2
No. 1496-P.H., 31ST OCTOBER 1922
the population is ripe for another epidemic. The vicious circle will continue
unless and until the necessity for protection is realized by local bodies and the
public.
5. Responsibility for ensuring protection rests with municipal councils and
local boards. A fair index of their conscience is the number of successful
operations performed annually per thousand of the population. The figures are
tabulated in Annexure A to this order, together with the number per mille
" protected." This " protection rate " is calculated on the total number success
fully vaccinated or revaccinated during the preceding seven years, seven years
being the period at which vaccination normally requires to be reinforced by
re-vaccination.
6. In the districts the " protection rate " in the year under report ranges
from 297 per mille in the Nilgiris to 135 per mille in Salem, the mean being 179
per mille. In municipalities the variations are much more startling. The mean
is 312 per mille. Madura stands easily first, with 764 per mille. Calicut stands
second (586 per mille), Vizianagram third (519 per mille). The last ten munici
palities on the list have been rather recently constituted, and it is hardly fair to
reckon against them the bad old record of their pre-municipal days. But older
municipalities such as Nellore (185 per mille). Tirupati (169), Tiruvālūr (163),
Conjeeveram (163), Erode (156), Chittoor (137) have no such excuses.
7. The number of successful operations in 1921-22 per mille of the popula
tion augurs ill. Only in the Nilgiris and South Kanara does the rate exceed 30
per mille and even a rate of 30 cannot afford effective protection. In 18 out of
24 districts the rate is well below the average for the preceding quinquennium ;
in Guntūr the drop is — 12.4, in Malabar — 9.7, in Kistna — 8.3, in Vizagapatam
— 7.6. This reduction is serious and the local boards concerned are requested to
examine very carefully the causes of decline and to report to the Government
through the Director of Public Health by 1st January 1923 the measures they
are taking to improve protection within their jurisdiction.
8. Vaccination work in rural areas presents difficulties which cannot be
pleaded in excuse for a low standard in municipalities. The annual birth-rate
for the Presidency is estimated to be between 42 and 43 per thousand, and under
the more intensive administration of urban areas a minimum rate of 50 successful
vaccinations per thousand inhabitants could reasonably be taken as the lowest
figure compatible with safety. Yet out of 82 municipalities, as many as 72 failed
to attain this figure; 43 of them did not even rise to 31 per mille. Out of the
80 municipalities, for which comparative figures are available, no less than 60 show
deterioration from the work turned out by them in the previous five years. This
deterioration was worst in the following 22 towns :—
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Madura ... ... ...
Ellore
...
...
...
Cocanada ... ... ...
Narasaraopet ... ... ...
Negapatam ... ... ...
Ootacamund ... ... ...
Biralipatam ... ... ...
Chirala ... ... ...
Mangalore ... ... ...
Vizianagram ... ... ...
Ongole ... ... ...
— 45.8
— 30.8
— 29.9
— 28.7
— 27.7
— 27.0
— 25.7
— 25.0
— 23.6
— 21.6
— 19.6
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Tanjore ...
...
...
Coonoor ... ... ...
Kodaikānal ... ... ...
Tiruvaunāmalai ... ... ...
Chidambaram ... ... ...
Masulipatam ... ... ...
Parlākimedi ... ... ...
Gudiyāttam ... ... ...
Cuddalore ... ... ...
Guntūr ... ... ...
Nandyal ...
...
...
—18.9
—18.7
—17.1
—17.1
—16.4
—16.1
—15.7
—15.2
—14.7
—14.6
—14.4
9. The chairmen of these municipalities are requested to lay these facts and
figures before their respective councils and to report to the Government through
the Director of Public Health not later than 1st January 1923 the causes of this
decline in the efficiency of their administration, and the measures they propose to
take to recover the ground lost and regain their former standards. Similar
reports must also be submitted by the municipal chairmen of the following munici
palities where the outturn is far below the limit of safety :—
Bōdināyakkanūr (24.5 per mille), Peddāpuram (24.4), Srīvilliputtūr (24.4),
Tirupati (23.6), Erode (22.8), Tadpatri (22.2), Kumbakōnam (21.6), Nellore
(20.7), Tiruvālūr (15.2), Conjeeveram (14.6), Hindupur (13.3), Rēpalle (9.3).