NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
8
TRIENNIAL REPORT ON VACCINATION IN BURMA
7. Re-vaccination in Towns.—78,202 re-vaccinations were performed
in towns during 1928-29, as compared with 124,391 in 1927-28—a
decrease of 46,189. The towns returning an excess are Mandalay,
Mônywa and Meiktila.
It is gratifying to note that since the enactment of the Burma
Vaccination Law Amendment (Amendment) Act of 1928 (Burma Act IV
of 1928) enabling Municipal and Town Committees to frame rules for
making re-vaccination compulsory in their respective areas, such rules
have been framed by the Municipal Committees of Pegu, Prome,
Mônywa and Syriam and the Town Committees of Zigôn, Thingangyun
and Kanbe, and it is hoped that other Municipal and Town Committees
will soon follow suit.
Appendix B.
8. Infant Vaccination in Towns.—In the 73 towns mentioned in the
previous paragraph, the total number of births registered during 1928-29
is 37,593, out of which 11,306 infants died before attaining the age of
one year, thus leaving 26,287 survivors available for vaccination. The
total number of children under one year successfully vaccinated in these
towns during the year was 32,707 or 6,420 children in excess of the
available survivors for the year. The excess over the available survivors
vaccinated in Rangoon and Mandalay towns was unusually large. In
the former town 1,709 infants were thus vaccinated in excess of the
surviving children and in the latter town 2,547.
In 18 towns, viz., Pegu, Nyaunglebin, Tharrawaddy. Thônzè, Minhla,
Insein, Thamaing, Kamayut, Prome, Bassein, Ma-ubin, Danubyu, Pyapôn,
Moulmein, Thayetmyo, Mandalay, Kyauksè and Myinmu (Sagaing
District), the number of children under one year successfully vaccinated
exceeded the total number of births registered. This may be due to
defective registration of births, and careless upkeep of vaccination
registers The number of children successfully vaccinated exceeding
the survivors available for vaccination was in Tavoy 136, in Meiktila
119, Pyinmana 120 and Myinmu 112.
In 34 towns, the number of infants successfully vaccinated was less
than the survivors available ; Ye-u town is the worst in this respect; of
the 109 infants available for vaccination, only 9 were successfully
vaccinated, thus leaving 100 children unprotected from small-pox by
vaccination—a very unsatisfactory state of affairs. The next place is
Myitkyina, in which 173 children were available for vaccination, and of
which only 27 were successfully vaccinated, the rest (146 children) being
left unprotected. The same remarks apply to Lashio and Taunggyi
towns, but as to all these towns the Vaccination Acts were only very
recently extended, perhaps the lack of powers is the chief reason for
the smaller number of children submitted to vaccination. In Pyu town,
201 survivors were available for vaccination, of which only 43 were
successfully vaccinated. The remaining cases were reported as either
having left the town or vaccination postponed on medical grounds. In
FOR THE YEARS 1926-27 TO 1928-29.
9
Toungoo, only 269 children were successfully vaccinated out of 425
survivors and in Shwegyin only 59 were vaccinated out of 161. The
reasons given were the same as for Pyu. In Akyab, 100 children were
thus left unprotected, in Thôngwa 130 and in Thatôn 110. No reasons
are forthcoming for the deficits in the vaccination reports submitted
from these towns.
The various reasons for the excess or deficit in infant vaccinations
noted above have been discussed in previous reports; the most
important being defective registration of births, defective upkeep of
vaccination registers, migration of children, postponement of vaccination
on medical grounds and non-employment of proper vaccination and
supervising staffs. The employment of whole-time Health Officers with
adequate powers in these towns seems to be the only solution of the
problem.
Statement I
(Summary).
9. Dispensary Vaccination.—In previous years, vaccination operations
performed in hospitals and dispensaries were shown separately in
Appendices attached to the Annual Reports as Statement No. III. In
the Report under review, these operations have been included in the
main Statement No. 1 at the instance of the Government. In effecting
this change, Public Health Department Circular No. 10, dated 31st
December 1928, was issued to all District Health Officers and Health
Officers giving instructions in the preparation of these statements.
During the triennium 23,859 operations were performed in hospitals
and dispensaries, of which 17,082 were primary and 6,777 re-vaccinations,
as compared with 23,884 (primary 14,474 and re-vaccination 9,410) in
the previous triennium.
In the year 1928-29, dispensary vaccination figures were reported
from 15 districts only. As in previous years the bulk of dispensary
vaccination work was done in Myitkyina district, in which 3,371 opera-
tions were performed ; while over 1,000 operations were reported from
Tharrawaddy, Northern Shan States and Southern Shan States. The
success rate in primary was 99.45 and in re-vaccination 43.31 per cent.
This is an indication perhaps that dispensary vaccination is not popular
or that the dispensary staff has no time for this work, which would be
better done by whole-time vaccinators under the control of whole-time
District Health Officers and Inspectors of Vaccination.
10. Jail Vaccination.—In Jails 32,585 operations were performed, of
which 1,109 were primary and 31,476 re-vaccinations. Of primary
cases, 897 were successful and of re-vaccinations 16,790, yielding success
rates of 80.88 and 53.34 per cent. respectively.
11. Vaccination by Private Practitioners.—During 1928-29 medical
practitioners performed 372 primary and 505 re-vaccinations, with a
success rate in the former of 97.53 and in the latter of 26.75 per cent.
The total number of children under one year successfully vaccinated by
them was 192 and between one and six years—122.
10
TRIENNIAL REPORT ON VACCINATION IN BURMA
12. Steamer Vaccination:—Under the provision of the Burma Vaccin-
ation Law Amendment Act of 1909 and the further Act of 1928,
186,966 labourers landing at the Port of Rangoon were vaccinated during
1928-29 by the Corporation Vaccination Staff under the supervision of
Port Health Department, as against 44,937 in 1927-28. The results are
unknown, as all of them were allowed to proceed to their destination
after operation.
13. Verification work of Inspecting Officers.—During the year 1928-29,
946,761 persons were vaccinated. The District Health Officers and
Assistant District Health Officers claimed to have inspected the results
of 98,926 or 10.45 per cent. (or the average minimum expected—10 per
cent.) as against 74,374 or 8.74 per cent. in 1927-28 and 60,661 or 8.38
per cent. in 1926-27 ; thus there was an improvement on the work of
the previous two years by these officers. Out of 41 districts, the total
number of cases inspected by the District Health Officers in 12 districts,
viz., Pegu, Prome, Ma-ubin, Amherst, Tavoy, Magwe, Chin Hills,
Mandalay, Meiktila, Sagaing, Katha and Northern Shan States is worthy
of mention. Of these 12 districts, the number of cases inspected by the
District Health Officer, Northern Shan States, topped the list with
11,681 or 28.00 pet cent of the total number of persons vaccinated in the
district, followed by Magwe with 7,937 or 28.65 per cent. The work of
the District Health Officer, Amherst, comes third, with 6,971 cases
inspected or 13.53 per cent. The inspection work of the remaining nine
District Health Officers in order of precedence of total number of
persons inspected is Katha 5,553, Tavoy 5,086, Pegu 4,381, Ma-ubin 4,053.
Meiktila 3,840, Chin Hills 3,584, Prome 3,086 and Mandalay 2,934. The
work of the District Health Officer, Chin Hills District (Dr. Ottman) is
highly commended by the Deputy Commissioner who writes "The
district is fortunate in having a Civil Surgeon who devotes so much of
his time to touring the' villages and helping the people. Great improve-
ment in vaccination is due to closer supervision and personal verification
in his extensive tours by the Civil Surgeon. " The inspection work done
by the District Health Officers of Tavoy and Katha is especially
commendable in view of many difficulties prevailing in these districts.
In the former district, 60.68 per cent. of the total number of persons
vaccinated and in the latter 38.6 per cent. were inspected. In Prome
and Meiktila districts a large number of cases was inspected by the
Assistant District Health Officers. In Myingyan district and Southern
Shan States, no vaccination cases were inspected by the District Health
Officers. The reasons for this are being enquired into. District Health
Officers of districts having large hospitals to attend to and often large
jails in addition, cannot be expected to do much touring in their
districts, but whenever they do tour, vaccination inspection should form
part of their work. The District Health Officer, Hill District of Arakan,
inspected the results of only 56 out of a total of 2,069 cases.
FOR THE YEARS 1926-27 TO 1928-29.
11
Reviewing the work of Inspectors of Vaccination and other inspecting
officers in rural areas of the districts, the work done in Tharrawaddy,
Amherst, Magwe, Yamèthin, Sagaing and Lower Chindwin Districts is
worthy of mention. In each of these districts, only a single Inspector
of Vaccination is employed, yet they inspected a larger number of cases
than the Inspectors of any other district. In Tharrawaddy, the results
of 63.88 per cent. of the total vaccinations were inspected by the
Inspector of Vaccination. The Inspector of Amherst inspected 32.45
per cent., Magwe 45.19 per cent., Yamèthin 40.13 per cent., Sagaing 62.29
per cent. and Lower Chindwin 46.70 per cent. In the districts in which
two Inspectors are employed viz., Pegu, Insein, Hanthawaddy, Prome,
Bassein, Henzada, Myaungmya, Ma-ubin, Pyapôn, Toungoo, Thatôn and
Katha, the work done by the Inspectors of Pegu, Myaungmya, Ma-ubin
and Pyapôn should be regarded as satisfactory as each inspected
the results of over 10,000 vaccinations. In the Report for 1927-28, the
work of the two Inspectors in Thatôn district has been criticised and in
that year each of them verified the results of 5,294 vaccinations. During
1928-29, they inspected 6,531 each—an increase of 1,237. Comparing
the work of Inspectors of districts mentioned above, the work done by
the Inspectors in Hanthawaddy, Insein, Prome, Bassein, Henzada and
Toungoo is inadequate. In Hanthawaddy, each Inspector verified 6,045,
Insein 4,962, Prome 5,220, Bassein 5,918 and Henzada 7,643.
Considering the conditions under which the Inspectors have to do
their work, those Inspectors employed in the Salween, Pakôkku, Chin
Hills and Upper Chindwin Districts have done creditably, as they managed
to verify a large percentage of the cases vaccinated. It may be
mentioned here that the inspection work involves not only the actual
inspection of the children vaccinated, but also of the various registers,
forms and foils maintained by the Ward headmen and Vaccinators, of the
equipment of the vaccinator and of the various methods employed for
finding out unregistered and unvaccinated children.
The District Health Officer, Insein and Hanthawaddy, reports that
though people are willing to have their children vaccinated, they consider
it a nuisance to take them again for verification by the District Health
Officer or Inspecting Officers, and that Ward-headmen have lost their
influence and prestige and are indifferent to sanitary and public health
matters.
An interesting system is followed by the District Health Officer,
Pakôkku, who instructs his Vaccinators to make an entry of each case in
the Headmen's Birth Registers and initial it with date, so as not to lose
sight of any registered birth. One or other of the following entries is
made—(1) successfully vaccinated, (2) vaccinated, but not successful, (3)
sick, (4) died, (5) absent, (6) under age, (7) parents opposed to vaccina-
tion. At their next visit they have to search for and vaccinate all
children under (2), (3), (5), (6) and 7.
12
TRIENNIAL REPORT ON VACCINATION IN BURMA
Statement II.
14. Establishment.—The strength of the Vaccination Staff employed
during the years of the two triennial periods is shown in the following
Table:—
Year.
(1)
1923-24 ... ...
1924-25 ... ...
1925-26 ... ...
Average ... ...
1926-27 ... ...
1927-28 ... ...
1928-29 ... ...
Average ... ...
District
Superin-
tendents
of Vacci-
nation.
(2)
41
41
41
41
41
41
41
41
Part-time Super-
vising Officers.
S.A.S.
(3)
36
27
27
30
28
28
31
29
P.H.I.
(4)
...
6
8
5
9
11
13
11
Inspec-
tors of
Vaccina-
tion.
(5)
44
43
44
44
42
43
42
42
Head
Vaccina-
tors.
(6)
1
1
1
1
1
1
3
2
Vaccina-
tors.
(7)
339
342
365
349
377
384
385
382
The number of Sub-Assistant Surgeons receiving vaccination allow-
ance, and employed in the Department as part-time Supervising Officers
in 1928-29, was 31, as against 28 in each of the two preceding years ;
and that of Public Health Inspectors 13, as compared with 11 in 1927-28
and 9 in 1926-27. The cadre of Inspectors of Vaccination was 42 as
against 43 in the previous year. The decrease of one was due to the
death of one Inspector of Vaccination in Bassein District, his place being
filled by appointing a Public Health Inspector. During the year three
Head vaccinators were employed as against one in the former year.
The increase was due to the post of Head Vaccinator left vacant in
Karenni State, having been filled by promoting a senior vaccinator and
the creation of a new post in Loimwe Subdivision.
Seven new posts of vaccinator were created during the year, viz., one
each in the districts of Pegu and Northern Shan States, two in Shwebo,
one each in the towns of Chauk, Taunggyi and Thingangyun cum Kanbè.
The six additional temporary vaccinators employed in Magwe
district in 1927-28 were dispensed with in 1928-29.
Seventeen additional temporary vaccinators were employed for varying
periods from one to six months in Amherst, Yamèthin, Meiktila,
Myingyan, Shwebo and Lower Chindwin Districts, and in Mandalay
and Rangoon towns.
During 1928-29, one Inspector in Toungoo district was invalided
on medical grounds and two Inspectors—one in Sandoway and another
in Bassein—died. Four vaccinators—one each in Myaungmya, Magwe,
Myingyan and Bhamo—resigned the service and four vaccinators—one
each in Tharrawaddy, Thatôn, Bhamo and Loimwe Subdivision of
FOR THE YEARS 1926-27 TO 1928-29.
13
Southern Shan States were removed or dismissed from the Service,
while seven vaccinators, one each in Prome town and in the districts of
Pegu, Thatôn, Pakôkku, Shwebo, Katha and Southern Shan States, died.
Statement II
15. Cost of Department.—The cost of the Department shown in State-
ment II as Rs. 4,29,062-6-0 includes Rs. 36,215-11-0 paid by Local Bodies
as price of lymph supplied to them by the Vaccine Depôt, Meiktila.
The expenditure of the Department on the production of the lymph
is also added to this total so that duplication of cost has resulted.
Deducting therefore Rs. 36,215-11-0 which was really a receipt by the
Government Department, there was an expenditure of Rs. 3,92,846-11-0,
as against Rs. 4,03,228-12-3 in 1927-28 and Rs. 3,86,245-10-1 in 1926-27.
The increase under the head " Pay of the Establishment" was
Rs. 9,621-2-2 due to increments of pay. There was a decrease of
Rs. 3,264-10-6 under the head " Travelling Allowances" due to the
introduction of the new travelling allowance rules.
The average cost per successful case of vaccination was Rs. 0-9-7 as
compared with Rs. 0-11-1 in 1927-28 and Rs. 0-11-7 in 1926-27. The
cost per successful case is highest in the Pakôkku Hill Tracts, viz.,
Rs. 2-9-3. The other districts and town which returned high rates are
the Hill District of Arakan Rs. 1-6-8, Rangoon Town Rs. 1-6-0, Upper
Chindwin District Rs. 1-3-7, Hanthawaddy and Salween Districts each
Rs. 1-3-3, Insein District Rs. 1-1-6 and Mergui District Rs. 1-0-2. The
high cost per case in undeveloped hill districts is inevitable, whilst in
Insein and Hanthawaddy the paid Inspecting Staff is greater than else-
where and their salary and travelling allowance swell the rate. In
Rangoon, out of a total of 39,215 operations less than 10,000 were
primary cases and nearly 30,000 were re-vaccinations. Only 7,324 of the
re-vaccinations were recorded as successful. Besides, 186,966
immigrants were vaccinated at the wharf and the results of these are
unknown, but a large staff has to be maintained for this purpose ;
their salaries and the heavy contingent expenditure on lymph, medicines
etc., increasing the rate per successful case. In Mergui District
2,179, i.e., about a quarter of the cases vaccinated were re-vaccinations
and of these only 816 were successful, while 510 were secondary vacci-
nations. A low cost per successful case was recorded from Yamèthin
District (Rs. 0-5-0), Sagaing District (Rs. 0-5-1) and Akyab District
(Rs. 0-5-5). In Meiktila District the cost was Rs. 0-6-0, Northern Shan
States Rs. 0-6-3 and Prome Rs. 0-6-5.
16. Small-pox Inoculation.—Although the practice of small-pox inocu-
lation is prohibited by law in all the districts in the Province, it is still
occasionally found in certain districts resulting in outbreaks of small-pox.
Thus in the Dedayè Township of Pyapôn District, one inoculator inocu-
lated 86 persons, among whom 37 contracted small-pox and two died ;
and in Kyaiklat Township, another inoculator operated on 15 persons, all
of whom contracted small-pox, while one died. These two inoculators
14
TRIENNIAL REPORT ON VACCINATION IN BURMA
along with the parents of the inoculated children were prosecuted and
the Saya who performed inoculation at Dedayè was sentenced to six
week's rigorous imprisonment while the other Saya at Kyaiklat was fined
Rs. 25. The six parents were fined Rs. 20 each. Another inoculation
case was pending in the Court at the close of the year. In Henzada 145
prosecutions were launched for inoculation and 129 parents along with the
inoculators were fined. The fines realized amounted to Rs. 900. Four
Headmen were also fined Rs. 25 each, for connivance in inoculation. In
Toungoo District 112 persons were prosecuted and all were fined except
one. In Lower Chindwin District, the inoculator and the Headmen were
fined Rs. 20 each. In Yamèthin District, three parents of inoculated
children were prosecuted and two were fined Rs. 25 each and one
Rs. 15. Cases of prosecution for small-pox inoculation in Tharrawaddy
were pending in the Court at the close of the year and in Akyab the
offenders escaped conviction for want of evidence.
17. Prosecutions under the Vaccination Acts.—The districts which re-
ported prosecutions for infringement of Vaccination Acts were Hantha-
waddy, Myaungmya, Pyapôn, Amherst, Thatôn and Mergui and the towns
were Moulmein, Mandalay and Kawkareik. In all, 159 prosecutions were
launched and most of the offenders were fined. In view of the vaccina-
tion prosecution cases from Pyapôn having been thrown out on appeal
by the High Court because of the wrong application of certain sections of
the Vaccination Acts, a Circular was sent to all District Health Officers
and Health Officers, drawing their attention to the High Court judgment.
For the same reason, revisions and amendments of the relevant forms
have been undertaken and proposals sent up to Government for
sanction. Some District Health Officers have drawn attention to the
difficulties encountered in rural areas in enforcing the provisions of the
Vaccination Act, 1880, regarding preliminary formalities prior to prosecu-
tion. In this connection, the Commissioner, Irrawaddy Division,
strongly recommends that the Vaccination Acts should be consolidated
and a Vaccination Manual issued.
18. Work of the Vaccine Depôt, Meiktila, during 1928-29.—The Calf
Hospital attached to the Depôt was flyproofed and converted into
a post-scraping stable. The dining room of the students hostel was
enclosed with expanded metal to prevent theft. Athermosyphon heater
was provided for the Benoid Gas Plant. A Glacia G—10 Ice Plant was
installed during the year. With these exceptions, no other important
alterations or additions were carried out at the Depôt. A new operation
room, operation table and water supply system have been sanctioned
for the Depôt, and funds have been provided for the building of a new
rabbit house, all of which schemes are expected to be taken up during
the financial year 1929-30.
Output of Lymph.—Three hundred and sixty-three cow-calves and
fifteen buffalo-calves were successfully vaccinated during the year.
FOR THE YEARS 1926-27 TO 1928-29.
15
Fifteen cow-calves and four buffalo-calves either failed to take or yielded
lymph of such poor quality that it had to be destroyed. The following
Table compares the output and issue of lymph during the years of the
triennium :—
Year.
1926-27...
1927-28...
1928-29...
Number of
calves.
485
...
378 calves ...
10 buffalos ...
363 calves ...
15 buffalos
Total yield.
Oz.
411.43
404.33
47.26
464.80
62.65
Gms.
11,664
11,463
1,340
13,177
1,776
Average yield per
calf.
Gms.
24.05
29.62
134.0
36.30
118.40
Grs.
370.36
457.09
2069.88
516.18
1827.14
Doses issued.
974,229
1,136,232
1,376,338
From the above Table, it will be seen that the average yield per cow-
calf increased from 29.62 grammes during 1927-28 to 36.30 grammes
during 1928-29. On the other hand, there was a drop in the yield from
buffalo-calves. The average yield in 1927-28 from a buffalo was 134.0
grammes, but only 118.40 grammes during the last year.
There were in stock 2,378 grammes on the 1st April 1928, while
14,953 grammes were obtained during the year, of which 976 grammes
were used as seed lymph. Owing to a broken bottle, 210 grammes were
lost in 1928. On the 1st April 1929 there was a balance of 2,988
grammes sufficient for 2½ months.
Technique.—Glycerinated lymph was used throughout the year and
all lymph was subjected to bacteriological, animal, and Cunningham's
potency tests before issue.
Lymph Supply.—Of the 1,376,338 doses issued, 1,332,014 were supplied
to Municipalities and districts on payment and the balance 44,324 doses
were supplied free of charge to Military (3,281), Jails (28,643) and
Government vaccinators at Kanpetlet and Chin Hills (12,400). For a
few months in the year, there was difficulty in supplying the full
demands, due to shortage of capillary tubes and to disease in calves.
Results.—Out of 265,842 primary vaccinations, the results of which
were reported, a success rate of 99.09 per cent. was obtained in 1928-29
as against 90.32 in 1927-28 and 95.74 in 1926-27. In 116,845
re-vaccinations, the percentage of success was 35.76 as against 31.9.
Finance.—The gross income of the Depôt during the year 1928-29
excluding a sum of Rs. 6,893 due from Local Bodies at the close of the
year was Rs. 37,322-11-6 of which Rs. 36,215-11-0 was realized from sale
of lymph to Local Bodies and Rs. 1,107-0-6 from sale of vaccinated
calves
The total expenditure of the Depôt for 1928-29 was Rs. 37,697-2-1
so that the net cost of the Depôt to Government during the financial
year was Rs. 374-6-7 A sum of Rs. 16,683-2-0 was expended on establish-
ment, Rs. 5,954 on purchase of calves and Rs. 4,283-12-6 as feeding