India's epidemic is the `Princess of Death'

By V. Anjaiah

JAKARTA (JP): Plague was a word which struck terror into the hearts of the men of the Middle Ages. Now that word and the disease it signifies has appeared to plague a country that can ill afford it: India, where it took 52 lives and sent thousands into the quarantine wards in a panic.

It has scared people in all corners of the world, from Bangladesh to Britain, Singapore to South Africa, though modern medicine can cure this deadly disease.

The panic grew to such an extent that persons suffering from ordinary disorders like headache, flu, fever and diarrhea rushed to hospitals sure they were afflicted with the plague. Thankfully only 252, out of the 4,200 persons tested, were positive.

But several countries, in an effort to arrest the spread of the disease, took unprecedented measures. These actions ranged from closing borders with India, to screening Indian travelers and halting trade with India temporarily.

Lebanon, obviously overreacting, banned the entry of Indians despite repeated statements from the World Health Organization (WHO) ruling out the possibility of the epidemic spreading to other countries.

"We are not aware of any recent plague epidemic having an international connection. Recent outbreaks have been confined to the territories in which they occur," said WHO spokesman Thomas Prentice.

Yet the hysteria goes on. Why? Is it some kind of conspiracy to disrupt the economic progress India has made in the last three years by opening up its economy? Or can the disease really cause death to the extent feared by several nations?

It is not known whether there is indeed a conspiracy or just overreaction. However that may be, India is hurt by the measures taken by a few countries against the spread of the plague. One thing is clear, in bygone days the plague not only created panic, but killed millions throughout the world.

Actually the term plague was initially used to describe any disease that causes a high rate of mortality.

Now plague refers to a particular disease caused by Bacillus Pasteurella Pestis or Bacterium Yersinia Pestis transmitted by fleas carried by rats.

The present generation may not know much about the plague, well-known to our forefathers as the "Black Death" or "Mahammari" (Princess of Death), which transformed several cities into the habitats of ghosts because the rudimentary medical science of the past had no cure.

Plague was a nightmare for the people of Constantinople. It killed more than 40 percent of the population in the sixth century A.D. It broke out as the "Great Epidemic" or "Black Death" in Europe during the 14th century and took the lives of 25 million people, equivalent to one-fourth of Europe's entire population.

Moving from Europe, the killing fields shifted to a far, distant place called Hyderabad, a beautiful garden city in southern India. It turned the garden into a graveyard by swallowing half the city's population during the end of the 16th century. In spite of heavy casualties, brave Hyderabadis, who won their bitter battle against the epidemic, built the beautiful monument, Charminar or four minarets, in 1591, in memory of the plague victims.

The plague's journey continued from country to country. It caused 70,000 deaths in London (1664-1665), 100,000 in China (1894) and 10 million deaths in India in the earlier years of this century.

It is this dark history that is sending shock waves throughout the world. But today there is no need to worry about this so- called "deadly disease". It is ignorance of the plague and its black history that is creating the confusion and panic.

Plague is an infectious disease and can be transmitted to the human body by fleas.

According to medical experts, the plague has three forms: bubonic plague, pneumonic plague and septisemic plague.

Bubonic plague is usually transmitted by fleas from rodents and has symptoms like shivering, vomiting, headache, back pain, sleeplessness, diarrhea, a sudden rise and fall in the body's temperature (104 degrees Fahrenheit or more) and the appearance of buboes (inflammatory swelling of a lymph gland) in the groin and armpits. McGraw-Hill Encyclopedia of Science & Technology says that bubonic plague constitutes three-fourths of all plague cases.

Unlike bubonic plague, which is transmitted from rodents to human beings, pneumonic plague moves from one person to another through coughing and sputum. Sometimes it develops from the bubonic infection. The symptoms of this, as stated in Time's Home Medical Manual, are high fever, rapid breathing and heartbeat and extreme restlessness. It must be cured within 10 to 15 hours of the fever, otherwise it means death for the patient.

These first two forms of the plague appeared in many of the cases in the recent outbreak in India.

The most fatal form is septisemic plague, which can cause prostration and brain damage and finally death within 24 hours.

What makes the "princess of death" deadly is that it spreads easily to anyone in any place and can even travel great distances, for example plague-infected rats on ships can carry the disease to different continents.

Nowadays, thanks to antibiotics and sulfonamides, the plague is no longer considered a major threat by medical experts. The main problem is that it rarely disappears from a region. Because even if you bury a person who has died from the plague, there is a possibility of this evil resurfacing through the insects and animals that are exposed to the corpse. The recent outbreak of plague in the industrial city of Surat (India), where it appeared last in 1966, is a glaring example.

Although Indian health authorities blame either a recent earth quake which rocked the area adjacent to Surat or floods which devastated the bustling streets in the hub of textile industries during the last rainy season, it was the local authorities' negligence in the initial stages which allowed the situation to get out of control.

Moreover, Surat is home to 2.2 million people with immigrant, illiterate rural laborers constituting a majority and living in slums notorious for lack of sanitation, poor health facilities and pollution, which contributed to the spread of the disease.

With the advancement of medical science, the plague can be cured with drugs such as Streptomycin, Kanamycin, Chloramphenicol, Tetracycline, TMP Sulphur Syrup and Paracetamol. The current overall death rate from the plague is around 15 percent and this could be reduced to five percent with proper care.

WHO says that on the average, 1,500 cases of plague are reported every year throughout the world. The areas known as dens of plague in present times, according to Darwin L. Palmer, an American plague expert, are southern America, the southern part of the former Soviet Union, India, Indochina and South Africa. But this list expands every year.

As far as recent outbreaks are concerned, in 1992, the plague took 140 lives in Zaire, 28 in Madagascar, 13 in Vietnam, six in China, four each in Mongolia and Peru, three in Myanmar and two, in the most developed country, the United States.

It is this that makes India, where only 57 people died of plague, feel that the present outbreak has been blown out of proportion and that many countries have overreacted to it.

The exaggeration might be creating panic worldwide, but in one way it throws light on the sanitary and health conditions, the image of which definitely lacks glitter in a country where nearly 60 percent of the population lives in utter poverty.