Part 3

The existence of famine in India, together with the filthy, overcrowded condition of the population, enabled the plague to gain a firm foothold in a relatively short time. Indeed, there can be no doubt but that the disease was well established at the time it was first recognized. It is no wonder, then, that in spite of the most stringent precautions, it spread like wildfire, so that in a short time the weekly deaths from the plague rose to nearly 2,000. In the face of such a relentless enemy, it is but natural that a large proportion of the population should seek safety in flight. It is believed that fully 300,000 people left Bombay shortly after the plague developed. There can be no doubt but that these refugees, directly or indirectly, carried the disease to the neighboring villages, and thus contributed to the enormous dissemination of the pest throughout Western India. In the Presidency of Bombay there were reported, in less than three years, more than 220,000 cases, with more than 164,000 deaths. When it is furthermore recognized that the natives concealed the existence of the disease as much as possible, it will be evident that these figures reveal a partial but, nevertheless, a grim truth.

With Bombay and the surrounding country thus seriously infected, it became merely a question of time when the disease would be carried to other ports and countries, by vessels and by overland routes. In spite of the sanitary perfection which we may flatter ourselves on having attained in recent years, it is nevertheless a fact that the disease is slowly but steadily and, as it were, stealthily invading port after port. That the sanitary methods, however, are not at fault is seen in the fact that when an early and prompt recognition occurred, the disease has been held in check. The insidious spread of the disease is rather due to the enormous development of commerce and to the rapid means of communication with distant countries.

From Bombay the plague has spread to ports on the Persian Gulf, on the Red Sea, and has reached Alexandria. Aden, Djeddah, Port Said, Cairo, have all had outbreaks of the disease. Beirut and Smyrna have each developed straggling cases. Isolated cases have been met with in London, at St. Petersburg and in Vienna. However, only three appreciable outbreaks have as yet occurred on European soil. The first was that at Oporto in Portugal, where one hundred and sixty cases, with fifty-five deaths, have developed up to the present time. The second outbreak occurred at Kolobovka, a village near Astrakhan. Of the twenty-four cases that developed there in July and August, 1899, twenty-three died. The last outbreak is that at Glasgow, where the disease made its appearance but a few weeks ago.

In addition to following the great international highway of Suez, the disease has insidiously spread to the countries of East Africa. Mauritius and Madagascar, with the adjoining mainland of Mozambique and Lorenzo Marquez, have become more or less infected, and, if reports are to be credited, it has also appeared in one of the Boer towns and also on the Ivory Coast in Western Africa. Last fall the disease reached South America. It apparently was first recognized at Santos, in Brazil, during October, although early in September, according to reports, a peculiar disease, causing swelling of the glands and death within forty-eight hours, was reported at Asunçion, the capital of Paraguay. At the present time Rio Janeiro is infected. The sanitary condition of these South American cities is far from being the best, and, consequently, there is but little hope that the disease will be eradicated or even held in check. With South America more or less thoroughly infected, it is evident that the United States, as well as Europe, are now threatened from all sides. The gravity of the situation is seen in the fact that already last November two cases of the plague were found in New York harbor aboard a coffee ship from Santos. Several cases have also developed on ships bound from the latter city for Mediterranean ports.

The United States is threatened not merely from the East Atlantic and South Atlantic, but also from the Pacific. As a matter of fact, the danger to our Pacific ports is greater, owing to the direct communication with the Orient. It has been already indicated that Hong Kong has continued to be infected ever since 1894. On several occasions it disappeared during the winter months, only to reappear in spring. With the more or less constant prevalence of the plague at this great seaport, it necessarily will lead directly or indirectly to a dissemination of the disease along the entire Pacific. Already it has prevailed at Amoy, and has even extended to other Chinese ports as far as Niu-Chwang. For several years it has already persisted on the island of Formosa. Japan was invaded last fall at Kobe and at Osaka, and although it disappeared during the winter, yet only a few weeks ago it has reappeared at the latter city. Sidney in Australia, and Noumea in New Caledonia, are also infected at the present time.

Manila, Honolulu and San Francisco have successively become infected. In all these places the disease, with but very few exceptions, has attacked the native or Oriental population. The extinction of the plague in the Hawaiian Islands since the end of March is a splendid demonstration of what energetic, vigorous measures can accomplish. The presence of the plague since March 8 in Chinatown, in San Francisco, is readily recognized as a most serious condition, especially after the courts have granted an injunction restraining the health officers from carrying out the necessary vigorous preventive measures.

A few words should be given here to the overland dissemination of the disease. Europe is not merely threatened by infected ships which may come from China, India, Eastern Africa or South America. The overland routes from China and India are fully as grave a source of danger. Indeed, as will be presently shown, these are the routes along which the great epidemics of cholera and plague have always traveled in the past.

One of these great caravan routes leads from Lahore in Punjab through Afghanistan into the Russian province of Turkestan, where it meets the Trans-Caspian railway. This railway begins at Samarcand in Turkestan, and passes through Bokhara, Merv, Askabad and ends at Uzun Ada on the Caspian Sea opposite Baku. Early in 1899 an outbreak of the plague occurred near Samarcand, undoubtedly brought up from India. The precautions taken to prevent the spread were entirely successful, and although no accounts have been officially published as to the means employed, nevertheless it will be seen that the radical procedure employed by Loris Melikoff some twenty years ago was again resorted to. Inasmuch as the entire village was said to be afflicted it was surrounded by troops, and no one was allowed to enter or leave. The village and all that it contained was destroyed by fire. With this route open continually it is evident that fresh importation must be expected sooner or later.

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.

The European black death, however, can be traced with accuracy to the Crimean peninsula. Gaffa, a town in Crimea, now known as Theodosia, had been founded and fortified by the Genoese. It, as well as other cities along the Black Sea, was largely populated by Italians. One of these, Gabriel de Mussis, a lawyer in Gaffa, has left a faithful account of his experience and share in the introduction of the plague into Europe. In 1346 in the Orient numberless Tartars and Saracens were attacked with an unknown disease and sudden death. In the city of Tanais, through some excess, a racial struggle ensued between the Tartars and the Italian merchants. The latter eventually escaped and took refuge in Gaffa, which in time was besieged by the Tartars. During the siege, which lasted three years, the Tartar hordes were attacked by the plague, which daily carried off many thousands. The besiegers, despairing of reducing the city by direct attack, attempted to do so in another way. By means of their engines of war they projected the dead bodies into the beleaguered city, which, as a result, soon became infected. The Christian defenders took to their ships, and abandoning Gaffa, sailed westward, touching at Constantinople, Greece, Italy and France.

Wherever the infected vessels touched they left the plague. Constantinople thus became infected early in 1347. During the summer Greece, Sardinia, Corsica and parts of the Italian coast developed the disease. In the fall it reached Marseilles. The following year it spread inland into Italy, France, Spain, and even into England. In another year or two it spread over Germany, Russia, and crossed to the Scandinavian peninsula. Within four years it had completed the circuit of Europe, spreading untold death and misery. No greater catastrophe has been recorded in the history of the world.

The rapidity with which the disease spread among the fugitives from Gaffa, and in the cities visited by their ships, is despairingly narrated by De Mussis, who, returning in one of the ships to Genoa, says: “After landing we entered our homes. Inasmuch as a grave disease had befallen us, and of the thousands that journeyed with us scarcely ten remained, the relatives, friends and neighbors hastened to greet us. Woe to us who brought with us the darts of death, who scattered the deadly poison through the breath of our words.” According to this writer 40,000 died in Genoa, leaving scarcely a seventh of the original population. Venice was said to have lost 100,000, Naples 60,000, Sienna 70,000, Florence 100,000. All told, Italy lost half of its population.

Of the contemporaneous writers none has printed the horrors of the plague more vividly than does Boccaccio in his introduction to the ‘Decameron.’

“What magnificent dwellings, what notable palaces were then depopulated to the last person! What families extinct! What riches and vast possessions left, and no known heir to inherit! What numbers of both sexes in the prime and vigor of youth, whom in the morning either Galen, Hippocrates, or Æsculapius himself but would have declared in perfect health, after dining with their friends here have supped with their departed friends in the other world!”

From Marseilles the plague spread through Provence with disastrous results. In some monasteries not even a single survivor was left. In one of these Petrarch’s brother buried thirty-four of his companions. At Avignon, the seat of the Pope, 1,800 deaths occurred in three days. In Paris more than fifty thousand died of the plague.

In England the black death appeared in August, 1348, and continued till the autumn of 1349, when it disappeared. London, which at that time probably had a population of 45,000, had a mortality of about 20,000. No exact statement can be made of the relative mortality in England, although many undoubtedly extravagant guesses are recorded by contemporaneous writers.

It is estimated that the population of Europe previous to the outbreak of the black death was about one hundred and five millions. One quarter of the population, or about twenty-five millions, are said to have died of the plague. This may be but a mere estimate, it may be grossly inaccurate, but it nevertheless indicates the deadly character of the pestilence. According to a report made to Pope Clement VI, the total mortality for the known world was placed at forty-three millions. One-half the population of Italy succumbed. The Order of Minorites in Italy lost 300,000 members. The Order of Capuchins in Germany lost 126,000 members, while the total of deaths in Germany was placed at 1,200,000.

The invasion of Europe by the black death was sudden and rapid. The seeds of the disease, once planted on European soil, persisted, as might be expected, for no little time. Although the great epidemic was said to have lasted till 1360, it must not be inferred that it then ceased altogether. Diverse localities retained the infection, and, as a result, new outbreaks, though to a less extent, continued to outcrop during the following years. From that time on every decade or two witnessed more or less pronounced outbreaks of the disease in France, England and Italy. The chroniclers of those local outbreaks during the latter half of the fourteenth and during the entire fifteenth century did not always make it clear that the pestilence described was the real plague. It was but natural to include typhus and other diseases under the dreaded term of pest. Nevertheless, the frequency of these outbreaks indicates the persistence and the wide dissemination of the plague during those years.

During the sixteenth century the plague apparently began to show a decrease in its frequency, although during this period, as before, other epidemic diseases were mistaken for it. Germany, Holland, certain cities in France, and especially in Italy were scourged by the plague during this century. The noteworthy outbreak in Italy in 1575-77 was due to fresh importation from the Orient. The disease spread throughout Italy, and the devastation it caused was not inferior to that of the great plague two centuries before. For example, in 1576 in Venice 70,000 died of the disease.

During the seventeenth century the plague asserted itself with great severity. Following a famine, it prevailed in Russia in 1601-1603, and some idea of its destructiveness may be gained when it is stated that in Moscow alone 127,000 lives were taken. During the following decade even greater epidemics prevailed in Western Europe. France and England were invaded, and in Switzerland it even penetrated to the highest Alps. Basel in 1609-1611 had 4,000 deaths, while London in 1603 yielded 33,000.