R. Bromley January 2005

The Bubonic Plague The Disease Yersinia pestis is a pleomorphic, facultatively aerobic, nonmotile, intracellular bacillus. Optimal temperature for growth is 28 °C.

The Flea As the disease grows, it blocks the flea’s digestive tract. Infected fleas become unable to swallow, and regurgitate blood back into the host.

The Rodent Once in the animal’s blood, the bacterium moves into the lymph nodes and survives in phagocytes. An overwhelming infection occurs.

Between outbreaks, the plague bacterium is believed to circulate within populations of certain species of rodents (rats, mice, squirrels, prairie dogs, chipmunks, and rabbits) and their predators without causing excessive mortality. Such groups of infected animals serve as silent, long-term reservoirs of infection. Attempts to eliminate wild rodent plague are costly and futile. Therefore, primary preventative measures are directed toward reducing the threat of infection to humans in high-risk areas through three techniques: environmental management, public health education, and preventative drug therapy.

Outbreak and Transmission Periodic outbreaks among rodents produce high mortality rates. At such times, infected fleas seek out alternate sources of blood. Alternately, plague may be transmitted through breaks in the skin, or by direct contact with infected tissue or fluid (skinning an infected animal, for example). Finally, inhaling infected droplets expelled by coughing may transmit the plague.

Bubonic Plague Onset occurs 2-6 days after exposure. Symptoms include: enlarged, tender lymph nodes (buboes), fever, headache, chills, convulsions, and extreme exhaustion. 5090% mortality/15% if treated with streptomycin.

Not dead yet?

Septicemic Plague (The Black Death) The blood becomes infected, and carries disease throughout the body. Symptoms include: fever, chills, abdominal pain, shock and internal bleeding. As the body disintegrates, massive tissue necrosis occurs. Capillary fragility results in haemorrhages which also result in visibly blackened patches. 80-90% mortality.

Not dead yet?

Pneumonic Plague Onset occurs 1-3 days after first buboes become visible. The infected become shockingly contagious. Symptoms include: high fever, chills, overwhelming pneumonia with cough and difficulty breathing. Death occurs within hours or days. 90-100% mortality.

Pleomorphic: Having different forms at different stages of the life cycle. Facultative: Of parasites.

Not dead yet? Liar.

R. Bromley January 2005

The Plague-Proof Suit 21st Century vs. 14th Century 30002 Barricade Hazmat Suit a.k.a. The Bunnysuit Front View • • • • • • •

Certified Level B Protection

1 – Attached and sealed hood with clear view port. 2 – Respirator mask and structural helmet. 3 – Pressure Bleed Valve. 4 – Valve. 5 – Integral sealed gloves with elastic wrists. 6 – Sealed non-spark zipper. 7 – Standard boots covering integral suit boots.

Rear View • •

1 – ID patch. 2 – Humpback® air tank pocket. www.sccfd.org/ clothing.html

Wearing a Bunnysuit • It is not uncommon for the environment inside the suit to reach 11-17°C hotter than the ambient temperature within minutes. Humidity reaches 100% quickly. • Up to five layers of gloves and boots, three layers of facemasks, and twelve layers of full body suits are worn at a time. Optional cooling vests, holding ice packs, may be worn as well. • Wearers must be decontaminated before they can remove any of the protective clothing. In the event of an accident, many medical personnel carry a knife into the suit with them, so that they can cut their way out from the inside. The outer suit is too heavy to tear through. • Although suits are equipped with exhaust valves, the suits tend to blow up like balloons as the wearer exhales. • Because of the heat, bulk, and weight of the suit, a wearer would find it almost impossible to move quickly. • Wearing a hazmat suit is not only uncomfortable, but expensive as well. Each suit costs between $4000 and $10000, and may need to be disposed of after one use.

Plague Doctor Suit a.k.a. That Silly-Looking Thing With The Beak Features • • • • • •

•

Long linen robe, coated with wax (to repel dangerous liquids). Long leather boots and gloves. Leather trousers. Hood tied at neck and tucked into robe. Leather “I’m a Doctor” hat. Mask Protective glass eyepieces (to ward off miasmas). Beaklike protrusion containing spices and herbs (to ward off contagion). Crimson prodding stick (to manipulate contaminated articles or people). Illustration from Historiarum anatomicarum medicarum (1661), by Thomas Bartholin.

R. Bromley January 2005

Medical Practitioners of the Middle Ages

Physicians Physicians were scholars who studied at universities. In order to be declared a physician, a student had to prove himself able to recite, lecture and debate the contents of his studies.

Dentatores Dentatores were the dentists of the medieval era and were so expensive that usually only the very rich could afford their services. They repaired loose teeth, made dentures, removed decay, which was believed to be caused by worms, and filled teeth.

Monks Monks copied manuscripts – some of which included the medical writings of Greek or Latin scholars. There is evidence that they practiced the medical knowledge they obtained as scribes. Not only did monasteries house infirmaries, monks brought medical aid to the poor living nearby, and to those who sought their care.

Barber/Surgeons

Herbalists (Folk Healers)

Surgeons belonged to the working class and did the jobs that were considered beneath physicians, such as bloodletting and pulling teeth. Most surgeries were performed by the barber/surgeon. The most common operations were for hernias, gallstones and cesarean section.

Practitioners of popular healing varied widely from place to place within Europe. In some areas the secrets of healing were carried by women, and in others by men. Certain groups held the belief that healing was an inherited gift, and if passed to outsiders, they would be ineffectual.

Leeches

Nurses

Midwives

Leeches were lay practitioners whose training was more practical than theoretical. Practicing without proper education, they relied more on informal observation and folk medicine. They may have been apprenticed to a barber-surgeon or physician at some point.

Medieval nurses were women who attended to the more basic needs of the ill in hospitals. Many joined monastic orders, but there were secular nursing orders as well, especially during the Plague. As the disease spread women from all socio-economic groups came forward to care for the sick. Noble-born women who became nurses of the poor or sick, were considered "nursing saints."

Midwives were taught their duties by other midwives or were introduced into the craft by fathers or husbands who were medical men. Midwives were usually apprenticed to older more experienced midwives. The only requirement for becoming a candidate for midwifery was a statement from the parish priest attesting to the applicant’s good character.

R. Bromley January 2005

The Plague and Normalcy •

Bills of Mortality The Bills of Mortality originated in the early sixteenth century in London, as a sort of early warning against the onset of bubonic plague. The information was collected by the Parish Clerk's Company of London, and was published weekly, monthly and yearly. • Over time the detail provided by the bills increased. Originally they contained only burials, but by the 1570s the total number of baptisms was included, and after 1629 the cause of death was given. • The areas covered by the bills also expanded as London grew. Until 1603 the Bills covered only the area governed by the Lord Mayor of London. By 1636, the 'out-parishes' [suburbs] and 'distant' parishes in Westminster, Stepney and South London were included. • The area referred to the London conurbation of the time and the phrase "within the Bills" came to mean what you might call 'greater London'. footguards.tripod.com/ 01ABOUT/01_sickness.htm

Ring Around the Rosy Ring around the rosy

A red ring of infected, secondary bites often surround swollen, rosy primary bites.

Pocket full of posy

A posy is an arrangement of flowers, usually given as a present. Having a pocket full of posy was important in plague-stricken areas: • Many reasoned that, since disease was borne on foul air, one could be protected by sweet smelling items. • Although today flowers are primarily marks of respect at sterile, western funerals, they were essential to stave off the smell of death in the Middle Ages. • The mobile infected endeavoured to mask the wretched smell of their infection by carrying flowers on their person. In the terminal phases of the disease, victims would hemorrhage internally, sometimes triggering sneezing as it irritated the breathing passages. "Ashes" is a child's approximation of a paroxysm of sneezing. In this weakened state, a victim could, and often did, sneeze their lungs out.

Ashes, ashes, (or, Achoo, Achoo,)

We all fall down!

Death.