The 'Black Death' In The 21st Century
The 'black death' still survives
A Pocket full of Posies
We all fall Down!
(English Nursery Rhyme - thought to be a reference to the plague)
The Plague didn't with its victims all those centuries ago. It's alive and killing right here in the 21st century.
Neither is this horrific disease confined to third world countries - it's an unpleasant surprise to find out just where the plague is still lurking.
What Is The Plague?
The word 'plague' tends to conjure up in our minds the bubonic plague, also known as the 'Black Death' . This title is generally used to describe the horrific devastation of the second and biggest out break of the disease throughout Europe and Asia between 1347/1348 and 1350.
The plague is caused by the enterobacteria Yersinia Pestis. The symptoms people suffer depends on where in the body the infection is most intense. For example:
- Bubonic plague is prevalent in the lymph nodes.
- Pneumonic plague in the lungs.
- Septicaemic plague infects the blood vessels.
The primary mode of transport for the infection is through rats carrying infected fleas. It is the fleas themselves that carry the plague bacteria. The fleas then bite humans so injecting the bacteria into the body.
The most common rodents responsible for carrying infected fleas are of course rats. In particular the black rat. However there are other rodents capable harbouring the fleas. For example some species of squirrels, prairie dogs, rabbits, chipmunks and even on occasion our pet dogs and cats.
The fleas are excellent carriers of the plague. Frequently the digestive tract of the flea becomes blocked by the plague bacteria. On biting its host, the flea literally vomits up a plug of the bacteria that then enters the hosts' body.
Signs and Symptoms of Plague Infection
The signs and symptoms of plague infection, as stated previously, will depend on what area of the body has the highest infection site - this would normally be the area of the body where the flea bite has occurred.
- Bubonic Plague will occur when bacteria enter directly into the lymphatic system. Once there they will begin to multiply at a ferocious speed. Due to this massive increase of the bacteria, the body's immune system kicks in to try to fight the disease. This causes severe inflammation and massive swelling of the lymph nodes as well as extreme pain. These swellings are called buboes and resemble huge blisters that form in the area of the lymph nodes - common areas to find them are in the arm pits, in the groin area or the neck region
- Septicaemic Plague is where the bacteria have entered the blood stream directly - perhaps by a flea bite occurring directly over a surface blood vessel. Unlike the lymphatic system that might be able to contain the bacteria, in the blood stream they are transported throughout the body. Death occurs quickly with this form of the disease - in some cases within 24 hours and is nearly always fatal.
- Pneumonic Plague is different from the other forms in that although it can be caused initially by a flea bite; more often than not this form has been contracted by the bacteria being inhaled from coughed up, infected water droplets expelled from the lungs of a person already suffering from the disease. Due to its virulence and extreme contagion rate, pneumonic plague is the most deadly, particularly if an out break occurs in over crowded, poorly ventilated buildings. Death is swift with pneumonic plague, usually 3 -4 days.
With all three forms of the disease internal bleeding occurs. These haemorrhages cause widespread bruising of the skin called 'acral necrosis giving the disease its descriptive title 'the Black Death'. In addition to these symptoms the victims also suffer severe chills, fever, delerium, muscle pain, skin rashes and seizures. These signs are in addition to:
- the painful buboes found in the Bubonic form;
- the breathing difficulties, coughing and bloody-frothy sputum found in pneumonic plague,
- the abdominal pain, diarrhoea, nausea, vomiting, general organ failure and low blood pressure found in the Septicaemic form.
Today treatment for plague takes the form of using modern anti-biotics such as streptomycin, tetracycline and gentamicin - plague vacine is no longer available and would be useless in an epidemic as it can take several weeks to have an effect. General medical and nursing support is also required for a victim of plague.
What Is The Risk For Us Today?
Taking information supplied by organisations such as WHO (World Health Organisation) and others the last great pandemic (an epidemic outbreak of disease that affects people in many different countries), ended in southern China at the begining of the 20th century. This pandemic finally killed about 10 million people by the 1920s. Today most of the deaths attributed to plague are reported in Africa, in particular the Congo. Other areas that do have regular outbreaks are Tanzania, Madagascar, Vietnam, Peru, China and Mongolia to name but a few. The U.S. Centre for Disease Control and Prevention report 10 to 15 cases of Plague each year.The number of victims and deaths reported are not as devastating as the medieval outbreaks and the trend seems to be one of decline in some areas - however, the figures still run into thousands.
The most disturbing fact about the plague and one that still causes concern is it's ability to appear in areas where the disease would seem to have died out. For example in Algeria in 2003 there was a number of confirmed cases of people suffering from the Plague. The disease had not been witnessed for at least 30-50 years and perhaps longer.
In addition we can all be at risk from catching this disease either through travelling to areas where Plague is endemic or through our work. For example in London and the surrounding area, plague pits that are hundreds of years old are still often discovered. In this situation environmental workers must be fully clothed in protective suits and masks due to the risk of the Plague bacilli still being active. Sewage workers and even funeral workers and embalmers could also be at risk of catching not only Plague but other infectious diseases.
One other concern relating to plague is its possible resistance to anti-biotic treatment. This is an increasing trend that is causing alarm world-wide given that anti-biotics are the primary treatment for many bacterial infections.
One of the main explanations for resistance is due to the misuse of anti-biotics. Over prescribing on the one hand along with improper use of the drug by patients on the other; has given many bacteria the ability to become tolerant of the effect of the drugs. For example patients who demand anti-biotics for the treatment of a cold/flu are taking the medication for a condition that the drug has no effect on. Frequent use of these drugs forces bacteria into a survivial mode, causing them to find any adaptations within their system to combat their anti-biotic foes. In addition, over use of anti-biotics destroy beneficial bacteria within the human body that would not only assist to fight deadly infections, but their depletion leaves the body much more vulnerable to attack from various bacterial sources.
Another misuse by patients is not taking the full course of anti-biotics as prescribed. In this case what patients are doing is taking the drugs over a much shorter period of time. This results in the strongest members of the bacteria remaining alive and dormant while building up resistance to the anti-biotics. Taking the full course, even if you feel better, ensures that all latent bacteria are eliminated.
The most common way for bacteria to build up resistance is by mutating. They will then pass on this ability to future generations of bacteria and even onto different species. This can then go onto produce 'super-bugs' capable of resisting all current forms of anti-biotic treatment.
The Plague bacilli like other bacterial infections also has this ability. For example in Madagascar in 1995 a resistant form of the Plague was discovered in the case of a 16 year old boy. The bacteria had developed a powerful resistance to eight different anti-biotics including streptomycin and tetracycline, two of the major drugs used in treatment. The concern is that if the plague continues to develop resistance in this manner it would become increasingly difficult to contain and treat a major outbreak.
Medieval Plague Pits
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The Plague is one of the oldest diseases we know and has claimed the lives of at least 200 million people throughout the centuries.
This horrible disease is however contained for the present and can be treated fairly successfully if caught early enough. However, will this change in the near future?
We're already aware of various other forms of bacteria that have become immune to most of the major anti-biotics. Will the plague bacilli begin to resist anti-biotics as other bacteria are now doing? Will we one day see another pandemic? A 21st century plague super bug?
At the moment this seems unlikely but we shouldn't underestimate the ever-changing, enduring world of bacteria and in particular the 'Black Death'. Remember, bacteria of all kinds have been here on Earth much longer than we have and have seen many other species of life come and go - will they also witness our demise?
© 2010 Helen Murphy Howell
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