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Although the plague has practically disappeared from Europe since the beginning of the 20th century, it is still present in everyone's memory. Owing to three pandemics, it has left an indelible mark on mankind and has given rise to many popular phrases, paintings, books or more recently movies and video games. After a brief description of the plague as a disease, we will try to trace the history of the plague through some of the works of art it inspired and then to show how the plague is still haunting our collective memory., (Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Manuscripts written on white pages or margins of ancient books often present some interest for the historian. Here is studied the handwritten inscription on the page facing the frontispiece of the Pharmacopée des dogmatiques by Joseph du Chesne. It referred to the opinion of traditional doctors such as Guy Patin or Jean Riolan about Joseph du Chesne and chemical medicine issued from the theories of Paracelsus. A special interest was given to the pills against plague.

In September 1901, a cruise for work and pleasure is organized in Mediterranean including VIP all firstclass (politicals, scientists, clergymen...) These were 174 passengers on the ship Senegal. After a departure from Marseille, the ship must quickly turn and go back on account of a sailor in the crew might be sicked with plague. A quarantine was organised in the lazaret of Frioul's island. This man died but an another actually ill will be cured. All the conference participents landed in the Frioul lazaret stayed only seven days on place and remained uninjured. This misadventure will be studied by scientific people and given to authorities. So, Pr Jules Buckoy' communication to the french Academy of medicine. Adrien Proust gave a report. In this doctoral thesis in 1902 Joseph Pellissier reported all the cases of plague cured in the Frioul lazaret. The physician Charles Leroux made an epidemiologic study about effects and troubles with plague serums. A lot of orig- inal and beautiful photographs, notably those by the famous passenger, Léon Gaumont, are joined in our presentation.

The author explains military surgeon Balme's biograpyhy, especially during Bonaparte's Egyptian campaign (1798-1801). As there is some possible confusion with another Claude Balme, some archives deserve to be closely scrutinized. Through Balme's reports the author insists on his courageous part in several scurvy or plague epidemics. He was himself marked on his face; he ended his life in Lyons as a town-councillor.

2013 was the year to celebrate Yersin: the 150th anniversary of his birth and the 70th anniversary of his death. Beyond the images usually attached to the memory of this doctor who discovered the bubonic plague bacillus (in Hong Kong in 1894), the author seeks to introduce Yersin, the man, as an explorer curious about his environment rather than a scientist concerned with honors and public recognition. Alexandre Yersin is an atypical figure in the universe of Pasteur, his collaborators, students, and followers. Although he began his career working with Louis Pasteur following the development of the vaccine against rabies, in 1885, the call of the sea led him to quit the laboratory on rue Ulm to, he said, "explore new lands". He worked for the Messageries maritimes merchant shipping company. In Saigon, he met Albert Calmette, who convinced him to join the newly created Colonial Army Medical Corps. In 1892 in Nha-Trang, Yersin set up a bacteriology laboratory in a straw hut; it subsequently became the first Pasteur Institute in Indochina, the starting point of a network of research laboratories. During the bubonic plague epidemic that raged in Hong Kong, Yersin succeeded in isolating its causal agent, surprising even himself by the ease with which he did so. He was 30 years old then, but what could have been the start of a prestigious career, crowned with honors, was spent instead at the service of the local populations. His exploration of the Vietnam highlands gave Yersin the occasion to cultivate and reveal a prodigious eclecticism and his profound humanism. He led three explorations in unknown regions of Annam and contributed to the development of this country by his social, educational, medical, and economic approach, entirely dedicated to aiding the indigenous populations. Yersin never left Vietnam again. He worked as an astronomer and agronomist (introducing the cultivation of cinchona (source of quinine) and rubber trees in the country) - always close to the population. He is buried at Nha-Trang; the Vietnamese continue to honor his memory fervently.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

Bonaparte's Egyptian Campaign (1798 - 1801), like all other episodes from the Napoleonic era, gave rise to an extensive literature on the subject, but most of all a significant medical literature. This fact is due to many reasons:--an important health service for this expeditionary corps of more than 36.000 men, with two main figures at its hea, Desgenettes and Larrey--but also with valuable subordinates like Assalini, Savaresi, Balme, Pugnet or Barbès.--A Commission for Science and Art, of which a few doctors and surgeons were members, but most of all pharmacists like Boudet or Rouyer--The presence in the field of Ludwig Frank, the nephew of the famous Johann Peter Frank.--The creation in Cairo of an Egyptian Institute and the publication of the masterly Description of Egypt and the establishment of printing houses.--The emergence of the myth of the Orient and its mysteries.--An extensive array of indigenous pathologies, which is characteristic of those countries. For instance: plague, dysentery, yellow fever, Egyptian ophthalmia, as well as more common diseases like tetanus, scurvy or venereal diseases. The main medical works that cover this period and its pathologies are skimmed.

Adrien Proust, Marcel's father, was a remarkable specialist of hygiens. He felt very responsible for the fight against epidemics, and his part was decisive at the Venice conference in 1896. In Marseilles and nearby islands quarantines were sill useful afterwards, especially in 1901.

Plague in Marseilles in 1720: what about its painted representation?

Born in 1670 Deidier became a medical doctor at the age of 21. The son-in-law, of Vieussens, he took care of the inhabitants of Marseilles during the plague of 1720. A contagionist and an experimenter, he was considered as a strange scientist by his colleagues. It is time now to rehabilitate his memory.

Plague in Marseilles in 1720 is compared with other epidemics in other European cities.

FACED WITH THE TERRIBLE MORTALITY OF THE EPIDEMICS DURING THE LAST YEARS OF THE MING DYNASTY: (1368-1644) AND THE INEFFICACY OF THE TREATMENTS APPLIED, WU YOUXING: (ca 1580-1660), the author of the Wenyilun (Treatise on warm factor epidemics), completed in 1642, proposed a new etiological explanation of these diseases, with a highly critical attitude towards his predecessors. Reception to the book was mixed; it sometimes encountered opposition due to the audacity of some of Wu Youxing's conceptions, but also, most likely, to the discrepancy between the author's assertions and the failures in actual application.

René Nicolas Dufriche Desgenettes (1762-1837) became famous through two historical events: the first and most famous one is where he proved his courage by inoculating himself with the plague during the Syrian campaign in 1799; the second one, rarely represented in paintings, happened during the Russian retreat in 1812 when he was freed thanks to his reputation. Two wide fresco paintings facing each other in the hall of Desgenettes, a hospital built during World War Two, are witnesses of these two major events. Jean Coquet (1907-1990), a decorator, painter and glassblower, who worked at the Beaux-Arts School of Lyon, first as a decoration teacher than as its director, painted these two works of art. In 1946, he inserted them into an ornamental group constituted of ironworks, furniture, stained glass and ceramics. Two paintings from Antoine-Jean Gros (1771-1835) inspired these works: Bonaparte visiting the plague-stricken of Jaffa (1804) and Napoleon on the battlefield of Eylau (1808). With their academic composition and daring stylization those two frescoes represent in a modern and original way Desgenettes' life style, an archetype of what the military doctor is.

Many infectious diseases were described in North Africa in 18th-19th centuries by European travellers. Most of them were allegedly imported by new migrant populations coming from sub-Saharan, European or Middle East countries. Plague outbreaks have been described since the Black Death as diseases of the Mediterranean harbours. Charles Nicolle and his collaborators at the Pasteur Institute were witnesses to the extinction of plague and typhus fever in Tunisia. Both could be considered as endemo-epidemic diseases propagated by ancient nomad communities for centuries. Typhus was exported to other countries; plague was imported by Mediterranean travellers but also hid in unknown wild-animal reservoirs. The role of the bite of a rat's flea was not confirmed and the pneumonic form might have prevailed in the medieval North African cities. Association between plague, typhus, flu and other causes of immune deficiencies could explain the high morbidity and mortality caused by plague in the past. The authors comment the local history of plague at the light of the evolutionary laws of infectious disease proposed by Charles Nicolle in 1930.

The reappearance of the plague in the 19th century, in what is generally referred to as the third pandemic, brought back painful memories of the great plague outbreaks of the past that had killed tens of millions of people. At the same time, this new pandemic opened the era of great discoveries, such as identification of the Yersinia pestis bacterium, of transmission vectors and the first effective treatments. With these advances it became possible to control a disease which had, because of progress in maritime transport, spread almost throughout the world.

The paper studies the great epidemics that have affected Europe from the middle ages until the 20th century. A special emphasis is put on in the mortality of the Black Death in 1348 (500 per thousand), the smallpox in the 18th century (150 per thousand), the spotted fever in the end of the 18th century (50 per thousand), the cholera pandemic in the 19th century (25.5 - 62.7 per thousand), the tuberculosis in the end of the 19th century (5.3 per thousand) and the mortality that the Spanish influenza produced in the beginnings of the 20th century (12.1 per thousand) in the Basque Country.

Between the years 1346 and 1353, a terrible epidemic swept over Western Asia, the Middle East, Africa, and Europe, causing catastrophic losses of population everywhere, both in the rural areas and in towns and cities. The Black Death was a disease of such magnitude that it not only shook the Old World to its economic and social foundations but changed the course of human history. The authors considered and analyzed many studies on the Black Death published in different languages. In the present paper they report medical and epidemiological specificities of the pandemic as well as its geographical origins and the routes of its spread.

A rapid diagnostic dipstick test (RDT) that detects Yersinia pestis F1 antigen has been recently applied on 18 putative plague victims exhumed from four archaeological burial sites in southeastern France dating back to the 16(th), 17(th) and 18(th) centuries. The Y. pestis antigen F1 was detected in 12 ancient samples out of 18 (67%). Negative controls confirmed their negativity (100%). Our results emphasize that the detection threshold of the RDT for plague (0.5 ng/ml) is sufficient for a first retrospective diagnosis of Y. pestis infection in ancient remains, and confirm the high specificity and sensitivity of the assay. Double-blind analyses performed by using two different techniques (RDT and 'suicide PCR') led us to the identification of the Y. pestis F1 antigen and the Y. pestis pla and gplD genes. These data provide clear evidence of the presence of Y. pestis in the examined specimens.

Before the Second World War, the plague was still rife in North Africa but occurred only as sporadic cases or small outbreaks as in Egypt or Morocco. The permanent foci of infected wild rodent were the cause of these rural outbreaks. In 1943 and 1944, plague came back in several Mediterranean towns and ports and was considered as a serious danger for the Allied Forces. These resurgences were related to the World War as well as the overpopulation of the cities, regroupings and population movements, relaxation of prophylactic measures of the plague in sea transport. The Allied Forces medical officers then showed the resistance of Yersinia pestis to penicillin which they had been supplied with recently, the effectiveness of sulphamides but mortality remained high (27%). In parallel, the drastic fight against rodents and fleas (DDT) gave excellent results.

The foundations of local health services in Madagascar were laid when the island was taken over by the French in 1896. Medical care was a major priority for the first colonial governor named General Galliéni. Local health services expanded greatly from 1896 to 1950 thanks notably to institutions such as the Tananarive Medical School and Pasteur Institute. These services played a crucial role in the fight against smallpox and bubonic plague. However they were also used for political purposes by both colonial and independent governments. In sum the history of local health services in Madagascar can be described as a battle between political power and scientific knowledge. The overall result is positive for some and controversial for others.

In 1721, when Geneva is threatened by a terrible epidemic devastating the south of France, the physician Jean-Jaques Manget states that "The Magistrates must establish a good Policy in time of plague"; and asks himself how it is possible to carry on "without good Regulations?". The State Archives of Geneva hold a draft consisting of 72 articles concerning health policy meant to be applied in case of plague. This is a remarkable document that enables an overview of the city's organisation in times of plague; it also allows to analyse some of the medical and sanitary theories this organisation is based on.

Ten flea species are reported in anthropic zones of Vietnam. Xenopsylla vexabilis is also here included because of it has been involved in others plague's countries. Lentistivalius klossi is the only selvatic flea known as parasite of synanthropic rats. L. klossi bispiniformis (Li and Wang, 1958), first describe from Chinese specimens, is here synonymized (syn. nov.) with the nominal subspecies.

It is known that plague epidemics and pandemics spread both by sea and by land. However, in the 16th century an entire "hidden face" of the continent was discovered and opened thanks to the Portuguese. It is noteworthy that just as Francis I or the Dutch, Yersinia pestis did not respect the longitudinal limits set out by the treaties of Tordessillas and Saragossa. Even before the arrival of Vasco de Gama in Goa and all the way to the settling of the Moluques in Macao, Canton and Kagoshima, one can follow the progression of at least ten or so epidemics against a general epidemic back drop, thanks especially to the works of Jose de Vasconcellos e Menezes as well as some others. Scurvy was, as far as plague was concerned, a regulating factor, at least to a certain extent.

Paul-Louis Simond was born on 30 July 1858 in the Drôme region of France and completed his medical degree in Bordeaux, having sojourned in Guyana. His professional career led him to serve in the military by representing the Paris Pasteur Institute in the Far East, Brazil, and Turkey. He was one of the founders of the Pharo School of Tropical Medicine in Marseille and he finished his career as head of the Health Service in Indochina. He died in 1947, in Valence, after a long period of retirement, which he devoted to social work in his hometown. His research covered numerous aspects of tropical pathology and public health. His studies of yellow fever and plague in particular were major landmarks. In 1898 he discovered and demonstrated the means of transmission of bubonic plague--a discovery which took time to be acknowledged and thus deprived him of the notoriety he deserved. By demonstrating the dependency of a human disease with regard to an onzooty, Simond opened the way to the concept of anthropozoonose and made a remarkable contribution to the epidemiological study of diseases transmitted by insects. P.L. Simond had an exceptionally rich personality. Besides being a rigorous Pasteurian, a military official endowed with important responsibilities, he was an enlightened amateur and a passionate naturalist. He was also a true humanist and his writings reveal a man loyal to his cause, a man of exceptional lucidity and rare serenity. Such qualities give him and his work a very special quality.

The impact of the three historic plague pandemics will remain engraved forever in the collective memory. During the first half of the XXth century, the development of vaccines inducing protection against bubonic plague, the first production of antibiotics, insecticides and raticides, could have lead some people to think that eradication was possible. But according to the data of epidemiological surveillance, far from disappearing, plague is remaining or so increasing that it is considered, in some places, as a reemerging disease. Yersinia pestis is highly variable, and a multidrug resistant strain has been isolated in 1995 in the Ambalavo district of Madagascar. This high-level of resistance includes the drugs recommended for plague prophylaxis and therapy, and this observation pointed the fact that Yersinia pestis is able to acquire the plasmid carrying the resistance genes, under natural conditions. Consequently, it is not unreasonable to think that clinically ominous events could occur again. Moreover, currently available vaccines do not induce protection against the pneumonic form of plague, and are reactogenic. Lastly, according to some accurate sources, one cannot turn down the assumption of a genetically engineered strain of Yersinia pestis used as a biological weapon by a terrorist organization. So, the surveillance of plague remains a topical activity, as the development of none reactogenic live and/or inactivated new vaccines, inducing protection against the pneumonic form of the disease.