1335NOTES FROM INDIA.

"THE WORKING OF THE NEW VACCINA-TION ACT."

To the Editors of THE LANCET.

SIRS,-I wish to endorse every word of the letter of"A Public Vaccinator" that appeared in THE LANCET ofNov. 4th. Personally I prefer to act towards my neigh-bours in accordance with the recognised rules of professionaletiquette rather than carry out the new Act to the letterby visiting their private patients to offer vaccination. As

regards the question of remuneration for families due to

bad lymph I am also heartily in accord. I have recentlyemployed ten tubes of National Vaccination Establishmentcalf lymph of the most unsatisfactory character. Two wereabsolute failures. One of these two involved a journey of12 miles for the operation and one of similar length forinspection. As the repetition of both operation and inspec-tion is inevitable an additional distance of 24 miles will haveto be traversed without any extra remuneration.

I am, Sirs, yours faithfully,Nov. 6th, 1899. PUBLIC VACCINATOR No. 2.

To the Editors of THE LANCET.

SIRS,-I agree with "A Public Vaccinator" and withmuch of the annotation in THE LANCET of Nov. 4th onthe unpleasant and unprofessional duty of canvassing nowimposed on public vaccinators. It has hitherto been theduty of the vaccination officer to visit the houses of un-

vaccinated infants, point out the advantages of vaccination,instruct the parents to take the infants to the vaccinationstations at the appointed time, and if they neglect to do so totake the necessary steps to enforce the law. Under this

system the public vaccinator did not go to the homes of theinfants and could not be accused of direct canvassing. Now,the effect of the recent Act and the Local Government Boardregulations is that the duties of the vaccination officer are toa large extent imposed upon the public vaccinator, and Iconsider that the vaccination officer should, when the infantis four months old, send a notice to the parents respectingvaccination and call and explain to them the advan-tages of the operation, and unless they say theyintend to have it done by their own medical man heshould tell them that the public vaccinator will call andvaccinate the infant free of charge. Having done so, heshould send the public vaccinator a list of those requiringhim. In any case, where the vaccination officer fails andthe child is six months old and not vaccinated, he shouldsend a more peremptory notice to the parents and ask thepublic vaccinator to call and offer vaccination previously totaking legal proceedings. By this means (which is only amoditication of the system in vogue) many visits to thehomes of our neighbour’s patients and the greatest part ofthe unsatisfactory "hawking" and canvassing would bedone away with. I am certain the majority of us would

willingly give up the Is. so-called registration fee to be ridof the work it entails, provided the fewer visits, paid as

suggested above, carried a fee of, say, 2s. 6d. within threemiles and 5s. beyond that distance.We are, I take it, agreed that it is most essential to have

vaccination as nearly universal as possible and to do so

it is necessary that the public vaccinator shall visit thehomes of the infants somewhat as laid down in the recentregulations. It is the details of the method which are atfault and not the theory. In my district 27’8 per cent. ofthe children vaccinated this year were over 12 months old,whereas 7 4 per cent. was the average for the previous fouryears. This means that by domiciliary vaccination manychildren are being vaccinated who under the old systemwould have escaped..

I found parents seldom brought a child more than twice or ]three times to the vaccination station and if then postponed they did not return. It is this class of cases which the new j Act is most useful in reaching, for when a child survives the first year there is a much greater chance of his living and it is of more importance to have him vaccinated. Domiciliaryvaccination has, I believe, come to stay, and it would be (well to endeavour to remove all possibility of friction between medical men and at the same time make the opei-ationpopular amongst the public. This last can be greatly helpedby the Local Government Board ensuring a supply of active

lymph, for nothing causes so much wrath amongst parents a&

the constant failures occurring during recent months.I am, Sirs, yours faithfully.

Nov. 7th. PUBLIC VACCINATOR No. 3.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

Great Increase in the Plague Epidemic.-Partial Destructionof the Imperial Laboratory by Fire.-The Sick Returns -

of Indian Jails.Six thousand deaths from plague in one week is a bad

record and unfortunately the numbers are still rising. Forthe whole of India the deaths from plague last week were6727, to which the Bombay Presidency contributed 5812.There is a very serious extension into the Nizam’s’Dominions also, as 592 deaths occurred there. An outbreakis reported from the Saran District in Bengal where a largenumber of deaths above the average has been occurring forsome weeks past. The Punjab is also reported to be againattacked, six cases having been discovered in Hoshiarpur.The general mortality in Bombay city is nearly 300 a weekhigher than it ought to be, and the plague figures are gettingworse. Altogether the epidemic seems extending far andwide as well as re-appearing in its old quarters.The report about plague suddenly subsiding in Poona is.

wrong. The outbreak has rapidly diminished in the cityand cantonment, but the plague cases reported daily even.now (Oct. 10th) average about 20, and in the district thecases and deaths are very numerous. The return of newcases given for Sept. 15th was published as nil, whereas for’the two days (Sept. 15th and 16th) the actual figures were163 cases and 139 deaths-a return very far from showingthat the plague had suddenly subsided. Calcutta shows some

improvement but the returns of from 30 to 40 deaths a weekshow that the disease has by no means become extinguished.It is unsafe to prophesy, but from the greater severity of theoutbreak in Calcutta this year and the continued existence-of what are termed "dropping" cases it is probable thatafter a further interval of quiescence plague will againdevelop itself.

Inoculation is coming more into favour. Several of thenative papers in Bombay are endeavouring to induce theirsubscribers and the public to resort to inoculation. Some-2000 people have been inoculated in Hyderabad (Sind).and large numbers have availed themselves of its benefits at-Nasik and other places.The recent fire at the important Imperial Laboratory

stationed at Muktesar was very disastrous. The whole ofthe apparatus and cultures for the preparation of malleinvaccine against glanders was destroyed, but fortunately therinderpest vaccine apparatus was saved. The manufactureof the latter prophylactic is being continued with successfulresults in the outbuildings of the laboratory.

Great efforts are being made to reduce the high mortalityin Indian jails. The Director-General has lately publishedan exhaustive note concerning the year 1898, and while-generally there is some improvement he refers to manypoints which require to be more carefully investigated. The-year 1898 seems to have been an exceptionally healthy oneand the comparative absence of cholera is remarkable.Malaria is sill one of the chief causes of mortality.Dysentery and diarrhoea give, perhaps, the greatest trouble-to the medical officers. As Surgeon-General Harveysays: "There would be little exaggeration in sayingthat the prevention of bowel complaints is the begin-ing and end of jail hygiene." ...... "A common,cause of bowel complaints, which perhaps does not always-receive the attention that it deserves, is the presence ofintestinal parasites. Probably the vast majority of prisonersare the hosts of at least one variety, and though no apparentharm results in many cases, in others diarrhoea, if not ulcera-tion of the intestines, is set up." The widely spread andfatal character of cholera, malaria, and dysentery among theaatives of India certainly does not support the law laid downby Dr. G. Archdall Reid, " that the resisting power of any.ace is exactly proportionate to its familiarity with thedisease " The year 1898 was perhaps exceptional, but the;tudy of figures for recent years shows how much has beenachieved by the earnest attention of the jail administrationmd by the honest work of the executive officers.

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Calcutta, Oct. 12th.