1432 



PLAGUE 



and dealing with information on a large scale, and to which will 

 be attached bacteriologists, who will carry out the necessary 

 bacteriological examinations and prepare prophylactics; and a 

 Port Sanitary Branch, for investigating and disinfecting ships. 



It is as well, if possible, to limit the communication with infected 

 areas to as few ports as possible, and to provide isolation hospitals 

 for the sick and for the healthy coming from infected areas. The 

 length of quarantine is fixed at present at five days, but this appears 

 to be too short, if the findings of the Indian Commission with regard 

 to fleas are considered. 



Attempts can be made to prevent the disease crossing land 

 frontiers by the medical inspection of persons coming by rail, road, 

 or river, but this method of prophylaxis is liable at any time to 

 break down. 



It would appear most necessary to disinfect the clothing and 

 persons of all people coming from infected areas, as they may carry 

 fleas, and this is most diflicult to effect; but it is not so difficult to 

 disinfect merchandise by the Clayton apparatus. 



In addition, rats must be caught regularly in places situated in 

 danger zones, and inspected to see if any are becoming diseased, 

 for the epizootic begins before the epidemic as a rule. 



But of all things the most difficult, as well as the most important, 

 appears to be the recognition of early cases, and pneumonia, buboes, 

 and sudden deaths must be regarded with the greatest suspicion. 



When an epidemic begins there are two periods, as Simpson points 

 out, at which the populace takes fright, and has to be firmly handled: 

 one at the beginning, and the second when the deaths begin to 

 increase rapidly in number. Riots and assassinations of magistrates, 

 medical officers, and inspectors may occur, and must be foreseen. 



As diagnosis is so difficult at first, a house-to-house inspection 

 by competent medical officers will be necessary to find out the 

 number of cases, and in no instance must a body be allowed to be 

 buried without being viewed by a medical officer. If this is not 

 done, it will be impossible to gauge the extent of the disease. 



Rats must, of course, be regularly and systematically examined, 

 and their mortality curves constructed. The sick must be isolated, 

 and the persons and clothing of contacts disinfected to kill the fleas. 

 Every infected house must be disinfected by filling the adjoining 

 houses with the gas from a Clayton apparatus, and after this the 

 house itself. If this method is not carried out, the rats will simply 

 pass from the infected to the non-infected houses, and spread the 

 plague. Village houses might be burnt, which is cheaper and a 

 fairly effective method, though, of course, measures should be taken 

 to prevent the rats escaping. The gas in question is generated by 

 burning sulphur at a very high temperature in a special apparatus, 

 when SO2 and SO3 and some unknown gases are evolved, which are 

 passed into the ship, house, warehouse, etc., and drawn through by 

 an exhaust-pipe until a 3 per cent, mixture of gas and air comes out, 

 when the exhaust is stopped, and gas passed in until 10 to 12 per cent. 



