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nor by that of serotherapy generally. The curative plague serum lias moreover
been tried in other diseases and also on healthy beings -without causing any
inconvenience.
The serum is usually injected under the skin once or twice a day. The single
dose for an adult is from 20 to 60 c. c., for children about the half. The injections
do not cause special pain and no local irritation or abscesses if the syringe is kept
septically clean, and fche skin is well disinfected. The effect of an injection becomes
manifest within 12 hours. The temperature either does not rise, or falls distinctly,
the arterial pressure is increased, the delirium subsides, the bubo is loss tender and
diminishes sometimes considerably. Improvement after the first injection is generally
observable, although it may not be progressive. This latter cannot be surprising
if we consider the probable mode of action of the remedy. The serum induces a
reaction in the tissues of the body, stimulating them to the production of bactericidal
or antitoxic substances by which the infection is overcome, or its poison neutralised.
Against degenerative changes which may have been already established in
different organs, principally in the heart, before the patient comes under treatment,
the serum is powerless. The gravity of such degenerations is determined by three
factors : the virulence of infection ; the time since the beginning of the infection ;
and the individual resistance. As we can neither diminish the virulence nor
increase the resistance, we must try to shorten the time, that is, we must resort to
the treatment as early as possible. This is a point that cannot be emphasised too
strongly. The earliest treatment is essential for the cure of a disease which leads to
death usually within 4 days and sets up irreparable changes in the heart within 24
hours and even less. No time should be lost as every hour's delay may prove fatal,
especially as the serum itself needs some time to develop its action. Fortunately the
diagnosis of plague in times of epidemic is so easy that in 00 per cent, of cases it
might be made by a layman.
Also symptomatic treatment has not to be neglected. The judicious nse of
alcoholic stimulants and cardiac remedies when the heart shows signs of impending
failure, or cold sponging when the fever is very high, will prove of great value.
The quality of the pulse, as an index of the condition of the heart is chiefly of
importance for the prognosis of patients treated with the serum. However alarming
the other symptoms may be, so long as the pulse can be felt well and is not too
frequent (l. <?., over 140) and soft, tliere is always the possibility of recovery.
Certainly also in such eases oollapse and death may follow very soon after injection.
Such coincidence is not to be wondered at if we remember how often unexpected
sudden changes for the worse occur in plague. If the pulse be almost imperceptible
very soft, and frequent, or intermittent then even serum treatment is of no avail and
had better be abandoned. There are limits for every remedy and the experienced
physician ought to know and to respect them.
The best results are obtained in the forms of plague in which recovery by
nature is more frequent, as in simple bubonic plague. Also septicsemic forms can be
cured if they are treated on the first day. No results have been obtained in plague
pneumonia. Too few cases have been treated to form a definite opinion whether this
worst type of plague infection is accessible to cure or not. As regards class it can
be said with certainty that children give the best results, no doubt because the
resistance of the heart is greater than in adults.
The observations outside the hospital which interest practitioners most, are but
scanty. Thirty-two cases have been treated and recorded. Nineteen of them re-
covered. The cases were without exception very severe,, and the majority .of them
far advanced, as the public seems to lookupon the serum as the last resource to be