Bubonic plague is fairly unusual but it still crops almost every year. This is the plague that killed 1/3 of Europe in the 1340s, and it is the prime suspect in an earlier plague called Justinian\’s plague.

Bubonic plauge has 3 main forms: Form 1: the one with mainly boils (buboes), Form 2: the pneumonic form. In the 2nd form, without treatment, according to medieval accounts, if a person starts coughing blood they are all dead within 24 hours. Form 3 is septicemic plague.

One report recalls that some pigs (all livestock ran around town in Medieval times) were snuffling around some old clothing of a person who died of plague, and within a minute they dropped dead.

Clinically, plague primarily manifests as bubonic, pneumonic, or septicemic plague. Other rare forms of plague, such as cutaneous or gastrointestinal plague, have also been reported.(Yang2017)

Plague is caused by a bacterium Yersinia pestis (sometimes misspelled \’Yersina\’), carried by fleas, which are normally carried by rats, dogs, marmots, and cats. Filhty conditions, like those in medieval times, led to more rats. People would sling their garbage, much of it was food, in the streets or pile it in the yards. Butchers would do the same thing, causing an enormous stink in the summer, and attracting many rats, as rats used the offal and waste for food. The rats carried plague. The rats then got into the houses, and the fleas would jump off the rats to burrow into straw-filled mattresses, where they would bite the people when they were asleep.

However, Y. pestis can be transmitted not only by flea bites (causing bubonic plague) and respiratory droplets (causing pneumonic plague), but also by the consumption of uncooked contaminated meat (causing gastrointestinal plague) and contact with infected pets/domestic animals (causing conjunctivitis, skin plague, or pneumonic plague) (12). In addition, plague pharyngitis, meningitis, and endophthalmitis have been reported, albeit rarely.(Yang2017)

Plague can also be spread by respiratory droplets.

Form 1 of the plague causes boils in the lymph nodes which can sometimes be drained, releasing a foul-smelling pus. These boils often have a red ring at the base of them. Thus the line from the children\’s song \”Ring around the rosy\”. A pocketful of posies, or any nice-smelling flower, was thought to keep the plague away but people had no inkling of microscopic organisms in Medieval times. Even when microspy showed clear evidence of bacteriums, the concept was heavily scoffed at by mainstream doctors.

Various other symptoms from Form 1 included fever, sweating, great fatigue, headache, general malaise. Symptoms of Form 2, pneumonic plague are: sudden high fever with chills, severe coughing.

People could develop a cough but if they coughed up blood, they only had 24 hours to live. This would be from Form 2, the pneumonic plague, which somehow affected the lungs with a 100% mortality rate.

Lab testing should be performed in a Level 3 biosafety lab.

Treatment

Streptomycin and gentamicin are recommended for adult patients, including immunocompromised patients and pregnant women. Streptomycin and gentamicin may also be administered in children; however, the dosage should be reduced. Alternatively, the combination of doxycycline, ciprofloxacin, and chloramphenicol could also be used for both adults and children. (Yang2017)

More details about antibiotic treatments are here: https://www.cdc.gov/plague/resources/Recommended-antibiotics-for-plague_revision-Aug-2015_Final-(00000002).pdf

Books on plague

Most books on archive.org are older texts published before 1920, thus they are interesting for a historical medical perspective.

1. A search on archive.org for texts: https://archive.org/search.php?query=bubonic&and[]=mediatype%3A%22texts%22
2. Hong Kong Bubonic Plague. 1896. https://archive.org/details/b22331207
3. Bubonic Plague in Cuba. 1915. https://archive.org/details/8910167.nlm.nih.gov
4. History of the Plague in London in 1665 by Joseph Crawhall. https://archive.org/details/fisherchapbook335
5. Report of the North Manchurian Plague Prevention Service. 1913. https://archive.org/details/reportofnorthman1911nort
6. Epidemics of the Middle Ages. Hecker. 1835. https://archive.org/details/epidemicsofmiddl01heck

More links

1. A Pubmed search for [Yersinia pestis treatment]: https://pubmed.ncbi.nlm.nih.gov/?term=Yersinia+pestis+treatment
2. WHO plague page. https://www.who.int/csr/don/archive/disease/plague/en/
3. CDC laboratory diagnosis standards. https://www.cdc.gov/plague/healthcare/clinicians.html
4. Wang X, Zhang X, Zhou D, Yang R. Live-attenuated Yersinia pestis vaccines. Expert Rev Vaccines. 2013 Jun;12(6):677-86. doi: 10.1586/erv.13.42. PMID: 23750796. Full text: http://www.tandfonline.com/doi/full/10.1586/erv.13.42
5. Raoult D, Mouffok N, Bitam I, Piarroux R, Drancourt M. Plague: history and contemporary analysis. J Infect. 2013 Jan;66(1):18-26. doi: 10.1016/j.jinf.2012.09.010. Epub 2012 Oct 3. PMID: 23041039. Full text: https://www.journalofinfection.com/article/S0163-4453(12)00277-0/fulltext
6. How well does freesing or UV light kill Yersinia pestis? Sommers CH, Sheen S. Inactivation of avirulent Yersinia pestis on food and food contact surfaces by ultraviolet light and freezing. Food Microbiol. 2015 Sep;50:1-4. doi: 10.1016/j.fm.2015.02.008. Epub 2015 Feb 21. PMID: 25998808. https://pubmed.ncbi.nlm.nih.gov/25998808/

Bibliography sorted by bib code

1. Yang2017: Yang R. Plague: Recognition, Treatment, and Prevention. J Clin Microbiol. 2017 Dec 26;56(1):e01519-17. doi: 10.1128/JCM.01519-17. PMID: 29070654; PMCID: PMC5744195. https://pubmed.ncbi.nlm.nih.gov/29070654/ and full study: https://jcm.asm.org/content/56/1/e01519-17.long