find 4 quotes and explain them

Document #1

Reading Directions: The objective of this reading is to provide students with a general overview of the Black Death and its clinical symptoms. With a basic understanding of the Black Death, students will be well-prepared to engage in the lecture material, the primary source materials related to Black Death, and the film Black Death (2010).

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And in many places in Siena great pits were dug and piled deep with the multitude of dead. And they died by the hundreds, both day and night, and all were thrown in those ditches and covered with earth. And as so.on as those ditches were filled, more were dug. And I, Agnola di Tura, called the Fat, buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who. wept for any death, for all awaited death. And so many died that all believed it was the end of the world. Agnola di Tura, Cronaca Senese, 1348

{� ver since humans began to s�ttle down sev.eral m�llennia ago and �ve in close quarters \tL..,, with their fellow human bemgs, along with their newly domesticated ammals, they have been plagued by epidemic and pandemic diseases. Smallpox, cholera, influenza, tuberculosis, typhus and typhoid fever, and most recently AIDS ( acquired immunodeficiency syndrome) are but a few of the many maladies that caused the deaths of untold millions before (in some cases) we had begun to find a cure. Some of these diseases have changed history. During the thir teenth century BCE, a succession of plagues convinced the pharaoh of Egypt to let his Hebrew slaves, led by Moses, return to the their "promised land" in Palestine, an event recorded in the Book of Exodus in the Old Testament. Between 430 and 426 BCE, a disease, perhaps smallpox, devastated the crowded city of Athens, killing its leading statesman, Pericles, and bringing to the fore political newcomers like Alcibiades, who altered the course of the Peloponnesian War. In the early sixteenth century CE, the Spanish adventurers Hernan Cortes and Francisco Pizarro conquered the Aztec and Inca empires of Central and South America largely with the help of the smallpox virus, to which the Native Americans had no prior exposure and therefore no immunity. In 1918� 19, an influenza pandemic, caused by a new strain of the vir us that was 200 percent more lethal than previous, non-virulent strains, killed an estimated 50-100 million people worldwide, more than had died from the Great War. The latest pandemic to stride the world stage, AIDS has to date claimed more than 25 million lives since it first emerged in the early 1980:, and currently no fewer than 33 million are living with the disease, two-thirds of whom are in sub-Saharan Africa, which by far has been hardest hit by the pandemic.

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- -� The First Horseman, Plague. (Reproduced with kind . . Institute of Art, London.) permissrnn of Conway Library, The Courtauld

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'. eve� co�pared with all these remarkable events, the Black Death of 1347-was umque m history. The Black Death, which most equate Wl.th i£· d" kn 1 a spec 1c 1sease his;

wn �s.f{. a�e, _wath s probably the most deadly disease outbreak ever recorded in humanory, 0 mg m its ree bubonic pneum · d . . 80 f . . . ' omc, an septicemic forms an average of 70 to percent o its victims whenever it strikes. Although more mod d . · fl h . ern pan em1cs such as: ue(

nz� �Y avenl killed more in total numbers than the plague outbreak in the late Middle ges w c was o Y one of three pandemics of 1 kn it is probabl true to sa th . p ague own to have occurred in history)'

d th � Y at n�ve1 before and never since has so much disproportionate th ea com

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e m such a short penod as during the Black Death. Imagine that tomorr e next ay ev th , ow or . ' ery o er person y ou see around y ou could be dead and somethin f th th y ou may grasp g_ o e terror at this disease coul d inspire. The Black Death, a term that di not come mto currency until well after the Middle A d"d ·1 . d · hr ges, l not str1 ,e JUst once but :�e: t o:ghout th_e second half of the fourteenth and throughout the fifteenth cent:�: . a con "emporanes called plague (from plaga' or "blow" from God) til simply the great mortality" nonetheless returned with a lower overall death pe

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occurrences whi h b bl ra e m 1 s ater E di c was pro a Y owing to the reduced extent of its spread throughout urope, ra er than any lower virulence, as plague confers no Ion -term imm . However, even without its recrudescence, the Black Death was terrif . g h . . un1:Y·first outbreak during the mid-fourt th h . · y mg enoug m JUst its een century, w en it carried off about 50 ercen �verage, of Europe 's population in a few y ears. Such a mortality was bound to fave la t,_on

impacts at all levels of European society. Little wonder that chroniclers of the I stmh g p ague, sue

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as Gabriele de Mussis, Louis Sanctus, and John Clynn, saw it as a sign that the Apocalypse, the end of the world, was at hand.

Was the Black Death plague?

AX abriele de Mussis's apocry phal story of Mongols' catapulting dead bodies into � the Genoese-held town of Caffa (now Feodosiy a) on the north coast of the Black Sea, retailed at the end of the previous chapter, seems to indicate that the disease first entered into Europe at the Crimea, perhaps from an endemic center of origin further east along the Mongol trade routes in Central Asia, or else from a more proximate source in southern Russia. Apocalyptic tales of a rain of frogs or fire that were reported by European chroniclers to have taken place in the East may actually have a scientific basis in fact, as native Chinese annals do report natural disasters, such as floods, famines, droughts, and earthquakes, as taldng place there during the 1330s. This may help explain why plague broke out when it did, for the sudden advent of the Little Ice Age .during the earlier part of the fourteenth century, which we have already seen brought in its wake a much wetter and unpredictable climate to the world, may have forced rodents carry ing the plague out of their remote habitats and into closer contact with humans. It is also likely that the bad weather created famine conditions-as it indeed did in northern Europe between 1315 and 1322-that compelled Asians to hunt and eat native marmots in greater numbers and more indiscriminately.

Nonetheless, it is rather doubtful that plague-infected fleas were actually lobbed into the town of Caffa along with the cadavers, as fleas will invariably abandon a host once it has gone cold to jump onto a nearby living one ; more likely, plague came to Caffa in the form of rats surreptitiously entering the town or else by means of fleas hitching a ride on animal furs, which was the most important export product of this region. From the Crimea, plague next commenced its march through the Middle East and Europe, invading Constantinople, the capital of the Byzantine Greek Empire, by the late spring or summer of 1347, and then reached Sicily and Alexandria in Egypt around the same time, in the autumn of that y ear. By the end of 134 7, plague also established bridgeheads at other strategic places in the Mediterranean, including the island of Mallorca off the eastern coast of Spain, the port of Marseilles in southern France, and the trading cities of Genoa, Pisa, and Venice in Italy. In 1348, the Black Death spread through Italy, the Balkans, and much of France and Spain,. and invaded Austria, Switzerland, southern England, and perhaps Ireland, Norway, and Denmark. By 1349 and 1350, plague completed its conquest of Spain, France, Austria, Switzerland, England, Ireland, Denmark, and Norway, and in addition it had come to Iraq, Germany, Belgium, the Netherlands, Sweden, Wales, Scotland, Poland, Bohemia, Hungary, Romania, and the Baltic states of Estonia, Latvia, and Lithuania. It was not until 1351 to 1353 that plague seems to have spread throughout eastern Germany, Poland, and Russia north of the Caucasus. More complete evidence than available hitherto indicates that the only large areas bypassed by the plague in the mid-fourteenth century were Iceland and Finland, perhaps owing to their isolation and sparse inhabitation.

On the basis of modern diagnoses, plague is a disease that occurs in three forms, depending on how the bacterium, Yersinia pestis (which causes the disease in all cases) invades and spreads within the body. In bubonic plague, the most common and widely-lmown form, the b�cteria

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,.----- ar� intro�uced int� the bloodstream by means of a flea bite, owing to the fact that the flea is said to be 'b�ocked by plague. What this means is that Y. pestis, once ingested with a blood meal rnto the flea s gut, proliferates very rapidly and at the same time produces an enzy me that clots the blood meal, so that together the mass of bacteria and clotted blood bloclc th e narrower uppe� portion of the flea 's stomach, known as the proventriculus, which prevents the insec: from rnge.sting a�y more blood, making it perpetually and ravenously hungry. Consequently, �e flea �111 bite its host even more in an attempt to feed, so that inevitably an infected flea willm turn infect the one it bites; this happens when it regurgitates a blood and bacterial mixtur it cairnot hold in its stomach back into its host, thus almost direcfly "injecting" its victim wi�perhaps thousands of plague bacteria. Though a blocked flea typically starves to death r th · hl a tt qruc !' an infe�ted, non-blocked flea and even a blocked one can live on for many months and_ still .transrmt the disease. Although the flea that typically spreads the plague (Nosopsyllus fasciatus � Euro�e and Xenops(1la cheopsi� in Asia) normally lives and feeds on house-dwelling rats ( which are highly susceptible to the disease), it will seek out other victims in the proxi ·ty 'Id d m1 , me u ing �mestic animals such as dogs and cats and, of course, humans, after all its preferred hosts �av� died from plague. With their flattened bodies, rat fleas are also specially adapted to traveling rn fur and thus can easily hitch a ride on human clothing or merchandise going from town _to town. Even more important, rat fleas have adapted to living solely on grain detritus (needing blood only for propagation) and thus could have traveled independently of animal hosts as a guest of the grain trade that was nearly ubiquitous throughout medieval Europe. In the case of pneumonic plague, the bacteria enter the lungs after being breathed in which typically occurs as the result of exposure to the infected expectorate, or airborn�droplets, that have been coughed or sneezed out by an infected person. Therefore, direct, �uman-to-human contagion is the norm in pneumonic plague, where no aJ.Iimal intermediaryIS necessary, even thou�h a pneumonic plague outbrealc seems to start out as a secondary s�pto� of �e bubomc fo�m and tends to be localized, owing to the narrow window of time m which this form of the disease can be spread by an infective cough . (This does not preclude, however, the possibility of local epidemics of pneumonic plague occurringconcurre�tly at consi�erabl� di�tances from one another, as patients are well enough to travel durmg the non-infective mcubation period.) Modern tests have demonstrated that coug�g pneumonic pla�e patients can be infective from more than three feet away and that their sputum, wh�n 1t 1s bloody, contains large numbers of bacteria. Yet the experience of modern \�.eumomc plague epidemics seems to indicate that, in general, "prolonged close contact 1s necessary for infection.Finally, septicemic plague, the third and rarest form of the disease, seems to be dissem�a�ed i� much the same way as bubonic plague, that is, through the bite of a flea. Transm1ss10n via the human flea, Pulex irritans, seems to be rare (owing to the reducedchance of blockage in this flea 's stomach and the more diffuse presence of plague bacteria inhuman blood compared to that of animals), but because the rat flea ty pically communicates as many as 25, 000 bacteria with each regurgitation of its blood meal, perhaps repeated bitesfrom, a ravenous blocked flea introduce bacteria in such numbers that they overwhelm the body s defense mechanisms. It is also possible that a human victim could have been bittennumerous times �Y dozens of different fleas: it has been estimated that 50 to 1 00 fleas may be present on an rnfected rat about to die of plague, at which point all those fleas will then seek a new host, and experiments conducted during the Third Pandemic of plague in India 82

around the turn of the twentieth century found that a man could expect to find an average f 75 human and rat fleas on his legs each tpne he entered a plague-infested home. How : individual body reacts to Y. pestis in term� of being able to isolate the bacteria within its l hatic sy stem may also determine whether one develops a case of bubonic or septicemic ;;

e. One should also not discoun: th� possibility of s�pticemia res.ulting from entirely·fi · 1 means such as tainted medical rnstruments, which, as we will see further, was a artI 1cia , distinct possibility during the Middle Ages.After an incubation period that typically lasts any where from two to seven day s, plague next begins to manifest itself in the patient through certain symptoms, not all of which, however, are unique to plague. In all three forms of the disease, the illness commences suddenly with flu-like symptoms such as high fever, violent headaches, . a�d body s�iffn.ess, chills, or pains. These may also be accompanied by nausea and vomiting, constipation, sensitivity to light, bloodshot ey es and a coated tongue, restlessness and an inability _to sleep, delirium or stupor and loss of motor control and, in general, a vague but unm1stalcable feeling of anxiety, dread, and fear. In the case of bubonic plague, the characteristic symptom is, of course, the bubo, a l hatic swelling caused by bacterial accumulation at the nodular point closest to where =�ea has bitten the victim. If infected on the legs, the bubo will appear in the groin area, which occurs in the majority of cases. Next most common is that the bubo appears in one of the armpits, the result of being bitten on the chest or back or on the arms . Finally, if bitten on the head or face, the bubo will appear on the neck, which seems to be the rarest locat10n of the swelling, even though it has been argued on the basis of contemporary descripti�ns that it was more prevalent during the medieval Black Death. (It should be noted that cervical bubos can also occur in cases of "tonsillar plague," which results from inhaling infected droplets that do not travel all the way down into the lungs.) However, it is n�t �nknown for buboes to form on other places aside from the lymph nodes, such on the ms1de of the elbow or on the back of the knee, and they are sometimes accompanied by painful vesicles or pustules that can appear almost any where on the body. The bubo is considered by most medical experts to be the defining symptom for a conclusive diagnosis of bubonic plague, even when the case is so mild that it can barely be distinguished from other diseases. It is also the symptom that has allowed historians to make a positive identification of the first plague pandemic in history, owing to the description by Procopius of Caesarea a�d John of Ephesus of the swelling that occurred in the ''boubon," the Greek word for grom, that accompanied the disease 's appearance in Constantinople in 542 CE. In both mod�rn and medieval cases, it has been noted that the bubo's getting larger in size (approaching the dimensions of a walnut) is actually a good sign for a prognosis of recovery, even as it remains tender or painful to the touch. After about a week of living with these symptoms, recovery is marked by spontaneous suppuration, or bursting open, of the bubo, r�leasing its pus. Without the timely intervention of modern-day antibiotics, death occurs m 60 to 90 percent of bubonic plague cases, usually three to six day s after the onset of symptoms.

In the case of pneumonic plague, the characteristic symptom is the coughing up of a bloody sputum, accompanied by rapid and painful breathing, although this can also occur as a secondary symptom of bubonic plague. What seems to ultimately confirm the prese�ce oftrue pneumonic plague is the fact that it is 1 00 percent fatal, and death ensues qmte qmckly,

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usually within two day s. Unless they die suddenly from heart failure, pneumonic plague patients can be cursed with a horrible death, gasping for hours from "air hunger."

By contrast, septicemic plague has almost no distinguishing sy mptoms beyond those characterizing the general onset of the disease, as it usually kills the patient too quickly� sometimes in 24 hours or less�to allow more marked outward signs such as the bubo to manifest themselves. However, for those who do live a little longer, before they invariably die, some very dramatic symptoms can emerge, such as spontaneous bleeding from the nose and eyes, blood present in the urine and stool, and subcutaneous bleeding as the bacteria plug capillaries just underneath the skin, resulting in dark, purplish spots all over the body, called in medical parlance "petechiae" or "disseminated intravascular coagulation" (DIC). A man I inter viewed (John Tull), who contracted plague in Santa Fe, New Mexico, in 2002, was fortunate (and unique) enough to survive septicemic plague, y et he still bears the purpuric spots on his skin to this day. These same sy mptoms of petechiae or DIC were also noted by medieval observers of the plague. They also occur in roughly half the cases of those suffering from bubonic plague ; indeed, some experts consider septicemic plague to be merely a "fulminant," or exceptionally virulent, form of bubonic plague, wherein the bacteria happen to overwhelm the bloodstream and bodily organs instead of being drained into and isolated in the lymphatic system.

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