Arthur Shadwell, Harriet L. Hennessy and Joseph Frank Payne

“ Singapore, where plague has several times been introduced, but never taken hold, is probably quite as dirty and insanitary as Hong-Kong, and it is pertinently remarked by the Bombay Research Committee that filth per se has but little influence, inasmuch as “there occurred in the House of Correction at Byculla, where cleanliness is brought as near to perfection as is attainable, an outbreak which exceeded in severity that in any of the filthy chawls and tenements around.” ”

“ It is clear, from the extreme variations in the severity of the illness, that the resisting power of individuals varies greatly. According to the Plague Research Committee of Bombay, the predisposing causes are “those leading to a lower state of vitality,” of which insufficient food is probably the most important. There is no evidence that age, sex or race exercises a distinct predisposing influence. The largest incidence in Bombay was on young adults, but then they are more numerous and more exposed to infection, because they go about more than the younger and the older. ”

“ The sick are a source of danger and one means of dissemination, and, since the illness may be so slight as to pass unrecognized, an obviously insidious one. The ambulatory plague patient goes far to explain the spread of the disease without leaving any track. But there is evidence that persons may carry the infection and give it to others without being ill at all themselves. One such case occurred at Glasgow, and another at Oporto. In the Glasgow case the wife of a laundryman employed in handling plague linen contracted the disease. ”

“ When it is not prevalent the diagnosis is never easy, and in pneumonia and septicaemic cases it is impossible without bacteriological assistance. The earliest cases have hardly ever been even suspected at the time in any outbreak in a fresh locality. It may be taken at first for almost any fever, particularly typhoid, or for venereal disease or lymphangitis. In plague countries the diseases with which it is most liable to be confounded are malaria, relapsing fever and typhus, or broncho-pneumonia in pneumonia cases. ”

“ The 16th century was not more free from plague than the 15th. Simultaneously with a terrible pestilence which is reported to have nearly depopulated China, plague prevailed over Germany Holland, Italy and Spain, in the first decade of the century, and revived at various times in the first half. ”

“ Again, a comparison between rat infested and rat-free districts in Bombay showed a much higher incidence of plague in the latter. A campaign against rats in Bombay, by which 50,000 or 60,000 were killed in a short time, had no effect in checking the disease. Plague-rats have rarely been found in ships sailing from infected ports; and though millions of these animals must have been carried backwards and forwards from quay to quay between Hong-Kong, Bombay and the great European ports, they have not brought the disease ashore. ”

“ When persons live crowded together in closing contact, and when they are careless with regard to discharges of all kinds from patients, the risk is obviously much increased. Discharges-vomited matters, sputa, urine and faeces-are possible media by which plague is spread from person to person. They also contaminate clothing, which thus becomes another means of dissemination capable of acting at a distance. This is the most probable explanation of the two cases of indirect infection related above. ”

“ Rats should be exterminated as far as possible, especially by means of the Danysz virus, which spreads a disease amongst rats which cannot be communicated to man. The greatest care should be taken in dealing with the hospital linen and discharges from patients. Hospital staffs should be kept apart. Inoculation with Haffkine’s prophylactic fluid should be offered to all persons willing to avail themselves of it. It is especially desirable for hospital and ambulance staffs to be inoculated with a vaccine prepared from sterilized cultures of plague bacillus. ”

“ The population of the city is 821,764, but during the earlier plague period large numbers fled, so that the foregoing figures do not give the true plague incidence according to population. Moreover, concealment was extensively practised. The most striking fact brought out by the tables just given is the large and steady increase year by year in the presidency, in spite of all efforts to arrest the spread of infection. It has gone on since 1899, and it has not been confined to Bombay, but has extended over the whole of India. ”

“ When plague is present in a place, the measures to be taken are the usual ones for dealing with infectious disease, with some additions. The sick and suspected should be removed in special ambulances to an isolation hospital, their soiled linen, &c., should be burnt, and the premises disinfected. Corrosive sublimate in an acid solution is the best disinfectant, but sulphuric acid, 1 in 250, is efficient and cheaper. Suspected cases should be bestowed in a special isolated building until the diagnosis is fully determined. ”

“ The plague of Justinian began at Pelusium in Egypt in A.D. 542; it spread over Egypt, and in the same or the next year passed to Constantinople, where it carried off 10,000 persons in one day, with all the symptoms of bubonic plague. It appeared in Gaul in 546, where it is described by Gregory of Tours with the same symptoms as lues inguinaria (from the frequent seat of buboes in the groin) . In Italy there was a great mortality in 543, but the most notable epidemic was in 565, which so depopulated the country as to leave it an easy prey to the Lombards. ”

“ Speaking generally, the disease has persisted and spread in the Far East since 1894, but Precise information is lacking, except with regard to Hong Kong. W. J. Simpson in his Report on the Causes of the Plague in Hong Kong (1903) reports the endemicity of the plague in that colony to be maintained by (a) infection among rats often connected with infectious material in rat runs or in houses, the virus of which has not been destroyed, (b) retention of infection in houses which are rat-ridden, and (c) infected clothing of people who have been ill or died of plague. ”

“ Mortality among rats is said to precede the appearance of human plague, but the evidence of this is always retrospective and of a very loose character. At Sydney a careful investigation was made; and the conclusion reached by Dr Tidswell was that “there was no ground for even a suspicion that our epidemic was being maintained by any process of direct contagion between man and man,” but that rats were the carriers. In Glasgow the experience was just the contrary. Personal connexion was traced in every case, and rats excluded ”

“ The risk of importing plague from India has been materially lessened by medical inspection of outward-bound ships at the principal ports. This has been very thoroughly carried out at Bombay with good results. In 1897 pilgrimages from India to the Hedjaz were prohibited. By the Venice convention a number of articles of merchandise are classed as susceptible and liable to be refused admission, but the only ones which there is any reason to consider dangerous are used clothing and rags. A watch should be kept on rats at ports of arrival and on board ships from infected countries. ”

“ Little is known of its toxic action; only a weak toxin has been obtained from cultures. Of the lower animals, mice, rats, guinea-pigs, rabbits, squirrels and monkeys are susceptible to the bacillus; horses, cattle, sheep, goats, pigs, dogs and cats are more or less resistant, but cats and dogs have been known to die of plague (Oporto, Daman, Cutch and Poona) . In the Great Plague of London they were believed to carry the infection, and were killed in vast numbers The bacillus has been demonstrated in the bodies of fieas, flies, bugs and ants. ”

“ In all the countries named plague appears to behave very much as it used to do in Europe from the time of the Black Death onwards. That is to say, there are periods of quiescence, with epidemic outbreaks which attract notice at irregular intervals. ”

“ Hong Kong was severely affected, and has never since been entirely free from plague. In two intermediate years—1895 and 1897—very few cases were recorded, but more recently the epidemic has gathered force again. The following table gives the cases and deaths in each of the six years 1894–1899:—
The excessively high rate of mortality is probably due in part to under-statement of the number of cases. Concealment is practised by the Chinese, who are chiefly attacked, and it is easier to conceal sickness than death. ”

“ Cases which are rapidly fatal from the general disturbance without marked local symptoms have been distinguished as fulminant plague (pestis siderans, paste foudroyarzte) .
History up to 1880.—The first historical notice of the plague is contained in a fragment of the physician Rufus of Ephesus, who lived in the time of Trajan, preserved in the Collections of Orzbasius. [2] Rufus speaks of the buboes called pestilential as being specially fatal, and as being found chiefly in Libya, Egypt and Syria. ”

“ Thousands of unburied corpses filled the streets, and in all 40,000 to 60,000 persons were carried off. In December 1721 the plague passed away, though isolated cases occurred in 1722 It passed to, or at least broke out in, Arles and Aix in 1720, causing great mortality, but in Toulon not till 1721, when it destroyed two-thirds of the population. The epidemic spread generally over Provence, but not to other parts of France, notwithstanding that, as confessed by D’Antrechaus, consul of Toulon, a believer in the exclusive power of contagion, there were abundant opportunities. ”

“ They do not prevail now in those “white countries” which have been invaded but have repelled the attack with comparative ease and little loss. It may be concluded, with some confidence, from experience and theory alike, that localities where they do not prevail may fail to keep plague out, but have very little to fear from it, except the disturbance of trade caused by the traditional terrors that still cling to the name. ”

“ In June 1858 intelligence was received in Constantinople of an outbreak of disease at the small town Benghazi, in the district of Barca, province of Tripoli, North Africa, which though at first misunderstood was clearly bubonic plague. From later researches there is reason to believe that it began in 1856 or in 1855. The disease did not spread, and ceased in the autumn, to return with less violence in 1859, when it died out. ”

“ But it spread in fact over the whole Roman world, beginning in maritime towns and radiating inland. In another direction it extended from Egypt along the north coast of Africa. Whether the numerous pestilences recorded in the 7th century were the plague cannot now be said; but it is possible the pestilences in England chronicled by Bede in the years 664, 672, 679 and 683 may have been of this disease, especially as in 690 pestis inguinaria is again recorded in Rome. For the epidemics of the succeeding centuries we must refer to more detailed works. ”

“ The most striking figures, however, are those for Bombay and Bengal which are given below as well as the total mortality in India.
Outside China and India plague has caused no great mortality in any of the countries in which it has appeared, with the exception perhaps of Arabia, about which very little is known. But some of the outbreaks are interesting for other reasons, and require notice. The first case is the singular occurrence of three deaths at Vienna in October 1898. ”