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patient becomes quiet and falls asleep. It is surprising how quick a dry tongue
sometimes gets moist after one or two injections, even in patients who die later.
The bubo does not increase in size and sometimes diminishes distinctly, becoming at
the same time less tender and reabsorbing oftener than otherwise. The recovery is
speedy and sequelæ appear seldom, if the patients come early for treatment. The
first signs of the influence of the treatment show themselves usually within 12 hours
after injection. A decided improvement in the general condition of the patients
takes place in the majority of cases within 24 hours, and is naturally more pronounced
in patients who recover.
Contra indications for the use of the serum do not exist. Still if a patient is
sinking in collapse, it is wise to delay the injection, lest the antithermic effect may
coincide with the collapse, and death, shortly after the beginning of the treatment,
be attributed to the serum. In such cases, it is better to try to improve the heart's
action by the use of stimulants. If the heart improves then the serum may still be
useful : if the heart cannot be revived, then the serum is useless and is probably not
absorbed quick enough to be effective.
It has always to be remembered that the serum influences symptoms only indirect-
ly through acting upon the cause which has produced them. The exact mechanism
of this action is not sufficiently known as yet. All that we can say at present is
that recovery by curative as well as immunity by prophylactic treatment is due to
a reaction in the body's tissues brought on by the respective agents. Sometimes
without apparent reason no such reaction is produced ; then cure and prophylaxis
fail.
The serum gives the best results as may be expected in the forms of plague
in which recovery by nature is more frequent, e.g., in uncomplicated bubonic plague.
Cases which show signs of septicaemia from the beginning can be cured, if the
serum is used on the first day.
Mixed and secondary infections are unfavourable. The recent investigations of*
the Austrian and German Plague Commissions have shown that in a considerable num-
ber of patients, death is not directly due to plague, but to infection by various cocci.
Plague, no doubt, paves the way for other micro-organisms which find a suitable soil
in v. body weakened by its action. Against the coccic infection, the plague serum,
as a specific remedy, is without any effect. We can, therefore, appreciate still moro
the necessity of early treatment which, by cheeking the plague at its beginning,
prevents the infection by other bacteria:
The frequency of such bacterial associations may vary in different epidemics
of plague, as it is known to vary in other diseases in which such associations also
occur, and they may have something to do with the malignity of certain epidemics and
the non-typical course of single cases. In these mixed or secondary infections,
a combined serum treatment may prove efficacious and is certainly worth
trying.
Unfavourable also are complications with relapsing fever, or malaria, which
were not infrequent in the patients at the Arthur Road Hospital.
No cures have been obtained in plague pneumonia. Comparatively few such
cases have been treated, as pneumonia patients are mostly beyond help when they
are admitted.
Symptomatic treatment is not to be neglected in serum cases. The patients
at the Arthur Road Hospital received a small quantity of rum every two hours and
cardiac stimulants when the heart; showed signs of impending failure.