2
The harvest of 1920 was comparatively favourable and the easier
conditions as regards good supply gave in 1921 a reduced mortality, but the
relative fall in the prices of agricultural produce, including rice, jute and
oil seeds, caused a reduction in the normal surplus wealth of the cultivator.
It is this surplus wealth which, '' spent almost exclusively in the mainten-
ance of large and frequent families," promotes a higher conception and
birth-rate.
The statistics of vital occurrences in many towns are extraordinarily
misleading. The machinery of registration differs fundamentally from that
of rural areas. Registration in towns is compulsory, but until municipal
boards appreciate more clearly the essential need of an accurate record, little
will be done to compel parents, guardians and relatives to discharge this
obligation to the State. In 1920, 36, and 1921, 28 towns out of 117 reported
death-rates of less than 20 per mille. Manicktala however reported the high
rate of 54.0 per mille in 1920, while Chandrakona in 1921 attained a similar
pre-eminence with a mortality of 52.1 per mille. These figures are doubtless
fairly accurate, but rates of 8.7 and 8.9 per mille in 1920 (Garulia and
Kanchrapara) and 5.3 and 6.6 per mille in 1921 (Suri and Garulia) can only
be greeted with blank incredulity.
The condition of birth registration is equally discouraging. In 1920
only 38 towns and in 1921 only 36 recorded birth-rates exceeding 20 per
mille, while in 14 towns (1921) the rate was less than 10 per mille. The
town of Jessore returned the absurd figure of 3.6 per mille.
'' These low birth-rates do not reflect the real condition of affairs, but are due to
sheer neglect to administer the law."
For seven years in succession, this flagrant neglect of the most ele-
mentary principle of public health administration has been strongly criticised
by the Director of Public Health. Dr. Bentley proposes that proper registrars
should be appointed, under certain statutory conditions, to undertake this
important work. The Minister for Local Self-Government agrees that an
improvement in the registration of vital statistics is a most urgent sanitary
reform, since it is on these figures that the sanitarian must ultimately rely
in gauging the effects of a public health measure.
3. Infant mortality.—In 1920 and 1921, 282,090 and 268,162 infants
died under the age of one year. The ratios in these two years were thus 207
and 206 per mille. But the figures are almost certainly inaccurate, and
actuarial calculations lead the Director of Public Health to place the probable
mean infant death-rate for Bengal at some figure between 190 and 250 per
mille. Exact observations extending over 5 years among a population of
15,000 in the Murshidabad district gave an infantile death-rate ranging
from 201 in 1917 and 1921 to 282 in 1918, with a quinquennial average of
237. In one small circle, however, of 5,000 people in the Murshidabad
district, exact intensive registration gave the appalling figure of 700 infantile
deaths per thousand births. Fifty per cent. of the deaths were due to
debility at birth and 11.4 per cent. to tetanus. If this latter figure holds
good throughout the province, it means that over 30,000 infants perished
from tetanus during 1921. The Director of Public Health remarks that—
" these infants are needlessly sacrificed to the ignorance of the village dais ".
It is also estimated that maternal causes (pre-natal, natal, and post-natal
conditions) were responsible for the death of roughly 60,000 mothers in 1921.
The Minister is glad to learn that the trained mid wives and lady health
visitors employed by the Calcutta Corporation have done excellent work,
that good results have been obtained at the infant welfare centres established
by voluntary agencies under the auspices of the Red Cross League, and that
a similar centre in Dacca has done fine service.
4. Cholera.—The mortality from cholera rose to 124,949 in 1919, fell
to only 54,199 in 1920, and in 1921 was 80,547. The Director of Public
Health observes that " in Bengal cholera appears to be on the decline ". As-
compared with the decade 1901—1911 deaths from cholera during the past.
ten years show a reduction of 309,546 or nearly 27 per cent. The greatest