Book Review--Plague by Wendy Orent (Updated)

Book: Plague: The mysterious past and terrifying future of the world's most dangerous disease by Wendy Orent (2004, 276 pages) (Amazon link here).

Overview: Wendy Orent attempts three things with this book. First, it is a history of the plague, beginning with the earliest recorded cases of plague, through Justinian's plague, the Black Death, the Great Plague of London, and the outbreaks of the early 20th Century. Second, it is an argument that plague comes in different strains, that depend on the source of the plague. Like The Great Mortality, which I have previously reviewed, Plague contends that the black death was the result of the marmot strain of plague, that is more likely to form pneumonic plague, which spreads rapidly among human populations, than bubonic plague which relies on fleas to spread from one host to another.   Third, she explores Japanese, Soviet and, later, Russian research into making anti-biotic resistant plague or otherwise weaponize it, and examines the possibility there may be future outbreaks.

Impression: This is actually the second time I've read this book. It is an interesting read, and full of little details that is easy to miss on the first or second pass. I think she makes a convincing case to explain why the black plague was so contagious and deadly. I would note at the time this book was written, there were conflicting theories that suggested the black death was not actually plague (y. pestis), but some other disease--possibly a hemorrhagic fever. However, this was put to rest in 2010 by studies of the remains of plague victims in Europe which conclusively showed that y. pestis was the causative agent.

Notable Points: There are numerous points that are notable about this book, such that it is hard to focus on the few that would be the most interesting or notable. So, I will start at the basic premise of the book: that plague resides in natural plague foci, or plague reservoirs, dominated by the rodents that are the primary carriers of the disease: gophers, marmots, ground squirrels, rats, and gerbils. The general belief in the west is that there are no differences in plagues from different animals--there are no different strains. They base this on experience with the plague found in the U.S. which was introduced from rats to prairie dogs and ground squirrels, and which generally causes bubonic plague.

The Russians, on the other hand, firmly believe that there are different strains and that the type of strain determines how contagious it is and how it spreads. Russian scientists believe that no plague strains compare in virulence or explosive power to the strains from the reservoirs of Kazakhstan--from marmots and gerbils. Moreover, Russian observations indicate that marmots are the only animals (other than humans) that suffer from pneumonic plague. They believe that the marmot strain has a tropism for lung tissue--the germs tend to settle in the lungs. The most virulent strains are found in Central Asia because that is where the oldest foci are located, and, therefore, where the evolutionary pressures and competition have had the longest to evolve through cycles of increased virulence and increased natural resistance.

The black plague was made possible by the Mongols that took control of the Central Asian steppes, up to Europe, and deep into the Muslim world. It was in the territory controlled by Genghis Khan's second son, Chagatai, (corresponding to southern Kazakhstan, Tajikistan, Kyrgyzstan, and part of ester Trukestan) that the black plague started. It is in a Nestorian Christian cemetary near Lake Issyk-Kul that the earliest traces of the black plague was found. It would eventually spread through China, the Middle-East and Europe, and possibly into India. The symptoms included: (1) a chilly stiffness, tingling sensation, or pricking sensation; (2) formation of boils (bubo), sometimes in the armpit, and other times in the groin; (3) burning fever with severe headaches that would cause some people to fall into a stupor; and (4) some people would develop an intolerable stench and others would vomit blood.

The Soviets and Russians spent considerable time and effort into weaponizing plague. They learned how to grow it in large quantities. They also attempted to make strains that were antibiotic resistant, or even chimera--the plague germ would contain yet another germ that would cause a secondary (and deadly) infection.

While not discussed in the book, people can and did develop a certain level of immunity to the plague. Unfortunately, the author did not discuss (and perhaps there is little research on this issue) whether that immunity is partly responsible for the limited scope of outbreaks today.

(Update--11/3/2012) One of the points in the book that I wanted to note, and almost forgot, was the impact of hygiene on eliminating bubonic plague, first from Europe, and then from other areas. From the time of the Black Death in the 14th Century, there were frequent outbreaks of plague from time to time across Europe (including the Great Plague of London in the 1600s). But, after a particular virulent outbreak in Marseilles in 1720, it disappeared from Europe. The reasonable explanation is changes in hygiene and, in particular, the manufacture and sale of inexpensive cakes of soap. The author writes:

It is this capacity of plague to be a human disease that Blanc and Baltazard force us to recognize. It was not a change in rat species, nor the spread of another form of Yersinia into populations of native rodents, nor even the imposition of sanitary quarantines that forced the plague out of Europe and much of Asia. It was the change in human hygiene that drove plague out of humanity altogether, back to being a true animal disease again. It was the irresistible spread of inexpensive cakes of soap.

(p. 171; italics in original).