3
information at present available to state with any certainty whether this low incidence
is to be interpreted as evidence of a definite decline in small-pox prevalence or whether it
is the prelude to a specially severe recrudescence on the return of the usual periodic
epidemic.
The Khulna District Board is to be congratulated on its very satis-
factory small-pox statistics ; Khulna vaccinators are reputed to be the best
operators in the province, while the public health of this district is particu-
larly good.
The total number of vaccinations reported in the Presidency in 1923-24
was 2,057,724 against 2,006,140 during 1922-23. These figures represent an
increase of 64,191 in primary vaccinations, and a decrease of 12,607 in re-
vaccinations.
Out of 1,355,980 infants requiring vaccination, only 278,286 or 205.2 per
mille were reported to have been successfully vaccinated in the rural areas,
as compared with 290,172 or 290.4 per mille of 998,829 infants in the previous
year, the proportion of successful vaccination in the case of children under
one year of age being 251'2 per mille as against 268.1 per mille in the year
1922-23. The protection afforded was obviously most inadequate. The
chief cause of the decline in the number of successful vaccination of infants
was the fact that people are generally averse from having their children
vaccinated until they are several years old.
An additional grant of Rs. 25,000 was provided in the budget for 1924-25
for the suppression of outbreaks of small-pox epidemics.
Fever.—The mortality in 1923 was 909,795, giving a ratio of 19.5 per
mille against the quinquennial average of 24.4. As usual deaths from fever
represented about 75 per cent. of the total mortality. Though the mortality
from malaria decreased from 540,463 in 1922 to 539,899 in 1923, deaths
from enteric, relapsing fever, measles, kala-azar and other fevers increased,
the increase being greatest under kala-azar. In respect of fever mortality,
there was great improvement in the Presidency and Burdwan Divisions
in comparison with other divisions where changes were small. In this
connection the Director of Public Health remarks as follows :—
This increase of malaria in Eastern Bengal districts appears to be associated
with certain changes that have occurred in these areas in recent years. There has
been a great increase of the water-hyacinth, there been a considerable multipli-
cation of village roads, and in certain areas, notably Mymensingh, there has been
considerable railway extension. The increase of water-hyacinth is an indication
of a greatly lessened flow of water in the bils and water courses and over the
surface of the country. This is exactly what might be anticipated as a result of the
multiplication of village roads which in deltaic areas are usually like the form of embanked
footpaths, raised considerably above the surface of the country. In existing circum-
stances, the multiplication of village roads in Eastern Bengal districts is likely to be
followed by certain consequences of which an extension of water-hyacinth is one and
an increase of malaria another. It is said that people can only learn by their own
personal experience and rarely gain wisdom from the experience of others. If this is so
the people of Eastern Bengal cannot be expected to appreciate the immense risks they
incur by interference with the flow of flood water across the surface of the country.
The results obtained from experiments carried on in the colliery area
(Singaran-Toposi) and at Meenglas in the Duars with a view to reducing
malaria proved successful. The Banka Valley scheme continued to give good
results and effected a reduction of the spleen index. A " flood and flush "
scheme was carried out at Jangipur, and the results so far obtained go to
show that the flushing of malarious areas not only improves the general
health but warrants the assumption that flood irrigation is one of the best
methods yet devised of dealing with malaria in deltaic areas.
Kala-azar.—The number of reported deaths from kala-azar was 4,565 in
1923 against 1,531 in 1922 and 1,552 in 1921. Kala-azar cases treated at
hospitals, dispensaries and special centres were 51,740 in 1923 against 7,689
in 1921 and 13,317 in 1922. It is satisfactory to note that district boards
started 125 special centres for the treatment of kala-azar, and that, in addition
to these centres the Central Co-operative Anti-malaria Society and the Bengal