NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
304
5. As one of the non-serum cases that was taken as cured in the report tur
January, died subsequently, the figures for that month would be as follows :—
Serum cases
...
...
Nori-serum cases ...
...
No.
59
59
Died,
38
45
Recovered.
21
14
rer ceut 01
Mortality.
64-40
76-27
6. Table showing the details of the serum cases have been appended to the
report as usual.
I haye, &c.,
N. H. CHOKOT,
Special Assistant Health Officer,
No. 735 OF 17TH APRIL 1900.
To
THE MUNICIPAL COMMISSIONER.
SIB,—I have the honour to submit the following report on cases of plague
treated with Professor Lustig's serum at the Arthur Road Hospital during March
3900 :—
1. As the supply of serum became temporarily exhausted, the serum treatment
had to be suspended from the 17th ultimo ; all the patients admitted thereafter up
to the end of the month were upon ordinary treatment. There were 149 admissions
during the former period, and of these 74 received the serum treatment, and 75
were treated as usual.
2. The serum cases were divided into 4 series, and their results as well as those
of the control cases of each series were as follows :•—
Series Horse No»
£XIV (com-
pleted).
XXV
XXVI
XXVII (to be
completed).
8 (1st bleeding)
4 (4th „ )
2 (3rd „
9 (Isfi „
Total ..
Serum Cases.
Control Cases.
No.
5
24
34
1
74
Died.
3
13
23
6
45
Recov-
ered .
2
11
11
5
29
No.
6
24
34
11
75
Died.
5
18
28
8
59
Recov-
er ed.
1
6
6
3
16
3. The mortality of serum cases was, therefore, GO'S per cent, as against 78'66
per cent, in the controls.
4. The serum as well as the control cases had 17 moribunds each ; there were
5 convalescents amongst the former as against 7 in the latter.
5. The total observations on the alternate system of treatment now amount
to 722 cases. 361 received the aerum treatment and an equal number were treated
by ordinary methods.
5. Of the 361 serum cases 239 died, and 122 recovered, giving a mortality
j-ate of 66-20 per cent.
305
7. Of the 361 non-serum cases 284= died and 77 recovered, giving a
mortality rate of 78'67 per cent.
8. The difference in the mortality rate in favour of the serum cases appears to
be 12*4:7 per cent.
• • •/
Serum Cases
Non-serum Oases ...
...
No.
361
362
Died.
239
284
Recovered.
122
77
Percentage of
Mortality.
66'20
78'67
9. The serum and the 'non-serum cases included an equal of moribnnds—
105, all of whom died : the former had 23 convalescents, whereas the latter had 29
and all these recovered.
10. If all the moribunds and convalescents be eliminated from comparison,
there remain the really accute cases that came under treatment in either series and
their results are as follows :—
S'crum Gases
Non-serum. Cases ...
No.
233
227
Died.
134
179
Kecovered.
99
48
Percentage of
Mortality.
57*51
78-85
11. The difference, therefore, in the mortality rate in favour of the serum
treatment appears to be 21-34 per cent.
12. If the ratios of recovery rates be calculated on the serum and non-serum
cases, including and excluding the moribunds and convalescents, respectively, they
stand as follows :—
berum .Cases.
.Non-serum Cases.
All cases
1-58
to
i
Excluding moribunds and con-
valescents
2'06
to
1
i.e., if 100 patients recover, out of a certain number under ordinary treatment,
the same number, if treated with the serum, would give 158 recoveries in the one
case, and '206 in the other; or to put it in another way, the chances of recovery by
the serum treatment are enhanced by 58 per cent, in one case, and by 106 per cent.
.In the other,
13. Table showing the details of the cases treated during March have been
appended to the report as usual.—I have, &c.,
N. H. CHOKSY,
Special Assistant Health Officer.
No. 894 OP lira MAY 1900.
To THE MUNICIPAL COMMISSIONER
for the City of Bombay,
SIR,—I have the honour to submit the following report on cases of Plague
treated with Professor Lustig's serum, at the Arthur Road Hospital during
April 1900 :—
1. The serum treatment was resumed during the month and out of 160 admis-
sions from plague, 80 were treated with it and 79 by ordinary methods. -In one
306
case only diagnosis could not be verified during life. Every alternate case was
injected with the serum, as usual.
2. The serum cases were divided into five series. The results of these,,
together with those of the control cases, were as follows :—
Series.
XXVII (Completed) ...
XXVIII
XXIX
XXX
XXXI(To be Completed)
Horse No.
9 (1st bleeding)
5 (5th
„ )
10 (1st
„ )
7 (2nd
„ )
1 (5th
„ )
Serum Oases.
No.
5
25
25
11
14
80
Died.
4
19
17
6
9
55
Recov-
ered.
1
6
8
5
5
25
Control Cases.
No-
5
25
25
11
13
79
Died.
3
19
23
8
8
61
Recov-
ered.-
2'
6
2
3
5-
18
0. The mortality amongst serum cases was 68*75 per cent, as against 77'21'
in the controls.
4. The serum cases included 3 convalescent patients and 21 moribund, where-
as the non-serum oases had 8 and 24, respectively.
5. Tables giving the details, of the -cases treated with the serum have been-
appended to the report, as usual.
I have, &c.,
N. H. CHOKSY,
Special, Assistant Health Officer.
No. 1143 OF 20TH JUNE 1900.
To THE MUNICIPAL COMMISSIONER.
SIR,—I have the honour to submit the following report on cases of Plague
treated with Professor Lustig's serum, at the Arthur Road Hospital during May
1900 :—
1. The total.admissions from Plague were 64 ; of these 31 were treated with
the serum alternately with 32 by ordinary methods; and one patient died before
he could be seen by the-Medical Officers.
2. The serum cases were divided into 3 series and'the results of each series,
together with those of the control cases, were as follows :—
Series.
XXXI (Completed). .«
XXXII ( „ )
...
XXXIII (To be com-
pleted)
Horse No.
1 (I5fch bleeding)
6 (1st
,,
) ...
12(lrt
„
) ...
Serum Cases.
No.
9
19
9.
31
Died.
2
13
6
21
Reco.
vered
1
6
3
10'
Control Cases.
No.
4
19
9
32
Died.
4
18
7
29
Reco-
vered.
1
2
3
3- Of the 31 serum cases, 21 died and 10 recovered, whereas of the 32- not
so treated, 29 died and only 3 recovered.
4. The serum cases included 2 convalescent and 10 moribund patients against.
1 and 12, respectively, in the non-serum.
5. Tables giving the details of the cases treated with the serum li&re been,
appended to the report, as usual.
307
6. The statistics for April require alteration, 'as six of the serum cases that
were taken as cured, died subsequently to the date of the last report, the causes ot
death and the period they were in hospital were as follows :—
1. Exhaustion
1£ months.
2. Dysentery
2
„
3.
Do.
1 month and 21 days.
4.
Do.
1
»
„ 10 „
5. General Tuberculosis 1 month.
6. Tabes Mesenterica
1$ months.
All those had practically recovered from Plague, but died from complications
above named.
The revised figures for April are therefore as follows :—
No.
Serum Cases
... 80
Non-serum Cases... 79
Died.
61
61
Recovered.
19
18
I have, &c.,
N. H. CHOKSY,
Special Assistant Health Officer.
Summary of all eases treated during the year
in question.
Professor Lusliys Serum.—As the observations on Professor Lustig's Curative
Serum which have now extended over nearly two and-a-half years (with some inter-
ruptions), have been brought to a close during the period covered by this report, it
would not be out of place to give here a brief resume of the results. 'Two sets of
observations were made extending over varying periods—one by the method of so-
called " Selection," in which all the mild, recovering and dying patients were excluded
and the other in which every alternate case was treated with the serum irrespective
of the condition of the patient.
The former comprised 403 cases treated with serum, and of these 154 recovered,
the rate of recovery being 38*2 per cent. During the same period, 1,190 patients
were treated by ordinary methods, with 233 recoveries or a recovery rate of 19'5 per
cent. The recovery rate in the serum treated cases was therefore double that of the
latter. And similarly during the same period, 4,762 patients admitted into the
Mahratta and Modikhana Hospitals had a recovery rate of 19*7(1 per cent., a fact
whi<;h demonstrates conclusively that the better recovery rate of serum cases was not
unduly favoured by the method of treatment adopted, or otherwise the mortality rate
in those not so treated would have "been preponderating^ high instead of being no
more than that of other Hospitals.
The .second scries of cases on the alternate system comprised 480 casos treated
with the serum, and 480 treated alternately by ordinary methods. Of the 4$0 serum
treated cases, 328 died, and Jr>2 recovered, giving a mortality rate of 68*33 per cent.
and, therefore, a recovery rate of 31*67 per cent. Of the 480 eases treated by ordinary
methods, 382 died, and 1)8 recovered, giving a mortality rate of 79'58 per cent., and,
therefore, a recovery rate of 20'42 per cent.—
Forv.wi cases
Non-Fornru cases ...
Ncv
-180
480
Died.
328
5S3
i'fcovcrocl.
152
98
Porcentuge
of Mortality.
68 3. 1 }
7SV5S
l'orcectf.g«
of Hecc™ry
31 «7
20-42
8 The difference in the recovery rate -of serum treated cases is therefore, 11*25
?7(!T COUt.
309
The following table shows the mortality rate by castes in all the plague patients
admitted into the Hospital from September 1898 to June 1900 :—
Castes.
Hindus
Mussalmans
Native Christiana
Parsees
Beai Israel
Total
No.
5,018
356
460
36
21
5,891
Died.
8,747
234
296
21
14
4,312
Recovered.
1,271
122
164
15
7
1,579
Percentage of
Mortality.
74-67
65-73
64'34
58-33
66-66
7819
The Hindus numbered 5,018 out of a total of 5,891, and the mortality amongst
them was the highest, viz.—74'67 per cent. Musalmans and Christians numbered
356 and 460 and their mortality rates were 65'73 and 64'34 per cent., respect-
ively. The number of Beni Israels and Parsees is too small for purposes of com-
parison.
Mortality rates ly sexes:—The following tables show the mortality rates by
sexes of all the castes for the 12 months ending 31st May 1900, and for all the
patients admitted since 1896:—
Sex.
Males
Females
Children
Total
Number.
6C5
215
149
1,029
Died.
518
166
87
771
Ee covered.
147
49
62
258
Percentage of
Mortality.
77-89
77-20
58-38
74-92
Sex.
Females
Children
,.
Total
Ko.
4 158
1,199
534
5,891
Died.
3,091
873
348
4,312
Recovered.
1 067
326
186
1,579
Percentage of
Mortality.
74-33
72-94
65-16
73-19
Comparing the mortality rates amongst the sexes of all castes, it appears that
children have the best chances of recovery, and show the least mortality—65'1G per
cent.; females come next with 72*94 per cent, and males have the highest rate 74-33
per cent. This difference between the sexes does not hold good in individual castes
as the following tables demonstrate. Children, however, have the least mortality in
all the various castes :—
Hindus.
Sex.
Males
Females
Children
. Total
Number.
3,503
1,046
469
5,018
Died.
2,673
764
310
3,747
Recovered.
830
282
159
3,271
Percentage of
Mortality.
76-30
73-04
66-09
74-67
310
Mussalmans.
6ex.
Females
...
...
...
Children
...
...
Total
Number.
298
41
17
356
Died.
192
32
10
234
Becovered.
106
9
7
122
Percentage of
Mortality,
6476
78-04
58-82
65-78
Native Christians.
Sex.
Males...
...
...
...
Females
Children
Total
Number.
323
98
39
460
Died.
206
67
23
296
Eecovered.
117
31
16
164
Percentage 'of
Mortality.
63-77
68-36
5h'97
64-34
Parsees.
Sex.
Males...
Females
Children
Tosal
Number.
24
10
2
86
Died.
]3
7
1
21
Eecovered.
11
3
1
15
Percentage of
Mortality.
54-16
70-00
50-00
58-33
Beni Israels.
Sex.
Males
Females
Children
Total
Number.
10
4
7
21
Died.
' 7
o
O
4
U
Eecovered.
8
1
3
7
Percentage of
Mortality.
70-00
75-00
57*14
6C-66
A comparison between the mortality rates of sexes in Hindus, Mussalmans and
Native Christians becomes very instructive and may be shown as follows :—
—
Hindus
Mussalmans ...
Native Christians
Males.
76*30
ti4-76
63-77
Females.
73-04
78*04
08-38
Children.
66*09
58'82
:>8-97
Total.
74'67
05-73
ti4'o4-
The mortality rate in children is lowest in all. Mussulmans and Native
Christian children being almost equal, whilst Hindus arc higher by 7 per cent.
The Mussalman females show the highest mortality^ any sex of any caste (7S'04.
per cent). Native Christian females, the lowest among female?, and Hindu females
stand between these at 73-04 per cent. Amongst males, Nathe Christians are the
lowest, then come Mussulmans one per cent, higher and lastly Hindus with over
12 per cent, higher mortality than Mussalmans, whilst Hindu females show a higher
mortality than children and lower than males. Mussalmans and Native Christian
females have the highest mortality rates, amongst their individual castes, being
higher than males and children in ouch case.
316
Fifty per cent., and sometimes more, of the patients admitted into the large
hospitals die within 48 hours after admission. It is certainly not an accidental coin-
cidence that out of the 51 series, in which the treated cases are divided according
to the different bleedings of every horse, only one shows -a recovery rate con-
siderably above fifty per cent. But the cases were only twelve .and .the epidemic
declining.
The percentage of patients which in the .ordinary cour.se dies within 48 hours
after admission, could not be saved even with the best serum. T]be fate of these
patients is unalterable at the moment they reach the hospital, they are morituri—
doomed to die. The reduction of a mortality of 80 per cent, to the insignia
ficaut figure which was demanded by those who were ignorant of the clinical
features of plague is impossible in hospitals. It remains to be seen if the intravenous
injections of the serum which could be made only occasionally, owing to the
pressure of work, or a serarn of still higher activity, or the excision of solitary
buboes in suitable cases, or the combination with some drug, treatment, will increase
the recovery-rate still further, thus proving my views to be erroneous. The above
makes it clear that the limits of the efficacy are not determined by the remedy, but
by circumstances of the hospital. In private practice, where no such limitations
exist, and the greater individual resistance is a potent factor in aid of the treatment
the efficacy of a strong serum will be almost unlimited and .in direct proportion to
promptitude with which the diagnosis is established and the treatment inaugurated.
Grave responsibility devolves for this reason upon the physician who in times of
« plague loses precious hours musing over ail possible improbabilities to which a
tender bubo is due 1
I must not be misunderstood.
The day may still be far ahead when, owing to the serum treatment, plague
will have lost some of its terrors. Death does not give up its prey so readily.
But we are on the right path, we see the goal for which to strive with patient
confidence.
That has been fully realised by Lieut.-Col. T. S, Wilkins, D. S. 0., I. M. S.,
Special Medical Officer, Plague Operations, who took great interest and pains in
watching personally the progress of the experiments at the Arthur Road Hospital.
He wrote as far back as June, 1899, to the Municipal Commissioner : '* I personally
am of the opinion that the manufacture of this sernm should be continued as long as
the results are hopefnl, which they decidedly are, or until 6ome other more potent
remedy is found to act on this most fatal disease."
S17
APPENDIX No. II,
FRO**
G. POLVERINI, M. D.,
OFFICER IN CHARGE, MUNICIPAL LABORATORY,
PAREL.
To
THE MUNICIPAL COMMISSIONER FOR THE CITY OF BOMBAY
THROUGH THE HEALTH OFFICER,
BOMBAY MUNICIPALITY.
MUNICIPAL LABORATORY, PAREL,
llth November 1899.
SIR,
I have the honour to submit a report on tho experiments -carried out on
behalf of the Bombay Municipality from the 12th of March 1898 to the 31st of
May 1899 with Prof. Lustig's curative plague serum in hospitals, and also in
private practice in Bombay. In the preparation of this Report I had the advan-
tage of the valuable collaboration of Dr. A. Mayr, at present assisting me in the
manufacture of the serum. I also attach herewith a report from Veterinary
Surgeon S. N. Ranina on the horses immunised in Bombay for the preparation of
the serum.
I ha.ve -the honour to be
Sir,
Your most obedient servant,
G. POLVERINI, M. D.,
Ofacr in charge, Municipal Laboratory.
319
Report on 475 Plague Cases treated in Bombay
with Professor Lustig's Curative Serum.
BY G. POLVERINI, M.D.
SEROTHERAPHY, in general, is based on the principle that suitable animals, when
injected with the germs of a particular disease, or with their metabolic products,
or with both, acquire immunity against the disease, and that the blood serum of
animals so immunised, besides possessing immunising qualities, shows often decided
curative effects as well.
For reasons which would take too long to explain here, Professor Lustig
was led to try the following method of immunisation against plague infection,
viz., the injection of animals with the albuminous substance of which the body of
plague microbes is chiefly composed. This albuminous substance is a nucleoproteid
and can be isolated from the bodies of plague bacilli in the following way. When
plague microbes are cultivated on large Agar-Agar plates, they form a thin layer
which is scraped off from the surface of the solid culture medium and treated with
caustic potash. By the strong alkali the microbes are not only killed, but also
completely disintegrated and dissolved. To the resulting solution, which is of a
mucilaginous consistence, acetic acid is added till a whita and flocculent precipitate
is thrown down, which changes on drying to a brown amorphous mass, without losing
its properties. This precipitate is the above-mentioned nucleoproteid free from the
metabolic products of the plague bacteria, and is used for immunisation after solution
in Carbonate of Soda.
Numerous experiments confirmed Professor Lustig in his idea, that the immun-
isation with the nuoleoproteid protects animals susceptible to plague, e. g., mice, ruts,
guinea-pigs and monkeys, and that the blood serum of these animals has marked
curative effects, if injected, into other infected animals.
Not only susceptible animals are able to produce a curative serum after
immunisation, but also others, like horses, &c., which are refractory to plague
infection.
The presumption that the serum from immunised animals, more especially from
horses, may act identically in human beings who have contracted plague by
natural infection, is supported by the experience gained in the serum treatment ot'
other diseases, and the attempt to apply such serum as a remedy in man is therefore
scientifically justified.
Hence, for the preparation of the curative plague serum, as asked for by the
Bombay Municipality, eleven horses have been immunised by injecting them under
the skin at given intervals, with increasing quantities of the already mentioned
rproteid.
Five of the horses were immunised in Florence by Professor Lustig and six
'in OBombay by Professor Galeotti and the undersigned.
'The horses re-act to the injections with fever, general signs of sickness and
swelling .-at the seat of injection. These symptoms subside usually within a fortnight,
•the .horaes losing much flesh during this time.
321
The.serum derived from different horses showed very different curative proper-
ties, which always corresponded with the results of the experiments on animals. Aa
tho difference of the results obtained from different sera is one of the chief proofs of
the efficacy of the serum treatment, the results are given in detail in the following
table:—
(a.) Horses immunised at Florence.
Serum from
horse.
No. 1
No. 2
No. 3
No. 4
No. 5
Total ...
No. of Patients
treated.
90
42
70
43
12
257
Recoveries
25
22
38
23
4
112
Deaths.
65
20
32
20
8
145
Percentage of
recovery.
27-77
52-38
54-28
53-48
33-33
43-57
(6.) Horses immunised in Bombay.
Serum from
horse.
No. 1
No. 2
No. 3
No. 4
No. 5
No. G
Total ...
No. of Patients
treated.
47
24
31
51
52
13
218
Recoveries.
17
5
14
19
35
5
75
Deaths.
30
19
17
32
37
8
143
Percentage of
recovery.
36-17
20-83
45-16
37-25
28-84
88-45
34-40
(a) Some serum from horses Nos. 2 and 4 immunised in Florence arrived deteriorated in
Bombay and could not be used. Horse No. 5 could not be further immunised, as after the
plague cases at Vienna the working with plague microbes was not allowed in Italy.
(fe) The horses immunised at Parel have been twice bled except Nos. 2 and 6, which were
once bled ; the latter became unfit for use after the first bleeding.
The table shows that the serum from horse No. 1 immunised in Florence with
which the treatment was commenced in March 1898, gave throughout little satisfac-
tion, as out of 90 patients treated 65 died, and 25 only recovered, giving a recovery
rate of 27'77 °/ 0 . The serum of horse No. 3, also immunised in Florence, gavo
the best results with 38 recoveries in 70 cases treated, equal to a recovery rate of
54-2S °| 0 .
This difference is independent from other influences, as both sera were used
under the same circumstances in the Arthur Road Hospital. I think it worth while
to enter into some details of it.
From the 12th to the 29th of March the serum from horse No. 1 was used; 21
patients were injected, 18 of whom died and 6 recovered.
323
The patients were treated in hospitals and in private practice as follows : —
Arthur Road Hospital
Maratha Hospital
Government House, Parel
Private
Total
No. of Patients
treated.
403
28
12
32
475
Recoveries.
154
11
3
19
187
Deaths.
249
17
9
13
288
Percentage of
recovery.
38.21
39'28
2500
59.37
39.36
The rate of recovery was therefore 39.36 per cent.
These results appear in themselves satisfactory if we compare them with the
following figures :—
At the Arthur Road Hospital, 1,190 patients were treated without serum during
the same period, 233 of whom recovered, equal to a recovery rate of 19.57 per cent.
At the Maratha Hospital, 3,378 patients were similarly treated, of whom 646
recovered, equal to a recovery of 19.12 per cent.
At the Modikhana Hospital, 1,384 patients were treated, of whom 295 recovered,
equal to a recovery rate of 21.31 per cent.
It is interesting to note that for the whole City of Bombay 24,752 attacks from
plague have been recorded with 21,193 deaths, equal to a recovery rate of 14.37
per cent.
But it would be entirely misleading, as statistics usually are, if not drawn from
very large numbers, to presume that the recovery rate of 39.36 per cent. represents
the whole efficacy of the serum treatment either in the past or for the future.
To come to a true judgment of the value of the serum treatment we have not
only to consider statistics, but also all the circumstances of the preparation and
application of the serum, which cannot be expressed in mere numbers, although
they may have influenced the results.
As to the preparation it has to be borne in mind that the manufacture of a
curative serum is not only the highest, but also one of the most complex problems
of practical medicine, the complete solution of which is not to be arrived at by the
first attempt, but by repeated experiments. This is instanced in the case of the
diphtheria serum. It took many years and numerous experiments before a satisfac-
tory curative serum was obtained.
It has further to be remembered that this report gives the results of a treatment
in its experimental stage, in which the dose of the remedy, the mode of its application,
and its effects under varying conditions, had to be ascertained ; so that the investiga-
tions had to be carried on under conditions unfavourable for statistical results.
But before dealing in detail with the circumstances of the application of the
serum, I think it necessary to say a few words about the method adopted in the
experiments, as the results obtained by this method have been questioned.
Whenever a new remedy is recommended there are two questions which have
to be decided in regard to it :—(1), Is it a remedy at all ? (2), Is it generally appli-
cable as a remedy ?