Category Archives: disease

Germs and Steel, Not Guns, Aided Early Conquistadors

From Seven Myths of the Spanish Conquest, by Matthew Restall (Oxford, 2004), Kindle Loc. 3181-3207:

Guns, too, were of limited use. Cannons were few in number in the Americas, and without roads or navigable rivers, their transportation was a major challenge. Much of the Americas where Spaniards fought was tropical or subtropical, and in the humidity the powder became too wet to fire. Firearms, in the form of harquebuses, whose unwieldy barrels required the support of tripods, were likewise not plentiful and required dry powder. Vargas Machuca advocated Spaniards using harquebuses in the Americas, but his detailed exposition on how to avoid damaging the gun, getting it wet, or discharging it prematurely or by accident would surely have caused any conquistador to think twice about carrying such a weapon. The more reliable and faster-loading musket was not invented until decades after Cortés and Pizarro invaded the American mainland. Nor had Europeans yet developed volley-fire techniques, in which soldiers formed banks of rows in order to provide continuous fire, although there were seldom enough firearms in a Conquest company to have made good use of such a technique. Those Spaniards who did have firearms were lucky to get a single shot off before reversing the weapon to use as a club or dropping it to concentrate on sword wielding.

The one weapon, then, whose efficacy is indubitable was the steel sword. It alone was worth more than a horse, a gun, and a mastiff put together. Because a steel sword was longer and less brittle than the obsidian weapons of Mesoamerican warriors, and longer and sharper than Andean clubbing weapons or copper-tipped axes, a Spaniard could fight for hours and receive light flesh wounds and bruises while killing many natives. Spanish swords were just the right length for reaching an enemy who lacked a similar weapon. Pizarro preferred to fight on foot so he could better manipulate his sword. Descriptions of battles in which Spanish swordplay caused terrible slaughter among native forces pepper the Conquest accounts of Cieza de León, Cortés, Díaz, Gómara, Jerez, Oviedo y Baños, Zárate, and others. Military historian John Guilmartin deftly summarizes the point: “While Spanish success in combat cannot be attributed to a single factor, it is clear that the other elements of Spanish superiority took effect within a tactical matrix established by the effectiveness of Spanish hand-held slashing and piercing weapons.”

This trilogy of factors—disease, native disunity, and Spanish steel—goes most of the way toward explaining the Conquest’s outcome. Remove just one and the likelihood of the failure of expeditions under Cortés, Pizarro, and others would have been very high. As Clendinnen has observed of the Spanish-Mexica war, both Spaniards and natives were aware that the Conquest was “a close-run thing,” a point that applies broadly across the Conquest. The failed expeditions outnumbered successful ones, and cautionary tales can be found by looking at the fate of Spanish expeditions such as Montejo’s early attempts to conquer Yucatan, the early campaigns into Oaxaca’s northern sierra, or the Pizarro-Orellana journey into Amazonia. Spaniards would have suffered steady mortality from fatal wounds, starvation, disease, and so on, with survivors limping back to Spain or to colonial enclaves scattered along the coasts and islands. Time and again, this outcome was averted because Spanish steel weapons permitted them to hold out long enough for native allies to save them, while the next wave of epidemic disease disrupted native defenses.

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Punitive Social Work in Vietnam

From: Vietnam: Rising Dragon, by Bill Hayton (Yale U. Press, 2010), Kindle Loc. 1379-1432:

The official response to public prostitution, public drug use and public vagrancy is the same: first of all try to persuade the offender to change their uncivilised lifestyle and then, if they fail to reform, remove them from the city. Control of what the authorities still call ‘social evil’ falls, not to the police, but to the local People’s Committee. Party cadres will visit uncivilised households, Women’s Union activists will try to persuade prostitutes to give up their trade and local neighbourhood wardens will try to organise neighbours to fight antisocial behaviour. But if they fail then the People’s Committee – not the court – will order detention. The campaign to promote civilised living has co-opted the old ways of dealing with social problems: exclusion and re-education.

From political dissidents in the 1950s, to army officers from the defeated south in the 1970s, to prostitutes and drug users now, the Party has long treated ‘deviants’ on the premise that it can change their minds and make them ‘better’ citizens. Re-education is an unsettling combination of liberalism and totalitarianism. On the one hand the regime believes that most of those with unacceptable behaviour can be ‘reformed’, but on the other it has a very rigid definition of acceptable behaviour. In practice, re-education has been far from liberal. Hundreds, perhaps thousands, of former southern soldiers, officials and dissidents died from abuse and neglect in re-education camps after the war and these days the centres set up to reform cases of ‘social evil’ more often harm their inmates than help them.

Male drug users are sent to ‘06 centres’. Female sex workers, who may also be drug users, are sent to ‘05 centres’ and street children to social protection centres. These are usually in remote places and although they are managed by the Ministry of Labour, Invalids and Social Affairs (MoLISA) rather than the Ministry of Public Security, in practice they are run like prisons. There are more than 80 state-run 06 centres in the country, each holding around a thousand inmates. There are few, if any, trained drugs counsellors or social workers in the centres; staff are simply allocated to work there by the Ministry. Inmates are all treated the same; little attempt is made to understand individuals or why they might have become involved with drugs or sex work. Re-education isn’t exactly stimulating. Half the day is spent memorising Party positions and the laws on crime, and chanting slogans such as: ‘The whole nation condemns social evil’. The rest is spent performing manual labour. The inmates wear blue striped pyjamas, conditions are hard and they are frequently beaten.

Unsurprisingly, the centres usually fail. They keep people off the streets for two or three years but then return them to the same neighbourhood and the same social problems, and the result is almost always the same. They’re then likely to be picked up again and sent away for another spell in the camp. While the centres may give the authorities the impression that they’re in control of the problem, in many ways they’ve made it worse. Surveys suggest that 60 per cent of the inmates of 06 centres are now HIV-positive. Though the authorities deny it, intravenous drug use is rampant and there is plenty of unsafe sex between inmates. Given that neither problem is supposed to exist, MoLISA refuses to provide them with clean needles or condoms. Maintaining the Party line has failed to change inmates’ behaviour. Instead it’s just increased the prevalence of HIV.

Party experts and government officials are struggling to find new ideas for ways to cope with the problems of the new society they are building. The top of the hierarchy clings to the utopian idea that socialism can solve everything. Theoreticians still argue over the legacies of social thinkers like Karl Marx, Max Weber and Émile Durkheim and their implications for solving the country’s problems. The lower levels try to cope using whatever resources are to hand. Social work – once abolished on the grounds that it was unnecessary under socialism – is being encouraged again. Religious groups, including the Catholic Church, are being allowed to provide social care; ‘empathy groups’ of families of people with HIV are being allowed to organise autonomously of the Party; and international experts from the UN and other agencies are being invited to advise on new strategies. Western-trained practitioners are turning local NGOs into agencies to try to treat the problems directly.

The problems are tying the Party’s ideologues up in ideological knots. For decades they argued that social evils were the result of foreign and capitalist influence, starting under the French and continuing under the Americans. Trying to explain why they have surged now, under Party leadership, has pitted theorists who hold the line that socialism has the answers against practitioners who work on the assumption that it hasn’t. It seems unlikely that the old line can be held for much longer but it still has powerful supporters. They don’t understand the new world they have created – they still announce strategies calling for a 90 per cent reduction in crime, for example – and for the time being it’s easier to fall back on traditional ideas than seek out new ones. Other arguments are familiar from other countries. Why should money be spent on those who’ve abused the Party, state and nation’s generosity when loyal citizens get by with less? Many people, addicts’ families included, see the re-education camps as a good solution to the problem. Families have been known to imprison their own children at home or bribe the army to send them to bases on remote islands to prevent them using drugs – why should they be opposed to sending them away to an 06 centre?

Similar dilemmas exist over street children. There are few sights which offend urbanites – Vietnamese and foreign – more than seeing children living on the street. Compared with most cities in Asia, the number of visible street children in Vietnam is relatively small, but that doesn’t mean they don’t exist. The authorities in the two big cities take dramatically contrasting approaches. Hanoi tends to be more hard line, regularly rounding up apparently vagrant children. In Ho Chi Minh City they are more tolerant. In Hanoi shoe-shine boys have learnt not to carry the tools of their trade openly. Instead they buy a school uniform and carry the brushes and polish in a rucksack so that the police don’t spot them. They also take less visible jobs, working in the markets rather than selling postcards in the tourist areas. In Ho Chi Minh City, tolerance has allowed well-organised trafficking rings to flourish. They ‘rent’ children from poor families, particularly in the centre of the country, promising to take care of their accommodation and employment. They tell the families the children will be trained and well looked after but the kids are usually put to work as cheap labour; selling flowers, cutting cloth and working in restaurants or as domestic servants. Sixteen-hour days, minimal wages and Dickensian accommodation are the norm.

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Scope of the Great War of Africa, 1996–?

From Dancing in the Glory of Monsters: The Collapse of the Congo and the Great War of Africa, by Jason Stearns (Public Affairs, 2011), Kindle Loc. 130-146:

The Democratic Republic of the Congo is a vast country, the size of western Europe and home to sixty million people. For decades it was known for its rich geology, which includes large reserves of cobalt, copper, and diamonds, and for the extravagance of its dictator Mobutu Sese Seko, but not for violence or depravity.

Then, in 1996, a conflict began that has thus far cost the lives of over five million people.

The Congolese war must be put among the other great human cataclysms of our time: the World Wars, the Great Leap Forward in China, the Rwandan and Cambodian genocides. And yet, despite its epic proportions, the war has received little sustained attention from the rest of the world. The mortality figures are so immense that they become absurd, almost meaningless. From the outside, the war seems to possess no overarching narrative or ideology to explain it, no easy tribal conflict or socialist revolution to use as a peg in a news piece. In Cambodia, there was the despotic Khmer Rouge; in Rwanda one could cast the genocidal Hutu militias as the villains. In the Congo these roles are more difficult to fill. There is no Hitler, Mussolini, or Stalin. Instead it is a war of the ordinary person, with many combatants unknown and unnamed, who fight for complex reasons that are difficult to distill in a few sentences—much to the frustration of the international media. How do you cover a war that involves at least twenty different rebel groups and the armies of nine countries, yet does not seem to have a clear cause or objective? How do you put a human face on a figure like “four million” when most of the casualties perish unsensationally, as a result of disease, far away from television cameras?

The conflict is a conceptual mess that eludes simple definition, with many interlocking narrative strands. The New York Times, one of the few American newspapers with extensive foreign coverage, gave Darfur nearly four times the coverage it gave the Congo in 2006, when Congolese were dying of war-related causes at nearly ten times the rate of those in Darfur.

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Help the Victims of Genocide or the Perpetrators?

From Dancing in the Glory of Monsters: The Collapse of the Congo and the Great War of Africa, by Jason Stearns (Public Affairs, 2011), Kindle Loc. 608-620:

The refugee camps were set up in July 1994 and stayed in place for over two years. Some would swell to contain more than 400,000 inhabitants, becoming the largest refugee camps in the world and larger than any city in eastern Zaire. Together they housed over a million people. In a perverse way, they provoked a mobilization of international resources that the genocide never had. Within days of the first arrivals, aid workers detected a cholera outbreak; the virulent parasite spread fast in the unhygienic and cramped quarters. Without proper health care, the disease killed the weak refugees within days, emptying their bodies of liquids through violent diarrhea and vomiting until their organs failed. By July 28, 1994, a thousand bodies were being collected a day and dumped unceremoniously into chalk-dusted pits by the dump-truck load.

Foreign television crews who had not been able to reach Rwanda during the genocide now set up camp in Goma; the pictures of hundreds of chalk-dusted bodies tumbling into mass graves suggested a strange moral equivalency to the recent genocide, except that this catastrophe was easier to fix: Instead of a complicated web of violence in which military intervention would have been messy and bloody, here was a crisis that could be addressed by spending money. Over the next two years, donors spent over $2 billion on the refugee crisis in eastern Zaire, more than twice as much as they spent on helping the new Rwandan government. The RPF was furious. Vice President Paul Kagame lamented, “Personally, I think this question of refugees is being overplayed at the expense of all our other problems. We no longer talk about orphans, widows, victims [in Rwanda]. We’re only talking about refugees, refugees, refugees.”

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Wordcatcher Tales: Yakinokori-zei, Yoyū-jūtaku-zei

From The Magatama Doodle: One Man’s Affair with Japan, 1950–2004, by Hans Brinckmann (Global Oriental, 2005), pp. 99-100:

She had contracted tuberculosis towards the end of the war, and had spent her teenage years in hospital and at home to fight the disease and recuperate. American-made streptomycin, not available in Japan at the time, saved her. Bought at great expense on the black-market, it consumed a good part of what remained of the family’s fortune after MacArthur’s confiscatory property taxes, including the infamous yakinokori-zei, ‘having-survived-the-bombings tax’ [焼き残り税 ‘burn-remainder tax’], levied on houses that were left standing, followed by the yoyū-jūtaku-zei, the ‘excess living space tax’ [余裕住宅税 ‘surplus residence tax’]. As she had been unfit to attend class, she had been tutored at home to prepare her for higher education.

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Japan’s Worst Century, the 700s

From Japan to 1600: A Social and Economic History, by William Wayne Farris (U. Hawai‘i Press, 2009), pp. 36-37:

Between 698 and 800, there were at least thirty-six years of plagues in Japan, or about one every three years. The most well-documented epidemic—and to judge by the mortality and its social, economic, and political effects, the most significant—was a smallpox outbreak during 735–737. It started in northern Kyushu, a certain sign of its foreign origin, but by 737 the virus had spread up the Inland Sea and on to eastern Honshu, aided, ironically enough, by the improved network of roads linking the capital and provinces. To its credit, the court tried to apply pragmatic principles to treat the symptoms of the disease, but to little effect. Statistics from various provinces scattered from northern Kyushu to eastern Honshu suggest that mortality was about twenty-five percent, meaning that a million or more persons may have succumbed. As a result of the depopulation, an entire layer of village administration was abolished. Another irony was that the death rate among the exalted aristocracy—living crowded together in the capital at Nara—was even higher, a full thirty-nine percent. At the end of 737, chroniclers wrote,”Through the summer and fall, people … from aristocrats on down have died one after another in countless numbers. In recent times, there has been nothing like this.” In the wake of the epidemic, government revenues plunged by more than twenty percent, even more draconian measures were implemented to stem cultivator flight from the land, and a guilt-ridden [Emperor] Shōmu approved large expenditures for Buddhist temples, statues, and other religious icons.

Epidemics certainly helped to reverse the long demographic expansion of the last several centuries, but two other factors contributed to population stasis. The first was crop failure and widespread famine, occurring about every third year between the late seventh and eighth centuries. Causes for bad harvests were complex, but various climate data indicate that the eighth century was one of the hottest and driest in Japanese history. In Western Europe, where there was a “medieval warm” at this time, the effect was to dry out water-logged soils and encourage the expansion of agriculture; in Japan, where farmers often depended upon rainfall as the only way to irrigate their paddies, the result was frequent crop failure and hunger. At ten to fifteen percent, mortality from a severe famine was lower than an epidemic, but, like pestilence, malnutrition also reduced fertility. Even in years when the harvest seemed adequate, the populace frequently went hungry in the spring when their supplies of grain were exhausted. More sophisticated means of watering rice paddies may have remedied the problem, but they were either unavailable or not applied.

A second factor leading to population stasis was the ecological degradation besetting the Kinai, the richest and most financially important region in the eighth century. Altogether, the government sponsored the construction of six capital cities and countless temples, shrines, and aristocratic mansions from 690 to 805. All these structures were built from timber harvested in the Kinai and adjacent provinces, and most had roof tiles requiring baking with charcoal in a kiln. During the second half of the eighth century, the shortage of lumber became so critical that planners began to recycle used timbers and roof tiles from older capitals, such as Fujiwara and Naniwa. When the court left Nara for Nagaoka in 784, for example, they used recycled lumber and tiles almost exclusively.

By the late eighth century, tile bakers were relying upon red pine to fire their kilns, a secondary forest cover that typically grows in nutrient-poor soil. Furthermore, the government began to note that the bald mountains in the Kinai and vicinity produced less rain and more erosion. In essence, the stripping of the forests throughout central Japan exacerbated the effects of the hot, dry climate and encouraged farmers to give up cropping altogether and flee to the seashores and mountains to forage as of old.

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More Good News about DDT

WASHINGTON (Reuters) – Mosquitoes that carry malaria, dengue fever and yellow fever avoid homes that have been sprayed with DDT, researchers reported on Wednesday.

The chemical not only repels the disease-carrying insects physically, but its irritant and toxic properties helps keep them away, the researchers reported in the Public Library of Science journal PLoS ONE.

They estimate that DDT spray reduced the risk of disease transmission by nearly three-quarters.

Malaria affects more 40 percent of the world’s population, killing more than a million people every year, most of them young children.

DDT use has been discontinued in most countries because of fears the pesticide may cause cancer and because of its potential effects on animals such as birds.

But the World Health Organization last year recommended the use of DDT in places like Africa where malaria is still common, saying the benefits outweighed the risks.

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Black Death Zerstörungsroman on a Plaque, 1349

In Derbyshire …, the most eloquent set of mortality statistics are in a small parish church where a plaque commemorates the Wakebridge family’s brush with annihilation in the summer of 1349.

  • 18 May, Nicholas, brother of William
  • 16 July, Robert, brother of William
  • 5 August, Peter, father of William and Joan, sister of William
  • 10 August, Joan, wife of William and Margaret, sister of William

William himself survived the pestilence.

SOURCE: The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time, by John Kelly (Harper Perennial, 2006), p. 226

UPDATE: I concocted the pseudo-German term Zerstörungsroman ‘destruction-novel’ as the opposite of Bildungsroman, a German term applied to novels about personal growth, education, and development. I was trying to capture the opposition between ‘coming of age’ and ‘falling apart’ (or the ‘age of destruction’).

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Medical Professionalization in Medieval Europe, 1300s

On November 2, 1322, Madame Felicie was convicted of violating an ordinance that prohibited unlicensed healers from visiting, prescribing medications, or performing other duties for a patient, except under the guidance of a university-trained and licensed physician. The conviction was a major victory for the Paris Medical Faculty, a principal architect of the new medical pecking order, which had a pyramid-like shape. At the pinnacle was a relatively small coterie of the university-trained physicians; they practiced what we would call internal medicine. Beneath them were the general surgeons, who usually lacked academic training, although that was changing. By the early fourteenth century surgery was beginning to find a place in the medical schools. A surgeon could treat wounds, sores, abscesses, fractures, and other disorders of the limbs and skin. Beneath the general surgeon “was the barber surgeon, a kind of paramedic, who could perform minor operations, including bleeding, cupping, and applying leeches, as well as cutting hair and pulling teeth; next came the apothecary and the empiric, who usually specialized in a single condition, like hernias or cataracts. At the base of the pyramid were thousands of unlicensed healers like Madame Felicie.

To reflect their new eminence, in the decades prior to the plague, physicians began to adopt a more professional—that is, authoritative—demeanor and code of behavior. A cardinal “don’t” in the new medical etiquette was: don’t jeopardize your professional dignity by visiting patients to solicit business. “Your visit means you are putting yourself in the patient’s hands,” warned William of Saliceto, “and that is just the opposite of what you want to do, which is getting him to express a commitment to you.” A cardinal “do” in the new etiquette was to conduct a comprehensive physical exam on a first visit; the exam should include not just urinalysis, but a detailed medical history and an analysis of the patient’s breath odor, skin color, muscle tone, saliva, sweat, phlegm, and stool. Some physicians also cast a patient’s horoscope on the first visit. Another cardinal “don’t” in the new etiquette was to admit to diagnostic uncertainty. Even when in doubt, said Arnauld of Villanova, a physician should look and act authoritative and confident. For the uncertain physician, Arnauld recommended prescribing a medicine, any medicine, “that may do some good but you know can do no harm.” Another strategy was to “tell the patient and his family that [you are] prescribing this or that drug to cause this or that condition in the patient so that [they] will always be looking for something new to happen.” A third “don’t” in the new etiquette was volubility. Reticence conveyed authority, especially when combined with a grave manner; besides, said one savant, the physician who discusses his medical reasoning with the patient and his family risks letting them think that they know as much as he does, and that may tempt them to dispense with his services.

What made the university-trained physician such an impressive figure to laymen, however, was not only his authoritative bedside manner but his mastery of the arcanae of the New Galenism. Its signature principle was the theory of the four humors. For the ancient Greeks, whose thinking shaped so much medieval medicine, the number four was, like the atom, a universal building block. Everything, the Greeks believed, was made out of four of something. In the case of the physical world, the four elements were earth, wind, water, and fire; in the case of the human body, the four humors were blood, black bile, yellow bile, and phlegm. An important element in the humoral theory were the four qualities of all matter: hot and cold, wet and dry. Thus, blood was said to be hot and moist; black bile, cold and dry; yellow bile, hot and dry; and phlegm, cold and wet.

SOURCE: The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time, by John Kelly (Harper Perennial, 2006), pp. 167-169

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Dids Rats or Catapulted Cadavers Bring Plague to Caffa?

[In 1346] one Russian chronicle speaks of the plague arriving on the western shore of the Caspian Sea and attacking several nearby cities and towns, including Sarai, capital of the Mongol Principality of the Golden Horde and home to the busiest slave market on the steppe. A year later, while Sarai buried its dead, the pestilence lurched the final few hundred miles westward across the Don and Volga to the Crimea, came up behind the Tartar army in the hills above Caffa, and bit it in the back of the neck.

The Genoese, who imagined that God was born in Genoa, greeted the plague’s arrival with prayers of thanksgiving. The Almighty had dispatched a heavenly host of warrior angels to slay the infidel Mongols with golden arrows, they told one another. However, in de’ Mussis’s account of events, it is Khan Janibeg who commands the heavenly host at Caffa. “Stunned and stupefied” by the arrival of the plague, the notary says that the Tartars “ordered corpses to be placed in catapults and lobbed into the city in hopes that the intolerable stench would kill everyone inside…. Soon rotting corpses tainted the air …, poisoned the water supply, and the stench was so overwhelming that hardly one man in several thousand was in a position to flee the remains of the Tartar army.”

On the basis of de’ Mussis’s account, Janibeg has been proclaimed the father of biological warfare by several generations of historians, but the notary may have invented some of the more lurid details of his story to resolve an inconvenient theological dilemma. Self-evidently—to Christians, at least—the plague attacked the Tartars because they were pagans, but why did the disease then turn on the Italian defenders? Historian Ole Benedictow thinks de’ Mussis may have fabricated the catapults and flying Mongols to explain this more theologically sensitive part of the story—God did not abandon the gallant Genoese, they were smitten by a skyful of infected Tartar corpses, which, not co-incidentally, was just the kind of devious trick good Christians would expect of a heathen people. Like most historians, Professor Benedictow believes the plague moved into the port the way the disease usually moves into human populations—through infected rats.* “What the besieged would not notice and could not prevent was that plague-infected rodents found their way through the crevices in the walls or between the gates and the gateways,” says the professor….

* Khan Janibeg does have one stout modern defender, Mark Wheelis, a professor of microbiology at the University of California. The professor notes that in a recent series of 284 plague cases, 20 percent of the infections came from direct contact—that is, the victim touched an object contaminated with the plague bacillus, Y. pestis. “Such transmissions,” he says, “would have been especially likely at Caffa, where cadavers would have been badly mangled by being hurled, and many of the defenders probably had cut or abraded hands from coping with the bombardment.” Professor Wheelis also thinks the rat scenario favored by many historians ignores a crucial feature of medieval siege warfare. To stay out of arrow and artillery range, besiegers often camped a kilometer (six-tenths of a mile) away from an enemy stronghold—normally beyond the range of the sedentary rat, who rarely ventures more than thirty or forty meters from its nest. (Mark Wheelis, “Biological Warfare at the 1346 Siege of Caffa,” Emerging Infectious Diseases 8, No. 9 [2002]:971–75.)

SOURCE: The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time, by John Kelly (Harper Perennial, 2006), pp. 8-9

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