REPORT ON VACCINATION IN ASSAM.                               19

of the tubes received from the Sanitary Commissioner, Bengal, contained lymph which for some reason
or other could not be blown out of them. I thought they may have been put aside for some time
before being sealed, and that the lymph dried in consequence. On the whole, the lymph received took
well. The supply was kept up by ' arm-to-arm' vaccination when possible, but ' house-to-house'
vaccination was practised in the majority of cases, the lymph being conveyed in capillary tubes, which
are especially valuable where caste prejudices are strong."

Staff of operators.

118. The staff comprised the Civil Surgeon, the Native Superintendent, and Assist-
ant-Superintendent of Vaccination, ten Government, one
municipal, eleven Local Fund vaccinators, five Hospital-
Assisants, three ex-inoculators, and two compounders: all worked well. Below is the
table of results of each:—

The average success is exceedingly good, and, if the work was genuine and
sufficient, there should be in five years a marked impression on the prevalence of small-
pox in the district.

Inspections are too favourable.

119. Dr. Macnamara is, however, too sanguine as to the value of the inspections.
He examined 281 cases, and found 253 successful, average
90.3 per cent.: and yet he accepts the statistics of his native
inspectors, that they personally examined 5,460 cases and found 5,439 successful, average
99.6 per cent.

Vaccination on tea-gardens.

120. Thirty-nine returns were received from tea-gardens, 2,083 total and 1,120
successful. " Many returns are plainly incorrect. Vacci-
nation by garden Native Doctors is all but valueless."
(Civil Surgeon.)

Expenditure.

121. The cost of these extended operations in Sylhet has been extremely moderate.
The total expenditure reached Rs. 1,904, and the average
was 1 anna 9 pies only. But the municipal vaccinator for
the town of Sylhet, where the Act is in force, seems to have been lazy or to have had no
work to do, for his operations cost nearly 8 annas each. Dr. Macnamara thinks he might
be employed elsewhere now, and vaccination within the compulsory area given over to
the dispensary or paid for by the better classes at their own homes.

Review by the Deputy-Commissioner.

122. The Sylhet Annual Report is covered by a careful and lengthy review of the
Deputy-Commissioner. Mr. Stevenson considers that the
inspections are not reliable, and that no practical checks are
devised. He also mentions that planters dislike to prepare forms, and that their returns
are of small value. He supports Dr. Macnamara's view that the appointment of vaccinators
for the cold weather only is a bad system:—" Not only is the quality of their raw work bad,
but the people do not take to a new man every year." The following is also the Deputy-
Commissioner's opinion:—

" There can be no doubt that vaccination should be made compulsory in all the areas in which
registration of vital statistics is compulsory, with the exception of Balaganj, i.e., in Karimganj, Sunám-
ganj, Maulavi Bázár, and Habiganj."

Prospects in Sylhet very encouraging and
have already given good results to increased
expenditure.

123. The progress of vaccination in Sylhet is exceedingly promising at present, and I
hope the Municipalities and Local Boards will recognise that
they have a strong man at the helm in the present Civil
Surgeon, that they will open their purse-strings freely, and cordially accept Dr. Macna-
mara's suggestions for the promotion of this blessing to the district at large.

Medical staff engaged

124. Cachar.—The vaccination report of the year is prepared by Surgeon-Major J. J.
Monteath, M.D., in civil medical charge. He had under his
orders four vaccinators, of whom one only is permanently
engaged, and three Hospital-Assistants.