Bubonic, Septicemic and Pneumonic Plague

By Kalee Green and Morgan Dinse

The plague is a severe and acute infectious disease that is caused by the bacterium Yersinia pestis. This was once thought to be carried by rats alone, however, we now know there are different animal hosts. There are several sub types of the plague, but all are caused by Yersinia pestis. Almost all have similar symptoms, but they target different organs. According to the Medical Officer of Health Reports there is the bubonic plague (swollen lymph nodes), septicemic plague (tissues begin to die on extremities), pneumonic plague (lungs), the nervous type, puerperal type, and the pestis minor type.

These types of the plague affected numerous places such as the Persian Gulf, Straits Settlements, Siam, Cambodia, China, Japan, Formosa, South Africa, South America, San Francisco and London in the late 19th and early 20th centuries.

Medical illustrations of bubonic plague symptoms. National Museum of Health and Medicine, Otis Historic Archives.

The bubonic plague is probably the most widely known form of the plague. This form of the plague is also the most common, about 70% of cases had the formation of buboes on the body. This is when a person’s glands swell greatly and then begin to leak pus and hurt. The symptoms of this form of the plague begin with the following: chills, splitting headaches, vomiting, body aches, quickened pulse and breathing, white tongue and red edges, fever, weakness, swelling in the glands, along with a few other things. Later on it was discovered that the buboes did not always present; in some cases the other symptoms came on too intensely and the person never had enough time to form the buboes before they died. The “Bubonic plague is usually associated with what is called true plague, it is now known that glands may enlarge and toxics symptoms develop without the formation of bubo.” (MOH London City Council 1900)

The pneumonic plague is a type of plague that is sometimes confused with simple pneumonia. This form of the plague shows glandular fever, delirium, and early signs of pneumonia. This type of plague has about the same symptoms as the bubonic plague (minus the buboes) but the symptoms appear more slowly than in the bubonic plague and attack the lungs more heavily. The pneumonic plague could have developed from inhaling droplets of infection or from bubonic or septicemic plague being untreated. “The Pneumonic form is directly infectious from patient to patient, the expectoration when the patient coughs containing plague bacilli.” (MOH Surbiton 1910) Cases in Bombay in 1896 were mostly children. Bombay had decided to have a bacteriological investigation of reports of deaths and they found out it was mostly the pneumonic type. This plague had often been known to be very infectious to other people around them. Pneumonic plague was usually fatal.

The septicemic plague was characterized by every gland being swollen, but one group of glands is swollen just slightly more. These glands also presented a pink color. This form of the plague also left tissues of the body to rot and turn black and die. This often occurred in fingers, feet, and the nose. There is no periglandular effusion or hemorrhage to be found. It was found that the poison in this form of plague was so strong that the patient could have actually not had the time to form the buboes. The septicemic plague was the most fatal form of the plague.

Another form of the plague is the puerperal type of the plague, this one is categorized by the occurrence of miscarriage after the plague shows symptoms.

The last type – the nervous type – is characterized by delirium, mania, convulsive seizures, aimless wanderings, tremors, deafness, and dumbness. The children who had this type of plague could sometimes die before they had the chance to be diagnosed.

In certain areas, the plague bacteria was presented in soldiers in case of pestis minor, which is the larval or abortive type of plague. This type of the plague presented the same symptoms but were not as intense as they were when presented in other forms. This form of the plague was often found by people who were traveling through the ports, much like the soldiers traveling from country to country. The symptoms of this form of the plague include: swelling of the groin gland, inflammatory effusion in the periglandular tissue, initial fever and gradually increasing temperatures, feeling of general malaise, reddened skin over the buboes, suppuration develops, and pus begins to leak. This form of the plague was present several years before the big outbreak came and stuck around for several after it was all under control. Due to this form of the plague they found that entrance of the plague into the body came by skin, the mouth, breath, glands, sores on the skin, and things alike. They also found that the source of the bacterium came from rats. These rats were around the more dirty areas of the city, like ports, which explains how easily it traveled around.

Many cases/reports of the plague has been reported all around. These are the examples I have found. “Two cases occurred on a vessel form Rosario whilst on a voyage to Hamburg, and one case occurred after the vessel had left Hamburg for an English port.”(MOH Port of London 1912) While in India the plague had affected a smaller part. “The Kelantan Malays in fact, so late as 1905 looked upon plague as a new disease and, for want of a better name, then referred to it as the ‘penyakit leger’ or ‘neck sickness’.”(Plague in Further India) As they were letting everyone know about this new name, many deaths had raised to be called this new name ‘neck sickness’ and the deaths very being reported by natives in a ton of villages. India, 1097 the plague broke out once again. The Javanese workers had been working at Duff Development Concession which is inside Kelantan. It had finally been known by the Malays as a new upcoming disease.

Another example in the report of St Martin-in-the-Fields, the services of Mr. James Cantile, M.M. and F.R.C.S who was once in the plague hospitals in Hong Kong. Mr. Cantile had a huge experience with the plague disase. Cantile was “to report upon every suspected case of plague in London in which there is any doubt as to the diagnosis, and to make post mortem examinations when necessary.” (MOH St Martin-in-the-Fields 1900) Also in the St Martin report the London City Council had met up and decided they were going to remove any person who was in contact with someone suffering from the plague. They had planned to move these people to a refuge where it is isolated.

This report was very interesting in Bethnal Green. There has been a notification come through to the Local Government Board, Whitehall, S.W, 20th September 1900. It stated “  Sir—I am directed by the Local Government Board to state that in consequence of the appearance of plague in Glasgow, and in view of the possible occurrence of cases of the disease in England and Wales, they have decided to issue and order requiring the immediate notification to the sanitary authorities and to themselves of all cases of the plague.” (MOH Bethnal Green 1900)

Once the Board of Health came to know the symptoms of the different types of the plague they were left to figure out why the plague was coming about. When they figured out that rats often carried the disease, they then determined that areas that were often hit the hardest with the plague was were areas of the city that were insanitary. These areas made it easier for the plague to spread, due to the poorness of the areas which left people in closer quarters. When they discovered where the disease was most prevalent, they came up with precautions that helped the spread much smaller, and in some cities, there was no spread at all. This lead to the plague along with some other epidemics becoming a part of the international sanitary conference and becoming a priority for the world to keep under control.

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