TYPHOID FEVER 193 



with large doses manifest an increased resistance as early as eight 

 to thirty-six hours following the injection. 



Symptoms following Vaccination. Usually within two or three 

 hours following vaccination a local reaction appears about the site 

 of inoculation, which is characterized by marked redness and infil- 

 tration. This is followed by elevation of temperature (up to 102 

 F.), and occasionally by headache, general lassitude, muscle pain, and 

 frequently by swelling of the regional lymph glands. These symp- 

 toms persist usually for one to three days and then disappear. In- 

 dividually there is a good deal of variation, both in the extent of the 

 local reaction and in the intensity of the general symptoms. The 

 majority of people are very little inconvenienced, and are able to 

 continue about their work as usual. In isolated cases, however, 

 the person may feel quite ill for a number of days, and suffer a good 

 deal of pain in the arm, which may be red and swollen over a consid- 

 erable area. Prompt recovery takes place in every instance. For 

 the local pain, Wright recommends warm applications and a salve 

 composed of carbolic acid, 1.0; fld. ext. of ergot, 4.0; oxide of zinc, 3.0; 

 lanolin, 20.0; for internal use he recommends 2.0 grams of calcium 

 chloride or calcium lactate. All observers remark that in malarial 

 cases the reaction is unusually severe, and had better be avoided. 

 The symptoms occurring after the second injection are usually 

 milder; Leishman noted marked sweating during the second night 

 following the reinjection. During the twenty-four hours following 

 the inoculation the individuals should be told to abstain from the use 

 of alcohol, and to avoid muscular exertion and exposure to the sun. 



Following the inoculations, there is a marked increase in the 

 bactericidal substances and bacteriolysins of the blood, which 

 reaches its highest point on the third day following the reinoculation 

 (fourteenth day) in the case of the first, and on the seventh day 

 (eighteenth day) in the case of the latter. Generally speaking the 

 increase amounts to from five to ten times the original quantity. 

 Agglutinin formation begins on the ninth day, drops after the second 

 injection, and starts again nine days later, reaching its maximum 

 between the twenty-second and twenty-fifth day (2000 to 4000). 

 Normal opsonins, according to Leishman, are not demonstrable, 

 while the stimulins (immune opsonins, i. e., elements occurring in 

 heated serum, which favor phagocytosis) are increased after eleven 

 days. 

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