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THE HONGKONG GOVERNMENT GAZETTE, 28TH APRIL, 1905.
(2.) Chinese female, aged 27, suffering from Bubonic Plague. A well nouri- shed woman, has a left femoral bubo; is delirious. Pulse fairly strong.
Was given injections as above described for four days successively, one injection each day. After the first injection purging set in-the motions were frequent, yellow and watery. This continued for two days. On the seventh day after admission a diffuse cellulitis set up over front of right upper arm apparently originating from a bruise. The pulse became weaker, the delirium continued. Then purging of the same nature set in again, and she died thirteen days after admission, and sixteen days after the incidence of Plague. The postmortem ex- amination was interesting. The intestinal tract shewed no pathological change, but the usual signs of Plague presented themselves. It was noteworthy however that no Plague bacilli were found in the heart blood, nor in the spleen, liver, bubo or peripheral blood. They were found in the blood on admission, but were absent from the blood taken immediately before death.
(3.) Chinese male, aged 30, was admitted suffering from Bubonic Plague. He was in a very low condition. Plague bacilli were found in the blood. An injec- tion of mixed serum was given, one into the peritoneal cavity and a second full dose into the substance of the bubo. The next day purging set in-the motions being yellow and loose. This subsided in a day. A little tenderness over the abdomen quickly subsided, but a certain amount of cedema set in aroun the bubo. His condition seemed to improve a little, but he died on the fifth day after ad- mission. At the postmortem examination no plague bacilli were found in the bubo, spleen, liver, lungs, kidneys or heart blood. It is worthy of note that no bacilli could be found in the peripheral blood examined immediately before death.
(b.) Treatment by Yersin's serum alone.—Thirty-two cases of Bubonic Plague, and seven of Septic were treated with Yersin's serum. An injection of 10 c.c. was made subcutaneously, or into the bubo. The number of injections varied from one to four, as were considered necessary, in each case. The results were as
follows:-
Bubonic Plague.--Recovered, M. 1, F. 5. Died, M. 20, F. 6. Septic Plague.-Recovered, M. 2, F. 0. Died, M. 3. F. 2.
Total under treatement,--Bubonic 32. Septic 7.
Percentage of Recoveries in Bubonic cases 19; in Septic cases 30.
It is difficult to estimate exactly what the effect was of the administration of the serum, owing to the fact that the reaction exhibited by the patient was not of a definite nature. It a matter of fact there was no amelioration in any direction that would justify me in saying that the serum was to that extent effective. If the patient was delirious the delirium might continue or abate irrespectively of the serum. The effect on the temperature was equally uncertain, in some cases a reduction to the extent of a degree or so might occur, in others the temperature would rise. And so too was the effect on the circulatory system--most uncertain. Locally, around the bubo, when the injection was made in that region, there appeared in some cases slight ædema. As regards its general effect viewed broadly the marked costitutional and local amelioration which is seen in the case of the administration of Diphtheria Antitoxin was absent. The addition to the serum of an equal quantity of immune serum (serum from convalescent cases) seemed to produce one marked reaction, namely a profuse diarrhoea. This was constant in the Cases. and was always of the same nature. May this have been an effect on the part of the body to get rid of noxious principles? It will be interesting to watch its effects again under similar conditions. In one particular however the administration of Yersin's serum was most interesting. Inoticed in some of the earliest cases that when plague bacilli were found in the blood in life, they were absent from the heart blood and tissues after death. In 6 cases of Bubonic and 1 of Septic Plague in which the bacillus was readily demonstrated in life, it could not be found in any of the tissues after death-namely, the bubo, spleen, liver, lungs, kidneys and heart blood In certain other cases--13 Bubonic and 1 Septic-- examination after death revealed the presence of the bacillus in the bubo (in the Bubouie cases) in varying numbers-in some swarming, in others numerous, in others a few and in the same series none could be found in the heart blood in eight cases, une in the spleen in four cases, whilst in the remainder of these cases a few could be found in the spleen. In 5 Bubonic cases the bacilli were numerous in all the organs and tissues after the injections. Thus we see that in nearly 17 per cent. of cases treated by Yersins' serum no bacilli could be found after death,
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