2
TRIENNIAL REPORT ON VACCINATION IN BURMA FOR THE YEARS 1914-15 TO 1916-17.
Pegu and Irrawaddy Divisions and to three districts of the Tenasserim Division.
It has been mainly due to improved organization and supervision, to greater energy
on the part of Civil Surgeons, and to the active support furnished by Deputy
Commissioners and their assistants.
In the four Divisions of Upper Burma, a falling off in primary operations of
44,726 or 8.69 per cent. of the work of the previous triennium, and of 33,672
revaccinations (34.14 per cent.), is observed. This decrease affects three Divisions ;
Sagaing Division alone showing an increase of 6,846 primary operations, which is
shared in by all four districts. The all but complete absence of epidemic small-
pox in Upper Burma Districts during the years 1914, 1915 and 1910 is the
principal explanation of the decrease in the output of vaccination work in the
other three Divisions.
2. Small-pox and Vaccination.—The intimate relation between the prevalence
of epidemic small-pox and increased vaccination work in Burma, merits a review
here of the course of small-pox in the Province.
The evidence of statistics and of the chronological sequence of events shows
convincingly that small-pox infection is an exotic which is maintained in, or
reintroduced into Burma by importation from India through the ports of Lower
Burma, and through that of Rangoon for the most part. Arakan is liable to
infection by land from Chittagong, but this infection does not extend by land into
the Irrawaddy Valley or Delta.
The port of Rangoon is in direct steamer connection with the ports of Bengal
and Madras, and hundreds of thousands of deck passengers from those Provinces,
and viâ Calcutta, from Bihar and Orissa, the United Provinces, and the Punjab,
arrive annually in Rangoon. The chronological association of small-pox preva-
lence in Burma with epidemic outbreaks in Madras, Bengal, and Bihar and
Orissa, is a close one, and during epidemics in Madras and Bengal Presidencies
many cases of the disease are landed in Rangoon, and a proportion of these come
from interior parts of the two Presidencies at a time when the ports of departure
are declared free from the disease or only lightly infected.
During the last two decades (to which my enquiry has been limited) small-
pox has with almost clock-like regularity broken out afresh in widespread
epidemic form in Burma at intervals of five years. The outbreak usually attains its
maximum in the second year, and then rapidly diminishes and five years later
recurs. The interval between the commencement of two successive outbreaks
is thus six years. Rangoon is never free from small-pox, but usually shows an
exacerbation of the disease in the year preceding the development of an epidemic
in the coastal and interior districts of Lower Burma. Recent epidemics in
Rangoon have been less severe than formerly, owing to an improved vaccination
department, and more particularly to the passing of the Vaccination Act of 1909,
which permits of the examination of all incoming deck passengers of the labouring
classes, and their summary vaccination if found to be unprotected. This Act has
been applied to Rangoon somewhat spasmodically, but with greater vigour since
1915, and its effect has been wholly salutary, so much so that the anticipated
outbreak of small-pox in Lower-Burma at the commencement of 1917, the fifth
year since the cessation of the last serious outbreak in Burma (in 1912), has
aborted. In 1916, 343 deaths from small-pox were returned by Rangoon, in due
sequence to the last previous severe outbreak of 1911 in that port, and fears were
entertained of a serious outbreak in Lower Burma in 1917. This is now very
unlikely to occur since it has been the experience of the last thirteen years that such
epidemics develop and expend their energies before the end of May. Moreover
the source of origin, Rangoon, which shares simultaneously with the neighbouring
districts in the development of the epidemic, has returned only 10 deaths since
the 1st January. It would seem as if the infection had been " scotched " at
its source, and largely through the vigilance of the Port Health staff, assisted by
the Vaccination staff of the Rangoon Health Department; who vaccinated in
1916 no less than 28,378 "unprotected" deck passengers out of a total of 29,310
declared by the Port Health Department; about 13 per cent. of the emigrants
from India. During 1916 the officers of the last-named Department detected
unreported cases of infectious disease in 20 per cent. of 217 "healthy " vessels
inspected under the Vaccination Act, and dealt with 56 cases of imported small-
pox. Unfortunately the facilities now offered for inspection of immigrants in the
port of Rangoon are inadequate, and only permit the Port Health staff to give partial
effect to the powers vested in it under the Vaccination Act of 1909. An exten-
sion of the wharf accommodation and some increase of staff would reduce to a
minimum the risk of introduction of sea-borne small-pox infection into Burma,
and the inevitable small local outbreaks could be more easily frustrated by the
district organizations.
It remains only to add that epidemics of small-pox follow the line of the
railways and main watercourses radiating from Rangoon, and that they affect Upper