1404 THE ENTEROIDEA GROUP OF TROPICAL FEVERS 



inoculation; fever with headache and rheumatoid pains. The 

 inoculated persons are generally fit to resume their duties twenty- 

 four to forty-eight hours after inoculation. 



In countries where cholera is endemic in addition to enteric, 

 the tetravaccine, typhoid, para A, para B, cholera, should be 

 used. Certain observers describe a * vaccine disease ' in analogy 

 to a ' serum disease,' and state that the human organism becomes 

 sensitized by a previous injection of vaccine. This phenomenon, 

 however — at least with marked features — is, in our experience, 

 extremely rare. 



Until 1916, in the British Army and practically in every other 

 army — with exception of the Serbian Army, which adopted Castel- 

 lani's tetravaccine (TABC) in 1915 — the vaccine used was the 

 Wright-Leishman typhoid monovaccine, which, as regards preven- 

 tion of typhoid, gave good results, but naturally was of no efficacy 

 in the prevention of the paratyphoid fevers. 



Vaccination by a Single Inoculation. — This has been attempted 

 with a certain degree of success by using oil emulsions of the various 

 bacteria (lipovaccines) , as done by Le Moignic and Pinoy, or by using 

 2 per cent, glycerin emulsions, as done by Castellani. 



As regards the results of simple typhoid vaccination, Firth's figures worked 

 out by Pearson's methods showed that out of 55, 368 inoculated persons in the 

 army in India, 61 were attacked by typhoid, and out of 12,074 non-inoculated 

 45 were attacked; while another series of figures showed 58,481 inoculated and 

 34 attacked, as against 10,927 non-inoculated and 22 attacks. 



The vaccine used in the army was the Wright-Leishman, made from cultures 

 not more than forty-eight hours old, which were sterilized at 53° C, and to 

 which, when cold, 0*4 per cent, of lysol was added. This vaccine was to be 

 used during the period extending from three weeks to three months after its 

 preparation, and was to be injected under the skin opposite the insertion of 

 the left deltoid. 



The first dose was 500 million bacilli, and the second, given ten days after, 

 was 1,000 million bacilli, and sometimes a third dose of 1,000 million was 

 also given. Inoculation takes place at 4 p.m., and the soldier goes to bed at 

 8 p.m., when the reaction begins, and is on light duty for two days. There 

 is practically no negative phase, and the reaction consists of a localized 

 hyperaemia with oedema and some slight fever, malaise, and chilliness. Occa- 

 sionally the symptoms are more severe, but usually disappear in forty-eight 

 hours. The typhoid monovaccine was prepared according to many other 

 methods: the Pfeiffer-Kolle vaccine, the Vincent vaccine, the nucleo-proteid 

 vaccine of Lustig and Galeotti, etc. An attenuated live vaccine was prepared 

 by one of us, and a non-attenuated sensitized live vaccine was prepared by 

 Metchnikoff and Besredka, and extensively used by Alcock. 



PARENTERIC. 



Synonyms. — Typhoid-like and paratyphoid-hke fevers; Enteric-like fevers; 

 Fevers due to intermediate germs. 



Definition. — The term ' parenteric ' indicates a group of fevers 

 clinically hardly distinguishable from one another, and from 

 enteric, but due to intestinal bacteria specifically different from 

 B. typhosus Ebertli, B. paratyphosus B Schottmiiller, and B. para- 

 typhosus A Schottmiiller. 



