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The Black Death: What Was It, How Did It Start And What Effect Has It Had?

It's a disease we associate with medieval times, when it was known as the "Black Death", but fears are growing that an outbreak of bubonic plague could be the next global pandemic.

With that fear in mind, scientists behind the Oxford/AstraZeneca Covid jab are working on a vaccine that could give immunity against the disease, which has killed more than 200 million people across the world throughout history.

While Britain has been plague-free for several centuries, there have been recent small outbreaks in other parts of the world, last summer, the WHO added the bacteria that causes the illness to its pathogen prioritisation watchlist of potential pandemic triggers.

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At present, cases of bubonic plague can be treated with antibiotics, but worries about the potential emergence of an antibiotic-resistant strain of the Black Death superbug has led to calls for the UK to find a vaccine to add to its stockpile, said The Telegraph. Trials of the newly developed vaccine on healthy adults began in 2021, and results have now shown it to be safe and able to produce an immune response. Professor Andrew Pollard, director of the Oxford Vaccine Group, who is leading the study, told The Telegraph that the results will be submitted to a journal for peer review "within weeks", and further clinical trials will take place.

Bubonic plague does continue to infect and kill people today, particularly in rural parts of Africa, Asia and America. There are even about seven cases in the US each year, although only 14 deaths were recorded between 2000 and 2020. "The risk of contracting bubonic plague in the UK is currently very low," Professor Pollard told The Telegraph.

As well as potentially saving lives, the development of the vaccine also "addresses broader challenges of managing re-emerging infectious diseases in a world increasingly interconnected by trade and travel", Select Science said.

What was the Black Death?

The Black Death, caused by the spread of the yersinia pestis bacteria by rats, was a devastating pandemic that first struck Europe in the mid-1300s, when it's estimated to have killed up to two-thirds of the population. Its name is a "reference to the gangrenous blackening and death of body parts, such as the fingers and toes, that can happen with the illness", said the BBC.

There are three different types of plague: bubonic, pneumonic and septicaemic ."If left untreated, the bubonic form has a 30 percent to 60 percent fatality rate and the pneumonic form is almost always fatal. Both bubonic and pneumonic plague can develop into a life-threatening infection of the blood called septicaemia," said an Oxford University briefing for the Oxford Vaccine Group.

Where did it come from?

A popular theory was that the Black Death originated in China, but "an international team of researchers now believes" that the 14th-century pandemic "began in Kyrgyzstan", wrote Clive Cookson, science editor at the Financial Times, in 2022. "Some tombs near Lake Issyk-Kul are inscribed with the word 'pestilence' in the Turkic language."

The researchers analysed DNA from human remains in two cemeteries in the Tian Shan region that saw a surge of burials in 1338 and 1339. Lead author Maria Spyrou, from the University of Tübingen, said: "We found that the ancient strains from Kyrgyzstan are positioned exactly at the node of this massive diversification event. In other words, we found the Black Death's source strain and we even know its exact date: 1338."

Her study also suggested the Black Death was originally spread from fleas on marmots and then moved into fleas on rats and then to humans through fleabites.

The "buck-toothed and fluffy" marmot might seem relatively harmless but "it could have been to blame for killing half of Europe", said The Telegraph.

The plague, seeded in what is now northern Kyrgyzstan, is thought to have jumped into a community of Christian traders "who then spread the disease via the Silk Road".

It arrived on the British Isles in 1348, travelling on boat from the then English (now French) province of Gascony, and the speed with which it spread has led scientists from Public Health England's Porton Down science labs to argue that it began to spread by air, making "its way into the lungs through coughs and sneezes", said History.

Between 1346 and 1353, the plague destroyed a higher proportion of the population than any other single known event. "The living were scarcely sufficient to bury the dead," said History Extra.

How did it end?

Most theories suggest that it was the imposition of quarantine measures that ensured the end of the Black Death. People would remain in their homes and only leave when it was necessary, to avoid becoming infected, while wealthier individuals would leave densely populated areas to live in greater isolation.

Improvements in personal hygiene are also thought to have played a part, alongside the introduction of cremations rather than burials, due to the sheer number of bodies.

In subsequent years, further plague epidemics hit the UK, with the worst outbreak since the Black Death beginning in 1665, when London lost around 15% of its population. It's commonly believed that it was finally wiped out by the Great Fire of London in 1066 – a good story, but sadly not true, said the London Museum. In reality, the number of deaths had been in decline before the fire, and continued after it. "We're still unsure why the plague did not return to our shores after it faded out in the 1670s, but it wasn't due to London's terrible fire," the museum's site said.

What is the Black Death's legacy?

"A historical turning point, as well as a vast human tragedy, the Black Death of 1346-53 is unparalleled in human history," said Ole J. Benedictow at History Today.

It would take 200 years before Europe alone was able to replenish its population to pre-plague numbers, while the world also suffered monumental setbacks in terms of labour, art, culture and the economy.

There is also an argument that some people today are susceptible to certain diseases because of DNA passed down the generation by plague survivors, said Fortune in 2022, citing a study that found that "genetic variants identified as protective against the plague are associated with Crohn's disease, rheumatoid arthritis and lupus".

However, in 2024, a team from the University of Cambridge said their own studies of skeletal DNA from people living before and after the plague in Cambridgeshire could find no "substantial evidence that the Black Death has shaped the genetic make-up of surviving individuals", said scientific news site Technology Networks.

Where is the Black Death found today?

With the exception of Oceania, plague can still be found on all continents as an animal disease, and there continues to be a risk that it can transfer to humans, reported the WHO.

While epidemics have occurred in Asia and South America, most human cases since the 1990s have been in Africa. The three most endemic countries are the Democratic Republic of Congo, Peru and Madagascar, where cases of bubonic plague are reported nearly every year.

Plague Transmission May Have Begun A Century Before The Black Death, Study Shows

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In The Wake Of The Plague: The Black Death And The World It Made

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In the Wake of the Plague: the Black Death and the World it Made Hello, I'm Ben Wattenberg. The plague that struck Europe in the middle of the fourteenth century wiped out nearly twenty million people. But according to a recent book by Norman Cantor, In the Wake of the Plague: The Black Death and the World it Made, that disease also forged a new world dedicated to the proposition that men had better learn how to shape their destiny scientifically. The topic before the house, In the Wake of the Plague, this week on Think Tank. The Black Death, believed to be bubonic plague, possibly mixed in with anthrax, killed between thirty and fifty percent of Europe's population in the years 1348 and 1349. Norman Cantor writes that it was 'the greatest biomedical disaster in European and possibly world history.' A contemporary writer in Florence referred to the 'extermination of humanity.' Franciscan friars were preaching that the pestilence was God's punishment wrought upon sinful people. The astrologers had their own take on the matter; a special commission in France determined that the problem was that Saturn was in the house of Jupiter. Of course, nothing worked. It is Cantor's view that this failure accelerated the birth of modern science and modern medicine. It also shook the basic economic and political institutions of medieval life to their core. Welcome to Think Tank, Norman Cantor.Cantor: Thank you.Ben: Let me begin by confessing uh, ignorance about the Middle Ages, the Dark Ages. Can….Can you just begin to sketch out what life was like then.Cantor: Well the Middle Age was a very hierarchic society, very class-ridden society. And the life of people in the classes were very different from one another. The life of the uh, of the nobility.Ben: We're talking Europe now basically.Cantor: We're talking Western Europe.Ben: Right.Cantor: Although you find about the same thing in most of the Mediterranean world as well. The….The life of the aristocracy was uh, one of a very high income. These were very rich people, had enormous income from their landed estates and from the work of peasants. They ate uh, a very elaborate uh, food and uh, they consumed enormous amount of wine, they dressed extremely well. Uh, their uh, domestic architecture we would find rather sparse but uh, they lived in large houses and uh, they were very comfortable. The uh, down side of their life was one which they were very frequently engaged in war. They were a military society. Uh, local wars and national wars, international wars….Ben: The international, the famous international wars…..Cantor: Right, the Crusades.Ben: Crusades, right.Cantor: And the Hundred Years War between England and France in….In the, from 1340 to 1450 uh, England and France was at war about half that time. The armies were about thirty/forty thousand and uh, very heavily armored. And to be a uh, to be an influential important member of the aristocratic class, you had to be a good fighter. You had to be able to carry a….A sword and a lance; you had to be able to engage in individual conflict.Ben: Now would…that must have involved what, the top one percent of the population?Cantor: About one to two percent. Down to about 1300, most of them were serfs.Ben: Now the year of the Black Plague was….Cantor: Thirteen forty-eight, thirteen fifty.Ben: Okay. Coming up to that period, as I understand it from your very fascinating book - I must say - uh, conditions in Europe were fairly prosperous, is that right? I mean as…Cantor: Conditions in Europe had been extremely prosperous in the twelfth and thirteenth century because it was a period where there was no infectious disease and the environment was a very good one. It was a period in which the climate of Europe had warmed up one or two degrees. The summers were longer uh, the harvests were very uh, good. There was no famine. After 1300 you had about forty years of environmental change in which you had a deterioration of the weather.Ben: Getting cooler?Cantor: It got cooler. In two summers of 1316 and 1317, it….It was cloudy and rainy almost the whole of those two summers and there was two years of crop failure. Most historians believe that this was due to a explosion of volcanoes in the East Indies in 1315. And these massive clouds moved over Europe, blocked out the sun and resulted in two years of crop failure. And when you have two years of crop failure in any pre-modern society, you will have famine. So 1317 was the year of famine in….In uh, Europe and the deterioration of the food supply. This, of course, did not affect the aristocracy or uh, most of the gentry. But it affected the peasants.Ben: They….They still kept eating those pigs with the apples stuffed in their mouths.Cantor: They….They still continued to eat very well, yes. Of course, the price of food went up. They had to pay more of their income for food. It….It fell on the peasants, probably two, three million peasants died of hunger in Europe in the 1317.Ben: Okay, so we (throat clear), we had some global warming and conditions got better, not worse for a while. And then, tell us about the plagueCantor: The plague began uh, in Italy in uh, the late months of 1346. Uh, some historians believe uh, it migrated in from East Asia. Others, including myself, think more likely it came from Africa up the…up the Nile and into the Eastern Mediterranean. But I don't know if we'll ever know that for sure. Uh, there was a very severe plague in the later months of 1346 in the cities of Northern Italy, like Florence and Genoa.Ben: And this is the Bubonic Plague?Cantor: This is Bubonic Plague. About 80 percent died of Bubonic Plague. Uh, it….It is my view that at least in England, and maybe some other historians and biologists, about 20 percent of the people in England actually died of anthrax. That is 1347, there were two great pandemics or infectious diseases going on in England.Ben: Were they related or not?Cantor: Well, they're not related biochemically. But what people witnessed, there was a relationship in that the first uh, four or five days of Bubonic Plague and the symptoms of anthrax are very similar.Ben: Let's uh, have you march us through the…the sequence of what happened in…in The Black Death where it starts in Northern Italy in 1346….Cantor: Well it reaches England in…in uh, the early months of 1347 through the Port of Bristol. The Genoese merchants had just opened direct sea communication by shipping directly from Genoa to England. The first time you had had uh, direct overseas shipping. And they, it's a probably very likely brought in. Uh, Bubonic Plague is uh, carried by uh, fleas uh, on the backs of rodents. Uh, in the Middle Ages, probably black rats were most common and….Ben: But the fleas were the actual culprits.Cantor: The…the fleas are the carrier. If the black rat dies, the fleas will seek to migrate to the closest warm body which is likely to be a human being.Ben: And….And then, so this plague develops and what starts wiping out populations?Cantor: Well it's a…a vast disaster. I mean it's like a….A nuclear bomb had dropped on the country. In 1347 and 1348, England lost 40 percent of its population.Ben: That's as if America today lost, what, a hundred and twenty-five million people, something like that.Cantor: That's right. And it fell hardest on the working class, on the peasantry. But it also fell upon members of the royal family, upon the aristocracy, on the bishops. It was a somewhat of a democratic uh, epidemic because they didn't know the cause of it.Ben: And…and…..Cantor: They had no idea that it was the….The rats that were spreading it. That wasn't known until the Eighteenth Century. So those who were not in the prime of life, were not in their twenties and thirties, were the most susceptible to it. But people at all ages died of the Bubonic Plague.Ben: This was regarded, I gather in part, as God's ret….Retribution?Cantor: Well that's the first response, I mean this society, you understand, medieval medicine was not entirely quackery, not entirely nonsense. And uh, they had a lot of pharmacy, a lot of natural herbal remedies, some of which were effective against things like headaches and stomachaches. But they did not have a concept of a disease being spread by microbes. They did not….They didn't all have microscopes and it was not actually uh, until the eighteen….Eighteen seventies that medicine fully concluded that infectious diseases were caused by the spread of microbes by Robert Koch in Germany, Louis Pasteur in France. The people had begun to suspect that since 1600, it wasn't definitely established. And they could begin to think of how to create antidotes. These people in the Middle Ages did not have that kind of concept uh, of uh, of medicine. So how did they respond to this? Well the first response is that of faith healing. Faith healing was the prime remedy of the Middle Ages so with…with the coming of the Black Death, you had religious procession. Uh, the churches were full, there were special prayers. Uh, the bishops put on their finest vestment and carried crosses and saints' relics through the streets. However, so many people died that uh, they began to have some doubts uh, about how effective this was. Another explanation that was very popular in France was astrological. They took astrology very seriously in the Fourteenth Century. And the King of France appointed a commission of professors at the University of Paris, which was the leading university in Europe, to tell 'em what was the cause of the….Of the Black Death which hit Northern France almost as badly as England. And they came back six months later and told 'em it was because of bad astrological signs. It did occur to people that flight into under-populated areas might be helpful. The royal family in England, by 1347, all but one of them were hiding out at very….They went to their furthest castles in Scotland and Wales where the population was very thin. But by the sheer fact of going out to thinly populated areas uh, it…..The level of mortality was noticeably lower. And some cities uh, in…in large cities in Europe tried quarantine. That was a favorite European approach to epidemics.Ben: One of the demographic movements, as I understand it uh, uh, was of Jews from Western Europe to Eastern Europe which were lesser populated, is that correct?Cantor: It was noticed by Christians in uh, Northern Spain and in Germany that the incidence of…of Black Death in the Jewish communities seemed to be lower. And that was probably because Jews had better public health, the rabbis were very instructive as to uh, how people should take care of themselves. The Jews were less affected by the Black Death and a result of this uh, rumors spread the Jews were causing the Black Death by poisoning wells. And there was a great outbreak of pogroms in Western Germany in the second half of the Fourteenth Century. And this uh, caused the beginnings of the great migration of Jews eastward. About a million people, million Jews migrated to Poland from about 1380 to about uh, 1550. This is the rise of the great uh, Jewish population in Eastern Europe and the beginning of the founder of the great Talmudic Academies. And when the Jews left Germany, they took their German language with them. Yiddish is the late Medieval German dialect which is written in Hebrew characters but it's…it's initially it was pure German.Ben: Uh, a point you make in the book and perhaps you can elaborate on it for us, is…is that this terrible catastrophe begins a movement of western thinkers toward science, that if…if astrology can't do it and religion can't do it, we better figure out what's doing it through the scientific method.Cantor: That is true.Cantor: The origins of modern science lie at Oxford University between 1320 and 1350. There was a group of uh, philosophers and mathematicians at Merton College, Oxford which is still there, you can still see it, who uh, were working out the beginnings of modern physics and uh, were making progress. Uh, they were uh, replacing the old uh, Greek science of Aristotle with a physics that turned into the physics of Galileo and Newton. This was the beginning of…of modern science. The leader of them uh, in the thirteen forties was a man named Thomas Braderdeen who had been an Oxford professor. And he and some of his colleagues saw that the way forward was to take the scientific method which they had been applying to physics and the falling bodies and velocity and uh, you know, algebraic proportions in nature to uh, take this kind of analytical and mathematical approach to all aspects of physical existence.Ben: Including medicine?Cantor: Including medicine. The problem is there was severe impediments. They didn't have microscope, that didn't come along until after 1500.Cantor: They had, they could have developed uh, microscopes. They had the….Developed the science of optics was very well developed. People for the first time began wearing corrective eyeglasses about the time of the Black Death. So they could have….Could have invented a microscope; they had the science for that. Their….Their other problem was that the uh, church uh, as is true in some countries today, uh, was opposed to dissection of the body. I mean their knowledge of uh, the body, of physical contours was pretty good but it was only external observation.Ben: Do we have some documentation or some sense…I mean was this part of a….An organic arc or….Or were there some people very specifically saying, 'Oh my God, look at what has happened to civilization. Here's a palpable moment, let's do something and head out in a new path to deal with these sorts of things.'Cantor: In the writings of uh, Thomas Braderdeen, you find remarks like that. And in the writings of a professor at the University of Paris named Jean Buridan, about the same time, you find these kind of writings.Ben: After the Black Death or during?Cantor: About the time of the Black Death. The need to apply what they identified as a scientific and experimental method, to try and apply it to the….In the fields of biology. But it actually didn't occur until the Sixteenth Century.Ben: The whole thing is…is uh, quite astonishing. This event occurred six hundred and fifty years ago and you're still writing books about it, people are still talking about it, we still have nursery rhymes, this 'ring around the rosy, pocketful of posy,' that…that is straight from, 'all fall down,' that is straight from the Bubonic Plague.Cantor: We have records of it going back to 1500 and it describes the symptoms of Bubonic Plague. Psychiatrists and folklorists tell us that children often develop defensive games when they face some horrible disaster, they turn it into a nursery rhyme and a game where people went around in the circle and then they all fell down.Ben: So that happened six hundred and fifty years ago and here we are beginning the Twenty-first Century and human beings have uh, microscopes and they have antibiotics….Cantor: Antibiotics…..Ben: Antibiotics and they have, up here on….In Maryland the great biotech corridor going into the human genome and in Atlanta the Centers for Disease Control and often you get the sense that modern man is pretty smug that anything of this sort we can handle.Cantor: Well there was a period of great optimism uh, between I would say about 1950 and about 1980 that uh, a high tech medicine using antibiotics, using the magic bullets uh, could encounter and uh, stave off and eliminate any kind of infectious disease.Ben: And in fact that remarkable….Cantor: And it was great, I mean tuberculosis, for instance, was devastating in the Nineteenth, early Twentieth Century. And then we know about uh, what happened with polio and the polio vaccine. But since around uh, 1980, there's been some doubts uh, uh, are creeping in. First of all, some of these infectious diseases like tuberculosis that had seemed to have been eliminated uh, started coming back in…in more uh, extreme strains. There is a….A new strain of tuberculosis that is much more resistant uh, to antibiotics and more of …..Of a danger. We do have a terrible problem with HIV…Ben: Well I wanted to talk about that.Cantor: …which is devastating sub-Saharan Africa. In Africa, you don't….You….You lack the infrastructure. Only 15 percent of the people are literate. The medical profession is not trained to deal with….With uh, massive uh, uh, outbreaks. And the costs of…of the medicine are…are prohibitive. Of course, there's talk now that the UN is gonna provide the money and the pharmaceutical companies will sell it at cost but you have a tremendous fiscal problem there, billions of dollars a year and you gotta really change the whole uh, political and educational infrastructure.Ben: Let me ask you just one quick question in….In closing uh, Norman Cantor. We're at the beginning of the Twenty-first Century. If you had to look out, you're a historian and you look back six hundred and fifty years - I'm gonna give you a simple one, a simple problem - just look forward a hundred uh, is…is it likely, in your judgement, that the world will see some truly great plague of the magnitude of the Bubonic Plague?Cantor: It's not likely but it's quite possible. I mean it's the opinion of…of uh, of scientists, it's the opinion of experts uh, that this could happen. Uh, a month ago I uh, I was invited to speak to the Board of the Institute of Medicine of the American uh, uh, of the American Academy of Sciences here in Washington, to about 40 people and all in uh, medical profession. And they were holding a special two-day session just on the question you have raised. Is infectious disease in some mass outbreak, in some kind a threat to us? And they looked upon the Black Death as….As instructive. They wanted me to come and talk about it because they…they think it could….We could, yes, we could have another terrible catastrophe. In 1918, there was a great outbreak of infect…..Infectious disease called the Span…Spanish Flu. More people died in this country in the year following the end of the First World War of the Spanish Flu, so-called, than died on the battlefields of Europe, which was about a hundred thousand Americans. And you know, medical science has never identified what the Spanish Flu really was. It's called that because one of the initial outbreaks occurred in Spain and the people developed severe flu-like symptoms and then died. But they really don't know what it was and in the last five years they've been trying to dig up bodies in Spitzbergen, Norway and in Alaska uh, of people who were victims of the flu and who were buried in permafrost and who might have uh, cells which they can analyze. But they….They really don't know, it may not turn out to be flu at all. And it was a very peculiar disease. It came on very fast and just at the point it seemed totally out of control, it stopped and no one knows why it stopped. They never…didn't have any antidote. This was before antibiotics. Suddenly over a three-month period it was gone.Ben: Do we have any idea whether or not a flu vaccine would work against that strain?Cantor: They don't know because they don't know what it was, that's the point. They're trying to find out what that strain was and whether the current flu vaccines would….Would work.Ben: Well on that happy note (laugh), we thank you so much for joining us and congratulations on a….On a truly uh, wonderful book.Cantor: Thank you.Ben: Uh, Professor Norman Cantor. Uh, and thank you. Please remember to send us your comments via e-mail. For Think Tank, I'm Ben Wattenberg.

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