Bubonic plague has been the most feared disease throughout history. Most people are aware of its ravages but see it as a pestilence of the middle ages. Few are aware that it remains a disease of the twenty-first century, is endemic in many parts of the developed and underdeveloped world, and has the potential to result in a new epidemic or even a pandemic. While much has been written about the epidemiology of plague, we remain uncertain as to why the disease has become epidemic and equally why the great pandemics have resolved.
Plague came to Australia in 1900. It was part of the 1884 pandemic that started in southern China and spread throughout central Asia and the Pacific countries. The mortality and morbidity associated with the 1900 outbreak—303 reported cases and 103 deaths—were by any measure small. In 1867, measles killed 740 and in 1875, scarlet fever killed 575. Yet, it invoked a level of hysteria and fear similar to community reaction centuries earlier. One hundred years later, the SARS outbreak has many parallels.
Australia contributed significantly to the understanding of plague epidemiology and management. Dr. John Ashburton Thompson, then Head of the NSW Board of Health, should be recognized as one of the great medical leaders of his country.
The plague outbreak itself, combined with the work of Thompson, Dr. Frank Tidswell, his bacteriologist deputy, and others caused a revolution in social medicine in Australia.
Despite being a medical graduate with a passing interest in medical history, I was unaware of the plague outbreak in Sydney. I became aware of it through the story of Tom Dudley, a sailor/yachtsman who was tried and convicted for cannibalism and who ultimately became the second reported case of bubonic plague and the first death on February 22, 1900. While Sydney was a very different place in 1900, there is much about human nature that appears to have changed little, consonant with the old adage that “the more things change, the more they stay the same.”
The science of plague
The responsible organism of plague is Yersinia pestis, a gram negative bacterium named after Alexandre Yersin. The disease is transmitted by the bite of a flea, commonly the rat flea Pulex cheopis. The flea’s preferred hosts are the rat or other wild rodents. The organism multiplies in the gut of the flea and before feeding on its new host, the flea regurgitates the obstructed bacterial mass into the new victim.
Plague manifests in four clinical forms: bubonic, septacaemic, pneumonic, and pestis minor. The most common form and the one that has given the plague its historical fame is bubonic plague or the Black Death. The bacillus enters the skin through the bite of a flea or the contamination of abrasions with flea or rat feces. The incubation period is between two and six days, after which there is fever, malaise, headache, rigors, and characteristic pain and swelling in the affected lymph nodes (the buboes of plague literature), usually in the armpits, groin, and neck. The buboes become painful, assume a purplish appearance, and ultimately ulcerate, adding to the historical offensiveness of the disease. Untreated recovery may occur, but frequently the disease progresses to the pneumonic and septicemic phase with nearly 100% mortality. The disease may present as a primary septicaemia with the bacillus bypassing the lymphatic glands and causing the fatal septicaemic form of the plague. The pneumonic phase of bubonic plague (or the primary pneumonic type) is the only form that can spread directly from person to person by airborne droplets. It is characterized by an overwhelming pneumonia and death in 100% of cases occurring within one to three days if untreated.
There have been several outbreaks of pneumonic plague in the twentieth century not associated with plague epidemics. Between 1910 and 1911, 60,000 died in Manchuria and between 1919 and 1924, small outbreaks occurred in Oakland and Los Angeles. In Australia there was one small outbreak of pneumonic plague in 1905 at Maryborough in Queensland.
The fourth clinical manifestation of plague, pestis minor, appears to be a variant of the classical bubonic plague, with buboes but without severe systemic symptoms and usually recovery. Although it is said that there was a reported outbreak of pestis minor in the Mossman district of north Queensland in 1907, one wonders if the mild cases occurring in the major outbreaks were in fact so called pestis minor. Arthur Payne was said to have a mild dose of the first case of plague in Sydney (reported January 19, 1900) and recovered quickly. Antibiotics were introduced in the 1930’s and revolutionized the treatment of plague. The mortality rate is now around 5% if a diagnosis is made and treatment promptly introduced. However, the rate is 20% if diagnosis is delayed, which is why mortality remains high even with treatment.
At the time of the Sydney outbreak, the only effective medical intervention was Haffkine’s serum, which significantly reduced mortality rates from around 70% to 25% in those inoculated and those who were asymptomatic.
Key players in the modern day understanding of plague were;1
- Alexandre Yersin, sent by the French government from The Pasteur Institute in Paris to Hong Kong in 1894. He is widely credited with the identification of the plague bacillus. His findings were presented to The Academy of Science in Paris on July 30, 1894.
- Professors Kitasato and Aoyoma were sent to Hong Kong by the Japanese government. They isolated bacilli from plague victims and reported their findings on July 7, 1894 (prior to Yersin announcing his findings), which were subsequently published in The Lancet on August 25th the same year.
- E.H. Hankin, P.L. Simond in 1898 in Bombay, and Thompson in Sydney in 1900 recognized the role of rat plague.
- M. Orgata from Formosa in 1897 and P.L. Simmond in 1898 observed the transmission of the disease by fleas.
- A.W. Bacot and C.J. Martin in 1914 described the specific mechanism of transmission of plague.
The plague bacillus is more widespread now than probably at any other time in history.1 Until the twentieth century, endemic plague was confined to central and north eastern China, Mongolia, and the borders of the Caspian Sea, the foothills of the Himalayas, and around the great lakes of Central Eastern Africa. With the introduction of more rapid sea travel, reservoirs became established in California, Argentina, and South Africa. In the United States, 34 species of wild rodents have been found to be chronically infected.1 Of particular interest is the introduction into species such as squirrels, raccoons, and foxes, which have become successful urban dwellers.
These reservoir populations live in symbiotic harmony with their rodent hosts. The trigger for the outbreak and spread to humans is not clear, but the infection of a non-immune population of rodents plays a clear part since human epidemics are preceded by the death of large numbers of diseased rats. The fleas quickly leave the cooling body of the rat and under appropriate urban conditions, seek the less preferred host: humans.
The association of excess deaths in rat populations was not fully understood in the west until the very late 1800’s. However, it was well-recognized in non-western societies. The Bhagavata Purana, a sacred Sanscrit text written many centuries ago, urged householders in Hindustan to vacate their homes as soon as rats fell from the roof and died.2
The Chinese in YunNan, the province where the 1900 outbreak originated, were also aware of the association of high rat mortality. In 1792, Chaochow Shih Tao-nan composed a poem entitled “Death of Rats” just a few days before his death from plague. He wrote, “Few days following the death of rats/Men pass away like falling walls!”3 Yersin and Ogata in Formosa between 1897 and 1902, Simond and Hankin in India in 1898, and Thompson in Sydney in 1900 all contributed to the recognition of the part played by rats.4 Prior to these works, plague was considered to be a gastrointestinal infection. The early management of the Sydney outbreak reflects a lack of understanding by the non-medical authorities of the true method of spread. In 1994, the World Health Organization reported 70 deaths among 267 cases in Zaire. In 1992, a total of 1,768 cases including 198 deaths were reported to WHO from nine countries— Zaire, 140 deaths; Madagascar, 26; Vietnam, 13; China, 6; Mongolia and Peru, 4; Burma, 3; and the United States, 2.5
Dr Evgueny Tikhoirov of WHO’s division of communicable diseases said, “Advances in medicine and the application of these health measures have almost removed the threat of large epidemics of human plague, but in countries where the disease is endemic the risk of human infection is still considerable.”5
Keeling and Gilligan6 described the use of computer modeling to better understand the impact of rat populations on the spread of plague to humans in Nature. The computer model shows that plague can persist in very low rat populations (about 60,000) and spreads to humans only when some random event reduces rodent numbers. The modeling simulates what happens when there is a drastic reduction in rat numbers, caused by anything from mass poisonings to a strangely dressed Hamlen man playing a hypnotic pipe. They argue that culling rats will not succeed if the plague has already spread to the human population and it may be better to let the rats run free, giving the fleas more rodent targets. This is not to say that keeping rat populations very low reduces the likelihood of an outbreak. The work does show that the ability of the disease to persist with very low rat populations explains how the plague can seem to disappear for centuries and then reappear without obvious reason.
There have been three great documented plague pandemics: the Justinian plague in the 6th century, the Black Death which started in the 14th century, and pandemic (which appears to have no exotic title) in the 20th century. There are also other well-described references to the bubonic plague dating back as far as 1320 B.C. and there are references in the Bible (Samuel V-VI), as well as evidence of outbreaks in 100 AD in Libya, Egypt, and Syria.
The plague of Justinian originated in AD 540. Two years later, it devastated Constantinople and killed up to a quarter of the Eastern Mediterranean population before spreading to western Europe.1 This pandemic lasted for 200 years. The Black Death pandemic raged from the 14th to the 17th century and was estimated to have killed approximately one half to one third of the population of Europe and England. Several outbreaks occurred in London during this time and finally ended with the great fire of London. A number of recent studies trying to quantify the mortality rates have consistently come up with estimates of between one third and one half of Europe’s population falling victim; i.e., around 20 million people dying in a three year period.
The pandemic originated in China in 1346. It migrated to the Black Sea, where it broke out among the Tartars fighting Italian merchants in the Crimea. The Christians are said to have taken refuge in the citadel at Kaffa (now Feodosia) where they were besieged. Before withdrawing (themselves decimated by the plague), the Tartars catapulted the corpses of their infected soldiers over the walls, introducing plague to the Christians (a well-documented case of bacterial warfare and perhaps in modern parlance the first use of weapons of mass destruction), who took it back to Genoa and then to the rest of Europe2 and as they say, “The rest is history.”
The 20th century pandemic has its origins in Yun-Nan in China, where the disease is thought to have established itself between 1800 and 1850.3 Its containment was breached when an uprising in 1855 by the Mohamedans required troops to be sent in. The returning troops and associated refugees brought plague back to the provincial capital Yun-Nan-Fu (now Kunming) in 1866. There was a slow spread over the next 28 years, reaching Hong Kong and Canton in 1894. By this time steamships were replacing sailing ships, which allowed for the rapid movement of goods and also of the rat/flea population.
Plague in Sydney
The official story of the plague outbreak in Sydney is documented in meticulous hand-written minutes of the NSW Board of Health held in the NSW State archives.1
The Board Chairman Dr. John Ashburton Thompson (1846-1915) played a key role and stands out as an enlightened man of principle. He accepted the relationship between dead rats and human infection early in the outbreak and constantly tried to influence government behavior based on the correct causative factors. Educated at Guys and Middlesex Hospitals, Thompson was formally trained in public health and epidemiology.2 In fact, in 1900 he was the only trained public health expert in the colony.
Together with his work on smallpox, leprosy, and the lead poisoning outbreak in Broken Hill, he deserves far greater recognition than he has been accorded. Thompson retired from his positions of Chief Medical Officer and President of the Board of Health in February, 1913, two years before his death.
The slow spread of plague gave the Board of Health adequate warning. There was never any doubt plague would arrive on the east coast. As early as December 1898, the Board had proposed Dr. Frank Tidswell visit India to study the outbreak in that country.3
At a meeting on December 28, 1899, the Board was told of the outbreak of plague in Noumea and ships coming from that port were quarantined, although passengers had already disembarked from the “Pacfique” before the quarantine was put in place. The later decision to allow ships to be quarantined in Noumea for 12 days before leaving for Sydney reflects the lack of understanding of the disease’s transmission.
At the first meeting of the Board in the new year (January 2, 1900), the protest of the French Consul to the quarantine of the ‘Maroc’ in Newcastle after leaving Sydney was noted. On January 15th, the Board discussed the possible outbreak of plague in South Australia (this proved to be a false alarm). Police had been instructed to collect the names of all South Australian tourists.4 On January 23, 1900 the Board noted the first possible case: Arthur Payne, a dock worker of Dawes Point. The diagnosis was confirmed, albeit a mild case (an example of so-called pestis minor) and together with his family and two unfortunate visitors to his house, were moved the Quarantine Station at North Head.
The community living around the waterfront was warned by the Board to look for unusual numbers of sick or dead rats and was given instructions on the safe destruction of the dead rats.
From January to August, 1900, 264 plague cases and 1,832 contacts were quarantined at North Head. There are 104 victims of plague buried at the station.5
Incidence of reported cases peaked in April 1900 with 105 reported cases declining to 1 case in August and no cases in September and October.6 There were sporadic reportings until 1908 but no real epidemic after August of 1900 except in 1902, when 130 cases were reported between January and July of that year. As a result of the experience gained, the mortality was reduced by one third and the financial cost to the community far less. Only the sick were quarantined and patients were treated at the Coast Hospital (as were sufferers of other infectious diseases).
In the same year, there was an outbreak of plague amongst marsupials at the zoo, then located at Moore Park near the city tip.7 It is interesting that this outbreak was contained and the disease appears to have become established in wild rodent populations, as was the case in the United States.
At this point it is appropriate to recount the story of Thomas Dudley,8 whose involvement with plague in Sydney ended the decent man’s tragic life and whose unfortunate circumstances lead to his story becoming a part of maritime law.
Born in Tollesbury, England in 1854, Tom grew up around the sea and became a sailor and professional yachtsman. He skippered racing yachts at Cowes in the days when owners stayed on shore, watching their professional crew from the comfort of a yacht club chair. Tom and a crew of three were employed to ferry the 50 ft. yacht “Mignonette” from the UK to NSW. On July 5th, the boat foundered, 1,200 miles from Cape Town with the crew set adrift in an unseaworthy dinghy.
They drifted over 1,000 miles during the ensuing 24 days, before being rescued by the German ship “Moctezuma.” Five days before they were rescued, with the most junior seaman Richard Parker close to death from dehydration and starvation, the three remaining sailors succumbed to “the custom of the sea”; i.e., killing the moribund cabin boy so that they could drink his blood and eat his flesh to avoid starvation. This practice was a widely accepted form of cannibalism as a last resort for sailors lost at sea and an accepted pecking order as to who ate whom and in what order.
Once rescued, Edwin Stephens (one of the two remaining crew) encouraged Tom to discard the dinghy and the evidence of their “crime,” but Tom insisted on telling the full story and not hiding the leftovers of young Richard Parker. Much to the surprise of the wider community, the UK Board of Trade decided to make an example of Dudley and Stephens and charged them with murder. There were strong political agendas associated with the trial. It was expected that after a widely publicized ‘show’ trial, the pair would either be let off or given some non custodial sentence. However, both were sentenced to death. Only after a great deal of public outcry and the political agendas had been satisfied were the sentences commuted. They were released from prison on May 20, 1885, one year and one day after they left Southampton for NSW.
The case of Regina versus Dudley and Stephens is familiar to every student of maritime law to this day. Tom Dudley left England forever along with his wife Phillipa and children on August 19, 1885 and arrived in Sydney on October 5, 1885. Tom joined his wife’s aunt in business in Clarence and then Sussex Streets, making oil skins, tarpaulins tents, and general rigging and boat outfitting. T.R. Dudley and Co. prospered and at one stage had over 40 employees.
Tom became the second victim of plague. It is recorded that on the morning of Monday, February 13th he had removed five dead rats from his work premises in Sussex Street, on the edge of the harbor. He fell ill on the following Saturday and died on Thursday, the 23rd at age 46, the first death from plague. Dr. Frank Tidswell carried out a post mortem that afternoon following an inspection of the body and the house by Thompson.
Seventeen family and business contacts were removed to quarantine and the house and business were put under police guard. Tom’s body was wrapped in sailcloth soaked in 5% sulphuric acid, placed in a watertight coffin also filled with sulphuric acid, and then wrapped in further sailcloth soaked in the acid and then a layer of asphalt cloth. The coffin was then towed in a skiff to North Head and buried in a deep grave (said to be 50 ft. deep) in the Quarantine Station’s cemetery.
Thompson’s inspection of the Dudley business premises highlighted the appalling state of the sewer system in parts of Sydney. The Board of Health subsequently admitted that only one in 20 houses in the area were properly connected to the sewer.
The management of the plague outbreak had four components:
- the quarantining of patients and contacts at the North Head Quarantine Station
- the quarantining and cleansing of affected parts of Sydney
- the extermination of the rat population
- inoculation of at risk populations
In addition, stringent measures were introduced to prevent infection from ships reaching the shore. While Thompson and his Board of Health supported the four pillars of management, they strongly opposed the government’s implementation. The Board repeatedly requested that the government use the Coast Hospital,9 but to no avail, despite the fact that the Quarantine station was grossly overcrowded and became a ‘tent city.’ The large number of quarantined Chinese were confined to the tents. The Board also disagreed with the extent of removal of contacts and the period of quarantine for asymptomatic people. Thompson commented, “The word contact is much in use; it has a certain convenience–unfortunately, it has no defined meaning.”10 Thompson had envisaged the situation which subsequently occurred at the Grosvenor Hotel when authorities attempted to remove 40 patrons as contacts of a plague victim. A public confrontation followed. One escapee got as far as Goulburn before being apprehended and returned to Sydney for quarantine. It was not until May that Premier Lyne was prepared to take a softer line on the definition of contacts.
After the removal of victim and contacts, the cleaning staff appointed by the Department moved in to “clean up” the premises. At one time, over 3,000 men were employed.
“The men entered and cleaned up every street, lane, house and premises, sweeping repairing, washing and renovating good structures, destroying old and tumbledown premises, clearing out and leveling yards, tearing up old and laying new drains and generally doing anything of the kind that suggests itself as a means of affecting cleanliness.”11
Not everyone shared these views of the City Council’s cleaning staff. One resident of the Rocks complained of:
“. . . the ravages of the cleaners, a body of desperadoes hired by a tyrannical government to carry out the bowelless edicts of the Health Dept., fortified by strong drink, these men carried out a veritable orgy of destruction. They had whitewashed everything they could lay their hands on. One lady assured me tearfully they had even whitewashed her piano”12
When the enormity of the cleaning task became too much for the City Council, the state government took responsibility and started quarantining large areas of the inner city. The first area quarantining order for a half kilometer harbor strip was not issued until March 23rd. The press, critical of the delays, believed the tardiness was due to the fact that the Colonial Secretary had a produce store in the area.
Local residents were employed in the cleanup of their area. The Sydney Morning Herald (SMH) reported that some enterprising men appeared to be residents of all the proclaimed areas. It wasn’t only local residents who complained; the quarantine requirements had a major impact on local businesses, particularly when the government tried to quarantine large areas. The shipping industry was particularly hard hit through loss of trade, particularly with Fiji (the French took over trade with Fiji since they were able to bypass Sydney and avoid quarantine requirements).
The quarantine requirements in Sydney of off-loading all cargo (even that destined for other ports) into lighters, fumigation of the ships, and then reloading was a costly and time-consuming exercise, and almost certainly futile.13 Thompson had accepted P.L. Simmonds rat/flea model of transmission and together with the evidence of Tom Dudley’s exposure to dead rats, moved quickly to focus on the rat problem. Despite the work of the Board, the government’s initial focus through March and April was directed at general cleaning. A forceful statement by Thompson finally brought action with a capitation fee of two pence (later increased to six pence) for each dead rat, the appointment of rat catchers and the issue of free rat poison. Numerous crazy schemes were proposed, including the use of ferrets, pits full of glucose syrup, and hunks of poisoned meat hung from manhole covers. One mega rat trap with a capacity for several hundred rats was set and reportedly captured only two cats (and no rats).
When the capitation fee was increased there were reports of rats being imported from the country.14 Thompson reported 108,308 rats destroyed by October 31st. What impact that had on controlling the outbreak is unclear. Haffkine’s vaccine developed in 1897 and although not 100% effective did significantly reduce mortality. The 300 doses ordered in 1899 before the outbreak were used to inoculate health workers. When further supplies became available in mid-March in 1900, inoculation was offered to the general population. Public demand increased rapidly. On one day two doctors immunized 1,000 people in six hours. By April 2nd, 8,000 had been inoculated when supplies ran out. New supplies arrived in May and to avoid panic, tickets were issued with priority to at-risk groups. By this stage the panic was beginning to subside and the response was disappointing. Only another 2,700 were inoculated, making a total of 10,700 a relatively small proportion of the population.
Only 14 cases of plague were recorded amongst the inoculated group, although the effect of the vaccine on those already infected seems to be minimal.15
Throughout the early months of the outbreak, the Board of Health and its Chairman Thompson disagreed with the government’s overreaction. As referenced previously, they objected to the Board’s attempt to focus attention on the rat population, the Board’s strident criticism of the government’s policy of isolating contacts (the Colonial Treasurer, then responsible for the Board, insisted there be no exceptions to the removal of all contacts), and the failure to use the Coast Hospital. The Board also argued the impracticality of quarantining large areas. The Board minutes of February 23, 19001 record: “The Board rose to interview the Premier in order to affirm and impress the views and point out practical difficulties in imposing quarantine over large parts of the city.” The Board was also in conflict with some self-interested Councils. The minutes record a letter from Strathfield Council in which they state that if “police engaged in quarantine, living in Strathfield, should contract plague and convey it to the Borough, the Council will hold the Board responsible.”2
Community reaction was slow to develop. Initially the Board of Health was accused of overreacting. However, there was considerable panic by early March. The SMH stated on December 3, 1900 that many cases reported were really “attaches of nervousness and fear”. On March 12, 1900, the SMH reported a boom in property sales in the Western suburbs and on March 31st, the Bulletin reported “a mad rush to the Blue Mountains” Sydney residents avoided traveling to the city and AJC Autumn Carnival was poorly attended. On April 3rd, the evening news reported that a bible used to swear in a witness in the Bankruptcy Court was removed when it found out the witness had only recently been released from quarantine. The State of Victoria overreacted, imposing restrictions on mail and rail services from Sydney. When plague eventually reached Melbourne, the Sunday Times wrote, “Sydney has but little sympathy for Melbourne in connection with the plague visitation, owing to the unneighborly attitude of the Southern Capital while the attack was confined to this city.”
In April, the Citizens Vigilante Committee was formed to assist the authorities by encouraging public interest and cooperation. While raising some legitimate issues, others had less worthy motives. For instance, the Committee was responsible for instituting house-to-house searches of Chinese dwellings. They must have caused sufficient concern at their motives as the City Council evicted them from the Town Hall in June (on the pretext of using the space for the German Ladies Society). They were subsequently offered space by the British Medical Society, forerunner of the Australian Medical Association.1
Some attempts were made to put the outbreak in perspective. Dr. S.T. Naggs, writing in the SMH, tried to point out the contrast to the number of deaths from typhoid, scarlet fever, and tuberculosis. The Bulletin quipped that football was about as dangerous as the risk of contracting the plague, and on March 31st, The Bulletin argued that the plague had a positive impact on the community, which could not be said for the effects of the Boer War.
Perhaps the most relevant part of the community response was the desire for scapegoats. While specific minority groups weren’t massacred, the irrationally racist behavior was not dissimilar to previous community reactions to the plague. On this occasion, however, the Jewish community do not seemed to have been singled out for blame, as occurred in the two previous great pandemics. But old racist fears about the Chinese were brought to the fore, worsened by the fact that the plague occurred in areas of high Chinese populations, and perhaps the knowledge that the plague had originated in China. The media and to some extent the authorities encouraged the scapegoating of the Chinese. The SMH on January 31, 1900 reported that Honolulu had dealt with the problem by burning down the Chinese quarter. John Norton, famous in my lifetime as editor of our worst tabloid, The Truth, and then A City Alderman, explained the lack of corpses of Chinese plague victims by the fact that, “the Chinese do not bury their dead—they pickle them and send them home to their ancestors.”2 Thompson was outspoken in defending minority groups. In his landmark report he made the point that of the total metropolitan population of 456,000 the Chinese numbered less than 4,000, and only ten of them contracted the plague.3
Chinese were not the only ones singled out. On January 4, 1900, before the first case was reported, Redfern Council discussed the issue. Alderman Sullivan expressed concern that Syrians (in those times, a term used to cover most people from the Middle East) and Indians who live in parts of Redfern were predisposed to the plague and would put the good Anglo Celtics at risk. Alderman Jackson, who admitted to living in their midst, recounted how as many as 20 and 40 slept in one room and that, “they did not sleep as white men would but arranged themselves around the room against the wall. In fact, some of them even slept sitting up. Alderman wrote, “I wonder if the rats and fleas knew this.”4
In times of disaster there are those who benefit fortuitously and there are those who exploit the opportunity, some doing no harm and others with total disregard. As early as 1722, Daniel Defoe had noted the mass assault on the citizenry of London by advertisers promoting a multitude of nostrums against the pestilence.1 At the time of SARS, local chemists in Sydney were aggressively marketing masks in a country that did not boast a single recorded case of the disease; and the real estate agents of the western suburbs and the Blue Mountains benefited, as did the chemists selling disinfectants.
The first reported advertisement aimed specifically at the plague appeared January 13th.2 Prior to the first case, Vitadatio, the great Tasmanian herbal blood remedy, was said to cure, not only the plague, but also cancer, Bright’s disease (renal failure), tuberculosis, and hydatid cysts. The ad stated, “The bubonic plague is at our door, the microbe readily enters impure blood, but not pure blood.”
It was later shown that the principle ingredient was cheap gin. But other therapies promoted were Canadian Club whiskey, Nichols Tasmanian Dandelion ale, Dr. Morse’s Indian Root pills, and Herr Rassmussen’s Alfaline herbal. Perhaps the most innovative remedy offered was Metzlers protective anklets, which were to stop fleas jumping onto their victims’ ankles. Less serious promotions included the good Bicycle Co., suggesting, “riding a bike was better than traveling in crowded buses,” the Hotel Australia, which offered plague-free accommodation for three pounds 10 shillings per week, and the Mutual Store Chain, which promoted “a mid-winter plague sale.”
On a more positive note, Dr. J.H.L. Cumpston, the first Commonwealth Director General of Health,3 felt the 1900 outbreak caused a complete revolution in social medicine in Australia. The awareness of the link between infectious disease and animals and the role of insects as vectors gave public health medicine a stronger scientific basis. The improvement in building regulations and their enforcement was another benefit, although the lessons may have been soon forgotten.
Conclusion (what have we learned?)
The 1900 outbreak of plague in Sydney provoked hysteria, racism, conflict, exploitation, and overreaction that were disproportionate to the real impact of the disease. With a little imagination, it is not hard to believe that the response in Sydney were not dissimilar to the community reaction in the 5th and 13th centuries. While our medieval ancestors were in retrospect more threatened and less educated and therefore more justified in reacting the way they did, our grandparents’ peers had much better methods of communication, allowing the immediate spread of misinformation to ferment government and public overreaction.
Another pandemic caught the world’s attention 103 years later. SARS was (possibly) responsible for approximately 500 deaths worldwide over a period of six months. There was not a single confirmed case in Australia. Several possible cases have been reported, but none substantiated, which is reminiscent of the March 12, 1900 SMH story that stated, “Doctors and the Department are continually being called on to investigate suspected cases of the plague, but which really are promptly diagnosed as attacks of nervousness and fear.”
The federal government reacted with travel warnings, nurses’ stations at every airport, and instructions to hospitals to defer elective surgery on patients who have recently visited SARS countries (as if there were no other infectious diseases other than SARS). Chemists aggressively marketed facemasks, and there were daily pictures from Asia showing people sticking thermometers in the ears of passing pedestrians and ballet students performing Swan Lake in masks. And all of this response was about a disease that predominantly affected those who had been in close and ongoing proximity to an infected patient. The disease was also not infectious in its incubation phase, which further reduced the risk. Yet, the travel industry was devastated at the time. The mortality and morbidity of the social impact of loss of jobs, incomes, etc. surely exceeded the supposed 500 SARS deaths.
The following is an anonymous email circulating amongst a network of readers that summarizes some of the issues.1
“The World Health Organization today issued a new warning against non-essential travel to the entire Western hemisphere following renewed concerns about the spread of Severe Loss of Perspective Syndrome (SLOPS). Officials are warning travelers not to visit the UK, the US, almost all of Western Europe, and Canada, following further outbreaks of the disease, which has led to mass panic among the media, thousands of ecstatic children being kept out of school by their credulous and moronic parents, and increased profits for DIY stores as the idiot public rush to bulk-buy face masks and boiler suits. A WHO spokesman said, “You’d be much better off going to somewhere like Thailand or China, because all you’ve got to worry about there is SARS, and let’s face it, you’re about as likely to die from that as you are to get kicked to death by a gang of zombie nuns.” The SARS virus has now claimed a staggering 500 lives in only six months, which makes it considerably more deadly than, say, malaria, which only kills around 3,000 people every single day. Malaria, however, mainly affects only darkies that speak foreign, whereas SARS has made at least one English person feel a bit iffy for a couple of days, and is therefore considered much more serious. The spread of SLOPS has now reached pandemic proportions, with many high-level politicians seemingly affected by the disease. The rapid spread of SLOPS has been linked to the end of the war in Iraq and the need for Western leaders to give the public something to worry about. Otherwise, they might start asking uncomfortable questions about domestic issues, and that simply would not do.”
Perhaps the last word goes to whoever said:
The more things change, the more they stay the same.2
- Thearle M.J & Jeffs D, 1994 ‘Plague revisited’ Royal Australasian College of Physicians monograph., p. ix
- Curson P. & McCraken K ‘Plague in Sydney’, NSW University Press. Chapter 1.
- Liston, 1924 as quoted in Pollitzer 1954 p.226
- Luu, L.T. et al as quoted by Pollitzer 1954 p 296
- Pollitzer R. 1954, ‘Plague’ WHO Geneva p 298.
- Report in ‘Australian Doctor’ 22/04/1994, reproduced by Thearle et al
- Keeling M.J. & Gilligan,C.A., 2000 ‘Metapopulation dynamics of bubonic plague’ Nature 407 903-906
- Porter R. 1997, ‘The Greatest Benefits to Mankind’, p.25
- Porter R. 1997 p. 123
- Thearle et al 1994 p.8
- NSW Medical Board, Minutes of proceedings and registers vol.1 1838-Feb 1901 (State Archives)
- Bright Sparcs Biographical entry , www.google.com.au
- Board minutes 1898 Dec.
- Board minutes 1900 15th Jan
- Foley, Jean D. ‘1995 ‘In Quarantine, a history of Sydney’s Quarantine Station 1828-1984. Kangaroo Press ch.7 p 89
- Board Minutes Jan.1900-October 1900
- Hanson, N. 1999 ‘The Custom of the Sea’ Doubleday
- Board Minutes 1900
- Thompson J.A. ‘Report on the outbreak of plague at Sydney 1900. Sydney Government Printer 1900:14
- Tidswell F.’ Some practical aspects of the plague at Sydney. London: Sanitary Institute 1901:574
- Sleeman P. ‘ A plague upon the Nation. Historic Australia 1987:4, 13-17
- McKellar N.L. 1977 ‘From Derby round to Burketown’ Univ. of QLD Press ch.21
- Curson & McCracken ch 6 p161
- Thearle & Jeffs p28
- Board Minutes 1900 23rd Feb.
- Board Minutes 1900 March
- Curson & McCracken Ch 7 p173
- Daily Telegraph 10th April 1900 p.7
- Thompson 1900 Plague report
- Volke H. Loc. Cit.
- Defoe, Daniel 1722 ‘Journal of the Plague Years’ p30
- Curson & McCracken ch8 p180
- Foley Jean D. 1995 ch 7 p 95
- Anonymous email 2003