4
REPORT ON VACCINATION IN BURMA FOR THE YEAR 1889-90.
GENERAL REMARKS.
24. Although the past three years have not been distinguished by any
remarkable increase in the number of vaccine operations, it is satisfactory to
note that the figures indicate a steady and progressive extension. The reports
of Superintendents of Vaccination show that such prejudices as the Burmese
entertain against vaccination and in favour of inoculation as a prophylactic are
surely disappearing before the apparent fact that, while vaccination confers a
comparative immunity against smallpox, it is attended with less inconvenience
and risk than inoculation. An interesting example of this is furnished by the
Civil Surgeon of Sandoway. In the little village of Khramaung, about 5
miles from the town, some persons who had been vaccinated, but who had
but little faith in the efficacy of the operation as a protection, sent for the sayas
to inoculate them. They were inoculated five days after the vaccination, but
without result. In each case inoculation was repeated three or four times
and with the same result. This was a test case and appealed to the understand-
ing of the villagers, ruined the reputation of the sayas, and induced the headmen
for a considerable distance round Sandoway to make earnest appeals to the Civil
Surgeon to send vaccinators to their villages.*
25. That, save in the presence of an epidemic of smallpox, the people
in the districts are for the most part averse to vaccination cannot be denied,
and for several reasons, the following among others. Like more advanced
peoples, the improvident Burmese are not wishful to take out an insurance against
a contingent possibility. Again, the results obtained by vaccinators in districts
are not always satisfactory, and in the very malarious districts, where the chil-
dren are weakly and anæmic, the vesicles, unless carefully tended, are prone to
develop ulcers followed by secondary abcesses. There can be no doubt also that
inoculation is sometimes practised in the guise of vaccination; indeed in Nga-
thainggyaung so much do the people fear that vaccination will induce smallpox
that a vaccinator appearing in a village which is free from the disease stands in
danger of being roughly handled. But the greatest obstacle in the way of
vaccination is the authority exercised by the sayas, whose living depends on
their practise of inoculation. These men have great influence and readily
persuade the people that vaccination not only does not ward off an attack of
smallpox, but itself exercises a most baneful influence on such as are operated
upon. In the more remote districts, where presumably the practice of inocu-
lation is not lucrative, the people take very kindly to vaccination.
26. While the sayas lead the popular mind against vaccination they them-
selves have no objection, theoretical or other, to the operation; indeed, in several
districts they have been employed as vaccinators as it was hoped that, seeing the
change of faith in their teachers, the people themselves might be converted.
The experiment has been tried in Thôngwa, Tharrawaddy, Henzada, and Prome.
At Shwedaung in the Prome district the mortality among those inoculated
was so great (8 per cent. of those operated upon) that special efforts were made
to stop the practice, but so infatuated were the people that it was not until
the Burmese officials took an active part in discouraging inoculation that it was
put an end to. The inoculators, finding their occupation gone, applied to be
permitted to vaccinate. They were thoroughly instructed and, efficient measures
having been devised for the proper control of their proceedings, permission was
granted. It is pleasing to find that the Civil Surgeon is able to report very
favourably of them.
27. There is good reason to fear that the practice of inoculation frequently
lights up an epidemic of smallpox in a district which would otherwise probably
escape the disease and, although an injustice would be done were inoculation
put down where the benefits of the milder operation are inaccessible, it is evident
that the two proceedings yield bad results when practised side by side, and in
districts where free vaccination is obtainable by any one who desires it the intro¬
* This case recalls the instance reported in page 12 of the Report on the Sanitary Administration, British
Burma, for 1884.