Chapter 3

BAMBOO HOUSE SUPPORTS NOT SEALED WITH CEMENT. NOTE HOLES GNAWED IN BAMBOO ENDS. RATS FREQUENTLY MAKE NESTS IN THESE HOLLOW BAMBOO RAFTERS.

The presence of food was also noted in the bamboo nests in Java and we often find articles of food in our Manila nests.

Dr. Korn, P. H. Service, and the writer (T. W. J.) investigated a good many of these bamboo house-timbers and we not only found such evidences of rats as food, rat fæces and nest materials, but in one case a rat was actually driven out of a bamboo nest by introducing a long thin strip of wood. The evidence of similar conditions then is complete.

We also duplicated the experiences of the Java workers in finding dead rats inside of the bamboo house timbers in close proximity to patients sick (or dead) with plague (see memoranda in the case of Esteban Masabik, of 140 Calle Perla, March 22, 1913).

Very extensive rat destruction and cleaning operations, covering a large portion of the city of Manila and including all sections where cases ofrat plague or human plague developed, were undertaken and this work was carried on without interruption for about two (2) years. City laborers to the number of 60 to 150 were used and the work was supervised by Sanitary Inspectors Brantigan and Searcy, of the Bureau of Health. During a part of the time a flying column of 50 men, under Sanitary Inspector Hunniecutt, was detached from the main party and employed at placing rat poison.

The total amount of accumulated dirt removed from houses and yards approximated 5250 tons (for 17 months ending November 1, 1913).

Without doubt this general cleaning campaign and the removal of this enormous accumulation of dirt and rubbish was of great value as an antiplague measure.

The rat catch will always be found to depend upon several factors, viz.: the number of persons employed; the number of traps and portions of poison placed; the location of the operations and the length of time a given locality is trapped, poisoned and cleaned. The variety of baits and poisons will also affect the results.

In addition to these factors certain others are found to operate in reducing the rat catch, as, forexample, weather conditions and the occurrence of Sundays, holidays and the days just preceding and following holidays.

Upon rainy days and the days just mentioned the rat catch almost invariably falls off.

From statistics collected by me in connection with this work, Dr. V. G. Heiser, then Director of Health for the Philippine Islands, published the following memorandum in 1914. As it is a correct transcript of my records I introduce it here in its entirety.

Comparative Statistics in Rat-catching Methods.[3]—With a view to ascertaining which type of rat trap was most effective and also the average number of rats that are caught by a given number of poisoned baits that are set out, statistics were kept during the antirat campaign in Manila. The ratio maintained in catching rats with two types of traps is indicated in the followingtable, a perusal of which will show that for the three months ended June 30, 1913, there were 120,565 spring or snap traps set and that for every 100 of this type of trap set there were caught 6.9 rats. During the same period there were 47,075 wire cage traps set; the total number of rats caught was 339; which gives 0.72 rat caught for each hundred traps set. For the quarter ended September 30, 130,627 spring or snap traps were set and 9,753 rats werecaught, which gives 7.47 for each 100 traps set. During this period 40,621 wire cage traps were set and 395 rats were caught, which gives 0.97 rat caught for each 100 wire cage traps set.[3]Reprint from the Public Health Reports, Vol. 29, No. 6, February 6, 1914.

[3]Reprint from the Public Health Reports, Vol. 29, No. 6, February 6, 1914.

No accurate record was kept of the number of each kind of rat bait set. Only the total of all was recorded. Bacon or coconut with strychnine and rice with arsenic were used. For instance, for the quarter ended June 30, 1913, there were 166,237 poison baits set in new territory and the rats found poisoned average for each 100 baits 0.72. During the next quarter there were 177,309 baits set in territory that had been worked over, and only 216 rats, or 0.12 rat per 100 baits, were killed. From the foregoing it appears that the rat poison ranks lowest in efficiency but perhaps highest in economy. In view of thefact that the original cost of the cage trap is many times more than that of the spring trap, and the cost of maintenance is very high, it will be apparent that the spring trap is by far the more economical as well as more effective of the two.

Generally speaking, however, the number of rat catchers engaged and the location of their operations has the largest influence upon the total catch of rats. For the fiscal year July 1, 1912, to June 30, 1913, inclusive, the total catch was 55,101 rats (Manila only); to December 1, 1913, 79,676.

The most natural explanation of the general correspondence between the highest rat catch and the highest incidence of human plague would be upon grounds of greater activity in rat catching effort at times of greatest plague prevalence, but from the inauguration of general systematic rat catching there was no cessation of effort, even during the abatement of plague, and in consequence this explanation does not apply strictly.

It is true, however, that whenever plague occurred in districts theretofore free from the disease, rat catching was pushed vigorously in the surrounding localities.

Making due allowance for all the factors mentioned I am impressed with the probability, amountingalmost to certainty, that the catch of more than 79,676 rats definitely affected and checked the spread of plague in Manila in 1913; and I am of the opinion that systematic and wholesale rat catching, carried out in the most economical manner possible, should be persisted in indefinitely, at least until plague disappears, wherever the disease occurs.

Efforts to prevent the spread of plague to the provinces of Luzon, by way of the railways, were successful and the present measures employed, freight inspection, the fumigation of packages suspected or likely to contain rats, and the similar treatment of freight cars showing signs of rats, should be continued. In a few cases these measures have driven rats out of both packages and cars and the animals have been killed by the sanitarians on duty at the station.

The matter of water transportation was entirely within the control of the authorities in charge of inter-island quarantine affairs.

Rat catching in Manila was systematically performed and all rats captured were turned over to the Bureau of Science for examination for plague.

MATERIALS MUST BE MOVED ABOUT IN THE SEARCH FOR RATS (MANILA PLAGUE CAMPAIGN)

When plague foci were discovered the localitieswere trapped and poisoned both circumferentially and centrally, with a view to preventing the diffusion of infected rats throughout the city.

Rat-proofing.—The theoretic desirability and superiority of "out building" the rat, over all other methods of rat suppression, is admitted. The apparent impracticability of actually rat-proofing Manila at the present time and our inability to starve the animals out, justify the other and less permanent measure, viz.: rat catching. However, I heartily favor and urge the most complete and thorough-going rat-proofing of buildings actually infected with human or animal plague, in all cases. The building ordinances of Manila already provide for rat-proof construction in all new buildings erected.

With a view to cutting off the food supply of the rat, more than 1100 orders upon householders, to provide covered garbage cans, were served in the district of Tondo alone.

The open ends of bamboo timbers in more than 2300 houses were closed, either by cement or tin cans, during 1913.

Theatre Disinfection.—All the cinematographs and theatres in the city were disinfected uponrepeated occasions by spraying with petroleum and cresols, with a view to destroying fleas and preventing plague infection.

Attempts at deception and concealment of plague patients, upon the part of members of their families, were numerous, but with the close scrutiny of death certificates and dead bodies exercised at all health stations it is believed that all cases were recognized.

One case of extremely careless diagnosis occurred. A death certificate was furnished by a local native doctor who certified the cause of death to be "uterine hemorrhage." Suspicion arising, an autopsy was ordered and a pronounced case of bubonic plague was disclosed postmortem. No evidence of uterine hemorrhage, except slight menstrual signs, was found.

The destruction of infected fleas in plague houses is of course the primary object of the disinfection by spraying, which is thoroughly carried out in every house where a case of human plague or rat plague appears. The method is a simple one and consists in spraying a mixture of cresols (2 per cent.) and kerosene (98 per cent.) over all surfaces of the house, floors, walls, underlying ground, furnitureand the spaces above ceilings, etc., using the mixture liberally and securing a general surface distribution. There is no doubt of the toxicity of this mixture to all fleas and bed-bugs which it reaches, and it is undoubtedly an effective measure in rendering an infected house safe. All of the instances of multiple house infections, where the cases recurred after disinfection, in Manila, have been in houses where, for one reason or another, the recommended structural rat-proofing has been postponed or where it has not been done. Thus, on Calle San Fernando the sequence of the four cases (their progress by days and in consecutive houses) is explained by the travel of rats through efficient rat runs present in the walls and ceilings, rather than by the passage of fleas through partition walls, from uncommunicating house to house.

A RAT INFESTED PLAGUE INTERIOR

So also at Calle Cabildo, where the superstructure of the house was a veritable sieve, there was a series of communicating double walls.

At the house on Calle T. Alonso a similar condition existed, but here the two cases which occurred may have been synchronously infected, or nearly so, previous to disinfection of the premises.

At Calle Comercio, where six days elapsed betweentwo cases, the rooms and building were piled full of merchandise, defeating immediate disinfection, that is, efficient disinfection, until all the merchandise was moved and the rooms were emptied.

At 1364 Calle Sande, Tondo, where 5 cases originated, the infections were undoubtedly almost synchronous and no infection occurred after disinfection of the house, while at 1226 Calle Juan Luna, Tondo, the two cases were plainly infected at about the same time and this previous to disinfecting the premises.

Guinea-pigs as Indicators of Infected Houses.—The following experiment shows strikingly the necessity for disinfecting houses where human or animal plague cases have occurred.

Upon December 17, 1912, Dr. O. Schöbl, of the Bureau of Science, and myself, placed two healthy guinea-pigs, free from fleas, in a wire trap cage in the house at No. 4 Calle Barraca, a few hours before the house was disinfected, a patient with plague from this house having died within the preceding twelve hours. The cage containing the guinea-pigs was placed exactly where the patient had slept upon the floor, as indicated by the other tenants of the house. Disinfection was delayed for a few hoursand the guinea-pigs were left in the house for one day. Upon December 21 one of the guinea-pigs died from typical bubonic plague—anatomically and bacteriologically positive—other inoculated experimental animals also developing the disease.

Other guinea-pigs placed in plague houses on Calle Cabildo and Calle San Fernando, after disinfection of the premises, failed to acquire plague.

Natural Enemies of the Flea.—It was observed during the studies in Java that certain natural enemies of fleas exist and operate against their laboratory cultivation and their natural reproduction.

Ants of several varieties, large and small red ants and small black ones, were found to be very antagonistic to fleas, both in the larval and adult states, destroying them actively.

Fleas in the laboratory were found to be affected with mites, with a resultant high mortality among the insects. The same parasites were not found upon wild fleas. On account of the prevalence of mites upon the laboratory fleas certain experiments concerning the transmission of plague were vitiated.

The activity of ants in attacking and disposing of rat cadavers found in our antiplague work inManila was frequently brought to my attention. We invariably included an attack upon ants in treatment of houses known to harbor, or suspected of harboring, plague rats. The combination of kerosene and cresols, elsewhere referred to, was found to be perfectly satisfactory in the destruction of ants; assuming, of course, that the necessary procedure of exposing the ants, by the moving of merchandise, boards or other protecting materials, was performed, so that contact, by spraying the insecticide mixture, was secured.

Activity of Fleas.—It was also observed during the Java studies that the rat flea, while rather lazy, may and does cover distances of five metres and that he sometimes covers eighteen centimetres at a single leap.

In addition to this, of course, there must be considered the possibility of his falling considerable distances.

Zoölogic Classification of Rats.—The matter of accurately, systematically and scientifically cataloguing and classifying rats is one of great difficulty and is not to be undertaken by anyone but a trained naturalist. However, some of the notes we have at our disposal, gathered from many sources,may be set before the reader. It is extremely difficult to find exact correspondence of statement in the various classifications offered by writers upon plague and rats.

Dr. Lantz gives the following brief classification in his section of the publication, "The Rat and Its Relation to Public Health."

Order:Rodentia.Family:Muridæ.Genus:Mus.Species are many, but only three or four are cosmopolitan.Cosmopolitan species:Mus rattus—black, brown, and roof (Alexandrine) rat;Mus decumanus—gray, barn, wharf, sewer, and Norway rat.

Order:Rodentia.

Family:Muridæ.

Genus:Mus.

Species are many, but only three or four are cosmopolitan.

Cosmopolitan species:Mus rattus—black, brown, and roof (Alexandrine) rat;Mus decumanus—gray, barn, wharf, sewer, and Norway rat.

Mus rattushas many varieties known throughout the world and these are named according to color and habitat.

In addition to the names given in Lantz's classification, we constantly see reference to the black house rat, the brownish-gray rat (Mus Alexandrinus), the ordinary ship rat, the field rat, etc.; terms descriptive of habitat and appearance being very loosely applied. Little account is taken, by many, of the well-known variations in the coloration of rats due to climate and season and of the well recognizedaptitude of the rat for living in-door or out-door according to circumstances of food supply, weather, etc. The "sawah" rat of Dutch India, implicated in the prevalence of plague there, was formerly considered a variety ofMus decumanus, but is now described as a field variety ofMus rattus. So too, varieties ofMus decumanusare frequently named according to alleged geographic origin, habitat, color and habits, viz.: sewer rat, brown rat, Norway rat and migratory rat.

The inevitable confusion bound to arise from such loose classification is obvious.

Another genus,Gunomys(Nesokia), implicated in plague, is represented in India by two species and by at least one (an undetermined one) in Java, some confusion existing in the matter as yet. Members of this genus are described as large, rough-coated rats which live both as house rats and field rats. In India the Plague Commission reported specimens of this genus as particularly susceptible to plague.

In the Philippine Islands no specimens ofGunomyshave been observed, butM. rattusandM. decumanusare both present and numerous and both are subject to plague, as shown by the presence of the disease in specimens examined.

In view of the unreliability of the points of difference in rats usually given as identifying data, such as the number and location of the mammæ, the variations in color and the peculiarities of the footpads, the Javan observers depend upon the conformation of the skulls for the determination of genera, the skull ofM. rattusbeing oval and arched, that ofM. decumanusmore closely approaching the square and rectangular conformation, and that ofGunomysbeing broader, higher and longer than either.

InM. rattusthe prominent borders which separate the parietal from the frontal surfaces of the skull are oval; inM. decumanusthey are parallel or slightly divergent; inGunomysthey are lyre-shaped.

M. rattusM. decumanusGunomys

M. rattus

M. decumanus

Gunomys

To determine these differences the heads of the rats are cut off, the tissues desiccated by antiformin, or by boiling and stripping.

From experiences in Porto Rico, Creel, of the U. S. Public Health Service, concludes thatM.norvegicus(decumanus), while essentially a burrowing animal and not addicted to climbing or swimming, is nevertheless quite capable of doing either. He was found to burrow in the hardest earth to a depth of two and one-half feet and to pass through all kinds of wood, soft brick and lime mortar, probably by gnawing.

The black rat and Alexandrine rat (M. rattus) in Porto Rico, according to the same observer, do not burrow at all, but can climb and jump in expert manner, and are the species found in the rural districts, remote from houses. He found that all varieties of rats may swim, from ships to the shore, distances of from one-fourth to one-half mile, but that they lack the sense of direction and probably do not land from ships naturally in this manner (Public Health Reports, No. 9, February 28, 1913).

The femaledecumanusis a prolific breeder and brings forth larger litters than theMus rattusfemale.

Mus decumanusis generally conceded to be larger and more ferocious thanMus rattus. For this reason he drives the smaller rats to the upper floors, thedecumanusspecies generally living near the ground. He is a burrower and is rarely foundin the upper stories of buildings.Decumanusis known as a wharf rat, but is rarely trapped on ships on the Pacific Coast, according to the observations of Surgeon Simpson of the U. S. Public Health Service (Public Health Reports, April 11, 1913). According to the same observer,Mus rattusis the commonest ship-borne rat. He also states that the black rat and the roof rat (Alexandrinus), both varieties ofM. rattus, differ chiefly in color. They live in upper floors, between ceilings, in walls and roofs and are remarkable climbers as well as being expert rope-walkers and wire-walkers. On account of their natural wariness and caution it is not always easy to induce them to enter or approach traps.

The photographs introduced were taken under my direction in Manila in 1912, 1913 and 1914. Some of them show the character of the house construction in Tondo District, Manila, where plague flourished in 1913. Others illustrate methods of rat-proofing bamboo timbers in houses of light material. These end openings were either closed by introducing cement or by placing tight-fitting tin cans over the ends of the bamboo rafters.

There are many interesting memoranda, gatheredand made in connection with our antiplague work in Manila, especially concerning the location and construction of rat nests found by our laborers; the materials used and the fabrication of the nests. Memoranda giving details of rat catching and rat-proofing are also presented and notes showing the location of dead rats found in relation to dead human bodies of plague victims.

Notes concerning cases of multiple house infection are also presented as being of possible interest.

The Javan studies in 1911 and 1912 establish the fact that it is possible to form a fair judgment as to the length of time a rat has been dead, up to ten or twelve days, from the condition and appearance of the rat cadaver, both as to decomposition and drying. A series of 50 rats was studied. It is to be understood that the conditions under which these observations were made were tropical conditions. They would be fairly comparable with summer conditions in America, but should not be followed too closely at other seasons of the year. In my own experience I have observed that ants are likely to attack the cadaver early and to obscure the deductions by their destruction of the body.

PROGRESSIVE POST-MORTEM CHANGES IN RAT CADAVERS. THE NUMBERS INDICATE THE NUMBER OF DAYS AFTER DEATH

Photograph (afterPublications of the Civil Medical Service in Netherlands, India) shows the progressive postmortem changes in rat cadavers, the numbers indicating the number of days after death.

A Collection of Notes Concerning Rat Runs, Rat Nests, Their Location and Other Data.—Attention is invited to the following collection of notes concerning rat runs, rat nests and their locations and other data collected by the various working parties under the direction of SanitaryInspectors Brantigan, Renner and Kennard, of Manila.

Special attention has been given to the finding and destroying of rat nests, and in this connection please note that during the month of May, 1913, one party of workmen (20 men) under Inspector Brantigan, killed by hand 511 rats out of a total of 1319. This means that many nests were broken up and that much breeding was interfered with. In June, 1913, two parties (40 men) killed 772 rats by hand out of a total of 3019.

This work occurred in Tondo District in connection with extensive cleaning and moving operations.

At 1279 C. Sandejas[4]7 rats were found in a nest at the foot of a cluster of bamboo trees, between the trunks. Nest was made of leaves.

[4]C. is abbreviation for Calle, the Spanish term for street.

At 728 C. Velasquez, Tondo, 12 rats were driven from a burrow underneath a thick cement floor by formaldehyde gas delivered in the burrow through a rubber hose. This burrow was in sand and the rats came out about ten minutes after the flow of gas began. All were killed or captured and two or three died from the effects of the gas.

On October 27, 1912, two of the rat terriers belonging to the Bureau of Health caught 192 rats in one storeroom at the Manila Railway Station, in 38 minutes. At various times they have killed from 10 to 25 rats at a single location, in connection with the cleaning and moving work done by the laborers. The dogs caught about 600 rats in all.

On March 11, 1913, 27 rats were caught by laborers at 202 Calle Concha. They were nesting in straw covers which had been removed from bottles.

On March 11, 1913, 13 rats were found beneath a pile of loose tiles at 203 C. Sardinas. The nest was made of fibres from coconut shells and straw.

On March 13, 1913, 12 rats were found among stones scattered in a shallow pile on the ground at C. Conservador (interior). Nest was made of rice chaff and small pieces of cloth.

On March 15, 1913, 9 rats were caught at 1353 C. Anloague on the ground floor beneath a pile of boards. Nest was made of coconut fibre and shavings.

On March 16, 1913, 24 rats were caught at 934 (interior) Velasquez beneath a wood pile. Nest was made of coconut-shell fibre and pieces of cloth.

On March 17, 1913, 14 rats were caught under a pile of hay and straw at 173 Velasquez. Nest was made from straw, chaff and hay.

The following articles of food were found in the above-mentioned nests: chicken bones, rice, coconut, fish and bread.

MEISIC DISTRICT

At 822 Sacristia 6 dead rats found in holes.

At 540 T. Alonso a family of 8 rats was smoked out and all were killed.

At 514 same street 6 rats were smoked out and killed.

At 538, interior, same street, 4 rats were smoked out and killed.

At 546 same street 4 rats were smoked out and killed.

At 715 San Bernardo dead rat found in a hole. Nest made of banana leaves and rags.

At 627, interior, Zacateros, 9 rats were smoked out and killed.

At 669 Benavides 6 rats were smoked out of four runs and were caught.

At 631 Zacateros 2 rats were smoked out and killed.

At 417, interior, Misericordia, 4 rats were secured in two holes under a tile floor. Many rats were caught at this number (interior) in traps.

At 221 Espelita 7 rats were found in a nest made of palm leaves and excelsior; location of run way and nest beneath tile floor.

At 124 Tetuan, in a nest of straw and lint, 5 rats were caught by hand, alive.

At 415 T. Alonso one live rat and 3 dead ones were dug out from beneath a tile floor.

SAMPOLOC DISTRICT

At 1001 Bilibid Viejo there were 5 rat runs, in a Chinese store. Eight rats were secured in a nest under the cement floor. Nest made of straw and paper.

At 928 San Sebastian there were 8 rat runs. In one of them there were caught 8 rats. The nest was made of straw.

At the same address, later, 3 rats were caught in another run and 8 young rats, with eyes still unopened, were found in a nest of straw. A supply of bread was on hand in this nest.

At 629 Tanduay 20 rats and nests of straw and paper were found.

At the same address upon another day another rat run was found and one large rat and 16 small ones were taken from a nest made of rags, straw, and fibres.

PACO DISTRICT

At 1115 San Andres in a Chinese tienda (food store), a long rat run and a nest of rags, straw, and paper, and 30 small rats were found.

One nest in a bamboo tree 30 feet above ground was found. Rats had been observed going up the tree and one was caught at the foot of the tree in a trap.

SAMPOLOC DISTRICT

At 629 Tanduay 14 young rats and a nest of straw, paper and rags were found in a stable.

Same address, later, one rat run and nest of straw and rags with one large rat and 16 small ones were found.

TONDO DISTRICT

March 27, 1913, one rat was caught alive inside of a bamboo timber in house at 51, interior, Pesqueria.

At 631 Azcarraga 4 young rats were found in a nest of paper, leaves, and hay. Chicken bones, crab shells, and rice were present in the nest.

A young python was caught in a lumber yard in the Santa Cruz District in June, 1913. In his stomach was found a half-grown rat. Another snake was caught in a rat trap at the same address about the same time.

Plan for Household Rat Destruction.—The following plan for household rat destruction was proposed by me to the Director of Health. It is considered worthy of trial if rat plague appears in new districts.

Proposal for periodic household rat poisoning in Manila.Proposed that, upon a certain day of each week, rat poison be issued free to all applicants (householders) in Manila who agree to place same about their premises, permitting the poison to remain in place for 48 hours.Instructions and poison placards to be issued with the poison. Issues to be made from Station Health Offices and records of issue to be kept.Collections of dead rats to be made at the end of 24 hours and 48 hours by Bureau of Health employees. Poison portions to be collected and turned in at the Station Health Offices at the end of 48 hours, that is, at the time of the last rat collection. Rats to be tagged and examined for plague in the usual manner.Due newspaper notice of the plan and of the gratuitous issue of poison to be given to the people and their coöperation requested.Plan to be tested for at least two months.

Proposal for periodic household rat poisoning in Manila.

Proposed that, upon a certain day of each week, rat poison be issued free to all applicants (householders) in Manila who agree to place same about their premises, permitting the poison to remain in place for 48 hours.

Instructions and poison placards to be issued with the poison. Issues to be made from Station Health Offices and records of issue to be kept.

Collections of dead rats to be made at the end of 24 hours and 48 hours by Bureau of Health employees. Poison portions to be collected and turned in at the Station Health Offices at the end of 48 hours, that is, at the time of the last rat collection. Rats to be tagged and examined for plague in the usual manner.

Due newspaper notice of the plan and of the gratuitous issue of poison to be given to the people and their coöperation requested.

Plan to be tested for at least two months.

MULTIPLE HOUSE INFECTION

Memorandum concerning 1364 Calle Sande:

Within 72 hours (April 25-27) five fatal cases of plague, all in Filipinos, occurred in Manila. The five deceased persons lived at 334 C. P. Rada (Meisic), 1419, interior, C. Dagupan, 1364 C. Sande (Tondo), 642 C. Ylala (Meisic), and 1492, interior, C. Dagupan (Tondo).

The following relationships were established by inquiry and investigation and the circumstances point strongly to a common source of infection and to a single geographic focus of plague infection in connection with all of the cases, viz.: at 1364 C. Sande (Tondo).

José Raymundo, boy, aged fifteen, lived at 334 C. P. Rada and worked daily until taken sick on Tuesday, April 22, at 1364 Sande, in the shop of Simplicio Enriques, a silversmith, who lived part of the time at the same address.José Raymundo died of bubonic plague at San Lazaro Hospital on Friday, April 25, 1913.Norberta Mendoza, woman, aged fifty-six, lived at 1418, interior, C. Dagupan. She was the mother-in-law of Simplicio Enriques, the silversmith at 1364 Sande, and visited her son-in-law there frequently and within a few days of her last illness. She was taken sick April 22 and died at 1419, interior, C. Dagupan, on the morning ofApril 26. At autopsy at San Lazaro morgue, the same day, bubonic plague was found to be present and the cause of her death.Trinidad Galves, a young woman, aged sixteen, lived at 1364 Sande and was taken sick there on April 25. She was removed to San Lazaro Hospital and died there April 26, extensive plague lesions being found at autopsy.Pablo Banzon, man, aged twenty-six, living at 646 C. Ylaya, was taken sick on Friday, April 25. He was removed to San Lazaro Hospital Saturday afternoon and died there Sunday evening, April 27. He was shown to have plague by bacteriologic examination made at the Bureau of Science. He worked at 1364 Sande as a silversmith, with José Raymundo and was employed by Simplicio Enriques.Simplicio Enriques, aged twenty-seven, a silversmith, conducting his business at 1364 C. Sande and employing José Raymundo and Pablo Banzon, was taken sick about April 23. He moved to two different houses in the interval between the onset of his sickness and his transfer to San Lazaro Hospital on April 27, first to 1419 C. Dagupan, interior, where he remained until the death of his mother at this house; then to 1492 Dagupan, interior, from which place he was transferred to San Lazaro Hospital, where he died with bubonic plague a few days later. Diagnosis was confirmed at autopsy.

José Raymundo died of bubonic plague at San Lazaro Hospital on Friday, April 25, 1913.

Norberta Mendoza, woman, aged fifty-six, lived at 1418, interior, C. Dagupan. She was the mother-in-law of Simplicio Enriques, the silversmith at 1364 Sande, and visited her son-in-law there frequently and within a few days of her last illness. She was taken sick April 22 and died at 1419, interior, C. Dagupan, on the morning ofApril 26. At autopsy at San Lazaro morgue, the same day, bubonic plague was found to be present and the cause of her death.

Trinidad Galves, a young woman, aged sixteen, lived at 1364 Sande and was taken sick there on April 25. She was removed to San Lazaro Hospital and died there April 26, extensive plague lesions being found at autopsy.

Pablo Banzon, man, aged twenty-six, living at 646 C. Ylaya, was taken sick on Friday, April 25. He was removed to San Lazaro Hospital Saturday afternoon and died there Sunday evening, April 27. He was shown to have plague by bacteriologic examination made at the Bureau of Science. He worked at 1364 Sande as a silversmith, with José Raymundo and was employed by Simplicio Enriques.

Simplicio Enriques, aged twenty-seven, a silversmith, conducting his business at 1364 C. Sande and employing José Raymundo and Pablo Banzon, was taken sick about April 23. He moved to two different houses in the interval between the onset of his sickness and his transfer to San Lazaro Hospital on April 27, first to 1419 C. Dagupan, interior, where he remained until the death of his mother at this house; then to 1492 Dagupan, interior, from which place he was transferred to San Lazaro Hospital, where he died with bubonic plague a few days later. Diagnosis was confirmed at autopsy.

The two women were patients of Dr. Hernando of Calle Ylaya. He recognized the case of the elder woman as a probable case of plague, after death, and reported the matter to the Bureau of Health.

The house at 1364 C. Sande is of the type inwhich cases of rat plague and human plague have recently been found. In our operations to put the house in a safe condition we found one dead rat, mummified, in the basement. Unfortunately, the workmen who swept it out did not note the exact location at which it was found. The house is in the midst of the district where rat plague has raged since early in March, 1913. The basement contained unauthorized and illegal sleeping rooms until a few days before this outbreak when they were removed in the course of our antiplague operations. The building is constructed of bamboo with a nipa thatch roof.

The front part of the basement was paved, but the pavement was undermined and broken. Being convinced that dead plague rats were present in the vicinity of this house and probably within it, I directed that the cement floor under the silversmith shop and the barber shop, located upon the ground floor at this address, be torn up. Accordingly, this was done (April 28) and three dead rats and one live one were found beneath the cement. As the bodies were mummified and unfit for bacteriologic examination they were burned. The living rat was examined at the Bureau of Science but was foundto be healthy. The cement floor was broken and permitted fleas from the dead rats to enter the basement room of the house which was occupied by the silversmith shop. The rats doubtless died from plague and the hungry fleas in due time attacked the nearest persons at hand, the unfortunate occupants of the silversmith shop and the two women who frequented the room also.

These facts account for the epidemic at 1364 Sande very completely.

The premises at 1364 Calle Sande were quarantined by the following order:

Manila, April 27, 1913.The premises 1364 Sande are hereby declared in Quarantine for Bubonic Plague by order of the Director of Health.The inmates will be permitted to leave the building and find quarters elsewhere, provided they leave their addresses with the policeman in charge, so that they may be readily found. They must remain in the District of Tondo. If they remain in the house they will be obliged to stay in the upper story of the house and will have to arrange for meals to be sent in.The barber shop and "platero" shop are hereby ordered closed until further orders.By order of the Director of Health.[Signed]T. W. Jackson,Medical Inspector, in Charge of Plague Suppression.

Manila, April 27, 1913.

The premises 1364 Sande are hereby declared in Quarantine for Bubonic Plague by order of the Director of Health.

The inmates will be permitted to leave the building and find quarters elsewhere, provided they leave their addresses with the policeman in charge, so that they may be readily found. They must remain in the District of Tondo. If they remain in the house they will be obliged to stay in the upper story of the house and will have to arrange for meals to be sent in.

The barber shop and "platero" shop are hereby ordered closed until further orders.

By order of the Director of Health.

[Signed]T. W. Jackson,

Medical Inspector, in Charge of Plague Suppression.

Memorandum reporting circumstance surrounding 2 cases of plague at 1226 C. Juan Luna (May 17, 1913):

Valeriano Lausin, aged fourteen, Filipino male, Carmelo maker by trade but out of work at time he was taken sick, recently removed to this house from 917 C. Jaboneros where he had been employed. The patient fixes the date at about a week previous to his sickness, but the proprietors of 917 Jaboneros are positive in their statement that he left the place where he lived and worked, at least two weeks before. This boy recovered.

The circumstances and especially the occurrence of a second case at 1226 C. Juan Luna, indicate that infection was incurred here.

Moreover, this house is in the midst of a rat-plague infected district.

PLAGUE HOUSE, 1226 CALLE JUAN LUNA

The house is of bamboo and nipa construction and contained illegal basement rooms until a week ago. About 60 persons lived in this house which was once licensed as a tenement but which is unsanitary in a multitude of ways. Bamboo construction, overcrowding, dirty condition and absence of proper drainage, water-closet, proper kitchens and paved ground floors, together with bad ventilation, made it a dangerous habitation and the added conditionof plague infection made it necessary to vacate and quarantine the building.

On May 15, at the daily inspection of contacts in the house 1226 C. Juan Luna, Filomena Suñga, aged nineteen, and a relative of the owner of the building, was found to be sick. Her only symptom was fever, but she was transferred to San Lazaro upon suspicion and promptly developed symptoms of plague. She died in a few days and the diagnosis of plague was verified at autopsy. The following order was issued:

Station "C," Tondo, Bureau of HealthManila, P. I., May 15, 1913.By order of the Director of Health, the house No. 1226 C. Juan Luna is declared infected and is quarantined this date, for Bubonic Plague. The house will be vacated and a policeman will register the names of all residents and the addresses to which they remove.The residents may remove their personal effects but will not be permitted to return while the quarantine is in effect.[Signed]T. W. Jackson,Medical Inspector, Station "C," Tondo.

Station "C," Tondo, Bureau of Health

Manila, P. I., May 15, 1913.

By order of the Director of Health, the house No. 1226 C. Juan Luna is declared infected and is quarantined this date, for Bubonic Plague. The house will be vacated and a policeman will register the names of all residents and the addresses to which they remove.

The residents may remove their personal effects but will not be permitted to return while the quarantine is in effect.

[Signed]T. W. Jackson,

Medical Inspector, Station "C," Tondo.

Memorandum: Human body (dead from plague) and dead rats found in the same basement room. Upon March 21, 1913, a Filipino laborer living at 140 Calle Perla, Tondo, was found dead from bubonic plague.

Upon careful investigation and search of the premises the following findings were disclosed:

One rat, large, mummified and dry and therefore dead for at least one week, was found clinging to a bamboo wall just back of the cot upon which the dead human body was found.

In a section of bamboo, in a timber constituting the ceiling of the basement and also the upper part of the door frame, a rat, dead and dried up, was found. This section was the end section of the timber which was partly covered with nipa thatch, with which the sides of the house were covered. The ends of a number of the outside rafters (bamboo) were found to be gnawed through.

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