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See how the bubonic plague throughout history has kept coming back and killing millions up to modern times.
Plague, Modern History
Plague is a greatly feared disease that has killed millions of people since medieval times. It is caused by the bacterium Yersinia pestis, which is carried by fleainfested rodents, and mortality rates are more than 50% if the disease is left untreated. The third pandemic of plague extended into the twentieth century and stimulated research into the cause and transmission of the disease.
There have been no major epidemics of plague in the United States for many years, although occasional cases still occur in the southwestern states. Globally, from 1,000 to 3,000 cases annually are reported to the World Health Organization (WHO), most of which occur in Africa, Southeast Asia, and Latin America. It may not be possible to eradicate plague, but outbreaks can be prevented by reducing rodent populations. Constant vigilance regarding plague is also necessary because it has some potential as an agent of a bioterrorist attack.
The History of the Plague: Every Major Epidemic - History
Man and Disease: The Black Death
People, Places, Events and Terms To Know:
High Middle Ages
"Little Ice Age"
Arno River (Florence)
Famine of 1315-1317
Rat Flea (Xenopsylla Cheopis)
Boccaccio, The Decameron
Dance of Death
Four Horsemen of the Apocalypse
I. Introduction: Europe before 1347 CE
Europe had experienced a remarkable period of expansion during the High Middle Ages (1050-1300 CE) but that age of growth reached its limit in the later part of the thirteenth century (the late 1200's CE). By then, good farmland had been overworked, and new fields were proving only marginally productive. As the population began to surpass the capacity of the land to feed its inhabitants, famine was imminent.
Worse yet, the climate of Europe was for reasons which are still unclear entering a cooling phase. Whereas in the High Middle Ages a warm, dry climate had predominated, by the turn of the fourteenth century global weather patterns changed for the colder and wetter. Scientists today find evidence of this so-called "Little Ice Age," in polar and Alpine glaciers which the data show began to advance at this time. Moreover, historical records from the day confirm that the winter of 1306-7 was unusually frigid, the first such lingering cold snap Europe had endured in nearly three centuries.
While the drop in global temperature was probably no more than one degree on average, it was enough to make a significant impact on agriculture. For instance, grain and cereal production had to be abandoned in Scandinavia, and viticulture (wine-production) became impossible in England, as it still is for the most part. Not only cooler but wetter, too, the change in climate brought with it increased rainfall which precipitated other problems, such as flooding. In particular, the Arno River which flows through Florence (central Italy) swept away many bridges with the force of its waters.
But the first real pan-European catastrophe resulting from the onset of the "Little Ice Age" was a widespread failure of crops. Beginning in 1315, the weather was so rainy that most grains sown in the ground suffered root rot, if they geminated at all. Also, the lack of sun, high humidity and cooler temperatures meant water evaporated at a slower rate, which caused salt production to drop. Less salt made it more difficult to preserve meats and that, combined with the losses in agriculture, led to famine by year's end.
When the same happened again in 1316 and then once more in 1317, peasants were forced to eat their seed grain. With little hope of recovery even if weather improved, despair spread across the continent. Frantic to survive, people ate cats, dogs, rats and, according to some historical records, their own children. In places, the announcement of a criminal's execution was seen as an invitation to dinner.
Later branded the Famine of 1315-1317, this disaster marked the beginning of a decrease in European population that would last more than a century and a half. Many cities were hard hit—for instance, in Ypres (Flanders) a tenth of the population died in six months and in Halesowen (England) the population dropped by fifteen percent during this period—all this led to general de-urbanization across the continent.
Nevertheless, these emaciated souls could not have known that worse, far worse, lurked on the horizon. A holocaust of unprecedented fury was stalking them and their children. Out in the hinterland of Asia there was a biological menace massing, a blight that would forever change the face of Europe, the bubonic plague.
II. The Black Death (1347-1352 CE)
The Black Death is the single most significant disease in Western civilization to date, a true and literal plague. The word plague derives from an ancient Greek medical term plêgê meaning "stroke"—it's a reference to the speed with which the disease brings down its victims—and this plague was a real death-blow to medieval Europe. The Black Death, or simply "The Plague," came on its victims so quickly and powerfully and with such a debilitating disruption of facilities it seemed to on-lookers in the day as if the person had been "struck" by some invisible force.
Yet, it was, in fact, not the first time bubonic plague had raised an angry hand to Europe. As far back as 664 CE when it was known as the "Plague of Cadwalader's Time," this disease had swept the continent. But in that age there were far fewer people in Europe and it moved much slower from place to place since there was little trade or travel in the aftermath of Rome's collapse (see Chapter 8). The more well-connected and vital Europe of the years following the High Middle Ages proved a much better host for this plague.
A. The Nature of Bubonic Plague
Devastating as the Black Death was to humankind in the fourteenth century, it is important to remember a central feature of this disease. Normally it does not live among human populations. Plague is endemic—a Greek-based word meaning "(persisting) in a population"—among rodents across the globe, particularly the rats of central Asia where it subsists at a low level and is not widely destructive. When for some reason it breaks out into other biological groups, it can become epidemic ("against a population").
All in all, the bubonic plague is fundamentally a rat disease since it does not persist long in human communities where rats are absent. Rats, however, are not the cause of Plague—its pathogen—rather, just like human hosts, they are victims of the disease. The actual pathogen is a bacillus (a form of bacteria pl. bacilli) called Yersinia pestis, which was first isolated and identified in 1894 by the French bacteriologist, Alexandre Yersin, after whom it is named. For all the destruction Yersinia pestis left in its wake, people at the time of the Black Death never knew this bacillus was the cause of the Plague. Thus, its invisible mechanisms combined with the extraordinary speed and violence with which it attacked contributed greatly to the terror and psychological damage it wrought upon late Medieval Europe.
All the same, knowing the life cycle of Yersinia pestis is essential to the modern understanding of its impact on human history and the course the disease took in the 1300's. This bacillus lives normally as a low-grade infection in the bloodstream of rats. It moves from rat to rat via fleas, in particular, the rat flea (Xenopsylla cheopis),which is in medical terms the vector ("carrier") of Plague. When a rat flea bites an infected rat, it sometimes drinks in Yersinia pestis along with the rat's blood. If so, the bacillus lodges in the flea's digestive tract where it begins to reproduce prodigiously until it forms a solid mass and blocks the flea's digestion.
With its digestive tract obstructed, the flea begins to starve. Frantic from hunger, it hops from rat to rat and repeatedly bites them, but because of the intestinal blockage caused by the clot of bacilli in its gut it can't swallow the blood it's ingested, so it vomits what it drinks back up into the rat's bloodstream. Along with the regurgitated blood come clumps of Yersinia pestis disgorged from the flea's belly. This causes an uninfected rat to become contaminated and, if the rat's immune system is slow to react, the fast-multiplying pathogen overwhelms the animal which dies. But if the rat's immune response is quick, it can counter and suppress the infection. Then, the bacillus continues to exist as a non-fatal parasite living in the rat's bloodstream where it waits until an uninfected flea by chance ingests it. And so the life cycle of Yersinia pestis continues as it volleys back and forth between its two hosts, the rat and flea, using each to infect the other.
Under normal conditions this cycle is restricted to rats and fleas, but if some sort of biological disruption occurs, the disease can spill out of its normal limited niche. For instance, if the rat population declines precipitously for some reason, fleas will be forced to move to other hosts, such as other types of rodents, domestic animals or even humans. While rats are the preferred host of Xenopsylla cheopis, when facing starvation this flea will feed off of almost any mammal.
If infected rat fleas begin biting humans, most of whom do not have resistance to Plague, the disease can reach epidemic levels. In that instance, individuals usually die within five days from the first onset of symptoms, in some cases, overnight. The human immune system is typically overwhelmed by Yersinia pestis which reproduces wildly within the victim's bloodstream. But if it responds quickly enough, survival is possible. If so, the body remembers the infection and pre-empts any second assault. Very few people ever contract Plague twice.
Because of the terror inspired by this disease and the large number of people afflicted, the progress of bubonic plague as it courses through its victims has been well-documented. Starting with a fever once the immune system has sensed the presence of a foreign organism, the victim's lymph nodes begin to swell as the body tries to flush out the contagion. These nodes are located in the neck, armpits and groin and become visibly enlarged. Called buboes (sing. bubo), swollen lymph nodes are among the most distinctive and painful features of the disease and give it the name "bubonic" plague.
Usually by the third day, the victim experiences high fever, diarrhea and delirium, and black splotches begin to appear on the skin, especially on the tips of the fingers, the nose and anywhere there's a concentration of capillaries. The reason for the black splotches is that the body's smaller blood vessels clog with bacilli and rupture, and blood begins to leak so profusely it becomes visible beneath the epidermis. This is often, though wrongly, said to be the reason the outbreak of Plague in 1347 came to be called the "Black Death," from the darkening of the victim's skin. The "black" in Black Death more likely derives from the Latin word atra, meaning "black, dreadful." Death usually follows soon afterwards, most often from septicemia (blood-poisoning), due to massive internal hemorrhaging as the bloodstream grows congested with bacteria.
This is not, however, the only course the disease is known to take. For example, a victim's buboes can swell so much they burst through the surface of the skin, most often around the fifth day after infection. This process is excessively painful, and Medieval medical records recount how patients seemingly near death would suddenly leap from bed in a frenzy screaming with pain as their buboes burst, spewing out pus and contagion. For all the trauma it causes, the bursting of buboes is, however, not altogether a bad thing. For one, the patient's survival for that long is a good sign in itself—at least half of victims die on average before the buboes have a chance to burst—and the elimination of bacilli through the bursting glands aids somewhat in clearing the infection.
There is worse yet. An even more virulent type of Plague exists which can pass from human to human directly, without employing fleas as vectors. In this form called pneumonic plague, the bacilli are transmitted directly from one human host to another on particulate matter exhaled by the infected. Since the lungs are designed to move air-born material efficiently into the bloodstream, pneumonic plague is especially quick in attacking its victims and almost always fatal. Those who contract pneumonic plague tend to collapse suddenly, cough up blood and die, sometimes within a matter of hours.
There was no cure for bubonic plague in the Middle Ages, none indeed until the discovery of antibiotics in the modern age. In the face of this unknown and irremediable onslaught, Medieval peoples attributed the disease to several factors: "bad airs," witches, astrology and a rare alignment of planets. Its appearance, in fact, brought out the worst in all groups and classes. Moslems blamed Christians, Christians blamed Moslems, and everyone blamed the Jews.
The Black Death was, thus, destructive not only to the physical well-being of Medieval Europe but also its general mental health, a situation which had as much to do with the timing of its onset as anything else. Coming off the peak of the High Middle Ages, people had already been rattled by the disintegration of the Church, the Famine of 1315-1317 and the outbreak of the Hundred Years' War. After the Plague erupted and in just five years killed a quarter to a third of Europe's inhabitants, not only population but morale hit record lows.
B. The Course of the Black Death
There can be little doubt that the Black Death began before the first historical accounts record its presence, but where or how is unclear. Even so, history offers some tantalizing prospects. In researching its origins, it's well to remember a central feature of bubonic plague: it's not at heart a human disease, but one that generally circulates through rat populations. The likelihood is, then, the Black Death began well before 1347 with some sort of disturbance in rodent communities, most likely ones in Central Asia since all historical data point to that as its geographic origin.
As one moves forward in time nearer to the first appearance of Plague in Europe in 1347, the picture becomes better, if still blurry. For some reason, the disease spread on a wide scale to the marmots of central Asia, a mammal resembling a woodchuck or "rockchuck." It's reasonable to assume these animals had little resistance to Plague, causing their population to begin dying quickly en masse. Around the mid-1340's, Asian trappers who hunted marmots for their hides found many dead ones lying around, a seeming boon but with a terrible price tag attached. Ignorant of the danger facing them, the trappers skinned the animals, packed up their hides and sold them off to dealers.
These retailers, then, sent the marmot hides in closed containers down the famous Silk Road, which runs across Asia, all the way from China, through Saray and Astrakhan which are northwest of the Caspian Sea, to Kaffa which is a port on the Crimean peninsula on the northern shore of the Black Sea and at that time was one of the major gateways between East and West. Thus, Plague could not have landed in better circumstances for its proliferation: a harbor town full of people, animals and cargo, many of which were on route to all ends of the known world. By then, news had, in fact, reached Moslems in the Near East that a devastating illness was killing the marmot trappers of central Asia and the dealers who sold their goods, but these reports were generally ignored in the West. It's well known traders carry not only exotic goods but also outlandish gossip.
When the containers with the marmot hides were opened in Kaffa, the rat fleas trapped within were released into an essentially defenseless population. Starting, no doubt, with the decimation of the local rats—but that's not likely to have made it into the historical record—there soon followed the infection and death of many other types of mammals none with significant resistance to this pathogen. Since people didn't rank high on that list because rat fleas prefer other animals like cats, dogs, and even cattle over humans, it took some time before the epidemic hit our species.
This initial delay was instrumental in the disease's ferocious progress. It ensured that Plague could establish itself on board the many ships leaving Kaffa every day. Here, historical documentation of the bubonic plague as a human disease finally begins to emerge. By late 1347, there is evidence of its presence in Constantinople, and soon thereafter Genoa in Italy and Messina in Sicily. The Byzantine Emperor Cantacuzenus watched it infect and consume his own son and, like the ancient Greek historian Thucydides, recorded a pathology, an account of its medical course.
Out of fear of Plague, the Genoese—to their lasting discredit!—turned foreign ships away from their harbor, which not only accelerated the spread of the disease but did nothing to spare Genoa. As a rule, efforts to limit Plague in the Middle Ages served mainly to disperse it more widely, since Medieval quarantines involved sequestering the infected in a building. That only forced rats, fleas, humans and bacilli, the essential ingredients in Plague, into close proximity. As the Genoese of this day knew but never fully understood the significance, rats can swim off infected ships and, in doing so, carry fleas and bubonic plague with them.
Soon thereafter the Black Death appeared in Pisa (Italy) and Marseilles (on the southern coast of France). Nor did it spare the Moslem world, which first saw its ravages in Alexandria (Egypt), their great port city. From there, it moved east to Damascus and Beirut, and also west to Morocco and Spain. But the cleaner and generally more rat-free environs of Islamic communities, where medicine and health were far more advanced than in the West at that time, forestalled the spread of Plague eastward and it took relatively few victims there, at least compared to Western Europe.
By early 1348, the disease had begun to cut a swath west across France and descended on Bordeaux, a port in the Aquitaine region of southwestern France, famous for exporting wine. On a ship laden with claret, Plague reached England late that same year. In 1349, another ship, this one carrying English wool to Scandinavia, was spotted several days after it had departed its home port, floating aimlessly off the Norwegian coast. The locals rowed out to see it and found its crew dead but its cargo intact. They happily took the wool and, along with this treasure, infected fleas.
As if from some passage in the Old Testament giving witness to the eighth commandment, "Thou shalt not steal," Plague erupted with a vengeance across Scandinavia. From 1350 to 1352, it continued apace, ravaging Denmark, Germany, Poland and finally Russia. Thus, having made a five-year clockwise circuit of Europe, it ultimately passed back into the same remote Asian hinterland from which it had emerged originally, and disappeared. The Black Death itself was over, but the worst of it still lay ahead, the memories of its rampage and the crippling, nauseating fear it might return one day, as in fact it did sporatically over the next few centuries.
III. The Negative Consequences of the Black Death
The consequences of the Black Death on the culture of late Medieval Europe are immeasurable and, needless to say, mostly negative. By itself, the decrease in population forever changed the face of Western Civilization—the overall population of Europe would not surpass pre-1347 levels until after 1500—a century and a half to recover from what began as half a decade of human ruin puts the impact of this disease into its proper perspective. In terms of carnage alone, no war has even come close to that level of long-term devastation.
Given the day and age, historians are hard pressed to produce reliable, even reasonable population figures. Nor does it help that prior to the Black Death many local governments had collapsed in the wake of the Great Famine of 1315-17 and the outbreak of the Hundred Years' War (1337-1453). Still, it's probably safe to say that something on the order of a quarter to a third of the population of Europe died during the Black Death, amounting to as many as twenty million people. Where the numbers of casualties can be calculated with any certainty—for instance, in urban centers like Paris—it's clear that between 1348 and 1444 the Black Death and recurrences of Plague cut the population by half, if not more.
The results of this contagion were, however, felt not in mortalities alone but in demographics and psychology, too. Grim experience quickly taught people in the day that Plague decimated cities more heavily than rural communities. The reason for this was that the bacillus depends on fleas carried by rats as its principal vector and the crush and filth of urban life aided greatly in the spread of bubonic plague, but that was not yet known. The result was that people fled the cities of Europe in large numbers. Even small villages were left depopulated, precipitating a trend toward de-urbanization far more catastrophic than that following Rome's disintegration a millennium before. And that, we should recall, had precipitated the Middle Ages.
This wave of de-urbanization and its concomitant catastrophes are well-evidenced in the art and literature of the day. Probably the most famous literary work of that time, The Decameron by Boccaccio, a collection of Medieval tales and folklore, is set in the Italian countryside where aristocrats, fleeing the Plague as it ravages Florence, are stranded without their usual entertainments. To pass the time, they tell each other stories, from which Boccaccio is said to have harvested a rich storehouse of traditional narrative. The Decameron later served as the foundation for many other Renaissance works, including several of Shakespeare's plays. Little wonder, then, so many of his dramas focus on death and the darker side of human life.
The visual arts of the day centered even more directly on the consequences of the Black Death. A macabre fascination with death and the process of dying fills painting and statuary from the fourteenth and fifteenth centuries. From these have sprung many of the images of death well-known today: the Grim Reaper, the "dance of death," and Albrecht Dürer's famous etching, "The Four Horsemen of the Apocalypse." Artists' emphasis on the democratic nature of death, which steals away both rich and poor, nobleman and peasant, pagan and priest, opened the door wide to a general questioning of the culture on which the Medieval synthesis had rested, such as the divine right of kings and the class constructs which tied serfs to the land. Offering little in the way of help—much less explanation or solace—these postulates began to crumble.
It also paved the way to extreme behavior. Staring down their mortality, many people gave into lewdness and revelry, while others turned to religion and extreme piety. In spite of the widespread devastation of both clergy and congregation, the Church ironically became richer than ever. More than one person in a desperate attempt to avert the Angel of Death surrendered all worldly possessions to the Church. When these prayerful gifts proved futile, the Church—and the papacy in Rome especially—ended up holding many a moneybag and deeds to land all over Europe. Thus, the failure of the Church to win divine mercy for its people turned out to be one of its greatest bull-markets ever, an irony not entirely lost on its laity.
And so wherever the cry of "Plague!" was heard, despair manifested itself and not just in art and literature but also in bizarre social phenomena, one of which was flagellants. Professional self-torturers who went from town to town, the flagellants scourged themselves for a fee to bring God's favor upon a community hoping to avert the bubonic plague—according to Medieval logic, the Black Death was a punishment for sin, and its atonement must be paid in real, physical terms—flagellants served, then, as a means for people to buy that remission from sin at the price of migrant "whipping boys." The Church outlawed flagellants, though that did little to stifle them. Sickness and death of every sort, it seemed, followed fast on each other in a spiral of unending despair.
IV. The Positive Consequences of the Black Death
When the plague abates, the traffic gets worse. (Unknown satirist)
With all that, it may seem hard to believe but there were also positive consequences to the Black Death. Primarily, manpower was suddenly of much greater value than it had been before. For the first time in centuries, peasants weren't available in prodigious numbers and nobles had difficulty securing the workforce necessary to sow their fields and harvest their crops. Thus, the late Medieval peasant found himself quite unexpectedly and unprecedentedly in demand, a shift which shook European society to its core.
Kings and dukes now had to bargain with their laborers over working conditions, and the under-classes were able to demand better compensation for their services. Wages rose, in some places doubling over the course of just one year. At the same time, prices were falling because there were fewer people to buy goods. So, caught between rising production costs and falling revenue, middle-class lords tried to force a price-freeze and, when they couldn't, many gave up and sold their estates.
The resulting social upheaval accelerated trends in social evolution which had already been under way before the devastation. In particular, the Black Death terminated serfdom in Europe—serfs were virtual slaves, peasants who were "tied to the land" and obliged to farm certain areas for no other reason than that their ancestors had—the impact of Plague on society is clearly visible when one compares those places where it hit hard with those it didn't. In Russia, for instance, where the disease was never so destructive, serfdom continued as a social institution well into the nineteenth century. As such, Plague changed some things for the better.
The growth of workers' rights was, in turn, the stimulus for other social change in Europe, as laborers across the continent began to fight for their rights. For instance, in 1358 French workers, called collectively the Jacquerie, revolted in an effort to create better working conditions for peasants. Two decades later in 1378, Italian workers in Florence followed suit, and in 1381 the English did much the same in the Peasants' Revolt. If these upheavals resulted in little more than devastation and pillage, it proves only that workers and their leaders were not yet ready to take on the responsibilities of managing life in the mainstream, not that their pursuit of independence and self-governance was unjustified. There's no doubt that these attempts to assert common fairness and decency in the workplace foreshadow the evolution of modern labor unions. Thus, the Black Death precipitated some change for the good, at least among those of the working class who survived its onslaught.
Also, as the agriculturally oriented manorial system which had dominated life during the High Middle Ages slowly failed, industry rose, yet another benefit left in the wake of the Black Death. Once the major impact of the disease was no longer felt, the towns of Europe repopulated faster than smaller communities in the countryside. This new, urbanized Europe paved the way for a society and economy based on different principles, laying the groundwork for modern life, an era when cities, industry and trade have come to predominate over farming and living in the country.
And one other positive result of the bubonic plague was the development of medicine as a science in the West. Whereas in the late Middle Ages Islamic doctors had for centuries been advocating sensible measures like general cleanliness and the value of studying anatomy, Western healers prior to 1347 were still encumbered by the Medieval scorn of the body and ancient medical fallacies like the theory of humors. But when Plague wiped out nearly all the doctors in Europe, just as it had the clergy—physicians, like priests, attend to the dying and because of this were exposed at a higher rate to the more virulent pneumonic form of Plague—it precipitated a change in both personnel and precept. Ironically, then, modern Western medicine owes much to Yersinia pestis, one of its most horrifying failures.
V. Conclusion: The End of the Bubonic Plague?
DNA isn’t destiny---it’s history. . . . Somewhere in your genetic code is the tale of every plague, every predator, every parasite and every planetary upheaval your ancestors managed to survive. (Sharon Moalem, Survival of the Sickest )
A. The Post-Mortem of the Black Death
The Plague's assault on the West did not end with the Black Death. Long after 1352, buboes continued to swell intermittently across Europe—in 1369, 1374-5, 1379, 1390, 1407 and so on until as late as 1722—but the disease has never struck the modern world again with the force it did in 1347. Though particularly virulent outbreaks are recorded in 1665 in London and as late as 1896 in Bombay (Mumbai), the rate of infection and the percentage of the population killed always stopped before reaching the levels it had in the mid-fourteenth century and, more important, recurrences invariably turned out to be localized. This raises an important question: why hasn't Plague hit again as hard as it did when it launched the Black Death?
Historians and physicians alike have puzzled over this issue and, though many answers have been suggested, none has won general approbation. One is that the general hygiene of Europeans improved after the Middle Ages, but while people may, in fact, have started bathing more after the fourteenth century, rats and fleas which are central in spreading Plague did not adopt better standards of health. Fleas were certainly a persistent factor in human life until quite recently, so hygiene is not likely to be the reason Plague has never reappeared in as devastating a form as it was in the 1300's.
Since rats are crucial in spreading Plague, other explanations have centered on them. Some scholars, for instance, have cited the relatively recent spread of brown rats across Europe—brown rats tend to live away from humans—as opposed to black rats which were more predominant earlier and usually live in or around human communities. This theory, however, does not hold up either, since the areas of Europe infested with brown rats do not coincide with those which evidence a reduction in the scope and impact of Plague.
Another explanation centering on rats is that the European species, both brown and black, developed a resistance to Plague. But that, too, seems unlikely since immunological resistance in a population, especially one with as high a birth and death rate as rats have, tends to dwindle over time. So, even if at some point their immunity to the disease increased, European rats should have become susceptible to Plague again fairly quickly.
A scientist named Colin McEvedy has proposed a new theory which seems to have some merit. According to McEvedy, the failure of Yersinia pestis to reappear in as virulent a form as it had in the fourteenth century depended on a change in the microbial world, not in humans or any mammalian species. Whether his thesis is right or wrong, it makes sense to look below the surface of visible life, since this disease operates principally on a microscopic, not macroscopic, level.
Respecting the durable dictum of pathology, that a "less virulent parasite will replace a more virulent parasite over time," McEvedy has suggested that after the Black Death European rats became less susceptible to Plague because Yersinia pseudotuberculosis, a bacillus closely related to Yersinia pestis but considerably less virulent, appeared in their environment. Exposure to this pathogen would have provided rat communities with some immunological resistance to Plague. That means, when Yersinia pestis re-appeared after the 1350's, the European rat population didn't die off as catastrophically as they had before, because some rats had acquired resistance to bubonic plague bacteria from having dealt with its milder, less often fatal counterpart, Yersinia pseudotuberculosis.
While humans were not exposed to this bacillus in any significant way and thus its appearance provided our species with no direct benefit, a growing immunity among rats to Yersinia pestis made the disease's journey from city to city more difficult. That is, too many rats across Europe had gained resistance to Plague for the pathogen to build up the momentum necessary to launch an all-out epidemic like the Black Death. And so while it continued to flare up on occasion, bubonic plague failed to sweep the continent ever again the way it did in the mid-fourteenth century.
With that, it would seem we have finally reached the end of the history of the Black Death, but in fact we have not. For one, though controlled by antibiotics and much suppressed, bubonic plague is still a factor in human life. Even today, it remains endemic in Uganda, the western Arabic peninsula, Kurdistan, northern India and the Gobi desert, and lately there have been ever increasing numbers of cases documented in the United States, particularly among hunters of rockchucks in the American West. Moreover, the possibility always exists that through some mutation Yersinia pestis could once again rampage through rats and other mammals and, if it gains the ability to resist antibiotics, devastate the human population as well.
At the moment, however, that seems unlikely, and the work of modern medical researchers centers more on the plagues which threaten and ravage the world today: AIDS, Ebola, Dengue fever, avian flu and the like. These, for the most part, stem from viruses, not bacteria, and draw attention toward the effort to find cures for viral infections. Recent research, however, has shown that the barrier between the world of the virus and the bacillus is not as impermeable as it might seem. Statistical analysis of AIDS mortalities has turned up an intriguing connection between the diseases plaguing us today and the one our Eurasian predecessors endured. To wit, data suggest that people whose ancestors come from those areas of Europe which suffered most heavily during the Black Death coincide with populations today which exhibit lower rates of mortality from AIDS.
If this thesis is correct, it means that the exposure of their ancestors to Plague enhances the possibility that certain peoples will in general be able to resist AIDS more effectively. Thus, the past indeed has great bearing on the present—and the future!—and as the report about this theory says, "it will add to a growing recognition among scientists of the importance of epidemics in shaping human evolution." That's something all competent historians, no matter their ancestry, could have told you long ago.
The History of the Plague: Every Major Epidemic - History
Scientists Use DNA in Search for Answers to 6th Century Plague
By THOMAS H. MAUGH II, Times Staff Writer
By the middle of the 6th century, the Emperor Justinian had spread his Byzantine Empire around the rim of the Mediterranean and throughout Europe, laying the groundwork for what he hoped would be a long-lived dynasty.
His dreams were shattered when disease-bearing mice from lower Egypt reached the harbor town of Pelusium in AD 540. From there, the devastating disease spread to Alexandria and, by ship, to Constantinople, Justinian's capital, before surging throughout his empire.
By the time Justinian's plague had run its course in AD 590, it had killed as many as 100 million people -- half the population of Europe -- brought trade to a near halt, destroyed an empire and, perhaps, brought on the Dark Ages. Some historians think that the carnage may also have sounded the death knell for slavery as the high demand for labor freed serfs from their chains. Justinian's plague was a "major cataclysm," says historian Lester K. Little, director of the American Academy in Rome, "but the amount of research that has been done by historians is really minimal."
Little is hoping to do something about that. In December, he brought the world's plague experts together in Rome to lay the groundwork for an ambitious research program on the pandemic. A book resulting from the meeting will be published this year.
Modern techniques for studying DNA have begun answering long-standing questions about the evolution of the plague bacillus, how it infects humans and what can be done to counteract it.
While a 6th century plague might seem an esoteric subject, Little and others think that it has great relevance in a modern world that is continually threatened by emerging diseases. A second pandemic of plague struck Europe in the Middle Ages -- the so-called Black Death -- killing 25 million people and once more producing widespread social disruption.
A third pandemic began in China in the late 19th century and spread to North America, where a large reservoir of the disease remains active in animals throughout the Southwest.
An outbreak occurred in Los Angeles in 1924-25, but was contained.
Plague could become a tool of bioterrorists. Russian experts have long argued that plague is a much more frightening prospect than anthrax. As part of their germ war efforts during the Cold War, Soviet scientists developed strains of plague resistant to antibiotics used to cure infections. Unleashing such organisms could potentially have a devastating effect on modern society.
Understanding Justinian's plague could also lead to insights into other types of disasters, man-made and natural, adds UCLA historian Michael Morony.
"People were dying faster than they could be buried," he said. "I find myself wondering how society survived. That's a relevant question to try to understand."
Plague is caused by a bacillus called Yersinia pestis, identified in 1894 by the Swiss bacteriologist Alexandre Yersin. The bacterium once killed more than half the people it infected but is now routinely controlled by such antibiotics as streptomycin, gentamicin or tetracycline.
About 2,000 deaths from plague are still reported worldwide every year, a handful of them in the United States. Naturally occurring strains resistant to antibiotics have been observed recently, however, and scientists fear that their spread could lead to large outbreaks.
Y. pestis is carried by rats and other animals. It can be transmitted to humans by direct exposure to an infected animal. Most often, however, it is carried by fleas that bite the infected animals, then bite humans.
People bitten by such fleas develop agonizingly painful, egg-sized swellings of the lymph nodes -- called buboes -- in the neck, armpit and groin. Hence the name bubonic plague.
Some authorities recognize two other forms of plague, one called pulmonary or pneumonic, in which the lungs are affected, and one called septicemic, in which the organism invades the bloodstream, but all are the same disease, Little said.
Because of its possible use in bioterrorism, researchers have been actively studying the plague organism. In October, a British team from the Sanger Center in Cambridge reported that they had decoded the complete DNA sequence of Y. pestis, a feat that could help to control outbreaks.
"The genome sequence we have produced contains every possible drug or vaccine target for the organism," said Dr. Julian Parkhill, the team's leader.
Genetics shows that the closest relative of Y. pestis is a gut bacterium called Yersinia pseudotuberculosis, which is transmitted through food and water and which causes diarrhea, gastroenteritis and other intestinal problems, but is rarely fatal. Y. pseudotuberculosis may be the immediate ancestor of Y. pestis, but it is not transmitted by fleas. Last month, researchers apparently discovered why.
Bacteriologist B. Joseph Hinnebusch and his colleagues at the National Institutes of Health's Rocky Mountain Laboratories in Montana reported that the key is a gene called PDL, which is carried by the plague bacterium, but not by the one that causes diarrhea.
Although they do not yet know how it works, PDL allows Y. pestis to survive in the gut of the rat flea. Artificially produced strains of the bacterium without the gene are destroyed in the flea's gut and thus cannot be transmitted to humans.
Hinnebusch and his colleagues believe the bacterium acquired the gene from other soil bacteria by a process called horizontal transfer, somewhat akin to a form of bacterial sex. The transfer probably took place 1,500 to 20,000 years ago, they said, setting the stage for full-scale epidemics of plague. "Our research illustrates how a single genetic change can profoundly affect the evolution of disease," Hinnebusch said.
Some scholars have argued that Y. pestis was not the cause of the Black Death and, by implication, of Justinian's plague as well. Jean Durliat, a French expert on the Byzantine Empire, argued in the 1980s that contemporary literary accounts of Justinian's plague were overblown and exaggerated, and not supported by archeological evidence.
Last year, British historians Susan Scott and Christopher Duncan published "Biology of Plagues," arguing that death spread through Europe much too rapidly in the 14th century to be caused by Y. pestis.
They believe that the Black Death must have spread through human-to-human contact and argue that it might have been caused by the Ebola virus or something similar.
Anthropologist James Wood of Pennsylvania State University made a similar argument last month at a meeting in Buffalo, N.Y.
"This disease appears to spread too rapidly among humans to be something that must first be established in wild rodent populations, like bubonic plague," Wood said. "An analysis of monthly mortality rates [among priests] during the epidemic shows a 45-fold greater risk of death than during normal times, far higher than usually associated with bubonic plague."
But molecular biology may be on the brink of answering questions that history cannot. One unique feature of the plague virus is that it accumulates inside the teeth of its victims, where its DNA can be protected for centuries, or perhaps even longer.
Molecular biologists Michel Drancourt and Olivier Dutour of the University of the Mediterranean in Marseilles, France, reported in 1998 that they had identified Y. pestis DNA in human remains dating from 1590 and 1722. Two years later, they reported a similar finding in remains dating from 1348.
That evidence is "pretty impressive," said Little, and indicates that Y. pestis at the very least played a role in the Black Death.
The Marseilles team is continuing to study other remains from the period to document how widespread the infections were. Meanwhile, archeologists are searching for plague cemeteries from the time of Justinian to perform similar studies.
Archeologist Michael McCormick of Harvard University has already identified eight mass graves in the Gaza Strip, Turkey and Italy where he expects to find human remains dating from the 6th to the 8th centuries. Remains have yet to be exhumed, however.
Some researchers speculate that a particularly virulent form of Y. pestis was responsible for Justinian's plague or the Black Death, just as an unusually pathogenic form of the influenza virus caused the worldwide flu pandemic in the early 20th century. Analysis of human remains could yield clues.
Theoretically, McCormick said, if DNA is found in the remains, it could be possible to grow the organisms in the laboratory and see if it is, in fact, more virulent.
One of the "major social issues" arising from the great mortality of the plague "is that it tends to raise the value of labor," Little said. "There are not enough workers around anymore. You can't find servants and, when you do find someone, they tend to charge outrageous amounts."
Little and others believe that this increased premium on labor was the final blow to slavery during the Justinian plague and that it similarly brought an end to serfdom during the Black Death.
Historians obviously still have a lot to learn about these pandemics, but valuable first steps have been taken, Little said. With the increasing assistance of molecular biologists, he added, the final pieces of the puzzle may now fall into place.
Why we're so fascinated by the plague
Centuries on from the Black Death, people around the world continue to be transfixed by the plague in a way they're not by other diseases.
These days, the plague is hardly the biggest health risk facing many countries. In 2017 alone, 219 million people caught malaria and 435,000 people died of the disease. By contrast, between 2010 and 2015, 584 people died of the plague worldwide, according to the World Health Organization.
While the plague can be deadly if untreated, patients can easily be treated with antibiotics. After the plague diagnosis in China, the Chinese Center for Disease Control and Prevention said there was an extremely low risk of it spreading, state media China Daily reported.
But even if the disease isn't a major threat for most countries, it still interests scientists and historians, who are continuing to make discoveries about the Black Death, despite it occurring hundreds of years ago.
Greatrex, from Hong Kong University, said the plague continued to be haunted by its history. "You hear of the plague, and instantly you think of Black Death which ravages Europe, it has that enormous historical baggage," he said. "It's where lots of our ideas about what it means to have an epidemic comes from."
Black, the historian, said the fascination with the Black Death comes from a deep cultural memory in the Middle East and Europe, where the disease was written about for centuries.
However, he said other diseases — such as malaria and Ebola — should be of greater concern.
"It's so central to Western identity," he said. "It's part of our past, where something like malaria, which is so much more devastating in the last century, it doesn't interest us."
Epidemics can bring devastation to a community. But past epidemics have taught us valuable lessons about how to deal with infectious diseases and about the communities that experienced them.
An infectious disease reaches epidemic proportions when it spreads to a large number of people in a relatively short amount of time. Humans have experienced epidemics for as long as they have lived together in communities. But once people started to travel around the world in significant numbers, they carried infectious diseases with them and epidemics became pandemics—disease outbreaks on global proportions.
The Black Death, as the plague was called in the 1200s, was one of the earliest pandemics that we know about. In many ways it defined how people would respond to large-scale outbreaks of disease in the future. Some of the measures developed to fight the plague are still used today. The world experienced two subsequent plague pandemics.
Smallpox is another epidemic disease that has existed in communities for centuries. But it has a unique place in the history of epidemics as the only infectious disease to be totally eradicated from all human populations.
The story of smallpox is intimately related to the story of vaccination, the technique developed by William Jenner to prevent people catching smallpox. Vaccination has been hugely successful in preventing and controlling the spread of infectious diseases but since its earliest days vaccination has caused controversy.
At the start of the 1900s, most infectious diseases were in decline, but incidents of poliomyelitis (polio) began to rise, reaching epidemic proportions by mid-century. Working out why this previously rare disease of childhood (also known as infantile paralysis) was on the rise and impacting whole communities was a true medical detective story.
Bubonic plague: the first pandemic
The impact of the bubonic plague epidemics of the past still echo across the centuries, reminding us of the devastation that disease can inflict on whole communities.
Smallpox and the story of vaccination
Smallpox and vaccination are intimately connected. Jenner developed the first vaccine to prevent smallpox infections. And the success of his vaccine led to the global eradication of smallpox and the development of many more life-saving vaccines.
Polio: a 20th century epidemic
While many infectious diseases began to decline by the end of the 1800s, incidents of polio increased to epidemic proportions. What was going on?
The iron lung
This coffin-shaped contraption was used for the most dangerous forms of polio, when the disease paralysed the lungs. It saved the lives of thousands of polio victims who couldn't breathe on their own.
Epidemiology: the public health science
Epidemiology is the science dealing with the spread and control of diseases and other factors relating to health in populations and other groups.
An Epidemic Every 100 years: Plague of 1720, Cholera of 1820, Spanish Flu of 1920, Coronavirus of 2020 – Is it Just a Coincidence!
There is a theory that every 100 years a pandemic erupts on the planet. It might be a coincidence, but the chronological accuracy is troubling.
In 1720 there was a plague, in 1820 – cholera, and in 1920 – Spanish flu…
Many researchers say that the current coronavirus epidemic resembles the events of previous centuries.
The logical question arises: what if these pandemics were artificially staged by some sinister force? Maybe a secret organization?
In 1720, there was the last large-scale bubonic plague pandemic, also called the great plague of Marseille. The catastrophic plague led to the death of 100,000 people. It is assumed that the bacteria are spread by flies infected with this bacteria.
The first cholera epidemic occurred on the centenary of the 1720 pandemic. It has affected Asian countries – the Philippines, Indonesia, and Thailand. Interestingly, about 100,000 people were killed in this epidemic. The pandemic is said to have started with people who drank water from lakes contaminated with this bacteria.
The Spanish flu appeared 100 years ago, at a time when people were battling the H1N1 flu virus, which had undergone a genetic mutation, which made it much more dangerous than the normal virus. This virus infected 500 million people and killed more than 100 million people in the world, this pandemic was the deadliest in history.
It seems like history repeats itself every 100 years, is it just a coincidence?
Today, China faces a major pandemic and has spread to South Korea, Iran, Italy, and other countries. More than 77,000 have been infected, over 2,000 have died. But every day the situation gets worse.
The worst part is that air travel and modern technology are accelerating the spread of the virus worldwide. And how it will end, only God knows …
Sixth Cholera Pandemic (1910-1911)
Death Toll: 800,000+
Like its five previous incarnations, the Sixth Cholera Pandemic originated in India where it killed over 800,000, before spreading to the Middle East, North Africa, Eastern Europe and Russia. The Sixth Cholera Pandemic was also the source of the last American outbreak of Cholera (1910–1911). American health authorities, having learned from the past, quickly sought to isolate the infected, and in the end only 11 deaths occurred in the U.S. By 1923 Cholera cases had been cut down dramatically, although it was still a constant in India.
Then came the disease epidemics of the Americas. Smallpox first arrived in the colonies of Florida, Carolina, and Virginia in 1519 and devastated the native population after being brought by the colonizing Europeans.  It reached Massachusetts in 1633. Due to the fact that the so-called New and Old Worlds were so far removed, the Native Americans had little, if any, immune resistance to the viruses of Europe, like measles, plague, and especially smallpox.
Smallpox was particularly brutal and spread to Central and South America as well, greatly infecting the Aztec Empire. In just 100 years, half the time of the Plague of Justinian, it wiped out 90 percent of the Aztec population, a drop from 17 million people to only 1.3 million. These diseases killed so many that only an estimated 530,000 Native Americans were left alive by 1900. This makes the American plagues some of the worst of recorded human history.
Pandemics and the Shape of Human History
Outbreaks have sparked riots and propelled public-health innovations, prefigured revolutions and redrawn maps.
What’s often referred to as the first pandemic began in the city of Pelusium, near modern-day Port Said, in northeastern Egypt, in the year 541. According to the historian Procopius, who was alive at the time, the “pestilence” spread both west, toward Alexandria, and east, toward Palestine. Then it kept on going. In his view, it seemed to move almost consciously, “as if fearing lest some corner of the earth might escape it.”
The earliest symptom of the pestilence was fever. Often, Procopius observed, this was so mild that it did not “afford any suspicion of danger.” But, within a few days, victims developed the classic symptoms of bubonic plague—lumps, or buboes, in their groin and under their arms. The suffering at that point was terrible some people went into a coma, others into violent delirium. Many vomited blood. Those who attended to the sick “were in a state of constant exhaustion,” Procopius noted. “For this reason everybody pitied them no less than the sufferers.” No one could predict who was going to perish and who would pull through.
In early 542, the plague struck Constantinople. At that time, the city was the capital of the Eastern Roman Empire, which was led by the Emperor Justinian. A recent assessment calls Justinian “one of the greatest statesmen who ever lived.” Another historian describes the first part of his reign—he ruled for almost forty years—as “a flurry of action virtually unparalleled in Roman history.” In the fifteen years before the pestilence reached the capital, Justinian codified Roman law, made peace with the Persians, overhauled the Eastern Empire’s fiscal administration, and built the Hagia Sophia.
As the plague raged, it fell to Justinian, in Procopius’ words, to “make provision for the trouble.” The Emperor paid for the bodies of the abandoned and the destitute to be buried. Even so, it was impossible to keep up the death toll was too high. (Procopius thought it reached more than ten thousand a day, though no one is sure if this is accurate.) John of Ephesus, another contemporary of Justinian’s, wrote that “nobody would go out of doors without a tag upon which his name was written,” in case he was suddenly stricken. Eventually, bodies were just tossed into fortifications at the edge of the city.
The plague hit the powerless and the powerful alike. Justinian himself contracted it. Among the lucky, he survived. His rule, however, never really recovered. In the years leading up to 542, Justinian’s generals had reconquered much of the western part of the Roman Empire from the Goths, the Vandals, and other assorted barbarians. After 542, the Emperor struggled to recruit soldiers and to pay them. The territories that his generals had subdued began to revolt. The plague reached the city of Rome in 543, and seems to have made it all the way to Britain by 544. It broke out again in Constantinople in 558, a third time in 573, and yet again in 586.
The Justinianic plague, as it became known, didn’t burn itself out until 750. By that point, there was a new world order. A powerful new religion, Islam, had arisen, and its followers ruled territory that included a great deal of what had been Justinian’s empire, along with the Arabian Peninsula. Much of Western Europe, meanwhile, had come under the control of the Franks. Rome had been reduced to about thirty thousand people, roughly the population of present-day Mamaroneck. Was the pestilence partly responsible? If so, history is written not only by men but also by microbes.
Just as there are many ways for microbes to infect a body, there are many ways for epidemics to play out in the body politic. Epidemics can be short-lived or protracted, or, like the Justinianic plague, recurrent. Often, they partner with war sometimes the pairing favors the aggressor, sometimes the aggressed. Epidemic diseases can become endemic, which is to say constantly present, only to become epidemic again when they’re carried to a new region or when conditions change.
To this last category belongs smallpox, dubbed the speckled monster, which may have killed more than a billion people before it was eradicated, in the mid-twentieth century. No one knows exactly where smallpox originated the virus—part of the genus that includes cowpox, camelpox, and monkeypox—is believed to have first infected humans around the time that people began domesticating animals. Signs of smallpox have been found in Egyptian mummies, including Ramses V, who died in 1157 B.C. The Romans seem to have picked up the pox near present-day Baghdad, when they went to fight one of their many enemies, the Parthians, in 162. The Roman physician Galen reported that those who came down with the new disease suffered a rash that was “ulcerated in most cases and totally dry.” (The epidemic is sometimes referred to as the Plague of Galen.) Marcus Aurelius, the last of the so-called Five Good Emperors, who died in 180, may also have been a smallpox victim.
By the fifteenth century, as Joshua S. Loomis reports in “Epidemics: The Impact of Germs and Their Power Over Humanity” (Praeger), smallpox had become endemic throughout Europe and Asia, meaning that most people were probably exposed to it at some point in their lives. Over all, the fatality rate was a terrifying thirty per cent, but among young children it was much higher—more than ninety per cent in some places. Loomis, a professor of biology at East Stroudsburg University, writes that the danger was so grave that “parents would commonly wait to name their children until after they had survived smallpox.” Anyone who made it through acquired permanent immunity (though many were left blind or horribly scarred). This dynamic meant that every generation or so there was a major outbreak, as the number of people who had managed to avoid getting infected as children slowly rose. It also meant, as Loomis rather cavalierly observes, that Europeans enjoyed a major advantage as they “began exploring distant lands and interacting with native populations.”
Alfred W. Crosby, the historian who coined the phrase “the Columbian Exchange,” also coined the term “virgin soil epidemic,” defined as one in which “the populations at risk have had no previous contact with the diseases that strike them and are therefore immunologically almost defenseless.” The first “virgin soil epidemic” in the Americas—or, to use another one of Crosby’s formulations, “the first New World pandemic”—began toward the end of 1518. That year, someone, presumably from Spain, carried smallpox to Hispaniola. This was a quarter of a century after Columbus ran aground on the island, and the native Taíno population had already been much reduced. The speckled monster laid waste to those who remained. Two friars, writing to the King of Spain, Charles I, in early 1519, reported that a third of the island’s inhabitants were stricken: “It has pleased Our Lord to bestow a pestilence of smallpox among the said Indians, and it does not cease.” From Hispaniola, smallpox spread to Puerto Rico. Within two years, it had reached the Aztec capital of Tenochtitlán, in what’s now Mexico City, a development that allowed Hernán Cortés to conquer the capital, in 1521. A Spanish priest wrote, “In many places it happened that everyone in a house died, and, as it was impossible to bury the great number of dead, they pulled down the houses over them.” Smallpox seems to have reached the Incan Empire before the Spaniards did the infection raced from one settlement to the next faster than the conquistadores could travel.
It’s impossible to say how many people died in the first New World pandemic, both because the records are sketchy and because Europeans also brought with them so many other “virgin soil” diseases, including measles, typhoid, and diphtheria. In all, the imported microbes probably killed tens of millions of people. “The discovery of America was followed by possibly the greatest demographic disaster in the history of the world,” William M. Denevan, a professor emeritus at the University of Wisconsin-Madison, has written. This disaster changed the course of history not just in Europe and the Americas but also in Africa: faced with a labor shortage, the Spanish increasingly turned to the slave trade.
The word “quarantine” comes from the Italian quaranta, meaning “forty.” As Frank M. Snowden explains in “Epidemics and Society: From the Black Death to the Present” (Yale), the practice of quarantine originated long before people understood what, exactly, they were trying to contain, and the period of forty days was chosen not for medical reasons but for scriptural ones, “as both the Old and New Testaments make multiple references to the number forty in the context of purification: the forty days and forty nights of the flood in Genesis, the forty years of the Israelites wandering in the wilderness . . . and the forty days of Lent.”
The earliest formal quarantines were a response to the Black Death, which, between 1347 and 1351, killed something like a third of Europe and ushered in what’s become known as the “second plague pandemic.” As with the first, the second pandemic worked its havoc fitfully. Plague would spread, then abate, only to flare up again.
During one such flareup, in the fifteenth century, the Venetians erected lazarettos—or isolation wards—on outlying islands, where they forced arriving ships to dock. The Venetians believed that by airing out the ships they were dissipating plague-causing vapors. If the theory was off base, the results were still salubrious forty days gave the plague time enough to kill infected rats and sailors. Snowden, a professor emeritus at Yale, calls such measures one of the first forms of “institutionalized public health” and argues that they helped legitimatize the “accretion of power” by the modern state.
There’s a good deal of debate about why the second pandemic finally ended one of the last major outbreaks in Europe occurred in Marseille in 1720. But, whether efforts at control were effective or not, they often provoked, as Snowden puts it, “evasion, resistance, and riot.” Public-health measures ran up against religion and tradition, as, of course, they still do. The fear of being separated from loved ones prompted many families to conceal cases. And, in fact, those charged with enforcing the rules often had little interest in protecting the public.
Consider the case of cholera. In the ranks of dread diseases, cholera might come in third, after the plague and smallpox. Cholera is caused by a comma-shaped bacterium, Vibrio cholerae, and for most of human history it was restricted to the Ganges Delta. Then, in the eighteen-hundreds, steamships and colonialism sent Vibrio cholerae travelling. The first cholera pandemic broke out in 1817 near Calcutta. It moved overland to modern-day Thailand and by ship to Oman, whence it was carried down to Zanzibar. The second cholera pandemic began in 1829, once again in India. It wound its way through Russia into Europe and from there to the United States.
In contrast to plague and smallpox, which made few class distinctions, cholera, which is spread via contaminated food or water, is primarily a disease of urban slums. When the second pandemic struck Russia, Tsar Nicholas I established strict quarantines. These may have slowed the spiral of spread, but they did nothing to help those already infected. The situation, according to Loomis, was exacerbated by health officials who indiscriminately threw together cholera victims and people suffering from other ailments. It was rumored that doctors were purposefully trying to kill off the sick. In the spring of 1831, riots broke out in St. Petersburg. One demonstrator returning from a melee reported that a doctor had “got a coupl’ve rocks in the neck he sure won’t forget us for a long time.” The following spring, cholera riots broke out in Liverpool. Once again, doctors were the main targets they were accused of poisoning cholera victims and turning them blue. (Cholera has been called the “blue death” because those suffering from the disease can get so dehydrated that their skin becomes slate-colored.) Similar riots broke out in Aberdeen, Glasgow, and Dublin.
In 1883, during the fifth cholera pandemic, the German physician Robert Koch established the cause of the disease by isolating the Vibrio cholerae bacterium. The following year, the pandemic hit Naples. The city dispatched inspectors to confiscate suspect produce. It also sent out disinfection squads, which arrived at the city’s tenements with guns drawn. Neapolitans were, understandably, skeptical of both the inspectors and the squads. They responded with an impressive sense of humor, if not necessarily a keen understanding of epidemiology. Demonstrators showed up at city hall with baskets of overripe figs and melons. They proceeded, Snowden writes, “to consume the forbidden fruit in enormous quantities while those who watched applauded and bet on which binger would eat the most.”
Eight years later, while the fifth pandemic raged on, one of the most violent cholera riots broke out in what’s now the Ukrainian city of Donetsk. Scores of shops were looted, and homes and businesses were burned. The authorities in St. Petersburg responded to the violence by cracking down on workers accused of promoting “lawlessness.” According to Loomis, the crackdown prompted more civil unrest, which in turn prompted more repression, and, thus, in a roundabout sort of way, cholera helped “set the stage” for the Russian Revolution.
The seventh cholera pandemic began in 1961, on the Indonesian island of Sulawesi. During the next decade, it spread to India, the Soviet Union, and several nations in Africa. There were no mass outbreaks for the next quarter century, but then one hit Peru in 1991, claiming thirty-five hundred lives another outbreak, in what is now the Democratic Republic of the Congo, in 1994, claimed twelve thousand.
By most accounts, the seventh pandemic is ongoing. In October, 2010, cholera broke out in rural Haiti, then quickly spread to Port-au-Prince and other major cities. This was nine months after a magnitude-7.0 earthquake had devastated the country. Rumors began to circulate that the source of the outbreak was a base that housed United Nations peacekeeping troops from Nepal. Riots occurred in the city of Cap-Haïtien at least two people were killed, and flights carrying aid to the country were suspended. For years, the U.N. denied that its troops had brought cholera to Haiti, but it eventually admitted that the rumors were true. Since the outbreak began, eight hundred thousand Haitians have been sickened and nearly ten thousand have died.
Epidemics are, by their very nature, divisive. The neighbor you might, in better times, turn to for help becomes a possible source of infection. The rituals of daily life become opportunities for transmission the authorities enforcing quarantine become agents of oppression. Time and time again throughout history, people have blamed outsiders for outbreaks. (On occasion, as in the case of the U.N. peacekeeping troops, they’ve been right.) Snowden recounts the story of what happened to the Jews of Strasbourg during the Black Death. Local officials decided that they were responsible for the pestilence—they had, it was said, poisoned the wells—and offered them a choice: convert or die. Half opted for the former. On February 14, 1349, the rest “were rounded up, taken to the Jewish cemetery, and burned alive.” Pope Clement VI issued papal bulls pointing out that Jews, too, were dying from the plague, and that it wouldn’t make sense for them to poison themselves, but this doesn’t seem to have made much difference. In 1349, Jewish communities in Frankfurt, Mainz, and Cologne were wiped out. To escape the violence, Jews migrated en masse to Poland and Russia, permanently altering the demography of Europe.
Whenever disaster strikes, like right about now, it’s tempting to look to the past for guidance on what to do or, alternatively, what not to do. It has been almost fifteen hundred years since the Justinianic plague, and, what with plague, smallpox, cholera, influenza, polio, measles, malaria, and typhus, there are an epidemic number of epidemics to reflect on.