PROPHYLACTIC IMMUNIZATION OR VACCINATION 693 



as physicians, nurses, and attendants in hospitals, should be immunized. 

 Hospital authorities are justified in making typhoid vaccination ob- 

 ligatory on all applicants for admission to training schools. 



3. All inmates of asylums, homes, and other public institutions 

 under forty-five years of age should be immunized and the State should 

 be ready, if necessary, to furnish the vaccine. 



4. The physician and nurse should urge vaccination upon all the 

 members of a family when there is a typhoid patient among them. 



5. The physician should especially advise immunization of those 

 about to leave their homes for a vacation in some neighboring seashore 

 or mountain resort. 



6. In times of epidemics of typhoid fever the physician should urge 

 vaccination of all over whom he has influence. Thorough vaccination 

 with proper sanitary conditions offers the best hope of eradicating this 

 dreaded disease. 



PARATYPHOID FEVER 



According to recent experiences in the European armies prophy- 

 lactic immunization with typhoid vaccine does not afford protection 

 against infections with Badllis paratyphosus A and Badllis paraty- 

 phosus B. In this country various investigators have estimated that 

 about 2 to 4 per cent, of the cases of so-called " clinical typhoid fever" 

 are due to paratyphoid infections; apparently the majority of these are 

 with Badllis paratyphosus B. It would appear advisable therefore to 

 immunize with these microorganisms in addition to Bacillis typhosus, 

 and particularly members of the Army, Navy, National Guards, and all 

 volunteer organizations called into service in time of war. For over a 

 year I have been using routinely a mixed vaccine prepared in the same 

 manner as the typhoid vaccine, each cubic centimeter of which contains 

 500,000,000 typhoid bacilli of the army strain and 250,000,000 each of 

 Bacillis paratyphosus A and B, the latter strains being selected from a 

 number on the basis of stimulating the production of agglutinins to a 

 well-marked degree in persons and rabbits. The first dose of this mixed 

 vaccine is \ c.c. ; three more injections are made at intervals of a week of 

 1 c.c. each, making a total of four injections. In the Army a mixed 

 vaccine of paratyphoid bacilli is generally administered after the usual 

 course of three injections of typhoid vaccine, and in the same manner. 

 Three doses are given; the first dose contains 500,000,000 Badllus para- 

 typhosus A and 300,000,000 Badllus paratyphosus B; the second and 

 third doses are the same, and contain 1,000,000,000 Badllus paraty* 

 phosus A and 600,000,000 Badllus paratyphosus B. 



