PLAGUE 205 



pheres. The resultant material is filtered and diluted with water, 

 so that the content in proteins shall be 1 per cent, (approximately 

 seven volumes of water). The broth is then neutralized with calcium 

 carbonate, and sodium chloride added to make it of physiological 

 strength. It is then sterilized and filtered into suitable flasks (to a 

 height of 7.5 cm.), into each of which a few drops of olive oil or butter 

 fat (sterile) are further added, to serve as floats from which surface 

 growth of the bacilli can take place. Every two or three days the 

 cultures should be shaken, so that new crops of the organism can 

 develop in contact with the air, the older ones going to the bottom. 



After a six weeks' growth has been obtained, the purity of the 

 culture is examined by plating out a small amount on agar. The 

 material is sterilized for one or more hours at 65 C., treated with 

 carbolic acid to the point of 0.5 per cent., and finally filled into small 

 vials of 30 c.c. capacity. 



Dose. The ordinary dose for adult males is 3 to 3.5 c.c.; for adult 

 females, 2 to 2.5 c.c.; for children more than ten years old, 1 c.c., 

 and for smaller children, 0.1 to 0.5 c.c. Much larger quantities, 

 however, can be employed without harm, and Haffkine himself has 

 injected as mnch as 20 c.c. A second injection is recommended 

 after eight to ten days. The injections are made subcutaneously, 

 with a sterile syringe, into the upper arm (area over the triceps) 

 or the loin, those districts being avoided, as usual, in which the skin 

 is tightly bound down. 



Symptoms following Injection. The symptoms following the injec- 

 tion are practically the same as those occurring after an anticholera 

 or antityphoid vaccination, and differ considerably in their severity 

 in different people. After twenty-four to forty-eight hours the indi- 

 viduals are usually no longer inconvenienced. 



After the disease has once developed vaccination is of no avail, 

 and in such cases serum treatment should be resorted to (see below). 

 The combined procedure would suggest itself as being of value when 

 there is reason to think that the person may have already been 

 exposed to the infection or when great danger actually exists. For 

 such purposes Shiga advocates an initial treatment of 0.6 to 1 c.c. each, 

 of antiplague serum and vaccine, which is to be followed after a few 

 days, i. e., after the reaction has disappeared, by a second injection 

 of vaccine alone. The latter is essentially an emulsion of three-day-old 

 agar cultures (incubated at 30 C.), 1 c.c. of physiological salt solution 



