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Nov/Dec 2000
Vol. 3, No. 9, pp. 75-76,

Clinical trials track

Bring out your dead!

Yersinia pestis, cause of ancient plagues, remains a modern peril.

The bubonic plague. The Black Death. The very name has the power to terrify, conjuring images of an inescapable demise. These images, half-remembered, are the heritage of not only the West but virtually every culture on the earth. Plague—the plague—has been a scourge on every inhabited continent. But it is not solely relegated to historical memory. The plague is still very much a reality at the beginning of the 21st century.

Historical plagues

While we all know of the Black Death, the great plague that decimated Europe in the 14th century, there were many other incidents of the disease. When Xerxes tried to invade Greece early in the 5th century BC, it was not only the famous Spartan stand at Thermopylae that stemmed the tide, but also the fact that some 300,000 of the 800,000 Persians in Xerxes’ army died of plague.

Less than a century later, during the Peloponnesian War, an epidemic now believed to have been plague swept through Athens. Among its victims was the great statesman Pericles. Plagues struck the Byzantine east and Egypt during the 6th century AD, just as they later depleted the ranks of the Crusaders in the 11th and 12th centuries. Louis VII of France, for example, saw his army of 100,000 men reduced to 5000 by a combination of famine, desertion, and plague in the Holy Land (1147–1149).

The 14th-century pandemic

In 1346, rumors reached Europe of a terrible epidemic in China. Little was made of the news, as fantastic tales had long been ascribed to the distant East. Even as the epidemic spread west into Mesopotamia and the eastern Mediterranean, the European world, quite insular at that time, thought little about it.

Yet in 1347, the plague, accompanied by reports of incredible mortality, reached Constantinople and Cyprus. By October 1347, a Genoese fleet brought the plague to Sicily. From there, it moved to the Italian peninsula. By January 1348, the plague infected Marseilles, France. Despite quarantines, it traveled the trade routes to reach Paris in the spring and England by September. The plague took longer to reach the edges of Europe: Scandinavia was not affected until 1349 and the eastern European hinterland not until 1350.

Within a year, one third of the population of Europe was dead—some 25 million people—and therein lies the significance of the plague. Nothing would ever be the same.

Europe in the middle of the 14th century was ripe for disaster. Bountiful harvests early in the century had combined with poor harvests and wet weather by the 1340s to produce a large and suddenly malnourished population.

When the plague struck, it struck this vulnerable population hard. People died, and they died quickly. Some developed swellings (called “buboes”) in the neck and groin. A second, more virulent kind of the disease attacked the lungs, and this pneumonic plague killed even faster. Signs of infection appeared within days. Body temperature soared. The disoriented victim began to vomit and experience intense pain. Blood vessels broke and turned the skin black. The immunologically naïve population was devastated. (Surprisingly, the term “Black Death” was not used in the Middle Ages. It arose in the 16th century to denote the terrible nature of the disease rather than the color of its victims.)

Faced with such a disaster, Europeans turned quite naturally to a search for causes. In a world in which religion and magic provided the explanatory framework for life’s mysteries, supernatural forces were blamed. Some suspected miasmas—noxious exhalations of the earth—were responsible. Others blamed the wrath of God, while still others pointed to a malign conjunction of the stars.

When Philip VI of France ordered the medical faculty of the University of Paris to provide an explanation for the plague in June 1348, the faculty reported that at exactly 1:00 p.m. on March 20, 1345, Mars, Saturn, and Jupiter had been in conjunction in Aquarius. Saturn and Mars portended death, while Mars and Jupiter spread pestilence through the air. The conjunction of all three could only portend calamity of epic proportions.

Whatever the causes they believed in, the dire effects of the pestilence cannot be understated. To the people of the time, it was literally the end of their world. Feudalism, a system of government wherein a landed, hereditary aristocracy (coupled in this case to a Europe-wide church) ruled a landless peasant majority, could not withstand the disruption from the severe population loss. People who had been poor became suddenly rich, either because they fell sole heir to inheritances or simply because there was no one to contest their ownership. Of the serfs that survived, many refused to work, and in some cases, they simply left the land. Those who survived demanded higher wages and new rights. Mills stood empty, looms were quiet, manorial fees went uncollected. But those who became personally richer lived in a Europe that was much poorer than before.

Socially, the European world was different. Plague opened doors for survivors to pursue new opportunities. Laborers became gentry; shop assistants became merchant princes. The old nobility was destroyed and although a new one rose to take its place, they had neither tradition nor sanctioned pedigree. This explains, for example, the explosive growth of etiquette literature in the postplague years. The new aristocracy was ignorant of the manners of the old.

The political climate of Europe changed, not only with the changing face of the aristocracy, but with a crisis of authority. The old authorities—the Church, the Crown—had been unable to stop the horror, so many wondered what use they were. And yet out of the pandemic grew the first systematic attempts by government to regulate public health. Fear created by the vast numbers of sick and dying during the outbreak led to boards of health with broad powers to protect society from pestilence.

Perhaps equally profound were cultural changes. A cult of the macabre developed, as exemplified by the popular images of the “dance of death”, wherein Death personified whisked the young and healthy off to their demise. A plague literature developed, such as Boccaccio’s The Decameron. Funerary sculpture emphasized the inevitability of decay instead of the repose of death.

The plague hit universities—responsible for training theologians, physicians, and lawyers—hard. Enrollment plummeted, and some universities ceased to exist. Yet many of the changes were extraordinary and helped to pave the way for the Renaissance. New colleges were founded as people made pious bequests and monarchs strove to halt the decay of learning. The curriculum changed, too. In the wake of the plague, for example, the University of Florence replaced scholastic logic curricula with the study of Greek and rhetoric, two mainstays of what would become modern humanism. As the number of teachers who knew Latin declined, the vernacular was used in instruction—increasing the dispersal of knowledge.

But of course, responses to the plague weren’t all positive. Religious fanaticism increased, as exemplified by the Flagellants, a group of people who whipped themselves to appease God. Such groups disrupted the stabilizing monopoly of the Catholic Church in religious matters. Anti-Semitism flared as Jews were accused of starting the plague by poisoning city wells. Never mind that Pope Clement VI issued a papal bull calling such a charge “unthinkable”. After all, as Clement argued, Jews died, too. But old authorities were losing their power to control the violent excesses of the Christian masses as well as their freedom, so the persecution continued.

Later plagues

Plague continued to simmer throughout the world in the succeeding centuries. Of particular note is the plague in England in 1665–1666. London suffered grievously as a result, then burned to the ground (cleansing itself in the process). But there was one historic benefit—the plague had a profound effect on one particular university professor—Isaac Newton. When Cambridge was closed by the plague, Newton retired to his farm, where, during his celebrated “year of miracles”, he spent his free time devising the calculus, developing his theory of light, and formulating an early form of universal gravitation.

India, China, and other places witnessed plague epidemics. Napoleon’s campaign in Syria at the end of the 18th century was routed not by the English but by plague.

Plague struck San Francisco and Los Angeles early in the 20th century, although in both cases, mortality was extremely low. Public health authorities in both cities had an advantage their medieval forebears lacked: They knew the cause of the plague. In 1894, almost simultaneously, Alexandre Yersin of the Pasteur Institute and Japanese physician Shibasabaroo Kitasato proved that the bacillus Pasteurella pestis (as it was first called) was the infectious agent. Shortly after, in 1897, Masanori Ogata of the Hygiene Institute in Tokyo proved the connection between infected rats, fleas, and the plague in humans.

More recently and ominously, plague broke out in India in 1994. The conditions in the city of Surat weren’t all that different than in a medieval European city: crowded and unhygienic. Although it wasn’t known how the outbreak started, it was clear that this highly contagious pneumonic variety of plague had the ability, through modern transportation, to spread farther and much more rapidly than in the Middle Ages. It took years for the plague to travel from China to western Europe in the 14th century. But today, an infected and asymptomatic person can travel from India to England in less than 12 hours. Although this particular plague epidemic killed “only” 56 people, it cost India hundreds of millions of dollars in lost tourism and trade revenue. And it raised tremendous fears that this old nemesis was still a modern threat (see “Diseases and Disorders”, p 96).

Suggested Reading

  1. (1) Gregg, C. T. Plague: An Ancient Disease in the Twentieth Century, revised ed.; University of New Mexico Press: Albuquerque, 1985, 1978.
  2. (2)Herlihy, D. The Black Death and the Transfor-mation of the West; Harvard University Press: Cambridge, MA, 1997.
  3. (3) Hirst, L. F. The Conquest of Plague: A Study in the Evolution of Epidemiology; Clarendon Press: Oxford, U.K., 1953.
  4. (4) History of Western Civilization: The Black Death. http://history.idbsu.edu/westciv/ plague/index.html.
  5. (5) Matterer, J. L. The Pestilence Tyme. www.godecookery.com/plague/plague.htm.

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