Although I am admittedly not anywhere near an expert on any topic, I still have a hard time understanding how Black Death and Bubonic plague are one in the same. Since plague still exists, with news stories about it every once in a while, and especially in places like India, why doesn't it spread with anywhere near the rate it did during the Middle Ages?

Obviously global society in general is much more sanitary than it was then, people also tend not to live in close quarters with animals today as they did then, however in places like rural India and China this lifestyle still takes place and plague still exists, so why aren't there large out breaks of plague in these areas if it indeed is Black Death?

Is it possible that Black Death has been miscategorised due to various historical circumstances and scholarly errors?

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    $\begingroup$ To answer your first question, just search "plague" in Google News: "Just last month the Chinese government sealed off a city of more than 100,000 people, fearing the spread of a plague outbreak.", and even "Struggling Liberia creates 'plague villages' in Ebola epicentre". The way poor people deal with plague changed from the times they thought the miasma is to blame, to the point that it is a model for fighting other epidemics. Also, the antibiotics are only 70 years old: old enough to be patent free and easily manufactured. China and India are in fact top manufacturers for such drugs. $\endgroup$
    – nvja
    Aug 22, 2014 at 16:14
  • $\begingroup$ @simontemplar I think you have answered your own question. sanitary practices, quarantine techniques and improved diagnosis and fast communication of such events prevents their rapid spread. $\endgroup$ Aug 22, 2014 at 16:28

2 Answers 2


The identification of the Black Death with plague is now fairly well-established - see this paper (open access) in which PCR and protein detection were used to detect the presence of Yersina pestis in human skeletons from plague-related mass graves across Europe.

Outbreaks of plague do occur in rural environments, see this WHO page for some details. The WHO plays a role in responding to these outbreaks, as long as they are notified by the relevant countries. Plague infections respond well to antibiotic treatment.

There has also been a recent outbreak in Madagascar. According to the epidemiologists we are still in the midst of the 3rd plague pandemic, which started in China in the mid 19th century.

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    $\begingroup$ Thank you for all of that. It's still unclear to me, though, how it managed to spread so incredibly fast during the time of Black Death, but subsequent outbreaks didn't spread as far and wide even in the Middle Age Europe, or rather that seems to be what I've inferred. I realise the population was much smaller, but even after it bounced back a lot, it still didn't seem to be as dangerous. Did people learn something or change something about their lives? $\endgroup$ Aug 22, 2014 at 16:12

An addition to Alan's answer:

Some sort of selection for more resistant genotypes inevitably did take place and left distinct footprints in the human populations1.

Specifically, the paper linked above presents evidence that Toll-like receptors, which are immune system proteins that recognize molecular patterns of pathogens, likely adapted to better recognize the plague bacterium Yersinia pestis:

Reconstruction of evolutionary history of European populations has identified Toll-like receptor 1 (TLR1)/TLR6/TLR10 as a pattern recognition pathway shaped by convergent evolution by infections, among which plague is a likely cause...


  1. Laayouni, H., Oosting, M., Luisi, P., Ioana, M., Alonso, S., Ricaño-Ponce, I., ... & Netea, M. G. (2014). Convergent evolution in European and Rroma populations reveals pressure exerted by plague on Toll-like receptors. Proceedings of the National Academy of Sciences, 111(7), 2668-2673.

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