active 19th century A. Mitra

“ Experience has proved that plague can be transmitted from one person to another by direct contact; when a case of plague occurs in a house, other inmates of the house are much liable to be attacked also. Visitors to the house, medical and other attendants are also liable to be seized or to carry with them fresh focus of infection. It was, however, found in the Hongkong epidemic of 1894 that none of the European medical men, some fifteen in number, nor any of the Chinese students who were on duty at the plague hospital died. ”

“ People with bare feet are, therefore, more liable to catch the infection. The infection may be spread by infected linen, bedding, furniture and fomites. The discharge from buboes contains the germs, and is, therefore, highly poisonous. The fæces, the urine, the sputum, the fur on the tongue are also infective. If the theory be true that the poison attaches itself to the soil, then persons living on ground-floor are more liable to the infection, and a floating population less so. Dust laden with germs is the principal agent in the diffusion of plague as that of any other germ disease. ”

“ In spite of these harsh measures, ‘the plague more and more increased.’ Nor will this surprise us if we imagine the frantic and successful efforts that must have been made by the non-infected to escape, and the temptation to servants and nurses to appropriate and remove the property of the dying and dead. ”

“ Such portions of towns where there is much congestion and over-crowding suffer most. Scarcity of food favours plague. It has been called Miseriæ Morbus, or the disease of misery, and the plague of London was called the “poor’s plague.” In Kumaon there is the usual custom of keeping cattle in the lower room of a hut, where a crowd of cattle stand udder deep in fœtid straw. In one of the rooms of the upper storey grain is kept, and in another the whole family sleeps with doors and windows shut. Such conditions are undoubtedly very favourable to plague. ”

“ A venereal bubo, or scrofulous enlargement of glands, or enlargement of femoral or inguinal gland due to traumatic or other causes which may be attended with fever should not be mistaken for a plague symptom. A medical man who has, however, carefully observed the facies of a few cases of true plague, and who carefully takes into consideration all other probable conditions which may be mistaken for plague, may not commit a mistake, but its probabilities are to be borne in mind. ”

“ In the epidemic at Bengazi in 1858 as well as in Mukai in 1863 famine and plague were found together. That a water-logged soil favours famine was illustrated during the epidemic on the Lower Euphrates in 1867. In Persia and Arabia many epidemics were self-limited and spontaneously came to an end after spreading on a certain area, while, on the other hand, it has been known to obtain an endemic foot-hold, the virus remaining from year to year, and, occasionally under the influence of meteorological or unknown causes, becoming epidemic among the population. ”

“ The size of the plague bacillus varies, and bacilli of same character, but of less virulent nature, have been found in the soil of infected places. Some bacteriologists observed some development after death in the bacilli, this, if confirmed by observations at Bombay, will be highly interesting from a bacteriological point of view. If mice, rats, guinea-pigs and rabbits are inoculated with the plague bacillus, they soon become infected and die, and in their internal organs the same bacilli are found. ”

“ It has been said that plague flourishes in a warm moist atmosphere and dry hot air kills it, but there are records of plague thriving in conditions antagonistic to this theory. A temperature between 60° and 85°F. is said to be very favourable to it.
Sex and Age.—Both sexes are equally liable. It is said that people between the ages of 10 to 30 are frequently attacked. But experience shows that children and old people are alike liable to attack. In Bombay the disease has occurred most frequently between the ages of 20 and 30, and the male sex has suffered more than the female. ”

“ The mortality from plague may be about 90 per cent. or more when the epidemic is at its height. In the beginning, or towards the end of the epidemic, the mortality is less, as it is the case with all other epidemic diseases. The average mortality at Bombay has been 84 per cent. and in Karachi 89 per cent. It is, therefore, more fatal than all other epidemic diseases, the mortality from cholera during the height of an epidemic being about 60 per cent.
In children and in the aged the disease is more fatal than in healthy adults. ”

“ In the Hongkong epidemic of 1894 three Japanese medical men contracted the disease, and in 1896, some European nurses were attacked. In Bombay the sad deaths of Surgeon-Major Manser and Miss Joyce prove that contagion plays an important part in the spread of the disease.
It has been maintained that plague is a miasmatic or soil-bred disease, and that the germs find in earth, water or in some form of fermenting or decomposing material a suitable nidus for growth. ”

“ These facts show that medical inspection and quarantine may be useful, but they can never be perfect, and therefore the principal safeguard of a place lies in the improvement of its sanitation, and therefore greater attention and energy should be directed towards it. ”

“ Wherever possible a medical inspection should be made to prevent importation of the disease. This is, however, a very difficult matter, and one unforeseen difficulty was experienced at Sukkur, where it was found that people booked to stations short of Sukkur, and rebooked at stations on the other side. Still this measure is highly important, and should be carried out most rigorously as long as there is any chance of importation of plague into an unaffected country. It is needless to feel the pulse of the patient ”

“ NATURE OF AN EPIDEMIC.
Plague is a very slow disease; it takes some weeks to travel from one quarter of a city to another. It took nine months to travel from the city of London to Soho, and ten from Hongkong to Macao—a distance of 30 miles. Thousands of persons from Canton and Hongkong sought shelter at Macao, and there was free communication between 14 these places, still Macao became affected nine months after plague ceased at Hongkong. When plague is first imported in a place, for three or four weeks isolated cases occur in one neighbourhood. ”

“ Plague is a disease in which collapse sets in early and cardiac asthenia is a very early complication. There is, therefore, great urgency for early stimulation. Alcohol may be given freely, but at the same time it must be remembered that if the organs of elimination are not acting properly, alcohol may do harm. For their stimulant effects whiskey or iced champagne may be given. Carbonate of ammonia or spirit ammonia aromatic are held to be very useful stimulants in plague cases. ”

“ Pyrexia is but a sign of the intensity of the activities of the infective agent, and by artificially reducing the body heat we really do not lessen the virulence of the poison, as shown by the rise of the temperature again as soon as the action of the antipyretic subsides. ”

“ It is needless to say that there should be special hospitals for women, where only 29 female attendants and nurses should be employed. Hospitals should be provided with means for free ventilation, both for the sake of patients as well as attendants. No other disease requires more careful nursing than the plague, therefore ample nursing staff should be provided. ”

“ If any infection is discovered, then isolation of the sick, disinfection of the ship and quarantine are required, but ships with clean bills of health, and if ten days have passed since its departure from the infected port, may be admitted after medical inspection. It must, however, be borne in mind that rats could easily carry infection from one port to another without any fear of detection. ”

“ It will be seen that flesh-eating animals are the sufferers, due evidently to their eating plague flesh. Snakes swallow rats, and rats become infected by consumption of poisoned material or from infected soil or by their cannibal habit. Like other diseases due to a specific germ, the infection of plague may be caught from various sources such as the following— (a) By means of breath. Plague dust and dirt 13 are very potent infective agents. A man getting a whiff of dust from the floor of a room in which there is a plague patient blown into his face may get the infection. ”

“ Dirt and filth, bad ventilation, and overcrowding are its manure. The history of plague from ancient times fully illustrates that plague thrives in dirt, filth, squalor and misery. Diseased grain and want of subsoil drainage are held to be potent factors in the diffusion of plague. ”

“ The look of the patient is anxious, pale and cyanosed. The expression of the face resembles that of a man who has had no sleep for two or three nights but is being overpowered with the fatigue consequent to it. These symptoms are usually ushered in with a rise in the temperature. Well-marked rigor is usually not seen, but a slight shiver or chillness is complained of. Pulse is full, bounding and rapid—130 or more per minute. Respiration is difficult and accelerated even to 40 or 50 per minute. Skin is dry and hot, face puffed, conjunctivæ congested. Sense of hearing is dull. ”

“ In this sense it is like malaria, which is endemic in a particular suitable area appearing and disappearing according as climatic or other conditions are favourable or unfavourable. The Chinese have a peculiar idea of the infection of plague. 12 They consider that the plague rises from the soil and believe that it first attacks small animals with breathing organs near the soil, such as rats, then animals with breathing organs a little higher, such as poultry, pigs, dogs, goats, cows, so on till it reaches man, whose breathing organs are higher from the soil than those of other animals. ”

“ In this and all other matters connected with bacteriology, such as germs, sero-therapeutics, &c., the medical profession now-a-days receives a good deal of satirical remarks 33 from sceptical lay public. It is natural that it should be so, for the science of bacteriology is still in its infancy, and many of its practical applications are still in their experimental stage. But undoubtedly the science is advancing, and by its aid we are now better able to understand diseases and their nature. Many facts have been demonstrated and proved with precision. ”

“ XI. Those who have to attend on plague cases should be very careful. Hands should be thoroughly washed with a disinfectant solution, and a nail brush used soon after the patient or anything in contact with him is touched. A bath to which some antiseptic is added should be taken immediately after coming in contact with plague patients. Workers in plague hospitals should be warned about scratches or wounds on their bodies. Use of respirators with an antiseptic sprinkled over the entrance valves is recommended. Only very healthy people should approach plague cases. ”

“ Occupation.—During one epidemic, water-carriers, or those who used much water, or who dealt in oil and fats were found comparatively free; but this observation cannot be relied upon. Those whose business requires them to come much in contact with the sick, and also those who are engaged in cleaning are naturally more exposed to infection. 16 It has been said that one attack generally protects from a second, which, if it occurs, usually runs a mild course.
Sanitation and Personal Hygiene.—Plague, germs thrive in filth. ”

“ Temper is irritable. The sloughing glands often take a long time to heal. Convalescence is soon established.
21 VARIETIES.
Just as before an epidemic of cholera visits a place, it is usual to observe cases of mild diarrhœa, and indigestion prevailing amongst its population; so, before plague actually breaks out, it has been found that cases of buboes and parotites with fever are commonly observed. Such cases were called Pestis Minor at Astrakhan. “No one died from the disease per se, but few people were confined to bed.” It is not known whether in pestis minor the plague germs could be found ”

“ What is disbelieved to-day, may, however, be believed tomorrow, for, with all human attempt to reveal secrets of nature, such is the case. Readers of Smollet’s Roderick Random may remember how in the Surgeon’s Hall one of the examiners said:—“I affirm that all wounds of the intestine whether great or small are mortal.” Now, however, if a man dies of a wound of the intestine, the unfortunate doctor in whose hand such a casualty takes place runs great risk of being charged with malpraxès. ”