PROPHYLACTIC VACCINATION 291 



quent and are exhibited by malaise, headache, fever, constipation and 

 occasionally chills. Maurange investigated the general reaction fol- 

 lowing 39,215 inoculations and reports the following results: 



Types of reaction JJ*** ^S? 



None 92.23 98.59 



Feeble 6.18 1.41 



Moderate 1.40 0.00 



Pronounced 0.19 o.oo 



Rarely the inoculations may be followed by arthritis, nephritis and 

 severe intestinal disturbances. Chantemesse has called attention to the 

 recrudescence of tuberculosis during immunization, and it has further 

 been suggested that other chronic diseases, including syphilis, may be 

 excited to renewed activity. We have observed cardiac arrhythmia in 

 individuals who have previously suffered from myocardial disease. 



Contraindications. The contraindications include kidney disease, 

 diabetes, myocardial and endocardial disease, aortitis, cachexia, gastro- 

 intestinal disturbances and alcoholism. The presence of acute infec- 

 tions is also regarded as contraindicating vaccination. According to 

 Maurange, age is no contraindication, although the relative unsuscep- 

 tibility of old people to typhoid fever may make it seem unnecessary to 

 vaccinate. Menstruation is not a contraindication. 



Vaccination Against Cholera. This was first employed by Ferran 

 in 1884. Haffkine published results in 1888, .and since then numerous 

 investigations have developed technical methods and have emphasized 

 the value of protective vaccination. Ferran injected broth cultures of 

 living vibrios subcutaneously, employing 0.25 c.c. as the first dose and 

 0.5 c.c. as the second and third doses. Haffkine employed two kinds 

 of vaccine, a weaker vaccine prepared from living organisms grown 

 on agar at 39 C. and a more virulent vaccine prepared from vibrios 

 which had been passed through a series of guinea-pigs. Subsequently 

 Kolle prepared a vaccine made from heat-killed agar cultures of viru- 

 lent organisms. The emulsion is made by suspending 2 mg. organisms 

 in saline and heating to 60 C. for one hour. Cantacuzene prepared a 

 vaccine by heating emulsions of the vibrios for one and one-half hours 

 at 55 to 56 C. The concentration of this vaccine was 500 to 1000 

 million organisms per cubic centimeter. Two inoculations were given, 

 the first of 2. c.c. and the second of 4. c.c. with a six-day interval. 

 Strong prepared a vaccine by incubating the emulsion in sterile water, 

 thereby breaking up the cells. The emulsion was then passed through 

 a Reichel filter and the sterile filtrate employed. At the present day 

 heat-killed vaccines are most commonly employed. 



Results. The earlier work of Ferran and of Haffkine was ex- 

 tremely encouraging, but the subsequent statistics lend even greater 

 support to the value of this procedure. Arnaud made a study of 

 108,000 men during the second Balkan War. These men were all in 

 infected areas. Among the unvaccinated men the morbidity was 5-75 

 per cent. Among those who had received insufficient vaccination it was 

 3.12 per cent, and among those who had received the full treatment it 



