NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
THE GOVT. OF BENGAL PROPER.
21
so disseminated; but it is not conducted under special superintendence
and guardianship, the results, therefore, are not altogether reliable.
67. The results of the district or zillah, and municipal vaccina-
tion are shewn in the table in the Appendix.
Detached vac-
cination at San¬
kerberiah.
68. Dr. Charles' account of the stamping out of small-pox at
Sankerberiah is very interesting, and together with his corollary upon
the proceedings therein, viz., his urging upon Government the sanction
for a moveable vaccine establishment, also find place in the Appendix.
69. I make the following remarks upon these papers :—
Dr. Charles' paper, in the Appendix, giving an account of success-
ful vaccination performed by a detached party of his Calcutta vacci-
nators at Sankerberiah, exhibits well the zeal and effective operation
of good vaccination in putting a stop to the extension and spread of
small-pox. This arrest of small-pox, in the vicinity of the metropolis
of India, is a matter fraught with great interest and importance. It
speaks well for the efficiency and thorough good training of the body
of native vaccinators, and the value of the inspecting agency of
Dr. Charles' establishment.
Moveable vac-
cine establish-
ment.
70. Dr. Charles, in his paper on the subject printed in the
Appendix, proposes to entertain a separate moveable establishment of
vaccinators, besides the sixty vaccinators and nine head vaccinators
now under his employment for the villages and country around
Calcutta, in which small-pox has been prohibited and made penal.
A scheme being also, at the same time, before the Government
for the institution of another vaccine circle which is to embrace the
districts of 24-Pergunnahs, Hooghly with Howrah, Burdwan and
Kishnagur, which lie around Calcutta.
71. It seems to me that this will be asking too much of Govern-
ment, considering the additions and concessions in favor of the Calcutta
vaccine establishment recently made. It is concentrating the expenditure
of the State for vaccine too much in one centre. The same increased
outlay may, with equal reason and argument of necessity, be urged by
the Superintendents of the Darjeeling and Ranchee circles, whose
sphere of operations is considerably larger than the Presidency one at
present. Dr. Charles' plan is a most excellent and desirable one, inas-
much as it provides a moveable body ready at any moment to proceed
to any suddenly infected tract of country, and by pouring in a flood of
vaccination to arrest may-be the spread of the invading small-pox, and
avert its approach from Calcutta. The season work of vaccination in
22
VACCINATION PROCEEDINGS THROUGHOUT, &C.
the new circle will not, in the meanwhile, be in any way interfered with
or curtailed ; but, should the expenditure be objected to by Government,
I think that some of the 60 vaccinators, and of the nine head vac-
cinators already granted, may be told off, and made to understand
that they constitute a moveable body, and are to be available for
itineration to infected parts at any moment, working at other times with
the general body of the rest of the staff.
Contents of
figured State¬
ment.
72. I should be sorry to see the proposal, now before the Govern-
ment, for a new circle of vaccination under a European medical officer,
comprising the several large districts or zillahs encircling Calcutta, in
any way prejudiced by a further additional and less important suggestion,
desirable as I acknowledge it to be.
73. The tables, exhibiting the number vaccinated in Bengal Proper,
are herewith attached. They include the vaccination by Dr. Charles,
the Superintendent General of Vaccination at Calcutta, performed at
and around the city itself; also those performed in the zillah districts,
under the dispensary system and within the municipalities; and,
besides, the vaccination carried on in the Darjeeling and Ranchee
circles, and those within the Sonthal Pergunnahs.
THIRD SPECIAL REPORT
ON THE
PRESIDENCY VACCINE DEPARTMENT.
BY
T. EDMONDSTON CHARLES, M. D., M. R. C. P. LOND.
SUPERINTENDENT GENERAL OF VACCINATION.
INDEX.
Nature of the Report ... ... ... ... ... ... ...
Duties of the Superintendent General of Vaccination
...
...
...
CHAPTER I.
Lymph Supply.
Character of the Virus ... ... ... ... ... ... ...
Degeneration of Vaccine ... ... ... ... ... ...
English Lymph ... ... ... ... ... ... ...
Mr. Pearson's Hill Lymph ... ... ... ... ... ...
Storage of the Virus ... ... ... ... ... ... ...
Number of supplies sent ... ... ... ... ... ...
Reports of Results ... ... ... ... ... ... ...
Causes of failure ... ... ... ... ... ... ...
Measures for obviating this tendency to decompose ... ... ...
Other modes of retaining Virus active ... ... ... ... ...
CHAPTER II.
Vaccination in Calcutta and the Suburbs.
Superintendents ... ... ... ... ... ... ...
Vaccinators ... ... ... ... ... ... ... ...
Character of Vaccination ... ... ... ... ... ...
Numbers Vaccinated ... ... ... ... ... ...
Progress of Vaccination. ... ... ... ... ... ...
Classes who do not receive Vaccination .. ... ... ... ...
Measures of Medical Police for arresting small-pox epidemics at their
commencement ... ... ... ... ... ... ...
CHAPTER III
Vaccination in the Districts round Calcutta.
History of the Temporary arrangement ... ... ... ... ...
General Superintendence... ... ... ... ... ... ...
Superintendents ... ... ... ... ... ... ...
Head Vaccinators ... ... ... ... ... ... ...
Vaccinators ... ... ... ... ... ... ... ...
Positions in which the Vaccinators worked ... ... ... ...
Example shewing mode of working
...
...
... ... ...
Number Vaccinated ... ... ... ... ... ... ...
Falling-off when compared with the previous season ... ... ...
Proposal to keep back part of the pay of the younger Vaccinators... ...
Character and Success of Vaccination ... ... ... ... ...
Explanation of Success ... ... ... ... ... ... ...
Conclusion
...
...
...
... ... ... ... ...
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32
THIRD SPECIAL REPORT
ON THE
PRESIDENCY VACCINE DEPARTMENT.
Nature of the
Report
1. The following report has been called for by the Principal
Inspector-General of the Medical Department, in order to enable him
to report fully on the present state of vaccination in Bengal. It will
embrace only the operations conducted under the direction of the
Superintendent General of Vaccination. The vaccination conducted by
the recently appointed Superintendents of Vaccination in the Darjeeling
and Ranchee circles of vaccination, and in that of the Sonthal Pergun¬
nahs, have not been in any way under his control. These new circles
as well as the vaccinators attached to the various civil dispensaries, are
quite independent of the Superintendent General of Vaccination, and are
immediately under the general medical administration of the country.
Duties of the
cination.
2. As stated in the first special report on the Presidency Vac-
cination Department, the functions of the Superintendent General
Vaccination are twofold:—
1st. He has to provide a supply of virus to be disseminated over
India to all those applying for it. 2nd. He has to direct the operations
of the Superintendents of Vaccination in Calcutta. In the report above
alluded to it was stated that also:—3rd." In accordance with a verbal
permission obtained two or three years ago from His Honor the
Lieutenant-Governor, he is allowed to make an attempt to introduce
vaccination in any part of the Mofussil, where he can do so without
entailing fresh expenses beyond those of travelling."
A separate chapter of the report will be devoted to a detail of each
of these duties.
CHAPTER I.
LYMPH SUPPLY
Character of
the virus
3. With the exception of a few supplies of lymph from England
and from the Himalaya, which will be separately alluded to in the fol¬
a
2
THIRD SPECIAL REPORT ON THE
lowing paragraphs, the lymph sent out from this office has been procured
from Calcutta itself. The virus has been of unexceptionable quality,
and, during the cold months, has been used most successfully. The virus
throughout the year has been kept in a high state of perfection, and no
vesicle which was not typically perfect has ever been used to provide
lymph for transmission to another station. In minor characters, the
vesicles in January differ somewhat from those in July, but in all essen-
tial characters they are precisely similar. Their contents I believe to
be identical in all important particulars. Arguing from analogy, I feel
sure that if simultaneous vaccinations were practised with the virus
procured in Calcutta at different seasons, at any place where climate
did not lead to the slight alterations in the appearance of the vesicles
alluded to, the vaccinations, after very few transmissions, would be found
to be not distinguishable, the one set from the other.
Degeneration
of Vaccine.
4. In looking into the annals of vaccination in India, I find
doubts have been expressed as to the efficacy of Indianized lymph. No
facts have been brought forward in support of such allegations, and I
look upon them as entirely groundless. The tendency of the virus to
degenerate and cease to produce vaccinia, seems to have been the founda-
tion on which such a hypothesis has been brought forward. Two ques-
tions are here involved, which, if accuracy is desired, must be kept
separate. The virus, it is true, degenerates in the sense of being unable
to keep up its kind, in consequence principally of superadded in-
flammatory results. When such changes first begin, the virus may, by
careful management, be brought back to a state of perfection. Even in
a single transmission it may become degenerated beyond recall; at
times the change may be more gradual. The moment this transforma-
tion has taken place it is no longer vaccine. A succession of degenerated
vaccinations is not kept up. If a vaccinator attempts from such a
source to keep up a lymph supply he fails. Once or twice he may
succeed in creating inflammatory processes of sorts; but his power of
effecting even this soon stops. No favouring change of climate can
ever bring back such lymph to the characteristic normal vaccine. The
virus, on the other hand, cannot degenerate in the sense of becoming less
protective against variola, and still continuing to be vaccine. The
virus of vaccinia may have subsidiary characteristics impressed on it,
some of which are salutary, while some are prejudicial; but in its great,
essential feature, the fact that it is variola deprived of its secondary
eruption, vaccine as long as it is vaccine remains the same. The
differences between the various forms of small-pox are very great
PRESIDENCY VACCINE DEPARTMENT.
3
and we do not know of one form of small-pox affording more protection
against a second attack than another will. The differences between
one specimen of vaccinia and another are infinitely small when
compared to the differences between even a slight attack of small-
pox and any form of vaccinia, and while it is held that vaccinia pro-
tects equally with a previous attack of variola against an attack of
small-pox, it is extremely difficult to believe that a minor difference in
a vaccine vesicle can, in any way, affect the result. Till the contrary
has been proved by facts, the mere assertion that this vaccine is good,
or that vaccine is bad, in the sense of a greater or less protective
efficacy, deserves but little attention. Degeneration of the virus in this
sense I have never seen to occur, and in the following remarks it is to
be understood, that it is not implied that any kind of vaccine is
superior to another as a prophylactic.
English Lymph.
5. A supply of lymph in tubes, as well as on points and glasses,
was received from the National Vaccine Institution on the 12th
November, 1867, and at once despatched to different stations. The virus
in Calcutta was perfect and was not renewed from this source. With
each supply a memorandum was sent requesting information as to its
success, with the view of comparing the results against those obtainable
from the lymph procured from Calcutta vaccinations, as well as from
that obtained from the Hills. So few replies have been received, that
such a comparison is not practicable. From the fact that so few reports
of failure have reached this office regarding it, it may be supposed that
a fair amount of success has attended on its use. I beg to draw attention
to the fact of the late arrival of the supply of lymph from England, and
suggest that arrangements be made to ensure its being sent at an
earlier date. It requires several transmissions to be made, before a
sufficient abundance of virus can be obtained for extensive vaccination,
and as the vaccinating season is short, the loss of some weeks at its
commencement, constitutes an obstacle to the spread of vaccination,
which should be carefully avoided.
Mr. Pearson's
Hill Lymph.
6. Knowing that Hill people are extremely liable to small-pox
in very virulent and fatal forms, and having seen among them vaccination
under some of its most typical and perfect aspects, at an early period of
my service in India, I contracted a great partiality for vaccine lymph
from such a stock. Believing that the use of such virus might tend
to a more early success in vaccinating throughout Bengal, I procured
several supplies of such lymph from Mr. Pearson, the Superintendent
General of Vaccination in the North-West Provinces. Owing to a
4
THIRD SPECIAL REPORT ON THE
very general want of acknowledgment of the memoranda sent out with
such supplies, it is to be regretted that it is impossible to make the com-
parative statements which it was desired to prepare. From having
myself seen vaccinations from this lymph, I am able to bear testimony
to its being a vaccine possessed of the most desirable characters, to
its infecting power being great, and to its results proving that the
very greatest care has been taken in its propagation and selection, by
those entrusted by Mr. Pearson with this duty. I regret much not
having been able to bring the results out in a statistical form, as such
would, doubtless, have shewn its perfection in a striking light. As on
a recent tour through Europe I have enjoyed opportunities of critically
inspecting vaccination in England, Scotland and Ireland, as well as
in France, Russia, Prussia, Austria, various of the smaller German
states, Holland, &c., &c., I am in a position to claim considerable
weight for my opinion on the subject of the excellency of Mr. Pearson's
Hill lymph. I have rarely seen vaccine with which I have been so
thoroughly satisfied as with that with which he has supplied me, and
I have never seen any that I would prefer to it, unless it be that to be
had in Bengal in January and February, when the climate is such,
that vaccinia flourishes in a state of perfection that it seems impossible
to surpass.
Storage of the
virus.
7. Up till 1864, the lymph sent out by this office was generally
sent in a dry state on ivory points, or between pieces of glass. In either
way it was found to be so unsuccessful that, trusting to my experience in
colder climates, I commenced to make an extensive use of Dr. Husband's
capillary tubes. These tubes had been in use in the department before
I assumed its direction. I find that my predecessor, Dr. J. Macpherson,
had indented for 250 tubes in the year 1859. There is no record
of how many of these were used, as it was only in November, 1862
that a column was introduced into the records to shew how many tubes
were filled. In the whole 12 months of 1863, I find 315 tubes were
filled. Since the end of 1864 and beginning of 1865 the use of
the tubes has become so general as almost to exclude all other methods;
tubes being sent in answer to all applications unless points or glasses
are specially asked for ; very few medical men ask to be supplied with
lymph in any other way, many expressly mentioning that they desire
the supply in tubes.
Number of sup-
plies sent.
8. As a rule, each supply consists of three tubes ; though through-
out the whole year occasional applications are made for lymph, it is prac-
tically only during the six cooler months that any demand for virus
PRESIDENCY VACCINE DEPARTMENT.
5
exists. Even in them the bulk of the applications is confined to
November and December, during which two months, above nine hundred
tubes were distributed last year. In October, January, and February
only some 650 tubes were distributed. In March, little over a hundred,
and in April, only 42 tubes were despatched.
Report of re-
sults.
9. As already stated, I have to regret my inability to tabulate the
results with exactitude. It has been attempted for years to obtain such
precise information, that the degree of untrustworthiness of the virus
supplied may be judged of, especially when compared with that from
other sources of supply. By determining the date at which vaccination
can generally be commenced at stations, at different distances from
Calcutta, it was hoped that the supplies might be so timed, that the
annoyance and other undesirable results, consequent on a yearly failure
to establish vaccinia at the commencement of the season, might be
avoided.
Owing to the over-occupation of the medical officers, the answers
to the memorandum accompanying the lymph have been much fewer
than would have been desirable, and many of them have been so devoid
of precision as to be only useful in a very general way. In estimating
the value of the answers actually received, it must be borne in mind
that a medical officer, receiving a supply of vaccine, is much more ready
to reply, if the result is not successful (as this is necessary to ensure a
further supply being sent) than he is, when success is obtained and no
further supplies are required. The ratio between success and failure
cannot even be approximately guessed at by any information at my
disposal. The effect of season, in determining the result, is evident
from the following table, though owing to a want of precision in
the reporters even this must not be taken to represent absolute
correctness.
Table shewing the results which have been reported from the use of
Calcutta Lymph from October, 1867 to March, 1868.
Year and Month.
1867.
October
...
...
...
...
November ... ... ... ...
December ... ... ... ...
1868.
January
...
... ... ...
February ... ... ... ...
March ... ... ... ...
Grand Total ... ... ...
Reports of success.
2
12
16
11
13
6
60
Reports of failure.
4
15
5
1
3
1
29
6
THIRD SPECIAL REPORT ON THE
As examples of stations in which success was obtained early in
the season, I may instance Mozufferpore and Midnapore, the dates of
the respective reports being 22nd and 30th October.
As shewing that it has been possible to send lymph in an active
state for long distances, in spite of very hot weather at the end of the
vaccinating season, I may state that lymph, despatched from Calcutta
on the 15th and 22nd February, and the 4th and 21st March, was success-
fully used at Jhansi to re-vaccinate the 93rd Highlanders.
I append a table shewing the results which have been reported
from the use of lymph from different sources, which, though very
defective and not quite reliable, is nevertheless of interest.
Table shewing the results of English, Hill, and Calcutta Lymph
despatched from this office in each month, commencing from
October 1867 to April 1868.
Year and Month.
1867
October ...
November ...
December
...
1868
January ...
February ...
March ...
April ...
Grand Total ...
English Lymph
Number of
Supplies
...
21
...
...
...
...
...
21
Successful
...
...
2
1
...
...
...
3
Failed.
...
...
2
2
...
...
...
4
Not
Reported
...
...
...
...
...
...
...
14
14
Hill Lymph.
Number of
Supplies
...
18
3
...
4
3
10
38
Successful.
...
1
4
1
...
...
...
6
Failed
...
1
...
1
1
...
...
3
Not
Reported
...
...
...
...
...
...
...
29
29
Calcutta Lymph.
Number of
Supplies.
74
131
127
80
65
43
9
528
Successful.
2
12
16
11
13
6
3
63
Failed.
4
15
5
1
3
1
...
29
Doubtful
1
1
...
...
...
...
...
2
Not
Ascertained
...
...
1
...
...
...
...
1
Not
Reported.
67
103
105
68
49
35
6
433
Causes of
failure.
10 In exceptional cases, want of skill in vaccinating, leaving the
virus unused for some time after its arrival, and the attempt to vacci-
nate too many subjects with a small amount of virus doubtless lead
to some of the want of success. That I am possibly insisting too
lightly on such causes, may be suspected, when I mention that two
medical officers reported that with three tubes they had respectively
attempted to vaccinate 30 and 40 subjects, but met with failure.
Primary differences in the infecting power of the lymph, and in the
receptive power of individuals in unfavourable climates, as well as
the prejudicial effect of a merely high temperature on the virus, may
also be surmised to be accountable for some of the failures. The
great cause of want of success, is to be found in the fact, that the
virus becomes rapidly inactive after being shut up in the tubes.
In arm to arm vaccination success is all but absolutely certain; but at
PRESIDENCY VACCINE DEPARTMENT.
7
a very early period after the virus is removed from the arm it becomes
inert. Under the microscope the lymph is found to have undergone
transformation, and frequently very beautiful crystalizations are met
with. Destructive changes of a putrefactive nature are very generally
observable in such lymph.
The virus sent from England, as well as that procured from the
Hills, is also liable to become inert. That introduced into tubes in
Calcutta, is much more apt, however, to decompose than either of the
other varieties.
I attribute the extreme liability to decomposition to two causes :
1st, to the use of improper tubes. 2nd, to the existence in the atmos-
phere of Calcutta, in great abundance, of an active agent which leads to
rapid Putrefaction.
Measures for
obviating this
tendency to de-
compose
1st provision
of better tubes
11. In my first special report in 1865, I pointed out that the tubes
supplied by the Medical Store Department, were unlike those proposed
by Dr. Husband, which I had previously been in the habit of using.
Both the bore, and the thickness of the glass, are excessive. From
this it results, that an unnecessary amount of air is shut up in the
tubes, and an avoidable amount of heat is required to close them: both
evils of the first magnitude, when delicate results are at stake. In 1864
the imperfections of these tubes were pointed out to the Officer in
charge of the Medical Stores; and a representation on the point was
sent to the authorities who supply them in England.
I observe also, that a letter from the Government of Bengal, No.
6925, of the 2nd December, 1865, to the officiating Principal Inspector-
General, says in para. 6 : " His Honor requests that you will either pro-
vide the capillary tubes referred to by Dr. Smith, or authorize him to
obtain them at a cost not exceeding Rs. 500," as I was not in India then,
and can find no further correspondence on the subject, I do not know
what further steps were taken in the matter.
The same form of tubes is issued as before my representations
were made. The worst of the tubes are rejected, and not filled with
lymph, but when even the best are bad, such a process of selection
affords only limited advantage. Early attention to this matter is solicited.
2nd counterac-
tion of putrefac-
tive agency.
At first sight the observation that vaccine lymph, shut up in tubes
in the Delta of the Ganges, at certain seasons, has a marked tendency to,
decompose more rapidly than that similarly treated among the heights of
the Himalayah, might seem to be a fanciful one. It is in strict accord,
however, with the investigations of Schroeder and other earlier observers
on similar points, unconnected with vaccination. The numerous enquiries