In the recent Balkan war (1913) Kolle’s vaccine was employed with considerable success. This vaccine is killed by exposure to 58°C. for one hour. It was found that this vaccine was not only of value prophylactically but diminished case mortality as well. With 91,224 persons vaccinated and 8,968 not vaccinated, the case rate among the inoculated was 0.7% and the death rate 10.2%, while among the noninoculated the case rate was 9.3% and the death rate 27.5%.
Ottolenghi prefers to sterilize with a temperature of 53°C. He gives 500 million at the first injection and 2 billion at the second.
Among 72,653 soldiers, having 2 inoculations of this vaccine, the incidence of cholera was about 13 times less than among 14,332 who were not vaccinated.
Of 2897 Greek sanitary corps men inoculated 0.45% were attacked while of 114,805 combatants, not inoculated, about 2% were attacked by cholera. One would naturally consider the greater exposure of the sanitary forces.
Cholera vaccines made from killed cultures are the ones now generally used.
During the World War a Roumanian regiment numbering 4,500 soldiers, had 386 cases of cholera develop in the course of six days, with 166 deaths. Vaccination was commenced and during the interval between the first and second injections, new cases continued to appear. Two days after the second injection the epidemic ceased. In another regiment the commandant refused to have his men vaccinated. A group of Jewish soldiers, 200 in number, insisted on being vaccinated, which was done. Later the regiment was stricken by cholera and 450 cases developed. None of the vaccinated Jewish soldiers contracted the disease.
Some prefer sensitized living cultures for prophylaxis but such vaccines are less practical.
There is much to indicate that Strong’s cholera autolysate is of value prophylactically. In this cholera cultures are killed at 60°C. The killed culture is then allowed to digest itself in the incubator at 37°C. for three or four days (peptonization). The preparation is then filtered and from 2 to 5 cc. of the filtrate is injected.
Treatment.—Many of the older authorities recommended the use of various astringent medications for the checking of suspicious diarrhoeas and most of these prescriptions contained opium in some form, such as lead and opium pills or aromatic sulphuric acid and laudanum. In view of the fact that for the infection of animals Koch had to employ opium for checking peristalsis in addition to neutralization of gastric juice it would seem very undesirable to use opium by mouth. Calomel in divided doses and continued over one or two days, but not exceeding 7 or 8 grains, has been recommended.
At present the treatment which is thought to give the best results is the permanganate one proposed by Rogers. In this the patient is given calcium permanganate water ad libitum and 2-grain pills of potassium permanganate every half hour until the stools become more faecal in character. These pills are made up with vaseline and coated with a mixture of a 1 part salol and 5 parts of sandarach varnish.