by 

1900

The Plague

WHAT IS THE PLAGUE?

The Plague, also known as Bubonic Plague, Black Plague or The Black Death, is a serious infection caused by a bacterial strain called Yersinia pestis (Y.pestis, formerly called Pasteurella pestis). This bacterium is found in animals throughout the world and is usually transmitted to humans through fleas, most often from rats. The risk of plague is highest in areas that have poor sanitation, overcrowding, and a large population of rodents.

There are three forms of the disease-Bubonic, Septicemic and Pneumonic. One may lead to another.

Bubonic Plague is the most common form infection, it is usually contracted when an infected rodent or flea bites you. In very rare cases, you can get the bacteria from material that has come into contact with an infected person. Bubonic plague infects a person’s lymphatic system (a part of the immune system), causing inflammation in the lymph nodes. Untreated, it can move into the bloodstream (causing septicemic plague) or to the lungs (causing pneumonic plague).

Bubonic plague develops into septicemic plague when bacteria enter the bloodstream directly and multiply there. When left untreated, both bubonic and pneumonic plague can lead to septicemic plague.

Pneumonic plague develops when the bacteria spreads to or first infects the lungs. It is the most lethal form of the disease. When someone with pneumonic plague coughs, the bacteria from their lungs are expelled into the air. People who breathe that air in may also develop this highly contagious form of the disease. This can lead to an epidemic. Pneumonic plague is the only form of plague that can be transmitted from person to person.

A SHORT HISTORY OF PLAGUE

References to plague are found in the Old Testament. A story in 1 Samuel recounts how the Philistines, having captured the Ark of the Lord from the Israelites, experienced an outbreak of ‘tumours’ (Hebrew ophal). The affliction followed them as they moved the Ark from city to city, leading the Philistines to conclude that the Ark was responsible for this disaster. The leaders decided to return it to the Israelites along with a guilt offering of five golden tumours and five golden rodents (akbar).

The plague may also have been a major factor in the fall of the Roman Empire, the last days of which were marked by a dreadful series of calamities during the reign of Justini­an (sixth century A.D.). During this period there was a succession of earthquakes and volcanic eruptions (e.g. Vesuvius, A.D. 513), famines and pestilence, which wrought terror and destruction throughout all of Europe, the Middle East and Asia for more than sixty years. 

The great plague of Justini­an’s time began in Egypt in A.D. 540, and according to Procopius, 

“it spread over the entire earth and it spared no habitations of men… Four months the plague remained in Byzantium… there were 10,000 deaths a day. All business ceased. Craftsmen deserted their crafts. Most people met in the streets were carrying a corpse…. Farms fell into decay, the animals wandered untended… and the vine withered on the ground.. . Finally, when there was a scarcity of grave-diggers, the roofs were taken off the towers of the forts, the interiors filled with the corpses, and the roofs replaced. …Ships were filled with corpses and let drift to sea without crews.”

In a matter of sixty to seventy years “…a considerable part of the known world was devastated by the disease. Cities and villages were abandoned, agriculture stopped and famine, panic and the flight of large populations away from the infected places threw the entire Roman world into confusion” (Hans Zinsser, 1935). This particular pandemic of plague lasted around two hundred years and then seemed to disappear.

About A.D. 1330 the pestilence appeared in the interior of Asia and spread along the caravan trading routes to India, to Crimea and Constantinople, to Mesopotamia, Arabia, Egypt and southern Europe. It reached the Lowlands, Germany and England in 1349, and within two years had spread throughout Europe and Asia. 
Much of this epidemic was the pneumonic form of the disease, which was almost invariably fatal. In Florence in 1348 more than 100,000 people perished and similar desolation occurred in other major European cities. The pestilence even spread as far as Greenland. 

In his Decameron (1353) Boccaccio gave a dramatic account of the plague in Italy: 

“The condition of the people was pitiable to behold… they sickened by the thousand daily and died unattended and unsuccoured. Many died in the open streets; others dying in their houses made it known that they were dead by the stench of their rotting bodies. Consecrated ground did not suffice for the vast multitude of bodies which were heaped by the hundred in vast trenches like goods aboard ship and covered with a little earth.”

At Avignon in France, the Pope consecrated the River Rhine so that bodies could be cast into it. Ships without crews drifted helplessly in the North Sea and the Mediterranean and spread the infection when driven ashore.

The whole of Europe was demoralized. Jews were accused of poisoning the wells and many thousands were burned alive. Fields were left untilled and flocks and herds wandered at large. Religious fanatics, the Flagellants, went about the countryside scourging themselves with whips for their sins, which they believed had brought such punishment upon mankind.

By some estimates about one quarter of the entire population of Europe was destroyed by the disease-an estimate of at least 25 million people. This state of affairs led some cities, notably those in the Republic of Ragusa on the eastern shore of the Adriatic, to enforce the isolation of any travellers or visitors to the city for a period of thirty days in a suitable place well out of town. This isolation period was known as the “trentina”. When it appeared that thirty days was not enough, the delay was increased to forty days, the quarantenaria”. This is the origin of the term “quarantine”.

At the end of the 19th century a third pandemic of plague flared in the Chinese province of Yunnan, spreading via Canton to Hong Kong. From China the infection spread to Bombay, Osaka and Formosa.

At this time scientists began to take notice of  the presence of an epizootic in rats, ie. an outbreak of the disease in the rat population which preceded the appearance of the disease in man. 

The plague bacillus itself was discovered independently by a Japanese researcher, Kitasato Shibasaburō, a pupil of pioneering bacteriologist Robert Koch, and by Frenchman Alexandre Yersin, a pupil of Louis Pasteur, in the Hong Kong epidemic of 1894. Originally called Pasteurella pestis, the pathogen was renamed Yersinia pestis, after Alexandre. 

In 1897, Dr. Waldemar Mordecai Haffkine, a Jewish Ukrainian scientist working for the Pasteur Institute in Bombay (Mumbai), developed the first anti-plague serum. That same year an International Conference was held in Venice, and Masanori Ogata of Japan suggested that suctorial insects might possibly act as vectors between rat and man. The following year, Paul-Louis Simond of France reported his observations on the role of fleas.

By 1898 the infection had reached Madagascar and Jeddah. 1899 saw the disease spread through the Malay States, the Philippines, Japan, New Caledonia, the Sandwich Islands, San Francisco, South American ports, Lisbon, Alexandria, the Red Sea ports, the French Ivory Coast, the Persian Gulf and Mauritius.

Even before it arrived in Australia authorities were aware of its pandemic potential. They also recognised the significance of the association of epidemic and epizootic, which was also recognized by sanitary officers in the Far East and India. The declaration of Noumea as plague infected in December, 1897 resulted in the adoption of intensive rat destruction measures on vessels arriving in Sydney from that port. 

Plague finally hit Australian shores in 1900.

PLAGUE IN AUSTRALIA

On 19th January 1900 a carman regularly employed in carrying goods from the city warehouses in Sydney to Central Wharf, fell ill with a disease subsequently found to be the bubonic form of plague.

With the role of the flea in the transmission of the disease reported by Ogata and Simmond, the observations of the latter were noted by Ashburton Thompson in his 1900 Plague Report as having provided a guide for the epidemiological and laboratory investigation of the first appearance of plague in Australia.

This early recognition by the authorities of the factors concerned in the transmission of plague and the enthusiasm of the sanitary officers throughout Australia, led to a general confirmation and extension of knowledge during the series of outbreaks between 1900-1909.

The actual source of the diseases entry into Australia was never accurately determined, although the danger of its arriving had been present since May 1894, when the plague reached the seaport of Hong Kong. In 1899 Mauritius, Japan, Honolulu and New Caledonia had all become infected. In Thompson’s view the disease was introduced by infected rats who passed the disease on to the local rats, but from which port and on which ship there is no evidence. The first four human cases were infected within a small area around the wharves but at the time there were no measures available to prevent rats leaving overseas ships when they tied up at Sydney ports.

Between January and August 1900, 303 cases of plague were reported in New South Wales with a mortality rate of 30 per cent. These cases were treated at the North Head Quarantine Station, to which thirteen of the Coast Hospital’s most experienced nurses were sent for nursing duty, together with four ambulance drivers. This staff remained at the Quarantine Station for eight months.

A second wave of plague started in January, 1902 and lasted six months. In this outbreak 139 cases were notified of whom thirty-nine died. Cases of plague continued to occur each year until 1909 after which time the disease disappeared entirely from New South Wales until 1921.

The Quarantine Act, which came into force on 1st July 1909, transferred quarantine services from a State to a Commonwealth responsibility, and required the use of effective rat guards and other measures to stop the transfer of rats from ships to wharfs. It also specified the destruction of rats on board ships and made the disease compulsorily notifiable.

As a point of interest, plague as seen in Sydney was the bubonic form and only on two occasions did the pneumonic form occur. In Sydney in June 1906 a seaman contracted pneumonic plague, followed by his wife and a neighbour. This dread form of the disease is caused by the inhalation of infected droplets which occurs when a victim of pneumonic plague coughs into the faces of those in attendance. 

At Maryborough in Queensland, seven children of a poor family contracted the septicaemic form of the disease and of these five died with secondary pneumonia. A neighbour in attendance and two hospital nurses contracted pneumonic plague from the children and also died.

Leading up to the 1921 outbreak there were multiple instances of plague infection, particularly in the Far East. Manchuria, which had a catastrophic epidemic of pneumonic plague in 1910, suffered another outbreak in 1920-1. This spread to Vladivostok in 1921. The infection eventually reached Java, which had 8,000 to 9,000 cases. In Hong Kong and the Chinese ports, it was endemic, flaring into maximum activity in the months of June and July, so that these months preceded the time of maximum risk in Australia. 

The first warning that the disease was once again on Australian shores came when a man in Brisbane died from an illness which later proved to be plague. This death occurred on 23rd August 1921. The victim worked in a produce store, and plague-infected rats were subsequently found in the premises next door. The source was traced back to S.S. Wyreema, which, having traveled from North Queensland via Brisbane, arrived in Sydney in September. Plague-infected rats were found in the hold. A human case in Sydney occurred on 29th November and the epidemic continued until June 1922. 

In all, there were thirty-five plague victims in the 1921 outbreak, of whom ten died. Thirty of these people were admitted to the Coast Hospital, where they were given Haffkine’s anti-plague serum. There were four cases of septicaemic plague, but none recorded of the pneumonic form of the disease. 

In both outbreaks, 1900-9 and 1921-2, the disease was limited almost entirely to seaports and river towns with large-scale trade with seaports, further proving the necessity of controlling rats to prevent the importation of the pathogen from overseas.

MODERN MEDICAL TREATMENT FOR PLAGUE

The discovery and development of antibiotics has all but eliminated plague from most western countries. Antibiotic treatment has proved highly effective against plague bacteria, so early diagnosis and early treatment saves lives.

 

Patients suspected to be infected with Y.pestis, are admitted to hospital and receive powerful antibiotics, such as: Gentamicin, Doxycycline (Monodox, Vibramycin), Ciprofloxacin (Cipro), Levofloxacin, Moxifloxacin (Avelox) and Chloramphenicol. This suspected of having the Pneumonic strain are placed in isolation and managed with barrier nursing.

Between 2010 and 2015 there were 3,248 cases reported worldwide, including 584 deaths.

Currently, the three countries where Bubonic Plague is most endemic are the Democratic Republic of the Congo, Madagascar, and Peru.