230 RAVENEL— THE CONTROL OF [April 18, 



for children should be smaller than that given to adults in propor- 

 tion to their weight, the dose given being that proportion of the adult 

 dose which the weight of the child bears to the average adult weight, 

 namely, one hundrd and fifty pounds. 



Major Russell reports that of three hundred and fifty-nine chil- 

 dren vaccinated in no case had any bad effects been observed, and 

 no case of typhoid fever had occurred amongst them up to the time 

 of his report. In approximately one hundred and twenty-nine thou- 

 sands injections in adults there were only six tenths of one per cent, 

 of severe reactions. Of these, three tenths of one per cent, followed 

 the first injection. 



The vaccine should not be given to anyone running a tem- 

 perature. Vincent has shown that in persons suffering from malaria 

 the occurrence of a paroxysm is oftentimes precipitated by the giving 

 of a dose of vaccine. In the enormous practice in the United States 

 army the only serious result which has been observed occurred in a 

 man suffering from an unrecognized incipient tuberculosis. The 

 rule, therefore, is to be sure that the person about to be inoculated 

 has a normal temperature. 



General Application of the Method. 



It is evident that the use of vaccine is particularly applicable to 

 armies or other large gatherings of men who are apt to be in tem- 

 porary quarters deprived of the usual sanitary arrangements for the 

 disposal of sewage. However, the use of the vaccine has a very 

 much wider range than this, being of great value in the suppression 

 of local epidemics. A typical case of its use under these circum- 

 stances will be mentioned. 



A water borne epidemic occurred in Avignon, France, a town 

 with a population of 49,000, in 191 2. Six hundred and forty-four 

 cases with sixty-four deaths were reported, but it is certain that the 

 total number of cases reached 1,500. The garrison of the town con- 

 sisted of 2,053 men. Of these, 1,366 were vaccinated; 687 not 

 vaccinated. Among the unvaccinated there occurred 159 cases of 

 typhoid fever with 21 deaths; while not a single case occurred 

 amongst those who had been vaccinated. All lived under the same 



