VACCINATION REPORT.
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24. Human lymph has been used in the following districts to the extent shown
after each :—Gódávari (31,927), Nellore (15,686), * Salem (10,004), Vizagapatam
Hill tracts (7,053), Kistna (5,083), Ganjám Hill tracts (4,227), * Ganjám (4,100),
* Malabar (3,354). In those districts marked with an asterisk the practice has been
stopped during the latter part of the year, and arrangements are being made in the
others for the early introduction of central depôts for the supply of animal lymph
to all their vaccinators.
25. During the year 20,579 deaths from small-pox have been registered, or
6,224 less than last year. Of these cases 7,972 or more than one-third occurred
in Malabar. Of 2,824 school children examined by me, 456 or 16.1 per cent. were
unprotected, and 527 or 18.7 per cent. bore marks of small-pox, showing that much
yet remains to be done before the full benefits of vaccination can be secured for
the people.
In accordance with G.O., dated 6th July 1893, No. 523, Public, the
attached diagrams have been prepared to show the effects of protection on the
death-rates from small-pox in each district and municipality. The total population
protected during the last ten years is indicated by the thick black lines, and
the average death-rate for the same period by shaded lines. In the diagram refer-
ring to districts, it will be noted how, towards the right-hand side, the lines tend
to approach one another; the apparent exceptions of Vizagapatam and Ganjám
being explicable when it is remembered that vaccination returns are received
from the Hill tracts of these districts and yet no registration is maintained there,
so that the number of deaths from small-pox is unknown. In the diagram refer-
ring to municipalities one fact is strikingly evident, and that is the bad effect on
the municipal death-rates of poorly-protected surroundings, e.g., Cochin, Calicut,
Palghat and Tellicherry in Malabar.
In regard to the reporting of small-pox epidemics, the practice largely followed
at present of reporting only once a fortnight is not sufficient, for it sometimes
happens that news of an outbreak does not reach the Deputy Inspector concerned,
for more than 20 days after, by which time, of course, the disease has had time to
establish itself firmly. The standing order (195) at present reads : " A Tahsildar
" or Deputy Tahsildar ....
must communicate the fact at once simul¬
" taneously to the Collector of the district, to the District Medical Officer, and to
" the Medical Subordinate in charge of the dispensary, if there is one of the taluk
" or division." In paragraph 2 provision is also made for sending notice to the
vaccinator of the circle. Now it would appear more important to warn the Deputy
Inspector of Vaccination, who can go to the spot at once, than the Medical sub-
ordinate who cannot leave his dispensary for more than a few hours without leave
from the District Surgeon. I would therefore suggest that the order be changed,
so that the Deputy Inspector be warned instead of the Medical Subordinate.
26. During the year two Deputy Inspectors died. Eight Deputies were fined
for various offences.
27. The service books of Deputy Inspectors have been maintained and brought
up to date, with the exception of two belonging to men recently appointed, which
are now under verification.
I have the honour to be,
Sir,
Your most obedient servant,
W. B. BANNERMAN, M.D.,
Surgeon-Captain, I.M.S.,
Inspector of Vaccination and Deputy
Sanitary Commissioner, Madras.
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