At that time the best scientific opinion still held that plague was exuded from the ground in what was called a "miasma," or poisonous mist. This belief had been current since the time of the ancient Greeks (it had been first propounded by Hippocrates), though by the end of the 19th century it was approaching the end of its long tenure.
The route of transmission via rat fleas was finally proved by one Paul-Louis Simond, Yersin's successor. The reason Marriott's book has an earlier focus is almost certainly that what got him going with the story was finding Yersin's manuscript describing his time in Hong Kong in a Paris medical library. This is the foundation on which Marriott constructs his account, and it no doubt also explains his championing of the Frenchman against his otherwise illustrious Japanese competitor.
One interesting aspect to the tale is the unique revulsion with which plague is regarded. The disease is medieval, and its presence in the modern world unequivocally spells backwardness. If your country is not in your eyes backward, then the disease simply hasn't happened. Modern India's self esteem suffered a profound blow with the Surat outbreak, so much so that the authorities at different times both denied it had been plague at all, and sought to blame the event on foreign research programs into biological warfare.
Exactly the same outraged reaction had occurred in San Francisco in 1900. There the disease also stimulated an already rampant racism, with editorials fulminating that resident Asians were to blame as being constitutionally more susceptible to the infection than their fellow citizens of European ancestry.
Plague outbreaks are likely after a nuclear war, we are informed. The US researched this in 1966, the author says, and found a strong link. Rat fleas leave their hosts when they perceive them to be dying, jumping onto other rats. When all the rats are dying at the same time, as after a nuclear explosion, they jump onto anything warm-blooded, taking with them pathogens that have been confined to rodents for centuries.
It's difficult not to conclude that the author's Hong Kong material was insufficient to make an entire book, so other things were added piecemeal. But the final product just about hangs together.
Plague could re-emerge anywhere and at any time, Marriott warns. Thirty died in a Los Angeles outbreak as recently as 1924, and New York's Health Department currently has a page on its Web site detailing symptoms and recommended courses of action. On this helpful note this compact and intriguing book concludes.
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