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29
BUBONIC PLAGUE.
Considerable alarm was caused in August owing to the occurrence at Glasgow of cases
of bubonic plague—a disease which was last epidemic in England in 1665 (the year preceding
the Great Fire of London) and of which a graphic account is contained in De Foe's
" History of the Plague," a work probably based on contemporary records. Plague is a highly
infectious fever closely resembling typhus in its symptoms, but distinguishable from it by the
absence of any true rash, and by the development of buboes and carbuncles. Due to a specific
organism, bacillus pestis, it affects chiefly the poor, is eminently contagious, and spreads rapidly
under the conditions of privation, filth, and overcrowding, characteristic of slum areas. The
infection may be conveyed by breath, by fomites, and by inoculation. Rats have been credited
(and not without reason) with a large share in the transmission of the infective matter.
The presumption is that the disease was introduced to Glasgow by shipping, but the
source of the original case or cases was not traced. The first known cases were of a child and
her grandmother who died after short illnesses on 7th and 9th August respectively, the cause
of death, as certified, being, in the child's case, zymotic enteritis; in the woman s case, acute,
gastro-enteritis. Wakes were held over both bodies, and to this cause the spread of infection
was attributed. The woman was buried 11th August. Next day the husband, a dock labourer, fell
ill, having apparently contracted the disease from his wife or his grandchild. He was admitted
to hospital on August 28th. Prior to this, however, four members of another family had fallen
ill—on the 19th, 20th, 22nd and 23rd August respectively. The first of these cases was
medically attended ten minutes only before death, which was attributed to acute pneumonia.
It chanced that the other three patients were seen, independently, by two medical men, who, on
comparing notes, recognised that they had to do with an infectious disease of an unusual kind,
and in order to secure admittance of the sufferers to hospital, notified the illnesses as "enteric
fever?" The cases were admitted 25th August; the characteristic buboes were observed;
microscopic and bacteriological examination of blood from them was made, the bacillus pestis
was isolated, and plague was diagnosed.
All the subsequent cases were removed to hospital, and persons who had been present at
the wakes, or had otherwise been brought into contact with the sick ("contacts" these are
called) were placed in "reception houses," and kept under observation. A few of these
persons subsequently developed plague, the cases for the most part being of a fairly mild type.
None of the medical men or nurses were attacked, they (and the "contacts" also) having been
inoculated with anti-plague serum obtained from the Pasteur Institute at Paris. Happily the
disease did not spread widely, and, thanks to the energy with which the emergency was met,
the disease did not become epidemic. Needless to say, the Glasgow authorities took every
possible precaution with the view to prevent spread of the malady. The insanitary area in
which the first known cases occurred received special attention, and efforts were made to
exterminate rats in the infected houses, though no evidence was forthcoming to show that they
were affected.
Plague has an incubatory period (i.e., the time between exposure to infection and
development of illness) of about four to fourteen days. The onset of illness is sudden, the
earlier and more prominent symptoms being shivering, general malaise, hot and dry skin,
quick pulse, sighing breathing, headache, nausea and vomiting, diarrhoea, pain in the abdomen,
tongue furred in the centre, clean at edges, etc. The fever, as before stated, is of the type
observed in typhus. Prostration comes on rapidly, and is great. The face is of a greyish
colour, the aspect dull and anxious; and there is stupor with delirium, proportional to the
gravity of the attack. These symptoms are not necessarily all present in every case, and they
vary in degree in different cases: the most characteristic, and that which gives name to the
disease, is the presence of swellings of the lymphatic glands—of the neck, arm-pit, groins, etc.—
"buboes." These buboes vary in size. Always more or less tender, they are in many cases
exquisitely painful and intensely inflamed. Death may ensue within a day or two. Usually
the fatal result happens at a later period. In severe cases that recover there is a crisis on the
12th to the 20th day of disease, marked by fall in temperature and pulse, diminution of local
pain and headache; the patient " feels much better."
Precautions in London.—The Local Government Board, in the exercise of the powers
given to them by the Public Health (London) Act, 1891, added plague to the list of
notifiable diseases; and in conformity with the requirement of their Order, dated September
19th, circular letters were sent by the late Vestry to all legally qualified medical practitioners in
Kensington, informing them of their duties under the regulations comprised in the said Order.
The Board, moreover, issued an advisory circular letter to the sanitary authorities (9th October),
together with "Memoranda with respect to Plague," comprising—
(a) Plague Memorandum, (1) Administrative Considerations, (2) Symptoms of Plague.
(b) Directions for obtaining and forwarding for Bacterioscopic examination Material
from Suspected Plague Cases.
(c) General Memorandum on the Proceedings which are advisable in Places attacked or
threatened by Epidemic Disease.