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The Metropolitan and Eastern Bengal circles and the municipalities show a very-
marked falling off, the numbers being 28,965, 70,110 and 14,265 respectively.
The decrease of 8,782 or 33.4 per cent. in the town of Calcutta is attributed to
the large number of operations (26,280) during the small-pox epidemic of the
previous year having left fewer subjects to be operated on during the year
under report. In the Eastern Bengal Circle, where the ratio of decrease
reaches 18.0 per cent., and corresponds closely to the reduction shown in the
number of operations, the Deputy Superintendent explains that in Chittagong the
number of operations fell off by 103,507—a decrease which he ascribes to
the fact that the licensed vaccinators had to work in the areas which had been
gone over by them in the previous year. However this may be, it is a
significant fact that during the last three years vaccination in the Chittagong
district shows a progressive falling off, as indicated in the following statement:—

and that the close of the last year in the series was marked by a serious
outbreak of small-pox in the town of Chittagong, in the course of which it
became apparent that the people regarded vaccination with considerable
distrust. Inquiry into the recent management of vaccination in the town showed
that out of 547 persons vaccinated during the year 1887-88 within Municipal
limits under the immediate supervision of the Civil Surgeon, as many as 331
or 60.5 per cent. had been attacked by small-pox. In 1888-89 the proportion
of attacked among those who had been vaccinated was 39.1; in the next year
31.5, and it was only in 1890-91, when the outbreak had drawn attention to the
subject, that the proportion fell to 6.5 per cent. When vaccination carried on
in a limited area, with exceptional facilities for constant supervision, is found to
yield such defective results, it becomes difficult to believe in the accuracy of the
returns of successful operations in areas where no thorough check can be applied.
It is clear that 'in many parts of Bengal the people have a strong prejudice
against the lymph that is used for vaccination, and until this prejudice has been
removed by fuller experience of the benefits of vaccination, no real and conti-
nuous progress can be looked for. Distrust of the lymph seems to be the main
cause which hinders the expansion of the operations of the Department, and
the efforts of the Sanitary Commissioner should now be directed to the produc-
tion of lymph of a sound and uniform character. This branch of the subject
has hitherto not been very fully treated in the annual report. In future reports
the Lieutenant-Governor would wish the Sanitary Commissioner to show more
clearly what is done to secure good lymph, not only on a first distribution to
the vaccinator, but as used by him eventually ; what checks there are on his
return of operations and of success; what reports and complaints regarding bad
lymph are received, and what amount of truth is in them.

5.    The percentage of successful cases, excluding cases the results of which
are unknown, is returned as 99.25 for primary and 39.62 for secondary opera-
tions. The statistics of secondary operations give a successful percentage in
Eastern Bengal of 83.33 and in Orissa of 94.11. Experience tends to show
that it is extremely improbable that so large a ratio of success should be attained
in cases of this class, and such returns cannot be accepted as trustworthy.
Each licensed vaccinator performed on an average 694 operations against
733 in 1889-90, and each Government vaccinator 1,267 against 893 in the
previous year, the average for the three years 1887—90 being 1,475 for
Government vaccinators and 671 for licensed vaccinators. For municipal
vaccinators the average fell from 405 in 1889-90 to 346 in the year under
report. The proportion of males among persons vaccinated was 51.60, and of
females 48.40.

6.    In every circle the returns of supervision done by the Superintendents
of Vaccination show an appreciable increase in the number of cases inspected.
The percentage of such cases to the total number of vaccinations ranges from
29.81 in the Orissa Circle to 3.38 in the Darjeeling Circle, and .60 in the town
of Calcutta. On the other hand, five out of the fourteen Deputy Superintendents
did a smaller amount of inspection than in the preceding year. The work of
inspection, however, cannot be judged only by quantity, and the Sanitary
Commissioner ought to satisfy himself by personal examination that these