158 REVIEW — TBOPICAL MEDICINE, ETC. 



Plague— Sandwith' has a good account of plague in Egypt, but one need not quote the description 



coidiniml of clinical symptoms. The method of procedure for obtaining plague material for 

 bacteriological diagnosis recommended by the Egyptian Sanitary Department may, however, 

 be detailed. 



Tlie syringe together with the needle should be sterilised in boiling water, immediately before being used. 



The syringe should be placed in a recipient containing cold water in such a quantity as to allow the syringe 

 to be entirely covered with water. The water will then be heated to boiling point and kept boiling for tifteea 

 minutes. Should the piston of the syringe not fit well, the screw at the extremity of the piston rod should be 

 well tightened. It is necessary to ascertain that the syringe works properly before it is sterilised. 



Before the puncture is made the skin to be punctured should be first cleaned by rubbing it thoroughly with 

 soap and water and a piece of clean cotton wool. Then it should be rubbed with cotton wool wet with corrosive 

 sublimate (1 in 1000), and finally with cotton wool wet with pure alcohol. 



The liquid withdrawn into the syringe must be deposited on the surface of the agar by pressing the piston. 

 The operation should be carried out with great care in order to avoid contaminating the agar by other bacteria. 



The cotton wool plug of the tube of agar should never be touched with the hand, except on the end which 

 is outside the tube. 



The cotton wool plug should under no ciroumstanoes be placed on the table or on any other place. 



The tube before being put into the wooden box should be well wrapped round with cotton wool in order 

 to avoid its breaking during transport. These boxes should always be posted as ordinary letters and not as parcels. 



Immediately after use, the syringe should be sterilised again in the following manner : — 



Fill and refill the syringe several times with water withdrawn from the sterilising vessel : this must be 

 continued until no trace of blood or pus remain in the syringe. 



During the emptying of the syringe the needle opening must always be kept beneath the water, to avoid any 

 small drops of infected matter being by chance spread about. 



The syringe and needle are then placed in the sterilising vessel and the water heated to boiling point, and 

 kept boiling for fifteen minutes. 



The syringe is to be used only for puncturing suspicious cases of plague. 



Typhus fever, according to Sandwith, is the disease most liable to be confounded with 

 plague in Egypt. He gives at some length the instructions for disinfection issued by the 

 Egyptian Sanitary Department, whose success in controlling the spread of plague is 

 universally recognised. Whether this is due to these disinfection measures is, however, 

 I venture to think, a point which requires to be determined in the light of the work of the 

 Indian Plague Commission. 



Sandwith also deals with rat destruction and quarantine, giving the regulations in force 

 at Tor, on the Red Sea. 



A review in the Lancet of September 8th, 1906, of the special plague pamphlet issued by 

 the above Department may be quoted in full, as the conditions in the Sudan closely resemble 

 those obtaining in Egypt. 



The Director-General of the Public Health Department begins by reminding all officers that the same care 

 must be exercised in disinfection and the general management of isolated cases as in dealing with distinct 

 outbreaks. It is this individual care so far exercised in Egypt, which has chiefly contributed to the success of 

 anti-plague measures. Directly a living case of plague is discovered a police guard should be placed on the house, 

 and the disinfector and the head man of the quarter must be sent for. The probable source of infection should 

 be ascertained and a list ra.ade of all contacts, which includes the inhabitants of the house and the nearest 

 relatives. The patient must be removed to the infectious hospital or to a special building or temporary hut which 

 can be utilised as one. The contacts must be examined every day for ten days, and disinfected. If a disinfecting 

 station exists in the town, all clothes and .soft goods must be removed there ; if not, the clothes must be disinfected 

 with the premises. As soon as possible after the p.atient's arrival at the hospital, some serum should be withdrawn 

 from his bubo (or lung in the case of pneumonic plague) with all aseptic precautions ; the drop or two of serum 

 ejected on to agar must be sent to Cairo or Alexandria without delay. When the patient is already dead, the 

 specimen for bacteriological examination must be procured in the place where the body is lying, corrosive 

 sublimate (1 in 1000) is given for washing the corpse, and the shroud must be soaked in the same solution ; the 

 bier should be lined with zinc or tin and disinfected after use. It is very seldom found necessary to destroy 

 infected clothes, but they should be soaked in sublimate solution for 20 minutes and afterwards thoroughly dried 

 in the sunlight. In all cases of pneumonic plague the contacts must be kept strictly isolated for ten days. It has 

 been found that when concealment of cases is practised in the village a secret gratuity of one dollar for each 

 report of a fresh case of jjlague has an excellent effect. In the ease of a foreign subject, neither disinfection nor 

 removal to hospital can take place without previous consultation with the Consul concerned. When the 

 disinfection of a house is finished, all rat holes must be thoroughly opened up, a small quantity of carbolic 

 solution (1 in 10) poured into them, some broken glass placed so as to plug the bottom of the rat run, and held in 

 position by mortar, and the hole mortared up flush with the wall. All dead rats and mice found by the workmen 

 are put into a special paraflin tin and covered with carbolic acid. Rat poisoning is best carried out with 

 phosphorus paste concealed in tomatoes. I may here mention that phosphorus and arsenic are the poisons, 

 together with traps, found most useful in Japan. The number of rats killed in Tokyo since 1900 averages more 

 than 800,000 a year, and it is calculated that these dead rats, laid side by side, would extend for a distance of over 



' Sandwith, P. M. (London, 190,5), "The Medical Diseases of Egypt," Part I. 



