Epidemics: The Story of South Africa's Five Most Lethal Human Diseases

2. Plague, 1901–1907: ‘The dreaded disorder’

38 2 Plague, 1901–1907 ‘The dreaded disorder’ ‘In most communities the mere mention of plague breaking out with such dramatic suddenness would have a disastrous effect on the public mind’ – Rand Daily Mail, 22 March 1904 If the movement of human beings was central to the spread of smallpox, the mobility of this species was of only secondary importance in the first epidemic to strike the subcontinent in the 20th century, plague. This is because plague is primarily a disease of rodents, caused by the bacillus Yersinia pestis, which is most commonly spread from an infected to an uninfected rodent by fleas. Only if infected rodents die in an epizootic in such numbers as to deprive the now infected fleas of rodent hosts, do they seek out other mammals in the vicinity to bite in search of blood, thereby infecting them too. 39 If these mammals are of the human variety, the effects of such a bite are swift and often lethal, for humans are particularly vulnerable to Yersinia pestis. Within three to six days, generalised symptoms like a raised temperature, splitting headache, inflamed eyes and giddiness appear, soon followed by the tell-tale sign of bubonic plague (the commonest form of the disease), the appearance of buboes, or inflammatory swellings in the groin or armpits. On average, 60 per cent of those so infected die within a week of the emergence of buboes. In bubonic plague, therefore, it is the movement not of humans but of rodents and their fleas that is central to the spread of the disease. The movement of humans becomes significant only in cases of bubonic plague in which Yersinia pestis so grossly infects patients’ lungs that it can be spread from person to person by coughing. In such circumstances it turns into airborne pneumonic plague, spreading from human to human with such alacrity and virulence that death occurs before buboes even appear. Pneumonic plague is usually even more lethal than flea-borne bubonic plague, claiming 70 to 90 per cent of cases. It seems likely that twice before the 19th century the die-off of rodents in this cycle reached such levels that their fleas turned to humans, producing two great pandemics, the so-called Plague of Justinian of 40 the 6th century AD and the grim Black Death of the 14th century. The latter, along with one of its later derivatives, the Great Plague of London of 1664–5, caused such mortality that these two outbreaks were indelibly and gruesomely impressed on the European mind for generations to come, making the name of the disease, plague, a synonym for ‘epidemic’. Plague thus possesses the ‘richest genealogy of fear in the Western psyche’, notes one of its historians.1 There is no evidence that southern Africa was touchedbyeitherof thesepandemics,probablybecause it was isolated from their centres in Asia, the Middle East, North Africa and Europe. However, by the end of the 19th century this was no longer the case, thanks to the expansion of global trade during the intervening centuries and the consequent incorporation of the subcontinent into the international maritime network. Thus, when, between 1894 and 1896, bubonic plague broke out in a number of Chinese and Indian ports, and from there began to spread swiftly across the seas aboard steamships carrying grain, alarm bells began ringing in southern Africa as loudly as on other continents at the possible approach of what has been labelled the third plague pandemic in world history. Alerted by horrifying reports of thousands of plague deaths in Asia and anticipating that it was unlikely that the ‘Oriental’ plague (as it was 41 pejoratively dubbed by contemporaries in the West) could be kept at bay forever, governments in southern Africa anxiously readied themselves against the arrival of what one local doctor called ‘the dreaded disorder’.2 The discovery of a suspicious case in Lourenço Marques in Mozambique in January 1899 quickly prompted an inter-state conference on plague control to be held in Pretoria, attended by representatives of the Cape, Natal, the Transvaal, the Orange Free State and Mozambique. Drawing on the recommendations of the 1897 International Sanitary Conference in venice, they drafted guidelines according to which any outbreak should be met. Nor did this remain armchair planning for long. Even as they debated, a suspected case of plague was reported from Middelburg in the Transvaal, sending a frisson of dread around the room and...