The Black Death
Special Issue: AAEM Tales of COVID-19
Author: Jeff Wade, MD FAAEM
“The Black Death, also known as the Great Plague or the Plague, or less commonly the Black Plague, was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe from 1347 to 1351.”
The plague has been a huge thing in my life. My third year of college I was still pre-veterinary, but starting to be ready to change. I was working for a vet and he wasn’t seemingly happy at his job, and from what I could see the job wasn’t happiness inducing. People call pediatrics and geriatrics, veterinary medicine. Your patients at either extreme of the lifespan are not able to talk to you and tell you what is wrong, nor understand why you are hurting them. And worse, they can have parents/adult children/owners who can be at either extreme: overly helicopter-y and in-your-face about everything or abusive/neglectful assholes. That’s a pretty good argument against veterinary medicine, peds, or geriatrics in my book (literally in my book). And I had just finished a test in my agribusiness/pre-vet major. The test question was: ‘You have just inherited a large quantity of money. You decide to use this money to open a pig farm (EXACTLY what I would do conveniently enough). Please describe in detail how you would setup the farm with room for breeding, food storage, waste disposal, etc.’ Nice.
Then I had my first microbiology class. The teacher read a case report from the Centers for Disease Control’s Morbidity & Mortality Weekly Report (CDC MMWR), a sampling of trending infection or toxic events. The case he read was about a case of modern-day plague. It still exists today, but as people became more used to it after the Black Death & just people’s and bacterial evolution, it is rare and almost only associated with desert rodent exposure anymore.
He described how the bacteria literally fill the blood vessels. And how from getting sick to dying can be as fast as a day or less. They can get the black swollen lymph nodes in the groin & armpits called buboes. This is where the terms Black Death and Bubonic Plague come from. He also talked about how sometimes it can spread to the lungs and become much more easily spread by coughing instead of requiring rat fleas, the typical way of transmission.
This came at THE right time for me. That day I decided to change my major to microbiology and my goal to med school. And I made the right choice. People are much better conversationalists and by virtue of that, much more interesting to work with than animals. As long as you see non-demented/drunk/high adults or older children, you don’t have to torture things that don’t at least understand the reason for the torture. And the adult children/parents/owners issue doesn’t come up.
Since then I have had an interest in the plague. It literally changed the face of Europe. Before the Black Death, Europe was feudal, where the majority of people were essentially the property of the local lord. The tremendous social change initiated by the plague (and other historical trends at the same time), got rid of the feudal system in all but Russia within a 100 years or so. This freeing of the individuals to live where and how they wanted and general mobilization of society was one of the biggest contributors to the Renaissance and modernity in general.
I have found and read several books that deal with the plague since then. One of the best is by the French Nobel winner Camus and called The Plague. It describes a fictionalized version of one of the last modern widespread outbreaks of the plague in North Africa, where Camus was born and grew up. It is a riveting account that includes all the standard stuff you see in an outbreak: dead rats, buboes, mass graves. However, Camus was an Existentialist, meaning he was interested in how people should act in a world where there is not necessarily a God. So the book is also about more than just the rats, it focuses on a group of accidental friends who band together to deal with the situation. Everyone has a crisis of conscience, even the priest. Quite a great book, one of my all-time favorites.
Another is A Journal of the Plague Year by Daniel DeFoe, the writer of Robinson Crusoe. It is about the 1666 London Plague. He was born not long after the plague, so was able to draw on survivors and recent records. It is a purely journalistic account of the plague and gets into the reactions to and management of this overwhelming event. It’s a nice book if you are interested in the plague.
Much later, I found out that Oxford University has summer school for adults who can afford to study in Oxford. We made plans to do that a few years ago after visiting Oxford. When we looked online at the available courses, the one that jumped out at me, was called The Plague. Of course, I took that one. I brought a fake concert T-shirt that I have had for years. It looks like your standard black long-sleeved concert shirt. Except on the front, it has a picture of a rat surrounded by flies and ‘Black Death European Tour 1347-51.’ The back has the ‘concert’ locations. While there, we learned tons about the plague and its societal aftereffects. As this was right after the big Ebola outbreak, it was even more topical. ANY disease, from Ebola to the plague or even the common flu, can mutate overnite and turn drastically more severe and/or more contagious.
We live in a world where when, not if, the next big epidemic comes up, it will be spread worldwide within days.
Get your flu and other shots. And be afraid. Be not so very afraid…
AAEM Tales of COVID-19
AAEM wants you to have a forum to share your thoughts, emotions, opinions, and stories related to the COVID-19 pandemic. Thank you for sharing your ideas with other members so we can get through this crisis together. We will continue to share new stories weekly online and then all stories will appear in the print version of the July/August issue of Common Sense. Submissions are now closed for this special feature.