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Introduction…………………………………………………………………….…3

The disease………………………………………………………………………..4

Mortality………………………………………………………………………….8

Physicians………………………………………………………………………..11

Effects of The Black Death………………………………………………………14



Introduction


Plague has a remarkable place in history. For centuries, plague represented disaster for those living in Asia, Africa and Europe, where, it has been said, populations were so affected that sometimes there were not enough people left alive to bury the dead. Because the cause of plague was unknown, plague outbreaks contributed to massive panic in cities and countries where it appeared. The disease was believed to be delivered upon the people by the displeasure of the gods, by other supernatural powers or, by heavenly disturbance. Innocent groups of people were blamed for spreading plague and were persecuted by the panicked masses. Numerous references in art, literature and monuments attest to the horrors and devastation of past plague epidemics. So imprinted in our minds is the fear of plague that, even now, entering into the 21st century, a suspected plague outbreak can incite mass panic and bring much of the world's economy to a temporary standstill. The number of human plague infections is low when compared to diseases caused by other agents, yet plague invokes an intense, irrational fear, disproportionate to its transmission potential in the post-antibiotic/vaccination era.



The disease


The most memorable example of what has been advanced is afforded by a

great pestilence of the fourteenth century, which desolated Asia, Europe, and Africa, and of which the people yet preserve the remembrance in gloomy traditions. It was an oriental plague, marked by inflammatory boils and tumours of the glands, such as break out in no other febrile disease. On account of these inflammatory boils, and from the black spots, indicatory of a putrid decomposition, which appeared upon the skin, it was called in Germany and in the northern kingdoms of Europe the Black Death, and in Italy, _la mortalega grande_, the Great Mortality.

Few testimonies are presented to us respecting its symptoms and its course, yet these are sufficient to throw light upon the form of the malady, and they are worthy of credence, from their coincidence with the signs of the same disease in modern times.

The imperial writer, Kantakusenos, whose own son, Andronikus, died of this plague in Constantinople, notices great imposthumes of the thighs and arms of those affected, which, when opened, afforded relief by the discharge of an offensive matter. Buboes, which are the infallible signs of the oriental plague, are thus plainly indicated, for he makes separate mention of smaller boils on the arms and in the face, as also in other parts of the body, and clearly distinguishes these from the blisters, which are no less produced by plague in all its forms. In many cases, black spots broke out all over the body, either single, or united and confluent.

These symptoms were not all found in every case. In many, one alone was sufficient to cause death, while some patients recovered, contrary to expectation, though afflicted with all. Symptoms of cephalic affection were frequent; many patients became stupefied and fell into a deep sleep, losing also their speech from palsy of the tongue; others remained sleepless and without rest. The fauces and tongue were black, and as if suffused with blood; no beverage could assuage their burning thirst, so that their sufferings continued without alleviation until terminated by death, which many in their despair accelerated with their own hands.

Contagion was evident, for attendants caught the disease of their relations and friends, and many houses in the capital were bereft even of their last inhabitant. Thus far the ordinary circumstances only of the oriental plague occurred. Still deeper sufferings, however, were connected with this pestilence, such as have not been felt at other times; the organs of respiration were seized with a putrid inflammation; a violent pain in the chest attacked the patient; blood was expectorated, and the breath diffused a pestiferous odour.

In England the malady appeared with spitting of blood, and with the same fatality, so that the sick who were afflicted either with this symptom or with vomiting of blood, died in some cases immediately, in others within twelve hours, or at the latest two days. The inflammatory boils and buboes in the groins and axillae were recognised at once as prognosticating a fatal issue, and those were past all hope of recovery in whom they arose in numbers all over the body. It was not till towards the close of the plague that they ventured to open, by incision, these hard and dry boils, when matter flowed from them in small quantity, and thus, by compelling nature to a critical suppuration, many patients were saved. Every spot which the sick had touched, their breath, their clothes, spread the contagion; and, as in all other places, the attendants and friends who were either blind to their danger, or heroically despised it, fell a sacrifice to their sympathy. Even the eyes of the patient were considered a sources of contagion, which had the power of acting at a distance, whether on account of their unwonted lustre, or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment. Flight from infected cities seldom availed the fearful, for the germ of the disease adhered to them, and they fell sick, remote from assistance, in the solitude of their country houses.

Thus did the plague spread over England with unexampled rapidity, afterit had first broken out in the county of Dorset, whence it advanced through the counties of Devon and Somerset, to Bristol, and thence reached Gloucester, Oxford and London. Probably few places escaped, perhaps not any; for the annuals of contemporaries report that throughout the land only a tenth part of the inhabitants remained alive.

From England the contagion was carried by a ship to Bergen, the capital of Norway, where the plague then broke out in its most frightful form, with vomiting of blood; and throughout the whole country, spared not more than a third of the inhabitants. The sailors found no refuge in their ships; and vessels were often seen driving about on the ocean and drifting on shore, whose crews had perished to the last man.

Thus much, from authentic sources, on the nature of the Black Death. The descriptions which have been communicated contain, with a few unimportant exceptions, all the symptoms of the oriental plague which have been observed in more modern times. No doubt can obtain on this point. The facts are placed clearly before our eyes. We must, however, bear in mind that this violent disease does not always appear in the same form, and that while the essence of the poison which it produces, and which is separated so abundantly from the body of the patient, remains unchanged, it is proteiform in its varieties, from the almost imperceptible vesicle, unaccompanied by fever, which exists for some time before it extends its poison inwardly, and then excites fever and buboes, to the fatal form in which carbuncular inflammations fall upon the most important viscera.

Such was the form which the plague assumed in the fourteenth century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine, a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs. Now, as every carbuncle, whether it be cutaneous or internal, generates in abundance the matter of contagion which has given rise to it, so, therefore, must the breath of the affected have been poisonous in this plague, and on this account its power of contagion wonderfully increased; wherefore the opinion appears incontrovertible, that owing to the accumulated numbers of the diseased, not only individual chambers and houses, but whole cities were infected, which, moreover, in the Middle Ages, were, with few exceptions, narrowly built, kept in a filthy state, and surrounded with stagnant ditches. Flight was, in consequence, of no avail to the timid; for even though they had sedulously avoided all communication with the diseased and the suspected, yet their clothes were saturated with the pestiferous atmosphere, and every inspiration imparted to them the seeds of the destructive malady, which, in the greater number of cases, germinated with but too much fertility. Add to which, the usual propagation of the plague through clothes, beds, and a thousand other things to which the pestilential poison adheres--a propagation which, from want of caution, must have been infinitely multiplied; and since articles of this kind, removed from the access of air, not only retain the matter of contagion for an indefinite period, but also increase its activity and engender it like a living being, frightful ill- consequences followed for many years after the first fury of the pestilence was past.


Mortality


We have no certain measure by which to estimate the ravages of the Black Plague, if numerical statements were wanted, as in modern times. Let us go back for a moment to the fourteenth century. The people were yet but little civilised. The Church had indeed subdued them; but they all suffered from the ill consequences of their original rudeness. The dominion of the law was not yet confirmed. Sovereigns had everywhere to combat powerful enemies to internal tranquillity and security. The cities were fortresses for their own defence. Marauders encamped on the roads. The husbandman was a feudal slave, without possessions of his own. Rudeness was general, humanity as yet unknown to the people. Witches and heretics were burned alive. Gentle rulers were contemned as weak; wild passions, severity and cruelty, everywhere predominated. Human life was little regarded. Governments concerned not themselves about the numbers of their subjects, for whose welfare it was incumbent on them to provide. Thus, the first requisite for estimating the loss of human life, namely, a knowledge of the amount of the population, is altogether wanting; and, moreover, the traditional statements of the amount of this loss are so vague, that from this source likewise there is only room for probable conjecture.


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