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I have the honour to submit the following report on cases o£ plague
treated with Professor Lustig's Serum at the Arthur Road Hospital during
January 1901 :—
1. Just about the end of last year a certain number of cases that were
observed in this hospital, as well as outside, gave indications of a
decided change for the worse in the virulence of plague, and as
cases began to be admitted during the month, it became at once
evident that we had to deal with a graver and more intensely
virulent type of plague than hitherto. A systematic examination
of the blood of all the cases undergoing the serum treatment
was therefore begun, and microscopic as well as culture examina-
tions showed that the cases were septicæmic having begun in them
much earlier and before the serum treatment was commenced.
The cases resolved themselves into two types. In the one, there
apparently existed a small single bubo, situated in the groin, neck
or axilla, varying in size from a pea to a small marble which
remained in much the same state during the life-time of the
patient or even became smaller. The general symptoms were
much more acute than in ordinary cases of the bubonic type, and
high fever, rapidly failing pulse, intense and violent delirium,
persistent vomiting of food and medicines, coffee-grounds
vomiting, &c., &c., characterised it. Death usually supervened
within 36 to 48 hours of the onset of initial symptoms. In the
other type were found a triple set of buboes involving the femoral
inguinal and superfinal and deep iliac glands varying in size from
a pigeon's egg to a full size cricket ball and with or without
extensive perigland or infiltration in the subcutaneous connective
tissue. The general symptoms were just as grave as in the first
type, and the patient succumbed within 3 to 4 days. In almost
all these cases, blood examination showed septicæmia, and
examination after death revealed the fact that the intense gravity
and virulence of these cases was due to blood septicæmia coupled
with a rapid extension of the infection to the deep glands of the
pelvis, the ilia3 and lumbar glands and other lymphatic glands
along the blood vessels in the abdomen. It was also noticed that
in many cases where only a single bubo was evident on the surface
and yet an apparently mild case had proved fatal in spite of the
serum treatment and that a large number of deep-seated buboes
also existed which could not be felt during the life-time of the
patient and the existence of which was not even suspected before
death. It is not implied from the above that such cases did not
exist in the previous epidemics. All that is contended here is that
whereas in former epidemics they were fewer in number and were
observed during the height of the epidemic only, they have
appeared now in large numbers—in fact constitute the bulk of the
admissions—and at the beginning of the present epidemic. And
again fresh arrivals in the City seem to have been greatly
susceptible to these virulent types.
2. It was under these circumstances that the serum treatment was
resumed in January 1901, and in spite of its being of the same, if
not somewhat greater potency than last year, not much impression
could be made in septicæmic cases. Much larger doses of the
serum were injected subcutaneously without any appreciable results
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