100 GEOGRAPHIC DISTRIBUTION OF BUBONIC PLAGUE 



and wide grave; the testator and his heirs and executors were hurled from the 

 same (;art into the same hole together. Fire became extinguished, as if its ele- 

 ment had expired, and the seams of the sailorless ships yawned to the sun. 

 Though doors were open and coffers unwatched, there was no theft ; all offenses 

 ceased, and no cry but the universal woe of tlie pestilence was heard among 

 men." 



That the " black death " of the fourteenth century was in fact the 

 same disease which subsequently prevailed in Europe under the name 

 of" the plague," and more recently known as "]>ubonic plague," can 

 scarcely be doubted. But the ei)ideraic was characterized by an un- 

 asually large number of cases of the pulmonary form of the disease, 

 in which it seems ])rol)aV>lethat the lungs are the primary seat of in- 

 fection, while in the bubonic form the bacillus effects a lodgment 

 through some superficial wound or abrasion or possibly through the 

 bites of insects, and first invades the 13'mphatics, producing inflam- 

 mation of the nearest 13'mphatic glands. General invasion of the 

 blood appears, from recent investigations, to be a secondary phenom- 

 enon which only occurs in very severe and usually fatal cases. 



The pulmonic form of the disease, which was so prominent in the 

 epidemic known as " black death," is extremely fatal and is known 

 to occur at the present day. Dr Calmette, a French physician, who 

 was sent by his government to study the recent outbreak in the city 

 of Oporto, Portugal, reports that the pulmonary form of the disease 

 was observed at that place as well as the usual or bubonic form, and 

 that in pulmonar}^ plague there are no buboes, but the cases are 

 marked at the outset b^^a profound depression of the vital powers, by 

 violent vomiting, cadaveric paleness, a rapidly failing pulse, and death 

 within a few hours. 



In the fifteenth century plague was again rampant in various parts 

 of Europe, and London suffered severely from the prevailing epidemic 

 in 1400, 1406, 1428, 1472, and 1499. In southern Europe the di.sease 

 prevailed extensively during the first quarter of the century, and in 

 Germany it was especially severe in 14'j8-'39. Italy, France, and 

 Spain were again ravaged by the pestilence in 1448 to 1450, appar- 

 ently as a result of a fresh importation from Asia. In 1406 over 

 40,000 persons died from plague in the city of Paris. These frequent 

 epidemics and the greater care with which they were studied resulted 

 aljout the end of the centur}', in differentiating bubonic plague from 

 typhus fever, with which it was no doubt frequently associated and 

 which was an important but unrecognized factor in the mortality 



