The Making of a Pandemic: Bubonic Plague in the 14th Century
By James T. Eastman
The Journal of Lancaster General Hospital, Vol.4:1 (2009)
Abstract: Bubonic plague—a fast-spreading, highly lethal infection caused by Yersinia pestis—is most commonly associated with the 14th century, when it wiped out at least one third of the entire Eurasian population with a rapidly progressive and often fatal illness characterized by lymphadenopathy, septicemia, and pneumopathic effects. The incidence and virulence of this disease has diminished over the years, being limited to well-circumscribed areas by the latter half of the 20th century. However, its recent re-emergence around the world, coupled with an expanded appreciation of its great genotypic and phenotypic diversity, has introduced the threat of multidrug resistance and a modern-day pandemic. This may be avoided through our continued efforts to develop more rapid diagnostic tests and strain-specifi c vaccines, as well as through improved physician awareness, patient education, and close monitoring of environmental and sociopolitical changes that could reintroduce the conditions that contributed to the “Black Death.”
Introduction: In October 1347, several Genoese ships pulled into port at Messina, Sicily. The harbor master noticed crew members who were clearly ill disembarking and quickly sent the ships away. It was too late; within a matter of days, people were dead or dying in the city. The plague had arrived in Europe.
Imagine the questions running through people’s minds: What is this disease? Boils, gangrene, vomiting blood, madness—it must have seemed more like Divine retribution than a potentially curable disease. Where did it come from? Perhaps from Caffa, a Genoese city in the Crimea that was attacked by Mongols who catapulted diseased corpses over the walls to kill or drive off the citizens within; or perhaps from China, where a similar disease was seen years earlier; or from a port along a trade route between China and the Mediterranean. Why does it kill so fast? Carts filled with dead bodies were wheeled past dead rats lining the city streets. But with no knowledge of bacteriology, the most learned medieval minds were unable to make a connection between the animal and the disease. Why were some sailors still alive? Many must have prayed to be similarly exempted.
This article provides modern answers to these questions, and offers lessons from this 14th century pandemic that can be used to avoid such devastation today.