A 58 year old New Mexico man, who is a resident of Santa Fe County, was diagnosed and treated for bubonic plague (also known as the Black Death). The patient presented to the hospital with high grade fever, swollen lymph nodes, and stomach pains. He was treated and released home, but his place of residence will be searched for evidence of infectious material. He is the first case of the disease to be reported in the United States this year. The U.S. Centers for Disease Control and Prevention states that about 1,000 to 3,000 cases are reported throughout the world each year. In the United States, only about 10-15 cases of bubonic plague are contract by people in any given year. About one in every seven cases results in a fatality, but it can be treated with antibiotics. The disease is caused by infection with the bacterium Yersinia pestis, which is transmitted by flea’s bites. The fleas, which go by the scientific name Xenopsylla cheopis, are commonly known as rat fleas and serve as an intermediary between humans and rats. After the flea bites a human, the bacteria infect the open wound and then spread by lymphatic drainage to the lymph nodes. As a result, the lymph nodes become enlarged and tender, and take on the appearance of buboes or swollen glands. The term bubonic plague is derived from the Greek word bubo, which means swollen gland. The bubonic plague has caused many large scale epidemics throughout the world before the advent of antibiotics. The term Black Death refers to the most infamous epidemic of bubonic plague which spread throughout Europe in the 14th century. It is estimated that the Black Death killed one out of every three Europeans living at the time. The Black Death is thought to have originated in China and spread by fleas on rats through the silk trade routes via Constantinople and Alexandria before eventually reaching Europe. A popular folk belief is that the children’s rhyme “Ring around the Rosy” originates from the Black Death. Proponents claim that “ring around the rosy” refers to the red rash that is produced by the bacteria after it infects a flea bite. “Pocket full of posies” refers to the practice of carrying flowers which were thought to ward off the disease. “Ashes, ashes” refers to the burning of the infected corpses that was a technique used to stop the spread of the disease. “We all fall down” refers to the catastrophic deaths that resulted as a result of the Black Death. There are some historians which dispute the association of the Black Death with the children’s rhyme. Bubonic plague has also been used by man in the form of biological warfare. The Imperial Japanese Air Service bombed Ningbo with fleas carrying bubonic plague during the second Sino-Japanese War. In addition, it was feared that Saddam Hussein of Iraq was stockpiling vessels of Yersinia pestis in preparation for biological warfare with the United States. This first case of bubonic plague is not likely to be the last reported this year, but through the use of antibiotics, we can hope to treat and limit the spread of the disease.