326
who,
although not moribund, would have died later ou under t
The decisive factor in the selection is the exclusion of the patients recovering by
nature ; and this factor went against the serum treatment. Sometimes no selection
was made, e.g., in private practice, and again at the Arthur Road Hospital, when
suitable patients came in in small numbers at a time when the urgency of reporting
on the progress of the experiments did not allow of any delay. In May 1899, by
special request, the cases were taken alternatively for treatment.
In other instances, the case3 were selected by the medical officers in charge of
the respective hospitals and also so-called "control cases " supposed to be in a simi-
lar condition. Sometimes patients known to be hopeless were injected in order
to study the effect of the treatment on special or distressing symptoms.
It is thus to be seen that, although selection was the rule, patients carao also
in other ways under the serum treatment; and it is further clear, that the selection,
far from giving undue advantage to the treatment, put it, on the contrary, at
distinct disadvantage.
So much for the method of clinical selection.
As to the results claimed for the treatment, it seems to me that they must be
accepted as established, if the general recovery rate from plague was at the time,
in fact, about 20 per cent, which has been taken as the basis for comparison, and if
the higher recovery rate of 39.36 per cent obtained by the serum, was not due ta
the selection.
To prove this, I shall proceed in the following purposely on statistical lines,
and shall confine myself only to the patients treated at the Arthur Road Hospital
for whom all the necessary data are at hand.
As an introduction to these statistics I may be permitted to give here shortly,
the history of the serum treatment.
The first patients were treated, in June and July 1897, at Poona and Bombay,
by Professor Lustig himself. Out of 30 patients selected by the officers in charge
of the respective hospitals, 26 recovered and 4 died. It was on the strength of
these results that the Bombay Municipality requested Professor Lustig to continue
the experiments.
When Professor Galeotti and the undersigned came to Bombay in March 1898,
with the serum prepared for the Municipality, they came naturally with high
expectations which, however, were not at first fulfilled.
The treatment was commenced on the 12th of March 1898 at the Arthur Road
Hospital with the serum of horse No. 1.
The epidemic was raging with unusual severity and seemed to baffle all
medical efforts,
No appreciable curative results could be obtained in the first weeks ; and had
it not been for the clinical observations showing undoubtedly that the specific
treatment was not without beneficial effect, the experiments would have been
abandoned at this early stage.
The arrival of a new serum was anxiously awaited, It came on the 26th of
March, and with it the solution of the problem. It was obtained from horse No. 3,
and was first used on the 28th of March. The difference in the efficacy of the
first and second serum was not only unmistakable clinically, but soon also evident
numerically as has already been shown in detail (vide page 3).