Plague (Gr. , a blow), an aggravated malignant fever, endemic in the East, and frequently epidemic. The words pestis and pes-tilentia, the synonymes of plague, as well as the corresponding Greek word used by the old writers, must be taken as meaning nothing more than an epidemic fever. True plague is a contagious fever characterized by an eruption of carbuncles and buboes. Formerly plague occasionally prevailed in many places of northern Europe. Before its last visitation in 1665, it invaded England, according to Sydenham, every 30 or 40 years. Marseilles suffered from it in 1720, Moscow in 1771 and 1772, and some points in the Neapolitan dominions as late as 1815 and 1816. The celebrated "black death," which ravaged all Europe in the middle of the 14th century, appears to have been the oriental plague. As in all severe epidemics of the disease, at its commencement many of the patients died before the development of the peculiar eruption; but the general occurrence of carbuncles and buboes is sufficiently authenticated.
It derived its name from the gangrenous eschars formed by the carbuncles, or perhaps from the petechias which accompanied the disease. - A report made to the French academy (Rapport a l'academie royale de medecine sur la peste et les quarantaines, etc, Paris, 1846) says: " 1. At present the countries where the plague still originates are in the first place Egypt, afterward Syria and the two Turkeys. It is probable, however, that the plague may be developed without importation in the regencies of Tripoli and Tunis, and in the empire of Morocco. 2. In those countries the conditions which determine and favor its development are the habitation of alluvial or marshy grounds; a hot, moist atmosphere; low, badly aired, and crowded houses; the accumulation of a great quantity of animal and vegetable matters in a state of putrefaction; a scanty and unwholesome diet; great moral and physical destitution; the negligence of the laws of public and private hygiene. 3. Sporadic plague does not seem to be transmissible. Epidemic plague is transmissible both in the localities where the plague is raging and without them. 4. It is transmitted by means of miasmata given out by the bodies of the sick; these miasmata, in close and ill ventilated places, may create centres of pestilential infection.
It results from the observations made at the lazarettos for more than a year that merchandise does not transmit the plague." The period of incubation in plague seems in no case to be beyond eight days. The course of the disease varies very much in different cases. Sometimes the local symptoms first show themselves, and the fever which follows is comparatively mild; at other times the patient is rapidly overwhelmed by the violence of the constitutional disorder, and dies without the appearance of carbuncles or buboes; between these extremes, and tending to one form or the other, the disease presents every variety. In its milder forms small spots like flea bites first make their appearance, especially on the parts of the body exposed to the air; these enlarge, become dusky, and are covered by vesicles or phlyctenae filled with a dark-colored fluid. The base of the spots is hard; it becomes black, forming a gangrenous eschar with a circumference of an inch or an inch and a half in diameter; these are the carbuncles. This process is attended with more or less fever, which as the eschar becomes detached gradually subsides. Often consequent upon the appearance of the carbuncles, glandular swellings form, commonly in the groins or armpits, more rarely in the neck.
These buboes, as they are termed, occasionally disappear without suppuration; more generally after a time pus is formed, sometimes healthy, sometimes thin and sanious. Cases in which buboes appear are attended with a higher grade of fever and with pro-founder depression of the vital forces; headache, restlessness, chills, and vertigo are commonly present; the eyes are red and muddy, the tongue coated, the skin hot and dry; the pulse small, weak, and frequent; petechias are frequently present. The duration of the disease varies. In the commencement of severe epidemics cases have been related in which the patients have died within 24 hours; in most instances, however, it continues from one to two weeks. In severe epidemics the majority of the patients die, and when recovery takes place convalescence is tedious. Morbid anatomy hitherto has added nothing to our knowledge of the disease; the blood is found to be altered and fluid, but no appearances have been noted which can be deemed characteristic. - Of the treament of plague little is known.
Nearly all that can be done is to make local applications to carbuncles and buboes, support the patient's strength, and place him under as favorable hygienic circumstances as possible.