Learning from the black death

Clinically, plague took two forms. Bubonic plaque showed itself as buboes, or massively swollen lymph glands, leading to septicaemia or in some cases purulent abscesses which could burst. By contrast, infiltration of the lungs led to pneumonic plague with violent frothy haemoptysis. Death by either form was hideous and could occur within days or even hours, but pneumonic plague led to far more rapid transmission of the bacteria via droplets, obviating the need for rats or fleas as vectors. There are records of physicians and those in holy orders who sacrificed their lives to give succour to the dying. Some others, along with several rulers and many instant entrepreneurs, used the opportunity to steal, rape, extort and abandon their own families. The majority of these probably delayed their own deaths only for a short while, although as with COVID-19, the poor and old were more likely to die than the young and rich. Some cities like Venice implemented rigorous public health policies that included the systematic collection and disposal of corpses. In Farnham in southern England, a conscientious estate manager called John Ronewyk maintained agricultural production and the collection of rents on the local bishop’s land while half the population around him died. Elsewhere across three continents, some communities collapsed into anarchy or vanished completely.