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REPORT OF THE KING INSTITUTE, GUINDY
vaccination lies in the thorough cleansing of the skin. Not more than three children should
be taken at a time, for it is desirable that the arms that have been cleansed are not exposed
too long to dust before the operation of vaccination is over.
V.—Vaccination.
The vaccinator should now take the lymph vial out of the wooden holder and shake it
well before opening it.
2. He should then gently rotate the cork and break the seal. The cork should now
remain only lightly inserted in the vial to facilitate its subsequent removal.
3. He should hold the tube in his left hand, and the lancet with the thumb and index
finger of the right. With the aid of the other fingers of the right hand he should remove
the cork and with the scoop end of the lancet take out a scoopful of lymph. While this is
being done, the inner end of the cork must not be allowed to touch anything. The cork
should be inserted immediately, and the tube replaced in the socket of the holder. The
object of this procedure is to ensure that the tube is not kept open too long and the lymph
exposed to air and dust while it is being taken out of the vial. One scoopful should suffice for
two insertions. The lymph should be applied with the convex side of the scoop in two places
one inch apart, on the outer aspect of the arm of the child. Taking a gentle grip of the
child's arm from behind and slightly stretching the skin, the vaccinator should then apply
the toothed end of the lancet on the skin through each drop of lymph and rotate it to
the right and to the left with a little pressure so as to produce a light circular cut. Care should
be taken that the cut is of the same depth over the whole circumference of the circle, it must
not be so deep as to produce bleeding. With the scoop end of the lancet, the lymph should
then be rubbed well into the scarifications.
4. The used lancet should then be sterilised in boiling water as described under IV. 4
above and replaced on the wooden holder.
5. Every child should be vaccinated on both arms, four insertions being made in all.
6 . I n r e - v a c c i n a t i o n c a s e s , s c a r i f i c a t i o n s h o u l d n o t b e d o n e o n t h e s i t e s o f o l d s c a r s .
7. Once a vaccine vial has been opened, the contents should be used as far as possible in
one place. Only one vial should be opened at a time. No lymph should be used later than
four days after its receipt by the vaccinator. The aim should be to use glycerine lymph as
promptly and as quickly as possible. Four days are allowed for its use excluding the date of
receipt; but the vaccinator must use the lymph on the date of the receipt of vaccine, unless
circumstances prevent him from doing so.
VI.—Precautions.
Vaccinations should be performed invariably during the cool hours of the morning or
the evening.
2. The vaccinator should examine every child carefully to ascertain that it is in a good
state of health before proceeding to vaccinate it. Children suffering from acute skin disease
should not be vaccinated.
3. Vaccinated children should not be allowed to go away till the lymph has thoroughly
dried; period required is at least fifteen minutes and is often more. Also their arms must not
be exposed in any way to the sun.
4. Parents and guardians should be instructed not to wipe off the lymph and should be
watched to see that they do not do so. They should be told to keep the child's arms scrupulously
clean and to preserve the vesicles intact once they have formed. They should be warned that
the vesicles should on no account be covered with cow-dung, ash, leaf-paste or similar obje
c - t i o n a b l e a p p l i c a t i o n s a n d i n f o r m e d o f t h e d a n g e r s o f s u c h a p p l i c a t i o n s .
VII.—Extra Indents.
Vaccinators requring vaccine for an extra number of cases should submit their indents
through the Health Inspector and the District Health Officers as in the case of deviation of
programme to the Director, King Institute of Preventive Medicine, Guindy, Saidapet, Madras.
These indents should be made on the printed post cards prescribed for such purpose. But in
times of smallpox, indents may be sent directly to the King Institute by the vaccinators or
Health Inspectors, the words "Original—Smallpox—Urgent" should be noted on all such
indents in order to distinguish them from the ordinary indents. Also copies of all such indents
should be marked "duplicate" and submitted to the District Health Officer who should
scrutinize them carefully and take necessary action as laid down under "Deviations from fixed
programme."
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