6
RESOLUTION ON THE REPORT ON VACCINATION IN BURMA
Progress of vaccination and pre-
valence of small-pox.
10. The Superintendent's report furnishes no precise information as to the
general effect of vaccination in reducing the mor-
tality from small-pox. The diagrams printed in para-
graphs 9 and 24 are of little value for this purpose.
It is observed that the order of the districts is merely reproduced from the dia-
gram in the previous year's report.
It is not likely that any convincing evidence of the efficacy of vaccination in
the districts will be forthcoming until the operations embrace a much larger
proportion than at present of the whole population. During the past ten years
the mortality from small-pox in Lower Burma varied from 115 in 1886 to 3,693
in 1890, and the variations had no traceable relation to the variations in the amount
of vaccination work performed during the same period. In 1895 the number of
deaths was 1,540 or .34 per mille, the majority of the deaths in this as in previous
years occurring among children under 12 years old.
But, though it is difficult to apply a conclusive test as to the value of vacci-
nation in the rural tracts of Burma, there is some indication that in the towns the
degree of protection ensured by the enforcement of the Act is higher than in the
rural tracts. Of the aggregate number of deaths (1,540) in 1895 only 102 occur-
red in towns, and the death-rate from this cause in towns was only .18 per mille
as compared with .36 per mille in the rural tracts. In 1894 the corresponding
death-rates were .30 per mille in the towns and .40 per mille outside, and in 1893
.63 and .69 per mille respectively. The real divergency is perhaps more striking
than would appear from these figures, since fewer deaths escape registration in
the towns than in the villages.
11. The report contains no remarks on the attitude of the people towards
vaccination. But in the Sanitary Report for 1895 it is stated that in the districts
of the Irrawaddy division, where small-pox has been more or less prevalent for
the past three years, " inoculators are largely at work and the opposition to
" vaccination, except in the Karen villages, is very pronounced." The last trien-
nial report on vaccination described the popular attitude as '' generally anta-
gonistic " to vaccination and the work of the vaccinators as " a hopeless struggle
against ignorance and prejudice." In these views Mr. Smeaton is not disposed
to concur. During his recent visit to Minbu he found that a trained vaccinator
had set up private practice in a sickly tract in the interior and was earning a
livelihood. In the towns at least it is clear that there is no general hostility
to vaccination, seeing that nearly all the municipalities have from time to time
voluntarily applied for the extension of the Vaccination Act. The benefits of
vaccination are less appreciated in rural tracts because its efficacy is not so well
understood, and the efforts to promote this understanding are not so strenuous
or persistent as in the towns. Inoculation as a rule flourishes only where vacci-
nation work has been slack and apathetic. The large increase in the number of
operations performed is in itself a sign that the popular distrust, such as it is,
is being gradually overcome.
12. The Chief Commissioner desires to call the attention of Civil Surgeons
to one further reason which in some districts may prevent the inhabitants of vil-
lages from taking to vaccination so kindly as the townspeople. In towns the
vaccinator himself or, failing him, the medical officer of the civil dispensary is near
at hand to furnish advice and medicine in case the vaccinated arm should be-