This Podcast Will Kill You - Ep 5 Plague Part 1: The GMOAT

Episode Date: November 28, 2017

That's right y'all... Today we're talking the GMOAT: The GREATEST MORTALITY OF ALL TIME: BLACK DEATH. This episode we'll cover the biology and history of one of the most epic diseases of all time- Yersinia pestis the causative agent of plague. It's such an epic topic in fact, that you'll have to tune in next week to catch up on the current status of plague around the world! See omnystudio.com/listener for privacy information.

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This is a job for Indeed sponsored jobs. Towards the beginning of spring, the doleful effects of the pestilence began to be horribly apparent by symptoms. An issue of blood from the nose was a manifest sign of inevitable death. But in men and women alike, it first betrayed itself by the emergence of certain tumors in the groin or armpits, some of which grew as large as a common apple. From the two said parts of the body, it soon began to propagate and spread itself in all directions, after which the form changed, black spots making their appearance in many cases on the arm or thigh or elsewhere, now few in large, minute and numerous. Almost all within three days from the appearance of said symptoms, sooner or later, died.

Many dropped dead in the open streets by day and night, whilst a great many others, though dying in their own homes, drew their neighbors' attention to the fact more by the smell of their rotting corpses than by any other means. And what with these and the others who were dying all over the city, bodies were here, there, and everywhere? It was not merely a question of one citizen avoiding another. This scourged had implanted such a great terror in the hearts of men and women that brothers abandoned brothers, uncles their nephews, sisters, their brothers, and in many cases, wives deserted husbands. But even worse, and almost incredible, was the fact that fathers and mothers refused to nurse and assist their own children as though they did not belong to them. That was so hard for me to remain quiet while you recorded that. Yeah, it, uh, so that is from.

Everyone's favorite plague chronicler, which everyone has a favorite plague chronicle, right? Giovanni Boccaccio, I think that's how you say it. Sounds right. Who was living in Florence during the time of the Black Death. Wow. And so he wrote a book called The Decameron based on what he saw, and that was just one of the little bits in there. According to other contemporary accounts, quite accurate. Oh, my God.

So hi, everybody. Hi. Welcome to Episode 5. Yes, of this podcast will kill you. Yeah, it really will today. Yeah. And you know what we haven't done yet, I realized? Tell me. Set our last names. Oh my God, you're right. Yeah. We're always like, I'm Aaron. And I'm also Aaron Welsh. And I'm also Aaron Alman Updike. So yeah, we wanted, I mean, we should have introduced ourselves earlier. Maybe. Well, if you've made it this far, it's nice to meet you. Yeah. Thanks for listening.

Can I just tell you how excited I am to talk about plague? I know how excited you are. This is the one. This is the disease that got me into epidemiology, into disease ecology, into history. I'm thrilled. I just am so excited based on how excited you are. Like, regardless of how much, you know, like your excitement is through the roof and that thrills me. Yay.

And so this week we're going to do something a little bit different. And next week also. So because plague is such a beast of a topic and has been all over the news lately, we're going to be splitting this up into two episodes to give at the time that it deserves. Yeah. Yeah. Plague is deserving of multiple episodes. And this week we'll be focusing on the biology of plague and then tracing its history up into the 20th century. Yeah.

And then next week we'll talk about the impact of plague in the last 120 years or so and then fill you in on what's been going on in Madagascar. Yeah. And don't worry, each week we'll be drinking quarantinis. Oh, yeah. Slightly different ones. Speaking of which, what are we drinking this week? It's quarantine time. It's quarantine time.

Yay. This week we're drinking the Bubo babyita, right? Buba babyita. Yeah. And what is in the Buba Bita? It's essentially an extra dry martini. Okay. It's pretty thrilling.

This is a gin martini. So if you'd like to drink along at home, go ahead and mix. one and three quarters ounces of your favorite gin. My favorite is Hendricks. And you mix that with a quarter ounce of dry vermouth. And then a hefty splash of the juice from cocktail onions. And we're doing cocktail onions because... They look the most like boobos, which you'll learn all about.

And it's disgusting. But hey. Okay. So speaking of boobos, I want to know about the biology and the symptomology and all of that good stuff about plague. I can't wait to tell you. I'm really excited to talk about plague today because this is our first real zoonotic disease. And vector-borne. And our first vector-borne disease.

So that's really exciting for me. And I would guess for you, too, since we're disease ecologists. And so this type of diseases is what's really exciting to us. And we also both study vector-borne diseases. Exactly. Right. If you are not aware, a zoonotic disease is essentially a disease that generally circulates in animal populations and often spills over into human populations.

And a vector-borne disease is a disease such as, for example, malaria that is transmitted by an insect vector. In the case of plague, it's transmitted by the humble flea. Ugh. I'm going to say some things that actually might make you have some sympathy for the fleas. No lie. I didn't think it was possible, but as I was reading, I kind of felt bad for fleas. I'm going to keep an open mind.

Keep an open mind. And wait to be convinced. So let's go through the life cycle of plague. So plague is caused by a bacterium called Yersinia pestis, which likely evolved to be a bloodborne pathogen quite a long time ago. And I'm assuming you'll talk a bit more about the evolutionary history of this disease. Yeah, cool. So we won't get into that now.

But what's really interesting is the life cycle of plague. Here's how it happens. A flea takes a blood meal from an infected, let's call it a rat, because those are really common. Yeah. And the amount of bacteria that is in the rat's blood directly correlates with the percentage of fleas that get infected. Not all fleas are going to get infected, but usually at least around 30% of fleas that are feeding on a rat will get infected. And if you think of a common rat, it's got more than a few fleas on it, right? Yeah, lots and lots and lots.

Exactly. So a good proportion of those fleas end up getting infected. What happens is Gersinia pestis travels to the fleas stomach, where it starts multiple. And multiplying and multiplying and multiplying. And within three to nine days after taking that infected blood meal, the bacteria have multiplied so much that they entirely block the esophagus of the flea. Oh my God. Isn't that the craziest thing? That's disgusting.

So then this poor flea is so hungry, it tries to take another blood meal from another rat. But it can't because its esophagus is completely blocked. And so gobs and gobs of bacteria are blocking the entrance into the stomach. As it tries and fails to take a blood meal, it ends up regurgitating a mixture of blood and bacteria back into the rat. It's amazing. It's so cool. And what's sad, and this is why you should have a little bit of empathy for the flea, is that that block flea will end up dying of starvation and dehydration.

Only after bringing the world to its knees. Well, you know, it's just one humble flee. But it's suggested that it has barfed 11,000 to 24,000 individual basile into its new host. Which is insane, considering that in some, like the infective dose, the number of bacteria needed to cause an infection is one in some cases. Yeah, exactly. One. It's crazy. So just one little vomitorious, you could infect 24,000 rats in theory, I guess.

In the mammalian host, ursinia pestis will spread from the bite wound into the lymph system, the lymphatics underneath the skin, and then it will travel to the lymph nodes, where it will replicate and replicate and replicate. Eventually, that infection can then spread to the bloodstream, it can spread to your liver, your spleen, and other organs. And so that is sort of the general life cycle. cycle until another flea bites you and the cycle begins again. Isn't that cool? That's super cool. It's really fun. So that's generally how the disease circulates in its enzoatic hosts, which means the host that it generally circulates in in the natural environment. Okay. So that's basically rodents for the most part. For the most part, rodents. And different species of rodents have different susceptibility to it. But if you think of, I believe its name is radis radis,

the common sewer rat, right? Black rat. Black rat? A city rat. There are some other species of rat that are common in North America. Right. Like the Norway rat, for instance. Yeah. Bigger and browner.

Oh, cool. Yeah. But so most species of rodent have at least some susceptibility to it, but whether or not they're going to have extreme symptoms and end up dying, like, for example, prairie dogs, or they'll be able to sustain a mild infection such as sewer rats. It varies. But what's really interesting is that over 200 mammalian species are known to be naturally infected with plague. Naturally infected. So rodents are the most important host, but they're by no means the only host. Rodents are likely the most important in part because they have a very short

lifespan, a high replacement rate, so they're reproducing very rapidly, and they have a generally long breeding season. And additionally, it's likely that this bacterium evolved with these rodents, and so there is only mild resistance in the majority of these rodent species, if that makes sense. I think so. So these rodents serve to be really good hosts to maintain infection in a given area. And then other hosts, like for example, cats can amplify the disease and allow for it to spread to other victims. Is that because the proximity of cats to crazy humans who have cats? That is certainly. No offense to all of our cat-owning listeners. Like me, for example. That is certainly possible. Yeah, so that's sort of the life cycle of the plague. But that's all in

animals. Yeah, I want to hear about it in humans. I do too. Get to the good stuff. I want to get to the good stuff. I mean, that was good stuff. No, I know. I really liked it. So the plague in humans. There's three different forms of plague. The first is the boobonic. The famous. The most famous, most likely that you've heard of it. It's what we named our drink after. Bubo. The boobonic plague. This plague is caused when a human is infected via the bite of an infected. flea. So it's not dissimilar from what we discussed in the animal cycle. A flea bites you, barfs a whole bunch of bacteria into your blood, and that's how you get infected. Those bacteria

travel through your lymph system to your lymph nodes, most commonly the ones in your armpit or your groin. And then the bacteria multiply a whole bunch of times there, and it forms what's called a boobo, which is essentially a giant infected lymph node full of bacteria. Did you know that in, and I'm going to talk a lot about the black death in a bit, but did you know that during the black death, one of the things that people wrote about in regards to boobos was that they made gurgling noises. Oh, wait. Like, like, the boobos were speaking.

Oh, my God, that's disgusting. I need to hear it. I would love to hear that, actually. I wonder if there's recordings on YouTube or something. So I'm not sure if this has ever been replicated in modern events, but I want to know. I know. That would be really cool. Gurgling boobos.

Might just be those medieval exaggerators, hyperboizers. I mean, yeah. What do they think the world was ending or something? So the incubation period for the bubonic plague is generally around one to seven days. It has a pretty large variation. And in addition to those characteristic bubos, you also have some general signs like fever, chills, head and body aches. Vomiting and nausea is very common with the bubonic plague.

So pretty generalized at the beginning. Pretty generalized except for that very characteristic bubo. Right. However, not everyone who gets infected with the plague is going to end up with bubos. There are two other forms of the disease. Oh, yeah. The first that I'll talk about. briefly is septicemic. Okay. So sepsis is a disease that can actually happen with any infection. It's

essentially just an overload of bacteria in your bloodstream specifically. And with bubonic plague, bubonic plague can spread to the bloodstream from the lymphatics and then become septic plague. However, it's also possible to get primary septic plague, which means that you have an overload of bacteria a very high bacterial load in your bloodstream without any characteristic boobos. Could a person get septicemic plague, for instance, somehow either via a flea or via contact with an infected individual, get bacteria deposited directly into their bloodstream through like an open wound? Yes, that's certainly possible. Okay.

And there may be differences in that different species of flea feed differently. There's not a lot of information on the various species of flea and how they transmit, but it is certainly possible that you can get infected directly through your bloodstream from the bite of a flea. It is also possible to get infected from, so the advanced stages of bubonic plague can end with open sores. Your boobos open up and they're just, whoa. Like oozing and seeping. Seeping bacteria, just everywhere. But human to human transmission of bubonic plague is very, very limited. You'd have to have a ton of contact with that boobo to really get infected that way. Bubonic plague.

Exactly. Bubonic. Okay. That is in contrast to pneumonic. Oh, yeah. Which I know is your favorite. Well, favorite is a tricky word. Too strong of a word, maybe? It's the most terrifying to me.

It is the most virulent form of the disease. Neumonic plague, which means that it has infected your lungs, is transmitted via respiratory droplets. It is quite high. So for bubonic plague, the mortality rate is between 30 to 60 percent. And for septicemic, untreated, yes. And for septicemic plague, it's on the high end, maybe 80 or 90 percent, but pneumonic plague, if untreated, is almost 100 percent fatal. It's really sad. Yeah. So pneumonic plague, again, means that it was transmitted via respiratory droplets. So bubonic plague, if it spreads to your lungs can become pneumonic plague. But what's scary about pneumonic plague is that it can also be transmitted directly

human to human via respiratory droplets. Uh-oh. Yeah. Like the flu. Like the flu, like smallpox, like so many other diseases that we've seen. So with pneumonic plague, the incubation period here in some cases can be as short as 24 hours. And again, the untreated fatality rate is almost 100%. And remind our listeners, incubation.

period is. Incubation period is the time from when you become infected to when you show symptoms. Okay. And so with pneumonic plague, it can be as little as 24 hours. Very soon. Very short. And what's really sad is that you can also die within that amount of time. So it takes over your body very rapidly. It encompasses very severe respiratory symptoms, including shortness of breath and coughing. Initially, the cough will be dry, but over time, it will become very productive, that's what we call it, productive cough, meaning you're coughing up gunk from your lungs. Flem, but mostly blood and bacteria. Whoa.

So the one good thing about the pneumonic plague. There's a good thing about it? Surprisingly, yes. Is that it is most infectious at the end stage of the disease. Okay. And so if you're treating someone or caring for someone who has pneumonic plague and they've just come down with symptoms, you may still be okay. Yes. As long as you just abandon them right before they die.

Abandon them before they die. Just kidding. Wear a mask. Oh, that's an alternative. That's an alternative. Abandon them or wear a mask. But yeah, you're most infectious during the last few hours, especially of your disease. However, what's scary is that you also remember.

make infectious after you die. What? So people who are preparing bodies for burial, for example, can become infected by close contact with the body because their body is still full of bacteria and that bacteria is still alive. And all it takes is just a couple bacteria. Exactly. Ooh. Yeah. So that's a little bit scary. That's rough. The other good news is that all of the plague is treatable with antibiotics. As long as you catch it early enough. Caviot. That's the big caveat. And we'll talk a lot about that when we talk about what's going on with plague today.

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over here. Oh my God. Let's just jump in. All right. The plague bacterium likely evolved as a human pathogen during the time when agriculture and large stationary human settlements became widespread. Okay. Which was about 5,000 to 10,000 years ago. That's for the plague jumping into humans. Awesome. Are you noticing a pattern yet, by the way? Like every disease is from the agricultural revolution? All, all of the diseases that we've discussed so far. Yeah. And probably many in the future have emerged as a result of farming and human crowding. The invention of agriculture was great for humans in many ways. It allowed us to have some degree of food security, which could support larger populations.

And then we could have division of labor, governments, more time for creative output, art, trade. Basically the things that we think of as being human. Right. And humans weren't the only ones that were positively impacted by this new way of life. Oh, yeah. Who else? Oh, yeah. The domestication of livestock and long-term storage of grains and other food meant that humans were living in close proximity to animals and their pathogens. Do you know who else loves piles and piles of grains?

I can guess. Well, your husband should know, Aaron. He works at a brewery. He does. So what is it? It's rats and mice and rodents. Yeah, rodents. They just got a cat, so they no longer have that problem. That's great.

But cats can still give you pneumonic plague as you learned. So whatever. Do you know who loves rodents? They're fleas. Oh, yeah. When humans domesticated livestock and began growing crops, some rodents were basically domesticated alongside livestock, though less intentionally. Rats and mice started living alongside humans, adapting to live in the nooks and crannies

of houses and food storage buildings. And they became a constant fixture. They were everywhere all the time. Wherever humans went, so did the rats. and their fleas. And their fleas bacteria. Yeah. And the more humans, the more rats. And the more rats, the more fleas, the more fleas, the more plague. You got it. I understand this cycle. But what about the plague bacterium? Well, the plague bacterium jumped from harmless little beep-bop to destroyer of worlds in Central Asia, right as farming was taking off. The plague bacterium doesn't just reside in

so-called domestic rodents, as you learn from the biology just a little bit ago. It also thrives in many, many species of wild rodent, and it's thought that wild rodents were where the plague bacterium turned pathogen. Oh, wow. Yeah. The favorable climate and newly adopting farming practices of humans led to huge population growths. For the first time, cities could sustain themselves, and wide-scale travel for trade increased. As human populations grew, they expanded into natural areas, which made them and domestic rats basically neighbors with these wild plague-bearing rodents. And fleas were happy to jump from wild to domestic rat and vice versa. Oh, yeah.

Taking with them their pathogens. And this is how humans were likely first exposed to the plague bacterium. As a side note, an increase in disease following human encroachment on natural areas has been seen time and time again. Yeah. Spikes in disease or emergence of zoonotic disease following deforestation or ecological upheaval are super common and we're definitely going to be addressing them in future episodes. Definitely, especially when we talk about things like Ebola, for example. Yeah, that's a big one. Yeah. Back to plague. All right. So we've established how the plague got into humans in the first place.

But what did it do once it was there? Kill them all. Yeah. Spoilers. Well, the answer is that it probably in the beginning caused local small epidemics. It bided its time, waiting. Waiting. until the black rat, who is the main reservoir for the plague bacterium, and plague's flea host had reached a near global distribution. Wow. And then it struck. The first time we see plague rear its ugly little head is in 541 to 542 AD. Wow.

Yeah, a while ago. In what is called the Plague of Justinian, named after the guy who was Roman emperor at the time in the East Roman Empire. You know what's crazy? if this thing jumped and was able to infect mammals 10,000 years ago, that means it spent 8,000 years just hanging out, not really killing people all that much. Well, it might just be that there are gaps in the historical record.

I bet that's probably true. So similar to cholera, this doesn't leave any mark on bone or skeleton, and so the evidence would be harder to detect. Cool. So it's only once we have sort of written, records that say this is totally plague guys. Yeah. That's when we know for sure that this was happening to people.

Well, and even then it's disputed sometimes whether the disease is plague or another. Right. Pathogen. Well, I guess those are kind of, you can see the symptoms are very different. But a lot of this is generalized symptoms. Right. And so in the plague of Justinian, the reason that they think that it was actually bubonic plague is because they're described the bubos.

Oh, I can't wait. Okay. Tell me all about it. Okay, yeah, the plague of Justinian. This one is a doozy. Oh, good. About 25 to 50 million people died during this pandemic. Yep.

In 500 AD. I literally didn't know there were that many humans at that point. It was remarkable, the devastation. Remember the 1918 influenza, everyone? I do. 50 to 100 million people died then, which is a lot of people. people about an estimated 3 to 6% of the global population. In the plague of Justinian, at least 13% of the global population died. And that's without the disease reaching global distribution.

What? If it had, that number would be a lot higher. So where was it limited to? Mostly the region of like Constantinople and like the, so the Eastern Roman Empire at the time. And it spread a little bit into like North Africa and a little bit further into like Eastern Asia. Oh my God. Yeah. In the infected areas, the death toll was really high. Oh, God. In Constantinople during the peak of the epidemic, 5,000 people died every day.

I mean, that happening in a modern city today would be unbelievable. Like, I can't. There are no words. No, there really are no words. 5,000 people. day. Just dead. There are roughly 44,000 students at this university. Yeah, total. So how many days would it take for everyone to die if 5,000 people died a day? No, stop. That's too depressing. Also, it's math. Nine days. Oh my God. Just nine days. The population loss and resulting chaos caused by the plague of

Justinian may have, and probably did, contribute to the downfall of the Roman Empire. There's like every disease we've talked about so far. I know. Measles, smallpox. Yeah. And this pandemic, oddly enough, seems to be more of a side note in history, attracting much less interest in the Black Death of the Middle Ages, despite having similar mortalities and far-reaching impacts.

But this is probably, or at least could be, due to the fact that there are fewer sources, firsthand accounts for this time period. Okay. All the same, this particular plague probably deserves an episode of its own. But we just don't have that time, y'all. Maybe someday. But not today.

No. Today is reserved for one of the most, if not the most, devastating pandemics of all time. I'm so excited. Finally, the moment we've all been waiting for. Introducing the Black Death. A pandemic so devastating that to simply say it changed the course of history does not. do it justice. That was not planned.

I loved that. Let's own it. The Black Death, which swept the Asian and European continents from 1347 to 1350, and killed up to 200 million people. Estimates range from around like 75 to 200 million people. That's what? That's close to like 30% of the global population at the time. 30% of the global population.

I mean, estimates vary widely, but are you doing some math right now? I'm going to try and figure out what is 30% of 7.5 billion. Oh, God. Yeah, let that sink in for a moment. That's 2.25 billion people today. Honestly, I can't even. There's no way to wrap your head around that number. No.

It's almost too much to even comprehend. We can't articulate how we're feeling right now. No, we don't have the words. as my therapist has told me. And so, yeah, the effect of such annihilation is really the only word for it reverberated for centuries and is reflected in art, literature, language, and even the economic structure following the Black Death. That is so cool.

I mean, like, cool, maybe, isn't it? I get in trouble for using the word cool talking about things like this. That is so fascinating. Yeah, we'll just, yeah, we'll stick with that one. Before I get into all the nitty gritty of the Black Death, let's get a sense of time and place. When I read that a certain event took place in the Middle Ages or the Victorian era or something, I have a hard time seeing what that time period looks like. So let's talk about it.

Let's. What was the first half of the 14th century like in Europe? I'm going to guess. dirty and not very pleasant. I don't know. That seems to be the case. This is just my guess. Let me just fill in some of those extra details. Well, steady population growth during the first couple of centuries before 1300 led to a population of about 75 million people in Europe. Wow. Which is a lot fewer people than today, which is around 400 million. Oh, okay. But growth had stalled as resources became much more limited and actually the population was hanging by a thread.

Really? Yeah, starvation was a problem. Resources were tapped. Wow. The carrying capacity had been met. Uh-oh. Just 20 or so years before the Black Death, periods of cooling, climatological cooling, had led to a lot of rain, very poor harvests, and famine was a result.

outbreaks of cattle disease such as anthrax and rinderpest also contributed to famine. About 10 to 15% of the population died of starvation and the rest of them were severely malnourished during this time prior to the Black Death. I'm just really excited. It was just one bad thing after another. Oh, also war and conflict was a near constant. Oh. Yeah. You remember last week's episode about cholera and the description of filth-ridden London in the 1800s?

That's what I'm guessing it's like worse, obviously. Oh yeah, no different. In Paris, for example, several streets were named after the French word for poop. Mird. You got it. Butchers everywhere did their jobs in open view on the street and let the blood and guts of animals run freely. One time I went to an event where they butchered a pig on stage. It was, I don't know why I was at that event.

How have we never talked about this? It was very weird. We should talk about it off microphone. Yeah, okay. We'll get back to that. Also, bathing was not a thing that people did. Yeah, no. When one person was, I had to do some quotes here.

When one person was stripped down after being assassinated. Just because that happened. It explains why, I guess, his body was being written about. And whatever. It was said that Vermin, quote, boiled over like water in a simmering cauldron from his body. We need to have like a not safe for breakfast on all of our future episodes. Maybe we should release it like noon? Maybe.

Not going to happen. Sorry, y'all. No. Fair warning. Halfway through. Yeah. And living in the country didn't keep you much safer. In fact, the rat to person ratio was much higher in rural areas.

The rat to person ratio. Yeah. That's such a great rate. Why don't we do anything in that ratio anymore? I think we do. I think we could. Yeah. Oh, my God.

Rats were everywhere living in every nook and cranny, every thatched roof, every barn. Keep in mind that a rat, a black rat or Norway rat, can fit through a hole with the circumference of a human pointer finger. Are you serious? I read that somewhere. Their skulls and ribs are that tiny? Apparently. That's what I imagine are the limiting factors. What?

That's what I read. They're so moldable because they're so chubby. Like a rat is kind of like chubby and cute. They can come up through your toilet. Let's stop talking. Yep. Oh, God. So, yeah, they were everywhere.

Wow. Also, medieval medicine is not something I'd wish even on my worst enemy. That's saying something. Largely driven by superstition and religion, doctors during this time were as clueless as their patients as to health care, but more dangerous since they held the illusion of knowledge and the power to wield it. Did you like that? That was so good. I love that. It was beautifully written. Thank you. All in all, the setting for the black death was gray and dismal, with a population half-starved and surrounded by rats and filth. In other words, it was perfect for a pandemic.

Let's head to the European ground zero of this plague. Yes. The port city of Kaffa, which is in modern Crimea. This is where I tell you to pull up a map, unless you're driving. If you're driving, I'll try to help you up. Okay, everyone knows what Italy looks like. Find Italy. Put your finger about halfway through Italy and then head east. Jump that first body of water to the landmass. Then you'll see a second body of water to the east again. This slightly bigger body of water is called the Black Sea. At the northeast corner of the Black Sea, there's some land that juts out.

This is around where Kaffa was located. That was so useful. I am so bad at geography. I mean, we were educated in the United States. Yeah. One time I did know all of the countries of the world, though, and where they were on a map in seventh grade. And then it made room for... I know all the Backstreet Boys lyrics to every song.

Worth it. Oh, dear. Okay. Anyway, by 1347, rumors of plague depopulating cities in China, India, and Syria had been circulating. Well, they weren't rumors. Plague was actually on their doorstep. Outside of the city walls were Mongol ships laying siege to the city. Frustrated with their lack of success and probably sick of the smell, some of the Mongol army tossed plague-ridden dead bodies over the walls in what may have been the first recorded act of bioterrorism. That is awesome.

Like, it's not awesome that it happened, but that is amazing that there are, A, records of that, and B, that we can trace like an actual plague outbreak to something like that. That is so incredible. Well, it was probably too late for the residents of Kappa anyway. Rats bearing plague-infected fleas had already traveled down the ropes, tying the ships to the harbor, so they'd already brought plague into the city. They're sneaky little rats. Oh, yeah. I mean, and they probably went under the disguise of dark night time. Oh, they always do.

People began dropping like flies. The sight of so many dead and dying struck terror into many, including a group of traders from Genoa in Italy, who hopped right onto a boat headed west. Unfortunately for the rest of Europe, they brought with them the plague. Over the course of the next three years, the plague would touch nearly every. corner of the continent, convincing many that the end of days had truly come.

In Florence, where the author of our first-hand account from earlier, witnessed the plague, 50% of the population died. Not just 50% of those infected, 50% of the entire population. Holy mackerel. Wiped out. Oh, my good, Jesus, H. You've seen a... Monty Python on the Holy Grail, right?

Bring out your dead. Yeah. Bring out your dead. I've been waiting to say that. That happened. That was real. Oh my God. Yep.

People were actually punished for keeping dead bodies inside. Okay, but also we learned that dead bodies can transmit plague, so maybe they should have been punished for that. You know what I mean? Sure. Not like the people who were taking them were probably protecting themselves as well as they should have been, but still. You can't harbor a plague-ridden body.

There were laws to not. keep dead bodies inside. Lots of laws enacted from diseases, as we've learned in this podcast so far. Yeah. There was no time for rituals, no time for coffin building, no time for funerals. And even if there was time, there was no one to perform them. The dead were laid out, quote, layer upon layer, just like one puts layers of cheese on lasagna. Sorry. It was according to one chronicler from Florence. Obviously, they're from Italy, first of all. Second of all, who puts layers of cheese on their lasagna? That's absurd. Well, I mean, I would, I would expect that the recipe for lasagna may have changed over the last 600 years or so. 700. That's a hilariously

disgusting. Layers of bodies layered like lasagna. Great. Keep that. Keep that image in your mind. I've got it. Front and center. Dirt was barely sprinkled over the bodies, and the stench of rotting flesh was in every molecule of air you breathed. Grody. The devastation spread from Italy west of France, Spain, Germany, and then on to Great Britain, north to Scandinavia, and so on, killing anywhere from 40 to 80% of the cities and villages it struck. Not just 40 to 80% of those infected. 40 to 80% of the entire village. Good gracious. There were some villages that were entirely wiped out or at least knocked down to the point where people abandoned the villages and only recently have these old villages been found via like drone technology and looking at aerial, aerial views.

Wow, that's amazing. People seem to be struck down instantly by this disease. Healthy one minute. well, I mean healthy by medieval standards. And then dead 24 hours later, coughing up blood and writhing in pain. So I'm going to guess they had pneumonic plague at that point, you know? Well, many cases of the Black Death were bubonic plague. Okay. But the horrifying descriptions of symptoms and the short interval between initial infection and death suggests a high rate of pneumonic plague, with a dash of septicemic plague thrown in.

Of course. There's always a dash. A little bit here and there. In fact, it has been suggested that the name Black Death, refers to one of the symptoms of septicemic plague in which the extremities turn very black and hard. But actually, I'm just going to be a little corrective here. Let's push up our glasses a little bit and get your nerd on. Here we go. Actually, that name was used to describe the pandemic a couple of centuries after it happened.

Oh, interesting. So it wasn't people who were seeing the symptoms who described it that way. No, while it was happening, it was usually referred to, in translation, the great mortality, or colloquially, the big death. So just everyone's dying, guys? Yeah. Which really speaks to the impact that it had. I mean, if you think about World War I was only called World War I after World War II started. Before it was just called the Great War, the War.

The War to end all wars, that kind of thing. So I think it's similar to that. Well, of course, hopefully not during a war you're going to call it. Here's the first of the many. Gosh, I mean, nowadays, who knows? Anyway. In any case, the great numbers of dead struck fear and panic into all. No one knew what was the cause of the pestilence.

Well, some thought they knew. There was the usual one of God is smiting us for our wicked ways. It's got to be God. It's got to be God. Well, astrology was another contender. Cats were also blamed. Maybe they had something to do with it, but it wasn't their fault. Well, in many cities, they were killed by the hundreds or thousands, which would have actually increased the rat population and thus plague incidents.

So it's like double sad because they were trying to help out, but then they all got infected by eating infected rats and then they all died so then they couldn't do their job and then the humans died. So the solution is we need more cats. Never the solution. I'm going to get roasted for that. It wouldn't be for another 500 years, actually, half a millennium that the transmission cycle of plague from rat to flee to human would be described. Wow. Yeah. So as you can guess, there were many popular hypotheses as to what was causing the plague.

The most damaging and widespread was that it was Jews. Are you serious? Oh, yeah. I did not know that at all. And sometimes Jews teaming up with leprosy victims. Oh my God. Humans are the worst. The rumor was that there was a conspiracy in which Jewish people were poisoning the water supplies. Way to be a nasty cliche medieval European Christians.

Seriously. Gross. Extermination of entire Jewish populations in France, Spain, Germany, Switzerland. The list goes on. Literally, how have I never heard about this? Listeners. It's a big part. Have you heard about this? Because what the actual essence is? Never mind that the Jewish people were dying at the same rate as Christians. Oh, God.

Never mind that the confessions, quote unquote, of well-poisoning by Jews were drawn out of people only after days of endless torture. The Christians wanted a scapegoat, and so they turned to their old favorite, claiming a widespread anti-Christian conspiracy to mask their age-old racist hatred. Oh, my God. Any excuse would do. Thousands of Jews were tortured or burned alive. mostly burned alive, to stop the plague, or in some areas, prevent it from even appearing. Oh, my God. So some were killed in advance of the plague.

Preemptory. That's disgusting. Obviously, the plague came for them anyway. And some felt despair rather than fear. An Irish monk wrote that he was, quote, waiting among the dead for death to come. And that sentence was to be the second to last in his manuscript. The final one was written by another monk, quote, and here it seems the author died.

It's a bummer. Yeah. It's going to be my dissertation. And here it seems the author died. Despair also came in the form of flagellence. Fletch. Which sounds like I'm saying flattulence. You're talking about they were so sad because they were farting.

No, I'm talking about flagellence. F-L-A-G-E-L-L-A-N-T-S. Flagellens. Flagellens? She just said flagellens is what she just said. She did not say flagellins. She said flagellants. Oh, okay.

Okay, getting back to the despair part. Flauglans were a radical anti-Semitic Christian group who believed that the only way to halt the point, plague was to atone with blood for their sins. Groups of 50 to 500 would travel from village to village dressed in white cloaks with red crosses on them. Sound familiar? Yeah, it does.

Whipping themselves with a stick, which had at the end of it tails of knotted rope with bits of iron in the knots to draw out the blood. So this is just like Da Vinci Code. Yeah. I mean, flagellants were not unique to the plague itself. the black death itself. But this was like a widespread movement. And part of it was that they didn't want or need priests or official leaders for this. And in many ways, the black death actually led to a shift in a more personal form of religion in which you did not have to go through a priest to

commune with God. Interesting. And also because a lot of the priests and monks died. So there's no more God communicators. So you just got to do it yourself. You got to do it yourself. The black death impacted more than just religious practices, though. By the time it ended in 1350, around 30 to 60% of Europe's population had been wiped from the face of the earth. Holy, oh my God. The Middle East lost about a third of their population as well. Wow. I could list shocking mortality rates for cities and countries, but the numbers would lose their impact because they're all so high. That's the thing. It's like, It's too much for our brains to even... We can't absorb it.

No. The death toll was so huge, partially because of the high incidence of pneumonic plague, but also because the preceding famine had weakened the population substantially. Right. There were also many who may have recovered if they received treatment, but there was no one to nurse them. Yeah. And there was also no real treatment back then. It's not like the head antibiotics.

Well, even just bringing someone... Water. Food. Yeah. Cleaning them. Yeah. although they probably wouldn't have wanted to be cleaned. I like my dirt.

The world that the great mortality left behind was fragmented, hopeless, baffled as to why they were spared when so many were not. And this was reflected in a popular art theme that arose after the pandemic called the dance macabre or a dance of the dead. In this allegory, death with a capital D goes to a ball and chooses his dance partners randomly without regard to age or class, just as the plague spared no group. In general, art became very realistic, if not fatalistic, with depressing depictions of death and suffering. And did you know tapestries probably arose from Black Death? No, why? Airflow should not be permitted. And so these giant tapestries covering windows and walls were made to ward off plague and pestilence. Oh my God, to not let things get in. That's so interesting.

The plague also inspired many works of literature, including the decamaran, which we've already talked about. Have you ever read The Mask of the Red Death by Po? No, but I feel like I need to. Oh, you definitely need to. It's a great short story. And it may have been inspired by the DeCamaran and the Black Death also. Cool. On the medicine front, there became a push towards more anatomical analysis of the stages of disease, more observational medicine, which was a good thing.

Unfortunately, though, the failure of physicians to combat the plague in any way, and in some areas, physicians actually died at higher rates than their patients. Oh, that's not surprising because they were probably the ones in there, getting all up in there, and then getting pneumonic plague from patients. Yeah. And so that led to a complete lack of confidence in the field of medicine. It is often reported that English became the predominant language in England as a result of the Black Death. Really? This is so cool. Before the plague, the French language dominated the cities in England among the educated and nobility, while the clergy mostly spoke Latin.

The only people who spoke English were the country folk and the very poor in the city. Interesting. Both clergy and city dwellers experienced overall higher rates of death than their rural counterparts, and as a result, English took over. Oh, my God. So we could all be speaking friends. Yeah, potentially. We could. Plague also gave us the word quarantine, which comes from the Italian phrase for 40 days. Ships and people arriving in the city of Ragusa, which is modern-day Dubrovnik, Croatia. I've been there. Cool. We're forced to undergo isolation for 40 days in an

attempt to halt plague. Unfortunately, rats were not quarantined and plague spread anyway. Okay, what else? How about the logistics side? of a sharp population decline. Before the plague, Europe was pretty much on the edge. The population had grown beyond what the land could support. The Black Death solved this, to put it frankly. And Europe didn't recover to its pre-plague population levels for another 150 years.

Wow. Also, after the plague, it was a laborer's market. The cost of goods and services skyrocketed so much so that governments imposed wage limits so is to not let those pesky peasants reach the income level of the nobility. Seriously? Oh, my God. Oh, dear.

Still, though, this caused a shift in economic structure and an end to feudalism, where basically all of the classes lower than a lord were forced to work and live on a particular piece of land. Kind of like slavery, just with more freedom. Just a different name, essentially. Some researchers suggest that the population drop led to a massive reforestation in Europe, with so few people to work the land. And that could have contributed to the little ice age that the world was undergoing. What?

Yeah. So you're telling me that so many people died that the entire ecology of the environment shifted, which literally caused climatological change. That's reported in some literature. That has got to be like the first evidence of anthropological climate change. Yeah. Thank you. Anthropocene.

Black death. Wow. That is so crazy. I could go honestly, I could go on and on about the impact of plague. Yeah. And I kind of have already. But I do want to cover a couple more things. The first is to briefly discuss the so-called, quote, plague deniers, which are many,

well, maybe many is stretching at this point. Several historians and biologists who believe that the black death was caused by something other than Yersinia pestis, which is the agent that we read. recognized today as causing bubonic, pneumonic, and septicemic plague. Some have suggested a hypervirulent form of anthrax, a hemorrhagic virus, or a completely unknown disease that is now extinct. Oh, God. They point to a few things to support their claim. One is the extreme speed with which the plague traveled across Europe and Asia. Modern outbreaks of plague took much longer to travel a similar distance. Another piece of evidence is the reported symptoms, high death toll, and quick onset of

death, none of which were exactly replicated in modern epidemics or in the third pandemic. However, DNA steps in and saves the day. Love it when science rules. Well, I mean, there's were, I would say, fairly legit scientific claims before. Before researchers went out and collected tooth pulp from plague victims buried in mass graves during the Black Death. They then tested this pulp for Yersinia Pestis DNA, which they found. That's so cool. The Black Death and subsequent outbreaks were caused by the plague bacterium, the same one that causes plague today. Wow.

Slightly different. It has evolved. The high mortality rate was probably due to its tendency to turn pneumonic and also the poor, very poor health of victims to begin with. Yeah. The next and final thing I want to do is dispel the notion that the pandemic we call a black death was the last one. Not in the slightest. The plague continued to simmer throughout Eurasia in the centuries following the 14th century pandemic, causing local epidemics here and there, which is not to suggest that they weren't devastating. The 1665 Great Plague of London killed 70,000 residents out of a population of 450,000.

Oh my God! It's about 16.6%. That's a lot of people. And during that particular outbreak, many of the wealthy nobility fled the city since they had the means to do so, often bringing their doctors with them. And so no one was left to help the poor as they became infected and died by the thousands. That's so sad. It wasn't until the 1800s that the third pandemic began. And that is where our episode next next year.

week we'll pick up. Yep, because we are so out of time. Oh, yeah. That's a lot of history right there. It really was. It had to be done, though. Yes. The Black Death left such a monumental impact on the world in so many ways. Reading about it is slightly terrifying. And also thrilling. Yeah, I always get chills when I try to imagine the kind of devastation that a 50 or 60 or 70% mortality rate had on a city or the world. Yeah, there's really not a good way to put it into words, really. I mean, 60% mortality. That's of your 100 friends, 60 of them dead. You've only got 40 friends left. It's really, I mean, even still, it's really hard to visualize. It really is. It's too devastating. Anyone who works long hours knows the routine. Wash, sanitize, repeat by the

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It allows the Lego Star Wars galaxy to play back. May the Force be with you. Shop Lego Star Wars sets, Now on Lego.com or in Lego retail stores. I hope you enjoyed learning about that because I loved it. I love telling it. It was really enjoyable despite the fact that it's some of the most depressing things I've ever heard. Well, if you want to read more, I have some suggestions for you.

Great. Okay. The Great Mortality by John Kelly is a fantastic, exciting read all about the Black Death slash Great Mortality of the 14th Century. It is really well done. It'll give you a really great view of what it was like, better than I could do for sure. Justinians Flea by William Rosen. I didn't actually read, but it does cover the plague of Justinian in the 500s.

Plagues and Peoples by William McNeil takes a nice broad view of the Black Death. Twelve Diseases That Changed Our World by Erwin Sherman. I do not recommend in the wake of the plague by Norman Cantor. It's terrible. It's vaguely misogynistic. It's not well done. It doesn't give you a good overview. The title is extremely misleading. Put it aside. Sounds also more than vaguely misogynistic based on your description of it to me. So the final one that I'll actually recommend is called Plague, an Ancient Disease in the 20th century by Charles Gregg. And a couple of fiction books. I mean, there are many more out there, but a couple of them that tackle plague outbreaks. One is called Year of Wonder. by Geraldine Brooks. And this is a good one. It's really interesting.

So it's based on the true story of a town in a village in England that willingly quarantined itself when it had an outbreak of plague within the village. Interesting. To prevent it from spreading to other populations in like the 1600s. Huh. That sounds interesting. And then a journal of the plague year by Daniel Defoe, who also wrote Robinson Crusoe. He was a kid during the 1665 London plague, but he was.

He wrote a book based off of it. Cool. Awesome. I don't have as many books to recommend, but I did read the longest paper of all time that might as well be a book. It was called Yersinia Pestis, Ediologic Agent of Plague by Perry and Featherston, published in Clinical Microbiology Reviews in 1997. It's kind of an old paper, but it's a really interesting overview of plague. So I don't know how many of you are that into reading. deep microbiology papers, but it was cool.

But also, in case you didn't know, dear listeners, we have a Goodreads list called These Books Will Kill You, Right? Yes, that's right. So you should definitely, if you're on Goodreads, check it out. If you're not on Goodreads, I don't know, get on Good Reeds. It's great. Aaron converted me. You can still access it.

Right. You can still see the list regardless. But that'll have all the books that we've ever recommended on that list. So you don't have to like frantically scribble them down as we're reading them. Mm-hmm. And as always, thanks for listening. Thank you so much for listening. Thank you to Bloodmobile for the music.

And I feel the need to point out today, since today is a day of self-identification. Bloodmobile is my younger brother Daniel. Thanks, Dan. We love you. We love the music. We really do. And also, some of the tracks were done by Dan and his friend Ian. Thanks, Ian.

As always, don't forget to rate, review, and subscribe. check us out on all of the social medias. And thanks for listening. Yeah, thanks so much. And tune in next week when we talk all about what is happening with plague today. Wash your hands.

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