Apparently a new plague focus, independent of that in Yunnan and Hong Kong, has been recently discovered in Manchuria. The plague seems to have existed in this province for more than ten years under the name of Tarabagan plague, and is believed to be spread by a rodent, the Arctomis cobuc, which is subject to a hemorrhagic pneumonia. The presence of such an independent endemic focus in Manchuria indicates the possibility of the spread of the disease by caravan to Lake Baikal, and thence by the Siberian railroad to Russia. Indeed, the epidemic of pneumonic type which began July, 1899, at Kolobovka, in Astrakhan, while it may have been imported from Persia, might also owe its origin to the Mongolian focus.
Russia, however, is not the only country endangered by the overland transmission of the disease. There are commercial highways which lead from Northwestern India through Baluchistan and Persia to the Caucasus, and through Turkey to Constantinople. Grave danger threatens from this source, and more especially from the cities along the Persian Gulf. Two important cities here are already infected, namely, Bushire, in Persia, and Bassorah on the Tigris, in Turkey. It would appear as if Turkey and Persia would escape with difficulty from a visitation of this dread disease.
Such, then, is the geographical distribution of the present outbreak of the plague. This, an apparently extinct disease, has suddenly reappeared and given evidence of its power to spread death and desolation. Fortunately, however, modern sanitary precautions are quite able to restrict its progress, provided they be applied at the proper time and place. Filth and overcrowding, protracted wars and famine, have been the powerful allies of the plague in the past. Through their aid this disease has made a deep impression upon the pages of history. It may not be out of place, therefore, to turn from the present outbreak of the disease and trace its grewsome past.
In ancient writings references are found which would seem to indicate the existence of the plague at a very early date. The Bible contains several such references (Deuteronomy, Chapter 28, paragraph 27. Samuel I, Chapter 5, paragraphs 6, 9). The latter especially deals with the plague which attacked the Philistines after they took the ark. The rôle of rats in the dissemination of the disease is, as some believe, apparently referred to in the trespass offering of “five golden emerods and five golden mice.” The return of the ark, together with this trespass offering, brought also the plague, “because they had looked into the ark of the Lord, even he smote of the people fifty thousand and threescore and ten men.” Poussin’s painting of this Philistine plague, exhibited in the Louvre, shows several dead rats on the streets. It is evident that the susceptibility of the rat to the plague had been noticed even at this early date. The plague of boils visited upon the Egyptians as related in Exodus (Chapter 9, paragraphs 9 and 10) has also been taken to indicate the pest of today, but neither of these scriptural references can be said to be sufficiently definite.
The Attic plague, which ravaged the Peloponnesus 430 years before Christ, has been accurately described by an eye-witness, the historian Thucydides. His narration may be considered the earliest exact record of an epidemic. Like all the great epidemics of subsequent ages, it was ushered in by the overcrowding, the misery and the famine consequent upon prolonged wars. The combustible material was there, and all that necessary was the spark to begin the work of death and devastation. It is noteworthy that the origin of the pest was traced by Thucydides to Egypt or Ethiopia, from whence it spread gradually overland to Asia Minor and thence by boat to Athens. The nature of this first great historic epidemic is and will remain uncertain. There are those who consider the Attic pestilence as one of bubonic plague, but the fact that in the very careful description of the disease no mention is made of buboes and the statement that death occurred from the seventh to the ninth day would indicate that the disease was something else. Buboes are characteristic, it is true, of the plague, but it should be remembered that outbreaks of the pneumonic form, with little or no glandular enlargement are not uncommon. Death, however, in the case of plague is very common on the second or third day, and is less liable to occur in more protracted cases. These facts lead to the commonly accepted belief that the Attic pest was not the bubonic plague. It may have been typhus fever, possibly smallpox.
The great pestilence which devastated Rome and its dependencies in 166, Anno Domini, is known as the plague of Antoninus or of Galen. This prolonged epidemic was brought to Rome by the returning legions from Seleucia. It was not characterized by buboes, and it is very probable that it was largely smallpox. On the other hand, the plague of Saint Cyprian, which prevailed from 251 to 266 Anno Domini, may have been partly bubonic in nature, since, it prevailed during the fall and winter months and ceased during the hot summer. The disease was said to be communicated by means of clothing and by the look. It spread from Ethiopia to Egypt and thence through the known world.
Although the above early epidemics cannot be identified with the bubonic plague, there is nevertheless excellent evidence of the existence of this disease in remote antiquity. The first undoubted testimony on this point is that furnished by Rufus of Ephesus, who lived in the first century of the Christian era. The writings of this author are no longer extant, but they are quoted by Oribasius, the physician and friend of Julian the Apostate, who lived in the fourth century. The writings of Oribasius were discovered in the Vatican Library and were published early in this century by Cardinal Mai. In the forty-fourth “Book of Oribasius” occurs the extract taken from Rufus of Ephesus, from which it appears that “the so-called pestilential buboes are all fatal and have a very acute course, especially when observed in Libya, Egypt and in Syria. Dionysius mentions it. Dioscorides and Posidonius have described it at length in their treatise upon the plague which prevailed during their time in Libya.” The description which then follows of the buboes and of the disease is an exact counterpart of the present plague. The writings of the authors quoted by Rufus are no longer extant, but one thing is certain, and that is that the Dionysius referred to lived not later than 300 years before Christ. The other two physicians lived in Alexandria contemporaneous with the birth of Christ. It may, therefore, be considered as an established fact that the plague existed in Egypt, Libya and Syria as early as 300 years before Christ. This is of especial interest in view of the recent discovery by Koch of an endemic plague focus in British Uganda and German Kisiba, at the headwaters of the Nile. Whether it ever invaded European territory prior to the sixth century is unknown.
The great plague of Justinian which broke out in 542, Anno Domini, appeared first in Egypt, and from thence it spread east and west throughout the known world and persisted for more than a half century. So unknown was the plague in Europe at that time that the physicians of Constantinople considered it a new disease. Procopius, who was an eye-witness of the plague at Constantinople, states that the daily mortality in that city was at times over 10,000.
The pandemic of Justinian resulted in the distribution of the plague for the first time throughout the length and breadth of known Europe. From that time on the early chroniclers make repeated mention of devastating plagues consequent upon the miseries of war and famine. The descriptions of these pestilences are, as a rule, insufficient to identify them with the bubonic plague. Typhus, scurvy, smallpox and other diseases undoubtedly alternated in the work of destruction. Of the scores of epidemics thus recorded during the eight centuries following this first visitation few, indeed, can be identified to a certainty with the bubonic plague, and yet there can be no doubt but that this disease occupied no second rank during the dreary darkness of the middle ages. This era in history may be said to have been ushered in by the Justinian plague, and it was closed by an even more disastrous outbreak of this same disease. All the ravages and slaughter consequent upon the great historic battles, when taken together, pale into insignificance on comparison with that dread visitation of the fourteenth century, the ‘black death’.
It is noteworthy that this great historic epidemic did not originate in Egypt, as did many of its predecessors. Without exception the contemporaneous writers ascribe its origin to Cathay, or the China of today. This fact is of interest when it is borne in mind that at the present time we know of the existence of two endemic foci in China, besides that of Gurhwal in India, of Beni Cheir in Arabia and of Uganda and Kisiba in Africa. Whatever may have been its source, the fact is that it advanced from the Orient along the three principal routes of travel. One of these led from the Persian Gulf through Bassorah and Bagdad along the Euphrates, across Arabia to Egypt and Northern Africa. Another route passed from India through Afghanistan, and skirting the southern borders of the Caspian and Black Seas, eventually reached Asia Minor. A third route from Turkestan and China led around the northern shore of the Caspian Sea to Crimea, and thence to Constantinople. It was along these several routes that the plague advanced and spread over most of Western Asia and Northern Africa.