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 EI few days it is hoped & scientific opinionwill 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).
1150
PAN AMERICAN
SANITARY
BUREAU
[Novemberwas 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.)
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
T
Icsfrhn’s data* Additional Reporte Month kctha1899 1900 1901 1902 1903-04 1905 1906 1907 Apr.-Dec. Jan.-Feb. Jan. Mar.-Dec. Jan.-Dec. Feb.-S&. Oct.-Nov. 100 14 7 ti 0 2 14 3
1908 Dec. 1
1909 Apr.-Nov. 8 1910 Feb.-De& 5
1911 1912 1913 1914 3915 1916-18 1919 1920 1921 July July-sept. Jan-Dec. Mar.-DW. Jan.-Apr. Oct.-Nov. 20 15 21 6 3 0 7 0 0 1922 1923 1924-26 1927 1928 Od. Aug. 0 0 0 10 2
Total 242
-
Plaguein Paraguay
12 1 8 30 w 23 Deaths
-
2 3OW 14 1 4 5-6 56July 24-31 %b. Health Reports.
June 23 II
Jan. 3, Concepeibn ‘<
Feb. 6, Asunción II
Dec. 10,1909-Feb., 1910, Northern Paraguay Aug.-Sept.
Feb. 4. ticínity of rae infeated mar&
Dec. 18, Preass reporta OdY
oct.
Apr. 1; July 10; Aug. 3
II II
?ositive plague diag- ?ositive plague diag- noses, Natl. In&. Par- noses, Natl. In&. Par- asitology, 1928 asitology, 1928 ?&i&
?&i&
* 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)
1152
PAN AMERICAN SANITARY BUREAU [NovemberIn 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.
The hu-
midity varied from a minimum of 62yo in September to a maximum of
77% in May, and dropped steadily from May to September.
’ Low, R. B.: “Reporta and Papenì. Bubonic Plague,” Local Governing Board, London, 1902, p. 428. 8 InsfrLn, Jos5 v.: “La peste en el Paraguay,” Bol. Oj. San. Pan., Oct. 1935, p. 925. (Presented to the Ninth Pan Ameritan Sanitary Conference by the Paraguayan DeIegate, Dr. Cayetano Masi.)
9 Urizar, Rogelio: An. In&. Na. Para&oZosia. Val. 1, No. 1, 1928, p. 295.
10 The mortality among the rata around the Customs-house was so great that ene of the employeea declared that “the Custome warehouses, whioh. liko al1 such, had heen plagued with rats, are today eo free of them thd we csnnot find a single ene.” (Agote & Medina, suva, p. 26.)
11 Inefr&n, J. V.: supra.
14 Peña, Raúl, personal communication, October 9.1941. The lack of detailed investigations may well be due to the fact that the Iargest and best studied outbresk occurred before the relation of tleaa to plague had been thoroughly worked out.
18 April, 1 death: May, 3; June. 1; July, 6; August, 22; September, 22; October, 26; November, 12; December, 8: January, 1900, 10; February, 4. (Agote & Medina, supnz, p. 32. The diagnosea from April through September were retrospective.)
14 Uriarte, Leopoldo: “Sur Iea epid&niea de peste bubonique 8. I’Aesomption et au Rosario,” Bnn. Inst Paateur, xv, 1901, p. 867.
Kinds of Plague.-Insfrán
has stated that the pneumonic form of
plague has been prevalent in Paraguay, although bubonic and septi-
cemic cases were also reported, and that the mortality
has been about
50Y&16 The mortality
from October through December, 1899, when
every possible effort was made to secure an accurate count of cases and
deaths, was 59%, although it was recognized that numerous cases
might have escaped observation.17
There were ll known cases of
pneumonic plague in the original epidemic, all of them fatal (7 members
of a single family from Itaguá, five of whom fled to Asunción and died
there, and 2 Sisters of Charity who were caring for plague patients).18
Two pneumonic cases were reported in October, 1928.1s Of 6 cases
reported in June-July
1928, 4 (2 fatal) were said to be septicemic.20
Agote and Medina reported a case of plague seen in Asunción, originally
bubonic, which on the eighth day developed a papular-vesicular
eruption
all over the body, especially on the face and arms; the right eye was aIso
affected, with ulcerations of the cornea. They also saw cases of “walk-
ing p1ague.“21
Urizar has cautioned that in making a microscopic diagnosis of plague in Para-
guay, one must “keep very much in mind the involution forms, which are those
habitually
found, especially during the warm season . . . and small, lanceolate
coccobacilli, joined at the ends.“*z
Control.-Plague
control work in Paraguay has sometimes consisted
chiefiy of extermination
of rats, isolation and treatment of cases, vac-
cination, and general sanitation measures after an outbreak, but the
legislation in forte provides authority for permanent anti-plague work,
and this has been carried on with varying degrees of intensity according
to the resources available.
The agency in charge is the Ministry
of
Public Health.
Among the legislative provisions are23 the compulsory
reporting of plague, and authority for general measures against it and
other contagious diseases (Law No. 153, Sept. 15, 1915); Decree No.
53,738, requiring public cooperation in the kihing of rats; Municipal
16 Imfdn, mbpra, p. 925.
1’ 77 cases 46 deaths (Agote & Medina, supra).
18
Ibid., p. 144.‘9 Bol. Of. San. Pan., Dec. 1928, p. 1525. The diagnosis 7~88 made by Dr. Rati Peña, then an idem, who became suspioious when the daughter of a patient who had died at the Clinical‘Eospitrtl of what had been thought to be pneumonia, reported that her father was very ill and that her brother had dfed
two
oì three days previously. Since bubonic plague cases had been reportad from the Campo Grande barracke a few months before, the possibility of pneumonio plague waa evident, and examination of blood from the lung revealed the bacilli. Preventive injections of antiplague serum mere immediately taken by the has- pital personnel. There were some severe reactions ta the serum, but none of the attendanta developed plague. (Personal communication of Dr. Peña, October 9, 1941.)20 An. Inst. Paras., Val. II, No. 2,1929, p. 125. 21 Agote & Nedina: supra, pp. 159, 167. 2’ Urizar, R.: supra, p. 298.
1154
BAN AMERICAN
SANITARY
BUREAU
[NovcmbarOrdinances regulating general sanitation
(No. 30, July 1891) ; house
construction (No. 46, July 1894) ; building regulations (No. 47, Decem-
ber 1894) ; requiring the placing of gratings across sewer openings to
prevent passage of rats (No. 72, January 14, 1905) ; stable regulations
(Nos. 242, and 1390 of Feb. 5, 1923, and 1408, of March 1923); and
requiring the use of rat-proof garbage cans. Furthermore,
Paraguay
has adopted the anti-plague measures recommended in an International
Sanitary Convention entered into with neighboring Republics in 1904,24
and those of the Pan Ameritan Sanitary Code.
As described in 1934,26 the activities of the anti-plague service include a survey
of dwellings and surroundings to determine which are in need of sanitation, rat-
proofing, or deratization;
the distribution
of poison and loan of traps (the cage
and snap types) and fumigators; encouragement of the keeping of rat-killing
cata
and dogs; and closing of burrows with cement and hroken glass, after fumigation.
In 1933 the number of rats killed in Asunción was 1,105; in 1938, 4,411;26 and from
January through August 1940, 2,012 (by poisoning).27
The health authorities
hope to begin soon the regular examination of rats, at least those from the port
area. Hydrocyanic
acid gas and sulfur and sodium nitrate combinations are
used for fumigation, according to the place to be fumigated; the Clayton apparatus
(sulfur) is generally used for ships. White phosphorus, barium carbonate, ar-
senic, gypsum, and strychnine, mixed with flour, powdered fish, bacon, cracklings,
and anise, are the poisons commonly employed.
Vaccination
and serum-therapy.-The
Institute
of Bacteriology
(later the Institute
of Parasitology)
of Paraguay was founded in 1900
for the manufacture
of plague serum and vaccine, and its products
have been used in subsequent outbreaks of plague.
The use of serum
was believed by the Argentine commission to have saved the life of one
of their number?*
In June and July 1928, plague broke out in the
barracks at Campo Grande, Asunción, and vaccination of al1 the regi-
ment and the Asunción garrison was resorted to, in additionto
such
effective anti-rat measures that no mice and rats were seen during the
following year.
There were 6 cases with 2 deaths (one of the deaths
was in an unvaccinated person, the other in a soldier who had received
the preliminary injection).2s
M Signed by Argentina, Brazil, Paraguuay, and Uruguay, but never put in forca beoause not ratified, although aorne of the provisions wore earried out by the vsrious countries. Thc most recent knowledge on plague control methods was included, and reciprocnl notificetion required. (See Bd. Of. San. Pon.. Dec. 1940, p. 1222.) The text of the convention appears in “Recopilsción de Leves, Decretos, Ordenanzas y Reglamentos, Año 1919,” Depto. Nao. de Hig. y Asia. Pub., Asuncibn, 1921,58 pp., p. 14.
25 InsfrBn: supra.
~0 Off. Int. Hyg. Pub.: “Lea dératisations maritimes en Amérique pendaut I’annés 1936,” Bd. Of. San. Pan., Jun. 1938, p. 513.
27 Bol. Min. Sahd Pzlb.. Aug. 1940, p. 112.
28 Dr. Malbrdn, who becnme exposed while examining pneumonic plague cases, 48 hours after receiving & preventive injection (0.10 CC) of serum. His illness became septicemic in type, with pulmonary con- gestion (although no pneumonicsymptoms oould bedetected), and herecoveled without incidont, having received curativeinjections of serum. (Agote & Medina, supm. p. 195.)