THE BUBONIC PLAGUE by Edgar R. Caro

Seventh-day Adventist Publishing Association · Battle Creek, Mich. · Jul 10, 1900

THE BUBONIC PLAGUE.

By Edgar R. Caro

Edgar R. Caro, M. D., in Herald of Health.

When the April issue of the Herald went to press, the plague had already invaded Sydney, but it was not expected to develop the epidemic proportions which it has since assumed. Accordingly a brief editorial was deemed sufficient to enlighten our readers concerning the nature of this undoubtedly grave malady. With a steadily increasing number of victims in various districts, extending even to other colonies than New South Wales, it has become necessary for medical writers and speakers to instruct the people by pen and voice as to their duty in such an intercolonial crisis.

The plague has come to the colonies, and to all appearance it has come to stay for some time. The medical profession is astonished, and naturally somewhat alarmed, at the rapidity with which cases are arising in the widely separated suburbs of Sydney, and in more distant localities.

At first it was thought impossible for a fifth disease to obtain more than a temporary foothold in Australasia. Less than three months ago a prominent medical gentleman expressed his opinion that “in our dry climate and comparatively salubrious surroundings the plague, if indeed it be the plague, can live but a day.” Compare this with a recent announcement made by the president of the New South Wales Board of Health: “I regret to have to point out that at the present time we are absolutely in the hands of the outbreak. Let none think that the epidemic is under control.”

In view of this important statement, coming as it does from one who is naturally conservative in confessing the ineffectiveness of the efforts made by his board to check the ravages of the microbic invader, it will be well for us to ask ourselves the following questions:—

1. What is bubonic plague?

2. What is the origin and history of the malady?

3. Why has the plague made Sydney a center of operations?

These interrogations we shall endeavor to answer in simple language, though all statements made will be well founded and thoroughly scientific.

1.—WHAT IS BUBONIC PLAGUE?

Bubonic plague is an infectious, febrile (feverish) condition, characterized by the presence of a specific germ, the bacillus of Kitasato, and the following serious symptoms:—

High temperature.

Collapse and great prostration.

Paralysis of brain and muscles, or wild delirium.

Hemorrhage from the body orifices, with occasional vomiting of blood.

Enlargement, with possible suppuration, of one or more groups of lymphatic glands, and swelling of the spleen.

A peculiar facial expression of great fear.

Markedly rapid termination to many fatal cases.

In from three to nine days after infection the symptoms develop. The temperature rises rapidly to from 104° to 106° F.; the glands of the groin, axilla, or neck enlarge, and later often suppurate, while blood may flow from the nose, mouth, bladder, or rectum. The victim may be either wildly delirious or apparently completely paralyzed in mind and body. Even in mild cases the prostration is very marked. By physicians practicing in Asiatic countries the facial expression has been considered as quite characteristic of this special malady. Fatal cases may terminate within twenty-four hours, though the symptoms sometimes persist for several days.

The disease derives its name from the enlarged glands of the groin, which are called buboes. It attacks several tribes of the lower animals, as well as man, though others are exempt. The rat seems especially prone to infection. Before nearly all severe epidemics large mortality among rodents has been noticed.

The specific germ, a bacillus, was discovered simultaneously by Dr. Kitasato, of Japan, and Dr. Yersin, a gentleman sent to China by the French government to study the plague, in the year 1894. It readily develops upon any form of filth or refuse, but loses its virulence when made to subsist upon less noxious matter. This is a consideration of considerable importance when viewed from the standpoint of city and house sanitation.

The bacillus is found in the blood, fæces (discharges), and in the pus from the suppurating buboes, but is not exhaled from the lungs. There is undoubted proof that the disease can be communicated from man to man, or from animal to man, per medium of the flea or mosquito, and possibly through the common house fly. The modes of infection are probably by:—

1. Direct inoculation through an abraded surface into the blood or lymph.

2. Inspiration of the germs.

3. Ingestion into the alimentary canal.

2.—WHAT IS THE ORIGIN AND HISTORY OF THE MALADY?

The first historical report of the plague has reference to an epidemic that took place in Egypt three hundred years before the Christian era, though some medical writers of authority think that the disease which afflicted the Philistines after taking the ark as a war trophy, about the year 1141 B. C., was none other than the bubonic plague.

In the sixth century, during the rule of the Emperor Justinian, an outbreak is described as having “depopulated towns, turned the country districts into a desert, and made the habitations of men to become the haunts of wild beasts.”

The famous black death of the middle centuries, which swept through Europe, carrying nearly twenty-five millions into their graves, was without doubt a true bubonic plague. Once again, almost three hundred years later, does the pen of the historian refer to a European epidemic of large proportions.

As in the early outbreaks, Egypt seemed to be the breeding ground for the germ, so, too, the epidemics of the present and the past century had their origin in the same country. From Egypt the plague spread in 1844 to China. Apparently dying out, the overcrowding and filth of fifty years later gave opportunity for new developments. Then followed a condition truly awful. Tens of thousands lost their lives before the disease was checked. Two years later India became the center of a still more extensive epidemic of the plague, which, despite the Herculean efforts of the British government, still rages in many localities with undiminished severity.

The opposition of the natives to the salutary efforts of the officials is well shown in a letter of condemnation from an Indian physician.

“I consider that there are three causes for the plague:—

“A predisposing cause—the Indian municipalities.

“An exciting cause—nature.

“An aggravating cause—the Plague Committee.”

Notwithstanding the utmost precautions, the disease spread to Europe. The sanitary state of the various countries of that Continent, however, very effectually prevented an extensive outbreak.

In Australasia it was fondly believed that the distance from infected localities, and the existing atmospheric conditions, would prevent the introduction of the bubonic plague. How rudely was this confidence shaken by the report of a case on the Island of New Caledonia, and later of a second on the mainland at Adelaide. By the end of January, Sydney became infected, and to-day is the very center of an extensive epidemic, which baffles the earnest efforts of the city and suburban councils and of the board of health. Cases are also reported from Melbourne, Fremantle, Rockhampton, Brisbane, as well as from Auckland, New Zealand.

Up to the hour of publication there have been no less than one hundred and fifty-one cases, with fifty-three deaths. Thus one in every three thousand of the entire population of Sydney has been attacked, this proportion daily becoming greater as new victims are stricken down.

3.—WHY HAS THE PLAGUE MADE SYDNEY A CENTER OF OPERATIONS?

Dr. Newman, of Edinburgh, in his work on Bacteria, states that “the plague is essentially a filth disease, which is frequently preceded by famine. The areas affected by the disease in the Middle Ages, and in 1894 to 1896, are alike in being characterized by filth and overcrowding.”

Dr. Lawson, of Hong-Kong, China, writes: “If any country is in a clean condition, it has very little to fear from the plague. There must be a good food supply, an abundance of pure water, proper drainage, and sanitary dwellings.”

Sydney is at the present time the seat of the plague outbreak, because it does not fulfill all these requirements. Until recently the drainage system has been defective, and many of the dwellings and business premises are damp and unwholesome, in addition to containing large amounts of filth and refuse, which long ago ought to have been destroyed by fire. Nor is Sydney any worse than other large colonial centers of population. These, too, unless they reform, will be visited by the microscopic allies of death.

Should the burden of the blame for this state of affairs rest with the city council or the board of health? How many of those who cry out the loudest at past negligence, now that they are in danger, would have welcomed the inspector’s frequent visit to their premises, when there was no apparent cause for alarm? Too often the official who zealously performed his duty was reported for officiousness by the very persons whose interests he was serving, and who now condemn those officers who formerly pleased them by their indifference.