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B.-On the asssumption that a bactericide of sufficient strength injected directly into the circulation might be efficacious. I tried a solution of Formic Aldehyde prepared in the same strength as MAGUIRE uses it in cases of Pulmo- nary Tuberculosis. Only three cases were subjected to this treament. They were all very severe cases, practically hopeless, so the efficacy of this method cannot be estimated; but I am prepared to try it again when opportunity offers. Fifty cubic centimetres were injected directly into one of the veins of the forearm. The following are the particulars of the cases :-
(1.) A Chinese male, aged 42, suffering from Bubonic Plague, with a well developed left Femoral and left Inguinal Bubo. He was admitted in a practically moribund condition, was delirious, the pulse was very weak and small, and the tongue dry and brown. Stimulants, alcoholic and other, were freely administered, and an injection of 50 c.c. of Hoemasepsin given intravenously. He died 9 hours after admission. At the postmortem examination Plague bacilli were found in the spleen but none in the heart blood or in the bubo.
(2.) A Chinese male, aged 28, in an advanced stage of Septic Plague. Had an intravenous injection of 50 c.c. Homasepsin three hours after admission. Seventeen hours afterwards had an injection of 10 c.c. of Yersin's serum. Nor the least sign of any improvement. Died 22 hours after admission. A postmortem was male, and smears taken from the organs, which were thrown away by a mis- understanding, so the presence of the bacillus pestis could not be determined.
(3.) A Chinese female, aged 48, suffering from Bubonic Plague. Has a left inguinal bubo and left femoral bubo. No Plague bacilli could be found in the blood. She was a well nourished woman but was in an extremely weak condition. She was given three injections of Homasepsin 50 c.c. intravenously, on successive days. After the first injection the temperature went down from 102° to 99.4°, but the next day, after a second injection it ran up to 104-8°. She rallied some- what, the temperature came down, and oscillated between, 100° and 103°. After the third injection she shewed some distinct improvement-the pulse became stronger and she was much lighter. Suddenly however she changed for the worse and died from heart faiture, 67 hours after admission. At the postmortem examination the buboes were crowded with Plague bacilli which were also found in the heart blood and spleen.
C.-Yersin's Serum.-Great expectatious were formed at one time of the curative properties of this serum. As it is prepared, there would seem to be lacking in its enposition a complement which should enable it to neutralise or counteract the protein poison secreted by the Plague bacillus. With the hope of supplying this deficiency I mixed with it an equal quantity of serum taken from convalescent Plague cases, which presumably contated the immune body. This mixture of Yersin's serum plus immune body would. by inductive reasoning be quire as efficient as the Diphtheria Antitoxin. In practice however it did not prove so.
(a.) Treatment by means of Yersin's serum plus serum from convalescent cose of Bubonic plague.-Three cases were treated by this method.
Yersin's serum 10 c.c. was mixed with 10 c.c. of serum removel from the vein of a convalescent case of Bubonic Plague, which shewed the bacillus pestis in the blood on admission, but not on convalescence. I detail the results.
(1.) A Chinese male, aged 27, suffering from Septic Plague, and shewing Plague bacilli in the blood on admission. He was given four injections on successive days. The first noticeable result was that diarrhoea occurred, the motions were yellow and very liquid. This lasted for ten days. The pulse was weak. Two days after the last injection the temperature became subnormal, and he had low muttering delirium, and later shewed a tendency to drowsiness. The temperature then went up and kept varying between 98° and 99.6°. The bowels became constipated, and later became regular in their action. The patient then gradually and steadily improved, and was discharged well after 56 days in hospital. No Plague bacilli were found in the blood on discharge. It is interesting to note that almost immediately after his discharge he contracted Beri-beri for which he was treated at the Tung Wah Hospital and recovered.