the bubonic plague essay

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Black Death

By: History.com Editors

Updated: March 28, 2023 | Original: September 17, 2010

The Black Death was a devastating global epidemic of bubonic plague that struck Europe and Asia in the mid-1300s. The plague arrived in Europe in October 1347, when 12 ships from the Black Sea docked at the Sicilian port of Messina. People gathered on the docks were met with a horrifying surprise: Most sailors aboard the ships were dead, and those still alive were gravely ill and covered in black boils that oozed blood and pus. Sicilian authorities hastily ordered the fleet of “death ships” out of the harbor, but it was too late: Over the next five years, the Black Death would kill more than 20 million people in Europe—almost one-third of the continent’s population.

How Did the Black Plague Start?

Even before the “death ships” pulled into port at Messina, many Europeans had heard rumors about a “Great Pestilence” that was carving a deadly path across the trade routes of the Near and Far East. Indeed, in the early 1340s, the disease had struck China, India, Persia, Syria and Egypt.

The plague is thought to have originated in Asia over 2,000 years ago and was likely spread by trading ships , though recent research has indicated the pathogen responsible for the Black Death may have existed in Europe as early as 3000 B.C.

Symptoms of the Black Plague

Europeans were scarcely equipped for the horrible reality of the Black Death. “In men and women alike,” the Italian poet Giovanni Boccaccio wrote, “at the beginning of the malady, certain swellings, either on the groin or under the armpits…waxed to the bigness of a common apple, others to the size of an egg, some more and some less, and these the vulgar named plague-boils.”

Blood and pus seeped out of these strange swellings, which were followed by a host of other unpleasant symptoms—fever, chills, vomiting, diarrhea, terrible aches and pains—and then, in short order, death.

The Bubonic Plague attacks the lymphatic system, causing swelling in the lymph nodes. If untreated, the infection can spread to the blood or lungs.

How Did the Black Death Spread?

The Black Death was terrifyingly, indiscriminately contagious: “the mere touching of the clothes,” wrote Boccaccio, “appeared to itself to communicate the malady to the toucher.” The disease was also terrifyingly efficient. People who were perfectly healthy when they went to bed at night could be dead by morning.

Did you know? Many scholars think that the nursery rhyme “Ring around the Rosy” was written about the symptoms of the Black Death.

Understanding the Black Death

Today, scientists understand that the Black Death, now known as the plague, is spread by a bacillus called Yersinia  pestis . (The French biologist Alexandre Yersin discovered this germ at the end of the 19th century.)

They know that the bacillus travels from person to person through the air , as well as through the bite of infected fleas and rats. Both of these pests could be found almost everywhere in medieval Europe, but they were particularly at home aboard ships of all kinds—which is how the deadly plague made its way through one European port city after another.

Not long after it struck Messina, the Black Death spread to the port of Marseilles in France and the port of Tunis in North Africa. Then it reached Rome and Florence, two cities at the center of an elaborate web of trade routes. By the middle of 1348, the Black Death had struck Paris, Bordeaux, Lyon and London.

Today, this grim sequence of events is terrifying but comprehensible. In the middle of the 14th century, however, there seemed to be no rational explanation for it.

No one knew exactly how the Black Death was transmitted from one patient to another, and no one knew how to prevent or treat it. According to one doctor, for example, “instantaneous death occurs when the aerial spirit escaping from the eyes of the sick man strikes the healthy person standing near and looking at the sick.”

How Do You Treat the Black Death?

Physicians relied on crude and unsophisticated techniques such as bloodletting and boil-lancing (practices that were dangerous as well as unsanitary) and superstitious practices such as burning aromatic herbs and bathing in rosewater or vinegar.

Meanwhile, in a panic, healthy people did all they could to avoid the sick. Doctors refused to see patients; priests refused to administer last rites; and shopkeepers closed their stores. Many people fled the cities for the countryside, but even there they could not escape the disease: It affected cows, sheep, goats, pigs and chickens as well as people.

In fact, so many sheep died that one of the consequences of the Black Death was a European wool shortage. And many people, desperate to save themselves, even abandoned their sick and dying loved ones. “Thus doing,” Boccaccio wrote, “each thought to secure immunity for himself.”

Black Plague: God’s Punishment?

Because they did not understand the biology of the disease, many people believed that the Black Death was a kind of divine punishment—retribution for sins against God such as greed, blasphemy, heresy, fornication and worldliness.

By this logic, the only way to overcome the plague was to win God’s forgiveness. Some people believed that the way to do this was to purge their communities of heretics and other troublemakers—so, for example, many thousands of Jews were massacred in 1348 and 1349. (Thousands more fled to the sparsely populated regions of Eastern Europe, where they could be relatively safe from the rampaging mobs in the cities.)

Some people coped with the terror and uncertainty of the Black Death epidemic by lashing out at their neighbors; others coped by turning inward and fretting about the condition of their own souls.

Flagellants

Some upper-class men joined processions of flagellants that traveled from town to town and engaged in public displays of penance and punishment: They would beat themselves and one another with heavy leather straps studded with sharp pieces of metal while the townspeople looked on. For 33 1/2 days, the flagellants repeated this ritual three times a day. Then they would move on to the next town and begin the process over again.

Though the flagellant movement did provide some comfort to people who felt powerless in the face of inexplicable tragedy, it soon began to worry the Pope, whose authority the flagellants had begun to usurp. In the face of this papal resistance, the movement disintegrated.

How Did the Black Death End?

The plague never really ended and it returned with a vengeance years later. But officials in the port city of Ragusa were able to slow its spread by keeping arriving sailors in isolation until it was clear they were not carrying the disease—creating social distancing that relied on isolation to slow the spread of the disease.

The sailors were initially held on their ships for 30 days (a trentino ), a period that was later increased to 40 days, or a quarantine — the origin of the term “quarantine” and a practice still used today. 

Does the Black Plague Still Exist?

The Black Death epidemic had run its course by the early 1350s, but the plague reappeared every few generations for centuries. Modern sanitation and public-health practices have greatly mitigated the impact of the disease but have not eliminated it. While antibiotics are available to treat the Black Death, according to The World Health Organization, there are still 1,000 to 3,000 cases of plague every year.

Gallery: Pandemics That Changed History

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Impact of the Black Death Essay

Introduction, social impacts of the black death, economic impacts of the black death, political impacts of the black death, reference list.

The Black Death was, no doubt, the greatest population disaster that has ever occurred in the history of Europe. The name is given to the bubonic plaque that occurred in the fourteenth century in Europe killing millions of people. The plaque began in the year 1348, and by the year 1359, it had killed an approximate 1.5 million people, out of an estimated total population of about 4 million people.

So terrifying was the Black Death that peasants were blaming themselves for its occurrence, and thus some of them resulted to punishing themselves as a way of seeking God’s forgiveness. The bubonic plaque was caused by fleas that were hosted by rats, a common phenomenon in the cities and towns. The presence of rats in the cities and towns was due to the fact that the towns were littered, and they were poorly managed.

The worst part of it is the fact that the medieval peasants did not know that the plaque was caused by the pleas hosted by the rats. They actually believed that the plague was caused by the rats themselves. As more and more people died from the Black Death, the impacts of the plague became more profound.

The plague affected the demographic composition of the society, and thus it had far-reaching effects on the social, economic, political and even cultural realms of the medieval society. To this day, the Black Death is remembered as the worst demographic disaster to be ever experienced in European history (Robin, 2011). This paper is an in-depth analysis of the impacts of the Black Death.

The Black Death had far reaching social impacts on the people who lived during the fourteenth century. An obvious social impact of the plague is the fact that the Black Death led to a significant reduction in the human population of the affected areas. This had extensive effects on all aspects of life, including the social and political structure of the affected areas.

Before the plague, feudalism, the European social structure in medieval times, had created a society in which inequality was rife, with many poor peasants, and rich lords. This fuelled overpopulation, which was a catalyst for the mortality of the plaque. After the plaque, a large number of the overpopulated peasants became victims of the plaque, and thus the lords lacked labourers in their farms. This also led to a significant reduction in the population (Bryrne, 2011).

The people who were spared by the plague lived full lives. They regarded themselves as the next victims of the bubonic plague. This led to immoral behaviour that saw societal codes like the sexual codes broken. People did not care about having virtues anymore because they knew that death was approaching fast. As people lost their partners to the plague, the marriage market grew, fuelling more sexual immorality (Carol, 1996).

Also among the immediate social impacts is the fact that at one point, the number of people who were dying from the bubonic plague was seemingly more than the number of the living. This made it virtually impossible for the living to take care of the ailing, or even for the living to bury the deceased. This was a social crisis that has remained in the books of history as a remarkable impact of the bubonic plague.

Immediately after the occurrence of the Black Death, all economic activities were paralysed. The first economic activity to suffer substantially from the plaque was trade. Although people were not aware that it was the infectiousness of the plaque that was making it to kill more people, they were afraid to travel to plagued areas for fear of coming into contact with rats, which they believed was the source of the disease. This substantially affected trade ties between villages and communities in the medieval European society.

After the occurrence of the Black Death, other impacts of the plague started affecting the community. The population of the European parts affected by the plaque reduced drastically, leading to a severe shortage of labour for the farms. The demand of peasant farmers increased, with the lords competing for them by relocating them from their villages to the farms of the latter. This made the peasants have a competitive economic edge, as they were able to negotiate for better salaries.

As the Black Death claimed more lives, farms were left unattended because the peasants who were responsible for ploughing had fallen victims of the plague. Where the lords were lucky to have had some harvest, it was challenging to bring it home due to a serious shortage of manpower.

Some harvest got destroyed in the field as there were no men to bring it home. Some animals got lost because the people who used to look after them had also fallen victims of the plague. These problems led to a number of other impacts in the medieval society of the fourteenth century (Bridbury, 1973).

As farms went unploughed and some harvest remained in the fields, people in the villages starved for food. Cities and towns also faced severe shortages of food since the farming villages around the towns did not have sufficient foodstuffs. Lords had to strategize economically in order to survive, and thus most of them resulted to keeping sheep since it was easier without the manpower.

Economic activities that required the presence of large numbers of peasants like the farming of grains lost their popularity. This, in turn, led to serious shortage of basic commodities like bread. This, coupled with the fact that the production of all kinds of foodstuffs had decreases, led to inflationary prices on commodities (“The Black Death And Its Effects”, 1935). The poor were left thriving in an environment full of hardships as the prices of foods skyrocketed.

The Black Death had a number of political impacts. First of all, the feudal social system of the fourteen-century European population demanded that peasants could not relocate from their villages at will. For a peasant to relocate from his/her village, he/she had to seek the permission of his/her lord.

After the Black Death, it became increasingly difficult for lords to get the number of peasants they required to provide them with the labour for their farms. This made lords to disregard the law, and relocate peasants to their villages so that they could work in their farms. Most of the times, the lords even declined to return the latter to their rightful villages in a bid to get maximum benefit from their labour.

Another political impact of the Black Death also stems from the reduced population of the affected areas. This is because after the number of peasants reduced, and they were able to negotiate salaries and even relocate from their villages, contrary to feudal law, the government imposed stricter rules to regulate the way peasants offer their manpower to the lords.

This was done by the introduction of the 1351 “statute for labourers” (Bridbury, 1973). The statute provided that payments to peasants were to be made with reference to the payments that were made in 1346. This meant that peasants would receive payments using the terms that were prevailing before the plague occurred.

The statute was structures such that both the lord and the peasant could be accused of breaking the law by either the peasant receiving a higher payment, or the lord giving the same. The effect of this statute was that a good number of peasants disobeyed it, leading to, arguably inhumane punishment. This fuelled revolt among the peasants who sought to fight for their rights in the 1381 Peasants Revolt (Bentley et al., 2008).

After oppressive statutes like the statute for labourers came into force, peasants started to be resistant. They therefore organized a number of revolts in a bid to attract the attention of legislators to their plea of fairness. The most serious of these revolts was the aforementioned 1381 peasant revolt. The peasants had gathered in huge numbers and marched to London. They killed senior officials of the King and took control over the tower of London.

Among their main grievances was the fact that, thirty-five years after the occurrence of the Black Death, the population had reasonably grown and the pre-existent demand for labour had substantially reduced. The lords were therefore threatening to withdraw the privileges they had given to peasants since their demand was no more. This led to the revolt as the peasants sought to fight for their privileges.

From the discussion above, it is evident that the Black Death had a lot of impacts on the European medieval society. It changed the demographic set-up of the community and thus it substantially affected the social activities of the peasants. This can be evidenced by the aforementioned increase in cases of sexual immorality as people had lost their partners in the plague.

The Black Death also had a number of economic impacts which resulted from the drastic decrease in the population of peasants. This can be evidenced by the aforementioned change by lords from grain farming to sheep farming. Lastly, the Black Death had a number of political impacts which can be exemplified by the development of the aforementioned statute for labourers.

Studies of the impacts of the bubonic plague are still ongoing. This is despite the fact that most of the impacts were realized immediately after the plague and their effects on the society analyzed. Political activists during the time, who were mostly lords, had observed the effects of the plague and made societal changes that were bound to benefit them.

However, scientists still believe that the European society still suffers significant effects of the bubonic plague. For instance, it has been established that England, where the greatest effects of the bubonic plague were perhaps felt, has significantly lower genetic diversity than it is suspected to have had in the eleventh century. Geneticists explain this by the argument that the deaths that resulted from the Black Deaths were the cause of the low genetic variation in Europe.

Bentley, Jerry H., Ziegler, Herbert F., Streets, Heather E. (2008) Traditions and

Encounters: A Brief Global History, ch9,15,19, McGraw-Hill, Inc.

Bridbury, A. (1973). The Black Death. The Economic History Review, 26: 577 – 592.

Bryrne, J. (2011). Black Death. World Book Advanced. Web.

Carol, B. (1996). Bubonic Plague in the nineteenth-century China.

Robin, N. (2011). Apocalypse Then: A History of Plague. Special Report. World Book Advanced. Web.

The Black Death And Its Effects. (1935). Readings in English History Drawn from the Original Sources: Intended to Illustrate a Short History of England. Boston: Ginn.

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IvyPanda. (2019, October 29). Impact of the Black Death. https://ivypanda.com/essays/impact-of-the-black-death/

"Impact of the Black Death." IvyPanda , 29 Oct. 2019, ivypanda.com/essays/impact-of-the-black-death/.

IvyPanda . (2019) 'Impact of the Black Death'. 29 October.

IvyPanda . 2019. "Impact of the Black Death." October 29, 2019. https://ivypanda.com/essays/impact-of-the-black-death/.

1. IvyPanda . "Impact of the Black Death." October 29, 2019. https://ivypanda.com/essays/impact-of-the-black-death/.

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History of the Plague: An Ancient Pandemic for the Age of COVID-19

During the fourteenth century, the bubonic plague or Black Death killed more than one third of Europe or 25 million people. Those afflicted died quickly and horribly from an unseen menace, spiking high fevers with suppurative buboes (swellings). Its causative agent is Yersinia pestis , creating recurrent plague cycles from the Bronze Age into modern-day California and Mongolia. Plague remains endemic in Madagascar, Congo, and Peru. This history of medicine review highlights plague events across the centuries. Transmission is by fleas carried on rats, although new theories include via human body lice and infected grain. We discuss symptomatology and treatment options. Pneumonic plague can be weaponized for bioterrorism, highlighting the importance of understanding its clinical syndromes. Carriers of recessive familial Mediterranean fever (FMF) mutations have natural immunity against Y. pestis . During the Black Death, Jews were blamed for the bubonic plague, perhaps because Jews carried FMF mutations and died at lower plague rates than Christians. Blaming minorities for epidemics echoes across history into our current coronavirus pandemic and provides insightful lessons for managing and improving its outcomes.

Clinical Significance

• • The Black Death or bubonic plague killed more than 25 million people in fourteenth-century Europe.
• • Yersinia pestis (the plague bacteria) can be easily weaponized as a bioterrorism agent.
• • Early plague treatment is curative, but its symptomatology can be nonspecific. Modern outbreaks still regularly occur. The plague existed in the ancient world and has killed more than 200 million across centuries.
• • Familial Mediterranean fever carriers have plague immunity, which is an important evolutionary adaptation.

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Introduction

Killing more than 25 million people or at least one third of Europe's population during the fourteenth century, the Black Death or bubonic plague was one of mankind's worst pandemics, invoking direct comparisons to our current coronavirus “modern plague.” 1 , 2 , 3 An ancient disease, its bacterial agent ( Yersinia pestis ) still causes periodic outbreaks and remains endemic in some parts of the world. 4 , 5 , 6 Additionally, because it could be weaponized for world bioterrorism, understanding its clinical syndromes, epidemiology, and treatment options remains critical for medical practitioners. 5 , 6 Finally, recent molecular discoveries linking recessive familial Mediterranean fever mutations to plague immunity have revolutionized how scientists and historians alike view this novel evolutionary adaptation. 7 , 8 This history of medicine article sheds light onto the plague and provides insights that can help us manage the COVID-19 epidemic.

History of Plague Epidemics

The plague has afflicted humanity for thousands of years. 1 , 2 , 3 Molecular studies identified the presence of the Y. pestis plague DNA genome in 2 Bronze Age skeletons dated at roughly 3800 years old. 9 In the biblical book 1 Samuel from approximately 1000 BCE, the Philistines experience an outbreak of tumors associated with rodents, which might have been bubonic plague. 3 Scholars identify 3 plague pandemics. 10 , 11 The first pandemic or Justinian plague probably came from India and reached Constantinople in 541-542 CE. At least 18 waves of plague spread across the Mediterranean basin into distant areas like Persia and Ireland from 541 to 750 CE. 10 , 11

The second pandemic or Black Death arrived in Messina in Sicily, probably from Central Asia via Genoese ships carrying flea-laden rats in October 1347, which initiated a wave of plague infections that rapidly spread across most of Europe like a relentless wildfire. 10 , 11 , 12 In Europe, plague-stricken citizens were often dead within a week of contracting the illness. Ultimately, at least one third of the European population (more than 25 million people) died between 1347 and 1352 from the Black Death. 10 , 11 , 12 The plague spread to France and Spain in 1348 and then to Germany, Switzerland, and Austria. It decimated London in 1349 and reached Scandinavia and northern England by 1350. 10 , 11 , 12 The plague died out by the century's end, but outbreaks resurfaced and spread throughout Europe over the next 400 years. In 1656-1657, two thirds of the population in Naples and Genoa died from the disease. In 1665-1666, London lost about one quarter of its citizens to plague, about 100,000, and the same number died in Vienna in 1679. 3 , 13 , 14 Moscow recorded more than 100,000 plague deaths during 1770-1771. 3 , 13 , 14

The fourteenth-century bubonic plague transformed European society and economies, leading to severe labor shortages in farming and skilled crafts. 1 , 2 , 3 The geopolitical impact included a decline in power and international status of the Italian states. 15 During the Black Death, European Christians blamed their Jewish neighbors for the plague, claiming Jews were poisoning the wells. These beliefs led to massacres and violence. 2 , 16 At least 235 Jewish communities experienced mass persecution and destruction during this period, often preemptively in a futile effort at plague containment. 16 The ancient physicians Hippocrates (c. 460-c. 370 BCE) and Galen (129-c. 210 CE) promoted the miasma theory, or poisoned air, to explain disease transmission, which Medieval Europeans believed caused the Black Death. 11 , 17 People of that period thought warm baths permitted plague miasma to enter humans’ pores, so public baths were closed. Victims’ clothes and possessions were thought contaminated and were burned, and cats were killed as possible transmission agents. So-called “plague doctors” wore protective clothing with a long cape, mask, and a bill-like portion over the mouth and nose containing aromatic substances (partly to block out the putrid smell of decaying corpses), perhaps an early version of the modern hazmat suit 10 ( Figure 1 ).

Costume of the plague doctor. The plague doctor wore a black hat, beaked white mask, which contained aromatic substances to block out the smell of decaying bodies, and a waxed gown. The rod or pointer kept afflicted patients away. The earliest version of a protective hazmat suit. Courtesy National Library of Medicine.

The third plague pandemic began in Yunnan Province in southwest China around 1855, where outbreaks had occurred since 1772, and spread to Taiwan. 10 , 11 , 18 It hit Canton in 1894, where it caused 70,000 deaths, and then appeared in Hong Kong. Ships carried it to Japan, India, Australia, and North and South America between 1910 and 1920. 10 , 11 , 18 An estimated 12 million people died from the plague in India between 1898 and 1918. 19 Rats from merchant ships brought the plague to Chinatown in San Francisco in 1900. 20 Although few European cases of the plague were reported after 1950, isolated outbreaks still occur worldwide. 4 , 20 It is estimated that more than 200 million people have died from the plague throughout human history. 10

Plague Microbiology

Y. pestis is an aerobic, gram-negative coccobacillus in the family Enterobacteriaceae . 21 , 22 , 23 Genetic DNA analysis shows that it diverged from its enteric pathogenic relative, Yersinia pseudotuberculosis , up to 6000 years ago. 24 After incubation for 24 to 48 hours in blood or on MacConkey agar at 37°C, small bacterial colonies can be identified. 21 , 22 , 23 Its primary vector for transmission is the Xenopsylla cheopis flea, although roughly 80 species of fleas can carry it. During the Black Death, the flea was transported by the black rat or Rattus . 21 , 22 , 23 A controversial new theory argues that ectoparasites such as human fleas and lice also spread the disease during the second plague pandemic. 25 Fleas can also survive in infected clothing or grain. 11 , 19 , 20 , 21 The bacteria multiply in infected rodents (more than 280 mammalian species can serve as carriers) and block the fleas’ alimentary canal, causing the fleas to regurgitate the Y. pestis bacteria into its animal host. 11 , 19 , 20 , 21 The bacterium is named for the Pasteur Institute physician Alexandre Yersin, who provided the first, most accurate description of its causative agent in 1894 during the Hong Kong outbreak. However, the Japanese physician Shibasaburo Kitasato was an independent coinvestigator whose bacterial plates were unfortunately contaminated and led to erroneous observations. 19 In 1898, Dr. Paul-Louis Simond in Karachi showed that fleas from infected rats could transmit the disease to healthy rats, and Ricardo Jorge in 1927 reported that wild rodents serve as a plague reservoir. 10

Clinical Presentation, Treatment, and Prophylaxis

There are 3 major clinical forms of the plague. 10 , 21 , 22 , 23 In the most common bubonic subtype, infected persons develop sudden onset of high fevers (>39.4°C), terrible pains in their limbs and abdomen, and headaches generally between 3 and 7 days after exposure. The bacteria reproduce rapidly in lymph nodes located closest to the flea bites, leading to painful swellings (“buboes”) in the groin, cervical, or axillary lymph nodes, which can enlarge to the size of an egg (or up to 10 cm) ( Figure 2 ) 12 . About 60% of untreated victims die within 1 week of exposure as the pus-filled buboes suppurate and the patient succumbs to overwhelming infection. 10 , 21 , 22 , 23 During the time of the Black Death, it must have been truly terrifying to witness otherwise healthy individuals cut down rapidly by a seemingly invisible demon. The rarer septicemic plague form (10%-15% of cases) occurs when the bacteria multiply in the blood, often triggering disseminated intravascular coagulation and gangrene of the extremities, ears, or nose 10 , 21 , 22 , 23 ( Figure 3 ). Finally, the infrequent, fulminant pneumonic plague syndrome represents the only form with human-to-human transmission as inhalation of aerosolized droplets (much like coronavirus transmission) from infected patients or even cats leads rapidly to hemoptysis and death. Because this clinical subtype is specifically aerosolized, pneumonic plague could be used for potential bioterrorist attacks. 5 , 6 , 26 Its initially nonspecific, flu-like symptoms include sudden onset of high fevers and dyspnea within 4 days of plague exposure, progressing quickly to a purulent, frothy, or ultimately bloody cough. 21 , 22 , 23 Chest X-ray for primary pneumonic plague may show lobar pneumonia, which spreads rapidly throughout the lungs. The blood-tinged sputum is highly infectious. 21 , 22 , 23 The latter 2 clinical subtypes are invariably fatal without treatment.

Buboes (swellings). Cervical buboes in a patient with bubonic plague from Madagascar. From Prentice MB, Rahalison L. Plague. Lancet . 2007;369:1196-1207. doi: 10.1016/S0140-6736(07)60566-2. Copyright Elsevier 2007.

Gangrene from plague sepsis. A man from Oregon developed bubonic plague after being bitten by an infected cat, leading to sepsis and acral amputation. Courtesy Centers for Disease Control and Prevention.

Plague transmission is generally from infected fleas by rodent vectors or, rarely, in clothing or grain but may also occur through ingesting contaminated animals, physical contact with infected victims, or direct inhalation of infectious respiratory droplets. 21 , 22 , 23 Early recognition and treatment with streptomycin (or gentamycin) or a combination of doxycycline, ciprofloxacin, and chloramphenicol can cure the bubonic plague. 21 , 22 , 23 One study compared the plague fatality rate in the United States from 1900-1942 (before antibiotics were available) at 66% compared with cases after 1942 and the advent of antibiotic treatments with a death rate of only 13%. 20 Prompt identification of plague infections and the introduction of appropriate antibiotics will generally lead to a full recovery, but because its initial symptoms may include a nonspecific fever and often no clear exposure to infected animals or fleas can be identified, diagnosis may be delayed, leading to death. The gold standard for diagnosis is isolation of the bacteria from tissue or body fluids, which should only be done in a biosafety level 3 laboratory, although confirmatory serologic testing for antibodies to the F1 antigen may also be performed. 21 , 22 , 23 Empiric chemoprophylaxis with oral doxycycline or ciprofloxacin for 7 days is recommended for family members or others in close contact to victims of plague. 21 , 22 , 23 , 27 There was a whole-cell, formalin-killed vaccine, but it was discontinued because it was only protective against bubonic plague. Efforts continue to produce a vaccine effective against the rare pneumonic plague subtype, which potentially could be used for biowarfare. 5 , 6

Modern Plague Outbreaks

More than just a historical oddity, plague outbreaks continue to surface and cause occasional deaths throughout the world. 4 , 20 Plague reservoirs exist in animal hosts, including wild squirrels, rats, prairie dogs, marmots, gophers, and other rodents; cats can become infected and transmit Y. pestis via aerosolized droplets. 10 , 21 , 22 , 23 An outbreak hit Los Angeles in 1924, killing 30 people, when a man contracted the disease and died after handling a dead rat. A Catholic priest administering last rites to victims and mourners attending associated funerals all also died of pneumonic plague. 28 The “telluric hypothesis” proposes that plague bacteria can survive in soil and not simply on rodents, which may explain why plague foci persist despite aggressive efforts to eradicate its hosts. 11 One recent analysis reported that Madagascar, Congo, and Peru remain the most plague-endemic countries. 5 Indeed, between 2010 and 2015, there were 3248 cases and 584 plague deaths worldwide, with the majority (75%) being in Madagascar. 5 Plague eruptions can disrupt production in modern economies, just as it did in the Middle Ages. In 2005, 130 men working in a diamond mine in Congo contracted plague, causing 57 deaths. Similarly, 162 workers were sickened in 2006 at a gold mine in Congo, leading to 45 deaths and temporarily shutting down these operations. 23 The World Health Organization (WHO) has deemed plague to be a reemerging disease since the 1990s. 5 Two unrelated teens contracted plague in separate incidents in August 2015 while visiting Yosemite National Park in California, apparently from infected squirrels, although local bears also demonstrated antibodies against Y. pestis . 29 Indeed, a healthy 15-year old boy died in July 2020 from plague in Mongolia after eating an infected marmot (similar to a large ground squirrel), and Mongolia has had almost 600 cases of marmot plague since 1928, with an associated mortality rate of 74%. 5 , 30

Systematic attempts to destroy plague reservoirs largely failed. For decades until 1991, the Union of Soviet Socialist Republics (USSR) launched an impressive, aggressive plague-eradication program. Poisons were placed manually into thousands of rodent burrows, pesticides like DDT were widely deployed to kill plague hosts, and potential mammalian carriers were destroyed. 26 Although such laborious efforts decreased cases, the plague was never fully eliminated. The potential toxicity to humans and the native ecosystem from insecticides promoted a shift toward vector control (not eradication) and epidemiological sampling to monitor the presence of Y. pestis in local rodent populations. 4 , 5 , 6 , 26 Current programs balance ongoing surveillance among plague vectors with protecting the natural environment as a multipronged approach toward plague containment. 4 , 5 , 6 , 26

Plague and Bioterrorism

The Centers for Disease Control and Prevention (CDC) classifies Y. pestis as a Category A (tier 1) biologic agent for potential bioterrorism. 5 It can be released and spread easily, which creates a major public health hazard and could lead to quarantines and potentially widespread economic devastation. 5 , 6 Pneumonic plague leads to death rapidly without prompt recognition and treatment. Its initial nonspecific symptomatology of flu-like illness coupled with a mistaken perception that plague is simply an obscure, dormant disease make it an ideal weapon for biowarfare. 5 , 6 Indeed, Tatars leveraged its lethality in 1346 by catapulting plague-ridden corpses into the Genoese-controlled seaport of Caffa, in one of the first uses of biological agents to wage war. 3 The Imperial Japanese Unit 731 during World War II developed and deployed biological weapons in Manchuria and China. On October 27, 1940, Japanese warplanes dropped plague-contaminated rice and fleas into Chuhsien, China, which led to an outbreak of pneumonic plague. 3 , 5 , 6 The World Health Organization estimates that if only 50 kg of Y. pestis were released in aerosolized form over a major city, the deadly pneumonic plague subtype could cause widespread devastation and death. The bacteria remain viable for up to 1 hour at a distance of up to 10 km from the drop point. 5 , 6 Because a main goal of bioterrorism would be to incite fear among its population, plague is an ideal biological tool because its victims die quickly in a horrific fashion (with hemoptysis, respiratory failure, high fevers, and the like).

Familial Mediterranean Fever and Y. Pestis

Molecular advances have linked familial Mediterranean fever (FMF) gene mutations to plague immunity. 7 , 31 , 32 , 33 , 34 FMF is a rare, recessive disease mostly seen in people of Arab, Armenian, Jewish, or Turkish ancestry. Symptoms of FMF include abdominal pain, arthritis, and fevers lasting 12-72 hours, although those affected are usually completely normal between spells. 32 , 33 Pyrin is its gene protein product, from the Greek word for “fever.” As an extremely important and versatile immune regulator, pyrin fights infection and cancer. When bacteria attack a cell, the immune system is activated. Pyrin is one of the major players in this immune system cascade and plays a crucial role in mounting and maintaining human defense systems against pathogens. Pyrin activates caspase-1, an enzyme that facilitates programmed cell death, and participates in IL-1β processing for fever production. 8 , 31 , 32 , 33 Y. pestis reduces production of IL-1β and IL-18, blocking the immune system from mounting a robust immune response. 8 , 31 , 32 , 33 The bacteria run unchecked as natural defenses are shut off.

Patients who carry the FMF mutation have a “gain-of-function” in the pyrin gene, as its activity is always “on.” Y. pestis shuts off pyrin in subjects who lack the mutation, which increases susceptibility to plague infections. 7 , 8 , 31 , 32 , 33 , 34 Like sickle cell trait and resistance to malaria, those harboring the FMF mutation have plague immunity, as an important example of an evolutionary adaptation. 35 Up to 20%-40% of Israeli Jews in some studies may carry a recessive mutation in the FMF gene. 36 , 37 , 38 This mutation is found throughout the Middle East, but during the Black Death, Jews were the only large European community with Middle Eastern origins. We hypothesize that the presence of the FMF mutation would have allowed fourteenth-century Jews to survive plague at higher rates than their non-Jewish neighbors, which may have led European Christians to blame Jews for spreading the plague. 2 , 16 , 17 It is unknown if FMF carriers possess resistance to other infections, including to coronavirus, which may warrant further investigation.

Conclusions

Plague represents a reemerging infectious disease with potential use for bioterrorism. 5 , 6 From prehistory to the modern era, Y. pestis has killed millions of people. Outbreaks of worldwide plague foci in both developed and underdeveloped countries continue to occur. 4 , 5 , 6 Although modern medicine has greatly improved therapies and limited its spread, many clinical practitioners remain unfamiliar with its symptomatology, thus preventing timely recognition and treatment. 10 , 11 , 20 , 21 , 22 , 23 Advanced technology has demonstrated the selective genetic benefit of protective FMF mutations, which likely provided plague immunity for many medieval Jews and perhaps contributed to violence against them during this period. 7 , 8 , 16

Our historical examination of plague provides important contemporary parallels with the COVID-19 pandemic. Both the coronavirus and the fourteenth-century Black Death pandemics likely originated in Asia. 3 , 39 During the Black Death, minority groups (Jews) were persecuted for supposedly spreading the disease. In a similar fashion echoing across centuries of history, Asians and other minorities have been blamed for spreading COVID-19, as one group marginalizes another amid a sea of anxiety, fear, and irrational hatred. 16 , 40 Reminiscent of the treatment of Jews during the plague, there have been acts of ethnic and racial hostility directed at Asians and immigrants based on the false belief that these individuals, because of their ethnicity, are responsible for the pandemic. 16 , 40 Studying the genetic, medical, and social science aspects of plague pandemics can lead us to greater understanding of the interplay among history, humanity, and science.

Funding: None.

Conflicts of Interest: None.

Authorship: Both authors had access to the data and a role in writing this manuscript.

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Free Essay About The Bubonic Plague

Type of paper: Essay

Topic: Disease , Health , Europe , Black Death , Death , Countries , Food , Medicine

Words: 2250

Published: 03/12/2020

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The bubonic plague was one of the worst in the history of mankind. Reason for this was that it wiped out millions of people throughout the world. In Europe alone, it killed more than a third of the entire population. The bubonic plague, commonly referred to as the Black Death originated in China in the early 1330s. The main way that the plague spread from one way to the other was through rodents like rats but its effects were spread even faster since even smaller insects like fleas could carry the disease also (Bentley and Ziegler, 256). Aside from rodents and parasites like fleas, the main way that the disease was carried from one way to the other was from human to human contact. Once a person was infected with the Black Death, he or she could infect others with amazing ease. With the limited medical facilities that were being used in the 14th century, once the first person was infected with the disease in China, the rest of the world’s population quickly followed following movement of people from one place to the other (Bentley and Ziegler, 276). The origin of the name the bubonic plague is from its name. Two of the major symptoms that a person signifies once infected is running a high fever and painful swelling of the lymph nodes called bubons, hence the name. Another symptom of the disease is that when a person is infected, they get red sores on the skin that eventually turn black when they are close to death and after death, hence the other name, the black death. The reason that the disease spread so fast was that China was one of the busiest commercial hubs in the world. Since it was trading with countries in west Asia and Europe, the disease spread to these countries as fast as the trading ships did. The exact time that the disease got to Europe was 1347. This was by merchant ships that came from China through the Black Sea. The merchant ships docked in Sicily, Italy and those that were within were already dying from the Black Death (Bentley and Ziegler, 292). Once the disease got to the shores of Europe there was no stopping it.

Spreading of the Plague

Thousands of people were dying on a daily basis in Europe. There were two main reasons that the disease spread so fast in Europe; the first reason was that there was no medical know how of how to handle the disease. The other reason was that during the 1300s, Europe was becoming a busy economic hub. This meant that the human interaction was at a maximum, and so was the spread of the Black Death. Since the merchant ships came with the disease to Europe (Italy), the abundance of rats and rat-fleas that were in the port carried it from there to the homes. From the homes, the infected people spread it to those that did not have it leading to thousands of infections and approximately the same number of deaths per day in Europe Another reason that the disease spread so fast was the result of how they responded to the first cases of the disease. Since no one had a clue about anything concerning the disease, they blamed anything that made sense to them. Some of their responses were detrimental to the efforts being made. While some of them barred the doors to prevent spreading of the disease, the others decided to riot. Rioting increased the amount of human to human contact and also caused other carriers like rats spread further into the mainland. This caused the disease to spread further than it might have.

Effects of the Plague

The effects of the plague were devastating, over 25 million people died in Europe and the Northern African region. Almost a third of European adults died in the 1300s due to the black plague (Bentley and Ziegler, 300). The first effect was alienation of minority groups like the Jews. In Europe, the Jews were the group that was most unlike the rest, their cultures and tradition gave them the platform to do things differently from other people in Europe, as a result, a majority of the people blamed them for the disease that they did not understand. Another consequence of the disease was a sharp economic downturn. Farm produce was a major economic product in Europe and Africa. After the Black Death had hit Europe, and the northern part of Africa, farmers abandoned their farms in fear of the Black Death. The lack of food for trading made the little food in the markets shoot up in price (Bentley and Ziegler, 306). Since the price of the food was so high, and there was no money in the economy, people could not buy food. This led to a massive number of deaths not due to the plague but due to starvation. Finally, there was a chaos in the towns in Europe that were hit by the Black Plague. The main reason behind this was the fact that due to the massive amounts of death that had occurred, a number of public officials that maintained law and order died. There was, therefore, no structural leadership in the towns which resulted in an everybody-for-himself state of mind. This inadvertently led to chaos and civil unrest in the towns.

Effect of Black Death on the Demography

The plague had an effect on every faucet of life. One area that was worst affected was the demographic of Europe and Africa. The duration of the disease saw the death of almost as third of the people. The smaller cities were desiccated by death, and some of the smaller communities moved to join bigger ones so as to escape the effects of the disease and get the little help the doctors could offer. The cities were the ones that were hit the hardest. Towns such as London had thousands die within the few years that The Black Death was at its climax (Bentley and Ziegler, 310). Since the disease was spread most rapidly by the infected people, smaller countries in Europe such as Lithuania were isolated since the disease spread so slowly to have as much impact like it had in the bigger towns. Strangely enough, there are some countries or parts of countries that did not get infected. For example, part of Hungary in what is today known as Belgium did not get hit by the scourge. Nobody knows the reason for this but some people speculate that the people in this area were resistant to the disease. This theory was later dissuaded by the fact that these areas were later affected by the scourge in one of the numerous resurgences of the disease after the first wave. The areas that were hit first were reduced by half in. Areas such as Florence in Italy reduced from over 120, 000 people to just under 50, 000 in a matter of four years. Even after the plague was over the demography of the affected countries was affected negatively. For example, the birth rates in Europe and affected African countries like Egypt reduced drastically. Years after the disease had come and gone the number of people in Europe alone was almost half of what it was before the Black Death. It took Europe several generations to recover its former glory, population wise.

Social and Economic Changes

The first change that occurred in economically in both Europe and northern Africa in countries like Egypt was the fact that with so much death, there was the shortage of labor. About a third of the population was wiped out in Europe alone. This meant that people from all walks of life had been affected. This means that the economic picture had to shift (Bentley and Ziegler, 269). There was a shortage of laborers that meant that fewer commodities were in supply. For example in the food markets, the process of food sky rocketed. The farmers in Europe fled and abandoned their farms in a bid to escape the disease and the death that quickly followed. This translated to less food in the market for the demand that was ever growing. The price of food made those that had the produce rich and those that did not even poorer. Some even starved from lack of food instead of the disease. One of the social changes that accompanied the economic dynamism was that the social stratification became less strict. At the height of the Black Death when so many people had died and others were facing the same fate from the disease or starvation, people opted for labor services instead of food (Bentley and Ziegler, 276). This meant that even those that had money but no farming land or food to trade had to work with the poorest. This effectively dissolved the social class barriers. Simple supply and demand laws applied in the parts of the world that the plague had struck. The whole of Europe was now under attack, the death of so many laborers meant that the few that were left were very expensive since those that had farms scrambled for them. The abandoning of the farm lands made the value of the land decrease drastically. This economic change caused warranted a social one. The more the wealthy needed the poor, the more the poor had bargaining power. In some ironical way, the Black Death translated into more interaction between social classes. During the four years that the Black Death devoured Europe and Africa, people turned to the church for divine intervention. Since the church could not offer any, and their prayers did not seem to yield any fruit, the faith of the people diminished considerably. This eventually led to the break of the Catholic Church in Europe. The scourge deepened the economic strain that both the European and northern African countries were in. This is because in the 1300s, the European countries were invested heavily in rehabilitating their land from the swamps; the European frontiers were reaching their limits fast. With the financial challenges that the Black Death involved, most of the European countries were on the brink of depression after the four years the bubonic plague wrecked the world. Another economic effect of the bubonic plague was in the fact that it seemed to add to the financial difficulties that the countries were in trying to reclaim the holy land. The holy land was lost the century before and trying to reclaim it was proving to be an expensive venture. The spreading took further financial toll on the country. Another social problem that occurred was alienation of a minority group (Bentley and Ziegler, 243). It is clear that the Jews were a race that did things differently from the rest of the people. The result of this was that the other racial groups blamed the Jews for the very existence of the bubonic plague. Consequently, the Jews were shunned for this and were considered social outcasts.

Political and Psychological Effects of Black Death

There were not long lasting political effects of the Black Death. However, during the height of the scourge, the governments faced the biggest challenge. The disease did not discriminate; everyone including the politicians was dying, almost dying, fled or barricaded in their housed. This ensured that there was no solid political structure. The lords that governed the lands also fled opening up national boundaries (Bentley and Ziegler, 293). This marked the end of feudalism. During the plague, when the rulers of the lands ran away or died, it gave the most powerful kings a platform on which they could expand their boundaries. This king made powerful governments that led Europe after the plague during the renaissance. Psychologically, the disease affected work the most. People were afraid of dying and this reflected the work that they did. Renaissance art after the scourge of the Black Death portrays the darkness that the world was put into.

Reactions to the Black Death by Religious Groups

Christian and Muslims were the main religious groups in Europe and North Africa respectively. The death toll on both of these areas was about 31 percent. One of the reasons it was so scary was that nobody had an explanation about what was going on. The people then turned to religion for an explanation of what was happening from a higher power (Bentley and Ziegler, 332). In Europe, the people reacted in a chaotic way. They saw the Black Death as the end of the world and as such did whatever they wanted since they had lost all sense of morality after lacking answers from above. The reaction of the Muslims was the direct opposite of the Christians’. The Muslims in Egypt and the affected areas of the Middle East saw the plague was a blessing from God. Some said that praying for the disease to end was abhorrent (Bentley and Ziegler, 332). The similarities between the two groups were that they both believed in the same cause of the disease and that they believed that the cure of the plague was a derivative of the Armenian clay. The differences were in their reactions. While the Christians separated with the spread of the disease to avoid infection, the Muslims drew together in an attempt to strengthen their faith (Bentley and Ziegler, 332) . The two groups ascribed a different meaning to God after the plague. The Christians saw the Black Death as God’s way of bringing about the apocalypse. On the contrary, the Muslims saw this as God’s gift to man (Bentley and Ziegler, 333) .

Works Cited

J. Bentley and H. Ziegler. Traditions and Encounters: A Global Perspective on the Past. Vol. 1, 5.th ed. New York. McGraw-Hill, 2003. Print.

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Home — Essay Samples — History — Black Death — The Black Plague in Medieval Europe

The Black Plague in Medieval Europe

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Published: Feb 12, 2019

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