Written by Kevin Jennings
From the moment the first lymph node under your armpit began to swell, you were already dead. The bubonic plague, or “Black Death” as it was more colloquially known, had already claimed you as its next victim. It began with swelling under your armpits and groin, with these boils becoming the size of an apple. Then, the other symptoms began to set in.
What began as a strange swelling had begun to cause fever, chills, vomiting, diarrhea, fatigue, and terrible aches and pains. As the infection spread, your extremities turned black with gangrene, giving the outbreak its name. Eventually, the plague would spread to the blood and lungs, resulting in death.
The Black Death was not only painful, it was efficient. A person could go to bed seemingly healthy, and already be dead by morning. The disease was caused by the bacterium Yersinia pestis. Because it is a bacterial infection we now have antibiotics that can cure it, but this was not the case in the 1300s when the Black Death claimed between 75 and 200 million lives, wiping out between 30-60% of the population of Europe as well as about a third of the population of the Middle East.
Even after the worst of it had subsided, outbreaks of the plague would continue to recur throughout the world, with some historians arguing that for the next 500 years, somewhere in the world there was always an active outbreak of the plague.
The disease is fortunately now treatable, as it does still come back from time to time. But throughout all of this there was one question that had remained unanswered for nearly 700 years. What was the origin of the Black Death? Where was patient zero of the first outbreak of the 14th century plague? It is only very recently that we may have finally found the answer.
Origins and Spread in Europe
In October of 1347, twelve ships from Crimea docked at the Sicilian port of Messina. When dockhands boarded the ship to help unload the cargo, they were not at all prepared for what they would find.
Instead of twelve ships full of rowdy sailors, they were instead met by corpses. On every ship, most of the crew was already dead. Those that survived will covered in black boils that oozed pus and blood. Immediately the Sicilian authorities ordered the ships out of the harbor, but it was too late. The Black Death had made landfall, and it was there to stay.
There are two main ways that the bubonic plague spreads. The first is bites from fleas or infected rats, with the fleas being the main carrier. For most people, this would not pose a major threat. However, ships were frequently infested with flea-ridden rats. This can help account for how the disease became so widespread so quickly, as any port town could easily become ground zero for a new outbreak.
However, the disease was able to spread inland so easily and rapidly, especially through densely packed cities, because the disease was also transmissible by humans. The bacteria can be transmitted through bodily fluids, and even by breathing as it resides in respiratory droplets. Those struck with the plague were prone to heavy coughing, so airborne transmissions accounted for a larger amount of the spread.
Although the nature of bacteria and the exact cause of the spread wasn’t known, its contagious nature was. People believed that even touching the clothing of an infected person could be enough to infect you. Were that person’s clothing covered in fleas looking for a new home, this could certainly be true.
Early attempts at treating the sick only made things worse. The two main “medical” treatments that were employed were bloodletting and boil lancing. Not only was this in no way helpful, it was extremely dangerous. Needlessly releasing infected bodily fluids would only increase the chances of infection in other people.
Other treatments included aromatherapy and prayer. This was back when miasma theory still ruled the medical community, so pleasant aromas made sense as a means to combat the disease. It did absolutely nothing to help, but it was a logical step to take based on their limited medical knowledge.
As the severity of the Black Death became clear, Europeans also proposed the first theory on the origins of the disease. Their theory was that it was divine retribution, a way for God to punish society for heresy, blasphemy, greed, and fornication.
Combating the Disease
It soon became clear to the people of Europe that bloodletting and pretty flowers weren’t helping. The Black Death was extremely contagious and extremely deadly, made more contagious by the lack of medical knowledge at the time.
The initial pandemic would last from 1347 until 1351. During this time, people began to understand more about how the disease was being spread, and they tried to take appropriate actions to stop the spread of the disease.
Rats were burned in the hopes that the fleas would die along with them. The sick were forced to quarantine and the healthy tried to socially distance themselves as much as possible. This had a major impact on the economy as shops began closing down. Shopkeepers didn’t want to be near customers, and those customers didn’t want to be near one another anyway. Eventually, it became everyone for themselves.
Social distancing became the de facto law of the land. The fear of the Black Death was so great that doctors would refuse to see patients. Priests would refuse to administer last rites. People would abandon their families in the hopes that by running off in isolation, they may just survive this brutal plague.
Many who fled tried abandoning large cities where populations were being absolutely devastated in favour of trying to live a reclusive life in the country. This may have worked out, save for one problem: livestock animals were not immune to the plague. The Black Death killed so many sheep in particular that it resulted in a wool shortage once the disease had subsided. Given that Europe had just survive through the Great Family earlier that century, a plague that wiped out not only people but their livestock was the last thing anyone had wanted.
In an effort to protect coastal cities from unleashing more diseased people into areas that might otherwise have been healthy, a waiting period was implemented. Sailors had to wait 30 days, also called a trentino before they were allowed to leave their ships to ensure that no one onboard was infected. This waiting period was later increased to 40 days. If you are familiar with Italian prefixes, then you’ve already guessed that this was the origin of the word quarantine.
With social distancing and quarantines taking place, there was only one last way to try to fight the Black Death. Since it was believed that the plague was God’s punishment, the best course of action would be to make God happy. There were a couple different ways that people went about this.
Some people turned inwards, reflecting on the nature of their own souls. They would seek penance and try to better their soul in the hopes of being spared and helping convince God to spare the remainder of humanity from this epidemic. There was even a group of upper-class men known as flagellants that traveled from town to town publically seeking penance.
Upon arriving in a new town, they would publically self-flagellate, meaning they beat themselves with heavy leather straps covered in sharp metal. They would repeat this process three times a day, every day, for 33 and a half days. Then it was on to the next town. Since we know enough about science to understand that the plague was just a bacterial infection run amok, we know that this did not do anything medically to help. However, it did provide a large boost of morale to an otherwise panicked citizenry who would feel a sense of comfort watching the public displays of repentance. In a time when people felt completely helpless against impending death, any form of comfort was welcome.
It was also a lot better than the alternative. These people had taken to punishing themselves for their sins, and many people had tried to be better after serious introspection. But the world is full of selfish, narcissistic people. To those people, they could not possibly the problem. The problem was everyone else, and those people needed to be exterminated.
Many communities tried to purge themselves of “undesirables”, the heretics and other such troublemakers in the community. For neither the first nor the last time in human history, the Jewish community found themselves being persecuted, with many thousands of them massacred.
In the absence of non-Christians or other heretics to scapegoat, people would lash out at their neighbours. The Black Death was already tearing people apart, and humanity decided to lend it a helping hand.
Centuries of Recurring Plagues
The peak of the Black Death died down after 1351, but it was far from over. It would continue to return to Europe and the Mediterranean from the 14th through 17th centuries as it retreated out of Europe, heading through the Middle East, Asia, and northern Africa. It may reach Sub-Saharan Africa as well, though there is dispute on when the plague first made it that far, with some historians believing it not to be until the 1900s.
The returning plagues were not isolated, localized events either. In the early 1600s, Italy suffered 1.7 million deaths due to the bubonic plague with nearly another million in France exclusively between 1628 and 1631. It is during the 1600s that the infamous plague doctors with whom we are all familiar originated.
For anyone unfamiliar with the effects of the Black Death, the visage of a plague doctor may have seemed more terrifying than any disease could have been. The plague doctor outfits were surprisingly effective, though for the wrong reasons. They wore long coats and leather gloves, often only touching a plague sufferer with their cane instead of the gloves anyway. Wearing gloves is certainly good medical practice, but the real key was in the masks.
A plague doctor’s mask was very effective at protecting them from the Black Death, so much so that it would have only reinforced the incorrect assumptions that led to their creation in the first place. The purpose of the mask was to protect the wearer from miasma. The beaks were filled with an assortment of 55 herbs and spices to purify the air they breathed and protect them from deadly vapors.
This doesn’t work, but the long beak shape masks which covered the wearer’s nose and mouth did force them to maintain a distance from the infected. While the bubonic plague can be passed from one human to another simply by breathing, this requires being at a very close distance that the masks would not allow. A coughing victim would extend the range they could propel the bacteria, but the doctors’ faces were covered and they probably would have either known to pull back if the plague victim coughed, or simply done so on instinct because no one wants to be coughed on.
Finally, in the year 1897, bacteriologist Waldemar Haffkine developed the world’s first vaccine against the Black Death. It is estimated that 26 million doses of his vaccine were given out over the next 28 years, reducing the plague mortality rate by 50-85%. These days, we’re less sure about that rate.
The studies of the vaccine that exist seem to be of a low quality, and it also appears to primary protect against plague from flea bites. There does not seem to be evidence that if the plague has spread to a person’s longs that the vaccine would protect others from this pneumonic form of the plague. Fortunately, the reason that research on the vaccine is so hard to qualify is because there are fewer and fewer outbreaks with fewer and fewer victims.
But it still isn’t gone. In the year 1900, the plague touched down in both Australia and North America for the first time. Fortunately, it was able to be heavily controlled. The North American outbreak lasted from 1900-1904 entirely in San Francisco’s Chinatown, and the death toll was only 119. Well, we say “only” 119, but that was out of 121 total cases of the disease.
In 1947, antibiotics were successfully used to defeat the Black Death. Five plague patients in Argentina were prescribed streptomycin for the first time, all of whom survived. It’s a huge step forward, but we still aren’t out of the woods yet.
Even in the last decade, there have been multiple outbreaks in Madagascar. The most recent outbreak in 2017 was the deadliest outbreak of bubonic plague in modern times, killing 170 and infecting thousands. The idea that outbreaks could get worse is bad, but there’s something much more terrifying: drug resistant bubonic plague.
Thus far, there has only been a single incident of drug resistant plague. This was also found in Madagascar back in 1996. If an outbreak of such a strain were to break free, the results could be devastating. It wouldn’t be like back in the 1300s thanks to our better understanding of medical science, but every day there were new infections would be a waking nightmare.
Think of how your life was affected by Covid-19, a disease with a 3.4% mortality rate worldwide. Now imagine what it would be like with an outbreak of drug resistant bubonic plague, a disease with a 50-70% mortality rate.
Origins Before Europe
This all finally brings us back to our original point: the true origin of the Black Death. When those ships reached Sicily, the crews were already dead and dying. They brought the plague to Europe, but it didn’t start there. So where did it come from?
For years, the prevailing theory was that it began in East Asia and moved its way west. There were rumours of a plague in China in the 1340s, but there was never any hard evidence that anyone in East Asia died of the bubonic plague until the 1400s. Recent research has proven this not to be the case.
Nearly 140 years ago, excavations near Lake Issyk-Kul in modern day Kyrgyzstan found that there had been a deadly epidemic that devastated the local community. The inscriptions on the tombstones simply listed “pestilence” as the cause of death. The significance of these graves had been a contentiously debated topic, until a paper was published on June 15th of this year.
The paper outlines how the exhumed bodies were tested. By testing DNA samples found in the teeth of the victims of the previously unknown pestilence, it was found that these people did in fact die of the Black Death, making these the earliest known deaths of the 14th century plague.
Though this seems to conclusively prove that the Black Death began not in China but in central Asia, there are still some who are not convinced. Some historians continue to argue that the plague began in China and traveled west along the Silk Road. However, the evidence seems to indicate otherwise and most are convinced that central Asia is the true origin of the 14th century outbreak of the plague. And it could have all started with a single person being bitten by an infected rodent or flea.
Of course, the Black Death of the Middle Ages is the most famous outbreak of bubonic plague in humans, but it still was not the first. There are other plagues throughout recorded history that have been proven or heavily believed to be the result of bubonic plague, but in October of 2015, the oldest case ever was discovered. DNA samples from 101 Bronze Age skeletons were tested.
DNA degrades over time which can make this process difficult, but after careful research, the results were conclusive. The plague has been claiming the lives of humans since at least 3,000 BC. These findings may have finally given an explanation for a sudden and massive migration, the reasons for which had always remained unclear. As hunter-gatherer types who could simply leave the infected behind and move away, the remains that were found are unlikely to have been part of a major outbreak.
These epidemics are more the result of densely packed cities where diseases have the ability to more quickly spread and people have less ability to simply move away. Modern medicine goes to great lengths to protect us from future epidemics, but given how long the Black Death has terrorized humanity, a drug resistant strain of the bacteria will always be a concern. It’s been 26 years since we saw that strain of plague, so let’s just pray we never see it again.