( 14 )
The case of the Dacca jail prisoners who had recently suffered from
small-pox being successfully vaccinated also at first sight appears to invalidate
the performance of vaccine operations, but this is not the case; for if one
attack of small-pox does not necessarily confer immunity against another
attack, it may reasonably be assumed that one attack of small-pox need not
necessarily protect against subsequent successful vaccination. Dr. Edwardes,
page 10, mentions that "Dr. Koch told the Commission (German) that he him-
self had seen a patient in a third attack of small-pox which proved fatal;" also
Professor Wundulich asserts that he saw one patient have two attacks in
the same epidemic. It will thus be seen that a survived attack of small-pox
does not absolutely confer immunity against another attack, but such cases
are very uncommon. As regards the Dacca prisoners, Dr. Cobb informed me
personally that three of the six were attacked very mildly, that only one had a
severe attack, and that all were vaccinated in two spots only.
Regarding the apparent failure of inoculation in affording protection, it
must be borne in mind that successful inoculation is only vaccination with a
lymph whose strength is not attenuated. If after inoculation, as not unfrequent¬
ly happens, the child suffers from a general eruption, the parents return the case
as one of pure small-pox only; if the child does not show a general eruption, it
is held to be successfully inoculated. That is to say, one of two things usually
results from inoculation—either an attack of small-pox which confers a large
amount of immunity, or a local sore, which is to all intents and purposes a vac-
cination sore; and as a single vaccine operation in childhood does not confer
immunity for life, it may be reasonably assumed that inoculation will equally
fail to do so.
The conclusion to be drawn from the above remarks is that if the general
public is to be completely protected from small-pox, re-vaccination at the age
of 10 is necessary. The statistics which I have quoted regarding Prussia are
conclusive on this point. The result of enforcing compulsory vaccination on
babes is to throw the incidence of small-pox on to the period of puberty,
though even at this age the primary vaccination exerts a most powerful effect
in modifying the severity of the disease. I would strongly recommend that all
children over 10 years of age attending schools and all Government employés
should bear marks of successful re-vaccination.
Extent to which vaccination has
been introduced.
13. Vaccination is now practised throughout the Province. In towns it is
compulsory, in rural areas optional. As an experi-
mental measure Act V (B.C.) of 1880 was two
years ago extended to the rural areas of the districts
of Rangpur, and portions of the districts of the Sonthal Parganas, Tippera,
and Bhagalpur, to overcome the resistance of the people of those districts to
vaccination. In the absence, however, of adequate machinery to enforce the
provisions of the whole Act, it has not been worked. But although the whole
Act cannot be put in motion with the establishment at our disposal, sections 11
(with the first paragraph only of Schedule D), 26, 27, 28 and 29 of Act V of 1880,
and section 8 (29A) of the amending Act II of 1887, can be worked without
extra expense. These are really the important sections. I am strongly of
opinion, and so are the majority of the Civil Surgeons whom I have consulted
on the subject, that if the present system of licensed vaccination is to continue,
the above sections of the Compulsory Vaccination Act should be extended to
all rural areas in which vaccination is actively resisted. It was thought that
under the reorganization scheme much of the opposition complained of by the
Sanitary Commissioner would be overcome by the Civil Surgeon working in
concert with the District Magistrate. It may be too early yet to judge the
result, but so far it does not appear to have justified the anticipation.
Lymph—Distribution and des-
cription of.
14. As usual, the work of the year 1892-23 was started throughout the
Province in the month of October with bovine
lymph supplied from the animal vaccine depôts of
Calcutta and Darjeeling. Vaccination was then
carried on by the arm-to-arm method supplemented from time to time with stored
lymph in tubes. This arm-to-arm practice is a most objectionable system for
the following reasons:—
(1) The children used as vaccinifers are invariably of the lowest classes—
Mehters, Chamars and low-class Musalmans—the use of whose