Tuesday, 8 April 2014

The Black Death and Public Health

“What more can be said except that the cruelty of heaven (and perhaps in part of humankind as well) was such that between March and July, thanks to the force of the plague and the fear that led the healthy to abandon the sick, more than one hundred thousand people died within the walls of Florence… How many valiant men, lovely ladies and handsome youths whom even Galen, Hippocrates and Aesculapius would have judged to be in perfect health, dined with their family, companions and friends in the morning and then in the evening with their ancestors in the other world?”- Boccaccio, The Decameron.

Look around you. Wherever you’re reading this, whether in the office or on your phone, look at the people around you. Everyone alive and, hopefully, relatively healthy. Now look at 30-60% of them. Imagine them catching a disease, almost out of nowhere, and succumbing to a gruesome death as soon as one day later.

As macabre as this exercise may be, it barely begins to replicate the situation the people of medieval Europe found themselves in when the plague broke out in the mid-fourteenth century. There is almost no modern parallel that can allow us to emphasize with the horrors wrought by the Black Death, because it wasn’t just the disease itself that ran wild over Europe. Fear itself dominated the continent as this mysterious illness swept through and killed an estimated 100 – 125 million people.

That’s almost double the current population of the United Kingdom.

You were probably taught in school that the bubonic plague came to Europe’s shores by rats carrying infected fleas. It turns out that the rats are only part of the story.

During the development of a new train line through London, workers recently discovered a plague pit of bodies that were buried quickly sometime during the 1348 – 1350 outbreak. By studying the DNA of victims claimed by the Black Death and the makeup of the disease itself, two factors were established.

First, the victims were seriously malnourished. This does not only reflect the state of poverty many people in medieval London lived in, but also reflects the poor harvest suffered during an early fourteenth-century drought, coinciding with the childhood of many people who died during the plague. By being malnourished in childhood, the victims were more susceptible to the disease as adults.

Second, the strain of plague found on the victims is identical to the plague still found today (Y. pestis). Yes, if you didn’t know, we can still catch the Black Death, though thankfully modern antibiotics act as a shield protecting us. Click here (http://www.theguardian.com/lifeandstyle/2014/jan/31/i-caught-plague-from-my-cat) to read the story of one man who recently caught the plague from his cat.

According to the World Health Organization, “Streptomycin is the most effective antibiotic against Y. pestis and the drug of choice for treatment of plague, particularly the pneumonic form,” followed by Chloramphenicol, Tetracyclines, Sulfonamides, and Fluoroquinolones such as ciprofloxacin.  (http://www.who.int/csr/resources/publications/plague/whocdscsredc992b.pdf )


The identical nature of the plague helped to confirm several academics’ theory that the plague was not simply transferred via flea bite, but must have reached a pneumonic phase for it to travel so virulently and quickly as the Black Death did back in the Middle Ages.

It’s easy to dismiss the plague as something for historians to consider or as something that seems almost fictional, a disease for a world of magic and witches. But the Black Death is not nearly so far away us as that. For those of us who live and work in London, the recent discoveries serve as a reminder that we walk the same streets as those bodies found in the plague pit. And for everyone else, it reminds us that if we do not ensure that everyone has access to the same nutrition and sanitation security that we all deserve from childhood, then who knows when the next outbreak will spread?
This article was written by Alexandra Zaleski, Research Executive at Branding Science

For more information about the medieval plague, I highly recommend Rosemary Horrox’s book The Black Death, a compilation and translation of firsthand accounts from the fourteenth century.

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