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Amanda Mitchell
Range
Composition II
April 21, 2014
Plague Possibilities
Throughout history, mankind has been tormented by various diseases, some to epidemic
proportions. The plague is one major disease that has led to several epidemic outbreaks, all
caused by a type of bacteria known as Yersinia pestis. This bacterium has been affecting humans
and evolving for thousands of years. However, a large-scale outbreak has not occurred for a little
over a century. Knowledge of the plagues history and the pathology of its causal bacteria can be
used to better understand the possibility of a modern-day plague epidemic.
The first major outbreak of the plague was the Justinian plague. This plague is often
referred to as the "bubonic plague". This outbreak occurred in the 6th century, and is estimated to
have killed between 30 million and 50 million people. The Justinian plague originated in Asia;
however, it spread all throughout North Africa, Arabia, and Europe. The second major outbreak
of the plague was the Black Death, which is also referred to as the "black plague". The Black
Death occurred 800 years after the Justinian plague, and did the most damage between the years
of 1347 and 1351. During these four years, approximately 50 million people died. After the
initial outbreak, the plague would continue to "plague" Europe every few years, typically in the
summer months. The third, and most recent, outbreak occurred in the late 1800s. It is referred to
simply as the "third pandemic" or "modern plague". This outbreak started in rural China and over
the course of twenty years spread to the city of Hong Kong and then to various ship ports around
the world. The third pandemic killed approximately 10 million people, far less than the previous
two outbreaks (Meyer 115-116).
Scientists have long believed that all three plagues were caused by the same bacterium,
but it was not until recently that they could confirm their hypothesis. The Black Death and the
third pandemic were known to have been caused by a bacterium known as Yersinia pestis.

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However, confirmation was still needed as to whether or not the Justinian plague was also caused
by this bacterium. To find the answer, one group of scientists conducted a study using dental pulp
extracted from the mouths of Justinian plague victims. From the dental pulp, researchers
extracted DNA. The DNA was then analyzed and compared to a database of different types of
DNA. The result: the Justinian plague was genetically similar to the Black Death and the third
pandemic, so scientists could conclude that all three plagues were caused by Yersinia pestis. The
Justinian plague, however, proved to be an "evolutionary dead end" and no longer exists in
nature. Why this particular strain of the plague died out is still a mystery to scientists. Possible
theories for this include evolution and climate change. Climate change could have changed the
environment in a way that was not favorable to the plague, causing it to die out. Evolution could
have caused newer generations of humans to have immunity to the Justinian strain of the plague.
Furthermore, it was found that the Black Death and third pandemic were likely related, meaning
that the third pandemic probably originated from the bacterium that caused the Black Death
(Than 29).
While the plague is always caused by the same bacterium, Yersinia pestis, this bacterium
can affect the body in multiple ways. There are a total of three known types of plague:
septicemic, bubonic, and pneumonic. The major differences among them are which part of the
body they infect. Bubonic plague infects the lymph nodes, septicemic plague infects the victims
blood, and pneumonic plague infects the lungs. Despite these differences, all three types of
plagues have a common origin, the stomach of an infected flea (Dunn 9-10). The way the
bacteria are transmitted from flea to human is pretty simple. Fleas rely on hosts, or mammals
whose blood they can ingest. The bacterium causes a blockage in the infected fleas digestive
system, so when it bites a human, or any other mammal, it is unable to swallow the blood it
draws, and regurgitates the blood and some of the bacteria from its digestive tract back into the

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host. The fleas just jump from mammal to mammal, infecting each one as they try to scrounge up
a meal (Meyer 118-119).
Bubonic plague infects the lymph nodes. It also causes the lymph nodes to swell up and
form "buboes", hence the name "bubonic" plague. This is the infection people most often think
of when they hear the word "plague". It is also the most common type of plague that infects
people (Dunn 9-11). This type of plague, however, often leads to one of the other two types of
the plague. Some scientists refer to it as primary bubonic plague, because it is the first infection
people experience when they contract the plague (Sebbane).
Another type of plague that a victim may develop is septicemic plague. Septicemic
plague infects the victims blood. The most notable symptom is the black splotches that appear
on a persons skin due to bleeding. These black splotches are also how the Black Plague got its
name (Dunn 9-11). There are two types of septicemic plague: primary and secondary. Primary
septicemic plague occurs when the flea bite initially infects the bloodstream. Secondary
septicemic plague occurs when Yersinia pestis spreads from another part of the body, typically
the lymph nodes, into the bloodstream. For example, a person could have primary bubonic
plague which could lead to secondary septicemic plague (Jarrett).
The final type of plague that infects humans is known as pneumonic plague. This type of
plague infects the lungs and respiratory system. Historically, pneumonic plague has killed its
victims faster than any other type of plague. Additionally, pneumonic plague is the only type of
plague that can be transmitted through person to person contact, such as coughing or sneezing
(Dunn 9-11). Like the septicemic plague, there is both a primary and a secondary form of the
pneumonic plague. Primary pneumonic plague can only occur through person to person contact
in which one of the persons already has pneumonic plague. Secondary pneumonic plague is
contracted when Yersinia pestis spreads to the lungs from other parts of the body, such as the

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lymph nodes or blood. For example, a person could develop septicemic plague, and could later
develop pneumonic plague as the bacterium slowly takes over the victims body (Jarrett).
In addition to understanding how the plague affects individuals, it is also important to
understand the way the plague has affected entire populations. The Black Death, which occurred
in the Middle Ages, affected all of Europe and parts of Asia. Why, at this point in history, did
sickness and disease spread even faster and farther than before? There are quite a few factors that
contributed to making certain times and locations in history prime targets for plague outbreaks.
The Middle Ages brought a sharp increase in population in Europe. There was also a major
migration from rural areas to cities during this time period. Large, dense populations and poor
hygiene made medieval Europe a prime target for epidemic diseases like the plague. Several
factors contributed to the poor hygienic conditions of medieval cities. First, there was no
plumbing. Most human waste ended up in the streets. Additionally, corpses were buried within
city walls, meaning that people were living among diseases that killed people. These factors and
a combination of others also made medieval cities a prime habitat for rats, a small mammal that
plague-bearing fleas favored as hosts. Another important aspect is that not only were the cities
disgusting, they were all connected. The introduction of trading routes allowed people, and the
diseases they carried, to be transported around the world faster and easier than ever before. Also
present on many ships were rats, which in turn meant that fleas were also present on many ships.
The culmination of these factors ultimately led to the major outbreak of the plague that is known
as the Black Death. Similar scenarios occurred to make the other outbreaks possible (Dunn1826).
Ironically, the attempted treatment of the plague often caused it to spread faster and lead
to the deaths of many of its victims. Some people believed that eating the teeth of dead victims
would provide them with immunity. Unfortunately, they were really just infecting themselves.

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Another method practiced by doctors was popping the buboes that formed on bubonic plague
victims. This usually just led to further infection, as the instruments used were usually not very
clean. Doctors themselves wore beak-like masks when they were treating patients. Usually the
"beaks" were stuffed with some sort of herb to mask the smell of death. Although many of the
attempted treatments were not helpful at all, one tactic used in many cities was isolation. The
infected and the healthy were effectively separated from each other. People had to fend for
themselves, and would typically abandon family members and friends to avoid catching the
plague (Byrne 33-64).
Almost everyone was affected by the plague, although some people were lucky enough to
be naturally immune to it. One group in particular hardly experienced the plague at all. Jewish
communities throughout Europe were rarely affected by the plague, or at least did not experience
it quite as severely as the rest of the continent. This was primarily due to the lifestyle carried out
by the Jewish people. Their dietary laws and other rules they followed from the Old Testament
made them a much more hygienic society than the rest of Europe. Furthermore, due to antiSemitism, Jewish communities were typically separated from the rest of society. Of course, the
Jews "immunity" to the plague only increased the pre-existing discrimination against them with
some people going so far as to accuse them of starting the plague (Kelly 150-153).
Taking all of this knowledge into account, one can better understand the future of the
plague. The plague is not entirely a thing of the past, as it still exists in certain areas of the world
today. To understand the possibility of a modern epidemic, one must first understand the
conditions necessary for an epidemic outbreak. Large, dense populations are crucial for epidemic
outbreaks. Another critical factor is ease of travel from one densely populated area to another.
Today's society definitely meets those qualifications. There are several large cities in every
country, and the world itself is overpopulated. Additionally, planes, trains, cars, and other modern

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modes of transportation would allow a disease such as the plague to spread faster than ever. It
used to take years for a person to go from eastern Asia to western Europe, but now that same trip
can be made in a matter of hours using an airplane. In short, if Yersinia pestis, the plagues causal
bacteria, was re-introduced into the human population, it could spread with great ease (Black
Death Could Make a Comeback).
Another factor that often contributes to epidemic outbreaks of diseases like the plague is
poor hygiene. In medieval Europe, poor hygienic conditions made big cities prime habitats for
rats, which often carried fleas infected by Yersinia pestis. There are still many rats in large cities
today, even though the cities themselves tend to be much cleaner than those of the Middle Ages.
Therefore, today's big cities offer a prime habitat for the spread of Yersinia pestis (Diamond 140143).
For a disease to spread, it must first be introduced into the general population. These
days, Yersinia pestis mainly dwells in isolated rodent populations and some laboratories.
However, it is certainly possible that, under some unfortunate set of circumstances, this disease
could wander back into society. To make another outbreak possible, a person would have to
come in contact with an infected flea, and then visit some major metropolitan area. For an
epidemic outbreak, a person would have to come in contact with several people before they were
diagnosed and quarantined. Big cities definitely provide the best environment to initiate an
epidemic. People in big cities are also often traveling to many other places, which would
perpetuate the spread of an outbreak (International Business Times).
Furthermore, it is important to take into account the views of scientists who view the
possibility of a modern plague epidemic quite differently. Many believe that, due to past plague
outbreaks, most people alive today have inherited some type of resistance to Yersinia pestis
(Than 33). Additionally, it has been shown that people can be vaccinated against the plague.
Antibiotics also exist for the treatment of the plague (Saikh). The plague is something that has

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been studied in laboratories for many years, and it is something that todays researchers
understand very well. With all of this in mind, it may seem that a modern plague outbreak could
never reach epidemic proportions.
However, one must keep in mind that, like any living thing, the plague is constantly
evolving. It is quite possible that, in some flea, in some rodent population somewhere, the plague
has evolved to the point where the antibiotics that have been developed to treat it would have
little to no effect on controlling the causal bacterium. Therefore, a large epidemic outbreak of the
plague would be very possible, and could be worse than any of the other previous outbreaks.
Whether or not a modern day outbreak will happen can obviously never be determined for
certain. However, as shown by the pathology of Yersinia pestis, knowledge of epidemiology, and
the history of the plague, another outbreak is certainly a very scary and very real possibility.
Works Cited
"Black Death and Bubonic Plagues May Return to Cause Modern Day Outbreaks Killing People
in 24 Hours." International Business Times. Health & Wellness Resource Center, 28 Jan
2014. Web. 23 Feb 2014.
"Black Death Could Make a Comeback, Scientists Warn." Breaking News. Health & Wellness
resource center, 28 Jan 2014. Web. 23 Feb 2014.
Byrne, Joseph Patrick. Daily Life during the Black Death. Westport, CT: Greenwood, 2006.
Print.
Diamond, Jared M. Guns, Germs, and Steel: The Fates of Human Societies. New York: W.W.
Norton &, 1998. Print.
Dunn, John M. Life during the Black Death. San Diego: Lucent, 2000. Print.
Kelly, John. The Great Mortality: An Intimate History of the Black Death, the Most Devastating
Plague of All Time. New York: HarperCollins, 2005. Print.
Jarrett, Clayton, Donald Gardner, Daniel Long, and Joseph Hinnebusch. "Role of the Yersinia
Pestis Plasminogen Activator in the Incidence of Distinct Septicemic and Bubonic Forms
of Flea Born Plague." PNAS (2006). JSTOR. Web. 23 Feb 2014.
Meyer, Ana. "The DNA Detectives." New York: Thunder's Mouth Press, 2005. Print.

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Sebbane, Florent, Nadine Lemaitre, Daniel Sturdevant, Roberto Rebell, Kimmo Virtaneva,
Stephen Porcella, Joseph Hinnebusch. "Adaptive Response of Yersinia Pestis to
Extracellular Effectors of Innate Immunity During Bubonic Plague." PNAS (2006).
JSTOR. Web. 23 Feb 2014.
Saikh, Kamal, Teri Kissner, Beverly Dyas, Joseph Tropea, David Waugh, and Robert Ulrich.
"Human Cytolytic T Cell Recognition of Yersinia Pestis Virulence Proteins That Target
Innate Immune Responses." The Journal of Infectious Diseases (2006). JSTOR. Web. 23
Feb 2014.
Than, Ker. "Two of History's Deadliest Plagues Were Linked." National Geographic. Jan 2014:
28-34. Print.