Plague (Bubonic Plague). Also known as plague death, pest and malignant adenitis, the characteristic of the disease being a general constitutional swelling of the glands throughout the body.
History. The disease has been known since time immemorial, but it is only lately that efficient measures for its prevention and a possibility of cure have been undertaken. It was known throughout Europe and Great Britain during the sixth century, it being estimated that in one century alone 161,000 people died in London. At a later epidemic, out of a population of 500,000, 68,000 deaths occurred from this disease. It is more prevalent in China, India and in the Philippines than in any other localities. Since 1894 it has been getting a strong foothold throughout China and the Eastern countries so that as late as 1903, 2,000,000 persons have perished in one province during an outbreak. At different times it has attained a temporary lodging place in Spain, Portugal and Scotland. In some of the Eastern countries it has also made its appearance and within ten years it got a foothold in San Francisco.
Causes. The disease is an epidemic infection caused by a bacillus known as bacillus pestus and its main characteristics are high fever, great prostration, tendency to bleeding from all parts of the body and the swellings throughout the body above spoken of. The disease is one of those which is markedly infectious but not contagious. By this we mean, the mere presence of a person in the room with one affected will not cause the disease to be contracted, but contact with that person, either through the discharges or more especially by insect bites, causes a large mortality. The disease is greatly favored by filth, in fact it is really a filth disease as the germs develop with great rapidity in dirt, poor food, overcrowding and similar media. It also increases rapidly in bad soils, may be conveyed in discharges and by about all vegetables, butter, milk and cheese. It is now known that many of the domestic animals, especially dogs and cats and rats, serve as the vehicles of contagion while the germ itself is carried to other animals and human beings through the medium ship of fleas, Flies, Mosquitoes and even lice. An interesting experiment which proves the method of conveyance, was used in Cairo in 1835 at which time two criminals were inoculated by plague blood and while both developed the disease, both recovered. Many physicians have contracted the disease through dissection wounds and surgical operations. The direct conveyance of the disease from man to man is possible though extremely rare compared with the many classes that occur through the bites of insects.
Prevention. When a case of the disease appears in any locality its extension takes place very slowly. If not completely eradicated at once, later on a few isolated cases will be discovered, and after a of one or more years the disease then spreads with alarming rapidity, usually among the poorer classes and later becoming epidemic with all classes. There are several varieties of the plague, the most common one being known as Bubonic plague, the septicamic plague which is a type of blood poisoning being more severe if possible than where the glands alone are affected. The third type recognized is the so-called pneumonic type in which the lungs seem to be affected more seriously than the rest of the body and death is usually the result of this type. A fourth one known as pestis minor occurs where either the resistance by the patient is very great, or in the conveyance of the germ its virulence has been attenuated so that the disease is simply strongly suspected. It is now thought possible that vaccination against the disease which is in line with the vaccine therapy and which has been so notable in smallpox, will reduce the mortality of plague to somewhere in the neighborhood of twenty or twenty five per cent, although before any of the recent measures were undertaken, the disease was usually mortal, at least eighty five or ninety per cent dying in its course. The method of prevention beyond this one of vaccination is, of course, a systematic system of prophylaxis. In India, for instance, they aim to limit the propagation of rats, which was the method employed by the commission to clean up San Francisco when the plague obtained its foothold there. The number of rat traps in India amounts to two per cent of the population according to Liston. The habits of the rat are studied and the carrying out of systematic rat trapping is very thorough. Next is the disinfection of clothing and all paraphernalia carried by travelers. Fleas which have left sickly rats are supposed to carry the infection to new localities through the medium ship of human beings. Cats are bred as one of the ready means of limiting the plague in addition to trapping the rat. Quarantine has never seemed an efficient check to the disease although this was one of the first measures taken, and now in addition to the extermination of rats and mice, hygienic measures are taken in regard to the sewerage, drinking water and dwellings. The protective measures above alluded to by vaccination may be again referred to report one unfortunate affair which has caused much antagonism in the Eastern countries. Because of its great success, many people had allowed the inoculation to be used, but after one incident when lockjaw developed in nineteen people and A died, practically all the good formerly obtained by the confidence in its use was vitiated, increasing the aversion of the natives, who in their ignorance could not understand the great good it would accomplish.
Symptoms. The disease shows itself in from two to ten days after exposure to some other being that is ill. The first symptoms start within one or two days, and in addition to dizziness, profound muscular weakness and pallor are accompanied with nausea, vomiting and diarrhea. Nose bleed often occurs, severe headache and occasionally chills. The fever rapidly becomes very high, even reaching to one hundred and seven degrees. At this stage, the disease appears like a serious type of typhoid fever that has been in existence two or three weeks, although all symptoms are very serious and out of proportion to the duration of the disease. Within two or three days the swellings throughout the body begin, those of the groin occurring in the majority of cases, those in the axilla or armpit in about half the cases and the neck and jaw in relatively few, the swellings or inflamed glands reaching a size from a pigeon's egg to that of a lemon. If the glands break down and discharge pus, the outlook is thought to be more favorable than though they remain hard until a local death or gangrene of the part has occurred. The disease, as will be noted, is one of great severity, quick onset, and if recovery is to take place the height of the disease has been reached within a week or so. This description is one of the more common type, the other being associated with more prostration possibly and a longer convalescence.
Treatment. Unfortunately, there is no remedy as yet discovered for a cure of this trouble. Nothing can be done except to ameliorate the symptoms. Cold sponging as would naturally be done in any continued fever, is of great comfort to the patient, purging is recommended by some and if this helps to check the vomiting, one good ~.as been accomplished, but as the cause of the disease is circulating in the blood, practically nothing is at our command except measures to support the strength and give sufficient nourishment to tide the patient through should his vitality enable him to overcome the disease, and then, as above noted, about eighty to ninety per cent of the cases will die. One observer in Hong Kong reported great success by the internal use of carbolic acid. This treatment would not be recommended except under the careful observation of a competent physician owing to the danger of carbolic acid poisoning, but as many cases seemingly were helped by its administration, Thompson considers this the most important contribution to the cures advocated that he had met. It may again be noted, therefore, that measures to prevent the occurrence of the disease, either by anti toxin injections for immunizing or the limitation of the methods of infection are the strongest weapons we have at present in fighting this dread disease.
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