﻿REPORT ON CHOLERA IN MANILA. 429 



m} r self. Inoculation of the human being with the extracted prophy- 

 lactic which I have described does not produce this hemorrhagic change 

 in the tissues. Haffkine in relation to this question and of the inocula- 

 tion of this fixed virus says : 



En inoculation souscutanee au cobaye, le virus ne tuait pas, mais produsait 

 une mortification des tissus et une eschare de grand extension. 



If this local reaction is entirely due to the immunizing substances of 

 the cholera organism, why are not similar lesions encountered elsewhere 

 in the animal body? Cholera is an intoxication and it seems almost 

 unreasonable to suppose that all of the toxin is bound locally, either 

 in the intestine in natural infection or in the subcutaneous tissues after 

 artificial subcutaneous injection; the immunizing substances are soluble 

 and must pass to the other organs of the body. It rather appears that 

 with the cholera spirillum, as with the diphtheria bacillus, we have to 

 do also with substances within the bacterial csll which give rise to a 

 local inflammatory reaction, but which have nothing to do with the true 

 immunity in the disease. However, in cholera, of course the toxin is of 

 an entirely different nature from that encountered in diphtheria and 

 probably only becomes liberated at the time of the disintegration of the 

 spirilla. 



Before ending this discussion upon the subject of the local reaction 

 produced by the extracted prophylactic, I wish to call attention to the 

 fact that Hetsch and Kutscher, 25 who employed the method of inocula- 

 tion of the free receptors in the typhoid bacilli prepared according to 

 the method of Neisser and Shiga, reported that very marked inflam- 

 matory local reactions followed the injection of 0.5 cubic centimeter of 

 the prophylactic in the inoculation of some of the German troops. Eed- 

 ness and swelling of the tissues occurred three hours after the injection. 

 The inflammatory area about the point of inoculation became of a scarlet- 

 red color, sharply circumscribed, resembling the inflammation frequently 

 seen in erysipelas. These manifestations subsided after forty-eight 

 hours, but the injections were not repeated because of the marked local 

 reaction which occurred from the first inoculation. 



I wish to emphasize that these results obtained with extracts of the 

 typhoid bacilli are entirely contrary to those which we have encountered 

 with the free receptors of the cholera organisms. In very numerous 

 inoculations performed in Americans and natives of these Islands we 

 have had abundant opportunity to observe the local reactions following 

 the inoculation of the prophylactic I have described; none of these have 

 been severe and the great majority have been very mild. Our injections 

 have been made intramuscularly because of the quick absorption which 

 occurs from the muscular tissues. Since the immunizing substances 

 in the extracted prophylactic are either in solution or colloidal suspension, 



25 KUn. Jahrbuch. (1905), 14, 148, 15G. 



