Bubonic plague

“ Buboes are characteristic, it is true, of the plague, but it should be remembered that outbreaks of the pneumonic form, with little or no glandular enlargement are not uncommon. Death, however, in the case of plague is very common on the second or third day, and is less liable to occur in more protracted cases. These facts lead to the commonly accepted belief that the Attic pest was not the bubonic plague. ”

“ No more terrible epidemic has ever threatened this country than bubonic plague and against the entry of no disease are more rigid precautions taken. It exists constantly in oriental countries, especially in China and India, and the great danger of introduction here always confronts us. There are several forms of plague, of which the pneumonic type is the most deadly. ”

“ In its common form the disease showed itself in swellings and carbuncles under the arm and in the groin. These were either few and large—being at times as large as a hen's egg—or smaller and distributed over the body of the sufferer. In this the disease does not appear to have been different from the ordinary bubonic plague, which ravaged Europe during many centuries, and which is perhaps best known in England as so destructive to human life in the great plague of London in 1665. ”

“ A case of bubonic plague in a ward with other patients would not be a source of danger provided there was freedom from fleas and a lack of development of secondary pneumonias. It is very doubtful as to infection ever taking place by way of the alimentary canal, although there is some evidence that rarely the tonsil may be primarily involved. Monkeys are very susceptible to plague and the possibility of an epizootic among them should be thought of during plague epidemics. ”

“ In the Hongkong epidemic of 1894 three Japanese medical men contracted the disease, and in 1896, some European nurses were attacked. In Bombay the sad deaths of Surgeon-Major Manser and Miss Joyce prove that contagion plays an important part in the spread of the disease.
It has been maintained that plague is a miasmatic or soil-bred disease, and that the germs find in earth, water or in some form of fermenting or decomposing material a suitable nidus for growth. ”

“ Symptoms.—Both forms of plague are characterised by sudden onset, sharp fever, giddiness, great weakness, a drunken gait, appearance and speech, and a tendency to heart failure.
In bubonic plague there is lassitude, headache and shivering, and the face is pale and anxious. The patient looks haggard, his eyes are often bloodshot, and his expression is frequently one of fear or horror. His temperature runs up to 102°, 104° F., or even higher, and his face gets hot and flushed. There is intense thirst, the tongue becomes dry and brown, the urine is scanty, and there may be delirium. ”

“ The Russo-Turkish war of 1878 brought the Russian troops into contact with the disease in the Caucasus, and the epidemic at Vetlianka on the lower Volga was unquestionably introduced by such returning soldiers.
Such, then, has been the history of the bubonic plague. No other epidemic disease can be traced authentically as far back as the ‘Black Death.’ The characteristic symptoms, the rapid death, the excessive mortality are all features which have been noted through more than twenty centuries. ”

“ Simond's claims and have completely revolutionized the methods of fighting plague.
There are several different types of plague, seeming to depend largely on the manner of infection. The most common type is that known as the bubonic plague which is characterized by buboes or swellings in various parts of the body. This form of infection is usually received through the skin in some manner or other. ”

“ Bubonic plague has always been classed as a typical filth disease, but here again careful laboratory work has resulted in a vastly clearer knowledge of its causation, though a great deal yet remains to be learned. The bacillus which causes it was discovered by Kitasato in 1894; and it has been found that it rarely if ever increases in numbers outside of the body, but rather tends to die off, frequently very rapidly. There is much reason to think that fleas and rats become infected, and are important factors in the spread of the disease, though more evidence on this point is to be desired. ”

“ The same infection is often at work in the fury of a mob, the panic of a beaten army, and it probably was an element in the Children's Crusade.
The Tarantism so common in Italy from the fifteenth to the eighteenth century is another example of epidemic hysteria. The Bubonic Plague ravaged Italy sixteen times between 1119 and 1340, and smallpox was at work when the black death could find no fresh victims. As a consequence of economic disturbance and fear the people were generally neurasthenic, and a slight shock was enough at times to set whole villages into hysterical convulsions. ”

“ Infant mortality was high and the life expectancy low. Hardly a household escaped the tragedy of death of the young and the robust; historians have sensed the influence omnipresent death had upon the attitudes and aspirations of the European and American of earlier centuries. School children today learn of such a dramatic killer as the bubonic plague, but even its terrible ravages do not dwarf the toll of ague (malaria) , smallpox, typhoid and typhus, diphtheria, respiratory disorders, scurvy, beriberi, and flux (dysentery) in the colonial period. ”

“ The Advisory Committee, under whose direction the investigation was carried out, consider that: firstly, in nature, plague is spread among rats by the agency of rat-fleas; secondly, bubonic plague is not directly infectious from man to man; thirdly, in the great majority of cases, during an epidemic of plague, man contracts the disease from plague-infected rats through the agency of plague-infected rat-fleas ”

“ Mohammedans always turn toward a certain point of the compass when they say their prayers, and it is toward the sacred black stone that they turn.
The gathering together of the pilgrims at Mecca has often brought plague, and nearly always brings disease in its train, and there is very little doubt but that the Bubonic Plague, which is raging in India, would be caught by the pilgrims, and spread by them over the whole of Asia and Europe. ”

“ It has been said that plague flourishes in a warm moist atmosphere and dry hot air kills it, but there are records of plague thriving in conditions antagonistic to this theory. A temperature between 60° and 85°F. is said to be very favourable to it.
Sex and Age.—Both sexes are equally liable. It is said that people between the ages of 10 to 30 are frequently attacked. But experience shows that children and old people are alike liable to attack. In Bombay the disease has occurred most frequently between the ages of 20 and 30, and the male sex has suffered more than the female. ”

“ Pneumonic and septicaemic plague give an almost absolutely unfavorable prognosis, many stating that every such case dies.
As regards bubonic plague the mortality averages 75%. The Egyptian epidemic of 1900 gave an average mortality of 50%. The mortality in natives is much higher than that among Europeans, these latter often showing death rates under 25% while in the same epidemic natives show from 75% to 95% mortality. Plague pneumonia, however, is absolutely fatal for Europeans as well as natives. ”

“ One should be suspicious of any case of fever of rapid onset in which there is marked dulling of intellect and impairment of speech, as of one intoxicated, together with evidences of rapidly developing heart weakness. In septicaemic plague we practically have no other symptoms to guide us—there is not the exquisitely tender bubo of bubonic plague nor the abundant, watery, sanguinolent sputum of pneumonic plague. ”

“ In spite of these harsh measures, ‘the plague more and more increased.’ Nor will this surprise us if we imagine the frantic and successful efforts that must have been made by the non-infected to escape, and the temptation to servants and nurses to appropriate and remove the property of the dying and dead. ”

“ It is only when there is a great incidence of plague among rats that we have outbreaks of bubonic plague in man, and it has been noted that the greater the epizootic, the more heavily infected was the blood of the sick rats with the plague bacilli. A flea with a stomach capacity of about 1⁄2 c.mm. could take in several thousand plague bacilli in a feeding on a rat whose blood was teeming with bacilli. The blood of a rat dying with plague may contain as many as fifty million bacilli to the cc. ”

“ This mild attack, it is thought, would protect the system from more potent forms of the poisonous germs. The inoculation for plague is still in its experimental stage, and cannot, for obvious reasons, be applied to a large population. Medical attendants, nurses and others who, by call of duty, have to constantly come in contact with plague patients may, however, take advantage of this means of protection, which, in the hands of M. Haffkine, may yield good results. Yersin also claims for his serum prophylactic value. ”

“ PUBLIC HEALTH: INDIA. PUBLIC HEALTH: BUBONIC PLAGUE: In the Philippines: How it was stamped out. Full accounts of the successful campaign against bubonic plague in the Philippines, in 1900-1902, are given in the annual reports of the Philippine Commission. From that source the main facts were summarized in the May number of the National Geographic Magazine, 1903, as follows: Bubonic plague was discovered at Manila on December 26, 1899, and slowly but steadily increased in its ravages up to December, 1901. "The deaths in 1900 numbered 199, and in 1901 reached a total of 432. ”

“ In September 1634, the town became infected with bubonic plague, and up to 58October 28, eighty-four people succumbed to the disease—about one-fifth of the population. The epidemic caused the people to vow that they would produce the Passion Play there every ten years. Murnau, Weilheim, and other places were severely attacked in the year 1634. In Andechs the mortality was increased in the year 1634 by an outbreak of dysentery and typhus fever, and on July 27 bubonic plague also appeared and remained until November, carrying away 200 of the 500 inhabitants of the town. ”

“ From the fourteenth to the sixteenth century plagues were frequent and attended with great mortality. Among the plagues known by various names as the "sweating sickness," "black death," etc., we are able to distinguish bubonic plague, typhus and small-pox. Likewise syphilis had been on the increase since the fifteenth century, and presented a peculiar malignancy, and, like small-pox, attacked high and low alike. The causes and origin of these plagues are not difficult to find. ”

“ In this sense it is like malaria, which is endemic in a particular suitable area appearing and disappearing according as climatic or other conditions are favourable or unfavourable. The Chinese have a peculiar idea of the infection of plague. 12 They consider that the plague rises from the soil and believe that it first attacks small animals with breathing organs near the soil, such as rats, then animals with breathing organs a little higher, such as poultry, pigs, dogs, goats, cows, so on till it reaches man, whose breathing organs are higher from the soil than those of other animals. ”

“ They further convey a virulent form of equine influenza from one stable to another, and also the ‘foot-and-mouth’ disease. But what is infinitely more important to man than all the other injuries put together is the harm they bring to suffering humanity by conveying the bubonic plague from one patient to another. ”

“ Scarlet fever, influenza, yellow fever, relapsing fever, and malaria (if the war is waged in countries where this disease is endemic—especially in the Lower Danube region, in the Netherlands, Spain, and Italy) have also played an important rôle in many wars. But we give the name ‘war pestilences’ only to those infectious diseases which in the course of centuries have usually followed at the heels of belligerent armies, such as typhus fever, bubonic plague, cholera, typhoid fever, dysentery, and small-pox ”

“ The plague spared ‘no order, age or sex.’ The divine was taken in the very exercise of his priestly office, and the physician while administering his own antidote; and though the soldiers retreated, and encamped out of the city, the contagion followed, and vanquished them. Many in their old age, others in their prime, most women and still more children, perished ”

“ Thus, the experimental evidence that fleas transmit the plague from rat to rat, from rats to guinea pigs, and from rats to monkeys is indisputable. There is lacking direct experimental proof of its transfer from rodents to man but the whole chain of indirect evidence is so complete that there can be no doubt that such a transfer does occur so commonly that in the case of bubonic plague it must be regarded as the normal method. ”

“ The fact, now fully established, that the bubonic plague is conveyed to man from infected rats, or from infected men to healthy men, by fleas has taken that wingless insect out of the category of those animals which it is indelicate to discuss. ”

“ People with bare feet are, therefore, more liable to catch the infection. The infection may be spread by infected linen, bedding, furniture and fomites. The discharge from buboes contains the germs, and is, therefore, highly poisonous. The fæces, the urine, the sputum, the fur on the tongue are also infective. If the theory be true that the poison attaches itself to the soil, then persons living on ground-floor are more liable to the infection, and a floating population less so. Dust laden with germs is the principal agent in the diffusion of plague as that of any other germ disease. ”