NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
ix
APPENDIX A.
STATEMENT SHOWING THE NUMBER OF VACCINATIONS PERFORMED
IN MUNICIPAL TOWNS ON CHILDREN UNDER ONE YEAR OF AGE
DURING THE YEAR 1917-18.
TOWNS.
1
HISSAR DISTRICT.
Hissar ... ... ...
Hansi ...
...
...
Bhiwani ... ... ...
Sirsa
...
... ...
Fatehabad ... ... ...
ROHTAK DISTRICT.
Rohtak ... ... ...
Jhajjar
...
...
...
Beri ...
... ...
Gohana ... ... ...
Bahadurgurh ... ... ...
Sonepat
...
... ...
GURGAON DISTRICT.
Rewari
...
... ...
Palwal
...
... ...
Firozpur ... ... ...
Hodal ... ... ...
Ballabgarh
...
...
...
Faridabad ... ... ...
KARNAL DISTRICT.
Karnal
...
... ...
Kaithal ... ... ...
Panipat ... ... ...
Shahabad
...
... ...
Thanesar ... ... ...
AMBALA DISTRICT.
Ambala ... ... ...
Jagadhri
...
...
...
Burya ... ... ...
Sadhaura
...
... ...
Rupar
...
... ...
Number of births during the year.
2
922
784
1,573
638
52
1,104
653
402
331
330
676
1,031
630
392
397
233
247
1,141
741
1,482
473
154
929
539
160
370
370
Number of deaths amongst child-
ren under one year during the
year.
3
225
223
416
232
14
269
137
127
91
69
156
262
199
143
98
46
85
245
174
430
92
31
75
159
71
82
95
Number of successful vaccinations
on children under one year
during the year ending March
1918.
4
607
444
785
491
50
691
262
214
66
143
390
544
402
75
174
182
116
710
362
918
360
114
856
301
78
248
230
Date of extension of Vaccination
Act to town.
5
Act is not in force.
28th August 19l7.
Act is not in force.
4th April 1891.
24th February 1909.
22nd May 1894.
24th February 1909.
7th November 1900.
16th July 1904.
15th June 1915.
Act is not in force.
19th February 1917.
Act is not in force.
23rd March 1914.
161h December 1909.
14th August 1917.
Act is not in force.
7th May 1890.
7tb February 1910.
Act is not in force.
12th June 1900.
X
APPENDIX A— CONTINUED.
TOWNS.
1
SIMLA DISTRICT.
Simla
...
...
...
KANGRA DISTRICT.
Kangra
...
...
...
Dharmsala
... ... ...
HOSHIARPUR DISTRICT.
Hoshiarpur
...
...
...
Khanpur
...
... ...
Hariana
...
...
...
Garhdiwala
...
... ...
Dasuya
...
... ...
Tanda-Urmar
...
... ...
Miani
...
...
...
Mukerian
...
...
...
Una
...
...
...
Anandpur
...
... ...
JULLUNDUR DISTRICT.
Jullundur
...
...
...
Kartarpur
...
... ...
Bungah
... ... ...
Rahon
...
... ...
Phillaur ... ... ...
Nurmahal
...
...
...
Nakodar
...
...
...
LUDHIANA DISTRICT.
Ludhiana
...
...
...
Jagraon
...
... ...
Raekot
...
...
...
Khanna
... ... ...
FEROZEPORE DISTRICT.
Ferozepore
...
...
...
Zira ... ... ...
Dharmkot
...
...
...
Muktsar
...
... ...
Fazilka
... ... ...
Number of births during the year.
2
381
118
65
769
102
169
112
292
397
262
111
1286
128
2,545
375
233
341
241
389
476
2,050
843
392
208
837
217
271
364
582
Number of deaths amongst child-
ren under one year during the
year.
3
142
27
14
199
19
31
18
64
84
46
31
34
34
528
55
47
68
59
47
66
373
200
95
55
220
62
28
64
181
Number of successful vaccinations
on children under one year
during
the year ending March
1918.
4
378
26
57
300
33
40
35
103
79
75
33
69
59
1,559
70
112
208
94
166
156
1,619
489
158
40
385
145
189
179
332
Date of extension of Vaccination
Act to town.
5
3rd October 1887.
Act is not in force.
11th November 1893.
Act is not in force.
13th September 1893.
Act is not in force.
25th February 1907.
23rd May 1917.
Act is not in force.
1st November 1911.
xi
APPENDIX A—CONTINUED.
TOWNS.
1
LAHORE DISTRICT.
Lahore
... ... ...
Chunian
...
... ...
Khudian
...
...
...
Kasur
...
... ...
Khem Karn
...
...
...
Patti ... ... ...
Baghbanpura Bhogiwal
...
...
AMRITSAR DISTRICT.
Amritsar
...
...
...
Majitha
...
...
...
Jandiala
...
...
...
Tarn Taran ... ... ...
GURDASPUR DISTRICT.
Gurdaspur
...
...
...
Dinanagar
...
... ...
Pathankot
...
... ...
Dalhousie
... ...
...
Batala ... ... ...
Dera Nanak
...
...
...
SIALKOT DISTRICT.
Slalkot ... ... ...
Daska ... ... ...
Jamke
...
...
...
Pasrur
...
...
...
Zaffarwal
...
...
...
Narowal
...
...
...
Sambarial
...
...
Sahowala
...
...
...
Begowala
...
...
...
Bhopalwala
...
... ...
Mitranwali
...
...
...
Badomali
...
...
...
Kalaswala
...
...
...
Daud
...
... ...
Chawinda
...
... ...
Number of births during the year.
2
7,455
412
173
1,174
308
406
345
7,169
259
331
234
180
323
255
20
1,480
159
2,580
835
150
279
112
181
165
181
239
232
178
113
166
158
164
Number of deaths amongst
children under one year during
the year.
3
2,179
130
51
271
79
105
142
2,120
74
64
62
35
106
91
9
261
27
410
71
32
78
46
54
80
37
136
63
32
14
35
49
24
Number of successful vaccinations
on children under one year
during the year ending March
1918.
4
6,832
80
81
682
111
197
76
4,540
171
226
78
128
184
164
150
951
120
1,413
145
102
116
48
76
95
121
90
137
116
39
90
60
48
Date of extension of Vaccination
Act to town.
5
25th November 1892.
13th October 1916.
Act is not in force.
18th January 1917.
13th March 1917.
Act is not in force.
17th December 1884.
Act is not in force.
2nd June 1917.
15th December 1916.
2nd December 1916.
25th October 1894.
Act is not in force.
16th June 1914
Act is not in force.
xii
APPENDIX A—CONTINUED.
TOWNS.
1
GUJRANWALA DISTRICT.
Gujranwala
...
... ...
Wazirabad
...
... ...
Eminabad
...
...
...
Kila Didar Singh ... ... ...
Akalgarh
...
...
...
Ram Nagar ... ... ...
Sohdra
...
...
...
Hafizabad ... ... ...
Khangah Dogran
...
...
Pindi Bhattian ... ... ...
Sangla
... ... ...
Sharakpur
... ... ...
Shahkot ... ... ...
Chuharkana Mandi
... ...
Nankana Sahib ... ...
GUJRAT DISTSICT.
Gujrat
...
... ...
Jalnlpur
... ... ...
Kanjah
...
... ...
Dinga
...
... ...
SHAHPUR DISTRICT.
Shahpur ... ... ...
Sahiwal
...
...
...
Bhora ... ... ...
Miani ... ... ...
Khushab
...
...
...
Sargodha
...
... ...
JHELUM DISTRICT.
Jhelum
...
...
...
Find Dadan Khan
...
...
RAWALPINDI DISTRICT.
Rawalpindi
...
...
...
Murree
...
... ...
Number of births during the year.
2
1,233
609
167
64
162
114
226
189
53
162
44
165
47
48
100
1,030
478
347
211
140
377
743
286
310
205
388
473
1,587
41
Number of deaths amongst
children under one year during
the year.
3
369
200
42
40
15
60
69
65
21
58
7
45
19
16
12
218
94
73
29
60
178
156
58
162
64
108
152
438
9
Number of successful vaccinations
on children under one year
during the year ending March
1918.
4
657
303
62
37
68
29
26
58
18
61
26
86
23
20
98
702
326
211
132
38
89
427
106
201
188
348
213
1,059
41
Date of extension of Vaccination
Act to town.
5
15th July 1898.
21st March 1914.
Act is not in force.
10th October 1916.
Act is not in force.
31st October 1900.
27th May 1904.
24th May 1916.
Act is not in force.
22nd May 1916.
3rd April 1908.
21st December 1915.
13th December 1907.
9th February 1916.
26th June 1896.
10th August 1896.
10ht July 1898.
xiii
APPENDIX A—CONCLUDED.
TOWNS.
1
ATTOCK DISTRICT.
Pindigheb
...
...
...
...
Hazro
... ... ... ...
MIANWALI DISTRICT.
Mianwali
... ... ... ...
Bhakkar
...
...
...
...
Isa Khel ... ... ... ...
Kalabagh ... ... ... ...
MONTGOMERY DISTRICT.
Montgomery ... ... ...
Kamalia ... ... ...
Pakpattan ... ... ...
LYALLPUR DISTRICT.
Lyallpur
...
...
...
Gojra ... ... ...
JHANG DISTRICT.
Jhang-Maghiana ... ...
Chiniot
...
...
...
MULTAN DISTRICT.
Multan ... ... ...
Shujabad
...
...
...
MUZAFFARGARH DISTRICT.
Muzaffargarh
...
...
...
Khangarh ... ... ...
Alipur
...
...
...
Leiah
...
...
...
Karor
...
...
...
DERA GHAZI KHAN DISTRICT.
Dera Ghazi Khan
...
...
Jampur
...
...
...
Dajal
...
...
...
Rajanpur
...
...
...
Kot Mithan
...
...
...
Number of births during the year.
2
377
385
308
276
197
287
149
394
298
627
148
1,554
992
3,932
287
165
130
140
393
211
554
308
257
160
186
Number of deaths amongst
children under one year during
the year.
3
76
85
63
102
77
60
52
135
154
145
32
555
253
1,524
177
71
73
69
131
101
156
109
136
120
100
Number of successful vaccinations
on children under one year
during the year ending March
1918.
4
265
227
291
126
144
150
31
...
80
404
98
767
628
1,433
125
47
24
37
129
57
320
185
97
41
21
Date of extension of Vaccination
Act to town.
5
Act is not in force.
5th October 1904.
11th April 1916.
10th December 1897.
12th February 1912.
25th July 1916.
16th June 1917.
2nd November 1917.
18th March 1914.
21st June 1916.
2nd October 1893.
19th November 1917.
1st February 1896.
24th February 1916.
10th December 1910.
Act is not in force.
17th September 1914.
4th November 1895.
Act is not in force.
18th September 1916.
26th September 1917.
pox per 10,000 of population for
ach district of the Punjab.
Diagram showing the death-rates from small-pox per 10,000 of population during the year 1917-18, the average rate of mortality from small-pox per 10,000 of population for the five years ending 1916-17, and the proportion of successful vaccinations
during the year 1917-18, and the preceding six years in each district of the Punjab.
IP/QB, 10
No. 21.
( NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON THE STANDARDISATION OF ANTI-TYPHOID
VACCINE.
BY
CAPTAIN GEORGE LAMB, M.D., I.M.S.,
(Director, Pasteur Institute of India ),
AND
CAPTAIN W. B. C. FORSTER, M.B., D.P.H., I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA :
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA.
1906
Price annas 6 or 7d.
No. 21.
(NEW SERIES.)
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON THE STANDARDISATION OF ANTI-TYPHOID
VACCINE.
BY
CAPTAIN GEORGE LAMB, M.D., I.M.S.,
(Director, Pasteur Institute of India),
AND
CAPTAIN W. B. C. FORSTER, M.B., D.P.H., I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
C ALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA.
1905.
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ON THE STANDARDISATION OF ANTI-TYPHOID
VACCINE.
FEW will deny that vaccination against typhoid fever has now taken its place
amongst the measures of preventive medicine. This achievement is princi-
pally due to the brilliant work and the untiring exertions of Wright, who since 1897
has devoted so much time and energy to the various problems which surround
this subject. That success has crowned his efforts is certain from the facts,
(1) that three scientific committees, successively convoked to examine into the
matter, have decided that the statistical evidence is sufficient to show that the
incidence and case mortality are reduced by inoculation, and (2) that the
Germans have adopted it in their army in the case of troops proceeding to
foreign service in Africa. There are still, however, many problems to be solved
before anti-typhoid vaccination becomes generally adopted by all who practise
preventive medicine, and one of the most important of these problems is the
elaboration of some method of standardisation. Before we consider the various
methods of standardisation which have been employed heretofore, it will be
necessary to glance for a moment at the nature and constitution of the vaccines
which are in common use.
An anti-typhoid vaccine may be prepared in any of the following ways:
—
(a) Sterilising by heat or by some antiseptic, such as lysol or carbolic acid,
a well-grown broth culture of bacillus typhosus. This method has been
greatly used by Wright and is, we believe, the method still employed by him. A
vaccine of this nature was employed by Leishman, Harrison, Smallman and
Tulloch in a recent research1on the blood changes following anti-typhoid
inoculation. We shall call this 'broth vaccine'.
Vaccines prepared by this method consist of:—
(1) Constituents of the broth, such as peptone, etc.
(2) The extra-cellular toxins of the bacteria.
(3) The free "receptors" arising either by disassociation from, or by the
dissolution of, the bodies of the bacteria.
(4) The undissolved bodies of dead bacteria with their infra-cellular
toxins and constituent receptors.
(b) Suspending the surface growth of agar cultures of bacillus typhosus
in a fluid medium, such as normal salt solution, and then killing the bacteria in
the same way as in the case of broth cultures.
B
2
This was the original method described by Wright 2 in 1897. It is the
method now recommended by a committee of German bacteriologists convoked
at the instance of the Prussian Government3. Such a vaccine we propose to
call 'agar vaccine'.
An agar vaccine is of similar composition to a broth vaccine, the constituents
of the broth and the extra-cellular toxins being, however, in very small quantity.
(c ) Dissolving up the bodies of the bacteria, either in a broth culture or in
the emulsions of the agar cultures, and then filtering through a porcelain filter.
It was first shown by Wright and Windsor 4 that the filtrate of a broth culture of
bacillus typhosus, which had been macerating at 37°C. for a period of five
months, diminished the bactericidal power of a serum with which it was mixed
to exactly the same degree as the unfiltered culture. These workers did not
suggest the use of such a filtrate as a vaccine.
Strong 5 working with the cholera vibrio prepared a vaccine in the following
manner :—
The surface growths on agar, 20 hours old, were suspended in sterile
water ; the bacteria were then killed by heating at 60°C. for from one to twenty-
four hours ; the mixture was afterwards put aside in the incubator at 37°C. for
from two to five days and finally filtered through a Reichel candle. With such a
vaccine he was able to immunise animals and to produce both specific agglutinins
and bactericidal substances in their blood. A vaccine prepared in this manner
was also used in a few instances on the human subject with results similar to
those which were obtained on animals.
A similar method of preparation has been adopted in the case of anti-typhoid
vaccine by Bassenge and Mayer 6. These workers suspended typhoid bacteria
grown on agar in sterile water ; the emulsion was well shaken up and then
filtered. By this means a filtrate, free from bacteria and which gave rise on
inoculation into animals and men to agglutinating and bactericidal substances,
was obtained. A vaccine prepared by this method we shall designate 'filtrate
vaccine', the word 'agar' or 'broth' being prefixed according as an agar or a
broth culture has been used in its preparation.
A filtrate vaccine will be of the same composition as the broth or agar
vaccine from which it was prepared, less the bodies of the bacteria and
particulate debris, the remains of broken-up organisms. If such a vaccine is
properly prepared, the total receptors which are present in the original emulsion
before filtration should be found in the filtrate.
Many advantages have been claimed for these filtrate vaccines, to wit, that
being clear and free from suspension their freedom from contamination is easily
appreciable even by a layman ; that the local and general reactions caused by
their injection is much lessened ; and finally that the degree of immunity
3
conferred is as great as that given by other vaccines which contain the bodies of
the bacteria and lasts as long.
Other methods of preparing anti-typhoid vaccine, such as that described by
Macfadyan and Rowland, have been promulgated from time to time, but as far
as we know all vaccines at present in common use are obtained by one of the
methods described above.
With this introduction we may now pass on to the question of the standar-
disation of these several vaccines, a question which is generally recognised
to be of dominating importance. The first desideratum in this connection is of
course to place before ourselves a perfectly clear mental picture of what is
connoted by the term standardisation. It seems to us that Wright7has supplied
us with an excellent definition of the term. He says, ' Standardisation involves,
on the one hand, the determination of the amount of immunising element
contained in a standard volume of the vaccine material ; on the other hand, the
adjustment of the dose administered to the resisting powers of the man or
animal subjected to the inoculation.' If we accept this definition, it is evident
that the first problems which have to be settled before any scientific method of
standardisation can be evolved are problems concerning the nature of the
immunising element of the vaccine and the manner in which it accomplishes
its object. Let us for a moment consider these questions.
It will, we think, be acknowledged by all pathologists that the immunity
induced by anti-typhoid vaccination is in the main, if not entirely, a bactericidal
immunity, that is to say, that it depends on an increased power of the individual
to kill the typhoid bacteria by means of his body fluids, and that there is no
evidence so far of an antitoxic immunity. This increased power is due, using the
language of Ehrlich, to an increase of the specific amboceptor or immune body
in the body fluids and not to any increase of the complement.
It is also probable that the organism, after an anti-typhoid inoculation,
acquires a habit of producing these protective substances on a stimulus of a
much slighter nature than before the inoculation. Such an hypothesis would
account for the presence of a certain degree of immunity after the amount of
protective substances, which are increased considerably in quantity immediately
after an inoculation of anti-typhoid vaccine, had again fallen to normal.
It is, however, possible that we have also to deal with the action of the
substances called by Wright ' opsonins ' or of the substances named by
Metchnikoff 'stimulins'. But the proof of these substances taking any part
in the process of typhoid immunity is still lacking. We need not, therefore,
take them into account at the present moment. We have consequently only to
account for an increased production of immune body which is called forth as a
result of the inoculation of the immunising substances contained in the vaccine.
B 2