NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
8
THIRD SPECIAL REPORT ON THE
of Pasteur during the last ten years into the subject of various fermen-
tations and decompositions, and especially his more recent labours on
the question of putrefaction, tend to explain what might be mysterious
or inexplicable in the fact I now bring to light. Pasteur's researches
also serve to guide us in making efforts in an intelligent direction
towards obviating the tendency to spoil.
We have abundant agencies at our command, to prevent the
lymph from undergoing the decomposition complained of, but unfor-
tunately most of our best antiputrescents are also disinfectants.
At the same time that we prevent decomposition we also destroy
completely the active principle of the virus. In experimenting with
sulphurous acid it has been found, that a ten per cent. solution of
that gas in water within a few seconds renders the virus inert.
A similar solution of carbolic acid is not nearly so destructive, but
as it coagulates the virus, in this strength at least, it will not fulfil neces-
sary requirements. I do not yet despair of finding some feeble antisep-
tic, which, in a state of great dilution, may sufficiently overcome this
tendency to putrefaction, without destroying the potentiality of the
virus. Knowing that cresylic acid possesses most of the properties
of carbolic acid, without the power of coagulating albumen, a supply
of it has been sent for from England, as none is obtainable in this
country. Memoranda for experiments, with a long list of substances,
have been prepared, some of which have already been tried or are at
present being investigated. As no useful purpose would be served by a
simple enumeration of partial success or failure, or of undetermined
results, I have not thought it necessary to give any detail regarding the
experiments. In the present state of the enquiry I may mention
that salts of soda and potass seem to hold out the most encouraging
prospects.
Glycerine by itself is possessed of little power of preservation,
possibly a glycerole of the chlorate of potass, or some similar preparation
may be found to answer. A ten per cent. solution of the chloride of
sodium in water affords most material aid in keeping the lymph
effective. Even were no other result obtained, the knowledge of this
one single fact would repay me for the thought and labour the investi-
gation has required. The property which such a solution has, of
keeping the virus from spoiling, can be usefully taken advantage of by
the medical officers all over India, as everywhere in the plains the
difficulty of keeping lymph exists. Now that the key to the solution
PRESIDENCY VACCINE DEPARTMENT.
9
of the question has been found, every medical officer will be able to
assist in the enquiry by experimenting with likely agents. It is only
now a question requiring time and observation, to determine the
relative capabilities of different substances in definite proportion, in
accomplishing this end.
Though it has been indicated that salting the lymph in a good
method, it cannot yet be predicated what will be found the best pro-
cedure.
In the course of these experiments it has been determined that
cobra poison (another animal virus) loses its potentiality by keeping.
Two specimens of dry cobra poison, which had been long kept in a dry
state, were found to be inert. Solutions of these specimens were injected
below the skin of pigeons, without effect.
The influence of temperature in facilitating decomposition was early
noticed during these enquiries. In the early months of 1865, stores of
lymph were shut up in the expence magazine of the Calcutta Ice-house.
The temperature was not sufficiently low to resist the extreme tendency
to decompose, and the experiment was a failure.
As even a few extra degrees of heat favour the production of such
changes (whether antiseptic agents are used or not) it has been found a
useful precaution to expose the tubes to the air as little as possible.
They are habitually kept in porous vessels filled with water. The
evaporation, when the air is dry, tends to reduce the temperature of the
water, and though a very simple measure, the precaution is sometimes
very efficacious in delaying the changes which it is wished to guard
against. I consider that this practise is so useful, that it deserves to be
made generally known to others, who may have experienced the same
difficulties in preserving a little store of lymph even for short periods.
Other modes of
retaining virus
active.
12. As my experience of the fluid lymph stored in tubes, differed so
much in India from my former experience of it, (at a time when it seemed
uncertain, as to whether success would be arrived at, in the endeavours to
keep lymph in a fluid state) some experiments were made to ascertain
the feasibility of keeping crusts or dried virus in an active condition.
Since so great a necessity for the investigation has not existed, such an
enquiry has been partially desisted from; it doubtless deserves, however,
future prosecution. As one instance, further exemplifying the direction
experiment ought to take, it may be stated that the virus was rapidly
dried over strong sulphuric acid in the exhausted receiver of an air
b
10
THIRD SPECIAL REPORT ON THE
pump, and then kept under the influence of soda lime to ensure
extreme dryness being retained.
CHAPTER II.
VACCINATION IN CALCUTTA AND THE SUBURBS.
Superin¬
tendents.
13. The three Sub-Assistant-Surgeons, who are the Superintendents
of vaccination in Calcutta, continue to discharge their duties, as well as
the present arrangements, which require that most of their time should
be devoted to superintend vaccination in the surrounding districts, will
permit them to do. In my two previous reports, I have drawn attention
to the fact, that it is extremely undesirable that the practice of taking
them away from their substantive duties should be allowed to continue.
In consequence of my previous representations on this question, I anti-
cipate that they will be required to devote themselves to their duties in
Calcutta and the Suburbs during the next vaccinating season.
Vaccinators.
14. The pay of the vaccinators is entirely defrayed by the muni-
cipalities of the respective places in which they are employed. The
Suburban Municipality has been paying for fifteen vaccinators at the
rate of ten rupees each per mensem since October 1866, while the
Calcutta Municipality has, since 1st January, 1868, provided for the
pay of three head vaccinators and twelve vaccinators at the rate of fifteen
rupees for each head vaccinator, and ten rupees to each man of the
other class. Owing to the unequal distribution of the suburbs round
Calcutta, it was found difficult to divide the duties, so as to make an
equal share of work fall on the class of head vaccinators. The arrange-
ment has been made that the pay of the Suburban Vaccinators shall be
graduated, so that those in positions little lighter than those of a head
vaccinator, shall be more highly recompensed than others. Vacccinators
have been entertained on a pay of eight rupees to permit of the arrange-
ment being carried out without entailing extra cost. In one instance,
in which the charge was more heavy than the others, the pay has been
supplemented up to that of a head vaccinator.
Character of
vaccination
15. After the remarks made, regarding the degeneration of vaccine
in para. 3, I trust my present meaning will not be liable to be misinter-
preted. During the last year I have seen more cases shewing a tendency
to take an inflammatory action than I have seen in Calcutta since 1865.
In the north division, I had again and again to call the attention of the
Superintendent to the subject, and to guard the vaccinators against the
danger they ran of allowing the virus to degenerate. My own attention
PRESIDENCY VACCINE DEPARTMENT.
11
was not attracted to the point so much in the other divisions; but in the
diary, kept by the Superintendent of the middle division, I see he has
made the same observation repeatedly, and has been most indefatigable
in insisting upon the vaccinators guarding against this fault. This daily
record of his proceedings has been most diligently prepared by Baboo
Buddynath Brummo and might serve as a model of neatness, complete-
ness, and precision, for any one requiring to be taught how to furnish
such a document. It serves to aid the Superintendent General in a
most effective way to obtain a more exact insight into the daily working
of the department than he could possibly obtain in any other way. This
inflammatory tendency is a great part preventable. As soon as the
Superintendents can devote more of their attention to the vaccinators it
may be expected to diminish. For this alone, if for no other cause, I
would urge that the Superintendents should be allowed to confine
themselves to the duties for which they were appointed.
Independent of the importance of a supply of perfect virus,
the question of good or bad vaccination exercises much influence on the
popularity with which the practice is received. The pain and fever
attendant on unnecessary inflammation, are drawbacks to accepting
vaccination, of which unwilling people will be ever ready to take
advantage in disparaging this prophylactic.
Numbers
vaccinated.
16. The numbers vaccinated in Calcutta during the last vaccinating
season have amounted to 3,848, while those in the Suburbs have been
4,685. These numbers may be taken to represent pretty fairly the
amount of vaccination among the permanent population of Calcutta
and its Suburbs, as many more persons have been vaccinated by the
same establishment, but have not been included in the above statements,
owing to their having only been temporary residents while passing
through Calcutta to some other destination. A great proportion of these
have been cases of juvenile vaccination, but the exact extent to which
infant vaccination has been practised cannot now be stated, as the time,
necessary to determine this point, precludes the calculation being made
before the report must leave this office. For practical purposes, however,
the figures as they stand might be compared against the birth-rate of
Calcutta, and they approach somewhat closely to the births which have
been registered. Owing to the imperfection of the data, as regards the
number of births, which actually take place in Calcutta, this happy state
of matters is only an apparent one; the real fact being, that the numbers
vaccinated yearly will be found to fall very far short of the birth-rate
12
THIRD SPECIAL REPORT ON THE
whenever a reliable registration is ensured. As stated in the second
special report, arrangements were made to register the vaccinations
according to the districts in which the births were registered, so that
those places in which the greatest discrepancy existed between the two
might be known. Owing to the system of registration having been
again changed during the year, I am yet unable to make the com-
parison wished for.
Progress of
Vaccination
17. In spite of the unsatisfactory nature of the figures which I
have more than once brought before the Government, and on the signi-
ficance of which I have before dwelt, I am personally aware of the fact
that year by year fresh families are persuaded to accept vaccination who
have never consented to receive it before. This fact is mentioned, more
with the intention of convincing the Government that something can be
done to remedy the unsatisfactory condition of matters at present exist-
ing, than of pretending that any real efficient progress is being made. If,
for a short series of years, a well organized attempt were directed towards
the accomplishment of this end, undoubted progress would be certain.
The fact was early recognized, that an ignorant vaccinator, a man of
no social standing, was absolutely ineffective as an agent for persuad-
ing the citizens of the metropolis to allow themselves to be vaccinated
That a medical man should go from house to house and combat the
obstacles which prevent progress, is a necessity that cannot be avoided.
As soon as the Superintendents are again made available for this duty,
more or less advance will follow as a matter of course.
In 1865 very strong recommendations were made to push the
advantage we had then within our reach. With the terrors full in
remembrance of the unparalleled calamity from the epidemic of small-
pox which had, at the time of my report desolated their households, the
task of forcing vaccination on their acceptance, would have been compara-
tively an easy one. Now the amount of labour required will be tenfold
more than it would have been if the suggestion had been acted on at the
time that it was made. The counter proposal to delay action in this matter
has resulted in a check to the further advance of vaccination in
Calcutta, which it will take many years, and much hardwork, to overcome.
Classes who do
not receive vac-
cination.
18. In addition to large numbers of the Bengalee population, who
have not yet adopted the practice of vaccination, simply because it has
not been systematically and effectively forced on their acceptance, there
exists a large class of Hindustanee residents, who have never yielded to
the strongest solicitations. The task does not seem a very hopeful one
PRESIDENCY VACCINE DEPARTMENT
13
but still I consider that if every year the subject is brought before them,
and urged on their attenion, some of the most influential members of the
community may yet be talked over. If this anticipation should be real-
ized, for the others to yield also, will only become a question of time. At
present the greatest danger to Calcutta from small-pox,lies in the presence
of this community. The thousands living in the " Burra Bazaar" form
an assembly of unprotected persons, among whom the slightest spark
of small-pox contagion would be sufficient to light up a conflagra-
tion, which would endanger the public health of every street in the city.
This community is too wealthy and too fond of having recourse to law
courts, to leave much ground for hoping that firmess in insisting that they
should comply with the practice of all other classes of their fellow
citizens, will for the present avail much. They are aware that the
subject of a compulsory vaccination law, at some future date, has
already been mooted for their special benefit. They have told me, as
they have no objection to vaccination, the passing of such a law would
not distress them. That when the law is passed they will at once obey
it, but that till then they will not allow themselves to be vaccinated.
In the mean time should the measures alluded to in the following
paragraph be legalised, they will doubtless re-act by making the Hindu-
stanee population more ready to listen, when appeals are made to them
on the subject of vaccination.
Measures of
Medical Police
for arresting
small-pox epi-
demics at their
commencement
19. Some measures of medical police are urgently called for, before
the good effects of systematic vaccination can be brought out, in the
forcible light in which they are capable of being exhibited. It is
necessary that each case of small-pox, as it occurs, should be brought
to notice, and that steps should be taken to ensure more or less
strict isolation of such cases. A report on this subject has been
addressed to the Commissioner of Police in Calcutta, and it is hoped
that he will take the necessary steps for having the matter brought
before Government. It seems unnecessary to go again into the question
at length, and a copy of the report referred to, is appended to this one
from which any further information that may be desired can be obtained.
CHAPTER III.
VACCINATION IN THE DISTRICTS ROUND CALCUTTA.
History of the
temporary ar-
rangement.
20. As already detailed in para. 2 of this report, the present
arrangement for vaccinating round Calcutta has resulted from a very
small beginning. It was desired to ascertain whether the country people
14
THIRD SPECIAL REPORT ON THE
in the neighbourhood could not be induced to accept vaccination. An
experiment was begun. In carrying it out, it was stipulated that no cost
beyond that of travelling should be incurred. In the beginning of 1865 a
sum of Rs. 500 was sanctioned, to pay for a few extra vaccinators, and as,
before the end of the season, the sum allowed had been expended, a grant
of Rs. 400, (required to enable vaccination to be continued till the hot
weather set in), was also sanctioned. A permanent establishment, on the
ground that the undertaking had now exceeded the bounds of an experi-
ment was proposed, and Superintendents, head vaccinators, vaccinators,
and, all the machinery for a complete vaccine establishment was asked
for. Permanent arrangements were deferred, and a grant of Rs. 900 for
extra vaccinators was made; subsequently two successive sums for
Rs. 500 were also provided, making a total of Rs. 1,900 for the
vaccinating season of 1865-66.
In December 1866, the entertainment of forty vaccinators during
six months was provided for, the arrangement being retrospective to
meet expenses which had been incurred in anticipation of the sanction.
On the 2nd of September, 1867, these forty vaccinators became a
permanent instead of a temporary establishment, the season 1867-68
being the first one in which a permanent establishmeut of vaccinators
for working round Calcutta has been in existence.
General Super¬
intendence.
21. While the experiment was being tried, the Superintendent
General directed the operations. Even after special vaccinators had been
sanctioned he continued in charge as a voluntary duty, anticipating that
permanent arrangements would shortly be made; without any correspon-
dence on the subject, the work of these vaccinators has been directed.
Last season it was found impossible on many occasions to leave Calcutta
when his presence in the districts round would have been very bene-
ficial. In other words, the necessary amount of supervision was found
incompatible with the due performance of the duties of his substantive
appointment. The general superintendence of vaccination, when counted
by the hundred thousand, constitutes no light or easy task when properly
performed, and it is respectfully urged that it is not a duty which
can be tacked on to those of an officer who has already sufficient
occupation.
I beg that the Principal Inspector-General will forward a strong repre-
sentation to Government on the subject, in order that I may be relieved
from a charge, which though cheerfully assumed, while an experiment,
was being made, has for long quite out-grown my capacity for exercising
PRESIDENCY VACCINE DEPARTMENT.
15
an effective control. I trust, that under no circumstances will it be
found necessary for me to continue in this charge any longer; but
should the exigencies of the public service require that this establish-
ment should be directly under me, during the next working season,
I trust that arrangements will be made to recompense me for the
responsibility involved. It is impossible to predict what will be the
out-turn of work performed by this establishment during the coming
cold weather; but if, as is expected, Superintendents are appointed,
it will be such, at to compare against the whole vaccination in the
Punjab or North-West Provinces. In the following season, if extra
vaccinators are sanctioned, it will prove a source of disappointment
if the work does not exceed that performed by the other vaccine
establishments named. If the matter were so placed before Govern-
ment, it seems certain that they would not expect that duties, now no
longer on an experimental footing, should be gratuitously performed.
Even in the event of a special officer being appointed to this duty,
it will probably seem right that, for the present at least, the direction
of the establishment should remain in my hands. Any medical
officer, could very soon make himself capable of performing the duties of
general superintendence; but it would take him much longer time
to direct efficiently, such a large undertaking.
Superinten-
dents.
22. The three Superintendents of Vaccination for the Town and
Suburbs have been, from necessity, employed in the supervision of the
vaccination practised in the Mofussil. No Superintendents have yet
been appointed for this duty. The duties to be performed by them are
very laborious, and when extensive vaccination is being practised in the
Mofussil, it is a most unsafe arrangement to entrust its supervision to
men with other duties.
In the Calcutta system, the Superintendent being a medical man,
may be held to represent the keystone of the arch. He is the centre
round which every minor arrangement hinges. He may be said to be
not only the controlling power but the moving power of the whole
machinery. In minor points of the arrangements, slight deficiencies
matter little, but by anything affecting the superintendence the
welfare of the department in every direction is involved. Diminish the
supervision, and the Calcutta system is no longer what it professes to be;
seriously interfere with it, the system collapses, the establishment
becomes inefficient for good, powerful only for evil. Gangs of vaccina-
tors working in Bengal, without the strict controlling agency of medical
16
THIRD SPECIAL REPORT ON THE
supervision, constitute an element, dangerous to the ultimate success
of vaccination, which cannot too carefully be guarded against. Baboos
Jadub Chunder Ghose, Buddynath Brammo, and Sreenath Mookerjee
have performed the duties of Superintendents. The two first mentioned
Sub-Assistant-Surgeons have been engaged in their present duties for
many years, and are most efficient, trustworthy, and meritorious in regard
to the responsibilities entrusted to them. They possess natural aptitude
for the work; while years of experience and training, render them
efficient in the discharge of their duties, to a degree which renders
their services in this department very valuable.
Baboo Sreenath Mookerjee is a First Grade Sub-Assistant-Surgeon
of 19 years' standing. This has been the first season that he has been
in the vaccine department, consequently I am not in a position to bear
such emphatic testimony regarding him. I am glad, however, to be able
to say that he has been anxious to do his duty, and up to his abilities-,
has discharged his various functions to my satisfaction.
During his long service, he has commanded the good opinions of
all under whom he has served, and he possesses testimonials, pointing to
his diligent service, of no ordinary character. In several respects I con-
sider him not so well qualified to fill the appointment he now holds, as
he would be to do justice to almost any other post. As I believe him
to be a very deserving and meritorious servant of the Government, I
have much pleasure in recommending that he should be promoted to
any other position, in which his services would be more appreciated, in
consequence of his greater fitness to discharge duties other than those
he now performs. I have the less hesitation in recommending such a
measure, as he has evinced his readiness to leave the vaccine depart-
ment by applying for another appointment. At present his loss to the
department will not be felt; after two or three years of training and
experience, it would doubtless be more difficult to part with his services.
Head Vaccina-
tors.
23. In the first special report on the Presidency vaccine establish-
ment the need for such a grade was pointed out, and sanction asked for
an addition of nine such men. In the second special report the same
point was again adverted to. On the 23rd October, 1867, a letter was
addressed to the Secretary to the Government of Bengal, requesting
that nine men of this grade might be provided for work during the
coming season. Sanction was given to the arrangement, and a report
called for, as to its working, at the end of six months. On the 16th
April this report was submitted, and these nine head vaccinators now