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THE history of bubonic plague extends back to

a remote antiquity. Greek physicians of the second and third century before the Christian era have left a record of a pestilential malady characterised by the formation of buboes, which prevailed in Libya, in Egypt, and in Syria ; and two Alexandrian physicians, Dioscorides and Poseidonios, who were contemporaries of Christ, have given a description of the disease which leaves no doubt as to its identity with the plague of more recent times. It may be well to explain at this point that the buboes characteristic of the disease are enlarged and inflamed glands in the groins, in the armpits, and elsewhere, which in chronic cases may suppurate and discharge a virulent pus by which the disease is propagated. We now know that the germ of the disease is found not only in these suppurating buboes but also in the blood of an infected individual.

Three forms of the disease are recognised by modern authors-one a mild or abortive form, in which there is little pain or fever and in which the buboes rarely suppurate. In this form the enlarged glands in the groin, armpit, and neck usually disappear in about two weeks. In its usual form the disease is ushered in with chilly sensations, fever, lassitude, and pain in the back and limbs. The buboes are quickly developed and the general symptoms soon assume a grave character. If the patient lives for a week or more, the buboes usually suppurate and carbuncles and boils are often developed. In the third or fulminant form of the disease, death may occur within a few hours from the outset of the attack and in advance of the development of the characteristic buboes. These cases could scarcely be recognised were it not for the fact they occur during the epidemic prevalence of the disease among persons who have been exposed to infection.

From the first to the sixth centuries of the Christian era we have no authentic accounts of the prevalence of bubonic plague, but there is no reason to believe that it had entirely disappeared from those countries in which it had previously prevailed. During the sixth century, however, its ravages were greatly extended and it prevailed as a devastating epidemic in many parts of the Roman Empire, both of the East

and of the West; indeed, in the time of Justinian it extended far beyond the limits of the Roman Empire. The origin of this extensive epidemic which raged for more than half a century appears to have been in Lower Egypt in the year 542; thence it extended in one direction along the north coast of Africa, and in the other into Palestine and Syria. The following year it invaded Europe, which at the time was in a state of political disturbance and warfare, and during this and subsequent years it devastated many sections of the country, depopulating towns and leaving the country in some instances nothing more than a desert inhabited by wild beasts. The accounts given of this widespread epidemic indicate that other infectious maladies, which at the time had not been clearly recognised as specific diseases, were associated with the plague and contributed to the general mortality.

During the middle ages epidemics continued to occur, but the accounts of the nature of the prevailing “pest” are usually confused and unsatisfactory, and it was not until nearly the middle of the fourteenth century that the horrible epidemic known as the black death devastated Europe and caused the death of more than 25,000,000 of its inhabitants. There has been considerable difference of opinion among the best authorities as to whether the black



death of the fourteenth century was identical with bubonic plague. It presented some features which seem to distinguish it from subsequent epidemics, and it had its origin from a different quarter of the globe. While bubonic plague has usually invaded Europe from Egypt, the black death is believed to have originated in Northern China. It is not known exactly when or where this epidemic had its origin, but it is known to have reached the Crimea in 1346 and Constantinople the following year. The same year it was conveyed by ships to several seaports of Italy both on the Mediterranean and the Adriatic, and also to Marseilles on the French coast; in 1348 it extended to the interior of these countries and to Spain ; also to England, Holland, and the Scandinavian peninsula. The following year it completed the invasion of Europe.

The disease first appeared in London in November, 1348, and it continued to prevail in various parts of England for a period of eight or nine years. In 1352 the epidemic prevailed in the town of Oxford to such an extent that this town lost two-thirds of its academic population. The plague again invaded England in 1361 and 1368. As a result of these devastating epidemics in England, as well as in other parts of Europe, large parts of the country remained for a time uncultivated, and owing to



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