164 PLAGUE in very exceptional positions, and as a rule would aggravate, by overcrowding, the intensity of the disease within. History of the Plague. The first historical notice of the plague is contained in a fragment of the physician Rufus of Ephesus, who lived in the time of Trajan, preserved in the Collections of Oribasius. 1 Rnfiis speaks of the buboes called pestilential as being specially fatal, and as being found chiefly in Libya, Egypt, and Syria. "He refers to the testimony of a physician Pionysius, who lived probably in the 3d century B.C. or earlier, and to Dioscorides and Posidonius, who fully described these buboes in a work on the plague which prevailed in Libya in their time. Whatever the precise date of these physicians may have been, this passage shows the antiquity of the plague in northern Africa, which for centuries was considered as its home. The great plague referred to by Livy (lx., Epitome) an dmore fully by Orosius (Histor., iv. 11) was pro bably the same, though the symptoms are not recorded. It is reported to have destroyed a million of persons in Africa, but is not stated to have passed into Europe. It is not till the 6th century of our era, in the reign of Justinian, that we find bubonic plague hi Europe, as a part of the great cycle of pestilence, accompanied by extraordinary natural phenomena, which lasted fifty years, and is described with a singular misunder standing of medical terms by Gibbon in his forty-third chapter. The descriptions of the contemporary writers Procopius, Evagrius, and Gregory of Tours are unite unmistakable.- The plague of Justinian began at Pelusium in Egypt in 542 A.I). ; it spread over Egypt, and in the same or the next year passed to Constantinople, where it carried off 10,000 persons in one day, with all the symptoms of bubonic plague. It appeared in Gaul in 546, where it is described by Gregory of Tours with the same symptoms as lues inguinaria (from the frequent seat of buboes in the groin). In Italy there was a great mortality in 543, but the most notable epidemic was in 565, which so depopulated the country as to leave it an easy prey to the Lombards. In 571 it is again recorded in Liguria, and in 590 a great epidemic at Rome is connected with the pontificate of Gregory the Great. But it spread in fact over the whole Roman world, beginning in maritime towns and radiating in land. In another direction it extended from Egypt along the north coast of Africa. Whether the numerous pestilences recorded in the 7th century were the plague cannot now be said ; but it is possible the pestilences in England chronicled by Bede in the years 664, 672, 679, and 683 may have been of this disease, especially as in 690 pestis inguinaria is again recorded in Rome. For the epidemics of the succeeding centuries we must refer to more detailed works. 3 It is impossible, however, to pass over the great cycle of epi demics in the 14th century known as the Black Death. Whether in all the pestilences known by this name the disease was really the same may admit of doubt, but it is clear that in some at least it was the bubonic plague. Contemporary observers agree that the disease was introduced from the East; and one eye-witness, Gabriel de Mussis, an Italian lawyer, traced, or indeed accom panied, the march of the plague from the Crimea (whither it was said to have been introduced from Tartary) to Genoa, where with a handful of survivors of a Genoese expedition he landed pro bably at the end of the year 1347. He narrates how the few that had themselves escaped the pest transmitted the contagion to all they met. 4 Other accounts, especially old Russian chronicles, place the origin of the disease still further to the east in Cathay (or China), where, as is confirmed to some extent by Chinese records, pestilence and destructive inundations are said to have destroyed the enormous number of thirteen millions. It appears to have passed by way of Armenia into Asia Minor and thence to Egypt and northern Africa. Nearly the whole of Europe was gradually overrun by the pestilence. It reached Sicily in 1346, Constantinople, Greece, and parts of Italy early in 1347, and towards the end of that year Marseilles. In 1348 it attacked Spain, northern Italy and Home, eastern Germany, many parts of France including Paris, and England; from England it is said to have been conveyed to the Scandinavian countries. In England the western counties were first invaded early in the year, and London in November. In 1349 we hear of it in the midlands ; and in subsequent years, at least till 1357, it prevailed in parts of the country, or generally, especially in the towns. In 1352 Oxford 1 Lib. xliv. cap. n,(Eucres de Oribate, ed. Busscmaker and Darembei p, Paris, 1R51, vol. iii. p. 607. 2 Evagrius, Hint. Ec.cle*., Iv. 29 ; Procopius, De Bella Periico, ii. 22, 23. 3 See Noah Webster s History of Epidemic Diseases, 8vo, "1 vols., London, 1800 (a work which makes no pretension to medical learning, but exhibits the history of epidemics in connexion with physical disai-ters, as earthquakes, famines, Ac.); Lernch, Klfine Pest-Ckronik, 8vo, 1880 (a convenient short compendium, but not always accurate); " Athanasii Kircheri Chronologia Pestium " (to 165(i A.D.), in Servtinium I estis (Rome, 1G5K), Leipsic, 1671, 4to; Bascome, History of Epidemic Pestilence*, London, 1851, 8vo. The most complete medical history of epidemics is Haescr s Geschichte der epidemisr/ttn Kranklir.iten (- Id edition, Jena, 188:>), form ing the third volume of his Jfislury of Medicine.
- Seethe original account reprinted with other documcn s in Haeser, Op. cit.;
also Hecker, Epidemics of the Middle Ages, trans, by Bat>ington, Sydenham Hoc., London, 1844; Voltttrankheiten Jff Mittela/terf, ed. Hirsch., Berlin, 1865; H. Hoeniger, Der &-hicarze Tod in Deutschland, Berlin, 1882. lost two-thirds of her academical population. The outbreaks of 1361 and 1368, known as the second and third plagues of the reign of Edward III., were doubtless of the same disease, though by some historians not called the black death. Scotland and Ireland, though later affected, did not escape. The nature of this pestilence has been a matter of much contro versy, and some have doubted its being truly the plague. But when the symptoms are fully described they seem to justify this conclusion, one character only being thought to make a distinction between this and Oriental plague, viz., the special implication of the lungs as shown by spitting of blood and other symptoms. Guy de Chauliac notes this feature in the earlier epidemic at Avignon, not in the later. Moreover, as this complication was a marked feature in certain epidemics of plague in India, the hypothesis has been framed by Hirsch that a special variety of plague, pestis Indian,, still found in India, is that which overran the world in the 14th century. But the same symptoms (haemoptysis) have been seen, though less notably, in many plague epidemics, even in the latest, that in Russia in 1878-79, and, moreover, according to the latest accounts, are not a special feature of Indian plague. Accord ing to Surgeon-General Francis (Tram. Epidem. S oc., vol v. p. 398) " hemorrhage is not an ordinary accompaniment" of Indian plague, though when seen it is in the form of haemoptysis. It seems, therefore, impossible to make a special variety of Indian plague, or to refer the black death to any such special form. Gabriel de Mussis describes it even in the East, before its arrival in Europe, as a bubonic disease. The mortality of the black death was, as is well known, enor mous. It is estimated in various parts of Europe at two-thirds or three-fourths of the population in the iirst pestilence, in England even higher, but some countries were much less severely affected. Hecker calculates that one-fourth of the population of Europe, or 25 millions of persons, died in the whole of the epidemics. It if hardly necessary to dwell upon the social results of this terrible mortality. In England great part of the country remained untilled, and the deficiency of labourers was such as to cause a sudden rise of wages, which, in spite of attempts to check it by legislation, is thought to have effected the final emancipation of the labouring class. On the other hand a great transfer of property to the church took place, with what results is well known. In the 15th century the plague recurred frequently in nearly all parts of Europe, in the first quarter it was very destructive in Italy, in Spain (especially Barcelona and Seville) , in Germany, and in England, where London was severely visited in 1400 and 1406, and again in 1428. In 1427 80,000 persons died in Dantzic and the neighbourhood. In 1438-39 the plague was in Germany, and its occurrence at Basel was described by ^Eneas Sylvius, afterwards Pope Pius II. In 1448-50 Italy (Kircher), Germany (Lersch, from old chronicles), France, and Spain were ravaged by a plague supposed to have arisen in Asia, scarcely less destructive than the black death. England was probably seldom quite free from plague, but the next great outbreak is recorded in 1472 and following years. In 1466 40,000 persons died of plague in Paris; in 1477-85 the cities of northern Italy were devastated, anil in 1485 Brussels. In the fifteenth year of Henry VII. (1499-1500) a severe plague in London caused the king to retire to Calais. The 16th century was not more free from plague than the 15th. Simultaneously with a terrible pestilence which is reported to have nearly depopulated China, plague prevailed over Germany, Holland, Italy and Spain in the first decade of the century, and revived at various times in the first half. In 1529 there was plague in Edin burgh ; in London in 1537-39, and again 1547-48 ; and also in the north of England, though probably not absent before. Some of the epidemics of this period in Italy and Germany are known by the accounts of eminent physicians, as Vochs, Fracastor, Mercun- alis, Borgarucci, Ingrassia, Massaria, Amici, &c., s whose writings are important because the question of contagion first began to be raised, and also plague had to be distinguished from typhus fever, which began in this century to appear in Europe. The epidemic of 1563-64 in London and England was very severe, a thousand dying weekly in London. In Paris about this time plamie was an everyday occurrence, of which some were less afraid than of a headache (Borgarucci). In 1570 200,000 persons died in Moscow and the neighbourhood, in 1572 50,000 at Lyons ; in 1568 and 1574 plague was at Edinburgh, and in 1570 atNewcastl When, however, in 1575 a new wave of plague passed over Europe, its origin was referred to Constantinople, whence it was said t have spread by sea to Malta, Sicily, and Italy, and by land through the Austrian territories to Germany. Others contended that 1 llfcirn iTiiini iiiinii /if rrftr.. TCII., i >, ">, % r ."? , i .,* littli- <r, Basel, 1.V.4, 8vo. The works of English physicians of thU period an- Of
medical value ; but Lodge s Treatlte ofthePlague (London, 1603) deserves mention.