Report on the outbreak of the plague at Sydney, 1900 / by the Chief Medical Officer of the Government and President of the Board of Health.

Thompson, J. Ashburton (John Ashburton), 1848-1915.

Date:: 1900

Credit: Report on the outbreak of the plague at Sydney, 1900 / by the Chief Medical Officer of the Government and President of the Board of Health. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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$to persons who cannot be removed from premises which are known to be infective; to those who, having evacuated the premises during cleansing, are returned to them while the area on which they stand is still infective; and to those who are obliged to frequent infective neighbourhoods, if they Avill receive it. It will be noticed that attacks which occurred at, or before the lapse of about ten days from, inoculation were not aggravated by it. IV.—Serum-treatment. Yersin-Roux serum became available on May 13th (Case 217). It was administered only by the Visiting Staff to cases diagnosed by them, and at the Maritime Quarantine Hospital. Its employment did not interfere with the natural course of the epidemic. Although it was intended to give the serum regularly to all admitted to hospital without exception, so as to avoid selection of cases, it was found that this rule could not be adhered to without introducing an equally objectionable influence. The enfeeblement of the infection, wliich had begun to be observable by about May 1st, led many patients to defer seeking medical advice, and, consequently, to escape notification until comparatively late dates of illness, when they presented very slight symptoms of constitutional disturbance. Thus a dilemma was caused, out of which no way could be found : if the cases were not selected a false impression of the effects of serum-treatment would certainly be given; on the other hand, if they were selected on principles which necessarily could not be strictly defined, the value of the experience would remain doubtful to all but the observer himself. Eortunately, averages and percentages are statements quite out of place in such connections as this. As a matter of fact, 22 of the 87 admitted after ]\Tay 12th were not treated for one reason or other—in 9 cases, because the patients either died before discovery, or were then moribund. On the other hand, to the remaining 65 must be added G admitted before May 13th, and on that date lying in a nearly desperate state, of whom 4 afterAvards died. Among the 71 were many very slight cases ; but some account of all of them will be found in Appendix E, p. 70. The opinion provisionally formed, and expressed subject to consideration of the day of illness on which the treatment began, the mode of administration, and the general features of each case, is that the serum has antitoxic powers wliich are manifested in useful recovery of the circulation from the depression which is a constant feature of the natural disease ; but that in its present state it can hardly be relied upon as a very active curative agent. Probably the dosage requires revision. V.—Administrative Measures. Before the plague came the Board and its permanent stafP had been watchful and active. Appearance of the disease at Hongkong was the beginning of general interest in plague as a modern danger, and the beginning of the special interest of the Department in it as one thenceforward threatening Australia. On four occasions during 1894, and twice in 1895 (when it was thought the disease was dying out at Hongkong and the risk nearly past), as well as in 1896, when plague first appeared in India, this danger was discussed, and was made the subject of resolutions and of special directions by the Board. The steadily progressive spread of the disease in epidemic form to other parts of the world was seen soon afterwards to necessitate further precautionary measures, and additional preparations against it. Possession and first-hand knowledge of the bacillus was clearly a primary condition of success in attempting to guard against the introduction of cases of plague, or to control spread of the disease after it had gained entrance. Accordingly, cultures of it were procured towards the end of 1897, and during the following twelve months its morphological and cultural characteristics were studied in the laboratories. In October, 1898, the Vienna incident became known; the popular impression it caused was obliquely communicated to the Department through ofiicial channels, and it was considered expedient to destroy the enfeebled and harmless specimens which then alone remained in the laboratories. At the same$