300 PROTECTIVE INOCULATIONS. 



"7. Never should the rubber stopper which closes the flask, or the cotton 

 which plugs the short straight tube, be removed, because otherwise the 

 germs of the external air might enter and contaminate the culture, and in 

 this way give place to local and general accidents among the inoculated. 

 Whenever, through the movements of transportation, the cotton plug in the 

 short glass tube has become so wet as to impede the passage of the air which 

 is to be forced into the flask in the act of expelling the vaccine from it, it 

 may be removed w r ith the point of a needle and rapidly substituted by an- 

 other plug of surgical cotton which has been carbonized or salicylized. If 

 this proceeds with cleanness and promptness, there is no danger in doing it. 

 When the cotton, although wet, does not impede the injection of the air, it is 

 better not to change it. 



"8. After terminating the vaccination, again the capillary extremity of 

 the curved tube is passed through the flame until the small quantity of liquid 

 remaining in it is evaporated ; it is then stopped a second time with a small 

 drop of wax ; and from the other glass tube the rubber tube which has been 

 employed for forcing in the air is removed and another thin layer of wax is 

 placed over the cotton plug. 



"9. If in the smaller vessel or cup any of the vaccine fluid remains after 

 the vaccination of all persons present, it is boiled, and in this manner the 

 culture is killed, for it should not be used in another operation, because at- 

 mospheric germs might become mixed with it. 



' ' 10. The technique for the practice of the inoculation is the same as for all 

 hypodermic injections. The most convenient region is that of the brachial 

 triceps. 



" 11. The dose is one cubic centimetre or the contents of a syringe into 

 each arm, for individuals of all ages and conditions. / 



" 12. Five days having elapsed, re vaccinations may be performed by fol- 

 lowing the same instructions." 



Shakespeare, who was sent by the United States Government to 

 Spain to investigate the results of these inoculations, reports as fol- 

 lows: 



" And now with respect to the human inoculations: The most of these 

 inoculations were performed in villages in the province of Valencia. The 

 number of persons inoculated considerably exceeds thirty thousand. Much 

 has been both said and written in Spain, France, and England concerning 

 the results of these inoculations. The results which have been published 

 have appeared to very strongly back up the claim of Dr. Ferrari that chol- 

 eraic inoculation has the power of protecting the individual against an at- 

 tack of cholera, and that the extensive practice of this inoculation among 

 villages already invaded by the epidemic is a powerful and at the same time 

 harmless means of bringing the epidemic to an end. This being the case, 

 for those who were unwilling to accept the deductions to be made from the 

 published statistics the only way of escaping their force seemed to be by 

 an attack upon their validity. 



"The statistics of the anti-choleraic inoculations have been widely at- 

 tacked. The first public onslaught upon these statistics of which the world, 

 outside of Spain, had much knowledge was made in the report of the French 

 Commission, with Dr. Brouardel at its head, which was presented to the 

 Minister of Commerce after the return of that Commission from Spain in the 

 summer of 1885. It is charged in that report that the results of the statistics 

 therein reproduced are assailable on account of having been collected by 

 physicians who were partisan supporters of Dr. Ferran, and that they neither 

 possessed any adequate official character nor did they possess sufficient de- 

 tails. As far as I can learn, the general impression entertained throughout 

 the world of the value of inoculation statistics is based, in the main, upon 

 this report of the French Commission. 



