April 1 1911


April 1 1911



WHENEVER there is a great war, or an exciting event such as the siege of the anarchists in London, there are always enterprising photographers who will venture into most ticklish positions to obtain pictures of the event. Subsequently these pictures are reproduced in the various papers throughout the world.

But it is safe to say that very few pictures are being printed to-day that show the progress of the Black Plague in the East. Photographers are less intrepid when it comes to facing an enemy that cannot be seen, and that creeps into one’s 'system, unfelt, until it seizes the very seat of life and chokes one to death. There are some pictures, to be sure. Some of these we reproduce from various papers that have been dealing with the subject. But on the whole the material is scanty, and it is doubtful, even if plenty of photographs were available, whether the average editor would be keen on handling anything that might have come from the plague districts of the world.

So keen has become the apprehension, throughout Europe at the unprecedented development of the plague epidemic in the far East, says Current Literature, that French dailies discussed last month a project for international action against the advancing peril. The spectacular tour of the German Crown Prince was brought

to a sudden close in India, while the coming visit of King George to the greatest of all the British dependencies may be put off indefinitely. Many grim stories of the epidemic in Manchuria are related in the advices of the Paris Temps from Harbin. “Some of them are almost too terrible for repetition. Many seem less ghastly only because of the heroism they reveal on the part of Europeans fighting the scourge.” Doctor Meunier, the distinguished Paris specialist, met his death while doing his utmost to stay the epidemic. Refugees from Chinese cities now in Harbin say that not only do the Chinese throw corpses into the street, but hurl plague patients yet alive out of the windows of the houses. One correspondent— that of the London Telegraph—affirms that in a two hours’ walk through a Manchurian town he counted thirty-six bodies in the streets. “Pariah dogs and birds of prey gather over every center of population.” It is not unusual to encounter an entire community peopled by the dead. In some instances wild beasts have left but the skeletons of the victims. Such are the incidents of a plague epidemic, which in China, we read in the London paper, has attained “horrible dimensions.” It is said to have been brought from the north by native hunters.

Had not the Chinese officials, with characteristic listlessness, watched the epidemic

in its incipiency, with no thought of therapeutic intervention, the scourge, says the Temps, might easily have been checked months ago. “The supply of medical men is not adequate to cope with an outbreak of such an extent as now threatens the celestial empire, and additional doctors were sent for as far away as St. Petersburg.” The death rate at Harbin three weeks ago was two hundred a day, the French daily reports. “There are no proper means of disposing of the dead, and in many cases corpses are thrown by scores into the river, thus disseminating the evil.” Traffic on railroads in northern China came to a standstill in consequence of such conditions. Voyagers between Siberia and the South are subject to rigid quarantine before being allowed to proceed to Dalny and Port Arthur. At Vladivostock the precautions of the Russian officials proved sufficiently stringent to hold the plague at bay, but in Peking several cases were notified to the diplomatic corps less than a month ago.

The spread of the epidemic in the Chinese capital was reported as “very slow” by the physician to the British legation last month. There is a possibility of exaggeration in reports from some parts of China, the Paris Debats hints. The weight of evidence, however, justifies the sensational inferences in Lóndon dailies. German authorities, as indicated in the Berlin Kreuz-Zeitung, take an alarmist view of the situation. Special precautions were put into effect at Kia Chau. It is deemed significant, too, that the Chinese Regent, who did not at first take the plague seriously, is at present exerting himself to stay its ravages. He has even decreed that any Chinese physician who may lose his life through the malady will be accorded posthumous honors and monetary rewards as if a state of war existed. The force of guards at the great wall was strengthened atthe same time, the object being to halt the army of refugees from Manchuria. A spirited controversy seems to have divided the medical men from Europe who were sent to the scene from Russia while the Manchurians were perishing. The epidemic is of the most virulent pneumonic form, according to Doctor Christie, of the United Free Church of Scotland Mission, who is in the

forefront of the fight at Mukden. The Russian authorities seem to have formed another idea of the subject. The .low temperature of the region affected at this season seems to the Scotch expert favorable to the bacillus.

Then there is the following in\he London Magazine, by E. S. Grew: ®

Not more than a stone’s throw from the spot where the London Magazine is printed was a plague-pit in which the bodies of those who died from the Great Plague of London in 1666 were tumbled from carts at night. When the excavations were made near Aldwych the navvies found some of the old plague-pipes which the burial men used to smoke while at their dreadful task, throwing the pipes into the burial pits when they covered up the bodies.

But it is impossible (people hastily add, when summoning these recollections") that plague should ever revisit England. Its visitations belong to bygone centuries when the Black Death was a menace to Europe, devastating the ports and spreading from Genoa and Venice to the hill towns of Italy; and finding its way by water from Constantinople to London and Vienna and Amsterdam.

Is it impossible? Plague is not fax away. Seven millions of people have died from it in India in the last fourteen years. Think of it. Plague has swept away the entire population of a Greater London from India since 1896, and—the plague never sleeps. It dies down and revives. It returns and returns. In one year, and that is only seven years ago (1904), plague killed more than a million people in India. It can be fought and the deaths reduced. Its devastation can be lessened. But fighting it is like fighting an underground fire. Its spread cannot be distinctly followed. While, above-ground and within sight, the plague is being fought, it may be in full blast beneath the earth, in the drains and sewers, in the unclean corners and hollows of walls and roofs and gullies of houses. In a word, while the human community is slowly recovering with a gasp from the epidemic which ‘has swept it, plague is smouldering among rate of the city or the village and is gathering forces for a renewed onslaught on man.

“Remember,” said one of the Plague Commissioners, appointed by the Indian Government, to the writer, “in considering the onset of plague, it is plague among rats that you must keep in view.” It is plague among rats which causes plague among men. The occurrence of plague among rats in India is followed in a fortnight by human plague. As the deaths from plague rise higher and higher among the rats, so, almost as if they were traced by the same terrible finger, will the deaths among men and women and children rise higher and higher a week or a fortnight later. Plague is a rat diease. Man could avoid it with ease were it not for the rat. It is the association of rats with men which is the direct cause of epidemic plague.

One cannot too often repeat that assertion in its varying forms. Where plague

came from in the first instance it is impossible to say. It has existed as long, as there are any historic records; and without doubt it is the disease among the Philistines mentioned in the First Book of Samuel. There are several great foci where it always exists. One is in China in the Unam province, another at the foot of the Himalayas, another is in Central Africa (Uganda), and yet another in Arabia; and why and how it perpetually maintains itself there is not clear. But it is clear how plague is maintained in India, and how it is spread. There are certain seasons of the year when plague is not very widespread among human beings. It is called the off-plague season, and falls towards the middle and end of summer. Even the non-epidemic season of plague in India would be alarming anywhere else. There are always human plague cases oc-

curring every week in some district or other. The smallest number recorded in one month in the Punjab is 129. Just as there is an off-plague season among human beings, so there is an off-plague season among rats. But there is this important distinction; while among human beings the number of cases -falls so low that the plague epidemic may be saidto have subsided, there is always plague among rats. It may fall in the-hot-weather because the conditions for infection become unfavorable. But plague is always there, awaiting the suitable moment when it may spread into renewed virulence from rat to rat and from rat to man. There can be no extermination of the plague without extermination of the rat.

Let us be quite clear on this point. People have a confused idea of how plague spreads. With pictures in their minds of Defoe’s account of the Great Plague in London, they imagine whole families catching plague from one another. They see husbands shrinking away from wives, mothers from their children, when the dreaded plague-spots appear; they see the passer-by drawing away with a shudder from houses marked with a cross to show that plague is there; they hear the cry of the men with the carts at night: “Bring out your dead!”

That is no doubt what happened in London. But usually plague is not “catching” in that way. There is one form of plague which is contagious. It is the only really contagious form—plaguepneumonia. Plague-pneumonia is comparatively a rare disease. There was an undoubted case in England some eighteen months ago. The victim, who was a young and brilliant investigator in the cause of science, did not at first suspect the nature of his seizure. The onset begins with a high temperature and pains in the head, and so may be (and was) taken for influenza. But at an early stage in plague-pneumonia the germs of plague seize on the lungs. The patient becomes delirious; he is anxious to move about and it is difficult to restrain him. He coughs and spits incessantly, and the germs of plague are thus constantly distributed among those who are near him. In the case of which we are speaking, the patient was devotedly nursed by two of his colleagues; and to minimise the dan-

ger of contagion to themselves they wore masks of cotton-wool throughout the illness, and no one but themselves was allowed to approach the patient. He died, a martyr to science.

What is truly alarming at the present juncture is that the four cases of plague which resulted in the deaths of those affected at Freston, near Shotley, in Suffolk, during last year, were cases of plaguepneumonia. This disease is so infectious that a healthy person who, unprotected by a mask or other precaution, entered a room where a sufferer from plague-pneumonia was coughing or sneezing, would

be hable to contract the disease — if merely a droplet of the patient’s sputum fell on his face. The victims at Freston all died very quickly, and one undoubtedly contracted the disease from another. There have been during the last three years a mysterious number of pneumonia cases in the neighborhood. Some are now suspected to have been plague-pneumonia.

It seems likely from historical records that in the instance of the Great Plague

oí London there was a good deal of plague-pneumonia (the scourge fell in the winter months), and consequently the affliction spread from person to person. People died like flies—or like rats. The mortality in plague-pneumonia is 95 per cent. Not one person in ten survives it.

But ordinarily plague requires a carrier. What are the carriers of plague? The carriers of plague are in the first place rats. But how do rats convey plague From one to another? Not, as was at first supposed, by contact with one another, or even by eating one another. Plague is conveyed from rat to rat by the rat flea. It is conveyed in the same way from rat to man. A rat has plague. Its body is infested with plague bacilli. In every drop of its blood there may be innumerable bacteria.

A flea bites the sick rat, and with the rat’s blood swallows plague bacilli. If the rat has plague badly the flea may swallow as many as 5,000 plague bacilli. However slightly the rat has plague the flea will swallow some germs, and these germs will multiply in its stomach. The flea, when its victim dies, or before, hastens to other rats and inoculates them with the bacilli of plague—the bacilli finding their way in through the stab that the flea has made. When the rats are killed off by the disease, the flea, from hunger, takes to man—bites him, inoculates him, kills him with plague. It is a nasty subject, full of nasty details. It is not nastier than the rat.

Let us now consider the rat, which is the first cause of plague. There are many different kinds of rats, but we may divide them for convenience into field-rats and house-rats. This is not a very accurate division, because some field-rats enter houses, and some house-rats are occasionally found in the fields. It is the housefrequenting rats which are of prime importance so far as plague in man is concerned.

There are, in India, four kinds of rats which frequent houses, though two of them, familiarly known as bandicoots, the large bandicoot and the lesser bandicoot, do not appear to play an important part in spreading plague now. They almost disappeared from Bombay when plague was introduced there.

That leaves two other kinds of rats on which plague depends for its perpetuation. One is the sewer-rat. It is the well-known grey rat, the scientific name of which is Mus decumanus, and which has spread to all countries. It is the commonest rat in England, and is said to have been imported From Norway, and so is often called the Norwegian rat. It is also called the Hanoverian rat, and there is reason for believing that it came to England from Persia in 1727. Before its importation into England the commonest rat in this country was the black rat, sometimes called the Alexandrine rat (Mus rattus.) The big grey sewer-rat, stronger and fiercer, drove the black rat out; and it is sometimes said that the disappearance of plague in England coincided with the disappearance of the black rat. That is a very doubtful statement.

In the first place there is nothing to show that the disappearance of plague coincided with the diminution of the black rat, which must have been very gradual. In the second place, the black rat has not disappeared. Black rats occur in London warehouses, and are abundant in Great Yarmouth and other localities. In Liverpool they are increasing in number. In the third place, plague occurs among sewer-rats as well as among black rats. Black rats spread plague among human beings to the greater extent because of their habits.

The grey Norwegian rat, or sewer-rat, despite his strength and fierceness and a certain power of survival which has enabled it to spread all over the world so that it is now a pest in Abstraía, where it has travelled up country by way of the rivers and streams, and is growing to an enormous size as well as greatly increasing in numbers ; this rat is, nevertheless, shy and timid of manner. It shuns the society of man, but Ives on the garbage he leaves. It lives chiefly in burrows and drains constructed for the most part outside human habitations, but it enters houses for food. It is a dirty rat, with greyish or brownish fur and a hairy tail.

The black rat is easily distinguished from the sewer-rat by its long tail and its large ears. It is a neat, clean-living creature; and in India one can call it a very domesticated animal, for it is constantly associated with man, as represented by the

Indian native. The native does not much mind the rat. In one dwelling which was investigated by the Plague Commissioners, and which was about the size of a large bathing-machine, more than three hundred black rats were found.

The black rat lives and breeds in such dwellings; in the mud walls; among the roof-beams and in the hollow roof; in cupboards, beneath boxes, or among any sort of lumber. It finds in the squalid native villages ideal conditions for existence. Thus intimately associated with man, it readily finds shelter on ships and trains among the materials placed on board for transport.

Some figures are available respecting the comparative populations of the sewerrats and the black rats. In the whole Bombay district there are probably three sewer-rats to every seven house-rats. The proportions, of course, are not the same m the Punjab villages, where there are more rats than people, but where all the rats are black rats. A Punjab village may be looked on as being honey-combed with rat-burrows, which ramify in all directions. Biit every habit of the native encourages the rat.

A white man, finding rats in his bungalow, would quickly make up his mind that he wouid not have rats there; he would take the most vigorous steps to exterminate them. Not so the native. The native suffers the presence of the rat even as he suffers the presence of vermin : or as he

encourages ;esenceof goats and fowls in his living-room. The rat, encour aged by this indifference of the other dom es~c animals, repays his host by furnish ing him with a supply of the germs of the ola~ue.

In India the proportion of white people who are infected with plague is small. That is, of course, because from their habits, and because of the condition of their houses, they are not often brought within the influence of plague. The white people recover from plague better than the natives. That must not betaken to imply that the white man is less suscep tible to plague than the Asiatic. His re covery is due partly to better nursing and partly to the fact that he has not the feel ing of despairing fatality of the native. The sick Asiatic seldom makes a fight fo! life.

Let us now consider the transference of plague from the rat to man, for the bacilli of plague exist in the first place inside the rat, and there must be some means by which man is inoculated with them. Some agent is necessitated. After much patient

investigation and experiment, the rat-flea has been proved to play this part. Most people know very little about fleas, and in England especially, polite persons do not even care to mention them save with bated breath. But as Captain Glen Liston, of the Plague Commission, observes, the subject of infection cannot be made clear without saying a word or two on the habits of fleas. There are some six kinds of

fleas which have been found on rats, Now fleas are parasites ; and like parasites, they have preferences. Some fleas will bite one kind of animal only. The human flea (Pulex irritans), for example, is seldom found on any other animal than man. Then there is a rat-flea found in some parts of Europe (and calledTyphotopsylla musculi) which will hardly bite anything but a rat. As a matter of fact this is a very reassuring circumstance about this flea because it has been distinctly shown to be a flea which can and does

transfer plague from rat to rat. This ratAea> though common enough in rats in some parts of Europe, is not the commonest of the European rat-fleas. That distinction is held by Ceratophyllus fasciatus. The one redeeming feature about this flea is that, it does not réadilv bite man Tt

will bite him, however, hen starved for two or three days.

The last of the fleas, Pulex cheopis, is the flea which is found on the plague rats of India. This flea has been proved~ with out the vestige of a doubt to be a carrier of plague from rat to rat and from rat to man. It prefers the rat, but it will readily bite man. A human arm plunged into a laboratory jar `whore these fleas ,~ pre served becomes at once. attacked by~them.

The varyiiig~ appeti~e of the rat~fleas in different paits of the world for human blood. may be an important factor in the prevalence of plague among human be ings. But the foundations of security are rather slender when they seem to depend on such a slightly varying cause.

A flea whi~h has fily orged itself on the blood of a plague-infected rat does not entirely rid itse'f of the plague bacilli

which it has swallowed for nearly three weeks. If in that time it does not find a rat to feed on it will certainly be hungry enough to feed on anything. The Pulex cheopis, which does not live in England, bites man readily. The Geratophyllus fasciatus, which does live in England, is not eager to bite man. But it has been shown that it will take to man in Australia, and therefore it may become a carrier of plague. It is not impossible for parasites to change their food habits under pressure of hunger. If there were a continuous rat plague in England as there is a continuous rat pague in India; and if under pressure of hunger the European rat-flea acquired the habit of feeding on human beings, then there would be a perpetual danger of small outbreaks of bubonic plague in all places where rats approached human habitations, whether in the slums of harbour towns and ports, or about farms and villages.

There is one other consideration to be mentioned. Rat-fleas are not great pedestrians. The rat-flea of India would regard thirty yards as rather a long journey. Its longer journeys are undertaken on the back of the rat. The rat is not itself much of a traveller, but at times rats are carried for long distances in trains and in ships, concealed among various articles of commerce, especially grain and rags. In this way the plague-infected flea may be transported from place to place with the rats. It is possible that fleas containing the germ of plague may thus have been carried to Suffolk by ships which pass Shotley Point on their way up the Stour or the Orwell. The numbers of rats in that neighborhood on both sides of the estuary are very great. It has been clearly shown that an epidemic of plague is either smouldering or raging amoúg them. That being the case, there is no reason why the fleas which infest the rats should not find their way ultimately to the domestic animals and the ground game of neighboring Suffolk. An instance similar to this is now occurring in California, where plague is believed to be spreading or to have spread from San Francisco up country by means of the California rabbit or ground squirrel. The number of fleas on rats is very great; thirty is no uncommon number, and the numbers increase as the rat falls a prey to the disease. A hun-

dred fleas have been found on a plague rat. We have spoken of the transference of these fleas to other animals. Guinea-pigs placed in plague-houses have been found to attract as many as thirtyplague-infected fleas to themselves. The guinea-pigs died of plague. Wherever, then, the plague-rat exists the danger is ever-present that the disease may spread from the rat to other animals or to man.

In the security of his own home, where a rat is as seldom seen as a burglar, the Englishman is apt to imagine that such a thing as plague could never happen to him. Fenced about by sanitary authorities, protected by hygienic measures and restrictions, he cannot conceive that plague should ever again sweep London as it devastated the city two hundred years ago, and as it is devastating the towns and villages of India to-day. But he forgets that in the restaurants where he eats, or in the billiard-rooms where he has a quiet game of pool, rats are lurking beneath the flooring, or perhaps are peering at the diners from the skirting-boards. There is a justly celebrated restaurant in the Strand from which the rats have now been evicted. But a few years ago late customers would often be startled by seeing a rat scamper across the floor, and an hour after the doors had been closed the floor was black with rats. Two hundred rats have been taken by the ratcatchers as one night’s bag. The rat population of underground London is as great as that of human beings above ground. What would happen if plague, brought from some of the black rats of the grain-ships, broke out among the London rats?

It would spread among them, especially in winter, till plague was within striking distance of every home in London that has drains. And if plague once thrust its head up from the sewers to some of the slums in East London, or South London —then a plague of Greater London might change the face of history.

Let us now consider what this means, or what it may mean. If by some series of disastrous coincidences plague were to spring up in half a dozen places at once among human beings; and if the disease were to assume that frightful pneumonia form which has characterised the five ascertained cases of plague occurring in England during the last twelve months then

there uru few medical authorities in this country who could set a limit to the devastation which might ensue. We do not live in the times of the Great l’lague of London, and probably our modern hygienic precautions would prevent

the infection from sweeping the country like a furnace fire. But after all, in spite of all our science, epidemics of other diseases have spread' and do spread. Why in exceptional cir-

cumstances should not a disease so terribly infectious as pneumonic plague spread too?

But even if it were arrested before it had gone far, does anyone realize what an

outbreak of plague, numbering thirty,

°r cases London or Liverpool or Glasgow would imply? Even a solitary case of plague has to be notified to ail foreign Governments. A definite outbreak of patently infectious plague in the

London Docks would result in the placing of every ship from the Port of London in quarantine when it reached a foreign port. That would be merely the beginning ; and if the epidemic assumed a grave aspect, the trade of the Port of London would be paralyzed.

We need not dwell on further possibili-

ties of horror if plague developed in England as it has in Asia.

While the rat lives it is a threat to the lives and health of human beings. We have enjoyed immunity so long that we refuse to believe in the possibility. But the possibility is always there; and the only chance of abolishing it is the abolition of the rat.