NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
4
VACCINATION PROCEEDINGS THROUGHOUT
Mount Stuart Elphinstone at about the year 1827, in the Bombay Presi-
dency; when four European Superintendents of Vaccination, (being-
medical officers) were at first appointed, who were distributed in four
vaccine districts, thus dividing between them the whole of the Presi-
dency ; under each European Superintendent is placed a head vaccinator
and an establishment of native vaccinators, varying in numbers with
the size of the division, with grades of pay sliding from Rs. 18 to 10 a
month.
The Bombay system requires the close inspection by the European
Superintendent of the work done by his native vaccinators. He keeps
his establishment spread over a district at reasonable distances apart,
principally in the neighbourhood of large towns, from which they pro-
gressively move on, protecting all the towns and villages in succession.
The European Superintendent follows them up. Arriving at any place
in the course of his tour, he has the children already vaccinated
brought to him, and examines their arms to assure himself of the
soundness of the vaccination; he sees the recently vaccinated cases,
looking at the arms in all their stages of the vesicle, ascertains the
purity of the vaccinia, and of the lymph used to propagate it. He
compares the native vaccinators' registers on the spot with the children
and people entered in them and with the vaccinator's own register, and
thus verifies the work performed. His duty is also to see that the local
registers of small-pox occurrences ordered to be kept up are so done.
This excellent system appertained to Bombay alone for many years,
and is still in operation, the number of circles and superintendents
and native vaccinators having been increased only. This system
essentially comprises the examination of every case vaccinated upon,
either by inspection of the arm during some one or other of the stages of
the vesicle, or else by investigation into the kind of cicatrix left; com-
paring the people vaccinated with the native vaccinator's registers; look-
ing at the crusts saved and produced.
Vaccination in
Bengal Proper.
8. In the Bengal Presidency, from time to time, slight shiftings and
alterations of the system have taken place. At Calcutta, under the
immediate eye of the Superintendent General of Vaccination a sound
vaccinia was maintained, but vaccination did not find its way into the
homes of the native population of Calcutta. From Calcutta sound vaccine
lymph was distributed all over the Presidency ; it was the only large
depôt for years, assisted by periodical supplies of lymph sent from the
National Vaccine Institution in London. By the resolution of the
THE GOVT. OF BENGAL PROPER.
5
Government of India in February 1829, the emoluments of the Civil
Surgeons and Assistant Surgeons at the 30 vaccine stations, previously in
operation, were reduced from Rs. 260 a month, which embraced the whole
cost of he establishment, to Rs. 160, and of these six only were to be kept
up, viz. Dacca, Moorshedabad, Patna, Benares, Bareilly and Subathoo. The
reason assigned for this change was, that the success in vaccination, as
shown by the returns, had in no degree corresponded with the expense
incurred. This curtailment of establishments led to a great falling-off in
the numbers of vaccination, as shown by the returns. The Medical Board
took the matter up, and in April 1834 the sanction of the Board of
Directors was obtained to the granting of a vaccine allowance, Rs. 20
a month, to Civil Surgeons acting as Superintendents of Vaccination
of their stations. This became a general allowance at all stations. The
vaccine institutions at the above six large stations were maintained.
In the course of a few years these were abolished also.
The Bombay
system
intro-
duced into the
North-West Pro-
vinces A new
era of vaccina-
tion,
9. No material improvements were put in practice until the Go-
vernment of India, in 1854, introduced the Bombay system into the
North-Western Provinces. Hence a new era in vaccination in the
Bengal Presidency was inaugurated. Dr. Pearson had, it would seem,
been carrying on vaccination under his own eye and special supervision
for some time previously to the introduction into the North-Western
Provinces, by Government order, of a system similar to the Bombay
one.
Recapitula¬
tion.
History of Vac-
cination more in
detail, giving the
salient points in
order of date and
sequence.
10. To recapitulate, in Bengal, from the report of the Superin-
tendent General of Vaccination at Calcutta published in 1831, it
appears that there were up to the year 1828, 30 vaccine stations within
the Bengal Presidency at a monthly cost of Rs. 260 each. By the
resolution of Government, of March 1830, these stations were reduced
to six, viz., at Dacca, Moorshedabad, Patna, Benares, Bareilly and
Subathoo, with a diminished allowance of Rs. 160 a month, upon the
ground of the exhibited inadequacy of the issues, and the absence
of anything like really substantially good results following upon
the great outlay made by the State; to which the like testimony
was borne by the Medical Board. The Board seems at this time to
have advocated the committing of vaccination, and its subsequent
management, to a European Medical Officer only, to the exclusion of
native assistance; but the very important point of European minute
management and supervision was not strenuously and persistently
adhered to. The contraction of the sphere of vaccine operations and
6
VACCINATION PROCEEDINGS THROUGHOUT
diminution of the number of stations was followed by an alarming
lessening of the numbers vaccinated from 61.910 in 1830, to 15.119
in 1832. This state of things called forth the remonstrances of the
Medical Board, and the Government, in consequence, ordered that
from January 1835 a vaccine allowance for local superintendence of
Rs. 20 per month, should be given to all Assistant Surgeons at civil
stations, whose allowances do not exceed Rs. 300 a month; for this they
were to vaccinate themselves, and teach their Native Doctors to vaccinate
around them; a vaccinator was employed at many zillah stations.
Dispensary
vaccination.
11. An important advance next took place in 1839 by the setting
up of dispensaries at 12 large towns in all parts of the Presidency;
the establishments costing each, upon an average, Rs. 250 a month.
These dispensaries were under the superintendence of the Civil Surgeon,
an educated Native Doctor, with a salary varying from Rs. 40 to 100,
was put in immediate medical charge, two or three subordinate
assistants, capable of performing vaccination, were attached to the
dispensaries.
Large vaccine
depôts abolished.
12. By order of the Government of India in April 1842, the
allowance of Rs. 100 a month, being part of the Rs. 160 to the Civil
Surgeons, Superintendents of Vaccine Depôts, at Dacca, Moorshedabad
and Patna, was put a stop to.
The Govern-
ment vaccinators
of districts be-
come dispensary
servants
Civil
Surgeons are
called upon to
pay more atten-
tion to vaccina-
tion.
Vaccinators'
pay increased.
13. In 1853, the Medical Board again drew the attention of all
medical officers to the obligation bearing upon them to advance the
work of vaccination, especially in connection with Charitable Dispen-
saries. The Government Native Vaccinators, two in number at most
civil stations, were then placed at the dispensaries where such existed.
They were to operate under the eye of the Civil Surgeon, the Super-
intendent, and of the Sub-Assistant Surgeon in charge. They were to
resort on certain days of the week to different public places of the town,
and there to vaccinate in the presence of the medical officers; careful
registers were to be kept of their work ; the pay of the vaccinators
was raised to Rs. 10 each. This system has continued in Bengal
Proper up to the present day.
Deputation
and travelling
allowance given
to Civil Surgeons
for
inspecting
vaccination.
14. The Bengal Government, in November 1867, granted travelling
and deputation allowance to Civil Surgeons for going out into their dis-
tricts, and visiting the vaccinators, and inspecting their work. This is
a step in advance certainly, but it is inefficient and not likely to
bear much fruit. The Civil Surgeons have not time for the work; the
inspections are scanty and intermittent. A good deal of good may be
THE GOVT. OF BENGAL PROPER.
7
done in this way by the Civil Surgeon keeping his vaccinators around
his station, within a radius of 3 or 4 miles, he may then visit them
frequently, and with advantage, and his actual expenses of carriage
should be allowed to him, although the distances may be small. This
mode of proceeding is now adopted in practice in the Punjab.
Dr. Pearson's
appointment,
his system of
vaccination in
the North-West
Provinces.
15. In 1854, Dr. Pearson was appointed Superintendent of Vac¬
cination in Rohilcund and Kumaon. The following is the system
pursued by him, extracted from one of his reports:—
" To every Tehseel in the North-West Provinces one vaccinator is
attached; and in every city where there is a municipality, composed
of enlightened commissioners, one, two, or three municipal vac-
cinators are employed. To about every twelve vaccinators there
is a Native Superintendent or head vaccinator, and to every fifty or
sixty vaccinators a European Superintendent (a Medical Officer). To
give a clear idea of the practical method of the system of working,
I will detail a day's duties of the European Superintendent. Having
arrived at the tehseel, he proceeds to the village or place where
the vaccinator had operated the previous seventh or eighth day (the
place is ascertained by referring to the vaccinator's daily (diary) book);
he then calls for the village record from the putwaree, zemindar, or
chowkeedar, or with whomsoever it may have been left, and summons
all the children whose names have been entered therein as vaccinated
seven or eight days previously; the results are inspected and verified ;
faults pointed out; instruments examined; the vaccinators' capacities
and character ascertained; and the people addressed. This round of
duties goes on from day to day throughout the whole vaccine season.
The Native Superintendent is also perpetually on the move, employed
on the same duties, and in this manner each vaccinator gets
visited several times during the season. The check against falsifi-
cation of returns, by repeated inspection of the vaccinator's diary,
and the return left in the village (which should correspond) is as
complete as any check can be; and I have no hesitation in declaring
that the system works well and honestly; and I make this declaration
after an experience of twelve years. The fault of the present system
is the paucity of the establishments, but Government cannot be ex-
pected to vaccinate gratuitously the millions of India; the time-will
come when vaccination will be believed in by the natives, and sought
for at the hands of their own native practitioners, as happens in other
civilized countries."
8
VACCINATION PROCEEDINGS THROUGHOUT
Hill dopôts of
vaccination.
16. In Kumaon or Gurhwal, (at Almorah) a hill vaccine depôt
was established thus early under Dr. Pearson.
The indepen-
dent dispensary¬
system of vacci-
nation still con-
tinued.
17. With the introduction of this system of close inspection under
a distinct vaccine department, vaccination still continued at some
zillah station dispensaries under the supervision of the Civil Surgeon.
Agra vaccine
division or circle
set up.
18. In 1856, the Agra division of vaccination was set up under
the superintendence of a European Medical Officer.
Hill depôt of
Simla supersed-
ing Subathoo.
19. Subathoo had ever since 1828 been one of the centres of
vaccination in the Bengal Presidency. Lymph had probably been taken
and preserved, and distributed thence to the stations in the plains;
latterly, the civil station of Simla became a depôt under the Civil
Surgeon there. In 1858 Dr. Peskett was appointed Superintendent
of the Simla vaccine hill depôt, as a distinct and separate duty. These
hill depôts, on the application of the Superintendents, were kept supplied
with lymph from England, besides that of their own collecting and
preserving on the spot.
Progression of
Vaccination.
20. Vaccination had thus fairly been started in the North-Western
Provinces, and there and in the Bombay Presidency, and at the metro-
polis of India, Calcutta only, had a sound system of vaccination been
practised. The rest of Bengal and Madras remained benighted in
this respect.
Other vaccine
divisions set up
in the N W.
Provinces and in
the Punjab.
21. In 1864 the Agra and Meerut, and the Benares and Goruckpore,
circles of European superintendence were established in the North¬
Western Provinces. Dr. Pearson, to whom especially vaccination owes
so much, in 1864 was most deservedly and advantageously appointed
Superintendent General of Vaccination of the North-Western Provinces
with his head quarters at Kumaon. In 1864, a Superintendent General
of Vaccination was appointed for the Punjab, with his head quarters,
during the summer months, at Simla.
Vaccine system
in the Punjab-
22. The Punjab vaccine establishment is as follows, and is
formed in accordance with the Bombay system: To each of the three
divisions into which the Punjab vaccine department has been divided,
five for Dalhousie, and at Simla and Murree six Native Superintendents
are allotted, with a salary of Rs. 20 for five months, and Rs. 16 for seven
months, with 46 vaccinators, with varying scales of pay from Rs. 12 to
Rs. 8 for five months, and Rs. 8 to 6 for seven months, at the Simla
Division; and 33 vaccinators for Murree and Dalhousie each. At the hill
depôts it is recommended that the Native Superintendents be paid their
THE GOVT. OF BENGAL PROPER.
9
full salaries for the whole year, and that the Native vaccinators there be
also paid their full salaries for three months longer than in the plains.
This system gives about three vaccinators to each district of each division,
besides leaving a reserve for emergencies. The European Superintendent
(one only is sanctioned ) visits a part of his large province, and looks to
the work, and supervises the performances of his vaccinators thoroughly
before he proceeds to another part; he ascertains the character
of the vaccine used, and supplies fresh virus. In so extensive
a Government as the Punjab, it is evident that anything like
thorough inspection can go on but very slowly; he can go over a small
part only of his department each year.
Jhansie and
Allahabad Vac¬
cine Circle.
23. In 1865, the Allahabad and Jhansie circle of European
superintendence was brought into operation.
Madras vacci-
nation, its origi-
nal status and
subsequent im¬
provement.
24. To go back to Madras, the system was that of the employment
of Civil Surgeons as Superintendents at stations of circuit and zillah
courts, together with the establishments of native vaccinators, all
working under the authority of the Superintending Surgeons of Divi-
sions. The Superintendents were the channel of communication
between the working vaccinators and the higher authorities; their duty
was to assist and support the vaccinators; to vaccinate themselves; to
inspect and check the vaccinators' work from time to time; they were
to verify their registers by every practicable means. But the strange
system existed in the Madras Presidency of placing the body of vaccina-
tors in each district immediately under the orders and control of the
Collector, by whom they were paid, and their movements directed.
This plan was established under the idea, it would seem, that, as the
Collector was moving about in his district, he could more effectually
watch the vaccinators' operations, and urge the more influential inhabi¬
ants of every place to assist in the spread of vaccination, and induce
these men to overlook and check the work at any or every village. The
Civil Surgeon was expected to do little more than supply good lymph,
and receive and transmit to the Superintending Surgeon the vaccinators'
periodical returns. He was to visit the vaccinators employed in
the district upon any emergency. The check and supervision was
evidently a loose one, and very different from that of the European
Superintendent on the Bombay side, who was always in the midst of
his men, moving about with them, and keeping his eyes upon them
here and there, and everywhere. The Madras Principal Inspector-
General of Hospitals, in his report of 1860-61, declared the present
B
10
VACCINATION PROCEEDINGS THROUGHOUT
system at Madras to be a failure, and its maintenance little better than
waste of public money. In 1863, the Government of India called for a
report on, and revisal of, the system. Since 1865 the Bombay system has
been introduced. The Madras establishment in 1865 consisted of one
General Superintendent; 11 deputies ; 145 vaccinators, and 25 peons.
There are 11 small circles with a deputy to each, and one Native
vaccinator or nearly so to every talook of each circle. The system, as
well described by one of the Deputy Superintendents, consists in the
Deputy Superintendent itinerating through the district with the
vaccinators working as a body, going in gangs or small parties from
village to village, doing the work thoroughly, although slowly.
The vaccination is thoroughly done in one talook at a time; the
deputy himself looking into the whole work. The Superinten-
dent General visits each Deputy Superintendent in his circle, in the
midst of his vaccinators, and spends a few days with each, thoroughly
examining the work. The method employed in the several circles is
to work thoroughly in a given locality ere proceeding to another. This
is the admirable Rohilcund plan of Dr. Pearson.
Central Pro-
vinces and Oudh
vaccination.
25. Vaccination under a European Superintendent was intro-
duced into the Central Provinces in 1864, and into Oudh in 1867.
Bengal Proper,
vaccination im-
proved.
Calcutta vacci-
nation under the
Superintendent
General at the
Presidency
Town.
26. Thus was seen spreading through India at large the benign
influence of vaccination, permeating everywhere by degrees, and offering
the blessings of protection against the scourge of small-pox. Bengal
Proper now aroused herself from her vaccine lethargy (excepting, in the
necessity for this, Calcutta itself). Dr. Charles, in his long and able paper,
published in the Calcutta Gazette of the 19th January 1866, lays the
whole subject of vaccination fully before the Government, regarding its
present condition as well in Calcutta as throughout India at large. He
reviews the several systems in vogue at the several Presidencies. He
thus describes the Calcutta system of vaccination:—Calcutta is divided
into districts, to each of which a Superintendent is appointed with a
staff of vaccinators; this has been the case since 1853. He goes from
house to house trying to overcome the objections of the people by
persuasion and explanation, and by bringing vaccinators to their very
doors and within their houses. Every vaccinated person is personally
inspected by the Superintendent, and the soundness and purity of the
operation ascertained beyond doubt or fraud; it is a great object in
this system to examine the vaccination in all its stages, from first to
last; to see the transmitted lymph in the different phases of its course
THE GOVT. OF BENGAL PROPER.
11
in any two or more individuals. The whole is superintended by the
Superintendent General. The expense of the system is necessarily great,
from the thoroughness and minuteness of the inspection.
Vaccination
extended to
tracts around
Calcutta where
small-pox inocu-
lation prohibi-
ted.
27. Dr. Charles especially reports upon vaccination at and around
Calcutta. He had already extended vaccination by his personal exer-
tions beyond his own legitimate boundaries, viz., the town and suburbs
of Calcutta. In order, if possible, to check the onslaught of small-
pox on Calcutta and its importation from without, he carried protective
vaccination into the villages and thannahs around Calcutta, and along
the highways and thoroughfares of rail and road.
New vaccine
circle composed
of four districts
encircling Cal-
cutta proposed
28. A very interesting part of his report is his scheme of vaccina-
tion for the mofussil. He proposes to set up a shield of protection
around Calcutta, by bringing within one new vaccine circle, the presi-
dency districts of the 24-Pergunnahs, Hooghly, Burdwan and Nuddea,
under thorough European supervision, and with an adequate staff of
Deputy Superintendents, head vaccinators, &c. I most fully endorse this
proposition, and trust that the Government of India in the Financial
Department will accede to it. It has been submitted and strongly
recommended from my office.*
Small-pox in¬
oculntion prohi-
bited in places.
29. In furtherance of the exertions made by Dr. Charles, inocula-
tion has been prohibited in Calcutta by law since 1865; and in the
villages and police stations in the neighbourhood of Calcutta, and in
several large stations in Bengal Proper since June 1866. By recent
Government enactment inoculation has been further prohibited in
Gurhwal.
An increased
staff of vaccina-
tors allowed for
the extended
operations
around Calcutta.
30. In aid of carrying on vaccination efficiently in the localities
more immediately bordering upon Calcutta, where inoculation has been
prohibited, the entertainment of a large additional staff of vaccinators
and head vaccinators has been sanctioned by the Government. These
for the present will work under Dr. Charles, who will lend the
aid of one or more of his experienced Calcutta Superintendents.
But all such work is additional to that really appertaining to his
office as Superintendent General of Vaccination at Calcutta. The
approval of the proposition for the institution of a new vaccine circle
around Calcutta is anxiously looked for, within which these new
localities will be included.
Municipalities
support vaccina-
tors,
31. In consequence of the prohibition of inoculation at many
of the large stations of Bengal Proper, it has become necessary to
* It has received sanction.