3

The figures above quoted speak for themselves and are a very satisfactory
record of the work done to stamp out and prevent small-pox in these States.
Both vaccination and to a large extent revaccination are practically compulsory
in the majority of these States; and both the record and the results of the
work are eminently satisfactory.

6.  Protection of Infants.—During last year out of 1,119,606 the esti-
mated number of children under one year available for vaccination 499,705,
equal to 446 per thousand, were successfully vaccinated as compared with 492,588
or 468 per thousand in the previous year. The protection of infants in muni-
cipalities is separately shown in statement VII and works out at a ratio of 690
per thousand of the surviving infant population.

These figures are very unsatisfactory as they show that more than half
the total number of operations are performed on children over one year of age.
Whilst the ratio of protected children under one year of age has fallen to
below 500 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 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 98,155 from which it may be inferred that over 600,000 cases of the
disease occurred in that period.

During the first quinquennium the number of deaths was 53,772 and
during the second 44,383. In the last quinquennium the mortality was as
follows:—4,347, 8,979, 14,628, 9,742 and 6,687.

The provincial ratios of the mortality from small-pox per 1,000 of popu-
lation during the last five years have been .11, .22, .42, .28, and .19 res-
pectively.

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 vaccina-
tion 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.

The inefficiency of the Department is being severely dealt with and
action has been taken against a large number of officers. The departmental
rules and regulations are being strictly enforced and the staff generally has
been warned against laziness, neglect of duty and breach of rules. The results
of two years' work in this direction are now beginning to make themselves
apparent.

At the same time 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 modi-
fied 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 vaccination staff in all the districts should be put on one consolidated
provincial cadre for purposes of administration and work.

9.  Inspection of work.—During the year under report the three Deputy
Sanitary Commissioners inspected 155,456 primary vaccinations as against