PROPHYLAXIS 



1435 



of guinea-pigs inoculated intraperitoneally with plague bacilli, and 

 killed some little time before they would have died naturally. The 

 exudate is diluted with a solution of carbolic acid and sodium 

 carbonate and chloride, and given in a dose of i«5 to 2'5 c.c. By 

 this method plague aggressins are produced and used. 



Klein has advocated an ' organ prophylactic,' obtained by drying 

 and powdering buboes, spleens, lungs, and livers of infected animals. 

 The dose for an individual is from 5 to 7 milligrammes, made into 

 an emulsion with warm, sterile, distilled water, and injected sub- 

 cutaneously, but it has not yet been tried on man as far as we know. 



Vaccines composed of Living Attenuated Bacilli. — Strong and Kolle 

 have recommended the use of living virulent cultures, and Strong 

 has practically shown that this method of vaccination can be 

 carried out without danger. This vaccination consists of the intra- 

 muscular injection of one whole twenty-four hour agar slant of the 

 living virulent culture in the adult, and one-quarter to one-half of 

 such a culture in a child. The reaction is not excessive. About 

 ten days after the inoculation Strong has observed a marked rise 

 in the opsonic index, and that the phenomenon of complement 

 fixation is given by the blood serum, thus proving the presence of 

 specific antibodies. 



Simpson, Strong, and Kitasato are of the opinion that Governments 

 should unite to deal with plague by attacking it in the endemic 

 centres by general vaccination of the population. 



Poly vaccines. — During the contemporaneous epidemics of plague 

 and cholera in Ceylon, in 1914, Castellani used with satisfactory 

 results a mixed bivaccine plague + cholera, using the local strain of 

 B. pestis. He also prepared and used a pentavaccine plague -f- 

 cholera -I- typhoid +para A +para B, and an hexavaccine containing 

 in addition Malta fever. 



The double vaccine plague-cholera consisted of a carbolized 

 emulsion of jB. pestis and V. cholem, containing per c.c. 1,000 million 

 plague and 2,000 million cholera organisms. One c.c. was given by 

 subcutaneous injection the first time, and 2 c.c. a week later. The 

 pentavaccine consisted of a carbolized saline emulsions of B. pestis, 

 B. typhosus, B. paratyphosus A, B. paratyphosus B, V. cholerce con- 

 taining per c.c. 500 million plague, 2,000 milhon cholera, 500 million 

 typhoid, 250 milHon para A, and 250 milhon para B ; J c.c. was given 

 the first time and double the dose a week later. The reaction was 

 severe, but not more than after Haffkine's monovaccine. The inocu- 

 lated persons developed immune bodies for the five diseases. The 

 penta- and hexavaccines have recently been further investigated by 

 Castellani and Taylor, /oMm^j;^ o fTropicalMedicine, November i, 1917. 



Masks. — ^These used to be worn in the Middle Ages as a prophy- 

 lactic measure, the use of which has been demonstrated by Strong and 

 Teague, and by Barber and Teague, in epidemics of plague pneu- 

 monia. The best mask is a hood of heavy Canton flannel-cloth 

 covering the entire head and tied round the neck, and provided with 

 a window in front composed of sheet celloidin. 



