The Black Death

The Plague, aka the black death, aka bad news, is a disease most people only know from their history lessons and the Middle Ages. But it is also hitting the news right now. In Madagascar, last month 30 persons died of the plague, more than 200 are infected. With Dr Eric Bertherat, a WHO epidemiologist in our mind saying “You can become contaminated in the morning and be dead by the evening.” It makes you wonder: is history going to repeat itself?

Today, the plague can be avoided with the right hygienic measures and, if prevention fails, easily treated when diagnosed in time. In Madagascar both are lacking right now. The cause is probably the overcrowded and unhygienic prisons infested with rats and remote rural areas with rats that come out during rain season. And don’t think the prison walls can hold this infection inside. And definitely don’t think those straw-roofed houses can truly keep the rats outside.

So while the health care officials do all they can in Madagascar and try to solve it, let’s understand first what the deal is with this disease and why it is so infamous (by the way, don’t think the plague only shows up in remote African countries. Here is a map of affected regions in 2012).

The disease is transmitted through the bite of a flea from a rat. It can also be transmitted from human to human via contaminated fluids, tissue or droplets to fly through the air like kamikaze pilots. Although, the disease is scary, not to mention the fluids, fleas and rats, the plague is actually a “normal” bacterial infection, just like Chlamydia. It is caused by the bacterium Yersinia pestis, causing the bubonic plague and the plague of the lungs (90% mortality rate of that one). But wait, I hear you think, bacterium, the world has antibiotics to treat those!

Well, not in the late Middle Ages.

In those days, people dreaded the plague even more than people fear Simon Cowell’s verdict these days. Between 1347-1351, the plague was responsible for the death of nearly one third of the entire population of Europe. If this would happen today in Europe, you could drive from the Netherlands – where I was born – to Spain – where we would spend the occasional holiday – without ever seeing a living person. Well, I like to have some peace and quiet, but this was too much. It was the mother of epidemics.

Not only the rats and their fleas were to blame though.

The whole thing supposedly started with the Mongols (from the land Mongolia). They had used the disease to their advantage in 1346 when they wanted to invade the city of Kaffa (Ukraine). During the fight they would shoot the dead bodies of plague victims over the walls of the city using catapults, thus infecting the inhabitants. They must have been some real Angry Birds. The surviving inhabitants of Kaffa fled back to their daddies and mommies who still lived Italy. Through Italy the disease could spread further in Europe.

Venice had a fantastic plan to stop infections after the death of almost half the Venetians during the first half of the outbreak. They implemented the rule that all ships had to remain in the harbor without docking for 40 days. Probably from the 40 days of fasting from the bible. After those 40 days of quarantine, they could step on land.

Quick party conversation “fun”-fact: quarantine derives from the Italian word for 40 which is “quaranta”.

In the meanwhile, the medical school jumped to the opportunity to train the so-called plague doctors. These doctors didn’t wear the classical white coat, but they wore an ankle length black overcoat, black hat (quite stylish I must say) and a beaked mask. This beak was very smart to prevent infection (sure…) but also to eliminate the horrible smell coming from their patients. In the end of the beak they would put herbs and flowers to prevent them from gagging at their patient’s side, because that just isn’t professional.

So, the mask a lot of people wear during carnivals is actually a plague mask. Makes you look slightly different at the crowd, doesn’t it? Or what about the “Eyes Wide Shut” orgy scene? Maybe in 500 years a remake will be made with the future Tom Cruise and Nicole Kidman with the gear we wear today: white coats, chalked gloves and properly sealed mouth caps.

Strange world we will live in.

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