Plague

e already referred to them in the relation of my Manila experiences in the preceding pages. I have decided, however, to add a chapt

d to such matter as I believe to b

time. Twice in recent years,[17] I have described the diagnosis and treatment of plague, attempting in each case to present a reasonably full account of the methods employed and advocated by authorities, for theoretic reasons and from the recorded personal ex

1907) and Hare's Modern

a epidemic of 1912–1914, have led me to discard as impracticable, unproven, disproven or unpromising, certain plans of treatment formerly deemed worthy of trial. I do not refer to these methods individua

gnosis and treatment, in the individual case, and from the community view-point of the recognition of the pr

ic diagnosis. Herein I would include not only the recovery of the pest bacillus from the patient, but the recovery and identification of the or

desirable for the proper study of all cases of plague, it is impracticable and unnecessary, in communities where plague is known to exist, t

er himself is both clinician and bacteriologist. Even in this case it is far better for two persons, clinician and bacteriologist, to work together. I will not discuss the technic of the procedu

t, occur too late to be of s

tion (microscopic) of aspirated material from the ?dematous tissues surrounding gland m

pirated material and blood cultures are the most reliable methods, in the hands of a compe

ries of cases of plague, both bubonic and septic?mic. As much blood as it was possible to secure was aspirated from su

matter obtained from ?dematous periglandular tissues or from gland puncture, an aspirating syringe being used. The dro

d that other diagnostic means than biol

t of a presumptive diagnosis. This presumptive diagnosis may be reached after due consideration of physical signs and symptoms. A carefully taken history of the onset and course of the disease will be valuable but unfortunately such historie

ection with B. pestis; that they are all expressions of the same disease; that they call for the same trea

a septic?mic case, either mildly or overwhelmingly so. Accordingly t

mortality of plague be greatly reduced. It is true of plague, just as it is true of cholera, that many of the fatal cases develop and become hopeless before the disease is suspecte

e of suspicion on the part of practitioners, wherever even a si

s, i.e., without resort to the microscope, the following symp

early and extreme prostration (perhaps more pronounced than in any other acute disease); extreme tenderness over involved gland masses, in the bubonic type of plague; cough, with con

sidered: typhus (exanthematicus), influenza pneumonia, broncho-pneumonia, sever

of plague, septic?mic and bubonic, occur at times

ll cases of septic?mic plague is hope

ia developing in the course of systemic plague are quite different in their sign

versal is the involvement of organs, glands and tissues in systemic plague and how widespread is the distribution of B. pestis throughout

er be lost sight of by the therapeutist, who must realize that fro

mely high. On account of the delay which usually occurs in the recognition of plague,-a delay which in the natural order of things is and must be the rule rather than the exception, because of th

reventive control. I do feel, however, that biologic treatment from the earliest possible moment,

except that with antipest serum. To this belief I subscribe assent, as I find it enti

treatment has for its object the securing of comfort and of relief from suffering for the patient and is highly pro

application of ice bags and cold or tepid sponge bathing for high temperature; stimulan

cept in cases which develop secondary surgical conditio

is misleading and unsatisfactory for reasons already given in our discussion of treatment, viz.: failure to secu

nd and non-moribund, and indeed such division, being a matter of

o support theories, or to break them down, all

der the administration of antiplague serum, is more impressive than the contemplation of

statistics supports the view that treat

the first 68 cases of plague in the recent Manila epidemic, 32 wer

ere remain 36 cases. All of these patients rece

eries in which cases found dead and moribund are considered, the recovery percentage here being a little more than 14 per cent. It is also quite fa

iplague serum to be given will vary somewhat with the age and w

c.c. to 500 c.c. of serum by injection, 100 c.c. being given every

lays of absorption from the tissues, the intravenous route should be given the preference. The serum may be delivered intravenously from a large glass s

way in which diphtheria antitoxin is used. Its protective properties are conceded to be somewhat superior to those of plague vaccines as the prote

umber of cases of "serum sickness" (anaphylaxis). These persons suffered from severe urticarial, arthralgic and nervous symptoms, lasting for several days and a few were obliged to enter a hospital. In one case the symptoms did not entirely abate f

ally it seems to be shown that this prophylactic immunization with dead bacteria reduces the incidence and mortality one-fourth or one-half (approximately). Experimentally, also, it appears that anti

y prevail. It is a mixed vaccine, so prepared that 1 c.c. of the emulsion contains 1000 millions of plague bacilli and 2

f Ceylon Branch of British Me

that the inoculation of human beings is harmless (producing less reaction than the Haffkine inoculation); (3) that a small amount of agglutinins, both for plague an

N

E F G H

R S T U

ylaxi

ue in Porto Rico,

ila

blic co?perat

a, plagu

plague

outh, pla

ntral, pla

ast, plag

tish East,

uguese East,

marm

, rat fle

y of fl

ce of cholera organism

t to temperature a

paign in Manila

ation of pla

asures in R

y of fl

lague Comm

of plague ba

of plague, obser

ague in Hong Ko

work, danger

gic observ

is, in air, 3

bugs,

by fleas,

ion of,

racteristics

ting blood

ats,

temperatur

ies,

leas

ce, 3

asonal condi

kroach

putu

f virulence

kin,

Dr. Ru

plague

ath of E

t Africa, p

of fl

rat flea

eyance of B.

, Dr.

uses for rat

virus, D

sz, 53 use of,

in Cape

hi mur

se-typhoid, o

tidis, G?

poisons, use o

of Manila

anila, pla

ers, closin

s, insan

ate of

cs of f

utch India

Science,

rat

ability of

rat nests,

amination of pla

ects, transmissio

cts found to contain

of plague, 167 proc

of pla

ce of pl

of pla

, Dr. B

ague in,

ia, plag

frica, pl

ground sq

plague th

ous pla

dia Plague Co

n plague conv

gue in, 2

plague i

ue, India Plague

Dr. D.

., U. S. P. H.

Dr. Aldo (de

llus fasc

flea

cepha

s beech

s abatement of, 35 organism,

, a plague

rat proo

g of rats and gro

mmary of prev

ear 1912 i

s of bamboo

e in Manila, 7

Philippine and J

istics in rat ca

sol

ion of

n of skulls

ability o

rwarding of rats

C. (Manila

g plague

diagnosis, 136 from observations of plague ou

plague infect

reatment and

d vacci

s of pla

on of pl

act, infecti

flea

infect

of rats by

us, 53 bacillus, 53

in Cape

rats by domes

on of ship

per dispo

eas from rat cad

ate of

a, Batavia

life of fast

bamboo hous

n, theatre,

oncealment of p

nts in rats, unr

with formaldehyde

nti-plague w

gue, importance of, 166

logic,

ue of serum admini

of plagu

ague in,

ica, pla

f seasonal conditio

pneumonic

tance of rat d

s by U. S. Agricul

ligious beliefs in India, 43 o

cts concerning p

gue (Table I), 130 of cases of pl

animals, plag

yance of B

yance of B.

gue convey

city of, 31 bite and

effect of seasona

. Carro

dog, 32

ce

squir

ty of,

ion of

ction to domestic c

ns for spread of p

la cases i

r habits, 77 b

ppines, 78 of

taly

t,

tions in numbe

and humidity on, 79 imago, effect

s, duration

n of plague extension from

ty of,

d ra

y Mur

f Mus decu

e successfully, 162 of Manila

ague of

tain, pla

irrel, Cal

ain, rat f

uirrel, f

B. enter

ing of plague ca

r sleeping

ning campaig

sanitary ord

ndicators of inf

s Mu

rat

(Nesok

bility of

ague Comm

of pla

plague

plague in,

V. C., 31, 5

Dr. W

as rat ca

ats as rat

n Tondo distri

ondo, light

fection by

destruction,

berg, 153, 154, 155, 156, 157, 158, 159,

of plague

vaccine

ducti

plagu

na, plag

rough digest

on, pla

rat fle

rat fle

n on contagion, 33 on

ty, pl

perstitions and rel

on of s

of plague

. I., pla

ry basem

the rat catch and

guinea-pigs as

gue Commi

tain Bacillus pestis

rapid diagnosi

nti-plague

lague in

plague

al rat poisons

T. W., corr

ch India, 77 Xenop

number of fl

facts concerni

use, 84 "bale ba

awah ra

bility of

s of rat cad

Dr. J.

, U. S. P. H

s an insec

reat plag

., 31 classific

lla che

yance of B.

se-typhoid ba

plague rats and ot

houses in Tondo

rning and ap

in relation to human plag

, 22, 23,

of pl

plague

of anti-plag

ges, pla

plague

, plague

an ports, p

t, As

fleas

pneumonic p

of rats into sh

d bacillus o

, B. t

aign in 1912-1914 in, 57

quaranti

lague from Hong

Quarantine

emic, begin

mbers of Manila

rst, 62 geographic group

tation

fleas from r

year 19

P. I., pl

suppression measures in, 70 pl

S. Army Commiss

ons and

terial h

leaning c

disinfect

, 99 alexa

us, 99 fero

nests, 106 driving out ra

ing with

ts in t

n rat tr

owed by s

infection (Ma

n and forwarding

se of Mani

on, 127 outbreak of plague amon

on of plague outbreak amon

Hospital,

rs in relation to huma

tical studies in,

Dr. C

ans, pla

emies of t

id, necess

ality of Manila

ateria

emies of t

ay r

t runs, 105

d,

infection in

n Hong Kong by Dr

ic diagnos

tic cats and dogs

Rodent

ong experimental anim

nimals suspected

eyance, 28

y suction of

plague app

ion in plague c

ty of plague

nes, pla

plague

plague

ast Africa,

h Service, U

tans, 32 p

umonia, se

plague e

problem, su

ague, 37 in

36 treatment and

tro

enti

essio

in San Fr

for rat destr

es, rat destr

r community,

sposal of

rnal of Scienc

la, 58 from Hong Kong, Manil

, importa

and mortality

-proven, and oth

po, Man

ndo, Ma

a, geographic

los, P.

ilo, P

nila, taking charge of, 70 figh

emoval of, in

9, 76, 150 rat, in U. S. Army C

ue extension from

planation of, 81 in Java, epid

abitatio

la) habitat

ion and conce

ion, In

rats (Table), 105 in

of rats as ind

ehold rat des

128 examination of fatal cases of (Table I),

on, Aust

rculating blood

, 134, 135 diagnosis, conclusion

g insects, tran

animals, outbreak o

animals, conclusions from

animals suspec

ion, Ge

otes on, by Dr.

in 1914, abat

f fighting su

ility of Manila

of rat cadavers in relat

f rapid diag

diagnos

disease in

atology

considera

eatment, cond

ment of, 174 sympto

serum and ana

accines,

ified, 56 stati

anila, pl

Italy, 32 o

at Bri

ted St

ague in, 35 suba

the practical

plague

n, 29 effect of seas

Dr. W.

, Dr. M

rieties of, 3

stral

orld, 41 destruction, e

ation me

enemie

l viruses for, 43 poi

ping

varie

by poisono

starvi

ng, 48 cos

ion of s

bility

hods of en

tion by rat

to diseases of bac

quirrels, chemica

nimals, 54 catchers, house ca

r dogs

terrier

osis, impor

leas in Manila from, 65 plagu

struction, 72 inapp

trapping, e

ate of, 73 de

opulation in

ry warehouse, Manila, 76 fleas of

78 breeding as influ

"bale b

ched ro

mboo house

, variati

ods, comparative

gue incidence, in

ic classific

ip, 99

olorati

way, 99

rn

er,

erential points in, 101 con

abilit

g abilit

ability

abilit

ability

ers, siz

lkers, 103 as r

f, 104 time of death as indicat

nges in (Table), 105

s on, 105 nest

notes

ila), brea

ith formaldehyde

with dogs

in trees (

Manila), 111 swallowed

and forwarding of

bacilli from cir

Dr. Da

virulence of

ague in rece

ion of p

spital, Manil

tto, 14, 29,

R. P., 16, 3

tury, pla

ica, plagu

plague

plague

ica, plag

d, plag

, plagu

tlements, p

n, Dr.

sites in plagu

effect on epidemics

lus pest

prevalen

plague in

abatement of

plague pne

prevention

o, plague ca

umigatio

ing r

t infesta

evention for

s, disinfec

solatio

ongsang, 59

n Manila, favorabl

arters, gro

bel, Ph.D.

ations of plagu

s, Manila (gar

rat

r ra

at of J

ability o

rat litt

on, U. S. P. H

at cadavers

at traps (M

wallowed by

anitary ord

(Hong Kong),

ology of

tment of p

treatment of

tudies in mor

on, dosage and tec

of pla

t of pla

Asia, pl

agan

, Dr.

gs as rat

as rat catche

la, rat plague in, 6

lague suppressive

t material

, habitations

sinfection

as indicated by pos

lague by blood-su

iologist, nece

, and prognosis, 173

ic, of pl

ge of serum admini

ic Health Service,

at fleas, 32 o

mber of fleas pe

m, Dr. J.

in the ra

, plague

Haffkine,

s, comb

semination in

ies, pla

epidemic

ary Board (Ho

cheopis i

assificatio

riber'

corrections

dded after J in "J B

iod added after

idemic, By Dr. Otto Sc

endom" changed

ype from the word genus

o this July case" J

ylla cheopsis" Loemopsyl

ses 5, 2, 19 and

infected house" plagueinfect

et with in" with i

is was found in the liver" teni

greble" changed

903) 2" added comma

s printed, including incon

pson, Dr. W. J. is miss