Part 2

Should the plague appear in any European country, the following rules were formulated to prevent its spread: (1) Whenever a case of the plague appears in any country the sanitary authorities of that country must give immediate notice to all other countries represented in the conference. This notice may pass through diplomatic or consular agencies, or it may be sent directly by telegraph. After this the sanitary authorities of the country in which the plague has appeared shall inform other countries at least once a week concerning the progress of the disease and the measures resorted to to prevent its spread.

(2) When an infected person enters a country by rail or other conveyance overland, disinfection of his person and personal effects is made obligatory. Land quarantine is condemned, and it is recommended that modern disinfection be practiced in its stead. Each country, however, may reserve the right to close its frontier against any other country in which the disease exists. It is recommended that medical inspection along the frontier be established in connection with custom-house examinations, in order to prevent unnecessary delay in travel. Passenger trains and postal cars are not to be detained at any frontier, but if a car be found to contain a real or a suspected case of the plague, this car shall be detached from the train at the frontier or at the nearest station thereto and its contents disinfected.

(3) Travelers coming from infected countries may be, at the discretion of the sanitary authorities, detained under observation for a period not exceeding eight days. Individual governments are allowed to take any special measures that may be deemed wise against the importation of the disease by means of gypsies, vagrants, and immigrants.

In formulating the above-mentioned rules to prevent the importation of the plague into Europe the members of the Venice Congress seem to have been thoroughly convinced that the longest period of incubation possible in this disease is ten days. It seems to have been assumed that if a vessel had been for ten days or longer at sea after departure from an infected port, and no cases of the plague had developed up to that time, there could be no danger of this vessel carrying the infection. It appears to me that a safer course would have been to require inspection of all persons and things going on board a vessel leaving an infected port, and the thorough disinfection of certain things, at least, on such vessels arriving at uninfected ports. The disinfection of a ship and its cargo by means of steam is not at present a very costly procedure.

Since the plague, if it reaches America at all, must come to us by sea, it may be of special interest to inquire concerning outbreaks of this disease on board ship. In making this inquiry we will confine ourselves to such cases as have occurred within the past two years. In March, 1897 (I have been unable to ascertain the exact date), the transport Dilwara left Bombay, bound for Southampton, with a regiment of English soldiers, together with their wives and children. On March 18th, while the vessel was in the Red Sea, a child died of the plague and was buried at sea. On arriving at Suez the persons who had been in immediate contact with the child were transferred to the Wells of Moses and properly disinfected. After this had been done, the vessel was allowed to pass through the Suez Canal in quarantine. No fresh case occurred, and the vessel arrived at Southampton April 6th. Here all articles which might possibly contain infection were disinfected, the passengers were allowed to go to their homes, and the troops were placed in barracks. No other cases resulted.

On July 6, 1897, one of the crew of the Carthage, of the Peninsular and Oriental Company's line, was attacked with the plague. The ship was then in the Arabian Sea. Two days later the sick man, with two other members of the crew detailed to attend him, was landed at Aden. Six days later a second member of the crew was attacked with slight symptoms of the plague. This fact was reported when the vessel passed Malta. The Carthage had intended to stop at Marseilles, but, on account of the plague on board, continued its course to England. Both of these patients were isolated by being placed in a large boat hung at a height at the side of the vessel so as to avoid communication with others on the ship. When the vessel arrived at Plymouth the passengers were allowed to depart to their respective homes. The only precaution that was taken consisted in ascertaining the destination of each person, and informing the health authorities of the places to which these people were going. The Carthage had on board a steam disinfector, and everything that had been exposed to the infection was thoroughly disinfected. On arrival at the port of London the second patient was isolated until he recovered. No cases developed in England.

On December 7, 1897, the Caledonia arrived at Plymouth, England, from Bombay, without touching at any Mediterranean port. While in the Red Sea two lascars developed symptoms of the plague. They were landed at Suez, and no further outbreak occurred. When the ship reached Plymouth one hundred and sixty passengers were landed, and their names and addresses forwarded to the local authorities of their respective destinations. After proper disinfection, the ship proceeded to London.

In December, 1898, a case of plague developed on the Golconda while at Marseilles, on her way from Bombay to London. The ship proceeded immediately, the patient was landed at Plymouth, proper disinfection was carried out, and no other cases developed. This is a proof that the assumption that a vessel is safe from infection after ten days have passed since leaving an infected port is fallacious, as this time was exceeded between Bombay and Marseilles.

The report that the Nippu Maru recently arrived at San Francisco with the plague on board has proved to be erroneous.

In September, 1896, a Portuguese-Indian steward died at the Seamen's Hospital, at Greenwich, England, very suddenly. This man was in the hospital for only forty-eight hours, and no one suspected the plague at that time. On the last day of October of the same year another patient in the same hospital was taken ill and died with symptoms of the plague. Bacteriological examinations of the glands of the body of the second man were made, and a bacillus which presented the well-known characters of the plague bacillus was found. The vessel on which the Portuguese steward came to England left Bombay about the end of August, 1896. There was at that time no official knowledge of the existence of the plague in Bombay, but it probably existed there. This is another evidence of the fallacy of the belief in the ten days' period of incubation. It seems quite evident to me that the English authorities lay too much stress upon the period of incubation. A man leaving Bombay or any other infected port may carry the bacillus under his finger nails, elsewhere on his person, or in his clothing, and may not become infected until many days after leaving the infected place. Careful inspection and thorough disinfection of all vessels coming from infected ports should be insisted upon. It has been abundantly demonstrated by the history of the plague, as well as that of other infectious diseases, that the old plan of detention in quarantine is a relic of bygone times. Detention is cruel, dangerous, and inefficient; inspection and disinfection are rational and efficacious.

The modes of infection with the bacillus of the plague are as follows: (1) By inoculation. The history of the present epidemic in Asia recounts several instances of inoculation with the plague bacillus. On June 22 or 23, 1896, while making a post-mortem examination, Professor Ayoama, of Tokio, one of the Japanese commissioners sent to Hong Kong to study the plague, scratched the third finger on his left hand; on June 27th he again scratched himself on the end of the right thumb; on the evening of June 28th he felt ill, and had a temperature of 101.6° F.; he slept well during that night, but during the afternoon of June 29th he had a temperature of 105° F. At that time a bubo was found in the left axilla, and there was well-marked lymphangitis of the right arm. Professor Ayoama has described his own case as follows: "On June 28th, after having finished a dissection, I took my meal about half past two and did not enjoy it. After the meal I went upstairs, when at certain movements of the arm I felt a slight pain in the left armpit, and on feeling with my finger I found some slightly enlarged glands present. In the evening I felt very ill, depressed, and languid, burning hot along the whole of the back, while the thermometer showed normal temperature. As Mr. Kitasato and I had invited guests that evening, I was present at supper. I had no appetite, and felt so languid that I often wished to withdraw. At half past eleven I hurried to my room, when I found my temperature was 39° C. I took one gramme of quinine, and slept well. Next morning I awoke and noticed, on the under side of the left ring finger, a small, whitish-yellow blister, and then, along the back of the hand, a red line. From this time I remembered nothing for more than two weeks."

Dr. Ishigami, another of the Japanese commission in Hong Kong, also inoculated himself with the plague while making a post-mortem examination.

A patient, while delirious with the pneumonic form of the plague, expectorated into the face of an English nurse caring for him. Within a few hours the eye on that side of the face became inflamed; later the parotid and cervical glands became involved, and the nurse died. Other illustrations of inoculation with the bacillus of the plague might be given. Dr. Wyssokowitch and Dr. Jobobat believe that the bacillus can penetrate the unbroken skin. In support of this belief they report some experiments made by them upon macaque monkeys. They found that when a needle was dipped in the culture of the plague bacillus and drawn across the palm of the hand of one of these monkeys, without making any visible scratch, the animal speedily developed the disease. However, this does not prove that the bacillus will penetrate the unbroken skin of man.

(2) By inhalation. That the pneumonic form of the plague results from inhalation of the bacillus can not be doubted. Monkeys caused to inhale the bacillus develop this form of the disease.

(3) By deglutition. That the disease may be acquired by taking the bacillus into the alimentary canal has been demonstrated by experiments upon animals of various kinds.

The sputum of patients suffering from the pneumonic form of the disease is filled with the bacilli. The germs are also found, sometimes at least, in the discharges from the bowels and kidneys. That the infection may be transported in clothing and rags has been long known. The following extract from a memoir by Sir John Hay, then minister from England to Morocco, indicates that the plague was introduced into Morocco in 1826 by means of infected articles of clothing: "The danger from plague by contagion can not, however, to my mind be called in question. That dire disease was introduced into Morocco about the year 1826 by an English frigate, which our Government had dispatched to Alexandria, where the plague was then raging, to convey from that port to Tangier two sons of the Sultan, returning from a pilgrimage to Mecca. No case of plague or other illness had occurred on board the frigate during the voyage, and the Sultan's sons and other passengers were allowed to land at Tangier.

"The customs officers, being suspicious that, in the numerous boxes brought by the pilgrims who had been permitted to embark with the Moorish princes, contraband goods were being smuggled, caused some of the cases to be opened. One contained Egyptian wearing apparel, which the owner said he had bought second hand, and subsequently confessed had belonged to a person who had died of the plague in Alexandria. The two Moorish officials who opened the boxes were attacked with the plague that night and died in a few hours. The disease spread rapidly throughout Morocco, carrying off eighty per cent of those who were attacked."

I mention these facts in order to emphasize the desirability of disinfecting all articles liable to carry the infection coming from infected places.

Professor Haffkine's preventive inoculation against the plague is still being largely employed in India. This consists in injecting hypodermically sterilized cultures of the bacillus. No curative action is claimed for this treatment, but it is believed to be protective against the disease. It is stated that more than eighty thousand people in India have undergone this form of vaccination, and that the death rate among these has been exceedingly low. However, it is well to be careful in accepting statistical statements on a matter of this nature. In the first place, it is probable that only the more intelligent will submit to vaccination, and these will also employ other means of protecting themselves against the disease. In the second place, there are many thousands of people exposed to the infection, or at least live in infected districts, who have never been vaccinated and who do not acquire the disease.

Three kinds of serum have been used as curative agents in the plague. In 1896 M. Yersin began the use of a specially prepared serum in China. The first cases treated with this preparation did unusually well, and it was hoped that most valuable results would follow from its more extended use. This serum is prepared after the manner of the antitoxine used in the treatment of diphtheria. That used most largely in India is made at the Imperial Institute of Experimental Medicine in St. Petersburg. Numerous physicians in India have reported upon the action of this serum, and none of them favorably. Very recently Dr. Clemow treated fifty cases with this serum, and compared them with fifty other cases treated without the serum. Every other case was selected for the serum treatment. The mortality was exactly the same in each group, forty patients out of fifty dying.

The second serum is that prepared by M. Roux, of the Pasteur Institute in Paris. This is practically the same as the preparation made by M. Yersin, and the results obtained are equally unsatisfactory. In 1897 the writer had the privilege of observing, both at Paris and at St. Petersburg, the preparation of these agents, from which at that time great results were expected. A third preparation is made by Professor Lustig, of Florence. I have been unable, so far, to find any detailed account of the method followed by Professor Lustig in preparing his serum. From all that I can learn, however, it is not a serum, but a sterilized bacterial culture; at any rate, Lustig's preparation has proved probably least valuable of all.

At present (July, 1899) the plague prevails throughout India, and has appeared at various places in Baluchistan and Afghanistan, at Samarkand in the Transcaspian Province of Russia; in Persia, at Bassorah and other points along the Persian Gulf; at several places along the western shore of the Red Sea; at Suez and Alexandria; at Tamatave, in Madagascar; at Port Lewis, Mauritius; at Penang, in the Straits Settlements; at Amoy and Hong Kong, China; and at numerous places in Formosa. For reasons already given, it will not be at all surprising should the recent report that the plague had appeared in Constantinople prove to be true. If it once reaches that place, it is more than likely that it will become scattered throughout the Balkan Peninsula. The sad death of Professor Müller and his laboratory servant, at Vienna, from the plague bacillus which Professor Müller brought from Bombay, shows the necessity for caution in handling the germ of this disease.

Are we in America in danger of the plague? I will have to answer this question very much as I did two years ago: "Yes, we are in danger; but this danger, being foreseen, may be easily avoided." In my opinion, our most vulnerable point is along the Pacific coast. With the plague at Hong Kong, it is possible that it may be transferred to Manila, and the transports bringing soldiers to this country may also bring the infection. However, I think the chances of this happening are small. The length of time required to make the voyage from Manila to San Francisco is so great that, with the infection on board, it would be almost certain to manifest itself before reaching our shores, and, knowing its presence on board a ship reaching San Francisco or any other point on the western coast, thorough inspection and disinfection will keep the disease out of this country. The probabilities are that for several years to come the larger cities of India, at least, will remain infected, and our sanitary authorities must be vigilant. The fact that, if the plague reaches us at all, it must come by sea, that a long voyage must be made before it can reach us, and that the disease will most probably appear on board ship before arrival at any American port--all these conditions are in our favor. The General Government should take upon itself the control of all measures to prevent the introduction of infectious diseases from without. Quarantine detention is a relic of ignorance of the true nature of infectious diseases. All transports and other vessels between Manila and this country should be provided with proper disinfecting apparatus. The Government should supply the Marine-Hospital Service with every needed equipment, and if this be done the plague can enter America only through incompetency in that service. There is another source of danger on our Western coast that must not be overlooked. The plague is now widely distributed in Formosa, which is under the control of Japan, and our intercourse with the last-mentioned country should be most carefully watched.

TUSKEGEE INSTITUTE AND ITS PRESIDENT.

BY M. B. THRASHER.

Tuskegee is a county town in the State of Alabama, not far from Montgomery. It is near the center of that part of the South commonly spoken of as the "black belt," because the negro inhabitants there greatly outnumber the whites. The town is one of the oldest in the South. It is said, in fact, that when De Soto made his famous journey across that part of the newly discovered continent he found an Indian village of the same name on the site of the present town. Tuskegee is five miles from the main line of the Southern Railroad, with which it is connected at Chehaw by means of a narrow-gauge road.

Tuskegee, as the word is oftenest used now, means the Normal and Industrial Institute, situated a mile out from the town and forming a little settlement in itself. This is the great school for young negro men and women which Booker T. Washington has built up, and of which he is the principal. The pupils who attend number a thousand each year. It is the largest school for colored people, managed by colored people, in the United States. There is no one connected with the school, except some of the members of the board of trustees, who is not of the race which the institute is designed to help.

Tuskegee Institute is so entirely the result of Booker T. Washington's labors, and his life has been so interwoven with the development of the school, that a brief account of his boyhood and youth is almost indispensable to a complete description of the institute, particularly as the conditions with which he struggled were so generally those which confronted all of the negroes at that time.

Booker T. Washington was born a slave in Virginia, not long before the breaking out of the war. It seems strange that a man who is so widely known to-day and is so universally respected as Mr. Washington, when asked how old he is should be obliged to reply that he does not know, yet such is the case. The birth of one more black babies on a large plantation at that time was a matter of too little moment to have sufficient notice taken of it to accurately fix the date. He was a boy old enough during the war, though, to know something of the struggle going on around him, for, speaking in public of Lincoln once, I heard him say: "My first acquaintance with our hero was this: Night after night, before the dawn of day, on an old slave plantation in Virginia, I recall the form of my sainted mother bending over the bundle of rags that enveloped my body, on a dirt floor, breathing a fervent prayer to Heaven that 'Massa Lincoln' might succeed, and that some day she and I might be free."

Another incident of those days I have heard him tell of in these words: "Word was sent over the plantation for all 'the hands' to come up to the 'big house.' We went, and to us men, women, and children gathered in the yard some one standing on the veranda read a paper. I was too young to understand why the men and women around me should have begun to shout, 'Hallelujah! Praise de Lawd!' when the reading was finished, but my mother, bending down to where I was clinging to her dress, whispered to me that we were free."

Not long after the close of the war the Washingtons left the plantation and went to West Virginia, where, in the coal mines, work could be had which would pay money wages. At first Booker worked in the mines with his brothers, but he soon became dissatisfied with the chance for improvement which that work afforded. "The first thing that led me to study," he has said, "was seeing a young colored man slowly reading a newspaper to a group of colored people who surrounded him with open mouths and gaping eyes. He was almost a god to them." The chance to study was soon found. An energetic woman of kindly nature hired the young colored boy to work about her house as a general chore-boy. Finding that he was anxious to learn, she offered to teach him to read in the spare minutes of his work, and did so. One day he overheard a man talking about Hampton, where General Armstrong had already begun his noble work. This, the man said, was a place where black boys could go to school, and at the same time work to pay their way. "As soon as I heard that," Mr. Washington has said, "I made up my mind that Hampton was just the place for me, and that I would go there. I started, although I had no money and did not even know where Hampton was. I felt sure I could inquire the way as I went, and work my passage. I walked a good share of the way, begged some rides, and when I had earned any money which I could spare, paid my fare to ride on the trains. I reached Richmond, Virginia, one night too late to get any work, and I was entirely out of money. While I was walking about wondering where I would get a lodging, I happened to see a nice dry place under a stretch of plank sidewalk. Watching my chance when no one was looking, I crawled in and curled up to sleep. The next day I was so fortunate as to get work helping to unload a vessel, and, as the job lasted several days, I came back each night to my lodging under the sidewalk, thus saving all my wages except the little required for food. In this way I was able to get money enough to carry me the rest of the way to Hampton, and leave me fifty cents when I got there."