Part II.]
VACCINATION IN THE CENTRAL PROVINCES.
71
Agency.
Principle upon which
work is conducted.
Provincial establish¬
ment.
General results.
Local establishments.
Results.
Vaccination in these provinces is carried on by a small provincial establish-
ment paid from provincial fund, and local establishments paid from municipal
and district funds. The former has not undergone any change, but the latter
has been increased a little as shown by this statement. The whole agency is
under the immediate superintendence of the civil surgeons of districts, the prin-
ciple laid down for guidance being, that no more work is to be attempted than
can be efficiently overlooked by the civil, medical, or other trustworthy officer.
The number of operations performed by the provincial establishment was 41,265,
being nearly 4,000 less than the number vaccinated by the establishment in the
previous year, but the deficiency occurred in the Seoni district only, and was due
to a large portion of the district, containing a third of its inhabitants, having
been transferred to Balaghat. The percentage of success was 93.5. Local and
municipal establishments performed 89,734 operations against 77,074 in the
previous year, with a percentage of success in primary cases of 87.77.
Sufficiency of vacci-
nation to the wants
of the province.
Touching the sufficiency of vaccination, as at present conducted, to the
wants of the province, Dr. Townsend writes :—
The amount of protection conferred on the people of these districts by the year's work
may be estimated by the number of infants vaccinated under one year of age, or by the
number of persons vaccinated per mille of the population.
In countries, as in England, where it is compulsory for all infants to be vaccinated within
three months after birth, the number of vaccinations per cent. of births affords the best estimate
of the extent to which the population is protected. In England, for some years prior to 1871,
the number of vaccinations did not exceed 65 per cent. of the number of births, and in that
year a violent epidemic of small-pox carried off nearly 23,000 persons. Measures were then
taken to ensure better enforcement of the law, and the rate of vaccination has since risen
considerably.
In this country we cannot as yet adopt this mode of estimating the efficiency of vaccina-
tion work, for in the first place our registration of births is still very imperfect, and secondly,
parents are generally much averse to having very young children operated on, and everywhere
a large proportion of those vaccinated are above one year old. As, however, young children are
more readily brought for operation in proportion as the protection it confers becomes known
and appreciated by the people, the proportion of children under one year operated on becomes a
good test of the progress that has been made in overcoming the prejudices of the people.
The number of births registered in the province in 1873 yielded a birth-rate of a little
over 30 per 1,000 of the population; this is undoubtedly much below the truth, and we must
have some other standard whereby we may estimate the relative value of the work of vaccina-
tion. According to the census of 1872, the number of children living under one year of age
amounted to 51 per 1,000 of the total population. As about 15 per cent. of the children die
before they reach the age of one year, if we took the census for our guide in estimating the
annual birth-rate, we should have to put it at about 60 per 1,000 of the population, or nearly
double the average birth-rate of European countries. One hesitates to accept this enormous
birth-rate as correct, more especially as it would show our efforts to make vaccination keep
pace with the births to be more inadequate even than we imagined them to be ; but I have
shown elsewhere that our vital statistics to a considerable extent support the figures of the
census, and even the statistics of vaccination in Sambalpur and the hill districts apparently
indicate that the birth rate is very high. For the present, however, and until we can get
more accurate statistics, it will be better to use the birth-rate of England, 36 per 1,000, as a
standard for comparison.
Taking 36 per 1,000 as the birth-rate, the proportion of children under one year old vacci-
nated, per cent. of stimated births in the districts given in Table I, compares very favourably
with the rates obtained in other provinces, as will be shown presently.
As, however, a large proportion of the children vaccinated in this country are above one
year old, the number of infants vaccinated is not a correct measure of the efficiency of vacci-
nation, and we must take the proportion of successful operations per 1,000 of the population
for the purpose of estimating the extent to which protection has been conferred by the annual
work. Assuming the birth-rate to be 36 per 1,000, and reducing this by a sixth to meet the
mortality among young children, 30 operations per 1,000 of the population would be the rate
which it would be necessary to keep up annually in order to exclude small-pox from a district.
Birth-rate.
It is remarked in the Government resolution on the report, that the as-
sumption that the birth-rate is 36 per 1,000 of population " is doubtless too
low an estimate, and it is probable that the real birth-rate is between 50 and
60 per mille"
Comparison with
Bombay and North-
-estern Provinces'
rates.
The rates obtained in 1873-74 in the three Satpura districts occupied by
the provincial establishment, is thus compared with the rates obtained in
Bombay and the best vaccinated districts of the North-Western Provinces:—