34 ACTIVE IMMUNIZATION 



2000 million. Wright used the two larger doses. An objection 

 raised to this method is that the general reaction obtained is more severe. 

 The editor, however, has employed these larger doses for inoculating the 

 nursing and medical staff of the hospital and a great number of laymen, 

 without any ill effect. 



Women and children should receive a dose in proportion to their 

 weight; a healthy man weighing 150 pounds being designated as the stand- 

 ard of comparison. 



Local and general reactions follow the inoculations. Thus local redness 

 and swelling of the skin, lymphangitis and enlargement of the neighbor- 

 ing glands are the usual consequences. The inflammation can at times 

 be severe enough to simulate erysipelas. The general symptoms, on 

 the other hand, may consist of a general feeling of illness, headache, 

 little fever, and occasionally nausea, not infrequently accompanied by 

 vomiting. These signs of indisposition, however, pass off rapidly without 

 leaving any permanent ill effects. Debilitated persons frequently present 

 the most profound reactions. Occasionally latent and chronic diseases 

 of a non-typhoidal character may be made active by inoculation. These 

 exacerbations are not serious and usually by diminishing the quantity 

 and increasing the number of doses, these effects can be avoided. Six 

 to eleven days after the injection, an increase in the number of agglutinat- 

 ing, bacteriolytic and bacteriotropic bodies can be demonstrated in the 

 blood of the inoculated individual. The immune bodies reach their 

 height in two to three months after incculation, and then fall 

 rapidly. In a series of forty cases Garbat was unable to demonstrate 

 complement fixation bodies with any regularity in the blood after pro- 

 phylactic injection. 



As to the results of antityphoid vaccination, opinion is somewhat 

 divided. According to Wright's statistics infections have been diminished 

 by about one-half, and in single series to one-sixth or even one-twenty- 

 eighth of the former, or control number. The mortality too is much lower. 

 Out of 1758 individuals who had been vaccinated, only 142 or 8 per 

 cent, died; out of 10,980 who had not been, 1800 or 16.6 per cent, met 

 death. 



The immunity attained is not absolute, for according to Russel, in 

 1911, among 80,000 p.ersons vaccinated in the United States Army there 

 were twelve cases of typhoid with one death (due to intestinal hemor- 

 rhage), and in 1910 six cases occurred with no fatalities. Had it not been 

 for the prophylactic immunization, there would have occurred at the pre- 

 vailing rates of incidence about 250 cases. Similar favorable statistics 

 have been collected in England, Germany and France. The period of 

 immunity lasts from two to three years. 



