Written by Christopher Jarrett

London Fever Hospital Wellcome M0001909EA.jpg
 “London Fever Hospital” Wellcome Images.


Popularly, bubonic plague, or just plague, is thought of as an archaic disease affecting only communities in the late middle ages. This view of the history and influence of the plague is very limited. Problematic outbreaks and local epidemics of plague continue to the modern day. However, through the efforts of the Medical Officers of Health and an improved understanding of the causes and spread of the disease, the incidence and death toll from this disease plummeted in the late 19th century.

The Plague

Throughout history the city of London has been struck by many waves of plague. However, by the 19th and 20th centuries, the intensity and frequency of outbreaks decreased significantly. This may be attributed to a greater understanding of the disease, its transmission vectors, and the handling of the infected. This page will investigate the response to local outbreaks mounted by the MOH and how these responses indicate general attitudes towards and understanding of this disease.

A brief background of the plague is necessary to understand the implications of the reports of the MOH. Understanding the exact cause of and transmission methods of the plague will allow connections to be drawn as to the level of understanding of this disease and the public attitude towards it from primary sources. Bubonic plague is caused by the bacteria Yersinia pestis (Y. pestis). Y. pestis is carried by the oriental flea (X. cheopis).(City Of London, 1927 p.45, MOH) The flea acts as a primary vector of the disease, the organism responsible for the direct transmission of the infectious agent, but rats act as a carrier. A carrier is an organism that can harbor another which directly transmits the disease.(Institute of Medicine) The transmission of Y. pestis is primarily caused by bites from infected fleas, however it may be spread by contact with the bodily fluids, such as sputum, blood, lymphatic fluid, and feces of infected individuals. Also, the disease may be spread by fleas biting those already infected with the disease.

“A Flea Infected With Yersinia pestis, Shown As A Dark Mass.” National Institute of Allergies and Infectious Disease. Wikipedia

The symptoms of plague are well documented in MOH reports. The disease had swept through London many times throughout history and its effects were well documented. Symptoms of the plague presented within three to five days after exposure. It was characterized by the sudden onset of fever, tachycardia, headache, hot skin, and thirst, accompanied by eruption of swellings. The description of the disease given by the MOH is truly terrifying and must have struck fear and dread into those whom it threatened to affect.

The eyes are injected as if inflamed; the expression, at first anxious and frightened,
becomes subsequently vacant and dull; the utterance is thick, and the gait unsteady as in one under the influence of drink. There is at times a distinct tendency to faint. The tongue is at first covered with a moist white fur, except at the edges, which are red, but later on it becomes dry and of a mahogany colour…The most distinctive sign of Plague is the presence of swellings, or “buboes,” as they are called, in the groin, armpit, or neck. (City Of London, 1900 p.80, MoH)

Rats and the Plague

Observing reports, the MOH understood the connection between the plague and rats as a secondary carrier. The MOH makes explicit reference to the possibility of a primary vector/carrier relationship between rats and fleas. The author states that rats are the primary vector of bubonic plague. While this is a step in the correct direction of understanding plague, the rat is merely a carrier for the primary vector, the flea. However, this understanding of the association between rats and plague was enough to prompt prophylactic measures against the import of potentially infected rats. By the year 1927, the MOH reported a decrease in the rat population aboard ships and ports by 80% since its formation. These areas were targeted for efforts to control rat populations as many rats would be transported to ports in ships, where they would escape and introduce the plague.(City of London, 1901 p.11, MoH) There was a massive effort to rat proof these areas and this reflected the public attitude towards the spread of epidemic plague. A major emphasis was placed on the prevention of importation of rats which might be infected with Y. pestis from other areas of the world. This was very important around the turn of the 20th century as the third wave of plague was rampant in colonial areas of the British Empire. Ships coming from India were especially suspected to have plague carrying rats. (City Of London, 1918 p.11, MoH) The MOH required that all ships be fumigated at their port of departure before coming to London, and that anybody suspected of contracting plague en route be quarantined and the entire ship be once again disinfected. Rats were almost ubiquitous on ships. One ship, fumigated in London, produced 245 rats, all of which were incinerated after death.  (City of London, 1927 p.44, MoH), (City Of London, 1901 p.12, MoH), (City Of London, 1901 p.19, MoH)(City Of London, 1904 p.16, MoH)

Management Of The Plague

While plague is generally considered to be a medieval disease, outbreaks were common and a significant one occurred in August 1900 in Glasgow. Although the outbreak was local, it prompted an immediate response from the MOH. By improvement of sanitation in the area by cleansing and ventilation of dwellings, lime-washing yards, removal of house refuse, the flushing and cleansing of courts and alleys, and identification of infected individuals; Glasgow was eventually declared plague free. One of the other major methods of containing the infection was the extermination of rats to decrease carriers of the disease. (Velten 2013) After this incident, the government board issued a mandate requiring any suspected cases of plague to be reported immediately and the disease was included in the list of notable diseases given to physicians. The MOH clearly took this very seriously. (City of London, 1900 p.31, MoH) As they should have because even though the mechanism of spread was somewhat understood, the response to the disease was more or less identical to methods used in the Great Plague of London in the 17th century. Not much aid was available or offered to those acutely infected with the plague. In the event of a positive diagnosis medical officers were ordered to set family members aside in special “Reception Houses” until they became ill or remained well longer than the incubation period of the bacteria Y. pestis. Then all bedding, clothing, and personal effects of the individual diagnosed with plague were to be seized and destroyed in an incinerator. The alienation of the family still continued however, the entire residence suspected of plague diagnosis was to be fumigated, stripped, and cleansed to the satisfaction of the MOH. The disease was allowed to run its course in the individual as nothing could be done to prevent it. The most basic antibiotics were years away at the time of this report and only supportive care could be offered to those afflicted. The patient had to sit and wait for the inevitable. Those diagnosed with bubonic plague were often moved to the South-Eastern Hospital in London to be quarantined and placed under supportive care. On the bright side for the families of the infected, the family was repaid for the cost of the destroyed belongings of their infected family member and their stay and transport to the South-Eastern Hospital was free of charge. (City Of London, 1900 p.33, MoH) This indicates that although this was still a terrible disease to be affected by, social altruism and assistance was beginning to be rendered to those unlucky enough to be infected with this disease.


1.  City of London, 1927 p.44, MoH

2. City of London, 1900 p.31, MoH

3.City Of London, 1900 p.80, MoH

4. City Of London, 1900 p.33, MoH

5. City Of London, 1901 p.12, MoH

6. City Of London, 1901 p.19, MoH

7. City Of London, 1904 p.16, MoH

8. CDC Summary Of Bubonic Plague

9. Institute of Medicine (US) Committee for the Study on Malaria Prevention and Control; Oaks SC Jr., Mitchell VS, Pearson GW, et al. “Malaria: Obstacles and Opportunities.” Washington (DC): National Academies Press (US); 1991. 7, Vector Biology, Ecology, and Control. (accessed April 06, 2017)

10. Velten, Hannah. Beastly London: A History of Animals in the City. Chicago, IL: Reaktion Books, 2013.

11. City Of London, 1918 p.11, MoH

12. City of London, 1901 p.11, MoH

13. City Of London, 1927 p.45, MoH