Bubonic plague is a zoonotic disease, circulating mainly in fleas on small rodents, and is one
of three types of bacterial infections caused by Yersinia pestis, that belongs to the family
Enterobacteriaceae. Without treatment, the bubonic plague kills about two thirds of infected
humans within four days. The term bubonic plague is derived from the
Greek word βουβών, meaning "groin". Swollen lymph nodes especially occur in the
armpit and groin in persons suffering from bubonic plague. Bubonic plague was often used
synonymously for plague, but it does in fact refer specifically to an infection that enters
through the skin and travels through the lymphatics, as is often seen in flea-borne infections.
Bubonic plague—along with the septicemic plague and the pneumonic plague, which are
the two other manifestations of Y. pestis—is commonly believed to be the cause of the Black
Death that swept through Europe in the 14th century and killed an estimated 25 million
people, or 30–60% of the European population. Around the Mediterranean Region, summers seemed
to be the season when the disease took place. While in Europe, people found the disease
most occurring in the autumn. Because the plague killed so many of the working population,
wages rose and some historians have seen this as a turning point in European economic development.
Signs and symptoms
The most infamous symptom of bubonic plague is an infection of the lymph glands, which
become swollen and painful and are known as buboes. After being transmitted via the bite
of an infected flea the Y. pestis bacteria become localized in an inflamed lymph node
where they begin to colonize and reproduce. Buboes associated with the bubonic plague
are commonly found in the armpits, upper femoral, groin and neck region. Acral gangrene, is
another common symptom. Due to its bite-based form of infection, the
bubonic plague is often the first step of a progressive series of illnesses. Bubonic
plague symptoms appear suddenly, usually 2–5 days after exposure to the bacteria. Symptoms
include: Gangrene of the extremities such as toes,
fingers, lips and tip of the nose. Chills
General ill feeling High fever
Muscle cramps Seizures
Smooth, painful lymph gland swelling called a bubo, commonly found in the groin, but may
occur in the armpits or neck, most often at the site of the initial infection
Pain may occur in the area before the swelling appears
Skin color changes to a pink hue in some very extreme cases
Other symptoms include heavy breathing, continuous vomiting of blood, aching limbs, coughing,
and extreme pain. The pain is usually caused by the decay or decomposition of the skin
while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal
problems, lenticulae, delirium, and coma. Two other types of Y. pestis plague are pneumonic
and septicemic. Pneumonic plague, unlike the bubonic or septicemic, induces coughing and
is very infectious, allowing it to be spread person to person.
Cause
Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of
an infected flea, Xenopsylla cheopis. In very rare circumstances, as in the septicemic plague,
the disease can be transmitted by direct contact with infected tissue or exposure to the cough
of another human. The fleas are often found on rodents such as rats and mice, and seek
out other prey when their rodent hosts die. The bacteria began its life harmlessly living
in the digestive tracts of mammals. The ability to propagate was dependent only upon its ability
to travel from mammal host to mammal host. The bacteria remained harmless to the flea,
allowing the new host to spread the bacteria. The bacteria form aggregates in the gut of
infected fleas and this results in the flea regurgitating ingested blood, which is now
infected, into the bite site of a rodent or human host. Once established, bacteria rapidly
spread to the lymph nodes and multiply. Y. pestis bacilli can resist phagocytosis
and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph
nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal
septicemic plague in some cases. The plague is also known to spread to the lungs and become
the disease known as the pneumonic plague. This form of the disease is highly communicable
as the bacteria can be transmitted in droplets emitted when coughing or sneezing.
Diagnosis Laboratory testing is required in order to
diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis
culture from a patient sample. Confirmation of infection can be done by examining serum
taken during the early and late stages of infection. To quickly screen for the Y. pestis
antigen in patients, rapid dipstick tests have been developed for field use.
Treatment Several classes of antibiotics are effective
in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin,
tetracyclines, and the fluoroquinolone ciprofloxacin. Mortality associated with treated cases of
bubonic plague is about 1–15%, compared to a mortality of 40–60% in untreated cases.
People potentially infected with the plague need immediate treatment and should be given
antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include
oxygen, intravenous fluids, and respiratory support. People who have had contact with
anyone infected by pneumonic plague are given prophylactic antibiotics. Using the broad-based
antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within
12 hours of infection. History
First outbreak
The first recorded epidemic ravaged the Byzantine Empire during the sixth century, and was named
the Plague of Justinian after emperor Justinian I, who was infected but survived through extensive
treatment. The epidemic is estimated to have killed approximately 50 million people in
the Roman Empire alone. The historian Procopius wrote, in Volume II of History of the Wars,
his encounter with the plague and the effect it had on the rising empire. In the spring
of 542, the plague arrived in Constantinople, working its way from port city to port city
and spreading through the Mediterranean, later migrating inland eastward into Asia Minor
and west into Greece and Italy. Because the infectious disease spread inland by the transferring
of merchandise through Justinian’s efforts in acquiring luxurious goods of the time and
exporting supplies, his capital became the leading exporter of the bubonic plague. Procopius,
in his work Secret History, declared that Justinian was a demon of an emperor who either
created the plague himself or was being punished for his sinfulness.
Second outbreak
In the Late Middle Ages Europe experienced the most deadly disease outbreak in history
when the Black Death, the infamous pandemic of bubonic plague, hit in 1347, killing a
third of the human population. It is believed that society subsequently became more violent
as the mass mortality rate cheapened life and thus increased warfare, crime, popular
revolt, waves of flagellants, and persecution. The Black Death originated in or near China
and spread from Italy and then throughout other European countries. Arab historians
Ibn Al-Wardni and Almaqrizi believed the Black Death originated in Mongolia, and this was
proven correct as Chinese records showed a huge outbreak in Mongolia in the early 1330s.
Research published in 2002 suggests that it began in the spring of 1346 in the steppe
region, where a plague reservoir stretches from the northwestern shore of the Caspian
Sea into southern Russia. The Mongols had cut off the trade route, the Silk Road, between
China and Europe which halted the spread of the Black Death from eastern Russia to Western
Europe. The epidemic began with an attack that Mongols launched on the Italian merchant's
last trading station in the region, Caffa in the Crimea. In the autumn of 1346, plague
broke out among the besiegers and from them penetrated into the town. When spring arrived,
the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried
by the fleas on rats, the plague initially spread to humans near the Black Sea and then
outwards to the rest of Europe as a result of people fleeing from one area to another.
There were many ethno-medical beliefs for avoiding the Black Death. One of the most
famous was that by walking around with flowers in or around their nose people would be able
to "ward off the stench and perhaps the evil that afflicted them. People believed the plague
to be a punishment from God, and that the only way to be rid of the plague was to be
forgiven by God. One such method used was to carve the symbol of the cross onto the
front door of a house with the words "Lord have mercy on us".
Pistoia, a city in Italy, even went as far as enacting rules and regulations on the city
and its inhabitants to keep it safe from the Black Death. The rules stated that no one
was allowed to visit any plague-infected area and if they did they were not allowed back
into the city. Some other rules were that no linen or woollen goods were to be imported
into the city and no corpses were to be buried in the city. However, despite strict enforcement
of the rules, the city eventually became infected. People who weren't infected with the plague
gathered in groups and stayed away from the sick. They ate and drank with limited food
and water and weren't even allowed oral communication because merely talking with one another increased
the chance of passing on the disease. While Europe was devastated by the disease,
the rest of the world fared much better. In India, populations rose from a population
of 91 million in 1300, to 97 million in 1400, to 105 million in 1500. Also sub-Saharan Africa
remained largely unaffected by the plagues.
The next few centuries were marked by several localized or regional outbreaks of lesser
severity. The Great Plague of Seville, the Great Plague of London, the Great Plague of
Vienna, Great Baltic plague and the Great Plague of Marseille, were the last major outbreaks
of the bubonic plague in Europe. Traditional treatment
Medieval doctors thought the plague was created by air corrupted by humid weather, decaying
unburied bodies, and fumes produced by poor sanitation. The recommended treatment of the
plague was a good diet, rest, and relocating to a non-infected environment so the individual
could get access to clean air. This did help, but not for the reasons the doctors of the
time thought. In actuality, because they recommended moving away from unsanitary conditions, people
were, in effect, getting away from the rodents that harbored the fleas carrying the infection.
However, this also helped to spread the infection to new areas previously non-infected.
Third outbreak
The plague resurfaced for a third time in the mid-19th century. Like the two previous
outbreaks, this one also originated in Eastern Asia. The initial outbreak occurred in China's
Yunnan province in 1855. The disease remained localized in Southwest China for several years
before spreading. In the city of Canton, beginning in March 1894, the disease killed 60,000 people
in a few weeks. Daily water-traffic with the nearby city of Hong Kong rapidly spread the
plague there, killing over 100,000 within two months.
From China, the plague spread to the Indian subcontinent around 1896. Over the next thirty
years, the India would lose 12.5 million people to the Bubonic plague. The disease was initially
seen in port cities, beginning with Bombay, but later emerged in Poona, Kolkata, and Karachi.
By 1899, the outbreak spread to smaller communities and rural areas in many regions of India.
Overall, the impact of plague epidemics was greatest in western and northern India—in
the provinces then designated as Bombay, Punjab, and the United Provinces—while eastern and
southern India were not as badly affected. Ultimately, more than 12 million people died
from the plague in India and China alone. In 1899, the plague reached the islands of
Hawaii. The first evidence of the disease was found in Honolulu's Chinatown on Oahu.
It was located very close to the island's piers, and rats in cargo ships from China
were able to land on the Hawaiian islands unseen. As the rats, hosts for disease-carrying
fleas, made their way deeper into the city, people started to fall ill. On December 12,
1899, the first case was confirmed. The Board of Health then quickly thought of ways to
prevent the disease from spreading even further inland. Their solution was to burn down any
buildings in Chinatown suspected of containing a source of the disease. On December 31, 1899,
the board set the first fire. They had originally planned to burn only a few targeted buildings,
and thought they could control the flames as each building was finished, but the fire
got out of control, burning down untargeted neighboring buildings. The resulting fire
caused many of Chinatown's homes to be destroyed and an estimated 4,000 people were left homeless.
Australia suffered 12 major plague outbreaks between 1900 and 1925 originating from shipping.
Research by Australian medical officers Thompson, Armstrong and Tidswell contributed to understanding
the spread of Yersinia pestis to humans by fleas from infected rats.
According to the World Health Organization, the pandemic was considered active until 1959,
when worldwide casualties dropped to 200 per year. In 1994, a plague outbreak in five Indian
states caused an estimated 700 infections and triggered a large migration of Indians
within India as they tried to avoid the plague. Biological warfare
Some of the earliest instances of biological warfare were said to have been products of
the plague, as armies of the 14th century were recorded catapulting diseased corpses
over the walls of towns and villages to spread the pestilence.
Later, plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial
Japanese Army. These weapons were provided by Shirō Ishii's units and used in experiments
on humans before being used on the field. For example, in 1940, the Imperial Japanese
Army Air Service bombed Ningbo with fleas carrying the bubonic plague. During the Khabarovsk
War Crime Trials, the accused, such as Major General Kiyashi Kawashima, testified that,
in 1941, some 40 members of Unit 731 air-dropped plague-contaminated fleas on Changde. These
operations caused epidemic plague outbreaks. See also
List of cutaneous conditions List of epidemics
Miasma theory Plague doctor
Plague doctor costume Footnotes
References Echenberg, Myron J.. Plague Ports: The Global
Urban Impact of Bubonic Plague, 1894–1901. New York, NY: New York University Press. ISBN 0-8147-2232-6.
OCLC 70292105. Little, Lester K.. "Life and Afterlife of
the First Plague Pandemic." In: Little, Lester K. editor., Plague and the End of Antiquity:
The Pandemic of 541–750. Cambridge University Press.. ISBN 978-0-521-84639-4; ISBN 978-0-521-71897-4.
McCormick, Michael. "Toward a Molecular History of the Justinian Pandemic." In: Little, Lester
K. editor., Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge University
Press.. ISBN 978-0-521-84639-4; ISBN 978-0-521-71897-4. "Bubonic Plague Originated in China", Discovery
News,1 November 2010. Retrieved on 6 December 2011.
"Bubonic Plague Fire Destroyed Honolulu's Chinatown" Hawaii for Visitors. Retrieved
on 6 December 2011. "Bubonic Plague and the Chinatown Fire Honolulu
Advertiser, 7 July 2005. Retrieved on 6 December 2011.
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