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opon in our previous report to which we refer. The plague, as already stated by
the German Plague Commission, is characterised by subsequent attacks of a few
days duration, the first attack being the most fatal.
(2). Native Christians.
(3). Hindu females.
(4). Children.
(5). Patients with single buboes.
The disproportionate reduction in these four classes, winch have also under
the ordinary treatment a lower mortality than the average, corresponds to another
law of serotherapy, which we might formulate thu3 : " Under those conditions
where the average mortality from an infectious disease decreases naturally, the
decrease under the influence of a serum treatment takes place in a much higher
ratio." Thus a serum of a given strength, which would reduce an average mortality
of 80 per cent. to 70 per cent., would not give the same difference of the percentages or
the same proportion of the reduction if the average mortality were 70 per cent. to begin
with. A mortality of 70 per cent. might be reduced to 50 per cent., and less. That is,
in the last instance, due to the fact that the germs of an infectious disease multiply in
an arithmetical progression, and that the serum becomes more effective in the same
ratio as the germs become less in numbers. Following on this law we understand
not only the deviations in our statistics, but also why the serum treatment gave
so much better results in 1897 when the mortality was considerably lower than it.
has been in the following years. We understand also the exceedingly favourable
reports which came from places where the mortality from plague was much lower
than it is in Bombay. A lower mortality means a less virulent infection ; a less
virulent infection a less rapid course of the disease, viz., a longer interval between
the infection and the fatal issue and an enhanced possibility of timely intervention.
Here the two laws of serotherapeutics meet, they are indeed one, and we are at
the old argument again, ceterum censeo curam non esse differendam.
The deviations we have found in the statistics are not striking, and cannot be
so, considering that the mortality was 80 per cent. and the reduction 11 per cent.
Each one of them could well be accidental. But what cannot be accidental, what
excludes every possibility of an error is their concurrence, their harmony with the
laws of serotherapy and with the clinical observations. With regard to the latter
we can say that they are fully borne out by the statistics. We point in this relation
to the statements made in last year's report, viz., that the serum gives the best
results in children, in patients with simple bubonic plague, that it is effective also
on the fourth and fifth day of illness, that the buboes reabsorb oftener, and that life
is prolonged. The analysis of the results obtained has thus not only answered our
query when the serum is most efficacious, it has also furnished another and most
convincing proof for the efficacy of the serum. Whereas the conditions of the
patients were originally the same on both sides, the results were different, on the
whole, and in the details, and the differences wore not irregular but governed by a
law and must logically be ascribed to the one new factor that was intentionally
introduced on the one side, viz.-, to the serum treatment.
Practically, the outcome of the analysis is important in two directions. It is
obvious that a Hindu male with contiguous buboes, all other conditions equal, will
have a worse prognosis and will require larger doses than a Native Christian malo
with a single inguinal bubo.
There is nothing more to be said about the alternate treatment, and we have
only to mention that four selected cases were treated with the serum in »June, 1899,
at the Arthur Road Hospital and had one recovery, whereas the 14 remaining
patients had two recoveries.