14

the patient not absolutely moribund, was submitted to the injections."²⁷ Of these
10 died, which is equivalent to a case-mortality of 77 per cent. These cases
were injected by Drs. Galeotti and Polverini with Florence-made serum.

    In the Modikhana Hospital in 1900 a fairly extensive trial of Lustig serum
as made in Bombay was carried out by Dr. D. A. Turkhud, M.B. (Edin.), in
charge of that plague hospital. The method of selection was as follows :—

    All acute cases of plague, about the diagnosis of which there could be no
doubt whatever, were taken for the trial, and each alternate case in the order of
admission into the ward, was taken for serum treatment. The following classes
of cases were not used either as controls or for serum treatment: (a) Convales
cent plague cases; (b) Cases admitted into the observation ward as being at
that time not recognisable as certainly plague cases.

    In these two categories 43 cases are included and it has been contended ²⁸
that in excluding patients who on admission were "doubtful cases" of plague,
an unwarrantable interference with the alternate system was brought about.
But, as pointed out by Dr. Turkhud, had these cases been taken for serum
treatment when the diagnosis was arrived at after a day or so in hospital, it
might have been said that they were put under treatment too late, and anyhow
as the cases were left out of account altogether it does not appear why this
procedure should favour one side more than the other. The following shows
the result :—

    Excluding 30 cases dying within 30 hours of admission, the doses adminis
tered varied from 20 c.c. (in one case) to 160 c.c.; the average working out
at 49.4 c.c. for each case. Eleven cases received 100 c.c. or above.

    In view of the unfavourable results obtained in this hospital, the following
criticism was made by Dr. Polverini,²⁹ viz. :— (a) That the alternate system
was not strictly observed. (b) That the serum was not given regularly or at
proper hours. (c) That the doses were insufficient. (d) That the total quantity
said to have been used was in excess of that supplied to the hospital. The first
heading has already been dealt with. As to (b) and (c) Dr. Turkhud says, ³⁰
"It is true that I was never, owing to other work, able to give the morning