Plagues & PeopleImago MortisPlague - the WordPlague - the Word (2)Plague - the Word (3)San Sebastiano e San Rocco Marchigiano late 15th centuryDeath With an Arrow From a French Book of Hours 2nd half 15th centuryThe PlayersYersinia pestis - TransmissionYersinia - Virulence FactorsPlague - Routes of TransmissionCutaneous Manifestations (1)Cutaneous Manifestations (2)General Bonaparte Visiting the Plague Stricken at Jaffa Jean-Gros 1804Slide 15The “Little” Plague Raphael/Raimondi ca 1514Doctors Incising BuboesPaleodiagnosis of Plague (1)Paleodiagnosis of Plague (2)Slide 20Phylogeny of Plague (2)Plague in the USPlague - Transmission in the USPlague - Current FociSome Early PlaguesPlague of Athens (430-426 BCE)Plague of Athens (2)Plague of Athens (3)Plague of Athens (4)First Pandemic of Bubonic PlagueFirst Pandemic-IslamIslam & the Plague (2)Black Death - Routes of SpreadBlack Death Spread (2)Black Death - Social UpheavalEconomics of Black Death 1347-55Black Death - Family StructurePlague by Dwelling (Bristol)Plague of 1665 - London (1)Plague of 1665 - DemographicsPlague of 1665 - EyamPlague of 1665 – Eyam (2)Plagues & People 2005Plagues & PeopleHoward M. ReisnerProfessor of Pathology6-4265 [email protected] & People 2005Imago MortisPlagues & People 2005Plague - 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 novelsPlagues & People 2005Plague - 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 5,6Plagues & People 2005Plague - 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)Plagues & People 2005San Sebastiano e San RoccoMarchigiano late 15th centuryPlagues & People 2005Death With an ArrowFrom a French Book of Hours 2nd half 15th centuryPlagues & People 2005The PlayersXenopsylla cheopis Yersinia pestisPlagues & People 2005Yersinia pestis - TransmissionYersinia pestisYersinia pseudotuberculosisBlocked FleaPlagues & People 2005Yersinia - Virulence FactorsPlagues & People 2005Plague - Routes of TransmissionPlagues & People 2005Cutaneous Manifestations (1)Plagues & People 2005Cutaneous Manifestations (2)Plagues & People 2005General Bonaparte Visiting the Plague Stricken at Jaffa Jean-Gros 1804Plagues & People 2005Plagues & People 2005The “Little” PlagueRaphael/Raimondi ca 1514Plagues & People 2005Doctors Incising BuboesPlagues & People 2005Paleodiagnosis of Plague (1)Mass grave from Marseilles (1720-1722)Pin implantation to verify deathPlagues & People 2005Paleodiagnosis of Plague (2)6/12 “plague teeth +, 0/7 controls - Pulp of unerupted teeth usedPlagues & People 2005PNAS 96:14043 1999123Phylogeny of Plague (1)Plagues & People 2005Phylogeny of Plague (2)Plagues & People 2005Plague in the USPlagues & People 2005Plague - Transmission in the USPlagues & People 2005Plague - Current FociPlagues & People 2005Some 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)Plagues & People 2005Plague 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 disputativePlagues & People 2005Plague 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 seasonalPlagues & People 2005Plague 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 headPlagues & People 2005Plague 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 hortatoryPlagues & People 2005First Pandemic of Bubonic Plague•Plague of Justinian (Byzantine Emperor 527-65 CE)–Started in Pelusium (Egyptian port), Alexandria, Egypt, Palestine, Syria•Origin said