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APPENDIX No. I.
A paper on Professor Lustig's Curative Plague Serum.
A paper was read at a meeting of the " Bombay Medical Union "
oa the 21st of April, 1900, by Dr. A. Mayr, of the Municipal Laboratory,
Parel. Sir Bhalchandra Krishna occupied the chair. The following is
the substance of the paper :—
Two years ago Mr. W. M. Haffkine, So. D., C.I.E., expounded in this hall the
facts relating to the efficacy of the preventive treatment of plague to the Medical Pro-
fession of Bombay in order to enable them to form their own opinion on the subject ;
to-day I ask your permission to do the same with regard to the curative treatment,
the experimental stage of which—I am glad to say—has been brought to a, successful
termination.
The treatment with Professor Lustig's curative plague serum, in the manufacture
of which Dr. G. Polverini and myself are engaged at present, was commenced at the
Arthur Eoad Hospital in March 1898, under the direction of Khan Bahadur Dr. N. H-
Choksy, the Medical Officer in charge, to whom the application of the serum was
entrusted and is still being continued there. Till May 1899, the patients were
selected for treatment ; since then they are taken alternately as they are admitted.
The clinical selection, which recommended itself naturally to the physician, has come
in for much adverse criticism, and the results obtained by it have been questioned.
It is not my intention here to vindicate the selection ; the reasons which prompted it
in the beginning have been laid down fully in a report to the Municipal Commissioner.
What I am tempted to say here is, that many disappointments which followed the
announcement of curative results in other diseases and have discredited serotherapy
would have been avoided, if exhaustive clinical investigation had preceded
the statistical conclusions. The clinical, investigation gives us the only possible
means to fix approximately the minimum number of observations which is necessary
in order to eliminate essential errors of subsequent statistics. 1 may be allowed
to quote a medical paper on the subject. Writing on the results of the serum
treatment of diphtheria the British Physician says : ll When a procedure or a theory
is on its trial, selection, with the view not of emphasising its advantages, but simply of
giving it a fair trial by excluding disturbing and antagonising influences, is justi-
fiable, indeed necessary, since such factors tend to obscure the main issue."
The guiding principles of selection were two : exclusion of patients of the later
days of disease, and of moribund and mild cases. No undue advantage accrued to
the serum treatment from this selection, as the patients of the earlier days show the
highest mortality in hospitals, whereas the exclusion of moribunds was irrelevant,
their place being taken, not by mild cases, but by such, as would have died later on
under the ordinary treatment. Sudden changes for the worse being so common in
plague there were not seldom errors of prognosis,- in fact, the selected cases showed
15 per cent, deaths within the first 24 hours. But before entering into statistical
details of the hospital, I may be permitted to give some particulars regarding the
manufacture of the serum.
The axioms of serotherapy are well known to us all. By injecting suitable
animab with substances of bacterial origin we are able to confer immunity upon them.
The carrier of the immunity is the blood serum which possesses often immunising
and also curative properties, The immunising substance used for the manufacture
of Professor Lustig's curative plague serum is prepared in the following way : plague
bacilli are cultivated in large dishes on a solid culture medium on which they form