Doctoral Dissertation Improvement Grant: Paleoepidemiological Studies of the Black Death

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The Black Death of 1347-51 was probably the most devastating epidemic in human history. It killed over 30 percent of Europe's population, and initiated profound social, economic, and demographic changes. Based on a broad similarity of symptoms, most researchers have accepted unquestioningly that the Black Death was an outbreak of bubonic plague; furthermore, many have assumed that the epidemiology of the Black Death was similar if not identical to that of modern plague. Recently, several researchers have questioned whether the Black Death was bubonic plague in light of the strikingly different epidemiological characteristics of the medieval and modern diseases. For example, mortality from the Black Death, as estimated from historical documents, was as high as 50 percent in affected populations, whereas modern plague mortality is rarely more than 2-3 percent even in the absence of treatment. Given the ongoing debates about the Black Death, there remains a need for further studies of the epidemiology of the disease. This project will investigate the epidemiology of the epidemic using a sample of almost 800 skeletons from the Black Death cemetery of East Smithfield, London, and two pre-Black Death cemeteries from medieval Denmark. The skeletons will be scored for a variety of skeletal lesions, sex, and recently-developed age indicators; these data will be analyzed using a multistate model of illness and death. This project will address several important questions about the Black Death. How high was the excess mortality associated with the Black Death? How was the excess mortality distributed by age and sex? Were infants, juveniles, and the elderly at a higher risk than other age groups, or were all ages at equal risk of death? Was the Black Death selective with respect to pre-existing health conditions? That is, were people in poor health at a higher risk of dying from the Black Death, or did the disease kill people indiscriminately, as is often assumed? By providing improved estimates of the pattern of mortality using a new statistical model of illness and death, this project will also contribute to recent debates over whether the Black Death was actually caused by bubonic plague. This research is part of a larger collaborative project, involving researchers from the US, the UK, and Denmark, that is re-examining the available evidence on the Black Death. One goal of this larger project is to introduce a new perspective into historical epidemiology by viewing the fourteenth-century Black Death as a newly emergent disease. Emergent infections are those, like AIDS or the Ebola virus, that have just appeared for the first time or are increasing in incidence and distribution. The present interest in emergent infections is new, but humans have probably faced such diseases for thousands of years. A better understanding of the epidemiology of the Black Death is of great importance for clarifying the role of emergent infections in human history.