30
Age.
5. The percentages of operations on persons below and above one year of age is respec-
tively 38.8 and 61.2, against 34.2 and 65.7 of the previous
year, showing an appreciable increase in the number of
operations on infants.
Success.
6. The percentage of success is somewhat higher in the past than in the previous
year, the numbers being 96.4 in the former, and 94.9 in
the latter year.
Quality of lymph in general use.
7. With very few exceptions the lymph in use has been excellent, having been changed
when necessary with Animal and Privy Council lymph.
In the month of November Privy Council lymph
received through the Superintendent General was used at Shikárpur successfully, and by the
end of March it had been distributed over the whole Province, and the vesicles resulting
being superior to those of the old lymph it was preferred. Now I think the lymph in Sindh
will compare favorably with any in the world! In the town of Mírpur, where Alá Baksh
was operating, I saw vesicles—the result of the use of both Animal and Privy Council
lymph—and they were really splendid.
Animal Vaccination.
8. In the beginning of November I proceeded to Sakkhar, and with the assistance of
Honorary Assistant Surgeon Leahy, operated on several
heifers, but all proved unsuccessful. More lymph was
asked for and received from Bombay, and its use was attended with successful results.
Lymph from this source was distributed to all the vaccinators with diagrams for distinguish-
ing this from the Privy Council and the old lymph. On account of the dryness of the
climate of Sindh, I have observed that when lymph is being transferred from the calf to the
arm of the child, or to another heifer, or in filling tubes, it desiccates very rapidly. To
prevent desiccation the tube should be applied to the lymph directly it begins to exude. If
this is not done the lymph soon begins to desiccate, and will not flow into the tube. Lymph
taken from the vesicle with a lancet should be used at once.
Method of operating when
using tube lymph.
9. In using tube lymph, after breaking off both ends of the tube, take hold of the
child's arm with the left hand, blow a bead of lymph on
. the spot where it is intended to operate, and at once
make the puncture with the lancet through the lymph
from above downwards. Operating in this way I have never once failed. Failure is next
to impossible, because the moisture on the surface of the skin preserves the normal fluidity
of the lymph until it is brought into contact with the blood. The skin is cool, and there is a
certain height of atmosphere above the surface of the skin—say an eighth or perhaps a
quarter of an inch—which is thoroughly saturated with moisture of exhalation, in which
the lymph can live for some time; but put the lymph on the point of a hot dry lancet in an
atmosphere intensely hot, devoid of moisture, and it desiccates at once. Hence I believe
frequent failures. If the virulence of the lymph existed in the fluid of the blastema, there
would be little hope of propagating lymph from tubes in Sindh during the hot weather, but
since it exists in the cell, as was lately pointed out by a German, it is possible to nurse it
through the heated air into contact with the blood.
Dispensary vaccination.
10. This year dispensary vaccination has been very backward indeed. I have over and
over again sent lymph to those officers who had sent in
blank returns, and urged them to try, if possible, to keep
their lymph going, but to very little purpose. These men complain that they cannot get
children to operate on, except by something stronger than "moral suasion," and I believe there
is some truth in this, because the parents of the children have no moral leader. Those in
authority, their Chiefs, and the Government Native Officials are dead against vaccination.