CO129-275 - Governor Sir Robinson - 1897 [1-5] — Page 197

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In the year 1894, of those engaged in attendance on the sick, ouly three Japanese physicians, one Italian Sister, one male Chinese attendant, and one female Chinese attendant, were attacked; and of 300 English soldiers engaged in the disinfection of the infected houses, 10 only. In 1896, of 30 persons employed as nurses and attendants at the Kennedy Town Hospital, one English Sister was attacked, and three Chinese died, one of these latter being employed in the disinfection of the hospital clothing. Of those persons, about 120 in number, employed in inspecting and disinfecting the hon and in transporting patients and dead bodies to the hospital, three only died, one English police inspector, and two Chinese engaged in cleaning out the houses. Of the English soldiers employed in 1896 in disinfecting the houses, not one was attacked. It is clear from these facts that contact with patients suffering from plague and with the dead bodies of those that had died of the disease, was not dangerous, provided that care was taken to avoid becoming soiled by the evacuations of the patient, and always to disinfect the hands thoroughly. The conclusion is further to be drawn that the contagium of plague is not contained in the air, and therefore is not taken into the system by the lungs, for had this mode of infection been possible, a greater number of those in charge of the patients, and of those engaged in inspecting and disinfecting the houses, would necessarily have been attacked by the disease. Against the possibility of infection through the air must further be counted the fact that the bacillus does not survive dessication, and cannot therefore, in a living condition, enter the air in the

form of dust. I have myself, notwithstanding repeated attempts, never been able to detect the plague bacillus in the air. Further, the clinical and pathological facts of the disease are altogether opposed to the idea that the bacillus enters the body by way of the respiratory tract.

It is, however, certain, that either by carelessness on the part of those in direct contact with the sick, or by fomites, the contagium of the plague may be transferred from person to person, and taken up by the skin and by the alimentary tract.

As regards infection through the skin, two incontestible cases were observed in the epidemic of 1894. Two Japanese physicians were infected while making post-mortem examinations, and were attacked a few days later by plague. They had axillary buboes and lymphangitis of the arm, which spread upwards from the small inflamed wounds of the fingers.

In 1896, wounds were seldom met with on the limbs on which buboes had formed. Inflamed wounds were seen in two cases only, they were small; in one case on the hand and in one case on the upper arm, with ascending lymphangitis and buboes in the axillary fossa.

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the unbroken skin, and that when there are no visible wounds it very rarely gives rise to local Afectious of the skin; this view is in accordance with the results of experiments on animals, and with the cases that have been actually observed of infection following small wounds.

The plague bacillus appears to enter the body, most frequently by way of the alimentary tract. This view is substantiated by the results of experiments on animals, and by those cases in which, both during the occurrence of the disease and on the post-mortem table, the principal changes were found to be in the stomach, the mesenteric glands, and the other abdominal

Additional facts

organs.

in support of this view are that plague bacilli were commonly found in the faces, that in nearly all cases the intestinal follicles and the mesenteric glands were found to be swollen, and that the buboes did not usually develop until the most severe symptons of the disease had already set in. The de- velopment of buboes may perhaps in some cases be precipitated by a secondary infection with staphy- locci and streptococci. It was shown experimentally that plague bacilli lived for two days in a 1/2 per cent. solution of hydrochloric acid. We may assume, therefore, that the bacilli are not readily killed by the gastric juice. The plague bacilli must therefore make their way into the stomach by Researches instituted to throw light on this point showed that on boiled pork, so

means of the food. long as in did not undergo decomposition, plague bacilli remained alive for three days; ou salt fish (one of the principal articles of diet of the Chinese), for four days; on the damp peel and pulp of apples three or four days, on bananas and tomatoes for two to three days; and on the dried rind of turnips for one to two days. In distilled water, plague bacilli could be detected alive for twenty days; in tap-water and in well-water (200 cc. with half an agar culture), for sixteen days; in sea-water (200 cc, with half an agar culture), for six days. In the village of Yau-ma-ti, near Kowloon, in which in June the plague was widely prevalent, I succeeded in detecting the presence of the plague bacillus in one of the three wells from which the people drew their water. The infected well was situated at a very low level, so that the water filled it to the brim, and it was contaminated by the inflow of surface water from all sides. Further, many of the people washed their hands, feet and clothing in this well. The other two wells were situated on elevations, and wore less exposed to contamina- tion, because in the first place the surface water could not flow into them, and in the second place the water in the wells stood four yards below the brim. Though Chinese as a rule drink boiled water only, yet infection may readily take place by means of drinking and eating utensils and other articles washed in contaminated water.

The infection of the water of rivers and harbours by means of drains conveying the plague bacilli, My experience leads me to think that infection through the skin is not common; for, on the one

and by means of people living on junks, seems highly probable. In Hongkong, from January to hand, in the great majority of cases the buboes do not appear until three or four days after the onset

September, 1896, those dwelling on boats in the harbour suffered from plague in proportion to their numbers to the same extent as those living on shore. I was unable to detect the plague bacillus in of severe symptoms; and, on the other hand, were such a mode of infection common, we should expect to see much more frequently local affections of the skin, since the plague bacillus when injected into

the water of Hongkong harbour, which is subject to rapid renewal by strong tides. It is, however, In favour of

conceivable, that close to the shore, where the boats are often left dry by the ebb, and where the water animals usually causes intense inflamination with a hæmorrhagic gelatinous exudation the view that the contagium enters the system through the skin would appear at first sight to be the

stagnates in corners, centres of infection may here and there be set up by contamination with slop- fact that the greater number of buboes were situated in the inguinal region and occurred in bare

water from the land or by cases of plague in the boats themselves, and that from these centres those footed Chinese. But when we consider the cases of the European patients in 1894 and 1896, we

living on the boats may in turn suffer. Further, a large number of the Chinese junks take their water from a small stream about four yards wide, which flows through the Chinese village of Lai-Chi- find that in the majority of these also, though they did not go barefoot, there were buboes in the inguinal region. Besides, were infection through the skin the rule, axillary buboes should be just Kok, in the neighbourhood of Yau-ma-ti; this stream can very readily have been contaminated with the plague bacillus, for many cases of plague occurred in the village, and the inhabitants wash their as common as inguinal buboes, since the hands are at least as much exposed as the feet to contamina-

Of the 300 English soldiers]

elothing and all kinds of implements and utensils in the stream. tion with the contagium of the plague by contact with infected articles. that in 1894 were engaged in the disinfection of the houses, all of whom wore shoes and stockings, 10 were affected with plague, and nearly all of these had inguinal buboes, notwithstanding the fact that in clearing out the infected houses their hands came into contact with all kinds of filth. la 1896, there was attacked at the Kennedy Town Hospital a Chinese washerman, whose business it was to disinfect the bed-clothing and body-clothing of the patients, so that he daily handled infected articles, and this man had double inguinal buboes, but no axillary bubo. Two Chinese sick-room attendants at the hospital and oue Chinese that assisted in the disinfection of the houses, died of plague without the formation of any buboes at all. Among the persons (Chinese) employed in 1896 in the daily collection and transport of large numbers of the filthily clothed bodies of those that had died of plague, positively not one became affected with the disease. From all these facts the con- clusion may be drawn that the contagium of plague does not readily penetrate into the body through

It may be positively affirmed that the plague bacillus was not disseminated by the public water- supply of Hongkong, for Chinese and Europeans alike make use of this water, and among the latter there were only sixteen cases of plague.

In favour of the view that the plague bacillus is taken into the system by means of the food, is the fact that frequently in a house the members of one family only were attacked, while the other inha- bitants of the house remained free from the disease. Further, in China, food and fruits of all kinds are everywhere hawked and bought in the streets, especially among the poorer classes, and this practice, on account of the excessively filthy state of the markets and other places of sale, entails great danger of the diffusion of infectious disorders.