Plague

n. The reason for this is plainly apparent. If the facts in the case are as stated and if the conclusions of the Plague Com

or of infected rat fleas in ships, trains, clothing, merchandise and upon the bodies of men and animals f

isted, the undertaking is formidable, with obstacles to its execution, and discouragement must often be expected. Extend

to require detailed review here. A successful campaign against rats in 1907 practically terminated an epidemic of considerable proportions well within a year. Behind this movement, however, were the powerful machinery of the Federal Government, money in generous amount and

does not appear to be unreasonable when one considers as indices the destruction of the rodents in cities by

ortance of rat destruction upon grounds other than those purely sanitary mu

asized in season and out of season. Such items as the value of the grain consumed by a single rat per year, as estimated by the experts of the Agricultural Department, are convincing arguments in the case. At a daily consumption of two ounces, the ration for a full-grown rat, thi

willingness to expend considerable money, neither single nor combined methods will be successful. Moreover in the countries where special effort is most needed there is often distrust on the part of the natives, religious prejudice against the destruction of animal life and frequently ope

dings, wharves, bakeries, stables, granaries, etc.; the introduction of diseases among the rat population by bacterial viruses and the conservatio

senous acid boiled with rice, or mixed with cheese or cornm

th glucose its inflammable properties are said to be lost. Its in

similar food is then treated with this mixture and placed where rats may eat it. It is said to be eaten readily by ground squirrels with fatal effect. It is, however, expensive and apt to

lar devices are placed in the rat highways. These highways are readily discovered in the cities. Considerable care must be taken to overcome the natural caution of the rat, and this includes judgment in the use of attractive bait, the concealing and smoking of traps after handling and perhaps the use of some scent, such as the oil of anise, of whi

destruction, the burrows may be filled with some asphyxiating or poisonous gas.

rts of the ship. In empty ships' holds and elsewhere the simple burning of sulphur in open vessels effects the same results, provided sufficient sulphur and a sufficient number of vessels be used and further provided that the generation and confining of gas be sufficiently

n air, penetrate the burrows and promptly poison or asphyxiate all living animals and fleas. Absorbent material of some ki

truction, fumigation has a limited application and a number o

persons or those unacquainted with the dangers

tarvation of rats and rat-proof cons

eta to modern and decent methods of waste disposal, so must the rat, a garbage scavenger the world over, give plac

on the prevalence of flies and the transmission of disease by these

d, where grain is stored and where animals are killed. Slaughter houses, markets, grocery stores, restaurants, bakeries, wharves and war

s are no more and when the catch basins of sewers have been made rat-proof the subsistence problem for the rat will be

ving attention and encouraging reports are recorded, more particularly with regard to the disappearance of plague in districts so treated than in the disappearance of rats. This is most important, for if the rat and his fl

D CEMENT BASE, SOLID CONCRETE

eviously infected localities goes hand in hand with the introduction of

6 and plague disappeared from Manila in the

at catching, with little appreciable effect upon the number of rats and without causing the plague to entirely

uction and is a perfectly effective measure against human plague. In the suppression

ing areas the expense need not always be prohibitive-at least in American governed cities. The Manila plan of plotting the city into "plague-infected" areas corresponding with the capture of plague-diseased rats an

except to the initiated, the extent to which some ships are infested is by no means understood. I have made voyages upon steamships, which upon alternate trips carried forage for animals in the holds, when the conditions were, to say the least, uncomfortable. To have one's state-room taken possession of by rats, his clothing carried away, or to awake with a rat

ooms as for better ventilation. In a certain ship in which I travelled some of the ship's officers amused themselves by shooting rats with

ere destroyed by a single fumigation on a vessel of only 260 tons burden. In Bombay 1300 rats

fact that they live, when permitted to do so, in cold storage and refrigera

harf stringers, etc. (2) By passing along the lines by which the ship is made fast to the dock

tunity to take passage and it is probably thus, as stowaways, that rats go to sea in the largest number. Plainly, then, the placing of rat-funnels upon all lines from ship to wharf, the use of special fenders, the raising of

nsiderable numbers upon railway

I saw a rat run along the window ledge, to the

hips apply to cars and trains as well. Grain car

emic disease communicable to rats, and great hopes were entertained that by means of this method decided reductions in the rat population would result. Indeed the results in Cape Town, South Africa, in 1901, and in Odessa, Russia, in 1902, seemed to justify the hope to some extent and certa

?rtner's B. enteritidis correspond closely with the Danysz organism and can scarcely be separated culturally. In rodents they produce enteritis, sometimes hemorrhagic in character, and they are by no means to b

this rule), and the clinical fact that no sufficient death rate among rodents is produced by feeding them upon bacterial vir

eferable method, at least equally effective and without most of the disa

l enemies of the rat, in the warfare against the offending rodents, there is considerable differen

liged to forage for their own subsistence, are often excellent rat-catchers. Small, active dogs, particularly of the terrier breeds, will often keep houses practically free from rats and upon farms they are especially valuable

t-fleas often leave dead rats for other animals and, all things considered, there are many other objections to the intimate house

place small reliance in the value of the ordinary dogs and cats found a

s; (2) Modified quarantine-detention or disinfection applied to persons, goods and animals; (3) Disinfection of cargoes shipped from infected ports; (4) Isolation of the sick and proper disposal of the dead; (5) International notification between governments

mpetent authority (national if possible), whose officers must be men of great moral co

les I have laid down by introducing personal experiences in the cond

count of the epidemic, the campaign of su

e principles already set forth and to confirm by the reported facts

it is hoped that, when taken in connection with concre

facts concerning the development and extension of p

f six years for the human disease and five years for rodent pla

ects these imported cases, originating in Hong Kong, China, with the epidemic which broke out in Manila a few months later, the fact of their occurrence and recognition is interesting enough for us to consider before

had arrived the day previous from Hongkong and had been in the harbor for twenty-four hours at the time of the death. At the medical inspection of the vessel, which was made the day previous, no illness was detected. An investigation showed that the victim had been on d

w. Upon investigation of this case, the captain stated that the man was apparently in good health, but that while hauling on a rope he fell over in an apparent faint and w

ew and of the passengers that arrived in vessels from foreign por

ed, but the patient stated that he did not feel ill and demanded to be released from the hospital. On this day, the expectoration was blood-stained, but no suspicious organisms could be found in the smears nor could any physical signs of pneumonia be detected. Furthermore, there were no palpable glands. On the morning of the seventh day, the temperature and pulse dropped and the general condition was distinctly worse. The patient now admitted that he felt ill. Several hours later, he flinched when pressure was made in the right axilla. Lymphatic enlargement was now made out, and by the evening of the seventh day the bubo in the axilla had increased markedly in size, the swelling approximating 3 by 7 centimetres. Glands now became palpable in other portions of the body, particu

d in June, 1912, we find that the total number of cases recorded from the time of the outbreak in 1912 until the last case

mber of cases of animal plague up to July, 1914, was 53. This refers only to laboratory-proven cases of rat plague. As a

o years, it must not be supposed that the progress and exten

ost active suppressive effort, and it is believed that this effort bro

l, geographic, human and domestic, which confront us at every turn of the path to correction, removal and reformation, our success in checking the spread of plague appears as a real achievement, especially when

to the Manila Railway Company's freight station and yard, as 920 Calle Antonio Rivera is but a stone's throw from the Manila Railway property. The connection, however, is not clear, and, on the other hand, it is not whol

ne 25, in a resident of a district somewhat removed from t

l August 4, during which time no case of pl

hth, fifteenth, and twenty-first days of the month

to the preceding ones so

f human plague. During this time, however, the first cases of rat plague were disco

s Day, 1912, the longest plague-free period being one week; the number of cases by calendar months being

ague among the employees of the Manila Railway Company, laborers at the freight station and yard of the company. This freight station and yard is located between Calle Azcarraga, Calle

larger number of cases than five could be traced, and in all the other instances wher

e San Fernando (804–814), November, 1912, 4 cases; Calle Teodoro Alonzo (518), November and December, 1912, 2 cases; Calle Cabildo (Intramuros), November and

t plague). This epidemic was not reported by the railroad company until the outbreak of human plague had begun. It was then too late to identify plague in the dead and mummified rats found under floors,

occurred upon October 21, and fif

on the part of the fleas, of several days. The human outbreak at the station and the death of a large number of rats at the same

hrough November and December, without apparent relation to each other,

cases in one house on Calle Teodoro Alonzo (November 26 and December 2); and 2 c

ses will be refer

es or to the few scattering cases of rat plague discovered from time to time. Without doubt, however, all were actually rel

the advanced degree of desiccation and mummification defeated the biologic determination

dead rats was alleged by the occupants, but

und up to this time (December 26, 1912), in connection with the location of plague houses, wa

orresponding sections of Manila, had been well established already by

erning the two epidemics, rat and human, at the

recorded total of 50 human cases

on January 24, just a month from the last previous case, that of C

es occurred and in March

Moriones. This was a new district for rat plague and as the cases increased in number we were able to foresee and predict the appearance of human plague in the same district, wh

s district. During the same period 25 cases of rat plague were reported from the same section, and a glance at

certain overcrowded houses, in the midst of the rat plague district, where multiple

AN LUNA IN WHICH TWO CASES OF PLAGUE OCCURRED. RAT CAD

iginating in the same house, and the May cases nu

of a large number of people who lived in a tenement at this address. Both patients were detected, while still alive, in Malolos, where they were living in different and widely separated houses. One of the patients died in Malolos but the other one was brought to Manila by train and died at San Lazaro Hospital. Fortunately no infection was transferred to Malolos by these two persons. I

ter investigation showed that he had been a resident of Iloilo at least since February, 1912. The next case was reported August 18, and the last case, September 17, 1912. There was a total of 9 cases. All of the cases were confined to two houses. During Ju

tes, on October 23, 1912, I received orders from the Director of Health to take charge of all plague

reau of Health, rat catchers and laborers of the Bureau and laborers of the City of Manila supplied by the Department of Sanitation and Transportation. The combined force varied in num

he closure of the open ends of bamboo timbers with cement and with tin cans, in the manner shown in photographs herewith. In addition to this, special attention was gi

amboo timbers were closed by ce

families were moved from these insanitary and dangerous ground-floor rooms to quarters well above ground and measurably removed from the rats, which roam over the ground from house to house, foraging for food unde

ereas everyone practically familiar with the work in such cities as Manila-or even in the United States-knows that there is often no choice permitted. Rat-proofing is highly desirable, permanent in its results, and in every respect the "method of election." On the other hand, it is entirely inapplicable at certain times and in certain localities where poverty, lack of interest of property owners, and ofttimes lack of interest and of money on the part of mun

te may keep pace with the normal rat death-rate it will not keep pace with the normal death-rate plus the poisoning and trapping death-rate i

fected with plague and unexposed to infection it will probably be found that rat-proofing, carried out in connection with the repairs of old buildings and the erection of n

Tondo district, Manila, will often have to take the place of rat-proofing; and rat destruction and expulsion will be found,

ndence which passed between the Dir

ected the following letter

Perla of bubonic plague, slept upon the ground floor of this house upon a bamboo bed. All the

ese basement dwellers, and it would appear that they visit the upper stories of the houses rather infrequently, un

vacation of these basement rooms which are a

lieve it should be enforced in every square or block where plague rats have

espect

] T. W.

r in Charge of P

ved the following let

in your letter of March 22, that on account of the danger of the spread of plague in the district in which plague has appe

espect

Victor

or of

es on the Pasig River near the Malecon. They were found dead by workmen there and were throw

at the same place, was reported to be sick. I took the cat to the Bure

ulated from the spleen and bubo died from the same disease. A guinea-pig, inoculated from

plague cat, were observed for two we

mortem signs of plague. The Medical Department, U. S. Army, then took up the matter of rat catching on all mi

ment at Batavia, Dutch India, in 1913, some interesting facts, developed by study and experimentation, are presented. Some of these facts have a bearing on the plague problem in the

rallel or confirmatory studies in the Philippines, we may state some of the conclusions of the Java workers with propriety, and we

vely. This flea, it will be remembered, is also the common rat flea of India, the Philippines, Australia, Italy, Brazil and tropical count

expect to find at least some of his observ

fewer fleas than house rats and that the number of fleas per house rat varies in different districts from .02 per rat to 2.3 or 4 per rat and that this variation is not invariably constant with the presence or absence of rat plague. Concerning the question whether or not a high flea census may indicate rat plague,

xperimentation that the duration of development of the egg varies under various hygrometric c

age; and also that a saturated humidity (in artificial cultures), causing condensation of water in the substratum, is very fatal to larv?. He offers the thought that thi

g fleas were made with laboratory-bred fleas which had neve

within 10 days and the remainder lived from ten to twenty days, only one-tenth, however, surviving for 13

itions, we should be led to the conclusion that the rainy season, with its greater humidity, would be quite the most favorable time of year for rat plague extension in

this reasoning, however, for during th

evalence of rat plague in Manila, may be explained, I feel sure, by the activity of o

iny season of 1912 (October), is the fact that rats are certainly driven above ground into houses and therefor

e Philippines seasonal variations in heat do not suffice to rid the rats of fleas during any months of the year. If, then, conditions of rainfall serve to drive the rats above grou

to be taken as evidence, and so we are reminded that generalizations f

n in the Philippines-and as the climate of Manila is fairly equable so far as heat and cold are concerned, the only factor which needs to be considered is that of

however, permits them to house themselves comfortably

oghem in a report upon "Some Epidemiological Facts Concerning the Plague in J

hed from plague-free villages, there exist

ed from plague. Fresh plague rats appear more often in the h

s even in the immed

enopsylla cheopis, which experimentally is

eatedly been found to harb

ave been demonstrated in

e same observer says: "Obviously an increase in the distance between man

tion of rats by poison, traps and rat catchers. Rats dying of plague in their nests furnish the greatest danger to man. The plague problem, therefore, where rats are already in

sought, from the time the Manila outbreak occurred, to verify some of the findings of the Java investigators, at least with special reference to the nesting of

he so-called "hard material districts," where house construction is entirely unlike that with which the Java workers dealt. With the invasion of Tondo, however, the Java and Manila conditio

with its roof sloping to the front and back, i.e., with its ridge parallel with the front and back aspects of the buildi

ucted of bamboo. These bamboo timbers are perforated at various points to pe

principal piece of furniture is the "bale bale," or bedstead, usually made of bamboo, except in the houses of the well-to-do. Small storerooms are often locat

Philippine house is commonly elevated 2 metres or more above the ground upon bamboo supports (see photographs). The basement is usually enclosed in a manner similar to the principal room of the Java house and the basement room may fairl

nt story, we have a practical repl

ten a bamboo bed, practically identical with the J

rats were found to be the interiors of horizontal b

bamboo sections near the outer end of the pole. Our Manila photographs show both th

thatched roofs, as they occas

dentical also. Straw, dry leaves and pieces of cotton are mentioned in the Java reports.

NOTE HOLES GNAWED IN BAMBOO ENDS. RATS FREQUEN

the bamboo nests in Java and we often f

t only found such evidences of rats as food, rat f?ces and nest materials, but in one case a rat was actually drive

f the bamboo house timbers in close proximity to patients sick (or dead) with plague

taken and this work was carried on without interruption for about two (2) years. City laborers to the number of 60 to 150 were used and the work was supervised by Sanitary Inspectors Brantigan

d from houses and yards approximated 5250 t

e removal of this enormous accumulation of dirt and

e number of traps and portions of poison placed; the location of the operations and the length of time a gi

ing the rat catch, as, for example, weather conditions and the occurrence

just mentioned the rat catc

Director of Health for the Philippine Islands, published the following memorandum in

of traps is indicated in the following table, a perusal of which will show that for the three months ended June 30, 1913, there were 120,565 spring or snap traps set and that for every 100 of this type of trap set there were caught 6.9 rats. During the same period there were 47,075 wire cage traps set; the total number of rats caught was

ic Health Reports, Vol. 2

Quarter ended June 30

et Numbe

Per cent. Number

poisoned

s 120,565 8,377 6.9

47,075 339 .72

coconuts 166,237 1,21

ter

30 Se

r of

by do

bs and other we

rom other ca

rats found poisoned average for each 100 baits 0.72. During the next quarter there were 177,309 baits set in territory that had been worked over, and only 216 rats, or 0.12 rat per 100 baits, were killed. From the foregoing it appears that the rat poison ranks lowest in efficiency but

ns has the largest influence upon the total catch of rats. For the fiscal year July 1, 1912, to Ju

on grounds of greater activity in rat catching effort at times of greatest plague prevalence, but from the inauguration of general systematic

districts theretofore free from the disease, rat catch

676 rats definitely affected and checked the spread of plague in Manila in 1913; and I am of the opinion that systematic and wholesale rat catching, c

ection, the fumigation of packages suspected or likely to contain rats, and the similar treatment of freight cars showing signs of rats, should be continu

rely within the control of the authorities

rmed and all rats captured were turned over to

BOUT IN THE SEARCH FOR RA

d poisoned both circumferentially and centrally, with a view to

la at the present time and our inability to starve the animals out, justify the other and less permanent measure, viz.: rat catching. However, I heartily favor and urge the most complete and thorough

re than 1100 orders upon householders, to provide covered

re than 2300 houses were closed, eith

ere disinfected upon repeated occasions by spraying with petroleum and

heir families, were numerous, but with the close scrutiny of death certificates and dea

ified the cause of death to be "uterine hemorrhage." Suspicion arising, an autopsy was ordered and a pronounced case o

paces above ceilings, etc., using the mixture liberally and securing a general surface distribution. There is no doubt of the toxicity of this mixture to all fleas and bed-bugs which it reaches, and it is undoubtedly an effective measure in rendering an infected house safe. All of the instances of multiple house infections, where the cases recurred after disinfection, in Manila, have been in houses where, for on

STED PLAGU

cture of the house was a veritable sieve, the

here the two cases which occurred may have been synchronously i

g were piled full of merchandise, defeating immediate disinfection, that is, effic

us and no infection occurred after disinfection of the house, while at 1226 Calle Juan Luna, Tondo, th

g experiment shows strikingly the necessity for disinfecti

gue from this house having died within the preceding twelve hours. The cage containing the guinea-pigs was placed exactly where the patient had slept upon the floor, as indicated by the other tenants of the house. Disinfection was delayed for a fe

le Cabildo and Calle San Fernando, after disinfe

n Java that certain natural enemies of fleas exist and operate ag

l black ones, were found to be very antagonistic to fleas, b

the insects. The same parasites were not found upon wild fleas. On account of the prevalence of mite

es known to harbor, or suspected of harboring, plague rats. The combination of kerosene and cresols, elsewhere referred to, was found to be perfectly satisfactory in the destruction of ants; assuming, of co

e rat flea, while rather lazy, may and does cover distances of five met

must be considered the possibility o

d is not to be undertaken by anyone but a trained naturalist. However, some of the notes we have at our disposal, gathered from many sources, may be set be

ication in his section of the publication,

: Rod

y: Mu

us:

ut only three or fo

wn, and roof (Alexandrine) rat; Mus decuman

throughout the world and these are n

y many, of the well-known variations in the coloration of rats due to climate and season and of the well recognized aptitude of the rat for living in-door or out-door according to circumstances of food supply, weather, etc. The "sawah" rat of Dutch India, implicated in the prevalence of plague

und to arise from such loos

e) in Java, some confusion existing in the matter as yet. Members of this genus are described as large, rough-coated rats which live b

. rattus and M. decumanus are both present and numerous and both are subjec

or and the peculiarities of the footpads, the Javan observers depend upon the conformation of the skulls for the determination of genera, the skull of M. rattus being

the frontal surfaces of the skull are oval; in M. decumanus they a

rat

ecum

no

the rats are cut off, the tissues desiccated

burrowing animal and not addicted to climbing or swimming, is nevertheless quite capable of doing either. He was found to burrow in the

he species found in the rural districts, remote from houses. He found that all varieties of rats may swim, from ships to the shore, distances of from one-fourth to o

breeder and brings forth larger l

is rarely trapped on ships on the Pacific Coast, according to the observations of Surgeon Simpson of the U. S. Public Health Service (Public Health Reports, April 11, 1913). According to the same observer, Mus rattus is the commonest ship-borne rat. He also states that the black rat and the roof rat (Alexandrinus

uction in Tondo District, Manila, where plague flourished in 1913. Others illustrate methods of rat-proofing bamboo timbers in houses of light

and construction of rat nests found by our laborers; the materials used and the fabrication of the nests. Memoranda giving details of rat cat

e house infection are also presen

as to decomposition and drying. A series of 50 rats was studied. It is to be understood that the conditions under which these observations were made were tropical conditions. They would be fairly comparable with summer conditions

N RAT CADAVERS. THE NUMBERS INDIC

r death A

Distention of the a

y Loosening of hai

oosening of the epide

and disappearance of distention. This perforation may result fr

of the body. Swarming of maggots. Sp

ghth day Dr

day Complete dry

therlands, India) shows the progressive postmortem changes in rat

e following collection of notes concerning rat runs, rat nests and their locations and other data collected by

, 1913, one party of workmen (20 men) under Inspector Brantigan, killed by hand 511 rats out of a total of 1319. This means that many nests

rict in connection with extensiv

nest at the foot of a cluster of bamboo tree

on for Calle, the Sp

gas delivered in the burrow through a rubber hose. This burrow was in sand and the rats came out about ten min

t the Manila Railway Station, in 38 minutes. At various times they have killed from 10 to 25 rats at a single loc

ers at 202 Calle Concha. They were nesting in s

pile of loose tiles at 203 C. Sardinas. The nest

d in a shallow pile on the ground at C. Conservador (interi

Anloague on the ground floor beneath a pile of bo

nterior) Velasquez beneath a wood pile. Nest was

er a pile of hay and straw at 173 Velasque

nd in the above-mentioned nests: chicke

C DIS

ia 6 dead rats

ly of 8 rats was smoked

t 6 rats were smo

e street, 4 rats were

t 4 rats were smo

t found in a hole. Nest mad

ateros, 9 rats were s

were smoked out of fou

2 rats were smoke

ured in two holes under a tile floor. Many rats

t made of palm leaves and excelsior; locat

f straw and lint, 5 rats w

t and 3 dead ones were dug o

LOC D

Chinese store. Eight rats were secured in a nest u

runs. In one of them there were caug

n and 8 young rats, with eyes still unopened, were found in

s and nests of straw

n was found and one large rat and 16 small ones wer

DIS

store), a long rat run and a nest of rags, st

found. Rats had been observed going up the tree a

LOC D

and a nest of straw, paper an

nest of straw and rags with one lar

O DI

alive inside of a bamboo timber i

nest of paper, leaves, and hay. Chicken bones,

in June, 1913. In his stomach was found a half-grown rat. Another sn

d rat destruction was proposed by me to the Director of Health. It

dic household rat

e to all applicants (householders) in Manila who agree to place same abo

ith the poison. Issues to be made from Station

oison portions to be collected and turned in at the Station Health Offices at the end of 48 hours, that

gratuitous issue of poison to be given to

ted for at lea

HOUSE I

ncerning 1364

anila. The five deceased persons lived at 334 C. P. Rada (Meisic), 1419, interior, C. Dag

stances point strongly to a common source of infection and to a single geographic focus

until taken sick on Tuesday, April 22, at 1364 Sande, in the shop of Simpli

c plague at San Lazaro Hospi

Sande, and visited her son-in-law there frequently and within a few days of her last illness. She was taken sick April 22 and died at 1419, interior, C

s taken sick there on April 25. She was removed to San Lazaro Hospital a

spital Saturday afternoon and died there Sunday evening, April 27. He was shown to have plague by bacteriologic examination mad

nt houses in the interval between the onset of his sickness and his transfer to San Lazaro Hospital on April 27, first to 1419 C. Dagupan, interior, where he remained until the death of his mothe

ecognized the case of the elder woman as a probable case of plag

ent. Unfortunately, the workmen who swept it out did not note the exact location at which it was found. The house is in the midst of the district where rat plague has raged since early in March, 1913. The basement c

e torn up. Accordingly, this was done (April 28) and three dead rats and one live one were found beneath the cement. As the bodies were mummified and unfit for bacteriologic examination they were burned. The living rat was examined at the Bureau of Science but was found to be healthy. The cement floor was broken and pe

r the epidemic at 1364

le Sande were quarantine

April

clared in Quarantine for Bubonic Plag

the policeman in charge, so that they may be readily found. They must remain in the District of Tondo. If they remain in

o" shop are hereby ordered

the Direct

] T. W.

, in Charge of Pl

surrounding 2 cases of plague at

e from 917 C. Jaboneros where he had been employed. The patient fixes the date at about a week previous to his sickness, but the proprietors of

ence of a second case at 1226 C. Juan Luna,

in the midst of a rat-

E, 1226 CAL

but which is unsanitary in a multitude of ways. Bamboo construction, overcrowding, dirty condition and absence of proper drainage, water-closet, proper kitchens and paved gr

r of the building, was found to be sick. Her only symptom was fever, but she was transferred to San Lazaro upon suspicion and promptly d

Tondo, Bure

. I., May

d and is quarantined this date, for Bubonic Plague. The house will be vacated and a pol

effects but will not be permitted to r

] T. W.

ector, Stati

he same basement room. Upon March 21, 1913, a Filipino laborer liv

search of the premises the fo

t least one week, was found clinging to a bamboo wall just

dead and dried up, was found. This section was the end section of the timber which was partly covered with nipa thatch, with

TH CEMENT TO PREVENT ENTRANCE O

ning houses and in one case a live rat

Medical Inspector in Charge of Plague Suppression. Similar orders we

er. Effective

ost thorough manner possible, searching meanwhile for rat nests and rat harbors; re-piling wood, tiles, stones and merchandise; moving all movable goods out of doors in their search for rats and rat-holes or nests. All goods are to be piled above ground at an elevation of at least one foot. All bamboo beds and bamboo rafters and part

s, but will not do general repairing. They will carry materials f

t in numbers, additional men may be de

] T. W.

r in Charge of P

nspector assisting in Plague Suppre

pector, Bure

ner in which other plague-infected districts have been treated, viz.: by policing the houses and yards, vacating all basements of light-material houses in which human habitations are illegally present; removing (wi

ed and complied with. There are a number of most insanitary and unsuitable shelters of bamboo, tin, etc., used for houses by a number of families in t

] T. W.

of Plague

ADOR, TONDO, WHERE INFECTED RATS W

he Medical Inspector in ch

" Tondo, Ma

and laborers engaged in antipla

ats in the district bounded on the west by Manila Bay and on the east by Estero Reina. The work wi

nd will begin trapping and poisoning at Calle Moriones, proceeding north. The poisoning and trapping is to be done in the mo

De la Rosa, Laxamana and Parás, will continue the cleaning operations now under way on both sides of C.

d will close up openings in structural bamboo by means of tin and cement. Emphasis is placed upon the necessity for permanently vacating basements and men will be sent bac

] T. W.

r in Charge of P

er issued to

tation "C," Bu

stables and other buildings in the vicinity. Search for rats, living and dead, rat nests and rats in bamboos and wood piles, stone piles, stables, under p

] T. W.

r in Charge of P

ry in Manila, P. I.-Rat catching,-trapping and poisoning,-is conducted in accordance with instructi

of Science for autopsy and for biologic examination for

es (iron pails) and a supply of a mixture of kerosene, cresol

ats are immersed, with a minimum amount of handling, as so

shaken or stirred when used, as it separates upon standing. The immersion is, of cour

the rat and firmly tied upon the same, where it remains until the rat cadaver is finally disposed of. This tag is a card of strong Manila paper and the record upon it is

gue may be returned to the Bureau of Health, for identificat

ped, and placed in large, tightly-covered, galvanized iron cans, in which c

ing the case of Mr. W. C., a prominent American reside

ntered St. Paul's Hospital September 19, and was transferred to San Lazaro Hospital, September 20, wit

ct which had furnished a number of cases of both rat and human plague, a dead rat, mummified, was f

t this desk was identified at the Bureau of

of Science and the following facts we

made and injected into guinea-pigs. The animals died from plague in a few days and plag

n the same building, during cleaning operation

omplete and convincing explanation of Mr. C.'s death than that afforded by these established facts and off

d publication and after consideration he approved and authorized publication upon February 10. No change was made in the wording of the proclamation, but it was issued over the signature of the Director of Health to give added force and authority to the appeal. The results were, as I had hoped they might be, highly beneficia

It May

congested district) is a dangerous one for all persons living or conducting business therein, on account of the presence there of extensive rat plague. Six hum

alled to the fact that they are required by law to keep their premises free from rats and to abolish all structural conditions of the buildings which favor t

rats to human beings. All dark insanitary places used for living rooms should be vacated at once; all merchandise should be piled upon trusses at least a foot above the floor; all straw, sh

ntly closed and all broken ceme

milies and your tenants. It is your duty to do your part in this matter, a

th has controlled plague in Manila and the P

erty must permanently make their buildings safe for

mic. They were printed in the December number of the Philippine Journal of Science in 1913, but as they belong so definitely to the epidemic I am describing and as Dr. Sch?bl has expressed his willingness for me to quote them in full, I gladly accept his permission. Dr. Sch?bl advanced the possibilities

s observation

ion of: (1) Specimens taken from patients and from dead bodies at autopsies, (2) samples of blood-sucking insects collected in houses where plague patients had lived,

al Examination o

sis as possible, the following pro

c syringe. The material thus obtained was placed in th

ge, and 5 centimetres of it were placed in an Erlenmeyer's flask, containing 200 centimetres of neutra

hanging-drop method were used. Polar-staining and chain formation in liquid media and the characteristic type of colony on the surface of agar were looked for.

4 patients are tabulated in the two following tables. Table I i

fluid being small and the bacilli very few, it was impossible to diagnose the case, especially when the cultures from the bubo were negative. Repeated examination of the patient was necessary under those

ation of Fatal

ace Sex A

tion Du

fore death Bubo

Cultur

e Agglutination Sm

n Smear Cu

cul

1912

ale (?) July 11 5 48

lipino Male 15 Sept. 29

no Male 39 Oct. 10 4 2

lipino Male 34 Oct. 22

pino Male 37 Oct. 22 3

pino Male 41 Oct. 22 3

ilipino Male 31 Oct. 22 3

ipino Male 30 Oct. 22 2

ino Male 34 {Oct. 22 2

82 0 0 0 0

ipino Male 35 Oct. 23 3

ino Male 25 Oct. 23 1 5

ino Male 23 Oct. 24 3

Male 14 Oct. 24 2 +

lipino Male 29 Nov. 1 1

ipino Male 27 Nov. 23 4

Filipino Male 20 Dec. 7

pino Male 8 Aug. 20 (?

pino Male [A]17 Nov. 24

Mo

ion of Plague Pati

ace Sex A

tion Du

e Bubo

Cultur

Culture Ag

1912

29 2 -

2 5 +

Filipino Male 18 {O

7 10 -

18 - -

European Female 6

22 2 +

24 4 +

Filipino Male 21 {Oc

8 18 -

25 - -

26 3 +

13 0 0 0

ipino Male 15 {Dec.

9

48 - -

(?) +

ese Male 35 {De

- - - -

Val Filipino Female 1

1 33 -

aled up in several weeks. Hard inguinal buboes of secondary order persisted in patient 19 at the time of second examination. No plague bacilli were found either in the bubo of the first or second order. Patient 20 had a considerable amount of pus in the

ght hours, respectively, before death. In case 18 there was no doubt that the skin lesions, which covered the whole body and the face, were of secondary nature, as the patient died shortly afterward. It was undoubtedly a case similar to those reported by Gotschlich and Zabolotny.[5] In the other two patients there was only 1 maculopapulous effloresc

der pathogenen Mikroorganismen. G

ll treated with antiplague serum. While cases 5, 11, 19, and 24

of repeated examinations that the plague bacilli disappear from the infected gland in a comparatively short time, as a rule at the time when pus starts to form. Contrary to the findings in patients who died, distinct phagocytosis was n

lating blood seems to have been, as Thompson remarks, that "the bacillus is r

., Cambridge (

es. Not a single positive blood culture was obtained from the patients who survived. The time of blood examination in positive cases was three and one-half to seventy-five and one-half hours before death. The amount of blood used was 1 cubic centimetre. Only 6 out of the 30 samples, which gave positive blood culture, were found positive by microscopic

. (1907)

sional early occurrence of plague bacilli in the blood stream, as the time of examination in the positive cases varied from one hour to one hundred six hours before death. In consideration of the ephemeral character of the septic?mic stage of plague, as evidenced by repeated blood cultures in the three patients who recovered, one can hardly avoid th

the German Plague Commission. Vagedes, Klein, and others[8] pointed out the defects of the reaction as a diagnostic means. Aside from the technical difficultie

sermann: Handbuch der pathogenen

t positive agglutination of plague bacilli by the patient's serum cannot be obtained in the first week of the disease, and, the

ournal of Science, S

(1912), 7

nd filtering the suspension through filter paper. No antiseptic was added nor heat applied. Serial dilutions of unheated patient's serum were mixed with equal amounts of bacterial suspension in small test tubes. Incubation at 35° C. followed. Controls, consisting of serial dilution

isease at the time of examination ranges from two to six days. The non-fatal cases showed slight agglutination from the sixth day on. From that day, the

ible to examine some of the survivors

ow titer of the curative serum (dilution 1:32, agglutination positive; dilution 1:64, agglutination negative), the rise of the agglutinant power of the patient's serum i

ervations the followin

lood culture was obtained in practically every case that was examined in the febrile stage of t

e found in the circulating blood of the patie

illus pestis circulates in the bloo

ntered in plague septic?mia

for the diagnosis of plague, as it was

s noticed only in patients who recovered afte

thout any apparent bubo, who is not so sick as to be detained from his daily occupation, may expectorate large numbers of plague bacilli, are facts of great importance with regard to the communicat

s Found to Contai

e of infection Expe

s Laborator

s Experimen

erimental infectio

perimental inf

f?ces Fed on

bugs Plagu

lea Pla

gue rats, exper

0 Flea Plague

3 Flea Plague

erimental infe

d Flea Experimental

ng pigs; harbored fleas;

tained Bacillus

Flea Repeated exp

bedbug Experimenta

e and Xanth

capitis Dead body

Transmission of Plague

periments of Gauthier and Raybaud that the actual transmission of plague infection by fleas was convincingly proved. Ever since the exhaustive and conclusive experiments, which were carried out both under natural and artificial conditions by the British Plague Commission, and the work of Verbijtski, which antedates the British Commission, were presented, there has been no doubt that the transmission of plague by blood-sucking insects, particul

Infectionskrankh. (1901), 36, 89. Kolle und Wassermann: Handbuch der pathogenen Mikroorganismen (1903), 2, 538. Zeitschr.

-bugs from the beds of the plague patients and dog fleas from a plague

ince the question has been conclusively answered by the work of the Indian Commission, nevertheless the following obs

ning the root of the right ear was scarified, and a loopful of the culture was smea

ischarge. Clear effusion in both pleural cavities and one hemorrhage in the pleura were found. The lungs were hyper?mic, but otherwise normal. The spleen was of somewhat darker color, but otherwise normal in size and appearance. The liver showed a slight degree of parenchymatous degeneration, the c

ently were dead. About 6 common rat fleas were found and identified as L?mopsylla cheopis Rothsch. The parasites were immersed in sterile salt so

died of plague within three days, showing considerable hemorrhagic ?dema around the place of inoculation, typical bilateral inguinal

been kept, died twenty-four hours after rat 1. The two cages were at least 10 ce

ead animal. The post-mortem findings were identical with those described in r

he time the rats had been kept in the plague house no irregular results were noticed in plague-inoculated animals. At the time the first rat was i

mopsylla cheopis) were found on the necks of these animals. They were collected and inoculated in the same way as the fleas from the first rat. The experimental animal, which was inoculated

could be found at that time, only the 2 rats and the first 3 guinea-pigs are positive

wed primary buboes on the neck with more or less extensive hemorrhagic ?dema extending in some cases over the thorax. There was little pleural effusion present; the spleen always showed typical changes of n

are the findings usually met within guinea-pigs artificially infected with plague by the vaccination method, if the lower part of the abdomen be chosen for inoculation. Th

be fresh flea bites, small, elevated, and fairly deep infiltrations partly covered with moist scab were found in the skin under the chin. Other animals showed changes us

guinea-pigs known to be naturally infected

f the gland, where it formed an almost continuous circular zone, leaving the central part less changed. Smaller irregular necrotic

ravasations were present in t

, but of normal structure. Throughout the parenchyma irregular multiple necrotic foci were found, leaving but litt

s indefinite; a few miliary hemorrhages

fatty degeneration, and pigmentation of the

ial layer of the surrounding skin. The same kind of infiltration reached deep into the skin, stripes of cellular infiltration penetratin

plague among these and the other animals in this outbreak,

ugust 30). The second animal (rat 2) died twenty-four hours later. Guinea-pigs 3, 4, and 5 (see plan) were found de

fected. The floor, the ceiling, and the walls were sprayed with kerosene and lysol solution. The remaining animal

two days each recorded two plague guinea-pigs (10, 11, 12, and 13). On September 11, the last guinea-pig died of plague in this outbreak. The whole building was then thoroughly di

AL H

st animal died and fourteen days after animal 1 was inoculated. Altog

ributed among the guinea-pigs. In fact, 2 rabbits were surrounded

teresting to know the dimensions and locatio

n regular metal animal cages. The dimensions of the cages are: Fifty centimetres long, 36 centimetres broad, and 30 centimetres high. The

he construction of the wooden frame, allowed a continuous passageway for the fleas to the second shelf of the racks. On the other hand, the deaths among t

ar as possible. They finally settled in those guinea-pig cages which had not been molested by the first disinfection. Having no new supply of plague blood (all of the plague-infected guinea-pigs having been removed, most of them before death), the fleas soon clear

ions can be drawn fro

psylla cheopis) prefers t

it will attack guinea-p

-pigs afflicted with plague septic?mia were found to

e rat and on the guinea-pigs, the presence of flea bites on the rats and on the guinea-pigs with positive findings of skin lesions on that part of the body where the fleas and flea

s on Animals Sus

effusion, enlarged spleen, and such changes of the liver as are characteristic of natural plague infection in rats. Microscopically, large numbers of plague bacilli were found in these cases, and pure cultures of Bacillus pestis were recovered from the spleen. Histolog

cervical or axillary buboes are not uncommon in Manila rats. Various pyogenic bacteria were found in the pus of such abscesses. Of the less common was Bacillu

rat leprosy, and 7.4 per cent. trypanosomiasis. One tumor of the mammary gland and one tumor in the axillary region were encountered, while one tumor of the large curvature of the stomach proved to be a chronic inflammatory tumor due to parasites. One peritoneal tumor in a rat (Mus decumanus) gav

ction extended over the neck and chest. The inguinal glands were small and pigmented. The lungs were collapsed, and showed hemorrhagic foci. The spleen was slightly enlarged, firm, and dark red. The liver was rather large, firm, pale red, with s

ssue of naturally infected plague

ere not larger than a miliary tubercle. The small necrotic foci were found to consist of few necrotic liver cells. The centre of the larger foci was formed by degenerated and necrotic liver tissue, surrounded by round-cell infiltration. Polymorphonuclears were also found in the z

th pycnotic nuclei were scattered throughout the organ, and vesicular cells with small, deeply stained, excentrically located nuclei were presen

w hemorrhages and polymorphonuclears were present. ?dema of the caps

d homogeneous masses and blood. There were numerous subpleura

ly showed vacuolization. The medullar part was better preserved. There were miliary subcapsular hemorrhages. A few

gue Infecti

mission, cats develop submaxillary buboes if fed on plague material. They are said by Albrecht and Gohn[13] sometimes to recover. Out of four cats fed on plague material two died of plague, one showing submaxill

st in Bombay im Jahre

e infection of a cat was reco

ydney, 1900. Referred to in Kol

ering from plague infection. The author also undertook a

fer from

may be acute

the disease

ally play a part in the

robably become infected through

plague infection in cats is of great i

et (1905)

n a warehouse in which dead rats had been found some time previously. The rats were not examined. In the morning of the 30t

he subcutaneous tissue, pericardium, mediastinum, an

t the time the cat was delivered for examination. They were kept under

submaxillary salivary glands. The surrounding tissue was ?dematous, but no hemorrhages were noticed in the vicinity of the enlarged glands. Upon section the glands were found to be necrotic, and upon pressure a thin purulent liquid escaped. There were no hemorrhages

bserved in both pleural cavities. The tissue of the lungs showed considerable ?dema and hyp

rt was

f light red color, with fo

sh in color; there were no hemo

wed prominent structure, the centres of the ac

minent, the surface smooth; there were no hemorrhages. The cortex was increased in breadth and was of

mal, as were also in

al findings we

gland as seen in cross section had undergone necrosis,

cocytes. The blood-vessels were dilated, particularly in the subpleural part of the organ. In some places capil

the primary bubo showed the normal struc

atous and fatty degeneration. The cells on the periphery of the acini exhibited typ

neration, ranging from parenchymatous to fatty infiltration. T

ese showed slig

tion, a few hemorrhages, and bac

on of the material from this

, many lymphocytes, and numerous bacteria, some of wh

ague-like, polar-stained bacilli.

ly contaminated with Bacillus coli

ed. Smears made from this growth revealed plague-like bacilli of the cultural type, showing a few club-shaped involution forms. Subcultures were made in order to secure pure

d with the material from the left bubo, another one with material from the

h the material from the spleen. I

from the nostrils obtained by swab. The anim

terial from the rectum obtained by sw

act that cats may contract the disease in spite of the high degree of resis

with rats on one side and human beings on the other. It is also a well-established fact that not only plague-infected cats, but also those wh

orities there, for the reason that the Manila plan was so much more productive of results, as shown by the apparent inability of the Hong Kong officials to gain control of the disease. However, I received from Dr. David Roberg, of the Oregon State Board of Health, a copy of a rep

o present on the epidemic of

onset in January there were 47 cases, in February 42, and in March 223. During the week previous

in May it reaches its maximum and then declines. In the epidemic of 1912, for the city of Victoria the monthly rate showed the following, January 9, February 22, March 61, April 265, May

monthly rates for the city of Kowloon during 1912, when the following cases occurred:

lity to the extent of being sufficient to again infect human beings. Moreover every other year shows a marked severity in the epidemics of human bubonic plague. This is explained by the fact that it requires two years' time for the rat population to become of sufficient greatness and s

e native district depends upon the available food supply, and as a result of this human overcrowding the amount of waste food so increased in the house

iciently to cause a severe outbreak during that year, and as a result of the lightness of epidemic in 1913, they

at is found plague-infected throughout the year, while the house rat is found infected only during the period in which the huma

Man also becomes infected by the drain rat when the drains are

een built with double floors and walls which harbor the rats. Where the construction is of wood it is possible to remove the rat spaces. It has been found since the introduction of plague into Hongkong in 1894, that those

f the Sani

the old city of Kowloon which is situated one mile and a third across the harbor and contains two and three-fourths square miles. The city of Victoria on the nor

s the floating population is so great. In the 1912 cen

over an area averaging from 31 to 140 acres. The houses in these districts average one thousand and the population from 8000 to 33,000. There are four i

y the Sanitary Board ar

drain openings and ventilating openings by iron gratings, and the prohibition of ceilings and of hol

or killed by them. There are 650 of these bins distributed throughout the city and its suburbs, and each of them is visited twice daily by rat collectors who take all rats found by them to the City Bacteriologist. Each rat is at once labelled with the number of the bin from which it is taken, and if subsequently found to be plague infected, a special sur

al efforts in this direction being made just before the onset of th

of the communi

dwellings at least once in three months with a flea

l of refuse from the houses, coupled with the provision of covered metal du

s, etc., are conveyed in a huge covered basket to the disinfecting plant and sterilized with superheated steam. No objection is made to the treatment of pla

es and explanations to induce the native populatio

ague was abating. The South China Morning Post of

there were 26 cases, of which 19 were fatal. All were Chinese. The total num

te in detail the work done and the observations made

eproduction here. It will therefore suffice to say that the first six months of 1914 witnessed the passing of the most threatening situation that has confronted the city of Manila in years. The record of plague rats found does not convey an accurate idea of the prevalence of rat plague by any me

e number of dead rats, in and adjacent to houses which furnished human plague cases. In one building alone more than 150 rat cadavers were fou

in the matter of intensity. Forces of the cleaning and rat-catching gangs were increased and the utmost thoroughness of treatment was insisted u

n I have directed the removal of some panel of woodwork, some post casing, or a board of the floor with the full expectation (seldom unrealized) of finding a dead rat or a rat nest. These experiences were positively uncanny at times. In the houses of the poorer class, usually of bamboo and thatch construction, the finding of the rat was less easy and more uncertain, although the nest was repeatedly found, and as related elsewhere the dead rat itself might be found in a hollow bamboo timbe

ever interesting they may be to the plague worker. The danger of pursuing these investigations, to the persons so engaged, must not be lost sight of, and exposure of such nests and rat cadavers should invariably