11
These facts clearly establish the protection afforded by vaccination, and this is
still further exemplified in the following statements which give mortality rates
among groups of vaccinated and unvaccinated persons.
(1) ANANTAPUR DISTRICT.
Under one year,
Protected.
A.
...
D.
...
Unprotec
ted.
A.
93
D.
40
(43%)
1—l0 years.
Protected.
A.
77
D.
2
(26%)
Unprotected.
A.
272
D.
50
(18.4%)
10—20 years.
Protected.
A
83
D.
1
(1.2%)
Unprotected.
A.
113
D.
3
(2.6%)
20—40 years.
Protected.
A.
48
P.
2
(4.2%)
Unprotec¬
ted.
A.
51
D.
12
(23·5·/.)
(2) (a) South Kanara … …
(b) Ganjām … … …
(c) North Arcot … …
(d) Bellary … … …
Total deaths
from smallpox in
1925-26.
133
420
1,176
87
Proportion of deaths
among vaccinated to
total deaths.
6.8 per cent.
3.0
„
0.25 „
2.3
„
Proportion of deaths
among unprotected to
total đeaths.
93.2 per cent.
97.0 „
99.75
„
97.7
„
22. During 1925-26, the Municipal Health Officer of Ootacamund sent in reports
of certain cases, admitted into the Infectious Diseases Hospital, which presented
diagnostic difficulties, the clinical manifestations being markedly different from
those seen in typical smallpox. All these cases occurred among vaccinated
persons, the eruptions and other signs and symptoms being very mild in charac
ter, whilst none proved fatal. The Director of Public Health, with one of his
Assistants and Col. Elwes, examined some of these individuals; and, after
consultation with the Director of the King Institute, the diagnosis of " Alastrim "
was arrived at. A circular on the subject was prepared by the Director, King
Institute, and was communicated to all officers of the Public Health Department
for guidance.
In all epidemic diseases, variations in virulence are frequently noted, even
during a single outbreak. This rule holds good for smallpox, but the mildest
case is as serious a danger to the community as the most severe. In his Annual
Report to the Ministry of Health, for the year 1924, Sir George Newman, the
Chief Medical Officer, has clearly established the fact that Alastrim, or as it is
sometimes called, " pseudo-smallpox “ or “ para-smallpox," etc., is really a mild
form of smallpox, and that preventive measures are just as important as in the
ordinary types of the disease. His conclusions regarding the methods of control
and eradication of smallpox are entirely applicable to India and they are here
reproduced :—
(a) Beyond all question the mortality from smallpox is much less now than
in pre-vaccination times ;
(b) In countries in which there is adequate vaccination and revaccination
relatively to the population, there is little smallpox ;
(c) In houses invaded by smallpox in the course of an outbreak, not
nearly so many of the vaccinated inmates are attacked as of the unvaccinated in
proportion to their numbers;
(d) The fatality-rate among persons attacked by smallpox is much greater,
age for age, among the unvaccinated than among the vaccinated ;
(e) The degree of protection conferred by vaccination corresponds to the
quality of the vaccine and to the thoroughness with which the operation of
vaccination has been performed ;
(f) The protection afforded by vaccination wanes with lapse of time ;
(g) Improved sanitation, however beneficial in itself, cannot account for
these facts ; and,