NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
58
used for the two experimental animals contracted tetanus after 12 hours, and died
after 24 hours.
The fact that both animals survived the further test of a hypodermic injection
of quinine would point to the spores being effectually dealt with at the site of
injection.
The result of this series of experiments is direct experimental proof that anti-
tetanic serum is a trustworthy prophylactic against tetanus when hypodermic injec-
tions of quinine are given.
Table XIX.
Experiments on Guinea Pigs to determine whether the hypodermic injection of Tetanus
antitoxin can protect against the hypodermic injection of a virulent Tetanus
culture.
No. of
experi-
ment.
Site of injection of
antitoxin.
Site of injection of
tetanus culture.
Result.
REMARKS.
1
3 c.c. front of chest . Hind leg . . Remained well . The culture used in these ex-
periments was extremely viru-
lent. Nos. 1 and 2 received
0.1 c.c., and No. 3 (control)
0.05 c.c., i.e., half the quan-
tity given to Nos. 1 and 2.
2
D i t t o
.
Ditto . .
Ditto
. 24 hours after the antitoxin
tetanus culture were given,
Nos. 1 and 2 received ¾ gr.
quinine hypodermically, but
this had no effect in producing
tetanus.
3 (Control
of tetanus
culture
used.)
Ditt o
.
Ditto
. .
Tetanus after 12
hours.
Died after 24 hours.
The results of this series of experiments prove that tetanus antitoxin is a trustworthy prophylactic against tetanus when it is
necessary to give quinine hypodermically.
59
CHAPTER VI.
Antitetanic Serum as a prophylactic in cases of Malaria in which it is
necessary to give Quinine hypodermically.
Although cases of tetanus are, comparatively speaking, of rare occurrence after
hypodermic injections of quinine, it is a terrible calamity when they do occur.
To avoid with certainty what the late Professor Maclean 18 described as " some
- t h i n g r e v o l t i n g i n a d e a t h b r o u g h t a b o u t d i r e c t l y o r i n d i r e c t l y b y a r e m e d y i n t e n d e d
to cure," the only reliable safeguard against tetanus when quinine must be injected
hypodermically is a dose of tetanus antitoxin. (See Table XIX.)
In countries where severe forms of malaria occur, and in those cases where
quinine cannot be tolerated by the stomach, or for other reasons, it may be some
- t i m e s n e c e s s a r y t o g i v e i t h y p o d e r m i c a l l y . W h e n s u c h a n e c e s s i t y a r i s e s , a n d
especially in those localities of tropical countries where tetanus frequently occurs,
it would be advisable to give a dose of antitetanic serum immediately before or
i mmedi atel y after gi vi ng qui ni ne hypodermi cal l y. A dose of from 10 to 15 c.c.
given hypodermically confers a passive immunity to tetanus for two or three weeks,
and by that time the patient would probably not require any further injections of
quinine.
It is well known that the principal use of antitetanic serum is not so much cura
- t i v e a s p r e v e n t i v e i n i t s a c t i o n ; a s a p r o p h y l a c t i c i t i s m o s t r e l i a b l e . A n i n j e c t i o n
of serum into the loose subcutaneous tissues of the side of the abdomen would not
cause any pain or inconvenience to the patient, and this amount, for the time
being, would render several daily injections of quinine safe as far as tetanus is
concerned.
Those who have had an extensive experience in treating malaria in tropical
climates assert that there are cases in which it is possible to save the patient by
hypodermic injections when it would be impossible to do so by the ordinary adminis
- t r a t i o n o f q u i n i n e . I t i s i n s u c h c a s e s , a n d n o t a s a r o u t i n e m e a s u r e i n t h o s e w h o c a n
tolerate quinine by the stomach, that hypodermic injections are justifiable. Given
with the precautions which a dose of antitetanic serum would ensure, there would
be no risk of tetanus ensuing, and the patient would only have to contend with
the local reaction caused by the quinine. The passive immunity to tetanus which
is so quickly conferred by antitetanic serum would prevent the local effects of
quinine from acting as a focus for the growth of tetanus spores, and it would also
prevent any latent spore infection from giving rise to tetanus under the combined
favouring influences of quinine and an attack of malaria.
60
CHAPTER VII
.
Conclusions.
1. Rabbi ts and gui nea pi gs are suscepti bl e to the acti on of qui ni ne when gi ven
hypodermically, or by the stomach. When a large dose is given to these animals it
produces muscular spasms, convulsions, and death by asphyxia. When given
hypodermically a certain lethal dose for a guinea pig is 1 grain per 150 grammes
of body weight, and for a rabbit 6 grains per kilogramme of body weight ; but in
some cases less would, suffice. When given by the stomach a certain lethal dose
for a gui nea pi g i s 1¼ grai ns per 150 grammes of body wei ght, and for a rabbi t 15.
grains per kilogramme ; but in some cases less would prove fatal.
Rabbits are very susceptible to small doses of quinine given intravenously.
I n t h e s e a n i m a l s ¾ g r a i n p e r k i l o g r a m m e o f r a b b i t i s a c e r t a i n l e t h a l d o s e , a n d k i l l s
in most cases within one minute, asphyxia being the immediate cause of death.
The fatal results of intravenous injections of quinine are not due to the acidity
of the solutions, as evidenced by the fact that rabbits can withstand the intra
- v e n o u s i n j e c t i o n o f d i l u t i o n s o f s u l p h u r i c o r h y d r o c h l o r i c a c i d o f m u c h g r e a t e r
acidity than the solutions of quinine which rapidly prove fatal.
¼ grain per kilogramme of body weight is a non-lethal dose of quinine for a.
rabbit when given intravenously.
2. When quinine is injected hypodermically, or into the muscles, it has a well
marked destructive action on the tissues at the site of injection ; and in addition to
producing these foci of dead tissue which would serve as suitable anærobic media
for the growth of tetanus spores should they by any chance become lodged
there, it also gives rise to conditions favourable for infection with " washed tetanus
spores " injected into other sites.
3. When quinine is given hypodermically to tetanus infected animals, tetanus
germs are transferred from the original site of the tetanus infection to the site where
the quinine has been injected. The experiments on this point confirm those carried
out by Vincent in 1904.
4. Pure " washed tetanus spores " given hypodermically to guinea pigs and
monkeys do not produce tetanus ; but when quinine is injected hypodermically
into a different part of the body, either the day before, the same day, or the day
after spores are given, a large percentage of these animals contract tetanus.
5. Pure " washed tetanus spores " when mixed with quinine, or weak lactic
acid, and injected hypodermically into guinea pigs invariably produce tetanus, but
when given mixed with morphia the animals remain well. Quinine and lactic acid
when injected hypodermically produce sites favourable for the development of
tetanus spores ; but morphia, and normal saline solution do not produce this effect.
6. Pure " washed tetanus spores " when injected hypodermically into guinea
pigs remain latent at the site of injection for months, as evidenced by the fact that
61
virulent tetanus bacilli may be recovered from these sites after a period of seven
months, and. possibly after a much longer period. The importance of this fact in
its relation to the hypodermic injection of quinine is evident.
7. Tetanus bacilli or tetanus spores are not found in the blood and internal
organs in cases of acute tetanus, although they are invariably found at the original
site of infection, and at the site of quinine injections given during the disease ; they
are also found at the site of quinine injections when quinine has been the means of
bringing about an infection with " washed tetanus spores " injected into a different
part of the body.
8. Tetanus infection was present in the intestinal tract of healthy human sub
- j e c t s i n f o u r c a s e s o u t o f t e n e x a m i n e d . I n t h r e e o f t h e s e c a s e s t h e t e t a n u s b a c i l l i
isolated were virulent for guinea pigs.
9. Cold has an influence in producing tetanus in guinea pigs when " washed
tetanus spores " are given hypodermically : and this influence is increased by the
hypodermic injection of quinine.
10. No evidence has been obtained of the presence of tetanus infection in any
of the solutions of quinine used in the experiments recorded in this paper.
11. Some strains of tetanus spores are extremely resistant, and may remain
alive and retain their virulence on a rusty nib for as long as 18 years, when
the nib is placed in a test tube capped with rubber, and kept in a cupboard at room
temperature.
12. Tetanus antitoxine is an efficient prophylactic against tetanus when it is
necessary to give quinine hypodermically.
References.
1 . F o u r n i e r P e s c a y , q u o t e d b y B u r n e t i n
2 . B a r o n L a r r e y , q u o t e d b y B u r n e t i n " C
3 . S e i d i l l o t , q u o t e d b y E t i e n n e B u r n e t i n
4 . V i n c e n t , A n n a l e s d e l ' I n s t i t u t P a s t e u r
5 . M a c l e a n , D i s e a s e s o f T r o p i c a l C l i m a
6 . M a n s o n , T r o p i c a l D i s e a s e s , 4 t h e d i t i
7 . V i n c e n t , A n n a l e s d e I ' I n s t i t u t P a s t e u r
8 . T h e o b a l d S m i t h , — J o u r n a l o f t h e A m
1 1 . H e n r i & C e n r o d e a n n u „ C o m p t . R e n
1 2 . Bu r n e t , Ca mp a i g n a g a i n s t Mi c r o b e s , 1 9 0 9 .
13. Metchnikoff on Immunity.
14. McFarl and' s Bacteri ol ogy, 4th edi ti on, 1904.
15. Vai l l ard & Vi ncent, Annal es de l ' Insti tut Pasteur, 25th January 1891.
16. Vincent, Annales de I'Institut Pasteur, December 1904.
17. Vi ncent, Annal es de I' Insti tut Pasteur, December 1904.
18. Macl ean, Di seases of Tropi cal Cl i mates, page 69.
CALCUTTA
SUPERI NTENDENT GOVERNMENT PRI NTI NG, I NDI A
8, HASTI NGS STREET
(NEW SERIES.)
No. 43.
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
The Relation of Titanus to the Hypodermic
or Intramuscuar Injection of
Quinine.
BY
LIEUTENANT-COLONEL SIR D. SEMPLE, KT., M.D.,
Director, Central Research Institute, Kasauli.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA BY THE
SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA, SIMLA.
CALCUTTA
SUPERINTENDENT GOVERNMENT PRINTING, INDIA
1911
Price annas 12 or 1s. 2d.
REPORT
ON
VACCINATION IN ASSAM
For the Year 1874-75.
BY
J. C. BOW, M.D.,
Deputy-Surgeon-General, Dacca Circle
SHILLONG:
PRINTED AT THE ASSAM SECRETARIAT PRESS.
1875.
REPORT
ON
VACCINATION IN ASSAM
For the Year 1874-75.
BY
J. C. BOW, M.D.,
Deputy-Surgeon-General, Dacca Circle.
SHILLONG:
PRINTED AT THE ASSAM SECRETARIAT PRESS.
1875.
No. 724, dated Shillong, the 28th July, 1875.
From—SURGEON-MAJOR J. C. Bow, M.D., Deputy-Surgeon-General, Dacca Circle,
To—The Secretary to the Chief Commissioner of Assam.
I HAVE the honour to submit the Report on Vaccination in Assam for the year ending
31st March, 1875.
For a few more general remarks, and for recommendations regarding the carrying out
of more extended operations next season, I must refer to my letter No. 480, dated 22nd
ultimo.
( 2 )
A.—DISPENSARY—
Statement showing particulars of Vaccination in the
1
Circle of Medical Superintendence.
1
2
3
4
5
6
7
8
9
10
11
2
Name and Bank of Superintendent of
Dispensaries.
P. J. Monteith, M.D., Civil Surgeon ....
A. Imthurn, Esq., Civil Medical Officer
J. E. C. Ferris, Esq., Civil Surgeon
Mr. J. Slane ,Civil Medical Officer ........
E. G. Russell, M.A., M.D., Civil Surgeon...
J. O. Brien, M. D. Civil Surgeon ........
J. White, Esq., Surgeon-Major, Civil
Surgeon.
Mr. A. D. Cooper, Civil Medical Officer..
Mr. J. W. Hughes, Civil Medical Officer..
Babu M. C. Mookerjee, Civil Medical
Officer.
T.Mathew, M.D., Surgeon-Major, Civil
Surgeon.
Total
3
Number of Native Superintendents of Vac-
cination attached to the Dispensary.
....
....
....
....
....
....
....
....
....
....
....
....
4
Number of Vaccinators attached to the
Dispensary.
1
1
4
1
55
2
5
....
2‡
1
1
....
5
6
TOTAL NUMBER
OF PERSONS
VACCINATED.
Present year, 1874-75.
1,416
303
1,733
147
10,001
1,438
1,908
36
....
265
1,391
1,245
19,883
Previous year, 1873-74.
1,431
104
784
302
11,474
928
2,123
77
....
348
2,277
1,377
21,225
7
Division or District Collectorate, Political
Agency, Native State, or Municipality, for
the population of which the Dispensary
is provided.
Cachar ................
Darrang ...............
Gáro Hills ........ ....
Goálpára ................
Kámrúp ............
Khási and Jaintiá Hills
Lakhimpur ..........
Ditto ............
Nága Hills
Nowgong ................
Sibságar .................
Sylhet ....................
8
Population of area included in last column.
205,027
236,009
90,000
407,714
561,681
60,000
94,318
26,424
256,390
64,539
1,717,889
9
Name of Dispensary.
Cachar....................
Tezpur.....................
Gáro Hills ........
Goálpára................
Gauháti .........
Shillong ................
Dibrugarh ................
Branch Dispensary, North
Lakhimpur.
Sibságar ....................
Sylhet ....................
* This term includes every species of local vaccination performed under the supervision of a Civil Surgeon, whether the vaccinators are attached
† That is to say, vaccination of persons who have been either previously vaccinated with success, or have been inoculated, or have had small-pox.
‡ One for the whole year, and one from 1st April to 15th June, 1874.
( 3 )
VACCINATION.*
Dispensaries of Assam during the year ending the 31st March, 1875.
10
PRIMARY VACCINATION.
A.
Sex.
Male.
875
160
906
71
6,056
727
1,060
20
....
140
728
751
11,504
Female.
512
143
827
76
3,945
701
848
16
....
125
663
492
8,348
B.
Caste.
Christian.
2
....
....
....
....
161
15
2
....
24
8
6
213
Hindu.
1,256
....
15
119
6,984
52
1,743
22
....
288
1,384
525
12,333
Mussulman.
115
....
1
28
3,017
1
72
12
....
....
4
712
3,962
Gáro.
....
....
1,717
....
....
....
....
....
....
....
....
....
1,717
Other castes.
14
....
....
....
....
1,224
78
....
....
8
....
....
1,324
Age.
Under one year.
20.8
14
655
36
1,274
162
305
3
....
19
452
84
3,212
Above one year.
1,179
289
1,078
111
8,727
1,276
1,603
33
....
246
939
1,159
16,640
C.
Results.
Successful.
1,091
298
1,448
127
9,331
1,150
1,493
13
....
194
1,391
876
17,407
Unsuccessful, including
those doubtful.
283
5
290
16
565
288
186
21
....
55
47
367
2,123
Unknown.
13
....
....
4
105
....
116
....
....
16
....
....
254
D.
Total.
1,387
808
1,733
147
10,001
1,438
1,795
34
....
265
1,438
1,243
19,784
11
RE-VACOINATION.†
A.
Successful.
24
..
..
..
..
..
113
2
..
..
..
..
139
B.
Unsuccessful, including those
doubtful.
5
....
....
....
....
....
....
....
....
....
....
2
7
C.
Unknown.
..
..
..
..
..
..
..
..
..
..
..
..
..
D.
Total.
29
....
....
....
....
....
113
2
....
....
....
2
146
12
PERCENTAGE OF
SUCCESSFUL
CASES, EXCLUD-
ING THOSE UN-
KNOWN FROM
THE TOTAL
VACCINATED.
In Primary Vaccination.
78.65
98.4
83.26
88.19
93.33
79.9
93.53
100
....
73.20
96.63
70.47
8,913
In Secondary Vaccina-
tion.
82.75
.......
......
......
......
......
100
100
......
......
......
......
95.2
13
Average number of persons vaccinated by
each vaccinator.
1,416
303
....
147
110.01
719
381.6
36
....
265
1,391
643½
5,412.11
14
TOTAL COST OF
VACCINATION
FOR THE
YEAR.
Paid by Government.
Rs.
120
90
240
120
None.
288
280
....
....
145
120
120
Paid
from
other
resources.
Nil.
......
......
......
Rs
10
paid
by
Municipal-
ity.
......
......
......
None.
......
......
Rs
40
paid by
Municipa-
lity.
to a dispensary or not.
J. C. BOW, M.D.
Deputy-Surgeon-General, Dacca Circle.
( 8 )
In Cachar and Nowgong the proportion of inoculated children to prisoners is very high. If
inoculation be spread equally through the population and the prisoners belonging to the district, the
conclusion would be that the practice of inoculation has been more common in the last ten years
than it formerly was.
In Goálpára, Sibságar, and Sylhet, there is little difference between the children and prisoners.
In Sibságar, judging from the returns, inoculation is not so common as in other districts, and here
vaccination has been brought to bear on the two classes under consideration.
X.—General Remarks.
There is not much to add under this head. One officer attributes the great and steady increase
in his district to the great interest taken in the matter by the civil authorities and himself; being of
opinion that, when the people see that the work is conducted under European supervision, they are
more open to conviction. Another despairs of success unless strenuous support is given by the district
authorities.
( 11 )
P.S.—Since writing the above, your office letter No. 1,350, of the 19th April, 1875,
with enclosures, regarding the employment of inoculators as vaccinators in the Sylhet
district, has been brought to my notice. I would recommend that the Deputy-Commissioner,
or the Civil Surgeon, should communicate with the Deputy-Commissioner or Civil
Surgeon of Grauháti, and inquire how the transformation was effected in that district.
There the inoculators receive no pay. They ought to receive subsistence allowance
when being taught vaccination; after that, if they like to submit to all the regulations which
apply to ordinary vaccinators, I see no reason why they should not be entertained.
A vaccinator is obtained, and at the same time an inoculator got rid of. They must,
however, charge no fees, and must do more work than the Kámrúp ex-inoculators
do to entitle them to Rs. 10 a month. On the other hand, if they prefer
vaccinating in the thannas in which they have been wont to inoculate, and take fees from
the vaccinated, they should be allowed to do so. The probability is that most of them would
prefer the latter plan; the result would be a great saving to Government. After what I
have said above regarding Sylhet, it need scarcely be added that employing only three or
six men, in my opinion, would be quite inadequate.
The rule with regard to the introduction of Act IV. (B.C.) of 1865 into a district is,
that it cannot or ought not to be put in force unless complete arrangements have been
made for fully vaccinating during the season all the unprotected of the said district. I see
in one of the old reports that inoculation was forbidden in Kámrúp, but the statement has
not been repeated in the later reports. Act IV. extends only to the municipality of
Gauháti. Annexed is a memo. (for reference) of the expenses of the Eastern Bengal
Circle of vaccination for March, 1875.
( 12 )
Statement showing the amount drawn on account of pay, &c., of the Vaccine Establishment
the Eastern Districts (Dacca) during the month of March, 1875.
NATURE OF CHARGES.
SALARIES AND ESTABLISHMENT.
Superintendent .....................
Superintendent Vaccinator .....................
Sub-Assistant-Surgeons ...........................
Head Vaccinators ..............................
Vaccinators ..............................
Clerks ..............................
Servants (Peons) ..................
Apprentices , at Rs 5 per month ...............
CONTINGENT CHARGES.
Office Expenses .....................
Travelling Allowances ..................
Cost of Postage Labels ...............
Office Rent ..................
Miscellaneous ..................
Gratuity to vaccinated children that
supplied lymph ........................
Boat-hire for the above .....................
Ferry-hire for the Vaccinators ............
Total
Number.
1
......
......
6
72
1
2
......
......
......
......
......
......
......
......
......
82
Amount
sanc-
tioned in the
Budget Esti-
mate for the
year 1874-75.
Rs
4,200
.........
......
1,080
6,480
360
144
.........
............
.........
6
.........
278
.........
.........
............
12,548
Amount drawn
during the month
of March, 1875.
Rs
350
As.
0
P.
0
.........
......
90
520
30
12
90
0
0
0
0
0
0
0
0
0
0
1 3 0
......
1 13 0
.........
.........
11
7
2
10
0
0
6
0
0
1,115,106
REMARKS.
DACCA STATION:
The 1st April, 1875.
BHOOBUN MOHON MITTER,
Superintendent.
Extract from the Proceedings of the Chief Commissioner of Assam in the General
Department, dated
December, 1875.
READ—
Vaccination Report for 1875.
RESOLUTION.
THE amount of vaccination undertaken in the Province, as already reported to the
Government of India, is not large, except in the district of Kámrúp, where an attempt to
make inoculators become vaccinators has been attended with some success.
2. The figure of vaccination per thousand of the population for Kámrúp (18.39) is
most encouraging, when it is considered that the attempt to reconcile the inoculators to
vaccination only originated in December, 1873. The Chief Commissioner would gladly
have sanctioned a small outlay this season in rewards for successful cases, had the sum
allowed him for Provincial Services admitted of any extra expenditure for this purpose.
3. The vaccination done in the Gáro Hills and Lakhimpur is fair in amount; but
there are doubts as to the accuracy of the census population of these districts. The
employment of four inoculators as vaccinators in the latter district is hopeful.
4. In the Khási Hills, considerable progress has been made.
5. Colonel Keatinge wishes for information, explanatory of the total absence of
vaccination in the Nága Hills, where the entire neglect of the subject compares so badly
with the good results obtained in the Gáro and Khási Hills.
6. The subject of the extension of vaccination in the Province forms the subject of
separate correspondence. Small-pox is a terrible scourge in the Province, and is specially
fatal to the hill tribes living within and beyond our borders. The Provincial finances are
(at present) quite incapable of bearing any extra charge, so that for the present this good
work must be postponed.
By order of the Chief Commissioner of Assam,
H. LUTTMAN-JOHNSON,
Secretary to the Chief Commissioner of Assam.
ANNUAL VACCINATION REPORT
OF THE
PROVINCE OF ASSAM
FOR THE
Year 1881-82.
BY J. J. CLARKE, M.D.,
DEPUTY SURGEON-GENERAL AND SANITARY COMMISSIONER.
SHILLONG:
PRINTED AT THE ASSAM SECRETARIAT PRESS.
1882.
No. 367 S.
FROM J. J. CLARKE, ESQ., M.D., Deputy-Surgeon-General, H. M.'s Forces,
Eastern Frontier District, and Sanitary Commissioner, Assam,
To C. J. LYALL, ESQ., M.A., C.I.E., C.S.,
Secretary to the Chief Commissioner of Assam,
Dated Shillong, the 29th June 1882.
SIR,
I HAVE the honour to submit the Vaccination Report of this Province for
1881-82.
2. The Report until this year has not been printed in a complete form since 1875,
and on this occasion I have endeavoured to illustrate the work and the agency employed
as clearly as possible.
3. In 1875 a scheme for circle vaccination was submitted by this office to the
Assam Administration and the Government of India but it was allowed to drop out of
sight, and until last season no addition to the vaccination staff of 17 or 18 dispensary
vaccinators has been made.
4. By the continued zeal and efforts of Civil Medical Officers and the strengthening
their hands, when circumstances warrant, by an increase of the vaccination staff, time will
doubtless overcome the prejudices of the people and the vaccination work of this Province
will in due course take a fair stand and compare favourably with that of other Provinces.
I have the honour to be,
SIR,
Your most obedient Servant,
J. J. CLARKE, M.D.,
Sanitary Commissioner, Assam.