July, 1944]
EDITORIALS
321
passing away of the epidemic when vigilance tends to relax that the number of susceptible persons increases, creating conditions
with the
Indian Medical Gazette JULY
SMALLPOX Uf the
IN CALCUTTA
diseases that
are notifiable in Calcutta, of the most important. It is prevented than any other disease of lis group, yet in no year has the city remained ree from it, and its average rate of mortality unng the decade 1930-39 was higher than in any other part of Bengal. Epidemics are common, and these happen so frequently and cgularly that smallpox has come to be regarded as part of our destiny. For some months past Calcutta has been in le grip of an epidemic which threatens to be a ecord one, considering its duration and severity, s most remarkable feature is the high death 6 \ according to the figures available to no was a little over 80 per cent during the first ur months of this year. This figure is probaPParent than real. The most likely pv i m01-e *S ^at many persons neglect to 1 occurrence of the disease as they m ^ Consequently, the health authorities rpo ei\e more accurate information about the deaths from smallpox than that of a fr actual cases.
smallpox is more easily
one
,
nnrfna^u?n ?
i
?
J4"01*1
interesting to know the vaccinal ^le Persons who developed the inf f are not m a position to throw lin-w n\ b it on this point. Certain available figures are owever highly suggestive. Thus during the first m?nths ^le year, 14 per cent of the dpn+i occurred in infants under 1 year of app qo Per cen^ in children from 1 to 5 years and' cen^ *n People of 10 years and above. Th ese indicate that primary vaccination is in lns^ances not done at the right time, thus a Se number of children exposed to tlip ection ?f a disease which is always am ongst us, and that re-vaccination is not done .?u?ciently large scale to add to the which tends to pass off in a few years numty a f ei, P^mary vaccination. There are no reasons that conditions were any better nri ? f eving ^le large number of people that ha + i n P^ce in Calcutta during the last two Vpo if n(^ ^ia^^ie^as undoubtedly added to the Corporation. Vaccination is thP iles
i?^ ?
lpav'^
.
irrma
diffi1^
sin a
known
ry lpox,
to
give protection against
and while unprotected individuals are ^ a danger, it is the presence of a large the disease, that P?Pulation spreads an *S ^le background of Calcutta's Drnhl m' ^ -sh?uJd be our aim to reduce, or bptt ak?lish, this susceptible population. It is n to vaccinate vigorously during an enid ^ c^oes no4 require much persuasion at thi s r5' time, for fear acts as a stimulus. It is
iCe?uf
.
favourable for fresh out-breaks. The remedy is obvious, and that is to enforce the vaccination laws and introduce compulsory re-vaccination, the need of which is also evident from the Health Officer's Annual Report for 1942-43. In this year, 4,560 infants under 1 year were not vaccinated. No wonder that ' infants and children under 1 year and of 1 to 5 years of age suffered more severely than others ', although smallpox occurred only sporadically during most of the year. He refers to the poor response to vaccination and ' says that many persons, especially the bustee people, go unprotected and refuse* re-vaccination '. A scheme for compulsory re-vaccination is, however, pending before the ' Corporation. As regards notification, he remarks the response of the public and the medical practitioners in this direction is very unsatisfactory. Although there is penal law for its enforcement, many practical difficulties arise if legal action be taken '. This is a frank statement, but offers no solution to the problem. Health propaganda work is carried out in the city, but we would like to see more intensive work of this nature. During the height of the present epidemic it was not unusual to see smallpox patients, convalescent but still in the infective stage, walking about in the crowded streets; nobody seemed to mind their presence. Such thoughtless actions undoubtedly spread the disease. Lastly, there is an urgent need for a modern hospital for infectious diseases in Calcutta, preferably in open-air surroundings, which should be well-equipped so as to attract both rich and poor patients. According to the Health Officer's figures, only 120 beds are available for smallpox patients. This accommodation is obviously very inadequate, and the matter requires serious attention. R. N. C.
EDITORIALS
321
passing away of the epidemic when vigilance tends to relax that the number of susceptible persons increases, creating conditions
with the
Indian Medical Gazette JULY
SMALLPOX Uf the
IN CALCUTTA
diseases that
are notifiable in Calcutta, of the most important. It is prevented than any other disease of lis group, yet in no year has the city remained ree from it, and its average rate of mortality unng the decade 1930-39 was higher than in any other part of Bengal. Epidemics are common, and these happen so frequently and cgularly that smallpox has come to be regarded as part of our destiny. For some months past Calcutta has been in le grip of an epidemic which threatens to be a ecord one, considering its duration and severity, s most remarkable feature is the high death 6 \ according to the figures available to no was a little over 80 per cent during the first ur months of this year. This figure is probaPParent than real. The most likely pv i m01-e *S ^at many persons neglect to 1 occurrence of the disease as they m ^ Consequently, the health authorities rpo ei\e more accurate information about the deaths from smallpox than that of a fr actual cases.
smallpox is more easily
one
,
nnrfna^u?n ?
i
?
J4"01*1
interesting to know the vaccinal ^le Persons who developed the inf f are not m a position to throw lin-w n\ b it on this point. Certain available figures are owever highly suggestive. Thus during the first m?nths ^le year, 14 per cent of the dpn+i occurred in infants under 1 year of app qo Per cen^ in children from 1 to 5 years and' cen^ *n People of 10 years and above. Th ese indicate that primary vaccination is in lns^ances not done at the right time, thus a Se number of children exposed to tlip ection ?f a disease which is always am ongst us, and that re-vaccination is not done .?u?ciently large scale to add to the which tends to pass off in a few years numty a f ei, P^mary vaccination. There are no reasons that conditions were any better nri ? f eving ^le large number of people that ha + i n P^ce in Calcutta during the last two Vpo if n(^ ^ia^^ie^as undoubtedly added to the Corporation. Vaccination is thP iles
i?^ ?
lpav'^
.
irrma
diffi1^
sin a
known
ry lpox,
to
give protection against
and while unprotected individuals are ^ a danger, it is the presence of a large the disease, that P?Pulation spreads an *S ^le background of Calcutta's Drnhl m' ^ -sh?uJd be our aim to reduce, or bptt ak?lish, this susceptible population. It is n to vaccinate vigorously during an enid ^ c^oes no4 require much persuasion at thi s r5' time, for fear acts as a stimulus. It is
iCe?uf
.
favourable for fresh out-breaks. The remedy is obvious, and that is to enforce the vaccination laws and introduce compulsory re-vaccination, the need of which is also evident from the Health Officer's Annual Report for 1942-43. In this year, 4,560 infants under 1 year were not vaccinated. No wonder that ' infants and children under 1 year and of 1 to 5 years of age suffered more severely than others ', although smallpox occurred only sporadically during most of the year. He refers to the poor response to vaccination and ' says that many persons, especially the bustee people, go unprotected and refuse* re-vaccination '. A scheme for compulsory re-vaccination is, however, pending before the ' Corporation. As regards notification, he remarks the response of the public and the medical practitioners in this direction is very unsatisfactory. Although there is penal law for its enforcement, many practical difficulties arise if legal action be taken '. This is a frank statement, but offers no solution to the problem. Health propaganda work is carried out in the city, but we would like to see more intensive work of this nature. During the height of the present epidemic it was not unusual to see smallpox patients, convalescent but still in the infective stage, walking about in the crowded streets; nobody seemed to mind their presence. Such thoughtless actions undoubtedly spread the disease. Lastly, there is an urgent need for a modern hospital for infectious diseases in Calcutta, preferably in open-air surroundings, which should be well-equipped so as to attract both rich and poor patients. According to the Health Officer's figures, only 120 beds are available for smallpox patients. This accommodation is obviously very inadequate, and the matter requires serious attention. R. N. C.
