What Is The Bubonic Plague?

The history and causes of the bubonic plague and its symptoms.

Bubonic Plague, known also as the Black Death, has been known for thousands of years; China records this disease 3000 years ago. Outbreaks have occurred throughout history, appearing to this day. Perhaps one of the most deadly outbreaks occurred in medieval Asia and Europe claiming an estimated 25 million lives. How do people get bubonic plague and are we at risk for it today?

Plague is spread to humans via fleas from rats infected with the bacteria Yersinia pestis. The fleas bite a human host and the bacteria are passed on. Early symptoms are fever, chills, headache and extreme exhaustion. Next come swollen glands, typically in the armpits and groin area. These infected glands are called buboes, from which the name bubonic plague derives. Incubation from the time of the bite to death from the disease is about two to six days. Unchecked, the disease is quickly fatal, killing 90% or more of its victims.

Plague hit medieval Europe with devastating force in late 1347. Merchants returning to Italy from plague infested Asia landed in Messina, Sicily with most of the hands on board dead. The surviving crew brought the disease ashore with them and it rapidly spread through the population. Plague is highly infectious; the bacteria are spread through droplets of water coughed or sneezed from a sufferer, infected blood or bodily fluid, pus and fleas.

Messina closed their port and sent ships on to Genoa and other ports whose towns were likewise infected. People started dying at alarming rates; so many died so quickly that there weren't enough people to bury the dead. Those who remained uninfected often abandoned their homes and sick family members for fear of contracting the disease themselves.

Panicked people fled cities and towns and ran to the countryside. Pandemonium gave way to pandemic as the bodies stacked up with no one to bury them. From Italy the disease spread to France, Germany and England, Scotland and Ireland and by 1352 fully one third of the European population was dead. Twenty-five million dead meant a severe economic impact and lead to a higher standard of living for those who managed to remain living.

The disease didn't stop all at once. It would abate during the winter when the fleas that transmitted the disease went dormant only to return again when the warmer weather roused the fleas. Europe dealt with plague for many years after its initial burst between 1347 and 1352. Its unclear why the plague hit with such tremendous force and why it tapered off like it did. What is clear is that it left in its wake tremendous change.

It's possible that the plague ushered in the Renaissance and its less puritanical values. Many that fled the cities for the countryside to escape the Black Death took on a shocking (for the times) lifestyle. Eat, drink and be merry, for tomorrow we may die seems to be the attitude that prevailed. When survivors straggled back to the cities and villages, they likely brought these looser morals with them, giving strength to the Renaissance.

During the height of the plague, changes came in the religious arena, too. Believing that the devastating disease was the result of immoral living, a splinter group broke away from the church and grew rapidly. This sect became known as the Flagellants and their method of dealing with the Black Death was bizarre. They believed that repentance was necessary to combat the disease and their form of repentance came with self-flagellation. They carried rods with leather thongs attached to them and at the end of the thongs were metal spikes. This rod was called a scourge and was used to whip the bare back of a Flagellant. These priests traveled from town to town, evangelizing as they went. The Church finally outlawed them.

Yet people remained desperate for something or someone to blame for the horror that overshadowed their lives. Anti-Semitism was no stranger to medieval Europe but it flourished during the Black Death. Jews were blamed for poisoning the water supply and were persecuted and murdered in terrible numbers.

Plague is still with us today and shows its face in three forms, all of which are still deadly if not diagnosed and treated quickly. Bubonic plague is the most common form. Buboes form at the site of the infected fleabite and quickly spread to the armpits, neck and groin. These buboes are excruciatingly painful and can grow quite large. Hemorrhaging takes place under the skin turning it purple and the patient dies usually with in four to six days of infection. Pneumonic plague occurs when the infection is present in the lungs. Many of the symptoms of bubonic plague will be present and accompanied by coughing, coughing up blood and vomiting blood. Death is quick at two to six days. Plague at its worst shows up in the form of septicemia. The disease is carried through the entire body by the blood and the patient experiences a rash followed by some of the other symptoms of plague. Death can be within a day of infection.

Plague is no respecter of borders and it has been known in the U.S. In fact, every year there are anywhere from 1,000 to 3,000 confirmed cases of plague worldwide. The disease is treatable if detected immediately. Because of the short span between onset and death, seeking medical attention quickly is the key to recovery. Perhaps the greatest source of plague in the U.S. has been transmission from wildlife to hunters. Unsuspecting hunters skin the carcasses of their bounty not knowing that their pelts are infested with the plague carrying fleas. Besides rats, squirrels, rabbits, cougars and other game have been known to be carriers of the plague bearing fleas.

In the years 1900-1909, California struggled with cases of plague. Again, a ship coming from Asia carried passengers infected with plague. The ship was quarantined for a while but allowed to enter the port at San Francisco. Along with its cargo, the ship carried rats that were infected with plague. The city and the state spent a great deal of time in denial about the existence of plague, fearing that it would adversely impact the economy. Finally, a bounty on rats was implemented and the plague was brought under control.

According to the U.S. Centers for Disease Control, the last outbreak of plague in epidemic proportions was in 1924-1925 in Los Angeles. Treatment is usually successful with antibiotics; U.S. cases number only 10-15 per year. Since we don't know what made the plague so virulent in the medieval European outbreak, it's difficult to say whether or not a pandemic of those proportions could happen again. However, if the bacteria don't mutate to a more antibiotic resistant strain, modern medicine should be able to continue to cope with the few cases that do appear every year. Historically, influenza has been more deadly than even the Black Death and is known to mutate often. There are plenty of things in the microscopic world that can wipe us out and plague may still be one of them. Only time will tell.

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