NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
2
cent of the population will not come for vaccination and the
only way this dangerous portion of the populace can be dealt
with is by compulsion. The high water-mark of voluntary
vaccination has been reached, though we are by no means neces-
sarily near the high water-mark of small-pox." The Deputy
Commissioner, Amraoti, adds that though in municipal areas
where the Act applies, the vaccination statistics do not give pro-
mise of greatly improved results accruing from its application
in rural areas, he considers that compulsion must come even
if it is to be limited at first as proposed by the District Council,
Amraoti, to villages with over 5,000 population, and further
that it is not the overcoming of active opposition to compul-
sion which he fears but the apathy and indifference of a large
section of the population to the Act. The local Government
endorses these remarks which find repetition to a greater or
less extent in most of the district reports.
2. The number of revaccinations performed was 154,000
as against 147,000 for the previous triennium. The Civil
Surgeon, Yeotmal, in commenting on the large increase
in the deaths from small-pox in that district notes that several
casualties occurred among vaccinated persons. As immunity
from small-pox only lasts for some seven years, revaccination
after a certain period is essential and the figures clearly show
that this matter is not receiving the attention it deserves.
3. The period under review was the first complete
triennium during which the administrative and executive
control of the vaccination staff has been exercised by local
bodies. Many local bodies have taken an active interest in
vaccination work and certain noteworthy innovations have
been introduced at their instance, but some have failed to
appreciate fully the responsibilities which devolved on them
with the transfer of control. An increase in the staff is over-
due in some districts, and more active work and more supervi-
sion in the field should be insisted on from Assistant Superin-
tendents. The local Government has noted with interest that
the scheme for training schoolmasters in vaccination, which
was sanctioned by it in the previous year at the instance of
the Buldana District Council, is reported to have worked
extremely successfully in that district and elsewhere where
it has been introduced. If further experience confirms the
conclusions reached this year, there is obviously a wide scope
for the development of this agency for carrying out both
vaccination and revaccination.
3
ORDER.—Ordered that a copy of this Resolution be
forwarded to the Director of Public Health, Central Provinces,
for information and guidance; also, that it be published in the
Supplement to the Central Provinces Gazette.
By order of the Governor in Council.
R. M. CROFTON,
Financial Secretary to Government,
Central Provinces.
Govt. Press, Nagpur—1065, Finl. Secy.—8-9-26—325.
TABLE OF CONTENTS.
Introductory
...
...
...
Administration ... ... ...
Area and population
...
...
...
Establishment ... ... ...
Total vaccinations ... ... ...
Vaccination by special staff
...
...
Cooly allowances to vaccinators ... ...
Re-vaccination ... ... ...
Dispensary vaccination and vaccination by other agencies
Cost of the Department
...
...
...
Supply of lymph and working of the Institute ...
Inspection of vaccination
...
...
Percentage of success in primary and re-vaccination ...
Vaccination performed in municipal towns ...
Deaths from small-pox ... ...
General ... ... ... ...
PARAS.
1
2
3
4
5
6—11
12
13
14
15
16&17
18—20
21 &22
23&24
25
26—30
TRIENNIAL REPORT ON VACCINATION
IN THE
Central Provinces and Berar for the years 1923-24,
1924-25 and 1925-26.
Introductory.—This report deals with the work per-
formed during the triennial period ending 1925-26.
2. Administration.—The charge of the Department
was held by Lieut.-Colonel T. G. N. Stokes, I.M.S., till the
17th February 1925 when he proceeded on leave. I took over
from him and remained in charge till the close of the trien-
nium except for the period from 22nd August to 21st Novem-
ber when I had proceeded on leave and Lieut.-Colonel
Powell, I.M.S., was in charge.
3. Area and population.—The area served by the
vaccination staff and the population remained the same as in
the previous triennium, viz., 99,823 square miles with a popu-
lation of 13,912,760 souls.
4. Establishment.—The number of assistant superin-
tendents of vaccination remained the same, viz., 36, but during
the years 1923-24 and 1924-25 the District Council, Mandla,
employed two assistant superintendents of vaccination instead
of one, as an additional post was sanctioned by them tempo-
rarily during these years. The Civil Surgeon, Mandla, urges
the need for the entertainment of a second assistant superin-
tendent of vaccination permanently ; so also the Civil Sur-
geon, Saugor, remarks that it is impossible for one assistant
superintendent of vaccination to manage the whole district
and that two men are needed. The District Councils will
give this matter their early consideration.
As regards vaccinators, the number was increased by
four men, i.e., in the districts of Bhandara, Hoshangabad and
Buldana, and thus at the end of the triennium there were in
all 306 vaccinators.
As regards the staff of vaccinators in Yeotmal district,
the Civil Surgeon remarks that the present number is quite
inadequate to meet the needs of the district and urges that
the number be increased by at least four vaccinators,
2
5. Total operations performed.—The following
table is inserted showing the progress of vaccination during
the two triennial periods ending 1922-23 and 1925-26 :—
Establish-
ment.
1
By vaccina-
tors.
By
sub-as-
sistant Sur-
geons at-
tached to
dis pensa-
ries.
By
other
agencies.
Total ...
Triennial period ending 1925-26.
1923-24.
2
500,806
110
482
501,398
1924-25.
3
519,991
402
723
521,116
1925-26.
4
555,941
2,849
4,642
563,432
Total.
5
1,576,738
3,361
5,847
1,585,946
Triennial period ending 1922-23.
1920-21.
6
438,501
32
961
439,494
1921-22.
7
409,979
109
294
410,380
1922-23.
8
427,874
1,033
384
429,291
Total.
9
1,276,354
1,174
1,639
1,279,167
Difference
10
+ 300,384
+ 2,187
+ 4,208
+ 306,779
As compared with the previous triennium, the total
number of operations increased by 306,779.
6. Vaccination performed by the special staff-
Statement I.—The total number of operations performed
by vaccinators during the triennium was 1,576,738 of which
1,421,851 were primary and 154,887 re-vaccinations (458,019
primary and 42,787 re-vaccinations in 1923-24, 472,135 and
47,856 in 1924-25 and 491,697 and 64,244 in 1925-26).
A comparison with the previous triennium shows that the
vaccinators performed 300,384 more operations and this
increase was contributed by all the districts except Jubbul-
pore which alone shows a slight decrease. The Civil Surgeon,
Jubbulpore, states that this decrease is entirely due to the
comparatively enormous amount of re-vaccinations done in
1920-21.
7. During the preceding triennium (1920-21 to 1922-23)
there was a great decrease of work, but during the three years
under report there has been a steady increase of work and
the figures show a decided improvement and now approximate
to the levels of pre-non-co-operation days. The increase
amounted to 30,337 in Raipur, 26,813 in Drug, 24,011 in
Nagpur, 20,810 in Chanda, 19,009 in Buldana, 17,728 in
3
Chhindwara, 17,500 in Bilaspur, 16,327 in Akola, 16,262 in
Mandla, 16,138 in Bhandara, 14,730 in Yeotmal, 14,205 in
Amraoti, 24,170 in Seoni, 11,834 in Saugor, 8,850 in
Hoshangabad, 7,009 in Balaghat, 6,978 in Betul, 6,887 in
Narsinghpur, 5,038 in Nimar, 4,943 in Wardha and 1,071 in
Damoh. As remarked by some Civil Surgeons, the close and
effective supervision exercised by the supervising staff, the
drastic action taken against the vaccinators and the keen
interest displayed by the Deputy Commissioners and their
assistants in vaccination work and the cordial relations exist-
ing between the District Councils and Civil Surgeons contri-
buted a good deal to the improvement of work during the
triennium under review. In Nagpur city it is reported that
some extra vaccinators were temporarily engaged for pushing
on with vaccination and re-vaccination work during the year
1925-26 owing to the prevalence of small-pox.
8. In spite of increase in the number of vaccinations,
there are still large number of children remaining unvaccinated
and this is mainly due to the slackness of the vaccination staff.
The returns show that in several districts vaccinators did not
perform even the minimum number of operations prescribed,
viz., 2,000. It is of extreme importance that steps should be
taken in order to ensure that these men give a sufficient outturn
of work. The infliction of adequate punishment on vaccinators
for faulty work and recruitment of suitable men in place of
slack and unreliable persons must be resorted to by Civil
Surgeons and District Councils in such cases.
9. The Civil Surgeon, Nimar, remarks that the work
has suffered owing to shortage of staff, discontent among vacci-
nators owing to the appointment of an outside person to the
post of assistant superintendent of vaccination and forfeiture
of claims of senior men in the department.
10. Cases of opposition to vaccination in rural areas are
not less frequent and the introduction of compulsory vaccina-
tion is therefore advocated from time to time. The Civil
Surgeon, Damoh, reports that he tried his best to explain to
the people the benefits of vaccination at his visits to the
villages, held meetings of the leading and influential villagers
and gave lectures on vaccination and small-pox, but the people
still refuse to have their children vaccinated, chiefly the high
castes. The Civil Surgeon, Raipur, quotes a particularly
4
marked instance of the kind. He states that Rai Bahadur
D. N. Choudhri, O.B.E., reported that a few cases of small-
pox had occurred in a village belonging to him and on his
requisition the services of a vaccinator were placed at his disposal
so that he could arrange to get all the unprotected children in
the village vaccinated. But he was unable to persuade the
villagers and the vaccinator had to return without succeeding
in carrying out a single vaccination. It is reported by some
Civil Surgeons that for want of such a legislation vaccination
work in rural areas is getting very difficult and the vaccinators
are even refused food, and sometimes abused. At times
they have also met with violence, and their equipment has
been damaged as already reported in previous year's report ;
the Civil Surgeon, Bilaspur, reports that in Padampur circle
the local vaccinator was assulted in Jogni village while in the
discharge of duties.
11. In order to avert such a state of affairs and to
adequately carry on vaccination work in rural areas there is
a genuine need for the early introduction of compulsory
vaccination. In this connection it is pleasing to read
Mr. G. A. Khan's (Commissioner, Nerbudda Division) remarks
reproduced below with which I concur :—
"In my forwarding memo on the Berar reports for
1924-25 I urged the desirability of extending compulsory
vaccination to rural areas. I strongly adhere to this opinion.
Compulsory vaccination has been in force in Indian towns for
many years past, and I venture to think that its extension
to rural areas is overdue. The present position is indeed
anomolous when it is remembered that vaccination is more
readily acquiesced in by the unsophisticated villagers than
by townspeople. It is to be hoped that the necessary legis-
lation will be enacted without further delay. The marked
increase in the number of deaths from small-pox in 1924-25
as compared with the previous year (vide paragraph 18 of the
Director of Public Health's note on vaccination for 1924-25)
affords strong argument for prompt governmental action, for
no enlightened Government can, in my humble opinion, evade
moral responsibility for deaths from preventable diseases such
as small-pox."
12. Cooly allowance to vaccinators.—In Raipur
and Buldana districts it is reported that vaccinators have not
5
been provided with any allowance or a cooly for the transport
of their kit. It seems unfair that the District Councils should
refuse the allowance to their vaccinators on plea of funds
when this has been allowed in most of the other districts.
It is essential to authorize this allowance to the staff to enable
them to carry on the work efficiently and it is hoped that
these bodies will now see their way to sanction it at an early
date.
13. Re-vaccinations.—During the year 1925-26 the
number of re-vaccinations performed was 64,244 against 47,856
in 1924-25 and 42,787 in 1923-24. As compared with the
previous triennium the work shows a slight increase amounting
to 7,727. The Civil Surgeons, Raipur and Bilaspur, report
that the system of re-vaccination is not very popular in their
districts, while the Civil Sergeon, Nimar, remarks that re-vacci-
nation is very difficult but if the District Council members and
other public-spirited individuals are induced to help the
vaccination staff, this difficulty can easily be surmounted.
In order to prevent severe epidemics of small-pox re-vacci-
nation is necessary and it is therefore desirable that the Dis-
trict Council members should help the vaccination staff in
the matter so that re-vaccination may be pushed on as
vigorously as possible.
14. Dispensary vaccination and vaccination
by other agencies.—Statement III.—During the year
1925-26 the medical officer in charge of the Jail Hospital
at Nagpur performed 1,163 vaccinations, the medical sub-
ordinate in charge Cantonment Hospital, Pachmarhi, 1,170
and at the Akola Jail 429. The assistant medical officer
attached to the Telhara dispensary (Akola district) performed
87 operations (19 primary and 68 re-vaccinations) as owing
to the outbreak of small-pox in this town the assistant
medical officer was authorized to do the vaccination work.
The Railway staff in Nagpur, Chanda, Saugor and Raipur
performed 760 vaccinations, the Mining agencies, Chhindwara,
364 and the Tea District Labour Association Depôt, Raipur,
3,518.
15. Cost of the Department.—Statement II.—-The
total cost of vaccination incurred during the triennium under
review is Rs. 6,01,196-2-9 against Rs. 5,34,789-9-3 in the
preceding triennium. The increase in the expenditure is
6
chiefly due to the payment made to the vaccination staff at
the increased rate according to the time scale of pay and
also rewards to vaccinators and payment of coolie allowance.
The cost of each successful case was Re. 0-6-10 in 1923-24,
Rs. 0-6-11 in 1924-25 and Rs. 0-6-7 in1925-26. Excluding
the expenditure incurred in connection with the Vaccine
Institute, Nagpur, the cost per successful case stands at
Re. 0-5-8 in 1925-26 against Re. 0-6-0 in 1924-25 and
Re. 0-5-11 in 1923-24.
16. Supply of lymph.—Only glycerinated calf lymph
prepared at the Vaccine Institute was used. The supply was
reported to be satisfactory and the lymph good.
17. The reports on the working of the Vaccine Ins-
titute for 1923-24 and 1924-25 were incorporated in the notes-
for these years. The report for the year 1925-26 as sub-
mitted by the Superintendent of the Institute Major F. G. H.
Deeks, I.M.D., is reproduced below :—
" 229 bovine calves, five buffalo calves and two rabbits
were operated on during the year. Among the bovine calves
four failed and one was rejected owing to a poor result. The
average yield of pulp per calf was 31.70 grammes. This is
the best result since I have been in charge for the past
three years. The total yield of pulp was 7260.86 grammes
equivalent to 36,884 c.c. lymph or 737,680 doses. The
cost per dose of lymph manufactured was six pies, compared
with nine pies last year and seven pies the previous year.
"The whole province of 22 districts; the States of Rai-
garh, Sirguja and Bhopal; Military units in the district, Rail-
ways, Jails, the Labour Association of Central Provinces and
Berar, and the Military and Mission Hospitals were supplied
with lymph on indents. To vaccinators of the province
584,090 doses ; to States and others 57,325 doses ; making
a total of 641,415 doses. The balance of lymph on hand
on 31st March 1926 was 351,640 doses. Results of lymph ;
Primary vaccination, case success 99 per cent; insertion
success 91 per cent; re-vaccination case success 60 per cent;
insertion success 44 per cent. The figures compare favour-
ably with last year's results.
"The total expenditure incurred was Rs. 27,110-5-3 of
which Rs. 14,899-3-0 were spent on salaries and travelling
allowance; the remainder on contingencies. Total receipts
7
amounted to Rs. 22,751-3-6 made up as follows: Sale of
lymph Rs. 19,752-11-6; sale of calves Rs. 2,245-4-0; sale
of Rabbits Rs. 8; sale of tonga bulls Rs. 60; sale of
lancets Rs. 318-8-6 and miscellaneous Rs. 366-11-6. The
value of lymph in storage on 1st April 1926 was Rs. 10,989.
" There were two sessions as usual, April to September
and October to March, and the Assistant Superintendent
Mr. Maruty Ramkrishna conducted the Training Classes
under the supervision of the Superintendent. Ten masters, 16
vaccinators, three sanitary inspectors and one assistant
superintendent of vaccination went through the Training
course successfully."
18. Inspection of vaccination-Statement V.—
The inspection work performed by Civil Surgeons in 1923-24
and 1924-25 has already been commented on in the notes for
these years. In 1925-26, 7.64 per cent of the primary and
4.36 of the re-vaccinations were inspected against 7.82 and
5.81 in 1924-25 and 7.28 and 7.21, respectively, in 1923-24.
Some of the Civil Surgeons have devoted more time
to this important part of their duties—Balaghat 96 days,
Chhindwara 59 days, Drug 56 days, Narsinghpur 47 days,
Seoni 42 days and Chanda 41. In Nagpur and Jubbulpore
the Civil Surgeons could not as usual do much touring for
inspection purposes owing to work at headquarters. Simi-
larly in Raipur it is reported that pressure of work at head-
quarters prevented more inspection work being carried out.
In Hoshangabad no inspection was carried out in rural areas
and this is attributed to the transfers of Civil Surgeons. The
Saugor report shows that in 8 days as many as 200 villages
were inspected, giving an average of 25 villages per day,
which shows that children from distant villages must have
been collected. Inspections by Civil Surgeons should be
carried out as near the village as possible and hence the
system of collecting children from distant villages should be
avoided.
In several districts it is noticed that the prescribed
period of vaccination tour, viz., six weeks, was not maintained.
The need for more effective supervision of the work of
vaccinators has already been urged in previous years' reports
and it is therefore hoped that Civil Surgeons will see that
the rules allotting six weeks for vaccination touring will not be
overlooked in future.
8
19. The assistant superintendents of vaccination and
others such as the Assistants to Civil Surgeons, epidemic
dispensary assistant medical officers and sanitary inspectors
in municipal towns inspected 56.11 per cent of the primary and
29.90 of the re-vaccinations in 1925-26 and 55.29 and 23.45 in
1924-25 and 49.43 and 21.09 in 1923-24 as compared with
52.18 and 20.54 in 1922-23, 50.37 and 17.65 in 1921-22
and 49.77 and 24.88 in 1920-21. In some of the districts
the amount of touring done by the assistant superintendents
of vaccination during the year 1925-26 was insufficient, as
it was below the prescribed standard of 135 days in the
vaccination season. As remarked in the notes for the year
1924-25 the outturn of vaccination work depends mostly on
the amount of energy, tact and supervision displayed by the
assistant superintendents of vaccination and it is therefore
very necessary that these men should spend at least 135 days
in every season on inspection tours. The Civil Surgeons
should see that the orders laying down the above standard
are rigidly enforced and that those giving less outturn except
for sufficient reasons are suitably dealt with in future. The
Civil Surgeon, Betul, remarks that the assistant superin-
tendent of vaccination still stays at headquarters too long
where really he has very little to do. It seems that these
men spend much of the time at headquarters which should
not be permitted.
20. The assistant medical officers in charge of local
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
children vaccinated by the vaccinator.
21. Percentage of success in primary and re-
vaccination.—The percentage of success in primary vaccina-
tion recorded by vaccinators during the past three years
was 98.85, 98.82 and 98.24, while the assistant superin-
tendents of vaccination found on inspection 97.85, 95.05 and.
93.97 and Civil Surgeons 98.70, 98.41 and 96.96. These
figures seem satisfactory.
22. In re-vaccinations the percentage of success claimed
by vaccinators was 58.96, 57.49 and 55.80, while the assistant
Superintendents of vaccination found on inspection 49.53,
43.77 and 35.52 and Civil Surgeons 42.33, 52.02 and 55.14.
As usual these figures vary considerably.
9
23. Vaccination in municipal towns.—In 1925-26
the births registered in municipal towns and notified areas
were 53,740 and deaths among children under one year of
age were 12,373. Thus 41,367 remained alive and of this,
31,734 or 77 per cent were successfully vaccinated which
is less than the percentage vaccinated in 1924-25, viz. 88
In 1923-24 it was 76 per cent. The reason for the lower
percentage may be attributed to lack of supervision as in
the case of Jubbulpore where the Health Officer and his
assistants have only inspected 19 per cent of the total
vaccinations against the prescribed standard of 50 per cent,
and also to want of proper facilities for the vaccinators to
work. These two great defects generally exist in several
towns. On account of less work during the last year, the
balance of unprotected children has accumulated, but as the
continuance of such a large balance of unprotected children
is dangerous, the need for taking prompt action to get the
balance cleared off is urgently called for. At present small-
pox is already gaining ground in many places and it is feared
that the disease may assume endemic proportions. I hope
the Municipal Committees will take energetic action to work
off the balance of unprotected children as early as possible.
24. During the course of my inspection tours I found
that vaccination work was not satisfactory in several towns
and drew the attention of the Committees to the importance
of the matter; but apathy and indifference still prevail with
the result that the advice given is not often followed. The
Civil Surgeon, Akola, in particular, brings to notice that
scanty attention is paid by the Municipal Committees in the
district to his recommendations in regard to vaccination work
and they remain as apathetic as ever.
25. Deaths from small-pox.—Deaths from small-
pox numbered 2,938 against 1,911 in 1924-25 and 420 in
1923-24. Of the deaths recorded in 1925-26, about three-
fourths occurred in the Berar districts where the disease was
widespread and affected many towns and villages. The
increase in small-pox is due to the fact that year after year
a large number of children are left unvaccinated and this state
of affairs was anticipated by my predecessor two years ago
in the report for 1922-23. In order to check this preventable
waste of infant life, it is extremely important to secure as
complete vaccination as possible every year.