The word ‘plague’ immediately conjures images of a medieval time-period, rats, and, if you have a brain like mine, Monty Python performers shouting ‘bring out yer dead’.
In fact, there were three pandemics of plague – the 17th century ‘black death’ being the best known. All three pandemic plagues – the Justinian plague of the 5th century, the medieval black plague and the third pandemic or ‘modern plague’ - had significantly high mortality rates and as a result have changed the course of civilisation.
Plague is caused by a bacteria Yersinia pestis, a gram-negative rod shaped coccobacillus. The infection is transmitted to humans by the bite of a rat flea and can then be passed between humans via contact with infected tissue.
Infection in humans occurs in three forms: bubonic plague, whereby the patient presents with painful large lymph node abscesses called buboes; pneumonic plague where the infection is in the lungs, and septicemic plague which is as it sounds: overwhelming septic shock.
I could tell a story of plague like this, in terms of bacteria, gram-negative sepsis, facts about how it presented where and when, and Monty Python references (because, really, nobody ever expects the Spanish Inquisition).
But to my mind, the story of plague in Australia is really the story of a public health physician named Dr John Ashburton Thompson.
Dr Thompson was born in London in 1846, educated at St Pauls, Guy’s and Middlesex hospitals and obtained a Diploma of Public Health from Cambridge. He was reportedly a brilliant epidemiologist and an ‘irascible administrator,’ which I take to mean he made a nuisance of himself. He emigrated to Australia in 1883 and was eventually appointed to the Board of Health. As the only trained epidemiologist in the entire country, he became its driving force.
At the time of his initial appointment there was no Public Health Act. Dr Thompson was of the belief that disease control measures must come through government actions in environment and sanitation. He pushed hard for legislation to address public health in 1885, and when that was unsuccessful, he published a barrage of articles on every outbreak of disease in the colonies at scientific congresses and in journals.
Dr Thompsonalso used his brother, Gerald Thompson, a journalist at the Daily Telegraph, to publish anonymously in the press.
By what I suspect was sheer force of personality, Dr Thompson was appointed president of the Board of Health in 1896 and a Public Health Act was passed by the colonial government not long thereafter.
Dr Thompson also began appointing microbiologists to Sydney and Newcastle and employing sanitation inspectors. It was lucky he did so, because overseas, the third plague pandemic was emerging in earnest.
The modern plague pandemic began in northern China in the late nineteenth century. As with its predecessors, the disease caused devastation and panic along trade routes. This time, however, those trade routes were primarily shipping routes and included Australian shores. By 1894, Hong Kong was a plague-infected port and Noumea followed in 1898. The first plague death occurred in Sydney in 1900. The victim’s name was Arthur Paine.
He was a 33-year-old delivery man who had daily work at Central Wharf. He was bitten by an infected flea on his left foot and was soon running a high fever with headache, vomiting, diarrhoea and myalgias. On 19 January his attending physician found a swollen lymph node in his groin and notified the Board of Health.
Dr Thompson confirmed the case himself. Paine and all of his close contacts were moved to the maritime Quarantine Station located at North Head, and he died not long thereafter.
There were no further confirmed cases in Sydney for a month and the reaction in Australia was surprisingly calm. At the time, the spread of plague via rat fleas was still just a theory, though Dr Thompson, for one, firmly believed it to be true. He campaigned through the media again for an extensive rat eradication program, despite various claims he was being alarmist.
Unfortunately he proved to be correct. The next death occurred in Sydney on 17 February. Between 1900 and 1925, there were a dozen outbreaks of plague across the nation, taking 1371 lives. Most deaths occurred in Sydney, but there were also outbreaks in Melbourne, Adelaide, Fremantle and Townsville.
It was a major public health concern. But it would have been a lot worse, had it not been for Australia’s fledgling Department of Public Health.
Dr Thompson, alongside his microbiologists Dr Frank Tidswell and Dr William Armstrong, are the reason I am able to tell you today with authority that plague is transmitted via rat fleas.
These three Australian doctors not only did the ground-breaking research that provided that confirmation of the theory, but also provided the impetus for the public health measures that helped contain its spread. This included putting a bounty on rats, educating the public on handling dead rats and fleas, quarantine of affected individuals and close contacts, and improvement of the quarantine facilities. Australia’s approach to quarantine in general has been unparalleled ever since.
Today, plague remains endemic in parts of Africa, Asia and the Western United States. Human infections still occur and can be severe. Luckily, we have urban planning in Australia that prevents plague pandemics, and it is now a treatable infection.
Author: Dr Gillian Riley