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the unprotected would alone disturb any conclusion. For instance, the three
consecutive districts of Jalpaiguri, Rungpore, and Bogra reached in the seven
years ending 1899 almost precisely the same measure of protection, 180 per
mille, but the ratio of deaths from small-pox in that period was 0.00 in
Jalpaiguri; 0.13 in Rungpore; 1.01 in Bogra. The first district entirely
escaped the epidemic among the unprotected majority, which was severe in the
third, and more lightly felt in the second.
In the five selected districts the result generally, except in Saran, has been
the reduction of small-pox mortality by a half. It is quite possible that this
reduction is more accidental than real, for in not one of the five districts is the
ratio of protection among the population particularly high. But, after all, this
is the real test by which the department must be eventually judged, its success
in checking the mortality from small-pox. Every year increases the area of its
protection ; every year increases the width of its statistics and the confidence
with which inferences can be drawn from them; and in future at least, every
triennial report should present an opportunity for a full and thorough examin-
ation of facts for encouragement or instruction, as the case may be. A striking
feature in the diagrams is the position of Puri and Cuttack—the districts
constantly noted as the hotbed of opposition to vaccination in Bengal. During
the last six years Puri has shown the highest mortality in Bengal three
times, the second once, and the fourth once, while Cuttack has held the first
place twice, the second twice, and the fourth and fifth once each. Similarly, the
districts of Patna, Gaya, and Shahabad, to the backwardness of which in
vaccination, attention has often been drawn, show, with a corresponding regular-
ity, a high mortality from small-pox. It should be noted that the pre-vaccina-
tion figures date back to a period when death registration was extremely
defective, and it may fairly be assumed that vaccination has had a considerably
greater effect in reducing the mortality than that shown by the present figures.
10. Vaccination direct from the calf.—In the triennial report for the years
1893-96, great stress was laid by Major Dyson on the importance of introducing
this method of vaccination throughout the Province. As is naturally the case
in India with novelties of this nature, difficulties were at first experienced,
but the anticipation of Major Dyson that these difficulties would, by tact
and judicious perseverance, be gradually overcome, is, it is satisfactory to see, in
a fair way to be realised. Major Dyson is to be congratulated on the successful
introduction of this important reform.
11. Inspections.—Owing to the impossibility already noticed of continuously
retaining Deputy Sanitary Commissioners in the three circles into which the
Province is divided, comparatively little inspection work has been done by these
officers during the period under review. In the Government Resolution on the
Vaccination Report for 1897-98, attention was drawn to the extraordinarily large
number of villages shown as having been inspected by some Civil Surgeons. On
enquiry it has been ascertained that this was due to the Civil Surgeon having in
some cases ordered the Inspectors and Sub-Inspectors of Vaccination to collect the
vaccinated children at several villages, at a particular spot for inspection, thereby
rendering it possible to return a large number of villages as having been inspected
by him. Under ordinary circumstances this is a most objectionable practice,
for it enables subordinates to set the seal of superior authority upon any
concealment of deficiencies which a genuine inspection would have disclosed.
But the Sanitary Commissioner asserts that under his orders his vaccinators
maintain a nominal record of all vaccinations and of the cicatrices of all success-
ful punctures. When the six-puncture system is in general operation, this plan
may afford sufficient check, but, while making all excuse for the hard-worked
Civil Surgeon, the Lieutenant-Governor is sorry to see that the practice of
assembling children at centres has been meanwhile so frequent.
The Sanitary Commissioner notices the great variation in the number of
inspections performed by the subordinate inspecting staff, and remarks that,
in the case of Inspectors and Sub-Inspectors of Vaccination, inspection of less
than 30 and 50 per cent., respectively, of the operations in their jurisdiction is
inexcusable. The attention of the Civil Surgeons should be drawn to this
matter. Admitting the correctness of the Sanitary Commissioner's conclusion
that the return of so high a ratio as 97.92 per cent. of successful operations is
incorrect, it would seem that inspection, as at present performed, is not an
efficient check on it. In the cases seen by Inspectors and Sub-Inspectors, this