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Plagues & People

Plagues & People. Howard M. Reisner Professor of Pathology 6-4265 reisner@med.unc.edu. Imago Mortis. Plague - the Word. Plague : from Latin plaga; sudden stroke, plangere; to strike Bubonic plague (1564 Reg. Privy Council Scot.) Pest(e) from Latin pestis; a deadly disease

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Plagues & People

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  1. Plagues & People Howard M. Reisner Professor of Pathology 6-4265 reisner@med.unc.edu

  2. Imago Mortis

  3. Plague - the Word • Plague: from Latin plaga; sudden stroke, plangere; to strike • Bubonic plague(1564 Reg. Privy Council Scot.) • Pest(e) from Latin pestis; a deadly disease • Great Mortality (or Pestilence); used during second pandemic 1348-on • Black Death 19th century - from German medical text, popular novels

  4. Plague - the Word (2) • Arabic - ta’un (tawa’in pl); to strike or pierce • specific for bubonic plague since 14th century • the pricking of the jinn • waba; more general idea of pain or pestilence • distinction spelled out by Ibn Hajjar al-Askalani (852/1449) • Much overlap in the literature • Hebrew - nega; to touch or strike also deber • note 1 Samuel 5,6

  5. Plague - the Word (3) • Chinese – No distinct nosological category • Yi or dayi (epidemic or major epidemic • 18-19 th century yangzibing in Yunnan • Epidemic disease with death of rats & lumps • Late 19 th century shuyi (rat epidemic)

  6. San Sebastiano e San RoccoMarchigiano late 15th century

  7. Death With an ArrowFrom a French Book of Hours 2nd half 15th century

  8. The Players Xenopsylla cheopis Yersinia pestis

  9. Yersinia pestis - Transmission Blocked Flea Yersinia pestis Yersinia pseudotuberculosis

  10. Yersinia - Virulence Factors

  11. Plague - Routes of Transmission

  12. Cutaneous Manifestations (1)

  13. Cutaneous Manifestations (2)

  14. General Bonaparte Visiting the Plague Stricken at JaffaJean-Gros 1804

  15. The “Little” PlagueRaphael/Raimondi ca 1514

  16. Doctors Incising Buboes

  17. Paleodiagnosis of Plague (1) Mass grave from Marseilles (1720-1722) Pin implantation to verify death

  18. Paleodiagnosis of Plague (2) 6/12 “plague teeth +, 0/7 controls - Pulp of unerupted teeth used

  19. Phylogeny of Plague (1) PNAS 96:14043 1999 3 2 1

  20. Phylogeny of Plague (2)

  21. Plague in the US

  22. Plague - Transmission in the US

  23. Plague - Current Foci

  24. Some Early Plagues • Mari-(early 2nd millennium) • The women Nanna is ill with simmum…Give strict orders that no one drink from her cup, sit on her chair, sleep in her bed…so that she does not infect…simmum is easily caught. • Hittite - ( Suppiluliuma 1320s BCE) came with Egyptian prisoners of war (under Pharaoh Ay successor to Tutankhamun) • killed successor (Arunwanda II 1321 BCE) • continued into reign of Mursili II • blamed on gods wrath, Suppiluliuma’s offenses • Biblical (1 Samuel 5 and 6) • outbreak of opalim; swellings among evil Philistines • also associated with mice (?) ravaging land • five gold tumors, five gold mice (guilt offering)

  25. Plague of Athens (430-426 BCE) • Thucydides’ account serves as a model for subsequent plague narratives • Very carefully described (but also a “moral tale”) • May be influenced by the Hippocratic school but not described in Hippocratic corpus • Additional accounts are late and disputative

  26. Plague of Athens (2) • Summary (from Peloponnesian War) • originated in Ethiopia-Egypt Libya Persia Piraeus (sea-born?), during siege of Athens • overcrowding (during siege), immunity, doctors suffered, all classes • high mortality rate (33% among Potidea expedition soldiers, perhaps 25% among Athenians (???) • occurred for two years (Summer 430-summer 428, than Winter 427/426); not seasonal

  27. Plague of Athens (3) • Symptoms- (in order) • 1. Heat in the head, red and burning eyes, throat and tongue red, malodorous breath • 2. Sneezing hoarseness, violent coughing • 3. Heart (stomach?) affected, evacuations of bile, empty retching inducing violent convulsions sometimes subside • 4. Body flushed with effloresence of small blisters & sores • 5. Internal heat high, unquenchable thirst, sleepless • 6. Bowels attacked, fluid diarrhoea, death from exhaustion • 7. Loss of tips of fingers, toes, privy parts, eyes • 8. Loss of memory • 9. Bodies “toxic to animals” (no birds, dogs perish) • 10. Fits model of descent from head

  28. Plague of Athens (4) • Many etiologic agents suggested: • Epidemic typhus (my favorite)-fits gangrene, memory loss. Has insect vector-influenced by crowding. Does not fit rash (?) • Bubonic Plague does not fit clinical description. • Smallpox rash fits well but not gangrene. Lasted too long in closed community. Descriptive Greek word for rash uncertain. • Also Rift Valley Fever, Lassa Fever, Thucydides syndrome (= influenza + toxic shocklike bacterial superinfection), anthrax (but no sheep?), fungal toxin and probably lots of others, unknown or now lost disease. • Must remember that the description is literary and hortatory

  29. First Pandemic of Bubonic Plague • Plague of Justinian (Byzantine Emperor 527-65 CE) • Started in Pelusium (Egyptian port), Alexandria, Egypt, Palestine, Syria • Origin said to be Ethiopia (copying Thucydides?) • Arabic sources suggest Sudan (850 CE), certainly not from Issyk Kul (source of second pandemic) based on Byzantine history • Killed 40% of population of Constantinople (200,00) • Also Italy, France, Rhine Valley, Iberia, North Africa • Reduction in population of Med. Basin by 20-25% 541-544 • Total decline of 50-60% of population 541-700 • Waxed & waned in Middle East, North Africa, through 900s, disappeared from Europe by about 700 • Procopius clearly describes disease as bubonic plague (buboes in groin, armpits and ears)

  30. First Pandemic-Islam • Plague recognised during early development of Islam. Chronicles cite five plagues before the 14th century “Black Death)- • Plague at Ctesiphon (Shirawayh) 6/627-8 • Plague at Amwas (Emmaus) Syria 17-18 638-9. In fighting against the Byzantines 25,000 Arabs die. • Story of Caliph ‘Umar & Abu ‘Ubaydah • Justified fleeing a plague to a healthy place • Much dispute through Islamic history on permissible response • The plague is a mercy and a martyrdom from God to the faithful, a punishment for the infidel. • The faithful should neither enter, nor flee, a plague stricken land • There was no contagion of plague, disease comes from God • But many differing opinions through history

  31. Islam & the Plague (2) • Galen & Hippocrates influential • Ibn Sina (980-1037)-miasma theory • “The pestilence resulted from a corruption of the air due to heavenly and terrestrial causes” • A sign of an approaching plague epidemic-rats and subterranean animals flee to the surface of the earth behave as intoxicated and die (source of observation is unknown!) • Andalusian writersinfluential in 14th Century (Black Death). • Ibn al-Khatib (1313-75) believed contagion immediate causeof plague. Denied fatwa against contagion “The existence of contagion is well established through experience, sense perception, autopsy and authenticated information-this is the proof” • He was killed in prison (heresy? Political malfeasance?) • Ibn al-Khatimah-more orthodox but good clinical evidence for contagion

  32. Black Death spread from SW Turkestan Land routes to Kaffa Sea Routes to Venice Entered England 1348 From Calais Melcombe Regis (Weymouth SW Coast) Bristol-Oxford-London Black Death - Routes of Spread

  33. Black Death Spread (2) Greenland was reached by 1350

  34. Black Death - Social Upheaval

  35. Economics of Black Death 1347-55 In opinion of Herlihy and many others, the Black Death had a critical role in the early industrial development (and social change) in Europe

  36. Black Death - Family Structure The young died -the population aged

  37. Plague by Dwelling (Bristol)

  38. Plague of 1665 - London (1)

  39. Plague of 1665 - Demographics Detailed demographic studies possible-confirms Defoe

  40. Plague of 1665 - Eyam 5/6 of Eyam died (or did they ?)

  41. Plague of 1665 – Eyam (2)

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