306 PROTECTIVE INOCULATIONS. 



up only of comma bacilli, and then the other part is used for seed material 

 for a tube culture preparatory to inoculation. 



"The inoculation itself is an exceedingly simple process ; the needle and 

 the syringe are boiled ; the tube containing the material to be used for inocu- 

 lation receives a syringef ul or pipetteful of sterilized beef broth, then with a 

 platinum needle the culture is thoroughly mixed with this broth, so that a 

 kind of emulsion is prepared; this emulsion is drawn up in a sterilized 

 pipette, and is then passed into a sterilized conical glass covered with steril- 

 ized paper. If a sixth of the culture is to be introduced, two more syringe- 

 fuls or pipettefuls of broth are to be added, so that we now have three in all ; 

 if an eighth, three are added, and so on ; the whole is mixed, and then half a 

 syringef ul is taken for use for each patient. In inoculating, the skin, just 

 above the crest of the ilium, is thoroughly cleansed with flve-per-ceiit solu- 

 tion of carbolic acid, the attenuated virus is inoculated 011 the left side, and 

 then after an interval of four or five days the second vaccine, or the more 

 virulent form, is inoculated on the right side. After inoculation everything 

 that has been used is thoroughly boiled, the skin of the patient is again 

 washed with five-per-cent carbolic acid, and the table is washed down with 

 the same solution." 



Haffkine commenced his experiments on man by inoculating him- 

 self, and has repeated the inoculation three times. He next inoculated 

 about fifty individuals in Paris, Cherbourg, and Moscow, and demon- 

 strated in a satisfactory way that the inoculations are without danger. 



A first inoculation in an unprotected person is said to give rise to 

 some malaise and febrile reaction, to pain and tumefaction at the 

 point of inoculation, and swelling of the neighboring glands. The 

 second inoculation with a strong virus, made after an interval of six 

 days, causes also some elevation of temperature, but no swelling at 

 the point of inoculation. This slight reaction from a strong virus is 

 supposed to be satisfactory evidence of a certain degree of immunity 

 as a result of the first inoculation. 



The results of the protective inoculations by Haffkine's method, 

 which have been practised in India, indicate that these inoculations 

 have a real value, but that immunity is not immediately established, 

 and consequently that during an epidemic a certain number of fatal 

 cases may be expected among the inoculated as well as among the 

 non-inoculated. This is illustrated by the results of inoculations 

 made among the prisoners in Gay a jail (1894), reported by Surgeon- 

 Major Macrae, I.M.S., from whose report we quote as follows: 



" Cholera broke out in Gaya jail on the 9th of July, and from that date 

 until 2d August 34 cases occurred, with 20 deaths, there being on date of first 

 attack 422 prisoners in jail. The disease was clearly traceable to importa- 

 tion, but its diffusion among the prisoners was a question of much greater 

 difficulty. The sanitary condition of the jail is excellent ; it was built quite 

 recently, on the latest plans, and is generally considered a model jail. The 

 water supply, which is from a well, is of excellent quality and protected 

 from pollution, and it is believed that the spread of the disease was largely 

 due to the agency of flies finding access to food and milk after being in con- 

 tact with cholera poison, and contaminating them. From the 9th to the 17th 

 July six cases occurred, with five deaths. 



