CHAPTER LIV 



PLAGUE 



Synonyms — Definition — History — Climatology — etiology — Pathology — 

 Symptomatology — Diagnosis — Prognosis — Treatment — Prophylaxis — 

 References. 



Synonyms. — Black Death, Pestis, Lues. French, La Peste; 

 Italian, Peste Bubbonica; German, Die Peste; India, Mahamari; 

 Japan, Yeki; China, Kota-wen; Uganda, Kaumpuli. 



Definition. — Plague is a septicaemia caused hy Pasteur ella pestis 

 Kitasato and Yersin 1894 (usual name Bacillus pestis) , which pro- 

 duces an epizootic in rats, from which it spreads to man and other 

 animals by the agency of fleas. 



In man it causes an acute specific fever, characterized by an 

 inflammation of the lymphatic glands; a secondary septicaemia, with 

 haemorrhages, skin necrosis, and often a secondary pneumonia; or 

 it may give rise to a primary pneumonia or a primary septicaemia. 

 The pneumonic forms are highly infectious, spreading from man to 

 man by aerial convection. 



History and Epidemiology. — Plague, because of its epidemicity and its high 

 mortality, is much feared, and has been noticed from early times to be associ- 

 ated with a mortality among rats. Thus, the Bible contains an account of 

 an epidemic disease in the Philistine country which produced buboes in human 

 beings and killed rats (' mice of the field '), and there is also reference in 

 Simpson's work on plague to the fact that Sennacherib's army was attacked 

 by a pestilence in which field-mice were in some way concerned. 



But it was not until the outbreak in Pelusium, a great Egyptian market, 

 in A.D. 542, that the disease was seriously considered, for it spread to Byzan- 

 tium, at that time the city of the world, and then passed into Asia, and through 

 North Africa into Western Europe as far as Ireland, lasting in epidemic form 

 for about 200 years. 



The next outbreak is in the eleventh century, when it spread as a pandemic, 

 reaching a maximum in the fourteenth century, and gradually declining, until 

 suddenly, in the seventeenth century, it left Western Europe, and in 1844 it 

 vanished from Eastern Europe, and practically from Asia Minor, remaining, 

 however, in the district of Assyr, in West Arabia. 



This great pandemic stirred Governments to take prophylactic measures, 

 and Count Bernabo, of Reggio, is found impressing stern quarantine laws 

 in 1374, while the Venetians, in 1403 and subsequent years, laid the founda- 

 tions of modern prophylaxis by erecting the first lazaretto, or depot for the 

 isolation of the sick, by instituting the quarantine for forty days (hence the 

 term), and by the disinfection of clothing and merchandise. Further, they 

 compelled the ship coming from an infected port to hoist a yellow flag, and 

 to allow an inspection of the crew and passengers before it was given pratique 



In the meanwhile plague occurred in India, where the first records are t 



1416 



