NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3
Chanda, (25,059), Drug (24,077), Saugor (23,777), Buldana
(19,485), Chhindwara (18,130), Jubbulpore (16,354), Balaghat
(15,267) and Amraoti (15,148). In most of the districts the
decrease is ascribed to the non-co-operation movement, low birth-
rate or other cause as noted below. The largest fall was in
Bilaspur where the work received a great setback in the years
1920-21 and 21.22. Owing to the unusual delay in the introduction
of the time-scale of pay, the staff became discontented and went on
strike, consequently the work suffered in the beginning of 1922-23
also but subsequently it made fair progress. In Seoni the fall is
attributed to several changes amongst vaccinators and non-pay-
ment to them of the allowance for carrying their equipment; in
Bhandara to the exodus of the people to other places owing to
scarcity, changes amongst vaccinators, high mortality among
infants and the prevalence of plague in Gondia circle in 1921-22 ;
in Raipur to the exodus of people to tea gardens and the Tata
Iron Works owing to scarcity, and also to slackness of vaccinators;
in Chanda to deficiency coupled with slackness of the vaccination
staff; in Drug to the prevalence of influenza and malaria, slackness
of the vaccination staff and scarcity prevailing in the district; in
Buldana to inefficiency of vaccination staff and prevalence of
plague; in Chhindwara and Jubbulpore to the prevalence of
plague; in Saugor, Balaghat and Amraoti to the non-co-operation
movement as stated above.
9. There can be no doubt that the non-co-operation move-
ment has affected vaccination to some extent, but the inefficiency
coupled with the slackness of vaccinators,as reported by several
Civil Surgeons, was also responsible for the decrease of work. Now
that the pay and prospects of the staff have improved, if it is
overhauled and stimulated, there is no doubt that a considerable
improvement in work can be shown. It is therefore essential to
put vaccination once more on a satisfactory footing, but apart from
the improvement that is necessary in the staff it is as remarked by
the Deputy Commissioner, Bhandara, absolutely necessary that the
general public and especially schoolmasters and Local Board
members should display a far greater degree of interest than they
evince at present. This, it is hoped, will result from the health
publicity campaign.
10. An important feature of the triennium was the revision
of pay of the vaccination staff and the transfer of the administrative
and executive control of these men to local bodies Government
sanctioned a time-scale of pay for these men and it was given
effect to from the 1st January 1921, but as most of the District
Councils and Boards expressed their financial inability to comply
4
with these orders, Goverement gave them grants aggregating
Rs. 25,846 to cover the extra cost involved upto the end of the
financial year 1921-22, and for subsequent years they were
requested to meet the extra cost from their own funds. It seems
that the revised scale has been introduced in all the districts
except Balaghat and Bhandara.
In Balaghat district the
staff was first given the increased rate of pay according to
the scale from January 1921 to February 1922 and after-
wards they were put back on the old rates, a peculiar
procedure adopted by the District Council and one which has
created discontent among the men. This will not be conducive to
good results. In this connection Mr. C. A. Clarke, C.B.E., I.C.S.,
the Commissioner, remarks " The District Council have apparently
not seen their way to treat the vaccinators generously and I am
afraid it will require a bad epidemic of small-pox in this district
to make the local authorities duly sensible of the dangers of the
present situation". Similarly, the Bhandara District Council have
introduced a special rate of pay but as this rate is not the same
as that sanctioned by Government, the staff is dissatisfied. The
Deputy Commissioner, Bhandara, writes " I consider that we
cannot expect a complete return to the good figures of 17-18
unless the staff is adequately treated in the matter of pay and the
useless members are weeded out". It would be well for these
Councils to reconsider the matter and treat the staff adequately.
11. Under the orders issued by Government in November
1922, the administrative and executive control of the vaccination
staff has been transferred to local bodies, but as these bodies have
no Health Officer of their own to advise them in technical matters
regarding vaccination, they have made arrangements with the Civil
Surgeon of their districts to carry on the technical control and
supervision of the staff. The relations of the local bodies with the
Civil Surgeons under the new régime have been cordial, and in
Nimar increased powers have been given to the Civil Surgeon. In
Berar the Commissioner remarks that there still remains to be
determined the exact relation of Civil Surgeons to local bodies as
Superintendents of Vaccination and the matter of entrusting definite
powers by the local bodies to Civil Surgeons is under consideration.
12. During the triennium reports of opposition to vaccina-
tion were received by Civil Surgeons from many villages and sent
to the tahsildars for necessary action. This is an irregular
procedure. Such reports should go to the Deputy Commissioner
and local body. It is stated that parents flatly refused to get their
children vaccinated as they have adopted a more independent
attitude towards vaccination and in spite of the persuasion used by
5
inspecting officers and others their attitude remains unchanged, so
it is difficult for the staff to work in rural areas. The Civil
Surgeon, Wardha, reports opposition in 58 villages and
84 villages in Jubbulpore refused vaccination. Unless therefore
vaccination is made compulsory in villages the work will become
more difficult in future years. In my notes on vaccination for the
year 1921-22 I had already suggested the desirability of extending
compulsory vaccination to villages. This view is supported by
the Commissioner, Chhattisgarh division, who writes " I think the
days of executive action are past. While the bulk of the people
realise the benefits of vaccination, the staff has to cope with general
apathy on the one hand and with passive resistance on the part of
a minority. Executive action by low paid subordinates, with its
inevitable vagaries, tends to aggravate rather than minimise these
difficulties and to make the department unpopular while I have no
doubt that the people would prefer the more dignified form or
compulsion under the law. Very few prosecutions under the Act,
if extended to rural areas, would be necessary and they may be
limited to those sanctioned by the District Magistrate".
13. It is disappointing to find that except in Yeotmal district,
the average number of persons vaccinated by each vaccinator
during the year 1922-23 has been very low in every district. In
Chanda, Saugor and Drug the average is a little more than half
the minimum standard laid down (viz., 2,000), while in Seoni and
Mandla it is less than half. It is therefore of extreme importance
that local bodies should pay attention to this matter and arrange
to set it right. There is no reason why one vaccinator in Yeotmal
can do 3,505 vaccinations while another in Seoni does only 600.
14. Revaccinations.—During the year 1922-23 the
number of revaccinations performed was 40,796 against 45,319
in 1921-22 and 61,045 in 1920-21. As compared with the previous
triennium, the work shows a great falling off, amounting to no less
than 112,700 as stated above. The causes are (1) political
agitation, (2) diminished supervision, (3) discontented staff as
mentioned above. The local bodies would be well advised to
take energetic action so that revaccination may be pushed on as
vigorously as possible. This step is desirable in order to avoid
severe epidemics of small-pox.
15. Vaccination by the dispensary staff and other
agencies. Statement III.—During the year 1922-23 the Railway
staff in Chanda Nagpur, Raipur and Bina performed 187 vaccinations
the Dhamtari Mission(Raipur) 21 and the Mining agencies, Chhind¬
wara, 176. While 107 vaccinations were done in the Nagpur Jail, 818
in Raipur Jail and 108 in the Cantonment Hospital, Pachmarhi.
6
16. Total cost of the department. Statement II.—
The total cost of vaccination incurred during the triennium under
review is Rs. 5,34,789-9-3 against Rs. 3,97,305-5-9 in the preced-
ing triennium. The increase in the expenditure is due to the
payments made to the staff at the increased rate according to the
time-scale of pay sanctioned by Government and also on account
of coolie allowance and rewards to vaccinators. The diminished
amount of work also has raised the cost per head. In consequence
of this, the cost per successful case rose from Re, 0-6-7 in
1920-21 to Re. 0-7-6 in 1921-22 and to Re 0-8-3 in 1922-23. If
the sale-proceeds of lymph and calves is taken into account,
the cost per successful case stands at Re. 0-7-9 in 1922-23
against Re. 0-6-8 in 1921-22 and Re. 0-6-1 in 1920-21.
17. Only glycerinated calf lymph prepared at the Vaccine
Institute was used. The supply was reported to be satisfactory
and the lymph good. The reports on the working of this Institute
for 1920-21 and 1921-22 were incorporated in the notes for those
years. The following is a report on the working of the Institute
for the year 1922-23 submitted by the Superintendent Mr. A. F.
C. Gomes, who has now been replaced by a senior grade Military
Assistant Surgeon Captain F. G. H. Deeks, I.M D. :—
" The whole province comprising 22 districts and Raigarh,
Sirguja and Bhopal States were supplied regularly with vaccine
lymph on indents, and casual supplies were given to all the other
feudatory states of the province, to the railways, to the jails and
to the military and mission hospitals. There were 231 calves
successfully vaccinated during the year and the total yield of
pulp amounted to 8047.39 grammes equivalent to 702,380 doses
of vaccine. In all 454,945 doses were issued to the vaccinators
of 22 districts and 60,340 doses to others including Sirguja,
Raigarh and Bhopal States.
" The average purchase price per calf was Rs. 13 and on the
average Rs. 10 was realised per calf on sale in the local bazaars.
The total expenditure incurred was Rs. 24,354-0-5 of which
Rs. 11,128-15-11 were spent on salaries and travelling allowances
and the rest in contingencies. Rs. 12,641-1-9 were realised
during the year as follows : —
On sale of vaccine lymph ...
„
„
calves ...
Rs.
10,021
1,997
a.
15
0
p.
6
0
and the rest as miscellaneous.
" The Assistant Superintendent conducted the training class
and 22 new vaccinators were trained and given certificates of
efficiency in vaccination and sanitation by the Director of Public
Health, Central Provinces and Berar.
7
" The cost per dose of vaccine manufactured was six pies
only. The results of primary vaccination were 99 per cent case
success and 94 per cent insertion success and for revaccination
72 case success and 49 per cent insertion success".
18. The cost of preparation of lymph has increased from
5½ pies in the preceding year to 6 pies per dose. Heretofore the
local bodies and others to whom lymph was supplied were charged
at the rate of three pies per dose, but from the 1st August 1922
the cost of lymph has been raised to six pies.
19. Inspection of vaccination. Statement V.—Out of
the 428,135 persons (386,346 primary and 41,789 revaccinations)
vaccinated during the year 1922-23, the Civil Surgeons inspected
5.68 per cent of primary operations and 6.87 of revaccination as
compared with 6.20 and 8.05, respectively, in 1921-22 and 6.92
and 5.43, respectively, in 1920-21. The fall in inspections is
ascribed to the non-production of children for inspection in villages
and also to the restrictions placed on the touring of Civil Surgeons.
During the year 1922-23 the Civil Surgeon, Nagpur, performed
no work at all as he states he was not able to go out in the district
for inspection purposes owing to pressure of work at the head-
quarters. In accordance with the orders issued by Government
tents are usually available with the Deputy Commissioner for
vaccination-touring and so in the absence of their own tents the
Civil Surgeons could not do much touring. They inspected the
vaccination of such villages only as were situated on road sides.
20. At present there is urgent need for more effective
supervision of the work of the vaccination staff and in my opinion
the time has now come to re-establish touring throughout the
six months of the vaccination season. It is therefore desirable
that the restrictions on touring referred to above may be withdrawn
and tents placed at the disposal of the Civil Surgeons. In this
connection the Deputy Commissioner, Hoshangabad, remarks
"The control of the Civil Surgeon over vaccination in the interior
is diminished by the restriction on touring. But it should be
possible for the Civil Surgeon to do more inspection than is
represented by 36 villages in six days if this work be combined
with the inspection of outlying dispensaries".
21. The Assistant Superintendents of Vaccination inspected
52.18 per cent of the primary and 20.54 of the revaccinations in
1922-23 and 50.37 and 17.65, respectively, in 1921-22 and 49.77
and 24.88, respectively, in 1920-21 as compared with 53.08 and
25.63 in 1919-20, 48.78 and 23.64 in 1918-19 and 46.34 and 25.55
in 1917-18 During the years 1920-21 and 1921-22 the fall is
8
attributed to the non-co-operation movement and the attendent
difficulties with which these men were faced but in the year
1922-23 the work shows some improvement although it was very
low in the districts of Jubbulpore, Saugor, Seoni and Chhindwara.
22. The Sub-Assistant Surgeons in charge of outlying
dispensaries and those in charge of epidemic dispensaries inspected
schools regularly and reported the names of children found
unvaccinated. Necessary action was taken to get these vaccinated
by the vaccinators of the circles.
23. Percentage of success in primary and revaccina-
tion.—The percentage of success in primary operations recorded
by vaccinators during the past three years was 98.19, 98.76 and
99.07, while the Assistant Superintendents of Vaccination found on
inspection 96.24, 97.34 and 98.11 and Civil Surgeons 98.40, 98.91
and 98.98. These figures seem satisfactory and show that the
vaccinators generally do not falsify their records.
In revaccinations the percentage of success claimed by vacci-
nators was 61.41, 57.87 and 60.19, while the Assistant Superin-
tendents found on inspection 40.44, 40.10 and 42.37 and Civil
Surgeons 42.14, 42.17 and 47.54. These figures show that the
success recorded by vaccinators and that found on inspection by
inspecting officers varied considerably which is due to the rapid
fading of the marks of revaccination.
24. Vaccination in Municipal towns.—In 1922-23 the
births registered in Municipal towns and notified areas were 45,961
and deaths among chidren under one year of age were 10,964. Of
those that remained alive, 26,816 or 77 per cent were successfully
vaccinated which is less than the percentage vaccinated in the
two preceding years, viz., 90 in 1921-22 and 84 in 1920-21. During
my tours of inspection I found the vaccination work very unsatis-
factory in several of the important towns and impressed on the
Municipal Committees the necessity for taking energetic action in
the matter but the advice given is not often followed. I quote
below a few instances of the kind referred to. In Jubbulpore town
there is a large balance of unprotected children, e.g, 4,723, but
the Municipal Committee does not seem to pay any attention to
the matter. In the towns of Saugor district a balance of 3,294
unprotected children is reported.
So also Narsinghpur and
Gadarwara have been great defaulters and there is little public
health spirit here as yet. In Raipur the percentage of children
unprotected within Municipal limits is large and the Deputy
Commissioner rightly remarks that the need for more vigorous
action on the part of the Municipality is indicated. The case of
9
Akola is well known. This as well as the Murtizapur Muni-
cipal Committee, is so indifferent that they do not give any
help to their vaccinators. The Deputy Commissioner, Akola,
writes " If the Murtizapur Municipality continue to be slack in
helping vaccination, it will be fair for Government to withhold a
part of their grant to the dispensary. The same applies to the
Akola Municipality for their failure to prosecute guardians of
unprotected children".
It is evident therefore that apathy and indifference of the
Municipal authorities are the main causes for this state of affairs.
I hope energetic action will be taken to have the balance of
unprotected children vaccinated as early as possible, otherwise a
severe epidemic of smallpox will result. Proper vaccination stations
are required in every town and children should be collected at them.
25. Mortality from small-pox,—Deaths from small-pox
numbered 373 against 1,216 in 1921-22 and 2,363 in 1920-21. The
mortality from this disease is very considerably less, but as
vaccination work has been dangerously neglected in recent years,
a severe epidemic of small-pox is apprehended sooner or later.
In the town of Mangrul Dastgir (population 5,511) in Amraoti
district there was a severe epidemic of small-pox in the last year
(260 attacks and 47 deaths) and it is reported that this outbreak was
due to apathy shown by the people there in getting their children
vaccinated. Although the vaccinator visited the place several
times he succeeded in doing very little work, the number of children
remaining unvaccinated (108) being very large. The village was
also visited by the Deputy Commissioner, Tahsildar, etc., but
little good came of their endeavours to persuade the villagers.
This case will serve as an example that continued deterioration
in work of vaccination must bring its own punishment.
26. The deaths registered from this cause since the year
1896 clearly indicate that small-pox has a definite periodicity. It
recurs at fairly regular intervals of 4—5 years. A chart illustrating
these observations is attached.
27. As a considerable percentage of children remain
unprotected each year and the results of vaccination wear off a
large and highly susceptible population gradually accummulates,
affording favourable ground for the spread of infection. Hence
the importance of securing as complete vaccination as possible
every year.
28. General remarks.—It will thus be seen that in the
period under report there has been a most serious general falling
off in vaccination which means that a fatal epidemic is in store
as is instanced in the particular case of the village Mangrul
Dastgir. Supervision by Civil Surgeons has markedly declined
10
and steps are required to make good this defect especially as local
bodies have now delegated powers of executive and technical control
to them and will expect a reasonable standard of supervision.
In towns Sanitary Inspectors are notified as additional
superintendents, but this branch of their work is almost neglected
by them. Committees who pay for this work to be done should
see that their money is not wasted.
The question of making vaccination compulsory in rural areas
is being urged and will be examined.
Now that Civil Surgeons are, at the request of the local bodies
themselves, acting as executive officers and technical advisers
in vaccination all complaints of refusal and obstruction should be
made known to the local body concerned as well as to the Deputy
Commissioner. Reports should not be made direct to the tahsildar.
Annual reports should moreover henceforth be sent to this office
through local bodies as well as through district officials so that
they may be informed of every thing that is taking place
The Civil Surgeon, Akola, feels the need for a district sani-
tary officer and proposes that a sub-assistant surgeon should
take the place of the assistant superintendent of vaccination in
this capacity. The above report in my opinion emphasises the
need for separate district health officers to look after vaccination
registration, school inspection, epidemic outbreaks, health pro-
paganda, etc I am quite sure that the work requires such an
officer and that the local bodies would rise to a consciousness of the
needs and responsibilities of public health if they had their own
whole-time expert to help and advise them.
The reports of Lieut.-Col. Fowler and Major Warwick,
I.M.S., are most useful while Captain Perdriau has also written an
excellent report.
The delay in submitting this report is due to the late receipt
of the district reports—as rural vaccination work ends in March,
district reports should be easily compiled by the 25th April.
T. G. N. STOKES, M.B., LT.-COL., I.M.S.,
Director of Public Health,
Central Provinces.
NAGPUR:
The 28 July 1923.
STATISTICAL STATEMENTS.
APPENDIX.
STATISTICAL STATEMENTS.
STATEMENT NO. I.—Showing particulars of vaccination in the
Central Provinces and Berar during the
year 1922-23,
STATEMENT NO. II.—Showing the cost of the Department in
the Central Provinces and Berar during
the year 1922-23.
STATEMENT NO. III.—Showing dispensary vaccination in the
Central-Provinces and Berar during the
year 1922-23.
STATEMENT NO. IV.—Showing the number of persons primarily
vaccinated and the number of those
persons who were successfully vaccinated
in the Central Provinces and Berar
since 1912-13.
STATEMENT NO. V.—Showing particulars of vaccination verified
by inspecting officers during the year
1922-23.
APPENDIX A.—Showing the number of vaccinations performed
in municipal towns on children under
one year of age in 1922-23.
APPENDIX B.—Showing the annual mortality from small-pox for
seven years and the annual proportion
of persons protected by vaccination
during each of the seven years.
APPENDIX C.—Diagram showing the death-rate from smallpox per
10,000 of population during the year
1922-23, the average rate of mortality
from smallpox per 10,000 of population
for the five years ending 1921-22, and
the proportion of persons successfully
vaccinated during the year 1922-23 and
the preceding six years in each district
of the Central Provinces and Berar.
PAGE.
2-7
8—11
12—13
14—17
18—19
20—23
24—23
2
A.—VACCINATION
STATEMENT No. I.—Showing the particulars of Vaccination in the
Number.
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Circles and Districts.
2
Nagpur Division.
Nagpur ...
Bhandara
...
Wardha
...
Chanda ...
Balaghat ...
Total ...
Jubbulpore Division.
Jubbulpore
...
Saugor ...
Damoh ...
Seoni
...
Mandla
...
Total ...
Nerbudda Division.
Hoshangabad ...
Nimar
...
Narsinghpur ...
Betul ...
Chhindwara ...
Total ...
Chhattisgarh Division.
Raipur ...
Bilaspur ...
Drug ...
Total ...
Berar Division.
Amraoti
...
Yeotmal ...
Akola ...
Buldana ...
Total ...
Total District Vaccination
...
Total Dispensary Vaccination ...
By Other Agencies
...
Total British Districts, Central
Provinces and Berar.
Population of
district according
to census of 1921.
3
792,521
717,747
463,696
660,630
511,634
3,146,228
745,685
528,380
287,126
348,871
386,446
2,296,508
445,733
396,554
315,162
363,737
491,835
2,013,021
1,406,676
1,231,765
743,246
3,381,687
828,384
748,959
798,544
699,429
3,075,316
13,912,760
...
...
13,912,760
Average.
population per
square mile.
4
Average
number
of
vaccinators
employed
throughout
the
year.
5
CENTRAL PROVINCES
206.39
181.02
190.98
70.94
163.36
138.74
190.61
133.36
101.96
108.82
76.42
121.17
121.06
93.81
159.49
93.94
106.20
109.47
143.89
161.69
159.99
153.44
175.02
143.89
194.91
187.46
173.10
160.08
...
...
160.08
19
13
12
13
8
65
18
12
7
9
11
57
10
9
7
8
11
45
24
24
18
66
15
10
14
13
52
285
...
285
*Differeace between the number of persons vaccinated and the number of operations