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the bacteriological examination having been negative even after death. The patient
was admitted on the third day of illness in a stupor and very low condition. He was
kept under observation for three days, and as the disease seemed to take the same
fatal turn as in the cases mentioned, he was declared and came to the serum treat-
ment. The temperature had been 104.5° on the previous evening and had fallen to
102.5° on the morning of the fourth day. It was again rising, the thermometer
showing 103° at 11 o'clock, when 20 c.c. of the serum were injected. After three
hours the temperature had fallen to 101.5°. It rose to 102.5° until 4 p. m., when
another 20 c.c. were given which brought the temperature to 101° at midnight. On
the next morning the general condition was much improved, the patient was conscious
and able to speak. Five more injections had to be made till the temperature fell
finally to normal on the morning of the fourth day of the treatment. The recovery
was speedy and uninterrupted. Simultaneously with the first injection blood was taken
for examination, from which a fairly abundant growth of plague bacilli was
obtained. There was no more occasion to try the serum in such cases as they became
rare and happened to come to the control side. The chart of the private patient is
interesting, because an exceptionally large quantity of serum was injected within a
short time. The patient came under treatment on the evening of the fourth day
of illness with swollen glands all round the neck and extreme infiltration and cedema
glottidis which threatened suffocation. Dr. Choksy realising the gravity of the
situation resorted to doses not tried before. The temperature was 105° when he
injected the first 60 c.c It fell but by one degree until the next morning, when
another 60 c.c. were given. In spite of that the temperature went up to 105.5°i
n the evening, when 60 c.c. more were injected. On the next morning the temper-
ature was 102°; still a further injection of 60 c.c. was thought advisable, the
patient having thus received 240 c.c. of serum within 36 hours. There was no even-
ing rise, almost invariably a favourable sign, and the treatment was discontinued and
the last 30 c.c. were given on the next morning. From this time the temperature
fell steadily, the patient making a good recovery, all buboes reabsorbing. From the
two charts of the serum patients who died, it appears that death was not due to
plague. The patients were transferred from the J. J. Hospital with well developed
buboes and all other symptoms of plague. They seemed on the highway to
recovery when relapsing fever set in, to which the patients eventually succumbed.
Relapsing fever, complicated with plague, must have been common during the past
years : relapsing fever is a disease of longer duration, it was prevalent in epidemic
form, and it attacks with predilection the same class of the population as plague
does. Clinically, it cannot be diagnosed with certainty during the acute stage of
the plague.
The alternate treatment was properly commenced on the first of July, 1899,
and was continued until the 31st of July, 1900, when it was abandoned by order
of the Municipal Commissioner in favour of the clinical selection. As already in
May, 1899, the patients had been alternately treated, the record for this month has
also been included in this report, although it is incorporated in that of the last year.
July, 1900, has been excluded, as the results were not known when the report was
taken in hand. Only 4 cases were treated on either side in that month. Three of
the serum patients recovered and three of the controls died. The records for the
single months are seen from the following table :—