Plague

Plague has been known in China under different names, such as wen IMG:p451_1.png:Chinese characters i cheng IMG:p451_2.png:Chinese characters 2Jai u tu 15*l6f,11, i.e. pest, and shu i gitS.- The last, meaning rat plague, is perhaps the most medical and lay books published in Chinese. HISTORY. — The history of plague is perhaps more fascinating than that of any other known disease, but it is not proposed to enter into details here except in so far as it concerns China. Plague is a very old disease and is mentioned in the Bible as occurring centuries before the Christian era in the land of the Philistines. Chinese history also teems with references to t cheng, but it is not quite certain how many of these reported epidemics are due to typhus, famine oc bubonic plague. The first authentic pandemic of plague originated somewhere in Egypt (b.c. 542) and spread to Constantinople and neighbouring cities. The second one recorded began insidiously in the 11th century and developed into the great pandemic known as " Black Death," because the sick turned black before death. Much dispute has arisen as to the origin of this great epidemic. The Ru ian records place it in India, the Grecian in Scythia, the English in India, the Arab in Tartary and the Italian in Cathay (China). It is probable that marmots inhabiting that long chain of mountains bordering on India and Tibet were the precursors of this disease and by infecting first the household rat and then man succeeded in spreading the plague, which, though at first bubonic in character, became pneumonic later on. This pandemic spread all over Europe and most parts of China, and killed millions of people. The Great Plague of London swept over England in the seventeenth century, and has been vividly described by Defoe in his great book. In India plague has appeared off and on since the 11th century, but it was not until the great outbreak of 1896 that serious attention was drawn to it in that country. Prof. W. J. Simpson (London) maintains that the extraordinary epidemic which swept over Canton and Hong kong in 1894, and two years afterwards spread all over India, had its origin in the province of Y'iinnan, where a Catholic priest encountered it in 1871 under the name of yang-tzu IMG:p451_3.png:Chinese characters J-. It is quite po ible that this too, as in the case of the Black Death, may be traced to the marmots of the Him a lay an and Altai Mountains. This view is supported by the work of American investigators, who have found plague in an endemic form among the ground squirrels inhabiting the Rocky Mountains. The last epidemic occurred in Manchuria and North China in the winter of 1910-11, known as the Pneumonic Plague, which in a few months killed over 60,000 people. This outbreak was traced to some bubonic cases in the Astrakhan district (Ru ia) where it has been endemic for scores of years. GEOGRAPHICAL DISTRIBUTION.— Plague is an insidious disease, beginning slowly, and then, 452 if not suppre ed in time, developing with unusual virulence. The outbreak in 1894 at Hong kong has maintained its course to the present time, and has invaded India, South China, Cochin China, Japan, Formosa, Australia, the Philippine Islands, South America, West Indies, United States, Cape Colony, Madagascar, Egypt, Asia Minor, Persia, Mauritius, Straits Settlements, Ru ia, West Africa, Siberia, Marseilles, Hamburg, and even England. The total number of deaths due to it approximate ten millions, of which six millions have occurred in India. With increase of knowledge of its cause and prevention, however, there is every sign of its dying out. Taking the two cities of Bombay and Hong kong, hotbeds of plague some years ago, we find that in 1915, only 599 cases were reported in the former city and 144 in the latter. CAUSES. — The actual organism of plague is a small, non-motile, straight bacillus discovered by KiT AS A TO in 1894. It grows and stains in a characteristic manner, is easily killed by heat but can withstand very great cold. Besides man and the rat, it may attack all sorts of rodents as well as rabbits, and dogs and even cats. When once it enters the human body it rapidly multiplies in number, and if death occurs the bacillus may be found in almost every o'rgan of the body. The usual form met with is the bubonic variety, caused by the rat flea. Thanks to the excellent work of the Indian Plague Commi ion and painstaking researches carried out in different parts of the world during the last twenty years, our knowledge of the plague has immensely increased. The following is a summary: — 1. Both the black rat (Mus rattus) and the brown rat [Mus decwnanus) are the principal agents by which bubonic plague is carried from place to place. Just before B.n epidemic occurs, these rats may be seen dying in large numbers, and migration and increased mortality of these animals are ominous signs of coming plague in a community. 2. The rat infects man through the rat flea (usually Xenopsylla cheopis, but sometimes Ceratojjhyllus fasci at us), which appears to convey the germ in a mechanical manner. 3. There is no fear of man infecting man in the bubonic type. In pneumonic plague, on the other hand, the greatest danger is experienced, owing to direct infection through the breath. 4. It is quite po ible that fleas and other insects attached to the baggage or clothing of infected persons may contribute to the spread of the disease, but a more potent factor is the migration of infected rats, carrying with them innumerable fleas. 5. Insanitary conditions have little or no relation to the occurrence of plague, except in so far as they favour infestation by rats. In pneumonic plague, insanitary habits, such as spitting and overcrowding, tend to spread infection. 6. Bubonic plague is more prevalent in warm weather, whereas the pneumonic type is most dangerous in winter. TYPES OF PLAGUE.— Three types of plague may be distinguished: — Bubonic, Pneumonic and Septicemic. (a) The Bubonic variety may be seen in a mild or severe form. In the former case (Pestis minnr) the patient suffers for a few days from fever with swelling of the glands and perhaps suppuration, and there is no. danger. Such cases often occur at the beginning of an outbreak. The severe bubonic variety constitutes 80 per cent, of all cases. The stage of invasion is characterized by headache, backache, stiffne of limbs, a feeling of anxiety and restle ne , and depre ion of spirits. The fever gradually rises until the fourth day, when it drops a few degrees and then rises again. The tongue turns brown, the patient feels very ill and may die. Swelling of the glands (buboes) is usually present in the groin, sometimes in the arm-pit, sometimes in the neck. Bacilli can always be detected in the fluid obtained by puncturing the buboes. Suppuration of the buboes is a good sign. Red spots (haemorrhages) frequently appear on the skin, and when extensive are bad omens. Nearly ten per cent, of untreated cases of bubonic plague recover in an epidemic, but if serum is used, 20-25 per cent, may be saved. (b) Pneumonic or Pulmonary Plague was considered a rare type until the Man chur i an outbreak of 1910-11. It begins with sudden fever, shortne of breath, headache, boneache, cough and discomfort in the chest region, after an incubation period of 2 to 3 days. Very soon the fever increases, the pulse becomes fast and small, marked signs of lung involvement are observed, and a pink, liquid, frothy sputum is coughed up containing enormous numbers of plague bacilli. Owing to difficulty of breathing, the patient becomes blue in the face, signs of bleeding in the mucous membranes appear, and the patient dies in 2 to 4 days after the first appearance of symptoms. No authentic case of recovery has been recorded. It is perhaps the most virulent type of all known diseases., (c) The Septicemic type may be the result of bubonic or pneumonic infection. Haemorrhages are common, and the bacilli are always present in the blood. 453 left to the trained doctor, and requires the maintenance of a laboratory where the appliances for the detection of plague and other infectious diseases are at hand. Plague itself is easily diagnosed, as the organism causing it has peculiar features. Unle proper measures are adopted, the first few cases may be overlooked, leading to disastrous results. In all suspicious cases, the medical man examines under the microscope either the bloody contents of a bubo or the phlegm coughed up by the patient. Once diagnosed the nece ary notification and preventive measures will be undertaken by the medical attendant.