90 INFECTION AND IMMUNITY 



Three forms of the disease are recognised by 

 modern authors one a mild or abortive form, in 

 which there is little pain or fever and in which the 

 buboes rarely suppurate. In this form the enlarged 

 glands in the groin, armpit, and neck usually disap- 

 pear in about two weeks. In its usual form the 

 disease is ushered in with chilly sensations, fever, 

 lassitude, and pain in the back and limbs. The bu- 

 boes are quickly developed and the general symp- 

 toms soon assume a grave character. If the patient 

 lives for a week or more, the buboes usually sup- 

 purate and carbuncles and boils are often developed. 

 In the third or fulminant form of the disease, death 

 may occur within a few hours from the outset of the 

 attack and in advance of the development of the 

 characteristic buboes. These cases could scarcely be 

 recognised were it not for the fact they occur during 

 the epidemic prevalence of the disease among per- 

 sons who have been exposed to infection. 



From the first to the sixth centuries of the Christian 

 era we have no authentic accounts of the prevalence 

 of bubonic plague, but there is no reason to believe 

 that it had entirely disappeared from those countries 

 in which it had previously prevailed. During the 

 sixth century, however, its ravages were greatly ex- 

 tended and it prevailed as a devastating epidemic in 

 many parts of the Roman Empire, both of the East 



