6
states that " although bye-laws have been framed and sanctioned by Govern-
ment, they are a dead letter. According to these bye-laws there ought to be
three Vaccinators and three vaccination stations, whereas there was only one
for the whole area with a population of 60,000." In Amritsar City there
were no vaccination stations at the time of my inspection and in Ferozepore
City the single vaccination station was located at an octroi post. In
Multan City the arrangements for vaccination are much more efficient.
In Amritsar City and also in Lahore City, where small-pox has for some
time been present in epidemic form, it is the exception rather than the
rule for small-pox cases to be notified to the Medical Officer of Health
and, owing perhaps to the difficulty of enforcing it, the powers conferred
by Section 141 of the Municipal Act are rarely utilized. Small-pox is
the most easily eliminated of all diseases and it is hoped that by means
of more vigorous efforts reinforced by propaganda Municipal Committees
will assist the Public Health Department to eradicate this disease to a greater
extent than in the past. There is also reason to believe that the number of
reported deaths from small-pox considerably under-state the true mortality
occasioned by this disease, whilst for reasons already stated, no reliable
statistics in regard to its incidence can be given. These facts are being
brought to the notice of all concerned and special attention will be devoted to
the inspection of the vaccination arrangements in Municipal Towns during
next cold weather.
Inoculation.
14. The old practice of inoculation has not completely died out in the
Punjab. The District Medical Officer of Health of Kangra reports some cases
of inoculation in the Dehra and Palampur Tahsils of Kangra District. Some
people were inoculated by a barber in Mahadev village and inoculation was
also practiced round about Khaira in Palampur Tahsil.
The exact number of operations in the latter case is not known. In
Mahadev a child of three years of age developed a fatal attack of small-pox
as the result of inoculation. In the case of three other persons a severe type of
small-pox also occurred as the result of inoculation. A report was made to the
Deputy Commissioner and a proclamation was issued warning people that
inoculation was dangerous to life and should not be resorted to.
Diagram.
15. A diagram showing the death-rate from small-pox per 1,000 of
population during the year 1923-24, the average recorded death-rate from
small-pox for the five years ending 1922-23, the proportion of successful vacci-
nations in 1923-24, and for the preceding six years per 10,000 of population in
each district of the Province is attached to this report.
A scrutiny of this diagram serves to emphasise the fact that the districts
with a low vaccination index during the past five years correspond precisely
with the districts exhibiting a high small-pox death-rate during the year under
review. The inference to be drawn from this fact is that the prevalence of
small-pox epidemics is mainly dependent upon persistent efforts from year to
year to increase the number of the protected population. It is to action on
these lines rather than to spasmodic efforts to carry out vaccination during the
time of epidemics that the reduction in small-pox mortality must be looked
for.
Vaccination
in
large Punjab States,
16. The reports received from those Punjab States which entertain
their own vaccination establishments show that in Patiala 44,502 primary and
21,335 re-vaccinations were performed during the year under review. The
corresponding figures for Bahawalpur State were 15,863 primary and 55
re-vaccinations, Faridkot report 5,046 primary and 986 re-vaccinations,
Kapurthala 2,949 primary and 818 re-vaccinations whilst in Jind and Nabha
8,793 and 322 primary vaccinations were carried out.
The above figures indicate a slight increase in the number of vaccina-
tions in the States of Kapurthala, Jind, Bahawalpur and Nabha. The per-
centage of succcss in primary cases was 93.85 in Faridkot, 98.85 in Patiala,
96.61 in Kapurthala, 95.63 in Jind, 99.65 in Bahawalpur and 80.85 in Nabha.
In Patiala, Kapurthala, Faridkot and Bahawalpur the percentage of successful
re-vaccinations was 77.27, 41.56, 30.42 and 94.00 respectively.