Epilogue• 283usually discernible in three days, matching the descriptions of Boghurst and
others.
The bloodstream soon becomes infected with bacteria. The body’s defense
response produces a raging fever, which is the body’s attempt to kill foreign
microbes. It is the symptom that Gideon Harvey, Thomas Sydenham, and
Thomas Willis used as a chief diagnostic indicator of plague. If the bacteria
survive this counterattack, the vital organs of the liver, the spleen, and more
rarely the lungs are next in line.^42 Finally, the heart is involved and heartbeats
become erratic, as reported by the physicians of the Great Plague. Death en-
sues, usually brought on by toxic shock.
The battle between the response mechanisms of the human cells’ immune
system and the invading microorganism’s stratagems has been termed a Mi-
crobial Dance of Death. Such a struggle might be seen as a game of chess
for immortality, reminiscent of Ingmar Bergman’s The Seventh Seal.(More
highly evolved pathogens than the plague bacillus have a more accommodat-
ing relationship with their human host cells.) When the buboes begin to ap-
pear, the victim has a mortality probability of 60 percent or more if not
treated. If the bacteria attack quickly through the bloodstream, as in septi-
cemic plague, the body is completely overwhelmed with little immune re-
sponse and no bubo formation. Death comes in two days in the vast majority
of cases. If the plague victim develops a lung infection, the disease is even
more deadly, approaching 100 percent mortality if untreated. A patient must
be diagnosed quickly and treatment begun within twelve to fifteen hours of
the fleabite.
An equally frightening aspect of this pneumonic plague is that a cough by
the victim can pass the infection to other humans via droplets containing
plague organisms. Although plague in the seventeenth century probably did
not enter the pneumonic stage, folk memories had carried the visions for-
ward from the Black Death, as seen in George Wither’s descriptions in 1625
and 1665 of the spotted siren killing with her “noisome breath.” This image
blended with the medical opinion of the time that one could catch the dis-
ease from a sick person’s exhalations. Pneumonic plague is short lived after
the initial transfers, unless a reservoir of infected rats or fleas exists. Such an
outbreak occurred in India in the late summer of 1994 , terrifying but brief,
with antibiotics helping to bring it to a quick end. A footnote on this out-
break provides yet another connection with the Great Plague of 1665 .Al-
though laboratory analysis was available in the 1994 outbreak, technicians
lacked training in plague identification and diagnosis was delayed. Officials