In the history of humanity, there has never been a disease with such devastating consequences as those of plague. Although plague is curable today, this illness has been associated with the ravages, sufferings, famine, and enormously high rates of mortality since medieval times. Bubonic plague was the most prevalent from of this disease then; it appeared to be the single biggest killer of the Middle Ages, accounting for far more deaths than all wars and conflicts combined. However, the most significant medical features and pathogenic agents of the disease were first accurately identified and specified in the nineteenth century.
The term “plague” originates from the Latin language; the Latin word plaga means “pest”. Plague is a contagious and potentially fatal infectious disease, which afflicts humans of all ages and nationalities. Epidemics of plague occurred several times; however, scholarly sources include some contradictory data. According to Kasper & Fauci (2010), the earliest plague epidemic was in China in 224 BC. Haensch et al. (2010) state that the first epidemic of the illness struck European populations in 541-542 AD and was known as Justinian's plague.
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The most devastating outbreak of plague affected people in Europe in the fourteenth century. “In 1347, an epidemic known as the Black Death spread from the Caspian Sea to almost all European countries, causing the death of one third of the European population over the next few years” (Haensch et al. 2010). Moreover, the period of the Black Death was followed by “the unremitting succession of plagues” within 300 years (Scott & Duncan 2003; Haensch et al. 2010; Carpenter 2010). Populations of Norway, Sweden, England, Scotland, Ireland, Iceland, and other countries were affected by the Black Death. However, the accurate number of deaths can appear underestimated because of panic caused by the illness outcomes. Black-colored, subcutaneous hemorrhages in affected individuals stipulated the name of the Black Death. Today, this period of plague occurrence is called the Great Pestilence or the Great mortality (Scott & Duncan 2003). The Black Death was defined as a pandemic due to its prevalence among the entire population of Europe and enormous rates of mortality. Neither the poor nor the rich escaped this dreadful disease; even members of royal families died of it. An afflicted person was doomed to die, as well as everybody who came into contact with him/her.
Medieval medicine appeared unable to utilize any efficient medications against plague and means of its treatment.Preventive maintenance included procedures limited by the formula “cito, longe, tarde”, which means leaving infected areas as soon and far as possible. Therefore, people fled their settlements in fear of this disease (Scott & Duncan 2003; Willey et al. 2008; Haensch et al. 2010). However, refugees frequently transmitted the infection to others inducing new cases of plague and aggravating the pandemic. Moreover, insufficient sanitary arrangements, sewage, uncleanness, absence of canalization, congestion, poor living conditions, extirpation of cats, and enormous populations of rats resulted in growing rates of bubonic plague.
Trying to justify their incompetence and explain fatality of plague and its causes, medieval scholars and devotees interpreted the disease prevalence by Divine punishment, contaminated air, miasmas, earthquakes, adverse arrangements of planets, and weather conditions (Scott & Duncan 2003). The Jewish, Muslims, and representatives of other nationalities were frequently perceived as the authors of the Black Death. People took refuge from the illness in churches and monasteries; they used talismans, Christ’s images, church amulets, and diverse magic and pseudo medical means in order to ensure their survival. Although the course and manifestations of plague were described in medieval manuscripts in detail, methods of plague treatment could not combat the disease. Numerous treatises involved erroneous concepts of treatment and useless recommendations concerning behavioral patterns and preferable food. Therefore, bubonic plague caused the enormous mortality in medieval Europe.
“Plague is a zoonotic disease circulating mainly among small animals and their fleas”, which “is transmitted between animals and humans by the bite of infected fleas, direct contact, inhalation, and rarely, ingestion of infective materials” (WHO 2005). Infectious agents can penetrate humans’ blood through their damaged skin or mucous membranes.
Zoonotic diseases are animal diseases that can be transmitted to humans. Although they frequently die of plague, rodents serve as reservoirs of the illness (Willey et al. 2008). Infected fleas search for new hosts, thus, they increase risk of spread of infection to people. Approximately 100 species of fleas can infest the most common black or roof rats (Rattus rattus) and their close relatives. Extirpation of cats during the pandemic of the Black Death led to growing populations of rats and induced an increase in rates of plague occurrence.
The infectious agent of plague was identified by Alexandre Yersin, a Swiss and French scientist, in Hong Kong in 1894. Plague is triggered by Yersinia pestis, a gram-negative extracellular coccobacillus. Pathogenic agents of plague are resistant to fluctuations of temperature and pH values (Kasper & Fauci 2010), thus, recommendations provided by medieval scholars and doctors were inappropriate and could not contribute to patients’ recovery in the Middle Ages.
Humans’ immune response to highly invasive and pathogenic Yersinia pestis is rather weak. Moreover, “the mechanisms by which the organism causes disease are incompletely understood” (Kasper & Fauci 2010). Almost all organs and tissues can be afflicted by plague. Clinical manifestations of the illness depend on its type, such as bubonic plague, pneumonic plague, septicemic plague, or plague pharyngitis (Scott & Duncan 2003; WHO 2005; Willey et al. 2008; Kasper & Fauci 2010). According to scientific findings, pneumonic plague is considered to be the most life-threatening form of the illness. Severity of symptoms depends on a type plague, its stage, localization of the infectious process, a patient’s age, and an individual immune response.
Bubonic plague is the most frequent form of the disease. If an affected person recovers, he/she becomes resistant to this form of plague. Being afflicted by bubonic plague, a person does not display any symptoms within an incubation period of 2-6 days, which can diminish within epidemics. This period of bubonic plague can be accompanied by vomiting, painful thirst, tachycardia and other cardiovascular disorders, rapidly developing psychomotor excitation, agitation, hallucinations, and delirium. The basic manifestations of bubonic plague involve a feeling of weakness or even extreme exhaustion, chills, headache, fever, myalgias, and arthralgias. The symptoms are rapidly aggravating due to intoxication caused by “the large number of bacilli in the blood” (Willey et al. 2008). Being untreated, bubonic plague can lead to death in more than 50 % of cases.
Buboes, enlarged lymph nodes, are a specific characteristic of bubonic plague. They generally appear on the first or second day of the illness. Locations of buboes are connected with the site of inoculation of Yersinia pestis; they can be femoral, inguinal, cervical, or axillary. Enlarging, affected buboes become painful and tender; “the surrounding tissue often becomes edematous, and the overlying skin may be erythematous, warm, and tense” (Kasper & Fauci 2010). Later, buboes can break down and discharge pus. Sometimes, patients could develop bacteremia without lymphadenopathy after being afflicted. Although buboes can be confused with manifestations of such diseases as a strangulated hernia, traumas, or diverse lymphadenitic conditions, their particular characteristics, involving extreme the rapid onset, tenderness, and signs of toxemia, provide evidence for bubonic plague. Surgical drainage of buboes can be utilized to treat patients with abscessed nodes.
Diagnostics is based on revealing the above-mentioned symptoms, thorough physical examination, and laboratory microscopic tests of blood and lymph node aspirates.
Credible knowledge of causes, symptoms, and potential outcomes of bubonic plague provide a scientific basis for selecting appropriate nursing interventions for a patient. Treatment for bubonic plague includes supportive therapy and such antibiotics as gentamicin, streptomycin, trimethoprim-sulfamethoxazole, tetracyclines, or chloramphenicol. In accordance with a patient’s health conditions, medications can be administered orally or intravenously. Timely diagnostics, comprehensive examination, deliberate medications and interventions, and patients’ isolation are essential ways to prevent and interrupt spread of the disease.
However, in spite of curability of plague today, well developed methods of treatment, efficient medications, advanced means of diagnostics and new assessment tools, and constant research studies, different forms of plague comprise a crucial health care issue “in many countries in Africa, in the former Soviet Union, the Americas and Asia” (WHO 2005). The prevalence of this disease is aggravated by modern trends of travelling and immigration. Moreover, according to recent publications, the etiology and infection carriers of plague in general and bubonic plague in particular has not been completely clarified yet (Haensch et al. 2010; Harwood 2011). Thus, in order to win humans’ fight against this disease, the global issue of plague prevalence should be overcome globally. Health care providers, empowered officials, and responsible professionals should develop and implement the most effective methods in order to reduce ”human plague… and limit its potential spread” (WHO 2005).
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