Ainongst a series of 28,461 births registered in the General Register Office and in the Chinese Public Dispensaries in 1937, some 21,282 infants were vaccinated by this means. Vaccination of school children is also compulsory and public vaccinators visited schools to offer their services.
Inmates of prisons, reformatories, refuges and similar institutions are also required to be vaccinated. Emigrants by boat from Hong Kong are subject to the compulsory clause. Vaccination of immigrants is also permissible under certain conditions, but has not been effected so far. The reasons for this are somewhat obscure, but relate to the desire that ships arriving in Hong Kong should suffer no delay of any sort from quarantine precautions, even though they may be actually importing cases of acute infectious disease or large numbers of unvaccinated passengers of the poorest class.
Lastly, vaccination is compulsory for persons whom the Health Authority has reason to suspect have been exposed to infection. This provision is valuable on theoretical rather than on practical grounds. Owing to the fact that the majority of the cases of smallpox during epidemic periods are "missed" or are found after death dumped into the streets, there are no means of ascertaining the addresses from which they were carried.
Lymph is prepared in the Government Bacteriological Institute under conditions which ensure a high standard of potency and low bacterial infection. Buffalo calves are used. The lymph is put up in metal containers each holding three cubic centimetres and capable of being used for about sixty insertions.
Cases of the disease were isolated at the Infectious Diseases Hospital, Kennedy Town when discovered; but nearly half the total number of cases notified were not found until after death.
In all, ninety-four deaths occurred in a total of 129. A high mortality rate is unlikely and it is much more probable that many "missed" cases occurred with unfortunate results. A more effectively organised sanitary inspectorate under the direct control of the Medical Officers of Health would prevent this state of affairs from taking place and should result in much avoidable suffering and loss of life from preventable disease. Disinfection of premises where cases were discovered or to which they could be traced was also carried out together with vaccination of contacts. Here again, as the sanitary inspectorate had not been trained as public vaccinators, time was lost—and contacts no doubt escaped—between the discovery of a case of smallpox and securing the services of a public vaccinator.