Doctoral Dissertation Improvement Grant: Paleoepidemiological Studies of the Black Death

1347- 1351年的黑死病可能是人类历史上最具破坏性的流行病。 它杀死了超过30%的欧洲人口，并引发了深刻的社会，经济和人口变化。 基于症状的广泛相似性，大多数研究人员毫无疑问地接受了黑死病是淋巴腺鼠疫的爆发;此外，许多人认为黑死病的流行病学与现代鼠疫相似，如果不是完全相同的话。 最近，鉴于中世纪和现代疾病的流行病学特征截然不同，一些研究人员质疑黑死病是否是鼠疫。例如，据历史文献估计，黑死病的死亡率在受影响的人群中高达50%，而现代鼠疫的死亡率即使在没有治疗的情况下也很少超过2%-3%。 鉴于目前关于黑死病的争论，仍有必要进一步研究该疾病的流行病学。 该项目将使用来自伦敦东史密斯菲尔德黑死病墓地和中世纪丹麦两个前黑死病墓地的近800具骨骼样本调查该流行病的流行病学。 将对骨骼的各种骨骼病变、性别和最近开发的年龄指标进行评分;将使用疾病和死亡的多状态模型分析这些数据。 这个项目将解决关于黑死病的几个重要问题。 与黑死病相关的超额死亡率有多高？ 超额死亡率如何按年龄和性别分布？ 婴儿、青少年和老年人的死亡风险高于其他年龄组，还是所有年龄段的死亡风险相同？ 黑死病对先前存在的健康状况有选择性吗？ 也就是说，是健康状况不佳的人死于黑死病的风险更高，还是像人们通常认为的那样，黑死病会不分青红皂白地杀死人？ 通过使用新的疾病和死亡统计模型提供更好的死亡率模式估计，该项目还将有助于最近关于黑死病是否实际上是由淋巴腺鼠疫引起的辩论。这项研究是一个更大的合作项目的一部分，涉及来自美国，英国和丹麦的研究人员，该项目正在重新审查黑死病的现有证据。 这个更大的项目的一个目标是通过将14世纪的黑死病视为一种新出现的疾病，为历史流行病学引入一个新的视角。 紧急感染是指艾滋病或埃博拉病毒等首次出现或发病率和分布正在增加的感染。 目前对突发性感染的兴趣是新的，但人类可能已经面对这些疾病数千年了。 更好地了解黑死病的流行病学对于阐明突发性感染在人类历史上的作用非常重要。

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 For example, mortality from the Black Death, as estimated from historical documents, was as high as 50 percent in affected populations, whereas modern plague mortality is rarely more than 2-3 percent even in the absence of treatment.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.