Day 31

The epic poem Gilgamesh, written down around 2000 B.C.E. but recounting events that apparently occurred several centuries earlier, tells of how the hero’s friend, Enkidu, contracts a debilitating illness that confines him to his bed for twelve days until he dies. The identity of the disease that kills Enkidu is never made clear, for its symptoms are not described; we know only that it causes Enkidu great pain and that he ascribes it to the curse of the gods in retribution for slaying the Bull of Heaven. However, further details as to what this illness may have entailed are supplied by the “Poem of the Righteous Sufferer,” part of the Meso-potamian wisdom literature dating to the Babylonian period during the first half of the third millennium B.C.E. Like Enkidu, the “Babylonian Job” lies prostrate in his bed, although his condition is more fully described: He has become deaf, blind, and dumb; a stiffness has taken over his limbs; and his flesh has become emaciated and inflamed. All this is accompanied by a headache, intestinal distress, and discharge of phlegm; at its worst, the disease forces the patient to spend “the night in my dung like an ox” and wallow “in my excrement like a sheep.” If the disease has come from the gods, the sufferer remains mystified as to why, since he has performed all of the usual rituals, libations, prayers, and other observances in honor of his deities. Like the later biblical Job, however, the sufferer is eventually redeemed by the Babylonian god Marduk, who restores him to his former health and happiness.
...
The disease known as “plague” may seem obscure to most people nowadays, but plague has been called the deadliest of all diseases, one that was responsible for perhaps the most lethal pandemic in all of history. And it is a disease that is still very much with us, even in a modern, developed country such as the United States, as John Tull and Lucinda Marker, a couple living in Santa Fe, New Mexico, found out in November of 2002. While Lucinda quickly recovered from her bout with plague, her husband, John, came down with a case of the disease that was so severe he was immediately put into a drug-induced coma that was to last for the next two and a half months, at the end of which John woke up to find both his legs amputated below the knee. John did survive plague, but barely; at one point, all his close family members were rushed to his bedside to pay what were thought to be their final respects. As John tells his tale, it’s clear that he’ll never forget his near-death experience with plague.

Plague is a specific disease, which should not be confused with its other, more general meaning in which it refers to disease in the abstract. It occurs in three forms, depending on how the microorganism that causes the disease in all cases, a bacterium known as Yersinia pestis, invades and spreads within the body. Plague is fairly unique among diseases in that it can be spread by both an insect vector, a trait it shares in common with malaria and typhus, for example, and also by direct, human-to-human transmission, which likewise happens in cases of influenza, tuberculosis, and smallpox.

Bubonic plague is the most common and widely known form of this disease, in which fleas are responsible for infecting hosts when they bite and attempt to feed on their host’s blood yet are unable to do so because their stomachs are already “blocked” by a proliferating mass of bacteria, which they must regurgitate along with the blood meal back into the bloodstream of their victims. As its name implies, the rat flea (Nosopsyllus fasciatus in Europe and Xenopsylla cheopsis in Asia) typically spreads plague among fur-bearing rodents, such as the black rat (Rattus rattus), which are highly susceptible to the disease, but once its animal hosts are dead and cold, the fleas will then jump onto any nearby hosts available, including humans. Keeping in mind that up to twenty-five thousand bacteria are injected into a host with each bite of a blocked flea, which can bite repeatedly as it ravenously attempts to feed; that each rat may host up to one hundred fleas on its body, all ready to seek a new host when necessary; and that hundreds if not thousands of fleas have been shown to be present in a home infested with rats, one can see how in some cases victims had so many bacteria introduced into their bloodstreams that they developed the far more virulent form of septicemic plague. As a matter of fact, Tull, who claims to be the only person in recorded history to have survived septicemic plague, was bitten by the same type of flea that had given a typical case of bubonic plague to his wife. Yet, in John’s case, the bubo on his groin was hardly noticeable and, instead of the bacteria becoming concentrated in the lymph glands, they seem to have turned inward and invaded nearly every organ in his body. How an individual body reacts to Yersinia pestis in terms of being able to isolate the bacteria within its lymphatic system may also determine whether one develops a case of bubonic or septicemic plague.

In pneumonic plague, the bacteria enter the lungs after being breathed in, which typically occurs as the result of exposure to the expectorate, or airborne droplets, that have been coughed or sneezed out by an infected person. Therefore, direct human-to-human contagion is the norm in pneumonic plague, where no other animal intermediary is necessary, even though a pneumonic plague outbreak seems to start out as a secondary symptom of the bubonic form and tends to be localized, owing to the narrow window of time in which this form of the disease can be spread by the symptom of an infective cough. However, since the patient is usually well enough to travel during the incubation period, which in pneumonic plague can last up to three or four days (but in bubonic plague can last up to a week), it is possible that an outbreak of the disease in one locality then gives rise to another at a considerable distance away.

~~Plagues in World History -by- John Aberth