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the lack of labourers there was a great increase in wages.

The following graphic account of the ravages of this pestilence is by a writer of the period :

“Wild places were sought for shelter; some went into ships and anchored themselves far off on the waters. But the angel that was pouring the vial had a foot on the sea as well as on the dry land. No place was so wild that the plague did not visit — none so secret that the quick-sighted pestilence did not discover

-none could fly that it did not overtake. For a time all commerce was in coffins and shrouds, but even that ended. Shrift there was none; churches and chapels were open, but neither priests nor penitents entered-all went to the charnel-house. The sexton and the physician were cast into the same deep and wide grave; the testator and his heirs and executors were hurled from the same cart to the same hole together. Fire became extinguished, as if its element had expired, and the seams of the sailorless ships yawned to the sun. Though doors were open and coffers unwatched, there was no theft; all offences ceased, and no cry but the universal woe of the pestilence was heard among


That the “black death” of the fourteenth century was in fact the same disease which subsequently prevailed in Europe under the name of “the plague,” and more recently known as “bubonic plague,” can scarcely be doubted. But the epidemic was characterised by an unusually large number of cases of the pulmonary form of the disease, in which it seems probable that the lungs are the primary seat of infection, while in the bubonic form the bacillus effects a



lodgment through some superficial wound or abrasion, or possibly through the bites of insects, and it first invades the lymphatics, producing inflammation of the nearest lymphatic glands. General invasion of the blood appears, from recent investigations, to be a secondary phenomenon which only occurs in very severe and usually fatal cases.

The pulmonic form of the disease, which was so prominent in the epidemic known as black death, is extremely fatal and is known to occur at the present day.

Bubonic plague continued to prevail in various parts of Europe at the end of the sixteenth century, and early in the seventeenth century (1603) an epidemic occurred in London which caused the death of 38,000 of its inhabitants. It continued to prevail in this city and in various parts of England, Holland, and Germany, and six years later caused a mortality of 11,785 in the city of London. During the year 1603 a most disastrous epidemic occurred in Egypt, which is said to have caused a mortality of at least a million. After an interval of ten or fifteen years, during which there was a marked diminution in the number of cases and the extent of its distribution in European countries, it again obtained wide prevalence during the year 1620 and subsequently, especially in Germany, Holland, and England. The epidemic in the city of


London in 1625 caused a mortality of more than 35,000. In 1630 a severe epidemic occurred in Milan, and in 1636 London again suffered a mortality of over 10,000, while the disease continued to claim numerous victims in other parts of England and on “the continent.” Later in the century (1656) some of the Italian cities suffered devastating epidemics. The mortality in the city of Naples was in the neighbourhood of 300,000, in Genoa 60,000, in Rome 14,000. The smaller mortality in the lastnamed city has been ascribed to the sanitary measures instituted by Cardinal Gastaldi. Up to this time prayers, processionals, the firing of cannons, etc., had been the chief reliance for the arrest of pestilence, with what success is shown by the brief historical review thus far presented. This enlightened prelate inaugurated a method of combating the plague and other infectious maladies which, with increasing knowledge and experience in the use of scientific preventive measures, has given us the mastery of these pestilential diseases, and has been the principal factor in the extinction of bubonic plague from the civilised countries of Europe.

But it was long after the time of Cardinal Gastaldi before sanitary science was established upon a scientific basis and had acquired the confidence of the educated classes. Indeed the golden age of preventive medicine has but recently had its dawn, and sanitarians at the present day often encounter great difficulty in convincing legislators and the public generally of the importance of the measures which have been proved to be adequate, when properly carried out, for the prevention of this and other infectious maladies.

We have now arrived in our review at the period of the “great plague of London.” For some years this city had been almost if not entirely free from the scourge, but in the spring of 1665 it again appeared and within a few months caused a mortality of 68,596 in a population estimated at 460,000. This, however, does not fairly represent the percentage of mortality among those exposed, for a large proportion of the population fled from the city to escape infection.

Upon the continent the disease prevailed extensively, especially in Austria, Hungary, and Germany. The epidemic in Vienna in 1679 caused a mortality of 76,000. In 1681 the city of Prague lost 83,000 of its inhabitants. During the last quarter of this century the disease disappeared from some of the principal countries of Europe. According to Hirsch, it disappeared from England in 1679, from France in 1668, from Holland about the same time, from Germany in 1683, and from Spain in 1681. In Italy it


continued to prevail to some extent until the end of the century.

At the beginning of the eighteenth century bubonic plague prevailed in Constantinople and at various points along the Danube; from here it extended in 1704 to Poland, and soon after to Silesia, Lithuania, Germany, and the Scandinavian countries. The mortality in Stockholm was about 40,000. The disease also extended westward from Constantinople through Austria and Bohemia.

In 1720 Marseilles suffered a severe epidemic, probably as a result of the introduction of cases on a ship from Leghorn. The mortality was estimated as being between 40,000 and 60,000. From Marseilles as a centre it spread through the province of Provence, but did not invade other parts of France. In 1743 a severe outbreak occurred on the island of Sicily. A destructive but brief epidemic, which is estimated to have caused a mortality of 300,000, occurred during the years 1770 and 1771 in Moldavia, Wallachia, Transylvania, Hungary, and Poland. At the same time the disease prevailed in Russia, and in 1771 caused the death of about one-fourth of the population of the city of Moscow.

Early in the nineteenth century (1802) bubonic plague appeared at Constantinople and in Armenia. It had previously prevailed in the Caucasus, from

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