THE PLAGUE. We have bpfore
us
two documents, which furnish
some
inter-
esting information regarding the prevalence of plague in Mesopotamia in 1875, and the circumstances under which it arose and spread. They are (1) A Medical Report on Bushire for the year ending 31st March 1875. By Surgeon G. Waters, Civil Surgeon, Bushire ; and (2) A report on plague by Surgeon-Major W. H. Colvill, Civil-Surgeon, Baghdad, dated 5th June 1875. The scene of the disease was a portion of Mesopotamia?an alluvial tract of country lying between the Rivers Tigris and Euphrates, belonging politically to Turkish Arabia. Surgeon-Major Colvill himself visited the infected tracts and gives a most valuable account of the physical geography of the country in which the disease was prevalent and of the disease itself. Colonel Nixon, the Political Resident in Turkish Arabia, writes :?" Mesopotamia is the seat of the grandest scheme of irrigation that the human mind water
was
irrigated
conceived, and doubtless in ancient times the regulated ; but, in latter years, the having been neglected and undrained, the waters
ever
controlled and
area
of the canals have
overflowed the country and collected into
malignant, malarious fever known as surprised that in certain years, when the rivers Euphrates and Tigris overflow their banks, this disease which decimates the inhabitants of Mesopotamia becomes more prevalent than ever." Surgeon-Major Colvill journeyed down the Euphrates and through the country adjoining its right and left banks from Baghdad to Hillah, thence to Diwaniyah, thence to Samawah, and thence to Sook-il-Shiook, and gives a minute account of its geographical features. A series of canals has been cut from marshes which evolve the
plague.
One cannot therefore be
both sides
of the river which branch off into the
neighbouring
country, divide and sub-divide, and finally end in marshes inland
seas, the
water
which unite to form
in
some
slowly gathers into channels large aqueducts which open into the river
To such
further down.
an
extent
is this system carried out that
the main stream is either reduced to
places
or
of which
a
small size
Cultivation of rice, wheat and barley takes place in the neighbourhood of the canals and swamps, the water being let or lifted on to the ground, and where no canals or marshes or
obliterated.
exist the country is dry, bare and unproductive, thinly iniiabited by Bedouins who with their numerous camels carry the produce of the fertile tracts to the nearest marts. The Euphrates freshes appear to occur in spring. Ordinarily the water just suffices to fill the canals and channels and refresh the marshes and inland
occasionally ttie river overflows its banks and adjoining country, converting it into swamps.
but
lakes,
pours over the
Embankments have been constructed with a view to retain the redundant water in the main stream ; but these have proved Dr Colvill likens the whole arrangement to the circulation in the animal body, the canals being the arteries, the marshes and lakes the capillaries, and the channels and aqueducts
inefficient.
THE INDIAN MEDICAL GAZETTE.
48 the yains/
it issues from the
Euphrates is muddy ; marshes, where the fluid deposits sometimes becomes brackish ; here it becomes perfectly clear, but acquires a deep black tint from the carbon of decayed vegetation and a strong marshy flavor." The circumstances and habits of the people may be surmised from this description The water
as
its mud in the lakes and
it
"
of their land and labours. of
villages takes place
Dr. Colvill describes
"
four classes
groups of huts. One class, where irrigation with skin buckets on account of the height of the or
bank, and the huts [alongside the canals] are on dry ground, and antiseptic influence of earth. In the
therefore receive all the second class the on
the
ground
villagers only spend
the season of cultivation
and return to the towns for the rest of the year.
In the third class, the
villagers
are
driven
rise of the water from the rice fields and habitations twice
on
account of the
forced to
move
their
grouid they occupy during the greater part of the year is thoroughly cleansed by the rising river. Those three classes of villages are all free from plague and the disease is confined to the fourth class only. In this class the villages or groups of villages are permanent; they are on ground which is a foot or two lower than the surface of the water in spring and the ground is so saturated with water that the refuse of the village is neither absorbed nor can it be evaporated; for it acquires moisture from the ground and this moisture acquires the form of a bluish-black oily fluid which surrounds the huts and covers the paths, and stains the walls two feet from the ground; and in fact the village is in such a state of filth that it requires to be seen to be believed. It was this class of villages which was exclusively attacked in Hindeah in 1867. It is no exaggeration to say that every hut in this class of village is a filthy pig-stye, for, put the pig in the morning, and in the afternoon he will be wallowing in the mire, so moist and polluted is the ground." Here then we have a graphic picture of the breeding ground of oriental plague. The elements of the causation are,?stagnant water, a supersaturated soil, organic decomposition and the filthy habits of the population. The only bright point in the sketch is the conviction which it impresses that the causes are palpable and remediable. Add to the foregoing a famine and the circle of causes of the most virulent fever appears to be complete. The outbreak under discussion arose
a
year, while the
in the spring of 1874, among the hnts of Dnrara and
Afiche?marshy localities adjoining canals?and spread to one or two adjoining towns. It subsided as the weather grew hot, as it always does, and again began to prevail partially in auIn January 1875 it broke out in its old haunts afresh, tumn. and spread with renewed vigor throughout portions of the swama second time as the heat arrived. py tracts described, subsiding which took place in the two years is of deaths number The estimated at 4,000. In some villages estimates are given of 108 deaths in 1,000, 500 in 4,000, 150 in 4,000, 20 in 300, and 43 in 250. The people fled on its approach. Cases of undoubted communication are detailed, but the
diffusibility of the distemper appears to have been feeble as compared with other outbreaks. The history of the disease, however, clearly confirmed that of past outbreaks in exhibiting alternate period of dormancy and activity, and it is remarkable that an inundation of the Euph. rates and Tigris preceded this outbreak as well as that of 1831 and 1867. Without going into further detail the evidence adduced in this report lends strong support to the idea that plague is a fever of endemic origin, under certain telluric and hygienic
[February 1, 1876.
conditions, which acquires powers of diffusion and contagion,
varying greatly in degree, and that its prevalence and spread are greatly governed by meteorological conditions. Surgeon-Major Colvill gives a most interesting description of the disease which is founded on his own observation and supported by a detail of We shall take the liberty of quoting it in full:? cases. " The symptoms of this disease are fever from twenty-four to thirty hours, but often immediately before that the patient appears more than absent, rushes along the bazaar speaking to no one, enters his house mechanically shutting the door, and drops on to his bed as if in despair or wandering in his mind. When fever sets in, the patient becomes stupid ; his eyes are red and turbid, and he looks like a drunken man ; or he is delirious, and on being asked a question only answers with a moan. His tongue is swollen, generally blackish brown and fissured, sometimes white or yellow. There are invariably sordes about the teeth and gums; the thirst is intense, and in certain cases if patient is able to answer, he complains of pain in the epi-
the
being stabbed by a
knife.
In this
epidemic there patient vomiis hurried, and the pulse during the fever stage is very rapid. The urine, as a rule, is natural, often pale and abundant, but as the case gastrium
as
if
ia very little vomiting, though in certain cases the The breathing ted blood towards the end.
goes
he often passes blood from the bladder. There is almost constipation, and when diarrhoea appeared it
on
always
obstinate
good sign. "When the fever left, the patiprofuse perspiration and became sensible, though
looked upon
was
ent burst into very weak.
had
set
and
so
as a
a
"With the fever,
in, there
sudden
was
was
or
intense
the
pain swelling
the attendant often discovered
oftener
few hours after it
a
in the
groin, arm-pit, or neck of the lymphatic glands that a considerable enlargement on
complaint of pain, and no case occurred in which the glands wa3 absent. The glands in the groin" more frequently swelled than anywhere else ; next to that in the arm-pit, the glands of the neck swelling more rarely than any. The glands of one groin as a rule swelled, but sometimes in both groins and indeed anywhere; it was seldom one gland only, but a chain of half a dozen, one being larger than the other, size of a pigeon's egg. round, the size of a walnut, or oval, the Petechia occurred only in fatal cases, and then only two or the first
swelling
of the
three hours before death.
Carbuncles did not
occur
this year,
spring in a certain number of appeared a good sign. as Death occurred patients, and were looked upon in from two to seven days, and if the patient survived to the 12th day he was considered to have escaped. The mortality in the first half of the epidemic in a village "was from 93 to 95 per cent, of those attacked, but during the latter half the greater in Diwaniyati last
but
number of patients recovered, and it is to be remarked that though plague may be decreasing and most of the patients be recovering when the disease is transferred to another village, still that other village fares no better, as if from some predisposing cause a certain number of victims are marked out for destruction; while the decrease is due not to a diminution in the
vitality
of the disease, but
probably
to
those most liable are killed among the first. remarked that many more people fell ill
wind than when the wind servation that
was
made
one
the fact that
all
It was
constantly during a southerly
was in the north, and this is an obhundred and two years ago when
plague attacked Busreh." Surgeon Waters puts forward
the
a
surmise that plague is but
February 1, 1876.]
INTERNATIONAL MEDICAL
a malignant variety of malarious fever. He seems to rest his opinion on the following grounds, namely :? ls?.?That malarious disease is extremely common in the haunts of plague. 2nd.?That in particular years malarious fevers assume virulent types simulating plague in some important features. 3rd.?That the types of plague vary from a form which it is difficult to distinguish from the severer types of malarious fever to well pronounced and unmistakeable plague! 1th.?That the genetic condition of both are similar; and 5th.?That outbreaks of unmistakeable plague in some localities are coincident with the prevalence of severe remittent
fever in others. The
speculation
dence than Mr.
is
an
ingenious
one, but much
Waters has adduced
stronger
evi-
is necessary to establish
it. We might pursue it further by discussing points of resemblance between the plague of Mesopotamia and the malignant
fever3 which have devastated India ble
;
Mauritius and certain parts of us much beyond plausi-
but the evidence would not carry
analogies.
It
seeins
quite
certain h
that
these
home for oriental
plague
observations have established
a
which has hitherto been
traced to
always
new
>wever
Egypt
or
Syria.
CONGRESS,
PHILADELPHIA.
49
us
two documents, which furnish
some
inter-
esting information regarding the prevalence of plague in Mesopotamia in 1875, and the circumstances under which it arose and spread. They are (1) A Medical Report on Bushire for the year ending 31st March 1875. By Surgeon G. Waters, Civil Surgeon, Bushire ; and (2) A report on plague by Surgeon-Major W. H. Colvill, Civil-Surgeon, Baghdad, dated 5th June 1875. The scene of the disease was a portion of Mesopotamia?an alluvial tract of country lying between the Rivers Tigris and Euphrates, belonging politically to Turkish Arabia. Surgeon-Major Colvill himself visited the infected tracts and gives a most valuable account of the physical geography of the country in which the disease was prevalent and of the disease itself. Colonel Nixon, the Political Resident in Turkish Arabia, writes :?" Mesopotamia is the seat of the grandest scheme of irrigation that the human mind water
was
irrigated
conceived, and doubtless in ancient times the regulated ; but, in latter years, the having been neglected and undrained, the waters
ever
controlled and
area
of the canals have
overflowed the country and collected into
malignant, malarious fever known as surprised that in certain years, when the rivers Euphrates and Tigris overflow their banks, this disease which decimates the inhabitants of Mesopotamia becomes more prevalent than ever." Surgeon-Major Colvill journeyed down the Euphrates and through the country adjoining its right and left banks from Baghdad to Hillah, thence to Diwaniyah, thence to Samawah, and thence to Sook-il-Shiook, and gives a minute account of its geographical features. A series of canals has been cut from marshes which evolve the
plague.
One cannot therefore be
both sides
of the river which branch off into the
neighbouring
country, divide and sub-divide, and finally end in marshes inland
seas, the
water
which unite to form
in
some
slowly gathers into channels large aqueducts which open into the river
To such
further down.
an
extent
is this system carried out that
the main stream is either reduced to
places
or
of which
a
small size
Cultivation of rice, wheat and barley takes place in the neighbourhood of the canals and swamps, the water being let or lifted on to the ground, and where no canals or marshes or
obliterated.
exist the country is dry, bare and unproductive, thinly iniiabited by Bedouins who with their numerous camels carry the produce of the fertile tracts to the nearest marts. The Euphrates freshes appear to occur in spring. Ordinarily the water just suffices to fill the canals and channels and refresh the marshes and inland
occasionally ttie river overflows its banks and adjoining country, converting it into swamps.
but
lakes,
pours over the
Embankments have been constructed with a view to retain the redundant water in the main stream ; but these have proved Dr Colvill likens the whole arrangement to the circulation in the animal body, the canals being the arteries, the marshes and lakes the capillaries, and the channels and aqueducts
inefficient.
THE INDIAN MEDICAL GAZETTE.
48 the yains/
it issues from the
Euphrates is muddy ; marshes, where the fluid deposits sometimes becomes brackish ; here it becomes perfectly clear, but acquires a deep black tint from the carbon of decayed vegetation and a strong marshy flavor." The circumstances and habits of the people may be surmised from this description The water
as
its mud in the lakes and
it
"
of their land and labours. of
villages takes place
Dr. Colvill describes
"
four classes
groups of huts. One class, where irrigation with skin buckets on account of the height of the or
bank, and the huts [alongside the canals] are on dry ground, and antiseptic influence of earth. In the
therefore receive all the second class the on
the
ground
villagers only spend
the season of cultivation
and return to the towns for the rest of the year.
In the third class, the
villagers
are
driven
rise of the water from the rice fields and habitations twice
on
account of the
forced to
move
their
grouid they occupy during the greater part of the year is thoroughly cleansed by the rising river. Those three classes of villages are all free from plague and the disease is confined to the fourth class only. In this class the villages or groups of villages are permanent; they are on ground which is a foot or two lower than the surface of the water in spring and the ground is so saturated with water that the refuse of the village is neither absorbed nor can it be evaporated; for it acquires moisture from the ground and this moisture acquires the form of a bluish-black oily fluid which surrounds the huts and covers the paths, and stains the walls two feet from the ground; and in fact the village is in such a state of filth that it requires to be seen to be believed. It was this class of villages which was exclusively attacked in Hindeah in 1867. It is no exaggeration to say that every hut in this class of village is a filthy pig-stye, for, put the pig in the morning, and in the afternoon he will be wallowing in the mire, so moist and polluted is the ground." Here then we have a graphic picture of the breeding ground of oriental plague. The elements of the causation are,?stagnant water, a supersaturated soil, organic decomposition and the filthy habits of the population. The only bright point in the sketch is the conviction which it impresses that the causes are palpable and remediable. Add to the foregoing a famine and the circle of causes of the most virulent fever appears to be complete. The outbreak under discussion arose
a
year, while the
in the spring of 1874, among the hnts of Dnrara and
Afiche?marshy localities adjoining canals?and spread to one or two adjoining towns. It subsided as the weather grew hot, as it always does, and again began to prevail partially in auIn January 1875 it broke out in its old haunts afresh, tumn. and spread with renewed vigor throughout portions of the swama second time as the heat arrived. py tracts described, subsiding which took place in the two years is of deaths number The estimated at 4,000. In some villages estimates are given of 108 deaths in 1,000, 500 in 4,000, 150 in 4,000, 20 in 300, and 43 in 250. The people fled on its approach. Cases of undoubted communication are detailed, but the
diffusibility of the distemper appears to have been feeble as compared with other outbreaks. The history of the disease, however, clearly confirmed that of past outbreaks in exhibiting alternate period of dormancy and activity, and it is remarkable that an inundation of the Euph. rates and Tigris preceded this outbreak as well as that of 1831 and 1867. Without going into further detail the evidence adduced in this report lends strong support to the idea that plague is a fever of endemic origin, under certain telluric and hygienic
[February 1, 1876.
conditions, which acquires powers of diffusion and contagion,
varying greatly in degree, and that its prevalence and spread are greatly governed by meteorological conditions. Surgeon-Major Colvill gives a most interesting description of the disease which is founded on his own observation and supported by a detail of We shall take the liberty of quoting it in full:? cases. " The symptoms of this disease are fever from twenty-four to thirty hours, but often immediately before that the patient appears more than absent, rushes along the bazaar speaking to no one, enters his house mechanically shutting the door, and drops on to his bed as if in despair or wandering in his mind. When fever sets in, the patient becomes stupid ; his eyes are red and turbid, and he looks like a drunken man ; or he is delirious, and on being asked a question only answers with a moan. His tongue is swollen, generally blackish brown and fissured, sometimes white or yellow. There are invariably sordes about the teeth and gums; the thirst is intense, and in certain cases if patient is able to answer, he complains of pain in the epi-
the
being stabbed by a
knife.
In this
epidemic there patient vomiis hurried, and the pulse during the fever stage is very rapid. The urine, as a rule, is natural, often pale and abundant, but as the case gastrium
as
if
ia very little vomiting, though in certain cases the The breathing ted blood towards the end.
goes
he often passes blood from the bladder. There is almost constipation, and when diarrhoea appeared it
on
always
obstinate
good sign. "When the fever left, the patiprofuse perspiration and became sensible, though
looked upon
was
ent burst into very weak.
had
set
and
so
as a
a
"With the fever,
in, there
sudden
was
was
or
intense
the
pain swelling
the attendant often discovered
oftener
few hours after it
a
in the
groin, arm-pit, or neck of the lymphatic glands that a considerable enlargement on
complaint of pain, and no case occurred in which the glands wa3 absent. The glands in the groin" more frequently swelled than anywhere else ; next to that in the arm-pit, the glands of the neck swelling more rarely than any. The glands of one groin as a rule swelled, but sometimes in both groins and indeed anywhere; it was seldom one gland only, but a chain of half a dozen, one being larger than the other, size of a pigeon's egg. round, the size of a walnut, or oval, the Petechia occurred only in fatal cases, and then only two or the first
swelling
of the
three hours before death.
Carbuncles did not
occur
this year,
spring in a certain number of appeared a good sign. as Death occurred patients, and were looked upon in from two to seven days, and if the patient survived to the 12th day he was considered to have escaped. The mortality in the first half of the epidemic in a village "was from 93 to 95 per cent, of those attacked, but during the latter half the greater in Diwaniyati last
but
number of patients recovered, and it is to be remarked that though plague may be decreasing and most of the patients be recovering when the disease is transferred to another village, still that other village fares no better, as if from some predisposing cause a certain number of victims are marked out for destruction; while the decrease is due not to a diminution in the
vitality
of the disease, but
probably
to
those most liable are killed among the first. remarked that many more people fell ill
wind than when the wind servation that
was
made
one
the fact that
all
It was
constantly during a southerly
was in the north, and this is an obhundred and two years ago when
plague attacked Busreh." Surgeon Waters puts forward
the
a
surmise that plague is but
February 1, 1876.]
INTERNATIONAL MEDICAL
a malignant variety of malarious fever. He seems to rest his opinion on the following grounds, namely :? ls?.?That malarious disease is extremely common in the haunts of plague. 2nd.?That in particular years malarious fevers assume virulent types simulating plague in some important features. 3rd.?That the types of plague vary from a form which it is difficult to distinguish from the severer types of malarious fever to well pronounced and unmistakeable plague! 1th.?That the genetic condition of both are similar; and 5th.?That outbreaks of unmistakeable plague in some localities are coincident with the prevalence of severe remittent
fever in others. The
speculation
dence than Mr.
is
an
ingenious
one, but much
Waters has adduced
stronger
evi-
is necessary to establish
it. We might pursue it further by discussing points of resemblance between the plague of Mesopotamia and the malignant
fever3 which have devastated India ble
;
Mauritius and certain parts of us much beyond plausi-
but the evidence would not carry
analogies.
It
seeins
quite
certain h
that
these
home for oriental
plague
observations have established
a
which has hitherto been
traced to
always
new
>wever
Egypt
or
Syria.
CONGRESS,
PHILADELPHIA.
49
