THE CONTROL OF PLAGUE 395 



has occurred in England and Wales a large diminution in the 

 mortality from most diseases of the infections class, and in the same 

 period typhus fever has declined almost to extinction. This latter 

 disease is that which, as regards the conditions under which it 

 becomes prevalent, most closely resembles plague. Wherefore it 

 may be confidently anticipated that the measures of sanitary 

 improvement, of isolation and .of disinfection, which have been 

 found effectual against indigenous disease such as typhus, will, if 

 promptly and thoroughly brought to bear, be equally effectual 

 against plague. 



First among measures requisite for control of plague is prompt 

 notification to the local authority of all cases of the disease 

 occurring in their district. As a rule, the first cases of an outbreak 

 will require bacteriological diagnosis in addition to or auxiliary to 

 clinical diagnosis. 



Secondly, in the event of plague being detected in any district, 

 the measures to be taken to prevent its spread are, generally 

 speaking, those which are available against the more ordinary 

 epidemic diseases. These measures include prompt removal of the 

 sick persons to hospital and their isolation therein ; the destruction 

 or thorough disinfection of all infected articles, with the effectual 

 disinfection also of the invaded dwelling-place ; the keeping under 

 observation during ten days after detection of each plague case all 

 persons who have been in contact with the patient ; house to house 

 visitation for the discovery of unreported or suspicious cases; the 

 abatement as speedily as possible of all insanitary conditions in the 

 locality which may tend to the spread of the disease ; and, in the 

 case of death, the prompt disposal of the body, with all due precau- 

 tions against its becoming a source of infection. 



Thirdly, an essential measure of precaution, in view of the 

 observed relation between plague in rats and plague in the human 

 subject, will be the prompt destruction of all rats in districts 

 threatened or invaded by plague, care being taken that their 

 carcases are collected and burnt without being unduly handled.* 



When treated in a well-appointed hospital, with plentiful fresh 

 air and proper attention to cleanliness and disinfection, plague, except 

 in its pneumonic and septicsemic forms, shows but small infective 

 power ; and that therefore doctors and nurses in attendance on the 

 sick run but little risk of contracting the disease. Nevertheless, these 

 and other persons brought into close relation with plague may be 

 afforded protection against infection by submitting themselves to 

 protective inoculation ten days before contact with plague cases. 



* Danysz has suggested the killing of rats by infecting them with an organism 

 fatal to them, Brit. Mnl. Jour., 1904, vol. i., p. 947. 



