;oo 



NA TURE 



[January 29, 1903 



the aid of a host of official documents, and partly from 

 numerous other publications. To procure, sift, digest 

 and arrange this enormous mass of polyglot literature is 

 a task as complex as it is difficult, and, looking through 

 the present volume, the reader will agree that Dr. Low 

 has done a difficult piece of work in an exhaustive 

 manner. The usefulness of such a work to the sani- 

 tarians of the world must be obvious. Dr. Low, in a 

 clear and systematic and at the same time objective 

 manner, describes the progress and general character of 

 plague as it appeared in and as it affected the various 

 countries during the period stated (middle of 1S98 — 

 middle of 1901); to this are added the official regulations 

 and procedures in use in the different countries in dealing 

 with plague. 



As might be expected, the first place is given to 

 England, Wales and Scotland ; there being no case of 

 plague recorded in Ireland, Dr. Low passes on to other 

 European countries in which cases of plague have 

 occurred, and then takes his readers into Turkey, the 

 Levant, Arabia, South and Central Al ica, India, the 

 Far East, Australia and New Zealand, and finally 

 America. As to the cases of plague that had been 

 imported into England and Wales, it is satisfactory to 

 learn from Dr. Low's account that the vigilance of, and 

 procedures adopted by, our port sanitary officers were on 

 the whole unremitting and thoroughly efficient ; that 

 whenever the case required it, the Local Government 

 Board by its medical inspectors promptly and energeti- 

 cally assisted'the port sanitary and local authorities in 

 devising and carrying out the necessary protective and 

 prophylactic measures. As a matter of fact, practically 

 all the cases of plague that reached our shores were 

 promptly intercepted and dealt with, and no further 

 spread of the disease occurred. 



Of no mean interest and importance are the facts 

 collected by Dr. Low as to the relation of plague in the 

 rat to plague in the human subject, and we cannot do 

 better than quote here the concise summary on the 

 subject by the Medical Officer of the Local Government 

 Board (p. x). 



"The records to which Dr. Low has had access, 

 though they go to confirm belief that as regards plague 

 man and the rat arc reciprocally infective, fail completely 

 in affording sufficient data for determining the degree to 

 which man is in danger through the rat. So far as 

 plague ashore is concerned, it would appear that in 

 particular localities man and the rat suffered from plague 

 coincidently ; that in other localities man suffered before 

 the rat ; and that in others again the rat suffered antece- 

 dently to man. Further, it would appear that when in 

 a particular district the one (man or the rat) has suffered 

 plague antecedently to the other, the interval between 

 invasion of the first and of the second species has been 

 often a long one — extending sometimes over weeks and 

 months. Finally, it would appear that plague may 

 prevail largely among men without rats becoming con- 

 spicuously affected ; and conversely that the disease may 

 cause large mortality among rats of a locality while 

 neglecting to attack its human inhabitants. As regards 

 plague on shipboard, very similar facts were forthcoming. 

 The disease does not, under conditions of sea transit, 

 appear to be at all readily conveyed from the rat to man 

 or from man to the rat. On the one hand, ships plague- 

 invaded for several weeks in the persons of crew or 

 passengers have come into port with the rats on board 

 them seemingly altogether exempt from disease ; and on 

 the other hand, ships infected with plague-smitten rats 

 have, after voyages of considerable duration, arrived at 

 their destinations wholly free from plague as regards 

 crew and passengers." 



There is, then, no cause for the extreme views which 

 some alarmists have put forward, i.e. those who would 

 wish us to prevent any ship coming from an infecled 



NO. 1735. V0L - 6 7] 



country from landing or discharging cargo unless pre- 

 viously all rats on board were destroyed, even in cases 

 where no disease occurred amongst the crew or pas- 

 sengers. Such a procedure would, in the face of Dr. 

 Low's array of facts, be quite unnecessary, and would 

 inflict on shipping in general hardships which experience 

 has shown would be scarcely justified even in the case of 

 ships which on their voyage had actually been infected 

 with plague. 



(From the detailed account by Dr. Tidswell of the 

 characters, origin and progress of the plague in Sydney, 1 

 it appears that the outbreak in man was preceded by 

 great mortality amongst rats from plague, and, further, 

 that the progress of the epidemic amongst human beings 

 in different parts of the town was consistent with the 

 dissemination of the contagion by rats.) 



There is one further important point to be noted in the 

 account by Dr. Low, and that is the comparatively simple 

 and comprehensive manner in which plague-stricken or 

 plague-suspected vessels arriving on our shores are dealt 

 with, and the complete success which so far has attended 

 the procedures both as to passengers and crew and 

 cargo. These procedures contrast in a most favourable 

 way with some of the doings in similar circumstances 

 of the authorities in some other countries, in which 

 countries machinery is put in action the chief object of 

 which appears to be the most vexatious treatment of 

 harmless passengers {vide s.s. Niger, Marseilles, p. 117). 



The description of the epidemic of plague in Oporto- 

 in 1899 is very instructive reading, and throws into 

 strong relief the broad fact, observed also in Glasgow 

 (1900), in Alexandria, Bombay, the Cape and other 

 places, how difficult, nay, impossible, it is to trace in 

 these epidemics the origin of the outbreaks, the manner 

 and channels in which the contagium had found entrance, 

 and the lapse of considerable and most valuable periods 

 before the disease as such is actually recognised. In 

 these respects, England and Wales have so far been 

 most fortunate in the Local Government Board having 

 everywhere, in our seaports as well as inland, the atten- 

 tion of Medical Officers of Health early, and especially, 

 directed to the danger of importation and to the best 

 means to lessen it and to deal with any case should such 

 occur. It is a fact that, in a good many instances, 

 Medical Officers of Health have with laudable prompti- 

 tude carefully taken account even of cases which from 

 their clinical and epidemiological characters were not 

 considered as cases of plague, but because they bore in 

 one respect or another a resemblance to plague were 

 notified and subjected to further examination. As was 

 to be expected, these cases were proved not to have been 

 cases of bubonic plague. On the other hand, the 

 necessity for noting all such cases lies in this, that there 

 are atypical cases of real plague which in clinical 

 respects have only a distant resemblance to that disease ; 

 such atypical cases of plague could, under less strict 

 supervision, easily escape detection and be the starting 

 point for dissemination of the disease. 



A point of extreme interest to western countries is the 

 comparison between the epidemics in the oriental, from 

 which the present pandemic of plague started (1894), and 

 the occidental countries into which it was imported and 

 disseminated. The result of this comparison is highly 

 gratifying, since it shows the very much lesser virulence 

 of the disease in the occidental than in the oriental 

 countries. The Medical Officer thus summarises these 

 important facts (p. viii) : — 



-There can be no question at all as to plague having 

 very especially affected certain Oriental populations ; 

 outside the Asiatic continent, the disease has manifested 

 small ability to become seriously epidemic. For instance, 

 in India, plague, while year after year producing a heavy 



1 "Some Practical Aspects of the Plague at Sydney," by Dr. Frank 

 Tid-well (Journalai the Sanitary Institute, \ol. xxi. part iv.\ 



