PLAGUE AT PYAWBWE (UPPER BURMA).

By N. SUBBIAH PILLAI, W Sub-Assistant Surgeon, V

Pyawbwe, Burma?

The recent epidemic of plague at Pyawbwe this year (1920) is a noteworthy event, for it made its appearance at a period quite unusual to it. Pyawbwe had been almost yearly visited by this scourge for the last four successive years. The previous epidemics showed their visage with the incoming cold season, from about

November, and lasted till about March in the

following year. But the one under review started in June, 1920, and lasted till about end of September. The scarcity of rain and the intense heat must have given an impetus to

the dormant germs. Being a Burman town, people were, as

usual, afraid of the troubles of segregation and inoculation. The rat falls were hid and the human attacks suppressed, but the verifica- tion of deaths revealed the grim nature of the

epidemic. :Vigilant . prophylaxis was immediately

taken and almost the whole town was protected by anti-plague inoculation; 3,500 were pro- tected out of a population of 4,400, excluding the Military Police. People of advanced age, women in advanced stage of pregnancy, and infants in arms were exempted from anti-

plague inoculation. The civil response was

rather slow, but the military people had to

obey orders. Anti-rat propaganda was pur- sued, and the rat population was annihilated as far as it could be done. Infected persons were segregated and houses washed and venti- lated. The result was pleasingly satisfactory, inasmuch as there were only 33 attacks from start to finish.

It is a known factor that plague is an

epizootic disease, first attacking the rat popu- lation (Mus Decuman.us species)?the >rat

flea?the habitat on the rat's body being the transmitter of the disease from rat to man.

It is often a solitary infectious bite that is the cause of an attack in man, giving rise to

all the horrors of an epidemic, the " Black

scourge of humanity." As I have already stated, there were 33

attacks with 20 deaths?a mortality of 60 per cent. Of these, only 15 cases came under my treatment, with 5 fatalities, or a mortality of 33 1 ] 3 per cent. The rest were either seen

late in the disease or after death during veri- fication. This was wholly due to the conser-

vative opinion of the illiterate and the dread of segregation, which was only magnified by their fearful minds.

Peculiarities.?In all the cases, buboes were noticed either in the axlll?e or in the groins and thighs. In one case epitrochlear bubo was noticed on the right elbow, in addition

March, 1921.] CURE OF HERNIA BY VACCINE: MALLANNAH. 99

to a bubo on the right groin, besides a few

large scattered pustular eruptions on the body. In another case there were two buboes, one on the left groin and the other on the left side

of the neck. The following are the cases in which erup-

tions were noticed, in addition to the buboes:?

1. Mah San?a young girl of 10 years?In- oculated on 11th July, 1920, was attacked on

8th August, 1920. A bubo on left thigh appeared on the third day after fever. Cutaneous erup- tions, limited in number, and a little larger than a small-pox pustule, were noticed on the sixth

day of fever, scattered on the abdomen and lower and upper limbs.

2. Mah Su?a Burmese female, age 30?not- inoculated. attacked on 10th August, 1920. Bubo on right elbow (epitrochlear) appeared oil the

14th, and one on the right groin was noticed the same night. About half a dozen cutaneous

eruptions, similar to those above described., appeared on the seventh day of fever. Smears, taken from the eruptions in both these cases,

were found to contain plague bacilli, under

microscopic examination. Both these cases

recovered after treatment. Two cases occurred amongst the inoculated,

of whom one is case No. 1 mentioned above, who recovered. The other was a young Bur- mese lad of 16 years, inoculated on the 11th

July and took ill the same evening, who develop- ed a bubo on the next day in his right thigh. He was treated by me from the beginning, and died on the 15th July, i.c.t from the fifth day, the fever being persistently high till death.

Treatment.?With my limited experience in previous epidemics, I give a patient a calomel (5 grs.) purge to start with and put him on the following mixture:?

Tincture iodine ... min. v. Acid carbolic .. min. (i. Tincture digitalis .. min. v.

Aqua m ad. .. 1 oz.

every 4 hours?the interval was lengthened as the case required, and even ordered thrice a day when the temperature was about nor-

mal. The buboes were painted with tincture of iodine four times a day. Only 12 cases were treated in this way, with three deaths, or a mor- tality of 25 per cent. When buboes suppurated, they were freely incised and treated in the usual way. Absolute rest in bed was enjoined in all cases, with a pure milk diet. Finding in one of the Indian Medical Gazettes that cam-

phor and iodine was also being used with great efficiency, I tried in three cases of my series, with two fatalities, as noted below:?

1. A Karen boy, age 15, n,ot inoculated, attacked on 14th August, 1920. A solution of

camphor, iodine and thymol was injected deeply into the bubo in the left groin. A few hours after the injection the whole of the

thigh and leg became much swollen and of a

chocolate colour. No further injections were

given, and the boy died on the 18th August, 1920 ?five days after the attack.

2. A Madrassi, aged 30, not inoculated, attacked on 13th August, 1920, came to my notice on 15th August, 1920, with a right axillary bubo. Camphor and iodine solution was injected on the 15th and was repeated on the next day, but the man died on 20th August, 1920, after a prolonged delirium.

3. A Burmese boy, aged 15, very thin sub- ject, living in the same house as No. 1, not

inoculated,& attacked on 12th August, 1920, came to my notice on the 15th with, a bubo in the right groin. Two injections were given into the bubo. The temperature came down at once. The bubo suppurated and burst, leaving a large dark grey slough, ending in ultimate recovery of the patient. The swelling of the limb, with the peculiar

chocolate colour reaction, mentioned under case No. 1, did not occur in the two other cases. It therefore seems to me that the solution in the former case niust have got directly into the venous circulation and produced such an alarming reaction. From the above I am led to conclude that

iodine treatment, which has stood the test of time, should never be discarded, as it is a very hopeful one. Regarding the injection

|' of iodine, camphor, and thymol deep into the

buboes, I am sorry I am not able to give any definite opinion, since I had only three cases this line of treatment; yet, I hope, this also be given, a trial.