Plague / Its Cause and the Manner of its Extension, Its Menace, Its Control and Suppression, Its Diagnosis and Treatment

by Thomas Wright Jackson

Beginning April 7, 1912, the temperature of all members of the crew and of the passengers that arrived in vessels from foreign ports was taken with a view to detecting any possible cases of plague.

On the arrival of the steamship Taisang from Amoy at the Mariveles Quarantine Station at about 6.30 A.M. on April 30, 1912, the entire personnel was carefully examined and found free from sickness of a suspicious nature and from elevations of temperature. Seventy-three persons were detained to serve a quarantine detention of seven days. On the evening of April 30, a Chinese passenger, aged fifty-one years, was found to have a temperature of 39° C. with a pulse of 100. He was placed in the hospital, but protested vehemently that he was not sick. He was carefully watched from the first; there was a slight cough; physical examination of the chest revealed a few râles; smears made of the sputum and stained for plague bacilli were negative. On the fifth day, the fever still persisted, but the patient stated that he did not feel ill and demanded to be released from the hospital. On this day, the expectoration was blood-stained, but no suspicious organisms could be found in the smears nor could any physical signs of pneumonia be detected. Furthermore, there were no palpable glands. On the morning of the seventh day, the temperature and pulse dropped and the general condition was distinctly worse. The patient now admitted that he felt ill. Several hours later, he flinched when pressure was made in the right axilla. Lymphatic enlargement was now made out, and by the evening of the seventh day the bubo in the axilla had increased markedly in size, the swelling approximating 3 by 7 centimetres. Glands now became palpable in other portions of the body, particularly in the cervical region, and a few hours later there were inguinal and femoral buboes. The patient became rapidly worse, and died at 7 o'clock on the morning of the eighth day of his illness. At the necropsy, the glands of the right axilla and those of the right side of the neck were found enlarged; the other lymphatic glands were also enlarged, but to a lesser degree. There was consolidation of the lower lobe of the right lung, and the spleen was about twice its normal size. In brief, the necropsy findings of a typical case of septicæmic plague were present. Smears from the spleen and the right axillary gland showed immense numbers of bipolar-staining organisms. Cultures made from fresh pieces of tissues and later inoculated into animals gave positive results for plague.

Beginning of the Manila Epidemic.—Proceeding with the Manila epidemic inaugurated with the two cases referred to as recorded in June, 1912, we find that the total number of cases recorded from the time of the outbreak in 1912 until the last case in 1914 was 90. (This includes none of the imported cases from China which developed en route to Manila from Chinese ports.)

Of these 90 human cases, 76 were fatal and autopsies were performed in all instances. Fourteen persons recovered. The number of cases of animal plague up to July, 1914, was 53. This refers only to laboratory-proven cases of rat plague. As a matter of fact, hundreds of dead rats, almost certainly plague rats, were found in the course of rat-proofing operations.

Although the period covered by this epidemic approximates two years, it must not be supposed that the progress and extension of the epidemic was an uninterrupted or unobstructed one.

On the contrary, such extension as occurred was made in spite of the most active suppressive effort, and it is believed that this effort brought about a creditable result, as indicated by the accompanying record.

When one considers the favorable conditions for the natural spread of plague, both in Manila and throughout the Philippine Islands, and realizes the interposed difficulties and obstructions, natural and unnatural, geographic, human and domestic, which confront us at every turn of the path to correction, removal and reformation, our success in checking the spread of plague appears as a real achievement, especially when contrasted with the results of effort during the same period in a British city of similar size but a few days' sail from Manila, where the cases were numbered by thousands and where the infection still persists.

First Manila Cases.—The first case of plague (June 12, 1912) occurred in a resident of Tondo, 920 Calle Antonio Rivera, and in the light of subsequent developments it may perhaps be grouped with the October cases traced to the Manila Railway Company's freight station and yard, as 920 Calle Antonio Rivera is but a stone's throw from the Manila Railway property. The connection, however, is not clear, and, on the other hand, it is not wholly inconceivable that the rat epidemic and human plague cases at the railway station in October may have been secondary to this June case. Such speculation is fruitless, however, so far as establishing facts is concerned.

The second case of human plague occurred 13 days later, June 25, in a resident of a district somewhat removed from the first case, but in the same general section of the city.

Then came a lull of more than a month, until August 4, during which time no case of plague occurred; or at least none was reported.