NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Notes and Statistics
ON
Vaccination in Burma
FOR THE YEAR 1924-25.
1. Vaccination Staff employed.—The following table gives the strength
of the Vaccination Staff actually employed during the year 1924-25 and
the two preceding years :—
Year
1922-23 ...
1923-24 ...
1924-25 ...
District
Superin-
tendents.
41
41
41
Sub-
Assistant
Surgeons.
31
36
27
Inspectors
of Vaccina-
tion
43
44
43
Head
Vacci-
nators.
1
1
1
Vacci-
nators
336
339
342
The number of Sub-Assistant Surgeons receiving vaccination allowance
or otherwise employed in the Vaccination Department, was nine less
than last year. The cadre of Inspectors of Vaccination has been
decreased by one owing to the death of the Prome Inspector whose
vacancy has not so far been filled. Two vacant Inspectorships in
Amherst and Myingyan Districts and one head vaccinatorship in the
Southern Shan States have not yet been filled up for want of qualified
candidates. The number of vaccinators' appointments was augmented
by three in the Southern Shan States—one in Nattalin Town,—one in
Bassein District,—one in Hanthawaddy District,—and one in-Kyaukse
District, while there was a decrease of three Vaccinators' appointments
in Rangoon and one in Thatôn District,—resulting in a net increase of
three appointments. Four vaccinators, two from Amherst District and
one each from Bassein and Sagaing Districts—were either removed or
dismissed from the service for different offences.
Statement I.
2. Vaccination work performed.—The total number of operations
reported during the year 1924-25 as performed by the permanent and
special staffs of the Department and other agencies—excluding vaccina-
tions in dispensaries and jails—was 806,619 of which 531,035 were
primary operations and 275,584 revaccinations. Out of the 42 districts
from which reports have been received 24 districts show a total increase
2
NOTES AND STATISTICS ON VACCINATION IN BURMA
of 112,450 as compared with last year's figure, while the remaining 18:
districts return a decrease of 58,278. Thus there has been a net increase
of 54,172 operations. The increase is wholly derived from revaccination,
there having been a considerable fall in primary cases. The increase in
revaccination, in many instances, has resulted from the prevalence of
small-pox in many parts of the Province. In comparison, with last year,
Rangoon shows the largest increase in revaccination (33,380), followed
by Sagaing (12,676) ; whereas the largest falling off in primary vaccination
has been in Thaton (—5,936), followed by Myingyan (—4,840), Magwe
(-4,825) and Sagaing (-4,407).
Including 10,148 operations, performed in dispensaries, the total
operations for the Province come to 816,767, of which 2,193 (primary 537
and revaccination 1,656) were returned by "other agencies" leaving
814,574 operations as the output of 342 vaccinators (or 2,382 per head)
employed during the year.
Statement I,
3. Primary Vaccination.—Successful primary operations performed
in rural areas amounted to 451,058, and urban areas 48,366; the total
for both being 499,424, showing a decrease of 15,153 in comparison
with the previous year's figure. The districts showing a considerable
increase in the number of successful cases performed as compared with
last year were the Northern Shan States (+4,314), Bassein (+3,989),
Myaungmya (+3,865), Hanthawaddy ( + 3,009), Rangoon (+2,210) and
Akyab (+1,596), whereas the places from which decrease was reported
were Thatôn (-5,904), Magwe (-4,773), Myingyan (-4,481), Sagaing
(-4,461), Southern Shan States (-3,193), Pakôkku (-3,014), Pyapôn
(-2,976), Kyauksè (-2,377) and Meiktila (-1,943).
Lower Burma.—In Lower Burma, Rangoon Division shows the
largest excess (5,975 successful primary operations) over last year's
figure. Arakan Division shows an excess of 2,903 and Irrawaddy
Division 3,059, whereas Pegu and Tenasserim Divisions show a deficit
of 407 and 5,841 successful operations respectively in comparison with
last year's figures.
In Arakan Division every district has shown an increase, the largest
being Akyab ( + 1,596). In Rangoon Division too the increase is shared
by all the districts, Hanthawaddy leading with 3,009 cases over the
previous year's figure. In Irrawaddy Division, the increase is shared by
Bassein (3,989) and Myaungmya (3,865) Districts only, whereas there
was a fall in Henzada, Ma-ubin and Pyapôn Districts. In Pegu and
Tenasserim Divisions, the decrease is shared by Tharrawaddy (—332),
Toungoo (-533), Thayetmyo (-751), Thatôn (-5,904), Tavoy (-808)
and Mergui (—420) Districts only.
Upper Burma.—In Upper Burma, the North-East Frontier Division
alone shows an excess of 540 successful primary operations over the
previous year's figure. This excess is shared by Myitkyina District
( + 178) and the Northern Shan States (+4,314). Both North-West
FOR THE YEAR 1924-25.
3
Border and Mandalay Divisions show a considerable falling off in
successful primary vaccination, as compared with the previous year's
figure. In the former Division, the deficit, which amounts to 9,135,
is shared by all districts except Pakôkku Hill Tracts and Chin Hills,
the principal defaulters being Pakôkku (—3,014) and Sagaing (—4,461)
Districts. In the latter Division, the deficit, which amounts to 12,247 is
shared by all districts, except Minbu, the principal defaulters being
Kyauksè (-2,377), Meiktila (-1,943), Myingyan (-4,481) and Magwe
(-4,773).
Statement I.
4. Revaccination.—Altogether 12 districts in Lower Burma and 13
districts in Upper Burma show an increased output in revaccination
and 10 districts in Lower Burma and 7 districts in Upper Burma return a
decrease, the sum total of the increase being 105,474 and of the decrease
37,996— making a net increase for the Province of 67,478.
In Arakan Division, Akyab and the Hill District of Arakan show a
decline whereas Kyaukpyu and Sandoway Districts show an increase,
the net decrease for the Division being 159 cases only. Rangoon
Division is mainly responsible for the increase, all districts having
returned larger figures than in the previous year and making a total
increase of 38,000 for the Division, of which Rangoon alone contributes
33,380. All the districts in the Pegu Division, except Pegu, show a
falling-off as compared with last year's figures. Thayetmyo (—2,246)
returns the largest deficit, followed by Tharrawaddy (—915) and Prome
(—831). Pegu District alone shows an increase of 1,830, the result
being a net deficit of 2,325. Bassein and Pyapôn Districts in Irrawaddy
Division are responsible for an increase of 2,679 and 1,449 cases
respectively, whereas Ma-ubin and Henzada Districts return a falling-
off of 1,904 and 738 cases respectively ; the result being a net increase
of 1,539 cases for the Division.
In Tenasserim Division, Amherst District shows a large increase of
6,767 cases and Thatôn District 3,427 cases. Both Tavoy and Mergui
show a slight decline. The net increase of the Division amounts to
9,123. In North-West Border Division, Pakôkku District shows a big
drop (—4,619 cases), whereas the principal increases are returned by
Katha ( + 2,232), Shwebo ( + 3,835), Sagaing ( + 12,676) and Upper
Chindwin ( + 3,632) ; the net increase of the Division being 17,639. In
Mandalay Division, Mandalay (+7,168), Kyauksè ( + 5,828), Meiktila
(+2,154) and Yamèthin (+7,040) Districts show a total increase of
22,190 cases, but the other three districts, Myingyan (—5,192), Magwe
(—7,959) and Minbu (—8,676) return a total decrease of 21,827 cases,
the gain for the Division thus being only 363. In the North-East
Frontier Division, all districts, except Southern Shan States, show an
increase resulting in a net increase of 3,298 cases.
It may be noted that vaccination is voluntary in most rural areas as
the Vaccination Acts have not been extended thereto. During the year
4
NOTES AND STATISTICS ON VACCINATION IN BURMA
under report, the Acts have been extended to the rural areas under the
control of the District Councils of Toungoo, Thatôn, Amherst, Tavoy,
Henzada, Ma-ubin, Bassein, Pyapôn, Myaungmya, Magwe, Minbu, Pegu,
Kyauksè, Insein, Hanthawaddy and Akyab and it is hoped that other
districts will follow suit, so that the Acts may soon be extended to all
parts of the Province. The people are gradually appreciating the benefit
of vaccination to which on the whole they seem less antagonistic than
they were previously. The opposition which, through ignorance and
prejudice, is sometimes shown in some quarters is sure to vanish at no
distant date. The few people, who, like the Mahomedan settlers of
Maungdaw Township of Akyab District, are hopelessly indifferent and
always turn a deaf ear to advice and persuasion, must be compelled to
submit to vaccination by the application of the Vaccination Acts.
Statement I.
5. Results of Vaccination.—The total number of successful primary
operations shows a decline of 15,153 on the previous year's return, the
figures for 1922-23, 1923-24 and 1924-25 being 488,208, 514,577 and
499,424 respectively. In 20,309 cases the results were unknown and
there were 11,302 failures in comparison with 8,495 failures with 21,269
unknown results in the previous year. Percentage successes in primary
vaccination and revaccination were 97.79 and 47.74 respectively, against
98.38 and 46.76 in the previous year. In Lower Burma, Insein District
heads the list with a success rate of 99.94 in primary cases closely
followed by Pyapôn District 99.90 per cent., Tharrawaddy District with
99.83 per cent., Henzada District with 99.69 per cent., Toungoo District
with 99.67 per cent., Rangoon Town District with 99.52 per cent., Ma-ubin
District with 99.47 per cent., Pegu District with 99.44 per cent, and
Myaungmya District with 99.30 per cent., while the lowest rate is
reported from Mergui 81.46 per cent.
In Upper Burma, Meiktila District heads the list with a success rate
of 99.19 per cent. and close upon this come Myitkyina with 98.95 per
cent., Mandalay with 98.88 per cent., Lower Chindwin with 98.65 per
cent., Magwe with 98.24 per cent., Kyauksè with 98.19 per cent. and
Sagaing with 98.16 per cent. The lowest rate is returned by Pakôkku
District with 94.35 per cent., the rate for 1922-23 and 1923-24 being
94.04 and 96.54 respectively.
6. Vaccination in Towns.—There are 62 towns, where the Vaccination
Acts are in force and from these 154,754 operations have been reported,
of which 49,964 are primary cases and 104,790 are revaccinations. There
has been an increase of 7,570 and 51,279 in primary and revaccination cases
respectively over the previous year's figures. In the towns of Kyaukpyu,
Rangoon, Tharrawaddy, Nyaunglebin, Paungdè, Shwegyin, Pyu, Bassein,
Ngathainggyaung, Myaungmya, Thatôn, Moulmein, Pakôkku, Shwebo,
Sagaing, Mandalay, Yamèthin, Pyinmana and Yenangyaung, primary
vaccination has advanced over the last year's figures, Myaungmya leading
FOR THE YEAR 1924-25.
5
the way. Primary vaccination, has markedly slackened in Salin, while
Akyab, Thôngwa, Letpadan, Minhla, Allanmyo, Myanaung, Wakèma,
Kyaiklat, Kyauksè, Magwè and Taungdwingyi show a decrease from the
previous year's figures.
Revaccination in Towns.—In revaccination, Rangoon Town shows
great improvement, the figures for 1923-24 and 1924-25 being 23,567 and
56,947 respectively, while the towns of Kyaukpyu, Sandoway, Insein,
Syriam, Pegu, Nyaunglebin, Shwedaung, Paungclè, Shwegyin, Bassein,
Henzada, Thatôn, Moulmein, Pakôkku, Shwebo, Sagaing, Mandalay,
Maymyo, Kyauksè, Meiktila and Pyinmana show an excellent improve-
ment over last year's figures. Revaccination shows a marked decline in
Akyab, Prome, Thayetmyo, Allanmyo, Myanaung. Wakèma, Ma-ubin
Pyapôn, Mergui, Nyaung-U, Magwe, Taungdwingyi, Yenangyaung,
Minbu and Salin. Pyawbwè is the only town where no revaccination has
been done. Both primary and revaccination show a falling-off in the
towns of Akyab, Thôngwa, Thônze, Letpadan, Toungoo, Thayetmyo,
Allanmyo, Myanaung, Kyangin, Wakèma, Ma-ubin, Kyaiklat, Tavoy,
Magwe, Taungdwingyi, Minbu and Salin.
Results of Vaccination in Towns.—The percentage successes of primary
and revaccinations are 98.87 and 52.89—those of the previous year being
98.92 and 53.23. In primary vaccination, 24 towns show the maximum
result 100 per cent. successes, while Minbu shows the lowest percentage
(72.34). In revaccination three towns show the maximum result
of 100 per cent. success, the lowest percentage 6.36 is returned by
Ma-ubin. Large number of unknown cases under both heads have been
reported from Rangoon (19,701), Thatôn (2,535) and Pyinmana (1,191).
It is noteworthy in this connection that the Civil Surgeon, Minbu,
complains that the vaccinator is doing very bad work but that in spite
of frequent letters to the President, the latter has taken no notice and
appears to do nothing to ameliorate matters. In many towns although
the Civil Surgeon is the only officer at the disposal of the Committees
competent to manage-the work of the municipal vaccinators, they decline
to delegate the necessary powers to him with the result that although he
is nominally Superintendent of Vaccination, he has no control of the
staff. Vaccination work suffers accordingly.
7. Infant Vaccination.—In 62 towns of the Province 32,721 births were
registered, of which 9,360 infants under one year of age died during the
year, leaving 23,361 survivors available for vaccination. Successful
operations are reported to have been performed on 28,870 infants. This
apparent excess is probably due to defective birth registration, deaths of
vaccinated children and immigration from rural areas into towns. From
reports received from Civil Surgeons, it is evident that in many towns a
large number of infants under one year of age escape vaccination. The
usual explanation put forth is that vaccination in some instances was
postponed owing to ill-health of the infants and in others the parents of
6
NOTES AND STATISTICS ON VACCINATION IN BURMA
the infants temporarily migrate to the rural areas. There may be some
truth in these explanations, but the real cause seems to be that the
Vaccination Acts are not rigorously enforced in many towns. The
Local Government in their Medical Department letter No. 403—1Z.-8,
dated the 11th February 1919, advised all Presidents of Municipalities
and Town Committees, regarding the procedure to be adopted annually
to ascertain the state of vaccination of the child population in towns.
From enquiries recently made by this office, it is evident that some of the
Presidents are not even aware of this order,—while the majority of those
who are cognisant thereof, have not taken any steps to carry out the
procedure suggested therein. This fact alone is sufficient to show that
infant vaccination is neglected in most of the towns, and little interest
seems to be taken in the health of the future generation.
Statement III.
3. Dispensary Vaccination.—The total number of primary and secon-
dary operations was 10,148 against 6,338 of the previous year, the
increase being contributed by both primary (1,582) and revaccination
(2,228). Hill District of Arakan, Kyaukpyu, Bassein, Pyapôn, Amherst,
Katha, Chin Hills, Kyauksè, Meiktila, Myitkyina, Northern Shan States
and Southern Shan States show an increase in primary vaccination, while
in revaccination the increase is returned from Hill District of Arakan,
Kyaukpyu, Tharrawaddy, Bassein, Myaungmya, Pyapôn, Amherst, Katha,
Upper Chindwin, Mandalay, Meiktila, Myitkyina, Bhamo and Northern
Shan States. The decrease in primary vaccination is reported from
Hanthawaddy, Tharrawaddy, Henzada, Myaungmya, Ma-ubin, Mergui,
Pakôkku, Shwebo, Upper Chindwin, Mandalay and Bhamo, while
Hanthawaddy, Henzada, Ma-ubin, Mergui, Pakôkku, Shwebo, Chin Hills,
Kyauksè, Magwe and Southern Shan States show a decrease in revac-
cination. Out of 42 districts, 20 have not reported any dispensary
vaccination.
9. Vaccination in Jails.—In an average population of 21,004 in 26
jails,—28,518 persons were vaccinated,—1,381 being primary and 27,137
being revaccinations. In primary vaccination 87.25 per cent. were
successful and in revaccination 49.55 per cent.
10. Vaccination by Private Practitioners.—Private Practitioners
performed 2,193 operations of which 537 were primary cases with 98.87
per cent. of success and 1,656 revaccinations with 54.80 per cent. of
success. In comparison with the previous year, there was a total decrease
of 2,806 cases, or over 56 per cent.
11. Vaccination on Steamers. —Under the provisions of section 9 of
Burma Vaccination Law Amendment Act, 1909, 30,202 labourers arriving
at the port of Rangoon were vaccinated by the Corporation Vaccination
Staff under the supervision of the Port Health Authorities, but owing to
the circumstances attending these vaccinations, results could not be
verified. In comparison with the previous year's figure, there was an
increase of 3,047 operations.
FOR THE YEAR 1924-25.
7
12. Verification work performed by Inspecting Officers.—Out of the
total number of 536,267 persons primarily vaccinated, Civil Surgeons
verified 43,678 cases or 8.14 per cent. as against 51,594 cases or 9.41 per
cent. in the previous year. The Inspectors of Vaccination and other
Inspecting Officers verified 285,962 cases or 53.32 per cent. against
286,169 or 52.22 per cent. in the previous year. Out of 279,513 persons
revaccinated, Civil Surgeons verified 14,998 persons or 5.37 per cent.
against 13,688 or 6.52 per cent. and Inspectors of Vaccination and other
Inspecting Officers verified 145,781 or 52'16 per cent. against 90,702 or
43.23 per cent. last year. It will thus be seen that verification of primary
cases decreased while that of revaccination cases increased over the last
year's figures.
A minimum of 10 per cent. is considered as an adequate proportion
for a Civil Surgeon's verification work. This year's work falls short of
this minimum and is also less than that of the previous year. The Civil
Surgeons of Toungoo, Thayetmyo and Myaungmya did no verification
work this year. The Civil Surgeon, Toungoo, reports that, being much
too busy at headquarters, he was unable to find time for touring in the
district and hence could do no verification work. A large percentage of
verification of primary cases was done by the Civil Surgeons of the Chin
Hills (79.13), Sandoway (59.74), Myitkyina (52.34), Upper Chindwin
(39.25), Kyauksè (37.17), Katha (26.94) and Meiktila (23.51), while very
little has been performed by the Civil Surgeons at Insein (.41), Akyab
(.64). Bassein ( .94), Minbu (1.24), Tharrawaddy (1.58), Hanthawaddy
(1.82), Thatôn (2.18) and by the Health Officer, Rangoon (2.95)
Excellent verification of primary cases was done by the Inspectors of
Vaccination and other Inspecting Officers in Upper Chindwin (90.31),
Rangoon (90.03), Kyauksè (89.26), Pegu (85.98), Ma-ubin (84.63), Tavoy
(83.10), Pyapôn (83.19). Meiktila (75.43), Myingyan (74.60), Mandalay
(70.16), Tharrawaddy (67.52), Hanthawaddy (67.19), Southern Shan
States (63.97), Yamèthin (61.91) and Sagaing (61.44). The Northern
Shan States (.25), Minbu (.53) and Hill District of Arakan (15.28) return
a very low proportion of verifications in primary vaccination, as there is
at present, no Inspector of Vaccination in any of these districts.
In verification of revaccination cases, the Civil Surgeon, Chin Hills,
heads the list, with 91.06 per cent. followed by the Civil Surgeons of the
Northern Shan States (75.84), Putao (60.51)., Myitkyina (52.78) and
Sandoway (45.39)- Very little verification has been done by Civil
Surgeons, Thatôn (.22), Insein (.86), Bassein 0.94), Southern Shan States
(1.19), Rangoon (1.20), Akyab (1.16), Mandalay (1.78) and Pyapôn (1.95).
The Civil Surgeons of Prome, Henzada and Mergui did not verify any
revaccination cases.
In 11 districts the Inspectors of Vaccination and other Inspecting
Officers verified more than 50 per cent. of the total number of persons
revaccinated. Meiktila heads the list with (98.59), followed by Rangoon
(86.88), Akyab (85.61), Bhamo (80.05), Ma-ubin (71.91), Thayetmyo
8
NOTES AND STATISTICS ON VACCINATION IN BURMA
(71.00), Kyauksè (67.31), Yamèthin (61.28), Myingyan (61.14),
Tharrawaddy (53.74) and Pegu (51.21). Very poor results have been
reported from Minbu (37), Henzada (8.44), and Northern Shan States
(1.75), but the Civil Surgeon, Minbu, appears to have many difficulties
to contend with.
13. Vaccine Depôt, Meiklila.—344 calves were successfully vaccinated
during the year, 4 either failed to take or yielded lymph of such poor
quality that the lymph had to be destroyed. A comparative statement
showing the output and issue of lymph during the year and two previous
years is given below :—
Year
1922-23 ...
1923-24 ...
1924-25 ...
Number of
calves
scraped
321
334
344
Total yield
Oz.
328.23
325.66
377.12
Grams
9,300
9,277
10,743
Average yield per calf.
Grs.
491.3
468.5
529.6
Grams.
28.97
27.63
34.23
Doses issued.
956,018
982,104
1,072,701
There was an unusually large demand for lymph during the year as
practically the whole of Burma was infected with small-pox.
During the months of January, February and March 1925, extra
doses to the number of 130,899 were indented from India. No such
demand has ever been made since the Depôt was inaugurated. The
large demand could not have been met had it not been for the more
rapid and newly adopted Phenol method of preparing lymph and had it
not been for the zeal shown by the Assistant Director, U Thaw Zan and
the rest of the Vaccine Depôt's staff, who worked overtime and on
holidays, in order to meet the increased demands.
Throughout the year the greatest difficulty was experienced in
obtaining calves for the Depôt. The supply was always uncertain, and
there were times when it failed entirely,—and had it not been for the
help of U Thein, Township Officer, Wundwin, who repeatedly accom-
panied the Assistant Director, Vaccine Depôt, on his visits to villages and
persuaded the people to part with their calves, the Depôt would most
probably have run short of lymph. The Director, Vaccine Depôt, has
reported this year also that he had experienced great difficulty in selling
the vaccinated calves as there is a popular belief among Burmans that
vaccinated calves are useless for breeding purposes. Thanks however to
the courtesy of the Burma Railways, revised regulations in respect of
cattle transport have been issued, and it is hoped that this, coupled with
grazing facilities which are being extended to the Vaccine Depôt, by the
Chief Conservator of Forests—may result in the discovery of other means
both for obtaining and disposing of Vaccine Depôt calves.
A certain amount of lymph is still being wasted, though to a lesser
extent than during the previous year. The Director reports that only
ten officers wasted lymph exceeding 20 per cent. of the amount issued.
Civil Surgeons recover the cost for culpable wastage from the subordi-
nates responsible, the cost being recredited to Government.