Chapter III: Its Control and Suppression (4)

1. The exclusion of rats from all dwellings by means of
concreted ground surfaces, the protection of all drain
openings and ventilating openings by iron gratings, and the
prohibition of ceilings and of hollow walls in new buildings
and in those existing buildings from which they have been
removed by order.

2. The collection and bacteriological examination of all dead
rats. Facilities for the collection of rats in the quarters
are provided in the shape of small covered bins attached to
lamp posts, telephone posts, electric light poles, etc. These
bins contain a carbolic acid disinfectant, and the
inhabitants are invited to at once put into them all rats
found or killed by them. There are 650 of these bins
distributed throughout the city and its suburbs, and each of
them is visited twice daily by rat collectors who take all
rats found by them to the City Bacteriologist. Each rat is at
once labelled with the number of the bin from which it is
taken, and if subsequently found to be plague infected, a
special survey is immediately made of the block of houses in
that vicinity. All rat-holes and rat runs are filled up with
broken glass and cement, defective gratings and drains dealt
with, and rat poison distributed free to the occupants. If
several plague-infected rats are found in one locality, a
special house-to-house survey and cleansing of that district
is made.

3. The destruction of rats by poison, traps and birdlime
boards; special efforts in this direction being made just
before the onset of the regular plague season which is in the
months of from March to July.

4. The encouraging of the community to keep cats.

5. The systematic cleaning and washing out of all native
dwellings at least once in three months with a flea killing
mixture made by emulsifying kerosene in water.

6. An efficient daily scavenging of all streets and lanes
and the daily removal of refuse from the houses, coupled
with the provision of covered metal dust-bins, to reduce as
far as possible the amount of food available for rats.

7. The disinfection of plague-infected premises by stripping
them and washing them out thoroughly with a kerosene
emulsion. The bedding, clothing, carpets, rugs, etc., are
conveyed in a huge covered basket to the disinfecting plant
and sterilized with superheated steam. No objection is made
to the treatment of plague cases in native hospitals, and no
restrictions are imposed in regard to the burial of those
dead with plague except the provision of a substantial
coffin.

8. Every effort is made by means of lectures, addresses and
explanations to induce the native population to participate
in the above preventive measures.

Upon my last visit to Hong Kong, in July last, plague was abating. _The South China Morning Post_ of July 15, 1914, contained the following statement:

Plague is gradually disappearing from Hongkong. Last week's
return shows that there were 26 cases, of which 19 were fatal.
All were Chinese. The total number of cases for the current
year to date is 2093, with 1939 deaths resulting.

I regret that circumstances do not permit me to relate in detail the work done and the observations made during the closing six months of the Manila epidemic.

Up to the day of my departure from the Philippines, in July, 1914, I remained in charge of plague suppression, but the added duties of administration at San Lazaro Hospital and the coincident occurrence of a cholera epidemic prevented me from keeping a detailed record in such form as to permit reproduction here. It will therefore suffice to say that the first six months of 1914 witnessed the passing of the most threatening situation that has confronted the city of Manila in years. The record of plague rats found does not convey an accurate idea of the prevalence of rat plague by any means, for the simple reason that, when found, the rat cadavers were in such condition as to forbid bacteriologic examination; and inasmuch as the bacteriologic test of plague had been used exclusively in determining rat plague up to this time, it seemed desirable to adhere to the original method.

In February we found in one of the districts, in which we undertook systematic work in consequence of a few cases of human plague, a very large number of dead rats, in and adjacent to houses which furnished human plague cases. In one building alone more than 150 rat cadavers were found during our cleaning and rat-proofing operations. It is this district concerning which the letter to the public (already quoted) was written.

The methods followed in treating this new and dangerous focus of infection did not differ from those practised during the previous year, except in the matter of intensity. Forces of the cleaning and rat-catching gangs were increased and the utmost thoroughness of treatment was insisted upon. The results fully justified our policy and demonstrated again how feasible it is to fight plague successfully if adequate authority be given.

During the last year of the epidemic in Manila it became the rule for us to expect our plague workers to locate and find the identical rat cadaver from which the infected fleas bore the disease to the human victim, provided the spot upon the floor where the patient's sleeping mat had been placed was known. In the better class of houses the rat (sometimes more than one) was found dead beneath the floor, behind some post casing, or in other space caused by double construction. Time and again I have directed the removal of some panel of woodwork, some post casing, or a board of the floor with the full expectation (seldom unrealized) of finding a dead rat or a rat nest. These experiences were positively uncanny at times. In the houses of the poorer class, usually of bamboo and thatch construction, the finding of the rat was less easy and more uncertain, although the nest was repeatedly found, and as related elsewhere the dead rat itself might be found in a hollow bamboo timber, or in the thatch construction of the wall. In a house on Calle Echague, from which a Filipino and his wife were removed, dead, within a few hours of each other, several dead rats were found in the floor (the only piece of double construction in the whole house) within four feet from the spot where the sleeping mats were placed. A rat hole led to the nest and through this hole the fleas from the dead rats found their way to the human victims sleeping on the floor above the encased nest.

These instances could be multiplied many times, but there is no longer any special reason to do so, as the rat and the rat-flea are so completely incriminated as to render these repetitions quite unnecessary, however interesting they may be to the plague worker. The danger of pursuing these investigations, to the persons so engaged, must not be lost sight of, and exposure of such nests and rat cadavers should invariably be preceded by thorough spraying of the place, and particularly of the spot where tearing out of double construction is to be done. I know of no more dangerous employment than this, both for laborer and bystander.