PROPHYLACTIC IMMUNIZATION OR VACCINATION 



645 



separate needle being used for each person. The vaccine may be put 

 up in individual ampules or in a stock bottle, the former being preferable. 



Dosage. Three injections are given at intervals of one week. For 



adults (150 pounds) the doses used in the army have been as follows: 



First dose: 500,000,000 bacilli. 



Second dose: 1,000,000,000 bacilli. 



Third dose: 1,000,000,000 bacilli. 



These amounts are contained in 1 c.c. (about 15 minims). Children 

 receive doses in proportion to their weight; if the dose cannot be divided 

 evenly, it is better to give a little more rather than a little less, for chil- 

 dren tolerate the injections remarkably well. 



Reactions. Persons in poor physical condition are more likely than 

 the robust to experience disagreeable after-effects. 



The local reaction consists of a small red and tender area lasting about 

 forty-eight hours. Occasionally the edema and pain may be more 

 marked, but abscess formation is practically unknown. 



The general reaction, when present, gives rise to headache, malaise, 

 and sometimes to fever, chills, and occasionally to nausea, vomiting, or 

 diarrhea. The severe reactions are not alarming and disappear quickly. 



The inoculated person should abstain from severe exercise for the 

 following twenty-four hours and rest; in the great majority of instances 

 our soldiers have not been inconvenienced and were able to continue 

 with their routine duties. 



The following tables, compiled by Major Russel, 1 show the propor- 

 tion of reactions in adults and children: 



TABLE 24. PERCENTAGE OF GENERAL REACTIONS IN ADULTS 



(128,903 DOSES) 



TABLE 25. PERCENTAGE OF GENERAL REACTIONS IN 359 CHILDREN, 

 TWO TO SIXTEEN YEARS OF AGE 



Jour. Amer. Med. Assoc., 1913, Ix, 344. 



