# The black plague was so deadly because people were already in marginal health
**URL:** https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850
**Category:** Great Debates
**Created:** [August 25, 2015, 5:18pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850 "2015-08-25T17:18:29Z")
**Posts on this page:** 16
**Page:** 1
### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [August 25, 2015, 5:18pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/1 "2015-08-25T17:18:29Z")
I heard this theory, that a major reason the plague killed so much wasn’t so much due to the bacteria itself being extremely fatal but because people were already sickly from malnutrition and other diseases. Then again, if that were true then all the other plagues that hit pre industrial society would also have had 30-50% mortality rates.
If a westerner gets the plague now would it have mortality rates nearly as high (assuming no medical care)?
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### Author:  [@rat\_avatar](https://boards.straightdope.com/u/rat_avatar)
#### Post date: [August 25, 2015, 5:34pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/2 "2015-08-25T17:34:03Z")
> [@Wesley\_Clark](#):
>
> I heard this theory, that a major reason the plague killed so much wasn’t so much due to the bacteria itself being extremely fatal but because people were already sickly from malnutrition and other diseases. Then again, if that were true then all the other plagues that hit pre industrial society would also have had 30-50% mortality rates.
>
> If a westerner gets the plague now would it have mortality rates nearly as high (assuming no medical care)?
I think the people positing that theory may have forgotten the complete lack of germ theory and the widespread un-sanitary disposal of fecal matter.
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### Author:  [@Melaradark](https://boards.straightdope.com/u/Melaradark)
#### Post date: [August 25, 2015, 6:00pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/3 "2015-08-25T18:00:04Z")
Well, according to the below link, this is what it looks like to me:
> **[Plague surveillance | CDC](https://www.cdc.gov/plague/maps/)**
>
> Information on where plague cases occur in the United States, and how many have occurred in recent years.
Clearly, plague spreads faster and to more people in rural, agricultural, third world areas than more urban or suburban areas. From what I can glean from this site- and if I made a mistake please let me know- that if a person is in a first world country with reasonable access to medicine and prompt treatment, the plague has an 8-10% fatality rate. Without those things or without prompt treatment, the fatality rate goes up dramatically.
In third world countries with less access to medical care, the fatality rate is much higher.
So it seems to be not so much the health condition of the plague victim prior to infection that makes much of a difference (though age and health history do make a bit of a difference), but how quickly diagnoses can be made and how quickly and available known and current treatments are to that person.
Make sense?
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### Author:  [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)
#### Post date: [August 25, 2015, 8:48pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/4 "2015-08-25T20:48:23Z")
People who are debilitated/malnourished can indeed be more susceptible to disease and more likely to die (a modern example is measles, which is much more deadly in those who are vitamin A-deficient).
As the OP noted, not all diseases are equally virulent in these groups. It may also be that plague in the Middle Ages involved a more dangerous strain than what we have today. Smallpox varied in severity over the years before being eradicated. Syphilis was reportedly extremely nasty in the past compared to now.
\*“”[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people’s faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"\*_y 1546, the disease had evolved into the disease with the symptoms so well known to us today.“[17] The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease”_
> **[History of syphilis](https://en.wikipedia.org/wiki/History_of_syphilis)**
>
> The first recorded outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as "French disease", and it was not until 1530 that the term "syphilis" was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905 at the Charité Clinic in Berlin. The first ef Many well...
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [August 25, 2015, 9:44pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/5 "2015-08-25T21:44:05Z")
> [@Melaradark](#):
>
> Well, according to the below link, this is what it looks like to me:
>
> [http://www.cdc.gov/plague/maps/](http://www.cdc.gov/plague/maps/)
>
> Clearly, plague spreads faster and to more people in rural, agricultural, third world areas than more urban or suburban areas. From what I can glean from this site- and if I made a mistake please let me know- that if a person is in a first world country with reasonable access to medicine and prompt treatment, the plague has an 8-10% fatality rate. Without those things or without prompt treatment, the fatality rate goes up dramatically.
>
> In third world countries with less access to medical care, the fatality rate is much higher.
>
> So it seems to be not so much the health condition of the plague victim prior to infection that makes much of a difference (though age and health history do make a bit of a difference), but how quickly diagnoses can be made and how quickly and available known and current treatments are to that person.
>
> Make sense?
My question is what happens if a westerner gets black plague w/o any medical care? Assume they are camping in the middle of nowhere and get it. They have food and water, but no medicine.
Does the fact that the westerner has a better immune system due to a diet high in vitamins, minerals and macronutrients, and the fact that their health is pretty decent to begin with (compared to people in pre-industrial societies) mean the death rate is lower, and possibly much lower, than 30-50%?
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### Author:  [@WhyNot](https://boards.straightdope.com/u/WhyNot)
#### Post date: [August 25, 2015, 10:14pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/6 "2015-08-25T22:14:26Z")
I don’t think we can give you the precise numbers you’re looking for. Plague, in all its forms, is pretty rare in the world, and even rarer in the US and other first and second world countries, and when it’s identified, it’s treated. So we don’t have a large control group of first world untreated people to look to. We only have about a dozen people a year, who are treated. And lots of them still die. The hypothesis is an interesting one, but completely unethical to research by withholding treatment, and we don’t have enough naturally undiagnosed cases to crunch the numbers post-mortem.
> [@](#):
>
> Infection in all forms can be fatal unless treated immediately with antibiotics, such as streptomycin. Mortality rates for treated individuals range from 1 percent to 15 percent for bubonic plague to 40 percent for septicemic plague. In untreated victims, the rates rise to about 50 percent for bubonic and 100 percent for septicemic. The mortality rate for untreated pneumonic plague is 100 percent; death occurs within 24 hours.
That’s today, not historically. [Rx for Survival . Deadly Diseases . Plague | PBS](http://www.pbs.org/wgbh/rxforsurvival/series/diseases/plague.html) Of course, that includes those in the third world, with health probably similar to those in plague ridden Europe.
But no, I don’t think I’d rely on a robust health status saving me from plague.
Frankly, it reminds me of the anti-vaxxer theory that improved sanitation and health status did away with measles, and not vaccination. Nice theory, but it’s not up to me to disprove it, it’s up to them to prove it. (They can’t, because it’s not true.)
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### Author:  [@Broomstick](https://boards.straightdope.com/u/Broomstick)
#### Post date: [August 26, 2015, 12:32am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/7 "2015-08-26T00:32:05Z")
> [@Wesley\_Clark](#):
>
> My question is what happens if a westerner gets black plague w/o any medical care? Assume they are camping in the middle of nowhere and get it. They have food and water, but no medicine.
>
> Does the fact that the westerner has a better immune system due to a diet high in vitamins, minerals and macronutrients, and the fact that their health is pretty decent to begin with (compared to people in pre-industrial societies) mean the death rate is lower, and possibly much lower, than 30-50%?
[According to the CDC](http://www.cdc.gov/plague/faq/#mortality) between 1900 and 1941 the fatality rate of the bubonic plague in the US was 66%. That’s _with_ medical care, but _without_ antibiotics.
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### Author:  [@Rune](https://boards.straightdope.com/u/Rune)
#### Post date: [August 26, 2015, 12:49am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/8 "2015-08-26T00:49:46Z")
> [@Wesley\_Clark](#):
>
> I heard this theory, that a major reason the plague killed so much wasn’t so much due to the bacteria itself being extremely fatal but because people were already sickly from malnutrition and other diseases. Then again, if that were true then all the other plagues that hit pre industrial society would also have had 30-50% mortality rates.
>
> If a westerner gets the plague now would it have mortality rates nearly as high (assuming no medical care)?
- One of the reason the Black Plague was so feared was that it took those in the prime and best of health. It doesn’t seem to have hit the young or elderly or those already sickly harder than the 20yo youth in the best of health and condition.
- Westerners, those descended from Europeans, today are supposed to have some measure of genetic protection against the Black Plague. It is speculated that this protection also helped to some extend in making the AIDS epidemic less severe. So westernes today, all things being the same, would probably have a lower mortality rate.
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### Author:  [@John\_Mace](https://boards.straightdope.com/u/John_Mace)
#### Post date: [August 26, 2015, 2:14am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/9 "2015-08-26T02:14:57Z")
Please. Plague of Color. Let’s not be committing any micro-aggressions here.
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### Author:  [@running\_coach](https://boards.straightdope.com/u/running_coach)
#### Post date: [August 26, 2015, 2:27am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/10 "2015-08-26T02:27:55Z")
> [@Broomstick](#):
>
> [According to the CDC](http://www.cdc.gov/plague/faq/#mortality) between 1900 and 1941 the fatality rate of the bubonic plague in the US was 66%. That’s _with_ medical care, but _without_ antibiotics.
Would the survivors’ children be Plague-Americans?
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### Author:  [@Finagle](https://boards.straightdope.com/u/Finagle)
#### Post date: [August 26, 2015, 3:52pm UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/11 "2015-08-26T15:52:16Z")
> [@Rune](#):
>
> - One of the reason the Black Plague was so feared was that it took those in the prime and best of health. It doesn’t seem to have hit the young or elderly or those already sickly harder than the 20yo youth in the best of health and condition.
Likewise, the flu pandemic of the 1918 affected those with the strongest immune systems the most.[https://en.wikipedia.org/wiki/1918\_flu\_pandemic](https://en.wikipedia.org/wiki/1918_flu_pandemic). So this is probably one of those hypotheses that sounds good when you propose it, but doesn’t really stand up to scrutiny.
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### Author:  [@Bridget\_Burke](https://boards.straightdope.com/u/Bridget_Burke)
#### Post date: [August 27, 2015, 2:43am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/12 "2015-08-27T02:43:00Z")
[This just in:](http://www.cnbc.com/2015/08/26/cdc-to-doctors-keep-an-eye-out-for-plague.html)
> [@](#):
>
> Doctors should think about the possibility of plague when they see patients with flu-like symptoms this summer and should ask if they’ve been camping, hiking or around dead rodents, federal health officials said Tuesday.
>
> Eleven cases of plague have been recorded in the U.S. this year, and three people have died.
>
> “It is unclear why the number of cases in 2015 is higher than usual,” the Centers for Disease Control and Prevention says in a brief update.
It’s a bacterial disease, so antibiotics can definitely help. As long as the doctor (or the patient) doesn’t assume it’s some kind of virus going around. No matter how healthy you are, avoid the plague. Like the plague?
Oh, look. There’s been an outbreak of [pneumonic plague](http://www.health24.com/Medical/infectious-diseases/Bacterial-infections/Pneumonic-plague-kills-eight-in-Madagascar-20150826) in Madagascar. It’s more easily spread…
> [@](#):
>
> Pneumonic plague is rare and more vicious than the commonly-known bubonic strain as it gives antibiotics little time to act and can kill within 24 hours.
>
> “Twelve cases of pneumonic plague have been identified,” out of which eight people have died in two days, Maherisoa Ratsitorahina, the health ministry’s chief epidemiologist, told AFP.
A healthy lifestyle is a great idea–but won’t save you from this one, either.
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### Author:  [@FlikTheBlue](https://boards.straightdope.com/u/FlikTheBlue)
#### Post date: [August 27, 2015, 4:03am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/13 "2015-08-27T04:03:25Z")
One theory is that the plague is less deadly today because the more virulent strains went extinct during the Black Plague, having killed most of those infected quickly and thus not having as much opportunity to spread as a less virulent strain. This might account for some of the difference in mortality as well.
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### Author:  [@ITR\_champion](https://boards.straightdope.com/u/ITR_champion)
#### Post date: [August 27, 2015, 4:08am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/14 "2015-08-27T04:08:44Z")
As I understand it, all infectious diseases should grow less deadly over the centuries. From a bacteria’s perspective, it’s bad to be too deadly. If you kill everyone that you infect right away, you don’t have time to spread to new people. What you want to do is have your victim linger for months or years, spreading germs during that time. So from a Darwinian perspective, less deadly bacteria win over more deadly ones.
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### Author:  [@AK84](https://boards.straightdope.com/u/AK84)
#### Post date: [August 27, 2015, 4:33am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/15 "2015-08-27T04:33:49Z")
> [@WhyNot](#):
>
> That’s today, not historically. [Rx for Survival . Deadly Diseases . Plague | PBS](http://www.pbs.org/wgbh/rxforsurvival/series/diseases/plague.html) Of course, that includes those in the third world, with health probably similar to those in plague ridden Europe.
:dubious:
I don’t think anyplace on Earth, except perhaps smack in the middle of a warzone has health as bad that of Middle Age Europe.
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### Author:  [@MrQwertyasd](https://boards.straightdope.com/u/MrQwertyasd)
#### Post date: [August 27, 2015, 6:05am UTC](https://boards.straightdope.com/t/the-black-plague-was-so-deadly-because-people-were-already-in-marginal-health/728850/16 "2015-08-27T06:05:19Z")
I don’t know, but i know a song about it [- YouTube](https://www.youtube.com/watch?v=NX9uUaYTR60)