plague

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An infectious disease of humans and rodents caused by the bacterium Yersinia pestis. The sylvatic (wild-animal) form persists today in more than 200 species of rodents throughout the world. The explosive urban epidemics of the Middle Ages, known as the Black Death, resulted when the infection of dense populations of city rats living closely with humans introduced disease from the Near East. The disease then was spread both by rat fleas and by transmission between humans. During these outbreaks, as much as 50% of the European population died. At present, contact with wild rodents and their fleas, sometimes via domestic cats and dogs, leads to sporadic human disease. See also Infectious disease.

After infection by Y. pestis, fleas develop obstruction of the foregut, causing regurgitation of plague bacilli during the next blood meal. The rat flea, Xenopsylla cheopsis, is an especially efficient plague vector, both between rats and from rats to humans. Human (bubonic) plague is transmitted by the bite of an infected flea; after several days, a painful swelling (the bubo) of local lymph nodes occurs. Bacteria can then spread to other organ systems, especially the lung; fever, chills, prostration, and death may occur. Plague pneumonia develops in 10–20% of all bubonic infections. In some individuals, the skin may develop hemorrhages and necrosis (tissue death), probably the origin of the ancient name, the Black Death. The last primary pneumonic plague outbreak in the United States occurred in 1919, when 13 cases resulting in 12 deaths developed before the disease was recognized and halted by isolation of cases.

Bubonic plaque is suspected when the characteristic painful, swollen glands develop in the groin, armpit, or neck of an individual who has possibly been exposed to wild-animal fleas in an area where the disease is endemic. Immediate identification is possible by microscopic evaluation of bubo aspirate stained with fluorescent-tagged antibody. Antibiotics should be given if plague is suspected or confirmed. Such treatment is very effective if started early. The current overall death rate, approximately 15%, is reduced to less than 5% among patients treated at the onset of symptoms. See also Immunofluorescence; Medical bacteriology.

noun

1. A cause of suffering or harm: affliction, bane, curse, evil, ill, scourge, woe. See help/harm/harmless.
2. A sudden increase in something, as the occurrence of a disease: epidemic, outbreak, rash². See increase/decrease.
3. Something that annoys: aggravation, annoyance, besetment, bother, irritant, irritation, nuisance, peeve, torment, vexation. See feelings, pain/pleasure.

verb

1. To disturb by repeated attacks: annoy, bait, bedevil, beleaguer, beset, harass, harry, pester, tease, torment, worry. See feelings, pain/pleasure.
2. To trouble persistently from or as if from all sides: badger, bedevil, beleaguer, beset, besiege, harass, harry, hound, importune, pester, solicit. See attack/defend.
3. To bring great harm or suffering to: afflict, agonize, anguish, curse, excruciate, rack, scourge, smite, strike, torment, torture. See attack/defend, help/harm/harmless.

Definition: annoyance, curse
Antonyms: advantage, good fortune, good luck

v

Definition: annoy, disturb
Antonyms: aid, assist, help, please

Plague is a disease of rodents and their fleas that can be transmitted to humans. Throughout history, plague, often referred to as the "Black Death," has caused catastrophic pandemics resulting in deaths of tens of millions of persons. The disease is caused by a gram-negative bacterium, Yersinia pestis. Humans are usually infected by the bite of infective rodent fleas, but infection also occurs through handling or ingesting infectious animals or by inhaling infective respiratory droplets expelled by humans or animals.

Initial signs and symptoms of plague may be nonspecific, with fever, chills, headache, malaise, musculoskeletal pains, nausea, and weakness leading to prostration. Persons with bubonic plague, the most common form of plague, typically develop painful, swollen lymph nodes near the site of an infective flea bite. Less common forms of plague can infect the bloodstream (septicemic plague), the lungs (pneumonic plague), the throat (pharyngeal plague), or the coverings of the brain (meningeal plague). Pneumonic plague is a severe and rapidly progressive form of the disease that quickly leads to difficulty in breathing, a cough with bloody sputum, and shock.

In any of its clinical forms, plague can be fatal if not diagnosed and treated correctly early in the course of the disease. The diagnosis is made by combining information on possible infective exposures, clinical signs and symptoms, and results from laboratory tests. Treatment, which should begin as soon as the diagnosis is suspected, relies on the aminoglycoside group of antibiotics (streptomycin, gentamicin), tetracyclines (doxycycline, tetracycline, oxytetracycline), chloramphenicol, or trimethoprim-sulfamethoxazole. Laboratory diagnosis is made by direct examination of stained clinical materials, serologies, antigen-detection, isolation of culture media, and molecular-genetic characterizations.

Plague is present in wild rodent populations over large but scattered rural areas of the Americas, Africa, and Asia. Outbreaks sometimes occur among wild rodent populations and occasionally among rat populations in villages and towns, though rarely in cities. When plague involves rats living in or around homes, humans are at their highest risk of exposure. In the United States, plague occurs in the western third of the country, most often in burrowing rodents and their fleas. Plague also occurs in scattered areas of South America, especially the Andean region; in north-central, eastern, and southern Africa; in Madagascar; in several states in the Near East (Saudi Arabia, Yemen, Jordan, and Iranian Kurdistan); central and southern Asia (Georgia, Kazakhstan, Mongolia, China, and India); and Southeast Asia (Myanmar, Vietnam, and Indonesia).

Plague prevention on an individual level involves avoidance of areas of known plague activity, taking personal precautions against flea bites, avoiding sick or dead animals, and seeking medical care at the earliest signs of illness. No vaccine against plague is available in the United States. Pneumonic plague patients should be managed in isolation under respiratory droplet precautions. Postexposure antibiotics may be warranted for persons who, in the previous two days, were likely to have been exposed to infectious fleas or have had close direct exposure to a person or animal with pneumonic plague. Routine community prevention and control of plague is achieved through sanitation and hygiene measures that limit food and harborage for rodents. In the event of a plague outbreak, flea control should be implemented before attempts are made to kill rats.

(SEE ALSO: Black Death; Epidemics; Isolation; Universal Precautions; Vector-Borne Diseases; Zoonoses)

Bibliography

Anonymous (2000). "Plague." In Control of Communicable Diseases Manual, 17th edition, ed. J. Chin. Washington, DC: American Public Health Association.

Dennis, D. T., and Gage, K. G. (1999). "Plague." In Infectious Diseases, Vol. 2, eds. D. Armstrong and J. Cohen. London: Mosby, Armstrong, and Cohen.

Perry, R. D., and Fetherston, J. D. (1997). "Yersinia pestis—Etiologic Agent of Plague." Clinical Microbiological Review 10:35–66.

World Health Organization (1999). Plague Manual: Epidemiology, Distribution, Surveillance and Control. Geneva: Author.

— DAVID T. DENNIS

Bubonic plague is a disease of rats, spread to humans by fleas deserting dead or dying rat hosts. Occurring primarily in the summer, it causes fever, vomiting, and inflammation of the lymphatic glands to give the characteristic swellings or buboes. Bubonic plague kills between 60 and 80 per cent of those infected. Still more lethal is pneumonic plague, which occurs when the bacillus enters the lungs and is then transmitted by droplet infection.

Plague arrived in England in 1348 as part of a European pandemic that lasted until the early 18th cent. No subsequent plague epidemic had the same ferocious impact as the Black Death. Recent estimates put the death toll at something like 47 per cent of the entire population. After the late 14th cent. plague tended to occur on a regional rather than a national level, although 1413, 1434, 1439, and 1464 were country-wide.

The overall impact of plague on the national death rate, however, diminished progressively. From the late 15th cent., plague increasingly became a disease of towns and cities, where man and rat lived in closest proximity, or hit villages located on lines of communication. Our historical perceptions are coloured by the experiences of those minority of communities which were devastated by plague. Norwich lost a third of its population in 1579. London accounted for one-third of all plague deaths that occurred in England between 1570 and 1670. The capital lost at least 25 per cent of its inhabitants in 1563, and a further 20 per cent or so perished in 1603 and again in 1625. The last ‘Great Plague’ in London in 1665, recorded in Pepys, killed about 56, 000 people. The disease disappeared from Britain after the mid-17th cent. Scotland's last serious outbreak was 1645-9, England's was 1665-6.

The Great Plague ravaged London, and other places, in 1665/6, and as with all major events generated its own set of beliefs and customs at the time, and also reverberating ever since. We are fortunate to have in Daniel Defoe's A Journal of the Plague Year (1722), a ‘fictionalized’ account of life in London in 1665, numerous examples of the folklore of the time. Indeed, Defoe proves to be an excellent observer of the folkloric, including, amongst other things, portents, preventative charms, herbal remedies, and omens. In the early stages of the plague, people's fears drove them to ‘running about to fortune-tellers, cunning-men and astrologers to know their fortune’ (p. 47), and he gives details of some of the charms used—‘papers tied up with so many knots, and certain words or figures written on them, as particularly the word Abracadabra, formed in a triangle or pyramid…’ (pp. 51-3). Other preventatives were herbal, including garlic, rue, tobacco, and vinegar. Defoe was also one of the first writers to identify what we now term contemporary legends (p. 102).

The Great Plague lives on, in various ways, in English folklore. At Eyam, Derbyshire, since 1905, the last Sunday in August has been Plague Sunday. This commemorates the heroic part played by the village people when the disease broke out in their midst. By maintaining a self-imposed quarantine neighbouring communities were spared, but 259 of Eyam's 350 inhabitants died (Kightly, 1986: 189; Palmer, 1991: 122). In addition, several places in England claim to have a Plague Stone, the distinguishing mark of which is an indentation which served as a receptacle for vinegar in which money could be placed by non-locals doing business with a quarantined village. Correspondence in N&Q 159 (1930) identifies existing examples and gives numerous references. In modern times, the plague is often cited as the origin of saying ‘bless you’ when someone sneezes, and also as the basis for the children's game Ring-a-Ring-a-Roses. Neither has any evidence to support it. In local lore, the presence of a ‘plague-pit’ is often postulated as the possible cause for hauntings or to explain unused pieces of land.

Epidemic disease spread by fleas that infest rats.

Plague is caused by the bacillus Pasteurella pestis. Bubonic plague, which affects the lymph nodes, is most commonly identified with major epidemics since the fourteenth century; it can decrease infected populations by as much as one-third. Numerous outbreaks were recorded in the Middle East in the nineteenth century. The most severe bubonic plague epidemic in the twentieth century was in Egypt, some 520 miles south of Cairo, in 1912. Some 237 deaths out of a total of 357 cases were recorded.

Pneumonic plague, which affects the lungs, occurs more commonly during the winter; it is highly infectious, with a mortality rate of almost 100 percent. It is spread through the air from person to person. Septicemic plague, which affects the bloodstream, is the rarest form. It is 100 percent fatal, because death occurs within a few hours of infection.

— JENAB TUTUNJI

The first great plague pandemic (1347–1350) was the greatest single epidemic interval in European history, yet some of the plagues of the period from 1500 to 1750 witnessed catastrophic mortality, in some cases over 40 percent. However, there was no continent-wide plague during any three-year interval after the Black Death of the fourteenth century. While in particular times and places later epidemics were as great as those of the Black Death, the burdens of mortality and disruption to ordinary life events fell most heavily upon those who could not escape to safe locales. Privileged sectors of the population typically had choices among fairly reliable strategies for avoiding exposure to plague.

The losses and costs of great epidemics between 1500 and 1750 can often be documented because one of the strategies of the elite and of governments representing them was to create surveillance systems that monitored urban mortality. After the invention of printing, local histories of plagues and plague treatises magnified the activities of urban administrators during mortality crises, reinforcing reams of correspondence and other non-printed records of church and state actions to minimize social and economic disruption from plague. In general, Italy and Spain led the rest of Europe in monitoring disease threats, relying upon trade and travel restrictions, urban boards of health, and hospital isolation strategies to segregate the ill from the well. All of these measures expanded bureaucratic surveillance and record keeping, and provided those with access to information a way to minimize the social and economic costs of plague. Collective governmental responses were more readily adopted in regions that remained Catholic. Protestants, instead, tended to encourage individual charitable care of one's afflicted neighbors, while retaining a strong sense that plague occurred as the result of God's moral judgment on the sinful. Therefore, fleeing the plague, as one would flee sin, was also sanctioned. Because plague controls were bureaucratized in what became the Catholic countries, better documentation of plague losses and responses survives from the late Middle Ages. Protestant regions began parish-level registration of births, marriages, and deaths after Catholic reforms at the Council of Trent (1545–1563). Such records were created to reinforce the sense of community and responsibility among members of individual Protestant churches, but historical demographers have used them in modern times to provide documentation of mortality crises comparable to urban mortality registers.

The cause or causes of these recurrent epidemics is the subject of considerable recent debate. Most geographical, demographical, and epidemiological evidence available from rural continental Europe suggests a slow spread of human mortality across trade and travel routes, patterns consistent with a rodent-borne bubonic plague. Great urban regions were served, however, by interregional trade, maritime and riverine, and were centers for distribution of infectious diseases. The practice of confining the ill and the well together in their homes or in vast pesthouses fueled morbidity and mortality during times of plague. The lazaretto of Milan, for example, held 12,000 to 15,000 people daily over the worst month of the murderous 1630 epidemic, in a complex that had a total of 256 enclosed rooms and minimal provision of clean water and medical care.

Recurrent plagues caused local population losses far steeper than chronic warfare or the burdens of other diseases. In the 150 years following the Black Death pandemic, the overall population of Europe fell 30 to 50 percent. Depopulation was especially dramatic in rural areas that had been cultivated during the High Middle Ages, leaving visible aerial traces of "deserted villages" and once-farmed land. As the overall population of Europe fell after the Black Death, the political and economic management of rural areas shifted to urban landowners, typically maximizing profits by turning the uses of the land to labor-conserving tasks, such as sheepherding (in Britain) or cattle-farming (in German and eastern European regions). European population recovery in the sixteenth century still left cities unable to replace their numbers, even in non-plague years. Cities had to draw their labor forces from the countryside. Rural to urban migration fueled early urban industries, such as cloth manufacture. Mountainous regions exploited mining. The first 150 years of recurrent plagues in Europe intersected with the beginnings of print, guns, and global trade all orchestrated from urban monetary sources of power, all requiring the move from agriculture to industry.

The economic costs of plagues in towns and cities increased over the early modern centuries, in part because of surveillance and isolation practices, in part because destruction of personal property dramatically impoverished survivors. Urban health boards devised mechanisms for sealing personal property within homes when early cases of plague were identified. With the seal unbroken, a closet or room could escape the fires and acids of disinfection procedures if plague subsequently entered the household. Maritime states meanwhile created the first international health procedures, codifying lengths of detention of people and goods in quarantine, mechanisms for disinfecting cargo, and the symbolism of a yellow flag, to indicate a ship that had "touched" plague.

Whatever the causes or the demographic and economic effects of recurrent plague, the methods of controlling both exposure to plague elsewhere and the unacceptable consequences of an epidemic locally established a tradition in epidemic management that is still very much a part of Western society. From particular urban plagues there also survives a legacy of literary and artistic production, of which Daniel Defoe's 1722 A Journal of the Plague Year, about the 1665 Great Plague in London, and Alessandro Manzoni's 1827 I promessi sposi (The betrothed), set in seventeenth-century Italy, are the two best-known novels. Plague art typically focused on divine retribution for sin, and the intervention of saints (especially St. Roch and St. Sebastian) to aid the plague-stricken, collective penance, and votive gifts expressing communal thanks for a specific plague's ending were popular themes. By the seventeenth century, plague art often portrayed themes of religious devotion to the sick even amid a chaotic tableau of suffering.

Plague, whatever its cause or causes, receded from Europe during the reign of Louis XIV (1643–1715). The last plagues in northern Europe and Britain occurred in the 1660s; the last plague in southern Europe occurred in Marseilles in 1720–1721. Messina, in Sicily, was stricken in 1743 and during the later eighteenth century the Austro-Hungarian Empire devised an extraordinary thousand-mile-long cordon sanitaire, a military border between Christian Europe and Muslim regions to the east. Whether through such aggressive measures to minimize all contact with plague in the Middle East and southern Russia, or because maritime trade was increasingly directed over the North Atlantic, commerce with regions that still experienced plague declined steeply. Local commercial barriers to the importation of plague certainly played a role in the plague's disappearance. But so, too, did the widespread use of arsenic oxide, a colorless, tasteless rat poison, by the late seventeenth century. Some have further speculated that the disappearance of plague in the years from 1650 to 1750 may have been the result of global ecological changes, reflected in the cooler climate called the "Little Ice Age" and the absence of sunspot activity called the "Maunder Minimum." The disappearance of plague, whatever its cause or causes, did coincide with the beginning of the modern rise of population throughout Eurasia and European domination of overseas trade.

Bibliography

Appleby, Andrew. "The Disappearance of Plague: A Continuing Puzzle." The Economic History Review, ser. 2, 33 (1980): 161–173.

Boeckl, Christine M. Images of Plague and Pestilence: Iconography and Iconology. Sixteenth Century Essays and Studies, vol. 53. Kirksville, Mo., 2000.

Cipolla, Carlo. Public Health and the Medical Profession in the Renaissance. Cambridge, U.K., and New York, 1976.

Jones, Colin. "Plague and Its Metaphors in Early Modern France." Representations 53 (1996): 97–127.

Konkola, Kari. "More than a Coincidence? The Arrival of Arsenic and the Disappearance of Plague in Early Modern Europe." Journal of the History of Medicine and Allied Sciences 47 (1992): 186–209.

Rothenberg, Gunther E. "The Austrian Sanitary Cordon and the Control of the Bubonic Plague, 1710–1871." Journal of the History of Medicine and Allied Sciences 28 (1973): 15–23.

Slack, Paul. The Impact of Plague in Tudor and Stuart England. London and Boston, 1985.

—ANN CARMICHAEL

A highly contagious disease, such as bubonic plague, that spreads quickly throughout a population and causes widespread sickness and death.

n.

In ancient times a general punishment of the innocent for admonition of their ruler, as in the familiar instance of Pharaoh the Immune. The plague as we of to-day have the happiness to know it is merely Nature's fortuitous manifestation of her purposeless objectionableness.

An epidemic of disease attended by great mortality.

• bubonic p. — an acute febrile, infectious, highly fatal disease caused by the bacillus Yersinia pestis. It is primarily a disease of rats and other rodents, dogs and cats, and is usually spread to humans by fleas. The more common form of plague is the bubonic. There is also a pneumonic type in humans, which can be spread directly from person to person by droplet infection. The clinical signs in all species are fever, vomiting and enlargement of lymph nodes, the buboes that give the disease its name.
• cattle p. — see rinderpest.
• duck p. — an acute infectious disease of ducks caused by a herpesvirus and characterized by tissue hemorrhages and blood free in body cavities, eruptions on the mucosae of the digestive tract, degeneration of parenchymatous organs and lesions in lymph nodes. Called also duck virus enteritis.
• equine p. — see african horse sickness.
• fowl p. — see avian influenza.
• pneumonic p. — see bubonic plague (above).
• septicemic p. — hematogenous spread of infection to many organs may occur without the formation of buboes; occurs in the cat with pulmonary involvement, disseminated intravascular coagulopathy and death.
• swine p. — see swine plague.
• sylvatic p. — bubonic plague in wild animals in uninhabited areas. See also sylvatic plague.

1. any disease of wide prevalence or of excessive mortality. n 2. the vernacular term for bubonic plague, marked by inflammatory enlargement of the lymphatic glands, particularly in the axillae and groins.

• Diseases and Infestations - plague: acute epidemic bacterial disease of rats, transmitted to humans by rat fleas, causing severe headache, fever, enlarged lymph nodes, and delirium, usu. fatal
• Animal Groups - plague: group of locusts
• Morality or Character
• Violent Actions - plague: torment; infest

Dansk (Danish)
n. - pest, plage
v. tr. - plage

idioms:

• a plague on    en plage for

Nederlands (Dutch)
pest, plaag, ramp, een last, plagen, lastig vallen vermijden als de pest

Français (French)
n. - (Méd) peste, épidémie, (fig) plaie, invasion de, vague, plaie (Bible)
v. tr. - être en proie à, être assailli par, harceler

idioms:

• a plague on    la peste soit (de toi) (arch)

Deutsch (German)
n. - Plage, Seuche, Pest
v. - plagen, quälen

idioms:

• a plague on    hol jmdn. die Pest!

Ελληνική (Greek)
n. - (παθολ.) πανώλη (κν. πανούκλα), λοιμός, (μτφ.) μάστιγα, πληγή
v. - μαστίζω, κατατρύχω, βασανίζω

idioms:

• a plague on    ανάθεμα σε

Italiano (Italian)
tormentare, importunare, piaga, peste

idioms:

• a plague on    accidenti a
• avoid someone/something like the plague    evitare qualcuno come la peste

Português (Portuguese)
n. - praga (f), maldição (f), epidemia (f), peste (m)
v. - amaldiçoar, praguejar, incomodar

idioms:

• a plague on    vá pro inferno
• avoid someone/something like the plague    fugir de alguém como o Diabo da cruz

Русский (Russian)
томиться, докучать, чума, бедствие

idioms:

• a plague on    черт (тебя) подери!
• avoid someone/something like the plague    бежать как от огня

Español (Spanish)
n. - plaga, azote, flagelo, peste, molestia, fastidio
v. tr. - plagar, infestar, atormentar

idioms:

• a plague on    ¡maldito sea!

Svenska (Swedish)
n. - pest, landsplåga, plågoris
v. - plåga, besvära

中文（简体）(Chinese (Simplified))
瘟疫, 灾祸, 麻烦, 折磨, 使得灾祸, 使苦恼

idioms:

• a plague on    讨厌的人或东西

中文（繁體）(Chinese (Traditional))
n. - 瘟疫, 災禍, 麻煩
v. tr. - 折磨, 使得災禍, 使苦惱

idioms:

• a plague on    討厭的人或東西

한국어 (Korean)
n. - 역병, 저주, 귀찮은 일
v. tr. - 역병에 걸리게 하다, 괴롭히다

idioms:

• a plague on    빌어먹을

日本語 (Japanese)
n. - 疫病, ペスト, 異常発生, 災害, 天災, 呪い
v. - 疫病にかからせる, うるさく困らせる

idioms:

• a plague on    いまいましい

العربيه (Arabic)
‏(الاسم) كارثه, بلاء, مصدر إزعاج (فعل) يصيبه بطاعون, يصيبه كارثه او مكروه, يزعج, يغيظ, يعذب‏

עברית (Hebrew)
n. - ‮מגיפה, דבר, מכה, מטרד, טרדן‬
v. tr. - ‮עינה, הציק, פגעה ב- (מגיפה)‬

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