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February 2010 Chirurgeon's Message

The Black Death

Coming out of the East, the Black Death reached the shores of Italy in the spring of 1348 unleashing a rampage of death across Europe unprecedented in recorded history. By the time the epidemic played out three years later, anywhere between 25% and 50% of Europe's population had fallen victim to the pestilence.

Some symptoms of the plague were swellings, called buboes, which were the victim's lymph nodes, and they gave the Bubonic Plague its name. But the bubonic form of the disease was only one manifestation of the horrible pandemic that swept Europe in the 1340s. Another form was Pneumonic Plague. The victims of Pneumonic Plague had no buboes, but they suffered severe chest pains, sweated heavily, and coughed up blood. Virtually no one survived the pneumonic form.

The third manifestation was Septicemia Plague. This sickness would befall when the contagion poisoned the victim's bloodstream. Victims of Septicemic Plague died the most swiftly, often before any notable symptoms had a chance to develop. Another form, Enteric Plague, attacked the victim's digestive system, but it too killed the patient too swiftly for diagnosis of any kind.

Plague is carried by rodents like rats and squirrels, but it is transmitted to humans by the fleas that live on them. A flea, having ingested plague-infected blood from its host, can live for as much as a month away from that host before he needs to find another warm body to live on. When a blood-engorged flea attempts to draw blood from another victim, it invariably injects into that victim some of the blood already within it. If the injected blood contains the bacterium Yersinia pestis, the result is Bubonic Plague. Fleas were, alas, such a part of everyday life that no one noticed them much. In this invisible manner the plague spread from rat to human and to cat and dog, as well.

Pneumonic plague is airborne. It is contracted by breathing the infected water droplets breathed (or coughed) out by a victim of the disease. The pneumonic form was much more virulent and spread much more quickly and just as invisibly.

In the 1300s, the plague killed approximately one-third (20 to 30 million) of Europe's population. In the mid-1800s, it killed 12 million people in China. Today, thanks to better living conditions, antibiotics, and improved sanitation, current World Health Organization statistics show there were only 2,118 cases in 2003 worldwide.

Approximately 10 to 20 people in the United States develop plague each year from flea or rodent bites in rural areas of the southwestern United States. About 1 in 7 of those infected die from the disease. Currently, there is no commercially available vaccine against plague in the United States.

Patients with suspected plague should be hospitalized, placed in isolation, have specimens obtained for plague diagnosis, and immediately treated. If diagnosed in time, plague is treatable with antibiotics.
People who live, work, or play in areas with active plague infection in wild rodents should take these precautions:

  • Eliminate food and shelter for rodents around homes, work places, and certain recreation areas, such as picnic sites or campgrounds where people congregate. Remove brush, rock piles, junk, and food sources, including pet food.
  • Allow health authorities to use appropriate and licensed insecticides to kill fleas during plague outbreaks in wild animals.
  • Treat pets (cats and dogs) for flea control regularly.
  • Avoid sick or dead animals, and report such animals to the health department. Hunters and trappers should wear rubber gloves when skinning animals.
  • Use insect repellents when outdoors in areas where there is a risk of flea exposure.
  • People who travel to countries where plague occurs should take additional precautions.

    THL Blase di Angelo
    Kingdom Chirurgeon


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