Contract of a Plague Doctor. A Plague Doctor Plague Victims.
THE PLAGUE
1
316 THE PLAGUE.-THE WAR. and solicit custom at private houses, and, if this were the case, much of the petty theft that is carried on systema- tically in London would be suppressed. It is satisfactory to notice that the general conduct of the men during the year has been exceedingly good. The Common Lodging. houses Act continues to be worked satisfactorily by the police, and the registered houses are increasing in number and improving in condition ; notwithstanding the preva- lence of small-.p(,x in the metropolis last year, the number of cases of infectious and contagious disease removed from the lodging-house is comparatively small. The report, as far as the police themselves are concerned, is highly satis- factory, but the condition of things it reveals and the little progress that has been made in combating crime and drunkenness, are greatly to be deplored. THE PLAGUE. NOTWITHSTANDING the momentous issues of the war now in progress, the appearance and continued prevalence of plague on the confiaes of Europe have engaged the anxious attention of the two belligerent powers, and there is reason to believe of others of the great continental powers also. Partly from interruption of communication with the seat of the disease in the East, and partly from the pre-ocoupation of news-writers with the events of the war, it has been diffi. cult to gather a connected account of the course of plague in the tract of country lying between the southern coast of the Caspian and the head of the Persian Gulf during the present year. Information recently received permits us now, however, to give an approximately accurate history of the disease from its cessation in Mesopotamia in the summer of 1876 to the present time. In 1875-76 plague underwent so great a development in Mesopotamia as to give rise to the gravest anxiety with re- gard to the future progress of the malady should it re- appear in the present year. Not only did it show itself with undiminiehed fatality over a greater area of country than at any time since the beginning of the outbreak in 1873, but, passing the south-eastern frontier of the country, it invaded Persia, causing a fatal outbreak at Shuster and in the district surrounding that town. The history of the outbreak in Mesopotamia to the beginning of 1876 has been given in detail in an official memorandum by Mr. Netten Radcliffe on the recent progress of Levantine Plague, pub- lished in the report of the Medical Officer of the Local Government Board for 1875; and we may express here a hope, in the interest of epidemiology, that the subsequent history will be given officially in like detail. For the re- appearance of plague, after its apparent extinction, is unquestionably the most remarkable epidemiological phenomenon which has occurred in the present genera- tion. The loss of life from plague in Mesopotamia in 1875 76 has been variously estimated. The fact ap- pears to be that a general estimate must be the merest guess-work. Any certain knowledge of the extent of prevalence and mortality from the disease was of neces- sity, from the small number of the Ottoman sanitary staff in the province, confined to a few of the principal centres of population. In Bagdad over three thousand deaths are stated to have been recorded, in Hillah and the neigh- bouring villages twice this number. Hardly a village and town lying between the Tigris on the east and the border of the Great Syrian desert on the west, and Bagdad on the north and the junction of the Shat-el-Hai with the Euphrates on the south, escaped the disease. The Ottoman sanitary department in Bagdad put down the total loss of life within this tract of country at a minimum of 20.000-a reasonable estimate, as would seem, if the disease were as fatal in other centres of population as in Bagdad and Hillah. The greater diffusiveness of the disease in 1875 76, together with its having, for the first time since its re-appearance in 1873, shown itself at Bagdad, gave rise to the fear that should plague break out again this year it might exhibit itself in still more formidable proportions. This fear has been in part realised. Plague broke out again in Mesopotamia early in the year, and it would appear to have prevailed more or less in all the locali- ties in which it had shown itself the previous year. But within this area of prevalence it does not Reem to have been either as diffusive or as fatal as in 1876. Bagdad again suffered, but the total loss of life from plague there is set down at little more than one-half that which occurred the previous year. Indeed, the information that we have as to ’his year’s outbreak in Mesopotamia would lead to the inference that the outbreak there is becoming exhausted, and but for the appearance of the disease on the borders of the Caspian, danger to surrounding countries and to Europe from this source might be looked upon for the moment M very remote, if not at an end. The appearance, however, of plague at Rpsbt and in other parts of the province of Gbilan wholly forbids so pleasant an assumption, and proves that the danger of a reappearance of plague in Europe is more imminent than had previously been conceived. Whether the outbreak of plague in Ghilan is an offshoot of the outbreak in Mesopotamia or not, the informati ’n at present accessible does not show. In Con- stantinople the disease is believed to have been carried to Reaht from the banks of the Tigris, and from Resht dis. seminated in Ghilan. Upon what evidence this belief in the Mesopotamian origin of the disease in that province rests we do not know. It is now certain that plague was first recognised in Resht in May, and that from that time to the present it has never been absent from the town and sur- rounding district. Just as in the early history of the malady during its recent outbreak in Mesopotamia, so also here, while presenting all its characteristic symptoms and proving very fatal, the disease has not to the present shown much diffusiveness. In Ghilan, however, the disease mani- fests no disposition to die out with the setting in of hot weather, as in Mesopotamia, and it appears as if it would continue gradually to increase in prevalence throughout the year. No returns seem to have been published of the numbers of cases and deaths which have occurred even in Resht, and it is probable that there is much concealment of the actual facts of the case. Russia is profoundly alarmed for the safety of the Caucasus and of Astracan ; indeed, it has been already rumoured that cases of plague had oc- curred in the district adjacent to Biku. Intercourse between the last-named port and the port of Astracan and Enzelli has been stopped, and sanitary cordons have been placedon the routes from Gbilan into Transcaucasia, Moreover, a Russian medical commission has been sent to Resht to investigate the disease and its movements, and to aid the Persian Government, if this be possible, in arresting its prevalence. Turkey has, moreover, through its General Board of Health, been giving much attention to the subject, but obviously, in the present state of affairs in Armenia, it cannot protect itself or help, even in appearance, to protect others. By the withdrawal of the regular troops from the province of Bagdad, and from the present disturbed state of the Kurdish frontier, even the quasi precaution of putting in force quarantine on the Persian frontier cannot well be adopted. THE WAR. RIGHTLY to understand the admirable design and arrange- ments for the drafting of the Russian wounded as rapidly as possible into the interior of the empire, and so relieving the hospitals at the front, the present distribution of the wounded who have been thus drafted should be studied on the map. The Journal de St. Petersbourg for the 18th August quotes from the Medical Gazette a return which shows that at that time 1329 wounded had been distributed in hospitals in the following cities and towns in the num. bers stated:-Kiev 150, Voronege 135, Ore! 170, Kursk 115, Kharkov 115, Rovno 90, Neijinol54, Moscow 400. Since this return was made the sanitary train of the Princess Eugpnie Maximilianovna has carried 262 sick and wounded to Kiev, of whom 21 have been placed at Bykovetz, 52 at Rakbay, and the remainder in the Kiev hospitals. The Russian Red Cross S ’ciety has published a report of the various articles which have been despatched from its central dep6t to the army. These include 69 000 bandages, compresses, &c., for surgical dressing, 36,000 articles of
Transcript of THE PLAGUE
316 THE PLAGUE.-THE WAR.
and solicit custom at private houses, and, if this were thecase, much of the petty theft that is carried on systema-tically in London would be suppressed. It is satisfactoryto notice that the general conduct of the men during theyear has been exceedingly good. The Common Lodging.houses Act continues to be worked satisfactorily by thepolice, and the registered houses are increasing in numberand improving in condition ; notwithstanding the preva-lence of small-.p(,x in the metropolis last year, the numberof cases of infectious and contagious disease removed fromthe lodging-house is comparatively small. The report, asfar as the police themselves are concerned, is highly satis-factory, but the condition of things it reveals and the littleprogress that has been made in combating crime anddrunkenness, are greatly to be deplored.
THE PLAGUE.
NOTWITHSTANDING the momentous issues of the war nowin progress, the appearance and continued prevalence ofplague on the confiaes of Europe have engaged the anxiousattention of the two belligerent powers, and there is reasonto believe of others of the great continental powers also.Partly from interruption of communication with the seat ofthe disease in the East, and partly from the pre-ocoupationof news-writers with the events of the war, it has been diffi.cult to gather a connected account of the course of plaguein the tract of country lying between the southern coast ofthe Caspian and the head of the Persian Gulf during thepresent year. Information recently received permits usnow, however, to give an approximately accurate history ofthe disease from its cessation in Mesopotamia in the summerof 1876 to the present time.
In 1875-76 plague underwent so great a development inMesopotamia as to give rise to the gravest anxiety with re-gard to the future progress of the malady should it re-appear in the present year. Not only did it show itselfwith undiminiehed fatality over a greater area of countrythan at any time since the beginning of the outbreak in1873, but, passing the south-eastern frontier of the country,it invaded Persia, causing a fatal outbreak at Shuster andin the district surrounding that town. The history of theoutbreak in Mesopotamia to the beginning of 1876 has beengiven in detail in an official memorandum by Mr. NettenRadcliffe on the recent progress of Levantine Plague, pub-lished in the report of the Medical Officer of the LocalGovernment Board for 1875; and we may express here ahope, in the interest of epidemiology, that the subsequenthistory will be given officially in like detail. For the re-
appearance of plague, after its apparent extinction, is
unquestionably the most remarkable epidemiologicalphenomenon which has occurred in the present genera-tion. The loss of life from plague in Mesopotamiain 1875 76 has been variously estimated. The fact ap-pears to be that a general estimate must be themerest guess-work. Any certain knowledge of the extentof prevalence and mortality from the disease was of neces-sity, from the small number of the Ottoman sanitary staffin the province, confined to a few of the principal centresof population. In Bagdad over three thousand deathsare stated to have been recorded, in Hillah and the neigh-bouring villages twice this number. Hardly a village andtown lying between the Tigris on the east and the borderof the Great Syrian desert on the west, and Bagdad onthe north and the junction of the Shat-el-Hai withthe Euphrates on the south, escaped the disease. TheOttoman sanitary department in Bagdad put down thetotal loss of life within this tract of country at a
minimum of 20.000-a reasonable estimate, as would seem,if the disease were as fatal in other centres of populationas in Bagdad and Hillah. The greater diffusiveness of thedisease in 1875 76, together with its having, for the firsttime since its re-appearance in 1873, shown itself at Bagdad,gave rise to the fear that should plague break out againthis year it might exhibit itself in still more formidableproportions. This fear has been in part realised. Plaguebroke out again in Mesopotamia early in the year, and itwould appear to have prevailed more or less in all the locali-
ties in which it had shown itself the previous year. Butwithin this area of prevalence it does not Reem to have beeneither as diffusive or as fatal as in 1876. Bagdad againsuffered, but the total loss of life from plague there is setdown at little more than one-half that which occurred theprevious year. Indeed, the information that we have as to’his year’s outbreak in Mesopotamia would lead to theinference that the outbreak there is becoming exhausted,and but for the appearance of the disease on the borders ofthe Caspian, danger to surrounding countries and to Europefrom this source might be looked upon for the moment Mvery remote, if not at an end.The appearance, however, of plague at Rpsbt and in other
parts of the province of Gbilan wholly forbids so pleasant anassumption, and proves that the danger of a reappearanceof plague in Europe is more imminent than had previouslybeen conceived. Whether the outbreak of plague in Ghilanis an offshoot of the outbreak in Mesopotamia or not, theinformati ’n at present accessible does not show. In Con-stantinople the disease is believed to have been carried toReaht from the banks of the Tigris, and from Resht dis.seminated in Ghilan. Upon what evidence this belief in theMesopotamian origin of the disease in that province restswe do not know. It is now certain that plague was firstrecognised in Resht in May, and that from that time to thepresent it has never been absent from the town and sur-rounding district. Just as in the early history of themalady during its recent outbreak in Mesopotamia, so alsohere, while presenting all its characteristic symptoms andproving very fatal, the disease has not to the present shownmuch diffusiveness. In Ghilan, however, the disease mani-fests no disposition to die out with the setting in of hotweather, as in Mesopotamia, and it appears as if it wouldcontinue gradually to increase in prevalence throughout theyear. No returns seem to have been published of thenumbers of cases and deaths which have occurred even inResht, and it is probable that there is much concealment ofthe actual facts of the case. Russia is profoundly alarmedfor the safety of the Caucasus and of Astracan ; indeed,it has been already rumoured that cases of plague had oc-curred in the district adjacent to Biku. Intercourse betweenthe last-named port and the port of Astracan and Enzellihas been stopped, and sanitary cordons have been placedon theroutes from Gbilan into Transcaucasia, Moreover, a Russianmedical commission has been sent to Resht to investigatethe disease and its movements, and to aid the PersianGovernment, if this be possible, in arresting its prevalence.Turkey has, moreover, through its General Board of Health,been giving much attention to the subject, but obviously, inthe present state of affairs in Armenia, it cannot protectitself or help, even in appearance, to protect others. Bythe withdrawal of the regular troops from the province ofBagdad, and from the present disturbed state of the Kurdishfrontier, even the quasi precaution of putting in forcequarantine on the Persian frontier cannot well be adopted.
THE WAR.
RIGHTLY to understand the admirable design and arrange-ments for the drafting of the Russian wounded as rapidlyas possible into the interior of the empire, and so relievingthe hospitals at the front, the present distribution of thewounded who have been thus drafted should be studied onthe map. The Journal de St. Petersbourg for the 18th
August quotes from the Medical Gazette a return whichshows that at that time 1329 wounded had been distributedin hospitals in the following cities and towns in the num.bers stated:-Kiev 150, Voronege 135, Ore! 170, Kursk 115,Kharkov 115, Rovno 90, Neijinol54, Moscow 400. Sincethis return was made the sanitary train of the Princess
Eugpnie Maximilianovna has carried 262 sick and woundedto Kiev, of whom 21 have been placed at Bykovetz, 52 atRakbay, and the remainder in the Kiev hospitals.The Russian Red Cross S ’ciety has published a report
of the various articles which have been despatched from itscentral dep6t to the army. These include 69 000 bandages,compresses, &c., for surgical dressing, 36,000 articles of
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