THE BLACK PLAGUE

If we asked you the scariest thing a disease can do, you’d probably say “kill you” and in a sense, of course, you’d be right.

But after years of studying the history of disease, we’re a little less impressed by the run-of-the-mill fatal stuff. After all, anything can kill you! Just look around. See that loose screw in the ceiling fan? That blender just a shade too close to the bathtub? That tuna salad you left out in the sun? Death is waiting for you around every corner.

What really gets us excited these days is those diseases that don’t just kill people . . . they change the very course of history. And the plague is just such a disease.

Just how scary was the plague? It’s so scary that “the plague” isn’t a scary enough name; we started to call it “The Black Death” right around the time it wiped out half of Europe. Since the very first plague bacteria infected its first human host, this disease has wreaked absolute havoc on our species. Or at least it did right up until the discovery of antibiotics blunted a bit of the threat. Nonetheless, it has earned itself a place in the hall of fame of history-altering illnesses, which isn’t a real place but probably should be.

The plague is caused by a bacteria called Yersinia pestis. Plague comes in more than one flavor, with multiple forms, each of which affects different systems and organs in our bodies and has its own complications and mortality rates. If you’ve heard of just one type of plague, it’s probably the bubonic one, which gets its name from the impressively swollen lymph nodes known as buboes. These could appear in a sufferer’s groin or armpit and were often large, tender, and hot. While these days we use “the plague” and “bubonic plague” interchangeably, other forms can actually be more deadly. Fun!

While we’re pondering the relative scariness of nomenclature, could we not cook up something a little more threatening than “buboes”? Big, hot, gross groin bubbles and we give them a name that would be more appropriate for an adorable Super Mario enemy? You can do better, science.

A PLAGUE OF PLAGUES

If you’re not into buboes, or just want to be different, you might consider septicemic plague for your next deadly disease. This variant spreads through your bloodstream and can cause bleeding from your mouth or rectum, shock, and even gangrene of your fingers or toes.

Still not convinced? How about the pneumonic plague, which helps you remember large chunks of information with fun acronyms? No, no, actually it primarily affects lungs, and is often mistaken for a really severe case of pneumonia. While its symptoms may sound the least dramatic, this one is actually the most fatal form, and needs to be treated as soon as possible.

Come to think of it, there’s not really a “good” plague to catch.

The plague is not an absolute death sentence, but . . . it ain’t great. Without treatment, about 50 to 90 percent of infected people will die. With modern treatment, that number is reduced to a much-better-but-still-not-all-that-comforting 15 percent.

A BRIEF HISTORY OF PLAGUE

We know now all these details thanks to, well, science. Folks in history weren’t so lucky—which we know because the plague is mentioned as far back as the Bible. In the first book of Samuel, the Philistines are struck with some sort of tumor-causing plague after stealing the Ark of the Covenant from the Israelites. (For more details, seek out the popular documentary Raiders of the Lost Ark.) Descriptions of this disease, as well as the outbreak suffered by the Israelites after the Ark’s return, all seem to point to plague.

In 532 CE, the Great Plague of Justinian spread from Byzantium throughout the Middle East, around the Mediterranean, and over to Egypt, eventually killing some 25 million people. This death toll represented 50 to 60 percent of the Eastern Roman Empire—and at least 13% of the entire world’s population. For the next few centuries history records only minor outbreaks, but that luck didn’t hold. In 1328, the plague appeared in China, quickly spreading along trade routes to Italy, and then to the rest of Europe. This outbreak lasted until about 1351, and wiped out 30 to 60 percent of Europe’s population.

You hear stats like that all the time when you read about plagues, but take a moment to let it sink in. Half of everybody you’ve ever known, gone. Entire towns wiped out, sometimes so quickly that the bodies were left stacked in town squares. We try to keep things light here, but yikes. It’s unfathomable. It’s horrifying. It’s the Black Death.

Sydnee’s Fun Medical Facts

Technically speaking, the Black Death is only used to refer to the outbreak of plague that devastated much of the world, around the middle of the 1300s. That’s what historians will tell you. That said, the name “Black Death” is just too sexy for the media to pass up, so it’s frequently used as an alternate name for the plague wherever it occurs.

SOMEBODY CALL FOR A DOCTOR?

Around the 17th century, we started seeing references to a new kind of specialist, to use the term loosely. Afflicted cities and villages hired plague doctors, supposed specialists in treating the sick and preventing the disease from spreading. These physicians were usually second rate, which is saying something, considering what passed for first rate at this point in history. The average plague doctor may or may not have actually been trained in any sort of medicine, but they all shared one important trait that qualified them for the job: they were willing to do it. They didn’t have much know-how, and they seriously lacked efficient medicines, but they did have some pretty sweet gear.

The Plague Doctor

Your mom probably wants you to be a doctor when you grow up, right? Booooring. Nobody looks good in a white coat, clipboards are lame, and crippling student debt isn’t as fun as it sounds. But wait! What if there was a way to skip all those boring science classes and spend every day dressed like an NPC in Assassin’s Creed? That’s right kids, you too can be a plague doctor. All you need is a spiffy outfit, a bunch of stinky herbs, a nice long stick, and a really strong immune system.

Accessory #1 is a beak-like mask stuffed full of potpourri. The idea was that filtering the bad air through nice-smelling things would help keep you from becoming sick yourself. (Always a great idea!)

Don’t forget your examinin’ stick! Since no one actually wanted to touch an infected plague victim, poking them with a stick seemed like a decent alternative. You know, just a good, old, scientific poke from a dude in Hellraiser-worthy leathers and a mask that smells like grandma’s linen closet.

Leather gear is treated with wax to make it waterproof. In case you get caught in the rain or splattered with disgusting fluids. Mainly the latter.

The Plague Doctor’s hat, robes, leggings, gloves, and boots were made of matching Moroccan leather. Maybe their undies too. We don’t judge.

IN THE AIR TONIGHT

It’s not likely that even the most conscientious plague doctors got much information from their examinations. And even if they had, any theories or findings would have been based on sketchy science at best. We humans have come up with many terrible theories as to why sickness occurs over the years, including magic, evil spirits, vengeful gods, unbalanced bodily fluids, and even the weather. Plague doctors were happy to give you advice (from across the room anyway), but it wouldn’t have been very helpful.

The most popular disease theory at the height of the Black Death was that illnesses are caused by miasma, which is Ancient Greek for pollution. The miasma theory of disease is easy to understand: Sometimes air is just bad and gross, and if you breathe the bad, gross air you get sick. Sure, it kinda sounds like an explanation of disease that your not-so-bright four-year-old nephew would cook up while half-distracted by the TV, but hey, they were doing their best.

Miasmas could arise from anywhere, it was believed, but they came to be associated with poor sanitation. This understanding of disease was totally wrong in the most helpful way possible, because it did indirectly lead to improved sanitary conditions that may well have helped stem the tide of the outbreak. For the first time, people cared about removing the human and animal waste that often littered the streets. In addition, the bodies of the deceased were removed from the home, and buried in pits or burnt. Sure, we were on the wrong track—we wouldn’t figure out the whole germ thing until the 19th century—but at least the train was getting cleaner.

TAKE TWO LIVE CHICKENS AND CALL ME IN THE MORNING

As we’ve established, the plague was terrifying, spreading fast and far, and killing the majority of those who contracted it in many places. Amping up the terror was the fact that nobody understood the disease well enough to combat it effectively. But as with all illnesses and, indeed, pretty much every nigh-impossible challenge in human history, our ignorance didn’t stop us from trying.

Some of the advice is what you’d call wrong, but relatively harmless. A plague sufferer might have been instructed to avoid meat and cheese, eating a diet of only bread, fruit, and vegetables. Their families would have been told to keep patients in bed, wash them with vinegar and water, and place nice-smelling flowers in the room. All pretty benign stuff.

But when these comparatively chill methods proved ineffective, it provoked the plague doctors to come up with new, worse, more deadly strategies. One of the most popular was . . . lancing the patient’s buboes. Remember, we’re talking about those nasty, pus-filled swellings that formed under the patients’ arms or in their groins. Once the buboes were cut open (probably not with the cleanest of surgical instruments) plague doctors would apply a special medicinal mixture to the wound “to facilitate healing.” What would one put on a gaping, still oozing pustule to facilitate healing? Tree resin, the root of white lilies, and human excrement.

Naturally.

Oh, hachi machi does this next part ever get grody. I wish I hadn’t read it, and I helped write it. Ugh. Also, if you notice any really obvious typos, it’s because I was only half peeking from between my fingers while I was blasting some really soothing Sarah McLachlan.

If that sounds too fancy for your tastes, what with the lilies and all, you may prefer the tried-and-never-true method of simply bleeding the patient. Just cut them and let them bleed a bit and then put some clay and violets over the cuts you made. No problem.

Some sufferers turned to extreme religious practices, such as self-flagellation, in hopes of winning forgiveness and healing from above. Others looked to witchcraft, which offered such treatments as drinking one’s own urine or strapping a live chicken to the bubo and waiting for the bird to die. Chickens have had it rough throughout history, but strapped to the oozing, pustule-covered arm of a plague sufferer has still got to be one of the top five worst ways for a chicken to die, right?

An entire field of “pestilence medicine” was developed over the Middle Ages, with fake cures and concoctions aplenty. One such recipe called for the sufferer to roast the shells of newly-laid eggs, crush them into powder, mix that with the chopped-up leaves and flowers of marigolds, put it all in a pot of good ale, add treacle, warm the mixture over a fire, and drink it twice a day. Until . . . well, until you died from the plague.

Sydnee’s Fun Medical Facts

While no one could figure out how to stop the Black Death, a few enterprising young soldiers saw it as an opportunity for victory.

As the plague swept through Europe and North Africa in the 14th Century, a number of conflicts and wars were also going on because, well, humanity. In this instance, a group of Tatars (descendents of Ghengis Khan’s Golden Horde most likely) were laying siege to Caffa, a Genoese port that’s now part of Ukraine. The Tatars were already having some difficulty breaching the city’s defenses, but things went from bad to worse when the plague broke out in their encampment.

In one of history’s earliest examples of bioterrorism, the invading Tatars had the equally brilliant and disgusting idea to toss the bodies of dead plague victims over the city walls. This plan worked, the plague spread throughout Caffa, and the Genoese army eventually retreated.

A WHOLE LOT OF BAD MEDICINE

Finally, when nothing else seemed to work, doctors would just keep making stuff up, hoping to somehow stumble onto a treatment that even remotely made sense. Patients were advised to eat . . . unusual substances, such as rotten treacle, or the powder of crushed emeralds. (Any dirt-poor villager worth their dirt had those lying around, right?) They were told to drink arsenic or mercury, avoid sex, stop going outside, squelch all thoughts of the plague or of death (yeah, that must’ve been a breeze for a plague victim) and last but not least, abandon their homes to go live in the sewers, where the stench of human waste was supposed to provide protection—somehow. (So much for that miasma theory, huh?)

Of course, sewers are often a place where rats happen to live, by the way. Keep that in mind, because that last bit of advice is about to get way more hilarious.

Fleas like to live on rats, and transmit the disease between their human and rodent hosts, allowing it to spread far and wide. It’s easy to see how poor sanitation and overcrowding contributed to the disease’s rapid spread, with all those infected fleas hopping around. Rats also like to live on ships and, since they take their fleas with them, the plague could spread anywhere a ship might sail. Scientists figured this out during the third and last Western plague pandemic in the 1860s, and were finally able to stop the disease from spreading by controlling the rat population.

Rats aren’t the only animal hosts, but with the development of antibiotics, we have a variety of medications that are effective in treating the plague. We’re able to save 85 percent of those infected, which, though obviously not effective enough, is a heck of a lot better than we were doing in the 1350s.

Thus ends our sobering, chapter-long reminder to hug your local scientist today.

JUSTIN VS SYDNEE

JUSTIN: OK, perfect, Syd, we’ve cracked it, it’s so simple I don’t know why we didn’t see it before. We should get rid of all rats. Then we’re good, right?

SYDNEE Well, unfortunately, Justin, a lot of animals can get the plague, including cows and sheep and small ground squirrels and rodents that live throughout the western United States, Africa, and Asia. This has sadly lead to isolated cases and small outbreaks of the plague in these areas ever since, many focused in sub-Saharan Africa and Madagascar.

JUSTIN: . . . Right, yes, but I’m still not exactly clear where we ended up vis-a-vis getting rid of all the rats? I feel like we were both feeling really good about it but now—

SYDNEE: We’re not getting rid of all rats.

JUSTIN: Fine.

SO, WHAT HAVE WE LEARNED?

Although miasma theory proved incorrect, plague doctors were onto something with their masks and outfits; they were essentially early hazmat suits, precursors to those worn by medical personnel treating outbreaks such as Ebola. (Thanks, plague doctors!) Another important discovery for the modern world is that we now know plague is carried by fleas that live on rats. The ones that live in sewers. (Thanks, plague doctors.)