3
slightly irregular periodic variation in the epidemic prevalence of small-pox
and it is probable that we have just passed through the period of least preva-
lence, and are entering upon a period of increasing epidemic prevalence;
I consider it likely that the prevalence of small-pox will increase materially
during the next two or three years and that there is likely to be a severe-
epidemic of small-pox in the province in 1926 or 1927.
The provincial ratios of the mortality from small-pox per thousand of
population during the last five years have been .53, .56, .14, .07 and .11.
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 wellknown in fact it is an admitted axiom—that thorough vaccina-
tion can and does stamp out small-pox altogether, and in the light of that
knowledge, and in face of the above facts, there is great necessity for a more
definite 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 gene-
rally enforced ; that vaccination should be free ; and that the supervision and
control of vaccination should be delegated to District Boards and Municipalities
and their Health Officers.
9. Inspection of work.—During the year under report the Assistant Direc-
tors of Public Health inspected 71,814 primary vaccinations as against 70,006
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 40,985 primary and 4,686
re-vaccination operations against 29,181 primary and 9,303 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
therefore 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. Five millions, three hundred and fifty-seven thousand and
twenty five doses of vaccine were manufactured during the year as
compared with 1,426,146 doses last year. The number of doses issued was
2,564,754 against 2,576,743 in 1922-23. The number of doses in stock at the
end of the year was 5,590,353. The number of cattle used during the year was
792 as compared with 246 in the previous year, and the average yield of crude
vaccine was over 63 grammes per animal as compared with 59 grammes in the
previous year. The working cost of the depôt for the year amounted to
Rs. 25,545 as compared with Rs. 33,206 in the previous year. The average
cost of the vaccine per dose works out at .91 pies on the gross expenditure and
to. 34 pies on the nett expenditure, when the receipts are taken into account.
11. Vaccine Depôt and Cold Storage.—During the year under report the
vaccine depôt suffered less than usual from epidemic diseases although there
was one slight epidemic of Foot and Mouth disease. Owing to the difficulty in
getting a sufficient supply of calves at reasonable rates Dr. Tiwari has tried
using adult animals with results which have so far been satisfactory. The
adult animals are cheaper and more robust, and they gave a large quantity of