4
borne out by facts, for the percentage of mortality from small-pox in the Garo
Hills is rising after several years of practical immunity. This year the ratio
(.13) is higher than any year since 1905. Efforts should, on no account, be
relaxed, for not only is a new and unprotected population of infants coming into
existence, but the immunity among those already vaccinated is gradually in course
of time becoming weaker. In the Khasi and Jaintia Hills the increase of 12,800
operations on the total of the last triennial period is due to the work of an additional
temporary staff which was employed in 1908-09. The Khasis are badly vaccina-
ted, compared with the neighbouring Garos, and outbreaks of small-pox among them
are of frequent occurrence. The question of permanently increasing the staff is under
consideration. In the Naga Hills, the Civil Surgeon remarks on the influence of
the Subdivisional Officer of Mokakchang in inducing the people to accept vaccination.
Surma Valley districts.
Cachar records a fall of nearly 11,000 operations during the triennium; and
though slight, it has been persistent each year. This district was formerly reputed
to be one of the best vaccinated districts in the province. In Sylhet also there
has been a fall of over 60,000 on the last triennium.
8. Strength and composition of the inspecting staff.
There are 24 Inspectors and 63 Sub-Inspectors on the staff, including 4
supernumeraries. Since the last report a second Inspector has been appointed to
Mymensingh, as it was impossible for one officer to supervise a district containing
nearly four and a half million inhabitants. The Sub-Inspectors also have received
two additions to their number by the appointment of an officer to the new Subdivi-
sion of Gopalganj in the Faridpur district, and by the addition of the Municipal
Inspector of Dacca city to the provincial cadre.
9. Verification of operations by inspecting officers.
In the last report, attention was drawn to the impossibility of the Deputy Sani-
tary Commissioner's carrying out the nominal programme of his work, which is
to visit every district and to inspect a sample of each officer's work. The condi-
tion has become even more pronounced now than it was then. His time has
been very largely taken up with special public health enquiries and with the
Provincial Laboratory, and this portion of his work has consequently fallen seriously into
arrears. He only succeeded in inspecting 592 operations in the course of the year, of
which 405 were in the subdivisions of Mymensingh. The Civil Surgeons' inspec-
tions in many of the Eastern Bengal districts are also becoming more difficult to
make each year, and are practically confined to the vicinity of their head-quarters
and to the larger centres of their districts.
In Bakarganj, for example, the inspections of primary operations were particularly
bad (.3 in 1908-1909, .09 in 1909-1910 and .02 in 1910-1911). In Mymensingh, Chit-
tagong, Tippera and Rangpur, they were under 1 per cent. and in only 7 districts,
Noakhali, Bogra, Malda, Nowgong, Naga Hills, Garo Hills and Manipur were they
over 10 per cent. The percentage of inspections by the Deputy Sanitary Commis-
sioner and Civil Surgeons is only 3.96 of the operations of the last three years
(167,000) which is quite insufficient for the purpose. A proposal to appoint special
inspecting officers for vaccination and vital statistics will be submitted shortly.
The subordinate staff inspected 89.93 per cent. of primary operations, and 66.26 per
cent. of re-vaccinations, during the last three years. In the Assam districts the ratio is
lower than in the Eastern Bengal districts, probably owing to the comparatively scattered
condition of the villages, and the sparseness of the population.
10. Vaccination in compulsory areas.
Of 12,926 infants under one year, said to be available for vaccination during
1910-1911, 7,133 or 55 per cent. were successfully vaccinated.
In the city of Dacca and in the municipalities of the Mymensingh district, com-
pulsory vaccination cannot be said to have been successful. In Dacca city, out of
2,360 children available, only 248 were vaccinated within the year. This condition is
not, I consider, due to want of effort on the part of the staff, for not only were the
ordinary notices in " Schedule E " issued by the police habitually to everybody re-
porting a birth ; but 822 notices requiring vaccination within 15 days, under the " first
schedule" were issued on defaulters ; 43 persons were prosecuted and 20 of these
were convicted and fined. The children ultimately get vaccinated ; but their parents
object to the performance of the operation during the first year of life.