The bubonic plague killed 60 million people. Moreover, in some regions the death toll reached two-thirds of the population. Due to the unpredictability of the disease, as well as the impossibility of curing it at that time, religious ideas began to flourish among people. Belief in a higher power has become commonplace. At the same time, persecution began of the so-called “poisoners”, “witches”, “sorcerers”, who, according to religious fanatics, sent the epidemic to people.

This period remained in history as a time of impatient people who were overcome by fear, hatred, mistrust and numerous superstitions. In fact, of course, there is a scientific explanation for the outbreak of bubonic plague.

The Myth of the Bubonic Plague

When historians were looking for ways the disease could penetrate Europe, they settled on the opinion that the plague appeared in Tatarstan. More precisely, it was brought by the Tatars.

In 1348, the Crimean Tatars, led by Khan Dzhanybek, during the siege of the Genoese fortress of Kafa (Feodosia), threw there the corpses of people who had previously died from the plague. After liberation, Europeans began to leave the city, spreading the disease throughout Europe.

But the so-called “plague in Tatarstan” turned out to be nothing more than a speculation of people who do not know how to explain the sudden and deadly outbreak of the “Black Death”.

The theory was defeated as it became known that the pandemic was not transmitted between people. It could be contracted from small rodents or insects.

This “general” theory existed for quite a long time and contained many mysteries. In fact, the plague epidemic of the 14th century, as it turned out later, began for several reasons.

Natural causes of the pandemic

In addition to dramatic climate change in Eurasia, the outbreak of bubonic plague was preceded by several other environmental factors. Among them:

• global drought in China followed by widespread famine;
• in Henan province there is a massive locust invasion;
• Rain and hurricanes prevailed in Beijing for a long time.

Like the Plague of Justinian, as the first pandemic in history was called, the Black Death struck people after massive natural disasters. She even followed the same path as her predecessor.

The decrease in people's immunity, provoked by environmental factors, has led to mass morbidity. The disaster reached such proportions that church leaders had to open rooms for the sick population.

The plague in the Middle Ages also had socio-economic prerequisites.

Socio-economic causes of bubonic plague

Natural factors could not provoke such a serious outbreak of the epidemic on their own. They were supported by the following socio-economic prerequisites:

• military operations in France, Spain, Italy;
• the dominance of the Mongol-Tatar yoke over part of Eastern Europe;
• increased trade;
• soaring poverty;
• too high population density.

Another important factor that provoked the invasion of the plague was a belief that implied that healthy believers should wash as little as possible. According to the saints of that time, contemplation of one’s own naked body leads a person into temptation. Some church followers were so imbued with this opinion that they never immersed themselves in water in their entire adult lives.

Europe in the 14th century was not considered a pure power. The population did not monitor waste disposal. Waste was thrown directly from the windows, slops and the contents of chamber pots were poured onto the road, and the blood of livestock flowed into it. This all later ended up in the river, from which people took water for cooking and even for drinking.

Like the Plague of Justinian, the Black Death was caused by large numbers of rodents that lived in close contact with humans. In the literature of that time you can find many notes on what to do in case of an animal bite. As you know, rats and marmots are carriers of the disease, so people were terrified of even one of their species. In an effort to overcome rodents, many forgot about everything, including their family.

How it all began

The origin of the disease was the Gobi Desert. The location of the immediate outbreak is unknown. It is assumed that the Tatars who lived nearby declared a hunt for marmots, which are carriers of the plague. The meat and fur of these animals were highly valued. Under such conditions, infection was inevitable.

Due to drought and other negative weather conditions, many rodents left their shelters and moved closer to people, where more food could be found.

Hebei province in China was the first to be affected. At least 90% of the population died there. This is another reason that gave rise to the opinion that the outbreak of the plague was provoked by the Tatars. They could lead the disease along the famous Silk Road.

Then the plague reached India, after which it moved to Europe. Surprisingly, only one source from that time mentions the true nature of the disease. It is believed that people were affected by the bubonic form of plague.

In countries that were not affected by the pandemic, real panic arose in the Middle Ages. The heads of the powers sent messengers for information about the disease and forced specialists to invent a cure for it. The population of some states, remaining ignorant, willingly believed rumors that snakes were raining on the contaminated lands, a fiery wind was blowing and acid balls were falling from the sky.

Modern characteristics of the bubonic plague

Low temperatures, a long stay outside the host's body, and thawing cannot destroy the causative agent of the Black Death. But sun exposure and drying are effective against it.

Symptoms of plague in humans

Bubonic plague begins to develop from the moment of being bitten by an infected flea. Bacteria enter the lymph nodes and begin their life activity. Suddenly, a person is overcome by chills, his body temperature rises, the headache becomes unbearable, and his facial features become unrecognizable, black spots appear under his eyes. On the second day after infection, the bubo itself appears. This is what is called an enlarged lymph node.

A person infected with the plague can be identified immediately. “Black Death” is a disease that changes the face and body beyond recognition. Blisters become noticeable already on the second day, and the patient’s general condition cannot be called adequate.

The symptoms of plague in a medieval person are surprisingly different from those of a modern patient.

Clinical picture of the bubonic plague of the Middle Ages

“Black Death” is a disease that in the Middle Ages was identified by the following signs:

• high fever, chills;
• aggressiveness;
• continuous feeling of fear;
• severe pain in the chest;
• dyspnea;
• cough with bloody discharge;
• blood and waste products turned black;
• a dark coating could be seen on the tongue;
• ulcers and buboes appearing on the body emitted an unpleasant odor;
• clouding of consciousness.

These symptoms were considered a sign of imminent and imminent death. If a person received such a sentence, he already knew that he had very little time left. No one tried to fight such symptoms; they were considered the will of God and the church.

Treatment of bubonic plague in the Middle Ages

Medieval medicine was far from ideal. The doctor who came to examine the patient paid more attention to talking about whether he had confessed than to directly treating him. This was due to the religious insanity of the population. Saving the soul was considered a much more important task than healing the body. Accordingly, surgical intervention was practically not practiced.

Treatment methods for plague were as follows:

• cutting tumors and cauterizing them with a hot iron;
• use of antidotes;
• applying reptile skin to the buboes;
• pulling out disease using magnets.

However, medieval medicine was not hopeless. Some doctors of that time advised patients to stick to a good diet and wait for the body to cope with the plague on its own. This is the most adequate theory of treatment. Of course, under the conditions of that time, cases of recovery were isolated, but they still took place.

Only mediocre doctors or young people who wanted to gain fame in an extremely risky way took on the treatment of the disease. They wore a mask that looked like a bird's head with a pronounced beak. However, such protection did not save everyone, so many doctors died after their patients.

Government authorities advised people to adhere to the following methods of combating the epidemic:

• Long distance escape. At the same time, it was necessary to cover as many kilometers as possible very quickly. It was necessary to remain at a safe distance from the disease for as long as possible.
• Drive herds of horses through contaminated areas. It was believed that the breath of these animals purifies the air. For the same purpose, it was advised to allow various insects into houses. A saucer of milk was placed in a room where a person had recently died of the plague, as it was believed to absorb the disease. Methods such as breeding spiders in the house and burning large numbers of fires near the living space were also popular.
• Do whatever is necessary to cover up the smell of the plague. It was believed that if a person does not feel the stench emanating from infected people, he is sufficiently protected. That is why many carried bouquets of flowers with them.

Doctors also advised not to sleep after dawn, not to have intimate relations and not to think about the epidemic and death. Nowadays this approach seems crazy, but in the Middle Ages people found solace in it.

Of course, religion was an important factor influencing life during the epidemic.

Religion during the bubonic plague epidemic

"Black Death" is a disease that frightened people with its uncertainty. Therefore, against this background, various religious beliefs arose:

• The plague is a punishment for ordinary human sins, disobedience, bad attitude towards loved ones, the desire to succumb to temptation.
• The plague arose as a result of neglect of faith.
• The epidemic began because shoes with pointed toes came into fashion, which greatly angered God.

Priests who were obliged to listen to the confessions of dying people often became infected and died. Therefore, cities were often left without church ministers because they feared for their lives.

Against the background of the tense situation, various groups or sects appeared, each of which explained the cause of the epidemic in its own way. In addition, various superstitions were widespread among the population, which were considered the pure truth.

Superstitions during the bubonic plague epidemic

In any, even the most insignificant event, during the epidemic, people saw peculiar signs of fate. Some superstitions were quite surprising:

• If a completely naked woman plows the ground around the house, and the rest of the family members are indoors at this time, the plague will leave the surrounding areas.
• If you make an effigy symbolizing the plague and burn it, the disease will recede.
• To prevent the disease from attacking, you need to carry silver or mercury with you.

Many legends developed around the image of the plague. People really believed in them. They were afraid to open the door of their house again, so as not to let the plague spirit inside. Even relatives fought among themselves, everyone tried to save themselves and only themselves.

The situation in society

The oppressed and frightened people eventually came to the conclusion that the plague was being spread by so-called outcasts who wanted the death of the entire population. The pursuit of the suspects began. They were forcibly dragged to the infirmary. Many people who were identified as suspects committed suicide. An epidemic of suicide has hit Europe. The problem has reached such proportions that the authorities have threatened those who commit suicide by putting their corpses on public display.

Since many people were sure that they had very little time left to live, they went to great lengths: they became addicted to alcohol, looking for entertainment with women of easy virtue. This lifestyle further intensified the epidemic.

The pandemic reached such proportions that the corpses were taken out at night, dumped in special pits and buried.

Sometimes it happened that plague patients deliberately appeared in society, trying to infect as many enemies as possible. This was also due to the fact that it was believed that the plague would recede if it was passed on to someone else.

In the atmosphere of that time, any person who stood out from the crowd for any reason could be considered a poisoner.

Consequences of the Black Death

The Black Death had significant consequences in all areas of life. The most significant of them:

• The ratio of blood groups has changed significantly.
• Instability in the political sphere of life.
• Many villages were deserted.
• The beginning of feudal relations was laid. Many people in whose workshops their sons worked were forced to hire outside craftsmen.
• Since there were not enough male labor resources to work in the production sector, women began to master this type of activity.
• Medicine has moved to a new stage of development. All sorts of diseases began to be studied and cures for them were invented.
• Servants and the lower strata of the population, due to the lack of people, began to demand a better position for themselves. Many insolvent people turned out to be heirs of rich deceased relatives.
• Attempts were made to mechanize production.
• Housing and rental prices have dropped significantly.
• The self-awareness of the population, which did not want to blindly obey the government, grew at a tremendous pace. This resulted in various riots and revolutions.
• The influence of the church on the population has weakened significantly. People saw the helplessness of the priests in the fight against the plague and stopped trusting them. Rituals and beliefs that were previously prohibited by the church came into use again. The age of “witches” and “sorcerers” has begun. The number of priests has decreased significantly. People who were uneducated and inappropriate in age were often hired for such positions. Many did not understand why death takes not only criminals, but also good, kind people. In this regard, Europe doubted the power of God.
• After such a large-scale pandemic, the plague did not completely leave the population. Periodically, epidemics broke out in different cities, taking people's lives with them.

Today, many researchers doubt that the second pandemic took place precisely in the form of the bubonic plague.

Opinions on the second pandemic

There are doubts that the “Black Death” is synonymous with the period of prosperity of the bubonic plague. There are explanations for this:

• Plague patients rarely experienced symptoms such as fever and sore throat. However, modern scholars note that there are many errors in the narratives of that time. Moreover, some works are fictional and contradict not only other stories, but also themselves.
• The third pandemic was able to kill only 3% of the population, while the Black Death wiped out at least a third of Europe. But there is an explanation for this too. During the second pandemic, there was terrible unsanitary conditions that caused more problems than illness.
• The buboes that arise when a person is affected are located under the armpits and in the neck area. It would be logical if they appeared on the legs, since that is where it is easiest for a flea to get into. However, this fact is not flawless. It turns out that, along with the rat flea, the human louse is the spreader of the plague. And there were many such insects in the Middle Ages.
• An epidemic is usually preceded by the mass death of rats. This phenomenon was not observed in the Middle Ages. This fact can also be disputed given the presence of human lice.
• The flea, which is the carrier of the disease, feels best in warm and humid climates. The pandemic flourished even in the coldest winters.
• The speed of the epidemic's spread was record-breaking.

As a result of the research, it was found that the genome of modern strains of plague is identical to the disease of the Middle Ages, which proves that it was the bubonic form of pathology that became the “Black Death” for the people of that time. Therefore, any other opinions are automatically moved to the incorrect category. But a more detailed study of the issue is still ongoing.

Even in the ancient world, not many diseases caused the same panic and destruction as Bubonic plague. This terrible bacterial infection was usually spread by rats and other rodents. But when it entered the human body, it quickly spread throughout the body and was often fatal. Death could occur in a matter of days. Let's look at six of the most notorious outbreaks of this disease.

Plague of Justinian

Justinian the First is often considered the most influential Byzantine emperor, but his reign coincided with one of the first well-documented outbreaks of plague. The pandemic is believed to have originated in Africa and then spread to Europe via infected rats on merchant ships.

The plague reached the Byzantine capital of Constantinople in 541 AD and was soon claiming 10,000 lives a day. This led to unburied bodies being stored inside buildings and even in the open air.

According to the ancient historian Procopius, victims exhibited many of the classic symptoms of bubonic plague, including a sudden rise in temperature and swollen lymph nodes. Justinian also fell ill, but he was able to recover, which cannot be said about the third part of the inhabitants of Constantinople, who were not so lucky.

Even after the plague subsided in Byzantium, it continued to appear in Europe, Africa and Asia for several years, causing widespread famine and devastation. It is believed that at least 25 million people died, but the actual number could be much higher.

Black Death

In 1347, the disease again invaded Europe from the East, most likely along with Italian sailors returning home from the Crimea. As a result, the Black Death tore apart the entire continent for half a decade. The populations of entire cities were wiped out, and people spent much of their time trying to bury all the dead in mass graves.

Medieval doctors tried to fight the disease using bloodletting and other crude methods, but most people were sure that this was God's punishment for their sins. Some Christians even blamed the Jews for everything and began mass pogroms.

The Black Death subsided in the West around 1353, but not before taking with it 50 million people - more than half the population of Europe. While the pandemic wreaked havoc across the continent, some historians believe the labor shortage it caused was a boon for the lower working classes.

Italian plague 1629-1631

Even after the Black Death had receded, the bubonic plague continued to rear its ugly head in Europe from time to time for several centuries. One of the most devastating outbreaks began in 1629, when troops fighting in the Thirty Years' War brought the infection to the Italian city of Mantua.

Over the next two years, the plague spread throughout the countryside, but also affected major cities such as Verona, Milan, Venice and Florence. In Milan and Venice, city officials quarantined sick people and completely burned their clothes and belongings to prevent the spread of the disease.

The Venetians even banished some plague victims to islands in a nearby lagoon. These brutal measures may have helped contain the disease, but by then 280,000 people had died, including more than half of Verona's inhabitants. The Republic of Venice lost a third of its population - 140 thousand people.

Some scholars argue that this outbreak undermined the city-state's strength, leading to a decline in its position as a major player on the world stage.

Great Plague of London

The plague besieged London several times during the 16th and 17th centuries, but the most famous incident occurred in 1665-1666. It first arose in the London suburb of St. Giles, and then spread to the dirty neighborhoods of the capital.

The peak occurred in September 1665, when 8 thousand people died every week. Rich residents, including King Charles II, fled to the villages, and the main victims of the plague were poor people.

As the disease spread, London authorities tried to keep those infected in their homes, which they marked with a red cross. Before the outbreak subsided in 1666, an estimated 75,000 to 100,000 people died. Later that year, London faced another tragedy when the Great Fire destroyed much of the city's central area.

Plague of Marseilles

The last major outbreak of plague in medieval Europe began in 1720 in the French port city of Marseille. The disease arrived on a merchant ship that picked up infected passengers during a trip to the Middle East.

The ship was in quarantine, but its owner, who also happened to be the deputy mayor of Marseille, convinced officials to allow him to unload the goods. The rats that lived in it soon spread throughout the city, which caused an epidemic.

People died in the thousands, and the piles of bodies on the street were so large that the authorities forced prisoners to dispose of them. In neighboring Provence, a “plague wall” was even built to contain the infection, but it spread to the south of France. The disease finally disappeared in 1722, but by that time about 100 thousand people had died.

Third pandemic

The first two pandemics are considered to be the Plague of Justinian and the Black Death. The most recent, the so-called Third Pandemic, broke out in 1855 in the Chinese province of Yunnan. Over the next few decades, the disease spread across the globe, and by the early 20th century, infected rats on ships carried it to all six continents.

Worldwide, the outbreak killed 15 million people before it was eradicated in 1950. Most of the victims were in China and India, but there were also scattered cases from South Africa to America. Despite the heavy toll, the Third Pandemic has led to several breakthroughs in doctors' understanding of the disease.

In 1894, a doctor from Hong Kong, Alexander Ersin, determined which bacilli were the cause of the disease. Several years later, another doctor finally confirmed that flea bites carried by rats were the main cause of the infection spreading to humans.

« However, on the same day, around noon, Dr. Rieux, stopping his car in front of the house, noticed at the end of their street a gatekeeper who was barely moving, with his arms and legs splayed out in an absurd way and his head hanging down, like a wooden clown. Old Michel's eyes shone unnaturally, his breath whistled out of his chest. While walking, he began to experience such sharp pains in his neck, armpits and groin that he had to turn back...

The next day his face turned green, his lips became like wax, his eyelids seemed to be filled with lead, he breathed intermittently, shallowly and, as if crucified by swollen glands, he kept huddling in the corner of the folding bed.

Days passed, and the doctors were called to new patients with the same disease. One thing was clear - the abscesses needed to be opened. Two cross-shaped incisions with a lancet - and a purulent mass mixed with ichor flowed out of the tumor. The patients were bleeding and lay as if crucified. Spots appeared on the stomach and legs, the discharge from the abscesses stopped, then they swelled again. In most cases, the patient died amid the horrifying stench.

...The word “plague” was uttered for the first time. It contained not only what science wanted to put into it, but also an endless series of the most famous pictures of disasters: Athens plagued and abandoned by birds, Chinese cities filled with silent dying people, Marseilles convicts throwing blood-oozing corpses into a ditch, Jaffa with its disgusting beggars, damp and rotten bedding lying right on the earthen floor of the Constantinople infirmary, plague-stricken people being dragged with hooks...».

This is how the French writer Albert Camus described the plague in his novel of the same name. Let's remember those times in more detail...

This is one of the deadliest diseases in human history, dating back more than 2,500 years. The disease first appeared in Egypt in the 4th century BC. e., and the earliest description of it was made by the Greek Rufus from Ephesus.

From then on, the plague struck first one continent and then another every five to ten years. Ancient Middle Eastern chronicles noted a drought that occurred in 639, during which the land became barren and a terrible famine occurred. It was a year of dust storms. The winds drove the dust like ash, and therefore the whole year was nicknamed “ashy.” The famine intensified to such an extent that even wild animals began to seek refuge with people.

“And at that time the plague epidemic broke out. It began in the Amawas district, near Jerusalem, and then spread throughout Palestine and Syria. Only 25,000 Muslims died. In Islamic times, no one had ever heard of such a plague. Many people died from it in Basra too.”

In the mid-14th century, an unusually contagious plague struck Europe, Asia and Africa. It came from Indochina, where fifty million people died from it. The world has never seen such a terrible epidemic before.

And a new plague epidemic broke out in 1342 in the possessions of the Great Kaan Togar-Timur, which began from the extreme limits of the east - from the country of Xing (China). Within six months, the plague reached the city of Tabriz, passing through the lands of the Kara-Khitai and Mongols, who worshiped fire, the Sun and the Moon and whose number of tribes reached three hundred. They all died in their winter quarters, in pastures and on their horses. Their horses also died and were left abandoned on the ground to rot. People learned about this natural disaster from a messenger from the country of the Golden Horde Khan Uzbek.

Then a strong wind blew, which spread the rot throughout the country. The stench and stench soon reached the most remote areas, spreading throughout their cities and tents. If a person or animal inhaled this smell, after a while they would certainly die.

The Great Clan itself lost such a huge number of warriors that no one knew their exact number. Kaan himself and his six children died. And in this country there was no one left who could rule it.

From China, the plague spread throughout the east, across the country of Uzbek Khan, the lands of Istanbul and Kaysariyya. From here it spread to Antioch and destroyed its inhabitants. Some of them fled to the mountains to escape death, but almost all of them died along the way. One day, several people returned to the city to pick up some of the things people had abandoned. Then they also wanted to take refuge in the mountains, but death overtook them too.

The plague spread throughout the Karaman possessions in Anatolia, throughout all the mountains and surrounding area. People, horses and livestock died. The Kurds, fearing death, left their homes, but did not find a place where there were no dead and where they could hide from the disaster. They had to return to their native places, where they all died.

There was a heavy downpour in the country of the Kara-Khitai. Together with the rain streams, the deadly infection spread further, bringing with it the death of all living things. After this rain, horses and cattle died. Then people, poultry and wild animals began to die.

The plague reached Baghdad. Waking up in the morning, people discovered swollen buboes on their faces and bodies. Baghdad at this time was besieged by Chobanid troops. The besiegers retreated from the city, but the plague had already spread among the troops. Very few managed to escape.

At the beginning of 1348, the plague swept through the Aleppo region, gradually spreading throughout Syria. All the inhabitants of the valleys between Jerusalem and Damascus, the sea coast and Jerusalem itself perished. The Arabs of the desert and the inhabitants of the mountains and plains perished. In the cities of Ludd and Ramla, almost everyone died. Inns, taverns and teahouses were overflowing with dead bodies that no one removed.

The first sign of the plague in Damascus was the appearance of pimples on the back of the ear. By scratching them, people then transferred the infection throughout their bodies. Then the glands under the person's armpit would swell and he would often vomit blood. After this, he began to suffer from severe pain and soon, almost two days later, he died. Everyone was gripped by fear and horror from so many deaths, for everyone saw how those who began vomiting and hemoptysis lived for only about two days.

On just one April day in 1348, more than 22 thousand people died in Gazza. Death swept through all the settlements around Gazza, and this happened shortly after the end of the spring plowing. People died right in the field behind the plow, holding baskets of grain in their hands. All the working cattle died along with them. Six people entered one house in Gazza for the purpose of looting, but they all died in the same house. Gazza has become a city of the dead.

People have never known such a cruel epidemic. While striking one region, the plague did not always invade the other. Now it has covered almost the entire earth - from east to west and from north to south, almost all representatives of the human race and all living things. Even sea creatures, birds of the air and wild animals.

Soon, from the east, the plague spread to African soil, to its cities, deserts and mountains. All of Africa was filled with dead people and the corpses of countless herds of cattle and animals. If a sheep was slaughtered, its meat turned out to be blackened and smelly. The smell of other products – milk and butter – also changed.

Up to 20,000 people died every day in Egypt. Most of the corpses were transported to the graves on boards, ladders and doors, and the graves were simply ditches into which up to forty corpses were buried.

Death spread to the cities of Damanhur, Garuja and others, in which the entire population and all livestock died. Fishing on Lake Baralas stopped due to the death of fishermen, who often died with a fishing rod in their hands. Even the eggs of caught fish showed dead spots. Fishing schooners remained on the water with dead fishermen, the nets were overflowing with dead fish.

Death walked along the entire sea coast, and there was no one who could stop it. No one approached the empty houses. Almost all the peasants in the Egyptian provinces died, and there was no one left who could harvest the ripe crop. There were such a great number of corpses on the roads that, having become infected from them, the trees began to rot.

The plague was especially severe in Cairo. For two weeks in December 1348, the streets and markets of Cairo were filled with the dead. Most of the troops were killed, and the fortresses were empty. By January 1349 the city already looked like a desert. It was impossible to find a single house that was spared by the plague. There are not a single passerby on the streets, only corpses. In front of the gates of one of the mosques, 13,800 corpses were collected in two days. And how many of them still remained in the deserted streets and alleys, in courtyards and other places!

The plague reached Alexandria, where at first one hundred people died every day, then two hundred, and on one Friday seven hundred people died. The textile manufactory in the city was closed due to the death of artisans; due to the lack of visiting merchants, trading houses and markets were empty.

One day a French ship arrived in Alexandria. The sailors reported that they saw a ship near the island of Tarablus with a huge number of birds circling above it. Approaching the ship, the French sailors saw that its entire crew was dead, and the birds were pecking at the corpses. And there were a great many dead birds themselves on the ship.

The French quickly sailed away from the plague-ridden ship. When they reached Alexandria, more than three hundred of them died.

The plague spread to Europe through the Marseille sailors.

"BLACK DEATH" OVER EUROPE

In 1347, the second and most terrible plague invasion of Europe began. This disease raged for three hundred years in the countries of the Old World and took a total of 75 million human lives to the grave. It was nicknamed the “Black Death” because of the invasion of black rats, which managed to bring this terrible epidemic to the vast continent in a short period.

In the previous chapter we talked about one version of its spread, but some scientists and doctors believe that most likely it originated in the warm southern countries. Here the climate itself contributed to the rapid rotting of meat products, vegetables, fruits, and simply garbage, in which beggars, stray dogs and, of course, rats rummaged. The disease claimed thousands of human lives, and then began to travel from city to city, from country to country. Its rapid spread was facilitated by the unsanitary conditions that existed at that time both among people of the lower class and among sailors (after all, there were a great many rats in the holds of their ships).

According to ancient chronicles, not far from Lake Issyk-Kul in Kyrgyzstan there is an ancient gravestone with an inscription that indicates that the plague began its march to Europe from Asia in 1338. Obviously, its carriers were the nomadic warriors themselves, the Tatar warriors, who tried to expand the territories of their conquests and in the first half of the 14th century invaded Tavria - present-day Crimea. Thirteen years after penetrating the peninsula, the “black disease” quickly spread beyond its borders and subsequently covered almost all of Europe.

In 1347, a terrible epidemic began in the trading port of Kafa (present-day Feodosia). Today's historical science has information that the Tatar khan Janibek Kipchak besieged Kafa and waited for its surrender. His huge army settled down by the sea along the stone defensive wall of the city. It was possible not to storm the walls and not lose soldiers, since without food and water the inhabitants, according to Kipchak’s calculations, would soon ask for mercy. He did not allow any ship to unload in the port and did not give the residents the opportunity to leave the city, so that they would not escape on foreign ships. Moreover, he deliberately ordered the release of black rats into the besieged city, which (as he was told) came off the arriving ships and brought with them disease and death. But, having sent a “black disease” to the residents of Kafa, Kipchak himself miscalculated. Having mowed down the besieged in the city, the disease suddenly spread to his army. The insidious disease did not care who it mowed down, and it crept up on the Kipchak soldiers.

His large army took fresh water from streams that descended from the mountains. The soldiers also began to get sick and die, and up to several dozen of them died a day. There were so many corpses that there was no time to bury them. This is what was said in the report of the notary Gabriel de Mussis from the Italian city of Piacenza: “Countless hordes of Tatars and Saracens suddenly fell victim to an unknown disease. The entire Tatar army was struck by disease, thousands died every day. The juices thickened in the groin, then they rotted, a fever developed, death occurred, the advice and help of doctors did not help...”

Not knowing what to do to protect his soldiers from the epidemic disease, Kipchak decided to take out his anger on the residents of Kafa. He forced local prisoners to load the bodies of the dead onto carts, take them to the city and dump them there. Moreover, he ordered to load cannons with the corpses of deceased patients and fire them at the besieged city.

But the number of deaths in his army did not decrease. Soon Kipchak could not count even half of his soldiers. When the corpses covered the entire coastline, they began to be thrown into the sea. Sailors from ships arriving from Genoa and stationed in the port of Cafa impatiently watched all these events. Sometimes the Genoese ventured into the city to find out the situation. They really didn’t want to return home with the goods, and they were waiting for this strange war to end, for the city to remove the corpses and start trading. However, having become infected in the Cafe, they themselves unwittingly transferred the infection to their ships, and besides, city rats also climbed onto the ships along the anchor chains.

From Kafa, the infected and unloaded ships sailed back to Italy. And there, naturally, along with the sailors, hordes of black rats landed ashore. The ships then went to the ports of Sicily, Sardinia and Corsica, spreading the infection to these islands.

About a year later, all of Italy - from north to south and from west to east (including the islands) - was engulfed in a plague epidemic. The disease was especially rampant in Florence, the plight of which was described by novelist Giovanni Boccaccio in his famous novel “The Decameron.” According to him, people fell dead in the streets, lonely men and women died in separate houses, whose death no one knew. The rotting corpses stank, poisoning the air. And only by this terrible smell of death could people determine where the dead lay. It was scary to touch the decomposed corpses, and under pain of prison punishment, the authorities forced ordinary people to do this, who, taking advantage of the opportunity, engaged in looting along the way.

Over time, in order to protect themselves from infection, doctors began to wear specially tailored long gowns, gloves on their hands, and special masks with a long beak containing incense plants and roots on their faces. Plates with smoking incense were tied to their hands with strings. Sometimes this helped, but they themselves became like some kind of monstrous birds bringing misfortune. Their appearance was so terrifying that when they appeared, people ran away and hid.

And the number of victims kept increasing. There were not enough graves in the city cemeteries, and then the authorities decided to bury all the dead outside the city, dumping the corpses in one mass grave. And in a short time, several dozen such mass graves appeared.

Within six months, almost half the population of Florence died. Entire neighborhoods in the city stood lifeless, and the wind was blowing through the empty houses. Soon even thieves and looters began to be afraid to enter the premises from which plague patients were taken out.

In Parma, the poet Petrarch mourned the death of his friend, whose entire family passed away within three days.

After Italy, the disease spread to France. In Marseille, 56 thousand people died in a few months. Of the eight doctors in Perpignan, only one survived; in Avignon, seven thousand houses were empty, and the local priests, out of fear, went so far as to consecrate the Rhone River and begin throwing all the corpses into it, causing the river water to become contaminated. The plague, which temporarily stopped the Hundred Years' War between France and England, claimed far more lives than open clashes between troops.

At the end of 1348, the plague entered what is today Germany and Austria. In Germany, a third of the clergy died, many churches and temples were closed, and there was no one to read sermons or celebrate church services. In Vienna, already on the first day, 960 people died from the epidemic, and then every day a thousand dead were taken outside the city.

In 1349, as if it had had its fill on the mainland, the plague spread across the strait to England, where a general pestilence began. In London alone, over half of its inhabitants died.

Then the plague reached Norway, where it was brought (as they say) by a sailing ship, the crew of which all died from the disease. As soon as the uncontrollable ship washed ashore, there were several people who climbed aboard to take advantage of the free booty. However, on the deck they saw only half-decomposed corpses and rats running over them. An inspection of the empty ship led to the fact that all the curious were infected, and the sailors working in the Norwegian port became infected from them.

The Catholic Church could not remain indifferent to such a formidable and terrible phenomenon. She sought to give her own explanation to the deaths, and in her sermons she demanded repentance and prayers. Christians saw this epidemic as a punishment for their sins and prayed day and night for forgiveness. Entire processions of people praying and repenting were organized. Crowds of barefoot and half-naked penitents wandered the streets of Rome, hanging ropes and stones around their necks, lashing themselves with leather whips, and covering their heads with ashes. Then they crawled to the steps of the Church of Santa Maria and asked the holy virgin for forgiveness and mercy.

This madness, which gripped the most vulnerable part of the population, led to the degradation of society, religious feelings turned into gloomy madness. Actually, during this period many people really went crazy. It got to the point that Pope Clement VI banned such processions and all types of flagellation. Those “sinners” who did not want to obey the papal decree and called for physical punishment of each other were soon thrown into prison, tortured and even executed.

In small European cities, they did not know at all how to fight the plague, and they believed that its main spreaders were incurable patients (for example, leprosy), disabled people and other infirm people suffering from various kinds of ailments. Established opinion: “They spread the plague!” - so mastered people that the unfortunate people (mostly homeless vagabonds) were turned into merciless popular anger. They were expelled from cities, not given food, and in some cases simply killed and buried in the ground.

Later, other rumors spread. As it turned out, the plague was the revenge of the Jews for their eviction from Palestine, for the pogroms; it was they, the Antichrists, who drank the blood of babies and poisoned the water in wells. And the masses of people took up arms against the Jews with renewed vigor. In November 1348, a wave of pogroms swept across Germany; Jews were literally hunted down. The most ridiculous accusations were brought against them. If several Jews gathered in houses, they were not allowed out. They set fire to houses and waited for these innocent people to burn. They were hammered into barrels of wine and lowered into the Rhine, imprisoned, and sent down the river on rafts. However, this did not reduce the scale of the epidemic.

In 1351, the persecution of Jews began to decline. And in a strange way, as if on command, the plague epidemic began to recede. People seemed to have recovered from their madness and gradually began to come to their senses. During the entire period of the plague’s march through the cities of Europe, a total of one third of its population died.

But at this time the epidemic spread to Poland and Russia. Suffice it to recall the Vagankovskoye cemetery in Moscow, which, in fact, was formed near the village of Vagankovo ​​for the burial of plague patients. The dead were taken there from all corners of the white stone and buried in a mass grave. But, fortunately, the harsh climatic conditions of Russia did not allow this disease to spread widely.

Plague Doctor

From time immemorial, plague cemeteries were considered a cursed place, because it was assumed that the infection was practically immortal. Archaeologists find tight wallets in the clothes of corpses, and untouched jewelry on the skeletons themselves: neither relatives, nor gravediggers, nor even robbers ever dared to touch the victims of the epidemic. And yet, the main interest that forces scientists to take risks is not the search for artifacts of a bygone era - it is very important to understand what kind of bacteria caused the Black Death.

It seems that a number of facts testify against combining the “great plague” of the 14th century with the pandemics of the 6th century in Byzantium and the end of the 19th century in port cities around the world (USA, China, India, South Africa, etc.). The bacterium Yersinia pestis, isolated during the fight against this latest outbreak, is by all descriptions also responsible for the first “plague of Justinian,” as it is sometimes called. But the “Black Death” had a number of specific features. Firstly, the scale: from 1346 to 1353 it wiped out 60% of the population of Europe. Never before or since has the disease led to such a complete breakdown of economic ties and the collapse of social mechanisms, when people even tried not to look into each other’s eyes (it was believed that the disease was transmitted through gaze).

Secondly, the area. The pandemics of the 6th and 19th centuries raged only in the warm regions of Eurasia, and the “Black Death” captured all of Europe right up to its northernmost limits - Pskov, Trondheim in Norway and the Faroe Islands. Moreover, the pestilence did not weaken at all even in winter. For example, in London the peak of mortality occurred between December 1348 and April 1349, when 200 people died per day. Third, the location of the plague in the 14th century is controversial. It is well known that the Tatars who besieged the Crimean Kafa (modern Feodosia) were the first to fall ill. Its inhabitants fled to Constantinople and brought the infection with them, and from there it spread throughout the Mediterranean and then throughout Europe. But where did the plague come to Crimea? According to one version - from the east, according to another - from the north. The Russian chronicle testifies that already in 1346 “the pestilence was very strong under the eastern country: both in Sarai and in other cities of those countries ... and as if there was no one to bury them.”

Fourthly, the descriptions and drawings left to us of the buboes of the “Black Death” do not seem to be very similar to those that occur with the bubonic plague: they are small and scattered throughout the patient’s body, but should be large and concentrated mainly in the groin.

Since 1984, various groups of researchers, based on the above-mentioned facts and a number of other similar ones, have come out with statements that the “great plague” was not caused by the bacillus Yersinia pestis, and strictly speaking, it was not a plague at all, but was an acute viral disease similar to Ebola hemorrhagic fever, currently raging in Africa. It was possible to reliably establish what happened in Europe in the 14th century only by isolating characteristic bacterial DNA fragments from the remains of victims of the Black Death. Such attempts have been carried out since the 1990s, when the teeth of some victims were examined, but the results were still subject to different interpretations. And now a group of anthropologists led by Barbara Bramanti and Stephanie Hensch analyzed biological material collected from a number of plague cemeteries in Europe and, having isolated DNA fragments and proteins from it, came to important, and in some ways completely unexpected, conclusions.

Firstly, the “great plague” was still caused by Yersinia pestis, as was traditionally believed.

Secondly, not one, but at least two different subspecies of this bacillus were rampant in Europe. One spread from Marseilles to the north and captured England. Surely it was the same infection that came through Constantinople, and everything is clear here. What is much more surprising is that the Dutch plague burial grounds contain a different strain that came from Norway. How he ended up in Northern Europe is still a mystery. By the way, the plague came to Rus' not from the Golden Horde and not at the beginning of the epidemic, as it would be logical to assume, but, on the contrary, at its very curtain, and from the north-west, through the Hansa. But in general, much more detailed paleoepidemiological research will be needed to determine the routes of infection.

Vienna, Plague Column (aka Holy Trinity Column), built in 1682-1692 by the architect Matthias Rauchmüller to commemorate Vienna's deliverance from the epidemic.

Another group of biologists led by Mark Achtman (Ireland) managed to build a “family tree” of Yersinia pestis: comparing its modern strains with those found by archaeologists, scientists concluded that the roots of all three pandemics, in the 6th, 14th and 19th centuries, grow from the same region of the Far East. But in the epidemic that broke out in the 5th century BC. e. in Athens and led to the decline of the Athenian civilization, Yersinia pestis was indeed innocent: it was not a plague, but typhus. Until now, scholars have been misled by the similarities between Thucydides' account of the Athenian epidemic and Procopius of Caesarea's account of the Constantinople pestilence of 541. It is now clear that the latter imitated the former too zealously.

Yes, but what then are the reasons for the unprecedented mortality brought about by the pandemic of the 14th century? After all, it slowed down progress in Europe for centuries. Perhaps the root of the troubles should be sought in the civilizational change that happened then? Cities developed rapidly, the population grew, commercial ties intensified unheard of, merchants traveled vast distances (for example, to get from the sources of the Rhine to its mouth, the plague took only 7.5 months - and how many borders had to be overcome!). But despite all this, sanitary ideas remained deeply medieval. People lived in the dirt, often slept among rats, and they carried the deadly Xenopsylla cheopis fleas in their fur. When the rats died, the hungry fleas jumped on the people who were always nearby.

But this is a general idea, it applies to many eras. If we talk specifically about the “Black Death,” then the reason for its unheard-of “efficiency” can be seen in the chain of crop failures of 1315-1319. Another unexpected conclusion that can be drawn by analyzing skeletons from plague cemeteries concerns the age structure of the victims: the majority of them were not children, as is more often the case during epidemics, but mature people whose childhood fell on that great shortage of the early 14th century. The social and biological are intertwined in human history more intricately than it seems. These studies are of great importance. Let us remember how Camus’s famous book ends: “... the plague microbe never dies, never disappears, it can sleep for decades somewhere in the curls of furniture or in a pile of linen, it patiently waits in the wings in the bedroom, in the basement, in a suitcase, in handkerchiefs and in papers, and perhaps the day will come to grief and as a lesson to people when the plague awakens the rats and sends them to kill them on the streets of a happy city.”

sources

http://mycelebrities.ru/publ/sobytija/katastrofy/ehpidemija_chumy_v_evrope_14_veka/28-1-0-827

http://www.vokrugsveta.ru/

http://www.istorya.ru/articles/bubchuma.php

Let me remind you of something else from medical topics: but . I think you will be interested in learning more The original article is on the website InfoGlaz.rf Link to the article from which this copy was made -

A case of bubonic plague in Kyrgyzstan. According to the Republican Center for Quarantine and Particularly Dangerous Infections, 15-year-old Temirbek Isakunov contracted a dangerous disease after he and his friends (whom doctors are now actively looking for) ate marmot kebab.

For many, the news that outbreaks of plague are still possible in our time came as a surprise. In fact, since the times of the great epidemics, the plague has certainly not disappeared anywhere and will not disappear in the near future. And the point here is not at all the state of medicine in Central Asia (although there are questions about it in this case too), but the fact that the disease persists in natural reservoirs, where it continues to infect its main carriers - marmots, gophers and other rodents. These reservoirs exist all over the world, on all continents, with the possible exception of Antarctica and Australia. Just under three thousand cases of bubonic plague are reported annually. It is not possible to destroy these foci, and since one way or another humanity will have to continue to live with the plague on the same planet, it is interesting to understand these complex relationships.

Three waves

On a global scale, humanity has encountered plague three times: the Justinian Plague, which raged in the second half of the sixth century during the reign of Justinian in Byzantium, the famous Black Death, which came to Europe in the middle of the 14th century and did not subside for almost three hundred years, and the last, Asian a plague that broke out in southern China in 1855. Scientists call these three wars of humanity for survival pandemics, that is, global epidemics that affected the entire known (to the West) world. Moreover, strictly speaking, the globality condition was met only for the third time - during the Asian pandemic. The medieval Black Death did not affect the New World, and the Justinian Plague (based on what we know from historical sources) did not reach southeast Asia. However, perhaps the simple fact is that this part of the world lay far beyond the western ecumene of the 5th century.

Scientists trying to figure out the history and origins of the plague are forced to use historical accounts from contemporaries who understood almost nothing about its nature. Before the concept of bacterial infection existed, before the agent that caused it was discovered, , "plague" or "pestilence" ( plague And pestilence) called any epidemic disease that led to the death of a large number of people.

One striking example of the unreliability of historical evidence in this sense is the Plague of Athens, which broke out on mainland Greece during the Peloponnesian War at the end of the 5th century BC. It is vividly described by the Greek historian Thucydides. The war began when the Spartan-backed Thebans attacked Athens' Boeotian ally, Plataea. A sixty-thousand-strong army of Peloponnesians led by Sparta entered Attica in May 431 BC and began to destroy everything in its path. Residents of the surrounding villages hastened to hide behind the Long Walls, as a result of which the city was overcrowded - many spent the night right in the open air. Lack of water and unsanitary conditions contributed to the spread of the disease. An epidemic broke out in the city, which claimed the lives of a quarter of the population, that is, approximately 30 thousand people. Pericles himself, the leader of the Athenian army and one of the outstanding figures of the Greek Golden Age, became its victim. The name "plague" was attached to this epidemic in the literature, and many scientists until recently believed that this name correctly reflected its nature.

However, in 2006, Greek microbiologists showed that the epidemic in Periclean Athens was not a plague in its current understanding. Scientists have isolated bacterial DNA from the teeth of several people buried in the ancient cemetery of Keramekos in Athens. It turned out that fragments of the genome of the plague bacillus , as well as the DNA of typhus, anthrax and smallpox pathogens were not in them. The cause of the epidemic appears to have been salmonella. Salmonella enterica (Typhi), which causes food infection - it was its DNA that was found in the teeth of Pericles’ contemporaries. However, if we are not talking about excluding the plague version, but about proving salmonellosis as the only cause of the epidemic, then the data obtained by the authors is still too fragmentary.

Decline of Europe

The first reliably proven pandemic is the Justinian Plague, which appeared in the capital of Byzantium in 532 and spread throughout Europe until the end of the 6th century. Historical evidence suggests that the disease came from Africa via a cargo of Egyptian grain, although there is no reliable evidence for this yet. As the disease spread along trade routes, it is not surprising that Constantinople became its epicenter. It is believed that in 541–542, at the peak of the plague fire, about 40 percent of the capital's population died. “At this time, few people could be found at work. Most of the people you could meet on the street were those who carried corpses,” says historian Procopius of Caesarea. Justinian I himself died from the plague.

According to existing estimates, the first pandemic killed 25 million people in Europe, halving its population, and in total a fantastic 100 million fell victim to the pandemic. We should not forget that the population of the Earth today is completely incomparable with the number in the 6th century, and besides, the first pandemic, as we know, affected only the Old World.

The Justinian Plague, which flared up for several years and then died down, lasted in such waves until the year 700, marking the beginning of the “Dark Ages” of Europe. This was a period of decline in European culture and the arts, and the destruction of trade relations. At the same time, the population, freed from constant epidemics, gradually grew and tripled by the beginning of the 14th century.

When trade communications with Asia began to improve again and the first trading and financial empires like the Medici, Sforza and their rivals began to appear in Europe, the plague returned to Europe again and this time it went much further than in the time of Justinian. This pandemic later became known as the Black Death.

"Many people are dying"

Perhaps the plague began to be called the Black Death because of a characteristic symptom - dark circles around the eyes of people who suffered from it, and perhaps because of the black spots that appeared on the skin of patients. At the same time, the disease began to be called bubonic plague because of the characteristic swellings of the lymph nodes, buboes, that appeared in the first days of the disease.

Be that as it may, we know much more about the second wave of the pandemic than about the plague of the Justinian era. The Black Death came to Europe with merchant ships landing in Sicily in 1347. From here it spread throughout Europe - right up to Greenland, penetrated the northern coast of Africa, and reached Arabia.

This is how Giovanni Boccaccio describes this invasion on the first pages of the Decameron:

“So, since the time of the saving incarnation of the Son of God, one thousand three hundred and forty-eight years have passed, when glorious Florence, the best city in all of Italy, was visited by a destructive plague; it arose, perhaps under the influence of celestial bodies, or perhaps the righteous wrath of God sent it upon us for our sins so that we could atone for them, but only a few years before that it appeared in the East and claimed countless lives, and then , constantly moving from place to place and growing to mind-boggling proportions, finally reached the West.”

The wave of the Black Death swept through Europe in many separate epidemics, followed by periods of relative calm. Epidemics continued for almost 300 years and disappeared only by the end of the 17th century. It is interesting that by this time the Black Death had, in a sense, managed to do something good: due to the epidemic of 1665, Isaac Newton had to leave Cambridge and return to his own home, where in rural solitude he created his “Principia” in 18 months of concentrated work ", which laid down the principles of all modern science.

Despite the lack of sea communication, the Black Death did not spare Russia. This happened almost immediately after the start of the pandemic - in 1349. The plague, according to Karamzin, came through Scandinavia and first spread in Pskov and Novgorod, where approximately half the population died as a result. Glukhov and Belozersk, according to the chronicler, became completely extinct. Kostomarov reports that in 1387 in Smolensk “there was such a strong pestilence that only five people remained who left the city and closed the gates behind them.”

The Black Death showed the complete helplessness of all medicine of the 14th-19th centuries, which was recognized even by contemporaries. Plague doctors, whose costume with a black cloak and a nosed mask was immortalized by the Venetian carnival, could not only prevent the spread of the disease, but even simply alleviate the suffering of the patient, using completely ineffective means: putting frogs on the buboes and, of course, bloodletting. It is characteristic that at the same time they usually received from the commune at least four times more in fees than ordinary honest doctors, although their ranks were replenished with all sorts of adventurers without any education at all (for this they were politely called “empiricists”).

Boccaccio and other contemporaries described what they saw in such detail that it is doubtful that the cause of the Black Death was precisely caused by plague, no need:

“...the onset of the disease was marked in both men and women by tumors under the armpits and in the groin, growing to the size of a medium-sized apple or an egg - depending on which case, people called them buboes. In a very short time, malignant buboes appeared and arose in patients and in other places. Then many showed a new sign of the above disease: black or blue spots appeared on their arms, thighs, and other parts of the body...”

Thanks to modern methods of molecular biology, it has recently been possible not only to show that the cause of the Black Death was , but also to study the DNA features of that very ill-fated strain. Recent research that all modern species are direct descendants of that very Black Death, and it itself is not so different from them.

Doubts about the identity of the strain arose because, according to historical evidence, in the Middle Ages the disease was much more severe and led to greater mortality than now. In addition, buboes used to appear more often in the upper part of the body on the neck and in the armpits, but now in most patients they appear more often in the groin (since the flea carriers jump onto the legs more easily). Contrary to expectations, animal experiments demonstrated approximately the same virulence of the Black Death strain, and the differences in DNA found could not be called significant.

Asian wave

The third, or Asian, wave of plague began in 1855 in the Chinese province of Yunnan, famous for its tea production. By the end of the century, it reached Hong Kong and Bombay, from where it spread throughout the world by steamship. The pandemic was not contained even thanks to the (extremely ingenious) invention of anti-rat discs, which were installed on ropes and prevented flea carriers from getting onto ships. In India alone, the Asian plague killed 12.5 million people.

Fortunately, by the end of the 19th century, vaccines had already been invented, and microbiology was booming. Inspired by the success of the fight against smallpox, in 1894 the Japanese scientist Shibasaburo Kitazato and the Frenchman Alexandre Yersin went to Bombay in search of a cure. Both almost simultaneously managed to detect the microorganism that causes the plague. At the same time, as it turned out later, Kitazato, who initially received wide recognition, actually discovered a commensal (accompanying) bacterium, and the true pathogen turned out to be the strain isolated by Yersin - it was his name in 1970 that was immortalized in the generic name of the pathogen Yersinia.

Already two years after the discovery, Yersen managed to obtain an anti-plague serum, and subsequently other scientists were able to make a vaccine, and more than one. However, it was impossible to talk about victory over the plague until Alexander Fleming made the main invention of the 20th century, which turned the life of mankind upside down - we are talking about the discovery of antibiotics. Today, plague is a serious disease that, if diagnosed in time, can be cured within ten days of a course of streptomycin. Those deaths that continue to be recorded in different parts of the world rather paradoxically illustrate the effectiveness of existing therapy. Usually they are a consequence of the fact that doctors simply cannot recognize a disease that they have encountered only on the pages of textbooks.

Unknown plague

Advances in medicine create the misleading impression that today, if not everything, then almost everything is known about the plague. Upon closer examination, it turns out that this is completely wrong. And the feeling of victory over the disease, if you think in a longer term, is also deceptive.

Firstly, the question of the origin itself remains open . It is known that this bacterium, a relative of E. coli, several tens of thousands of years ago was a completely common enterobacteria that lived in the intestines and caused - in the most severe cases - intestinal poisoning like salmonellosis. How exactly does this bacterium Yersinia pseudotuberculosis, has become a deadly plague, it is unclear. Russian microbiologists Viktor and Nina Suntsov from the Institute of Ecology and Evolution named after A.N. Severtsov RAS have developed a complex hypothetical mechanism for this transition, related to the wintering habits of marmots and taking into account climate change, but how much it reflects the real process is still unclear.

Secondly, scientists do not know why the plague entered Europe only in the 6th century AD, and before that it avoided it. Well-established trade ties existed much earlier - just remember the Greek colonies, which in the 7th century BC stretched across the space from Portugal to the Sea of ​​​​Azov. If there really was no plague in those days, then this can be explained either by amazing luck, or by the (again incomprehensible) absence of plague in the Greek ecumene.

Thirdly, it is unknown why the first and second waves of the plague lasted as long as they did, and why they finally ended. It is unclear how one can explain the apparent absence of epidemics in the Dark Ages and their rarity in the 18th and early 19th centuries.

And finally, fifthly, it is not clear whether the victory over the plague is final and how many more quiet years are allotted to humanity in this regard. Antibiotics remain the main weapon against the plague, and the situation with them in the modern world is becoming more and more threatening. The lack of effective global regulatory authorities, the release of antibiotics into the environment and the reluctance of commercial companies to spend money on developing new generations of medicines are steadily depleting the supply of effective drugs. The creation of antibiotics, unlike almost all other products of pharmaceutical companies, is associated with a tragic paradox: each new generation becomes more toxic, less effective and more expensive, while it can only be sold to a few thousand patients infected with resistant strains of infections. All this makes it increasingly possible that future generations will look back on the 20th century as a wonderful but brief golden age for humanity.

They also belong to the Ancient World. Thus, Rufus from Ephesus, who lived during the time of Emperor Trajan, referring to more ancient doctors (whose names have not reached us), described several cases of definitely bubonic plague in Libya, Syria and Egypt.

The Philistines did not calm down and for the third time transported the trophy of war, and with it the plague, to the city of Ascalon. All the Philistine rulers later gathered there - the kings of the five cities of Philistia - and they decided to return the ark to the Israelites, because they realized that this was the only way to prevent the spread of the disease. And chapter 5 ends with a description of the atmosphere that reigned in the doomed city. “And those who did not die were smitten with growths, so that the cry of the city went up to heaven” (1 Sam.). Chapter 6 depicts the council of all the rulers of the Philistines, to which priests and soothsayers were called. They advised to bring a trespass offering to God - to put gifts in the ark before returning it to the Israelites. “According to the number of the rulers of the Philistines, there are five golden growths and five golden mice that devastate the land; for the execution is one for all of you and for those who rule you” (1 Sam.). This biblical legend is interesting in many respects: it contains a hidden message about an epidemic that most likely swept through all five cities of Philistia. We could be talking about the bubonic plague, which affected people young and old and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests apparently associated this disease with the presence of rodents: hence the golden sculptures of mice “ravaging the earth.”

There is another passage in the Bible that is considered to be a record of another instance of the plague. The Fourth Book of Kings (2 Kings) tells the story of the campaign of the Assyrian king Sennacherib, who decided to devastate Jerusalem. A huge army surrounded the city, but did not capture it. And soon Sennacherib withdrew without a fight with the remnants of the army, in which the “Angel of the Lord” struck 185 thousand soldiers overnight (2 Kings).

Plague epidemics in historical times

Plague as a biological weapon

The use of the plague pathogen as a biological weapon has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of the corpses of infected animals (horses and cows), human bodies by the Huns, Turks and Mongols to contaminate water sources and water supply systems. There are historical reports of cases of ejection of infected material during the siege of some cities (Siege of Kaffa).

Current state

Every year the number of people infected with the plague is about 2.5 thousand people, with no downward trend.

According to available data, according to the World Health Organization, from 1989 to 2004, about forty thousand cases were recorded in 24 countries, with a mortality rate of about 7% of the number of cases. In a number of countries in Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Congo, Tanzania and Madagascar), and the Western Hemisphere (USA, Peru), cases of human infection are recorded almost every year.

At the same time, on the territory of Russia, over 20 thousand people are at risk of infection every year in the territory of natural foci (with a total area of ​​more than 253 thousand km²). For Russia, the situation is complicated by the annual identification of new cases in states neighboring Russia (Kazakhstan, Mongolia, China), and the importation of a specific carrier of the plague - fleas - through transport and trade flows from the countries of Southeast Asia. Xenopsylla cheopis .

From 2001 to 2006, 752 strains of the plague pathogen were recorded in Russia. At the moment, the most active natural foci are located in the territories of the Astrakhan region, the Kabardino-Balkarian and Karachay-Cherkess republics, the republics of Altai, Dagestan, Kalmykia, and Tyva. Of particular concern is the lack of systematic monitoring of the activity of outbreaks located in the Ingush and Chechen Republics.

In July 2016, in Russia, a ten-year-old boy with bubonic plague was taken to the hospital in the Kosh-Agach district of the Altai Republic.

In 2001-2003, 7 cases of plague were registered in the Republic of Kazakhstan (with one death), in Mongolia - 23 (3 deaths), in China in 2001-2002, 109 people fell ill (9 deaths). The forecast for the epizootic and epidemic situation in the natural foci of the Republic of Kazakhstan, China and Mongolia adjacent to the Russian Federation remains unfavorable.

At the end of August 2014, an outbreak of plague occurred again in Madagascar, which by the end of November 2014 had claimed 40 lives out of 119 cases.

Forecast

Under modern therapy, mortality in the bubonic form does not exceed 5-10%, but in other forms the recovery rate is quite high if treatment is started early. In some cases, a transient septic form of the disease is possible, which is poorly amenable to intravital diagnosis and treatment (“fulminant form of plague”).

Infection

The causative agent of plague is resistant to low temperatures, preserves well in sputum, but at a temperature of 55 ° C it dies within 10-15 minutes, and when boiled, almost instantly. The gate of infection is damaged skin (with a flea bite, as a rule, Xenopsylla cheopis), mucous membranes of the respiratory tract, digestive tract, conjunctiva.

Based on the main carrier, natural plague foci are divided into ground squirrels, marmots, gerbils, voles and pikas. In addition to wild rodents, the epizootic process sometimes includes so-called synanthropic rodents (in particular, rats and mice), as well as some wild animals (hares, foxes) that are the object of hunting. Among domestic animals, camels suffer from the plague.

In a natural outbreak, infection usually occurs through the bite of a flea that previously fed on a sick rodent. The likelihood of infection increases significantly when synanthropic rodents are included in the epizootic. Infection also occurs during hunting of rodents and their further processing. Massive diseases of people occur when a sick camel is slaughtered, skinned, butchered, or processed. An infected person, in turn, is a potential source of plague, from which the pathogen can be transmitted to another person or animal, depending on the form of the disease, by airborne droplets, contact or transmission.

Fleas are a specific carrier of the plague pathogen. This is due to the peculiarities of the digestive system of fleas: just before the stomach, the flea's esophagus forms a thickening - a goiter. When an infected animal (rat) is bitten, the plague bacterium settles in the flea’s crop and begins to multiply intensively, completely clogging it (the so-called “plague block”). Blood cannot enter the stomach, so the flea regurgitates the blood along with the pathogen back into the wound. And since such a flea is constantly tormented by a feeling of hunger, it moves from owner to owner in the hope of getting its share of blood and manages to infect a large number of people before dying (such fleas live no more than ten days, but experiments on rodents have shown that one flea can infect up to 11 hosts).

When a person is bitten by fleas infected with plague bacteria, a papule or pustule filled with hemorrhagic contents (skin form) may appear at the site of the bite. The process then spreads through the lymphatic vessels without the appearance of lymphangitis. The proliferation of bacteria in macrophages of the lymph nodes leads to their sharp increase, fusion and formation of a conglomerate (“bubo”). Further generalization of the infection, which is not strictly necessary, especially in the conditions of modern antibacterial therapy, can lead to the development of a septic form, accompanied by damage to almost all internal organs. From an epidemiological point of view, it is important that plague bacteremia develops, as a result of which a sick person himself becomes a source of infection through contact or transmission. However, the most important role is played by the “screening out” of infection into the lung tissue with the development of the pulmonary form of the disease. From the moment plague pneumonia develops, the pulmonary form of the disease is already transmitted from person to person - extremely dangerous, with a very rapid course.

Symptoms

The bubonic form of plague is characterized by the appearance of sharply painful conglomerates, most often in the inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Over the course of several days, the size of the conglomerate increases, and the skin over it may become hyperemic. At the same time, an increase in other groups of lymph nodes appears - secondary buboes. The lymph nodes of the primary focus undergo softening; upon puncture, purulent or hemorrhagic contents are obtained, microscopic analysis of which reveals a large number of gram-negative rods with bipolar staining. In the absence of antibacterial therapy, festering lymph nodes are opened. Then gradual healing of the fistula occurs. The severity of the patients' condition gradually increases by the 4-5th day, the temperature may be elevated, sometimes a high fever immediately appears, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person sick with bubonic plague can fly from one part of the world to another, considering himself healthy.

However, at any time, the bubonic form of plague can cause generalization of the process and turn into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely serious. Symptoms of intoxication increase by the hour. The temperature after severe chills rises to high febrile levels. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes agitation (the patient rushes about in bed), insomnia. With the development of pneumonia, cyanosis increases, a cough appears with the release of foamy, bloody sputum containing a huge amount of plague bacilli. It is this sputum that becomes the source of infection from person to person with the development of the now primary pneumonic plague.

Septic and pneumonic forms of plague occur, like any severe sepsis, with manifestations of disseminated intravascular coagulation syndrome: minor hemorrhages may appear on the skin, bleeding from the gastrointestinal tract is possible (vomiting of bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop in blood pressure. Auscultation reveals a picture of bilateral focal pneumonia.

Clinical picture

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.

Diagnosis

The most important role in diagnosis in modern conditions is played by epidemiological anamnesis. Arrival from zones endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Karakalpakstan, etc.), or from anti-plague stations of a patient with the signs of the bubonic form described above or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is for doctor of first contact is a sufficiently serious argument for taking all measures to localize the suspected plague and accurately diagnose it. It should be especially emphasized that in the conditions of modern drug prevention, the likelihood of illness among personnel who have been in contact with a coughing plague patient for some time is very small. Currently, there are no cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel. An accurate diagnosis must be made using bacteriological studies. The material for them is the punctate of a suppurating lymph node, sputum, the patient’s blood, discharge from fistulas and ulcers.

Laboratory diagnosis is carried out using a fluorescent specific antiserum, which is used to stain smears of discharge from ulcers, punctate lymph nodes, and cultures obtained on blood agar.

Treatment

In the Middle Ages, the plague was practically not treated; actions were reduced mainly to cutting out or cauterizing the plague buboes. No one knew the real cause of the disease, so there was no idea how to treat it. Doctors tried to use the most bizarre means. One such drug included a mixture of 10-year-old molasses, finely chopped snakes, wine and 60 other ingredients. According to another method, the patient had to take turns sleeping on his left side, then on his right. Since the 13th century, attempts have been made to limit the plague epidemic through quarantines.

A turning point in plague treatment was reached in 1947, when Soviet doctors were the first in the world to use streptomycin to treat plague in Manchuria. As a result, all patients who were treated with streptomycin recovered, including a patient with pneumonic plague, who was already considered hopeless.

Treatment of plague patients is currently carried out using antibiotics, sulfonamides and medicinal anti-plague serum. Prevention of possible outbreaks of the disease consists of carrying out special quarantine measures in port cities, deratization of all ships that sail on international flights, creating special anti-plague institutions in steppe areas where rodents are found, identifying plague epizootics among rodents and combating them.

Anti-plague sanitary measures in Russia

If plague is suspected, the sanitary and epidemiological station of the area is immediately notified. The notification is filled out by the doctor who suspects an infection, and its forwarding is ensured by the chief physician of the institution where such a patient was found.

The patient should be immediately hospitalized in the infectious diseases hospital. A doctor or paramedical worker of a medical institution, upon discovering a patient or suspected of having the plague, is obliged to stop further admission of patients and prohibit entry and exit from the medical institution. While remaining in the office or ward, the medical worker must inform the chief physician in a way accessible to him about the identification of the patient and demand anti-plague suits and disinfectants.

In cases of receiving a patient with lung damage, before putting on a full anti-plague suit, the medical worker is obliged to treat the mucous membranes of the eyes, mouth and nose with streptomycin solution. If there is no cough, you can limit yourself to treating your hands with a disinfectant solution. After taking measures to separate the sick person from the healthy, a list of persons who had contact with the patient is compiled in a medical institution or at home, indicating the last name, first name, patronymic, age, place of work, profession, home address.

Until the consultant from the anti-plague institution arrives, the health worker remains in the outbreak. The issue of its isolation is decided in each specific case individually. The consultant takes the material for bacteriological examination, after which specific treatment of the patient with antibiotics can begin.

When identifying a patient on a train, plane, ship, airport, or railway station, the actions of medical workers remain the same, although the organizational measures will be different. It is important to emphasize that isolation of a suspicious patient from others should begin immediately after identification.

The head doctor of the institution, having received a message about the identification of a patient suspected of plague, takes measures to stop communication between the hospital departments and clinic floors, and prohibits leaving the building where the patient was found. At the same time, organizes the transmission of emergency messages to a higher organization and the anti-plague institution. The form of information can be arbitrary with the obligatory presentation of the following data: last name, first name, patronymic, age of the patient, place of residence, profession and place of work, date of detection, time of onset of the disease, objective data, preliminary diagnosis, primary measures taken to localize the outbreak, position and the name of the doctor who diagnosed the patient. Along with the information, the manager requests consultants and the necessary assistance.

However, in some situations, it may be more appropriate to carry out hospitalization (before establishing an accurate diagnosis) in the institution where the patient is at the time of the assumption that he has plague. Therapeutic measures are inseparable from the prevention of infection of personnel, who must immediately put on 3-layer gauze masks, shoe covers, a scarf made of 2 layers of gauze that completely covers the hair, and protective glasses to prevent splashes of sputum from entering the mucous membrane of the eyes. According to the rules established in the Russian Federation, personnel must wear an anti-plague suit or use special means of anti-infective protection with similar properties. All personnel who had contact with the patient remain to provide further assistance to him. A special medical post isolates the compartment where the patient and the personnel treating him are located from contact with other people. The isolated compartment should include a toilet and a treatment room. All personnel immediately receive prophylactic antibiotic treatment, continuing throughout the days they spend in isolation.

Treatment of plague is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. Antibiotics of the streptomycin series are most effective for treating plague: streptomycin, dihydrostreptomycin, pasomycin. In this case, streptomycin is most widely used. For the bubonic form of plague, the patient is administered streptomycin intramuscularly 3-4 times a day (daily dose 3 g), tetracycline antibiotics (vibromycin, morphocycline) intramuscularly at 4 g/day. In case of intoxication, saline solutions and hemodez are administered intravenously. A drop in blood pressure in the bubonic form should in itself be regarded as a sign of generalization of the process, a sign of sepsis; in this case, there is a need for resuscitation measures, administration of dopamine, and installation of a permanent catheter. For pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g/day, and tetracycline - to 6 g. For forms resistant to streptomycin, chloramphenicol succinate can be administered up to 6-8 g intravenously. When the condition improves, the dose of antibiotics is reduced: streptomycin - up to 2 g / day until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g / day daily orally, chloramphenicol - up to 3 g / day, for a total of 20-25 g. Biseptol is also used with great success in the treatment of plague.

In case of pulmonary, septic form, development of hemorrhage, they immediately begin to relieve disseminated intravascular coagulation syndrome: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out in any centrifuge with special or air cooling with a capacity of 0.5 l or more) in the volume removed plasma 1-1.5 liters when replaced with the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, daily administration of fresh frozen plasma should not be less than 2 liters. Until the acute manifestations of sepsis are relieved, plasmapheresis is performed daily. The disappearance of signs of hemorrhagic syndrome and stabilization of blood pressure, usually in sepsis, are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for dopamine to stabilize blood pressure decreases, muscle pain subsides, and shortness of breath decreases.

The team of medical personnel providing treatment to a patient with pneumonic or septic form of plague must include an intensive care specialist.

see also

• Inquisitio
• Plague (group)

Notes

1. Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
2. Jared Diamond, Guns, Germs and Steel. The Fates of Human Societies.
3. , With. 142.
4. Plague
5. , With. 131.
6. Plague - for doctors, students, patients, medical portal, abstracts, cheat sheets for doctors, disease treatment, diagnosis, prevention
7. , With. 7.
8. , With. 106.
9. , With. 5.
10. Papagrigorakis, Manolis J.; Yapijakis, Christos; Synodinos, Philippos N.; Baziotopoulou-Valavani, Effie (2006). “DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens” . International Journal of Infectious Diseases. 10 (3): 206-214.