August 24, 191 1] 



NATURE 



249 



it will be an admirable companion, and even the 

 resident of many years' standing cannot fail to find 

 explanation of much that he has not understood 

 before, and have his attention directed to many things 

 which he had previously failed to notice. 



PLAGUE IN ENGLAND. 1 

 T'HE recent appearance of plague in East Suffolk 



*■ forms the subject of some valuable reports and 

 papers recently issued by the medical department of 

 the Local Government Board. The reports are divided 

 into three sections, each of which deals with the 

 plague from different aspects. The first section con- 

 tains the late Dr. Bulstrode's "report upon the 

 occurrence, in the autumn of 1910, of four deaths at 

 Freston, near Ipswich, from a rapidly fatal and in- 

 fectious malady diagnosed as pneumonic plague, and 

 upon the prevalence of plague in rodents in Suffolk 

 and Essex." It also includes his report upon two 

 localised outbreaks of disease in East Suffolk in 

 1909-10 and 1900-7, which may have been instances of 

 bubonic and pneumonic plague respectively." The 

 second section records the results of an inquiry by 

 Drs. Martin and Roland, in the months of November 

 and December, 1910, into rat plague in East Anglia, 

 with special reference to the fleas infesting rodents; 

 and the third section gives a report by Drs. Petrie and 

 Macalister "upon the examination of rats collected 

 in Suffolk and Essex for plague-infection between 

 January 16 and February 14, 191 1." 



The information in the volume, though not sufficient 

 to fix the exact origin of the Freston outbreak, cr 

 the avenues by which the other two outbreaks spread, 

 is nevertheless very complete so far as the facts could 

 be traced. The great loss which the medical depart- 

 ment of the Local Government Board has sustained 

 by the death of Dr. Bulstrode is impressed upon one 

 when perusing his able report on the investigations 

 which he made on the plague. Like all his former 

 work, it is characterised by care, thoroughness, and 

 good judgment. 



It appears that between September 16 and Septem- 

 ber 29 there occurred in a four-roomed cottage in 

 Freston three deaths. Daughter, mother, and father 

 in a family of six succumbed to an obscure lung 

 affection after a few days' illness. In a cottage a 

 quarter of a mile away there also died on September 

 29 a woman with the same symptoms. She had 

 nursed the mother, and had evidently caught the 

 infection from her. The main features of the illness 

 were the obscurity of the lung symptoms, the dark- 

 stained expectoration, the high temperature, the great 

 prostration, and the rapidly fatal issue in about three 

 days without any corresponding serious physical signs 

 to account for it. In three out of the four cases 

 vomiting and purging were present. The anomalous 

 character of the symptoms, the nature of which 

 puzzled the medical men attending the cases, led to a 

 bacteriological examination being made by Dr. 

 Heath, the honorary bacteriologist to the Ipswich and 

 East Suffolk Hospital, who found in the specimens 

 and cultures a bacillus corresponding in its reaction 

 and appearance with those of the plague bacillus. 

 The illness was then recognised as pneumonic plague, 

 which is well known for its infectivity and fatality. 



No direct evidence could be obtained as to the 

 manner in which the daughter, a child of seven years 

 of age, who was first attacked, had become infected, 

 but the inquiry as to the source of infection led to 

 the important discovery that an epizootic affecting 



1 Reports and Papers on Suspected Cases of Human Plague in East 

 Suffolk and on an Epizootic of Plague in Rodents. Reports to the Local 

 Government Board on Public Health and Medical Subjects. New Series 

 No. 52. (19"-) 



NO. 2l82, VOL. 87 j 



rats and hares was prevailing in the district. Bacterio- 

 logical examination of a number of rats, hares, a 

 cat, and a ferret showed them to be plague-infected, 

 and accordingly afforded opportunities for human in- 

 fection. There was evidence also that the epizootic 

 among rats extended so far back as 190b. In that 

 year a large number of dead rats had been observed 

 at Shottley and its neighbourhood, about four miles 

 distant from Freston. it was here that a sudden and 

 fatal illness had occurred in December, 1906, in a 

 poor family, and had extended to those who nursed 

 the sick. Eight persons were attacked with what 

 appeared at the time to be a virulent form of influenza, 

 and six of these died after three to four days' illness. 



Another outbreak of a puzzling character occurred 

 in December, 1909, and January, 1910, at Frimlev, 

 on the north bank of the Orwell, and almost opposite 

 Shottley. It was in a two-roomed cottage occupied 

 by a family of seven in poor circumstances. The 

 whole of the family was successively attacked by an 

 illness unfamiliar to the medical men, and in some 

 cases associated with glandular enlargements. Four 

 of the family died and three recovered. One of the 

 family went to stay with a friend for a few days, and 

 subsequently the child of the friend was fatally at- 

 tacked with similar symptoms. Dr. Bulstrode con- 

 cludes from his investigation of the Frimley outbreak 

 that, "although there are, from lack of full informa- 

 tion, many lacuna in the story, the balance of evidence 

 certainly seems in favour of a view that the malady 

 was bubonic and septicemic plague." 



It is an instructive story, and shows that in Eng- 

 land as in other countries plague can be overlooked 

 both in human beings and in the lower animals. It 

 is evident that the infection of plague has existed in 

 this part of the country for the past four years, intro- 

 duced probably by infected rats in grain ships arriving 

 from infected ports. 



Drs. Petrie and Macalister's work is valuable in 

 demonstrating that out of 6071 rats examined from 

 the districts immediately surrounding those proved to 

 be infected, all were of the Mus decumanus variety, 

 and none were found to be infected with plague. It 

 is to be hoped that the Government will continue this 

 good work in the autumn and in the coming years, 

 for it by no means follows that the rat plague-infec- 

 tions which, as has been shown by Drs. Martin and 

 Roland, occur in pockets, have been all discovered, 

 even with this large number of examinations. 



The investigations of Drs. Martin and Roland have 

 demonstrated some interesting facts relative to the rat- 

 flea population. It appears that the rat-flea of India, 

 Xcnopsylla cheopis, could not be found on any of the 

 rats examined ; that more than 50 per cent, of the rat- 

 fleas in East Suffolk consisted of the Ctenophthalmus 

 agyrtes, which evidently does not bite men, and that 

 the remainder of the rat-flea population is composed 

 of Ceratophyllus fasciatus, which bites man, but not 

 so readily as does Xcnopsylla cheopis. These facts 

 are cheering so far as they go, as it is estimated that 

 on an average there is less than half a man-biting 

 flea for a rat. It would be reassuring if it were proved 

 that the flea was the only method by which human 

 plague spreads, and if the history of the three out- 

 breaks pointed in that direction. Unfortunately, two 

 of them appear to have been of the pneumonic variety, 

 and the third septicajmic and bubonic in character. 

 The evidence so far scarcely lends itself to the view 

 that the comparative freedom of the rat from man- 

 biting fleas will secure safety from plague in Eng- 

 land. Dr. Newsholme recognises the dangers from 

 this aspect of the question, and the warning given by 

 him and the late Dr. Bulstrode as to the necessity 

 for vigilance is timely and none too strong. The 



