One of the earliest recorded and most devastating pandemics in human history was the plague outbreak of Europe. The plague was called the black death and has been a global disaster associated with the history of early medieval Europe. Its effects were devastating on the economies, social organization, and population of the continent. The plague though related to the Black Death, has caused outbreaks worldwide, especially in Asia and Africa. This paper will discuss the cause, history, preventive methodologies, treatment, current statistics, and future outlook of the plague.
Definitions and Background
The plague was the name given to outbreaks of infectious diseases, which became epidemics or pandemics in early societies. The Black Death, which ravaged Europe in the 1300s, is a disease that scientists would later name the Bubonic plague (Frith, 2012). This plague has affected the world in three major waves, and it was during the last wave in the late 19 th century that science had developed enough to lead to an identification of the disease and its cause (Science Museum, 2019). Alexandre Yersin, one of the scientists sent to study the outbreak in Hong Kong in the 1890s, isolated the plague bacterium in 1894 (Frith, 2012). It was named Yersinia Pestis in his honor. In 1898, Paul Louis Somond would discover the means of transmission of the disease to be fleas that infected their hosts, majorly rats which would then transmit to other hosts through bites or scratches (Science Museum, 2019). These fleas could also be spread through infested clothing and contact with other animals such as house pets which contact infested rodents. Consumption of infected animals is also another way through which the disease is transmitted.
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The Bubonic Plague is one of three plagues associated with the Yersinia Pestis bacillus. The other two are septicemic plague caused by the bacteria reproducing in the blood and pneumonic plague caused by reproduction in the lungs. If not treated, the Bubonic plague may develop into either of the other two varieties. A flea bite introduces the bacteria to the skin once a person is bitten or scratched by an infected host in bubonic form. The bacteria then spread to the nearest lymph node through the lymphatic vessels causing it to swell to the size of an egg. These swollen and painful lymph nodes are called "buboes," which is the origin of the word bubonic. The "buboes" may sometimes break open, oozing blood and pus. Other symptoms of the disease are flu-like, which begin between 1-7 days of being bitten, including headaches, fever, chills, malaise, and vomiting. Infected lymph nodes usually hemorrhage, leading to tissue death and necrosis. This causes extremities such as toes, fingers, lips, and the tip of the nose to turn black due to gangrene.
The infection can also be transmitted through aerial droplets from infected animals or people and direct contact with infected tissue or fluids of animals or people. The disease affects humans of all ages and historically affects those from all social classes (Science Museum, 2019). However, in the early stages of a pandemic, poor classes of people and sailors who came into contact with infected rats were the first victims. Animals that are susceptible to the disease include mammals such as rats, hares, some cat species, ground squirrels, chipmunks, while domestic animals and prairie dogs, among others, may carry fleas. During the Black Death, domestic animals succumbed to the disease, with sheep dying so much that there was a shortage of wool in Europe (History, 2020). Meat from infected animals could lead to transmission in humans and carnivores.
History
Once referred to as the "Great Mortality," the disease had its first recorded outbreak in The Plague of Justinian. The disease infected the Byzantine Empire, ruled by emperor Justin I, who himself contracted it but recovered after extensive treatments. It was believed that the disease reached Constantinople through infected rats on merchant ships from Africa. Over a third of Constantinople's residents succumbed to the disease, which killed more than 10, 000 lives per day and an estimated 25 million people in the three continents of Asia, Europe, and Africa (Andrews, 2018). The outbreak occurred around 542 A.D. and carried on to the next century causing several recurrences across the three regions leading to famine and devastation.
The most infamous and widespread record of the plague was the 1300s European Black Death and was one of several waves lasting till the 20 th century. In 1347, the first wave of the plague ravaged Europe from Asia (Science Museum, 2019). The origin of the pandemic is believed to be Crimea and Mongolia, where Italian sailors returning home brought the disease to the port of Messina in Sicily, Italy. The trade routes in the Near and Far East were rumored to be under a great pestilence, with Egypt, China, India, and Syria being struck by the disease in the 1340s. In Mongolia, dead-infested bodies were used as biochemical weapons, which were thrown in the city of Kaffa, which Italians held. The sailor ships would then carry the disease to other ports such as Marseilles and Tunis. The disease proceeded to Florence and Rome, which were centers of a web of trade routes. It then reached London, Bordeaux, Paris, Lyon in 1948 and would continue to kill millions in Europe until it subsided in 1353. Records from writers and poets such as the Welsh Jeuan Gethin noted how the pandemic was like a rootless, merciless phantom that cut off the young (Andrew, 2018). Other records say the death was like black smoke, while the Italian poet Giovanni Boccaccio wrote that at the beginning, people developed swellings that were as large as an egg or apple under the armpits or on the groins, which were commonly called plague-boils (History, 2020). The effects of the disease were exacerbated by its mysterious nature, with even doctors left clueless. They resorted to unconventional treatments such as bloodletting and boil lancing, which was ineffective. The people ultimately resorted to superstition and religious beliefs claiming the disease was a punishment for their sins.
The disease disappeared in the 1950s but would re-occur every few generations or centuries. The second wave, which was the most notable reappearance of the disease, occurred in the 1600s. There was the Italian Plague of 1629-31, which was caused by troops of the Thirty Years War who brought the disease to the city of Mantua (Andrews, 2018). From there, the epidemic spread to major Italian cities of Venice, Florence, Milan, and Verona. Between 1665 and 1666, an outbreak that had begun at St. Giles in the Fields ravaged through London. It is estimated at its peak 8, 000 people were dying each week, leading to 75, 000- 100, 000 deaths by its end in 1966. The last major outbreak of the second wave was The Great Plague of Marseille, which began in 1720 and disappeared in 1722. A ship called the Grand Saint Antoine had ferried infected passengers from the Middle East. The vessel was quarantined, but the cargo was unloaded, which released plague-infested rat fleas to the city. Estimated 100, 000 deaths occurred, forcing convicts to be used to dispose of the dead while "plague walls” built to contain the infection failed. The third and most recent wave occurred in 1855. It was also the “Third Pandemic” after the first two major plagues, the Justinian and Black Death. It began in Yunnan in China and traversed the world in the next few decades. By the early 20 th century, steamships had carried infected rats to all inhabited continents. The most hit regions were India, Hong Kong, and China. The outbreak fully ended around the 1950s and had claimed over 15 million lives (Andrew, 2018). The disease was reported in San Francisco and South African towns, leading it to become endemic in some regions.
Preventative Actions
The Third Pandemic provided the medical and scientific world with insights into the plague. This ultimately led to modern interventions such as the disease being treated by antibiotics (Science Museum, 2019). In the Venetian-controlled port city of Ragusa, the disease was slowed by isolating arriving sailors initially for 30 days – a Trentino- which was increased to 40 days called a quarantine which was the origin of modern quarantine (History, 2020). This isolation was also extended to dead animals. Another preventive method is for pets to be regularly cleaned and treated for fleas. They are also not be let to freely roam to prevent them from coming into contact with infected animals. Modern sanitation measures by governments and city councils involve fumigation of cities to reduce the number of rats and prevent contact with humans.
Current Statistics
Between 1900 and 2012, 1006 confirmed or probable human plague cases occurred in the United States. Most of these cases are in the Southern West States, where the bacteria is endemic in wild rodents. By 1990-2010 overall mortality had decreased to 11%, with the last US urban plague endemic occurring in Los Angeles between 1924-1925 (CDC, 2019). According to the CDC, over 80% of United States plague cases have been bubonic form and recently average to 7 cases annually ranging between 1-17(CDC, 2019). It infects people of all ages ranging from infants up to age 96, although 50% of cases occur in people ages 12–45. Worldwide, between 1,000 and 2,000 cases each year are reported to the World Health Organization, with most cases occurring in Africa.
Future
There is no vaccine available for the plague, and the only prevention is pyrophytic antibiotics. A genetically attenuated Yersinia pseudotuberculosis was an efficient oral vaccine against pneumonic plague but failed to offer full protection against bubonic plague; hence the wait for when the other vaccines in development can be commercially available is bound to take a while (Derbise et al., 2015). Diagnosis is made using a laboratory test on blood and other body samples. The available antibiotics effectively treat the plague; however, there is a need to diagnose and treat it early since it is still a fatal disease if ignored and could lead to antibiotic-resistant strains if not properly managed.
Conclusion
The Bubonic plague was historically one of the most devastating pandemics ever recorded in human history. It led to massive population losses in medieval times, leading to a multitude of related challenges. Modern medicine, specifically antibiotics, effectively treat the disease, making it less of the threat it once was. However, a vaccine is still not available; hence people need to have it diagnosed and treated early.
References
Andrews, E. (2018, August 22). 6 devastating plagues . HISTORY. https://www.history.com/news/6-devastating-plagues
CDC. (2019, December 3). Plague Surveillance . Centers for Disease Control and Prevention. https://www.cdc.gov/plague/maps/index.html
Derbise et al. (2015). Complete protection against pneumonic and bubonic plague after a single oral vaccination. PLOS Neglected Tropical Diseases , 9 (10), e0004162. https://doi.org/10.1371/journal.pntd.0004162
Frith, J. (2012). The History of Plague – Part 1. The Three Great Pandemics. JMVH , 20 (2). https://jmvh.org/article/the-history-of-plague-part-1-the-three-great-pandemics/
History. (2020, July 6). Black Death . HISTORY. https://www.history.com/topics/middle-ages/black-death
Science Museum. (2019, April 25). Bubonic plague: The first pandemic . https://www.sciencemuseum.org.uk/objects-and-stories/medicine/bubonic-plague-first-pandemic
