98 GEOGRAPHIC DISTIUB UTIOX OF B UBOXIC PL A G UE 



which leaves no douht as to its identity witli the jiLagiie of more re- 

 cent times. It may he well to ex{)lain at this })oint that the hiihoes 

 characteristic of the disease are enlarged and inflan^ed glands in the 

 groins, in the armpits, and elsewhere, which in chronic cases may 

 suppurate and discharge a virulent i)us, 1)\' which the disease is 

 propagated. We now know that the germ of the disease is found 

 not only in these sui)purating hul)oes, but also in the blood of an 

 infected individual. 



Three forms of the disease are recognized b}' modern authors. A 

 mild or a))ortive form, in which there is little pain or fever, and in 

 which the buboes rarely supj)urate. In this form the enlarged glands 

 in the groin, armpit, and neck usualh^ disappear in about two weeks. 

 In its usual form the disease is ushered in with chilly sensations, fever, 

 lassitude, and i)ain in the back and limbs. The buboes are quickly 

 developed and the general symj^toms soon assume a grave character. 

 If the patient lives for a week or more the buboes usually' supi)urate 

 and carbuncles and boils are often developed. In the third or ful- 

 minant form of the disease death ma}' occur within a few hours from 

 the outset of the attack and in advance of the develojiment of the 

 characteristic buboes. These cases could scarcely be recognized were 

 it not for the fact that they occur during the epidemic prevalence of 

 the disease among persons who have been exjjosed to infection. 



From the first to the sixth centuries of the Christian era we have 

 no authentic accounts of the prevalence of bubonic ])lague, but there 

 is no reason to believe that it had entirel}' disapjieared from those 

 countries in which it had previously ])revailed. During the sixth 

 centur}', however, its ravages were greatly extended, and it })revailed 

 as a devastating ei)idemic in many ])arts of the Roman ]Mii))ire, both 

 of the P]ast and of the West. Indeed, in the time of Justinian it ex- 

 tended far beyond the limits of the Roman Empire. The origin of 

 this extensive epidemic, which raged for more than half a centur}', 

 appears to have been in lower Egypt in the year 542 ; thence it ex- 

 tended in one direction along the north coast of Africa and in the 

 other into Palestine and S3'ria. The following year it invaded Europe, 

 which at the time was in a state of political disturbance and warfare, 

 and during this and subsequent years devastated many sections of 

 the country, depopulating towns and leaving the countr}' in some 

 instances nothing more than a desert inhabited by wild beasts. The 

 accounts given of this widespread epidemic indicate that other infec- 

 tious maladies, which at that time had not been clearly recognized as 



