3
Dispensary Vaccination.
STATEMENT III.
8. Sub-Assistant Surgeons attached to charitable and travelling dispensaries
did 6,969 operations during small-pox epidemics, of
which 2,573 were primary with 1,898 successful, and
4,396 re-vaccinations, of which 2,182 were successful.
The Civil Surgeon. Akola, deplores the fact that Sub-Assistant Surgeons no
longer vaccinate, but I think these officials were distinctly relieved at the time of
the new orders. When the central factory is in full swing, there can be little
objection to their operating on their own patients provided they observe the
correct procedure for reporting results.
Vaccination by others.
9. Medical officers attached to Railways and others did 4,473 vaccinations
during the triennium. Of these 1,512 were primary and
2,961 re-vaccinations, the successful results being 1,209
for the former and 1,693 for the latter.
Inspection of vaccination.
STATEMENT V.
10. During the past year Civil Surgeons were out on tour for 696 days
and inspected 47,699 of the primary and 9,367 of the
re-vaccinations done in 3,630 villages. This is less work
than was done in the two previous years, and I think there is a general tendency
towards the curtailment of their inspections which cannot but be deplored. The
relaxation of reliable supervision must occur at times and in busy places, but we
are not prepared to dispense with it altogether by a very long way. It is very
necessary to recognise that personal inspection of the work and supervision of
returns by the Civil Surgeon are essential, and a reasonable amount of both can
and should be carried out in all but two or three of the largest places. A Civil
Surgeon who can only spare three days in the whole season of six months must
either have his hands exceedingly full or else place extremely slender reliance
on his staff. Assistant Superintendents of Vaccination and others, viz., Sub-
Divisional Medical Officers and Assistants to Civil Surgeons, were out on tour
for 4,582 days, visited 20,921 villages and inspected 282,691 or 54.82 of the
primary and 34,489 or 34.71 of the re-vaccinations, a satisfactory amount of
work. In Saugor, Mandla and Nagpur the amount of inspection is low.
11. Of the number inspected, the Civil Surgeons found 98.55 per cent
successful in primary and 50.94 in re-vaccinations and the Assistant Superintend-
ents of Vaccination and other officers found 97.59 for the former and 39.65 for
the latter, the vaccinators' results being 97.85 and 65.03.
Inspection by the Sanitary
Commissioner.
12. During my tours I inspected the vaccination work of 15 towns. The
registers showed that 5,580 children had been vaccinated
with 4,889 successful results, 249 failures and 521
unknown. The actual number of children seen by me was 1,557, of which 80 per
cent showed a sufficient vesicular area to secure fair immunity. There is still
some evidence of irregularity in the number and method of making these
insertions, and it should be clearly understood that four good vesicles (all on one
arm or two on each, according to the wish of the parent), having an aggregate
area of half a square inch is what is desired. It is a fairly clearly established
fact that the immunity conferred by the operation is in direct proportion to the
extent of the vesicular area, and there is no doubt that neglect of this considera-
tion is one of the factors tending to permit the continuance of epidemic small-pox ;
the other factors will be referred to later.
My inspections of re-vaccination work were few because it is almost
impossible to form any opinion of the efficacy of the operation at long periods
after its performance. The points requiring attention in town vaccination are
briefly—
(1) Municipal responsibility, and
(2) Attention to the clauses of the Act.
In rural areas I inspected work in 80 villages of the Akola, Amraoti and
Buldana Districts where 2,653 primary vaccinations had been performed, and of
these 1,317 (50 per cent) results were verified, showing 22 failures. It would
be satisfactory to know that there were only 22 failures in the uninspected