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As no specific has hitherto been discovered for the cure of plague, the treatment
resolves itself into the carrying out of the general principles of medicine as applied to
the treatment of symptoms arising in the course of the disease.
The stimulant method and the administration of liq. hydrargyri perchloridse
have both been given the fullest trial, and both have proved equally inefficacious in
either controlling or checking the disease.
In order to arrive at some definite conclusion as to the value of the various
methods of treatment, and especially to compare the results of the general, in contrast
to the special, treatment by inoculation of serum antipesteux, I have collected 100
cases which were admitted to hospital between the first and the fourth day of the disease,
and treated by the usual methods, and I had hoped to have been able to collect 100
cases of patients treated by inoculation, admitted under exactly the same conditions as
those of the first hundred, but the lack of serum at the critical time has rendered this
difficult to accomplish.
Appended is a list of 30 cases inoculated, and nearly 100 cases non-inoculated.
The mortality in the former is 60 per cent., in the latter 83 per cent., that is to say,
a saving of life of 23 per cent.; and, although this is not as good a result as I had at one
time anticipated, it is sufficient to indicate the right path and to act as a further
stimulus in perfecting the only means we have at present of even influencing one of
the direst diseases that ever afflicted humanity.
With regard to the action of the serum itself by reason of the irregularity of the
temperature curves in plague, it is very difficult to determine exactly the modification
which the administration of serum produces on these curves.
It is absolutely certain that in ordinary cases the temperature falls under the
action of the first injection, that is to say, in the first 24 hours, and it is equally certain
in many cases that it never re-ascends.
This fall is obtained whatever the day of the disease on which the treatment is
commenced, unless the patient is moribund.
The fall in temperature is generally temporary even in those about to recover.
The most characteristic actions of serum (in cases of ordinary gravity) inoculated
in the earliest stages of the disease are : (a) fall in temperature, (b) amelioration of
the general condition, (c) diminution of stupor, (d) improvement in prostration.
The improvement in the general condition like the fall in temperature is in
the majority of the gravest cases transitory, the symptoms again become serious, and
the disease appears to run its course as if the serum had not been given.
The alteration brought about by the serum exercises an influence which is
prolonged over the temporary improvement noticeable after the inoculation.
In cases treated early from the first to the second day, the progress of the disease
and the intensity of the symptoms are diminished.
When the first re-action of the serum is exhausted, the fever returns with less viru-
lence, and there is generally less stupor than before the commencement of the treatment.
In cases which appear certain to die, the course of the disease seems to be stayed,
and even, if recovery does not take place, it nevertheless provides a most powerful
insistence to the disease and one which may last a considerable time.
The decided action of the serum is proved in all cases where the patient does not
die within 24 hours (which is an indispensable condition, in order that the serum may
have time to act). I therefore submit that, if the treatment by serum is ineffective in a
certain number of cases, it has an enormous power over those cases where the toxin
poisoning is not the gravest and where the disease does not run its most rapid course. In
the majority of these cases, we are bound to admit that the recovery is due to the serum.
Illustrated temperature charts are appended.