333
It is a serious disadvantage for the serum treatment in our plague hospitals
that on the first day of disease when the chances of recovery are favourable so fow
patients are admitted.
The majority of patients were admitted to the hospital and received serum
treatment on the second and third days of illness.
From the third day the number of treated decreases considerably, and this out
of proportion to the number of admissions. This is due to the selection.
After the sixth day only 18 patients were treated, in all of whom protracted
dangerous symptoms called for special intervention.
If we compare the percentage of recoveries on the different days without giving
undue weight to this comparison, as the figures are small, we see that for the first
three days the recovery rate corresponds to that axiom of serotheraphy which has
already been referred to. At first sight, in apparent contradiction to the above-
mentioned axiom, is the higher recovery rate for the fourth and the following days.
To understand this discrepancy, which has also been noted in the results of other
plague sera, we have to remember that no treatment can essentially alter the curve of
mortality of a particular disease. It can only keep it lower on the whole and
modify it in certain phases, but the characteristic features must always remain. We
can even perceive that in a single instance the recovery rate might be cent. per cent.
higher in patients who came late to treatment, if this corresponds to the normal,
curve of mortality of a disease. We have, therefore, to see how the curve of mor-
tality from plague runs normally.
If we put the time of incubation down to 10 days we may say that in the first
days no deaths occur. In the later days of incubation deaths, no doubt, occur, but
they aro not always recognized as due to plague, evident symptoms being absent.
With the eleventh day of infections or first day of illness manifest symptoms set in, the
disease reaching its height in the majority of cases already on this day. The curve
of mortality rises suddenly almost to its highest point, which is arrived at on the third
or fourth day of illness. Then the mortality declines slowly to the sixth or seventh
day, being somewhat lower on these days than it was on the first,, The decline
continues in moderate progression till the tenth day which can be looked upon as the
end of the acute stage.
Patients in the incubation period are almost never to be found in hospitals, which
is unfortunate, as in this period, or even in the first hours of the first day of illness,
serum treatment can arrest and abort entirely the disease as was experienced in some
cases.
The curve of mortality in hospitals begins therefore on the first day of illness
and is higher than among patients treated outside, as only such patients are brought
in who show very severe symptoms in the beginning. There is in fact little differ-
ence in hospitals between the mortality of the patients of the first or the third day,
which latter shows the highest mortality. From the third day the mortality may
deviate probably little from the general mortality. As has already been mentioned,
the mortality in the serum cases follows the mortality in hospitals for the first three
days, the mortality being highest on the third day. With the fourth clay the morta-
lity in the serum cases falls off considerably more than in the non-serum cases.
How can we explain that the serum is effective even at this later stage ? Clini-
cal observation gives the information.
Plague is characterized by attacks of three to four days' duration. The first attack
is the most malignant one and carries away the most victims. Then there is a short