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The Plague.

Problems:

Synonyms.—Bubonic Plague; Pestilence, or Pest; Black Death; Plague of Egypt.

Definition.—A specific, infectious, and contagious disease of peculiar intensity, rapidly running its course, and characterized by inflammation of the glands (buboes), carbuncles, ecchymoses, and petechise upon the surface. It is endemic on the eastern coast of the Mediterranean Sea and the Oriental countries adjacent. Epidemics occur when it spreads to other parts of the world, traveling along the great thoroughfares of travel and commerce.

History.—The plague is a very old disease, and probably epidemics raged and devastated peoples centuries before we had any authentic accounts. Sacred and profane histories speak of pestilences which ravaged the Valley of the Nile and the Plain of Philistia. Greece was severely visited, and Athens lost nearly a third of her population four hundred years B. C. Many believe that these "visitations" were none other than the plague.

The earliest positive knowledge that we have of the disease dates from the epidemic which occurred in the sixth century, beginning in Egypt in 542, and extending to Palestine, Syria, and Persia; passing thence into Asia Minor, then on into Europe, carrying off, at Constantinople, ten thousand victims in one day (543 A. D.). Becoming pandemic, it spread in every direction. It is estimated that fifty per cent of the inhabitants of the Eastern Hemisphere died, either directly or indirectly, from this great epidemic before the close of the sixth century.

The next great epidemic was the irresistible march of the "Black Death" during the fourteenth century. Beginning in the East, it spread throughout Armenia, Asia Minor, Egypt, Northern Africa, and nearly all of Europe. It is estimated "that one-fourth of the population, or twenty-five millions, perished as a result of this epidemic or pandemic in Europe." (Hecker.)

The seventeenth century witnessed its ravages in London, 1664, where, seventy thousand, or one-third of the population, succumbed to the dread plague. Many epidemics have occurred since then, attended with the usual mortality, but there has been no great pandemic since 1664, unless the epidemics during the early parts of the eighteenth century be included. Interest in this disease has been renewed since the outbreak at Hong-Kong in 1894, when twenty-five hundred deaths resulted. In 1896 it broke out in the Bombay district, where, according to Wyman, there were two hundred and twenty thousand, nine hundred and seven cases, with a mortality of over one hundred and sixty thousand.

In 1899, China was invaded, and also Europe. In October, 1899, the plague appeared in Brazil, according to Wyman, the first instance of its appearance in the Western Hemisphere. In 1899, two cases appeared on board the British steamship, J. W. Taylor, at quarantine off New York; but owing to prompt and vigorous action of the officials, the disease was not permitted to spread. During 1901 a few cases appeared in the Chinese quarters at San Francisco, but prompt measures on the part of the Sanitary Department prevented its further progress.

This disease has aroused an interest never before felt in America since our new possessions, Hawaii and the Philippines, have been so severely visited. In 1899 and 1900 the disease broke out in Honolulu and Manila, but, thanks to the vigorous action on the part of the military authorities, the disease was not allowed to assume alarming proportions.

Etiology.—Predisposing causes are poverty and filth. The more wretched classes are compelled to live in closely crowded quarters, where but little, if any, attention is given to sanitary measures. As a result, the inhabitants, weakened by their environments and vices, early succumb to the infection, which rapidly multiplies in so favorable quarters.

Soil and season also influence its spread; for low, marshy tracts and hot weather favor its propagation, though it has occurred in mountain heights, and in cold weather.

Exciting Cause.—To Kitasato belongs the honor of discovering the specific cause, the bacillus pestis bubonicae. This is a short bacterium, almost as broad as long. On entering the body, either by inoculation or by way of the digestive or respiratory tracts, it multiplies with great rapidity. It is found in the blood, in the internal organs, in the intestinal canal, lymphatic glands, and in great numbers in suppurating buboes.

Outside the body it is found in dust and infected clothing and bedding of infected houses; it is also found in fleas, flies, rats, mice, cats, dogs, and other domestic animals. It is now believed that rats are the common carriers of this dread plague.

Pathology.—Rigor mortis occurs early, and often there is elevation of temperature immediately after death. Petechiae, ecchymoses, and carbuncles are generally found upon the skin. The lymphatic system is early affected, the lymph glands of the groin and axilla being the first to show evidence of the inflammation.

Broncho-pneumonia is a common result, the lung tissues being involved more than in ordinary broncho-pneumonia. The spleen is soft and swollen, with hemorrhagic areas. The liver and kidneys also show degenerative changes.

Symptoms.—Three varieties are recognized: (1) The bubonic; (2) The pneumonic; (3) The septicemic. The first named is the most frequent and typical.

Four stages are given: (1) Invasion or prodromes; (2) Fever; (3) Localization, or development of the buboes; (4) Convalescence.

Incubation.—This period lasts from twelve hours to seven or eight days.

Invasion.—This stage begins suddenly, with dizziness, pain in the head and back, and with more or less depression; the patient is dull, eyes expressionless, and the mind is confused. When the patient attempts to walk, he staggers like a drunken man. There may be no distinct rigor, but chilliness occurs, with nausea and vomiting. Often diarrhea appears early. These symptoms last twelve, twenty-four, or thirty-six hours, when the second stage is ushered in.

Fever.—This stage frequently commences with a chill, followed by a quick rise of temperature. The pain in the head and back increases; the pulse-beat is from 120 to 140 per minute; the skin becomes hot, dry, and constricted; the temperature rises to 103°, i04°, or even 107°. The tongue is heavily coated, and sordes early show on the teeth and lips in the form of dark, bloody crusts. The vomiting may continue through this stage. The patient may become very restless, with active delirium, or the delirium may be passive, early passing into stupor. The pulse now becomes small and feeble, the face assumes a bluish hue, with coldness of the extremities, and collapse is threatened; enlargement of the glands now begins, and the third stage is present.

Development of Buboes.—The lymphatics in the groin first appear, followed, in severe cases, by those of the axilla and other parts of the body; these develop from the third to the fifth day. If suppuration occurs, it is looked upon as a favorable symptom.

Carbuncles often occur in connection with the buboes, a favorite location being the legs, buttocks, and back of the neck. Petechiae also may appear, which is always regarded as a grave symptom. These are known as plague spots,—responsible no doubt for the term "Black Death," the body becoming livid or black after death.

Convalescence, or Fourth Stage.—This stage begins from the sixth to the tenth day, and may be rapid, or prolonged for days, by the suppuration of the buboes.

Pneumonic Form.—In this variety the infectious agent enters by way of the lungs, while in other cases it is usually by bites or abrasions of the surface. In this form the lungs receive the full force of the poison, which is shown by the cough, bloody expectoration, pain in chest, and all the phenomena of pneumonia. These cases number the greatest fatality, and often death intervenes before the development of the buboes.

Septicemic Form.—This is regarded by Sternberg and others as rather a secondary phenomenon, occurring in fatal cases, and not a distinct form of disease.

Diagnosis.—The diagnosis would not be difficult during an epidemic; the sudden invasion, high fever, and the development of buboes are symptoms so characteristic as to leave but little room for doubt.

Prognosis.—This is the most fatal of all the infectious diseases, ranging from eighty to a hundred per cent.

Treatment.—The treatment heretofore has been very unsatisfactory, and serum therapy at present is occupying the mind of those who have to deal with the disease. If any remedy would influence the disease, we are inclined to think that it would be phytolacca and echinacea in large doses. This, however, is speculation, for we know personally nothing about it. Means to hasten the suppurative process should always be used.

Prophylaxis.—Since it is a filth disease, the attention in the future will be turned to its prevention. Vigorous action on the part of Sanitary Boards will so overcome the conditions which favor the development of the disease, that, in time, plague will become a disease of history.


The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.



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