SPECIFIC THERAPY WITH BACTERIOPHAGE SUSPENSIONS 569 



pension having a very high virulence (+ + + +) for B. pestis* This 

 race of the bacteriophage is the one which I isolated from the excreta 

 of the rat at Bac-Lieu in Indo-China, and since its isolation it had under- 

 gone about 100 passages. After 20 hours incubation at 37 °C, bacterio- 

 phagy was complete. The clear liquid was filtered in the morning and 

 the patients were inoculated a few hours later. 



In each of the four cases the sole method of treatment was the in- 

 jection of the bacteriophage, given directly into the bubo. The results 

 are presented here in some detail. 



Case 1. Georges Cap 18 years old. On July 10, 1925, 



he complained of fever, lassitude, vertigo, headache, and examination 

 showed a bilateral tonsillitis. On the following day his condition 

 became worse. During the night of the 11th and 12th the crural gland 

 on each side swelled. He was brought to the hospital on July 12th. 



Some of the material from the bubo on the left side was removed, 

 and direct examination of smears showed cocco-bacilli with bipolar 

 staining. The cultures which later developed from this material yielded 

 perfectly characteristic B. pestis, which were agglutinated by a known 

 anti-plague serum. An inoculated guinea pig died after 68 hours, 

 showing the lesions characteristic of experimental plague. 



On July 13th, at 2 p.m., the patient had a temperature of 40.3°C., 

 the pulse was 130, the face was congested, the eyes were injected and 

 drooping, and prostration was extreme. The two buboes were of the 

 size of nuts, and painful when pressed. I gave an injection of 0.5 cc. 

 of Pestis-bacteriophage into each of the two buboes, the needle being 

 introduced to about the center of the bubo. Apparently the injections 

 caused no pain, since the patient showed no reactions of defense. 



At 8 p.m., of this same day there was some sweating of the axillae 

 and the forearms. 



On the morning of the 14th the condition of the patient was completely 

 changed. He stated that he felt weak, but that he was not in pain and 

 felt well. The buboes were somewhat painful and had slightly increased 

 in volume. 



On the 15th he sat up in bed; and on the 16th he begged for food. 



On the 16th the buboes had increased in size to that of a small hen's 

 egg, but they were not painful. Puncture of the left bubo with a 

 syringe permitted the withdrawal of a few drops of bloody fluid. Direct 



* B. pestis, as has been stated, is a very homogeneous species as regards the 

 bacteriophage. All of the strains which I have tested, laboratory cultures as 

 well as strains freshly isolated from buboes, have showed practically the sam? 

 susceptibility. 



