2
crease was due as usual to grade promotion in the vaccination staff,
travelling allowances and contingencies in consequence of the deputation
of vaccinators to combat epidemic diseases other than small-pox and to
attend classes for training at the Punjab Vaccine Institute, Lahore ; enter-
tainment of extra vaccinators, grain compensation, war and temporary allowances.
The total cost of the department for the triennium under review was
Rs. 4,35,589 as compared with Rs. 4,31,084 in the preceding triennial period.
Cost of each suc-
cessful case.
Statement No. II.
5. The cost per successful operation was Re. 0-3-5 against Re. 0-2-10
and Re. 0-3-0 in the years 1918-19 and 1917-18, respectively. The increase in
the cost is due to the reasons given in the preceding paragraph. The average
cost of each successful case, viz., Re. 0-3-1 during the triennial period under
report remained nearly the same as in the preceding period. If the sum of
Rs. 38,058 which has been received and credited to Government on account of
cost of vaccine sold be deducted from the total cost the average cost works out
Re. 0-2-7 for the year 1919-20 as compared with Re. 0-2-1 and Re. 0-2-5 in
the years 1918-19 and 1917-18, respectively. On this basis the average cost
in the triennium is Re. 0-2-4.
Total operations
done by all establish-
ments.
Statement No. I.
6. The total number of operations performed by all establishments
during the year amounted to 928,822 showing a decrease of 65,771
compared with the previous year. The total operations during the triennium
under review numbered 2,727,644 as against 2,600,325 in the previous triennium,
the annual averages being 909,215 and 866,775, respectively. Primary vaccina-
tions numbered 1,792,855 or 252,980 less than in the preceding triennium,
while revaccinations numbered 934,789 showing an increase of 380,299. The de-
crease in primary vaccination in 1917-18 and 1918-19 as already reported was due
to fewer infants being available for vaccination in consequence of the high in-
fantile mortality that occurred during the wide spread epidemic of malaria in
the autumn of 1917 and to the prevalence of influenza in 1918. During the
year under report there was an increase in primary vacciation and a decrease
in re-vaccination as compared with the figures for the previous year. The
increase in primary vaccination is due to the employment of extra vaccinators
in some districts and to the special efforts made to prevent the spread of
small-pox in accordance with the instructions issued by me to all Civil Sur-
geons and Health Officers in the Punjab.
In explanation of the decrease in re-vaccination it is generally put for-
ward that last year almost all school children were revaccinated. There can be
little doubt however that the deficit is in no small measure due to lack of
sustained effort.
The Medical Department is notoriously overworked at
present and the systematic appointment of District Health Officers responsi-
ble for vaccination operations will relieve the situation.
House to house
vaccination.
7. A total of 25,636 operations was attained during 1919-20 under
the house to house system in 9 districts, viz., Hissar (3,596), Karnal (6,115), Simla,
Municipality (2,147), Ferozepore (2,137), Lahore Municipality (6,000), Shahpur
(2,197), Montgomery (608), Jhang (2,120) and Muzaffargarh (716). In the
Gujranwala District house to house vaccination was performed in the towns of
Gujranwala and Akalgarh.
District Staff.
Statement No, I.
8. In the triennial period under report the number of operations
performed by the district staff amounted to 2,504,157 as against 2,420,746
during the previous triennium. Of the total number of operations 1,688,642
were primary and 815,515 re-vaccinations, showing a decrease of 250,501 in
the former and an increase of 333,912 in the latter as compared with the
triennial period 1914—1917. Compared with the outturn of work in the
triennium 1914—1917 there was a decrease of primary vaccination in all the
districts in the province except Simla and Rawalpindi. The decrease was most
marked in the districts of Lahore (25,703), Gujranwala (23,984) and Gurgaon
(20,495) while an increase of re vaccination was recorded in all the districts
except Gurgaon, Hoshiarpur and Jullundur. The increase was most marked
in the districts of Kangra (60,104), Dera Ghazi Khan (37,468), Karnal (30,113),
Amritsar (29,773) and Lahore (24,463). The diminution in primary vaccina-
tion is due to the smaller number of children available for vaccination in
1917-18 and 1918-19 while the increase in re-vaccination is due to the threat of
outbreaks of small-pox. Compared with the previous year there was an increase
of 38,276 in primary and a decrease of 77,656 in re-vaccination, the reasons for