Re: Black Death timeline
- From: "Peter Jason" <pj@xxxxxxxxxx>
- Date: Fri, 7 Nov 2008 16:26:52 +1100
"J Antero" <ae@xxxxxx> wrote in message
"John Briggs" <john.briggs4@xxxxxxxxxxxx> wrote in message
J Antero wrote:
Perhaps the discrepancies you're finding are due to
uncertainty as to
exactly what epidemic was hitting, and when. A further
is that there are 3 types of The Plague: bubonic,
septicaemic. I think they all are somewhat different in
the last one kills very quickly.
Those are just three different manifestations of the same
They have different symptoms - that's the point.
She's wondering about diferences in reported dates of
occurence ... get it?
The mild infections are almost always bubonic.
Pneumonic and septicemic plague are invariably severe and
almost always fatal unless treated. The incubation period
is usually three to six days but may be as short as 36
hours or as long as 10 days. As a rule the onset is sudden
and well marked.
Bubonic plague constitutes about three-fourths of plague
cases. Typically, bubonic plague starts with shivering,
then vomiting, headache, giddiness, intolerance to light;
pain in the back and limbs; sleeplessness, apathy, or
delirium. The temperature rises rapidly to 104° F (40° C)
or higher and frequently falls two or three degrees on the
second or third day, with marked prostration. Constipation
is usual; diarrhea is a grave sign. Most characteristic is
the early appearance of buboes, which are usually
distributed in the groin and armpits. Bubonic plague is
not directly infectious from man to man; the bacillus is
carried from one person to another by the flea.
In pneumonic plague the physical signs are those of
bronchopneumonia; edema (filling with fluid) of the lungs
soon follows; and death occurs in three or four days.
Septicemic plague is marked by prostration and brain
damage; death may occur within 24 hours. Septicemic plague
may prove fatal before there is time for pneumonia to
develop. If, however, pneumonia does occur, the patient
becomes highly infectious. His contacts will contract
pneumonic, not bubonic, plague. Pneumonic plague is nearly
I have posted this before. It is a scan from the "Merck
Manual" 17th Ed c.1998.....
PLAGUE (Bubonic Plague; Pestis; Black Death)
An acute, severe infection appearing most commonly in a
bubonic or pneumonic form, caused by the bacillus Yersinia
+*Etiology and Epidemiology
Yersiniapestis (formerlyPasteurellapestis) is a short
bacillus that often shows bipolar staining (especially with
Giemsa stain) and may resemble safety pins.
Plague occurs primarily in wild rodents (eg, rats, mice,
squirrels, prairie dogs); it may
be acute, subacute, or chronic, and urban (mainly murine) or
sylvatic. Massive human epidemics have occurred (eg, the
Black Death of the Middle Ages); more recently, plague has
occurred sporadically or in limited outbreaks. In the USA, >
90 % of human plague occurs in the southwestern states,
especially New Mexico, Arizona, California, and Colorado.
Bubonic plague is the most common form.
Plague is transmitted from rodent to humans by the bite of
an infected flea vector. Human-to-human transmission occurs
by inhaling droplet nuclei through the cough of patients
with bubonic or septicemic plague who have pulmonary lesions
(primary pneumonic plague). In endemic areas in the USA, a
number of cases have been associated with household pets,
especially cats. Transmission from cats can be by bite, or,
if the cat has pneumonic plague, by inhalation of infected
*Symptoms and Signs
In bubonic plague, the incubation period is usually 2 to 5
days but varies from a few hours to 12 days. Onset is abrupt
and often associated with chills; the temperature rises to
39.5 to 41° C (103 to 106° F). The pulse may be rapid and
thready; hypotension may occur. Enlarged lymph nodes
(buboes) appear with or shortly before the fever. The
femoral or inguinal lymph nodes are most commonly involved
(50%), followed by axillary (22%), cervical (10%), or
multiple (13%) nodes. Typically, the nodes are extremely
tender and firm, surrounded by considerable edema; they may
suppurate in the 2nd wk. The overlying skin is smooth and
reddened but often not warm. A primary cutaneous lesion,
varying from a small vesicle with slight local lymphangitis
to an eschar, occasionally appears at the bite. The patient
may be restless, delirious, confused, and uncoordinated. The
liver and spleen may be palpable. The-WBC count is usually
10,000 to 20,000/p.L with a predominance of immature and
mature neutrophils. The nodes may suppurate in the 2nd wk.
Primary pneumonic plague has a 2- to 3day incubation period,
followed by abrupt onset of high fever, chills, tachycardia,
and headache, often severe. Cough, not prominent initially,
develops within 20 to 24 h; sputum is mucoid at first,
rapidly shows blood specks, and then becomes uniformly pink
or bright red (resembling raspberry syrup) and foamy.
Tachypnea and dyspnea are present, but pleurisy is not.
Signs of consolidation are rare, and rales may be absent.
Chest x-rays show a rapidly progressing pneumonia.
Septicemic plague usually occurs with the bubonic form as an
acute, fulminant illness. Abdominal pain, presumably due to
mesenteric lymphadenopathy, occurs in 40% of patients.
Pharyngeal plague and plague meningitis are less common
forms. Pestis minor, a benign form of bubonic plague,
usually occurs only in endemic areas. Lymphadenitis, fever,
headache, and prostration subside within a week.
*Diagnosis and Prognosis
Diagnosis is based on recovery of the organism, which may be
cultured from blood, sputum, or lymph node aspirate. Because
surgical drainage may disseminate the organism, needle
aspiration of a bubo is preferred. Y. pestis can grow on
ordinary culture media or be isolated by animal (especially
guinea pig) inoculation. Serologic tests include complement
fixation, passive hemagglutination, and immunofluorescent
staining of a node or tissue biopsy or secretions. Prior
vaccination does not exclude plague in the differential
diagnosis, since clinical illness may occur in vaccinated
The mortality rate for untreated patients with bubonic
plague is about 60%, with most deaths occurring from sepsis
in 3 to 5 days. Most untreated patients with pneumonic
plague die within 48 h of symptom onset. Septicemic plague
may be fatal before bubonic or pulmonary manifestations
*Prophylaxis and Treatment
Rodents should be controlled and repellents used to minimize
fleabites. Although immunization with standard killed plague
vaccine gives protection, vaccination is not indicated for
most travelers to countries reporting cases of plague.
Travelers should consider prophylaxis with tetracycline 500
mg po q 6 h during exposure periods.
Immediate treatment reduces mortality to < 5%. In septicemic
or pneumonic plague, treatment must begin within 24 h with
streptomycin 30 mg/kg/day IM in 4 divided doses q 6 h for 7
to 10 days. Many physicians give higher initial dosages, up
to 0.5 g IM q 3 h for
48 h. Tetracycline 30 mg/kg IV or po in 4 divided doses is
an alternative. Gentarrticit, is probably also effective,
although no controlled clinical trials have been conducted.
For plague meningitis, chloramphenicol should be given in a
loading dose of 25 mg/ kg IV, followed by 50 mg/kg/day in 4
divided doses IV or po. A multidrug-resistant strain has
been reported from Madagascar.
Routine aseptic precautions are adequate for patients with
bubonic plague. Those with primary or secondary pneumonic
plague require strict (airborne agent) isolation. All
pneumonic plague contacts should be under medical
surveillance; their temperatures should be taken q 4 h for 6
days. If this is not possible, tetracycline 1 g/day po for 6
days can be given; however, this can produce drug-resistant
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