244 VACCINE TREATMENT IN THE PREVENTION OF DYSENTERY 



type of the B. dysenteriae, it was extremely difficult to do so 

 with the Shiga type. Further, we found, as have also other 

 investigators, that the Flexner organism may be present in the 

 intestinal tract without causing the characteristic clinical symp- 

 toms of acute dysentery, thus showing that even in the human 

 system this type of dysentery bacillus can exist without pro- 

 ducing marked toxic symptoms. It seemed fair then to conclude 

 that a vaccine made from such an organism recovered from a 

 case of infantile Flexner dysentery would be the most appropri- 

 ate organism to use for preventive vaccination. The following 

 plan was therefore adopted : A vaccine was made from a 24-hour 

 agar growth of B. dysenteriae Flexner of the strength that 

 one cubic centimeter of the emulsion equalled 100,000,000 

 bacilli. At the first injection one cubic centimeter of an anti- 

 dysenteric serum was used in combination with 50,000,000 bacilli 

 or one-half cubic centimeter of the standard emulsion. The plan 

 was to give a second injection five days after the first. This 

 was not always possible, however, from the character of the 

 clinic and the time of the second inoculation varied from five 

 days to three weeks. It was planned to give three inoculations, 

 but the majority of the cases received only one or two injections. 

 Fifty-one cases received one injection and forty-four two or 

 three. Ninety-five cases in all were vaccinated. The reactions 

 from the vaccinations varied from a slight local reaction and a 

 temperature of 99 with slight fussiness to a very marked local 

 swelling, oedema and considerable tenderness. In no case was 

 there any abscess formation and usually the most marked re- 

 actions disappeared within 24 hours. All the vaccinations were 

 given in the morning and each case was visited from four to 

 six hours later when the local condition and temperature were 

 noted. The highest temperature noted was a hundred and three. 

 In all cases where the temperature was over 101 the case was 

 visited the following morning and in no case did the temperature 

 remain above 99 on this second visit. 



Thirty-one of these vaccinated cases had from one to four 

 fecal cultures taken. These were taken by the method used by 

 Kendall, which consists of a small glass tube with rounded ends 

 about 12 cm. long with a 3 mm. bore and plugged with cotton 

 at one end. This was sterilized inside of an ordinary thick- 

 walled culture tube. These tubes were kept in stock in the 

 clinic and the cultures were obtained by passing the sterile tube 

 into the rectum. At the end of the clinic these tubes were ex- 

 pressed to the laboratory where the contents of the tube were 

 discharged into a tube of plain broth. From this emulsion the 

 isolation of the Bacillus dysenteriae was carried out by a modifi- 

 cation of the method used by Kendall and Walker. 9 Two large 



