3
7. Incidence and mortality of small-pox.—During the last ten years, the
total number of deaths from small-pox in. the districts of this province has
been 94,994.
During the first quinquennium, the number of deaths was 55,776 and
during the second 39,218. In each of the last five years, the mortality was
as follows :—19,374, 4,911, 2,695, 3,893 and 8,345.
During the last few months of the period now under report small-pox had
been widely prevalent throughout Orissa and in several of the districts of Bihar
and was still prevalent at the end of the year. In last year's report, I predic-
ted the probability of an increase in the prevalence of small-pox this year and
for the next two or three years. The prediction has so far been fulfilled.
There has been an increase of about 4,500 deaths during the year under report
and the disease has been very prevalent during April and May which months
will be included in the next year's statistics. There is in my opinion little
doubt but that the number of deaths from small-pox will show another large
increase in 1925-26 and there is a serious risk that the disease may rage in
epidemic form during the next two years unless strong action is taken to
enforce the vaccination of the population in a much more thorough and
comprehensive manner.
The provincial ratios of the mortality from small-pox per thousand of
population during the last five years have been .56, .14, .07, .11 and .24.
8. Prevention of small-pox .—The constant and considerable mortality
noted in the preceding paragraph is, in my opinion, a complete demonstration
both of the insufficiency and of the inefficiency of the existing arrangements
for vaccination.
It is well known, in fact it is an admitted axiom—that thorough vaccination
can and does stamp out small-pox altogether, and in the light of that know-
ledge, and in face of the above facts, there is great necessity for a stronger
vaccination policy.
I do not consider that small-pox can be effectively dealt with and stamped
out unless vaccination is made compulsory throughout the province, and I
would recommend that the Vaccination Act should be modified so as to extend
the age within which vaccination is required, to one year, and should be
generally enforced; that vaccination should be free ; and that the supervision
and control of vaccination should be delegated to district boards and munici-
palities and their Health Officers.
9. Inspection of work.—During the year under report the Assistant
Directors of Public Health inspected 58,788 primary vaccinations as against
71,814 in the previous year.
The inspecting work done by the Assistant Directors of Public Health has
been comprehensive and they have submitted valuable reports on the efficiency
of the staff and work in 20 out of the 21 districts in the province.
The Civil Surgeons of the province inspected 22,638 primary and 3,510
re-vaccination operations against 40,985 primary and 4,686 re-vaccinations
last year.
It should be noted that the methods of inspection of Civil Surgeons and
Assistant Directors of Public Health are different. Civil Surgeons inspect the new
work which has just been done and the numbers returned by them are there-
fore smaller, whereas Assistant Directors of Public Health inspect all the
children under ten years of age, and look at old work as well as new work, and
also look for unvaccinated children and children who are marked with small-
pox, and they also examine vaccinators' registers and other records in the
villages where they can be verified and checked.
10. Supply of vaccine.—The Vaccine Depôt at Namkum supplied the
province with vaccine throughout the year. A large supply of vaccine is held
in reserve and the necessary stores and supplies for manufacture are in ample
stock. One million, six hundred and two thousand seven hundred and seventy-