652 ACTIVE IMMUNIZATION 



some immunity. This protection may be apparent after the first dose, 

 but is more marked after the second. The immunity conferred is far 

 from being absolute, and it is noteworthy that while the prophylactic 

 diminishes the liability of the inoculated person to cholera, it has less 

 influence on the mortality when the disease occurs in those who have 

 been vaccinated. 



Used in conjunction with modern sanitary regulations, however, 

 Kolle's vaccine certainly proves of value and should be used in combating 

 epidemics. 



OTHER DISEASES 



Dysentery. Protective vaccination against bacillary dysentery has 

 been attempted, but has not as yet yielded satisfactory results. Shiga 

 practised mixed active and passive immunization (vaccine plus immune 

 serum) on 10,000 persons, and while this did not decrease the number 

 of infections, a lower mortality resulted. The various types of the 

 dysentery bacillus and the high toxicity of the vaccines are obstacles 

 to the more general use of protective inoculation in this condition. 



Cerebrospinal Meningitis. Sophian and Black 1 have shown ex- 

 perimentally that a polyvalent meningococcic vaccine, heated to 50 C., 

 standardized in the usual manner, and given in three injections, in 

 doses of 100,000,000, 500,000,000, and 1,000,000,000, at intervals of a 

 week, appears to afford a high degree of protection. In the blood- 

 serums of inoculated persons these observers were able to demonstrate 

 opsonins, agglutinins, and complement-fixing amboceptors. All evi- 

 dence points to the efficacy of prophylactic vaccination, as only a 

 moderate degree of immunity may give complete protection against the 

 disease. The method has not thus far received extensive trial, but in 

 the presence of an epidemic its harmlessness and apparent value should 

 be borne in mind. 



Scarlet Fever. Several Russian physicians, particularly Gabrick- 

 evski, 2 Longovi, Nitikin, Shamarin, and others, have secured good 

 results from a method of prophylactic vaccination against scarlet fever 

 with a polyvalent vaccine of scarlet-fever streptococci. Heat-killed 

 vaccines were given in three successive doses. In this country the 

 method has been tried by Kolmer, 3 who found that while inoculations 

 with a heat-killed streptococcic vaccine cannot prevent scarlet fever 



1 Jour. Amer. Med. Assoc., 1912, lix, 527. Black, ibid., 1913, Ix, 1289. 



2 Russk. Vratch, St. Petersburg, 1906, x, 469. 



3 Penna. Med. Jour., February, 1912. 



