11
preparation should consist in wholesale
vaccination and re-vaccination of the
whole population.
21. The protection which vaccination
and re-vaccination affords cannot be dis-
puted by anyone who has had actual
experience in dealing with small-pox.
The long experience of the country has
taught us—
(a) that, beyond all question, the mor-
tality from small-pox is much
less now than in pre-vaccination
times;
(b) that the greatest diminution in the
small-pox mortality is found in
the early years of life, in which
there is most vaccination.
(c) that in countries in which there is
adequate vaccination and
re-
vaccination relatively to the
population, there is little small-
pox;
(d) that in houses invaded by small-
pox in the course of an outbreak.
not nearly so many of the in-
mates are attacked as of the un-
vaccinated in proportion to their
numbers;
(e) that the fatality rate among per-
sons attacked by samll-pox is
much greater, age for age,
among the unvaccinated than
among the vaccinated;
(f) that the degree of protection con-
ferred by vaccination corres-
ponds to the quality of the vac-
cine and to the thoroughness with
which the operation of vaccina-
tion has been performed;
(g) that the protection afforded by vac-
cination wanes with the lapse of
time;
(h) that improved sanitation, however
beneficial
in itself,
cannot
account for these facts; and
(i) that though
early
diagnosis,
prompt isolation of small-pox
patients in suitable hospitals,
effective disinfection, supervi-
sion of " contacts " and other
such public health methods are
invaluauble, they are no substi-
tute for vaccination.
22. Insufficiency and inefficiency of
vaccinators, coupled with inadequacy of
pay, should be remedied without further
delay. No evasion of the statutory
rules for the qualifications of public vac-
cinators should be allowed, and their
prescribed duties should be strictly en-
forced. For this reason, a living wage
must be ensured before good work, satis-
factory both in quality and quantity, can
be reasonably expected from the vacci-
nators. The local funds, set free by the
Local Government's provision of a com-
plete public health organisation, should
be utilised in employing an adequate
number of qualified vaccinators of the
right stamp,
to
whom
adequate
remuneration should be
offered. The
Health Officers, Assistant Health Offi-
cers, Sanitary Inspectors and Vaccina-
tion Inspectors should keep a close watch
over the vaccination condition of their
jurisdiction and exercise a strict super-
vision over the Health Assistants and
public vaccinators work. Those Dis-
trict Boards and Municipalities which
still employ only season vaccinators
should abandon
this false economy,
which costs so much in human lives, and
begin at once to keep all the year round
wholetime Health Assistants, who are
qualified public vaccinators and whose
services will be available in the other
lines of public health work also.
In conclusion, I should like to place on
record the valuable advice and assistance
always rendered me by Dr. M. K. Chak-
ravartti, M.B , the veteran Superinten-
dent of the Bengal Vaccine Depôt.
M. E. SUFI,
Assistant Director of Public Health,
Vaccination and Vital Statistics.
CALCUTTA :
The 18th October 1927