About the Black Death in History

Plague is one of the three epidemic diseases that is still a problem to the International Health Regulations and is reported by the World Health Organization. The bacteria Yersinia Pestis is said to be the agent that causes this disease. This type of bacteria is a zoonotic bacteria that is embedded in small animals and fleas (Plague, 2017).Yersenia Pestis bacteria is recognized by humans as being able of causing a pathogenic disease (Stenseth, et al., 2008). The plague has led to three major pandemics.

A pandemic is a widespread epidemic that invades the population of a vast region, country, or continent (Merrill, 2016, p.6).These three major plagues hit the world at different times. They were the Justinian Plague, the Black Death, and the Modern Plague. The Black Death started in China and expanded along the great trade routes to Constantinople and then to Europe (Plague, 2015). This plague can come in different forms, found in different places, transmitted in different ways, can be treated, can cause death, and can be prevented.

Plague can take distinct clinical forms, but the most known forms are bubonic, pneumonic, and septicemic. In the bubonic form, patients start to develop rapid onset of fever, headache, chills, and swollen tender painful lymph nodes. This form usually emerges from the bite of an infected flea. If the bite is left untreated, it can expand to other body parts in the human body. An individual usually starts to become sick with bubonic plague 2 to 6 days after being infected by a species. In the septicemic form, patients start to develop fever, chills, severe weakness, abdominal pain, shock, and most likely bleeding into the skin and other organs. In this form, the skin and other tissues may also be black in color and eventually die. The septicemic can develop as the first symptom of plague or can occur from untreated bubonic plague. This type happens due to bites from infected fleas or from taking care of an infected animal. In the pneumonic form, patients start to develop fever, headache, weakness, and very quickly develop pneumonia with shortness of breath, chest pain, cough, and occasionally bloody or watery mucous. This form may occur from breathing in infectious droplets or may happen due to untreated bubonic or septicemic plague after bacteria has spread to the lungs. This is the most serious form of the disease. A person that is exposed to the disease by breathing it in through the air becomes sick within 1 to 3 days after being exposed. It is the only form of plague that can spread from person to person (Plague, 2015). Plague symptoms depends only on how the patient was exposed to the plague bacteria.

Plague was first made known in the United States in 1900, due to rat infested steamships that had sailed from areas that had the disease, mostly Asia. The last urban epidemic of rat associated plague in the U.S. occurred in Los Angeles in the years 1924 and 1935. Since that time, plague has taken place in rural and semi-rural areas of the western U.S., generally in semi and upland forests and grasslands where many different kinds of rodent species can be found (Plague, 2015). Plague epidemics have appeared in Africa, Asia, and South America. Over the years there has been a big shift in cases from Asia to Africa with nearly 90% of all cases and deaths in the last five years taking place in Madagascar, Tanzania, Mozambique, Malawi, Uganda, and the Democratic Republic of the Congo. Africa is specifically in danger for a number of reasons. Some of these reasons include poor rural communities that usually are found in close proximity to rodents, lack of money, and long distances from health facilities frequently results in delay in seeking health care and getting treatment (Stenseth, et al., 2008).

Nearly all of the cases reported in the last 20 years has happened among people living in small towns, villages, and agricultural areas rather than in large towns and cities. This life threatening disease occurs in both men and women. Historically, the Black Death is somewhat more common among men, which is probably because of an increased in outdoor activities and that puts them at a higher risk than women. The plague has appeared in infants all the way up to individuals that are 96 years old. Only 50% of cases have appeared in individuals ranging from 12 year of age to 45 year of age (Plague, 2015). This shows that no one is exempt from getting this deadly disease.

The plague bacteria can be transmitted to humans in many different ways. The first method of transmission is through flea bites. Plague bacteria are most often transmitted by the bite of an infected flea. The second method of transmission is by contact with contaminated fluid or tissue. Humans can become infected when handling tissue of body fluids of a plague infected animal. The last method of transmission is by infectious droplets. When a person has plague pneumonia, they may cough droplets containing the plague bacteria into the air. If these droplets containing the bacteria are breathed in by another person they can cause pneumonic plague (Plague, 2015). Typically this requires direct or close contact with an individual that has pneumonic plague. This type of spread has not been reported in the U.S. since 1924, but still occurs with some frequency in developing countries (Stenseth, et al., 2008).

The disease is contagious, spread very quickly, fast clinical course, and high death rate if it is left untreated. Plague can be dealt with by the use of antibiotics. Therefore, it is a must to get tested and get treated early on. The antibiotics that are used to treat the Black Death are streptomycin, tetracyclines, and sulfonamides. The other antibiotics that should be taken are gentamicin and fluoroquinolones when the previous mentioned antibiotics are not available (Stenseth, et al., 2008). Once it has been determined that the patient has plague they should be hospitalized, and should be placed in a room by themselves if they have pneumonic plague. This is done, so no one else is able to get the disease. Also, laboratory tests should be done, including blood cultures for plague bacteria and microscopic testing of lymph nodes, blood, and sputum samples. To keep a high risk of death associated with the disease from occurring in patients with pneumonic plague, antibiotics should be given as soon as possible. Antibiotics should be given preferably within 24 hours of the first sign of symptoms. A plague vaccine is not available at this time in the United States (Plague, 2015).

The Black Death has been responsible for taking the life of numbers of individuals in various places at different times. In 1334, in China the plague took the life of roughly 60% of the European population. Entire towns were destroyed (Plague, 2015). In 1400, the plague reduced the world's population from an estimated 450 million to somewhere between 350 and 375 million. It took Europe 150 years to rebuild from the destruction that swept through the country (Black Death, 2011, p.1). In the year 1994, in India a plague outbreak caused a widespread panic. The outbreak killed a total of 50 people in the city of Surat. This outbreak resulted in there being a nationwide downfall in tourism and trade, and that costed the city of Surat roughly $600 million. Over the last 20 years, there have been 1,000 to 5,000 human cases of the plague. There have been a total of 100 to 200 deaths reported to World Health Organization (WHO) annually. Because of poor diagnostic facilities and underreporting the number of cases is almost certainly much higher than what has been reported. Although, the number of human cases of plague is somewhat low, it would be a mistake to overlook its threat to humanity (Stenseth, et al., 2008).

If I were an epidemiologist, I would prevent the spread of the Black Death in the following ways. One way is having an investigation team to study the animal and flea species that are found to be the cause of the plague. This team would be in charge of finding out where the species came from, and how did they get where they are at now. The second way is developing some sort of environmental management program that has a complete understanding of the cycle of the disease. Another way to prevent the spread of the Black Death, is to have a team that is surveilling the animal species nonstop. This team would be responsible for being the first response when it comes to the animal outbreaks, and would give the report to the authorities. These different ways could decrease the number of outbreaks that occur in the human population.

After reading what has been stated above, one would agree that the Black Death is a serious disease that should be taken serious. The Black Death can come in different forms, found in different places, transmitted in different ways, can be treated, can cause death, and can be prevented. If this disease is not treated properly it can be deadly for an individual or even individuals. This is why it is so important when any symptom is experienced, to seek medical professionals immediately. Today, the disease is found mostly in Africa hopefully something will be done in the near future to decrease the number of cases that are found there.

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