3
reduction has occurred since 1915, since when the annual average has been
75,473 deaths or 34.3 per cent. below the average of the decade of 1901—
1910. To some extent this striking decrease may be due to. improved
sanitary administration and educative propaganda, but a vast amount remains
to be done in securing the early notification of the disease and in providing
for adequate disinfection and water-sterilization.
Cholera is an easily
preventable disease, and no more effective measure for raising the science
of public health in the estimation of the public could be devised than
the mobilization of sanitary forces against this disease. The Minister for
Local Self-Government is pleased to find that the Howrah and Khulna
District Boards have recognized the need for organizing measures to eradicate
this scourge. District Boards generally show a tendency to approach this
question of cholera control in a more business-like manner than municipalities.
5. Small-pox.—The heavy mortality of 1919 (37,010 deaths) and 1920
(36,190 deaths) was followed by the usual periodic decline : in 1921, only
8,257 deaths from small-pox were reported. Here also a vigorous public
health administration might immediately achieve momentous results. The
seasonal incidence of small-pox and its tendency to be mainly localized in
certain centres—such as Calcutta, Howrah, and the 24-Parganas—from
which in epidemic years infection is spread, have been carefully studied, and
there can be little doubt that a vigorous vaccination policy in these and
certain other mufassal danger-spots, whence infection is diffused, would,
within a short lime, considerably mitigate the ravages of this disease.
6. Vaccination.—The total number of vaccinations reported in the
Presidency in 1920-21 was 2,326,497 against 3,186,642 in 1919-20. These
figures represent a decrease of 226,062 primary vaccinations and 634,088
re-vaccinations. Only 301,168 infants, or 290.4 per mille of 1,037,089 infants
who required vaccination, were successfully vaccinated. The protection
afforded was obviously most inadequate. The chief cause of the decrease
was the fact that small-pox was less prevalent. The mortality was 21,950
against 41,200 in 1919-20, when people eagerly accepted vaccination. The
Rangpur. Chittagong and Tippera boards made a notable advance by
introducing free, vaccination, which eight district boards had already pro-
vided. The Minister is glad to find that in the Dacca district some of the
union boards undertook to provide free vaccination, while some district
boards appointed a few paid vaccinators for this purpose in areas where small-
pox was epidemic. The Compulsory Vaccination Acts (V of 1880 and II of
1911) were extended to all rural areas except in the districts of Darjeeling
and the Chittagong Hill Tracts, where free vaccination has been in force for
many years. It is naturally difficult to induce people to submit to vaccina-
tion in rural areas, when they are enjoying a comparative, though temporary,
immunity from small-pox, but local bodies should remember that a vigorous
vaccination policy during a period of quiescence will restrict the foci of infec-
tion, and thereby the extension of the disease, when small-pox again, in
accordance with its usual periodicity, blazes up with fresh force.
7. Fever.—The mortality in 1920 and 1921 was 1,144,421 and 1,070,368
giving ratios of 25.2 and 23.0 per mille against a quinquennial average of
23.7. Of febrile diseases, malaria is undoubtedly the most important, but
tuberculosis, pneumonia, enteric, Kala-azar and febrile respiratory affections
help to swell the returns under the head of " fever."
The Director of Public Health points out that the total death-rate is a
safer guide to the relative prevalence of malaria than the death-rate under
"fever" with its necessarily inaccurate classification. It is found that in
those areas, such as the Burdwan and Presidency Divisions, where a decline
in population occurs as the result of adverse economic conditions, malaria is
most prevalent. And, by a vicious circle, as population declines, the propor-
tion of anopheles per head grows and causes the static malaria ratio to rise.
In the Dacca and Chittagong Divisions, where malaria is least prevalent,
the mean fever indices show a serious increase, and this phenomenon is