Black Death (The Plague)

The Black Death (also known as the Pestilence, the Great Mortality, or the Plague) was the deadliest pandemic recorded in human history. The Black Death resulted in the deaths of up to 75–200 million people in Eurasia and North Africa, peaking in Europe from 1347 to 1351. Plague, the disease caused by the bacterium Yersinia pestis, was the cause; The Y. pestis infection most commonly results in bubonic plague, but can also cause septicaemic or pneumonic plagues.

The signs and symptoms as well as mortality rate vary based on which plague you had, Bubonic, Septicaemic or Pneumonic.

Bubonic

Symptoms of the Bubonic include fever of 38–41 °C (100–106 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Left untreated, of those that contract the bubonic plague, 80 percent die within eight days.

Contemporary accounts of the pandemic are varied and often imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos) in the groin, neck, and armpits, which oozed pus and bled when opened. Boccaccio's description:

PLAGUE BY NUMBERS

Disease: Yersinia pestis

Location: Eurasia, parts of Africa

Date: 1346–1353

Deaths: 75,000,000 – 200,000,000

Mortality Rate: 80% to 100%

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Above: Yersinia pestis (200× magnification), the bacterium which causes plague.

"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."

This was followed by acute fever and vomiting of blood. Most victims died two to seven days after initial infection.

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Below: An inguinal bubo on the upper thigh of a person infected with bubonic plague. Swollen lymph nodes (buboes) often occur in the neck, armpit and groin (inguinal) regions of plague victims.

Above: A hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black.

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Pneumonic

Lodewijk Heyligen, whose master the Cardinal Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague, that infected the lungs and led to respiratory problems. Symptoms include fever, cough, and blood-tinged sputum. As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90 to 95 percent.

Septicaemic

Septicaemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation). In cases of pneumonic and particularly septicaemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes.

Means of Transmission

Mathematical modelling is used to match the spreading patterns and the means of transmission. A research in 2018 challenged the popular hypothesis that "infected rats died, their flea parasites could have jumped from the recently dead rat hosts to humans". It suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of death toll because the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, which contradict historical death data.

The importance of hygiene was recognized only in the nineteenth century with the development of the germ theory of disease; until then streets were commonly filthy, with live animals of all sorts around and human parasites abounding, facilitating the spread of transmissible disease.

One early medical advance as a result of the Black Death was the establishment of the idea of quarantine in the city-state of Ragusa (modern Dubrovnik, Croatia) in 1377 after continuing outbreaks.

Second Plague Pandemic

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671. The second pandemic was particularly widespread in the following years: 1360–63; 1374; 1400; 1438–39; 1456–57; 1464–66; 1481–85; 1500–03; 1518–31; 1544–48; 1563–66; 1573–88; 1596–99; 1602–11; 1623–40; 1644–54; and 1664–67.

Many believe it was during this Second Pandemic that the nursery rhyme, "Ring Around the Rosie" surfaced, which is believed to depict a picture of plague filled European countries during the 1600s. Take a look at the lyrics:

"Ring-a-ring-a-roses, A pocket full of posies, A-tishoo! A-tishoo! We all fall down.

The invariable sneezing and falling down in modern English versions have given would-be origin finders the opportunity to say that the rhyme dates back to the Great Plague. A rosy rash, they allege, was a symptom of the plague, and posies of herbs were carried as protection and to ward off the smell of the disease.

Plague Doctor

It was during this 'Second Pandemic' that the iconic plague doctor costumes came into use. The garments were invented by Charles de L'Orme in 1630 and were first used in Naples, but later spread to be used throughout Europe. The protective suit consisted of a light, waxed fabric overcoat, a mask with glass eye openings and a beak shaped nose, typically stuffed with herbs, straw, and spices. Plague doctors would also commonly carry a cane to examine and direct patients without the need to make direct contact with them.

The scented materials included juniper berry, ambergris, roses (Rosa), mint (Mentha spicata L.) leaves, camphor, cloves, labdanum, myrrh, and storax. Per the then-widely accepted miasma theory of disease, it was believed this suit would sufficiently protect the doctor from miasma while tending to patients.

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