The Plague The citizens of Gloucester thought that the disease must be somehow contagious and expected that by closing their gates to refugees from Bristol, they would be able to prevent its incursion. Yet, the Black Death was rarely spread from person to person by normal viral means, and when it was, it was in such a virulent form that the carrier was usually dead before they could pass the disease on to anyone outside their immediate household. The plague was caused by a complex series of bacterial strains called Yersinia pestis (Y. pestis), found in the digestive tract of fleas. It usually lives in the fleas of animals, Xenopsylla cheopsis or Cortophylus fasciatus, but in exceptional circumstances, it can live in the human flea Pulex irritans, and can even 'hibernate' for up to 6 months in favourable conditions like dung-piles or cargo bales. There are 3 varieties of plague: bubonic, pneumonic and septicaemic. In general it is benign, but occasionally, for reasons the epidemiologists still do not understand, the bacilli multiply in a flea's stomach until they cause a blockage. The 'blocked' flea then regurgitates these into its victim's bloodstream whilst feeding, infecting them with the plague. There are 3 varieties of plague: bubonic, pneumonic and septicaemic. Bubonic is by far the most common. About six days after suffering the infected flea bite, the victim develops a blackish pustule at the point of the bite. This is followed by a swelling of the lymph nodes in the affected limb as the body tries to cope with the infection. These are the buboes, from which bubonic plague gets its name. Finally, subcutaneous haemorrhaging occurs, causing purplish blotches. The bacilli overwhelm the nervous system, causing neurological and psychological disorders which may go to explain the danse macabre rituals associated with the Black Death, and killing 50-60% of its victims. Top

Variations Pneumonic plague is a more virulent form, caused in cold weather when the infection moves into the lungs and results in a form of pneumonia. The victim is wracked by fever and starts coughing up blood, which contains plague bacteria and makes transmission airborne. Neurological difficulties and coma follow infection, and death is 95-100% certain within three days. Pneumonic plague is a more virulent form. Though pneumonic plague is far less frequent than bubonic, it is much more virulent. Septicaemic plague is caused when vast numbers of Y. pestis bacilli enter the bloodstream and overwhelm the system. A rash forms within hours and death occurs within a day, before the buboes even have time to form. This form of plague is always fatal, but very rare because it is flea-borne and the victim is usually dead before transmission can occur. Some very particular things have to happen for an epidemic of plague to break out: An infectious rodent population must be present, in which an 'epizootic' outbreak has been caused by blocked Y. pestis carrying fleas.

The temperature must be between 15-20°C, with 90-95% humidity, since cold and heat retard the flea's activity, whilst humidity of under 70% kills it. This limits the outbreaks to particular seasons in Europe.

The fleas must run out of rodents, forcing them to fall-back on man. Top

Origins The plague bacteria is thought to have spread from the arid plains of central Asia. The plague generally left untouched the indigenous nomad population, because rat fleas do not like the smell of horses, with which the nomads lived in close proximity. However, from the mid-thirteenth century, increased commercialisation in Europe opened up silk routes through the steppelands, and the trading posts set up to service this trade formed convenient stepping-stones for infected fleas to break out of the area. The first known victims of plague were probably a community of Nestorian Christians at Issyk Kul, south of Lake Balkash, whose cemetery explicitly records three plague victims in 1338-9, a year in which there were unusually heavy mortalities. In 1343, it had reached the Black Sea port of Kaffa (Theodosia) in the Crimea. There, a Genoese colony was under siege from a khan of the Golden Horde named Yannibeg, when his army was decimated by an outbreak of plague. Determined to make his enemies suffer the torments of his men, he ordered that bodies of plague victims be catapulted into the city. The Genoese hurriedly dumped these into the sea, but the plague spread anyway. Taking to their ships, the fleeing Genoese carried the plague far and wide. His army was decimated by an outbreak of plague. The dead bodies of plague victims were hardly likely to be infectious: they would have been abandoned by fleas in favour of living hosts, and they were in no position to cough up infectious pneumonic phlegm onto their enemies. Like Gloucester after it, the locked gates of Kaffa were undoubtedly penetrated by questing rats, carrying infectious fleas on their backs. No amount of hasty corpse-dumping was likely to save the already doomed town. The plague was now set to sweep through the whole of Europe with only a few isolated pockets escaping the disease. Top

Who was to blame? The Black Death was blamed on evil humours carried in the air or earthquakes releasing poisonous fumes. In Europe, the Jews were blamed for poisoning the wells (an explanation which was impossible in England thanks to Edward I's expulsion of the Jews in 1290); and of course, it was also blamed on sin. If I am asked what is the cause of pestilence, what is its physical cause and by what means can someone save himself from it, I answer to the first question that sin is the cause. To the second question, I say that it arises from the sea, as the evangelist says: "There shall be signs in the sun and in the moon and in the stars; and upon the earth distress of nations, by reason of the confusion of the roaring of the sea and of the waves." For the devil, by the power committed to him when the seas rise up high, is voiding his poison, sending it forth to be added to the poison in the air, and that air spreads gradually from place to place and enters man through the ears, eyes, nose, mouth, pores and other orifices. Then, if the man has a strong constitution, nature can expel the poison through ulcers, and if the ulcers putrefy, are strangled and fully run their course, the patient will be saved, as can be clearly seen. But if the poison should be stronger than his nature, so that his constitution cannot prevail against it, then the poison instantly lays siege to the heart and the patient dies within a short time, without the relief that comes from the formation of ulcers. (Anon. BL Sloane MS 965, folio 144.) This does have a perceptively accurate diagnosis of the symptoms and epidemiology of the plague; for those who contracted the bubonic form were much more likely to survive than those who never developed buboes in the pneumonic or septicaemic form, and the plague was carried to England via the sea. Yet those implicit assumptions of sin and God's wrath were often to hamper any attempt to deal with the crisis. Top

Sin or prayer? On 24th October 1348, Bishop Edendon of Winchester issued an edict throughout his diocese, known as the 'Voice in Rama' Speech because of its opening line, which once again graphically underlines this conflict in understanding: A voice in Rama has been heard, and much lamentation and mourning has echoed throughout the world*... We report with anguish the serious news which has come to our ears, that this cruel plague has now begun a similarly savage attack upon the coastal areas of England. we are struck by terror lest (may God avert it!) this brutal disease should rage in any part of our city or diocese. Although God often strikes us, to test our patience and justly punish our sins, it is not in the power of man to understand the divine will. But is to be feared that the most likely explanation is that human sensuality - that fire which blazed up as a result of Adam's sin - has now plumbed greater depths of evil, producing a multitude of sins which have provoked the divine anger, by a just judgement, to this revenge. Bishop Edendon *Rama: This is a reference to Matthew II·18: 'A voice in Rama was heard, lamentation and great mourning; Rachel bewailing her children would not be comforted, because they could not." It is a reference to the Massacre of the Innocents. Half of Hampshire's population died. The local populace, anxious of the evil humours being given off by the bodies of the plague victims, mobbed a monk of St Swithun's. He goes on to exhort his flock into concerted prayer and confession of their sins, for which he grants a 40-day indulgence to any who take part in a procession and mass of purification. All to no avail. The plague struck all along the Hampshire coast, ravaging his diocese, which was one of the most severely hit due to its coastal nature. Half of its population died. Yet throughout, Edendon continued to berate his flock with the wages of sin: "Sickness and premature death often come from sin and by the healing of souls, this kind of sickness is known to cease." He insisted that all burials must continue to take place on consecrated ground, but by January 1349, the cemeteries of Winchester had become swamped. The local populace, anxious of the evil humours being given off by the bodies of the plague victims, mobbed a monk of St Swithun's, the Cathedral Priory, as he was conducting a burial service, wounding him and dragging the corpses out of the town. The outraged Bishop Edendon ordered the excommunication of all concerned, but in the face of public pressure bowed to the inevitable and ordered the opening of new cemeteries away from the centre of the town. Top