HISTORY AND EPIDEMIOLOGY 



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be found in a sacred Hindu book, the ' Bhagavat Purana,' believed to be 

 800 years old, which describes a disease in man associated with death among 

 rats, and advises the vacation of a house in which dead rats are found. Plague 

 is known to have formed epidemics in the eleventh, twelfth, fourteenth, 

 fifteenth, sixteenth, and seventeenth centuries, after which, apparently, it 

 disappeared, only to reappear in Gu jurat and Sindh in 181 2. In 1823 it was 

 discovered that plague existed in the districts of Garhwal and Kumaon, but no 

 one has been able to determine from whence it came, or how long it had existed 

 in those places. It is now said to be endemic there, and to form the focus for 

 the epidemic of Delhi in 1825, and Rohilcund in 1836. In 1836 plague broke 

 out in Rajputana — the so-called Pali Plague, from the place first infected — 

 and lasted two years. Since then plague has been introduced into India from 

 China, and has spread therein, as will be explained later. With regard to 

 China, it is difficult to obtain any exact information, but it is possible that 

 plague may have been introduced at some time by Mohammedans returning 

 from Mecca via Burma to the province of Yunnan, where, according to Mina- 

 kata, it was known some time between 1736 and 1809, for a Chinese author 

 who lived during this period gives an account of a disease which caused death 

 in men and rats. From that time plague has been endemic in Yunnan, from 

 which it appears to have spread southwards, reaching Pakhoi, on the southern 

 coast, about 1867, where it disappears and reappears at intervals without 

 apparently affecting other regions, until 1894, when, after an absence of ten 

 years, it again reappears, and, infecting the district of Kaochao, spreads via 

 Canton to Hong-Kong. In June, 1894, the causative bacillus was discovered 

 by Kitasato in cases in Hong-Kong, and a little later by Yersin in the same 

 town. In 1896 plague spread from China to Bombay, from which it has 

 gradually extended over the larger portion of India, causing an enormous 

 number of deaths. 



In 1897 a most important international conference was held at Venice, 

 when protective measures were agreed to, and regulations framed to combat 

 the disease, based upon the view that the sick person and his personal effects 

 were the chief source of danger, and a quarantine of ten days from the last 

 infected port was placed upon healthy ships. In 1898 the pandemic spread 

 from India to Madagascar, and from there to Lorenzo Marquez and Mauritius. 

 In 1899 it affected the Malay States, the Philippine Islands, New Caledonia, 

 the Sandwich Islands, Australia, San Francisco, New York, Asun9ion, Rosario, 

 Buenos Ayres, Rio de Janeiro, Oporto, Lisbon, and Alexandria. In 1900 

 it passed from Rosario to Cape Town, and also appeared in Glasgow. 



In 1900 Clemow pointed out that the disease had existed endemically in 

 Mongolia, Southern China, the Himalayas, Mesopotamia, Persia, Arabia, 

 Uganda, Transbaikalia, Russian Central Asia, and Tripoli, between 1850 and 

 1894. 



In 1903 a Second International Conference v/as held in Paris, which issued 

 a series of regulations confirming those of the Venetian Conference, except 

 that the quarantine of ships was reduced to five days, and that the agency of 

 the rat in the disease was clearly recognized, and regulations for its destruction 

 framed. Further, this Conference established an International Sanitary 

 Office in Paris for the purpose of collecting and transmitting sanitary informa- 

 tion to the different countries. In 1904 Johannesburg was attacked, in 1905 

 Persia and Russia, in 1906 Leigh, and in 1907 Accra, on the Gold Coast, in 

 which year the disease was widespread throughout the world, occurring in 

 India, Persia,* Arabia, Egypt, Tunisia, Algeria, West Africa, South Africa, 

 East Africa, Russia, Glasgow, Argentina, Brazil, Chili, Paraguay, Peru, Uru- 

 guay, United States, Australia, New Zealand, Japan, China, and Indo-China. 



Turning to Africa, which has already been mentioned to have been often 

 infected, it is now known to possess two infected endemic areas — viz., Ben- 

 ghazi, in Tripoli, and Buddu, Koki, and Nkole, in Uganda, from the latter of 

 which an epidemic is supposed to have spread into the Kissiba district of 

 East Africa. 



Such a pandemic as the one just described could hardly exist without 

 numerous careful inquiries into its causation and spread, for Governments 



