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LEFT BUBONIC PLAGUE 213 BUBONIC PLAGUE BUBONIC PLAGUE, a disease sup- posed to be identical with the plague known as the Black Death, which had its origin in China, and made its first appearance in Europe 543 A. D., at Con- stantinople. It derives its modern name from the fact that it attacks the lym- phatic glands in the neck, armpits, groins and other parts of the body. The swollen parts are extremely sensitive to the touch, the patient suffers from head- ache, vertigo, high fever, vomiting, and great prostration. Another feature is the appearance of purple spots and a mottling of the skin. In severe cases death generally ensues in 48 hours, and, at best, recovery is slow. It is now generally agreed that this plague is a germ disease. The bacillus has been identified by Indian bacteriologists as well as by European and American in- vestigators. It is found without trouble in the blood of the patient. At the Hoagland laboratory in Brooklyn, N. Y., extensive experiments have been made, both in the culture of the germs and in an anti-toxin, by means of which im- munity from this scourge may be ob- tained. The disease has been called "the poor's plague," from the fact that it first attacked the half-starved masses who congregate in the slums of the cities. This was the case in Bombay, where it has produced fatal ravages. Pure air, wholesome food, the free external use of cold water, and proper sanitary regu- lations modify to some extent the at- tacks of the plague. History, — The first authentic descrip- tion of the bubonic plague is contained in the writings of Rufus of Ephesus, who described the disease as having existed in northern Africa during the 3d or 4th century B. C. Since that time the disease has been variously described by writers under the name of Levantine, Oriental and Bubonic Plague and the Black Plague, or Black Death. These designations are more or less open to criticism and lack scientific foundation. In the reign of Justinian, 542 a. d., the disease appeared in Egypt, and within a year extended to Constantinople, where it is said to have caused the death of 10,000 persons in one day. In 1352 the plague spread through the whole of Eu- rope and nearly one-fourth of the popu- lation died. It is estimated by Hecker that, during this reign of terror, out of 2,000,000 inhabitants of Norway but 300,000 survived. It was estimated, by Pope Clement VI., that the mortality from black death for the entire world was 40,000,000. This outbreak lasted about 20 years. During the great plague of London, in 1665, there were 63,596 deaths out of a population of 460,000. CharacteHstics. — The bacillus of the bubonic plague was discovered and studied by Kitasato and Yersin, working independently, and at about the same time, in 1894, during the epidemic of the plague at Hong Kong. It is found in large numbers in the pus, in the lym- phatic glands, and occasionally in the internal organs. It is apparently present in the blood only in the acute hemor-. rhagic types of the disease, and shortly before death. An anti-plague serum in- jected into a young Chinaman, at the Catholic mission at Canton, in June, 1896, who was attacked with a severe type of the disease, was effective. It is believed the plague is transmitted solely through infection from previous cases. It is apparent, however, that hot, dry air is fatal to the disease, and that moist warm air is favorable to it. It even may be very active in cold weather. This was shown by the outbreak that occurred on the Volga river, in Russia, in the severe winter of 1878. Like ty- phus fever, the plague is unknown in the tropics, and, like typhus, again, it usu- ally selects its victims from the lowest class, and thrives on filth and famine. The invasion is abrupt, associated with chills, great depression, blunted con- dition of the intellect, pains in the bones and high fever. Death frequently oc- curs within 48 hours, and even earlier. Remedies. — The chief causes of the plague are given as famine and filth. The various serums seem to be unavailable against these obstacles and even the use of antipyretics or stimulants. As a pre- ventive serum, that of Professor Haff- kins has proven the most effectual. The compulsory evacuation of infected cities and districts has accomplished much. In- deed, this was the most available remedy during the epidemic in the Punjab Dis- trict in 1896-1897, and is the first pre- ventive of a spread in case of an out- Animals also have a tendency to spread the plague. Mice, rats, cats and monkeys have been known to infect a ship and bring the scourge from a for- eign port. Excessive precautions are taken at all ports leading from Asia, that of the Suez canal being the most danger- ous and carefully guarded highway into Europe. Precautions, however, are quite im- possible in the incipient stages of the disease, as the evidences may not ap- pear in the victim till he or she is al- ready marked for death. The white races are more immune than any other. The mode of life in civilized countries is conducive to suc- cessful battle with the plague. As it is rather sporadic than epidemic, even in