47

REPORT ON A SERIES OF 70 CASES OF PLAGUE TREATED WITH
BRAZIL'S ANTI-PLAGUE SERUM.

BY W. M. HAFFKINE, C.I.E.,
Director-in-Chief, Plague Research Laboratory,

AND

W. G. WEST, M.R.C.S. (Eng.), L.R.C.P. (Lond.), M.D. (Geneva),
Attached to the Laboratory.

THE serum used in this series of cases was prepared by Dr. Vital Brazil,
Director of the State Sero-therapeutic Institute of San Paulo, Brazil,
and sent out for trial by the Secretary of State in August 1903.

      The serum was supplied in sealed test-tubes each containing about 20 c.c.
Of these, 600 were received and stored in an ice-box till February, when a
sufficient number of patients began to come to the hospitals. The patients
treated were those admitted to hospital between the 10th of February and the
end of March 1904. Fifty were treated in the Maratha Municipal Plague
Hospital (in charge of Dr. N. H. Choksy) and 20 in the Modikhana Municipal
Plague Hospital (in charge of Dr. D. A. Turkhud). These medical men were
responsible for the ordinary symptomatic treatment, which was used for all
cases whether or not they also received the serum treatment.

      Every alternate patient received serum treatment, the others being kept to
serve as controls. In the Modikhana hospital, which received a somewhat
different class of patients, several (79, with a subsequent mortality of 67.1 per
cent.) refused to undergo the serum treatment. In such circumstances the
serum was offered to the next patient admitted until one was found willing to
undergo the treatment, when the next case was taken as a control case. This
did not disturb the experiment to any extent; but more difficulty was found with
patients admitted with no definite symptoms of plague. These had to be kept
separate till a definite diagnosis was arrived at. The procedure was thus the
same as in the trial of Terni's serum (vide p. 37).

      The serum injections, which in all cases were hypodermic, were given by
one of us (W. G. West), who was likewise responsible for the correctness of the
history of each patient, as observed by him at the hospitals.

      The initial dose injected was 40 c.c. in all the cases (20 in number) treated
in the Modikhana Hospital, while in the Maratha Hospital two cases received
20 C.C., six received 40 c.c., while the remainder (42) got 60 c.c. The doses
were repeated once in 24 hours, so that those who lived for some time, or
recovered, received as much as 340 to 360 c.c. in some cases. This method