Report on the outbreak of plague at Sydney [1900-1907] / by J. Ashburton Thompson, Chief Medical Officer of the Government and President of the Board of Health.
- New South Wales. Department of Public Health
- Date:
- 1900-1908
Licence: In copyright
Credit: Report on the outbreak of plague at Sydney [1900-1907] / by J. Ashburton Thompson, Chief Medical Officer of the Government and President of the Board of Health. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![•were then shod, and, the season having heen winter, were otherwise fully clothed. Case K(d), having heen excepted in view of remarks made in a foot-note to Table III, it is difficult to see how the skin of the lower extremity could have heen brought into casual contact with deposited infection in the cases in which femoral buboes were exhibited {Of. Report, 1902, pars. 262-70.) 29. A suggestion has been made that the infection may, perhaps, be commonly received by way of the stomach, through the eating of food that has been contaminated by the excreta or by the secretions of plague-rats. It is perhaps worth while, therefore, to refer specially to the 9 jjersons who were infected at their places of employment, and to point out that workmen carry their dinner with them in parcels, in which it remains until eaten. It cannot be reasonably assumed that the food of these 9 j^atients had ever been exposed to infection, although it may have been eaten in an infected place. 30. The foregoing details (pars. 20-9) comprise not merely what was learned of each case, but all that was learned. They are complete in essential respects, and they provide a conspectus of the epidemiology of plague, although as the number of cases was but 3 2 no safe induction could be framed with them. They do not stand alone, however. The conclusions to which they point can be tested by refer- ence to the 303 cases of the outbreak of 1900, to the 139 cases of the outbreak of 1902, and to the two cases of 1903 ; and when this has been done, it is seen that the phenomena recorded in ] 904 agreed precisely with those recorded in former years. That this was so as regards the more important points is shown in the following paragraphs. 31. In the first place, the question whether these 12 patients owed their infection to cases which had preceded theirs must be examined, and with it the correlated question whether any of them communicated infection to jiersons with whom they were in contact during their illness. Now, the infection in Case A was not received from an earlier case—(«) because attack in the last preceding case dated 9 months earlier, {h) because absence of communication between A. and any other sick person during more than 10 days prior to his sudden attack was j)ositively established; and (c) he was positively known to have worked down to the time of his attack on premises where rodents were dying in unusual number, some of which were ascertained to be infected with plague after his case had been notified. The infection in Case A, then, was not derived from any previous case in man. Nor in the 10 cases, B to L, which next followed upon it, was the infection derived either from A or from any of them. Inter-communication was positively ascertained to have been all but impossible, and certainly did not take place. The 12th patient, M(d), was exposed to L(d) during the first 36 hours of his illness; a possibility of communication of the infection from L to M consequently existed, which will be examined immediately below. It is certain, therefore, that the cause of illness in the 11 cases A to L, did not consist in infection derived from man. The inference thus suggested, namely, that direct communication of the infection from the sick was no factor in production of this epidemic prevalence of bubonic and of septicaemic plague, is shown to be sound as soon as it is tested by comparison with the experience of 1900 and of 19U2. In the former year (Ptcport, 1900, p. 32), 276 households furnished 289 cases; 266 households yielded but a single case apiece. In the latter year (Report, 1902, par. 195), 124 households furnished 139 cases; 115 households yielded but a single case apiece. These broad statements, based as they are on the observed facts of 2 outbreaks, each of which was sufiiciently extensive to avoid error, and which were widely separated from each other in point of time, suffice by themselves to establish the proposition mentioned above, namely, that these outbreaks did not owe their epidemic character to direct communication of the infection from the sick. And Avhen, as in the year under review, the circumstances of each case are examined minutely, that broad inference is found to stand the test of individual application perfectly. 32. After having shown that epidemics of bubonic and of septicsemic plague are not due to direct communication of infection from the sick, an answer to the subsidiary question, how often such communication does occur, may be sought. The three couplets constituted by cases B and E(d), D and P, L(d) and M(d), were respectively connected with two places of employment and with one residence. A prima facie case for direct communication appears therefore, but it breaks down as soon](https://iiif.wellcomecollection.org/image/b21354704_0246.jp2/full/800%2C/0/default.jpg)
