44
Prophylactic.
72. The European Medical Practitioners were met at Ambala on September 18th, 1002,
by representatives of the Punjab Govern-
ment. When speaking of their own in-
oculation certain of them mentioned that they had received doses of only I C. C. of the prophy-
lactic, and on it being remarked that I. c. c. was a very small dose, they replied that the method
of preparing the prophylactic had lately been changed, so that instead of being 5 c. c or
more as formerly the dose was only 5 or I c. c. This was the first intimation which had
reached the Punjab of any change connected with the prophylactic. A telegram was there-
fore immediately despatched to the Director-in-Chief, Plague Research Laboratory, en-
quiring if it was true that the method of preparing the prophylactic had been changed, and
asking for particulars of any change that might have been made.
Just after the telegram was despatched a letter was received from the Superintendent
of the Plague Research Laboratory confirming the statements of the European Medical
Practitioners as to the change in the method of preparing the prophylactic, and adding that
the Laboratory could only supply the Punjab with 15,000 doses daily from October 1st.
In reply to the telegram just referred to the Director-in-Chief, Plague Research
Laboratory, telegraphed inviting reference to a letter of his' published in the report of the
Indian Plague Commission and stating that modifications were being introduced on the lines
therein sketched. Reference was also invited to the Superintendent's letter mentioned
above, Without going into details it may be stated here that modifications in the prophylac-
tic affected both the method of its manufacture and its composition.
The change in the method of manufacture involved more manipulation and hence
more danger of contamination, and the change in the composition of the prophylactic,
although of a similar nature to that recommended by the Indian Plague Commission, was
in opposition to the views of Mr. Haffkine himself expressed before the Commission several
months after the date of his letter to which he had invited reference.
In preparing its scheme of extensive inoculation operations the Punjab Government
had contemplated the use only of prophylactic exactly similar to that the efficacy and harmless-
ness of which had been demonstrated by its extensive use in the Province for several years,
but for which experience, indeed, its scheme would never have been formulated. The
receipt immediately before the commencement of its great undertaking of the information
that the prophylactic to be supplied for the inoculation of several millions of its dependents
was to differ in important respects from that previously used was a matter of the greatest
concern to the Punjab Government, outweighing in its seriousness the information recorded
at the same time of the great deficiency in» the amount of the fluid which could be supplied.
It was felt that however beneficial the results of the changes connected with prophy-
lactic might be expected to be, the occasion of the introduction was the most inopportune
that could have been chosen.
The scheme of the Punjab Government had for its chief support the experience of
several years of a fluid which, whatever theoretical objections could be urged against it, had
been proved to be safe and efficacious, and it is hardly necessary to state that in such a
matter as the protection of millions of human beings from plague by inoculating them with
a fluid requiring for its preparation the most delicate bacteriological manipulations no
expected advantages which had only theoretical considerations in their support could com-
pensate for the loss of a confidence based upon the experiences of years. •
To abandon the scheme when all preparations for undertaking it had been completed
and great expense had been incurred and to deprive the people of the Punjab of a measure
which had been promised them to protect them from the ravages of plague was a course
which could not be entertained except for the very strongest reasons : at the same time it be-
came incumbent upon the Punjab Government to assure itself as far as possible that the new
fluid prepared by the Plague Research Laboratory was likely to be not only effective but
safe to use, and that a sufficient supply would be forthcoming to permit of the scheme being
proceeded with. After informal consultation with the Government of India it was decided
to depute the Chief Plague Medical Officer to Bombay to enquire into the matter, and this
officer after careful enquiry at the Plague Research Laboratory reported on October 2nd
that although in his opinion the changes in the fluid were very considerable, its use might
be adopted solely on the responsibility of Mr. Haffkine as to its efficacy and harmlessness.
He further reported that owing to the changes which had been introduced in the method of
preparing the fluid a large amount of it became contaminated- and had therefore to be re-
jected, and for this reason the authorities of the Laboratory were unable to guarantee a
supply of over more than 10,000 doses daily at first, though they were nearly confident of being
able to supply 20,000 doses daily during November and of being ultimately able to send out
70,000 doses daily, though they could not fix a date on which the last named amount would be
reached.
Commencement of operations.
73. With the short supply of fluid it was only possible to commence operations on
a small scale, and it was decided to restrict
inoculation at first to those districts in which
plague had been previously most severe and to those persons who expressed a real desire
for the operation.