Sept.
1893.1
PLAGUE EPIDEMICS IN RUSSIA: CLEUOW.
331
land
of the extension disease, through and Persia to Central Asia and the Some Historical Notes.* Caucasus. This was the route followed by the last plague epidemic which occurred in Europe By FRANK G. CLEMOW, M.D. (Edin.), D. P. H. (Camb.), (1879); and it was the route followed by the Late Medical C fficer in charge of the British Seamen's cholera epidemic of 1892. The Russian GovernHospital, Cronstadt, St. Petersburg ; Secretary for ment has evidently recognised the risk, and Russia to the Epidemiological Society of London ; both last year and this has sent a commission Honorary Member of the Russian National of medical men to report upon the epidemic in Health Society ; etc. : India. Nor is it surprising that, in view of Medical Officer on Special Plague Duty, Calcutta. this special exposure of .Russia to the risk of plague and of the fact that she was the last European country to suffer from the disease, The literature of plague is growing rapidly. the Russian literature upon the subject should The heritage left us from the past, in the be still and extensive growing. From a fairly writings of those who witnessed the great histo- study of some of the literature that has issued ric epidemics of this disease, is a rich one, richer during the past twenty years from the presses of perhaps than in the case of any other infectious St. Petersburg, Moscow, Kazan, and other cities, fever; and, if the modern literature of plague a highly interesting picture might be reconwas until recently rather scanty, this reproach structed of what Russia has suffered in the is being rapidly removed. from the ravages of plague, and it apIt is not surprising that so much should be past to the writer that a brief review of some peared written upon plague. The subject has, at all of the epidemics through which our neighbour times, a fascination of its own. If it is of inter- has passed, and more particularly of the methods est to the physician in consequence of the she has adopted in dealing with them, might many problems?clinical, bacteriological, epi- prove interesting and possibly instructive at the demiological, many solved, many still awaiting present moment. solution?which it presents, it is of no less interThe earlier epidemics may be rapidly disest to the layman. He cannot but find a grim missed, presenting as they do little of practical attraction in the picturesque aspect of the great while their historic interest is largely interest, pestilences of the past, as depicted by a Boccacio, discounted by the uncertainty as to whether a Pepys or a Defoe ; or, if more seriously inSome of were epidemics of plague at all. clined, he ma}' study in the writings of Heclcer or they them in all probablity were so, but the Russian Fere Gasquet, or still better, in the original monastic chroniclers of the time, just as their contemporary records themselves, the enormous contemporaries in the West, used the word social and political effects of a great epidemic, pestis," or its Russian equivalent mor," with such as that of the Black Death in the fourteenth a gay indifference as to its exact significance? century. now applying it in its specific sense, as the true But if plague in the abstract is a subject bubonic plague,?now in its general sense as a of perennial interest, it becomes trebly so when of any kind. We may therefore pass pestilence the disease is at our doors. Europe has been over the of 1092 in Kief, of 1128 in epidemics free from the disease for twenty years, and had and some others, and come at once to Novgorod perhaps, until recently, begun to regard herself the great outbreak of the middle of the fourteenth as immune to its ravages, but since the malady century the Black Death of 1348?52. In has become so widely epidemic in India, she has Russia this truly terrible visitation was no less been roused to a fresh sense of danger, or at destructive than it was in the rest of Europe. least of the possibility of the infection being It is curious to note that, while the Greek, Italian, imported to her shores. Almost every European and other Western writers regard China or nation has sent a body of trained experts to Cathay" as the place of origin of this pestistudy the disease and the modes of dealing with lence, the Russian chroniclers state that it came it, as exemplified in Bomba}7 and other parts of from India. The infection seems to have India. To every European nation the danger entered Russia by two routes?one from the of the importation of plague is a more or less South-East, through the Caucasus and up the real one, but there are two countries more and a second and later one from the North Volga, exposed to risk than any other. To Great West, invading Pskof and Novgorod. It spared Britain with her constant and manifold relations neither high nor low, rich nor poor. In Moscow with India, it is obvious that the infection might it caused the death of the reigning Grand at any moment (it has already been so imported Prince (the title of Tsar was then unknown) on at least one occasion) be imported by sea. and all his seven sons. The great Russian hisTo Russia the fear is rather of a gradual overtorian, Karamsin, has devoted but a few paraof his history to this epidemic; but it graphs ? Some of the material upon wbich the present piper is is easy to see that it was a disaster of no ordiba-ed appeared in ihe form of a short article contributed nary kind. That it has left less impress upon the by the writer to The Practitioner, in October 1891. PLAGUE EPIDEMICS IN RUSSIA:
Afghanistan
"
"
?
"
332
THE INDIAN MEDICAL
history of this nation than upon that of others may be due to the condition of the country at the time. The ravages and slaughter which invariably followed on a Tartar invasion left her scarce breathing time to notice the added horrors of the Black Death. And yet a Ginghiz Khan or a Tamerlane might have envied the death-dealing powers of this pestilence. Where they and their hordes, with all their thirst for blood, could but slay a few thousands, the plague numbered its victims by millions. Small wonder is it then that in a country so accustomed to wholesale slaughter by Tartar enemy from without or by rival rulers from within, the additional mortality caused by the Black Death did not effect those social or political transformations, which it has been shewn to have effected in the more advanced and settled countries of the West. It is, however a remarkable fact that in the adjoining country of Lithuania or Poland the Black Death had one social consequence, which has left its traces in the clearest manner to the present day. It is a fact perhaps not very generally known that the extraordinary number of Jews now met with in Poland owe their presence there directly to the occurrence of the great plague epidemic of the fourteenth century. In almost every other country in Europe, but more particularly in Germany, the epidemic was taken advantage of for a most violent and cruel crusade against the Jews. They were charged with being: the cause of the terrible disease. They were believed to be spreading it by poisoning the wells with some mysterious powder which they received from their brethren in Toledo. Any charge, however trivial, was sufficient in the Middle Ages to light the fires of persecution against the Jews; but the results of a monstrous charge such as this may easily be imagined. The Jews were tortured and put to death literally by tens of thousands. There was but one country where they could find refuge. Casimir the Great, the reigning king of Poland, moved, it is said, by the entreaties of a favourite Jewess, named Esther, granted them asylum and protection. And so, in view of the fact that the Poland of those days, or a great part of it, has since become Russian territory, it may be said (in apparent contradiction to the earlier statement) that the Black Death did have a most profound and far-reaching effect upon social and political affairs in Russia Not, however, on the Russia of the fourteenth century, but on the Russia of to-day, where it has been indirectly the means of raising one of the most difficult and of recent years one of the most of social questions. The many occurrences of plague in Russia and seventeenth during the fifteenth, sixteenth centuries may be passed over with brief notice. To many of them the same doubt as to their true nature clings as to those of the earlier cen-
burning
GAZETTE.
[Sept.
1898.
turies. One of the worst epidemics in this period was the plague of 1654?50 in Moscow and elsewhere, just ten years earlier than the memorable great plague of London. This outbreak is of interest, as it is the first in which mention is made of land quarantine as a method of dealing with a plague epidemic. The principal measures adopted seem to have been the following :?The clothes of all persons who had died of plague were burnt; infected houses were fumigated, and the city was surrounded by a cordon, which it was forbidden to pass under penalty of death. The last measure seems to have failed lamentably. The guards told off to cordon the city themselves contracted the disease, and in some instances died off to the last man. In others, when one or two of the men died, the rest deserted their post in panic. Evasion of the quarantine, open or secret, is said to have been of hourly occurrence, and plague spread unchecked to the country round. Another serious outbreak of plague occurred in 1709. Peter the Great was then at war with the Poles, and his troops were attacked by the pestilence somewhere near the frontier of the two countries. His efforts to quell the disease were most energetic and characteristic'; and some of his measures, it must be added, were strikingly in accordance with modern practice. He caused the troops to be removed by sea from Marienburg to Reval. There they were landed and scattered over as large an area of country as possible; divisions were ordered to encamp so many miles apart, and regiments at least a verst (two-thirds of a mile) from each other. Some of his other measures were less to be commended. The cordon system was enforced with the utmost severity. Death was the almost invariable penalty for the least infringement of Gallows were Peter's Plague Regulations. erected on the public highways, and no trial was accorded to the unfortunate victim caught trying to break through the cordon; he was hanged at once without benefit of clergy. But then, as now, plague was not to be overcome by mere force, or to be exterminated at the point of the bayonet, like a regiment of Swedes or Puie3; and the hero of Poltava for once found himself in the presence of an enemy whom even he could not subdue. In this epidemic it is stated that about a hundred thousand persons fell victims to the plague ; and in the following year, when Peter was attacking the fortress of Riga, died from over 00,000 persons are said to have the disease. It is interesting to note that at that time, and also in the earlier epidemics, fumigation, which may be regarded as the earliest form of disinfection, was freety emplo3red. Letters, for example, which had been brought by couriers from an infected district were passed through the smoke of a fire, were then copied out three times, and only the third copy was delivered to the addressee.
PLAGUE EPIDEMICS IN RUSSIA: CLEMOW.
Sept. 1898.1
Exactly similar another epidemic
measures
were
enforced in[
the
measures
trust
which this
333
body
to Shafonski the task of
took
was to en-
writing
a historiand a few years cal and clinical of the epidemic. description later it is interesting to observe that a de- This task he executed most faithfully, and the termined effort was made, not to prevent the result was an written book?a book admirably spread of the disease in the country itself, worthy to rank with the similar works of but to prevent its introduction into the counBoghurst and Hodges on the Great Plague of In 1721-22 one of the worst London. try at all. epidemics on record was raging in France. The Great Plague of Moscow coincided, as so Peter issued orders that no French ship was to other epidemics have done, with a Euromany be admitted into a Russian port without a passpean war. Catherine was fighting the Turks ; port from the Russian ambassador in Paris, and and the first appearance of plague was in the without a strict examination and inquiry as to Russian army on the Danube. Gradually the as the presence of infection 011 board. Whether infection spread, in spite of military cordons, a result of these measures, or from the fact that and gallows. First Kief, the ancient the sea traffic between the two countries was quarantines of Russia, was affected ; then Tchernigof. too small in amount and the voyage too long, capital in October 1770, some suspicious Suddenly for there to be any appreciable risk of conveying deaths occurred among Turkish prisoners, who it is none the a that less fact the infection, plague had been sent to Moscow for safe keeping. Then does not appear to have become epidemic in in November an officer, who had come to Moscow Russia in either of the years in question. direct from the seat of war, died and was secretly the historic in of Among epidemics plague buried. Almost immediately after, the medical Russia, the great plague of Moscow of 1770?72 man who had attended the officer sickened from was the most disastrous that had occurred since a fever with black spots," and died after only the Black Death. Of all the Russian epidemics, three days' illness. Gradually other,suspicious it is the most interesting and instructive. Of cases occurred in various parts of the town. From the previous outbreaks we know but little in the middle of December a fatal malady began detail. In many of them all that has been at Shafonski's handed down to us is a brief statement of their to appear among the attendants seen he at as we have and, already, hospital occurrence and perhaps a rough guess as to the once declared his belief that the disease was the number of their victims. If anything is adviews of many ded as to the symptoms, mode in which the plague, in spite of the contrary His of his hospital was surroundcolleagues. epidemic was propagated, or the measures adopfor nine weeks, and in that time ted to deal with it, it is usually of so scant}' a ed by a coi'don of the attendants sickened, and of these no character as merely to whet our appetite for 27 less than 22 died. further information on these points. But of the Early in March of the year 1771, an unusual great Moscow epidemic of 1770?72 we have was noted by the police as mortality occurring almost as full an account as of the Great Plague the inhabitants of the Great Cloth Fair, among O is So a earlier. of London interesting century which then stood close to the river?the river the story of this outbreak that we propose to which the city of Moscow is Moskva?upon tell it in some detail. built. At once a " house-to-house visitation" The principal contemporary authority for this was instituted, and sixteen persons ill of the epidemic is a rare little book, written by a plague were discovered. It was also ascertained physician, Dr. Athanasius Shafonski, who was that, during the preceding two mouths, as many in charge of one of the largest of the Moscow as 130 persons had died in the fair, with plague hospitals during the whole of the epi- symptoms precisely similar to those found in demic. He was the first to diagnose the disease these The sixteen living patients. story as plague, and he had the honesty and courage current in the fair was that the infection had to report his opinion to the authorities; with been brought to the fair by a woman, who the result?not unknown in our own times came from a house where every member of the of calling down upon his head a shower of had died from plague. She herself had a family abuse and a storm of denial; as though the swollen gland behind the ear when she arrived most strenuous denial of an unpleasant truth at the and she died shortly after. Grafair, could alter or remedy it. However he seems one dually, by one, the whole family with to have convinced the authorities at last; and whom she had lodged in the fair sickened and a cordon of soldiers was placed round his hospi- died. tal to isolate it from the rest of the city. For There was still some doubt and discussion as nine weeks he was shut up in the hospital in a to the nature of the disease, some affirming, hand-to-hand fight with the disease. When, some Much denying, its specific character. towards the close of the epidemic, the Empress valuable time was lost, and when the police Catherine sent her favourite, Count Gregory began to take action it was already too late to Orlof, to Moscow to organise measures against the spread of the disease. It was decided stop the epidemic, a Plague Commission or Plague to remove to the outskirts of the town all the Committee was of course formed ; and one of d
in
1718;
"
'
?
_?o4
__
THE INDIAN MEDICAL GAZETTE.
[Pet>t.
1898.
inhabitants of the fair; the sick were removed sent to quarantine. The definition of '? rapid to the Monastery of St. Nicholas the Miracle" death was limited to cases illness or sudden worker, and the healthy were placed in a couple of under four days' duration, and as it was of empty factories, or, as it would be expressed to the relatives to declare that open always now-a-days, the patients were removed to an the case in question was of five or six days* isolation hospital, the "contacts" were segreduration, and thus escape quarantine, a large gated. But when it came to putting these number of cases slipped through the authorites' measures into force, only 730 persons, sick and hands. The sub-inspectors made daily returns, well, instead of the usual 2,500 inhabitants of the and from these official it seems that the figures fair could be found. What had become of the deaths from plague in Moscow in April 1771 were remainder was only too clear; they had fled 778 in number. In the succeeding months the to other parts of the town and carried the official statistics, probably far below the truth, infection with them. Rapidly the disease spread June 1,099, July were as follows:?May 878, through the city and something like a panic set 1,708, 7,268, 21,401, October September August in. The Imperial Senate, the highest organ November 5,235, and December 805. 17,561, of Government under the Empress, took the In the month of May a somewhat unfortunate matter up, just as in modern days Governments order wa? issued. This was an order to collect and have been known to intervene supersede all the possessions of the people who had been local authorities in the management of an removed from the cloth fair and burn them. It epidemic. The number of medical men was had the effect of the people from the alienating to remove such was of it decided increased; authorites and probably assisted in still further the late occupants of the cloth fair as could the disease, as the condemned possesthe and to from further search spreading be found still city, sions were of course hidden or passed on from out the others who had escaped and compel hand to hand to prevent them falling into the them to leave the city. About half the number clutches of the police. were found and segregated in another monastery The epidemic continued to increase in spite far from the city walls; but the other half were of measures. There were the usual terrible scenes never discovered. Finally, at the end of March which have distinguished most great historical the Senate appointed General Yeropkin as (what epidemics?the dead and dying deserted by their we should now call) Plague Commissioner, with relatives, bodies thrust out into the street and full authority in all measures directed against left there, the deserted sick crawling from their the epidemic. homes and dying by the roadside. The authorIt is well worth following in some detail the ities were at their wits' end. They pressed into plan adopted by Yeropkin and seeing how it their service?being unable to persuade or force worked. He divided the city into fourteen the citizens to help them?criminals condemned districts and appointed one inspector and one to death or to severe punishment, and made medical man in charge of each. In addition, them collect and bury the deserted bodies. They had each division attached to it an officer who the same class of men to act as attenlooked after the furnishing and provisioning of appointed dants in the hospitals and quarantine stations, and observation camps, and two the hospitals where the original attendants had died or fled, other medical men who were in charge of these sometimes to the last man. Another mode of institutions and whose duty it was to examine these vacancies was still more original. all cases of sickness and death. Every house- filling up All persons found secretly attempting to evade holder was enjoined to report to the police any quarantine or to leave infected houses were sent case of rapid illness or sudden death occurring to the hospitals and forced to act as attendants in his house. On receiving the report of such on the patients; surely a not inappropriate an occurrence a sub-inspector and one of the I for the offender, though a rather medical men at once visited the house to examine |punishment from the patient's point of risky experiment the patient or the body, and if the symptoms a spirit of despair seems to view. Gradually the case was were suspicious reported to Yerop- have j taken hold of the people. The inspectors kin. He then sent a senior medical officer to ! and medical men were met with sullenness, If it was a true case confirm the diagnosis. threats and even actual violence. The sick and of plague, the patient was removed to one of the the dead were thrown into the streets in ever and the house was surrounded plague-hospitals,isolated so that it was impossible to for several days. If the increasing numbers, by a guard and tell from which house they came, and this, case was only suspicious, the patient was not notwithstanding an Imperial edict issued in the removed from the house, but the house was month of August, which made such an act surrounded in the same way for two days, and with transportation to the mines on the third punishable a fresh visit of inspection made The most active efforts of the for life. day, when it was thought the symptoms would authorities failed to make any apparent impreshave so far developed as to leave 110 doubt of sion upon the epidemic, which had now assumed the diagnosis. In a house where a sudden death gigantic proportions. The people became more had occurred, all the remaining inmates were and more in the and at "
"
discontented,
last,
Sept
PLAGUE EPIDEMICS
1898.]
IN RUSSIA :ICJLEMOW.
month of September, a riot broke out. It was ?one of the most serious plague riots on record. Mob-law was triumphant for three days. One terrible tragedy occurred. Ambrose, the Archbishop of Moscow, with a courage which lends one touch of brightness to this gloomy picture, went out to face the people and attempt to reason with them. But the cry went forth that he was in league with the doctors, and with that unreasoning cry there was an end to reason. The unfortunate Archbishop was the famous his monastery from dragged monastery of the Don?and literally torn to pieces by the mob; an ignominious but surely not an ignoble end. The rioting lasted from the loth to the 18th of September; that month marked the climax of the epidemic; during it the number of deaths officially recorded amounted to the enormous figure of 21,401, or over 700 deaths a day, and this, it should be remembered, was probabty much below the truth. From this month onwards the epidemic began to decline, but it was not until December, 1772, that Moscow was officially declared to be free of the plague. There are few things more difficult than to determine, in a disease such as plague, to what extent the measures taken to control an epidemic are to be credited with its extinction, or how far its extinction is the result of the general law by which all epidemics appear to have a distinct life of their own, more or less gradually coming to a climax and more or less gradually declining until they finally disappear altogether. It was on the 26th of September J 771 that Count Gregory Orlof arrived in Moscow and took over the charge of the plague measures. And it was from the month of September that the deaths from plague began to decrease in number. It would be equally rash now to assert or deny any connection between the two occurrences. At the time the whole credit of overcoming the epidemic was given to Orlof, and he became the hero of the day. He was called the saviour of Moscow ; medals were struck in his honour, and triumphal arches erected all along the route of his return journey to St. Petersburg. The Empress Catherine showered honours upon him, I and still more substantial benefits enriched the pockets of the lucky favourite. Let us examine briefly the measures which he had inaugurated, and by which he claimed to liave put a check upon, and finally completely stopped, the career of a raging epidemic. There can be no question that the scheme was in many ways a commendable one; it was thorough, it was quite rational and based on the medical views held at the time as to the which the disease was spread, -way in and it must be added that man}' of the measures, then used empirically, are in entire accordance with what modern science has shewn to be | effective methods of destroying infection. The ?
1
335
the principal measures adopted Commission:? 1. Rags and other rubbish thrown into the street were collected and burnt. 2. Leaflets containing advice on the best methods of avoiding infection were distributed among the people. 3. All beggars were summarily seized and forcibly removed to a monastery. 4. Several new hospitals were built. 5. The city was divided into 27 sections, and a medical officer and inspector attached to each. 6. Each section had a supply of horses, carts and grave-diggers, and it was made a punishable offence for private persons to bury their own dead. The punishment was an appropriate one; the offender was forced to become one of the
following
were
by Orlot's Plague
Commission's
grave-diggers!
7. To encourage people to report cases and to send them to hospital, a new suit of clothes and a sum of ten roubles (over ?1) to married persons and five roubles to single, were promised to every patient who left the hospital and to every person who left a quarantine camp. 8. After a death from plague, the relatives were compelled to allow all infected articles to be burnt. (No mention is made of compensa-
tion.)
9. All stray cats and dogs were killed and their bodies buried. 10. Shopping in the ordinary way was prohibited. Customers were forbidden to enter shops; they were to deposit their money in a vessel containing vinegar and receive the article purchased through a grating. All articles of food were to be washed in water or fumigated before being sold. 11. Barbers were forbidden to let blood, while the epidemic lasted, without an order from
a
surgeon. 12. A quarantine detention of fifteen daj's was enforced upon all persons leaving Moscow. 13. Persons arriving from elsewhere were admitted freely into and out of the cit}% provided their stay there was not of more than three days' duration. If they remained in the city longer than three days they were compelled to
undergo quarantine. When the
epidemic began
general and gation of all
to
distinctly abate,
simultaneous cleansing and fumiinfected houses was organised. Each division of the town was provided with a gang of fumigators," consisting of nine men and an officer in charge. The process of fumigating began on December 12th, 1771, and was continued without interruption to the following spring. All small articles of no great value were burnt; the rest were well fumigated and then exposed to a current of air. The method employed is interesting. All the doors and windows of the room to be fumigated were closed, and twice a day for four daj7s a certain a
"
336
'
THE INDIAN MEDICAL GAZETTE.
quantity of the fumigating powder was burnt. The powder was composed of the following ingredients :?finely chopped leaves of the juniper plant, crushed juniper berries; guaiacum wood, (of each 61bs.), nitre, (8tbs.),. sulphur (Gibs.) and myrrh (2lbs). At the end of four days the
vvindows and doors of the room were left open -and air freely admitted for five days in the winter, or for two weeks at any other period of the year. All wooden articles were in the meantime washed with a mixture of vinegar, salt and hot water; hangings were well beaten and brushed, and other objects were washed with hot water or vinegar and water. The Imperial Senate offered the tempting reward of twenty roubles (at least ?3 at that time) to persons giving information of concealed cases of plague, or of bodies being secretly buried. The Government in fact spared neither expense nor trouble to put an end to the epidemic, and they were rewarded by seeing a steady decline, in the number of cases until, as already stated, the epidemic came to an end in December 1772, rather more than two years from the date of its first appearance. {To be continued.)
[Sept.
1898.
1893.1
PLAGUE EPIDEMICS IN RUSSIA: CLEUOW.
331
land
of the extension disease, through and Persia to Central Asia and the Some Historical Notes.* Caucasus. This was the route followed by the last plague epidemic which occurred in Europe By FRANK G. CLEMOW, M.D. (Edin.), D. P. H. (Camb.), (1879); and it was the route followed by the Late Medical C fficer in charge of the British Seamen's cholera epidemic of 1892. The Russian GovernHospital, Cronstadt, St. Petersburg ; Secretary for ment has evidently recognised the risk, and Russia to the Epidemiological Society of London ; both last year and this has sent a commission Honorary Member of the Russian National of medical men to report upon the epidemic in Health Society ; etc. : India. Nor is it surprising that, in view of Medical Officer on Special Plague Duty, Calcutta. this special exposure of .Russia to the risk of plague and of the fact that she was the last European country to suffer from the disease, The literature of plague is growing rapidly. the Russian literature upon the subject should The heritage left us from the past, in the be still and extensive growing. From a fairly writings of those who witnessed the great histo- study of some of the literature that has issued ric epidemics of this disease, is a rich one, richer during the past twenty years from the presses of perhaps than in the case of any other infectious St. Petersburg, Moscow, Kazan, and other cities, fever; and, if the modern literature of plague a highly interesting picture might be reconwas until recently rather scanty, this reproach structed of what Russia has suffered in the is being rapidly removed. from the ravages of plague, and it apIt is not surprising that so much should be past to the writer that a brief review of some peared written upon plague. The subject has, at all of the epidemics through which our neighbour times, a fascination of its own. If it is of inter- has passed, and more particularly of the methods est to the physician in consequence of the she has adopted in dealing with them, might many problems?clinical, bacteriological, epi- prove interesting and possibly instructive at the demiological, many solved, many still awaiting present moment. solution?which it presents, it is of no less interThe earlier epidemics may be rapidly disest to the layman. He cannot but find a grim missed, presenting as they do little of practical attraction in the picturesque aspect of the great while their historic interest is largely interest, pestilences of the past, as depicted by a Boccacio, discounted by the uncertainty as to whether a Pepys or a Defoe ; or, if more seriously inSome of were epidemics of plague at all. clined, he ma}' study in the writings of Heclcer or they them in all probablity were so, but the Russian Fere Gasquet, or still better, in the original monastic chroniclers of the time, just as their contemporary records themselves, the enormous contemporaries in the West, used the word social and political effects of a great epidemic, pestis," or its Russian equivalent mor," with such as that of the Black Death in the fourteenth a gay indifference as to its exact significance? century. now applying it in its specific sense, as the true But if plague in the abstract is a subject bubonic plague,?now in its general sense as a of perennial interest, it becomes trebly so when of any kind. We may therefore pass pestilence the disease is at our doors. Europe has been over the of 1092 in Kief, of 1128 in epidemics free from the disease for twenty years, and had and some others, and come at once to Novgorod perhaps, until recently, begun to regard herself the great outbreak of the middle of the fourteenth as immune to its ravages, but since the malady century the Black Death of 1348?52. In has become so widely epidemic in India, she has Russia this truly terrible visitation was no less been roused to a fresh sense of danger, or at destructive than it was in the rest of Europe. least of the possibility of the infection being It is curious to note that, while the Greek, Italian, imported to her shores. Almost every European and other Western writers regard China or nation has sent a body of trained experts to Cathay" as the place of origin of this pestistudy the disease and the modes of dealing with lence, the Russian chroniclers state that it came it, as exemplified in Bomba}7 and other parts of from India. The infection seems to have India. To every European nation the danger entered Russia by two routes?one from the of the importation of plague is a more or less South-East, through the Caucasus and up the real one, but there are two countries more and a second and later one from the North Volga, exposed to risk than any other. To Great West, invading Pskof and Novgorod. It spared Britain with her constant and manifold relations neither high nor low, rich nor poor. In Moscow with India, it is obvious that the infection might it caused the death of the reigning Grand at any moment (it has already been so imported Prince (the title of Tsar was then unknown) on at least one occasion) be imported by sea. and all his seven sons. The great Russian hisTo Russia the fear is rather of a gradual overtorian, Karamsin, has devoted but a few paraof his history to this epidemic; but it graphs ? Some of the material upon wbich the present piper is is easy to see that it was a disaster of no ordiba-ed appeared in ihe form of a short article contributed nary kind. That it has left less impress upon the by the writer to The Practitioner, in October 1891. PLAGUE EPIDEMICS IN RUSSIA:
Afghanistan
"
"
?
"
332
THE INDIAN MEDICAL
history of this nation than upon that of others may be due to the condition of the country at the time. The ravages and slaughter which invariably followed on a Tartar invasion left her scarce breathing time to notice the added horrors of the Black Death. And yet a Ginghiz Khan or a Tamerlane might have envied the death-dealing powers of this pestilence. Where they and their hordes, with all their thirst for blood, could but slay a few thousands, the plague numbered its victims by millions. Small wonder is it then that in a country so accustomed to wholesale slaughter by Tartar enemy from without or by rival rulers from within, the additional mortality caused by the Black Death did not effect those social or political transformations, which it has been shewn to have effected in the more advanced and settled countries of the West. It is, however a remarkable fact that in the adjoining country of Lithuania or Poland the Black Death had one social consequence, which has left its traces in the clearest manner to the present day. It is a fact perhaps not very generally known that the extraordinary number of Jews now met with in Poland owe their presence there directly to the occurrence of the great plague epidemic of the fourteenth century. In almost every other country in Europe, but more particularly in Germany, the epidemic was taken advantage of for a most violent and cruel crusade against the Jews. They were charged with being: the cause of the terrible disease. They were believed to be spreading it by poisoning the wells with some mysterious powder which they received from their brethren in Toledo. Any charge, however trivial, was sufficient in the Middle Ages to light the fires of persecution against the Jews; but the results of a monstrous charge such as this may easily be imagined. The Jews were tortured and put to death literally by tens of thousands. There was but one country where they could find refuge. Casimir the Great, the reigning king of Poland, moved, it is said, by the entreaties of a favourite Jewess, named Esther, granted them asylum and protection. And so, in view of the fact that the Poland of those days, or a great part of it, has since become Russian territory, it may be said (in apparent contradiction to the earlier statement) that the Black Death did have a most profound and far-reaching effect upon social and political affairs in Russia Not, however, on the Russia of the fourteenth century, but on the Russia of to-day, where it has been indirectly the means of raising one of the most difficult and of recent years one of the most of social questions. The many occurrences of plague in Russia and seventeenth during the fifteenth, sixteenth centuries may be passed over with brief notice. To many of them the same doubt as to their true nature clings as to those of the earlier cen-
burning
GAZETTE.
[Sept.
1898.
turies. One of the worst epidemics in this period was the plague of 1654?50 in Moscow and elsewhere, just ten years earlier than the memorable great plague of London. This outbreak is of interest, as it is the first in which mention is made of land quarantine as a method of dealing with a plague epidemic. The principal measures adopted seem to have been the following :?The clothes of all persons who had died of plague were burnt; infected houses were fumigated, and the city was surrounded by a cordon, which it was forbidden to pass under penalty of death. The last measure seems to have failed lamentably. The guards told off to cordon the city themselves contracted the disease, and in some instances died off to the last man. In others, when one or two of the men died, the rest deserted their post in panic. Evasion of the quarantine, open or secret, is said to have been of hourly occurrence, and plague spread unchecked to the country round. Another serious outbreak of plague occurred in 1709. Peter the Great was then at war with the Poles, and his troops were attacked by the pestilence somewhere near the frontier of the two countries. His efforts to quell the disease were most energetic and characteristic'; and some of his measures, it must be added, were strikingly in accordance with modern practice. He caused the troops to be removed by sea from Marienburg to Reval. There they were landed and scattered over as large an area of country as possible; divisions were ordered to encamp so many miles apart, and regiments at least a verst (two-thirds of a mile) from each other. Some of his other measures were less to be commended. The cordon system was enforced with the utmost severity. Death was the almost invariable penalty for the least infringement of Gallows were Peter's Plague Regulations. erected on the public highways, and no trial was accorded to the unfortunate victim caught trying to break through the cordon; he was hanged at once without benefit of clergy. But then, as now, plague was not to be overcome by mere force, or to be exterminated at the point of the bayonet, like a regiment of Swedes or Puie3; and the hero of Poltava for once found himself in the presence of an enemy whom even he could not subdue. In this epidemic it is stated that about a hundred thousand persons fell victims to the plague ; and in the following year, when Peter was attacking the fortress of Riga, died from over 00,000 persons are said to have the disease. It is interesting to note that at that time, and also in the earlier epidemics, fumigation, which may be regarded as the earliest form of disinfection, was freety emplo3red. Letters, for example, which had been brought by couriers from an infected district were passed through the smoke of a fire, were then copied out three times, and only the third copy was delivered to the addressee.
PLAGUE EPIDEMICS IN RUSSIA: CLEMOW.
Sept. 1898.1
Exactly similar another epidemic
measures
were
enforced in[
the
measures
trust
which this
333
body
to Shafonski the task of
took
was to en-
writing
a historiand a few years cal and clinical of the epidemic. description later it is interesting to observe that a de- This task he executed most faithfully, and the termined effort was made, not to prevent the result was an written book?a book admirably spread of the disease in the country itself, worthy to rank with the similar works of but to prevent its introduction into the counBoghurst and Hodges on the Great Plague of In 1721-22 one of the worst London. try at all. epidemics on record was raging in France. The Great Plague of Moscow coincided, as so Peter issued orders that no French ship was to other epidemics have done, with a Euromany be admitted into a Russian port without a passpean war. Catherine was fighting the Turks ; port from the Russian ambassador in Paris, and and the first appearance of plague was in the without a strict examination and inquiry as to Russian army on the Danube. Gradually the as the presence of infection 011 board. Whether infection spread, in spite of military cordons, a result of these measures, or from the fact that and gallows. First Kief, the ancient the sea traffic between the two countries was quarantines of Russia, was affected ; then Tchernigof. too small in amount and the voyage too long, capital in October 1770, some suspicious Suddenly for there to be any appreciable risk of conveying deaths occurred among Turkish prisoners, who it is none the a that less fact the infection, plague had been sent to Moscow for safe keeping. Then does not appear to have become epidemic in in November an officer, who had come to Moscow Russia in either of the years in question. direct from the seat of war, died and was secretly the historic in of Among epidemics plague buried. Almost immediately after, the medical Russia, the great plague of Moscow of 1770?72 man who had attended the officer sickened from was the most disastrous that had occurred since a fever with black spots," and died after only the Black Death. Of all the Russian epidemics, three days' illness. Gradually other,suspicious it is the most interesting and instructive. Of cases occurred in various parts of the town. From the previous outbreaks we know but little in the middle of December a fatal malady began detail. In many of them all that has been at Shafonski's handed down to us is a brief statement of their to appear among the attendants seen he at as we have and, already, hospital occurrence and perhaps a rough guess as to the once declared his belief that the disease was the number of their victims. If anything is adviews of many ded as to the symptoms, mode in which the plague, in spite of the contrary His of his hospital was surroundcolleagues. epidemic was propagated, or the measures adopfor nine weeks, and in that time ted to deal with it, it is usually of so scant}' a ed by a coi'don of the attendants sickened, and of these no character as merely to whet our appetite for 27 less than 22 died. further information on these points. But of the Early in March of the year 1771, an unusual great Moscow epidemic of 1770?72 we have was noted by the police as mortality occurring almost as full an account as of the Great Plague the inhabitants of the Great Cloth Fair, among O is So a earlier. of London interesting century which then stood close to the river?the river the story of this outbreak that we propose to which the city of Moscow is Moskva?upon tell it in some detail. built. At once a " house-to-house visitation" The principal contemporary authority for this was instituted, and sixteen persons ill of the epidemic is a rare little book, written by a plague were discovered. It was also ascertained physician, Dr. Athanasius Shafonski, who was that, during the preceding two mouths, as many in charge of one of the largest of the Moscow as 130 persons had died in the fair, with plague hospitals during the whole of the epi- symptoms precisely similar to those found in demic. He was the first to diagnose the disease these The sixteen living patients. story as plague, and he had the honesty and courage current in the fair was that the infection had to report his opinion to the authorities; with been brought to the fair by a woman, who the result?not unknown in our own times came from a house where every member of the of calling down upon his head a shower of had died from plague. She herself had a family abuse and a storm of denial; as though the swollen gland behind the ear when she arrived most strenuous denial of an unpleasant truth at the and she died shortly after. Grafair, could alter or remedy it. However he seems one dually, by one, the whole family with to have convinced the authorities at last; and whom she had lodged in the fair sickened and a cordon of soldiers was placed round his hospi- died. tal to isolate it from the rest of the city. For There was still some doubt and discussion as nine weeks he was shut up in the hospital in a to the nature of the disease, some affirming, hand-to-hand fight with the disease. When, some Much denying, its specific character. towards the close of the epidemic, the Empress valuable time was lost, and when the police Catherine sent her favourite, Count Gregory began to take action it was already too late to Orlof, to Moscow to organise measures against the spread of the disease. It was decided stop the epidemic, a Plague Commission or Plague to remove to the outskirts of the town all the Committee was of course formed ; and one of d
in
1718;
"
'
?
_?o4
__
THE INDIAN MEDICAL GAZETTE.
[Pet>t.
1898.
inhabitants of the fair; the sick were removed sent to quarantine. The definition of '? rapid to the Monastery of St. Nicholas the Miracle" death was limited to cases illness or sudden worker, and the healthy were placed in a couple of under four days' duration, and as it was of empty factories, or, as it would be expressed to the relatives to declare that open always now-a-days, the patients were removed to an the case in question was of five or six days* isolation hospital, the "contacts" were segreduration, and thus escape quarantine, a large gated. But when it came to putting these number of cases slipped through the authorites' measures into force, only 730 persons, sick and hands. The sub-inspectors made daily returns, well, instead of the usual 2,500 inhabitants of the and from these official it seems that the figures fair could be found. What had become of the deaths from plague in Moscow in April 1771 were remainder was only too clear; they had fled 778 in number. In the succeeding months the to other parts of the town and carried the official statistics, probably far below the truth, infection with them. Rapidly the disease spread June 1,099, July were as follows:?May 878, through the city and something like a panic set 1,708, 7,268, 21,401, October September August in. The Imperial Senate, the highest organ November 5,235, and December 805. 17,561, of Government under the Empress, took the In the month of May a somewhat unfortunate matter up, just as in modern days Governments order wa? issued. This was an order to collect and have been known to intervene supersede all the possessions of the people who had been local authorities in the management of an removed from the cloth fair and burn them. It epidemic. The number of medical men was had the effect of the people from the alienating to remove such was of it decided increased; authorites and probably assisted in still further the late occupants of the cloth fair as could the disease, as the condemned possesthe and to from further search spreading be found still city, sions were of course hidden or passed on from out the others who had escaped and compel hand to hand to prevent them falling into the them to leave the city. About half the number clutches of the police. were found and segregated in another monastery The epidemic continued to increase in spite far from the city walls; but the other half were of measures. There were the usual terrible scenes never discovered. Finally, at the end of March which have distinguished most great historical the Senate appointed General Yeropkin as (what epidemics?the dead and dying deserted by their we should now call) Plague Commissioner, with relatives, bodies thrust out into the street and full authority in all measures directed against left there, the deserted sick crawling from their the epidemic. homes and dying by the roadside. The authorIt is well worth following in some detail the ities were at their wits' end. They pressed into plan adopted by Yeropkin and seeing how it their service?being unable to persuade or force worked. He divided the city into fourteen the citizens to help them?criminals condemned districts and appointed one inspector and one to death or to severe punishment, and made medical man in charge of each. In addition, them collect and bury the deserted bodies. They had each division attached to it an officer who the same class of men to act as attenlooked after the furnishing and provisioning of appointed dants in the hospitals and quarantine stations, and observation camps, and two the hospitals where the original attendants had died or fled, other medical men who were in charge of these sometimes to the last man. Another mode of institutions and whose duty it was to examine these vacancies was still more original. all cases of sickness and death. Every house- filling up All persons found secretly attempting to evade holder was enjoined to report to the police any quarantine or to leave infected houses were sent case of rapid illness or sudden death occurring to the hospitals and forced to act as attendants in his house. On receiving the report of such on the patients; surely a not inappropriate an occurrence a sub-inspector and one of the I for the offender, though a rather medical men at once visited the house to examine |punishment from the patient's point of risky experiment the patient or the body, and if the symptoms a spirit of despair seems to view. Gradually the case was were suspicious reported to Yerop- have j taken hold of the people. The inspectors kin. He then sent a senior medical officer to ! and medical men were met with sullenness, If it was a true case confirm the diagnosis. threats and even actual violence. The sick and of plague, the patient was removed to one of the the dead were thrown into the streets in ever and the house was surrounded plague-hospitals,isolated so that it was impossible to for several days. If the increasing numbers, by a guard and tell from which house they came, and this, case was only suspicious, the patient was not notwithstanding an Imperial edict issued in the removed from the house, but the house was month of August, which made such an act surrounded in the same way for two days, and with transportation to the mines on the third punishable a fresh visit of inspection made The most active efforts of the for life. day, when it was thought the symptoms would authorities failed to make any apparent impreshave so far developed as to leave 110 doubt of sion upon the epidemic, which had now assumed the diagnosis. In a house where a sudden death gigantic proportions. The people became more had occurred, all the remaining inmates were and more in the and at "
"
discontented,
last,
Sept
PLAGUE EPIDEMICS
1898.]
IN RUSSIA :ICJLEMOW.
month of September, a riot broke out. It was ?one of the most serious plague riots on record. Mob-law was triumphant for three days. One terrible tragedy occurred. Ambrose, the Archbishop of Moscow, with a courage which lends one touch of brightness to this gloomy picture, went out to face the people and attempt to reason with them. But the cry went forth that he was in league with the doctors, and with that unreasoning cry there was an end to reason. The unfortunate Archbishop was the famous his monastery from dragged monastery of the Don?and literally torn to pieces by the mob; an ignominious but surely not an ignoble end. The rioting lasted from the loth to the 18th of September; that month marked the climax of the epidemic; during it the number of deaths officially recorded amounted to the enormous figure of 21,401, or over 700 deaths a day, and this, it should be remembered, was probabty much below the truth. From this month onwards the epidemic began to decline, but it was not until December, 1772, that Moscow was officially declared to be free of the plague. There are few things more difficult than to determine, in a disease such as plague, to what extent the measures taken to control an epidemic are to be credited with its extinction, or how far its extinction is the result of the general law by which all epidemics appear to have a distinct life of their own, more or less gradually coming to a climax and more or less gradually declining until they finally disappear altogether. It was on the 26th of September J 771 that Count Gregory Orlof arrived in Moscow and took over the charge of the plague measures. And it was from the month of September that the deaths from plague began to decrease in number. It would be equally rash now to assert or deny any connection between the two occurrences. At the time the whole credit of overcoming the epidemic was given to Orlof, and he became the hero of the day. He was called the saviour of Moscow ; medals were struck in his honour, and triumphal arches erected all along the route of his return journey to St. Petersburg. The Empress Catherine showered honours upon him, I and still more substantial benefits enriched the pockets of the lucky favourite. Let us examine briefly the measures which he had inaugurated, and by which he claimed to liave put a check upon, and finally completely stopped, the career of a raging epidemic. There can be no question that the scheme was in many ways a commendable one; it was thorough, it was quite rational and based on the medical views held at the time as to the which the disease was spread, -way in and it must be added that man}' of the measures, then used empirically, are in entire accordance with what modern science has shewn to be | effective methods of destroying infection. The ?
1
335
the principal measures adopted Commission:? 1. Rags and other rubbish thrown into the street were collected and burnt. 2. Leaflets containing advice on the best methods of avoiding infection were distributed among the people. 3. All beggars were summarily seized and forcibly removed to a monastery. 4. Several new hospitals were built. 5. The city was divided into 27 sections, and a medical officer and inspector attached to each. 6. Each section had a supply of horses, carts and grave-diggers, and it was made a punishable offence for private persons to bury their own dead. The punishment was an appropriate one; the offender was forced to become one of the
following
were
by Orlot's Plague
Commission's
grave-diggers!
7. To encourage people to report cases and to send them to hospital, a new suit of clothes and a sum of ten roubles (over ?1) to married persons and five roubles to single, were promised to every patient who left the hospital and to every person who left a quarantine camp. 8. After a death from plague, the relatives were compelled to allow all infected articles to be burnt. (No mention is made of compensa-
tion.)
9. All stray cats and dogs were killed and their bodies buried. 10. Shopping in the ordinary way was prohibited. Customers were forbidden to enter shops; they were to deposit their money in a vessel containing vinegar and receive the article purchased through a grating. All articles of food were to be washed in water or fumigated before being sold. 11. Barbers were forbidden to let blood, while the epidemic lasted, without an order from
a
surgeon. 12. A quarantine detention of fifteen daj's was enforced upon all persons leaving Moscow. 13. Persons arriving from elsewhere were admitted freely into and out of the cit}% provided their stay there was not of more than three days' duration. If they remained in the city longer than three days they were compelled to
undergo quarantine. When the
epidemic began
general and gation of all
to
distinctly abate,
simultaneous cleansing and fumiinfected houses was organised. Each division of the town was provided with a gang of fumigators," consisting of nine men and an officer in charge. The process of fumigating began on December 12th, 1771, and was continued without interruption to the following spring. All small articles of no great value were burnt; the rest were well fumigated and then exposed to a current of air. The method employed is interesting. All the doors and windows of the room to be fumigated were closed, and twice a day for four daj7s a certain a
"
336
'
THE INDIAN MEDICAL GAZETTE.
quantity of the fumigating powder was burnt. The powder was composed of the following ingredients :?finely chopped leaves of the juniper plant, crushed juniper berries; guaiacum wood, (of each 61bs.), nitre, (8tbs.),. sulphur (Gibs.) and myrrh (2lbs). At the end of four days the
vvindows and doors of the room were left open -and air freely admitted for five days in the winter, or for two weeks at any other period of the year. All wooden articles were in the meantime washed with a mixture of vinegar, salt and hot water; hangings were well beaten and brushed, and other objects were washed with hot water or vinegar and water. The Imperial Senate offered the tempting reward of twenty roubles (at least ?3 at that time) to persons giving information of concealed cases of plague, or of bodies being secretly buried. The Government in fact spared neither expense nor trouble to put an end to the epidemic, and they were rewarded by seeing a steady decline, in the number of cases until, as already stated, the epidemic came to an end in December 1772, rather more than two years from the date of its first appearance. {To be continued.)
[Sept.
1898.
