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a thin layer. The microbes are then scraped off from the surface of- the culture
medium and dissolved in caustic potash -whereby they are killed and completely
disintegrated. By neutralisation with acid, the immunising substance, a so-called
nucleoproteid is precipitated in large white flakes. The proteid is then dissolved in
carbonate of soda and used for the immunisation of horses. After 3 or 7 immunising
injections the horses are bled and their serum is used for treatment.
During the time of selection, 403 patients were treated with the serum at the
Arthur Boad Hospital, 154 of whom recovered, the rate of recovery being 38'2 per
cent., 1,190 cases were under the ordinary treatment and had 233 recoveries or a rato
of 19'5 per cent. If we compare these figures \ve see that the serum gave twice as
many recoveries as the ordinary treatment. The increase can only be credited to the
serum, if it was nofc due to the selection. To investigate this we have two means :
first, comparison of the recovery rate of the non-serum patients with that of the Arthur
Boad Hospital at a time when the serum was not used, and, secondly, comparison-with
that of other hospitals. No serum was available during the inter-epidemic months of
November and December, 1898, and January, 1899. The admissions were 273 with
51 recoveries or 18*6 per cent., being even less than in the non-serum patients of the
serum period. The Mahratta and Modikhana Hospitals had 4,762 admissions from
February, 1898, till June, 1890, the 3 abovementioned months being excluded.
The recoveries were 941 or 19'7 per cent. The selection has, therefore, not lowered
the recovery-rate of the non-serum patients at the Arthur Eoad Hospital, and the
increase on the serum side is real, and must be attributed to the serum. The crucial
test for its efficacy is given by the higher total recovery-rate of the Arthur Eoad
Hospital, when compared with that of the two other hospitals. The Mahratta and
Modikhana Hospitals had a recovery-rate of 19'76 per cent, in 4,762 patients, and
the Arthur Boad Hospital a rate of 24'29 per cent, in a total of 1,593 patients. The
increase is 4*5 per cent, in favour of the latter, although only one-fourth of all the
patients received specific treatment.
That the increase of the recovery-rate at the Arthur Boad Hospital was due to
the serum is made evident also by the following figures : From February to Nov-
ember, 1898, the serum was used during the height of the epidemic and during its
recrudescence ; the total admissions were 663 with 186 recoveries or 28 per cent.
From October, 1898, till February, 1899, during the inter-epidemic months no
serum was available. The admissions were 273 with 51 recoveries or 18'6 per cent.
From January to June, 1899, during the worst epidemic Bombay has gone through,
the serum was again used. The admissions were 930 with 201 recoveries or 2V6
per cent. The total recovery-rate was therefore higher in both the serum periods
than in the intermediate period, although, considering the epidemiological conditions
the contrary might have been expected.
That the higher total recovery-rate at the Arthur 'Boad Hospital during the
serum periods was due to the treatment, and not to other influences, is further
proved by the fact that the rate increased in the months of the beginning of the
treatment in spite of the rising epidemic. The rising of the epidemic can be
demonstrated by the increase of the mortality in the whole City of Bombay and in
the Maratha Hospital in the corresponding months. The City of Bombay shows a
mortality of 94*5 per cent, in February 1898, rising to 100 per cent, in March, and
of S4'7 per cent, in January 1899, rising to 87'4 per cent, in February. The
Maratha Hospital had a mortality of S1'2 per cent, in February 3898, rising io 87'8
per cent, in March, and of 80'5 per cent, in January 1899, rising to 83*5 per cent,
in February. The Arthur Boad Hospital on the contrary had a mortality of 78 per
cent, in February 1898, falling to 75'1 per cent, in March, and of 83'7 per cent. h>
January 1899, falling to 79*3 per cent, in February,