?81
Of the remaining 23 cases of undoubted  plague, 13  died and  10 recovered ;
mortality per cent., 56.5.

Known day of disease.
Died.
Recovered.
Percentage of mortality.
1st day
2
2
50.0
2nd
8
6
57.2
3rd & 4th day
4
1
80.0
4th & 5th
1
1
60.0
Definitely known in hours 3 - 42.
7
1
87.5

The temperature charts, with the actual times of taking observations, show in
red when the patients were injected, the amount of serum, and the exact tempera-
ture at the time of injection. The temperature, pulse, and respirations were
recorded and taken personally immediately before injection in each case.
The most obvious effect was a marked fall in the temperature. In a few cases
the fever increased, and in a few no effect was produced.
Patients seemed less liable to complications, but No. 9 in the series developed
double broncho-pneumonia on the fourth day in hospital ; and, after, 80 ccms, of
serum had been injected. The pneumonia came on two days after the last injection,
and he died eight days later.
Delirium seemed to be lessened by the serum. No improvement in the
general condition of the patients could be seen, and the inflamed glands were
certainly not favourably affected.
In one case, given in detail, in which the latest Pasteur Institute serum was
used, the patient was not benefited in any way. (This serum had the guarantee
of M. Roux and M. Yersin.) On the contrary, fresh buboes appeared, and the
primary bubo became larger, more inflamed with increased surrounding œdema,
and the little patient died. This patient was injected exactly 42 hours from the
initial rigor, had a full dose of 40cc-a large quantity for a child 4 years old-
It was not a severe type of the disease, but in every way a most suitable case
for curative serum treatment according to the dicta of M. Yersin.
The serum was perfectly innocuous and unirritating. Two patients developed
temporary urticaria, and one slight synoritis of one knee joint, after injection.
In cases that recovered, convalescence was no quicker than under ordinary
methods of treatment, and suppuration of the inflamed glands, if they had been
previously irritated, was not prevented.
Patients once put on serum treatment got no other drugs except sleeping
draughts or purgatives as occasion demanded.
The general mortality was slightly better than under hospital routine treatment,
in the proportion of 56.5 to 64.5, but in the latter were 66 moribund on admission ;
and if these 66 are excluded (and 28 cases treated otherwise), the proportion of
deaths amongst M. Yersin's cases to hospital cases stands at 56.5 to 33.5 per cent. of
cases treated.
Case No. 1 in the series had hypostatic pneumonia and had been ill four or five
days when injected. None of the others had complications at the time the serum treat-
ment was begun. The cases generally were of the ordinary mild type, and the last of
the series specially selected for early treatment show no favourable results over those
treated at a later stage of the disease. If anything, serum cases received more
nursing and general attention than other cases.
No. 13 in the series had recurrence of the urticaria on and off up till two months
after recovery.