History and Geography

Most of the historical literature of plague identifies three lengthy time periods when bubonic plague repeatedly assaulted human communities. The first known cycle of widespread human plague occurred during late Greco-Roman antiquity. Byzantine historian Procopius of Caesarea described the acute lymphadenopathy well: "Those in whom the bubo grew to the largest size and suppurated while ripening usually survived, no doubt because the malignant property of the already weakened boil was annihilated" (quoted in Biraben and Le Goff 1975). Procopius described the devastating epidemic of 542 in Constantinople, which was dubbed the "Plague of Justinian" because of his dramatic account. The wave of epidemic reached western Europe by 547, which was also powerfully described by Bishop Gregory of Tours. Virulent, epidemic plague recurred throughout the Mediterranean for the next 200 years.

The second cycle of plague, at least in its early stages, is often referred to as the Black Death and is treated in this work as a separate entry, for certainly it is the most heavily studied of the plague cycles. Beginning about 1300, the cycle is generally considered to have ended at about 1800, although the ending date can be disputed. This manifestation of the disease took a very heavy toll in the Middle East as well as in Europe and appears to have also invaded Asia. It has held a special fascination for Europeans, however, and any bibliography assembled on important European works dealing with this second cycle would contain several hundred listings.

This is the case because the plague has been viewed as pivotal in so many areas of historical inquiry. Surely it was to some significant extent responsible for the stagnant demographic performance in Europe prior to the mid-eighteenth century, and surely, too, the plague stimulated new and important public health efforts in the great urban centers of Europe. In addition, the continued presence of the disease in Europe presents a mystery because at no other time in history was the disease able to survive in northern Europe without constant reintroduction from the Middle East. Finally, over the course of a half millennium the plague was the source of inspiration for numerous literary works, and more than a few on medicine.

Historians frequently credit public health measures devised during the fifteenth through the seventeenth centuries to combat the plague with some mitigation of the disease and its ultimate disappearance. However, in the light of modern medical knowledge of bubonic plague, it is clear that such measures — quarantine of well individuals, isolation of the sick and their household contacts, large pesthouses or lazarettoes, and even the elaboration of a theory of contagion - would have little effect on its course.

Certainly the most important questions about these 500 years of plague in Europe have to do with its disappearance and demographic consequences. In the latter case, it is important to realize that much of the mortality credited to the plague was due to its indirect impact, rather than infection. When an epidemic struck, panic ensued and this alone, by bringing an end to normal sanitary and social services while precipitating headlong flight, would have taken a significant number of lives, as would isolating both ill and well in hospitals and pesthouses. Chief among these victims would have been the very young, the very old, and the economically disadvantaged.

Beginning in the early eighteenth century, Europe was increasingly protected from plague invasions from Ottoman lands by a staunch Austrian barrier. Manned by over 100,000 men and featuring numerous quarantine and checkpoint stations, this famous sanitary cordon limited both trade and human traffic, which may have helped to spare Europe from the third or most recent cycle of the plague that seems to have had its beginning in central Asia about the middle of the eighteenth century (Benedict 1988).

From there the plague spread to the Yunnan region of China and simultaneously to northern India and, then, aided by rapid sea transportation, radiated globally from Hong Kong, Bombay, and Calcutta.

But if Europe was bypassed, the Americas were not. Rather, along with Australia and eastern Africa, North and South America were infected for the first time, and by the early years of the nineteenth century some regions of the Western Hemisphere were experiencing relatively minor, but nonetheless panic-inspiring, epidemics. Those that struck San Francisco are among the best documented in this pandemic cycle, although the disease killed millions in India and in African countries.

If the Americas and Australia did not suffer greatly from this third cycle of the plague, one consequence was that the disease did establish itself among the rodents and lagomorphs of these New Worlds. In North America the geographic extent of the plague has subsequently widened each year, and sporadic cases of human plague claim 8 to 15 victims annually despite the effectiveness of therapy with antibiotics such as tetracycline and streptomycin. In the Americas, as elsewhere, smoldering enzootic foci of plague demand a constant global effort in surveillance and control.

Ann G. Carmichael

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