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1.1 Background to the Study

       Bubonic Plague is a zoonotic disease caused by Yersinia Pestis bacteria transmitted

through infected fleas and their rodents. The infected animals and their fleas function as

reservoirs for the bacteria in an enzootic cycle. Yersinia pestis is transmitted to humans

through the bite of fleas or contamination with infected fluid, tissue or droplets.1

According to the World Health Organisation, ‘Bubonic Plague is a very severe disease in

people, with case fatality rates of 50-60% if left untreated’.2The various manifestations

and symptoms of Bubonic Plague include:

Bubonic Plague: Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form usually results from the bite of an infected flea. The bacteria multiply in the lymph node closest to where the bacteria entered the human body. If the patient is not treated with the appropriate antibiotics, the bacteria can spread to other parts of the body…Septicemic Plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic Plague can occur as the first symptom of Plague, or may develop from untreated Bubonic Plague. This form results from bites of infected fleas or from handling an infected animal…Pneumonic Plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic Plague may develop from inhaling infectious droplets or may develop from untreated Bubonic or septicemic Plague after the bacteria spread to the lungs.3

     The Plague in colonial Lagos was primarily Bubonic. The increased transformation of

the primary Bubonic cases to other secondary forms (septicaemic and pneumonic) during

the outbreak was largely due to ineffective biomedical treatment.4 While the Bubonic

Plague may not be totally new to the West African region, the 1924 outbreak in Lagos was

the first noticeable occurrence of the disease in Nigeria. The available evidence shows that

the bacteria agent responsible for the outbreak (Yersinia Pestis) was introduced to Lagos

(Nigeria) from Kumasi (Ghana) by Hausa transborder Kola nut traders ‘during the period

5th May to 17th June [1924] when quarantine against the Gold Coast ports was raised’.5

Affirming the foregoing, the Medical Research Institute, Yaba, Lagos, observed in its

Annual report in 1924 that ‘for the first time in its history, as far as records show, Lagos

suffered from an epidemic of Plague. It occurred in the latter half of the year. The first

definite case, Bubonic in type, was found on 28th July [1924]. The disease was in all

probability introduced by sea’.6

     Globalization enhances the spread of infectious diseases due to the increased

transborder microbial traffic caused by the rapid speed and volume of international

migration and trade.7 Human migration has been active since Homo-Erectus migrated

from Africa to other parts of the world about 300,000 years ago. The arrival of Europeans

in America and Africa in the 15th and 16th centuries ushered in a period of mass

intercontinental migration with health-wise implications. As noted by J.E. Inikori, ‘the

Indians in the Americas were almost completely wiped out by the new diseases which the

Europeans carried to the area’.8 The twentieth century marked an unprecedented volume

and speed of international movement of people and commodities with its consequent

transborder spread of infectious diseases such as Influenza, Bubonic Plague, and Ebola in

West Africa.9  Thus, the dawn of the twentieth century witnessed an unprecedented

landmark in the history of disease processes in Lagos as new infectious diseases were

introduced through an expanding global maritime trade network. The focus of this thesis is

the experience of the Bubonic Plague epidemic in Lagos from 1924 to 1959. This scenario

is discussed as a peculiar experience within the global series of Bubonic Plague epidemics.