Sarah Gorbatov 

Ms. Edelman 

Humanities 10 

December 12, 2019 

How and Why Has Our Response to Disease Changed?: The Black Death, 1884 Hong 

Kong Plague, and the Modern-Day Return of Medieval Diseases 

Despite being microscopic and invisible to the naked eye, pathogens that cause disease 

have greatly affected the way humans live for centuries. Many infectious diseases have been 

significant enough to affect how and where we live, our economies, our cultures, and our daily 

lives, and the effects have continued long after these calamitous diseases were eliminated. 

Today, we understand the medical and scientific aspects of epidemics in ways that people 

formerly could not, and therefore it is evident that our collective response to disease has 

drastically changed over time, synchronously with changing times. Be that as it may, in spite of 

our awareness and comprehension of medicine expanding, cross-cultural contact through 

dense trade networks escalated, and this meant a contagion effect of the damage that could be 

caused by disease. It was not a coincidence that a plague in the 14th century did more damage 

than one in the 19th, but it was also not a coincidence that it did more damage than one in the 

6th, for instance. Even now, medicine is still evolving and significant challenges remain.  

 
 The outbreak of the European ​bubonic​ plague, or Black Death, in the mid-14th century, 

is the ideal illustration of an early reaction to disease, a first encounter. In a passage from his 

book titled T
​ he Decameron​, Florencian writer Giovani Boccaccio described the Black Death, 

which reached Florence in 1348, as such: “It first betrayed itself by the emergence of certain 

tumors. The deadly bubo then began to propagate itself in all directions indifferently; after 

which the form of the malady began to change, black spots or livid making their appearance 

now few and large, then minute and numerous.” The plague killed at least 20 million people, 

half of the total population of Europe and the Middle East. Physicians in the 14th century had a 

number of different rationales as to what had originally caused the plague to prosper. Lisan 

al-Din Ibn al-Khatib, a Muslim doctor living in Spain, was the first to claim that plague is 

contagious: “When it happens in a city, it starts in one house and then affects the visitors of the 

house, then the neighbors, the relatives, and other visitors until it spreads throughout the city.” 

Philip VI, the king of France at the time of the plague, asked the doctors at the Paris Medical 

School for an explanation, and the following was that explanation: “It is known that in India the 

constellations exerted their power against the sea and the waters of the ocean arose in the form 

of vapor. Thereby the waters were so corrupted that the fish which they contained died. This 

vapor spread itself through the air in many places on Earth.”  

Some people even believed that “evil” people had caused the plague. Many minorities, 

specifically Jews, were persecuted unjustly because people blamed them for somehow inciting 

the plague. Cities eventually began to take measures in order to contain the disease and prevent 

it from spreading, such as in the form of quarantine and the suspension of trade. However, the 
medical knowledge of the 14th century was exceedingly limited. Irrespective of the endeavors of 

medical practitioners and public and religious institutions to establish r​ egulations, medieval 

Europe never had an adequate healthcare system. As populations increased, hygienic 

conditions worsened, culminating in a vast array of health predicaments. Antibiotics would not 

be invented until the 1800s and without them, it was nearly impossible to cure disease. No 

matter if you were of the aristocracy or the peasantry, even the best medical care could not 

rebut the majority of sicknesses and ailments, such as the plague.​ The specialization and 

comprehension of science during the time were insufficiently developed for any effective 

treatments of the plague. 

In contrast, the 19th century was a groundbreaking period of time for medical 

inventions and the advancement of modern medicine in general. Bacteria had just been 

discovered and scientists were beginning to understand the connection between these helpful, 

yet concurrently harmful microorganisms and disease. Just now, after 300 years of 

experimenting and studying, we have finally discerned how bacteria “see” their own world and 

inferred that they do so in a remarkably similar manner to human beings.  

In 1884, there was a disease outbreak in Hong Kong which killed 2,000 people. 

Immediately, after word had spread of a plague, scientists gained interest in finding both a 

cause and a cure. In June of that year, two researchers across the globe, one in Japan, 

Shibasaburo Kitasato, and the other in Switzerland, Alexandre Yersin, simultaneously 

identified the bacteria that had caused the plague. Using microscopes, they examined blood 
from infected rats and people, Yersin ultimately coming to a more accurate, however still 

erroneous conclusion. He had falsely assessed the interrelation of rats and the plague. In his 

journal he wrote, “I have placed healthy mice and inoculated mice in the same cage. The 

inoculated ones died first, but within a few days, all of the others died from the invasive plague 

bacillus. Plague is, therefore, a contagious and transmissible disease. It is probable that rats are 

the major vector.” Yersin was inquisitive and intelligent, but he was wrong about rats 

transmitting the infection. In 1898, a French physician and biologist, Paul-Louis Simond, 

demonstrated the connection between fleas and plague with the subsequent experiment:  

“I prepared a device consisting of a large glass bottle. I was fortunate enough to catch a 

plague-infected rat in the home of a plague victim. In the rat’s fur, there were several fleas running 

around. After 24 hours the animal I was experimenting on rolled up into a little ball, with its hair 

standing on end. I then introduced into the bottle a small metal cage containing a perfectly healthy 

young Alexandria rat caught several weeks before and kept sequestered from any danger of 

infection. The cage was suspended inside of the bottle… The rat inside the cage could not have any 

contact with the sick rat. The next morning the sick rat had died. I left its body in the bottle for one 

more day. Then I carefully removed it. During the next four days, the other Alexandria rat 

remained imprisoned in its cage and continued to eat normally. About the fifth day, it seemed to 

have difficulty moving. By the evening of the sixth day, it was dead. An autopsy of this previously 

uninfected rat revealed there was abundant plague bacilli in the organs and blood. That day, 2 June 

1898, I felt an emotion that was inexpressible in the face of the thought that I had uncovered a secret 

that had tortured man since the appearance of plague in the world.”  
  

The plague that devastated Hong Kong in the late-19th century was predominantly 

concentrated in a remote settlement before eventually expanding across the rest of Hong Kong, 

China, Asia, Africa, Europe, and in time, overseas elsewhere, becoming one of the most 

ubiquitous pandemics in history. This Hong Kong settlement existed in the mountains, where 

trade routes did not extend to. For the few that were infected by the plague, measures were 

taken: plague hospitals were instituted, the medical staff was deployed to treat and isolate 

plague patients, house-to-house search operations were conducted, infected houses and areas 

were cleaned and disinfected, designated cemeteries were organized, and the dead were 

tentatively transported and buried. As for the rats, people were paid for “turning them in” and a 

rat patrol was formed.  

Methodically, everything was deliberated and executed much more efficiently in the 19th 

century than during the Black Plague, and that’s certainly one justification as to why 2,000 

people died as a result of plague in comparison to 20 million. The astonishingly low mortality 

rate also pertained to pioneering scientific and medical progress from the 14th to 19th century. 

Further, because of the seclusion of the Chinese settlement that was minorly affected and hence 

the lack of trade circulating throughout, the plague was less likely to be spread, or at the least 

rapidly and viciously spread as in the Black Plague.  

Now, in the 21st century, diseases once linked to the wretchedness of medieval times 

and living have reemerged with a vengeance. In many major cities in the U.S., especially cities 
along the West Coast, there has been a prompt incline in the number of encampments and 

people dwelling in poverty, and this increase in the homeless population has caused the 

accelerated ascent of disease. The conditions in which these people reside are the ideal habitat 

for vermin-like rats, and fleas on these rats are imperative to the spread of a disease such as 

typhus. Recently In Los Angeles, a typhus outbreak occasioned in the closing of City Hall amid 

concerns of rats in the building. With increased rat density, diseases such as typhus are likely to 

take shape.  

As homelessness has been on the rise, typhus cases in Los Angeles have risen from 13 in 

2008 to 167 between January of 2018 and February of 2019. Food being discarded on the street, 

people illegally urinating on sidewalks, human waste, and the accumulation of pillows and 

blankets are creating almost Third World conditions. The more that streets are flooded with 

garbage, the more rats thrive. However, as homeless populations rise, containing garbage and 

pollution also becomes progressively more difficult. This April, the Los Angeles Daily News 

stated that city officials had lost a court case in their efforts to decongest homeless 

encampments. Regardless of this drawback, measures must still be taken and improvement 

must be made. Human feces contaminate the areas where people eat and sleep—the hygiene 

situation is horrendous, and not only does it affect homeless populations, but also anyone in the 

vicinity of the encampments. Even those who want to believe they are protected from the 

repercussions of the situation might not be.  

 
 Over the course of time, from the 14th to the 19th to the 21st century, our reaction and 

response to disease have drastically changed. In the 14th century, scientists couldn’t even 

distinguish the cause of the plague, let alone the cure. In the 19th, we had greatly broadened our 

knowledge of disease and epidemics such as the plague, and therefore we were much better 

equipped to prevent them from forming and prepared to confront them if they were to ever 

occur. In the 21st century, epidemics are much less susceptible to materialize due to 

technological and medical advancement. Nowadays, people with diseases are consummately 

treated and we all sustain much longer lives than we did just 100 years ago. We have antibiotics 

that treat severe infections and vaccines which obstruct them from even revealing themselves.  

Nevertheless, although today we understand the medical aspects of the plague in ways 

that people in both the 14th and 19th centuries could not, we must still consider how people who 

lived during those times perceived the plague and how it impacted them. Doing so will assist us 

in our struggle to restrain diseases and epidemics, such as those currently sweeping through 

the West Coast, inhibit them from reappearing, and envisage cures for those suffering. From a 

wider perspective of world history, the salient point made by the Black Death and the 1884 Hong 

Kong Plague is that medical evolution requires scientific evidence and factual support, not 

merely superstitious belief. In science, you can’t trust something you can’t prove. Fortunately, if 

such requirements are upheld, we can prevent diseases from their inception. Living in an 

affluent country like the United States, the threat we face from deadly viruses, bacteria, and 

parasites can seem distant, but these infectious microbes are ever-present among us. After all, 
pathogens have shaped our lives all throughout history and they will remain one of the forces 

that we adapt to and evolve alongside.