380
made in the administration of the serum. The possibilities in this direction, apart
from the intravenous injections, are by no means exhausted. We admit that part-
ly out of imposed economy the doses have not been pushed for some time past as
far as might have been done with advantage, as further experience has taught us.
It is certain that with larger doses more cures could have been effected. More-
over, the serum was usually injected in repeated small doses, whereas in all
probability one large dose would have been more effective. It might turn
out that the first dose, necessarily a large one, decides the question of life or
death, and that the subsequent doses are of little value. But experience, where
human life is concerned, is not gained so quickly as in the laboratory. Still the
increase of the doses can only be a stopgap, until improvement is made in the
manufacture of the serum which must be the task of the future. That the task
is not an impossible one, probably nobody doubts. What we may hope for from
an improved manufacture and application of the serum has already been alluded
to in our previous report. The results in private practice will depend on the
promptness with which the public and the practitioners will avail themselves of
the remedy. The chief responsibility rests with the latter who must be quick
with the diagnosis and therapy. The germs of the disease double their number
in half-an-hour ; there is not a minute to be wasted. Better to inject 100 patients
erroneously, who are not sick with plague, than to miss the injection in one who
is suffering from it. Unfortunately the probability of a faulty diagnosis is infinitesi-
mal. In time of an epidemic every swollen and tender gland which cannot he
accounted for by other obvions causes must be looked upon as a manifestation of the
plague. The same axiom holds good during epidemics generally with regard to the
characteristic symptom of an infection, why, therefore, should it be otherwise in the
case of plague ? To delay the treatment until the case turns out to be severe
would be even worse than to lose time with the diagnosis. When a man is strug-
gling with the waves, who would wait in going to the rescue until he is sinking ?
In our hospitals, where 50 per cent. of the patients die within 48 hours after admis-
sion, the limit of our expectations is more restricted than in private practice.
Notwithstanding the lesson of modesty the plague has taught us with regard
to " stamping it out" by sanitary measures, there may still be some who are as yet
unwilling to draw the obvious inference also with respect to the curative efforts, and
who view with scanty satisfaction the promise we are holding out and esteem slight-
ly the results we offer. Only 11 per cent. ! Could it be that such contempt is
prompted by the comparison with the results obtained by the serum treatment in
other diseases ? There is only one disease in which the efficacy of serotherapy has
remained undisputed, although it has been claimed for many. What then are the
results in diphtheria ? We have at hand the latest statistics of the Metropolitan
Asylums Board, based on many thousands of observations, which give the mortality
from diphtheria at 30 per cent. previous to the serum treatment and at 18 per cent.
after its introduction. Only 12 per cent. ! And to obtain this the most eminent
scientists have been working in the best equipped laboratories for nearly a decade.
Yet the results are considered as highly satisfactory and the serum has become a
remedy, the public and the physician would be loath to be without. The percentage
of the cure3 is the same in diphtheria and plague, but what a difference of the
conditions under which it has been obtained ! There the accumulated experience of
the whole scientific world, unlimited means, selected horses, selected serum, the
public fully aware that time is life, the patients with healthy organs, the disease
of relatively slow course and with a mortality of only 30 per cent
Against it here,
manufacture and treatment on their trial, the horses selected with regard to their
cost, the serum used regardless of its strength, the patients of the lowest classes
in an advanced stage of the disease, their vital power undermined by previous or