246 VACCINE TREATMENT IN THE PREVENTION OF DYSENTERY 



dysentery infection this vaccine treatment. The future history 

 of these cases, however, showed very clearly that no harm was 

 done. The immediate reaction in all these cases was very mild, 

 the highest temperature being 101.5 F. All the local reactions 

 were of the mildest type and there was no general reaction noted 

 beyond slight fussiness. In no case was the immediate intestinal 

 condition aggravated and in all but one case no further intestinal 

 trouble has appeared up to the present. One case receiving 

 two doses of vaccine, the last being given August 7th, did well 

 until September 8th, when the child developed an acute intestinal 

 infection and was entered in one of the hospitals as a case of 

 acute infectious diarrhoea. This attack was only of moderate 

 severity and the child, when last seen October 24th, was in the 

 best of condition. These six cases show very clearly that vac- 

 cine made from the B. dysenteriae Flexner is not contra-indicated 

 in those cases which may have this organism in a clinically un- 

 recognizable form. 



Out of the 95 cases vaccinated there were two deaths. Both 

 these cases received two vaccinations. In both of them the 

 original cultures were negative for the B. dysenteriae. One, 

 case 7, contracted acute infectious diarrhoea 17 days after its 

 last inoculation and died ten days later. The outcome of this 

 case is interesting from the standpoint of hygiene. The family 

 or rather several families, lived under conditions of the worst 

 kind, with flies in superabundance. The utter lack of intelli- 

 gence and indifference to the sickness of the child were features 

 which were impossible to cope with and which undoubtedly led 

 more than any other thing to the fatal result. The second case 

 was that of a very delicate child who lived under the worst 

 sanitary conditions of filthy people and with numerous flies. This 

 child did well for one month after its last inoculation, when it 

 also contracted acute infectious diarrhoea and died two weeks 

 later. All the other cases did perfectly well throughout the 

 whole summer and when last seen, sometime in the latter part 

 of October, were in the best of condition. 



It is interesting to compare these cases with 97 cases which 

 did not receive any vaccination and which proved culturally to 

 be negative as far as the presence of the B. dysenteriae 'was 

 concerned. Of this number three died, apparently of acute in- 

 fectious diarrhoea, after comparatively short illnesses, from three 

 to five days. No bacteriological examinations were made on 

 these cases and autopsies could not be obtained. 



There were 25 cases studied culturally, but not vaccinated, 

 which proved to have the B. dysenteriae present. In 24 of these 

 the Flexner type of the organism was present and in only one 

 the Shiga was found. There has been one death from this group 



