5
Civil Surgeon as a technical adviser, and it is, therefore, to their discredit when
the work is incomplete, or when large percentages of unprotected children are
found in their schools.
I
During the triennium the Vaccination Act was extended to the Munici-
pal towns of Mowar in Nagpur and Pandhurna and Sausar in Chhindwara and
withdrawn from all Notified Areas.
Deaths from small-pox.
18. Deaths from small-pox rose from 2,767 (0.20 per 1,000) in 1911-12 to
5,081 (0.37 per 1,000) in 1912-13 and 6,174 (or 0.44)
during the past year.
Although the prevalence of epidemic small-pox has decreased very markedly
when comparisons are made over long periods, as mentioned in the recent
Sanitary Report, yet we are never without traces of it. Like other diseases it
waxes and wanes, flaring up at times into a serious outbreak as it did in Nagpur
during 1912-13, and then subsiding. The epidemiological factors producing
this phenomenon are imperfectly understood, but there can be little doubt that a
large unprotected population must be a potent predisposing cause. The number
of persons successfully vaccinated per 1,000 of the population was 40.05 against
38.18 last year ; the ratio is however regrettably lower than in the previous
triennium, in the last year of which it reached 44.57. Regarding the treatment
of small-pox, Captain Fraser, I. M. S., has made an interesting report upon the
use of Iodine painted twice daily over the skin lesions. He claims for it the
absence of suppuration, secondary fever, and of subsequent " pitting" of the skin.
19. Having proceeded thus far with this report it will be of advantage to
pause and consider what are the causes actuating against a more complete
control of the disease, and to examine them with a view to finding a remedy. In
this connection the following remarks of Rai Bahadur S. N. Barat are of
interest:—
That some children also of the better class dodge the Vaccinator and elude his needle
is evident from my inspection of village schools. It is remarkable how these children are
picked up by the disease when it breaks out in a village. Adults in whom the immunity of
primary vaccination has waned or ceased have also fallen victims, emphasising the
necessity of re-vaccination which people fail to realise.
20. Here we have the whole matter in a nutshell: primary vaccination is
incomplete, hence children figure largely in small-pox mortality lists (a fact noted
in Nagpur and Akola), and re-vaccination is not understood, so that the whole
cause of vaccination tends to be discredited. As the control of small-pox is the
kernel of this whole subject, let us see what steps have been or can be taken to
improve matters. The following measures have been already taken :—
(1) A revised scheme for the vaccination staff has been drawn up and
approved.
(2) A Central Lymph Depôt has been started.
(3) School inspections in Municipal areas have been instituted and a
certain amount of similar work is done in rural circles.
(4) Leaflets have been issued to schoolmasters by the Director of Public
Instruction, explaining the importance of vaccination and re-vacci-
nation, instructing them also in the policy adopted by Government
and soliciting their co-operation.
21. We still, however, require that—
(1) Local bodies should recognise their responsibilities in the matter.
Members of Taluk Boards in Yeotmal have given assistance.
(2) Work should be kept up-to-date by a closer scrutiny of weekly
returns and the movements of the staff should be known.
(3) An accurate calculation of the material available is essential, and, if
work cannot be completed in the ordinary course of events, it
should be finished later.