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V20n11p1149.Pdf (494.7Kb) PLAGUE IN THE AMERICAS (Continued)” VIII. PARAQUAY Paraguay was the first of the American countries in which the pres- ence of bubonic plague was rep0rted.l The country lies close to the heart of the South Ameritan continent, from 800 to 1,600 miles up the La Plata River and its tributaries (between about 19”30’ and 28” South Latitude and 54 to 63” West Longitude). It covers an area of some 169,000 square miles and has a population estimated at l,OOO,OOO,of which about 20,000 are Indians. The eastern part of Paraguay is rolling or hilly, and forested; the western half is made up of grassy plains with occasional wooded hills, and is crossed by numerous tree-fringed streams. The climate is sub-tropical, with three hot months, December, January, and February (and sometimes March and November). Summer lasts from October to March and winter from April to September. The mean temperature varies between 71 and 73 F, with a maximum of 98 F. The heaviest rains occur about March, but some rain falls every month. The industries of the country include agriculture (cotton, tobacco, yerba mate, coffee, rice, sugar, oranges) in forest clearings, stock-raising on the plains, and lumbering. As noted elsewhere (See General Review), the first case of plague in Paraguay seems to have been that of a sailor arriving on the Argentine coasting steamer Centauro, which had taken on at Montevideo, Uruguay, a cargo of Indian rice from the Dutch sailing vessel ZezYer. Four sailors fell ill during the voyage, and three of them died in Asunción, April 28 (two days after the vessel’s arrival), May 1, and May 4, 1899.2 These first cases were not diagnosed as plague, although characteristic symptoms were observed.3 The disease continued to spread slowly among the scattered inhabitants of Asunción, and the corre& diagnosis . * See General Review. 1 Kinycun has pointed out thd plague wa~ prcbebly present in California befcre 1899 (see General ‘Review, Note 35). Rodrfguez also disputad Paraguayan pricrity, expressing the opinion that the Cm- tauro left plague infection in the Argentine ports which she touched befcre reaohing Asunci&, and that clima& conditiom mere respomible fcr the delayed appearmce of the disease in the tormer localities. (Rodrfguez, M.: Rev. Son. dililitar, Paraguay, May 1929, p. 2153: BoE. OJ San. Pan., Sept. 1929, p. 893.) His conclusions mere based cn B study of Agote and Medina’8 wcrk (Agote, L., & Medina, A.: “La Peste Bubónica en la República Argentina y en el Paraguay, 1899-1900.” Buenos Aires, 1901). Agote and Me- dina, however, ststed thnt “Tha vess& wbich at that time leftksuncibn [that fs, in the period between tha outbreak cf plague and its accurate diagnosis, cr April tc September, 18991 weresurely those which sowed the plague germ along cur coa&. :’ (Ibid., p. 40). * A U. S. Consular report cf the period ravesls the reaoticn to the appearance cf plague in Amrmibn: “There is a kind cf disease existing here said to be peculiar to Paraguay. It seema that the physiciam do not know what it fs. It kills in fcrty-eight hcurs; if nct, afta that time there is hope. It is safd ti take the glands; that is, causts them to swell. It seems to have ita origin in filth, and began in the soldiers’ bar- ra& . , . At presenta bnderiolcgical rtnrilysis is being made. In EIfew days it is hoped & scientific opinion will be reached. Schools have been dismissed today to be cleaned and painted imide; the Government buildfngs are undergcing the sant? prcoess. The soldiers from that part of the barra& whioh was affected will be sent cutside the oity. The hospital papera mncunce ll sick soldíers, 8 conv&aoing snd 3 stiU VB~Y lcw. Don% think the diseme will develop cr increase . .” (Pub. Eedth Repwts, U. S., Oct. 27, 1899, p. 876). 1149 1150 PAN AMERICAN SANITARY BUREAU [November was established September 14, 1899, with the cooperation of an Argen- tine commission, though some persons continued to claim that the dis- ease was not plague.4 PLAGUE IN PARAGUAY I 1 600 -5* This first epidemic was also the severest and most extensive which Paraguay was to suffer. A total of between 89 and 100 deaths in 1899 have been estimated from records and personal testimony,E with 14 more in January and February, 4 Tbe Argentine scientista, Agote and Medina, after quoting Ricardo Jorge’s expwiences in Oporto, report that similar opposition wa8 encountered in Asunción, Rosario, and even Buenos Aires: “Here. it was also neoessary, in arder ta satisfv popular clamor. to have recoure to the opinion of ‘foreign experta,’ and when tbeir opinion completely coofirmed that of our own bacteriologists and clinicians oonnected with the investigation. the opposition simply denied their competence in the field.” (Supra, p. 19.) 6 Agote and Medina give 100 deaths (64 from April thmugh September and 77 cases 46 deatba from October through December, 1899) (Ibid., p, 36). Tbis figure hss been aocepted by Paraguayan writers. (See Table) 19411 PLAGUB 1151 1900, when the epidemic temporarily ceased, to reappear in July. These figures do not include deaths in the railway towns of Tembetary (suburb of Asunción), Trinidad, Luque, Tacuaral (Ypacaraí), Itagua, Paraguarí, and Villarica, which were also infected. Since 1900 th ere have been about 15 limited outbreaks and some sporadic cases, including the occurrence in December 1909 of 30 suspicious Plague in Paraguay - Icsfrhn’s data* Additional Reporte T - Month kctha Deaths 1899 Apr.-Dec. 100 1900 Jan.-Feb. 14 12 2 July 24-31 %b. Health Reports. 1901 Jan. 7 1 June 23 II 1902 Mar.-Dec. ti 1903-04 0 1905 Jan.-Dec. 2 1906 Feb.-S&. 14 1907 Oct.-Nov. 3 8 Jan. 3, Concepeibn ‘< Feb. 6, Asunción II 1908 Dec. 1 1909 Apr.-Nov. 8 1910 Feb.-De& 5 30 w 3OW Dec. 10,1909-Feb., 1910, Northern Paraguay 1911 July 20 23 14 Aug.-Sept. 1912 July-sept. 15 1913 Jan-Dec. 21 1914 Mar.-DW. 6 3915 Jan.-Apr. 3 1916-18 0 1919 Oct.-Nov. 7 1920 0 1921 0 1 Feb. 4. ticínity of rae infeated mar& 1922 0 1923 0 4 Dec. 18, Preass reporta OdY 1924-26 0 1927 Od. 10 1928 Aug. 2 oct. II Apr. 1; July 10; Aug. 3 ?ositive plague diag- noses, Natl. In&. Par- asitology, 1928 5-6 ?&i& Total 242 56 * InsfrBn. José V.: Bol. Of. San. Pan., Oct. 1935, p. 928. t There wero at least 10 cases and 5 oì 6 deaths from plague in Aauncibn in 1928, according tc the recol- lection of Dr. Rati Peña (Personal ccmmunication, October 9, 1941). At lea.& 3 of the cases were pneu- monic plague. A suspiciow case reported in 1936 proved cn bscteriolcgic examination to be lymphogranuloms, not plague. Insfrán gsve August 28, 1928. as the data of the last pla.que death in Asuncibn. (S) = Suspicious only. deaths in Northern ParaguayG; a flare-up in Asunción in July-September, 1911, with some 20 deaths; and 21 deaths in 1913, 15 in the last half of 1912, and 14 in 1906. No cases mere reported for 1903-04, 1916-18, and 1923-27; the last recorded outbreak was in 1928 (6 cases, 2 deaths June-August; 3 cases, October). The total number of deaths reported was 298, including some unverified reports, and the total number of cases was probably not over 500. (See Table) 6 Pt&. IleoU Repds, 1910. These cases aro apparently not included in the Paraguayan reporto; 1152 PAN AMERICAN SANITARY BUREAU [November In addition to the towns from which plague cases were reported during the original outbreak, Patiño-cue (1900 ?), Villa del Pilar (1900 ?), Villa Concepción (suspicious cases, October 1900, later declared not plague),’ Areguá, Carapeguá,8 and Puerto Pinasco (Oct. 1927)g have been listed as having had plague at some time. Rats and Mice.-Dead rats were conspicuous during the original outbreak of plague in Asunción (they were found on the Centauro, and then in the vicinity of the Customs-house some 15 days after her arrival).lo Anti-rat measures have been a part of subsequent control campaigns. According to Insfrán, the two rats fouad in Paraguay are the gray rat (Mus decumanus or Rattus norvegicus), living in burrows and sewers; it is the domestic rat and the most abundant; and the black rat (Mus rattus), living in roofs, walls, and trees.‘l Fleas.-There do not seem to have been any studies of the fleas connected with plague in Paraguay, although Xenopsylla cheopis is probably the most common, according to Peña.12 Seasonal Distribution.-The original epidemic lasted from the intro- duction of plague in April, 1899, through February, 1900, with the heav- iest incidence from August to October.13 The disease apparently reappeared in July and again in October, 1900.14 While the available later statistics do not always give the month of the outbreak, they seem to show a majority of cases occurring between July and February, and especially between July and Octobei-. Agote and Medina, studying the temperature and humidity curves for Asunci6n, stated that the “mild temperature and low humidity . of late winter and spring” (that is, from about July to September), were favorable to the develop- ment of plague.16 The average temperature of Asunción they found to be about 74 F, ranging from 60.2 in June to 81 in December; with the highest temperature ranging from 106 F in December to 89.8 in June, and the lowest from 32.3 F in June to 60 in January.
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