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6. The percentage of successful cases in primary vaccinations fell from 90.9 to
88.9, and of secondary vaccinations from 72.1 to 63.4. The latter may be left out of
consideration. My own belief is, that in secondary vaccinations a genuine vesicle is
even more rarely established than the returns show. If such is not the case, the pri-
mary vaccination must have been very indifferent. That there should have been a
falling-off in the percentage of successful cases in primary vaccinations is unsatis-
factory and disappointing. Apart from the skill of the operators, all the elements of
success were present to an unusual extent: the lymph sent from the hills was active
and good, the season was specially cool and suitable for vaccine operations, and the
number of very young children in greater proportion than last year. The cause of failure
is apparent from a glance at the returns : it was plainly the consequence of the sud-
den addition to the establishment of a large number of inexperienced vaccinators. Of
the 17 local vaccinators, all are comparatively new hands, and the average percent-
age of successful operations performed by them out of 15,807 cases, amounted only
to 77.8. Excluding these, the percentage of success would be almost the same as for
the previous season. Last year, likewise, there was a large proportion of inexperienced
men employed in the Seharunpore and Meerut Districts ; but I was able, to a certain
extent, by personal superintendence and assistance, to keep their work up to a fair
standard of excellence. With one exception, all the local vaccinators belong to the
Meerut Division, and as I was for the greater part of this season employed in the
inspection of the Agra Division, it was impossible for me directly to influence the quality
of their work. Next year, greater experience on the part of the vaccinators, com-
bined with the more efficient supervision which the appointment of a deputy superin-
tendent will secure, cannot fail to produce an impovement in the quality of the vaccina-
tion,—a greatly more important consideration than an increase in its amount.
7. The average number of operations performed by each vaccinator was 239.9, or
eight fewer than last year. The epidemic prevalence of small-pox last season probably
had a considerable effect in inducing parents to submit their children to be vaccinated,
and consequently in increasing the numbers operated upon. The absence of epidemic
small-pox during this season has probably had an opposite effect, and may to some
extent account for the diminution in the number of operations performed by each vac-
cinator. Similar effects have, in previous years, been observed uniformly to attend
the presence and absence of small-pox prevailing as an epidemic. But another and
main cause will be seen from the returns to be the falling-off in the numbers vaccinated
in'Dehra Doon and Tehree Gurhwal. In these two districts alone there were upwards
of 7,000 fewer vaccinations than last year. In both the birth-rate has been reached,
and in future the numbers will probably never again reach those of last year. Even
this season's numbers would represent the birth-rate of a population of nearly half a
million, which is probably greatly in excess of that of Tehree Gurhwal and Dehra
Doon.
8. During 1873 small-pox prevailed with great severity over the whole of this
circle, with the exception of Dehra Doon and Tehree Gurhwal. In both of these the
fixed population is almost thoroughly protected by vaccination. When small-pox
breaks out in Dehra Doon, the disease is usually found to have been imported from
outside the Sewaliks, and those attacked to be the unprotected children of persons
from other districts. The mortality in the districts of Boolundshuhur and Etah was
very great: in the former, 6,967 persons died ; and in the latter, 5,045. The
great majority of deaths occurred amongst children under three years of age.
Calculating these in Boolundshuhur at about 70,000, and at 50,000 in Etah,
the annual birth-rate in the former being 28,000, and in the latter 21,000,
and making allowance for deaths from birth up to three years, their numbers
were more than decimated. In neither of these districts can vaccination have had
very much influence in diminishing the number of deaths;—until towards the
close of last season, vaccination was very backward in the Boolundshuhur District.
At length, however, through the exertions of the Magistrate, Mr. Willock, the number