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

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PLAGUE


PLAGUE

ITS CAUSE AND THE MANNER OF ITS EXTENSION—ITS MENACE—ITS CONTROL AND SUPPRESSION—ITS DIAGNOSIS AND TREATMENT

BY
THOMAS WRIGHT JACKSON, M.D.

MEMBER AMERICAN RED CROSS SANITARY COMMISSION TO SERBIA, 1915; LATELY CAPTAIN AND ASSISTANT SURGEON, U. S. VOLUNTEERS; LATELY LECTURER ON TROPICAL DISEASES, JEFFERSON MEDICAL COLLEGE; MEMBER OF MANILA MEDICAL SOCIETY AND PHILIPPINE ISLANDS MEDICAL ASSOCIATION; AUTHOR OF A TEXT BOOK ON TROPICAL MEDICINE; DIRECTOR, DEPARTMENT OF SANITATION AND EPIDEMIOLOGY FOR H. K. MULFORD COMPANY

WITH BACTERIOLOGIC OBSERVATIONS
BY
DR. OTTO SCHÖBL
BUREAU OF SCIENCE, MANILA

ILLUSTRATED

PRESS OF
J. B. LIPPINCOTT COMPANY


COPYRIGHT, 1916
BY THOMAS WRIGHT JACKSON, M.D.


THIS BOOK IS DEDICATED BY THE AUTHOR TO
DR. ALDO CASTELLANI

REGIUS PROFESSOR OF TROPICAL DISEASES, UNIVERSITY OF NAPLES. EMINENT IN MEDICAL RESEARCH, MY FRIEND, COLLEAGUE AND COMRADE DURING STRENUOUS DAYS IN SERBIA.


CONTENTS

page
Introduction11
CHAPTER I
Its History and Its Extension19
 History of Plague—The Widespread Dissemination of Plague in Recent Years—The Appearance of Plague in Porto Rico, New Orleans and Manila. 
CHAPTER II
The Cause and the Menace of Plague28
 Causation of the Disease and its Mode of Conveyance—Types of Plague—Chronic Plague and Immunity in Rats—Flea Conveyance of Plague Bacilli—The Stability of Virulence of Plague Bacilli—Summary of Facts Concerning the Cause and Manner of Extension of Plague. 
CHAPTER III
Its Control and Suppression40
 Plague Prevention by Extermination of Rats—General Uselessness of the Rat and Its Enormous Destructiveness, with Details of Trapping and Other Extermination Methods—The Manila Epidemic, 1912–1914—The First Cases—Unusual Character of Plague Cases at Quarantine—Clinical Description of Two Cases at Quarantine—Inauguration of the Manila Epidemic—Directed to Take Charge of Plague Suppression in Manila—Plague Fighting Organization—Method of Rat Proofing and Rat Destruction—Correspondence Between Dr. Jackson and Dr. Heiser, Director of Public Health—Observations on Fleas and Their Habits—Conditions of Habitations in Manila Favoring Rat Multiplication and Spread of Plague—Comparative Statistics on Methods of Catching Rats—The Natural Enemies of the Flea—Zoölogic Classification of Rats—A Collection of Notes Concerning Rat Runs, Rat Nests, Multiple House Infections and Other Data—Sample of Detailed Orders Issued Regarding Rat Extermination—Method of Procedure of Collecting and Forwarding Rats Suspected of Plague Infection to Laboratory—Memoranda in Plague Cases—Letter of Warning and Appeal for Coöperation—Bacteriologic Observations made During the Manila Plague Epidemic, by Dr. Otto Schöbl—Notes Concerning the Bubonic Plague in Hong Kong, by Dr. David Roberg. 
CHAPTER IV
Its Diagnosis and Treatment165
 Biologic Diagnosis—Necessity for Trained Bacteriologist—Bacteriologic Procedure—Non-Biologic Diagnosis—Symptomatology—Pathologic Considerations—Treatment, Conditions and Prognosis—Serum Treatment—Symptomatic Treatment—Statistical Studies in Mortality—Dosage and Technique of Serum Administration—Prophylactic Serum and Anaphylaxis—Plague Vaccines. 

ILLUSTRATIONS

page
Rat-Proof Structure48
Cleaning and Rat-Proofing in Basement69
Bamboo House Supports not Sealed with Cement86
Materials Must be Moved About in the Search for Rats93
A Rat-Infested Plague Interior95
Progressive Post-mortem Changes in Rat Cadavers105
Plague House116
Bamboo House Supports Sealed with Cement119
View of House Where Infected Rats Were Found120
Animal House144

PLAGUE

ITS CAUSE AND THE MANNER OF ITS EXTENSION—ITS MENACE—ITS CONTROL AND SUPPRESSION—ITS DIAGNOSIS AND TREATMENT


INTRODUCTION

The question of the need for new books upon medical topics must ever remain undecided, by general agreement, in the medical profession.

There is no such thing in medical literature as an insistent demand from the profession for new volumes upon old topics.

Authors need not hope, therefore, to create the impression that they are meeting long-felt though unexpressed wants of medical readers in launching new books.

On the other hand, the creator of a new volume upon an old subject should seek justification for literary paternity in the progressive changes in the status of our knowledge of disease, its causes, prevention, and cure. Such changes are admittedly going on with a certain degree of constancy and at such a rate of frequency that new presentations of old themes, are both justified and desirable from time to time.

With this idea in mind and with the desire to present, in useful and practical form, a work which shall contain at least some unhackneyed material and which shall represent modern studies and a record of actual control work done in this justly-dreaded disease, the following pages are submitted to the medical profession and to sanitarians generally.

With a profound respect for the laboratory worker and his work and with a profound conviction that to him belongs the greater measure of credit for real accomplishment in connection with plague up to the present time, I desire to insist that the true utility of knowledge gained within laboratory walls lies in its intelligent application in the outer world and that ofttimes this application must be made by men who are themselves without extended laboratory training. An appreciation of principles—with an intelligent ability to accept, to appropriate, to apply and, most of all, to refrain from entering without due preparation the domain of the laboratory worker—is an indispensable requisite in the equipment of the practical sanitarian, upon whom must fall the responsibilities of success or failure in combating the disease we are now to consider.

During the past fourteen years it has been my privilege to observe two epidemics of plague in the Philippine Islands. Some of these observations were made in the capacity of a military medical officer, but my later observations, upon which this report and study are chiefly based, were made from the view-point of a civil health officer. At different times I have been called upon to deal with the disease both as sanitary officer and clinician, and from October, 1912, to July, 1914, I had charge of all plague suppressive measures in Manila. In 1914 I was also in charge, as acting chief, of the San Lazaro Hospitals Division of the Bureau of Health, Manila, where all cases of plague are brought, either for treatment or autopsy.

As some of the material which I have collected for text-book articles during the past eight years bears directly upon the present discussion and presentation, I have ventured to quote from it, sometimes without rephrasing, such parts as are accurate at the present time. I am also quoting freely from the records and from the experiences of my predecessors and colleagues in the work in Manila.

It should be understood that the pathology of the disease has been practically omitted from consideration as out of place in an epidemiologic investigation and report. The pathologic side of the work during the Manila epidemic of 1912–1914 was covered in a masterly manner by Dr. B. C. Crowell and his associates at the Medical School of the University of the Philippines, and I have no doubt that the record of the work done and studies made will appear in appropriate form in due time and will hereafter be referred to as among the most valuable pathologic studies ever made during a plague epidemic, on account of their accuracy and completeness.

I have included, as of great value and directly related to the epidemiologic phase of this study, reports of some of the bacteriologic work done in connection with this epidemic at the Bureau of Science, Manila, by Dr. Otto Schöbl. I am sure that the value of his studies as reported in part here, with his permission, will be apparent to every careful reader. I am greatly indebted to him for his permission to make use of this portion of his studies. Having been in daily touch with Dr. Schöbl during the year and a half of the continuance of this epidemic, I can appreciate to the fullest extent the painstaking and accurate character of his work and findings, of which the part here presented is by no means the greatest.

I am quite aware of the fact that there are those who view with some question the practicability of controlling plague by the measures applied in Manila, as recited here; but American plague workers are likely to meet this unbelief by pointing to the accomplished fact, in San Francisco, in Honolulu, in Porto Rico, as well as in Manila; and before long, as we confidently expect, in New Orleans.

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