Plague in the Orient with Special Reference to the Manchurian Outbreaks

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Abstract
1. Pneumonic Plague epidemics arise as a secondary manifestation of Bubonic Plague. 2. The prevalence of purely septicaemic cases towards the end of the epidemic is significant as a probable explanation of its decline and termination. 3. Subacute or chronic plague may exist among tarabagans (Arctomys bobac) in Mongolia and Siberia, giving rise to periodical outbreaks of bubonic plague in man, as a result of direct infection from injury due to skinning by trappers or marmot eaters. 4. The tarabagan is easily susceptible to pneumonic plague produced by inhalation of B. pestis in spray form. 5. The existence of Pneumonic Plague carriers has been proved in the 1921 Manchurian epidemic. 6. Rooms where patients have died of pneumonic Plague are not particularly dangerous. In all four instances recorded, sick patients travelling in railway carriages have not infected their fellow passengers. 7. Disinfectants and antiseptics, even in strengths above those usually employed, have very little effect upon plague sputum. Alcohol is the surest means of sterilising the hands and gloves in plague work. 8. We have cultivated B. pestis from seemingly dry sputum of partients. 9. The mask is the principal means of personal protection against Pneumonic Plague. 10. The problem of successful vaccination against Pneumonic Plague still awaits solution.

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