Medicine: Plague Spot

Andrew Sakacs, 43, had a pleasant Saturday outing a fortnight ago with his son and little grandson. He tramped through woods in sparsely settled Lockwood Valley in California’s Ventura County, got in some target practice. Back in El Rio and getting undressed, he noticed a red spot, like a fleabite, on the inner side of his right ankle, but thought nothing of it. Feeling fit on Monday, Sakacs, a retired Navy chief petty officer, put in a full day’s work as a mechanic on a water research project at the Port Hueneme naval base. That night he had chills and fever and diarrhea, so he took the following day off and went to see an osteopath. He got a shot of penicillin, quinine for a suspected recurrence of malaria, and aspirin for the aches and pains−which were worst in his right groin. There was a slight lump there, too. Two days later, with Sakacs’ symptoms getting worse, he was taken to Corona Naval Hospital southeast of Los Angeles.

Lieut. Commander Lay M. Fox, 31, an internist from Baltimore, got the same story of chills and fever, noted a pustule on the right ankle. In Sakacs’ right groin he found two groups of enlarged lymph nodes, each about one inch by two inches. Like 99.9% of U.S. physicians, young Dr. Fox had never seen a case like it. But on the strength of the fleabite and the buboes, he made a quick diagnosis: bubonic plague.

Sakacs was started on a heroic regimen of four antibiotics plus sulfa drugs. Bubonic plague itself is not highly contagious. But there was a danger that the disease might spread to his lungs−where it would become the dangerously infectious form known as pneumonic plague, or “Black Death.”* Two dozen people who had come in contact with him got sulfa and an antibiotic as a preventive.

California’s elaborate machinery for confirming a case of bubonic plague began to grind. The plague bacillus lives in fleas, which in turn infest Western ground rodents. When an epizootic occurs, the disease kills many of the rodents. In Lockwood Valley, disease detectives found the shriveled carcasses of rabbits and ground squirrels by the score. More significant, they found fleas on the ground because their animal hosts had died.

Last week Andrew Sakacs died. By this time there was no doubt as to what killed him, or how he got his fatal infection. His was the first case of plague in southern California since 1936. But millions of flea-infested rodents constitute an ever-filled reservoir of the disease throughout the West and Southwest. The hopeful word from Lockwood Valley was that with the rodents already dead, the epizootic had burned itself out. Sakacs was a casualty only by rare and unhappy chance.

* In the great cycle of epidemics which swept across Europe in the 14th century, up to 25 million people are estimated to have died of plague. In some areas two-thirds or three-fourths of the population died.