The Third Plague Pandemic (1855 to 1959)
This pandemic, masquerading under a rather prosaic name, whilst a slow-burner, lasted over a century and accounted for more than 12 million people in China and India alone. It was the third major bubonic plague pandemic, following on from the Plague of Justinian (vide infra) and the Black Death.
The patterns of deaths suggest very strongly that there were two different sources of plague. The first manifestations were predominantly bubonic in character and its spread was consequent upon expanding global trade which made it easier for infected rats and humans and cargoes harbouring disease-carrying fleas to be transported from country to country. The second more virulent strain was predominantly pneumonic and was spread by human contact.
The first reported outbreaks were in the south-western Chinese province of Yunnan in the 1850s. The disease was pretty much contained in the province until the Panthay rebellion (1856 to 1873) broke out. This violent rebellion led to upheavals of populations which in turn exposed other parts of China to the plague. By March 1894 the disease was entrenched in Canton, killing 60,000 in a few weeks, and soon appeared in Hong Kong which was just across the water accounting for some 100,000 in the first two months. It was not until 1929 that the disease ceased to be endemic in Hong Kong.
Having arrived at the great trading port of Hong Kong it was inevitable it would spread across the British Empire. The plague arrived in India in 1896 and over the next thirty years some 12.5 million would die in the country alone, principally in the northern and western regions. Interestingly, almost all of the cases in India were bubonic in character.
The reaction of the Raj to this health disaster was repressive at first. They resorted to quarantine, isolation camps, travel restrictions and a ban on traditional Indian medical practices, all enforced by the British military. But these measures were unable to keep pace with the spread of the disease and, not unnaturally, provoked resentment amongst and direct action by the local population. In a change of tack the authorities in 1898-99 introduced a policy of mass vaccination using a vaccine developed by Waldemar Haffkine which was voluntary but had 4 million takers by the turn of the century and also incorporated traditional medical practices into the treatments available. Nevertheless the disease spread to Egypt, Paraguay, South Africa, San Francisco, Australia, the Caribbean and Western Europe. The plague came and went and returned in each of these areas until the 1950s when with the global death toll down to 200 a year in 1959 the World Health Organisation withdrew its pandemic status. The last significant outbreak associated with it occurred in Peru and Argentina in 1945.
On the bright side, the challenge posed to the medical authorities by the type and geographical spread of the disease meant that researchers, doctors and immunologists had the perfect opportunity to further their knowledge and hone their techniques. It was the first pandemic where scientific advances in the understanding of the causes of disease and the corresponding development of immunology provided some assistance and those advances explain why there has not been a Fourth Pandemic (yet).
And in India, the Raj’s steep learning curve in how to implement general health programmes helped inform their overall public healthcare programmes.