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three less than 4,000 and two less than 5,000. In some cases, the shortage in
inspections has been explained by the presence of cholera epidemics. Due notice
will be taken of those cases where no satisfactory explanation has been given.
(2) The number of cases inspected by Municipal Health Officers (excluding
Madras Corporation) ranged from 461 in Coonoor to 14,269 in Madura. Ten
Health Officers verified more than 75 per cent of the cases (the minimum
prescribed in the Public Health Code), four inspected between 65 and 75 per cent
and nine between 50 and 65 per cent. Those in the latter two groups will be
asked to explain the shortage.
(3) In municipalities not having Health Officers, the percentage of cases
inspected varied from 33.3 in Bimlipatam to 100.0 per cent in Kodaikānal.
Twenty-eight verified more than 75 per cent of the cases, seven between 65 and 75
per cent, sixteen between 50 and 65 per cent and the rest below 50 per cent.
The attention of the Surgeon-General will be drawn to those officers at default.
(4) District Medical Officers and Civil Surgeons inspected 7,571 cases in
1925-26.
(5) One hundred and eighty-six Health Inspectors inspected more than
85 per cent of their cases against 153 in 1924-25. Of the other Health Inspect
ors, 30 could not reach their minimum on account of epidemic duties. Suitable
action will be taken in the remaining cases if no satisfactory explanation is
offered.
20. The mortality from smallpox which amounted to 26,526 in the last year
of the previous triennium has steadily decreased, the number of deaths during the
triennium under report being 22,626 in 1923-24, 20,227 in 1924-25 and 14,498 in
1925-26. The actual decline in mortality is probably much greater than these
figures indicate, as formerly many of the cases were concealed and remained
unrecorded.
During 1925-26, no district escaped infection. The mortality exceeded a
thousand in the districts of Gōdāvari (1,204), South Arcot (1,199), and North
Arcot (1,122); it ranged between 500 and 1,000 in ten districts and was lowest in
the Nilgiris (27). Of 1,320 deaths registered in municipal towns, Madras City
alone returned 411 deaths or 31.1 per cent. Twenty-four towns were absolutely
free from the disease.
The figures for the last four years encourage the hope that smallpox is one
of the preventible diseases which is gradually being brought under control in this
Presidency. At the same time, there is no reason for any relaxation of effort.
It should be the aim of every member of the Public Health Department to wipe
this disease entirely off his records. Individual effort counts for much, but three
other conditions are fundamental. These are—
(1) The extension of compulsory vaccination throughout the Presidency
and enforcement of the smallpox rules and regulations,
(2) The maintenance of correct records of births and of unprotected
persons, and
(3) The prompt notification of smallpox cases.
The first and second conditions have already been discussed. As regards
the third, it is a constant complaint that local authorities either do not notify the
disease at all or their reports are belated or incomplete. For example, out of
1,176 smallpox deaths in North Arcot district, only 456 were intimated to the
Health Inspectors concerned. In many cases also, outbreaks are allowed to
develop until they are discovered by the health staffs themselves. As a result, a
large number of deaths often occur before preventive measures can be under
taken. The attention of revenue and village officers may be again drawn to the
dangers of delay.
21. The unvaccinated or imperfectly protected person is not only a source
of danger to himself but also to the community at large. In an analysis of 66
outbreaks of smallpox in Anantapur district in 1925, it was found that, in 54, the
first case was an unvaccinated person, whilst in the other 12, the persons attacked
first had been vaccinated in infancy but had not been subsequently revaccinated.