3
But the graph also shows not only that smallpox is still a cause of
considerable mortality, but it demonstrates that from the year 1880 up to the
year 1921 no marked reduction in the incidence of the disease has taken
place. The precise effect of vaccination in reducing the smallpox mortality
can be appraised by comparing the average annual smallpox mortality
during the
last five years (1910 to 1923)
(334 per million)
with the corresponding figure (1,388 per million) for the quinquennium
immediately preceding the year 1880. It is, however, clear, since 77 per
cent, of the total
mortality
during
the period 1919
to
1923
occurred in children under ten years of age, that smallpox still takes a
large toll amongst infants and young children. It is of interest to note that
in England the corresponding figure, which in the quinquennium before the
passing of the first Vaccination Act was 85.8 per cent., has now declined to 36
per cent. In order to obtain precise evidence regarding the incidence of
smallpox amongst children it was arranged that the number of children
showing obvious pitting of the face as the result of smallpox should be
recorded at the time of taking the spleen census of school children in June
1924. As the result of this procedure 15,976 children attending some 500 schools
located in all districts of the Province (save Simla, Sheikhupura, Shahpur,
Lyalipur, where the instructions were either not understood or not carried out)
were examined with the result that no less than 7.2 per cent. of these children
were found to exhibit evidence of a previous attack of smallpox. The actual
number of children examined in each district together with the " pock-rate " is
shown in Table I from a scrutiny of which it will be seen that the percentage
of children showing evidence of a previous attack of smallpox: varied from as
high as 17.4 in Ludhiana district to 3.2 in Kangra district.
TABLE I.
The " pock-rate " of school children between 6 —10 years of age.
District.
Hissar ... ... ...
Rohtak ... ... ...
Gurgaon ... ... ...
Karnal ... ... ...
Ambala ... ... ...
Simla ... ... ...
Kangra ... ... ...
Hoshiarpur ... ... ...
Jullundur ... ... ...
Ludhiana ... ... ...
Ferozepore ... ... ...
Lahore ... ... ...
Amritsar ... ... ...
Gurdaspur ... ... ...
Sialkot ... ... ...
Gujranwala ... ... ...
Sheikhupura ... ... ...
Gujrat ... ... ...
Shahpur ... ... ...
Jhelum ... ... ...
Rawalpindi ... ... ...
Attock ... ... ...
Mianwali ... ... ...
Montgomery ... ... ...
Lyallpur ... ... ...
Jhang ... ... ...
Multan ... ... ...
Muzaffargarh ... ... ...
Dera Ghazi Khan ... ...
Total ...
No. of
children
examined.
744
886
1,147
1,640
966
...
666
3,171
2,967
1,968
1,483
7,302
3,630
l,700
3,000
2,681
...
1,326
...
885
2,080
851
356
1,189
...
1,376
1,771
802
1,389
45,976
Children
pock-
marked.
63
135
89
254
72
...
21
252
177
113
139
409
319
104
120
319
...
64
...
70
97
54
22
138
...
65
91
46
63
3,296
Pock-rate.
8.5
15.2
7.8
15.5
7.5
...
3.2
8.0
6.0
17.4
9.4
5.6
8.8
6.1
4.0
11.9
...
4.8
...
7.9
4.7
6.4
6.2
11.6
...
4.7
5.1
5.7
4.5
7.2
When it is recollected that the " pock-rate " takes no account of those
dying from smallpox or of those in whom a mild attack of the disease has left