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book, giving also the date of inoculation and the number of the name
sheet. The sheets for each day should be tied up together and arranged
in order, when it will be a matter of a few moments only by means of
the index to ascertain whether any individual has really been inoculated
or not, and by referring to the sheet full details will be forthcoming.
In this manner, statistics can be subsequently compiled showing the
extent to which protection of a population subjected to an epidemic of
plague has been secured by inoculation.
Instructions for the use of the Plague Prophylactic.
1. Parcel to be opened and unpacked carefully. Any bottle found
open, cracked or with the sealing wax broken, is to be sent back to the
Laboratory without being used. Prolonged exposure of the prophylac-
tic to daylight is to be avoided.
2. The prophylactic is to be given by injection under the skin. For
this purpose a hypodermic syringe of a suitable size is to be disinfected,
in the beginning, by keeping it filled with a 5 per cent, solution of
carbolic acid for 24 hours. After that, if the syringe is not used for
other purposes, it will be sufficient to keep it filled for one hour before
commencing operations. After the completion of each series of injec-
tions the syringe is to be washed out with the same antiseptic solution.
The needle is cleaned outside with a wet cotton pad soaked with carbolic
lotion. Syringes may be obtained from the Plague Research Labora-
tory, Bombay, or by indent on the Sanitary Commissioner, Madras.
3. Each bottle before being opened is to be shaken, and the contents
well mixed up each time before being absorbed into the syringe.
4. For opening a bottle a pair of dissecting forceps is used, the
branches being heated beforehand in a spirit lamp, and guarded from
contact with any other unsterilised object.
5. While opening a bottle, the mouth of it is passed several times
through the flame of a lamp, and the sealing wax melted. The cork is
then withdrawn with the sterilised forceps, both branches of which are
shoved in between the cork and the neck of the bottle, on two opposite
sides of the cork simultaneously. After the bottle is opened any
contact between its mouth and other unsterilised objects is to be avoided;
and if contact inadvertently occurs, the mouth is to be heated again in the
flame, for disinfecting it. The contents, or a part of it, is absorbed into
the syringe, For this purpose the bottle is kept as nearly horizontal as
possible.
6. For an adult man, in average state of health, the standard dose
is 2½ cubic centimeters (15 minims counting for 1 c.c.). This is to
be injected under the skin of the back of the upper arm, preferably the
left one, avoiding as carefully as possible the muscles or the big vessels.
For a woman the dose is 2 c.c. ; for weakly persons the initial injection
is tried with a reduced dose. A child of 10 gets 1 c.c., of three years
from 0 1 to 0 3 c.c. The symptoms commence as a rule 8 to 5 hours
after inoculation, and consist chiefly of swelling and pain at the seat
of inoculation, and of rise of temperature. The pain is felt particu-
larly on movement of the part. The fever is accompanied by general
discomfort usual to this condition. No treatment of the symptoms is
required, beyond applying ice for the relief of headache, if any felt,