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The great leveller: humanity's struggle against infectious disease

William Simpson on plague

Sir William John Ritchie Simpson (1855-1931) was professor of hygiene at King’s College London from 1898 to 1923, a post for which he was eminently well suited, as he had become an expert on public health in the British colonies. There was no salary for this post, and his duties included lectures on the laws of hygiene to students of theology!

During the course of his career he investigated the epidemiology of various infectious diseases in India, Hong Kong and Africa. In 1899 he co-founded the London School of Tropical Medicine with Patrick Manson, the ‘father of tropical medicine’, who had suggested the role of the mosquito in the aetiology of malaria. Unlike Manson, who was a bacteriologist,

Fold-out statistical chart showing mean weekly temperature and seasonal prevalence of plague in Hongkong for the years 1896-1902, with colour graphicsDiagram showing mean weekly temperature and seasonal prevalence of plague in Hong Kong for the years 1896-1902Simpson was a sanitarian in the tradition of Edwin Chadwick and Sir John Simon. These predecessors had found that local authorities were often myopic and niggardly in their attitudes to public health. Simpson constantly railed against this problem in the colonies, which, during his career, was magnified by the British obsession with administering its colonies on the cheap, and by official indifference to the health of indigenous people, except when outbreaks of epidemic disease threatened Europeans.

The images shown here are from books written by Simpson a few years after bacteriologists had revolutionised our understanding of the causes of bubonic plague. The plague bacillus was isolated and plague identified as a specific disease entity in 1894 by Shibasaburo Kitasato, a Japanese pupil of Robert Koch, and Alexandre Yersin, a Swiss pupil of Louis Pasteur.

Yersin showed that rats were carriers of the disease and in 1898 Paul Louis-Simond established that plague was carried from rats to humans by fleas. Simpson’s treatise on plague, a copy of which with Simpson’s own inscription, is shown here, takes account of these advances. Nevertheless, these discoveries took some time to filter through to measures of plague prevention. 

Investigators in India and China had also established plague’s symptoms and pathology by 1900. These include high temperatures, carbuncles at the site of the initial flea bites, and buboes in the neck, groin or armpit, shown in the images of victims below, before death occurred three to five days after onset. The plague victims shown here are two of the eight million who died in India from bubonic plague in the period from 1896 to 1912.

Images of plague victimsImages of plague victimsAt the suggestion of Manson, who had a very high regard for his abilities, Simpson was appointed to investigate plague in Hong Kong in 1902. The third plague pandemic had originated in Yunan, in south-west China. When it reached ports at the hub of the Asian-Pacific trading network it advanced quickly, causing major outbreaks in India, China and Manchuria in the first decades of the 20th century. It did not affect other parts of the world to any great extent, thanks to strict measures of quarantine and isolation. There are still reservoirs of bubonic plague among rodents in several parts of the world, including India and California.

The Hong Kong report on bubonic plague shows an awareness of the role of rats and fleas in causing plague, but does not fully integrate this awareness into an epidemiological model of the disease. Simpson displays the preoccupation of the public health official with sanitation, drainage and pollution, concerns which were not unjustified. In the statistical graphic shown here, a correlation is shown between increase in incidence of plague victims and a rise in seasonal temperature. The report speculates on the reasons for this, and attributes it to more movements of people over greater distances, but does not take account of increased flea activity following rises in temperature.

Because the discoveries concerning the aetiology of plague occurred too late to affect public policy, measures such as quarantine and isolation, as employed in Hong Kong and India by the colonial authorities, were only partly successful. Medication was almost completely ineffective, as no plague vaccine existed.

Plague continues to occur in isolated epidemics and is present in animals in many parts of the world. According to the World Health Organisation, which classifies bubonic plague as an emerging disease, there are between 1,000 and 5,000 cases annually. Many of these are in parts of Asia and Africa where the disease had been unknown.

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