International Plague Conference (1911 : Mukden).

Report of the International plague conference held at Mukden, April, 1911 online

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Report of the Inter

NATIONAL Plague

Conference



HELD AT

MUKDEN, APRIL, 1911




MANILA
BUREAU OF PRINTING

1912




321407



/






PREFACE

The epidemic of pneumonic plague, which raged in Manchuria
and north China during the winter months of 1910-11, caused the
death of nearly 50,000 people. No outbreak of this magnitude
and nature has occurred in modern times, and hitherto, as
our knowledge concerning epidemic pneumonic plague has been
meager, the study of the Manchurian epidemic, in all of its
features, was one of particular importance.

When the outbreak assumed alarming proportions, the Chinese
Government, actuated by the highest motives of humanity, invited
the eleven foreign powers represented at Peking to send special-
ists to attend an international plague conference for the purpose
of throwing further light upon the nature of the disease and
to give advice regarding methods for its prevention. This Con-
ference was held in Mukden, one of the larger cities which
suffered severely from the disease, where the Delegates were
officially received by His Excellency Hsi Liang, viceroy, and the
Hon. Sao Ke Alfred Sze, Imperial Commissioner. The proceed-
ings of this Conference and the information gained therefrom,
together with the results of certain supplementary bacteriolog-
ical investigations, constitute the present Report.

The Conference considered almost exclusively the subject of
the pneumonic form of plague and endeavored to investigate
the question of bubonic plague only in so far as it seemed to bear
some relation to or to throw light upon the Manchurian epidemic.

The publication of the Report was placed in the hands of an
editorial committee consisting of Dr. Martini, Dr. Petrie, Dr.
Stanley, and the writer. Dr. Martini has reread the evidence
in Part I of the bacteriological section and Drs. Petrie and
Stanley the evidence in Part I of the epidemiological section.
In addition, Dr. Petrie has prepared the epidemiological review
in Part III and Dr. Stanley the summary in Part III, regarding
the measures employed to combat the epidemic. The writer has
reread the entire Report and prepared the same for publication,
and also is responsible for the summary in Part III upon the
clinical, bacteriological, and pathological features of the disease.
I have to thank Miss H. E. Kupfer of the Bureau of Science and
Mr. S. H. Musick of the Bureau of Printing for much valuable
assistance in preparing the Report for the press.



[y Pi'eface

It was necessary to redraw all of the charts which are repro-
duced in the Report. This work was performed at the Bureau
of Science, Manila.

Owing to the fact that the same subject M^as often discussed
in several different sessions of the Conference and that epidem-
iological questions were sometimes considered in the bacterio-
logical sessions, at first, the reader may fear, upon turning
through the pages of the Report, that it will be difficult to
obtain all of the evidence upon some particular subject. How-
ever, if the Table of Contents together with the Index are con-
sulted carefully, it is believed that this difficulty will be obviated.
In any case, no better arrangement of the material could be made,
for the Chinese Government desired the original form of the
report of the Conference to be retained so far as possible. For
the reason that the programme arranged for the daily sessions
of the Conference was not always fully carried out, a summary
of the proceedings of each session also has been added to the
Table of Contents and to the chapter headings.

The publication has been divided into three parts : Part I, in
addition to the proceedings in relation to the opening of the
Conference and the arrangement of the programme and of the
Rules of Procedure, is occupied almost entirely with the evidence
presented regarding the epidemic and the discussion regarding
the same. Part II consists of two sections : The first comprises
the discussions which took place relating to the preparation of
the provisional conclusions and resolutions forming the Interim
Report. In this section the reader probably will find little of
scientific interest; however, it was the wish of the Chinese Gov-
ernment that the complete record of the Conference should be
published. The second section of Part II consists of the Interim
Report to the Chinese Government and of that of the closing
ceremony of the Conference. Part III consists of a summary
of our knowledge gained from the study of the epidemic. In
regard to the record of the proceedings (in Parts I and II),
it may be stated that, because so many nationalities were repre-
sented in the personnel of the Conference and for this reason
there was the necessity for the majority of those presenting
evidence to speak in a foreign tongue (the official languages
actually employed were English, German, and French) , the task of
conveying in the record the exact idea of the speaker sometimes
was not an easy one. However, the proceedings were reread
by the Editorial Committee and the Medical Secretary as soon
as the record of each session had been typewritten, and authors
were consulted regarding any testimony in which there appeared



Preface V

to be a discrepancy between the remarks made by the individual
and the stenographic record of the same. In addition, minutes
of the proceedings of each session were submitted to the Con-
ference at the beginning of the following session for acceptance,
for revision, or for correction. It was largely due to the efforts
of Dr. Aspland, the medical secretary, Mr. Lauru, the secretary,
and Mr. Woodhead, the official stenographer, aided by their
assistants, that the proceedings of the Conference were so com-
pletely recorded. Fortunately in a number of instances the
original manuscripts written in German also were presented, and
these have been carefully consulted in editing the Report. Certain
discrepancies will be found in different portions of the Report
regarding the dates of infection in certain towns and the number
of people infected. It was not always found possible to harmonize
these, as the dates and statistics given in the official records
sometimes were found to vary. The reader may not always be
reconciled to the spelling adopted in the Report for Chinese and
Manchurian geographical names. The writer is not aware of
any definitive authority on this subject, but has striven to obtain
uniformity.

In editing the Report for publication, it was found that in
several instances the evidence upon certain subjects discussed
in the bacteriological sessions was not entirely complete, and it
was necessary to perform further experiments to complete the
evidence; also, upon the subject of the susceptibility to infection
with pneumonic plague of donkeys and dogs, and the question of
the efficacy of vaccination against pneumonic plague, the Con-
ference recommended that further experimental work be per-
formed. Experiments on these subjects have been carried out
by Dr. Teague and the writer, and the results briefly referred
to, either in footnotes in Part 1 or in the text in Part III, Chapter
III, of the bacteriological section of the Report.

Richard P. Strong.
Manila, P. I., October, 1911.



LIST OF DELEGATES TO THE INTERNATIONAL
PLAGUE CONFERENCE



AMERICA, UNITED STATES OF

Dr. R. P. Strong, Ph. B., M. D.; professor of Tropical Medicine, chief of
Biological Laboratory, Bureau of Science, Manila.

Dr. Oscar Teague, M. S., M. D.; assistant. Biological Laboratory, Bureau
of Science, Manila.

AUSTRIA-HUNGARY

Dr. EuGEN WORELL, surgeon. Imperial and Royal Austro-Hungarian Navy.

FRANCE

Dr. C. Broquet, surgeon, French Army; formerly assistant director of the
Pasteur Institute in Indo-China (captain).

GERMANY

Professor Dr. Erich Martini, surgeon-general. Imperial German Navy
(attached to the Ministry of Interior).

GREAT BRITAIN

Dr. Reginald Farrar, M. D., D. P. H.; Local Government Board inspector,
London.

Dr. G. F. Petrie, M. D. ; Lister Institute of Preventive Medicine ; member
of Plague Research Commission, India 1905 to 1907; bacteriologist in
charge, Investigation of Rat Infection in East-Anglia.

Dr. G. Douglas Gray, M. D.; physician to H. B. M.'s Legation, Peking.

ITALY

Dr. GiNO Galeotti, professor of Experimental Pathology, Royal University

of Naples, Italy.
Dr. Dl Giura, surgeon, Italian Navy; physician to the Italian Legation.

Peking.
Dr. Ernesto Signorelli, assistant. Laboratory of Experimental Pathology,

Royal University of Naples, Italy.

JAPAN

Professor Dr. S. Kitasato, director of the Imperial Institute for Infectious
Diseases, Tokyo; F. R. S. London. (Royal professor, Prussia.)

Dr. Akira Fujinami, professor of Pathological Anatomy, Imperial Uni-
versity of Kyoto.

Professor Dr. G. Shibayama, chief of Clinical Department, Imperial In-
stitute for Infectious Diseases, Tokyo.

Dr. M. Uyama, staff surgeon-general, Japanese Army.

Dr. K. Shimose, surgeon, Japanese Army; physician to H. I. J. M.'s
Legation, Peking (lieutenant-colonel).

vii



viii List of Delegates

MEXICO

Dr. O. Gonzalez-Fabela, professor of Bacteriology, National School of
Medicine; bacteriologist of the Pathological Institute and of the Su-
perior Board of Health, Mexico.

NETHERLANDS

Dr. F. H. Hehewerth, surgeon, Netherlands Indian Army (captain).

RUSSIA

Professor D. Zabolotny, professor of Bacteriology, Medical Institute, St.
Petersburg; chief of Syphilogical Laboratory, Imperial Institute of
Experimental Medicine, St. Petersburg; chief of Russian Commission
for Plague Investigation in China.

Dr. S. T. Zlatogoroff, assistant chief of Bacteriological Laboratory,
Medical Institute, St. Petersburg, member of Russian Commission
for Plague Investigation in China.

Professor Dr. G. Koulecha, prosector Municipal Hospital of Ste. Marie-
Madeleine, St. Petersburg; member of the Russian Commission for
Plague Investigation in China.

Dr. L. Padlevsky, assistant, Institute of Pathology; assistant director,
Institute of Bacteriology, Imperial University of Moscow; member
of Russian Commission for Plague Investigation in China.

Dr. Marie Ssouragewskaja, assistant. Institute Sero-diagnostic, St. Peters-
burg; assistant member of Russian Commission for Plague Investi-
gation in China.

Dr. Anna Tchourilina, assistant, Bacteriologic and Hygienic Laboratory,
High Medical School for Women, St. Petersburg; assistant member
of Russian Commission for Plague Investigation in China.

CHINA

Dr. Wu Lien Teh, B. C, M. A., M. D. (Cambridge) ; assistant director

of Imperial Army Medical College, Tientsin.
Dr. Ch'uan Shao Ching, otticial of the Fourth Civil Rank, designated

assistant sub-prefect; professor of Medicine, Therapeutics, and

Medical Jurisprudence, Imperial Medical College, and medical officer,

Pei-Yang Hospital, Tientsin.
Dr. Fang Chin, M. D. (Chiba) ; professor of Bacteriology, Imperial Army

Medical College, Tientsin.
Dr. Y. S. Wang, doctor in charge of Sanitary Hospital; assistant director,

Antiplague Bureau, Mukden; expectant district magistrate.
Dr. R. A. P. Hill, M. B. (Cambridge), D. P. H. (London); lecturer in

the Union Medical College, Peking.
Dr. W. H. Graham Aspland, M. D., F. R. C. S.; professor in the Union

Medical College, and Peking University; medical superintendent of

Anglican Hospital, Peking.
Dr. Dugald Christie, F. R. C. P., F. R. C. S. (Ed.) ; director of the Mukden

Hospital and medical adviser to the Manchurian Government.
Dr. Arthur Stanley, M. D., B. S. (London), D. P. H.; health officer of

the Shanghai Municipal Council.
Dr. Paul B. Haffkine, director of the Russian Plague Hospital, Harbin.



List of Deputies and Secretaires ix

DEPUTIES

RUSSIA

Monsieur M. kokcharoff, president of the Russian Antiplague Bureau,

Harbin.
Dr. Paul Woscressensky, surgeon, Chinese Eastern Railway.
Dr. F. Iasienski, chief of the Medical Staff, Chinese Eastern Railway.
Dr. WiNCENTY BoGUCKi, medical superintendent of the Russian Antiplague

Bureau, Harbin.

CHINA

Dr. Woo Wai U, surgeon. Imperial Guard; deputy from the Ministry of

Interior, Peking.
Dr. J. Chabaneix, surgeon, French Army; professor at the Imperial School

of Medicine, Tientsin; attached to the Sanitary Department of the

Province of Chihli (major).
Dr. C. W. Wong, assistant professor. Imperial Army Medical College,

Tientsin; deputy from Fengtien Province.
Mr. L. S. Wang, pharmaceutical adviser to the Government of Fengtien

Province; deputy from Fengtien Province.
Dr. M. S. Chung, taotai designated; director of the Government Hospital,

Kirin; deputy from Kirin Province.
Dr. Wang Hsing-an, deputy from Heilungkiang Province.
Dr. B. Y. Wong, deputy of the Imperial Chinese Red Cross Society and the

Chinese Public Isolation Hospital, Shanghai.
Dr. P. Quincey, resident physician, Shanghai Hospital.

SECRETARIES

Dr. W. H. Graham Aspland (as above), medical secretary.

Mr. C. H. Lauru, deputy commissioner. Imperial Maritime Customs, sec-
retary.

Mr. SzE Shao-tsang, official with brevet of the Third Civil Rank, member
of the Waiwupu, Chinese secretary.

Mr. Tsang Woo Huan, official with brevet of the Second Civil Rank, member
of the Waiwupu, secretary interpreter.

Mr. H. G. W. Woodhead, M. J. I., official stenographer.

Mr. Ll KWAY Yoong, Chinese Imperial Customs, clerk.

Mr. Ll Wen Hoei, Chinese Imperial Posts, clerk.



CONTENTS



Part I

PRESENTATION OF EVIDENCE REGARDING THE EPIDEMIC

OPENING CEREMONY

PROGRAMME

Page.

1. Reception of Delegates and guests by His Excellency Hsi Liang,

viceroy, and the Hon. Sao Ke Alfred Sze, Imperial commissioner.. 3

2. Opening of the Conference.

a. Message from His Imperial Highness the Prince Regent.... 3

b. Address of welcome by His Excellency the Viceroy 4

c. Address by the Imperial Commissioner, the Hon. Sao Ke

Alfred Sze 5

d. Reply by the representative of the foreign Delegates 8

MINUTES OF A SPECIAL MEETING OF DELEGATES

PROGRAMME

1. Adoption of rules of procedure 10

2. Arrangement of programme of questions for discussion by the Con-

ference regarding the epidemic of pneumonic plague 10

3. Rules of procedure for Part I , 12

4. Programme for Part I of the Conference .. - 14

SESSION I

PROGRAMME

1. Preliminary business .- 18

2. Address of the Chairman 18

SESSION II

PROGRAMME ARRANGED FOR THE DAY

A. Epidemiology 26

1. The origin of the past epidemic.

2. The diffusion of the past epidemic throughout the affected

areas in relation to time and place, and the influence on
, ,., its dissemination of roads, rivers, railways, and shipping.

3. The relation of animal plague to the past epidemic.

a. Tarbagans.

b. Rats.

summary of PROCEEDINGS OF THE SESSION

1. Preliminary business 26

2. Some observations on the origin of plague in Manchouli; discus-

sion 27,30

3. The history of the spread of plague in north China 31

4. Epidemiology of the plague in southern Manchuria; discussion 33,34

5. Epidemiology of plague in Manchuria; discussion , 35,36

xi



xii Contents

SESSION III

PROGRAMME ARRANGED FOR THE DAY

Page.

C. Bacteriology and Pathology 39

1. Characters of the strain of the bacillus isolated during the
epidemic.

a. Cultural tests.

b. Agglutination tests.

c. Toxins.

d. Virulence.

e. Pathogenicity to animals.

f. Vitality of the bacillus on inanimate objects.

g. Resistance to exposure to varying conditions — dry-

ing, sunlight, freezing, etc.

SUMMARY OF PROCEEDINGS OF THE SESSION

1. Preliminary business 39

2. Characters of the strain of the bacillus isolated during the epi-

demic; discussion 40, 42

3. Other papers on the subjects given in the programme above 43, 50, 53

SESSION IV

PROGRAMME ARRANGED FOR THE DAY

A. Epidemiology 57

3. The relation of animal plague to the past epidemic.

b. Rats.

c. Other animals (pigs, dogs, horses, etc.).

4. The character of the past epidemic curves as illustrated

in cities and districts.

5. The relation of the past epidemic to climatic influences,

atmospheric temperature, and humidity.

SUMMARY OF PROCEEDINGS OF THE SESSION

1. Preliminary business 57

2. Rat infection; discussion 59,60

3. Discussion on infection of pigs, dogs, and donkeys 62

4. The effect of temperature upon the mortality curves 64

5. Relation of mortality to meteorological conditions 66

SESSION V

Special session for the purpose of discussing subsection 1 of the bacteriolog-
ical and pathological section

PROGRAMME ARRANGED FOR THE DAY

C. Bacteriology and Pathology 67

1. Characters of the strain of bacillus isolated during the
epidemic :

a. Cultural tests 67

b. Agglutination tests -. 69

c. Toxins 70

d. Viiulence 71

e. Pathogenicity to animals 71



Contefits xiii

SESSION VI

PROGRAMME ARRANGED FOR THE DAY

Page.

C. Bacteriology and Pathology '. 77

f. Vitality of the bacillus on inanimate objects.

g. Resistance to exposure to varying conditions — e. g., drying,

sunlight, freezing, alternate freezing and thawing, etc.
2. Infectivity of the plague patient.

a. Infectivity of the excreta.

b. Infectivity of the breath.

c. Infectivity of fleas and other insects parasitic on the

patient.

d. Infectivity of corpses.

SUMMARY of PROCEEDINGS OF THE SESSION

1. Preliminary business 77

2. Method of conservation of plague organs for diagnosis 78

3. Infectivity of the breath 83

4. Infectivity of corpses 87

5. Discussion of above papers and other topics of the programme as

given above 88, 90, 93, 94

SESSION VII

PROGRAMME ARRANGED FOR THE DAY.

C. Bacteriology and Pathology 96

3. Bacteriological diagnosis of plague pneumonia.

a. Examination of the sputum.

b. Examination of the blood.

c. Lung puncture.

d. Spleen puncture.

4. Immunity.

a. Prophylactic inoculations.

b. Serum-therapy.

SUMMARY OF PROCEEDINGS OF THE SESSION

1. Preliminary business 96

2. Bacteriological diagnosis of plague pneumonia by examination of

sputum 96

3. Bacteriological diagnosis by the examination of blood 97

4. Vaccination against plague 98

5. Prophylactic inoculations with nucleoproteid 99

6. Results of prophylactic inoculations with killed cultures made at

Fuchiatien 101

7. Serum-therapy 102, 103

8. Results of serum-therapy in experimental pneumonic plague in

animals 108

9. Discussion of the above papers and other topics of the pro-

gramme 112, 113, 114, 115



xiv Conte7its

SESSION VIII

PROGRAMME ARRANGED FOR THE DAY p.

C. Bacteriology and Pathology 118

4. Immunity.

a. Prophylactic inoculations.

b. Serum-therapy.

5. Morbid anatomy especially in relation to the mode of infec-

tion in plague pneumonia.

summary of proceedings of the session

1. Preliminary business 118

2. Serum-therapy in Bombay 118

3. Discussion on prophylactic inoculations (continued) 121

4. Discussion on serum-therapy 125

5. Aspects of question of prophylactic inoculation against pneumonic

plague 127

6. Prophylactic and therapeutic plague-serum injections and ag-

glutination; discussion 129, 133

7. Morbid anatomy 135

SESSION IX
programme arranged for the day

I

C. Bacteriology and Pathology 143

5. Morbid anatomy, especially in relation to the mode of in-
fection in plague pneumonia (continued).

II
B. Clinical Data 163

1. Types of the disease met with during the past epidemic.

2. Incubation period.

3. Symptoms.

4. Diagnosis.

summary of proceedings of the session

1. Cases of plague infection among donkeys 143

2. The pathologic anatomy of plague pneumonia in Manchuria 144

3. Morbid anatomy 151

4. Remarks on the pathogenesis of the present epidemic 155

5. Discussion on the above four papers 157, 159

6. Clinical data 163

7. Diagnosis of pneumonic plague in its early stages 166

8. Types of the disease and the incubation period 168

9. Notes on the incubation period and treatment with serum 170

10. Summary of clinical symptoms, etc 171

SESSION X

programme arranged for the day

I

B. Clinical Data (continued) 179

1. Types of the disease met with during the past epidemic

apart from primary pneumonic plague.

2. Incubation period.

3. Symptoms.

4. Diagnosis.

5. Prognosis.

6. Treatment: Serum, vaccine, chemotherapy, drugs.



Contents XV

IT Pase.

A. Epidemiology :.. 191

6. Has there been a spontaneous decline in the past epidemic —

i. e., apart from the influence of preventive measures;
and, if the evidence of this exists, what is the cause of
the decline.

7. Data relating to the origin of infection in villages and

towns :

a. The importation of persons incubating the disease,

or of sick persons, or healthy carriers of the
disease.

b. The importation of infected clothing or merchandise.

8. The infectivity of the plague patient.

SUMMARY OF PROCEEDINGS OF THE SESSION

1. Preliminary business 180

2. Clinical notes of an epidemic of pneumonic plague in Bombay and

its relation to the present epidemic 180

3. Discussion of clinical features of the disease; diagnosis, prog-

nosis, etc - 182

4. Data relating to the origin of infection in villages and towns. 191

5. Spontaneous decline of the epidemic 194, 195

6. Origin of the infection in Tientsin 196

7. Infectivity of the patient; noninfectivity of merchandise or cloth-

ing 196,197

8. Infection by healthy carriers of the disease 198

9. The plague epidemic at Harbin 200

SESSION XI

PROGRAMME ARRANGED FOR THE DAY

A. Epidemiology 208

6. Has there been a spontaneous decline in the past epi-

demic — i. e., apart from the influence of preventive
measures; and, if the evidence for this exists, what is
the cause of the decline (continued).

7. Data relating to the origin of infection in villages and

towns.

a. The importation of persons incubating the disease,

or of sick persons, or healthy carriers of the
disease (continued).

b. The importation of infected clothing or mer-

chandise.
9. The infectivity of houses in which one or more plague
cases occurred.

a. Danger from the contamination of floors, k'angs

[brick beds], food, and vessels for food, etc., by
sputum of plague patients.

b. Have fomites (infected clothing, etc.) played any

part in the spread of the epidemic as agents in
the spread of infection.

c. Is dust capable of carrying infection.



xvi Contents

d. Artificial heating of rooms and ventilation or the

absence of ventilation of rooms as factors which
may influence the infectivity of houses.

e. The relation of overcrowding and the habits of the

people to the spread of the disease within houses.

f. The duration of infectivity of rooms or houses.

10. The question of variation in virulence of the bacillus at

different stages of the past epidemic, as evidenced by
the average duration of the illness, by the case mor-
tality, and by the inoculation of animals.

11. Evidence as to natural immunity in persons exposed to

infection.

12. The question of the danger of transmission of the in-

fection to rats during the past epidemic.

a. By the sputum of plague patients.

b. By gnawing exposed plague corpses.

c. By fleas and other insects.

d. By inhalation of plague bacilli.

SUMMARY OF PROCEEDINGS OF THE SESSION

Page.

1. Preliminary business 209

2. Discussion on the cause of the decline of the epidemic 210

3. Data relating to the origin of infection of towns and villages.. 217

4. Some instances of healthy carriers of the disease, with evidence

of its transmission by infected clothing 226

5. General discussion of programme 227

SESSION XII

PROGRAMME ARRANGED FOR THE DAY

Preliminary discussion on the subject of the tarbagan in its relation

to plague 234

A. Epidemiology 234

13. Statistical data:

a. The death rate from the disease in different com-

munities.

b. Age incidence.

c. Sex incidence.

d. Race incidence.

e. The incidence in various classes of the population

as judged by their social condition.

f. Occupational incidence.

g. Incidence among contacts at different stages of

the past epidemic.

h. Statistics relating to the liability to infection of
doctors, students, nurses, attendants, and mem-
bers of the sanitary staff.

i. Case mortality in different places.
D. Measures Employed to Combat the Epidemic 244

1. Prophylactic inoculations with vaccines and sera.

d. Local and constitutional effects produced by vac-
cines and sera obtained from different sources.

2. Measures to be taken to limit the spread of infection in

an infected town or village.




Online LibraryInternational Plague Conference (1911 : Mukden)Report of the International plague conference held at Mukden, April, 1911 → online text (page 1 of 51)