i 7 2 MEDICINE 



Reginald Farrar's account, from personal observation, of this Manchurian plague; they 

 contain also the discussion on his paper. He gives the evidence of plague occurring 

 among the marmots. 



"The first human victims claimed were probably trappers who hunt and trap this animal 

 for the sake of its fur. After an explosive outbreak in Manchu-li, the frontier town of 

 Siberia and Manchuria, and in Harbin, it was rapidly carried south along the railway and 

 the roads by the hordes of Chinese coolies from Shantung, who migrate every year into 

 Manchuria for the soya-bean harvest, and return home to worship their ancestors at the 

 Chinese New Year. . . . The difficulties of sanitary administration were enormously 

 enhanced by international diplomatic complications. The virulence of the infection was 

 such that in many instances whole families and large households were mown down by the 

 disease; and its fatality so appalling that out of more than 40,000 cases only three recoveries 

 are claimed. . . . None dared give shelter to a stricken patient, and the sick were 

 often thrust out into the streets to die. Tho^e who died were often hidden under the roofs 

 of their houses, or in other places of concealment. Burial was impossible, for the temperature 

 of Manchuria in winter is often 40 below zero, and the ground is frozen hard to a depth of 

 more than 3 feet. 



"... When, however, we come to consider in cold blood the actual extent of this 

 epidemic, we are surprised to note that its real proportions were, in fact, relatively small; 

 we find that it was brought under control with comparative ease, despite the complete 

 absence at the moment of its outbreak of an organised sanitary service in China; and the 

 limitation of the epidemic rather than its extension is found to be the factor that requires 

 explanation." 



Dr. Farrar is of opinion that the limitation of the epidemic was due to the absence 

 of rat infection, and to sanitary administrative measures. 



In Suffolk, in the autumn of 1910, four cases of pneumonic plague suddenly occurred 

 in one household; see the paper by Dr. Brown and Dr. Sleigh, Brit. Med. Journ., 

 November 12, 1910. The bacillus pestis was found in two of them, and there seems no 

 reason to doubt that they were typical cases of the disease. A memorandum was 

 accordingly issued by the Local Government Board, giving instructions as to the danger 

 of rat infection. It will be remembered that small outbreaks of the disease, during the 

 last twelve years, have occurred in more than one of the chief British ports. 



Polio-myelitis, Epidemic. Polio-myelitis (infantile paralysis) accounts for a very 

 large proportion of the inmates of Cripples' Homes; and cases of it come daily to the 

 out-patient departments of the great Hospitals. Yet, in Great Britain, the fact has only 

 lately received general recognition, that infantile paralysis, like epidemic meningitis, 

 must be reckoned among the infective diseases. In Great Britain it never attains to the 

 ways of a great epidemic disease; but in other countries America, Australia, Norway 

 and Sweden it reveals, by the severity of its epidemics, the sure signs of infection from 

 child to child. Indeed, there are instances of the utmost infectivity, e.g. during an 

 epidemic of 200 cases in a town in Nebraska, July 1909. " Numerous families had 

 several children, all of whom were attacked by the disease: thus, in one family of six 

 children, all were affected; in another family of six, four cases occurred; in a family of 

 five, four cases occurred; and in a family of four, all were attacked. Some of the cases 

 illustrate the infectivity of the disease. Thus, a woman went with her child to the 

 wedding of a sister, in whose house a younger sister was ill with the disease. The 

 mother with the child returned home, and nine days later one of her own children showed 

 symptons of paralysis. In an adjoining house there lived a family of six children, all of 

 whom developed the disease. A woman who came to visit this family brought her 

 baby; in four days it died of the disease." (Seidler, Journ. Amer. Med. Ass., Jan. 22, 

 1910). 



For a short historical review of some of these epidemics, see Dr. Batten's paper on 

 " The Epidemiology of Polio-myelitis," Proc. Roy. Soc. Med., June 1911. For a minute 

 study of the clinical and pathological aspects of the disease, see the monograph by Drs. 

 Peabody, Draper, and Rochez, A Clinical Study of Acute Polio-myelitis (Rockefeller 

 Institute, New York, June 1911.) Finally, we have the Huxley Lecture, given by Dr. 

 Flexner, in November 1912, at Charing Cross Hospital. It is to him, more than to any 

 man, that we owe our present knowledge of the nature of epidemic polio-myelitis. From 

 his laborious and successful study of epidemic meningitis, he advanced straight to this 



