3
per thousand, the total number of operations performed is still in excess of the
total number of infants available, as it always has been. In previous years
the excess has been very marked, and as there has been a constant excess it
must be inferred that the returns are to that extent on the average fictitious.
Civil Surgeons and Deputy Sanitary Commissioners are unanimous in
attributing the opposition to vaccination to be concerned more with the age
of the child than with the operation itself, and, in view of the strong popular
prejudice which exists against the vaccination of infants at an early age, I
consider that it is desirable that the Vaccination Act should be amended so as
to raise the age for compulsory vaccination to one year instead of six months.
7. Incidence and Mortality of Small-pox.—During the last ten years the
total number of deaths from small-pox in the districts of this Province has
been 94,305.
During the first quinquennium the number of deaths were 33,783 and
during the second 60,522. In each of the last five years the mortality was as
follows :—9,742, 6,687, 6,205,18,514 and 19,374.
The provincial ratios of the mortality from small-pox per thousand of
population during the last five years have been .28, .19, .17, .53 and .56
respectively.
8. Prevention of Small-pox.—The constant and considerable mortality noted
in the preceding paragraph is, in my opinion, a complete demonstration both of
the insufficiency and of the inefficiency of the existing arrangements for
vaccination.
It is well known—in fact it is an admitted axiom—that thorough vaccination
can and does stamp out small-pox altogether, and in the light of that knowledge,
and in face of the above facts, there is great necessity for a more definite
vaccination policy.
I do not consider that small-pox can be effectively dealt with and stamped
out unless vaccination is made compulsory throughout the Province, and I
would recommend that the Vaccination Act should be modified so as to extend
the age within which vaccination is required, to one year, and should be
generally enforced ; that vaccination should be free ; and that the super-
vision and control of vaccination should be delegated to District Boards and
Municipalities and their Health Officers.
9. Inspection of Work.—During the year under report the Deputy Sanitary
Commissioners inspected 145,627 primary vaccinations as against 24,905 in the
previous year. The increase is considerable and satisfactory. The inspecting
work done by the Deputy Sanitary Commissioners has been comprehensive
and they have submitted valuable reports on the efficiency of the staff and the
arrangements in 19 out of the 21 districts in the Province.
The Civil Surgeons of the Province inspected 53,177 primary and 9,047
revaccination operations against 50,044 primary and 9,065 revaccination last
year. It should be noted that the methods of inspection of Civil Surgeons
and Deputy Sanitary Commissioners are different. Civil Surgeons inspect the
new work which has just been done and the numbers returned by them are
therefore smaller, whereas Deputy Sanitary Commissioners inspect all the
children under ten years of age, and look at old work as well as new work
and also look for unvaccinated children and children who are marked with
small-pox, and they also examine vaccinators' registers and other records in
the villages where they can be verified and checked.
10. Officers of the Inspecting staff. — The officers of the inspecting staff
have not yet attained to a very satisfactory standard of efficiency. A few of
them are energetic and capable, and these men are being rapidly promoted and
put in the most responsible positions. The majority, however, are careless
and negligent and do not attempt to carry out their duties honestly and
efficiently. The supervision and control of a large staff which is distributed
throughout the Province is a matter of considerable difficulty for a central