Lessons to be Learned from the Great Mortality of the 14th Century

There have been many pandemics in human history.  There was a smallpox or measles outbreak called the Antonine Plague of 165 AD that killed 5 million people and decimated the Roman army returning from Mesopotamia.  There was the 6th century Plague of Justinian (bubonic) with around 25 million dead.  DNA sequencing from bodies uncovered in the 1960s in Germany shows that they were killed by the same bacterium that swept through the 6th through 8th centuries in more than 12 waves that killed 50 million people.  Then there was the granddaddy of all plagues known today as The Black Death.  That plague wiped out half of the population of Europe in the 14th century.  This was another bubonic plague spread by a bacterium carried by black rats and their fleas.  The death toll was likely in the 75 to 200 million range.  The Black Death is a modern term for what had been called The Great Mortality during its time.  The peak in Europe was between 1346 and 1353.

Danse Macabre 14th Century Artwork

There are parallels and lessons to be learned today from the Great Mortality that sprang out of China in 1346 and spread slowly across land trade routes and more quickly by sea from port to port.  The bacterium that caused the bubonic plague was Yersinia pestis.  This plague could be pneumonic, septicemic, or bubonic.  In its pneumonic form, it attacked the lungs causing headaches, shortness of breath, chest pain, and cough.  The septicemic version caused a life-threatening infection of the blood.  The bubonic variety caused painful swelling of the lymph nodes of the groin and armpits known as buboes.  It is thought that our modern English term for a minor injury that we call a “booboo” came from the days of the great plagues.  Both fleabites and infection through exposure to bodily fluids were a means of transmission.

The Black Death is estimated to have been fatal to 25-60% of the inhabitants of Europe. Accurate statistics are not available and much of what we know was written by both scholars and laypersons with varying degrees of reliability.  It was thought to have started as early as the 1330s in Mongolia.  Around 1346, while the Mongols were laying siege to the city of Caffa, the besiegers came down with the plague and their ranks were decimated.  At one point, the Mongols gathered up their dead and used catapults to hurl dead bodies over the walls at their Italian merchant enemies.  Those merchants started getting sick and eventually moved westward to begin the spread of the disease to the rest of the civilized world.  Biological warfare had its start.

Skeleton takes center stage in Warnemunde Germany

church art

In my travels around Europe, I often wondered why so much of their artwork depicted people, skulls, and skeletons.  They seemed to have a morbid fascination with death.  I see now that it was more than just fascination; they were surrounded by death.  While they didn’t wholly grasp how they were being infected, they did make some observations that were not far off the mark.  In many of the writings of the period, they mention that it might be transmitted by miasma or “bad air.”  The plague doctors of the time actually developed a hazmat suit of sorts with a bird-like headpiece.  The beak would be filled with sweet-smelling flowers and herbs that would help cut down on the stench of death.  It would also help with the foul smell emanating from lanced buboes.

Leather Plague Mask for Doctors

With so much death, leaders needed someone or something to blame.  For some, it had to do with the alignment of the stars and planets.  The period prior to the plague was also at a time of warmer winters and plentiful rain.  This would have been an ideal environment for an explosion of the rat population and their fleas.  For some, it was thought to be the wrath of God and they sought various methods to atone for their sins.  Some turned to hedonism to celebrate their last days on earth.  Flagellates wandered through the cities publicly whipping themselves as a sign of faith.  Still, others blamed the Jews and claimed that the Jews were poisoning wells.  Some Jews were tortured to confess their “crimes” and signed confessions were used to massacre thousands.  There were superstitions of an old woman or an old man spreading the disease in the dead of night.  Children were also suspects and a few were sacrificed to assuage their fears.

A medieval depiction of the burning of Jews to stop the plague

Bubonic plague has had several periods of recurrence but none at the level of the mid-fourteenth century.  The bacterium that causes the plague is still with us and saw 3248 cases and 584 deaths between 2010 and 2015.  Modern antibiotics keep the death toll below 15% but, left untreated, the death rate matches that of medieval Europe at 40-60%.  The Great Mortality ended roughly in 1453 and how it ended is open to conjecture.  Most believe the implementation of quarantines and improvements in personal hygiene were the best deterrents.  The adoption of cremations over burials due to the sheer numbers of bodies also helped.  It would take another 200 years before Europe would regain its population to pre-plague numbers.

So, what have you heard in all of this that parallels the progression of Covid-19 aka Sars-Cov-2?  My observations are that:

• Both diseases started in China and were zoonotic in origin.
• The pneumonic form causes the fastest spread of the disease.
• Superstition and the need to place blame (scapegoating) for the origin of the plague were common.
• Retaliation against the perceived sources was sought.
• Climate change may have exacerbated or been a precursor to the spread of disease.
• Both of these plagues infected victims in several ways.
• God’s wrath was identified as a cause for both.
• Both outbreaks prompted people to wear masks.
• World economies were decimated and trade policies were changed.
• Xenophobia and persecution were prevalent and nationalists used the opportunity to seek further isolation and closed borders.
• Borrowing costs in medieval Europe were cut in half and we see such trends now.
• Quarantines were shown to be effective in the 14th century and in 2020.

My take-away is that such pandemics are inevitable and that we should plan for the next one, even if it is another hundred years away.  Our last major pandemic was the influenza outbreak of 1918-19, which killed 50 million worldwide and 675,000 in the U.S.  At this writing on June 17, 2020, our death toll from Covid-19 stands at 119,000.  The end is not in sight.  Our early declarations of victory and our desire to re-open our economy may be premature.  Mistakes will be very costly in terms of loss of life and these decisions may extend our financial problems.  On the morbid bright side, losses among our elderly population may benefit the Social Security coffers.  I would hate that such thoughts aren’t motivating our decision-makers.  Knowing them now as we do, such thoughts are not without foundation.

Mistakes are being made.  Even when/if a vaccine is developed, we should not sigh in relief and move on but we should use that time to reflect on those mistakes and plan for the next outbreak.  I suspect the impetus will be to work on the economic recovery and ignore our mistakes.  This would be a failure much as the decimation of our pandemic response teams prior to Sars-Cov-2.  I feel our world will be forever changed due to what has transpired in the first several months of the year 2020.  We have made mistakes and we will continue to make mistakes.  Those who don't learn from their mistakes, you know the rest.