3
your special attention and control during the current year. With improved
supervision in districts where the work is now inefficiently performed the num-
bers vaccinated should show a considerable increase. The average number of
vaccinations by each vaccinator was last year apparently 1,697, not 1,644 as
entered in column 7, Statement I., while other entries in this statement seem
wrongly calculated and require revision.
7. It is unnecessary to enter further into the details of work in each dis-
trict commented on by Dr. Barter in paragraphs 12 to 43 of his report. These
details deserve the careful consideration of the several Medical officers who con-
trol vaccine operations in districts, and it is hoped that at least one fertile source of
delay will not be allowed anywhere to recur, viz. the failure on the part of
Civil Surgeons to keep up their own supply of lymph. In some districts
it is stated that Hospital Assistants " have systematically and deliberately
" disobeyed standing orders " in regard to vaccination. As a rule, it may be said
that when Civil Surgeons insist on Hospital Assistants taking up the work
of vaccination, so far as this can properly be done in connection with their other
duties, the work is done. Thus in Jubbulpore under Dr. Rice the Hospital Assist-
ants vaccinated 5,619 children, whereas in Nagpur, where somewhat similar results
might have been expected under Dr. Brake, who formerly controlled vaccine
operations in the Province, Hospital Assistants only vaccinated 871 cases altogether.
The Chief Commissioner does not share your apprehension that the popularity
of dispensaries might suffer if Hospital Assistants did much in the way of
vaccination, and in most cases they can well undertake the vaccination work of
the town in which they are located, and in large cities of one or more mohullas
or divisions. The influence they possess as resident professionals should facilitate
their work in vaccination, and it seems to the Chief Commissioner that Civil
Surgeons who fail to utilize their Hospital Assistants in this special duty
neglect an opportunity of permanently benefiting the community. Of Jubbul-
pore it is stated " that the immunity from small-pox of the head-quarter city
" and cantonment, as well as the towns in the interior, is evidence of the
" thoroughness of work done in previous years." This has apparently largely
resulted from the judicious employment of Hospital Assistants, and from the care
taken in supervising their work. Other districts might well follow this
example, and where Hospital Assistants failed to carry out the vaccination duties
entrusted to them the punishment of suspension or reduction should be inflicted,
after warning, in order to convince the subordinate staff of the importance which
the Administration attaches to this particular work. There is no insuperable
difficulty, under proper arrangements, in protecting the towns where medical
subordinates are stationed from the scourge of small-pox, as in such towns a
permanent trained agency exists to perform vaccination, and this agency can by
careful supervision be made to do thoroughly good work. The Chief Com-
missioner expects therefore to see real progress made in vaccination work in
towns.
8. The real cause which retards the progress of vaccination is doubtless
the fact that the work is often badly done. In parts of Sambalpur it would
seem that the faith of the people has been shaken because vaccination offered
no apparent protection against small-pox on its recent appearance in an epidemic
form, but such protection would doubtless have been afforded if vaccination
had everywhere been properly carried out. This had been done in the adjoin-
ing Patna State under direct management, and as a result the people enjoyed
complete immunity from the disease. The Commissioner writes:—
" Here for some years past vaccination has been carried out thoroughly, village by vil-
lage, and in consequence this tract was entirely free from small-pox during the
year. A better proof on a large scale of the value of vaccination properly per-
formed could not be given, nor a stronger proof afforded that the vaccine arrange-
ments of the khalsa portion of the district were defective, for the protection
obtained in Patna should also have been obtained over some part at least of the
khalsa if the same thoroughness of work had been the rule."
It is clear now, and Dr. Barter states that the conclusion is forced on him,
"that the quality of the work in Sambalpur is not so good as it might be." It
is only by close supervision that this can be remedied, and that vaccine opera-