329
That the addition of moribunda to the non-serum cases has not influenced their
recovery rate, is shown by the following figures :—
Of the 493 serum cases 63 died within the first 24 hours and 68 within the next
24 hours after the beginning of the treatment. As the day of admission was not
always identical with the day of the beginning of the treatment, the respective figures
are 52 and 58 in regard to the admission. The serum cases had therefore 27
per cent. deaths within the first 48 hours after admission. For the 1,190 non-
sarum cases the figures are 445 and 227 respectively. The deaths within the 48
hours are therefore 672 or 56.47 per cent. As is well known, the mortality within
the 48 hours after admission is 50 per cent. and more in the large Plague hospitals,
and therefore its increase in the non-serum cases is at the most 7 per cent. That a
greater number of patients who die within the first 48 hours cannot influence
unfavourably the recovery rate, as long as the exchange does not take place in the
class of recovering patients, is obvious.
The 7 per cent. more deaths within the first 48 hours after admission in the
non-serum cases correspond probably to the number of patients who died a few hours
after admission and could not possibly have been taken for treatment, as patient3
arriving in the evening had to wait till the next morning before the special line of
treatment was decided upon by the Medical Officer.
Hence the exclusion of moribunds was due to involuntary causes rather than to
anything else. When intentional, it was strictly confined to actually dying patients.
That the principles of selection were so rigorously adhered to, reflects great credit
to the conscientiousness and ability of Dr. Choksy, by whom the selection was made
in the majority of cases.
We have already seen from the comparison with the recovery rate of other
hospitals that the selection brought no advantage to the serum treatment. This can
be further demonstrated from the records of the Arthur Road Hospital itself. Dur-
ing the months of November and December 1898, and January 1899, the serum treat-
ment was discontinued as no serum was available. During this time 273 patients
were admitted, 51 of whom recovered, the rate being 18.68 per cent. or 0.89
per cent. lower than in the non-serum cases of the serum period. The total recovery
rate of this serum period compared with the above period gives a difference of
5.61 per cent. in favour of the serum. Or we may put it in another way.
From the 12th of March to the 31st of October 1898, the serum was used during
the epidemic and the recrudescence : the admissions were 663 with 186 recoveries or
28.05 per cent. the 53 convalescents being excluded. During the inter-epidemic
months of November and December 1898 and January 1899, the serum was not
used : the admissions were 273 with 51 recoveries or 18.68 per cent.
From the 1st of February to the 31st of May 1899 the serum was used again :
the admissions were 930 with 201 recoveries or 21.61 per cent.
Thus the 'total recovery rate was higher in both periods in which the serum was
used than in the period in which it was not employed, although considering the
epidemiological conditions the contrary should have been the case.
That the higher total recovery rate at the Arthur Road Hospital was due to the
serum treatment and not to other unknown influences, is directly proved by the fact
that in 1898 as well as in 1899 the recovery rate rose immediately with the com-
mencement of the treatment in spite of the synchronous rising of the epidemic.