Return of the Black Death: The world鈥檚 greatest serial killer by Susan Scott and Christopher Duncan, Wiley, 拢16.99/$27.95, ISBN 0470090006
MOST of us know the story of the Black Death: it appeared in Europe in 1347 and killed millions of Europeans over 300 years before disappearing. And everyone agrees that the bacterium Yersinia pestis is responsible for both the bubonic plague that is transmitted by fleas and the pneumonic plague that passes from human to human, as happens in 5 per cent of bubonic cases when the lungs become infected by the plague bacillus. But Susan Scott and Christopher Duncan argue that the Black Death was not pneumonic or bubonic plague and was not caused by Y. pestis but was a completely unrelated disease.
Although Return of the Black Death is a compelling read with excerpts from contemporary accounts, the case put before the readers is of necessity far from watertight. For example, inferring transmission of the plague from parish records of death dates is prone to errors because it is possible that unrecorded contacts linked households and villages. There is also controversy surrounding the isolation of Y. pestis from the dental pulp of Black Death victims; this is a red herring in the view of Scott and Duncan.
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They suggest the increased frequency in Europeans of a mutation associated with resistance to HIV is evidence of strong selective pressure from a historic virus, which they believe to be the aetiological agent of the Black Death. (Interestingly, this mutation was recently demonstrated not to affect Y. pestis infections in mice.) The authors go as far as speculating that this Black Death virus was zoonotic, that an animal reservoir could remain a source of future epidemics and that available antimicrobials would be ineffective.
Diseases that pass frequently from person to person before symptoms appear are hard to control by isolation and quarantine, and a lengthy time between infection and symptoms would allow infected individuals to travel widely before disease was detected.
Given their conclusions about the nature of Black Death infections, the authors inevitably predict that a modern outbreak would likely lead to a catastrophic global epidemic. As one of many potential victims of this deadly pandemic, I certainly hope they turn out to be wrong.