2
TRIENNIAL REPORT ON VACCINATION IN BURMA FOR THE YEARS 1899-1900-1901-02.
The proportion of the population under vaccination protected during the trien-
nium was in the annual ratio of 43.36 per 1,000 as against 49.07 in the previous
corresponding period. As vaccination extends so will the proportion of the popu-
lation protected decline until the time comes when only the natural increase by
births will remain to be vaccinated.
Statement I.
3. Average work of each vaccinator.—The average number of operations
performed by each vaccinator has decreased from 2,579 to 2,200. Generally, this
is due to more effective inspection and closer scrutiny of the vaccinators' returns.
Some vaccinators were in the habit of returning impossible figures, as in the
Sandoway district for instance, where the average number of operations per
vaccinator in 1898-99 is shown as 7,247. The attention of Civil Surgeons
having been called to the point, the result has been a general fall in numbers.
Ordinarily 2,000 primary operations per vaccinator is a fair year's work and
the best energies of the staff should be entirely devoted to primary vaccination.
Re-vacination is the resort of the lazy vaccinator, who, having neglected his work
during the month, has thus to re-vaccinate a number of his adult acquaintances or
to submit their names as re-vaccinated, for such cases can seldom be found for
verification and fictitious returns can thus be submitted with impunity.
The only occasion when re-vaccination is justifiable, in the present state of
infantile vaccination, is when small-pox is prevalent and re-vaccination is resorted
to in order to stop the spread of infection from any particular centre, or in cases
where the primary operation has been irregular or imperfect. From a long prac-
tical experience of vaccination in the East I strongly hold to the opinion that
vaccination efficiently performed once in a life-time confers, as a rule, absolute
protection against small-pox and will protect the constitution from the disease as
much as the inoculated or natural small-pox itself will. The proportion of the
efficiently vaccinated subsequently contracting small-pox is so small, and in these
the disease is so modified by the vaccination as to be generally void of danger, that
we may, as a general rule in an Eastern country and amongst primitive people, dis-
regard re-vaccination entirely, save under the conditions specified above, and devote
our entire energy to primary vaccination in the first instance, until the entire
population has been generally protected. Re-vaccination rather tends to discredit
vaccination in Burma, where inoculation is so generally practised, for why, it is asked,
should we prefer vaccination, which has to be repeated once or oftener, to afford
certain protection, when the indigenous inoculator, who has been working amongst
the people from time immemorial, can protect by a small puncture not nearly so
severe as the vaccinator's scarifications.
To induce the Burman to willingly accept vaccination he must be made to
understand that it is quite as effective, when efficiently performed, as inoculation
to prevent the occurrence of small-pox. But then comes the question, what is
efficient vaccination?
It has been established as a fact that the efficiency of vaccination is
determined by the character and area of the cicatrices. The experienced or
well-instructed vaccinator should be able to discriminate with accuracy the
perfect vesicle and the typical cicatrix of successful vaccination, from spurious
or unsuccessful results. The lesson is not very difficult to learn, but there are
very few, if any, of our vaccinators who have even a fair knowledge of the subject,
judging from the cases brought up before me on my inspections. As regards area,
the standard which I have suggested should be aimed at is the production of three
scars, each not less than the size of a two-anna piece.
I have seen a large amount of insufficient and almost useless vaccination
producing results which, though in one sense successful, still left the individual
very imperfectly protected against small-pox.
More competency on the part of vaccinators and more supervision of their
work is required and till this is attained, I am of opinion, that re-vaccination should
not be generally practised, but more care and attention should be given to the
efficient performance of the primary operation; for carelessness in primary vacci-
nation cannot be excused on the grounds that re-vaccination will make good its
defects.