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(3) The man attacked was in the steward's department; the connection
between him and rat flea is through the community of interest of patient and
rat in the food available.
(4) The rat infection probably began in Calcutta, and was disturbed and
driven up on deck at Buenos Ayres and in London.
(5) The clinical aspect of the whole case formed the guide to action,
and the bacteriological certainty obtained was, of necessity from its
difficulties, behind the time for the prompt action required by the case and
taken by your Deputy Medical Officer.
The circumstances were fully notified to the Ministry of Health.
The s.s. "Nauoya" arrived in London on Saturday, 25th October, 1919,
midday, from Yokohama via Kobe, Shanghai, Hongkong, Singapore, Penang,
Colombo, Port Said, Marseilles, Gibraltar and Plymouth. The ship left Yokohama
on the 30th August, and Marseilles on October 17th.
On visiting the ship on her arrival, your Boarding Medical Offcer, Dr. Kidd, found
that a death and cases of Influenza which were reported were in fact Plague.
The passengers on board numbered 165. In addition 53 passengers had landed
at Plymouth. The lists of addresses were scrutinised and the passengers disembarked.
Conditions and history: —
Cases.—(1) Fakeer Massajee Kasab was taken ill on the 21st October and
died on the 23rd He presented only Fever without glandular enlargement.
He was buried at sea.
(2) Kassim Mesial, Lascar assistant to Case 1, aged 15, was taken ill on
the 22nd a.m. His history and condition showed Fever, malaise, a slight
gland (bubo) in the left femoral region, excessive vomiting and delirium He
was moribund on the ship, and died on landing into Denton Plospital. Your
Medical Officer examined the bubo forthwith and found in stained films abundant
microscopic evidence of Plague. The diagnosis was confirmed bv the Ministry
of Health.
(3) Fakeer Nala, 38, Lascar 111 on the 22nd October, presented Fever
and malaise, with a large right femoral bubo. This man died suddenly on the
14th November.
(4) Abdul Ismail, 18, Lascar, was ill on the 23rd October. He now
presented a deep left inguinal tenderness. On suppuration the Plague bacillus
was demonstrated.
(5) Alle Omer, 56, fireman, was ill on the 25th with Fever and malaise.
This man appeared cachectic. It is possible he has not suffered from Plague.
(6) Ismail Abram, Lascar, had a temperature of 103 on the 22nd October,
and was normal on the 24th, his symptoms being those of simple Fever and
malaise.
Cases 2, 3, 4, 5 and 6 were removed to hospital on October 25th.
(7) On Sunday, 26th, I saw Hassim Eloy, 30, Lascar, on the ship. He
had been taken ill that morning. He presented a collapse temperature of
96 deg., and an extreme tenderness in the right femoral region with slight
swelling This man was removed to hospital forthwith and died on Tuesday
the 27th. The diagnosis was confirmed microscopically.
(8) Hassim Kassim, Lascar, an eighth case, was taken to Hospital on the
27th, and proved a mild case.
Where the diagnosis of Plague is not evident (Cases 5 and 6), the fact that these
cases, 1 to 6, were grouped originally as an Influenza epidemic warranted the
supposition that all had suffered from the same disease. Case No. 5 can possibly
be put in another category, in that he was berthed entirely apart from the Lascars
who form the remainder of the cases, and on his appearance of chronic weakness.
As in every Infectious Disease, however, in Plague quite mild cases occur.
History of Eats and Rat Mortality.—Enquiry elicited the following facts:—
On the outward voyage from London, on the 23rd June, before Aden was
reached, cabin floors in the 'tween deck accommodation were being moved in order
to find the source of effluvia. Dead rats were found. The upper 'tween decks in the
holds are converted throughout into passenger accommodation. The deck is planked
on battening deep enough to harbour rats between the temporary wooden and iron
decks.