force this season,
and probably to a fuller extent next year. Some means of inciting the
vaccinators to increased exertion, has always been felt as a great want.
For actual fault, or negligences, they can be fined, but it is difficult to
deal with them for less marked failure of duty. By placing the bulk
of the establishment on the footing of smaller pay for the hot months,
a system of rewards for special good service can be gained, without any
additional cost being entailed. This year such inducement for extra
exertion will come at a most opportune moment, when the most
strenuous efforts will be required to make up for the want of success in
the early months of the year.
Character and
success of vacci-
nation.
30. Hitherto the want of success as regards numbers has been
dwelt on. Unfavorable circumstances, which no foresight could pre-
dict, no systematic management could guard against, unavoidably led to
the result. Now it is under very different circumstances that I come
to speak of the character of the vaccination, and of the ratio of suc-
cessful cases to those of doubtful and failures. Here the establishment
had the matter in their own hands, and have not been wanting in
pushing success to nearly the utmost limits of attainment. As before
pointed out, the excellence is so absolute, that it is necessary to guard
against the supposition, that it fairly represents the amount of perfec-
tion to which individual vaccinators have been trained.
The following Table shews the results arrived at under each of the
three Superintendents:—
Superintendents.
Jadub Chunder Ghose ... ... ...
Buddynath Brummo ... ...
Sreenath Mookerjee ... ...
Total ... ...
Successful.
28,395
16,528
27,300
72,223
Doubtful.
168
8
202
378
Failures.
70
100
148
318
The percentage of successful cases against the total numbers con-
tained in the table amounts to 99.40. For practical purposes this may
be taken to represent the limits of attainable perfection. I anticipate
still further perfection will be reached, but any future improvement can
be so infinitesimal, that it should rather be looked on as departmental
trifling, straining after an ideal perfection, when the actual one has been
already reached, than as any real improvement. Always the success
PRESIDENCY VACCINE DEPARTMENT.
25
of the vaccination conducted in Calcutta seems to have presented a
marked contrast to that in most other parts of India. For the last year
or two gradual improvement has been taking place. Taking the whole
of the operations performed by the department as superintended by the
three Sub-Assistant-Surgeons, I find that the following table is suffici-
ently accurate to compare against the work of the last season at
present under consideration :—
Ratios calculated on the total ascertained numbers of each year,
for eight years.
YEARS.
1860-1861
1861-1862
1862-1863
1863-1864
1864-1865
1865-1866
1866-1867
1867-1868
Successful
per cent.
91
91.5
94.40
94.18
94.11
96.79
98.11
98.76
Doubtful
per cent.
3.90
4.19
2.25
2.17
2.59
1.78
.83
.83
Failed
per cent.
5
4.74
3.34
3.63
3.28
1.39
.97
.41
REMARKS.
No re-vaccination or un-
ascertained cases included.
Allowance requires to be made for the influx of new vaccinators
in 1865, which led to what was departmentally considered, a lament-
able falling-off, from attainable perfection. Allowance must also be
made for a slight possible mistake of a few actually successful cases
having been registered as doubtful or failures, owing to individual vacci-
nators attempting to gain a character for honesty by making a parade
of less favourable returns. With every deduction, however, the result is
a most satisfactory one, and I point to it as shewing very great care on
the part of the Superintendents. The result on paper is most conclusive,
but as depending on reports received from vaccinators, I should have
had to accept it with caution, had I not year by year noticed a marked
improvement during my inspections.
Judging by an English standard, the results I bring forward, though
good, are not perfect. I have long been familiar with the fact that
Mr. Marson considers that an expert vaccinator should not fail more
than once out of 150 times. Dr. Seaton, in his recent work on vaccina-
tion, mentions that on examining the records of some of the stations of
d