BUBONIC PLAGUE. An epidemic dis ease which has been very prevalent and terribly destructive in almost every part of the eastern hemisphere since the 3d century B.C. and prob ably before that time. It was referred to as the pestilential buboes in the writings of Rufus of Ephesus who lived in the 1st century A.D. and was said to have been prevalent for ages in Libya, Egypt and Syria. Froth the dis coloration of the skin by effusions of blood, which is characteristic of the severe and fatal cases, it became known as the Death.* It has also been known as the Levantine, Oriental, Egyptian and Pali plague. While it has been a tremendous scourge to humanity during all the ages of the Christian era it is by no means certain that all the accounts of it are descriptive of the same disease; that would be expecting too much from ancient pathology.
It first appeared in Europe at Constantinople in 543 A.D., having been brought thither from Egypt. Its ravages were terrible and as many as 10,000 were said to have died from it in Constantinople in a single day. In the 14th century it was prevalent for at least 20 years not only in Europe, but in the most of the eastern world, and during that period its victims numbered from twenty-five to forty millions. In the 15th century there were fre quently recurring epidemics in nearly all parts of Europe but especially in Italy, Spain, Ger many, England, France and Belgium. In the 16th century China was almost depopulated by it, and it was rampant in Germany, Holland, Italy, Spain, England and Scotland. In this century also typhus fever, which has been equally well known as ship fever, spotted fever, etc., appeared in Europe, and was terribly fatal among the poor, the dirty and the underfed, the same classes which were attacked by the plague. It is not improbable that the two dis eases were confused from time to time, thus giving uncertainty to the records. In the 17th century it was widely diffused and very preva lent in England, Italy, Spain, Germany and Holland. Naples is said to have lost 300,000 by it during five months in 1656, and Genoa 60,000 in about the same period. In 1665 the great plague of London occurred, with a mor tality of 68,000 out of a population of 460,000. It prevailed also in other parts of England and was constantly in evidence until the beginning of the 18th century. In the 18th century it was
prevalent in Germany, Austria, Sweden, Russia and other countries in the north of Europe, and then it moved to Italy and France in the south. In the 19th century Constantinople was re peatedly scourged by it as it had been so many tunes before and from that unfortunate city it was carried to India, Persia and other countries. From this time the disease began to receive real scientific attention, and such attention and study have been continued to the present time. It is unlikely that it will ever again obtain an extensive foothold among the white races. The last great epidemic began at Hongkong in 1894 and has continued un interruptedly in China, India and many other countries. In 1900 it appeared in South America and soon afterward it was noted on the Pacific coast of the United States. Up to 1908 there had been 121 cases in San Francisco, 77 of which were fatal. It was observed sporadically in England between 1906 and 1911. In the Punjab, Bombay and the United Prov inces of India the mortality from this disease between 1906 and 1911 was five and a half millions, while an additional two millions perished from it in other parts of India. In 1912 there were 47 cases in Porto Rico, of which 23 were fatal.
Clinical After an incubation period of three to eight days the disease is ushered in with chill, fever, pain in the limbs, head and stomach, intense thirst, congested eyes, swollen tongue and profound nervous symptoms. Vomiting is of common occurrence, and constipation alternates with diarrhoea. The characteristic features are buboes or swellings of the glands in the groins, the armpits and the neck. These swellings frequently sup purge and discharge, and this is sometimes a favorable sign. In the severe cases there are carbuncles and dark discolorations of the skin, which indicate haemorrhage. There may also be haemorrhages from the stomach, bowels, lungs and nose, and cases in which such haemorrhages occur are usually fatal. The disease may be fatal within 24 hours or it may continue for a month. The fatal cases almost invariably ter minate by the fifth day. It is the most de structive of any known form of epidemic dis ease, the mortality at different periods and different localities running from 50 to almost 100 per cent.