Historical review provides lessons for the control of the plague
Archaeologists unearthed a ‘Black Death’ grave in London, containing more than a dozen skeletons of people suspected to have died from the plague. The victims are thought to have died during the 14th century and archaeologists anticipate finding many more as they excavate the site.
The Plague is by definition a re-emerging infectious disease which affects the lungs and is highly contagious, leading to mass outbreaks across populations. History shows us that population levels suffered globally due to the plague, with around 75 million people globally perishing during the 14th century Black Death.
This study, published in Infection, Genetics and Evolution, analysed the Great Plague of Marseille, which caused 100,000 deaths between 1720 and 1723. The researchers aimed to highlight issues we are facing with infectious diseases today, to identify the best ways to respond to epidemics and whether we are still at risk of the plague re-emerging again.
Pieter Bruegel’s The Triumph of Death (c. 1562) reflects the social upheaval and terror that followed the plague which devastated medieval Europe
Results show that a number of factors show we are still at risk of plague today. This is largely due to transport trade and novel threats in developing countries where multi-drug resistant pathogens are currently emerging and spreading rapidly. This genetic change has also contributed to a development in the way the bacteria infect new hosts meaning they can now live in mammalian blood.
The study also highlighted the need for effective management of epidemics in future. Fear of in infection can have a negative impact on a population’s economic situation due to a significant loss of tourism, and widespread panic. History has shown us that providing the necessary information about diseases and improving the management of epidemics are vital steps for avoiding panic and containing diseases.
Skeletons in a mass grave from 1720–1721 in Martigues, France, yielded molecular evidence of the orientalis strain of Yersinia pestis, the organism responsible for bubonic plague. The second pandemic of bubonic plague was active in Europe from AD 1347, the beginning of the Black Death, until 1750.
The Black Death was one of the most devastating pandemics in human history, peaking in Europe between 1348 and 1350, and killing between 75 million and 200 million people. Although there were several competing theories as to the etiology of the Black Death, recent analysis of DNA from victims in northern and southern Europe indicates that the pathogen responsible was the Yersinia pestis bacterium probably causing several forms of plague.
Plague victims being blessed, shown with symptoms from a late 14th century manuscript Omne Bonum by James le Palmer
The Black Death is thought to have started in China or central Asia. It then travelled along the Silk Road and reached the Crimea by 1346. From there, it was probably carried by Oriental rat fleas living on the black rats that were regular passengers on merchant ships. Spreading throughout the Mediterranean and Europe, the Black Death is estimated to have killed 30 to 60 percent of Europe’s population.All in all, the plague reduced the world population from an estimated 450 million to a number between 350 and 375 million in the 14th century.
The aftermath of the plague created a series of religious, social and economic upheavals, which had profound effects on the course of European history. It took 150 years for Europe’s population to recover. The plague reoccurred occasionally in Europe until the 19th century.
There have been three major outbreaks of plague. The Plague of Justinian in the 6th and 7th centuries is the first known attack on record, and marks the first firmly recorded pattern of bubonic plague. From historical descriptions, as much as 40 percent of the population of Constantinople died from the plague. Modern estimates suggest half of Europe’s population was wiped out before the plague disappeared in the 700s. After 750, major epidemic diseases did not appear again in Europe until the Black Death of the 14th century. The Third Pandemic hit China in the 1890s and devastated India, but was confined to limited outbreaks in the west.
The Black Death originated in or near China and spread by way of the Silk Road or by ship. It may have reduced world population from an estimated 450 million to between 350 and 375 million in 1400.
The plague is thought to have returned at intervals with varying virulence and mortality until the 18th century. On its return in 1603, for example, the plague killed 38,000 Londoners.
Other notable 17th-century outbreaks were the Italian Plague (1629–1631); the Great Plague of Seville (1647–1652); the Great Plague of London (1665–1666); and the Great Plague of Vienna (1679). There is some controversy over the identity of the disease, but in its virulent form, after the Great Plague of Marseille in 1720–1722,the Great Plague of 1738 (which hit Eastern Europe), and the Russian plague of 1770-1772, it seems to have gradually disappeared from Europe.
Plague Riot in Moscow in 1771: During the course of the city’s plague, between 50,000 and 100,000 died (1/6 to 1/3 of its population).
By the early 19th century, the threat of plague had diminished, but it was quickly replaced by a new disease. The Asiatic cholera was the first of several cholera pandemics to sweep through Asia and Europe during the 19th and 20th centuries.
The 14th-century eruption of the Black Death had a drastic effect on Europe’s population, irrevocably changing the social structure, and resulted in widespread persecution of minorities such as Jews, foreigners, beggars, and lepers (see Persecutions). The uncertainty of daily survival has been seen as creating a general mood of morbidity, influencing people to “live for the moment,” as illustrated by Giovanni Boccaccio in The Decameron (1353).
Medieval people called the catastrophe of the 14th century either the “Great Pestilence”‘ or the “Great Plague”. Writers contemporary to the plague referred to the event as the “Great Mortality”. Swedish and Danish chronicles of the 16th century described the events as “black” for the first time, not to describe the late-stage sign of the disease, in which the sufferer’s skin would blacken due to subepidermal hemorrhages and the extremities would darken with a form of gangrene, acral necrosis, but more likely to refer to black in the sense of glum or dreadful and to denote the terror and gloom of the events.
The German physician and medical writer Justus Hecker suggested that a mistranslation of the Latin atra mors (terrible, or black, death) had occurred in Scandinavia when he described the catastrophe in 1832 in his publication “Der schwarze Tod im vierzehnten Jahrhundert”. The work was translated into English the following year, and with the cholera epidemic happening at that time, “The Black Death in the 14th century” gained widespread attention and the terms Schwarzer Tod and Black Death became more widely used in the German- and English-speaking worlds, respectively.
Contemporary accounts of the plague are often varied or imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos) in the groin, the neck and armpits, which oozed pus and bled when opened. Boccaccio’s description is graphic:
“In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg…From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves.”
Ziegler comments that the only medical detail that is questionable is the infallibility of approaching death, as if the bubo discharges, recovery is possible.
A hand showing how acral gangrene of thefingers due to bubonic plague causes theskin and flesh to die and turn black.
An inguinal bubo on the upper thigh of a person infected with bubonic plague. Swollen lymph glands (buboes) often occur in the neck, armpit and groin (inguinal) regions of plague victims
This was followed by acute fever and vomiting of blood. Most victims died two to seven days after initial infection. David Herlihy identifies another potential sign of the plague: freckle-like spots and rashes which could be caused by flea-bites.
Some accounts, like that of Louis Heyligen, a musician in Avignon who died of the plague in 1348, noted a distinct form of the disease which infected the lungs and led to respiratory problems and which is identified with pneumonic plague.
Worldwide distribution of plague-infected animals 1998
“It is said that the plague takes three forms. In the first people suffer an infection of the lungs, which leads to breathing difficulties. Whoever has this corruption or contamination to any extent cannot escape but will die within two days. Another form…in which boils erupt under the armpits,…a third form in which people of both sexes are attacked in the groin.”
This article is “Small oversights that led to the Great Plague of Marseille (1720 – 1723): Lessons from the past” by Christian A. Devaux (DOI: 10.1016/j.meegid.2012.11.016,) and appears in Infection, Genetics and Evolution published by Elsevier.
Contacts and sources: