Science & Technology

Black Death: Plague history, causes, and treatments

Written by Black Hot Fire Network on October 5, 2025

Types of plague

The Black Death was a bubonic plague, the disease’s most common form. The name refers to telltale buboes—painfully swollen lymph nodes—that appear around the groin, armpit, or neck. Skin sores become black, hence its foreboding nickname during the 14th-century pandemic. Initial symptoms of this early stage include vomiting, nausea, and fever.

(Black Death discovery offers rare new look at plague catastrophe)

Pneumonic plague, the most infectious type, is an advanced stage of plague that moves into the lungs. During this stage, the disease is passed directly, person to person, through airborne particles coughed from an infected person’s lungs.

If untreated, bubonic and pneumonic plague can progress to septicemic plague, infecting the bloodstream. If left untreated, pneumonic and septicemic plague kills almost 100 percent of those it infects.

Transmission and symptoms

For hundreds of years, what caused outbreaks remained mysterious, and shrouded in superstitions. But keen observations and advances in microscopes eventually helped unveil the true culprit. In 1894, Alexandre Yersin discovered the cause of the disease, the bacterium Yersinia pestis.

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Centers for Disease Control and Prevention: Plague
Johns Hopkins: Center for Health Security
National Institute of Allergy and Infectious Diseases: Priority Pathogens
Plague as a Biological Weapon
Plague: from natural disease to bioterrorism
U.S. Fish & Wildlife Service: Black-footed ferret
World Health Organization: Plague
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Plague outbreaks like the Black Death are the most notorious epidemics in history, even inciting fears of the disease’s use as a biological weapon.”]},{“type”:”p”,”content”:[“Today, cases still pop up sporadically around the world, including in the United States. 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By the late 1340s, it had reached Europe via Sicilian ports and ultimately killed an estimated 25 million people.”]}],{“type”:”inline”,”content”:{“name”:”Ad”,”props”:{“ad”:{“type”:”fitt-article-inline-box”,”className”:”fitt-article-inline-box”},”className”:”natgeo-ad”,”placeholders”:{“compact”:{“size”:[300,250]},”regular”:{“size”:[300,250]}},”initSelf”:true},”context”:{},”config”:{“gridDisplayMode”:”none”}}},[{“type”:”p”,”content”:[“The Black Death lingered for centuries, particularly in cities. 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It was brought to North America in the early 1900s by ships and spread to small mammals throughout the U.S.”]},{“type”:”p”,”content”:[“The high rate of fatality during these pandemics meant that the dead were often buried in quickly dug mass graves. 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The name refers to telltale buboes—painfully swollen lymph nodes—that appear around the groin, armpit, or neck. Skin sores become black, hence its foreboding nickname during the 14th-century pandemic. Initial symptoms of this early stage include vomiting, nausea, and fever.”]},{“type”:”p”,”content”:[“(“,{“type”:”a”,”content”:[{“type”:”i”,”content”:[“Black Death discovery offers rare new look at plague catastrophe”]}],”attrs”:{“href”:”https://www.nationalgeographic.com/history/article/black-death-discovery-rare-look-plague”,”target”:”_blank”,”dir”:”ltr”}},”)”]},{“type”:”p”,”content”:[{“type”:”a”,”content”:[“Pneumonic plague”],”attrs”:{“href”:”https://www.cdc.gov/plague/signs-symptoms/index.html”,”target”:”_blank”,”dir”:”ltr”}},”, the most infectious type, is an advanced stage of plague that moves into the lungs. 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Once these cells are knocked out, the bacteria can multiply unhindered.”]},{“type”:”p”,”content”:[“(“,{“type”:”a”,”content”:[{“type”:”i”,”content”:[“Why plague doctors wore those strange beaked masks”]}],”attrs”:{“href”:”https://www.nationalgeographic.com/history/article/plague-doctors-beaked-masks-coronavirus”,”target”:”_blank”,”dir”:”ltr”}},”)”]},{“type”:”p”,”content”:[“Many small mammals act as hosts to the bacteria, including rats, mice, chipmunks, “,{“type”:”a”,”content”:[“prairie dogs”],”attrs”:{“href”:”https://www.nationalgeographic.com/animals/article/why-plague-still-afflicts-us-wildlife”,”target”:”_blank”,”dir”:”ltr”}},”, rabbits, and squirrels. During an “,{“type”:”a”,”content”:[“enzootic cycle”],”attrs”:{“href”:”https://www.cdc.gov/plague/resources/PlagueEcologyUS.pdf”,”target”:”_blank”,”dir”:”ltr”}},”, “,{“type”:”i”,”content”:[“Y. pestis”]},” can circulate at low rates within populations of rodents, mostly undetected because it doesn’t produce an outbreak.”]},{“type”:”p”,”content”:[“When the bacteria pass to other species, during an epizootic cycle, humans face a greater risk for becoming infected with plague bacteria.”]},{“type”:”p”,”content”:[“(“,{“type”:”a”,”content”:[{“type”:”i”,”content”:[“Bubonic plague traced to ancient Egypt”]}],”attrs”:{“href”:”https://www.nationalgeographic.com/science/article/bubonic-plague-traced-to-ancient-egypt”,”target”:”_blank”,”dir”:”ltr”}},”)”]}],{“type”:”inline”,”content”:{“name”:”Ad”,”props”:{“ad”:{“type”:”fitt-article-inline-box”,”className”:”fitt-article-inline-box”},”className”:”natgeo-ad”,”placeholders”:{“compact”:{“size”:[300,250]},”regular”:{“size”:[300,250]}},”initSelf”:true},”context”:{},”config”:{“gridDisplayMode”:”none”}}},[{“type”:”p”,”content”:[“Rats have long been thought to be the main vector of plague outbreaks because of their intimate connection with humans in urban areas. Scientists have more recently discovered that a flea that lives on rats, “,{“type”:”i”,”content”:[“Xenopsylla cheopis”]},”,”,{“type”:”i”,”content”:[” “]},{“type”:”a”,”content”:[“primarily causes human cases of plague”],”attrs”:{“href”:”https://www.nationalgeographic.com/science/article/rats-plague-black-death-humans-lice-health-science”,”target”:”_blank”,”dir”:”ltr”}},”.”]},{“type”:”p”,”content”:[“When rodents die from the infection, fleas jump to a new host. The inevitable “,{“type”:”a”,”content”:[“flea bite”],”attrs”:{“href”:”https://www.sciencedirect.com/science/article/abs/pii/S0966842X0800053X”,”target”:”_blank”,”dir”:”ltr”}},” transmits “,{“type”:”i”,”content”:[“Y. pestis”]},”. Transmission also occurs by handling tissue or blood from a plague-infected animal, or inhalation of infected droplets.”]},{“type”:”h2″,”content”:[“Plague cases today”]},{“type”:”p”,”content”:[“Plague is still a public health issue today, popping up in various parts of the world. The “,{“type”:”a”,”content”:[“World Health Organization”],”attrs”:{“href”:”https://www.who.int/csr/disease/plague/en/”,”target”:”_blank”,”dir”:”ltr”}},” closely follows cases, most of which have appeared in Africa since the 1990s.”]},{“type”:”p”,”content”:[“(“,{“type”:”a”,”content”:[{“type”:”i”,”content”:[“When bubonic plague first struck America, officials tried to cover it up”]}],”attrs”:{“href”:”https://www.nationalgeographic.com/history/article/bubonic-plague-first-struck-america-officials-tried-cover-up”,”target”:”_blank”,”dir”:”ltr”}},”)”]},{“type”:”p”,”content”:[“Between 2004 to 2014, the Democratic Republic of the Congo reported the majority of plague cases worldwide, with 4,630 human cases and 349 deaths. Scientists link the disease’s prevalence in the “,{“type”:”a”,”content”:[“Democratic Republic of Congo”],”attrs”:{“href”:”https://wwwnc.cdc.gov/eid/article/24/2/16-0122_article”,”target”:”_blank”,”dir”:”ltr”}},” to the ecosystem—primarily mountain tropical climate.”]}],{“type”:”inline”,”content”:{“name”:”Ad”,”props”:{“ad”:{“type”:”fitt-article-inline-box”,”className”:”fitt-article-inline-box”},”className”:”natgeo-ad”,”placeholders”:{“compact”:{“size”:[300,250]},”regular”:{“size”:[300,250]}},”initSelf”:true},”context”:{},”config”:{“gridDisplayMode”:”none”}}},[{“type”:”p”,”content”:[“The U.S., China, India, Vietnam, and Mongolia are among the other countries that have had confirmed human plague cases in recent years. Within the U.S., on average “,{“type”:”a”,”content”:[“seven human cases”],”attrs”:{“href”:”https://www.pbs.org/newshour/health/the-u-s-sees-7-plague-cases-a-year-heres-why”,”target”:”_blank”,”dir”:”ltr”}},” appear each year, emerging primarily in California and the Southwest.”]},{“type”:”h2″,”content”:[“Treatments and prevention”]},{“type”:”p”,”content”:[“Plague is classified as a “,{“type”:”a”,”content”:[“Category A pathogen”],”attrs”:{“href”:”https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens”,”target”:”_blank”,”dir”:”ltr”}},” because it readily passes between people and could result in high mortality rates, if untreated.”]},{“type”:”p”,”content”:[“This classification has helped stoke fears that “,{“type”:”i”,”content”:[“Y. pestis”]},” could be used as a “,{“type”:”a”,”content”:[“biological weapon”],”attrs”:{“href”:”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200711/”,”target”:”_blank”,”dir”:”ltr”}},” if distributed in aerosol form. As a small airborne particle it would cause pneumonic plague, the most lethal and contagious form of the infectious disease.”]},{“type”:”p”,”content”:[“(“,{“type”:”a”,”content”:[{“type”:”i”,”content”:[“A quiet plague outbreak has been killing Yellowstone’s cougars for years”]}],”attrs”:{“href”:”https://www.nationalgeographic.com/animals/article/plague-cougars-yellowstone-bubonic”,”target”:”_blank”,”dir”:”ltr”}},”)”]},{“type”:”p”,”content”:[“Of “,{“type”:”a”,”content”:[“conservation concern”],”attrs”:{“href”:”https://www.fws.gov/project/black-footed-ferret-recovery”,”target”:”_blank”,”dir”:”ltr”}},”, federally endangered “,{“type”:”a”,”content”:[“black-footed ferrets”],”attrs”:{“href”:”https://www.nationalgeographic.com/animals/mammals/facts/black-footed-ferret”,”target”:”_blank”,”dir”:”ltr”}},” contract “,{“type”:”a”,”content”:[“sylvatic plague”],”attrs”:{“href”:”https://www.usgs.gov/programs/fish-and-wildlife-disease/sylvatic-plague”,”target”:”_blank”,”dir”:”ltr”}},” from nearby prairie dogs. It can decimate prairie dog populations, which are a critical food source for black-footed ferrets. Scientists have started to administer a “,{“type”:”a”,”content”:[“vaccine to prevent outbreaks”],”attrs”:{“href”:”https://www.denverpost.com/2017/09/05/endangered-black-footed-ferret-prairie-dog-deadly-plague-vaccine/”,”target”:”_blank”,”dir”:”ltr”}},” in prairie dogs and black-footed ferrets.”]}],{“type”:”inline”,”content”:{“name”:”Ad”,”props”:{“ad”:{“kvps”:{“pos”:”fitt-article-inline-outstream-4″},”type”:”fitt-article-inline-outstream”,”className”:”fitt-article-inline-outstream”},”className”:”natgeo-ad”,”placeholders”:{“compact”:{“size”:[320,50]},”regular”:{“size”:[728,90]}},”initSelf”:true},”context”:{},”config”:{“gridDisplayMode”:”none”}}},[{“type”:”p”,”content”:[“Most people today survive with rapid diagnosis and “,{“type”:”a”,”content”:[“antibiotic treatment”],”attrs”:{“href”:”https://www.cdc.gov/plague/resources/recommended-antibiotics-for-plague-web-site-rev-jan2018-p.pdf”,”target”:”_blank”,”dir”:”ltr”}},”. Good sanitation practices and pest control minimize contact with infected fleas and rodents to help “,{“type”:”a”,”content”:[“prevent plague”],”attrs”:{“href”:”https://www.cdc.gov/plague/prevention/index.html”,”target”:”_blank”,”dir”:”ltr”}},” pandemics, like the Black Death, from happening again.”]},{“type”:”inline”,”content”:{“name”:”EditorsNote”,”props”:{“body”:”SOURCES
Centers for Disease Control and Prevention: Plague
Johns Hopkins: Center for Health Security
National Institute of Allergy and Infectious Diseases: Priority Pathogens
Plague as a Biological Weapon
Plague: from natural disease to bioterrorism
U.S. Fish & Wildlife Service: Black-footed ferret
World Health Organization: Plague
Britannica: Black Death”,”header”:null},”context”:{},”config”:{“align”:”full”}}},{“type”:”inline”,”content”:{“name”:”EditorsNote”,”props”:{“body”:”This story originally published on August 20, 2019. 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Centers for Disease Control and Prevention: Plague
Johns Hopkins: Center for Health Security
National Institute of Allergy and Infectious Diseases: Priority Pathogens
Plague as a Biological Weapon
Plague: from natural disease to bioterrorism
U.S. Fish & Wildlife Service: Black-footed ferret
World Health Organization: Plague
Britannica: Black Death”,”header”:null,”inlineId”:”inline-2″}},{“type”:”editorsNote”,”data”:{“articleConfig”:{“align”:”full”},”body”:”This story originally published on August 20, 2019. 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Centers for Disease Control and Prevention: Plague
Johns Hopkins: Center for Health Security
National Institute of Allergy and Infectious Diseases: Priority Pathogens
Plague as a Biological Weapon
Plague: from natural disease to bioterrorism
U.S. Fish & Wildlife Service: Black-footed ferret
World Health Organization: Plague
Britannica: Black Death”,”header”:null,”inlineId”:”inline-2″}},{“type”:”editorsNote”,”data”:{“articleConfig”:{“align”:”full”},”body”:”This story originally published on August 20, 2019. It has been updated.”,”header”:null,”inlineId”:”inline-3″}}],”Blockquote”:{“disableQuotationMark”:true,”simple”:true},”datelineSeparator”:”—”,”stripBr”:false,”className”:”PrismArticleBody SingleColumn”,”hideReadTime”:true},”dataConstructorMap”:{}},”contentPackage”:”freemium”,”dt”:”2025-10-03T07:00:00.000Z”,”story_id”:”drn:src:natgeo:unison::prod:5e29947d-6dc7-4d3c-bf26-9b4c049b98d5″}},”request”:{“headers”:{},”httpVersion”:”1.1″,”method”:”GET”,”url”:”/science/article/the-plague?userab=ng_pw_copy-287%2Avariant_a-1126″,”vary”:{“cached”:true,”device”:”pc”,”host”:”www.nationalgeographic.com”,”path”:”/science/article/the-plague”,”forwarded-proto”:”https”,”country”:”us”,”edition”:”natgeo-en-us”,”edition-view”:”natgeo-en-us”,”loggedin”:”false”,”userab”:”ng_pw_copy-287*variant_a-1126″}},”viewport”:{“width”:1260,”height”:0},”user”:{}};

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