8
VACCINATION REPORT.
supplement to this report with reference to the re-organization of the department,
that rates of pay much above the average, should be allowed to men working in
these tracts.
QUALITY OF WORK EFFECTED BY THE VARIOUS BRANCHES
OF THE DEPARTMENT.
16. Nothing short of the laborious checking of the work of vaccinators as pur-
sued during actual inspection, can testify accurately as to the value of the vacci-
nation performed: so-called vaccination marks may be made which are of little
or no value. Statements as to quality of work are forwarded to Government after
special inspections of Municipalities and districts by the Sanitary Commissioner
and his Deputy; but the percentage of successful operations to total performed is
also a guide of some value as to the quality of lymph used and skill exhibited,
when applied to statistics furnished with this report. This is shown in Table IX
attached. As the number of Deputy Inspectors employed is not sufficient to
verify the total cases per annum by vaccinators, a large percentage of cases have
to be regarded as " successful" on the report of the operators. The average of
success for Local Fund Circles, as reported by vaccinators, by all methods of
vaccination, amounts to 95.7 per cent., whereas the average result after inspection
by Deputy Inspectors amounts to 91.4 per cent. (including work of Municipal
Vaccinators reported on by Deputy Inspectors), showing a difference of 4.3 per
cent. between the two statements. It will be observed the result of inspections
by the Deputy Inspectors does not show uniformly a smaller percentage than that
stated by vaccinators, as might naturally be expected; but it is possible the expla-
nation in these cases may be that the greater number of cases verified by these
Deputy Inspectors, may have been in divisions where more skilful performance of
the operation was effected than in others in the same range. In only one case
do the rates exactly correspond. This average rate represents a degree of success
by all modes of employment of lymph, namely, with lymph taken from arm to arm,
stored in tubes, or between glasses and in bottles, and by the softening of scabs.
It will be seen, as, indeed, should be the case, that in the majority of operations
with human lymph the arm-to-arm method has been employed. According to a
standard authority—Marson—an expert vaccinator ought not to fail in producing
successful results more than once in one hundred and fifty cases; so that, irre-
spective of the deduction that should be made on account of the difference reported
on inspection, the rate of success for this mode of vaccination even at 96.8 per
cent. shown in Table X attached, cannot be said to bring the vaccinators employed
by District Boards under the definition of experts. Where stored lymph is used,
some latitude must be allowed, in consideration of climatic conditions to be
contended against, when compared with European results. In Europe, it is
expected that a vaccinator ought not to fail when employing this mode in more
than 5 per cent. of his cases; the grade of 91.5 per cent. shown under the head-
ing of stored lymph need not be regarded, therefore, as proving more than the
imperfect skill exhibited in operating from arm to arm plus climatic conditions,
with reference to the preservation of lymph. I trust, in calling attention to these
points, I may not be mistaken. Vaccinators doubtless perform their duties to the
best of their power; the fault, if fault there be, lies in the system which places
uneducated men in the department.
17. The rate of success for all methods of primary vaccinations in the case of
Municipalities is lower than that found under Local Fund Boards, namely, 93.5 per
cent.—a rate uncorrected by inspection. Again, the rate for operations by Medical
Subordinates attached to dispensaries and hospitals is still worse, being 86.9 per
cent. This result, in the case of the latter, may be said conclusively to show that
my argument as to better education of vaccinators securing better results is dis-
proved, having regard to the medical training of these operators; but I believe
that a Medical Subordinate is much more likely to be a correct judge of what is a
" successful vesicle " than a District Board Vaccinator in the first place; and, in the
second, the method necessarily pursued courts failure. It is impossible for Medical
Subordinates to attend punctually, on account of other duties, for the taking of
fresh lymph, and therefore they use very largely material in tubes supplied by