Updated 12 December 2013

The Plague is back

Bubonic and pneumonic plague wiped out two-thirds of the inhabitants of parts of Europe in the 14th century. Now, twenty-one people have died in one week in Madagascar from this disease.

According to a SAPA report, at least 21 people died in one week during December 2013 after contracting pneumonic plague (a form of Bubonic plague).

The deaths were counted in the district of Mandritsara and since September, a total of 36 people on the island have died due to the infectious disease. 

The Ministry of Health ascribes the high number of deaths in Mandritsara to late detection of the disease and the fact that people first resorted to traditional medicine.  

While Bubonic plague is transmitted to humans via fleas living on rats, Pneumonic plague is the most virulent and least common form of plague and can be inhaled and transmitted between humans without involvement of animals or fleas. It occurs when Y. pestis bacteria infect the lungs and cause pneumonia and, without treatment, it can kill within 24 hours. .

According to the WHO Collaborating Centre for Plague in Antananarivo, plague is a re-emerging disease and pneumonic plague is the most feared clinical form.

include shortness of breath, chest pain and cough, sometimes coughing up blood and blood in the sputum. It's often accompanied by fever, headache, and weakness. Treatment is done using antibiotics.

Bubonic plague is an infection of the lymphatic system, the pneumonic plague is an infection of the respiratory system, and the septicemic plague is an infection in the blood stream.

The Bubonic plague

The Bubonic plague signified real terror in urban communities for hundreds of years. Spread by airborne bacteria or by infected fleas living on rats in unhygienic urban conditions, this disease wiped out two-thirds of the inhabitants of parts of Europe in the 14th century.

The plague returned for centuries, often in the summer months. It is thought that the Great Fire of London in 1666 was largely responsible for ending this scourge in London, as it destroyed many of the favourite haunts of the rats which bore the infected fleas.

But in other areas, including modern urban environments, the Black Plague (aka Black Death) is still a reality – although a lot less terrifying since the advent of antibiotics.

TIPRead more about the plague, alternative names and treatments

Here are some more facts about this disease:
  • Bubonic plague is the most common form of plague. It occurs when an infected flea bites a person or, in rare cases, when material contaminated with the Yersinia pestis bacterium enters through a crack in the skin. 
  • The pneumonic plague, which was spread via the coughing of infected people, had a death rate of 100%.
  • In the 14th century it killed almost two-thirds of the inhabitants of northern Europe – mostly within three or four days of the time of infection.
  • In 1347 the inhabitants of Genoa shot burning arrows at a naval vessel returning from war in the Crimea known to have bubonic plague on board.
  • It spread nevertheless, and in four years killed 75 million people in Europe, often more than half the population of a given country.
  • It was called the 'Black Plague', because of the black discolouration of toes and fingers as a result of coagulation of the blood in these body parts.
  • No one knew then what caused it: it turned out to be fleas spreading the plague from infected rats. But for many years people were under the impression that the disease was spread by filthy air. Often household pets or rats were the first ones to die, and they were blamed for this disease, leading to the killing of many pets as a (useless) preventative measure.
  • Initially it was thought that disease was a punishment from God and that the patient was possessed by demons or evil spirits, which led to many sick people being killed in an effort to drive out the demons.
  • The other two types of plague are pneumonic plague (which was also rampant in the 14th century) and septicaemic plague.
  • Pneumonic plague spreads incredibly easily and quickly from person to person and is a lot more deadly than Bubonic plague.
  • Bacteria infect the lymph system and become inflamed. Patients develop swollen, tender lymph glands (called buboes) and fever, headache, chills and weakness. Infections caused by bacteria can now be treated with antibiotics.
  • Bubonic plague is not contagious between humans, but pneumonic plague is.. In the 14th century it killed almost two-thirds of the inhabitants of northern Europe.
  • Two-thirds of the students at Oxford died and in many European cities people died more quickly than they could be buried by the remaining population.
  • Doctors had no idea what caused any of these diseases and there was precious little they could do to relieve the suffering of those around them.
  • Superstitions abounded, everyone, including doctors, was terrified.
  • In some areas entire villages were wiped out, as people were confined to their homes if even one family member became ill with the plague.
  • Thousands of corpses were unceremoniously dumped into large limepits when churchyards overflowed. These burial sites are discovered from time to time when building work is undertaken in older urban areas. The discovery of plague pits is reputed to have delayed the building of the London Underground.
  • The word quarantine is derived from Italian quarantena, meaning “forty days”, referring to the 40-day period of isolation practiced during the Black Death plague. Between 1348 and 1359, this plague wiped out an estimated 30% of Europe’s population, as well as a significant percentage of Asia’s population.

(National Institutes of Health, the Health24)

(Susan Erasmus, Health24, March 2013)


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