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Epidemiology of the Black Death and Successive Waves of Plague

Epidemiology of the Black Death and Successive Waves of Plague

By Samuel K Cohn Jr

Medical History (Supplement) Vol.27 (2008)

Introduction: Open any textbook on infectious diseases and its chapter on plague will describe three pandemics of bubonic plague. The first, the plague of Justinian, erupted in the Egyptian port city of Pelusium in the summer of ad 541 and quickly spread, devastating cities and countryside in and around Constantinople, Syria, Anatolia, Greece, Italy, Gaul, Iberia, and North Africa: “none of the lands bordering the Mediterranean escaped it”, and it reached as far east as Persia and as far north as Ireland in less than two years and spread through their hinterlands. Historians have counted eighteen waves of this plague through Europe and the Near East that endured until ad 750, if not longer. The second pandemic originated in India, China, or the steppes of Russia, touched the shores of western Europe (Messina) in the autumn of 1347, circumnavigated most of continental Europe in less than three years and eventually struck places as remote as Greenland. While the first lasted just over two centuries and the third a mere twenty-five years in pandemic form, this second wave returned periodically for nearly five hundred years in western Europe. Its last attack in Italy was at Noja (Noicattaro), near Bari, in 1815, but it persisted longer in eastern Europe and Russia. Its cycles, however, lengthened from a hit about every ten years for any locale during the latter half of the fourteenth century to absences of 120 years or more for major cities at least in Italy by the seventeenth century. Despite repeated claims in textbooks, the plague of Marseilles in 1720–1 was not this pandemic’s European finale. In 1743, 48,000 perished from plague in Messina; in 1770–1 over 100,000 in Moscow; and in the Balkans, Egypt, Asia Minor and Russia this Black-Death-type of contagious plague may have persisted as late as 1879.

The ‘‘third pandemic’’ began in the mid-nineteenth century and crept slowly through the Yunnan peninsula until it reached Hong Kong in 1894. From there, steamship commerce carried it across much of the world. However, except for China and India and a few other subtropical regions, its spread (unlike that of the other two pandemics) was limited in epidemic force to coastal cities and even there hardly penetrated beyond docklands. Instead of millions killed, as happened with the previous two pandemics and as Europe feared at the beginning of the twentieth century, death counts of this third pandemic in temperate zones rarely exceeded one hundred.

Few quantitative records such as burials or last wills and testaments or narrative sources that describe the signs or symptoms of plague survive for the first pandemic. But several — Procopius of Caesarea, John of Ephesus, Gregory of Tours, the Antiochene lawyer Evagrius ‘‘Scholasticus’’, the Chronicle of Zuqnn, and Paul the Deacon—report swellings in the groin, armpits, or on the neck just below the ear. Like later chroniclers of the Black Death, Procopius also observed that black pustules covered victims’ bodies.

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