4
no permanent evidence of its occurrence it is clear that smallpox is widely pre-
valent amongst infants and young children. In these circumstances it is
pertinent to consider the number of primary vaccinations carried out in this
province during recent years. From a scrutiny of Statement IV it will be seen
that in a population of approximately 20 millions with an average birth-rate of
40 per mille (800,000 births per annum) about 500,000 successful primary
vaccinations were carried out annually during the period 1867 to 1913 in-
clusive, whilst during the period from 1914 to 1925 the figures were as fol-
lows :—
1913-14 ... ... ...
1914-15 ... ... ... ...
1915-16 ... ... ... ...
1916-17 ... ... ... ...
1917-18 ... ... ... ...
1918-19 ... ... ... ...
1919-20 ... ... ... ...
1920-21 ... ... ... ...
1921-22 ... ... ... ...
1922-23 ... ... ... ...
1923-24 ... ... ... ...
1924-25 ... ... ... ...
628,010
623,683
614,376
634,005
580,865
532,930
563,995
594,447
576,358
588,386
622,986
621,962
These figures show that the annual number of primary vaccinations
during the past twelve years is equal to approximately 75 per cent. of the
total number of children born each year, but they also show that not only has
no increase in the number of primary vaccinations taken place during the past
twelve years but they indicate that the number of primary vaccinations per-
formed during the past two years is somewhat smaller than the corresponding
figure for the first two years of the duodecennial period. An even more dis-
quieting feature brought out by the figures is the decline in vaccination
during the period from 1918—1923. This decline, which it may be observed
was most marked during the year 1918-19, is of course mainly attributable to
the grave disturbances that took place during the spring of 1919 and to the
non-co-operation movement during the three succeeding years. It is satisfac-
tory to be able to state that the vaccination figures have now almost reached
their pre-war level but it is also necessary to recognise that, as the result of the
political unrest during the years 1918 to 1923, some 200,000 children who
would otherwise have been vaccinated have been added to the unprotected
section of the community.
To summarise the result of this brief retrospect regarding smallpox and
vaccination in the Punjab it must be stated that it shows, in the first place,
that smallpox is far more prevalent amongst children than has hitherto been
recognised ; secondly, that a decline rather than an increase in primary vacci-
nations took place during the five years immediately following the war ; and
finally that, as the result of political troubles during the years 1918—1923, the
susceptibility of the population to smallpox is at the present time abnormally
high.
5. In the light of these considerations it was decided that a special
effort should be made during the year under review to increase the
efficiency and thoroughness of vaccination operations. With this object in
view all Municipal Committees and Notified Area Committees who had not
already adopted the Vaccination Act were urged to do so. The special atten-
tion of Municipal Committees was drawn to the need of improving vaccination
in Municipal towns where not only is the smallpox death-rate normally one
and a half times greater than in rural areas but where the arrangements for
vaccination are often markedly defective. In order to enable close supervision
to be maintained over the progress of vaccination in Municipal towns it was
arranged that separate vaccination returns should be submitted from each
Municipal town and that these figures should be shown separately in State-
ment No. I.
In the case of rural areas each District Health Officer was required at
the commencement of the vaccination season to draw up a programme of
operations and to maintain a vaccination register in which should be entered
the state of vaccination in each village. In the case of small Municipal towns
and in Small Towns, in many of which vaccination is carried out by vaccina-