EEVIEW — TROPICAL MEDICINE, ETC. 157 



He then considers the plan of abandoning an infected locality for shorter or longer Plague- 

 periods. This, which may be termed a gecond stage in a campaign against plague, while at continued 

 times useful and salutary, is often impracticable and may inflict great hardship and suffering. 

 To whatever extent it is feasible, to that extent the effect of it is beneficial. 



By a process of exclusion he thus arrives at what he calls the ultimate method of 

 combating bubonic plague in the areas in which it becomes endemic, viz., that of 

 conferring on the population immunity from the disease by means of an artificial treatment, 

 i.e. preventive inoculation. 



He tabulates the salient facts established as regards this method during the last ten 

 years of Indian experience as follow : — 



1. That in a native of that country, who is more susceptible to the disease than Africans, Europeans and 

 some other races, the inoculation now in force in India reduces the liability to attack to less than one-third of what 

 it is in a non-inoculated Indian. 



2. That in the one-third of cases which still occur the recovery rate is at least double that in the non- 

 inoculated .attacked, the ultimate result being a reduction of the plague mortality by some 85 per cent, of what it 

 is in non-inoculated Indians. 



3. That in an inoculated European, an attack of plague, if it subsequently occur, has so far always ended in 

 recovery. 



4. That the inoculation is applicable to persons already infected and incubating the plague, and prevents the 

 appearance of symptoms, or else mitigates the attack, a fact which disclosed a basis for the bacterio-therapeutic 

 treatment of disease. 



6. That in natives of India, the degree of immunity conferred by this inoculation, though gradually 

 vanishing, seems to last during several outbreaks of plague ; and that 



6. In Europeans, the effect has not yet been seen to disappear in the space of time, since 1897, that this 

 inoculation has been under study. 



Haffkine's able advocacy of his method is confirmed by Simpson, ' who first of all cites 

 the conclusions arrived at by Haffkine in connection with the outbreak at BycuUa jail. 

 These were : — 



(1) That one injection of 3 c.c, of the prophylactic was sufficient to protect during an existing epidemic ; 

 (2) that inoculation was powerless to arrest the disease in those in whom the symptoms have already appeared or 

 develop in a few hours after inoculation ; (3) that the inoculation mitigated or aborted the disease in those who 

 were in the incubation stage, and had been infected three or four days previously ; (4) that the pi"ophylactic, 

 unlike the vaccines for cholera, rabies, anthrax, or small-pox, exercised its protective effect in less than twenty-four 

 hours, acting in this respect with a rapidity which was only known in antitoxic sera. 



He then proceeds to give tables on the working of Haffkine's system both on a small 

 and on a large scale which leave no manner of doubt as to its value and efficiency. 



As regards the duration of immunity, it would seem that the efl'ect of the inoculations 

 lasts for four or five years, though gradually it diminishes. 



At this stage it may be well to give the instructions issued in the Punjab Plague 

 Order^* for performing inoculation against plague : — 



Hot v.aseline is used for sterilising syringes, needles and instruments. Kapadia's lamp, which consists of a 

 spirit lamp, with a pot for vaseline and a thermometer attached, is recommended for .sterilising purposes. When 

 the vaseline reaches a temperature of 90' C, the motsture in the syringe is rinsed out with vaseline ; and 

 when a temperature of 160" C. is reached the syringe is sterilised by being filled and emptied three times. 

 The neck of the bottle contaiuing the i^rophylactic is sterilised by means of a flame, or by dipping the bottle into 

 the hot vaseline, and when the neck cracks the tip is knocked off by sterile forceps. 



The site of inoculation should be prepared as follows : — The patient's arm should be thoroughly washed with 

 soap and water, then dried; then thoroughly washed with cyllinand water (1 in 40) ; and then a small square of 

 lint soaked in cyllin lotion (1 to 20) should be applied over the exact place where the puncture will be made. 



Before each inoculation the needle must be dipped into vaseline at 160° C. 



Should any blood ooze from the puncture on the withdrawal of the needle, a piece of lint soaked in cyllin 

 lotion (1 to 20) should be applied. 



Whenever the syringe has to be laid on the inoculating table it should be placed on one piece of lint and 

 covered with another piece, both pieces of lint being thoroughly soaked in 1 to 20 cyllin lotion. 



At the conclusion of each day's operations the operator should himself rinse out with cyllin lotion (1 to 20) 

 all syringes that have been in use, and should sterilise all his needles and instruments in vaseline heated to 

 160° C, thus also protecting them from rust. 



A lotion of cyllin of 1 to 20 strength is also prescribed for the bowls contaiuing the spare needles and forceps. 



Substitution of cyllin as a disinfectant in place of perchloride of mercury in these 

 manipulations is worthy of note. 



• Simpson, W. J. (August Ist, 1907), " Croonian Lectures on Plague, Lecture III." Journal of Tropical 

 Medicine and Hygiene, Vol. X. 



' " Plague Inoculation Manipulations." Quoted in Journal of Tropical Medicine and Hygiene, March 16111, 

 1908, Vol. XI. 



* Ai-ticle not consulted in the original. 



