Bubonic plague: a history of disease and epidemic outbreaks. The war against the Black Death: from defense to offense

Candidate of Medical Sciences V. GANIN (Irkutsk Research Anti-Plague Institute of Siberia and the Far East).

Devastating pandemics and plagues have left a devastating mark on human history. Over the past two centuries, doctors have worked to create a preventive and therapeutic vaccine against a deadly infection. Sometimes testing new drugs cost devotees their lives. In the second half of the twentieth century, new effective vaccines and antibacterial drugs appeared, which gave people hope of complete deliverance from the Black Death. But in fact, the ground for new plague epidemics still exists.

The Asian rat flea Xenopsylla chepsis transmits the plague bacilli from rats to humans.

Microorganisms - causative agents of Yersina pestis plague under a microscope.

The creator of the world's first plague vaccine, Vladimir Khavkin, is vaccinating the local population. Calcutta, 1893.

Sometimes the “Black Death” served as a source of inspiration for poets, like the chairman of a feast during a plague singing a hymn in honor of a terrible disease. Illustration by V. A. Favorsky for “A Feast during the Plague” by A. S. Pushkin, 1961.

This is how the 19th century Swiss artist Arnold Böcklin depicted the Black Death.

Production of the Khavkin anti-plague vaccine. Bombay, late 1890s.

Scheme of transmission of the plague pathogen from rodents to humans.

The spread of plague across the globe, 1998.

History of epidemics

The first reliable pandemic of the plague, included in literature under the name “Justinian,” arose in the 6th century during the heyday of the culture of the Eastern Roman Empire, during the reign of Emperor Justinian, who himself died from this disease. The plague came from Egypt. During the period from 532 to 580, it covered many countries. The epidemic spread in two directions: in the west - towards Alexandria, along the coast of Africa, and in the east - through Palestine and Syria into Western Asia. The plague spread along trade routes: first along the seashores, then deep into the states bordering the sea coast. It reached its peak when it penetrated into Turkey and Greece in 541-542, and then into the territory of present-day Italy (543), France and Germany (545-546). Then more than half the population of the Eastern Roman Empire died - almost 100 million people.

The second pandemic, known as the Black Death, came in the 14th century (1348-1351). Not a single European state has escaped the onslaught of infection, not even Greenland. This pandemic is well documented in many author's sources. It ushered in a period of epidemics that did not leave Europe alone for five centuries. During the second pandemic, which affected almost all countries of the world, about 40 million people died around the globe. Dirt, poverty, lack of basic hygiene skills and crowded population were the reasons for the unchecked spread of the disease. The plague "moved" at the speed of a horse - the main transport of that time.

Giovanni Boccaccio painted a tragic picture of the plague epidemic in Italy in 1348 in the first short story of the Decameron: “Glorious Florence, the best city of Italy, was visited by a destructive plague... Neither doctors nor drugs helped or cured this disease... Since for the great multitude of the dead the bodies that were brought to the churches every hour, there was not enough consecrated ground, then in the overcrowded cemeteries at the churches they dug huge holes and hundreds of corpses were lowered in. In Florence, as they say, 100 thousand people died... How many noble families, rich inheritances, huge fortunes left without legitimate heirs! How many strong men, beautiful women, charming young men, whom even Galen, Hippocrates and Aesculapius would have recognized as completely healthy, had breakfast in the morning with relatives, comrades and friends, and in the evening dined with their ancestors in the next world."

Indeed, during the years of the second pandemic, many famous people died from the disease: Louis IX (the Saint), Jeanne of Bourbon - the wife of Philip of Valois, Jeanne of Navarre - the daughter of Louis X, Alphonse of Spain, the German Emperor Gunther, the brothers of the King of Sweden, the artist Titian.

The nature of the disease remained unknown, but even then doctors understood that to stop the spread of the disease it was necessary to separate the sick and the healthy. This is how quarantine was invented. The word "quarantine" comes from the Italian "quaranta" - forty. In Venice in 1343, special houses were built for visitors, in which they were kept for forty days, under no circumstances going outside. Sea transport arriving from dangerous places was also ordered to remain in the roadstead for forty days. Quarantine became one of the first barriers to infection.

The third plague pandemic began at the end of the 19th century in the Chinese province of Yunnan. Spreading along the southern coast of China, by 1894 it reached first the city of Canton and then Hong Kong. The pandemic was rapidly gaining momentum. About 174 thousand people died in six months. In 1896, the Indian city of Bombay was struck. In India alone, 12.5 million people died from the plague from 1896 to 1918. The replacement of sailing merchant ships with steam-powered ships with greater power and speed allowed the infection to quickly spread to other continents, causing outbreaks in port cities along major international shipping lines. Major plague epidemics occurred in South Africa, South and North America.

The "Chinese" pandemic was very different from all previous outbreaks of plague. Firstly, it was a “port plague”, which in the vast majority of cases did not penetrate into the interior of the mainland. Secondly, it was the “rat plague”, since the source of its spread was ship and port rats. Thirdly, it was mainly the “bubonic” plague. Complications of secondary pneumonic plague were observed rarely. Realizing that rats were somehow spreading the “port plague,” quarantine doctors insisted that all mooring ropes in ports and on ships have metal discs that served as an insurmountable barrier to the migration of these rodents.

The Black Death did not spare Russia either. Over the course of the 13th-14th centuries, she visited Kyiv, Moscow, Smolensk, and Chernigov. In Smolensk, out of all the city residents, five people survived; they got out of the city, closed the city gates and left. In the 14th century, in Pskov and Novgorod, the plague destroyed two-thirds of the population, and in Glukhov and Belozersk all the inhabitants died out. This is how the ancient chronicler described the plague epidemic in Pskov in 1352: “And old and young, men and women all died with iron. And whoever takes something from whom, in that hour dies incurably. Many want to serve the dying and soon incurably dying, and for the sake of many who are running away, serve the dying.” If you believe the chronicles, then in two years in the Pskov and Novgorod lands the plague claimed the lives of 250,652 people.

N. M. Karamzin in his work “History of the Russian State” wrote: “In 1349, an infection from Scandinavia came to Pskov and Novgorod. The disease was detected by glands in the soft parts of the body. The man coughed up blood and died on the next or third day. One cannot imagine the sights so terrible: young men and elders, spouses and children lay in coffins next to each other, numerous families disappeared in one day. Each priest in the morning found thirty or more deceased in his church; they buried everyone together, and there was no longer room in the cemeteries for new ones graves: they were buried outside the city in the forests... In a word, they thought that everyone should die.” The Black Death epidemic of the 14th century killed many of the crowned heads, historical figures and aristocrats. Gone into oblivion were Grand Duke Simeon Ioanovich Proud with his brother George and seven children, Novgorod Archbishop Vasily, Grand Duke Vasily Vladimirovich, Prince Yaroslav, his princess and son, the deputy of the Moscow Tsar, Boyar Pronsky, Kazan Metropolitan Corniliy and Astrakhan Archbishop Pachomius.

In 1718, Peter I, realizing the danger the plague posed, issued a decree: “Villages infected with the plague should be surrounded by outposts and deprived of any communication with others, and the houses in which they died out should be burned with all their junk, even horses and cattle... "the gallows, and whoever sneaks in secretly, hanged without being written off. Receive letters from couriers through fire, rewrite three (!) times and send only the last copy to their intended destination; deliver information about the sick under the threat of deprivation of life and property." Under penalty of death, it was forbidden to enter infected houses and take things from sick people.

By the beginning of the winter of 1770, the disease had spread to Moscow. During the Moscow epidemic, 130 thousand people died. In the midst of the plague epidemic, the “Commission for the Prevention and Treatment of Pestilence and Contagious Ulcers” was created. At the end of the epidemic, the Commission instructed one of its members, the senior doctor of the Main Land Hospital, Afanasy Shafonsky, to draw up a detailed report. A. Shafonsky completed the task assigned to him, and in 1775 the book “Description of the pestilence that occurred in the capital city of Moscow from 1770 to 1772 with the annex of all the then established institutions for ending it” was published.

And in the 19th century, the plague repeatedly visited the southern territories of Russia - the Astrakhan province, Odessa, the Caucasus - but did not spread from local temporary foci to the central regions. The last plague epidemic in Russia is considered to be an outbreak of its pneumonic form in the Primorsky Territory in 1921, which came from China. Since the 30s of the last century, the incidence of plague has sharply decreased: both the number of cases and the number of countries in which cases of plague have been recorded have decreased.

But the disease did not go away completely. According to WHO annual reports, from 1989 to 2003, 38,310 cases of plague were reported in 25 countries in Asia, Africa and America. In eight countries (China, Mongolia, Vietnam, the Democratic Republic of the Congo, the United Republic of Tanzania, Madagascar, Peru and the United States), human cases of plague occur almost annually.

Looking for a reason

For a long time, doctors did not know how to save a patient from the Black Death. The disease spared neither the hungry, ragged crowd, nor the privileged and wealthy classes. Fasting and prayers did not help. The cause of the illness remained unknown.

In 1894, the best medical forces from many countries around the world were sent to fight the third plague pandemic that began in China. The Japanese government sent doctor Shibasaburo Kitazato to China, and the French government sent Alexandre Yersin. By this time, the causative agents of cholera, tuberculosis, anthrax and some other infections had already been discovered, but the microorganism that caused the plague remained unknown. Kitazato isolated microorganisms from the tissues of a deceased patient, which he considered to be the causative agents of the plague. Independently of the Japanese doctor, Yersen, having obtained a culture of microorganisms from those killed by the plague, simultaneously discovered the plague bacillus in the corpses of dead rats. For a long time, it was believed in medical circles that the microorganisms discovered by researchers were identical. But two years later, Japanese bacteriologists K. Nakamura and M. Ogata with pathologist M. Yamagawa established that the true causative agent of the plague was still a microbe isolated by A. Yersin, and the microorganism isolated by S. Kitazato belonged to the accompanying microflora. Ogata made a report about this at the International Congress in Moscow in 1896.

The microorganism that causes plague, the plague bacillus, has changed its taxonomic nomenclature several times: Bacterium pestis- before 1900, Bacillus pestis- until 1923, Pasteurella pestis- until 1970 and finally Yersinia pestis as recognition of the priority of the French scientist.

So, the causative agent of the plague was found, but it remained unclear how the disease spreads.

Before the start of the third plague pandemic in China (in Canton), a massive migration of rats was observed, leaving their nests. For no apparent reason, in the light of day they staggered as if drunk, made frequent high jumps on their hind legs, as if trying to jump out of somewhere, then made one or two circular involuntary movements, coughed up blood and died. By the end of the “human” plague epidemic, almost all the rats in the city had died out. Doctors realized that there is a direct connection between the rodent disease and the plague pandemic among humans.

In 1899, the famous Russian epidemiologist and microbiologist D.K. Zabolotny wrote: “Various breeds of rodents, in all likelihood, represent in nature the environment in which plague bacteria persist.” The assumption was verified in 1911, when a Russian expedition led by Zabolotny was sent to Manchuria to study and eliminate the pneumonic plague epidemic. There were no port rats in the endless steppes. Nevertheless, the Mongols believed that the plague was transmitted from rodents to humans. The Mongolian name for the plague, “tarbagane-ubuchi,” directly indicated the connection of the disease with marmots, the tarbagans.

In June 1911, student L.M. Isaev, working in Zabolotny’s group near the Sharasun station, noticed a large marmot, the tarbagan, moving with difficulty. Isaev caught him, wrapped him in a cloak and brought him to the laboratory. The plague microbe was isolated from the animal's organs. The scientific discovery of Russian scientists was of global significance. It marked the beginning of epizootology and the theory of natural focality of plague. Zabolotny’s formula: “epizootic among rodents - man - epidemic” - explained the causes of many outbreaks of plague.

The first objective confirmation that the plague microbe can be transmitted from rodents to humans was obtained in 1912. Then, in the northwestern Caspian region, mobile laboratories began to work under the leadership of D.K. Zabolotny and I.I. Mechnikov. A member of the expedition, doctor I. A. Deminsky, isolated a plague microbe from the organs of a gopher. While working with the resulting strain, I. A. Deminsky became infected with the plague and died.

It became clear that rodents are, as it were, a natural reservoir of the plague pathogen. A person can become infected from the “hosts” of the plague bacillus directly when cutting up animal carcasses and through “intermediaries” - fleas, as was the case during the “port plague” in China. When there is a mass death of rats, fleas leave the dead bodies of rodents in search of new hosts. Tens of thousands of insects carrying a deadly disease appear in the human environment.

In India, China, and Madagascar, plague is carried by synanthropic rats (Ratus ratus and Ratus norvegicus). The "repository" of plague in Mongolia, Transbaikalia and Altai turned out to be marmots - tarbagans (Marmota sibirica), and the culprit for outbreaks of plague in the northwestern Caspian region was the small gopher (Citellus pigmaeus).

The vaccine that saved humanity

Since the time of the first plague epidemics, medical practitioners have argued about whether it is possible to become infected with the plague from a patient or not, and if so, in what way. There were conflicting opinions. On the one hand, it was argued that touching the sick and their belongings was dangerous. On the other hand, proximity to sick people and being in an infected area were considered safe. There was no clear answer, since rubbing the patient’s pus into the skin or wearing his clothes did not always lead to infection.

Many doctors saw a connection between the plague and malaria. The first experiment on self-infection with plague was carried out in the city of Alexandria in 1802 by the English doctor A. White. He wanted to prove that the plague could cause an attack of malaria. White extracted the purulent contents of the plague patient's bubo and rubbed it into his left thigh. Even when a carbuncle appeared on his own thigh and the lymph nodes began to enlarge, the doctor continued to claim that he had malaria. It was only on the eighth day, when the symptoms became obvious, that he diagnosed himself with plague and was taken to the hospital, where he died.

It is now clear that plague is transmitted from person to person mainly by airborne droplets, so patients, especially with the pneumonic form of plague, pose a huge danger to others. Also, the plague causative agent can enter the human body through the blood, skin and mucous membranes. Although the cause of the disease remained unclear for a long time, doctors have long been looking for ways to protect against this terrible disease. Long before the era of antibiotics, with the help of which plague is now quite successfully cured, and vaccine prevention, they offered various ways to increase the body's resistance to plague.

An experiment carried out in 1817 by the Austrian doctor A. Rosenfeld ended tragically. He assured that the drug, prepared from bone powder and dried lymph glands taken from the remains of those who died from the plague, when taken orally, completely protects against the disease. In one of the hospitals in Constantinople, Rosenfeld locked himself in a ward with twenty plague patients, having previously taken the drug he advertised. At first everything went well. The six weeks allotted for the experiment were ending, and the researcher was about to leave the hospital when he suddenly fell ill with the bubonic plague, from which he died.

The experiment of the Russian doctor Danila Samoilovich ended more successfully. His colleague fumigated with poisonous powders the underwear of a man who died of the plague. After this procedure, Samoilovich put the underwear on his naked body and wore it for a day. Samoilovich rightly believed that the “living ulcerative principle” (that is, in modern language, the causative agent of the plague) should die from fumigation. The experiment was successful, Samoilovich did not get sick. Thus, science, a hundred years before Yersin’s discovery, received indirect confirmation that the causative agent of the plague was a living microorganism.

The search for means to prevent and treat the plague continued. The first therapeutic anti-plague serum was prepared by Yersen. After injecting the serum into patients, the plague progressed in a milder form, and the number of deaths decreased. Before the discovery of antibacterial drugs, this vaccine was the main therapeutic agent in the treatment of plague, but it did not help with the most severe, pulmonary form of the disease.

In 1893-1915, Vladimir Khavkin, a graduate of Novorossiysk University, worked in India. In 1896, in Bombay, he organized a laboratory in which he created the world's first killed anti-plague vaccine and tested it on himself. The new vaccine had both therapeutic and preventive effects. After vaccination, morbidity decreased by half, and mortality by four. Vaccinations with the Haffkine vaccine have become widespread in India. Until the 40s of the 20th century, the Haffkine vaccine remained essentially the only cure for the plague. In 1956, it was 60 years since the creation of the anti-plague laboratory (since 1925 - the Khavkin Bacteriological Institute). In this regard, President of India Prasad noted: “We in India are greatly indebted to Dr. Vladimir Khavkin. He helped India get rid of epidemics of plague and cholera.”

In our country, the development of live vaccines against plague began in 1934 with the production of a new vaccine strain at the Stavropol Research Anti-Plague Institute by M.P. Pokrovskaya by treating a culture of the plague pathogen with bacteriophages. After testing the vaccine on animals, Pokrovskaya and her collaborator injected themselves subcutaneously with 500 million microbes of this weakened culture of the plague bacillus. The experimenters’ body reacted sharply to the introduction of “foreign” microorganisms with a rise in temperature, a deterioration in the general condition, and a reaction at the injection site. However, after three days, all symptoms of the disease disappeared. Having thus received a “start in life,” the vaccine began to be successfully used in eliminating the plague outbreak in Mongolia.

At the same time, on the islands of Java and Madagascar, French scientists L. Otten and G. Girard also worked on creating a live vaccine. Girard managed to isolate a strain of the plague microbe, which spontaneously lost virulence, that is, it ceased to be dangerous to humans. The scientist named the vaccine based on this strain after the initials of the girl who died in Madagascar from whom it was isolated - EV. The vaccine turned out to be harmless and highly immunogenic, so the EV strain is still used to this day to prepare a live anti-plague vaccine.

A new vaccine against plague was created by V.P. Smirnov, a researcher at the Irkutsk Research Anti-Plague Institute of Siberia and the Far East, who participated in the elimination of 24 local outbreaks of plague outside our country. Based on numerous experiments on laboratory animals, he confirmed the ability of the plague microbe to cause the pulmonary form of the disease when infected through the conjunctiva of the eye. These experiments formed the basis for the development of conjunctival and combined (subcutaneous-conjunctival) methods of vaccination against plague. To verify the effectiveness of the method he proposed, Smirnov injected himself with a new vaccine and at the same time infected himself with a virulent strain of the most dangerous, pneumonic form of plague. For the purity of the experiment, the scientist categorically refused treatment. On the 16th day after self-infection, he left the isolation ward. According to the conclusion of the medical commission, Smirnov suffered from the cutaneous bubonic form of plague. Experts stated that the vaccination methods proposed by V.P. Smirnov turned out to be effective. Subsequently, in the Mongolian People's Republic, during the elimination of the plague outbreak, 115,333 people were vaccinated using these methods, of whom only two fell ill.

Healthcare against plague

The formation of the anti-plague system in Russia began at the end of the 19th century. In 1880, in St. Petersburg, on Aptekarsky Island, there was an anti-plague laboratory, organized on the initiative of Academician D.K. Zabolotny and Professor A.A. Vladimirov. Working with cultures of the plague microbe was dangerous and required isolation. Based on these considerations, in 1899 the laboratory was moved outside the city to the out-of-the-way fort "Alexander I".

Departments of the St. Petersburg laboratory were engaged in studying the microbiology of the plague microbe, the susceptibility of various animal species to it, preparing anti-plague vaccines and serums, and training doctors and paramedical personnel. Over 18 years, articles on the microbiology of plague were written within its walls, the authors of which were plague doctors D.K. Zabolotny, S.I. Zlatogorov, V.I. Isaev, M.G. Tartakovsky, V.I. Turchinovich-Vyzhnikovich , I. Z. Shurupov, M. F. Schreiber.

In 1901, a well-equipped anti-plague laboratory for that time appeared in Astrakhan. It was headed by N. N. Klodnitsky. In 1914, a congress on the fight against plague and gophers was held in Samara, at which the question of organizing a bacteriological institute with an anti-plague bias was raised. Such an institute was opened in 1918 in Saratov, where the laboratory was transferred from the Kronstadt Fort. Now it is the Russian Research Anti-Plague Institute "Microbe". To this day, "Microbe" remains Russia's advisory and methodological center for especially dangerous infections.

In the USSR, a powerful network of anti-plague institutions was created with research institutes with subordinate stations and departments, which functions to this day. Annual observations of natural plague foci ensure the epidemiological well-being of the country. Special laboratories in major seaports are studying strains isolated from ship rats on ships sailing from countries where isolated cases of plague are still observed.

Unfortunately, the Central Asian Research Anti-Plague Institute with a network of anti-plague stations in active outbreaks of Kazakhstan and the anti-plague service of other republics of the former USSR fell out of the unified anti-plague system. And in the Russian Federation, the scale of inspection of plague foci has noticeably decreased. Abandoned collective and state farm lands are overgrown with weeds, and the number of rodents - potential carriers of plague - is increasing. But the reasons for the periodic awakening and extinction of natural plague foci are still unknown. It is also necessary to take into account the fact that the new generation of doctors in the general medical network has never seen patients with plague and is familiar with this infection only from literary sources.

In general, the ground for the emergence of epidemic complications exists, and everything possible must be done to prevent the “Black Death” from the distant past from becoming a disease of future generations.

"Science and Life" about vaccines:

Turbin A. Vaccine. - 1982, No. 7.

Marchuk G., Petrov R. Immunology and progress of medicine. - 1986, No. 1.

Zverev V. - 2006, No. 3.

The oldest type of bubonic plague was discovered in the Samara region. Ogonyok found out how Russia became the birthplace of a terrible disease and what it means.

Plague is usually looked for in teeth.

This is a transient disease: unlike syphilis or tuberculosis, it does not have time to leave traces on the skeleton. And in the pulp of the tooth there are many blood vessels, and there is a high probability of finding remains of bacteria there. In addition, the tooth is the densest part of the human body. It is perfectly preserved even after death, so external contaminants are not mixed with the biological material contained inside,” explains the discoverer of the ancient plague, Rezeda Tukhbatova, senior lecturer at the Department of Biochemistry and Biotechnology at Kazan Federal University (KFU).

Despite her age (barely 30) and the fact that Reseda is still only a candidate of biological sciences, she is one of the leading experts on ancient diseases in the Russian Federation. She is interested in syphilis and tuberculosis, but her specialty is the plague. After Rezeda Tukhbatova found evidence of a plague epidemic in medieval Bulgar, she was sent samples from all over the Volga region. A collection of teeth and other bone remains in her laboratory for 5 thousand copies. Is it any wonder that the next teeth brought from Samara gave a sensational result? They discovered the oldest known samples of bubonic plague, 3800 years old!

Means of mass infection

Let’s make a reservation right away: scientists also know an older type of plague. The samples found in Armenia are 5 thousand years old. But it was a less contagious disease, it did not lead to the appearance of buboes and could not cause such mass mortality as the still terrifying epidemics of the Middle Ages. Simply put, the bacterium has not yet been transmitted through insect bites.

In order to “learn” this, the plague bacillus Yersinia pestis had to acquire several evolutionary mechanisms that allow it to use insects. The flea has a so-called goiter in front of the stomach. Bacteria multiply in it and, with the help of a special enzyme (this is the main evolutionary acquisition), block the passage of the esophagus, and nothing goes further into the stomach. The blood that is drunk does not get there, the goiter becomes full, and the flea regurgitates the blood along with the plague bacillus back into the wound, infecting the victim. And, having never had enough to eat, it urgently looks for someone else to bite. Before dying of hunger, the insect manages to infect several people with the deadly disease. At the same time it kills plague and fleas. And from the site of the bite, the infection migrates to the nearest lymph nodes, which become inflamed and enlarged - these are the buboes.

To launch such a “mechanism of mass infection”, a number of genetic changes were needed, which, taken together, were first identified in samples from near Samara.

But in more ancient Armenian strains there is no such thing.

Most likely, the ancient disease spread by airborne droplets, like most colds, explains Rezeda Tukhbatova. “Apparently, both variations of the plague existed in parallel for many years.

In a paper published in June this year in the respected scientific journal Nature, a Russian-German team of scientists constructed a complete genealogy of the bacterium. According to the authors, all subsequent varieties - both the Black Death, which devastated Europe in the 14th century, and the current plague, from which, by the way, people still die - are descended from the strain from the Samara find. From the German side, the head of the Max Planck Institute for Research in the History of Humanity, Johannes Krause, worked on the project.

This professor, who is not even 40, is the author of a number of sensations, and all of them are from the history of the evolution of diseases. Only this year, using genetic research, he proved that Europe is the birthplace of leprosy, and the hepatitis B virus has accompanied humans for at least 7 thousand years. The genome of Yersinia pestis from the London medieval plague cemetery was deciphered by Johannes Krause back in 2011. And at the same time he proved the origin of the plague bacillus from the much more peaceful pathogen of pseudotuberculosis. It is not surprising that when Rezeda Tukhbatova decided to prove the existence of a plague epidemic in the capital of Volga Bulgaria in 2014, she went to Krause’s laboratory. And many years of cooperation led to the discovery.

The work of Kazan and German scientists is structured like this: our side collects and prepares samples, in Germany they isolate the genome. And the point is not that we do not have the necessary equipment: a number of scientific centers have equipment. The point is how they work with it.

Laboratory work

We need not just sterile, but super-sterile conditions. We put on a special suit, and not in one layer. Positive pressure must be maintained in the room to prevent anything from being brought in from outside. The requirements are stricter than for operating rooms,” says Rezeda Tukhbatova. “Unfortunately, there is nothing similar in Russia yet.

In their entire form, plague bacilli do not persist for so long, so scientists cannot become infected. But they will have to assemble the complete genome of the bacterium from many scattered fragments.

There has been a lot of interest in the topic lately, and our ideas about ancient diseases are changing rapidly,” says Rezeda Tukhbatova. “It was recently believed that the Black Death appeared only in the 14th century. Then it turned out that the Justinian plague was caused by the same bacterium. And now we see that it is almost 4 thousand years old.

Today there are three known plague epidemics. The plague that arose during the reign of the Byzantine emperor Justinian I (it covered the territory of the entire civilized world of that era and manifested itself in outbreaks from 541 to 750), the Black Death, which claimed the lives of 25–50 million in Europe alone in the middle of the 14th century, and the last epidemic , which began in China in the mid-19th century. But for other diseases known from history, the version of plague was not confirmed. "Antonine Plague" of the 2nd century AD. turned out to be smallpox, the Athenian plague of the 4th century BC - measles.

The answer to the riddle

The Mikhailovsky burial mound in the Kinelsky district of the Samara region, where the plague was found, at first glance does not stand out among the others. It dates back to the 17th century BC, this is the late Bronze Age, Timber-frame culture (so named because of the method of burial).

Its representatives dug a grave pit and installed a frame in it. Then they covered it with logs and covered it with earth. The result was such an underground house,” explains Pavel Kuznetsov, director of the Volga Region Museum of Archeology.

There are many similar mounds in these parts. They are often excavated when the slopes of the mound are to be plowed or built. It was the same this time. In 2015, nine skeletons were found in the burial ground, and in 2016, archaeologist Alexander Khokhlov sent one tooth from each to Kazan paleogeneticists. Plague bacteria were found in two samples.

The high mortality rate of the population in the Srubnaya culture remained a mystery to historians. Children especially died a lot,” says Khokhlov. “And now we have an answer: perhaps it’s the plague.”

The epidemic could also have more global historical consequences. In the 17th–16th centuries BC, that is, soon after the time to which the finds from the Mikhailovsky burial ground belong, people of the Timber-Grave culture from this region moved westward, to the Dnieper region. How to know if the plague has moved them? However, scientists are cautious in their conclusions.

Not a single village was found where there were traces of mass extinction due to the disease. Why are we sure of this? Because during a mass epidemic, funeral rites are simplified: the depth of burials decreases, collective burials appear. We don’t see any of this in the timber-frame culture,” states Pavel Kuznetsov. “Perhaps the disease was not so terrible.

It is important to note that, despite the excavations, we still know very little about the people of the Srubnaya culture. Apparently, these were Iranian-speaking tribes, the ancestors of the Sarmatians, and possibly the Scythians. They lived sedentary lives. According to Alexander Khokhlov, they were engaged in agriculture and cattle breeding. Pavel Kuznetsov disagrees: they are all cattle breeders and did not grow plants. Be that as it may, until we understand how people got sick in the Bronze Age and what the ancient epidemics led to, scientists still have to dig and dig.

The main thing is that people do not panic because of the plague and begin to interfere with the excavations. There are no living bacteria there,” says Alexander Khokhlov.

By the way, even after deciphering the genome of the Black Death, Johannes Krause’s team could not explain why so many people died from it. The current varieties of the plague bacillus are very similar to the fossil one. But the mortality rate from them is much lower, even if the disease is not treated.

Studying the evolution of pathogenic bacteria provides a chance to predict the further development of other pathogens of dangerous diseases. And ultimately help doctors resist them, Professor Krause is sure. But it is already clear that the discovery of a group of Russian and German scientists provides a chance for a new reading of a number of mysterious pages in the history of mankind.

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 take control of 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 agent 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 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 on the skin are possible, 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 2019-04-18 - 2019-04-18 - 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.

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 followers of the church 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 area were also popular.
• Do whatever is necessary to kill 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.

Plague is an infectious disease caused by the bacterium Yersinia Pestis. Depending on the presence of pulmonary infection or sanitary conditions, plague can be spread through the air, transmitted through direct contact, or very rarely through contaminated cooked food. Symptoms of plague depend on the concentrated areas of infection: bubonic plague appears in the lymph nodes, septicemic plague in the blood vessels, and pneumonic plague in the lungs. Plague is treatable if detected early. Plague is still a relatively common disease in some remote parts of the world. Until June 2007, plague was one of three epidemic diseases specifically reported to the World Health Organization (the other two being cholera and yellow fever). The bacterium is named after the French-Swiss bacteriologist Alexandre Yersin.

The massive plague pandemics that swept across Eurasia are believed to have been associated with very high mortality rates and major cultural changes. The largest of these was the Plague of Justinian of 541–542, the Black Death of 1340, which continued at intervals during a second plague pandemic, and a third pandemic that began in 1855 and has been considered inactive since 1959. The term "plague" is currently applied to any severe inflammation of a lymph node resulting from Y. pestis infection. Historically, the medical use of the term "plague" applied to pandemics of infection in general. The word "plague" is often associated with bubonic plague, but this type of plague is only one of its manifestations. Other names such as the Black Plague and the Black Death have been used to describe this disease; the latter term is now used primarily by scientists to describe the second, and most devastating, pandemic of the disease. The word "plague" is believed to come from the Latin plāga ("strike, wound") and plangere (to strike), cf. German Plage (“infestation”).

Cause

Transmission of Y. pestis to an uninfected individual is possible by any of the following methods.

Airborne transmission – coughing or sneezing on another person

Direct physical contact – touching an infected person, including sexual contact

Indirect contact – usually by touching contaminated soil or a contaminated surface

Airborne transmission – if the microorganism can remain in the air for a long time

Fecal-oral transmission - usually from contaminated food or water sources - is carried by insects or other animals.

The plague bacillus circulates in the body of animal carriers of the infection, especially in rodents, in natural foci of infection located on all continents except Australia. Natural foci of plague are located in a wide belt of tropical and subtropical latitudes and warm areas of temperate latitudes throughout the globe, between the parallels of 55 degrees north latitude and 40 degrees south latitude. Contrary to popular belief, rats were not directly involved in the beginning of the spread of bubonic plague. The disease was mainly transmitted through fleas (Xenopsylla cheopis) to rats, making rats themselves the first victims of the plague. In humans, infection occurs when a person is bitten by a flea that was infected by biting a rodent that was itself infected by the bite of a flea carrying the disease. The bacteria multiply inside the flea and clump together to form a plug that blocks the flea's stomach and causes it to starve. The flea then bites the host and continues to feed, even being unable to suppress its hunger, and consequently vomiting bacteria-infested blood back into the bite wound. The bubonic plague bacterium infects a new victim, and the flea eventually starves to death. Serious outbreaks of plague are usually triggered by other outbreaks of disease in rodents, or by an increase in the rodent population. In 1894, two bacteriologists, Alexandre Yersin of France and Kitasato Shibasaburo of Japan, independently isolated the bacterium in Hong Kong responsible for the third pandemic. Although both researchers reported their results, a series of confusing and contradictory statements by Shibasaburo ultimately led to Yersin being accepted as the primary discoverer of the organism. Yersin named the bacterium Pasteurella pestis after the Pasteur Institute, where he worked, but in 1967 the bacterium was transferred to a new genus and renamed Yersinia pestis, in Yersin's honor. Yersin also noted that rat plague was observed not only during plague epidemics, but also often preceded such epidemics in humans, and that many local residents believed that plague was a disease of rats: villagers in China and India claimed that the death of large numbers of rats entailed an outbreak of plague. In 1898, French scientist Paul-Louis Simon (who also came to China to fight the third pandemic) established the rat-flea vector that controls the disease. He noted that sick people should not be in close contact with each other so as not to acquire the disease. In Yunnan Province, China, residents fled their homes as soon as they saw dead rats, and on the island of Formosa (Taiwan), residents believed that contact with dead rats was associated with an increased risk of developing plague. These observations led the scientist to suspect that the flea might be an intermediate factor in the transmission of plague, since humans only acquired plague when they were in contact with recently deceased rats that had died less than 24 hours earlier. In a classic experiment, Simon demonstrated how a healthy rat died of plague after infected fleas jumped onto it from rats that had recently died of plague.

Pathology

Bubonic plague

When a flea bites a person and contaminates the wound with blood, plague-transmitting bacteria are transferred to the tissue. Y. pestis can reproduce inside a cell, so even if the cells are phagocytosed, they can still survive. Once in the body, the bacteria can enter the lymphatic system, which pumps out interstitial fluid. Plague bacteria produce several toxins, one of which is known to cause life-threatening beta-adrenergic blockade. Y. pestis spreads through the lymphatic system of an infected person until it reaches the lymph node, where it stimulates severe hemorrhagic inflammation that causes the lymph nodes to become enlarged. Enlargement of the lymph nodes is the cause of the characteristic "bubo" associated with this disease. If the lymph node is congested, the infection can spread to the blood, causing secondary septicemic plague, and if the lungs are seeded, it can cause secondary pneumonic plague.

Septicemic plague

The lymphatic system eventually drains into the blood, so plague bacteria can enter the bloodstream and end up in almost any part of the body. In the case of septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), resulting in the formation of small blood clots throughout the body and possibly ischemic necrosis (tissue death due to lack of circulation/perfusion to that tissue) of the clots. DIC depletes the body's clotting resources and the body can no longer control bleeding. Consequently, bleeding occurs into the skin and other organs, which can cause a red and/or black spotty rash and hemoptysis/hematemesis (coughing/vomiting blood). There are bumps on the skin that look like several insect bites; they are usually red, and sometimes white in the center. If left untreated, septicemic plague is usually fatal. Early treatment with antibiotics reduces mortality rates by between 4 and 15 percent. People who die from this form of plague often die the same day symptoms first appear.

Pneumonic plague

The pneumonic form of plague occurs from an infection of the lungs. It causes coughing and sneezing, and thus produces airborne droplets that contain bacterial cells that can infect someone if they are inhaled. The incubation period for pneumonic plague is short, typically lasting two to four days, but sometimes lasting only a few hours. Initial symptoms are indistinguishable from several other respiratory diseases; these include headache, weakness, and coughing up blood or hematemesis (spitting or vomiting blood). The course of the disease is rapid; if the diagnosis is not made and treatment is not carried out quickly enough, usually within a few hours, the patient dies within one to six days; in untreated cases, the mortality rate is almost 100%.

Pharyngeal plague

Meningeal plague

This form of plague occurs when bacteria cross the blood-brain barrier, resulting in infectious meningitis.

Other clinical forms

There are several other rare manifestations of plague, including asymptomatic plague and abortive plague. Cellulocutaneous plague sometimes leads to infections of the skin and soft tissue, often around the site of the flea bite.

Treatment

The first person to invent and test a vaccine against bubonic plague in 1897 was Vladimir Khavkin, a physician who worked in Bombay, India. When diagnosed early, various forms of plague are usually very responsive to antibiotic therapy. Commonly used antibiotics include streptomycin, chloramphenicol, and tetracycline. Among the newer generation of antibiotics, gentamicin and doxycycline have proven effective in the monotherapy treatment of plague. The plague bacterium may develop drug resistance and once again become a serious health threat. One case of a drug-resistant form of the bacterium was discovered in Madagascar in 1995. Another outbreak in Madagascar was reported in November 2014.

Vaccine against plague

Because human plague is rare in most parts of the world, routine vaccination is only needed for people at particularly high risk of infection or for people living in areas with enzootic plague occurring on a regular basis at predictable rates in populations and specific areas, such as the western United States States. Vaccinations are not even offered to most travelers to countries with known recent cases of the disease, especially if their travel is limited to urban areas with modern hotels. The Centers for Disease Control therefore recommends vaccination only for: (1) all laboratory and field personnel who work with antimicrobial-resistant Y. pestis organisms; (2) people participating in aerosol experiments with Y. pestis; and (3) people engaged in field operations in areas with enzootic plague when preventing exposure is not possible (eg, in some disaster areas). A systematic review by the Cochrane Collaboration found no studies of high enough quality to make any statement about the vaccine's effectiveness.

Epidemiology

Epidemic in Surat, India, 1994

In 1994, pneumonic plague broke out in Surat, India, killing 52 people and causing a major internal migration of some 300,000 residents who fled for fear of quarantine. The combination of heavy monsoon rains and clogged sewers led to widespread flooding due to unsanitary conditions and animal carcasses littering the streets. This situation is believed to have accelerated the epidemic. There was widespread fear that a sudden exodus of people from this area could have spread the epidemic to other parts of India and the world, but this scenario was averted, probably as a result of the effective response of Indian public health authorities. Some countries, especially in the neighboring Gulf region, have taken the step of canceling some flights and imposing a short-term ban on shipments from India. Much like the Black Death that spread across medieval Europe, some questions about the 1994 Surat epidemic still remain unanswered. Early questions about whether it was a plague epidemic arose because Indian health authorities were unable to culture the plague bacillus, but this may be due to poor quality laboratory procedures. However, there are several lines of evidence suggesting that this was a plague epidemic: blood tests for Yersinia were positive, the number of individuals showing antibodies against Yersinia, and the clinical symptoms displayed by sufferers were compatible with plague.

Other modern cases

On August 31, 1984, the Centers for Disease Control and Prevention (CDC) reported a case of pneumonic plague in Claremont, California. The CDC believes the patient, a veterinarian, contracted the distemper from a stray cat. Since the cat was not available for necropsy, this cannot be confirmed. From 1995 to 1998, annual plague outbreaks were observed in Mahajanga, Madagascar. The plague was confirmed in the United States from 9 western states during 1995. Currently, between 5 and 15 people in the United States are estimated to contract plague each year, usually in western states. Mice are considered to be the reservoir of the disease. In the US, about half of all plague deaths since 1970 have occurred in New Mexico. There were 2 plague deaths in the state in 2006, the first fatalities in 12 years. In February 2002, a small outbreak of pneumonic plague occurred in the Shimla district of Himachal Pradesh in northern India. In the fall of 2002, a couple in New Mexico became infected shortly before visiting New York. Both men were treated with antibiotics, but the man required both legs to be amputated to make a full recovery due to the lack of blood flow to his legs cut off by bacteria. On April 19, 2006, CNN News and other news outlets reported a case of plague in Los Angeles, California involving Nirvana laboratory technician Kowlessar, the first case in that city since 1984. In May 2006, KSL Newsradio reported a case of distemper in dead field mice and chipmunks at Natural Bridges National Wildlife Refuge, located about 40 miles (64 km) west of Blanding in San Juan County, Utah. In May 2006, Arizona media reported a case of distemper in a cat. One hundred deaths due to pneumonic plague were reported in the Ituri region in eastern Democratic Republic of Congo in June 2006. Control of the plague proved difficult due to the ongoing conflict. In September 2006, it was reported that three mice infected with distemper had apparently disappeared from a laboratory belonging to a public health research institute located on the campus of the University of Medicine and Dentistry of New Jersey, which conducts research on combating bioterrorism. for the US government. On May 16, 2007, an 8-year-old capuchin monkey died of bubonic plague at the Denver Zoo. Five squirrels and a rabbit were also found dead at the zoo and tested positive for the disease. On June 5, 2007, in Torrance County, New Mexico, a 58-year-old woman developed bubonic plague, which evolved into pneumonic plague. On November 2, 2007, Eric York, a 37-year-old wildlife biologist with the Mountain Lion National Park Conservation Program and the Felid Conservation Foundation, was found dead at his home in Grand Canyon National Park. On October 27, York performed a necropsy on a mountain lion that had apparently succumbed to illness and three days later, York reported flu-like symptoms and took time off work due to illness. He was treated at a local clinic but was not diagnosed with any serious illness. His death caused a minor panic, with officials saying he likely died from the plague or exposure to hantaviruses, and 49 people who had come into contact with York were given aggressive antibiotic treatment. None of them got sick. Autopsy results released on November 9 confirmed the presence of Y. pestis in his body, confirming plague as the likely cause of his death. In January 2008, at least 18 people died from bubonic plague in Madagascar. On June 16, 2009, Libyan authorities reported an outbreak of bubonic plague in Tobruk, Libya. There were 16-18 cases reported, including one death. On August 2, 2009, Chinese authorities quarantined the village of Ziketan, in Xinghai County, Hainan Tibet Autonomous Prefecture, Qinghai Province of China (Northwest China), following an outbreak of pneumonic plague. On September 13, 2009, Dr. Malcolm Casadaban died after accidental laboratory exposure to a weakened strain of the plague bacterium. This was due to his undiagnosed hereditary hemochromatosis (iron overload). He was an assistant professor of molecular genetics and cell biology and microbiology at the University of Chicago. On July 1, 2010, eight human cases of bubonic plague were reported in the Chicama region of Peru. One 32-year-old man was injured, as well as three boys and four girls aged 8 to 14 years. 425 houses were fumigated and 1,210 guinea pigs, 232 dogs, 128 cats and 73 rabbits were treated against fleas in an attempt to stop the epidemic. On May 3, 2012, a ground squirrel trapped at a popular campground on Mount Palomar in San Diego, California, tested positive for distemper bacteria during routine testing. On June 2, 2012, a man in Crook County, Oregon, was bitten and contracted septicemic plague while trying to save a cat that had choked on a mouse. On July 16, 2013, a squirrel captured at a campground in the Angeles National Forest tested positive for plague, prompting the closure of the campground while researchers tested other squirrels and took action against plague fleas. On August 26, 2013, Temir Isakunov, a teenager, died of bubonic plague in northern Kyrgyzstan. In December 2013, an epidemic of pneumonic plague was reported in 5 of Madagascar's 112 districts, believed to be caused by large bush fires forcing rats to flee to cities. On July 13, 2014, a Colorado man was diagnosed with pneumonic plague. On July 22, 2014, the city of Yumen, China, went into lockdown and 151 people were quarantined after one man died of bubonic plague. On 21 November 2014, the World Health Organization reported 40 deaths and 80 other infections on the island of Madagascar, with the first known case in the outbreak believed to have occurred in late August 2014.

Story

Antiquity

Y. pestis plasmids have been found in archaeological dental samples from seven Bronze Age individuals dating back 5,000 years ago (3000 BC), the Afanasyevskaya culture at Afanasyevo in Siberia, the Battle Ax culture in Estonia, the Sintashta culture in Russia, the Unetitsa culture in Poland and Andronovo culture in Siberia. Y. pestis existed in Eurasia during the Bronze Age. The common ancestor of all Y. pestis is estimated to be 5,783 years before the present. Yersinia mouse toxin (YMT) allows the bacteria to infect fleas, which can then transmit bubonic plague. Early versions of Y. pestis do not have the YMT gene, which was only found in 951 calibrated specimens dating back to BC. The Amarna Archive and Mursili II's plague prayers describe an outbreak among the Hittites, although some modern sources claim it may have been tularemia. The first book of Kings describes a possible outbreak of plague in Philistia, and the Septuagint version says it was caused by "the devastation of mice." In the second year of the Peloponnesian War (430 BC), Thucydides described an epidemic that was said to have started in Ethiopia, passed through Egypt and Libya, and then came to the Greek world. During the Plague of Athens, the city lost perhaps a third of its population, including Pericles. Modern historians disagree on whether the plague was a critical factor in population loss during the war. Although this epidemic has long been considered an outbreak of plague, many modern scientists believe that the descriptions made by the survivors are more likely to be typhus, smallpox, or measles. A recent study of DNA found in the tooth pulp of plague victims suggests that typhus was actually involved. In the first century AD, Rufus Ephesus, a Greek anatomist, described an outbreak of plague in Libya, Egypt and Syria. He notes that the Alexandrian physicians Dioscorides and Posidonius described symptoms including acute fever, pain, agitation, and delirium. Under the knees, around the elbows, and “in the usual places” the patients developed buboes - large, hard and not suppurating. The death toll among those infected was very high. Rufus also wrote that similar buboes were described by Dionysius Curtus, who may have practiced medicine in Alexandria in the third century BC. If this is correct, the eastern Mediterranean world may have been familiar with the bubonic plague at such an early stage. In the second century, the Antonine Plague, named after the surname of Marcus Aurelius Antoninus, swept across the world. The disease is also known as the Plague of Galen, who knew about it first hand. There is speculation that the disease may actually have been smallpox. Galen was in Rome when in 166 AD. this epidemic began. Galen was also present in the winter of 168-69. during an outbreak of disease among troops stationed in Aquileia; he had experience with the epidemic, calling it "very long" and describing the symptoms of the disease and his methods of treating it. Unfortunately, his notes are very brief and scattered across several sources. According to Barthold Georg Niebuhr, “this infection raged with incredible force, taking with it countless victims. The ancient world never recovered from the blow dealt by the plague during the reign of M. Aurelius.” The mortality rate from the plague was 7-10 percent; outbreak in 165(6)-168. killed between 3.5 and 5 million people. Otto Sieck believes that more than half the empire's population died. J. F. Gilliam believes that the Antonine plague probably caused more deaths than any other epidemic from imperial times to the mid-3rd century.

Medieval and post-medieval pandemics

Local outbreaks of plague are grouped into three plague pandemics, with the result that the respective start and end dates of some pandemic outbreaks are still a matter of debate. According to Joseph P. Byrne of Belmont University, these pandemics were: The first plague pandemic from 541 to ~750, spreading from Egypt to the Mediterranean (starting with the Plague of Justinian) and northwestern Europe. Second plague pandemic from ~1345 to ~1840, spreading from Central Asia to the Mediterranean and Europe (starting with the Black Death), and probably also entering China. Third plague pandemic from 1866 to the 1960s, spreading from China throughout the world, particularly in India and the West Coast of the United States. However, the Black Death of the late Middle Ages is sometimes seen not as the beginning of the second, but as the end of the first pandemic - in this case, the beginning of the second pandemic would be in 1361; Also, the end dates of the second pandemic in this literature are not constant, for example, ~1890 instead of ~1840.

First Pandemic: Early Middle Ages

Plague of Justinian in 541-542 AD. is the first known epidemic to be described. It marks the first recorded pattern of bubonic plague. This disease is believed to have originated in China. It then spread to Africa, where the huge city of Constantinople imported large quantities of grain, mainly from Egypt, to feed its citizens. Grain ships were a source of infection for the city, and the massive government granaries harbored populations of rats and fleas. At the peak of the epidemic, according to Procopius, it killed 10,000 people daily in Constantinople. The real number was more likely around 5,000 people per day. The plague ultimately may have killed 40% of the city's inhabitants. The plague killed up to a quarter of the population of the eastern Mediterranean. In 588 AD. a second major wave of plague spread across the Mediterranean into what is now France. The Plague of Justinian is estimated to have killed approximately 100 million people worldwide. This epidemic reduced the population of Europe by approximately half between 541 and 700 BC. In addition, the plague may have contributed to the success of the Arab conquests. An outbreak of plague in 560 AD was described in 790 AD. The source says that the plague caused "swelling of the glands ... in the form of a nut or a date" in the groin area "and in other rather delicate places, followed by an intolerable fever." While the swellings in this description are identified by some as buboes, there is some disagreement as to whether this pandemic should be classified as the bubonic plague, Yersinia pestis, as known in modern times.

Second pandemic: from the 14th century to the 19th century

From 1347 to 1351, the Black Death, a massive and deadly pandemic originating in China, spread along the Silk Road and swept through Asia, Europe and Africa. This epidemic may have reduced the world population from 450 million to 350-375 million. China lost about half of its population, from about 123 million to about 65 million; Europe lost about 1/3 of its population, from about 75 million to 50 million people; and Africa lost about 1/8 of its population, from about 80 million to 70 million (death rates tend to correlate with population density, so Africa, being less dense overall, had the lowest death rates). The Black Death was associated with the highest number of deaths of any known non-viral epidemic. Although there are no exact statistics, it is believed that 1.4 million people died in England (a third of the 4.2 million people living in England), while in Italy an even larger percentage of the population was probably killed. On the other hand, populations in northeastern Germany, the Czech Republic, Poland and Hungary were likely less affected, and there are no estimates of mortality in Russia or the Balkans. It is possible that Russia was not as affected due to its very cold climate and large size, which resulted in less close contact with the infection. The plague returned repeatedly to Europe and the Mediterranean from the 14th to the 17th centuries. According to Biraben, the plague was present in Europe every year between 1346 and 1671. A second pandemic spread in 1360-1363; 1374; 1400; 1438-1439; 1456-1457; 1464-1466; 1481-1485; 1500-1503; 1518-1531; 1544-1548; 1563-1566; 1573-1588; 1596-1599; 1602-1611; 1623-1640; 1644-1654; and 1664-1667; subsequent outbreaks, although severe, marked the waning of outbreaks across much of Europe (18th century) and North Africa (19th century). According to Geoffrey Parker, "France lost nearly a million people in the plague of 1628-31." In England, in the absence of a census, historians offer a range of pre-epidemic population estimates ranging from 4 to 7 million in 1300, and 2 million after the epidemic. By the end of 1350, the Black Death had subsided, but it never fully disappeared from England. Over the next few hundred years, further outbreaks occurred in 1361-62, 1369, 1379-83, 1389-93 and during the first half of the 15th century. An outbreak in 1471 killed 10-15% of the population, and mortality from the plague of 1479-80. could reach 20%. The most common outbreaks in Tudor and Stuart England began in 1498, 1535, 1543, 1563, 1589, 1603, 1625 and 1636 and ended with the Great Plague of London in 1665. In 1466, 40,000 people died from the plague in Paris. During the 16th and 17th centuries, plague swept through Paris almost every third year. The Black Death ravaged Europe for three years and then continued into Russia, where the disease struck about once every five or six years from 1350 to 1490. Plague epidemics devastated London in 1563, 1593, 1603, 1625, 1636 and 1665, reducing its population by 10-30% in these years. More than 10% of Amsterdam's population died in 1623-1625, and again in 1635-1636, 1655 and 1664. There were 22 outbreaks of plague in Venice between 1361 and 1528. The plague of 1576-1577 killed 50,000 people in Venice, almost a third of the population. Later outbreaks in central Europe included the Italian plague of 1629–1631, which was associated with troop movements during the Thirty Years' War, and the great plague of Vienna in 1679. More than 60% of the population in Norway died in 1348-1350. The last outbreak of plague devastated Oslo in 1654. In the first half of the 17th century, the Great Plague of Milan killed 1.7 million people in Italy, or about 14% of the population. In 1656, plague killed about half of the 300,000 inhabitants of Naples. More than 1.25 million deaths are attributed to the extreme spread of plague in 17th century Spain. The plague of 1649 probably halved the population of Seville. In 1709-1713, the plague epidemic following the Great Northern War (1700-1721, Sweden vs. Russia and allies) killed about 100,000 people in Sweden and 300,000 people in Prussia. The plague killed two-thirds of the inhabitants of Helsinki, and a third of the population of Stockholm. The last major epidemic in Western Europe occurred in 1720 in Marseilles, in Central Europe the last major outbreaks occurred during the Great Northern War, and in Eastern Europe during the Russian plague of 1770-72. The Black Death devastated much of the Islamic world. Plague was present in some region of the Islamic world almost every year between 1500 and 1850. The plague struck cities in North Africa several times. Algeria lost 30,000-50,000 men in 1620-21, and again in 1654-57, 1665, 1691 and 1740-42. Plague remained an important factor in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, 37 major and minor epidemics were recorded in Constantinople, and 31 epidemics between 1751 and 1800. Baghdad was hit hard by the plague and two-thirds of its population was destroyed.

Nature of the Black Death

In the early 20th century, following Yersin and Shibasaburo's identification of the plague bacterium that caused the Asian bubonic plague (Third Pandemic) in the late 19th and early 20th centuries, most scientists and historians became convinced that the Black Death was strongly linked to the presence of more contagious pneumonic and septic variants of the disease, which increased the growth of infection and spread the disease deep into the interior of the continents. Some modern researchers argue that the disease was more likely viral, pointing to the absence of rats in parts of Europe that were heavily affected by epidemics, and to the belief of people at the time that the disease was spread by direct contact with an infected person. According to stories of the time, the Black Death was highly contagious, unlike the bubonic plague of the 19th and early 20th centuries. Samuel K. Cohn made a comprehensive attempt to disprove the bubonic plague theory. The researchers proposed a mathematical model based on the changing demographics of Europe from 1000 to 1800, demonstrating how plague epidemics from 1347 to 1670 may have driven selection that raised mutation rates to levels seen today, which prevents HIV from entering macrophages and CD4+ T cells that carry the mutation (average frequency of this allele is 10% in European populations). It is believed that one original mutation appeared more than 2,500 years ago, and that persistent epidemics of hemorrhagic fever broke out during the early classical civilizations. However, there is evidence that two previously unknown clades (variant strains) of Y. pestis were responsible for the Black Death. A multinational team conducted new surveys that used both ancient DNA analyzes and protein-specific detection methods to search for DNA and protein specific to Y. pestis in human skeletons from widespread mass graves in northern, central and southern Europe that were archaeologically associated with the Black Death and subsequent outbreaks. The authors concluded that this study, together with previous analyzes from southern France and Germany, "... puts to rest the debate over the etiology of the Black Death, and demonstrates unequivocally that Y. pestis was the causative agent of the plague that devastated Europe in the Middle Ages." The study also identified two previously unknown but related strains of Y. pestis that were associated with various medieval mass graves. These have been recognized as the ancestors of modern isolates of Y. pestis strains "Orientalis" and "Medievalis", suggesting that these variant strains (now considered extinct) may have entered Europe in two waves. Surveys of the graves of plague victims remaining in France and England indicate that the first variant entered Europe through the port of Marseille around November 1347 and spread throughout France over the next two years, eventually reaching England in the spring of 1349, where it spread throughout the country in three consecutive epidemics. Surveys of plague graves remaining in the Dutch town of Bergen op Zoom revealed the presence of a second genotype of Y. pestis, which is different from the genotype in Great Britain and France, and this second strain was believed to be responsible for the pandemic that spread through Holland. Belgium and Luxembourg since 1350. This discovery means that Bergen-op-zoom (and perhaps other regions in the southern Netherlands) did not directly receive infection from England or France around 1349, and the researchers suggested a second wave of plague infection, distinct from the infection that occurred in England and France may have reached the Low Countries from Norway, the Hanseatic cities or other regions.

Third pandemic: 19th and 20th centuries

The Third Pandemic began in China's Yunnan province in 1855, spreading the plague to every inhabited continent and ultimately causing the death of more than 12 million people in India and China. The analysis shows that the waves of this pandemic may come from two different sources. The first source is mainly the bubonic plague, which spread throughout the world through ocean trade, transporting infected people, rats and cargo that harbored fleas. The second, more virulent strain was mainly pulmonary in nature, with strong person-to-person transmission. This strain was largely limited to Manchuria and Mongolia. Researchers during the "Third Pandemic" identified plague vectors and plague bacteria, which eventually led to modern treatments. The plague struck Russia in 1877-1889, and it happened in rural areas near the Ural Mountains and the Caspian Sea. Efforts at hygiene and patient isolation reduced the spread of the disease, and the disease claimed only 420 lives in the region. It is important to note that the Vetlyanka region is located near a population of the steppe marmot, a small rodent considered a very dangerous reservoir of plague. The last significant outbreak of plague in Russia occurred in Siberia in 1910, after a sudden increase in demand for marmot pelts (a sable substitute) increased the price of the pelts by 400 percent. Traditional hunters did not hunt sick marmots, and it was forbidden to eat the fat from under a marmot's shoulder (where the axillary lymph gland in which plague often developed is located), so outbreaks tended to be limited to individuals. The rising prices, however, attracted thousands of Chinese hunters from Manchuria, who not only caught the sick animals, but also ate their fat, which is considered a delicacy. The plague spread from the hunting grounds to the end of the Chinese Eastern Railway and along the highway beyond it for 2,700 km. The plague lasted 7 months and killed 60,000 people. Bubonic plague continued to circulate through various ports around the world for the next fifty years; however, the disease was primarily found in Southeast Asia. An epidemic in Hong Kong in 1894 was associated with a particularly high mortality rate, 90%. As early as 1897, the medical authorities of the European powers organized a conference in Venice in search of a way to contain the plague in Europe. In 1896, the Mumbai plague epidemic struck the city of Bombay (Mumbai). In December 1899, the disease reached Hawaii, and the Board of Health's decision to initiate controlled burns of selected buildings in Honolulu's Chinatown resulted in an out-of-control fire that inadvertently burned most of Chinatown on January 20, 1900. Shortly thereafter, the plague reached the continental United States, marking the beginning of the 1900-1904 plague. in San Francisco. The plague persisted in Hawaii on the outer islands of Maui and Hawaii (The Big Island) until it was finally eradicated in 1959. Although the outbreak that began in China in 1855, traditionally known as the Third Pandemic, remains unclear, it was Whether there are fewer or more major outbreaks of bubonic plague than three. Most modern outbreaks of bubonic plague in humans were preceded by a strikingly high mortality rate in rats, but descriptions of this phenomenon are missing from accounts of some earlier epidemics, especially the Black Death. Buboes, or swellings in the groin area, which are especially characteristic of bubonic plague, are also a characteristic feature of other diseases. Research carried out by a team of biologists from the Pasteur Institute in Paris and the Johannes Gutenberg University of Mainz in Germany, by analyzing DNA and proteins from plague graves, published in October 2010, reported that, without a doubt, all "three major epidemics" were caused by by at least two previously unknown strains of Yersinia Pestis and originated in China. A team of medical geneticists, led by Mark Achtman of University College Cork in Ireland, reconstructed the family tree of this bacterium and, in the online issue of Nature Genetics on October 31, 2010, scientists concluded that all three major waves of plague originated in China.

Plague as a biological weapon

The plague was used as a biological weapon. Historical evidence from ancient China and medieval Europe demonstrates the use of contaminated animal carcasses, such as cows or horses, and human corpses by the Huns, Mongols, Turks, and other peoples to contaminate enemy water supplies. General Huo Qibin of the Han Dynasty died from such pollution while participating in military operations against the Huns. Plague victims were also catapulted into cities under siege. In 1347, Genoese-held Kaffa, a large trading center on the Crimean Peninsula, came under siege by an army of Mongol warriors of the Golden Horde under the command of Janibek. After a long siege, during which the Mongol army was reported to have suffered from the disease, the Mongols decided to use the infected corpses as biological weapons. The corpses were catapulted beyond the city walls, infecting the inhabitants. Genoese traders fled, carrying the plague (Black Death) with the help of their ships to the south of Europe, from where it quickly spread throughout the world. During World War II, a plague broke out in the Japanese army due to large numbers of fleas. During the Japanese occupation of Manchuria, Unit 731 deliberately infected Chinese, Korean, and Manchu civilians and prisoners of war with the plague bacterium. These people, called "maruta" or "logs", were then studied by dissection, others by vivisection while they were still conscious. Bloc members such as Shiro Ishii were exonerated from the Tokyo Tribunal by Douglas MacArthur, but 12 of them were prosecuted in trials in the Khabarovsk Military Courts in 1949, during which some admitted to spreading bubonic plague within a 36-minute radius km around the city of Changde. Ishii bombs, containing live mice and fleas, with very small explosive loads to deliver the weaponized microbes, overcame the problem of killing infected animals and insects with an explosive device by using a ceramic, rather than metal, warhead housing. Although no records remain regarding the actual use of ceramic shells, prototypes exist and they are believed to have been used in experiments during World War II. After World War II, the United States and the Soviet Union developed remedies for the military use of pneumonic plague. Experiments included different delivery methods, vacuum drying, calibrating the bacteria, developing antibiotic-resistant strains, combining the bacteria with other diseases (such as diphtheria), and genetic engineering. Scientists who worked on biological weapons programs in the USSR stated that the Soviet Union carried out powerful efforts in this direction, and that large stocks of plague bacteria were produced. Information about many Soviet projects is largely missing. Aerosol pneumonic plague remains the most serious threat. The plague can be easily treated with antibiotics, which some countries, such as the United States, stockpile in case of such an attack.

Wheelis M. (2002). "Biological warfare at the 1346 siege of Caffa." Emerg Infect Dis (Center for Disease Control) 8(9):971–5. doi:10.3201/eid0809.010536. PMC 2732530. PMID 12194776