NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
4
26TH JULY 1894, Nos. 1385, 1386 L., LOCAL AND MUNICIPAL.
8. The proposal made by Dr. King regarding the establishment of a central vaccine
institute is out of place in a periodical report, but will be considered when the
question of the reorganization of the department comes to be dealt with. The further
report called for from the Sanitary Commissioner in G.O., dated 25th May 1893,
No. 1148 L., regarding this subject and referred to in paragraph 8 of the review of'
the last year's report has just been received and will be disposed of in due course.
The suggestion made by the Inspector of Vaccination in paragraph 25 of his report
regarding the amendment of the Revenue Board's Standing Order, No. 195, will be
considered in the Revenue Department.
(True Extract.)
J. F. PRICE
Chief Secretary.
To the Sanitary Commissioner.
„ the Surgeon-General.
„ the Sanitary Board.
„ the Sanitary Engineer.
„ the Public Department.
„ the Judicial
„
„ the Revenue
„
„ the Military
„
„ all Collectors.
„ all Presidents of District Boards.
„ all Chairmen of Municipal Councils.
„ the President, Municipal Commission, Madras.
„ the Director of Public Instruction.
„ the Accountant-General.
Editors' Table.
ENDORSEMENT-dated 26th July 1894, No. 1386 L., Local and Municipal.
Copy to the Government of India, Home Department.
J. F. PRICE,
Chief Secretary-
Exd. J. Moses.
Govt. of {1894} Madras.
LOCAL AND MUNICIPAL.
Issued
Recd.
Encl.
G.O., &c., 26th July 1894,
Nos. 1385, 1386 L.
JULY.
Vaccination.
Reviewing the report on — for 1893-94.
MANUAL OF VACCINATION,
UNITED PROVINCES OF AGRA AND OUDH.
MANUAL OF VACCINATION
FOR THE
UNITED PROVINCES OF AGRA AND OUDH
By Major J. CHAYTOR-WHITE, I.M.S., M.D., D.P.H., (Camb.),
Sanitary Commissioner, United Provinces of Agra and Oudh.
ALLAHABAD:
Printed at the United Provinces of Agra and Oudh Government Press
1903.
PRICE 12 annas (1s,)
Errata to the Manual of Vaccination, United Provinces.
Reference as to
page, &c.
Page 6, para. 11, rule
VIII.
Page 8, para. 12, rule
XI.
For—
On the 8th of each
month the vaccinator
will
prepare
two
monthly returns.
On the 15th ...
Read—
On the 5th and 8th of
each month the vac-
cinator will prepare
a monthly return.
By the 7th.
CONTENTS.
PART I.
Introduction
.
.
.
.
.
.
.
.
.
.
.
.
.
.
The object of vaccination . . . . . . . . . . . . . .
Cow-pox in the cow . . . . . . . . . . . . . .
Discovery of vaccination . . . . . . . . . . . . . .
Spread of vaccination . . . . . . . . . . . . . .
Incidence with regard to sex, age, and race . . . . . . . . . . . . . .
Protective power of cow-pox and revaccination . . . . . . .
Objections which have been urged against vaccination . . . . . .
Conclusions reached by the Royal Commission on Vaccination . . . .
Inoculation . . . . . . . . . . . . . .
Means pursued by Government for conferring
vaccination upon its subjects in the United
Provinces of Agra and Oudh.
Staff employed and spheres of employment . . . . . . . . . . . . . .
Duties of the vaccinator . . . . . . . . . . . . . .
Duties of the Assistant Superintendent of Vaccination
....
Duties of the Deputy Sanitary Commissioners and District Superintendents
of Vaccination . . . . . . . . . . . . . .
Duties of Deputy Sanitary Commissioners . . . . . . . . . . . . . .
Duties of the District Superintendent of vaccination . . . . . . . . . . . . . .
Vaccination Season . . . . . . . . . . . . . .
PART II.
Pratice of vaccination . . . . . . . . . . . . . .
Instruments required for vaccination . . . . . . . . . . . . . .
Mode of operating . . . . . . . . . . . . . .
Description of a regular vaccine vesicle . . . . . . . . . . . . . .
Vaccine virus—varieties in use . . . . . . . . . . . . . .
Lymph . . . . . . . . . . . . . .
Capillary tubes . . . . . . . . . . . . . .
Mode of charging the points . . . . . . . . . . . . . .
Directions for the use of lanoline paste . . . . . . . . . . . . . .
Certain irregular results results of vaccination . . . . . . . . . . . . . .
When Children should be vaccinated . . . . . . . . . . . . . .
When children should not be vaccinated . . . . . . . . . . . . . .
APPENDICES.
Vaccination of the calf . . . . . . . . . . . . . .
Rules for vaccinating calves in the district . . . . . . . . . . . . . .
Rules for the guidance and maintenance of bovine lymph depôts in the
United Provinces of Agra and Oudh . . . . . . . . . . . . . .
References.
Abstract of notes for the guidance of Assistant Superintendents of Vaccination
Abstract of notes for the guidance of vaccinators . . . . . . . . . . . . . .
Paragraph.
...
1
2
3
4
5
6
7
8
9
10
11
12
...
13(a)
13(b)
14
...
15
16
17
18
19
20
21
22
23
24
25
No.
I
II
III
Page.
23
24
MANUAL OF VACCINATION
FOR THE
UNITED PROVINCES OF AGRA AND OUDH.
PART I.
INTRODUCTION.
THE following pages have been compiled with a twofold
object: firstly, to serve as a manual for the use of the vaccine
establishments in these Provinces ; and, secondly, to instruct the
general public as to the nature of vaccination and the methods
used by Government to bring its benefits within the reach of all
free of cost.
10
MANUAL OF VACCINATION FOR THE
authorities, and engaged in any extra work without the sanction of the
District Superintendent.
(xi) They will require their Assistant Superintendents to visit
each circle and check by personal inspection the work of each vaccinator to
the greatest extent practicable.
(xii) Transfers of vaccinators from one district to another will
be made by the Sanitary Commissioner, in communication with the authorities
concerned.
Vaccination Season.
14. The vaccination season extends from 1st October to 31st March, but
in the plains of these Provinces, it is only possible to conduct operations
successfully for about five months. Operations are, however, performed on
the appearance of epidemic small-pox during the hot season, in which
case lymph is supplied from the hills by the Deputy Sanitary Commissioners.
To meet all emergencies, lymph is constantly kept alive in the colder
climtae of the Himálayan districts throughout the year—a duty that devolves
on the Deputy Sanitary Commissioners, the arrangements for which are made
by them during their tours in the hills in the spring. In the hills vaccination
operations continue throughout the whole year, and a supply of lymph is
continuously kept up.
UNITED PROVINCES OF AGRA AND OUDH.
11
PART II.
PRACTICE OF VACCINATION.
Instruments required for Vaccination.
15. (a) Scarifiers.— In these Provinces the instruments generally used
are the vaccine needle for scarifying the arm, and vaccine points and capil-
lary tubes for the conveyance of lymph. The needle consists of an ivory
handle, at one end of which the points of four ordinary needles project for
about one-fourth of an inch. The needles are set in the handle about one-eight
of an inch apart, so that two marks consisting each of four good cross scarifica-
tions, equal about four insertions with a lancet. The ordinary lancer or patent
vaccinators (Loane's, Spratley's, Cooper Rose's) may also be used for scratch-
ing the arm.
(b) Vaccine points —They are made of ivory slips rounded off and
bevelled at both ends.
Mode of operating.
16. The vaccine needle is now used in preference to the lancet, but the
latter may also be utilized. As being the most convenient, the upper and
outer part of the arm is generally selected as the site for operation. The
arm in its upper part is bared and should be cleansed, preferably with hot
water. It is hardly necessary to use antiseptic lotion, and, if used, it should
be washed off with sterilized water. Scratch the skin on the upper and
well, either with the point from which the lymph is taken, or with the smooth
clean end of the needle. The scratches should be deep enough to penetrate
the cuticle but should not draw blood, which tends to wash away the vaccine
virus. After operation the scratches should be allowed to dry before
pulling down the sleeve. In England elaborate precautions are taken in
sterilizing the needle and cleaning the skin which are, however, unnecessary,
and in this country impossible. In these Provinces two good marks are
considered sufficient, and if made as above described, they will cover
an area of half a square inch. But unquestionably a higher degree of pro.
tection is afforded when lymph is inserted in three or four places.
When insertion is made on the same arm the cicatrices should be placed
well apart. If the lancet be used instead of the needle, the lymph is
introduced on the lancet by four or five valvular punctures into the skin,
situated about three-fourth of an inch apart from each other. It should be
the aim of the operator to cover an area of half a square inch by the vac-
cination marks.
16
MANUAL OF VACCINATION FOR THE U. P. OF AGRA AND OUDH.
as late as the beginning of dentition (six months). If small-pox be prevalent,
children should be vaccinated within three days of birth. In India, vaccina-
tion should never be delayed beyond the first year of life.
When Children should not be vaccinated.
25. When a child is very weak and ill-nourished, or suffering from any
acute skin disease, from severe diarrhœa or bronchitis, or suffering severely
from teething or any other ailment, vaccination should be delayed until the
health improves, unless the child has been in contact with a case of small-pox,
in which case immediate vaccination is safer than delay.
UNITED PROVINCES OF AGRA AND OUDH.
21
(vi) On the fifth day the calf is visited, and on casting on straw the
vesicles will be found developed. The abdomen of the calf and the hands
of the operator are again well washed and the instruments required steril-
ized. The skin of the part is put on the stretch and the vesicles and their
pulp removed by the spatula provided for the purpose. If it is only required
to fill points or tubes this can be accomplished with readiness.
(vii) As is usually done elsewhere, the children of the village are
vaccinated direct from the calf as it lies on the straw. Later the calf is
brought on to another village for use or for the purpose of vaccinating a
fresh calf. Afterwards the animal is returned to its original owner in
perfect health and quite uninjured.
APPENDIX III.
Rules for the guidance and maintenance of bovine lymph
depots in the United Provinces of Agra and Oudh.
Vaccination of the call.
(a)
i. Where possible a veterinary examination of calves before
operation is desirable.
ii. If there be any actual illness or suspicion thereof, or if the calf
be malformed, the animal must be rejected.
iii. If during or after operation, or during the process of extracting
lymph, the calf shows signs of illness, the calf and lymph taken therefrom
should be rejected.
iv. The inoculation-room, stalls, byres, and surroundings are to be
kept clean and free from all dirt and litter.
v. The calves are to be stalled in well-ventilated byres, and fed
regularly under the superintendence of the officer in charge. A book is to
be kept up in which the officer in charge will sign his name daily and note
the hours of attendance.
vi. No calf will be inoculated until it has been fed in the depôt for
a week. A calf three to six months old is the most suitable for operation.
vii. Before proceeding to operate, or before extracting lymph from
the calf, the careful and systematic cleansing of the parts must be first
effected.
viii. The calf having been strapped to the table the lower part of the
abdomen, as far forward as the umbilicus, is carefully shaved. This shaved
area is washed first with soap and water, then with a solution of carbolic
acid (1 in 20), and afterwards with water sterilized by boiling.
ix. Before operating the operator must cleanse his hands and nails,
and no person who has not done so should be allowed to touch the area of
operation or operation instruments.
x. The calf vaccinating needle or lancet should be perfectly clean,
and should be held point down in boiling water for a few minutes before
operating.
xi. With the operating instrument parallel linear incisions are made
sufficiently deep to penetrate the epidermis without drawing blood. The
incisions are usually two to three inches long and half to one inch apart. As
they are made, glycerinated calf lymph is run into the incisions. It is
desirable to inoculate the incisions immediately they are made, as the lips
of the wounds are apt to swell up and close the openings.
xii. After each inoculation operation, or after taking lymph from
the calf, all utensils, tables, instruments, glass point holders, &c., must be
22
MANUAL OF VACCINATION FOR THE
thoroughly cleansed in boiling water before extracting lymph ; the
Volkman's spoon spatula and ivory points also must be sterilized. It is
advisable to place a native-made bamboo collar on the neck of the calf to
prevent its licking itself.
Collection of Vaccine material.
(b) i. After five days the calf is again placed on the table, and the vac-
cinated surface of the abdomen is thoroughly washed with soap and water,
and then cleansed with sterilized water. No antiseptic should he used. Any
crusts are picked off by a sterilized forceps. The vesicles should be healthy
and well developed.
ii. If vaccine points are to be used they should be taken out of the
boiling water, allowed to cool and then filled. When charged they should
be placed on glass rods to dry. Tubes may be filled at the same time.
Glycerination of vaccine material.
(c) If it is desired to glycerinate the lymph, the skin is placed on
stretch and the vesicle and contents removed by a sterilized and Volkman's
spoon and transferred to a sterilized bottle of known weight, each line
being treated in turn and scraped once only. No blood should be allowed
to mix with the lymph. The pulp in the bottle is now weighed and then
transferred to a sterilized mortar, and rubbed up with a sterilized pestle.
Unless very dry, no glycerine is added until the rubbing up is completed. To
the triturated pulp is now added little by little, five or six times its weight of
a sterilized mixture of 50 per cent. pure glycerine in distilled water. From
this are filled the capillary tubes and points. If no scales and weights are
handy, an approximate amount of the glycerine solution may be used, as
it is not necessary to be very exact as to the dilution of the vaccine.
REFERENCES.
(i) Final Report of the Royal Commission on Vaccination, dated 18th
September 1896 (Eyre and
Spotlisivoode).
(ii) "Natural
and Casual Cow-pox"
(Crookshank).
(iii )" Vaccination, Hygiene, and Public Health"
(Whitelegge).
(iv) Report on the preparation
and storage of glycerinated calf lymph.
(British Medical Journal, August 21st, 1897.)
(v) Milroy Lectures on the Natural
History of Vaccinia, by Monkton
Copeman.
(British Medical Journal, 14th May 1898.)
(vi) Reports of Medical Officer of the Privy
Council.
PROVINCIAL
ACTS
AND
CIRCULARS.
(i) No. 1905G ,from Superintendent,
Government Press, United
Provinces
of Agra and Oudh, to Sanitary Commissioner, United Provinces of Agra and
Oudh, dated Allahabad, 14th July 1893. Schedule of Vaccination forms in
use in the United Provinces of Agra and Oudh.
(ii) Resolution No. 412/ V-267 B—12, dated 23rd September 1893 (Sani-
tation Department),
on reorganisation
of vaccination
establishments.
(iii) Act (Vaccination)
XIII of 1880.
(iv) Letter No. 141/XVI-23BC. dated 8th May 1896, from the Secretary
to Government, United Provinces of Agra and Oudh.
(v) Manual of Government Orders, Department XVI
(Vaccination).
J. CHAYTOR.WHITE, M.D., D.P.H. (CAMB.), MAJOR, I.M.S.,
Sanitary Commissioner, United Provinces of Agra and Oudh.
UNITED PROVINCES OF AGRA AND OUDH.
23
Abstract of the notes for the guidance of the Assistant
Superintendents of Vaccination.
(i) During the vaccination season your duties are to move continually
about your district examining the work of the vaccinators and satisfying
yourself that the work is progressing.
(ii) You are held responsible for the veracity and correctness of the
vaccinators' diaries and returns.
(iii) In the event of the work of any vaccinator not being satis-
factory, as for instance if the lymph be of bad quality—you should remain
with that vaccinator till such time as the work proceeds properly and
arrange for a supply of lymph if necessary.
(iv) Inspect the instruments of all vaccinators from time to time and
satisfy yourself that they are clean and in good order.
(v) You should satisfy yourself that vaccinators are able to recog-
nise those communicable diseases which they are likely to meet with in the
course of their work.
(vi) Your chief duty is to explain to the people the nature and object
of vaccination and to persuade them to accept it.
(vii) See that the vaccinators are courteous in manner and kind in
conduct towards the people, and that they are guilty' of no irregularity.
(viii) Keep a diary of the work you inspect.
(ix) Submit your weekly and monthly returns on due dates to your
District Superintendent, and forward after countersignature the returns
submitted by the vaccinators.
(x) Do not communicate direct with the Civil authorities.
(xi) Examine the birth and death registers kept by the chaukidárs.
(xii) Forward to District Superintendent, with your remarks, all peti-
tions &c., submitted by vaccinators.
(xiii) Wear your uniform when on duty.
(xiv) Do not include the inspections made with the District Superin-
tendent or Deputy Sanitary Commissioner in your returns.
(xv) Compare with chaukidárs' birth registers if the vaccinator has
done sufficient amount of work according to births.
(xvi) Report on the nature of vesicle if many arms are ulcerated or
not.
(xvii) Leave addresses with the District Superintendent when you are
on tour in the interior of the district.
(xviii) See that the sale of quinine is encouraged by the vaccinators
and sale proceeds are remitted.
J. CHAYTOR-WHITE, M.D., D.P.H. (CAMB.), MAJOR, I.M.S.,
Sanitary Commissioner, U. P. of Agra and Oudh.
24
MANUAL OF VACCINATION FOR THE
Abstract of the notes for the guidance of the vaccinators.
(i) Vaccinators are to keep their points and needles clean and free
from dust and dirt. They should always, for this reason, be kept in the
wooden box provided for the purpose.
(ii) Lymph should be taken from infants—
(a) under one year of age ;
(b) from a vesicle six days old;
(c) from a healthy child.
(iii) Lymph should not be taken from a child—
(a) over one year old ;
(b) with areola formed;
(c) from a vesicle over eight days old;
(d) from an unhealthy or a syphilitic child.
(iv) The lymph should not be mixed with blood, and blood should not
be drawn from the vesicle.*
(v) It is better to vaccinate on both arms: if vaccination is done on
one arm, sufficient distance should be left between the two insertions to avoid
union of the two or ulceration will probably result.
(vi) Wash the arms with clean water before vaccinating.
(vii) After establishing your lymph, in the beginning of season, pro-
ceed systematically from village to village in one onward direction and
vaccinate all unprotected children in them.
(viii) Ascertain from chaukidárs' birth register all children born since
previous season and vaccinate them all.
(ix) Call upon the village headman and the chaukidár for any
necessary help in collecting the children for vaccination.
(x) Keep all your registers properly and correctly made up to date.
(xi) Village register (No. 5) should be left with the chaukidár.
(xii) Submit your weekly and monthly returns regularly to your
Assistant Superintendent.
(xiii) Use every possible means of persuasion to induce the villagers
to have their children vaccinated and explain to them the benefits and object
of vaccination.
(xiv) Do not work in another vaccinator's circle.
(xv) You will have to perform duty in the hospital for two months to
study the diagnosis of various infectious diseases.
(xvi) Encourage the sale of quinine and remit the sale proceeds to the
District Superintendent of Vaccination for transmission to the Superinten-
dent of District Jail, Aligarh.
(xvii) Examine the birth and death register of the chaukidárs and
report the errors or omissions discovered to the District Magistrate through
your Assistant Superintendent.
(xviii) You must wear your uniform when on duty.
(xix) All communications to higher authorities should be submitted
through your Assistant Superintendent of Vaccination.
(xx) Explain to the parents of the children at the time of vaccination,
to protect the childrens' arms from sun, dirt, flies, &c., by letting them wear
*Do not squeeze the vesicle to get out lymph. It must exudo spontaneously. The
lymph should be limpid and clear, not turbid.
UNITED PROVINCES OF AGRA AND OUDH.
25
loose sleeves to their coats, and inform them that they should not apply
anything whatever to the vesicle but to leave it undisturbed to run its
course.
(xxi) Do not vaccinate children whose faces are pitted with small-pox
marks, or children who are suffering from illness.
(xxii) Each vaccinator should perform not less than 2,000 operations
in the season. Rewards will be given and promotion accorded for good
work.
J. CHAYTOR-WHITE, M.D., D.P.H., (CAMB.), MAJOR, I.M.S.,
Sanitary Commissioner, U. P. of Agra and Oudh.
4
UNITED PROVINCES OF AGRA AND OUDH.
29
VACCINATION FORM No. 1.
Initial signature of District
Superintendent or Deputy
Sanitary Commissioner.
Number of vaccination.
Date of vaccination.
Name of
village or
mohalla.
Name of the
person vacci-
nated with that
of father.
Caste.
Christians.
Muhammadans.
Hindus.
Other classes.
Primary vaccination.
Sex.
Male.
Female.
Results.
Successful.
Unsuccessful.
Absent.
Age of suc-
cessful case.
Under
one
year.
One and under
six years.
Six years and
upwards.
Re-vaccination.
Sex.
Male.
Female.
Result.
Successful.
Unsuccessful.
Absent.
Name of person with whom
Register No. 5 is left.
Signature of the Assistant
Superintendent of Vacci-
nation.
30
MANUAL OF VACCINATION FOR THE.
VACCINATION FORM No. 2.
Weekly abstract of totals of the Vaccination Register for the month of—190
, for Tahsíl—,
District—
Week.
First ...
Second
...
Third
...
Fourth* ...
Dates of week.
From 1st to 7th ...
From 8th to 14th ...
From 15th to 21st ...
From 22nd to end of
month.
Total ...
Total for the corresponding month of
the previous year.
Primary vaccination.
Sex.
Male.
Female.
Total.
Caste.
Christians.
Muhammadans.
Hindus.
Other classes.
Total.
Result.
Successful.
Unsuccessful.
Absent.
Total.
Age of successful case.
Under
one
year.
One and under
six years.
Six years and
upwards.
Total.
Re-vaccination.
Sex.
Male.
Female.
Total.
Success¬
ful.
* The remaining days of the month should be included in the fourth week.
NOTE.—This statement should be submitted to the Assistant Superintendent of Vaccination within five days after the expiry of the month.
Date—
Signature of
Vaccinator—
UNITED PROVINCES OF AGRA AND OUDH
31
VACCINATION FORM No. 3.
Statement showing vaccinations performed in the district during the month
of—190
Number.
Name of
Vaccinator
Name of
Tahsíl
where
posted.
Total
...
Primary vaccination.
Sex.
Male.
Female.
Total.
Caste.
Christians.
Muhammadans.
Hindus.
Other classes.
Total.
Result.
Successful.
Unsuccessful.
Absent.
Total.
Age of successful
case.
Under
one
year.
One and under
six years.
Six years and
upwards.
Total.
Re-vaccination.
Sex.
Male.
Female.
Total.
Successful.
Increase or decrease in com¬
parison with corresponding
month of the previous year.
Total of successful
primary vaccinations
and re-vaccinations
for the present month.
Total of successful
primary vaccinations
and re-vaccinations
for the correspond-
ing month of the
previous year.
Increase.
Decrease.
NOTE.—This statement should be submitted to the District Superintendent of Vaccination within seven days after the expiry of the month.
Date—
Signature of Assistant Superintendent of Vaccination.
32
MANUAL OF VACCINATION FOR THE
VACCINATION FORM No. 5.
List of persons vaccinated in village or mohalla—district—
Serial number.
Date of vacci-
nation.
Name of the
child vaccinated. Father's name
Caste.
Sex.
Age.
Result.
Number of
vaccination
as entered in
the register.
Seal or
signature of
the vacci¬
nator.
VACCINATION FORM No. 5a.
List of persons vaccinated in village or
mohalla—district—
Number.
Date of vacci¬
nation.
Name of the
child
vaccinated.
Father's name
Caste.
Sex.
Age.
Result.
Number of
vaccination
as entered in
the register.
Seal or
signature
of the vac¬
cinator.