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THE REPORTED OUTBREAK OF PLAGUE IN RUSSIA.
738 not stayed. Those who helped in the exhumation died first-among them Hassan himself, his three sons, their mother, his two daughters-in-law, his brother, and his brother’s wife and son. The terrible mortality in Anzob may be judged from the fact that out of a population of 387 inhabitants only 150 remained alive on Oct. 3rd-237. or over 61 per cent. of the total, having died in about six weeks. Of 60 families only three escaped without a case.
was
Correspondence. II
Andi alteram partem.11
PLAGUE
REPORTED OUTBREAK OF IN RUSSIA. It would occupy too much space to quote or to discuss the To the Editor; of THE LANCET. symptoms which the disease presented. Though they differed SIRS,—There would appear now to be little room for doubt to some extent from those most frequently met with in that plague has made its appearance in European Russia. plague in India there seems no room to doubt that it was The outbreak is at present confined to the village of plague, particularly as the bacillus associated with the was isolated from some of the cases. Kolobovka, in the government of Astrakhan, and near the disease The most interesting question is, How and whence did the mouths of the Volga. It was in this neighbourhood that the
THE
last appearance of plague in European Russia-the infection reach this remote spot?? Dr. Levin asserts that Vetlianka epidemic of 1878-79-occurred. That outbreak, it could not have come directly from India. He suggests The ordinary pilgrimage it will be recalled, although extremely severe in the few one or two other possibilities. routes to Mecca closed last being year it is faintly possible and there villages attacked, was entirely confined to them, that pilgrims from Central Asia making their way from was no general spread of the infection to other parts of through Afghanistan to Bombay (sic) chose the Europe. This consideration should do much to lessen any Bokhara mountain paths instead of the ordinary roads, but there is outbreak be the with which might present apprehensions whatever of this. A second suggestion is that regarded, even were this outbreak not quite overshadowed in no evidence from Bokhara (which has constant communication interest and in the apprehensions which it arouses by the pilgrims much nearer epidemic in Portugal. The only disquieting with India) may have visited the tombs of local saints or Ishans feature in the outlook is the fact that the renewed appearance which exist both in Anzob and Marzitch. But a much more of plague in Russia is a fresh indication that the infection is important point brought forward by Dr. Levin is the follow. He examined every surviving inhabitant of both month by month becoming more widely spread. Five years ing. In many he found buboes in various stages of villages. the China was known of centre the now disease; only ago there are centres of greater or less activity in China, India, absorption or which had been opened and were in various stages of scarring. Now in several other persons who had Egypt, Portugal, Russia, and perhaps in East Africa.’ In view of the re-appearance of plague in Russia the not been attacked in tlte recent epidemic exactly similar were present. These persons said that they had following details, which have not yet, I believe, appeared in appearances the English press, relating to the outbreak which occurred, been ill two, four, or even 10 or 20 years previously. it will be remembered, last autumn in Central Asiatic Russia They described the illness as lasting from three to five days and as characterised by headache, fever, pain, and swelling are not only of interest but of considerable importance, the groin ; the swellings suppurated and either burst or pointing as they do to a possible source of infection in the in were opened by the" wise-woman " of the village. That the outbreak. These details have to come present only recently not venereal in was were the fact swellings origin by proved from a my knowledge, partly report published by Dr. A. M. Levin, who personally visited the scene of the outbreak, and that children of five or six years of age had had them. syphilis nor scrofula was present in a single case partly from the minutes of the frequent meetings of the Neither small-pox could be excluded. Swellings of this kind Imperial Commission which the Russian Government and found in 30 people in the two villages above named. despatched at the time to Central Asia under the personal were The author of the leDort comes to the conclusion that presidency of His Highness the Prince of Oldenburg. For there exists in these kishlalaks. or mountain villages, aim the latter papers I am indebted to the courtesy of Dr. Yassenski, who, after conducting the Russian Plague Com- endemic disease which he christens lymphadenitis mission to India, was appointed in charge of the plague femoralis suppurativa." Might not plague, he asks, have been introduced into this remote spot 20 years ago and have measures in the Khanate of Bokhara. The scene ot the outbreaK was Anzob, a viiiage near a pass remained to give rise to occasional epidemics’! Epidemics of the same name which divides the province of Samarkandof this kind might easily escape notice. For example, last from the Khanate of Bokhara. It lies on a stream which year’s outbreak only became known by an accident; falls into the Fan-Darya-one of the sources of the the villagers of Margif, though only eight versts Zeriafshan river (which flows through Samarkand). It is (five and a half miles) from Anzob, had heard nothing of the 220 versts (or 140 miles) south-east of Samarkand, in a appalling occurrences there until a month after they began mountainous region most difficult of access and some 6000 and 200 people had already died. They had run short of linen for shrouds"(even to the last detail the story of or 7000 feet above sea-level. It was at the end of September, poor highlanders is gruesome and pitiful) and 1898, that the authorities first heard of the outbreak and on these Oct. 3rd (15th) a medical man, Dr. Aphramovitch, reached some of them went to Anzob to borrow some. It was the spot. His inquiries elicited the following very interest. they who reported the occurrences there to the authorities. it is very appositely asked, that they had not run ing facts. At the end of August in a village called Marzitch short of linen ? A whole village might have died out and 12 years, (16 versts from Anzob) a boy named Shukur, aged sickened and died after four days’ illness. Ten days after the world have been none the wiser. The last suggestion which the author makes is that the his death his brother Shakir, aged nine years, sickened and he died also on the fourth day of his illness. A few days later recent outbreak was caused by infection from Bagdad, where, their mother sickened and she died on the third day of her he states, plague was epidemic in 1873 and where there were illness. These were all the cases in this particular village. many isolated cases at least as late as 1892. I have already trespassed far upon your valuable space Two days after the last death a woman named Ashur Bibi, a relative of the deceased, came over from Anzob. She and must leave the facts here brought forward with but the washed the body of the last patient, took part in the funeral, briefest comment. Their importance is obvious. It is and received the customary present. Returning to Anzob, certain that last autumn a concentrated and virulent she became ill and died on the third day of the illness. epidemic of plague occurred in the region described; it is After this cases occurred among this woman’s relatives and possible that the disease has been endemic in certain centres among people who attended her and their funerals. The there for many years past. Such centres in this region would rapid spread of the disease was ascribed to Divine wrath be closely analogous to the so-called endemic centres in the and one of the villagers, Hassan Rakhimof, induced others Himalayas, in Gurwhal and Kumaon. They are the nearest to believe that the scourge was sent because in burying and most probably are the actual sources whence the Ashur Bibi they had omitted some of the rites prescribed by infection has during the past week or two been introduced the Shariat, or traditional Muhammadan law. So the body into European Russia. By far the larger part of the traffic between Central Asia and European Russia passes through was exhumed and re-interred with full rites. But the scourge Astrakhan, and it is therefore not surprising that it is in the 1 On August 19th it was telegraphed to the Times from Lorenzo neighbourhood of that town that plague has made its Marques that many cases of an illness thought to be plague had occurred appearance. I am, Sirs, yours faithfully, at Magude, two days’ journey from that port. On August 22nd it was FRANK G. CLEMOW, M.D. Edin., D.P.H. Camb. stated that the disease was then thought not to be plague, but the place was still isolated by a cordon of soldiers. London, August 29th, 1899
Supposing,
.
was
Correspondence. II
Andi alteram partem.11
PLAGUE
REPORTED OUTBREAK OF IN RUSSIA. It would occupy too much space to quote or to discuss the To the Editor; of THE LANCET. symptoms which the disease presented. Though they differed SIRS,—There would appear now to be little room for doubt to some extent from those most frequently met with in that plague has made its appearance in European Russia. plague in India there seems no room to doubt that it was The outbreak is at present confined to the village of plague, particularly as the bacillus associated with the was isolated from some of the cases. Kolobovka, in the government of Astrakhan, and near the disease The most interesting question is, How and whence did the mouths of the Volga. It was in this neighbourhood that the
THE
last appearance of plague in European Russia-the infection reach this remote spot?? Dr. Levin asserts that Vetlianka epidemic of 1878-79-occurred. That outbreak, it could not have come directly from India. He suggests The ordinary pilgrimage it will be recalled, although extremely severe in the few one or two other possibilities. routes to Mecca closed last being year it is faintly possible and there villages attacked, was entirely confined to them, that pilgrims from Central Asia making their way from was no general spread of the infection to other parts of through Afghanistan to Bombay (sic) chose the Europe. This consideration should do much to lessen any Bokhara mountain paths instead of the ordinary roads, but there is outbreak be the with which might present apprehensions whatever of this. A second suggestion is that regarded, even were this outbreak not quite overshadowed in no evidence from Bokhara (which has constant communication interest and in the apprehensions which it arouses by the pilgrims much nearer epidemic in Portugal. The only disquieting with India) may have visited the tombs of local saints or Ishans feature in the outlook is the fact that the renewed appearance which exist both in Anzob and Marzitch. But a much more of plague in Russia is a fresh indication that the infection is important point brought forward by Dr. Levin is the follow. He examined every surviving inhabitant of both month by month becoming more widely spread. Five years ing. In many he found buboes in various stages of villages. the China was known of centre the now disease; only ago there are centres of greater or less activity in China, India, absorption or which had been opened and were in various stages of scarring. Now in several other persons who had Egypt, Portugal, Russia, and perhaps in East Africa.’ In view of the re-appearance of plague in Russia the not been attacked in tlte recent epidemic exactly similar were present. These persons said that they had following details, which have not yet, I believe, appeared in appearances the English press, relating to the outbreak which occurred, been ill two, four, or even 10 or 20 years previously. it will be remembered, last autumn in Central Asiatic Russia They described the illness as lasting from three to five days and as characterised by headache, fever, pain, and swelling are not only of interest but of considerable importance, the groin ; the swellings suppurated and either burst or pointing as they do to a possible source of infection in the in were opened by the" wise-woman " of the village. That the outbreak. These details have to come present only recently not venereal in was were the fact swellings origin by proved from a my knowledge, partly report published by Dr. A. M. Levin, who personally visited the scene of the outbreak, and that children of five or six years of age had had them. syphilis nor scrofula was present in a single case partly from the minutes of the frequent meetings of the Neither small-pox could be excluded. Swellings of this kind Imperial Commission which the Russian Government and found in 30 people in the two villages above named. despatched at the time to Central Asia under the personal were The author of the leDort comes to the conclusion that presidency of His Highness the Prince of Oldenburg. For there exists in these kishlalaks. or mountain villages, aim the latter papers I am indebted to the courtesy of Dr. Yassenski, who, after conducting the Russian Plague Com- endemic disease which he christens lymphadenitis mission to India, was appointed in charge of the plague femoralis suppurativa." Might not plague, he asks, have been introduced into this remote spot 20 years ago and have measures in the Khanate of Bokhara. The scene ot the outbreaK was Anzob, a viiiage near a pass remained to give rise to occasional epidemics’! Epidemics of the same name which divides the province of Samarkandof this kind might easily escape notice. For example, last from the Khanate of Bokhara. It lies on a stream which year’s outbreak only became known by an accident; falls into the Fan-Darya-one of the sources of the the villagers of Margif, though only eight versts Zeriafshan river (which flows through Samarkand). It is (five and a half miles) from Anzob, had heard nothing of the 220 versts (or 140 miles) south-east of Samarkand, in a appalling occurrences there until a month after they began mountainous region most difficult of access and some 6000 and 200 people had already died. They had run short of linen for shrouds"(even to the last detail the story of or 7000 feet above sea-level. It was at the end of September, poor highlanders is gruesome and pitiful) and 1898, that the authorities first heard of the outbreak and on these Oct. 3rd (15th) a medical man, Dr. Aphramovitch, reached some of them went to Anzob to borrow some. It was the spot. His inquiries elicited the following very interest. they who reported the occurrences there to the authorities. it is very appositely asked, that they had not run ing facts. At the end of August in a village called Marzitch short of linen ? A whole village might have died out and 12 years, (16 versts from Anzob) a boy named Shukur, aged sickened and died after four days’ illness. Ten days after the world have been none the wiser. The last suggestion which the author makes is that the his death his brother Shakir, aged nine years, sickened and he died also on the fourth day of his illness. A few days later recent outbreak was caused by infection from Bagdad, where, their mother sickened and she died on the third day of her he states, plague was epidemic in 1873 and where there were illness. These were all the cases in this particular village. many isolated cases at least as late as 1892. I have already trespassed far upon your valuable space Two days after the last death a woman named Ashur Bibi, a relative of the deceased, came over from Anzob. She and must leave the facts here brought forward with but the washed the body of the last patient, took part in the funeral, briefest comment. Their importance is obvious. It is and received the customary present. Returning to Anzob, certain that last autumn a concentrated and virulent she became ill and died on the third day of the illness. epidemic of plague occurred in the region described; it is After this cases occurred among this woman’s relatives and possible that the disease has been endemic in certain centres among people who attended her and their funerals. The there for many years past. Such centres in this region would rapid spread of the disease was ascribed to Divine wrath be closely analogous to the so-called endemic centres in the and one of the villagers, Hassan Rakhimof, induced others Himalayas, in Gurwhal and Kumaon. They are the nearest to believe that the scourge was sent because in burying and most probably are the actual sources whence the Ashur Bibi they had omitted some of the rites prescribed by infection has during the past week or two been introduced the Shariat, or traditional Muhammadan law. So the body into European Russia. By far the larger part of the traffic between Central Asia and European Russia passes through was exhumed and re-interred with full rites. But the scourge Astrakhan, and it is therefore not surprising that it is in the 1 On August 19th it was telegraphed to the Times from Lorenzo neighbourhood of that town that plague has made its Marques that many cases of an illness thought to be plague had occurred appearance. I am, Sirs, yours faithfully, at Magude, two days’ journey from that port. On August 22nd it was FRANK G. CLEMOW, M.D. Edin., D.P.H. Camb. stated that the disease was then thought not to be plague, but the place was still isolated by a cordon of soldiers. London, August 29th, 1899
Supposing,
.