WEBVTT 00:01.630 --> 00:04.710 Prof: Well, what we'll do this morning is 00:04.712 --> 00:06.092 to start right now. 00:06.090 --> 00:12.030 And we'll be dealing today with the beginnings of our first 00:12.033 --> 00:15.213 major epidemic in the course. 00:15.210 --> 00:17.940 We'll be talking about bubonic plague. 00:17.940 --> 00:23.730 This time we'll have an overview of bubonic plague and 00:23.729 --> 00:27.879 its passage through Western society. 00:27.880 --> 00:32.820 And then in the next two classes we'll look at specific 00:32.818 --> 00:38.008 features of bubonic plague; next time, community responses 00:38.006 --> 00:41.216 to the plague, and the time after that, 00:41.219 --> 00:45.529 the impact on society, and in particular on European 00:45.530 --> 00:46.630 culture. 00:46.630 --> 00:48.420 So, that's where we're headed. 00:48.420 --> 00:51.950 And this morning we'll have a sort of overview. 00:51.950 --> 00:57.390 Now, one of the reasons for dealing first with the plague is 00:57.392 --> 01:02.842 that it's very important as part of testing the theme of our 01:02.835 --> 01:06.005 course; the theme being--one of the 01:06.007 --> 01:10.557 themes--that epidemic diseases aren't just interchangeable 01:10.561 --> 01:14.721 causes of illness and death; that each one has its own 01:14.724 --> 01:18.164 particular history that is determined by a number of 01:18.161 --> 01:20.791 variables that we'll be looking at, 01:20.790 --> 01:23.880 such as virulence, the nature of the symptoms of 01:23.875 --> 01:27.385 the disease, and a number of others. 01:27.390 --> 01:34.080 And we'll be testing the theory too that epidemic diseases are 01:34.081 --> 01:40.881 major determinants of historical change, and have major impacts 01:40.884 --> 01:42.534 on society. 01:42.530 --> 01:45.970 Well, plague, in a sense, set the standard by 01:45.970 --> 01:49.020 which all other epidemics are judged. 01:49.019 --> 01:51.579 The plague was, we might call it, 01:51.584 --> 01:55.434 the worst-case scenario, and we'll see that in later 01:55.425 --> 01:58.975 centuries, when societies experienced some 01:58.980 --> 02:04.480 new and unfamiliar disease, they waited anxiously to see if 02:04.480 --> 02:09.020 those diseases would be similar in their impact. 02:09.020 --> 02:12.620 And especially terrible diseases like cholera, 02:12.620 --> 02:15.360 in the nineteenth century, and influenza, 02:15.360 --> 02:19.230 just after the First World War, were said to be "the 02:19.227 --> 02:21.227 return of the plague." 02:21.229 --> 02:23.859 Tuberculosis, the great killer of the 02:23.855 --> 02:27.205 nineteenth century, was known also as "the 02:27.211 --> 02:28.891 white plague." 02:28.889 --> 02:33.449 What were some of the distinctive features of bubonic 02:33.449 --> 02:34.239 plague? 02:34.240 --> 02:38.280 The first thing that stands out is its extreme virulence. 02:38.280 --> 02:43.510 That's one of the first words that we may want to define as we 02:43.512 --> 02:44.372 move on. 02:44.370 --> 02:50.430 By that I mean its capacity to cause harm and symptoms in the 02:50.426 --> 02:51.736 human body. 02:51.740 --> 02:57.330 It's a measurement of the ability of a pathogen to cause 02:57.333 --> 02:58.353 disease. 02:58.348 --> 03:02.378 Plague in that sense was highly virulent. 03:02.379 --> 03:04.779 It also struck rapidly. 03:04.780 --> 03:08.860 It caused excruciating and degrading symptoms, 03:08.860 --> 03:11.640 and it achieved a case fatality rate-- 03:11.639 --> 03:15.409 another technical term, which simply means the kill 03:15.405 --> 03:17.735 rate that a disease achieved. 03:17.740 --> 03:21.630 In the case of bubonic plague, it normally killed fifty to 03:21.634 --> 03:24.784 seventy percent of the patients it infected; 03:24.780 --> 03:28.680 a rate attained by few other diseases. 03:28.680 --> 03:33.630 Its course in the human body was also terrifyingly swift. 03:33.628 --> 03:38.578 Normally it killed within about three days of the first 03:38.578 --> 03:40.868 appearance of symptoms. 03:40.870 --> 03:45.700 Another feature that was characteristic of bubonic plague 03:45.696 --> 03:48.536 was the profile of its victims. 03:48.538 --> 03:53.418 I mean that both in terms of their age and their social 03:53.417 --> 03:54.137 class. 03:54.139 --> 04:00.309 Familiar endemic childhood diseases in a society tend to 04:00.312 --> 04:05.252 strike primarily children and the elderly. 04:05.250 --> 04:08.920 That, if you like, would be the normal experience 04:08.915 --> 04:11.815 of society with infectious diseases. 04:11.819 --> 04:14.439 But the plague was different. 04:14.438 --> 04:17.858 It struck men and women in the prime of life. 04:17.860 --> 04:20.510 And this fact, among others, 04:20.511 --> 04:25.421 made plague seem like an unnatural, or might we say 04:25.422 --> 04:27.782 supernatural, event. 04:27.778 --> 04:32.128 It also magnified the economic and social dislocations it 04:32.129 --> 04:32.829 caused. 04:32.829 --> 04:36.639 In other words, plague left in its wake vast 04:36.636 --> 04:41.236 numbers of orphans, widows and destitute families. 04:41.240 --> 04:44.170 Furthermore, the plague, unlike most 04:44.168 --> 04:48.268 epidemic diseases, did not show a predilection for 04:48.271 --> 04:49.361 the poor. 04:49.360 --> 04:54.150 It struck universally, again magnifying a sense that 04:54.154 --> 04:59.704 this was the final day of reckoning, a divine visitation. 04:59.699 --> 05:05.399 Another feature of plague we'll be looking at is terror as a 05:05.398 --> 05:07.038 response to it. 05:07.040 --> 05:11.230 All of the things that we'll be saying about plague magnified 05:11.233 --> 05:14.943 the responses of the societies that were afflicted. 05:14.939 --> 05:18.869 Plague was associated with mass hysteria; 05:18.870 --> 05:21.950 with terror; with violence; 05:21.949 --> 05:26.479 with religious revivals, as people sought to assuage the 05:26.483 --> 05:27.723 divine wrath. 05:27.720 --> 05:31.340 It was associated with scapegoating and witch-hunts, 05:31.338 --> 05:34.958 for the guilty people in society responsible for the 05:34.956 --> 05:35.876 disaster. 05:35.879 --> 05:41.139 Perhaps those were the sinful, for those who saw the disease 05:41.139 --> 05:43.279 as divine retribution. 05:43.279 --> 05:48.719 Or it could be a search for the homicidal agents of some human 05:48.723 --> 05:53.723 conspiracy, for the demonic interpretation of disease. 05:53.720 --> 06:00.440 Those might be foreigners, witches, Jews or poisoners. 06:00.439 --> 06:05.699 Then the plague was important because it generated a major 06:05.697 --> 06:09.937 societal response: the development of the first 06:09.939 --> 06:12.429 forms of public health. 06:12.430 --> 06:15.290 In part because of its very virulence, 06:15.290 --> 06:20.210 the plague inspired the first and most extreme form of public 06:20.214 --> 06:24.404 health policy to protect populations and contain the 06:24.401 --> 06:28.591 spread of this horrendous and terrible disease. 06:28.589 --> 06:32.669 Plague public health--and we'll see this more next 06:32.668 --> 06:37.748 time--involved a military style policy carried out by the army 06:37.745 --> 06:39.155 and the navy. 06:39.160 --> 06:44.400 It involved maritime and land-based quarantines, 06:44.399 --> 06:48.969 sanitary cordons, which are military lines 06:48.970 --> 06:51.980 isolating a population. 06:51.980 --> 06:56.150 It gave rise to pest houses or lazarettos. 06:56.149 --> 06:59.079 And to new health authorities--variously called, 06:59.079 --> 07:02.649 over the centuries, health magistrates or boards of 07:02.653 --> 07:05.493 health-- equipped with extraordinary 07:05.485 --> 07:08.535 powers to enforce the plague measures. 07:08.540 --> 07:13.440 In some places there were erected stocks and scaffolds to 07:13.437 --> 07:18.597 remind the population of the powers of these authorities. 07:18.600 --> 07:24.620 Early Italian states, at the time of the Renaissance, 07:24.620 --> 07:28.150 devoted a special role--deserved a special role as 07:28.151 --> 07:31.611 the inventors of these public health measures. 07:31.610 --> 07:36.340 This was thrust upon them by their vulnerable position at the 07:36.343 --> 07:40.843 geographic center of trade routes in the Mediterranean. 07:40.839 --> 07:44.889 So, we'll see the decisive role in the development of these 07:44.887 --> 07:49.137 measures was played by places like Florence and the great port 07:49.144 --> 07:53.764 cities like Genoa, Naples, Venice. 07:53.759 --> 07:56.899 Later centuries will see another pattern, 07:56.899 --> 08:01.849 when a new, mysterious and frightful disease strikes-- 08:01.850 --> 08:05.920 say cholera, yellow fever or AIDS--one of 08:05.923 --> 08:10.913 the first responses of authorities is to return to 08:10.913 --> 08:14.583 plague measures of self-defense. 08:14.579 --> 08:19.199 It's said of generals that they always try to fight the last war 08:19.196 --> 08:23.516 over again, often confronting new enemies with inappropriate 08:23.519 --> 08:24.619 strategies. 08:24.620 --> 08:28.620 The same might be said of public health authorities over 08:28.624 --> 08:29.794 the centuries. 08:29.790 --> 08:34.090 And this temptation is all the greater for authorities because 08:34.090 --> 08:38.110 the battery of anti-plague defenses gives an impression of 08:38.109 --> 08:40.929 taking forceful and decisive action; 08:40.928 --> 08:43.978 providing the population, in other words, 08:43.975 --> 08:46.255 with some sense of security. 08:46.259 --> 08:52.059 A third feature of the plague is its enormous impact on 08:52.056 --> 08:53.126 society. 08:53.129 --> 08:57.179 As we've said, infectious diseases are not 08:57.178 --> 09:00.338 narrow, specialized interests. 09:00.340 --> 09:03.810 They're often part of the big picture, 09:03.808 --> 09:08.208 as essential for understanding a society and its history as 09:08.214 --> 09:11.224 studying war, religion, economics, 09:11.216 --> 09:13.626 high politics and culture. 09:13.629 --> 09:17.919 I'm not trying to make a case for disease determinism, 09:17.916 --> 09:22.926 and I'm not what you might want to call a microbial Marxist. 09:22.928 --> 09:28.498 My argument instead is simply that certain diseases do have a 09:28.495 --> 09:33.965 transforming effect on society, plague being one of them. 09:33.970 --> 09:38.580 Certain others do not, even great killers such as 09:38.575 --> 09:40.585 polio or influenza. 09:40.590 --> 09:45.950 We're going to examine why this major difference--why some 09:45.947 --> 09:51.397 diseases have a much more lasting footprint than others. 09:51.399 --> 09:56.169 Bubonic plague was a disease that affected every aspect of 09:56.172 --> 09:57.012 society. 09:57.009 --> 10:00.329 It transformed the demography of Europe. 10:00.330 --> 10:03.900 Recurring cycles of plague, with an epidemic every 10:03.899 --> 10:07.149 generation, constituted a major break on 10:07.149 --> 10:10.969 population between the fourteenth century and the 10:10.974 --> 10:12.094 eighteenth. 10:12.090 --> 10:16.750 It had devastating effect on economic life and economic 10:16.751 --> 10:17.531 growth. 10:17.528 --> 10:23.118 It also had a major impact on religion and popular culture. 10:23.120 --> 10:28.490 It gave rise to a new piety, to cults of plague saints, 10:28.490 --> 10:30.380 to passion plays. 10:30.379 --> 10:34.849 Plague led to an outpouring of sermons and religious pamphlets, 10:34.845 --> 10:38.945 with a central theme being what we might call theodicy; 10:38.950 --> 10:44.530 that is, how do you justify God's ways towards men? 10:44.529 --> 10:48.629 A just and loving God could be angry and punish sinners who 10:48.634 --> 10:50.904 turned from him and disobeyed. 10:50.899 --> 10:55.129 But how were priests and ministers to explain the 10:55.129 --> 11:00.589 gruesome suffering and death of innocents, and in particular of 11:00.594 --> 11:01.744 children? 11:01.740 --> 11:05.690 Thus also we see another undertow. 11:05.690 --> 11:07.500 We talked about piety. 11:07.500 --> 11:12.310 I would argue that plague also led sometimes to its opposite; 11:12.308 --> 11:16.998 the terrifying conclusion that how could there be a good God, 11:17.000 --> 11:20.500 because a loving and all-powerful being would not 11:20.496 --> 11:24.646 take the lives of half the population of a great city, 11:24.649 --> 11:28.959 indiscriminately killing men, women and children. 11:28.960 --> 11:32.230 So, for some, the result wasn't an act of 11:32.227 --> 11:36.637 atheism but a mute despair that was not articulated; 11:36.639 --> 11:41.619 a psychological impact that with historical hindsight we 11:41.618 --> 11:45.238 might even call post-traumatic stress. 11:45.240 --> 11:49.570 So, plague had a major psychological impact on the 11:49.570 --> 11:53.720 relationship of human beings to their mortality, 11:53.724 --> 11:55.584 and to their god. 11:55.580 --> 12:00.450 Plague had a major impact on the arts and culture. 12:00.450 --> 12:03.120 In literature we'll be seeing--and in fact you're 12:03.121 --> 12:05.311 starting to see, I hope already, 12:05.313 --> 12:09.333 by reading Defoe--that there's a whole genre of plague 12:09.325 --> 12:12.505 literature, including not only Defoe but 12:12.513 --> 12:16.153 names like Boccaccio, Camus, Manzoni; 12:16.149 --> 12:17.759 of whom more later. 12:17.759 --> 12:21.819 It affected European painting profoundly, and we'll be looking 12:21.815 --> 12:22.475 at that. 12:22.480 --> 12:26.550 It affected architecture, with large numbers of churches 12:26.554 --> 12:30.264 dedicated to the redeemer and the plague saints. 12:30.259 --> 12:34.389 It led to sculpture, and plague columns appeared 12:34.385 --> 12:38.245 throughout Vienna and the Austrian cities. 12:38.250 --> 12:42.670 We have, even in modern times, the film that I hope you'll be 12:42.672 --> 12:45.992 seeing, The Seventh Seal by Bergman. 12:45.990 --> 12:51.270 Plague also had a major impact intellectually on the medical 12:51.269 --> 12:53.239 paradigm of disease. 12:53.240 --> 12:59.150 Plague profoundly tested the humoral framework of disease. 12:59.149 --> 13:04.339 And we can see this in a man I mentioned in the last lecture, 13:04.342 --> 13:08.242 Girolamo Fracastoro, who developed a theory of 13:08.238 --> 13:09.708 contagionism. 13:09.710 --> 13:13.220 Now, the humoral idea, and Hippocrates, 13:13.216 --> 13:18.746 had recognized the difficulty that epidemics pose for humoral 13:18.754 --> 13:19.774 theory. 13:19.769 --> 13:24.669 How is it possible to account for vast numbers of people 13:24.674 --> 13:30.034 experiencing the same humoral imbalance at precisely the same 13:30.027 --> 13:30.827 time? 13:30.830 --> 13:36.780 Well, Fracastoro took that idea and he eliminated the mediation 13:36.778 --> 13:40.988 of the humors, suggesting instead that the 13:40.990 --> 13:45.290 disease was caused by a poisonous chemical, 13:45.288 --> 13:48.558 transmitted in a way he didn't understand, 13:48.559 --> 13:51.259 from one person to another. 13:51.259 --> 13:56.189 But let's not think of Fracastoro as a modern medical 13:56.191 --> 13:57.331 scientist. 13:57.330 --> 14:02.450 He thought that plague was caused, not by a living entity, 14:02.445 --> 14:04.235 but by a chemical. 14:04.240 --> 14:07.620 That's the background, then. 14:07.620 --> 14:13.410 Let's remember the history of three pandemics of bubonic 14:13.407 --> 14:16.877 plague that afflicted the West. 14:16.879 --> 14:19.799 Now, first maybe we should define what we mean. 14:19.798 --> 14:24.388 An outbreak--let's talk about three terms--an outbreak, 14:24.385 --> 14:26.845 an epidemic and a pandemic. 14:26.850 --> 14:33.420 An outbreak is a small surge in morbidity and mortality in a 14:33.423 --> 14:34.653 locality. 14:34.649 --> 14:39.679 So, we might talk of an outbreak of influenza in New 14:39.679 --> 14:40.469 Haven. 14:40.470 --> 14:47.240 An epidemic is a much bigger surge, over a larger area. 14:47.240 --> 14:53.380 And a pandemic is when an epidemic goes transnational; 14:53.379 --> 14:57.659 becomes an international phenomenon, affecting whole 14:57.659 --> 15:01.269 continents, or occasionally going global. 15:01.269 --> 15:05.489 The plague struck the West in three pandemic waves. 15:05.490 --> 15:08.640 We'll be talking about the history, then, 15:08.639 --> 15:11.709 of three pandemics of bubonic plague. 15:11.710 --> 15:17.780 And each pandemic as a subset, if we like, had a series of 15:17.783 --> 15:24.073 recurring visitations that might even last for centuries. 15:24.070 --> 15:27.860 And in addition to being cyclical in that sense, 15:27.856 --> 15:30.916 plague had a pronounced seasonality. 15:30.918 --> 15:35.608 An epidemic of bubonic plague usually began in the spring or 15:35.614 --> 15:39.124 summer months, and faded away with the coming 15:39.115 --> 15:40.225 of winter. 15:40.230 --> 15:44.080 Especially favorable were months that were both hot and 15:44.081 --> 15:44.511 wet. 15:44.509 --> 15:47.139 The explanation for that, as we'll see, 15:47.144 --> 15:48.744 wasn't a humoral one. 15:48.740 --> 15:52.850 But that provides an ideal environment for fleas, 15:52.846 --> 15:57.806 which are decisive in plague, and their need for warmth and 15:57.807 --> 16:01.057 humidity, for their eggs to hatch; 16:01.058 --> 16:07.038 and they become inactive in cold or very dry climate. 16:07.038 --> 16:09.968 The first pandemic, when was that? 16:09.970 --> 16:14.430 That lasted for two centuries after 541 A.D., 16:14.427 --> 16:18.477 and is called the Plague of Justinian. 16:18.480 --> 16:24.190 It was the first appearance of bubonic plague as a major player 16:24.187 --> 16:28.417 in world history, and there are estimates that it 16:28.423 --> 16:31.753 afflicted Africa, Asia and Europe with--people 16:31.745 --> 16:35.045 are guessing, but there are figures bandied 16:35.048 --> 16:38.548 about of perhaps a hundred million victims. 16:38.548 --> 16:41.948 There are few accounts, or records that have survived, 16:41.950 --> 16:46.030 and there's some debate about whether this so-called Plague of 16:46.028 --> 16:48.968 Justinian was even bubonic plague at all, 16:48.970 --> 16:51.260 or whether it was some other disease. 16:51.259 --> 16:54.999 But as we speak, paleopathologists are at work 16:55.000 --> 16:59.570 exhuming bodies from ancient cemeteries in order to find 16:59.572 --> 17:04.312 conclusive DNA evidence to support a firm diagnosis, 17:04.308 --> 17:08.878 and the latest news is that they're pretty certain that it 17:08.876 --> 17:10.556 was bubonic plague. 17:10.558 --> 17:16.068 The second pandemic occurred from the 1330s, 17:16.069 --> 17:20.939 in the Middle East, until the 1830s. 17:20.940 --> 17:26.600 So, we have--what's that?--five centuries of bubonic plague in 17:26.598 --> 17:28.638 the second pandemic. 17:28.640 --> 17:31.830 It began with what was called the Black Death. 17:31.828 --> 17:37.948 This erupted in Central Asia in the 1330s, and first invaded 17:37.954 --> 17:39.724 Europe in 1347. 17:39.720 --> 17:43.580 And the early years, from 1347 into the 1350s, 17:43.579 --> 17:48.469 were usually called the Black Death, which referred to the 17:48.470 --> 17:51.730 first wave of the second pandemic; 17:51.730 --> 17:56.360 after which it's usually referred to simply as bubonic 17:56.355 --> 17:59.145 plague, plague, or pestilence. 17:59.150 --> 18:04.300 It may well--and this is the common theory--have arrived 18:04.300 --> 18:09.920 aboard a Genoese merchant ship that had sailed from the Black 18:09.920 --> 18:12.730 Sea in the summer of 1347. 18:12.730 --> 18:16.280 In any case, Italy was the first land to be 18:16.284 --> 18:19.504 invaded by the disease; again, as I say, 18:19.503 --> 18:22.613 not by chance, because Italy was at the center 18:22.612 --> 18:25.722 of the trade routes of the Mediterranean, 18:25.720 --> 18:28.210 and therefore was always, at this time, 18:28.210 --> 18:30.930 permanently at risk. 18:30.930 --> 18:35.910 About a third of the population of Europe is estimated to have 18:35.911 --> 18:36.811 perished. 18:36.808 --> 18:42.098 And after the 1350s, after the Black Death, 18:42.098 --> 18:46.458 the plague returned more or less once in a generation, 18:46.460 --> 18:50.520 for a number of centuries, with some famous local 18:50.516 --> 18:51.526 epidemics. 18:51.529 --> 18:55.359 Let me just remember some of the worst cases. 18:55.358 --> 18:59.148 Florence in 1348, when the disease killed half 18:59.147 --> 19:04.027 the population--and that's portrayed vividly in Boccaccio's 19:04.030 --> 19:10.750 Decameron; 1576 to 1577, Milan; 19:10.750 --> 19:15.330 1630, again Milan--and there are two major plague works of 19:15.329 --> 19:19.509 literature: Manzoni's novel The Betrothed, 19:19.509 --> 19:22.239 and his work The Column of Infamy-- 19:22.240 --> 19:27.020 1656 in Naples; and 1665 and 1666 in London, 19:27.015 --> 19:31.575 which you're reading about in Dafoe's Journal of the Plague 19:31.580 --> 19:32.480 Year. 19:32.480 --> 19:35.270 Then for reasons we're going to return to, 19:35.269 --> 19:39.459 the plague was vanquished in Western Europe between the end 19:39.464 --> 19:43.954 of the seventeenth century and the middle of the eighteenth. 19:43.950 --> 19:49.110 The last outbreaks in Western Europe, of the second pandemic, 19:49.114 --> 19:52.734 were 1720 to 1722, at Marseilles in France, 19:52.730 --> 19:56.690 the last on the Western European mainland; 19:56.690 --> 20:00.690 and in 1743 at Messina and Sicily. 20:00.690 --> 20:03.660 Interestingly, Messina is a convenient 20:03.664 --> 20:07.054 bookend; the very first place in Western 20:07.048 --> 20:11.618 Europe to be afflicted by the plague, and also the last, 20:11.624 --> 20:14.124 during the second pandemic. 20:14.118 --> 20:18.318 Now, don't make the mistake of assuming that the virulence of 20:18.318 --> 20:21.328 the plague declines over these centuries. 20:21.328 --> 20:24.778 In many cases the last epidemics of the seventeenth or 20:24.778 --> 20:28.358 eighteenth century were the most devastating of all, 20:28.358 --> 20:33.858 including the experience of London that you're reading 20:33.858 --> 20:34.688 about. 20:34.690 --> 20:41.370 Then we come to the third pandemic, which lasted from 20:41.374 --> 20:45.874 about 1855 until 1959, more or less, 20:45.873 --> 20:48.833 when it fades away. 20:48.828 --> 20:53.578 It began in earnest, and attracted world attention 20:53.583 --> 20:59.213 in China, when it attacked Hong Kong and Canton in 1894. 20:59.210 --> 21:02.020 And, as I said, it lasted until the middle of 21:02.023 --> 21:03.563 the twentieth century. 21:03.558 --> 21:08.858 Now, this pandemic ravaged India and affected five 21:08.863 --> 21:12.943 countries, but mostly not the industrial 21:12.935 --> 21:17.155 West, apart from a brief flare-up in 21:17.160 --> 21:21.570 Naples in 1899, and an also limited outbreak in 21:21.573 --> 21:26.113 San Francisco in the early years of the twentieth century. 21:26.108 --> 21:30.728 That's the topic of Marilyn Chase's work that you'll be 21:30.731 --> 21:33.901 reading, The Barbary Plague. 21:33.900 --> 21:38.670 It was the steamship that enabled plague to reach the New 21:38.674 --> 21:43.114 World for the first time in the twentieth century. 21:43.108 --> 21:47.508 It had limited impact on humans, but it did establish a 21:47.508 --> 21:51.908 stable reservoir of infection among wild rodents in the 21:51.906 --> 21:57.406 southwest of the United States, where it persists to this very 21:57.412 --> 22:01.872 day and causes an ongoing trickle of cases of bubonic 22:01.869 --> 22:04.099 plague in this country. 22:04.098 --> 22:09.858 The great disaster was India from 1898 to 1908, 22:09.859 --> 22:16.869 which experienced some 13 million deaths from the bubonic 22:16.872 --> 22:18.252 plague. 22:18.250 --> 22:22.310 Present day plague--and I think a number of you may have the 22:22.310 --> 22:26.100 idea that plague is something medieval that doesn't have 22:26.097 --> 22:28.987 anything to do with the modern world, 22:28.990 --> 22:32.960 and I want to make it clear that plague is not extinct. 22:32.960 --> 22:37.610 Indeed, I have a friend myself who is a survivor of bubonic 22:37.608 --> 22:42.338 plague, which she contracted in Arizona in the southwest. 22:42.338 --> 22:47.008 As I said, it continues to cause a trickle of cases every 22:47.010 --> 22:52.960 year in the United States, because it persists in the wild 22:52.961 --> 22:58.261 animal population, and there are occasional 22:58.262 --> 22:59.652 flare-ups. 22:59.650 --> 23:03.700 We also need to remember there's a somber background 23:03.703 --> 23:07.323 threat, then, of bubonic plague even 23:07.315 --> 23:11.155 today, which is made more vivid by the 23:11.155 --> 23:16.245 threat possibly of bubonic plague as an instrument of 23:16.248 --> 23:17.618 bio-terror. 23:17.618 --> 23:23.628 And just to show the sort of modern--here's a modern image of 23:23.632 --> 23:27.142 the grim reaper as still with us. 23:27.140 --> 23:32.280 Now, our focus here in our class will be instead firmly on 23:32.280 --> 23:36.160 the second pandemic, and especially its last 23:36.160 --> 23:40.490 terrible century in Europe, the seventeenth. 23:40.490 --> 23:44.680 Let's talk about some of the features of bubonic plague, 23:44.683 --> 23:47.433 and we'll begin with its etiology. 23:47.430 --> 23:52.140 Again a bit of jargon, and by that I simply mean the 23:52.144 --> 23:55.384 causes or origins of the disease. 23:55.380 --> 24:00.950 And the plague is a disease with a complex history of four 24:00.952 --> 24:02.422 protagonists. 24:02.420 --> 24:06.630 First there's the bacterium--and there it 24:06.628 --> 24:11.258 is--Yersinia pestis, sometimes called, 24:11.259 --> 24:17.469 in a more old-fashioned way, Pasteurella pestis. 24:17.470 --> 24:21.500 It was discovered in Hong Kong by Alexander Yersin, 24:21.500 --> 24:27.210 a Swiss student of Louis Pasteur, and at the same time by 24:27.214 --> 24:30.894 his rival the Japanese physician, 24:30.890 --> 24:37.470 Shibasaburo Kitasato, a prot�g� instead of Robert 24:37.472 --> 24:38.362 Koch. 24:38.358 --> 24:42.318 So, the first protagonist is this bacterium, 24:42.324 --> 24:44.634 Yersinia pestis. 24:44.630 --> 24:47.260 And then there are two vectors. 24:47.259 --> 24:51.839 The vector is normally another bit of jargon: 24:51.835 --> 24:58.385 An animal or insect responsible for conveying a disease to human 24:58.385 --> 24:59.525 beings. 24:59.529 --> 25:05.569 And in this case there are two vectors or carriers that convey 25:05.571 --> 25:10.131 the disease to human beings: fleas and rodents, 25:10.127 --> 25:12.107 especially rats. 25:12.108 --> 25:17.548 And then there's the fourth protagonist, you and me. 25:17.548 --> 25:24.248 By between 1894 and 1898, Yersin and his colleague, 25:24.250 --> 25:27.680 Paul-Louis Simond, unraveled the complex 25:27.676 --> 25:31.746 relationship among rats, fleas and humans, 25:31.753 --> 25:36.483 and the bacterium, that governs the epidemiology 25:36.483 --> 25:38.273 of bubonic plague. 25:38.269 --> 25:42.029 Normally the plague began as an infection, 25:42.029 --> 25:48.249 an epidemic among animals and especially wild rodents: 25:48.250 --> 25:51.250 hamsters, gerbils, prairie dogs, 25:51.249 --> 25:54.139 chipmunks, squirrels in their burrows, 25:54.140 --> 25:57.520 where underground catastrophes, unknown to humans, 25:57.519 --> 25:59.289 took place. 25:59.288 --> 26:03.108 A particularly important moment was when it inflicted this 26:03.109 --> 26:07.759 particular creature and friend, that lives not so distant from 26:07.762 --> 26:12.252 us, Rattus rattus, the black rat or ship rat; 26:12.250 --> 26:16.630 and as you see, extremely cute it is. 26:16.630 --> 26:19.370 Unlike his cousin, the brown rat, 26:19.374 --> 26:23.494 that took over its ecological niche later on, 26:23.490 --> 26:26.180 and is more familiar in modern times, 26:26.180 --> 26:29.260 the black rat was definitely not shy, 26:29.259 --> 26:33.229 but lived in close proximity to people, 26:33.230 --> 26:37.880 with whom they shared the same dietary preferences. 26:37.880 --> 26:41.240 So, the rat was extremely important. 26:41.240 --> 26:47.900 The bacterium was spread in a third major character, 26:47.897 --> 26:55.337 the flea, a highly efficient vector for bubonic plague. 26:55.338 --> 27:00.478 The flea is naturally parasitic on warm-blooded animals. 27:00.480 --> 27:05.200 In a single feed it sucks up an amount of blood equal to its own 27:05.203 --> 27:05.883 weight. 27:05.880 --> 27:09.920 I'm talking about something like a billion bacteria at a 27:09.915 --> 27:10.425 time. 27:10.430 --> 27:15.800 And here we're looking at the slide of a flea engorged with 27:15.804 --> 27:17.754 blood after a meal. 27:17.750 --> 27:22.510 Now, once infected--and here you'll feel sorry for the poor 27:22.506 --> 27:26.766 flea--the flea does not survive the plague either. 27:26.769 --> 27:32.499 The bacterium blocks the gut of the flea, causing it to starve 27:32.497 --> 27:33.527 to death. 27:33.529 --> 27:35.509 Poor thing. 27:35.509 --> 27:39.719 But before dying, in a frenzied bid to survive, 27:39.720 --> 27:44.130 the flea feeds repeatedly, and in each bite inoculates 27:44.131 --> 27:48.961 perhaps a hundred thousand bacteria into the bloodstream of 27:48.959 --> 27:51.289 its warm-blooded victim. 27:51.288 --> 27:55.848 So, when a rodent host of fleas sickens and dies, 27:55.848 --> 28:01.548 the fleas leap to the warm body of another mammal that passes 28:01.548 --> 28:04.018 within leaping radius. 28:04.019 --> 28:09.249 And the flea also is capable of hibernating for as much as a 28:09.247 --> 28:12.257 couple of months, lying in wait. 28:12.259 --> 28:17.129 Now, how did human beings come to be involved in this 28:17.128 --> 28:18.438 catastrophe? 28:18.440 --> 28:22.940 Well, it might be sometimes that the remote steppes where 28:22.939 --> 28:27.839 wild rodents lived had their ecological systems disrupted, 28:27.838 --> 28:33.068 perhaps by floods or droughts, that sent animals scurrying 28:33.068 --> 28:37.488 over long distances, and then they encountered other 28:37.493 --> 28:40.933 rodents who lived in close proximity to man, 28:40.930 --> 28:45.280 and especially our friend the black rat. 28:45.279 --> 28:48.609 Alternatively, human beings invaded rodents' 28:48.612 --> 28:52.102 habitats, exposing themselves to infection; 28:52.098 --> 28:56.308 soldiers perhaps, or refugees in times of war, 28:56.306 --> 28:58.826 or hunters and shepherds. 28:58.828 --> 29:04.128 So, the first foci--that is, the first locuses where 29:04.131 --> 29:08.811 infections sprang up amongst human beings-- 29:08.808 --> 29:13.378 were the first infected men and women which shared their fleas 29:13.382 --> 29:17.432 and infection with other members of their household. 29:17.430 --> 29:21.660 The plague would then begin, not as a disease so much of 29:21.664 --> 29:24.904 isolated individuals, but of households. 29:24.900 --> 29:27.190 Housing conditions were important. 29:27.190 --> 29:31.360 Overcrowding, with whole families sleeping in 29:31.355 --> 29:35.135 a single bed, facilitated the exchange of 29:35.143 --> 29:36.093 fleas. 29:36.088 --> 29:39.948 And there were particular moments that were especially 29:39.946 --> 29:44.306 dangerous, such as the laying out and final attentions to the 29:44.314 --> 29:44.974 dead. 29:44.970 --> 29:50.070 As the body cooled, the fleas infesting it became 29:50.067 --> 29:56.437 desperate to escape to the next warm body that approached; 29:56.440 --> 29:59.380 quite possibly you and me. 29:59.380 --> 30:05.080 Then there was the wider spread; and this was dependent on 30:05.080 --> 30:07.810 networks of trade and commerce. 30:07.808 --> 30:12.148 It was not an accident that plague emerged when it did in 30:12.147 --> 30:13.617 European history. 30:13.618 --> 30:17.628 It spread overland and along river valleys, 30:17.626 --> 30:19.436 by river traffic. 30:19.440 --> 30:24.130 Now, fleas obviously are severely restricted in their 30:24.134 --> 30:28.564 range, but rats are really wonderful travelers. 30:28.558 --> 30:32.448 They hide in the shipments of wheat and are transported 30:32.448 --> 30:33.238 overland. 30:33.240 --> 30:37.460 They travel by barge down waterways. 30:37.460 --> 30:40.470 But the garments of victims were also important, 30:40.471 --> 30:42.331 because they were recycled. 30:42.328 --> 30:47.278 Remember how precious an item of clothing was in the early 30:47.277 --> 30:48.577 modern world. 30:48.578 --> 30:53.358 And, so, the clothing of dead men and women was packed in 30:53.357 --> 30:58.557 crates, and sold in markets and fairs, often with fleas intact 30:58.561 --> 31:00.441 among their folds. 31:00.440 --> 31:04.460 Certain professions were also highly at risk: 31:04.455 --> 31:08.085 street vendors, market-stall-holders, 31:08.092 --> 31:10.752 washerwomen, gravediggers, 31:10.750 --> 31:16.220 physicians, priests, and also millers and bakers, 31:16.220 --> 31:20.880 because of the dietary preferences of your friend the 31:20.875 --> 31:21.945 black rat. 31:21.950 --> 31:25.820 But the disease also went further afield, 31:25.823 --> 31:28.053 and it did so by sea. 31:28.048 --> 31:32.388 And shipping was essential to the spread of the plague over 31:32.392 --> 31:35.242 long distance, and helps to explain its 31:35.237 --> 31:37.747 epidemiology; its tendency, 31:37.751 --> 31:43.581 that is, to arrive in a country first by striking port cities, 31:43.582 --> 31:49.032 and only then moving inland by road and river traffic. 31:49.029 --> 31:52.219 Infected rats would clamor aboard ships, 31:52.219 --> 31:56.639 by ropes and gangplanks, or they could be lifted aboard 31:56.635 --> 32:00.475 in crates of grain or shipments of clothes. 32:00.480 --> 32:04.920 Istanbul was a great hub of trade in the Middle East, 32:04.920 --> 32:09.160 and it linked the rest of the Mediterranean world by trade 32:09.162 --> 32:13.502 overland across the Balkans, and by ship to Venice, 32:13.501 --> 32:17.471 Naples, Genoa, Marseilles, Valencia. 32:17.470 --> 32:21.770 Sometimes there was havoc at sea when a whole crew and its 32:21.772 --> 32:26.232 passengers would be killed by the plague before they arrived 32:26.228 --> 32:30.248 at port, and there were ghost ships that 32:30.249 --> 32:33.189 floated on the Mediterranean. 32:33.190 --> 32:37.950 Once reaching a port, however, the ship would dock 32:37.950 --> 32:42.730 and rats would disembark, in crates, or by rope, 32:42.732 --> 32:47.402 or by the gangplank again, and at the same time infected 32:47.402 --> 32:50.082 passengers and crew could go ashore, 32:50.079 --> 32:52.389 together with their fleas. 32:52.390 --> 32:55.430 Normally the first indication of plague-- 32:55.430 --> 32:59.740 one that's dramatically apparent in Camus' novel The 32:59.741 --> 33:03.491 Plague, but we'll also see in some of 33:03.490 --> 33:08.120 the paintings that we'll look at time after next-- 33:08.118 --> 33:13.108 an important indication was a sudden and massive die-off of 33:13.106 --> 33:13.706 rats. 33:13.710 --> 33:19.370 And there would be pictures like this of rats killed by an 33:19.369 --> 33:25.199 epidemic of bubonic plague; in this case Sydney, Australia. 33:25.200 --> 33:28.800 So, ports are crucial in epidemics, and in the 33:28.795 --> 33:33.265 development of public health measures to counter them. 33:33.269 --> 33:37.759 Almost invariably in Western Europe the plague arrived in 33:37.759 --> 33:42.089 port cities and then spread inland, following roads and 33:42.087 --> 33:42.967 rivers. 33:42.970 --> 33:46.720 In the large cities, the disease typically would 33:46.722 --> 33:51.452 arrive in the spring, reach a peak of ferocity after 33:51.449 --> 33:54.869 a few weeks, then continue as a violent 33:54.869 --> 33:59.059 outbreak for two to four months, and then decline with the 33:59.056 --> 34:01.296 coming of colder, dry weather, 34:01.299 --> 34:06.679 either to disappear entirely, or to be rekindled when 34:06.682 --> 34:10.832 favorable climatic conditions returned. 34:10.829 --> 34:13.789 Well, that's the etiology, in a nutshell, 34:13.786 --> 34:14.966 of the plague. 34:14.969 --> 34:18.809 I'd like to turn now to its symptomatology and pathology; 34:18.809 --> 34:24.159 that is, how does it affect the individual human body? 34:24.159 --> 34:29.749 And the study of the symptoms of the epidemics we study isn't 34:29.748 --> 34:33.288 just a matter of ghoulish curiosity. 34:33.289 --> 34:37.819 I'm going to argue that the history of each epidemic disease 34:37.815 --> 34:38.885 is distinct. 34:38.889 --> 34:42.409 That's one of the reasons that I will be showing slides, 34:42.411 --> 34:46.001 to fix the image of a particular disease in your mind. 34:46.000 --> 34:48.990 Because it's important not to confuse them, 34:48.989 --> 34:51.479 because each has its own history. 34:51.480 --> 34:56.810 And a crucial variable is the differing way in which each of 34:56.807 --> 35:00.237 these diseases affected its victims. 35:00.239 --> 35:03.479 A feature of the plague, I would argue, 35:03.480 --> 35:07.570 is that it seemed almost purposefully designed to 35:07.574 --> 35:09.284 maximize terror. 35:09.280 --> 35:12.470 I will be showing you some vivid material, 35:12.467 --> 35:15.887 and I'm sorry that it's just before lunch. 35:15.889 --> 35:20.369 And indeed a couple of years ago in this class someone in the 35:20.367 --> 35:23.797 front row fainted with some of the pictures. 35:23.800 --> 35:27.570 So, if you don't wish to look at them, I can tell you in 35:27.572 --> 35:29.632 advance it's not compulsory. 35:29.630 --> 35:32.710 You can simply close your eyes. 35:32.710 --> 35:35.930 In any case, Yersinia pestis is 35:35.934 --> 35:41.254 exceptionally virulent because of its ability to overwhelm the 35:41.253 --> 35:43.873 immune system of the body. 35:43.869 --> 35:47.549 After an infective bite, there's an incubation period, 35:47.550 --> 35:53.040 usually of one to six days, and then the classic symptoms 35:53.039 --> 35:56.609 appear-- the first beginning--launching 35:56.612 --> 35:59.642 the first stage of bubonic plague. 35:59.639 --> 36:05.199 That is, at the site of the flea bite, there's what's called 36:05.204 --> 36:10.964 a carbuncle or gangrenous black blister, surrounded by red pot 36:10.956 --> 36:11.896 marks. 36:11.900 --> 36:15.730 And this will be familiar to you because it's been 36:15.731 --> 36:20.271 immortalized in the nursery rhyme, "The Ring a Ring o' 36:20.268 --> 36:21.518 Roses." 36:21.518 --> 36:26.708 But also, along with it, there's high temperature and 36:26.708 --> 36:31.498 shivering, violent headache, nausea and vomiting, 36:31.496 --> 36:37.416 and general flu-like symptoms; after which the patient passes 36:37.416 --> 36:41.036 on to the second stage of bubonic plague, 36:41.039 --> 36:45.619 when it invades--the bacteria invade the lymph system and 36:45.617 --> 36:47.987 drain into the lymph nodes. 36:47.989 --> 36:52.609 A couple of days later a so-called bubo--which gives the 36:52.608 --> 36:57.558 symptom that gives the disease its name, bubonic plague--the 36:57.563 --> 37:00.003 plague of buboes appears. 37:00.000 --> 37:03.880 This is an infected swelling of the lymph nodes, 37:03.876 --> 37:08.246 a hard mass the size of an orange beneath the skin. 37:08.250 --> 37:12.490 The site of the bubo varies, according to the location of 37:12.489 --> 37:14.079 the infective bite. 37:14.079 --> 37:19.359 If a flea bites the legs, the bubo is usually in the 37:19.364 --> 37:22.894 groin, and would look like that. 37:22.889 --> 37:27.309 If the fleas instead were to bite the arms, 37:27.309 --> 37:30.929 the bubo would appear in the armpit or on the neck, 37:30.929 --> 37:36.299 and there would be symptoms--would look like this, 37:36.300 --> 37:39.980 or like that. 37:39.980 --> 37:44.780 In any case, Daniel Defoe imagined, 37:44.780 --> 37:49.300 and he writes in our book, that the agony was so violent 37:49.295 --> 37:54.135 from the bubo that victims hurled themselves from roofs, 37:54.139 --> 37:56.909 or into the Thames to escape it. 37:56.909 --> 38:01.569 And there was a general consensus that the body and all 38:01.570 --> 38:05.890 of its excretions--urine, sweat, the breath--had an 38:05.887 --> 38:07.957 overpowering stench. 38:07.960 --> 38:13.530 This led--I want us to remember how dehumanizing the symptoms of 38:13.525 --> 38:16.525 plague were, and that's tremendously 38:16.532 --> 38:20.192 important to the way that societies experienced its 38:20.190 --> 38:21.070 outbreak. 38:21.070 --> 38:24.110 In the third stage, the bacteria releases a 38:24.110 --> 38:27.370 powerful toxin, and this circulates throughout 38:27.367 --> 38:31.057 the bloodstream, and it's the toxin that kills. 38:31.059 --> 38:34.519 It attacks tissues, causing blood vessels to 38:34.523 --> 38:39.363 hemorrhage, and giving rise to purpurous, subcutaneous spots, 38:39.358 --> 38:42.178 the so-called tokens of plague. 38:42.179 --> 38:44.259 Another bit of jargon to remember. 38:44.260 --> 38:49.870 The plague is associated with tokens and these--let's have a 38:49.867 --> 38:52.907 look at--which look like this. 38:52.909 --> 38:56.699 They gain their name because they were thought by many to be 38:56.704 --> 38:59.424 the signs, that is the tokens, 38:59.423 --> 39:03.893 of God's anger, the anger that led him to smite 39:03.889 --> 39:06.399 his people with the plague. 39:06.400 --> 39:11.720 The toxin initiates the septic phase of this disease, 39:11.719 --> 39:15.789 causing rapid degeneration of the muscles of the heart, 39:15.789 --> 39:18.759 of the kidneys, of the nerves and the central 39:18.762 --> 39:22.562 nervous system, and this leads to such symptoms 39:22.556 --> 39:26.216 as bloodshot eyes, general prostration, 39:26.224 --> 39:29.384 fever, nausea, severe headache, 39:29.380 --> 39:34.710 and progressive neurological damage that's manifested by 39:34.708 --> 39:38.438 slurred speech, a staggering gait, 39:38.443 --> 39:42.443 psychic disturbances and derangement. 39:42.440 --> 39:49.230 We again see how this disease is terrifyingly dehumanizing and 39:49.233 --> 39:50.573 agonizing. 39:50.570 --> 39:55.250 And it leads then to delirium and coma. 39:55.250 --> 40:00.070 Sometimes it also causes gangrene of the extremities-- 40:00.070 --> 40:04.850 and I will also have a picture of that-- 40:04.849 --> 40:08.899 and this may, in fact, be the origin of the 40:08.898 --> 40:10.728 term Black Death. 40:10.730 --> 40:15.380 Now, in terms of the symptomatology--let me pass on 40:15.380 --> 40:17.240 from that to this. 40:17.239 --> 40:21.689 This is a Franciscan friar, Michael of Piazza, 40:21.690 --> 40:26.350 a chronicler--you'll remember I said Messina was the first place 40:26.347 --> 40:29.597 to be afflicted by bubonic plague in 1347. 40:29.599 --> 40:33.929 He wrote this terrifying description of how it afflicted 40:33.927 --> 40:34.947 a sufferer. 40:34.949 --> 40:38.789 He wrote: "Not only did the burned blisters appear, 40:38.789 --> 40:42.209 but there developed in different parts of the body 40:42.211 --> 40:45.931 gland boils; in some on the sexual organs. 40:45.929 --> 40:53.719 In others"--whoops, sorry, there we go--"In 40:53.722 --> 40:58.672 others on the arms or the neck. 40:58.670 --> 41:02.430 At first these were the size of a hazelnut and developed 41:02.434 --> 41:06.614 accompanied by violent shivering fits that soon rendered those 41:06.608 --> 41:10.508 attacked so weak they could no longer stand upright, 41:10.510 --> 41:13.200 but were forced to lie in their beds, 41:13.199 --> 41:18.439 consumed by violent fever and overcome by great tribulation. 41:18.440 --> 41:21.360 Soon the boils grew to the size of a walnut, 41:21.360 --> 41:23.950 then a hen's egg, and they were exceedingly 41:23.945 --> 41:28.865 painful and irritated the body, causing it to vomit blood by 41:28.867 --> 41:31.087 vitiating the juices. 41:31.090 --> 41:34.710 The blood rose from the affected lungs to the throat, 41:34.711 --> 41:38.541 producing on the whole body a putrefying and decomposing 41:38.543 --> 41:39.313 effect. 41:39.309 --> 41:42.989 The sickness lasted three days, and on the fourth, 41:42.985 --> 41:46.355 at the latest, the patient succumbed." 41:46.360 --> 41:49.480 So, as soon as anyone was seized with headache and 41:49.481 --> 41:52.131 shivering, he knew that he was bound to 41:52.125 --> 41:54.585 pass away within the specified time, 41:54.590 --> 41:57.800 and first confessed his sins to the priest, 41:57.800 --> 42:00.080 and then made his will. 42:00.079 --> 42:06.049 Death occurred in about half of cases within a few days, 42:06.050 --> 42:10.600 though some of the afflicted lingered in agony for as long as 42:10.603 --> 42:15.083 three to four weeks, and then a minority slowly 42:15.076 --> 42:16.226 recovered. 42:16.230 --> 42:20.350 The symptoms of bubonic plague are agonizing. 42:20.349 --> 42:23.699 They're terrifying, dehumanizing, 42:23.702 --> 42:29.152 as suffers succumb to hallucinations and delirium. 42:29.150 --> 42:32.240 Now, there are three forms of bubonic plague, 42:32.239 --> 42:35.819 and I want to mention what those are immediately. 42:35.820 --> 42:38.290 These are not three separate diseases. 42:38.289 --> 42:42.789 They're one disease in three separate manifestations. 42:42.789 --> 42:46.979 The first is what we've been describing as classic bubonic 42:46.978 --> 42:50.948 plague, the most common and historically most important 42:50.947 --> 42:51.607 form. 42:51.610 --> 42:56.720 Then there's septicemic plague, which is an overwhelming 42:56.717 --> 43:00.987 infection in which the patient frequently dies, 43:00.990 --> 43:04.150 even before developing a bubo. 43:04.150 --> 43:07.480 But this, as I said, is not a separate disease; 43:07.480 --> 43:10.940 simply a fulminant form of plague; 43:10.940 --> 43:14.780 and it's most common among the elderly. 43:14.780 --> 43:19.530 Then there's pneumonic plague, which again is the same 43:19.530 --> 43:24.640 disease, but clinically and epidemiologically distinct. 43:24.639 --> 43:29.099 It begins with an ordinary case of plague, complicated by 43:29.101 --> 43:33.881 pneumonia, and can then give rise to a secondary catastrophe, 43:33.880 --> 43:39.050 within the general disaster; that is, the disease is then 43:39.047 --> 43:44.747 spread by bacteria coughed out in the sputum of the victim and 43:44.751 --> 43:49.991 spread person to person when inhaled by those near him or 43:49.987 --> 43:50.827 her. 43:50.829 --> 43:55.339 This form of plague is not dependent on fleas. 43:55.340 --> 44:00.360 It's highly infectious, and as far as is known is one 44:00.362 --> 44:02.682 hundred percent fatal. 44:02.679 --> 44:05.619 And even today, in the antibiotic era, 44:05.619 --> 44:08.719 there's no cure for pneumonic plague. 44:08.719 --> 44:14.819 And pneumonic plague is also recorded in your favorite 44:14.818 --> 44:16.658 nursery rhyme. 44:16.659 --> 44:19.709 This is the, "ah-choo, 44:19.710 --> 44:23.700 ah-choo, we all fall down." 44:23.699 --> 44:25.969 Now, what did doctors do? 44:25.969 --> 44:29.809 What were treatments historically? 44:29.809 --> 44:33.519 There was a continuity of strategy from the Black Death, 44:33.518 --> 44:38.138 through the eighteenth century, based on Galenic principles of 44:38.135 --> 44:41.915 dealing with the a disequilibrium of the humors. 44:41.920 --> 44:46.900 So, the main indication of treatment was to assist the body 44:46.900 --> 44:51.880 in expelling what was called the peccant humor responsible, 44:51.880 --> 44:54.200 or the morbific poison. 44:54.199 --> 44:58.559 The physician regarded his task as one of assisting Nature, 44:58.561 --> 45:03.451 as the body was already clearly attempting to expel the poison. 45:03.449 --> 45:06.919 After all, it was vomiting, there was diarrhea and 45:06.920 --> 45:07.700 sweating. 45:07.699 --> 45:12.449 So, physicians attempted to assist the body in its fight; 45:12.449 --> 45:17.099 perhaps directly by bleeding, a very popular therapy, 45:17.099 --> 45:20.439 although there were intense debates about timing, 45:20.440 --> 45:25.450 about the best veins to be opened, and the amount of blood 45:25.449 --> 45:26.679 to be drawn. 45:26.679 --> 45:30.409 Other key practices were administering powerful 45:30.414 --> 45:34.644 purgatives or emetics, so the poison could pour forth 45:34.637 --> 45:38.007 more copiously; or to cause the patient to 45:38.009 --> 45:40.969 sweat, piling him or her high with clothes, 45:40.965 --> 45:44.055 even mattresses, so the poison would pass out 45:44.061 --> 45:47.781 through the pores; and forbidding the sufferer to 45:47.780 --> 45:50.230 drink; and of course lancing or 45:50.230 --> 45:54.970 cauterizing the bubo itself, so that it too could discharge 45:54.967 --> 45:57.497 its load of poison directly. 45:57.500 --> 46:01.160 Some doctors applied hot compresses. 46:01.159 --> 46:03.409 There were also internal medicines that were 46:03.411 --> 46:05.981 administered, as they were thought to raise 46:05.983 --> 46:08.683 the buboes, or to hasten recovery by 46:08.681 --> 46:13.411 fortifying what was called the flagging animal energy of the 46:13.407 --> 46:18.107 victim; things like brandy or opium. 46:18.110 --> 46:22.360 But in practice, treatment was pitifully rare 46:22.358 --> 46:24.578 for plague sufferers. 46:24.579 --> 46:29.269 Physicians, priests and attendants recognized that they 46:29.271 --> 46:32.361 were powerless; that they were too few in 46:32.358 --> 46:35.958 number to cope with the catastrophe that engulfed them. 46:35.960 --> 46:40.710 And they perished too in great numbers during the outbreaks. 46:40.710 --> 46:45.200 And many, overcome with terror like everyone else, 46:45.197 --> 46:46.477 simply fled. 46:46.480 --> 46:50.720 So, one of the terrors of the plague was that it broke the 46:50.717 --> 46:55.147 common bonds of humanity, and the common plight of plague 46:55.150 --> 46:57.880 victims was often to be abandoned, 46:57.880 --> 47:01.090 to face agony and death alone. 47:01.090 --> 47:10.550 Let's listen to the famous and awful testimony of Boccaccio in 47:10.547 --> 47:17.367 The Decameron, describing Florence. 47:17.369 --> 47:22.779 Sorry for a momentary technological glitch, 47:22.777 --> 47:25.607 but we'll get there. 47:25.610 --> 47:27.140 There we are. 47:27.139 --> 47:32.889 This is Boccaccio describing Florence in 1348. 47:32.889 --> 47:36.609 "Let us omit that one Citizen fled after another, 47:36.610 --> 47:39.620 and one neighbor had not any care of another, 47:39.619 --> 47:42.359 Parents nor kindred ever visiting them, 47:42.360 --> 47:45.710 but utterly they were forsaken on all sides: 47:45.708 --> 47:49.678 this tribulation pierced into the hearts of men, 47:49.679 --> 47:53.429 and with such a dreadful terror, that one brother forsook 47:53.431 --> 47:55.991 another, the Uncle, the Nephew, 47:55.989 --> 48:00.139 the Sister, the Brother, and the Wife the Husband: 48:00.143 --> 48:04.213 nay a matter much greater, and almost incredible; 48:04.210 --> 48:08.860 Fathers and Mothers fled from their own Children, 48:08.855 --> 48:13.205 even as if they no way appertained to them. 48:13.210 --> 48:16.020 In regard whereof, it could not be otherwise, 48:16.018 --> 48:19.848 but that a countless multitude of men and women fell sick; 48:19.849 --> 48:24.519 finding no charity among their friends, except a very few, 48:24.518 --> 48:28.778 and were subject to the avarice of servants." 48:28.780 --> 48:33.500 So, this is our first overview of plague in its three 48:33.500 --> 48:34.590 pandemics. 48:34.590 --> 48:39.250 Next time what I'd like to do is to talk about the response of 48:39.246 --> 48:43.916 communities to this catastrophe, and to look in particular at 48:43.920 --> 48:47.920 public health measures designed to protect communities. 48:47.920 --> 48:50.040 That's where we're heading next. 48:50.039 --> 48:54.999