“Everybody knows that pestilences have a way of recurring in the world, yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise.”- Albert Camus
Not in the harsh unforgiving winters of the Eurasian Steppe, but the gentle spring when crops are sown, did the Great Plague of 1346 originate. In the estuary of River Don, as it flows into the sea of Azov, local gerbils and voles would often get infected, resulting in smouldering outbreaks. As the mighty Mongols lay successive attacks on the town of Kaffa in modern day Crimea, the infiltrators were struck by the bubonic plague. As the survivors of these marauding attacks gathered their belongings and sailed for modern day Italy, the plague travelled with them.
In Europe however, amongst the golden age of civilization, sprung the golden age of bacteria. Early marketing developments, combined with newer shipping lines, employing wide bellied ships, served as the basis for making a great plague. Large scale increase in populations of the Middle Ages meant land was dear and so was food. Forests were cleared, while small village hamlets turned into a complex network of animal husbandry.
“Many continued hoping that the epidemic would soon die out and they and their families be spared. Thus they felt under no obligation to make any change in their habits, as yet. Plague was an unwelcome visitant, bound to take its leave one day as unexpectedly as it had come.”
Often moving a distance of hundreds of kilometres in a mere fortnight, no one could predict where next would the Black Death rise. Over busy highways, it would take a calmer course of 2 kilometres in a day.
From the town of Kaffa, the plague arrived at Constantinople by early July of 1347. Onwards, it spread to towns of Marseilles, Venice and Genoa. Serving as what would be known today as the modern-day epicentre, it spreads northwards to the Rhone Valley and Leons and southwards to the Spanish Mediterranean coast. The early arrival of Black Death in England marked it northward spread, and by 1349 it had effectively conquered the whole of Europe.
“By the force of things, this last remnant of decorum went by the board, and men and women were flung into the death-pits indiscriminately. Happily, this ultimate indignity synchronized with the plague’s last ravages.”
In 14th Century Italy, authorities speedily established protocols that would still bear relevance today. 40-day quarantines, combined with the construction of emergency primitive isolation hospitals, called pests, resulted in early successes. A black cross would be painted outside the home of an infected person and a guard would be placed outside. By the 17TH century, epidemiologists described the ‘poisoner’, an asymptomatic individual who would infect his own family members.
Among humans, with an incubation period of 2 to 6 days, following which temperatures would rise to 38.8 C to 39.4 C. Soon, the individual would splitting headaches, confusion, lethargy, prostration followed by shock. In 5 percent of individuals, the bubonic plague would reach the lungs, be coughed up and result in the pneumonic plague. By the 6th or 7th day, individuals would struggle to recover or die. Pathognomic would be the god’s token, the black bubo that signalled death within the next five days.
“What’s natural is the microbe. All the rest — health, integrity, purity (if you like) — is a product of the human will, of a vigilance that must never falter. The good man, the man who infects hardly anyone, is the man who has the fewest lapses of attention.”
By the late Middle ages, the Black Death had killed 30-60 percent of Europe’s population, shrinking the world population from an estimated 475 million to 350 million. 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. During the early years of this third pandemic, the ultimate death toll in India and China alone was 12 million.
“Its energy was flagging, out of exhaustion and exasperation, and it was losing, with its self-command, the ruthless, almost mathematical efficiency that had been its trump-card hitherto.”
In the siege of Kaffa, the invading Tartars were besieged by an outbreak of plague. To turn it to their advantage, the besiegers hurled infected cadavers over the walls of the mighty city. With the end of World War II, emerging superpowers heavily experimented with the plague bacillus and contemplated the creation of multi drug resistant and aerosolized versions of the deadly bacteria. In the worst-case scenario, the deliberate release of 50 kg of Y. pestis in aerosolized form over a city of 5 million—pneu-monic plague could occur in as many as 150,000 persons, 36,000 of whom were expected to die from the disease. In conclusion, with the WHO categorizing the plague as an emerging disease, the medical community as well as the public should be educated about the basic infectious disease epidemiology and control measures to increase the possibility of a calm and reasoned response if an outbreak should occur. Vaccines against smallpox, stockpiled for decades even after eradication, should prompt the creation of a cache of bio-defence against other organisms, such as the highly virulent plague.
“Once the faintest stirring of hope became possible, the dominion of the plague was ended.”