370
In the table are included the extra cases in order to allow a comparison with
the records of the Maratha Hospital which are also given for the last official year.
With regard to this table it may not be superfluous to mention that the mortality
amongst the serum patients, and the total mortality, compared favourably with that
of the controls, when the serum treatment had to be discontinued in March last, and
that the total mortality for the first half of the month, when the serum was used, was
more then 5 per cent. less than for the second half when it was not employed. The
comparison with the Maratha Hospital shows that the monthly mortality at the Arthur
Road Hospital, except during October, 1899, and May,1900, was lower than at the for-
mer, and that the lower mortality was maintained during the four months, January to
April, 1900, when the epidemic was at its height. It is of special interest to observe
how the mortality at the Arthur Road Hospital followed the fluctuations of the death-
rate at the other hospital during the above-mentioned months. In February and April
the disease showed the highest virulence, and the difference of the mortality of the
two hospitals is 5 per cent., in January and March the virulence was a trifle less, and
the difference increased to 11 per cent. The higher figures on which the mortality
works out during these months are a safeguard that the increase was not accidental,
and we shall see later on that it corresponds to a law of serotherapeutics. The mortality
for the period of the alternate treatment was less by 6.5 per cent. at the Arthur Road
Hospital, although only half the patients received the serum treatment. If all the
patients had received it the reduction of the mortality would have to be calculated
at 13 per cent. The difference between the mortality of the serum patients and the
controls at the Arthur Road Hospital itself is 11.25 per cent. and, therefore, fairly
conforms with the calculated difference of the mortality of both the hospitals. It is
this conformity which gives the proof that the reduction of the death-rate on the
serum side is real. It might be suggested that the mortality at the Arthur Road
Hospital is generally lower than at the Maratha Hospital. Although there seems to
be no apparent reason for this, the Maratha Hospital receiving the higher Hindu
castes, we thought it useful to meet this suggestion with facts and figures. The
Maratha Hospital opened on January 21st, 1898, as we find from Sir James Camp-
bell's Report of 1897-1898. The plague mortality up to the 30th of April, 1898,
amongst 738 patients under English treatment, was 73.44 per cent. During the
same period, also including one month and a half of the serum treatment, which was
commenced on the 13th March, the Arthur Road Hospital had l,23i admissions with
a mortality of 74.16 per cent. It had 273 admissions with 222 deaths, equal to a
mortality of 81.31 per cent. in November and December, 1898, and January, 1899,
when no serum was available. During these months the Maratha Hospital had 557
admissions with 453 deaths, equal to a mortality of 81.32 per cent. The mortality
during the time when no serum was used was, therefore, somewhat higher at the
Arthur Road Hospital.
It follows from the last table that the mortality amongst the serum patients was
68.33 per cent. and amongst the controls 79.58 per cent., the difference being 11.25
per cent. in favour of the serum. The alternate treatment was started under the im-
pression that this difference would be the expression of the efficacy of the serum.
We have been obliged to demonstrate that such might, or might not, be the case, and
to undermine thus the very ground on which we were to base our arguments for the
efficacy of the serum. Truly, not an enviable position in which we find ourselves.
There is only one way out of this difficulty. The results obtained by the alternate
treatment might be accepted as essentially correct if the three classes in which we
have divided the patients with regard to the effects of the serum and non-serum treat-
ment were evenly distributed on both sides. That cannot be ascertained directly,
but we might find it out indirectly by going into the details of the distribution of the
patients as regards caste, sex, age, individual resistance, duration, mode and virulence