2
employed from 40 to 50, and to careful supervision by the Civil Surgeon. In Manipur
the increase is reported to be due to vaccination having been carried on throughout
the year instead of during six months of the vaccination season. I am not disposed
to accept without reserve the figures returned from Manipur, as 2,830 operations per
vaccinator is a phenomenal record, being more than double the best seasonal records
from plains districts where the population is more closely aggregated and much more
easily accessible, and I propose to enquire whether the Civil Surgeon has himself
verified sufficient of the returns to be able to vouch for their accuracy, as it would
appear as if either the Manipuri vaccinators are exceptionally energetic and their
visits unusually welcome or else that their returns are unreliable. The large decrease
of 27,012 and 15,188 cases in the districts of Sylhet and Cachar, respectively, is
very unsatisfactory. The growing increase in the mortality from small-pox in the
district of Cachar is of serious import. The Civil Surgeon attributes the decrease in
the vaccination operations to stricter supervision, but an analysis of the figures
submitted from this district suggest the contrary view. Whatever may be the cause
of the fall, the vaccination of the district should in future receive more attention with
the object of increasing the number of operations performed. In Sylhet the decrease
is attributed by the Civil Surgeon to a comparative freedom from widespread epidemics
of small-pox as compared with the preceding year in which 13 extra vaccinators had
to be entertained to deal with epidemics. Statement VII appended to the report
shows that there was a further increase in mortality from small-pox in the district
during the year under report and that the number of operations performed is the
lowest since 1910-11. The explanation given cannot be accepted as satisfactory and
it is necessary that more attention should be given to vaccination by the Civil
Surgeon, as the system of delegating its supervision to the Subdivisional Assistant
Surgeons is associated with the unfortunate results revealed by the returns in
question. The decrease of 6,137 operations in the district of Sibsagar is attributed
by the Civil Surgeon to the following causes—(1) a smaller number of vaccinations
being performed in the non-vaccination season as compared with the preceding year,
(2) non-receipt of a number of returns from tea gardens, and (3) the exclusion from
the return of 2,008 entries which were found by the inspecting staff to be false. Falsi-
fication of returns seems common in this district and several vaccinators were
punished for false entries. It is only fair to the Civil Surgeon to add that the vac-
cination inspecting staff in this district during the past year have worked very badly,
being incompetent or ignorant, or both. A pleasing contrast with the disappointing
work in these three districts is afforded by the returns from Nowgong where the
steady increase in the protection afforded by vaccination and the resulting fall in
the ratio of mortality from small-pox is most satisfactory. Much credit is due to
the Deputy Commissioner and the Civil Surgeon for the results of their combined
efforts, which one could wish to see imitated elsewhere High percentages of success in
re-vaccinations in the districts of Naga Hills (79.39), Goalpara (77.05), Sibsagar
(76.51) and Lakhimpur (76.83) seems improbable, and will be investigated. The
higher percentage of cases in which results were not ascertained by vaccinators in the
district of the Lushai Hills received the attention of the Civil Surgeon. It is stated that
in spite of his instructions one of the four temporary vaccinators failed to carry out
orders.
9. Composition and strength of the inspecting staff.—There was no change under
this head during the year under report.
10. Verification by inspecting offcers.—The
Civil Surgeons inspected 18,945
primary operations and 2,796 re-vaccinations, or 6.98 and 5.42 per cent., respectively,
of the total number of operations of each class performed during the year. The per-
centage of inspections was the highest in the district of Nowgong, followed by Manipur,
Lushai Hills, and Sylhet. In the last named district the Civil Surgeon was assisted by
Assistant Surgeons in charge of the subdivisions. The amount of verification done by
Civil surgeons is not wholly satisfactory. The Civil Surgeon, Cachar, in whose district
small-pox was rife, inspected only 735 operations and one would have thought that
under the circumstances this department of his work should have received more
attention. Other plains districts returning small inspection figures are Darrang and
Lakhimpur. These low verification figures may be compared with those from Now-
gong where Dr. Dodds Price inspected 2,158 operations. The importance of these
inspections lies in the fact that the success or otherwise of district vaccination is very
largely dependant in the amount of attention given to it by the district Civil Surgeon.
The subordinate inspecting staff inspected 55.18 per cent. of the primary operations
and 40.86 of the re-vaccinations during the year under report, as compared with
35.10 and 32.81, respectively, of the preceding year.