798 



ZYMOTIC DISEASES. 



puncture is elevated, and motion causes pain 

 in the surrounding muscles. These phenomena 

 continue for about six hours, when all unpleas- 

 ant sensations begin to disappear. The day 

 following the inoculation, Ferran claimed that 

 only a slight tenderness upon pressure was no- 

 ticed, and by the fourth day the wound had 

 entirely healed. He also claimed that the proof 

 that the inoculation gave a certain amount of 

 immunity was the fact that he could not renew 

 the vaccination upon the same person. In some 

 cases, severe disturbance resulted from the in- 

 oculations prostration, nausea, vomiting, rig- 

 ors, and abundant diuresis. 



The first to submit himself to the risky ex- 

 periment was Dr. P. Sareriana, of Catalonia. 

 On Feb. 23 he received an injection into each 

 arm of half a cubic centimetre of the attenu- 

 ated virus. He says that in less than three 

 hours severe pain was felt in the posterior por- 

 tion of the arms, which increased, and move- 

 ment became very painful and difficult. At 

 the end of seven hours he had a severe chill, 

 followed by languor, elevation of temperature, 

 headache, and insomnia. The pulse became 

 very rapid. This condition continued about 

 twenty-four hours, when all symptoms abated. 

 Dr. Eugene Jacques was the second to sub- 

 mit to the operation, and although he received 

 only half a cubic centimetre in one arm, his suf- 

 ferings were more severe than those of Dr. Sare- 

 nana. In addition to greater elevation of tem- 

 perature, he experienced nausea and cramps. 

 An examination of the blood, eighteen hours 

 after inoculation, was said to reveal the pres- 

 ence of micrococci. Ferran claimed that this 

 was the first form assumed by the comma-ba- 

 cillus, when injected into the living organism. 

 In the diarrhoaal dejections that followed the 

 operation, he claimed to notice the oogonia 

 oospheris and spherical green corpuscles. He 

 considered, also, that this diarrhoea, which 

 ceased of itself, confirmed the fact of immu- 

 nity from cholera. Ferran further claimed 

 that he had inoculated 5,400 persons of Alcira, 

 and that only seven suffered from cholera dur- 

 ing the epidemic. These claims, though seem- 

 ing to be warranted by the observations that 

 Ferran has recorded, have been opposed by 

 recent experiences with the epidemic, and have 

 been sharply criticised by investigators. M. 

 Capitan, after careful investigation, decided 

 against the claims of Ferran, saying that "the 

 organisms described by Ferran are most sin- 

 gular and strange, never having been noticed 

 by observers who have been especially occu- 

 pied with this question. The technical manip- 

 ulations of the Spaniard are full of faults, and 

 exceedingly defective, the sterilization being 

 far from complete, and the introduction of 

 foreign microbes not guarded against. It is 

 curious that the intestinal inoculations, which 

 do not succeed with Ferran's cultures, do suc- 

 ceed with those of Nicati, Rietsch, and Livon. 

 Ferran's experiments are full of failures." 



Prof. Van Ermengen, in his report to the 



Belgian Minister of Public Instruction, concern- 

 ing the cholera vaccination of Ferran, says: 

 u The vaccine contained none of the varied 

 forms of development described ; the subcuta- 

 neous injection of his vaccine liquid, in the 

 quantity of 2 c. c., produces in man phenom- 

 ena of local irritation and slight febrile reaction, 

 very different from the syndromata of cholera. 

 Blood taken from six cases in which inocula- 

 tion had been practiced exhibited the char- 

 acteristics of normal blood, and contained no 

 micro-organisms. It remains to be shown that 

 the local inflammation produced by the injec- 

 tion of vaccine is due to a specific action of the 

 microbe upon the tissues, and not to the bile 

 which M. Ferran adds to his cultures. M. Fer- 

 ran did not consent to the performance of con- 

 trol experiments to establish this point. Inocu- 

 lations in the cases observed have been without 

 deleterious results. It is doubtful whether the 

 vaccine of M. Ferran is of attenuated cultures, 

 the methods by which they were obtained be- 

 ing unknown to me, Ferran refusing to reveal 

 them until after his communication to the 

 Acad6mie des Sciences de Paris. The statis- 

 tics collected, hitherto without control, and 

 solely by partisans of the prophylactic system 

 of Ferran, are not sufficiently complete or pre- 

 cise to allow any decision whatever to be made 

 as to the efficacy of the inoculations." 



In conclusion, it might be said of Ferran's 

 claims that he has empirically found an attenu- 

 ated virus susceptible of conferring immunity; 

 but there are serious objections concerning 

 the existence of this immunity. Cholera, like 

 diphtheria and many other infective diseases, 

 may be repeated in its attacks, and one attack 

 does not confer immunity. In the latter part 

 of September the President of the United States 

 issued an executive order directing Dr. E. 0. 

 Shakespeare, of Philadelphia, " to proceed, un- 

 der direction of the Secretary of State, as the 

 representative of the United States, to Spain and 

 other countries in Europe where cholera exists, 

 and make investigations of the causes, prog- 

 ress, and proper prevention and cure of the said ' 

 disease, in order that a full report may be made 

 to Congress during the next session." Dr. 

 Shakespeare departed upon his mission on Oct. 

 10, and returned in March, 1886. From care- 

 ful collection of statistical reports, it might safe- 

 ly be said that during the epidemic of 1885 

 there were in Spain upward of 250,000 cases 

 of cholera and 92,000 deaths. The largest 

 number of new cases reported in a single day 

 was on Aug. 11 6,464 cases and 2,109 deaths. 

 On this day, in Madrid alone, there were 52 

 new cases, with 38 deaths. The number of 

 infected Spanish towns was over 380. The 

 panic that prevailed throughout the country 

 was daily increasing, and on Aug. 14 fully 60,- 

 000 persons fled. Toward the latter part of 

 the month the disease seemed to be declining, 

 and on Aug. 31 it was reported from Madrid 

 that the daily average decrease was 300 new 

 cases and 140 deaths ; by the end of October the 



