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tried when till others have failed. Although the number is too small for genera
conclusions the favourable influence of better conditions of life is unmistakable. It is
to be hoped that in the future the serum will have an extensive trial in private
practice where it will show to full advantage.
I have but few more remarks to make and they bear on the future of the
serum-treatment of plague. Going over its history in this City, and recollecting
the exaggerated expectations with which Dr. Yersin was received in 1897, I should
not be surprised to hear some one exclaim : Only twelve per cent.! That is nothing
to speak of ! There is no arguing with such a cold-blooded arithmetician. Twelve
per cent, is a handsome profit in business ; should it be otherwise where human
life is concerned ? Let'him ask the twelve per cent, who owe life and health to the
serum, if they agree with him, or let him go io our plague hospitals and look at the
poor plague-stricken inmates and he may perhaps begin to wonder that even one
per cent, could be saved by human intervention. "Would he not change his views
-tf he or his family or friends were threatened ? And if we are to adopt Mr. W.
M. Haffkine's statistical method of calculating the benefit of plague prevention, the
serum shows an increase of fifty-eight per cent, on the actual recovery rate by
ordinary treatment. In other words for every hundred who recover by ordinar} r
treatment a hundred and fifty-eight recover by serum treatment. The serum cures
one-third and nature but one-fifth of those attacked. Is that not worth while ?
It would be just as great an error to rely entirely upon the curative serum and
neglect the prophylaxis. In such a rapid and deadly disease prevention will always
be safer than cure. No one would be careless in handling fire just because there
was a fire-engine round the corner.
The question whether no improvement is possible, deserves fnll consideration. I
can answer confidently that improvement is certain, the results of the past having
been obtained under the most unfavourable conditions.
The serum was on its trial ; the laws how to prepare it best have yet to be Inid
down j sera of inferior quality had to be used ; the mode of application to be studied ;
while, on the other hand, there were patients of the lowest castes, with little natural
resistance and in an advanced stage of disease—only nine per nent. being patients of
the first day—ill-fed ; weakened by previous illness, not seldom simultaneously
suffering from complications, such as relapsing fever, malaria, phthysis, or infection
by cocci—a multitude of (< factors tending to obscure the main issue."
If we now ask what are the best results we may hope for, we have to distinguish
treatment in hospitals from treatment in private practice. There are unfavorable
conditions inherent in the treatment in hospitals which we have to reckon with. As
long as patients do not avail themselves at the earliest date of the advantages the
hospital offers them, the best results will be an increase of the recovery-rate from 20
per cent, to 50 per cent. This increase has already been obtained with the best serum
and it will be obtained again, since the regular manufacture of a serum of highest
activity is merely a question of time and further experience. The prospects of the
seram treatment must not therefore be judged by the average result obtained, but
by the best results. If the serum be prepared on a larger scale it will, moreover,
be possible to discard the use of inferior sera.
That a further increase cannot be obtained in our large hospitals even with tlaft
most active serum, I am led to believe by the following considerations :—