TRIENNIAL REPORT
ON
VACCINATION IN BURMA
FOR THE YEARS 1914-15 to 1916-17.
Statement I.
I. General review of Vaccination Work.—The outstanding feature of the
return of vaccination work during the triennium ending with 1916-17 is a decrease
in the number of operations, both primary and revaccination, performed, as con-
trasted with the work of the previous triennial period. Whereas the returns of the
triennium ending with 1913-14 showed an increase in the total operations performed
of 32.51 per cent. on the work of the period 1908-09 to 1910-11—those of the
triennium under review show a decline of 4.23 per cent. on the intermediate
period though still 26.91 per cent. in excess of the earlier triennium. The total
decrease amounts to 65,729 cases, including 38,355 primary operations and 27,374
revaccinations.
As will presently be shown, a large part of this decrease has been due to
circumstances beyond human control—mainly to the freedom from visitation of the
Province by small-pox in serious epidemic form during the last triennium, and in
a minor degree to the effects of the war, which have deprived the Department of
the services of the whole of the Assistant and Subordinate Medical staff of the
Sanitary Department previously available to assist in the supervision of vaccination.
This deprivation has been almost complete since the end of 1914. The Depart-
ment has thus lost the services of 2 Deputy Sanitary Commissioners, 15 Military
Assistant Surgeons, and 13 Military and Civil Sub-Assistant Surgeons. There
has also been much disorganization of sanitary control owing to frequent changes
in the personnel of District Civil Surgeons, most of the more experienced of whom
have been transferred to military duty.
The main factors which stimulate vaccination work in Burma may be briefly
stated as follows:—
(1) Outbreaks of epidemic small-pox.
(2) Improved organization and supervision of the District Vaccination
staffs, with which must be included an increase in establishment.
(3) Increased interest shown in Vaccination work by Deputy Com-
missioners and their Assistant District Officers, and by Presidents and Members of
Municipal Committees
The reverse conditions constitute factors unfavourable to the progress of
vaccination, and speedily make their influence apparent in the vaccination returns.
So great has been the effect in the past of small-pox prevalence in Burma
Districts in imparting vigour to the work of vaccination establishments, that the
apparently paradoxical result obtains that success in preventive measures against
small-pox leads to a diminution in protective work subsequently performed. Chief
among these preventive measures is the operation of vaccination itself. The
decrease of small-pox prevalence is closely accompanied by a total cessation of
the spontaneous demand for vaccination by the public. At the same time a
decrease in the enhanced activity of the medical and lay district officials in push-
ing vaccination is a usual result of relief from the threat of epidemic outbreaks.
It was therefore as certain as that the night follows the day,
that the vaccination returns of the last triennium would show a diminution
on those of the preceding three-year period. The returns for the period under
review show however that this law is subject to modification under conditions
favourable to the progress of the vaccination propaganda, especially those
conditions classed as (2) and (3) of the stimulating factors stated above. As the
following analysis of the returns of the several Divisions and Districts will disclose
these last-named factors have had the effect in large and important areas of
counteracting unfavourable influences, and have effected a very considerable and
gratifying advance in vaccination in the districts concerned. It will also be shown
that in Lower Burma the greater part of the falling off in vaccination is limited to
a few districts, and that elsewhere real progress has been made. If we exclude
from present consideration the Arakan Division, the circumstances of which will
be shown to be peculiar and not closely comparable to those of the rest of
Burma, we find that the returns of the other three Divisions of Lower Burma
show a total increase in primary operations of 33,977, equal to 6.36 per cent. of
the aggregate for the previous triennium. If again we exclude the returns of the
six defaulting districts (Amherst, Thatôn, Rangoon, Henzada, Pegu, Mergui) it
is found that in the 11 remaining districts, there has been an advance of 64,549
primary operations in these districts, or 22.36 per cent. on the work of primary
vaccination achieved in the previous triennium. This increase is limited to the