14
Now, these results are very good in some districts and only really bad in Gáro Hills and Sylhet,
as also to a less extent in Cachar and Goálpára. The Principal Medical Officer, Assam, in his letter
of 28th January appended says "In nearly every case the first supplies of lymph from your depôt
were actual or comparative failures. " This, I think, can hardly be considered correct, after carefully
considering the reports tabled above. It will be seen at a glance that the results obtained vary in
each district, but that the first six districts, Nowgong, Sibságar, Manipur, Kámrúp, Darrang, and
Lakhimpur give on the whole very good results, the other four districts, Cachar, Sylhet, Goálpára,
and Gáro Hills, on the other hand, give poor results, more especially Sylhet and Gáro Hills. I will
now proceed to analyse in detail the lymph supplied to those districts which gave bad returns and
try to explain the cause of the failure.
Firstly, then, as regards the lymph supplied :
Sylhet.—The first supply consisted of Nos. 34, 35, 36, 37, 38, and 39. The results were bad, only
20 per cent. successful. Now it is a curious fact that Nowgong was supplied with Nos. 34, 36,
37, and 38, and the results were 70 per cent. successful.
Cachar.—The first supply consisted of Nos. 34, 38, and 39. The results were bad. No figures
given compare with Nowgong as given above. The difference in the results obtained in
Cachar, Sylhet, and Nowgong, where the lymph is identical, can only be due to greater care
taken by Civil. Surgeon of Nowgong.
Goálpára.—The first supply consisted of Nos. 35, 40, 41, and 42, and the results were 15 out of 75
cases successful, or 20 per cent. decidedly bad, but I believe the lymph was not used
immediately on its receipt. Lakhimpur had Nos. 40, 41, and 42, and showed 50 per cent
successful, and Kámrúp 40 and 41 with good results. No figures given.
Gáro Hills.—This is the most noticeable of all the districts for bad results, yet its first supply,
Nos. 32 and 33, which did not give a single successful case, in the case of Manipur No. 33 gave
80 per cent. successful and 32 over 50 per cent. in Darrang.
I need not go further into detail to show how hopeless the results obtained are than by stating
that the second supply is somewhat like the first, and the same Civil Surgeon who got good results
with the first supply got good with the second also.
The only districts which showed really bad results were Sylhet, Gáro Hills, and Goálpára :
Sylhet.—Gives only 20 per cent. successful. Now, the supply consisted,of Nos. 48, 49, 51, 53, and
57. Manipur, with Nos 48 and 49, had 84 per cent. successful, Darrang, with 49, 50, and 51,
had 75 per cent. successful, Kámrúp, with 47, 48, 49, 57, and 58, gives no figures, but states
"good." The results being bad can only be due to want of care on the part of the vaccination
staff in Sylhet,
Gáro Hills.—Not a case successful with No. 50, yet Darrang had 75 per cent. successful with
the same.
Goálpára.—70 successful out of 171 cases with Nos. 45, 53, 58, 59, and 60, yet Lakhimpur has
75 per cent. successful, with 55, 56, 58, 59, and 60.
I think I have given sufficient figures to show that the fault in the result obtained must be
due to some local causes and not to the lymph supplied, and that it is chiefly in two districts, Sylhet
and Gáro Hills, that these bad results are extraordinary. Secondly, I will now try to explain the causes
of failure. To render vaccination a success there are several points which should be carefully
carried out where bovine lymph is used. These are what I have called local causes, and can only
account for greater success of some Civil Surgeons than others. I will now state what I consider
necessary to successful vaccination :
(1) All bovine lymph should be used as soon as possible after its manufacture. It should not
be allowed to lie in a Civil Surgeon's Office till the Native Inspector or vaccinator comes, but each
week the day it is received it should be distributed, and arrangements accordingly made to carry
this out. Any delay in the plains, where the heat is great, especially in the beginning of October and
the end of March, is sure to affect results.
(2) Vaccine operations in some parts of the plains should not begin before the 15th of October,
and should not be continued after 20th March, i.e., wherever the heat is great, because the lymph
will not keep well in heat, though I have found it perfectly good four to five months after manufac-
ture in the hills, where care is taken how it is stored.
(3) Care should be taken in the distribution and storage of the tubes. They should not be
exposed to sunlight and heat. I have the windows of the depôt covered with blue paper to
prevent the bright sun shining on the lymph while being prepared. Many a time, in each district
I have been in, I have had to explain to the Native Superintendents and vaccinators that they
must not put down the boxes or glass cases containing the tubes right in the sun, thereby doing
their best to destroy the efficacy of the lymph. All vaccinators should keep their tubes in a wooden
box, with wool round them.
(4) (a) The mode of operating is important, and I am certain that this is a most important
feature as regards results. The scarification should be superficial, not deep, in fact, so light that no
oozing should take place till the lymph is being rubbed in, when the oozing should be very slight.
A deep scratch where blood oozes tends to prevent the absorption of the lymph. The skin should
be well stretched by the finger and thumb of the left hand and a light scratch made with the right hand
either by a needle or lancet.
(b) Before scarifying, if there is oil on the arm, as is so frequently seen in young infants, the
arm should be rubbed with a damp cloth ; the same if dirty.
(c) The scarification having been made, the lymph should be put on an ivory point and well
rubbed in to the scratch. I say well rubbed in, not simply applied on, the scratch. If the scratch
is deep this will make it bleed and the results be unsatisfactory, so I always use needles if possible
instead of a lancet. When the scratch is deep, wait till the oozing ceases and dry with a cloth before
applying the lymph, and only rub it in gently. It is very easy to make a needle,—a small piece of
bone or ivory, with four needles tied at the end, and the handle does for rubbing in the lymph.