Since 1900 there have been several mild outbreaks of bubonic plague.
One of the results of recent observation is the classification of plague cases under three heads, which have already been mentioned several times: (1) bubonic, (2) pneumonic, (3) septicaemic. (The word " pesti-caemic " is also used instead of " septi-caemic," and though etymologically objectionable, it is otherwise better, as " septicaemic " already has a specific and quite different meaning.) It should be understood that this classification is a clinical one, and that the second and third varieties are just as much plague as the first.
(1) Bubonic cases usually constitute three-fourths of the whole, and the symptoms may therefore be called typical.
Gabriel de Mussis describes it even in the East, before its arrival in Europe, as a bubonic disease.
In June 1858 intelligence was received in Constantinople of an outbreak of disease at the small town Benghazi, in the district of Barca, province of Tripoli, North Africa, which though at first misunderstood was clearly bubonic plague.
" It is impossible," writes Sir Richard Thorne (Local Government Board Report, 1898-1899), " to read the medical history of this disease in almost every part of the world without being impressed with the frequency with which recognized plague has been preceded by ailments of such slight severity, involving some bubonic enlargement of glands and some rise in body-temperature, as to mask the real nature of the malady."
It is necessary to say this, because a misleading use of the word " bubonic " has given rise to the erroneous idea that true plague is necessarily bubonic, and that non-bubonic types are a different disease altogether.
The disease, on which the 14th century bestowed this name, was the bubonic plague, still familiar in the East.
Bubonic plague, to be sure, is a disease.
Its already evil reputation has been increased of late years by the fact that it is one of the chief disseminators of bubonic plague.
Cholera is endemic in some parts of the vilayet, and before 1875 the same was true of the bubonic plague.
542; it spread over Egypt, and in the same or the next year passed to Constantinople, where it carried off io,000 persons in one day, with all the symptoms of bubonic plague.
Whether in all the pestilences known by this name the disease was really the same may admit of doubt, but it is clear that in some at least it was the bubonic plague.
But numerous cases of nonfatal mild bubonic disease (mild plague or pestis minor) occurred both before and after the epidemic, and according to Tholozan similar cases had been observed nearly every year from 1856 to 1865.8 The next severe epidemic of plague in Irak began in December 1873.
In both places the symptoms were the same, of undoubted bubonic plague.
In 310 cases of plague examined by Simpson 56% were bubonic, 40% septic and 4% pneumonic.
In pneumonic cases it is presumed to enter by the air-passages, and in bubonic cases by the skin.
From the fact that bacilli are hardly ever found in the blood of bubonic cases it may be inferred that they are arrested by the lymphatic glands next above the seat of inoculation, and that the fight - which is the illness - takes place largely in the bubo; in non-bubonic cases they are not so arrested, and the fight takes place in the general circulatory system, or in the lungs.
The word " plague " - or " pest," which is the name used in other languages - had originally a general meaning, and may have required qualifications when applied to this particular fever; but it has now become a specific label, and the prefix "bubonic" should be dropped.
The mild cases are always bubonic; the other varieties are invariably severe, and almost always fatal.
It is not till the 6th century of our era, in the reign of Justinian, that we find bubonic plague in Europe, a s a part of the great cycle of pestilence, accompanied by extraordinary natural phenomena, which lasted fifty years, and is described with a singular misunderstanding of medical terms by Gibbon in his forty-third chapter.
(3) In septicaemic cases the symptoms are those of the bubonic type, but more severe and without buboes.
When plague is prevalent in a locality, the diagnosis is easy in fairly well-marked cases of the bubonic type, but less so in the other varieties.