298 PROTECTIVE INOCULATIONS. 
in 1884, and in group L of general observations in that questonario is found 
the following: ‘Have there been observed recurrences among the people 
attacked, either in a former epidemic or in the present one? Give the results 
of this:recurrence.’ In response to their questions the Academy received 184 
communications, but the committee appointed to analyze them eliminated 
79; for various reasons given only 104 were used for analysis. Of this num- 
ber only 8 bore upon the particular question above mentioned, and it is 
reasonable to assume that the other 96 observers said nothing concerning this 
point because they had observed nothing bearing upon it. The results of 
this analysis may be stated as follows : 
“From Castelnaudary, with a population of 10,000, we learn that there 
were 54 cases and 18 deaths from cholera, among which there was 1 recur- 
rence; from Aix, with 20,257, number of cases unknown, deaths, 117, among 
these 2 recurrences were observed, at intervals of ten and forty days; from 
Beseges, with 11,400 inhabitants, we learn of 124 cases and 40 deaths, among 
which were 2 recurrences; from Cette, with 35,000, the number of cases is 
not mentioned, but we learn that there were 92 deaths and 1 recurrence; 
from Nantes, with 124,300 inhabitants we learn of 251 cases and 112 deaths, 
with 1 recurrence ; from Perpignan, with 25,000 inhabitants, we hear of 325 
cases and 225 deaths, and receive the indefinite statement that there were 
some fatal recurrences ; from Pignans, population not stated, we learn of 22 
attacks and 12 deaths, with 1 recurrence ; from Cadenet, with a population 
of 26,000, we are not informed of the number of cases, but learned that there 
were 20 deaths and 2 recurrences.” 
“IMMUNITY AFTER AN ATTACK OF CHOLERA—EXPERIENCE IN 
SPAIN, 1885. 
“While examining cholera in Spain, the writer prepared a circular con- 
taining a series of twenty-five questions relating especially to the nature, eti- 
ology, and prophylaxis of cholera, one of which requested the physician to 
state whether or not, in his own personal experience, he had observed a sec- 
ond or a third attack of cholera during the same epidemic, and in case of a 
positive reply to detail the symptoms and all the circumstances surrounding 
it. This circular-letter was addressed to some twenty-five hundred Spanish 
physicians, located in the various cities, towns, and villages in that kingdom 
which had suffered from the epidemic. Among the large number of replies 
there were only eight in which a second attack was reported, and from an ex- 
amination of the details of these there was no doubt left in our mind that six 
were not genuine second attacks after a complete recovery, but were in 
reality relapses due to imprudences of diet or otherwise before convalescence 
and complete recovery had been established. Two of the eight cases, from the 
details of the reports given, may have been genuine recurrent attacks of 
Asiatic cholera, or may have been simply seizures of cholera morbus (cholera 
nostras). It is well known that after an attack of Asiatic cholera the di- 
gestive apparatus is left ina damaged condition, and disorders of the in- 
testines continue for a long time. The habits of life and the imprudences so 
common to theclass of people most frequently suffering from Asiatic cholera 
in that country are such as to render them more than usually liable to suffer 
attacks of cholera nostras. As having an important bearing upon this sug- 
gestion, the writer made an analysis of the vital statistics of Spain, covering 
the five years previous to 1885, for the purpose of learning the extent of 
prevalence of cholera nostras among that population, and the result of the in- 
quiry shows that the number of deaths attributed to that disease averaged 
per year sixteen per every million inhabitants.” 
Dr. Ferrén, who practised inoculations on an extensive scale dur- 
ing the epidemic of 1885, in Spain, gives the following account of his 
method of performing these inoculations: 
