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NOTES
ON
VACCINATION
IN THE
UNITED PROVINCES OF AGRA AND OUDH
For the year ending March 31, 1928
BY
LIEUT.-COL. C. L. DUNN, C.I.E., D.P.H., I.M.S.
Director of Public Health
and
Superintendent-General
of
Vaccination,
United
Provinces
ALLAHABAD:
THE SUPERINTENDENT, GOVERNMENT PRESS, UNITED PROVINCES
1928
Errata Slip to the Notes on Vaccination in the United Provinces
of Agra and Oudh for the year ending March 31, 1928.
Page.
iii
„
v
xii
„
xiv
3A
„
4A
6A
For—
.5
7.68
1,579.93
31,905
13,093
1,225,964
small-pox
vaccinatinos
45
Mirzapur-
Bindahchal
Read —
.58
37.68
1,597.93
31,695
13,903
1,225,694
small-pox
vaccinations
452
Mirzapur-
Bindhachal
Remarks.
In column 19 against Bulandahahr.
In column 17 against Sitapur.
Under Summary in column " Persons vaccinated by each
vaccinator " against Total.
Under 1922-23 in column " Number successfully vaccin-
ated" against Government, Lucknow division, second
range.
Under 1922-23 in column " Number successfully vaccin-
ated " against Municipality, Lucknow division, second
range.
Under 1919-20 in column " Number successfully vaccin-
ated against Grand Total.
Under 1923-24 in the heading of the third column.
Under 1924-25 in the heading of the first column.
Under 1926-27 in column " Successful primary vaccin-
ations " against Total of dispensary staff.
In column 3 Municipality against Mirzapur.
NOTES ON VACCINATION IN THE UNITED PROVINCES
FOR THE YEAR 1927-28.
Area and popula-
tion.
According to census of 1921 the area of the province, excluding
the States of Rampur, Benares and Tehri-
Garhwal, was 107,167 square miles and the
population 45,375,787.
Charge of the depart-
ment.
2. I held charge of the office of the Superintendent-General of
Vaccination throughout the year.
Constitution
and
strength of the depart-
ment (Statement II).
3. As stated in paragraph 75 of the annual sanitary report for
1927, the III and IV Ranges were combined into
one range with headquarters at Allahabad with
effect from October 1, 1927, from which date the
post of the Assistant Director of Public Health (Hygiene Publicity
Bureau) was created. The following officers were in charge of the
several ranges during the year under report: —
I RANGE.
Rai Bahadur Dr. K. L. Chaudhri throughout the year.
II RANGE.
Lieutenant-Colonel W. A. Mearns, I.M.S., from January 1 to
March 9, and again from November 7 to the close of the year.
Captain (now Major) D. Clyde, I.M.S., from March 10 to Novem-
ber 6.
III RANGE.
Dr. A. Sousa from January 1 to September 30. On the amalga-
mation of this range with the IV Range with effect from October 1,
1927, Dr. K. P. Mathur was placed in charge of the amalgamated
range, which charge he held till the close of the year.
IV RANGE.
Dr. K. P. Mathur from January 1 to September 30, 1927, after
which date, as stated above, the IV Range was amalgamated with the
III Range.
The number of assistant superintendents of vaccination (49) re-
mained unaltered, but that of vaccinators increased from 898 in 1926-
27 to 917 during the year under report.
The District Health Service having been further extended to all
the districts of the Lucknow division and to the districts of Muttra,
Muzaffarnagar and Fatehpur during the year under review, the dis-
trict medical officers of health of these districts are now the superin-
tendents of vaccination in those districts instead of the civil surgeons.
The total number of such districts is now 26.
( 2 )
Expenditure on vac-
cination
(Statement
II).
4. There was a decrease of Rs. 18,388 in the total expenditure
in 1927-28, including the charges on account of
the assistant directors of public health and
their establishment and of Rs. 8,775 excluding
these charges as compared with 1926-27, the
total amounts spent during the two years being Rs. 4,71,005 and
Rs. 4,89,393 and Rs. 4,06,950 and Rs. 4,15,725, respectively. The dec-
rease is attributable to (1) the abolition of the IV Range, (2) the dec-
reased expenditure under the Government Bovine Lymph Dépôt,
Patwa Dangar, and (3) the fact that the Assistant Director of Public
Health, II Range, was on leave ex-India for eight months.
Average cost of each
successful case of vac-
cination
(Statement
II).
5.
The average cost of each successful case of vaccination in these
provinces during the year under report was
practically the same as in the preceding year.
The figures for the two years were annas four
and pies four and annas four and pies six, res-
pectively. The following table shows the average cost of each suc-
cessful case of vaccination in these provinces during the year under
report as compared with other provinces :—
Province.
United Provinces .. .. .. .. .. ..
Bihar and Orissa .. .. .. .. .. ..
North-West Frontier Province .. .. .. ..
Delhi .. .. .. .. .. ..
Assam
..
..
..
..
..
Bengal .. .. .. .. ..
Punjab .. .. .. ..
Burma .. .. .. ..
Central Provinces .. .. .. ..
Madras .. .. .. .. ..
Bombay .. .. .. ..
Cost of each
successful case
of vaccination
during
1927-28.
Rs.
0
0
0
0
0
a.
4
2
2
5
3
p.
4
3
3
4
3†
*
0
0
0
0
1
5
11 7
6
0
1†
1
3
8
10†
* Information not received.
† These figures are for 1926-27 as those for 1927-23 have not; yet been received.
General operations
(Statement I).
6. During the year under report 1,465,647 persons were vacci-
nated [1,465,306 by the special (district staff)
and 341 by the dispensary staff] as against
1,433,056 in the preceding year, exhibiting an
increase of 32,591. The number of vaccination operations performed
in 1927-28 also indicated an increase of 42,398 as compared with
1926-27, the actual figures for the two years being 1,492,442 (1,381,974
primary and 110,468 re-vaccinations) and 1,450,044 (1,304,844 pri-
mary and 145,200 re-vaccinations). This is satisfactory. The num-
ber of secondary operations in 1927-28 was 26,795 against 16,988 in
1926-27. The number and percentage of successful primary vaccina-
tions in which the results were known in 1927-28 were, respectively,
1,282,505 and 94.14 as against 1,219,979 and 94.79 in 1926-27. In
the case of re-vaccinations they were 54,222 and 54.32 as compared
with 70,621 and 53.83, respectively.
( 3 )
During the year each vaccinator vaccinated on an average 1,597.93
persons as against 1,615.89 in the preceding year. The ratio of per-
sons successfully vaccinated by the district staff was 29.45 per mille
of the population as compared with 28.44 in 1926-27.
Successful primary
vaccinations in differ-
ent districts (State-
ment I).
7. Like last year, in 31 out of 48 districts the number of success-
ful primary vaccinations performed in 1927-28
was in excess of that performed in the preceding
year. Of these Gorakhpur stood first with an
increase of 30,435 and was followed by Benares
(3,744), Kheri (3,229), Rae Bareli (2,751), Azamgarh (2,475) and
Muttra (2,442). In all these districts the district medical officers
of health were in charge of vaccination instead of civil surgeons. Of
the 17 districts showing a decrease, the most conspicuous were Bijnor
(1,844), Shahjahanpur (1,046), Garhwal (790), Fyzabad (665) and
Pilibhit (611).
The causes of decrease in these districts are reported to be :—
Bijnor, Fyzabad and Pilibhit. -Prevalence of plague.
Shahjahanpur.—Prevalence
of small-pox, performance of a larger
number of vaccinations in the Army Clothing Factory during the
previous year and slackness on the part of certain vaccinators who have
been suitably dealt with.
Garhwal.—Prevalence
of scabies and measles in certain parts of the
district.
Successful vaccina-
tion and degree of
protection
afforded
(Statement I).
8. During the year under review the number of persons successfully
vaccinated per mille of the population was 29.46
against 28.44 in the preceding year. Among the
best protected districts Garhwal and Almora
retained their positions of the last year as first
and second on the list with ratios of 56.13 and 47.22, respectively.
Then in order came Hamirpur with 44.59, Mirzapur with 39.98 and
Saharanpur with 38.70. The districts showing the least protection were
Bara Banki (20.98), Mainpuri (21.01), Rae Bareli (21.70), Allahabad
(23.07) and Gonda (23.42). The second and third show a slight im-
provement over last year, while the fourth and fifth a further decline.
The first remained stationary. The decrease in Allahabad is stated to
be due to the slackness on the part of certain vaccinators, while in
Gonda it is ascribed to the prevalence of plague.
Vaccination in pro-
portion to births and
according to age.
9 In 1927-28 the percentages of successful vaccination operations
in proportion to births showed a general, though
slight, decrease as compared with the preceding
year, the ratios for the two years being 51.63
and 52.28 in the case of children under one year of age, 21.57 and 22.20
in the case of those between one and six years of age and 76.96 and
78.60 for all ages, respectively.
Taking the figures by ranges, 58.78 children under one year were
successfully vaccinated per 100 births in the first range during the
year under review as against 62.68 in the preceding year. These
figures for the second and third ranges were, respectively, 43.59 and
50.48 in 1927-28 against 43.70 and 48.56 in 1926-27. Like last year,
the first range showed the best protection in comparison to other
ranges.
( 4 )
Mortality from small-
pox.
10. The number of deaths from small-pox registered during 1927
was 7,894 against 12,020 of the previous year.
The death rates for the two years were .17 and
.26, respectively, and the average for the past five
years .11.
Diagram.
11. A diagram showing the relation between the mortality from
small-pox and the protection afforded by vaccina-
tion in each district is attached.
Dispensary vaccina-
tion (Statement III).
12. The total number of vaccination operations performed by
medical subordinates at dispensaries during 1927-
28 was 341 (193 primary and 148 re-vaccinations)
against 1,373 (552 primary and 821 re-vaccina-
tions) in 1926-27.
Vaccination in muni-
cipalities.
13. The vaccination work performed in municipalities during the
year under review shows a decrease as compared
with that of the preceding year, the total number
of persons vaccinated during the two years being
125,722 and 141,801, respectively. The total number of vaccination
operations performed in municipal towns in 1927-28 was 133,265
(110,975 primary and 22,290 re-vaccinations) and that in 1926-27 145,100
(110,006 primary and 35,094 re-vaccinations). The ratio of persons
successfully vaccinated per mille of the population was 36.78 against
38.14 in the preceding year. This decline in work is due to the spread
of plague during the vaccination season. It is also due to the fact that
in 1926-27, owing to the prevalence of small-pox, a larger number of
vaccination operations was performed.
Among the well protected municipalities Mussoorie occupied the
first position with a ratio of 174.86 per mille and was followed by
Sitapur, Etah, Sultanpur and Gonda with ratios of 92.99, 72.10, 68.39
and 61.31, respectively.
Among those showing the least protection, Kashipur, Naini Tal,
Brindaban, Farrukhabad and Kanauj were the worst showing ratios of
21.56, 22.97, 25.15, 25.24 and 25.36, respectively.
In Kashipur the decrease was due to the fact that most of the people
left Kashipur on account of plague, while in Naini Tal owing to an out-
break of small-pox in 1926-27 more persons were vaccinated than in
1927-28.
Brindaban, Farrukhabad and Kanauj show an improvement over last
year.
The number of successful vaccinations performed on children under
the age of one year in the municipalities, during the year under report,
was 77,862 (vide Appendix B) as against 74,981 in 1926-27, indicating
an increase of 2,881.
Vaccination in can-
tonments.
14. During the year under report 11,783 persons were vaccinated
and 12,195 operations (6,446 primary and 5,749
re-vaccinations) were performed by the vaccination
staff in cantonments against 17,376 and 17,404,
respectively, in the preceding year. The numbers of successful primary
vaccinations and successful re-vaccinations for the two years were 5,645
and 3,206 and 5,452 and 6,599, respectively. The number of persons
( 5 )
successfully vaccinated per mille of the population was 44.25 in 1927-28
and 60.25 in 1926-27.
During the calendar year 1927, the military medical officers in
cantonments performed 1,171 primary vaccinations and 11,891 re-
vaccinations, of which 1,055 and 8,469, respectively, were successful.
Vaccination in noti-
fied areas.
15. The number of persons vaccinated in notified areas during the
year under report was 14,752 as compared with
13,583 in 1926-27. Vaccination operations num-
bered 15,282 against 13,806. The total number
of successful primary vaccinations amounted to 12,772 and that of
successful re-vaccinations to 389 as against 11,234 and 788, respectively,
in the preceding year. The number of persons successfully vaccinated
per 1,000 of the population was 35.20 in 1927-28 and 34.45 in 1926-27.
Among the well protected areas, Chunar settlement stood first with a
ratio of 91.84, followed by Gorakhpur, Bhimtal, Bhinga and Rath with
the respective ratios of 83.21, 58.63, 57.34 and 48.76. Among those
showing the least protection were Rikhikesh, Bhowali, Ramnagar,
Bilgram and Auraiya, each giving a ratio of 10.18, 19.19, 20.00, 21.84
and 21.79, respectively. Ramnagar, Auraiya and Bilgram show an
improvement over last year. In Rikhikesh the decrease is ascribed
to the fact that less lymph was indented for on account of the Kumbh
fair. This explanation is unsatisfactory and the president, notified
area committee, is being addressed on the subject. In Bhowali the
decrease is negligible.
Vaccination
of
school children.
16. The public health staff visited as many as 3,054 schools for the
inspection of the vaccination state of school chil-
dren. They found a large number of scholars un-
vaccinated. Many of these were got vaccinated
by the officers in their presence. The total number of vaccinations
carried out in schools as reported by the district medical officers of
health and civil surgeons was 28,187.
The assistant directors of public health also conducted similar
inspections in the course of their tours.
Although vaccination is compulsory in municipal areas, a fairly
large percentage of the scholars escape vaccination. The attempts of
the medical officers of health to vaccinate these are hampered in
certain cases by the school masters themselves. A particular instance
was brought to the notice of the Director of Public Instruction, United
Provinces, who kindly issued instructions to the educational authori-
ties for extending the necessary facilities to medical officers of health.
Application of the
Vaccination Act.
17. Up to the end of March, 1928 the Vaccination Act was in
force in all municipalities, cantonments and noti-
fied areas, except in the notified areas of Jalaun,
Bindki (Fatehpur district) and Hasanpur (Mora-
dabad district), which were newly created during the year. The
question of the extension of the provisions of the Act to these areas is
under the consideration of the local authorities concerned. The pro-
visions of the Act were extended to the notified areas of Rikhikesh in
the Dehra Dun district and Ganjdundwara in the Etah district and to
the Basti town area, during the year under report.
( 6 )
Compulsory vaccina-
tion in rural areas.
18. The necessity of making vaccination compulsory in rural areas
is increasingly felt every year and nearly all the
district medical officers of health have commented
on the opposition to vaccination in rural areas
offered by the high caste people. In spite of persuasion and propa-
ganda carried on in the villages, the number of children which escape
vaccination is very considerable, being in some districts as much as
33 per cent. of the children available. The danger of an epidemic of
small-pox under such conditions can be well understood. In more
than one case vaccinators were roughly handled by the villagers in
their attempts to vaccinate the recalcitrants.
Vaccination on a voluntary basis has now been in existence for a
very long time and the ground has been well prepared for the intro-
duction of compulsion. It is gratifying to note that the Government
are considering the making of the Vaccination Act compulsory in rural
areas. A number of children escapes vaccination in municipal towns
owing to defect in section 9 of the Vaccination Act which lays down
that girls up to 8 years of age and boys up to 14 years of age only
should be vaccinated. I hope Government will accept my recommen-
dation to remove this defect by making necessary amendments when
the present Act is amended.
General results of
inspection (Statement
V).
19. (a) By assistant
directors
of public health and
district
superintendents
of vaccination.—214,466
vacci-
nation operations (207,436 primary and 7,030
re-vaccinations) were inspected by the assistant
directors of public health and district superintendents of vaccination
during the year under report against 179,223 (174,337 primary and
4,886 re-vaccinations) in the preceding year, showing a satisfactory
increase of 35,243.
The districts showing the largest number of inspections were Par-
tabgarh (11,416), Jaunpur (10,579), Azamgarh (10,226), Sultanpur
(10,108) and Gonda (9,079). Among the districts showing the lowest
number of inspections, the most conspicuous were Etah (nil), Shahja-
hanpur (122), Naini Tal (267), Saharanpur (278), Garhwal (809) and
Bijnor (852). Partabgarh, Gonda, Shahjahanpur, Garhwal and Bijnor
show an increase over the previous year's figures, while Jaunpur,
Azamgarh, Sultanpur, Naini Tal and Saharanpur show a decrease.
The percentages of these inspections to the total number of vaccina-
tion operations performed was 15.31 in the case of primary and 6.38
in the case of re-vaccinations, against 13.54 and 3.39, respectively, in
the preceding year.
(b) By assistant superintendents
of vaccination
and other inspect-
ing officers. — 606,447 operations (567,507 primary and 38,940 re-
vaccinations) were inspected by assistant superintendents of vacci-
nation and other inspecting officers during the year against 603,884
(558,312 primary and 45,572 re-vaccinations) during the preceding
year, indicating an increase of 2,563. These inspections were 41.88
and 35.01 per cent. of the total number of primary operations and
re-vaccinations performed as compared with 43.36 and 31.60, respec-
tively, in 1926-27.
( 8 )
on fee. Of the 318 calves used only one failed, while 20 died after
operation. The deaths amongst the calves were low because of the
precautionary measures taken to check the spread of the disease and
the better class of the animals supplied by the contractor. Out of the
298 calves which survived after vaccination, 248 calves were sold and
50 were returned to their owner.
The total quantity of crude lymph obtained from the 317 calves
successfully vaccinated was 16,371½ grammes giving an average yield
of 51.45 grammes per calf. In the preceding year 19,024 grammes of
crude lymph were obtained from 452 calves with an average yield of
42.09 grammes. The increase in the yield in the year under report
was therefore 9.36 grammes per calf. The average yield of crude
lymph per cow calf and buffalo calf, separately, was 19.50 grammes
and 62.40 grammes, respectively, against 21.96 grammes and 47.98
grammes, respectively, in the preceding year.
47,587 ½ grammes of glycerinated lymph of the strength of 1—3
were manufactured, including 1,527 grammes of glycerine paste. The
total quantity of lymph manufactured for issue was 119,334.2 grammes
of strength varying from 1—5 to 1—7 and 1,629½ grammes of glyce-
rine paste, against 85,301 grammes of glycerine lymph and 3,528
grammes of glycerine paste manufactured for issue in the preceding
year.
(c) Issue of lymph. —The total quantity of lymph issued for vacci-
nation during the year was 113,851¾ grammes in metal collapsible
tubes and 136,259 capillary tubes and 15½ grammes of glycerine paste
sufficient to vaccinate 2,982,943 persons, against 106,693 grammes in
metal collapsible tubes and 145,087 capillary tubes and 263 grammes
of glycerine paste issued in the preceding year sufficient to vaccinate
2,693,987 persons.
Out of the above quantity 141¼ grammes in metal collapsible tubes
and 186 glass capillary tubes of the total value of Rs. 87 were issued
free for use in jails, police and charitable institutions. In the
preceding year the value of the lymph so supplied was Rs. 104.
The following supplies were made from the dépôt to the other
vaccine dépôts in India :—
(i) Vaccine dépôt, Bengal—11,264 grammes of lymph to the
value of Rs. 5,004.
(ii) Vaccine Institute, Belgaum —10 grammes paste to the value
of Rs. 20.
(iii) Technical Vaccine Institute, Lahore—20 grammes of lymph
to the value of Rs. 11.
Glycerine paste is mostly issued for vaccinating calves to obtain seed
lymph and hence the issue is less.
(d) Lymph set aside in the cold storage plant.—16,621.2 grammes
of glycerinated lymph of the strength of 1—3 and 963.5 grammes
of glycerine paste have been set aside for issue in 1928-29 against
28,956 grammes of glycerine lymph of strength varying from 1—3 to
1 — 5 and 111 grammes of glycerine paste set aside last year, which
were issued during the year under report. The reduction is explained
in (b) above.
(e) Results of vaccination with the lymph issued.—The total num-
ber of vaccinations performed with calf lymph amounted to 1,492,101