The Plague

In 1347 news reached England of a terrible disease that was sweeping the Continent. Named the pestilence, it had seemingly begun on the island of Sicily, devastating the population, then crossed to mainland Italy where it rapidly spread throughout the country causing countless deaths particularly in Florence and Venice. It also crossed the Mediterranean to Marseille, where it established a base, and from there spread throughout northern Europe.

In the summer of 1348 the pestilence arrived in England aboard a merchant ship from Gascony. After docking at Weymouth in Dorset, one crew member, totally unaware he had been infected with the disease before setting sail, soon began to mix with the locals. All he came into contact with were immediately infected and within days the disease was carried out of Dorset by merchants and travellers. Within weeks the whole of England, Scotland and Ireland were being ravaged.

The reason the sailor was unaware he had been infected with the disease was due its long incubation period, which was in excess of thirty days. When the symptons did appear though, death was inevitable and victims faced five days of absolute agony.

The contemporary Franciscan Friar Michael of Piazza described the symptons thus: 'The 'burn blisters' appeared, and boils developed in different parts of the body: on the sexual organs, in others on the thighs, or on the arms, and in others on the neck. The patient was seized by violent shivering fits, which soon rendered him so weak that he could no longer stand upright, but was forced to lie on his bed, consumed by a violent fever. The blood rose from the affected lungs to the throat, producing a putrefying and ultimately decomposing effect on the whole body'. We now know that in the victims' final days, internal bleeding began to liquify the body's internal organs and death was the only happy release.

The plague reached London in the autumn of 1348 and within weeks decimated its population. How many Londoners died is impossible to calculate because no accurate medieval records exist, but modern historians believe it was anywhere between 17,000 and 50,000. Some think half of the city's population was killed, equalling 500,000 people. In Europe the death toll has been estimated at 25 million people, and worldwide a third of the population are thought to have perished. The plague persisted mainly in France for a further 300 years and England's population suffered regularly, mainly due to crews of merchant ships regularly bringing the disease to London and south coast ports.

The Black Death and bubonic plague were always believed to be one and the same thing, mainly because the diagnostic feature of this disease is swelling of the lymph glands – called buboes – and the same sympton had been found in some victims of the Black Death. It was also firmly believed that the disease was spread directly from one person to another. This was disproved in the wake of the most recent pandemic that began in China in 1894 and which, before it subsided around 1910, had circled the globe and killed an estimated 12 million people, mostly in India. Scientists concluded that bubonic plague was caused by a bacterial disease (yersinia pestis) of rodents, spread by their fleas.

This does not mean that rats were the primary carriers of the disease as tradition suggests, but that it was more likely to have been wild rodents such as gerbils, voles and squirrels that were resistent to the virus. A rat died after it had been infected by fleas, perhaps after contact with a wild rodent, and only then did the fleas jump to nearby people looking for a source of food.

Of the three types of disease, bubonic plague is the most common. The bacteria (bacilli) enters into the body's lymphatic system by flea bites, causing large inflamed swelling in the lymph glands depending on where the flea bite occured. Historically, 60% of those infected in this way died.

The second is septicaemic plague, the bacilli entering the bloodstream directly through fleabites, lesions on the skin, or by contact between fleas excrement and scratches. It is almost invariably fatal.

The third type is pneumonic plague, the most deadly of all and usually always fatal. This can be passed directly from person to person by water droplet infection, generally transmitted when someone coughs, or on clothing. When the bacilli reach the lungs, severe pneumonia occurs.

It is possible that human fleas also transmitted the disease between people but disease of pandemic proportion, like the one that wiped out millions in Britain and Europe during the Middle Ages and thousands in Hong Kong in 1894, is still dependent on wild rodents and their fleas.

However, more recent research by scholars *Susan Scott and Christopher Duncan, has caused them to challenge this belief. The real diagnostic feature of the Black Death, they say, was the haemorrhagic red spots that appeared on the chest of victims, which were due to bleeding from damaged blood vessels under the skin. This they believe was caused by a virus spread by droplet infection as opposed to flea-borne dissemination of bubonic plague. A person didn't need to be touched by a sufferer; just standing within 12 feet of them would prove fatal.

The conclusion they draw is that the plague was probably related to a viral filovirus, the infectious agent of Ebola which, today, is the disease that most closely resembles the Black Death. The hypothesis offered is that it was a viral disease of mammals in Africa that escaped thousands of years ago to infect man in Ethiopia. From there it may have moved along the Nile and established a base in the eastern Mediterranean, making many fatal strikes at early civilizations before moving to Mesopatamia in 1340.

Their reason given for the disappearance of plagues in Britain and Europe in the late 17th century, is because those most affected by it i.e. populations of towns and cities, eventually developed a genetic resistence to the virus. Although experts say that Scott and Duncan's filovirus thesis cannot be dismissed, it is not universally accepted.

Where the Black Death came from is also much debated but most historians seem to agree the disease originated in the Gobi Desert, Mongolia. Neighbouring China suffered terribly from the 1328 outbreak, the population there reduced from 125 million to 90 million within a few years. From China the disease travelled on the caravan trade routes across Asia, then on to the known world via merchant shipping. In 1340 the disease moved into Mesopatamia and the Black Sea creating epidemics in the Crimea, then moved swiftly to Constantinople, Alexandria, Cairo and the port of Messina in Sicily. This was the stepping stone to Europe.

Tradition has it that the term 'Black Death' was derived from the blackened and putrefying flesh of plague victims, but in fact the 'buboes' caused by septicaemic plague show up as purple and black blotches. It is thought more likely the term was a mistranslation of the Latin expression for the plague: pestis atra or atra mors. 'Atra' is translated as 'dreadful' or 'terrible' but can also mean 'black'. The term only came into common usage in the 18th century when it was used to differentiate between the plague of 1348–50 and the Great Plague of London in 1665.

It is widely believed that reference to the Great Plague is made in the nursery rhyme 'Ring-a-ring o' roses': the 'roses' referring to the red spots that appear over the buboes, and 'A-tishoo! A-tishoo! We all fall down!' describing the violent coughing of victims and the swift death that follows pneumonic plague.

Although plague gradually disappeared in Britain and Europe in the late 17th century, it is still endemic in parts of Asia and, more surprisingly, in the western states of America where it is spread by rodents, prairie dogs and even infected house pets. The last urban plague epidemic there occured in Los Angeles in 1924–25, but in rural areas 10–15 people are still infected each year. Globally, the World Health Organisation reports 1,000–3,000 cases of plague every year. More Information

* Return of the Black Death by Susan Scott and Christopher Duncan (Wiley, 2004)