Shops were boarded up. The streets were almost empty and there was a stench of death in the air.
Francesco was just trying to get hold of a few vegetables. Florence seemed deserted these days.
It meant that for a while he'd been able to hear the distant echo of horses hooves on the cobblestone roads bouncing from house to house.
And now the sound broke out into the streets ahead. The whole train of carriages heading his way at some speed.
He scampered to the walls and peered back as it comes to. It was full of the dead.
Maybe neighbours shocked, nervous blacksmiths, people who need it all on their way down to the grave in either the.
Soon there'll be another carriage load on the way. That was the only life in the city.
The bodies look bloated with blackened toes and fingers hanging over the sides of the car.
And as the winds hit, each Flagstad hands jumped and found as if they were waiting in.
A cold chill crept along his spine. And as he turned back into the street, two dogs sprinted past him, chasing after the dead.
Welcome to the 14th century to the third episode of our history of pandemic's season, we've already heard about the plague.
If it wasn't,
then about humanity's first genuine recorded with plague and now you'll discover what we do and don't know about its most notorious outbreak.
The Black Death is a gruesome name, well matched with a grim disease, and both the epithet and the infection have survived to the modern period.
But first, we should cheque back in with my colleague, Dr. Bloche Agouti, who can remind us what exactly the plague is.
Well, essentially, the plague is an acute life-Threatening infectious disease caused by gram negative interest,
only a bacterium called Yesenia pestis. So you see it.
This often infects small rodents like rats, mice, squirrels.
That's kind of where it likes to hang out. And it's usually transmitted to humans through the bite of an infected flea,
although there are other transmission routes that it can take with only since the 19th century
even understood that it was a bacterium that caused such an infamous thing as the plague,
which before then it was thought to be some kind of punishment from God or my Ismar.
So essentially something caused from bad smells. Future isn't matter, the cost of sick people just rather than actually being a microorganism.
So that's a reminder of what plague is. But how did the black outbreak start?
To find the answer to that was someone in Glassco. I need you to call.
My name is Samuel Cohn and I'm professor of mediaeval history at the University of Glasgow.
For the last 20 years, more than 20 years, I've been working on principally the black cat, but on diseases and for the human reactions to diseases.
And on this side, I finish and 2018, a rather large book, at least in terms of pages.
And in terms of the scope, geographical scope and the temporal.
So I spoke with Oxford University Press titled Epidemics Hate and Compassion from the Plague of Athens to AIDS.
I was keen to learn from where the outbreak first emerged.
That narrative evidence is that it enters Europe coming from those that we support.
And it arrives in the fall of thirteen forty seven.
We know about earlier bouts with dystonia pestis.
This type of disease that we now think like that was that goes back at least five thousand years ago to the Bronze Age.
Now, this is not recorded.
This is computed evidence that stems from genome sequencing and phylogenetic trees of the ancestry and the splits of different strands.
Oh, you're. Over these shootings now for the Black Death, whether it is more virulent or just could spread much more efficiently.
Is it another question that the genome sequencing, I think, hasn't really gotten a hold of and may not ever be able to get a hold?
But if it is right, there is this notion of a big bang that occurred someplace and there's a lot of disputing about this.
This is really very much up in the air now, someplace properly and the plateau of Mongolia, China.
This goes back depending on who you're reading to.
Even the they need a level of the 12th century.
But does it really seem to be spreading out of that area through different trade droughts and to the 14th century?
And then we have a key point that's take it not from genetic studies, apart from archaeology, yet this goes back to the 1880, actually.
Actually, this is the gravestones, numerous gravestones from the story in Christian communities.
And that part where China meets with the Russians steps the high plateaus around the lake of all, which is just to the west of Pakistan.
So very close to China. And there we have this this Semin nation of these Christian communities through their gravestones.
So they go back further. So we know that the increase in mortality is about the same ratio that we find with the Black Death.
We have that data. So if you want to call that recorded, in some ways it is recorded.
It's on it's recorded in stone.
The problem is that there's been keen interest in both gravesites since the techniques of genome sequencing have been developed.
However, no one has been able to use that information to connect back,
go straight to plague or leave it know that it's really in the same ballpark as the same disease as what the Black Death was.
So the court is out there and unfortunately, in the 1880 80s, so soon afterwards, a lot of that evidence was removed.
Then it seems a be destroyed.
But there are other settlement Schoop to be investigated slightly before it gets to Messine, Sicily and October, or maybe slightly here or there.
By the time the chroniclers pay attention to it, but it goes on another route, a completely different crowd.
It seems that area to Constantinople and it hits Constantinople slightly early.
And it has its own Farrukh curious little twists and turns.
It gets the Masino before it gets to Florence or in Heller.
It goes to Florence by probably Jeno.
Was that general word down the piece of pizza then across and it's moved across land is is slightly slower than by sea.
You get a strike of it as early as this summer. The debit copes in 13 48.
But then for some reason in the Netherlands, we don't see it really blossoming until between forty nine.
You've really had.
A significant outbreak, this disease travels as fast as any disease back contemporaries had ever experienced, and especially over long distances.
And much more quickly than modern Yersinia pestis of the third and deadly.
Even with the benefit of railways, horrible fields stinks.
So that's how the outbreak started. I also wanted to know how the disease spread.
Yesenia pestis usually likes to be transmitted around small rodents.
So that is their chosen host, especially the black rats, which makes you know about the practise rats.
What happens is you've got two main cycles. You've got the ensuing tick cycle.
So the plague back to your sexily at no rates within populations of regions without causing excessive die off,
which is quite important because it means that the fleas that are associated with those
rodents can continue to live off those animals and serve as Long-Term Reservoirs.
So that's what usually happens in nature. You don't happen at these all tick cycle so other species can become infected by the plague,
which could cause an outbreak amongst animals that are used to having the plague.
And then you get a lot of die off of those animals and then they're fleas.
Want to jump off to whatever's in their response to get a blood meal.
And that's when humans can become accidental hosts. So essentially,
there are passive or active ways that humans can get caught up in these cycles because you have a symbiotic cycle which essentially in the wild life.
So you have wylder agents and their fleas kind of circulating the plague amongst themselves.
And then you've got an urban cycle. So he's got more domestic type rodents like mice,
which you might find around the house and say the wild rodents are kind of become close to the domestic rodents.
Their sleep can then jump from the wild cycle into the urban cycle.
And then those domestic rodents, like the mice, come and go into human habitats and then their fleas can jump to humans that way.
So that's essentially why you tend to find outbreaks of plague at the moment in really rural areas,
areas where humans have settled too close to wildlife, deforestation.
So that you can have the silvertail cycle of plague meat, the urban cycle of say, and then jump on to humans by accident.
One thing I've always wondered about the Black Death is whether that name would have been used at the time.
I use the word black death mainly to talk about thirty, forty eight or thirty or forty seven to fifty to have the plague afterwards.
Contemporaries did understand this disease, says the same disease, even though they could see changes in it for candidates.
I think they were right. They, they, they did. Just so people, especially botanists, could study diseases in the 20th century, they think,
oh, you know, in the Middle Ages they knew nothing and they called everything plague.
Well, that is the colloquial is. Yes. And they make big distinctions based on clinical and epidemiological level.
They didn't call it black death. They had different names for it.
Like the great mortality is one that I repeated over and over again later.
I think the word pestilence, true plague become more common.
Plague becomes a problem. And now they don't use the late Middle Ages, especially the early voting period.
They use the word plague often for other things, like the track that they're talking about here,
though, the plague of heresy or even earlier is the plague.
So popular rebels, the rabble. But when they're talking about disease, it's often very clear they're talking about the devil.
The big word that comes in in the early voting period is that there are called top kill the Bacon H.
And I studied the word contagion, which I think is interesting because before the black death, with that word, with use, it is by chroniclers.
It was barely used by people in the medical profession. But disease it was.
But it's hard to find it much harder to find amongst products when they talk about contagion.
It mainly had to do with heresy. But the spread of heresy or popular rebellion.
But the black death changes, despite all the sudden top kill becomes almost a daily word and not a word just for a beat.
And people do that. Do we know whether this disease was the same strain we discussed in Episode two
and the same one that will go on to discuss when it returns in the 17th century?
There are essentially three different main. Manifestations of plague.
So you've got your bubonic plague, which is the most well-known, and where the bank gets its name.
You cap the swollen purity of bleeding lymph nodes, which then become black, and people have nausea, vomiting, the joint pains.
And essentially, this was quite common in the 14th century.
And you had a case fatality rate of about 36 percent.
Then you've also got the pneumonic plague, which is essentially the fever, the shortness of breath, he says, which is coughing out the blood.
And then you have you can have person to person spread with this form of plague.
And this is the one that has the most epidemic potential.
So I think there are sometimes people that think that different types, because with the people at play,
they don't think they can't see how they would have had so much death with a version of plague that doesn't transmit as easily.
However, bubonic plague can actually become pneumonic plague because you can get it as
a secondary consequence of having people take to lunch and then back to you.
You can see the lungs and treat a second during monic, take that away and then spread from person to person.
Or you can have the primary pneumonic plague version, which essentially is when people directly breathe in aerosols which have plague
bacilli hanging in them and they can get them pneumonic plague directly.
And I also found out that you can get pneumonic plague from coughing animals.
And before I was reading about the plague, I didn't actually realise that animals could cough.
I was thought of it as a quite a human thing. But apparently cats and dogs can cough and you can catch the plague from them.
The final version is set to see McLay, which I can either be caused from the progression of chronic plague and pneumonic plague,
then seeding into a bloodstream infection and both forms compressed to this all day.
You can have a direct septicaemia form because Plake has got some kind of genetic
mutations that allow it to directly go through the guts and get into the bloodstream.
And it's very difficult then to link that to bubonic plague because you don't have the buboes which are
well known and characterised and drawn in images and pictures from the 14th century that sounded horrific.
And from my reading about this outbreak, I knew that the mortality rates were equally horrendous.
So I cheque back in with Sam on the numbers.
The ones I know are in Cambridgeshire, where you have up to 76 percent of the population of these villages being wiped out.
But three miles down the road, other villages which were only five percent.
And I think that no one repeats this but the Italian chronicler mocktail Ballade,
who took up writing this long chronicle of Flight 13 48 because his brother Jovani had died from the plague.
He had a beautiful metaphor about a hailstorm, destroyed one field and then skips over the next few or like the clouds on this,
somewhere's warning that fragments the light shines on some areas of another area.
I think this is an aspect of play which doesn't work, which has some regional aspects,
but mainly with the with the injury, with in the countryside having these very different mortality fortunes.
I wondered whether the stories of graveyards piling up with bodies in some places,
the ones that the historical records would corroborate or actually talks about the great day it goes and the great fraternity.
So I think the lowest the workers have come in from the countryside and overcharge charge extortionate breaks.
And you get that going on through Manzoni. You know, the pomace his policy of the same being the horror of these or not,
that causes these people who collect the bodies for the grave and the bills being piled into the wagons.
I think the best stories actually for that come in the 16th and 17th centuries.
That's when the literature really piles up.
And I think it's you find much more on these on these great figures on the terror really of rounding up these bodies.
Some of them are still alive and they fall off.
There probably are these burial alive. There's one notary who writes a Chronicle plague in Venice.
Seventy five or six books out of this window when there's one train of horse drawn carriages that take the dead bodies in one direction.
Another strain that passes under his window that takes them down to the plaza,
ready to be quarantined in the other direction, and people on the streets think that this is the only life in the city.
Sort of like Prophet 19 at the beginning of lockdown when the only place in the city was going to be going either to the pharmacy,
signify the or the grocery store. But I guess not as good wishes.
It was very ghoulish indeed.
So terrible. In fact, the contemporary writer Francesco Petrarch wrote that future generations wouldn't
understand how awful it would be to be alive in a city full of funerals and empty homes.
He has two basic reflections around 13 48 in his letters.
He talks about how gets to the end of time, whether it's a sense of the collapse of a civilisation, of a whole society of the world.
You know, the Chronicle is also like, again, on your little Torah says we pray.
It's my baby because of the world. When you think about it and you read about places like Philadelphia in 1918 when things were overwhelmed,
hospitals did go over the level, as we're seeing perhaps now.
And this was happening in Philadelphia in October, 18 bodies not being buried.
And then you look at the mortality rates and what Carletti rate of Philadelphia was around two percent mortality rate.
I think we get for a place like Florence, a place that is about seventy five percent.
It's hard to imagine, given the infrastructure these people have, the medical knowledge they had, how they cope at all.
Why? Because society didn't collapse at this point.
I thought it would be interesting to find out more about how symptoms were described by contemporary writers and whether, as I've heard said,
this was where the famous nursery rhyme reference to bring a ring a roses came from the ring around
the roses at the general clinical sign of a pack plague or a black death and subsequent plagues.
What you do find is that not only do you get the buboes and the principal left, but you also get these the spread of black postals,
which is extraordinarily rare with in play and even through the early morning period doctors this on.
This has been the most deadly form. Now, one thing that does change that way, we have to look back and think about changes.
The 15th and 16th, 17th century is pneumonic plague, pneumonic plague, because it's very rare.
And some of the doctors reflect back. They go back to they see they read it as surely act.
And these subscriptions and they say plague just doesn't operate that way.
We don't find this.
And there are some incidents of it, but it's extraordinarily rare and it can spread just as fast as it did in thirteen, forty eight.
It's just much better contained than it was at thirteen forty eight.
Like the real revival and I think a change in the strength of the disease in the 17th century in places like Genoa and Naples,
Milan to a certain extent,
then it's where you have 50 percent or more of the population, city populations and the countryside being levelled by just two seats.
Even then, there's no description of new panic play.
These are people who get some sort of skin disorders when they go in further with this to be to the whole medical the medical side.
This is very interesting. And what you have, what the Black Death really does create is a new medical genre that was promised by the 16th century,
the most populous form of any medical text.
And this is the plague. Tax and base become increasingly written in the vernacular and written for communities and not just for other doctors to read.
So they go from these so long citation, so classical and Arabic authorities stacking one to the other to what they call experimentation,
what they say are their discoveries and treatment of these of these seats and also, more importantly, preventative measures.
It's interesting, with the beginning of Crovitz 19, the instructions we were getting.
Well, you wash your hands, cover your face. Know, you could read that in the public.
Thirty, forty eight so much, but I think 13. Thirteen.
Seventeen.
They were really big on washing your hands and doing things that we're not doing well, wearing things like using vinegar and rosewater in your nose.
A lot more attention to the nose than with cold at night. I don't know.
Well, perhaps I'd better pay more attention to my nose over the next few months.
I also thought it would be important to understand how these messages were being conveyed and about the role of the medical profession.
Well, a lot of the impetus for this new health care is coming from secular governments,
not coming necessarily from the church, even though hospitals are increasing as the institution.
It depends where you are. But in Italy, this is a university positions.
Doctors are part of the clergy. That's extraordinarily rare.
So less so in England where you can be a for friar and a doctor.
No cases like that come to mind. I'm sure that must must've been something. And even you have a whole system that goes back before the flock.
In cities like Siena and Florence, where you have and it still exists today.
This is a good tourist to the doctors who are appointed by the city.
Municipal appointments to give give free medical assistance.
And so I know that maybe this is when I first started going to Italy.
Sometimes people got very sick. They would call out these these doctors.
Now, one thing that does happen with plague and with the doctors, I think is looking at the causes of Flaig canonically.
We know that the first call so Flaig, of course, is God, but we don't want to play God too much.
So it's our sense. But doctors really don't repeat this that much.
They don't bother with it. And by the 16th century, when they're questioned about it, they become pretty blunt.
They say, look, I'm a doctor and as a doctor, I'm interested in natural causes.
If you want to know about super natural causes, go to a theologian.
And I think that there is this growing sexualisation about what the causes of plague are.
And I think more and more, as you march into the 16th century, certainly by the time upfront pastoral,
it is about contagion and it's about conditions like the supply of water and the physicians themselves.
We have to give them credit in these early Graig traps that often they throwing up their hands.
So give the show the act in a certain extent. Reflecting back on 13 Forty-Eight when he's writing in the second 13 63.
He says, look,
we've never seen a disease like this in history before and he even does something that mediaevalist the mediaeval people don't usually do.
He goes back to biblical history. The history of plagues in Libby.
And he says there's been no plague in the past that can equal the plague we are experiencing now.
And we just don't know what to do. We don't have any remedy. We don't know any cure.
Then he goes on to suggest he says, look, we're in the dark here.
And you get a symbolists. Such since this happens with doctors every now and then, they do become unpopular.
This happens in 1918. The great influenza doctors, some of them say, yes, yes, it's a bacterium and this is a new vaccine.
We have four other doctors. So it's sort of saying we don't know this.
This this is something this type of flu, if it is flu, it's a different type of flu.
We just do not so sure. And it's one of those periods where nurses got more credit and got more praise from doctors.
I'd read about sham doctors during this period, like the doctor making much doled out to the student Chaucer describes.
But I didn't know how prevalent these practises would have been. Actually, the word is used as charlatans, but it's not that's so pejorative.
This our word charlatans. They were they were people who connected with the and that these, you know, these magic cures.
So it's all over the place. But the real negative statements about doctors are really in 13, 48.
And then I think there's a change in opinion. And I've looked at that one of it on your little Toora, which is the major chroniclers,
and says, well, one thing, he's talking to his audience of seeing these,
if you want to go see your great soldier all the more quickly and you want to lose your money, just get a doctor, they'll kill you faster.
By the 15th century, one week, we know that doctors salaries continue to decline.
And by one comparison, they become the wealthiest profession, at least at Florence, by by about Circo 14.
Sometime in the 15th century, they go beyond the lawyers, their status.
Does the what this much take still a risky profession?
Well, perhaps because of the risks, their salaries cut and and and the chronicles become less hostile towards one very long chronicle.
A very, really interesting clinical funking chronicle by Jovani Marvella here.
It's also an advice book for his own family, says, look, in Plake time,
it's best to get hold of a good doctor, but it's not going to necessarily save.
But the analogy he makes is to going into battle with or without a shield for good doctors.
She'll have to play. So there's a certain sort of respect for what they're doing, what they know.
Even though some of the actors still may strike us as a bit strange and maybe counterproductive.
Like my favourite one, which is your skin, the anus or the genitals of either a rooster or a hen,
and you put it on top of your boy and let the anus of the genitals suck up the poison.
We shouldn't generalise too much. After all, they're also telling us to clean out our nostrils and wash our hands.
Right? Well, I don't think I'll be trying that. However,
this wider discussion did make me reflect on whether there were any longer term consequences of this dramatic experience for the medical profession.
What also happens that one has to be careful with this is the evolution of hospitals.
But the big moment of really the founding of any of the big,
important hospitals was before the fact that hospitals take on much more specialist
roles and much more of a definition of hospital that we have today than they had before.
Often things called hospitals were just sort of places where priests and other clergy,
they spend the night for free along the roadside and now they become really hospitals and their take on specialisations,
different types of medical treatment. And this is, I think, goes back to follow.
It seems like this pandemic left a huge mark on a whole range of areas.
One thing that's rather striking is that the slower populations recover their populations.
It seems the better it was for the economy.
In the case in point eight, which goes up to the industrial revolution, first thing guess winning and recovery is pretty black population.
The century with Florence recover its pre black population sometime after 1850.
Well, after last, tourists come on the back as a money maker and industrial revolution.
That's quite a statistic.
Before we finished, I was keen to hear a medical perspective on why the Black Death has become so infamous and where we are today with the disease.
So I cheque back in with Bloche Eguchi from Oxford Vaccine.
The death rate is very, very high with plague. Before we had the antibiotics and yes, remember, most of these blades happened before the 19th century.
They weren't even close to having antibiotics or were we even close to having an
understanding of what the plague was before there was understanding of germ theory.
And so nobody knew where this disease was coming from.
They were fighting an invisible enemy.
They had the plague doctors, but they had absolutely no actual clue about what was going on and had close to zero percent success rates.
And if they were successful, it was it was luck that that person had a strong enough immune system.
It ravages an area very quickly, especially if you've got the pneumonic form.
There's about a 24 hour incubation period, which means people can get sick rapidly if it enters into an area every one person can spread to.
Seven people only takes 24 hours to get ill. So you literally before your eyes seeing half the population die.
That's frightening to anyone. The way it looked, frightened people.
It's called the Black Death because of the fact that you've got all of this necrosis and dead tissue.
You've got the swollen buboes, the lymph nodes under the armpits and the neck and in the groyne,
which essentially were becoming black because they were haemorrhagic.
So it looked frightening. And people even used to paint on this.
So nobody died without having these disfiguring Edgell actual sized things on them,
marking them almost with death at the time, especially the the 14th century.
They thought that it was related to a wrath from God. So there's people who were afraid then that they're getting punished for their sins.
And it allowed the uprising of movements like the judgements in Germany and such.
That pram wasn't helping.
And people did actually start turning away from religion following these pandemics and moving more toward science and philosophy,
because no matter how much pressure was made, it didn't save people.
It didn't matter how rich people were. They would die.
People were seeing their neighbours die before their their eyes were abandoning their relatives, abandoning their friends.
People weren't even doing last rites. Priests were too afraid to come and lay hands.
There weren't enough people alive to bury the dead.
So they literally had dead bodies piled up in the streets. The smells were horrific.
These things, the fact that it happened so fast. Most people died.
And you could see before your eyes. But nobody had any understanding of what was going on.
That was frightening. If it happens today, people have an understanding that there is a bacterium involved and we can visualise it.
And we do have some tools against it. However, even with antibiotics, antibiotics, I think can reduce death rates to about 15 percent.
But that's only if recognise, that's what it is.
I mean, most of the population don't even believe the plague exists outside of biblical times, including some doctors in some areas.
If you had the pandemic, it would be difficult to recognise that was what was going on.
But if you're not treated within 24 hours, you will die. And then everybody around you who's within two metres of you might die.
And that's frightening how fast it happens. The fact that most people don't survive it if they don't get antibiotics.
And you can literally see populations decrease before your eyes.
And they look scary, too. And that's not the only reason.
It's a scary disease. Plague is also being used in war as a biological weapon.
That's bullshit.
Outlined in the 14th century, soldiers used to throw corpses of people who died of played over the wall into enemy soldiers and kill people.
That way. If he's heard of Unit 731, that was the Japanese over China,
they were involved in research and development of experimental epidemic treating bio warfare weapons.
And they used these assaults against the Chinese populous front World War Two.
And they essentially flew low flying planes over China and now play infected fleas,
which they bred in their laboratories to be spread amongst Chinese cities.
And this was 1942 41. So you had a military aerial spraying which killed tens of thousands of people on plague.
And by the end of World War Two, we found documentation of something called Operation Cherry Blossoms at night.
And essentially, Japan had planned to use plague as a biological weapon against San Diego and California.
And they created these porcelain bombs which were filled with infected fleas and they were actually scheduling to launch it in September 22nd, 1945.
As we know, Japan surrendered a few weeks earlier.
But this frightened America to this to the point where they decided to push for a vaccine against plague.
And we're not only interested in a vaccine for self-defence against biological weapons because plague is still very much around today.
We finally discovered that it was your senior pestis that was causing the plague.
It wasn't until nineteen forty seven that streptomycin, which is an antibiotic they found out used,
was finally starting to be used in these kind of epidemics. And then they saw kind of the mortality from the epidemics go down from about 63 percent,
19, 40 to 50 to about 20 percent after 1950 to the start of the 21st century.
And what you had a lot of during this time was a lot of outbreaks that happened during periods of war.
So during the Vietnam War, you had a breakdown in public health services and creation of refugees.
And you had an outbreak of cases. We thought maybe there was a possible outbreak of cases during the Arab Spring in 2011.
Then we don't actually have much information about that.
And then we also have quite enough information that during World War two, they had a lot of plague cases in outbreaks.
And we've got Albert Camus, who located his novel The Past in Iran in 1945, because they had some money to play cases then.
Nowadays, it's more likely that you get a plague epidemic when there is a breakdown in sanitary practises or chaos in the middle of wars.
So you have a lot of these unstable countries that are being affected and a lot of poor countries as well.
And I think the worst affected at the moment is Madagascar.
And that accounts for about 95 percent of all the imported cases. They have about 500 cases a year.
They have an outbreak every year. They kind of have a plague season which runs between December and eight floors.
Their last massive epidemic was in 2017, which is actually outside the plague season.
It was caused by just one guy was a 31 year old man.
He travelled from the Central Highlands and then he travelled via the capital city in a crowded bus.
And he ended up that two hundred people or more action died.
He got bubonic plague out in the highlands and then developed pneumonic plague.
And he managed the seemed the biggest epidemic that we have had in the last few years.
And it was around this time because it also had the Ebola outbreak that kind of happened a few years before that.
Then governments and health organisations started thinking, right,
we need to try to figure out ways to kind of get ahead of these kinds of epidemic causing organisms that can lead onto pandemics.
Now, just briefly, I think it's something quite important to mention with that climate is that there are main ways that plague can be passed over.
So you've got the bite of the infected flu, which we talked about, and this is the type that you get the the on type from.
And then you you have direct contact with infectious produce fluids.
So this can be from Hongta still infected animals or or like you said, getting back to Scratchpad infected tatt.
So this is why you can usually have an epidemic of demonic plague,
because you can have hunters in the village that go out and skim an infected animal and then they managed to get the plague that way.
But then you've got the inhalation of respiratory droplets. And this is where you can get the person to person spread.
And now the epidemics of plague that we're having these days are more of this form.
And this is a really dangerous form because it only takes about 24 hours minimum to get sick from this.
And to be able to pass it on to somebody else, you can die within 72 hours from it before you even realise that you have it.
You've passed onto somebody else. And every person that has been on it, they can spread it to several other people.
Then you can have an explosion of plague. But the ones we get in other countries, like in Mongolia, say, which we actually get every year,
is the oral transmission, which people don't usually know or talk about.
And we have sporadic cases in the media involving individuals in Mongolia, China.
And this is usually from the consumption of poorly cooked meat or slaughtered sick animals.
And this illustrates how deadly trade can be.
Because China was born on July this year, there was a 15 year old boy in western Mongolia who died from phonic plague after eating infected moment.
They had to have a lockdown, essentially of the local area, according to the health minister and also a few months before that.
I think you may. There was a couple from Mongolia who died from eating an infected mom.
So these days we have these foredeck forms. You do get this all transmission from eating this infected meat.
And also, I think in Saudi Arabia and they describe pharyngitis in the 20th century in Jordan as well.
And this is what actually surprised me think that the plague bacterium that we have now is evolved from a senior seed,
a typical osis, because it that's an Terek bacterium and it's retained quite a lot of the same genes.
So it has the ability to infect through the enteric area, all of which led a group at Oxford some years ago to start working on a vaccine for plague.
And they've now reached an exciting stage. We have been working on the plague vaccine, which we have actually manufactured now.
We are planning on starting the trial in a month or two.
Once we've gotten approvals in place.
Professor Christine Wolly and Dr Christine Donald at the University of Oxford Vaccine Group who have actually created invented this vaccine.
And it's Andrew Pollard, who is the chief investigator for the Oxford Cosied vaccine, who is actually the chief investigator for this this trial.
I wrote the protocol for the trial along with colleagues,
and we'll be putting that forth to kind of have a phase one vaccine trial will be inviting and a few young,
healthy people to essentially test the safety and immunogenicity of this plague vaccine.
There isn't actually a licenced vaccine at the moment, although there have been attempts in the past.
So they had a formalin killed wholesale vaccine, which was safe and used for military personnel during the Vietnam War.
But there were loads of adverse reactions and most of this is required.
You also had the live attenuated and virulent some investors vaccine, but there were loads of safety concerns and severe side effects.
It's rarely used. It wasn't even used during the Madagascar outbreak. That's how bad they thought the side effects from it were.
You've got live attenuated, genetically attenuated strains, which had good safety and retained protective efficacy,
but still had some side effects in animal models and safety concerns.
And I think lossy have protein based sabeen vaccines. These are in clinical trials, I think in the US and China possibly.
But there's a problem of multiple doses required.
We're not sure that they'll actually protect against pneumonic plague, which is what we're hoping our vaccine will be able to protect against some.
As I said, the pneumonic form is the one that the epidemic potential when people breathe,
then plague bacilli from the spittle of people who've coughed, essentially.
And you have the plague bacilli hanging inside that spittle and it can hang around for about an hour.
And then somebody comes them and breathes it in and it's the most deadly form of plague.
So that's what we're hoping our vaccine is going to be used against, and we're hoping it will rapidly induce immune responses.
We're going to try to see if we can just get it in one kind of injection,
iron injection, so that during an epidemic it can be used and deployed quickly.
So, yes, we're going to be awesome to volunteers, Sue.
And it will be starting in Oxford next time on Future Makers.
We journey forward in time to the last of our four plague and arrive in 17.
Century Europe, where the great pestilence has once again returned.
I hope you can join me then for the next episode of our history of pandemic season.
I'm Peter Milliken, and you've been listening to Future Makers.
Feature makers was created in-house at the University of Oxford and presented by Professor Peter Milliken from Harvard College.
A voice actor today was Tom Wilkinson, and the score for the series was designed and created by Richard Watts.
The series is written and produced by Steve Richard and me, Ben Howard. Thank you.
On behalf of the whole team for listening to the history of pandemics, we'd love as many people as possible to hear it.
So if you could spread the word to your friends and family, we'd really appreciate it.