A CASE SHEWING THE APPARENT GREAT
value of cholera inoculation. By Sukgn.-Capt. A. H
Nott, m.b,,
Civil Surgeon, Hazaribagh.
In July last an extremely virulent type of cholera became epidemic in the town of Hazaribagh and the surrounding villages, the general mortality being from first to last well over 80 per cent., and at first almost 100 per cent. Cholera inoculation, according to Professor Haffkine's method, was carried out by AssistantSurgeon Gopal Chunder Mookerjee under the directions of Surgeon-Capt. J. 0. Vaughan, in chai'ge of cholera inoculation work at Purulia. On the whole, little was to be gathered in an affirmative sense as to the value of the work by a statistical consideration, as considerable delay took place owing to difficulties of communication and delay of the passage tubes in the post, it being the rainy season, before any considerable amount of work could be performed. However, it has been ascertained with certainty that no deaths from cholera took place out of the individuals 500 inoculated. nearly Reference however has been made in the Englishman by a correspondent to an incident which occurred under my close immediate notice in a European family, which has been considered, and I think with reasonable grounds, I as striking evidence in favour of its value. have thought it, therefore, desirable to place on record the facts in connection with it, so that those interested in the matter may form a judgment as to its value as evidence. On Sunday morning, July 25th, at about 10 A.M., in the family of Mrs. D., which consisted of the mother and five daughters, two of the At about 4 a.m. the latter were inoculated. next morning the youngest daughter, aged nine years, who had not been inoculated, developed the initial symptoms of cholera, the case turning out to be of the most virulent type, death occurring the same afternoon. About 7 a.m., whilst I was in attendance on this patient, the mother and one of the older daughters also complained of identical symptoms. In the case of the mother, who had not been inoculated, in the course of two or three hours well-marked symptoms of cholera developed and death occurred the next day, the case being hopeless after the initial period. But with regard to the daughter, who was attacked at the same time as the mother, the result was very different as, although for two to three hours the symptoms were exactly the same as those of the other two patients, yet rapid recovery after that period took place under treat-
May
SARCOMA OF THIGH: BANERJI.
1898.]
chlorodyne and stimulants, and she well enough to assist in nursing her mother. This young lady was one of the two who had been inoculated the previous day, the other escaping altogether, as it is right to say did two others who had not been inoculated. The symptoms actually displayed were profuse watery diarrhoea and well-marked nausea, alrnent with was
soon
there was no actual vomiting. It is of course possible, in the absence of proof of the presence of the cholera bacillus in the evacuations, which under the circumstances was impracticable to obtain, to urge that the attack was only one of simple intestinal derangement, but it seems unreasonable to believe that, in an individual who had been remarkably free from diarrhoea at a time when most of the European residents were more or less affected with slight bowel disorders, such a remarkable incidence should happen as this would be. It might also be said that it was only the result of the inoculation, but this can hardly be accepted since all the symptoms, such as fever and lassitude caused by the inoculation, had passed off before she went to bed the night before and hardly any of the other Europeans who had been inoculated shewed any symptoms at all of this character, and none of any thing like the same severity. It must, hovvever, be admitted that such an extremely favourable result is more than the warmest advocates of inoculation would claim for it, as it seems quite certain that the latest period at which the infection could have been received was at breakfast time on the Sunday, ?-e., almost immediately after the inoculation had taken place. No doubt, however, the immediate efficacy has been much hastened since the practice of using two inoculations has been re-
though
placed by
a
single operation.
The result in this family was therefore as follows :?Of four individuals uninoculated, two contracted the disease and both died, whilst of two who were inoculated one escaped entirely and the other was attacked as above recorded and recovered.
177
value of cholera inoculation. By Sukgn.-Capt. A. H
Nott, m.b,,
Civil Surgeon, Hazaribagh.
In July last an extremely virulent type of cholera became epidemic in the town of Hazaribagh and the surrounding villages, the general mortality being from first to last well over 80 per cent., and at first almost 100 per cent. Cholera inoculation, according to Professor Haffkine's method, was carried out by AssistantSurgeon Gopal Chunder Mookerjee under the directions of Surgeon-Capt. J. 0. Vaughan, in chai'ge of cholera inoculation work at Purulia. On the whole, little was to be gathered in an affirmative sense as to the value of the work by a statistical consideration, as considerable delay took place owing to difficulties of communication and delay of the passage tubes in the post, it being the rainy season, before any considerable amount of work could be performed. However, it has been ascertained with certainty that no deaths from cholera took place out of the individuals 500 inoculated. nearly Reference however has been made in the Englishman by a correspondent to an incident which occurred under my close immediate notice in a European family, which has been considered, and I think with reasonable grounds, I as striking evidence in favour of its value. have thought it, therefore, desirable to place on record the facts in connection with it, so that those interested in the matter may form a judgment as to its value as evidence. On Sunday morning, July 25th, at about 10 A.M., in the family of Mrs. D., which consisted of the mother and five daughters, two of the At about 4 a.m. the latter were inoculated. next morning the youngest daughter, aged nine years, who had not been inoculated, developed the initial symptoms of cholera, the case turning out to be of the most virulent type, death occurring the same afternoon. About 7 a.m., whilst I was in attendance on this patient, the mother and one of the older daughters also complained of identical symptoms. In the case of the mother, who had not been inoculated, in the course of two or three hours well-marked symptoms of cholera developed and death occurred the next day, the case being hopeless after the initial period. But with regard to the daughter, who was attacked at the same time as the mother, the result was very different as, although for two to three hours the symptoms were exactly the same as those of the other two patients, yet rapid recovery after that period took place under treat-
May
SARCOMA OF THIGH: BANERJI.
1898.]
chlorodyne and stimulants, and she well enough to assist in nursing her mother. This young lady was one of the two who had been inoculated the previous day, the other escaping altogether, as it is right to say did two others who had not been inoculated. The symptoms actually displayed were profuse watery diarrhoea and well-marked nausea, alrnent with was
soon
there was no actual vomiting. It is of course possible, in the absence of proof of the presence of the cholera bacillus in the evacuations, which under the circumstances was impracticable to obtain, to urge that the attack was only one of simple intestinal derangement, but it seems unreasonable to believe that, in an individual who had been remarkably free from diarrhoea at a time when most of the European residents were more or less affected with slight bowel disorders, such a remarkable incidence should happen as this would be. It might also be said that it was only the result of the inoculation, but this can hardly be accepted since all the symptoms, such as fever and lassitude caused by the inoculation, had passed off before she went to bed the night before and hardly any of the other Europeans who had been inoculated shewed any symptoms at all of this character, and none of any thing like the same severity. It must, hovvever, be admitted that such an extremely favourable result is more than the warmest advocates of inoculation would claim for it, as it seems quite certain that the latest period at which the infection could have been received was at breakfast time on the Sunday, ?-e., almost immediately after the inoculation had taken place. No doubt, however, the immediate efficacy has been much hastened since the practice of using two inoculations has been re-
though
placed by
a
single operation.
The result in this family was therefore as follows :?Of four individuals uninoculated, two contracted the disease and both died, whilst of two who were inoculated one escaped entirely and the other was attacked as above recorded and recovered.
177
