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Bubonic plague

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Plague

Plague or The Plague may refer to:

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Bubonic plague

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A Journal of the Plague Year

A Journal of the Plague Year: Being Observations or Memorials, Of the most Remarkable Occurrences, As well Publick as Private, which happened in London During the last Great Visitation In 1665 , commonly called A Journal of the Plague Year , is a book by Daniel Defoe , first published in March 1722. It is an account of one man's experiences of the year 1665, in which the bubonic plague struck the city of London in what became known as the Great Plague of London , the last epidemic of plague in that city. The book is told somewhat chronologically, though without sections or chapter headings, and with frequent digressions and repetitions. Presented as an eyewitness account of the events at the time, it was written in the years just prior to the book's first publication in March 1722. Defoe was only five years old in 1665 when the Great Plague took place, and the book itself was published under the initials H. F. and is probably based on the journals of Defoe's uncle, Henry Foe, who, like 'H. F.', was a saddler who lived in the Whitechapel district of East London . In the book, Defoe goes to great pains to achieve an effect of verisimilitude , identifying specific neighbourhoods, streets, and even houses in which events took place. Additionally, it provides tables of casualty figures and discusses the credibility of various accounts and anecdotes received by the narrator. The book is often compared to the actual, contemporary accounts of the plague in the diary of Samuel Pepys . Defoe's account, which appears to include much research, is far more systematic and detailed than Pepys's first-person account.How the Journal is to be classified has been disputed. It was initially presented and read as a work of nonfiction, but by the 1780s the work's fictional status was accepted. Debate continued as to whether Defoe could be regarded as the work's author rather than merely its editor. Edward Wedlake Brayley wrote in 1835 that the Journal is "emphatically, not a fiction, not based on fiction ... great injustice is done to [Defoe's] memory so to represent it." Brayley takes pains to compare Defoe's account with known bona fide accounts such as Loimologia by Dr. Nathaniel Hodges (1672), the diary of Samuel Pepys , and Thomas Vincent 's God's Terrible Voice in the City by Plague and Fire (1667), as well as primary sources. This view was also held by Watson Nicholson – writing in 1919 – who argued that "there is not one single statement in the Journal , pertinent to the history of the Great Plague in London, that has not been verified during the course of this investigation", and "we are compelled to class the Journal of the Plague Year with authentic histories." It is, according to Nicholson, "a faithful record of historical facts ... [and] was so intended by the author." At least one modern literary critic, Frank Bastian , has agreed that "the invented detail is ... small and inessential" and that the Journal "stands closer to our idea of history than to that of fiction", and that "any doubts that remain whether to label it "fiction" or "history" arise from the ambiguities inherent in those words." Other literary critics have argued that the work should be regarded as a work of imaginative fiction, and thus can justifiably be described as an "historical novel". This view was held by Everett Zimmerman, who wrote that "It is the intensity of the focus on the narrator that makes A Journal of the Plague Year more like a novel than like ... history." Indeed, Defoe's use of the narrator "H.F.", and his initial presentation of the Journal as being the recollections of an eye-witness to the plague, is the major sticking point for critics who consider it more of a "romance" – "one of the peculiar class of compositions which hovers between romance and history" as it was described by Sir Walter Scott – than a historical account. Walter George Bell, a historian of the plague, noted that Defoe should not be considered to be a historian because he uses his sources uncritically. Scott's somewhat ambiguous view of the nature of the Journal was shared by Defoe's first major biographer, Walter Wilson , who wrote in Memoir of the Life and Times of Daniel De Foe (1830) about it that "[Defoe] has contrived to mix up so much that is authentic with the fabrications of his own brain, that it is impossible to distinguish one from the other; and he has given the whole such a likeness to the dreadful original, as to confound the sceptic, and encircle him in his enchantments." In Wilson's view the work is an "alliance between history and fiction" in which one continually morphs into the other and back again. This view is shared by John Richetti who calls the Journal a type of "pseudohistory", a "thickly factual, even grossly truthful book" in which "the imagination ... flares up occasionally and dominates those facts." These alternative conceptualisations of the Journal – as fiction, history, or history-cum-fiction – continue [ needs update ] to exist. A Journal of the Plague Year also served as the initial inspiration for Anthony Clarvoe 's play The Living .References to the book's title have been made in Michael D. O'Brien 's 1999 novel Plague Journal , where the narrator and main character chooses the title to describe the theme of the book (jokingly referring to himself as a modern-day Defoe) and Norman Spinrad 's 1995 Journals of the Plague Years , a satirical novel about a sexually transmitted viral disease that cannot be defeated by vaccines, referencing how AIDS was in its earliest days known as "the gay plague" . A comparison of plague-driven behaviour described by Defoe and the COVID-19 crisis of 2020 is discussed in "Persistent Patterns of Behavior: Two Infectious Disease Outbreaks 350 Years Apart", an article in the journal Economic Inquiry , and also in a commentary in The Guardian .

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Bubonic plague

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The Plague Dogs (film)

21 October 1982 ( 1982-10-21 ) (United Kingdom) 9 January 1985 ( 1985-01-09 ) (United States) United Kingdom United States The Plague Dogs is a 1982 animated adventure drama film , based on the 1977 novel of the same name by Richard Adams . It was written, directed and produced by Martin Rosen , who also directed Watership Down , the film adaptation of another novel by Adams, with animation direction by Tony Guy. The Plague Dogs was produced by Nepenthe Productions ; it was released by Embassy Pictures in the United States and by United Artists in the United Kingdom. The film was originally released unrated in the United States, but for its DVD release, was later re-rated PG-13 by the MPAA for mature themes such as animal cruelty , violent imagery, and emotionally distressing scenes. The Plague Dogs is the first non-family-oriented MGM animated film, and the first adult animated feature by the studio. The film's story is centered on two dogs named Rowf and Snitter, who escape from a research laboratory in Great Britain . In the process of telling the story, the film highlights the cruelty of performing vivisection and animal research for its own sake (though Rosen said that this was not an anti-vivisection film, but an adventure).Rowf, a labrador - mix , and Snitter, a smooth fox terrier , are two of many dogs used for experimental purposes at an animal research facility in the Lake District of north-western England . Snitter has had his brain surgically experimented upon-(leaving the top of his head scarred and covered with bandages) while Rowf has been drowned and resuscitated repeatedly. One evening, Snitter squeezes under the netting of his cage and into Rowf's, where they discover his cage is unlatched. They explore the facility in order to escape until they sneak into the incinerator , where they are nearly killed before finally escaping. Initially relieved and eager to experience their new freedom, the dogs are soon faced not only with the realities of life in the wild but with another more terrifying realization—they are being hunted by their former captors. They come to befriend the Tod, a nameless Geordie -accented fox who goes by the local slang term for a wild fox. The Tod teaches them to hunt in the wild in exchange for a share of their kills. Snitter hopes for a new home as he once had a master, but after accidentally killing a man by stepping onto the trigger of his shotgun as he climbs up onto him, Snitter loses hope. As time passes the two dogs grow emaciated, having to steal more and more food while still avoiding capture. The Tod is also proven to be difficult for the dogs to understand and cooperate. When the Tod finds a nest of eggs, he eats them all himself, enraging Rowf. The Tod himself disapproves of their risky behaviour, like killing domestic sheep grazing on the local hills. They go their separate ways for a time, but the Tod eventually returns to assist them by distracting a lab-hired gunman who then falls to his death. The three reconcile and wander about aimlessly, with the 3rd Battalion Parachute Regiment and the media roped into the pursuit, driven by rumours of the two dogs carrying bubonic plague and killing humans and sheep. The Tod parts company with the two dogs after leading them to a train pulled by River Irt on the Ravenglass and Eskdale Railway . While the dogs escape on the train, the Tod sacrifices his life distracting the humans in order to allow Snitter and Rowf to escape. Thanks to the Tod's distraction, Snitter and Rowf arrive at the coastal village of Ravenglass , but upon departing the train, the two dogs are spotted by an RAF Sea King helicopter and are pursued by it until they reach the shoreline and can run no further. As armed troops approach and prepare to shoot the dogs, Snitter looks out over the water and claims to see an island—he jumps into the sea and begins to swim to it. Rowf is hesitant to follow due to his conditioned fear of water , but his greater fear of the gunmen drives him to jump in as well and catch up with Snitter. Two gunshots are fired at the dogs but seemingly miss; immediately a white mist envelops the pair, and the humans and the helicopter disappear. The dogs swim through the mist towards the island Snitter claims to see but Rowf can't spot, until, at last, Snitter begins to doubt that "there is any island" and he stops paddling, losing hope. Rowf, however, claims to finally spot the island and urges Snitter to continue. As the dogs elude the helicopters in the foggy sea, audio from a phone conversation reveals that the lab would need to cease all experiments and shut down. By causing such a local panic, Rowf and Snitter saved the other lab animals from their cruelty. The dogs venture forth heading further into the mist, en route to what maybe is an island possibly waiting for them on the other side of it. The fates of Rowf and Snitter are left on an ambiguous note, as the sea they are swimming through is engulfed in an even thicker layer of mist. The following moment segues to the reveal of an island visible in the distance on the horizon. It is left uncertain if the body of land shown actually exists and is really there or if it is just an illusion with symbolic meaning.The film was animated in both Britain and San Francisco , California between 1979 and 1982. British animators such as Arthur Humberstone, Alan Simpson, George Jackson , and Colin White came from the unit that had previously worked on Watership Down . The San Francisco crew included Brad Bird , Phil Robinson, and Retta Scott , a "Disney veteran who had animated the vicious hunting dogs in Bambi ." Goldcrest Films invested £900,000 in the film and earned £308,000, losing the company £595,000. Jake Eberts who helped finance this and Watership Down thought the filmmakers made two errors: the film was downbeat with an unhappy ending, unlike the book, and was made without a distributor (an arrangement was made with Embassy but then the filmmakers wanted to re-negotiate and Embassy pulled out while United Artists became the film's UK distributor). The theme song, "Time and Tide", was composed and sung by Alan Price . The song, as well as dialogue from the film, was sampled by the Canadian industrial group Skinny Puppy for their anti-vivisection single , " Testure ", from their 1988 album VIVIsectVI . The theme song, "Time and Tide", was composed and sung by Alan Price . The song, as well as dialogue from the film, was sampled by the Canadian industrial group Skinny Puppy for their anti-vivisection single , " Testure ", from their 1988 album VIVIsectVI . The film had a test screening in Seattle on 17 December 1983. Rosen had difficulty in finding distributors for the film, and it entered a limited release in the U.S. on 9 January 1985. On Rotten Tomatoes the film has an approval rating of 63% based on reviews from eight critics, with an average rating of 7.3/10 . Janet Maslin , in her 1985 New York Times review of the U.S. release, praised the visual style: "Martin Rosen treats his Plague Dogs almost as though it were live action. He varies the scenery and the camera angles imaginatively [...] Mr. Rosen's direction is quite ingenious, much more so than Mr. Adams's story." Two versions exist: the original UK theatrical release (103 minutes) and the edited US version (86 minutes). Most edits were made to reduce running time but one was for its shocking content: After hired gunman Ackland falls to his death from a steep crag from which he attempts to shoot the dogs, a military helicopter flies over the snow-covered crags and valleys and the soldiers in the helicopter find the body ripped to shreds, implying that the starving dogs had eaten the corpse. The full theatrical cut was first released on a UK rental-only, PG-certificate VHS by Thorn EMI in December 1983; only around 8,000 copies were issued. On 22 August 1988, it was commercially released on VHS in the UK by Warner Home Video . In 1986, the edit was released on US VHS by Charter Entertainment . In 2002, Anchor Bay released a Region 2 DVD, but contained the US recut. Soon afterwards, Dutch budget label Indies Home Entertainment released a Region 2 disc which also contained the US cut but includes forced Dutch subtitles. In 2004, a DVD was released by Hollywood DVD in the UK with the US cut. Trinity Home Entertainment released their DVD in the United States the same year; Trinity tried to get the full cut, but when they were unable to obtain it, they ended up settling with using the truncated US version. Trinity's DVD was re-released by Phase 4 Films in 2010. In 2005, Australian distributor Umbrella Entertainment released both cuts on Region 4 DVD (they also released the full theatrical cut of Watership Down ), sourced from Rosen's private print. The same print was later released on Region 2 DVD in the UK by Optimum Releasing in 2008. In 2017, Shout! Factory announced that they had acquired the rights to the film in the United States, and that they would release the film for the first time on Blu-ray on 24 February 2018 under their Shout Select line. In late 2017, Shout! Factory announced that they had delayed the film's Blu-ray release to work with director Rosen in hopes of releasing the original version instead of the edit. In September 2018, Shout! Factory announced that the original version would be released on Blu-ray on 15 January 2019. The 2019 release includes both a 2K restoration of the original cut and the edit, as well as an interview with director Rosen regarding production. Screenbound Films also released a Blu-ray in the UK on 10 August 2020, likewise containing both cuts. It was also featured on The Criterion Channel as part of their arthouse animation lineup.

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Bubonic plague

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Black Death in Italy

The Black Death was present in Italy between 1347-1348. Sicily and the Italian Peninsula was the first area in then Catholic Western Europe to be reached by the bubonic plague pandemic known as the Black Death, which reached the region by an Italian ship from the Crimea which landed in Messina in Sicily in October 1347. Coming to a completely unprepared region, the Black Death was a shock to Italy and to Europe. The Black Death in Italy belongs to the most documented among its outbreaks in Europe, with many literate eyewitnesses, among them being Giovanni Boccaccio , Marchionne di Coppo Stefani , and Agnolo di Tura , whose descriptions of it in their own cities and areas have become famous. The well-organized and Urban city republics of Central and Northern Italy had the most well-developed administration in Europe prior to the Black Death; their documentation has provided among the most useful descriptions of the pandemic, and the preventive measures and regulations initiated by the Italian city-states during and following the Black Death pandemic has been referred to as the foundation of modern quarantine law regulation. When the Black Death reached modern-day Italy, it was roughly divided into the Kingdom of Sicily and the Kingdom of Naples in the south, the Papal States in the middle, and the heavily urbanised Northern Italy, which formally belonged to the Holy Roman Empire but in reality, divided into several autonomous city republics or principalities. The traditional story of how the plague first came to Europe was that it was introduced to Europe via Genoese traders from their slave trade port city of Kaffa in the Crimea . During a protracted siege of the city , the Mongol Golden Horde army of Jani Beg , whose mainly Tatar troops were suffering from the disease, catapulted infected corpses over the city walls of Kaffa to infect the inhabitants. When the plague spread inside the city, the Genoese ships in the harbour fled from Kaffa toward Italy, bringing the plague with them. This story is now largely discredited as a xenophobic blame narrative. When the Black Death reached modern-day Italy, it was roughly divided into the Kingdom of Sicily and the Kingdom of Naples in the south, the Papal States in the middle, and the heavily urbanised Northern Italy, which formally belonged to the Holy Roman Empire but in reality, divided into several autonomous city republics or principalities.The traditional story of how the plague first came to Europe was that it was introduced to Europe via Genoese traders from their slave trade port city of Kaffa in the Crimea . During a protracted siege of the city , the Mongol Golden Horde army of Jani Beg , whose mainly Tatar troops were suffering from the disease, catapulted infected corpses over the city walls of Kaffa to infect the inhabitants. When the plague spread inside the city, the Genoese ships in the harbour fled from Kaffa toward Italy, bringing the plague with them. This story is now largely discredited as a xenophobic blame narrative. The arrival of the Black Death to Sicily has been described by the chronicler Michele da Piazza . In October 1347, 12 Genoese ships from the East arrived at Messina on Sicily. After the Genoese came ashore, the inhabitants of Messina started to develop abscesses, cough and die. The Genoese were immediately banished from the city, but the illness spread with such speed that the city experienced a collapse of social order. The sick wished to be cured, to make wills and to take the confession, but physicians, notaries and priests were infected and soon refused to go near them; people abandoned their homes, which were pillaged by criminals without being stopped by the guards and officials, who also died. On Sicily, Messina was pointed out as a city being condemned by God for its sins. Refugees from Messina fled toward Catania to ask the statue of Saint Agatha to be brought to Messina to appeal to God, but the citizens of Catania locked the gates to them. They were instead allowed to take the statue of the Virgin Mary from Santa Maria della Scala to Messina. During November, refugees desperately fled from Messina in all directions, dying on the roads and spreading the plague all over the island of Sicily, including Catania, which became the 2nd plague centre of the island. One of the members of the royal family, Duke Giovanni, fled from Catania to the forest of Mascalia where he was referred to as the last victim of the plague in Sicily in April 1348. According to Agnolo di Tura , the Black Death migrated from Genova to Pisa in January 1348 and spread from Pisa to the rest of Central Italy: to Piombino, Lucca in February, to Florence in March and Siena, Perugia and Orvieto in April and May 1348. Agnolo di Tura described how people abandoned their loved ones whose bodies were thrown down holes all over the city of Siena, but how no one cried because everyone thought that they would soon die as well. The survivors pleasured themselves with food, wine, pleasure hunting and games. When the plague finally left Siena, the cities rulers had died, as well as the artists Ambrogio and Pietro Lorenzetti : Agnolo di Tura claimed that only 8 people remained alive in Siena when the plague left. The Black Death in Florence has been famously described by Giovanni Boccaccio . In the autumn of 1347, rumours had reached the city about a great epidemic. To prevent it from reaching Florence, the city streets were cleaned, ill travellers were refused entry, the authorities instructed all inhabitants to keep their houses, streets and squares empty and not allow animals entry into the city, butchers were mandated to strict hygienic regulations, prostitutes and homosexuals were banned from the city in order to lessen the wrath of God, and processions of prayers were held in public to prevent the plague from reaching the city. In March 1348, the plague reached Florence, where it lasted until July. Neither formally educated medical doctors nor the traditional male and female folk healers and medical practitioners could do anything about it. The infected died within 3 days, people were infected by the smallest contact, even with the clothes or other objects handled by the ill. Boccaccio witnessed dead bodies being thrown out upon the streets, after which, the animals who started to touch it fell down dead. Priests and other authorities died so swiftly that the administration and law and order collapsed. People refused to bury their dead, who were instead buried by a special group of grave diggers recruited from the poorest beggars, the becchini , who charged enormous sums to throw the bodies in mass graves. Those who couldn't pay left the bodies on the street, which were soon full of rotting corpses. In the countryside outside Florence, the peasantry fell down dead in their fields which were abandoned by the living, who let loose their animals and ate their supplies because they lost any hope of surviving. Matteo Villani described how people in Florence, expecting their death, lived to enjoy life without consequences: the poor ignored the class system and started to eat luxury food and dress in the fashion of dead aristocrats, and how people started to marry anyone that they wished without considering class, status or suitability. Giovanni Boccaccio claimed that 100,000 people died in Florence. This isn't possible because the entire city population didn't reach that number, but the death toll was nonetheless very high. One of the most well-known victims was the painter Bernardo Daddi . One of the most well-known contemporary descriptions of the Black Death in Northern Italy is the Historia de Morbo by Gabriele de' Mussi . He describes it with a focus on his own home town of Piacenza . According to the chronicle, the plague didn't migrate from the South across the Italian Peninsula but was taken directly to Genova and Venice by Genoese plague ships. The plague came to Piacenza with the Genoese Fulco della Croce, who died shortly after his arrival, followed by his host family and their neighbours. When the plague entered a house through one victim, 3 days remained before all of the inhabitants of that house were dead. The ill called upon physicians to care for them, notaries to make their will and priests or monks to take their confessions and witness their wills, and all of the visitors took the plague with them when they left; convents, especially, were badly infected through the priests taking the confessions from the sick. Soon, the sick and dying were abandoned by physicians, priests and their own families who fled from the illness and the lonely screams of the dying could be heard from the abandoned houses. The corpses of the dead were left in the abandoned houses, which were closed off in fear of the deceased, and only the richest paid the poorest to bury the remains of the dead. The cemeteries were filled so rapidly that mass burials were arranged, and eventually, the sick started to dig their own graves in the middle of the town squares. Between March and September 1348, in Bologna , several famous academics of the University of Bologna died, among them Giovanni d'Andrea . The Black Death of Trento (June 1348) has been described in the chronicle of Giovanni of Parma. In July 1348, 2 of the rulers of Padua died in succession. The Black Death of the Republic of Venice has been described in the chronicles of the Doge Andrea Dandolo , the monk Francesco della Grazia and Lorenzo de Monacis . Venice was one of the biggest cities in Europe, and at this point overcrowded with refugees from the famine in the countryside the year prior and the earthquake in January. In April 1348, the plague reached the crowded city and the streets became littered with the bodies of the sick, dying and the dead, and with smells emanating from houses where the dead had been abandoned. Between 25-30 people were buried daily in the cemetery near Rialto, and corpses were transported to be buried on islands in the lagoon by people who gradually caught the plague and died themselves. So many Venetians fled the city, including the officials of the state, that the remaining members of the city councils banned the Venetians from leaving the city in July by threatening loss of their position and status if they did, to prevent a collapse of social order. The arrival of the Black Death to Sicily has been described by the chronicler Michele da Piazza . In October 1347, 12 Genoese ships from the East arrived at Messina on Sicily. After the Genoese came ashore, the inhabitants of Messina started to develop abscesses, cough and die. The Genoese were immediately banished from the city, but the illness spread with such speed that the city experienced a collapse of social order. The sick wished to be cured, to make wills and to take the confession, but physicians, notaries and priests were infected and soon refused to go near them; people abandoned their homes, which were pillaged by criminals without being stopped by the guards and officials, who also died. On Sicily, Messina was pointed out as a city being condemned by God for its sins. Refugees from Messina fled toward Catania to ask the statue of Saint Agatha to be brought to Messina to appeal to God, but the citizens of Catania locked the gates to them. They were instead allowed to take the statue of the Virgin Mary from Santa Maria della Scala to Messina. During November, refugees desperately fled from Messina in all directions, dying on the roads and spreading the plague all over the island of Sicily, including Catania, which became the 2nd plague centre of the island. One of the members of the royal family, Duke Giovanni, fled from Catania to the forest of Mascalia where he was referred to as the last victim of the plague in Sicily in April 1348. According to Agnolo di Tura , the Black Death migrated from Genova to Pisa in January 1348 and spread from Pisa to the rest of Central Italy: to Piombino, Lucca in February, to Florence in March and Siena, Perugia and Orvieto in April and May 1348. Agnolo di Tura described how people abandoned their loved ones whose bodies were thrown down holes all over the city of Siena, but how no one cried because everyone thought that they would soon die as well. The survivors pleasured themselves with food, wine, pleasure hunting and games. When the plague finally left Siena, the cities rulers had died, as well as the artists Ambrogio and Pietro Lorenzetti : Agnolo di Tura claimed that only 8 people remained alive in Siena when the plague left. The Black Death in Florence has been famously described by Giovanni Boccaccio . In the autumn of 1347, rumours had reached the city about a great epidemic. To prevent it from reaching Florence, the city streets were cleaned, ill travellers were refused entry, the authorities instructed all inhabitants to keep their houses, streets and squares empty and not allow animals entry into the city, butchers were mandated to strict hygienic regulations, prostitutes and homosexuals were banned from the city in order to lessen the wrath of God, and processions of prayers were held in public to prevent the plague from reaching the city. In March 1348, the plague reached Florence, where it lasted until July. Neither formally educated medical doctors nor the traditional male and female folk healers and medical practitioners could do anything about it. The infected died within 3 days, people were infected by the smallest contact, even with the clothes or other objects handled by the ill. Boccaccio witnessed dead bodies being thrown out upon the streets, after which, the animals who started to touch it fell down dead. Priests and other authorities died so swiftly that the administration and law and order collapsed. People refused to bury their dead, who were instead buried by a special group of grave diggers recruited from the poorest beggars, the becchini , who charged enormous sums to throw the bodies in mass graves. Those who couldn't pay left the bodies on the street, which were soon full of rotting corpses. In the countryside outside Florence, the peasantry fell down dead in their fields which were abandoned by the living, who let loose their animals and ate their supplies because they lost any hope of surviving. Matteo Villani described how people in Florence, expecting their death, lived to enjoy life without consequences: the poor ignored the class system and started to eat luxury food and dress in the fashion of dead aristocrats, and how people started to marry anyone that they wished without considering class, status or suitability. Giovanni Boccaccio claimed that 100,000 people died in Florence. This isn't possible because the entire city population didn't reach that number, but the death toll was nonetheless very high. One of the most well-known victims was the painter Bernardo Daddi . One of the most well-known contemporary descriptions of the Black Death in Northern Italy is the Historia de Morbo by Gabriele de' Mussi . He describes it with a focus on his own home town of Piacenza . According to the chronicle, the plague didn't migrate from the South across the Italian Peninsula but was taken directly to Genova and Venice by Genoese plague ships. The plague came to Piacenza with the Genoese Fulco della Croce, who died shortly after his arrival, followed by his host family and their neighbours. When the plague entered a house through one victim, 3 days remained before all of the inhabitants of that house were dead. The ill called upon physicians to care for them, notaries to make their will and priests or monks to take their confessions and witness their wills, and all of the visitors took the plague with them when they left; convents, especially, were badly infected through the priests taking the confessions from the sick. Soon, the sick and dying were abandoned by physicians, priests and their own families who fled from the illness and the lonely screams of the dying could be heard from the abandoned houses. The corpses of the dead were left in the abandoned houses, which were closed off in fear of the deceased, and only the richest paid the poorest to bury the remains of the dead. The cemeteries were filled so rapidly that mass burials were arranged, and eventually, the sick started to dig their own graves in the middle of the town squares. Between March and September 1348, in Bologna , several famous academics of the University of Bologna died, among them Giovanni d'Andrea . The Black Death of Trento (June 1348) has been described in the chronicle of Giovanni of Parma. In July 1348, 2 of the rulers of Padua died in succession. The Black Death of the Republic of Venice has been described in the chronicles of the Doge Andrea Dandolo , the monk Francesco della Grazia and Lorenzo de Monacis . Venice was one of the biggest cities in Europe, and at this point overcrowded with refugees from the famine in the countryside the year prior and the earthquake in January. In April 1348, the plague reached the crowded city and the streets became littered with the bodies of the sick, dying and the dead, and with smells emanating from houses where the dead had been abandoned. Between 25-30 people were buried daily in the cemetery near Rialto, and corpses were transported to be buried on islands in the lagoon by people who gradually caught the plague and died themselves. So many Venetians fled the city, including the officials of the state, that the remaining members of the city councils banned the Venetians from leaving the city in July by threatening loss of their position and status if they did, to prevent a collapse of social order. The population decline caused by the Black Death resulted in smaller taxes and smaller income for the elite, and a smaller workforce who demanded better salaries and better conditions from the elite, who reacted to the demands by repression and violence toward their workforce. In parallel, the dissolution of law and order in the countryside during the plague became long-lasting when unemployed mercenaries, known as the Condottiero , took control of the countryside population. The Black Death in Italy came to have great importance for the development of modern quarantine law, health authorities and hospitals in Europe. When the Black Death migrated toward the well-organized urban city-states of Northern Italy, the cities banned travellers from infected areas from entering their city and occasionally also the destruction of textiles and other objects which had been in contact with the sick. From the second half of the 14th century, quarantine regulations against travellers from infected areas were introduced in city after city in Northern Italy (ship quarantine in port cities and hospital quarantine for inland cities), which also strengthened the belief that isolation of the sick was an effective prevention method of epidemic and eventually became common all over Italy and Europe.

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Bubonic plague

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1770–1772 Russian plague

The Russian plague epidemic of 1770–1772 , also known as the Plague of 1771 , was the last large-scale outbreak of plague in central Russia , claiming between 52,000 and 100,000 lives in Moscow alone (1/6 to 1/3 of its population). The bubonic plague epidemic that originated in the Moldovan theatre of the 1768–1774 Russian-Turkish war in January 1770 swept northward through Ukraine and central Russia, peaking in Moscow in September 1771 and causing the Plague Riot . The epidemic reshaped the map of Moscow, as new cemeteries were established beyond the 18th-century city limits.Russian troops in Focşani , Moldova discovered the first signs of plague in January 1770; the disease, indigenous to the area, was contracted through prisoners of war and booty. The news was hailed and exaggerated by adversaries of Russia, and Catherine wrote a reassuring letter to Voltaire , arguing that "in spring those killed by plague will resurrect for the fighting". Commanding general Christopher von Stoffeln coerced army doctors to conceal the outbreak, which was not made public until Gustav Orreus , a Russian-Finnish surgeon reporting directly to Field Marshal Pyotr Rumyantsev , examined the situation, identified it as plague and enforced quarantine in the troops. Stoffeln, however, refused to evacuate the infested towns and himself fell victim to the plague in May 1770. Of 1,500 patients recorded in his troops in May–August 1770, only 300 survived. Medical quarantine checkpoints instituted by Peter I and expanded by Catherine II were sufficient to prevent plague from reaching inside the country in peacetime, but they proved to be inadequate in time of war. The system regarded all epidemics as external threats, focusing on border control, and paid less attention to domestic measures. The epidemic blocked the logistics of Rumyantsev's army, and as the state tried to push more reserves and supplies to the theatre, peacetime quarantine controls had to be lifted. Plague swept into Poland and Ukraine ; by August 1770 it reached Bryansk . Catherine refused to admit the plague in public, although she was clearly aware of the nature and proportions of the threat, as evidenced by her letters to Governor of Moscow Pyotr Saltykov . When Peter the Great died in 1725, he left behind him the blooming, new capital of St. Petersburg , and the city of Moscow , now unstable because he had transferred the seat of power from that city to St. Petersburg. The now-abandoned Moscow and its suburbs attracted vast numbers of serfs and army deserters, who prompted the government to instigate change by "tightening serfdom and strengthening—or even just creating—administrative and estate institutions, and knitting all three into a seamless web of social control." The increasing population created more waste that needed to be dealt with, and no real solution for getting rid of it. There was human waste, horse waste, and waste from tanneries, slaughterhouses and other slatternly industries, all of which was piling up on each other. [ citation needed ] Catherine II inherited the throne in 1762 and recognized the social concerns her empire was facing, such as the drastic increase in pollution and decrease in living standards. In 1767, her government decreed that the polluting factories, slaughterhouses, fish markets, and cemeteries be removed from the city, that it was illegal to pollute the waterways, and that dumps be established. Her goal in this was to westernize Moscow as well as St. Petersburg. She contended that by eliminating the foul smells associated with the city, the health of the inhabitants would improve; during the 18th century, the miasma theory (that disease came from bad smells) was prevalent. By moving the factories out of the city proper, Catherine also ensured a dispersal of the peasants and serfs, whom the city considered to be the source of the putrefaction, and therefore bring the source of the disease outside the city as well. As her memoires indicate, Catherine herself saw the stench and filth of the city as evidence of its being rooted in the past, before Russia became westernized. She hated Moscow, and before the plague outbreak, Moscow had no formal boundaries, there was no population count, and no real city planning. This lack of planning was also evidenced by the fact that the city was mostly still built from wood, despite the government urging change to stone structures in this department. While there were some stone buildings, they tended to be located in the center of the city, and the use of stone showed no real sign of spreading. There were fires, there was a high crime rate, the filth was unimaginable; the state of the city was a set up for disaster. Catherine attempted to fix these problems through pardons, case reviews, creating jobs for the unemployed and homeless, and strengthening the local government. [ citation needed ] Despite her efforts to change the city, Catherine found herself facing an outbreak of the bubonic plague in the Russian Empire in 1770. The plague was somewhat of a constant threat in early modern Europe; no one could be sure where or when it would strike. In 1765, rumors circulated that the plague had traveled north from the Ottoman Empire into Poland . The same rumors echoed over the course of the next year, with the plague also supposedly appearing in Constantinople and the Crimea. There was a false alarm of the plague entering Russian territory, and another false alarm of supposed plague around Moscow that turned out to be smallpox. There were efforts made to keep plague out of Russia by creating quarantine stations on the southern border, but these proved to be ineffective. In December 1770, a Doctor A. F. Shafonskiy, the chief physician at the Moscow General Hospital, identified a case of the bubonic plague and promptly reported it to German doctor A. Rinder, who was in charge of the public health of the city. Unfortunately, Rinder did not trust the former's judgment, and ignored the report. The next day, the Medical Council met and established the fact that the plague had entered the city, and informed the Senate in St. Petersburg. The response of the national government was to send military guards to the hospital in order to quarantine the cases. However, Shafonskiy and Rinder continued to stand on opposing sides, until Rinder denied Shafonskiy's claim in January 1771. Shafonskiy submitted a report in February [ citation needed ]The plague peaked in September 1771, killing an estimated thousand Muscovites a day (20,401 confirmed dead in September), despite the fact that an estimated three quarters of the population fled the city. Many deaths escaped the statistics: residents, fearing that the infested properties would be destroyed by authorities, routinely concealed the casualties, burying the dead at night or simply throwing them on the streets. Authorities set up chain gangs of prisoners to collect and bury the bodies, but their forces were insufficient even for this single task. [ citation needed ] Governor Saltykov, failing to control the situation, preferred to desert his station and fled to his country estate; the police chief followed suit. Jacon Lerche , the newly appointed sanitary inspector of Moscow, declared state of emergency, shutting down shops, inns, taverns, factories and even churches; the city was placed under quarantine. Masses of people, literally thrown into the streets, were denied their regular trade and recreation habits. On September 15, 1771, Moscow residents revolted against the authorities. The mob perceived any emergency measures of the state as a conspiracy to spread the disease. In particular, archbishop Amvrosy, who removed a revered icon from the public to curtail transmission of the disease by worshippers, was accused of conspiracy, hunted down and killed as an "enemy of the people". Active rioting continued for three days. The remaining unrest was finally subdued by Grigory Orlov in the end of September. [ citation needed ]When the riot was still unwinding, empress Catherine dispatched Grigory Orlov to take control of Moscow; it is not clear whether her choice was an assignment in good faith or an attempt to get rid of a former lover and a leader of an influential political clan. Orlov, accompanied by Gustav Orreus and four regiments of troops, arrived in Moscow on September 26, immediately calling an emergency council with local doctors. They confirmed presence of both bubonic and septicemic forms of plague. Orlov established and supervised an executive medical commission charged with developing the ways to check the epidemic. More important, he succeeded in changing public opinion in favor of the state's emergency measures, at the same improving the efficiency and quality of medical quarantine (in particular, varying quarantine duration for different groups of exposed but yet healthy people, and paying them for the quarantine stay). The epidemic in Moscow, although still rampant in October, gradually reduced through the year. November 15 Catherine declared that it was officially over, but deaths continued into 1772. Estimates of total death toll in Moscow range from 52 to 100 thousand out of total 300 thousand. The plague stimulated local research in disease prevention, which was boosted by discovering indigenous plague in newly conquered territories of the Caucasus . The epidemic was professionally exposed to Western European academia through An account of plague which raged in Moscow 1771 , published in 1798 in Latin by Belgian physician Charles de Mertens ; an English translation was released in 1799. Devastation caused by the plague forced the government to reduce taxes and military conscription quotas in the affected provinces; both measures decreased the military capabilities of the state and pushed Catherine to seek truce . The statesmen divided between supporters of further pressing into Moldova and Walachia and those who sided with Frederick II 's proposal to quit the war and take Polish territories as compensation: nearby Polish lands were seen as cash source while Moldova had to be ceded to the Turks anyway. Catherine preferred to suit both parties and engaged in the Partitions of Poland while the war in the South protracted until 1774. Orlov, dismissed from the court, retired for a long tour of Europe. [ citation needed ] In a move to control disease, authorities banned any burials in the traditional parish cemeteries inside the city of Moscow. Instead, they set up a chain of new cemeteries outside the city limits. This ring of cemeteries, established in 1771 ( Vagankovo and others) is mostly extant today; some were razed to make way for new construction ( Dorogomilovo cemetery ), some, also destroyed, are now public parks (Lazarevskoe cemetery). Rogozhskoye cemetery , east of Moscow, became and remains a leading Old Believers shrine. [ citation needed ]Devastation caused by the plague forced the government to reduce taxes and military conscription quotas in the affected provinces; both measures decreased the military capabilities of the state and pushed Catherine to seek truce . The statesmen divided between supporters of further pressing into Moldova and Walachia and those who sided with Frederick II 's proposal to quit the war and take Polish territories as compensation: nearby Polish lands were seen as cash source while Moldova had to be ceded to the Turks anyway. Catherine preferred to suit both parties and engaged in the Partitions of Poland while the war in the South protracted until 1774. Orlov, dismissed from the court, retired for a long tour of Europe. [ citation needed ]In a move to control disease, authorities banned any burials in the traditional parish cemeteries inside the city of Moscow. Instead, they set up a chain of new cemeteries outside the city limits. This ring of cemeteries, established in 1771 ( Vagankovo and others) is mostly extant today; some were razed to make way for new construction ( Dorogomilovo cemetery ), some, also destroyed, are now public parks (Lazarevskoe cemetery). Rogozhskoye cemetery , east of Moscow, became and remains a leading Old Believers shrine. [ citation needed ]

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Bubonic plague

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Hittite plague

The Hittite Plague or Hand of Nergal was an epidemic , possibly of tularemia , which occurred in the mid-to-late 14th century BC .The Hittite Empire stretched from Turkey to Syria. The plague was likely an outbreak of Francisella tularensis which occurred along the Arwad-Euphrates trading route in the 14th century BC. Much of the ancient Near East suffered from outbreaks; however, Egypt and Assyria initiated a quarantine along their border, and they did not experience the epidemic. Tularemia is a bacterial infection which is still a threat. It is also referred to as "rabbit fever" and it is a zoonotic disease which can easily pass from animals to humans. The most common way that it is spread is through various insects which hop between species, such as ticks. The symptoms of an infection range from skin lesions to respiratory failure. Without treatment the mortality rate is 15% of those infected. According to former microbiologist Siro Trevisanato, "Tularemia is rare in many countries today, but remains a problem in some countries including Bulgaria." According to author Philip Norrie ( How Disease Affected the End of the Bronze Age ), there are three diseases most likely to have caused a post- Bronze Age societal collapse: smallpox , bubonic plague and tularemia. The tularemia plague which struck the Hittites could have been spread by insects or infected dirt or plants, through open wounds, or by eating infected animals. Hittite texts from the mid-14th century BC refer to the plague causing disabilities and death. Hittite King Muršili II wrote prayers seeking relief from the epidemic, which had lasted two decades and killed many of his subjects. The two kings who preceded him, Šuppiluliuma I and Šuppiluliuma's immediate heir, Arnuwanda II , had also succumbed to tularemia. Muršili had ascended to the throne because he was the last surviving son of Šuppiluliuma. Muršili believed that the plague had been transmitted to the Hittites by Egyptian prisoners who had been paraded through the capital city, Hattusa . There is some evidence suggesting that the Egyptians suffered from tularemia in the years preceding 1322 BC. The Hittites apparently also suspected zoonotic transmission, because they banned the use of donkeys in caravans. Another theory of the plague's origin suggests that it originated with rams that the Hittites had taken as spoils of war, along with other animals, after the Hittites raided Simyra . Soon after the animals were brought into Hittite villages, the tularemia outbreak began. The plague is mentioned in Amarna letter EA 35 , a letter written in Akkadian from the ruler of Alashiya (Cyprus) to the Pharaoh of Egypt during the Amarna Period . It dates from between 1350 and 1325 BC. In it, the plague is specially named as The Hand of Nergal.The disease was intentionally brought to western Anatolia in what is described as the "first known record of biological warfare ". Shortly after the Hittites experienced the outbreak of disease, the Arzawans from western Anatolia believed the Hittites were weakened and attacked them. The Arzawans claimed that rams suddenly appeared (1320 and 1318 BC) and the Arzawans brought them into their villages. It is thought that the Hittites had sent rams diseased with tularemia to infect their enemies. The Arzawans became so weakened by the plague that they failed in their attempt to conquer the Hittites.

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Bubonic plague

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Saint Sebastian

Sebastian ( Latin : Sebastianus ; c. AD 255 – c. AD 288 ) was an early Christian saint and martyr . According to traditional belief, he was killed during the Diocletianic Persecution of Christians. He was initially tied to a post or tree and shot with arrows, though this did not kill him. He was, according to tradition, rescued and healed by Irene of Rome , which became a popular subject in 17th-century painting. In all versions of the story, shortly after his recovery he went to Diocletian to warn him about his sins, and as a result was clubbed to death. He is venerated in the Catholic Church and the Orthodox Church . The oldest record of the details of Sebastian's martyrdom is found in the Chronograph of 354 , which mentions him as a martyr, venerated on January 20. He is also mentioned in a sermon on Psalm 118 by 4th-century bishop Ambrose of Milan : in his sermon, Ambrose stated that Sebastian came from Milan and that he was already venerated there at that time. The full account of his martyrdom comes from the Passio Sancti Sebastiani , a 5th-century text written by an anonymous author, possibly Arnobius the Younger . Sebastian is a popular male saint, especially today among athletes. In medieval times, he was regarded as a saint with a special ability to intercede to protect from plague , and devotion to him greatly increased when plague was active.There is not much known about Saint Sebastian's early life, but the ancient source mentioning Sebastian is found in the Chronograph of 354 , a compilation of chronological and calendrical texts produced in 354 AD by the calligrapher and illustrator Furius Dionysius Filocalus , which mentions him as a martyr who was venerated on January 20. His cult is also mentioned by Ambrose of Milan in his Expositio in Psalmum CXVIII , a theological and exegetical commentary of Psalm 118 dated to 386–390 AD; Ambrose states that Sebastian came from Milan and that he was venerated as a saint there. The first surviving account of Sebastian's life and death is the Passio Sancti Sebastiani , long thought to have been written by Ambrose in the 4th century, but now regarded as a 5th-century account by an unknown author (possibly Arnobius the Younger ). This includes the "two martyrdoms", and the care by Irene in between, and other details that remained part of the story. According to Sebastian's 18th-century entry in Acta Sanctorum , still attributed to Ambrose by the 17th-century hagiographer Jean Bolland , and the briefer account in the 14th-century Legenda Aurea , he was a man of Gallia Narbonensis who was taught in Mediolanum ( Milan ). In 283, Sebastian entered the army in Rome under Emperor Carinus to assist the martyrs . Because of his courage he became one of the captains of the Praetorian Guards under Diocletian and Maximian , who were unaware that he was a Christian. According to tradition, Marcus and Marcellianus were twin brothers from a distinguished family and were deacons . Both brothers married, and they resided in Rome with their wives and children. The brothers refused to sacrifice to the Roman gods and were arrested. They were visited by their parents Tranquillinus and Martia in prison, who attempted to persuade them to renounce Christianity. Sebastian succeeded in converting Tranquillinus and Martia, as well as Tiburtius , the son of Chromatius, the local prefect. Another official, Nicostratus, and his wife Zoe were also converted. It has been said that Zoe had been a mute for six years; however, she made known to Sebastian her desire to be converted to Christianity. As soon as she had, her speech returned to her. Nicostratus then brought the rest of the prisoners; these 16 persons were converted by Sebastian. Chromatius and Tiburtius converted; Chromatius set all of his prisoners free from jail, resigned his position, and retired to the country in Campania . Marcus and Marcellianus, after being concealed by a Christian named Castulus , were later martyred, as were Nicostratus, Zoe, and Tiburtius. Sebastian had prudently concealed his faith, but in 286 it was detected. Diocletian reproached him for his supposed betrayal, and he commanded him to be led to a field and there to be bound to a stake so that the chosen archers from Mauretania would shoot arrows at him. "And the archers shot at him till he was as full of arrows as an urchin [Note 1] is full of pricks, and thus left him there for dead." Miraculously, the arrows did not kill him. The widow of Castulus, Irene of Rome , went to retrieve his body to bury it, and discovered he was still alive. She brought him back to her house and nursed him back to health. Sebastian later stood by a staircase where the emperor was to pass and harangued Diocletian for his cruelties against Christians. This freedom of speech, and from a person whom he supposed to have been dead, greatly astonished the emperor; but recovering from his surprise, he gave orders for Sebastian to be seized and beaten to death with cudgels , and his body thrown into the common sewer. A holy lady named Lucina, admonished by the martyr in a vision, privately removed the body and buried it in the catacombs at the entrance of the cemetery of Calixtus, where now stands the Basilica of St. Sebastian . Remains reputed to be those of Sebastian are housed in Rome in the Basilica Apostolorum , built by Pope Damasus I in 367 on the site of the provisional tomb of Saints Peter and Paul . The church, today called San Sebastiano fuori le mura , was rebuilt in the 1610s under the patronage of Scipione Borghese . Ado, Eginard, Sigebert, and other contemporary authors relate that, in the reign of Louis Debonnair , Pope Eugenius II gave the body of Sebastian to Hilduin, Abbot of St. Denys, who brought it into France , and it was deposited at Saint Medard Abbey , at Soissons , on 8 December, in 826. Sebastian's cranium was brought to the town of Ebersberg ( Germany ) in 934. A Benedictine abbey was founded there and became one of the most important pilgrimage sites in southern Germany. It is said the silver-encased cranium was used as a cup in which to present the consecrated wine of the Blessed Sacrament to the faithful during the feast of Saint Sebastian. Sebastian had prudently concealed his faith, but in 286 it was detected. Diocletian reproached him for his supposed betrayal, and he commanded him to be led to a field and there to be bound to a stake so that the chosen archers from Mauretania would shoot arrows at him. "And the archers shot at him till he was as full of arrows as an urchin [Note 1] is full of pricks, and thus left him there for dead." Miraculously, the arrows did not kill him. The widow of Castulus, Irene of Rome , went to retrieve his body to bury it, and discovered he was still alive. She brought him back to her house and nursed him back to health. Sebastian later stood by a staircase where the emperor was to pass and harangued Diocletian for his cruelties against Christians. This freedom of speech, and from a person whom he supposed to have been dead, greatly astonished the emperor; but recovering from his surprise, he gave orders for Sebastian to be seized and beaten to death with cudgels , and his body thrown into the common sewer. A holy lady named Lucina, admonished by the martyr in a vision, privately removed the body and buried it in the catacombs at the entrance of the cemetery of Calixtus, where now stands the Basilica of St. Sebastian . Remains reputed to be those of Sebastian are housed in Rome in the Basilica Apostolorum , built by Pope Damasus I in 367 on the site of the provisional tomb of Saints Peter and Paul . The church, today called San Sebastiano fuori le mura , was rebuilt in the 1610s under the patronage of Scipione Borghese . Ado, Eginard, Sigebert, and other contemporary authors relate that, in the reign of Louis Debonnair , Pope Eugenius II gave the body of Sebastian to Hilduin, Abbot of St. Denys, who brought it into France , and it was deposited at Saint Medard Abbey , at Soissons , on 8 December, in 826. Sebastian's cranium was brought to the town of Ebersberg ( Germany ) in 934. A Benedictine abbey was founded there and became one of the most important pilgrimage sites in southern Germany. It is said the silver-encased cranium was used as a cup in which to present the consecrated wine of the Blessed Sacrament to the faithful during the feast of Saint Sebastian. The belief that Saint Sebastian was a defense against the plague was a medieval addition to his reputation, which largely accounts for the enormous increase in his importance in the Late Middle Ages . The connection of the martyr shot with arrows with the plague is not an intuitive one. However, the hopeful example of Sebastian being able to recover from his "first martyrdom " (or "sagittation", as it is sometimes called) was relevant as the arrow-wounds can resemble the buboes that were symptoms of bubonic plague. Visually, "the arrow wounds call to God for mercy to us, as the symptoms of the infirm call for pity from the passerby", as Molanus put it. The chronicler Paul the Deacon relates that, in 680, Rome was freed from a raging pestilence by him. The Golden Legend transmits the episode of a great plague that afflicted the Lombards in the time of King Gumburt, which was stopped by the erection of an altar in honor of Sebastian in the Church of Saint Peter in the Province of Pavia .The earliest known representation of Sebastian is a mosaic in the Basilica of Sant'Apollinare Nuovo (Ravenna, Italy) dated between 527 and 565. The right lateral wall of the basilica contains large mosaics representing a procession of 26 martyrs, led by Saint Martin and including Sebastian. The martyrs are represented in Byzantine style, lacking any individuality, and all have identical expressions. Another early representation is in a mosaic in the Church of San Pietro in Vincoli in Rome, probably made in the year 682. It shows a grown, bearded man in court dress but contains no trace of an arrow. The archers and arrows begin to appear by 1000, and ever since have been far more commonly shown than the actual moment of his death by clubbing, so that there is a popular misperception that this is how he died. As protector of potential plague victims (a connection popularized by the Golden Legend ) and soldiers, Sebastian occupied an important place in the popular medieval mind. He was among the most frequently depicted of all saints by Late Gothic and Renaissance artists, in the period after the Black Death . The opportunity to show a semi-nude young male, often in a contorted pose, also made Sebastian a favorite subject. His shooting with arrows was the subject of the largest engraving by the Master of the Playing Cards in the 1430s, when there were few other current subjects with male nudes other than Christ. Sebastian appears in many other prints and paintings, although this was due to his popularity with the faithful. Among many others, Botticelli , Perugino , Titian , Pollaiuolo , Giovanni Bellini , Guido Reni (who painted the subject seven times), Mantegna (three times), Hans Memling , Gerrit van Honthorst , Luca Signorelli , El Greco , Honoré Daumier , John Singer Sargent and Louise Bourgeois all painted Saint Sebastians. An early work by the sculptor Gianlorenzo Bernini is of Saint Sebastian . The saint is ordinarily depicted as a handsome youth pierced by arrows. Predella scenes when required often depicted his arrest, confrontation with the Emperor, and final beheading. The illustration in the infobox is the Saint Sebastian of Il Sodoma , at the Pitti Palace , Florence. Hans Holbein the Elder created a statuette of Saint Sebastian "in silver and parcel-gilt", now in the Victoria and Albert Museum in London . A mainly 17th-century subject, though found in predella scenes as early as the 15th century, was Saint Sebastian Tended by Saint Irene , painted by Georges de La Tour , Trophime Bigot (four times), Jusepe de Ribera , Hendrick ter Brugghen (in perhaps his masterpiece ) and others. This may have been a deliberate attempt by the Church to get away from the single nude subject, which is already recorded in Vasari as sometimes arousing inappropriate thoughts among female and male churchgoers. The Baroque artists usually treated it as a nocturnal chiaroscuro scene, illuminated by a single candle, torch or lantern, in the style fashionable in the first half of the 17th century. There exist several cycles depicting the life of Sebastian. Among them are the frescos in the basilica church of San Sebastiano, Acireale in Sicily painted by Pietro Paolo Vasta . Egon Schiele , an Austrian Expressionist artist, painted a self-portrait as Saint Sebastian in 1915. In 1911, the Italian playwright Gabriele d'Annunzio in conjunction with Claude Debussy produced Le Martyre de saint Sébastien . The American composer Gian Carlo Menotti composed a ballet score for a Ballets Russes production which was first given in 1944. In his novella Death in Venice , Thomas Mann hails the "Sebastian-Figure" as the supreme emblem of Apollonian beauty, that is, the artistry of differentiated forms; beauty as measured by discipline, proportion, and luminous distinctions. This allusion to Sebastian's suffering, associated with the writerly professionalism of the novella's protagonist, Gustav Aschenbach, provides a model for the "heroism born of weakness", which characterizes poise amidst agonizing torment and plain acceptance of one's fate as, beyond mere patience and passivity, a stylized achievement and artistic triumph. Sebastian's death was depicted in the 1949 film Fabiola , in which he was played by Massimo Girotti . In 1976, the British director Derek Jarman made a film, Sebastiane , which caused controversy in its treatment of the martyr as a " homosexual icon ", according to a number of critics reflecting a subtext perceptible in the imagery since the Renaissance. Also in 1976, in the American horror film Carrie , a figure of Saint Sebastian (commonly misconstrued as a figure of the crucified Christ) appears in Carrie's prayer closet. Boxer Muhammad Ali was pictured in the iconography of a bound Saint Sebastian pierced by arrows, in the April 1968 issue of Esquire Magazine . The image was created by photographer George Lois and art director Carl Fischer. A depiction of Saint Sebastian in a fresco restoration in an isolated Italian village is the central motif and cryptic mystery of the 1976 giallo horror film The House with Laughing Windows . In her 1965 story " Everything That Rises Must Converge ", Flannery O'Connor 's character Julian feels as if he were the martyr while taking his mother to "reducing" classes at the Y. In 1997, the eighth episode of the second season of the television series Millennium , the protagonists search for the hand of Saint Sebastian. In 2007, artist Damien Hirst presented Saint Sebastian, Exquisite Pain from his Natural History series. The piece depicts a cow in formaldehyde, bound in metal cable and shot with arrows. British pop band Alt-J 's video for " Hunger of the Pine " contains references to the story of Saint Sebastian's death, adapted to fit the lyrics of the song. Tarsem Singh 's video for the R.E.M. song " Losing My Religion " makes use of imagery of Saint Sebastian, drawing particular inspiration from paintings by Guido Reni and Caravaggio . The indie folk band the Mountain Goats have a song called "Hail, St. Sebastian" that makes reference to his life. Scottish musician Momus has a song "Lucky like St Sebastian", featuring on his 1986 debut album Circus Maximus . Madonna 's song "I'm a Sinner" from her 2012 album MDNA has a segment resembling a litany , with one line saying, "St. Sebastian, don't you cry; let those poisoned arrows fly." The 2013–2018 Canadian drama series Forgive Me centres on a priest haunted by recurring visions of Saint Sebastian. The look of the character Gemino in the popular action-platform videogame Blasphemous is clearly inspired by Saint Sebastian. The family del Valle in Isabel Allende 's novel " House of the Spirits " attends Sunday mass in the Church of Saint Sebastian.The earliest known representation of Sebastian is a mosaic in the Basilica of Sant'Apollinare Nuovo (Ravenna, Italy) dated between 527 and 565. The right lateral wall of the basilica contains large mosaics representing a procession of 26 martyrs, led by Saint Martin and including Sebastian. The martyrs are represented in Byzantine style, lacking any individuality, and all have identical expressions. Another early representation is in a mosaic in the Church of San Pietro in Vincoli in Rome, probably made in the year 682. It shows a grown, bearded man in court dress but contains no trace of an arrow. The archers and arrows begin to appear by 1000, and ever since have been far more commonly shown than the actual moment of his death by clubbing, so that there is a popular misperception that this is how he died. As protector of potential plague victims (a connection popularized by the Golden Legend ) and soldiers, Sebastian occupied an important place in the popular medieval mind. He was among the most frequently depicted of all saints by Late Gothic and Renaissance artists, in the period after the Black Death . The opportunity to show a semi-nude young male, often in a contorted pose, also made Sebastian a favorite subject. His shooting with arrows was the subject of the largest engraving by the Master of the Playing Cards in the 1430s, when there were few other current subjects with male nudes other than Christ. Sebastian appears in many other prints and paintings, although this was due to his popularity with the faithful. Among many others, Botticelli , Perugino , Titian , Pollaiuolo , Giovanni Bellini , Guido Reni (who painted the subject seven times), Mantegna (three times), Hans Memling , Gerrit van Honthorst , Luca Signorelli , El Greco , Honoré Daumier , John Singer Sargent and Louise Bourgeois all painted Saint Sebastians. An early work by the sculptor Gianlorenzo Bernini is of Saint Sebastian . The saint is ordinarily depicted as a handsome youth pierced by arrows. Predella scenes when required often depicted his arrest, confrontation with the Emperor, and final beheading. The illustration in the infobox is the Saint Sebastian of Il Sodoma , at the Pitti Palace , Florence. Hans Holbein the Elder created a statuette of Saint Sebastian "in silver and parcel-gilt", now in the Victoria and Albert Museum in London . A mainly 17th-century subject, though found in predella scenes as early as the 15th century, was Saint Sebastian Tended by Saint Irene , painted by Georges de La Tour , Trophime Bigot (four times), Jusepe de Ribera , Hendrick ter Brugghen (in perhaps his masterpiece ) and others. This may have been a deliberate attempt by the Church to get away from the single nude subject, which is already recorded in Vasari as sometimes arousing inappropriate thoughts among female and male churchgoers. The Baroque artists usually treated it as a nocturnal chiaroscuro scene, illuminated by a single candle, torch or lantern, in the style fashionable in the first half of the 17th century. There exist several cycles depicting the life of Sebastian. Among them are the frescos in the basilica church of San Sebastiano, Acireale in Sicily painted by Pietro Paolo Vasta . Egon Schiele , an Austrian Expressionist artist, painted a self-portrait as Saint Sebastian in 1915. In 1911, the Italian playwright Gabriele d'Annunzio in conjunction with Claude Debussy produced Le Martyre de saint Sébastien . The American composer Gian Carlo Menotti composed a ballet score for a Ballets Russes production which was first given in 1944. In his novella Death in Venice , Thomas Mann hails the "Sebastian-Figure" as the supreme emblem of Apollonian beauty, that is, the artistry of differentiated forms; beauty as measured by discipline, proportion, and luminous distinctions. This allusion to Sebastian's suffering, associated with the writerly professionalism of the novella's protagonist, Gustav Aschenbach, provides a model for the "heroism born of weakness", which characterizes poise amidst agonizing torment and plain acceptance of one's fate as, beyond mere patience and passivity, a stylized achievement and artistic triumph. Sebastian's death was depicted in the 1949 film Fabiola , in which he was played by Massimo Girotti . In 1976, the British director Derek Jarman made a film, Sebastiane , which caused controversy in its treatment of the martyr as a " homosexual icon ", according to a number of critics reflecting a subtext perceptible in the imagery since the Renaissance. Also in 1976, in the American horror film Carrie , a figure of Saint Sebastian (commonly misconstrued as a figure of the crucified Christ) appears in Carrie's prayer closet. Boxer Muhammad Ali was pictured in the iconography of a bound Saint Sebastian pierced by arrows, in the April 1968 issue of Esquire Magazine . The image was created by photographer George Lois and art director Carl Fischer. A depiction of Saint Sebastian in a fresco restoration in an isolated Italian village is the central motif and cryptic mystery of the 1976 giallo horror film The House with Laughing Windows . In her 1965 story " Everything That Rises Must Converge ", Flannery O'Connor 's character Julian feels as if he were the martyr while taking his mother to "reducing" classes at the Y. In 1997, the eighth episode of the second season of the television series Millennium , the protagonists search for the hand of Saint Sebastian. In 2007, artist Damien Hirst presented Saint Sebastian, Exquisite Pain from his Natural History series. The piece depicts a cow in formaldehyde, bound in metal cable and shot with arrows. British pop band Alt-J 's video for " Hunger of the Pine " contains references to the story of Saint Sebastian's death, adapted to fit the lyrics of the song. Tarsem Singh 's video for the R.E.M. song " Losing My Religion " makes use of imagery of Saint Sebastian, drawing particular inspiration from paintings by Guido Reni and Caravaggio . The indie folk band the Mountain Goats have a song called "Hail, St. Sebastian" that makes reference to his life. Scottish musician Momus has a song "Lucky like St Sebastian", featuring on his 1986 debut album Circus Maximus . Madonna 's song "I'm a Sinner" from her 2012 album MDNA has a segment resembling a litany , with one line saying, "St. Sebastian, don't you cry; let those poisoned arrows fly." The 2013–2018 Canadian drama series Forgive Me centres on a priest haunted by recurring visions of Saint Sebastian. The look of the character Gemino in the popular action-platform videogame Blasphemous is clearly inspired by Saint Sebastian. The family del Valle in Isabel Allende 's novel " House of the Spirits " attends Sunday mass in the Church of Saint Sebastian.In the Roman Catholic Church , Sebastian is commemorated by an optional memorial on 20 January. In the Church of Greece , Sebastian's feast day is on 18 December. As a protector from the bubonic plague , Sebastian was formerly one of the Fourteen Holy Helpers . In Catholicism, Sebastian is the patron saint of archers, pin-makers, athletes (a modern association) and of a holy death. Sebastian is one of the patron saints of the city of Qormi in Malta Sebastian is the patron saint of Acireale, Caserta and Petilia Policastro in Italy , Melilli in Sicily , and San Sebastián as well as Palma de Mallorca , Lubrín and Huelva in Spain. He is the patron saint of Negombo , Sri Lanka and Rio de Janeiro , Brazil . Informally, in the tradition of the Afro-Brazilian syncretic religion Umbanda , Sebastian is often associated with Oxossi , especially in the state of Rio de Janeiro itself. In Lubrín , every year on 20 January, there is a festival in honor of Saint Sebastian. A statue of Saint Sebastian leads a procession around the village, and people hurl bread rolls from their balconies to the crowds following the saint in the streets below. The rolls have a hole in the middle and some people string them on a rope around their body. The festival is thought to have originated in the 14th century, after a plague of cholera hit the area. At this time, the wealthy were said to have thrown bread and money to the poor on the streets below, so as to avoid catching the disease. The San Sebastian 'bread festival' is so unusual that it has been declared a Fiesta of National Tourist Interest in Andalusia . King Sebastian I of Portugal , the only King to ever have this name, was so named for having been born on this saint's feast day. The Feast of St. Sebastian is celebrated among Catholic communities of Kerala in India. Churches are illuminated and decorated, with fireworks being a main event in Catholic homes to commemorate the saint. Every parish has its own date of celebration, especially in the districts of Thrissur , Ernakulam , St. Andrew's Basilica, Arthunkal and Kottayam . In Kanjoor Syro Malabar Church the feast is celebrated with the largest procession of golden crosses and decorated umbrellas in Asia. Besides this, many pilgrim centres, churches, shrines and many educational institutions too, throughout Kerala, bear the name of the saint. He is the patron of San Sebastian College – Recoletos in Manila , Philippines , which is adjacent to the Minor Basilica of San Sebastian, the all-steel church in the Philippines and in Asia administered by the Order of Augustinian Recollect (OAR). At the Catholic Newman Community at the University of Rochester , the St. Sebastian Society is an organization of campus-wide Christian athletes that works to serve the greater Rochester, New York , area through methods of restorative justice , special needs fundraising and community service . Sebastian is the patron saint of the Roman Catholic Diocese of Bacolod , in Negros Occidental , Philippines and Lipa City in Batangas , Philippines . Also, Sebastian is the patron saint of Leon City Mexico . A representation of the Saint in his martyrdom is present in the upper left corner of the city coat of arms. Sebastian is the patron of Knights of Columbus Council #4926 in the Roman Catholic Diocese of San Jose in California , serving the cities of Mountain View and Los Altos . Sebastian is the patron saint of the Catholic War Veterans of the United States of America. The highest award given by the CWV is the Honor Legion of the Order of St. Sebastian. In his 1906 Reminiscences , Carl Schurz recalls the annual "bird shoot" pageant of the Rhenish town of Liblar ( de ), sponsored by the Saint Sebastian Society, a club of sharpshooters and their sponsors to which nearly every adult member of the town belonged. The St. Sebastian River in the American state of Florida is named after him. The river is a tributary of the Indian River Lagoon and comprises part of the boundary between Indian River County and Brevard County . The adjacent city of Sebastian, Florida , and St. Sebastian River Preserve State Park are also named for Saint Sebastian. Within the Diocese of Central Florida, the nearby Episcopal Church on Melbourne Beaches is named St Sebastian-by-the-Sea.American author Richard A. Kaye wrote in 1996 that "Contemporary gay men have seen in Sebastian at once a stunning advertisement for homosexual desire (indeed, a homoerotic ideal ), and a prototypical portrait of tortured closet case ." Some religious images depicting Saint Sebastian have been adopted by the LGBT community. A combination of his strong, shirtless physique, the symbolism of the arrows penetrating his body, and the countenance of rapturous pain have intrigued artists (gay or otherwise) for centuries. In Yukio Mishima 's novel Confessions of a Mask , the protagonist Kochan has his first gay sexual experience while looking at a reproduction of Guido Reni 's Saint Sebastian . Kochan remarks: "It is an interesting coincidence that Hirschfeld should place 'pictures of St. Sebastian' in the first rank of those kinds of art works in which the invert takes special delight," referencing Magnus Hirschfeld 's belief that gay men have an inclination towards certain artistic subjects including Saint Sebastian.

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Bubonic plague

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Moscow plague riot of 1771

The Plague Riot ( Russian : Чумной бунт , romanized : Chumnoy bunt ) was a riot in Moscow in 1771 between 15 and 17 September, caused by an outbreak of bubonic plague . The first signs of plague in Moscow appeared in late 1770, which would turn into a major epidemic in the spring of 1771. The measures undertaken by the authorities, such as creation of forced quarantines , destruction of contaminated property without compensation or control, and closing of public baths caused fear and anger among the citizens . The city's economy was mostly paralyzed because many factories, markets, stores, and administrative buildings had been closed down. All of this was followed by acute food shortages , causing deterioration of living conditions for the majority of the Muscovites. Dvoryane (Russian nobility) and well-off city dwellers left Moscow due to the plague outbreak. The first outbursts of mass protest against the measures undertaken by the authorities took place on 29 August and 1 September in a neighborhood of Lefortovo . By early September, the rumors of an imminent uprising had already been circulating. An attempt by the Archbishop Ambrose of Moscow to prevent the citizens from gathering at the Icon of the Virgin Mary of Bogolyubovo ( Икона Боголюбской Богоматери ) in Kitai-gorod as a quarantine measure served as an immediate cause for the Plague Riot. On 15 September, huge crowds of Muscovites began to flow towards Red Square at the sound of the alarm bell. Pushing aside a military unit, they burst into the Kremlin and destroyed the Chudov Monastery ( archbishop 's residence) and its wine cellars . Archbishop Ambrosius managed to escape to the Donskoy Monastery . On 16 September the riot gained in strength. Angry citizens captured the Donskoy Monastery, killed Archbishop Ambrosius, and destroyed two quarantine zones ( Danilov Monastery and the one beyond the Serpukhov Gates ). In the afternoon, most of the rebels approached the Kremlin and were met by a number of military units. The crowd demanded the surrender of Lieutenant General Pyotr Yeropkin , who had been overseeing the affairs of Moscow after Pyotr Saltykov 's departure. As soon as the Muscovites tried to attack the Kremlin's Spasskiye Gates , the army opened fire with buckshot , dispersing the crowd and capturing some of the rebels. On the morning of 17 September, around 1000 people gathered at the Spasskiye gates again, demanding the release of captured rebels and elimination of quarantines. The army managed to disperse the crowd yet again and finally suppressed the riot. Some 300 people were brought to trial. A government commission headed by Grigory Orlov was sent to Moscow on 26 September to restore order. It took some measures against the plague and provided citizens with work and food, which would finally pacify the people of Moscow. The commission improved services in quarantines, put an end to the burning of property, reopened public baths, permitted trade, increased food deliveries, and organized public works . At the same time, the commission was engaged in prosecuting those who had taken part in the Plague Riot. Four of them were executed; 165 adults and twelve teenagers were subjected to punishment. With the onset of cold weather, the outbreak began to subside. Around 200,000 people died in Moscow and its outskirts during the plague. There was another unlikely convict: the church bell that was used to start the alarm. By the order of Catherine the Great , an executor cut the tongue from the bell. For more than thirty years, the silent bell hung on the bell tower. Eventually, in 1803, it was removed and sent to the Arsenal and, in 1821, to the Kremlin Armoury .

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Bubonic plague

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Shirō Ishii

Surgeon General Shirō Ishii ( Japanese : 石井 四郎 , Hepburn : Ishii Shirō , [iɕiː ɕiɾoː] ; June 25, 1892 – October 9, 1959) was a Japanese war criminal , microbiologist and army medical officer who was the director of Unit 731 , a biological warfare unit of the Imperial Japanese Army . Ishii led the development and application of biological weapons at Unit 731 in Manchukuo during the Second Sino-Japanese War from 1937 to 1945, including the bubonic plague attacks at Chinese cities of Changde and Ningbo , and planned the Operation Cherry Blossoms at Night biological attack against the United States. Ishii and his colleagues also engaged in human experimentation , resulting in the deaths of over 10,000 subjects, most of them civilians or prisoners of war. Estimates for the number of people killed by Japanese biological warfare range as high as 300,000. Ishii was later granted immunity in the International Military Tribunal for the Far East by the United States government in exchange for information and research for the U.S. biological warfare program .Shirō Ishii was born in Shibayama [ dubious – discuss ] in Chiba Prefecture , Japan , the fourth son of Katsuya Ishii, a wealthy landowner and sake maker. The Ishii family was the community's largest landholder and exercised a feudal dominance over the local village and surrounding hamlets. Ishii attended the Chiba Middle School (now Chiba Prefectural Chiba High School) in Chiba City and the Fourth Higher School (now Kanazawa University ), a higher school in Kanazawa , Ishikawa Prefecture . He was a "teacher's favorite" and was said to have a photographic memory, able to recite a difficult text from cover to cover in one reading. Some of his classmates regarded him as brash, abrasive and arrogant. His daughter Harumi felt that Shiro had been "unjustly condemned", saying "my father was a very warm-hearted person...he was so bright that people sometimes could not catch up with the speed of his thinking and that made him irritated, and he shouted at them." In 1916, Ishii enrolled at Faculty of Medicine, Kyoto Imperial University . He graduated in 1920, and married the daughter of Akari Torasaburō, the university's president, in the same year. In 1921, Ishii was commissioned into the Imperial Japanese Army as a military surgeon with the rank of Army Surgeon, First Class (surgeon lieutenant). In 1922, Ishii was assigned to the 1st Army Hospital and Army Medical School in Tokyo , where his work impressed his superiors enough to enable him to return to Kyoto Imperial University to pursue post-graduate medical schooling in 1924. During his studies, Ishii would often grow bacteria "pets" in multiple petri dishes, and his odd practice of raising bacteria as companions rather than as research subjects made him notable to the staff of the university. He did not get along well with his classmates; they would become infuriated as a result of his "pushy behaviour" and "indifference". One of his mentors, Professor Ren Kimura, recalled that Ishii had an odd habit of doing his laboratory work in the middle of the night, using laboratory equipment that had been carefully cleaned by his classmates earlier. His classmates would "really be mad when they came in and found the laboratory equipment dirty the next morning". In 1925, Ishii was promoted to Army Surgeon, Second Class (surgeon captain). By 1927, Ishii was advocating for the creation of a Japanese bio-weapons program, and in 1928 began a two-year tour of the West, where he did extensive research on the effects of biological warfare and chemical warfare developments from World War I onwards. Ishii's travels were highly successful and helped win him the patronage of Sadao Araki , the Japanese Minister of the Army . Ishii also received the backing of Araki's ideological rival in the army, Major-General Tetsuzan Nagata , who was later considered Ishii's "most active supporter" at the Khabarovsk War Crime Trials . In January 1931, Ishii received promotion to Senior Army Surgeon, Third Class (surgeon major). According to Ishii's followers, Ishii was extremely loyal to the Emperor and had an "enthusiastic personality" and "daring and carefree attitude", with eccentric work habits such as working late at night in the lab after hanging out with friends at town. He was also known for his heavy drinking, womanizing and embezzling habits, which were tolerated by his colleagues. Ishii was described as a vehement nationalist, and this helped him gain access to the people who could provide him funds. In 1935, Ishii was promoted to Senior Army Surgeon, Second Class (surgeon lieutenant-colonel). On August 1, 1936, Ishii would be given formal control over Unit 731 and its research facilities. A former member of Unit 731 recalled in 1998 that when he first met Ishii in Tokyo, he was surprised at his commander's appearance: "Ishii was slovenly dressed. His uniform was covered with food stains and ashes from numerous cigarettes. His officer's sword was poorly fastened and dragged on the floor". However, in Manchuria , Ishii would transform into a different character: "he was dressed immaculately. His uniform was spotless, and his sword was tied correctly". As the leader of Unit 731, Ishii conducted a variety of experiments, including vivisections, testing biological weapons on Chinese villages, poisoning by toxins and gases and forcing inmates to inflict syphillis on each other. Ishii also reportedly showed Hideki Tojo , who would later become Prime Minister in 1941, films of the experiments over several years. Tojo considered them "unpleasant" and eventually stopped watching them. Further promotions for Ishii would follow: he was promoted to Senior Army Surgeon, First Class (surgeon colonel) in 1938, Assistant Surgeon General (surgeon Major General ) in March 1941, and Surgeon General (surgeon Lieutenant General) in March 1945. Towards the end of the war, Ishii would develop a plan to spread plague fleas along the populated west coast of the US, known as Operation Cherry Blossoms at Night . This plan was not realized due to the surrender of Japan on August 15, 1945. Ishii and the Japanese government attempted to cover up the facilities and experiments, but ultimately failed with their secret university lab in Tokyo and their main lab in Harbin , China. The Japanese Army's Unit 731 War Crimes Exhibition Hall (731罪证陈列馆) in Harbin stands to this day as a museum to the unit and the atrocities they committed. Ishii was arrested by United States authorities during the Occupation of Japan at the end of World War II and, along with other leaders, was supposed to be thoroughly interrogated by Soviet authorities. Instead, Ishii and his team managed to negotiate and receive immunity in 1946 from Japanese war crimes prosecution before the Tokyo tribunal in exchange for their full disclosure. Although the Soviet authorities wished the prosecutions to take place, the United States objected after the reports of a team of military microbiologists headed by Lieutenant Colonel Murray Sanders stated that the information was "absolutely invaluable"; it "could never have been obtained in the United States because of scruples attached to experiments on humans" and "the information was obtained fairly cheaply." On May 6, 1947, Douglas MacArthur wrote to Washington that "additional data, possibly some statements from Ishii probably can be obtained by informing Japanese involved that information will be retained in intelligence channels and will not be employed as 'War Crimes' evidence." Ishii's immunity deal was concluded in 1948 and he was never prosecuted for any war crimes or crimes against humanity. After being granted immunity, Ishii was hired by the U.S. government to lecture American officers at Fort Detrick on the uses of bioweapons and the findings made by Unit 731. During the Korean War , Ishii traveled to Korea to take part in the U.S. Army's biological warfare activities. After returning to Japan, Ishii opened a clinic, performing examinations and treatments for free. He kept a diary, but it did not make reference to any of his wartime activities with Unit 731. In his last years, Ishii could not speak clearly; he was uncomfortable and on pain medication, speaking in a harsh voice. He died on October 9, 1959, from laryngeal cancer at the age of 67 at a hospital in Shinjuku , Tokyo. Ishii's funeral was chaired by Masaji Kitano , his second-in-command at Unit 731. According to his daughter, Ishii became a Roman Catholic shortly before his death. Ishii's daughter, Harumi Ishii, recalled in an interview that shortly before his death, Ishii's medical condition worsened: One day he took some sample tissue from himself to the University of Tokyo's Faculty of Medicine and asked one of his former subordinates to examine it, without telling him to whom it belonged. When he was told that the tissue was riddled by cancer, he proudly shouted that he had thought so too. No doctor had dared tell him he was suffering from cancer of the throat. He eventually underwent surgery and lost his voice. He was an earnest student of medicine to his last day, taking notes on his physical condition. He told his old professor Ren Kimura who came to visit him at that time: "it's all over now", writing the message because he could no longer speak. Shortly before his death, he asked to be baptised by the late Dr Herman Heuvers , former President of Sophia University in Tokyo. Dr Heuvers and my father were acquainted with each other since before the war. My father had much respect for the German people and their culture. He was baptised into the Roman Catholic Church and took the name Joseph. It seems to me that my father felt relieved somehow.Shirō Ishii was born in Shibayama [ dubious – discuss ] in Chiba Prefecture , Japan , the fourth son of Katsuya Ishii, a wealthy landowner and sake maker. The Ishii family was the community's largest landholder and exercised a feudal dominance over the local village and surrounding hamlets. Ishii attended the Chiba Middle School (now Chiba Prefectural Chiba High School) in Chiba City and the Fourth Higher School (now Kanazawa University ), a higher school in Kanazawa , Ishikawa Prefecture . He was a "teacher's favorite" and was said to have a photographic memory, able to recite a difficult text from cover to cover in one reading. Some of his classmates regarded him as brash, abrasive and arrogant. His daughter Harumi felt that Shiro had been "unjustly condemned", saying "my father was a very warm-hearted person...he was so bright that people sometimes could not catch up with the speed of his thinking and that made him irritated, and he shouted at them." In 1916, Ishii enrolled at Faculty of Medicine, Kyoto Imperial University . He graduated in 1920, and married the daughter of Akari Torasaburō, the university's president, in the same year. In 1921, Ishii was commissioned into the Imperial Japanese Army as a military surgeon with the rank of Army Surgeon, First Class (surgeon lieutenant). In 1922, Ishii was assigned to the 1st Army Hospital and Army Medical School in Tokyo , where his work impressed his superiors enough to enable him to return to Kyoto Imperial University to pursue post-graduate medical schooling in 1924. During his studies, Ishii would often grow bacteria "pets" in multiple petri dishes, and his odd practice of raising bacteria as companions rather than as research subjects made him notable to the staff of the university. He did not get along well with his classmates; they would become infuriated as a result of his "pushy behaviour" and "indifference". One of his mentors, Professor Ren Kimura, recalled that Ishii had an odd habit of doing his laboratory work in the middle of the night, using laboratory equipment that had been carefully cleaned by his classmates earlier. His classmates would "really be mad when they came in and found the laboratory equipment dirty the next morning". In 1925, Ishii was promoted to Army Surgeon, Second Class (surgeon captain).By 1927, Ishii was advocating for the creation of a Japanese bio-weapons program, and in 1928 began a two-year tour of the West, where he did extensive research on the effects of biological warfare and chemical warfare developments from World War I onwards. Ishii's travels were highly successful and helped win him the patronage of Sadao Araki , the Japanese Minister of the Army . Ishii also received the backing of Araki's ideological rival in the army, Major-General Tetsuzan Nagata , who was later considered Ishii's "most active supporter" at the Khabarovsk War Crime Trials . In January 1931, Ishii received promotion to Senior Army Surgeon, Third Class (surgeon major). According to Ishii's followers, Ishii was extremely loyal to the Emperor and had an "enthusiastic personality" and "daring and carefree attitude", with eccentric work habits such as working late at night in the lab after hanging out with friends at town. He was also known for his heavy drinking, womanizing and embezzling habits, which were tolerated by his colleagues. Ishii was described as a vehement nationalist, and this helped him gain access to the people who could provide him funds. In 1935, Ishii was promoted to Senior Army Surgeon, Second Class (surgeon lieutenant-colonel). On August 1, 1936, Ishii would be given formal control over Unit 731 and its research facilities. A former member of Unit 731 recalled in 1998 that when he first met Ishii in Tokyo, he was surprised at his commander's appearance: "Ishii was slovenly dressed. His uniform was covered with food stains and ashes from numerous cigarettes. His officer's sword was poorly fastened and dragged on the floor". However, in Manchuria , Ishii would transform into a different character: "he was dressed immaculately. His uniform was spotless, and his sword was tied correctly". As the leader of Unit 731, Ishii conducted a variety of experiments, including vivisections, testing biological weapons on Chinese villages, poisoning by toxins and gases and forcing inmates to inflict syphillis on each other. Ishii also reportedly showed Hideki Tojo , who would later become Prime Minister in 1941, films of the experiments over several years. Tojo considered them "unpleasant" and eventually stopped watching them. Further promotions for Ishii would follow: he was promoted to Senior Army Surgeon, First Class (surgeon colonel) in 1938, Assistant Surgeon General (surgeon Major General ) in March 1941, and Surgeon General (surgeon Lieutenant General) in March 1945. Towards the end of the war, Ishii would develop a plan to spread plague fleas along the populated west coast of the US, known as Operation Cherry Blossoms at Night . This plan was not realized due to the surrender of Japan on August 15, 1945. Ishii and the Japanese government attempted to cover up the facilities and experiments, but ultimately failed with their secret university lab in Tokyo and their main lab in Harbin , China. The Japanese Army's Unit 731 War Crimes Exhibition Hall (731罪证陈列馆) in Harbin stands to this day as a museum to the unit and the atrocities they committed.Ishii was arrested by United States authorities during the Occupation of Japan at the end of World War II and, along with other leaders, was supposed to be thoroughly interrogated by Soviet authorities. Instead, Ishii and his team managed to negotiate and receive immunity in 1946 from Japanese war crimes prosecution before the Tokyo tribunal in exchange for their full disclosure. Although the Soviet authorities wished the prosecutions to take place, the United States objected after the reports of a team of military microbiologists headed by Lieutenant Colonel Murray Sanders stated that the information was "absolutely invaluable"; it "could never have been obtained in the United States because of scruples attached to experiments on humans" and "the information was obtained fairly cheaply." On May 6, 1947, Douglas MacArthur wrote to Washington that "additional data, possibly some statements from Ishii probably can be obtained by informing Japanese involved that information will be retained in intelligence channels and will not be employed as 'War Crimes' evidence." Ishii's immunity deal was concluded in 1948 and he was never prosecuted for any war crimes or crimes against humanity. After being granted immunity, Ishii was hired by the U.S. government to lecture American officers at Fort Detrick on the uses of bioweapons and the findings made by Unit 731. During the Korean War , Ishii traveled to Korea to take part in the U.S. Army's biological warfare activities. After returning to Japan, Ishii opened a clinic, performing examinations and treatments for free. He kept a diary, but it did not make reference to any of his wartime activities with Unit 731. In his last years, Ishii could not speak clearly; he was uncomfortable and on pain medication, speaking in a harsh voice. He died on October 9, 1959, from laryngeal cancer at the age of 67 at a hospital in Shinjuku , Tokyo. Ishii's funeral was chaired by Masaji Kitano , his second-in-command at Unit 731. According to his daughter, Ishii became a Roman Catholic shortly before his death. Ishii's daughter, Harumi Ishii, recalled in an interview that shortly before his death, Ishii's medical condition worsened: One day he took some sample tissue from himself to the University of Tokyo's Faculty of Medicine and asked one of his former subordinates to examine it, without telling him to whom it belonged. When he was told that the tissue was riddled by cancer, he proudly shouted that he had thought so too. No doctor had dared tell him he was suffering from cancer of the throat. He eventually underwent surgery and lost his voice. He was an earnest student of medicine to his last day, taking notes on his physical condition. He told his old professor Ren Kimura who came to visit him at that time: "it's all over now", writing the message because he could no longer speak. Shortly before his death, he asked to be baptised by the late Dr Herman Heuvers , former President of Sophia University in Tokyo. Dr Heuvers and my father were acquainted with each other since before the war. My father had much respect for the German people and their culture. He was baptised into the Roman Catholic Church and took the name Joseph. It seems to me that my father felt relieved somehow.Ishii was portrayed by Min Ji-hwan in the MBC TV series Eyes of Dawn , and portrayed by Gang Wang in the 1988 film Men Behind The Sun .

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Bubonic plague

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Plague of Athens

The Plague of Athens ( Ancient Greek : Λοιμὸς τῶν Ἀθηνῶν , Loimos tôn Athênôn ) was an epidemic that devastated the city-state of Athens in ancient Greece during the second year (430 BC) of the Peloponnesian War when an Athenian victory still seemed within reach. The plague killed an estimated 75,000 to 100,000 people, around 25% of the population, and is believed to have entered Athens through Piraeus , the city's port and sole source of food and supplies. Much of the eastern Mediterranean also saw an outbreak of the disease, albeit with less impact. The war, along with the plague, had serious effects on Athens' society. This resulted in a lack of adherence to laws and religious belief; in response, laws became stricter, resulting in the punishment of non-citizens claiming to be Athenian. Among the victims of the plague was Pericles , the leader of Athens. The plague returned twice more, in 429 BC and in the winter of 427/426 BC. Some 30 pathogens have been suggested as having caused the plague. Sparta and its allies, except for Corinth , were almost exclusively land-based powers, able to summon large land armies that were very nearly unbeatable. In the face of a combined campaign on land from Sparta and its allies beginning in 431 BC, the Athenians, under the direction of Pericles , pursued a policy of retreat within the city walls of Athens, relying on Athenian maritime supremacy for supply while the superior Athenian navy harassed Spartan troop movements. Unfortunately, the strategy also resulted in massive migration from the Attic countryside into an already highly populated city, generating overpopulation and resource shortage. Due to the close quarters and poor hygiene exhibited at that time, Athens became a breeding ground for disease, and many citizens died. In the history of epidemics in wartime, the 'Plague' of Athens is remarkable for the limitation of the affliction to one side as well as for its influence on the outcome of the war. [ citation needed ] The Athenians thought that the Spartans could have poisoned their water supply to kill them to win the Peloponnesian War. The Spartans somehow were unaffected by the plague, which may have been a reason for the Athenians' suspicion. It has been noted that the Plague of Athens was the worst sickness of Classical Greece. In his History of the Peloponnesian War , the historian Thucydides , who was present and contracted the disease himself and survived, describes the epidemic. He writes of a disease coming from Ethiopia and passing through Egypt and Libya into the Greek world and spreading throughout the wider Mediterranean; a plague so severe and deadly that no one could recall anywhere its like, and physicians ignorant of its nature not only were helpless but themselves died the fastest, having had the most contact with the sick. In overcrowded Athens, the disease killed an estimated 25% of the population. The sight of the burning funeral pyres of Athens caused the Spartans to withdraw their troops, being unwilling to risk contact with the diseased enemy. Many of Athens' infantry and expert seamen died. According to Thucydides , not until 415 BC had Athens recovered sufficiently to mount a major offensive, the disastrous Sicilian Expedition . [ citation needed ] The first corroboration of the plague was not revealed until 1994-95 when excavation revealed the first mass grave . Upon this discovery, Thucydides' accounts of the event as well as analysis of the remains had been used to try and identify the cause of the epidemic. [ citation needed ]Thucydides claims that the plague spread from Ethiopia to Athens. The plague first emerged in the port of Piraeus from ships with plague infected passengers. From there it spread to Athens via the Long Walls where refugees would camp out. The small space and poor hygiene of the people living in the Long Walls led to a significant spread of the plague. The plague affected certain groups over others, however, there is a lack of details of how the plague spread among inbreeds and certain working members. Physicians and health care workers were at a higher risk to catch the plague due to the exposure of other diseases. Higher-ranking members of society were at a lower risk of catching the plague due to better living standards and better hygiene. Lack of food was not an issue for Athens, for they had plenty of grain storage. Athens lacked vitamin C due to their mainly grain diet. The lack of vitamin C caused a lower immunity. The lower immunity left Athenians more susceptible to diseases. The Plague of Athens was most likely caused by a reservoir disease or respiratory disease , though neither has been confirmed. If the plague was caused by a reservoir disease, it would be very similar to arboviral diseases or typhus as later mentioned. If it was a respiratory disease, it would most likely be similar to smallpox . Most Athenian doctors and physicians believed in Humorism . The belief is centered around the idea that a person contains four humors-yellow bile, black bile, phlegm, and blood-that must be equally balanced to have a healthy body. Practices to balance the humors include blood-letting, purging, urine sampling, and using the opposite humor to treat the imbalanced humor.Accounts of the Athenian plague graphically describe the social consequences of an epidemic. Thucydides' account details the complete disappearance of social morals during the time of the plague: ...the catastrophe was so overwhelming that men, not knowing what would happen next to them, became indifferent to every rule of religion or law." The perceived impact of the Athenian plague on collective social and religious behavior echoes accounts of the medieval pandemic best known as the Black Death , although scholars have disputed its objective veracity in both instances, citing a historical link between epidemic disease and unsubstantiated moral panic that bordered on hysteria . Thucydides states that people ceased fearing the law since they felt they were already living under a death sentence. Likewise, people started spending money indiscriminately. Many felt they would not live long enough to enjoy the fruits of wise investment, while some of the poor unexpectedly became wealthy by inheriting the property of their relatives. It is also recorded that people refused to behave honorably because most did not expect to live long enough to enjoy a good reputation for it. Another reason for the lack of honorable behavior was the sheer contagiousness of the illness. Those who tended to the ill were most vulnerable to catching the disease. This meant that many people died alone because no one was willing to risk caring for them. The dead were heaped on top of each other, left to rot, or shoved into mass graves. Sometimes those carrying the dead would come across an already burning funeral pyre, dump a new body on it, and walk away. Others appropriated prepared pyres to have enough fuel to cremate their own dead. Survivors of the plague developed an immunity and so became the main caretakers of those who later fell ill. A mass grave and nearly 1,000 tombs, dated between 430 and 426 BC, have been found just outside Athens' ancient Kerameikos cemetery. The mass grave was bordered by a low wall that seemed to have protected the cemetery from a wetland. Excavated during 1994–95, the shaft-shaped grave may have contained a total of 240 individuals, at least ten of them children. Skeletons in the graves were randomly placed with no layers of soil between them. [ citation needed ] Excavator Efi Baziotopoulou-Valavani, of the Third Ephoreia (Directorate) of Antiquities, reported that "[t]he mass grave did not have a monumental character. The offerings we found consisted of common, even cheap, burial vessels; black-finished ones, some small red-figured, as well as white lekythoi (oil flasks) of the second half of the 5th century BC. The bodies were placed in the pit within a day or two. These [factors] point to a mass burial in a state of panic, quite possibly due to a plague." During this time refugees from the Peloponnesian war had immigrated within the Long Walls of Athens, inflating the populations of both the polis of Athens and the port of Piraeus. The population had tripled in this time increasing the chance of infection and worsening hygiene. The plague also caused religious uncertainty and doubt. Since the disease struck without regard to a person's piety toward the gods, people felt abandoned by the gods and there seemed to be no benefit to worshiping them. The temples themselves were sites of great misery, as refugees from the Athenian countryside had been forced to find accommodation in the temples. Soon the sacred buildings were filled with the dead and dying. The Athenians pointed to the plague as evidence that the gods favored Sparta, and this was supported by an oracle that Apollo himself (the god of disease and medicine) would fight for Sparta if they fought with all their might. An earlier oracle had warned that "A Dorian [Spartan] war will come, and bring a pestilence with it". Thucydides was skeptical of these conclusions and believed that people were simply being superstitious. He relied upon the prevailing medical theory of the day, Hippocratic theory , and strove to gather evidence through direct observation. He observed that carrion -eating birds and animals disappeared, though he left it an open question whether they died after eating the corpses or refused to eat them and were driven away: All the birds and beasts that prey upon human bodies, either abstained from touching them (though there were many lying unburied), or died after tasting them. In proof of this, it was noticed that birds of this kind disappeared; they were not about the bodies, or indeed to be seen at all. The plague was an unforeseen event that resulted in one of the largest recorded loss of life in ancient Greece as well as a breakdown of Athenian society. The epidemic caused the death of an estimated 25% of Athens, which at the time ranged from 250,000 to 300,000. The balance of power between citizens had changed due to many of the rich dying and their fortunes being inherited by remaining relatives of the lower class. According to Thucydides, those who had become ill and survived were the most sympathetic to others suffering: believing that they could no longer succumb to any illness, many survivors offered to assist with the remaining sick. The plague also contributed to Athens' overall loss of power and ability to expand. Many of the remaining Athenians were found to be metics who had forged their documentation or had bribed officials to hide their original status. A number of these people were reduced to slaves once they were caught. This resulted in the passing of the Citizenship Law of Pericles. This law stated that only those born to two Athenian parents could be considered an Athenian citizen, reducing both their number of potential soldiers and amount of political power, but also a decline in treatment and rights for metics in Athens. The plague dealt massive damage to Athens two years into the Peloponnesian War, from which it never recovered. Their political strength had weakened, and morale among their armies and citizens had fallen significantly. Athens would then go on to be defeated by Sparta and fall from being a major power in Ancient Greece. [ citation needed ]Thucydides states that people ceased fearing the law since they felt they were already living under a death sentence. Likewise, people started spending money indiscriminately. Many felt they would not live long enough to enjoy the fruits of wise investment, while some of the poor unexpectedly became wealthy by inheriting the property of their relatives. It is also recorded that people refused to behave honorably because most did not expect to live long enough to enjoy a good reputation for it. Another reason for the lack of honorable behavior was the sheer contagiousness of the illness. Those who tended to the ill were most vulnerable to catching the disease. This meant that many people died alone because no one was willing to risk caring for them. The dead were heaped on top of each other, left to rot, or shoved into mass graves. Sometimes those carrying the dead would come across an already burning funeral pyre, dump a new body on it, and walk away. Others appropriated prepared pyres to have enough fuel to cremate their own dead. Survivors of the plague developed an immunity and so became the main caretakers of those who later fell ill. A mass grave and nearly 1,000 tombs, dated between 430 and 426 BC, have been found just outside Athens' ancient Kerameikos cemetery. The mass grave was bordered by a low wall that seemed to have protected the cemetery from a wetland. Excavated during 1994–95, the shaft-shaped grave may have contained a total of 240 individuals, at least ten of them children. Skeletons in the graves were randomly placed with no layers of soil between them. [ citation needed ] Excavator Efi Baziotopoulou-Valavani, of the Third Ephoreia (Directorate) of Antiquities, reported that "[t]he mass grave did not have a monumental character. The offerings we found consisted of common, even cheap, burial vessels; black-finished ones, some small red-figured, as well as white lekythoi (oil flasks) of the second half of the 5th century BC. The bodies were placed in the pit within a day or two. These [factors] point to a mass burial in a state of panic, quite possibly due to a plague." During this time refugees from the Peloponnesian war had immigrated within the Long Walls of Athens, inflating the populations of both the polis of Athens and the port of Piraeus. The population had tripled in this time increasing the chance of infection and worsening hygiene. The plague also caused religious uncertainty and doubt. Since the disease struck without regard to a person's piety toward the gods, people felt abandoned by the gods and there seemed to be no benefit to worshiping them. The temples themselves were sites of great misery, as refugees from the Athenian countryside had been forced to find accommodation in the temples. Soon the sacred buildings were filled with the dead and dying. The Athenians pointed to the plague as evidence that the gods favored Sparta, and this was supported by an oracle that Apollo himself (the god of disease and medicine) would fight for Sparta if they fought with all their might. An earlier oracle had warned that "A Dorian [Spartan] war will come, and bring a pestilence with it". Thucydides was skeptical of these conclusions and believed that people were simply being superstitious. He relied upon the prevailing medical theory of the day, Hippocratic theory , and strove to gather evidence through direct observation. He observed that carrion -eating birds and animals disappeared, though he left it an open question whether they died after eating the corpses or refused to eat them and were driven away: All the birds and beasts that prey upon human bodies, either abstained from touching them (though there were many lying unburied), or died after tasting them. In proof of this, it was noticed that birds of this kind disappeared; they were not about the bodies, or indeed to be seen at all. The plague was an unforeseen event that resulted in one of the largest recorded loss of life in ancient Greece as well as a breakdown of Athenian society. The epidemic caused the death of an estimated 25% of Athens, which at the time ranged from 250,000 to 300,000. The balance of power between citizens had changed due to many of the rich dying and their fortunes being inherited by remaining relatives of the lower class. According to Thucydides, those who had become ill and survived were the most sympathetic to others suffering: believing that they could no longer succumb to any illness, many survivors offered to assist with the remaining sick. The plague also contributed to Athens' overall loss of power and ability to expand. Many of the remaining Athenians were found to be metics who had forged their documentation or had bribed officials to hide their original status. A number of these people were reduced to slaves once they were caught. This resulted in the passing of the Citizenship Law of Pericles. This law stated that only those born to two Athenian parents could be considered an Athenian citizen, reducing both their number of potential soldiers and amount of political power, but also a decline in treatment and rights for metics in Athens. The plague dealt massive damage to Athens two years into the Peloponnesian War, from which it never recovered. Their political strength had weakened, and morale among their armies and citizens had fallen significantly. Athens would then go on to be defeated by Sparta and fall from being a major power in Ancient Greece. [ citation needed ]According to Thucydides, the illness began by showing symptoms in the head as it worked its way through the rest of the body. He also described in detail the symptoms that victims of the plague experienced. Fever Redness and inflammation in the eyes Sore throats leading to bleeding and bad breath Sneezing Loss of voice Coughing Vomiting Pustules and ulcers on the body Extreme thirst Insomnia Diarrhea Convulsions GangreneHistorians have long tried to identify the disease behind the Plague of Athens. The disease has traditionally been considered an outbreak of the bubonic plague in its many forms, but a reconsideration of the reported symptoms and epidemiology have led scholars to advance alternative explanations. These include typhus , smallpox , measles , and toxic shock syndrome . Based upon striking descriptive similarities with recent outbreaks in Africa, as well as the fact that the Athenian plague itself came from Africa (as Thucydides recorded), Ebola or a related viral hemorrhagic fever has been considered. Given the possibility that profiles of a known disease may have changed over time, or that the plague was caused by a disease that no longer exists, the exact nature of the Athenian plague may never be known. In addition, crowding caused by the influx of refugees into the city led to inadequate food and water supplies and a probable proportionate increase in insects, lice, rats, and waste. These conditions would have encouraged more than one epidemic disease during the outbreak. [ citation needed ] In January 1999, the University of Maryland devoted their fifth annual medical conference, dedicated to notorious case histories, to the Plague of Athens. They concluded that the disease that killed the Greeks was typhus . "Epidemic typhus fever is the best explanation," said Dr. David Durack, consulting professor of medicine at Duke University . "It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features." In typhus cases, progressive dehydration, debilitation, and cardiovascular collapse ultimately cause the patient's death. [ citation needed ] This medical opinion is supported by the opinion of A. W. Gomme , who wrote a comprehensive annotated edition of Thucydides and who also believed typhus was the cause of the epidemic. This opinion is expressed in his monumental work An Historical Commentary on Thucydides , completed after Gomme's death by A. Andrewes and K. J. Dover. Angelos Vlachos ( Άγγελος Βλάχος ), a member of the Academy of Athens and a diplomat, in his Remarks on Thucydides ( Παρατηρήσεις στο Î˜Î¿Ï ÎºÏ Î´Î¯Î´Î· , I: 177–178) acknowledges and supports Gomme's opinion: "Today, according to Gomme, it is generally acceptable that it was typhus" (" Σήμερα, όπως γράφει ο Gomme, έχει γίνει από ÏŒÎ»Î¿Ï Ï‚ παραδεκτό ότι ήταν τύφος "). The theory has also found recent support in a study of the plague by Greek epidemiologists. Symptoms generally associated with typhoid resemble Thucydides' description. They include: Some characteristics of typhoid are at clear variance from Thucydides' description. Scavenger animals do not die from infection with typhoid, The onset of fever in typhoid is typically slow and subtle, and typhoid generally kills later in the disease course. As typhoid is most commonly transmitted through poor hygiene habits and public sanitation conditions in crowded urban areas, it is an unlikely cause of a plague emerging in the less urbanized Africa, as reported by Thucydides. [ citation needed ] A 2005 DNA study of dental pulp from teeth recovered from an ancient Greek burial pit, led by orthodontist Dr. Manolis Papagrigorakis of the University of Athens, found DNA sequences similar to those of Salmonella enterica ( S. enterica ), the organism that causes typhoid fever . A second group of researchers, including American evolutionary molecular biologist Dr. Beth Shapiro of the University of California, Santa Cruz , disputed the Papagrigorakis team's findings, citing what they claim are serious methodological flaws. In a letter to the International Journal of Infectious Diseases , Shapiro et al. stated that "while this DNA analysis confirms that the Athens sequence is possibly Salmonella , it demonstrates clearly that it is not typhoid." The technique used by the Papagrigorakis team ( PCR ) has shown itself to be prone to contamination-induced false-positive results, and the source burial site is known to have been heavily trafficked in antiquity by hogs, carriers of another Salmonella serovar that may have been confused with the one that causes typhoid fever. Nonetheless, the Papagrigorakis team asserts that the basis of this refutation is flimsy, and that the methodology used by the Shapiro team has historically produced conflicting results. Thucydides' narrative pointedly refers to increased risk among caregivers, more typical of the person-to-person contact spread of viral hemorrhagic fever (e.g., Ebola virus disease or Marburg virus ) than typhus or typhoid. Unusual in the history of plagues during military operations, besieging Spartan troops are described as not having been afflicted by the illness raging near them within the city. Thucydides' description further invites comparison with VHF in the character and sequence of symptoms developed and of the usual fatal outcome on about the eighth day. Some scientists have interpreted Thucydides' expression " lygx kenē " ( λύγξ κενή ) as the unusual symptom of hiccups, which is now recognized as a common finding in Ebola virus disease. Outbreaks of VHF in Africa in 2012 and 2014 reinforced observations of the increased hazard to caregivers and the necessity of barrier precautions for preventing disease spread related to grief rituals and funerary rites. The 2015 West African Ebola outbreak noted the persistence of effects on genitalia and eyes in some survivors, both described by Thucydides. With an up to 21-day clinical incubation period, and up to 565-day infectious potential recently demonstrated in a semen-transmitted infection, movement of Ebola via Nile commerce into the busy port of Piraeus is plausible. Ancient Greek intimacy with African sources is reflected in accurate renditions of monkeys in the art of frescoes and pottery, most notably guenons ( Cercopithecus ), the type of primates responsible for transmitting Marburg virus into Germany and Yugoslavia when that disease was first characterized in 1967. Circumstantially tantalizing is the requirement for the large quantity of ivory used in the Athenian sculptor Phidias' two monumental ivory and gold statues of Athena and of Zeus (one of the Seven Wonders ), which were fabricated in the same decade. Never again in antiquity was ivory used on such a large scale. [ citation needed ] A second ancient narrative suggestive of hemorrhagic fever etiology is that of Titus Lucretius Carus . Writing in the 1st century BC, Lucretius characterized the Athenian plague as having bloody discharges from bodily orifices ( Book 6.1146–47: "sudabant etiam fauces intrinsecus atrae / sanguine" – the throat sweated within, black with blood). That descriptor may have been derived from direct observation because Lucretius cited scientific predecessors in Greek Sicily- Empedocles and Acron . While none of the original works of Acron , a physician, are extant, it is reported that he died c. 430 BC after traveling from Sicily to Athens to assist against the plague. [ citation needed ] Unfortunately, DNA sequence-based identification is limited by the inability of some important pathogens to leave a "footprint" retrievable from archaeological remains after several millennia. The lack of a durable signature by RNA viruses means some etiologies, notably the hemorrhagic fever viruses, are not testable hypotheses using currently available scientific techniques. [ citation needed ]In January 1999, the University of Maryland devoted their fifth annual medical conference, dedicated to notorious case histories, to the Plague of Athens. They concluded that the disease that killed the Greeks was typhus . "Epidemic typhus fever is the best explanation," said Dr. David Durack, consulting professor of medicine at Duke University . "It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features." In typhus cases, progressive dehydration, debilitation, and cardiovascular collapse ultimately cause the patient's death. [ citation needed ] This medical opinion is supported by the opinion of A. W. Gomme , who wrote a comprehensive annotated edition of Thucydides and who also believed typhus was the cause of the epidemic. This opinion is expressed in his monumental work An Historical Commentary on Thucydides , completed after Gomme's death by A. Andrewes and K. J. Dover. Angelos Vlachos ( Άγγελος Βλάχος ), a member of the Academy of Athens and a diplomat, in his Remarks on Thucydides ( Παρατηρήσεις στο Î˜Î¿Ï ÎºÏ Î´Î¯Î´Î· , I: 177–178) acknowledges and supports Gomme's opinion: "Today, according to Gomme, it is generally acceptable that it was typhus" (" Σήμερα, όπως γράφει ο Gomme, έχει γίνει από ÏŒÎ»Î¿Ï Ï‚ παραδεκτό ότι ήταν τύφος "). The theory has also found recent support in a study of the plague by Greek epidemiologists. Symptoms generally associated with typhoid resemble Thucydides' description. They include: Some characteristics of typhoid are at clear variance from Thucydides' description. Scavenger animals do not die from infection with typhoid, The onset of fever in typhoid is typically slow and subtle, and typhoid generally kills later in the disease course. As typhoid is most commonly transmitted through poor hygiene habits and public sanitation conditions in crowded urban areas, it is an unlikely cause of a plague emerging in the less urbanized Africa, as reported by Thucydides. [ citation needed ] A 2005 DNA study of dental pulp from teeth recovered from an ancient Greek burial pit, led by orthodontist Dr. Manolis Papagrigorakis of the University of Athens, found DNA sequences similar to those of Salmonella enterica ( S. enterica ), the organism that causes typhoid fever . A second group of researchers, including American evolutionary molecular biologist Dr. Beth Shapiro of the University of California, Santa Cruz , disputed the Papagrigorakis team's findings, citing what they claim are serious methodological flaws. In a letter to the International Journal of Infectious Diseases , Shapiro et al. stated that "while this DNA analysis confirms that the Athens sequence is possibly Salmonella , it demonstrates clearly that it is not typhoid." The technique used by the Papagrigorakis team ( PCR ) has shown itself to be prone to contamination-induced false-positive results, and the source burial site is known to have been heavily trafficked in antiquity by hogs, carriers of another Salmonella serovar that may have been confused with the one that causes typhoid fever. Nonetheless, the Papagrigorakis team asserts that the basis of this refutation is flimsy, and that the methodology used by the Shapiro team has historically produced conflicting results. Symptoms generally associated with typhoid resemble Thucydides' description. They include: Some characteristics of typhoid are at clear variance from Thucydides' description. Scavenger animals do not die from infection with typhoid, The onset of fever in typhoid is typically slow and subtle, and typhoid generally kills later in the disease course. As typhoid is most commonly transmitted through poor hygiene habits and public sanitation conditions in crowded urban areas, it is an unlikely cause of a plague emerging in the less urbanized Africa, as reported by Thucydides. [ citation needed ]A 2005 DNA study of dental pulp from teeth recovered from an ancient Greek burial pit, led by orthodontist Dr. Manolis Papagrigorakis of the University of Athens, found DNA sequences similar to those of Salmonella enterica ( S. enterica ), the organism that causes typhoid fever . A second group of researchers, including American evolutionary molecular biologist Dr. Beth Shapiro of the University of California, Santa Cruz , disputed the Papagrigorakis team's findings, citing what they claim are serious methodological flaws. In a letter to the International Journal of Infectious Diseases , Shapiro et al. stated that "while this DNA analysis confirms that the Athens sequence is possibly Salmonella , it demonstrates clearly that it is not typhoid." The technique used by the Papagrigorakis team ( PCR ) has shown itself to be prone to contamination-induced false-positive results, and the source burial site is known to have been heavily trafficked in antiquity by hogs, carriers of another Salmonella serovar that may have been confused with the one that causes typhoid fever. Nonetheless, the Papagrigorakis team asserts that the basis of this refutation is flimsy, and that the methodology used by the Shapiro team has historically produced conflicting results. Thucydides' narrative pointedly refers to increased risk among caregivers, more typical of the person-to-person contact spread of viral hemorrhagic fever (e.g., Ebola virus disease or Marburg virus ) than typhus or typhoid. Unusual in the history of plagues during military operations, besieging Spartan troops are described as not having been afflicted by the illness raging near them within the city. Thucydides' description further invites comparison with VHF in the character and sequence of symptoms developed and of the usual fatal outcome on about the eighth day. Some scientists have interpreted Thucydides' expression " lygx kenē " ( λύγξ κενή ) as the unusual symptom of hiccups, which is now recognized as a common finding in Ebola virus disease. Outbreaks of VHF in Africa in 2012 and 2014 reinforced observations of the increased hazard to caregivers and the necessity of barrier precautions for preventing disease spread related to grief rituals and funerary rites. The 2015 West African Ebola outbreak noted the persistence of effects on genitalia and eyes in some survivors, both described by Thucydides. With an up to 21-day clinical incubation period, and up to 565-day infectious potential recently demonstrated in a semen-transmitted infection, movement of Ebola via Nile commerce into the busy port of Piraeus is plausible. Ancient Greek intimacy with African sources is reflected in accurate renditions of monkeys in the art of frescoes and pottery, most notably guenons ( Cercopithecus ), the type of primates responsible for transmitting Marburg virus into Germany and Yugoslavia when that disease was first characterized in 1967. Circumstantially tantalizing is the requirement for the large quantity of ivory used in the Athenian sculptor Phidias' two monumental ivory and gold statues of Athena and of Zeus (one of the Seven Wonders ), which were fabricated in the same decade. Never again in antiquity was ivory used on such a large scale. [ citation needed ] A second ancient narrative suggestive of hemorrhagic fever etiology is that of Titus Lucretius Carus . Writing in the 1st century BC, Lucretius characterized the Athenian plague as having bloody discharges from bodily orifices ( Book 6.1146–47: "sudabant etiam fauces intrinsecus atrae / sanguine" – the throat sweated within, black with blood). That descriptor may have been derived from direct observation because Lucretius cited scientific predecessors in Greek Sicily- Empedocles and Acron . While none of the original works of Acron , a physician, are extant, it is reported that he died c. 430 BC after traveling from Sicily to Athens to assist against the plague. [ citation needed ] Unfortunately, DNA sequence-based identification is limited by the inability of some important pathogens to leave a "footprint" retrievable from archaeological remains after several millennia. The lack of a durable signature by RNA viruses means some etiologies, notably the hemorrhagic fever viruses, are not testable hypotheses using currently available scientific techniques. [ citation needed ]

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Bubonic plague

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Freston, Suffolk

Freston Freston is a small village and civil parish in the Babergh district, in the county of Suffolk , England, located on the Shotley Peninsula , 4 miles south-east of Ipswich . In 2001 the parish had a population of 122, reducing slightly to 120 at the 2011 Census. Freston is notable as the location of the last outbreak of bubonic plague in England in 1910. The centre of the outbreak was Latimer Cottages, where it is thought plague-bearing rats may have come ashore with smuggled goods. However, the diagnosis of plague has been disputed. Freston is notable as the location of the last outbreak of bubonic plague in England in 1910. The centre of the outbreak was Latimer Cottages, where it is thought plague-bearing rats may have come ashore with smuggled goods. However, the diagnosis of plague has been disputed. For transport there is the B1456 road nearby.

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Bubonic plague

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Diseases and epidemics of the 19th century

Diseases and epidemics of the 19th century included long-standing epidemic threats such as smallpox , typhus , yellow fever , and scarlet fever . In addition, cholera emerged as an epidemic threat and spread worldwide in six pandemics in the nineteenth century.Epidemics of the 19th century were faced without the medical advances that made 20th-century epidemics much rarer and less lethal. Micro-organisms (viruses and bacteria) had been discovered in the 18th century, but it was not until the late 19th century that the experiments of Lazzaro Spallanzani and Louis Pasteur disproved spontaneous generation conclusively, allowing germ theory and Robert Koch 's discovery of micro-organisms as the cause of disease transmission . Thus throughout the majority of the 19th century, there was only the most basic, common-sense understanding of the causes, amelioration, and treatment of epidemic disease. [ citation needed ] The 19th century did, however, mark a transformation period in medicine. This included the first uses of chloroform and nitrous dioxides as anesthesia, important discoveries in regards of pathology and the perfection of the autopsy , and advances in our understanding of the human body. Medical institutions were also transitioning to new hospital styles to try to prevent the spread of disease and stop over crowding with the mixing of the poor and the sick which had been a common practice. With the increasing rise in urban population, disease and epidemic crisis became much more prevalent and was seen as a consequence of urban living. Problems arose as both governments and the medical professionals at the time tried to get a handle on the spread of disease. They had yet to figure out what actually causes disease. So as those in authority scrambled to make leaps and bounds in science and track down what may be the cause of these epidemics, entire communities would be lost to the grips of terrible ailments. During these many outbreaks, members of the medical profession rapidly began trying different cures to treat their patients. During the cholera epidemic of 1832 , a doctor in London, Thomas Latta , discovered that he could greatly increase the survival rate of his patients by injecting saline solutions into their arms. However, due to the wide range of medicines being touted as cures and treatments, his technique failed to gain widespread adoption. Many other medical discoveries made in the 19th century failed to gain traction for similar reasons. With the increasing circulation of mass media and little content review in medical journals , almost anyone with or without proper education could publish a potential cure for disease. Actual practicing medical professionals also had to compete with the ever expanding pharmacy companies that were all too ready to provide new elixirs and promising treatments for the epidemics of the time. Emerging from the medical chaos were legitimate and life changing treatments. The late 19th century was the beginning of widespread use of vaccines . The cholera bacterium was isolated in 1854 by Italian anatomist Filippo Pacini , and a vaccine, the first to immunize humans against a bacterial disease, was developed by Spanish physician Jaume Ferran i Clua in 1885, and by Russian–Jewish bacteriologist Waldemar Haffkine in July 1892. Antibiotic drugs did not appear until the middle of the 20th century. Sulfonamides did not appear until 1935 , and penicillin , discovered in 1928, was not available as a treatment until 1950. [ citation needed ] A big response and potential cure to these epidemics were better sanitation in the cities. Sanitation prior to this was very poor and sometimes attempts to get better sanitation often exacerbated the diseases, especially during the cholera epidemics because their understanding of diseases relied on the miasma (bad air) theory . During the first cholera epidemic, Edwin Chadwick made an inquiry into sanitation and used quantitative data to link poor living conditions and disease and low life expectancy. As a result, the Board of Health in London took measure to improve drainage and ventilation around the city. Unfortunately, the measures helped clean the city but it further contaminated the River Thames (the primary drinking water for the city) and the epidemic got worse. During the second cholera pandemic of 1816–1837, the scientific community varied in its beliefs about its causes. In France, doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious and quarantined their citizens. The United States believed that cholera was brought by recent immigrants, specifically the Irish. Lastly, some British thought the disease might arise from divine intervention. During the third pandemic , Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. The prevalence of the disease in the South in areas of black populations convinced United States scientists that cholera was associated with African Americans. Current researchers note they lived near the waterways by which travelers and ships carried the disease and their populations were underserved with sanitation infrastructure and health care. The Soho outbreak in London in 1854 ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle. Snow believed that germ-contaminated water was the source of cholera , rather than particles in the air (referred to as "miasmata"). His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. Though Filippo Pacini had isolated Vibrio cholerae as the causative agent for cholera that year, it would be many years before miasma theory would fall out of favor. [ citation needed ] In London, in June 1866 ), a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems. William Farr , using the work of John Snow, et al. , as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths. During the fifth cholera pandemic , Robert Koch isolated Vibrio cholerae and proposed postulates to explain how bacteria caused disease. His work helped to establish the germ theory of disease . Prior to this time, many physicians believed that microorganisms were spontaneously generated, and disease was caused by direct exposure to filth and decay. Koch helped establish that the disease was more specifically contagious and was transmittable through the contaminated water supply. The fifth was the last serious European cholera outbreak, as cities improved their sanitation and water systems. [ citation needed ]Epidemics of the 19th century were faced without the medical advances that made 20th-century epidemics much rarer and less lethal. Micro-organisms (viruses and bacteria) had been discovered in the 18th century, but it was not until the late 19th century that the experiments of Lazzaro Spallanzani and Louis Pasteur disproved spontaneous generation conclusively, allowing germ theory and Robert Koch 's discovery of micro-organisms as the cause of disease transmission . Thus throughout the majority of the 19th century, there was only the most basic, common-sense understanding of the causes, amelioration, and treatment of epidemic disease. [ citation needed ] The 19th century did, however, mark a transformation period in medicine. This included the first uses of chloroform and nitrous dioxides as anesthesia, important discoveries in regards of pathology and the perfection of the autopsy , and advances in our understanding of the human body. Medical institutions were also transitioning to new hospital styles to try to prevent the spread of disease and stop over crowding with the mixing of the poor and the sick which had been a common practice. With the increasing rise in urban population, disease and epidemic crisis became much more prevalent and was seen as a consequence of urban living. Problems arose as both governments and the medical professionals at the time tried to get a handle on the spread of disease. They had yet to figure out what actually causes disease. So as those in authority scrambled to make leaps and bounds in science and track down what may be the cause of these epidemics, entire communities would be lost to the grips of terrible ailments. During these many outbreaks, members of the medical profession rapidly began trying different cures to treat their patients. During the cholera epidemic of 1832 , a doctor in London, Thomas Latta , discovered that he could greatly increase the survival rate of his patients by injecting saline solutions into their arms. However, due to the wide range of medicines being touted as cures and treatments, his technique failed to gain widespread adoption. Many other medical discoveries made in the 19th century failed to gain traction for similar reasons. With the increasing circulation of mass media and little content review in medical journals , almost anyone with or without proper education could publish a potential cure for disease. Actual practicing medical professionals also had to compete with the ever expanding pharmacy companies that were all too ready to provide new elixirs and promising treatments for the epidemics of the time. Emerging from the medical chaos were legitimate and life changing treatments. The late 19th century was the beginning of widespread use of vaccines . The cholera bacterium was isolated in 1854 by Italian anatomist Filippo Pacini , and a vaccine, the first to immunize humans against a bacterial disease, was developed by Spanish physician Jaume Ferran i Clua in 1885, and by Russian–Jewish bacteriologist Waldemar Haffkine in July 1892. Antibiotic drugs did not appear until the middle of the 20th century. Sulfonamides did not appear until 1935 , and penicillin , discovered in 1928, was not available as a treatment until 1950. [ citation needed ] A big response and potential cure to these epidemics were better sanitation in the cities. Sanitation prior to this was very poor and sometimes attempts to get better sanitation often exacerbated the diseases, especially during the cholera epidemics because their understanding of diseases relied on the miasma (bad air) theory . During the first cholera epidemic, Edwin Chadwick made an inquiry into sanitation and used quantitative data to link poor living conditions and disease and low life expectancy. As a result, the Board of Health in London took measure to improve drainage and ventilation around the city. Unfortunately, the measures helped clean the city but it further contaminated the River Thames (the primary drinking water for the city) and the epidemic got worse. During the second cholera pandemic of 1816–1837, the scientific community varied in its beliefs about its causes. In France, doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious and quarantined their citizens. The United States believed that cholera was brought by recent immigrants, specifically the Irish. Lastly, some British thought the disease might arise from divine intervention. During the third pandemic , Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. The prevalence of the disease in the South in areas of black populations convinced United States scientists that cholera was associated with African Americans. Current researchers note they lived near the waterways by which travelers and ships carried the disease and their populations were underserved with sanitation infrastructure and health care. The Soho outbreak in London in 1854 ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle. Snow believed that germ-contaminated water was the source of cholera , rather than particles in the air (referred to as "miasmata"). His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. Though Filippo Pacini had isolated Vibrio cholerae as the causative agent for cholera that year, it would be many years before miasma theory would fall out of favor. [ citation needed ] In London, in June 1866 ), a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems. William Farr , using the work of John Snow, et al. , as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths. During the fifth cholera pandemic , Robert Koch isolated Vibrio cholerae and proposed postulates to explain how bacteria caused disease. His work helped to establish the germ theory of disease . Prior to this time, many physicians believed that microorganisms were spontaneously generated, and disease was caused by direct exposure to filth and decay. Koch helped establish that the disease was more specifically contagious and was transmittable through the contaminated water supply. The fifth was the last serious European cholera outbreak, as cities improved their sanitation and water systems. [ citation needed ]Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae . Cholera is transmitted primarily by drinking water or eating food that has been contaminated by the cholera bacterium. The bacteria multiply in the small intestine; the feces (waste product) of an infected person, including one with no apparent symptoms, can pass on the disease if it contacts the water supply by any means. History does not recount any incidents of cholera until the 19th century . Cholera came in seven waves, the last two of which occurred in the 20th century. [ citation needed ] The first cholera pandemic started in 1816, spread across India by 1820, and extended to Southeast Asia and Central Europe, lasting until 1826. A second cholera pandemic began in 1829, reached Russia, causing the Cholera riots . It spread to Hungary , Germany and Egypt in 1831, and London, Paris, Quebec , Ontario and New York City the following year. Cholera reached the Pacific coast of North America by 1834, reaching into the center of the country by steamboat and other river traffic. The third cholera pandemic began in 1846 and lasted until 1860. It hit Russia hardest, with over one million deaths. In 1846, cholera struck Mecca , killing over 15,000. A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives. In 1849, outbreak occurred again in Paris, and in London, killing 14,137, over twice as many as the 1832 outbreak. Cholera hit Ireland in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever. In 1849, cholera claimed 5,308 lives in the major port city of Liverpool , England, an embarkation point for immigrants to North America, and 1,834 in Hull , England. Cholera spread throughout the Mississippi River system. Thousands died in New York City, a major destination for Irish immigrants. Cholera killed 200,000 people in Mexico. That year, cholera was transmitted along the California , Mormon and Oregon Trails , killing people that are believed to have died on their way to the California Gold Rush , Utah and Oregon in the cholera years of 1849–1855. In 1851, a ship coming from Cuba carried the disease to Gran Canaria , killing up to 6,000 people. The pandemic spread east to Indonesia by 1852, and China and Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran , Iraq , Arabia and Russia. Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. The Ansei outbreak of 1858–60, for example, is believed to have killed between 100,000 and 200,000 people in Tokyo alone. An outbreak of cholera in Chicago in 1854 took the lives of 5.5% of the population (about 3,500 people). In 1853–4, London's epidemic claimed 10,738 lives. Throughout Spain , cholera caused more than 236,000 deaths in 1854–55. In 1854, it entered Venezuela; Brazil also suffered in 1855. The fourth cholera pandemic (1863–1875) spread mostly in Europe and Africa. At least 30,000 of the 90,000 Mecca pilgrims died from the disease. Cholera ravaged northern Africa in 1865 and southeastward to Zanzibar , killing 70,000 in 1869–70. Cholera claimed 90,000 lives in Russia in 1866. The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have killed 165,000 people in the Austrian Empire . In 1867, 113,000 died from cholera in Italy. and 80,000 in Algeria . Outbreaks in North America in 1866–1873 killed some 50,000 Americans. In 1866, localized epidemics occurred in the East End of London, in southern Wales , and Amsterdam . In the 1870s, cholera spread in the U.S. as an epidemic from New Orleans along the Mississippi River and to ports on its tributaries. [ citation needed ] In the fifth cholera pandemic (1881–1896), according to Dr A. J. Wall, the 1883–1887 part of the epidemic cost 250,000 lives in Europe and at least 50,000 in the Americas. Cholera claimed 267,890 lives in Russia (1892); 120,000 in Spain ; 90,000 in Japan and over 60,000 in Persia . In Egypt , cholera claimed more than 58,000 lives. The 1892 outbreak in Hamburg killed 8,600 people. [ citation needed ]Smallpox is caused by either of the two viruses, Variola major and Variola minor. Smallpox vaccine was available in Europe, the United States, and the Spanish Colonies during the last part of the century. The Latin names of this disease are Variola Vera. The words come from various (spotted) or varus (pimple). In England, this disease was first known as the "pox" or the "red plague". Smallpox settles itself in small blood vessels of the skin and in the mouth and throat. The symptoms of smallpox are rash on the skin and blisters filled with raised liquid. [ citation needed ] The disease killed an estimated 400,000 Europeans annually during the 19th century and one-third of all the blindness of that time was caused by smallpox. 20 to 60% of all the people that were infected died and 80% of all the children with the infection also died. It caused also many deaths in the 20th century, over 300–500 million. Wolfgang Amadeus Mozart also had smallpox when he was only 11 years old. He survived the smallpox outbreak in Austria. [ citation needed ]Epidemic typhus is caused by the bacteria Rickettsia Prowazekii; it comes from lice . Murine typhus is caused by the Rickettsia Typhi bacteria, from the fleas on rats. Scrub typhus is caused by the Orientia Tsutsugamushi bacteria, from the harvest mites on humans and rodents. Queensland tick typhus is caused by the Rickettsia Australis bacteria, from ticks . [ citation needed ] During Napoleon 's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816 and 1819, during the Year Without a Summer ; an estimated 100,000 Irish perished. Typhus appeared again in the late 1830s, and between 1846 and 1849 during the Great Irish Famine . Spreading to England, and called "Irish fever", it was noted for its virulence. It killed people of all social classes, as lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata. In Canada alone, the typhus epidemic of 1847 killed more than 20,000 people from 1847 to 1848, mainly Irish immigrants in fever sheds and other forms of quarantine, who had contracted the disease aboard coffin ships . In the United States, epidemics occurred in Baltimore , Memphis and Washington DC between 1865 and 1873, and during the US Civil War . [ citation needed ]This disease is transmitted by the bite of female mosquito; the higher prevalence of transmission by Aedes aegypti has led to it being known as the Yellow Fever Mosquito. The transmission of yellow fever is entirely a matter of available habitat for vector mosquito and prevention such as mosquito netting. They mostly infect other primates, but humans can be infected. The symptoms of the fever are: Headaches, back and muscle pain, chills and vomiting, bleeding in the eyes and mouth, and vomit containing blood. [ citation needed ] Yellow fever accounted for the largest number of the 19th-century's individual epidemic outbreaks, and most of the recorded serious outbreaks of yellow fever occurred in the 19th century. It is most prevalent in tropical-like climates, but the United States was not exempted from the fever. New Orleans was plagued with major epidemics during the 19th century, most notably in 1833 and 1853. At least 25 major outbreaks took place in the Americas during the 18th and 19th centuries, including particularly serious ones in Santo Domingo in 1803 and Memphis in 1878 . Major outbreaks occurred repeatedly in Gibraltar ; outbreaks in 1804, 1814, and again in 1828. Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans . The third plague pandemic was a major bubonic plague pandemic that began in Yunnan , China in 1855. This episode of bubonic plague spread to all inhabited continents in the 1890s and first years of the 1900s, and ultimately led to more than 12,000,000 deaths in India and China, with about 10,000,000 killed in India alone. A natural reservoir of plague is located in western Yunnan and is an ongoing health risk today. The third pandemic of plague originated in this area after a rapid influx of Han Chinese to exploit the demand for minerals, primarily copper, in the latter half of the 19th century. By 1850, the population had exploded to over 7,000,000 people. Increasing transportation throughout the region brought people in contact with plague-infected fleas , the primary vector between the yellow-breasted rat ( Rattus flavipectus ) and humans. The spread of European empires and the development of new forms of transport such as the steam engine made it easier for both humans and rats to spread the disease along existing trade routes. [ citation needed ]Haemolytic streptococcus, which was identified in the 1880s, causes scarlet fever , which is a bacterial disease. Scarlet fever spreads through respiratory droplets and children between the ages of 5 and 15 years were most affected by scarlet fever. Scarlet fever had several epidemic phases, and around 1825 to 1885 outbreaks began to recur cyclically and often highly fatal. In the mid-19th century, the mortality caused by scarlet fever rose in England and Wales . The major outbreak in England and Wales took place during 1825–1885 with high mortality marking this as remarkable. There were several other notable outbreaks across Europe, South America, and the United States in the 19th century. In the UK, scarlet fever was considered benign for two centuries, but fatal epidemics were seen in the 1700s. Scarlet fever broke out in England in the 19th century and was responsible for an enormous number of deaths in the 60-year period from 1825 to 1885; decades that followed had lower levels of annual mortality from scarlet fever. In NW England there was heavy mortality in Liverpool . Babies born in Liverpool with a birthday in 1861 were only expected to live 26 years, and in larger cities, life expectancy was less than 35 years. Over time, the life expectancy changed as well as the number of fatalities from scarlet fever. There was a reduction in child mortality from scarlet fever when you compare the decades, 1851–60 and 1891–1900. The decline of mortality seen for scarlet fever was noticed after the identification of streptococcus , but the decline was not associated with a treatment. A treatment would not be available until the introduction of sulphonamides in the 1930s, and the decline in mortality was due to the quality of air, food, and water improving. Outbreaks of scarlet fever also took place in Dublin in 1896 with 1,354 cases and 149 deaths, Norway from 1862 to 1884, Scotland in 1861, and in the rest of United Kingdom. The United Kingdom saw cases in Canterbury from 1839 to 1865 with 305 deaths, Bristol in 1870 with 106 deaths and in 1875, and Manchester in 1886 with six cases. Chile reported scarlet fever the first time in 1827 and highest rates were seen during winter months. The disease spread from Valparaiso to Santiago from 1831 to 1832 and claimed 7,000 lives. There were multiple outbreaks in different locations of Chile, including Copaipo in 1875 and Caldera in 1876. Similarly to Europe, America considered scarlet fever to be benign for two centuries. In the early 19th century the scarlet fever impact drastically changed and lethal epidemics started to arise in the United States. The United States had a notable outbreak of scarlet fever in Minnesota in 1847 and Augusta, Georgia had a lethal epidemic in 1832–1833. Scarlet fever had low mortality rates in New York for many years before 1828, but remained high for long after. Cases of scarlet fever were also seen in Boston during a period of decreasing severity after 1885. Boston City Hospital opened a scarlet fever pavilion in 1887 to house patients with infectious diseases and saw nearly 25,000 patients during 1895–1905. In the mid-1800s, more specific epidemiological information was emerging and incidence in infants were found to be low. In 1870, the US census showed a decrease in scarlet fever mortality in children below the age of one. In the UK, scarlet fever was considered benign for two centuries, but fatal epidemics were seen in the 1700s. Scarlet fever broke out in England in the 19th century and was responsible for an enormous number of deaths in the 60-year period from 1825 to 1885; decades that followed had lower levels of annual mortality from scarlet fever. In NW England there was heavy mortality in Liverpool . Babies born in Liverpool with a birthday in 1861 were only expected to live 26 years, and in larger cities, life expectancy was less than 35 years. Over time, the life expectancy changed as well as the number of fatalities from scarlet fever. There was a reduction in child mortality from scarlet fever when you compare the decades, 1851–60 and 1891–1900. The decline of mortality seen for scarlet fever was noticed after the identification of streptococcus , but the decline was not associated with a treatment. A treatment would not be available until the introduction of sulphonamides in the 1930s, and the decline in mortality was due to the quality of air, food, and water improving. Outbreaks of scarlet fever also took place in Dublin in 1896 with 1,354 cases and 149 deaths, Norway from 1862 to 1884, Scotland in 1861, and in the rest of United Kingdom. The United Kingdom saw cases in Canterbury from 1839 to 1865 with 305 deaths, Bristol in 1870 with 106 deaths and in 1875, and Manchester in 1886 with six cases. Chile reported scarlet fever the first time in 1827 and highest rates were seen during winter months. The disease spread from Valparaiso to Santiago from 1831 to 1832 and claimed 7,000 lives. There were multiple outbreaks in different locations of Chile, including Copaipo in 1875 and Caldera in 1876. Similarly to Europe, America considered scarlet fever to be benign for two centuries. In the early 19th century the scarlet fever impact drastically changed and lethal epidemics started to arise in the United States. The United States had a notable outbreak of scarlet fever in Minnesota in 1847 and Augusta, Georgia had a lethal epidemic in 1832–1833. Scarlet fever had low mortality rates in New York for many years before 1828, but remained high for long after. Cases of scarlet fever were also seen in Boston during a period of decreasing severity after 1885. Boston City Hospital opened a scarlet fever pavilion in 1887 to house patients with infectious diseases and saw nearly 25,000 patients during 1895–1905. In the mid-1800s, more specific epidemiological information was emerging and incidence in infants were found to be low. In 1870, the US census showed a decrease in scarlet fever mortality in children below the age of one.

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Bubonic plague

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Waldemar Haffkine

Waldemar Mordechai Wolff Haffkine CIE , born Vladimir Aronovich (Markus-Volf) Khavkin ( Russian : Владимир Аронович (Маркус-Вольф) Хавкин ; 15 March 1860 – 26 October 1930) was a Russian-French bacteriologist known for his pioneering work in vaccines . Haffkine was educated at the Imperial Novorossiya University and later emigrated first to Switzerland , then to France , working at the Pasteur Institute in Paris , where he developed a cholera vaccine that he tried out successfully in India . He is recognized as the first microbiologist who developed and used vaccines against cholera and bubonic plague . He tested the vaccines on himself. Joseph Lister , named him "a saviour of humanity". He was appointed Companion of the Order of the Indian Empire (CIE) in Queen Victoria's 1897 Diamond Jubilee Honours . The Jewish Chronicle of that time noted "a Ukraine Jew, trained in the schools of European science, saves the lives of Hindus and Mohammedans and is decorated by the descendant of William the Conqueror and Alfred the Great ." He naturalised as a British Subject in 1900. In his final years Haffkine became more religious , becoming an advocate and philanthropist for Orthodox Jewish causes and a supporter of Zionism .Born into a Jewish family in Odessa, Kherson Governorate, Russian Empire, the fourth of five children of Aaron and Rosalie (daughter of David-Aïsic Landsberg) in a family of a Jewish schoolmaster. Received his education at the gymnasium of Berdyansk , Odessa, and St. Petersburg . Young Haffkine was also a member of the Jewish League for Self-Defense in Odessa. Haffkine was injured while defending a Jewish home during a pogrom . As a result of this action he was arrested but later released due to the intervention of biologist Ilya Mechnikov . Haffkine continued his studies from 1879 to 1883 with Mechnikov at Odessa University , but after the assassination of Tsar Alexander II , the government increasingly cracked down on people it considered suspicious, including intelligentsia . Haffkine graduated with a Doctor of Science at the age of 23. Haffkine was also employed by the zoological museum at Odessa from 1882 to 1888. Debarred from professorship, as a Jew, in 1888, Haffkine was allowed to emigrate to Switzerland and began his work at the University of Geneva , as an assistant professor of Physiology. In 1889 he joined Mechnikov and Louis Pasteur in Paris at the newly established Pasteur Institute where he took up the only available post of librarian. Haffkine began his scientific career as a protozoologist and protistologist , under the tutelage of Ilya Mechnikov at Imperial Novorossiya University in Odessa and later at the Pasteur Institute in Paris. His early research was on protists such as Astasia , Euglena , and Paramecium , as well as the earliest studies on Holospora , a bacterial parasite of Paramecium . In the early 1890s, Haffkine shifted his attention to studies in practical bacteriology . The euglenid genus Khawkinea is named in honor of Haffkine's early studies of euglenids, first published in French journals with the author name transliterated from Cyrillic as "Mardochée-Woldemar Khawkine".At the time, one of the five great cholera pandemics of the 19th century ravaged Asia and Europe. Even though Robert Koch discovered Vibrio cholerae in 1883, the medical science at that time did not consider it a sole cause of the disease. This view was supported by experiments by several biologists, notably Jaume Ferran i Clua in Spain. [ citation needed ] Haffkine focused his research on developing a cholera vaccine, and produced an attenuated form of the bacterium . Risking his own life, on 18 July 1892, Haffkine performed the first human test on himself and reported his findings on 30 July to the Biological Society . Even though his discovery caused an enthusiastic stir in the press, it was not widely accepted by his senior colleagues, including both Mechnikov and Pasteur, nor by European official medical establishment in France, Germany and Russia. [ citation needed ] Haffkine considered India, where hundreds of thousands died from ongoing epidemics, as the best place to test his vaccine. Through the influence of the Marquis of Dufferin and Ava, who was in Paris as the British Ambassador, he was allowed to demonstrate his ideas in England. He proceeded to India in 1893 and established a laboratory at Byculla in 1896, which moved to Parel and was later called the Haffkine Institute . Haffkine worked on the plague and by 1902–03 half a million were inoculated but on 30 October 1902, 19 people died from tetanus out of 107 inoculated at Mulkowal. This "Mulkowal disaster" led to an enquiry. He was briefly suspended but reappointed director of the Biological Laboratory in Calcutta. [ citation needed ] He retired in 1915 and suffering from malaria , had to return to France."Unlike tetanus or diphtheria, which were quickly neutralized by effective vaccines by the 1920s, the immunological aspects of bubonic plague proved to be much more daunting." In October 1896, an epidemic of bubonic plague struck Bombay and the government asked Haffkine to help. He embarked upon the development of a vaccine in a makeshift laboratory in a corridor of Grant Medical College . In three months of persistent work (one of his assistants experienced a nervous breakdown ; two others quit), a form for human trials was ready and on 10 January 1897 Haffkine tested it on himself. "Haffkine's vaccine used a small amount of the bacteria to produce an immune reaction." After these results were announced to the authorities, volunteers at the Byculla jail were inoculated and survived the epidemics, while seven inmates of the control group died. "Like others of these early vaccines, the Haffkine formulation had nasty side effects, and did not provide complete protection, though it was said to have reduced risk by up to 50 percent." Despite Haffkine's successes, some officials still primarily insisted on methods based on sanitarianism : washing homes by fire hose with lime , herding affected and suspected persons into camps and hospitals, and restricting travel. [ citation needed ] Even though official Russia was still unsympathetic to his research, [ citation needed ] Haffkine's Russian colleagues, doctors V. K. Vysokovich and D. K. Zabolotny , visited him in Bombay. During the 1898 cholera outbreak in the Russian Empire, the vaccine called "лимфа Хавкина" ("limfa Havkina", Havkin's lymph ) saved thousands of lives across the empire. By the turn of the 20th century, the number of inoculees in India alone reached four million and Haffkine was appointed the Director of the Plague Laboratory in Bombay (now called Haffkine Institute ). In 1900, he was awarded the Cameron Prize for Therapeutics of the University of Edinburgh . Haffkine was the first to prepare a vaccine for human prophylaxis by killing virulent culture by heat at 60 °C. The major limit of his vaccine was the lack of activity against pulmonary forms of plague. In 1898, Haffkine approached Aga Khan III with an offer for Sultan Abdul Hamid II to resettle Jews in Palestine , then a province of the Ottoman Empire : the effort "could be progressively undertaken in the Holy Land ", "the land would be obtained by purchase from the Sultan's subjects", "the capital was to be provided by wealthier members of the Jewish community", but the plan was rejected. [ citation needed ]In March 1902, nineteen Indian villagers from Mulkowal in Punjab (inoculated from a single bottle of vaccine) died of tetanus , whilst the other 88 villagers were well. Evidence pointed to the contamination of one bottle - 53N. The procedure for sterilisation at the Parel lab had been changed from carbolic acid to sterilisation using heating, a process that had been used at the Pasteur Institute safely for two years but was new in the British Empire. The 1903 commission from the Indian government concluded this was the source of the contamination. An inquiry commission indicted Haffkine, and he was relieved of his position and returned to England. The report was unofficially known as the "Little Dreyfus affair ", as a reminder of Haffkine's Jewish background and religion. [ citation needed ] The Lister Institute reinvestigated the claim and overruled the verdict: it was discovered that an assistant used a dirty bottle cap without sterilizing it. In July 1907, a letter published in The Times called the case against Haffkine "distinctly disproven". It was signed by Ronald Ross , William R. Smith , and Simon Flexner , among other medical dignitaries. This led to Haffkine's acquittal.Since Haffkine's post in Bombay was already occupied, he moved to Calcutta and worked there until his retirement in 1914. Haffkine returned to France and later moved to Lausanne, Switzerland , where he spent the last years of his life. Haffkine received numerous honors and awards. In 1925, the Plague Laboratory in Bombay was renamed the Haffkine Institute . In commemoration of the centennial of his birth, Haffkine Park was planted in Israel in the 1960s. In a biography of him, Nobelist Selman Abraham Waksman explains that, in this last phase of his life, Haffkine had become a deeply religious man. Haffkine returned to Orthodox Jewish practice and wrote A Plea for Orthodoxy (1916). In this article, he advocated traditional religious observance and decried the lack of such observance among "enlightened" Jews, and stressed the importance of community life, stating: A brotherhood built up of racial ties, long tradition, common suffering, faith and hope, is a union ready-made, differing from artificial unions in that the bonds existing between the members contain an added promise of duration and utility. Such a union takes many centuries to form and is a power for good, the neglect or disuse of which is as much an injury to humanity as the removal of an important limb is to the individual... no law of nature operates with more fatality and precision than the law according to which those communities survive in the strife for existence that conform the nearest to the Jewish teachings on the relation of man to his Creator; on the ordering of time for work and rest; on the formation of families and the duties of husband and wife, parents and children; on the paramount obligations of truthfulness and justice between neighbor and neighbor and to the stranger within the gates. In 1929, he established the Haffkine Foundation to foster Jewish education in Eastern Europe . Haffkine was also respectful of other religions, and "he considered it of the utmost importance to promote the study of the Bible." In 1982, the Chabad Hasidic movement published three letters addressed to Haffkine by the sixth Lubavitcher Rebbe, Rabbi Yosef Yitzchak Schneersohn , who had engaged Haffkine to support the Jews living in communist Russia. : 32–47In a biography of him, Nobelist Selman Abraham Waksman explains that, in this last phase of his life, Haffkine had become a deeply religious man. Haffkine returned to Orthodox Jewish practice and wrote A Plea for Orthodoxy (1916). In this article, he advocated traditional religious observance and decried the lack of such observance among "enlightened" Jews, and stressed the importance of community life, stating: A brotherhood built up of racial ties, long tradition, common suffering, faith and hope, is a union ready-made, differing from artificial unions in that the bonds existing between the members contain an added promise of duration and utility. Such a union takes many centuries to form and is a power for good, the neglect or disuse of which is as much an injury to humanity as the removal of an important limb is to the individual... no law of nature operates with more fatality and precision than the law according to which those communities survive in the strife for existence that conform the nearest to the Jewish teachings on the relation of man to his Creator; on the ordering of time for work and rest; on the formation of families and the duties of husband and wife, parents and children; on the paramount obligations of truthfulness and justice between neighbor and neighbor and to the stranger within the gates. In 1929, he established the Haffkine Foundation to foster Jewish education in Eastern Europe . Haffkine was also respectful of other religions, and "he considered it of the utmost importance to promote the study of the Bible." In 1982, the Chabad Hasidic movement published three letters addressed to Haffkine by the sixth Lubavitcher Rebbe, Rabbi Yosef Yitzchak Schneersohn , who had engaged Haffkine to support the Jews living in communist Russia. : 32–47

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Bubonic plague

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Caragea's plague

Caragea's plague ( Romanian : Ciuma lui Caragea ) was a bubonic plague epidemic that occurred in Wallachia , mainly in Bucharest , in the years 1813 and 1814. It coincided with the rule of the Phanariote Prince Ioan Caragea .As Caragea came to Bucharest in 1812 after being appointed prince, the plague was already claiming victims in Istanbul , the Ottoman capital. A man in Caragea's retinue grew sick and died. It is alleged that this was the source of the plague in Wallachia, although the next reported death from plague in Wallachia occurred in June 1813. [ citation needed ] The plague was expected and in January 1813, Caragea founded two quarantine hospitals, one in Teleorman and one in Giurgiu County . There were reports of people with the plague on the streets of Bucharest as early as in April, but the first death attributed to bubonic plague was on 11 June 1813 in Văcărești . Quarantine was established, the gates of the city of Bucharest were closed and all the roads from Văcăreşti to Dealul Spirii were guarded to prevent anyone from entering the city without permission. Government clerks and priests had to check each house for plague-infected people, all the foreigners and non-residents were expelled from the city, and the beggars were sent to monasteries outside Bucharest. The money which came from the counties where the plague was spread (Ilfov, Vlaşca, Teleorman and Olt) had to be washed in vinegar and the number of gravediggers was increased to 60. In spite of that, the plague continued to spread, mostly due to lack of qualified medical care. The July 1813 register books of the Wallachian government show that most of the decrees were related to the plague. Among the restrictions, meetings in pubs and coffee shops were forbidden, alcohol being only sold for home consumption. The people who died had a simple burial with no attendants. The people who hid sick people or the peddlers ("both Jewish and Christians") were expelled from the city and their belongings were burnt. In August, due to the spread of the plague, the request to allow people to flee the city was approved, Caragea asking the ispravnics to take care to avoid contact with the villagers. To avoid crowds, markets and schools were closed down, most judicial proceedings were stopped, and the people in the debtors' prison were freed. Many of the new rules were not respected, despite the rulers' attempts, which included the spread of printed fliers. By August, the city became almost deserted, with even the doctors fleeing, as did Caragea, who moved his residence outside Bucharest to Cotroceni . The French consul said that two-thirds of the Bucharesters fled. Initially, sick people were to be committed to the Dudești hospital (later also Cioplea and Băneasa ), but soon the 14 quarantine rooms of the unit were overrun, and the place became a simple mass grave. [ citation needed ] People with immunity to the disease were hired as undertakers, and walked from door to door to gather corpses. The corpses were taken to the mass graves in Dudeşti and buried there. Often, dying people were taken also and buried alive, and sometimes beaten to death. An undertaker squad once reported that "we collected 15 dead today, but only buried 14, because one of them ran away". Sometimes, sick people with enough strength fought back, and killed the undertakers. The highest mortality was in October 1813; the gravediggers couldn't even bury all the dead, and many of them were put in large pits, which were not covered and many "were eaten by dogs and other beasts". In February 1814, the last market still open, Târgul de Afară ( Obor ), was closed down, but soon the people returned to the city. In 1818 the quarantine hospitals of Plumbuita and Văcărești were closed down. An estimated 60,000 people died of the plague in the two years, 20–30,000 of them in Bucharest, which is a large number, as the city population at the time was about 120,000. According to a church teacher, the church reports say that 20,000 died in Bucharest by January 1814 (excluding those buried in backyards), while the personal doctor of Caragea claimed that between 25,000 and 30,000 died.

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Bubonic plague

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The Last Man

The Last Man is an apocalyptic , dystopian science fiction novel by Mary Shelley , first published in 1826. The narrative concerns Europe in the late 21st century, ravaged by the rise of a bubonic plague pandemic that rapidly sweeps across the entire globe, ultimately resulting in the near-extinction of humanity. It also includes discussion of the British state as a republic , for which Shelley sat in meetings of the House of Commons to gain insight to the governmental system of the Romantic era . The novel includes many fictive allusions to her husband Percy Bysshe Shelley , who drowned in a shipwreck four years before the book's publication, as well as their close friend Lord Byron , who had died two years previously. The Last Man is one of the first pieces of dystopian fiction published. It was critically savaged and remained largely obscure at the time of its publication. It was not until the 1960s that the novel resurfaced for the public.Lionel Verney : The Last Man. The orphan son of an impoverished nobleman, Lionel is originally lawless, self-willed, and resentful of the nobility for casting aside his father. When he is befriended by Adrian, however, he embraces civilization and particularly scholarship. Verney is largely an autobiographical figure for Mary Shelley . Adrian, Earl of Windsor : Son of the last King of England, Adrian embraces republican principles . He is motivated by philosophy and philanthropy, rather than ambition. He is based on Percy Bysshe Shelley . Lord Raymond : An ambitious young nobleman, Raymond becomes famous for his military efforts on behalf of Greece against the Turks , but eventually chooses love over his ambition to become King of England. He instead becomes Lord Protector of England before returning to Greece . Raymond is motivated by passion and ambition rather than principle. He is based on Lord Byron . Perdita : Lionel's sister, and Raymond's wife. Growing up an orphan, Perdita was independent, distrustful, and proud, but she is softened by love for Raymond, to whom she is fiercely loyal. Idris : Adrian's sister, and Lionel's wife. She is loving, maternal, and self-sacrificing. Countess of Windsor : Mother of Adrian and Idris, an Austrian princess and former Queen of the United Kingdom. She is haughty and ambitious, scheming to restore the monarchy through her children. Evadne Zaimi : A Greek princess with whom Adrian falls in love, but who loves Raymond. She is devoted and proud, even when she becomes impoverished. Clara : Daughter of Raymond and Perdita. Alfred and Evelyn : Sons of Lionel and Idris. Ryland : Leader of the popular democratic party, Ryland has grand plans for the abolition of nobility before the plague, but is unwilling to govern England during the plague. Merrival : An astronomer who is oblivious to the plague, instead speculating about the condition of earth in six thousand years, until his family dies. Broken by his tragedy, he dies not long afterwards. Lucy Martin : A young woman who chose to marry a repulsive suitor rather than wait for her true love, to provide for her ageing mother. Her devotion to her mother almost leads to her being left behind in England after the exile. The Imposter : Unnamed – a false prophet (from ambition, rather than fanaticism ) who creates a radical religious sect in opposition to Adrian while in France. Juliet : A young noblewoman who joins the Imposter's party to support her baby, but is later killed revealing his imposture.Mary Shelley states that in 1818 she discovered, in a cave near Naples , prophetic writings painted on leaves by the Cumaean Sibyl . She says she has edited these writings into the narrative of a man living at the end of the 21st century, commencing in 2073 and concluding in 2100. Lionel's father was a friend of the king before he was cast away because of his gambling. Lionel's father left to take his life, but before he did so he left a letter for the king to take care of his family after his death. After Lionel's father died the letter was never delivered. Lionel and his sister grow up with no parental influence and become uncivilised. Lionel develops a hatred of the royal family, and Perdita grows to enjoy her isolation from society. When the king leaves the throne, the monarchy comes to an end and a republic is created. When the king dies, the Countess attempts to raise their son, Adrian, to reclaim the throne. However, Adrian opposes his mother and refuses to take the throne. He moves to Cumberland where Lionel, who bears a grudge against Adrian and his family for the neglect of the Verney family, intends to confront Adrian. He is mollified by Adrian's good nature and his explanation that he only recently discovered the letter. The two become close friends, and Lionel becomes civilised under Adrian's influence. Adrian assists Lionel in pursuing political endeavours in Vienna which Lionel accepts and leaves for 2 years but chooses to return to England because he has not heard from either Adrian or his sister. Lionel returns to England to face the personal turmoil amongst his acquaintances. Lord Raymond, who came to be renowned for his exploits in a war between Greece and Turkey, has returned to England searching for a political position. Perdita and Evadne soon fall in love with him. On discovering that his beloved, Evadne, is in love with Raymond, Adrian goes into exile, presumably mad. Raymond intends to marry Idris (with whom Lionel is in love) as a first step towards becoming king, with the help of the Countess. However, he ultimately chooses his love for Perdita over his ambition, and the two marry. Under Lionel's care, Adrian recovers but remains physically weak. On learning of the love between Idris and Lionel, the Countess schemes to drug Idris, bring her to Austria , and force her to make a politically motivated marriage. Idris discovers the plot and flees to Lionel, who marries her soon after. The Countess leaves for Austria , resentful of her children and of Lionel. Adrian and the others live happily together until Raymond runs for Lord Protector and wins. Perdita adjusts to her newfound social position, while Raymond becomes well-beloved as an administrator. He discovers, however, that Evadne, after the political and financial ruin of her husband (on account of her own political schemes) lives in poverty in London, unwilling to plead for assistance. Raymond attempts to support Evadne by employing her artistic skills in secrecy, and later nursing her in illness, but Perdita learns of the relationship and suspects infidelity . Her suspicions arouse Raymond's proud nature, and the two separate. Raymond resigns his position and leaves to rejoin the war in Greece , accompanied by Adrian. Shortly after a wounded Adrian returns to England, rumours arise that Raymond has been killed. Perdita, loyal nonetheless, convinces Lionel to bring her and Clara to Greece to find him. Arriving in Athens , Lionel learns that Raymond had been captured by the Ottomans , and negotiates his return to Greece. Shortly after this, Lionel and Raymond return to the Greek army and fight their way to Constantinople . After a decisive battle near Constantinople's gates, Lionel discovers Evadne, who was wounded while fighting in the war. Before dying, Evadne prophesies Raymond's death, a prophecy which confirms his own suspicions. Raymond's intention to enter Constantinople causes dissension and desertion amongst the army because of reports of the plague . Raymond goes alone to find that Constantinople has been seemingly deserted and soon dies in an explosion, the result of a trap laid by the Turks. He is taken to a site near Athens for burial. Perdita refuses to leave Greece, but Lionel drugs her and brings her aboard a steamship, believing it to be in the best interests of Clara. Perdita awakens and, distraught at Raymond's death, throws herself overboard and drowns. In 2092, while Lionel and Adrian attempt to return their lives to normality, the plague continues to spread across Europe and the Americas. The appearance of a black sun causes panic throughout the world, and storm surges flood coastal towns across Europe. At first, England is thought to be safe, but soon the plague reaches it. Ryland, recently elected Lord Protector , is unprepared for the plague, and flees northward, later dying alone amidst a stockpile of provisions. Adrian takes command and is largely effective at maintaining order, although the plague rages on summer after summer. Ships arrive in Ireland carrying survivors from America, who lawlessly plunder Ireland and Scotland before invading England. Adrian raises a military force against them and ultimately manages to resolve the situation peacefully. The few remaining survivors decide to abandon England, looking for an easier climate. On the eve of their departure to Dover , Lionel receives a letter from Lucy Martin, who could not join the exiles because of her mother's illness. Lionel and Idris travel through a snowstorm to assist Lucy. Idris, weak from years of stress and maternal fears, dies along the way during the fierce weather. Lionel brings her body to Windsor Castle , interring her in St George's Chapel , and is met by the Countess, who reconciles with Lionel at Idris' tomb. Lionel recovers Lucy (whose mother has died), and the party reaches Dover en route to France. In France, Adrian learns the earlier emigrants have divided into factions, amongst them a fanatical religious sect led by a false messiah who claims his followers will be saved from disease. Adrian unites most of the factions, but the fanatics declare their opposition to Adrian. Lionel sneaks into Paris, where the cult has settled, to try to rescue Juliet. She refuses to leave because the impostor has her baby but helps Lionel escape after the impostor's followers imprison him. Later, when her baby sickens, Juliet discovers the impostor has been hiding the effects of the plague from his followers. She is killed warning the other followers. The impostor commits suicide, and his followers return to the main body of exiles at Versailles . The exiles travel towards Switzerland , hoping to spend the summer in a colder climate less favourable to the plague. By the time they reach Switzerland, however, all but four (Lionel, Adrian, Clara, and Evelyn) have died. They spend a few relatively happy seasons at Switzerland , Milan , and Como before Evelyn dies of typhus . The survivors attempt to sail across the Adriatic Sea from Venice to Greece , but a storm destroys the boat and drowns Clara and Adrian. Lionel swims to shore at Ravenna . Fearing to be the last human left on Earth, Lionel follows the Apennine Mountains to Rome , befriending a sheepdog along the way. A year passes without anyone else entering Rome, and Lionel resolves to leave with his dog and live the rest of his life as a wanderer of the depopulated continents of Africa and Asia looking for other survivors. The story ends in the year 2100.Mary Shelley states that in 1818 she discovered, in a cave near Naples , prophetic writings painted on leaves by the Cumaean Sibyl . She says she has edited these writings into the narrative of a man living at the end of the 21st century, commencing in 2073 and concluding in 2100.Lionel's father was a friend of the king before he was cast away because of his gambling. Lionel's father left to take his life, but before he did so he left a letter for the king to take care of his family after his death. After Lionel's father died the letter was never delivered. Lionel and his sister grow up with no parental influence and become uncivilised. Lionel develops a hatred of the royal family, and Perdita grows to enjoy her isolation from society. When the king leaves the throne, the monarchy comes to an end and a republic is created. When the king dies, the Countess attempts to raise their son, Adrian, to reclaim the throne. However, Adrian opposes his mother and refuses to take the throne. He moves to Cumberland where Lionel, who bears a grudge against Adrian and his family for the neglect of the Verney family, intends to confront Adrian. He is mollified by Adrian's good nature and his explanation that he only recently discovered the letter. The two become close friends, and Lionel becomes civilised under Adrian's influence. Adrian assists Lionel in pursuing political endeavours in Vienna which Lionel accepts and leaves for 2 years but chooses to return to England because he has not heard from either Adrian or his sister. Lionel returns to England to face the personal turmoil amongst his acquaintances. Lord Raymond, who came to be renowned for his exploits in a war between Greece and Turkey, has returned to England searching for a political position. Perdita and Evadne soon fall in love with him. On discovering that his beloved, Evadne, is in love with Raymond, Adrian goes into exile, presumably mad. Raymond intends to marry Idris (with whom Lionel is in love) as a first step towards becoming king, with the help of the Countess. However, he ultimately chooses his love for Perdita over his ambition, and the two marry. Under Lionel's care, Adrian recovers but remains physically weak. On learning of the love between Idris and Lionel, the Countess schemes to drug Idris, bring her to Austria , and force her to make a politically motivated marriage. Idris discovers the plot and flees to Lionel, who marries her soon after. The Countess leaves for Austria , resentful of her children and of Lionel. Adrian and the others live happily together until Raymond runs for Lord Protector and wins. Perdita adjusts to her newfound social position, while Raymond becomes well-beloved as an administrator. He discovers, however, that Evadne, after the political and financial ruin of her husband (on account of her own political schemes) lives in poverty in London, unwilling to plead for assistance. Raymond attempts to support Evadne by employing her artistic skills in secrecy, and later nursing her in illness, but Perdita learns of the relationship and suspects infidelity . Her suspicions arouse Raymond's proud nature, and the two separate. Raymond resigns his position and leaves to rejoin the war in Greece , accompanied by Adrian. Shortly after a wounded Adrian returns to England, rumours arise that Raymond has been killed. Perdita, loyal nonetheless, convinces Lionel to bring her and Clara to Greece to find him.Arriving in Athens , Lionel learns that Raymond had been captured by the Ottomans , and negotiates his return to Greece. Shortly after this, Lionel and Raymond return to the Greek army and fight their way to Constantinople . After a decisive battle near Constantinople's gates, Lionel discovers Evadne, who was wounded while fighting in the war. Before dying, Evadne prophesies Raymond's death, a prophecy which confirms his own suspicions. Raymond's intention to enter Constantinople causes dissension and desertion amongst the army because of reports of the plague . Raymond goes alone to find that Constantinople has been seemingly deserted and soon dies in an explosion, the result of a trap laid by the Turks. He is taken to a site near Athens for burial. Perdita refuses to leave Greece, but Lionel drugs her and brings her aboard a steamship, believing it to be in the best interests of Clara. Perdita awakens and, distraught at Raymond's death, throws herself overboard and drowns. In 2092, while Lionel and Adrian attempt to return their lives to normality, the plague continues to spread across Europe and the Americas. The appearance of a black sun causes panic throughout the world, and storm surges flood coastal towns across Europe. At first, England is thought to be safe, but soon the plague reaches it. Ryland, recently elected Lord Protector , is unprepared for the plague, and flees northward, later dying alone amidst a stockpile of provisions. Adrian takes command and is largely effective at maintaining order, although the plague rages on summer after summer. Ships arrive in Ireland carrying survivors from America, who lawlessly plunder Ireland and Scotland before invading England. Adrian raises a military force against them and ultimately manages to resolve the situation peacefully.The few remaining survivors decide to abandon England, looking for an easier climate. On the eve of their departure to Dover , Lionel receives a letter from Lucy Martin, who could not join the exiles because of her mother's illness. Lionel and Idris travel through a snowstorm to assist Lucy. Idris, weak from years of stress and maternal fears, dies along the way during the fierce weather. Lionel brings her body to Windsor Castle , interring her in St George's Chapel , and is met by the Countess, who reconciles with Lionel at Idris' tomb. Lionel recovers Lucy (whose mother has died), and the party reaches Dover en route to France. In France, Adrian learns the earlier emigrants have divided into factions, amongst them a fanatical religious sect led by a false messiah who claims his followers will be saved from disease. Adrian unites most of the factions, but the fanatics declare their opposition to Adrian. Lionel sneaks into Paris, where the cult has settled, to try to rescue Juliet. She refuses to leave because the impostor has her baby but helps Lionel escape after the impostor's followers imprison him. Later, when her baby sickens, Juliet discovers the impostor has been hiding the effects of the plague from his followers. She is killed warning the other followers. The impostor commits suicide, and his followers return to the main body of exiles at Versailles . The exiles travel towards Switzerland , hoping to spend the summer in a colder climate less favourable to the plague. By the time they reach Switzerland, however, all but four (Lionel, Adrian, Clara, and Evelyn) have died. They spend a few relatively happy seasons at Switzerland , Milan , and Como before Evelyn dies of typhus . The survivors attempt to sail across the Adriatic Sea from Venice to Greece , but a storm destroys the boat and drowns Clara and Adrian. Lionel swims to shore at Ravenna . Fearing to be the last human left on Earth, Lionel follows the Apennine Mountains to Rome , befriending a sheepdog along the way. A year passes without anyone else entering Rome, and Lionel resolves to leave with his dog and live the rest of his life as a wanderer of the depopulated continents of Africa and Asia looking for other survivors. The story ends in the year 2100.Many of the central characters are wholly or partially based upon Shelley's acquaintances. Shelley had been forbidden by her father-in-law, Sir Timothy Shelley , from publishing a biography of her husband, so she memorialised him, amongst others, in The Last Man . The utopian Adrian, Earl of Windsor, who leads his followers in search of a natural paradise and dies when his boat sinks in a storm, is a fictional portrait of Percy Bysshe Shelley , although other minor characters such as Merrival bear traces of Percy as well. Lord Raymond, who leaves England to fight for the Greeks and dies in Constantinople , is based on Lord Byron . The novel expresses Mary Shelley's pain at the loss of her community of the "Elect", as she called them, and Lionel Verney has been seen as an outlet for her feelings of loss and boredom following their deaths and the deaths of her children. It appears that Shelley found inspiration for the title of her novel in Jean-Baptiste Cousin de Grainville 's Le Dernier Homme (1805), translated into English in 1806 as Omegarus and Syderia . The Last Man not only laments the loss of Shelley's friends, but also questions the Romantic political ideals for which they stood. In a sense, the plague is metaphorical, since the revolutionary idyll of the élite group is corroded from within by flaws of human nature. As literary scholar Kari Lokke writes, "in its refusal to place humanity at the center of the universe, its questioning of our privileged position in relation to nature, then, The Last Man constitutes a profound and prophetic challenge to Western humanism." Specifically, Mary Shelley, in making references to the failure of the French Revolution and the Godwinian , Wollstonecraftian , and Burkean responses to it, "attacks Enlightenment faith in the inevitability of progress through collective efforts". Hugh Luke argues, "By ending her story with the picture of the Earth's solitary inhabitant, she has brought nearly the whole weight of the novel to bear upon the idea that the condition of the individual being is essentially isolated and therefore ultimately tragic " (xvii). Shelley shares this theme of tragic isolation with the poetry of Lord Byron and William Wordsworth . Just as her earlier and better-known novel Frankenstein (1818) engaged with scientific questions of electromagnetism, chemistry, and materialism, The Last Man finds Shelley again attempting to understand the scope of scientific inquiry. Unlike the earlier novel's warnings about Faustian over-reaching, this novel's devastating apocalypse strongly suggests that medicine had become too timid and ultimately come too late. The ineffectual astronomer Merrival, for example, stands in stark contrast to the frighteningly productive Victor Frankenstein. Shelley's construction of Lionel Verney's immunity remains a subject of significant critical debate, but the novel certainly demonstrates a deep understanding of the history of medicine, specifically the development of the smallpox vaccine and the various nineteenth-century theories about the nature of contagion. Eileen Hunt Botting of the University of Notre Dame has stated that the novel "saw that the disaster of a pandemic would be driven by politics," and that the "spiraling health crisis would be caused by what people and their leaders had done and failed to do on the international stage—in trade, war and the interpersonal bargains, pacts and conflicts that precede them." Botting has further described the novel as identifying "three patterns of modern democratic corruption, which would be exposed and exacerbated by a pandemic: 1. slow yet steady institutional erosion of norms and practices of trust and equality; 2. authoritarian forms of populism that betray the people who bring an executive leader to power; and 3. patriarchal and religious forms of populism that manipulate the people's beliefs through fear and disinformation. The novel also comments on the racism expressed by imperial European nations towards the rest of the world. According to Olivia Murphy of the University of Sydney , the novel shows that "this sense of racial superiority and immunity is unfounded: all people are united in their susceptibility to the fatal disease." Many of the central characters are wholly or partially based upon Shelley's acquaintances. Shelley had been forbidden by her father-in-law, Sir Timothy Shelley , from publishing a biography of her husband, so she memorialised him, amongst others, in The Last Man . The utopian Adrian, Earl of Windsor, who leads his followers in search of a natural paradise and dies when his boat sinks in a storm, is a fictional portrait of Percy Bysshe Shelley , although other minor characters such as Merrival bear traces of Percy as well. Lord Raymond, who leaves England to fight for the Greeks and dies in Constantinople , is based on Lord Byron . The novel expresses Mary Shelley's pain at the loss of her community of the "Elect", as she called them, and Lionel Verney has been seen as an outlet for her feelings of loss and boredom following their deaths and the deaths of her children. It appears that Shelley found inspiration for the title of her novel in Jean-Baptiste Cousin de Grainville 's Le Dernier Homme (1805), translated into English in 1806 as Omegarus and Syderia . The Last Man not only laments the loss of Shelley's friends, but also questions the Romantic political ideals for which they stood. In a sense, the plague is metaphorical, since the revolutionary idyll of the élite group is corroded from within by flaws of human nature. As literary scholar Kari Lokke writes, "in its refusal to place humanity at the center of the universe, its questioning of our privileged position in relation to nature, then, The Last Man constitutes a profound and prophetic challenge to Western humanism." Specifically, Mary Shelley, in making references to the failure of the French Revolution and the Godwinian , Wollstonecraftian , and Burkean responses to it, "attacks Enlightenment faith in the inevitability of progress through collective efforts". Hugh Luke argues, "By ending her story with the picture of the Earth's solitary inhabitant, she has brought nearly the whole weight of the novel to bear upon the idea that the condition of the individual being is essentially isolated and therefore ultimately tragic " (xvii). Shelley shares this theme of tragic isolation with the poetry of Lord Byron and William Wordsworth . Just as her earlier and better-known novel Frankenstein (1818) engaged with scientific questions of electromagnetism, chemistry, and materialism, The Last Man finds Shelley again attempting to understand the scope of scientific inquiry. Unlike the earlier novel's warnings about Faustian over-reaching, this novel's devastating apocalypse strongly suggests that medicine had become too timid and ultimately come too late. The ineffectual astronomer Merrival, for example, stands in stark contrast to the frighteningly productive Victor Frankenstein. Shelley's construction of Lionel Verney's immunity remains a subject of significant critical debate, but the novel certainly demonstrates a deep understanding of the history of medicine, specifically the development of the smallpox vaccine and the various nineteenth-century theories about the nature of contagion. Eileen Hunt Botting of the University of Notre Dame has stated that the novel "saw that the disaster of a pandemic would be driven by politics," and that the "spiraling health crisis would be caused by what people and their leaders had done and failed to do on the international stage—in trade, war and the interpersonal bargains, pacts and conflicts that precede them." Botting has further described the novel as identifying "three patterns of modern democratic corruption, which would be exposed and exacerbated by a pandemic: 1. slow yet steady institutional erosion of norms and practices of trust and equality; 2. authoritarian forms of populism that betray the people who bring an executive leader to power; and 3. patriarchal and religious forms of populism that manipulate the people's beliefs through fear and disinformation. The novel also comments on the racism expressed by imperial European nations towards the rest of the world. According to Olivia Murphy of the University of Sydney , the novel shows that "this sense of racial superiority and immunity is unfounded: all people are united in their susceptibility to the fatal disease." The Last Man followed several other last-man themed works including a French narrative ( Le Dernier Homme ) [1805)]), Byron's poem " Darkness " (1816), and Thomas Campbell 's poem "The Last Man" (1824). (Campbell claimed Byron had taken his own poem from Campbell's idea.) Two editions of The Last Man were published by Henry Colburn in London on 23 January 1826, and one edition in Paris in 1826 by Galignani . A pirated edition was printed in the United States of America in 1833. The novel was not reprinted until 1965.The Last Man received the worst reviews of all of Mary Shelley's novels: [ citation needed ] most reviewers derided the very theme of lastness, which had become a common one in the previous two decades. Individual reviewers labelled the book "sickening", criticised its "stupid cruelties", and called the author's imagination "diseased". The reaction startled Mary Shelley, who promised her publisher a more popular book next time. Nonetheless, she later spoke of The Last Man as one of her favourite works. In the 20th century it received new critical attention, perhaps because the notion of lastness had become more relevant. The novel received a further surge in attention in the 2020s. Rebecca Barr of the University of Cambridge wrote that the novel was "an astonishing work" that "resonates with contemporary feelings of climate grief as well as the sense of helplessness as we confront COVID-19 ." Eileen Hunt Botting of the University of Notre Dame described the book as Shelley's "second great work of science fiction," saying that it provided "an existential mind-set for collectively dealing with the threat of a global man-made disaster." The Last Man received the worst reviews of all of Mary Shelley's novels: [ citation needed ] most reviewers derided the very theme of lastness, which had become a common one in the previous two decades. Individual reviewers labelled the book "sickening", criticised its "stupid cruelties", and called the author's imagination "diseased". The reaction startled Mary Shelley, who promised her publisher a more popular book next time. Nonetheless, she later spoke of The Last Man as one of her favourite works.In the 20th century it received new critical attention, perhaps because the notion of lastness had become more relevant. The novel received a further surge in attention in the 2020s. Rebecca Barr of the University of Cambridge wrote that the novel was "an astonishing work" that "resonates with contemporary feelings of climate grief as well as the sense of helplessness as we confront COVID-19 ." Eileen Hunt Botting of the University of Notre Dame described the book as Shelley's "second great work of science fiction," saying that it provided "an existential mind-set for collectively dealing with the threat of a global man-made disaster."

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Bubonic plague

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Swatantrya Veer Savarkar (film)

Randeep Hooda Films Legend Studios Avak Films Anand Pandit Motion Pictures 22 March 2024 ( 2024-03-22 ) Swatantrya Veer Savarkar is a 2024 Indian Hindi -language film on the life of Vinayak Damodar Savarkar . It is directed, co-written, and co-produced by Randeep Hooda , who also plays the titular role of Savarkar. It was released in theatres on 22 March 2024. The film has been criticised for distorting history and for promoting one-sided agenda but received praises for its actors' performances. The film narrates the life of Vinayak Damodar Savarkar , beginning with the backdrop of the Bubonic plague of 1897 , which claims his father's life. Angered by injustices, Vinayak becomes a revolutionary, inspired by figures like Shivaji Maharaj and Mazzini . He founds the secret society Abhinav Bharat Society and later joins Indian revolutionaries in London at the India House . Vinayak completes his thesis on the 1857 War of Independence, and secretly dispatches weapons to India. He meets Mahatma Gandhi but finds their approaches different. As India witnesses various revolutionary acts, the Savarkar brothers—Vinayak and Ganesh Damodar Savarkar —are arrested, and imprisonend in the infamous Kalapani in Andaman. In prison, the Savarkar brothers face brutal treatment, including solitary confinement and physical abuse. Despite hardships, Vinayak continues his struggle, advocating for better conditions for political prisoners. After years of imprisonment, Vinayak is released but faces restrictions. He coins the term Hindutva and continues his activism, challenging casteism and advocating for a united India. He refuses to support Gandhi's Quit India Movement . Fearing partition, and urges Hindus to prepare for military defense. As India moves towards independence, the film delves on the partition , the Naval Mutiny , and Gandhi's assassination .Varun Buddhadev as young Veer SavarkarRandeep Hooda took over directing the film from Mahesh Manjrekar , who quit the project citing differences with Randeep over the script and inclusion of irrelevant historical figures and events. The music of the film is composed by Anu Malik , Vipin Patwa and Sambata while the background score is composed by Mathias Duplessy and Sandesh Shandilya .The film was theatrically released on 22 March 2024 in Hindi, along with Marathi dubbed version. The movie earned ₹11.37 nett crore in India its first week. In second week, the movie earned ₹6.34 nett crore. For third week, the movie earned ₹4.45 nett crore. In it's fourth week, the movie earned ₹1.40 nett crore. As of 14 April 2024, the film has a worldwide gross of ₹31.23 crore . On the review aggregator website Rotten Tomatoes , 0% of 6 critics' reviews are positive, with an average rating of 4/10. Catherine Bray of The Guardian gave the film 2 out of 5 stars and stated, "It all adds up to a funny mixture of hagiography and limp film-making, albeit built around a fine central performance." Rishil Jogani of Pinkvilla rated the film 4/5 and opined that "The life decisions of Vinayak Damodar Savarkar can have polarising views, but not the film, that can be classified as 'peak cinema'. While one can't claim authenticity of everything shown in the film, this interpretation of Savarkar's life by Randeep Hooda and the team of Swatantrya Veer Savarkar makes for great, engaging cinema." Anuj Kumar of The Hindu wrote "The film attempts to uplift Savarkar in the popular imagination by vilifying Gandhi through a stylistically mounted and carefully crafted narrative". In the review for Indian Express , Shubhra Gupta gave a rating of 2/5 and described the movie as "stridently one-sided, and, ultimately, reductive". Dishya Sharma of News 18 rated the film 3 out of 5 stars and wrote "In a sea of patriotic films that Bollywood has been releasing in recent years, Swatantra Veer Savarkar is among the better ones. The production value of the film and the performances keep you seated through the three-hour watch. I wish it was edited well, for there were a few scenes that could have been done away with. This would have given the film a lasting impact." Rohit Bhatnagar of Free Press Journal gave a rating of 2.5/5 and wrote "Randeep's film is a slow burner and it drains you with facts and figures but it is a well-intended project that might strictly excite and appeal history lovers." The review finds the movie to be "bothersome" and to have distorted historical realities. Sana Farzeen of India Today rated 2 out of 5 stars and added that " Swatantrya Veer Savarkar turned out to be a shallow attempt. It can be only passed off as a very long, often one-sided history lesson on the 'neglected' freedom fighter." Monika Rawal Kukreja of Hindustan Times writes in her review that the film "ends up being a one-sided narrative that's not bothered about presenting a balanced outlook about the contributions made towards India's struggle for freedom. Prateek Sur of the Outlook gave 2.5/5 stars and stated that, "'Swatantrya Veer Savarkar' is a wasted effort to be honest. The performances of the other characters could have been lifted and given much more weightage than it currently got. Not to forget that its already too long and yet you feel that there are many angles that have been missed out. So, a possibility of having the film releasing two parts or probably as a web series would have been better." Catherine Bray of The Guardian gave the film 2 out of 5 stars and stated, "It all adds up to a funny mixture of hagiography and limp film-making, albeit built around a fine central performance." Rishil Jogani of Pinkvilla rated the film 4/5 and opined that "The life decisions of Vinayak Damodar Savarkar can have polarising views, but not the film, that can be classified as 'peak cinema'. While one can't claim authenticity of everything shown in the film, this interpretation of Savarkar's life by Randeep Hooda and the team of Swatantrya Veer Savarkar makes for great, engaging cinema." Anuj Kumar of The Hindu wrote "The film attempts to uplift Savarkar in the popular imagination by vilifying Gandhi through a stylistically mounted and carefully crafted narrative". In the review for Indian Express , Shubhra Gupta gave a rating of 2/5 and described the movie as "stridently one-sided, and, ultimately, reductive". Dishya Sharma of News 18 rated the film 3 out of 5 stars and wrote "In a sea of patriotic films that Bollywood has been releasing in recent years, Swatantra Veer Savarkar is among the better ones. The production value of the film and the performances keep you seated through the three-hour watch. I wish it was edited well, for there were a few scenes that could have been done away with. This would have given the film a lasting impact." Rohit Bhatnagar of Free Press Journal gave a rating of 2.5/5 and wrote "Randeep's film is a slow burner and it drains you with facts and figures but it is a well-intended project that might strictly excite and appeal history lovers." The review finds the movie to be "bothersome" and to have distorted historical realities. Sana Farzeen of India Today rated 2 out of 5 stars and added that " Swatantrya Veer Savarkar turned out to be a shallow attempt. It can be only passed off as a very long, often one-sided history lesson on the 'neglected' freedom fighter." Monika Rawal Kukreja of Hindustan Times writes in her review that the film "ends up being a one-sided narrative that's not bothered about presenting a balanced outlook about the contributions made towards India's struggle for freedom. Prateek Sur of the Outlook gave 2.5/5 stars and stated that, "'Swatantrya Veer Savarkar' is a wasted effort to be honest. The performances of the other characters could have been lifted and given much more weightage than it currently got. Not to forget that its already too long and yet you feel that there are many angles that have been missed out. So, a possibility of having the film releasing two parts or probably as a web series would have been better."

Wiki

Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Quarantine/html

Quarantine

A quarantine is a restriction on the movement of people , animals and goods which is intended to prevent the spread of disease or pests . It is often used in connection to disease and illness, preventing the movement of those who may have been exposed to a communicable disease , yet do not have a confirmed medical diagnosis . It is distinct from medical isolation , in which those confirmed to be infected with a communicable disease are isolated from the healthy population. Quarantine considerations are often one aspect of border control . [ citation needed ] The concept of quarantine has been known since biblical times, and is known to have been practised through history in various places. Notable quarantines in modern history include the village of Eyam in 1665 during the bubonic plague outbreak in England; East Samoa during the 1918 flu pandemic ; the Diphtheria outbreak during the 1925 serum run to Nome , the 1972 Yugoslav smallpox outbreak , the SARS pandemic, the Ebola pandemic and extensive quarantines applied throughout the world during the COVID-19 pandemic since 2020. Ethical and practical considerations need to be considered when applying quarantine to people. Practice differs from country to country; in some countries, quarantine is just one of many measures governed by legislation relating to the broader concept of biosecurity ; for example, Australian biosecurity is governed by the single overarching Biosecurity Act 2015 .The word quarantine comes from quarantena or quarantaine , meaning "forty days", used in the Venetian language in the 14th and 15th centuries and also in France. The word is designated in the period during which all ships were required to be isolated before passengers and crew could go ashore during the Black Death plague. The quarantena followed the trentino , or "thirty-day isolation" period, first imposed in 1347 in the Republic of Ragusa , Dalmatia (modern Dubrovnik in Croatia). Merriam-Webster gives various meanings to the noun form, including "a period of 40 days", several relating to ships, "a state of enforced isolation", and as "a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests ". The word is also used as a verb. Quarantine is distinct from medical isolation , in which those confirmed to be infected with a communicable disease are isolated from the healthy population. Quarantine may be used interchangeably with cordon sanitaire , and although the terms are related, cordon sanitaire refers to the restriction of movement of people into or out of a defined geographic area, such as a community, in order to prevent an infection from spreading. An early mention of isolation occurs in the Biblical book of Leviticus , written in the 7th century BC or perhaps earlier, which describes the procedure for separating out people infected with the skin disease Tzaraath . The medical nature of this isolation is, however, disputed. As traditional exegesis (dated 700 CE) sees it as a punishment for trespassing one of several negative commandment, most notably Evil Speech . A more recent hypothesis postulates that the infected are required to isolate themselves in order to prevent spread of disease [ citation needed ] (although the Bible does not imply contagiousness of Tzaraath ): Anyone with such a defiling disease must wear torn clothes, let their hair be unkempt, cover the lower part of their face and cry out, "Unclean! Unclean!" As long as they have the disease they remain unclean. They must live alone; they must live outside the camp. [ non-primary source needed ] Moses ordered that dwellings from which infected Jews had gone should be inspected before being occupied again, and that people recovering from contagious disease were not to be allowed to go abroad until examined. [ citation needed ] A hadith attributed to the Islamic prophet Muhammad advised individuals present in a region with a plague outbreak to remain in place, and advised healthy individuals to avoid traveling there. The Persian Muslim polymath Avicenna argued for controlling "the spread of diseases" in his medical encyclopedia The Canon [Al-Qanun] of Medicine, published in 1025. He also recommended quarantine for patients with infectious diseases, especially tuberculosis . Since the sixteenth century, the Ottoman empire has isolated travellers coming from epidemic areas during the Bubonic plague. A quarantine involved isolating healthy travellers for a period of time so that it could be ascertained if they were sick or not. The mandatory quarantine of special groups of patients, including those with leprosy, started early in Islamic history. In the early 8th century the sixth Umayyad caliph Al-Walid I segregated lepers from the general population, with some later sources crediting the caliph with opening a hospital . The separation of lepers from the general population was also practiced in the Moroccan city of Fez, where lepers were relocated to a cave system outside of the city. Dedicated leprosariums were built in the time of the Ottoman sultan Murad II in the 15th century, with some of the facilities operating for centuries. The word "quarantine" originates from quarantena , the Venetian language form, meaning "forty days". This is due to the 40-day isolation of ships and people practised as a measure of disease prevention related to the plague . Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population. Such a disaster led governments to establish measures of containment to handle recurrent epidemics. A document from 1377 states that before entering the city-state of Ragusa in Dalmatia (modern Dubrovnik in Croatia), newcomers had to spend 30 days (a trentine ) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop. In 1448 the Venetian Senate prolonged the waiting period to 40 days, thus giving birth to the term "quarantine". The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. Dubrovnik was the first city in Europe to set up quarantine sites such as the Lazzarettos of Dubrovnik where arriving ship personnel were held for up to 40 days. According to current estimates, the bubonic plague had a 37-day period from infection to death; therefore, the European quarantines would have been highly successful in determining the health of crews from potential trading and supply ships. Other diseases lent themselves to the practice of quarantine before and after the devastation of the plague. Those affected by leprosy were historically isolated long-term from society, and attempts were made to check the spread of syphilis in northern Europe after 1492, the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831. [ citation needed ] Venice took the lead in measures to check the spread of plague, having appointed three guardians of public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio / Modena in 1374. Venice founded the first lazaret (on a small island adjoining the city) in 1403. In 1467 Genoa followed the example of Venice, and in 1476 the old leper hospital of Marseille was converted into a plague hospital. The great lazaret of Marseille, perhaps the most complete of its kind, was founded in 1526 on the island of Pomègues . The practise at all the Mediterranean lazarets did not differ from the English procedure in the Levantine and North African trade. On the arrival of cholera in 1831 some new lazarets were set up at western ports; notably, a very extensive establishment near Bordeaux . Afterwards, they were used for other purposes. [ citation needed ] Epidemics of yellow fever ravaged urban communities in North America throughout the late-eighteenth and early-nineteenth centuries, the best-known examples being the 1793 Philadelphia yellow fever epidemic and outbreaks in Georgia (1856) and Florida (1888). Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected Honolulu and San Francisco from 1899 until 1901. State governments generally relied on the cordon sanitaire as a geographic quarantine measure to control the movement of people into and out of affected communities. During the 1918 influenza pandemic, some communities instituted protective sequestration (sometimes referred to as "reverse quarantine") to keep the infected from introducing influenza into healthy populations. Additionally, the nature of the influenza virus that caused the 1918 pandemic gave rise to a public awareness of the dichotomy between "crowd" and "home" diseases. Simply quarantining the sick in isolation was ineffective in halting the spread of the disease, and new quarantine standards that extended regulations to public spaces became increasingly more common. Most Western countries implemented a range of containment strategies, including isolation, surveillance, and the closure of schools, churches, theatres, and public events. People were prevented from entering the Ashanti Empire at border checkpoints if they exhibited symptoms of smallpox. Those who discovered symptoms of the disease after entering Ashanti were quarantined in remote villages. In the 1830s, both the Ottoman Empire and Egypt established new quarantine systems. In 1831, Mehmet Ali of Egypt founded the Quarantine Board in Alexandria. In 1838, the Ottoman government installed the Supreme Council of Health, including the Quarantine Administration, in Istanbul. These two institutions set up permanent quarantines throughout the eastern Mediterranean, based on the western Mediterranean quarantine model. For example, at the port of İzmir , all ships and their cargo would be inspected and those suspected of carrying the plague would be towed to separate docks and their personnel housed in separate buildings for a determined period of time. In Thessaly , along the Greek-Turkish border, all travellers entering and exiting the Ottoman Empire would be quarantined for 9–15 days. Upon appearance of the plague, the quarantine stations would be militarised and the Ottoman army would be involved in border control and disease monitoring . Since 1852, several conferences were held involving European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe. All but that of 1897 were concerned with cholera . No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by the United Kingdom for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece, and Russia (the British possessions at the time, Gibraltar, Malta, and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions was very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags. [ citation needed ] The Venice convention of 30 January 1892 dealt with cholera by the Suez Canal route; that of Dresden of 15 April 1893, with cholera within European countries; that of Paris of 3 April 1894, with cholera by the pilgrim traffic; and that of Venice, on 19 March 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. An additional convention was signed in Paris on 3 December 1903. A multilateral international sanitary convention was concluded at Paris on 17 January 1912. This convention was most comprehensive and was designated to replace all previous conventions on that matter. It was signed by 40 countries, and consisted of 160 articles. Ratifications by 16 of the signatories were exchanged in Paris on 7 October 1920. Another multilateral convention was signed in Paris on 21 June 1926, to replace that of 1912. It was signed by 58 countries worldwide, and consisted of 172 articles. In Latin America, a series of regional sanitary conventions were concluded. Such a convention was concluded in Rio de Janeiro on 12 June 1904. A sanitary convention between the governments of Argentina, Brazil, Paraguay, and Uruguay was concluded in Montevideo on 21 April 1914. The convention covers cases of Asiatic cholera , oriental plague and yellow fever . It was ratified by the Uruguayan government on 13 October 1914, by the Paraguayan government on 27 September 1917 and by the Brazilian government on 18 January 1921. Sanitary conventions were also concluded between European states. A Soviet-Latvian sanitary convention was signed on 24 June 1922, for which ratifications were exchanged on 18 October 1923. A bilateral sanitary convention was concluded between the governments of Latvia and Poland on 7 July 1922, for which ratifications were exchanged on 7 April 1925. Another was concluded between the governments of Germany and Poland in Dresden on 18 December 1922, and entered into effect on 15 February 1923. Another one was signed between the governments of Poland and Romania on 20 December 1922. Ratifications were exchanged on 11 July 1923. The Polish government also concluded such a convention with the Soviet government on 7 February 1923, for which ratifications were exchanged on 8 January 1924. A sanitary convention was also concluded between the governments of Poland and Czechoslovakia on 5 September 1925, for which ratifications were exchanged on 22 October 1926. A convention was signed between the governments of Germany and Latvia on 9 July 1926, for which ratifications were exchanged on 6 July 1927. In 1897, the incubation period for this disease was determined and this was to be adopted for administrative purposes. The incubation period was comparatively short, some three or four days. After much discussion ten days was accepted by a majority. The principle of disease notification was unanimously adopted. Each government had to notify other governments of the existence of plague within their jurisdictions and state the measures of prevention being carried out to prevent its spread. The area declared infected was limited to the district or village where the disease prevailed, and no locality was deemed to be infected because of the importation into it of a few cases of plague while there has been no spread. It was decided during the prevalence of plague, every country had the right to close its land borders to traffic. At the Red Sea , it was decided after discussion a healthy vessel could pass through the Suez Canal and continue its voyage in the Mediterranean during the incubation period of the disease and that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal up in quarantine at Port Said by night or by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and a disinfecting stove, have a right to navigate the Canal in quarantine and subject only to the landing of those who have plague. [ citation needed ] In the 20th and 21st centuries, people suspected of carrying infectious diseases have been quarantined, as in the cases of Andrew Speaker (multi-drug-resistant tuberculosis, 2007) and Kaci Hickox (Ebola, 2014). During the 1957–58 influenza pandemic and the 1968 flu pandemic , several countries implemented measures to control spread of the disease. In addition, the World Health Organization applied a global influenza surveillance network. During the 1994 plague in India , many people were quarantined. Vessels and aircraft carrying passengers were fumigated. In the SARS epidemic , thousands of Chinese people were quarantined and checkpoints to take temperatures were set up. Moving infected patients to isolation wards and home-based self-quarantine of people potentially exposed was the main way the Western African Ebola virus epidemic was ended in 2016; members of the 8th WHO Emergency Committee criticised international travel restrictions imposed during the epidemic as ineffective due to difficulty of enforcement, and counterproductive as they slowed down aid efforts. The People's Republic of China has employed mass quarantines – firstly of the city of Wuhan and subsequently of all of the Hubei province (population 55.5 million) – in the coronavirus disease 2019 pandemic . After a few weeks, the Italian government imposed lockdowns for the entire country (more than 60 million people) in an attempt to stop the spread of the disease there . India quarantined itself from the world for a period of one month. Most governments around the world restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak. By late 2020, the virus had already spread within communities in large parts of the world, with many not knowing where or how they were infected. An early mention of isolation occurs in the Biblical book of Leviticus , written in the 7th century BC or perhaps earlier, which describes the procedure for separating out people infected with the skin disease Tzaraath . The medical nature of this isolation is, however, disputed. As traditional exegesis (dated 700 CE) sees it as a punishment for trespassing one of several negative commandment, most notably Evil Speech . A more recent hypothesis postulates that the infected are required to isolate themselves in order to prevent spread of disease [ citation needed ] (although the Bible does not imply contagiousness of Tzaraath ): Anyone with such a defiling disease must wear torn clothes, let their hair be unkempt, cover the lower part of their face and cry out, "Unclean! Unclean!" As long as they have the disease they remain unclean. They must live alone; they must live outside the camp. [ non-primary source needed ] Moses ordered that dwellings from which infected Jews had gone should be inspected before being occupied again, and that people recovering from contagious disease were not to be allowed to go abroad until examined. [ citation needed ] A hadith attributed to the Islamic prophet Muhammad advised individuals present in a region with a plague outbreak to remain in place, and advised healthy individuals to avoid traveling there. The Persian Muslim polymath Avicenna argued for controlling "the spread of diseases" in his medical encyclopedia The Canon [Al-Qanun] of Medicine, published in 1025. He also recommended quarantine for patients with infectious diseases, especially tuberculosis . Since the sixteenth century, the Ottoman empire has isolated travellers coming from epidemic areas during the Bubonic plague. A quarantine involved isolating healthy travellers for a period of time so that it could be ascertained if they were sick or not. The mandatory quarantine of special groups of patients, including those with leprosy, started early in Islamic history. In the early 8th century the sixth Umayyad caliph Al-Walid I segregated lepers from the general population, with some later sources crediting the caliph with opening a hospital . The separation of lepers from the general population was also practiced in the Moroccan city of Fez, where lepers were relocated to a cave system outside of the city. Dedicated leprosariums were built in the time of the Ottoman sultan Murad II in the 15th century, with some of the facilities operating for centuries. The word "quarantine" originates from quarantena , the Venetian language form, meaning "forty days". This is due to the 40-day isolation of ships and people practised as a measure of disease prevention related to the plague . Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population. Such a disaster led governments to establish measures of containment to handle recurrent epidemics. A document from 1377 states that before entering the city-state of Ragusa in Dalmatia (modern Dubrovnik in Croatia), newcomers had to spend 30 days (a trentine ) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop. In 1448 the Venetian Senate prolonged the waiting period to 40 days, thus giving birth to the term "quarantine". The forty-day quarantine proved to be an effective formula for handling outbreaks of the plague. Dubrovnik was the first city in Europe to set up quarantine sites such as the Lazzarettos of Dubrovnik where arriving ship personnel were held for up to 40 days. According to current estimates, the bubonic plague had a 37-day period from infection to death; therefore, the European quarantines would have been highly successful in determining the health of crews from potential trading and supply ships. Other diseases lent themselves to the practice of quarantine before and after the devastation of the plague. Those affected by leprosy were historically isolated long-term from society, and attempts were made to check the spread of syphilis in northern Europe after 1492, the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831. [ citation needed ] Venice took the lead in measures to check the spread of plague, having appointed three guardians of public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio / Modena in 1374. Venice founded the first lazaret (on a small island adjoining the city) in 1403. In 1467 Genoa followed the example of Venice, and in 1476 the old leper hospital of Marseille was converted into a plague hospital. The great lazaret of Marseille, perhaps the most complete of its kind, was founded in 1526 on the island of Pomègues . The practise at all the Mediterranean lazarets did not differ from the English procedure in the Levantine and North African trade. On the arrival of cholera in 1831 some new lazarets were set up at western ports; notably, a very extensive establishment near Bordeaux . Afterwards, they were used for other purposes. [ citation needed ]Epidemics of yellow fever ravaged urban communities in North America throughout the late-eighteenth and early-nineteenth centuries, the best-known examples being the 1793 Philadelphia yellow fever epidemic and outbreaks in Georgia (1856) and Florida (1888). Cholera and smallpox epidemics continued throughout the nineteenth century, and plague epidemics affected Honolulu and San Francisco from 1899 until 1901. State governments generally relied on the cordon sanitaire as a geographic quarantine measure to control the movement of people into and out of affected communities. During the 1918 influenza pandemic, some communities instituted protective sequestration (sometimes referred to as "reverse quarantine") to keep the infected from introducing influenza into healthy populations. Additionally, the nature of the influenza virus that caused the 1918 pandemic gave rise to a public awareness of the dichotomy between "crowd" and "home" diseases. Simply quarantining the sick in isolation was ineffective in halting the spread of the disease, and new quarantine standards that extended regulations to public spaces became increasingly more common. Most Western countries implemented a range of containment strategies, including isolation, surveillance, and the closure of schools, churches, theatres, and public events. People were prevented from entering the Ashanti Empire at border checkpoints if they exhibited symptoms of smallpox. Those who discovered symptoms of the disease after entering Ashanti were quarantined in remote villages. In the 1830s, both the Ottoman Empire and Egypt established new quarantine systems. In 1831, Mehmet Ali of Egypt founded the Quarantine Board in Alexandria. In 1838, the Ottoman government installed the Supreme Council of Health, including the Quarantine Administration, in Istanbul. These two institutions set up permanent quarantines throughout the eastern Mediterranean, based on the western Mediterranean quarantine model. For example, at the port of İzmir , all ships and their cargo would be inspected and those suspected of carrying the plague would be towed to separate docks and their personnel housed in separate buildings for a determined period of time. In Thessaly , along the Greek-Turkish border, all travellers entering and exiting the Ottoman Empire would be quarantined for 9–15 days. Upon appearance of the plague, the quarantine stations would be militarised and the Ottoman army would be involved in border control and disease monitoring . Since 1852, several conferences were held involving European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe. All but that of 1897 were concerned with cholera . No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by the United Kingdom for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece, and Russia (the British possessions at the time, Gibraltar, Malta, and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions was very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags. [ citation needed ] The Venice convention of 30 January 1892 dealt with cholera by the Suez Canal route; that of Dresden of 15 April 1893, with cholera within European countries; that of Paris of 3 April 1894, with cholera by the pilgrim traffic; and that of Venice, on 19 March 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. An additional convention was signed in Paris on 3 December 1903. A multilateral international sanitary convention was concluded at Paris on 17 January 1912. This convention was most comprehensive and was designated to replace all previous conventions on that matter. It was signed by 40 countries, and consisted of 160 articles. Ratifications by 16 of the signatories were exchanged in Paris on 7 October 1920. Another multilateral convention was signed in Paris on 21 June 1926, to replace that of 1912. It was signed by 58 countries worldwide, and consisted of 172 articles. In Latin America, a series of regional sanitary conventions were concluded. Such a convention was concluded in Rio de Janeiro on 12 June 1904. A sanitary convention between the governments of Argentina, Brazil, Paraguay, and Uruguay was concluded in Montevideo on 21 April 1914. The convention covers cases of Asiatic cholera , oriental plague and yellow fever . It was ratified by the Uruguayan government on 13 October 1914, by the Paraguayan government on 27 September 1917 and by the Brazilian government on 18 January 1921. Sanitary conventions were also concluded between European states. A Soviet-Latvian sanitary convention was signed on 24 June 1922, for which ratifications were exchanged on 18 October 1923. A bilateral sanitary convention was concluded between the governments of Latvia and Poland on 7 July 1922, for which ratifications were exchanged on 7 April 1925. Another was concluded between the governments of Germany and Poland in Dresden on 18 December 1922, and entered into effect on 15 February 1923. Another one was signed between the governments of Poland and Romania on 20 December 1922. Ratifications were exchanged on 11 July 1923. The Polish government also concluded such a convention with the Soviet government on 7 February 1923, for which ratifications were exchanged on 8 January 1924. A sanitary convention was also concluded between the governments of Poland and Czechoslovakia on 5 September 1925, for which ratifications were exchanged on 22 October 1926. A convention was signed between the governments of Germany and Latvia on 9 July 1926, for which ratifications were exchanged on 6 July 1927. In 1897, the incubation period for this disease was determined and this was to be adopted for administrative purposes. The incubation period was comparatively short, some three or four days. After much discussion ten days was accepted by a majority. The principle of disease notification was unanimously adopted. Each government had to notify other governments of the existence of plague within their jurisdictions and state the measures of prevention being carried out to prevent its spread. The area declared infected was limited to the district or village where the disease prevailed, and no locality was deemed to be infected because of the importation into it of a few cases of plague while there has been no spread. It was decided during the prevalence of plague, every country had the right to close its land borders to traffic. At the Red Sea , it was decided after discussion a healthy vessel could pass through the Suez Canal and continue its voyage in the Mediterranean during the incubation period of the disease and that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal up in quarantine at Port Said by night or by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and a disinfecting stove, have a right to navigate the Canal in quarantine and subject only to the landing of those who have plague. [ citation needed ] In the 20th and 21st centuries, people suspected of carrying infectious diseases have been quarantined, as in the cases of Andrew Speaker (multi-drug-resistant tuberculosis, 2007) and Kaci Hickox (Ebola, 2014). During the 1957–58 influenza pandemic and the 1968 flu pandemic , several countries implemented measures to control spread of the disease. In addition, the World Health Organization applied a global influenza surveillance network. During the 1994 plague in India , many people were quarantined. Vessels and aircraft carrying passengers were fumigated. In the SARS epidemic , thousands of Chinese people were quarantined and checkpoints to take temperatures were set up. Moving infected patients to isolation wards and home-based self-quarantine of people potentially exposed was the main way the Western African Ebola virus epidemic was ended in 2016; members of the 8th WHO Emergency Committee criticised international travel restrictions imposed during the epidemic as ineffective due to difficulty of enforcement, and counterproductive as they slowed down aid efforts. The People's Republic of China has employed mass quarantines – firstly of the city of Wuhan and subsequently of all of the Hubei province (population 55.5 million) – in the coronavirus disease 2019 pandemic . After a few weeks, the Italian government imposed lockdowns for the entire country (more than 60 million people) in an attempt to stop the spread of the disease there . India quarantined itself from the world for a period of one month. Most governments around the world restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak. By late 2020, the virus had already spread within communities in large parts of the world, with many not knowing where or how they were infected. Since 1852, several conferences were held involving European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe. All but that of 1897 were concerned with cholera . No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by the United Kingdom for many years. The principal countries which retained the old system at the time were Spain, Portugal, Turkey, Greece, and Russia (the British possessions at the time, Gibraltar, Malta, and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventions was very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags. [ citation needed ] The Venice convention of 30 January 1892 dealt with cholera by the Suez Canal route; that of Dresden of 15 April 1893, with cholera within European countries; that of Paris of 3 April 1894, with cholera by the pilgrim traffic; and that of Venice, on 19 March 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. An additional convention was signed in Paris on 3 December 1903. A multilateral international sanitary convention was concluded at Paris on 17 January 1912. This convention was most comprehensive and was designated to replace all previous conventions on that matter. It was signed by 40 countries, and consisted of 160 articles. Ratifications by 16 of the signatories were exchanged in Paris on 7 October 1920. Another multilateral convention was signed in Paris on 21 June 1926, to replace that of 1912. It was signed by 58 countries worldwide, and consisted of 172 articles. In Latin America, a series of regional sanitary conventions were concluded. Such a convention was concluded in Rio de Janeiro on 12 June 1904. A sanitary convention between the governments of Argentina, Brazil, Paraguay, and Uruguay was concluded in Montevideo on 21 April 1914. The convention covers cases of Asiatic cholera , oriental plague and yellow fever . It was ratified by the Uruguayan government on 13 October 1914, by the Paraguayan government on 27 September 1917 and by the Brazilian government on 18 January 1921. Sanitary conventions were also concluded between European states. A Soviet-Latvian sanitary convention was signed on 24 June 1922, for which ratifications were exchanged on 18 October 1923. A bilateral sanitary convention was concluded between the governments of Latvia and Poland on 7 July 1922, for which ratifications were exchanged on 7 April 1925. Another was concluded between the governments of Germany and Poland in Dresden on 18 December 1922, and entered into effect on 15 February 1923. Another one was signed between the governments of Poland and Romania on 20 December 1922. Ratifications were exchanged on 11 July 1923. The Polish government also concluded such a convention with the Soviet government on 7 February 1923, for which ratifications were exchanged on 8 January 1924. A sanitary convention was also concluded between the governments of Poland and Czechoslovakia on 5 September 1925, for which ratifications were exchanged on 22 October 1926. A convention was signed between the governments of Germany and Latvia on 9 July 1926, for which ratifications were exchanged on 6 July 1927. In 1897, the incubation period for this disease was determined and this was to be adopted for administrative purposes. The incubation period was comparatively short, some three or four days. After much discussion ten days was accepted by a majority. The principle of disease notification was unanimously adopted. Each government had to notify other governments of the existence of plague within their jurisdictions and state the measures of prevention being carried out to prevent its spread. The area declared infected was limited to the district or village where the disease prevailed, and no locality was deemed to be infected because of the importation into it of a few cases of plague while there has been no spread. It was decided during the prevalence of plague, every country had the right to close its land borders to traffic. At the Red Sea , it was decided after discussion a healthy vessel could pass through the Suez Canal and continue its voyage in the Mediterranean during the incubation period of the disease and that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal up in quarantine at Port Said by night or by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and a disinfecting stove, have a right to navigate the Canal in quarantine and subject only to the landing of those who have plague. [ citation needed ] In the 20th and 21st centuries, people suspected of carrying infectious diseases have been quarantined, as in the cases of Andrew Speaker (multi-drug-resistant tuberculosis, 2007) and Kaci Hickox (Ebola, 2014). During the 1957–58 influenza pandemic and the 1968 flu pandemic , several countries implemented measures to control spread of the disease. In addition, the World Health Organization applied a global influenza surveillance network. During the 1994 plague in India , many people were quarantined. Vessels and aircraft carrying passengers were fumigated. In the SARS epidemic , thousands of Chinese people were quarantined and checkpoints to take temperatures were set up. Moving infected patients to isolation wards and home-based self-quarantine of people potentially exposed was the main way the Western African Ebola virus epidemic was ended in 2016; members of the 8th WHO Emergency Committee criticised international travel restrictions imposed during the epidemic as ineffective due to difficulty of enforcement, and counterproductive as they slowed down aid efforts. The People's Republic of China has employed mass quarantines – firstly of the city of Wuhan and subsequently of all of the Hubei province (population 55.5 million) – in the coronavirus disease 2019 pandemic . After a few weeks, the Italian government imposed lockdowns for the entire country (more than 60 million people) in an attempt to stop the spread of the disease there . India quarantined itself from the world for a period of one month. Most governments around the world restricted or advised against all non-essential travel to and from countries and areas affected by the outbreak. By late 2020, the virus had already spread within communities in large parts of the world, with many not knowing where or how they were infected. Plain yellow, green, and even black flags have been used to symbolise disease in both ships and ports, with the colour yellow having a longer historical precedent, as a colour of marking for houses of infection, previous to its use as a maritime marking colour for disease. The former flag used for the purpose was the "Lima" ( L ) flag, which is a mixture of yellow and black flags previously used. It is sometimes called the "yellow jack" but this was also a name for yellow fever , which probably derives its common name from the flag, not the colour of the victims (cholera ships also used a yellow flag). The plain yellow flag ("Quebec" or Q in international maritime signal flags ) probably derives its letter symbol for its initial use in quarantine , but this flag in modern times indicates the opposite—a ship that 'requests free pratique ', i.e. that declares itself free of quarantinable disease, and requests boarding and routine port inspection. Ships in quarantine today would fly either the Q flag alone, meaning "My vessel is 'healthy' and I request free pratique", or the double Q flag (QQ), meaning "I require health clearance". The quarantining of people often raises questions of civil rights , especially in cases of long confinement or segregation from society, such as that of Mary Mallon (also known as Typhoid Mary), a typhoid fever carrier who was arrested and quarantined in 1907 and later spent the last 23 years and 7 months of her life in medical isolation at Riverside Hospital on North Brother Island . Guidance on when and how human rights can be restricted to prevent the spread of infectious disease is found in the Siracusa Principles , a non-binding document developed by the Siracusa International Institute for Criminal Justice and Human Rights and adopted by the United Nations Economic and Social Council in 1984. The Siracusa Principles state that restrictions on human rights under the International Covenant on Civil and Political Rights must meet standards of legality, evidence-based necessity , proportionality, and gradualism, noting that public health can be used as grounds for limiting certain rights if the state needs to take measures 'aimed at preventing disease or injury or providing care for the sick and injured.' Limitations on rights (such as quarantine) must be 'strictly necessary,' meaning that they must: respond to a pressing public or social need (health) proportionately pursue a legitimate aim (prevent the spread of infectious disease) be the least restrictive means required for achieving the purpose of the limitation be provided for and carried out in accordance with the law be neither arbitrary nor discriminatory only limit rights that are within the jurisdiction of the state seeking to impose the limitation. In addition, when quarantine is imposed, public health ethics specify that: all restrictive actions must be well-supported by data and scientific evidence all information must be made available to the public all actions must be explained clearly to those whose rights are restricted and to the public all actions must be subject to regular review and reconsideration. Finally, the state is ethically obligated to guarantee that: infected people will not be threatened or abused basic needs such as food, water, medical care, and preventive care will be provided communication with loved ones and with caretakers will be permitted constraints on freedom will be applied equally, regardless of social considerations patients will be compensated fairly for economic and material losses, including salary. Quarantine can have adverse psychological effects on the quarantined, including post-traumatic stress , confusion, and anger. According to a "Rapid Review" published in The Lancet in response to the COVID-19 pandemic , "Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable." Although youngsters appear to be less vulnerable to COVID-19 , the side effects of the pandemic can be devastating. Quarantine from the pandemic led to an increase the prevalence of violence in the family, depression, anxiety, and post-traumatic stress disorder. Children and adolescents may be highly exposed to biopsychosocial stressors generated by the pandemic and once population's containment measures to reduce virus spread are required, they could be potentially affected by the disruption in daily life routine as a result of social isolation and their unseasoned ability to conceive and comprehend the short- and long-term consequences of this outbreak. Quarantine periods can be very short, such as in the case of a suspected anthrax attack, in which people are allowed to leave as soon as they shed their potentially contaminated garments and undergo a decontamination shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent. The February–March 2003 issue of HazMat Magazine suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax". [ citation needed ] Standard-Times senior correspondent Steve Urbon (14 February 2003) describes such temporary quarantine powers: Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people". The purpose of such quarantine-for-decontamination is to prevent the spread of contamination and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect. It can also be used to limit exposure, as well as eliminate a vector . New developments for quarantine include new concepts in quarantine vehicles such as the ambulance bus , mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility under lockdown. Guidance on when and how human rights can be restricted to prevent the spread of infectious disease is found in the Siracusa Principles , a non-binding document developed by the Siracusa International Institute for Criminal Justice and Human Rights and adopted by the United Nations Economic and Social Council in 1984. The Siracusa Principles state that restrictions on human rights under the International Covenant on Civil and Political Rights must meet standards of legality, evidence-based necessity , proportionality, and gradualism, noting that public health can be used as grounds for limiting certain rights if the state needs to take measures 'aimed at preventing disease or injury or providing care for the sick and injured.' Limitations on rights (such as quarantine) must be 'strictly necessary,' meaning that they must: respond to a pressing public or social need (health) proportionately pursue a legitimate aim (prevent the spread of infectious disease) be the least restrictive means required for achieving the purpose of the limitation be provided for and carried out in accordance with the law be neither arbitrary nor discriminatory only limit rights that are within the jurisdiction of the state seeking to impose the limitation. In addition, when quarantine is imposed, public health ethics specify that: all restrictive actions must be well-supported by data and scientific evidence all information must be made available to the public all actions must be explained clearly to those whose rights are restricted and to the public all actions must be subject to regular review and reconsideration. Finally, the state is ethically obligated to guarantee that: infected people will not be threatened or abused basic needs such as food, water, medical care, and preventive care will be provided communication with loved ones and with caretakers will be permitted constraints on freedom will be applied equally, regardless of social considerations patients will be compensated fairly for economic and material losses, including salary. Quarantine can have adverse psychological effects on the quarantined, including post-traumatic stress , confusion, and anger. According to a "Rapid Review" published in The Lancet in response to the COVID-19 pandemic , "Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable." Although youngsters appear to be less vulnerable to COVID-19 , the side effects of the pandemic can be devastating. Quarantine from the pandemic led to an increase the prevalence of violence in the family, depression, anxiety, and post-traumatic stress disorder. Children and adolescents may be highly exposed to biopsychosocial stressors generated by the pandemic and once population's containment measures to reduce virus spread are required, they could be potentially affected by the disruption in daily life routine as a result of social isolation and their unseasoned ability to conceive and comprehend the short- and long-term consequences of this outbreak. Quarantine periods can be very short, such as in the case of a suspected anthrax attack, in which people are allowed to leave as soon as they shed their potentially contaminated garments and undergo a decontamination shower. For example, an article entitled "Daily News workers quarantined" describes a brief quarantine that lasted until people could be showered in a decontamination tent. The February–March 2003 issue of HazMat Magazine suggests that people be "locked in a room until proper decon could be performed", in the event of "suspect anthrax". [ citation needed ] Standard-Times senior correspondent Steve Urbon (14 February 2003) describes such temporary quarantine powers: Civil rights activists in some cases have objected to people being rounded up, stripped and showered against their will. But Capt. Chmiel said local health authorities have "certain powers to quarantine people". The purpose of such quarantine-for-decontamination is to prevent the spread of contamination and to contain the contamination such that others are not put at risk from a person fleeing a scene where contamination is suspect. It can also be used to limit exposure, as well as eliminate a vector . New developments for quarantine include new concepts in quarantine vehicles such as the ambulance bus , mobile hospitals, and lockdown/invacuation (inverse evacuation) procedures, as well as docking stations for an ambulance bus to dock to a facility under lockdown. Biosecurity in Australia is governed by the Biosecurity Act 2015 . The Department of Agriculture, Water and the Environment (DAWE) is responsible for border inspection of products brought into Australia, and assesses the risks the products might harm Australian environment. No person, goods, and vessels are permitted into Australia without clearance from DAFF. Visitors are required to fill in the information card on arriving in Australia. Besides other risk factors, visitors are required to declare what food and products made of wood and other natural materials they have. Visitors who fail to do so may be subject to a fine of A$444, or may face criminal prosecution and be fined up to A$444,000 or imprisonment of up to 10 years. Australia has very strict quarantine standards. Quarantine in northern Australia is especially important because of its proximity to South-East Asia and the Pacific, which have many pests and diseases not present in Australia. For this reason, the region from Cairns to Broome—including the Torres Strait —is the focus for quarantine activities that protect all Australians. As Australia has been geographically isolated from other major continents for millions of years, there is an endemically unique ecosystem free of several severe pests and diseases that are present in many parts of the world. If other products are brought inside along with pests and diseases, it would damage the ecosystem seriously and add millions of costs in the local agricultural businesses. There are three quarantine Acts of Parliament in Canada: Quarantine Act (humans), Health of Animals Act (animals), and Plant Protection Act (vegetations). The first legislation is enforced by the Canada Border Services Agency after a complete rewrite in 2005. The second and third legislations are enforced by the Canadian Food Inspection Agency . If a health emergency exists, the Governor in Council can prohibit importation of anything that it deems necessary under the Quarantine Act . Under the Quarantine Act , all travellers must submit to screening and if they believe they might have come into contact with communicable diseases or vectors , they must disclose their whereabouts to a Border Services Officer . If the officer has reasonable grounds to believe that the traveller is or might have been infected with a communicable disease or refused to provide answers, a quarantine officer (QO) must be called and the person is to be isolated. If a person refuses to be isolated, any peace officer may arrest without warrant. A QO who has reasonable grounds to believe that the traveller has or might have a communicable disease or is infested with vectors, after the medical examination of a traveller, can order him/her into treatment or measures to prevent the person from spreading the disease. QO can detain any traveller who refuses to comply with his/her orders or undergo health assessments as required by law. Under the Health of Animals Act and Plant Protection Act , inspectors can prohibit access to an infected area, dispose or treat any infected or suspected to be infected animals or plants. The Minister can order for compensation to be given if animals/plants were destroyed pursuant to these acts. Each province also enacts its own quarantine/environmental health legislation. Under the Prevention and Control of Disease Ordinance (HK Laws. Chap 599), a health officer may seize articles they believe to be infectious or containing infectious agents. All travellers, if requested, must submit themselves to a health officer. Failure to do so is against the law and is subject to arrest and prosecution. The law allows for health officers who have reasonable grounds to detain, isolate, quarantine anyone or anything believed to be infected, and to restrict any articles from leaving a designated quarantine area. He/she may also order the Civil Aviation Department to prohibit the landing or leaving, embarking or disembarking of an aircraft. This power also extends to land, sea or air crossings. Under the same ordinance, any police officer, health officer, member of the Civil Aid Service , or member of the Auxiliary Medical Service can arrest a person who obstructs or escapes from detention. To reduce the risk of introducing rabies from continental Europe, the United Kingdom used to require that dogs, and most other animals introduced to the country, spend six months in quarantine at an HM Customs and Excise pound; this policy was abolished in 2000 in favour of a scheme generally known as Pet Passports , where animals can avoid quarantine if they have documentation showing they are up to date on their appropriate vaccinations . The plague had disappeared from England for more than thirty years before the practice of quarantine against it was definitely established by the Quarantine Act 1710 ( 9 Ann. ). The first act was called for due to fears that the plague might be imported from Poland and the Baltic region . The second act of 1721 was due to the prevalence of plague at Marseille and other places in Provence, France . It was renewed in 1733 after a new outbreak in continental Europe , and again in 1743, due to an epidemic in Messina . In 1752 a rigorous quarantine clause was introduced into an act regulating trade with the Levant , and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic region. Although no plague cases ever came to England during that period, the restrictions on traffic became more stringent, and in 1788 a very strict Quarantine Act was passed, with provisions affecting cargoes in particular. The act was revised in 1801 and 1805, and in 1823–24 an elaborate inquiry was followed by an act making quarantine only at discretion of the privy council , which recognised yellow fever or other highly infectious diseases as calling for quarantine, along with plague. The threat of cholera in 1831 was the last occasion in England of the use of quarantine restrictions. Cholera affected every country in Europe, despite all efforts to keep it out. When cholera returned to England in 1849, 1853 and 1865–66, no attempt was made to seal the ports. In 1847 the privy council ordered all arrivals with a clean bill of health from the Black Sea and the Levant to be admitted, provided there had been no case of plague during the voyage, and afterwards the practice of quarantine was discontinued. After the passing of the first Quarantine Act (1710) the protective practices in England were haphazard and arbitrary. In 1721 two vessels carrying cotton goods from Cyprus, then affected by the plague, were ordered to be burned with their cargoes, the owners receiving an indemnity . By the clause in the Levant Trade Act of 1752, ships arriving in the United Kingdom with a "foul bill" (i.e. coming from a country where plague existed) had to return to the lazarets of Malta, Venice, Messina, Livorno, Genoa, or Marseille, to complete a quarantine or to have their cargoes opened and aired. Since 1741 Stangate Creek (on the Medway ) had been the quarantine station but it was available only for vessels with clean bills of health. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews ) having been done previously on the ship's deck. No medical inspections were conducted, but control was the responsibility of the Officers of Royal Customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic region had to spend forty days in quarantine, and unpack and air their cargoes, but due to complaints mainly from Edinburgh and Leith , an exception was made for grain after that date. About 1788 an order of the council required every ship liable to quarantine to hoist a yellow flag in the daytime and show a light at the main topmast head at night, in case of meeting any vessel at sea, or upon arriving within four leagues of the coast of Great Britain or Ireland , the Channel Islands , or the Isle of Man . After 1800, ships from plague-affected countries (or with foul bills) were permitted to complete their quarantine in the Medway instead of at a Mediterranean port on the way, and an extensive lazaret was built on Chetney Hill near Chatham (although it was later demolished). The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador in Morocco were ordered to be sunk with their cargoes at the Nore , the owners receiving an indemnity. Animal hides were suspected of harbouring infections, along with a long list of other items, and these had to be exposed on the ship's deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired for another forty days. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. From 1846 onwards the quarantine establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague. The powers to deal with cholera ships had been already transferred by the Public Health Act 1875 . British regulations of 9 November 1896 applied to yellow fever , plague and cholera . Officers of Her Majesty's Customs , as well as of Her Majesty's Coastguard and the Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposedly infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority . The medical officer of the port boarded the ship and examined every person in it. Every person found infected was taken to a hospital and quarantined under the orders of the medical officer, and the vessel remained under his orders. Every person suspected could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land upon giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast pumped out at a suitable distance before the ship entered a dock or basin. Mail was subject to no detention. A stricken ship within 3 miles of the shore had to fly a yellow and black flag at the main mast from sunrise to sunset. In the United States, authority to quarantine people with infectious diseases is split between the state and federal governments. States (and tribal governments recognised by the federal government) have primary authority to quarantine people within their boundaries. Federal jurisdiction only applies to people moving across state or national borders, or people on federal property. Communicable diseases for which apprehension, detention, or conditional release of people are authorised must be specified in Executive Orders of the President. As of 2014, these include Executive Orders 13295 13375, and 13674; the latest executive order specifies the following infectious diseases: cholera , diphtheria , infectious tuberculosis , plague , smallpox , yellow fever , viral haemorrhagic fevers ( Lassa , Marburg , Ebola , Crimean-Congo , South American , and others not yet isolated or named), severe acute respiratory syndromes (SARS), and influenza from a novel or re-emergent source. The Department of Health and Human Services is responsible for quarantine decisions, specifically the Centers for Disease Control and Prevention 's Division of Global Migration and Quarantine . As of 21 March 2017, Centers for Disease Control and Prevention (CDC) regulations specify: All commercial passenger flights must report deaths or illnesses to the CDC. Individuals must apply for a travel permit if they are under a Federal quarantine, isolation, or conditional release order. When an individual who is moving between U.S. states is "reasonably believed to be infected" with a quarantinable communicable disease in a "qualifying stage", the CDC may apprehend or examine that individual for potential infection. This includes new regulatory authority permitting the CDC Director to prohibit the importation of animals or products that pose a threat to public health. The rules: The Division of Global Migration Health (DGMH) of the US Centers for Disease Control (CDC) operates small quarantine facilities at a number of US ports of entry. As of 2014, these included one land crossing (in El Paso, Texas ) and 19 international airports. [note 1] Besides the port of entry where it is located, each station is also responsible for quarantining potentially infected travellers entering through any ports of entry in its assigned region. These facilities are fairly small; each one is operated by a few staff members and capable of accommodating 1–2 travellers for a short observation period. Cost estimates for setting up a temporary larger facility, capable of accommodating 100 to 200 travellers for several weeks, have been published by the Airport Cooperative Research Program (ACRP) in 2008 of the Transportation Research Board . The United States puts immediate quarantines on imported products if a contagious disease is identified and can be traced back to a certain shipment or product. All imports will also be quarantined if the disease appears in other countries. [ citation needed ] According to Title 42 U.S.C. §§264 and 266 Archived 24 September 2015 at the Wayback Machine , these statutes provide the Secretary of Health and Human Services peacetime and wartime authority to control the movement of people into and within the United States to prevent the spread of communicable disease. Quarantine law began in Colonial America in 1663, when in an attempt to curb an outbreak of smallpox , the city of New York established a quarantine. In the 1730s, the city built a quarantine station on the Bedloe's Island . The Philadelphia Lazaretto was the first quarantine hospital in the United States, built in 1799, in Tinicum Township , Delaware County , Pennsylvania. There are similar national landmarks such as the Columbia River Quarantine Station , Swinburne Island and Angel Island . The Pest House in Concord, Massachusetts was used as early as 1752 to quarantine those with cholera, tuberculosis and smallpox. In early June 1832, during the cholera epidemic in New York, Governor Enos Throop called a special session of the Legislature for 21 June, to pass a Public Health Act by both Houses of the State Legislature. It included to a strict quarantine along the Upper and Lower New York-Canadian frontier. In addition, New York City Mayor Walter Browne established a quarantine against all peoples and products of Europe and Asia, which prohibited ships from approaching closer than 300 yards to the city, and all vehicles were ordered to stop 1.5 miles away. The Immigrant Inspection Station on Ellis Island , built in 1892, is often mistakenly assumed to have been a quarantine station, however its marine hospital ( Ellis Island Immigrant Hospital ) only qualified as a contagious disease facility to handle less virulent diseases like measles, trachoma and less advanced stages of tuberculosis and diphtheria; those affected by smallpox, yellow fever, cholera, leprosy or typhoid fever, could neither be received nor treated there. Mary Mallon was quarantined in 1907 under the Greater New York Charter, Sections 1169–1170, which permitted the New York City Board of Health to "remove to a proper place…any person sick with any contagious, pestilential or infectious disease." During the 1918 flu pandemic , people were also quarantined. Most commonly suspect cases of infectious diseases are requested to voluntarily quarantine themselves, and Federal and local quarantine statutes only have been uncommonly invoked since then, including for a suspected smallpox case in 1963. The 1944 Public Health Service Act "to apprehend, detain, and examine certain infected persons who are peculiarly likely to cause the interstate spread of disease" clearly established the federal government 's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States, and expanded quarantine authority to include incoming aircraft. The act states that "...any individual reasonably believed to be infected with a communicable disease in a qualifying stage and...if found to be infected, may be detained for such time and in such manner as may be reasonably necessary." No federal quarantine orders were issued from 1963 until 2020, as American citizens were evacuated from China during the COVID-19 pandemic . Biosecurity in Australia is governed by the Biosecurity Act 2015 . The Department of Agriculture, Water and the Environment (DAWE) is responsible for border inspection of products brought into Australia, and assesses the risks the products might harm Australian environment. No person, goods, and vessels are permitted into Australia without clearance from DAFF. Visitors are required to fill in the information card on arriving in Australia. Besides other risk factors, visitors are required to declare what food and products made of wood and other natural materials they have. Visitors who fail to do so may be subject to a fine of A$444, or may face criminal prosecution and be fined up to A$444,000 or imprisonment of up to 10 years. Australia has very strict quarantine standards. Quarantine in northern Australia is especially important because of its proximity to South-East Asia and the Pacific, which have many pests and diseases not present in Australia. For this reason, the region from Cairns to Broome—including the Torres Strait —is the focus for quarantine activities that protect all Australians. As Australia has been geographically isolated from other major continents for millions of years, there is an endemically unique ecosystem free of several severe pests and diseases that are present in many parts of the world. If other products are brought inside along with pests and diseases, it would damage the ecosystem seriously and add millions of costs in the local agricultural businesses. There are three quarantine Acts of Parliament in Canada: Quarantine Act (humans), Health of Animals Act (animals), and Plant Protection Act (vegetations). The first legislation is enforced by the Canada Border Services Agency after a complete rewrite in 2005. The second and third legislations are enforced by the Canadian Food Inspection Agency . If a health emergency exists, the Governor in Council can prohibit importation of anything that it deems necessary under the Quarantine Act . Under the Quarantine Act , all travellers must submit to screening and if they believe they might have come into contact with communicable diseases or vectors , they must disclose their whereabouts to a Border Services Officer . If the officer has reasonable grounds to believe that the traveller is or might have been infected with a communicable disease or refused to provide answers, a quarantine officer (QO) must be called and the person is to be isolated. If a person refuses to be isolated, any peace officer may arrest without warrant. A QO who has reasonable grounds to believe that the traveller has or might have a communicable disease or is infested with vectors, after the medical examination of a traveller, can order him/her into treatment or measures to prevent the person from spreading the disease. QO can detain any traveller who refuses to comply with his/her orders or undergo health assessments as required by law. Under the Health of Animals Act and Plant Protection Act , inspectors can prohibit access to an infected area, dispose or treat any infected or suspected to be infected animals or plants. The Minister can order for compensation to be given if animals/plants were destroyed pursuant to these acts. Each province also enacts its own quarantine/environmental health legislation.Under the Prevention and Control of Disease Ordinance (HK Laws. Chap 599), a health officer may seize articles they believe to be infectious or containing infectious agents. All travellers, if requested, must submit themselves to a health officer. Failure to do so is against the law and is subject to arrest and prosecution. The law allows for health officers who have reasonable grounds to detain, isolate, quarantine anyone or anything believed to be infected, and to restrict any articles from leaving a designated quarantine area. He/she may also order the Civil Aviation Department to prohibit the landing or leaving, embarking or disembarking of an aircraft. This power also extends to land, sea or air crossings. Under the same ordinance, any police officer, health officer, member of the Civil Aid Service , or member of the Auxiliary Medical Service can arrest a person who obstructs or escapes from detention.To reduce the risk of introducing rabies from continental Europe, the United Kingdom used to require that dogs, and most other animals introduced to the country, spend six months in quarantine at an HM Customs and Excise pound; this policy was abolished in 2000 in favour of a scheme generally known as Pet Passports , where animals can avoid quarantine if they have documentation showing they are up to date on their appropriate vaccinations . The plague had disappeared from England for more than thirty years before the practice of quarantine against it was definitely established by the Quarantine Act 1710 ( 9 Ann. ). The first act was called for due to fears that the plague might be imported from Poland and the Baltic region . The second act of 1721 was due to the prevalence of plague at Marseille and other places in Provence, France . It was renewed in 1733 after a new outbreak in continental Europe , and again in 1743, due to an epidemic in Messina . In 1752 a rigorous quarantine clause was introduced into an act regulating trade with the Levant , and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic region. Although no plague cases ever came to England during that period, the restrictions on traffic became more stringent, and in 1788 a very strict Quarantine Act was passed, with provisions affecting cargoes in particular. The act was revised in 1801 and 1805, and in 1823–24 an elaborate inquiry was followed by an act making quarantine only at discretion of the privy council , which recognised yellow fever or other highly infectious diseases as calling for quarantine, along with plague. The threat of cholera in 1831 was the last occasion in England of the use of quarantine restrictions. Cholera affected every country in Europe, despite all efforts to keep it out. When cholera returned to England in 1849, 1853 and 1865–66, no attempt was made to seal the ports. In 1847 the privy council ordered all arrivals with a clean bill of health from the Black Sea and the Levant to be admitted, provided there had been no case of plague during the voyage, and afterwards the practice of quarantine was discontinued. After the passing of the first Quarantine Act (1710) the protective practices in England were haphazard and arbitrary. In 1721 two vessels carrying cotton goods from Cyprus, then affected by the plague, were ordered to be burned with their cargoes, the owners receiving an indemnity . By the clause in the Levant Trade Act of 1752, ships arriving in the United Kingdom with a "foul bill" (i.e. coming from a country where plague existed) had to return to the lazarets of Malta, Venice, Messina, Livorno, Genoa, or Marseille, to complete a quarantine or to have their cargoes opened and aired. Since 1741 Stangate Creek (on the Medway ) had been the quarantine station but it was available only for vessels with clean bills of health. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews ) having been done previously on the ship's deck. No medical inspections were conducted, but control was the responsibility of the Officers of Royal Customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic region had to spend forty days in quarantine, and unpack and air their cargoes, but due to complaints mainly from Edinburgh and Leith , an exception was made for grain after that date. About 1788 an order of the council required every ship liable to quarantine to hoist a yellow flag in the daytime and show a light at the main topmast head at night, in case of meeting any vessel at sea, or upon arriving within four leagues of the coast of Great Britain or Ireland , the Channel Islands , or the Isle of Man . After 1800, ships from plague-affected countries (or with foul bills) were permitted to complete their quarantine in the Medway instead of at a Mediterranean port on the way, and an extensive lazaret was built on Chetney Hill near Chatham (although it was later demolished). The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador in Morocco were ordered to be sunk with their cargoes at the Nore , the owners receiving an indemnity. Animal hides were suspected of harbouring infections, along with a long list of other items, and these had to be exposed on the ship's deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired for another forty days. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. From 1846 onwards the quarantine establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague. The powers to deal with cholera ships had been already transferred by the Public Health Act 1875 . British regulations of 9 November 1896 applied to yellow fever , plague and cholera . Officers of Her Majesty's Customs , as well as of Her Majesty's Coastguard and the Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposedly infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority . The medical officer of the port boarded the ship and examined every person in it. Every person found infected was taken to a hospital and quarantined under the orders of the medical officer, and the vessel remained under his orders. Every person suspected could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land upon giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast pumped out at a suitable distance before the ship entered a dock or basin. Mail was subject to no detention. A stricken ship within 3 miles of the shore had to fly a yellow and black flag at the main mast from sunrise to sunset. The plague had disappeared from England for more than thirty years before the practice of quarantine against it was definitely established by the Quarantine Act 1710 ( 9 Ann. ). The first act was called for due to fears that the plague might be imported from Poland and the Baltic region . The second act of 1721 was due to the prevalence of plague at Marseille and other places in Provence, France . It was renewed in 1733 after a new outbreak in continental Europe , and again in 1743, due to an epidemic in Messina . In 1752 a rigorous quarantine clause was introduced into an act regulating trade with the Levant , and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic region. Although no plague cases ever came to England during that period, the restrictions on traffic became more stringent, and in 1788 a very strict Quarantine Act was passed, with provisions affecting cargoes in particular. The act was revised in 1801 and 1805, and in 1823–24 an elaborate inquiry was followed by an act making quarantine only at discretion of the privy council , which recognised yellow fever or other highly infectious diseases as calling for quarantine, along with plague. The threat of cholera in 1831 was the last occasion in England of the use of quarantine restrictions. Cholera affected every country in Europe, despite all efforts to keep it out. When cholera returned to England in 1849, 1853 and 1865–66, no attempt was made to seal the ports. In 1847 the privy council ordered all arrivals with a clean bill of health from the Black Sea and the Levant to be admitted, provided there had been no case of plague during the voyage, and afterwards the practice of quarantine was discontinued. After the passing of the first Quarantine Act (1710) the protective practices in England were haphazard and arbitrary. In 1721 two vessels carrying cotton goods from Cyprus, then affected by the plague, were ordered to be burned with their cargoes, the owners receiving an indemnity . By the clause in the Levant Trade Act of 1752, ships arriving in the United Kingdom with a "foul bill" (i.e. coming from a country where plague existed) had to return to the lazarets of Malta, Venice, Messina, Livorno, Genoa, or Marseille, to complete a quarantine or to have their cargoes opened and aired. Since 1741 Stangate Creek (on the Medway ) had been the quarantine station but it was available only for vessels with clean bills of health. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews ) having been done previously on the ship's deck. No medical inspections were conducted, but control was the responsibility of the Officers of Royal Customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic region had to spend forty days in quarantine, and unpack and air their cargoes, but due to complaints mainly from Edinburgh and Leith , an exception was made for grain after that date. About 1788 an order of the council required every ship liable to quarantine to hoist a yellow flag in the daytime and show a light at the main topmast head at night, in case of meeting any vessel at sea, or upon arriving within four leagues of the coast of Great Britain or Ireland , the Channel Islands , or the Isle of Man . After 1800, ships from plague-affected countries (or with foul bills) were permitted to complete their quarantine in the Medway instead of at a Mediterranean port on the way, and an extensive lazaret was built on Chetney Hill near Chatham (although it was later demolished). The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador in Morocco were ordered to be sunk with their cargoes at the Nore , the owners receiving an indemnity. Animal hides were suspected of harbouring infections, along with a long list of other items, and these had to be exposed on the ship's deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired for another forty days. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. From 1846 onwards the quarantine establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague. The powers to deal with cholera ships had been already transferred by the Public Health Act 1875 . British regulations of 9 November 1896 applied to yellow fever , plague and cholera . Officers of Her Majesty's Customs , as well as of Her Majesty's Coastguard and the Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposedly infected ship, and detained the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority . The medical officer of the port boarded the ship and examined every person in it. Every person found infected was taken to a hospital and quarantined under the orders of the medical officer, and the vessel remained under his orders. Every person suspected could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land upon giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast pumped out at a suitable distance before the ship entered a dock or basin. Mail was subject to no detention. A stricken ship within 3 miles of the shore had to fly a yellow and black flag at the main mast from sunrise to sunset. In the United States, authority to quarantine people with infectious diseases is split between the state and federal governments. States (and tribal governments recognised by the federal government) have primary authority to quarantine people within their boundaries. Federal jurisdiction only applies to people moving across state or national borders, or people on federal property. Communicable diseases for which apprehension, detention, or conditional release of people are authorised must be specified in Executive Orders of the President. As of 2014, these include Executive Orders 13295 13375, and 13674; the latest executive order specifies the following infectious diseases: cholera , diphtheria , infectious tuberculosis , plague , smallpox , yellow fever , viral haemorrhagic fevers ( Lassa , Marburg , Ebola , Crimean-Congo , South American , and others not yet isolated or named), severe acute respiratory syndromes (SARS), and influenza from a novel or re-emergent source. The Department of Health and Human Services is responsible for quarantine decisions, specifically the Centers for Disease Control and Prevention 's Division of Global Migration and Quarantine . As of 21 March 2017, Centers for Disease Control and Prevention (CDC) regulations specify: All commercial passenger flights must report deaths or illnesses to the CDC. Individuals must apply for a travel permit if they are under a Federal quarantine, isolation, or conditional release order. When an individual who is moving between U.S. states is "reasonably believed to be infected" with a quarantinable communicable disease in a "qualifying stage", the CDC may apprehend or examine that individual for potential infection. This includes new regulatory authority permitting the CDC Director to prohibit the importation of animals or products that pose a threat to public health. The rules: The Division of Global Migration Health (DGMH) of the US Centers for Disease Control (CDC) operates small quarantine facilities at a number of US ports of entry. As of 2014, these included one land crossing (in El Paso, Texas ) and 19 international airports. [note 1] Besides the port of entry where it is located, each station is also responsible for quarantining potentially infected travellers entering through any ports of entry in its assigned region. These facilities are fairly small; each one is operated by a few staff members and capable of accommodating 1–2 travellers for a short observation period. Cost estimates for setting up a temporary larger facility, capable of accommodating 100 to 200 travellers for several weeks, have been published by the Airport Cooperative Research Program (ACRP) in 2008 of the Transportation Research Board . The United States puts immediate quarantines on imported products if a contagious disease is identified and can be traced back to a certain shipment or product. All imports will also be quarantined if the disease appears in other countries. [ citation needed ] According to Title 42 U.S.C. §§264 and 266 Archived 24 September 2015 at the Wayback Machine , these statutes provide the Secretary of Health and Human Services peacetime and wartime authority to control the movement of people into and within the United States to prevent the spread of communicable disease. Quarantine law began in Colonial America in 1663, when in an attempt to curb an outbreak of smallpox , the city of New York established a quarantine. In the 1730s, the city built a quarantine station on the Bedloe's Island . The Philadelphia Lazaretto was the first quarantine hospital in the United States, built in 1799, in Tinicum Township , Delaware County , Pennsylvania. There are similar national landmarks such as the Columbia River Quarantine Station , Swinburne Island and Angel Island . The Pest House in Concord, Massachusetts was used as early as 1752 to quarantine those with cholera, tuberculosis and smallpox. In early June 1832, during the cholera epidemic in New York, Governor Enos Throop called a special session of the Legislature for 21 June, to pass a Public Health Act by both Houses of the State Legislature. It included to a strict quarantine along the Upper and Lower New York-Canadian frontier. In addition, New York City Mayor Walter Browne established a quarantine against all peoples and products of Europe and Asia, which prohibited ships from approaching closer than 300 yards to the city, and all vehicles were ordered to stop 1.5 miles away. The Immigrant Inspection Station on Ellis Island , built in 1892, is often mistakenly assumed to have been a quarantine station, however its marine hospital ( Ellis Island Immigrant Hospital ) only qualified as a contagious disease facility to handle less virulent diseases like measles, trachoma and less advanced stages of tuberculosis and diphtheria; those affected by smallpox, yellow fever, cholera, leprosy or typhoid fever, could neither be received nor treated there. Mary Mallon was quarantined in 1907 under the Greater New York Charter, Sections 1169–1170, which permitted the New York City Board of Health to "remove to a proper place…any person sick with any contagious, pestilential or infectious disease." During the 1918 flu pandemic , people were also quarantined. Most commonly suspect cases of infectious diseases are requested to voluntarily quarantine themselves, and Federal and local quarantine statutes only have been uncommonly invoked since then, including for a suspected smallpox case in 1963. The 1944 Public Health Service Act "to apprehend, detain, and examine certain infected persons who are peculiarly likely to cause the interstate spread of disease" clearly established the federal government 's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States, and expanded quarantine authority to include incoming aircraft. The act states that "...any individual reasonably believed to be infected with a communicable disease in a qualifying stage and...if found to be infected, may be detained for such time and in such manner as may be reasonably necessary." No federal quarantine orders were issued from 1963 until 2020, as American citizens were evacuated from China during the COVID-19 pandemic . Communicable diseases for which apprehension, detention, or conditional release of people are authorised must be specified in Executive Orders of the President. As of 2014, these include Executive Orders 13295 13375, and 13674; the latest executive order specifies the following infectious diseases: cholera , diphtheria , infectious tuberculosis , plague , smallpox , yellow fever , viral haemorrhagic fevers ( Lassa , Marburg , Ebola , Crimean-Congo , South American , and others not yet isolated or named), severe acute respiratory syndromes (SARS), and influenza from a novel or re-emergent source. The Department of Health and Human Services is responsible for quarantine decisions, specifically the Centers for Disease Control and Prevention 's Division of Global Migration and Quarantine . As of 21 March 2017, Centers for Disease Control and Prevention (CDC) regulations specify: All commercial passenger flights must report deaths or illnesses to the CDC. Individuals must apply for a travel permit if they are under a Federal quarantine, isolation, or conditional release order. When an individual who is moving between U.S. states is "reasonably believed to be infected" with a quarantinable communicable disease in a "qualifying stage", the CDC may apprehend or examine that individual for potential infection. This includes new regulatory authority permitting the CDC Director to prohibit the importation of animals or products that pose a threat to public health. The rules:The Division of Global Migration Health (DGMH) of the US Centers for Disease Control (CDC) operates small quarantine facilities at a number of US ports of entry. As of 2014, these included one land crossing (in El Paso, Texas ) and 19 international airports. [note 1] Besides the port of entry where it is located, each station is also responsible for quarantining potentially infected travellers entering through any ports of entry in its assigned region. These facilities are fairly small; each one is operated by a few staff members and capable of accommodating 1–2 travellers for a short observation period. Cost estimates for setting up a temporary larger facility, capable of accommodating 100 to 200 travellers for several weeks, have been published by the Airport Cooperative Research Program (ACRP) in 2008 of the Transportation Research Board . The United States puts immediate quarantines on imported products if a contagious disease is identified and can be traced back to a certain shipment or product. All imports will also be quarantined if the disease appears in other countries. [ citation needed ] According to Title 42 U.S.C. §§264 and 266 Archived 24 September 2015 at the Wayback Machine , these statutes provide the Secretary of Health and Human Services peacetime and wartime authority to control the movement of people into and within the United States to prevent the spread of communicable disease.Quarantine law began in Colonial America in 1663, when in an attempt to curb an outbreak of smallpox , the city of New York established a quarantine. In the 1730s, the city built a quarantine station on the Bedloe's Island . The Philadelphia Lazaretto was the first quarantine hospital in the United States, built in 1799, in Tinicum Township , Delaware County , Pennsylvania. There are similar national landmarks such as the Columbia River Quarantine Station , Swinburne Island and Angel Island . The Pest House in Concord, Massachusetts was used as early as 1752 to quarantine those with cholera, tuberculosis and smallpox. In early June 1832, during the cholera epidemic in New York, Governor Enos Throop called a special session of the Legislature for 21 June, to pass a Public Health Act by both Houses of the State Legislature. It included to a strict quarantine along the Upper and Lower New York-Canadian frontier. In addition, New York City Mayor Walter Browne established a quarantine against all peoples and products of Europe and Asia, which prohibited ships from approaching closer than 300 yards to the city, and all vehicles were ordered to stop 1.5 miles away. The Immigrant Inspection Station on Ellis Island , built in 1892, is often mistakenly assumed to have been a quarantine station, however its marine hospital ( Ellis Island Immigrant Hospital ) only qualified as a contagious disease facility to handle less virulent diseases like measles, trachoma and less advanced stages of tuberculosis and diphtheria; those affected by smallpox, yellow fever, cholera, leprosy or typhoid fever, could neither be received nor treated there. Mary Mallon was quarantined in 1907 under the Greater New York Charter, Sections 1169–1170, which permitted the New York City Board of Health to "remove to a proper place…any person sick with any contagious, pestilential or infectious disease." During the 1918 flu pandemic , people were also quarantined. Most commonly suspect cases of infectious diseases are requested to voluntarily quarantine themselves, and Federal and local quarantine statutes only have been uncommonly invoked since then, including for a suspected smallpox case in 1963. The 1944 Public Health Service Act "to apprehend, detain, and examine certain infected persons who are peculiarly likely to cause the interstate spread of disease" clearly established the federal government 's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States, and expanded quarantine authority to include incoming aircraft. The act states that "...any individual reasonably believed to be infected with a communicable disease in a qualifying stage and...if found to be infected, may be detained for such time and in such manner as may be reasonably necessary." No federal quarantine orders were issued from 1963 until 2020, as American citizens were evacuated from China during the COVID-19 pandemic . Eyam was a village in Britain that imposed a cordon sanitaire on itself to stop the spread of the bubonic plague to other communities in 1665. The plague ran its course over 14 months and one account states that it killed at least 260 villagers. The church in Eyam has a record of 273 individuals who were victims of the plague. On 28 July 1814, the convict ship Surry arrived in Sydney Harbour from England. Forty-six people had died of typhoid during the voyage, including 36 convicts, and the ship was placed in quarantine on the North Shore. Convicts were landed, and a camp was established in the immediate vicinity of what is now Jeffrey Street in Kirribilli . This was the first site in Australia to be used for quarantine purposes. Mary Mallon was a cook who was found to be a carrier of Salmonella enterica subsp. enterica , the cause of typhoid fever , and was forcibly isolated from 1907 to 1910. At least 53 cases of the infection were traced to her, and three deaths. Subsequently, she spent a further 23 years in isolation prior to her death in 1938. The presence of the bacteria in her gallbladder was confirmed on autopsy. During the 1918 flu pandemic , the then Governor of American Samoa , John Martin Poyer , imposed a full protective sequestration of the islands from all incoming ships, successfully preventing influenza from infecting the population and thus achieving zero deaths within the territory. In contrast, the neighbouring New Zealand-controlled Western Samoa was among the hardest hit, with a 90% infection rate and over 20% of its adults dying from the disease. This failure by the New Zealand government to prevent and contain the Spanish Flu subsequently rekindled Samoan anti-colonial sentiments that led to its eventual independence. In 1942, during World War II , British forces tested out their biological weapons program on Gruinard Island and infected it with anthrax . Subsequently, a quarantine order was placed on the island. The quarantine was lifted in 1990, when the island was declared safe, and a flock of sheep was released onto the island. Between 24 July 1969 and 9 February 1971, the astronauts of Apollo 11 , Apollo 12 , and Apollo 14 , were quarantined (in each case for a total of 21 days) after returning to Earth, initially where they were recovered, and then were transferred to the Lunar Receiving Laboratory , to prevent possible interplanetary contamination by microorganisms from the Moon . All lunar samples were also held in the biosecure environment of the Lunar Receiving Laboratory for initial assay. The 1972 Yugoslav smallpox outbreak was the final outbreak of smallpox in Europe. The World Health Organization fought the outbreak with extensive quarantine and a cordon sanitaire , and the government instituted martial law . In 2014, Kaci Hickox , a Doctors Without Borders nurse from Maine, legally battled 21-day quarantines imposed by the states of New Jersey and Maine after returning home from treating Ebola patients in Sierra Leone . "Hickox was sequestered in a medical tent for days because New Jersey announced new Ebola regulations the day she arrived. She eventually was allowed to travel to Maine, where the state sought to impose a 'voluntary quarantine' before trying and failing to create a buffer between her and others. A state judge rejected attempts to restrict her movements, saying she posed no threat as long as she wasn't demonstrating any symptoms of Ebola. Hickox said health care professionals like those at the U.S. Centers for Disease Control and Prevention – not politicians like New Jersey Gov. Chris Christie and Maine Gov. Paul LePage – should be in charge of making decisions that are grounded in science, not fear." During the COVID-19 pandemic , multiple governmental actors enacted quarantines in an effort to curb the rapid spread of the virus. Quarantine-like restrictions on movement included curfews and restrictions variously described as stay-at-home orders , shelter-in-place orders, shutdowns or lockdowns . [ citation needed ] On 26 March 2020, 1.7 billion people worldwide were under some form of lockdown , which increased to 2.6 billion people two days later—around a third of the world's population . In Hubei, the origin of the epidemic, a cordon sanitaire was imposed on Wuhan and other major cities in China, affecting around 500 million people, which is unprecedented in scale in human history, to limit the rate of spread of the disease. The 'lockdown' of Wuhan, and subsequently a wider-scale 'lockdown' throughout Hubei province, began on 23 January 2020. At this stage, the spread of the virus in mainland China was running at approximately 50% growth in cases per day. On 8 February, the daily rate of spread fell below 10%. [ citation needed ] As the outbreak spread there, beginning 22 February 2020, a cordon sanitaire was imposed on a group of at least 10 different municipalities in Northern Italy , effectively quarantining more than 50,000 people. This followed a second day when the declared detected cases leapt enormously (the period from 21 to 23 February saw daily increases of 567%, 295% and 90% respectively). A week later the rate of increase of cases in Italy was significantly reduced (the period from 29 February to 4 March saw daily increases of 27%, 50%, 20%, 23%, and 23%). On 8 March 2020, a much wider region of Northern Italy was placed under quarantine restrictions, involving around 16 million people. On the next day, the quarantine was extended to the whole of Italy, effective on 10 March 2020, placing roughly 60 million people under quarantine. A team of Chinese experts, together with some 31 tonnes of supplies, arrived in Rome on 13 March 2020 to help Italy fight the virus. On 22 March 2020, Russia sent nine Ilyushin 76 planes with expert virologists, epidemiologists, medical equipment, and pharmaceuticals in a humanitarian aid operation that Italian media dubbed "From Russia With Love". Eventually the lockdown was extended until 3 May, although starting from 14 April stationery shops, bookshops, and children clothing's shops were allowed to open. On 26 April 2020, the so-called "Phase 2" was announced, to start from 4 May. Movements across regions were still forbidden, while movements between municipalities were allowed only to visit relatives or for work and health reasons. Moreover, closed factories could re-open, but schools, bars, restaurants, and barbers were still closed. As at 4 May 2020, when new cases were running around 0.5%, ( c. 1600 persons) per day and consistently falling, it was expected that museums and retailers might reopen from 18 May, while hairdressers, bars and restaurants were expected to reopen fully on 1 June. Regional lockdowns were subsequently imposed as further waves of the virus spread through the country. As cases of the virus spread to and took hold in more European countries, many followed the earlier examples of China and Italy and began instituting policies of lockdown. Notable among these were Ireland (where schools were closed in mid March for the rest of the month, and limits were set on sizes of meetings), Spain (where a lockdown was announced on 14 March), Czech Republic , Norway , Denmark , Iceland , Poland , Turkey , and France , while the United Kingdom noticeably lagged behind in adopting such measures. As of 18 March 2020, more than 250 million people were in lockdown across Europe. In the immediate context of the start of the pandemic in Wuhan, countries neighbouring or close to China adopted a cautious approach. For example, Sri Lanka, Macau, Hong Kong, Vietnam, Japan, and South Korea had all imposed some degree of lockdown by 19 February. As countries across the world reported escalating case numbers and deaths, more and more countries began to announce travel restrictions and lockdowns. Africa and Latin America were relatively delayed in the spread of the virus, but even on these continents, countries began to impose travel bans and lockdowns. Brazil and Mexico began lockdowns in late February and much of the rest of Latin America followed suit in early March. Much of Africa was on lockdown by the start of April. Kenya, for example, blocked certain international flights and subsequently placed a ban on 'global' meetings. As of 1 April 2020 [ update ] , more than 280 million people, or about 86% of the population, were under some form of lockdown in the United States , 59 million people were in lockdown in South Africa , and 1.3 billion people were in lockdown in India . Eyam was a village in Britain that imposed a cordon sanitaire on itself to stop the spread of the bubonic plague to other communities in 1665. The plague ran its course over 14 months and one account states that it killed at least 260 villagers. The church in Eyam has a record of 273 individuals who were victims of the plague. On 28 July 1814, the convict ship Surry arrived in Sydney Harbour from England. Forty-six people had died of typhoid during the voyage, including 36 convicts, and the ship was placed in quarantine on the North Shore. Convicts were landed, and a camp was established in the immediate vicinity of what is now Jeffrey Street in Kirribilli . This was the first site in Australia to be used for quarantine purposes. Mary Mallon was a cook who was found to be a carrier of Salmonella enterica subsp. enterica , the cause of typhoid fever , and was forcibly isolated from 1907 to 1910. At least 53 cases of the infection were traced to her, and three deaths. Subsequently, she spent a further 23 years in isolation prior to her death in 1938. The presence of the bacteria in her gallbladder was confirmed on autopsy. During the 1918 flu pandemic , the then Governor of American Samoa , John Martin Poyer , imposed a full protective sequestration of the islands from all incoming ships, successfully preventing influenza from infecting the population and thus achieving zero deaths within the territory. In contrast, the neighbouring New Zealand-controlled Western Samoa was among the hardest hit, with a 90% infection rate and over 20% of its adults dying from the disease. This failure by the New Zealand government to prevent and contain the Spanish Flu subsequently rekindled Samoan anti-colonial sentiments that led to its eventual independence. In 1942, during World War II , British forces tested out their biological weapons program on Gruinard Island and infected it with anthrax . Subsequently, a quarantine order was placed on the island. The quarantine was lifted in 1990, when the island was declared safe, and a flock of sheep was released onto the island.Between 24 July 1969 and 9 February 1971, the astronauts of Apollo 11 , Apollo 12 , and Apollo 14 , were quarantined (in each case for a total of 21 days) after returning to Earth, initially where they were recovered, and then were transferred to the Lunar Receiving Laboratory , to prevent possible interplanetary contamination by microorganisms from the Moon . All lunar samples were also held in the biosecure environment of the Lunar Receiving Laboratory for initial assay. The 1972 Yugoslav smallpox outbreak was the final outbreak of smallpox in Europe. The World Health Organization fought the outbreak with extensive quarantine and a cordon sanitaire , and the government instituted martial law .In 2014, Kaci Hickox , a Doctors Without Borders nurse from Maine, legally battled 21-day quarantines imposed by the states of New Jersey and Maine after returning home from treating Ebola patients in Sierra Leone . "Hickox was sequestered in a medical tent for days because New Jersey announced new Ebola regulations the day she arrived. She eventually was allowed to travel to Maine, where the state sought to impose a 'voluntary quarantine' before trying and failing to create a buffer between her and others. A state judge rejected attempts to restrict her movements, saying she posed no threat as long as she wasn't demonstrating any symptoms of Ebola. Hickox said health care professionals like those at the U.S. Centers for Disease Control and Prevention – not politicians like New Jersey Gov. Chris Christie and Maine Gov. Paul LePage – should be in charge of making decisions that are grounded in science, not fear." During the COVID-19 pandemic , multiple governmental actors enacted quarantines in an effort to curb the rapid spread of the virus. Quarantine-like restrictions on movement included curfews and restrictions variously described as stay-at-home orders , shelter-in-place orders, shutdowns or lockdowns . [ citation needed ] On 26 March 2020, 1.7 billion people worldwide were under some form of lockdown , which increased to 2.6 billion people two days later—around a third of the world's population . In Hubei, the origin of the epidemic, a cordon sanitaire was imposed on Wuhan and other major cities in China, affecting around 500 million people, which is unprecedented in scale in human history, to limit the rate of spread of the disease. The 'lockdown' of Wuhan, and subsequently a wider-scale 'lockdown' throughout Hubei province, began on 23 January 2020. At this stage, the spread of the virus in mainland China was running at approximately 50% growth in cases per day. On 8 February, the daily rate of spread fell below 10%. [ citation needed ] As the outbreak spread there, beginning 22 February 2020, a cordon sanitaire was imposed on a group of at least 10 different municipalities in Northern Italy , effectively quarantining more than 50,000 people. This followed a second day when the declared detected cases leapt enormously (the period from 21 to 23 February saw daily increases of 567%, 295% and 90% respectively). A week later the rate of increase of cases in Italy was significantly reduced (the period from 29 February to 4 March saw daily increases of 27%, 50%, 20%, 23%, and 23%). On 8 March 2020, a much wider region of Northern Italy was placed under quarantine restrictions, involving around 16 million people. On the next day, the quarantine was extended to the whole of Italy, effective on 10 March 2020, placing roughly 60 million people under quarantine. A team of Chinese experts, together with some 31 tonnes of supplies, arrived in Rome on 13 March 2020 to help Italy fight the virus. On 22 March 2020, Russia sent nine Ilyushin 76 planes with expert virologists, epidemiologists, medical equipment, and pharmaceuticals in a humanitarian aid operation that Italian media dubbed "From Russia With Love". Eventually the lockdown was extended until 3 May, although starting from 14 April stationery shops, bookshops, and children clothing's shops were allowed to open. On 26 April 2020, the so-called "Phase 2" was announced, to start from 4 May. Movements across regions were still forbidden, while movements between municipalities were allowed only to visit relatives or for work and health reasons. Moreover, closed factories could re-open, but schools, bars, restaurants, and barbers were still closed. As at 4 May 2020, when new cases were running around 0.5%, ( c. 1600 persons) per day and consistently falling, it was expected that museums and retailers might reopen from 18 May, while hairdressers, bars and restaurants were expected to reopen fully on 1 June. Regional lockdowns were subsequently imposed as further waves of the virus spread through the country. As cases of the virus spread to and took hold in more European countries, many followed the earlier examples of China and Italy and began instituting policies of lockdown. Notable among these were Ireland (where schools were closed in mid March for the rest of the month, and limits were set on sizes of meetings), Spain (where a lockdown was announced on 14 March), Czech Republic , Norway , Denmark , Iceland , Poland , Turkey , and France , while the United Kingdom noticeably lagged behind in adopting such measures. As of 18 March 2020, more than 250 million people were in lockdown across Europe. In the immediate context of the start of the pandemic in Wuhan, countries neighbouring or close to China adopted a cautious approach. For example, Sri Lanka, Macau, Hong Kong, Vietnam, Japan, and South Korea had all imposed some degree of lockdown by 19 February. As countries across the world reported escalating case numbers and deaths, more and more countries began to announce travel restrictions and lockdowns. Africa and Latin America were relatively delayed in the spread of the virus, but even on these continents, countries began to impose travel bans and lockdowns. Brazil and Mexico began lockdowns in late February and much of the rest of Latin America followed suit in early March. Much of Africa was on lockdown by the start of April. Kenya, for example, blocked certain international flights and subsequently placed a ban on 'global' meetings. As of 1 April 2020 [ update ] , more than 280 million people, or about 86% of the population, were under some form of lockdown in the United States , 59 million people were in lockdown in South Africa , and 1.3 billion people were in lockdown in India . In Hubei, the origin of the epidemic, a cordon sanitaire was imposed on Wuhan and other major cities in China, affecting around 500 million people, which is unprecedented in scale in human history, to limit the rate of spread of the disease. The 'lockdown' of Wuhan, and subsequently a wider-scale 'lockdown' throughout Hubei province, began on 23 January 2020. At this stage, the spread of the virus in mainland China was running at approximately 50% growth in cases per day. On 8 February, the daily rate of spread fell below 10%. [ citation needed ]As the outbreak spread there, beginning 22 February 2020, a cordon sanitaire was imposed on a group of at least 10 different municipalities in Northern Italy , effectively quarantining more than 50,000 people. This followed a second day when the declared detected cases leapt enormously (the period from 21 to 23 February saw daily increases of 567%, 295% and 90% respectively). A week later the rate of increase of cases in Italy was significantly reduced (the period from 29 February to 4 March saw daily increases of 27%, 50%, 20%, 23%, and 23%). On 8 March 2020, a much wider region of Northern Italy was placed under quarantine restrictions, involving around 16 million people. On the next day, the quarantine was extended to the whole of Italy, effective on 10 March 2020, placing roughly 60 million people under quarantine. A team of Chinese experts, together with some 31 tonnes of supplies, arrived in Rome on 13 March 2020 to help Italy fight the virus. On 22 March 2020, Russia sent nine Ilyushin 76 planes with expert virologists, epidemiologists, medical equipment, and pharmaceuticals in a humanitarian aid operation that Italian media dubbed "From Russia With Love". Eventually the lockdown was extended until 3 May, although starting from 14 April stationery shops, bookshops, and children clothing's shops were allowed to open. On 26 April 2020, the so-called "Phase 2" was announced, to start from 4 May. Movements across regions were still forbidden, while movements between municipalities were allowed only to visit relatives or for work and health reasons. Moreover, closed factories could re-open, but schools, bars, restaurants, and barbers were still closed. As at 4 May 2020, when new cases were running around 0.5%, ( c. 1600 persons) per day and consistently falling, it was expected that museums and retailers might reopen from 18 May, while hairdressers, bars and restaurants were expected to reopen fully on 1 June. Regional lockdowns were subsequently imposed as further waves of the virus spread through the country. As cases of the virus spread to and took hold in more European countries, many followed the earlier examples of China and Italy and began instituting policies of lockdown. Notable among these were Ireland (where schools were closed in mid March for the rest of the month, and limits were set on sizes of meetings), Spain (where a lockdown was announced on 14 March), Czech Republic , Norway , Denmark , Iceland , Poland , Turkey , and France , while the United Kingdom noticeably lagged behind in adopting such measures. As of 18 March 2020, more than 250 million people were in lockdown across Europe. In the immediate context of the start of the pandemic in Wuhan, countries neighbouring or close to China adopted a cautious approach. For example, Sri Lanka, Macau, Hong Kong, Vietnam, Japan, and South Korea had all imposed some degree of lockdown by 19 February. As countries across the world reported escalating case numbers and deaths, more and more countries began to announce travel restrictions and lockdowns. Africa and Latin America were relatively delayed in the spread of the virus, but even on these continents, countries began to impose travel bans and lockdowns. Brazil and Mexico began lockdowns in late February and much of the rest of Latin America followed suit in early March. Much of Africa was on lockdown by the start of April. Kenya, for example, blocked certain international flights and subsequently placed a ban on 'global' meetings. As of 1 April 2020 [ update ] , more than 280 million people, or about 86% of the population, were under some form of lockdown in the United States , 59 million people were in lockdown in South Africa , and 1.3 billion people were in lockdown in India . Self-quarantine (or self-isolation ) is a popular term that emerged during the COVID-19 pandemic , which spread to most countries in 2020. Citizens able to do so were encouraged to stay home to limit the spread of the disease . Health specialists advise that self-quarantine lasts 14 days. Two weeks gives the necessary time for them to determine whether or not they will become ill and become contagious to others. U.S. President John F. Kennedy euphemistically referred to the U.S. Navy's interdiction of shipping en route to Cuba during the Cuban Missile Crisis as a "quarantine" rather than a blockade , because a quarantine is a legal act in peacetime, whereas a blockade is defined as an act of aggression under the U.N. Charter . In computer science, "quarantining" describes putting files infected by computer viruses into a special directory, so as to eliminate the threat they pose, without irreversibly deleting them. The Spanish term for quarantine, (la) cuarentena , refers also to the period of postpartum confinement in which a new mother and her baby are sheltered from the outside world.

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Bubonic plague

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Defoliation bacilli bomb

Defoliation bacilli bombs , made between 1932 and 1933, were used by the Imperial Japanese Army to spread bubonic plague across China . The deployment of these lethal munitions provided the Japanese with the ability to launch devastating biological attacks , infecting agriculture, reservoirs, wells and populated areas with anthrax , plague -infected fleas , typhoid , dysentery and cholera . The alumni of Unit 731 , the unit that prepared these weapons, became top bioweapons researchers and were not prosecuted as war criminals .

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Bubonic plague

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Ark of the Covenant

The Ark of the Covenant , [lower-alpha 1] also known as the Ark of the Testimony [lower-alpha 2] or the Ark of God , [lower-alpha 3] is believed to have been the most sacred religious relic of the Israelites . It is described as a wooden chest coated in pure gold and topped off by an elaborate golden lid known as the mercy seat . According to the Book of Exodus and First Book of Kings in the Hebrew Bible and the Old Testament , the Ark contained the Tablets of the Law , by which God delivered the Ten Commandments to Moses at Mount Sinai . According to the Book of Exodus , the Book of Numbers , and the Epistle to the Hebrews in the New Testament , it also contained Aaron's rod and a pot of manna . The biblical account relates that approximately one year after the Israelites' exodus from Egypt , the Ark was created according to the pattern that God gave to Moses when the Israelites were encamped at the foot of Mount Sinai. Thereafter, the gold-plated acacia chest's staves were lifted and carried by the Levites approximately 2,000 cubits ( 800 meters or 2,600 feet ) in advance of the people while they marched. God spoke with Moses "from between the two cherubim " on the Ark's cover. In 2023, Thomas Römer argued that "the original Ark contained a statue [i.e. a cult image ] of Yahweh ". He also suggested that "it is possible that the ark transported two betyles (sacred stones), or two cult image statues symbolizing Yhwh and his female companion Ashera or a statue representing Yhwh alone". Noegel and Falk argued that the Ark had Egyptian origins, the former arguing that it was retroactively merged into the Exodus narrative. According to the Book of Exodus , God instructed Moses to build the Ark during his 40-day stay upon Mount Sinai . He was shown the pattern for the tabernacle and furnishings of the Ark, and told that it would be made of shittim wood (also known as acacia wood) to house the Tablets of Stone . Moses instructed Bezalel and Aholiab to construct the Ark. The Book of Exodus gives detailed instructions on how the Ark is to be constructed. It is to be 2 + 1 ⁄ 2 cubits in length, 1 + 1 ⁄ 2 cubits breadth, and 1 + 1 ⁄ 2 cubits height (approximately 131×79×79 cm or 52×31×31 in ) of acacia wood. Then it is to be gilded entirely with gold, and a crown or molding of gold is to be put around it. Four rings of gold are to be attached to its four corners, two on each side—and through these rings staves of shittim wood overlaid with gold for carrying the Ark are to be inserted; and these are not to be removed. The biblical account continues that, after its creation by Moses, the Ark was carried by the Israelites during their 40 years of wandering in the desert. Whenever the Israelites camped, the Ark was placed in a separate room in a sacred tent , called the Tabernacle . When the Israelites, led by Joshua toward the Promised Land , arrived at the banks of the River Jordan , the Ark was carried in the lead, preceding the people, and was the signal for their advance. During the crossing, the river grew dry as soon as the feet of the priests carrying the Ark touched its waters, and remained so until the priests—with the Ark—left the river after the people had passed over. As memorials, twelve stones were taken from the Jordan at the place where the priests had stood. During the Battle of Jericho , the Ark was carried around the city once a day for six days, preceded by the armed men and seven priests sounding seven trumpets of rams' horns . On the seventh day, the seven priests sounding the seven trumpets of rams' horns before the Ark compassed the city seven times, and, with a great shout, Jericho's wall fell down flat and the people took the city. After the defeat at Ai , Joshua lamented before the Ark. When Joshua read the Law to the people between Mount Gerizim and Mount Ebal , they stood on each side of the Ark. The Ark was then kept at Shiloh after the Israelites finished their conquest of Canaan. We next hear of the Ark in Bethel , [lower-alpha 4] where it was being cared for by the priest Phinehas , the grandson of Aaron . According to this verse, it was consulted by the people of Israel when they were planning to attack the Benjaminites at the Battle of Gibeah . Later the Ark was kept at Shiloh again, where it was cared for by Hophni and Phinehas , two sons of Eli . According to the biblical narrative, a few years later the elders of Israel decided to take the Ark onto the battlefield to assist them against the Philistines , having recently been defeated at the battle of Eben-Ezer . They were again heavily defeated, with the loss of 30,000 men. The Ark was captured by the Philistines and Hophni and Phinehas were killed. The news of its capture was at once taken to Shiloh by a messenger "with his clothes rent, and with earth upon his head". The old priest, Eli, fell dead when he heard it; and his daughter-in-law, bearing a son at the time the news of the Ark's capture was received, named him Ichabod —explained as "The glory has departed Israel" in reference to the loss of the Ark. Ichabod's mother died at his birth. The Philistines took the Ark to several places in their country, and at each place misfortune befell them. At Ashdod it was placed in the temple of Dagon . The next morning Dagon was found prostrate, bowed down, before it; and on being restored to his place, he was on the following morning again found prostrate and broken. The people of Ashdod were smitten with tumors; a plague of rodents was sent over the land. This may have been the bubonic plague . The affliction of tumours was also visited upon the people of Gath and of Ekron , whither the Ark was successively removed. After the Ark had been among them for seven months, the Philistines, on the advice of their diviners, returned it to the Israelites, accompanying its return with an offering consisting of golden images of the tumors and mice wherewith they had been afflicted. The Ark was set up in the field of Joshua the Beth-shemite , and the Beth-shemites offered sacrifices and burnt offerings. Out of curiosity the men of Beth-shemesh gazed at the Ark; and as a punishment, seventy of them (fifty thousand and seventy in some translations) were struck down by the Lord. The Bethshemites sent to Kirjath-jearim , or Baal-Judah, to have the Ark removed; and it was taken to the house of Abinadab , whose son Eleazar was sanctified to keep it. Kirjath-jearim remained the abode of the Ark for twenty years. Under Saul, the Ark was with the army before he first met the Philistines, but the king was too impatient to consult it before engaging in battle. In 1 Chronicles 13:3 it is stated that the people were not accustomed to consulting the Ark in the days of Saul . In the biblical narrative, at the beginning of his reign over the United Monarchy , King David removed the Ark from Kirjath-jearim amid great rejoicing. On the way to Zion , Uzzah , one of the drivers of the cart that carried the Ark, put out his hand to steady the Ark, and was struck dead by God for touching it. The place was subsequently named " Perez-Uzzah ", literally ' outburst against Uzzah ' , as a result. David, in fear, carried the Ark aside into the house of Obed-edom the Gittite , instead of carrying it on to Zion, and it stayed there for three months. On hearing that God had blessed Obed-edom because of the presence of the Ark in his house, David had the Ark brought to Zion by the Levites, while he himself, "girded with a linen ephod [...] danced before the Lord with all his might" and in the sight of all the public gathered in Jerusalem, a performance which caused him to be scornfully rebuked by his first wife, Saul's daughter Michal . In Zion, David put the Ark in the tent he had prepared for it, offered sacrifices, distributed food, and blessed the people and his own household. David used the tent as a personal place of prayer. The Levites were appointed to minister before the Ark. David's plan of building a temple for the Ark was stopped on the advice of the prophet Nathan . The Ark was with the army during the siege of Rabbah ; and when David fled from Jerusalem at the time of Absalom 's conspiracy, the Ark was carried along with him until he ordered Zadok the priest to return it to Jerusalem. According to the Biblical narrative, when Abiathar was dismissed from the priesthood by King Solomon for having taken part in Adonijah 's conspiracy against David, his life was spared because he had formerly borne the Ark. Solomon worshipped before the Ark after his dream in which God promised him wisdom. During the construction of Solomon's Temple , a special inner room, named Kodesh Hakodashim (' Holy of Holies '), was prepared to receive and house the Ark; and when the Temple was dedicated, the Ark—containing the original tablets of the Ten Commandments —was placed therein. When the priests emerged from the holy place after placing the Ark there, the Temple was filled with a cloud, "for the glory of the Lord had filled the house of the Lord". When Solomon married Pharaoh's daughter, he caused her to dwell in a house outside Zion , as Zion was consecrated because it contained the Ark. King Josiah also had the Ark returned to the Temple, from which it appears to have been removed by one of his predecessors (cf. 2 Chronicles 33–34 and 2 Kings 21–23). Prior to king Josiah who is the last biblical figure mentioned as having seen the Ark, king Hezekiah had seen the Ark. Hezekiah is also known for protecting Jerusalem against the Assyrian Empire by improving the city walls and diverting the waters of the Gihon Spring through a tunnel known today as Hezekiah's Tunnel , which channeled the water inside the city walls to the Pool of Siloam . In a noncanonical text known as the Treatise of the Vessels, Hezekiah is identified as one of the kings who had the Ark and the other treasures of Solomon's Temple hidden during a time of crisis. This text lists the following hiding places, which it says were recorded on a bronze tablet: (1) a spring named Kohel or Kahal with pure water in a valley with a stopped-up gate; (2) a spring named Kotel (or "wall" in Hebrew); (3) a spring named Zedekiah; (4) an unidentified cistern; (5) Mount Carmel; and (6) locations in Babylon. To many scholars, Hezekiah is also credited as having written all or some of the Book of Kohelet ( Ecclesiastes in the Christian tradition), in particular the famously enigmatic epilogue. Notably, the epilogue appears to refer to the Ark story with references to almond blossoms (i.e., Aaron's rod), locusts, silver, and gold. The epilogue then cryptically refers to a pitcher broken at a fountain and a wheel broken at a cistern. Although scholars disagree on whether the Pool of Siloam's pure spring waters were used by pilgrims for ritual purification, many scholars agree that a stepped pilgrimage road between the pool and the Temple had been built in the first century CE. This roadway has been partially excavated, but the west side of the Pool of Siloam remains unexcavated. In 587 BC, when the Babylonians destroyed Jerusalem , an ancient Greek version of the biblical third Book of Ezra, 1 Esdras , suggests that Babylonians took away the vessels of the ark of God, but does not mention taking away the Ark: And they took all the holy vessels of the Lord, both great and small, with the vessels of the ark of God, and the king's treasures, and carried them away into Babylon In Rabbinic literature , the final disposition of the Ark is disputed. Some rabbis hold that it must have been carried off to Babylon, while others hold that it must have been hidden lest it be carried off into Babylon and never brought back. A late 2nd-century rabbinic work known as the Tosefta states the opinions of these rabbis that Josiah , the king of Judah, stored away the Ark, along with the jar of manna , and a jar containing the holy anointing oil, the rod of Aaron which budded and a chest given to Israel by the Philistines. The Kohathites were one of the Levite houses from the Book of Numbers . Theirs was the responsibility to care for "the most holy things" in the tabernacle . When the camp, then wandering the Wilderness, set out the Kohathites would enter the tabernacle with Aaron and cover the ark with the screening curtain and "then they shall put on it a covering of fine leather, and spread over that a cloth all of blue, and shall put its poles in place." The ark was one of the items of the tent of meeting that the Kohathites were responsible for carrying. According to the Book of Exodus , God instructed Moses to build the Ark during his 40-day stay upon Mount Sinai . He was shown the pattern for the tabernacle and furnishings of the Ark, and told that it would be made of shittim wood (also known as acacia wood) to house the Tablets of Stone . Moses instructed Bezalel and Aholiab to construct the Ark. The Book of Exodus gives detailed instructions on how the Ark is to be constructed. It is to be 2 + 1 ⁄ 2 cubits in length, 1 + 1 ⁄ 2 cubits breadth, and 1 + 1 ⁄ 2 cubits height (approximately 131×79×79 cm or 52×31×31 in ) of acacia wood. Then it is to be gilded entirely with gold, and a crown or molding of gold is to be put around it. Four rings of gold are to be attached to its four corners, two on each side—and through these rings staves of shittim wood overlaid with gold for carrying the Ark are to be inserted; and these are not to be removed. The biblical account continues that, after its creation by Moses, the Ark was carried by the Israelites during their 40 years of wandering in the desert. Whenever the Israelites camped, the Ark was placed in a separate room in a sacred tent , called the Tabernacle . When the Israelites, led by Joshua toward the Promised Land , arrived at the banks of the River Jordan , the Ark was carried in the lead, preceding the people, and was the signal for their advance. During the crossing, the river grew dry as soon as the feet of the priests carrying the Ark touched its waters, and remained so until the priests—with the Ark—left the river after the people had passed over. As memorials, twelve stones were taken from the Jordan at the place where the priests had stood. During the Battle of Jericho , the Ark was carried around the city once a day for six days, preceded by the armed men and seven priests sounding seven trumpets of rams' horns . On the seventh day, the seven priests sounding the seven trumpets of rams' horns before the Ark compassed the city seven times, and, with a great shout, Jericho's wall fell down flat and the people took the city. After the defeat at Ai , Joshua lamented before the Ark. When Joshua read the Law to the people between Mount Gerizim and Mount Ebal , they stood on each side of the Ark. The Ark was then kept at Shiloh after the Israelites finished their conquest of Canaan. We next hear of the Ark in Bethel , [lower-alpha 4] where it was being cared for by the priest Phinehas , the grandson of Aaron . According to this verse, it was consulted by the people of Israel when they were planning to attack the Benjaminites at the Battle of Gibeah . Later the Ark was kept at Shiloh again, where it was cared for by Hophni and Phinehas , two sons of Eli . According to the biblical narrative, a few years later the elders of Israel decided to take the Ark onto the battlefield to assist them against the Philistines , having recently been defeated at the battle of Eben-Ezer . They were again heavily defeated, with the loss of 30,000 men. The Ark was captured by the Philistines and Hophni and Phinehas were killed. The news of its capture was at once taken to Shiloh by a messenger "with his clothes rent, and with earth upon his head". The old priest, Eli, fell dead when he heard it; and his daughter-in-law, bearing a son at the time the news of the Ark's capture was received, named him Ichabod —explained as "The glory has departed Israel" in reference to the loss of the Ark. Ichabod's mother died at his birth. The Philistines took the Ark to several places in their country, and at each place misfortune befell them. At Ashdod it was placed in the temple of Dagon . The next morning Dagon was found prostrate, bowed down, before it; and on being restored to his place, he was on the following morning again found prostrate and broken. The people of Ashdod were smitten with tumors; a plague of rodents was sent over the land. This may have been the bubonic plague . The affliction of tumours was also visited upon the people of Gath and of Ekron , whither the Ark was successively removed. After the Ark had been among them for seven months, the Philistines, on the advice of their diviners, returned it to the Israelites, accompanying its return with an offering consisting of golden images of the tumors and mice wherewith they had been afflicted. The Ark was set up in the field of Joshua the Beth-shemite , and the Beth-shemites offered sacrifices and burnt offerings. Out of curiosity the men of Beth-shemesh gazed at the Ark; and as a punishment, seventy of them (fifty thousand and seventy in some translations) were struck down by the Lord. The Bethshemites sent to Kirjath-jearim , or Baal-Judah, to have the Ark removed; and it was taken to the house of Abinadab , whose son Eleazar was sanctified to keep it. Kirjath-jearim remained the abode of the Ark for twenty years. Under Saul, the Ark was with the army before he first met the Philistines, but the king was too impatient to consult it before engaging in battle. In 1 Chronicles 13:3 it is stated that the people were not accustomed to consulting the Ark in the days of Saul . In the biblical narrative, at the beginning of his reign over the United Monarchy , King David removed the Ark from Kirjath-jearim amid great rejoicing. On the way to Zion , Uzzah , one of the drivers of the cart that carried the Ark, put out his hand to steady the Ark, and was struck dead by God for touching it. The place was subsequently named " Perez-Uzzah ", literally ' outburst against Uzzah ' , as a result. David, in fear, carried the Ark aside into the house of Obed-edom the Gittite , instead of carrying it on to Zion, and it stayed there for three months. On hearing that God had blessed Obed-edom because of the presence of the Ark in his house, David had the Ark brought to Zion by the Levites, while he himself, "girded with a linen ephod [...] danced before the Lord with all his might" and in the sight of all the public gathered in Jerusalem, a performance which caused him to be scornfully rebuked by his first wife, Saul's daughter Michal . In Zion, David put the Ark in the tent he had prepared for it, offered sacrifices, distributed food, and blessed the people and his own household. David used the tent as a personal place of prayer. The Levites were appointed to minister before the Ark. David's plan of building a temple for the Ark was stopped on the advice of the prophet Nathan . The Ark was with the army during the siege of Rabbah ; and when David fled from Jerusalem at the time of Absalom 's conspiracy, the Ark was carried along with him until he ordered Zadok the priest to return it to Jerusalem. According to the Biblical narrative, when Abiathar was dismissed from the priesthood by King Solomon for having taken part in Adonijah 's conspiracy against David, his life was spared because he had formerly borne the Ark. Solomon worshipped before the Ark after his dream in which God promised him wisdom. During the construction of Solomon's Temple , a special inner room, named Kodesh Hakodashim (' Holy of Holies '), was prepared to receive and house the Ark; and when the Temple was dedicated, the Ark—containing the original tablets of the Ten Commandments —was placed therein. When the priests emerged from the holy place after placing the Ark there, the Temple was filled with a cloud, "for the glory of the Lord had filled the house of the Lord". When Solomon married Pharaoh's daughter, he caused her to dwell in a house outside Zion , as Zion was consecrated because it contained the Ark. King Josiah also had the Ark returned to the Temple, from which it appears to have been removed by one of his predecessors (cf. 2 Chronicles 33–34 and 2 Kings 21–23).Prior to king Josiah who is the last biblical figure mentioned as having seen the Ark, king Hezekiah had seen the Ark. Hezekiah is also known for protecting Jerusalem against the Assyrian Empire by improving the city walls and diverting the waters of the Gihon Spring through a tunnel known today as Hezekiah's Tunnel , which channeled the water inside the city walls to the Pool of Siloam . In a noncanonical text known as the Treatise of the Vessels, Hezekiah is identified as one of the kings who had the Ark and the other treasures of Solomon's Temple hidden during a time of crisis. This text lists the following hiding places, which it says were recorded on a bronze tablet: (1) a spring named Kohel or Kahal with pure water in a valley with a stopped-up gate; (2) a spring named Kotel (or "wall" in Hebrew); (3) a spring named Zedekiah; (4) an unidentified cistern; (5) Mount Carmel; and (6) locations in Babylon. To many scholars, Hezekiah is also credited as having written all or some of the Book of Kohelet ( Ecclesiastes in the Christian tradition), in particular the famously enigmatic epilogue. Notably, the epilogue appears to refer to the Ark story with references to almond blossoms (i.e., Aaron's rod), locusts, silver, and gold. The epilogue then cryptically refers to a pitcher broken at a fountain and a wheel broken at a cistern. Although scholars disagree on whether the Pool of Siloam's pure spring waters were used by pilgrims for ritual purification, many scholars agree that a stepped pilgrimage road between the pool and the Temple had been built in the first century CE. This roadway has been partially excavated, but the west side of the Pool of Siloam remains unexcavated. In 587 BC, when the Babylonians destroyed Jerusalem , an ancient Greek version of the biblical third Book of Ezra, 1 Esdras , suggests that Babylonians took away the vessels of the ark of God, but does not mention taking away the Ark: And they took all the holy vessels of the Lord, both great and small, with the vessels of the ark of God, and the king's treasures, and carried them away into Babylon In Rabbinic literature , the final disposition of the Ark is disputed. Some rabbis hold that it must have been carried off to Babylon, while others hold that it must have been hidden lest it be carried off into Babylon and never brought back. A late 2nd-century rabbinic work known as the Tosefta states the opinions of these rabbis that Josiah , the king of Judah, stored away the Ark, along with the jar of manna , and a jar containing the holy anointing oil, the rod of Aaron which budded and a chest given to Israel by the Philistines. The Kohathites were one of the Levite houses from the Book of Numbers . Theirs was the responsibility to care for "the most holy things" in the tabernacle . When the camp, then wandering the Wilderness, set out the Kohathites would enter the tabernacle with Aaron and cover the ark with the screening curtain and "then they shall put on it a covering of fine leather, and spread over that a cloth all of blue, and shall put its poles in place." The ark was one of the items of the tent of meeting that the Kohathites were responsible for carrying. The Talmud in Yoma suggests that the Ark was removed from the Temple towards the end of the First Temple era, and the Second Temple never housed it. According to one view, it was taken to Babylonia when Nebuchadnezzar conquered Jerusalem, exiling King Jeconiah along with the upper classes. Another perspective proposes that King Josiah hid the Ark, anticipating the Temple's destruction. Where it was hidden remains uncertain. One account in the Talmud mentions a priest's suspicion of a tampered stone in a chamber designated for wood storage, hinting at the Ark's concealment. Alternatively, it's suggested that the Ark remained hidden in the Holy of Holies, underground. Some of Chazal including the Radak and Maimonides propose that King Solomon designed tunnels beneath the Temple to safeguard the Ark, which Josiah later used. Attempts to excavate this area have yielded little due to political sensitivities. A final opinion, found in the Book of Maccabees II 2:4-10, asserts that the Prophet Jeremiah hid the Ark and other sacred items in a cave on Mount Nebo in present-day Jordan, anticipating Babylonian invasion.Archaeological evidence shows strong cultic activity at Kiriath-Jearim in the 8th and 7th centuries BC, well after the ark was supposedly removed from there to Jerusalem. In particular, archaeologists found a large elevated podium, associated with the Northern Kingdom and not the Southern Kingdom , which may have been a shrine. [ citation needed ] Thomas Römer suggests that this may indicate that the ark was not moved to Jerusalem until much later, possibly during the reign of King Josiah (reigned c. 640–609 BCE ). He notes that this might explain why the ark featured prominently in the history before Solomon, but not after. Additionally, 2 Chronicles 35:3 indicates that it was moved during King Josiah's reign. However, Yigal Levin argues that there is no evidence that Kiriath-Jearim was a cultic center in the monarchical era or that it ever housed any "temple of the Ark". : 52, 57 Some scholars believe the story of the Ark was written independently around the 8th century BC in a text referred to as the "Ark Narrative" and then incorporated into the main biblical narrative just before the Babylonian exile . Römer also suggests that the ark may have originally carried sacred stones "of the kind found in the chests of pre-Islamic Bedouins" and speculates that these may have been either a statue of Yahweh or a pair of statues depicting both Yahweh and his companion goddess Asherah . In contrast, Scott Noegel has argued that the parallels between the ark and these practices "remain unconvincing" in part because the Bedouin objects lack the ark's distinctive structure, function, and mode of transportation. Specifically, unlike the ark, the Bedouin chests "contained no box, no lid, and no poles," they did not serve as the throne or footstool of a god, they were not overlaid with gold, did not have kerubim figures upon them, there were no restrictions on who could touch them, and they were transported on horses or camels. Noegel suggests that the ancient Egyptian bark is a more plausible model for the Israelite ark, since Egyptian barks had all the features just mentioned. Noegel adds that the Egyptians also were known to place written covenants beneath the feet of statues, proving a further parallel to the placement of the covenantal tablets inside the ark.

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Bubonic plague

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Mystery Lab

Felipe Castanhari Bruno Miranda Lilian Regina Guilherme Briggs Estilingue Filmes Polar Filmes Psycho N Look Webedia Mystery Lab (Portuguese: Mundo Mistério , literally " Mystery World ") is a Brazilian educational web television limited series that premiered on Netflix on August 4, 2020. The series was created by YouTuber Felipe Castanhari , who also serves as presenter. It features 8 episodes which follow some of humanity's most intriguing mysteries. Among the topics dealt with are the disappearances in the Bermuda Triangle , time travel , the bubonic plague and the possibility of a zombie apocalypse . Felipe Castanhari Wendel Bezerra as Raul Gordon Bruno Miranda as Betinho Lilian Regina as Dr. Thay Guilherme Briggs as Briggs

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Bubonic plague

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Black Death in France

The Black Death was present in France between 1347-1352. The bubonic plague pandemic, known as the Black Death, reached France by ship from Italy to Marseille in November 1347, spread first through Southern France, and then continued outwards to Northern France. Due to the large size and population of the Kingdom of France , the pandemic lasted for several years, as some parts weren't affected until the plague was over in others. The Kingdom of France had the largest population of Europe at the time, and the Black Death was a major catastrophe. The Black Death in France was described by eyewitnesses, such as Louis Heyligen , Jean de Venette , and Gilles Li Muisis . The Black Death migrated from Southern France to Spain , from Eastern France to the Holy Roman Empire , and to England by ship from Gascony. At the time, Pope Clement VI resided in Avignon in present-day France during the Western Schism , and issued his condemnations of the Jewish persecutions during the Black Death , as well as the flagellants . During the Black Death in France, King Philip VI of France ordered the University of Paris to compose the pioneering work, Compendium de epidemia, due to the pandemic. At this point in time, France and England had entered the Hundred Years' War . In 1346, France had lost the Battle of Crécy . Pope Clement VI lived in Avignon in present-day France during the Western Schism . The war had placed considerable financial strain on France, and in November 1347 Philip VI called a general assembly of the Estates General to agree emergency measures to fund the conflict – a war subsidy; different regions of the kingdom decided how to pay the subsidy, such as opting for sales taxes or hearth taxes . The Kingdom of France had a population of between 16-20 million people, the largest population of Europe. Similarly to Italy, it was relatively urbanized. Since the outbreak of the Black Death at the Crimea , it had reached Sicily by an Italian ship from the Crimea. After having spread across the Italian states, the plague reached France by a plague ship in November 1347. At this point in time, France and England had entered the Hundred Years' War . In 1346, France had lost the Battle of Crécy . Pope Clement VI lived in Avignon in present-day France during the Western Schism . The war had placed considerable financial strain on France, and in November 1347 Philip VI called a general assembly of the Estates General to agree emergency measures to fund the conflict – a war subsidy; different regions of the kingdom decided how to pay the subsidy, such as opting for sales taxes or hearth taxes . The Kingdom of France had a population of between 16-20 million people, the largest population of Europe. Similarly to Italy, it was relatively urbanized. Since the outbreak of the Black Death at the Crimea , it had reached Sicily by an Italian ship from the Crimea. After having spread across the Italian states, the plague reached France by a plague ship in November 1347. The plague in Southern France was described by Louis Heyligen in Avignon . According to Heyligen, the Black Death reached France in December 1347, when a Genovese plague ship from the East was forced to leave its home port of Genova shortly after its return, and arrived in Marseilles instead. The ship spread the plague in Marseilles, was subsequently forced to leave the city, and continued on its way along the coast of Southern France. The plague ship spread the pestilence all along its course, which included areas from West Marseille towards Toulouse , and north toward Avignon. In May 1348, a 2nd wave came by land from Genova. In Avignon, the Pope arranged religious processions to dampen the wrath of God, as the plague was interpreted by the church as a punishment by God for the sins of humanity. The Pope was advised by his physician, Gui de Chauliac , to hide from the plague in Étoile-sur-Rhône , where he survived the outbreak. The Black Death in Southwest France was not as well-documented as it was in Avignon. It was noted to have been in Carcassonne in January 1348, and in Toulouse by April that same year. It was confirmed in Bordeaux in June 1348, but it was likely to have been present there already by as early as March. Documentation stated that it was a ship of pilgrims from Bordeaux who brought the plague to Santiago de Compostela in Spain. In April 1348, the Black Death was recorded to have reached Lyon . From Lyon, the plague spread rapidly across Burgundy . In the village of Givry in Burgundy, 50% of the population was confirmed to have died within the short period of August-November 1348. The Black Death in Paris has been described in the famous chronicle of the Carmelite Jean de Venette , who resided at the Saint-Denis Abbey in Île-de-France , located outside of Paris. At the time, Paris was the biggest city in Europe, with a population between 80,000-200,000 people. According to Jean de Venette, the plague first arrived to Roissy near Gonesse in June 1348. In his writings, de Venette claimed that 16,000 people died in Saint-Denis, and an additional 800 people perished each day in Paris between November-December 1348. Overwhelming amounts of death resulted in daily transports of up to 500 dead bodies to mass burial sites. The deceased were transported from the Hôtel-Dieu, Paris hospital, which was staffed by nuns, whose numbers dwindled as they perished alongside the sick to which they attended. The Black Death didn't leave Paris until January 1349. [ citation needed ] The presence of the plague was documented in the Normanniae nova Cronica to have reached Rouen in Normandie during the feast of John the Baptist on 24 June 1348. In Normandie, the plague made it impossible to bury the corpses even in country villages, and each village which was reached by the plague flagged a black flag to warn anyone approaching. In the very Northern parts of France, the Black Death is described in the chronicle of the abbot Gilles li Muisis of Tournai . According to Li Muisis, the plague reached Tournai in August 1349 and lasted until November. In Tournai, the Black Death caused a religious reformation. Because the plague was seen as punishment of God for the sins of humanity, the authorities issued regulations to ban everything regarded as sinful, such as gambling, as well as forcing couples who lived together without being married to separate or marry immediately. Due to the size of France, certain parts weren't immediately reached by the plague, which travelled more slowly by land than by sea. Brittany and Auvergne weren't reached until 1349, and some remote parts weren't reached until 1351. The last part of France to be reached by the Black Death was Tonnerre, which wasn't reached until 1352. The plague in Southern France was described by Louis Heyligen in Avignon . According to Heyligen, the Black Death reached France in December 1347, when a Genovese plague ship from the East was forced to leave its home port of Genova shortly after its return, and arrived in Marseilles instead. The ship spread the plague in Marseilles, was subsequently forced to leave the city, and continued on its way along the coast of Southern France. The plague ship spread the pestilence all along its course, which included areas from West Marseille towards Toulouse , and north toward Avignon. In May 1348, a 2nd wave came by land from Genova. In Avignon, the Pope arranged religious processions to dampen the wrath of God, as the plague was interpreted by the church as a punishment by God for the sins of humanity. The Pope was advised by his physician, Gui de Chauliac , to hide from the plague in Étoile-sur-Rhône , where he survived the outbreak. The Black Death in Southwest France was not as well-documented as it was in Avignon. It was noted to have been in Carcassonne in January 1348, and in Toulouse by April that same year. It was confirmed in Bordeaux in June 1348, but it was likely to have been present there already by as early as March. Documentation stated that it was a ship of pilgrims from Bordeaux who brought the plague to Santiago de Compostela in Spain. In April 1348, the Black Death was recorded to have reached Lyon . From Lyon, the plague spread rapidly across Burgundy . In the village of Givry in Burgundy, 50% of the population was confirmed to have died within the short period of August-November 1348. The Black Death in Paris has been described in the famous chronicle of the Carmelite Jean de Venette , who resided at the Saint-Denis Abbey in Île-de-France , located outside of Paris. At the time, Paris was the biggest city in Europe, with a population between 80,000-200,000 people. According to Jean de Venette, the plague first arrived to Roissy near Gonesse in June 1348. In his writings, de Venette claimed that 16,000 people died in Saint-Denis, and an additional 800 people perished each day in Paris between November-December 1348. Overwhelming amounts of death resulted in daily transports of up to 500 dead bodies to mass burial sites. The deceased were transported from the Hôtel-Dieu, Paris hospital, which was staffed by nuns, whose numbers dwindled as they perished alongside the sick to which they attended. The Black Death didn't leave Paris until January 1349. [ citation needed ] The presence of the plague was documented in the Normanniae nova Cronica to have reached Rouen in Normandie during the feast of John the Baptist on 24 June 1348. In Normandie, the plague made it impossible to bury the corpses even in country villages, and each village which was reached by the plague flagged a black flag to warn anyone approaching. In the very Northern parts of France, the Black Death is described in the chronicle of the abbot Gilles li Muisis of Tournai . According to Li Muisis, the plague reached Tournai in August 1349 and lasted until November. In Tournai, the Black Death caused a religious reformation. Because the plague was seen as punishment of God for the sins of humanity, the authorities issued regulations to ban everything regarded as sinful, such as gambling, as well as forcing couples who lived together without being married to separate or marry immediately. Due to the size of France, certain parts weren't immediately reached by the plague, which travelled more slowly by land than by sea. Brittany and Auvergne weren't reached until 1349, and some remote parts weren't reached until 1351. The last part of France to be reached by the Black Death was Tonnerre, which wasn't reached until 1352. When the plague spread across Southern France, king Philip VI of France ordered the University of Paris to compose the pioneering work Compendium de epidemia due to the pandemic. The Black Death made it much more difficult for the kingdom to pay the war subsidy that had been agreed in late 1347. By the second half of 1349, France's spending on war had decreased as the Black Death had spread to England by this point and led to a pause in fighting. The migration of the plague caused panic across France, and people started looking for scapegoats. Rumours started to spread that the plague was caused by people who poisoned the wells to cause the plague and exterminate Christendom. Initially, these accusations weren't directed at people of any particular category, but directed at anyone who appeared suspicious simply because they were different or unidentified, particularly travellers (such as pilgrims and beggars) invalids, or people in possession of any kind of powder. In April 1348, Louis Heyligen reported that people were executed for well-poisoning in Avignon; the same month, Andre Benezeit, secretary of mayor Aymar of Narbonne, reported to the mayor of Gerona in Catalonia that many beggars had been arrested, tortured and executed in Narbonne, Carcassonne and Grasse for well-poisoning. These accusations were eventually directed against the Jewish population, and on 5 July (and again on 26 September) Pope Clement VI issued his condemnations of the Jewish persecutions during the Black Death and explained that since the plague was a punishment issued by God himself, it was sinful to accuse the Jews of having caused it, and declared the Jews to be under his protection. While there isn't much information about the Jewish persecutions during the Black Death in France, the Jewish population was small due to the fact that Louis IX of France had banned them from France, the well-poisoning rumours from France erupted into documented persecutions and mass executions in the Duchy of Savoy , and resulted in massacres in the Holy Roman Empire , where the Jewish population was larger. Bubonic plague would return regularly, but with fewer death victims, until the 18th century. The last epidemic in France was the Great Plague of Marseille in 1720.

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Bubonic plague

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1924 Los Angeles pneumonic plague outbreak

The 1924 Los Angeles pneumonic plague outbreak was an outbreak of the pneumonic plague in Los Angeles , California that began on September 28, 1924, and was declared fully contained on November 13, 1924. It represented the first time that the plague had emerged in Southern California ; plague outbreaks had previously surfaced in San Francisco and Oakland . The outbreak killed 30 people and infected several more. Public health officials credited the lessons learned from the San Francisco outbreak with saving lives, and swiftly implemented preventative measures , including hospitalization of the sick and all their contacts, a neighborhood quarantine , and a large-scale rat eradication program. The epicenter of the plague was in the Macy Street District , primarily home to Mexican immigrants . Racism against Mexican Americans tainted the reaction to the plague, an issue not made public until the outbreak concluded. This outbreak was the last instance of aerosol transmission of the plague and the last major plague outbreak in the United States. During the 1920s, thousands of Mexicans crossed the border to work on large plantations that thrived on "cheap, compliant labor." The large plantation owners supported open immigration , because Mexicans were thought of as "docile and backward." However, immigrants faced a backlash from labor unions which supported increased border security and often expressed racists tendencies towards Hispanic immigrants due to the belief that cheap labor on plantations would favor immigrants instead of American workers. In addition, Hispanics also had to face the stereotype of spreading crime and disease, and some worried that they refused to assimilate into white America. As a consequence, Hispanics were often "physically isolated from the white" communities of Los Angeles . At the time, roughly 19% of Los Angeles residents were foreign born, 22,000 of which were Mexican. At the time, Los Angeles, being the largest city on the West Coast and the fifth-largest in the country , was growing on an economy primarily reliant on its flourishing tourism industry, a " land boom ," and a new harbor . An ideal climate allowed its population to explode in the early 20th century: it grew by 80.66% between 1910 and 1920 and by 114.69% between 1920 and 1930 . Mexicans in Los Angeles mostly settled in Eastern Los Angeles and unincorporated territory of Los Angeles County , primarily in two neighborhoods – known by white residents as ghettos – Belvedere and the Macy Street District . In the Macy Street District, named for its southern boundary of Macy Street (now Cesar Chavez Avenue), roughly 3,000 residents were surrounded by the Los Angeles River , polluted by dead carcasses and brick, coal , gas and meatpacking plants . The rat population also thrived on the prevalence of horse and mule yards. Residents were crammed into one-fifth of a square mile, living in cramped residences with high rent despite low-quality living conditions. Residents often had to travel through someone's else's apartment to get to their own room. Despite often illegal living conditions, no investigations into the Macy District's living conditions was ever held, and the only four paved roads into the District were never inspected by the Department of Streets and Sanitation. On September 28, 1924, in the Macy Street District (present day Los Angeles Chinatown ) of Los Angeles , California , a 51-year-old man named Jesús Lajun fell ill with a fever and a painful lump in his groin . Prior to the onset of symptoms, Lajun had discovered a decaying rat under his house and picked it up, throwing it in the trash. A physician initially diagnosed Lajun's pneumonic plague as a venereal disease (sexually transmitted infection) , due to his enlarged lymph node . Even after the Los Angeles City Health Officers' eventual confirmation of the disease as the pneumonic plague, the disease was still referred to as a strange malady, pneumonia , virulent pneumonia , or malignant pneumonia until November 6, 1924. Investigators initially believed that Lajun had contracted the bubonic plague . Left untreated, the bubonic plague can move to the lungs and cause a secondary pneumonic infection, with a mortality rate of 40–60%. As Lajun's condition worsened, he developed extreme symptoms such as bloody sputum , causing physician to believe it converted into pneumonic form. Because he was the first with identifiable symptoms of the plague, Lajun was designated the index patient . In the same week, on October 3, 1924, Jesús Lajun's fifteen-year-old daughter Francisca also fell ill, complaining of fever and shortness of breath . Both also had sore throats and back pain . Giles Porter, a physician of the Los Angeles City Health Office, was called to the house and diagnosed Francisca with lobar pneumonia , a form of pneumonia weakening the lobe of a lung due to inflammatory exudate between alveoli . Porter was also the physician who had initially diagnosed Lajun's plague as a venereal disease, or sexually transmitted infection , due to his enlarged lymph node . Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street, which would become the eventual epicenter of the outbreak. However, neither of the Lajuns recovered. 15-year old Francisca died in an ambulance on its way to Los Angeles County General Hospital after her symptoms worsened. An autopsy of Francisca performed by pathologist Webb ruled her cause of death as double pneumonia . Jesús Lajun died on October 11, with his cause of death ruled as bronchopneumonia . Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having acute myocarditis , or inflammation of the heart muscle . Samarano's baby was stillborn and her body was returned to her husband Guadalupe Samarano, who later developed infection. Between October 15 and 19, Father M. Brualla, a Catholic priest who had administered last rites to the affected people and held the requiem mass for Samarano, developed the same respiratory symptoms and died days later, as did several attendants of Samarano's funeral. Many of the Samaranos' friends and family were unknowingly infected by Guadalupe Samarano, and within a week, the plague killed his entire family of eight. On October 22, Guadalupe and Jessie Flores, neighbors of the Samaranos, also fell ill with symptoms of the pneumonic plague and are subsequently hospitalized at the General Hospital. On October 24, physicians again misdiagnosed the Flores with severe pneumonia as there was no known connection at the time between the Flores and Samaranos. On October 26, Guadalupe Flores died and received an autopsy by pathologist Lawrence Parsons, who misruled his cause of death as double pneumonia. No bacterial culture was conducted to correctly identify the cause of his pneumonia as Yersinia pestis , the causative agent of the pneumonic plague. Flores' body was returned to his family on October 27, exposing them to the bacteria. Afterwards, the hospital's morgue staff was quarantined for five days. On October 28, physician George Stevens reported an unknown, highly contagious disease to the hospital and recommended the construction of a quarantine ward after he and physician Elmer Anderson both treated patients in unusually critical condition. That same day, brothers Mike and Jose Jiminez also fell ill and vacated 742 Clara Street, the residence of the Samaranos, exposing the rest of the district to the plague. On October 29, several people who were in close contact with the Samaranos contracted the plague, including Mary Costello, Guadalupe Samarano's nurse; Fred Ortega, who lived at 742 Clara Street; Samarano's mother, Maria; and his brother, Victor. Maria and Victor Samarano were hospitalized under physician Bogen's supervision after exhibiting suspected symptoms of avian influenza . Jesus and Maria Valenzuela, cousins of the Samaranos, also fell ill with symptoms of the plague, though they were not traced back to the Samaranos. The Samaranos' children, Alfredo, Gilberto, Raul, and Roberto, along with six others, were hospitalized and diagnosed with meningitis , despite their skin turning black, a pathognomonic symptom of the plague. A physician also requested an ambulance from the hospital for two patients in critical condition and were highly contagious. On October 30, the Los Angeles County Hospital pathologist George Maner finally identified the pneumonic plague as the disease causing the outbreak and notified the Los Angeles City Health Department and state officials. Maner identified it from a blood serum sample from a patient who died after attending Lucena Samarano's funeral. City health officials quarantined an eight- block area encompassing Clara Street, where the funeral had taken place, as well as a six-block area in Belvedere after Jesús Lajun was identified as the index case , but did not announce the causative disease of the outbreak. Thirteen more cases of an unknown disease were admitted, all of whom developed cyanosis and hemoptysis , or bloody sputum, the former of which is indicative of low oxygen saturation of tissues near the skin surface. Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported gram-negative bipolar staining bacilli resembling the plague. Alexandre Yersin , the co-discoverer of Yersinia pestis, and the hospital's assistant superintendent, sent a telegram ordering antiserum and vaccine on October 31, notifying the California Board of Health United States Public Health Service of the outbreak. However, the antiserum requested was produced solely by the H.K. Mulford Company laboratories in Philadelphia , a 3,141-mile journey which would require automobile transport to Mineola, New York then a flight by mail plane to Los Angeles with a stopover in San Francisco. With cooperation from the United States Post Office Department and its respective air mail officials, it was prepared within an hour, according to the company. In spite of the rapid deployment of the antiserum, it was successfully used on only two patients, Raul Samarano and Mary Costello, and remained largely unused for the rest of the outbreak. Cumming subsequently commenced an investigation into the outbreak. The same day, County Health Commissioner J. L. Pomeroy imposed a quarantine, with 75 police officers and 200 armed World War I veterans deployed to assist quarantine guards in enforcing the quarantine, who often looted from local residents and businesses. On November 1, Benjamin Brown, a United States Public Health Service surgeon in Los Angeles , warned the United States Surgeon General Hugh S. Cumming of the outbreak and Yersin's request for an antiserum. Brown's transmission was encoded, referring to "pneumonic plague" as "ekkil," "suspected cases" as "suspects," "deaths" as "begos," and "situation bad" as "ethos": Eighteen cases ekkil. Three suspects. Ten begos. Ethos. Recommend federal aid Cumming then alerted Senior Surgeon James Perry, who was then stationed in San Francisco , to confidentially investigate the outbreak, attempting to avoid gratuitous involvement in state and municipal affairs. 10 more fatalities were recorded, and Pomeroy extended the quarantine to encompass the entire Macy Street District , purportedly to ensure that " Mexicans who we feared would scatter" couldn't evade the original quarantine. The border's boundaries were closed to regular vehicle traffic and guards were positioned at every home with suspected cases. Agricultural and railroad workers were exempted from the quarantine. A temporary laboratory was constructed by the Los Angeles City Health Department in the quarantined area to quickly identify new cases. By this time, the cause of the outbreak had been definitively established as the pneumonic plague. Fatalities spiked yet again on November 2. Among them was Father Bruella, who oversaw the last rites of many of the plague patients in his ward and died from the plague at 9 a.m. By this time, over 400 armed guards were deployed to implement the quarantine. Despite its rapid spread, the outbreak remained largely unknown to the public – information that was released was often falsified or distorted, such as the Los Angeles Times , which attributed the quarantine to pneumonia , as opposed to newspapers on the East Coast which generally covered the outbreak without hesitation. By November 3, 24 people died over the course of two weeks, [lower-alpha 1] all but one of whom were Mexicans. All Mexicans who died were required to undergo an autopsy even if it is not suspected that they died of the plague. Los Angeles authorities racially quarantined Mexican homes outside of the Macy Street District as well as majority African American , Chinese , and Japanese neighborhoods. The Macy Street District port mandated the inspection and fumigation of incoming ships while outgoing ships hung a yellow flag , indicating the ship originated in a quarantined zone. On November 4, 5 more died, bringing the total death toll to 29 (reported as 25 in local newspapers). On November 5, the plague antiserum requested by the Los Angeles County Hospital finally arrived, though it was only used on three patients. By this time, everyone else who lived at 742 Clara Street died. Despite a piling death toll, the hospital continued falsifying or contorting information regarding the outbreak. A six-block quarantine was also imposed in Belvedere Gardens in response to two suspected plague deaths. By November 6, the death toll rose to 33 deaths (reported as 30 in local newspapers). That same day, El Heraldo de México became the first local newspaper to transparently report on the outbreak, revealing that the plague spread by rat fleas , not pneumonia, was its cause. The newspaper also refuted city officials' claims that the plague outbreak began on October 30. Consequently, the Port of Los Angeles began the eradication of all rats to avoid a quarantine and economic downturn. The Los Angeles government advised those in the Macy Street District not to congregate by or heed to the newspaper. On November 8, Los Angeles government and hospitals began the rollout of a vaccine . However, it would require the quarantined to leave the restricted area, meaning the vaccine was largely isolated to the sick. The plague vaccine at the time was also largely ineffective against the pneumonic plague, and in those who were vaccinated, the plague often progressed too far for the vaccine to be effective. On November 10, the Los Angeles County General Hospital superintendent, N. N. Wood, officially reported 9 clinically diagnosed plague cases after weeks of silence on the plague, which was adjusted to 37 on November 11. On November 13, the quarantine was lifted after 6 days of no new cases. On November 14, a man named Martin Hernandez, who did not live anywhere near the Macy Street District, died of the plague; his case was not reported to any authorities. On November 15, the plague was officially declared over by local health officials in spite of lingering active cases of the plague, allowing the introduction of a citywide rat extermination program. On September 28, 1924, in the Macy Street District (present day Los Angeles Chinatown ) of Los Angeles , California , a 51-year-old man named Jesús Lajun fell ill with a fever and a painful lump in his groin . Prior to the onset of symptoms, Lajun had discovered a decaying rat under his house and picked it up, throwing it in the trash. A physician initially diagnosed Lajun's pneumonic plague as a venereal disease (sexually transmitted infection) , due to his enlarged lymph node . Even after the Los Angeles City Health Officers' eventual confirmation of the disease as the pneumonic plague, the disease was still referred to as a strange malady, pneumonia , virulent pneumonia , or malignant pneumonia until November 6, 1924. Investigators initially believed that Lajun had contracted the bubonic plague . Left untreated, the bubonic plague can move to the lungs and cause a secondary pneumonic infection, with a mortality rate of 40–60%. As Lajun's condition worsened, he developed extreme symptoms such as bloody sputum , causing physician to believe it converted into pneumonic form. Because he was the first with identifiable symptoms of the plague, Lajun was designated the index patient . In the same week, on October 3, 1924, Jesús Lajun's fifteen-year-old daughter Francisca also fell ill, complaining of fever and shortness of breath . Both also had sore throats and back pain . Giles Porter, a physician of the Los Angeles City Health Office, was called to the house and diagnosed Francisca with lobar pneumonia , a form of pneumonia weakening the lobe of a lung due to inflammatory exudate between alveoli . Porter was also the physician who had initially diagnosed Lajun's plague as a venereal disease, or sexually transmitted infection , due to his enlarged lymph node . Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street, which would become the eventual epicenter of the outbreak. However, neither of the Lajuns recovered. 15-year old Francisca died in an ambulance on its way to Los Angeles County General Hospital after her symptoms worsened. An autopsy of Francisca performed by pathologist Webb ruled her cause of death as double pneumonia . Jesús Lajun died on October 11, with his cause of death ruled as bronchopneumonia . Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having acute myocarditis , or inflammation of the heart muscle . Samarano's baby was stillborn and her body was returned to her husband Guadalupe Samarano, who later developed infection. Between October 15 and 19, Father M. Brualla, a Catholic priest who had administered last rites to the affected people and held the requiem mass for Samarano, developed the same respiratory symptoms and died days later, as did several attendants of Samarano's funeral. Many of the Samaranos' friends and family were unknowingly infected by Guadalupe Samarano, and within a week, the plague killed his entire family of eight. On October 22, Guadalupe and Jessie Flores, neighbors of the Samaranos, also fell ill with symptoms of the pneumonic plague and are subsequently hospitalized at the General Hospital. On October 24, physicians again misdiagnosed the Flores with severe pneumonia as there was no known connection at the time between the Flores and Samaranos. On October 26, Guadalupe Flores died and received an autopsy by pathologist Lawrence Parsons, who misruled his cause of death as double pneumonia. No bacterial culture was conducted to correctly identify the cause of his pneumonia as Yersinia pestis , the causative agent of the pneumonic plague. Flores' body was returned to his family on October 27, exposing them to the bacteria. Afterwards, the hospital's morgue staff was quarantined for five days. On October 28, physician George Stevens reported an unknown, highly contagious disease to the hospital and recommended the construction of a quarantine ward after he and physician Elmer Anderson both treated patients in unusually critical condition. That same day, brothers Mike and Jose Jiminez also fell ill and vacated 742 Clara Street, the residence of the Samaranos, exposing the rest of the district to the plague. On October 29, several people who were in close contact with the Samaranos contracted the plague, including Mary Costello, Guadalupe Samarano's nurse; Fred Ortega, who lived at 742 Clara Street; Samarano's mother, Maria; and his brother, Victor. Maria and Victor Samarano were hospitalized under physician Bogen's supervision after exhibiting suspected symptoms of avian influenza . Jesus and Maria Valenzuela, cousins of the Samaranos, also fell ill with symptoms of the plague, though they were not traced back to the Samaranos. The Samaranos' children, Alfredo, Gilberto, Raul, and Roberto, along with six others, were hospitalized and diagnosed with meningitis , despite their skin turning black, a pathognomonic symptom of the plague. A physician also requested an ambulance from the hospital for two patients in critical condition and were highly contagious. On October 30, the Los Angeles County Hospital pathologist George Maner finally identified the pneumonic plague as the disease causing the outbreak and notified the Los Angeles City Health Department and state officials. Maner identified it from a blood serum sample from a patient who died after attending Lucena Samarano's funeral. City health officials quarantined an eight- block area encompassing Clara Street, where the funeral had taken place, as well as a six-block area in Belvedere after Jesús Lajun was identified as the index case , but did not announce the causative disease of the outbreak. Thirteen more cases of an unknown disease were admitted, all of whom developed cyanosis and hemoptysis , or bloody sputum, the former of which is indicative of low oxygen saturation of tissues near the skin surface. Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported gram-negative bipolar staining bacilli resembling the plague. Alexandre Yersin , the co-discoverer of Yersinia pestis, and the hospital's assistant superintendent, sent a telegram ordering antiserum and vaccine on October 31, notifying the California Board of Health United States Public Health Service of the outbreak. However, the antiserum requested was produced solely by the H.K. Mulford Company laboratories in Philadelphia , a 3,141-mile journey which would require automobile transport to Mineola, New York then a flight by mail plane to Los Angeles with a stopover in San Francisco. With cooperation from the United States Post Office Department and its respective air mail officials, it was prepared within an hour, according to the company. In spite of the rapid deployment of the antiserum, it was successfully used on only two patients, Raul Samarano and Mary Costello, and remained largely unused for the rest of the outbreak. Cumming subsequently commenced an investigation into the outbreak. The same day, County Health Commissioner J. L. Pomeroy imposed a quarantine, with 75 police officers and 200 armed World War I veterans deployed to assist quarantine guards in enforcing the quarantine, who often looted from local residents and businesses. On November 1, Benjamin Brown, a United States Public Health Service surgeon in Los Angeles , warned the United States Surgeon General Hugh S. Cumming of the outbreak and Yersin's request for an antiserum. Brown's transmission was encoded, referring to "pneumonic plague" as "ekkil," "suspected cases" as "suspects," "deaths" as "begos," and "situation bad" as "ethos": Eighteen cases ekkil. Three suspects. Ten begos. Ethos. Recommend federal aid Cumming then alerted Senior Surgeon James Perry, who was then stationed in San Francisco , to confidentially investigate the outbreak, attempting to avoid gratuitous involvement in state and municipal affairs. 10 more fatalities were recorded, and Pomeroy extended the quarantine to encompass the entire Macy Street District , purportedly to ensure that " Mexicans who we feared would scatter" couldn't evade the original quarantine. The border's boundaries were closed to regular vehicle traffic and guards were positioned at every home with suspected cases. Agricultural and railroad workers were exempted from the quarantine. A temporary laboratory was constructed by the Los Angeles City Health Department in the quarantined area to quickly identify new cases. By this time, the cause of the outbreak had been definitively established as the pneumonic plague. Fatalities spiked yet again on November 2. Among them was Father Bruella, who oversaw the last rites of many of the plague patients in his ward and died from the plague at 9 a.m. By this time, over 400 armed guards were deployed to implement the quarantine. Despite its rapid spread, the outbreak remained largely unknown to the public – information that was released was often falsified or distorted, such as the Los Angeles Times , which attributed the quarantine to pneumonia , as opposed to newspapers on the East Coast which generally covered the outbreak without hesitation. By November 3, 24 people died over the course of two weeks, [lower-alpha 1] all but one of whom were Mexicans. All Mexicans who died were required to undergo an autopsy even if it is not suspected that they died of the plague. Los Angeles authorities racially quarantined Mexican homes outside of the Macy Street District as well as majority African American , Chinese , and Japanese neighborhoods. The Macy Street District port mandated the inspection and fumigation of incoming ships while outgoing ships hung a yellow flag , indicating the ship originated in a quarantined zone. On November 4, 5 more died, bringing the total death toll to 29 (reported as 25 in local newspapers). On November 5, the plague antiserum requested by the Los Angeles County Hospital finally arrived, though it was only used on three patients. By this time, everyone else who lived at 742 Clara Street died. Despite a piling death toll, the hospital continued falsifying or contorting information regarding the outbreak. A six-block quarantine was also imposed in Belvedere Gardens in response to two suspected plague deaths. By November 6, the death toll rose to 33 deaths (reported as 30 in local newspapers). That same day, El Heraldo de México became the first local newspaper to transparently report on the outbreak, revealing that the plague spread by rat fleas , not pneumonia, was its cause. The newspaper also refuted city officials' claims that the plague outbreak began on October 30. Consequently, the Port of Los Angeles began the eradication of all rats to avoid a quarantine and economic downturn. The Los Angeles government advised those in the Macy Street District not to congregate by or heed to the newspaper. On November 8, Los Angeles government and hospitals began the rollout of a vaccine . However, it would require the quarantined to leave the restricted area, meaning the vaccine was largely isolated to the sick. The plague vaccine at the time was also largely ineffective against the pneumonic plague, and in those who were vaccinated, the plague often progressed too far for the vaccine to be effective. On November 10, the Los Angeles County General Hospital superintendent, N. N. Wood, officially reported 9 clinically diagnosed plague cases after weeks of silence on the plague, which was adjusted to 37 on November 11. On November 13, the quarantine was lifted after 6 days of no new cases. On November 14, a man named Martin Hernandez, who did not live anywhere near the Macy Street District, died of the plague; his case was not reported to any authorities. On November 15, the plague was officially declared over by local health officials in spite of lingering active cases of the plague, allowing the introduction of a citywide rat extermination program. The pneumonic plague is the only form of the plague capable of person-to-person transmission , which occurs during droplet-respiration , or breathing , as opposed to other forms of the plague. The 1924 Los Angeles pneumonic plague outbreak was the last instance of aerosol transmission of the plague in the United States. A person is infected when they breathe in particles of Yersinia pestis , a bacterium transmitted by rat fleas , in the air. Alternatively, if the bubonic plague (another form of the plague) goes untreated, the bacteria can spread to the lungs through the bloodstream and cause a secondary case of the pneumonic plague. Between 1900 and 2009, there were 1,001 reported cases of pneumonic plague, of which 81% occurred before 1943, when effective antibiotics , such as doxycycline , ciprofloxacin , and levofloxacin became widely available. In that time period, 92% of cases were fatal. The pneumonic plague's potency of person-to-person transmission is disputed – it is agreed that Yersinia pestis can spread the pneumonic plague through aerosol transmission of infected droplets , and the bacterium can survive in the air for up to one hour in optimum conditions. Somebody exposed to someone infected with the pneumonic plague can fall ill within 1 to 6 days. However, Jacob L. Kool objects to the supposed high risk of person-to-person transmission in an article titled ""Risk of Person‐to‐Person Transmission of Pneumonic Plague" in Clinical Infectious Diseases , stating that people are only at risk of exposure to the plague when the disease has progressed to its end stage and the infected begin coughing bloody sputum . Even then, direct and close contact within six feet is required for the plague to spread, according to the Centers for Disease Control and Prevention 's National Center for Emerging and Zoonotic Infectious Diseases. Transmission can be prevented by tight-fitting surgical masks and social distancing . Only 11% of patients that contracted the disease actually spread it to another person. After the 1924 outbreak in Los Angeles, there have been no secondary transmissions (transmission of the disease from a secondary case). Bodily fluids and tissue of an infected animal can still transmit the plague to humans through direct contact if handled improperly, but this is exceedingly rare: today, the World Health Organization reports only 1,000 to 3,000 cases of the plague annually. Zoonosis is often the direct result of an epizootic , a flare-up of a disease in animals analogous to a human epidemic . Though the plague is most common in rural and semi-arid regions of the western United States , epizootics are frequent among rodents in big cities and urban areas with large, diverse specimen populations, as exemplified in this outbreak, the last urban plague epizootic. The pneumonic plague primarily affects the lungs, and common symptoms include fatigue , fever , and pneumonia , the latter of which in turn can cause chest pain , coughing , hemoptysis (bloody sputum), and shortness of breath . The plague may also cause abdominal pain , nausea , and vomiting . If antibiotic treatments, which were not available until 1943, are not administered within 24 hours of the onset of symptoms, the plague will often progress into respiratory failure , shock , and death . The pneumonic plague is diagnosed after evaluation by a healthcare worker and a laboratory test of the patient's blood , lymph node aspirate , or sputum confirms infection. The plague can be treated with a therapeutic antiserum , a treatment first initiated in 1896 by Alexandre Yersin , a bacteriologist , physician , and co-discoverer of Yersinia pestis as the causative bacterium of the plague. The efficacy of antiserum is disputed but it is generally accepted to be successful in mitigating negative effects of the plague: the mortality rates for antiserum-treated patients was 35%, as opposed to 82% for untreated patients. In the 1924 Los Angeles outbreak, the serum was only successfully used on two patients, Mary Costello and Raul Samarano, remaining largely unused. At the time, it was only produced by H.K. Mulford Company laboratories in Philadelphia, Pennsylvania , but was quickly flown the 3,141-mile route via car to Mineola, New York then flown on air mail to Los Angeles via San Francisco . The pneumonic plague is the only form of the plague capable of person-to-person transmission , which occurs during droplet-respiration , or breathing , as opposed to other forms of the plague. The 1924 Los Angeles pneumonic plague outbreak was the last instance of aerosol transmission of the plague in the United States. A person is infected when they breathe in particles of Yersinia pestis , a bacterium transmitted by rat fleas , in the air. Alternatively, if the bubonic plague (another form of the plague) goes untreated, the bacteria can spread to the lungs through the bloodstream and cause a secondary case of the pneumonic plague. Between 1900 and 2009, there were 1,001 reported cases of pneumonic plague, of which 81% occurred before 1943, when effective antibiotics , such as doxycycline , ciprofloxacin , and levofloxacin became widely available. In that time period, 92% of cases were fatal. The pneumonic plague's potency of person-to-person transmission is disputed – it is agreed that Yersinia pestis can spread the pneumonic plague through aerosol transmission of infected droplets , and the bacterium can survive in the air for up to one hour in optimum conditions. Somebody exposed to someone infected with the pneumonic plague can fall ill within 1 to 6 days. However, Jacob L. Kool objects to the supposed high risk of person-to-person transmission in an article titled ""Risk of Person‐to‐Person Transmission of Pneumonic Plague" in Clinical Infectious Diseases , stating that people are only at risk of exposure to the plague when the disease has progressed to its end stage and the infected begin coughing bloody sputum . Even then, direct and close contact within six feet is required for the plague to spread, according to the Centers for Disease Control and Prevention 's National Center for Emerging and Zoonotic Infectious Diseases. Transmission can be prevented by tight-fitting surgical masks and social distancing . Only 11% of patients that contracted the disease actually spread it to another person. After the 1924 outbreak in Los Angeles, there have been no secondary transmissions (transmission of the disease from a secondary case). Bodily fluids and tissue of an infected animal can still transmit the plague to humans through direct contact if handled improperly, but this is exceedingly rare: today, the World Health Organization reports only 1,000 to 3,000 cases of the plague annually. Zoonosis is often the direct result of an epizootic , a flare-up of a disease in animals analogous to a human epidemic . Though the plague is most common in rural and semi-arid regions of the western United States , epizootics are frequent among rodents in big cities and urban areas with large, diverse specimen populations, as exemplified in this outbreak, the last urban plague epizootic. The pneumonic plague primarily affects the lungs, and common symptoms include fatigue , fever , and pneumonia , the latter of which in turn can cause chest pain , coughing , hemoptysis (bloody sputum), and shortness of breath . The plague may also cause abdominal pain , nausea , and vomiting . If antibiotic treatments, which were not available until 1943, are not administered within 24 hours of the onset of symptoms, the plague will often progress into respiratory failure , shock , and death . The pneumonic plague is diagnosed after evaluation by a healthcare worker and a laboratory test of the patient's blood , lymph node aspirate , or sputum confirms infection. The plague can be treated with a therapeutic antiserum , a treatment first initiated in 1896 by Alexandre Yersin , a bacteriologist , physician , and co-discoverer of Yersinia pestis as the causative bacterium of the plague. The efficacy of antiserum is disputed but it is generally accepted to be successful in mitigating negative effects of the plague: the mortality rates for antiserum-treated patients was 35%, as opposed to 82% for untreated patients. In the 1924 Los Angeles outbreak, the serum was only successfully used on two patients, Mary Costello and Raul Samarano, remaining largely unused. At the time, it was only produced by H.K. Mulford Company laboratories in Philadelphia, Pennsylvania , but was quickly flown the 3,141-mile route via car to Mineola, New York then flown on air mail to Los Angeles via San Francisco . The government of Los Angeles consistently ensured that the pneumonic plague outbreak never became public. On October 29, Yersinia pestis , the bacterium causing the plague , was found in the lungs of a plague victim, a finding not released to the public until after the outbreak. As cases piled up, a telegram sent on October 31 recommended federal aid for the city of Los Angeles , replacing the terms "pneumonic plague," "death," and "situation" with code "ekkil," "begos," and "ethos," respectively. Government officials knew the outbreak was attributed to the pneumonic plague well before October 30, when it was first labeled in official government documents. Secretary of the State Board of Health Doctor Walter Dickie conducted a test on a guinea pig with a lymph node sample taken from Jesus Lajun before he died. The guinea pig died from the pneumonic plague, yet it took 17 days for an announcement confirming the outbreak was the fault of the plague. In spite of significant delays in medical announcements, significant preventative measures were still enacted: a quarantine of the eight blocks surrounding Jesús Lajun's residence was quickly imposed, affecting roughly 2,500 residents, most of whom were Mexican immigrants . Medical personnel traveled to each house inspecting residents for signs and symptoms of the plague. Two years following the outbreak's conclusion, Dickie reported to Governor of California Friend W. Richardson commending the response to the outbreak as "the most outstanding accomplishment" of the year, which was questioned as "historical drift" by Arthur J. Viseltear in a 1974 article published in Yale Journal of Biology and Medicine . Los Angeles media coverage of the plague was considered vague compared to that of media outside of the city, often attributing the outbreak to pneumonia , as seen in a subheading in the Los Angeles Examiner reading "Officials Believe Virulent Pneumonia Outbreak Controlled" and a headline in the Los Angeles Times reading "Seven are Dead from Pneumonia," both of which published on November 3. The plague was not referred to by name until November 6, by which time the plague was practically over. Many Los Angeles newspapers also incorrectly depicted Belvedere Gardens and the Macy Street District , both heavily populated by Mexican immigrants , as separate from the City of Los Angeles . Any news reports that did refer to the outbreak by name often portrayed Mexican Americans and their respective neighborhoods as 'menaces.' By comparison, The New York Times and The Washington Post both referred to the plague by name, even comparing it to the Black Death of the 14th century. Several newspapers outside of Los Angeles covered the deployment of the plague antiserum in early November in detail, including the Chicago Tribune ; The Evening World ; Herald & Review ; The Indianapolis Times ; Moon-Journal of Battle Creek, Michigan ; New York World ; The Philadelphia Bulletin ; The Philadelphia Inquirer ; The Philadelphia North American ; Public Ledger ; San Francisco Daily News ; and the San Francisco Evening Bulletin . The city's handling of the outbreak reinforced the widespread stereotype that Mexicans were poor and of a degraded class. Due to cramped and often illegal living conditions, rats were prevalent in majority Hispanic neighborhoods , cultivating the belief that the plague was an ethnic trait, as exemplified in a University of California, Los Angeles professor who claimed that Mexicans have a tendency to "huddle together" and therefore spread disease. Institutional racism and poverty also advanced the spread of the plague, as overcrowding , poor ventilation , poor sanitization, and high rodent populations often exacerbate the spread and harshness of the plague. In 1924, Mexican immigrants made up the largest ethnic group living in often dense and unsafe work camps, which flourished under widespread sentiment against Mexican immigrants and workers . Employment discrimination was also frequent as Mexicans were viewed as cheap and expendable, and many perceived Mexican Americans being relegated to working in factories and agricultural fields enclosing Los Angeles . On November 9, 200 Mexican workers at the Biltmore Hotel , most of whom did not live in the Macy Street District, were rehired after previously and controversially being fired. Several Mexican residents believed that quarantine guards and the over 200 armed veterans enforcing the quarantine were holding them against their will. Mexican men often had to convert from Catholicism to Protestantism to be respected, while Mexican women were societally obligated to be trained in proper housekeeping. These racist sentiments were possibly the fault of the misdiagnosis of Jesus Lajun's cause of death as a sexually transmitted infection and bronchopneumonia . After the plague, health officials recognized the need for programs encouraging safe hygiene practices among the Mexican population. Health officials blamed the plague outbreak on Mexicans' supposed ignorance of proper hygiene , despite actually being the fault of notoriously inferior living conditions and poverty in the Macy Street District . Some health officials even blamed the outbreak itself entirely on Mexican Americans, which Feldinger argues reinforced the pro- segregation views widely held at the time. The response also failed to provide vital access to clean water and sanitary disposal . After the 1900–1904 San Francisco bubonic plague outbreak , squirrels carrying fleas with the Yersinia pestis bacteria were found all throughout California . At the time, it was widely believed that rodents or small animals were directly responsible for spreading the plague , rather than fleas . In response, the City of Los Angeles hired people to systematically eradicate or tag rodents , primarily targeting squirrels. Following the Los Angeles outbreak, the City of Los Angeles began a citywide rat and ground squirrel extermination program. On November 15, Doctor Walter Dickie announced an ordinance requiring Los Angeles residents to maintain a clean household. Violations could result in the destruction of said private property, a consequence that devastated Mexicans. A committee dedicated to the eradication of rats received $250,000 in funding between November 1924 and July 1925 and $500,000 between July 1925 and July 1926. The city established a rat bounty and infected rats were found Downtown , in Beverly Hills , and at the harbor . The city lifted houses 18 inches above the ground and ripped off their siding to allow stray cats and dogs to eat infected rats. Buildings were also sprayed with hydrogen cyanide , rodenticide , and sulfur . Health officials also burned lumber, clothing, and garbage. Today, only 5 to 15 cases of the plague are reported annually in the western United States , and naturally occurring pneumonic plague is practically nonexistent. The government of Los Angeles consistently ensured that the pneumonic plague outbreak never became public. On October 29, Yersinia pestis , the bacterium causing the plague , was found in the lungs of a plague victim, a finding not released to the public until after the outbreak. As cases piled up, a telegram sent on October 31 recommended federal aid for the city of Los Angeles , replacing the terms "pneumonic plague," "death," and "situation" with code "ekkil," "begos," and "ethos," respectively. Government officials knew the outbreak was attributed to the pneumonic plague well before October 30, when it was first labeled in official government documents. Secretary of the State Board of Health Doctor Walter Dickie conducted a test on a guinea pig with a lymph node sample taken from Jesus Lajun before he died. The guinea pig died from the pneumonic plague, yet it took 17 days for an announcement confirming the outbreak was the fault of the plague. In spite of significant delays in medical announcements, significant preventative measures were still enacted: a quarantine of the eight blocks surrounding Jesús Lajun's residence was quickly imposed, affecting roughly 2,500 residents, most of whom were Mexican immigrants . Medical personnel traveled to each house inspecting residents for signs and symptoms of the plague. Two years following the outbreak's conclusion, Dickie reported to Governor of California Friend W. Richardson commending the response to the outbreak as "the most outstanding accomplishment" of the year, which was questioned as "historical drift" by Arthur J. Viseltear in a 1974 article published in Yale Journal of Biology and Medicine . Los Angeles media coverage of the plague was considered vague compared to that of media outside of the city, often attributing the outbreak to pneumonia , as seen in a subheading in the Los Angeles Examiner reading "Officials Believe Virulent Pneumonia Outbreak Controlled" and a headline in the Los Angeles Times reading "Seven are Dead from Pneumonia," both of which published on November 3. The plague was not referred to by name until November 6, by which time the plague was practically over. Many Los Angeles newspapers also incorrectly depicted Belvedere Gardens and the Macy Street District , both heavily populated by Mexican immigrants , as separate from the City of Los Angeles . Any news reports that did refer to the outbreak by name often portrayed Mexican Americans and their respective neighborhoods as 'menaces.' By comparison, The New York Times and The Washington Post both referred to the plague by name, even comparing it to the Black Death of the 14th century. Several newspapers outside of Los Angeles covered the deployment of the plague antiserum in early November in detail, including the Chicago Tribune ; The Evening World ; Herald & Review ; The Indianapolis Times ; Moon-Journal of Battle Creek, Michigan ; New York World ; The Philadelphia Bulletin ; The Philadelphia Inquirer ; The Philadelphia North American ; Public Ledger ; San Francisco Daily News ; and the San Francisco Evening Bulletin . The city's handling of the outbreak reinforced the widespread stereotype that Mexicans were poor and of a degraded class. Due to cramped and often illegal living conditions, rats were prevalent in majority Hispanic neighborhoods , cultivating the belief that the plague was an ethnic trait, as exemplified in a University of California, Los Angeles professor who claimed that Mexicans have a tendency to "huddle together" and therefore spread disease. Institutional racism and poverty also advanced the spread of the plague, as overcrowding , poor ventilation , poor sanitization, and high rodent populations often exacerbate the spread and harshness of the plague. In 1924, Mexican immigrants made up the largest ethnic group living in often dense and unsafe work camps, which flourished under widespread sentiment against Mexican immigrants and workers . Employment discrimination was also frequent as Mexicans were viewed as cheap and expendable, and many perceived Mexican Americans being relegated to working in factories and agricultural fields enclosing Los Angeles . On November 9, 200 Mexican workers at the Biltmore Hotel , most of whom did not live in the Macy Street District, were rehired after previously and controversially being fired. Several Mexican residents believed that quarantine guards and the over 200 armed veterans enforcing the quarantine were holding them against their will. Mexican men often had to convert from Catholicism to Protestantism to be respected, while Mexican women were societally obligated to be trained in proper housekeeping. These racist sentiments were possibly the fault of the misdiagnosis of Jesus Lajun's cause of death as a sexually transmitted infection and bronchopneumonia . After the plague, health officials recognized the need for programs encouraging safe hygiene practices among the Mexican population. Health officials blamed the plague outbreak on Mexicans' supposed ignorance of proper hygiene , despite actually being the fault of notoriously inferior living conditions and poverty in the Macy Street District . Some health officials even blamed the outbreak itself entirely on Mexican Americans, which Feldinger argues reinforced the pro- segregation views widely held at the time. The response also failed to provide vital access to clean water and sanitary disposal . After the 1900–1904 San Francisco bubonic plague outbreak , squirrels carrying fleas with the Yersinia pestis bacteria were found all throughout California . At the time, it was widely believed that rodents or small animals were directly responsible for spreading the plague , rather than fleas . In response, the City of Los Angeles hired people to systematically eradicate or tag rodents , primarily targeting squirrels. Following the Los Angeles outbreak, the City of Los Angeles began a citywide rat and ground squirrel extermination program. On November 15, Doctor Walter Dickie announced an ordinance requiring Los Angeles residents to maintain a clean household. Violations could result in the destruction of said private property, a consequence that devastated Mexicans. A committee dedicated to the eradication of rats received $250,000 in funding between November 1924 and July 1925 and $500,000 between July 1925 and July 1926. The city established a rat bounty and infected rats were found Downtown , in Beverly Hills , and at the harbor . The city lifted houses 18 inches above the ground and ripped off their siding to allow stray cats and dogs to eat infected rats. Buildings were also sprayed with hydrogen cyanide , rodenticide , and sulfur . Health officials also burned lumber, clothing, and garbage. Today, only 5 to 15 cases of the plague are reported annually in the western United States , and naturally occurring pneumonic plague is practically nonexistent.

Wiki

Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Acral_necrosis/html

Acral necrosis

Acral necrosis is a symptom common in bubonic plague . The striking black discoloration of skin and tissue, primarily on the extremities ("acral"), is commonly thought to have given rise to the name " Black Death ," associated both with the disease and the pandemic which occurred in the 14th century. The term in fact came from the figural sense of "black", that is ghastly, lugubrious or dreadful. Acral necrosis may be a symptom of other diseases too. It also has been observed as an adverse event related to a medical treatment. Clotting and bleeding beneath the skin cause an area of haemorrhage, the presence of red blood cells lying outside of capillaries, into the skin and subcutaneous tissue. In isolation, this is called an ecchymosis or bruise and may be the result of injury or illness. However, acral necrosis occurs when blood supply is disrupted for prolonged periods, blackening and damaging the affected area and surrounding tissue. With appropriate medical treatment, areas with acral necrosis may be successfully restored to function and lead a normal life. Untreated cases can lead to death. [ citation needed ]

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Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Kitasato_Shibasaburō/html

Kitasato Shibasaburō

Baron Kitasato Shibasaburō ( 北里 柴三郎 , January 29 [O.S. 17 January] , 1853 – June 13, 1931) was a Japanese physician and bacteriologist . He is remembered as the co-discoverer of the infectious agent of bubonic plague in Hong Kong during an outbreak in 1894, almost simultaneously with Alexandre Yersin . Kitasato was nominated for the first annual Nobel Prize in Physiology or Medicine in 1901. Kitasato and Emil von Behring , working together in Berlin in 1890, announced the discovery of diphtheria antitoxin serum. Von Behring was awarded the 1901 Nobel Prize because of this work, but Kitasato was not.Kitasato was born in Okuni village, Higo Province , (present-day Oguni Town , Kumamoto Prefecture , Kyūshū ), the son of Kitasato Korenobu, a village head , and Tei, the daughter of a samurai . His parents were strict about his education and sent him to a relative's home and requested rigid discipline. He is said to have inherited his leadership qualities from his mother. He was educated at Kumamoto Medical School and Tokyo Imperial University . He studied under Robert Koch in the University of Berlin from 1885 to 1891. In 1889, he became the first person to grow the tetanus bacillus in pure culture , and in 1890 cooperated with Emil von Behring in developing a serum therapy for tetanus using this pure culture. He also worked on antitoxins for diphtheria and anthrax . Kitasato and Behring demonstrated the value of antitoxin in preventing disease by causing passive immunity to tetanus in an animal that received graded injections of blood serum from another animal infected with the disease. Kitasato's discoveries on tetanus and von Behring's work on diphtheria lead to the field of serotherapy, which has benefitted many, worldwide. After returning to Japan in 1891, he founded the Institute for Study of Infectious Diseases with the assistance of Fukuzawa Yukichi . One of his early assistants was August von Wassermann . Kitasato demonstrated how dead cultures can be used in vaccination . He also studied the mode of infection in tuberculosis . He traveled to Hong Kong in 1894 at the request of the Japanese government during an outbreak of the bubonic plague , and identified a bacterium that he concluded was causing the disease. Yersin, working separately, found the same organism several days later. Because Kitasato's initial reports were vague and somewhat contradictory, and later reports proved inaccurate, some scientific historians give Yersin sole credit for the discovery; while others advise dual credit. However, a thorough analysis of the morphology of the organism discovered by Kitasato by microbiologists determined that although his samples likely became contaminated with pneumococci later, leading to the conflicting reports from his laboratory, there is "little doubt that Kitasato did isolate, study, and reasonably characterize the plague bacillus" in Hong Kong and "should not be denied this credit". Four years later, Kitasato and his student Shiga Kiyoshi were able to isolate and describe the organism that caused dysentery . After his work on the Bubonic Plague in Hong Kong, Kitasato continued his work on infectious diseases by researching Northeast Asian epidemic plagues and in 1909, he presented a paper on Tuberculosis in Europe. In 1911, Kitasato found himself in Manchuria amidst one of their most severe pneumonic plagues studying its prevention, as he believed his purpose was to investigate the science behind public health and provide advancement in that field. When the Institute for Infectious Diseases was incorporated into Tokyo Imperial University in 1914, he resigned in protest and founded the Kitasato Institute (the forerunner of Kitasato University ), which he headed for the rest of his life. While Kitasato was still involved with the activities of the newly established institute, he also organized a new medical facility, in collaboration with Yukichi , that has since become a prominent center of medical learning in Japan. In September 1921, Kitasato founded, together with several medical scientists, the Sekisen Ken-onki Corporation, with the intention of manufacturing the most reliable clinical thermometer possible. The company was later renamed Terumo Corporation . Kitasato also was the first dean of medicine at Keio University , first president of the Japan Medical Association, and served on the House of Peers . He was ennobled with the title of danshaku ( baron ) in the kazoku peerage system in February 1924. Although Kitasato transitioned from actively studying disease to politics and conferences, he continued improving upon his work on tuberculosis up until his death and made significant contributions in the realm of public health. Kitasato was elected an International Member of the American Philosophical Society in 1914. Kitasato Shibasaburō died of an intracranial hemorrhage at his home in Azabu , Tokyo , on June 13, 1931. His grave is at the Aoyama Cemetery in Tokyo. His portrait is going to be used in new 1,000 yen banknotes scheduled to be issued in 2024.

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Bubonic plague

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Oriental rat flea

The Oriental rat flea ( Xenopsylla cheopis ), also known as the tropical rat flea or the rat flea , is a parasite of rodents , primarily of the genus Rattus , and is a primary vector for bubonic plague and murine typhus . This occurs when a flea that has fed on an infected rodent bites a human, although this flea can live on any warm blooded mammal. The Oriental rat flea has no genal or pronotal combs. This characteristic can be used to differentiate the Oriental rat flea from the cat flea , dog flea , and other fleas . The flea's body is about one tenth of an inch long (about 2.5 mm ). Its body is constructed to make it easier to jump long distances. The flea's body consists of three regions: head, thorax, and abdomen. The head and the thorax have rows of bristles (called combs), and the abdomen consists of eight visible segments. A flea's mouth has two functions: one for squirting saliva or partly digested blood into the bite, and one for sucking up blood from the host. This process mechanically transmits pathogens that may cause diseases it might carry. Fleas smell exhaled carbon dioxide from humans and animals and jump rapidly to the source to feed on the newly found host. The flea is wingless so it can not fly, but it can jump long distances with the help of small, powerful legs. A flea's leg consists of four parts: the part that is closest to the body is the coxa; next are the femur, tibia, and tarsus. A flea can use its legs to jump up to 200 times its own body length (about 20 in or 50 cm ). [ citation needed ]There are four stages in a flea's life. The first stage is the egg stage. Microscopic white eggs fall easily from the female to the ground or from the animal she lays on. If they are laid on an animal, they soon fall off in the dust or in the animal's bedding. If the eggs do fall immediately on the ground, then they fall into crevices on the floor where they will be safe until they hatch one to ten days later (depending on the environment that they live in, it may take longer to hatch). They hatch into a larva that looks very similar to a worm and is about two millimeters long. It only has a small body and a mouth part. At this stage, the flea does not drink blood; instead it eats dead skin cells, flea droppings, and other smaller parasites lying around them in the dust. When the larva is mature it makes a silken cocoon around itself and pupates . The flea remains a pupa from one week to six months changing in a process called metamorphosis . When the flea emerges, it begins the final cycle, called the adult stage. A flea can now suck blood from hosts and mate with other fleas. A single female flea can mate once and lay eggs every day with up to 50 eggs per day. [ citation needed ] Experimentally, it has been shown that the fleas flourish in dry climatic conditions with temperatures of 20–25 °C (68–77 °F) , they can live up to a year and can stay in the cocoon stage for up to a year if the conditions are not favourable.The Oriental rat flea was collected in Shendi , Sudan by Charles Rothschild along with Karl Jordan and described in 1903. He named it cheopis after the Cheops pyramids . This species can act as a vector for plague , Yersinia pestis , Rickettsia typhi and also act as a host for the tapeworms Hymenolepis diminuta and Hymenolepis nana . Diseases can be transmitted from one generation of fleas to the next through the eggs.

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Bubonic plague

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Fourteen Holy Helpers

The Fourteen Holy Helpers ( German : Vierzehn Nothelfer , Latin : Quattuordecim auxiliatores ) are a group of saints venerated together by Catholics because their intercession is believed to be particularly effective, especially against various diseases. This group of Nothelfer ("helpers in need") originated in the 14th century at first in the Rhineland , largely as a result of the epidemic (probably of bubonic plague ) that became known as the Black Death .Devotion to the fourteen Holy Helpers began in Rhineland , now part of Germany, in the time of the Black Death . Among the fourteen were three virgin martyrs . A German mnemonic for them says: Margaretha mit dem Wurm, Barbara mit dem Turm, Katharina mit dem Radl das sind die drei heiligen Madl. ("Margaret with the lindworm , Barbara with the tower, Catherine with the wheel, those are the three holy maids.") As the other saints began to be invoked along with these three virgin martyrs, they were represented together in works of art. Popular veneration of these saints often began in a monastery that held their relics . All of the saints except Giles were accounted martyrs . Saint Christopher and Saint Giles were invoked against the plague itself. Saint Denis was prayed to for relief from headache, Saint Blaise against ills of the throat, Saint Elmo , against abdominal maladies, Saint Barbara against fever, and Saint Vitus against epilepsy. Saint Pantaleon was the patron of physicians, Saint Cyriacus invoked against temptation on the deathbed, and Saints Christopher, Barbara, and Catherine for protection against a sudden and unprovided-for death. Saint Giles was prayed to for a good confession, and Saint Eustace as healer of family troubles. Domestic animals were also attacked by the plague, and so Saints George , Elmo, Pantaleon, and Vitus were invoked for their protection. Saint Margaret of Antioch is the patron of safe childbirth. As the saints' joint cultus spread in the fifteenth century, Pope Nicholas V attached indulgences to devotion of the Fourteen Holy Helpers, though these no longer apply. While each had a separate feast day, the Fourteen Holy Helpers were in some places celebrated as a group on 8 August, but this celebration never became part of the General Roman Calendar for universal veneration. When that calendar was revised in 1969, the individual celebrations of St Barbara, St Catherine of Alexandria, St Christopher, and St Margaret of Antioch were dropped, but in 2004 Pope John Paul II reinstated the 25 November optional memorial of Catherine of Alexandria, whose voice was heard by Saint Joan of Arc . The individual celebrations of all fourteen are included in the General Roman Calendar as in 1954 , the General Roman Calendar of Pope Pius XII and the General Roman Calendar of 1960 . Comparable to the devotion of the Fourteen Holy Helpers was that of the Four Holy Marshals , who were also venerated in the Rhineland as "Marshals of God". These were Quirinus of Neuss , Saint Anthony the Great , Pope Cornelius , and Saint Hubert . The fourteen saints are: Half the saints are regarded as historical figures (Blaise, Cyriacus, Erasmus, George, Giles, Pantaleon, Vitus) while the other may be only legends (Agathius, Barbara, Catherine of Alexandria, Christopher, Denis, Eustace, Margaret of Antioch). In the case of the latter group, their supposed "legendary" status is primarily based on analysis of the saints' traditional hagiographies alone with out due consideration of other possibilities and interpretations, as well as the changes associated with the Mysterii Paschalis , irrespective of which changes actually applied to these particular saints — in the instance of the Fourteen Holy Helpers, while the feasts were in several cases removed from the General Roman Calendar , none were decanonized or were denied as having existed to begin with (furthermore, their feasts remain on particular calendars ). For one or another of the saints in the original set, Anthony the Anchorite , Leonard of Noblac , Nicholas , Sebastian , Oswald the King , Pope Sixtus II , Apollonia , Dorothea of Caesarea , Wolfgang of Regensburg or Roch were sometimes substituted. In France an extra "helper" is added: the Virgin Mary . The Fourteen Holy Helpers are honored in Bavaria as the vierzehn Heiligen , and the Basilica of the Vierzehnheiligen is dedicated to these auxiliary saints. The Rococo pilgrimage church near the town of Bad Staffelstein was designed by Balthasar Neumann and built between 1743 and 1772. Devotion to these saints began in that region on 24 September 1445 when Hermann Leicht, the young shepherd of a nearby Franciscan monastery, saw a crying child in a field that belonged to the nearby Cistercian monastery of Langheim. As he bent down to pick up the child, it abruptly disappeared. A short time later, the child reappeared in the same spot. This time, two candles were burning next to it. In June 1446, Leicht saw the child a third time. This time, the child bore a red cross on its chest and was accompanied by thirteen other children. The child said: "We are the fourteen helpers and wish to erect a chapel here, where we can rest. If you will be our servant, we will be yours!" Shortly after, Leicht saw two burning candles descending to this spot. It is alleged that miraculous healings soon began, through the intervention of the fourteen saints. The Cistercian brothers to whom the land belonged erected a chapel, which immediately attracted pilgrims. An altar was consecrated as early as 1448. Pilgrimages to the Vierzehnheiligen continue to the present day between May and October.One of the group depictions of the fourteen Saints is a 1503 altarpiece by Matthias Grünewald for the monastery in Lichtenfels in Upper Franconia . The fourteen angels of the lost children's prayer in Engelbert Humperdinck 's fairy opera , Hansel and Gretel , symbolize the Fourteen Holy Helpers. The English words are familiar: When at night I go to sleep, Fourteen angels watch do keep, Two my head are guarding, Two my feet are guiding; Two upon my right hand, Two upon my left hand. Two who warmly cover Two who o'er me hover, Two to whom 'tis given To guide my steps to heaven.

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Bubonic plague

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Franco Mormando

Historian Franco Mormando (born 17 August 1955) is a historian, university professor, and author, focusing on the art , literature , and religious culture of Italy from the late Medieval period to the Baroque . His principal publications have been on fifteenth-century preacher Bernardino of Siena and Baroque artist Gian Lorenzo Bernini , with other notable contributions to the study of the artist Caravaggio and the bubonic plague .Mormando was born and raised in New York City , in Manhattan 's Lower East Side , of Italian immigrant parents. His undergraduate education was at Columbia University , where he was a John Jay National Scholar, receiving his B.A. (1977) summa cum laude and Phi Beta Kappa. At Columbia, he also received the Bigongiari Award for Excellence in Italian Studies. From Columbia, he went on to Harvard University , where he received both his M.A. (1979) and Ph.D. (1983) in Italian literature , with a dissertation on The Vernacular Sermons of Bernardino of Siena, OFM (1380-1444): A Literary Analysis . While at Harvard, he received the "Travel-Study Prize for Excellence in Teaching," from the Department of Romance Languages (May 1980) and the "Certificate of Distinction in Teaching" from the University Committee on Undergraduate Education" (December 1983). After graduating from Harvard, Mormando entered the Jesuit Order , where he furthered his education in the form of a two-year, non-degree study of philosophy ( Biennio di Filosofia ) at the Pontifical Gregorian University in Rome , Italy , and a five-year program at the Jesuit School of Theology at Berkeley, California , receiving a Master's of Divinity (1992) and the S.T.L. (or Licentiate of Sacred Theology, a pontifical degree) in Church History (1994). Mormando was ordained a priest in the Jesuit order but left the Society and the priesthood in 2002. After his studies in Berkeley, Mormando obtained (July 1994) a full-time tenure-track position in the Department of Romance Languages and Literatures at Boston College , where he has been since, now at the rank of full professor, and where he also serves as the department's chairperson. He also holds an affiliate position in the university's History Department. A popular lecturer on Italian art to general audiences, Mormando has made presentations at the Metropolitan Museum and Frick Museum of New York ; the Museum of Fine Arts, Boston ; the National Gallery of Art , Washington, D.C. ; the Galleria Borghese , Rome ; the Kimbell Art Museum , Fort Worth, Texas ; the Phoenix Art Museum ; the Istituto Italiano di Cultura ( San Francisco ); the Italian Embassy in Washington, D.C. ; and Harvard and Yale Universities . On October 12, 2005, he was awarded the title of Cavaliere (Knight) in the honorary Order of the Star of Italy , conferred by the President of Italy in recognition of achievement in the promotion of Italian language and culture . Mormando's first scholarly publication was published in 1999 by the University of Chicago Press : The Preacher's Demons: Bernardino of Siena and the Social Underworld of Early Renaissance Italy , an extensive study of the preaching campaigns of the popular Franciscan preacher Bernardino , "the voice most eagerly listened to" and "perhaps the most influential religious force" in Italy during his lifetime. A study of the preacher's vociferous and at time violent campaigns against witches, sodomites, and Jews, all seen as dangerous enemies of Christian society, Mormando's book singlehandedly overturned the prevailing image of Bernardino as a benevolent, reassuring, pacific presence in late medieval /early Renaissance Italy , in contrast to the later preacher Girolamo Savonarola . Cornell University historian Richard Trexler noted in his review of Mormando's monograph: "As is clearly shown in this well-written, thoroughly documented study, few historical figures of fifteenth-century Italy have come up smelling like roses at the hands of historians quite like the Observant Franciscan, Bernardino of Siena. But in fact, Bernardino was a rhetorical assassin, encouraging his listeners to denounce, and even to kill those who did not meet with his approval." The Preacher's Demons went on to win the prestigious Howard R. Marraro Prize for Distinguished Scholarship in Italian History, conferred (January 2001) by the American Catholic Historical Association . In the same years that he was completing The Preacher's Demons , Mormando was busy organizing at Boston College 's McMullen Museum of Art a major art exhibition of Italian Baroque art , conceived by him and entitled Saints and Sinners: Caravaggio and the Baroque Image Opening in February 1999, Saints and Sinners had at its centerpiece the long-lost painting by Baroque artist , Michelangelo Merisi da Caravaggio , The Taking of Christ (Rome, 1602), discovered in a Jesuit residence in Dublin , Ireland , and subsequently given on indefinite loan to the National Gallery of Ireland . Mormando's exhibition represented the first appearance of the newly-discovered painting in North America and, as such, garnered much attention from the world press and was visited by many thousands of people in its four-month run. In addition to introducing the North American public to the painting, the aim of Saints and Sinners was to place Caravaggio within the context of early modern conventions and the traditions of religious art ; in other words, while acknowledging his at times unconventional manner and maverick ways, it stressed his direct connection to the familiar tradition of religious art. Edited by Mormando, the exhibition catalog featured original scholarship by leading experts in Baroque art and culture, including one by Sergio Benedetti (the Dublin conservator who rediscovered and restored the painting) and two essays by Mormando, "Teaching the Faithful to Fly: Mary Magdalene and Peter in Baroque Italy" and "Just as your lips approach the lips of your brothers: Judas Iscariot and the Kiss of Betrayal." Both essays represent surveys and analyses of extensive primary sources to discover what Caravaggio's original audience would have been taught about these three figures of New Testament history that are featured prominently in his art. Several years later, Mormando conceived and organized, with some of the same colleagues who put together the Saints and Sinners exhibition, another art exhibition of early modern Italian painting entitled Hope and Healing: Painting in Italy in a Time of Plague, 1500-1800 (Worcester Art Museum, April–September 2005). The exhibition aimed to illustrate the hitherto-unrecognized deep and wide presence of the bubonic plague in Old Master Italian painting, as well as the civic role of art in a time of the pandemic. The exhibition's catalog features essays by some of the leading scholars of the history of bubonic plague in Europe , including a long introduction by Mormando based on an extensive survey of primary sources, "Response to the Plague in Early Modern Italy: What the Primary Sources, Printed and Painted, Reveal." The exhibition was followed by a later companion volume, co-edited by Mormando, Piety and Plague: From Byzantium and the Baroque (Kirksville, MO: Truman State University Press, 2007), which extended the chronological and thematic breadth of the exhibition. Mormando's contribution to the volume was a seventy-five-page essay, "Pestilence, Apostasy, and Heresy in Seventeenth-Century Rome: Deciphering Michael Sweerts' Plague in an Ancient City ," in which he offers for the first time in the scholarship on that Flemish painter an answer to the long-standing question: What is the real subject of Sweerts's mysterious painting? In the most recent phase of his evolving scholarly interests and publication, Mormando has turned his attention to the leading artist of Roman Baroque art and one of the most important influences on all of early modern European sculpture and architecture , Gian Lorenzo Bernini (1598-1680). His first work on Bernini was the first unabridged English translation and critical edition of one of the early biographical sources for the life of the artist, written by his youngest son : Domenico Bernini's Life of Gian Lorenzo Bernini (University Park, PA: Pennsylvania State University Press, 2011). Containing close to two hundred pages of source notes and a bibliography of over 600 titles, Mormando's Domenico Bernini edition, as the publisher's dustjacket explains, "is, in effect, a one-volume encyclopedia on the artist's life and work. As such, it stands alone within the immense bibliography of Bernini scholarship." Months after the publication of the Domenico Bernini volume, Mormando produced his own biography of Gian Lorenzo , Bernini: His Life and His Rome . As English art historian Claire Ford-Wille emphasizes in her review of the work, " Bernini: His Life and His Rome is a biography for the general reader […]. Nonetheless, the biography is underpinned by Mormando's immense and serious research and is packed with information […]." Drawing on many years of research in compiling his annotated Domenico Bernini volume, this subsequent work "can claim to be the first biography of Bernini to appear in the English and one of the very few to appear in any language since the artist's death in 1680;" it is also the first to make "the pursuit of 'Bernini himself,' the uncensored flesh-and-blood human being, one of its primary objectives." Departing in stark fashion from all of the previous, idealizing, hagiographic, uncritical portraits of Bernini of the preceding centuries, Bernini: His Life and His Rome has been criticized by a few readers for including so much unflattering, indeed, at times scandalous, information about Bernini and the people around him (including the popes and the cardinals who were his patrons), but, as the author himself points out in reply to these criticisms (in the online journal, Berfois of London, Oct. 11, 2012), all of the information in the book is documented in authentic primary sources. As Mormando further reports in the Berfois article, "[W]hen I first took up my Bernini biographical project [in 2000] and for a long time into it (it took eleven years to complete), I too simply accepted the conventional wisdom, the aforementioned clichés about Bernini, his religion and his art. Yet, the more I studied and uncovered the falsifications of Domenico's biography, the more I discovered the skeletons in the life of Bernini, and the more I read of the darker side of his seventeenth-century contemporaries, be they pope, cardinals, or laymen, the more skeptical I became of the myth of Bernini and of his 'Roma Sancta.' Hence, the present call to a more critical approach to the study of Bernini and his art and of his ecclesiastical patrons." Describing the development of Bernini scholarship in modern times, author Loyd Grossman places Mormando in the same company as Rudolph Wittkower, John Pope-Hennessy and Irving Lavin, declaring: "Among today's scholars no one has done more to promote Bernini studies than [Franco] Mormando as author of the only English language biography of Bernini and through his magnificent editing of Domenico Bernini's life of his father." In addition to his book and articles on Franciscan topics, Mormando has also made Jesuit studies another one of his secondary specializations. In 2006, on the occasion of the anniversary of the Jesuit saint 's death, Mormando organized an exhibition at the Burns Rare Book Library, Francis Xavier and the Jesuit Missions in the Far East , featuring the most important primary sources for the biography and canonization of 'the second Jesuit saint' (after Ignatius of Loyola ), and contributing an article on "The Making of the Second Jesuit Saint: The Campaign for the Canonization of Francis Xavier, 1555-1622." Mormando also contributed to the planning of a 2018 art exhibition conceived and organized by Linda Wolk-Simon at the Fairfield University Art Museum devoted to Jesuit Baroque art , The Holy Name. Art of the Gesù: Bernini and His Age . His essay, "Gian Paolo Oliva: The Forgotten Celebrity of Baroque Rome," in the accompanying catalog (published by Saint Joseph University Press ), presented the first major survey in English of the career of Jesuit Father General Oliva (1600-1681), a friend to and spiritual advisor to Gian Lorenzo Bernini . Most recently, Mormando has addressed the topic of "Ignatius the Franciscan: The Franciscan Roots of Jesuit Spirituality," overturning the received wisdom about the putative revolutionary, unique character of the spirituality and way of proceeding of the Jesuit order as founded by Ignatius of Loyola . Mormando's first scholarly publication was published in 1999 by the University of Chicago Press : The Preacher's Demons: Bernardino of Siena and the Social Underworld of Early Renaissance Italy , an extensive study of the preaching campaigns of the popular Franciscan preacher Bernardino , "the voice most eagerly listened to" and "perhaps the most influential religious force" in Italy during his lifetime. A study of the preacher's vociferous and at time violent campaigns against witches, sodomites, and Jews, all seen as dangerous enemies of Christian society, Mormando's book singlehandedly overturned the prevailing image of Bernardino as a benevolent, reassuring, pacific presence in late medieval /early Renaissance Italy , in contrast to the later preacher Girolamo Savonarola . Cornell University historian Richard Trexler noted in his review of Mormando's monograph: "As is clearly shown in this well-written, thoroughly documented study, few historical figures of fifteenth-century Italy have come up smelling like roses at the hands of historians quite like the Observant Franciscan, Bernardino of Siena. But in fact, Bernardino was a rhetorical assassin, encouraging his listeners to denounce, and even to kill those who did not meet with his approval." The Preacher's Demons went on to win the prestigious Howard R. Marraro Prize for Distinguished Scholarship in Italian History, conferred (January 2001) by the American Catholic Historical Association . In the same years that he was completing The Preacher's Demons , Mormando was busy organizing at Boston College 's McMullen Museum of Art a major art exhibition of Italian Baroque art , conceived by him and entitled Saints and Sinners: Caravaggio and the Baroque Image Opening in February 1999, Saints and Sinners had at its centerpiece the long-lost painting by Baroque artist , Michelangelo Merisi da Caravaggio , The Taking of Christ (Rome, 1602), discovered in a Jesuit residence in Dublin , Ireland , and subsequently given on indefinite loan to the National Gallery of Ireland . Mormando's exhibition represented the first appearance of the newly-discovered painting in North America and, as such, garnered much attention from the world press and was visited by many thousands of people in its four-month run. In addition to introducing the North American public to the painting, the aim of Saints and Sinners was to place Caravaggio within the context of early modern conventions and the traditions of religious art ; in other words, while acknowledging his at times unconventional manner and maverick ways, it stressed his direct connection to the familiar tradition of religious art. Edited by Mormando, the exhibition catalog featured original scholarship by leading experts in Baroque art and culture, including one by Sergio Benedetti (the Dublin conservator who rediscovered and restored the painting) and two essays by Mormando, "Teaching the Faithful to Fly: Mary Magdalene and Peter in Baroque Italy" and "Just as your lips approach the lips of your brothers: Judas Iscariot and the Kiss of Betrayal." Both essays represent surveys and analyses of extensive primary sources to discover what Caravaggio's original audience would have been taught about these three figures of New Testament history that are featured prominently in his art.Several years later, Mormando conceived and organized, with some of the same colleagues who put together the Saints and Sinners exhibition, another art exhibition of early modern Italian painting entitled Hope and Healing: Painting in Italy in a Time of Plague, 1500-1800 (Worcester Art Museum, April–September 2005). The exhibition aimed to illustrate the hitherto-unrecognized deep and wide presence of the bubonic plague in Old Master Italian painting, as well as the civic role of art in a time of the pandemic. The exhibition's catalog features essays by some of the leading scholars of the history of bubonic plague in Europe , including a long introduction by Mormando based on an extensive survey of primary sources, "Response to the Plague in Early Modern Italy: What the Primary Sources, Printed and Painted, Reveal." The exhibition was followed by a later companion volume, co-edited by Mormando, Piety and Plague: From Byzantium and the Baroque (Kirksville, MO: Truman State University Press, 2007), which extended the chronological and thematic breadth of the exhibition. Mormando's contribution to the volume was a seventy-five-page essay, "Pestilence, Apostasy, and Heresy in Seventeenth-Century Rome: Deciphering Michael Sweerts' Plague in an Ancient City ," in which he offers for the first time in the scholarship on that Flemish painter an answer to the long-standing question: What is the real subject of Sweerts's mysterious painting? In the most recent phase of his evolving scholarly interests and publication, Mormando has turned his attention to the leading artist of Roman Baroque art and one of the most important influences on all of early modern European sculpture and architecture , Gian Lorenzo Bernini (1598-1680). His first work on Bernini was the first unabridged English translation and critical edition of one of the early biographical sources for the life of the artist, written by his youngest son : Domenico Bernini's Life of Gian Lorenzo Bernini (University Park, PA: Pennsylvania State University Press, 2011). Containing close to two hundred pages of source notes and a bibliography of over 600 titles, Mormando's Domenico Bernini edition, as the publisher's dustjacket explains, "is, in effect, a one-volume encyclopedia on the artist's life and work. As such, it stands alone within the immense bibliography of Bernini scholarship." Months after the publication of the Domenico Bernini volume, Mormando produced his own biography of Gian Lorenzo , Bernini: His Life and His Rome . As English art historian Claire Ford-Wille emphasizes in her review of the work, " Bernini: His Life and His Rome is a biography for the general reader […]. Nonetheless, the biography is underpinned by Mormando's immense and serious research and is packed with information […]." Drawing on many years of research in compiling his annotated Domenico Bernini volume, this subsequent work "can claim to be the first biography of Bernini to appear in the English and one of the very few to appear in any language since the artist's death in 1680;" it is also the first to make "the pursuit of 'Bernini himself,' the uncensored flesh-and-blood human being, one of its primary objectives." Departing in stark fashion from all of the previous, idealizing, hagiographic, uncritical portraits of Bernini of the preceding centuries, Bernini: His Life and His Rome has been criticized by a few readers for including so much unflattering, indeed, at times scandalous, information about Bernini and the people around him (including the popes and the cardinals who were his patrons), but, as the author himself points out in reply to these criticisms (in the online journal, Berfois of London, Oct. 11, 2012), all of the information in the book is documented in authentic primary sources. As Mormando further reports in the Berfois article, "[W]hen I first took up my Bernini biographical project [in 2000] and for a long time into it (it took eleven years to complete), I too simply accepted the conventional wisdom, the aforementioned clichés about Bernini, his religion and his art. Yet, the more I studied and uncovered the falsifications of Domenico's biography, the more I discovered the skeletons in the life of Bernini, and the more I read of the darker side of his seventeenth-century contemporaries, be they pope, cardinals, or laymen, the more skeptical I became of the myth of Bernini and of his 'Roma Sancta.' Hence, the present call to a more critical approach to the study of Bernini and his art and of his ecclesiastical patrons." Describing the development of Bernini scholarship in modern times, author Loyd Grossman places Mormando in the same company as Rudolph Wittkower, John Pope-Hennessy and Irving Lavin, declaring: "Among today's scholars no one has done more to promote Bernini studies than [Franco] Mormando as author of the only English language biography of Bernini and through his magnificent editing of Domenico Bernini's life of his father." In addition to his book and articles on Franciscan topics, Mormando has also made Jesuit studies another one of his secondary specializations. In 2006, on the occasion of the anniversary of the Jesuit saint 's death, Mormando organized an exhibition at the Burns Rare Book Library, Francis Xavier and the Jesuit Missions in the Far East , featuring the most important primary sources for the biography and canonization of 'the second Jesuit saint' (after Ignatius of Loyola ), and contributing an article on "The Making of the Second Jesuit Saint: The Campaign for the Canonization of Francis Xavier, 1555-1622." Mormando also contributed to the planning of a 2018 art exhibition conceived and organized by Linda Wolk-Simon at the Fairfield University Art Museum devoted to Jesuit Baroque art , The Holy Name. Art of the Gesù: Bernini and His Age . His essay, "Gian Paolo Oliva: The Forgotten Celebrity of Baroque Rome," in the accompanying catalog (published by Saint Joseph University Press ), presented the first major survey in English of the career of Jesuit Father General Oliva (1600-1681), a friend to and spiritual advisor to Gian Lorenzo Bernini . Most recently, Mormando has addressed the topic of "Ignatius the Franciscan: The Franciscan Roots of Jesuit Spirituality," overturning the received wisdom about the putative revolutionary, unique character of the spirituality and way of proceeding of the Jesuit order as founded by Ignatius of Loyola .

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Bubonic plague

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Alexandre Yersin

Alexandre Emile Jean Yersin (22 September 1863 – 1 March 1943) was a Swiss - French physician and bacteriologist . He is remembered as the co-discoverer of the bacillus responsible for the bubonic plague or pest, which was later named in his honour: Yersinia pestis . Another bacteriologist, the Japanese physician Kitasato Shibasaburō , is often credited with independently identifying the bacterium a few days earlier. Yersin also demonstrated for the first time that the same bacillus was present in the rodent as well as in the human disease, thus underlining the possible means of transmission.Yersin was born in 1863 in Aubonne , in the canton of Vaud , Switzerland , as the posthumous son of Jean-Alexandre-Marc Yersin from his wife Fanny-Isaline-Emilie Moschell. From 1883 to 1884 he studied medicine at Lausanne , followed by Marburg , and Paris (1884–1886).In 1886, Yersin entered Louis Pasteur 's research laboratory at the École Normale Supérieure , by invitation of Emile Roux , and participated in the development of the anti- rabies serum. In 1888 he received his doctorate with a dissertation titled Étude sur le Développement du Tubercule Expérimental [Study on the Development of Experimental Tubercule] and spent two months with Robert Koch in Germany. He joined the recently created Pasteur Institute in 1889 as Roux's collaborator and discovered with him the diphtheric toxin , produced by the Corynebacterium diphtheriae bacillus. In order to practice medicine in France, Yersin applied for and obtained French nationality in 1888. Soon afterwards (1890), he left for French Indochina (current Vietnam, Laos and Cambodia) in Southeast Asia as a physician for the Messageries Maritimes company, on the Saigon - Manila line and then on the Saigon- Haiphong line. He participated in one of the Auguste Pavie missions. In 1894 Yersin was sent by request of the French government and the Pasteur Institute to Hong Kong , to investigate the plague happening there. There, in a small hut since he was denied access to British hospitals at his arrival, he made his greatest discovery: that of the pathogen which causes the disease. Dr Kitasato Shibasaburō , also in Hong Kong, had identified a bacterium several days earlier. There is controversy whether this was the same pneumococci or a mix of the two. Because Kitasato's initial reports were vague and somewhat contradictory, some give Yersin sole credit for the discovery. However, a 1976 thorough analysis of the morphology of the organism discovered by Kitasato determined that "we are confident that Kitasato had examined the plague bacillus in Hong Kong in late June and early July 1894", only days after Yersin announced his own discovery on 20 June, and that Kitasato "should not be denied this credit". The plague bacillus develops better at lower temperatures, so Yersin's less well-equipped lab turned out to be an advantage in the race with Kitasato, who used an incubator. Therefore, although at first named "Kitasato-Yersin bacillus" by the scientific community, the microbe will later assume only the latter's name because of the one identified by Kitasato, a type of streptococcus , cannot be found in the lymphatic glands . Yersin was also able to demonstrate for the first time that the same bacillus was present in the rodent as well as in the human disease, thus underlining the possible means of transmission. This important discovery was communicated to the French Academy of Sciences in the same year, by his colleague Emile Duclaux , in a classic paper titled "La peste bubonique à Hong-Kong". From 1895 to 1897, Yersin further pursued his studies on the bubonic plague. In 1895 he returned to the Institute Pasteur in Paris and with Émile Roux, Albert Calmette and Amédée Borrel , prepared the first anti-plague serum . In the same year, he returned to Indochina , where he installed a small laboratory at Nha Trang to manufacture the serum (in 1905 this laboratory became a branch of the Pasteur Institute). Yersin tried the serum received from Paris in Canton and Amoy , in 1896, and in Bombay , India , in 1897, with disappointing results. Having decided to stay in his country of adoption, he participated actively in the creation of the Medical School of Hanoi in 1902, and was its first director, until 1904. Yersin tried his hand at agriculture and was a pioneer in the cultivation of rubber trees ( Hevea brasiliensis ) imported from Brazil into Indochina. For this purpose, he obtained in 1897 a concession from the government to establish an agricultural station at Suoi Dau . He opened a new station at Hon Ba in 1915, where he tried to acclimatize the quinine tree ( Cinchona ledgeriana ), which was imported from the Andes in South America by the Spaniards , and which produced the first known effective remedy for preventing and treating malaria , a disease which prevails in Southeast Asia to this day. Alexandre Yersin is well remembered in Vietnam, where he was affectionately called Ông Năm (Mr Nam/Fifth) by the people. On 8 January 1902, Yersin was accredited to be the first Headmaster of Hanoi Medical University by the Governor-General of French Indochina , future president of France Paul Doumer . In 1934 he was nominated honorary director of Pasteur Institute and a member of its Board of Administration.He died at his home in Nha Trang , in 1943. Following the country's independence, streets named in his honor kept their designation and his tomb in Suoi Dau was graced by a pagoda where rites are performed in his worship. Yersin Market in Ho Chi Minh City was named after him. His house in Nha Trang is now the Yersin Museum , and the epitaph on his tombstone describes him as a "Benefactor and humanist, venerated by the Vietnamese people". In Hanoi , the Lycée français Alexandre Yersin , a French international school was named after him. A private university founded in 2004 in Da Lat was named "Yersin University" in his honour [Trường Đại Học Yersin Đà Lạt]. Dr Yersin was credited with founding the site for the new town of Da Lat in 1893. Because of the high altitude and European-like climate, Da Lat became an R&R spot for French officers. There was a high school named after him which was built in the 1920s, the Lycée Yersin , aka Grand Lycée (grade 6 to 12), the Petit Lycée (elementary to grade 5), and a university named after him which was built in the 2000s. While in Hong Kong, Yersin was helped in his research by an Italian priest of the PIME order named Bernardo Vigano. He provided cadavers and assisted with his quest to find a remedy for the plague.

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Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Post-classical_history/html

Post-classical history

In world history , post-classical history refers to the period from about 500 CE to 1500 CE, roughly corresponding to the European Middle Ages . The period is characterized by the expansion of civilizations geographically and the development of trade networks between civilizations. [upper-alpha 1] This period is also called the medieval era , post-antiquity era , post-ancient era , pre-modernity era , or pre-modern era . In Asia , the spread of Islam created a series of caliphates and inaugurated the Islamic Golden Age , leading to advances in science in the medieval Islamic world and trade among the Asian, African , and European continents. East Asia experienced the full establishment of the power of Imperial China , which established several prosperous dynasties influencing Japan, Korea, and Vietnam. Religions such as Buddhism and neo-Confucianism spread in the region. Gunpowder was developed in China during the post-classical era. The Mongol Empire connected Europe and Asia, creating safe trade and stability between the two regions. In total, the population of the world doubled in the time period, from approximately 210 million in 500 CE to 461 million in 1500 CE. The population generally grew steadily throughout the period but endured some incidental declines due to events including the Plague of Justinian , the Mongol invasions , and the Black Death . Post-classical history is a periodization used by historians employing a world history approach to history, specifically the school developed during the late 20th and early 21st centuries. Outside of world history, the term is also sometimes used to avoid erroneous pre-conceptions around the terms Middle Ages , Medieval and the Dark Ages (see medievalism ), though the application of the term post-classical on a global scale is also problematic, and may likewise be Eurocentric . Academic publications sometimes use the terms post-classical and late antiquity synomously to describe the history of Western Eurasia between 250 and 800 CE. The post-classical period corresponds roughly to the period from 500 CE to 1450 CE. Beginning and ending dates might vary depending on the region, with the period beginning at the end of the previous classical period: Han China (ending in 220 CE), the Western Roman Empire (in 476 CE), the Gupta Empire (in 543 CE), and the Sasanian Empire (in 651 CE). The post-classical period is one of the five or six major periods world historians use: Although post-classical is synonymous with the Middle Ages of Western Europe, the term post-classical is not necessarily a member of the traditional tripartite periodisation of Western European history into classical , middle and modern . The historical field of world history , which looks at common themes occurring across multiple cultures and regions, has enjoyed extensive development since the 1980s. However, World History research has tended to focus on early modern globalization (beginning around 1500) and subsequent developments, and views post-classical history as mainly pertaining to Afro-Eurasia . Historians recognize the difficulties of creating a periodization and identifying common themes that include not only this region but also, for example, the Americas, since they had little contact with Afro-Eurasia before the Columbian exchange . Thus researchers around the year 2020 emphasised that "a global history of the period between 500 and 1500 is still wanting" and that "historians have only just begun to embark on a global history of the Middle Ages". For many regions of the world, there are well established histories. Although medieval studies in Europe tended in the nineteenth century to focus on creating histories for individual nation-states, much twentieth-century research focused, successfully, on creating an integrated history of medieval Europe. The Islamic World likewise has a rich regional historiography, ranging from the fourteenth-century Ibn Khaldun to the twentieth-century Marshall Hodgson and beyond. Correspondingly, research into the network of commercial hubs which enabled goods and ideas to move between China in the East and the Atlantic islands in the West—which can be called the early history of globalization —is fairly advanced; one key historian in this field is Janet Abu-Lughod . Understanding of communication within Sub-Saharan Africa or the Americas is, by contrast, far more limited. Around the 2010s, therefore, researchers began to explore the possibilities of writing history covering the Old World, where human activities were fairly interconnected, and establish its relationship with other cultural spheres, such as the Americas and Oceania. In the assessment of James Belich , John Darwin , Margret Frenz, and Chris Wickham , Global history may be boundless, but global historians are not. Global history cannot usefully mean the history of everything, everywhere, all the time. [...] Three approaches [...] seem to us to have real promise. One is global history as the pursuit of significant historical problems across time, space, and specialism. This can sometimes be characterized as 'comparative' history . [...] Another is connectedness, including transnational relationships. [...] The third approach is the study of globalization [...]. Globalization is a term that needs to be rescued from the present, and salvaged for the past. To define it as always encompassing the whole planet is to mistake the current outcome for a very ancient process. A number of commentators have pointed to the history of the Earth's climate as a useful approach to World History in the Middle Ages, noting that certain climate events had effects on all human populations. Post-classical history is a periodization used by historians employing a world history approach to history, specifically the school developed during the late 20th and early 21st centuries. Outside of world history, the term is also sometimes used to avoid erroneous pre-conceptions around the terms Middle Ages , Medieval and the Dark Ages (see medievalism ), though the application of the term post-classical on a global scale is also problematic, and may likewise be Eurocentric . Academic publications sometimes use the terms post-classical and late antiquity synomously to describe the history of Western Eurasia between 250 and 800 CE. The post-classical period corresponds roughly to the period from 500 CE to 1450 CE. Beginning and ending dates might vary depending on the region, with the period beginning at the end of the previous classical period: Han China (ending in 220 CE), the Western Roman Empire (in 476 CE), the Gupta Empire (in 543 CE), and the Sasanian Empire (in 651 CE). The post-classical period is one of the five or six major periods world historians use: Although post-classical is synonymous with the Middle Ages of Western Europe, the term post-classical is not necessarily a member of the traditional tripartite periodisation of Western European history into classical , middle and modern .The historical field of world history , which looks at common themes occurring across multiple cultures and regions, has enjoyed extensive development since the 1980s. However, World History research has tended to focus on early modern globalization (beginning around 1500) and subsequent developments, and views post-classical history as mainly pertaining to Afro-Eurasia . Historians recognize the difficulties of creating a periodization and identifying common themes that include not only this region but also, for example, the Americas, since they had little contact with Afro-Eurasia before the Columbian exchange . Thus researchers around the year 2020 emphasised that "a global history of the period between 500 and 1500 is still wanting" and that "historians have only just begun to embark on a global history of the Middle Ages". For many regions of the world, there are well established histories. Although medieval studies in Europe tended in the nineteenth century to focus on creating histories for individual nation-states, much twentieth-century research focused, successfully, on creating an integrated history of medieval Europe. The Islamic World likewise has a rich regional historiography, ranging from the fourteenth-century Ibn Khaldun to the twentieth-century Marshall Hodgson and beyond. Correspondingly, research into the network of commercial hubs which enabled goods and ideas to move between China in the East and the Atlantic islands in the West—which can be called the early history of globalization —is fairly advanced; one key historian in this field is Janet Abu-Lughod . Understanding of communication within Sub-Saharan Africa or the Americas is, by contrast, far more limited. Around the 2010s, therefore, researchers began to explore the possibilities of writing history covering the Old World, where human activities were fairly interconnected, and establish its relationship with other cultural spheres, such as the Americas and Oceania. In the assessment of James Belich , John Darwin , Margret Frenz, and Chris Wickham , Global history may be boundless, but global historians are not. Global history cannot usefully mean the history of everything, everywhere, all the time. [...] Three approaches [...] seem to us to have real promise. One is global history as the pursuit of significant historical problems across time, space, and specialism. This can sometimes be characterized as 'comparative' history . [...] Another is connectedness, including transnational relationships. [...] The third approach is the study of globalization [...]. Globalization is a term that needs to be rescued from the present, and salvaged for the past. To define it as always encompassing the whole planet is to mistake the current outcome for a very ancient process. A number of commentators have pointed to the history of the Earth's climate as a useful approach to World History in the Middle Ages, noting that certain climate events had effects on all human populations. The post-classical era saw several common developments or themes. There was the expansion and growth of civilization into new geographic areas; the rise and/or spread of the three major world, or missionary, religions; and a period of rapidly expanding trade and trade networks. While scholastic emphasis has remained on Eurasia there is a growing effort to examine the effects of these global trends on other places. In describing geographic zones historians have identified three large self contained world regions, Afro-Eurasia, the Americas, and Oceania. [upper-alpha 2] First was the expansion and growth of civilization into new geographic areas across Asia , Africa , Europe , Mesoamerica , and western South America . However, as noted by world historian Peter N. Stearns , there were no common global political trends during the post-classical period, rather it was a period of loosely organized states and other developments, but no common political patterns emerged. In Asia, China continued its historic dynastic cycle and became more complex, improving its bureaucracy. The creation of the Islamic Empires established a new power in the Middle East, North Africa, and Central Asia . Africa created the Mali and Songhai Empires in the West. The fall of Roman civilization not only left a power vacuum for the Mediterranean and Europe, but forced certain areas to build what some historians might call new civilizations entirely. An entirely different political system was applied in Western Europe (i.e. feudalism ), as well as a different society (i.e. manorialism ). But the once East Roman Empire, Byzantium, retained many features of old Rome, as well as Greek and Persian similarities. Kievan Rus' and subsequently Russia began development in Eastern Europe as well. In the isolated Americas, Mesoamerica saw the building of the Aztec Empire , while the Andean region of South America saw the establishment of the Wari Empire first and the Inca Empire later. In Oceania, ancestors of modern Polynesians were established in village communities by the 6th century, a gradual intensification of complexity took place. In the 13th century, complex states were established, most notably the Tuʻi Tonga Empire which collected tribute from many island chains in the greater region. Religion that envisaged the possibility that all humans could be included in a universal order had emerged already in the first millennium BCE, particularly with Buddhism. In the following millennium, Buddhism was joined by two other major, universalizing, missionary religions, both developing from Judaism : Christianity and Islam. By the end of the period, these three religions were between them widespread, and often politically dominant, across the Old World. Outside of Eurasia, religion or otherwise a veneration of the supernatural was also used to reinforce power structures, articulate world views and create foundatonal myths for society. Mesoamerican cosmological narratives are an example of this. Finally, communication and trade across Afro-Eurasia increased rapidly. The Silk Road continued to spread cultures and ideas through trade. Communication spread throughout Europe, Asia, and Africa. Trade networks were established between western Europe, Byzantium, early Russia, the Islamic Empires, and the Far Eastern civilizations. In Africa, the earlier introduction of the camel allowed for a new and eventually large trans-Saharan trade , which connected Sub-Saharan West Africa to Eurasia. The Islamic Empires adopted many Greek, Roman, and Indian advances and spread them through the Islamic sphere of influence, allowing these developments to reach Europe , North and West Africa, and Central Asia. Islamic sea trade helped connect these areas, including those in the Indian Ocean and in the Mediterranean , replacing Byzantium in the latter region. The Christian Crusades into the Middle East (as well as Muslim Spain and Sicily ) brought Islamic science, technology, and goods to Western Europe . Western trade into East Asia was pioneered by Marco Polo . Importantly, China began to influence regions like Japan, Korea, and Vietnam through trade and conquest. Finally, the growth of the Mongol Empire in Central Asia established safe trade which allowed goods, cultures, ideas, and disease to spread between Asia, Europe, and Africa. The Americas had their own trade network, but here trade was restricted by range and scope. The Mayan network spread across Mesoamerica but lacked direct connections to the complex societies of South and North America, and these zones remained separate from one another. In Oceania , some of the island chains of Polynesia engaged in trade with one another. For instance, with outrigger canoes long-distance communication of over 2,300 miles between Hawaii and Tahiti was maintained for centuries before its disruption and separation. Meanwhile, in Melanesia there is evidence of exchanges between mainland Papua New Guinea and the Trobriand Islands off its coast, most likely for obsidian . Populations moved westward until 1200, after which the network dissolved into much smaller economies. During post-classical times, there is evidence that many regions of the world were affected similarly by global climate conditions; however, direct effects in temperature and precipitation varied by region. According to the Intergovernmental Panel on Climate Change , changes did not all occur at once. Generally however, studies found that temperatures were relatively warmer in the 11th century, but colder by the early 17th century. The degree of climate change which occurred in all regions across the world is uncertain, as is whether such changes were all part of a global trend. Climate trends appear to be more recognizable in the Northern than in the Southern Hemisphere however, there are instances where climate in areas without written records have been estimated, historians now believe the Southern Hemisphere became colder between 950 and 1250. There are shorter climate periods that could be said roughly to account for large scale climate trends in the post-classical period. These include the Late Antique Little Ice Age , the Medieval Warm Period and the Little Ice Age . The extreme weather events of 536–537 were likely initiated by the eruption of the Lake Ilopango caldera in El Salvador . Sulfate emitted into the air initiated global cooling, migrations and crop failures worldwide, possibly intensifying an already cooler time period. Records show that the world's average temperature remained colder for at least a century afterwards. The Medieval Warm Period from 950 to 1250 occurred mostly in the Northern Hemisphere, causing warmer summers in many areas; the high temperatures would only be surpassed by the global warming of the 20th/21st centuries. It has been hypothesized that the warmer temperatures allowed the Norse to colonize Greenland, due to ice-free waters. Outside of Europe there is evidence of warming conditions, including higher temperatures in China and major North American droughts which adversely affected numerous cultures. After 1250, glaciers began to expand in Greenland, affecting its thermohaline circulation , and cooling the entire North Atlantic. In the 14th century, the growing season in Europe became unreliable; meanwhile in China the cultivation of oranges was driven southward by colder temperatures. Especially in Europe, the Little Ice Age had great cultural ramifications. It persisted until the Industrial Revolution , long after the post-classical period. Its causes are unclear: possible explanations include sunspots , orbital cycles of the Earth , volcanic activity , ocean circulation , and man-made population decline . This timetable gives a basic overview of states, cultures and events which transpired roughly between the years 200 and 1500. Sections are broken by political and geographic location. First was the expansion and growth of civilization into new geographic areas across Asia , Africa , Europe , Mesoamerica , and western South America . However, as noted by world historian Peter N. Stearns , there were no common global political trends during the post-classical period, rather it was a period of loosely organized states and other developments, but no common political patterns emerged. In Asia, China continued its historic dynastic cycle and became more complex, improving its bureaucracy. The creation of the Islamic Empires established a new power in the Middle East, North Africa, and Central Asia . Africa created the Mali and Songhai Empires in the West. The fall of Roman civilization not only left a power vacuum for the Mediterranean and Europe, but forced certain areas to build what some historians might call new civilizations entirely. An entirely different political system was applied in Western Europe (i.e. feudalism ), as well as a different society (i.e. manorialism ). But the once East Roman Empire, Byzantium, retained many features of old Rome, as well as Greek and Persian similarities. Kievan Rus' and subsequently Russia began development in Eastern Europe as well. In the isolated Americas, Mesoamerica saw the building of the Aztec Empire , while the Andean region of South America saw the establishment of the Wari Empire first and the Inca Empire later. In Oceania, ancestors of modern Polynesians were established in village communities by the 6th century, a gradual intensification of complexity took place. In the 13th century, complex states were established, most notably the Tuʻi Tonga Empire which collected tribute from many island chains in the greater region. Religion that envisaged the possibility that all humans could be included in a universal order had emerged already in the first millennium BCE, particularly with Buddhism. In the following millennium, Buddhism was joined by two other major, universalizing, missionary religions, both developing from Judaism : Christianity and Islam. By the end of the period, these three religions were between them widespread, and often politically dominant, across the Old World. Outside of Eurasia, religion or otherwise a veneration of the supernatural was also used to reinforce power structures, articulate world views and create foundatonal myths for society. Mesoamerican cosmological narratives are an example of this. Finally, communication and trade across Afro-Eurasia increased rapidly. The Silk Road continued to spread cultures and ideas through trade. Communication spread throughout Europe, Asia, and Africa. Trade networks were established between western Europe, Byzantium, early Russia, the Islamic Empires, and the Far Eastern civilizations. In Africa, the earlier introduction of the camel allowed for a new and eventually large trans-Saharan trade , which connected Sub-Saharan West Africa to Eurasia. The Islamic Empires adopted many Greek, Roman, and Indian advances and spread them through the Islamic sphere of influence, allowing these developments to reach Europe , North and West Africa, and Central Asia. Islamic sea trade helped connect these areas, including those in the Indian Ocean and in the Mediterranean , replacing Byzantium in the latter region. The Christian Crusades into the Middle East (as well as Muslim Spain and Sicily ) brought Islamic science, technology, and goods to Western Europe . Western trade into East Asia was pioneered by Marco Polo . Importantly, China began to influence regions like Japan, Korea, and Vietnam through trade and conquest. Finally, the growth of the Mongol Empire in Central Asia established safe trade which allowed goods, cultures, ideas, and disease to spread between Asia, Europe, and Africa. The Americas had their own trade network, but here trade was restricted by range and scope. The Mayan network spread across Mesoamerica but lacked direct connections to the complex societies of South and North America, and these zones remained separate from one another. In Oceania , some of the island chains of Polynesia engaged in trade with one another. For instance, with outrigger canoes long-distance communication of over 2,300 miles between Hawaii and Tahiti was maintained for centuries before its disruption and separation. Meanwhile, in Melanesia there is evidence of exchanges between mainland Papua New Guinea and the Trobriand Islands off its coast, most likely for obsidian . Populations moved westward until 1200, after which the network dissolved into much smaller economies. During post-classical times, there is evidence that many regions of the world were affected similarly by global climate conditions; however, direct effects in temperature and precipitation varied by region. According to the Intergovernmental Panel on Climate Change , changes did not all occur at once. Generally however, studies found that temperatures were relatively warmer in the 11th century, but colder by the early 17th century. The degree of climate change which occurred in all regions across the world is uncertain, as is whether such changes were all part of a global trend. Climate trends appear to be more recognizable in the Northern than in the Southern Hemisphere however, there are instances where climate in areas without written records have been estimated, historians now believe the Southern Hemisphere became colder between 950 and 1250. There are shorter climate periods that could be said roughly to account for large scale climate trends in the post-classical period. These include the Late Antique Little Ice Age , the Medieval Warm Period and the Little Ice Age . The extreme weather events of 536–537 were likely initiated by the eruption of the Lake Ilopango caldera in El Salvador . Sulfate emitted into the air initiated global cooling, migrations and crop failures worldwide, possibly intensifying an already cooler time period. Records show that the world's average temperature remained colder for at least a century afterwards. The Medieval Warm Period from 950 to 1250 occurred mostly in the Northern Hemisphere, causing warmer summers in many areas; the high temperatures would only be surpassed by the global warming of the 20th/21st centuries. It has been hypothesized that the warmer temperatures allowed the Norse to colonize Greenland, due to ice-free waters. Outside of Europe there is evidence of warming conditions, including higher temperatures in China and major North American droughts which adversely affected numerous cultures. After 1250, glaciers began to expand in Greenland, affecting its thermohaline circulation , and cooling the entire North Atlantic. In the 14th century, the growing season in Europe became unreliable; meanwhile in China the cultivation of oranges was driven southward by colder temperatures. Especially in Europe, the Little Ice Age had great cultural ramifications. It persisted until the Industrial Revolution , long after the post-classical period. Its causes are unclear: possible explanations include sunspots , orbital cycles of the Earth , volcanic activity , ocean circulation , and man-made population decline . This timetable gives a basic overview of states, cultures and events which transpired roughly between the years 200 and 1500. Sections are broken by political and geographic location. This section explains events and trends which affected the geographic area of Eurasia . The civilizations within this area were distinct from one another but still endured shared experiences and some development patterns. In the context of global history, the label of feudalism has been used to describe any agricultural society where central authority broke down to be replaced by a warrior aristocracy . Feudal societies are characterized by reliance on personal relationships with military elites, rather than a bureaucracy with a state-supported professional standing army. The label of feudalism has thus been used to describe many areas of Eurasia including medieval Europe , the Islamic iqta' system, Indian feudalism, and Heian Japan . Some world historians generalize that societies can be called feudal if authority was fragmented, with a set of obligations between vassal and lord. After the 8th century, feudalism became more common across Europe. Even Byzantium, which had inherited the government of the Roman Empire , chose to devolve its military obligations into themes to increase the number of soldiers and ships available for military service during times of crisis. There were similarities between European feudalism and the Islamic iqta' , as both featured landed classes of mounted warriors whose titles were granted by a monarch or sultan. Because of these similarities, it was common for societal structures to be preserved in the face of religious upheaval; for instance, after the Islamic Delhi Sultanate conquered large portions of India, it imposed higher taxes but otherwise left local feudal structures in place. Though most of Eurasia adopted feudalism and similar systems during this era, China employed a centralized bureaucracy throughout much of the post classical period, particularly after 1000. A major factor that distinguished China from other regions was that local leaders were reluctant to self-identify by their current location; instead, they typically displayed an ambition to unite the country in times of disunity. Beyond a broad generalization, the usefulness of the term "feudalism" is debated by contemporary historians, as the daily functions of feudalism sometimes differed greatly between world regions. Comparisons between feudal Europe and post-classical Japan have been particularly controversial. Throughout the 20th century, historians often compared medieval Europe to post-classical Japan. More recently, it has been argued that, until roughly 1400, Japan balanced its decentralized military power with more centralized forms of imperial (governmental) and monastic (religious) authority. Only in the Sengoku period did there come to be fully decentralized power dominated by private military leaders. Still other historians reject the term feudalism outright, challenging its ability to usefully describe societies either within or outside of medieval Europe. The Mongol Empire, which existed during the 13th and 14th centuries, was the largest continuous land empire in history. Originating in the steppes of Central Asia, the Mongol Empire eventually stretched from Central Europe to the Sea of Japan , extending northwards into Siberia , eastwards and southwards into the Indian subcontinent , Indochina , and the Iranian Plateau , and westwards as far as the Levant and Arabia. The Mongol Empire emerged from the unification of nomadic tribes in the Mongolia homeland under the leadership of Genghis Khan , who was proclaimed ruler of all Mongols in 1206. The empire grew rapidly under his rule and then under his descendants, who sent invasions in every direction. The vast transcontinental empire connected east and west with an enforced Pax Mongolica allowing trade, technologies, commodities, and ideologies to be disseminated and exchanged across Eurasia . The empire began to split due to wars over succession, as the grandchildren of Genghis Khan disputed whether the royal line should follow from his son and initial heir Ögedei , or one of his other sons such as Tolui , Chagatai , or Jochi . After Möngke Khan died, rival kurultai councils simultaneously elected different successors, the brothers Ariq Böke and Kublai Khan , who then not only fought each other in the Toluid Civil War , but also dealt with challenges from descendants of other sons of Genghis. Kublai successfully took power, but civil war ensued as Kublai sought unsuccessfully to regain control of the Chagatayid and Ögedeid families. The Battle of Ain Jalut in 1260 marked the high-water point of the Mongol conquests and was the first time a Mongol advance had ever been beaten back in direct combat on the battlefield. Though the Mongols launched many more invasions into the Levant, briefly occupying it and raiding as far as Gaza after a decisive victory at the Battle of Wadi al-Khazandar in 1299, they withdrew due to various geopolitical factors. By the time of Kublai's death in 1294, the Mongol Empire had fractured into four separate khanates or empires, each pursuing its own separate interests and objectives: the Golden Horde khanate in the northwest; the Chagatai Khanate in the west; the Ilkhanate in the southwest; and the Yuan dynasty based in modern-day Beijing . In 1304, the three western khanates briefly accepted the nominal suzerainty of the Yuan dynasty, but it was later overthrown by the Han Chinese Ming dynasty in 1368. The Genghisid rulers returned to Mongolia homeland and continued rule in the Northern Yuan dynasty . All of the original Mongol Khanates collapsed by 1500, but smaller successor states remained independent until the 1700s. Descendants of Chagatai Khan created the Mughal Empire that ruled much of India in early modern times. The conquests and the interactions the Mongol Empire had with western Eurasia are one of the more comprehensively researched areas for historians looking to define a globalized Middle Ages. The Silk Road was a Eurasian trade route that played a large role in global communication and interaction. It stimulated cultural exchange; encouraged the learning of new languages; resulted in the trade of many goods, such as silk, gold, and spices; and also spread religion and disease. It is even claimed by some historians – such as Andre Gunder Frank , William Hardy McNeill , Jerry H. Bentley , and Marshall Hodgson – that the Afro-Eurasian world was loosely united culturally, and that the Silk Road was fundamental to this unity. This major trade route began with the Han dynasty of China, connecting it to the Roman Empire and any regions in between or nearby. At this time, Central Asia exported horses, wool , and jade into China for the latter's silk; the Romans would trade for the Chinese commodity as well, offering wine in return. The Silk Road would often decline and rise again in trade from the Iron Age to the post-classical era. Following one such decline, it was reopened in Central Asia by Han dynasty general Ban Chao during the 1st century. There were vulnerabilities as well to changing political situations. The rise of Islam changed the Silk Road, because Muslim rulers generally closed the Silk Road to Christian Europe to an extent that Europe would be cut off from Asia for centuries. Specifically, the political developments that affected the Silk Road included the emergence of the Turks, the political movements of the Byzatine and Sasanian Empires , and the rise of the Arabs, among others. The Silk Road flourished again in the 13th century during the reign of the Mongol Empire, which through conquest had brought stability in Central Asia comparable to the Pax Romana . It was claimed by a Muslim historian that Central Asia was peaceful and safe to transverse. "(Central Asia) enjoyed such a peace that a man might have journeyed from the land of sunrise to the land of sunset with a golden platter upon his head without suffering the least violence from anyone." As such, trade and communication between Europe, East Asia, South Asia, and West Asia required little effort. Handicraft production, art, and scholarship prospered, and wealthy merchants enjoyed cosmopolitan cities. Notable Travelers including Ibn Battuta , Rabban Bar Sauma , and Marco Polo traveled across North Africa and Eurasia freely, those that left accounts of their experiences inspired future adventurers. The Silk Road was also a major factor in spreading religion across Afro-Eurasia. Muslim teachings from Arabia and Persia reached East Asia. Buddhism spread from India, to China, to Central Asia. One significant development in the spread of Buddhism was the carving of the Gandhara School in the cities of ancient Taxila and the Peshwar , allegedly in the mid 1st century. In addition to commercial travel was the esteem of pilgrimage that existed across all of Afro-Eurasia, in the words of world historian R. I. Moore "if any single institution 'made' the Eurasian Middle Ages it was pilgrimage." Nevertheless, after the 15th century, the Silk Road disappeared from regular use. This was primarily a result from the growing sea travel pioneered by Europeans, which allowed the trade of goods by sailing around the southern tip of Africa and into the Indian Ocean. The route was vulnerable to spreading plague. The Plague of Justinian originated in East Africa and had a major outbreak in Europe in 542 causing the deaths of a quarter of the Mediterranean's population. Trade between Europe, Africa, and Asia along the route was at least partially responsible for spreading the plague. Eight centuries later, the Silk Road trade played a role in spreading the infamous Black Death . The disease, spread by rats, was carried by merchant ships sailing across the Mediterranean that brought the plague back to Sicily, causing an epidemic in 1347. In the Eurasian world, disease was an inescapable part of daily life. Europe in particular suffered minor outbreaks of disease every decade during the period. Using both land and sea routes, devastating pandemics could spread far beyond their initial focal point. Tracking the origin of massive bubonic plagues and their potential spread between Eastern and Western Eurasia has been academically contentious. Besides bubonic plague, other diseases including smallpox also spread across cultural regions. The first plague pandemic caused by Yersinia pestis began with the 541–549 Plague of Justinian. The origin of the plague appears to have been the Tian Shan mountains in Kyrgyzstan . But the origin of the 541–549 epidemic remains uncertain: some historians postulate East Africa as a possible geographical origin. There is no record of a disease with the characteristics of Yersinia pestis breaking out in China before its appearance in Pelusium Egypt . The plague spread to Europe and West Asia, with a possible spread into East Asia. [upper-alpha 3] Established urban civilizations were massively depopulated; the economies and social fabric of established empires were severely destabilized. Rural societies, while still facing horrific death tolls, saw fewer socioeconomic effects. In addition, no evidence has been found of bubonic plague in India before 1600. Nevertheless, it is likely that the trauma of disease (and other natural disasters) was a major cause of profound religious and political changes in Eurasia. Different authorities reacted to disease outbreaks with strategies that they believed would best protect their power. The Catholic Church in France spoke of healing miracles; Confucian bureaucrats asserted that sudden deaths of Chinese emperors represented the loss of a dynasty's Mandate of Heaven , shifting blame away from themselves. The severe loss of manpower in the Byzantine and Sasanian Empires contributed to early Muslim conquests in the region. In the long term, overland trade in Eurasia diminshed, as coastal Indian Ocean trade became more frequent. There were recurrent aftershocks of the Plague of Justinian until around 750, after which many nations saw an economic recovery. Six centuries later, a relative (but not a direct descendant) of Yersinia Pestis rose to afflict Eurasia: the Black Death . The first instance of the second plague pandemic was between 1347 and 1351. It killed variously between 25% and 50% of populations. Traditionally many historians believed the Black Death started in China and was then spread westward by invading Mongols who inadvertently carried infected fleas and rats with them. Although there is no concrete historical evidence for this theory, the plague is considered endemic on the steppe. Currently there is extensive historiography of the Black Death's effects in Europe and the Islamic world, but beyond Western Eurasia direct evidence for Black Death's presence is lacking. The Bulletin of the History of Medicine explored the potential linking of known 14th century epidemics in Asia with the plague. One example is the Deccan Plateau , where much of the Delhi Sultanate 's army suddenly died of a sickness in 1334. As this was 15 years before Europe's Black Death but little detail about the symptoms, it is unlikely that this was an instance of bubonic plague. Meanwhile, Yuan China suffered from major epidemics in the mid-14th century, including a recorded 90% death rate in Hebei Province. As with the Deccan event, surviving accounts do not describe symptoms; so historians are left to speculate. Perhaps these outbreaks were not the Black Death but instead some other disease already common to East Asia at the time, such as typhus , smallpox , or dysentery . Compared to Western reactions to the Black Death, Chinese records that do mention the epidemics are relatively muted, indicating that epidemics were a routine occurrence. Historians consider the hypothesis of a Chinese origin of a westward-moving plague unlikely given the fragmentation of the Mongol Empire and the 5,000-mile journey between China proper and Crimea through sparsely populated Central Asia. The aftershocks of the plague continued to affect populations well into the early modern period. In Western Europe, the devastating loss of people created lasting changes. Wage labor began to rise in Western Europe and there was more emphasis on labor-saving machines and mechanisms. Slavery, which had almost vanished from medieval Europe, returned and was one of the reasons for early Portuguese exploration after 1400. The adoption of Arabic numerals may have been partially caused by the plague. Importantly, many economies became specialist, producing only certain goods, seeking expansion elsewhere for exotic resources and slave labor. While typically Western European expansion as a result of the Black Death is most discussed, Islamic countries including the Ottoman Empire also partook in land-based expansionism and used their own slave trade. The term post-classical science is often used in academic circles and in college courses to combine the study of medieval European science and medieval Islamic science due to their interactions with one another. However scientific knowledge also spread westward by trade and war from Eastern Eurasia, particularly from China by Arabs. The Islamic world also took medical knowledge from South Asia . In the Western world and in Islamic realms, much emphasis was placed on preserving the rationalist Greek tradition of figures such as Aristotle . In the context of science within Islam there are questions as to whether Islamic scientists simply preserved accomplishments from classical antiquity or built upon earlier Greek advances. Regardless, classical European science was brought back to the Christian kingdoms due to the experience of the Crusades . As a result of Persian trade in China, and the battle of the Talas River , Chinese innovations entered the Islamic intellectual world. These include advances in astronomy and in papermaking . Paper-making spread through the Islamic world as far west as Islamic Spain , before paper-making was acquired for Europe by the Reconquista . There is debate about transmission of gunpowder regarding whether the Mongols introduced Chinese gunpowder weapons to Europe or whether gunpowder weapons were independently invented in Europe. In the Mongol Empire, information from diverse cultures was brought together for large projects: for instance in 1303 the Mongol Yuan dynasty combined Chinese and Islamic cartography to make a map that likely included all of Eurasia including western Europe. This "Eurasia map" is now lost, but it influenced Chinese and Korean geographical knowledge centuries later. It is apparent that within Eurasia transfer of information between world cultures did occur, usually through translations of written documents. Within Eurasia, there were four major civilization groups that had literate cultures and created literature and arts, including Europe, West Asia, South Asia, and East Asia. Southeast Asia could be a possible fifth category but was influenced heavily from both South and East Asia literal cultures. All four cultures in post-classical times used poetry , drama , and prose . Throughout the period and until the 19th century poetry was the dominant form of literary expression. In West Asia, South Asia, Europe, and China, great poetic works often used figurative language. Examples include, the Sanskrit Shakuntala , the Arabic Thousand and one nights , Old English Beowulf and works by the Chinese Du Fu and the Persian Rumi . In Japan, prose uniquely thrived more than in other geographic areas. The Tale of Genji is considered the world's first realistic novel written in the 9th century. Musically, most regions of the world only used monophonic melodies as opposed to harmony . Medieval Europe was the lone exception to this rule, developing harmonic music in the 14th/15th century as musical culture transitioned form sacred music (meant for the church) to secular music. South Asian and West Asian music were similar to each other for their use of microtone . East Asian music shared some similarities with European music by using twelve tones and employing scales, but differed in the number of scales used- 5 for the former and seven for the latter In the context of global history, the label of feudalism has been used to describe any agricultural society where central authority broke down to be replaced by a warrior aristocracy . Feudal societies are characterized by reliance on personal relationships with military elites, rather than a bureaucracy with a state-supported professional standing army. The label of feudalism has thus been used to describe many areas of Eurasia including medieval Europe , the Islamic iqta' system, Indian feudalism, and Heian Japan . Some world historians generalize that societies can be called feudal if authority was fragmented, with a set of obligations between vassal and lord. After the 8th century, feudalism became more common across Europe. Even Byzantium, which had inherited the government of the Roman Empire , chose to devolve its military obligations into themes to increase the number of soldiers and ships available for military service during times of crisis. There were similarities between European feudalism and the Islamic iqta' , as both featured landed classes of mounted warriors whose titles were granted by a monarch or sultan. Because of these similarities, it was common for societal structures to be preserved in the face of religious upheaval; for instance, after the Islamic Delhi Sultanate conquered large portions of India, it imposed higher taxes but otherwise left local feudal structures in place. Though most of Eurasia adopted feudalism and similar systems during this era, China employed a centralized bureaucracy throughout much of the post classical period, particularly after 1000. A major factor that distinguished China from other regions was that local leaders were reluctant to self-identify by their current location; instead, they typically displayed an ambition to unite the country in times of disunity. Beyond a broad generalization, the usefulness of the term "feudalism" is debated by contemporary historians, as the daily functions of feudalism sometimes differed greatly between world regions. Comparisons between feudal Europe and post-classical Japan have been particularly controversial. Throughout the 20th century, historians often compared medieval Europe to post-classical Japan. More recently, it has been argued that, until roughly 1400, Japan balanced its decentralized military power with more centralized forms of imperial (governmental) and monastic (religious) authority. Only in the Sengoku period did there come to be fully decentralized power dominated by private military leaders. Still other historians reject the term feudalism outright, challenging its ability to usefully describe societies either within or outside of medieval Europe. The Mongol Empire, which existed during the 13th and 14th centuries, was the largest continuous land empire in history. Originating in the steppes of Central Asia, the Mongol Empire eventually stretched from Central Europe to the Sea of Japan , extending northwards into Siberia , eastwards and southwards into the Indian subcontinent , Indochina , and the Iranian Plateau , and westwards as far as the Levant and Arabia. The Mongol Empire emerged from the unification of nomadic tribes in the Mongolia homeland under the leadership of Genghis Khan , who was proclaimed ruler of all Mongols in 1206. The empire grew rapidly under his rule and then under his descendants, who sent invasions in every direction. The vast transcontinental empire connected east and west with an enforced Pax Mongolica allowing trade, technologies, commodities, and ideologies to be disseminated and exchanged across Eurasia . The empire began to split due to wars over succession, as the grandchildren of Genghis Khan disputed whether the royal line should follow from his son and initial heir Ögedei , or one of his other sons such as Tolui , Chagatai , or Jochi . After Möngke Khan died, rival kurultai councils simultaneously elected different successors, the brothers Ariq Böke and Kublai Khan , who then not only fought each other in the Toluid Civil War , but also dealt with challenges from descendants of other sons of Genghis. Kublai successfully took power, but civil war ensued as Kublai sought unsuccessfully to regain control of the Chagatayid and Ögedeid families. The Battle of Ain Jalut in 1260 marked the high-water point of the Mongol conquests and was the first time a Mongol advance had ever been beaten back in direct combat on the battlefield. Though the Mongols launched many more invasions into the Levant, briefly occupying it and raiding as far as Gaza after a decisive victory at the Battle of Wadi al-Khazandar in 1299, they withdrew due to various geopolitical factors. By the time of Kublai's death in 1294, the Mongol Empire had fractured into four separate khanates or empires, each pursuing its own separate interests and objectives: the Golden Horde khanate in the northwest; the Chagatai Khanate in the west; the Ilkhanate in the southwest; and the Yuan dynasty based in modern-day Beijing . In 1304, the three western khanates briefly accepted the nominal suzerainty of the Yuan dynasty, but it was later overthrown by the Han Chinese Ming dynasty in 1368. The Genghisid rulers returned to Mongolia homeland and continued rule in the Northern Yuan dynasty . All of the original Mongol Khanates collapsed by 1500, but smaller successor states remained independent until the 1700s. Descendants of Chagatai Khan created the Mughal Empire that ruled much of India in early modern times. The conquests and the interactions the Mongol Empire had with western Eurasia are one of the more comprehensively researched areas for historians looking to define a globalized Middle Ages. The Silk Road was a Eurasian trade route that played a large role in global communication and interaction. It stimulated cultural exchange; encouraged the learning of new languages; resulted in the trade of many goods, such as silk, gold, and spices; and also spread religion and disease. It is even claimed by some historians – such as Andre Gunder Frank , William Hardy McNeill , Jerry H. Bentley , and Marshall Hodgson – that the Afro-Eurasian world was loosely united culturally, and that the Silk Road was fundamental to this unity. This major trade route began with the Han dynasty of China, connecting it to the Roman Empire and any regions in between or nearby. At this time, Central Asia exported horses, wool , and jade into China for the latter's silk; the Romans would trade for the Chinese commodity as well, offering wine in return. The Silk Road would often decline and rise again in trade from the Iron Age to the post-classical era. Following one such decline, it was reopened in Central Asia by Han dynasty general Ban Chao during the 1st century. There were vulnerabilities as well to changing political situations. The rise of Islam changed the Silk Road, because Muslim rulers generally closed the Silk Road to Christian Europe to an extent that Europe would be cut off from Asia for centuries. Specifically, the political developments that affected the Silk Road included the emergence of the Turks, the political movements of the Byzatine and Sasanian Empires , and the rise of the Arabs, among others. The Silk Road flourished again in the 13th century during the reign of the Mongol Empire, which through conquest had brought stability in Central Asia comparable to the Pax Romana . It was claimed by a Muslim historian that Central Asia was peaceful and safe to transverse. "(Central Asia) enjoyed such a peace that a man might have journeyed from the land of sunrise to the land of sunset with a golden platter upon his head without suffering the least violence from anyone." As such, trade and communication between Europe, East Asia, South Asia, and West Asia required little effort. Handicraft production, art, and scholarship prospered, and wealthy merchants enjoyed cosmopolitan cities. Notable Travelers including Ibn Battuta , Rabban Bar Sauma , and Marco Polo traveled across North Africa and Eurasia freely, those that left accounts of their experiences inspired future adventurers. The Silk Road was also a major factor in spreading religion across Afro-Eurasia. Muslim teachings from Arabia and Persia reached East Asia. Buddhism spread from India, to China, to Central Asia. One significant development in the spread of Buddhism was the carving of the Gandhara School in the cities of ancient Taxila and the Peshwar , allegedly in the mid 1st century. In addition to commercial travel was the esteem of pilgrimage that existed across all of Afro-Eurasia, in the words of world historian R. I. Moore "if any single institution 'made' the Eurasian Middle Ages it was pilgrimage." Nevertheless, after the 15th century, the Silk Road disappeared from regular use. This was primarily a result from the growing sea travel pioneered by Europeans, which allowed the trade of goods by sailing around the southern tip of Africa and into the Indian Ocean. The route was vulnerable to spreading plague. The Plague of Justinian originated in East Africa and had a major outbreak in Europe in 542 causing the deaths of a quarter of the Mediterranean's population. Trade between Europe, Africa, and Asia along the route was at least partially responsible for spreading the plague. Eight centuries later, the Silk Road trade played a role in spreading the infamous Black Death . The disease, spread by rats, was carried by merchant ships sailing across the Mediterranean that brought the plague back to Sicily, causing an epidemic in 1347. In the Eurasian world, disease was an inescapable part of daily life. Europe in particular suffered minor outbreaks of disease every decade during the period. Using both land and sea routes, devastating pandemics could spread far beyond their initial focal point. Tracking the origin of massive bubonic plagues and their potential spread between Eastern and Western Eurasia has been academically contentious. Besides bubonic plague, other diseases including smallpox also spread across cultural regions. The first plague pandemic caused by Yersinia pestis began with the 541–549 Plague of Justinian. The origin of the plague appears to have been the Tian Shan mountains in Kyrgyzstan . But the origin of the 541–549 epidemic remains uncertain: some historians postulate East Africa as a possible geographical origin. There is no record of a disease with the characteristics of Yersinia pestis breaking out in China before its appearance in Pelusium Egypt . The plague spread to Europe and West Asia, with a possible spread into East Asia. [upper-alpha 3] Established urban civilizations were massively depopulated; the economies and social fabric of established empires were severely destabilized. Rural societies, while still facing horrific death tolls, saw fewer socioeconomic effects. In addition, no evidence has been found of bubonic plague in India before 1600. Nevertheless, it is likely that the trauma of disease (and other natural disasters) was a major cause of profound religious and political changes in Eurasia. Different authorities reacted to disease outbreaks with strategies that they believed would best protect their power. The Catholic Church in France spoke of healing miracles; Confucian bureaucrats asserted that sudden deaths of Chinese emperors represented the loss of a dynasty's Mandate of Heaven , shifting blame away from themselves. The severe loss of manpower in the Byzantine and Sasanian Empires contributed to early Muslim conquests in the region. In the long term, overland trade in Eurasia diminshed, as coastal Indian Ocean trade became more frequent. There were recurrent aftershocks of the Plague of Justinian until around 750, after which many nations saw an economic recovery. Six centuries later, a relative (but not a direct descendant) of Yersinia Pestis rose to afflict Eurasia: the Black Death . The first instance of the second plague pandemic was between 1347 and 1351. It killed variously between 25% and 50% of populations. Traditionally many historians believed the Black Death started in China and was then spread westward by invading Mongols who inadvertently carried infected fleas and rats with them. Although there is no concrete historical evidence for this theory, the plague is considered endemic on the steppe. Currently there is extensive historiography of the Black Death's effects in Europe and the Islamic world, but beyond Western Eurasia direct evidence for Black Death's presence is lacking. The Bulletin of the History of Medicine explored the potential linking of known 14th century epidemics in Asia with the plague. One example is the Deccan Plateau , where much of the Delhi Sultanate 's army suddenly died of a sickness in 1334. As this was 15 years before Europe's Black Death but little detail about the symptoms, it is unlikely that this was an instance of bubonic plague. Meanwhile, Yuan China suffered from major epidemics in the mid-14th century, including a recorded 90% death rate in Hebei Province. As with the Deccan event, surviving accounts do not describe symptoms; so historians are left to speculate. Perhaps these outbreaks were not the Black Death but instead some other disease already common to East Asia at the time, such as typhus , smallpox , or dysentery . Compared to Western reactions to the Black Death, Chinese records that do mention the epidemics are relatively muted, indicating that epidemics were a routine occurrence. Historians consider the hypothesis of a Chinese origin of a westward-moving plague unlikely given the fragmentation of the Mongol Empire and the 5,000-mile journey between China proper and Crimea through sparsely populated Central Asia. The aftershocks of the plague continued to affect populations well into the early modern period. In Western Europe, the devastating loss of people created lasting changes. Wage labor began to rise in Western Europe and there was more emphasis on labor-saving machines and mechanisms. Slavery, which had almost vanished from medieval Europe, returned and was one of the reasons for early Portuguese exploration after 1400. The adoption of Arabic numerals may have been partially caused by the plague. Importantly, many economies became specialist, producing only certain goods, seeking expansion elsewhere for exotic resources and slave labor. While typically Western European expansion as a result of the Black Death is most discussed, Islamic countries including the Ottoman Empire also partook in land-based expansionism and used their own slave trade. The first plague pandemic caused by Yersinia pestis began with the 541–549 Plague of Justinian. The origin of the plague appears to have been the Tian Shan mountains in Kyrgyzstan . But the origin of the 541–549 epidemic remains uncertain: some historians postulate East Africa as a possible geographical origin. There is no record of a disease with the characteristics of Yersinia pestis breaking out in China before its appearance in Pelusium Egypt . The plague spread to Europe and West Asia, with a possible spread into East Asia. [upper-alpha 3] Established urban civilizations were massively depopulated; the economies and social fabric of established empires were severely destabilized. Rural societies, while still facing horrific death tolls, saw fewer socioeconomic effects. In addition, no evidence has been found of bubonic plague in India before 1600. Nevertheless, it is likely that the trauma of disease (and other natural disasters) was a major cause of profound religious and political changes in Eurasia. Different authorities reacted to disease outbreaks with strategies that they believed would best protect their power. The Catholic Church in France spoke of healing miracles; Confucian bureaucrats asserted that sudden deaths of Chinese emperors represented the loss of a dynasty's Mandate of Heaven , shifting blame away from themselves. The severe loss of manpower in the Byzantine and Sasanian Empires contributed to early Muslim conquests in the region. In the long term, overland trade in Eurasia diminshed, as coastal Indian Ocean trade became more frequent. There were recurrent aftershocks of the Plague of Justinian until around 750, after which many nations saw an economic recovery. Six centuries later, a relative (but not a direct descendant) of Yersinia Pestis rose to afflict Eurasia: the Black Death . The first instance of the second plague pandemic was between 1347 and 1351. It killed variously between 25% and 50% of populations. Traditionally many historians believed the Black Death started in China and was then spread westward by invading Mongols who inadvertently carried infected fleas and rats with them. Although there is no concrete historical evidence for this theory, the plague is considered endemic on the steppe. Currently there is extensive historiography of the Black Death's effects in Europe and the Islamic world, but beyond Western Eurasia direct evidence for Black Death's presence is lacking. The Bulletin of the History of Medicine explored the potential linking of known 14th century epidemics in Asia with the plague. One example is the Deccan Plateau , where much of the Delhi Sultanate 's army suddenly died of a sickness in 1334. As this was 15 years before Europe's Black Death but little detail about the symptoms, it is unlikely that this was an instance of bubonic plague. Meanwhile, Yuan China suffered from major epidemics in the mid-14th century, including a recorded 90% death rate in Hebei Province. As with the Deccan event, surviving accounts do not describe symptoms; so historians are left to speculate. Perhaps these outbreaks were not the Black Death but instead some other disease already common to East Asia at the time, such as typhus , smallpox , or dysentery . Compared to Western reactions to the Black Death, Chinese records that do mention the epidemics are relatively muted, indicating that epidemics were a routine occurrence. Historians consider the hypothesis of a Chinese origin of a westward-moving plague unlikely given the fragmentation of the Mongol Empire and the 5,000-mile journey between China proper and Crimea through sparsely populated Central Asia. The aftershocks of the plague continued to affect populations well into the early modern period. In Western Europe, the devastating loss of people created lasting changes. Wage labor began to rise in Western Europe and there was more emphasis on labor-saving machines and mechanisms. Slavery, which had almost vanished from medieval Europe, returned and was one of the reasons for early Portuguese exploration after 1400. The adoption of Arabic numerals may have been partially caused by the plague. Importantly, many economies became specialist, producing only certain goods, seeking expansion elsewhere for exotic resources and slave labor. While typically Western European expansion as a result of the Black Death is most discussed, Islamic countries including the Ottoman Empire also partook in land-based expansionism and used their own slave trade. The term post-classical science is often used in academic circles and in college courses to combine the study of medieval European science and medieval Islamic science due to their interactions with one another. However scientific knowledge also spread westward by trade and war from Eastern Eurasia, particularly from China by Arabs. The Islamic world also took medical knowledge from South Asia . In the Western world and in Islamic realms, much emphasis was placed on preserving the rationalist Greek tradition of figures such as Aristotle . In the context of science within Islam there are questions as to whether Islamic scientists simply preserved accomplishments from classical antiquity or built upon earlier Greek advances. Regardless, classical European science was brought back to the Christian kingdoms due to the experience of the Crusades . As a result of Persian trade in China, and the battle of the Talas River , Chinese innovations entered the Islamic intellectual world. These include advances in astronomy and in papermaking . Paper-making spread through the Islamic world as far west as Islamic Spain , before paper-making was acquired for Europe by the Reconquista . There is debate about transmission of gunpowder regarding whether the Mongols introduced Chinese gunpowder weapons to Europe or whether gunpowder weapons were independently invented in Europe. In the Mongol Empire, information from diverse cultures was brought together for large projects: for instance in 1303 the Mongol Yuan dynasty combined Chinese and Islamic cartography to make a map that likely included all of Eurasia including western Europe. This "Eurasia map" is now lost, but it influenced Chinese and Korean geographical knowledge centuries later. It is apparent that within Eurasia transfer of information between world cultures did occur, usually through translations of written documents. Within Eurasia, there were four major civilization groups that had literate cultures and created literature and arts, including Europe, West Asia, South Asia, and East Asia. Southeast Asia could be a possible fifth category but was influenced heavily from both South and East Asia literal cultures. All four cultures in post-classical times used poetry , drama , and prose . Throughout the period and until the 19th century poetry was the dominant form of literary expression. In West Asia, South Asia, Europe, and China, great poetic works often used figurative language. Examples include, the Sanskrit Shakuntala , the Arabic Thousand and one nights , Old English Beowulf and works by the Chinese Du Fu and the Persian Rumi . In Japan, prose uniquely thrived more than in other geographic areas. The Tale of Genji is considered the world's first realistic novel written in the 9th century. Musically, most regions of the world only used monophonic melodies as opposed to harmony . Medieval Europe was the lone exception to this rule, developing harmonic music in the 14th/15th century as musical culture transitioned form sacred music (meant for the church) to secular music. South Asian and West Asian music were similar to each other for their use of microtone . East Asian music shared some similarities with European music by using twelve tones and employing scales, but differed in the number of scales used- 5 for the former and seven for the latter During the post-classical era, Africa was both culturally and politically affected by the introduction of Islam and the Arab empires. This was especially true in the north, the Sudan , and the east coast. However, this conversion was not complete nor uniform among different areas, and the low-level classes hardly changed their beliefs at all. Prior to the migration and conquest of Muslims into Africa, much of the continent was dominated by diverse societies of varying sizes and complexities. These were ruled by kings or councils of elders who would control their constituents in a variety of ways. Most of these peoples practiced spiritual, animistic religions. Africa was culturally separated between Saharan Africa (which consisted of North Africa and the Sahara Desert ) and sub-Saharan Africa (everything south of the Sahara). Sub-Saharan Africa was further divided into the Sudan, which covered everything north of Central Africa , including West Africa . The area south of the Sudan was primarily occupied by the Bantu peoples who spoke the Bantu language . From 1100 onward, Christian Europe and the Islamic world became dependent on Africa for gold. After approximately 650 urbanization expanded for the first time beyond the ancient kingdoms Aksum and Nubia . African civilizations can be divided into three categories based on religion: Sub-Saharan Africa was part of two large, separate trading networks, the trans-Saharan trade that bridged commerce between West and North Africa. Due to the huge profits from trade native African Islamic empires arose, including those of Ghana , Mali, and Songhai. In the 14th century, Mansa Musa king of Mali may have been the wealthiest person of his time. Within Mali, the city of Timbuktu was an international center of science and well known throughout the Islamic world, particularly from the University of Sankoré . East Africa was part of the Indian Ocean trade network, which included both Arab ruled Islamic cities on the East African Coast such as Mombasa and traditional cities such as Great Zimbabwe which exported gold, copper and ivory to markets in the Middle East, South Asia, and Southeast Asia. In Europe, Western civilization reconstituted after the fall of the Western Roman Empire into the period now known as the Early Middle Ages (500–1000). The Early Middle Ages saw a continuation of trends begun in late antiquity : depopulation, deurbanization, and increased barbarian invasion. From the 7th until the 11th centuries, Arabs , Magyars , and Norse were all threats to the Christian Kingdoms that killed thousands of people over centuries. Raiders however, also created new trading networks. In Western Europe, the Frankish king Charlemagne attempted to kindle the rise of culture and science in the Carolingian Renaissance . In 800, Charlemagne founded the Holy Roman Empire in attempt to resurrect ancient Rome. The reign of Charlemagne attempted to kindle a rise of learning and literacy in what has become known as the Carolingian Renaissance . In Eastern Europe, the Eastern Roman Empire survived in what is now called the Byzantine Empire, which created the Code of Justinian that inspired the legal structures of modern European states. Overseen by Eastern Orthodox emperors, in the 9th–10th centuries the Byzantine Eastern Orthodox Church Christianized the First Bulgarian Empire and Kievan Rus' , the cultural and political ancestors to modern-day Bulgaria and North Macedonia , on the one hand, and Russia and Ukraine , on the other. Byzantium flourished as the leading power and trade center in its region in the Macedonian Renaissance until it was overshadowed by Italian city-states and the Islamic Ottoman Empire near the end of the Middle Ages. Later in the period, the creation of the feudal system allowed greater degrees of military and agricultural organization. There was sustained urbanization in northern and western Europe . Later developments were marked by manorialism and feudalism , and evolved into the prosperous High Middle Ages . After 1000 the Christian kingdoms that had emerged from Rome's collapse changed dramatically in their cultural and societal character. During the High Middle Ages (c. 1000–1300), Christian -oriented art and architecture flourished and the Crusades were mounted to recapture the Holy Land from Muslim control. The influence of the emerging nation-state was tempered by the ideal of an international Christendom and the presence of the Catholic Church in all western kingdoms. The codes of chivalry and courtly love set rules for proper behavior, while the Scholastic philosophers attempted to reconcile faith and reason. The age of Feudalism would be dramatically transformed by the cataclysm of the Black Death and its aftermath. This time would be a major underlying cause for the Renaissance. By the turn of the 16th century European or Western civilization would be engaging in the Age of Discovery . The term "Middle Ages" first appears in Latin in the 15th century and reflects the view that this period was a deviation from the path of classical learning, a path supposedly reconnected by Renaissance scholarship. The Arabian Peninsula and the surrounding Middle East and Near East regions saw dramatic change during the post-classical era caused primarily by the spread of Islam and the establishment of the Arab caliphates . In the 5th century, the Middle East was separated by empires and their spheres of influence; the two most prominent were the Persian Sasanian Empire , centered in what is now Iran , and the Byzantine Empire in Anatolia (modern-day Turkey ). The Byzantines and Sasanians fought with each other continually, a reflection of the rivalry between the Roman Empire and the Persian Empire seen during the previous five hundred years. The fighting weakened both states, leaving the stage open to a new power. Meanwhile, the nomadic Bedouin tribes who dominated the Arabian desert saw a period of tribal warfare for scarce resources and a familiarity with Abrahamic religions or monotheism. While the Byzantine and Sasanian Empires were both weakened by the Byzantine–Sasanian War of 602–628 , a new power in the form of Islam grew in the Middle East under Muhammad in Medina . In a series of rapid Muslim conquests , the Rashidun army , led by the caliphs and skilled military commanders such as Khalid ibn al-Walid , swept through most of the Middle East, taking more than half of Byzantine territory in the Arab–Byzantine wars and completely engulfing Persia in the Muslim conquest of Persia . It would be the Arab caliphates of the Middle Ages that would first unify the entire Middle East as a distinct region and create the dominant ethnic identity that persists today. These caliphates included the Rashidun , Umayyad , and Abbasid Caliphates , along with the later Turkic-based Seljuk Empire . After Muhammad introduced Islam, it jump-started Middle Eastern culture into an Islamic Golden Age , inspiring achievements in architecture , the revival of old advances in science and technology, and the formation of a distinct way of life. Muslims saved and spread Greek advances in medicine , algebra , geometry , astronomy , anatomy , and ethics that would later find their way back to Western Europe. The dominance of the Arabs came to a sudden end in the mid-11th century with the arrival of the Seljuk Turks, migrating south from the Turkic homelands in Central Asia. They conquered Persia, Iraq (capturing Baghdad in 1055), Syria, Palestine, and the Hejaz . This was followed by a series of Christian Western Europe invasions. The fragmentation of the Middle East allowed joint European forces mainly from England , France , and the emerging Holy Roman Empire , to enter the region. In 1099 the knights of the First Crusade captured Jerusalem and founded the Kingdom of Jerusalem , which survived until 1187, when Saladin retook the city. Smaller crusader fiefdoms survived until 1291. In the early 13th century, a new wave of invaders, the armies of the Mongol Empire , swept through the region, sacking Baghdad in the siege of Baghdad and advancing as far south as the border of Egypt in what became known as the Mongol conquests . The Mongols eventually retreated in 1335, but the chaos that ensued throughout the empire deposed the Seljuk Turks. In 1401, the region was further plagued by the Turko-Mongol , Timur , and his ferocious raids. By then, another group of Turks had arisen as well, the Ottomans. There has been difficulty applying the word "medieval" or "post-classical" to the history of South Asia. This section follows historian Stein Burton's definition that corresponds from the 8th century to the 16th century, more or less following the same time frame of the post-classical period and the European Middle Ages. Until the 13th century, there was no less than 20 to 40 different states on the Indian subcontinent which hosted a variety of cultures, languages, writing systems and religions. At the beginning of the time period Buddhism was predominant throughout the area with the short-lived Pala Empire on the Indo-Gangetic Plain sponsoring the faith's institutions. One such institution was the Buddhist Nalanda mahavihara in modern-day Bihar , a centre of scholarship that brought the divided South Asia onto the global intellectual stage. Another accomplishment was the invention of the Chaturanga game which later was exported to Europe and became chess . In South India , the Hindu kingdom of Chola gained prominence with an overseas empire that controlled parts of modern-day Sri Lanka, Malaysia, and Indonesia as oversees territories and accelerated the spread of Hinduism into the historic culture of these places. In this time period, neighboring areas such as Afghanistan , Tibet , and Myanmar were under South Asian influence . From 1206 onward, a series of Turkic invasions from modern-day Afghanistan and Iran conquered massive portions of North India , founding the Delhi Sultanate which remained supreme until the 16th century. Buddhism declined in South Asia vanishing in many areas but Hinduism survived and reinforced itself in areas conquered by Muslims . In the far south, the Vijayanagara Empire was not conquered by any Muslim state in the period. The turn of the 16th century would see the rise of a new Islamic empire – the Mughals and the establishment of European trade posts by the Portuguese . From the 8th century onward, Southeast Asia stood to benefit from the trade taking place between South and East Asia, numerous kingdoms arose in the region due to the flow of wealth passing through the Strait of Malacca . While Southeast Asia had numerous outside influences including Indian and Chinese Civilization, local cultures strove to cement their own unique identities. North Vietnam (known as Dai Viet) was culturally closer to China for centuries due to conquest. Since rule from the third century BCE, North Vietnam continued to be subjugated by Chinese states, although they continually resisted periodically. There were three periods of Chinese domination that spanned near 1100 years. The Vietnamese gained long lasting independence in the 10th century when China was divided with Tĩnh Hải quân and the successor Đại Việt . Nonetheless, even as an independent state a sort of begrudging Sinicization occurred. South Vietnam was governed by the ancient Hindu Champa Kingdom but was annexed by the Vietnamese in the 15th century. The spread of Hinduism, Buddhism, and maritime trade between China and South Asia created the foundation for Southeast Asia's first major empires; including the Khmer Empire from Cambodia and Srivijaya from Indonesia. During the Khmer Empire's height in the 12th century the city of Angkor Thom was among the largest of the pre-modern world due to its water management. King Jayavarman II constructed over a hundred hospitals throughout his realm. Nearby rose the Pagan Empire in modern-day Burma, using elephants as military might. The construction of the Buddhist Shwezigon Pagoda and its tolerance for believers of older polytheistic gods helped Theravada Buddhism become supreme in the region. In Indonesia, Srivijaya from the 7th through 14th century was a thalassocracy that focused on maritime city states and trade. Controlling the vital choke points of the Sunda and Malacca Straits it became rich from trade ranging from Japan through Arabia. Gold, ivory, and ceramics were all major commodities traveling through port cities. The empire was also responsible for the construction of wonders such as Borobudur . During this time Indonesian sailors crossed the Indian Ocean ; evidence suggests that they may have colonized Madagascar . Indian culture spread to the Philippines , likely through Indonesian trade resulting in the first documented use of writing in the archipelago and Indianized kingdoms. Over time, changing economic and political conditions elsewhere and wars weakened the traditional empires of Southeast Asia. While the Mongol invasions did not directly annex Southeast Asia, the war-time devastation paved way for the rise of new nations. In the 14th century the Khmer Empire was uprooted by persistent years of war - losing the functionality and engineering knowledge of its advanced water management system. Srivijaya was overtaken by the Majapahit . Islamic missionaries and merchants arrived eventually leading to Islamization in Indonesia. [upper-alpha 4] The time frame of 500–1500 in East Asia's history and China in particular has been proposed as a possible classification for the region's history within the context of global post-classical history. Discussions within Columbia University's Association of Asian studies have postulated that similarities between China and other regions of Eurasia during post-classical times have often been overlooked. [upper-alpha 5] Typically the English language histography of Japan postulates that its 'medieval period' began as late as 1185. [upper-alpha 6] During this period the Eastern empires continued to expand through trade, migration and conquests of neighboring areas. Japan and Korea went under the process of voluntary Sinicization, or the impression of Chinese cultural and political ideas. Korea and Japan sinicized because their ruling class were largely impressed by China's bureaucracy. The major influences China had on these countries were the spread of Confucianism, the spread of Buddhism, and the establishment of centralized governance. Throughout East Asia, Buddhism was most visible in monasteries and local educational institutions and Confucianism remained the ideology of social cohesion and state power. In the times of the Sui , Tang , and Song dynasties (581–1279), China remained the world's largest economy and most technologically advanced society. Inventions such as gunpowder, woodblock printing, and the magnetic compass were improved upon. China stood in contrast to other areas at the time as the imperial governments exhibited concentrated central authority instead of feudalism. China exhibited much interest in foreign affairs during the Tang and Song dynasties. From the 7th through the 10th centuries, Tang China was focused on securing the Silk Road as the selling of its goods westwards was central to the nation's economy. For a time China successfully secured its frontiers by integrating their nomadic neighbors - the Göktürks - into their civilization. The Tang dynasty expanded into Central Asia and received tribute from countries as distant as Eastern Iran. Western expansion ended with wars with the Abbasid Caliphate and the deadly An Lushan Rebellion which resulted in a deadly but uncertain death toll of millions. After the collapse of the Tang dynasty and subsequent civil wars came the second phase of Chinese interest in foreign relations. Unlike the Tang, the Song specialized in overseas trade and peacefully created a maritime network, and China's population became concentrated in the south. Chinese merchant ships reached Indonesia, India and Arabia. Southeast Asia's economy flourished from trade with Song China. With the country's emphasis on trade and economic growth. Song China's economy began to use machines to manufacture goods and coal as a source of energy. The advances of the Song in the 11th/12th centuries have been considered an early industrial revolution . Economic advancements came at the cost of military affairs and the Song became open to invasions from the north. China became divided as Song's northern lands were conquered by the Jurchen people . By 1200, there were five Chinese kingdoms stretching from modern day Turkestan to the Sea of Japan including the Western Liao , Western Xia , Jin , Southern Song , and Dali . Because these states competed with each other they all were eventually annexed by the rising Mongol Empire before 1279. After seventy years of conquest , the Mongols proclaimed the Yuan dynasty and also annexed Korea ; they failed to conquer Japan . Mongol conquerors also made China accessible to European travelers such as Marco Polo . The Mongol era was short lived due to plagues and famine. After the revolution in 1368, the succeeding Ming dynasty ushered in a period of prosperity and brief foreign expeditions before isolating itself from global affairs for centuries. Korea and Japan however continued to have relations with China and with other Asian countries. In the 15th century Sejong the Great of Korea cemented his country's identity by creating the Hangul writing system to replace use of Chinese characters . Meanwhile, Japan fell under military rule of the Kamakura and later Ashikaga Shogunate dominated by the samurai . Separate from developments in Afro-Eurasia and the Americas the region of greater Oceania continued to develop independently of the outside world. In Australia , the society of Aboriginal Australians changed little through the post-classical Period since their arrival in the area from Africa around 50,000 BCE. The only evidence of outside contact were encounters with fishermen of Indonesian origin. [upper-alpha 7] Polynesian and Micronesian peoples are rooted from Taiwan and Southeast Asia and began their migration into the Pacific Ocean from 3000 to 1500 BCE. After the 4th century, the Micronesians and Polynesians began to explore the South Pacific and later constructed cities in previously uninhabited areas including Nan Madol Muʻa and others. [upper-alpha 8] Around 1200 CE the Tuʻi Tonga Empire spread its influence far and wide throughout the South Pacific Islands, being described by academics as a maritime chiefdom which used trade networks to keep power centralized around the king's capital. Polynesians on outrigger canoes discovered and colonized some of the last uninhabited islands of earth. Hawaii , New Zealand , and Easter Island were among the final places to be reached, settlers discovering pristine lands. Oral tradition claimed that navigator Ui-te-Rangiora discovered icebergs in the Southern Ocean . In exploring and settling, Polynesian settlers did not strike at random but used their knowledge of wind and water currents to reach their destinations. On the settled islands some Polynesian groups became distinct from one another, a significant example being the Maori of New Zealand. Other island systems kept in contact with each other, including Hawaii and the Tahiti , goods in long distance trade included basalt, and Pearl shell. Ecologically, Polynesians had the challenge of sustaining themselves within limited environments. Some settlements caused mass extinctions of some native plant and animal species over time by hunting species such as the moa and introducing the Polynesian rat . Easter Island settlers engaged in complete ecological destruction of their habtiat and their population crashed afterwards possibly due to the construction of the Easter Island Statues . [upper-alpha 9] Other colonizing groups adapted to accommodate to the ecology of specific islands such as the Moriori of the Chatham Islands . Europeans on their voyages visited many Pacific islands in the 16th and 17th century, but most areas of Oceania were not colonized until after the voyages of British explorer James Cook in the 1780s. The post-classical era of the Americas can be considered set at a different time span from that of Afro-Eurasia. As the developments of Mesoamerican and Andean civilization differ greatly from that of the Old World, as well as the speed at which it developed, the post-classical era in the traditional sense does not take place until near the end of the medieval age in Western Europe. [upper-alpha 10] As such, for the purposes of this article, the Woodland period and Classic stage of the Americas will be discussed here, which takes place from about 400 to 1400. For the technical post-classical stage in American development which took place on the eve of European contact, see Post-Classic stage . As a continent there was little unified trade or communication. Advances in agriculture spread northward from Mesoamerica indirectly through trade. Major cultural areas however still developed independently of each other. While there was little regular contact between the Americas and the Old World, the Norse explored and even colonized Greenland and Canada as early as 1000. None of these settlements survived past medieval times. Outside of Scandinavia knowledge of the discovery of the Americas was interpreted as a remote island or the North Pole . The Norse arriving from Iceland settled Greenland from approximately 980 to 1450. The Norse arrived in southern Greenland prior to the 13th century approach of Inuit Thule people in the area. The extent of the interaction between the Norse and Thule is unclear. Greenland was valuable to the Norse due to trade of ivory that came from the tusks of walruses. The Little Ice Age adversely affected the colonies and they vanished. Greenland would be lost to Europeans until Danish Colonization in the 18th century. The Norse also explored and colonized farther south in Newfoundland , Canada at L'Anse aux Meadows referred to by the Norse as Vinland . The colony at most existed for twenty years and resulted in no known transmission of diseases or technology to the First Nations . To the Norse Vinland was known for plentiful grape vines to make superior wine. One reason for the colony's failure was constant violence with the native Beothuk people who the Norse referred to as skrælings . After initial expeditions there is a possibility that the Norse continued to visit modern day Canada. Surviving records from medieval Iceland indicate some sporadic voyages to a land called Markland , possibly the coast of Labrador , Canada, as late as 1347 presumably to collect wood for deforested Greenland. In North America , many hunter-gatherer and agricultural societies thrived in the diverse region. Native American tribes varied greatly in characteristics; some, including the Mound Builders and the Oasisamerican cultures were complex chiefdoms. Other nations which inhabited the states of the modern northern United States and Canada had less complexity and did not follow technological changes as quickly. Approximately around the year 500 during the Woodland period , Native Americans began to transition to bows and arrows from spears for hunting and warfare. Around the year 1,000 corn was widely adopted as a staple crop in the Eastern United States . Corn would continue to be the staple crop of natives in the Eastern United States and Canada until the Columbian exchange. In the Eastern United States, rivers were the medium of trade and communication. Cahokia located in the modern U.S. state of Illinois was among the most significant city within the Mississippian culture . Focused around Monks Mound archaeology indicates the population increased exponentially after 1000 because it manufactured important tools for agriculture and hosted cultural attractions. Around 1350 Cahokia was abandoned, environmental factors have been proposed for the city's decline. At the same time Ancestral Puebloans constructed clusters of buildings in the Chaco Canyon site located in the State of New Mexico . Individual houses may have been occupied by more than 600 residents at any one time. Chaco Canyon was the only pre-Columbian site in the United States to build paved roads. Pottery indicates a society that was becoming more complex, turkeys for the first time in the continental United States were also domesticated. Around 1150 the structures of Chaco Canyon were abandoned, likely as a result of severe drought. There were also other Pueblo complexes in the Southwestern United States like the Cliff Palace located in Mesa Verde National Park . After reaching climaxes native complex societies in the United States declined and did not entirely recover before the arrival of European explorers. [upper-alpha 11] Concentrating a significant number of islands, the Caribbean had been the scene of constant maritime migrations via canoes since the Lithic stage , with its first inhabitants reaching the area by around 5000 BCE. After a millennia of population flows, the various peoples of the Caribbean entered in the post-classical period with notable developments on numerous permanent settlements and more complex social organizations, which were a result of the improvement of agricultural techniques and also the considerable growth of villages, that became great ceremonial and commercial centers led by different Cacique . Trading goods like shells, cotton, gold, colored stones and rare feathers were largely exported from island to island, ranging from the Lesser to the Great Antilles. By around 650 C.E and 800 C.E, new migratory waves from the Caribbean coast of present-day Venezuela took place and several people began a process of major cultural, sociopolitical, and ritual reformulations, which led to the formation of the first chiefdoms and the emergence of social hierarchy . This period can also be described by the expulsion of the ancient Saladoid peoples from the main islands of the Caribbean and their subsequent replacement by the newly arrived Taíno people, who fiercely competed with other Arawak-speaking groups for arable land and war captives. Despite little evidence, some scholars still claim that the Taíno may have had a tenuous influence from the Maya civilization , as certain customs, such as the practice of batey , may have been inherited from the original Mesoamerican ballgame which also carried a religious character. When Christopher Columbus landed in the Bahamas in 1492 , he and his crew initially maintained a peaceful contact with the local Taíno people, but soon afterwards they were enslaved by the Spanish colonizers, bringing the area into the early modern period . At the beginning of the global post-classical period, the city of Teotihuacan was at its zenith, housing over 125,000 people, at 500 A.D it was the sixth largest city in the world at the time. The city's residents built the Pyramid of the Sun the third largest pyramid of the world, oriented to follow astronomical events. Suddenly in the 6th and 7th centuries, the city suddenly declined possibly as a result of severe environmental damage caused by extreme weather events of 535–536 . There is evidence that large parts of the city were burned, possibly in a domestic rebellion. [upper-alpha 12] The city's legacy would inspire all future civilizations in the region. At the same time was Classic Age of the Maya civilization clustered in dozens of city states on the Yucatán and modern day Guatemala . The most significant of these cities was Chichen Itza which often fiercely competed with anywhere from 60 to 80 city states to be the dominant economic influence in the region. Likewise, other Mayan cities such as Tikal and Calakmul also initiated a series of full-scale conflicts in the area over power and prestige, culminating in the Tikal-Calakmul Wars in the 6th century. The Mayans had an upper caste of priests, who were well versed in astronomy, mathematics, and writing. The Mayan developed the concept of zero, and a 365-day calendar which possibly pre-dates its creation in Old World societies. After 900, many Mayan cities suddenly declined due to ecological disaster which was likely caused by a combination of drought and an incessant cycle of warfare, It's also been noted that classical Mayan Cities lacked food storage facilities. The Toltec Empire arose from the Toltec culture, and were remembered as wise and benevolent leaders. One priest-king called Ce Acatl Topiltzin advocated against human sacrifice. After his death in 947, civil wars of religious character broke out between those who supported and opposed Topiltzin's teachings. Modern historians however are skeptical of the extent of Toltec and influence and believe that much of the information known about the Toltecs was created by the later Aztecs as an inspiration myth. In the 1300s, a small band of violent, religious radicals called the Aztecs began minor raids throughout the area. Eventually they began to claim connections with the Toltec civilization, and insisted they were the rightful successors. They began to grow in numbers and conquer large areas of land. Fundamental to their conquest, was the use of political terror in the sense that the Aztec leaders and priests would command the human sacrifice of their subjugated people as means of humility and coercion. Most of the Mesoamerican region would eventually fall under the Aztec Empire. On the Yucatán Peninsula most of the Maya peoples continued to be independent of the Aztecs but their traditional civilization declined. Aztec developments expanded cultivation, applying the use of chinampas , irrigation, and terrace agriculture ; important crops included maize , sweet potatoes , and avocados . In 1430, the city of Tenochtitlan allied with other powerful Nahuatl -speaking cities, Texcoco and Tlacopan , to create the Aztec Empire, otherwise known as the Triple Alliance. Though referred to as an empire the Aztec Empire functioned as a system of tribute collection with Tenochtitlan at its center. By the turn of the 16th century, " flower wars " between the Aztecs and rival states such as Tlaxcala had continued for over fifty years. South American civilization was concentrated in the Andean region which had already hosted complex cultures since 2,500 BCE. East of the Andean region, societies were generally semi nomadic. Discoveries on the Amazon River Basin indicate the region likely had a pre-contact population of five million people and hosted complex societies. Around the continent numerous agricultural peoples from Colombia to Argentina steadily advanced through numerous stages of development from 500 CE until European contact. During ancient times, the Andes had developed civilizations independent of outside influences including that of Mesoamerica. Through the Post Classical era a cycle of civilizations continued until Spanish contact . Collectively Andean societies lacked currency, a written language and solid draft animals enjoyed by old world civilizations. Instead Andeans developed other methods to foster their growth, including use of the quipu system to communicate messages, llamas to carry smaller loads and an economy based on reciprocity . Societies were often based on strict social hierarchies and economic redistribution from the ruling class. In the first half of the post-classical period, the Andes was dominated by two almost equally powerful states. In the north of Peru was the Wari Empire and in the south of Peru and Bolivia there was the Tiwanaku Empire , both of whom were inspired by the earlier Moche people . While the extent of their relationship to each other is unknown, it is believed that they competed with one another, but avoided direct conflict. Without war, there was prosperity and around the year 700 Tiwanaku city hosted a population of 1.4 million. After the 8th century both states declined due to changing environmental conditions, laying the ground work for the Incas and other minor kingdoms to emerge as distinct cultures centuries later. In the 15th century, the Inca Empire rose to annex all other nations in the area. Led by their sun-god king, Sapa Inca , they slowly conquered what is now Peru , and built their society throughout the Andes cultural region. The Incas spoke the Quechua languages . Taking advantage of ancient advances left by previous Andean societies, the Incas were able to create the most advanced system of trade routes of South America, known as the Inca road system , which allowed greater interconnection between the conquered provinces. Incas have been known to have used abacuses to calculate mathematics. The Inca Empire is known for some of its magnificent structures, such as Machu Picchu in the Cusco region . The empire expanded quickly northwards to Ecuador, southwards to central Chile. To the north of the Inca Empire remained the independent Tairona and Muisca Confederation who practiced agriculture and gold metallurgy. During the post-classical era, Africa was both culturally and politically affected by the introduction of Islam and the Arab empires. This was especially true in the north, the Sudan , and the east coast. However, this conversion was not complete nor uniform among different areas, and the low-level classes hardly changed their beliefs at all. Prior to the migration and conquest of Muslims into Africa, much of the continent was dominated by diverse societies of varying sizes and complexities. These were ruled by kings or councils of elders who would control their constituents in a variety of ways. Most of these peoples practiced spiritual, animistic religions. Africa was culturally separated between Saharan Africa (which consisted of North Africa and the Sahara Desert ) and sub-Saharan Africa (everything south of the Sahara). Sub-Saharan Africa was further divided into the Sudan, which covered everything north of Central Africa , including West Africa . The area south of the Sudan was primarily occupied by the Bantu peoples who spoke the Bantu language . From 1100 onward, Christian Europe and the Islamic world became dependent on Africa for gold. After approximately 650 urbanization expanded for the first time beyond the ancient kingdoms Aksum and Nubia . African civilizations can be divided into three categories based on religion: Sub-Saharan Africa was part of two large, separate trading networks, the trans-Saharan trade that bridged commerce between West and North Africa. Due to the huge profits from trade native African Islamic empires arose, including those of Ghana , Mali, and Songhai. In the 14th century, Mansa Musa king of Mali may have been the wealthiest person of his time. Within Mali, the city of Timbuktu was an international center of science and well known throughout the Islamic world, particularly from the University of Sankoré . East Africa was part of the Indian Ocean trade network, which included both Arab ruled Islamic cities on the East African Coast such as Mombasa and traditional cities such as Great Zimbabwe which exported gold, copper and ivory to markets in the Middle East, South Asia, and Southeast Asia. In Europe, Western civilization reconstituted after the fall of the Western Roman Empire into the period now known as the Early Middle Ages (500–1000). The Early Middle Ages saw a continuation of trends begun in late antiquity : depopulation, deurbanization, and increased barbarian invasion. From the 7th until the 11th centuries, Arabs , Magyars , and Norse were all threats to the Christian Kingdoms that killed thousands of people over centuries. Raiders however, also created new trading networks. In Western Europe, the Frankish king Charlemagne attempted to kindle the rise of culture and science in the Carolingian Renaissance . In 800, Charlemagne founded the Holy Roman Empire in attempt to resurrect ancient Rome. The reign of Charlemagne attempted to kindle a rise of learning and literacy in what has become known as the Carolingian Renaissance . In Eastern Europe, the Eastern Roman Empire survived in what is now called the Byzantine Empire, which created the Code of Justinian that inspired the legal structures of modern European states. Overseen by Eastern Orthodox emperors, in the 9th–10th centuries the Byzantine Eastern Orthodox Church Christianized the First Bulgarian Empire and Kievan Rus' , the cultural and political ancestors to modern-day Bulgaria and North Macedonia , on the one hand, and Russia and Ukraine , on the other. Byzantium flourished as the leading power and trade center in its region in the Macedonian Renaissance until it was overshadowed by Italian city-states and the Islamic Ottoman Empire near the end of the Middle Ages. Later in the period, the creation of the feudal system allowed greater degrees of military and agricultural organization. There was sustained urbanization in northern and western Europe . Later developments were marked by manorialism and feudalism , and evolved into the prosperous High Middle Ages . After 1000 the Christian kingdoms that had emerged from Rome's collapse changed dramatically in their cultural and societal character. During the High Middle Ages (c. 1000–1300), Christian -oriented art and architecture flourished and the Crusades were mounted to recapture the Holy Land from Muslim control. The influence of the emerging nation-state was tempered by the ideal of an international Christendom and the presence of the Catholic Church in all western kingdoms. The codes of chivalry and courtly love set rules for proper behavior, while the Scholastic philosophers attempted to reconcile faith and reason. The age of Feudalism would be dramatically transformed by the cataclysm of the Black Death and its aftermath. This time would be a major underlying cause for the Renaissance. By the turn of the 16th century European or Western civilization would be engaging in the Age of Discovery . The term "Middle Ages" first appears in Latin in the 15th century and reflects the view that this period was a deviation from the path of classical learning, a path supposedly reconnected by Renaissance scholarship. The Arabian Peninsula and the surrounding Middle East and Near East regions saw dramatic change during the post-classical era caused primarily by the spread of Islam and the establishment of the Arab caliphates . In the 5th century, the Middle East was separated by empires and their spheres of influence; the two most prominent were the Persian Sasanian Empire , centered in what is now Iran , and the Byzantine Empire in Anatolia (modern-day Turkey ). The Byzantines and Sasanians fought with each other continually, a reflection of the rivalry between the Roman Empire and the Persian Empire seen during the previous five hundred years. The fighting weakened both states, leaving the stage open to a new power. Meanwhile, the nomadic Bedouin tribes who dominated the Arabian desert saw a period of tribal warfare for scarce resources and a familiarity with Abrahamic religions or monotheism. While the Byzantine and Sasanian Empires were both weakened by the Byzantine–Sasanian War of 602–628 , a new power in the form of Islam grew in the Middle East under Muhammad in Medina . In a series of rapid Muslim conquests , the Rashidun army , led by the caliphs and skilled military commanders such as Khalid ibn al-Walid , swept through most of the Middle East, taking more than half of Byzantine territory in the Arab–Byzantine wars and completely engulfing Persia in the Muslim conquest of Persia . It would be the Arab caliphates of the Middle Ages that would first unify the entire Middle East as a distinct region and create the dominant ethnic identity that persists today. These caliphates included the Rashidun , Umayyad , and Abbasid Caliphates , along with the later Turkic-based Seljuk Empire . After Muhammad introduced Islam, it jump-started Middle Eastern culture into an Islamic Golden Age , inspiring achievements in architecture , the revival of old advances in science and technology, and the formation of a distinct way of life. Muslims saved and spread Greek advances in medicine , algebra , geometry , astronomy , anatomy , and ethics that would later find their way back to Western Europe. The dominance of the Arabs came to a sudden end in the mid-11th century with the arrival of the Seljuk Turks, migrating south from the Turkic homelands in Central Asia. They conquered Persia, Iraq (capturing Baghdad in 1055), Syria, Palestine, and the Hejaz . This was followed by a series of Christian Western Europe invasions. The fragmentation of the Middle East allowed joint European forces mainly from England , France , and the emerging Holy Roman Empire , to enter the region. In 1099 the knights of the First Crusade captured Jerusalem and founded the Kingdom of Jerusalem , which survived until 1187, when Saladin retook the city. Smaller crusader fiefdoms survived until 1291. In the early 13th century, a new wave of invaders, the armies of the Mongol Empire , swept through the region, sacking Baghdad in the siege of Baghdad and advancing as far south as the border of Egypt in what became known as the Mongol conquests . The Mongols eventually retreated in 1335, but the chaos that ensued throughout the empire deposed the Seljuk Turks. In 1401, the region was further plagued by the Turko-Mongol , Timur , and his ferocious raids. By then, another group of Turks had arisen as well, the Ottomans. There has been difficulty applying the word "medieval" or "post-classical" to the history of South Asia. This section follows historian Stein Burton's definition that corresponds from the 8th century to the 16th century, more or less following the same time frame of the post-classical period and the European Middle Ages. Until the 13th century, there was no less than 20 to 40 different states on the Indian subcontinent which hosted a variety of cultures, languages, writing systems and religions. At the beginning of the time period Buddhism was predominant throughout the area with the short-lived Pala Empire on the Indo-Gangetic Plain sponsoring the faith's institutions. One such institution was the Buddhist Nalanda mahavihara in modern-day Bihar , a centre of scholarship that brought the divided South Asia onto the global intellectual stage. Another accomplishment was the invention of the Chaturanga game which later was exported to Europe and became chess . In South India , the Hindu kingdom of Chola gained prominence with an overseas empire that controlled parts of modern-day Sri Lanka, Malaysia, and Indonesia as oversees territories and accelerated the spread of Hinduism into the historic culture of these places. In this time period, neighboring areas such as Afghanistan , Tibet , and Myanmar were under South Asian influence . From 1206 onward, a series of Turkic invasions from modern-day Afghanistan and Iran conquered massive portions of North India , founding the Delhi Sultanate which remained supreme until the 16th century. Buddhism declined in South Asia vanishing in many areas but Hinduism survived and reinforced itself in areas conquered by Muslims . In the far south, the Vijayanagara Empire was not conquered by any Muslim state in the period. The turn of the 16th century would see the rise of a new Islamic empire – the Mughals and the establishment of European trade posts by the Portuguese . From the 8th century onward, Southeast Asia stood to benefit from the trade taking place between South and East Asia, numerous kingdoms arose in the region due to the flow of wealth passing through the Strait of Malacca . While Southeast Asia had numerous outside influences including Indian and Chinese Civilization, local cultures strove to cement their own unique identities. North Vietnam (known as Dai Viet) was culturally closer to China for centuries due to conquest. Since rule from the third century BCE, North Vietnam continued to be subjugated by Chinese states, although they continually resisted periodically. There were three periods of Chinese domination that spanned near 1100 years. The Vietnamese gained long lasting independence in the 10th century when China was divided with Tĩnh Hải quân and the successor Đại Việt . Nonetheless, even as an independent state a sort of begrudging Sinicization occurred. South Vietnam was governed by the ancient Hindu Champa Kingdom but was annexed by the Vietnamese in the 15th century. The spread of Hinduism, Buddhism, and maritime trade between China and South Asia created the foundation for Southeast Asia's first major empires; including the Khmer Empire from Cambodia and Srivijaya from Indonesia. During the Khmer Empire's height in the 12th century the city of Angkor Thom was among the largest of the pre-modern world due to its water management. King Jayavarman II constructed over a hundred hospitals throughout his realm. Nearby rose the Pagan Empire in modern-day Burma, using elephants as military might. The construction of the Buddhist Shwezigon Pagoda and its tolerance for believers of older polytheistic gods helped Theravada Buddhism become supreme in the region. In Indonesia, Srivijaya from the 7th through 14th century was a thalassocracy that focused on maritime city states and trade. Controlling the vital choke points of the Sunda and Malacca Straits it became rich from trade ranging from Japan through Arabia. Gold, ivory, and ceramics were all major commodities traveling through port cities. The empire was also responsible for the construction of wonders such as Borobudur . During this time Indonesian sailors crossed the Indian Ocean ; evidence suggests that they may have colonized Madagascar . Indian culture spread to the Philippines , likely through Indonesian trade resulting in the first documented use of writing in the archipelago and Indianized kingdoms. Over time, changing economic and political conditions elsewhere and wars weakened the traditional empires of Southeast Asia. While the Mongol invasions did not directly annex Southeast Asia, the war-time devastation paved way for the rise of new nations. In the 14th century the Khmer Empire was uprooted by persistent years of war - losing the functionality and engineering knowledge of its advanced water management system. Srivijaya was overtaken by the Majapahit . Islamic missionaries and merchants arrived eventually leading to Islamization in Indonesia. [upper-alpha 4]The time frame of 500–1500 in East Asia's history and China in particular has been proposed as a possible classification for the region's history within the context of global post-classical history. Discussions within Columbia University's Association of Asian studies have postulated that similarities between China and other regions of Eurasia during post-classical times have often been overlooked. [upper-alpha 5] Typically the English language histography of Japan postulates that its 'medieval period' began as late as 1185. [upper-alpha 6] During this period the Eastern empires continued to expand through trade, migration and conquests of neighboring areas. Japan and Korea went under the process of voluntary Sinicization, or the impression of Chinese cultural and political ideas. Korea and Japan sinicized because their ruling class were largely impressed by China's bureaucracy. The major influences China had on these countries were the spread of Confucianism, the spread of Buddhism, and the establishment of centralized governance. Throughout East Asia, Buddhism was most visible in monasteries and local educational institutions and Confucianism remained the ideology of social cohesion and state power. In the times of the Sui , Tang , and Song dynasties (581–1279), China remained the world's largest economy and most technologically advanced society. Inventions such as gunpowder, woodblock printing, and the magnetic compass were improved upon. China stood in contrast to other areas at the time as the imperial governments exhibited concentrated central authority instead of feudalism. China exhibited much interest in foreign affairs during the Tang and Song dynasties. From the 7th through the 10th centuries, Tang China was focused on securing the Silk Road as the selling of its goods westwards was central to the nation's economy. For a time China successfully secured its frontiers by integrating their nomadic neighbors - the Göktürks - into their civilization. The Tang dynasty expanded into Central Asia and received tribute from countries as distant as Eastern Iran. Western expansion ended with wars with the Abbasid Caliphate and the deadly An Lushan Rebellion which resulted in a deadly but uncertain death toll of millions. After the collapse of the Tang dynasty and subsequent civil wars came the second phase of Chinese interest in foreign relations. Unlike the Tang, the Song specialized in overseas trade and peacefully created a maritime network, and China's population became concentrated in the south. Chinese merchant ships reached Indonesia, India and Arabia. Southeast Asia's economy flourished from trade with Song China. With the country's emphasis on trade and economic growth. Song China's economy began to use machines to manufacture goods and coal as a source of energy. The advances of the Song in the 11th/12th centuries have been considered an early industrial revolution . Economic advancements came at the cost of military affairs and the Song became open to invasions from the north. China became divided as Song's northern lands were conquered by the Jurchen people . By 1200, there were five Chinese kingdoms stretching from modern day Turkestan to the Sea of Japan including the Western Liao , Western Xia , Jin , Southern Song , and Dali . Because these states competed with each other they all were eventually annexed by the rising Mongol Empire before 1279. After seventy years of conquest , the Mongols proclaimed the Yuan dynasty and also annexed Korea ; they failed to conquer Japan . Mongol conquerors also made China accessible to European travelers such as Marco Polo . The Mongol era was short lived due to plagues and famine. After the revolution in 1368, the succeeding Ming dynasty ushered in a period of prosperity and brief foreign expeditions before isolating itself from global affairs for centuries. Korea and Japan however continued to have relations with China and with other Asian countries. In the 15th century Sejong the Great of Korea cemented his country's identity by creating the Hangul writing system to replace use of Chinese characters . Meanwhile, Japan fell under military rule of the Kamakura and later Ashikaga Shogunate dominated by the samurai . Separate from developments in Afro-Eurasia and the Americas the region of greater Oceania continued to develop independently of the outside world. In Australia , the society of Aboriginal Australians changed little through the post-classical Period since their arrival in the area from Africa around 50,000 BCE. The only evidence of outside contact were encounters with fishermen of Indonesian origin. [upper-alpha 7] Polynesian and Micronesian peoples are rooted from Taiwan and Southeast Asia and began their migration into the Pacific Ocean from 3000 to 1500 BCE. After the 4th century, the Micronesians and Polynesians began to explore the South Pacific and later constructed cities in previously uninhabited areas including Nan Madol Muʻa and others. [upper-alpha 8] Around 1200 CE the Tuʻi Tonga Empire spread its influence far and wide throughout the South Pacific Islands, being described by academics as a maritime chiefdom which used trade networks to keep power centralized around the king's capital. Polynesians on outrigger canoes discovered and colonized some of the last uninhabited islands of earth. Hawaii , New Zealand , and Easter Island were among the final places to be reached, settlers discovering pristine lands. Oral tradition claimed that navigator Ui-te-Rangiora discovered icebergs in the Southern Ocean . In exploring and settling, Polynesian settlers did not strike at random but used their knowledge of wind and water currents to reach their destinations. On the settled islands some Polynesian groups became distinct from one another, a significant example being the Maori of New Zealand. Other island systems kept in contact with each other, including Hawaii and the Tahiti , goods in long distance trade included basalt, and Pearl shell. Ecologically, Polynesians had the challenge of sustaining themselves within limited environments. Some settlements caused mass extinctions of some native plant and animal species over time by hunting species such as the moa and introducing the Polynesian rat . Easter Island settlers engaged in complete ecological destruction of their habtiat and their population crashed afterwards possibly due to the construction of the Easter Island Statues . [upper-alpha 9] Other colonizing groups adapted to accommodate to the ecology of specific islands such as the Moriori of the Chatham Islands . Europeans on their voyages visited many Pacific islands in the 16th and 17th century, but most areas of Oceania were not colonized until after the voyages of British explorer James Cook in the 1780s. The post-classical era of the Americas can be considered set at a different time span from that of Afro-Eurasia. As the developments of Mesoamerican and Andean civilization differ greatly from that of the Old World, as well as the speed at which it developed, the post-classical era in the traditional sense does not take place until near the end of the medieval age in Western Europe. [upper-alpha 10] As such, for the purposes of this article, the Woodland period and Classic stage of the Americas will be discussed here, which takes place from about 400 to 1400. For the technical post-classical stage in American development which took place on the eve of European contact, see Post-Classic stage . As a continent there was little unified trade or communication. Advances in agriculture spread northward from Mesoamerica indirectly through trade. Major cultural areas however still developed independently of each other. While there was little regular contact between the Americas and the Old World, the Norse explored and even colonized Greenland and Canada as early as 1000. None of these settlements survived past medieval times. Outside of Scandinavia knowledge of the discovery of the Americas was interpreted as a remote island or the North Pole . The Norse arriving from Iceland settled Greenland from approximately 980 to 1450. The Norse arrived in southern Greenland prior to the 13th century approach of Inuit Thule people in the area. The extent of the interaction between the Norse and Thule is unclear. Greenland was valuable to the Norse due to trade of ivory that came from the tusks of walruses. The Little Ice Age adversely affected the colonies and they vanished. Greenland would be lost to Europeans until Danish Colonization in the 18th century. The Norse also explored and colonized farther south in Newfoundland , Canada at L'Anse aux Meadows referred to by the Norse as Vinland . The colony at most existed for twenty years and resulted in no known transmission of diseases or technology to the First Nations . To the Norse Vinland was known for plentiful grape vines to make superior wine. One reason for the colony's failure was constant violence with the native Beothuk people who the Norse referred to as skrælings . After initial expeditions there is a possibility that the Norse continued to visit modern day Canada. Surviving records from medieval Iceland indicate some sporadic voyages to a land called Markland , possibly the coast of Labrador , Canada, as late as 1347 presumably to collect wood for deforested Greenland. In North America , many hunter-gatherer and agricultural societies thrived in the diverse region. Native American tribes varied greatly in characteristics; some, including the Mound Builders and the Oasisamerican cultures were complex chiefdoms. Other nations which inhabited the states of the modern northern United States and Canada had less complexity and did not follow technological changes as quickly. Approximately around the year 500 during the Woodland period , Native Americans began to transition to bows and arrows from spears for hunting and warfare. Around the year 1,000 corn was widely adopted as a staple crop in the Eastern United States . Corn would continue to be the staple crop of natives in the Eastern United States and Canada until the Columbian exchange. In the Eastern United States, rivers were the medium of trade and communication. Cahokia located in the modern U.S. state of Illinois was among the most significant city within the Mississippian culture . Focused around Monks Mound archaeology indicates the population increased exponentially after 1000 because it manufactured important tools for agriculture and hosted cultural attractions. Around 1350 Cahokia was abandoned, environmental factors have been proposed for the city's decline. At the same time Ancestral Puebloans constructed clusters of buildings in the Chaco Canyon site located in the State of New Mexico . Individual houses may have been occupied by more than 600 residents at any one time. Chaco Canyon was the only pre-Columbian site in the United States to build paved roads. Pottery indicates a society that was becoming more complex, turkeys for the first time in the continental United States were also domesticated. Around 1150 the structures of Chaco Canyon were abandoned, likely as a result of severe drought. There were also other Pueblo complexes in the Southwestern United States like the Cliff Palace located in Mesa Verde National Park . After reaching climaxes native complex societies in the United States declined and did not entirely recover before the arrival of European explorers. [upper-alpha 11] Concentrating a significant number of islands, the Caribbean had been the scene of constant maritime migrations via canoes since the Lithic stage , with its first inhabitants reaching the area by around 5000 BCE. After a millennia of population flows, the various peoples of the Caribbean entered in the post-classical period with notable developments on numerous permanent settlements and more complex social organizations, which were a result of the improvement of agricultural techniques and also the considerable growth of villages, that became great ceremonial and commercial centers led by different Cacique . Trading goods like shells, cotton, gold, colored stones and rare feathers were largely exported from island to island, ranging from the Lesser to the Great Antilles. By around 650 C.E and 800 C.E, new migratory waves from the Caribbean coast of present-day Venezuela took place and several people began a process of major cultural, sociopolitical, and ritual reformulations, which led to the formation of the first chiefdoms and the emergence of social hierarchy . This period can also be described by the expulsion of the ancient Saladoid peoples from the main islands of the Caribbean and their subsequent replacement by the newly arrived Taíno people, who fiercely competed with other Arawak-speaking groups for arable land and war captives. Despite little evidence, some scholars still claim that the Taíno may have had a tenuous influence from the Maya civilization , as certain customs, such as the practice of batey , may have been inherited from the original Mesoamerican ballgame which also carried a religious character. When Christopher Columbus landed in the Bahamas in 1492 , he and his crew initially maintained a peaceful contact with the local Taíno people, but soon afterwards they were enslaved by the Spanish colonizers, bringing the area into the early modern period . At the beginning of the global post-classical period, the city of Teotihuacan was at its zenith, housing over 125,000 people, at 500 A.D it was the sixth largest city in the world at the time. The city's residents built the Pyramid of the Sun the third largest pyramid of the world, oriented to follow astronomical events. Suddenly in the 6th and 7th centuries, the city suddenly declined possibly as a result of severe environmental damage caused by extreme weather events of 535–536 . There is evidence that large parts of the city were burned, possibly in a domestic rebellion. [upper-alpha 12] The city's legacy would inspire all future civilizations in the region. At the same time was Classic Age of the Maya civilization clustered in dozens of city states on the Yucatán and modern day Guatemala . The most significant of these cities was Chichen Itza which often fiercely competed with anywhere from 60 to 80 city states to be the dominant economic influence in the region. Likewise, other Mayan cities such as Tikal and Calakmul also initiated a series of full-scale conflicts in the area over power and prestige, culminating in the Tikal-Calakmul Wars in the 6th century. The Mayans had an upper caste of priests, who were well versed in astronomy, mathematics, and writing. The Mayan developed the concept of zero, and a 365-day calendar which possibly pre-dates its creation in Old World societies. After 900, many Mayan cities suddenly declined due to ecological disaster which was likely caused by a combination of drought and an incessant cycle of warfare, It's also been noted that classical Mayan Cities lacked food storage facilities. The Toltec Empire arose from the Toltec culture, and were remembered as wise and benevolent leaders. One priest-king called Ce Acatl Topiltzin advocated against human sacrifice. After his death in 947, civil wars of religious character broke out between those who supported and opposed Topiltzin's teachings. Modern historians however are skeptical of the extent of Toltec and influence and believe that much of the information known about the Toltecs was created by the later Aztecs as an inspiration myth. In the 1300s, a small band of violent, religious radicals called the Aztecs began minor raids throughout the area. Eventually they began to claim connections with the Toltec civilization, and insisted they were the rightful successors. They began to grow in numbers and conquer large areas of land. Fundamental to their conquest, was the use of political terror in the sense that the Aztec leaders and priests would command the human sacrifice of their subjugated people as means of humility and coercion. Most of the Mesoamerican region would eventually fall under the Aztec Empire. On the Yucatán Peninsula most of the Maya peoples continued to be independent of the Aztecs but their traditional civilization declined. Aztec developments expanded cultivation, applying the use of chinampas , irrigation, and terrace agriculture ; important crops included maize , sweet potatoes , and avocados . In 1430, the city of Tenochtitlan allied with other powerful Nahuatl -speaking cities, Texcoco and Tlacopan , to create the Aztec Empire, otherwise known as the Triple Alliance. Though referred to as an empire the Aztec Empire functioned as a system of tribute collection with Tenochtitlan at its center. By the turn of the 16th century, " flower wars " between the Aztecs and rival states such as Tlaxcala had continued for over fifty years. South American civilization was concentrated in the Andean region which had already hosted complex cultures since 2,500 BCE. East of the Andean region, societies were generally semi nomadic. Discoveries on the Amazon River Basin indicate the region likely had a pre-contact population of five million people and hosted complex societies. Around the continent numerous agricultural peoples from Colombia to Argentina steadily advanced through numerous stages of development from 500 CE until European contact. During ancient times, the Andes had developed civilizations independent of outside influences including that of Mesoamerica. Through the Post Classical era a cycle of civilizations continued until Spanish contact . Collectively Andean societies lacked currency, a written language and solid draft animals enjoyed by old world civilizations. Instead Andeans developed other methods to foster their growth, including use of the quipu system to communicate messages, llamas to carry smaller loads and an economy based on reciprocity . Societies were often based on strict social hierarchies and economic redistribution from the ruling class. In the first half of the post-classical period, the Andes was dominated by two almost equally powerful states. In the north of Peru was the Wari Empire and in the south of Peru and Bolivia there was the Tiwanaku Empire , both of whom were inspired by the earlier Moche people . While the extent of their relationship to each other is unknown, it is believed that they competed with one another, but avoided direct conflict. Without war, there was prosperity and around the year 700 Tiwanaku city hosted a population of 1.4 million. After the 8th century both states declined due to changing environmental conditions, laying the ground work for the Incas and other minor kingdoms to emerge as distinct cultures centuries later. In the 15th century, the Inca Empire rose to annex all other nations in the area. Led by their sun-god king, Sapa Inca , they slowly conquered what is now Peru , and built their society throughout the Andes cultural region. The Incas spoke the Quechua languages . Taking advantage of ancient advances left by previous Andean societies, the Incas were able to create the most advanced system of trade routes of South America, known as the Inca road system , which allowed greater interconnection between the conquered provinces. Incas have been known to have used abacuses to calculate mathematics. The Inca Empire is known for some of its magnificent structures, such as Machu Picchu in the Cusco region . The empire expanded quickly northwards to Ecuador, southwards to central Chile. To the north of the Inca Empire remained the independent Tairona and Muisca Confederation who practiced agriculture and gold metallurgy. As a continent there was little unified trade or communication. Advances in agriculture spread northward from Mesoamerica indirectly through trade. Major cultural areas however still developed independently of each other. While there was little regular contact between the Americas and the Old World, the Norse explored and even colonized Greenland and Canada as early as 1000. None of these settlements survived past medieval times. Outside of Scandinavia knowledge of the discovery of the Americas was interpreted as a remote island or the North Pole . The Norse arriving from Iceland settled Greenland from approximately 980 to 1450. The Norse arrived in southern Greenland prior to the 13th century approach of Inuit Thule people in the area. The extent of the interaction between the Norse and Thule is unclear. Greenland was valuable to the Norse due to trade of ivory that came from the tusks of walruses. The Little Ice Age adversely affected the colonies and they vanished. Greenland would be lost to Europeans until Danish Colonization in the 18th century. The Norse also explored and colonized farther south in Newfoundland , Canada at L'Anse aux Meadows referred to by the Norse as Vinland . The colony at most existed for twenty years and resulted in no known transmission of diseases or technology to the First Nations . To the Norse Vinland was known for plentiful grape vines to make superior wine. One reason for the colony's failure was constant violence with the native Beothuk people who the Norse referred to as skrælings . After initial expeditions there is a possibility that the Norse continued to visit modern day Canada. Surviving records from medieval Iceland indicate some sporadic voyages to a land called Markland , possibly the coast of Labrador , Canada, as late as 1347 presumably to collect wood for deforested Greenland. In North America , many hunter-gatherer and agricultural societies thrived in the diverse region. Native American tribes varied greatly in characteristics; some, including the Mound Builders and the Oasisamerican cultures were complex chiefdoms. Other nations which inhabited the states of the modern northern United States and Canada had less complexity and did not follow technological changes as quickly. Approximately around the year 500 during the Woodland period , Native Americans began to transition to bows and arrows from spears for hunting and warfare. Around the year 1,000 corn was widely adopted as a staple crop in the Eastern United States . Corn would continue to be the staple crop of natives in the Eastern United States and Canada until the Columbian exchange. In the Eastern United States, rivers were the medium of trade and communication. Cahokia located in the modern U.S. state of Illinois was among the most significant city within the Mississippian culture . Focused around Monks Mound archaeology indicates the population increased exponentially after 1000 because it manufactured important tools for agriculture and hosted cultural attractions. Around 1350 Cahokia was abandoned, environmental factors have been proposed for the city's decline. At the same time Ancestral Puebloans constructed clusters of buildings in the Chaco Canyon site located in the State of New Mexico . Individual houses may have been occupied by more than 600 residents at any one time. Chaco Canyon was the only pre-Columbian site in the United States to build paved roads. Pottery indicates a society that was becoming more complex, turkeys for the first time in the continental United States were also domesticated. Around 1150 the structures of Chaco Canyon were abandoned, likely as a result of severe drought. There were also other Pueblo complexes in the Southwestern United States like the Cliff Palace located in Mesa Verde National Park . After reaching climaxes native complex societies in the United States declined and did not entirely recover before the arrival of European explorers. [upper-alpha 11]While there was little regular contact between the Americas and the Old World, the Norse explored and even colonized Greenland and Canada as early as 1000. None of these settlements survived past medieval times. Outside of Scandinavia knowledge of the discovery of the Americas was interpreted as a remote island or the North Pole . The Norse arriving from Iceland settled Greenland from approximately 980 to 1450. The Norse arrived in southern Greenland prior to the 13th century approach of Inuit Thule people in the area. The extent of the interaction between the Norse and Thule is unclear. Greenland was valuable to the Norse due to trade of ivory that came from the tusks of walruses. The Little Ice Age adversely affected the colonies and they vanished. Greenland would be lost to Europeans until Danish Colonization in the 18th century. The Norse also explored and colonized farther south in Newfoundland , Canada at L'Anse aux Meadows referred to by the Norse as Vinland . The colony at most existed for twenty years and resulted in no known transmission of diseases or technology to the First Nations . To the Norse Vinland was known for plentiful grape vines to make superior wine. One reason for the colony's failure was constant violence with the native Beothuk people who the Norse referred to as skrælings . After initial expeditions there is a possibility that the Norse continued to visit modern day Canada. Surviving records from medieval Iceland indicate some sporadic voyages to a land called Markland , possibly the coast of Labrador , Canada, as late as 1347 presumably to collect wood for deforested Greenland. In North America , many hunter-gatherer and agricultural societies thrived in the diverse region. Native American tribes varied greatly in characteristics; some, including the Mound Builders and the Oasisamerican cultures were complex chiefdoms. Other nations which inhabited the states of the modern northern United States and Canada had less complexity and did not follow technological changes as quickly. Approximately around the year 500 during the Woodland period , Native Americans began to transition to bows and arrows from spears for hunting and warfare. Around the year 1,000 corn was widely adopted as a staple crop in the Eastern United States . Corn would continue to be the staple crop of natives in the Eastern United States and Canada until the Columbian exchange. In the Eastern United States, rivers were the medium of trade and communication. Cahokia located in the modern U.S. state of Illinois was among the most significant city within the Mississippian culture . Focused around Monks Mound archaeology indicates the population increased exponentially after 1000 because it manufactured important tools for agriculture and hosted cultural attractions. Around 1350 Cahokia was abandoned, environmental factors have been proposed for the city's decline. At the same time Ancestral Puebloans constructed clusters of buildings in the Chaco Canyon site located in the State of New Mexico . Individual houses may have been occupied by more than 600 residents at any one time. Chaco Canyon was the only pre-Columbian site in the United States to build paved roads. Pottery indicates a society that was becoming more complex, turkeys for the first time in the continental United States were also domesticated. Around 1150 the structures of Chaco Canyon were abandoned, likely as a result of severe drought. There were also other Pueblo complexes in the Southwestern United States like the Cliff Palace located in Mesa Verde National Park . After reaching climaxes native complex societies in the United States declined and did not entirely recover before the arrival of European explorers. [upper-alpha 11]Concentrating a significant number of islands, the Caribbean had been the scene of constant maritime migrations via canoes since the Lithic stage , with its first inhabitants reaching the area by around 5000 BCE. After a millennia of population flows, the various peoples of the Caribbean entered in the post-classical period with notable developments on numerous permanent settlements and more complex social organizations, which were a result of the improvement of agricultural techniques and also the considerable growth of villages, that became great ceremonial and commercial centers led by different Cacique . Trading goods like shells, cotton, gold, colored stones and rare feathers were largely exported from island to island, ranging from the Lesser to the Great Antilles. By around 650 C.E and 800 C.E, new migratory waves from the Caribbean coast of present-day Venezuela took place and several people began a process of major cultural, sociopolitical, and ritual reformulations, which led to the formation of the first chiefdoms and the emergence of social hierarchy . This period can also be described by the expulsion of the ancient Saladoid peoples from the main islands of the Caribbean and their subsequent replacement by the newly arrived Taíno people, who fiercely competed with other Arawak-speaking groups for arable land and war captives. Despite little evidence, some scholars still claim that the Taíno may have had a tenuous influence from the Maya civilization , as certain customs, such as the practice of batey , may have been inherited from the original Mesoamerican ballgame which also carried a religious character. When Christopher Columbus landed in the Bahamas in 1492 , he and his crew initially maintained a peaceful contact with the local Taíno people, but soon afterwards they were enslaved by the Spanish colonizers, bringing the area into the early modern period .At the beginning of the global post-classical period, the city of Teotihuacan was at its zenith, housing over 125,000 people, at 500 A.D it was the sixth largest city in the world at the time. The city's residents built the Pyramid of the Sun the third largest pyramid of the world, oriented to follow astronomical events. Suddenly in the 6th and 7th centuries, the city suddenly declined possibly as a result of severe environmental damage caused by extreme weather events of 535–536 . There is evidence that large parts of the city were burned, possibly in a domestic rebellion. [upper-alpha 12] The city's legacy would inspire all future civilizations in the region. At the same time was Classic Age of the Maya civilization clustered in dozens of city states on the Yucatán and modern day Guatemala . The most significant of these cities was Chichen Itza which often fiercely competed with anywhere from 60 to 80 city states to be the dominant economic influence in the region. Likewise, other Mayan cities such as Tikal and Calakmul also initiated a series of full-scale conflicts in the area over power and prestige, culminating in the Tikal-Calakmul Wars in the 6th century. The Mayans had an upper caste of priests, who were well versed in astronomy, mathematics, and writing. The Mayan developed the concept of zero, and a 365-day calendar which possibly pre-dates its creation in Old World societies. After 900, many Mayan cities suddenly declined due to ecological disaster which was likely caused by a combination of drought and an incessant cycle of warfare, It's also been noted that classical Mayan Cities lacked food storage facilities. The Toltec Empire arose from the Toltec culture, and were remembered as wise and benevolent leaders. One priest-king called Ce Acatl Topiltzin advocated against human sacrifice. After his death in 947, civil wars of religious character broke out between those who supported and opposed Topiltzin's teachings. Modern historians however are skeptical of the extent of Toltec and influence and believe that much of the information known about the Toltecs was created by the later Aztecs as an inspiration myth. In the 1300s, a small band of violent, religious radicals called the Aztecs began minor raids throughout the area. Eventually they began to claim connections with the Toltec civilization, and insisted they were the rightful successors. They began to grow in numbers and conquer large areas of land. Fundamental to their conquest, was the use of political terror in the sense that the Aztec leaders and priests would command the human sacrifice of their subjugated people as means of humility and coercion. Most of the Mesoamerican region would eventually fall under the Aztec Empire. On the Yucatán Peninsula most of the Maya peoples continued to be independent of the Aztecs but their traditional civilization declined. Aztec developments expanded cultivation, applying the use of chinampas , irrigation, and terrace agriculture ; important crops included maize , sweet potatoes , and avocados . In 1430, the city of Tenochtitlan allied with other powerful Nahuatl -speaking cities, Texcoco and Tlacopan , to create the Aztec Empire, otherwise known as the Triple Alliance. Though referred to as an empire the Aztec Empire functioned as a system of tribute collection with Tenochtitlan at its center. By the turn of the 16th century, " flower wars " between the Aztecs and rival states such as Tlaxcala had continued for over fifty years. South American civilization was concentrated in the Andean region which had already hosted complex cultures since 2,500 BCE. East of the Andean region, societies were generally semi nomadic. Discoveries on the Amazon River Basin indicate the region likely had a pre-contact population of five million people and hosted complex societies. Around the continent numerous agricultural peoples from Colombia to Argentina steadily advanced through numerous stages of development from 500 CE until European contact. During ancient times, the Andes had developed civilizations independent of outside influences including that of Mesoamerica. Through the Post Classical era a cycle of civilizations continued until Spanish contact . Collectively Andean societies lacked currency, a written language and solid draft animals enjoyed by old world civilizations. Instead Andeans developed other methods to foster their growth, including use of the quipu system to communicate messages, llamas to carry smaller loads and an economy based on reciprocity . Societies were often based on strict social hierarchies and economic redistribution from the ruling class. In the first half of the post-classical period, the Andes was dominated by two almost equally powerful states. In the north of Peru was the Wari Empire and in the south of Peru and Bolivia there was the Tiwanaku Empire , both of whom were inspired by the earlier Moche people . While the extent of their relationship to each other is unknown, it is believed that they competed with one another, but avoided direct conflict. Without war, there was prosperity and around the year 700 Tiwanaku city hosted a population of 1.4 million. After the 8th century both states declined due to changing environmental conditions, laying the ground work for the Incas and other minor kingdoms to emerge as distinct cultures centuries later. In the 15th century, the Inca Empire rose to annex all other nations in the area. Led by their sun-god king, Sapa Inca , they slowly conquered what is now Peru , and built their society throughout the Andes cultural region. The Incas spoke the Quechua languages . Taking advantage of ancient advances left by previous Andean societies, the Incas were able to create the most advanced system of trade routes of South America, known as the Inca road system , which allowed greater interconnection between the conquered provinces. Incas have been known to have used abacuses to calculate mathematics. The Inca Empire is known for some of its magnificent structures, such as Machu Picchu in the Cusco region . The empire expanded quickly northwards to Ecuador, southwards to central Chile. To the north of the Inca Empire remained the independent Tairona and Muisca Confederation who practiced agriculture and gold metallurgy. During ancient times, the Andes had developed civilizations independent of outside influences including that of Mesoamerica. Through the Post Classical era a cycle of civilizations continued until Spanish contact . Collectively Andean societies lacked currency, a written language and solid draft animals enjoyed by old world civilizations. Instead Andeans developed other methods to foster their growth, including use of the quipu system to communicate messages, llamas to carry smaller loads and an economy based on reciprocity . Societies were often based on strict social hierarchies and economic redistribution from the ruling class. In the first half of the post-classical period, the Andes was dominated by two almost equally powerful states. In the north of Peru was the Wari Empire and in the south of Peru and Bolivia there was the Tiwanaku Empire , both of whom were inspired by the earlier Moche people . While the extent of their relationship to each other is unknown, it is believed that they competed with one another, but avoided direct conflict. Without war, there was prosperity and around the year 700 Tiwanaku city hosted a population of 1.4 million. After the 8th century both states declined due to changing environmental conditions, laying the ground work for the Incas and other minor kingdoms to emerge as distinct cultures centuries later. In the 15th century, the Inca Empire rose to annex all other nations in the area. Led by their sun-god king, Sapa Inca , they slowly conquered what is now Peru , and built their society throughout the Andes cultural region. The Incas spoke the Quechua languages . Taking advantage of ancient advances left by previous Andean societies, the Incas were able to create the most advanced system of trade routes of South America, known as the Inca road system , which allowed greater interconnection between the conquered provinces. Incas have been known to have used abacuses to calculate mathematics. The Inca Empire is known for some of its magnificent structures, such as Machu Picchu in the Cusco region . The empire expanded quickly northwards to Ecuador, southwards to central Chile. To the north of the Inca Empire remained the independent Tairona and Muisca Confederation who practiced agriculture and gold metallurgy. As the post-classical era drew to a close in the 15th century, many of the empires established throughout the period were in decline. The Byzantine Empire would soon be overshadowed in the Mediterranean by both Islamic and Christian rivals including Venice , Genoa , and the Ottoman Empire. The Byzantines faced repeated attacks from eastern and western powers during the Fourth Crusade , and declined further until the loss of Constantinople to the Ottomans in 1453. The largest change came in terms of trade and technology. The global significance of the fall of the Byzantines was the disruption of overland routes between Asia and Europe. Traditional dominance of nomadism in Eurasia declined and the Pax Mongolica which had allowed for interactions between different civilizations was no longer available. West Asia and South Asia were conquered by gunpowder empires which successfully used advances in military technology but closed the Silk Road. [upper-alpha 13] Europeans – specifically the Portuguese and various Italian explorers – intended to replace land travel with sea travel. Originally European exploration merely looked for new routes to reach known destinations. Portuguese explorer Vasco da Gama traveled to India by sea in 1498 by circumnavigating Africa around the Cape of Good Hope . India and the coast of Africa were already known to Europeans but none had attempted a large trading mission prior to that time. Due to navigation advances Portugal would create a global colonial empire beginning with the conquest of Malacca in modern-day Malaysia from 1511. Other explorers such as the Spanish-sponsored Italian Christopher Columbus intended to engage in trade by traveling on unfamiliar routes west from Europe. The subsequent European discovery of the Americas in 1492 resulted in the Columbian exchange and the world's first pan-oceanic globalization . Spanish explorer Ferdinand Magellan performed the first known circumnavigation of Earth in 1521. The transfer of goods and diseases across oceans was unprecedented in creating a more connected world. From developments in navigation and trade, modern history began.

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Bubonic plague

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La peste (TV series)

La peste ( The Plague ) is a Spanish historical drama television series created by Alberto Rodríguez and Rafael Cobos for Movistar+ . It tells a crime story set in the 16th century Seville during an outbreak of the bubonic plague . The series premiered on 12 January 2018 on Movistar+'s VOD service and on #0 . Before it first aired, on 30 September 2017, it was announced that it had been renewed for a second season, which premiered on 15 November 2019. "During an outbreak of the bubonic plague in the magnificent Seville of 1597, Mateo, a former soldier, returns, honouring his word to find and extract a dead friend's son from the city. Previously, Mateo had been forced to flee the city to save his life, having been sentenced to death by the Inquisition for printing forbidden books. Before he can complete his task, Mateo is arrested by the Inquisitor's bailiffs, who promise to pardon his life in exchange for solving a series of crimes of diabolic overtones being committed in Seville." The second season was shot in Cuevas del Almanzora , Almería , from 15 October 2018 to 19 October.

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Bubonic plague

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Cromwellian conquest of Ireland

English Parliamentarian victory English Parliamentarian conquest of Ireland End of the Irish Catholic Confederation Destruction of the Irish Catholic landed gentry Act for the Settlement of Ireland 1652 Irish Catholic Confederation English Parliamentarian 1641–42 Irish Rebellion 1642–49 1649–53 Cromwellian Conquest The Cromwellian conquest of Ireland or Cromwellian war in Ireland (1649–1653) was the re-conquest of Ireland by the forces of the English Parliament , led by Oliver Cromwell , during the Wars of the Three Kingdoms . Cromwell invaded Ireland with the New Model Army on behalf of England's Rump Parliament in August 1649. Following the Irish Rebellion of 1641 against King Charles I, most of Ireland came under the control of the Irish Catholic Confederation . In early 1649, the Confederates allied with the English Royalists , who had been defeated by the Parliamentarians in the English Civil War . By May 1652, Cromwell's Parliamentarian army had defeated the Confederate and Royalist coalition in Ireland and occupied the country, ending the Irish Confederate Wars (or Eleven Years' War). However, guerrilla warfare continued for a further year. As punishment for the rebellion of 1641, Parliament passed more Penal Laws against Roman Catholics (the majority of the population) and confiscated large amounts of their land , which was given to former Parliamentarian soldiers . It is a myth that the Catholic landowners were all transplanted to Connacht . The Act of Settlement 1652 formalised the change in land ownership. Catholics were barred from the Irish Parliament altogether, forbidden to live in towns and from marrying Protestants. The Parliamentarian struggle with Royalists was brutal and in Nationalist ideology, Cromwell became a reviled figure in Ireland. The extent to which Cromwell, who was in direct command for the first year of the campaign, was responsible for the atrocities is debated to this day. Some authors have argued that the actions of Cromwell were within what many empires at the time viewed as accepted rules of war, while many academic historians disagree. The impact of the war on the Irish population was unquestionably severe and although there is no consensus as to the magnitude of the loss of life, most modern estimates generally fall in between 15 and 50% of the native population. The war resulted in famine, which was worsened by an outbreak of bubonic plague . Older estimates of the drop in the Irish population resulting from the Parliamentarian campaign reach as high as 83 percent. The Parliamentarians also transported about 50,000 people as indentured labourers to the English colonies in North America and the Caribbean . Some estimates cover population losses over the course of the Conquest Period (1649–52) only, while others cover the period of the Conquest to 1653 and the period of the Cromwellian Settlement from August 1652 to 1659 together.The English Rump Parliament, victorious in the English Civil War, and having executed King Charles in January 1649, had several reasons for sending the New Model Army to Ireland in 1649. The first and most pressing reason was an alliance signed in 1649 between the Irish Confederate Catholics , Charles II , proclaimed King of Ireland in January 1649, and the English Royalists. This allowed for Royalist troops to be sent to Ireland and put the Irish Confederate Catholic troops under the command of Royalist officers led by James Butler, Earl of Ormonde . Their aim was to invade England and restore the monarchy there. This was a threat which the new English Commonwealth could not afford to ignore. Secondly, Parliament also had a longstanding commitment to re-conquer Ireland dating back to the Irish Rebellion of 1641. Even if the Irish Confederates had not allied themselves with the Royalists, it is likely that the English Parliament would have eventually tried to invade the country to crush Catholic power there. They had sent Parliamentary forces to Ireland throughout the Wars of the Three Kingdoms (most of them under Michael Jones in 1647). They viewed Ireland as part of the territory governed by right by the Kingdom of England and only temporarily out of its control since the Rebellion of 1641. Many Parliamentarians wished to punish the Irish for alleged atrocities supposedly committed against the mainly Scottish Protestant settlers during the 1641 Uprising. Furthermore, some Irish towns (notably Wexford and Waterford) had acted as bases from which privateers had attacked English shipping throughout the 1640s. In addition, the English Parliament had a financial imperative to invade Ireland to confiscate land there in order to repay its creditors. The Parliament had raised loans of £10 million under the Adventurers' Act to subdue Ireland since 1642, on the basis that its creditors would be repaid with land confiscated from Irish Catholic rebels. To repay these loans, it would be necessary to conquer Ireland and confiscate such land. The Parliamentarians also had internal political reasons to send forces to Ireland. Army mutinies at Banbury and Bishopsgate in April and May 1649 were unsettling the New Model Army, and the soldiers' demands would probably increase if they were left idle. Finally, for many Parliamentarians, the wars in Ireland, Scotland and England were religious wars. Cromwell, unlike much of his army was not strictly a Puritan. The did consider Roman Catholics to be oppressors and for them, the reconquest was viewed as a liberation. The Irish Confederates had been supplied with arms and money by the Papacy and had welcomed the papal legate Pierfrancesco Scarampi and later the Papal Nuncio Giovanni Battista Rinuccini in 1643–49.By the end of the period, known as Confederate Ireland, in 1649 the only remaining Parliamentarian outpost in Ireland was in Dublin, under the command of Colonel Jones. A combined Royalist and Confederate force under Marquess of Ormonde gathered at Rathmines, south of Dublin, to take the city and deprive the Parliamentarians of a port in which they could land. Jones, however, launched a surprise attack on the Royalists while they were deploying on 2 August, putting them to flight. Jones claimed to have killed around 4,000 Royalist or Confederate soldiers and taken 2,517 prisoners. Oliver Cromwell called the battle "an astonishing mercy, so great and seasonable that we are like them that dreamed", as it meant that he had a secure port at which he could land his army in Ireland, and that he retained the capital city. With Admiral Robert Blake blockading the remaining Royalist fleet under Prince Rupert of the Rhine in Kinsale, Cromwell landed on 15 August with thirty-five ships filled with troops and equipment. Henry Ireton landed two days later with a further seventy-seven ships. Ormonde's troops retreated from around Dublin in disarray. They were badly demoralised by their unexpected defeat at Rathmines and were incapable of fighting another pitched battle in the short term. As a result, Ormonde hoped to hold the walled towns on Ireland's east coast to hold up the Cromwellian advance until the winter, when he hoped that "Colonel Hunger and Major Sickness" (i.e. hunger and disease) would deplete their ranks. Upon landing, Cromwell proceeded to take the other port cities on Ireland's east coast, to facilitate the efficient landing of supplies and reinforcements from England. The first town to fall was Drogheda, about 50 km north of Dublin. Drogheda was garrisoned by a regiment of 3,000 English Royalist and Irish Confederate soldiers, commanded by Arthur Aston . After a week-long siege, Cromwell's forces breached the walls protecting the town. Aston refused Cromwell's request that he surrender. In the ensuing battle for the town, Cromwell ordered that no quarter be given, and the majority of the garrison and Catholic priests were killed. Many civilians also died in the sack. Aston was beaten to death by the Roundheads with his own wooden leg. The massacre of the garrison in Drogheda, including some after they had surrendered and some who had sheltered in a church, was received with horror in Ireland and is used today as an example of Cromwell's extreme cruelty. Having taken Drogheda, Cromwell took most of his army south to secure the southeastern ports. He sent a detachment of 5,000 men north under Robert Venables to take eastern Ulster from the remnants of a Scottish Covenanter army that had landed there in 1642. They defeated the Scots at the Battle of Lisnagarvey (6 December 1649) and linked up with a Parliamentarian army composed of English settlers based around Derry in western Ulster, which was commanded by Charles Coote .The New Model Army then marched south to secure the ports of Wexford, Waterford and Duncannon. Wexford was the scene of another infamous atrocity: the Sack of Wexford , when Parliamentarian troops broke into the town while negotiations for its surrender were ongoing, and sacked it, killing about 2,000 soldiers and 1,500 townspeople and burning much of the town. The Royalist commander Ormonde thought that the terror of Cromwell's army had a paralysing effect on his forces. Towns like New Ross and Carlow subsequently surrendered on terms when besieged by Cromwell's forces. On the other hand, the massacres of the defenders of Drogheda and Wexford prolonged resistance elsewhere, as they convinced many Irish Catholics that they would be killed even if they surrendered. Such towns as Waterford, Duncannon, Clonmel, Limerick and Galway only surrendered after determined resistance. Cromwell was unable to take Waterford or Duncannon and the New Model Army had to retire to winter quarters, where many of its men died of disease, especially typhoid and dysentery. The port city of Waterford and Duncannon town eventually surrendered after prolonged sieges in 1650.The following spring, Cromwell mopped up the remaining walled towns in Ireland's southeast—notably the Confederate capital of Kilkenny, which surrendered on terms . The New Model Army met its only serious reverse in Ireland at the Siege of Clonmel , where its attacks on the town's defences were repulsed at a cost of up to 2,000 men. The town nevertheless surrendered the following day. Cromwell's treatment of Kilkenny and Clonmel is in contrast to that of Drogheda and Wexford . Despite the fact that his troops had suffered heavy casualties attacking the former two, Cromwell respected surrender terms which guaranteed the lives and property of the townspeople and the evacuation of armed Irish troops who were defending them. The change in attitude on the part of the Parliamentarian commander may have been a recognition that excessive cruelty was prolonging Irish resistance. However, in the case of Drogheda and Wexford no surrender agreement had been negotiated, and by the rules of continental siege warfare prevalent in the mid-17th century, this meant no quarter would be given; thus it can be argued that Cromwell's attitude had not changed. Ormonde's Royalists still held most of Munster , but were outflanked by a mutiny of their own garrison in Cork . The British Protestant troops there had been fighting for the Parliament up to 1648 and resented fighting with the Confederates. Their mutiny handed Cork and most of Munster to Cromwell and they defeated the local Irish garrison at the Battle of Macroom . The Irish and Royalist forces retreated behind the River Shannon into Connacht or (in the case of the remaining Munster forces) into the fastness of County Kerry .In May 1650, Charles II repudiated his father's (Charles I's) alliance with the Irish Confederates in preference for an alliance with the Scottish Covenanters (see Treaty of Breda ). This totally undermined Ormonde's position as head of a Royalist coalition in Ireland. Cromwell published generous surrender terms for Protestant Royalists in Ireland and many of them either capitulated or went over to the Parliamentarian side. This left in the field only the remaining Irish Catholic armies and a few diehard English Royalists. From this point onwards, many Irish Catholics, including their bishops and clergy, questioned why they should accept Ormonde's leadership when his master, the King, had repudiated his alliance with them. Cromwell left Ireland in May 1650 to fight the Third English Civil War against the new Scottish–Royalist alliance. He passed his command onto Henry Ireton.The most formidable force left to the Irish and Royalists was the 6,000 strong army of Ulster, formerly commanded by Owen Roe O'Neill , who died in 1649. However the army was now commanded by an inexperienced Catholic bishop named Heber MacMahon . The Ulster Army met a Parliamentarian army commanded by Charles Coote, at the Battle of Scarrifholis in County Donegal in June 1650. The Ulster army was routed and as many as 2,000 of its men were killed. In addition, MacMahon and most of the Ulster Army's officers were either killed at the battle or captured and executed after it. This eliminated the last strong field army opposing the Parliamentarians in Ireland and secured for them the northern province of Ulster. Coote's army, despite suffering heavy losses at the Siege of Charlemont , the last Catholic stronghold in the north, was now free to march south and invade the west coast of Ireland.The Parliamentarians crossed the River Shannon into the western province of Connacht in October 1650. An Irish army under Clanricarde had attempted to stop them but this was surprised and routed at the Battle of Meelick Island . Ormonde was discredited by the constant stream of defeats for the Irish and Royalist forces and no longer had the confidence of the men he commanded, particularly the Irish Confederates. He fled for France in December 1650 and was replaced by an Irish nobleman Ulick Burke of Clanricarde as commander. The Irish and Royalist forces were penned into the area west of the River Shannon and placed their last hope on defending the strongly walled cities of Limerick and Galway on Ireland's west coast. These cities had built extensive modern defences and could not be taken by a straightforward assault as at Drogheda or Wexford. Ireton besieged Limerick while Charles Coote surrounded Galway, but they were unable to take the strongly fortified cities and instead blockaded them until a combination of hunger and disease forced them to surrender. An Irish force from County Kerry attempted to relieve Limerick from the south, but was intercepted and routed at the Battle of Knocknaclashy . Limerick fell in 1651 and Galway the following year. Disease however killed indiscriminately and Ireton, along with thousands of Parliamentarian troops, died of plague outside Limerick in 1651. The fall of Galway saw the end of organised resistance to the Cromwellian conquest, but fighting continued as small units of Irish troops launched guerrilla attacks on the Parliamentarians. The guerrilla phase of the war had been going since late 1650 and at the end of 1651, despite the defeat of the main Irish or Royalist forces, there were still estimated to be 30,000 men in arms against the Parliamentarians. Tories (from the Irish word tóraí meaning "pursuer" or "outlaw") operated from difficult terrain such as the Bog of Allen , the Wicklow Mountains and the drumlin country in the north midlands, and within months made the countryside extremely dangerous for all except large parties of Parliamentarian troops. Ireton mounted a punitive expedition to the Wicklow mountains in 1650 to try to put down the tories there, but without success. By early 1651, it was reported that no English supply convoys were safe if they travelled more than two miles outside a military base. In response, the Parliamentarians destroyed food supplies and forcibly evicted civilians who were thought to be helping the Tories. John Hewson systematically destroyed food stocks in counties Wicklow and County Kildare , Hardress Waller did likewise in the Burren in County Clare , as did Colonel Cook in County Wexford . The result was famine throughout much of Ireland, aggravated by an outbreak of bubonic plague . As the guerrilla war ground on, the Parliamentarians, as of April 1651, designated areas such as County Wicklow and much of the south of the country as what would now be called free-fire zones, where anyone found would be, "taken slain and destroyed as enemies and their cattle and good shall be taken or spoiled as the goods of enemies". This tactic had succeeded in the Nine Years' War . This phase of the war was by far the most costly in terms of civilian loss of life. The combination of warfare, famine and plague caused a huge mortality among the Irish population. William Petty estimated (in the 1655–56 Down Survey ) that the death toll of the wars in Ireland since 1641 was over 618,000 people, or about 40% of the country's pre-war population. Of these, he estimated that over 400,000 were Catholics, 167,000 killed directly by war or famine, and the remainder by war-related disease. Modern estimates put the toll at closer to 20%. In addition, some fifty thousand Irish people, including prisoners of war, were sold as indentured servants under the English Commonwealth regime. They were often sent to the English colonies in North America and the Caribbean where they subsequently comprised a substantial portion of certain Caribbean colony populations in the late 17th century. In Barbados, some of their descendants are known as Redlegs . Eventually, the guerrilla war was ended when the Parliamentarians published surrender terms in 1652 allowing Irish troops to go abroad to serve in foreign armies not at war with the Commonwealth of England. Most went to France or Spain. The largest Irish guerrilla forces under John Fitzpatrick (in Leinster, Edmund O'Dwyer (in Munster) and Edmund Daly (in Connacht) surrendered in 1652, under terms signed at Kilkenny in May of that year. However, up to 11,000 men, mostly in Ulster , were still thought to be in the field at the end of the year. The last Irish and Royalist forces (the remnants of the Confederate's Ulster Army, led by Philip O'Reilly) formally surrendered at Cloughoughter in County Cavan on 27 April 1653. The English Parliament then declared the Irish rebellion subdued on 27 September 1653. However, low-level guerrilla warfare continued for the remainder of the decade and was accompanied by widespread lawlessness. Undoubtedly some of the tories were simple brigands , whereas others were politically motivated. The Cromwellians distinguished in their rewards for information or capture of outlaws between "private tories" and "public tories". Cromwell imposed an extremely harsh settlement on the Irish Catholic population. This was because of his deep religious antipathy to the Catholic religion and to punish Irish Catholics for the rebellion of 1641, in particular the massacres of Protestant settlers in Ulster. Also he needed to raise money to pay off his army and to repay the London merchants who had subsidised the war under the Adventurers Act back in 1640. [ citation needed ] The Long Parliament had passed the Adventurers Act in 1640 (the act received royal assent in 1642), under which those who lent money to Parliament for the subjugation of Ireland would be paid in confiscated land in Ireland. In addition, Parliamentarian soldiers who served in Ireland were entitled to an allotment of confiscated land there, in lieu of their wages, which the Parliament was unable to pay in full. As a result, many thousands of New Model Army veterans were settled in Ireland. Moreover, the pre-war Protestant settlers greatly increased their ownership of land (see also: The Cromwellian Plantation ). Before the wars, Irish Catholics had owned 60% of the land in Ireland, whereas by the time of the Stuart Restoration , when compensations had been made to Catholic Royalists, they owned only 20% of it. During the Commonwealth period, Catholic landownership had fallen to 8%. Even after the Restoration of 1660, Catholics were barred from all public office, but not from the Irish Parliament . The Parliamentarian campaign in Ireland was the most ruthless of the Civil War period. In particular, Cromwell's actions at Drogheda and Wexford earned him a reputation for cruelty. Cromwell's critics point to his response to a plea by Catholic Bishops to the Irish Catholic people to resist him in which he states that although his intention was not to "massacre, banish and destroy the Catholic inhabitants", if they did resist "I hope to be free from the misery and desolation, blood and ruin that shall befall them, and shall rejoice to exercise the utmost severity against them". [lower-alpha 1] Tom Reilly, an amateur historian not taken seriously by most academics, argues in Cromwell, an Honourable Enemy that what happened at Drogheda was not unusually severe by the standards of 17th century siege warfare. In Cromwell was Framed (2014), he also claims that civilians were not targeted. John Morrill commented, "A major attempt at rehabilitation was attempted by Tom Reilly, Cromwell: An Honourable Enemy (London, 1999) but this has been largely rejected by other scholars." Morrill himself argued, that what happened at Drogheda, "was without straightforward parallel in 17th century British or Irish history... So the Drogheda massacre does stand out for its mercilessness, for its combination of ruthlessness and calculation, for its combination of hot- and cold-bloodiness". Moreover, historians critical of Cromwell point out that at the time the killings at Drogheda and Wexford were considered atrocities. They cite such sources as Edmund Ludlow , the Parliamentarian commander in Ireland after Ireton's death, who wrote that the tactics used by Cromwell at Drogheda showed "extraordinary severity". Cromwell's actions in Ireland occurred in the context of a mutually cruel war. In 1641–42 Irish insurgents in Ulster killed some 4,000 Protestant settlers who had settled on land confiscated from their former Catholic owners. These events were magnified in Protestant propaganda as an attempt by Irish Catholics to exterminate the English Protestant settlers in Ireland, with English Parliamentarian pamphlets claiming that over 200,000 Protestants had died. In turn, this was used as justification by English Parliamentary and Scottish Covenant forces to take vengeance on the Irish Catholic population. A Parliamentary tract of 1655 argued that, "the whole Irish nation, consisting of gentry, clergy and commonality are engaged as one nation in this quarrel, to root out and extirpate all English Protestants from amongst them". Atrocities were subsequently committed by all sides. When Murrough O'Brien , the Earl of Inchiquin and Parliamentarian commander in Cork, took Cashel in 1647, he slaughtered the garrison and Catholic clergy there (including Theobald Stapleton ), earning the nickname "Murrough of the Burnings". Inchiquin switched allegiances in 1648, becoming a commander of the Royalist forces. After such battles as Dungans Hill and Scarrifholis , English Parliamentarian forces executed thousands of their Irish Catholic prisoners. Similarly, when the Confederate Catholic general Thomas Preston took Maynooth in 1647, he hanged its Catholic defenders as apostates . Seen in this light, some have argued that the severe conduct of the Parliamentarian campaign of 1649–53 appears unexceptional. Nevertheless, the 1649–53 campaign remains notorious in Irish popular memory as it was responsible for a huge death toll among the Irish population. The main reason for this was the counter-guerrilla tactics used by such commanders as Henry Ireton, John Hewson and Edmund Ludlow against the Catholic population from 1650, when large areas of the country still resisted the Parliamentary Army. These tactics included the wholesale burning of crops, forced population movement, and killing of civilians. Total excess deaths for the entire period of the Wars of the Three Kingdoms in Ireland was estimated by Sir William Petty , the 17th century economist, to be 600,000 out of a total Irish population of 1,400,000 in 1641. One modern estimate estimated that at least 200,000 were killed out of a population of allegedly 2 million. [ citation needed ] In addition, the whole post-war Cromwellian settlement of Ireland has been characterised by historians such as Mark Levene and Alan Axelrod as ethnic cleansing , in that it sought to remove Irish Catholics from the eastern part of the country, others such as the historical writer Tim Pat Coogan have described the actions of Cromwell and his subordinates as genocide. The aftermath of the Cromwellian campaign and settlement saw extensive dispossession of landowners who were Catholic, and a huge drop in population. In the event, the much larger number of surviving poorer Catholics were not moved westwards; most of them had to fend for themselves by working for the new landowners.Ireland became a republic for the first time. The balance of power was no longer in favour of Roman Catholic landowners. The Cromwellian settlement was mythologised by Irish Catholic nationalism from the 19th century onwards although the reality was that England had suffered in much the same way regarding religious oppression and war devastation. After the Stuart Restoration in 1660, Charles II of England restored about a third of the confiscated land to the former landlords in the Act of Settlement 1662 , but not all, as he sought the support of former Parliamentarians in England and Ireland. A generation later, during the Glorious Revolution , many of the Irish Catholic gentry tried to reverse the remaining Cromwellian settlement in the Williamite War in Ireland (1689–91), where they fought for the Jacobites . They were defeated once again. Irish Catholics were not represented in the Irish Parliament. In the aftermath of the French Revolution, however, Roman Catholicism began to be tolerated in Great Britain and Ireland and led this led to the [Roman Catholic Relief Act 1829|1829]]. The process began as early as 1778 with the Papists Act. The Cromwellian government also contributed to the decline and eventual extinction of wolves in Ireland , through such methods as deforestation and anti-wolf legislation, the latter including bounties paid out for killing wolves.

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Bubonic plague

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Emerods

Emerods is an archaic term for hemorrhoids . Derived from the Old French word emoroyde , it was used as the common English term until the nineteenth century, after which it was replaced in medicine by a direct transliteration of the original Greek term haimorrhoides . The word is most commonly encountered, however, in the King James Bible , where it appears in the First Book of Samuel as a plague that afflicted the Philistines who had captured the Ark of the Covenant from the Israelites . Chapter 5 of I Samuel describes a "plague of emerods" that smote the people of Ashdod in their "secret parts", causing many to die. According to chapter 6, the plague was not relieved until the Philistines returned the Ark of the Covenant to the Israelites, along with a trespass offering of "five golden emerods and five golden mice" (the plague of emerods occurred simultaneously with a plague of mice). The concept of "golden hemorrhoids" has on occasion given rise to puzzlement or humor. Modern scholars have pointed out that the Hebrew term Apholim , translated "emerods" in the King James Version, could also be translated as "tumors", as is done in the Revised Version of the Bible. In the fourth century A.D., the early Christian scholar Jerome translated it as "swellings of the secret parts". It has often been speculated that the "plague of emerods" was actually an outbreak of bubonic plague , and that the "plague of mice" was actually a plague of rats, which are not distinguished from mice in ancient Hebrew. Other scholars, however, have identified the "plague of emerods" with other medical conditions, such as bilharziasis , or the bites of camel spiders .

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Bubonic plague

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Black Death in Poland

The Black Death ( Polish : Czarna śmierć ), a major bubonic plague pandemic, is believed to have spread to Poland in 1351. The region, along with the northern Pyrenees and Milan , is often believed to have been minimally affected by the disease compared to other regions of Europe .During the mid-14th century, the Kingdom of Poland was ruled by Casimir III the Great . This period was largely marked by military and legal reform, extensive Jewish migration, and eastern expansion into Galicia–Volhynia . Previously in a weakened state, the reign of Casimir III largely allowed Poland to prosper during a time of relative instability and hardship for the rest of the continent. It is traditionally believed that the Black Death spread into Europe via Genoese traders in their Black Sea port of Kaffa in the year 1347. As the story goes, Golden Horde troops besieging the city catapulted diseased carcasses into the walls of the city in an act of early biological warfare . This then spread into the city of Genoa itself from fleeing ships, and then throughout Italy where it gained a foothold into Europe. During the mid-14th century, the Kingdom of Poland was ruled by Casimir III the Great . This period was largely marked by military and legal reform, extensive Jewish migration, and eastern expansion into Galicia–Volhynia . Previously in a weakened state, the reign of Casimir III largely allowed Poland to prosper during a time of relative instability and hardship for the rest of the continent.It is traditionally believed that the Black Death spread into Europe via Genoese traders in their Black Sea port of Kaffa in the year 1347. As the story goes, Golden Horde troops besieging the city catapulted diseased carcasses into the walls of the city in an act of early biological warfare . This then spread into the city of Genoa itself from fleeing ships, and then throughout Italy where it gained a foothold into Europe. During the Black Death, the Kingdom of Poland was a landlocked country, largely surrounded by plague-infected areas. Though disputed, the country's lack of depopulation was largely evidenced in a 2019 study, citing the stable amount of cereal grain pollen in the region. Dr Piotr Guzowski of the University of Bialystok noted "In the cores we have analyzed so far, no significant decreases in the share of pollen of cereals, weeds or other plants related to human activity are recorded, which means that there was no depopulation." The spread of the Black Death had a large impact on Polish society, particularly demographically. Many Jews in Europe were discriminated against during this period as they were blamed for the plague's spread. With existing large Jewish communities within Poland's borders , particularly in Poznań and Kraków , Casimir III the Great at the time welcomed an influx of Jews into this population, encouraging this settlement and even giving them personal protection as "people of the king". This largely bolstered existing Jewish communities and greatly increased their numbers, to a point where for centuries afterwards Poland was home to the largest Jewish community in the world (see Golden Age of Jews in Poland ). Jews in Poland may have contributed to resistance to the disease. Jews brought religious practices of hygienics, in particular handwashing in a practice known as × ×˜×™×œ×ª ידיים‎ ( netilat yadayim ) which was not only encouraged but mandatory for members of the faith. During the close of Casimir's reign, attitudes towards Jews in Poland soured. Blood libel against Jews became a growing phenomenon and initial tolerance was disturbed, although interfaith relations were still fairly tame compared to other European nations. The first pogrom in Poland was recorded in the city of Poznań during 1367, near the end of the Black Death. This trend of hysteria afterwards largely continued into the Jagiellonian era , with further discrimination going into the 15th century . [ citation needed ]There have been various explanations for the plague's apparent lack of spread in Poland. Casimir III the Great , who was the King of Poland during the period, reportedly at the time banned all travel into Poland from other nations, which may have impacted its spread. However, a ban would have been difficult to enforce, especially during the period. The law mostly applied to major individual cities, specifically walled cities, while in the countryside many could still come and go as they pleased. One theory via French historians Stéphane Barry and Norbert Gualde suggests that, within the Kingdom of Poland, there was a variety of resistant blood groups in the Polish population that helped to reduce the spread. However, this is largely disproved by various subsequent resurgences of the plague in the region, such as during the Great Northern War plague outbreak . During the start of the COVID-19 pandemic in Poland , some Poles had optimistically embraced this theory and referenced Poland's prior resistance to the bubonic plague outbreak. Poland's geographic location was likely a factor in the regional outcome. The Carpathian Mountains , at the time a part of the Polish borderland, could have lessened the impact of the plague. (Existing mountain ranges, such as the Himalayas , are believed instrumental in preventing the bubonic plague's spread into India . ) This, coupled with Poland's already relatively sparse population, may have helped to lessen the impact in the region. However, Poland's border with the Holy Roman Empire , the northern reaches of which were actively ridden with the plague, was not shielded by the mountains. It is widely disputed how much effect the plague had on Poland. Neighboring cities with frequent Polish trade, such as Vienna , as well as the Hanseatic League , were known to spread disease widely through their trading partners along busy shipping routes. Poland was particularly engaged in trade during this era, especially through the Hanseatic League, making it unusual and unlikely the plague had as little of an effect on Poland as believed. Certain historians believe this to be a discrepancy. A popular belief is that the argument that Poland was resistant to the plague comes from a lack of statistics attributed to Communist rule in Poland during the 20th century. A proponent of this is Norwegian Black Death expert Ole Jørgen Benedictow , who claims in his book The Black Death 1346–1353: The Complete History , "Communist authorities and ideological watchdogs prevented serious research on the Black Death and the following plague epidemics, suspecting (correctly) that this study could establish disturbing alternative demographic views to Marxist orthodoxy on important historical developments in the Late Middle Ages." Other evidence against Polish omission from the plague includes societal changes often associated with the plague. In particular, during the second half of the fourteenth century, changes included the increase in the size of Polish forests, the increase in wages in Kraków, and the collapse of grain prices. These societal changes are widely attributed to the demographic shifts resulting from the Black Death and were documented in both Poland and other European countries. It is widely disputed how much effect the plague had on Poland. Neighboring cities with frequent Polish trade, such as Vienna , as well as the Hanseatic League , were known to spread disease widely through their trading partners along busy shipping routes. Poland was particularly engaged in trade during this era, especially through the Hanseatic League, making it unusual and unlikely the plague had as little of an effect on Poland as believed. Certain historians believe this to be a discrepancy. A popular belief is that the argument that Poland was resistant to the plague comes from a lack of statistics attributed to Communist rule in Poland during the 20th century. A proponent of this is Norwegian Black Death expert Ole Jørgen Benedictow , who claims in his book The Black Death 1346–1353: The Complete History , "Communist authorities and ideological watchdogs prevented serious research on the Black Death and the following plague epidemics, suspecting (correctly) that this study could establish disturbing alternative demographic views to Marxist orthodoxy on important historical developments in the Late Middle Ages." Other evidence against Polish omission from the plague includes societal changes often associated with the plague. In particular, during the second half of the fourteenth century, changes included the increase in the size of Polish forests, the increase in wages in Kraków, and the collapse of grain prices. These societal changes are widely attributed to the demographic shifts resulting from the Black Death and were documented in both Poland and other European countries.

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Bubonic plague

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Bonaparte Visiting the Plague Victims of Jaffa

Bonaparte Visits the Plague Stricken in Jaffa ( French : Bonaparte visitant les pestiférés de Jaffa ) is an oil-on-canvas painting commissioned by Napoleon Bonaparte and painted in 1804 by Antoine-Jean Gros , portraying an event during the French invasion of Egypt . The scene shows Napoleon during a striking scene which is supposed to have occurred in Jaffa on 11 March 1799, depicting the French general making a visit to his ill soldiers at the Armenian Saint Nicholas Monastery . The commission was an attempt to embroider Bonaparte's mythology and quell reports that Napoleon had ordered fifty plague victims in Jaffa be given fatal doses of opium during his retreat from his Syrian expedition. It also served a propaganda purpose in countering reports of French atrocities during their capture of Jaffa . On 18 September 1804, the painting was exhibited at the Salon de Paris , between Napoleon's proclamation as emperor on 18 May and his coronation at Notre-Dame de Paris on 2 December. Dominique Vivant Denon , who participated in Bonaparte's expedition to Egypt and was now director of the musée du Louvre, acted as advisor to Gros on it. The painting now forms part of the collection of French paintings at the Louvre . The painting was ordered by the state after Napoleon had become emperor, and it had a clear propaganda purpose. As for eyewitnesses, in General Berthier 's campaign report there is no mention about such an event. Bourrienne , Bonaparte's private secretary, wrote only that the general crossed the lazaretto at a fast pace. However, Doctor Desgenettes (present in the painting between Napoleon and the patient with the raised arm) wrote that Bonaparte grabbed the sick and helped to transport them. It is now known that the plague is not transmitted by touch. The painting was also commissioned in part to counter reports of French atrocities during their capture of Jaffa . After two French messengers sent to parley with the Ottomans had been killed and their heads displayed on the city walls, Napoleon promised the troops under his command two days and nights to plunder the city. After the city capitulated on the fourth day, the French brutally sacked the city, "slaughtering Christians, Jews and Muslims indiscriminately." Napoleon also ordered the mass killing of 3,000 Ottoman prisoners in French captivity. News of such atrocities contradicted the French justification for their invasions of Ottoman-held Egypt and Syria, namely that it was a mission civilisatrice "that would bring enlightenment to the benighted lands of the East." The painting "thus had a very specific propagandist function." This painting uses elements of the composition of Jacques-Louis David 's 1784 Oath of the Horatii , also held at the Louvre, such as the three arcades from Oath , which defined three different worlds (the three sons making the oath in the left, the father brandishing the swords in the middle and the women abandoned to sadness in the right), a principle taken up in this painting as well. It is sometimes mistaken to be set in a mosque but is actually set in the Armenian Saint Nicholas Monastery , whose courtyard can be seen in the background. Further into the background are the walls of Jaffa , with a breached tower above that flies an oversized French flag . The smoke from a fire, or excessive cannon smoke, dominates the town. To the left, dominated by a typically Egyptian horseshoe arch , a man is richly dressed in the oriental manner hands out bread and is aided by a servant carrying a bread-basket. Behind them, two black men carry a stretcher on which is a form, probably a cadaver. The two-coloured arcade opens out on a gallery full of the sick. To the right, under two arcades, under a broken arch, is Napoleon, accompanied by his officers, touching the armpit bubo presented to him by one of the sick. In front of him, an Arab doctor is caring for another sick man, and a blind man struggles to approach the general. The bottom of the painting is occupied by prostrate and extended men. The light of the painting and the play of colours paint Bonaparte's gesture in the best possible light.The capture and the violent sack of Jaffa by the French army under Bonaparte on 7 March 1799 were rapidly followed by an outbreak of bubonic plague , identified by January 1799, which decimated the army. On 11 March, Bonaparte made a spectacular visit to his sick soldiers and touched them, [ dubious – discuss ] which was considered to be either magnificent or suicidal, according to one's point of view on the Napoleonic legend or of the terrors of an age of plagues. The Napoleonic army requested the help of the priests from the Armenian monastery, who provided medicine that was able to cure some of the soldiers. Napoleon personally thanked the Armenian patriarch and gifted him with his own tent and sword. [ citation needed ] The sick man with bandaged eyes on the right is suffering from blindness as well as plague. Since the army's arrival in Egypt in July 1798, several French had suffered serious eye problems because of the sand, dust and the extreme light of the sun. In 1804, there was no question of representing it as other than a daring deed by Bonaparte, but the officer behind Napoleon tries to stop him touching the bubo. The means by which bubonic plague spread were still unknown in the early 19th century, and the flea 's role in its transmission was unknown until Paul-Louis Simond found evidence for it in 1898. Touching a bubo with a bare hand was not particularly risky since all of the other actors in the scene are now known to be running exactly the same risk of transmission of the disease by fleas. The left-hand officer's action of holding something over his mouth and nose is not entirely unjustified, however, since certain cases of bubonic plague can evolve into a pulmonary plague, with a highly-elevated risk of infection from aerosols emitted by patients' coughs. Medical efforts to stop the plague, seen a little further to the right, were unchanged since the Middle Ages. An old doctor is incising the bubos to let the pus flow out, which is in fact inefficient in terms of treating the disease and weakens the patient. He has already operated on a bubo under the raised right arm of his patient, who holds a bloodied compress under his arm, and is wiping his blade ready to incise a second bubo. The doctor's assistant supports the patient during the operation. The bodies are sick and languishing, and the hero is less heroic for being surrounded by ordinary people. Idealism and classicism were abandoned in favour of a certain romanticism . In effect, it is suffering in painted form, which was a novelty since previously, only noble deaths were painted. On 23 April 1799, during the Siege of Acre , Bonaparte suggested to Desgenettes , the expedition's chief doctor, that the sick should be administered a fatal-level dose of opium . Desgenetted refused to perform euthanasia . On 27 May, Napoleon made a second visit to the plague victims. In the context of the Troubadour style , especially while Napoleon was becoming emperor, this episode evoked the tradition of the thaumaturgical royal touch which the French kings carried out with sufferers of scrofula . A longstanding question concerning the interpretation of the painting is the significance of the number "32" on the hat of one of the patients. Since Gros, the artist, was 32 years old at the time at the composition, the shy, naked prisoner behind the patient raising his arm in front of Napoleon may in fact be a hidden self-portrait. Alternatively, it could reflect the soldier's regiment since the 32e demi-brigade was one of the French units committed to the Egyptian campaign.A longstanding question concerning the interpretation of the painting is the significance of the number "32" on the hat of one of the patients. Since Gros, the artist, was 32 years old at the time at the composition, the shy, naked prisoner behind the patient raising his arm in front of Napoleon may in fact be a hidden self-portrait. Alternatively, it could reflect the soldier's regiment since the 32e demi-brigade was one of the French units committed to the Egyptian campaign.

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Bubonic plague

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1899 Porto plague outbreak

The 1899 Porto plague outbreak was an epidemic of bubonic plague centered in the city of Porto , in the north of Portugal . The arrival of plague in the Portuguese city of Porto signalled the first outbreak of the third plague pandemic in Europe, attracting international attention, due to fears of a return of the Black Death in the continent. It also pitched local and national authorities as well as medical experts in heated arguments about the nature of the disease and the way to contain it, namely, the controversial decision to surround the city by a military-enforced cordon sanitaire for four months, imposed by the government of Prime Minister José Luciano de Castro . The city's Medical Health Officer , Ricardo Jorge , head of the city's Municipal Services of Health and Hygiene and of the Municipal Bacteriological Laboratory, led the efforts to contain the disease and personally gathered laboratory proof to correctly identify the responsible infectious agent : this earned him a great reputation as a modern sanitarian and bacteriologist and launched his highly successful national and international career. There were 132 deaths attributed to the plague outbreak, out of 320 total cases. Eminent bacteriologist Luís da Câmara Pestana contracted the disease after receiving a small scratch while examining a plague corpse during the outbreak, and died shortly afterwards. The plague outbreak had considerable political, social, and economic repercussions: it exacerbated class divisions and tensions between republicans in Porto and the royalist government in Lisbon (the centuries-old Portuguese Monarchy and would be replaced by the Portuguese First Republic in a revolution just 10 years later ). Portugal's public health legislation was modernised in the years following the crisis; the Directorate-General of Health was established in response to the outbreak; it remains the country's leading agency for public health and disease prevention. [ citation needed ]

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Bubonic plague

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Great Hanoi Rat Massacre

The Great Hanoi Rat Massacre ( Vietnamese : Cuộc đại thảm sát chuột ở Hà Nội ; chữ Nôm : å±€å¤§æ ˜æ®ºð¤žæ–¼æ²³å § ; French : Massacre des rats de Hanoï ) occurred in 1902, in Hanoi , Tonkin , French Indochina (present day Hanoi, Vietnam ), when the French government authorities attempted to control the rat population of the city by hunting them down. As they felt that they were making insufficient progress, and due to labour strikes, they created a bounty programme that paid a reward of 1 ¢ for each rat killed. To collect the bounty, people would need to provide the severed tail of a rat. Colonial officials, however, began noticing rats in Hanoi with no tails. The Vietnamese rat catchers would capture rats, sever their tails, then release them back into the sewers so that they could produce more rats. The Great Hanoi Rat Massacre happened in the middle of a global pandemic only a few years after Swiss -French physician and bacteriologist Alexandre Yersin linked the spread of the pandemic to rodents. Today, the events are often used as an example of a perverse incentive , commonly referred to as the Cobra Effect . The modern discoverer of this event, American historian Michael G. Vann argues that the cobra example from the British Raj cannot be proven, but that the rats in Vietnam case can be proven, so the term should be changed to the Rat Effect . France formally assumed control of Hanoi in 1882, occupying the city after the failure of the Treaty of Saigon . However, the region of Tonkin was not fully pacified until as late as 1896. The French colonised Eastern Indochina (present day Vietnam, Cambodia , and Laos ) in several stages to gain backdoor access to the wealth of China through its market, specifically the French sought a river route to the Chinese province of Yunnan , which at the time was imagined as " El Dorado with silk instead of gold". Prior to the establishment of the French protectorate of Tonkin, the city of Hanoi was a collection of 36 streets, each of these streets was devoted to a specific craft as well as several temples and pagodas spread around the settlement. Furthermore, the city of Hanoi also possessed a citadel and fort, these were ironically constructed in 1803 (the year after the Nguyá» n dynasty was established by the Gia Long Emperor) with the assistance of French military engineers that were trained in the Vauban tradition of fortification. However, the French viewed Hanoi as a dirty, squalid, ramshackle collection of villages. So they sought to transform it into a French-style city worthy of being the seat of one of the colonial possessions of the French Empire . This process began with the arrival of French administrators in the 1880s, namely Paul Bert in 1886, really set off the Gallicisation of the city. Large areas of Hanoi, including most of the old citadel as well many temples, were demolished to make way for the new French-style buildings that would become the core of the new city. Most notable among these new constructions were St. Joseph's Cathedral and the Lanessan Hospital . In 1897 Paul Doumer had been appointed Governor-General of French Indochina after he was briefly the French Minister of Finance (1895–1896) when he tried without success to introduce an income tax. Under his leadership, the old Hanoi would be transformed into a completely different city and the transformation went into overdrive. As Doumer planned on making Hanoi the new capital of the Union of Indochina he insisted that it should also look the part. To fulfil this plan, a new palace for the residence of the Governor-General of French Indochina was constructed (which serves today as Vietnam's Presidential Palace). Large parts of Hanoi were cleared to make room for the new French-style inner city that was filled with broad tree-lined boulevards, colonial-style villas, and well-tended gardens. This new area would be known as the "French Quarter" ( Quartier Européen / Khu phố Pháp , today's Ba Đình District ), as some visitors would describe it as "a slice of Paris on the other side of the world". This area of the city sharply contrasted the cramped, narrow, and chaotic "Native Quarter" ( Quartier indigène ), where both the indigenous Annamese people and Han Chinese people resided. In the year 1902 the capital city of French Indochina was moved from Saigon , Cochinchina (present day Ho Chi Minh City) to Hanoi, Tonkin and it remained so until 1945. When Paul Doumer arrived in Hanoi, he launched several major infrastructure projects, such as the Paul Doumer Bridge (now called the Long Biên Bridge ), which spanned the 1,700-meter (5,600 ft) width of the Red River, and the Grand Palais d'Expositions which built for the Hanoi Exhibition in 1903. These actions were enacted to make Hanoi a showcase for France's civilising mission in Indochina and to provide the city with the very first electricity network in Asia. Among the large projects ordered by Paul Doumer was the construction of a massive underground sewage system that would serve both as a symbol of French modernity and keep the "French Quarter" clear of any human waste . As toilets were seen as "a sign of civilisation" Doumer wanted there to be flushable toilets in every French palace. By the time of Paul Doumer's departure in March 1902, over 19 kilometers of sewers had been built underneath Hanoi, the largest concentration of which lay beneath the "French Quarter". A smaller section of the sewage system also lay underneath the "Indigenous Quarter" of the city. The new sewer system did help fight Cholera , a disease brought to Hanoi by the French expeditionary forces coming from Algeria . This large new sewage system also brought with it a new unforeseen problem from the French, rats. In the sewers rats found no natural predators and if they would get hungry they could easily penetrate directly into the most luxurious apartments in the city through the "highway" hidden deep beneath human footsteps. This caused major concerns for the French both for hygienic reasons and an outbreak of the Bubonic Plague (or the " Black Death "). Just a few years earlier in 1894 the famous Alexandre Yersin discovered the Yersinia pestis bacteria that caused the disease and his colleague Paul-Louis Simond linked it to fleas found on rodents . Because of the new knowledge about how rats caused the Bubonic Plague the French colonists became very concerned with the situation and quickly wanted to remedy the situation. "If industrialisation changed the world for human beings, it also created new opportunities for their furry neighbours. Expanding cities and long-distance trade networks offered rats new habitats and new ways to travel distances far greater than they could with just their stubby little legs. As with humans, these technological changes resulted in a demographic explosion. I'm not sure if we breed like rats or they breed like people. It is impossible to know the exact rat population, but scientific estimates indicate that these rodents currently outnumber human beings by several billion. I find it fascinating that as humans went through an unprecedented population boom from 1800 to the present, rats, which most people consider a pest, increased in number as a direct consequence of human actions." Michael G. Vann at "The Great Hanoi Rat Hunt: A Conversation with Michael G. Vann" (20 August 2020) - The Made in China Journal . The third plague pandemic started in 1855 in Yunnan , China during the Qing dynasty period. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China (and perhaps over 15 million worldwide ), with at least 10 million killed in India alone, making it one of the deadliest pandemics in history. In 1898 Paul-Louis Simond was in the city of Karachi , Sind , India where, despite limited resources, he was able to demonstrate that fleas transmit the bacterium Yersinia pestis , the agent causing bubonic plague , from rat to rat, and from rat to human. The third plague pandemic happened at the same time as the French renovation of Hanoi. From Yunnan it spread to Guangzhou and then to Hong Kong . The Bubonic plague then spread from Hong Kong to the British Raj . The United States military brought it to Manila during their invasion of the Philippines at the Asian theatre of the Spanish–American War . In 1899 it struck the Republic of Hawaii , where in Honolulu (its capital city) the authorities chose to burn down its Chinatown . Before the Bubonic plague hit the American city of San Francisco its municipal authorities decided to enact a quarantine policy for its Chinatown . During the quarantine the municipal authorities discussed enacting a "Honolulu Solution" to prevent the disease from affecting the rest of the city. The global situation became serious for Hanoi when French residents reported an infestation of rats in the French Quarter. It seems that brown rats in Hanoi arrived on ships and trains that came from China where the pandemic started. This invasive species of rats quickly discovered that the new sewers were an ideal ecosystem and quickly took over Hanoi's urban infrastructure, with reports coming out that people had spotted rats climbing up the outflow pipes and later even out of the toilets in French houses. The realisation that these might be plague-carrying cats created a panic among health officials leading to their response to attempt to eradicate the rat infestation before the city would succumb to the pandemic. France formally assumed control of Hanoi in 1882, occupying the city after the failure of the Treaty of Saigon . However, the region of Tonkin was not fully pacified until as late as 1896. The French colonised Eastern Indochina (present day Vietnam, Cambodia , and Laos ) in several stages to gain backdoor access to the wealth of China through its market, specifically the French sought a river route to the Chinese province of Yunnan , which at the time was imagined as " El Dorado with silk instead of gold". Prior to the establishment of the French protectorate of Tonkin, the city of Hanoi was a collection of 36 streets, each of these streets was devoted to a specific craft as well as several temples and pagodas spread around the settlement. Furthermore, the city of Hanoi also possessed a citadel and fort, these were ironically constructed in 1803 (the year after the Nguyá» n dynasty was established by the Gia Long Emperor) with the assistance of French military engineers that were trained in the Vauban tradition of fortification. However, the French viewed Hanoi as a dirty, squalid, ramshackle collection of villages. So they sought to transform it into a French-style city worthy of being the seat of one of the colonial possessions of the French Empire . This process began with the arrival of French administrators in the 1880s, namely Paul Bert in 1886, really set off the Gallicisation of the city. Large areas of Hanoi, including most of the old citadel as well many temples, were demolished to make way for the new French-style buildings that would become the core of the new city. Most notable among these new constructions were St. Joseph's Cathedral and the Lanessan Hospital . In 1897 Paul Doumer had been appointed Governor-General of French Indochina after he was briefly the French Minister of Finance (1895–1896) when he tried without success to introduce an income tax. Under his leadership, the old Hanoi would be transformed into a completely different city and the transformation went into overdrive. As Doumer planned on making Hanoi the new capital of the Union of Indochina he insisted that it should also look the part. To fulfil this plan, a new palace for the residence of the Governor-General of French Indochina was constructed (which serves today as Vietnam's Presidential Palace). Large parts of Hanoi were cleared to make room for the new French-style inner city that was filled with broad tree-lined boulevards, colonial-style villas, and well-tended gardens. This new area would be known as the "French Quarter" ( Quartier Européen / Khu phố Pháp , today's Ba Đình District ), as some visitors would describe it as "a slice of Paris on the other side of the world". This area of the city sharply contrasted the cramped, narrow, and chaotic "Native Quarter" ( Quartier indigène ), where both the indigenous Annamese people and Han Chinese people resided. In the year 1902 the capital city of French Indochina was moved from Saigon , Cochinchina (present day Ho Chi Minh City) to Hanoi, Tonkin and it remained so until 1945. When Paul Doumer arrived in Hanoi, he launched several major infrastructure projects, such as the Paul Doumer Bridge (now called the Long Biên Bridge ), which spanned the 1,700-meter (5,600 ft) width of the Red River, and the Grand Palais d'Expositions which built for the Hanoi Exhibition in 1903. These actions were enacted to make Hanoi a showcase for France's civilising mission in Indochina and to provide the city with the very first electricity network in Asia. Among the large projects ordered by Paul Doumer was the construction of a massive underground sewage system that would serve both as a symbol of French modernity and keep the "French Quarter" clear of any human waste . As toilets were seen as "a sign of civilisation" Doumer wanted there to be flushable toilets in every French palace. By the time of Paul Doumer's departure in March 1902, over 19 kilometers of sewers had been built underneath Hanoi, the largest concentration of which lay beneath the "French Quarter". A smaller section of the sewage system also lay underneath the "Indigenous Quarter" of the city. The new sewer system did help fight Cholera , a disease brought to Hanoi by the French expeditionary forces coming from Algeria . This large new sewage system also brought with it a new unforeseen problem from the French, rats. In the sewers rats found no natural predators and if they would get hungry they could easily penetrate directly into the most luxurious apartments in the city through the "highway" hidden deep beneath human footsteps. This caused major concerns for the French both for hygienic reasons and an outbreak of the Bubonic Plague (or the " Black Death "). Just a few years earlier in 1894 the famous Alexandre Yersin discovered the Yersinia pestis bacteria that caused the disease and his colleague Paul-Louis Simond linked it to fleas found on rodents . Because of the new knowledge about how rats caused the Bubonic Plague the French colonists became very concerned with the situation and quickly wanted to remedy the situation. "If industrialisation changed the world for human beings, it also created new opportunities for their furry neighbours. Expanding cities and long-distance trade networks offered rats new habitats and new ways to travel distances far greater than they could with just their stubby little legs. As with humans, these technological changes resulted in a demographic explosion. I'm not sure if we breed like rats or they breed like people. It is impossible to know the exact rat population, but scientific estimates indicate that these rodents currently outnumber human beings by several billion. I find it fascinating that as humans went through an unprecedented population boom from 1800 to the present, rats, which most people consider a pest, increased in number as a direct consequence of human actions." Michael G. Vann at "The Great Hanoi Rat Hunt: A Conversation with Michael G. Vann" (20 August 2020) - The Made in China Journal . The third plague pandemic started in 1855 in Yunnan , China during the Qing dynasty period. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China (and perhaps over 15 million worldwide ), with at least 10 million killed in India alone, making it one of the deadliest pandemics in history. In 1898 Paul-Louis Simond was in the city of Karachi , Sind , India where, despite limited resources, he was able to demonstrate that fleas transmit the bacterium Yersinia pestis , the agent causing bubonic plague , from rat to rat, and from rat to human. The third plague pandemic happened at the same time as the French renovation of Hanoi. From Yunnan it spread to Guangzhou and then to Hong Kong . The Bubonic plague then spread from Hong Kong to the British Raj . The United States military brought it to Manila during their invasion of the Philippines at the Asian theatre of the Spanish–American War . In 1899 it struck the Republic of Hawaii , where in Honolulu (its capital city) the authorities chose to burn down its Chinatown . Before the Bubonic plague hit the American city of San Francisco its municipal authorities decided to enact a quarantine policy for its Chinatown . During the quarantine the municipal authorities discussed enacting a "Honolulu Solution" to prevent the disease from affecting the rest of the city. The global situation became serious for Hanoi when French residents reported an infestation of rats in the French Quarter. It seems that brown rats in Hanoi arrived on ships and trains that came from China where the pandemic started. This invasive species of rats quickly discovered that the new sewers were an ideal ecosystem and quickly took over Hanoi's urban infrastructure, with reports coming out that people had spotted rats climbing up the outflow pipes and later even out of the toilets in French houses. The realisation that these might be plague-carrying cats created a panic among health officials leading to their response to attempt to eradicate the rat infestation before the city would succumb to the pandemic. The demand for silk waned as the French completed their railway between Kunming , Yunnan and Hanoi, but this opened up a new market for opium . Yunnan was a major producer of opium and the French wanted to use the line of Yunnan to Haiphong to supply the French Concession in Shanghai . Paul Doumer turned French Indochina into a narco-state and uplifted French Indochina's revenue from being consistently making losses to being profitable. But this also made the colony economically interdependent with the Chinese Empire. This turned Chinese goods, Chinese merchants, and Chinese labourers into "the life blood" of the Union of Indochina. Because of the colony's dependence on the Chinese market French colonists commonly claimed that neither they nor the natives were in charge of it as the Chinese effectively controlled it, while others referred to the Chinese negatively as "the Jews of Asia". During Napoleon III 's Second Empire France was an authoritarian technocratic state , but after the Second Empire fell the new Third Republic embraced Progressivism and the technocrats who had a free rein during the Empire were frustrated by the new democratic constraints placed upon them. Many of these technocrats were drawn by French colonial empire , where they could engage in widespread social experiments without the fear of opposition or negative public opinion as they could use the military to enforce their policies. In Hanoi this translated to a complete renewal of the city based on French modernity. The French Quartier Européen was located right next to the old 36 streets of Hanoi, in the perspective of the French the 36 streets were an old and dirty place. The Native Quarter had many lakes and ponds, the roads were mostly dirt roads, when it rained it became muddy, and the houses were shabby with mostly thatched roofs. By contrast, the Quartier Européen area had wide roads, green trees, and white spacious villas. Roughly 90% of the population of Hanoi lived in the Old Quarter which made up only ⠓rd of its surface area, while the Quartier Européen and an administrative and military district to the west held only 10% of the city's population and made up the other ⠔ of the city. This resulted in Hanoi being an examplar "colonial dual city" where the colonial elites enjoyed a spacious luxurious lifestyles compared to the colonised natives who were all cramped into pre-colonial slums . During the early period of French rule in the Union of Indochina, colonial officials knew almost nothing about the tropical diseases they would encounter. When epidemics of smallpox , diarrhea , dengue fever , syphilis , etc. would break out they could do nothing but erect barriers between them and the natives. The French regarded their colonial empire as a Mission Civilisatrice and justified the urban renovations of Hanoi as an act to "combat disease". While during the 1890s Hanoi was being equipped with modern sewers using the latest technology and the city received its own freshwater system, the access to these resources was quite strictly divided between racial lines as the system only served the White parts of town while very little Asians actually had access to the benefits of the city's new urban infrastructure. While the newly built French-style villas contained both running water systems and modern flush toilets, most of the Vietnamese and Chinese residents of the city who resided in the Old Quarter had to collect water from public fountains. The human waste commonly found in these public fountains were removed by pre-dawn night-soil collectors. Rather than having any proper sewers the Old Quarter only contained gutter drains. On 8 January 1902, Yersin was accredited to be the first Headmaster of Indochina Medical College by the Governor-General of French Indochina, future president of France Paul Doumer. Yersin as well as a number of other medical experts in Hanoi were concerned about the bubonic plague arriving there from southern China on the newly established steamship lines. As the source of the plague was in Yunnan, the French vilified China and Chinese people . During the beginning of the campaign in April 1902 the Government-General of French Indochina hired professional Vietnamese rat-catchers , these would descend into the sewers to hunt the rats down, and be paid for each rat that they had eliminated. "One had to enter the dark and cramped sewer system, make one's way through human waste in various forms of decay, and hunt down a relatively fierce wild animal which could be carrying fleas with the bubonic plague or other contagious diseases. This is not even to mention the probable existence of numerous other dangerous animals, such as snakes , spiders , and other creatures, that make this author's skin crawl with anxiety." Michael G. Vann at "The Cobra Effect: A New Freakonomics Radio Podcast". In the last week of April it was reported that the rat-catchers had killed 7,985 rats, in early May they started gaining more experience and the death toll was higher than 4,000 rats a day. By the end of May the numbers were even higher. On 30 May alone, they reported having killed 15,041 rats. In June, daily kill counts topped 10,000, and on June 21, they reported having killed as many as 20,112 rats in a single day. The success of these professional rat-catchers immediately caused a reduction of deaths caused by diseases carried by the rodents. Despite the high number of rats killed being reported the French realised that the professional pest control services weren't making a dent in the rat population as the rats could quickly reproduce, so they sought alternative measures to try and reduce the rat population in the city. The people hired to hunt the rats in the sewers began getting displeased with their situation. They saw their complex and dangerous working environment surrounded by all kinds of waste, human excrement, uncleanliness, and having to deal with dangerous animals like snakes and centipedes, while they were paid very little for their work relative to the effort they invested. In July 1902, Dr. Serez reported to his superiors that he was having problems with the locals during the rat eradication campaign, as they started to go on strike demanding to have their wages increased. The VNEconomics Academy of Blockchain and Cryptocurrencies reports that Professor Nguyá» n Văn Tuấn claimed that by 1904, the authorities increased the commission for every rat killed to 4 cents. Nguyá» n Văn Tuấn further noted that during the campaign a total of 55,000,000 rats were reported as being killed. While the French colonial empire saw itself as a modern technocratic administration and administered its colonies based on rigid record-keeping and statistics as well as a vast collection of data, the data collected by the technocrats was often unreliable. All data collected by the French such as the city's population figures, the number of plague cases to the daily count of dead rats were just best guesses. So the number of reported rats killed likely didn't reflect the actual number of rats that were killed. As the Quartier Européen was usually seen as the "civilised part of Hanoi" with its clean neighbourhoods, this hunt had also had perceived negative social effects for its residents. According to a report from the Resident-Superior of Tonkin on June 9 to the Government-General of French Indochina, the French population kept running into indigenous rat-catchers arising from the Quartier Européen's numerous manhole covers completely covered in filth and carrying hundreds of bloody dead rats and a foul odour, which caused many of them to complain about these activities. As the French authorities found that the extermination process wasn't going fast enough they proceeded to Plan B , offering any enterprising local the opportunity to get in on the hunt for rats. To incentivise this the French set a bounty of 1 cent per rat. To not be overrun with rat corpses the civilians only had to submit a rat's tail to the municipal offices. The French thought that this was a good idea because they had a policy of trying to encourage entrepreneurialism in Vietnam. Initially the new plan appeared to be working as devised as large numbers of tails were being brought in. But then an unintended consequence emerged. The enterprising Vietnamese that were hired to kill the rats soon realised that killing a rat would only make future rewards less likely. After all, they needed the rats to breed more rats with tails as these would become a future source of income. The French soon started noticing living and healthy rats running around without their tails. The rat hunters amputated their tails and then let them escape so they could breed and create more offspring with tails to then repeat the process. Furthermore, there were also reports that some Vietnamese people were deliberately smuggling in rats from outside Hanoi into the city. The final straw for this plan was when French health inspectors discovered rat farming operations popping up in the countryside on the outskirts of Hanoi, that were breeding rats solely for their tails as some sort of "tail creation factories". As the French policies had failed to accomplish its objectives, in fact having made the rat problem even worse in Hanoi, they cancelled the bounty programme. After the failed campaign ended, the rats, now more numerous than ever, continued frolicking underneath the city and the French had resigned to have to live with them. Former Governor-General Paul Doumer wanted to organise the Hanoi Exhibition (an international colonial exposition) as an occasion to flaunt the city of Hanoi as a civilised and sanitary, presenting it as a victory of the French government. The Hanoi Exhibition ran from 1902 until 1903 and during its time many goods and cargo from all over the world poured into Hanoi, this added to Hanoi's burden of disease because foreign rats brought pathogenic germs along with the cargo. By 1903 the Bubonic plague had infected 159 people; Of these, 110 died. Most of the victims were native Vietnamese people, while only 6 French colonists were infected, of which 2 died. Among the reasons why the death toll was higher among the Vietnamese was because they kept their sick family members a secret out of a fear that if the authorities found out about them that they would come to check and interfere. The Bubonic plague continued to spread for the coming years. In the year 1906, an outbreak in Tonkin negatively affected the Tonkinese economy. Because of the economic downturn caused by the pandemic a lot of people from the Tonkinese countryside fled to Hanoi, where many migrants became homeless beggars . Between the years 1906 and 1908, French health officials officially recorded 263 deaths from the Bubonic plague. As a result, the authorities decided to take other anti-pandemic measures and stricter hygiene control in the 36 streets of the "Native Quarter". The French authorities realised that they could only contain the pandemic through very intense and often invasive public health measures designed to stop it from spreading further once it has been identified. These measures included quarantining the sick in lazarettes, burning the belongings and often the homes of those who were found to be infected, and seizing corpses. These stricter measures were successful in reducing the further spread of the pandemic within the city. The French continued to enforce these measures after the pandemic as the natives didn't have the personal hygiene habits that the French desired them to acquire. This reflected the racial politics of the time, as similar attitudes existed in places like South Africa , India , the United States , and Hong Kong . However, these measures weren't very popular and angered the local population. In 1998, the Vietnamese authorities closed restaurants selling cat meat , which was marketed as "little tiger ( tiểu hổ ) meat", because they thought that if the cat population decreased, rats would invade the rice fields, showcasing a similar mentality to the French almost a century earlier. In 1995, American historian Michael G. Vann was researching for his doctoral dissertation on the city of Hanoi during French protectorate period in the overseas archives ( Centre des Archives Section d'Outre-Mer ) in Aix-en-Provence , Bouches-du-Rhône . During his research there he stumbled across one of the more bizarre primary sources that a historian is ever likely to find. Buried deep within the overseas archives Vann found a folder that labelled "Destruction of Hazardous Animals: Rats" concerning pest control . The archived file was a haphazard collection of records from the French government of Indochina detailing the number of rats that were killed on each day and the amount of money that the French had awarded to the rat hunters. The archives included about a hundred of identical forms that would list the number of rats that were reportedly killed between April 1902 and July 1902 in the first and second arrondissements (districts) of Hanoi. Vann noted that while the dossiers recorded hundreds of thousands of rats being killed the numbers inexplicably started to decline, with first a few thousand, then a few hundred, and then only a few dozen before reporting no rat deaths at all on the last page. Vann stated that there was no indication what caused the decline in reported rat deaths anywhere in the dossier. Michael G. Vann would continue to search for more information in the Centre des Archives Section d'Outre-Mer in Aix-en-Provence and various collections in Paris . In the year 1997, Michael G. Vann went to Vietnam to do archival research on the rat massacre for more information on the topic. While researching the archives, he attempted to reach into the top drawer of a card catalogue that was dedicated to pre-1954 French-language files, and then suddenly felt the sensation of a rat walking over his hand. Vann originally published Of Rats, Rice, and Race: The Great Hanoi Rat Massacre, an Episode in French Colonial History in a journal in 2003. For years he assumed that only "a few dozen colleagues read the piece and kind of forgot about it" until he was approached by the producers of a podcast show called Freakonomics Radio through a phone call that took place in 2012. The producers of Freakonomics Radio asked Vann if he would attend the podcast to illustrate the economic principle of perverse incentives , a concept he was unfamiliar with at the time. After the interview he learned that his article on the Great Hanoi Rat Massacre was being cited by a substantial number of economists and business journalists. In 2018 Micheal G. Vann and comic book artist Liz Clarke published the book The Great Hanoi Rat Hunt: Empire, Disease, and Modernity in French Colonial Vietnam ( Vietnamese : Cuộc đại thảm sát chuột tại Hà Nội: Đế chế, Dịch bệnh và Sá»± Hiện đại ở VN thời Pháp thuộc ) through the Oxford University Press . The book is a hybrid scholarly volume and graphic novel (long-form comic book ). While the bulk of the information contained within the book is the form of an academic work authored by Vann, there are hundreds of pages in comic book format, which were drawn up by Clarke. In an interview with PV Thanh Niên Vann said "This book is like a love letter I want to send to Hanoi" ( Cuốn sách nà y cÅ©ng giống nhÆ° bức thÆ° tình tôi muốn gá»­i tới Hà Nội ) talking about the hospitality that he received when he visited the city back in 1997. Among his motivations for writing the book he noted that it was a part of his mission is to let Americans know more about the country of city Vietnam, to educate them more about the history of this country with "thousands of years of civilisation", rather than only knowing about it through the Vietnam War . Ivan Franceschini of the Made in China Journal describes the work as being a praiseworthy case study in the history of imperialism , noting that the book delves deep into the racialised economic inequalities of empire. Franceschini further notes that it explores the idea of colonisation as a form of modernisation, while also discussing the creation of a radical power differential between "the West and the rest" created by industrial capitalism . Vann describes his choice to make half the book in comic book format as way to reach a larger audience as he noted "that Oxford had this series that takes unusual and quirky historical research and puts it into comic form" and he found the Great Hanoi Rat Massacre to also be a "quirky story". Furthermore, Michael G. Vann felt that the topics discussed in the book would be presented in a better way if they were in an illustrated format as he wanted to visually showcase the differences between the Vietnamese and French neighbourhoods of Hanoi. For researching the topic Vann went on multiple trips to Hanoi between 1997 and 2014. Michael G. Vann says that the rats themselves are one of the main characters in his book, describing them as the "totem animal of modernity". While he took inspiration from Art Spiegelman 's Maus for the rats, he refused to anthropomorphise them. Vann also included themes in the book about racism (including sinophobia ) and after learning that Dr. Sun Yat-Sen resided in Hanoi during the time of these events he included him in the book, both because he wanted to illustrate sinophobia and because he was also a graduate of the Ê»Iolani School in Honolulu . In 1995, American historian Michael G. Vann was researching for his doctoral dissertation on the city of Hanoi during French protectorate period in the overseas archives ( Centre des Archives Section d'Outre-Mer ) in Aix-en-Provence , Bouches-du-Rhône . During his research there he stumbled across one of the more bizarre primary sources that a historian is ever likely to find. Buried deep within the overseas archives Vann found a folder that labelled "Destruction of Hazardous Animals: Rats" concerning pest control . The archived file was a haphazard collection of records from the French government of Indochina detailing the number of rats that were killed on each day and the amount of money that the French had awarded to the rat hunters. The archives included about a hundred of identical forms that would list the number of rats that were reportedly killed between April 1902 and July 1902 in the first and second arrondissements (districts) of Hanoi. Vann noted that while the dossiers recorded hundreds of thousands of rats being killed the numbers inexplicably started to decline, with first a few thousand, then a few hundred, and then only a few dozen before reporting no rat deaths at all on the last page. Vann stated that there was no indication what caused the decline in reported rat deaths anywhere in the dossier. Michael G. Vann would continue to search for more information in the Centre des Archives Section d'Outre-Mer in Aix-en-Provence and various collections in Paris . In the year 1997, Michael G. Vann went to Vietnam to do archival research on the rat massacre for more information on the topic. While researching the archives, he attempted to reach into the top drawer of a card catalogue that was dedicated to pre-1954 French-language files, and then suddenly felt the sensation of a rat walking over his hand. Vann originally published Of Rats, Rice, and Race: The Great Hanoi Rat Massacre, an Episode in French Colonial History in a journal in 2003. For years he assumed that only "a few dozen colleagues read the piece and kind of forgot about it" until he was approached by the producers of a podcast show called Freakonomics Radio through a phone call that took place in 2012. The producers of Freakonomics Radio asked Vann if he would attend the podcast to illustrate the economic principle of perverse incentives , a concept he was unfamiliar with at the time. After the interview he learned that his article on the Great Hanoi Rat Massacre was being cited by a substantial number of economists and business journalists. In 2018 Micheal G. Vann and comic book artist Liz Clarke published the book The Great Hanoi Rat Hunt: Empire, Disease, and Modernity in French Colonial Vietnam ( Vietnamese : Cuộc đại thảm sát chuột tại Hà Nội: Đế chế, Dịch bệnh và Sá»± Hiện đại ở VN thời Pháp thuộc ) through the Oxford University Press . The book is a hybrid scholarly volume and graphic novel (long-form comic book ). While the bulk of the information contained within the book is the form of an academic work authored by Vann, there are hundreds of pages in comic book format, which were drawn up by Clarke. In an interview with PV Thanh Niên Vann said "This book is like a love letter I want to send to Hanoi" ( Cuốn sách nà y cÅ©ng giống nhÆ° bức thÆ° tình tôi muốn gá»­i tới Hà Nội ) talking about the hospitality that he received when he visited the city back in 1997. Among his motivations for writing the book he noted that it was a part of his mission is to let Americans know more about the country of city Vietnam, to educate them more about the history of this country with "thousands of years of civilisation", rather than only knowing about it through the Vietnam War . Ivan Franceschini of the Made in China Journal describes the work as being a praiseworthy case study in the history of imperialism , noting that the book delves deep into the racialised economic inequalities of empire. Franceschini further notes that it explores the idea of colonisation as a form of modernisation, while also discussing the creation of a radical power differential between "the West and the rest" created by industrial capitalism . Vann describes his choice to make half the book in comic book format as way to reach a larger audience as he noted "that Oxford had this series that takes unusual and quirky historical research and puts it into comic form" and he found the Great Hanoi Rat Massacre to also be a "quirky story". Furthermore, Michael G. Vann felt that the topics discussed in the book would be presented in a better way if they were in an illustrated format as he wanted to visually showcase the differences between the Vietnamese and French neighbourhoods of Hanoi. For researching the topic Vann went on multiple trips to Hanoi between 1997 and 2014. Michael G. Vann says that the rats themselves are one of the main characters in his book, describing them as the "totem animal of modernity". While he took inspiration from Art Spiegelman 's Maus for the rats, he refused to anthropomorphise them. Vann also included themes in the book about racism (including sinophobia ) and after learning that Dr. Sun Yat-Sen resided in Hanoi during the time of these events he included him in the book, both because he wanted to illustrate sinophobia and because he was also a graduate of the Ê»Iolani School in Honolulu .

Wiki

Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Rats_in_New_York_City/html

Rats in New York City

Rats in New York City are widespread, as they are in many densely populated areas. They are considered a cultural symbol of the city. For a long time, the number of rats in New York City was unknown, and a common urban legend declared there were up to five times as many rats as people. However, a 2023 study estimates that there are approximately 3 million rats in New York, which is close to a third of New York's human population. The city's rat population is dominated by the brown rat (also known as the Norway rat). The average adult body weight is 350 grams (12 oz) in males and about 250 grams (8.8 oz) in females. The adult rat can squeeze through holes or gaps 1 inch (25 mm) wide, jump a horizontal distance of up to 4 feet (1.2 m) (or vertically from a flat surface to 3 feet (0.91 m) ), survive a fall from a height of almost 40 feet (12 m) , and tread water for three days. New York City rats carry pathogens that can cause diarrhea , vomiting , and fever in humans – especially in children. The pathogens they carry include bacteria such as Clostridium difficile ( C. diff ), Salmonella , E. coli , and Leptospira . Bartonella bacteria cause cat scratch disease , trench fever , and Carron disease. These bacteria may be spread through contact with rat saliva , urine or feces . Rats can carry disease-causing viruses such as sapoviruses , cardioviruses , kobuviruses , parechoviruses , rotaviruses , hepaciviruses , and Seoul virus . Rats may carry fleas that are vectors of diseases such as bubonic plague , typhus , and spotted fever . In addition, some people have an allergic reaction to the presence of rodent hair, urine or feces. New York City rodent complaints can be made online, or by dialing 3-1-1 , and the New York City guide Preventing Rats on Your Property discusses how the New York City Health Department inspects private and public properties for rats. Property owners that fail inspections receive a Commissioner's Order and have five days to correct the problem. If, after five days, the property fails a second inspection, the owner receives a notice of violation and can be fined. The property owner is billed for any cleanup or extermination carried out by the Health Department.Rarely seen in daylight, rats have been reported in New York City since early colonial days. As recently as 1944, two distinct species were prevalent: the brown rat (Norway rat) and the black rat (ship rat, roof rat). Over the next few decades, the more aggressive brown variety displaced the black rats, typically by attacking and killing them, but also by out-competing them for food and shelter. By 2014, the city's rat population was dominated by the brown rat. The brown rat is 16 to 20 inches (410 to 510 mm) long and weighs 1 to 2 pounds (450 to 910 g) . It is brown or gray in color with a lighter-colored belly. It is nocturnal , and sleeps approximately 10 hours a day. The black rat is between 5 and 7 inches (130 and 180 mm) long (not including the tail) and weighs between 2.5 and 8 ounces (71 and 227 g) . It is usually black to light brown in color with a lighter-colored belly. Rats are elusive by nature, and public health officials have not developed any reliable way to estimate their numbers. However, a 2014 study by Jonathan Auerbach, which was reported in the Royal Statistical Society 's Significance magazine, estimated that there were closer to 2 million rats in the city. In 2023, another study by pest control company MMPC using Auerbach's methodology estimated that the rat population has since increased to nearly 3 million. This is close to a third of New York's human population. It conflicts with the often-repeated statistic that there are more rats than people in the five boroughs of New York City (8.5 million in 2023), with some estimates putting the number of rats far higher at as many as five rats per person (33.6 million). In 2014, the television channel Animal Planet named New York City the "Worst Rat City in the World". Compared to other cities within the United States, studies indicate New York is particularly well-suited for rats. This conclusion is based on characteristics such as human population patterns, public sanitation practices, climate, housing construction standards and other variables. Experts consider that the actual population of rats varies, depending on climate, sanitation practices, efforts to control the population, and season. Studies have repeatedly failed to find restricted gene flow in Manhattan 's rats due to the island's buildings. However Combs et al. (2018) presents a more geographically detailed analysis. They find that the island's buildings are restricting gene flow, especially in Midtown . Rats only require 1 ounce (28 g) of food and water a day to live. The rodents primarily find food and shelter at human habitations and therefore interact with humans in various ways. In particular, the city's rats adapt to practices and habits among New Yorkers for disposing of food waste . Curbside overnight garbage disposal from residences, stores, subway and restaurants, as well as littering, contribute to the sustenance of the city's rats. Rats nearly always use the same routes to their food sources. Rat infestations have increased as a result of budget reductions and more wasteful disposal of food. Rats burrow underground or create nests in suitable soft material, with a small group of rats in each nest. Brown rats in New York City prefer to live at ground level or basement level. They congregate in colonies of 30 to 50 rats. Rats live 100 feet (30 m) to 400 feet (120 m) from their food source. Unlike many mammals , the rat's skull is not plated together. This means it can change the shape of its head to squeeze through holes or gaps as small as a quarter ( 0.955 inches (24.3 mm) ). They are able to leap 4 feet (1.2 m) laterally and can fall five floors without any injuries. An adult rat can tread water for three days. They typically travel tight, well-worn paths. Each litter has up to a dozen pups. Rats can mate at the age of two or three months and then produce a new litter every two months. The rats live for approximately one year, mostly due to predation rather than natural lifespan. They rarely travel more than 600 feet (180 m) from where they were born. Rarely seen in daylight, rats have been reported in New York City since early colonial days. As recently as 1944, two distinct species were prevalent: the brown rat (Norway rat) and the black rat (ship rat, roof rat). Over the next few decades, the more aggressive brown variety displaced the black rats, typically by attacking and killing them, but also by out-competing them for food and shelter. By 2014, the city's rat population was dominated by the brown rat. The brown rat is 16 to 20 inches (410 to 510 mm) long and weighs 1 to 2 pounds (450 to 910 g) . It is brown or gray in color with a lighter-colored belly. It is nocturnal , and sleeps approximately 10 hours a day. The black rat is between 5 and 7 inches (130 and 180 mm) long (not including the tail) and weighs between 2.5 and 8 ounces (71 and 227 g) . It is usually black to light brown in color with a lighter-colored belly.Rats are elusive by nature, and public health officials have not developed any reliable way to estimate their numbers. However, a 2014 study by Jonathan Auerbach, which was reported in the Royal Statistical Society 's Significance magazine, estimated that there were closer to 2 million rats in the city. In 2023, another study by pest control company MMPC using Auerbach's methodology estimated that the rat population has since increased to nearly 3 million. This is close to a third of New York's human population. It conflicts with the often-repeated statistic that there are more rats than people in the five boroughs of New York City (8.5 million in 2023), with some estimates putting the number of rats far higher at as many as five rats per person (33.6 million). In 2014, the television channel Animal Planet named New York City the "Worst Rat City in the World". Compared to other cities within the United States, studies indicate New York is particularly well-suited for rats. This conclusion is based on characteristics such as human population patterns, public sanitation practices, climate, housing construction standards and other variables. Experts consider that the actual population of rats varies, depending on climate, sanitation practices, efforts to control the population, and season. Studies have repeatedly failed to find restricted gene flow in Manhattan 's rats due to the island's buildings. However Combs et al. (2018) presents a more geographically detailed analysis. They find that the island's buildings are restricting gene flow, especially in Midtown . Rats only require 1 ounce (28 g) of food and water a day to live. The rodents primarily find food and shelter at human habitations and therefore interact with humans in various ways. In particular, the city's rats adapt to practices and habits among New Yorkers for disposing of food waste . Curbside overnight garbage disposal from residences, stores, subway and restaurants, as well as littering, contribute to the sustenance of the city's rats. Rats nearly always use the same routes to their food sources. Rat infestations have increased as a result of budget reductions and more wasteful disposal of food. Rats burrow underground or create nests in suitable soft material, with a small group of rats in each nest. Brown rats in New York City prefer to live at ground level or basement level. They congregate in colonies of 30 to 50 rats. Rats live 100 feet (30 m) to 400 feet (120 m) from their food source. Unlike many mammals , the rat's skull is not plated together. This means it can change the shape of its head to squeeze through holes or gaps as small as a quarter ( 0.955 inches (24.3 mm) ). They are able to leap 4 feet (1.2 m) laterally and can fall five floors without any injuries. An adult rat can tread water for three days. They typically travel tight, well-worn paths. Each litter has up to a dozen pups. Rats can mate at the age of two or three months and then produce a new litter every two months. The rats live for approximately one year, mostly due to predation rather than natural lifespan. They rarely travel more than 600 feet (180 m) from where they were born. The greatest danger posed to humans from rats are the diseases that the latter can transmit. City-dwelling rats carry pathogens that can cause diarrhea and vomiting in humans. Disease-causing bacteria commonly carried by rats include E. coli , Clostridium difficile ( C. diff ), and Salmonella . The bacteria can be spread by contact with rat saliva, urine or feces. Viral diseases spread by rats include rat-bite fever and hemorrhagic fevers caused by Seoul hantavirus . A survey conducted by Columbia University 's Mailman School of Public Health in 2014 studied 133 brown rats from residential buildings in Manhattan. The rats carried numerous pathogens that can cause serious illness in humans, including bacteria ( Salmonella and E. coli ) that cause food poisoning and dermatitis , pathogens that cause fevers (such as Seoul hantavirus and Leptospira ), sapoviruses , cardioviruses , kobuviruses , parechoviruses , rotaviruses , Hepacivirus A, and hepaciviruses , including some never before seen in New York. While at least 18 of the viruses found are known to cause disease in humans, it is unclear how infectious the rats are to residents. Peter Daszak, president of EcoHealth Alliance , a nonprofit scientific organization that researches links between human health and wildlife, called the study "shocking and surprising". Given the close quarters shared by rats and New York City residents, he found it to be "a recipe for a public health nightmare". A 2015 joint study by Columbia University and Cornell University found that the rats are commonly infested with fleas , lice , and mites that carry bacteria that can cause disease in humans, including bubonic plague , typhus , and spotted fever . They found an average of five fleas per rat, a sharp increase from a 1925 study that found one out of five rats had no fleas at all. Bartonella pathogens (which can cause cat scratch disease , trench fever , and Carron disease) and various viruses were also found in New York City's rats in this study. These results were confirmed by a study published in 2015 in the Journal of Medical Entomology . A higher risk of allergies and asthma is linked to exposure to rodent hair, droppings , and urine , especially in children. The NYC Health Department recommends that people bitten by a rat seek immediate medical attention, as bacteria from the rat's teeth can cause tetanus as well as rat-bite fever , which can be fatal. The New York City Department of Health handles enforcement of rat infestation problems in New York City. Local authorities in New York have long recognized that eliminating rats from the city is unrealistic, but have made various efforts to control their prevalence. The approach has traditionally been reactive: after receiving complaints of infestation, officials would commence control efforts at that site by placing rodent poison, traps, or contraceptives. In recent years, the city adopted a more proactive approach to rodent control known as integrated pest management , which focuses on preventive measures. Such efforts include developing a rodent control map using geotagging to focus countermeasures more systematically, instituting a "Rodent Control Academy" that trains city employees on rat behavior and control, and emphasizing building integrity and garbage disposal. In 2009, the Health Department began offering a half-day course in combating rat infestations. In 2010, the city cut its budget for rodent control programs by $1.5 million to help reduce an overall deficit of $2 billion. In 2013, it was announced that New York municipal authorities would implement a plan for mass sterilization of the city's rats, using a chemical to neutralize the reproductive systems of female rats. Bait stations loaded with the chemical were to be deployed. The chemical's effects were to gradually shrink the number of pups a female rat can have in a litter, eventually rendering them infertile. The Upper West Side and the Upper East Side logged the most rat complaints to the Health Department from 2010 to mid-2014. In 2014 the Health Department hired 9 new inspectors to augment its staff of 45. With $611,000 in funding, the new squad was tasked with targeting major infestations in the South Bronx and Manhattan. A private group, Ryders Alley Trencher-fed Society , conducts rat hunts in New York using dogs. This group is not the only one hunting rats with dogs in New York City. New York City property owners and managing agents are legally responsible for keeping their properties rat-free through maintenance measures and the use of pest control professionals. Conditions both inside and outside of buildings, including on public property, that contribute to or allow the establishment of rat populations constitute violations of Article 151 of the Health Code. Maintenance measures include proper storage of garbage, removal of water sources, and elimination of environments suitable for nesting. Garbage cans need to be rat-resistant and made out of metal rather than plastic. Because rats easily chew through plastic, the Health Department recommends placing plastic garbage bags inside rat-resistant metal garbage cans. Garbage should be placed out on the street close to the pickup time, rather than the night before. It also becomes important to keep garbage that are in parks inside litter cans, and not feeding birds or any of the surrounding wildlife that could potentially attract them. New York City publishes a guide for property owners and tenants, entitled Preventing Rats on Your Property: A Guide for Property Owners and Tenants , that discusses how the Health Department inspects for rats, and how to control rats, including looking for evidence, cleaning up, starving them, shutting them out, and wiping them out. The guide covers the use of traps, rat poison, and wire mesh at the base of trees, as well as the new rules for garbage pickup, with landlords bringing out garbage in the morning immediately prior to pickup rather than the night before. Rodent baiting is suggested as an effective approach to wiping out rats. New York City property owners and residents are advised to watch for signs of infestation like gnawed wood and plastic and evidence of rat trails. Property should be inspected to look for entry points such as gaps around pipes. An online map created by the New York City Department of Health enables people to search specific addresses for rat issues. The Village Voice asked readers to email them about incidents of rat sightings. New York City rodent complaints can be made online, by filling out the New York City Rodent Complaint Form, or by dialing 3-1-1 . The New York City guide Preventing Rats on Your Property discusses how the NYC Health Department, through its Pest Control Services program, inspects private and public properties for rats. Property owners that fail an inspection receive a Health Department Commissioner's Order and have five days to correct the problem. If, after five days, the property fails a second inspection, the owner receives a Notice of Violation and can be fined. If the Health Department feels it must itself exterminate or clean up the property, the property owner is billed (about $1,000 a day in 2004). Unpaid charges become a priority lien against the building, preventing property owners from selling with a clean legal title . Failure to comply with an order of the Commissioner is a misdemeanor , and subjects the landlord to criminal prosecution , a fine and/or imprisonment, as well as additional civil penalties. The penalty for each rodent violation was as high as $2,000 in 2004. In 2014, New York City Comptroller Scott Stringer criticized the Health Department as "weak" in investigating and fixing residents' rat complaints. From fiscal year 2012 to fiscal year 2013, pest complaints, including rat problems, increased 10 percent in the city, and 24 percent of the time Health Department workers failed to inspect the complaints in the 10-day target period, an audit by the comptroller found. In 160 cases, the Health Department failed to carry out any field inspection. Caroline Bragdon at the Department of Health said: "The inspection is only as good as the inspector on that day and time. If you feel we're really missing the boat, which sometimes we do, let your community board and elected officials know." In July 2000, the mayoral administration of Rudy Giuliani established a rat abatement task force in response to increasing rat-infestation complaints. The task force was headed by "rat czar" Joe Lhota . Manhattan borough president C. Virginia Fields simultaneously created a "rat complaint hot line" where Manhattan residents could report rats; this effort was criticized by Lhota, who said the city government already had its own hotline. Later in 2000, the city government proposed new laws that targeted rat infestations. After several months of hearings, a New York City Council committee recommended creating a permanent agency to combat rat infestations in February 2001. The mayoral administration of Bill de Blasio launched a $400,000 pilot program in the mid-2010s to combat rat infestations in parks, the subway, and sewers. De Blasio allocated $2.9 million to reduce rat infestations in 2015, following the success of that program. In July 2017, the New York City government announced a $32 million rat reduction plan in which it initially aimed to reduce rat infestations by 70% by the end of 2018. The plan would alleviate rat infestations in East Village , Chinatown , and the Lower East Side in Lower Manhattan ; Concourse in the Bronx; and Bedford–Stuyvesant and Bushwick in Brooklyn. These neighborhoods were chosen because they had high numbers of rat complaints in the past. The plan included installing padding or tiling on dirt floors in the basements of apartment buildings, installing solar-powered rat-proof trash cans, as well as increased trash management. In addition, de Blasio proposed suffocating rats by pouring dry ice into their burrows. Rat sightings increased 71 percent from 2020 to 2023, prompting the City Council to propose a Rat Action Plan in July 2022, with five pieces of legislation. A revised plan was passed that October, consisting of four laws that aimed to reduce rodent infestations in the city. As part of the plan, the city government began looking for a director of rodent mitigation in late 2022. The government also announced in March 2023 that it would create eight "rat-mitigation zones" in neighborhoods with particularly severe rat infestations. That April, mayor Eric Adams appointed New York City's first director of rodent mitigation: former elementary school teacher Kathleen Corradi, who developed New York City's Zero Waste Schools initiative and led the Education Department's rodent reduction efforts. The same month, the city started requiring that building superintendents bring their garbage to the curb at 8 p.m., rather than at 4 p.m., on garbage collection days. Between August 2023 and March 2024, the city implemented rules requiring all businesses to put out trash within sturdy bins on garbage collection days. New York City property owners and managing agents are legally responsible for keeping their properties rat-free through maintenance measures and the use of pest control professionals. Conditions both inside and outside of buildings, including on public property, that contribute to or allow the establishment of rat populations constitute violations of Article 151 of the Health Code. Maintenance measures include proper storage of garbage, removal of water sources, and elimination of environments suitable for nesting. Garbage cans need to be rat-resistant and made out of metal rather than plastic. Because rats easily chew through plastic, the Health Department recommends placing plastic garbage bags inside rat-resistant metal garbage cans. Garbage should be placed out on the street close to the pickup time, rather than the night before. It also becomes important to keep garbage that are in parks inside litter cans, and not feeding birds or any of the surrounding wildlife that could potentially attract them. New York City publishes a guide for property owners and tenants, entitled Preventing Rats on Your Property: A Guide for Property Owners and Tenants , that discusses how the Health Department inspects for rats, and how to control rats, including looking for evidence, cleaning up, starving them, shutting them out, and wiping them out. The guide covers the use of traps, rat poison, and wire mesh at the base of trees, as well as the new rules for garbage pickup, with landlords bringing out garbage in the morning immediately prior to pickup rather than the night before. Rodent baiting is suggested as an effective approach to wiping out rats. New York City property owners and residents are advised to watch for signs of infestation like gnawed wood and plastic and evidence of rat trails. Property should be inspected to look for entry points such as gaps around pipes. An online map created by the New York City Department of Health enables people to search specific addresses for rat issues. The Village Voice asked readers to email them about incidents of rat sightings. New York City rodent complaints can be made online, by filling out the New York City Rodent Complaint Form, or by dialing 3-1-1 . The New York City guide Preventing Rats on Your Property discusses how the NYC Health Department, through its Pest Control Services program, inspects private and public properties for rats. Property owners that fail an inspection receive a Health Department Commissioner's Order and have five days to correct the problem. If, after five days, the property fails a second inspection, the owner receives a Notice of Violation and can be fined. If the Health Department feels it must itself exterminate or clean up the property, the property owner is billed (about $1,000 a day in 2004). Unpaid charges become a priority lien against the building, preventing property owners from selling with a clean legal title . Failure to comply with an order of the Commissioner is a misdemeanor , and subjects the landlord to criminal prosecution , a fine and/or imprisonment, as well as additional civil penalties. The penalty for each rodent violation was as high as $2,000 in 2004. In 2014, New York City Comptroller Scott Stringer criticized the Health Department as "weak" in investigating and fixing residents' rat complaints. From fiscal year 2012 to fiscal year 2013, pest complaints, including rat problems, increased 10 percent in the city, and 24 percent of the time Health Department workers failed to inspect the complaints in the 10-day target period, an audit by the comptroller found. In 160 cases, the Health Department failed to carry out any field inspection. Caroline Bragdon at the Department of Health said: "The inspection is only as good as the inspector on that day and time. If you feel we're really missing the boat, which sometimes we do, let your community board and elected officials know." In July 2000, the mayoral administration of Rudy Giuliani established a rat abatement task force in response to increasing rat-infestation complaints. The task force was headed by "rat czar" Joe Lhota . Manhattan borough president C. Virginia Fields simultaneously created a "rat complaint hot line" where Manhattan residents could report rats; this effort was criticized by Lhota, who said the city government already had its own hotline. Later in 2000, the city government proposed new laws that targeted rat infestations. After several months of hearings, a New York City Council committee recommended creating a permanent agency to combat rat infestations in February 2001. The mayoral administration of Bill de Blasio launched a $400,000 pilot program in the mid-2010s to combat rat infestations in parks, the subway, and sewers. De Blasio allocated $2.9 million to reduce rat infestations in 2015, following the success of that program. In July 2017, the New York City government announced a $32 million rat reduction plan in which it initially aimed to reduce rat infestations by 70% by the end of 2018. The plan would alleviate rat infestations in East Village , Chinatown , and the Lower East Side in Lower Manhattan ; Concourse in the Bronx; and Bedford–Stuyvesant and Bushwick in Brooklyn. These neighborhoods were chosen because they had high numbers of rat complaints in the past. The plan included installing padding or tiling on dirt floors in the basements of apartment buildings, installing solar-powered rat-proof trash cans, as well as increased trash management. In addition, de Blasio proposed suffocating rats by pouring dry ice into their burrows. Rat sightings increased 71 percent from 2020 to 2023, prompting the City Council to propose a Rat Action Plan in July 2022, with five pieces of legislation. A revised plan was passed that October, consisting of four laws that aimed to reduce rodent infestations in the city. As part of the plan, the city government began looking for a director of rodent mitigation in late 2022. The government also announced in March 2023 that it would create eight "rat-mitigation zones" in neighborhoods with particularly severe rat infestations. That April, mayor Eric Adams appointed New York City's first director of rodent mitigation: former elementary school teacher Kathleen Corradi, who developed New York City's Zero Waste Schools initiative and led the Education Department's rodent reduction efforts. The same month, the city started requiring that building superintendents bring their garbage to the curb at 8 p.m., rather than at 4 p.m., on garbage collection days. Between August 2023 and March 2024, the city implemented rules requiring all businesses to put out trash within sturdy bins on garbage collection days. In February 2007, a morning news program featured a live report of a pack of rats overrunning a joint Taco Bell - KFC fast food restaurant in Greenwich Village . Inside the restaurant, numerous rats so severely infested the restaurant that they were visible in groups from the street, through the windows. Owners of the store reassured customers that the infestation was an isolated incident, but neighborhood residents interviewed stated that the franchise had exhibited a consistent presence of rats. Though the city's Department of Health and Mental Hygiene ordered both restaurants to stay closed, both storefronts gathered crowds, who came to observe the sheer quantity of rats inside the stores. While Health Department officials investigated the Taco Bell-KFC, it was uncovered that the restaurant had passed health inspections as recently as a week before the infestation. Following the infestation, the restaurant was officially closed by the Health Department, and it was reported that the restaurant had only previously passed health inspections by having rat droppings and not live rats, leading some to call for stricter measurements on health inspections. In March 2023, a couple reported finding a whole rat in their delivery order from a K-Town restaurant, Gammeeok. Prior to this event, the restaurant received several health code violations including, "establishment is not free of harborage or conditions conducive to rodents, insects, or pests." Rats in New York City have been observed on multiple occasions entering dwellings through plumbing and emerging from the toilet . Pest control experts say that many rats have no problem climbing through pipes. Though the most memorable incidents involve rats entering the bowl of the toilet or even leaving the toilet, it is not uncommon for them to become trapped in the pipes and die. Plumbers in New York are allegedly so used to dealing with rats in toilets, that they appear completely unfazed and even make jokes. Rats prefer means of entry which give them close proximity to food, which plumbing pipes do not, however, the change of rat behavior during the COVID-19 pandemic has caused an increase in toilet rats. Though most toilet rat infestations are facilitated by uncapped pipes, which are often not in the control of tenants, plumbers say the best way to hinder toilet rats is to leave the lid closed when not in use. Babies are frequent victims, especially if left alone with food or a bottle. In 1860, The New York Times reported that a newborn infant had died subsequent to rats eating part of its face and one foot. The NYC Health Department undertook an anti-rat campaign in 1921 that involved rat-proofing as well as trapping and killing rats. Rats have been frequently known to have bitten infants and young children to get food off their faces. In August 2003, a fire station at 153 - 11 Hillside Avenue in Queens was condemned and gutted after rats had taken over the building. After exterminators visited the building 26 times between March 2003 and August 2003, the building was eventually evacuated and stripped after the stench of dead rats built up in the walls and ceilings. The 60 staff members of the fire station were redistributed among nearby firehouses. In 2014, New York City Councilman Mark D. Levine said at a public hearing that "We've had rats who are going into cars and eating out electrical cables. We have rats that are entering homes." He described the problem as "epidemic" on some streets in Manhattan. In October 2020, a 33-year-old man in the Bronx fell through a sidewalk that collapsed under him into a nest of rats, an event colloquially referred to as the "New York City rat chasm". The victim was hospitalized for three weeks. Shortly following the accident, the victim filed a lawsuit for gross negligence against EH & HD 183rd Realty LLC and the city of New York. EH & HD 183rd Realty LLC was charged with gross negligence for not properly maintaining the vault, and the New York City Department of Buildings was charged with gross negligence for not properly inspecting the sidewalk. In 2011, a video of a rat climbing on a sleeping man's face on the subway went viral . Rats are so common that ex-Manhattan Borough President Scott Stringer quipped in 2013, "The rats don't scurry. They walk right up to you and say, 'How are you, Mr. Borough President? ' " That year, YouTube videos of rats on subway tracks and in a subway car in New York City went viral, as did videos of rats in a Dunkin' Donuts in Manhattan. In June 2014, residents at adjacent Upper West Side buildings started a rent strike, demanding an end to the rat problem. Also in 2014, Allerton Coops in Bronx Park East received three Notices of Violation from the Health Department and was fined for their inadequate response to a severe rat infestation. In 2015, a YouTube video of a rat carrying a slice of pizza in the subway, dubbed " Pizza Rat ", went viral. The video was trending worldwide on Twitter and Facebook within 15 hours of the YouTube upload, garnered 5 million views within two days, and spawned similar staged videos with trained rats such as Selfie Rat . In early 2016, another video of a rat climbing on a sleeping subway rider was uploaded to social media. The uploader was criticized for his choice to film the incident and post it online rather than intervene. In late 2021, Tropical Storm Ida caused severe flooding in the New York City sewer system , which was then followed by multiple reports of dozens of rat corpses washing up on the banks of bodies of water in New York. There was no official count of the number of rats living in the sewers of New York, but experts hypothesize that the flooding from Ida may have caused one of the biggest rat depopulation events in New York in decades. In February 2007, a morning news program featured a live report of a pack of rats overrunning a joint Taco Bell - KFC fast food restaurant in Greenwich Village . Inside the restaurant, numerous rats so severely infested the restaurant that they were visible in groups from the street, through the windows. Owners of the store reassured customers that the infestation was an isolated incident, but neighborhood residents interviewed stated that the franchise had exhibited a consistent presence of rats. Though the city's Department of Health and Mental Hygiene ordered both restaurants to stay closed, both storefronts gathered crowds, who came to observe the sheer quantity of rats inside the stores. While Health Department officials investigated the Taco Bell-KFC, it was uncovered that the restaurant had passed health inspections as recently as a week before the infestation. Following the infestation, the restaurant was officially closed by the Health Department, and it was reported that the restaurant had only previously passed health inspections by having rat droppings and not live rats, leading some to call for stricter measurements on health inspections. In March 2023, a couple reported finding a whole rat in their delivery order from a K-Town restaurant, Gammeeok. Prior to this event, the restaurant received several health code violations including, "establishment is not free of harborage or conditions conducive to rodents, insects, or pests." Rats in New York City have been observed on multiple occasions entering dwellings through plumbing and emerging from the toilet . Pest control experts say that many rats have no problem climbing through pipes. Though the most memorable incidents involve rats entering the bowl of the toilet or even leaving the toilet, it is not uncommon for them to become trapped in the pipes and die. Plumbers in New York are allegedly so used to dealing with rats in toilets, that they appear completely unfazed and even make jokes. Rats prefer means of entry which give them close proximity to food, which plumbing pipes do not, however, the change of rat behavior during the COVID-19 pandemic has caused an increase in toilet rats. Though most toilet rat infestations are facilitated by uncapped pipes, which are often not in the control of tenants, plumbers say the best way to hinder toilet rats is to leave the lid closed when not in use. Babies are frequent victims, especially if left alone with food or a bottle. In 1860, The New York Times reported that a newborn infant had died subsequent to rats eating part of its face and one foot. The NYC Health Department undertook an anti-rat campaign in 1921 that involved rat-proofing as well as trapping and killing rats. Rats have been frequently known to have bitten infants and young children to get food off their faces. In August 2003, a fire station at 153 - 11 Hillside Avenue in Queens was condemned and gutted after rats had taken over the building. After exterminators visited the building 26 times between March 2003 and August 2003, the building was eventually evacuated and stripped after the stench of dead rats built up in the walls and ceilings. The 60 staff members of the fire station were redistributed among nearby firehouses. In 2014, New York City Councilman Mark D. Levine said at a public hearing that "We've had rats who are going into cars and eating out electrical cables. We have rats that are entering homes." He described the problem as "epidemic" on some streets in Manhattan. In October 2020, a 33-year-old man in the Bronx fell through a sidewalk that collapsed under him into a nest of rats, an event colloquially referred to as the "New York City rat chasm". The victim was hospitalized for three weeks. Shortly following the accident, the victim filed a lawsuit for gross negligence against EH & HD 183rd Realty LLC and the city of New York. EH & HD 183rd Realty LLC was charged with gross negligence for not properly maintaining the vault, and the New York City Department of Buildings was charged with gross negligence for not properly inspecting the sidewalk. In 2011, a video of a rat climbing on a sleeping man's face on the subway went viral . Rats are so common that ex-Manhattan Borough President Scott Stringer quipped in 2013, "The rats don't scurry. They walk right up to you and say, 'How are you, Mr. Borough President? ' " That year, YouTube videos of rats on subway tracks and in a subway car in New York City went viral, as did videos of rats in a Dunkin' Donuts in Manhattan. In June 2014, residents at adjacent Upper West Side buildings started a rent strike, demanding an end to the rat problem. Also in 2014, Allerton Coops in Bronx Park East received three Notices of Violation from the Health Department and was fined for their inadequate response to a severe rat infestation. In 2015, a YouTube video of a rat carrying a slice of pizza in the subway, dubbed " Pizza Rat ", went viral. The video was trending worldwide on Twitter and Facebook within 15 hours of the YouTube upload, garnered 5 million views within two days, and spawned similar staged videos with trained rats such as Selfie Rat . In early 2016, another video of a rat climbing on a sleeping subway rider was uploaded to social media. The uploader was criticized for his choice to film the incident and post it online rather than intervene. In late 2021, Tropical Storm Ida caused severe flooding in the New York City sewer system , which was then followed by multiple reports of dozens of rat corpses washing up on the banks of bodies of water in New York. There was no official count of the number of rats living in the sewers of New York, but experts hypothesize that the flooding from Ida may have caused one of the biggest rat depopulation events in New York in decades.

Wiki

Bubonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Consequences_of_the_Black_Death/html

Consequences of the Black Death

The Black Death peaked in Europe between 1348 and 1350, with an estimated third of the continent's population ultimately succumbing to the disease. Often simply referred to as "The Plague", the Black Death had both immediate and long-term effects on human population across the world as one of the most devastating pandemics in human history, including a series of biological, social, economic, political and religious upheavals that had profound effects on the course of world history , especially European history . Symptoms of the Bubonic Plague included painful and enlarged or swollen lymph nodes, headaches, chills, fatigue, vomiting, and fevers, and within 3 to 5 days, 80% of the victims would be dead. Historians estimate that it reduced the total world population from 475 million to between 350 and 375 million. In most parts of Europe, it took nearly 80 years for population sizes to recover, and in some areas, it took more than 150 years. [ citation needed ] From the perspective of many of the survivors, the effect of the plague may have been ultimately favourable, as the massive reduction of the workforce meant their labor was suddenly in higher demand. R. H. Hilton has argued that the English peasants who survived found their situation to be much improved. For many Europeans, the 15th century was a golden age of prosperity and new opportunities. The land was plentiful, wages were high and serfdom had all but disappeared. A century later, as population growth resumed, the lower classes once again faced deprivation and famine. Figures for the death toll vary widely by area and from source to source, and estimates are frequently revised as historical research brings new discoveries to light. Most scholars estimate that the Black Death killed up to 75 million people in the 14th century, at a time when the entire world population was still less than 500 million. Even where the historical record is considered reliable, only rough estimates of the total number of deaths from the plague are possible. Europe suffered an especially significant death toll from the plague. Modern estimates range between roughly one third and one half of the total European population in the five-year period of 1347 to 1351 died during which the most severely-affected areas may have lost up to 80% of the population. Contemporary chronicler Jean Froissart estimated the toll to be one-third, which modern scholars consider less an accurate assessment than an allusion to the Book of Revelation meant to suggest the scope of the plague. Deaths were not evenly distributed across Europe, and some areas were affected very little, but others were all but entirely depopulated. The Black Death hit the culture of towns and cities disproportionately hard although rural areas, where most of the population lived at the time, were also significantly affected. Larger cities were the worst off, as population densities and close living quarters made disease transmission easier. Cities were also strikingly filthy, infested with lice , fleas , and rats , and subject to diseases caused by malnutrition and poor hygiene . The population of the city of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. In the cities of Hamburg and Bremen , 60–70% of the inhabitants died. In Provence , Dauphiné , and Normandy , historians observe a decrease of 60% of fiscal hearths. In some regions, two thirds of the population was annihilated. In the town of Givry , in the Bourgogne region of France, the local friar, who used to note 28–29 funerals a year, recorded 649 deaths in 1348, half of them in September. About half the population of Perpignan died over the course of several months (only two of the eight physicians survived the plague). Over 60% of Norway's population died between 1348 and 1350. London may have lost two thirds of its population during the 1348–49 outbreak; England as a whole may have lost 70% of its population, which declined from 7 million before the plague to 2 million in 1400. Some places, including the Kingdom of Poland , parts of Hungary , the Brabant region, Hainaut , and Limbourg (in modern Belgium), as well as Santiago de Compostela , were unaffected for unknown reasons. Some historians have assumed that the presence of resistant blood groups in the local population helped them resist infection, but the regions were touched by the second plague outbreak in 1360–1363 (the "little mortality") and later during the numerous resurgences of the plague (in 1366–1369, 1374–75, 1400, 1407 etc.). Other areas escaping the plague were isolated in mountainous regions such as the Pyrenees . All social classes were affected, but the lower classes, living together in unhealthy places, were most vulnerable. Alfonso XI of Castile and Joan of Navarre (daughter of Louis X le Hutin and Margaret of Burgundy ) were the only European monarchs to die of the plague, but Peter IV of Aragon lost his wife , his daughter and a niece in six months. Joan of England , daughter of Edward III , died in Bordeaux on her way to Castile to marry Alfonso's son Pedro . The Byzantine Emperor lost his son, while in the Kingdom of France , Bonne of Luxembourg , the wife of the future John II of France , died of the plague. Estimates of the demographic effect of the plague in Asia are based on population figures during the time and estimates of the disease's toll on population centers. The most severe outbreak of plague, in the Chinese province of Hubei in 1334, claimed up to 80% of the population. [ citation needed ] China had several epidemics and famines from 1200 to the 1350s and its population decreased from an estimated 125 million to 65 million in the late 14th century. The precise demographic effect of the disease in the Middle East is very difficult to calculate. Mortality was particularly high in rural areas, including significant areas of Gaza and Syria . Many rural people fled, leaving their fields and crops, and entire rural provinces are recorded as being totally depopulated. Surviving records in some cities reveal a devastating number of deaths. The 1348 outbreak in Gaza left an estimated 10,000 people dead, and Aleppo recorded a death rate of 500 per day during the same year. In Damascus , at the disease's peak in September and October 1348, a thousand deaths were recorded every day, with overall mortality estimated at between 25 and 38 percent. Syria had lost a total of 400,000 people when the epidemic subsided, in March 1349. In contrast to some higher mortality estimates in Asia and Europe, scholars such as John Fields of Trinity College, Dublin , believe the mortality rate in the Middle East to have been less than one third of the total population, with higher rates in selected areas.Europe suffered an especially significant death toll from the plague. Modern estimates range between roughly one third and one half of the total European population in the five-year period of 1347 to 1351 died during which the most severely-affected areas may have lost up to 80% of the population. Contemporary chronicler Jean Froissart estimated the toll to be one-third, which modern scholars consider less an accurate assessment than an allusion to the Book of Revelation meant to suggest the scope of the plague. Deaths were not evenly distributed across Europe, and some areas were affected very little, but others were all but entirely depopulated. The Black Death hit the culture of towns and cities disproportionately hard although rural areas, where most of the population lived at the time, were also significantly affected. Larger cities were the worst off, as population densities and close living quarters made disease transmission easier. Cities were also strikingly filthy, infested with lice , fleas , and rats , and subject to diseases caused by malnutrition and poor hygiene . The population of the city of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. In the cities of Hamburg and Bremen , 60–70% of the inhabitants died. In Provence , Dauphiné , and Normandy , historians observe a decrease of 60% of fiscal hearths. In some regions, two thirds of the population was annihilated. In the town of Givry , in the Bourgogne region of France, the local friar, who used to note 28–29 funerals a year, recorded 649 deaths in 1348, half of them in September. About half the population of Perpignan died over the course of several months (only two of the eight physicians survived the plague). Over 60% of Norway's population died between 1348 and 1350. London may have lost two thirds of its population during the 1348–49 outbreak; England as a whole may have lost 70% of its population, which declined from 7 million before the plague to 2 million in 1400. Some places, including the Kingdom of Poland , parts of Hungary , the Brabant region, Hainaut , and Limbourg (in modern Belgium), as well as Santiago de Compostela , were unaffected for unknown reasons. Some historians have assumed that the presence of resistant blood groups in the local population helped them resist infection, but the regions were touched by the second plague outbreak in 1360–1363 (the "little mortality") and later during the numerous resurgences of the plague (in 1366–1369, 1374–75, 1400, 1407 etc.). Other areas escaping the plague were isolated in mountainous regions such as the Pyrenees . All social classes were affected, but the lower classes, living together in unhealthy places, were most vulnerable. Alfonso XI of Castile and Joan of Navarre (daughter of Louis X le Hutin and Margaret of Burgundy ) were the only European monarchs to die of the plague, but Peter IV of Aragon lost his wife , his daughter and a niece in six months. Joan of England , daughter of Edward III , died in Bordeaux on her way to Castile to marry Alfonso's son Pedro . The Byzantine Emperor lost his son, while in the Kingdom of France , Bonne of Luxembourg , the wife of the future John II of France , died of the plague.Estimates of the demographic effect of the plague in Asia are based on population figures during the time and estimates of the disease's toll on population centers. The most severe outbreak of plague, in the Chinese province of Hubei in 1334, claimed up to 80% of the population. [ citation needed ] China had several epidemics and famines from 1200 to the 1350s and its population decreased from an estimated 125 million to 65 million in the late 14th century. The precise demographic effect of the disease in the Middle East is very difficult to calculate. Mortality was particularly high in rural areas, including significant areas of Gaza and Syria . Many rural people fled, leaving their fields and crops, and entire rural provinces are recorded as being totally depopulated. Surviving records in some cities reveal a devastating number of deaths. The 1348 outbreak in Gaza left an estimated 10,000 people dead, and Aleppo recorded a death rate of 500 per day during the same year. In Damascus , at the disease's peak in September and October 1348, a thousand deaths were recorded every day, with overall mortality estimated at between 25 and 38 percent. Syria had lost a total of 400,000 people when the epidemic subsided, in March 1349. In contrast to some higher mortality estimates in Asia and Europe, scholars such as John Fields of Trinity College, Dublin , believe the mortality rate in the Middle East to have been less than one third of the total population, with higher rates in selected areas.Because 14th-century healers were at a loss to explain the cause of the Black Death, many Europeans believed supernatural forces, earthquakes, malicious conspiracies were credible explanations for the plague's emergence. No one in the 14th century considered rat control a way to ward off the plague, and people began to believe that only God's anger could produce such horrific displays of suffering and death. Giovanni Boccaccio , an Italian writer and poet of the era, questioned whether it was sent by God for their correction, or if it came through the influence of the heavenly bodies. Christians accused Jews of poisoning public water supplies and alleged that Jews were making an effort to ruin European civilization. The spreading of those rumours led to the complete destruction of entire Jewish towns. In February 1349, 2,000 Jews were murdered in Strasbourg . In August that year, the Jewish communities of Mainz and Cologne were murdered. Where government authorities were concerned, most monarchs instituted measures that prohibited exports of foodstuffs, condemned black market speculators , set price controls on grain and outlawed large-scale fishing . At best, those proved mostly unenforceable; at worst, they contributed to a continental downward spiral. The hardest-hit lands, like England, were unable to buy grain abroad from France because of the prohibition and from most of the rest of the grain producers because of crop failures from shortage of labour. Any grain that could be shipped was eventually taken by pirates or looters to be sold on the black market. Meanwhile, many of the largest countries, most notably England and Scotland, had been at war, used up much of their treasury which exacerbated inflation . In 1337, on the eve of the first wave of the Black Death, England and France went to war in what would become known as the Hundred Years' War . Malnutrition, poverty, disease and hunger, coupled with war, growing inflation and other economic concerns, made Europe in the mid-14th century ripe for tragedy. The historian Walter Scheidel contends that waves of plague following the initial outbreak of the Black Death had a levelling effect, which changed the ratio of land to labour by reducing the value of the former and boosting that of the latter, which lowered economic inequality by making landowners and employers less well-off and improved the lot of the workers: "the observed improvement in living standards of the laboring population was rooted in the suffering and premature death of tens of millions over the course of several generations". The levelling effect was reversed by a "demographic recovery that resulted in renewed population pressure ". On the other hand, in the quarter-century after the Black Death, many labourers, artisans, and craftsmen, those living from money-wages alone, suffer a reduction in real incomes in England from rampant inflation. In 1357, a third of property in London was unused because of a severe outbreak in 1348–49. However, for reasons still debated, population levels declined after the Black Death's first outbreak until around 1420 and did not begin to rise again until 1470 and so the initial Black Death event on its own does not entirely provide a satisfactory explanation to that extended period of decline in prosperity. See medieval demography for a more complete treatment of this issue and current theories on why improvements in living standards took longer to evolve. The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse. The great population loss brought favorable results to the surviving peasants in England and the rest of Western Europe . There was increased social mobility, as depopulation further eroded the peasants' already-weakened obligations to remain on their traditional holdings. Seigneurialism never recovered. Land was plentiful, wages high, and serfdom had all but disappeared. It was possible to move about and rise higher in life. Younger sons and women especially benefited. As population growth resumed, however, peasants again faced deprivation and famine. In Eastern Europe , by contrast, renewed stringency of laws tied the remaining peasantry more tightly to the land than ever before through serfdom . Furthermore, the plague's great population reduction brought cheaper land prices; more food for the average peasant; and a relatively large increase in per capita income among the peasantry, if not immediately, in the coming century. Since the plague left vast areas of farmland untended, they were made available for pasture and put more meat on the market. The consumption of meat and dairy products went up, as did the export of beef and butter from the Low Countries, Scandinavia and northern Germany. However, the upper class often attempted to stop the changes, initially in Western Europe and more forcefully and successfully in Eastern Europe, by instituting sumptuary laws . They regulated what people (particularly of the peasant class) could wear so that nobles could ensure that peasants did not begin to dress and act as a higher-class member with their increased wealth. Another tactic was to fix prices and wages so that peasants could not demand more with increasing value. In England, the Statute of Labourers 1351 was enforced, which stated that no peasant could ask for more wages than in 1346. That was met with varying success depending on the amount of rebellion it inspired. Such a law was one of the causes of the 1381 Peasants' Revolt in England . The rapid development of the use was probably one of the consequences of the Black Death during which many landowning nobles died and left their realty to their widows and minor orphans. [ citation needed ] In the wake of the drastic population decline brought on by the plague, wages shot up, and labourers could move to new localities in response to wage offers. Local and royal authorities in Western Europe instituted wage controls. The government controls sought to freeze wages at the old levels before the Black Death. Within England, for example, the Ordinance of Labourers , enacted in 1349, and the Statute of Labourers, enacted in 1351, restricted both wage increases and the relocation of workers. If workers attempted to leave their current post, employers were given the right to have them imprisoned. The statute was poorly enforced in most areas, and farm wages in England on average doubled between 1350 and 1450, but they were then static until the late 19th century. Cohn, comparing numerous countries, argues that the laws were not designed primarily to freeze wages. Instead, he says that the energetic local and royal measures to control labour and artisans' prices were responses to elite fears of the greed and the possible new powers of the lesser classes that had gained new freedom. Cohn continues that the laws reflected the anxiety that followed the Black Death's new horrors of mass mortality and destruction and from elite anxiety about manifestations, such as the flagellant movement and the persecution of Jews, Catalans (in Sicily) and beggars. The Black Death encouraged innovation of labour-saving technologies, leading to higher productivity. There was also a shift from grain farming to animal husbandry. Grain farming was very labor-intensive, but animal husbandry needed only a shepherd and a few dogs and pastureland. By 1200, virtually all of the Mediterranean basin and most of northern Germany had been deforested and cultivated. Indigenous flora and fauna were replaced by domestic grasses and animals, and domestic woodlands were lost. With depopulation, the process was reversed. Much of the primeval vegetation returned, and abandoned fields and pastures were reforested. Plague brought an eventual end of serfdom in Western Europe. The manorial system was already in trouble, but the Black Death assured its demise throughout much of Western and Central Europe by 1500. Severe depopulation and migration of the village to cities caused an acute shortage of agricultural labourers. Many villages were abandoned. In England, more than 1300 villages were deserted between 1350 and 1500. Wages of labourers were high, but the rise in nominal wages after the Black Death was swamped by inflation and so real wages fell. Labour was in such a short supply that landlords were forced to give better terms of tenure. That resulted in much lower rents in Western Europe. By 1500, a new form of tenure called copyhold became prevalent in Europe. In copyhold, both a landlord and peasant made their best business deal, whereby the peasant got use of the land and the landlord got a fixed annual payment, and both possessed a copy of the tenure agreement. Serfdom did not end everywhere and lingered in parts of Western Europe and was introduced to Eastern Europe only after the Black Death. There was also a change in inheritance law. Before the plague, only sons, especially the eldest son, inherited the ancestral property. After the Plague, all sons and daughters started to inherit property. Renewed religious fervor and fanaticism came in the wake of the Black Death. Some Europeans targeted "groups such as Jews, friars, foreigners, beggars, pilgrims" lepers and Romani , who were thought to have caused the crisis. Differences in cultural and lifestyle practices also led to persecution. As the plague swept across Europe in the mid-14th century, annihilating more than half the population, Jews became scapegoats ,partly because better hygiene among Jewish communities and their isolation in ghettos meant that Jews were less affected. Accusations spread that Jews had caused the disease by deliberately poisoning wells . Mobs attacked Jewish settlements across Europe; by 1351, 60 major and 150 smaller Jewish communities had been destroyed, and more than 350 separate massacres had occurred. According to Joseph P. Byrne, women also faced persecution during the Black Death. Muslim women in Cairo became scapegoats when the plague struck. Byrne writes that in 1438, the sultan of Cairo was informed by his religious lawyers, that the arrival of the plague was "Allah's punishment for the sin of fornication " and that in accordance with that theory, a law was set in place stating that women were not allowed to make public appearances, as "they may tempt men into sin". Byrne describes that law as being lifted only when "the wealthy complained that their female servants could not shop for food". The Black Death hit the monasteries very hard because of their proximity with the sick who sought refuge there. That left a severe shortage of clergy after the epidemic cycle. Eventually, the losses were replaced by hasty and inexperienced clergy members, many of whom knew little of the rigours of their predecessors. New colleges were opened at established universities, and the training process was sped up. The shortage of priests opened new opportunities for laywomen to assume more extensive and more important service roles in the local parish. Flagellants practiced self-flogging (whipping of oneself) to atone for sins. The movement became popular after the Black Death. It may be that the flagellants' later involvement in hedonism was an effort to accelerate, to absorb God's wrath and to shorten the time with which others suffered. More likely, the focus of attention and popularity of their cause contributed to a sense that the world itself was ending and that their individual actions were of no consequence. Reformers rarely pointed to failures on the part of the Church in dealing with the catastrophe. The great population loss brought favorable results to the surviving peasants in England and the rest of Western Europe . There was increased social mobility, as depopulation further eroded the peasants' already-weakened obligations to remain on their traditional holdings. Seigneurialism never recovered. Land was plentiful, wages high, and serfdom had all but disappeared. It was possible to move about and rise higher in life. Younger sons and women especially benefited. As population growth resumed, however, peasants again faced deprivation and famine. In Eastern Europe , by contrast, renewed stringency of laws tied the remaining peasantry more tightly to the land than ever before through serfdom . Furthermore, the plague's great population reduction brought cheaper land prices; more food for the average peasant; and a relatively large increase in per capita income among the peasantry, if not immediately, in the coming century. Since the plague left vast areas of farmland untended, they were made available for pasture and put more meat on the market. The consumption of meat and dairy products went up, as did the export of beef and butter from the Low Countries, Scandinavia and northern Germany. However, the upper class often attempted to stop the changes, initially in Western Europe and more forcefully and successfully in Eastern Europe, by instituting sumptuary laws . They regulated what people (particularly of the peasant class) could wear so that nobles could ensure that peasants did not begin to dress and act as a higher-class member with their increased wealth. Another tactic was to fix prices and wages so that peasants could not demand more with increasing value. In England, the Statute of Labourers 1351 was enforced, which stated that no peasant could ask for more wages than in 1346. That was met with varying success depending on the amount of rebellion it inspired. Such a law was one of the causes of the 1381 Peasants' Revolt in England . The rapid development of the use was probably one of the consequences of the Black Death during which many landowning nobles died and left their realty to their widows and minor orphans. [ citation needed ]In the wake of the drastic population decline brought on by the plague, wages shot up, and labourers could move to new localities in response to wage offers. Local and royal authorities in Western Europe instituted wage controls. The government controls sought to freeze wages at the old levels before the Black Death. Within England, for example, the Ordinance of Labourers , enacted in 1349, and the Statute of Labourers, enacted in 1351, restricted both wage increases and the relocation of workers. If workers attempted to leave their current post, employers were given the right to have them imprisoned. The statute was poorly enforced in most areas, and farm wages in England on average doubled between 1350 and 1450, but they were then static until the late 19th century. Cohn, comparing numerous countries, argues that the laws were not designed primarily to freeze wages. Instead, he says that the energetic local and royal measures to control labour and artisans' prices were responses to elite fears of the greed and the possible new powers of the lesser classes that had gained new freedom. Cohn continues that the laws reflected the anxiety that followed the Black Death's new horrors of mass mortality and destruction and from elite anxiety about manifestations, such as the flagellant movement and the persecution of Jews, Catalans (in Sicily) and beggars. The Black Death encouraged innovation of labour-saving technologies, leading to higher productivity. There was also a shift from grain farming to animal husbandry. Grain farming was very labor-intensive, but animal husbandry needed only a shepherd and a few dogs and pastureland. By 1200, virtually all of the Mediterranean basin and most of northern Germany had been deforested and cultivated. Indigenous flora and fauna were replaced by domestic grasses and animals, and domestic woodlands were lost. With depopulation, the process was reversed. Much of the primeval vegetation returned, and abandoned fields and pastures were reforested. Plague brought an eventual end of serfdom in Western Europe. The manorial system was already in trouble, but the Black Death assured its demise throughout much of Western and Central Europe by 1500. Severe depopulation and migration of the village to cities caused an acute shortage of agricultural labourers. Many villages were abandoned. In England, more than 1300 villages were deserted between 1350 and 1500. Wages of labourers were high, but the rise in nominal wages after the Black Death was swamped by inflation and so real wages fell. Labour was in such a short supply that landlords were forced to give better terms of tenure. That resulted in much lower rents in Western Europe. By 1500, a new form of tenure called copyhold became prevalent in Europe. In copyhold, both a landlord and peasant made their best business deal, whereby the peasant got use of the land and the landlord got a fixed annual payment, and both possessed a copy of the tenure agreement. Serfdom did not end everywhere and lingered in parts of Western Europe and was introduced to Eastern Europe only after the Black Death. There was also a change in inheritance law. Before the plague, only sons, especially the eldest son, inherited the ancestral property. After the Plague, all sons and daughters started to inherit property. Renewed religious fervor and fanaticism came in the wake of the Black Death. Some Europeans targeted "groups such as Jews, friars, foreigners, beggars, pilgrims" lepers and Romani , who were thought to have caused the crisis. Differences in cultural and lifestyle practices also led to persecution. As the plague swept across Europe in the mid-14th century, annihilating more than half the population, Jews became scapegoats ,partly because better hygiene among Jewish communities and their isolation in ghettos meant that Jews were less affected. Accusations spread that Jews had caused the disease by deliberately poisoning wells . Mobs attacked Jewish settlements across Europe; by 1351, 60 major and 150 smaller Jewish communities had been destroyed, and more than 350 separate massacres had occurred. According to Joseph P. Byrne, women also faced persecution during the Black Death. Muslim women in Cairo became scapegoats when the plague struck. Byrne writes that in 1438, the sultan of Cairo was informed by his religious lawyers, that the arrival of the plague was "Allah's punishment for the sin of fornication " and that in accordance with that theory, a law was set in place stating that women were not allowed to make public appearances, as "they may tempt men into sin". Byrne describes that law as being lifted only when "the wealthy complained that their female servants could not shop for food". The Black Death hit the monasteries very hard because of their proximity with the sick who sought refuge there. That left a severe shortage of clergy after the epidemic cycle. Eventually, the losses were replaced by hasty and inexperienced clergy members, many of whom knew little of the rigours of their predecessors. New colleges were opened at established universities, and the training process was sped up. The shortage of priests opened new opportunities for laywomen to assume more extensive and more important service roles in the local parish. Flagellants practiced self-flogging (whipping of oneself) to atone for sins. The movement became popular after the Black Death. It may be that the flagellants' later involvement in hedonism was an effort to accelerate, to absorb God's wrath and to shorten the time with which others suffered. More likely, the focus of attention and popularity of their cause contributed to a sense that the world itself was ending and that their individual actions were of no consequence. Reformers rarely pointed to failures on the part of the Church in dealing with the catastrophe. The Black Death had profound effects on art and literature. After 1350, European culture in general turned very morbid. The general mood was one of pessimism, and contemporary art turned dark with representations of death. The widespread image of the "dance of death" showed death (a skeleton) choosing victims at random. The skeletons in the dance of death or danse macabre paintings often are of different social classes dancing together, representing how no amount of wealth can save one from death. The painting motif was first found as fresco on a wall in a Paris cemetery and emphasizes how the living will someday join the dead. Many of the most graphic depictions come from writers such as Boccaccio and Petrarch . Peire Lunel de Montech , writing about 1348 in the lyric style long out of fashion, composed the following sorrowful sirventes "Meravilhar no·s devo pas las gens" during the height of the plague in Toulouse : They died by the hundreds, both day and night, and all were thrown in... ditches and covered with earth. And as soon as those ditches were filled, more were dug. And I, Agnolo di Tura ... buried my five children with my own hands.... And so many died that all believed it was the end of the world. Boccaccio wrote: How many valiant men, how many fair ladies, breakfast with their kinfolk and the same night supped with their ancestors in the next world! The condition of the people was pitiable to behold. They sickened by the thousands daily, and died unattended and without help. Many died in the open street, others dying in their houses, made it known by the stench of their rotting bodies. Consecrated churchyards did not suffice for the burial of the vast multitude of bodies, which were heaped by the hundreds in vast trenches, like goods in a ship's hold and covered with a little earth. Another common painting motif that originated from the Black Death was called "three living meet the three dead", which depicts three living people encountering three corpses, reminding the living of their inevitable fate. Although the Black Death highlighted the shortcomings of medical science in the Middle Ages, it also led to positive changes in the field of medicine. As described by David Herlihy in The Black Death and the Transformation of the West , more emphasis was placed on "anatomical investigations" after the Black Death. The way that individuals studied the human body notably changed and became a process that dealt more directly with the human body in varied states of sickness and health. Furthermore, the importance of surgeons became more evident. A theory put forth by Stephen O'Brien is that the Black Death is likely responsible by natural selection for the high frequency of the CCR5-Δ32 genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV , smallpox and possibly plague, but for the last, no explanation exists on how it would do that. However, that is now challenged since the CCR5-Δ32 gene has been found to be just as common in Bronze Age tissue samples. The Black Death also inspired European architecture to move in two different directions: (1) a revival of Greco-Roman styles, and (2) a further elaboration of the Gothic style . Late medieval churches had impressive structures centred on verticality in which one's eye is drawn up towards the high ceiling. The basic Gothic style was revamped with elaborate decoration in the late medieval period. Sculptors in Italian city-states emulated the work of their Roman forefathers, and sculptors in Northern Europe, no doubt inspired by the devastation they had witnessed, gave way to a heightened expression of emotion and an emphasis on individual differences. A tough realism came forth in architecture as in literature. Images of intense sorrow, decaying corpses and individuals with faults as well as virtues emerged. North of the Alps, painting reached a pinnacle of precise realism with Early Dutch painting by artists such as Jan van Eyck ( c. 1390 – 1441). The natural world was reproduced in those works with meticulous detail whose realism was not unlike photography. Boccaccio wrote: How many valiant men, how many fair ladies, breakfast with their kinfolk and the same night supped with their ancestors in the next world! The condition of the people was pitiable to behold. They sickened by the thousands daily, and died unattended and without help. Many died in the open street, others dying in their houses, made it known by the stench of their rotting bodies. Consecrated churchyards did not suffice for the burial of the vast multitude of bodies, which were heaped by the hundreds in vast trenches, like goods in a ship's hold and covered with a little earth. Another common painting motif that originated from the Black Death was called "three living meet the three dead", which depicts three living people encountering three corpses, reminding the living of their inevitable fate. Although the Black Death highlighted the shortcomings of medical science in the Middle Ages, it also led to positive changes in the field of medicine. As described by David Herlihy in The Black Death and the Transformation of the West , more emphasis was placed on "anatomical investigations" after the Black Death. The way that individuals studied the human body notably changed and became a process that dealt more directly with the human body in varied states of sickness and health. Furthermore, the importance of surgeons became more evident. A theory put forth by Stephen O'Brien is that the Black Death is likely responsible by natural selection for the high frequency of the CCR5-Δ32 genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV , smallpox and possibly plague, but for the last, no explanation exists on how it would do that. However, that is now challenged since the CCR5-Δ32 gene has been found to be just as common in Bronze Age tissue samples. The Black Death also inspired European architecture to move in two different directions: (1) a revival of Greco-Roman styles, and (2) a further elaboration of the Gothic style . Late medieval churches had impressive structures centred on verticality in which one's eye is drawn up towards the high ceiling. The basic Gothic style was revamped with elaborate decoration in the late medieval period. Sculptors in Italian city-states emulated the work of their Roman forefathers, and sculptors in Northern Europe, no doubt inspired by the devastation they had witnessed, gave way to a heightened expression of emotion and an emphasis on individual differences. A tough realism came forth in architecture as in literature. Images of intense sorrow, decaying corpses and individuals with faults as well as virtues emerged. North of the Alps, painting reached a pinnacle of precise realism with Early Dutch painting by artists such as Jan van Eyck ( c. 1390 – 1441). The natural world was reproduced in those works with meticulous detail whose realism was not unlike photography.

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Bubonic plague

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Plagues and Peoples

Plagues and Peoples is a book on epidemiological history by historian William H. McNeill published by Anchor Books in 1976. It was a critical and popular success, offering a radical new interpretation of the extraordinary impact of infectious disease on cultures as a means of enemy attack. The book ranges from examining the effects of smallpox in Mexico , the bubonic plague in China, to the typhoid epidemic in Europe. With the onset of the AIDS epidemic in the early 1980s, a new preface was added to the book.

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Bubonic plague

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Derby plague of 1665

During the Great Plague of 1665 the area of Derby , England , fell victim to the bubonic plague epidemic , with many deaths. Some areas of Derby still carry names that record the 1665 visitation such as Blagreaves Lane which was Black Graves Lane, while Dead Man's Lane speaks for itself. It has been claimed by some historians [ citation needed ] that bodies were buried standing upright at St. Peter's Church, Derby, but this legend has been refuted by experts. [ citation needed ] Trade was carried out at a Market Stone on Ashbourne Road which leads into the Town Centre. [ citation needed ] During the epidemic, trade almost ceased and the population faced possible starvation, as well as a cruel death by infection with the plague. [ citation needed ] Market stones took many forms, here we see the stone placed at Friar Gate (formerly Nuns Green) at the northern road into Derby (England). This was a medieval headless cross , and also called the "Vinegar Stone" because money was deposited in a trough of vinegar in the top of the stone in the belief that the vinegar would disinfect the coins and prevent the spread of the plague from happening. [ citation needed ] Eyam Museum in the village of Eyam in the Peak District , Derbyshire , has a special emphasis on the Plague as it struck Eyam.

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Bubonic plague

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Great Plague of Vienna

The Great Plague of Vienna occurred in 1679 in Vienna , Austria , the imperial residence of the Austrian Habsburg rulers. From contemporary descriptions, the disease is believed to have been bubonic plague , which is caused by the bacterium Yersinia pestis , carried by fleas associated with the black rat and other rodents. The city was crippled by the epidemic, which recurred fitfully into the early 1680s, claiming an estimated 76,000 residents. Vienna, located on the River Danube , was a major trading crossroads between east and west. As a result of this traffic, the city had suffered from episodic plague outbreaks since the first wave of " Black Death " in the fourteenth century. The city was crowded and densely built. Descriptions indicate that there were no public sewers or drainage systems, with stinking mounds of domestic garbage littering the streets. In addition, warehouses for trade goods, which held items such as clothing, carpets, and grain for months at a time, were heavily infested with rats. Conditions in the city were considered so unhealthy and filthy, even for the time, that the plague often carried the title "Viennese death" in other parts of Europe. A religious order operating in Vienna, the Brotherhood of the Holy Trinity , created special hospitals for both children and adults during the 1679 epidemic. The basic nursing care offered in the hospitals was simple, but was generally a vast improvement over other medical and public health measures in the city. Doctors treated patients by using emetics , bloodletting , and by applying noxious ointments. The corpses of plague victims were carted to the outer edges of the city and placed in large open pits for burning. However, the pits were exposed to the open air for several days until they were nearly full, allowing ongoing infection of the rat population. To commemorate the city's deliverance from the Great Plague and later waves of the disease, the Viennese erected monuments such as the famous Baroque Karlskirche with the associated 69 foot plague columns known as the Pestsäule .What has become known as the "Great Plague of Vienna", was actually only a subset of a much larger outbreak across Germany, Austria, Bohemia , and neighboring regions. This epidemic appears to have been carried into the region from two opposing directions. It had been raging in Western Europe for many years, traveling East by trade routes . The Great Plague of London of 1665–1666, which is believed to have originated from the Netherlands in the 1650s, killed around 100,000 people, and was the first major epidemic in a series of outbreaks. In 1666 a severe plague raged in Cologne and on the Rhine , which was prolonged until 1670 in the district. In the Netherlands, there was a plague in 1667–1669, but there are no definite notices of it after 1672. France saw its last plague epidemic in 1668. In the years 1675–1684 a new plague wave originated in the Ottoman Empire ( Turkey and areas of the Balkans ). It moved into North Africa , Bohemia , Poland , Hungary , Austria and Saxony , progressing generally northward. The island of Malta lost 11,000 people in an epidemic in 1675–76 . The plague of Vienna in 1679 was very severe, causing at least 76,000 deaths. Other urban centers in this area of Europe had similar levels of casualties. For instance, Prague in 1681 lost 83,000 due to plague. Dresden was affected in 1680, Magdeburg and Halle in 1682. In Halle, a mortality of 4,397 out of a population of about 10,000 was recorded. Many North German city populations fell in these years. By 1683, the plague disappeared from Germany until the epidemic of 1707. The great plague of 1679 gave rise to the legend of Lieber Augustin ("Dear Augustin"). Augustin was a popular street musician , who, according to the legend, fell into a pit with bodies of plague victims, late at night when he was drunk. Augustin did not contract the disease, which may have been owed to the influence of the alcohol. [ citation needed ] Augustin is remembered in the popular folk song Oh du lieber Augustin . [ citation needed ]

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Bubonic plague

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Rat flea

A rat flea is a parasite of rats . There are at least four species :

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Bubonic plague

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Wildlife trade and zoonoses

Wildlife trafficking practices have resulted in the emergence of zoonotic diseases . Exotic wildlife trafficking is a multi-billion dollar industry that involves the removal and shipment of mammals, reptiles, amphibians, invertebrates, and fish all over the world. Traded wild animals are used for bushmeat consumption, unconventional exotic pets , animal skin clothing accessories, home trophy decorations, privately owned zoos, and for traditional medicine practices. Dating back centuries, people from Africa, Asia, Latin America, the Middle East, and Europe have used animal bones, horns, or organs for their believed healing effects on the human body. Wild tigers , rhinos , elephants , pangolins , and certain reptile species are acquired through legal and illegal trade operations in order to continue these historic cultural healing practices. Within the last decade nearly 975 different wild animal taxa groups have been legally and illegally exported out of Africa and imported into areas like China, Japan, Indonesia, the United States, Russia, Europe, and South America. Consuming or owning exotic animals can propose unexpected and dangerous health risks. A number of animals, wild or domesticated, carry infectious diseases and approximately 75% of wildlife diseases are vector -borne viral zoonotic diseases. Zoonotic diseases are complex infections residing in animals and can be transmitted to humans. The emergence of zoonotic diseases usually occurs in three stages. Initially the disease is spread through a series of spillover events between domesticated and wildlife populations living in close quarters. Diseases then spread through series of direct contact methods, indirect contact methods, contaminated foods, or vector-borne transmissions. After one of these transmission methods occurs, the disease then rises exponentially in human populations living in close proximities. After the appearance of the COVID-19 pandemic , whose origins have been linked to the Huanan Seafood Wholesale Market in Wuhan , China, Elizabeth Maruma Mrema , the acting executive secretary of the UN Convention on Biological Diversity , called for a global ban on wildlife markets to prevent future pandemics. Others have also called for a total ban on the global wildlife trade or for already existing bans to be enforced, in order both to reduce cruelty to animals as well as to reduce health risks to humans, or to implement other disease control intervention measures in lieu of total bans. Direct contact transmissions occur when humans encounter first hand contaminated feces, urine, water sources, or bodily fluids. Bodily fluid transmission may happen either from ingesting pathogens or through open wound contact. Indirect contact transmissions occur when humans interact within an infected species' habitat. Humans are often exposed to contaminated soils, plants, and surfaces where bacterial germs are present. Contaminated food transmissions occur when humans eat infected bushmeat, vegetables, fruits, or drink contaminated water. Often these food and water supplies are tainted by fecal pellets of infected bats, birds, or monkeys. Vector-borne transmissions occur when individuals are bitten by infected parasites such as ticks or insects like mosquitos and fleas . Other factors for escalated disease transmissions include climate change , globalization of trade, accelerated logging practices, irrigation increases, sexual activity between individuals, blood transfusions , and urbanization developments near infected ecosystems. Exotic wildlife trafficking admits a number of infectious diseases that spell potential life-threatening results for human populations if contracted. Researchers believe eliminating the transmission of infectious diseases is not plausible. Instead, creating health screening services is critical for minimizing transmission rates among populations and infected wildlife species involved in trafficking. [ citation needed ] Annually, 15.8% of human deaths have been associated with dangerous infectious disease outbreaks linked to exotic trafficking. Researchers, zoologists, and environmentalists determine that financially poor countries in Africa may attribute to nearly 44% of these deaths due to zoonosis related diseases. People in Africa are exposed to an increased risk of contracting and dispatching life-threatening zoonotic infections. The continent is considered a hot spot for emerging disease transmissions for reasons like socio-culture livelihood interests, livestock farming, land use methods, globalization influences, and consumption behavior practices. Many Africans make a living from the wildlife trade due to the high market demand for exotic animals. These individuals partaking in poaching activities are able to produce an income by selling to vendors all around the world. However, hunters are highly susceptible to encountering infected droplets, water sources, soils, carcasses, and viral airborne pathogens while traveling through the bush. Once they have successfully hunted and killed the wild animal, they run the risk of blood or bodily fluid transfer from close contact with possible infected species. They're also at an increased risk of harvesting arthropod-borne pathogens carried in ticks . Often ticks can be found on the wild animal or in its surrounding wildlife habitat. A study conducted in Tanzania revealed major gaps in locals knowledge of zoonotic diseases. Individuals in these pastoral communities acknowledged health symptoms commonly found in both humans and animals, however they did not have a synthesized term for zoonosis and believed pathogens were not life-threatening. Researchers found that the pastoral communities were more concerned with keeping cultural practices of producing cooked meals rather than the potential infections harvested from the animals. The urbanization of new environments in Africa increases the migration patterns of humans. New settlements and tourist attractions near these wildlife habitats bring vulnerable individuals with no disease immunity closer to areas of diseases. The greatest possibility of contracting deadly zoonotic diseases occurs during the bushmeat cooking process. Cooking exotic bushmeat requires sharp knives, steady handwork, and skilled techniques when correctly butchering an animal. Consumers often purchase bushmeat directly from African poachers. This means they have no way of knowing whether the wild animal is carrying dangerous zoonotic pathogens. On average people cut themselves 38% of the time when butchering bushmeat, allowing for infected bodily fluid transmissions . African women are more likely to contract these dangerous zoonotic pathogens because they are the ones handling and cooking the bushmeat. Many Africans make a living from the wildlife trade due to the high market demand for exotic animals. These individuals partaking in poaching activities are able to produce an income by selling to vendors all around the world. However, hunters are highly susceptible to encountering infected droplets, water sources, soils, carcasses, and viral airborne pathogens while traveling through the bush. Once they have successfully hunted and killed the wild animal, they run the risk of blood or bodily fluid transfer from close contact with possible infected species. They're also at an increased risk of harvesting arthropod-borne pathogens carried in ticks . Often ticks can be found on the wild animal or in its surrounding wildlife habitat. A study conducted in Tanzania revealed major gaps in locals knowledge of zoonotic diseases. Individuals in these pastoral communities acknowledged health symptoms commonly found in both humans and animals, however they did not have a synthesized term for zoonosis and believed pathogens were not life-threatening. Researchers found that the pastoral communities were more concerned with keeping cultural practices of producing cooked meals rather than the potential infections harvested from the animals. The urbanization of new environments in Africa increases the migration patterns of humans. New settlements and tourist attractions near these wildlife habitats bring vulnerable individuals with no disease immunity closer to areas of diseases. The greatest possibility of contracting deadly zoonotic diseases occurs during the bushmeat cooking process. Cooking exotic bushmeat requires sharp knives, steady handwork, and skilled techniques when correctly butchering an animal. Consumers often purchase bushmeat directly from African poachers. This means they have no way of knowing whether the wild animal is carrying dangerous zoonotic pathogens. On average people cut themselves 38% of the time when butchering bushmeat, allowing for infected bodily fluid transmissions . African women are more likely to contract these dangerous zoonotic pathogens because they are the ones handling and cooking the bushmeat. If sanitation standards are not maintained, live animal markets can transmit zoonoses. Because of the openness, newly introduced animals may come in direct contact with sales clerks, butchers, and customers or to other animals which they would never interact with in the wild. This may allow for some animals to act as intermediate hosts , helping a disease spread to humans. Due to unhygienic sanitation standards and the connection to the spread of zoonoses and pandemics , critics have grouped live animal markets together with factory farming as major health hazards in China and across the world. In March and April 2020, some reports have said that wildlife markets in Asia, Africa, and in general all over the world are prone to health risks. H5N1 avian flu outbreaks can be traced to live animal markets where the potential for zoonotic transmission is greatly increased. The exact origin of the COVID-19 pandemic is yet to be confirmed as of February 2021 and was originally linked to the Huanan Seafood Wholesale Market in Wuhan , China due to reports that two-thirds of the initial cases had direct exposure to the Huanan Seafood Wholesale Market in Wuhan. although a 2021 WHO investigation concluded that the Huanan market was unlikely to be the origin due to the existence of earlier cases. The Huanan market sold "live wolf pups, salamanders , civets , and bamboo rats " amongst other species. Alternate theories and misinformation emerged in January that the viruses were instead artificially created in a laboratory, but these claims were largely rejected by scientists and news outlets as unfounded rumours and conspiracy theories. In April 2020, United States intelligence officials launched examinations into unverified reports that the virus may have originated from accidental exposure of scientists studying coronaviruses in bats at the BSL-4 -capable Wuhan Institute of Virology rather than a wildlife market. On 3 May 2020, United States Secretary of State Mike Pompeo claimed that there is "enormous evidence" that the coronavirus outbreak originated in a Chinese laboratory. However, Pompeo later distanced himself from the claim, while virologists have stated that available data overwhelmingly suggest that there was no chance of scientific misconduct or negligence such that the virus emerged from a lab. In May 2020, George Gao , the director of the Chinese Center for Disease Control and Prevention , said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event , but it was not the site of the initial outbreak. The results of a WHO investigation yielded similar results, confirming what most scientists expected, that the location of the first contact with the virus was still unknown but unlikely to be the Huanan market due to the existence of earlier cases. During the first few months of the COVID-19 pandemic in 2020, Chinese wet markets were heavily criticized in media outlets as a potential source for the virus. Media reports urging for permanent blanket bans on all wet markets, as opposed to solely live animal markets or wildlife markets, have been criticized for undermining infection control needs to be specific about wildlife markets, such as the Huanan Seafood Wholesale Market. Media focus on foreign wet markets has also been blamed for distracting public attention from public health threats, such as local sources of zoonotic diseases. In Western media , wet markets have been portrayed during the COVID-19 pandemic without distinguishing between general wet markets, live animal wet markets, and wildlife markets, using montages of explicit images from different markets across Asia without identifying locations. Fairness & Accuracy in Reporting criticized several news articles from mainstream media outlets during the first half of 2020 as "ignorant or worse", pointing to sensationalist coverage utilizing graphic images for shock value . These depictions have been criticized as exaggerated and Orientalist , and have been blamed for fueling Sinophobia and "Chinese otherness". Monkeypox is a viral zoonotic double stranded DNA disease that occurs in both humans and animals. It often accumulates in wild animals and is transmitted by close contact within animal trade. It is most commonly found in central and west Africa where it is carried in a number of infected species including monkeys , apes , rats , prairie dogs , and other small rodents . In an attempt to reduce the rate of disease spread, researchers believe minimizing direct and indirect contact rates between species in wildlife trade markets is the most practical solution. Severe acute respiratory syndrome (SARS), often referred to as a severe form of pneumonia , is a highly contagious zoonotic respiratory illness causing extreme breathing difficulties. Factors attributing to widespread dispersal include the destruction of wildlife natural ecosystems, overextended urbanization effects on biodiversity , and contact with bacterially contaminated objects. The 2002–2004 SARS outbreak can be traced to live animal markets where the potential for zoonotic transmission is greatly increased. In a 2007 study, Chinese scientists identified the presence of SARS-CoV-like viruses in horseshoe bats combined with unsanitary wildlife markets and the culture of eating exotic mammals in southern China as a "time-bomb". In April 2020, scientist Peter Daszak described a Chinese wildlife market as follows: "it is a bit of shock to go to a wildlife market and see this huge diversity of animals live in cages on top of each other with a pile of guts that have been pulled out of an animal and thrown on the floor [...] These are perfect places for viruses to spread." Chinese environmentalists, researchers and state media have called for stricter regulation of exotic animal trade in the markets. Medical experts Zhong Nanshan , Guan Yi and Yuen Kwok-yung have also called for the closure of wildlife markets since 2010. H5N1 avian flu outbreaks can be traced to live animal markets where the potential for zoonotic transmission is greatly increased. The exact origin of the COVID-19 pandemic is yet to be confirmed as of February 2021 and was originally linked to the Huanan Seafood Wholesale Market in Wuhan , China due to reports that two-thirds of the initial cases had direct exposure to the Huanan Seafood Wholesale Market in Wuhan. although a 2021 WHO investigation concluded that the Huanan market was unlikely to be the origin due to the existence of earlier cases. The Huanan market sold "live wolf pups, salamanders , civets , and bamboo rats " amongst other species. Alternate theories and misinformation emerged in January that the viruses were instead artificially created in a laboratory, but these claims were largely rejected by scientists and news outlets as unfounded rumours and conspiracy theories. In April 2020, United States intelligence officials launched examinations into unverified reports that the virus may have originated from accidental exposure of scientists studying coronaviruses in bats at the BSL-4 -capable Wuhan Institute of Virology rather than a wildlife market. On 3 May 2020, United States Secretary of State Mike Pompeo claimed that there is "enormous evidence" that the coronavirus outbreak originated in a Chinese laboratory. However, Pompeo later distanced himself from the claim, while virologists have stated that available data overwhelmingly suggest that there was no chance of scientific misconduct or negligence such that the virus emerged from a lab. In May 2020, George Gao , the director of the Chinese Center for Disease Control and Prevention , said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event , but it was not the site of the initial outbreak. The results of a WHO investigation yielded similar results, confirming what most scientists expected, that the location of the first contact with the virus was still unknown but unlikely to be the Huanan market due to the existence of earlier cases. During the first few months of the COVID-19 pandemic in 2020, Chinese wet markets were heavily criticized in media outlets as a potential source for the virus. Media reports urging for permanent blanket bans on all wet markets, as opposed to solely live animal markets or wildlife markets, have been criticized for undermining infection control needs to be specific about wildlife markets, such as the Huanan Seafood Wholesale Market. Media focus on foreign wet markets has also been blamed for distracting public attention from public health threats, such as local sources of zoonotic diseases. In Western media , wet markets have been portrayed during the COVID-19 pandemic without distinguishing between general wet markets, live animal wet markets, and wildlife markets, using montages of explicit images from different markets across Asia without identifying locations. Fairness & Accuracy in Reporting criticized several news articles from mainstream media outlets during the first half of 2020 as "ignorant or worse", pointing to sensationalist coverage utilizing graphic images for shock value . These depictions have been criticized as exaggerated and Orientalist , and have been blamed for fueling Sinophobia and "Chinese otherness". During the first few months of the COVID-19 pandemic in 2020, Chinese wet markets were heavily criticized in media outlets as a potential source for the virus. Media reports urging for permanent blanket bans on all wet markets, as opposed to solely live animal markets or wildlife markets, have been criticized for undermining infection control needs to be specific about wildlife markets, such as the Huanan Seafood Wholesale Market. Media focus on foreign wet markets has also been blamed for distracting public attention from public health threats, such as local sources of zoonotic diseases. In Western media , wet markets have been portrayed during the COVID-19 pandemic without distinguishing between general wet markets, live animal wet markets, and wildlife markets, using montages of explicit images from different markets across Asia without identifying locations. Fairness & Accuracy in Reporting criticized several news articles from mainstream media outlets during the first half of 2020 as "ignorant or worse", pointing to sensationalist coverage utilizing graphic images for shock value . These depictions have been criticized as exaggerated and Orientalist , and have been blamed for fueling Sinophobia and "Chinese otherness". Monkeypox is a viral zoonotic double stranded DNA disease that occurs in both humans and animals. It often accumulates in wild animals and is transmitted by close contact within animal trade. It is most commonly found in central and west Africa where it is carried in a number of infected species including monkeys , apes , rats , prairie dogs , and other small rodents . In an attempt to reduce the rate of disease spread, researchers believe minimizing direct and indirect contact rates between species in wildlife trade markets is the most practical solution. Severe acute respiratory syndrome (SARS), often referred to as a severe form of pneumonia , is a highly contagious zoonotic respiratory illness causing extreme breathing difficulties. Factors attributing to widespread dispersal include the destruction of wildlife natural ecosystems, overextended urbanization effects on biodiversity , and contact with bacterially contaminated objects. The 2002–2004 SARS outbreak can be traced to live animal markets where the potential for zoonotic transmission is greatly increased. In a 2007 study, Chinese scientists identified the presence of SARS-CoV-like viruses in horseshoe bats combined with unsanitary wildlife markets and the culture of eating exotic mammals in southern China as a "time-bomb". In April 2020, scientist Peter Daszak described a Chinese wildlife market as follows: "it is a bit of shock to go to a wildlife market and see this huge diversity of animals live in cages on top of each other with a pile of guts that have been pulled out of an animal and thrown on the floor [...] These are perfect places for viruses to spread." Chinese environmentalists, researchers and state media have called for stricter regulation of exotic animal trade in the markets. Medical experts Zhong Nanshan , Guan Yi and Yuen Kwok-yung have also called for the closure of wildlife markets since 2010. Ebola virus disease is a rare infectious disease that is likely transmitted to humans by wild animals. The natural reservoirs of Ebola virus are unknown, but possible reservoirs include fruit bats, non-human primates , rodents, shrews, carnivores, and ungulates. Transmission of this virus likely occurs when individuals live closely to infected habitats, exchange bodily liquids, or consume infected animals. West Africa's Ebola outbreak was termed the most destructive infectious disease epidemic in recent history, killing a total of 16,000 individuals between 2014 and 2015. Wildlife poachers have the greatest chance of contracting and dispersing this disease at they return from the bush . HIV is a life-threatening virus that attacks the immune system . The virus weakens the white blood cell count and their ability to detect and ward off potentially harmful diseases. Dispersal of the disease includes acts of consuming infected bushmeat, pathogens coming into contact with open wounds, and through infected blood transfers. The two major strains of HIV, HIV-1 and HIV-2, are both believed to have originated in West or Central Africa from strains of simian immunodeficiency virus (SIV), which infects various non-human primate species. Some of these primates affected by SIV are often hunted and trafficked for bushmeat, traditional medicine practices, and for exotic pet trade purposes. [ citation needed ] Bubonic plague is caused by the bacterium Yersinia pestis and is transmitted through open wound contact or exposure to contaminated bodily fluids. Oriental rat fleas , which are thought to originate in northern Africa carry the bacteria and transmit the disease by biting and infecting both humans and wild animals. Marburg virus , which causes Marburg virus disease , is a zoonotic RNA virus within the filovirus family. It is closely related to the Ebola virus and is transmitted by wild animals to humans. African monkeys and fruit bats are believed to be the main carries of the infectious disease. In 2012 the most recent outbreak occurred in Uganda , where fifteen individuals contracted the disease and four ultimately died from elevated hemorrhagic fevers . Rising numbers of deforestation, urbanization, and exotic animal trade have increased the likeliness of spreading this viral disease. West Nile virus is a single stranded RNA virus that can cause neurological diseases within humans. The first outbreak was recorded in Uganda and other areas of West Africa in 1937. Disease transmission is primarily through mosquitos feeding on infected dead birds. The infection then circulates within the mosquito and is transferred to humans or animals when bitten by the infected insect. African trypanosomiasis or sleeping sickness is caused by a microscopic parasite called the Trypanosoma brucei , which is transferred to humans and animals through the bite of a tsetse fly . The disease is a reoccurring issue in many rural parts of Africa and over 500,000 individuals currently carry the disease. Livestock, game animals , and wild species of the bush are prone to the infection. Wildlife game markets and other exotic animal trade methods continue to spread transmission. These trade operations have introduced dangerous repercussions as the disease becomes more adaptive to drug resistance . Ebola virus disease is a rare infectious disease that is likely transmitted to humans by wild animals. The natural reservoirs of Ebola virus are unknown, but possible reservoirs include fruit bats, non-human primates , rodents, shrews, carnivores, and ungulates. Transmission of this virus likely occurs when individuals live closely to infected habitats, exchange bodily liquids, or consume infected animals. West Africa's Ebola outbreak was termed the most destructive infectious disease epidemic in recent history, killing a total of 16,000 individuals between 2014 and 2015. Wildlife poachers have the greatest chance of contracting and dispersing this disease at they return from the bush . HIV is a life-threatening virus that attacks the immune system . The virus weakens the white blood cell count and their ability to detect and ward off potentially harmful diseases. Dispersal of the disease includes acts of consuming infected bushmeat, pathogens coming into contact with open wounds, and through infected blood transfers. The two major strains of HIV, HIV-1 and HIV-2, are both believed to have originated in West or Central Africa from strains of simian immunodeficiency virus (SIV), which infects various non-human primate species. Some of these primates affected by SIV are often hunted and trafficked for bushmeat, traditional medicine practices, and for exotic pet trade purposes. [ citation needed ]Bubonic plague is caused by the bacterium Yersinia pestis and is transmitted through open wound contact or exposure to contaminated bodily fluids. Oriental rat fleas , which are thought to originate in northern Africa carry the bacteria and transmit the disease by biting and infecting both humans and wild animals. Marburg virus , which causes Marburg virus disease , is a zoonotic RNA virus within the filovirus family. It is closely related to the Ebola virus and is transmitted by wild animals to humans. African monkeys and fruit bats are believed to be the main carries of the infectious disease. In 2012 the most recent outbreak occurred in Uganda , where fifteen individuals contracted the disease and four ultimately died from elevated hemorrhagic fevers . Rising numbers of deforestation, urbanization, and exotic animal trade have increased the likeliness of spreading this viral disease. West Nile virus is a single stranded RNA virus that can cause neurological diseases within humans. The first outbreak was recorded in Uganda and other areas of West Africa in 1937. Disease transmission is primarily through mosquitos feeding on infected dead birds. The infection then circulates within the mosquito and is transferred to humans or animals when bitten by the infected insect. African trypanosomiasis or sleeping sickness is caused by a microscopic parasite called the Trypanosoma brucei , which is transferred to humans and animals through the bite of a tsetse fly . The disease is a reoccurring issue in many rural parts of Africa and over 500,000 individuals currently carry the disease. Livestock, game animals , and wild species of the bush are prone to the infection. Wildlife game markets and other exotic animal trade methods continue to spread transmission. These trade operations have introduced dangerous repercussions as the disease becomes more adaptive to drug resistance . Managing the risk of zoonotic diseases includes educating those in the wildlife trade about potential disease hazards. Other ways to manage risk include creating disease surveillance systems to monitor all stages of wildlife trade, from sources to markets. Other suggestions include education about proper storage, handling, and cooking of wildlife. Due to the suspicions that wet markets could have played a role in the emergence of COVID-19, a group of US lawmakers, NIAID director Anthony Fauci , UNEP biodiversity chief Elizabeth Maruma Mrema, and CBCGDF secretary general Zhou Jinfeng called in April 2020 for the global closure of wildlife markets due to the potential for zoonotic diseases and risk to endangered species . In April 2021, the World Health Organization called for a total ban on the sale of live animals in food markets in order to prevent future pandemics. Planetary health studies have called for disease control intervention measures to be implemented at live animal markets in lieu of complete bans. These include proposals for "standardised global monitoring of water, sanitation, and hygiene (WASH) conditions", which the World Health Organization announced in April 2020 that it was developing as requirements for wet markets in general to open. Other proposals include less homogeneous policies that are specialized for local social, cultural, and financial factors, as well as new proposed rapid assessment tools for monitoring the hygiene and biosecurity of live animal stalls in markets. Planetary health studies have called for disease control intervention measures to be implemented at live animal markets in lieu of complete bans. These include proposals for "standardised global monitoring of water, sanitation, and hygiene (WASH) conditions", which the World Health Organization announced in April 2020 that it was developing as requirements for wet markets in general to open. Other proposals include less homogeneous policies that are specialized for local social, cultural, and financial factors, as well as new proposed rapid assessment tools for monitoring the hygiene and biosecurity of live animal stalls in markets.

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Bubonic plague

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Niall Ó Glacáin

Niall Ó Glacáin , anglicised O'Glacan ( c. 1563 - 1653) was an Irish physician and plague doctor who worked to treat victims of bubonic plague outbreaks throughout continental Europe. He was a physician to Hugh Roe O'Donnell and King Louis XIII . Working as a physician to the prominent O'Donnell clan during the Irish Nine Years' War , he may have followed them to Spain after the Siege of Kinsale , where he spent two decades practicing medicine. He moved to France in the 1620s, settling in Toulouse to publish his work Tractatus de Peste , a treatise on plague treatment. Later in life he took up a post at the University of Bologna as Professor of Medicine. Ó Glacáin was a pioneer in pathological anatomy , with his work predating that of anatomist Giovanni Battista Morgagni by several decades. Ó Glacáin was born in Tyrconnell in the last half of the sixteenth century. Some historians give him a birth date of around 1563, owing to a 1653 engraving that gives his age as 90. Professor Giorgio Scharpes estimated Ó Glacáin to be about 48 when recommending him to the University of Bologna in the 1630s, which would mean he was born in the 1580s. Ó Glacáin's medical education was founded on the works of Greek physicians Galen and Hippocrates , whom he refers to in his later works. He probably received his early education from the local Donlevy family, a hereditary family of physicians. At the time, most medical families were attached to a powerful clan - the Donlevys were the personal physicians of Tyrconnell's ruling O'Donnell clan . Conversely, Charles Cameron suggests Ó Glacáin received his medical education abroad. Owen Ultach MacDonlevy - the last recorded ollam leighis (official physician) of the O'Donnells - died in 1586. By the early 1600s, Ó Glacáin was working as the O'Donnell's physician. After the Irish defeat at the Battle of Kinsale , the O'Donnell clan left Ireland to seek refuge in Spain. Ó Glacáin treated clan chief Hugh Roe O'Donnell for a bubonic plague sore during his illness and eventual death at the Spanish court in 1602. Ó Glacáin writes in his work Tractatus de Peste: "...I was staying with my Magnanimous Hugh O'Donnell the Great Prince of Tír Chonaill in the court of the King of Spain, with a venereal bubo. Some of the citizens of Madrid, who would not readily accept the treatment of any of the surgeons, approached me, and quickly and successfully recovered unharmed with the following poultice..." Ó Glacáin subsequently spent many years practicing medicine in Salamanca . In 1622, he moved to Valencia , residing there for two years. He mentions "Dyonisius Ultanus", of the Donlevy family, as a patient he treated in Valencia. In 1621, Ó Glacáin was recorded as attending the Irish College in Bordeaux under Archbishop François d'Escoubleau de Sourdis . In July 1625, he graduated from the University of Cahors [ en ] in Southern France . It would later merge with the University of Toulouse in 1751. It is also possible Ó Glacáin attended the Irish College in Toulouse , Bordeaux's sister school. Around 1628, he worked as a travelling plague doctor , treating victims at local hospitals in towns such as Fons , Figeac , Capdenac , Cajarc , Rouergue and Floyeac. His work was encouraged by the Bishop of Cahors . He had settled in Toulouse in time to treat victims of the plague outbreak of 1628. MacCuinneagáin states that Ó Glacáin "gained high esteem and general consideration because of the devotion which he showed in braving the contagion to succor the sick. He was appointed physician at the xenodochium pestiferorum , the plague hospital at Toulouse in 1628 and was appointed to the University there with the title Premier Professor of Medicine." Ó Glacáin also spent time in Paris as both physician and Privy Councillor to King Louis XIII . By now a respected authority on plague treatment, he published his most famous work, Tractatus de Peste , at Toulouse in May 1629. It contained his concise descriptions of the plague, its various effects on different patients such as buboes , rashes, headaches, vomiting and coma. Suggested treatments including bleeding, the use of clysters , purgatives , and fumigation . An especially interesting part of the text is a description of four post-mortems which he carried out, where he noted the occurrence of petechial haemorrhages which "covered the surface of the victims' lungs and also the swelling of the spleen ." Ó Glacáin also references the protective clothing worn by plague doctors , including leather coats, gauntlets and long beak-like masks filled with fumigants. Ó Glacáin moved to Italy in the early 1630s. He was "head-hunted" by the Faculty of Medicine at the University of Bologna , which had a tradition of employing very eminent foreign doctors as their Medicina Sopraordinaria (Professor of Medicine). To this end, the university's senate asked Giorgio Scharpes (Professor of Medicine, 1634-7) to write a report on the Irishman, whose fame by then spanned all of Europe. Scharpes' reply was as follows: "With regard to religion Mr. Glacáin is a Catholic , and there is no doubt because it would be difficult for a heretic to live in a city like Tolosa (Toulouse) which is known to be one of the most Catholic places and where they cannot bear heretics. Mr. Glacáin is about 48. He is famous because during the plague in these regions of France during the years 1627 to 1629 he was very helpful and in the year 1629 he produced a book whose title is Tractatus de Peste ... and I invite you to read this book to understand exactly why Mr. Glacáin is valuable and why he is still teaching in the University of Tolosa ... About his teaching he is well estimated because he is a good philosopher, good in fighting against his enemies that accused him of being a magician; his book can confirm that he was not a magician ... Mr. Glacáin knows Greek very well ... talking about the other questions ... from a letter from Mr. Glacáin where he says he would really like to serve the University of Bologna, I can understand that there will not be any problem for the salary and for him to come." In 1646, he became Professor of Medicine at the University of Bologna. MacCuinneagáin gives this date as 1642, and claims Ó Glacáin held this office until his death. During his years in Bologna, Ó Glacáin wrote his final work, Cursus Medicus , which was published in three volumes in 1655. The first volume dealt with physiology , the second pathology , and the third – published after his death – on the theory of signs. This final volume dealt with the different diagnosis by doctors, descriptions of diseases, and was overall an introduction to the modern concept of differential diagnosis . Two other Irish residents in the city, Gregory Fallon of Connacht and the Rev. Phillip Roche , S.J., wrote commendatory verses prefixing volume two. Although the details of Niall Ó Glacáin's personal life are almost unknown, many of his associates are referenced in contemporary records. He entertained Bishop of Ferns Nicholas French and Sir Nicholas Plunkett at his home in Bologna, when the latter were on their way to Rome in 1648. In collaboration with them he wrote eulogistic poems in Latin to Pope Innocent X , titled Regni Hiberniae ad Sanctissimi Innocenti Pont. Max. Pyramides Encomiasticae . Ó Glacáin himself visited Rome at some point. In his later work he mentions another friend, the Franciscan catechist and grammarian Fr. Froinsias Ó Maolmhuaidh . He was also an associate of Irish bishop Peter Talbot and Portuguese physician Gabriel da Fonseca , personal physician to Innocent X . Other friends in Italy include Gerard O'Fearail and John O'Fahy. Ó Glacáin died in 1653, probably in Bologna. The final volume of Cursus Medicus begins with his eulogy, as written by Peter von Adrian Brocke, Professor of Eloquence at Lucca : "With healing art he arms us to repel, dire troops of agues and of fevers fell, whatever ills the patient may endure, known or unknown, unerring is his cure..."

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Bubonic plague

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Fulminant

Fulminant ( / ˈ f ʊ l m ɪ n ən t / ) is a medical descriptor for any event or process that occurs suddenly and escalates quickly, and is intense and severe to the point of lethality, i.e., it has an explosive character. The word comes from Latin fulmināre , to strike with lightning . There are several diseases described by this adjective: Beyond these particular uses, the term is used more generally as a descriptor for sudden-onset medical conditions that are immediately threatening to life or limb. Some viral hemorrhagic fevers , such as Ebola , Lassa fever , and Lábrea fever , may kill in as little as two to five days. Diseases that cause rapidly developing lung edema , such as some kinds of pneumonia , may kill in a few hours. It was said of the " black death " (pneumonic bubonic plague ) that some of its victims would die in a matter of hours after the initial symptoms appeared. Other pathologic conditions that may be fulminating in character are acute respiratory distress syndrome , asthma , acute anaphylaxis , septic shock , and disseminated intravascular coagulation . The term is generally not used to refer to immediate death by trauma, such as gunshot wound, but can refer to trauma-induced secondary conditions, such as commotio cordis , a sudden cardiac arrest caused by a blunt, non-penetrating trauma to the precordium , which causes ventricular fibrillation of the heart. Cardiac arrest and stroke in certain parts of the brain , such as in the brainstem (which controls cardiovascular and respiratory system functions), and massive hemorrhage of the great arteries (such as in perforation of the walls by trauma or by sudden opening of an aneurysm of the aorta ) may be very quick, causing "fulminant death". Sudden infant death syndrome (SIDS) is still a mysterious cause of respiratory arrest in infants. Certain infections of the brain, such as rabies , meningococcal meningitis , or primary amebic meningoencephalitis can kill within hours to days after symptoms appear. Some toxins , such as cyanide , may also provoke fulminant death. Abrupt hyperkalemia provoked by intravenous injection of potassium chloride leads to fulminant death by cardiac arrest.

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Bubonic plague

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Bill Harris (geneticist)

Professor Bill Harris (17 November 1944 – 2 June 2014) was a genetic scientist who specialised in antibody research. An author of about 70 scientific research papers, author, editor, and contributor to many books, and 15 patent applications, Bill was most notable for his work translating science from the lab in to industry. His recent academic research centred on engineering of antibodies for application in health care, management of environmental pollution, and the derivation and use of novel combinatorial libraries . In early 2015, Bill was celebrated as a pioneering bio-entrepreneur by the University of Aberdeen during a two-day symposium at the Institute of Medical sciences. Bill lived in Carnoustie, Scotland , known as one of the most challenging golf course in the world where the Open Championship was held in 1999 and 2007. He played this golf course every week and was formerly a committee member of The Carnoustie Golf Club , established 1842. In 2013, he published the book 'Sons of Carnoustie', which followed from his research into former golfers of Carnoustie who are thought to have spread golf around the world, known as the 'Sons of Carnoustie'. His research identified 163 such golfers from Carnoustie and his book tells of their lives and experiences. He also published a book of poetry in 2005, "thoughts and memories". Bill studied biochemistry at the University of St Andrews , Scotland and then obtained his PhD at the University of Dundee in 1969. His first publication, 'The origin of life - A master molecule' was winner of the Endeavour Prize in 1968. At the time, it was not yet understood what were the 'minimal requirements' of the living cell and in this review, possible mechanisms for the origin of the primeval cell were discussed. Between 1969 and 1978 Bill was a lecturer in biochemistry in Aberdeen University and then entered industry as Head of In Vitro Toxicology, Inveresk Research International (IRI Ltd.) 1978–80. He established and was Head of Biotechnology at IRI, 1980–86, was Research Director of Bioscot Ltd. 1986-87 and then became Professor of Genetics in Aberdeen University in 1987 where he remained until taking early retirement in 2003. Between 1980 and 1987 he also served as Technical Director of Investments in Biotechnology by Cogent Ltd , the Technology Transfer Investment Arm of Legal & General /Commercial Union Assurance companies. He was co-founder of one of the first and world leading antibody engineering companies, Scotgen Ltd., in 1987, its Managing Director 1987–92, and President and Chief Scientific Officer of Scotgen Biopharmaceutical Inc. until he resigned in 1994.Bill's research focused in health care and environmental management and the work involved tackling problems focusing on protein engineering . Combinatorial libraries were designed and used to select and evolve new proteins that would have higher affinity for their targets, improved stability and ease of production. The aims of the research were: "to provide novel binding proteins with affinities for their targets which are much higher than those provided by traditional monoclonals through the use of antibody phage display libraries and combinatorial libraries based upon novel scaffolds. to design antibody fragment configurations with improved solubility, thermal, proteolytic resistance, and stability in organic solvents and detergents. to provide methods for manufacture of antibody fragments on a scale, and at a cost acceptable for application in environmental management and as components of topical pharmaceuticals, cosmeceuticals or consumer goods." In 1999, Bill headed a research team from Aberdeen University to carry out research at Porton Down to develop antibodies for the treatment of bubonic plague . The work was reportedly commissioned by the Defence Evaluation and Research Agency in response to fears that British forces could be attacked by countries which had been thought to have built up stockpiles of biological weapons. The research was revealed after concerns about the secrecy of work carried out by UK universities at Porton Down were raised by the Scottish National Party. As a result of pollution caused by harmful industrial chemicals, international legislation setting minimal levels of organic pollutants in potable and environmental waters and soil were introduced leading to the need for sensitive and cost effective methods for detection and routine monitoring. This research programme was sponsored by the U.K. Biological Sciences and Biotechnology Research Council (BBSRC) for 7 years and focused on provision of antibody based reagents using herbicides such as atrazine , diuron , mecoprop and paraquat as prototypes. In 1999 it was shown that antibody fragments could offer the possibility of sensitive detection and efficient removal of organic pollutants from the environment. Initially the insolubility of anti-herbicide antibody fragments when expressed in E. coli had restricted this work, however work later carried out showed that disulfide linked scFvs , termed SCABS, had improved stability in a range of environments. In 1999, Bill headed a research team from Aberdeen University to carry out research at Porton Down to develop antibodies for the treatment of bubonic plague . The work was reportedly commissioned by the Defence Evaluation and Research Agency in response to fears that British forces could be attacked by countries which had been thought to have built up stockpiles of biological weapons. The research was revealed after concerns about the secrecy of work carried out by UK universities at Porton Down were raised by the Scottish National Party. As a result of pollution caused by harmful industrial chemicals, international legislation setting minimal levels of organic pollutants in potable and environmental waters and soil were introduced leading to the need for sensitive and cost effective methods for detection and routine monitoring. This research programme was sponsored by the U.K. Biological Sciences and Biotechnology Research Council (BBSRC) for 7 years and focused on provision of antibody based reagents using herbicides such as atrazine , diuron , mecoprop and paraquat as prototypes. In 1999 it was shown that antibody fragments could offer the possibility of sensitive detection and efficient removal of organic pollutants from the environment. Initially the insolubility of anti-herbicide antibody fragments when expressed in E. coli had restricted this work, however work later carried out showed that disulfide linked scFvs , termed SCABS, had improved stability in a range of environments. Bill Harris spent 9 years (1978–87) with Inveresk Research International, Edinburgh, Scotland, initially as Head of In Vitro Toxicology and then introduced and was Head of Biotechnology. IRI Ltd were a contract research organisation providing safety testing facilities for new chemicals. They later merged with the Charles River Laboratories in Edinburgh, before being acquired by Quotient Bioresearch Limited in 2009. He managed contracts with US. NCI, NIOSH, US Army as well as many European and USA companies. This was the exciting era of environmental toxicology with predictive mutagenicity and carcinogenicity testing of thousands of chemicals in widespread use in pharmaceutical, cosmetic, chemical and food industries and a lot of time was spent visiting and advising companies on the impact of results on their businesses. A broad knowledge of procedures and legal requirements for safety assessment of new drugs during product development programmes was obtained at this time. During this period, Bill was also technical advisor for investments in biotechnology by Cogent Ltd. This pioneering investment group provided vital funding to projects at the stage between initial university research discovery and industrial product development. In 1987, Cogent Ltd acquired the monoclonal antibody manufacturing company, Bioscot Ltd where Bill then served as Research Director. During this time, he directed the expansion of the companies' business into provision of novel immunoassay technologies and products, and developed an ELISA based test for the environmental monitoring of Legionella pneumophila , marketed by Boots Microcheck. Between 1987 and 1990, Bill was awarded four UK Department of Trade and Industry " SMART" awards for projects related to diagnosis of susceptibility to heart disease, and rapid detection of microbial infection. In 1989 he was a semi-final winner of the Toshiba Year of Invention awards for a programme to remove alcohol from wine. He was co-inventor on 20 process and product patent applications. Scotgen was established in 1987 with seedcorn finance from the Founders, an investment by Aberdeen University Research and Innovation Services, and the Scottish Development Agency. This raised around £200,000 and with a small additional loan in 1989, was the only investment in the company until 1993. The Company expanded its contract research business at a rate averaging around 20% per annum and in 1992 had a turnover of approximately $2.0 million with 30% net profit margins. Profit was used to develop own products and in 1991 the first Scotgen product, reshaped human antibodies for respiratory syncytial virus (fatal childhood infection), was licensed to Smith Kline Beecham . Anti-infective therapeutic products developed up to 1992 included those for treatment of respiratory syncytial virus (RSV), Varicella zoster (chicken pox/shingles), cytomegalovirus and rabies . The RSV product was licensed to Smith Kline Beecham in 1991 but was not pursued after completion of early phase II clinical trials. Four anti-cancer antibodies were developed in collaboration with Sloan-Kettering Institute for Cancer Research and Ludwig Institute of Cancer Research , New York. Between 1987 and 1990, Bill was awarded four UK Department of Trade and Industry " SMART" awards for projects related to diagnosis of susceptibility to heart disease, and rapid detection of microbial infection. In 1989 he was a semi-final winner of the Toshiba Year of Invention awards for a programme to remove alcohol from wine. He was co-inventor on 20 process and product patent applications.Scotgen was established in 1987 with seedcorn finance from the Founders, an investment by Aberdeen University Research and Innovation Services, and the Scottish Development Agency. This raised around £200,000 and with a small additional loan in 1989, was the only investment in the company until 1993. The Company expanded its contract research business at a rate averaging around 20% per annum and in 1992 had a turnover of approximately $2.0 million with 30% net profit margins. Profit was used to develop own products and in 1991 the first Scotgen product, reshaped human antibodies for respiratory syncytial virus (fatal childhood infection), was licensed to Smith Kline Beecham . Anti-infective therapeutic products developed up to 1992 included those for treatment of respiratory syncytial virus (RSV), Varicella zoster (chicken pox/shingles), cytomegalovirus and rabies . The RSV product was licensed to Smith Kline Beecham in 1991 but was not pursued after completion of early phase II clinical trials. Four anti-cancer antibodies were developed in collaboration with Sloan-Kettering Institute for Cancer Research and Ludwig Institute of Cancer Research , New York.

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Bubonic plague

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Walter Charles Rand

Walter Charles Rand (12 May 1863 – 3 July 1897 ) was an Indian Civil Service officer in British India. An epidemic of bubonic plague spread in Pune in 1896. On 19 February 1897, Rand was appointed as plague commissioner of the city. The British, in general and Rand, in particular, were keen to eradicate the plague as quickly as possible as it adversely affected the commercial interests of the British. Rand misused his post and looted innocent Indians and humiliated women." Rand's efforts to control plague were tyrannical and brutal and reminded by many in Pune including Lokmanya Bal Gangadhar Tilak . Rand and his military escort Lt. Charles Egerton Ayerst were shot by Chapekar brothers on 22 June 1897. Ayerst died on the spot, while Rand died of his injuries on 3 July. Prior to being posted at Pune, Rand was posted as assistant collector of Satara . His assassination rapidly became a part of the Indian national movement, especially in Bombay Presidency .

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Bubonic plague

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History of Europe

The history of Europe is traditionally divided into four time periods: prehistoric Europe (prior to about 800 BC), classical antiquity (800 BC to AD 500), the Middle Ages (AD 500–1500), and the modern era (since AD 1500). The first early European modern humans appear in the fossil record about 48,000 years ago, during the Paleolithic era. Settled agriculture marked the Neolithic era, which spread slowly across Europe from southeast to the north and west. The later Neolithic period saw the introduction of early metallurgy and the use of copper-based tools and weapons, and the building of megalithic structures, as exemplified by Stonehenge . During the Indo-European migrations , Europe saw migrations from the east and southeast. The period known as classical antiquity began with the emergence of the city-states of ancient Greece . Later, the Roman Empire came to dominate the entire Mediterranean Basin . The Migration Period of the Germanic people began in the late 4th century AD and made gradual incursions into various parts of the Roman Empire. The fall of the Western Roman Empire in AD 476 traditionally marks the start of the Middle Ages. While the Eastern Roman Empire would continue for another 1000 years, the former lands of the Western Empire would be fragmented into a number of different states. At the same time, the early Slavs began to become established as a distinct group in the central and eastern parts of Europe. The first great empire of the Middle Ages was the Frankish Empire of Charlemagne , while the Islamic conquest of Iberia established Al-Andalus . The Viking Age saw a second great migration of Norse peoples. Attempts to retake the Levant from the Muslim states that occupied it made the High Middle Ages the age of the Crusades , while the political system of feudalism came to its height. The Late Middle Ages were marked by large population declines, as Europe was threatened by the bubonic plague , as well as invasions by the Mongol peoples from the Eurasian Steppe . At the end of the Middle Ages, there was a transitional period, known as the Renaissance . Early Modern Europe is usually dated to the end of the 15th century. Technological changes such as gunpowder and the printing press changed how warfare was conducted and how knowledge was preserved and disseminated. The Reformation saw the fragmentation of religious thought, leading to religious wars . The Age of Exploration led to colonization , and the exploitation of the people and resources of colonies brought resources and wealth to Europe. After 1800, the Industrial Revolution brought capital accumulation and rapid urbanization to Western Europe, while several countries transitioned away from absolutist rule to parliamentary regimes. The Age of Revolution saw long-established political systems upset and turned over. In the 20th century, World War I led to a remaking of the map of Europe as the large Empires were broken up into nation-states . Lingering political issues would lead to World War II , during which Nazi Germany perpetrated The Holocaust . After World War II, during the Cold War , most of Europe became divided by the Iron Curtain in two military blocs: NATO and the Warsaw Pact . The post-war period saw decolonization as Western European colonial empires were dismantled. The post-war period also featured the gradual development of the European integration process, which led to the creation of the European Union ; this extended to Eastern European countries after the fall of the Berlin Wall . The 21st century saw the European debt crisis , the withdrawal of the United Kingdom from the European Union and the Russian invasion of Ukraine .Homo erectus migrated from Africa to Europe before the emergence of modern humans. Homo erectus georgicus , which lived roughly 1.8 million years ago in Georgia , is the earliest hominid to have been discovered in Europe. The earliest appearance of anatomically modern people in Europe has been dated to 45,000 BC, referred to as the Early European modern humans . Some locally developed transitional cultures ( Uluzzian in Italy and Greece, Altmühlian in Germany, Szeletian in Central Europe and Châtelperronian in the southwest) use clearly Upper Palaeolithic technologies at very early dates. Nevertheless, the definitive advance of these technologies is made by the Aurignacian culture, originating in the Levant (Ahmarian) and Hungary (first full Aurignacian). By 35,000 BC, the Aurignacian culture and its technology had extended through most of Europe. The last Neanderthals seem to have been forced to retreat to the southern half of the Iberian Peninsula . Around 29,000 BC a new technology/culture appeared in the western region of Europe: the Gravettian . This technology/culture has been theorised to have come with migrations of people from the Balkans (see Kozarnika ). Around 16,000 BC, Europe witnessed the appearance of a new culture, known as Magdalenian , possibly rooted in the old Gravettian. This culture soon superseded the Solutrean area and the Gravettian of mainly France, Spain, Germany, Italy, Poland, Portugal and Ukraine. The Hamburg culture prevailed in Northern Europe in the 14th and the 13th millennium BC as the Creswellian (also termed the British Late Magdalenian) did shortly after in the British Isles . Around 12,500 BC, the Würm glaciation ended. Magdalenian culture persisted until c. 10,000 BC, when it quickly evolved into two microlithist cultures: Azilian ( Federmesser ), in Spain and southern France , and then Sauveterrian , in southern France and Tardenoisian in Central Europe, while in Northern Europe the Lyngby complex succeeded the Hamburg culture with the influence of the Federmesser group as well. Evidence of permanent settlement dates from the 8th millennium BC in the Balkans. The Neolithic reached Central Europe in the 6th millennium BC and parts of Northern Europe in the 5th and 4th millenniums BC. The modern indigenous populations of Europe are largely descended from three distinct lineages: Mesolithic hunter-gatherers , a derivative of the Cro-Magnon population, Early European Farmers who migrated from Anatolia during the Neolithic Revolution , and Yamnaya pastoralists who expanded into Europe in the context of the Indo-European expansion . The Indo-European migrations started in Southeast Europe at around c. 4200 BC. through the areas around the Black sea and the Balkan peninsula . In the next 3000 years the Indo-European languages expanded through Europe. Around this time, in the 5th millennium BC the Varna culture evolved. In 4700 – 4200 BC, the Solnitsata town, believed to be the oldest prehistoric town in Europe, flourished. Homo erectus migrated from Africa to Europe before the emergence of modern humans. Homo erectus georgicus , which lived roughly 1.8 million years ago in Georgia , is the earliest hominid to have been discovered in Europe. The earliest appearance of anatomically modern people in Europe has been dated to 45,000 BC, referred to as the Early European modern humans . Some locally developed transitional cultures ( Uluzzian in Italy and Greece, Altmühlian in Germany, Szeletian in Central Europe and Châtelperronian in the southwest) use clearly Upper Palaeolithic technologies at very early dates. Nevertheless, the definitive advance of these technologies is made by the Aurignacian culture, originating in the Levant (Ahmarian) and Hungary (first full Aurignacian). By 35,000 BC, the Aurignacian culture and its technology had extended through most of Europe. The last Neanderthals seem to have been forced to retreat to the southern half of the Iberian Peninsula . Around 29,000 BC a new technology/culture appeared in the western region of Europe: the Gravettian . This technology/culture has been theorised to have come with migrations of people from the Balkans (see Kozarnika ). Around 16,000 BC, Europe witnessed the appearance of a new culture, known as Magdalenian , possibly rooted in the old Gravettian. This culture soon superseded the Solutrean area and the Gravettian of mainly France, Spain, Germany, Italy, Poland, Portugal and Ukraine. The Hamburg culture prevailed in Northern Europe in the 14th and the 13th millennium BC as the Creswellian (also termed the British Late Magdalenian) did shortly after in the British Isles . Around 12,500 BC, the Würm glaciation ended. Magdalenian culture persisted until c. 10,000 BC, when it quickly evolved into two microlithist cultures: Azilian ( Federmesser ), in Spain and southern France , and then Sauveterrian , in southern France and Tardenoisian in Central Europe, while in Northern Europe the Lyngby complex succeeded the Hamburg culture with the influence of the Federmesser group as well.Evidence of permanent settlement dates from the 8th millennium BC in the Balkans. The Neolithic reached Central Europe in the 6th millennium BC and parts of Northern Europe in the 5th and 4th millenniums BC. The modern indigenous populations of Europe are largely descended from three distinct lineages: Mesolithic hunter-gatherers , a derivative of the Cro-Magnon population, Early European Farmers who migrated from Anatolia during the Neolithic Revolution , and Yamnaya pastoralists who expanded into Europe in the context of the Indo-European expansion . The Indo-European migrations started in Southeast Europe at around c. 4200 BC. through the areas around the Black sea and the Balkan peninsula . In the next 3000 years the Indo-European languages expanded through Europe. Around this time, in the 5th millennium BC the Varna culture evolved. In 4700 – 4200 BC, the Solnitsata town, believed to be the oldest prehistoric town in Europe, flourished. The first well-known literate civilization in Europe was the Minoan civilization that arose on the island of Crete and flourished from approximately the 27th century BC to the 15th century BC. The Minoans were replaced by the Mycenaean civilization which flourished during the period roughly between 1600 BC, when Helladic culture in mainland Greece was transformed under influences from Minoan Crete, and 1100 BC. The major Mycenaean cities were Mycenae and Tiryns in Argolis, Pylos in Messenia, Athens in Attica, Thebes and Orchomenus in Boeotia, and Iolkos in Thessaly. In Crete , the Mycenaeans occupied Knossos . Mycenaean settlement sites also appeared in Epirus , Macedonia , on islands in the Aegean Sea , on the coast of Asia Minor , the Levant , Cyprus and Italy. Mycenaean artefacts have been found well outside the limits of the Mycenean world. Quite unlike the Minoans, whose society benefited from trade, the Mycenaeans advanced through conquest. Mycenaean civilization was dominated by a warrior aristocracy . Around 1400 BC, the Mycenaeans extended their control to Crete, the centre of the Minoan civilization, and adopted a form of the Minoan script (called Linear A ) to write their early form of Greek in Linear B . The Mycenaean civilization perished with the collapse of Bronze-Age civilization on the eastern shores of the Mediterranean Sea. The collapse is commonly attributed to the Dorian invasion , although other theories describing natural disasters and climate change have been advanced as well. [ citation needed ] Whatever the causes, the Mycenaean civilization had definitely disappeared after LH III C , when the sites of Mycenae and Tiryns were again destroyed and lost their importance. This end, during the last years of the 12th century BC, occurred after a slow decline of the Mycenaean civilization, which lasted many years before dying out. The beginning of the 11th century BC opened a new context, that of the protogeometric, the beginning of the geometric period, the Greek Dark Ages of traditional historiography. The Bronze Age collapse may be seen in the context of a technological history that saw the slow spread of ironworking technology from present-day Bulgaria and Romania in the 13th and the 12th centuries BC. The Tumulus culture and the following Urnfield culture of central Europe were part of the origin of the Roman and Greek cultures. Classical antiquity , also known as the classical era, classical period, classical age, or simply antiquity, is the period of cultural history between the 8th century BC and the 5th century AD comprising the interwoven civilizations of ancient Greece and ancient Rome known together as the Greco-Roman world , centered on the Mediterranean Basin . It is the period during which ancient Greece and ancient Rome flourished and had major influence throughout much of Europe , North Africa , and West Asia . The Hellenic civilisation was a collection of city-states or poleis with different governments and cultures that achieved notable developments in government, philosophy, science, mathematics, politics, sports, theatre and music. The most powerful city-states were Athens , Sparta , Thebes , Corinth , and Syracuse . Athens was a powerful Hellenic city-state and governed itself with an early form of direct democracy invented by Cleisthenes ; the citizens of Athens voted on legislation and executive bills themselves. Athens was the home of Socrates , Plato , and the Platonic Academy . The Hellenic city-states established colonies on the shores of the Black Sea and the Mediterranean Sea ( Asian Minor , Sicily , and Southern Italy in Magna Graecia ). By the late 6th century BC, the Greek city states in Asia Minor had been incorporated into the Persian Empire , while the latter had made territorial gains in the Balkans (such as Macedon , Thrace , Paeonia , etc.) and Eastern Europe proper as well. In the course of the 5th century BC, some of the Greek city states attempted to overthrow Persian rule in the Ionian Revolt , which failed. This sparked the first Persian invasion of mainland Greece . At some point during the ensuing Greco-Persian Wars , namely during the Second Persian invasion of Greece , and precisely after the Battle of Thermopylae and the Battle of Artemisium , almost all of Greece to the north of the Isthmus of Corinth had been overrun by the Persians, but the Greek city states reached a decisive victory at the Battle of Plataea . With the end of the Greco-Persian wars, the Persians were eventually forced to withdraw from their territories in Europe. The Greco-Persian Wars and the victory of the Greek city states directly influenced the entire further course of European history and would set its further tone. Some Greek city-states formed the Delian League to continue fighting Persia, but Athens' position as leader of this league led Sparta to form the rival Peloponnesian League . The Peloponnesian Wars ensued, and the Peloponnesian League was victorious. Subsequently, discontent with Spartan hegemony led to the Corinthian War and the defeat of Sparta at the Battle of Leuctra . At the same time at the north ruled the Thracian Odrysian Kingdom between the 5th century BC and the 1st century AD. Hellenic infighting left Greek city states vulnerable, and Philip II of Macedon united the Greek city states under his control. The son of Philip II, known as Alexander the Great , invaded neighboring Persia , toppled and incorporated its domains, as well as invading Egypt and going as far off as India, increasing contact with people and cultures in these regions that marked the beginning of the Hellenistic period . After the death of Alexander the Great , his empire split into multiple kingdoms ruled by his generals, the Diadochi . The Diadochi fought against each other in a series of conflicts called the Wars of the Diadochi . In the beginning of the 2nd century BC, only three major kingdoms remained: the Ptolemaic Egypt , the Seleucid Empire and Macedonia . These kingdoms spread Greek culture to regions as far away as Bactria . Much of Greek learning was assimilated by the nascent Roman state as it expanded outward from Italy, taking advantage of its enemies' inability to unite: the only challenge to Roman ascent came from the Phoenician colony of Carthage , and its defeats in the three Punic Wars marked the start of Roman hegemony . First governed by kings , then as a senatorial republic (the Roman Republic ), Rome finally became an empire at the end of the 1st century BC, under Augustus and his authoritarian successors. The Roman Empire had its centre in the Mediterranean, controlling all the countries on its shores; the northern border was marked by the Rhine and Danube rivers. Under the emperor Trajan (2nd century AD) the empire reached its maximum expansion, controlling approximately 5,900,000 km 2 (2,300,000 sq mi) of land surface, including Italia , Gallia , Dalmatia , Aquitania , Britannia , Baetica , Hispania , Thrace , Macedonia , Greece , Moesia , Dacia , Pannonia , Egypt, Asia Minor , Cappadocia , Armenia , Caucasus , North Africa, Levant and parts of Mesopotamia . Pax Romana , a period of peace, civilisation and an efficient centralised government in the subject territories ended in the 3rd century, when a series of civil wars undermined Rome's economic and social strength. In the 4th century, the emperors Diocletian and Constantine were able to slow down the process of decline by splitting the empire into a Western part with a capital in Rome and an Eastern part with the capital in Byzantium, or Constantinople (now Istanbul). Constantinople is generally considered to be the center of " Eastern Orthodox civilization ". Whereas Diocletian severely persecuted Christianity , Constantine declared an official end to state-sponsored persecution of Christians in 313 with the Edict of Milan , thus setting the stage for the Church to become the state church of the Roman Empire in about 380. The Roman Empire had been repeatedly attacked by invading armies from Northern Europe and in 476, Rome finally fell . Romulus Augustus , the last emperor of the Western Roman Empire , surrendered to the Germanic King Odoacer . When Emperor Constantine had reconquered Rome under the banner of the cross in 312, he soon afterwards issued the Edict of Milan in 313 (preceded by the Edict of Serdica in 311), declaring the legality of Christianity in the Roman Empire. In addition, Constantine officially shifted the capital of the Roman Empire from Rome to the Greek town of Byzantium , which he renamed Nova Roma – it was later named Constantinople ("City of Constantine"). Theodosius I , who had made Christianity the official religion of the Roman Empire , would be the last emperor to preside over a united Roman Empire, until his death in 395. The empire was split into two halves: the Western Roman Empire centred in Ravenna , and the Eastern Roman Empire (later to be referred to as the Byzantine Empire ) centred in Constantinople. The Roman Empire was repeatedly attacked by Hunnic , Germanic , Slavic and other "barbarian" tribes (see: Migration Period ), and in 476 finally the Western part fell to the Heruli chieftain Odoacer . Roman authority in the Western part of the empire had collapsed, and a power vacuum left in the wake of this collapse; the central organization, institutions, laws and power of Rome had broken down, resulting in many areas being open to invasion by migrating tribes. Over time, feudalism and manorialism arose, providing for division of land and labour, as well as a broad if uneven hierarchy of law and protection. These localised hierarchies were based on the bond of common people to the land on which they worked, and to a lord, who would provide and administer both local law to settle disputes among the peasants, as well as protection from outside invaders. The western provinces soon were to be dominated by three great powers: first, the Franks ( Merovingian dynasty ) in Francia 481–843 AD, which covered much of present France and Germany; second, the Visigothic kingdom 418–711 AD in the Iberian Peninsula (modern Spain); and third, the Ostrogothic kingdom 493–553 AD in Italy and parts of the western Balkans. The Ostrogoths were later replaced by the Kingdom of the Lombards 568–774 AD. Although these powers covered large territories, they did not have the great resources and bureaucracy of the Roman empire to control regions and localities; more power and responsibilities were left to local lords. On the other hand, it also meant more freedom, particularly in more remote areas. In Italy, Theodoric the Great began the cultural romanisation of the new world he had constructed. He made Ravenna a centre of Romano-Greek culture of art and his court fostered a flowering of literature and philosophy in Latin . In Iberia, King Chindasuinth created the Visigothic Code . In the Eastern part the dominant state was the remaining Eastern Roman Empire. In the feudal system, new princes and kings arose, the most powerful of which was arguably the Frankish ruler Charlemagne . In 800, Charlemagne, reinforced by his massive territorial conquests, was crowned Emperor of the Romans by Pope Leo III , solidifying his power in western Europe. Charlemagne's reign marked the beginning of a new Germanic Roman Empire in the west, the Holy Roman Empire . Outside his borders, new forces were gathering. The Kievan Rus' were marking out their territory, a Great Moravia was growing, while the Angles and the Saxons were securing their borders. For the duration of the 6th century, the Eastern Roman Empire was embroiled in a series of deadly conflicts, first with the Persian Sassanid Empire (see Roman–Persian Wars ), followed by the onslaught of the arising Islamic Caliphate ( Rashidun and Umayyad ). By 650, the provinces of Egypt , Palestine and Syria were lost to the Muslim forces , followed by Hispania and southern Italy in the 7th and 8th centuries (see Muslim conquests ). The Arab invasion from the east was stopped after the intervention of the Bulgarian Empire (see Han Tervel ).The first well-known literate civilization in Europe was the Minoan civilization that arose on the island of Crete and flourished from approximately the 27th century BC to the 15th century BC. The Minoans were replaced by the Mycenaean civilization which flourished during the period roughly between 1600 BC, when Helladic culture in mainland Greece was transformed under influences from Minoan Crete, and 1100 BC. The major Mycenaean cities were Mycenae and Tiryns in Argolis, Pylos in Messenia, Athens in Attica, Thebes and Orchomenus in Boeotia, and Iolkos in Thessaly. In Crete , the Mycenaeans occupied Knossos . Mycenaean settlement sites also appeared in Epirus , Macedonia , on islands in the Aegean Sea , on the coast of Asia Minor , the Levant , Cyprus and Italy. Mycenaean artefacts have been found well outside the limits of the Mycenean world. Quite unlike the Minoans, whose society benefited from trade, the Mycenaeans advanced through conquest. Mycenaean civilization was dominated by a warrior aristocracy . Around 1400 BC, the Mycenaeans extended their control to Crete, the centre of the Minoan civilization, and adopted a form of the Minoan script (called Linear A ) to write their early form of Greek in Linear B . The Mycenaean civilization perished with the collapse of Bronze-Age civilization on the eastern shores of the Mediterranean Sea. The collapse is commonly attributed to the Dorian invasion , although other theories describing natural disasters and climate change have been advanced as well. [ citation needed ] Whatever the causes, the Mycenaean civilization had definitely disappeared after LH III C , when the sites of Mycenae and Tiryns were again destroyed and lost their importance. This end, during the last years of the 12th century BC, occurred after a slow decline of the Mycenaean civilization, which lasted many years before dying out. The beginning of the 11th century BC opened a new context, that of the protogeometric, the beginning of the geometric period, the Greek Dark Ages of traditional historiography. The Bronze Age collapse may be seen in the context of a technological history that saw the slow spread of ironworking technology from present-day Bulgaria and Romania in the 13th and the 12th centuries BC. The Tumulus culture and the following Urnfield culture of central Europe were part of the origin of the Roman and Greek cultures. Classical antiquity , also known as the classical era, classical period, classical age, or simply antiquity, is the period of cultural history between the 8th century BC and the 5th century AD comprising the interwoven civilizations of ancient Greece and ancient Rome known together as the Greco-Roman world , centered on the Mediterranean Basin . It is the period during which ancient Greece and ancient Rome flourished and had major influence throughout much of Europe , North Africa , and West Asia . The Hellenic civilisation was a collection of city-states or poleis with different governments and cultures that achieved notable developments in government, philosophy, science, mathematics, politics, sports, theatre and music. The most powerful city-states were Athens , Sparta , Thebes , Corinth , and Syracuse . Athens was a powerful Hellenic city-state and governed itself with an early form of direct democracy invented by Cleisthenes ; the citizens of Athens voted on legislation and executive bills themselves. Athens was the home of Socrates , Plato , and the Platonic Academy . The Hellenic city-states established colonies on the shores of the Black Sea and the Mediterranean Sea ( Asian Minor , Sicily , and Southern Italy in Magna Graecia ). By the late 6th century BC, the Greek city states in Asia Minor had been incorporated into the Persian Empire , while the latter had made territorial gains in the Balkans (such as Macedon , Thrace , Paeonia , etc.) and Eastern Europe proper as well. In the course of the 5th century BC, some of the Greek city states attempted to overthrow Persian rule in the Ionian Revolt , which failed. This sparked the first Persian invasion of mainland Greece . At some point during the ensuing Greco-Persian Wars , namely during the Second Persian invasion of Greece , and precisely after the Battle of Thermopylae and the Battle of Artemisium , almost all of Greece to the north of the Isthmus of Corinth had been overrun by the Persians, but the Greek city states reached a decisive victory at the Battle of Plataea . With the end of the Greco-Persian wars, the Persians were eventually forced to withdraw from their territories in Europe. The Greco-Persian Wars and the victory of the Greek city states directly influenced the entire further course of European history and would set its further tone. Some Greek city-states formed the Delian League to continue fighting Persia, but Athens' position as leader of this league led Sparta to form the rival Peloponnesian League . The Peloponnesian Wars ensued, and the Peloponnesian League was victorious. Subsequently, discontent with Spartan hegemony led to the Corinthian War and the defeat of Sparta at the Battle of Leuctra . At the same time at the north ruled the Thracian Odrysian Kingdom between the 5th century BC and the 1st century AD. Hellenic infighting left Greek city states vulnerable, and Philip II of Macedon united the Greek city states under his control. The son of Philip II, known as Alexander the Great , invaded neighboring Persia , toppled and incorporated its domains, as well as invading Egypt and going as far off as India, increasing contact with people and cultures in these regions that marked the beginning of the Hellenistic period . After the death of Alexander the Great , his empire split into multiple kingdoms ruled by his generals, the Diadochi . The Diadochi fought against each other in a series of conflicts called the Wars of the Diadochi . In the beginning of the 2nd century BC, only three major kingdoms remained: the Ptolemaic Egypt , the Seleucid Empire and Macedonia . These kingdoms spread Greek culture to regions as far away as Bactria . Much of Greek learning was assimilated by the nascent Roman state as it expanded outward from Italy, taking advantage of its enemies' inability to unite: the only challenge to Roman ascent came from the Phoenician colony of Carthage , and its defeats in the three Punic Wars marked the start of Roman hegemony . First governed by kings , then as a senatorial republic (the Roman Republic ), Rome finally became an empire at the end of the 1st century BC, under Augustus and his authoritarian successors. The Roman Empire had its centre in the Mediterranean, controlling all the countries on its shores; the northern border was marked by the Rhine and Danube rivers. Under the emperor Trajan (2nd century AD) the empire reached its maximum expansion, controlling approximately 5,900,000 km 2 (2,300,000 sq mi) of land surface, including Italia , Gallia , Dalmatia , Aquitania , Britannia , Baetica , Hispania , Thrace , Macedonia , Greece , Moesia , Dacia , Pannonia , Egypt, Asia Minor , Cappadocia , Armenia , Caucasus , North Africa, Levant and parts of Mesopotamia . Pax Romana , a period of peace, civilisation and an efficient centralised government in the subject territories ended in the 3rd century, when a series of civil wars undermined Rome's economic and social strength. In the 4th century, the emperors Diocletian and Constantine were able to slow down the process of decline by splitting the empire into a Western part with a capital in Rome and an Eastern part with the capital in Byzantium, or Constantinople (now Istanbul). Constantinople is generally considered to be the center of " Eastern Orthodox civilization ". Whereas Diocletian severely persecuted Christianity , Constantine declared an official end to state-sponsored persecution of Christians in 313 with the Edict of Milan , thus setting the stage for the Church to become the state church of the Roman Empire in about 380. The Roman Empire had been repeatedly attacked by invading armies from Northern Europe and in 476, Rome finally fell . Romulus Augustus , the last emperor of the Western Roman Empire , surrendered to the Germanic King Odoacer .When Emperor Constantine had reconquered Rome under the banner of the cross in 312, he soon afterwards issued the Edict of Milan in 313 (preceded by the Edict of Serdica in 311), declaring the legality of Christianity in the Roman Empire. In addition, Constantine officially shifted the capital of the Roman Empire from Rome to the Greek town of Byzantium , which he renamed Nova Roma – it was later named Constantinople ("City of Constantine"). Theodosius I , who had made Christianity the official religion of the Roman Empire , would be the last emperor to preside over a united Roman Empire, until his death in 395. The empire was split into two halves: the Western Roman Empire centred in Ravenna , and the Eastern Roman Empire (later to be referred to as the Byzantine Empire ) centred in Constantinople. The Roman Empire was repeatedly attacked by Hunnic , Germanic , Slavic and other "barbarian" tribes (see: Migration Period ), and in 476 finally the Western part fell to the Heruli chieftain Odoacer . Roman authority in the Western part of the empire had collapsed, and a power vacuum left in the wake of this collapse; the central organization, institutions, laws and power of Rome had broken down, resulting in many areas being open to invasion by migrating tribes. Over time, feudalism and manorialism arose, providing for division of land and labour, as well as a broad if uneven hierarchy of law and protection. These localised hierarchies were based on the bond of common people to the land on which they worked, and to a lord, who would provide and administer both local law to settle disputes among the peasants, as well as protection from outside invaders. The western provinces soon were to be dominated by three great powers: first, the Franks ( Merovingian dynasty ) in Francia 481–843 AD, which covered much of present France and Germany; second, the Visigothic kingdom 418–711 AD in the Iberian Peninsula (modern Spain); and third, the Ostrogothic kingdom 493–553 AD in Italy and parts of the western Balkans. The Ostrogoths were later replaced by the Kingdom of the Lombards 568–774 AD. Although these powers covered large territories, they did not have the great resources and bureaucracy of the Roman empire to control regions and localities; more power and responsibilities were left to local lords. On the other hand, it also meant more freedom, particularly in more remote areas. In Italy, Theodoric the Great began the cultural romanisation of the new world he had constructed. He made Ravenna a centre of Romano-Greek culture of art and his court fostered a flowering of literature and philosophy in Latin . In Iberia, King Chindasuinth created the Visigothic Code . In the Eastern part the dominant state was the remaining Eastern Roman Empire. In the feudal system, new princes and kings arose, the most powerful of which was arguably the Frankish ruler Charlemagne . In 800, Charlemagne, reinforced by his massive territorial conquests, was crowned Emperor of the Romans by Pope Leo III , solidifying his power in western Europe. Charlemagne's reign marked the beginning of a new Germanic Roman Empire in the west, the Holy Roman Empire . Outside his borders, new forces were gathering. The Kievan Rus' were marking out their territory, a Great Moravia was growing, while the Angles and the Saxons were securing their borders. For the duration of the 6th century, the Eastern Roman Empire was embroiled in a series of deadly conflicts, first with the Persian Sassanid Empire (see Roman–Persian Wars ), followed by the onslaught of the arising Islamic Caliphate ( Rashidun and Umayyad ). By 650, the provinces of Egypt , Palestine and Syria were lost to the Muslim forces , followed by Hispania and southern Italy in the 7th and 8th centuries (see Muslim conquests ). The Arab invasion from the east was stopped after the intervention of the Bulgarian Empire (see Han Tervel ).The Middle Ages are commonly dated from the fall of the Western Roman Empire (or by some scholars, before that) in the 5th century to the beginning of the early modern period in the 16th century marked by the rise of nation states , the division of Western Christianity in the Reformation , the rise of humanism in the Italian Renaissance , and the beginnings of European overseas expansion which allowed for the Columbian Exchange . Many consider Emperor Constantine I (reigned 306–337) to be the first " Byzantine emperor ". It was he who moved the imperial capital in 324 from Nicomedia to Byzantium , which re-founded as Constantinople, or Nova Roma (" New Rome "). The city of Rome itself had not served as the capital since the reign of Diocletian (284–305). Some date the beginnings of the Empire to the reign of Theodosius I (379–395) and Christianity's official supplanting of the pagan Roman religion , or following his death in 395, when the empire was split into two parts, with capitals in Rome and Constantinople. Others place it yet later in 476, when Romulus Augustulus , traditionally considered the last western emperor, was deposed, thus leaving sole imperial authority with the emperor in the Greek East . Others point to the reorganisation of the empire in the time of Heraclius (c. 620) when Latin titles and usages were officially replaced with Greek versions. In any case, the changeover was gradual and by 330, when Constantine inaugurated his new capital, the process of hellenization and increasing Christianisation was already under way. The Empire is generally considered to have ended after the fall of Constantinople to the Ottoman Turks in 1453. The Plague of Justinian was a pandemic that afflicted the Byzantine Empire, including its capital Constantinople , in the years 541–542. It is estimated that the Plague of Justinian killed as many as 100 million people. It caused Europe's population to drop by around 50% between 541 and 700. It also may have contributed to the success of the Muslim conquests . During most of its existence, the Byzantine Empire was one of the most powerful economic, cultural, and military forces in Europe, and Constantinople was one of the largest and wealthiest cities in Europe. The Early Middle Ages span roughly five centuries from 500 to 1000. In the East and Southeast of Europe new dominant states formed: the Avar Khaganate (567–after 822), Old Great Bulgaria (632–668), the Khazar Khaganate (c. 650–969) and Danube Bulgaria (founded by Asparuh in 680) were constantly rivaling the hegemony of the Byzantine Empire. From the 7th century Byzantine history was greatly affected by the rise of Islam and the Caliphates . Muslim Arabs first invaded historically Roman territory under Abū Bakr , first Caliph of the Rashidun Caliphate , who entered Roman Syria and Roman Mesopotamia . As the Byzantines and neighboring Sasanids were severely weakened by the time, amongst the most important reason(s) being the protracted, centuries-lasting and frequent Byzantine–Sasanian wars , which included the climactic Byzantine–Sasanian War of 602–628 , under Umar , the second Caliph, the Muslims entirely toppled the Sasanid Persian Empire , and decisively conquered Syria and Mesopotamia, as well as Roman Palestine , Roman Egypt , and parts of Asia Minor and Roman North Africa . In the mid 7th century AD, following the Muslim conquest of Persia , Islam penetrated into the Caucasus region, of which parts would later permanently become part of Russia. This trend, which included the conquests by the invading Muslim forces and by that the spread of Islam as well continued under Umar's successors and under the Umayyad Caliphate , which conquered the rest of Mediterranean North Africa and most of the Iberian Peninsula . Over the next centuries Muslim forces were able to take further European territory, including Cyprus , Malta, Crete , and Sicily and parts of southern Italy . The Muslim conquest of Hispania began when the Moors invaded the Christian Visigothic kingdom of Hispania in 711, under the Berber general Tariq ibn Ziyad . They landed at Gibraltar on 30 April and worked their way northward. Tariq's forces were joined the next year by those of his Arab superior, Musa ibn Nusair . During the eight-year campaign most of the Iberian Peninsula was brought under Muslim rule – save for small areas in the northwest ( Asturias ) and largely Basque regions in the Pyrenees . In 711, Visigothic Hispania was weakened because it was immersed in a serious internal crisis caused by a war of succession to the throne. The Muslims took advantage of the crisis within the Hispano - Visigothic society to carry out their conquests. This territory, under the Arab name Al-Andalus , became part of the expanding Umayyad empire. The second siege of Constantinople (717) ended unsuccessfully after the intervention of Tervel of Bulgaria and weakened the Umayyad dynasty and reduced their prestige. In 722 Don Pelayo formed an army of 300 Astur soldiers, to confront Munuza's Muslim troops. In the battle of Covadonga , the Astures defeated the Arab-Moors, who decided to retire. The Christian victory marked the beginning of the Reconquista and the establishment of the Kingdom of Asturias , whose first sovereign was Don Pelayo. The conquerors intended to continue their expansion in Europe and move northeast across the Pyrenees, but were defeated by the Frankish leader Charles Martel at the Battle of Poitiers in 732. The Umayyads were overthrown in 750 by the ' Abbāsids , and, in 756, the Umayyads established an independent emirate in the Iberian Peninsula. The Holy Roman Empire emerged around 800, as Charlemagne, King of the Franks and part of the Carolingian dynasty , was crowned by the pope as emperor. His empire based in modern France, the Low Countries and Germany expanded into modern Hungary, Italy, Bohemia , Lower Saxony and Spain. He and his father received substantial help from an alliance with the Pope, who wanted help against the Lombards . His death marked the beginning of the end of the dynasty, which collapsed entirely by 888. The fragmentation of power led to semi-autonomy in the region, and has been defined as a critical starting point for the formation of states in Europe. To the east, Bulgaria was established in 681 and became the first Slavic country. [ citation needed ] The powerful Bulgarian Empire was the main rival of Byzantium for control of the Balkans for centuries and from the 9th century became the cultural centre of Slavic Europe. The Empire created the Cyrillic script during the 9th century AD, at the Preslav Literary School , and experienced the Golden Age of Bulgarian cultural prosperity during the reign of emperor Simeon I the Great (893–927). Two states, Great Moravia and Kievan Rus' , emerged among the Slavic peoples respectively in the 9th century. In the late 9th and 10th centuries, northern and western Europe felt the burgeoning power and influence of the Vikings who raided, traded, conquered and settled swiftly and efficiently with their advanced seagoing vessels such as the longships . The Vikings had left a cultural influence on the Anglo-Saxons and Franks as well as the Scots . The Hungarians pillaged mainland Europe, the Pechenegs raided Bulgaria, Rus States and the Arab states. In the 10th century independent kingdoms were established in Central Europe including Poland and the newly settled Kingdom of Hungary . The Kingdom of Croatia also appeared in the Balkans. The subsequent period, ending around 1000, saw the further growth of feudalism , which weakened the Holy Roman Empire. In eastern Europe, Volga Bulgaria became an Islamic state in 921, after Almış I converted to Islam under the missionary efforts of Ahmad ibn Fadlan . Slavery in the early medieval period had mostly died out in western Europe by about the year 1000 AD, replaced by serfdom . It lingered longer in England and in peripheral areas linked to the Muslim world, where slavery continued to flourish. Church rules suppressed slavery of Christians. Most historians argue the transition was quite abrupt around 1000, but some see a gradual transition from about 300 to 1000. In 1054, the East–West Schism occurred between the two remaining Christian seats in Rome and Constantinople (modern Istanbul). The High Middle Ages of the 11th, 12th, and 13th centuries show a rapidly increasing population of Europe, which caused great social and political change from the preceding era. By 1250, the robust population increase greatly benefited the economy, reaching levels it would not see again in some areas until the 19th century. From about the year 1000 onwards, Western Europe saw the last of the barbarian invasions and became more politically organized. The Vikings had settled in Britain, Ireland, France and elsewhere, whilst Norse Christian kingdoms were developing in their Scandinavian homelands. The Magyars had ceased their expansion in the 10th century, and by the year 1000, the Roman Catholic Apostolic Kingdom of Hungary was recognised in central Europe. With the brief exception of the Mongol invasions , major barbarian incursions ceased. Bulgarian sovereignty was re-established with the anti-Byzantine uprising of the Bulgarians and Vlachs in 1185. The crusaders invaded the Byzantine Empire, captured Constantinople in 1204 and established their Latin Empire . Kaloyan of Bulgaria defeated Baldwin I , Latin Emperor of Constantinople , in the Battle of Adrianople on 14 April 1205. The reign of Ivan Asen II of Bulgaria led to maximum territorial expansion and that of Ivan Alexander of Bulgaria to a Second Golden Age of Bulgarian culture . The Byzantine Empire was fully re-established in 1261. In the 11th century, populations north of the Alps began to settle new lands. Vast forests and marshes of Europe were cleared and cultivated. At the same time settlements moved beyond the traditional boundaries of the Frankish Empire to new frontiers in Europe, beyond the Elbe river, tripling the size of Germany in the process. Crusaders founded European colonies in the Levant , the majority of the Iberian Peninsula was conquered from the Muslims, and the Normans colonised southern Italy, all part of the major population increase and resettlement pattern. The High Middle Ages produced many different forms of intellectual, spiritual and artistic works . The most famous are the great cathedrals as expressions of Gothic architecture , which evolved from Romanesque architecture . This age saw the rise of modern nation-states in Western Europe and the ascent of the famous Italian city-states , such as Florence and Venice . The influential popes of the Catholic Church called volunteer armies from across Europe to a series of Crusades against the Seljuq Turks , who occupied the Holy Land . The rediscovery of the works of Aristotle led Thomas Aquinas and other thinkers to develop the philosophy of Scholasticism . After the East–West Schism , Western Christianity was adopted by the newly created kingdoms of Central Europe: Poland , Hungary and Bohemia . The Roman Catholic Church developed as a major power, leading to conflicts between the Pope and emperor. The geographic reach of the Roman Catholic Church expanded enormously due to the conversions of pagan kings (Scandinavia, Lithuania , Poland, Hungary), the Christian Reconquista of Al-Andalus , and the Crusades. Most of Europe was Roman Catholic in the 15th century. Early signs of the rebirth of civilization in western Europe began to appear in the 11th century as trade started again in Italy, leading to the economic and cultural growth of independent city-states such as Venice and Florence ; at the same time, nation-states began to take form in places such as France, England, Spain, and Portugal, although the process of their formation (usually marked by rivalry between the monarchy, the aristocratic feudal lords and the church) actually took several centuries. These new nation-states began writing in their own cultural vernaculars, instead of the traditional Latin . Notable figures of this movement would include Dante Alighieri and Christine de Pizan . The Holy Roman Empire , essentially based in Germany and Italy, further fragmented into a myriad of feudal principalities or small city states, whose subjection to the emperor was only formal. The 14th century, when the Mongol Empire came to power, is often called the Age of the Mongols . Mongol armies expanded westward under the command of Batu Khan . Their western conquests included almost all of Kievan Rus' (save Novgorod , which became a vassal), and the Kipchak-Cuman Confederation . Bulgaria , Hungary, and Poland managed to remain sovereign states. Mongolian records indicate that Batu Khan was planning a complete conquest of the remaining European powers, beginning with a winter attack on Austria, Italy and Germany, when he was recalled to Mongolia upon the death of Great Khan Ögedei . Most historians believe only his death prevented the complete conquest of Europe. [ citation needed ] The areas of Eastern Europe and most of Central Asia that were under direct Mongol rule became known as the Golden Horde . Under Uzbeg Khan , Islam became the official religion of the region in the early 14th century. The invading Mongols, together with their mostly Turkic subjects, were known as Tatars . In Russia, the Tatars ruled the various states of the Rus' through vassalage for over 300 years. In the Northern Europe, Konrad of Masovia gave Chełmno to the Teutonic Knights in 1226 as a base for a Crusade against the Old Prussians and Grand Duchy of Lithuania . The Livonian Brothers of the Sword were defeated by the Lithuanians, so in 1237 Gregory IX merged the remainder of the order into the Teutonic Order as the Livonian Order . By the middle of the century, the Teutonic Knights completed their conquest of the Prussians before converting the Lithuanians in the subsequent decades. The order also came into conflict with the Eastern Orthodox Church of the Pskov and Novgorod Republics . In 1240 the Orthodox Novgorod army defeated the Catholic Swedes in the Battle of the Neva , and, two years later, they defeated the Livonian Order in the Battle on the Ice . The Union of Krewo in 1386, bringing two major changes in the history of the Grand Duchy of Lithuania: conversion to Catholicism and establishment of a dynastic union between the Grand Duchy of Lithuania and the Crown of the Kingdom of Poland marked both the greatest territorial expansion of the Grand Duchy and the defeat of the Teutonic Knights in the Battle of Grunwald in 1410. The Late Middle Ages spanned around the 14th and late 15th centuries. Around 1300, centuries of European prosperity and growth came to a halt. A series of famines and plagues, such as the Great Famine of 1315–1317 and the Black Death , killed people in a matter of days, reducing the population of some areas by half as many survivors fled. Kishlansky reports: Depopulation caused labor to become scarcer; the survivors were better paid and peasants could drop some of the burdens of feudalism. There was also social unrest; France and England experienced serious peasant risings including the Jacquerie and the Peasants' Revolt . The unity of the Catholic Church was shattered by the Great Schism . Collectively these events have been called the Crisis of the Late Middle Ages . Beginning in the 14th century, the Baltic Sea became one of the most important trade routes . The Hanseatic League , an alliance of trading cities, facilitated the absorption of vast areas of Poland, Lithuania , and Livonia into trade with other European countries. This fed the growth of powerful states in this part of Europe including Poland–Lithuania, Hungary, Bohemia, and Muscovy later on. The conventional end of the Middle Ages is usually associated with the fall of the city of Constantinople and of the Byzantine Empire to the Ottoman Turks in 1453. The Turks made the city the capital of their Ottoman Empire , which lasted until 1922 and included Egypt, Syria, and most of the Balkans. The Ottoman wars in Europe marked an essential part of the history of the continent. A key 15th-century development was the advent of the movable type of printing press circa 1439 in Mainz, building upon the impetus provided by the prior introduction of paper from China via the Arabs in the High Middle Ages. The adoption of the technology across the continent at dazzling speed for the remaining part of the 15th century would usher a revolution and by 1500 over 200 cities in Europe had presses that printed between 8 and 20 million books. Many consider Emperor Constantine I (reigned 306–337) to be the first " Byzantine emperor ". It was he who moved the imperial capital in 324 from Nicomedia to Byzantium , which re-founded as Constantinople, or Nova Roma (" New Rome "). The city of Rome itself had not served as the capital since the reign of Diocletian (284–305). Some date the beginnings of the Empire to the reign of Theodosius I (379–395) and Christianity's official supplanting of the pagan Roman religion , or following his death in 395, when the empire was split into two parts, with capitals in Rome and Constantinople. Others place it yet later in 476, when Romulus Augustulus , traditionally considered the last western emperor, was deposed, thus leaving sole imperial authority with the emperor in the Greek East . Others point to the reorganisation of the empire in the time of Heraclius (c. 620) when Latin titles and usages were officially replaced with Greek versions. In any case, the changeover was gradual and by 330, when Constantine inaugurated his new capital, the process of hellenization and increasing Christianisation was already under way. The Empire is generally considered to have ended after the fall of Constantinople to the Ottoman Turks in 1453. The Plague of Justinian was a pandemic that afflicted the Byzantine Empire, including its capital Constantinople , in the years 541–542. It is estimated that the Plague of Justinian killed as many as 100 million people. It caused Europe's population to drop by around 50% between 541 and 700. It also may have contributed to the success of the Muslim conquests . During most of its existence, the Byzantine Empire was one of the most powerful economic, cultural, and military forces in Europe, and Constantinople was one of the largest and wealthiest cities in Europe. The Early Middle Ages span roughly five centuries from 500 to 1000. In the East and Southeast of Europe new dominant states formed: the Avar Khaganate (567–after 822), Old Great Bulgaria (632–668), the Khazar Khaganate (c. 650–969) and Danube Bulgaria (founded by Asparuh in 680) were constantly rivaling the hegemony of the Byzantine Empire. From the 7th century Byzantine history was greatly affected by the rise of Islam and the Caliphates . Muslim Arabs first invaded historically Roman territory under Abū Bakr , first Caliph of the Rashidun Caliphate , who entered Roman Syria and Roman Mesopotamia . As the Byzantines and neighboring Sasanids were severely weakened by the time, amongst the most important reason(s) being the protracted, centuries-lasting and frequent Byzantine–Sasanian wars , which included the climactic Byzantine–Sasanian War of 602–628 , under Umar , the second Caliph, the Muslims entirely toppled the Sasanid Persian Empire , and decisively conquered Syria and Mesopotamia, as well as Roman Palestine , Roman Egypt , and parts of Asia Minor and Roman North Africa . In the mid 7th century AD, following the Muslim conquest of Persia , Islam penetrated into the Caucasus region, of which parts would later permanently become part of Russia. This trend, which included the conquests by the invading Muslim forces and by that the spread of Islam as well continued under Umar's successors and under the Umayyad Caliphate , which conquered the rest of Mediterranean North Africa and most of the Iberian Peninsula . Over the next centuries Muslim forces were able to take further European territory, including Cyprus , Malta, Crete , and Sicily and parts of southern Italy . The Muslim conquest of Hispania began when the Moors invaded the Christian Visigothic kingdom of Hispania in 711, under the Berber general Tariq ibn Ziyad . They landed at Gibraltar on 30 April and worked their way northward. Tariq's forces were joined the next year by those of his Arab superior, Musa ibn Nusair . During the eight-year campaign most of the Iberian Peninsula was brought under Muslim rule – save for small areas in the northwest ( Asturias ) and largely Basque regions in the Pyrenees . In 711, Visigothic Hispania was weakened because it was immersed in a serious internal crisis caused by a war of succession to the throne. The Muslims took advantage of the crisis within the Hispano - Visigothic society to carry out their conquests. This territory, under the Arab name Al-Andalus , became part of the expanding Umayyad empire. The second siege of Constantinople (717) ended unsuccessfully after the intervention of Tervel of Bulgaria and weakened the Umayyad dynasty and reduced their prestige. In 722 Don Pelayo formed an army of 300 Astur soldiers, to confront Munuza's Muslim troops. In the battle of Covadonga , the Astures defeated the Arab-Moors, who decided to retire. The Christian victory marked the beginning of the Reconquista and the establishment of the Kingdom of Asturias , whose first sovereign was Don Pelayo. The conquerors intended to continue their expansion in Europe and move northeast across the Pyrenees, but were defeated by the Frankish leader Charles Martel at the Battle of Poitiers in 732. The Umayyads were overthrown in 750 by the ' Abbāsids , and, in 756, the Umayyads established an independent emirate in the Iberian Peninsula. The Holy Roman Empire emerged around 800, as Charlemagne, King of the Franks and part of the Carolingian dynasty , was crowned by the pope as emperor. His empire based in modern France, the Low Countries and Germany expanded into modern Hungary, Italy, Bohemia , Lower Saxony and Spain. He and his father received substantial help from an alliance with the Pope, who wanted help against the Lombards . His death marked the beginning of the end of the dynasty, which collapsed entirely by 888. The fragmentation of power led to semi-autonomy in the region, and has been defined as a critical starting point for the formation of states in Europe. To the east, Bulgaria was established in 681 and became the first Slavic country. [ citation needed ] The powerful Bulgarian Empire was the main rival of Byzantium for control of the Balkans for centuries and from the 9th century became the cultural centre of Slavic Europe. The Empire created the Cyrillic script during the 9th century AD, at the Preslav Literary School , and experienced the Golden Age of Bulgarian cultural prosperity during the reign of emperor Simeon I the Great (893–927). Two states, Great Moravia and Kievan Rus' , emerged among the Slavic peoples respectively in the 9th century. In the late 9th and 10th centuries, northern and western Europe felt the burgeoning power and influence of the Vikings who raided, traded, conquered and settled swiftly and efficiently with their advanced seagoing vessels such as the longships . The Vikings had left a cultural influence on the Anglo-Saxons and Franks as well as the Scots . The Hungarians pillaged mainland Europe, the Pechenegs raided Bulgaria, Rus States and the Arab states. In the 10th century independent kingdoms were established in Central Europe including Poland and the newly settled Kingdom of Hungary . The Kingdom of Croatia also appeared in the Balkans. The subsequent period, ending around 1000, saw the further growth of feudalism , which weakened the Holy Roman Empire. In eastern Europe, Volga Bulgaria became an Islamic state in 921, after Almış I converted to Islam under the missionary efforts of Ahmad ibn Fadlan . Slavery in the early medieval period had mostly died out in western Europe by about the year 1000 AD, replaced by serfdom . It lingered longer in England and in peripheral areas linked to the Muslim world, where slavery continued to flourish. Church rules suppressed slavery of Christians. Most historians argue the transition was quite abrupt around 1000, but some see a gradual transition from about 300 to 1000. The Holy Roman Empire emerged around 800, as Charlemagne, King of the Franks and part of the Carolingian dynasty , was crowned by the pope as emperor. His empire based in modern France, the Low Countries and Germany expanded into modern Hungary, Italy, Bohemia , Lower Saxony and Spain. He and his father received substantial help from an alliance with the Pope, who wanted help against the Lombards . His death marked the beginning of the end of the dynasty, which collapsed entirely by 888. The fragmentation of power led to semi-autonomy in the region, and has been defined as a critical starting point for the formation of states in Europe. To the east, Bulgaria was established in 681 and became the first Slavic country. [ citation needed ] The powerful Bulgarian Empire was the main rival of Byzantium for control of the Balkans for centuries and from the 9th century became the cultural centre of Slavic Europe. The Empire created the Cyrillic script during the 9th century AD, at the Preslav Literary School , and experienced the Golden Age of Bulgarian cultural prosperity during the reign of emperor Simeon I the Great (893–927). Two states, Great Moravia and Kievan Rus' , emerged among the Slavic peoples respectively in the 9th century. In the late 9th and 10th centuries, northern and western Europe felt the burgeoning power and influence of the Vikings who raided, traded, conquered and settled swiftly and efficiently with their advanced seagoing vessels such as the longships . The Vikings had left a cultural influence on the Anglo-Saxons and Franks as well as the Scots . The Hungarians pillaged mainland Europe, the Pechenegs raided Bulgaria, Rus States and the Arab states. In the 10th century independent kingdoms were established in Central Europe including Poland and the newly settled Kingdom of Hungary . The Kingdom of Croatia also appeared in the Balkans. The subsequent period, ending around 1000, saw the further growth of feudalism , which weakened the Holy Roman Empire. In eastern Europe, Volga Bulgaria became an Islamic state in 921, after Almış I converted to Islam under the missionary efforts of Ahmad ibn Fadlan . Slavery in the early medieval period had mostly died out in western Europe by about the year 1000 AD, replaced by serfdom . It lingered longer in England and in peripheral areas linked to the Muslim world, where slavery continued to flourish. Church rules suppressed slavery of Christians. Most historians argue the transition was quite abrupt around 1000, but some see a gradual transition from about 300 to 1000. In 1054, the East–West Schism occurred between the two remaining Christian seats in Rome and Constantinople (modern Istanbul). The High Middle Ages of the 11th, 12th, and 13th centuries show a rapidly increasing population of Europe, which caused great social and political change from the preceding era. By 1250, the robust population increase greatly benefited the economy, reaching levels it would not see again in some areas until the 19th century. From about the year 1000 onwards, Western Europe saw the last of the barbarian invasions and became more politically organized. The Vikings had settled in Britain, Ireland, France and elsewhere, whilst Norse Christian kingdoms were developing in their Scandinavian homelands. The Magyars had ceased their expansion in the 10th century, and by the year 1000, the Roman Catholic Apostolic Kingdom of Hungary was recognised in central Europe. With the brief exception of the Mongol invasions , major barbarian incursions ceased. Bulgarian sovereignty was re-established with the anti-Byzantine uprising of the Bulgarians and Vlachs in 1185. The crusaders invaded the Byzantine Empire, captured Constantinople in 1204 and established their Latin Empire . Kaloyan of Bulgaria defeated Baldwin I , Latin Emperor of Constantinople , in the Battle of Adrianople on 14 April 1205. The reign of Ivan Asen II of Bulgaria led to maximum territorial expansion and that of Ivan Alexander of Bulgaria to a Second Golden Age of Bulgarian culture . The Byzantine Empire was fully re-established in 1261. In the 11th century, populations north of the Alps began to settle new lands. Vast forests and marshes of Europe were cleared and cultivated. At the same time settlements moved beyond the traditional boundaries of the Frankish Empire to new frontiers in Europe, beyond the Elbe river, tripling the size of Germany in the process. Crusaders founded European colonies in the Levant , the majority of the Iberian Peninsula was conquered from the Muslims, and the Normans colonised southern Italy, all part of the major population increase and resettlement pattern. The High Middle Ages produced many different forms of intellectual, spiritual and artistic works . The most famous are the great cathedrals as expressions of Gothic architecture , which evolved from Romanesque architecture . This age saw the rise of modern nation-states in Western Europe and the ascent of the famous Italian city-states , such as Florence and Venice . The influential popes of the Catholic Church called volunteer armies from across Europe to a series of Crusades against the Seljuq Turks , who occupied the Holy Land . The rediscovery of the works of Aristotle led Thomas Aquinas and other thinkers to develop the philosophy of Scholasticism . After the East–West Schism , Western Christianity was adopted by the newly created kingdoms of Central Europe: Poland , Hungary and Bohemia . The Roman Catholic Church developed as a major power, leading to conflicts between the Pope and emperor. The geographic reach of the Roman Catholic Church expanded enormously due to the conversions of pagan kings (Scandinavia, Lithuania , Poland, Hungary), the Christian Reconquista of Al-Andalus , and the Crusades. Most of Europe was Roman Catholic in the 15th century. Early signs of the rebirth of civilization in western Europe began to appear in the 11th century as trade started again in Italy, leading to the economic and cultural growth of independent city-states such as Venice and Florence ; at the same time, nation-states began to take form in places such as France, England, Spain, and Portugal, although the process of their formation (usually marked by rivalry between the monarchy, the aristocratic feudal lords and the church) actually took several centuries. These new nation-states began writing in their own cultural vernaculars, instead of the traditional Latin . Notable figures of this movement would include Dante Alighieri and Christine de Pizan . The Holy Roman Empire , essentially based in Germany and Italy, further fragmented into a myriad of feudal principalities or small city states, whose subjection to the emperor was only formal. The 14th century, when the Mongol Empire came to power, is often called the Age of the Mongols . Mongol armies expanded westward under the command of Batu Khan . Their western conquests included almost all of Kievan Rus' (save Novgorod , which became a vassal), and the Kipchak-Cuman Confederation . Bulgaria , Hungary, and Poland managed to remain sovereign states. Mongolian records indicate that Batu Khan was planning a complete conquest of the remaining European powers, beginning with a winter attack on Austria, Italy and Germany, when he was recalled to Mongolia upon the death of Great Khan Ögedei . Most historians believe only his death prevented the complete conquest of Europe. [ citation needed ] The areas of Eastern Europe and most of Central Asia that were under direct Mongol rule became known as the Golden Horde . Under Uzbeg Khan , Islam became the official religion of the region in the early 14th century. The invading Mongols, together with their mostly Turkic subjects, were known as Tatars . In Russia, the Tatars ruled the various states of the Rus' through vassalage for over 300 years. In the Northern Europe, Konrad of Masovia gave Chełmno to the Teutonic Knights in 1226 as a base for a Crusade against the Old Prussians and Grand Duchy of Lithuania . The Livonian Brothers of the Sword were defeated by the Lithuanians, so in 1237 Gregory IX merged the remainder of the order into the Teutonic Order as the Livonian Order . By the middle of the century, the Teutonic Knights completed their conquest of the Prussians before converting the Lithuanians in the subsequent decades. The order also came into conflict with the Eastern Orthodox Church of the Pskov and Novgorod Republics . In 1240 the Orthodox Novgorod army defeated the Catholic Swedes in the Battle of the Neva , and, two years later, they defeated the Livonian Order in the Battle on the Ice . The Union of Krewo in 1386, bringing two major changes in the history of the Grand Duchy of Lithuania: conversion to Catholicism and establishment of a dynastic union between the Grand Duchy of Lithuania and the Crown of the Kingdom of Poland marked both the greatest territorial expansion of the Grand Duchy and the defeat of the Teutonic Knights in the Battle of Grunwald in 1410.After the East–West Schism , Western Christianity was adopted by the newly created kingdoms of Central Europe: Poland , Hungary and Bohemia . The Roman Catholic Church developed as a major power, leading to conflicts between the Pope and emperor. The geographic reach of the Roman Catholic Church expanded enormously due to the conversions of pagan kings (Scandinavia, Lithuania , Poland, Hungary), the Christian Reconquista of Al-Andalus , and the Crusades. Most of Europe was Roman Catholic in the 15th century. Early signs of the rebirth of civilization in western Europe began to appear in the 11th century as trade started again in Italy, leading to the economic and cultural growth of independent city-states such as Venice and Florence ; at the same time, nation-states began to take form in places such as France, England, Spain, and Portugal, although the process of their formation (usually marked by rivalry between the monarchy, the aristocratic feudal lords and the church) actually took several centuries. These new nation-states began writing in their own cultural vernaculars, instead of the traditional Latin . Notable figures of this movement would include Dante Alighieri and Christine de Pizan . The Holy Roman Empire , essentially based in Germany and Italy, further fragmented into a myriad of feudal principalities or small city states, whose subjection to the emperor was only formal. The 14th century, when the Mongol Empire came to power, is often called the Age of the Mongols . Mongol armies expanded westward under the command of Batu Khan . Their western conquests included almost all of Kievan Rus' (save Novgorod , which became a vassal), and the Kipchak-Cuman Confederation . Bulgaria , Hungary, and Poland managed to remain sovereign states. Mongolian records indicate that Batu Khan was planning a complete conquest of the remaining European powers, beginning with a winter attack on Austria, Italy and Germany, when he was recalled to Mongolia upon the death of Great Khan Ögedei . Most historians believe only his death prevented the complete conquest of Europe. [ citation needed ] The areas of Eastern Europe and most of Central Asia that were under direct Mongol rule became known as the Golden Horde . Under Uzbeg Khan , Islam became the official religion of the region in the early 14th century. The invading Mongols, together with their mostly Turkic subjects, were known as Tatars . In Russia, the Tatars ruled the various states of the Rus' through vassalage for over 300 years. In the Northern Europe, Konrad of Masovia gave Chełmno to the Teutonic Knights in 1226 as a base for a Crusade against the Old Prussians and Grand Duchy of Lithuania . The Livonian Brothers of the Sword were defeated by the Lithuanians, so in 1237 Gregory IX merged the remainder of the order into the Teutonic Order as the Livonian Order . By the middle of the century, the Teutonic Knights completed their conquest of the Prussians before converting the Lithuanians in the subsequent decades. The order also came into conflict with the Eastern Orthodox Church of the Pskov and Novgorod Republics . In 1240 the Orthodox Novgorod army defeated the Catholic Swedes in the Battle of the Neva , and, two years later, they defeated the Livonian Order in the Battle on the Ice . The Union of Krewo in 1386, bringing two major changes in the history of the Grand Duchy of Lithuania: conversion to Catholicism and establishment of a dynastic union between the Grand Duchy of Lithuania and the Crown of the Kingdom of Poland marked both the greatest territorial expansion of the Grand Duchy and the defeat of the Teutonic Knights in the Battle of Grunwald in 1410.The Late Middle Ages spanned around the 14th and late 15th centuries. Around 1300, centuries of European prosperity and growth came to a halt. A series of famines and plagues, such as the Great Famine of 1315–1317 and the Black Death , killed people in a matter of days, reducing the population of some areas by half as many survivors fled. Kishlansky reports: Depopulation caused labor to become scarcer; the survivors were better paid and peasants could drop some of the burdens of feudalism. There was also social unrest; France and England experienced serious peasant risings including the Jacquerie and the Peasants' Revolt . The unity of the Catholic Church was shattered by the Great Schism . Collectively these events have been called the Crisis of the Late Middle Ages . Beginning in the 14th century, the Baltic Sea became one of the most important trade routes . The Hanseatic League , an alliance of trading cities, facilitated the absorption of vast areas of Poland, Lithuania , and Livonia into trade with other European countries. This fed the growth of powerful states in this part of Europe including Poland–Lithuania, Hungary, Bohemia, and Muscovy later on. The conventional end of the Middle Ages is usually associated with the fall of the city of Constantinople and of the Byzantine Empire to the Ottoman Turks in 1453. The Turks made the city the capital of their Ottoman Empire , which lasted until 1922 and included Egypt, Syria, and most of the Balkans. The Ottoman wars in Europe marked an essential part of the history of the continent. A key 15th-century development was the advent of the movable type of printing press circa 1439 in Mainz, building upon the impetus provided by the prior introduction of paper from China via the Arabs in the High Middle Ages. The adoption of the technology across the continent at dazzling speed for the remaining part of the 15th century would usher a revolution and by 1500 over 200 cities in Europe had presses that printed between 8 and 20 million books. The Early Modern period spans the centuries between the Middle Ages and the Industrial Revolution , roughly from 1500 to 1800, or from the discovery of the New World in 1492 to the French Revolution in 1789. The period is characterised by the rise in importance of science and increasingly rapid technological progress , secularised civic politics, and the nation state. Capitalist economies began their rise, and the early modern period also saw the rise and dominance of the economic theory of mercantilism . As such, the early modern period represents the decline and eventual disappearance, in much of the European sphere, of feudalism , serfdom and the power of the Catholic Church. The period includes the Renaissance , the Scientific Revolution , the Protestant Reformation , the disastrous Thirty Years' War , the European colonisation of the Americas and the European witch-hunts . Despite these crises, the 14th century was also a time of great progress within the arts and sciences. A renewed interest in ancient Greek and Roman led to the Italian Renaissance , a cultural movement that profoundly affected European intellectual life in the early modern period. Beginning in Italy, and spreading to the north, west and middle Europe during a cultural lag of some two and a half centuries, its influence affected literature, philosophy, art, politics, science, history, religion, and other aspects of intellectual inquiry. The Humanists saw their repossession of a great past as a Renaissance – a rebirth of civilization itself. Important political precedents were also set in this period. Niccolò Machiavelli 's political writing in The Prince influenced later absolutism and realpolitik. Also important were the many patrons who ruled states and used the artistry of the Renaissance as a sign of their power. The Scientific Revolution took place in Europe starting towards the second half of the Renaissance period, with the 1543 Nicolaus Copernicus publication De revolutionibus orbium coelestium ( On the Revolutions of the Heavenly Spheres ) often cited as its beginning. Toward the end of the period, an era of discovery began. The growth of the Ottoman Empire , culminating in the fall of Constantinople in 1453, cut off trading possibilities with the east. Western Europe was forced to discover new trading routes, as happened with Columbus' travel to the Americas in 1492, and Vasco da Gama 's circumnavigation of India and Africa in 1498. The numerous wars did not prevent European states from exploring and conquering wide portions of the world, from Africa to Asia and the newly discovered Americas. In the 15th century, Portugal led the way in geographical exploration along the coast of Africa in search of a maritime route to India, followed by Spain near the close of the 15th century, dividing their exploration of the world according to the Treaty of Tordesillas in 1494. They were the first states to set up colonies in America and European trading posts (factories) along the shores of Africa and Asia, establishing the first direct European diplomatic contacts with Southeast Asian states in 1511, China in 1513 and Japan in 1542. In 1552, Russian tsar Ivan the Terrible conquered two major Tatar khanates, the Khanate of Kazan and the Astrakhan Khanate . The Yermak 's voyage of 1580 led to the annexation of the Tatar Siberian Khanate into Russia, and the Russians would soon after conquer the rest of Siberia , steadily expanding to the east and south over the next centuries. Oceanic explorations soon followed by France, England and the Netherlands, who explored the Portuguese and Spanish trade routes into the Pacific Ocean, reaching Australia in 1606 and New Zealand in 1642. With the development of the printing press , new ideas spread throughout Europe and challenged traditional doctrines in science and theology. Simultaneously, the Reformation under German Martin Luther questioned Papal authority. The most common dating of the Reformation begins in 1517, when Luther published The Ninety-Five Theses , and concludes in 1648 with the Treaty of Westphalia that ended years of European religious wars . During this period corruption in the Catholic Church led to a sharp backlash in the Protestant Reformation. It gained many followers especially among princes and kings seeking a stronger state by ending the influence of the Catholic Church. Figures other than Martin Luther began to emerge as well like John Calvin whose Calvinism had influence in many countries and King Henry VIII of England who broke away from the Catholic Church in England and set up the Anglican Church . These religious divisions brought on a wave of wars inspired and driven by religion but also by the ambitious monarchs in Western Europe who were becoming more centralized and powerful. The Protestant Reformation also led to a strong reform movement in the Catholic Church called the Counter-Reformation , which aimed to reduce corruption as well as to improve and strengthen Catholic dogma. Two important groups in the Catholic Church who emerged from this movement were the Jesuits , who helped keep Spain, Portugal, Poland, and other European countries within the Catholic fold, and the Oratorians of Saint Philip Neri , who ministered to the faithful in Rome, restoring their confidence in the Church of Jesus Christ that subsisted substantially in the Church of Rome. Still, the Catholic Church was somewhat weakened by the Reformation, portions of Europe were no longer under its sway and kings in the remaining Catholic countries began to take control of the church institutions within their kingdoms. Unlike many European countries, the Polish–Lithuanian Commonwealth and Hungary were more tolerant. While still enforcing the predominance of Catholicism, they continued to allow the large religious minorities to maintain their faiths, traditions and customs. The Polish–Lithuanian Commonwealth became divided among Catholics, Protestants, Orthodox, Jews and a small Muslim population. Another development was the idea of 'European superiority'. There was a movement by some such as Montaigne that regarded the non-Europeans as a better, more natural and primitive people. Post services were founded all over Europe, which allowed a humanistic interconnected network of intellectuals across Europe, despite religious divisions. However, the Roman Catholic Church banned many leading scientific works; this led to an intellectual advantage for Protestant countries, where the banning of books was regionally organised. Francis Bacon and other advocates of science tried to create unity in Europe by focusing on the unity in nature. 1 In the 15th century, at the end of the Middle Ages, powerful sovereign states were appearing, built by the New Monarchs who were centralising power in France, England, and Spain. On the other hand, the Parliament in the Polish–Lithuanian Commonwealth grew in power, taking legislative rights from the Polish king. The new state power was contested by parliaments in other countries especially England. New kinds of states emerged which were co-operation agreements among territorial rulers, cities, farmer republics and knights. The Iberian kingdoms were able to dominate colonial activity in the 16th century. The Portuguese forged the first global empire in the 15th and 16th century, whilst during the 16th century and the first half of the 17th century, the crown of Castile (and the overarching Hispanic Monarchy, including Portugal from 1580 to 1640) became the most powerful empire in the world. Spanish dominance in America was increasingly challenged by British , French , Dutch and Swedish colonial efforts of the 17th and 18th centuries. New forms of trade and expanding horizons made new forms of government , law and economics necessary. Colonial expansion continued in the following centuries (with some setbacks, such as successful wars of independence in the British American colonies and then later Haiti , Mexico , Argentina , Brazil , and others amid European turmoil of the Napoleonic Wars ). Spain had control of a large part of North America, all of Central America and a great part of South America, the Caribbean and the Philippines ; Britain took the whole of Australia and New Zealand, most of India, and large parts of Africa and North America; France held parts of Canada and India (nearly all of which was lost to Britain in 1763 ), Indochina , large parts of Africa and the Caribbean islands; the Netherlands gained the East Indies (now Indonesia ) and islands in the Caribbean; Portugal obtained Brazil and several territories in Africa and Asia; and later, powers such as Germany, Belgium, Italy and Russia acquired further colonies. [ citation needed ] This expansion helped the economy of the countries owning them. Trade flourished, because of the minor stability of the empires. By the late 16th century, American silver accounted for one-fifth of Spain's total budget. The French colony of Saint-Domingue was one of richest European colonies in the 18th century, operating on a plantation economy fueled by slave labor . During the period of French rule, cash crops produced in Saint-Domingue comprised thirty percent of total French trade while its sugar exports represented forty percent of the Atlantic market. The 17th century was an era of crisis. Many historians have rejected the idea, while others promote it as an invaluable insight into the warfare, politics, economics, and even art. The Thirty Years' War (1618–1648) focused attention on the massive horrors that wars could bring to entire populations. The 1640s in particular saw more state breakdowns around the world than any previous or subsequent period. The Polish–Lithuanian Commonwealth , the largest state in Europe, temporarily disappeared. In addition, there were secessions and upheavals in several parts of the Spanish empire, the world's first global empire. In Britain the entire Stuart monarchy ( England , Scotland , Ireland , and its North American colonies ) rebelled. Political insurgency and a spate of popular revolts seldom equalled shook the foundations of most states in Europe and Asia. More wars took place around the world in the mid-17th century than in almost any other period of recorded history. Across the Northern Hemisphere , the mid-17th century experienced almost unprecedented death rates. The "absolute" rule of powerful monarchs such as Louis XIV (ruled France 1643–1715), Peter the Great (ruled Russia 1682–1725), Maria Theresa (ruled Habsburg lands 1740–1780) and Frederick the Great (ruled Prussia 1740–86), produced powerful centralized states, with strong armies and powerful bureaucracies, all under the control of the king. Throughout the early part of this period, capitalism (through mercantilism) was replacing feudalism as the principal form of economic organisation, at least in the western half of Europe. The expanding colonial frontiers resulted in a Commercial Revolution . The period is noted for the rise of modern science and the application of its findings to technological improvements, which animated the Industrial Revolution after 1750. The Reformation had profound effects on the unity of Europe. Not only were nations divided one from another by their religious orientation, but some states were torn apart internally by religious strife, avidly fostered by their external enemies. France suffered this fate in the 16th century in the series of conflicts known as the French Wars of Religion , which ended in the triumph of the Bourbon Dynasty . England settled down under Elizabeth I to a moderate Anglicanism . Much of modern-day Germany was made up of numerous small sovereign states under the theoretical framework of the Holy Roman Empire , which was further divided along internally drawn sectarian lines. The Polish–Lithuanian Commonwealth is notable in this time for its religious indifference and general immunity to European religious strife. The Thirty Years' War was fought between 1618 and 1648, across Germany and neighbouring areas, and involved most of the major European powers except England and Russia, involving Catholics versus Protestants for the most part. The major impact of the war was the devastation of entire regions scavenged bare by the foraging armies. Episodes of widespread famine and disease, and the breakup of family life, devastated the population of the German states and, to a lesser extent, the Low Countries , the Crown of Bohemia and northern parts of Italy, while bankrupting many of the regional powers involved. Between one-fourth and one-third of the German population perished from direct military causes or from disease and starvation, as well as postponed births. After the Peace of Westphalia , which ended the war in favour of nations deciding their own religious allegiance, absolutism became the norm of the continent, while parts of Europe experimented with constitutions foreshadowed by the English Civil War and particularly the Glorious Revolution . European military conflict did not cease, but had less disruptive effects on the lives of Europeans. In the advanced northwest, the Enlightenment gave a philosophical underpinning to the new outlook, and the continued spread of literacy, made possible by the printing press , created new secular forces in thought. From the Union of Krewo, central and eastern Europe was dominated by Kingdom of Poland and Grand Duchy of Lithuania . In the 16th and 17th centuries Central and Eastern Europe was an arena of conflict for domination of the continent between Sweden , the Polish–Lithuanian Commonwealth (involved in series of wars, like Khmelnytsky uprising , Russo-Polish War , the Deluge , etc.) and the Ottoman Empire . This period saw a gradual decline of these three powers which were eventually replaced by new enlightened absolutist monarchies: Russia, Prussia and Austria (the Habsburg monarchy ). By the turn of the 19th century they had become new powers, having divided Poland between themselves, with Sweden and Turkey having experienced substantial territorial losses to Russia and Austria respectively as well as pauperisation. The War of the Spanish Succession (1701–1715) was a major war with France opposed by a coalition of England, the Netherlands, the Habsburg monarchy, and Prussia. Duke of Marlborough commanded the English and Dutch victory at the Battle of Blenheim in 1704. The main issue was whether France under King Louis XIV would take control of Spain's very extensive possessions and thereby become by far the dominant power, or be forced to share power with other major nations. After initial allied successes, the long war produced a military stalemate and ended with the Treaty of Utrecht , which was based on a balance of power in Europe. Historian Russell Weigley argues that the many wars almost never accomplished more than they cost. British historian G. M. Trevelyan argues: Frederick the Great , king of Prussia 1740–86, modernized the Prussian army , introduced new tactical and strategic concepts, fought mostly successful wars ( Silesian Wars , Seven Years' War) and doubled the size of Prussia. Russia fought numerous wars to achieve rapid expansion toward the east – i.e. Siberia , Far East , south, to the Black Sea, and south-east and to central Asia. Russia boasted a large and powerful army , a very large and complex internal bureaucracy, and a splendid court that rivaled Paris and London. However the government was living far beyond its means and seized Church lands, leaving organized religion in a weak condition. Throughout the 18th century Russia remained "a poor, backward, overwhelmingly agricultural, and illiterate country." The Enlightenment was a powerful, widespread cultural movement of intellectuals beginning in late 17th-century Europe emphasizing the power of reason rather than tradition; it was especially favourable to science (especially Isaac Newton's physics) and hostile to religious orthodoxy (especially of the Catholic Church). It sought to analyze and reform society using reason, to challenge ideas grounded in tradition and faith, and to advance knowledge through the scientific method . It promoted scientific thought, skepticism, and intellectual interchange. The Enlightenment was a revolution in human thought. This new way of thinking was that rational thought begins with clearly stated principles, uses correct logic to arrive at conclusions, tests the conclusions against evidence, and then revises the principles in light of the evidence. Enlightenment thinkers opposed superstition. Some Enlightenment thinkers collaborated with Enlightened despots , absolutist rulers who attempted to forcibly impose some of the new ideas about government into practice. The ideas of the Enlightenment exerted significant influence on the culture, politics, and governments of Europe. Originating in the 17th century, it was sparked by philosophers Francis Bacon , Baruch Spinoza , John Locke , Pierre Bayle , Voltaire , Francis Hutcheson , David Hume and physicist Isaac Newton . Ruling princes often endorsed and fostered these figures and even attempted to apply their ideas of government in what was known as enlightened absolutism . The Scientific Revolution is closely tied to the Enlightenment, as its discoveries overturned many traditional concepts and introduced new perspectives on nature and man's place within it. The Enlightenment flourished until about 1790–1800, at which point the Enlightenment, with its emphasis on reason, gave way to Romanticism , which placed a new emphasis on emotion; a Counter-Enlightenment began to increase in prominence. In France, Enlightenment was based in the salons and culminated in the great Encyclopédie (1751–72). These new intellectual strains would spread to urban centres across Europe, notably England, Scotland, the German states, the Netherlands, Poland, Russia, Italy, Austria, and Spain, as well as Britain's American colonies. The political ideals of the Enlightenment influenced the American Declaration of Independence , the United States Bill of Rights , the French Declaration of the Rights of Man and of the Citizen , and the Polish–Lithuanian Constitution of 3 May 1791 . Norman Davies has argued that Freemasonry was a powerful force on behalf of Liberalism and Enlightenment ideas in Europe, from about 1700 to the 20th century. It expanded rapidly during the Age of Enlightenment , reaching practically every country in Europe. The great enemy of Freemasonry was the Roman Catholic Church, so that in countries with a large Catholic element, such as France, Italy, Austria, Spain and Mexico, much of the ferocity of the political battles involve the confrontation between supporters of the Church versus active Masons. 20th-century totalitarian and revolutionary movements, especially the Fascists and Communists , crushed the Freemasons. Despite these crises, the 14th century was also a time of great progress within the arts and sciences. A renewed interest in ancient Greek and Roman led to the Italian Renaissance , a cultural movement that profoundly affected European intellectual life in the early modern period. Beginning in Italy, and spreading to the north, west and middle Europe during a cultural lag of some two and a half centuries, its influence affected literature, philosophy, art, politics, science, history, religion, and other aspects of intellectual inquiry. The Humanists saw their repossession of a great past as a Renaissance – a rebirth of civilization itself. Important political precedents were also set in this period. Niccolò Machiavelli 's political writing in The Prince influenced later absolutism and realpolitik. Also important were the many patrons who ruled states and used the artistry of the Renaissance as a sign of their power. The Scientific Revolution took place in Europe starting towards the second half of the Renaissance period, with the 1543 Nicolaus Copernicus publication De revolutionibus orbium coelestium ( On the Revolutions of the Heavenly Spheres ) often cited as its beginning.Toward the end of the period, an era of discovery began. The growth of the Ottoman Empire , culminating in the fall of Constantinople in 1453, cut off trading possibilities with the east. Western Europe was forced to discover new trading routes, as happened with Columbus' travel to the Americas in 1492, and Vasco da Gama 's circumnavigation of India and Africa in 1498. The numerous wars did not prevent European states from exploring and conquering wide portions of the world, from Africa to Asia and the newly discovered Americas. In the 15th century, Portugal led the way in geographical exploration along the coast of Africa in search of a maritime route to India, followed by Spain near the close of the 15th century, dividing their exploration of the world according to the Treaty of Tordesillas in 1494. They were the first states to set up colonies in America and European trading posts (factories) along the shores of Africa and Asia, establishing the first direct European diplomatic contacts with Southeast Asian states in 1511, China in 1513 and Japan in 1542. In 1552, Russian tsar Ivan the Terrible conquered two major Tatar khanates, the Khanate of Kazan and the Astrakhan Khanate . The Yermak 's voyage of 1580 led to the annexation of the Tatar Siberian Khanate into Russia, and the Russians would soon after conquer the rest of Siberia , steadily expanding to the east and south over the next centuries. Oceanic explorations soon followed by France, England and the Netherlands, who explored the Portuguese and Spanish trade routes into the Pacific Ocean, reaching Australia in 1606 and New Zealand in 1642.With the development of the printing press , new ideas spread throughout Europe and challenged traditional doctrines in science and theology. Simultaneously, the Reformation under German Martin Luther questioned Papal authority. The most common dating of the Reformation begins in 1517, when Luther published The Ninety-Five Theses , and concludes in 1648 with the Treaty of Westphalia that ended years of European religious wars . During this period corruption in the Catholic Church led to a sharp backlash in the Protestant Reformation. It gained many followers especially among princes and kings seeking a stronger state by ending the influence of the Catholic Church. Figures other than Martin Luther began to emerge as well like John Calvin whose Calvinism had influence in many countries and King Henry VIII of England who broke away from the Catholic Church in England and set up the Anglican Church . These religious divisions brought on a wave of wars inspired and driven by religion but also by the ambitious monarchs in Western Europe who were becoming more centralized and powerful. The Protestant Reformation also led to a strong reform movement in the Catholic Church called the Counter-Reformation , which aimed to reduce corruption as well as to improve and strengthen Catholic dogma. Two important groups in the Catholic Church who emerged from this movement were the Jesuits , who helped keep Spain, Portugal, Poland, and other European countries within the Catholic fold, and the Oratorians of Saint Philip Neri , who ministered to the faithful in Rome, restoring their confidence in the Church of Jesus Christ that subsisted substantially in the Church of Rome. Still, the Catholic Church was somewhat weakened by the Reformation, portions of Europe were no longer under its sway and kings in the remaining Catholic countries began to take control of the church institutions within their kingdoms. Unlike many European countries, the Polish–Lithuanian Commonwealth and Hungary were more tolerant. While still enforcing the predominance of Catholicism, they continued to allow the large religious minorities to maintain their faiths, traditions and customs. The Polish–Lithuanian Commonwealth became divided among Catholics, Protestants, Orthodox, Jews and a small Muslim population. Another development was the idea of 'European superiority'. There was a movement by some such as Montaigne that regarded the non-Europeans as a better, more natural and primitive people. Post services were founded all over Europe, which allowed a humanistic interconnected network of intellectuals across Europe, despite religious divisions. However, the Roman Catholic Church banned many leading scientific works; this led to an intellectual advantage for Protestant countries, where the banning of books was regionally organised. Francis Bacon and other advocates of science tried to create unity in Europe by focusing on the unity in nature. 1 In the 15th century, at the end of the Middle Ages, powerful sovereign states were appearing, built by the New Monarchs who were centralising power in France, England, and Spain. On the other hand, the Parliament in the Polish–Lithuanian Commonwealth grew in power, taking legislative rights from the Polish king. The new state power was contested by parliaments in other countries especially England. New kinds of states emerged which were co-operation agreements among territorial rulers, cities, farmer republics and knights.The Iberian kingdoms were able to dominate colonial activity in the 16th century. The Portuguese forged the first global empire in the 15th and 16th century, whilst during the 16th century and the first half of the 17th century, the crown of Castile (and the overarching Hispanic Monarchy, including Portugal from 1580 to 1640) became the most powerful empire in the world. Spanish dominance in America was increasingly challenged by British , French , Dutch and Swedish colonial efforts of the 17th and 18th centuries. New forms of trade and expanding horizons made new forms of government , law and economics necessary. Colonial expansion continued in the following centuries (with some setbacks, such as successful wars of independence in the British American colonies and then later Haiti , Mexico , Argentina , Brazil , and others amid European turmoil of the Napoleonic Wars ). Spain had control of a large part of North America, all of Central America and a great part of South America, the Caribbean and the Philippines ; Britain took the whole of Australia and New Zealand, most of India, and large parts of Africa and North America; France held parts of Canada and India (nearly all of which was lost to Britain in 1763 ), Indochina , large parts of Africa and the Caribbean islands; the Netherlands gained the East Indies (now Indonesia ) and islands in the Caribbean; Portugal obtained Brazil and several territories in Africa and Asia; and later, powers such as Germany, Belgium, Italy and Russia acquired further colonies. [ citation needed ] This expansion helped the economy of the countries owning them. Trade flourished, because of the minor stability of the empires. By the late 16th century, American silver accounted for one-fifth of Spain's total budget. The French colony of Saint-Domingue was one of richest European colonies in the 18th century, operating on a plantation economy fueled by slave labor . During the period of French rule, cash crops produced in Saint-Domingue comprised thirty percent of total French trade while its sugar exports represented forty percent of the Atlantic market. The 17th century was an era of crisis. Many historians have rejected the idea, while others promote it as an invaluable insight into the warfare, politics, economics, and even art. The Thirty Years' War (1618–1648) focused attention on the massive horrors that wars could bring to entire populations. The 1640s in particular saw more state breakdowns around the world than any previous or subsequent period. The Polish–Lithuanian Commonwealth , the largest state in Europe, temporarily disappeared. In addition, there were secessions and upheavals in several parts of the Spanish empire, the world's first global empire. In Britain the entire Stuart monarchy ( England , Scotland , Ireland , and its North American colonies ) rebelled. Political insurgency and a spate of popular revolts seldom equalled shook the foundations of most states in Europe and Asia. More wars took place around the world in the mid-17th century than in almost any other period of recorded history. Across the Northern Hemisphere , the mid-17th century experienced almost unprecedented death rates.The "absolute" rule of powerful monarchs such as Louis XIV (ruled France 1643–1715), Peter the Great (ruled Russia 1682–1725), Maria Theresa (ruled Habsburg lands 1740–1780) and Frederick the Great (ruled Prussia 1740–86), produced powerful centralized states, with strong armies and powerful bureaucracies, all under the control of the king. Throughout the early part of this period, capitalism (through mercantilism) was replacing feudalism as the principal form of economic organisation, at least in the western half of Europe. The expanding colonial frontiers resulted in a Commercial Revolution . The period is noted for the rise of modern science and the application of its findings to technological improvements, which animated the Industrial Revolution after 1750. The Reformation had profound effects on the unity of Europe. Not only were nations divided one from another by their religious orientation, but some states were torn apart internally by religious strife, avidly fostered by their external enemies. France suffered this fate in the 16th century in the series of conflicts known as the French Wars of Religion , which ended in the triumph of the Bourbon Dynasty . England settled down under Elizabeth I to a moderate Anglicanism . Much of modern-day Germany was made up of numerous small sovereign states under the theoretical framework of the Holy Roman Empire , which was further divided along internally drawn sectarian lines. The Polish–Lithuanian Commonwealth is notable in this time for its religious indifference and general immunity to European religious strife. The Thirty Years' War was fought between 1618 and 1648, across Germany and neighbouring areas, and involved most of the major European powers except England and Russia, involving Catholics versus Protestants for the most part. The major impact of the war was the devastation of entire regions scavenged bare by the foraging armies. Episodes of widespread famine and disease, and the breakup of family life, devastated the population of the German states and, to a lesser extent, the Low Countries , the Crown of Bohemia and northern parts of Italy, while bankrupting many of the regional powers involved. Between one-fourth and one-third of the German population perished from direct military causes or from disease and starvation, as well as postponed births. After the Peace of Westphalia , which ended the war in favour of nations deciding their own religious allegiance, absolutism became the norm of the continent, while parts of Europe experimented with constitutions foreshadowed by the English Civil War and particularly the Glorious Revolution . European military conflict did not cease, but had less disruptive effects on the lives of Europeans. In the advanced northwest, the Enlightenment gave a philosophical underpinning to the new outlook, and the continued spread of literacy, made possible by the printing press , created new secular forces in thought. From the Union of Krewo, central and eastern Europe was dominated by Kingdom of Poland and Grand Duchy of Lithuania . In the 16th and 17th centuries Central and Eastern Europe was an arena of conflict for domination of the continent between Sweden , the Polish–Lithuanian Commonwealth (involved in series of wars, like Khmelnytsky uprising , Russo-Polish War , the Deluge , etc.) and the Ottoman Empire . This period saw a gradual decline of these three powers which were eventually replaced by new enlightened absolutist monarchies: Russia, Prussia and Austria (the Habsburg monarchy ). By the turn of the 19th century they had become new powers, having divided Poland between themselves, with Sweden and Turkey having experienced substantial territorial losses to Russia and Austria respectively as well as pauperisation. The War of the Spanish Succession (1701–1715) was a major war with France opposed by a coalition of England, the Netherlands, the Habsburg monarchy, and Prussia. Duke of Marlborough commanded the English and Dutch victory at the Battle of Blenheim in 1704. The main issue was whether France under King Louis XIV would take control of Spain's very extensive possessions and thereby become by far the dominant power, or be forced to share power with other major nations. After initial allied successes, the long war produced a military stalemate and ended with the Treaty of Utrecht , which was based on a balance of power in Europe. Historian Russell Weigley argues that the many wars almost never accomplished more than they cost. British historian G. M. Trevelyan argues: Frederick the Great , king of Prussia 1740–86, modernized the Prussian army , introduced new tactical and strategic concepts, fought mostly successful wars ( Silesian Wars , Seven Years' War) and doubled the size of Prussia. Russia fought numerous wars to achieve rapid expansion toward the east – i.e. Siberia , Far East , south, to the Black Sea, and south-east and to central Asia. Russia boasted a large and powerful army , a very large and complex internal bureaucracy, and a splendid court that rivaled Paris and London. However the government was living far beyond its means and seized Church lands, leaving organized religion in a weak condition. Throughout the 18th century Russia remained "a poor, backward, overwhelmingly agricultural, and illiterate country." The Thirty Years' War was fought between 1618 and 1648, across Germany and neighbouring areas, and involved most of the major European powers except England and Russia, involving Catholics versus Protestants for the most part. The major impact of the war was the devastation of entire regions scavenged bare by the foraging armies. Episodes of widespread famine and disease, and the breakup of family life, devastated the population of the German states and, to a lesser extent, the Low Countries , the Crown of Bohemia and northern parts of Italy, while bankrupting many of the regional powers involved. Between one-fourth and one-third of the German population perished from direct military causes or from disease and starvation, as well as postponed births. After the Peace of Westphalia , which ended the war in favour of nations deciding their own religious allegiance, absolutism became the norm of the continent, while parts of Europe experimented with constitutions foreshadowed by the English Civil War and particularly the Glorious Revolution . European military conflict did not cease, but had less disruptive effects on the lives of Europeans. In the advanced northwest, the Enlightenment gave a philosophical underpinning to the new outlook, and the continued spread of literacy, made possible by the printing press , created new secular forces in thought. From the Union of Krewo, central and eastern Europe was dominated by Kingdom of Poland and Grand Duchy of Lithuania . In the 16th and 17th centuries Central and Eastern Europe was an arena of conflict for domination of the continent between Sweden , the Polish–Lithuanian Commonwealth (involved in series of wars, like Khmelnytsky uprising , Russo-Polish War , the Deluge , etc.) and the Ottoman Empire . This period saw a gradual decline of these three powers which were eventually replaced by new enlightened absolutist monarchies: Russia, Prussia and Austria (the Habsburg monarchy ). By the turn of the 19th century they had become new powers, having divided Poland between themselves, with Sweden and Turkey having experienced substantial territorial losses to Russia and Austria respectively as well as pauperisation.The War of the Spanish Succession (1701–1715) was a major war with France opposed by a coalition of England, the Netherlands, the Habsburg monarchy, and Prussia. Duke of Marlborough commanded the English and Dutch victory at the Battle of Blenheim in 1704. The main issue was whether France under King Louis XIV would take control of Spain's very extensive possessions and thereby become by far the dominant power, or be forced to share power with other major nations. After initial allied successes, the long war produced a military stalemate and ended with the Treaty of Utrecht , which was based on a balance of power in Europe. Historian Russell Weigley argues that the many wars almost never accomplished more than they cost. British historian G. M. Trevelyan argues:Frederick the Great , king of Prussia 1740–86, modernized the Prussian army , introduced new tactical and strategic concepts, fought mostly successful wars ( Silesian Wars , Seven Years' War) and doubled the size of Prussia. Russia fought numerous wars to achieve rapid expansion toward the east – i.e. Siberia , Far East , south, to the Black Sea, and south-east and to central Asia. Russia boasted a large and powerful army , a very large and complex internal bureaucracy, and a splendid court that rivaled Paris and London. However the government was living far beyond its means and seized Church lands, leaving organized religion in a weak condition. Throughout the 18th century Russia remained "a poor, backward, overwhelmingly agricultural, and illiterate country." The Enlightenment was a powerful, widespread cultural movement of intellectuals beginning in late 17th-century Europe emphasizing the power of reason rather than tradition; it was especially favourable to science (especially Isaac Newton's physics) and hostile to religious orthodoxy (especially of the Catholic Church). It sought to analyze and reform society using reason, to challenge ideas grounded in tradition and faith, and to advance knowledge through the scientific method . It promoted scientific thought, skepticism, and intellectual interchange. The Enlightenment was a revolution in human thought. This new way of thinking was that rational thought begins with clearly stated principles, uses correct logic to arrive at conclusions, tests the conclusions against evidence, and then revises the principles in light of the evidence. Enlightenment thinkers opposed superstition. Some Enlightenment thinkers collaborated with Enlightened despots , absolutist rulers who attempted to forcibly impose some of the new ideas about government into practice. The ideas of the Enlightenment exerted significant influence on the culture, politics, and governments of Europe. Originating in the 17th century, it was sparked by philosophers Francis Bacon , Baruch Spinoza , John Locke , Pierre Bayle , Voltaire , Francis Hutcheson , David Hume and physicist Isaac Newton . Ruling princes often endorsed and fostered these figures and even attempted to apply their ideas of government in what was known as enlightened absolutism . The Scientific Revolution is closely tied to the Enlightenment, as its discoveries overturned many traditional concepts and introduced new perspectives on nature and man's place within it. The Enlightenment flourished until about 1790–1800, at which point the Enlightenment, with its emphasis on reason, gave way to Romanticism , which placed a new emphasis on emotion; a Counter-Enlightenment began to increase in prominence. In France, Enlightenment was based in the salons and culminated in the great Encyclopédie (1751–72). These new intellectual strains would spread to urban centres across Europe, notably England, Scotland, the German states, the Netherlands, Poland, Russia, Italy, Austria, and Spain, as well as Britain's American colonies. The political ideals of the Enlightenment influenced the American Declaration of Independence , the United States Bill of Rights , the French Declaration of the Rights of Man and of the Citizen , and the Polish–Lithuanian Constitution of 3 May 1791 . Norman Davies has argued that Freemasonry was a powerful force on behalf of Liberalism and Enlightenment ideas in Europe, from about 1700 to the 20th century. It expanded rapidly during the Age of Enlightenment , reaching practically every country in Europe. The great enemy of Freemasonry was the Roman Catholic Church, so that in countries with a large Catholic element, such as France, Italy, Austria, Spain and Mexico, much of the ferocity of the political battles involve the confrontation between supporters of the Church versus active Masons. 20th-century totalitarian and revolutionary movements, especially the Fascists and Communists , crushed the Freemasons. The " long 19th century ", from 1789 to 1914 saw the drastic social, political and economic changes initiated by the Industrial Revolution , the French Revolution and the Napoleonic Wars . Following the reorganisation of the political map of Europe at the Congress of Vienna in 1815, Europe experienced the rise of Nationalism, the rise of the Russian Empire and the peak of the British Empire, as well as the decline of the Ottoman Empire . Finally, the rise of the German Empire and the Austro-Hungarian Empire initiated the course of events that culminated in the outbreak of the First World War in 1914. The Industrial Revolution saw major changes in agriculture, manufacturing, and transport impacted Britain and subsequently spread to the United States and Western Europe. Technological advancements, most notably the utilization of the steam engine, were major catalysts in the industrialisation process. It started in England and Scotland in the mid-18th century with the mechanisation of the textile industries, the development of iron-making techniques and the increased use of coal as the main fuel. Trade expansion was enabled by the introduction of canals , improved roads and railways. The introduction of steam power (fuelled primarily by coal) and powered machinery (mainly in textile manufacturing ) underpinned the dramatic increases in production capacity. The development of all-metal machine tools in the first two decades of the 19th century facilitated the manufacture of more production machines for manufacturing in other industries. The effects spread throughout Western Europe and North America during the 19th century, eventually affecting most of the world. Historians R.R. Palmer and Joel Colton argue: The era of the French Revolution and the subsequent Napoleonic wars was a difficult time for monarchs. Tsar Paul I of Russia was assassinated; King Louis XVI of France was executed, as was his queen Marie Antoinette . Furthermore, kings Charles IV of Spain , Ferdinand VII of Spain and Gustav IV Adolf of Sweden were deposed as were ultimately the Emperor Napoleon and all of the relatives he had installed on various European thrones. King Frederick William III of Prussia and Emperor Francis II of Austria barely clung to their thrones. King George III of Great Britain lost the better part of the First British Empire. The American Revolution (1775–1783) was the first successful revolt of a colony against a European power. It rejected aristocracy and established a republican form of government that attracted worldwide attention. The French Revolution (1789–1804) was a product of the same democratic forces in the Atlantic World and had an even greater impact. French historian François Aulard says: French intervention in the American Revolutionary War had nearly bankrupted the state. After repeated failed attempts at financial reform, King Louis XVI had to convene the Estates-General , a representative body of the country made up of three estates: the clergy, the nobility, and the commoners. The third estate, joined by members of the other two, declared itself to be a National Assembly and created, in July, the National Constituent Assembly . At the same time the people of Paris revolted, famously storming the Bastille prison on 14 July 1789 . At the time the assembly wanted to create a constitutional monarchy , and over the following two years passed various laws including the Declaration of the Rights of Man and of the Citizen , the abolition of feudalism , and a fundamental change in the relationship between France and Rome. At first the king agreed with these changes and enjoyed reasonable popularity with the people. As anti-royalism increased along with threat of foreign invasion, the king tried to flee and join France's enemies. He was captured and on 21 January 1793, having been convicted of treason, he was guillotined. On 20 September 1792 the National Convention abolished the monarchy and declared France a republic. Due to the emergency of war , the National Convention created the Committee of Public Safety to act as the country's executive. Under Maximilien de Robespierre , the committee initiated the Reign of Terror , during which up to 40,000 people were executed in Paris, mainly nobles and those convicted by the Revolutionary Tribunal , often on the flimsiest of evidence. Internal tensions at Paris drove the Committee towards increasing assertions of radicalism and increasing suspicions. A few months into this phase, more and more prominent revolutionaries were being sent to the guillotine by Robespierre and his faction, for example Madame Roland and Georges Danton . Elsewhere in the country, counter-revolutionary insurrections were brutally suppressed. The regime was overthrown in the coup of 9 Thermidor (27 July 1794) and Robespierre was executed. The regime which followed ended the Terror and relaxed Robespierre's more extreme policies. Napoleon Bonaparte was France's most successful general in the Revolutionary wars. In 1799 on 18 Brumaire (9 November) he overthrew the government, replacing it with the Consulate , which he dominated. He gained popularity in France by restoring the Church, keeping taxes low, centralizing power in Paris, and winning glory on the battlefield. In 1804 he crowned himself Emperor . In 1805, Napoleon planned to invade Britain, but a renewed British alliance with Russia and Austria ( Third Coalition ), forced him to turn his attention towards the continent, while at the same time the French fleet was demolished by the British at the Battle of Trafalgar , ending any plan to invade Britain. On 2 December 1805, Napoleon defeated a numerically superior Austro-Russian army at Austerlitz , forcing Austria's withdrawal from the coalition (see Treaty of Pressburg ) and dissolving the Holy Roman Empire . In 1806, a Fourth Coalition was set up. On 14 October Napoleon defeated the Prussians at the Battle of Jena-Auerstedt , marched through Germany and defeated the Russians on 14 June 1807 at Friedland . The Treaties of Tilsit divided Europe between France and Russia and created the Duchy of Warsaw . On 12 June 1812 Napoleon invaded Russia with a Grande Armée of nearly 700,000 troops. After the measured victories at Smolensk and Borodino Napoleon occupied Moscow, only to find it burned by the retreating Russian army. He was forced to withdraw. On the march back his army was harassed by Cossacks , and suffered disease and starvation. Only 20,000 of his men survived the campaign. By 1813 the tide had begun to turn from Napoleon. Having been defeated by a seven nation army at the Battle of Leipzig in October 1813, he was forced to abdicate after the Six Days' Campaign and the occupation of Paris. Under the Treaty of Fontainebleau he was exiled to the island of Elba . He returned to France on 1 March 1815 (see Hundred Days ), raised an army, but was finally defeated by a British and Prussian force at the Battle of Waterloo on 18 June 1815 and exiled to the small British island of Saint Helena . Roberts finds that the Revolutionary and Napoleonic wars, from 1793 to 1815, caused 4 million deaths (of whom 1 million were civilians); 1.4 million were French. Outside France the Revolution had a major impact. Its ideas became widespread. Roberts argues that Napoleon was responsible for key ideas of the modern world, so that, "meritocracy, equality before the law , property rights , religious toleration , modern secular education , sound finances, and so on-were protected, consolidated, codified, and geographically extended by Napoleon during his 16 years of power." Furthermore, the French armies in the 1790s and 1800s directly overthrew feudal remains in much of western Europe. They liberalised property laws , ended seigneurial dues , abolished the guild of merchants and craftsmen to facilitate entrepreneurship , legalised divorce, closed the Jewish ghettos and made Jews equal to everyone else . The Inquisition ended as did the Holy Roman Empire . The power of church courts and religious authority was sharply reduced and equality under the law was proclaimed for all men. France conquered Belgium and turned it into another province of France. It conquered the Netherlands, and made it a client state . It took control of the German areas on the left bank of the Rhine River and set up a puppet Confederation of the Rhine . It conquered Switzerland and most of Italy, setting up a series of puppet states. The result was glory and an infusion of much needed money from the conquered lands. However the enemies of France, led by Britain, formed a Second Coalition in 1799 (with Britain joined by Russia, the Ottoman Empire and Austria). It scored a series of victories that rolled back French successes, and trapped the French Army in Egypt. Napoleon slipped through the British blockade in October 1799, returning to Paris, where he overthrew the government and made himself the ruler. Napoleon conquered most of Italy in the name of the French Revolution in 1797–99. He split up Austria's holdings and set up a series of new republics, complete with new codes of law and abolition of feudal privileges. Napoleon's Cisalpine Republic was centered on Milan; Genoa became a republic; the Roman Republic was formed as well as the small Ligurian Republic around Genoa. The Neapolitan Republic was formed around Naples, but it lasted only five months. He later formed the Kingdom of Italy , with his brother as King. In addition, France turned the Netherlands into the Batavian Republic , and Switzerland into the Helvetic Republic . All these new countries were satellites of France, and had to pay large subsidies to Paris, as well as provide military support for Napoleon's wars. Their political and administrative systems were modernized, the metric system introduced, and trade barriers reduced. Jewish ghettos were abolished. Belgium and Piedmont became integral parts of France. Most of the new nations were abolished and returned to prewar owners in 1814. However, Artz emphasizes the benefits the Italians gained from the French Revolution: Likewise in Switzerland the long-term impact of the French Revolution has been assessed by Martin: The greatest impact came in France itself. In addition to effects similar to those in Italy and Switzerland, France saw the introduction of the principle of legal equality, and the downgrading of the once powerful and rich Catholic Church . Power became centralized in Paris, with its strong bureaucracy and an army supplied by conscripting all young men. French politics were permanently polarized – new names were given, "left" and "right" for the supporters and opponents of the principles of the Revolution. By the 19th century, governments increasingly took over traditional religious roles, paying much more attention to efficiency and uniformity than to religiosity. Secular bodies took control of education away from the churches, abolished taxes and tithes for the support of established religions , and excluded bishops from the upper houses. Secular laws increasingly regulated marriage and divorce, and maintaining birth and death registers became the duty of local officials. Although the numerous religious denominations in the United States founded many colleges and universities, that was almost exclusively a state function across Europe. Imperial powers protected Christian missionaries in African and Asian colonies. In France and other largely Catholic nations, anti-clerical political movements tried to reduce the role of the Catholic Church. Likewise briefly in Germany in the 1870s there was a fierce Kulturkampf (culture war) against Catholics , but the Catholics successfully fought back. The Catholic Church concentrated more power in the papacy and fought against secularism and socialism . It sponsored devotional reforms that gained wide support among the churchgoers. The political development of nationalism and the push for popular sovereignty culminated with the ethnic/national revolutions of Europe. During the 19th century nationalism became one of the most significant political and social forces in history; it is typically listed among the top causes of World War I . Most European states had become constitutional monarchies by 1871, and Germany and Italy merged many small city-states to become united nation-states. Germany in particular increasingly dominated the continent in economics and political power. Meanwhile, on a global scale, Great Britain, with its far-flung British Empire , unmatched Royal Navy, and powerful bankers, became the world's first global power. The sun never set on its territories, while an informal empire operated through British financiers, entrepreneurs, traders and engineers who established operations in many countries, and largely dominated Latin America. The British were especially famous for financing and constructing railways around the world. Napoleon's conquests of the German and Italian states around 1800–1806 played a major role in stimulating nationalism and demand for national unity. In the German states east of Prussia Napoleon abolished many of the old or medieval relics, such as dissolving the Holy Roman Empire in 1806. He imposed rational legal systems and his organization of the Confederation of the Rhine in 1806 promoted a feeling of German nationalism . In the 1860s it was Prussian chancellor Otto von Bismarck who achieved German unification in 1870 after the many smaller states followed Prussia's leadership in wars against Denmark, Austria and France. Italian nationalism emerged in the 19th century and was the driving force for Italian unification or the "Risorgimento". It was the political and intellectual movement that consolidated different states of the Italian Peninsula into the single state of the Kingdom of Italy in 1860. The memory of the Risorgimento is central to both Italian nationalism and Italian historiography. For centuries the Orthodox Christian Serbs were ruled by the Muslim -controlled Ottoman Empire . The success of the Serbian revolution (1804–1817) against Ottoman rule in 1817 marked the foundation of modern Principality of Serbia . It achieved de facto independence in 1867 and finally gained recognition in the Berlin Congress of 1878. The Serbs developed a larger vision for nationalism in Pan-Slavism and with Russian support sought to pull the other Slavs out of the Austro-Hungarian Empire . Austria, with German backing, tried to crush Serbia in 1914 but Russia intervened, thus igniting the First World War in which Austria dissolved into nation states. In 1918, the region of Vojvodina proclaimed its secession from Austria-Hungary to unite with the pan-Slavic State of Slovenes, Croats and Serbs ; the Kingdom of Serbia joined the union on 1 December 1918, and the country was named Kingdom of Serbs, Croats, and Slovenes . It was renamed Yugoslavia , which was never able to tame the multiple nationalities and religions and it flew apart in civil war in the 1990s. The Greek drive for independence from the Ottoman Empire inspired supporters across Christian Europe, especially in Britain. France, Russia and Britain intervened to make this nationalist dream become reality with the Greek War of Independence (1821-1829/1830). Bulgarian modern nationalism emerged under Ottoman rule in the late 18th and early 19th century. An autonomous Bulgarian Exarchate was established in 1870/1872 for the diocese of Bulgaria as well as for those, wherein at least two-thirds of Orthodox Christians were willing to join it. The April Uprising in 1876 indirectly resulted in the re-establishment of Bulgaria in 1878 . In the 1790s, Germany, Russia and Austria partitioned Poland . Napoleon set up the Duchy of Warsaw , igniting a spirit of Polish nationalism . Russia took it over in 1815 as Congress Poland with the tsar as King of Poland. Large-scale nationalist revolts erupted in 1830 and 1863–64 but were harshly crushed by Russia, which tried to Russify the Polish language , culture and religion . The collapse of the Russian Empire in the First World War enabled the major powers to reestablish an independent Second Polish Republic , which survived until 1939. Meanwhile, Poles in areas controlled by Germany moved into heavy industry but their religion came under attack by Bismarck in the Kulturkampf of the 1870s. The Poles joined German Catholics in a well-organized new Centre Party , and defeated Bismarck politically. He responded by stopping the harassment and cooperating with the Centre Party. After the War of the Spanish Succession , the assimilation of the Crown of Aragon by the Castilian Crown through the Decrees of Nova planta was the first step in the creation of the Spanish nation state, through the imposition of the political and cultural characteristics of the dominant ethnic group, in this case the Castilians, over those of other ethnic groups, who became national minorities to be assimilated. Since the political unification of 1714, Spanish assimilation policies towards Catalan-speaking territories ( Catalonia , Valencia , the Balearic Islands , part of Aragon ) and other national minorities have been a historical constant. The nationalization process accelerated in the 19th century, in parallel to the origin of Spanish nationalism , the social, political and ideological movement that tried to shape a Spanish national identity based on the Castilian model, in conflict with the other historical nations of the State. These nationalist policies, sometimes very aggressive, and still in force, are the seed of repeated territorial conflicts within the State. An important component of nationalism was the study of the nation's heritage, emphasizing the national language and literary culture. This stimulated, and was in turn strongly supported by, the emergence of national educational systems . Latin gave way to the national language, and compulsory education , with strong support from modernizers and the media, became standard in Germany and eventually other West European nations. Voting reforms extended the franchise. Every country developed a sense of national origins – the historical accuracy was less important than the motivation toward patriotism. Universal compulsory education was extended to girls at the elementary level. By the 1890s, strong movements emerged in some countries, including France, Germany and the United States, to extend compulsory education to the secondary level. After the defeat of revolutionary France, the great powers tried to restore the situation which existed before 1789. The 1815 Congress of Vienna produced a peaceful balance of power among the European empires, known as the Metternich system. The powerbase of their support was the aristocracy. However, their reactionary efforts were unable to stop the spread of revolutionary movements: the middle classes had been deeply influenced by the ideals of the French revolution, and the Industrial Revolution brought important economical and social changes. Radical intellectuals looked to the working classes for a base for socialist, communist and anarchistic ideas. Widely influential was the 1848 Communist Manifesto by Karl Marx and Friedrich Engels . The middle classes and businessmen promoted liberalism, free trade and capitalism. Aristocratic elements concentrated in government service, the military and the established churches. Nationalist movements (in Germany, Italy, Poland, Hungary, and elsewhere) sought national unification and/or liberation from foreign rule. As a result, the period between 1815 and 1871 saw a large number of revolutionary attempts and independence wars. Greece successfully revolted against Ottoman rule in the 1820s. Napoleon III , nephew of Napoleon I, parlayed his famous name and to widespread popularity across France. He returned from exile in 1848, promising to stabilize the chaotic political situation. He was elected president and maneuvered successfully to name himself Emperor, a move approved later by a large majority of the French electorate. The first part of his Imperial term brought many important reforms, facilitated by Napoleon's control of the lawmaking body, the government, and the French Armed Forces . Hundreds of old Republican leaders were arrested and deported. Napoleon controlled the media and censored the news. In compensation for the loss of freedom, Napoleon gave the people new hospitals and asylums, beautified and modernized Paris, and built a modern railroad and transportation system that dramatically improved commerce. The economy grew, but industrialization was not as rapid as Britain, and France depended largely on small family-oriented firms as opposed to the large companies that were emerging in the United States and Germany. France was on the winning side in the Crimean War (1854–56), but after 1858 Napoleon's foreign-policy was less and less successful. Foreign-policy blunders finally destroyed his reign in 1870–71. His empire collapsed after being defeated in the Franco-Prussian War . France became a republic, but until the 1880s there was a strong popular demand for monarchy. Hostility to the Catholic Church became a major issue, as France battle between secular and religious forces well into the 20th century, with the secular elements usually more successful. The French Third Republic emerged in 1871. From his base in Prussia, Otto von Bismarck in the 1860s engineered a series of short, decisive wars, that unified most of the German states (excluding Austria) into a powerful German Empire . By 1871 he used balance of power diplomacy to preserve Germany's new role and keep Europe at peace. The new German Empire industrialized rapidly and challenged Britain for economic leadership. Bismarck was removed from office in 1890 by an aggressive young Kaiser Wilhelm II , who pursued a disruptive foreign policy that polarized Europe into rival camps. These rival camps went to war with each other in 1914. The power of nationalism to create new states was irresistible in the 19th century, and the process could lead to collapse in the absence of a strong nationalism. Austria-Hungary had the advantage of size and a large army, but multiple disadvantages: rivals on four sides, unstable finances, a fragmented population, a thin industrial base, and minimal naval resources. It did have the advantage of good diplomats, typified by Metternich . They employed a grand strategy for survival that balanced out different forces, set up buffer zones, and kept the Hapsburg empire going despite wars with the Ottomans, Frederick the Great, Napoleon and Bismarck, until the First World War. The Empire overnight disintegrated into multiple states based on ethnic nationalism and the principle of self-determination. The Russian Empire likewise brought together a multitude of languages and cultures, so that its military defeat in the First World War led to multiple splits that created independent Finland, Latvia, Lithuania, Estonia, and Poland, and briefly independent Ukraine, Armenia, Georgia, and Azerbaijan. Colonial empires were the product of the European Age of Discovery from the 15th century. The initial impulse behind these dispersed maritime empires and those that followed was trade. Both the Portuguese Empire and Spanish Empire quickly grew into the first global political and economic systems with territories spread around the world. Subsequent major European colonial empires included the French , Dutch , and British . The latter, consolidated during the period of British maritime hegemony in the 19th century, became the largest empire in history because of the improved ocean transportation technologies of the time as well as electronic communication. At its height in 1920, the British Empire covered a quarter of the Earth's land area and comprised a quarter of its population. Other European countries, such as Belgium , Germany , and Italy , pursued colonial empires as well (mostly in Africa), but they were smaller. Russia built its Russian Empire through conquest by land in Eastern Europe, and Asia. By the mid-19th century, the Ottoman Empire had declined. This instigated the Crimean War in 1854 and began a tenser period of minor clashes among the globe-spanning empires of Europe. In the second half of the 19th century, the Kingdom of Sardinia and the Kingdom of Prussia carried out a series of wars that resulted in the creation of Italy and Germany as nation-states, significantly changing the balance of power in Europe. From 1870, Otto von Bismarck engineered a German hegemony that put France in a critical situation. It slowly rebuilt its relationships, seeking alliances with Russia and Britain to control the growing power of Germany. In this way, two opposing sides – the Triple Alliance of 1882 (Germany, Austria-Hungary and Italy) and the Triple Entente of 1907 (Britain, France and Russia) – formed in Europe, escalating military forces and alliances.The Industrial Revolution saw major changes in agriculture, manufacturing, and transport impacted Britain and subsequently spread to the United States and Western Europe. Technological advancements, most notably the utilization of the steam engine, were major catalysts in the industrialisation process. It started in England and Scotland in the mid-18th century with the mechanisation of the textile industries, the development of iron-making techniques and the increased use of coal as the main fuel. Trade expansion was enabled by the introduction of canals , improved roads and railways. The introduction of steam power (fuelled primarily by coal) and powered machinery (mainly in textile manufacturing ) underpinned the dramatic increases in production capacity. The development of all-metal machine tools in the first two decades of the 19th century facilitated the manufacture of more production machines for manufacturing in other industries. The effects spread throughout Western Europe and North America during the 19th century, eventually affecting most of the world. Historians R.R. Palmer and Joel Colton argue: The era of the French Revolution and the subsequent Napoleonic wars was a difficult time for monarchs. Tsar Paul I of Russia was assassinated; King Louis XVI of France was executed, as was his queen Marie Antoinette . Furthermore, kings Charles IV of Spain , Ferdinand VII of Spain and Gustav IV Adolf of Sweden were deposed as were ultimately the Emperor Napoleon and all of the relatives he had installed on various European thrones. King Frederick William III of Prussia and Emperor Francis II of Austria barely clung to their thrones. King George III of Great Britain lost the better part of the First British Empire. The American Revolution (1775–1783) was the first successful revolt of a colony against a European power. It rejected aristocracy and established a republican form of government that attracted worldwide attention. The French Revolution (1789–1804) was a product of the same democratic forces in the Atlantic World and had an even greater impact. French historian François Aulard says: French intervention in the American Revolutionary War had nearly bankrupted the state. After repeated failed attempts at financial reform, King Louis XVI had to convene the Estates-General , a representative body of the country made up of three estates: the clergy, the nobility, and the commoners. The third estate, joined by members of the other two, declared itself to be a National Assembly and created, in July, the National Constituent Assembly . At the same time the people of Paris revolted, famously storming the Bastille prison on 14 July 1789 . At the time the assembly wanted to create a constitutional monarchy , and over the following two years passed various laws including the Declaration of the Rights of Man and of the Citizen , the abolition of feudalism , and a fundamental change in the relationship between France and Rome. At first the king agreed with these changes and enjoyed reasonable popularity with the people. As anti-royalism increased along with threat of foreign invasion, the king tried to flee and join France's enemies. He was captured and on 21 January 1793, having been convicted of treason, he was guillotined. On 20 September 1792 the National Convention abolished the monarchy and declared France a republic. Due to the emergency of war , the National Convention created the Committee of Public Safety to act as the country's executive. Under Maximilien de Robespierre , the committee initiated the Reign of Terror , during which up to 40,000 people were executed in Paris, mainly nobles and those convicted by the Revolutionary Tribunal , often on the flimsiest of evidence. Internal tensions at Paris drove the Committee towards increasing assertions of radicalism and increasing suspicions. A few months into this phase, more and more prominent revolutionaries were being sent to the guillotine by Robespierre and his faction, for example Madame Roland and Georges Danton . Elsewhere in the country, counter-revolutionary insurrections were brutally suppressed. The regime was overthrown in the coup of 9 Thermidor (27 July 1794) and Robespierre was executed. The regime which followed ended the Terror and relaxed Robespierre's more extreme policies.Napoleon Bonaparte was France's most successful general in the Revolutionary wars. In 1799 on 18 Brumaire (9 November) he overthrew the government, replacing it with the Consulate , which he dominated. He gained popularity in France by restoring the Church, keeping taxes low, centralizing power in Paris, and winning glory on the battlefield. In 1804 he crowned himself Emperor . In 1805, Napoleon planned to invade Britain, but a renewed British alliance with Russia and Austria ( Third Coalition ), forced him to turn his attention towards the continent, while at the same time the French fleet was demolished by the British at the Battle of Trafalgar , ending any plan to invade Britain. On 2 December 1805, Napoleon defeated a numerically superior Austro-Russian army at Austerlitz , forcing Austria's withdrawal from the coalition (see Treaty of Pressburg ) and dissolving the Holy Roman Empire . In 1806, a Fourth Coalition was set up. On 14 October Napoleon defeated the Prussians at the Battle of Jena-Auerstedt , marched through Germany and defeated the Russians on 14 June 1807 at Friedland . The Treaties of Tilsit divided Europe between France and Russia and created the Duchy of Warsaw . On 12 June 1812 Napoleon invaded Russia with a Grande Armée of nearly 700,000 troops. After the measured victories at Smolensk and Borodino Napoleon occupied Moscow, only to find it burned by the retreating Russian army. He was forced to withdraw. On the march back his army was harassed by Cossacks , and suffered disease and starvation. Only 20,000 of his men survived the campaign. By 1813 the tide had begun to turn from Napoleon. Having been defeated by a seven nation army at the Battle of Leipzig in October 1813, he was forced to abdicate after the Six Days' Campaign and the occupation of Paris. Under the Treaty of Fontainebleau he was exiled to the island of Elba . He returned to France on 1 March 1815 (see Hundred Days ), raised an army, but was finally defeated by a British and Prussian force at the Battle of Waterloo on 18 June 1815 and exiled to the small British island of Saint Helena . Roberts finds that the Revolutionary and Napoleonic wars, from 1793 to 1815, caused 4 million deaths (of whom 1 million were civilians); 1.4 million were French. Outside France the Revolution had a major impact. Its ideas became widespread. Roberts argues that Napoleon was responsible for key ideas of the modern world, so that, "meritocracy, equality before the law , property rights , religious toleration , modern secular education , sound finances, and so on-were protected, consolidated, codified, and geographically extended by Napoleon during his 16 years of power." Furthermore, the French armies in the 1790s and 1800s directly overthrew feudal remains in much of western Europe. They liberalised property laws , ended seigneurial dues , abolished the guild of merchants and craftsmen to facilitate entrepreneurship , legalised divorce, closed the Jewish ghettos and made Jews equal to everyone else . The Inquisition ended as did the Holy Roman Empire . The power of church courts and religious authority was sharply reduced and equality under the law was proclaimed for all men. France conquered Belgium and turned it into another province of France. It conquered the Netherlands, and made it a client state . It took control of the German areas on the left bank of the Rhine River and set up a puppet Confederation of the Rhine . It conquered Switzerland and most of Italy, setting up a series of puppet states. The result was glory and an infusion of much needed money from the conquered lands. However the enemies of France, led by Britain, formed a Second Coalition in 1799 (with Britain joined by Russia, the Ottoman Empire and Austria). It scored a series of victories that rolled back French successes, and trapped the French Army in Egypt. Napoleon slipped through the British blockade in October 1799, returning to Paris, where he overthrew the government and made himself the ruler. Napoleon conquered most of Italy in the name of the French Revolution in 1797–99. He split up Austria's holdings and set up a series of new republics, complete with new codes of law and abolition of feudal privileges. Napoleon's Cisalpine Republic was centered on Milan; Genoa became a republic; the Roman Republic was formed as well as the small Ligurian Republic around Genoa. The Neapolitan Republic was formed around Naples, but it lasted only five months. He later formed the Kingdom of Italy , with his brother as King. In addition, France turned the Netherlands into the Batavian Republic , and Switzerland into the Helvetic Republic . All these new countries were satellites of France, and had to pay large subsidies to Paris, as well as provide military support for Napoleon's wars. Their political and administrative systems were modernized, the metric system introduced, and trade barriers reduced. Jewish ghettos were abolished. Belgium and Piedmont became integral parts of France. Most of the new nations were abolished and returned to prewar owners in 1814. However, Artz emphasizes the benefits the Italians gained from the French Revolution: Likewise in Switzerland the long-term impact of the French Revolution has been assessed by Martin: The greatest impact came in France itself. In addition to effects similar to those in Italy and Switzerland, France saw the introduction of the principle of legal equality, and the downgrading of the once powerful and rich Catholic Church . Power became centralized in Paris, with its strong bureaucracy and an army supplied by conscripting all young men. French politics were permanently polarized – new names were given, "left" and "right" for the supporters and opponents of the principles of the Revolution.Roberts finds that the Revolutionary and Napoleonic wars, from 1793 to 1815, caused 4 million deaths (of whom 1 million were civilians); 1.4 million were French. Outside France the Revolution had a major impact. Its ideas became widespread. Roberts argues that Napoleon was responsible for key ideas of the modern world, so that, "meritocracy, equality before the law , property rights , religious toleration , modern secular education , sound finances, and so on-were protected, consolidated, codified, and geographically extended by Napoleon during his 16 years of power." Furthermore, the French armies in the 1790s and 1800s directly overthrew feudal remains in much of western Europe. They liberalised property laws , ended seigneurial dues , abolished the guild of merchants and craftsmen to facilitate entrepreneurship , legalised divorce, closed the Jewish ghettos and made Jews equal to everyone else . The Inquisition ended as did the Holy Roman Empire . The power of church courts and religious authority was sharply reduced and equality under the law was proclaimed for all men. France conquered Belgium and turned it into another province of France. It conquered the Netherlands, and made it a client state . It took control of the German areas on the left bank of the Rhine River and set up a puppet Confederation of the Rhine . It conquered Switzerland and most of Italy, setting up a series of puppet states. The result was glory and an infusion of much needed money from the conquered lands. However the enemies of France, led by Britain, formed a Second Coalition in 1799 (with Britain joined by Russia, the Ottoman Empire and Austria). It scored a series of victories that rolled back French successes, and trapped the French Army in Egypt. Napoleon slipped through the British blockade in October 1799, returning to Paris, where he overthrew the government and made himself the ruler. Napoleon conquered most of Italy in the name of the French Revolution in 1797–99. He split up Austria's holdings and set up a series of new republics, complete with new codes of law and abolition of feudal privileges. Napoleon's Cisalpine Republic was centered on Milan; Genoa became a republic; the Roman Republic was formed as well as the small Ligurian Republic around Genoa. The Neapolitan Republic was formed around Naples, but it lasted only five months. He later formed the Kingdom of Italy , with his brother as King. In addition, France turned the Netherlands into the Batavian Republic , and Switzerland into the Helvetic Republic . All these new countries were satellites of France, and had to pay large subsidies to Paris, as well as provide military support for Napoleon's wars. Their political and administrative systems were modernized, the metric system introduced, and trade barriers reduced. Jewish ghettos were abolished. Belgium and Piedmont became integral parts of France. Most of the new nations were abolished and returned to prewar owners in 1814. However, Artz emphasizes the benefits the Italians gained from the French Revolution: Likewise in Switzerland the long-term impact of the French Revolution has been assessed by Martin: The greatest impact came in France itself. In addition to effects similar to those in Italy and Switzerland, France saw the introduction of the principle of legal equality, and the downgrading of the once powerful and rich Catholic Church . Power became centralized in Paris, with its strong bureaucracy and an army supplied by conscripting all young men. French politics were permanently polarized – new names were given, "left" and "right" for the supporters and opponents of the principles of the Revolution.By the 19th century, governments increasingly took over traditional religious roles, paying much more attention to efficiency and uniformity than to religiosity. Secular bodies took control of education away from the churches, abolished taxes and tithes for the support of established religions , and excluded bishops from the upper houses. Secular laws increasingly regulated marriage and divorce, and maintaining birth and death registers became the duty of local officials. Although the numerous religious denominations in the United States founded many colleges and universities, that was almost exclusively a state function across Europe. Imperial powers protected Christian missionaries in African and Asian colonies. In France and other largely Catholic nations, anti-clerical political movements tried to reduce the role of the Catholic Church. Likewise briefly in Germany in the 1870s there was a fierce Kulturkampf (culture war) against Catholics , but the Catholics successfully fought back. The Catholic Church concentrated more power in the papacy and fought against secularism and socialism . It sponsored devotional reforms that gained wide support among the churchgoers. The political development of nationalism and the push for popular sovereignty culminated with the ethnic/national revolutions of Europe. During the 19th century nationalism became one of the most significant political and social forces in history; it is typically listed among the top causes of World War I . Most European states had become constitutional monarchies by 1871, and Germany and Italy merged many small city-states to become united nation-states. Germany in particular increasingly dominated the continent in economics and political power. Meanwhile, on a global scale, Great Britain, with its far-flung British Empire , unmatched Royal Navy, and powerful bankers, became the world's first global power. The sun never set on its territories, while an informal empire operated through British financiers, entrepreneurs, traders and engineers who established operations in many countries, and largely dominated Latin America. The British were especially famous for financing and constructing railways around the world. Napoleon's conquests of the German and Italian states around 1800–1806 played a major role in stimulating nationalism and demand for national unity. In the German states east of Prussia Napoleon abolished many of the old or medieval relics, such as dissolving the Holy Roman Empire in 1806. He imposed rational legal systems and his organization of the Confederation of the Rhine in 1806 promoted a feeling of German nationalism . In the 1860s it was Prussian chancellor Otto von Bismarck who achieved German unification in 1870 after the many smaller states followed Prussia's leadership in wars against Denmark, Austria and France. Italian nationalism emerged in the 19th century and was the driving force for Italian unification or the "Risorgimento". It was the political and intellectual movement that consolidated different states of the Italian Peninsula into the single state of the Kingdom of Italy in 1860. The memory of the Risorgimento is central to both Italian nationalism and Italian historiography. For centuries the Orthodox Christian Serbs were ruled by the Muslim -controlled Ottoman Empire . The success of the Serbian revolution (1804–1817) against Ottoman rule in 1817 marked the foundation of modern Principality of Serbia . It achieved de facto independence in 1867 and finally gained recognition in the Berlin Congress of 1878. The Serbs developed a larger vision for nationalism in Pan-Slavism and with Russian support sought to pull the other Slavs out of the Austro-Hungarian Empire . Austria, with German backing, tried to crush Serbia in 1914 but Russia intervened, thus igniting the First World War in which Austria dissolved into nation states. In 1918, the region of Vojvodina proclaimed its secession from Austria-Hungary to unite with the pan-Slavic State of Slovenes, Croats and Serbs ; the Kingdom of Serbia joined the union on 1 December 1918, and the country was named Kingdom of Serbs, Croats, and Slovenes . It was renamed Yugoslavia , which was never able to tame the multiple nationalities and religions and it flew apart in civil war in the 1990s. The Greek drive for independence from the Ottoman Empire inspired supporters across Christian Europe, especially in Britain. France, Russia and Britain intervened to make this nationalist dream become reality with the Greek War of Independence (1821-1829/1830). Bulgarian modern nationalism emerged under Ottoman rule in the late 18th and early 19th century. An autonomous Bulgarian Exarchate was established in 1870/1872 for the diocese of Bulgaria as well as for those, wherein at least two-thirds of Orthodox Christians were willing to join it. The April Uprising in 1876 indirectly resulted in the re-establishment of Bulgaria in 1878 . In the 1790s, Germany, Russia and Austria partitioned Poland . Napoleon set up the Duchy of Warsaw , igniting a spirit of Polish nationalism . Russia took it over in 1815 as Congress Poland with the tsar as King of Poland. Large-scale nationalist revolts erupted in 1830 and 1863–64 but were harshly crushed by Russia, which tried to Russify the Polish language , culture and religion . The collapse of the Russian Empire in the First World War enabled the major powers to reestablish an independent Second Polish Republic , which survived until 1939. Meanwhile, Poles in areas controlled by Germany moved into heavy industry but their religion came under attack by Bismarck in the Kulturkampf of the 1870s. The Poles joined German Catholics in a well-organized new Centre Party , and defeated Bismarck politically. He responded by stopping the harassment and cooperating with the Centre Party. After the War of the Spanish Succession , the assimilation of the Crown of Aragon by the Castilian Crown through the Decrees of Nova planta was the first step in the creation of the Spanish nation state, through the imposition of the political and cultural characteristics of the dominant ethnic group, in this case the Castilians, over those of other ethnic groups, who became national minorities to be assimilated. Since the political unification of 1714, Spanish assimilation policies towards Catalan-speaking territories ( Catalonia , Valencia , the Balearic Islands , part of Aragon ) and other national minorities have been a historical constant. The nationalization process accelerated in the 19th century, in parallel to the origin of Spanish nationalism , the social, political and ideological movement that tried to shape a Spanish national identity based on the Castilian model, in conflict with the other historical nations of the State. These nationalist policies, sometimes very aggressive, and still in force, are the seed of repeated territorial conflicts within the State. An important component of nationalism was the study of the nation's heritage, emphasizing the national language and literary culture. This stimulated, and was in turn strongly supported by, the emergence of national educational systems . Latin gave way to the national language, and compulsory education , with strong support from modernizers and the media, became standard in Germany and eventually other West European nations. Voting reforms extended the franchise. Every country developed a sense of national origins – the historical accuracy was less important than the motivation toward patriotism. Universal compulsory education was extended to girls at the elementary level. By the 1890s, strong movements emerged in some countries, including France, Germany and the United States, to extend compulsory education to the secondary level. After the defeat of revolutionary France, the great powers tried to restore the situation which existed before 1789. The 1815 Congress of Vienna produced a peaceful balance of power among the European empires, known as the Metternich system. The powerbase of their support was the aristocracy. However, their reactionary efforts were unable to stop the spread of revolutionary movements: the middle classes had been deeply influenced by the ideals of the French revolution, and the Industrial Revolution brought important economical and social changes. Radical intellectuals looked to the working classes for a base for socialist, communist and anarchistic ideas. Widely influential was the 1848 Communist Manifesto by Karl Marx and Friedrich Engels . The middle classes and businessmen promoted liberalism, free trade and capitalism. Aristocratic elements concentrated in government service, the military and the established churches. Nationalist movements (in Germany, Italy, Poland, Hungary, and elsewhere) sought national unification and/or liberation from foreign rule. As a result, the period between 1815 and 1871 saw a large number of revolutionary attempts and independence wars. Greece successfully revolted against Ottoman rule in the 1820s. Napoleon III , nephew of Napoleon I, parlayed his famous name and to widespread popularity across France. He returned from exile in 1848, promising to stabilize the chaotic political situation. He was elected president and maneuvered successfully to name himself Emperor, a move approved later by a large majority of the French electorate. The first part of his Imperial term brought many important reforms, facilitated by Napoleon's control of the lawmaking body, the government, and the French Armed Forces . Hundreds of old Republican leaders were arrested and deported. Napoleon controlled the media and censored the news. In compensation for the loss of freedom, Napoleon gave the people new hospitals and asylums, beautified and modernized Paris, and built a modern railroad and transportation system that dramatically improved commerce. The economy grew, but industrialization was not as rapid as Britain, and France depended largely on small family-oriented firms as opposed to the large companies that were emerging in the United States and Germany. France was on the winning side in the Crimean War (1854–56), but after 1858 Napoleon's foreign-policy was less and less successful. Foreign-policy blunders finally destroyed his reign in 1870–71. His empire collapsed after being defeated in the Franco-Prussian War . France became a republic, but until the 1880s there was a strong popular demand for monarchy. Hostility to the Catholic Church became a major issue, as France battle between secular and religious forces well into the 20th century, with the secular elements usually more successful. The French Third Republic emerged in 1871. From his base in Prussia, Otto von Bismarck in the 1860s engineered a series of short, decisive wars, that unified most of the German states (excluding Austria) into a powerful German Empire . By 1871 he used balance of power diplomacy to preserve Germany's new role and keep Europe at peace. The new German Empire industrialized rapidly and challenged Britain for economic leadership. Bismarck was removed from office in 1890 by an aggressive young Kaiser Wilhelm II , who pursued a disruptive foreign policy that polarized Europe into rival camps. These rival camps went to war with each other in 1914. The power of nationalism to create new states was irresistible in the 19th century, and the process could lead to collapse in the absence of a strong nationalism. Austria-Hungary had the advantage of size and a large army, but multiple disadvantages: rivals on four sides, unstable finances, a fragmented population, a thin industrial base, and minimal naval resources. It did have the advantage of good diplomats, typified by Metternich . They employed a grand strategy for survival that balanced out different forces, set up buffer zones, and kept the Hapsburg empire going despite wars with the Ottomans, Frederick the Great, Napoleon and Bismarck, until the First World War. The Empire overnight disintegrated into multiple states based on ethnic nationalism and the principle of self-determination. The Russian Empire likewise brought together a multitude of languages and cultures, so that its military defeat in the First World War led to multiple splits that created independent Finland, Latvia, Lithuania, Estonia, and Poland, and briefly independent Ukraine, Armenia, Georgia, and Azerbaijan. In the German states east of Prussia Napoleon abolished many of the old or medieval relics, such as dissolving the Holy Roman Empire in 1806. He imposed rational legal systems and his organization of the Confederation of the Rhine in 1806 promoted a feeling of German nationalism . In the 1860s it was Prussian chancellor Otto von Bismarck who achieved German unification in 1870 after the many smaller states followed Prussia's leadership in wars against Denmark, Austria and France. Italian nationalism emerged in the 19th century and was the driving force for Italian unification or the "Risorgimento". It was the political and intellectual movement that consolidated different states of the Italian Peninsula into the single state of the Kingdom of Italy in 1860. The memory of the Risorgimento is central to both Italian nationalism and Italian historiography. For centuries the Orthodox Christian Serbs were ruled by the Muslim -controlled Ottoman Empire . The success of the Serbian revolution (1804–1817) against Ottoman rule in 1817 marked the foundation of modern Principality of Serbia . It achieved de facto independence in 1867 and finally gained recognition in the Berlin Congress of 1878. The Serbs developed a larger vision for nationalism in Pan-Slavism and with Russian support sought to pull the other Slavs out of the Austro-Hungarian Empire . Austria, with German backing, tried to crush Serbia in 1914 but Russia intervened, thus igniting the First World War in which Austria dissolved into nation states. In 1918, the region of Vojvodina proclaimed its secession from Austria-Hungary to unite with the pan-Slavic State of Slovenes, Croats and Serbs ; the Kingdom of Serbia joined the union on 1 December 1918, and the country was named Kingdom of Serbs, Croats, and Slovenes . It was renamed Yugoslavia , which was never able to tame the multiple nationalities and religions and it flew apart in civil war in the 1990s.The Greek drive for independence from the Ottoman Empire inspired supporters across Christian Europe, especially in Britain. France, Russia and Britain intervened to make this nationalist dream become reality with the Greek War of Independence (1821-1829/1830). Bulgarian modern nationalism emerged under Ottoman rule in the late 18th and early 19th century. An autonomous Bulgarian Exarchate was established in 1870/1872 for the diocese of Bulgaria as well as for those, wherein at least two-thirds of Orthodox Christians were willing to join it. The April Uprising in 1876 indirectly resulted in the re-establishment of Bulgaria in 1878 .In the 1790s, Germany, Russia and Austria partitioned Poland . Napoleon set up the Duchy of Warsaw , igniting a spirit of Polish nationalism . Russia took it over in 1815 as Congress Poland with the tsar as King of Poland. Large-scale nationalist revolts erupted in 1830 and 1863–64 but were harshly crushed by Russia, which tried to Russify the Polish language , culture and religion . The collapse of the Russian Empire in the First World War enabled the major powers to reestablish an independent Second Polish Republic , which survived until 1939. Meanwhile, Poles in areas controlled by Germany moved into heavy industry but their religion came under attack by Bismarck in the Kulturkampf of the 1870s. The Poles joined German Catholics in a well-organized new Centre Party , and defeated Bismarck politically. He responded by stopping the harassment and cooperating with the Centre Party. After the War of the Spanish Succession , the assimilation of the Crown of Aragon by the Castilian Crown through the Decrees of Nova planta was the first step in the creation of the Spanish nation state, through the imposition of the political and cultural characteristics of the dominant ethnic group, in this case the Castilians, over those of other ethnic groups, who became national minorities to be assimilated. Since the political unification of 1714, Spanish assimilation policies towards Catalan-speaking territories ( Catalonia , Valencia , the Balearic Islands , part of Aragon ) and other national minorities have been a historical constant. The nationalization process accelerated in the 19th century, in parallel to the origin of Spanish nationalism , the social, political and ideological movement that tried to shape a Spanish national identity based on the Castilian model, in conflict with the other historical nations of the State. These nationalist policies, sometimes very aggressive, and still in force, are the seed of repeated territorial conflicts within the State.An important component of nationalism was the study of the nation's heritage, emphasizing the national language and literary culture. This stimulated, and was in turn strongly supported by, the emergence of national educational systems . Latin gave way to the national language, and compulsory education , with strong support from modernizers and the media, became standard in Germany and eventually other West European nations. Voting reforms extended the franchise. Every country developed a sense of national origins – the historical accuracy was less important than the motivation toward patriotism. Universal compulsory education was extended to girls at the elementary level. By the 1890s, strong movements emerged in some countries, including France, Germany and the United States, to extend compulsory education to the secondary level. After the defeat of revolutionary France, the great powers tried to restore the situation which existed before 1789. The 1815 Congress of Vienna produced a peaceful balance of power among the European empires, known as the Metternich system. The powerbase of their support was the aristocracy. However, their reactionary efforts were unable to stop the spread of revolutionary movements: the middle classes had been deeply influenced by the ideals of the French revolution, and the Industrial Revolution brought important economical and social changes. Radical intellectuals looked to the working classes for a base for socialist, communist and anarchistic ideas. Widely influential was the 1848 Communist Manifesto by Karl Marx and Friedrich Engels . The middle classes and businessmen promoted liberalism, free trade and capitalism. Aristocratic elements concentrated in government service, the military and the established churches. Nationalist movements (in Germany, Italy, Poland, Hungary, and elsewhere) sought national unification and/or liberation from foreign rule. As a result, the period between 1815 and 1871 saw a large number of revolutionary attempts and independence wars. Greece successfully revolted against Ottoman rule in the 1820s. Napoleon III , nephew of Napoleon I, parlayed his famous name and to widespread popularity across France. He returned from exile in 1848, promising to stabilize the chaotic political situation. He was elected president and maneuvered successfully to name himself Emperor, a move approved later by a large majority of the French electorate. The first part of his Imperial term brought many important reforms, facilitated by Napoleon's control of the lawmaking body, the government, and the French Armed Forces . Hundreds of old Republican leaders were arrested and deported. Napoleon controlled the media and censored the news. In compensation for the loss of freedom, Napoleon gave the people new hospitals and asylums, beautified and modernized Paris, and built a modern railroad and transportation system that dramatically improved commerce. The economy grew, but industrialization was not as rapid as Britain, and France depended largely on small family-oriented firms as opposed to the large companies that were emerging in the United States and Germany. France was on the winning side in the Crimean War (1854–56), but after 1858 Napoleon's foreign-policy was less and less successful. Foreign-policy blunders finally destroyed his reign in 1870–71. His empire collapsed after being defeated in the Franco-Prussian War . France became a republic, but until the 1880s there was a strong popular demand for monarchy. Hostility to the Catholic Church became a major issue, as France battle between secular and religious forces well into the 20th century, with the secular elements usually more successful. The French Third Republic emerged in 1871. From his base in Prussia, Otto von Bismarck in the 1860s engineered a series of short, decisive wars, that unified most of the German states (excluding Austria) into a powerful German Empire . By 1871 he used balance of power diplomacy to preserve Germany's new role and keep Europe at peace. The new German Empire industrialized rapidly and challenged Britain for economic leadership. Bismarck was removed from office in 1890 by an aggressive young Kaiser Wilhelm II , who pursued a disruptive foreign policy that polarized Europe into rival camps. These rival camps went to war with each other in 1914. The power of nationalism to create new states was irresistible in the 19th century, and the process could lead to collapse in the absence of a strong nationalism. Austria-Hungary had the advantage of size and a large army, but multiple disadvantages: rivals on four sides, unstable finances, a fragmented population, a thin industrial base, and minimal naval resources. It did have the advantage of good diplomats, typified by Metternich . They employed a grand strategy for survival that balanced out different forces, set up buffer zones, and kept the Hapsburg empire going despite wars with the Ottomans, Frederick the Great, Napoleon and Bismarck, until the First World War. The Empire overnight disintegrated into multiple states based on ethnic nationalism and the principle of self-determination. The Russian Empire likewise brought together a multitude of languages and cultures, so that its military defeat in the First World War led to multiple splits that created independent Finland, Latvia, Lithuania, Estonia, and Poland, and briefly independent Ukraine, Armenia, Georgia, and Azerbaijan. Colonial empires were the product of the European Age of Discovery from the 15th century. The initial impulse behind these dispersed maritime empires and those that followed was trade. Both the Portuguese Empire and Spanish Empire quickly grew into the first global political and economic systems with territories spread around the world. Subsequent major European colonial empires included the French , Dutch , and British . The latter, consolidated during the period of British maritime hegemony in the 19th century, became the largest empire in history because of the improved ocean transportation technologies of the time as well as electronic communication. At its height in 1920, the British Empire covered a quarter of the Earth's land area and comprised a quarter of its population. Other European countries, such as Belgium , Germany , and Italy , pursued colonial empires as well (mostly in Africa), but they were smaller. Russia built its Russian Empire through conquest by land in Eastern Europe, and Asia. By the mid-19th century, the Ottoman Empire had declined. This instigated the Crimean War in 1854 and began a tenser period of minor clashes among the globe-spanning empires of Europe. In the second half of the 19th century, the Kingdom of Sardinia and the Kingdom of Prussia carried out a series of wars that resulted in the creation of Italy and Germany as nation-states, significantly changing the balance of power in Europe. From 1870, Otto von Bismarck engineered a German hegemony that put France in a critical situation. It slowly rebuilt its relationships, seeking alliances with Russia and Britain to control the growing power of Germany. In this way, two opposing sides – the Triple Alliance of 1882 (Germany, Austria-Hungary and Italy) and the Triple Entente of 1907 (Britain, France and Russia) – formed in Europe, escalating military forces and alliances.After the relative peace of most of the 19th century, the rivalry between European powers, compounded by rising nationalism among ethnic groups, exploded in 1914, when World War I started. Over 65 million European soldiers were mobilised from 1914 to 1918; 20 million soldiers and civilians died. On one side were Germany, Austria-Hungary , the Ottoman Empire and Bulgaria (the Central Powers / Triple Alliance ), while on the other side stood Serbia and the Triple Entente (France, Britain and Russia), which were joined by Italy in 1915, Romania in 1916 and the United States in 1917. The Western Front involved especially brutal combat without any territorial gains by either side. Single battles like Verdun and the Somme killed hundreds of thousands. Czarist Russia collapsed in the February Revolution of 1917 and Germany claimed victory on the Eastern Front . After eight months of liberal rule , the October Revolution brought Vladimir Lenin and the Bolsheviks to power, leading to the creation of the Soviet Union. With American entry into the war in 1917, and the failure of Germany's spring 1918 offensive , Germany had run out of manpower. Germany's allies, Austria-Hungary and the Ottoman Empire , surrendered and dissolved, followed by Germany on 11 November 1918. The world war was settled by the victors at the Paris Peace Conference, 1919 . The major decisions were the creation of the League of Nations ; peace treaties with defeated enemies, most notably the Treaty of Versailles with Germany; the awarding of German and Ottoman overseas possessions as "mandates" , chiefly to Britain and France; and the drawing of new national boundaries to better reflect the forces of nationalism. Multiple nations were required to sign minority rights treaties . The Treaty of Versailles itself weakened Germany's military power and placed full blame for the war and costly reparations on its shoulders – the humiliation and resentment in Germany was probably one of the causes of Nazi success and indirectly a cause of World War II . In the Treaty of Versailles (1919) the winners recognised the new states ( Poland , Czechoslovakia , Hungary, Austria, Yugoslavia , Finland, Estonia, Latvia, Lithuania) created in central Europe from the defunct German, Austro-Hungarian and Russian empires, based on national (ethnic) self-determination. It was a peaceful era with a few small wars before 1922 such as the Ukrainian–Soviet War (1917–1921) and the Polish–Soviet War (1919–1921). Prosperity was widespread, and the major cities sponsored a youth culture called the " Roaring Twenties " or " Jazz Age ". The Allied victory in the First World War seemed to mark the triumph of liberalism . Historian Martin Blinkhorn argues that the liberal themes were ascendant in terms of " cultural pluralism , religious and ethnic toleration, national self-determination , free-market economics , representative and responsible government , free trade , unionism , and the peaceful settlement of international disputes through a new body, the League of Nations." However, as early as 1917, the emerging liberal order was being challenged by the new communist movement . Communist revolts were beaten back everywhere else, but succeeded in Russia. Italy adopted an authoritarian dictatorship known as Fascism in 1922. Authoritarian regimes replaced democracy in the 1930s in Nazi Germany , Portugal , Austria , Poland, Greece , the Baltic countries and Francoist Spain . By 1940, there were only four liberal democracies left on the European continent: France , Finland, Switzerland and Sweden. After the Wall Street Crash of 1929 , most of the world sank into a Great Depression; prices and profits fell and unemployment soared. The worst hit sectors included heavy industry, export-oriented agriculture, mining and lumbering, and construction. World trade fell by two-thirds. In most of Europe, many nations turned to dictators and authoritarian regimes. The most momentous change of government came when Hitler took power in Germany in 1933. The main institution that was meant to bring stability was the League of Nations , created in 1919. However the League failed to resolve any major crises, undermined by the bellicosity of Nazi Germany , Imperial Japan , the Soviet Union, and Mussolini's Italy, and by the non-participation of the United States. By 1937 it was largely ignored. Italy conquered Ethiopia in 1931. The Spanish Civil War (1936–1939) was won by the rebels (the Nationalist faction ), led by Francisco Franco . The civil war did not escalate into a larger conflict, but did become a worldwide ideological battleground that pitted the left, the communist movement and many liberals against Catholics, conservatives, and fascists. Britain, France and the US remained neutral. Worldwide there was a decline in pacifism and a growing sense that another world war was imminent. In 1938 Adolf Hitler annexed the Sudetenland . In the Munich Agreement , Britain and France adopted a policy of appeasement , but Germany subsequently took over the rest of Czechoslovakia . After allying with Japan in the Anti-Comintern Pact and then also with Benito Mussolini 's Italy in the " Pact of Steel ", and finally signing a non-aggression treaty with the Soviet Union in August 1939, Hitler launched the Second World War on 1 September 1939 by attacking Poland . Britain and France declared war on Germany, but there was little fighting during the " Phoney War " period. War began in earnest in spring 1940 with the successful Blitzkrieg conquests of Denmark, Norway, the Low Countries, and France. Britain defeated Germany's air attacks in the Battle of Britain . Hitler's goal was to control Eastern Europe but the attack on the Soviet Union was delayed until June 1941 and the Wehrmacht was stopped close to Moscow in December 1941. Over the next year the Germans started to suffer a series of defeats. War raged between the Axis Powers (Germany, Italy, and Japan) and the Allied Forces (British Empire, Soviet Union, and the United States). The Allied Forces won in North Africa, invaded Italy in 1943, and recaptured France in 1944. In 1945 Germany itself was invaded from the east by the Soviet Union and from the west by the other Allies . As the Red Army conquered the Reichstag in the Battle of Berlin , Hitler committed suicide and Germany surrendered. World War II was the deadliest conflict in human history, causing between 50 and 80 million deaths , the majority of whom were civilians (approximately 38 to 55 million). This period was also marked by systematic genocide. In 1942–45, separately from the war-related deaths, the Nazis killed over 11 million civilians identified through IBM-enabled censuses , including the majority of the Jews and Gypsies of Europe, millions of Polish and Soviet Slavs, homosexuals, Jehovah's Witnesses , disabled people, and political enemies. Meanwhile, in the 1930s the Soviet system of forced labour , expulsions and allegedly engineered famine had a similar death toll. Millions of civilians were affected by forced population transfers. After the relative peace of most of the 19th century, the rivalry between European powers, compounded by rising nationalism among ethnic groups, exploded in 1914, when World War I started. Over 65 million European soldiers were mobilised from 1914 to 1918; 20 million soldiers and civilians died. On one side were Germany, Austria-Hungary , the Ottoman Empire and Bulgaria (the Central Powers / Triple Alliance ), while on the other side stood Serbia and the Triple Entente (France, Britain and Russia), which were joined by Italy in 1915, Romania in 1916 and the United States in 1917. The Western Front involved especially brutal combat without any territorial gains by either side. Single battles like Verdun and the Somme killed hundreds of thousands. Czarist Russia collapsed in the February Revolution of 1917 and Germany claimed victory on the Eastern Front . After eight months of liberal rule , the October Revolution brought Vladimir Lenin and the Bolsheviks to power, leading to the creation of the Soviet Union. With American entry into the war in 1917, and the failure of Germany's spring 1918 offensive , Germany had run out of manpower. Germany's allies, Austria-Hungary and the Ottoman Empire , surrendered and dissolved, followed by Germany on 11 November 1918. The world war was settled by the victors at the Paris Peace Conference, 1919 . The major decisions were the creation of the League of Nations ; peace treaties with defeated enemies, most notably the Treaty of Versailles with Germany; the awarding of German and Ottoman overseas possessions as "mandates" , chiefly to Britain and France; and the drawing of new national boundaries to better reflect the forces of nationalism. Multiple nations were required to sign minority rights treaties . The Treaty of Versailles itself weakened Germany's military power and placed full blame for the war and costly reparations on its shoulders – the humiliation and resentment in Germany was probably one of the causes of Nazi success and indirectly a cause of World War II .In the Treaty of Versailles (1919) the winners recognised the new states ( Poland , Czechoslovakia , Hungary, Austria, Yugoslavia , Finland, Estonia, Latvia, Lithuania) created in central Europe from the defunct German, Austro-Hungarian and Russian empires, based on national (ethnic) self-determination. It was a peaceful era with a few small wars before 1922 such as the Ukrainian–Soviet War (1917–1921) and the Polish–Soviet War (1919–1921). Prosperity was widespread, and the major cities sponsored a youth culture called the " Roaring Twenties " or " Jazz Age ". The Allied victory in the First World War seemed to mark the triumph of liberalism . Historian Martin Blinkhorn argues that the liberal themes were ascendant in terms of " cultural pluralism , religious and ethnic toleration, national self-determination , free-market economics , representative and responsible government , free trade , unionism , and the peaceful settlement of international disputes through a new body, the League of Nations." However, as early as 1917, the emerging liberal order was being challenged by the new communist movement . Communist revolts were beaten back everywhere else, but succeeded in Russia. Italy adopted an authoritarian dictatorship known as Fascism in 1922. Authoritarian regimes replaced democracy in the 1930s in Nazi Germany , Portugal , Austria , Poland, Greece , the Baltic countries and Francoist Spain . By 1940, there were only four liberal democracies left on the European continent: France , Finland, Switzerland and Sweden. After the Wall Street Crash of 1929 , most of the world sank into a Great Depression; prices and profits fell and unemployment soared. The worst hit sectors included heavy industry, export-oriented agriculture, mining and lumbering, and construction. World trade fell by two-thirds. In most of Europe, many nations turned to dictators and authoritarian regimes. The most momentous change of government came when Hitler took power in Germany in 1933. The main institution that was meant to bring stability was the League of Nations , created in 1919. However the League failed to resolve any major crises, undermined by the bellicosity of Nazi Germany , Imperial Japan , the Soviet Union, and Mussolini's Italy, and by the non-participation of the United States. By 1937 it was largely ignored. Italy conquered Ethiopia in 1931. The Spanish Civil War (1936–1939) was won by the rebels (the Nationalist faction ), led by Francisco Franco . The civil war did not escalate into a larger conflict, but did become a worldwide ideological battleground that pitted the left, the communist movement and many liberals against Catholics, conservatives, and fascists. Britain, France and the US remained neutral. Worldwide there was a decline in pacifism and a growing sense that another world war was imminent. After the Wall Street Crash of 1929 , most of the world sank into a Great Depression; prices and profits fell and unemployment soared. The worst hit sectors included heavy industry, export-oriented agriculture, mining and lumbering, and construction. World trade fell by two-thirds. In most of Europe, many nations turned to dictators and authoritarian regimes. The most momentous change of government came when Hitler took power in Germany in 1933. The main institution that was meant to bring stability was the League of Nations , created in 1919. However the League failed to resolve any major crises, undermined by the bellicosity of Nazi Germany , Imperial Japan , the Soviet Union, and Mussolini's Italy, and by the non-participation of the United States. By 1937 it was largely ignored. Italy conquered Ethiopia in 1931. The Spanish Civil War (1936–1939) was won by the rebels (the Nationalist faction ), led by Francisco Franco . The civil war did not escalate into a larger conflict, but did become a worldwide ideological battleground that pitted the left, the communist movement and many liberals against Catholics, conservatives, and fascists. Britain, France and the US remained neutral. Worldwide there was a decline in pacifism and a growing sense that another world war was imminent. In 1938 Adolf Hitler annexed the Sudetenland . In the Munich Agreement , Britain and France adopted a policy of appeasement , but Germany subsequently took over the rest of Czechoslovakia . After allying with Japan in the Anti-Comintern Pact and then also with Benito Mussolini 's Italy in the " Pact of Steel ", and finally signing a non-aggression treaty with the Soviet Union in August 1939, Hitler launched the Second World War on 1 September 1939 by attacking Poland . Britain and France declared war on Germany, but there was little fighting during the " Phoney War " period. War began in earnest in spring 1940 with the successful Blitzkrieg conquests of Denmark, Norway, the Low Countries, and France. Britain defeated Germany's air attacks in the Battle of Britain . Hitler's goal was to control Eastern Europe but the attack on the Soviet Union was delayed until June 1941 and the Wehrmacht was stopped close to Moscow in December 1941. Over the next year the Germans started to suffer a series of defeats. War raged between the Axis Powers (Germany, Italy, and Japan) and the Allied Forces (British Empire, Soviet Union, and the United States). The Allied Forces won in North Africa, invaded Italy in 1943, and recaptured France in 1944. In 1945 Germany itself was invaded from the east by the Soviet Union and from the west by the other Allies . As the Red Army conquered the Reichstag in the Battle of Berlin , Hitler committed suicide and Germany surrendered. World War II was the deadliest conflict in human history, causing between 50 and 80 million deaths , the majority of whom were civilians (approximately 38 to 55 million). This period was also marked by systematic genocide. In 1942–45, separately from the war-related deaths, the Nazis killed over 11 million civilians identified through IBM-enabled censuses , including the majority of the Jews and Gypsies of Europe, millions of Polish and Soviet Slavs, homosexuals, Jehovah's Witnesses , disabled people, and political enemies. Meanwhile, in the 1930s the Soviet system of forced labour , expulsions and allegedly engineered famine had a similar death toll. Millions of civilians were affected by forced population transfers. The world wars ended the pre-eminent position of Britain, France and Germany in Europe and the world. At the Yalta Conference , Europe was divided into spheres of influence between the victors of World War II, and soon became the principal zone of contention in the Cold War between the Western countries and the Communist bloc . The United States and the majority of European liberal democracies established the NATO military alliance. Later, the Soviet Union and its satellites in 1955 established the Warsaw Pact . The Warsaw Pact had a much larger ground force, but the American-French-British nuclear umbrellas protected NATO. Communist states were imposed by the Red Army in the East, while parliamentary democracy became dominant in the West. Most historians point to its success as the product of exhaustion with war and dictatorship, and the promise of continued economic prosperity. The United States gave away about $20 billion in Marshall Plan grants and other funding to Western Europe, 1945 to 1951. Historian Michael J. Hogan argues that American aid was critical in stabilizing the economy and politics of Western Europe. It brought in modern management that dramatically increased productivity, and encouraged cooperation between labor and management, and among states. Local Communist parties were opposed, and they lost prestige and influence and a role in government. In strategic terms, says Hogan, the Marshall Plan strengthened the West against the possibility of a communist invasion or political takeover. However, the Marshall Plan's role in the rapid recovery has been debated. Most reject the idea that it only miraculously revived Europe, since the evidence shows that a general recovery was already under way. Economic historians Bradford De Long and Barry Eichengreen conclude: The Soviet Union concentrated on its own recovery. It seized and transferred most of Germany's industrial plants and it exacted war reparations from East Germany, Hungary, Romania, and Bulgaria. It used trading arrangements deliberately designed to favor the Soviet Union. Moscow controlled the Communist parties that ruled the satellite states. Historian Mark Kramer concludes: Looking at the half century after the war historian Walter Lacquer concluded: The post-war period witnessed a significant rise in the standard of living of the Western European working class. Western Europe's industrial nations in the 1970s were hit by a global economic crisis . Causes included obsolescent heavy industry, sudden high energy prices which caused sharp inflation, inefficient nationalized railways and heavy industries, lagging computer technology , high government deficits and growing unrest led by militant labour unions . Germany and Sweden sought to create a social consensus behind a gradual restructuring. Germany's efforts proved highly successful. In Britain under the premiership of Margaret Thatcher , the solution was shock therapy, high interest rates, austerity, and selling off inefficient corporations as well as the public housing. One result was escalating social tensions in Britain. Thatcher eventually defeated her opponents and radically changed the British economy , but controversy persisted. The United States gave away about $20 billion in Marshall Plan grants and other funding to Western Europe, 1945 to 1951. Historian Michael J. Hogan argues that American aid was critical in stabilizing the economy and politics of Western Europe. It brought in modern management that dramatically increased productivity, and encouraged cooperation between labor and management, and among states. Local Communist parties were opposed, and they lost prestige and influence and a role in government. In strategic terms, says Hogan, the Marshall Plan strengthened the West against the possibility of a communist invasion or political takeover. However, the Marshall Plan's role in the rapid recovery has been debated. Most reject the idea that it only miraculously revived Europe, since the evidence shows that a general recovery was already under way. Economic historians Bradford De Long and Barry Eichengreen conclude: The Soviet Union concentrated on its own recovery. It seized and transferred most of Germany's industrial plants and it exacted war reparations from East Germany, Hungary, Romania, and Bulgaria. It used trading arrangements deliberately designed to favor the Soviet Union. Moscow controlled the Communist parties that ruled the satellite states. Historian Mark Kramer concludes: Looking at the half century after the war historian Walter Lacquer concluded: The post-war period witnessed a significant rise in the standard of living of the Western European working class. Western Europe's industrial nations in the 1970s were hit by a global economic crisis . Causes included obsolescent heavy industry, sudden high energy prices which caused sharp inflation, inefficient nationalized railways and heavy industries, lagging computer technology , high government deficits and growing unrest led by militant labour unions . Germany and Sweden sought to create a social consensus behind a gradual restructuring. Germany's efforts proved highly successful. In Britain under the premiership of Margaret Thatcher , the solution was shock therapy, high interest rates, austerity, and selling off inefficient corporations as well as the public housing. One result was escalating social tensions in Britain. Thatcher eventually defeated her opponents and radically changed the British economy , but controversy persisted. Western Europe began economic and then political integration, with the aim to unite the region and defend it. This process included organisations such as the European Coal and Steel Community and the Council of Europe . The Solidarność movement in the 1980s weakened the Communist government in Poland . At the time the Soviet leader Mikhail Gorbachev initiated perestroika and glasnost , which weakened Soviet influence in Europe. In 1989 after the Pan-European Picnic the Iron Curtain and the Berlin Wall came down and Communist governments outside the Soviet Union were deposed. In 1990 the Federal Republic of Germany absorbed East Germany. In 1991 the Communist Party of the Soviet Union in Moscow collapsed, ending the USSR , which split into fifteen independent states. The most violent dissolution happened in Yugoslavia. Four out of six Yugoslav republics declared independence and for most of them a violent war ensued, in some parts lasting until 1995. In 2006 Montenegro seceded and became an independent state. Kosovo 's government unilaterally declared independence from Serbia on 17 February 2008. The European Economic Community pushed for closer integration, co-operation in foreign and home affairs, and started to increase its membership into the neutral and former communist countries. In 1993, the Maastricht Treaty established the European Union , succeeding the EEC. The neutral countries of Austria, Finland and Sweden acceded to the EU, and those that did not join were tied into the EU's economic market via the European Economic Area . These countries also entered the Schengen Agreement which lifted border controls between member states. The euro was created in 1999 and replaced all previous currencies in participating states in 2002, forming the eurozone . The EU did not participate in the Yugoslav Wars , and was divided on supporting the United States in the 2003–2011 Iraq War . NATO was part of the war in Afghanistan , but at a much lower level of involvement than the United States. In the post–Cold War era , NATO and the EU have been gradually admitting most of the former members of the Warsaw Pact. In 2004, the EU gained 10 new members . ( Estonia , Latvia , and Lithuania , which had been part of the Soviet Union; Czech Republic , Hungary, Poland, Slovakia , and Slovenia , five former-communist countries; Malta , and the divided island of Cyprus .) These were followed by Bulgaria and Romania in 2007 . Russia's regime interpreted these expansions as violations against NATO's promise to not expand "one inch to the east" in 1990. Russia engaged in bilateral disputes about gas supplies with Belarus and Ukraine which endangered the European supply, and engaged in a war with Georgia in 2008. Public opinion in the EU turned against enlargement, partially due to what was seen as over-eager expansion including Turkey gaining candidate status. The European Constitution was rejected in France and the Netherlands , and then (as the Treaty of Lisbon ) in Ireland, although a second vote passed in Ireland in 2009. The financial crisis of 2007–08 affected Europe, and government responded with austerity measures . Limited ability of the smaller EU nations (most notably Greece ) to handle their debts led to social unrest, government liquidation, and financial insolvency. In May 2010, the German parliament agreed to loan 22.4 billion euros to Greece over three years, with the stipulation that Greece follow strict austerity measures. See European sovereign-debt crisis . Beginning in 2014, Ukraine has been in a state of revolution and unrest. On 16 March, a disputed referendum was held in Crimea leading to the de facto secession of Crimea and its largely internationally unrecognized annexation to the Russian Federation. In June 2016, in a referendum in the United Kingdom on the country's membership in the European Union , 52% of voters voted to leave the EU, leading to the complex Brexit separation process and negotiations, which led to political and economic changes for both the UK and the remaining European Union countries. The UK left the EU on 31 January 2020. Later that year, Europe was affected by the COVID-19 pandemic . According to the Wall Street Journal in 2021 as Angela Merkel stepped down as Chancellor of Germany after 16 years: Ms. Merkel leaves in her wake a weakened Europe, a region whose aspirations to act as a third superpower have come to seem ever more unrealistic. When she became chancellor in 2005, the EU was at a high point: It had adopted the euro , which was meant to rival the dollar as a global currency , and had just expanded by absorbing former members of the Soviet bloc . Today's EU, by contrast, is geographically and economically diminished. Having lost the U.K. because of Brexit , it faces deep political and cultural divisions, lags behind in the global race for innovation and technology and is increasingly squeezed by the mounting U.S.-China strategic rivalry . Europe has endured thanks in part to Ms. Merkel's pragmatic stewardship, but it has been battered by crises during her entire time in office. Russia began an invasion of Ukraine on 24 February 2022, in a major escalation of the Russo-Ukrainian War that began in 2014. It is the largest conventional military attack in Europe since World War II. AD

Wiki

Bubonic plague

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Amentum (company)

Amentum Services, Inc. (formally Amentum Government Services Holding LLC ) is an American government and commercial services contractor based in Chantilly, Virginia . The company was formed in 2020 from the spinout of AECOM's Management Services / federal group. After Leidos , it is the second-largest government services (non equipment producing) contractor in the US government contracting market. Amentum was founded in 2020 as a spinout of the Management Services Group of AECOM , consisting of the non-construction parts of the company's federal work as well as its commercial operations and maintenance business. This came as a result of a process by AECOM to realign its business to focus more clearly on the architect, engineering, and construction market. Amentum traces its AECOM roots back to several well-known government contracting firms that now form the basis of its current work. These firms came to be a part of the company by way of AECOM's acquisition of URS Corporation and include EG&G , Washington Group International , Westinghouse Government Services , and Lear Siegler . As part of the strategy by its owners, Amentum has pursued acquisitions of other government contractors including:As part of the strategy by its owners, Amentum has pursued acquisitions of other government contractors including:

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Pneumonic plague

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Pneumonic plague

Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis . Symptoms include fever , headache, shortness of breath , chest pain , and coughing. They typically start about three to seven days after exposure. It is one of three forms of plague , the other two being septicemic plague and bubonic plague . The pneumonic form may occur following an initial bubonic or septicemic plague infection. It may also result from breathing in airborne droplets from another person or animal infected with pneumonic plague. The difference between the forms of plague is the location of infection; in pneumonic plague the infection is in the lungs, in bubonic plague the lymph nodes , and in septicemic plague within the blood. Diagnosis is by testing the blood, sputum, or fluid from a lymph node. While vaccines are being developed, in most countries they are not yet commercially available. Prevention is by avoiding contact with infected rodents, people, or cats. It is recommended that those infected be isolated from others. Treatment of pneumonic plague is with antibiotics . Plague is present among rodents in Africa, the Americas, and Asia. Pneumonic plague is more serious and less common than bubonic plague. The total reported number of cases of all types of plague in 2013 was 783. Left untreated, pneumonic plague is always fatal. Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 75 - 200 million deaths in the 1300s. The most apparent symptom of pneumonic plague is coughing, often with hemoptysis (coughing up blood). With pneumonic plague, the first signs of illness are fever, headache, weakness and rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery sputum . The pneumonia progresses for two to four days and may cause respiratory failure and shock . Patients will die without early treatment, some within 36 hours. [ citation needed ] Initial pneumonic plague symptoms can often include the following: [ citation needed ] Rapidly developing pneumonia with: [ citation needed ]Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolized plague bacteria , or secondary, when septicemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is not exclusively vector-borne like bubonic plague; instead, it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. This is one of the types of plague formerly known as the Black Death . Pneumonic plague is a very aggressive infection requiring early treatment, which must be given within 24 hours of first symptoms to reduce the risk of death. Streptomycin , gentamicin , tetracyclines and chloramphenicol are all able to kill the causative bacterium. [ citation needed ] Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection. The mortality rate from untreated pneumonic plague approaches 100%. Since 2002, the World Health Organization (WHO) has reported seven plague outbreaks, though some may go unreported because they often happen in remote areas. Between 1998 and 2009, nearly 24,000 cases have been reported, including about 2,000 deaths, in Africa, Asia, the Americas, and Eastern Europe. Ninety-eight percent of the world's cases occur in Africa. Two outbreaks occurred in the Democratic Republic of the Congo in 2005 and 2006. The outbreak in 2005 was only detected by looking back at blood samples. The total death toll was 111. In September 1994, India experienced an outbreak of plague that killed 50 and caused travel to New Delhi by air to be suspended until the outbreak was brought under control. The outbreak was feared to be much worse because the plague superficially resembles other common diseases such as influenza and bronchitis; over 200 people that had been quarantined were released when they did not test positive for the plague. All but two of the deaths occurred around the city of Surat . [ citation needed ] A major outbreak of the pneumonic plague occurred in Manchuria from 1910 to 1911, in what became known as the Manchurian plague , killing around 60,000 people. The Qing court dispatched Wu Lien-teh , a doctor educated at Cambridge University , to oversee disease control and treatment efforts. He made the novel observation that the disease was transmitted by air , and developed prototypical respirators to help prevent its spread. A second, less deadly outbreak occurred in 1920–21, killing approximately 9,300 people. The People's Republic of China has eradicated pneumonic plague from most parts of the country, but still reports occasional cases in remote western areas, where the disease is carried by rats and the marmots that live across the Himalayan plateau . Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats. A 2006 WHO report from an international meeting on plague cited a Chinese government disease expert as saying that most cases of the plague in China's northwest occur when hunters are contaminated while skinning infected animals. The expert said at the time that, due to the region's remoteness, the disease killed more than half the infected people. The report also said that since the 1990s, there was a rise in plague cases in humans—from fewer than 10 in the 1980s to nearly 100 cases in 1996 and 254 in 2000. In September 2008, two people in East Tibet died of pneumonic plague. An outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province . The town was sealed off and several people died as a result of the disease. According to spokesperson Vivian Tan of the WHO office in Beijing , "In cases like this [in August 2009], we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts, and to treat confirmed cases as soon as possible. So far, they have done exactly that. There have been sporadic cases reported around the country in the last few years so the authorities do have the experience to deal with this." In September 2010, five cases of pneumonic plague were reported in Tibet. In July 2014, Chinese media reported one case found in Gansu. On 12 November 2019, It was announced that two people from the Chinese province of Inner Mongolia were diagnosed with pneumonic plague. They received treatment in Chaoyang District, Beijing , and authorities implemented preventative control measures. Later in November, a third case of plague was confirmed. A 55-year-old man was diagnosed with bubonic plague after eating wild rabbit in Inner Mongolia. The region's health commission says it has no evidence to suggest that this case is linked to the previous two. By the end of November, a fourth case was confirmed. Chinese health authorities reported a fresh case of bubonic plague in the country's northern Inner Mongolia region, bringing the total number of reported plague cases originating from Inner Mongolia to four. In August 2010, Peru's health minister Oscar Ugarte announced that an outbreak of plague had killed a 14-year-old boy and had infected at least 31 people in a northern coastal province. The boy died of bubonic plague on 26 July 2010. Ugarte stated that authorities were screening sugar and fish meal exports from Ascope Province , located about 325 miles (520 km) northwest of Lima , not far from the popular Chicama beach . Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague. The first recorded plague outbreak in Peru was in 1903. Prior to the above case, the last known outbreak was in 1994, killing 35 people. In November 2013, an outbreak of plague occurred in the African island nation of Madagascar . As of 16 December, at least 89 people were infected, with 39 deaths with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague. From 23 August to 30 September 2017, a total of 73 suspected, probable, and confirmed cases of pneumonic plague, including 17 deaths, were reported in Madagascar. The diagnosis was confirmed by the Institut Pasteur de Madagascar by a polymerase chain reaction test, while field health workers used a Rapid Diagnostic Test. The WHO and Institut Pasteur de Madagascar were both involved in administering antibiotic compounds and attempting to stop the spread of the disease. By mid-October, there were an estimated 684 confirmed cases of plague with 474 pneumonic, 156 bubonic and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague. The outbreak officially ended on 26 November 2017 with 2,348 cases and 202 deaths officially reported. In the fall of 1924, an outbreak occurred in Los Angeles that killed 30 people. On 2 November 2007, wildlife biologist Eric York died of pneumonic plague in Grand Canyon National Park . York was exposed to the bacteria while conducting a necropsy on a cougar carcass. In 2014, the Colorado Department of Public Health and Environment confirmed that a Colorado man had been diagnosed with pneumonic plague, the first confirmed human case in Colorado in more than 10 years, and one of only 60 cases since 1957. The man was found to have the disease after the family dog died unexpectedly and a necropsy revealed that the disease was the cause. Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended. Two outbreaks occurred in the Democratic Republic of the Congo in 2005 and 2006. The outbreak in 2005 was only detected by looking back at blood samples. The total death toll was 111.In September 1994, India experienced an outbreak of plague that killed 50 and caused travel to New Delhi by air to be suspended until the outbreak was brought under control. The outbreak was feared to be much worse because the plague superficially resembles other common diseases such as influenza and bronchitis; over 200 people that had been quarantined were released when they did not test positive for the plague. All but two of the deaths occurred around the city of Surat . [ citation needed ]A major outbreak of the pneumonic plague occurred in Manchuria from 1910 to 1911, in what became known as the Manchurian plague , killing around 60,000 people. The Qing court dispatched Wu Lien-teh , a doctor educated at Cambridge University , to oversee disease control and treatment efforts. He made the novel observation that the disease was transmitted by air , and developed prototypical respirators to help prevent its spread. A second, less deadly outbreak occurred in 1920–21, killing approximately 9,300 people. The People's Republic of China has eradicated pneumonic plague from most parts of the country, but still reports occasional cases in remote western areas, where the disease is carried by rats and the marmots that live across the Himalayan plateau . Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats. A 2006 WHO report from an international meeting on plague cited a Chinese government disease expert as saying that most cases of the plague in China's northwest occur when hunters are contaminated while skinning infected animals. The expert said at the time that, due to the region's remoteness, the disease killed more than half the infected people. The report also said that since the 1990s, there was a rise in plague cases in humans—from fewer than 10 in the 1980s to nearly 100 cases in 1996 and 254 in 2000. In September 2008, two people in East Tibet died of pneumonic plague. An outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province . The town was sealed off and several people died as a result of the disease. According to spokesperson Vivian Tan of the WHO office in Beijing , "In cases like this [in August 2009], we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts, and to treat confirmed cases as soon as possible. So far, they have done exactly that. There have been sporadic cases reported around the country in the last few years so the authorities do have the experience to deal with this." In September 2010, five cases of pneumonic plague were reported in Tibet. In July 2014, Chinese media reported one case found in Gansu. On 12 November 2019, It was announced that two people from the Chinese province of Inner Mongolia were diagnosed with pneumonic plague. They received treatment in Chaoyang District, Beijing , and authorities implemented preventative control measures. Later in November, a third case of plague was confirmed. A 55-year-old man was diagnosed with bubonic plague after eating wild rabbit in Inner Mongolia. The region's health commission says it has no evidence to suggest that this case is linked to the previous two. By the end of November, a fourth case was confirmed. Chinese health authorities reported a fresh case of bubonic plague in the country's northern Inner Mongolia region, bringing the total number of reported plague cases originating from Inner Mongolia to four. In August 2010, Peru's health minister Oscar Ugarte announced that an outbreak of plague had killed a 14-year-old boy and had infected at least 31 people in a northern coastal province. The boy died of bubonic plague on 26 July 2010. Ugarte stated that authorities were screening sugar and fish meal exports from Ascope Province , located about 325 miles (520 km) northwest of Lima , not far from the popular Chicama beach . Most of the infections in Peru were bubonic plague, with four cases of pneumonic plague. The first recorded plague outbreak in Peru was in 1903. Prior to the above case, the last known outbreak was in 1994, killing 35 people. In November 2013, an outbreak of plague occurred in the African island nation of Madagascar . As of 16 December, at least 89 people were infected, with 39 deaths with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague. From 23 August to 30 September 2017, a total of 73 suspected, probable, and confirmed cases of pneumonic plague, including 17 deaths, were reported in Madagascar. The diagnosis was confirmed by the Institut Pasteur de Madagascar by a polymerase chain reaction test, while field health workers used a Rapid Diagnostic Test. The WHO and Institut Pasteur de Madagascar were both involved in administering antibiotic compounds and attempting to stop the spread of the disease. By mid-October, there were an estimated 684 confirmed cases of plague with 474 pneumonic, 156 bubonic and one septicemic. The remainder were not classified. At least 74 deaths have been ascribed to pneumonic plague. The outbreak officially ended on 26 November 2017 with 2,348 cases and 202 deaths officially reported. In the fall of 1924, an outbreak occurred in Los Angeles that killed 30 people. On 2 November 2007, wildlife biologist Eric York died of pneumonic plague in Grand Canyon National Park . York was exposed to the bacteria while conducting a necropsy on a cougar carcass. In 2014, the Colorado Department of Public Health and Environment confirmed that a Colorado man had been diagnosed with pneumonic plague, the first confirmed human case in Colorado in more than 10 years, and one of only 60 cases since 1957. The man was found to have the disease after the family dog died unexpectedly and a necropsy revealed that the disease was the cause. Three additional pneumonic plague cases were confirmed in Colorado before the outbreak ended.

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Pneumonic plague

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Bubonic plague

Bubonic plague is one of three types of plague caused by the bacterium Yersinia pestis . One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever , headaches , and vomiting , as well as swollen and painful lymph nodes occurring in the area closest to where the bacteria entered the skin. Acral necrosis , the dark discoloration of skin, is another symptom. Occasionally, swollen lymph nodes, known as " buboes ", may break open. The three types of plague are the result of the route of infection: bubonic plague, septicemic plague , and pneumonic plague . Bubonic plague is mainly spread by infected fleas from small animals . It may also result from exposure to the body fluids from a dead plague-infected animal. Mammals such as rabbits , hares , and some cat species are susceptible to bubonic plague, and typically die upon contraction. In the bubonic form of plague, the bacteria enter through the skin through a flea bite and travel via the lymphatic vessels to a lymph node , causing it to swell. Diagnosis is made by finding the bacteria in the blood, sputum , or fluid from lymph nodes. Prevention is through public health measures such as not handling dead animals in areas where plague is common. While vaccines against the plague have been developed, the World Health Organization recommends that only high-risk groups, such as certain laboratory personnel and health care workers, get inoculated. Several antibiotics are effective for treatment, including streptomycin , gentamicin , and doxycycline . Without treatment, plague results in the death of 30% to 90% of those infected. Death, if it occurs, is typically within 10 days. With treatment, the risk of death is around 10%. Globally between 2010 and 2015 there were 3,248 documented cases, which resulted in 584 deaths. The countries with the greatest number of cases are the Democratic Republic of the Congo , Madagascar , and Peru . The plague is considered the likely cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people, including about 25% to 60% of the European population. Because the plague killed so many of the working population, wages rose due to the demand for labor. Some historians see this as a turning point in European economic development . The disease is also considered to have been responsible for the Plague of Justinian , originating in the Eastern Roman Empire in the 6th century CE, as well as the third epidemic , affecting China , Mongolia , and India , originating in the Yunnan Province in 1855. The term bubonic is derived from the Greek word Î²Î¿Ï Î²ÏŽÎ½ , meaning "groin." The bubonic plague is an infection of the lymphatic system , usually resulting from the bite of an infected flea, Xenopsylla cheopis (the Oriental rat flea ). Several flea species carried the bubonic plague, such as Pulex irritans (the human flea ), Xenopsylla cheopis , and Ceratophyllus fasciatus . Xenopsylla cheopis was the most effective flea species for transmission. The flea is parasitic on house and field rats and seeks out other prey when its rodent host dies. Rats were an amplifying factor to bubonic plague due to their common association with humans as well as the nature of their blood. The rat's blood allows the rat to withstand a major concentration of the plague. The bacteria form aggregates in the gut of infected fleas, and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, the bacteria rapidly spread to the lymph nodes of the host and multiply. The fleas that transmit the disease only directly infect humans when the rat population in the area is wiped out from a mass infection. Furthermore, in areas with a large population of rats, the animals can harbor low levels of the plague infection without causing human outbreaks. With no new rat inputs being added to the population from other areas, the infection only spread to humans in very rare cases of overcrowding. After being transmitted via the bite of an infected flea, the Y. pestis bacteria become localized in an inflamed lymph node , where they begin to colonize and reproduce. Infected lymph nodes develop hemorrhages, which result in the death of tissue. Y. pestis bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can hemorrhage and become swollen and necrotic . Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague . Symptoms appear 2–7 days after getting bitten and they include: The best-known symptom of bubonic plague is one or more infected, enlarged, and painful lymph nodes, known as buboes . Buboes associated with the bubonic plague are commonly found in the armpits, upper femoral area, groin, and neck region. These buboes will grow and become more painful over time, often to the point of bursting. Symptoms include heavy breathing, continuous vomiting of blood ( hematemesis ), aching limbs, coughing, and extreme pain caused by the decay or decomposition of the skin while the person is still alive. Additional symptoms include extreme fatigue, gastrointestinal problems, spleen inflammation, lenticulae (black dots scattered throughout the body), delirium, coma , organ failure, and death. Organ failure is a result of the bacteria infecting organs through the bloodstream. Other forms of the disease include septicemic plague and pneumonic plague , in which the bacterium reproduces in the person's blood and lungs respectively. Laboratory testing is required in order to diagnose and confirm plague. Ideally, confirmation is through the identification of Y. pestis culture from a patient sample. Confirmation of infection can be done by examining serum taken during the early and late stages of infection . To quickly screen for the Y. pestis antigen in patients, rapid dipstick tests have been developed for field use. Samples taken for testing include: Bubonic plague outbreaks are controlled by pest control and modern sanitation techniques. This disease uses fleas commonly found on rats as a vector to jump from animals to humans. The mortality rate is highest in the summer and early fall. The successful control of rat populations in dense urban areas is essential to outbreak prevention. One example is the use of a machine called the Sulfurozador , used to deliver sulphur dioxide to eradicate the pest that spread the bubonic plague in Buenos Aires, Argentina during the early 18th century. Targeted chemoprophylaxis , sanitation , and vector control also played a role in controlling the 2003 Oran outbreak of the bubonic plague. Another means of prevention in large European cities was a city-wide quarantine to not only limit interaction with people who were infected, but also to limit the interaction with the infected rats. Several classes of antibiotic are effective in treating bubonic plague. These include aminoglycosides such as streptomycin and gentamicin , tetracyclines (especially doxycycline ), and the fluoroquinolone ciprofloxacin . Mortality associated with treated cases of bubonic plague is about 1–15%, compared to a mortality of 40–60% in untreated cases. People potentially infected with the plague need immediate treatment and should be given antibiotics within 24 hours of the first symptoms to prevent death. Other treatments include oxygen, intravenous fluids, and respiratory support. People who have had contact with anyone infected by pneumonic plague are given prophylactic antibiotics. Using the broad-based antibiotic streptomycin has proven to be dramatically successful against the bubonic plague within 12 hours of infection. Globally between 2010 and 2015, there were 3,248 documented cases, which resulted in 584 deaths. The countries with the greatest number of cases are the Democratic Republic of the Congo , Madagascar , and Peru . For over a decade since 2001, Zambia, India, Malawi, Algeria, China, Peru, and the Democratic Republic of the Congo had the most plague cases, with over 1,100 cases in the Democratic Republic of the Congo alone. From 1,000 to 2,000 cases are conservatively reported per year to the WHO . From 2012 to 2017, reflecting political unrest and poor hygienic conditions, Madagascar began to host regular epidemics. Between 1900 and 2015, the United States had 1,036 human plague cases, with an average of 9 cases per year. In 2015, 16 people in the western United States developed plague, including 2 cases in Yosemite National Park . These US cases usually occur in rural northern New Mexico, northern Arizona, southern Colorado, California, southern Oregon, and far western Nevada. In November 2017, the Madagascar Ministry of Health reported an outbreak to the WHO (World Health Organization) with more cases and deaths than any recent outbreak in the country. Unusually, most of the cases were pneumonic rather than bubonic. In June 2018, a child was confirmed to be the first person in Idaho to be infected by bubonic plague in nearly 30 years. A couple died in May 2019, in Mongolia, while hunting marmots . Another two people in the province of Inner Mongolia, China, were treated in November 2019 for the disease. In July 2020, in Bayannur , Inner Mongolia of China, a human case of bubonic plague was reported. Officials responded by activating a city-wide plague-prevention system for the remainder of the year. Also in July 2020, in Mongolia, a teenager died from bubonic plague after consuming infected marmot meat. Yersinia pestis has been discovered in archaeological finds from the Late Bronze Age (~3800 BP ). The bacteria is identified by ancient DNA in human teeth from Asia and Europe dating from 2,800 to 5,000 years ago. Some authors have suggested that the plague was responsible for the Neolithic decline . The first recorded epidemic affected the Sasanian Empire and their arch-rivals, the Eastern Roman Empire (Byzantine Empire) and was named the Plague of Justinian (541–549 AD) after emperor Justinian I , who was infected but survived through extensive treatment. The pandemic resulted in the deaths of an estimated 25 million (6th century outbreak) to 50 million people (two centuries of recurrence). The historian Procopius wrote, in Volume II of History of the Wars , of his personal encounter with the plague and the effect it had on the rising empire. In the spring of 542, the plague arrived in Constantinople, working its way from port city to port city and spreading around the Mediterranean Sea , later migrating inland eastward into Asia Minor and west into Greece and Italy. The Plague of Justinian is said to have been "completed" in the middle of the 8th century. Because the infectious disease spread inland by the transferring of merchandise through Justinian's efforts in acquiring luxurious goods of the time and exporting supplies, his capital became the leading exporter of the bubonic plague. Procopius, in his work Secret History , declared that Justinian was a demon of an emperor who either created the plague himself or was being punished for his sinfulness. Medieval society's increasing population was put to deadly halt when, in the Late Middle Ages , Europe experienced the deadliest disease outbreak in history. They called it the Great Dying or The Great Pestilence, later coined The Black Death. Lasting in potency for roughly 6 years, 1346–1352, the Black Death claimed one-third of the European human population. Having mortality rates as high as 70%-80%. Some historians believe that society subsequently became more violent as the mass mortality rate cheapened life and thus increased warfare, crime, popular revolt, waves of flagellants , and persecution. The Black Death originated in Central Asia and spread from Italy and then throughout other European countries. Arab historians Ibn Al-Wardni and Almaqrizi believed the Black Death originated in Mongolia. Chinese records also show a huge outbreak in Mongolia in the early 1330s. In 2022, researchers presented evidence that the plague originated near Lake Issyk-Kul in Kyrgyzstan . The Mongols had cut the trade route (the Silk Road ) between China and Europe, which halted the spread of the Black Death from eastern Russia to Western Europe. The European epidemic may have begun with the siege of Caffa , an attack that Mongols launched on the Italian merchants' last trading station in the region, Caffa , in the Crimea . In late 1346, plague broke out among the besiegers and from them penetrated the town. The Mongol forces catapulted plague-infested corpses into Caffa as a form of attack, one of the first known instances of biological warfare . When spring arrived, the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried by the fleas on rats, the plague initially spread to humans near the Black Sea and then outwards to the rest of Europe as a result of people fleeing from one area to another. Rats migrated with humans, traveling among grain bags, clothing, ships, wagons, and grain husks. Continued research indicates that black rats , those that primarily transmitted the disease, prefer grain as a primary meal. Due to this, the major bulk grain fleets that transported major city's food shipments from Africa and Alexandria to heavily populated areas, and were then unloaded by hand, played a role in increasing the transmission effectiveness of the plague. The plague resurfaced for a third time in the mid-19th century; this is also known as "the modern pandemic". Like the two previous outbreaks, this one also originated in Eastern Asia , most likely in Yunnan , a province of China, where there are several natural plague foci . The initial outbreaks occurred in the second half of the 18th century. The disease remained localized in Southwest China for several years before spreading. In the city of Canton , beginning in January 1894, the disease had killed 80,000 people by June. Daily water traffic with the nearby city of Hong Kong rapidly spread the plague there, killing over 2,400 within two months during the 1894 Hong Kong plague . The third pandemic spread the disease to port cities throughout the world in the second half of the 19th century and the early 20th century via shipping routes. The plague infected people in Chinatown in San Francisco from 1900 to 1904, and in the nearby locales of Oakland and the East Bay again from 1907 to 1909. During the former outbreak, in 1902, authorities made permanent the Chinese Exclusion Act , a law originally signed into existence by President Chester A. Arthur in 1882. The Act was supposed to last for 10 years, but was renewed in 1892 with the Geary Act , then followed by the 1902 decision. The last major outbreak in the United States occurred in Los Angeles in 1924, though the disease is still present in wild rodents and can be passed to humans that come in contact with them. According to the World Health Organization , the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. In 1994, a plague outbreak in five Indian states caused an estimated 700 infections (including 52 deaths) and triggered a large migration of Indians within India as they tried to avoid the disease. [ citation needed ] It was during the 1894 Hong Kong plague outbreak that Alexandre Yersin isolated the bacterium responsible ( Yersinia pestis ), a few days after Japanese bacteriologist Kitasato Shibasaburō had isolated it. However, the latter's description was imprecise and also expressed doubts of its relation to the disease, and thus the bacterium is today only named after Yersin. The first recorded epidemic affected the Sasanian Empire and their arch-rivals, the Eastern Roman Empire (Byzantine Empire) and was named the Plague of Justinian (541–549 AD) after emperor Justinian I , who was infected but survived through extensive treatment. The pandemic resulted in the deaths of an estimated 25 million (6th century outbreak) to 50 million people (two centuries of recurrence). The historian Procopius wrote, in Volume II of History of the Wars , of his personal encounter with the plague and the effect it had on the rising empire. In the spring of 542, the plague arrived in Constantinople, working its way from port city to port city and spreading around the Mediterranean Sea , later migrating inland eastward into Asia Minor and west into Greece and Italy. The Plague of Justinian is said to have been "completed" in the middle of the 8th century. Because the infectious disease spread inland by the transferring of merchandise through Justinian's efforts in acquiring luxurious goods of the time and exporting supplies, his capital became the leading exporter of the bubonic plague. Procopius, in his work Secret History , declared that Justinian was a demon of an emperor who either created the plague himself or was being punished for his sinfulness. Medieval society's increasing population was put to deadly halt when, in the Late Middle Ages , Europe experienced the deadliest disease outbreak in history. They called it the Great Dying or The Great Pestilence, later coined The Black Death. Lasting in potency for roughly 6 years, 1346–1352, the Black Death claimed one-third of the European human population. Having mortality rates as high as 70%-80%. Some historians believe that society subsequently became more violent as the mass mortality rate cheapened life and thus increased warfare, crime, popular revolt, waves of flagellants , and persecution. The Black Death originated in Central Asia and spread from Italy and then throughout other European countries. Arab historians Ibn Al-Wardni and Almaqrizi believed the Black Death originated in Mongolia. Chinese records also show a huge outbreak in Mongolia in the early 1330s. In 2022, researchers presented evidence that the plague originated near Lake Issyk-Kul in Kyrgyzstan . The Mongols had cut the trade route (the Silk Road ) between China and Europe, which halted the spread of the Black Death from eastern Russia to Western Europe. The European epidemic may have begun with the siege of Caffa , an attack that Mongols launched on the Italian merchants' last trading station in the region, Caffa , in the Crimea . In late 1346, plague broke out among the besiegers and from them penetrated the town. The Mongol forces catapulted plague-infested corpses into Caffa as a form of attack, one of the first known instances of biological warfare . When spring arrived, the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried by the fleas on rats, the plague initially spread to humans near the Black Sea and then outwards to the rest of Europe as a result of people fleeing from one area to another. Rats migrated with humans, traveling among grain bags, clothing, ships, wagons, and grain husks. Continued research indicates that black rats , those that primarily transmitted the disease, prefer grain as a primary meal. Due to this, the major bulk grain fleets that transported major city's food shipments from Africa and Alexandria to heavily populated areas, and were then unloaded by hand, played a role in increasing the transmission effectiveness of the plague. The plague resurfaced for a third time in the mid-19th century; this is also known as "the modern pandemic". Like the two previous outbreaks, this one also originated in Eastern Asia , most likely in Yunnan , a province of China, where there are several natural plague foci . The initial outbreaks occurred in the second half of the 18th century. The disease remained localized in Southwest China for several years before spreading. In the city of Canton , beginning in January 1894, the disease had killed 80,000 people by June. Daily water traffic with the nearby city of Hong Kong rapidly spread the plague there, killing over 2,400 within two months during the 1894 Hong Kong plague . The third pandemic spread the disease to port cities throughout the world in the second half of the 19th century and the early 20th century via shipping routes. The plague infected people in Chinatown in San Francisco from 1900 to 1904, and in the nearby locales of Oakland and the East Bay again from 1907 to 1909. During the former outbreak, in 1902, authorities made permanent the Chinese Exclusion Act , a law originally signed into existence by President Chester A. Arthur in 1882. The Act was supposed to last for 10 years, but was renewed in 1892 with the Geary Act , then followed by the 1902 decision. The last major outbreak in the United States occurred in Los Angeles in 1924, though the disease is still present in wild rodents and can be passed to humans that come in contact with them. According to the World Health Organization , the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. In 1994, a plague outbreak in five Indian states caused an estimated 700 infections (including 52 deaths) and triggered a large migration of Indians within India as they tried to avoid the disease. [ citation needed ] It was during the 1894 Hong Kong plague outbreak that Alexandre Yersin isolated the bacterium responsible ( Yersinia pestis ), a few days after Japanese bacteriologist Kitasato Shibasaburō had isolated it. However, the latter's description was imprecise and also expressed doubts of its relation to the disease, and thus the bacterium is today only named after Yersin. The scale of death and social upheaval associated with plague outbreaks has made the topic prominent in many historical and fictional accounts since the disease was first recognized. The Black Death in particular is described and referenced in numerous contemporary sources , some of which, including works by Chaucer , Boccaccio , and Petrarch , are considered part of the Western canon . The Decameron , by Boccaccio, is notable for its use of a frame story involving individuals who have fled Florence for a secluded villa to escape the Black Death. First-person, sometimes sensationalized or fictionalized, accounts of living through plague years have also been popular across centuries and cultures. For example, Samuel Pepys 's diary makes several references to his first-hand experiences of the Great Plague of London in 1665–66. Later works, such as Albert Camus 's novel The Plague or Ingmar Bergman 's film The Seventh Seal have used bubonic plague in settings, such as quarantined cities in either medieval or modern times, as a backdrop to explore a variety of concepts. Common themes include the breakdown of society, institutions, and individuals during the plague, the cultural and psychological existential confrontation with mortality, and the allegorical use of the plague about contemporary moral or spiritual questions. [ citation needed ] Some of the earliest instances of biological warfare were said to have been products of the plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages to spread the pestilence. This was done by Jani Beg when he attacked the city of Kaffa in 1343. Later, plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army . These weapons were provided by Shirō Ishii 's units and used in experiments on humans before being used in the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbo with fleas carrying the bubonic plague. During the Khabarovsk War Crime Trials , the accused, such as Major General Kiyoshi Kawashima, testified that, in 1941, 40 members of Unit 731 air-dropped plague -contaminated fleas on Changde . These operations caused epidemic plague outbreaks. Substantial research has been done regarding the origin of the plague and how it traveled through the continent. Mitochondrial DNA of modern rats in Western Europe indicated that these rats came from two different areas, one being Africa and the other unclear. The research regarding this pandemic has greatly increased with technology. Through archaeo-molecular investigation, researchers have discovered the DNA of plague bacillus in the dental core of those that fell ill to the plague. Analysis of teeth of the deceased allows researchers to further understand both the demographics and mortuary patterns of the disease. For example, in 2013 in England, archeologists uncovered a burial mound to reveal 17 bodies, mainly children, who had died of the Bubonic plague. They analyzed these burial remains using radiocarbon dating to determine they were from the 1530s, and dental core analysis revealed the presence of Yersinia pestis. Other evidence for rats that are currently still being researched consists of gnaw marks on bones, predator pellets and rat remains that were preserved in situ . This research allows individuals to trace early rat remains to track the path traveled and in turn connect the impact of the Bubonic Plague to specific breeds of rats. Burial sites, known as plague pits, offer archaeologists an opportunity to study the remains of people who died from the plague. Another research study indicates that these separate pandemics were all interconnected. A current computer model indicates that the disease did not go away in between these pandemics. It rather lurked within the rat population for years without causing human epidemics. Some of the earliest instances of biological warfare were said to have been products of the plague, as armies of the 14th century were recorded catapulting diseased corpses over the walls of towns and villages to spread the pestilence. This was done by Jani Beg when he attacked the city of Kaffa in 1343. Later, plague was used during the Second Sino-Japanese War as a bacteriological weapon by the Imperial Japanese Army . These weapons were provided by Shirō Ishii 's units and used in experiments on humans before being used in the field. For example, in 1940, the Imperial Japanese Army Air Service bombed Ningbo with fleas carrying the bubonic plague. During the Khabarovsk War Crime Trials , the accused, such as Major General Kiyoshi Kawashima, testified that, in 1941, 40 members of Unit 731 air-dropped plague -contaminated fleas on Changde . These operations caused epidemic plague outbreaks. Substantial research has been done regarding the origin of the plague and how it traveled through the continent. Mitochondrial DNA of modern rats in Western Europe indicated that these rats came from two different areas, one being Africa and the other unclear. The research regarding this pandemic has greatly increased with technology. Through archaeo-molecular investigation, researchers have discovered the DNA of plague bacillus in the dental core of those that fell ill to the plague. Analysis of teeth of the deceased allows researchers to further understand both the demographics and mortuary patterns of the disease. For example, in 2013 in England, archeologists uncovered a burial mound to reveal 17 bodies, mainly children, who had died of the Bubonic plague. They analyzed these burial remains using radiocarbon dating to determine they were from the 1530s, and dental core analysis revealed the presence of Yersinia pestis. Other evidence for rats that are currently still being researched consists of gnaw marks on bones, predator pellets and rat remains that were preserved in situ . This research allows individuals to trace early rat remains to track the path traveled and in turn connect the impact of the Bubonic Plague to specific breeds of rats. Burial sites, known as plague pits, offer archaeologists an opportunity to study the remains of people who died from the plague. Another research study indicates that these separate pandemics were all interconnected. A current computer model indicates that the disease did not go away in between these pandemics. It rather lurked within the rat population for years without causing human epidemics.

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Pneumonic plague

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Plague (disease)

Plague is an infectious disease caused by the bacterium Yersinia pestis . Symptoms include fever , weakness and headache . Usually this begins one to seven days after exposure. There are three forms of plague, each affecting a different part of the body and causing associated symptoms. Pneumonic plague infects the lungs, causing shortness of breath, coughing and chest pain; bubonic plague affects the lymph nodes , making them swell; and septicemic plague infects the blood and can cause tissues to turn black and die . The bubonic and septicemic forms are generally spread by flea bites or handling an infected animal, whereas pneumonic plague is generally spread between people through the air via infectious droplets. Diagnosis is typically by finding the bacterium in fluid from a lymph node, blood or sputum . Those at high risk may be vaccinated . Those exposed to a case of pneumonic plague may be treated with preventive medication. If infected, treatment is with antibiotics and supportive care . Typically antibiotics include a combination of gentamicin and a fluoroquinolone . The risk of death with treatment is about 10% while without it is about 70%. Globally, about 600 cases are reported a year. In 2017, the countries with the most cases include the Democratic Republic of the Congo , Madagascar and Peru . In the United States, infections occasionally occur in rural areas, where the bacteria are believed to circulate among rodents . It has historically occurred in large outbreaks , with the best known being the Black Death in the 14th century, which resulted in more than 50 million deaths in Europe. There are several different clinical manifestations of plague. The most common form is bubonic plague, followed by septicemic and pneumonic plague. Other clinical manifestations include plague meningitis, plague pharyngitis, and ocular plague. General symptoms of plague include fever, chills, headaches, and nausea. Many people experience swelling in their lymph nodes if they have bubonic plague. For those with pneumonic plague, symptoms may (or may not) include a cough, pain in the chest, and haemoptysis. When a flea bites a human and contaminates the wound with regurgitated blood, the plague-causing bacteria are passed into the tissue. Y. pestis can reproduce inside cells, so even if phagocytosed , they can still survive. Once in the body, the bacteria can enter the lymphatic system , which drains interstitial fluid . Plague bacteria secrete several toxins , one of which is known to cause beta-adrenergic blockade . Y. pestis spreads through the lymphatic vessels of the infected human until it reaches a lymph node , where it causes acute lymphadenitis . The swollen lymph nodes form the characteristic buboes associated with the disease, and autopsies of these buboes have revealed them to be mostly hemorrhagic or necrotic . If the lymph node is overwhelmed, the infection can pass into the bloodstream, causing secondary septicemic plague and if the lungs are seeded, it can cause secondary pneumonic plague . Lymphatics ultimately drain into the bloodstream, so the plague bacteria may enter the blood and travel to almost any part of the body. In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), causing tiny clots throughout the body and possibly ischemic necrosis (tissue death due to lack of circulation/perfusion to that tissue) from the clots. DIC results in depletion of the body's clotting resources so that it can no longer control bleeding. Consequently, there is bleeding into the skin and other organs, which can cause red and/or black patchy rash and hemoptysis/hematemesis (coughing up/ vomiting of blood). There are bumps on the skin that look somewhat like insect bites; these are usually red, and sometimes white in the centre. Untreated, the septicemic plague is usually fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 per cent. The pneumonic form of plague arises from infection of the lungs . It causes coughing and thereby produces airborne droplets that contain bacterial cells and are likely to infect anyone inhaling them. The incubation period for pneumonic plague is short, usually two to four days, but sometimes just a few hours. The initial signs are indistinguishable from several other respiratory illnesses; they include headache, weakness, and spitting or vomiting of blood. The course of the disease is rapid; unless diagnosed and treated soon enough, typically within a few hours, death may follow in one to six days; in untreated cases, mortality is nearly 100%. When a flea bites a human and contaminates the wound with regurgitated blood, the plague-causing bacteria are passed into the tissue. Y. pestis can reproduce inside cells, so even if phagocytosed , they can still survive. Once in the body, the bacteria can enter the lymphatic system , which drains interstitial fluid . Plague bacteria secrete several toxins , one of which is known to cause beta-adrenergic blockade . Y. pestis spreads through the lymphatic vessels of the infected human until it reaches a lymph node , where it causes acute lymphadenitis . The swollen lymph nodes form the characteristic buboes associated with the disease, and autopsies of these buboes have revealed them to be mostly hemorrhagic or necrotic . If the lymph node is overwhelmed, the infection can pass into the bloodstream, causing secondary septicemic plague and if the lungs are seeded, it can cause secondary pneumonic plague . Lymphatics ultimately drain into the bloodstream, so the plague bacteria may enter the blood and travel to almost any part of the body. In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), causing tiny clots throughout the body and possibly ischemic necrosis (tissue death due to lack of circulation/perfusion to that tissue) from the clots. DIC results in depletion of the body's clotting resources so that it can no longer control bleeding. Consequently, there is bleeding into the skin and other organs, which can cause red and/or black patchy rash and hemoptysis/hematemesis (coughing up/ vomiting of blood). There are bumps on the skin that look somewhat like insect bites; these are usually red, and sometimes white in the centre. Untreated, the septicemic plague is usually fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 per cent. The pneumonic form of plague arises from infection of the lungs . It causes coughing and thereby produces airborne droplets that contain bacterial cells and are likely to infect anyone inhaling them. The incubation period for pneumonic plague is short, usually two to four days, but sometimes just a few hours. The initial signs are indistinguishable from several other respiratory illnesses; they include headache, weakness, and spitting or vomiting of blood. The course of the disease is rapid; unless diagnosed and treated soon enough, typically within a few hours, death may follow in one to six days; in untreated cases, mortality is nearly 100%. Transmission of Y. pestis to an uninfected individual is possible by any of the following means: droplet contact – coughing or sneezing on another person Direct physical contact;– touching an infected person, including sexual contact indirect contact – usually by touching soil contamination or a contaminated surface airborne transmission – if the microorganism can remain in the air for long periods fecal-oral transmission – usually from contaminated food or water sources vector borne transmission – carried by insects or other animals. Yersinia pestis circulates in animal reservoirs, particularly in rodents, in the natural foci of infection found on all continents except Australia. The natural foci of plague are situated in a broad belt in the tropical and sub-tropical latitudes and the warmer parts of the temperate latitudes around the globe, between the parallels 55° N and 40° S. Contrary to popular belief, rats did not directly start the spread of the bubonic plague. It is mainly a disease in the fleas ( Xenopsylla cheopis ) that infested the rats, making the rats themselves the first victims of the plague. Rodent-borne infection in a human occurs when a person is bitten by a flea that has been infected by biting a rodent that itself has been infected by the bite of a flea carrying the disease. The bacteria multiply inside the flea, sticking together to form a plug that blocks its stomach and causes it to starve. The flea then bites a host and continues to feed, even though it cannot quell its hunger, and consequently, the flea vomits blood tainted with the bacteria back into the bite wound. The bubonic plague bacterium then infects a new person and the flea eventually dies from starvation. Serious outbreaks of plague are usually started by other disease outbreaks in rodents or a rise in the rodent population. A 21st-century study of a 1665 outbreak of plague in the village of Eyam in England's Derbyshire Dales – which isolated itself during the outbreak, facilitating modern study – found that three-quarters of cases are likely to have been due to human-to-human transmission, especially within families, a much bigger proportion than previously thought. Symptoms of plague are usually non-specific and to definitively diagnose plague, laboratory testing is required. Y. pestis can be identified through both a microscope and by culturing a sample and this is used as a reference standard to confirm that a person has a case of plague. The sample can be obtained from the blood, mucus ( sputum ), or aspirate extracted from inflamed lymph nodes ( buboes ). If a person is administered antibiotics before a sample is taken or if there is a delay in transporting the person's sample to a laboratory and/or a poorly stored sample, there is a possibility for false negative results. Polymerase chain reaction (PCR) may also be used to diagnose plague, by detecting the presence of bacterial genes such as the pla gene (plasmogen activator) and caf1 gene, (F1 capsule antigen). PCR testing requires a very small sample and is effective for both alive and dead bacteria. For this reason, if a person receives antibiotics before a sample is collected for laboratory testing, they may have a false negative culture and a positive PCR result. Blood tests to detect antibodies against Y. pestis can also be used to diagnose plague, however, this requires taking blood samples at different periods to detect differences between the acute and convalescent phases of F1 antibody titres. In 2020, a study about rapid diagnostic tests that detect the F1 capsule antigen (F1RDT) by sampling sputum or bubo aspirate was released. Results show rapid diagnostic F1RDT test can be used for people who have suspected pneumonic and bubonic plague but cannot be used in asymptomatic people. F1RDT may be useful in providing a fast result for prompt treatment and fast public health response as studies suggest that F1RDT is highly sensitive for both pneumonic and bubonic plague. However, when using the rapid test, both positive and negative results need to be confirmed to establish or reject the diagnosis of a confirmed case of plague and the test result needs to be interpreted within the epidemiological context as study findings indicate that although 40 out of 40 people who had the plague in a population of 1000 were correctly diagnosed, 317 people were diagnosed falsely as positive. Bacteriologist Waldemar Haffkine developed the first plague vaccine in 1897. He conducted a massive inoculation program in British India , and it is estimated that 26 million doses of Haffkine's anti-plague vaccine were sent out from Bombay between 1897 and 1925, reducing the plague mortality by 50–85%. Since human plague is rare in most parts of the world as of 2023, routine vaccination is not needed other than for those at particularly high risk of exposure, nor for people living in areas with enzootic plague, meaning it occurs at regular, predictable rates in populations and specific areas, such as the western United States. It is not even indicated for most travellers to countries with known recent reported cases, particularly if their travel is limited to urban areas with modern hotels. The United States CDC thus only recommends vaccination for (1) all laboratory and field personnel who are working with Y. pestis organisms resistant to antimicrobials: (2) people engaged in aerosol experiments with Y. pestis ; and (3) people engaged in field operations in areas with enzootic plague where preventing exposure is not possible (such as some disaster areas). A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine. Diagnosing plague early leads to a decrease in transmission or spread of the disease. Pre-exposure prophylaxis for first responders and health care providers who will care for patients with pneumonic plague is not considered necessary as long as standard and droplet precautions can be maintained. In cases of surgical mask shortages, patient overcrowding, poor ventilation in hospital wards, or other crises, pre-exposure prophylaxis might be warranted if sufficient supplies of antimicrobials are available. Postexposure prophylaxis should be considered for people who had close (<6 feet), sustained contact with a patient with pneumonic plague and were not wearing adequate personal protective equipment. Antimicrobial postexposure prophylaxis also can be considered for laboratory workers accidentally exposed to infectious materials and people who had close (<6 feet) or direct contact with infected animals, such as veterinary staff, pet owners, and hunters. Specific recommendations on pre- and post-exposure prophylaxis are available in the clinical guidelines on treatment and prophylaxis of plague published in 2021. Bacteriologist Waldemar Haffkine developed the first plague vaccine in 1897. He conducted a massive inoculation program in British India , and it is estimated that 26 million doses of Haffkine's anti-plague vaccine were sent out from Bombay between 1897 and 1925, reducing the plague mortality by 50–85%. Since human plague is rare in most parts of the world as of 2023, routine vaccination is not needed other than for those at particularly high risk of exposure, nor for people living in areas with enzootic plague, meaning it occurs at regular, predictable rates in populations and specific areas, such as the western United States. It is not even indicated for most travellers to countries with known recent reported cases, particularly if their travel is limited to urban areas with modern hotels. The United States CDC thus only recommends vaccination for (1) all laboratory and field personnel who are working with Y. pestis organisms resistant to antimicrobials: (2) people engaged in aerosol experiments with Y. pestis ; and (3) people engaged in field operations in areas with enzootic plague where preventing exposure is not possible (such as some disaster areas). A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine. Diagnosing plague early leads to a decrease in transmission or spread of the disease. Pre-exposure prophylaxis for first responders and health care providers who will care for patients with pneumonic plague is not considered necessary as long as standard and droplet precautions can be maintained. In cases of surgical mask shortages, patient overcrowding, poor ventilation in hospital wards, or other crises, pre-exposure prophylaxis might be warranted if sufficient supplies of antimicrobials are available. Postexposure prophylaxis should be considered for people who had close (<6 feet), sustained contact with a patient with pneumonic plague and were not wearing adequate personal protective equipment. Antimicrobial postexposure prophylaxis also can be considered for laboratory workers accidentally exposed to infectious materials and people who had close (<6 feet) or direct contact with infected animals, such as veterinary staff, pet owners, and hunters. Specific recommendations on pre- and post-exposure prophylaxis are available in the clinical guidelines on treatment and prophylaxis of plague published in 2021. If diagnosed in time, the various forms of plague are usually highly responsive to antibiotic therapy. The antibiotics often used are streptomycin , chloramphenicol and tetracycline . Amongst the newer generation of antibiotics, gentamicin and doxycycline have proven effective in monotherapeutic treatment of plague. Guidelines on treatment and prophylaxis of plague were published by the Centers for Disease Control and Prevention in 2021. The plague bacterium could develop drug resistance and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995. Further outbreaks in Madagascar were reported in November 2014 and October 2017. Globally about 600 cases are reported a year. In 2017, the countries with the most cases include the Democratic Republic of the Congo , Madagascar and Peru . It has historically occurred in large outbreaks , with the best known being the Black Death in the 14th century which resulted in more than 50 million dead. In recent years, cases have been distributed between small seasonal outbreaks which occur primarily in Madagascar, and sporadic outbreaks or isolated cases in endemic areas. In 2022 the possible origin of all modern strands of Yersinia pestis DNA was found in human remains in three graves located in Kyrgyzstan , dated to 1338 and 1339. The siege of Caffa in Crimea in 1346, is known to have been the first plague outbreak with following strands, later to spread over Europe. Sequencing DNA compared to other ancient and modern strands paints a family tree of the bacteria. Bacteria today affecting marmots in Kyrgyzstan, are closest to the strand found in the graves, suggesting this is also the location where plague transferred from animals to humans. The plague has a long history as a biological weapon . Historical accounts from ancient China and medieval Europe details the use of infected animal carcasses, such as cows or horses, and human carcasses, by the Xiongnu / Huns , Mongols , Turks and other groups, to contaminate enemy water supplies. Han dynasty general Huo Qubing is recorded to have died of such contamination while engaging in warfare against the Xiongnu. Plague victims were also reported to have been tossed by catapult into cities under siege. In 1347, the Genoese possession of Caffa , a great trade emporium on the Crimean peninsula , came under siege by an army of Mongol warriors of the Golden Horde under the command of Jani Beg . After a protracted siege during which the Mongol army was reportedly withering from the disease, they decided to use the infected corpses as a biological weapon. The corpses were catapulted over the city walls, infecting the inhabitants. This event might have led to the transfer of the Black Death via their ships into the south of Europe , possibly explaining its rapid spread. During World War II , the Japanese Army developed weaponized plague, based on the breeding and release of large numbers of fleas. During the Japanese occupation of Manchuria , Unit 731 deliberately infected Chinese , Korean and Manchurian civilians and prisoners of war with the plague bacterium. These subjects, termed "maruta" or "logs", were then studied by dissection , others by vivisection while still conscious. Members of the unit such as Shiro Ishii were exonerated from the Tokyo tribunal by Douglas MacArthur but 12 of them were prosecuted in the Khabarovsk War Crime Trials in 1949 during which some admitted having spread bubonic plague within a 36-kilometre (22 mi) radius around the city of Changde . Ishii innovated bombs containing live mice and fleas, with very small explosive loads, to deliver the weaponized microbes, overcoming the problem of the explosive killing the infected animal and insect by the use of a ceramic, rather than metal, casing for the warhead. While no records survive of the actual usage of the ceramic shells, prototypes exist and are believed to have been used in experiments during WWII. After World War II, both the United States and the Soviet Union developed means of weaponising pneumonic plague. Experiments included various delivery methods, vacuum drying, sizing the bacterium, developing strains resistant to antibiotics, combining the bacterium with other diseases (such as diphtheria ), and genetic engineering. Scientists who worked in USSR bio-weapons programs have stated that the Soviet effort was formidable and that large stocks of weaponised plague bacteria were produced. Information on many of the Soviet and US projects is largely unavailable. Aerosolized pneumonic plague remains the most significant threat. The plague can be easily treated with antibiotics. Some countries, such as the United States, have large supplies on hand if such an attack should occur, making the threat less severe.

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Pneumonic plague

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21st century Madagascar plague outbreaks

Madagascar has experienced several outbreaks of bubonic and pneumonic plague in the 21st century. In the outbreak beginning in 2014, 71 died; in 2017, 202 died. Smaller outbreaks occurred in January 2008 (18 deaths), and December 2013. An outbreak of plague in Madagascar in 2014 started on 31 August. On that day the first case, a man from Soamahamanina village in Tsiroanomandidy , was identified. The patient died on 3 September. The outbreak was in the form of bubonic and pneumonic plague . By 16 November 2014, a total of 119 cases had been confirmed, including 40 deaths. Two percent of reported cases were of the pneumonic form. By 21 November, in the capital Antananarivo there were two confirmed cases, including one death. On 4 November 2014, the Ministry of Health of Madagascar reported the outbreak to the World Health Organization . On 11 February 2015, the WHO and Madagascar Ministry of Health released a follow-up situation report the outbreak. The report stated the outbreak beginning in September 2014 peaked from November through end-December and had slowed down as of February 2015. The WHO report cited 263 cases and 71 deaths with a 27% fatality rate. Efficient identification and treatment with antibiotics were noted as critical to treatment efficacy, evidenced by fatality rates ranging from 15% - 60% depending on early identification and treatment. The report explained that Madagascar's plague "season" typically runs through April and stopped short of officially declaring the outbreak over. A more recent outbreak of plague in Madagascar began in August 2017 and expanded rapidly, with about two-thirds of cases transmitted person-to-person as pneumonic plague, the most dangerous form of the disease. The death toll of 124 by 20 October exceeded that of previous outbreaks. [ citation needed ] More than half of cases have been recorded in the capital of Antananarivo and the main port of Toamasina, the largest cities in Madagascar. Nine nearby countries were considered at high risk of a similar outbreak. The outbreak appeared to peak in mid-October with the number of new cases declining. Typically the annual plague outbreak peaks in December and runs until April. On 2 November, a ProMED-mail moderator expressed surprise at the considerable variation reported in numbers of cases and deaths, especially with the relatively low case-fatality rate considering that pneumonic plague is reported to account for over 60 percent of deaths. An article from the World Health Organization reported more than 1800 cases as of late October, while nearly 500 fewer had been reported in the week previously. In January 2018 the experts declared the outbreak over as no new cases had been reported since November 2017, although the World health organization stated that there was a "moderate" chance of re-occurrence. Malagasy Prime Minister Olivier Mahafaly Solonandrasana had declared the crisis over on 23 November 2017. The outbreak began in August 2017 with the death from pneumonic plague of a 31-year-old man who had been traveling in a crowded minibus toward the capital city of Antananarivo in the central highlands. The outbreak expanded rapidly, transmitted person-to-person in the pneumonic form of the disease, which accounted for more than 60 percent of cases. Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk of transmission to other countries. Urban areas that are major transportation hubs for shipping and recreation are at high risk for transmitting plague to nearby countries. The outbreak was initially recognized on 11 September by local authorities and confirmed by the Institut Pasteur de Madagascar . Authorities called the outbreak "quite worrisome" because the number of cases per day was growing rapidly, and many cases were in urban areas where there are more opportunities for contact between people. Panic was reported in the capital, with the main hospital overcrowded with cases. The death toll in this outbreak had by mid-October exceeded an outbreak in 2014 . Most cases were of the pneumonic form. The bubonic form, transmitted by the bites of fleas from rodents, is more usual in the annual outbreaks in Madagascar. The government announced they had "temporarily suspended gatherings to the general public in places where the traceability of the participants is difficult if not impossible (stadiums, sports palaces, gymnasiums …)". By 8 November, deaths had risen to 165 with infections totalling over 2000, however the rate of spread had slowed, raising hope that the outbreak was starting to come under control. Concerns continued to be raised that plague might still spread to neighboring countries, or mutate to a form that could be more difficult to treat. By 15 November, there had been 171 deaths and 2119 total cases of plague, however no new infections had been reported since 28 October. An outbreak of plague in Madagascar in 2014 started on 31 August. On that day the first case, a man from Soamahamanina village in Tsiroanomandidy , was identified. The patient died on 3 September. The outbreak was in the form of bubonic and pneumonic plague . By 16 November 2014, a total of 119 cases had been confirmed, including 40 deaths. Two percent of reported cases were of the pneumonic form. By 21 November, in the capital Antananarivo there were two confirmed cases, including one death. On 4 November 2014, the Ministry of Health of Madagascar reported the outbreak to the World Health Organization . On 11 February 2015, the WHO and Madagascar Ministry of Health released a follow-up situation report the outbreak. The report stated the outbreak beginning in September 2014 peaked from November through end-December and had slowed down as of February 2015. The WHO report cited 263 cases and 71 deaths with a 27% fatality rate. Efficient identification and treatment with antibiotics were noted as critical to treatment efficacy, evidenced by fatality rates ranging from 15% - 60% depending on early identification and treatment. The report explained that Madagascar's plague "season" typically runs through April and stopped short of officially declaring the outbreak over.A more recent outbreak of plague in Madagascar began in August 2017 and expanded rapidly, with about two-thirds of cases transmitted person-to-person as pneumonic plague, the most dangerous form of the disease. The death toll of 124 by 20 October exceeded that of previous outbreaks. [ citation needed ] More than half of cases have been recorded in the capital of Antananarivo and the main port of Toamasina, the largest cities in Madagascar. Nine nearby countries were considered at high risk of a similar outbreak. The outbreak appeared to peak in mid-October with the number of new cases declining. Typically the annual plague outbreak peaks in December and runs until April. On 2 November, a ProMED-mail moderator expressed surprise at the considerable variation reported in numbers of cases and deaths, especially with the relatively low case-fatality rate considering that pneumonic plague is reported to account for over 60 percent of deaths. An article from the World Health Organization reported more than 1800 cases as of late October, while nearly 500 fewer had been reported in the week previously. In January 2018 the experts declared the outbreak over as no new cases had been reported since November 2017, although the World health organization stated that there was a "moderate" chance of re-occurrence. Malagasy Prime Minister Olivier Mahafaly Solonandrasana had declared the crisis over on 23 November 2017. The outbreak began in August 2017 with the death from pneumonic plague of a 31-year-old man who had been traveling in a crowded minibus toward the capital city of Antananarivo in the central highlands. The outbreak expanded rapidly, transmitted person-to-person in the pneumonic form of the disease, which accounted for more than 60 percent of cases. Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk of transmission to other countries. Urban areas that are major transportation hubs for shipping and recreation are at high risk for transmitting plague to nearby countries. The outbreak was initially recognized on 11 September by local authorities and confirmed by the Institut Pasteur de Madagascar . Authorities called the outbreak "quite worrisome" because the number of cases per day was growing rapidly, and many cases were in urban areas where there are more opportunities for contact between people. Panic was reported in the capital, with the main hospital overcrowded with cases. The death toll in this outbreak had by mid-October exceeded an outbreak in 2014 . Most cases were of the pneumonic form. The bubonic form, transmitted by the bites of fleas from rodents, is more usual in the annual outbreaks in Madagascar. The government announced they had "temporarily suspended gatherings to the general public in places where the traceability of the participants is difficult if not impossible (stadiums, sports palaces, gymnasiums …)". By 8 November, deaths had risen to 165 with infections totalling over 2000, however the rate of spread had slowed, raising hope that the outbreak was starting to come under control. Concerns continued to be raised that plague might still spread to neighboring countries, or mutate to a form that could be more difficult to treat. By 15 November, there had been 171 deaths and 2119 total cases of plague, however no new infections had been reported since 28 October. The outbreak began in August 2017 with the death from pneumonic plague of a 31-year-old man who had been traveling in a crowded minibus toward the capital city of Antananarivo in the central highlands. The outbreak expanded rapidly, transmitted person-to-person in the pneumonic form of the disease, which accounted for more than 60 percent of cases. Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk of transmission to other countries. Urban areas that are major transportation hubs for shipping and recreation are at high risk for transmitting plague to nearby countries.The outbreak was initially recognized on 11 September by local authorities and confirmed by the Institut Pasteur de Madagascar . Authorities called the outbreak "quite worrisome" because the number of cases per day was growing rapidly, and many cases were in urban areas where there are more opportunities for contact between people. Panic was reported in the capital, with the main hospital overcrowded with cases. The death toll in this outbreak had by mid-October exceeded an outbreak in 2014 . Most cases were of the pneumonic form. The bubonic form, transmitted by the bites of fleas from rodents, is more usual in the annual outbreaks in Madagascar. The government announced they had "temporarily suspended gatherings to the general public in places where the traceability of the participants is difficult if not impossible (stadiums, sports palaces, gymnasiums …)". By 8 November, deaths had risen to 165 with infections totalling over 2000, however the rate of spread had slowed, raising hope that the outbreak was starting to come under control. Concerns continued to be raised that plague might still spread to neighboring countries, or mutate to a form that could be more difficult to treat. By 15 November, there had been 171 deaths and 2119 total cases of plague, however no new infections had been reported since 28 October. Plague is caused by the bacterium Yersinia pestis and is most commonly transmitted through infected fleas. There are three types of plague: bubonic, pneumonic and septicemic. Bubonic plague is the most well-known type. This type of plague results in swollen lymph nodes that are called buboes. This type of plague is treatable with antibiotics, but if not treated effectively, the infection can spread to different parts of the body. Pneumonic plague occurs when plague infects the lungs and is transmissible person to person through infected droplets. This form of plague is very deadly. Septicemic plague occurs when plague enters the blood. Skin and tissues turn black and die, and bleeding into skin and organs often occurs. This form of plague is also deadly. Pneumonic plague and septicemic plague often occur when bubonic plague goes untreated and are difficult to diagnose. Plague has endemically resided in Madagascar since it was first brought to the island from India in 1898, on the central high plateau of Madagascar , usually occurring every year as a seasonal upsurge during the rainy season. Plague resides in Madagascar similar to the way flu resides in the United States. "Plague season" is generally October through March, and mostly affects rural areas of Madagascar. Plague, although endemic, has been relatively dormant in Madagascar until 1990. Annually until then, there were about 20-30 cases reported a year. Recently, however, the annual number of cases has risen to typically between 800 and 1500 a year. All cases of plague must be reported to the Ministry of Health; however, cases often go underreported due to lack of quality epidemiologic resources in rural areas. Tests for plague used in these areas often have low sensitivity and are unreliable. In the past, cases of plague in Madagascar have been bubonic and not transmittable person to person. The increase in plague cases over the last 20 years have been largely due to an increase in pneumonic plague. Pneumonic plague is transmitted person to person via infected droplets. It is often difficult to diagnose and by the time it is diagnosed, cases are usually fatal. Case fatality rate of pneumonic plague in Madagascar is close to 75%. When an endemic disease, such as Ebola or plague, is introduced to a new geographic area that is densely populated with international shipping routes, it increases transmission rates and leads to severe outbreaks and potential pandemics. Although urban areas like Antananarivo and Mahajanga are more affluent, they are still impoverished in global comparison. Insufficient waste management, lack of clean water, and poor infrastructure are all issues that are breeding grounds for rats and fleas and therefore perpetuate plague transmission in urban areas. Furthermore, the rat-to-flea cycle of transmission has not changed since the first pandemic of plague. This type of consistency allows the organism to become more infectious. High rates of plague transmission have been associated with low rat abundance and high volume of flea vectors. Historically, rats who acted as hosts to the flea vector subsequently died once they were infected with plague. However, the organism evolved and scientists are now finding that rats are not dying from plague. This means that plague survives longer in the host and allows for the bacteria to live longer and potentially infect more people. The elevation of the mountains where most of the agriculture takes place, in addition to the ideal climate that allows rats and fleas to prosper, scientists have seen plague thrive in Madagascar's climate compared to other countries where there is endemic plague. Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk for transmission to other countries. Urban areas that are a major transportation hub for shipping and recreation are at high risk for transmitting plague to nearby countries. Plague in Madagascar is predominantly a rural disease related to agricultural activities. Plague "season" (October through April) coincides with the hot and rainy season in the agricultural highlands. Rats do not thrive in cold climate, and therefore are more prevalent during this time of year. Rice is a vital crop in Madagascar, and due to the high prevalence of fleas and rats in agricultural areas, plague bacteria often infects crops and soil. Many scientists have found that the plague bacteria Y. pestis can live in soil for months at a time. In addition to agricultural factors that increase prevalence of plague, burial practices in Madagascar also spread disease. Famadihana is a burial practice in Madagascar that is practiced among the Malagasy people. It is commonly known as "turning of the bones." Family members exhume their deceased family members from the family crypts and wrap them up in fresh cloth. Then, they dance around the crypt with the body to live music. This custom is based on a belief that the dead do not join the rest of their ancestors until their body reaches full decomposition with appropriate ceremonies. This process could take up to several years and involves direct contact with corpses. This burial practice perpetuates the spread of plague among other diseases. Plague is symptomatic of poverty. Rats and fleas thrive in rural and urban areas of Madagascar due to the impoverishment of the country. Lack of proper infrastructure, lack of sanitation and waste removal, little clean water, and scarce health facilities create a perfect breeding ground for rats and fleas to thrive. Although plague is prevalent in other countries, Madagascar has the highest fatality and accounts for 30% of all plague cases largely due to poverty and lack of health resources like antibiotics and proper testing. Furthermore, outbreaks of plague have become increasingly more severe due to bubonic plague going untreated and developing into pneumonic plague. Once plague becomes pneumonic, it is significantly more contagious and is transmittable person to person. Recently, plague outbreaks have become increasingly more severe. The most recent outbreak in August 2017 is the worst to date with over 1,800 confirmed cases of plague. Of these confirmed cases, 1,100 of them were cases of pneumonic plague. 114 districts of Madagascar were affected by the plague outbreak. Usually, endemic plague only affects around 20 rural districts. This outbreak was different in nature due to the fact that the plague shifted from rural geographic location to urban geographic location. Plague was found in major shipping ports like Mahajanga and in the capital Antananarivo. The capital alone is home to 2.7 million people. Plague moving into urban areas increased transmission rates due to the high volume of people living in these areas and the amount of trade traffic that occurs on a daily basis.Plague has endemically resided in Madagascar since it was first brought to the island from India in 1898, on the central high plateau of Madagascar , usually occurring every year as a seasonal upsurge during the rainy season. Plague resides in Madagascar similar to the way flu resides in the United States. "Plague season" is generally October through March, and mostly affects rural areas of Madagascar. Plague, although endemic, has been relatively dormant in Madagascar until 1990. Annually until then, there were about 20-30 cases reported a year. Recently, however, the annual number of cases has risen to typically between 800 and 1500 a year. All cases of plague must be reported to the Ministry of Health; however, cases often go underreported due to lack of quality epidemiologic resources in rural areas. Tests for plague used in these areas often have low sensitivity and are unreliable. In the past, cases of plague in Madagascar have been bubonic and not transmittable person to person. The increase in plague cases over the last 20 years have been largely due to an increase in pneumonic plague. Pneumonic plague is transmitted person to person via infected droplets. It is often difficult to diagnose and by the time it is diagnosed, cases are usually fatal. Case fatality rate of pneumonic plague in Madagascar is close to 75%. When an endemic disease, such as Ebola or plague, is introduced to a new geographic area that is densely populated with international shipping routes, it increases transmission rates and leads to severe outbreaks and potential pandemics. Although urban areas like Antananarivo and Mahajanga are more affluent, they are still impoverished in global comparison. Insufficient waste management, lack of clean water, and poor infrastructure are all issues that are breeding grounds for rats and fleas and therefore perpetuate plague transmission in urban areas. Furthermore, the rat-to-flea cycle of transmission has not changed since the first pandemic of plague. This type of consistency allows the organism to become more infectious. High rates of plague transmission have been associated with low rat abundance and high volume of flea vectors. Historically, rats who acted as hosts to the flea vector subsequently died once they were infected with plague. However, the organism evolved and scientists are now finding that rats are not dying from plague. This means that plague survives longer in the host and allows for the bacteria to live longer and potentially infect more people. The elevation of the mountains where most of the agriculture takes place, in addition to the ideal climate that allows rats and fleas to prosper, scientists have seen plague thrive in Madagascar's climate compared to other countries where there is endemic plague. Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk for transmission to other countries. Urban areas that are a major transportation hub for shipping and recreation are at high risk for transmitting plague to nearby countries. Plague in Madagascar is predominantly a rural disease related to agricultural activities. Plague "season" (October through April) coincides with the hot and rainy season in the agricultural highlands. Rats do not thrive in cold climate, and therefore are more prevalent during this time of year. Rice is a vital crop in Madagascar, and due to the high prevalence of fleas and rats in agricultural areas, plague bacteria often infects crops and soil. Many scientists have found that the plague bacteria Y. pestis can live in soil for months at a time. In addition to agricultural factors that increase prevalence of plague, burial practices in Madagascar also spread disease. Famadihana is a burial practice in Madagascar that is practiced among the Malagasy people. It is commonly known as "turning of the bones." Family members exhume their deceased family members from the family crypts and wrap them up in fresh cloth. Then, they dance around the crypt with the body to live music. This custom is based on a belief that the dead do not join the rest of their ancestors until their body reaches full decomposition with appropriate ceremonies. This process could take up to several years and involves direct contact with corpses. This burial practice perpetuates the spread of plague among other diseases. Plague is symptomatic of poverty. Rats and fleas thrive in rural and urban areas of Madagascar due to the impoverishment of the country. Lack of proper infrastructure, lack of sanitation and waste removal, little clean water, and scarce health facilities create a perfect breeding ground for rats and fleas to thrive. Although plague is prevalent in other countries, Madagascar has the highest fatality and accounts for 30% of all plague cases largely due to poverty and lack of health resources like antibiotics and proper testing. Furthermore, outbreaks of plague have become increasingly more severe due to bubonic plague going untreated and developing into pneumonic plague. Once plague becomes pneumonic, it is significantly more contagious and is transmittable person to person. When an endemic disease, such as Ebola or plague, is introduced to a new geographic area that is densely populated with international shipping routes, it increases transmission rates and leads to severe outbreaks and potential pandemics. Although urban areas like Antananarivo and Mahajanga are more affluent, they are still impoverished in global comparison. Insufficient waste management, lack of clean water, and poor infrastructure are all issues that are breeding grounds for rats and fleas and therefore perpetuate plague transmission in urban areas. Furthermore, the rat-to-flea cycle of transmission has not changed since the first pandemic of plague. This type of consistency allows the organism to become more infectious.High rates of plague transmission have been associated with low rat abundance and high volume of flea vectors. Historically, rats who acted as hosts to the flea vector subsequently died once they were infected with plague. However, the organism evolved and scientists are now finding that rats are not dying from plague. This means that plague survives longer in the host and allows for the bacteria to live longer and potentially infect more people. The elevation of the mountains where most of the agriculture takes place, in addition to the ideal climate that allows rats and fleas to prosper, scientists have seen plague thrive in Madagascar's climate compared to other countries where there is endemic plague.Scientists discovered three new strains of Y. pestis in Madagascar in 2017. Additionally, one strain of Y. pestis was found to be resistant to antibiotic treatment. Because of plague moving from rural to urban areas, there is increased risk for transmission to other countries. Urban areas that are a major transportation hub for shipping and recreation are at high risk for transmitting plague to nearby countries.Plague in Madagascar is predominantly a rural disease related to agricultural activities. Plague "season" (October through April) coincides with the hot and rainy season in the agricultural highlands. Rats do not thrive in cold climate, and therefore are more prevalent during this time of year. Rice is a vital crop in Madagascar, and due to the high prevalence of fleas and rats in agricultural areas, plague bacteria often infects crops and soil. Many scientists have found that the plague bacteria Y. pestis can live in soil for months at a time. In addition to agricultural factors that increase prevalence of plague, burial practices in Madagascar also spread disease. Famadihana is a burial practice in Madagascar that is practiced among the Malagasy people. It is commonly known as "turning of the bones." Family members exhume their deceased family members from the family crypts and wrap them up in fresh cloth. Then, they dance around the crypt with the body to live music. This custom is based on a belief that the dead do not join the rest of their ancestors until their body reaches full decomposition with appropriate ceremonies. This process could take up to several years and involves direct contact with corpses. This burial practice perpetuates the spread of plague among other diseases. Plague is symptomatic of poverty. Rats and fleas thrive in rural and urban areas of Madagascar due to the impoverishment of the country. Lack of proper infrastructure, lack of sanitation and waste removal, little clean water, and scarce health facilities create a perfect breeding ground for rats and fleas to thrive. Although plague is prevalent in other countries, Madagascar has the highest fatality and accounts for 30% of all plague cases largely due to poverty and lack of health resources like antibiotics and proper testing. Furthermore, outbreaks of plague have become increasingly more severe due to bubonic plague going untreated and developing into pneumonic plague. Once plague becomes pneumonic, it is significantly more contagious and is transmittable person to person. Recently, plague outbreaks have become increasingly more severe. The most recent outbreak in August 2017 is the worst to date with over 1,800 confirmed cases of plague. Of these confirmed cases, 1,100 of them were cases of pneumonic plague. 114 districts of Madagascar were affected by the plague outbreak. Usually, endemic plague only affects around 20 rural districts. This outbreak was different in nature due to the fact that the plague shifted from rural geographic location to urban geographic location. Plague was found in major shipping ports like Mahajanga and in the capital Antananarivo. The capital alone is home to 2.7 million people. Plague moving into urban areas increased transmission rates due to the high volume of people living in these areas and the amount of trade traffic that occurs on a daily basis.Madagascar proposed a National Plague Control Program, which is a surveillance program run by the government and the Ministry of Health that is based on immediate notification of every suspected case of plague. Every case reported to the National Plague Control Program is treated with antibiotics. In addition to this course of treatment, insecticide is brought to the home or work for flea control. Although the ideas and intentions of the National Plague Control Program are good and in theory could be very beneficial to treating and preventing outbreaks of plague, severe economic limitations make the execution of this program less than ideal. Furthermore, disparities in rural areas compared to urban areas make accessibility and testing in rural areas challenging. Economic resources need to be strengthened before this program can live up to its full potential. After the most recent, major outbreak, the WHO created a Crisis Emergency Committee to monitor the situation. They deployed epidemiologists, doctors, and risk management coordinators in order to coordinate surveillance, facilitate tracing contacts, oversee case management, administer isolation protocol, and distribute supplies. In addition to the new committee, Madagascar reallocated funds in order to help with isolation, treatment, and supplies. These solutions to the outbreak helped, as cases of plague declined and hospitalized patients decreased in volume.Twelve more cases of suspected plague appeared in the Seychelles days after the death of a 34-year-old male who had recently traveled to Madagascar and who was confirmed as having pneumonic plague on 10 October 2017. Air Seychelles suspended all flights to Madagascar. More sophisticated tests later showed that the infection was not plague. A South African basketball player who contracted plague while attending a tournament in Madagascar was successfully treated and returned home. The type of plague the player had was not reported, but one of the cases in the Seychelles who died of pneumonic plague was thought to have attended the same tournament. The World Health Organization warned that there was a high risk the disease could spread to nine other countries in Africa and the Indian Ocean (Ethiopia, Kenya, Tanzania, Mozambique, South Africa, Seychelles, Comoros, Reunion, and Mauritius) because of frequent trade and travel with Madagascar.

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Pneumonic plague

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1924 Los Angeles pneumonic plague outbreak

The 1924 Los Angeles pneumonic plague outbreak was an outbreak of the pneumonic plague in Los Angeles , California that began on September 28, 1924, and was declared fully contained on November 13, 1924. It represented the first time that the plague had emerged in Southern California ; plague outbreaks had previously surfaced in San Francisco and Oakland . The outbreak killed 30 people and infected several more. Public health officials credited the lessons learned from the San Francisco outbreak with saving lives, and swiftly implemented preventative measures , including hospitalization of the sick and all their contacts, a neighborhood quarantine , and a large-scale rat eradication program. The epicenter of the plague was in the Macy Street District , primarily home to Mexican immigrants . Racism against Mexican Americans tainted the reaction to the plague, an issue not made public until the outbreak concluded. This outbreak was the last instance of aerosol transmission of the plague and the last major plague outbreak in the United States. During the 1920s, thousands of Mexicans crossed the border to work on large plantations that thrived on "cheap, compliant labor." The large plantation owners supported open immigration , because Mexicans were thought of as "docile and backward." However, immigrants faced a backlash from labor unions which supported increased border security and often expressed racists tendencies towards Hispanic immigrants due to the belief that cheap labor on plantations would favor immigrants instead of American workers. In addition, Hispanics also had to face the stereotype of spreading crime and disease, and some worried that they refused to assimilate into white America. As a consequence, Hispanics were often "physically isolated from the white" communities of Los Angeles . At the time, roughly 19% of Los Angeles residents were foreign born, 22,000 of which were Mexican. At the time, Los Angeles, being the largest city on the West Coast and the fifth-largest in the country , was growing on an economy primarily reliant on its flourishing tourism industry, a " land boom ," and a new harbor . An ideal climate allowed its population to explode in the early 20th century: it grew by 80.66% between 1910 and 1920 and by 114.69% between 1920 and 1930 . Mexicans in Los Angeles mostly settled in Eastern Los Angeles and unincorporated territory of Los Angeles County , primarily in two neighborhoods – known by white residents as ghettos – Belvedere and the Macy Street District . In the Macy Street District, named for its southern boundary of Macy Street (now Cesar Chavez Avenue), roughly 3,000 residents were surrounded by the Los Angeles River , polluted by dead carcasses and brick, coal , gas and meatpacking plants . The rat population also thrived on the prevalence of horse and mule yards. Residents were crammed into one-fifth of a square mile, living in cramped residences with high rent despite low-quality living conditions. Residents often had to travel through someone's else's apartment to get to their own room. Despite often illegal living conditions, no investigations into the Macy District's living conditions was ever held, and the only four paved roads into the District were never inspected by the Department of Streets and Sanitation. On September 28, 1924, in the Macy Street District (present day Los Angeles Chinatown ) of Los Angeles , California , a 51-year-old man named Jesús Lajun fell ill with a fever and a painful lump in his groin . Prior to the onset of symptoms, Lajun had discovered a decaying rat under his house and picked it up, throwing it in the trash. A physician initially diagnosed Lajun's pneumonic plague as a venereal disease (sexually transmitted infection) , due to his enlarged lymph node . Even after the Los Angeles City Health Officers' eventual confirmation of the disease as the pneumonic plague, the disease was still referred to as a strange malady, pneumonia , virulent pneumonia , or malignant pneumonia until November 6, 1924. Investigators initially believed that Lajun had contracted the bubonic plague . Left untreated, the bubonic plague can move to the lungs and cause a secondary pneumonic infection, with a mortality rate of 40–60%. As Lajun's condition worsened, he developed extreme symptoms such as bloody sputum , causing physician to believe it converted into pneumonic form. Because he was the first with identifiable symptoms of the plague, Lajun was designated the index patient . In the same week, on October 3, 1924, Jesús Lajun's fifteen-year-old daughter Francisca also fell ill, complaining of fever and shortness of breath . Both also had sore throats and back pain . Giles Porter, a physician of the Los Angeles City Health Office, was called to the house and diagnosed Francisca with lobar pneumonia , a form of pneumonia weakening the lobe of a lung due to inflammatory exudate between alveoli . Porter was also the physician who had initially diagnosed Lajun's plague as a venereal disease, or sexually transmitted infection , due to his enlarged lymph node . Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street, which would become the eventual epicenter of the outbreak. However, neither of the Lajuns recovered. 15-year old Francisca died in an ambulance on its way to Los Angeles County General Hospital after her symptoms worsened. An autopsy of Francisca performed by pathologist Webb ruled her cause of death as double pneumonia . Jesús Lajun died on October 11, with his cause of death ruled as bronchopneumonia . Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having acute myocarditis , or inflammation of the heart muscle . Samarano's baby was stillborn and her body was returned to her husband Guadalupe Samarano, who later developed infection. Between October 15 and 19, Father M. Brualla, a Catholic priest who had administered last rites to the affected people and held the requiem mass for Samarano, developed the same respiratory symptoms and died days later, as did several attendants of Samarano's funeral. Many of the Samaranos' friends and family were unknowingly infected by Guadalupe Samarano, and within a week, the plague killed his entire family of eight. On October 22, Guadalupe and Jessie Flores, neighbors of the Samaranos, also fell ill with symptoms of the pneumonic plague and are subsequently hospitalized at the General Hospital. On October 24, physicians again misdiagnosed the Flores with severe pneumonia as there was no known connection at the time between the Flores and Samaranos. On October 26, Guadalupe Flores died and received an autopsy by pathologist Lawrence Parsons, who misruled his cause of death as double pneumonia. No bacterial culture was conducted to correctly identify the cause of his pneumonia as Yersinia pestis , the causative agent of the pneumonic plague. Flores' body was returned to his family on October 27, exposing them to the bacteria. Afterwards, the hospital's morgue staff was quarantined for five days. On October 28, physician George Stevens reported an unknown, highly contagious disease to the hospital and recommended the construction of a quarantine ward after he and physician Elmer Anderson both treated patients in unusually critical condition. That same day, brothers Mike and Jose Jiminez also fell ill and vacated 742 Clara Street, the residence of the Samaranos, exposing the rest of the district to the plague. On October 29, several people who were in close contact with the Samaranos contracted the plague, including Mary Costello, Guadalupe Samarano's nurse; Fred Ortega, who lived at 742 Clara Street; Samarano's mother, Maria; and his brother, Victor. Maria and Victor Samarano were hospitalized under physician Bogen's supervision after exhibiting suspected symptoms of avian influenza . Jesus and Maria Valenzuela, cousins of the Samaranos, also fell ill with symptoms of the plague, though they were not traced back to the Samaranos. The Samaranos' children, Alfredo, Gilberto, Raul, and Roberto, along with six others, were hospitalized and diagnosed with meningitis , despite their skin turning black, a pathognomonic symptom of the plague. A physician also requested an ambulance from the hospital for two patients in critical condition and were highly contagious. On October 30, the Los Angeles County Hospital pathologist George Maner finally identified the pneumonic plague as the disease causing the outbreak and notified the Los Angeles City Health Department and state officials. Maner identified it from a blood serum sample from a patient who died after attending Lucena Samarano's funeral. City health officials quarantined an eight- block area encompassing Clara Street, where the funeral had taken place, as well as a six-block area in Belvedere after Jesús Lajun was identified as the index case , but did not announce the causative disease of the outbreak. Thirteen more cases of an unknown disease were admitted, all of whom developed cyanosis and hemoptysis , or bloody sputum, the former of which is indicative of low oxygen saturation of tissues near the skin surface. Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported gram-negative bipolar staining bacilli resembling the plague. Alexandre Yersin , the co-discoverer of Yersinia pestis, and the hospital's assistant superintendent, sent a telegram ordering antiserum and vaccine on October 31, notifying the California Board of Health United States Public Health Service of the outbreak. However, the antiserum requested was produced solely by the H.K. Mulford Company laboratories in Philadelphia , a 3,141-mile journey which would require automobile transport to Mineola, New York then a flight by mail plane to Los Angeles with a stopover in San Francisco. With cooperation from the United States Post Office Department and its respective air mail officials, it was prepared within an hour, according to the company. In spite of the rapid deployment of the antiserum, it was successfully used on only two patients, Raul Samarano and Mary Costello, and remained largely unused for the rest of the outbreak. Cumming subsequently commenced an investigation into the outbreak. The same day, County Health Commissioner J. L. Pomeroy imposed a quarantine, with 75 police officers and 200 armed World War I veterans deployed to assist quarantine guards in enforcing the quarantine, who often looted from local residents and businesses. On November 1, Benjamin Brown, a United States Public Health Service surgeon in Los Angeles , warned the United States Surgeon General Hugh S. Cumming of the outbreak and Yersin's request for an antiserum. Brown's transmission was encoded, referring to "pneumonic plague" as "ekkil," "suspected cases" as "suspects," "deaths" as "begos," and "situation bad" as "ethos": Eighteen cases ekkil. Three suspects. Ten begos. Ethos. Recommend federal aid Cumming then alerted Senior Surgeon James Perry, who was then stationed in San Francisco , to confidentially investigate the outbreak, attempting to avoid gratuitous involvement in state and municipal affairs. 10 more fatalities were recorded, and Pomeroy extended the quarantine to encompass the entire Macy Street District , purportedly to ensure that " Mexicans who we feared would scatter" couldn't evade the original quarantine. The border's boundaries were closed to regular vehicle traffic and guards were positioned at every home with suspected cases. Agricultural and railroad workers were exempted from the quarantine. A temporary laboratory was constructed by the Los Angeles City Health Department in the quarantined area to quickly identify new cases. By this time, the cause of the outbreak had been definitively established as the pneumonic plague. Fatalities spiked yet again on November 2. Among them was Father Bruella, who oversaw the last rites of many of the plague patients in his ward and died from the plague at 9 a.m. By this time, over 400 armed guards were deployed to implement the quarantine. Despite its rapid spread, the outbreak remained largely unknown to the public – information that was released was often falsified or distorted, such as the Los Angeles Times , which attributed the quarantine to pneumonia , as opposed to newspapers on the East Coast which generally covered the outbreak without hesitation. By November 3, 24 people died over the course of two weeks, [lower-alpha 1] all but one of whom were Mexicans. All Mexicans who died were required to undergo an autopsy even if it is not suspected that they died of the plague. Los Angeles authorities racially quarantined Mexican homes outside of the Macy Street District as well as majority African American , Chinese , and Japanese neighborhoods. The Macy Street District port mandated the inspection and fumigation of incoming ships while outgoing ships hung a yellow flag , indicating the ship originated in a quarantined zone. On November 4, 5 more died, bringing the total death toll to 29 (reported as 25 in local newspapers). On November 5, the plague antiserum requested by the Los Angeles County Hospital finally arrived, though it was only used on three patients. By this time, everyone else who lived at 742 Clara Street died. Despite a piling death toll, the hospital continued falsifying or contorting information regarding the outbreak. A six-block quarantine was also imposed in Belvedere Gardens in response to two suspected plague deaths. By November 6, the death toll rose to 33 deaths (reported as 30 in local newspapers). That same day, El Heraldo de México became the first local newspaper to transparently report on the outbreak, revealing that the plague spread by rat fleas , not pneumonia, was its cause. The newspaper also refuted city officials' claims that the plague outbreak began on October 30. Consequently, the Port of Los Angeles began the eradication of all rats to avoid a quarantine and economic downturn. The Los Angeles government advised those in the Macy Street District not to congregate by or heed to the newspaper. On November 8, Los Angeles government and hospitals began the rollout of a vaccine . However, it would require the quarantined to leave the restricted area, meaning the vaccine was largely isolated to the sick. The plague vaccine at the time was also largely ineffective against the pneumonic plague, and in those who were vaccinated, the plague often progressed too far for the vaccine to be effective. On November 10, the Los Angeles County General Hospital superintendent, N. N. Wood, officially reported 9 clinically diagnosed plague cases after weeks of silence on the plague, which was adjusted to 37 on November 11. On November 13, the quarantine was lifted after 6 days of no new cases. On November 14, a man named Martin Hernandez, who did not live anywhere near the Macy Street District, died of the plague; his case was not reported to any authorities. On November 15, the plague was officially declared over by local health officials in spite of lingering active cases of the plague, allowing the introduction of a citywide rat extermination program. On September 28, 1924, in the Macy Street District (present day Los Angeles Chinatown ) of Los Angeles , California , a 51-year-old man named Jesús Lajun fell ill with a fever and a painful lump in his groin . Prior to the onset of symptoms, Lajun had discovered a decaying rat under his house and picked it up, throwing it in the trash. A physician initially diagnosed Lajun's pneumonic plague as a venereal disease (sexually transmitted infection) , due to his enlarged lymph node . Even after the Los Angeles City Health Officers' eventual confirmation of the disease as the pneumonic plague, the disease was still referred to as a strange malady, pneumonia , virulent pneumonia , or malignant pneumonia until November 6, 1924. Investigators initially believed that Lajun had contracted the bubonic plague . Left untreated, the bubonic plague can move to the lungs and cause a secondary pneumonic infection, with a mortality rate of 40–60%. As Lajun's condition worsened, he developed extreme symptoms such as bloody sputum , causing physician to believe it converted into pneumonic form. Because he was the first with identifiable symptoms of the plague, Lajun was designated the index patient . In the same week, on October 3, 1924, Jesús Lajun's fifteen-year-old daughter Francisca also fell ill, complaining of fever and shortness of breath . Both also had sore throats and back pain . Giles Porter, a physician of the Los Angeles City Health Office, was called to the house and diagnosed Francisca with lobar pneumonia , a form of pneumonia weakening the lobe of a lung due to inflammatory exudate between alveoli . Porter was also the physician who had initially diagnosed Lajun's plague as a venereal disease, or sexually transmitted infection , due to his enlarged lymph node . Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street, which would become the eventual epicenter of the outbreak. However, neither of the Lajuns recovered. 15-year old Francisca died in an ambulance on its way to Los Angeles County General Hospital after her symptoms worsened. An autopsy of Francisca performed by pathologist Webb ruled her cause of death as double pneumonia . Jesús Lajun died on October 11, with his cause of death ruled as bronchopneumonia . Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having acute myocarditis , or inflammation of the heart muscle . Samarano's baby was stillborn and her body was returned to her husband Guadalupe Samarano, who later developed infection. Between October 15 and 19, Father M. Brualla, a Catholic priest who had administered last rites to the affected people and held the requiem mass for Samarano, developed the same respiratory symptoms and died days later, as did several attendants of Samarano's funeral. Many of the Samaranos' friends and family were unknowingly infected by Guadalupe Samarano, and within a week, the plague killed his entire family of eight. On October 22, Guadalupe and Jessie Flores, neighbors of the Samaranos, also fell ill with symptoms of the pneumonic plague and are subsequently hospitalized at the General Hospital. On October 24, physicians again misdiagnosed the Flores with severe pneumonia as there was no known connection at the time between the Flores and Samaranos. On October 26, Guadalupe Flores died and received an autopsy by pathologist Lawrence Parsons, who misruled his cause of death as double pneumonia. No bacterial culture was conducted to correctly identify the cause of his pneumonia as Yersinia pestis , the causative agent of the pneumonic plague. Flores' body was returned to his family on October 27, exposing them to the bacteria. Afterwards, the hospital's morgue staff was quarantined for five days. On October 28, physician George Stevens reported an unknown, highly contagious disease to the hospital and recommended the construction of a quarantine ward after he and physician Elmer Anderson both treated patients in unusually critical condition. That same day, brothers Mike and Jose Jiminez also fell ill and vacated 742 Clara Street, the residence of the Samaranos, exposing the rest of the district to the plague. On October 29, several people who were in close contact with the Samaranos contracted the plague, including Mary Costello, Guadalupe Samarano's nurse; Fred Ortega, who lived at 742 Clara Street; Samarano's mother, Maria; and his brother, Victor. Maria and Victor Samarano were hospitalized under physician Bogen's supervision after exhibiting suspected symptoms of avian influenza . Jesus and Maria Valenzuela, cousins of the Samaranos, also fell ill with symptoms of the plague, though they were not traced back to the Samaranos. The Samaranos' children, Alfredo, Gilberto, Raul, and Roberto, along with six others, were hospitalized and diagnosed with meningitis , despite their skin turning black, a pathognomonic symptom of the plague. A physician also requested an ambulance from the hospital for two patients in critical condition and were highly contagious. On October 30, the Los Angeles County Hospital pathologist George Maner finally identified the pneumonic plague as the disease causing the outbreak and notified the Los Angeles City Health Department and state officials. Maner identified it from a blood serum sample from a patient who died after attending Lucena Samarano's funeral. City health officials quarantined an eight- block area encompassing Clara Street, where the funeral had taken place, as well as a six-block area in Belvedere after Jesús Lajun was identified as the index case , but did not announce the causative disease of the outbreak. Thirteen more cases of an unknown disease were admitted, all of whom developed cyanosis and hemoptysis , or bloody sputum, the former of which is indicative of low oxygen saturation of tissues near the skin surface. Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported gram-negative bipolar staining bacilli resembling the plague. Alexandre Yersin , the co-discoverer of Yersinia pestis, and the hospital's assistant superintendent, sent a telegram ordering antiserum and vaccine on October 31, notifying the California Board of Health United States Public Health Service of the outbreak. However, the antiserum requested was produced solely by the H.K. Mulford Company laboratories in Philadelphia , a 3,141-mile journey which would require automobile transport to Mineola, New York then a flight by mail plane to Los Angeles with a stopover in San Francisco. With cooperation from the United States Post Office Department and its respective air mail officials, it was prepared within an hour, according to the company. In spite of the rapid deployment of the antiserum, it was successfully used on only two patients, Raul Samarano and Mary Costello, and remained largely unused for the rest of the outbreak. Cumming subsequently commenced an investigation into the outbreak. The same day, County Health Commissioner J. L. Pomeroy imposed a quarantine, with 75 police officers and 200 armed World War I veterans deployed to assist quarantine guards in enforcing the quarantine, who often looted from local residents and businesses. On November 1, Benjamin Brown, a United States Public Health Service surgeon in Los Angeles , warned the United States Surgeon General Hugh S. Cumming of the outbreak and Yersin's request for an antiserum. Brown's transmission was encoded, referring to "pneumonic plague" as "ekkil," "suspected cases" as "suspects," "deaths" as "begos," and "situation bad" as "ethos": Eighteen cases ekkil. Three suspects. Ten begos. Ethos. Recommend federal aid Cumming then alerted Senior Surgeon James Perry, who was then stationed in San Francisco , to confidentially investigate the outbreak, attempting to avoid gratuitous involvement in state and municipal affairs. 10 more fatalities were recorded, and Pomeroy extended the quarantine to encompass the entire Macy Street District , purportedly to ensure that " Mexicans who we feared would scatter" couldn't evade the original quarantine. The border's boundaries were closed to regular vehicle traffic and guards were positioned at every home with suspected cases. Agricultural and railroad workers were exempted from the quarantine. A temporary laboratory was constructed by the Los Angeles City Health Department in the quarantined area to quickly identify new cases. By this time, the cause of the outbreak had been definitively established as the pneumonic plague. Fatalities spiked yet again on November 2. Among them was Father Bruella, who oversaw the last rites of many of the plague patients in his ward and died from the plague at 9 a.m. By this time, over 400 armed guards were deployed to implement the quarantine. Despite its rapid spread, the outbreak remained largely unknown to the public – information that was released was often falsified or distorted, such as the Los Angeles Times , which attributed the quarantine to pneumonia , as opposed to newspapers on the East Coast which generally covered the outbreak without hesitation. By November 3, 24 people died over the course of two weeks, [lower-alpha 1] all but one of whom were Mexicans. All Mexicans who died were required to undergo an autopsy even if it is not suspected that they died of the plague. Los Angeles authorities racially quarantined Mexican homes outside of the Macy Street District as well as majority African American , Chinese , and Japanese neighborhoods. The Macy Street District port mandated the inspection and fumigation of incoming ships while outgoing ships hung a yellow flag , indicating the ship originated in a quarantined zone. On November 4, 5 more died, bringing the total death toll to 29 (reported as 25 in local newspapers). On November 5, the plague antiserum requested by the Los Angeles County Hospital finally arrived, though it was only used on three patients. By this time, everyone else who lived at 742 Clara Street died. Despite a piling death toll, the hospital continued falsifying or contorting information regarding the outbreak. A six-block quarantine was also imposed in Belvedere Gardens in response to two suspected plague deaths. By November 6, the death toll rose to 33 deaths (reported as 30 in local newspapers). That same day, El Heraldo de México became the first local newspaper to transparently report on the outbreak, revealing that the plague spread by rat fleas , not pneumonia, was its cause. The newspaper also refuted city officials' claims that the plague outbreak began on October 30. Consequently, the Port of Los Angeles began the eradication of all rats to avoid a quarantine and economic downturn. The Los Angeles government advised those in the Macy Street District not to congregate by or heed to the newspaper. On November 8, Los Angeles government and hospitals began the rollout of a vaccine . However, it would require the quarantined to leave the restricted area, meaning the vaccine was largely isolated to the sick. The plague vaccine at the time was also largely ineffective against the pneumonic plague, and in those who were vaccinated, the plague often progressed too far for the vaccine to be effective. On November 10, the Los Angeles County General Hospital superintendent, N. N. Wood, officially reported 9 clinically diagnosed plague cases after weeks of silence on the plague, which was adjusted to 37 on November 11. On November 13, the quarantine was lifted after 6 days of no new cases. On November 14, a man named Martin Hernandez, who did not live anywhere near the Macy Street District, died of the plague; his case was not reported to any authorities. On November 15, the plague was officially declared over by local health officials in spite of lingering active cases of the plague, allowing the introduction of a citywide rat extermination program. The pneumonic plague is the only form of the plague capable of person-to-person transmission , which occurs during droplet-respiration , or breathing , as opposed to other forms of the plague. The 1924 Los Angeles pneumonic plague outbreak was the last instance of aerosol transmission of the plague in the United States. A person is infected when they breathe in particles of Yersinia pestis , a bacterium transmitted by rat fleas , in the air. Alternatively, if the bubonic plague (another form of the plague) goes untreated, the bacteria can spread to the lungs through the bloodstream and cause a secondary case of the pneumonic plague. Between 1900 and 2009, there were 1,001 reported cases of pneumonic plague, of which 81% occurred before 1943, when effective antibiotics , such as doxycycline , ciprofloxacin , and levofloxacin became widely available. In that time period, 92% of cases were fatal. The pneumonic plague's potency of person-to-person transmission is disputed – it is agreed that Yersinia pestis can spread the pneumonic plague through aerosol transmission of infected droplets , and the bacterium can survive in the air for up to one hour in optimum conditions. Somebody exposed to someone infected with the pneumonic plague can fall ill within 1 to 6 days. However, Jacob L. Kool objects to the supposed high risk of person-to-person transmission in an article titled ""Risk of Person‐to‐Person Transmission of Pneumonic Plague" in Clinical Infectious Diseases , stating that people are only at risk of exposure to the plague when the disease has progressed to its end stage and the infected begin coughing bloody sputum . Even then, direct and close contact within six feet is required for the plague to spread, according to the Centers for Disease Control and Prevention 's National Center for Emerging and Zoonotic Infectious Diseases. Transmission can be prevented by tight-fitting surgical masks and social distancing . Only 11% of patients that contracted the disease actually spread it to another person. After the 1924 outbreak in Los Angeles, there have been no secondary transmissions (transmission of the disease from a secondary case). Bodily fluids and tissue of an infected animal can still transmit the plague to humans through direct contact if handled improperly, but this is exceedingly rare: today, the World Health Organization reports only 1,000 to 3,000 cases of the plague annually. Zoonosis is often the direct result of an epizootic , a flare-up of a disease in animals analogous to a human epidemic . Though the plague is most common in rural and semi-arid regions of the western United States , epizootics are frequent among rodents in big cities and urban areas with large, diverse specimen populations, as exemplified in this outbreak, the last urban plague epizootic. The pneumonic plague primarily affects the lungs, and common symptoms include fatigue , fever , and pneumonia , the latter of which in turn can cause chest pain , coughing , hemoptysis (bloody sputum), and shortness of breath . The plague may also cause abdominal pain , nausea , and vomiting . If antibiotic treatments, which were not available until 1943, are not administered within 24 hours of the onset of symptoms, the plague will often progress into respiratory failure , shock , and death . The pneumonic plague is diagnosed after evaluation by a healthcare worker and a laboratory test of the patient's blood , lymph node aspirate , or sputum confirms infection. The plague can be treated with a therapeutic antiserum , a treatment first initiated in 1896 by Alexandre Yersin , a bacteriologist , physician , and co-discoverer of Yersinia pestis as the causative bacterium of the plague. The efficacy of antiserum is disputed but it is generally accepted to be successful in mitigating negative effects of the plague: the mortality rates for antiserum-treated patients was 35%, as opposed to 82% for untreated patients. In the 1924 Los Angeles outbreak, the serum was only successfully used on two patients, Mary Costello and Raul Samarano, remaining largely unused. At the time, it was only produced by H.K. Mulford Company laboratories in Philadelphia, Pennsylvania , but was quickly flown the 3,141-mile route via car to Mineola, New York then flown on air mail to Los Angeles via San Francisco . The pneumonic plague is the only form of the plague capable of person-to-person transmission , which occurs during droplet-respiration , or breathing , as opposed to other forms of the plague. The 1924 Los Angeles pneumonic plague outbreak was the last instance of aerosol transmission of the plague in the United States. A person is infected when they breathe in particles of Yersinia pestis , a bacterium transmitted by rat fleas , in the air. Alternatively, if the bubonic plague (another form of the plague) goes untreated, the bacteria can spread to the lungs through the bloodstream and cause a secondary case of the pneumonic plague. Between 1900 and 2009, there were 1,001 reported cases of pneumonic plague, of which 81% occurred before 1943, when effective antibiotics , such as doxycycline , ciprofloxacin , and levofloxacin became widely available. In that time period, 92% of cases were fatal. The pneumonic plague's potency of person-to-person transmission is disputed – it is agreed that Yersinia pestis can spread the pneumonic plague through aerosol transmission of infected droplets , and the bacterium can survive in the air for up to one hour in optimum conditions. Somebody exposed to someone infected with the pneumonic plague can fall ill within 1 to 6 days. However, Jacob L. Kool objects to the supposed high risk of person-to-person transmission in an article titled ""Risk of Person‐to‐Person Transmission of Pneumonic Plague" in Clinical Infectious Diseases , stating that people are only at risk of exposure to the plague when the disease has progressed to its end stage and the infected begin coughing bloody sputum . Even then, direct and close contact within six feet is required for the plague to spread, according to the Centers for Disease Control and Prevention 's National Center for Emerging and Zoonotic Infectious Diseases. Transmission can be prevented by tight-fitting surgical masks and social distancing . Only 11% of patients that contracted the disease actually spread it to another person. After the 1924 outbreak in Los Angeles, there have been no secondary transmissions (transmission of the disease from a secondary case). Bodily fluids and tissue of an infected animal can still transmit the plague to humans through direct contact if handled improperly, but this is exceedingly rare: today, the World Health Organization reports only 1,000 to 3,000 cases of the plague annually. Zoonosis is often the direct result of an epizootic , a flare-up of a disease in animals analogous to a human epidemic . Though the plague is most common in rural and semi-arid regions of the western United States , epizootics are frequent among rodents in big cities and urban areas with large, diverse specimen populations, as exemplified in this outbreak, the last urban plague epizootic. The pneumonic plague primarily affects the lungs, and common symptoms include fatigue , fever , and pneumonia , the latter of which in turn can cause chest pain , coughing , hemoptysis (bloody sputum), and shortness of breath . The plague may also cause abdominal pain , nausea , and vomiting . If antibiotic treatments, which were not available until 1943, are not administered within 24 hours of the onset of symptoms, the plague will often progress into respiratory failure , shock , and death . The pneumonic plague is diagnosed after evaluation by a healthcare worker and a laboratory test of the patient's blood , lymph node aspirate , or sputum confirms infection. The plague can be treated with a therapeutic antiserum , a treatment first initiated in 1896 by Alexandre Yersin , a bacteriologist , physician , and co-discoverer of Yersinia pestis as the causative bacterium of the plague. The efficacy of antiserum is disputed but it is generally accepted to be successful in mitigating negative effects of the plague: the mortality rates for antiserum-treated patients was 35%, as opposed to 82% for untreated patients. In the 1924 Los Angeles outbreak, the serum was only successfully used on two patients, Mary Costello and Raul Samarano, remaining largely unused. At the time, it was only produced by H.K. Mulford Company laboratories in Philadelphia, Pennsylvania , but was quickly flown the 3,141-mile route via car to Mineola, New York then flown on air mail to Los Angeles via San Francisco . The government of Los Angeles consistently ensured that the pneumonic plague outbreak never became public. On October 29, Yersinia pestis , the bacterium causing the plague , was found in the lungs of a plague victim, a finding not released to the public until after the outbreak. As cases piled up, a telegram sent on October 31 recommended federal aid for the city of Los Angeles , replacing the terms "pneumonic plague," "death," and "situation" with code "ekkil," "begos," and "ethos," respectively. Government officials knew the outbreak was attributed to the pneumonic plague well before October 30, when it was first labeled in official government documents. Secretary of the State Board of Health Doctor Walter Dickie conducted a test on a guinea pig with a lymph node sample taken from Jesus Lajun before he died. The guinea pig died from the pneumonic plague, yet it took 17 days for an announcement confirming the outbreak was the fault of the plague. In spite of significant delays in medical announcements, significant preventative measures were still enacted: a quarantine of the eight blocks surrounding Jesús Lajun's residence was quickly imposed, affecting roughly 2,500 residents, most of whom were Mexican immigrants . Medical personnel traveled to each house inspecting residents for signs and symptoms of the plague. Two years following the outbreak's conclusion, Dickie reported to Governor of California Friend W. Richardson commending the response to the outbreak as "the most outstanding accomplishment" of the year, which was questioned as "historical drift" by Arthur J. Viseltear in a 1974 article published in Yale Journal of Biology and Medicine . Los Angeles media coverage of the plague was considered vague compared to that of media outside of the city, often attributing the outbreak to pneumonia , as seen in a subheading in the Los Angeles Examiner reading "Officials Believe Virulent Pneumonia Outbreak Controlled" and a headline in the Los Angeles Times reading "Seven are Dead from Pneumonia," both of which published on November 3. The plague was not referred to by name until November 6, by which time the plague was practically over. Many Los Angeles newspapers also incorrectly depicted Belvedere Gardens and the Macy Street District , both heavily populated by Mexican immigrants , as separate from the City of Los Angeles . Any news reports that did refer to the outbreak by name often portrayed Mexican Americans and their respective neighborhoods as 'menaces.' By comparison, The New York Times and The Washington Post both referred to the plague by name, even comparing it to the Black Death of the 14th century. Several newspapers outside of Los Angeles covered the deployment of the plague antiserum in early November in detail, including the Chicago Tribune ; The Evening World ; Herald & Review ; The Indianapolis Times ; Moon-Journal of Battle Creek, Michigan ; New York World ; The Philadelphia Bulletin ; The Philadelphia Inquirer ; The Philadelphia North American ; Public Ledger ; San Francisco Daily News ; and the San Francisco Evening Bulletin . The city's handling of the outbreak reinforced the widespread stereotype that Mexicans were poor and of a degraded class. Due to cramped and often illegal living conditions, rats were prevalent in majority Hispanic neighborhoods , cultivating the belief that the plague was an ethnic trait, as exemplified in a University of California, Los Angeles professor who claimed that Mexicans have a tendency to "huddle together" and therefore spread disease. Institutional racism and poverty also advanced the spread of the plague, as overcrowding , poor ventilation , poor sanitization, and high rodent populations often exacerbate the spread and harshness of the plague. In 1924, Mexican immigrants made up the largest ethnic group living in often dense and unsafe work camps, which flourished under widespread sentiment against Mexican immigrants and workers . Employment discrimination was also frequent as Mexicans were viewed as cheap and expendable, and many perceived Mexican Americans being relegated to working in factories and agricultural fields enclosing Los Angeles . On November 9, 200 Mexican workers at the Biltmore Hotel , most of whom did not live in the Macy Street District, were rehired after previously and controversially being fired. Several Mexican residents believed that quarantine guards and the over 200 armed veterans enforcing the quarantine were holding them against their will. Mexican men often had to convert from Catholicism to Protestantism to be respected, while Mexican women were societally obligated to be trained in proper housekeeping. These racist sentiments were possibly the fault of the misdiagnosis of Jesus Lajun's cause of death as a sexually transmitted infection and bronchopneumonia . After the plague, health officials recognized the need for programs encouraging safe hygiene practices among the Mexican population. Health officials blamed the plague outbreak on Mexicans' supposed ignorance of proper hygiene , despite actually being the fault of notoriously inferior living conditions and poverty in the Macy Street District . Some health officials even blamed the outbreak itself entirely on Mexican Americans, which Feldinger argues reinforced the pro- segregation views widely held at the time. The response also failed to provide vital access to clean water and sanitary disposal . After the 1900–1904 San Francisco bubonic plague outbreak , squirrels carrying fleas with the Yersinia pestis bacteria were found all throughout California . At the time, it was widely believed that rodents or small animals were directly responsible for spreading the plague , rather than fleas . In response, the City of Los Angeles hired people to systematically eradicate or tag rodents , primarily targeting squirrels. Following the Los Angeles outbreak, the City of Los Angeles began a citywide rat and ground squirrel extermination program. On November 15, Doctor Walter Dickie announced an ordinance requiring Los Angeles residents to maintain a clean household. Violations could result in the destruction of said private property, a consequence that devastated Mexicans. A committee dedicated to the eradication of rats received $250,000 in funding between November 1924 and July 1925 and $500,000 between July 1925 and July 1926. The city established a rat bounty and infected rats were found Downtown , in Beverly Hills , and at the harbor . The city lifted houses 18 inches above the ground and ripped off their siding to allow stray cats and dogs to eat infected rats. Buildings were also sprayed with hydrogen cyanide , rodenticide , and sulfur . Health officials also burned lumber, clothing, and garbage. Today, only 5 to 15 cases of the plague are reported annually in the western United States , and naturally occurring pneumonic plague is practically nonexistent. The government of Los Angeles consistently ensured that the pneumonic plague outbreak never became public. On October 29, Yersinia pestis , the bacterium causing the plague , was found in the lungs of a plague victim, a finding not released to the public until after the outbreak. As cases piled up, a telegram sent on October 31 recommended federal aid for the city of Los Angeles , replacing the terms "pneumonic plague," "death," and "situation" with code "ekkil," "begos," and "ethos," respectively. Government officials knew the outbreak was attributed to the pneumonic plague well before October 30, when it was first labeled in official government documents. Secretary of the State Board of Health Doctor Walter Dickie conducted a test on a guinea pig with a lymph node sample taken from Jesus Lajun before he died. The guinea pig died from the pneumonic plague, yet it took 17 days for an announcement confirming the outbreak was the fault of the plague. In spite of significant delays in medical announcements, significant preventative measures were still enacted: a quarantine of the eight blocks surrounding Jesús Lajun's residence was quickly imposed, affecting roughly 2,500 residents, most of whom were Mexican immigrants . Medical personnel traveled to each house inspecting residents for signs and symptoms of the plague. Two years following the outbreak's conclusion, Dickie reported to Governor of California Friend W. Richardson commending the response to the outbreak as "the most outstanding accomplishment" of the year, which was questioned as "historical drift" by Arthur J. Viseltear in a 1974 article published in Yale Journal of Biology and Medicine . Los Angeles media coverage of the plague was considered vague compared to that of media outside of the city, often attributing the outbreak to pneumonia , as seen in a subheading in the Los Angeles Examiner reading "Officials Believe Virulent Pneumonia Outbreak Controlled" and a headline in the Los Angeles Times reading "Seven are Dead from Pneumonia," both of which published on November 3. The plague was not referred to by name until November 6, by which time the plague was practically over. Many Los Angeles newspapers also incorrectly depicted Belvedere Gardens and the Macy Street District , both heavily populated by Mexican immigrants , as separate from the City of Los Angeles . Any news reports that did refer to the outbreak by name often portrayed Mexican Americans and their respective neighborhoods as 'menaces.' By comparison, The New York Times and The Washington Post both referred to the plague by name, even comparing it to the Black Death of the 14th century. Several newspapers outside of Los Angeles covered the deployment of the plague antiserum in early November in detail, including the Chicago Tribune ; The Evening World ; Herald & Review ; The Indianapolis Times ; Moon-Journal of Battle Creek, Michigan ; New York World ; The Philadelphia Bulletin ; The Philadelphia Inquirer ; The Philadelphia North American ; Public Ledger ; San Francisco Daily News ; and the San Francisco Evening Bulletin . The city's handling of the outbreak reinforced the widespread stereotype that Mexicans were poor and of a degraded class. Due to cramped and often illegal living conditions, rats were prevalent in majority Hispanic neighborhoods , cultivating the belief that the plague was an ethnic trait, as exemplified in a University of California, Los Angeles professor who claimed that Mexicans have a tendency to "huddle together" and therefore spread disease. Institutional racism and poverty also advanced the spread of the plague, as overcrowding , poor ventilation , poor sanitization, and high rodent populations often exacerbate the spread and harshness of the plague. In 1924, Mexican immigrants made up the largest ethnic group living in often dense and unsafe work camps, which flourished under widespread sentiment against Mexican immigrants and workers . Employment discrimination was also frequent as Mexicans were viewed as cheap and expendable, and many perceived Mexican Americans being relegated to working in factories and agricultural fields enclosing Los Angeles . On November 9, 200 Mexican workers at the Biltmore Hotel , most of whom did not live in the Macy Street District, were rehired after previously and controversially being fired. Several Mexican residents believed that quarantine guards and the over 200 armed veterans enforcing the quarantine were holding them against their will. Mexican men often had to convert from Catholicism to Protestantism to be respected, while Mexican women were societally obligated to be trained in proper housekeeping. These racist sentiments were possibly the fault of the misdiagnosis of Jesus Lajun's cause of death as a sexually transmitted infection and bronchopneumonia . After the plague, health officials recognized the need for programs encouraging safe hygiene practices among the Mexican population. Health officials blamed the plague outbreak on Mexicans' supposed ignorance of proper hygiene , despite actually being the fault of notoriously inferior living conditions and poverty in the Macy Street District . Some health officials even blamed the outbreak itself entirely on Mexican Americans, which Feldinger argues reinforced the pro- segregation views widely held at the time. The response also failed to provide vital access to clean water and sanitary disposal . After the 1900–1904 San Francisco bubonic plague outbreak , squirrels carrying fleas with the Yersinia pestis bacteria were found all throughout California . At the time, it was widely believed that rodents or small animals were directly responsible for spreading the plague , rather than fleas . In response, the City of Los Angeles hired people to systematically eradicate or tag rodents , primarily targeting squirrels. Following the Los Angeles outbreak, the City of Los Angeles began a citywide rat and ground squirrel extermination program. On November 15, Doctor Walter Dickie announced an ordinance requiring Los Angeles residents to maintain a clean household. Violations could result in the destruction of said private property, a consequence that devastated Mexicans. A committee dedicated to the eradication of rats received $250,000 in funding between November 1924 and July 1925 and $500,000 between July 1925 and July 1926. The city established a rat bounty and infected rats were found Downtown , in Beverly Hills , and at the harbor . The city lifted houses 18 inches above the ground and ripped off their siding to allow stray cats and dogs to eat infected rats. Buildings were also sprayed with hydrogen cyanide , rodenticide , and sulfur . Health officials also burned lumber, clothing, and garbage. Today, only 5 to 15 cases of the plague are reported annually in the western United States , and naturally occurring pneumonic plague is practically nonexistent.

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Pneumonic plague

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Black Death

The Black Death was a bubonic plague pandemic occurring in Europe from 1346 to 1353. One of the most fatal pandemics in human history, as many as 50 million people perished, perhaps 50% of Europe's 14th century population. Bubonic plague is caused by the bacterium Yersinia pestis and spread by fleas . One of the most significant events in European history, the Black Death had far-reaching population, economic, and cultural impacts. It was the beginning of the second plague pandemic . The plague created religious, social and economic upheavals, with profound effects on the course of European history. The origin of the Black Death is disputed. Genetic analysis points to the evolution of Yersinia pestis in the Tian Shan mountains on the border between Kyrgyzstan and China 2,600 years ago. The immediate territorial origins of the Black Death and its outbreak remain unclear, with some evidence pointing towards Central Asia , China , the Middle East , and Europe . The pandemic was reportedly first introduced to Europe during the siege of the Genoese trading port of Kaffa in Crimea by the Golden Horde army of Jani Beg in 1347. From Crimea, it was most likely carried by fleas living on the black rats that travelled on Genoese ships, spreading through the Mediterranean Basin and reaching North Africa , Western Asia , and the rest of Europe via Constantinople , Sicily , and the Italian Peninsula . There is evidence that once it came ashore, the Black Death mainly spread from person-to-person as pneumonic plague , thus explaining the quick inland spread of the epidemic, which was faster than would be expected if the primary vector was rat fleas causing bubonic plague. In 2022, it was discovered that there was a sudden surge of deaths in what is today Kyrgyzstan from the Black Death in the late 1330s; when combined with genetic evidence, this implies that the initial spread may not have been due to Mongol conquests in the 14th century, as previously speculated. The Black Death was the second great natural disaster to strike Europe during the Late Middle Ages (the first one being the Great Famine of 1315–1317 ) and is estimated to have killed 30% to 60% of the European population, as well as approximately 33% of the population of the Middle East. There were further outbreaks throughout the Late Middle Ages and, also due to other contributing factors (the Crisis of the Late Middle Ages ), the European population did not regain its 14th century level until the 16th century. [lower-alpha 1] Outbreaks of the plague recurred around the world until the early 19th century.European writers contemporary with the plague described the disease in Latin as pestis or pestilentia , ' pestilence ' ; epidemia , ' epidemic ' ; mortalitas , ' mortality ' . In English prior to the 18th century, the event was called the "pestilence" or "great pestilence", "the plague" or the "great death". Subsequent to the pandemic "the furste moreyn " (first murrain ) or "first pestilence" was applied, to distinguish the mid-14th century phenomenon from other infectious diseases and epidemics of plague. The 1347 pandemic plague was not referred to specifically as "black" in the time of occurrence in any European language, though the expression "black death" had occasionally been applied to fatal disease beforehand. "Black death" was not used to describe the plague pandemic in English until the 1750s; the term is first attested in 1755, where it translated Danish : den sorte død , lit. ' the black death ' . This expression as a proper name for the pandemic had been popularized by Swedish and Danish chroniclers in the 15th and early 16th centuries, and in the 16th and 17th centuries was transferred to other languages as a calque : Icelandic : svarti dauði , German : der schwarze Tod , and French : la mort noire . Previously, most European languages had named the pandemic a variant or calque of the Latin : magna mortalitas , lit. ' Great Death ' . The phrase 'black death' – describing Death as black – is very old. Homer used it in the Odyssey to describe the monstrous Scylla , with her mouths "full of black Death" ( Ancient Greek : πλεῖοι μέλανος Θανάτοιο , romanized : pleîoi mélanos Thanátoio ). Seneca the Younger may have been the first to describe an epidemic as 'black death', ( Latin : mors atra ) but only in reference to the acute lethality and dark prognosis of disease. The 12th–13th century French physician Gilles de Corbeil had already used atra mors to refer to a "pestilential fever" ( febris pestilentialis ) in his work On the Signs and Symptoms of Diseases ( De signis et symptomatibus aegritudium ). The phrase mors nigra , ' black death ' , was used in 1350 by Simon de Covino (or Couvin), a Belgian astronomer, in his poem "On the Judgement of the Sun at a Feast of Saturn" ( De judicio Solis in convivio Saturni ), which attributes the plague to an astrological conjunction of Jupiter and Saturn. His use of the phrase is not connected unambiguously with the plague pandemic of 1347 and appears to refer to the fatal outcome of disease. The historian Cardinal Francis Aidan Gasquet wrote about the Great Pestilence in 1893 and suggested that it had been "some form of the ordinary Eastern or bubonic plague". [lower-alpha 2] In 1908, Gasquet said use of the name atra mors for the 14th-century epidemic first appeared in a 1631 book on Danish history by J. I. Pontanus : "Commonly and from its effects, they called it the black death" ( Vulgo & ab effectu atram mortem vocitabant ). Research from 2017 suggests plague first infected humans in Europe and Asia in the Late Neolithic - Early Bronze Age . Research in 2018 found evidence of Yersinia pestis in an ancient Swedish tomb, which may have been associated with the " Neolithic decline " around 3000 BCE, in which European populations fell significantly. This Y. pestis may have been different from more modern types, with bubonic plague transmissible by fleas first known from Bronze Age remains near Samara . The symptoms of bubonic plague are first attested in a fragment of Rufus of Ephesus preserved by Oribasius ; these ancient medical authorities suggest bubonic plague had appeared in the Roman Empire before the reign of Trajan , six centuries before arriving at Pelusium in the reign of Justinian I . In 2013, researchers confirmed earlier speculation that the cause of the Plague of Justinian (541–549 CE, with recurrences until 750) was Y . pestis . This is known as the first plague pandemic . In 610, the Chinese physician Chao Yuanfang described a "malignant bubo" "coming in abruptly with high fever together with the appearance of a bundle of nodes beneath the tissue." The Chinese physician Sun Simo who died in 652 also mentioned a "malignant bubo" and plague that was common in Lingnan ( Guangzhou ). Ole Jørgen Benedictow believes that this indicates it was an offshoot of the first plague pandemic which made its way eastward to Chinese territory by around 600. A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" ( miasma theory ). Muslim religious scholars taught that the pandemic was a "martyrdom and mercy" from God, assuring the believer's place in paradise. For non-believers, it was a punishment. Some Muslim doctors cautioned against trying to prevent or treat a disease sent by God. Others adopted preventive measures and treatments for plague used by Europeans. These Muslim doctors also depended on the writings of the ancient Greeks. Due to climate change in Asia , rodents began to flee the dried-out grasslands to more populated areas, spreading the disease. The plague disease, caused by the bacterium Yersinia pestis , is enzootic (commonly present) in populations of fleas carried by ground rodents , including marmots , in various areas, including Central Asia , Kurdistan , Western Asia , North India , Uganda and the western United States. Y. pestis was discovered by Alexandre Yersin , a pupil of Louis Pasteur , during an epidemic of bubonic plague in Hong Kong in 1894; Yersin also proved this bacillus was present in rodents and suggested the rat was the main vehicle of transmission. The mechanism by which Y. pestis is usually transmitted was established in 1898 by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several days after feeding on an infected host. This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try and clear the blockage via regurgitation , resulting in thousands of plague bacteria flushing into the feeding site and infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts , keeping the disease endemic , and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic . Definitive confirmation of the role of Y. pestis arrived in 2010 with a publication in PLOS Pathogens by Haensch et al. [lower-alpha 3] They assessed the presence of DNA / RNA with polymerase chain reaction (PCR) techniques for Y. pestis from the tooth sockets in human skeletons from mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this new research, together with prior analyses from the south of France and Germany, "ends the debate about the cause of the Black Death, and unambiguously demonstrates that Y. pestis was the causative agent of the epidemic plague that devastated Europe during the Middle Ages". In 2011 these results were further confirmed with genetic evidence derived from Black Death victims in the East Smithfield burial site in England. Schuenemann et al. concluded in 2011 "that the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer exist". Later in 2011, Bos et al. reported in Nature the first draft genome of Y. pestis from plague victims from the same East Smithfield cemetery and indicated that the strain that caused the Black Death is ancestral to most modern strains of Y. pestis . Later genomic papers have further confirmed the phylogenetic placement of the Y. pestis strain responsible for the Black Death as both the ancestor of later plague epidemics—including the third plague pandemic —and the descendant of the strain responsible for the Plague of Justinian . In addition, plague genomes from prehistory have been recovered. DNA taken from 25 skeletons from 14th century London showed that plague is a strain of Y. pestis almost identical to that which hit Madagascar in 2013 . Further DNA evidence also proves the role of Y. pestis and traces the source to the Tian Shan mountains in Kyrgyzstan . Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague vary by over 100%, as no census was undertaken in England between the time of publication of the Domesday Book of 1086 and the poll tax of the year 1377. Estimates of plague victims are usually extrapolated from figures for the clergy. Mathematical modelling is used to match the spreading patterns and the means of transmission . In 2018 researchers suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data. Lars Walløe argued that these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of Yersinia pestis infection could spread". Similarly, Monica Green has argued that greater attention is needed to the range of (especially non- commensal ) animals that might be involved in the transmission of plague. Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of numerous rats in the archaeological record of the medieval waterfront in London, and that the disease spread too quickly to support the thesis that Y. pestis was spread from fleas on rats; he argues that transmission must have been person to person. This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic . Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance. Many scholars arguing for Y. pestis as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus , smallpox and respiratory infections . In addition to the bubonic infection, others point to additional septicemic and pneumonic forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms. In 2014, Public Health England announced the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. Currently, while osteoarcheologists have conclusively verified the presence of Y. pestis bacteria in burial sites across northern Europe through examination of bones and dental pulp , no other epidemic pathogen has been discovered to bolster the alternative explanations. The importance of hygiene was not recognized until the 19th century and the germ theory of disease . Until then streets were usually unhygienic, with live animals and human parasites facilitating the spread of transmissible disease . By the early 14th century, so much filth had collected inside urban Europe that French and Italian cities were naming streets after human waste. In medieval Paris, several street names were inspired by merde, the French word for "shit". There were rue Merdeux, rue Merdelet, rue Merdusson, rue des Merdons and rue Merdiere—as well as a rue du Pipi. Pigs, cattle, chickens, geese, goats and horses roamed the streets of medieval London and Paris. Medieval homeowners were supposed to police their housefronts, including removing animal dung, but most urbanites were careless. William E. Cosner, a resident of the London suburb of Farringdon Without, received a complaint alleging that "men could not pass [by his house] for the stink [of] . . . horse dung and horse piss." One irate Londoner complained that the runoff from the local slaughterhouse had made his garden "stinking and putrid", while another charged that the blood from slain animals flooded nearby streets and lanes, "making a foul corruption and abominable sight to all dwelling near." In much of medieval Europe, sanitation legislation consisted of an ordinance requiring homeowners to shout, "Look out below!" three times before dumping a full chamber pot into the street. Early Christians considered bathing a temptation. With this danger in mind, St. Benedict declared, "To those who are well, and especially to the young, bathing shall seldom be permitted." St. Agnes took the injunction to heart and died without ever bathing. According to a team of medical geneticists led by Mark Achtman , Yersinia pestis "evolved in or near China" over 2,600 years ago. Later research by a team led by Galina Eroshenko placed its origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China. However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region previously thought to be restricted to China. There is also no physical or specific textual evidence of the Black Death in 14th century China. As a result, China's place in the sequence of the plague's spread is still debated to this day. According to Charles Creighton, records of epidemics in 14th century China suggest nothing more than typhus and major Chinese outbreaks of epidemic disease post-date the European epidemic by several years. The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s. Nestorian gravesites dating from 1338 to 1339 near Issyk-Kul have inscriptions referring to plague, which has led some historians and epidemiologists to think they mark the outbreak of the epidemic ; this is supported by recent direct findings of Y. pestis DNA in teeth samples from graves in the area with inscriptions referring to "pestilence" as the cause of death. Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347. The evidence does not suggest, at least at present, that these mortality crises were caused by plague. Although some scholars, including McNeill and Cao, see the 1333 outbreak as a prelude to the outbreaks in Europe from the late 1340s to the early 1350s, scholars of the Yuan and Ming periods remain skeptical about such an interpretation. Nonetheless, the remarkably high mortality rates during the Datong mortality should discourage us from rejecting the possibility of localized/regional outbreaks of plague in different parts of China, albeit differing in scale from, and unrelated to, the pandemic mortality of the Black Death. What we lack is any indication of a plague pandemic that engulfed vast territories of the Yuan Empire and later moved into western Eurasia through Central Asia. According to John Norris, evidence from Issyk-Kul indicates a small sporadic outbreak characteristic of transmission from rodents to humans with no wide-scale impact. According to Achtman, the dating of the plague suggests that it was not carried along the Silk Road , and its widespread appearance in that region probably postdates the European outbreak. Additionally, the Silk Road had already been heavily disrupted before the spread of the Black Death; Western and Middle Eastern traders found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making its role in the spread of plague less likely. There are no records of the symptoms of the Black Death from Mongol sources or writings from travelers east of the Black Sea prior to the Crimean outbreak in 1346. Others still favor an origin in China. The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside Mongol armies and traders, or possibly arriving via ship—however, this theory is still contested. It is speculated that rats aboard Zheng He 's ships in the 15th century may have carried the plague to Southeast Asia , India and Africa. Research on the Delhi Sultanate and the Yuan Dynasty shows no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague in fourteenth-century China, suggesting that the Black Death may not have reached these regions. Ole Benedictow argues that since the first clear reports of the Black Death come from Kaffa , the Black Death most likely originated in the nearby plague focus on the northwestern shore of the Caspian Sea . Demographic historians estimate that China's population fell by at least 15 per cent, and perhaps as much as a third, between 1340 and 1370. This population loss coincided with the Black Death that ravaged Europe and much of the Islamic world in 1347–52. However, there is a conspicuous lack of evidence for pandemic disease on the scale of the Black Death in China at this time. War and famine – and the diseases that typically accompanied them – probably were the main causes of mortality in the final decades of Mongol rule. Monica H. Green suggests that other parts of Eurasia outside the west do not contain the same evidence of the Black Plague, because there were actually four strains of Yersinia pestis that became predominant in different parts of the world. Mongol records of illness such as food poisoning may have been referring to the Black Plague. Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China. Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China. Norris specifically argues for an origin in Kurdistan rather than Central Asia. The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in Dorsetshire , where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive. ... But at length it came to Gloucester , yea even to Oxford and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive. Geoffrey the Baker , Chronicon Angliae Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the Crimea in 1347. During a protracted siege of the city in 1345–1346, the Mongol Golden Horde army of Jani Beg —whose mainly Tatar troops were suffering from the disease— catapulted infected corpses over the city walls of Kaffa to infect the inhabitants, though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants. As the disease took hold, Genoese traders fled across the Black Sea to Constantinople , where the disease first arrived in Europe in summer 1347. The epidemic there killed the 13-year-old son of the Byzantine emperor , John VI Kantakouzenos , who wrote a description of the disease modelled on Thucydides 's account of the 5th century BCE Plague of Athens , noting the spread of the Black Death by ship between maritime cities. Nicephorus Gregoras , while writing to Demetrios Kydones , described the rising death toll, the futility of medicine, and the panic of the citizens. The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400. Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347; the disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles . From Italy , the disease spread northwest across Europe, striking France , Spain , Portugal, and England by June 1348, then spreading east and north through Germany , Scotland and Scandinavia from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at Askøy , then spread to Bjørgvin (modern Bergen ). Finally, it spread to northwestern Russia in 1351. Plague was less common in parts of Europe with less-established trade relations, including the majority of the Basque Country , isolated parts of Belgium and the Netherlands , and isolated Alpine villages throughout the continent. According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts, inducing plague outbreaks which often peaked in the hot summers of the Mediterranean and during the cool autumn months of the southern Baltic region . [lower-alpha 4] Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population. The disease struck various regions in the Middle East and North Africa during the pandemic , leading to serious depopulation and permanent change in both economic and social structures. By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves. By late summer 1348 it reached Cairo, capital of the Mamluk Sultanate , cultural center of the Islamic world , and the largest city in the Mediterranean Basin ; the Bahriyya child sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died. The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th century bimaristan of the Qalawun complex . The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites ; plague recurred in Cairo more than fifty times over the following one and a half centuries. During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus , and in October plague had broken out in Aleppo . That year, in the territory of modern Lebanon , Syria , Israel and Palestine , the cities of Ascalon , Acre , Jerusalem , Sidon and Homs were all infected. In 1348–1349, the disease reached Antioch . The city's residents fled to the north, but most of them ended up dying during the journey. Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa. [ page needed ] The pandemic spread westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in 1348 and brought the contagion with them to Morocco, whose epidemic may also have been seeded from the Islamic city of Almería in al-Andalus . Mecca became infected in 1348 by pilgrims performing the Hajj . In 1351 or 1352, the Rasulid sultan of the Yemen , al-Mujahid Ali , was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. Symptoms of the plague include fever of 38–41 °C (100–106 °F) , headaches, painful aching joints , nausea and vomiting, and a general feeling of malaise . Left untreated, 80% of victims die within eight days. Contemporary accounts of the pandemic are varied and often imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos ) in the groin, neck and armpits, which oozed pus and bled when opened. Boccaccio 's description: In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg ... From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. [lower-alpha 5] This was followed by acute fever and vomiting of blood . Most people died two to seven days after initial infection. Freckle-like spots and rashes, which may have been caused by flea-bites , were identified as another potential sign of plague. Lodewijk Heyligen , whose master Cardinal Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague , that infected the lungs and led to respiratory problems. Symptoms include fever, cough and blood-tinged sputum . As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90–95%. Septicemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches ( purpura due to disseminated intravascular coagulation ). In cases of pneumonic and particularly septicemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes. There are no exact figures for the death toll; the rate varied widely by locality. Urban centers with higher populations suffered longer periods of abnormal mortality. Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia. [ better source needed ] A study published in 2022 of pollen samples across Europe from 1250 to 1450 was used to estimate changes in agricultural output before and after the Black Death. The authors found great variability in different regions, with evidence for high mortality in areas of Scandinavia, France, western Germany, Greece and central Italy, but uninterrupted agricultural growth in central and eastern Europe, Iberia and Ireland. The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere." The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert S. Gottfried writes that as early as 1351, "agents for Pope Clement VI calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the Book of Revelation , a favorite medieval source of information." Ole J. Benedictow proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century. [lower-alpha 6] According to medieval historian Philip Daileader , it is likely that over four years, 45–50% of the European population died of plague. [lower-alpha 7] The mortality rate of the Black Death in the 14th century was far greater than the worst 20th-century outbreaks of Y. pestis plague, which occurred in India and killed as much as 3% of the population of certain cities. The overwhelming number of deceased bodies produced by the Black Death caused the necessity of mass burial sites in Europe, sometimes including up to several hundred or several thousand skeletons. The mass burial sites that have been excavated have allowed archaeologists to continue interpreting and defining the biological, sociological, historical and anthropological implications of the Black Death. In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die. Half of Paris' population of 100,000 people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished, and a similar percentage of Londoners may have died from the disease as well, leaving a death toll of approximately 62,000 between 1346 and 1353. [lower-alpha 8] Florence's tax records suggest that 80% of the city's population died within four months in 1348. Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450. The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion . Plague did not appear in Flanders until the turn of the 15th century, and the impact was less severe on the populations of Hainaut , Finland , northern Germany and areas of Poland. Monks, nuns and priests were especially hard-hit since they cared for people ill with the plague. In 1382 the physician to the Avignon Papacy , Raimundo Chalmel de Vinario ( Latin : Magister Raimundus , lit. ' Master Raymond ' ), observed the decreasing mortality rate of successive outbreaks of plague in 1347–1348, 1362, 1371 and 1382 in his treatise On Epidemics ( De epidemica ). In the first outbreak, two thirds of the population contracted the illness and most patients died; in the next, half the population became ill but only some died; by the third, a tenth were affected and many survived; while by the fourth occurrence, only one in twenty people were sickened and most of them survived. By the 1380s in Europe, the plague predominantly affected children. Chalmel de Vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the Roman Curia , whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he was never able to effect a cure. The populations of some Italian cities, notably Florence , did not regain their pre-14th century size until the 19th century. The most widely accepted estimate for the Middle East, including Iraq, Iran and Syria, during this time, is for a death toll of about a third of the population. The Black Death killed about 40% of Egypt's population. In Cairo, with a population numbering as many as 600,000, and possibly the largest city west of China, between one third and 40% of the inhabitants died within eight months. By the 18th century, the population of Cairo was halved from its numbers in 1347. Italian chronicler Agnolo di Tura recorded his experience from Siena , where plague arrived in May 1348: Father abandoned child, wife husband, one brother another; for this illness seemed to strike through the breath and sight. And so they died. And none could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices ... great pits were dug and piled deep with the multitude of dead. And they died by the hundreds both day and night ... And as soon as those ditches were filled more were dug ... And I, Agnolo di Tura ... buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who wept for any death, for all awaited death. And so many died that all believed it was the end of the world. It has been suggested that the Black Plague, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens. But along with population decline from the pandemic, wages soared in response to a subsequent labor shortage. Many laborers, artisans and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation. Landowners were also pushed to substitute monetary rents for labor services in an effort to keep tenants. The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse. A study performed by Thomas Van Hoof of the Utrecht University suggests that the innumerable deaths brought on by the pandemic cooled the climate by freeing up land and triggering reforestation . This may have led to the Little Ice Age . Renewed religious fervor and fanaticism increased in the wake of the Black Death. Some Europeans targeted "various groups such as Jews , friars , foreigners, beggars, pilgrims ", lepers and Romani , blaming them for the crisis. Lepers , and others with skin diseases such as acne or psoriasis , were killed throughout Europe. Because 14th-century healers and governments were at a loss to explain or stop the disease, Europeans turned to astrological forces, earthquakes and the poisoning of wells by Jews as possible reasons for outbreaks. Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning God's forgiveness . There were many attacks against Jewish communities. In the Strasbourg massacre of February 1349, about 2,000 Jews were murdered. In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. During this period many Jews relocated to Poland , where they received a welcome from King Casimir the Great . One theory that has been advanced is that the Black Death's devastation of Florence , between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the Renaissance . Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife . [lower-alpha 9] It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art. This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors, in combination with an influx of Greek scholars after the fall of the Byzantine Empire . As a result of the drastic reduction in the populace the value of the working class increased, and commoners came to enjoy more freedom. To answer the increased need for labor, workers travelled in search of the most favorable position economically. [ better source needed ] Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of fiefs and city-states frequently managed by the Catholic Church. The pandemic completely restructured both religion and political forces; survivors began to turn to other forms of spirituality and the power dynamics of the fiefs and city-states crumbled. The survivors of the pandemic found not only that the prices of food were lower but also that lands were more abundant, and many of them inherited property from their dead relatives, and this probably contributed to the destabilization of feudalism . The word " quarantine " has its roots in this period, though the practice of isolating people to prevent the spread of disease is older. In the city-state of Ragusa (modern Dubrovnik , Croatia), a thirty-day isolation period was implemented in 1377 for new arrivals to the city from plague-affected areas. The isolation period was later extended to forty days, and given the name "quarantino" from the Italian word for "forty". A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" ( miasma theory ). Muslim religious scholars taught that the pandemic was a "martyrdom and mercy" from God, assuring the believer's place in paradise. For non-believers, it was a punishment. Some Muslim doctors cautioned against trying to prevent or treat a disease sent by God. Others adopted preventive measures and treatments for plague used by Europeans. These Muslim doctors also depended on the writings of the ancient Greeks. Due to climate change in Asia , rodents began to flee the dried-out grasslands to more populated areas, spreading the disease. The plague disease, caused by the bacterium Yersinia pestis , is enzootic (commonly present) in populations of fleas carried by ground rodents , including marmots , in various areas, including Central Asia , Kurdistan , Western Asia , North India , Uganda and the western United States. Y. pestis was discovered by Alexandre Yersin , a pupil of Louis Pasteur , during an epidemic of bubonic plague in Hong Kong in 1894; Yersin also proved this bacillus was present in rodents and suggested the rat was the main vehicle of transmission. The mechanism by which Y. pestis is usually transmitted was established in 1898 by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several days after feeding on an infected host. This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try and clear the blockage via regurgitation , resulting in thousands of plague bacteria flushing into the feeding site and infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts , keeping the disease endemic , and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic . Definitive confirmation of the role of Y. pestis arrived in 2010 with a publication in PLOS Pathogens by Haensch et al. [lower-alpha 3] They assessed the presence of DNA / RNA with polymerase chain reaction (PCR) techniques for Y. pestis from the tooth sockets in human skeletons from mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this new research, together with prior analyses from the south of France and Germany, "ends the debate about the cause of the Black Death, and unambiguously demonstrates that Y. pestis was the causative agent of the epidemic plague that devastated Europe during the Middle Ages". In 2011 these results were further confirmed with genetic evidence derived from Black Death victims in the East Smithfield burial site in England. Schuenemann et al. concluded in 2011 "that the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer exist". Later in 2011, Bos et al. reported in Nature the first draft genome of Y. pestis from plague victims from the same East Smithfield cemetery and indicated that the strain that caused the Black Death is ancestral to most modern strains of Y. pestis . Later genomic papers have further confirmed the phylogenetic placement of the Y. pestis strain responsible for the Black Death as both the ancestor of later plague epidemics—including the third plague pandemic —and the descendant of the strain responsible for the Plague of Justinian . In addition, plague genomes from prehistory have been recovered. DNA taken from 25 skeletons from 14th century London showed that plague is a strain of Y. pestis almost identical to that which hit Madagascar in 2013 . Further DNA evidence also proves the role of Y. pestis and traces the source to the Tian Shan mountains in Kyrgyzstan . Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague vary by over 100%, as no census was undertaken in England between the time of publication of the Domesday Book of 1086 and the poll tax of the year 1377. Estimates of plague victims are usually extrapolated from figures for the clergy. Mathematical modelling is used to match the spreading patterns and the means of transmission . In 2018 researchers suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data. Lars Walløe argued that these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of Yersinia pestis infection could spread". Similarly, Monica Green has argued that greater attention is needed to the range of (especially non- commensal ) animals that might be involved in the transmission of plague. Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of numerous rats in the archaeological record of the medieval waterfront in London, and that the disease spread too quickly to support the thesis that Y. pestis was spread from fleas on rats; he argues that transmission must have been person to person. This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic . Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance. Many scholars arguing for Y. pestis as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus , smallpox and respiratory infections . In addition to the bubonic infection, others point to additional septicemic and pneumonic forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms. In 2014, Public Health England announced the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. Currently, while osteoarcheologists have conclusively verified the presence of Y. pestis bacteria in burial sites across northern Europe through examination of bones and dental pulp , no other epidemic pathogen has been discovered to bolster the alternative explanations. A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" ( miasma theory ). Muslim religious scholars taught that the pandemic was a "martyrdom and mercy" from God, assuring the believer's place in paradise. For non-believers, it was a punishment. Some Muslim doctors cautioned against trying to prevent or treat a disease sent by God. Others adopted preventive measures and treatments for plague used by Europeans. These Muslim doctors also depended on the writings of the ancient Greeks. Due to climate change in Asia , rodents began to flee the dried-out grasslands to more populated areas, spreading the disease. The plague disease, caused by the bacterium Yersinia pestis , is enzootic (commonly present) in populations of fleas carried by ground rodents , including marmots , in various areas, including Central Asia , Kurdistan , Western Asia , North India , Uganda and the western United States. Y. pestis was discovered by Alexandre Yersin , a pupil of Louis Pasteur , during an epidemic of bubonic plague in Hong Kong in 1894; Yersin also proved this bacillus was present in rodents and suggested the rat was the main vehicle of transmission. The mechanism by which Y. pestis is usually transmitted was established in 1898 by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several days after feeding on an infected host. This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try and clear the blockage via regurgitation , resulting in thousands of plague bacteria flushing into the feeding site and infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts , keeping the disease endemic , and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic . Definitive confirmation of the role of Y. pestis arrived in 2010 with a publication in PLOS Pathogens by Haensch et al. [lower-alpha 3] They assessed the presence of DNA / RNA with polymerase chain reaction (PCR) techniques for Y. pestis from the tooth sockets in human skeletons from mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this new research, together with prior analyses from the south of France and Germany, "ends the debate about the cause of the Black Death, and unambiguously demonstrates that Y. pestis was the causative agent of the epidemic plague that devastated Europe during the Middle Ages". In 2011 these results were further confirmed with genetic evidence derived from Black Death victims in the East Smithfield burial site in England. Schuenemann et al. concluded in 2011 "that the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer exist". Later in 2011, Bos et al. reported in Nature the first draft genome of Y. pestis from plague victims from the same East Smithfield cemetery and indicated that the strain that caused the Black Death is ancestral to most modern strains of Y. pestis . Later genomic papers have further confirmed the phylogenetic placement of the Y. pestis strain responsible for the Black Death as both the ancestor of later plague epidemics—including the third plague pandemic —and the descendant of the strain responsible for the Plague of Justinian . In addition, plague genomes from prehistory have been recovered. DNA taken from 25 skeletons from 14th century London showed that plague is a strain of Y. pestis almost identical to that which hit Madagascar in 2013 . Further DNA evidence also proves the role of Y. pestis and traces the source to the Tian Shan mountains in Kyrgyzstan . Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague vary by over 100%, as no census was undertaken in England between the time of publication of the Domesday Book of 1086 and the poll tax of the year 1377. Estimates of plague victims are usually extrapolated from figures for the clergy. Mathematical modelling is used to match the spreading patterns and the means of transmission . In 2018 researchers suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data. Lars Walløe argued that these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of Yersinia pestis infection could spread". Similarly, Monica Green has argued that greater attention is needed to the range of (especially non- commensal ) animals that might be involved in the transmission of plague. Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of numerous rats in the archaeological record of the medieval waterfront in London, and that the disease spread too quickly to support the thesis that Y. pestis was spread from fleas on rats; he argues that transmission must have been person to person. This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic . Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance. Many scholars arguing for Y. pestis as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus , smallpox and respiratory infections . In addition to the bubonic infection, others point to additional septicemic and pneumonic forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms. In 2014, Public Health England announced the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. Currently, while osteoarcheologists have conclusively verified the presence of Y. pestis bacteria in burial sites across northern Europe through examination of bones and dental pulp , no other epidemic pathogen has been discovered to bolster the alternative explanations. The importance of hygiene was not recognized until the 19th century and the germ theory of disease . Until then streets were usually unhygienic, with live animals and human parasites facilitating the spread of transmissible disease . By the early 14th century, so much filth had collected inside urban Europe that French and Italian cities were naming streets after human waste. In medieval Paris, several street names were inspired by merde, the French word for "shit". There were rue Merdeux, rue Merdelet, rue Merdusson, rue des Merdons and rue Merdiere—as well as a rue du Pipi. Pigs, cattle, chickens, geese, goats and horses roamed the streets of medieval London and Paris. Medieval homeowners were supposed to police their housefronts, including removing animal dung, but most urbanites were careless. William E. Cosner, a resident of the London suburb of Farringdon Without, received a complaint alleging that "men could not pass [by his house] for the stink [of] . . . horse dung and horse piss." One irate Londoner complained that the runoff from the local slaughterhouse had made his garden "stinking and putrid", while another charged that the blood from slain animals flooded nearby streets and lanes, "making a foul corruption and abominable sight to all dwelling near." In much of medieval Europe, sanitation legislation consisted of an ordinance requiring homeowners to shout, "Look out below!" three times before dumping a full chamber pot into the street. Early Christians considered bathing a temptation. With this danger in mind, St. Benedict declared, "To those who are well, and especially to the young, bathing shall seldom be permitted." St. Agnes took the injunction to heart and died without ever bathing. According to a team of medical geneticists led by Mark Achtman , Yersinia pestis "evolved in or near China" over 2,600 years ago. Later research by a team led by Galina Eroshenko placed its origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China. However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region previously thought to be restricted to China. There is also no physical or specific textual evidence of the Black Death in 14th century China. As a result, China's place in the sequence of the plague's spread is still debated to this day. According to Charles Creighton, records of epidemics in 14th century China suggest nothing more than typhus and major Chinese outbreaks of epidemic disease post-date the European epidemic by several years. The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s. Nestorian gravesites dating from 1338 to 1339 near Issyk-Kul have inscriptions referring to plague, which has led some historians and epidemiologists to think they mark the outbreak of the epidemic ; this is supported by recent direct findings of Y. pestis DNA in teeth samples from graves in the area with inscriptions referring to "pestilence" as the cause of death. Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347. The evidence does not suggest, at least at present, that these mortality crises were caused by plague. Although some scholars, including McNeill and Cao, see the 1333 outbreak as a prelude to the outbreaks in Europe from the late 1340s to the early 1350s, scholars of the Yuan and Ming periods remain skeptical about such an interpretation. Nonetheless, the remarkably high mortality rates during the Datong mortality should discourage us from rejecting the possibility of localized/regional outbreaks of plague in different parts of China, albeit differing in scale from, and unrelated to, the pandemic mortality of the Black Death. What we lack is any indication of a plague pandemic that engulfed vast territories of the Yuan Empire and later moved into western Eurasia through Central Asia. According to John Norris, evidence from Issyk-Kul indicates a small sporadic outbreak characteristic of transmission from rodents to humans with no wide-scale impact. According to Achtman, the dating of the plague suggests that it was not carried along the Silk Road , and its widespread appearance in that region probably postdates the European outbreak. Additionally, the Silk Road had already been heavily disrupted before the spread of the Black Death; Western and Middle Eastern traders found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making its role in the spread of plague less likely. There are no records of the symptoms of the Black Death from Mongol sources or writings from travelers east of the Black Sea prior to the Crimean outbreak in 1346. Others still favor an origin in China. The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside Mongol armies and traders, or possibly arriving via ship—however, this theory is still contested. It is speculated that rats aboard Zheng He 's ships in the 15th century may have carried the plague to Southeast Asia , India and Africa. Research on the Delhi Sultanate and the Yuan Dynasty shows no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague in fourteenth-century China, suggesting that the Black Death may not have reached these regions. Ole Benedictow argues that since the first clear reports of the Black Death come from Kaffa , the Black Death most likely originated in the nearby plague focus on the northwestern shore of the Caspian Sea . Demographic historians estimate that China's population fell by at least 15 per cent, and perhaps as much as a third, between 1340 and 1370. This population loss coincided with the Black Death that ravaged Europe and much of the Islamic world in 1347–52. However, there is a conspicuous lack of evidence for pandemic disease on the scale of the Black Death in China at this time. War and famine – and the diseases that typically accompanied them – probably were the main causes of mortality in the final decades of Mongol rule. Monica H. Green suggests that other parts of Eurasia outside the west do not contain the same evidence of the Black Plague, because there were actually four strains of Yersinia pestis that became predominant in different parts of the world. Mongol records of illness such as food poisoning may have been referring to the Black Plague. Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China. Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China. Norris specifically argues for an origin in Kurdistan rather than Central Asia. The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in Dorsetshire , where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive. ... But at length it came to Gloucester , yea even to Oxford and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive. Geoffrey the Baker , Chronicon Angliae Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the Crimea in 1347. During a protracted siege of the city in 1345–1346, the Mongol Golden Horde army of Jani Beg —whose mainly Tatar troops were suffering from the disease— catapulted infected corpses over the city walls of Kaffa to infect the inhabitants, though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants. As the disease took hold, Genoese traders fled across the Black Sea to Constantinople , where the disease first arrived in Europe in summer 1347. The epidemic there killed the 13-year-old son of the Byzantine emperor , John VI Kantakouzenos , who wrote a description of the disease modelled on Thucydides 's account of the 5th century BCE Plague of Athens , noting the spread of the Black Death by ship between maritime cities. Nicephorus Gregoras , while writing to Demetrios Kydones , described the rising death toll, the futility of medicine, and the panic of the citizens. The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400. Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347; the disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles . From Italy , the disease spread northwest across Europe, striking France , Spain , Portugal, and England by June 1348, then spreading east and north through Germany , Scotland and Scandinavia from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at Askøy , then spread to Bjørgvin (modern Bergen ). Finally, it spread to northwestern Russia in 1351. Plague was less common in parts of Europe with less-established trade relations, including the majority of the Basque Country , isolated parts of Belgium and the Netherlands , and isolated Alpine villages throughout the continent. According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts, inducing plague outbreaks which often peaked in the hot summers of the Mediterranean and during the cool autumn months of the southern Baltic region . [lower-alpha 4] Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population. The disease struck various regions in the Middle East and North Africa during the pandemic , leading to serious depopulation and permanent change in both economic and social structures. By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves. By late summer 1348 it reached Cairo, capital of the Mamluk Sultanate , cultural center of the Islamic world , and the largest city in the Mediterranean Basin ; the Bahriyya child sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died. The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th century bimaristan of the Qalawun complex . The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites ; plague recurred in Cairo more than fifty times over the following one and a half centuries. During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus , and in October plague had broken out in Aleppo . That year, in the territory of modern Lebanon , Syria , Israel and Palestine , the cities of Ascalon , Acre , Jerusalem , Sidon and Homs were all infected. In 1348–1349, the disease reached Antioch . The city's residents fled to the north, but most of them ended up dying during the journey. Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa. [ page needed ] The pandemic spread westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in 1348 and brought the contagion with them to Morocco, whose epidemic may also have been seeded from the Islamic city of Almería in al-Andalus . Mecca became infected in 1348 by pilgrims performing the Hajj . In 1351 or 1352, the Rasulid sultan of the Yemen , al-Mujahid Ali , was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. The importance of hygiene was not recognized until the 19th century and the germ theory of disease . Until then streets were usually unhygienic, with live animals and human parasites facilitating the spread of transmissible disease . By the early 14th century, so much filth had collected inside urban Europe that French and Italian cities were naming streets after human waste. In medieval Paris, several street names were inspired by merde, the French word for "shit". There were rue Merdeux, rue Merdelet, rue Merdusson, rue des Merdons and rue Merdiere—as well as a rue du Pipi. Pigs, cattle, chickens, geese, goats and horses roamed the streets of medieval London and Paris. Medieval homeowners were supposed to police their housefronts, including removing animal dung, but most urbanites were careless. William E. Cosner, a resident of the London suburb of Farringdon Without, received a complaint alleging that "men could not pass [by his house] for the stink [of] . . . horse dung and horse piss." One irate Londoner complained that the runoff from the local slaughterhouse had made his garden "stinking and putrid", while another charged that the blood from slain animals flooded nearby streets and lanes, "making a foul corruption and abominable sight to all dwelling near." In much of medieval Europe, sanitation legislation consisted of an ordinance requiring homeowners to shout, "Look out below!" three times before dumping a full chamber pot into the street. Early Christians considered bathing a temptation. With this danger in mind, St. Benedict declared, "To those who are well, and especially to the young, bathing shall seldom be permitted." St. Agnes took the injunction to heart and died without ever bathing. According to a team of medical geneticists led by Mark Achtman , Yersinia pestis "evolved in or near China" over 2,600 years ago. Later research by a team led by Galina Eroshenko placed its origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China. However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region previously thought to be restricted to China. There is also no physical or specific textual evidence of the Black Death in 14th century China. As a result, China's place in the sequence of the plague's spread is still debated to this day. According to Charles Creighton, records of epidemics in 14th century China suggest nothing more than typhus and major Chinese outbreaks of epidemic disease post-date the European epidemic by several years. The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s. Nestorian gravesites dating from 1338 to 1339 near Issyk-Kul have inscriptions referring to plague, which has led some historians and epidemiologists to think they mark the outbreak of the epidemic ; this is supported by recent direct findings of Y. pestis DNA in teeth samples from graves in the area with inscriptions referring to "pestilence" as the cause of death. Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347. The evidence does not suggest, at least at present, that these mortality crises were caused by plague. Although some scholars, including McNeill and Cao, see the 1333 outbreak as a prelude to the outbreaks in Europe from the late 1340s to the early 1350s, scholars of the Yuan and Ming periods remain skeptical about such an interpretation. Nonetheless, the remarkably high mortality rates during the Datong mortality should discourage us from rejecting the possibility of localized/regional outbreaks of plague in different parts of China, albeit differing in scale from, and unrelated to, the pandemic mortality of the Black Death. What we lack is any indication of a plague pandemic that engulfed vast territories of the Yuan Empire and later moved into western Eurasia through Central Asia. According to John Norris, evidence from Issyk-Kul indicates a small sporadic outbreak characteristic of transmission from rodents to humans with no wide-scale impact. According to Achtman, the dating of the plague suggests that it was not carried along the Silk Road , and its widespread appearance in that region probably postdates the European outbreak. Additionally, the Silk Road had already been heavily disrupted before the spread of the Black Death; Western and Middle Eastern traders found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making its role in the spread of plague less likely. There are no records of the symptoms of the Black Death from Mongol sources or writings from travelers east of the Black Sea prior to the Crimean outbreak in 1346. Others still favor an origin in China. The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside Mongol armies and traders, or possibly arriving via ship—however, this theory is still contested. It is speculated that rats aboard Zheng He 's ships in the 15th century may have carried the plague to Southeast Asia , India and Africa. Research on the Delhi Sultanate and the Yuan Dynasty shows no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague in fourteenth-century China, suggesting that the Black Death may not have reached these regions. Ole Benedictow argues that since the first clear reports of the Black Death come from Kaffa , the Black Death most likely originated in the nearby plague focus on the northwestern shore of the Caspian Sea . Demographic historians estimate that China's population fell by at least 15 per cent, and perhaps as much as a third, between 1340 and 1370. This population loss coincided with the Black Death that ravaged Europe and much of the Islamic world in 1347–52. However, there is a conspicuous lack of evidence for pandemic disease on the scale of the Black Death in China at this time. War and famine – and the diseases that typically accompanied them – probably were the main causes of mortality in the final decades of Mongol rule. Monica H. Green suggests that other parts of Eurasia outside the west do not contain the same evidence of the Black Plague, because there were actually four strains of Yersinia pestis that became predominant in different parts of the world. Mongol records of illness such as food poisoning may have been referring to the Black Plague. Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China. Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China. Norris specifically argues for an origin in Kurdistan rather than Central Asia. The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in Dorsetshire , where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive. ... But at length it came to Gloucester , yea even to Oxford and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive. Geoffrey the Baker , Chronicon Angliae Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the Crimea in 1347. During a protracted siege of the city in 1345–1346, the Mongol Golden Horde army of Jani Beg —whose mainly Tatar troops were suffering from the disease— catapulted infected corpses over the city walls of Kaffa to infect the inhabitants, though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants. As the disease took hold, Genoese traders fled across the Black Sea to Constantinople , where the disease first arrived in Europe in summer 1347. The epidemic there killed the 13-year-old son of the Byzantine emperor , John VI Kantakouzenos , who wrote a description of the disease modelled on Thucydides 's account of the 5th century BCE Plague of Athens , noting the spread of the Black Death by ship between maritime cities. Nicephorus Gregoras , while writing to Demetrios Kydones , described the rising death toll, the futility of medicine, and the panic of the citizens. The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400. Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347; the disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles . From Italy , the disease spread northwest across Europe, striking France , Spain , Portugal, and England by June 1348, then spreading east and north through Germany , Scotland and Scandinavia from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at Askøy , then spread to Bjørgvin (modern Bergen ). Finally, it spread to northwestern Russia in 1351. Plague was less common in parts of Europe with less-established trade relations, including the majority of the Basque Country , isolated parts of Belgium and the Netherlands , and isolated Alpine villages throughout the continent. According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts, inducing plague outbreaks which often peaked in the hot summers of the Mediterranean and during the cool autumn months of the southern Baltic region . [lower-alpha 4] Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population. The disease struck various regions in the Middle East and North Africa during the pandemic , leading to serious depopulation and permanent change in both economic and social structures. By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves. By late summer 1348 it reached Cairo, capital of the Mamluk Sultanate , cultural center of the Islamic world , and the largest city in the Mediterranean Basin ; the Bahriyya child sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died. The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th century bimaristan of the Qalawun complex . The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites ; plague recurred in Cairo more than fifty times over the following one and a half centuries. During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus , and in October plague had broken out in Aleppo . That year, in the territory of modern Lebanon , Syria , Israel and Palestine , the cities of Ascalon , Acre , Jerusalem , Sidon and Homs were all infected. In 1348–1349, the disease reached Antioch . The city's residents fled to the north, but most of them ended up dying during the journey. Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa. [ page needed ] The pandemic spread westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in 1348 and brought the contagion with them to Morocco, whose epidemic may also have been seeded from the Islamic city of Almería in al-Andalus . Mecca became infected in 1348 by pilgrims performing the Hajj . In 1351 or 1352, the Rasulid sultan of the Yemen , al-Mujahid Ali , was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. Symptoms of the plague include fever of 38–41 °C (100–106 °F) , headaches, painful aching joints , nausea and vomiting, and a general feeling of malaise . Left untreated, 80% of victims die within eight days. Contemporary accounts of the pandemic are varied and often imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos ) in the groin, neck and armpits, which oozed pus and bled when opened. Boccaccio 's description: In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg ... From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. [lower-alpha 5] This was followed by acute fever and vomiting of blood . Most people died two to seven days after initial infection. Freckle-like spots and rashes, which may have been caused by flea-bites , were identified as another potential sign of plague. Lodewijk Heyligen , whose master Cardinal Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague , that infected the lungs and led to respiratory problems. Symptoms include fever, cough and blood-tinged sputum . As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90–95%. Septicemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches ( purpura due to disseminated intravascular coagulation ). In cases of pneumonic and particularly septicemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes. Symptoms of the plague include fever of 38–41 °C (100–106 °F) , headaches, painful aching joints , nausea and vomiting, and a general feeling of malaise . Left untreated, 80% of victims die within eight days. Contemporary accounts of the pandemic are varied and often imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos ) in the groin, neck and armpits, which oozed pus and bled when opened. Boccaccio 's description: In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg ... From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. [lower-alpha 5] This was followed by acute fever and vomiting of blood . Most people died two to seven days after initial infection. Freckle-like spots and rashes, which may have been caused by flea-bites , were identified as another potential sign of plague.Lodewijk Heyligen , whose master Cardinal Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague , that infected the lungs and led to respiratory problems. Symptoms include fever, cough and blood-tinged sputum . As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90–95%. Septicemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches ( purpura due to disseminated intravascular coagulation ). In cases of pneumonic and particularly septicemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes. There are no exact figures for the death toll; the rate varied widely by locality. Urban centers with higher populations suffered longer periods of abnormal mortality. Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia. [ better source needed ] A study published in 2022 of pollen samples across Europe from 1250 to 1450 was used to estimate changes in agricultural output before and after the Black Death. The authors found great variability in different regions, with evidence for high mortality in areas of Scandinavia, France, western Germany, Greece and central Italy, but uninterrupted agricultural growth in central and eastern Europe, Iberia and Ireland. The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere." The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert S. Gottfried writes that as early as 1351, "agents for Pope Clement VI calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the Book of Revelation , a favorite medieval source of information." Ole J. Benedictow proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century. [lower-alpha 6] According to medieval historian Philip Daileader , it is likely that over four years, 45–50% of the European population died of plague. [lower-alpha 7] The mortality rate of the Black Death in the 14th century was far greater than the worst 20th-century outbreaks of Y. pestis plague, which occurred in India and killed as much as 3% of the population of certain cities. The overwhelming number of deceased bodies produced by the Black Death caused the necessity of mass burial sites in Europe, sometimes including up to several hundred or several thousand skeletons. The mass burial sites that have been excavated have allowed archaeologists to continue interpreting and defining the biological, sociological, historical and anthropological implications of the Black Death. In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die. Half of Paris' population of 100,000 people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished, and a similar percentage of Londoners may have died from the disease as well, leaving a death toll of approximately 62,000 between 1346 and 1353. [lower-alpha 8] Florence's tax records suggest that 80% of the city's population died within four months in 1348. Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450. The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion . Plague did not appear in Flanders until the turn of the 15th century, and the impact was less severe on the populations of Hainaut , Finland , northern Germany and areas of Poland. Monks, nuns and priests were especially hard-hit since they cared for people ill with the plague. In 1382 the physician to the Avignon Papacy , Raimundo Chalmel de Vinario ( Latin : Magister Raimundus , lit. ' Master Raymond ' ), observed the decreasing mortality rate of successive outbreaks of plague in 1347–1348, 1362, 1371 and 1382 in his treatise On Epidemics ( De epidemica ). In the first outbreak, two thirds of the population contracted the illness and most patients died; in the next, half the population became ill but only some died; by the third, a tenth were affected and many survived; while by the fourth occurrence, only one in twenty people were sickened and most of them survived. By the 1380s in Europe, the plague predominantly affected children. Chalmel de Vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the Roman Curia , whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he was never able to effect a cure. The populations of some Italian cities, notably Florence , did not regain their pre-14th century size until the 19th century. The most widely accepted estimate for the Middle East, including Iraq, Iran and Syria, during this time, is for a death toll of about a third of the population. The Black Death killed about 40% of Egypt's population. In Cairo, with a population numbering as many as 600,000, and possibly the largest city west of China, between one third and 40% of the inhabitants died within eight months. By the 18th century, the population of Cairo was halved from its numbers in 1347. Italian chronicler Agnolo di Tura recorded his experience from Siena , where plague arrived in May 1348: Father abandoned child, wife husband, one brother another; for this illness seemed to strike through the breath and sight. And so they died. And none could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices ... great pits were dug and piled deep with the multitude of dead. And they died by the hundreds both day and night ... And as soon as those ditches were filled more were dug ... And I, Agnolo di Tura ... buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who wept for any death, for all awaited death. And so many died that all believed it was the end of the world. It has been suggested that the Black Plague, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens. But along with population decline from the pandemic, wages soared in response to a subsequent labor shortage. Many laborers, artisans and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation. Landowners were also pushed to substitute monetary rents for labor services in an effort to keep tenants. The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse. A study performed by Thomas Van Hoof of the Utrecht University suggests that the innumerable deaths brought on by the pandemic cooled the climate by freeing up land and triggering reforestation . This may have led to the Little Ice Age . Renewed religious fervor and fanaticism increased in the wake of the Black Death. Some Europeans targeted "various groups such as Jews , friars , foreigners, beggars, pilgrims ", lepers and Romani , blaming them for the crisis. Lepers , and others with skin diseases such as acne or psoriasis , were killed throughout Europe. Because 14th-century healers and governments were at a loss to explain or stop the disease, Europeans turned to astrological forces, earthquakes and the poisoning of wells by Jews as possible reasons for outbreaks. Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning God's forgiveness . There were many attacks against Jewish communities. In the Strasbourg massacre of February 1349, about 2,000 Jews were murdered. In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. During this period many Jews relocated to Poland , where they received a welcome from King Casimir the Great . One theory that has been advanced is that the Black Death's devastation of Florence , between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the Renaissance . Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife . [lower-alpha 9] It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art. This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors, in combination with an influx of Greek scholars after the fall of the Byzantine Empire . As a result of the drastic reduction in the populace the value of the working class increased, and commoners came to enjoy more freedom. To answer the increased need for labor, workers travelled in search of the most favorable position economically. [ better source needed ] Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of fiefs and city-states frequently managed by the Catholic Church. The pandemic completely restructured both religion and political forces; survivors began to turn to other forms of spirituality and the power dynamics of the fiefs and city-states crumbled. The survivors of the pandemic found not only that the prices of food were lower but also that lands were more abundant, and many of them inherited property from their dead relatives, and this probably contributed to the destabilization of feudalism . The word " quarantine " has its roots in this period, though the practice of isolating people to prevent the spread of disease is older. In the city-state of Ragusa (modern Dubrovnik , Croatia), a thirty-day isolation period was implemented in 1377 for new arrivals to the city from plague-affected areas. The isolation period was later extended to forty days, and given the name "quarantino" from the Italian word for "forty". There are no exact figures for the death toll; the rate varied widely by locality. Urban centers with higher populations suffered longer periods of abnormal mortality. Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia. [ better source needed ] A study published in 2022 of pollen samples across Europe from 1250 to 1450 was used to estimate changes in agricultural output before and after the Black Death. The authors found great variability in different regions, with evidence for high mortality in areas of Scandinavia, France, western Germany, Greece and central Italy, but uninterrupted agricultural growth in central and eastern Europe, Iberia and Ireland. The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere." The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert S. Gottfried writes that as early as 1351, "agents for Pope Clement VI calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the Book of Revelation , a favorite medieval source of information." Ole J. Benedictow proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century. [lower-alpha 6] According to medieval historian Philip Daileader , it is likely that over four years, 45–50% of the European population died of plague. [lower-alpha 7] The mortality rate of the Black Death in the 14th century was far greater than the worst 20th-century outbreaks of Y. pestis plague, which occurred in India and killed as much as 3% of the population of certain cities. The overwhelming number of deceased bodies produced by the Black Death caused the necessity of mass burial sites in Europe, sometimes including up to several hundred or several thousand skeletons. The mass burial sites that have been excavated have allowed archaeologists to continue interpreting and defining the biological, sociological, historical and anthropological implications of the Black Death. In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die. Half of Paris' population of 100,000 people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished, and a similar percentage of Londoners may have died from the disease as well, leaving a death toll of approximately 62,000 between 1346 and 1353. [lower-alpha 8] Florence's tax records suggest that 80% of the city's population died within four months in 1348. Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450. The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion . Plague did not appear in Flanders until the turn of the 15th century, and the impact was less severe on the populations of Hainaut , Finland , northern Germany and areas of Poland. Monks, nuns and priests were especially hard-hit since they cared for people ill with the plague. In 1382 the physician to the Avignon Papacy , Raimundo Chalmel de Vinario ( Latin : Magister Raimundus , lit. ' Master Raymond ' ), observed the decreasing mortality rate of successive outbreaks of plague in 1347–1348, 1362, 1371 and 1382 in his treatise On Epidemics ( De epidemica ). In the first outbreak, two thirds of the population contracted the illness and most patients died; in the next, half the population became ill but only some died; by the third, a tenth were affected and many survived; while by the fourth occurrence, only one in twenty people were sickened and most of them survived. By the 1380s in Europe, the plague predominantly affected children. Chalmel de Vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the Roman Curia , whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he was never able to effect a cure. The populations of some Italian cities, notably Florence , did not regain their pre-14th century size until the 19th century. The most widely accepted estimate for the Middle East, including Iraq, Iran and Syria, during this time, is for a death toll of about a third of the population. The Black Death killed about 40% of Egypt's population. In Cairo, with a population numbering as many as 600,000, and possibly the largest city west of China, between one third and 40% of the inhabitants died within eight months. By the 18th century, the population of Cairo was halved from its numbers in 1347. Italian chronicler Agnolo di Tura recorded his experience from Siena , where plague arrived in May 1348: Father abandoned child, wife husband, one brother another; for this illness seemed to strike through the breath and sight. And so they died. And none could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices ... great pits were dug and piled deep with the multitude of dead. And they died by the hundreds both day and night ... And as soon as those ditches were filled more were dug ... And I, Agnolo di Tura ... buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who wept for any death, for all awaited death. And so many died that all believed it was the end of the world. It has been suggested that the Black Plague, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens. But along with population decline from the pandemic, wages soared in response to a subsequent labor shortage. Many laborers, artisans and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation. Landowners were also pushed to substitute monetary rents for labor services in an effort to keep tenants. The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse. A study performed by Thomas Van Hoof of the Utrecht University suggests that the innumerable deaths brought on by the pandemic cooled the climate by freeing up land and triggering reforestation . This may have led to the Little Ice Age . Renewed religious fervor and fanaticism increased in the wake of the Black Death. Some Europeans targeted "various groups such as Jews , friars , foreigners, beggars, pilgrims ", lepers and Romani , blaming them for the crisis. Lepers , and others with skin diseases such as acne or psoriasis , were killed throughout Europe. Because 14th-century healers and governments were at a loss to explain or stop the disease, Europeans turned to astrological forces, earthquakes and the poisoning of wells by Jews as possible reasons for outbreaks. Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning God's forgiveness . There were many attacks against Jewish communities. In the Strasbourg massacre of February 1349, about 2,000 Jews were murdered. In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. During this period many Jews relocated to Poland , where they received a welcome from King Casimir the Great . One theory that has been advanced is that the Black Death's devastation of Florence , between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the Renaissance . Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife . [lower-alpha 9] It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art. This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors, in combination with an influx of Greek scholars after the fall of the Byzantine Empire . As a result of the drastic reduction in the populace the value of the working class increased, and commoners came to enjoy more freedom. To answer the increased need for labor, workers travelled in search of the most favorable position economically. [ better source needed ] Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of fiefs and city-states frequently managed by the Catholic Church. The pandemic completely restructured both religion and political forces; survivors began to turn to other forms of spirituality and the power dynamics of the fiefs and city-states crumbled. The survivors of the pandemic found not only that the prices of food were lower but also that lands were more abundant, and many of them inherited property from their dead relatives, and this probably contributed to the destabilization of feudalism . The word " quarantine " has its roots in this period, though the practice of isolating people to prevent the spread of disease is older. In the city-state of Ragusa (modern Dubrovnik , Croatia), a thirty-day isolation period was implemented in 1377 for new arrivals to the city from plague-affected areas. The isolation period was later extended to forty days, and given the name "quarantino" from the Italian word for "forty". The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to Jean-Noël Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671 (although some researchers have cautions about the uncritical use of Biraben's data). The second pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667. Subsequent outbreaks, though severe, marked the plague's retreat from most of Europe (18th century) and northern Africa (19th century). Historian George Sussman argued that the plague had not occurred in East Africa until the 1900s. However, other sources suggest that the Second pandemic did indeed reach Sub-Saharan Africa. According to historian Geoffrey Parker , "France alone lost almost a million people to the plague in the epidemic of 1628–31." In the first half of the 17th century, a plague killed some 1.7 million people in Italy. More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain . The Black Death ravaged much of the Islamic world . Plague could be found in the Islamic world almost every year between 1500 and 1850. Sometimes the outbreaks affected small areas, while other outbreaks affected multiple regions. Plague repeatedly struck the cities of North Africa. Algiers lost 30,000–50,000 inhabitants to it in 1620–21, and again in 1654–57, 1665, 1691 and 1740–42. Cairo suffered more than fifty plague epidemics within 150 years from the plague's first appearance, with the final outbreak of the second pandemic there in the 1840s. Plague remained a major event in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, thirty-seven larger and smaller epidemics were recorded in Constantinople , and an additional thirty-one between 1751 and 1800. Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population had died. The third plague pandemic (1855–1859) started in China in the mid-19th century, spreading to all inhabited continents and killing 10 million people in India alone. The investigation of the pathogen that caused the 19th-century plague was begun by teams of scientists who visited Hong Kong in 1894, among whom was the French-Swiss bacteriologist Alexandre Yersin , for whom the pathogen was named. Twelve plague outbreaks in Australia between 1900 and 1925 resulted in over 1,000 deaths, chiefly in Sydney. This led to the establishment of a Public Health Department there which undertook some leading-edge research on plague transmission from rat fleas to humans via the bacillus Yersinia pestis . The first North American plague epidemic was the San Francisco plague of 1900–1904 , followed by another outbreak in 1907–1908. Modern treatment methods include insecticides , the use of antibiotics , and a plague vaccine . It is feared that the plague bacterium could develop drug resistance and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995. Another outbreak in Madagascar was reported in November 2014. In October 2017, the deadliest outbreak of the plague in modern times hit Madagascar, killing 170 people and infecting thousands. An estimate of the case fatality rate for the modern plague , after the introduction of antibiotics , is 11%, although it may be higher in underdeveloped regions. The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to Jean-Noël Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671 (although some researchers have cautions about the uncritical use of Biraben's data). The second pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667. Subsequent outbreaks, though severe, marked the plague's retreat from most of Europe (18th century) and northern Africa (19th century). Historian George Sussman argued that the plague had not occurred in East Africa until the 1900s. However, other sources suggest that the Second pandemic did indeed reach Sub-Saharan Africa. According to historian Geoffrey Parker , "France alone lost almost a million people to the plague in the epidemic of 1628–31." In the first half of the 17th century, a plague killed some 1.7 million people in Italy. More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain . The Black Death ravaged much of the Islamic world . Plague could be found in the Islamic world almost every year between 1500 and 1850. Sometimes the outbreaks affected small areas, while other outbreaks affected multiple regions. Plague repeatedly struck the cities of North Africa. Algiers lost 30,000–50,000 inhabitants to it in 1620–21, and again in 1654–57, 1665, 1691 and 1740–42. Cairo suffered more than fifty plague epidemics within 150 years from the plague's first appearance, with the final outbreak of the second pandemic there in the 1840s. Plague remained a major event in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, thirty-seven larger and smaller epidemics were recorded in Constantinople , and an additional thirty-one between 1751 and 1800. Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population had died. The third plague pandemic (1855–1859) started in China in the mid-19th century, spreading to all inhabited continents and killing 10 million people in India alone. The investigation of the pathogen that caused the 19th-century plague was begun by teams of scientists who visited Hong Kong in 1894, among whom was the French-Swiss bacteriologist Alexandre Yersin , for whom the pathogen was named. Twelve plague outbreaks in Australia between 1900 and 1925 resulted in over 1,000 deaths, chiefly in Sydney. This led to the establishment of a Public Health Department there which undertook some leading-edge research on plague transmission from rat fleas to humans via the bacillus Yersinia pestis . The first North American plague epidemic was the San Francisco plague of 1900–1904 , followed by another outbreak in 1907–1908. Modern treatment methods include insecticides , the use of antibiotics , and a plague vaccine . It is feared that the plague bacterium could develop drug resistance and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995. Another outbreak in Madagascar was reported in November 2014. In October 2017, the deadliest outbreak of the plague in modern times hit Madagascar, killing 170 people and infecting thousands. An estimate of the case fatality rate for the modern plague , after the introduction of antibiotics , is 11%, although it may be higher in underdeveloped regions.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Manchurian_plague/html

Manchurian plague

The Manchurian plague was a pneumonic plague that occurred mainly in Manchuria in 1910–1911. It killed 60,000 people, stimulating a multinational medical response and the wearing of the first personal protective equipment (PPE).The plague is thought to have originated from a tarbagan marmot infected with bacterial pneumonia. Tarbagan marmots were hunted for their fur in Manchuria. It was an airborne spread disease and was incredibly deadly, with a near 100 percent mortality rate. Its spread was magnified by marmot hunters gathering in the bitter winter months, and the eventual travel of migrant workers during the Chinese New Year . Russia and Japan both had economic interests in the region and needed to cooperate with Chinese authorities. The Cambridge -trained doctor Wu Lien-teh led Chinese efforts to end the plague, and promoted quarantine and the wearing of cloth face masks . He also convened the International Plague Conference in Mukden in April 1911, the first major event of its kind that brought together an international team of scientists concerned with disease control. The Chinese government also sought the support of foreign doctors, a number of whom died as a consequence of the disease. In Harbin, this included the Frenchman Gérald Mesny, from the Imperial Medical College in Tientsin, who disputed Wu's recommendation of masks; a few days later, he died after catching the plague when visiting patients without wearing a mask. Another was the 26-year-old Arthur F. Jackson, a United Free Church of Scotland missionary doctor , who fell ill within eight days of inspecting and quarantining hundreds of poor laborers; he died two days later in Mukden. In the end, the death toll reached some 60,000 lives. The hardest hit cities included Changchun , Harbin , and Mukden. Although the disease was largely confined to Manchuria, cases were found elsewhere in cities such as Beijing and Tianjin . The Manchurian plague is believed to have highlighted the importance of a multinational medical response, setting precedents for organizations such as the World Health Organization . Wu Lien-teh's widespread promotion of cloth plague mask -wearing by doctors, nurses, patients, contacts, and (to the degree that it was possible) the population at large was the first time such an epidemic containment measure had been attempted. The event was also influential in establishing the use of personal protective equipment to stop the spread of disease, and is credited for the origins of the modern hazmat suit . Parallels have also been made between the management and control of the Manchurian plague and other outbreaks of infectious disease such as the Ebola epidemic in West Africa (2013–2016) and COVID-19 pandemic (2019–present) .

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Septicemic_plague/html

Septicemic plague

Septicemic plague is one of the three forms of plague , and is caused by Yersinia pestis , a gram-negative species of bacterium . Septicemic plague is a systemic disease involving infection of the blood and is most commonly spread by bites from infected fleas. Septicemic plague can cause disseminated intravascular coagulation and is always fatal when untreated. The other varieties of the plague are bubonic plague and pneumonic plague . The usual symptoms are: Abdominal pain Bleeding under the skin due to blood clotting problems Bleeding from mouth, nose or rectum Gastrointestinal symptoms, including nausea, vomiting, which can be with blood , and diarrhea Fever Chills Low blood pressure Organ failure Shock Death of tissue ( gangrene ) in extremities, mostly fingers, nose, and toes Difficulty breathing Death These symptoms are common to many human illnesses and are not considered, in and of themselves, to signify infection with any form of plague. [ citation needed ] It is important to note that septicemic plague may be asymptomatic and may cause death absent of any symptoms. [ citation needed ]Human Yersinia infections most commonly result from the bite of an infected flea or occasionally an infected mammal, but like most bacterial systemic diseases , the disease may be transmitted through an opening in the skin or by inhaling infectious droplets of moisture from sneezes or coughs. In both cases septicemic plague need not be the result, and in particular, not the initial result, but it occasionally happens that bubonic plague for example leads to infection of the blood, and septicemic plague results. If the bacteria happen to enter the bloodstream rather than the lymph or lungs, they multiply in the blood, causing bacteremia and severe sepsis . In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), where tiny blood clots form throughout the body, commonly resulting in localised ischemic necrosis , tissue death from lack of circulation and perfusion . [ citation needed ] DIC results in depletion of the body's clotting resources, so that it can no longer control bleeding. Consequently, the unclotted blood bleeds into the skin and other organs, leading to a red or black patchy rash and to hematemesis (vomiting blood) or hemoptysis (coughing up blood). The rash may cause bumps on the skin that look somewhat like insect bites, usually red, sometimes white in the centre. [ citation needed ] Septicemic plague is caused by horizontal and direct transmission. Horizontal transmission is the transmitting of a disease from one individual to another regardless of blood relation. Direct transmission occurs from close physical contact with individuals, through common air usage, or from direct bite from a flea or an infected rodent. Most common rodents may carry the bacteria and so may Leporidae such as rabbits. The bacteria are cosmopolitan, mainly in rodents on all continents except Australia and Antarctica. The greatest frequency of human plague infections occurs in Africa. The bacteria most commonly appear in rural areas and wherever there is poor sanitation, overcrowding, and high rodent populations in urban areas. Outdoor activities such as hiking, camping, or hunting where plague-infected animals may be found, increase the risk of contracting septicemic plague, and so do certain occupations such as veterinary or other animal-related work. Human Yersinia infections most commonly result from the bite of an infected flea or occasionally an infected mammal, but like most bacterial systemic diseases , the disease may be transmitted through an opening in the skin or by inhaling infectious droplets of moisture from sneezes or coughs. In both cases septicemic plague need not be the result, and in particular, not the initial result, but it occasionally happens that bubonic plague for example leads to infection of the blood, and septicemic plague results. If the bacteria happen to enter the bloodstream rather than the lymph or lungs, they multiply in the blood, causing bacteremia and severe sepsis . In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), where tiny blood clots form throughout the body, commonly resulting in localised ischemic necrosis , tissue death from lack of circulation and perfusion . [ citation needed ] DIC results in depletion of the body's clotting resources, so that it can no longer control bleeding. Consequently, the unclotted blood bleeds into the skin and other organs, leading to a red or black patchy rash and to hematemesis (vomiting blood) or hemoptysis (coughing up blood). The rash may cause bumps on the skin that look somewhat like insect bites, usually red, sometimes white in the centre. [ citation needed ] Septicemic plague is caused by horizontal and direct transmission. Horizontal transmission is the transmitting of a disease from one individual to another regardless of blood relation. Direct transmission occurs from close physical contact with individuals, through common air usage, or from direct bite from a flea or an infected rodent. Most common rodents may carry the bacteria and so may Leporidae such as rabbits. The bacteria are cosmopolitan, mainly in rodents on all continents except Australia and Antarctica. The greatest frequency of human plague infections occurs in Africa. The bacteria most commonly appear in rural areas and wherever there is poor sanitation, overcrowding, and high rodent populations in urban areas. Outdoor activities such as hiking, camping, or hunting where plague-infected animals may be found, increase the risk of contracting septicemic plague, and so do certain occupations such as veterinary or other animal-related work. A doctor or veterinarian will perform a physical exam which includes asking about the medical history and possible sources of exposure. The following possible test could include: Blood samples (detecting antibodies) Culture samples of body fluids (check for the bacteria Yersinia pestis ) Kidney and liver testing Checking lymphatic system for signs of infection Examining body fluids for abnormal signs Checking for swelling Checking for signs of dehydration Checking for fever Checking for lung infection The following steps and precautions should be used to avoid infection of the septicemic plague: Caregivers of infected patients should wear masks, gloves, goggles and gowns Take antibiotics if close contact with the infected patient has occurred Use insecticides throughout the house Avoid contact with dead rodents or sick cats Set traps if mice or rats are present around the house Do not allow family pets to roam in areas where plague is common Flea control and treatment for animals (especially rodents)Starting antibiotics early is the first step in treating septicemic plague in humans. One of the following antibiotics may be used: [ citation needed ] Lymph nodes may require draining and the patient will need close monitoring. In animals, antibiotics such as tetracycline or doxycycline can be used. Intravenous drip may be used to assist in dehydration scenarios. Flea treatment can also be used. In some cases, euthanasia may be the best option for treatment and to prevent further spreading. Untreated septicemic plague is almost always fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 per cent. Death is almost inevitable if treatment is delayed more than about 24 hours, and some people may even die on the same day they present with the disease. [ citation needed ]In 2015, Taylor Gaes, a 16-year-old in Larimer County in northern Colorado, contracted septicemic plague and subsequently died after being bitten by a flea that had bitten a rodent on his family's rural property. Only three people in Colorado had contracted the bacteria in the previous thirty years. The septicemic plague was the least common of the three plague varieties that occurred during the Black Death from 1348 to 1350 (the other two being bubonic plague and pneumonic plague ). Like the others, septicemic plague spread from East Asia through trade routes on the Black Sea and down to the Mediterranean Sea . [ citation needed ] Major port cities and trade centres such as Venice and Florence were hit the hardest. The massive loss of the working population in Europe following the Black Death, resulting in the increased economic bargaining power of the serf labour force, was a major precipitating factor for the Peasants' Revolt of 1381. [ citation needed ]Septicemic plague is a zoonosis , a disease that generally is acquired by humans from animals, such as rodents and carnivores. Goats, sheep and camels also may carry the bacteria. Cats rarely develop clinical signs but can be infected. Areas west of the Great Plains of North America are one region where plague-infected animals commonly occur. Plague-infested animals are found in many other countries as well, especially in developing countries where health controls are not effective. [ citation needed ] Animals that commonly carry plague bacteria are large rodents and Leporidae , but carnivores sometimes also become infected by their prey. Prey animals are not immune to the disease, and outbreaks of various strains of plague, such as sylvatic plague , have on occasion devastated populations of black-tailed prairie dogs and black-footed ferrets . Plague has been active in black-tailed prairie dog populations since the 1960s. In the United States outbreaks only occur in the western States and they are devastating, with mortality rates near 100% because the animals have no immunity to the plague. Survivors are the ones that happened not to become infected and colonies that recover from a plague outbreak remain at risk. Because black-footed ferrets prey on black-tailed prairie dogs, wild ferret populations also fall victim to sylvatic plague. An outbreak can kill nearly 100% of ferrets in a population, and surviving ferrets commonly face starvation because prairie dogs are their main prey. Spray-and-vaccinate campaigns have aimed at preventing the spread of the plague among these animals. Similar septicemic problems occur in many countries across the world, especially in developing countries where spending on health systems is very low and health controls are not effective. [ citation needed ]

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Pneumonic plague

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1994 plague in India

The 1994 plague in India was an outbreak of bubonic and pneumonic plague in south-central and western India from 26 August to 18 October 1994. 693 suspected cases and 56 deaths were reported from the five affected Indian states as well as the Union Territory of Delhi . These cases were from Maharashtra (488 cases), Gujarat (77 cases), Karnataka (46 cases), Uttar Pradesh (10 cases), Madhya Pradesh (4 cases) and New Delhi (68 cases). There are no reports of cases being exported to other countries. A committee under chairmanship of Professor Vulimiri Ramalingaswami was formed by the Government of India to investigate the plague episode. In 1995, the committee submitted the report "The Plague Epidemic of 1994" to the government of India. The report concluded that the disease was plague, but did not identify the origin. Other sources identify the ultimate cause as the 1993 Latur earthquake , which caused a large number of homes to be abandoned with food grains inside. This destabilised the population of domestic and wild rats (in which the plague is endemic ), allowing transmission of the plague from wild rats to domestic rats to people. The World Health Organization collected reports of excessive rat deaths in Malma in the Beed district of Maharashtra on 5 August 1994, followed by complaints of fleas. After three weeks, WHO received reports of suspected bubonic plague in Malma, followed by other villages and districts. Flooding in Surat, which had open sewers, put the bodies of many dead rats on the street, which residents probably came into contact with. The Ganesh Chaturthi festival created crowds in the city shortly thereafter, promoting the spread of pneumonic plague , which was declared on 21 September. By the end of the outbreak, an estimated 78% of confirmed cases were in the slums of Surat. In the first week of August 1994, health officials reported unusually large numbers of deaths of domestic rats in Surat city of Gujarat state. On 21 September 1994, the Deputy Municipal Commissioner of Health (DMCH) for Surat city received a report that a patient had died seemingly due to pneumonic plague . The DMCH of Surat alerted medical officers in the area where the patient had died. Later that day, a worried caller informed DMCH about 10 deaths in Ved Road residential area and around 50 seriously ill patients admitted to the hospital. News of the plague spread through Surat city through the night of 21 September 1994. Ill-prepared, medical shops quickly exhausted stocks of tetracycline . This led to panic with people fleeing hospitals fearing infection from other sick patients. This triggered one of the biggest post- partition migration of people in India with around 300,000 people leaving Surat city in 2 days, for fear of illness or of being quarantined.Initial questions about whether it was an epidemic of plague arose because the Indian health authorities were unable to culture Yersinia pestis , but this could have been due to lack of sophisticated laboratory equipment. Yet there are several lines of evidence strongly suggesting that it was a plague epidemic: blood tests for Yersinia were positive, a number of individuals showed antibodies against Yersinia and the clinical symptoms displayed by the affected were all consistent with the disease being plague. About 6,000 cases of fever were misidentified as plague, adding to panic and confusion. Villagers in Rajasthan reportedly tried to exterminate rats, which might have led to more cases as fleas would have had to abandon rat hosts for humans. Tourism was negatively affected, flights to India were cancelled, and some planes from India were fumigated at airports. Many flights from India to the nearby Gulf region were suspended. Some countries also put a hold on the imports from India. Paramilitary forces set up checkpoints to deal with people fleeing Surat. Panic buying and government-ordered closures spread to Mumbai and Delhi. Economic damage in Surat was estimated at ₹ 816 crore (₹8.160 billion). The city implemented massive infrastructure improvements, tearing down slums, covering sewers, constructing public pay toilets, and implementing fines for littering. It also improved its plans for emergency travel advisories, and fired some corrupt officials and disciplined ineffective city workers, including street sweepers.

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Pneumonic plague

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Pneumonic

Pneumonic (not to be confused with mnemonic ) may refer to:

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Pneumonic plague

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Plague vaccine

none Plague vaccine is a vaccine used against Yersinia pestis to prevent the plague . Inactivated bacterial vaccines have been used since 1890 but are less effective against the pneumonic plague , so live, attenuated vaccines and recombinant protein vaccines have been developed to prevent the disease. The first plague vaccine was developed by bacteriologist Waldemar Haffkine in 1897. He tested the vaccine on himself to prove that the vaccine was safe. Later, Haffkine conducted a massive inoculation program in British India , and it is estimated that 26 million doses of Haffkine's anti-plague vaccine were sent out from Bombay between 1897 and 1925, reducing the plague mortality by 50%-85%. A plague vaccine is used for an induction of active specific immunity in an organism susceptible to plague by means of administrating an antigenic material (a vaccine ) via a variety of routes to people at risk of contracting any clinical form of plague. This method is known as plague immunization . There is strong evidence for the efficacy of administration of some plague vaccines in preventing or ameliorating the effects of a variety of clinical forms of infection by Yersinia pestis . Plague immunization also encompasses incurring a state of passive specific immunity to plague in a susceptible organism after administration of a plague serum or plague immunological in people with an immediate risk of developing the disease. A systematic review by the Cochrane Collaboration found no studies of sufficient quality to be included in the review, and were thus unable to make any statement on the efficacy of modern vaccines.

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List of epidemics and pandemics

This is a list of the largest known epidemics and pandemics caused by an infectious disease . Widespread non-communicable diseases such as cardiovascular disease and cancer are not included. An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time; in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Due to the long time spans, the first plague pandemic (6th century – 8th century) and the second plague pandemic (14th century – early 19th century) are shown by individual outbreaks, such as the Plague of Justinian (first pandemic) and the Black Death (second pandemic). Infectious diseases with high prevalence are listed separately (sometimes in addition to their epidemics), such as malaria , which may have killed 50–60 billion people throughout history, or about half of all humans that have ever lived. Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain. There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain.There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Events in boldface are ongoing.

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Yersinia pestis

Bacille de la peste Yersin, 1894 Bacterium pestis Lehmann & Neumann, 1896 Pasteurella pestis (Lehmann & Neumann, 1896) The Netherlands, 1920 Yersinia pestis ( Y. pestis ; formerly Pasteurella pestis ) is a gram-negative , non-motile , coccobacillus bacterium without spores that is related to both Yersinia enterocolitica and Yersinia pseudotuberculosis , the pathogen from which Y. pestis evolved and responsible for the Far East scarlet-like fever . It is a facultative anaerobic organism that can infect humans via the Oriental rat flea ( Xenopsylla cheopis ). It causes the disease plague , which caused the Plague of Justinian and the Black Death , the deadliest pandemic in recorded history. Plague takes three main forms: pneumonic , septicemic , and bubonic . Yersinia pestis is a parasite of its host, the rat flea , which is also a parasite of rats, hence Y. pestis is a hyperparasite . Y. pestis was discovered in 1894 by Alexandre Yersin , a Swiss/French physician and bacteriologist from the Pasteur Institute , during an epidemic of the plague in Hong Kong . Yersin was a member of the Pasteur school of thought. Kitasato Shibasaburō , a Japanese bacteriologist who practised Koch's methodology , was also engaged at the time in finding the causative agent of the plague. However, Yersin actually linked plague with a bacillus, initially named Pasteurella pestis ; it was renamed Yersinia pestis in 1944. Every year, between one thousand and two thousand cases of the plague are still reported to the World Health Organization . With proper antibiotic treatment, the prognosis for victims is much better than before antibiotics were developed. A five- to six-fold increase in cases occurred in Asia during the time of the Vietnam War , possibly due to the disruption of ecosystems and closer proximity between people and animals. The plague is now commonly found in sub-Saharan Africa and Madagascar, areas that now account for over 95% of reported cases. The plague also has a detrimental effect on non-human mammals; in the United States, these include the black-tailed prairie dog and the endangered black-footed ferret .Y. pestis is a non-motile coccobacillus , a facultative anaerobic bacterium with bipolar staining (giving it a safety pin appearance) that produces an antiphagocytic slime layer. Similar to other Yersinia species, it tests negative for urease , lactose fermentation, and indole . Its closest relatives are the gastrointestinal pathogen Yersinia pseudotuberculosis , and, more distantly, Yersinia enterocolitica . [ citation needed ]Several complete genome sequences are available for various strains and subspecies of Y. pestis : strain KIM (of biovar Y. p. medievalis ), and strain CO92 (of biovar Y. p. orientalis , obtained from a clinical isolate in the United States). In 2006 the genome sequence of a strain of biovar Antiqua was completed. Some strains are non-pathogenic, such as that of strain 91001 , whose sequence was published in 2004. Like Y. pseudotuberculosis and Y. enterocolitica , Y. pestis is host to the plasmid pCD1. It also hosts two other plasmids, pPCP1 (also called pPla or pPst) and pMT1 (also called pFra) that are not carried by the other Yersinia species. pFra codes for a phospholipase D that is important for the ability of Y. pestis to be transmitted by fleas. pPla codes for a protease , Pla, that activates plasmin in human hosts and is a very important virulence factor for pneumonic plague. Together, these plasmids, and a pathogenicity island called HPI, encode several proteins that cause the pathogenesis for which Y. pestis is famous. Among other things, these virulence factors are required for bacterial adhesion and injection of proteins into the host cell, invasion of bacteria in the host cell (via a type-III secretion system ), and acquisition and binding of iron harvested from red blood cells (by siderophores ). Y. pestis is thought to be descended from Y. pseudotuberculosis , differing only in the presence of specific virulence plasmids. [ citation needed ] A comprehensive and comparative proteomics analysis of Y. pestis strain KIM was performed in 2006. The analysis focused on the transition to a growth condition mimicking growth in host cells. [ citation needed ] Numerous bacterial small noncoding RNAs have been identified to play regulatory functions. Some can regulate the virulence genes. Some 63 novel putative sRNAs were identified through deep sequencing of the Y. pestis sRNA-ome. Among them was Yersinia -specific (also present in Y. pseudotuberculosis and Y. enterocolitica ) Ysr141 ( Yersinia small RNA 141). Ysr141 sRNA was shown to regulate the synthesis of the type III secretion system (T3SS) effector protein YopJ. The Yop-Ysc T3SS is a critical component of virulence for Yersinia species. Many novel sRNAs were identified from Y. pestis grown in vitro and in the infected lungs of mice suggesting they play role in bacterial physiology or pathogenesis. Among them sR035 predicted to pair with SD region and transcription initiation site of a thermo-sensitive regulator ymoA, and sR084 predicted to pair with fur, ferric uptake regulator . Several complete genome sequences are available for various strains and subspecies of Y. pestis : strain KIM (of biovar Y. p. medievalis ), and strain CO92 (of biovar Y. p. orientalis , obtained from a clinical isolate in the United States). In 2006 the genome sequence of a strain of biovar Antiqua was completed. Some strains are non-pathogenic, such as that of strain 91001 , whose sequence was published in 2004. Like Y. pseudotuberculosis and Y. enterocolitica , Y. pestis is host to the plasmid pCD1. It also hosts two other plasmids, pPCP1 (also called pPla or pPst) and pMT1 (also called pFra) that are not carried by the other Yersinia species. pFra codes for a phospholipase D that is important for the ability of Y. pestis to be transmitted by fleas. pPla codes for a protease , Pla, that activates plasmin in human hosts and is a very important virulence factor for pneumonic plague. Together, these plasmids, and a pathogenicity island called HPI, encode several proteins that cause the pathogenesis for which Y. pestis is famous. Among other things, these virulence factors are required for bacterial adhesion and injection of proteins into the host cell, invasion of bacteria in the host cell (via a type-III secretion system ), and acquisition and binding of iron harvested from red blood cells (by siderophores ). Y. pestis is thought to be descended from Y. pseudotuberculosis , differing only in the presence of specific virulence plasmids. [ citation needed ]A comprehensive and comparative proteomics analysis of Y. pestis strain KIM was performed in 2006. The analysis focused on the transition to a growth condition mimicking growth in host cells. [ citation needed ]Numerous bacterial small noncoding RNAs have been identified to play regulatory functions. Some can regulate the virulence genes. Some 63 novel putative sRNAs were identified through deep sequencing of the Y. pestis sRNA-ome. Among them was Yersinia -specific (also present in Y. pseudotuberculosis and Y. enterocolitica ) Ysr141 ( Yersinia small RNA 141). Ysr141 sRNA was shown to regulate the synthesis of the type III secretion system (T3SS) effector protein YopJ. The Yop-Ysc T3SS is a critical component of virulence for Yersinia species. Many novel sRNAs were identified from Y. pestis grown in vitro and in the infected lungs of mice suggesting they play role in bacterial physiology or pathogenesis. Among them sR035 predicted to pair with SD region and transcription initiation site of a thermo-sensitive regulator ymoA, and sR084 predicted to pair with fur, ferric uptake regulator . In the urban and sylvatic (forest) cycles of Y. pestis, most of the spreading occurs between rodents and fleas. In the sylvatic cycle, the rodent is wild, but in the urban cycle, the rodent is primarily the brown rat ( Rattus norvegicus ). In addition, Y. pestis can spread from the urban environment and back. Transmission to humans is usually through the bite of infected fleas. If the disease has progressed to the pneumonic form, humans can spread the bacterium to others by coughing, vomiting, and possibly sneezing. [ citation needed ] Several species of rodents serve as the main reservoir for Y. pestis in the environment. In the steppes , the natural reservoir is believed to be principally the marmot . In the western United States, several species of rodents are thought to maintain Y. pestis . However, the expected disease dynamics have not been found in any rodent. Several species of rodents are known to have a variable resistance, which could lead to an asymptomatic carrier status. Evidence indicates fleas from other mammals have a role in human plague outbreaks. The lack of knowledge of the dynamics of plague in mammal species is also true among susceptible rodents such as the black-tailed prairie dog ( Cynomys ludovicianus ), in which plague can cause colony collapse, resulting in a massive effect on prairie food webs. However, the transmission dynamics within prairie dogs do not follow the dynamics of blocked fleas; carcasses, unblocked fleas, or another vector could possibly be important, instead. The CO92 strain was isolated from a patient who died from pneumonia and who contracted the infection from an infected cat. In other regions of the world, the reservoir of the infection is not clearly identified, which complicates prevention and early-warning programs. One such example was seen in a 2003 outbreak in Algeria . The transmission of Y. pestis by fleas is well characterized. Initial acquisition of Y. pestis by the vector occurs during feeding on an infected animal. Several proteins then contribute to the maintenance of the bacteria in the flea digestive tract, among them the hemin storage system and Yersinia murine toxin (Ymt). Although Ymt is highly toxic to rodents and was once thought to be produced to ensure reinfection of new hosts, it is essential for flea colonization and for the survival of Y. pestis in fleas. The hemin storage system plays an important role in the transmission of Y. pestis back to a mammalian host. While in the insect vector, proteins encoded by hemin storage system genetic loci induce biofilm formation in the proventriculus , a valve connecting the midgut to the esophagus . The presence of this biofilm seems likely to be required for stable infection of the flea. Aggregation in the biofilm inhibits feeding, as a mass of clotted blood and bacteria forms (referred to as "Bacot's block" after entomologist A.W. Bacot , the first to describe this phenomenon). Transmission of Y. pestis occurs during the futile attempts of the flea to feed. Ingested blood is pumped into the esophagus, where it dislodges bacteria lodged in the proventriculus, which is regurgitated back into the host circulatory system. Pathogenesis due to Y. pestis infection of mammalian hosts is due to several factors, including an ability of these bacteria to suppress and avoid normal immune system responses such as phagocytosis and antibody production. Flea bites allow for the bacteria to pass the skin barrier. Y. pestis expresses a plasmin activator that is an important virulence factor for pneumonic plague and that might degrade on blood clots to facilitate systematic invasion. Many of the bacteria's virulence factors are antiphagocytic in nature. Two important antiphagocytic antigens , named F1 (fraction 1) and V or LcrV , are both important for virulence . These antigens are produced by the bacterium at normal human body temperature. Furthermore, Y. pestis survives and produces F1 and V antigens while it is residing within white blood cells such as monocytes , but not in neutrophils . Natural or induced immunity is achieved by the production of specific opsonic antibodies against F1 and V antigens; antibodies against F1 and V induce phagocytosis by neutrophils. In addition, the type-III secretion system (T3SS) allows Y. pestis to inject proteins into macrophages and other immune cells. These T3SS-injected proteins, called Yersinia outer proteins (Yops), include Yop B/D, which form pores in the host cell membrane and have been linked to cytolysis . The YopO, YopH , YopM, YopT, YopJ, and YopE are injected into the cytoplasm of host cells by T3SS into the pore created in part by YopB and YopD. The injected Yops limit phagocytosis and cell signaling pathways important in the innate immune system , as discussed below. In addition, some Y. pestis strains are capable of interfering with immune signaling (e.g., by preventing the release of some cytokines ). [ citation needed ] Y. pestis proliferates inside lymph nodes , where it is able to avoid destruction by cells of the immune system such as macrophages . The ability of Y. pestis to inhibit phagocytosis allows it to grow in lymph nodes and cause lymphadenopathy . YopH is a protein tyrosine phosphatase that contributes to the ability of Y. pestis to evade immune system cells. In macrophages, YopH has been shown to dephosphorylate p130Cas , Fyb ( FYN binding protein) SKAP-HOM and Pyk , a tyrosine kinase homologous to FAK . YopH also binds the p85 subunit of phosphoinositide 3-kinase , the Gab1 , the Gab2 adapter proteins, and the Vav guanine nucleotide exchange factor . [ citation needed ] YopE functions as a GTPase-activating protein for members of the Rho family of GTPases such as RAC1 . YopT is a cysteine protease that inhibits RhoA by removing the isoprenyl group , which is important for localizing the protein to the cell membrane . YopE and YopT has been proposed to function to limit YopB/D-induced cytolysis. This might limit the function of YopB/D to create the pores used for Yop insertion into host cells and prevent YopB/D-induced rupture of host cells and release of cell contents that would attract and stimulate immune system responses. [ citation needed ] YopJ is an acetyltransferase that binds to a conserved α-helix of MAPK kinases . YopJ acetylates MAPK kinases at serines and threonines that are normally phosphorylated during activation of the MAP kinase cascade . YopJ is activated in eukaryotic cells by interaction with target cell phytic acid (IP6). This disruption of host cell protein kinase activity causes apoptosis of macrophages, and this is proposed to be important for the establishment of infection and for evasion of the host immune response. YopO is a protein kinase also known as Yersinia protein kinase A (YpkA). YopO is a potent inducer of human macrophage apoptosis. It has also been suggested that a bacteriophage – Ypφ – may have been responsible for increasing the virulence of this organism. Depending on which form of the plague infects the individual, the plague develops a different illness; however, the plague overall affects the host cell's ability to communicate with the immune system, hindering the body bringing phagocytic cells to the area of infection. Y. pestis is a versatile killer. In addition to rodents and humans, it is known to have killed camels, chickens, and pigs. Domestic dogs and cats are susceptible to plague, as well, but cats are more likely to develop illness when infected. In either, the symptoms are similar to those experienced by humans, and can be deadly to the animal. People can be exposed by coming into contact with an infected animal (dead or alive), or inhaling infectious droplets that a sick dog or cat has coughed into the air. A formalin -inactivated vaccine was available in the United States for adults in 1993 at high risk of contracting the plague until removal from the market by the Food and Drug Administration . It was of limited effectiveness and could cause severe inflammation . Experiments with genetic engineering of a vaccine based on F1 and V antigens are underway and show promise. However, bacteria lacking antigen F1 are still virulent, and the V antigens are sufficiently variable such that vaccines composed of these antigens may not be fully protective. The United States Army Medical Research Institute of Infectious Diseases has found that an experimental F1/V antigen-based vaccine protects crab-eating macaques , but fails to protect African green monkey species . A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine. Several species of rodents serve as the main reservoir for Y. pestis in the environment. In the steppes , the natural reservoir is believed to be principally the marmot . In the western United States, several species of rodents are thought to maintain Y. pestis . However, the expected disease dynamics have not been found in any rodent. Several species of rodents are known to have a variable resistance, which could lead to an asymptomatic carrier status. Evidence indicates fleas from other mammals have a role in human plague outbreaks. The lack of knowledge of the dynamics of plague in mammal species is also true among susceptible rodents such as the black-tailed prairie dog ( Cynomys ludovicianus ), in which plague can cause colony collapse, resulting in a massive effect on prairie food webs. However, the transmission dynamics within prairie dogs do not follow the dynamics of blocked fleas; carcasses, unblocked fleas, or another vector could possibly be important, instead. The CO92 strain was isolated from a patient who died from pneumonia and who contracted the infection from an infected cat. In other regions of the world, the reservoir of the infection is not clearly identified, which complicates prevention and early-warning programs. One such example was seen in a 2003 outbreak in Algeria . The transmission of Y. pestis by fleas is well characterized. Initial acquisition of Y. pestis by the vector occurs during feeding on an infected animal. Several proteins then contribute to the maintenance of the bacteria in the flea digestive tract, among them the hemin storage system and Yersinia murine toxin (Ymt). Although Ymt is highly toxic to rodents and was once thought to be produced to ensure reinfection of new hosts, it is essential for flea colonization and for the survival of Y. pestis in fleas. The hemin storage system plays an important role in the transmission of Y. pestis back to a mammalian host. While in the insect vector, proteins encoded by hemin storage system genetic loci induce biofilm formation in the proventriculus , a valve connecting the midgut to the esophagus . The presence of this biofilm seems likely to be required for stable infection of the flea. Aggregation in the biofilm inhibits feeding, as a mass of clotted blood and bacteria forms (referred to as "Bacot's block" after entomologist A.W. Bacot , the first to describe this phenomenon). Transmission of Y. pestis occurs during the futile attempts of the flea to feed. Ingested blood is pumped into the esophagus, where it dislodges bacteria lodged in the proventriculus, which is regurgitated back into the host circulatory system. Pathogenesis due to Y. pestis infection of mammalian hosts is due to several factors, including an ability of these bacteria to suppress and avoid normal immune system responses such as phagocytosis and antibody production. Flea bites allow for the bacteria to pass the skin barrier. Y. pestis expresses a plasmin activator that is an important virulence factor for pneumonic plague and that might degrade on blood clots to facilitate systematic invasion. Many of the bacteria's virulence factors are antiphagocytic in nature. Two important antiphagocytic antigens , named F1 (fraction 1) and V or LcrV , are both important for virulence . These antigens are produced by the bacterium at normal human body temperature. Furthermore, Y. pestis survives and produces F1 and V antigens while it is residing within white blood cells such as monocytes , but not in neutrophils . Natural or induced immunity is achieved by the production of specific opsonic antibodies against F1 and V antigens; antibodies against F1 and V induce phagocytosis by neutrophils. In addition, the type-III secretion system (T3SS) allows Y. pestis to inject proteins into macrophages and other immune cells. These T3SS-injected proteins, called Yersinia outer proteins (Yops), include Yop B/D, which form pores in the host cell membrane and have been linked to cytolysis . The YopO, YopH , YopM, YopT, YopJ, and YopE are injected into the cytoplasm of host cells by T3SS into the pore created in part by YopB and YopD. The injected Yops limit phagocytosis and cell signaling pathways important in the innate immune system , as discussed below. In addition, some Y. pestis strains are capable of interfering with immune signaling (e.g., by preventing the release of some cytokines ). [ citation needed ] Y. pestis proliferates inside lymph nodes , where it is able to avoid destruction by cells of the immune system such as macrophages . The ability of Y. pestis to inhibit phagocytosis allows it to grow in lymph nodes and cause lymphadenopathy . YopH is a protein tyrosine phosphatase that contributes to the ability of Y. pestis to evade immune system cells. In macrophages, YopH has been shown to dephosphorylate p130Cas , Fyb ( FYN binding protein) SKAP-HOM and Pyk , a tyrosine kinase homologous to FAK . YopH also binds the p85 subunit of phosphoinositide 3-kinase , the Gab1 , the Gab2 adapter proteins, and the Vav guanine nucleotide exchange factor . [ citation needed ] YopE functions as a GTPase-activating protein for members of the Rho family of GTPases such as RAC1 . YopT is a cysteine protease that inhibits RhoA by removing the isoprenyl group , which is important for localizing the protein to the cell membrane . YopE and YopT has been proposed to function to limit YopB/D-induced cytolysis. This might limit the function of YopB/D to create the pores used for Yop insertion into host cells and prevent YopB/D-induced rupture of host cells and release of cell contents that would attract and stimulate immune system responses. [ citation needed ] YopJ is an acetyltransferase that binds to a conserved α-helix of MAPK kinases . YopJ acetylates MAPK kinases at serines and threonines that are normally phosphorylated during activation of the MAP kinase cascade . YopJ is activated in eukaryotic cells by interaction with target cell phytic acid (IP6). This disruption of host cell protein kinase activity causes apoptosis of macrophages, and this is proposed to be important for the establishment of infection and for evasion of the host immune response. YopO is a protein kinase also known as Yersinia protein kinase A (YpkA). YopO is a potent inducer of human macrophage apoptosis. It has also been suggested that a bacteriophage – Ypφ – may have been responsible for increasing the virulence of this organism. Depending on which form of the plague infects the individual, the plague develops a different illness; however, the plague overall affects the host cell's ability to communicate with the immune system, hindering the body bringing phagocytic cells to the area of infection. Y. pestis is a versatile killer. In addition to rodents and humans, it is known to have killed camels, chickens, and pigs. Domestic dogs and cats are susceptible to plague, as well, but cats are more likely to develop illness when infected. In either, the symptoms are similar to those experienced by humans, and can be deadly to the animal. People can be exposed by coming into contact with an infected animal (dead or alive), or inhaling infectious droplets that a sick dog or cat has coughed into the air. A formalin -inactivated vaccine was available in the United States for adults in 1993 at high risk of contracting the plague until removal from the market by the Food and Drug Administration . It was of limited effectiveness and could cause severe inflammation . Experiments with genetic engineering of a vaccine based on F1 and V antigens are underway and show promise. However, bacteria lacking antigen F1 are still virulent, and the V antigens are sufficiently variable such that vaccines composed of these antigens may not be fully protective. The United States Army Medical Research Institute of Infectious Diseases has found that an experimental F1/V antigen-based vaccine protects crab-eating macaques , but fails to protect African green monkey species . A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine. In 1894, two bacteriologists, Alexandre Yersin of Switzerland and Kitasato Shibasaburō of Japan, independently isolated in Hong Kong the bacterium responsible for the 1894 Hong Kong plague . Though both investigators reported their findings, a series of confusing and contradictory statements by Kitasato eventually led to the acceptance of Yersin as the primary discoverer of the organism. Yersin named it Pasteurella pestis in honor of the Pasteur Institute , where he worked. In 1967, it was moved to a new genus and renamed Yersinia pestis in his honor. Yersin also noted that rats were affected by plague not only during plague epidemics, but also often preceding such epidemics in humans and that plague was regarded by many locals as a disease of rats; villagers in China and India asserted that when large numbers of rats were found dead, plague outbreaks soon followed. [ citation needed ] In 1898, French scientist Paul-Louis Simond (who had also come to China to battle the Third Pandemic) discovered the rat–flea vector that drives the disease. He had noted that persons who became ill did not have to be in close contact with each other to acquire the disease. In Yunnan , China, inhabitants would flee from their homes as soon as they saw dead rats, and on the island of Formosa ( Taiwan ), residents considered the handling of dead rats heightened the risks of developing plague. These observations led him to suspect that the flea might be an intermediary factor in the transmission of plague, since people acquired plague only if they were in contact with rats that had died less than 24 hours before. In a now classic experiment, Simond demonstrated how a healthy rat died of the plague after infected fleas had jumped to it from a rat that had recently died of the plague. The outbreak spread to Chinatown, San Francisco, from 1900 to 1904 and then to Oakland and the East Bay from 1907 to 1909. It has been present in the rodents of western North America ever since, as fear of the consequences of the outbreak on trade caused authorities to hide the dead of the Chinatown residents long enough for the disease to be passed to widespread species of native rodents in outlying areas. Three main strains are recognised: Y. p. antiqua , which caused a plague pandemic in the sixth century; Y. p. medievalis , which caused the Black Death and subsequent epidemics during the second pandemic wave; and Y. p. orientalis , which is responsible for current plague outbreaks. On January 15, 2018, researchers at the University of Oslo and the University of Ferrara suggested that humans and their parasites (most likely fleas and lice at the time) were the biggest carriers of the plague. In 2010, researchers in Germany definitively established, using PCR evidence from samples obtained from Black Death victims, that Y. pestis was the cause of the medieval Black Death . In 2011, the first genome of Y. pestis isolated from Black Death victims was published, and concluded that this medieval strain was ancestral to most modern forms of Y. pestis . In 2015, Cell published results from a study of ancient graves. Plasmids of Y. pestis were detected in archaeological samples of the teeth of seven Bronze Age individuals, in the Afanasievo culture in Siberia, the Corded Ware culture in Estonia, the Sintashta culture in Russia, the Unetice culture in Poland, and the Andronovo culture in Siberia. In 2018, the emergence and spread of the pathogen during the Neolithic decline (as far back as 6,000 years ago) was published. A site in Sweden was the source of the DNA evidence and trade networks were proposed as the likely avenue of spread rather than migrations of populations. There is evidence that suggests Y. pestis may have originated in Europe in the Cucuteni–Trypillia culture , not in Asia as is more commonly believed. DNA evidence published in 2015 indicates Y. pestis infected humans 5,000 years ago in Bronze Age Eurasia, but genetic changes that made it highly virulent did not occur until about 4,000 years ago. The highly virulent version capable of transmission by fleas through rodents, humans, and other mammals was found in two individuals associated with the Srubnaya culture from the Samara region in Russia from around 3,800 years ago and an Iron Age individual from Kapan , Armenia, from around 2,900 years ago. This indicates that at least two lineages of Y. pestis were circulating during the Bronze Age in Eurasia. The Y. pestis bacterium has a relatively large number of nonfunctioning genes and three "ungainly" plasmids, suggesting an origin less than 20,000 years ago. One such strain has been identified from about 4000 BP (the "LNBA lineage" (Late Neolithic and Bronze Age lineage)) in western Britain, indicating that this highly transmissible form spread from Eurasia to the far north-western edges of Europe. On September 8, 2016, the Y. pestis bacterium was identified from DNA in teeth found at a Crossrail building site in London . The human remains were found to be victims of the Great Plague of London , which lasted from 1665 to 1666. In 2021, researchers found a 5,000-year-old victim of Y. pestis , the world's oldest-known, in hunter-gatherer remains in the modern Latvian and Estonian border area. Between 1970 and 2020, 496 cases were reported in the United States. Cases have been found predominantly in New Mexico, Arizona, Colorado, California, Oregon, and Nevada. In 2008, plague was commonly found in sub-Saharan Africa and Madagascar, areas that accounted for over 95% of the reported cases. In September 2009, the death of Malcolm Casadaban , a molecular genetics professor at the University of Chicago , was linked to his work on a weakened laboratory strain of Y. pestis . Hemochromatosis was hypothesised to be a predisposing factor in Casadaban's death from this attenuated strain used for research. On November 3, 2019, two cases of pneumonic plague were diagnosed at a hospital in Beijing's Chaoyang district, prompting fears of an outbreak. The patient was a middle-aged man with fever, who had complained of difficulty breathing for some ten days, accompanied by his wife with similar symptoms. Police quarantined the emergency room at the hospital and controls were placed on Chinese news aggregators. On 18 November a third case was reported, in a 55-year-old man from Xilingol League , one of the twelve Mongolian autonomous regions in Northern China. The patient received treatment, and 28 symptomless contacts were placed in quarantine. In July 2020, officials increased precautions after a case of bubonic plague was confirmed in Bayannur , a city in China's Inner Mongolia autonomous region. The patient was quarantined and treated. According to China's Global Times , a second suspected case was also investigated, and a level 3 alert was issued, in effect until the end of the year. It forbade hunting and eating of animals that could carry plague, and called on the public to report suspected cases. In 2010, researchers in Germany definitively established, using PCR evidence from samples obtained from Black Death victims, that Y. pestis was the cause of the medieval Black Death . In 2011, the first genome of Y. pestis isolated from Black Death victims was published, and concluded that this medieval strain was ancestral to most modern forms of Y. pestis . In 2015, Cell published results from a study of ancient graves. Plasmids of Y. pestis were detected in archaeological samples of the teeth of seven Bronze Age individuals, in the Afanasievo culture in Siberia, the Corded Ware culture in Estonia, the Sintashta culture in Russia, the Unetice culture in Poland, and the Andronovo culture in Siberia. In 2018, the emergence and spread of the pathogen during the Neolithic decline (as far back as 6,000 years ago) was published. A site in Sweden was the source of the DNA evidence and trade networks were proposed as the likely avenue of spread rather than migrations of populations. There is evidence that suggests Y. pestis may have originated in Europe in the Cucuteni–Trypillia culture , not in Asia as is more commonly believed. DNA evidence published in 2015 indicates Y. pestis infected humans 5,000 years ago in Bronze Age Eurasia, but genetic changes that made it highly virulent did not occur until about 4,000 years ago. The highly virulent version capable of transmission by fleas through rodents, humans, and other mammals was found in two individuals associated with the Srubnaya culture from the Samara region in Russia from around 3,800 years ago and an Iron Age individual from Kapan , Armenia, from around 2,900 years ago. This indicates that at least two lineages of Y. pestis were circulating during the Bronze Age in Eurasia. The Y. pestis bacterium has a relatively large number of nonfunctioning genes and three "ungainly" plasmids, suggesting an origin less than 20,000 years ago. One such strain has been identified from about 4000 BP (the "LNBA lineage" (Late Neolithic and Bronze Age lineage)) in western Britain, indicating that this highly transmissible form spread from Eurasia to the far north-western edges of Europe. On September 8, 2016, the Y. pestis bacterium was identified from DNA in teeth found at a Crossrail building site in London . The human remains were found to be victims of the Great Plague of London , which lasted from 1665 to 1666. In 2021, researchers found a 5,000-year-old victim of Y. pestis , the world's oldest-known, in hunter-gatherer remains in the modern Latvian and Estonian border area. Between 1970 and 2020, 496 cases were reported in the United States. Cases have been found predominantly in New Mexico, Arizona, Colorado, California, Oregon, and Nevada. In 2008, plague was commonly found in sub-Saharan Africa and Madagascar, areas that accounted for over 95% of the reported cases. In September 2009, the death of Malcolm Casadaban , a molecular genetics professor at the University of Chicago , was linked to his work on a weakened laboratory strain of Y. pestis . Hemochromatosis was hypothesised to be a predisposing factor in Casadaban's death from this attenuated strain used for research. On November 3, 2019, two cases of pneumonic plague were diagnosed at a hospital in Beijing's Chaoyang district, prompting fears of an outbreak. The patient was a middle-aged man with fever, who had complained of difficulty breathing for some ten days, accompanied by his wife with similar symptoms. Police quarantined the emergency room at the hospital and controls were placed on Chinese news aggregators. On 18 November a third case was reported, in a 55-year-old man from Xilingol League , one of the twelve Mongolian autonomous regions in Northern China. The patient received treatment, and 28 symptomless contacts were placed in quarantine. In July 2020, officials increased precautions after a case of bubonic plague was confirmed in Bayannur , a city in China's Inner Mongolia autonomous region. The patient was quarantined and treated. According to China's Global Times , a second suspected case was also investigated, and a level 3 alert was issued, in effect until the end of the year. It forbade hunting and eating of animals that could carry plague, and called on the public to report suspected cases.

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Great Plague of London

The Great Plague of London , lasting from 1665 to 1666, was the last major epidemic of the bubonic plague to occur in England . It happened within the centuries-long Second Pandemic , a period of intermittent bubonic plague epidemics that originated in Central Asia in 1331 (the first year of the Black Death ), and included related diseases such as pneumonic plague and septicemic plague , which lasted until 1750. The Great Plague killed an estimated 100,000 people—almost a quarter of London's population—in 18 months. The plague was caused by the Yersinia pestis bacterium , which is usually transmitted to a human by the bite of a flea or louse. The 1665–66 epidemic was on a much smaller scale than the earlier Black Death pandemic . It became known afterwards as the "great" plague mainly because it was the last widespread outbreak of bubonic plague in England during the 400-year Second Pandemic. The plague was endemic in 17th-century London, as it was in other European cities at the time. The disease periodically erupted into massive epidemics. There were 30,000 deaths due to the plague in 1603, 35,000 in 1625, 10,000 in 1636, and smaller numbers in other years. In late 1664, a bright comet was seen in the sky, and the people of London became fearful, wondering what evil event it portended. London at that time was a city of about 448 acres surrounded by a city wall that had originally been built to keep out raiding bands, and, in the south, by the River Thames . There were gates in the wall at Ludgate , Newgate , Aldersgate , Cripplegate , Moorgate , Bishopsgate and Aldgate , and the Thames was crossable at London Bridge . In the poorer parts of the city, filled with overcrowded tenements and garrets, hygiene was impossible to maintain. There was no sanitation, and open drains flowed along the centre of winding streets. The cobbles were slippery with animal droppings, rubbish and the slops thrown out of the houses; they were muddy and buzzing with flies in summer, and awash with sewage in winter. The City Corporation employed "rakers" to remove the worst of the filth, and it was transported to mounds outside the walls, where it accumulated and continued to decompose. The stench was overwhelming, and people walked around with handkerchiefs or nosegays pressed against their nostrils. Some of the city's necessities, such as coal, arrived by barge , but most came by road. Carts, carriages, horses and pedestrians were crowded together, and the gateways in the wall formed bottlenecks through which it was difficult to progress. The nineteen-arch London Bridge was even more congested. Those who were better-off used hackney carriages and sedan chairs to get to their destinations without getting filthy. The poor walked, and might be drenched by water tossed up by wheeled vehicles, slops thrown into the street, or water pouring off overhanging roofs. Another hazard was the choking black smoke belching forth from soap factories, breweries , iron smelters and about 15,000 households that were burning coal to heat their homes. Outside the city walls, shanty towns with wooden shacks and no sanitation had sprung up, providing homes for the craftsmen and tradespeople who had flocked to the already overcrowded city. The government had tried to limit the development of these "suburbs", but had failed: Over a quarter of a million people lived in them. When Royalists had fled the country during the Commonwealth , they had left many fine town houses vacant, and some immigrants to London had crowded into them, converting them into tenements that housed different families in every room. These properties were soon vandalised and became rat-infested. The City of London proper was administered by the Lord Mayor, the Aldermen and the common councillors, but some parts of the greater metropolitan area were not legally part of the city. Some of these areas, both inside the City walls and outside its boundaries, had long been organised into districts of various sizes, called " liberties ", that had historically been granted rights to self-government. (Many had originally been associated with the religious institutions that were abolished in the Dissolution of the Monasteries , whereupon their historic rights and property had been transferred to secular owners.) By 1665, the walled City was surrounded by a ring of liberties which had come under its authority, and these had come to be referred to collectively as 'the City and Liberties'. However, this area was surrounded by additional suburbs with other independent administrations. For example, Westminster was an independent town with its own liberties, joined to London by urban development, and the Tower of London was an independent liberty. Areas that were not part of any of these various independent administrations came under the authority of the county of Middlesex if they were north of the river, and under the authority of Surrey if they were south of the river. At that time, bubonic plague was a much feared disease, but its cause was not understood. Many mistakenly blamed emanations from the earth, "pestilential effluvia", unusual weather, sickness in livestock, abnormal behaviour of animals or an increase in the numbers of moles, frogs, mice or flies. It was not until 1894 that its causal agent, the bacterium Yersinia pestis , was identified by Alexandre Yersin , and its transmission by rat fleas became known. Although the Great Plague in London was long assumed to be bubonic plague, caused by Yersinia pestis , this was only confirmed (by DNA analysis) in 2016. It is now believed that human body lice also played a key role in causing infections, perhaps more so than rats. In order to judge the severity of an epidemic, it is first necessary to know how big the population was in which it occurred. There was no official census of the population to provide this figure, and the best contemporary count comes from the work of John Graunt (1620–1674), who was one of the earliest Fellows of the Royal Society and one of the first demographers , bringing a scientific approach to the collection of statistics. In 1662, he estimated that 384,000 people lived in the City of London, the Liberties, Westminster and the out-parishes, based on figures in the Bills of Mortality published each week in the capital. These different districts with different administrations constituted the officially recognized extent of London as a whole. In 1665, he revised his estimate to "not above 460,000". Other contemporaries put the figure higher (the French Ambassador, for example, suggested 600,000), but with no mathematical basis to support their estimates. The next largest city in the kingdom was Norwich , with a population of 30,000. There was no duty to report a death to anyone in authority. Instead, each parish appointed two or more " searchers of the dead ", whose duty was to inspect a corpse and determine the cause of death. A searcher was entitled to charge a small fee from relatives for each death they reported, and so habitually the parish would appoint someone to the post who would otherwise be destitute and would be receiving support from the parish poor rate. Typically, this meant searchers would be old women who were illiterate, might know little about identifying diseases and who would be open to dishonesty. Searchers would typically learn about a death either from the local sexton who had been asked to dig a grave or from the tolling of a church bell. Anyone who did not report a death to their local church, such as Quakers , Anabaptists , other non-Anglican Christians or Jews , frequently did not get included in the official records. Searchers during times of plague were required to live apart from the community, avoid other people and carry a white stick to warn of their occupation when outdoors, and stay indoors except when performing their duties, to avoid spreading the diseases. Searchers reported to the Parish Clerk, who made a return each week to the Company of Parish Clerks in Brode Lane. Figures were then passed to the Lord Mayor and then to the Minister of State once plague became a matter of national concern. The reported figures were used to compile the Bills of Mortality, which listed total deaths in each parish and whether by the plague. The system of Searchers to report the cause of death continued until 1836. Graunt recorded the incompetence of the Searchers at identifying true causes of death, remarking on the frequent recording of 'consumption' rather than other diseases which were recognized then by physicians. He suggested a cup of ale and a doubling of their fee to two groats rather than one was sufficient for Searchers to change the cause of death to one more convenient for the householders. No one wished to be known as having had a death by plague in their household, and Parish Clerks, too, connived in covering up cases of plague in their official returns. Analysis of the Bills of Mortality during the months plague took hold shows a rise in deaths other than by plague well above the average death rate, a tell-tale sign of misrepresentation of the true cause of death. As plague spread, a system of quarantine was introduced, whereby any house where someone had died from plague would be locked up and no one allowed to enter or leave for 40 days. This frequently led to the deaths of the other inhabitants, by neglect if not from the plague, and provided ample incentive not to report the disease. The official returns record 68,596 cases of plague, but a reasonable estimate suggests this figure is 30,000 short of the true total. A plague house was marked with a red cross on the door with the words "Lord have mercy upon us", and a watchman stood guard outside. Reports of plague around Europe began to reach England in the 1660s, causing the Privy Council to consider what steps might be taken to prevent it crossing to England. Quarantining (isolation) of ships had been used during previous outbreaks and was again introduced for ships coming to London in November 1663, following outbreaks in Amsterdam and Hamburg . Two naval ships were assigned to intercept any vessels entering the Thames estuary. Ships from infected ports were required to moor at Hole Haven on Canvey Island for a trentine – period of 30 days – before being allowed to travel up-river. Ships from ports free of plague or completing their isolation period were given a certificate of health and allowed to travel on. A second inspection line was established between the forts on opposite banks of the Thames at Tilbury and Gravesend with instructions to pass only ships with a certificate. The isolation period was increased to forty days – a quarantine – in May 1664 as the continental plague worsened, and the areas subject to quarantine changed with the news of the spread of plague to include all of Holland , Zeeland and Friesland (all regions of the Dutch Republic ); restrictions on Hamburg were removed in November. Quarantine measures against ships coming from the Dutch Republic were put in place in 29 other ports from May, starting with Great Yarmouth . The Dutch ambassador objected at the constraint of trade with his country, but England responded that it had been one of the last countries introducing such restrictions. Regulations were enforced quite strictly, so that people or houses where voyagers had come ashore without serving their quarantine were also subjected to 40 days of quarantine. Plague was one of the hazards of life in Britain from its dramatic appearance in 1348 with the Black Death. The Bills of Mortality began to be published regularly in 1603, in which year 33,347 deaths were recorded from plague. Between then and 1665, only four years had no recorded cases. In 1563, a thousand people were reportedly dying in London each week. In 1593, there were 15,003 deaths, 1625 saw 41,313 dead, between 1640 and 1646 came 11,000 deaths, culminating in 3,597 for 1647. The 1625 outbreak was recorded at the time as the 'Great Plague', until deaths from the plague of 1665 surpassed it. These official figures are likely to under-report actual numbers. Plague was sufficiently uncommon that medical practitioners might have had no personal experience of seeing the disease; medical training varied from those who had attended the college of physicians, to apothecaries who also acted as doctors, to charlatans. Other diseases abounded, such as an outbreak of smallpox the year before, and these uncertainties all added to difficulties identifying the true start of the epidemic. Contemporary accounts suggest cases of plague occurred through the winter of 1664–65, some of which were fatal but a number of which did not display the virulence of the later epidemic. The winter was cold, the ground frozen from December to March, river traffic on the Thames twice blocked by ice, and it may be that the cold weather held back its spread. This outbreak of bubonic plague in England is thought to have spread from the Netherlands, where the disease had been occurring intermittently since 1599. It is unclear exactly where the disease first struck but the initial contagion may have arrived with Dutch trading ships carrying bales of cotton from Amsterdam , which was ravaged by the disease in 1663–64, with a mortality given of 50,000. The first areas to be struck are believed to be the dock areas just outside London, and the parish of St Giles . In both of these localities, poor workers were crowded into ill-kept structures. Two suspicious deaths were recorded in St Giles parish in 1664 and another in February 1665. These did not appear as plague deaths on the Bills of Mortality, so no control measures were taken by the authorities, but the total number of people dying in London during the first four months of 1665 showed a marked increase. By the end of April, only four plague deaths had been recorded, two in the parish of St. Giles, but total deaths per week had risen from around 290 to 398. There had been three official cases in April, a level of plague which in earlier years had not induced any official response, but the Privy Council now acted to introduce household quarantine. Justices of the Peace in Middlesex were instructed to investigate any suspected cases and to shut up the house if it was confirmed. Shortly after, a similar order was issued by the King's Bench to the City and Liberties. A riot broke out in St. Giles when the first house was sealed up; the crowd broke down the door and released the inhabitants. Rioters caught were punished severely. Instructions were given to build pest-houses, which were essentially isolation hospitals built away from other people where the sick could be cared for (or stay until they died). This official activity suggests that despite the few recorded cases, the government was already aware that this was a serious outbreak of plague. With the arrival of warmer weather, the disease began to take a firmer hold. In the week 2–9 May, there were three recorded deaths in the parish of St Giles, four in neighbouring St Clement Danes and one each in St Andrew Holborn and St Mary Woolchurch Haw . Only the last was actually inside the city walls. A Privy Council committee was formed to investigate methods to best prevent the spread of plague, and measures were introduced to close some of the ale houses in affected areas and limit the number of lodgers allowed in a household. In the city, the Lord Mayor issued a proclamation that all householders must diligently clean the streets outside their property, which was a householder's responsibility, not a state one (the city employed scavengers and rakers to remove the worst of the mess). Matters just became worse, and Aldermen were instructed to find and punish those failing their duty. As cases in St. Giles began to rise, an attempt was made to quarantine the area and constables were instructed to inspect everyone wishing to travel and contain inside vagrants or suspect persons. People began to be alarmed. Samuel Pepys , who had an important position at the Admiralty , stayed in London and provided a contemporary account of the plague through his diary. On 30 April he wrote: "Great fears of the sickness here in the City it being said that two or three houses are already shut up. God preserve us all!" Another source of information on the time is A Journal of the Plague Year , which was written by Daniel Defoe and published in 1722. He had been only five when the plague struck but made use of his family's recollections (his uncle was a saddler in East London and his father a butcher in Cripplegate ), interviews with survivors and sight of such official records as were available. The onset of the disease was recalled two years later by Puritan minister Thomas Vincent : It was in the month of May that the Plague was first taken notice of; our Bill of Mortality did let us know but of three which died of the disease in the whole year before; but in the beginning of May the bill tells us of nine...fear quickly begins to creep upon peoples hearts; great thoughts and discourse there is in Town about the Plague, and they cast in their minds whether they should go if the Plague should increase. Yet when the next weeks Bill signifieth to them the disease from nine to three their minds are something appeased; discourse of that subject cools; fears are hushed, and hopes take place, that the black cloud did but threaten, and give a few drops; but the wind would drive it away. But when in the next Bill the number of the dead by the Plague is mounted from three to fourteen, and in the next to seventeen, and in the next to forty-three, and the disease begins so much to increase, and disperse. Now secure sinners begin to be startled, and those who would have slept at quiet still in their nests, are unwillingly awakened. By July 1665, plague was rampant in the City of London. The rich ran away, including King Charles II of England , his family and his court, who left the city for Salisbury , moving on to Oxford in September when some cases of plague occurred in Salisbury. The aldermen and most of the other city authorities opted to stay at their posts. The Lord Mayor of London , Sir John Lawrence , also decided to stay in the city. Businesses were closed when merchants and professionals fled. Defoe wrote "Nothing was to be seen but wagons and carts, with goods, women, servants, children, coaches filled with people of the better sort, and horsemen attending them, and all hurrying away". As the plague raged throughout the summer, only a small number of clergymen , physicians and apothecaries remained to cope with an increasingly large number of victims. Ellen Cotes, author of London's Dreadful Visitation , expressed the hope that "Neither the Physicians of our Souls or Bodies may hereafter in such great numbers forsake us". The poorer people were also alarmed by the contagion and some left the city, but it was not easy for them to abandon their accommodation and livelihoods for an uncertain future elsewhere. Before exiting through the city gates, they were required to possess a certificate of good health signed by the Lord Mayor and these became increasingly difficult to obtain. As time went by and the numbers of plague victims rose, people living in the villages outside London began to resent this exodus and were no longer prepared to accept townsfolk from London, with or without a certificate. The refugees were turned back, were not allowed to pass through towns and had to travel across country, and were forced to live rough on what they could steal or scavenge from the fields. Many died in wretched circumstances of starvation and dehydration in the hot summer that was to follow. In the last week of July, the London Bill of Mortality showed 3,014 deaths, of which 2,020 had died from the plague. The number of deaths as a result of plague may have been underestimated, as deaths in other years in the same period were much lower, at around 300. As the number of victims affected mounted up, burial grounds became overfull, and pits were dug to accommodate the dead. Drivers of dead-carts travelled the streets calling "Bring out your dead" and carted away piles of bodies. The authorities became concerned that the number of deaths might cause public alarm and ordered that body removal and interment should take place only at night. As time went on, there were too many victims, and too few drivers, to remove the bodies which began to be stacked up against the walls of houses. Daytime collection was resumed and the plague pits became mounds of decomposing corpses. In the parish of Aldgate, a great hole was dug near the churchyard, fifty feet long and twenty feet wide. Digging was continued by labourers at one end while the dead-carts tipped in corpses at the other. When there was no room for further extension it was dug deeper until ground water was reached at twenty feet. When finally covered with earth it housed 1,114 corpses. Plague doctors traversed the streets diagnosing victims, many of them without formal medical training. Several public health efforts were attempted. Physicians were hired by city officials and burial details were carefully organized, but panic spread through the city and, out of the fear of contagion, bodies were hastily buried in overcrowded pits. The means of transmission of the disease were not known but thinking they might be linked to the animals, the City Corporation ordered a cull of dogs and cats. This decision may have affected the length of the epidemic since those animals could have helped keep in check the rat population carrying the fleas which transmitted the disease. Thinking bad air was involved in transmission, the authorities ordered giant bonfires to be burned in the streets and house fires to be kept burning night and day, in the hope that the air would be cleansed. Tobacco was thought to be a prophylactic and it was later said that no London tobacconist had died from the plague during the epidemic. Trade and business had dried up, and the streets were empty of people except for the dead-carts and the dying victims, as witnessed and recorded by Samuel Pepys in his diary: "Lord! How empty the streets are and how melancholy, so many poor sick people in the streets full of sores… in Westminster, there is never a physician and but one apothecary left, all being dead." That people did not starve was down to the foresight of Sir John Lawrence and the Corporation of London who arranged for a commission of one farthing to be paid above the normal price for every quarter of corn landed in the Port of London. Another food source was the villages around London which, denied of their usual sales in the capital, left vegetables in specified market areas, negotiated their sale by shouting, and collected their payment after the money had been left submerged in a bucket of vinegar to "disinfect" the coins. Records state that plague deaths in London and the suburbs crept up over the summer from 2,000 people per week to over 7,000 per week in September. These figures are likely to be a considerable underestimate. Many of the sextons and parish clerks who kept the records themselves died. Quakers refused to co-operate and many of the poor were just dumped into mass graves unrecorded. It is not clear how many people caught the disease and made a recovery because only deaths were recorded and many records were destroyed in the Great Fire of London the following year. In the few districts where intact records remain, plague deaths varied between 30% and over 50% of the total population. Vincent wrote: it was very dismal to behold the red crosses, and read in great letters "LORD, HAVE MERCY UPON US" on the doors, and watchmen standing before them with halberds...people passing by them so gingerly, and with such fearful looks as if they had been lined with enemies in ambush to destroy them...a man at the corner of Artillery-wall, that as I judge, through the dizziness of his head with the disease, which seized upon him there, had dasht his face against the wall; and when I came by, he lay hanging with his bloody face over the rails, and bleeding upon the ground...I went and spoke to him; he could make no answer, but rattled in the throat, and as I was informed, within half an hour died in the place. It would be endless to speak of what we have seen and heard, of some in their frenzy, rising out of their beds, and leaping about their rooms; others crying and roaring at their windows; some coming forth almost naked, and running into the streets...scarcely a day passed over my head for, I think, a month or more together, but I should hear of the death of some one or more that I knew. The first day that they were smitten, the next day some hopes of recovery, and the third day, that they were dead. The outbreak was concentrated in London, but it affected other areas as well. Perhaps the best known example occurred in the village of Eyam in Derbyshire . The plague allegedly arrived with a merchant carrying a parcel of cloth sent from London. The villagers imposed a quarantine on themselves to stop the further spread of the disease. This prevented the disease from moving into surrounding areas, but around 33% of the village's inhabitants died over a period of fourteen months. Other places hit hard included Derby and Norwich . In Bristol strenuous efforts by the City Council seems to have limited the death rate to c.0.6 per cent during an outbreak lasting from April to September 1666. Plague was sufficiently uncommon that medical practitioners might have had no personal experience of seeing the disease; medical training varied from those who had attended the college of physicians, to apothecaries who also acted as doctors, to charlatans. Other diseases abounded, such as an outbreak of smallpox the year before, and these uncertainties all added to difficulties identifying the true start of the epidemic. Contemporary accounts suggest cases of plague occurred through the winter of 1664–65, some of which were fatal but a number of which did not display the virulence of the later epidemic. The winter was cold, the ground frozen from December to March, river traffic on the Thames twice blocked by ice, and it may be that the cold weather held back its spread. This outbreak of bubonic plague in England is thought to have spread from the Netherlands, where the disease had been occurring intermittently since 1599. It is unclear exactly where the disease first struck but the initial contagion may have arrived with Dutch trading ships carrying bales of cotton from Amsterdam , which was ravaged by the disease in 1663–64, with a mortality given of 50,000. The first areas to be struck are believed to be the dock areas just outside London, and the parish of St Giles . In both of these localities, poor workers were crowded into ill-kept structures. Two suspicious deaths were recorded in St Giles parish in 1664 and another in February 1665. These did not appear as plague deaths on the Bills of Mortality, so no control measures were taken by the authorities, but the total number of people dying in London during the first four months of 1665 showed a marked increase. By the end of April, only four plague deaths had been recorded, two in the parish of St. Giles, but total deaths per week had risen from around 290 to 398. There had been three official cases in April, a level of plague which in earlier years had not induced any official response, but the Privy Council now acted to introduce household quarantine. Justices of the Peace in Middlesex were instructed to investigate any suspected cases and to shut up the house if it was confirmed. Shortly after, a similar order was issued by the King's Bench to the City and Liberties. A riot broke out in St. Giles when the first house was sealed up; the crowd broke down the door and released the inhabitants. Rioters caught were punished severely. Instructions were given to build pest-houses, which were essentially isolation hospitals built away from other people where the sick could be cared for (or stay until they died). This official activity suggests that despite the few recorded cases, the government was already aware that this was a serious outbreak of plague. With the arrival of warmer weather, the disease began to take a firmer hold. In the week 2–9 May, there were three recorded deaths in the parish of St Giles, four in neighbouring St Clement Danes and one each in St Andrew Holborn and St Mary Woolchurch Haw . Only the last was actually inside the city walls. A Privy Council committee was formed to investigate methods to best prevent the spread of plague, and measures were introduced to close some of the ale houses in affected areas and limit the number of lodgers allowed in a household. In the city, the Lord Mayor issued a proclamation that all householders must diligently clean the streets outside their property, which was a householder's responsibility, not a state one (the city employed scavengers and rakers to remove the worst of the mess). Matters just became worse, and Aldermen were instructed to find and punish those failing their duty. As cases in St. Giles began to rise, an attempt was made to quarantine the area and constables were instructed to inspect everyone wishing to travel and contain inside vagrants or suspect persons. People began to be alarmed. Samuel Pepys , who had an important position at the Admiralty , stayed in London and provided a contemporary account of the plague through his diary. On 30 April he wrote: "Great fears of the sickness here in the City it being said that two or three houses are already shut up. God preserve us all!" Another source of information on the time is A Journal of the Plague Year , which was written by Daniel Defoe and published in 1722. He had been only five when the plague struck but made use of his family's recollections (his uncle was a saddler in East London and his father a butcher in Cripplegate ), interviews with survivors and sight of such official records as were available. The onset of the disease was recalled two years later by Puritan minister Thomas Vincent : It was in the month of May that the Plague was first taken notice of; our Bill of Mortality did let us know but of three which died of the disease in the whole year before; but in the beginning of May the bill tells us of nine...fear quickly begins to creep upon peoples hearts; great thoughts and discourse there is in Town about the Plague, and they cast in their minds whether they should go if the Plague should increase. Yet when the next weeks Bill signifieth to them the disease from nine to three their minds are something appeased; discourse of that subject cools; fears are hushed, and hopes take place, that the black cloud did but threaten, and give a few drops; but the wind would drive it away. But when in the next Bill the number of the dead by the Plague is mounted from three to fourteen, and in the next to seventeen, and in the next to forty-three, and the disease begins so much to increase, and disperse. Now secure sinners begin to be startled, and those who would have slept at quiet still in their nests, are unwillingly awakened. By July 1665, plague was rampant in the City of London. The rich ran away, including King Charles II of England , his family and his court, who left the city for Salisbury , moving on to Oxford in September when some cases of plague occurred in Salisbury. The aldermen and most of the other city authorities opted to stay at their posts. The Lord Mayor of London , Sir John Lawrence , also decided to stay in the city. Businesses were closed when merchants and professionals fled. Defoe wrote "Nothing was to be seen but wagons and carts, with goods, women, servants, children, coaches filled with people of the better sort, and horsemen attending them, and all hurrying away". As the plague raged throughout the summer, only a small number of clergymen , physicians and apothecaries remained to cope with an increasingly large number of victims. Ellen Cotes, author of London's Dreadful Visitation , expressed the hope that "Neither the Physicians of our Souls or Bodies may hereafter in such great numbers forsake us". The poorer people were also alarmed by the contagion and some left the city, but it was not easy for them to abandon their accommodation and livelihoods for an uncertain future elsewhere. Before exiting through the city gates, they were required to possess a certificate of good health signed by the Lord Mayor and these became increasingly difficult to obtain. As time went by and the numbers of plague victims rose, people living in the villages outside London began to resent this exodus and were no longer prepared to accept townsfolk from London, with or without a certificate. The refugees were turned back, were not allowed to pass through towns and had to travel across country, and were forced to live rough on what they could steal or scavenge from the fields. Many died in wretched circumstances of starvation and dehydration in the hot summer that was to follow. In the last week of July, the London Bill of Mortality showed 3,014 deaths, of which 2,020 had died from the plague. The number of deaths as a result of plague may have been underestimated, as deaths in other years in the same period were much lower, at around 300. As the number of victims affected mounted up, burial grounds became overfull, and pits were dug to accommodate the dead. Drivers of dead-carts travelled the streets calling "Bring out your dead" and carted away piles of bodies. The authorities became concerned that the number of deaths might cause public alarm and ordered that body removal and interment should take place only at night. As time went on, there were too many victims, and too few drivers, to remove the bodies which began to be stacked up against the walls of houses. Daytime collection was resumed and the plague pits became mounds of decomposing corpses. In the parish of Aldgate, a great hole was dug near the churchyard, fifty feet long and twenty feet wide. Digging was continued by labourers at one end while the dead-carts tipped in corpses at the other. When there was no room for further extension it was dug deeper until ground water was reached at twenty feet. When finally covered with earth it housed 1,114 corpses. Plague doctors traversed the streets diagnosing victims, many of them without formal medical training. Several public health efforts were attempted. Physicians were hired by city officials and burial details were carefully organized, but panic spread through the city and, out of the fear of contagion, bodies were hastily buried in overcrowded pits. The means of transmission of the disease were not known but thinking they might be linked to the animals, the City Corporation ordered a cull of dogs and cats. This decision may have affected the length of the epidemic since those animals could have helped keep in check the rat population carrying the fleas which transmitted the disease. Thinking bad air was involved in transmission, the authorities ordered giant bonfires to be burned in the streets and house fires to be kept burning night and day, in the hope that the air would be cleansed. Tobacco was thought to be a prophylactic and it was later said that no London tobacconist had died from the plague during the epidemic. Trade and business had dried up, and the streets were empty of people except for the dead-carts and the dying victims, as witnessed and recorded by Samuel Pepys in his diary: "Lord! How empty the streets are and how melancholy, so many poor sick people in the streets full of sores… in Westminster, there is never a physician and but one apothecary left, all being dead." That people did not starve was down to the foresight of Sir John Lawrence and the Corporation of London who arranged for a commission of one farthing to be paid above the normal price for every quarter of corn landed in the Port of London. Another food source was the villages around London which, denied of their usual sales in the capital, left vegetables in specified market areas, negotiated their sale by shouting, and collected their payment after the money had been left submerged in a bucket of vinegar to "disinfect" the coins. Records state that plague deaths in London and the suburbs crept up over the summer from 2,000 people per week to over 7,000 per week in September. These figures are likely to be a considerable underestimate. Many of the sextons and parish clerks who kept the records themselves died. Quakers refused to co-operate and many of the poor were just dumped into mass graves unrecorded. It is not clear how many people caught the disease and made a recovery because only deaths were recorded and many records were destroyed in the Great Fire of London the following year. In the few districts where intact records remain, plague deaths varied between 30% and over 50% of the total population. Vincent wrote: it was very dismal to behold the red crosses, and read in great letters "LORD, HAVE MERCY UPON US" on the doors, and watchmen standing before them with halberds...people passing by them so gingerly, and with such fearful looks as if they had been lined with enemies in ambush to destroy them...a man at the corner of Artillery-wall, that as I judge, through the dizziness of his head with the disease, which seized upon him there, had dasht his face against the wall; and when I came by, he lay hanging with his bloody face over the rails, and bleeding upon the ground...I went and spoke to him; he could make no answer, but rattled in the throat, and as I was informed, within half an hour died in the place. It would be endless to speak of what we have seen and heard, of some in their frenzy, rising out of their beds, and leaping about their rooms; others crying and roaring at their windows; some coming forth almost naked, and running into the streets...scarcely a day passed over my head for, I think, a month or more together, but I should hear of the death of some one or more that I knew. The first day that they were smitten, the next day some hopes of recovery, and the third day, that they were dead. The outbreak was concentrated in London, but it affected other areas as well. Perhaps the best known example occurred in the village of Eyam in Derbyshire . The plague allegedly arrived with a merchant carrying a parcel of cloth sent from London. The villagers imposed a quarantine on themselves to stop the further spread of the disease. This prevented the disease from moving into surrounding areas, but around 33% of the village's inhabitants died over a period of fourteen months. Other places hit hard included Derby and Norwich . In Bristol strenuous efforts by the City Council seems to have limited the death rate to c.0.6 per cent during an outbreak lasting from April to September 1666. By late autumn, the death toll in London and the suburbs began to slow until, in February 1666, it was considered safe enough for the King and his entourage to come back to the city. With the return of the monarch, others began to return: The gentry returned in their carriages accompanied by carts piled high with their belongings. The judges moved back from Windsor to sit in Westminster Hall ; Parliament , which had been prorogued in April 1665, did not reconvene until September 1666. Trade recommenced and businesses and workshops opened up. London was the goal of a new wave of people who flocked to the city in expectation of making their fortunes. Writing at the end of March 1666, Lord Clarendon , the Lord Chancellor , stated "... the streets were as full, the Exchange as much crowded, the people in all places as numerous as they had ever been seen ...". Plague cases continued to occur sporadically at a modest rate until mid-1666. That September, the Great Fire of London destroyed much of the City of London, and some people believed that the fire put an end to the epidemic. It is now thought that the plague had largely subsided before the fire took place. Most of the later cases of plague were found in the suburbs, and it was the City of London that was destroyed by the fire. According to the Bills of Mortality, there were in total 68,596 deaths in London from the plague in 1665. Lord Clarendon estimated that the true number of mortalities was probably twice that figure. 1666 saw further deaths in other cities but on a lesser scale. Dr Thomas Gumble , chaplain to the Duke of Albemarle , both of whom had stayed in London for the whole of the epidemic, estimated that the total death count for the country from plague during 1665 and 1666 was about 200,000. Among the more notable death victims were Samuel Fisher , John Godwin , John Lewger and George Starkey . The Great Plague of 1665/1666 was the last major outbreak of bubonic plague in Great Britain. The last recorded death from plague came in 1679, and it was removed as a specific category in the Bills of Mortality after 1703. It spread to other towns in East Anglia and the southeast of England but fewer than ten per cent of parishes outside London had a higher than average death rate during those years. Urban areas were more affected than rural ones; Norwich, Ipswich, Colchester, Southampton and Winchester were badly affected, while the west of England and areas of the English Midlands escaped altogether. The population of England in 1650 was approximately 5.25 million, which declined to about 4.9 million by 1680, recovering to just over 5 million by 1700. Other diseases, such as smallpox, took a high toll on the population without the contribution by plague. The higher death rate in cities, both generally and specifically from the plague, was made up by continuous immigration, from small towns to larger ones and from the countryside to the towns. There were no contemporary censuses of London's population, but available records suggest that the population returned to its previous level within a couple of years. Burials in 1667 had returned to 1663 levels, Hearth Tax returns had recovered, and John Graunt contemporarily analysed baptism records and concluded they represented a recovered population. Part of this could be accounted for by the return of wealthy households, merchants and manufacturing industries, all of which needed to replace losses among their staff and took steps to bring in necessary people. Colchester had suffered more severe depopulation, but manufacturing records for cloth suggested that production had recovered or even increased by 1669, and the total population had nearly returned to pre-plague levels by 1674. Other towns did less well: Ipswich was affected less than Colchester, but in 1674, its population had dropped by 18%, more than could be accounted for by the plague deaths alone. [ dubious – discuss ] As a proportion of the population who died, the London death toll was less severe than in some other towns. The total of deaths in London was greater than in any previous outbreak for 100 years, though as a proportion of the population, the epidemics in 1563, 1603 and 1625 were comparable or greater. Perhaps around 2.5% of the English population died. The plague in London largely affected the poor, as the rich were able to leave the city by either retiring to their country estates or residing with kin in other parts of the country. The subsequent Great Fire of London ruined many city merchants and property owners. As a result of these events, London was largely rebuilt and Parliament enacted the Rebuilding of London Act 1666 . The street plan of the capital remained relatively unchanged, but some improvements were made: streets were widened, pavements were created, open sewers abolished, wooden buildings and overhanging gables forbidden, and the design and construction of buildings controlled. The use of brick or stone was mandatory and many gracious buildings were constructed. Not only was the capital rejuvenated, but it became a healthier environment in which to live. Londoners had a greater sense of community after they had overcome the great adversities of 1665 and 1666. Rebuilding took over ten years and was supervised by Robert Hooke as Surveyor of London. The architect Sir Christopher Wren was involved in the rebuilding of St Paul's Cathedral and more than fifty London churches . King Charles II did much to foster the rebuilding work. He was a patron of the arts and sciences and founded the Royal Observatory and supported the Royal Society , a scientific group whose early members included Robert Hooke, Robert Boyle and Sir Isaac Newton . In fact, out of the fire and pestilence flowed a renaissance in the arts and sciences in England. Plague pits have been archaeologically excavated during underground construction work. Between 2011 and 2015, 3,500 burials from the ' New Churchyard ' or 'Bethlam burial ground' were discovered during the construction of the Crossrail railway at Liverpool Street. Yersinia pestis DNA was found in the teeth of individuals found buried in pits at the site, confirming they had died of bubonic plague.

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Pneumonic plague

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Sylvatic plague

Sylvatic plague is an infectious bacterial disease caused by the plague bacterium ( Yersinia pestis ) that primarily affects rodents , such as prairie dogs . It is the same bacterium that causes bubonic and pneumonic plague in humans. Sylvatic, or sylvan, means 'occurring in woodland,' and refers specifically to the form of plague in rural wildlife. Urban plague refers to the form in urban wildlife. It is primarily transmitted among wildlife through flea bites and contact with infected tissue or fluids. Sylvatic plague is most commonly found in prairie dog colonies and some mustelids , like the black-footed ferret . The flea that feeds on prairie dogs and other mammals serves as the vector for transmission of sylvatic plague to the new host, primarily through flea bites, or contact with contaminated fluids or tissue, through predation or scavenging. Humans can contract plague from wildlife through flea bites and handling animal carcasses . Yersinia pestis circulates in rodent reservoirs on all continents except Australia. Sylvatic plague affects over 50 species of rodents worldwide. It is vectored by a variety of flea species. Non-rodent animals susceptible to the disease include shrews , lagomorphs , ferrets , badgers , skunks , weasels , coyotes , domestic dogs and cats , bobcats , cougars , camels , goats , sheep , pigs , deer , and primates , including humans . Birds are not known to be susceptible. Sylvatic plague is normally enzootic , meaning it occurs at regular, predictable rates in populations and specific areas. At unpredictable times, it becomes epizootic in unexpected places. It is during these epizootic outbreaks that transmission to humans is most common. Factors that predispose to epizootic cycles include dense populations of rodents, multiple species of rodents in a particular area, and multiple rodent species in diverse habitats. Prairie dog colonies reach nearly 100% mortality rates during outbreaks. Prairie dogs are a keystone species and play a vital role as the primary prey of black-footed ferrets. Developing methods to control plague is of high concern for preserving ferrets and the conservation of Western prairie and grassland ecosystems. In the absence of understanding the prairie dog/plague cycles, dusting rodent dens with pesticides to kill fleas is currently the main method of controlling sylvatic plague in the wild, with some interest in using vaccines developing. An oral live vaccine for prairie dogs was developed by the U.S. Geological Survey, National Wildlife Health Center, from a recombinant raccoon poxvirus expressing plague antigens. It was originally developed by a Fort Detrick company in 2003 which showed it protected mice against lethal plague.

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Pneumonic plague

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Wu Lien-teh

Wu Lien-teh ( Chinese : 伍連德 ; pinyin : Wǔ Liándé ; Jyutping : Ng 5 Lin 4 Dak 1 ; Pe̍h-ōe-jī : Gó͘ Liân-tek ; Goh Lean Tuck and Ng Leen Tuck in Minnan and Cantonese transliteration respectively; 10 March 1879 – 21 January 1960) was a Malayan physician renowned for his work in public health , particularly the Manchurian plague of 1910–11. He is the inventor of the Wu mask, which is the forerunner of today's N95 respirator . Wu was the first medical student of Chinese descent to study at the University of Cambridge . He was also the first Malayan nominated for the Nobel Prize in Physiology or Medicine , in 1935. Wu was born in Penang , one of the three towns of the Straits Settlements (the others being Malacca and Singapore ), currently as one of the states of Malaysia . The Straits Settlements formed part of the colonies of the United Kingdom . His father was a recent immigrant from Taishan , China , and worked as a goldsmith . Wu's mother's was of Hakka heritage and was a second-generation Peranakan born in Malaya. Wu had four brothers and six sisters. His early education was at the Penang Free School , a Church of England school. Wu was admitted to Emmanuel College, Cambridge in 1896, after winning the Queen's Scholarship . The women in his family made him a version of his college's lion crest in Perakanan beadwork as a leaving gift. He had a successful career at university, winning virtually all the available prizes and scholarships. His undergraduate clinical years were spent at St Mary's Hospital, London and he then continued his studies at the Liverpool School of Tropical Medicine (under Sir Ronald Ross ), the Pasteur Institute , Halle University , and the Selangor Institute. Wu returned to the Straits Settlements in 1903. Some time after that, he married Ruth Shu-chiung Huang, whose sister was married to Lim Boon Keng , a physician who promoted social and educational reforms in Singapore . The sisters were daughters of Wong Nai Siong , a Chinese revolutionary leader and educator who had moved to the area from 1901 to 1906. Wu and his family moved to China in 1907. During his time in China, Wu's wife and two of their three sons died. While Ms Huang lived in Peking, Wu started a second family in Shanghai with Marie Lee Sukcheng, whom he had met in Manchuria. Wu had four children with Lee. During the Japanese invasion of Manchuria , in November 1931, Wu was detained and interrogated by the Japanese authorities under suspicion of being a Chinese spy. In 1937, during the Japanese occupation of much of China and the retreat of the Nationalists, Wu was forced to flee, returning to the Settlements to live in Ipoh . His home and all his ancient Chinese medical books were burnt. In 1943 Wu was captured by Malayan left-wing resistance fighters and held for ransom. Then he nearly was prosecuted by the Japanese for supporting the resistance movement by paying the ransom, but was protected by having treated a Japanese officer. In September 1903, Wu joined the Institute for Medical Research in Kuala Lumpur as the first research student. However, there was no specialist post for him because, at that time, a two-tier medical system in the British colonies provided that only British nationals could hold the highest positions of fully qualified medical officers or specialists. Wu spent his early medical career researching beri-beri and roundworms ( Ascarididae ) before entering private practice toward the end of 1904 in Chulia Street, George Town , Penang. Wu was a vocal commentator on the social issues of the time. In the early 1900s, he became friends with Lim Boon Keng and Song Ong Siang , a lawyer who was active in developing Singapore's civil society. He joined them in editing The Straits Chinese Magazine . With his friends, Wu founded the Anti-Opium Association in Penang. He organised a nationwide anti-opium conference in the spring of 1906 that was attended by approximately 3000 people. This attracted the attention of the powerful forces involved in the lucrative trade of opium and, in 1907, this led to a search and subsequent discovery of one ounce of tincture of opium in Wu's dispensary, for which he was convicted and fined. In 1908, Dr Wu accepted the then Grand Councillor Yuan Shikai 's offer to become the Vice Director of the Imperial Army Medical College, now known as the Army Medical College , based in Tianjin , in 1908. This was established to train doctors for the Chinese Army. In the winter of 1910, Wu was given instructions from the Foreign Office of the Imperial Qing court in Peking, to travel to Harbin to investigate an unknown disease that killed 99.9% of its victims. This was the beginning of the large pneumonic plague epidemic of Manchuria and Mongolia, which ultimately claimed 60,000 lives. Wu was able to conduct a postmortem (usually not accepted in China at the time) on a Japanese woman who had died of the plague. Having ascertained via the autopsy that the plague was spreading by air , Wu developed surgical masks into more substantial masks with layers of gauze and cotton to filter the air. Gérald Mesny, a prominent French doctor who had come to replace Wu, refused to wear a mask and died days later of the plague. The mask was widely produced, with Wu overseeing the production and distribution of 60,000 masks in a later epidemic, and it featured in many press images. It is believed that the N95 mask is the descendant of Wu's design. Wu initiated a quarantine, arranged for buildings to be disinfected, and the old plague hospital to be burned down and replaced. The measure that Wu is best remembered for was in asking for imperial sanction to cremate plague victims. It was impossible to bury the dead because the ground was frozen, and the bodies could only be disposed of by soaking them in paraffin and burning them on pyres. Cremation of these infected victims turned out to be the turning point of the epidemic; days after cremations began, plague began to decline and within months it had been eradicated. Wu chaired the International Plague Conference in Mukden ( Shenyang ) in April 1911, a historic event attended by scientists from the United States of America, the United Kingdom of Great Britain and Ireland, France, Germany, Italy, Austria-Hungary, the Netherlands, Russia, Mexico, and China. The conference took place over three weeks and featured demonstrations and experiments. Wu later presented a plague research paper at the International Congress of Medicine, London in August 1911 which was published in The Lancet in the same month. At the plague conference, epidemiologists Danylo Zabolotny and Anna Tchourilina announced that they had traced the initial cause of the outbreak to Tarbagan marmot hunters who had contracted the disease from the animals. A tarabagan became the conference mascot. However, Wu raised the question of why traditional marmot hunters had not experienced deadly epidemics before. He later published a work arguing that the traditional Mongol and Buryat hunters had established practices that kept their communities safe and he blamed more recent Shandong immigrants to the area ( Chuang Guandong ) for using hunting methods that captured more sick animals and increased risk of exposure. In 1912, Wu became the first director of the Manchurian Plague Service. He was a founder member and first president of the Chinese Medical Association (1916–1920). Wu led the efforts to combat the 1920-21 cholera pandemic in the north-east of China. In 1929, he was appointed a trustee of the 'Nanyang Club' in Penang by Cheah Cheang Lim , along with Wu Lai Hsi , Robert Lim Kho Seng , and Lim Chong Eang . The 'Nanyang Club', an old house in Beiping, China , provided convenient accommodation to overseas Chinese friends. In the 1930s he became the first director of the National Quarantine Service. Around 1939, Wu moved back to Malaya and continued to work as a general practitioner in Ipoh . Wu collected donations to start the Perak Library (Now the Tun Razak Library) in Ipoh, a free-lending public library, and donated to Shanghai City Library and the University of Hong Kong . Wu was a mandarin of the second rank [ clarification needed ] and sat on advisory committees for the League of Nations . He was given awards by the Czar of Russia and the President of France, and was awarded honorary degrees by Johns Hopkins University , Peking University , University of Hong Kong , and University of Tokyo . Wu was a vocal commentator on the social issues of the time. In the early 1900s, he became friends with Lim Boon Keng and Song Ong Siang , a lawyer who was active in developing Singapore's civil society. He joined them in editing The Straits Chinese Magazine . With his friends, Wu founded the Anti-Opium Association in Penang. He organised a nationwide anti-opium conference in the spring of 1906 that was attended by approximately 3000 people. This attracted the attention of the powerful forces involved in the lucrative trade of opium and, in 1907, this led to a search and subsequent discovery of one ounce of tincture of opium in Wu's dispensary, for which he was convicted and fined. In 1908, Dr Wu accepted the then Grand Councillor Yuan Shikai 's offer to become the Vice Director of the Imperial Army Medical College, now known as the Army Medical College , based in Tianjin , in 1908. This was established to train doctors for the Chinese Army. In the winter of 1910, Wu was given instructions from the Foreign Office of the Imperial Qing court in Peking, to travel to Harbin to investigate an unknown disease that killed 99.9% of its victims. This was the beginning of the large pneumonic plague epidemic of Manchuria and Mongolia, which ultimately claimed 60,000 lives. Wu was able to conduct a postmortem (usually not accepted in China at the time) on a Japanese woman who had died of the plague. Having ascertained via the autopsy that the plague was spreading by air , Wu developed surgical masks into more substantial masks with layers of gauze and cotton to filter the air. Gérald Mesny, a prominent French doctor who had come to replace Wu, refused to wear a mask and died days later of the plague. The mask was widely produced, with Wu overseeing the production and distribution of 60,000 masks in a later epidemic, and it featured in many press images. It is believed that the N95 mask is the descendant of Wu's design. Wu initiated a quarantine, arranged for buildings to be disinfected, and the old plague hospital to be burned down and replaced. The measure that Wu is best remembered for was in asking for imperial sanction to cremate plague victims. It was impossible to bury the dead because the ground was frozen, and the bodies could only be disposed of by soaking them in paraffin and burning them on pyres. Cremation of these infected victims turned out to be the turning point of the epidemic; days after cremations began, plague began to decline and within months it had been eradicated. Wu chaired the International Plague Conference in Mukden ( Shenyang ) in April 1911, a historic event attended by scientists from the United States of America, the United Kingdom of Great Britain and Ireland, France, Germany, Italy, Austria-Hungary, the Netherlands, Russia, Mexico, and China. The conference took place over three weeks and featured demonstrations and experiments. Wu later presented a plague research paper at the International Congress of Medicine, London in August 1911 which was published in The Lancet in the same month. At the plague conference, epidemiologists Danylo Zabolotny and Anna Tchourilina announced that they had traced the initial cause of the outbreak to Tarbagan marmot hunters who had contracted the disease from the animals. A tarabagan became the conference mascot. However, Wu raised the question of why traditional marmot hunters had not experienced deadly epidemics before. He later published a work arguing that the traditional Mongol and Buryat hunters had established practices that kept their communities safe and he blamed more recent Shandong immigrants to the area ( Chuang Guandong ) for using hunting methods that captured more sick animals and increased risk of exposure. In 1912, Wu became the first director of the Manchurian Plague Service. He was a founder member and first president of the Chinese Medical Association (1916–1920). Wu led the efforts to combat the 1920-21 cholera pandemic in the north-east of China. In 1929, he was appointed a trustee of the 'Nanyang Club' in Penang by Cheah Cheang Lim , along with Wu Lai Hsi , Robert Lim Kho Seng , and Lim Chong Eang . The 'Nanyang Club', an old house in Beiping, China , provided convenient accommodation to overseas Chinese friends. In the 1930s he became the first director of the National Quarantine Service. Around 1939, Wu moved back to Malaya and continued to work as a general practitioner in Ipoh . Wu collected donations to start the Perak Library (Now the Tun Razak Library) in Ipoh, a free-lending public library, and donated to Shanghai City Library and the University of Hong Kong . Wu was a mandarin of the second rank [ clarification needed ] and sat on advisory committees for the League of Nations . He was given awards by the Czar of Russia and the President of France, and was awarded honorary degrees by Johns Hopkins University , Peking University , University of Hong Kong , and University of Tokyo . Wu practised medicine until his death at the age of 80. He had bought a new house in Penang for his retirement and had just completed his 667-page autobiography, Plague Fighter, the Autobiography of a Modern Chinese Physician . On 21 January 1960, he died of a stroke while in his home in Penang. A road named after Wu can be found in Ipoh Garden South, a middle-class residential area in Ipoh. In Penang, a residential area named Taman Wu Lien Teh is located near the Penang Free School . In that school, his alma mater, a house has been named after him. There is a Dr. Wu Lien-teh Society, Penang. The Wu Lien-teh Collection, which comprises 20,000 books, was given by Wu to the Nanyang University , which later became part of the National University of Singapore . The Art Museum of the University of Malaya has a collection of Wu's paintings. In 1995, Wu's daughter, Dr. Yu-lin Wu, published a book about her father, Memories of Dr. Wu Lien-teh, Plague Fighter. In 2015, the Wu Lien-Teh Institute opened at Harbin Medical University . In 2019, The Lancet launched an annual Wakley-Wu Lien Teh Prize in honour of Wu and the publication's founding editor, Thomas Wakley . Dr. Wu Lien-teh is regarded as the first person to modernise China's medical services and medical education. In Harbin Medical University , bronze statues of him commemorate his contributions to public health, preventive medicine, and medical education. Wu's work in the field of epidemiology had contemporary relevance during the COVID-19 pandemic . In May 2020, Dr. Yvonne Ho united the 22 known "medical and scientific descendants" of Dr. Wu Lien-Teh for a video conference meeting spanning 14 cities around the world. In July 2020, some of these medical and scientific descendants collaborated to publish an article to memorialize Dr. Wu's lifetime work in public health. In August 2020, a second group of Wu's medical and scientific descendants collaborated on a similar piece. In March 2021, Wu was honoured with a Google Doodle , depicting Wu assembling surgical masks and distributing them to reduce the risk of disease transmission. Wu's work in the field of epidemiology had contemporary relevance during the COVID-19 pandemic . In May 2020, Dr. Yvonne Ho united the 22 known "medical and scientific descendants" of Dr. Wu Lien-Teh for a video conference meeting spanning 14 cities around the world. In July 2020, some of these medical and scientific descendants collaborated to publish an article to memorialize Dr. Wu's lifetime work in public health. In August 2020, a second group of Wu's medical and scientific descendants collaborated on a similar piece. In March 2021, Wu was honoured with a Google Doodle , depicting Wu assembling surgical masks and distributing them to reduce the risk of disease transmission.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Neolithic_decline/html

Neolithic decline

The Neolithic decline was a rapid collapse in populations between 5000 and 6000 years ago (approximately 3000 BC) during the Neolithic period in western Eurasia . The specific causes of that broad population decline are still debated. While heavily populated settlements were regularly created, abandoned, and resettled during the Neolithic, after around 5400 years ago, a great number of those settlements were permanently abandoned. The population decline is associated with worsening agricultural conditions and a decrease in cereal production. Other suggested causes include the emergence of communicable diseases spread from animals living in close quarters with humans. The population increase that preceded the decline between 5950 and 5550 BP was catalysed by the introduction of agriculture, along with the spread of technologies such as pottery, the wheel, and animal husbandry. After the Neolithic decline, there were massive human migrations from the Pontic–Caspian steppe into eastern and central Europe, beginning approximately 4600 BP. An ancient version of the Yersinia pestis has come up from multiple skeletal studies throughout Eurasia, skeletons which have dated back to around the estimated periods of the Neolithic Decline. Additionally, genomes of the plague have been found as far back as 5,000 BP in areas such as Latvia and Sweden. A tomb in modern-day Frälsegården in Gökhem parish, Falbygden, Sweden , contained 79 corpses buried within a short time of one another about 4,900 years ago. This discovery uncovered fragments of a unique strain of the plague pathogen Yersinia pestis found in two individual's teeth. The strain contained the " plasminogen activator gene that is sufficient to cause pneumonic plague ", an extremely deadly form of the plague which is airborne and directly communicable between humans. This strain of plague, researchers claim, alongside high demands of resources whilst living in close proximity to each other, would have allowed a pneumonic plague to quickly spread amongst inhabitants and wipe them out. Neolithic-era human teeth from Eurasia have also shown evidence of some of the oldest strains of Yersinia pestis . The ages of the skeletons identified between 2,800 and 5,000 years old, with seven of the one hundred and one individuals carrying similar sequences of the bacterium. Additionally, studies of the ancient strains discovered show these ancient strains lack the Yersinia murine toxin (ymt), which would have prevented the strains from using fleas as a vector. A similar site was found in China in 2011; the site Hamin Mangha in northeast China dates back to approximately 5000 years ago and features a small structure filled with almost 100 bodies. Whilst there are several theories as what the reasons are for so many bodies in one location, such as a geological disaster or a ritual sacrifice, a plague is also considered as a hypothesis. In the case of the plague, despite being the weakest of the hypotheses, the placement of the bodies suggesting others carrying them in, alongside being intact before being burned, and the lack of artifacts alongside the bodies. Two other sites like these have been found in Northeast China: Miaozigou and Laijia, but archaeologists did not speculate as to the causal agent. Some studies have contested the hypothesis that the plague was responsible for the Neolithic decline. Analysis of the plague bacteria that infected a hunter-gatherer in Latvia during this period indicates that, unlike modern plague strains, the strain which afflicted this man was incapable of causing flea-spread bubonic plague and could only cause septicemic plague via a rodent bite or a largely non-contagious case of pneumonic plague, implying that the disease would have had difficulty spreading across vast distances in a short amount of time. The man identified in this particular case, after being studied, does not have a clear indicator of how much he was actually affected by the bacteria. A tomb in modern-day Frälsegården in Gökhem parish, Falbygden, Sweden , contained 79 corpses buried within a short time of one another about 4,900 years ago. This discovery uncovered fragments of a unique strain of the plague pathogen Yersinia pestis found in two individual's teeth. The strain contained the " plasminogen activator gene that is sufficient to cause pneumonic plague ", an extremely deadly form of the plague which is airborne and directly communicable between humans. This strain of plague, researchers claim, alongside high demands of resources whilst living in close proximity to each other, would have allowed a pneumonic plague to quickly spread amongst inhabitants and wipe them out. Neolithic-era human teeth from Eurasia have also shown evidence of some of the oldest strains of Yersinia pestis . The ages of the skeletons identified between 2,800 and 5,000 years old, with seven of the one hundred and one individuals carrying similar sequences of the bacterium. Additionally, studies of the ancient strains discovered show these ancient strains lack the Yersinia murine toxin (ymt), which would have prevented the strains from using fleas as a vector. A similar site was found in China in 2011; the site Hamin Mangha in northeast China dates back to approximately 5000 years ago and features a small structure filled with almost 100 bodies. Whilst there are several theories as what the reasons are for so many bodies in one location, such as a geological disaster or a ritual sacrifice, a plague is also considered as a hypothesis. In the case of the plague, despite being the weakest of the hypotheses, the placement of the bodies suggesting others carrying them in, alongside being intact before being burned, and the lack of artifacts alongside the bodies. Two other sites like these have been found in Northeast China: Miaozigou and Laijia, but archaeologists did not speculate as to the causal agent. Some studies have contested the hypothesis that the plague was responsible for the Neolithic decline. Analysis of the plague bacteria that infected a hunter-gatherer in Latvia during this period indicates that, unlike modern plague strains, the strain which afflicted this man was incapable of causing flea-spread bubonic plague and could only cause septicemic plague via a rodent bite or a largely non-contagious case of pneumonic plague, implying that the disease would have had difficulty spreading across vast distances in a short amount of time. The man identified in this particular case, after being studied, does not have a clear indicator of how much he was actually affected by the bacteria. Studies of the ancient variations of the bacteria have tried to show connections to the specific strain they studied and the more modern strands, such as one's during the Black Death. Studies in Sweden, on the Gok2 Neolithic Yersinia pestis strain, was discovered to be the basal to all known Y. pestis strains with the use of genome reconstruction, as well as containing plasminogen activators genes that would have allowed it to start a pneumonic plague. Other cases revealed a lack of ability to be able to use fleas as a vector of transmission; the case in Sweden contained Yersinia murine toxin which prevented the use of fleas, alongside a separate case studying late bronze-age bodies revealing the use of fleas in transmission would have occurred around the time after the collapse, being a few hundred years off. Studies of the ancient variations of the bacteria have tried to show connections to the specific strain they studied and the more modern strands, such as one's during the Black Death. Studies in Sweden, on the Gok2 Neolithic Yersinia pestis strain, was discovered to be the basal to all known Y. pestis strains with the use of genome reconstruction, as well as containing plasminogen activators genes that would have allowed it to start a pneumonic plague. Other cases revealed a lack of ability to be able to use fleas as a vector of transmission; the case in Sweden contained Yersinia murine toxin which prevented the use of fleas, alongside a separate case studying late bronze-age bodies revealing the use of fleas in transmission would have occurred around the time after the collapse, being a few hundred years off.

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Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Changchun/html

Changchun

Changchun [lower-alpha 1] is the capital and largest city of Jilin Province in China. Lying in the center of the Songliao Plain , Changchun is administered as a sub-provincial city , comprising 7 districts, 1 county and 3 county-level cities. According to the 2020 census of China, Changchun had a total population of 9,066,906 under its jurisdiction. The city's metro area, comprising 5 districts and 1 development area, had a population of 5,019,477 in 2020, as the Shuangyang and Jiutai districts are not urbanized yet. It is one of the biggest cities in Northeast China , along with Shenyang , Dalian and Harbin . The name of the city means "long spring" in Chinese . Between 1932 and 1945, Changchun was renamed Xinjing ( Chinese : 新京 ; pinyin : XÄ«njÄ«ng ; lit. ' new capital ' ) or Hsinking by the Kwantung Army as it became the capital of the Imperial Japanese puppet state of Manchukuo , occupying modern Northeast China . After the foundation of the People's Republic of China in 1949, Changchun was established as the provincial capital of Jilin in 1954. Known locally as China's "City of Automobiles", Changchun is an important industrial base with a particular focus on the automotive sector. Because of its key role in the domestic automobile industry, Changchun was sometimes referred to as the " Detroit of China." Apart from this industrial aspect, Changchun is also one of four "National Garden Cities" awarded by the Ministry of Construction of P.R. China in 2001 due to its high urban greening rate. [ failed verification ] Changchun is also one of the top 40 cities in the world by scientific research as tracked by the Nature Index according to the Nature Index 2020 Science Cities. The city is home to several major universities , notably Jilin University and Northeast Normal University , members of China's prestigious universities in the Double First-Class Construction .Changchun was initially established on imperial decree as a small trading post and frontier village during the reign of the Jiaqing Emperor in the Qing dynasty . Trading activities mainly involved furs and other natural products during this period. In 1800, the Jiaqing Emperor selected a small village on the east bank of the Yitong River and named it "Changchun Ting". At the end of the 18th century peasants from overpopulated provinces such as Shandong and Hebei began to settle in the region. In 1889, the village was promoted into a city known as "Changchun Fu". In May 1898, Changchun got its first railway station, located in Kuancheng , part of the railway from Harbin to Lüshun (the southern branch of the Chinese Eastern Railway ), constructed by the Russian Empire . After Russia's loss of the southernmost section of this branch as a result of the Russo-Japanese War of 1904–1905, the Kuancheng station (Kuanchengtze, in contemporary spelling) became the last Russian station on this branch. The next station just a short distance to the south—the new "Japanese" Changchun station—became the first station of the South Manchuria Railway , which now owned all the tracks running farther south, to Lüshun , which they re-gauged to the standard gauge (after a short period of using the narrow Japanese 3 ft 6 in ( 1,067 mm ) gauge during the war). A special Russo-Japanese agreement of 1907 provided that Russian gauge tracks would continue from the "Russian" Kuancheng Station to the "Japanese" Changchun Station, and vice versa, tracks on the "gauge adapted by the South Manchuria Railway" (i.e. the standard gauge) would continue from Changchun Station to Kuancheng Station. An epidemic of pneumonic plague occurred in surrounding Manchuria from 1910 to 1911, known as the Manchurian plague . It was the worst-ever recorded outbreak of pneumonic plague which was spread through the Trans-Manchurian railway from the border trade port of Manzhouli . This turned out to be the beginning of the large pneumonic plague pandemic of Manchuria and Mongolia which ultimately claimed 60,000 victims. The Treaty of Portsmouth formally ended the Russo-Japanese War of 1904–05 and saw the transfer and assignment to the Empire of Japan in 1906 the railway between Changchun and Port Arthur, and all its branches. Having realized the strategic importance of Changchun's location with respect to Japan, China and Russia, the Japanese Government sent a group of planners and engineers to Changchun to determine the best site for a new railway station. Without the consent of the Chinese Government, Japan purchased or seized from local farmers the land on which the Changchun Railway Station was to be constructed as the centre of the South Manchuria Railway Affiliated Areas (SMRAA). In order to turn Changchun into the centre for extracting the agricultural and mineral resources of Manchuria, Japan developed a blueprint for Changchun and invested heavily in the construction of the city. At the beginning of 1907, as the prelude to, and preparation for, the invasion and occupation of China, Japan initiated the planning programme of the SMRAA, which embodied distinctive colonial characteristics. The guiding ideology of the overall design was to build a high standard colonial city with sophisticated facilities, multiple functions and a large scale. Accordingly, nearly Â¥7 million on average was allocated on a year-by-year basis for urban planning and construction during the period 1907 to 1931. The comprehensive plan was to ensure the comfort required by Japanese employees on Manchurian Railways, build up Changchun into a base for Japanese control of the whole Manchuria in order to provide an effective counterweight to Russia in this area of China. The city's role as a rail hub was underlined in its planning and construction, the main design concepts of which read as follows: under conventional grid pattern terms, two geoplagiotropic boulevards were newly carved eastward and westward from the grand square of the new railway station. The two helped form two intersections with the gridded prototypes, which led to two circles of South and West. The two sub-civic centres served as axes on which eight radial roads were blazed that took the shape of a sectoral structure. At that time, the radial circles and the design concept of urban roads were quite advanced and scientific. It activated to great extent the serious urban landscapes as well as clearly identifying the traditional gridded pattern. [ by whom? ] With the new Changchun railway station as its centre, the urban plan divided the SMRAA into various specified areas: residential quarters 15%, commerce 33%, grain depot 19%, factories 12%, public entertainment 9%, and administrative organs (including a Japanese garrison) 12%. Each block provided the railway station with supporting and systematic services dependent on its own functions. In the meantime, a comprehensive system of judiciary and military police was established which was totally independent of China. That accounted for the widespread nature of military facilities within the urban construction area of 3.967 km 2 (1.532 sq mi) , such as the railway garrison, the gendarmerie and the police department, with its 18 local police stations. Perceiving Changchun as a tabula rasa upon which to construct new and sweeping conceptions of the built environment, the Japanese used the city as a practical laboratory to create two distinct and idealized urban milieus, each appropriate to a particular era. From 1906 to 1931, Changchun served as a key railway town through which the Japanese orchestrated an informal empire. Between 1932 and 1945, the city became home to a grandiose new Asian capital. Yet, while the façades in the city and later the capital contrasted markedly, along with the attitudes of the state they upheld, the shifting styles of planning and architecture consistently attempted to represent Japanese rule as progressive, beneficent, and modern. [ by whom? ] The development of Changchun, in addition to being driven by the railway system, suggested an important period of the Northeast modern architectural culture, reflecting Japanese urban design endeavours and revealing that county's ambition to invade and occupy China. Japanese architecture and culture had been widely applied to Manchukuo to highlight the special status of the Japanese puppet. Urban planning clearly stems from a culture, be it aggressive or creative. Changchun's planning and construction process serves as a good example. [ by whom? ] Changchun expanded rapidly as the junction between of the Japanese-owned South Manchurian Railway and the Russian-owned Chinese Eastern Railway , remaining the break of gauge point between the Russian and standard gauges into the 1930s, On 10 March 1932 the capital of Manchukuo , a Japan-controlled puppet state in Manchuria , was established in Changchun. The city was then renamed Hsinking ( Chinese : 新京 ; pinyin : XÄ«njÄ«ng ; Wade–Giles : Hsin-ching ; Japanese : Shinkyō ; literally "New Capital") on 13 March. The Emperor Puyi resided in the Imperial Palace ( Chinese : 帝宮 ; pinyin : Dì gōng ) which is now the Museum of the Manchu State Imperial Palace . During the Manchukuo period, the region experienced harsh suppression, brutal warfare on the civilian population, [ citation needed ] forced conscription and labor and other Japanese sponsored government brutalities; at the same time a rapid industrialisation and militarisation took place. Hsinking was a well-planned city with broad avenues and modern public works. The city underwent rapid expansion in both its economy and infrastructure. Many of buildings built during the Japanese colonial era still stand today, including those of the Eight Major Bureaus of Manchukuo ( Chinese : å «å¤§éƒ¨ ; pinyin : Bādà bù ) as well as the Headquarters of the Japanese Kwantung Army . Hsinking was the only Direct-controlled municipality ( 特别市 ) in Manchukuo after Harbin was incorporated into the jurisdiction of Binjiang Province . In March 1932, the Inspection Division of South Manchuria Railway started to draw up the Metropolitan Plan of Great Hsinking ( simplified Chinese : 大新京都市计画 ; traditional Chinese : 大新京都市計畫 ; pinyin : Dà xÄ«n jÄ«ngdÅ« shì jìhuà ). The Bureau of capital construction ( 国都建设局 ; 國都建設局 ; GuódÅ« jià nshè jú ) which was directly under the control of State Council of Manchukuo was established to take complete responsibility of the formulation and the implementation of the plan. Kuniaki Koiso , the Chief of Staff of the Kwantung Army , and Yasuji Okamura , the Vice Chief-of-Staff, finalized the plan of a 200 km 2 (77 sq mi) construction area. The Metropolitan Plan of Great Hsinking was influenced by the renovation plan of Paris in the 19th century, the garden city movement , and theories of American cities' planning and design in the 1920s. The city development plan included extensive tree planting. By 1934 Hsinking was known as the Forest Capital with Jingyuetan Park built, which is now China's largest Plantation and a AAAA-rated recreational area. In accordance with the Metropolitan Plan of Great Hsinking, the area of publicly shared land (including the Imperial Palace, government offices, roads, parks and athletic grounds) in Hsinking was 47 km 2 (18 sq mi) , whilst the area of residential, commercial and industrial developments was planned to be 53 km 2 (20 sq mi) . However, Hsinking's population exceeded the prediction of 500,000 by 1940. In 1941, the Capital Construction Bureau modified the original plan, which expanded the urban area to 160 km 2 (62 sq mi) . The new plan also focused on the construction of satellite towns around the city with a planning of 200 m 2 (2,200 sq ft) land per capita. Because the effects of war, the Metropolitan Plan of Great Hsinking remained unfinished. By 1944, the built up urban area of Hsinking reached 80 km 2 (31 sq mi) , while the area used for greening reached 70.7 km 2 (27.3 sq mi) . As Hsinking's city orientation was the administrative center and military commanding center, land for military use exceeded the originally planned figure of 9 percent, while only light manufacturing including packing industry, cigarette industry and paper-making had been developed during this period. Japanese force also controlled Hsinking's police system, instead of Manchukuo government. Major officers of Hsinking police were all ethnic Japanese. The population of Hsinking also experienced rapid growth after being established as the capital of Manchukuo. According to the census in 1934 taken by the police agency, the city's municipal area had 141,712 inhabitants. By 1944 the city's population had risen to 863,607, with 153,614 Japanese settlers . This population amount made Hsinking the third largest metropolitan city in Manchukuo after Mukden and Harbin, as the metropolitan mainly focused on military and political function. In 1936, the Imperial Japanese Army established Unit 100 to develop plague biological weapons , although the declared purpose of Unit 100 was to conduct research about diseases originating from animals . During the Second Sino-Japanese War (1937–1945) and World War II the headquarters of Unit 100 ("Wakamatsu Unit") was located in downtown Hsinking, under command of veterinarian Yujiro Wakamatsu . This facility was involved in research of animal vaccines to protect Japanese resources, and, especially, biological-warfare. Diseases were tested for use against Soviet and Chinese horses and other livestock . In addition to these tests, Unit 100 ran a bacteria factory to produce the pathogens needed by other units. Biological sabotage testing was also handled at this facility: everything from poisons to chemical crop destruction. On 20 August 1945 the city was captured by the Soviet Red Army and renamed Changchun. The Russians maintained a presence in the city during the Soviet occupation of Manchuria until 1946. National Revolutionary Army forces under Zheng Dongguo occupied the city in 1946, but were unable to hold the countryside against Lin Biao 's People's Liberation Army forces during the Chinese Civil War . The city fell to the Chinese Communist Party in 1948 after the five-month Siege of Changchun , and the communist victory was a turning point which allowed an offensive to capture the remainder of Mainland China . Between 10 and 30 percent of the civilian population starved to death under the siege; estimates range from 150,000 to 330,000. As of 2015 [ update ] the PRC government avoids all mention of the siege. Renamed Changchun by the People's Republic of China government , it became the capital of Jilin in 1954. The Changchun Film Studio is also one of the remaining film studios of the era. Changchun Film Festival has become a unique gala for film industries since 1992. From the 1950s, Changchun was designated to become a center for China's automotive industry . Construction of the First Automobile Works (FAW) began in 1953 and production of the Jiefang CA-10 truck, based on the Soviet ZIS-150 started in 1956. Soviet Union lent assistance during these early years, providing technical support, tooling, and production machinery. In 1958, FAW introduced the famous Hongqi (Red Flag) limousines This series of cars are billed as "the official car for minister-level officials". In 2002, the local television broadcast was hijacked by a small group of Falun Gong practitioners. These events were depicted in the documentary Eternal Spring . Changchun hosted the 2007 Winter Asian Games . Changchun was initially established on imperial decree as a small trading post and frontier village during the reign of the Jiaqing Emperor in the Qing dynasty . Trading activities mainly involved furs and other natural products during this period. In 1800, the Jiaqing Emperor selected a small village on the east bank of the Yitong River and named it "Changchun Ting". At the end of the 18th century peasants from overpopulated provinces such as Shandong and Hebei began to settle in the region. In 1889, the village was promoted into a city known as "Changchun Fu". In May 1898, Changchun got its first railway station, located in Kuancheng , part of the railway from Harbin to Lüshun (the southern branch of the Chinese Eastern Railway ), constructed by the Russian Empire . After Russia's loss of the southernmost section of this branch as a result of the Russo-Japanese War of 1904–1905, the Kuancheng station (Kuanchengtze, in contemporary spelling) became the last Russian station on this branch. The next station just a short distance to the south—the new "Japanese" Changchun station—became the first station of the South Manchuria Railway , which now owned all the tracks running farther south, to Lüshun , which they re-gauged to the standard gauge (after a short period of using the narrow Japanese 3 ft 6 in ( 1,067 mm ) gauge during the war). A special Russo-Japanese agreement of 1907 provided that Russian gauge tracks would continue from the "Russian" Kuancheng Station to the "Japanese" Changchun Station, and vice versa, tracks on the "gauge adapted by the South Manchuria Railway" (i.e. the standard gauge) would continue from Changchun Station to Kuancheng Station. An epidemic of pneumonic plague occurred in surrounding Manchuria from 1910 to 1911, known as the Manchurian plague . It was the worst-ever recorded outbreak of pneumonic plague which was spread through the Trans-Manchurian railway from the border trade port of Manzhouli . This turned out to be the beginning of the large pneumonic plague pandemic of Manchuria and Mongolia which ultimately claimed 60,000 victims. The Treaty of Portsmouth formally ended the Russo-Japanese War of 1904–05 and saw the transfer and assignment to the Empire of Japan in 1906 the railway between Changchun and Port Arthur, and all its branches. Having realized the strategic importance of Changchun's location with respect to Japan, China and Russia, the Japanese Government sent a group of planners and engineers to Changchun to determine the best site for a new railway station. Without the consent of the Chinese Government, Japan purchased or seized from local farmers the land on which the Changchun Railway Station was to be constructed as the centre of the South Manchuria Railway Affiliated Areas (SMRAA). In order to turn Changchun into the centre for extracting the agricultural and mineral resources of Manchuria, Japan developed a blueprint for Changchun and invested heavily in the construction of the city. At the beginning of 1907, as the prelude to, and preparation for, the invasion and occupation of China, Japan initiated the planning programme of the SMRAA, which embodied distinctive colonial characteristics. The guiding ideology of the overall design was to build a high standard colonial city with sophisticated facilities, multiple functions and a large scale. Accordingly, nearly Â¥7 million on average was allocated on a year-by-year basis for urban planning and construction during the period 1907 to 1931. The comprehensive plan was to ensure the comfort required by Japanese employees on Manchurian Railways, build up Changchun into a base for Japanese control of the whole Manchuria in order to provide an effective counterweight to Russia in this area of China. The city's role as a rail hub was underlined in its planning and construction, the main design concepts of which read as follows: under conventional grid pattern terms, two geoplagiotropic boulevards were newly carved eastward and westward from the grand square of the new railway station. The two helped form two intersections with the gridded prototypes, which led to two circles of South and West. The two sub-civic centres served as axes on which eight radial roads were blazed that took the shape of a sectoral structure. At that time, the radial circles and the design concept of urban roads were quite advanced and scientific. It activated to great extent the serious urban landscapes as well as clearly identifying the traditional gridded pattern. [ by whom? ] With the new Changchun railway station as its centre, the urban plan divided the SMRAA into various specified areas: residential quarters 15%, commerce 33%, grain depot 19%, factories 12%, public entertainment 9%, and administrative organs (including a Japanese garrison) 12%. Each block provided the railway station with supporting and systematic services dependent on its own functions. In the meantime, a comprehensive system of judiciary and military police was established which was totally independent of China. That accounted for the widespread nature of military facilities within the urban construction area of 3.967 km 2 (1.532 sq mi) , such as the railway garrison, the gendarmerie and the police department, with its 18 local police stations. Perceiving Changchun as a tabula rasa upon which to construct new and sweeping conceptions of the built environment, the Japanese used the city as a practical laboratory to create two distinct and idealized urban milieus, each appropriate to a particular era. From 1906 to 1931, Changchun served as a key railway town through which the Japanese orchestrated an informal empire. Between 1932 and 1945, the city became home to a grandiose new Asian capital. Yet, while the façades in the city and later the capital contrasted markedly, along with the attitudes of the state they upheld, the shifting styles of planning and architecture consistently attempted to represent Japanese rule as progressive, beneficent, and modern. [ by whom? ] The development of Changchun, in addition to being driven by the railway system, suggested an important period of the Northeast modern architectural culture, reflecting Japanese urban design endeavours and revealing that county's ambition to invade and occupy China. Japanese architecture and culture had been widely applied to Manchukuo to highlight the special status of the Japanese puppet. Urban planning clearly stems from a culture, be it aggressive or creative. Changchun's planning and construction process serves as a good example. [ by whom? ] Changchun expanded rapidly as the junction between of the Japanese-owned South Manchurian Railway and the Russian-owned Chinese Eastern Railway , remaining the break of gauge point between the Russian and standard gauges into the 1930s, On 10 March 1932 the capital of Manchukuo , a Japan-controlled puppet state in Manchuria , was established in Changchun. The city was then renamed Hsinking ( Chinese : 新京 ; pinyin : XÄ«njÄ«ng ; Wade–Giles : Hsin-ching ; Japanese : Shinkyō ; literally "New Capital") on 13 March. The Emperor Puyi resided in the Imperial Palace ( Chinese : 帝宮 ; pinyin : Dì gōng ) which is now the Museum of the Manchu State Imperial Palace . During the Manchukuo period, the region experienced harsh suppression, brutal warfare on the civilian population, [ citation needed ] forced conscription and labor and other Japanese sponsored government brutalities; at the same time a rapid industrialisation and militarisation took place. Hsinking was a well-planned city with broad avenues and modern public works. The city underwent rapid expansion in both its economy and infrastructure. Many of buildings built during the Japanese colonial era still stand today, including those of the Eight Major Bureaus of Manchukuo ( Chinese : å «å¤§éƒ¨ ; pinyin : Bādà bù ) as well as the Headquarters of the Japanese Kwantung Army . Hsinking was the only Direct-controlled municipality ( 特别市 ) in Manchukuo after Harbin was incorporated into the jurisdiction of Binjiang Province . In March 1932, the Inspection Division of South Manchuria Railway started to draw up the Metropolitan Plan of Great Hsinking ( simplified Chinese : 大新京都市计画 ; traditional Chinese : 大新京都市計畫 ; pinyin : Dà xÄ«n jÄ«ngdÅ« shì jìhuà ). The Bureau of capital construction ( 国都建设局 ; 國都建設局 ; GuódÅ« jià nshè jú ) which was directly under the control of State Council of Manchukuo was established to take complete responsibility of the formulation and the implementation of the plan. Kuniaki Koiso , the Chief of Staff of the Kwantung Army , and Yasuji Okamura , the Vice Chief-of-Staff, finalized the plan of a 200 km 2 (77 sq mi) construction area. The Metropolitan Plan of Great Hsinking was influenced by the renovation plan of Paris in the 19th century, the garden city movement , and theories of American cities' planning and design in the 1920s. The city development plan included extensive tree planting. By 1934 Hsinking was known as the Forest Capital with Jingyuetan Park built, which is now China's largest Plantation and a AAAA-rated recreational area. In accordance with the Metropolitan Plan of Great Hsinking, the area of publicly shared land (including the Imperial Palace, government offices, roads, parks and athletic grounds) in Hsinking was 47 km 2 (18 sq mi) , whilst the area of residential, commercial and industrial developments was planned to be 53 km 2 (20 sq mi) . However, Hsinking's population exceeded the prediction of 500,000 by 1940. In 1941, the Capital Construction Bureau modified the original plan, which expanded the urban area to 160 km 2 (62 sq mi) . The new plan also focused on the construction of satellite towns around the city with a planning of 200 m 2 (2,200 sq ft) land per capita. Because the effects of war, the Metropolitan Plan of Great Hsinking remained unfinished. By 1944, the built up urban area of Hsinking reached 80 km 2 (31 sq mi) , while the area used for greening reached 70.7 km 2 (27.3 sq mi) . As Hsinking's city orientation was the administrative center and military commanding center, land for military use exceeded the originally planned figure of 9 percent, while only light manufacturing including packing industry, cigarette industry and paper-making had been developed during this period. Japanese force also controlled Hsinking's police system, instead of Manchukuo government. Major officers of Hsinking police were all ethnic Japanese. The population of Hsinking also experienced rapid growth after being established as the capital of Manchukuo. According to the census in 1934 taken by the police agency, the city's municipal area had 141,712 inhabitants. By 1944 the city's population had risen to 863,607, with 153,614 Japanese settlers . This population amount made Hsinking the third largest metropolitan city in Manchukuo after Mukden and Harbin, as the metropolitan mainly focused on military and political function. In 1936, the Imperial Japanese Army established Unit 100 to develop plague biological weapons , although the declared purpose of Unit 100 was to conduct research about diseases originating from animals . During the Second Sino-Japanese War (1937–1945) and World War II the headquarters of Unit 100 ("Wakamatsu Unit") was located in downtown Hsinking, under command of veterinarian Yujiro Wakamatsu . This facility was involved in research of animal vaccines to protect Japanese resources, and, especially, biological-warfare. Diseases were tested for use against Soviet and Chinese horses and other livestock . In addition to these tests, Unit 100 ran a bacteria factory to produce the pathogens needed by other units. Biological sabotage testing was also handled at this facility: everything from poisons to chemical crop destruction.Hsinking was the only Direct-controlled municipality ( 特别市 ) in Manchukuo after Harbin was incorporated into the jurisdiction of Binjiang Province . In March 1932, the Inspection Division of South Manchuria Railway started to draw up the Metropolitan Plan of Great Hsinking ( simplified Chinese : 大新京都市计画 ; traditional Chinese : 大新京都市計畫 ; pinyin : Dà xÄ«n jÄ«ngdÅ« shì jìhuà ). The Bureau of capital construction ( 国都建设局 ; 國都建設局 ; GuódÅ« jià nshè jú ) which was directly under the control of State Council of Manchukuo was established to take complete responsibility of the formulation and the implementation of the plan. Kuniaki Koiso , the Chief of Staff of the Kwantung Army , and Yasuji Okamura , the Vice Chief-of-Staff, finalized the plan of a 200 km 2 (77 sq mi) construction area. The Metropolitan Plan of Great Hsinking was influenced by the renovation plan of Paris in the 19th century, the garden city movement , and theories of American cities' planning and design in the 1920s. The city development plan included extensive tree planting. By 1934 Hsinking was known as the Forest Capital with Jingyuetan Park built, which is now China's largest Plantation and a AAAA-rated recreational area. In accordance with the Metropolitan Plan of Great Hsinking, the area of publicly shared land (including the Imperial Palace, government offices, roads, parks and athletic grounds) in Hsinking was 47 km 2 (18 sq mi) , whilst the area of residential, commercial and industrial developments was planned to be 53 km 2 (20 sq mi) . However, Hsinking's population exceeded the prediction of 500,000 by 1940. In 1941, the Capital Construction Bureau modified the original plan, which expanded the urban area to 160 km 2 (62 sq mi) . The new plan also focused on the construction of satellite towns around the city with a planning of 200 m 2 (2,200 sq ft) land per capita. Because the effects of war, the Metropolitan Plan of Great Hsinking remained unfinished. By 1944, the built up urban area of Hsinking reached 80 km 2 (31 sq mi) , while the area used for greening reached 70.7 km 2 (27.3 sq mi) . As Hsinking's city orientation was the administrative center and military commanding center, land for military use exceeded the originally planned figure of 9 percent, while only light manufacturing including packing industry, cigarette industry and paper-making had been developed during this period. Japanese force also controlled Hsinking's police system, instead of Manchukuo government. Major officers of Hsinking police were all ethnic Japanese. The population of Hsinking also experienced rapid growth after being established as the capital of Manchukuo. According to the census in 1934 taken by the police agency, the city's municipal area had 141,712 inhabitants. By 1944 the city's population had risen to 863,607, with 153,614 Japanese settlers . This population amount made Hsinking the third largest metropolitan city in Manchukuo after Mukden and Harbin, as the metropolitan mainly focused on military and political function. In 1936, the Imperial Japanese Army established Unit 100 to develop plague biological weapons , although the declared purpose of Unit 100 was to conduct research about diseases originating from animals . During the Second Sino-Japanese War (1937–1945) and World War II the headquarters of Unit 100 ("Wakamatsu Unit") was located in downtown Hsinking, under command of veterinarian Yujiro Wakamatsu . This facility was involved in research of animal vaccines to protect Japanese resources, and, especially, biological-warfare. Diseases were tested for use against Soviet and Chinese horses and other livestock . In addition to these tests, Unit 100 ran a bacteria factory to produce the pathogens needed by other units. Biological sabotage testing was also handled at this facility: everything from poisons to chemical crop destruction.On 20 August 1945 the city was captured by the Soviet Red Army and renamed Changchun. The Russians maintained a presence in the city during the Soviet occupation of Manchuria until 1946. National Revolutionary Army forces under Zheng Dongguo occupied the city in 1946, but were unable to hold the countryside against Lin Biao 's People's Liberation Army forces during the Chinese Civil War . The city fell to the Chinese Communist Party in 1948 after the five-month Siege of Changchun , and the communist victory was a turning point which allowed an offensive to capture the remainder of Mainland China . Between 10 and 30 percent of the civilian population starved to death under the siege; estimates range from 150,000 to 330,000. As of 2015 [ update ] the PRC government avoids all mention of the siege. Renamed Changchun by the People's Republic of China government , it became the capital of Jilin in 1954. The Changchun Film Studio is also one of the remaining film studios of the era. Changchun Film Festival has become a unique gala for film industries since 1992. From the 1950s, Changchun was designated to become a center for China's automotive industry . Construction of the First Automobile Works (FAW) began in 1953 and production of the Jiefang CA-10 truck, based on the Soviet ZIS-150 started in 1956. Soviet Union lent assistance during these early years, providing technical support, tooling, and production machinery. In 1958, FAW introduced the famous Hongqi (Red Flag) limousines This series of cars are billed as "the official car for minister-level officials". In 2002, the local television broadcast was hijacked by a small group of Falun Gong practitioners. These events were depicted in the documentary Eternal Spring . Changchun hosted the 2007 Winter Asian Games . Changchun lies in the middle portion of the Northeast China Plain . Its municipality area is located at latitude 43° 05′−45° 15′ N and longitude 124° 18′−127° 02' E. The total area of Changchun municipality is 20,571 km 2 (7,943 sq mi) , including metro areas of 2,583 square kilometres (997 sq mi) , and a city proper area of 159 km 2 (61 sq mi) . The city is situated at a moderate elevation, ranging from 250 to 350 metres (820 to 1,150 ft) within its administrative region. In the eastern portion of the city, there lies a small area of low mountains, with the Laodaodong Mountain, which has an altitude of 711 meters, being the highest. The city is also situated at the crisscross point of the third east–westward "Europe-Asia Continental Bridge". [ citation needed ] Changchun prefecture is dotted with 222 rivers and lakes. The Yitong River, a small tributary of the Songhua River, runs through the city proper. Changchun has a four-season, monsoon-influenced, humid continental climate ( Köppen Dwa ). Winters are long (lasting from November to March), cold, and windy, but dry, due to the influence of the Siberian anticyclone , with a January mean temperature of −14.3 °C (6.3 °F) . Spring and autumn are somewhat short transitional periods, with some precipitation, but are usually dry and windy. Summers are hot and humid, with a prevailing southeasterly wind due to the East Asian monsoon; July averages 23.7 °C (74.7 °F) . Snow is usually light during the winter, and annual rainfall is heavily concentrated from June to August. With monthly percent possible sunshine ranging from 49 percent in July to 69 percent in February, a typical year will see around 2,597 hours of sunshine, and a frost-free period of 140 to 150 days. Extreme temperatures have ranged from −33.0 °C (−27 °F) to 35.7 °C (96 °F) . Changchun has a four-season, monsoon-influenced, humid continental climate ( Köppen Dwa ). Winters are long (lasting from November to March), cold, and windy, but dry, due to the influence of the Siberian anticyclone , with a January mean temperature of −14.3 °C (6.3 °F) . Spring and autumn are somewhat short transitional periods, with some precipitation, but are usually dry and windy. Summers are hot and humid, with a prevailing southeasterly wind due to the East Asian monsoon; July averages 23.7 °C (74.7 °F) . Snow is usually light during the winter, and annual rainfall is heavily concentrated from June to August. With monthly percent possible sunshine ranging from 49 percent in July to 69 percent in February, a typical year will see around 2,597 hours of sunshine, and a frost-free period of 140 to 150 days. Extreme temperatures have ranged from −33.0 °C (−27 °F) to 35.7 °C (96 °F) . The sub-provincial city of Changchun has direct jurisdiction over 7 districts , 3 county-level cities and 1 County :According to the Sixth China Census , the total population of the City of Changchun reached 7.677 million in 2010. The statistics in 2011 estimated the total population to be 7.59 million. The birth rate was 6.08 per thousand and the death rate was 5.51 per thousand. The urban area had a population of 3.53 million people. In 2010 the sex ratio of the city population was 102.10 males to 100 females. As in most of Northeastern China the ethnic makeup of Changchun is predominantly Han nationality (96.57 percent), with several other minority nationalities . [ citation needed ]As in most of Northeastern China the ethnic makeup of Changchun is predominantly Han nationality (96.57 percent), with several other minority nationalities . [ citation needed ]The most commonly spoken dialect in Changchun is the Northeastern Mandarin, which is originated from the mix of several languages spoken by immigrants from Hebei and Shandong . Then, after the PRC was established, the rapid economic growth in Changchun attracted a huge amount of immigrants from various places, so the northeastern dialect spoken in urban areas of Changchun is closer to the Mandarin Chinese than the in rural areas because the immigrants had a great impact on the northeastern dialect spoken in urban areas. Changchun has four major religions: Buddhism, Taoism, Christianity, and Islam. There are 396 government-approved places for religious activities and worship services. The temples in Changchun include Changchun Wanshou Temple, Baoguo Prajna Temple, Baiguo Xinglong Temple, Pumen Temple, Big Buddha Temple, Changchun Temple, Changchun Catholic Church , Changchun West Wuma Road Christian Church , and Changchun City Mosque. Shamanism had been circulated in Northeast China during ancient times and was believed by many Manchus. Now the shamanism and the study of it have become an important cultural heritage of the region. Jilin Provincial Museum , a national first-grade museum , is located in Changchun. The museum was moved to Changchun from Jilin City after the transfer of the provincial government seat. It was originally located in the centre of the old town, but, after nine years of construction, a new building for the museum's collections was completed in 2016 on the city's outskirts in Nanguan District near Jingyuetan Park. Badabu is a group of buildings of the former eight Manchukuo ministries which are Ministry of Public Safety, Ministry of Justice, Ministry of Economy, Ministry of Communications, Ministry of Agriculture, Ministry of Culture and Education, Ministry of Foreign Affairs, Ministry of Civil Affairs that has recently become a sightseeing highlight because of their unique combined Chinese, Japanese and Manchurian architecture. Jingyuetan National Forest Park is located to the southeast of the city, and is one of the AAAAA Tourist Attractions of China . The park hosts Vasaloppet China annually. The most commonly spoken dialect in Changchun is the Northeastern Mandarin, which is originated from the mix of several languages spoken by immigrants from Hebei and Shandong . Then, after the PRC was established, the rapid economic growth in Changchun attracted a huge amount of immigrants from various places, so the northeastern dialect spoken in urban areas of Changchun is closer to the Mandarin Chinese than the in rural areas because the immigrants had a great impact on the northeastern dialect spoken in urban areas. Changchun has four major religions: Buddhism, Taoism, Christianity, and Islam. There are 396 government-approved places for religious activities and worship services. The temples in Changchun include Changchun Wanshou Temple, Baoguo Prajna Temple, Baiguo Xinglong Temple, Pumen Temple, Big Buddha Temple, Changchun Temple, Changchun Catholic Church , Changchun West Wuma Road Christian Church , and Changchun City Mosque. Shamanism had been circulated in Northeast China during ancient times and was believed by many Manchus. Now the shamanism and the study of it have become an important cultural heritage of the region. Jilin Provincial Museum , a national first-grade museum , is located in Changchun. The museum was moved to Changchun from Jilin City after the transfer of the provincial government seat. It was originally located in the centre of the old town, but, after nine years of construction, a new building for the museum's collections was completed in 2016 on the city's outskirts in Nanguan District near Jingyuetan Park. Badabu is a group of buildings of the former eight Manchukuo ministries which are Ministry of Public Safety, Ministry of Justice, Ministry of Economy, Ministry of Communications, Ministry of Agriculture, Ministry of Culture and Education, Ministry of Foreign Affairs, Ministry of Civil Affairs that has recently become a sightseeing highlight because of their unique combined Chinese, Japanese and Manchurian architecture. Jingyuetan National Forest Park is located to the southeast of the city, and is one of the AAAAA Tourist Attractions of China . The park hosts Vasaloppet China annually. Changchun achieved a gross domestic product (GDP) of RMB332.9 billion in 2010, representing a rise of 15.3 percent year on year. Primary industry output increased by 3.3 percent to RMB25.27 billion. Secondary industry output experienced an increase of 19.0 percent, reaching RMB171.99 billion, while the tertiary industry output increased 12.6 percent to RMB135.64 billion. The GDP per capita of Changchun was Â¥ 58,691 in 2012, which equates to $9338. The GDP of Changchun in 2012 was RMB445.66 billion and increased 12.0 percent compared with 2011. The primary industry grew 4.3 percent to RMB31.71 billion. Secondary industry increased by RMB229.19 billion, which is a rise of 13.1 percent year on year. Tertiary industry of Changchun in 2012 grew 11.8 percent and increased by RMB184.76 billion. The city's leading industries are production of automobiles, agricultural product processing, biopharmaceuticals, photo electronics, construction materials, and the energy industry. Changchun is the largest automobile manufacturing, research and development centre in China, producing 9 percent of the country's automobiles in 2009. Changchun is home to China's biggest vehicle producer FAW ( First Automotive Works ) Group, which manufactured the first Chinese truck in 1956 and car in 1958. The automaker's factories and associated housing and services occupy a substantial portion of the city's southwest end. Specific brands produced in Changchun include the Red Flag luxury brand, as well as joint ventures with Audi , Volkswagen , and Toyota . In 2012, FAW sold 2.65 million units of auto. The sales revenue of FAW amounted to RMB 408.46 billion, representing a rise of 10.8% on year. As cradle of the auto industry, one of Changchun's better known nicknames is "China's Detroit". Manufacturing of transportation facilities and machinery is also among Changchun's main industries. 50 percent of China's passenger trains , and 10 percent of tractors are produced in Changchun. Changchun Railway Vehicles , one of the main branches of China CNR Corporation , has a joint venture established with Bombardier Transportation to build Movia metro cars for the Guangzhou Metro and Shanghai Metro , and the Tianjin Metro . Foreign direct investment in the city was US$3.68 billion in 2012, up 19.6% year on year. In 2004 Coca-Cola set up a bottling plant in the city's ETDZ with an investment of US$20 million. Changchun hosts the yearly Changchun International Automobile Fair, Changchun Film Festival , Changchun Agricultural Fair, Education Exhibition and the Sculpture Exhibition. CRRC manufactures most of its bullet train carriages at its factory in Changchun. In November 2016, CRCC Changchun unveiled the first bullet train carriages in the world with sleeper berths, thus extending their use for overnight passages across China. They would be capable of running in ultra low temperature environments. Nicknamed Panda , the new bullet trains are capable of running at 250 km/h, operate at −40 degrees Celsius , have Wi-Fi hubs and contain sleeper berths that fold into seats during the day. Other large companies in Changchun include: Founded in 1993, the Changchun Automotive Trade Center was re-established as the Changchun Automotive Economic Trade and Development Zone in 1996. The development zone is situated in the southwest of the city and is adjacent to the China First Automobile Works Group Corporation and the Changchun Film ThemeCity. It covers a total area of approximately 300,000 square metres (3,229,173 square feet) . Within the development zone lies an exhibition center and five specially demarcated industrial centers. The Changchun Automobile Wholesale Center began operations in 1994 and is the largest auto-vehicle and spare parts wholesale center in China. The other centers include a resale center for used auto-vehicles, a specialized center for industrial/commercial vehicles, and a tire wholesale center. The zone is one of the first 27 state-level advanced technology development zones and is situated in the southern part of the city, covering a total area of 49 km 2 (19 sq mi) . There are 18 full-time universities and colleges, 39 state and provincial-level scientific research institutions, and 11 key national laboratories. The zone is mainly focusing on developing five main industries, namely bio-engineering, automobile engineering, new material fabrication, photo-electricity, and information technology. Established in April 1993, the zone enjoys all the preferential policies stipulated for economic and technological development zones of coastal open cities. The total area of CETDZ is 112.72 square kilometres (43.52 square miles) , of which 30 square kilometres (12 square miles) has been set aside for development and utilization. It is located 5 kilometres (3 miles) from downtown Changchun, 2 km (1.2 mi) from the freight railway station and 15 km (9 mi) from the Changchun international airport. The zone is devoted to developing five leading industries: namely automotive parts and components, photoelectric information, bio-pharmaceutical, fine processing of foods, and new building materials. In particular, high-tech and high value added projects account for over 80 percent of total output. In 2006 the zone's total fixed assets investment rose to RMB38.4 billion. Among the total of 1656 enterprises registered, 179 are foreign-funded. The zone also witnessed a total industrial output of RMB 277 billion in 2007. Founded in 1993, the Changchun Automotive Trade Center was re-established as the Changchun Automotive Economic Trade and Development Zone in 1996. The development zone is situated in the southwest of the city and is adjacent to the China First Automobile Works Group Corporation and the Changchun Film ThemeCity. It covers a total area of approximately 300,000 square metres (3,229,173 square feet) . Within the development zone lies an exhibition center and five specially demarcated industrial centers. The Changchun Automobile Wholesale Center began operations in 1994 and is the largest auto-vehicle and spare parts wholesale center in China. The other centers include a resale center for used auto-vehicles, a specialized center for industrial/commercial vehicles, and a tire wholesale center. The zone is one of the first 27 state-level advanced technology development zones and is situated in the southern part of the city, covering a total area of 49 km 2 (19 sq mi) . There are 18 full-time universities and colleges, 39 state and provincial-level scientific research institutions, and 11 key national laboratories. The zone is mainly focusing on developing five main industries, namely bio-engineering, automobile engineering, new material fabrication, photo-electricity, and information technology. Established in April 1993, the zone enjoys all the preferential policies stipulated for economic and technological development zones of coastal open cities. The total area of CETDZ is 112.72 square kilometres (43.52 square miles) , of which 30 square kilometres (12 square miles) has been set aside for development and utilization. It is located 5 kilometres (3 miles) from downtown Changchun, 2 km (1.2 mi) from the freight railway station and 15 km (9 mi) from the Changchun international airport. The zone is devoted to developing five leading industries: namely automotive parts and components, photoelectric information, bio-pharmaceutical, fine processing of foods, and new building materials. In particular, high-tech and high value added projects account for over 80 percent of total output. In 2006 the zone's total fixed assets investment rose to RMB38.4 billion. Among the total of 1656 enterprises registered, 179 are foreign-funded. The zone also witnessed a total industrial output of RMB 277 billion in 2007. Founded in 1993, the Changchun Automotive Trade Center was re-established as the Changchun Automotive Economic Trade and Development Zone in 1996. The development zone is situated in the southwest of the city and is adjacent to the China First Automobile Works Group Corporation and the Changchun Film ThemeCity. It covers a total area of approximately 300,000 square metres (3,229,173 square feet) . Within the development zone lies an exhibition center and five specially demarcated industrial centers. The Changchun Automobile Wholesale Center began operations in 1994 and is the largest auto-vehicle and spare parts wholesale center in China. The other centers include a resale center for used auto-vehicles, a specialized center for industrial/commercial vehicles, and a tire wholesale center. The zone is one of the first 27 state-level advanced technology development zones and is situated in the southern part of the city, covering a total area of 49 km 2 (19 sq mi) . There are 18 full-time universities and colleges, 39 state and provincial-level scientific research institutions, and 11 key national laboratories. The zone is mainly focusing on developing five main industries, namely bio-engineering, automobile engineering, new material fabrication, photo-electricity, and information technology.Established in April 1993, the zone enjoys all the preferential policies stipulated for economic and technological development zones of coastal open cities. The total area of CETDZ is 112.72 square kilometres (43.52 square miles) , of which 30 square kilometres (12 square miles) has been set aside for development and utilization. It is located 5 kilometres (3 miles) from downtown Changchun, 2 km (1.2 mi) from the freight railway station and 15 km (9 mi) from the Changchun international airport. The zone is devoted to developing five leading industries: namely automotive parts and components, photoelectric information, bio-pharmaceutical, fine processing of foods, and new building materials. In particular, high-tech and high value added projects account for over 80 percent of total output. In 2006 the zone's total fixed assets investment rose to RMB38.4 billion. Among the total of 1656 enterprises registered, 179 are foreign-funded. The zone also witnessed a total industrial output of RMB 277 billion in 2007. Changchun is a very compact city, planned by the Japanese with a layout of open avenues and public squares. The city is developing its layout in a long-term bid to alleviate pressure on limited land, aid economic development, and absorb a rising population. According to a draft plan up until 2020, the downtown area will expand southwards to form a new city center around Changchun World Sculpture Park, Weixing Square and their outskirts, and the new development zone. For the north of the city, there is a new development zone called "Changchun New Area", locate near the North Lake Park. Changchun has two passenger rail stations, all conventional trains and some high-speed trains stop at the central Changchun railway station ( simplified Chinese : 长春站 ; traditional Chinese : 長春站 ), which is connected by Beijing-Harbin Railway , Changchun-Hunchun intercity railway and serval railway lines. The station have multiple daily departures to other cities in the province and northeast area, such as Jilin City , Yanji , Harbin , Shenyang , and Dalian , as well as other major cities throughout the country such as Beijing , Shanghai and Guangzhou . [ citation needed ] The new Changchun West railway station , situated in the western end of urbanized area, is the station mainly for the high-speed trains of the Harbin–Dalian high-speed railway . Changchun is served by a comprehensive bus system, which having more than 250 bus route, most buses charge 1-2 yuan per ride. Changchun is one of the few cities preserving the historic tram system in China. The tram system first opened in 1941, having 6 lines covering almost 53km at its peak. But after several route adjustments, there is only one line left since the 2000s. A new branch line is opened in 2014, which links the new Changchun West Railway Station . The whole system is now operated under the bus system of Changchun. Changchun Rail Transit is an rapid transit system of Changchun, combind light rail lines and metro lines. Its first line was opened on 30 October 2002, making Changchun the fifth metropolitan city in China to open rail transit. Till November 2018, there are 5 lines in Changchun, including Line 1, Line 2, Line 3, Line 4, and Line 8. Changchun railway covers about 100.17 kilometers. Till September 2019, there are 4 lines of Changchun Rail Transit under construction, including Line 6 and Line 9, as well as Line 2 West Extension and Line 3 East Extension. By 2025, the Changchun rail transit line network will consist of 10 lines with a total length of 341.62 kilometers. In September 2019, the average daily passenger volume of Changchun Rail Transit reached 680,400 person, and the maximum daily passenger volume of its line network was 830,500 person on 13 November 2019. The total estimated passenger volume in 2019 is about 168 million person. Changchun is linked to the national highway network through the Beijing – Harbin Expressway (G1), the Ulanhot – Changchun – Jilin – Hunchun Expressway (G12), the Changchun – Shenzhen Expressway (G25), the Changchun – Changbaishan Expressway (S1) and the busiest section in the province, the Changchun–Jilin North Highway. This section connects the two biggest cities in Jilin and is the trunk line for the social and economic communication of the two cities. Private automobiles are becoming very common on the city's congested streets. Bicycles are relatively rare compared to other northeastern Chinese cities, but mopeds, as well as pedal are relatively common. Changchun Longjia International Airport is located 31.2 kilometres (19.4 miles) north-east of Changchun urban area. The airport's construction began in 1998, and was intended to replace the older Changchun Dafangshen Airport , which was a joint-use airport built in 1941. The airport opened for passenger service on 27 August 2005. The operation of the airport is shared by both Changchun and nearby Jilin City. The airport has scheduled flights to major cities including Beijing, Shanghai, Guangzhou, Shenzhen, Chengdu and 68 other cities. There are also scheduled international flights between Changchun and overseas cities such as Bangkok , Osaka , Khabarovsk , Singapore , Tokyo and Vladivostok .Changchun has two passenger rail stations, all conventional trains and some high-speed trains stop at the central Changchun railway station ( simplified Chinese : 长春站 ; traditional Chinese : 長春站 ), which is connected by Beijing-Harbin Railway , Changchun-Hunchun intercity railway and serval railway lines. The station have multiple daily departures to other cities in the province and northeast area, such as Jilin City , Yanji , Harbin , Shenyang , and Dalian , as well as other major cities throughout the country such as Beijing , Shanghai and Guangzhou . [ citation needed ] The new Changchun West railway station , situated in the western end of urbanized area, is the station mainly for the high-speed trains of the Harbin–Dalian high-speed railway . Changchun is served by a comprehensive bus system, which having more than 250 bus route, most buses charge 1-2 yuan per ride. Changchun is one of the few cities preserving the historic tram system in China. The tram system first opened in 1941, having 6 lines covering almost 53km at its peak. But after several route adjustments, there is only one line left since the 2000s. A new branch line is opened in 2014, which links the new Changchun West Railway Station . The whole system is now operated under the bus system of Changchun.Changchun Rail Transit is an rapid transit system of Changchun, combind light rail lines and metro lines. Its first line was opened on 30 October 2002, making Changchun the fifth metropolitan city in China to open rail transit. Till November 2018, there are 5 lines in Changchun, including Line 1, Line 2, Line 3, Line 4, and Line 8. Changchun railway covers about 100.17 kilometers. Till September 2019, there are 4 lines of Changchun Rail Transit under construction, including Line 6 and Line 9, as well as Line 2 West Extension and Line 3 East Extension. By 2025, the Changchun rail transit line network will consist of 10 lines with a total length of 341.62 kilometers. In September 2019, the average daily passenger volume of Changchun Rail Transit reached 680,400 person, and the maximum daily passenger volume of its line network was 830,500 person on 13 November 2019. The total estimated passenger volume in 2019 is about 168 million person.Changchun is linked to the national highway network through the Beijing – Harbin Expressway (G1), the Ulanhot – Changchun – Jilin – Hunchun Expressway (G12), the Changchun – Shenzhen Expressway (G25), the Changchun – Changbaishan Expressway (S1) and the busiest section in the province, the Changchun–Jilin North Highway. This section connects the two biggest cities in Jilin and is the trunk line for the social and economic communication of the two cities. Private automobiles are becoming very common on the city's congested streets. Bicycles are relatively rare compared to other northeastern Chinese cities, but mopeds, as well as pedal are relatively common.Changchun Longjia International Airport is located 31.2 kilometres (19.4 miles) north-east of Changchun urban area. The airport's construction began in 1998, and was intended to replace the older Changchun Dafangshen Airport , which was a joint-use airport built in 1941. The airport opened for passenger service on 27 August 2005. The operation of the airport is shared by both Changchun and nearby Jilin City. The airport has scheduled flights to major cities including Beijing, Shanghai, Guangzhou, Shenzhen, Chengdu and 68 other cities. There are also scheduled international flights between Changchun and overseas cities such as Bangkok , Osaka , Khabarovsk , Singapore , Tokyo and Vladivostok .Changchun has 27 regular institutions of full-time tertiary education with a total enrollment of approximate 160,000 students. Jilin University and Northeast Normal University are two key universities in China. Jilin University is also one of the largest universities in China, with more than 60,000 students. International schools include:Changchun has 27 regular institutions of full-time tertiary education with a total enrollment of approximate 160,000 students. Jilin University and Northeast Normal University are two key universities in China. Jilin University is also one of the largest universities in China, with more than 60,000 students.International schools include:As a major Chinese city, Changchun is home to many professional sports teams: There are two major multi-purpose stadiums in Changchun, including Changchun City Stadium and Development Area Stadium . Jinlin Tseng Tou are a professional ice hockey team based in the city, and compete in the Russian-based Supreme Hockey League . They are one of two Chinese-based teams to enter the league during the 2017–18 season, the other being based in Harbin. [ citation needed ]

Wiki

Pneumonic plague

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Ziketan Town

Zigortang Town ( Tibetan : རྩི་གོར་ཐང་གྲོང་བརྡལ། ), Zigongtang Town ( རྩི་ཀོང་ཐང་ ), or Ziketan Town ( Chinese : 子科滩镇 ) is a farming town in Xinghai County of Hainan Tibetan Autonomous Prefecture , Qinghai province, People's Republic of China. Zigortang town covers approximately 3,000 square kilometres (1,158 sq mi) and has a population of 10,000. Zigortang is 167 kilometres (104 mi) southwest of the Qinghai provincial capital of Xining . Zigortang lies approximately 1,300 kilometres (810 mi) west of Beijing . The outbreak in Zigortang was first detected on Thursday, July 30, 2009. On August 2, the authorities quarantined Zigortang after a dozen people were sickened with pneumonic plague , a lung infection that can kill a human in 24 hours if left untreated. Police checkpoints were set up in a 17-mile (27 km) radius around Zigortang, and residents were not allowed to leave. The streets were largely deserted and most shops shut, and 23 quarantine stations were set up in the town. The quarantine zone covered an area of 3,500 square kilometres (1,400 sq mi) centred on the town. The first casualty was a 32-year-old herder who had fallen ill after burying his dog, which had died suddenly after eating a marmot infected with the bacterium Yersinia pestis . The dog's owner caught the disease while burying the dog, according to professor Wang Hu, director of the Qinghai disease control bureau. The herder died four days after the dog's burial, and the relatives who handled his funeral were showing symptoms within days. The 10 people sickened, mostly relatives of the herder, were undergoing isolated treatment in hospital, managed by the local health bureau. Police guarded the quarantine center at the township hospital. On Sunday, a 37-year-old man identified only as Danzin, a neighbour of the first victim, became the second reported fatality from the outbreak. On Monday, a 64-year-old man named Danzhi, a neighbour of the first two victims, was the third fatality. As of August 6, no new cases of pneumonic plague had been found beyond the 12 patients in the town who were quarantined on July 31. As of August 6, three patients died and two were still in critical condition . The quarantine on the town was lifted on Saturday (2000 hrs, local time), August 8, 2009. This came after no reports of new infections for more than a week. Authorities urged anyone who had visited Zigortang town since mid-July and has developed a cough or fever to seek hospital treatment. The World Health Organization office in China is in close contact with Chinese health authorities. More than 140 epidemic-prevention professionals from the Ministry of Health and provincial-level institutions were working in the area. In Zigortang, authorities have said homes and shops should be disinfected, and residents should wear face masks when they go out. Around 80 percent of the town's shops were closed on Monday, and prices of disinfectants and some vegetables have already tripled. County officials distributed flyers and made television and radio announcements on how to prevent infection. Medical workers in Zigortang were disinfecting and killing rodents and insects that can be carriers for the bacterium that causes the plague. Authorities are keeping close track of people who came into contact with those infected. This was the third outbreak of the disease in Qinghai within the last 10 years. Provincial health authorities in Qinghai and central government have been concerned about pneumonic plague for some years. As of February 2009, there were 55 teams across the province tasked to monitor and control the disease . Authorities urged anyone who had visited Zigortang town since mid-July and has developed a cough or fever to seek hospital treatment. The World Health Organization office in China is in close contact with Chinese health authorities. More than 140 epidemic-prevention professionals from the Ministry of Health and provincial-level institutions were working in the area. In Zigortang, authorities have said homes and shops should be disinfected, and residents should wear face masks when they go out. Around 80 percent of the town's shops were closed on Monday, and prices of disinfectants and some vegetables have already tripled. County officials distributed flyers and made television and radio announcements on how to prevent infection. Medical workers in Zigortang were disinfecting and killing rodents and insects that can be carriers for the bacterium that causes the plague. Authorities are keeping close track of people who came into contact with those infected. This was the third outbreak of the disease in Qinghai within the last 10 years. Provincial health authorities in Qinghai and central government have been concerned about pneumonic plague for some years. As of February 2009, there were 55 teams across the province tasked to monitor and control the disease .

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Pneumonic plague

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Theories of the Black Death

Theories of the Black Death are a variety of explanations that have been advanced to explain the nature and transmission of the Black Death (1347–51). A number of epidemiologists from the 1980s to the 2000s challenged the traditional view that the Black Death was caused by plague based on the type and spread of the disease. The confirmation in 2010 and 2011 that Yersinia pestis DNA was associated with a large number of plague sites has led researchers to conclude that "Finally, plague is plague." Several possible causes have been advanced for the Black Death; the most prevalent is the bubonic plague theory. Efficient transmission of Yersinia pestis is generally thought to occur only through the bites of fleas whose mid guts become obstructed by replicating Y. pestis several days after feeding on an infected host. This blockage results in starvation and aggressive feeding behaviour by fleas that repeatedly attempt to clear their blockage by regurgitation , resulting in thousands of plague bacteria being flushed into the feeding site, infecting the host. However, modelling of epizootic plague observed in prairie dogs , suggests that occasional reservoirs of infection such as an infectious carcass, rather than "blocked fleas" are a better explanation for the observed epizootic behaviour of the disease in nature. One hypothesis about the epidemiology —the appearance, spread, and especially disappearance—of plague from Europe is that the flea-bearing rodent reservoir of disease was eventually succeeded by another species. The black rat ( Rattus rattus ) was originally introduced from Asia to Europe by trade, but was subsequently displaced and succeeded throughout Europe by the bigger brown rat ( Rattus norvegicus ). The brown rat was not as prone to transmit the germ-bearing fleas to humans in large die-offs due to a different rat ecology. The dynamic complexities of rat ecology, herd immunity in that reservoir, interaction with human ecology, secondary transmission routes between humans with or without fleas, human herd immunity, and changes in each might explain the eruption, dissemination, and re-eruptions of plague that continued for centuries until its unexplained disappearance. The plague comes in three forms and it brought an array of signs and symptoms to those infected. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck, and armpits, which oozed pus and bled. Most victims died within four to seven days after infection. The septicaemic plague is a form of "blood poisoning", and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The bubonic plague was the most commonly seen form during the Black Death. The bubonic form of the plague has a mortality rate of thirty to seventy-five percent and symptoms include fever of 38–41 ° C (101–105 °F ), headaches , painful aching joints, nausea and vomiting , and a general feeling of malaise . The second most common form is the pneumonic plague and has symptoms that include fever, cough, and blood-tinged sputum . As the disease progressed, sputum became free flowing and bright red and death occurred within 2 days. The pneumonic form of the plague has a high mortality rate at ninety to ninety-five percent. Septicemic plague is the least common of the three forms, with a mortality rate close to one hundred percent. Symptoms include high fevers and purple skin patches ( purpura due to DIC ). Both pneumonic and septicemic plague can be caused by flea bites when the lymph nodes are overwhelmed. In this case they are referred to as secondary forms of the disease. David Herlihy identifies from the records another potential sign of the plague: freckle-like spots and rashes. Sources from Viterbo, Italy refer to "the signs which are vulgarly called lenticulae ", a word which bears resemblance to the Italian word for freckles, lentiggini . These are not the swellings of buboes, but rather "darkish points or pustules which covered large areas of the body". The uncharacteristically rapid spread of the plague could be due to respiratory droplet transmission, and low levels of immunity in the European population at that period. Historical examples of pandemics of other diseases in populations without previous exposure, such as smallpox and tuberculosis transmitted by aerosol amongst Native Americans , show that the first instance of an epidemic spreads faster and is far more virulent than later instances among the descendants of survivors, for whom natural selection has produced characteristics that are protective against the disease. [ citation needed ] Historians who believe that the Black Death was indeed caused by bubonic plague have put forth several theories questioning the traditional identification of Rattus sp. and their associated fleas as plague's primary vector . A 2012 report from the University of Bergen acknowledges that Y. pestis could have been the cause of the pandemic, but states that the epidemiology of the disease is different, most importantly the rapid spread and the lack of rats in Scandinavia and other parts of Northern Europe . R. rattus was present in Scandinavian cities and ports at the time of the Black Death but was not found in small, inland villages. Based on archaeological evidence from digs all over Norway , the black rat population was present in sea ports but remained static in the cold climate and would only have been sustained if ships continually brought black rats and that the rats would be unlikely to venture across open ground to remote villages. It argues that while healthy black rats are rarely seen, rats suffering from bubonic plague behave differently from healthy rats; where accounts from warmer climates mention rats falling from roofs and walls and piling high in the streets, Samuel Pepys , who described trifling observations and events of the London plague of 1665 in great detail, makes no mention of sick or dead rats, nor does Absalon Pederssøn in his diary, which contains detailed descriptions of a plague epidemic in Bergen in 1565. Ultimately, Hufthammer and Walløe offer the possibility of human fleas and lice in place of rats. University of Oslo researchers concluded that Y. pestis was likely carried over the Silk Road via fleas on giant gerbils from Central Asia during intermittent warm spells. Michael McCormick, a historian supporting bubonic plague as the Black Death, explains how archaeological research has confirmed that the black or "ship" rat ( Rattus rattus) was already present in Roman and medieval Europe . Also, the DNA of Y. pestis has been identified in the teeth of the human victims, the same DNA which has been widely believed to have come from the infected rodents. Pneumonic expression of Y. pestis can be transmitted by human-to-human contact, but McCormick states that this does not spread as easily as previous historians have imagined. According to him, the rat is the only plausible agent of transmission that could have led to such a wide and quick spread of the plague. This is because of rats' proclivity to associate with humans and the ability of their blood to withstand very large concentrations of the bacillus . When rats died, their fleas (which were infected with bacterial blood) found new hosts in the form of humans and animals. The Black Death tapered off in the eighteenth century, and according to McCormick, a rat-based theory of transmission could explain why this occurred. The plague(s) had killed a large portion of the human host population of Europe and dwindling cities meant that more people were isolated, and so geography and demography did not allow rats to have as much contact with Europeans. Greatly curtailed communication and transportation systems due to the drastic decline in human population also hindered the replenishment of devastated rat colonies. [ clarification needed ]The plague comes in three forms and it brought an array of signs and symptoms to those infected. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck, and armpits, which oozed pus and bled. Most victims died within four to seven days after infection. The septicaemic plague is a form of "blood poisoning", and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The bubonic plague was the most commonly seen form during the Black Death. The bubonic form of the plague has a mortality rate of thirty to seventy-five percent and symptoms include fever of 38–41 ° C (101–105 °F ), headaches , painful aching joints, nausea and vomiting , and a general feeling of malaise . The second most common form is the pneumonic plague and has symptoms that include fever, cough, and blood-tinged sputum . As the disease progressed, sputum became free flowing and bright red and death occurred within 2 days. The pneumonic form of the plague has a high mortality rate at ninety to ninety-five percent. Septicemic plague is the least common of the three forms, with a mortality rate close to one hundred percent. Symptoms include high fevers and purple skin patches ( purpura due to DIC ). Both pneumonic and septicemic plague can be caused by flea bites when the lymph nodes are overwhelmed. In this case they are referred to as secondary forms of the disease. David Herlihy identifies from the records another potential sign of the plague: freckle-like spots and rashes. Sources from Viterbo, Italy refer to "the signs which are vulgarly called lenticulae ", a word which bears resemblance to the Italian word for freckles, lentiggini . These are not the swellings of buboes, but rather "darkish points or pustules which covered large areas of the body". The uncharacteristically rapid spread of the plague could be due to respiratory droplet transmission, and low levels of immunity in the European population at that period. Historical examples of pandemics of other diseases in populations without previous exposure, such as smallpox and tuberculosis transmitted by aerosol amongst Native Americans , show that the first instance of an epidemic spreads faster and is far more virulent than later instances among the descendants of survivors, for whom natural selection has produced characteristics that are protective against the disease. [ citation needed ]Historians who believe that the Black Death was indeed caused by bubonic plague have put forth several theories questioning the traditional identification of Rattus sp. and their associated fleas as plague's primary vector . A 2012 report from the University of Bergen acknowledges that Y. pestis could have been the cause of the pandemic, but states that the epidemiology of the disease is different, most importantly the rapid spread and the lack of rats in Scandinavia and other parts of Northern Europe . R. rattus was present in Scandinavian cities and ports at the time of the Black Death but was not found in small, inland villages. Based on archaeological evidence from digs all over Norway , the black rat population was present in sea ports but remained static in the cold climate and would only have been sustained if ships continually brought black rats and that the rats would be unlikely to venture across open ground to remote villages. It argues that while healthy black rats are rarely seen, rats suffering from bubonic plague behave differently from healthy rats; where accounts from warmer climates mention rats falling from roofs and walls and piling high in the streets, Samuel Pepys , who described trifling observations and events of the London plague of 1665 in great detail, makes no mention of sick or dead rats, nor does Absalon Pederssøn in his diary, which contains detailed descriptions of a plague epidemic in Bergen in 1565. Ultimately, Hufthammer and Walløe offer the possibility of human fleas and lice in place of rats. University of Oslo researchers concluded that Y. pestis was likely carried over the Silk Road via fleas on giant gerbils from Central Asia during intermittent warm spells. Michael McCormick, a historian supporting bubonic plague as the Black Death, explains how archaeological research has confirmed that the black or "ship" rat ( Rattus rattus) was already present in Roman and medieval Europe . Also, the DNA of Y. pestis has been identified in the teeth of the human victims, the same DNA which has been widely believed to have come from the infected rodents. Pneumonic expression of Y. pestis can be transmitted by human-to-human contact, but McCormick states that this does not spread as easily as previous historians have imagined. According to him, the rat is the only plausible agent of transmission that could have led to such a wide and quick spread of the plague. This is because of rats' proclivity to associate with humans and the ability of their blood to withstand very large concentrations of the bacillus . When rats died, their fleas (which were infected with bacterial blood) found new hosts in the form of humans and animals. The Black Death tapered off in the eighteenth century, and according to McCormick, a rat-based theory of transmission could explain why this occurred. The plague(s) had killed a large portion of the human host population of Europe and dwindling cities meant that more people were isolated, and so geography and demography did not allow rats to have as much contact with Europeans. Greatly curtailed communication and transportation systems due to the drastic decline in human population also hindered the replenishment of devastated rat colonies. [ clarification needed ]Although Y. pestis as the causative agent of plague was still widely accepted during this period, scientific and historical investigations in the late 20th century through publication of conclusive evidence in 2011 led some researchers to doubt the long-held belief that the Black Death was an epidemic of bubonic plague. The arguments for an alternate causative agent were based on differences in mortality levels, disease diffusion rates, rat distribution, flea reproduction and climate, and distribution of human population. In 1984, Graham Twigg published The Black Death: A Biological Reappraisal , where he argued that the climate and ecology of Europe and particularly England made it nearly impossible for rats and fleas to have transmitted bubonic plague. Combining information on the biology of Rattus rattus , Rattus norvegicus , and the common fleas Xenopsylla cheopis and Pulex irritans with modern studies of plague epidemiology, particularly in India, where the R. rattus is a native species and conditions are nearly ideal for plague to be spread, Twigg concluded that it would have been nearly impossible for Yersinia pestis to have been the causative agent of the plague, let alone its explosive spread across Europe. Twigg also showed that the common alternate theory of entirely pneumonic spread does not hold up. He proposed, based on a reexamination of the evidence and symptoms, that the Black Death may actually have been an epidemic of pulmonary anthrax caused by Bacillus anthracis . In 2002, Samuel K. Cohn published the controversial article, "The Black Death: End of the Paradigm". Cohn argued that the medieval and modern plagues were two distinct diseases differing in their symptoms, signs, and epidemiologies. Cohn's argument that medieval plague was not rat-based is supported by his claims that the modern and medieval plagues occurred in different seasons (a claim supported in a 2009 article by Mark Welford and Brian Bossak ), had unparalleled cycles of recurrence, and varied in the manner in which immunity was acquired. The modern plague reaches its peak in seasons with high humidity and a temperature of between 50 °F (10 °C) and 78 °F (26 °C) , as rats' fleas thrive in this climate. In comparison, the Black Death is recorded as occurring in periods during which rats' fleas could not have survived, i.e. hot Mediterranean summers above 78 °F (26 °C) . In terms of recurrence, the Black Death on average did not resurface in an area for between five and fifteen years after it had occurred. In contrast, modern plagues often recur in a given area yearly for an average of eight to forty years. Last, Cohn presented evidence displaying that individuals gained immunity to the Black Death, unlike the modern plague, during the fourteenth century. He stated that in 1348, two-thirds of those suffering from plague died, in comparison to one-twentieth by 1382. Statistics display that immunity to the modern plague has not been acquired in modern times. In the Encyclopedia of Population, Cohn pointed to five major weaknesses in the bubonic plague theory: Cohn also pointed out that while the identification of the disease as having buboes relies on accounts of Boccaccio and others, they described buboes, abscesses , rashes and carbuncles occurring all over the body, the neck or behind the ears. In contrast, the modern disease rarely has more than one bubo, most commonly in the groin, and is not characterised by abscesses, rashes and carbuncles. This difference, he argued, ties in with the fact that fleas caused the modern plague and not the Black Death. Since flea bites do not usually reach beyond a person's ankles, in the modern period the groin was the nearest lymph node that could be infected. As the neck and the armpit were often infected during the medieval plague, it appears less likely that these infections were caused by fleas on rats. In 2001, Susan Scott and Christopher Duncan, respectively a demographer and zoologist from Liverpool University , proposed the theory that the Black Death might have been caused by an Ebola -like virus , not a bacterium. Their rationale was that this plague spread much faster and the incubation period was much longer than other confirmed Y. pestis –caused plagues. A longer period of incubation will allow carriers of the infection to travel farther and infect more people than a shorter one. When the primary vector is humans, as opposed to birds, this is of great importance. Epidemiological studies suggest the disease was transferred between humans (which happens rarely with Yersinia pestis and very rarely for Bacillus anthracis ), and some genes that determine immunity to Ebola-like viruses are much more widespread in Europe than in other parts of the world. Their research and findings are thoroughly documented in Biology of Plagues . More recently the researchers have published computer modeling demonstrating how the Black Death has made around 10% of Europeans resistant to HIV. In a similar vein, historian Norman Cantor , in In the Wake of the Plague: The Black Death and the World It Made (2001), suggested the Black Death might have been a combination of pandemics including a form of anthrax , a cattle murrain . He cited reported disease symptoms not in keeping with the known effects of either bubonic or pneumonic plague, the discovery of anthrax spores in a plague pit in Scotland, and the fact that meat from infected cattle was known to have been sold in many rural English areas prior to the onset of the plague. The means of infection varied widely, with infection in the absence of living or recently dead humans in Sicily (which speaks against most viruses). Also, diseases with similar symptoms were generally not distinguished between in that period (see murrain above), at least not in the Christian world; Chinese and Muslim medical records can be expected to yield better information which however only pertains to the specific disease(s) which affected these areas. Cutaneous anthrax infection in humans shows up as a boil-like skin lesion that eventually forms an ulcer with a black center ( eschar ), often beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot. Cutaneous infections generally form within the site of spore penetration between two and five days after exposure. Without treatment about 20% of cutaneous skin infection cases progress to toxemia and death. Respiratory infection in humans initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse. Historical mortality was 92%. Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty, vomiting of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite. After the bacteria invades the bowel system, it spreads through the bloodstream throughout the body, making more toxins on the way. The arguments for an alternate causative agent were based on differences in mortality levels, disease diffusion rates, rat distribution, flea reproduction and climate, and distribution of human population. In 1984, Graham Twigg published The Black Death: A Biological Reappraisal , where he argued that the climate and ecology of Europe and particularly England made it nearly impossible for rats and fleas to have transmitted bubonic plague. Combining information on the biology of Rattus rattus , Rattus norvegicus , and the common fleas Xenopsylla cheopis and Pulex irritans with modern studies of plague epidemiology, particularly in India, where the R. rattus is a native species and conditions are nearly ideal for plague to be spread, Twigg concluded that it would have been nearly impossible for Yersinia pestis to have been the causative agent of the plague, let alone its explosive spread across Europe. Twigg also showed that the common alternate theory of entirely pneumonic spread does not hold up. He proposed, based on a reexamination of the evidence and symptoms, that the Black Death may actually have been an epidemic of pulmonary anthrax caused by Bacillus anthracis . In 2002, Samuel K. Cohn published the controversial article, "The Black Death: End of the Paradigm". Cohn argued that the medieval and modern plagues were two distinct diseases differing in their symptoms, signs, and epidemiologies. Cohn's argument that medieval plague was not rat-based is supported by his claims that the modern and medieval plagues occurred in different seasons (a claim supported in a 2009 article by Mark Welford and Brian Bossak ), had unparalleled cycles of recurrence, and varied in the manner in which immunity was acquired. The modern plague reaches its peak in seasons with high humidity and a temperature of between 50 °F (10 °C) and 78 °F (26 °C) , as rats' fleas thrive in this climate. In comparison, the Black Death is recorded as occurring in periods during which rats' fleas could not have survived, i.e. hot Mediterranean summers above 78 °F (26 °C) . In terms of recurrence, the Black Death on average did not resurface in an area for between five and fifteen years after it had occurred. In contrast, modern plagues often recur in a given area yearly for an average of eight to forty years. Last, Cohn presented evidence displaying that individuals gained immunity to the Black Death, unlike the modern plague, during the fourteenth century. He stated that in 1348, two-thirds of those suffering from plague died, in comparison to one-twentieth by 1382. Statistics display that immunity to the modern plague has not been acquired in modern times. In the Encyclopedia of Population, Cohn pointed to five major weaknesses in the bubonic plague theory: Cohn also pointed out that while the identification of the disease as having buboes relies on accounts of Boccaccio and others, they described buboes, abscesses , rashes and carbuncles occurring all over the body, the neck or behind the ears. In contrast, the modern disease rarely has more than one bubo, most commonly in the groin, and is not characterised by abscesses, rashes and carbuncles. This difference, he argued, ties in with the fact that fleas caused the modern plague and not the Black Death. Since flea bites do not usually reach beyond a person's ankles, in the modern period the groin was the nearest lymph node that could be infected. As the neck and the armpit were often infected during the medieval plague, it appears less likely that these infections were caused by fleas on rats. In 2001, Susan Scott and Christopher Duncan, respectively a demographer and zoologist from Liverpool University , proposed the theory that the Black Death might have been caused by an Ebola -like virus , not a bacterium. Their rationale was that this plague spread much faster and the incubation period was much longer than other confirmed Y. pestis –caused plagues. A longer period of incubation will allow carriers of the infection to travel farther and infect more people than a shorter one. When the primary vector is humans, as opposed to birds, this is of great importance. Epidemiological studies suggest the disease was transferred between humans (which happens rarely with Yersinia pestis and very rarely for Bacillus anthracis ), and some genes that determine immunity to Ebola-like viruses are much more widespread in Europe than in other parts of the world. Their research and findings are thoroughly documented in Biology of Plagues . More recently the researchers have published computer modeling demonstrating how the Black Death has made around 10% of Europeans resistant to HIV.In a similar vein, historian Norman Cantor , in In the Wake of the Plague: The Black Death and the World It Made (2001), suggested the Black Death might have been a combination of pandemics including a form of anthrax , a cattle murrain . He cited reported disease symptoms not in keeping with the known effects of either bubonic or pneumonic plague, the discovery of anthrax spores in a plague pit in Scotland, and the fact that meat from infected cattle was known to have been sold in many rural English areas prior to the onset of the plague. The means of infection varied widely, with infection in the absence of living or recently dead humans in Sicily (which speaks against most viruses). Also, diseases with similar symptoms were generally not distinguished between in that period (see murrain above), at least not in the Christian world; Chinese and Muslim medical records can be expected to yield better information which however only pertains to the specific disease(s) which affected these areas. Cutaneous anthrax infection in humans shows up as a boil-like skin lesion that eventually forms an ulcer with a black center ( eschar ), often beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot. Cutaneous infections generally form within the site of spore penetration between two and five days after exposure. Without treatment about 20% of cutaneous skin infection cases progress to toxemia and death. Respiratory infection in humans initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse. Historical mortality was 92%. Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty, vomiting of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite. After the bacteria invades the bowel system, it spreads through the bloodstream throughout the body, making more toxins on the way. Recently, however, more evidence has appeared that the Black Death was caused by Y. pestis . In 2000, Didier Raoult and others reported finding Y. pestis DNA by performing a "suicide PCR " on tooth pulp tissue from a fourteenth-century plague cemetery in Montpellier . Drancourt and Raoult reported similar findings in a 2007 study. However, other researchers argued the study was flawed and cited contrary evidence. In 2003, Susan Scott of the University of Liverpool argued that there was no conclusive reason to believe the Montpellier teeth were from Black Death victims. Also in 2003, a team led by Alan Cooper from Oxford University tested 121 teeth from sixty-six skeletons found in 14th century mass graves, including well-documented Black Death plague pits in East Smithfield and Spitalfields . Their results showed no genetic evidence for Y. pestis , and Cooper concluded that though in 2003 "[w]e cannot rule out Yersinia as the cause of the Black Death ... right now there is no molecular evidence for it." Other researchers argued that those burial sites where Y. pestis could not be found had nothing to do with the Black Death in the first place. In October 2010 the journal PLoS Pathogens published a paper by Haensch et al. (2010), a multinational team that investigated the role of Yersinia pestis in the Black Death. The paper detailed the results of new surveys that combined ancient DNA analyses and protein-specific detection which were used to find DNA and protein signatures specific for Y. pestis in human skeletons from widely distributed mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this research, together with prior analyses from the south of France and Germany Significantly, the study also identified two previously unknown but related clades (genetic branches) of the Y. pestis genome that were associated with distinct medieval mass graves. These were found to be ancestral to modern isolates of the modern Y. pestis strains Orientalis and Medievalis, suggesting that these variant strains (which are now presumed to be extinct) may have entered Europe in two distinct waves. The presence of Y. pestis during the Black Death and its phylogenetic placement was definitely established in 2011 with the publication of a Y. pestis genome using new amplification techniques used on DNA extracts from teeth from over 100 samples from the East Smithfield burial site in London. Surveys of plague pit remains in France and England indicate that the first variant entered western Europe through the port of Marseilles around November 1347 and spread through France over the next two years, eventually reaching England in the spring of 1349, where it spread through the country in three successive epidemics. However, surveys of plague pit remains from the Netherlands town of Bergen op Zoom showed that the Y. pestis genotype responsible for the pandemic that spread through the Low Countries from 1350 differed from that found in Britain and France, implying that Bergen op Zoom (and possibly other parts of the southern Netherlands) was not directly infected from England or France in AD 1349, suggesting that a second wave of plague infection, distinct from those in Britain and France, may have been carried to the Low Countries from Norway, the Hanseatic cities, or another site.

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Pneumonic plague

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Bubo

A bubo (Greek Î²Î¿Ï Î²ÏŽÎ½, boubṓn , 'groin') is adenitis or inflammation of the lymph nodes and is an example of reactive infectious lymphadenopathy . Buboes are a symptom of bubonic plague and occur as painful swellings in the thighs, neck, groin or armpits. They are caused by Yersinia pestis bacteria spreading from flea bites through the bloodstream to the lymph nodes, where the bacteria replicate, causing the nodes to swell. Plague buboes may turn black and necrotic , rotting away the surrounding tissue, or they may rupture, discharging large amounts of pus . Infection can spread from buboes around the body, resulting in other forms of the disease such as pneumonic plague . Plague patients whose buboes swell to such a size that they burst tend to survive the disease. Before the discovery of antibiotics , doctors often drained buboes with leeches or heated rods to save patients. Buboes are also symptoms of other diseases, such as chancroid and lymphogranuloma venereum . In these conditions, a two-week course of antibiotics is the recommended treatment, and incision and drainage or excision of the swollen lymph nodes is best avoided. However, aspiration may sometimes be performed to prevent buboes from rupturing. Although incision and drainage yields better results in such cases—since usually no further intervention is necessary, whereas repeat aspirations may be required— incision and drainage wounds may heal more slowly, increasing the risk of secondary infection.

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Famadihana

Famadihana is a funerary tradition of the Malagasy peoples of Madagascar . During this ceremony, known as the turning of the bones , people bring forth the bodies of their ancestors from the family crypts, rewrap the corpses in fresh cloth, and rewrite their names on the cloth so they will always be remembered. Then they dance to live music while carrying the corpses over their heads and go around the tomb before returning the corpses to the family tomb. They believe in celebrating the life lived by the dead person. Famadihana appears to be a custom of somewhat recent origin, perhaps only since the 17th century in its present form, although it may be an adaptation of premodern double funeral customs from Southeast Asia and Oceania . The custom is based upon a belief that the spirits of the dead finally join the world of the ancestors after the body's complete decomposition and appropriate ceremonies, which may take many years. In Madagascar, this became a regular ritual usually once every five to seven years, and the custom brings together extended families in celebrations of kinship, sometimes even those with troubled relations. The practice of Famadihana is on the decline due to the expense of silk shrouds and belief by some Malagasy that the practice is outdated. Early missionaries discouraged the practice, and Evangelical Christian Malagasy have abandoned the practice in increasing numbers. The Catholic Church , however, no longer objects to the practice, because it regards Famadihana as purely cultural rather than religious. As one Malagasy man explained to the BBC, "It's important because it's our way of respecting the dead. It is also a chance for the whole family, from across the country, to come together." Additionally, the practice of Famadihana is thought to be connected to pneumonic plague transmission in the region. The Malagasy government has issued rulings forbidding the practice for individuals who died of plague, but there have been reports of people ignoring this decree.

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NCIS season 2

The second season of the police procedural drama NCIS was originally broadcast between September 28, 2004, and May 24, 2005, on CBS . This season shifts away from the naval setting of the show somewhat, and includes more character development than the first season. With the episode "Lt. Jane Doe", the show also introduced the phoofs, a black and white "preview" which was shown at the beginning of each act of that episode and has continued to be used to this day. Season two had Norfolk Case Agent Timothy McGee being promoted to a full-time field agent, and transferring to NCIS HQ in Washington to work with the Major Case Response Team. Tony DiNozzo nearly died of the pneumonic plague in "SWAK" while the season finale, "Twilight", ended with a shocking and unexpected twist: Caitlin Todd was shot and killed by Ari Haswari .23 Episodes 6-Disc Set English (Dolby Digital 5.1 Surround) Investigating Season 2 What's New in Season 2 The Real N.C.I.S. Lab Tour with Pauley Perrette Like the Special Features on Season 1, these are only available on the Region 1 DVD as the Region 2 DVD only has the episodes, not any of the Special Features.

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Pneumonic plague

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Hemoptysis

Hemoptysis or haemoptysis is the discharge of blood or blood-stained mucus through the mouth coming from the bronchi , larynx , trachea , or lungs . It does not necessarily involve coughing. In other words, it is the airway bleeding. This can occur with lung cancer , infections such as tuberculosis , bronchitis , or pneumonia , and certain cardiovascular conditions. Hemoptysis is considered massive at 300 mL (11 imp fl oz; 10 US fl oz) . In such cases, there are always severe injuries. The primary danger comes from choking , rather than blood loss . Past history, history of present illness, family history history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc. history of cigarette smoking , occupational diseases by exposure to silica dust, etc. Blood duration, frequency, amount Amounts of blood: large amounts of blood, or is there blood-streaked sputum Probable source of bleeding: Is the blood coughed up, or vomited? Bloody sputum color, characters: blood-streaked, fresh blood, frothy pink, bloody gelatinous. Accompanying symptoms fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice. Imaging examination chest X-ray, CT scan and 3D reconstruction images or CT virtual bronchoscopy, bronchial angiography. Laboratory tests blood test: WBC Sputum: cells and bacterial examinations, sputum culture Bronchial fiber endoscopy history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc. history of cigarette smoking , occupational diseases by exposure to silica dust, etc. duration, frequency, amount Amounts of blood: large amounts of blood, or is there blood-streaked sputum Probable source of bleeding: Is the blood coughed up, or vomited? color, characters: blood-streaked, fresh blood, frothy pink, bloody gelatinous. fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice. chest X-ray, CT scan and 3D reconstruction images or CT virtual bronchoscopy, bronchial angiography. blood test: WBC Sputum: cells and bacterial examinations, sputum cultureThe most common causes for hemoptysis in adults are chest infections such as bronchitis or pneumonia . In children, hemoptysis is commonly caused by the presence of a foreign body in the airway . Other common causes include lung cancers and tuberculosis . Less common causes include aspergilloma , bronchiectasis , coccidioidomycosis , pulmonary embolism , pneumonic plague , and cystic fibrosis . Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), Goodpasture's syndrome , and granulomatosis with polyangiitis . A rare cause of hemoptysis in women is endometriosis , which leads to intermittent hemoptysis coinciding with menstrual periods in 7% of women with thoracic endometriosis syndrome. Hemoptysis may be exacerbated or even caused by overtreatment with anticoagulant drugs such as warfarin . [ citation needed ] Blood-laced mucus from the sinus or nose area can sometimes be misidentified as symptomatic of hemoptysis (such secretions can be a sign of nasal or sinus cancer , but also a sinus infection ). Extensive non-respiratory injury can also cause one to cough up blood. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out. The origin of blood can be identified by observing its color. Bright-red, foamy blood comes from the respiratory tract, whereas dark-red, coffee-colored blood comes from the gastrointestinal tract . Sometimes hemoptysis may be rust-colored. [ citation needed ]Although there are reports that the fatality rate is as high as 80%, the mortality rate for hospitalized hemoptysis patients is 9.4% (with n =28539), calculated from the data in the article by Kinoshita et al. This is probably the most reasonable figure considering the overwhelming number of cases. [ citation needed ] The general definition of massive hemoptysis is more than 200 ml within 24 hours, but there is a wide range in the literature (100-600 ml). Considering that the total volume of the tracheal and bronchial lumen is about 150 cc, it may be reasonable to define massive hemoptysis as 200 ml, which is a little more than 150 ml, in terms of setting the threshold for fatal hemoptysis. More than 400ml/day is not adequate for screening purposes. [ citation needed ]Treatment depends on the underlying cause. Treatments include iced saline , and topical vasoconstrictors such as adrenaline or vasopressin . Tranexamic acid was proved to improve in-hospital mortality. Selective bronchial intubation can be used to collapse the lung that is bleeding. Also, endobronchial tamponade can be used. Laser photocoagulation can be used to stop bleeding during bronchoscopy . Angiography of bronchial arteries can be performed to locate the bleeding, and it can often be embolized . Bronchial artery embolization (BAE) is the first line treatment nowadays. Surgical option is usually the last resort and can involve removal of a lung lobe or removal of the entire lung . Cough suppressants can increase the risk of choking.

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Pneumonic plague

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Third plague pandemic

The third plague pandemic was a major bubonic plague pandemic that began in Yunnan , China, in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China (and perhaps over 15 million worldwide ), and at least 10 million Indians were killed in British Raj India alone, making it one of the deadliest pandemics in history. According to the World Health Organization , the pandemic was considered active until 1960 when worldwide casualties dropped to 200 per year. Plague deaths have continued at a lower level for every year since. The name refers to the third of at least three known major plague pandemics. The first began with the Plague of Justinian , which ravaged the Byzantine Empire and surrounding areas in 541 and 542; the pandemic persisted in successive waves until the middle of the 8th century. The second began with the Black Death , which killed at least one third of Europe 's population in a series of expanding waves of infection from 1346 to 1353; this pandemic recurred regularly until the 19th century. Casualty patterns indicate that waves of this late-19th-century/early-20th-century pandemic may have come from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, through transporting infected persons, rats , and cargoes harboring fleas . The second, more virulent strain, was primarily pneumonic in character with a strong person-to-person contagion. This strain was largely confined to Asia. [ citation needed ]The bubonic plague was endemic in populations of infected ground rodents in Central Asia and was a known cause of death among the migrant and established human populations in that region for centuries. An influx of new people because of political conflicts and global trade led to the spread of the disease throughout the world from Asia to the rest of Europe, to reach Africa and the Americas . [ citation needed ] A natural reservoir or nidus for plague is in western Yunnan and is still an ongoing health risk. The third pandemic of plague originated in the area after a rapid influx of Han Chinese to exploit the demand for minerals, primarily copper , in the second half of the 19th century. By 1850, the population had exploded to over 7 million people. Increasing transportation throughout the region brought people in contact with plague-infected fleas , the primary vector between the yellow-breasted rat ( Rattus flavipectus ) and humans. People brought the fleas and rats back into growing urban areas, where small outbreaks sometimes reached epidemic proportions. The plague spread further and began to appear in the Pearl River delta, including Canton and Hong Kong . Although William McNeil and others believe the plague to have been brought from the interior to the coastal regions by troops returning from battles against the Muslim rebels, Benedict suggested evidence to favor the growing and lucrative opium trade, which began after about 1840. In the city of Canton, beginning in March 1894, the disease killed 80,000 people in a few weeks. Daily water-traffic with the nearby city of Hong Kong rapidly spread the plague. Within two months, after 100,000 deaths, the death rates dropped below epidemic rates, but the disease continued to be endemic in Hong Kong until 1929. The network of global shipping ensured the widespread distribution of the disease over the next few decades. Recorded outbreaks included the following: Each of the areas, as well as Great Britain , France , and other areas of Europe, continued to experience plague outbreaks and casualties until the 1960s, although extremely few of these occurred after 1950. The last significant outbreak of plague associated with the pandemic occurred in Peru and Argentina in 1945. [ citation needed ] The 1894 Hong Kong plague was a major outbreak of the third global pandemic from the late 19th century to the early 20th century. The first case, discovered in May 1894, was a hospital clerk who had just returned from Canton . The hardest hit was the mountainous area in Sheung Wan , the most densely-populated area in Hong Kong, characterised by Chinese-style buildings. From May to October 1894, the plague killed more than 6,000 people, leading to the exodus of one third of the population. In the 30 years starting in 1926 [ dubious – discuss ] , the plague occurred in Hong Kong almost every year and killed more than 20,000 people. Through maritime traffic, the epidemic spread to the rest of the country after 1894 and eventually spread to British Raj India where about ten million Indians were killed . There were several reasons for the rapid outbreak and spread of the plague. Firstly, in the early days, Sheung Wan was a Chinese settlement. Houses — in the mountains — had no drainage channels, toilets, or running water. The houses were small and the floors were not paved. Secondly, during the Ching Ming Festival in 1894, many Chinese living in Hong Kong returned to the countryside to tend to family graves, which coincided with the outbreak of the epidemic in Canton and the introduction of bacteria into Hong Kong. Thirdly, in the first four months of 1894, rainfall decreased and soil dried up, accelerating the spread of the plague. The main preventive measures were setting up plague hospitals and deploying medical staff to treat and isolate plague patients; conducting house-to-house search operations, discovering and transferring plague patients, and cleaning and disinfecting infected houses and areas; and setting up designated cemeteries and assigning a person responsible for transporting and burying the plague dead. The 1894 Hong Kong plague was a major outbreak of the third global pandemic from the late 19th century to the early 20th century. The first case, discovered in May 1894, was a hospital clerk who had just returned from Canton . The hardest hit was the mountainous area in Sheung Wan , the most densely-populated area in Hong Kong, characterised by Chinese-style buildings. From May to October 1894, the plague killed more than 6,000 people, leading to the exodus of one third of the population. In the 30 years starting in 1926 [ dubious – discuss ] , the plague occurred in Hong Kong almost every year and killed more than 20,000 people. Through maritime traffic, the epidemic spread to the rest of the country after 1894 and eventually spread to British Raj India where about ten million Indians were killed . There were several reasons for the rapid outbreak and spread of the plague. Firstly, in the early days, Sheung Wan was a Chinese settlement. Houses — in the mountains — had no drainage channels, toilets, or running water. The houses were small and the floors were not paved. Secondly, during the Ching Ming Festival in 1894, many Chinese living in Hong Kong returned to the countryside to tend to family graves, which coincided with the outbreak of the epidemic in Canton and the introduction of bacteria into Hong Kong. Thirdly, in the first four months of 1894, rainfall decreased and soil dried up, accelerating the spread of the plague. The main preventive measures were setting up plague hospitals and deploying medical staff to treat and isolate plague patients; conducting house-to-house search operations, discovering and transferring plague patients, and cleaning and disinfecting infected houses and areas; and setting up designated cemeteries and assigning a person responsible for transporting and burying the plague dead. Researchers working in Asia during the "Third Pandemic" identified plague vectors and the plague bacillus. In 1894, in Hong Kong, Swiss-born French bacteriologist Alexandre Yersin isolated the responsible bacterium ( Yersinia pestis , named for Yersin) and determined the common mode of transmission. His discoveries led in time to modern treatment methods, including insecticides , the use of antibiotics and eventually plague vaccines . In 1898, French researcher Paul-Louis Simond demonstrated the role of fleas as a vector. The disease is caused by a bacterium usually transmitted by the bite of fleas from an infected host, often a black rat . The bacteria are transferred from the blood of infected rats to flea ( Xenopsylla cheopis ). The bacillus multiplies in the stomach of the flea, blocking it. When the flea next bites a mammal, the consumed blood is regurgitated along with the bacillus into the bloodstream of the bitten animal. Any serious outbreak of plague in humans is preceded by an outbreak in the rodent population. During the outbreak, infected fleas that have lost their normal rodent hosts seek other sources of blood. The British colonial government in India pressed medical researcher Waldemar Haffkine to develop a plague vaccine. After three months of persistent work with a limited staff, a form for human trials was ready. On January 10, 1897, Haffkine tested it on himself. After the initial test was reported to the authorities, volunteers at the Byculla jail were used in a control test. All inoculated prisoners survived the epidemics, while seven inmates of the control group died. By the turn of the century, the number of inoculees in India alone reached four million. Haffkine was appointed the Director of the Plague Laboratory (now called the Haffkine Institute ) in Bombay. In the early 1900s, despite the increasing knowledge of germ theory and the rapid growth of scientific communities around the prevention of major disease, there was little the international communities could do other than create standard protocols for how to deal with an outbreak of the plague. In 1897 and 1903, two conventions were held known as International Sanitary Conferences; the first in Venice and the second in Paris, to help deal with threat of the new outbreaks of the bubonic plague. From these conventions was formed an international disease convention supervised by the Office International d'Hygiene Publique (OIHP) in Paris which would be one of the major predecessors of the League of Nations health organization. From these conventions came the standard Protocols used in dealing with the bubonic plague throughout the early 1900s. These protocols were often old fashioned and were generally summarized as the 3 "I's": Isolation, Incineration, and Inoculation. Isolation is a standard protocol of many modern disease outbreaks, but the usage of incineration was a protocol of disease control used most uniquely for dealing with the bubonic plague. Burning was used often to deal with the Plague as it was believed to the be most effective way to eliminate strains of the disease from places inhabited by the infected. But it was also a problematic technique as it led to the creation of many out-of-control fires that devastated communities, the most notable being the great fire in Honolulu which devastated the Chinatown community there. Inoculation was the usage of newly invented plague vaccines, with some in India being recorded to have an efficacy of over 50%. In many instances, the third plague pandemic either revealed or exacerbated major social conflicts and racial inequalities. Many of the ports infected during the plague were at the time in British colonies. Because of this, the British authorities often ended up enforcing western hygiene and medical practices and radical quarantine measures in countries and provinces such as India, South Africa and Hong Kong. In India harsh quarantines were initially implemented by the British governments, leading to Indian resentment of quarantine measures. In South Africa, when the plague broke out in Cape Colony , the colonial government forced a large group of Black South Africans to move out of a supposed slum into areas on the outskirts of the city, which historians have argued as a racially-motivated move by White South Africans to segregate Blacks into other parts of the city. In Hong Kong the British enforced many locally unfamiliar medical practices, such as floating plague victims out on boats onto the water and cooling plague victims with ice, which scared many Chinese residents of Hong Kong and led to their migrating back to mainland China, which was then even more badly affected by the plague. Another instance of social harm caused by the response to the plague is the "great fire of Honolulu " in 1900, in which much of Chinatown in Honolulu was burned by the Honolulu Board of Health in order to control the plague, rendering over 7,000 Chinese and Japanese residents homeless. In America when the plague reached San Francisco, the medical board of the city implemented a strict quarantine of the entire Chinatown district after discovering only one case of the plague; this has led historians to question whether this measure was motivated by racial bias among medical professionals.

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Great Plague of Seville

The Great Plague of Seville (1647–1652) was a massive outbreak of disease in Spain that killed up to a quarter of Seville 's population.Unlike the plague of 1596–1602, which claimed 600,000 to 700,000 lives, or a little under 8% of the population and initially struck northern and central Spain and Andalusia in the south, the Great Plague, which may have arisen in Algeria, struck the Mediterranean side of Spain first. The coastal city of Valencia was the first city to be hit, losing an estimated 30,000 people. The disease raged through Andalucía, in addition to sweeping the north into Catalonia and Aragon. The coast of Málaga lost upwards of 50,000 people. In Seville, quarantine measures were evaded, ignored, unproposed and/or unenforced. The results were devastating. The city of Seville and its rural districts were thought to have lost 150,000 people—starting with a total population of 600,000. Altogether Spain was thought to have lost 500,000 people, out of a population of slightly fewer than 10,000,000, or nearly 5% of its entire population. This was the greatest, but not the only, plague of 17th century Spain. Almost 25 years later, another plague ravaged Spain. For nine years (1676–1685), great outbreaks of the disease attacked in waves across the country. It struck the areas of Andalucía and Valencia particularly hard. In conjunction with the poor harvest of 1682-83, which created famine conditions, the effects killed tens of thousands of the weakened and exhausted population. When it ended in 1685, it is estimated to have taken over 250,000 lives. This was the last outbreak of plague in Spain in the 17th century. Three great plagues ravaged Spain in the 17th century. They were: The Plague of 1596–1602 (arrived in Santander by ship from northern Europe, most likely the Netherlands, then spread south through the center of Castile, reaching Madrid by 1599 and arriving in the southern city of Seville by 1600.) The Plague of 1646–1652 ("The Great Plague of Seville"; believed to have arrived by ship from Algeria, it was spread north by coastal shipping, afflicting towns and their hinterlands along the Mediterranean coast as far north as Barcelona.) The Plague of 1676–1685 Factoring in normal births, deaths, plus emigration, historians reckon the total cost in human lives due to these plagues throughout Spain, throughout the entire 17th century, to be a minimum of nearly 1.25 million. As a result, the population of Spain scarcely budged between the years 1596 and 1696. The disease is generally believed to have been bubonic plague , an infection by the bacterium Yersinia pestis , transmitted via a rat vector . Other symptom patterns of the bubonic plague, such as septicemic plague and pneumonic plague , were also present.

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Great Plague in the late Ming dynasty

The Great Plague in the late Ming dynasty ( Chinese : æ˜Žæœ«å¤§é¼ ç–« ; pinyin : Míngmò Dà shǔyì ), also known as the North China Plague in the late Ming dynasty ( simplified Chinese : æ˜Žæœ«åŽåŒ—é¼ ç–« ; traditional Chinese : æ˜Žæœ«è¯åŒ—é¼ ç–« ; pinyin : Míngmò Huáběi Shǔyì ), or the Great Plague of Jingshi ( Chinese : äº¬å¸ˆå¤§é¼ ç–« ; pinyin : JÄ«ngshÄ« Dà shǔyì ), was a major plague epidemic between 1633 and 1644, the last phase of the Ming dynasty in China , during the Chongzhen Emperor 's reign (1627–1644). The epidemic started in Shanxi in 1633 and reached Beijing in 1641, where the plague caused the deaths of more than 200,000 people in 1643, directly contributing to the collapse of the Ming dynasty in 1644. In 1633, during the sixth year of the Chongzhen Emperor , the plague epidemic started in Shanxi. In 1641, the plague arrived in Beijing , the capital of the Ming dynasty . At the same time, historical records indicate that more than half of the population in northern Zhejiang fell ill in 1641, and 90% of the local people died in 1642. In 1643, the epidemic reached its peak, killing more than 200,000 people in Beijing alone, accounting for 20%-25% of the local population. The "pimple plague" and "vomit blood plague," recorded in Chinese literature at the time, were possibly bubonic plague and pneumonic plague . In March 1644, Beijing was under siege by Li Zicheng 's troops, whereas the defending force in Beijing weakened significantly due to the plague, with some 50,000 soldiers left–down from the original 100,000. Soon, Li won the Battle of Beijing and the Chongzhen Emperor committed suicide, marking the end of the Ming dynasty, although Li was subsequently defeated in the Battle of Shanhai Pass by the allied forces of the former Ming general Wu Sangui and the Manchu-led Qing dynasty . Wu Youke (1582–1652) developed the idea that some diseases were caused by transmissible agents, which he called Li Qi (戾气 ''violent qi energy'' ) when he observed various epidemics rage around him between 1641 and 1644. His book Wen Yi Lun (瘟疫论,Treatise on Pestilence/Treatise of Epidemic Diseases) can be regarded as the main etiological work that brought forward the concept.

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Pneumonic plague

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Index case

The index case or patient zero is the first documented patient in a disease epidemic within a population, or the first documented patient included in an epidemiological study. It can also refer to the first case of a condition or syndrome (not necessarily contagious) to be described in the medical literature, whether or not the patient is thought to be the first person affected. [ citation needed ] An index case can achieve the status of a "classic" case study in the literature, as did Phineas Gage , the first known person to exhibit a definitive personality change as a result of a brain injury. The index case may or may not indicate the source of the disease , the possible spread, or which reservoir holds the disease in between outbreaks , but may bring awareness of an emerging outbreak. Earlier cases may or may not be found and are labeled primary or coprimary, secondary, tertiary, etc. The term primary case can only apply to infectious diseases that spread from human to human, and refers to the person who first brings a disease into a group of people. In epidemiology, the term is often used by both scientists and journalists alike to refer to the individual known or believed to have been the first infected or source of the resulting outbreak in a population as the index case, but such would technically refer to the primary case. "Patient zero" was used to refer to the supposed source of HIV outbreak in the United States , flight attendant Gaëtan Dugas in the popular press, but the term's use was based on a misunderstanding (and Dugas was not the index case). In the 1984 study of Centers for Disease Control and Prevention (CDC), one of the earliest recorded HIV-patients was code-named "patient O", which stands for "patient o ut of California". The letter O , however, was interpreted by some readers of the report as the numeral 0 . The designation patient zero (for Gaëtan Dugas) was subsequently propagated by the San Francisco Chronicle journalist Randy Shilts in his book And the Band Played On in 1987. William Darrow, behavioral scientist of CDC responsible to figure out why gay men in Los Angeles were dying of a strange illness, said: "That's correct. I never labeled him Patient Zero". The term has been expanded into general usage to refer to an individual identified as the first carrier of a communicable disease in a population (the primary case) or pandemics , or the first incident in the onset of a catastrophic trend. In some cases, a known or suspected patient zero may be informally referred to as an index case for the purpose of a scientific study, such as the two-year-old boy in a remote village in Guinea who was thought to be the source of the largest Ebola virus outbreak in history, or an unknown one, such as the mysterious patient zero of COVID-19 . In genetics, the index case is the case of the original patient (i.e. propositus or proband ) that stimulates investigation of other members of the family to discover a possible genetic factor. The term can also be used in non-medical fields to describe the first individual affected by something negative that since propagated to others, such as the first user on a network infected by malware . "Patient zero" was used to refer to the supposed source of HIV outbreak in the United States , flight attendant Gaëtan Dugas in the popular press, but the term's use was based on a misunderstanding (and Dugas was not the index case). In the 1984 study of Centers for Disease Control and Prevention (CDC), one of the earliest recorded HIV-patients was code-named "patient O", which stands for "patient o ut of California". The letter O , however, was interpreted by some readers of the report as the numeral 0 . The designation patient zero (for Gaëtan Dugas) was subsequently propagated by the San Francisco Chronicle journalist Randy Shilts in his book And the Band Played On in 1987. William Darrow, behavioral scientist of CDC responsible to figure out why gay men in Los Angeles were dying of a strange illness, said: "That's correct. I never labeled him Patient Zero". The term has been expanded into general usage to refer to an individual identified as the first carrier of a communicable disease in a population (the primary case) or pandemics , or the first incident in the onset of a catastrophic trend. In some cases, a known or suspected patient zero may be informally referred to as an index case for the purpose of a scientific study, such as the two-year-old boy in a remote village in Guinea who was thought to be the source of the largest Ebola virus outbreak in history, or an unknown one, such as the mysterious patient zero of COVID-19 . In genetics, the index case is the case of the original patient (i.e. propositus or proband ) that stimulates investigation of other members of the family to discover a possible genetic factor. The term can also be used in non-medical fields to describe the first individual affected by something negative that since propagated to others, such as the first user on a network infected by malware . In the early years of the AIDS epidemic , a patient zero transmission scenario was compiled by William Darrow and colleagues at the United States Centers for Disease Control and Prevention (CDC). This epidemiological study showed how patient zero had infected multiple partners with HIV , and they, in turn, transmitted it to others causing rapid spread of the virus to locations all over the world (Auerbach et al., 1984). The CDC identified Gaëtan Dugas as a carrier of the virus from Europe to the United States, who spread it to other men he had sexual contact with at gay bathhouses . Journalist Randy Shilts subsequently wrote about patient zero, based on Darrow's findings, in his 1987 book And the Band Played On , which identified patient zero as being Gaëtan Dugas. Dugas was a flight attendant who was sexually promiscuous in several North American cities, according to Shilts' book. He was vilified for several years as a "mass spreader" of HIV, and was seen as the original source of the HIV epidemic among homosexual men . Four years later, Darrow repudiated the study's methodology and how Shilts had represented its conclusions. A 2007 study by Michael Worobey and Arthur Pitchenik published in the Proceedings of the National Academy of Sciences of the United States of America claimed that, based on the results of genetic analysis , current North American strains of HIV probably moved from Africa to Haiti before entering the United States around 1969, probably through a single immigrant . However, a teenager named Robert Rayford died in St. Louis , Missouri , possibly of complications from AIDS in 1969, having most likely become infected with the virus before 1966. This would imply that there were prior carriers of HIV-strains in North America. The phrase patient zero is now used in the media to refer to the primary case for infectious disease outbreaks, as well as for computer virus outbreaks, and more broadly, as the source of ideas or actions that have far-reaching consequences. David Heymann , professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, and formerly with the World Health Organization ( WHO ), has questioned the importance of finding patient zero, stating, "Finding patient zero may be important in some instances, but only if they are still alive and spreading the disease; and more often than not, especially in large disease outbreaks, they're not." In the early years of the AIDS epidemic , a patient zero transmission scenario was compiled by William Darrow and colleagues at the United States Centers for Disease Control and Prevention (CDC). This epidemiological study showed how patient zero had infected multiple partners with HIV , and they, in turn, transmitted it to others causing rapid spread of the virus to locations all over the world (Auerbach et al., 1984). The CDC identified Gaëtan Dugas as a carrier of the virus from Europe to the United States, who spread it to other men he had sexual contact with at gay bathhouses . Journalist Randy Shilts subsequently wrote about patient zero, based on Darrow's findings, in his 1987 book And the Band Played On , which identified patient zero as being Gaëtan Dugas. Dugas was a flight attendant who was sexually promiscuous in several North American cities, according to Shilts' book. He was vilified for several years as a "mass spreader" of HIV, and was seen as the original source of the HIV epidemic among homosexual men . Four years later, Darrow repudiated the study's methodology and how Shilts had represented its conclusions. A 2007 study by Michael Worobey and Arthur Pitchenik published in the Proceedings of the National Academy of Sciences of the United States of America claimed that, based on the results of genetic analysis , current North American strains of HIV probably moved from Africa to Haiti before entering the United States around 1969, probably through a single immigrant . However, a teenager named Robert Rayford died in St. Louis , Missouri , possibly of complications from AIDS in 1969, having most likely become infected with the virus before 1966. This would imply that there were prior carriers of HIV-strains in North America. The phrase patient zero is now used in the media to refer to the primary case for infectious disease outbreaks, as well as for computer virus outbreaks, and more broadly, as the source of ideas or actions that have far-reaching consequences. David Heymann , professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, and formerly with the World Health Organization ( WHO ), has questioned the importance of finding patient zero, stating, "Finding patient zero may be important in some instances, but only if they are still alive and spreading the disease; and more often than not, especially in large disease outbreaks, they're not." The term is used to identify the first computer or user to be infected with malware on a network, which then infected other systems. Monica Lewinsky has described herself as the "patient zero" of online harassment, meaning that she was the first person to receive widespread public harassment via the internet.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Hazmat_suit/html

Hazmat suit

A hazmat suit ( haz ardous mat erials suit) is a piece of personal protective equipment that consists of an impermeable whole-body garment worn as protection against hazardous materials. Such suits are often combined with self-contained breathing apparatus (SCBA) to ensure a supply of breathable air. Hazmat suits are used by firefighters , emergency medical technicians , paramedics , researchers, personnel responding to toxic spills, specialists cleaning up contaminated facilities, and workers in toxic environments.An early primitive form of the hazmat suit arose during bubonic plague epidemics, when European plague doctors of the 16th and 17th centuries wore distinctive costumes consisting of bird-like beak masks and large overcoats while treating victims of the bubonic plague. At the time, it was thought that the inhalation of "bad air" was the cause of disease (a theory known as the miasma theory ), so the bird-like beak masks functioned as respirators that contained aromatic items such as herbs and dried flowers. The modern hazmat suit is believed to originate from the Manchurian plague of 1910–1911, wherein Malayan physician Wu Lien-teh promoted the use of various forms of personal protective equipment to prevent the spread of the pneumonic plague . The United States Department of Homeland Security defines a hazmat suit as "an overall garment worn to protect people from hazardous materials or substances, including chemicals, biological agents, or radioactive materials." More generally, hazmat suits may provide protection from: The hazmat suit generally includes breathing air supplies to provide clean, uncontaminated air for the wearer. In laboratory use, clean air may be supplied through attached hoses. This air is usually pumped into the suit at positive pressure with respect to the surroundings as an additional protective measure against the introduction of dangerous agents into a potentially ruptured or leaking suit. Working in a hazmat suit is very strenuous, as the suits tend to be less flexible than conventional work garments. With the exception of laboratory versions, hazmat suits can be hot and poorly ventilated (if at all). Therefore, use is usually limited to short durations of up to 2 hours, depending on the difficulty of the work. Level A (United States) suits, for example, are limited by their air supply to around 15–20 minutes of very strenuous work (such as a firefighting rescue in a building). However, OSHA/EPA protective level A suits/ensembles are not typically used in firefighting rescue, especially during a building/structure fire. National Fire Protection Association (NFPA) compliant "turnout gear", and NIOSH-certified SCBA, or CBRN SCBA, are the primary protection technologies for structure firefighting in the US. Hazmat protective clothing is classified as any of Level A, B, C, or D, based upon the degree of protection they provide. Most suits used in Europe are covered by a set EU Norms , and divided into a total of six types (levels) of protection: 1 : Can be used in places where the chemical in gaseous form isn't harmful to the body exterior. In the GOST system of norms, EN 943 is equivalent to GOST 12.4.284.2-2014. Following the American standards, there are 4 different types of suits, from A to D. The suits are known to the Brazilian military as Roupa Protetora Permeável de Combate (Protective Permeable Combat Clothing). There are within the Brazilian military several specialized hazmat regiments. The regiments were deployed during the FIFA 2014 World Cup, 2016 Summer Olympics in Rio de Janeiro, and the COVID-19 pandemic . The United States Department of Homeland Security defines a hazmat suit as "an overall garment worn to protect people from hazardous materials or substances, including chemicals, biological agents, or radioactive materials." More generally, hazmat suits may provide protection from: The hazmat suit generally includes breathing air supplies to provide clean, uncontaminated air for the wearer. In laboratory use, clean air may be supplied through attached hoses. This air is usually pumped into the suit at positive pressure with respect to the surroundings as an additional protective measure against the introduction of dangerous agents into a potentially ruptured or leaking suit. Working in a hazmat suit is very strenuous, as the suits tend to be less flexible than conventional work garments. With the exception of laboratory versions, hazmat suits can be hot and poorly ventilated (if at all). Therefore, use is usually limited to short durations of up to 2 hours, depending on the difficulty of the work. Level A (United States) suits, for example, are limited by their air supply to around 15–20 minutes of very strenuous work (such as a firefighting rescue in a building). However, OSHA/EPA protective level A suits/ensembles are not typically used in firefighting rescue, especially during a building/structure fire. National Fire Protection Association (NFPA) compliant "turnout gear", and NIOSH-certified SCBA, or CBRN SCBA, are the primary protection technologies for structure firefighting in the US.Hazmat protective clothing is classified as any of Level A, B, C, or D, based upon the degree of protection they provide. Most suits used in Europe are covered by a set EU Norms , and divided into a total of six types (levels) of protection: 1 : Can be used in places where the chemical in gaseous form isn't harmful to the body exterior. In the GOST system of norms, EN 943 is equivalent to GOST 12.4.284.2-2014. Following the American standards, there are 4 different types of suits, from A to D. The suits are known to the Brazilian military as Roupa Protetora Permeável de Combate (Protective Permeable Combat Clothing). There are within the Brazilian military several specialized hazmat regiments. The regiments were deployed during the FIFA 2014 World Cup, 2016 Summer Olympics in Rio de Janeiro, and the COVID-19 pandemic . Hazmat protective clothing is classified as any of Level A, B, C, or D, based upon the degree of protection they provide. Most suits used in Europe are covered by a set EU Norms , and divided into a total of six types (levels) of protection: 1 : Can be used in places where the chemical in gaseous form isn't harmful to the body exterior.In the GOST system of norms, EN 943 is equivalent to GOST 12.4.284.2-2014.Following the American standards, there are 4 different types of suits, from A to D. The suits are known to the Brazilian military as Roupa Protetora Permeável de Combate (Protective Permeable Combat Clothing). There are within the Brazilian military several specialized hazmat regiments. The regiments were deployed during the FIFA 2014 World Cup, 2016 Summer Olympics in Rio de Janeiro, and the COVID-19 pandemic . Hazmat suits come in two variations: splash protection and gastight suits. The splash protection suits are designed to prevent the wearer from coming into contact with a liquid. These suits do not protect against gases or dust. Gastight suits additionally protect against gases and dust. Such suits (level A in the US) are gas or vapor -tight, providing total encapsulation and the highest level of protection against direct and airborne chemical contact. They are typically worn with a self-contained breathing apparatus (SCBA) enclosed within the suit. These suits are typically constructed of several layers and, being airtight, include a release valve so the suit does not overinflate from air exhaled by the SCBA. The release valve does retain some air to keep some positive pressure ("overpressure") inside the suit. As noted, such suits are usually limited to just 15–20 minutes of use by their mobile air supply. With each suit described here, there is a manufactured device designed to protect the respiratory system of the wearer (called a respirator ) while the suit/ensemble is used to protect skin exposed to potential hazardous dermal agents. A respirator may be something as simple as a headband strap filtering facepiece respirator (FFR); to a head harness negative pressure full face respirator (air-purifying respirator/APR); to a full face, tight fitting, closed breathing air; or open circuit, self-contained breathing apparatus (CC-SCBA or SCBA). Such suits (level B in the US) are not vapor-tight and thus provide a lesser level of protection. They are, however, worn with an SCBA, which may be located inside or outside of the suit, depending on the type of suit (encapsulating or non-encapsulating). They more closely resemble the one-piece Tyvek coveralls often seen used in construction and demolition work. Yet, Level B splash suits may also be fully encapsulating suits which are simply not airtight. Lesser protection (level C in the US) suits may be coveralls of treated material, or multi-piece combinations, sealed with tape. This kind of protection is still "proof" against many non-invasive substances, such as anthrax . Such suits (level A in the US) are gas or vapor -tight, providing total encapsulation and the highest level of protection against direct and airborne chemical contact. They are typically worn with a self-contained breathing apparatus (SCBA) enclosed within the suit. These suits are typically constructed of several layers and, being airtight, include a release valve so the suit does not overinflate from air exhaled by the SCBA. The release valve does retain some air to keep some positive pressure ("overpressure") inside the suit. As noted, such suits are usually limited to just 15–20 minutes of use by their mobile air supply. With each suit described here, there is a manufactured device designed to protect the respiratory system of the wearer (called a respirator ) while the suit/ensemble is used to protect skin exposed to potential hazardous dermal agents. A respirator may be something as simple as a headband strap filtering facepiece respirator (FFR); to a head harness negative pressure full face respirator (air-purifying respirator/APR); to a full face, tight fitting, closed breathing air; or open circuit, self-contained breathing apparatus (CC-SCBA or SCBA).Such suits (level B in the US) are not vapor-tight and thus provide a lesser level of protection. They are, however, worn with an SCBA, which may be located inside or outside of the suit, depending on the type of suit (encapsulating or non-encapsulating). They more closely resemble the one-piece Tyvek coveralls often seen used in construction and demolition work. Yet, Level B splash suits may also be fully encapsulating suits which are simply not airtight. Lesser protection (level C in the US) suits may be coveralls of treated material, or multi-piece combinations, sealed with tape. This kind of protection is still "proof" against many non-invasive substances, such as anthrax .

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Oakland,_California/html

Oakland, California

Oakland is the most populous city in and the county seat of Alameda County, California , United States. A major West Coast port, Oakland is the largest city in the East Bay region of the San Francisco Bay Area , and the third-largest city overall in the Bay Area. With a population of 440,646 in 2020, it serves as the Bay Area's trade center: the Port of Oakland is the busiest port in Northern California , and the fifth- or sixth-busiest in the United States. A charter city , Oakland was incorporated on May 4, 1852, in the wake of the state's increasing population due to the California gold rush . Oakland's territory covers what was once a mosaic of California coastal terrace prairie , oak woodland , and north coastal scrub . In the late 18th century, it became part of a large rancho grant in the colony of New Spain , and known for its plentiful oak tree stands. Its land served as a resource when its hillside oak and redwood timber were logged to build San Francisco . The fertile flatland soils helped it become a prolific agricultural region. In the 1850s, what became the first campus of the University of California was founded in Oakland, and Oakland was selected as the western terminal of the Transcontinental Railroad in 1869. The following year, Oakland's Lake Merritt became the United States' first officially designated wildlife refuge, now a National Historic Landmark . Following the catastrophic 1906 San Francisco earthquake , many San Francisco citizens moved to Oakland, enlarging the population, increasing its housing stock, and improving its infrastructure. It continued to grow in the 20th century with its port, shipyards , and manufacturing industry.The earliest known inhabitants were the Huchiun natives, who lived there for thousands of years. The Huchiun belonged to a linguistic grouping later called the Ohlone (a Miwok word meaning "western people"). In Oakland, they were concentrated around Lake Merritt and Temescal Creek , a stream that enters the San Francisco Bay at Emeryville . In 1772, the area that later became Oakland was colonized, along with the rest of California, by Spanish settlers for the king of Spain . In the early 19th century, the Spanish crown granted the East Bay area to Luis María Peralta for his Rancho San Antonio . The grant was confirmed by the successor Mexican republic upon its independence from Spain. Upon his death in 1842, Peralta divided his land among his four sons. Most of Oakland was within the shares given to Antonio Maria and Vicente. The portion of the parcel that is now Oakland was called Encinar (misrendered at an early date and carried forward as "encinal") – Spanish for " oak grove " – due to the large oak forest that covered the area, which eventually led to the city's name. According to Stanford University historian Albert Camarillo, the Peralta family struggled to keep their land after the incorporation of California into the United States after the Mexican–American War . Camarillo claims the family was the victim of targeted racial violence. He writes in Chicanos in California , "They lost everything when squatters cut down their fruit trees, killed their cattle, destroyed their buildings, and even fenced off the roads leading to the rancho. Especially insidious were the actions of attorney Horace Carpentier , who tricked Vicente Peralta into signing a 'lease' which turned out to be a mortgage against the 19,000-acre rancho. The lands became Carpentier's when Peralta refused to repay the loan he believed was fraudulently incurred. The Peraltas had no choice but to abandon the homesite they had occupied for two generations." In 1851, three men— Horace Carpentier , Edson Adams, and Andrew Moon—began developing what is now downtown Oakland. In 1852, the Town of Oakland was incorporated by the state legislature. During this time, Oakland had 75–100 inhabitants, two hotels, a wharf, two warehouses, and only cattle trails. Two years later, on March 25, 1854, Oakland re-incorporated as the City of Oakland. Horace Carpentier was elected the first mayor, though a scandal ended his mayorship in less than a year. [ citation needed ] In 1853, a preparatory academy was founded in Oakland that soon became the College of California , and in 1869, the first campus of the University of California , the university moved just north to Berkeley in the 1870s. During the 1850s, just as gold was discovered in California, Oakland started growing and further developing because land was becoming too expensive in San Francisco . People in China were struggling financially as a result of the First Opium War , the Second Opium War , and the Taiping Rebellion , so they began migrating to Oakland, many of whom were recruited to work on railroads. However, the Chinese struggled to settle because they were discriminated against by the white community and their living quarters were burned down on several occasions. [ page needed ] The city and its environs quickly grew with the railroads, becoming a major rail terminal in the late 1860s and 1870s. In 1868, the Central Pacific constructed the Oakland Long Wharf at Oakland Point, the site of today's Port of Oakland . A number of horsecar and cable car lines were constructed in Oakland during the latter half of the 19th century. The first electric streetcar set out from Oakland to Berkeley in 1891, and other lines were converted and added over the course of the 1890s. The various streetcar companies operating in Oakland were acquired by Francis "Borax" Smith and consolidated into what eventually became known as the Key System , the predecessor of today's publicly owned AC Transit . Oakland was one of the worst affected cities in California that was impacted by the San Francisco plague of 1900–1904 . Quarantine measures were set in place at the Oakland ports requiring the authorities at the port to inspect the arriving vessels for the presence of infected rats. Quarantine authorities at these ports inspected over a thousand vessels per year for plague and yellow fever. By 1908, over 5,000 people were detained in quarantine. Hunters were sent to poison the affected areas in Oakland and shoot the squirrels, but the eradication work was limited in its range because the State Board of Health and the United States Public Health Service were only allotted about $60,000 a year to eradicate the disease. During this period Oakland did not have sufficient health facilities, so some of the infected patients were treated at home. The State Board of Health along with Oakland also advised physicians to promptly report any cases of infected patients. Yet, in 1919 it still resulted in a small epidemic of Pneumonic plague which killed a dozen people in Oakland. This started when a man went hunting in Contra Costa Valley and killed a squirrel. After eating the squirrel, he fell ill four days later and another household member contracted the plague. This in turn was passed on either directly or indirectly to about a dozen others. The officials in Oakland acted quickly by issuing death certificates to monitor the spread of plague. At the time of incorporation in 1852, Oakland had consisted of the territory that lay south of today's major intersection of San Pablo Avenue, Broadway, and Fourteenth Street. The city gradually annexed farmlands and settlements to the east and the north. Oakland's rise to industrial prominence, and its subsequent need for a seaport, led to the digging of a shipping and tidal channel in 1902. This resulted in the nearby town of Alameda being made an island. In 1906, the city's population doubled with refugees made homeless after the 1906 San Francisco earthquake and fire. In 1908, the lawyer, former miner, and newspaper owner Homer Wood (1880–1976) suggested to his friend Frank Bilger of Blake and Bilger Rock Quarry and Paving Company that he organize a gathering to establish a Rotary Club east of the bay. On November 27, 1908, Homer took a ferry across the bay in a driving rainstorm and met for lunch with Frank and twenty three other businessmen at the Hotel Metropole at 13th and Jefferson. This gathering became the first meeting of the Tri-City Rotary Club, renamed in 1911 The Rotary Club of Oakland, the third Rotary Club in the world. This group established the tradition of weekly meetings, something most clubs worldwide follow today. In 1917, General Motors opened an automobile factory in East Oakland called Oakland Assembly . It produced Chevrolet cars and then GMC trucks until 1963, when it was moved to Fremont in southern Alameda County. Also in 1916, the Fageol Motor Company chose East Oakland for their first factory, manufacturing farming tractors from 1918 to 1923. By 1920, Oakland was the home of numerous manufacturing industries, including metals , canneries, bakeries, internal combustion engines , automobiles, and shipbuilding. By 1929, when Chrysler expanded with a new plant there, Oakland had become known as the " Detroit of the West," referring to the major auto manufacturing center in Michigan. Oakland expanded during the 1920s, as its population expanded with factory workers. Approximately 13,000 homes were built in the 3 years between 1921 and 1924, more than during the 13 years between 1907 and 1920. Many of the large downtown office buildings, apartment buildings, and single-family houses still standing in Oakland were built during the 1920s; they reflect the architectural styles of the time. Russell Clifford Durant established Durant Field at 82nd Avenue and East 14th Street in 1916. The first transcontinental airmail flight finished its journey at Durant Field on August 9, 1920, flown by Army Capt. Eddie Rickenbacker and Navy Lt. Bert Acosta . Durant Field was often called Oakland Airport, though the current Oakland International Airport was soon established four miles (6.4 km) to the southwest. During World War II, the East Bay Area was home to many war-related industries. Oakland's Moore Dry Dock Company expanded its shipbuilding capabilities and built over 100 ships. Valued at $100 million in 1943, Oakland's canning industry was its second-most-valuable war contribution after shipbuilding. The largest canneries were in the Fruitvale District, and included the Josiah Lusk Canning Company, the Oakland Preserving Company (which started the Del Monte brand), and the California Packing Company. President Franklin D. Roosevelt called on defense industries with government contracts to integrate their workforces and provide opportunities for all Americans. Tens of thousands of laborers came from around the country, especially poor whites and blacks from the Deep South: Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, and Texas, as well as Missouri and Tennessee. Henry J. Kaiser 's representatives recruited sharecroppers and tenant farmers from rural areas to work in his shipyards. African Americans were part of the Great Migration by which five million persons left the South, mostly for the West, from 1940 to 1970. White migrants from the Jim Crow South carried their racial attitudes, causing tensions to rise among black and white workers competing for the better-paying jobs in the Bay Area. The racial harmony Oakland African-Americans had been accustomed to prior to the war evaporated. Also migrating to the area during this time were many Mexican Americans from southwestern states such as New Mexico , Texas , and Colorado . Many worked for the Southern Pacific Railroad , at its major rail yard in West Oakland. Their young men encountered hostility and discrimination by Armed Forces personnel, and tensions broke out in " zoot suit riots " in downtown Oakland in 1943 in the wake of a major disturbance in Los Angeles that year. In 1946, National City Lines (NCL), a General Motors holding company , acquired 64% of Key System stock; during the next several years NCL engaged in the conspiratorial dissolution of Oakland's electric streetcar system. The city's expensive electric streetcar fleet was converted to the cheaper diesel buses. The state Legislature created the Alameda and Contra Costa Transit District in 1955, which operates today as AC Transit , the third-largest bus-only transit system in the nation. After the war, as Oakland's shipbuilding industry declined and the automobile industry went through restructuring, many jobs were lost. [ citation needed ] In addition, labor unrest increased as workers struggled to protect their livelihoods. Oakland was the center of a general strike during the first week of December 1946, one of six cities across the country that had such a strike after World War II. The Mary's First and Last Chance in Oakland was a lesbian bar, once the focus of the 1950s California Supreme Court lawsuit Vallerga v. Dept. Alcoholic Bev. Control, when the bar challenged a state law for the right to serve gay patrons and won in 1959. In 1960, Kaiser Corporation opened its new headquarters; it was the largest skyscraper in Oakland, as well as "the largest office tower west of Chicago " up to that time. In the postwar period, suburban development increased around Oakland, and wealthier residents moved to new housing . Despite the major increases in the number and proportion of African Americans in the city, in 1966 only 16 of the city's 661 police officers were black. Tensions between the black community and the largely white police force were high, as expectations during the civil rights era increased to gain social justice and equality before the law. Police abuse of blacks was common. Students Huey Newton and Bobby Seale founded the Black Panther Party at Merritt College (then located at a former high school on Grove Street, now occupied by Children's Hospital Oakland Research Institute ), which emphasized Black nationalism , advocated armed self-defense against police, and was involved in several incidents that ended in the deaths of police officers and other Black Panther members. Among their social programs were feeding children and providing other services to the needy. As in many other American cities during the 1980s, crack cocaine became a serious problem in Oakland. Drug dealing in general, and the dealing of crack cocaine in particular, resulted in elevated rates of violent crime, causing Oakland to consistently be listed as one of America's most crime-ridden cities. In 1980, Oakland's Black population reached its 20th-century peak at approximately 47% of the overall city population. The 6.9 M w Loma Prieta earthquake occurred on October 17, 1989. The rupture was related to the San Andreas fault system and affected the entire San Francisco Bay Area with a maximum Mercalli intensity of IX ( Violent ). Many structures in Oakland were badly damaged including the double-decker portion of Interstate 880 that collapsed. The eastern span of the San Francisco–Oakland Bay Bridge also sustained damage and was closed to traffic for one month. On October 20, 1991, a massive firestorm swept down from the Berkeley /Oakland hills above the Caldecott Tunnel. Twenty-five people were killed, 150 people were injured, and nearly 4,000 homes destroyed. With the loss of life and an estimated economic loss of US$ 1.5 billion, this was the worst urban firestorm in American history, until 2017. During the mid-1990s, Oakland's economy began to recover as it transitioned to new types of jobs. In addition, the city participated in large development and urban renewal projects, concentrated especially in the downtown area, at the Port of Oakland , and at the Oakland International Airport . After his 1999 inauguration, Oakland Mayor Jerry Brown continued his predecessor Elihu Harris' public policy of supporting downtown housing development in the area defined as the Central Business District in Oakland's 1998 General Plan. Brown's plan and other redevelopment projects were controversial due to potential rent increases and gentrification , which would displace lower-income residents from downtown Oakland into outlying neighborhoods and cities. Due to allegations of misconduct by the Oakland Police Department , the City of Oakland has paid claims for a total of US$ 57 million during the 2001–2011 timeframe to plaintiffs claiming police abuse; this is the largest sum paid by any city in California. On October 10, 2011, protesters and civic activists began " Occupy Oakland " demonstrations at Frank Ogawa Plaza in Downtown Oakland . African-Americans dropped to 28% of Oakland's population in 2010, from nearly half in 1980, due to fast-rising rents and an extreme housing crisis in the region. The city inspected warehouses and live/work spaces after a fire broke out in the Ghost Ship warehouse , killing 36 people in 2016. Oakland is the second U.S. city, after Denver , to decriminalize psilocybin mushrooms . In June 2019, the City Council passed the resolution in a unanimous vote ending the investigation and imposition of criminal penalties for use and possession of natural entheogens . In November 2019, two homeless mothers and their children moved into a vacant three-bedroom house in West Oakland. The group, calling themselves Moms 4 Housing , said their goal was to protest what they said was a large number of vacant houses in Oakland owned by redevelopment companies while the city experienced a housing crisis. Two months later they were evicted from the house by three dozen sheriff's deputies, as hundreds of supporters demonstrated in favor of the women. The incident received nationwide coverage. The company that owns the house later said they would sell it to a nonprofit affordable housing group. As of 2019, Oakland's per-capita homeless rate was higher than San Francisco and Berkeley. Between 2014 and 2020, Oakland strengthened its protections for tenants in order to reduce the displacement of its long-time residents. Between January 2020 and March 2022, Oakland suffered a disproportionate death toll from the COVID-19 pandemic and Delta cron hybrid variant within the San Francisco Bay Area. In 2023, prior to and during the Covid pandemic, Oakland became the first city in American history to lose three professional major league sports teams to other cities within a span of five years. The earliest known inhabitants were the Huchiun natives, who lived there for thousands of years. The Huchiun belonged to a linguistic grouping later called the Ohlone (a Miwok word meaning "western people"). In Oakland, they were concentrated around Lake Merritt and Temescal Creek , a stream that enters the San Francisco Bay at Emeryville .In 1772, the area that later became Oakland was colonized, along with the rest of California, by Spanish settlers for the king of Spain . In the early 19th century, the Spanish crown granted the East Bay area to Luis María Peralta for his Rancho San Antonio . The grant was confirmed by the successor Mexican republic upon its independence from Spain. Upon his death in 1842, Peralta divided his land among his four sons. Most of Oakland was within the shares given to Antonio Maria and Vicente. The portion of the parcel that is now Oakland was called Encinar (misrendered at an early date and carried forward as "encinal") – Spanish for " oak grove " – due to the large oak forest that covered the area, which eventually led to the city's name. According to Stanford University historian Albert Camarillo, the Peralta family struggled to keep their land after the incorporation of California into the United States after the Mexican–American War . Camarillo claims the family was the victim of targeted racial violence. He writes in Chicanos in California , "They lost everything when squatters cut down their fruit trees, killed their cattle, destroyed their buildings, and even fenced off the roads leading to the rancho. Especially insidious were the actions of attorney Horace Carpentier , who tricked Vicente Peralta into signing a 'lease' which turned out to be a mortgage against the 19,000-acre rancho. The lands became Carpentier's when Peralta refused to repay the loan he believed was fraudulently incurred. The Peraltas had no choice but to abandon the homesite they had occupied for two generations." In 1851, three men— Horace Carpentier , Edson Adams, and Andrew Moon—began developing what is now downtown Oakland. In 1852, the Town of Oakland was incorporated by the state legislature. During this time, Oakland had 75–100 inhabitants, two hotels, a wharf, two warehouses, and only cattle trails. Two years later, on March 25, 1854, Oakland re-incorporated as the City of Oakland. Horace Carpentier was elected the first mayor, though a scandal ended his mayorship in less than a year. [ citation needed ] In 1853, a preparatory academy was founded in Oakland that soon became the College of California , and in 1869, the first campus of the University of California , the university moved just north to Berkeley in the 1870s. During the 1850s, just as gold was discovered in California, Oakland started growing and further developing because land was becoming too expensive in San Francisco . People in China were struggling financially as a result of the First Opium War , the Second Opium War , and the Taiping Rebellion , so they began migrating to Oakland, many of whom were recruited to work on railroads. However, the Chinese struggled to settle because they were discriminated against by the white community and their living quarters were burned down on several occasions. [ page needed ] The city and its environs quickly grew with the railroads, becoming a major rail terminal in the late 1860s and 1870s. In 1868, the Central Pacific constructed the Oakland Long Wharf at Oakland Point, the site of today's Port of Oakland . A number of horsecar and cable car lines were constructed in Oakland during the latter half of the 19th century. The first electric streetcar set out from Oakland to Berkeley in 1891, and other lines were converted and added over the course of the 1890s. The various streetcar companies operating in Oakland were acquired by Francis "Borax" Smith and consolidated into what eventually became known as the Key System , the predecessor of today's publicly owned AC Transit .Oakland was one of the worst affected cities in California that was impacted by the San Francisco plague of 1900–1904 . Quarantine measures were set in place at the Oakland ports requiring the authorities at the port to inspect the arriving vessels for the presence of infected rats. Quarantine authorities at these ports inspected over a thousand vessels per year for plague and yellow fever. By 1908, over 5,000 people were detained in quarantine. Hunters were sent to poison the affected areas in Oakland and shoot the squirrels, but the eradication work was limited in its range because the State Board of Health and the United States Public Health Service were only allotted about $60,000 a year to eradicate the disease. During this period Oakland did not have sufficient health facilities, so some of the infected patients were treated at home. The State Board of Health along with Oakland also advised physicians to promptly report any cases of infected patients. Yet, in 1919 it still resulted in a small epidemic of Pneumonic plague which killed a dozen people in Oakland. This started when a man went hunting in Contra Costa Valley and killed a squirrel. After eating the squirrel, he fell ill four days later and another household member contracted the plague. This in turn was passed on either directly or indirectly to about a dozen others. The officials in Oakland acted quickly by issuing death certificates to monitor the spread of plague. At the time of incorporation in 1852, Oakland had consisted of the territory that lay south of today's major intersection of San Pablo Avenue, Broadway, and Fourteenth Street. The city gradually annexed farmlands and settlements to the east and the north. Oakland's rise to industrial prominence, and its subsequent need for a seaport, led to the digging of a shipping and tidal channel in 1902. This resulted in the nearby town of Alameda being made an island. In 1906, the city's population doubled with refugees made homeless after the 1906 San Francisco earthquake and fire. In 1908, the lawyer, former miner, and newspaper owner Homer Wood (1880–1976) suggested to his friend Frank Bilger of Blake and Bilger Rock Quarry and Paving Company that he organize a gathering to establish a Rotary Club east of the bay. On November 27, 1908, Homer took a ferry across the bay in a driving rainstorm and met for lunch with Frank and twenty three other businessmen at the Hotel Metropole at 13th and Jefferson. This gathering became the first meeting of the Tri-City Rotary Club, renamed in 1911 The Rotary Club of Oakland, the third Rotary Club in the world. This group established the tradition of weekly meetings, something most clubs worldwide follow today. In 1917, General Motors opened an automobile factory in East Oakland called Oakland Assembly . It produced Chevrolet cars and then GMC trucks until 1963, when it was moved to Fremont in southern Alameda County. Also in 1916, the Fageol Motor Company chose East Oakland for their first factory, manufacturing farming tractors from 1918 to 1923. By 1920, Oakland was the home of numerous manufacturing industries, including metals , canneries, bakeries, internal combustion engines , automobiles, and shipbuilding. By 1929, when Chrysler expanded with a new plant there, Oakland had become known as the " Detroit of the West," referring to the major auto manufacturing center in Michigan. Oakland expanded during the 1920s, as its population expanded with factory workers. Approximately 13,000 homes were built in the 3 years between 1921 and 1924, more than during the 13 years between 1907 and 1920. Many of the large downtown office buildings, apartment buildings, and single-family houses still standing in Oakland were built during the 1920s; they reflect the architectural styles of the time. Russell Clifford Durant established Durant Field at 82nd Avenue and East 14th Street in 1916. The first transcontinental airmail flight finished its journey at Durant Field on August 9, 1920, flown by Army Capt. Eddie Rickenbacker and Navy Lt. Bert Acosta . Durant Field was often called Oakland Airport, though the current Oakland International Airport was soon established four miles (6.4 km) to the southwest. During World War II, the East Bay Area was home to many war-related industries. Oakland's Moore Dry Dock Company expanded its shipbuilding capabilities and built over 100 ships. Valued at $100 million in 1943, Oakland's canning industry was its second-most-valuable war contribution after shipbuilding. The largest canneries were in the Fruitvale District, and included the Josiah Lusk Canning Company, the Oakland Preserving Company (which started the Del Monte brand), and the California Packing Company. President Franklin D. Roosevelt called on defense industries with government contracts to integrate their workforces and provide opportunities for all Americans. Tens of thousands of laborers came from around the country, especially poor whites and blacks from the Deep South: Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, and Texas, as well as Missouri and Tennessee. Henry J. Kaiser 's representatives recruited sharecroppers and tenant farmers from rural areas to work in his shipyards. African Americans were part of the Great Migration by which five million persons left the South, mostly for the West, from 1940 to 1970. White migrants from the Jim Crow South carried their racial attitudes, causing tensions to rise among black and white workers competing for the better-paying jobs in the Bay Area. The racial harmony Oakland African-Americans had been accustomed to prior to the war evaporated. Also migrating to the area during this time were many Mexican Americans from southwestern states such as New Mexico , Texas , and Colorado . Many worked for the Southern Pacific Railroad , at its major rail yard in West Oakland. Their young men encountered hostility and discrimination by Armed Forces personnel, and tensions broke out in " zoot suit riots " in downtown Oakland in 1943 in the wake of a major disturbance in Los Angeles that year. In 1946, National City Lines (NCL), a General Motors holding company , acquired 64% of Key System stock; during the next several years NCL engaged in the conspiratorial dissolution of Oakland's electric streetcar system. The city's expensive electric streetcar fleet was converted to the cheaper diesel buses. The state Legislature created the Alameda and Contra Costa Transit District in 1955, which operates today as AC Transit , the third-largest bus-only transit system in the nation. After the war, as Oakland's shipbuilding industry declined and the automobile industry went through restructuring, many jobs were lost. [ citation needed ] In addition, labor unrest increased as workers struggled to protect their livelihoods. Oakland was the center of a general strike during the first week of December 1946, one of six cities across the country that had such a strike after World War II. The Mary's First and Last Chance in Oakland was a lesbian bar, once the focus of the 1950s California Supreme Court lawsuit Vallerga v. Dept. Alcoholic Bev. Control, when the bar challenged a state law for the right to serve gay patrons and won in 1959. At the time of incorporation in 1852, Oakland had consisted of the territory that lay south of today's major intersection of San Pablo Avenue, Broadway, and Fourteenth Street. The city gradually annexed farmlands and settlements to the east and the north. Oakland's rise to industrial prominence, and its subsequent need for a seaport, led to the digging of a shipping and tidal channel in 1902. This resulted in the nearby town of Alameda being made an island. In 1906, the city's population doubled with refugees made homeless after the 1906 San Francisco earthquake and fire. In 1908, the lawyer, former miner, and newspaper owner Homer Wood (1880–1976) suggested to his friend Frank Bilger of Blake and Bilger Rock Quarry and Paving Company that he organize a gathering to establish a Rotary Club east of the bay. On November 27, 1908, Homer took a ferry across the bay in a driving rainstorm and met for lunch with Frank and twenty three other businessmen at the Hotel Metropole at 13th and Jefferson. This gathering became the first meeting of the Tri-City Rotary Club, renamed in 1911 The Rotary Club of Oakland, the third Rotary Club in the world. This group established the tradition of weekly meetings, something most clubs worldwide follow today. In 1917, General Motors opened an automobile factory in East Oakland called Oakland Assembly . It produced Chevrolet cars and then GMC trucks until 1963, when it was moved to Fremont in southern Alameda County. Also in 1916, the Fageol Motor Company chose East Oakland for their first factory, manufacturing farming tractors from 1918 to 1923. By 1920, Oakland was the home of numerous manufacturing industries, including metals , canneries, bakeries, internal combustion engines , automobiles, and shipbuilding. By 1929, when Chrysler expanded with a new plant there, Oakland had become known as the " Detroit of the West," referring to the major auto manufacturing center in Michigan. Oakland expanded during the 1920s, as its population expanded with factory workers. Approximately 13,000 homes were built in the 3 years between 1921 and 1924, more than during the 13 years between 1907 and 1920. Many of the large downtown office buildings, apartment buildings, and single-family houses still standing in Oakland were built during the 1920s; they reflect the architectural styles of the time. Russell Clifford Durant established Durant Field at 82nd Avenue and East 14th Street in 1916. The first transcontinental airmail flight finished its journey at Durant Field on August 9, 1920, flown by Army Capt. Eddie Rickenbacker and Navy Lt. Bert Acosta . Durant Field was often called Oakland Airport, though the current Oakland International Airport was soon established four miles (6.4 km) to the southwest. During World War II, the East Bay Area was home to many war-related industries. Oakland's Moore Dry Dock Company expanded its shipbuilding capabilities and built over 100 ships. Valued at $100 million in 1943, Oakland's canning industry was its second-most-valuable war contribution after shipbuilding. The largest canneries were in the Fruitvale District, and included the Josiah Lusk Canning Company, the Oakland Preserving Company (which started the Del Monte brand), and the California Packing Company. President Franklin D. Roosevelt called on defense industries with government contracts to integrate their workforces and provide opportunities for all Americans. Tens of thousands of laborers came from around the country, especially poor whites and blacks from the Deep South: Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, and Texas, as well as Missouri and Tennessee. Henry J. Kaiser 's representatives recruited sharecroppers and tenant farmers from rural areas to work in his shipyards. African Americans were part of the Great Migration by which five million persons left the South, mostly for the West, from 1940 to 1970. White migrants from the Jim Crow South carried their racial attitudes, causing tensions to rise among black and white workers competing for the better-paying jobs in the Bay Area. The racial harmony Oakland African-Americans had been accustomed to prior to the war evaporated. Also migrating to the area during this time were many Mexican Americans from southwestern states such as New Mexico , Texas , and Colorado . Many worked for the Southern Pacific Railroad , at its major rail yard in West Oakland. Their young men encountered hostility and discrimination by Armed Forces personnel, and tensions broke out in " zoot suit riots " in downtown Oakland in 1943 in the wake of a major disturbance in Los Angeles that year. In 1946, National City Lines (NCL), a General Motors holding company , acquired 64% of Key System stock; during the next several years NCL engaged in the conspiratorial dissolution of Oakland's electric streetcar system. The city's expensive electric streetcar fleet was converted to the cheaper diesel buses. The state Legislature created the Alameda and Contra Costa Transit District in 1955, which operates today as AC Transit , the third-largest bus-only transit system in the nation. After the war, as Oakland's shipbuilding industry declined and the automobile industry went through restructuring, many jobs were lost. [ citation needed ] In addition, labor unrest increased as workers struggled to protect their livelihoods. Oakland was the center of a general strike during the first week of December 1946, one of six cities across the country that had such a strike after World War II. The Mary's First and Last Chance in Oakland was a lesbian bar, once the focus of the 1950s California Supreme Court lawsuit Vallerga v. Dept. Alcoholic Bev. Control, when the bar challenged a state law for the right to serve gay patrons and won in 1959. In 1960, Kaiser Corporation opened its new headquarters; it was the largest skyscraper in Oakland, as well as "the largest office tower west of Chicago " up to that time. In the postwar period, suburban development increased around Oakland, and wealthier residents moved to new housing . Despite the major increases in the number and proportion of African Americans in the city, in 1966 only 16 of the city's 661 police officers were black. Tensions between the black community and the largely white police force were high, as expectations during the civil rights era increased to gain social justice and equality before the law. Police abuse of blacks was common. Students Huey Newton and Bobby Seale founded the Black Panther Party at Merritt College (then located at a former high school on Grove Street, now occupied by Children's Hospital Oakland Research Institute ), which emphasized Black nationalism , advocated armed self-defense against police, and was involved in several incidents that ended in the deaths of police officers and other Black Panther members. Among their social programs were feeding children and providing other services to the needy. As in many other American cities during the 1980s, crack cocaine became a serious problem in Oakland. Drug dealing in general, and the dealing of crack cocaine in particular, resulted in elevated rates of violent crime, causing Oakland to consistently be listed as one of America's most crime-ridden cities. In 1980, Oakland's Black population reached its 20th-century peak at approximately 47% of the overall city population. The 6.9 M w Loma Prieta earthquake occurred on October 17, 1989. The rupture was related to the San Andreas fault system and affected the entire San Francisco Bay Area with a maximum Mercalli intensity of IX ( Violent ). Many structures in Oakland were badly damaged including the double-decker portion of Interstate 880 that collapsed. The eastern span of the San Francisco–Oakland Bay Bridge also sustained damage and was closed to traffic for one month. On October 20, 1991, a massive firestorm swept down from the Berkeley /Oakland hills above the Caldecott Tunnel. Twenty-five people were killed, 150 people were injured, and nearly 4,000 homes destroyed. With the loss of life and an estimated economic loss of US$ 1.5 billion, this was the worst urban firestorm in American history, until 2017. During the mid-1990s, Oakland's economy began to recover as it transitioned to new types of jobs. In addition, the city participated in large development and urban renewal projects, concentrated especially in the downtown area, at the Port of Oakland , and at the Oakland International Airport . After his 1999 inauguration, Oakland Mayor Jerry Brown continued his predecessor Elihu Harris' public policy of supporting downtown housing development in the area defined as the Central Business District in Oakland's 1998 General Plan. Brown's plan and other redevelopment projects were controversial due to potential rent increases and gentrification , which would displace lower-income residents from downtown Oakland into outlying neighborhoods and cities. Due to allegations of misconduct by the Oakland Police Department , the City of Oakland has paid claims for a total of US$ 57 million during the 2001–2011 timeframe to plaintiffs claiming police abuse; this is the largest sum paid by any city in California. On October 10, 2011, protesters and civic activists began " Occupy Oakland " demonstrations at Frank Ogawa Plaza in Downtown Oakland . African-Americans dropped to 28% of Oakland's population in 2010, from nearly half in 1980, due to fast-rising rents and an extreme housing crisis in the region. The city inspected warehouses and live/work spaces after a fire broke out in the Ghost Ship warehouse , killing 36 people in 2016. Oakland is the second U.S. city, after Denver , to decriminalize psilocybin mushrooms . In June 2019, the City Council passed the resolution in a unanimous vote ending the investigation and imposition of criminal penalties for use and possession of natural entheogens . In November 2019, two homeless mothers and their children moved into a vacant three-bedroom house in West Oakland. The group, calling themselves Moms 4 Housing , said their goal was to protest what they said was a large number of vacant houses in Oakland owned by redevelopment companies while the city experienced a housing crisis. Two months later they were evicted from the house by three dozen sheriff's deputies, as hundreds of supporters demonstrated in favor of the women. The incident received nationwide coverage. The company that owns the house later said they would sell it to a nonprofit affordable housing group. As of 2019, Oakland's per-capita homeless rate was higher than San Francisco and Berkeley. Between 2014 and 2020, Oakland strengthened its protections for tenants in order to reduce the displacement of its long-time residents. Between January 2020 and March 2022, Oakland suffered a disproportionate death toll from the COVID-19 pandemic and Delta cron hybrid variant within the San Francisco Bay Area. In 2023, prior to and during the Covid pandemic, Oakland became the first city in American history to lose three professional major league sports teams to other cities within a span of five years. Oakland is in the eastern region of the San Francisco Bay . The United States Census Bureau says the city's total area is 78.0 square miles (202 km 2 ) , including 55.8 square miles (145 km 2 ) of land and 22.2 square miles (57 km 2 ) (28.48 percent) of water. Oakland's highest point is near Grizzly Peak Blvd, east of Berkeley, just over 1,760 feet (540 m) above sea level at about 37°52′43″N 122°13′27″W / 37.8786°N 122.2241°W / 37.8786; -122.2241 . Oakland has 19 miles (31 km) of shoreline, but Radio Beach is the only beach in Oakland. Oaklanders refer to their city's terrain as "the flatlands" and "the hills" . Until recent waves of gentrification, these terms also symbolized Oakland's deep economic divide, with "the hills" being more affluent communities. About two-thirds of Oakland lies in the flat plain of the East Bay, with one-third rising into the foothills and hills of the East Bay range. Ruptures along the nearby San Andreas Fault caused severe earth movement in the San Francisco Bay Area in 1906 and 1989. San Andreas quakes induces creep (movement occurring on earthquake faults) in the Hayward fault, which runs directly through Oakland, Berkeley, San Jose and other Bay Area cities. Oakland has more than 50 distinct neighborhoods. The city's greater divisions include downtown Oakland and its greater Central Business District , Lake Merritt , East Oakland , North Oakland , West Oakland , and the Oakland Hills . East Oakland, which includes the East Oakland Hills, encompasses more than half of Oakland's land area, stretching from Lakeshore Avenue on the east shore of Lake Merritt southeast to the San Leandro border. North Oakland encompasses the neighborhoods between downtown and Berkeley and Emeryville . West Oakland is the area between downtown and the Bay, partially surrounded by the Oakland Point , and encompassing the Port of Oakland . In 2011, Oakland was ranked the tenth most walkable city in the United States by Walk Score . Lake Merritt, an urban estuary near downtown, is a mix of fresh and salt water draining in and out from the Oakland Harbor at the San Francisco Bay and one of Oakland's most notable features. It was designated the United States' first official wildlife refuge in 1870. Originally a marsh-lined wildlife haven, Lake Merritt was dredged and bordered with parks from the 1890s to the 1910s. Despite this reduction in habitat, Oakland is home to a number of rare and endangered species, many of which are localized to serpentine soils and bedrock. Lake Merritt is surrounded by residential and business districts, including downtown and Grand Lake . The city of Piedmont , incorporated in Oakland's central foothills after the 1906 earthquake, is a small independent city surrounded by the city of Oakland. Oakland has a warm-summer Mediterranean climate ( Köppen Csb ) with an average of 260 sunny days per year. In general, the city features warm, dry summers, and cool, wet winters. Based on data gathered by the National Oceanic and Atmospheric Administration , Oakland is ranked No. 1 in climate among U.S. cities. Oakland's climate is typified by the temperate and seasonal Mediterranean climate. Summers are usually dry and warm and winters are cool and damp. It has features found in both nearby coastal cities such as San Francisco and inland cities such as San Jose , making it warmer than San Francisco and cooler than San Jose. Its position on San Francisco Bay across from the Bay Bridge means the northern part of the city can have cooling maritime fog . It is far enough inland that the fog often burns off by midday, allowing it to have typically sunny California days. The hills tend to have more fog than the flatlands, as the fog drifts down from Berkeley . The U.S. Weather Bureau kept weather records in downtown Oakland from October 4, 1894, to July 31, 1958. During that time, the record high temperature was 104 °F (40 °C) on June 24, 1957, and the record low temperature was 24 °F (−4 °C) on January 23, 1949. Dry, warm offshore "Diablo" winds (similar to the Santa Ana winds of Southern California) sometimes occur, especially in fall, and raise the fire danger. In 1991, such an episode allowed the catastrophic Oakland Hills fire to spread and consume many homes. Oakland, like much of Northern California, is susceptible to winter rainstorms and Atmospheric rivers . The wettest "rain year" was from July 1997 to June 1998 with 47.76 inches (1,213.1 mm) and the driest from July 2019 to June 2020 with 9.28 inches (235.7 mm) . The most rainfall in one month was 15.35 inches (390 mm) in January 1911. The most rainfall in 24 hours was 4.29 inches (109 mm) on January 26, 2008. Rainfall near the bayfront is only 23 inches (580 mm) , but is higher in the Oakland Hills to the east (up to 30 inches [760 mm] ), with nearly all precipitation falling between November and April. Overnight lows are mild. Oakland seldom experiences warm nights with the warmest recorded night of 72 °F (22 °C) in September 1971 and an average of 64 °F (18 °C) for the annual warmest low. The coldest day of the year averages a mild 50 °F (10 °C) and has never been recorded below 36 °F (2 °C) . The National Weather Service today has two official weather stations in Oakland: Oakland International Airport and the Oakland Museum (established 1970). The higher rainfall in the hills supports woods of oak, madrona, pine, fir and a few redwood groves in the wetter areas. Before being logged in the 19th century, some of the tallest redwood trees in California (used for navigation by ships entering the Golden Gate) may have stood in the Oakland Hills. One old stump 30 feet (9.1 m) in diameter can be seen near Redwood Regional Park. Sunny, drier slopes are grassy or covered in scattered oaks and chaparral brush. Australian eucalyptus trees have been extensively planted in many areas, as they come from a similar climate.Oakland has more than 50 distinct neighborhoods. The city's greater divisions include downtown Oakland and its greater Central Business District , Lake Merritt , East Oakland , North Oakland , West Oakland , and the Oakland Hills . East Oakland, which includes the East Oakland Hills, encompasses more than half of Oakland's land area, stretching from Lakeshore Avenue on the east shore of Lake Merritt southeast to the San Leandro border. North Oakland encompasses the neighborhoods between downtown and Berkeley and Emeryville . West Oakland is the area between downtown and the Bay, partially surrounded by the Oakland Point , and encompassing the Port of Oakland . In 2011, Oakland was ranked the tenth most walkable city in the United States by Walk Score . Lake Merritt, an urban estuary near downtown, is a mix of fresh and salt water draining in and out from the Oakland Harbor at the San Francisco Bay and one of Oakland's most notable features. It was designated the United States' first official wildlife refuge in 1870. Originally a marsh-lined wildlife haven, Lake Merritt was dredged and bordered with parks from the 1890s to the 1910s. Despite this reduction in habitat, Oakland is home to a number of rare and endangered species, many of which are localized to serpentine soils and bedrock. Lake Merritt is surrounded by residential and business districts, including downtown and Grand Lake . The city of Piedmont , incorporated in Oakland's central foothills after the 1906 earthquake, is a small independent city surrounded by the city of Oakland.Oakland has a warm-summer Mediterranean climate ( Köppen Csb ) with an average of 260 sunny days per year. In general, the city features warm, dry summers, and cool, wet winters. Based on data gathered by the National Oceanic and Atmospheric Administration , Oakland is ranked No. 1 in climate among U.S. cities. Oakland's climate is typified by the temperate and seasonal Mediterranean climate. Summers are usually dry and warm and winters are cool and damp. It has features found in both nearby coastal cities such as San Francisco and inland cities such as San Jose , making it warmer than San Francisco and cooler than San Jose. Its position on San Francisco Bay across from the Bay Bridge means the northern part of the city can have cooling maritime fog . It is far enough inland that the fog often burns off by midday, allowing it to have typically sunny California days. The hills tend to have more fog than the flatlands, as the fog drifts down from Berkeley . The U.S. Weather Bureau kept weather records in downtown Oakland from October 4, 1894, to July 31, 1958. During that time, the record high temperature was 104 °F (40 °C) on June 24, 1957, and the record low temperature was 24 °F (−4 °C) on January 23, 1949. Dry, warm offshore "Diablo" winds (similar to the Santa Ana winds of Southern California) sometimes occur, especially in fall, and raise the fire danger. In 1991, such an episode allowed the catastrophic Oakland Hills fire to spread and consume many homes. Oakland, like much of Northern California, is susceptible to winter rainstorms and Atmospheric rivers . The wettest "rain year" was from July 1997 to June 1998 with 47.76 inches (1,213.1 mm) and the driest from July 2019 to June 2020 with 9.28 inches (235.7 mm) . The most rainfall in one month was 15.35 inches (390 mm) in January 1911. The most rainfall in 24 hours was 4.29 inches (109 mm) on January 26, 2008. Rainfall near the bayfront is only 23 inches (580 mm) , but is higher in the Oakland Hills to the east (up to 30 inches [760 mm] ), with nearly all precipitation falling between November and April. Overnight lows are mild. Oakland seldom experiences warm nights with the warmest recorded night of 72 °F (22 °C) in September 1971 and an average of 64 °F (18 °C) for the annual warmest low. The coldest day of the year averages a mild 50 °F (10 °C) and has never been recorded below 36 °F (2 °C) . The National Weather Service today has two official weather stations in Oakland: Oakland International Airport and the Oakland Museum (established 1970).The higher rainfall in the hills supports woods of oak, madrona, pine, fir and a few redwood groves in the wetter areas. Before being logged in the 19th century, some of the tallest redwood trees in California (used for navigation by ships entering the Golden Gate) may have stood in the Oakland Hills. One old stump 30 feet (9.1 m) in diameter can be seen near Redwood Regional Park. Sunny, drier slopes are grassy or covered in scattered oaks and chaparral brush. Australian eucalyptus trees have been extensively planted in many areas, as they come from a similar climate.The 2020 United States Census reported Oakland had a population of 440,646. The population density was 7,898.30 inhabitants per square mile (3,049.55/km 2 ) . 34.95% of people in Oakland are affiliated with a religion, in a total of 417 congregations. Major places of worship in Oakland include – 31st Street Islamic Center, Islam Allen Temple Baptist Church, American Baptist Churches USA and the Progressive National Baptist Convention, Inc. Ascension Cathedral , Greek Orthodox Beth Jacob Congregation, Modern Orthodox Judaism Cathedral of Christ the Light , Roman Catholic Chinese Community Church , United Methodist Elmhurst Seventh-day Adventist Church, Seventh-day Adventist Church First Congregational Church of Oakland, United Church of Christ First Presbyterian Church of Oakland, Presbyterian First Unitarian Church , Unitarian Green Pastures, Evangelistic Outreach Association His Gospel Christian Fellowship Islamic Cultural Center of Northern California, Islam Light-House Mosque, Islam Kingdom Hall of Jehovah's Witnesses, Jehovah's Witnesses Oakland California Temple , The Church of Jesus Christ of Latter-day Saints Oakland City Church Oakland Bahá'í Center Second Bethel Missionary Baptist Church St. Paul Lutheran Church, Lutheran St. Vartan Armenian Church, Armenian Apostolic Church Temple Beth Abraham, United Synagogue of Conservative Judaism Temple Sinai , Reform Judaism The 2020 United States Census reported that the racial makeup of Oakland was 156,429 (35.5%) White , 104,873 (23.8%) Black or African American , 68,300 (15.5%) Asian , 2,643 (0.6%) Pacific Islander , 3,965 (0.9%) Native American , and 30,404 (6.9%) multiracial (two or more races). There were 118,974 (27.0%) of Hispanic or Latino ancestry, of any race. From the 2010 United States Census the racial makeup of Oakland was 134,925 (34.5%) White (non-Hispanic White 25.9%), 129,471 (28.0%) African American , 3,040 (0.8%) Native American , 65,811 (16.8%) Asian (8.7% Chinese , 2.2% Vietnamese , 1.6% Filipino , 0.7% Cambodian , 0.7% Laotian , 0.6% Korean , 0.5% Japanese , 0.5% Indian , 0.1% Mongolian ), 2,222 (0.6%) Pacific Islander (0.3% Tongan ), 53,378 (13.7%) from other races , and 21,877 (5.6%) from two or more races. There were 99,068 people of Hispanic or Latino ancestry, of any race (25.4%). 18.1% of the population were of Mexican descent, 1.9% Salvadoran , 1.3% Guatemalan , and 0.7% Puerto Rican . Racial Makeup of Oakland (2022) Racial/Ethnic Makeup of Oakland excluding Hispanics from Racial Categories (2022) NH=Non-Hispanic Racial Makeup of Hispanics in Oakland (2022) According to 2022 US Census Bureau estimates, Oakland's population declined to 430,531, and was 31.1% White (29.7% Non-Hispanic White and 1.5% Hispanic White ), 20.6% Black or African American , 1.3% Native American and Alaskan Native , 15.9% Asian , 0.3% Pacific Islander , 19.6% Other Race, and 11.3% from two or more races . White Americans are the largest racial/ethnic group at either 31.1% (including White Hispanics ) or 29.7% (excluding White Hispanics). Hispanics have been the second largest ethnic group since 2012 when they displaced the Black population. However, Black Americans still form the second largest racial group. By ethnicity, 26.8% of the total population is Hispanic-Latino (of any race) and 73.2% is Non-Hispanic (of any race). The majority of Hispanics self-identify as Some Other Race (69.3%) with the remainder choosing White (5.4%), Multiracial (19.2%), Black (1.6%), American Indian and Alaskan Native (3.8%), Asian (0.7%), and Hawaiian and Pacific Islander (0.1%). The Black population is the third largest ethnic group and second largest racial group at either 20.6% (including Black Hispanics) or 20.1% excluding Black Hispanics. The Asian population continues to remain the fourth largest group at 15.9% of the population. 5.1% are of English ancestry, French (except Basque), 1.4% German, 6.1% Irish - 6.2% Italian, 3.1% Norwegian, 1.1% Polish - 1.7% Scottish and 1.0%Subsaharan African 2.5%. The greater Oakland area [ specify ] has the fifth largest cluster of "elite zip codes" ranked by the number of households with the highest combination of income and education. 37.9% of residents over 25 years of age have bachelor's degree or higher. Oakland ranked among the top cities with residents with bachelor's degrees and graduate degrees per square mile. Oakland ranks in the top 20 of American cities in median household income, with a 2012 value of US$ 51,863. In 2012, the median income for a household in the city was US$ 51,863 and the median income for a family was US$ 59,459. The mean income for a household was US$ 77,888 and the mean income for a family was US$ 90,948. Males had a median income of US$ 50,140 versus US$ 50,304 for females. The unemployment rate as of December 2013 was 9.7%. In 2007 approximately 15.3 percent of families and 17.0 percent of the general population were below the poverty line, including 27.9 percent of those under age 18 and 13.1 percent of those age 65 or over. 0.7% of the population is homeless. Home ownership is 41% and 14% of rental units are subsidized. As of the census of 2000, 19.4% of the population and 16.2% of families were below the poverty line. Out of the total population, 27.9% of those under the age of 18 and 13.1% of those 65 and older were living below the poverty line. The census reported 382,586 people (97.9% of the population) lived in households, 5,675 (1.5%) lived in non-institutionalized group quarters, and 2,463 (0.6%) were institutionalized. There were 153,791 households, out of which 44,762 (29.1%) had children under the age of 18 living in them, 50,797 (33.0%) were opposite-sex married couples living together, 24,122 (15.7%) had a female householder with no husband present, 8,799 (5.7%) had a male householder with no wife present. There were 11,289 (7.3%) unmarried opposite-sex partnerships , and 3,442 (2.2%) same-sex married couples or partnerships . 52,103 households (33.9%) were made up of individuals, and 13,778 (9.0%) had someone living alone who was 65 years of age or older. The average household size was 2.49. There were 83,718 families (54.4% of all households); the average family size was 3.27. The population was spread out, with 83,120 people (21.3%) under the age of 18, 36,272 people (9.3%) aged 18 to 24, 129,139 people (33.1%) aged 25 to 44, 98,634 people (25.2%) aged 45 to 64, and 43,559 people (11.1%) who were 65 years of age or older. The median age was 36.2 years. For every 100 females, there were 94.2 males. For every 100 females age 18 and over, there were 91.8 males. There were 169,710 housing units at an average density of 2,175.7 per square mile (840.0/km 2 ) , of which 153,791 were occupied, of which 63,142 (41.1%) were owner-occupied, and 90,649 (58.9%) were occupied by renters. The homeowner vacancy rate was 3.0%; the rental vacancy rate was 8.5%. 166,662 people (42.7% of the population) lived in owner-occupied housing units and 215,924 people (55.3%) lived in rental housing units. Oakland has consistently ranked as one of the most ethnically diverse major cities in the country. A 2019 analysis by WalletHub showed that Oakland was the most ethnoracially diverse city in the United States. The city's formerly most populous ethnic group, whites, declined from 95.3% in 1940 to 32.5% by 1990, due to a combination of factors, including suburbanization. Oakland became a destination for African Americans in the Great Migration during and after World War II as they gained high-paying jobs in the defense industry. Blacks have formed a plurality in Oakland for many years, peaking in 1980 at about 47% of the population. Oakland's Black population decreased by nearly 25 percent between 2000 and 2010. The city's demographics have changed due to a combination of rising housing prices associated with gentrification and with blacks relocating to better (and in many cases more affordable) housing in Bay Area suburbs or moving to the Southern United States in a reverse migration, where conditions (including race relations) are considered to have improved in comparison to previous generations. These trends and cultural shifts have led to a decline among some of Oakland's long standing black institutions, such as churches, businesses and nightclubs, which had developed during the growing years of the 1950s through 1970. In the 2010 census African Americans maintained their status as Oakland's single largest ethnic group, with 27% of the population, followed by non-Hispanic whites at 25.9%, and Hispanics of any race at 25.4%. Ethnic Asians constitute 17%, followed by smaller minority groups. Many immigrants have settled in the city. Immigrants and others have marched by the thousands down Oakland's International Boulevard in support of legal reforms benefiting undocumented immigrants . An analysis by the Urban Institute of U.S. Census 2000 numbers showed Oakland had the third-highest concentration of gays and lesbians among the 50 largest U.S. cities, behind San Francisco and Seattle. Census data showed that among incorporated places that have at least 500 female couples, Oakland had the nation's largest proportion. In the 2000 census, 2,650 lesbian couples identified as such in Oakland; one in every 41 Oakland couples identified as a same-sex female partnership. As of 2020, the San Francisco-Oakland Metro shows indications of having the greatest intensity of gentrification nationally, with over 31% of eligible neighborhoods gentrifying. Gentrifying neighborhoods showed significant increases in median home value, median household income, percentage of college educated residents, but also in economic inequality. Historically low-income neighborhoods have been rapidly changed by new, higher-income residents as high-wage tech workers and expensive housing have continued to push lower-wage residents out of Oakland. In West Oakland, for example, median household income rose from $80,700 to $86,300 between 2010 and 2017, while the percent of population with four-year degrees rose from one-third to nearly one-half, according to the National Community Reinvestment Coalition. Big tech companies have continued to transform the communities and culture of Oakland as modern apartments have appeared, housing prices have spiked, and many prior working-class residents have moved to suburbs further inland. According to 2015 data compiled by the Bay Area Equity Atlas, 91% of low-income households of color were either in neighborhoods that were gentrifying or were at risk of gentrification at the time. The number was higher for individual low-income communities, with 96% of Native American households in neighborhoods that either experienced gentrification or were at risk of being gentrified, followed by Latino households at 94%, Black households at 92%, and Asian or Pacific Islander households at 88%. A 2014 study by the Chief Justice Earl Warren Institute on Law & Social Policy at the University of California, Berkeley School of Law examined crime in the city from 1987 to 2012 and concluded that "The story of crime in Oakland over the last 25 years is a nuanced one, as there are both positive and negative aspects of the crime trends." Crime dramatically decreased since the early 1990s but the city has continued to suffer from serious violent crime problems. Crime trends generally tracked comparison cities of Fresno , Richmond , Sacramento , and Stockton "in terms of direction if not magnitude"; this suggested that crime trends are regional rather than city-specific. A 2007 journal article identified crime in Oakland as being fueled by the dramatic increase of street narcotics sales and use since the 1970s, with Oakland becoming a major west-coast hub for heroin and cocaine distribution. Subsequent battle for control over the lucrative narcotics trade incited gang conflicts and violence, with shootings becoming a regular occurrence. A concurrent rise in rape, robbery, burglary, auto-theft and other crimes occurred as well. Prior to 1960, there had been successful government-funded social programs whereby rebellious teens were enrolled in youth centers that would teach them proper values and improve their behavior. Similar programs since then have been inconsistent. By the 1970s, the police and Federal Bureau of Investigation (FBI) used military tactics such as SWAT teams, infiltration and counter intelligence in an attempt to counter groups such as the Black Panthers (responsible for several police ambushes), the S.L.A. and organized drug gangs such as the "69 Mob", with increases in arrests, prosecutions, and imprisonment. During the first decade of the 21st century, Oakland has consistently been listed as one of the most dangerous large cities in the United States. The number of Oakland Police Department officers has varied from a low of 626 (in 1996 and in 2012) to a high of 814 (in 2002). There were 723 officers at the end of 2015. The city's strategic plan recommended 925 officers, and an independent study commissioned by the city in the mid-1990s recommended 1,200 officers. Among Oakland's 35 police patrol beats, violent crime remains a serious problem in specific East and West Oakland neighborhoods. In 2008, homicides were concentrated: 72% occurred in three City Council districts, District 3 in West Oakland and Districts 6 and 7 in East Oakland, although these districts have 44% of Oakland's residents. In 2012, Oakland implemented Operation Ceasefire , a gang violence reduction plan used in other cities, based in part on the research and strategies of author David M. Kennedy . 34.95% of people in Oakland are affiliated with a religion, in a total of 417 congregations. Major places of worship in Oakland include – 31st Street Islamic Center, Islam Allen Temple Baptist Church, American Baptist Churches USA and the Progressive National Baptist Convention, Inc. Ascension Cathedral , Greek Orthodox Beth Jacob Congregation, Modern Orthodox Judaism Cathedral of Christ the Light , Roman Catholic Chinese Community Church , United Methodist Elmhurst Seventh-day Adventist Church, Seventh-day Adventist Church First Congregational Church of Oakland, United Church of Christ First Presbyterian Church of Oakland, Presbyterian First Unitarian Church , Unitarian Green Pastures, Evangelistic Outreach Association His Gospel Christian Fellowship Islamic Cultural Center of Northern California, Islam Light-House Mosque, Islam Kingdom Hall of Jehovah's Witnesses, Jehovah's Witnesses Oakland California Temple , The Church of Jesus Christ of Latter-day Saints Oakland City Church Oakland Bahá'í Center Second Bethel Missionary Baptist Church St. Paul Lutheran Church, Lutheran St. Vartan Armenian Church, Armenian Apostolic Church Temple Beth Abraham, United Synagogue of Conservative Judaism Temple Sinai , Reform JudaismThe 2020 United States Census reported that the racial makeup of Oakland was 156,429 (35.5%) White , 104,873 (23.8%) Black or African American , 68,300 (15.5%) Asian , 2,643 (0.6%) Pacific Islander , 3,965 (0.9%) Native American , and 30,404 (6.9%) multiracial (two or more races). There were 118,974 (27.0%) of Hispanic or Latino ancestry, of any race. From the 2010 United States Census the racial makeup of Oakland was 134,925 (34.5%) White (non-Hispanic White 25.9%), 129,471 (28.0%) African American , 3,040 (0.8%) Native American , 65,811 (16.8%) Asian (8.7% Chinese , 2.2% Vietnamese , 1.6% Filipino , 0.7% Cambodian , 0.7% Laotian , 0.6% Korean , 0.5% Japanese , 0.5% Indian , 0.1% Mongolian ), 2,222 (0.6%) Pacific Islander (0.3% Tongan ), 53,378 (13.7%) from other races , and 21,877 (5.6%) from two or more races. There were 99,068 people of Hispanic or Latino ancestry, of any race (25.4%). 18.1% of the population were of Mexican descent, 1.9% Salvadoran , 1.3% Guatemalan , and 0.7% Puerto Rican .Racial Makeup of Oakland (2022) Racial/Ethnic Makeup of Oakland excluding Hispanics from Racial Categories (2022) NH=Non-Hispanic Racial Makeup of Hispanics in Oakland (2022) According to 2022 US Census Bureau estimates, Oakland's population declined to 430,531, and was 31.1% White (29.7% Non-Hispanic White and 1.5% Hispanic White ), 20.6% Black or African American , 1.3% Native American and Alaskan Native , 15.9% Asian , 0.3% Pacific Islander , 19.6% Other Race, and 11.3% from two or more races . White Americans are the largest racial/ethnic group at either 31.1% (including White Hispanics ) or 29.7% (excluding White Hispanics). Hispanics have been the second largest ethnic group since 2012 when they displaced the Black population. However, Black Americans still form the second largest racial group. By ethnicity, 26.8% of the total population is Hispanic-Latino (of any race) and 73.2% is Non-Hispanic (of any race). The majority of Hispanics self-identify as Some Other Race (69.3%) with the remainder choosing White (5.4%), Multiracial (19.2%), Black (1.6%), American Indian and Alaskan Native (3.8%), Asian (0.7%), and Hawaiian and Pacific Islander (0.1%). The Black population is the third largest ethnic group and second largest racial group at either 20.6% (including Black Hispanics) or 20.1% excluding Black Hispanics. The Asian population continues to remain the fourth largest group at 15.9% of the population. 5.1% are of English ancestry, French (except Basque), 1.4% German, 6.1% Irish - 6.2% Italian, 3.1% Norwegian, 1.1% Polish - 1.7% Scottish and 1.0%Subsaharan African 2.5%. The greater Oakland area [ specify ] has the fifth largest cluster of "elite zip codes" ranked by the number of households with the highest combination of income and education. 37.9% of residents over 25 years of age have bachelor's degree or higher. Oakland ranked among the top cities with residents with bachelor's degrees and graduate degrees per square mile. Oakland ranks in the top 20 of American cities in median household income, with a 2012 value of US$ 51,863. In 2012, the median income for a household in the city was US$ 51,863 and the median income for a family was US$ 59,459. The mean income for a household was US$ 77,888 and the mean income for a family was US$ 90,948. Males had a median income of US$ 50,140 versus US$ 50,304 for females. The unemployment rate as of December 2013 was 9.7%. In 2007 approximately 15.3 percent of families and 17.0 percent of the general population were below the poverty line, including 27.9 percent of those under age 18 and 13.1 percent of those age 65 or over. 0.7% of the population is homeless. Home ownership is 41% and 14% of rental units are subsidized. As of the census of 2000, 19.4% of the population and 16.2% of families were below the poverty line. Out of the total population, 27.9% of those under the age of 18 and 13.1% of those 65 and older were living below the poverty line.The census reported 382,586 people (97.9% of the population) lived in households, 5,675 (1.5%) lived in non-institutionalized group quarters, and 2,463 (0.6%) were institutionalized. There were 153,791 households, out of which 44,762 (29.1%) had children under the age of 18 living in them, 50,797 (33.0%) were opposite-sex married couples living together, 24,122 (15.7%) had a female householder with no husband present, 8,799 (5.7%) had a male householder with no wife present. There were 11,289 (7.3%) unmarried opposite-sex partnerships , and 3,442 (2.2%) same-sex married couples or partnerships . 52,103 households (33.9%) were made up of individuals, and 13,778 (9.0%) had someone living alone who was 65 years of age or older. The average household size was 2.49. There were 83,718 families (54.4% of all households); the average family size was 3.27. The population was spread out, with 83,120 people (21.3%) under the age of 18, 36,272 people (9.3%) aged 18 to 24, 129,139 people (33.1%) aged 25 to 44, 98,634 people (25.2%) aged 45 to 64, and 43,559 people (11.1%) who were 65 years of age or older. The median age was 36.2 years. For every 100 females, there were 94.2 males. For every 100 females age 18 and over, there were 91.8 males. There were 169,710 housing units at an average density of 2,175.7 per square mile (840.0/km 2 ) , of which 153,791 were occupied, of which 63,142 (41.1%) were owner-occupied, and 90,649 (58.9%) were occupied by renters. The homeowner vacancy rate was 3.0%; the rental vacancy rate was 8.5%. 166,662 people (42.7% of the population) lived in owner-occupied housing units and 215,924 people (55.3%) lived in rental housing units.Oakland has consistently ranked as one of the most ethnically diverse major cities in the country. A 2019 analysis by WalletHub showed that Oakland was the most ethnoracially diverse city in the United States. The city's formerly most populous ethnic group, whites, declined from 95.3% in 1940 to 32.5% by 1990, due to a combination of factors, including suburbanization. Oakland became a destination for African Americans in the Great Migration during and after World War II as they gained high-paying jobs in the defense industry. Blacks have formed a plurality in Oakland for many years, peaking in 1980 at about 47% of the population. Oakland's Black population decreased by nearly 25 percent between 2000 and 2010. The city's demographics have changed due to a combination of rising housing prices associated with gentrification and with blacks relocating to better (and in many cases more affordable) housing in Bay Area suburbs or moving to the Southern United States in a reverse migration, where conditions (including race relations) are considered to have improved in comparison to previous generations. These trends and cultural shifts have led to a decline among some of Oakland's long standing black institutions, such as churches, businesses and nightclubs, which had developed during the growing years of the 1950s through 1970. In the 2010 census African Americans maintained their status as Oakland's single largest ethnic group, with 27% of the population, followed by non-Hispanic whites at 25.9%, and Hispanics of any race at 25.4%. Ethnic Asians constitute 17%, followed by smaller minority groups. Many immigrants have settled in the city. Immigrants and others have marched by the thousands down Oakland's International Boulevard in support of legal reforms benefiting undocumented immigrants . An analysis by the Urban Institute of U.S. Census 2000 numbers showed Oakland had the third-highest concentration of gays and lesbians among the 50 largest U.S. cities, behind San Francisco and Seattle. Census data showed that among incorporated places that have at least 500 female couples, Oakland had the nation's largest proportion. In the 2000 census, 2,650 lesbian couples identified as such in Oakland; one in every 41 Oakland couples identified as a same-sex female partnership. As of 2020, the San Francisco-Oakland Metro shows indications of having the greatest intensity of gentrification nationally, with over 31% of eligible neighborhoods gentrifying. Gentrifying neighborhoods showed significant increases in median home value, median household income, percentage of college educated residents, but also in economic inequality. Historically low-income neighborhoods have been rapidly changed by new, higher-income residents as high-wage tech workers and expensive housing have continued to push lower-wage residents out of Oakland. In West Oakland, for example, median household income rose from $80,700 to $86,300 between 2010 and 2017, while the percent of population with four-year degrees rose from one-third to nearly one-half, according to the National Community Reinvestment Coalition. Big tech companies have continued to transform the communities and culture of Oakland as modern apartments have appeared, housing prices have spiked, and many prior working-class residents have moved to suburbs further inland. According to 2015 data compiled by the Bay Area Equity Atlas, 91% of low-income households of color were either in neighborhoods that were gentrifying or were at risk of gentrification at the time. The number was higher for individual low-income communities, with 96% of Native American households in neighborhoods that either experienced gentrification or were at risk of being gentrified, followed by Latino households at 94%, Black households at 92%, and Asian or Pacific Islander households at 88%. A 2014 study by the Chief Justice Earl Warren Institute on Law & Social Policy at the University of California, Berkeley School of Law examined crime in the city from 1987 to 2012 and concluded that "The story of crime in Oakland over the last 25 years is a nuanced one, as there are both positive and negative aspects of the crime trends." Crime dramatically decreased since the early 1990s but the city has continued to suffer from serious violent crime problems. Crime trends generally tracked comparison cities of Fresno , Richmond , Sacramento , and Stockton "in terms of direction if not magnitude"; this suggested that crime trends are regional rather than city-specific. A 2007 journal article identified crime in Oakland as being fueled by the dramatic increase of street narcotics sales and use since the 1970s, with Oakland becoming a major west-coast hub for heroin and cocaine distribution. Subsequent battle for control over the lucrative narcotics trade incited gang conflicts and violence, with shootings becoming a regular occurrence. A concurrent rise in rape, robbery, burglary, auto-theft and other crimes occurred as well. Prior to 1960, there had been successful government-funded social programs whereby rebellious teens were enrolled in youth centers that would teach them proper values and improve their behavior. Similar programs since then have been inconsistent. By the 1970s, the police and Federal Bureau of Investigation (FBI) used military tactics such as SWAT teams, infiltration and counter intelligence in an attempt to counter groups such as the Black Panthers (responsible for several police ambushes), the S.L.A. and organized drug gangs such as the "69 Mob", with increases in arrests, prosecutions, and imprisonment. During the first decade of the 21st century, Oakland has consistently been listed as one of the most dangerous large cities in the United States. The number of Oakland Police Department officers has varied from a low of 626 (in 1996 and in 2012) to a high of 814 (in 2002). There were 723 officers at the end of 2015. The city's strategic plan recommended 925 officers, and an independent study commissioned by the city in the mid-1990s recommended 1,200 officers. Among Oakland's 35 police patrol beats, violent crime remains a serious problem in specific East and West Oakland neighborhoods. In 2008, homicides were concentrated: 72% occurred in three City Council districts, District 3 in West Oakland and Districts 6 and 7 in East Oakland, although these districts have 44% of Oakland's residents. In 2012, Oakland implemented Operation Ceasefire , a gang violence reduction plan used in other cities, based in part on the research and strategies of author David M. Kennedy . Oakland is a major West Coast port, and the fifth-busiest in the United States by cargo volume. The Port of Oakland handles 99% of all containerized goods moving through Northern California, representing $41 billion worth of international trade. There are nearly 200,000 jobs related to marine cargo transport in the Oakland area. These jobs range from minimum wage hourly positions to Transportation Storage and Distribution Managers who earn an annual average salary of US$ 91,520. The Port of Oakland was an early innovator/pioneer in the technologies of Intermodal Containerized Shipping . The city is also home to several major corporations including Kaiser Permanente , Clorox , and Dreyer's ice cream. Tech companies such as Ask.com and Pandora Radio are in Oakland, and in recent years many start-up high tech and green energy companies have found a home in the downtown neighborhoods of Uptown, City Center, Jack London Square and Lake Merritt Financial District. As of 2013 [ update ] , the San Francisco-Oakland-Hayward metropolitan area has a gross domestic product (GDP) of US$ 360.4 billion, ranking eighth among metropolitan areas in the United States. In 2014, Oakland was amongst the best cities to start a career, the highest ranked city in California after San Francisco. Additionally, Oakland ranked fourth in cities with professional opportunities. Numerous companies in San Francisco continue to expand in or migrate over to Oakland. Oakland experienced an increase of both its population and of land values in the early-to-mid first decade of the 21st century. The 10k Plan , which began during former mayor Elihu Harris ' administration, and intensified during former mayor Jerry Brown 's administration resulted in several thousand units of new multi-family housing and development. In 2023, Oakland became the first American city ever to lose three professional major league sports teams to other cities within a brief five-year span. As of 2020 [ update ] , the top employers in the city were: In 2013, over 2.5 million people visited Oakland, injecting US$ 1.3 billion into the economy. Oakland has been experiencing an increase in hotel demand. Occupancy is 74%, while RevPAR (Revenue Per Available Room) increased by 14%, the highest increase of any big city in the western region of the United States. Both Oakland and San Francisco were forecasted to experience the highest increases in ADR ( Average daily rate ). In recent years, Oakland has gained national recognition as a travel destination. In 2012, The New York Times named Oakland the top North American city to visit, highlighting its growing number of sophisticated restaurants and bars, top music venues, and increasing nightlife appeal. Oakland also took the No. 16 spot in "America's Coolest Cities", ranked by metrics like entertainment options and recreational opportunities per capita, etc. In 2013, Oakland topped the No. 1 spot in "America's Most Exciting Cities", notably having the most movie theaters, theater companies, and museums per square mile. In "America's Most Hipster Cities", Oakland took the number-5 spot, cited for luring San Francisco "hippies" into the city. Oakland has also increased its travel destination allure internationally. As of 2020 [ update ] , the top employers in the city were: In 2013, over 2.5 million people visited Oakland, injecting US$ 1.3 billion into the economy. Oakland has been experiencing an increase in hotel demand. Occupancy is 74%, while RevPAR (Revenue Per Available Room) increased by 14%, the highest increase of any big city in the western region of the United States. Both Oakland and San Francisco were forecasted to experience the highest increases in ADR ( Average daily rate ). In recent years, Oakland has gained national recognition as a travel destination. In 2012, The New York Times named Oakland the top North American city to visit, highlighting its growing number of sophisticated restaurants and bars, top music venues, and increasing nightlife appeal. Oakland also took the No. 16 spot in "America's Coolest Cities", ranked by metrics like entertainment options and recreational opportunities per capita, etc. In 2013, Oakland topped the No. 1 spot in "America's Most Exciting Cities", notably having the most movie theaters, theater companies, and museums per square mile. In "America's Most Hipster Cities", Oakland took the number-5 spot, cited for luring San Francisco "hippies" into the city. Oakland has also increased its travel destination allure internationally. Oakland has a vibrant art scene and claims the highest concentration of artists per capita in the United States. In 2013, Oakland was designated as one of America's top twelve art communities, recognizing Downtown (including Uptown), Chinatown, Old Oakland, and Jack London Square as communities "that have most successfully combined art, artists and venues for creativity and expression with independent businesses, retail shops and restaurants, and a walkable lifestyle to make vibrant neighborhoods." Galleries exist in various parts of Oakland, with the newest additions centered mostly in the Uptown area. Oakland ranked 11th in cities for designers and artists. The city is a renowned culinary hotbed, offering both a wide variety and innovative approaches to diverse cuisines in restaurants and markets, often featuring locally grown produce and international styles such as French , Italian , Portuguese / Spanish , Ethiopian , Asian , Latin American , as well as Caribbean , Southern United States / Louisiana Creole , etc., all of which reflects the culinary traditions of the city's ethnically diverse population. Historically a focal point of the West Coast blues and jazz scenes, Oakland is also home to musicians representing such genres as rhythm and blues , gospel , funk , punk , heavy metal , Rap / Gangsta rap , and hip hop . Artists who come out of Oakland include Tower of Power , Mistah F.A.B. , E-40 , Too Short , Raphael Saadiq , MC Hammer , Keyshia Cole , Kehlani , G-Eazy , Del the Funky Homosapien , Edwin Hawkins , Tony! Toni! Toné! and many more. Free walking tours are offered by the City. Archived May 24, 2018, at the Wayback Machine Downtown Oakland has an assortment of bars and nightclubs . They include dive bars, dance clubs, modern lounges and jazz bars. The Paramount Theater features headlining musical tours and productions, while Fox Oakland Theatre draws various musical genres including jam bands , rock, punk, blues, jazz, and reggae. The Paramount and Fox theaters often book simultaneous events, creating busy nights uptown. In 2012, Oakland was dubbed a "New Sin City", following its 2010 decision to relax its cabaret laws, which gave a boost to its nightclub and bar scene. Recent years have seen the growth of the Oakland Art Murmur event, occurring in the Uptown neighborhood the first Friday evening of every month. The event attracts around 20,000 people along twenty city blocks, featuring live performances, food trucks, and over 30 galleries and venues. Gertrude Stein wrote about Oakland in her 1937 book Everybody's Autobiography "There is no there there", upon learning that the neighborhood where she lived as a child had been torn down to make way for an industrial park . The quote is usually misconstrued to refer to Oakland as a whole. Modern-day Oakland has made steps to rebuke Stein's claim with a statue downtown titled There . In 2005 a sculpture called HERETHERE was installed by the City of Berkeley on the Berkeley-Oakland border at Martin Luther King Jr. Way. The sculpture consists of eight-foot-tall letters spelling "HERE" and "THERE" in front of the BART tracks as they descend from their elevated section in Oakland to the subway through Berkeley . Free walking tours are offered by the City. Archived May 24, 2018, at the Wayback MachineDowntown Oakland has an assortment of bars and nightclubs . They include dive bars, dance clubs, modern lounges and jazz bars. The Paramount Theater features headlining musical tours and productions, while Fox Oakland Theatre draws various musical genres including jam bands , rock, punk, blues, jazz, and reggae. The Paramount and Fox theaters often book simultaneous events, creating busy nights uptown. In 2012, Oakland was dubbed a "New Sin City", following its 2010 decision to relax its cabaret laws, which gave a boost to its nightclub and bar scene. Recent years have seen the growth of the Oakland Art Murmur event, occurring in the Uptown neighborhood the first Friday evening of every month. The event attracts around 20,000 people along twenty city blocks, featuring live performances, food trucks, and over 30 galleries and venues. Gertrude Stein wrote about Oakland in her 1937 book Everybody's Autobiography "There is no there there", upon learning that the neighborhood where she lived as a child had been torn down to make way for an industrial park . The quote is usually misconstrued to refer to Oakland as a whole. Modern-day Oakland has made steps to rebuke Stein's claim with a statue downtown titled There . In 2005 a sculpture called HERETHERE was installed by the City of Berkeley on the Berkeley-Oakland border at Martin Luther King Jr. Way. The sculpture consists of eight-foot-tall letters spelling "HERE" and "THERE" in front of the BART tracks as they descend from their elevated section in Oakland to the subway through Berkeley . Oakland has variously been represented by major professional teams in baseball, basketball, American football, soccer, and hockey. The Oakland Athletics (of Major League Baseball ) won three consecutive World Series championships in 1972, 1973, and 1974, and appeared in another three consecutive World Series from 1988 to 1990, winning their fourth championship in 1989. Currently based at the Oakland Coliseum , the Athletics announced plans to move to Las Vegas to play at a new 33,000-seat partially retractable ballpark on the Las Vegas Strip with the team itself spending three seasons at Sutter Health Park in West Sacramento as a temporary home. It would leave Oakland without a major professional sports team for the first time since 1959. Oakland's former football team, the Oakland Raiders of the National Football League (NFL), won Super Bowl XI in 1976 and Super Bowl XV in 1980, during their tenure in Oakland. The Raiders relocated to Las Vegas in 2020 and are now known as the Las Vegas Raiders . Oakland's former basketball team, the Golden State Warriors won the 1974–75 , 2014–15 , 2016–17 , and the 2017–18 NBA championships , while losing in 2016 and 2019. The Warriors, whose primary owners reside in Southern California, announced in April 2014 that they would leave Oakland once their new arena was built across the Bay in San Francisco. In 2019, the Warriors built and moved to Chase Center across the Bay. Since the team remained in the Bay Area, they decided not to revert to the San Francisco Warriors name it had in its first stint with the city. The Oakland Roots SC are a professional soccer team that was formed in 2018. The Roots began play in 2019 in a new third division professional league known as the National Independent Soccer Association , however, the team announced that it would move into the second division of US professional soccer, and play in the USL Championship beginning in the 2021 season. The Roots play their home matches at Laney College Football Stadium . The Oakland Soul, a woman's professional soccer club will begin play in May 2023 as an expansion team in the USL W League ; they will also play their home matches at LCFS. Oakland's former hockey team, the California Golden Seals were a professional ice hockey club that competed in the National Hockey League (NHL) from 1967 to 1976 . Based in Oakland, they played their home games at the Oakland–Alameda County Coliseum Arena . The Seals were one of six teams added to the league as part of the 1967 NHL expansion . Initially named the California Seals , the team was renamed the Oakland Seals during the 1967–68 season and then the Bay Area Seals in 1970 before becoming the California Golden Seals the same year. The Seals were the least successful of the teams added in the 1967 expansion, never earning a winning record and only making the playoffs twice in nine seasons of play. Off the ice, they were plagued by low attendance. The franchise was relocated prior to the beginning of the 1976–77 season to become the Cleveland Barons , who would cease operation two years later. Oakland's ultimate team, Oakland Spiders , relocated to Oakland in 2022 after playing eight years as the San Jose Spiders. Oakland's former sports teams include:Oakland has many parks and recreation centers which total 5,937 acres (2,403 ha) . In its 2013 ParkScore ranking, The Trust for Public Land , a national land conservation organization, reported that Oakland had the 18th best park system among the 50 most populous U.S. cities. In 2013, Oakland ranked fourth among American cities as an urban destination for nature lovers. Some of the city's most notable parks include: Additionally, the following seven East Bay Regional Parks are entirely or partially in the city of Oakland:Oakland has many parks and recreation centers which total 5,937 acres (2,403 ha) . In its 2013 ParkScore ranking, The Trust for Public Land , a national land conservation organization, reported that Oakland had the 18th best park system among the 50 most populous U.S. cities. In 2013, Oakland ranked fourth among American cities as an urban destination for nature lovers. Some of the city's most notable parks include: Additionally, the following seven East Bay Regional Parks are entirely or partially in the city of Oakland:Oakland has a mayor-council government . The mayor is elected at-large for a four-year term. The Oakland City Council has eight council members representing seven districts in Oakland with one member elected at-large and others from single-member districts ; council members serve staggered four-year terms. The mayor appoints a city administrator, subject to the confirmation by the City Council, who is the city's chief administrative officer. Other city officers include: city attorney (elected), city auditor (elected), and city clerk (appointed by city administrator). Oakland's mayor is limited to two terms. There are no term limits for the city council. Oakland City Hall was evacuated after the 1989 Loma Prieta earthquake until US$ 80M seismic retrofit and hazard abatement work was complete in 1995. City offices had to be housed in leased space and other locations. Jean Quan was elected mayor in November 2010, beating Don Perata and Rebecca Kaplan in the city's first ranked choice balloting . This new system is intended to increase voters' ability to choose preferred candidates, as they can combine ranked votes when several candidates are competing. Sheng Thao , the first Hmong American mayor of a major city in the United States, took office in 2023. Oakland is also part of Alameda County , for which the Government of Alameda County is defined and authorized under the California Constitution , California law , and the Charter of the County of Alameda. The County government provides countywide services such as elections and voter registration, law enforcement, jails, vital records, property records, tax collection, public health, and social services. The County government is primarily composed of the elected five-member Board of Supervisors , other elected offices including the Sheriff /Coroner, the District Attorney , Assessor , Auditor-Controller/County Clerk/Recorder , and Treasurer/Tax Collector , and numerous county departments and entities under the supervision of the County Administrator. In the California State Legislature , Oakland is in the 9th Senate District , represented by Democrat Nancy Skinner , and is split between the 14th , 15th , and 18th Assembly districts, represented by Buffy Wicks , Tim Grayson , and Mia Bonta , respectively. In the United States House of Representatives , Oakland is in California's 12th congressional district , represented by Democrat Barbara Lee . Oakland was a Republican Party bastion from the 1860s to the 1950s, with positions expressed by the Republican-oriented Oakland Tribune newspaper. In the 1960s, the majority of voters began to favor liberal policies and the Democratic Party . Oakland has the second highest percentage of registered Democrats of any of the incorporated cities in Alameda County, with Berkeley coming in first. The last Republican presidential candidate to receive at least one-third of vote in Oakland was Richard Nixon in 1972. Since then, the Republican percentage of the vote has generally declined in each successive election. According to the California Secretary of State , as of February 10, 2019, Oakland has 245,111 registered voters. Of those, 159,771 (65.2%) are registered Democrats , 9,544 (3.9%) are registered Republicans , and 65,416 (26.7%) have declined to state a political party. Oakland is widely regarded as being one of the most liberal major cities in the nation. The Cook Partisan Voting Index of Congressional District 12 , which includes Oakland and Berkeley, is D+40, making it the most Democratic congressional district in California and the fourth most Democratic district in the US. Oakland was a Republican Party bastion from the 1860s to the 1950s, with positions expressed by the Republican-oriented Oakland Tribune newspaper. In the 1960s, the majority of voters began to favor liberal policies and the Democratic Party . Oakland has the second highest percentage of registered Democrats of any of the incorporated cities in Alameda County, with Berkeley coming in first. The last Republican presidential candidate to receive at least one-third of vote in Oakland was Richard Nixon in 1972. Since then, the Republican percentage of the vote has generally declined in each successive election. According to the California Secretary of State , as of February 10, 2019, Oakland has 245,111 registered voters. Of those, 159,771 (65.2%) are registered Democrats , 9,544 (3.9%) are registered Republicans , and 65,416 (26.7%) have declined to state a political party. Oakland is widely regarded as being one of the most liberal major cities in the nation. The Cook Partisan Voting Index of Congressional District 12 , which includes Oakland and Berkeley, is D+40, making it the most Democratic congressional district in California and the fourth most Democratic district in the US. The Oakland Unified School District (OUSD), which covers the city except for Sheffield Village, operates most of Oakland's public schools. Due to financial troubles and administrative failures, it was in receivership by the state of California from 2002 to 2008. As of 2015 [ update ] , the Oakland Unified School District includes 86 division-run schools and 32 charter schools; the district also manages several adult education programs. As of 2015 [ update ] there are 48,181 K–12 students; among division-run schools, there are 4,600 plus employees. OUSD test scores historically lag behind the rest of California, in particular due to a high proportion of English-language learners. Some individual schools have much better performance than the citywide average. As of 2013 [ update ] , for example, over half the students at Hillcrest Elementary School in the Montclair upper hills neighborhood performed at the "advanced" level in the English portion of the test, and students at Lincoln Elementary School in the Chinatown neighborhood performed at the "advanced" level in the math portion. Oakland's three largest public high schools are Oakland High School , Oakland Technical High School , and Skyline High School . Other Oakland public high schools include Castlemont High School , Fremont High School , and McClymonds High School , briefly known as Castlemont Community of Small Schools, Fremont Federation of High Schools, and McClymonds Educational Complex , respectively. Among charter schools in the district, North Oakland Community Charter School (NOCCS), an elementary and middle school, is one of the few public progressive schools in the country. [ clarification needed ] Other charter schools include the Oakland Military Institute , Oakland School for the Arts , Bay Area Technology School , East Bay Innovation Academy , and Oakland Charter Academy . There are several religious and secular private high schools, including The College Preparatory School , Head-Royce School , Bishop O'Dowd High School , Holy Names High School , St. Elizabeth High School and Oakland Hebrew Day School . Catholic schools in Oakland are operated by the Roman Catholic Diocese of Oakland also include eight K–8 schools (plus one in Piedmont on the Oakland city border). Northern Light School is a private nonprofit elementary and middle school. Bentley School is an Independent Co-educational K–12, college preparatory school on two campuses in Oakland and Lafayette, California. In 2017, the Oakland Unified School District has received funding from Pandora in partnership with Little Kids Rock, towards expanding music education programs within the schools. The result from these donations has given teachers from 20 additional Oakland- area schools the ability to participate in an eight-hour professional development workshop, and receive music education instruction from Little Kids Rock. The donation includes providing new instruments, that will benefit over 2,000 Oakland students. Accredited colleges and universities include: In 2001, the SFSU Oakland Multimedia Center was opened, allowing San Francisco State University to conduct classes near downtown Oakland. The Oakland Higher Education Consortium and the City of Oakland's Community and Economic Development Agency (CEDA) opened the Oakland Higher Education Center downtown in 2002 to provide "access to multiple higher education service providers within a shared urban facility." Member schools include primary user California State University, East Bay as well as Lincoln University, New College of California , Saint Mary's College of California , SFSU Multimedia Studies Program, UC Berkeley Extension, University of Phoenix and Peralta Community College District. The Oakland Unified School District (OUSD), which covers the city except for Sheffield Village, operates most of Oakland's public schools. Due to financial troubles and administrative failures, it was in receivership by the state of California from 2002 to 2008. As of 2015 [ update ] , the Oakland Unified School District includes 86 division-run schools and 32 charter schools; the district also manages several adult education programs. As of 2015 [ update ] there are 48,181 K–12 students; among division-run schools, there are 4,600 plus employees. OUSD test scores historically lag behind the rest of California, in particular due to a high proportion of English-language learners. Some individual schools have much better performance than the citywide average. As of 2013 [ update ] , for example, over half the students at Hillcrest Elementary School in the Montclair upper hills neighborhood performed at the "advanced" level in the English portion of the test, and students at Lincoln Elementary School in the Chinatown neighborhood performed at the "advanced" level in the math portion. Oakland's three largest public high schools are Oakland High School , Oakland Technical High School , and Skyline High School . Other Oakland public high schools include Castlemont High School , Fremont High School , and McClymonds High School , briefly known as Castlemont Community of Small Schools, Fremont Federation of High Schools, and McClymonds Educational Complex , respectively. Among charter schools in the district, North Oakland Community Charter School (NOCCS), an elementary and middle school, is one of the few public progressive schools in the country. [ clarification needed ] Other charter schools include the Oakland Military Institute , Oakland School for the Arts , Bay Area Technology School , East Bay Innovation Academy , and Oakland Charter Academy . There are several religious and secular private high schools, including The College Preparatory School , Head-Royce School , Bishop O'Dowd High School , Holy Names High School , St. Elizabeth High School and Oakland Hebrew Day School . Catholic schools in Oakland are operated by the Roman Catholic Diocese of Oakland also include eight K–8 schools (plus one in Piedmont on the Oakland city border). Northern Light School is a private nonprofit elementary and middle school. Bentley School is an Independent Co-educational K–12, college preparatory school on two campuses in Oakland and Lafayette, California. In 2017, the Oakland Unified School District has received funding from Pandora in partnership with Little Kids Rock, towards expanding music education programs within the schools. The result from these donations has given teachers from 20 additional Oakland- area schools the ability to participate in an eight-hour professional development workshop, and receive music education instruction from Little Kids Rock. The donation includes providing new instruments, that will benefit over 2,000 Oakland students. In 2017, the Oakland Unified School District has received funding from Pandora in partnership with Little Kids Rock, towards expanding music education programs within the schools. The result from these donations has given teachers from 20 additional Oakland- area schools the ability to participate in an eight-hour professional development workshop, and receive music education instruction from Little Kids Rock. The donation includes providing new instruments, that will benefit over 2,000 Oakland students. Accredited colleges and universities include: In 2001, the SFSU Oakland Multimedia Center was opened, allowing San Francisco State University to conduct classes near downtown Oakland. The Oakland Higher Education Consortium and the City of Oakland's Community and Economic Development Agency (CEDA) opened the Oakland Higher Education Center downtown in 2002 to provide "access to multiple higher education service providers within a shared urban facility." Member schools include primary user California State University, East Bay as well as Lincoln University, New College of California , Saint Mary's College of California , SFSU Multimedia Studies Program, UC Berkeley Extension, University of Phoenix and Peralta Community College District. Oakland is served by major television stations broadcasting primarily out of San Francisco and San Jose. The region's Fox O&O , KTVU 2, is based in (and licensed to) Oakland at Jack London Square along with co-owned independent station KICU-TV 36 (licensed to San Jose). In addition, the city is served by various AM and FM radio stations as well; AM stations KKSF 910, KMKY 1310 and KNEW 960 are licensed to Oakland. Oakland was served by the Oakland Tribune , which published its first newspaper on February 21, 1874. The Tribune Tower , which features a large clock, is an Oakland landmark. At key times throughout the day (8:00 am, noon and 5:00 pm), the clock tower carillon plays a variety of classic melodies, which change daily. In 2007, the Oakland Tribune moved its offices from the tower to an East Oakland location, before folding in 2011. The East Bay Express , a locally owned free weekly paper, is based in Jack London Square and distributed throughout the East Bay. Oaklandwiki is a thriving (mostly) English-language LocalWiki .Oakland residents have access to the three major airports of the San Francisco Bay Area: Oakland International Airport , San Francisco International Airport , and San Jose International Airport . Oakland International Airport, within Oakland's city limits, is 4 mi (6.4 km) south of downtown Oakland and serves domestic and international destinations. AC Transit provides 24-hour service to the airport, and BART's Coliseum–Oakland International Airport automated guideway transit line provides frequent service between the airport and Oakland Coliseum station . The city has regional and long-distance passenger train service provided by Amtrak , with stations near Jack London Square and the RingCentral Coliseum . Amtrak's California Zephyr has its western terminus at the nearby Emeryville station . Historically, the city was served by several train companies, which terminated in different terminals. Santa Fe trains terminated at its Oakland depot, actually located within the city limits of Emeryville at 40th and San Pablo. Southern Pacific trains ended at the 16th Street Station . Western Pacific trains ended at the 3rd and Washington station. However, a common feature was that the different railroads continued one more stop to a station at Oakland Pier . From this latter point passengers would ride ferries to San Francisco. Data compiled in 2007 by the United States Census Bureau before gasoline price spikes in 2008, showed that 24.3% of Oaklanders used public transportation, walked or used "other means" to commute to work, not including remote work , with 17% of Oakland households being "car free" and/or statistically categorized as having "no vehicles available." Bus transit service in Oakland and the inner East Bay is provided by the Alameda and Contra Costa Transit District, AC Transit . The district originated in 1958 after the conspiratorial dissolution of the Key System of streetcars. Many AC Transit lines follow old routes of the Key System. Intercity bus companies that serve Oakland include Greyhound , BoltBus , USAsia , and Hoang Transportation . Megabus no longer serves Oakland. The metropolitan area is served by Bay Area Rapid Transit (BART) from eight stations in Oakland, served by all BART lines.The system has headquarters in Oakland, with major transfer hubs at MacArthur and 19th Street stations. BART's headquarters was in a building above the Lake Merritt BART station until 2006, when it relocated to the Kaiser Center due to seismic safety concerns. The Alameda / Oakland Ferry operates ferry service from Jack London Square to Alameda , Oracle Park , Pier 41 , the San Francisco Ferry Building , and the South San Francisco Ferry Terminal . Oakland licenses taxi cabs, and has zoned cab stands in its downtown, including a bicycle pedi-cab service. The Oakland City Council adopted a Bicycle Master Plan in 1999 as a part of the Land Use and Transportation (LUTE) element of Oakland's 1998 General Plan. The creation of the plan was to promote alternatives to the private automobile. The Oakland City Council reaffirmed the bike plan in 2005, revised it in 2007, and reaffirmed it in 2012. From 1999 to 2007, the city installed 900 bike racks throughout Oakland, accommodating over 2,000 bicycles. By the end of 2017, over 160 bikeway miles and 9,900 bike parking spaces were constructed. Facilities for parking thousands of bicycles have been installed downtown and in other commercial districts throughout Oakland. According to the U.S. Census Bureau's 2011 American Community Survey , Oakland came in seventh place out of the 100 largest cities in the nation by percentage of people that chose to commute by bike in 2011. In July 2019, the City of Oakland Department of Transportation announced that it had issued official permits for the deployment of shared e-scooters to four companies: Bird , Clevr, Lime, and Lyft. Oakland requires these operators to educate users on the correct and safe use of scooters, to distribute the scooters equitably throughout the city, to ensure accessibility, and to provide insurance and indemnification. Oakland is served by several major highways: Eastbound Bay Bridge traffic entering Oakland then splits into three freeways at the MacArthur Maze freeway interchange: Interstate 580 (MacArthur Freeway) heads southeast toward Hayward and eventually to the California Central Valley ; Interstate 880 (Nimitz Freeway) runs south to San Jose ; and the Eastshore Freeway ( Interstate 80 /I-580) runs north, providing connections to Sacramento and San Rafael , respectively. Interstate 980 (Williams Freeway) begins its eastbound journey at I-880 in Downtown Oakland before turning into State Route 24 (Grove Shafter Freeway) at I-580. State Route 13 begins as the Warren Freeway at I-580, and runs through a scenic valley in the Montclair District before entering Berkeley . A stub of a planned freeway was constructed at the High Street exit from the Nimitz Freeway, but that freeway extension plan was abandoned. At the time of the 1989 Loma Prieta earthquake , the Cypress Street Viaduct double-deck segment of the Nimitz Freeway collapsed, killing 42 people. The old freeway segment had passed through the middle of West Oakland, forming a barrier between West Oakland neighborhoods. Following the earthquake, this section was rerouted around the perimeter of West Oakland and rebuilt in 1997–2001. The east span of the San Francisco–Oakland Bay Bridge also suffered damage from the quake when a 50-foot (15-m) section of the upper deck collapsed onto the lower deck; the damaged section was repaired within a month of the earthquake. As a result of Loma Prieta, a significant seismic retrofit was performed on the western span of the Bay Bridge. The eastern span has now been replaced with a dramatic single-tower self-anchoring suspension span. Two underwater tunnels, the Webster and Posey Tubes, connect the main island of Alameda to downtown Oakland, coming above ground in Chinatown. In addition, the Park Street , Fruitvale , and High Street bridges connect Alameda to East Oakland over the Oakland Estuary . In the hills, the Leimert Bridge crosses Dimond Canyon, connecting the Oakmore neighborhood to Park Boulevard. The Caldecott Tunnel carries Highway 24 through the Berkeley Hills , connecting central Contra Costa County to Oakland. The Caldecott has four bores. On April 11, 2020, the City of Oakland launched its Slow Streets Program. This was facilitated in part by the sudden decrease of vehicle traffic that resulted from the state-wide stay-at-home order and school closures in response to the spread of the COVID-19 in California . The goal of the program was to "support safe physical activity and alleviate overcrowding in parks and on trails by discouraging through traffic." This was accomplished by closing 74 miles of streets to through traffic. Over the course of three months the city installed "soft closure" barriers consisting of signage, traffic cones, and barricades in over 21 miles of city streets. While the primary goal at the time was to encourage socially distanced outdoor physical activities like biking, walking, and jogging, the long term implementation of the Slow Streets Program contributed to the city's traffic calming measures and promoted alternatives to car use as well. Although the Slow Streets Program was initially praised for its rapid implementation and prioritization of pedestrian safety, the Oakland Department of Transportation quickly came under fire for its failure to collect feedback that represented the opinions of the diverse range of residents whom the program affected. The high engagement with online surveys by wealthy white residents initially suggested an almost universally positive reaction to the program. The disproportionately low number of responses from residents of East Oakland—a largely Black and Latino and low-income area—revealed both the oversight of city officials as well as the shortcomings of urban planning systems' ability to equally benefit different social groups, which consequently perpetuates inequalities like the transport divide . After the flaws of the feedback forms were brought to light, city planners made concentrated efforts to meet with representatives from different community groups who in turn stressed that simply closing streets to through traffic was not enough to protect pedestrians from dangerous driving. In response the city expressed its commitment to its local residents calling for road traffic safety by rolling out Slow Streets: Essential Places, a phase of the program which installed cones and signage at dangerous traffic areas in order to make grocery stores, COVID-19 test sites, and food distribution sites easily and safely accessible. Freight service, which consists primarily of moving shipping containers to and from the Port of Oakland, is provided today by Union Pacific Railroad (UP), and to a lesser extent by BNSF Railway (which now shares the tracks of the UP between Richmond and Oakland). Historically, Oakland was served by several railroads. Besides the transcontinental line of the Southern Pacific, there was also the Santa Fe (whose Oakland terminal was actually in Emeryville), the Western Pacific Railroad (who built a pier adjacent to the SP's), and the Sacramento Northern Railroad (eventually absorbed by the Western Pacific, which in turn was absorbed by UP in 1983). As one of the three major ports on the West Coast of the United States , the Port of Oakland is the largest seaport on San Francisco Bay and the fifth busiest container port in the United States. It was one of the earliest seaports to switch to containerization and to intermodal container transfer , thereby displacing the Port of San Francisco , which never modernized its waterfront. One of the earlier limitations to growth was the inability to transfer containers to rail lines, all cranes historically operating between ocean vessels and trucks. In the 1980s, the Port of Oakland began the evaluation of development of an intermodal container transfer capability, i.e., facilities that now allow trans-loading of containers from vessels to either trucks or rail modes. Public water supply and sewage treatment are provided by East Bay Municipal Utility District (EBMUD). Pacific Gas and Electric Company (PG & E) provides natural gas and electricity service. Municipal garbage collection is franchised to Waste Management, Inc . Telecommunications and subscriber television services are provided by multiple private corporations and other service providers in accordance with the competitive objectives of the Telecommunications Act of 1996 . Oakland tops the list of the 50 largest US cities using electricity from renewable sources. Originating in Oakland, Kaiser Permanente is an HMO started in 1942, during World War II, by industrialist Henry J. Kaiser to provide medical care for Kaiser Shipyards workers. It is the largest managed care organization in the United States and the largest non-governmental health care provider in the world. It is headquartered at One Kaiser Plaza in Downtown Oakland and maintains a large medical center in the Piedmont Avenue neighborhood. Alta Bates Summit Medical Center , an East Bay hospital system, maintains its Summit Campus in the neighborhood known as "Pill Hill" north of downtown. Until 2000, it was the Summit Medical Center before merging with Berkeley-based Alta Bates. All campuses now operate under the Sutter Health network. Alameda Health System is an integrated public health care system organized as a public hospital authority. It operates five Alameda County hospitals including Oakland's Highland Hospital and four primary care medical clinics including Oakland's Highland Wellness Center and Eastmont Wellness Center. Children's Hospital Oakland is the primary medical center specializing in pediatrics in the East Bay. It is a designated Level I pediatric trauma center and the only independent children's hospital in Northern California. There are also several community health centers in Oakland. Some examples include Lifelong Medical Care, Asian Health Services, and Roots Community Health Center.Oakland residents have access to the three major airports of the San Francisco Bay Area: Oakland International Airport , San Francisco International Airport , and San Jose International Airport . Oakland International Airport, within Oakland's city limits, is 4 mi (6.4 km) south of downtown Oakland and serves domestic and international destinations. AC Transit provides 24-hour service to the airport, and BART's Coliseum–Oakland International Airport automated guideway transit line provides frequent service between the airport and Oakland Coliseum station . The city has regional and long-distance passenger train service provided by Amtrak , with stations near Jack London Square and the RingCentral Coliseum . Amtrak's California Zephyr has its western terminus at the nearby Emeryville station . Historically, the city was served by several train companies, which terminated in different terminals. Santa Fe trains terminated at its Oakland depot, actually located within the city limits of Emeryville at 40th and San Pablo. Southern Pacific trains ended at the 16th Street Station . Western Pacific trains ended at the 3rd and Washington station. However, a common feature was that the different railroads continued one more stop to a station at Oakland Pier . From this latter point passengers would ride ferries to San Francisco. Data compiled in 2007 by the United States Census Bureau before gasoline price spikes in 2008, showed that 24.3% of Oaklanders used public transportation, walked or used "other means" to commute to work, not including remote work , with 17% of Oakland households being "car free" and/or statistically categorized as having "no vehicles available." Bus transit service in Oakland and the inner East Bay is provided by the Alameda and Contra Costa Transit District, AC Transit . The district originated in 1958 after the conspiratorial dissolution of the Key System of streetcars. Many AC Transit lines follow old routes of the Key System. Intercity bus companies that serve Oakland include Greyhound , BoltBus , USAsia , and Hoang Transportation . Megabus no longer serves Oakland. The metropolitan area is served by Bay Area Rapid Transit (BART) from eight stations in Oakland, served by all BART lines.The system has headquarters in Oakland, with major transfer hubs at MacArthur and 19th Street stations. BART's headquarters was in a building above the Lake Merritt BART station until 2006, when it relocated to the Kaiser Center due to seismic safety concerns. The Alameda / Oakland Ferry operates ferry service from Jack London Square to Alameda , Oracle Park , Pier 41 , the San Francisco Ferry Building , and the South San Francisco Ferry Terminal . Oakland licenses taxi cabs, and has zoned cab stands in its downtown, including a bicycle pedi-cab service. The Oakland City Council adopted a Bicycle Master Plan in 1999 as a part of the Land Use and Transportation (LUTE) element of Oakland's 1998 General Plan. The creation of the plan was to promote alternatives to the private automobile. The Oakland City Council reaffirmed the bike plan in 2005, revised it in 2007, and reaffirmed it in 2012. From 1999 to 2007, the city installed 900 bike racks throughout Oakland, accommodating over 2,000 bicycles. By the end of 2017, over 160 bikeway miles and 9,900 bike parking spaces were constructed. Facilities for parking thousands of bicycles have been installed downtown and in other commercial districts throughout Oakland. According to the U.S. Census Bureau's 2011 American Community Survey , Oakland came in seventh place out of the 100 largest cities in the nation by percentage of people that chose to commute by bike in 2011. In July 2019, the City of Oakland Department of Transportation announced that it had issued official permits for the deployment of shared e-scooters to four companies: Bird , Clevr, Lime, and Lyft. Oakland requires these operators to educate users on the correct and safe use of scooters, to distribute the scooters equitably throughout the city, to ensure accessibility, and to provide insurance and indemnification. Oakland is served by several major highways: Eastbound Bay Bridge traffic entering Oakland then splits into three freeways at the MacArthur Maze freeway interchange: Interstate 580 (MacArthur Freeway) heads southeast toward Hayward and eventually to the California Central Valley ; Interstate 880 (Nimitz Freeway) runs south to San Jose ; and the Eastshore Freeway ( Interstate 80 /I-580) runs north, providing connections to Sacramento and San Rafael , respectively. Interstate 980 (Williams Freeway) begins its eastbound journey at I-880 in Downtown Oakland before turning into State Route 24 (Grove Shafter Freeway) at I-580. State Route 13 begins as the Warren Freeway at I-580, and runs through a scenic valley in the Montclair District before entering Berkeley . A stub of a planned freeway was constructed at the High Street exit from the Nimitz Freeway, but that freeway extension plan was abandoned. At the time of the 1989 Loma Prieta earthquake , the Cypress Street Viaduct double-deck segment of the Nimitz Freeway collapsed, killing 42 people. The old freeway segment had passed through the middle of West Oakland, forming a barrier between West Oakland neighborhoods. Following the earthquake, this section was rerouted around the perimeter of West Oakland and rebuilt in 1997–2001. The east span of the San Francisco–Oakland Bay Bridge also suffered damage from the quake when a 50-foot (15-m) section of the upper deck collapsed onto the lower deck; the damaged section was repaired within a month of the earthquake. As a result of Loma Prieta, a significant seismic retrofit was performed on the western span of the Bay Bridge. The eastern span has now been replaced with a dramatic single-tower self-anchoring suspension span. Two underwater tunnels, the Webster and Posey Tubes, connect the main island of Alameda to downtown Oakland, coming above ground in Chinatown. In addition, the Park Street , Fruitvale , and High Street bridges connect Alameda to East Oakland over the Oakland Estuary . In the hills, the Leimert Bridge crosses Dimond Canyon, connecting the Oakmore neighborhood to Park Boulevard. The Caldecott Tunnel carries Highway 24 through the Berkeley Hills , connecting central Contra Costa County to Oakland. The Caldecott has four bores. On April 11, 2020, the City of Oakland launched its Slow Streets Program. This was facilitated in part by the sudden decrease of vehicle traffic that resulted from the state-wide stay-at-home order and school closures in response to the spread of the COVID-19 in California . The goal of the program was to "support safe physical activity and alleviate overcrowding in parks and on trails by discouraging through traffic." This was accomplished by closing 74 miles of streets to through traffic. Over the course of three months the city installed "soft closure" barriers consisting of signage, traffic cones, and barricades in over 21 miles of city streets. While the primary goal at the time was to encourage socially distanced outdoor physical activities like biking, walking, and jogging, the long term implementation of the Slow Streets Program contributed to the city's traffic calming measures and promoted alternatives to car use as well. Although the Slow Streets Program was initially praised for its rapid implementation and prioritization of pedestrian safety, the Oakland Department of Transportation quickly came under fire for its failure to collect feedback that represented the opinions of the diverse range of residents whom the program affected. The high engagement with online surveys by wealthy white residents initially suggested an almost universally positive reaction to the program. The disproportionately low number of responses from residents of East Oakland—a largely Black and Latino and low-income area—revealed both the oversight of city officials as well as the shortcomings of urban planning systems' ability to equally benefit different social groups, which consequently perpetuates inequalities like the transport divide . After the flaws of the feedback forms were brought to light, city planners made concentrated efforts to meet with representatives from different community groups who in turn stressed that simply closing streets to through traffic was not enough to protect pedestrians from dangerous driving. In response the city expressed its commitment to its local residents calling for road traffic safety by rolling out Slow Streets: Essential Places, a phase of the program which installed cones and signage at dangerous traffic areas in order to make grocery stores, COVID-19 test sites, and food distribution sites easily and safely accessible. Oakland residents have access to the three major airports of the San Francisco Bay Area: Oakland International Airport , San Francisco International Airport , and San Jose International Airport . Oakland International Airport, within Oakland's city limits, is 4 mi (6.4 km) south of downtown Oakland and serves domestic and international destinations. AC Transit provides 24-hour service to the airport, and BART's Coliseum–Oakland International Airport automated guideway transit line provides frequent service between the airport and Oakland Coliseum station . The city has regional and long-distance passenger train service provided by Amtrak , with stations near Jack London Square and the RingCentral Coliseum . Amtrak's California Zephyr has its western terminus at the nearby Emeryville station . Historically, the city was served by several train companies, which terminated in different terminals. Santa Fe trains terminated at its Oakland depot, actually located within the city limits of Emeryville at 40th and San Pablo. Southern Pacific trains ended at the 16th Street Station . Western Pacific trains ended at the 3rd and Washington station. However, a common feature was that the different railroads continued one more stop to a station at Oakland Pier . From this latter point passengers would ride ferries to San Francisco.Data compiled in 2007 by the United States Census Bureau before gasoline price spikes in 2008, showed that 24.3% of Oaklanders used public transportation, walked or used "other means" to commute to work, not including remote work , with 17% of Oakland households being "car free" and/or statistically categorized as having "no vehicles available." Bus transit service in Oakland and the inner East Bay is provided by the Alameda and Contra Costa Transit District, AC Transit . The district originated in 1958 after the conspiratorial dissolution of the Key System of streetcars. Many AC Transit lines follow old routes of the Key System. Intercity bus companies that serve Oakland include Greyhound , BoltBus , USAsia , and Hoang Transportation . Megabus no longer serves Oakland. The metropolitan area is served by Bay Area Rapid Transit (BART) from eight stations in Oakland, served by all BART lines.The system has headquarters in Oakland, with major transfer hubs at MacArthur and 19th Street stations. BART's headquarters was in a building above the Lake Merritt BART station until 2006, when it relocated to the Kaiser Center due to seismic safety concerns. The Alameda / Oakland Ferry operates ferry service from Jack London Square to Alameda , Oracle Park , Pier 41 , the San Francisco Ferry Building , and the South San Francisco Ferry Terminal . Oakland licenses taxi cabs, and has zoned cab stands in its downtown, including a bicycle pedi-cab service. The Oakland City Council adopted a Bicycle Master Plan in 1999 as a part of the Land Use and Transportation (LUTE) element of Oakland's 1998 General Plan. The creation of the plan was to promote alternatives to the private automobile. The Oakland City Council reaffirmed the bike plan in 2005, revised it in 2007, and reaffirmed it in 2012. From 1999 to 2007, the city installed 900 bike racks throughout Oakland, accommodating over 2,000 bicycles. By the end of 2017, over 160 bikeway miles and 9,900 bike parking spaces were constructed. Facilities for parking thousands of bicycles have been installed downtown and in other commercial districts throughout Oakland. According to the U.S. Census Bureau's 2011 American Community Survey , Oakland came in seventh place out of the 100 largest cities in the nation by percentage of people that chose to commute by bike in 2011. In July 2019, the City of Oakland Department of Transportation announced that it had issued official permits for the deployment of shared e-scooters to four companies: Bird , Clevr, Lime, and Lyft. Oakland requires these operators to educate users on the correct and safe use of scooters, to distribute the scooters equitably throughout the city, to ensure accessibility, and to provide insurance and indemnification. Oakland is served by several major highways: Eastbound Bay Bridge traffic entering Oakland then splits into three freeways at the MacArthur Maze freeway interchange: Interstate 580 (MacArthur Freeway) heads southeast toward Hayward and eventually to the California Central Valley ; Interstate 880 (Nimitz Freeway) runs south to San Jose ; and the Eastshore Freeway ( Interstate 80 /I-580) runs north, providing connections to Sacramento and San Rafael , respectively. Interstate 980 (Williams Freeway) begins its eastbound journey at I-880 in Downtown Oakland before turning into State Route 24 (Grove Shafter Freeway) at I-580. State Route 13 begins as the Warren Freeway at I-580, and runs through a scenic valley in the Montclair District before entering Berkeley . A stub of a planned freeway was constructed at the High Street exit from the Nimitz Freeway, but that freeway extension plan was abandoned. At the time of the 1989 Loma Prieta earthquake , the Cypress Street Viaduct double-deck segment of the Nimitz Freeway collapsed, killing 42 people. The old freeway segment had passed through the middle of West Oakland, forming a barrier between West Oakland neighborhoods. Following the earthquake, this section was rerouted around the perimeter of West Oakland and rebuilt in 1997–2001. The east span of the San Francisco–Oakland Bay Bridge also suffered damage from the quake when a 50-foot (15-m) section of the upper deck collapsed onto the lower deck; the damaged section was repaired within a month of the earthquake. As a result of Loma Prieta, a significant seismic retrofit was performed on the western span of the Bay Bridge. The eastern span has now been replaced with a dramatic single-tower self-anchoring suspension span. Two underwater tunnels, the Webster and Posey Tubes, connect the main island of Alameda to downtown Oakland, coming above ground in Chinatown. In addition, the Park Street , Fruitvale , and High Street bridges connect Alameda to East Oakland over the Oakland Estuary . In the hills, the Leimert Bridge crosses Dimond Canyon, connecting the Oakmore neighborhood to Park Boulevard. The Caldecott Tunnel carries Highway 24 through the Berkeley Hills , connecting central Contra Costa County to Oakland. The Caldecott has four bores.On April 11, 2020, the City of Oakland launched its Slow Streets Program. This was facilitated in part by the sudden decrease of vehicle traffic that resulted from the state-wide stay-at-home order and school closures in response to the spread of the COVID-19 in California . The goal of the program was to "support safe physical activity and alleviate overcrowding in parks and on trails by discouraging through traffic." This was accomplished by closing 74 miles of streets to through traffic. Over the course of three months the city installed "soft closure" barriers consisting of signage, traffic cones, and barricades in over 21 miles of city streets. While the primary goal at the time was to encourage socially distanced outdoor physical activities like biking, walking, and jogging, the long term implementation of the Slow Streets Program contributed to the city's traffic calming measures and promoted alternatives to car use as well. Although the Slow Streets Program was initially praised for its rapid implementation and prioritization of pedestrian safety, the Oakland Department of Transportation quickly came under fire for its failure to collect feedback that represented the opinions of the diverse range of residents whom the program affected. The high engagement with online surveys by wealthy white residents initially suggested an almost universally positive reaction to the program. The disproportionately low number of responses from residents of East Oakland—a largely Black and Latino and low-income area—revealed both the oversight of city officials as well as the shortcomings of urban planning systems' ability to equally benefit different social groups, which consequently perpetuates inequalities like the transport divide . After the flaws of the feedback forms were brought to light, city planners made concentrated efforts to meet with representatives from different community groups who in turn stressed that simply closing streets to through traffic was not enough to protect pedestrians from dangerous driving. In response the city expressed its commitment to its local residents calling for road traffic safety by rolling out Slow Streets: Essential Places, a phase of the program which installed cones and signage at dangerous traffic areas in order to make grocery stores, COVID-19 test sites, and food distribution sites easily and safely accessible. Freight service, which consists primarily of moving shipping containers to and from the Port of Oakland, is provided today by Union Pacific Railroad (UP), and to a lesser extent by BNSF Railway (which now shares the tracks of the UP between Richmond and Oakland). Historically, Oakland was served by several railroads. Besides the transcontinental line of the Southern Pacific, there was also the Santa Fe (whose Oakland terminal was actually in Emeryville), the Western Pacific Railroad (who built a pier adjacent to the SP's), and the Sacramento Northern Railroad (eventually absorbed by the Western Pacific, which in turn was absorbed by UP in 1983).As one of the three major ports on the West Coast of the United States , the Port of Oakland is the largest seaport on San Francisco Bay and the fifth busiest container port in the United States. It was one of the earliest seaports to switch to containerization and to intermodal container transfer , thereby displacing the Port of San Francisco , which never modernized its waterfront. One of the earlier limitations to growth was the inability to transfer containers to rail lines, all cranes historically operating between ocean vessels and trucks. In the 1980s, the Port of Oakland began the evaluation of development of an intermodal container transfer capability, i.e., facilities that now allow trans-loading of containers from vessels to either trucks or rail modes. Public water supply and sewage treatment are provided by East Bay Municipal Utility District (EBMUD). Pacific Gas and Electric Company (PG & E) provides natural gas and electricity service. Municipal garbage collection is franchised to Waste Management, Inc . Telecommunications and subscriber television services are provided by multiple private corporations and other service providers in accordance with the competitive objectives of the Telecommunications Act of 1996 . Oakland tops the list of the 50 largest US cities using electricity from renewable sources. Originating in Oakland, Kaiser Permanente is an HMO started in 1942, during World War II, by industrialist Henry J. Kaiser to provide medical care for Kaiser Shipyards workers. It is the largest managed care organization in the United States and the largest non-governmental health care provider in the world. It is headquartered at One Kaiser Plaza in Downtown Oakland and maintains a large medical center in the Piedmont Avenue neighborhood. Alta Bates Summit Medical Center , an East Bay hospital system, maintains its Summit Campus in the neighborhood known as "Pill Hill" north of downtown. Until 2000, it was the Summit Medical Center before merging with Berkeley-based Alta Bates. All campuses now operate under the Sutter Health network. Alameda Health System is an integrated public health care system organized as a public hospital authority. It operates five Alameda County hospitals including Oakland's Highland Hospital and four primary care medical clinics including Oakland's Highland Wellness Center and Eastmont Wellness Center. Children's Hospital Oakland is the primary medical center specializing in pediatrics in the East Bay. It is a designated Level I pediatric trauma center and the only independent children's hospital in Northern California. There are also several community health centers in Oakland. Some examples include Lifelong Medical Care, Asian Health Services, and Roots Community Health Center.Oakland has 13 sister cities : Oakland has 18 friendship cities: Oakland has 13 sister cities : Oakland has 18 friendship cities:

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Harbin

Harbin [lower-alpha 1] is a sub-provincial city and the provincial capital of Heilongjiang province , People's Republic of China . It is the largest city of Heilongjiang, as well as being the city with the second-largest urban population (after Shenyang , Liaoning province ) and largest metropolitan population (urban and rural regions together) in Northeast China . Harbin has direct jurisdiction over nine metropolitan districts, two county-level cities and seven counties, and is the eighth most populous Chinese city according to the 2020 census . The built-up area of Harbin (which consists of all districts except Shuangcheng and Acheng) had 5,841,929 inhabitants, while the total metropolitan population was up to 10,009,854, making it one of the 100 largest urban areas in the world . Harbin, whose name was originally a Manchu word meaning "a place for drying fishing nets ", grew from a small rural fishing village on the Songhua River to become one of the largest cities in Northeast China. Founded in 1898 with the coming of the Russian -built Chinese Eastern Railway , the city first prospered as a settlement inhabited by an overwhelming majority of immigrants from the Russian Empire. In the 1920s, the city was considered China's fashion capital since new designs from Paris and Moscow reached here first before arriving in Shanghai . From 1932 until 1945, Harbin was the largest city in the Imperial Japanese puppet state of Manchukuo . Known for its bitterly cold winters, Harbin is heralded as the Ice City ( 冰 城 ) for its winter tourism and recreations. Harbin is notable for its ice sculpture festival in the winter. Being well known for its historical Russian legacy and architecture, the city is famed for its European influence and serves as an important gateway in Sino-Russian trade today. Harbin serves as a key political, economic, scientific, cultural and communications hub in Northeast China, as well as an important industrial base of the nation. The city was voted "China Top Tourist City" by the China National Tourism Administration in 2004. Harbin is one of the top 65 cities and metropolitan areas in the world by scientific research output as tracked by the Nature Index . The city hosts several major universities in Northeast China , including Harbin Engineering , Harbin Medical , Northeast Agricultural , Harbin University of Science and Technology , Harbin Normal , Northeast Forestry , and Heilongjiang . Notably, Harbin Institute of Technology is consistently ranked as one of the best universities in the world for engineering. Human settlement in the Harbin area dates from at least 2200 BC during the late Stone Age . Wanyan Aguda , the founder and first emperor (reigned 1115–1123) of the Jin dynasty (1115–1234), was born in the Jurchen Wanyan tribes who resided near the Ashi River in this region. In AD 1115 Aguda established Jin's capital Shangjing (Upper Capital) Huining Prefecture in today's Acheng District of Harbin. After Aguda's death, the new emperor Wanyang Sheng ordered the construction of a new city on a uniform plan. The planning and construction emulated major Chinese cities, in particular Bianjing ( Kaifeng ), although the Jin capital was smaller than its Northern Song prototype. Huining Prefecture served as the first superior capital of the Jin Empire until Wanyan Liang (the fourth emperor of the Jin Dynasty) moved the capital to Yanjing (now Beijing ) in 1153. Liang even went to destroy all palaces in his former capital in 1157. Wanyan Liang's successor Wanyan Yong ( Emperor Shizong ) restored the city and established it as a secondary capital in 1173. Ruins of the Shangjing Huining Prefecture were discovered and excavated about 2 km (1.2 mi) from present-day Acheng's central urban area. The site of the old Jin capital ruins is a national historic reserve, and includes the Jin Dynasty History Museum [ zh ] . The museum, open to the public, was renovated in late 2005. Mounted statues of Aguda and of his chief commander Wanyan Zonghan (also Nianhan) stand in the grounds of the museum. Many of the artifacts found there are on display in nearby Harbin. After the Mongol conquest of the Jin Empire (1211–1234), Huining Prefecture was abandoned. In the 17th century, the Manchus used building materials from Huining Prefecture to construct their new stronghold in Alchuka . The region of Harbin remained largely rural until the 19th century, with over ten villages and about 30,000 people in the city's present-day urban districts by the end of the 19th century. A small village in 1898 grew into the modern city of Harbin. Polish engineer Adam Szydłowski drew plans for the city following the construction of the Chinese Eastern Railway , which the Russian Empire had financed. The Russians selected Harbin as the base of their administration over this railway and the Chinese Eastern Railway Zone . The railways were largely constructed by Russian engineers and indentured workers. The Chinese Eastern Railway extended the Trans-Siberian Railway , substantially reducing the distance from Chita to Vladivostok and also linking the new port city of Dalny ( Dalian ) and the Russian naval base of Port Arthur ( Lüshun ). The settlement founded by the Russian-owned Chinese Eastern Railway quickly turned into a boomtown , growing into a city within five years. The majority of settlers in Harbin came from all over the Russian Empire. There were many Ukrainians, Poles, Jews, Georgians, and Tatars . The city was intended as a showcase for Russian imperialism in Asia and the American scholar Simon Karlinsky , who was born in Harbin in 1924 into a Russian-Jewish family, wrote that in Harbin "the buildings, boulevards, and parks were planned—well before the October Revolution —by distinguished Russian architects and also by Swiss and Italian town planners", giving the city a very European appearance. Starting in the late 19th century, a mass influx of Han Chinese arrived in Manchuria, and taking advantage of the rich soils, founded farms that soon turned Manchuria into the "breadbasket of China" while others went to work in the mines and factories of Manchuria, which become one of the first regions of China to industrialize. Harbin became one of the main points through which food and industrial products were shipped out of Manchuria. A sign of Harbin's wealth was that a theater had established during its first decade and in 1907 the play K zvezdam by Leonid Andreyev had its premiere there. During the Russo-Japanese War (1904–05), Russia used Harbin as its base for military operations in Manchuria. Following Russia's defeat, its influence declined. Several thousand nationals from 33 countries, including the United States, Germany, and France, moved to Harbin. Sixteen countries established consulates to serve their nationals, who established several hundred industrial, commercial and banking companies. Churches were rebuilt for Russian Orthodox , Lutheran/German Protestant , and Polish Catholic Christians. Chinese capitalists also established businesses, especially in brewing, food, and textiles. Harbin became the economic hub of northeastern China and an international metropolis. The rapid growth of the city challenged the public healthcare system. The worst-ever recorded outbreak of pneumonic plague spread to Harbin through the Trans-Manchurian railway from the border trade port of Manzhouli . The plague lasted from late autumn of 1910 to spring 1911 and killed 1,500 Harbin residents (mostly ethnic Chinese), or about five percent of its population at the time. This turned out to be the beginning of the large so-called Manchurian plague pandemic , which ultimately claimed 60,000 victims. In the winter of 1910, Dr. Wu Lien-teh (later the founder of Harbin Medical University ) was given instructions from the Foreign Office, Peking, to travel to Harbin to investigate the plague. Dr. Wu asked for imperial sanction to cremate plague victims, as cremation of these infected victims turned out to be the turning point of the epidemic. The suppression of this plague pandemic changed medical progress in China. Bronze statues of Dr. Wu Lien-teh were built in Harbin Medical University to remember his contributions in promoting public health, preventive medicine, and medical education. The first generation of Harbin Russians were mostly the builders and employees of the Chinese Eastern Railway. They moved to Harbin in order to work on the railroad. At the time Harbin was not an established city. The city was almost built from scratch by the builders and early settlers. Houses were constructed, furniture and personal items were brought in from Russia. After the Manchurian plague epidemic, Harbin's population continued to increase sharply, especially inside the Chinese Eastern Railway Zone. In 1913 the Chinese Eastern Railway census showed its ethnic composition as: Russians – 34,313, Chinese (that is, including Hans , Manchus etc.) – 23,537, Jews – 5,032, Poles – 2556, Japanese – 696, Germans – 564, Tatars – 234, Latvians – 218, Georgians – 183, Estonians – 172, Lithuanians – 142, Armenians – 124; there were also Karaims , Ukrainians , Bashkirs , and some Western Europeans. In total, 68,549 citizens of 53 nationalities, speaking 45 languages. Research shows that only 11.5 percent of all residents were born in Harbin. By 1917, Harbin's population exceeded 100,000, with over 40,000 of them being ethnic Russians. Immediately after the February Revolution of 1917 Harbin Soviet was organized. It sought to seize control over the Chinese Eastern Railway and to defend Russian citizens in Manchuria . The Bolshevik Martemyan Ryutin was the chairman of the Harbin Soviet. After Russia's Great October Socialist Revolution in November 1917, the new Soviet government in Russia recognized the Harbin Soviet as its representation in Manchuria and placed Russian citizens in Manchuria under its protection. Subsequently, the Harbin Soviet requested recognition of the local taotai . On December 12, 1917, Bolsheviks seized control over the Harbin Soviet, pressuring Mensheviks and Socialist-Revolutionaries to leave the body. Through Golos Truda the Harbin Soviet declared itself as the government of the area. On December 18, 1917, the Harbin Soviet declared the Chinese Eastern Railway administrator Dmitry Horvat dismissed and directed its militia to seize control of the railway installations. The Bolshevik militia was soon confronted by Chinese troops and Horvat loyalists, who disarmed and deported some 1,560 Bolshevik fighters. Ryutin went underground. In 1920 more than 100,000 defeated Russian White Guards and refugees retreated to Harbin, which became a major center of White Russian émigrés and the largest Russian enclave outside the Soviet Union . Karlinsky noted that a major difference with the Russian émigrés who arrived in Harbin was: "Unlike the Russian émigrés who went to Paris or Prague or even to Shanghai, the new residents of Harbin were not a minority surrounded by a foreign population. They found themselves instead in an almost totally Russian city, populated mainly by people with roots in the south of European Russia." The city had a Russian school system, as well as publishers of Russian-language newspapers and journals. The Russian Harbintsy [lower-alpha 2] community numbered around 120,000 at its peak in the early 1920s. Many of Harbin's Russians were wealthy, which sometimes confused foreign visitors who expected them to be poor, with for instance the American writer Harry A. Franck in his 1923 book Wanderings in North China writing the Russian "ladies as well gowned as at the Paris races [who] strolled with men faultlessly garbed by European standards", leading him to wonder how they had achieved this "deceptive appearance". The Harbin Institute of Technology was established in 1920 as the Harbin Sino-Russian School for Industry to educate railway engineers via a Russian method of instruction. Students could select from two majors at the time: Railway Construction or Electric Mechanic Engineering. On 2 April 1922, the school was renamed the Sino-Russian Industrial University. The original two majors eventually developed into two major departments: the Railway Construction Department and the Electric Engineering Department. Between 1925 and 1928 the university's Rector was Leonid Ustrugov , the Russian Deputy Minister of Railways under Nicholas II before the Russian Revolution , Minister of Railways under Admiral Kolchak 's government and a key figure in the development of the Chinese Eastern Railway . The Russian community in Harbin made it their mission to preserve the pre-revolutionary culture of Russia. The city had numerous Russian language newspapers, journals, libraries, theaters, and two opera companies. One of the famous Russian poets in Harbin was Valery Pereleshin , who started publishing his intensely homoerotic poetry in 1937 and was also one of the few Russian writers in Harbin who learned Mandarin. The subject of Pereleshin's poetry caused problems with the Russian Fascist Party , and led Pereleshin to leave Harbin for Shanghai, and ultimately to the United States. Not all of the Russian newspapers were of high quality, with Karlinsky calling Nash put' , the newspaper of the Russian Fascist Party "the lowest example of gutter journalism that Harbin had ever seen". Nikolai Baikov , a Russian writer in Harbin was known for his novels of exile life in that city together with his accounts of his travels across Manchuria and the folklore of its Manchu and Chinese population. Boris Yulsky , a young Russian writer who published his short stories in the newspaper Rubezh was considered to be a promising writer whose career was cut short when he gave up literature for activism in the Russian Fascist Party and cocaine addiction. Moya-tvoya (mine – yours), a pidgin language that was a combination of Russian and Mandarin Chinese that had developed in the 19th century when Chinese went to work in Siberia, was considered essential by the Chinese businesspeople of Harbin. In the early 1920s, according to Chinese scholars' recent studies, over 20,000 Jews lived in Harbin. After 1919, Dr. Abraham Kaufman played a leading role in Harbin's large Russian Jewish community. The Republic of China discontinued diplomatic relations with the Russian Republic in 1920, leaving many Russians stateless. [ further explanation needed ] When the Chinese Eastern Railway and government in Beijing announced in 1924 that they agreed the railroad would employ only Russian or Chinese nationals, the émigrés were forced to announce their ethnic and political allegiance. Most accepted Soviet citizenship. [ citation needed ] The Chinese warlord Zhang Xueliang , the "Young Marshal" seized the Chinese Eastern Railway in 1929. The Soviet military force quickly put an end to the crisis and forced the Nationalist Chinese to accept the restoration of joint Soviet-Chinese administration of the railway. Japan invaded Manchuria outright after the Mukden Incident in September 1931. After the Japanese captured Qiqihar in the Jiangqiao Campaign , the Japanese 4th Mixed Brigade moved toward Harbin, closing in from the west and south. Bombing and strafing by Japanese aircraft forced the Chinese army to retreat from Harbin. Within a few hours, the Japanese occupation of Harbin was complete. With the establishment of the puppet state of Manchukuo , the so-called " pacification of Manchukuo " began, as volunteer armies continued to fight the Japanese. Harbin became a major operations base for the infamous medical experimenters of Unit 731 , who killed people of all ages and ethnicities. All these units were known collectively as the Epidemic Prevention and Water Purification Department of the Kwantung Army . The main facility of the Unit 731 was built in 1935 at Pingfang District , approximately 24 km (15 mi) south of Harbin urban area at that time. Between 3,000 and 12,000 citizens, including men, women, and children, —from which around 600 every year were provided by the Kempeitai —died during the human experimentation conducted by Unit 731 at the camp based in Pingfang alone, which does not include victims from other medical experimentation sites. Almost 70 percent of the victims who died in the Pingfang camp were Chinese , including both civilian and military. Close to 30 percent of the victims were Russian. The Russian Fascist Party had the task of capturing "unreliable" Russians living in Harbin to hand over to Unit 731 to serve as the unwilling subjects of the gruesome experiments. Some others were Southeast Asians and Pacific Islanders from the colonies of the Empire of Japan , and a small number of the prisoners of war from the Allies of World War II (although many more Allied POWs were victims of Unit 731 at other sites). Prisoners of war were subjected to vivisection without anesthesia, after being infected with various diseases. Prisoners were injected with inoculations of disease, disguised as vaccinations, to study their effects. Unit 731 and its affiliated units (Unit 1644 and Unit 100 among others) were involved in research, development, and experimental deployment of epidemic-creating biowarfare weapons in assaults against the Chinese populace (both civilian and military) throughout World War II. Human targets were also used to test grenades positioned at various distances and in different positions. Flame throwers were tested on humans. Humans were tied to stakes and used as targets to test germ-releasing bombs , chemical weapons , and explosive bombs . Twelve Unit 731 members were found guilty in the Khabarovsk War Crime Trials but later repatriated. Others received secret immunity by the Supreme Commander of the Allied Powers , Douglas MacArthur , before the Tokyo War Crimes Tribunal in exchange for their biological warfare work in the Cold War for the American Forces. Chinese revolutionaries including Zhao Shangzhi , Yang Jingyu , Li Zhaolin , Zhao Yiman continued to struggle against the Japanese in Harbin and its administrative area, commanding the main anti-Japanese guerrilla army- Northeast Anti-Japanese United Army —which was originally organized by the Manchurian branch of the Chinese Communist Party (CCP). The army was supported by the Comintern after the CCP Manchurian Provincial Committee was dissolved in 1936. Under the Manchukuo régime and Japanese occupation, Harbin Russians had a difficult time. In 1935, the Soviet Union sold the Chinese Eastern Railway (KVZhD) to the Japanese, and many Russian emigres left Harbin (48,133 of them were arrested during the Soviet Great Purge between 1936 and 1938 as "Japanese spies" ). Most departing Russians returned to the Soviet Union, but a substantial number moved south to Shanghai or emigrated to the United States and Australia. By the end of the 1930s, the Russian population of Harbin had dropped to around 30,000. Many of Harbin's Jews (13,000 in 1929) fled after the Japanese occupation as the Japanese associated closely with militant anti-Soviet Russian Fascists , whose ideology of anti-Bolshevism and nationalism was laced with virulent anti-Semitism. The Kwantung Army-sponsored and financed the Russian Fascist Party, which after 1932 started to play an over-sized role in the Harbin's Russian community as its thugs began to harass and sometimes kill those opposed to it. Most Jews left for Shanghai , Tianjin , and the British Mandate of Palestine . In the late 1930s, some German Jews fleeing the Nazis moved to Harbin. Japanese officials later facilitated Jewish emigration to several cities in western Japan, notably Kobe , which came to have Japan's largest synagogue. The Soviet Army took the city on 20 August 1945 and Harbin never came under the control of the Nationalist Government , whose troops stopped 60 km (37 mi) short of the city. The city's administration was transferred by the departing Soviet Army to the Chinese People's Liberation Army in April 1946. On 28 April 1946, the communist government of Harbin was established, making the 700,000-citizen-city the first large city governed by the communists. During the short occupation of Harbin by the Soviet Army (August 1945 to April 1946), thousands of Russian emigres who had been identified as members of the Russian Fascist Party and fled communism after the Russian October Revolution, were forcibly deported to the Soviet Union. After 1952 the Soviet Union launched a second wave of immigration back to Russia. By 1964, the Russian population in Harbin had been reduced to 450. The rest of the European community (Russians, Germans, Poles, Greeks, etc.) emigrated from 1950 to 1954 to Australia, Brazil, Canada, Israel, and the US, or were repatriated to their home countries. By 1988 the original Russian community numbered just thirty, all of them elderly. Modern Russians living in Harbin mostly moved there in the 1990s and 2000s, and have no relation to the first wave of emigration. [ citation needed ] Harbin was one of the key construction cities of China during the First Five-Year Plan period from 1951 to 1956. 13 of the 156 key construction projects were aid-constructed by the Soviet Union in Harbin. This project made Harbin an important industrial base of China. During the Great Leap Forward from 1958 to 1961, Harbin experienced a very tortuous development course as several Sino-Soviet contracts were cancelled by the Soviet Union. During the Cultural Revolution many foreign and Christian things were uprooted. On 23 August 1966, Red Guards stormed into St. Nicholas Cathedral, burned its icons on the streets while chanting xenophobic slogans before destroying the church. As the normal economic and social order was seriously disrupted, Harbin's economy also suffered from serious setbacks. One of the main reasons of this setback is with its Soviet ties deteriorating and the Vietnam War escalating, China became concerned of a possible nuclear attack. Mao Zedong ordered an evacuation of military and other key state enterprises away from the northeastern frontier, with Harbin being the core zone of this region, bordering the Soviet Union . During this Third Front Development Era of China, several major factories of Harbin were relocated to Southwestern Provinces including Gansu , Sichuan , Hunan and Guizhou , where they would be strategically secure in the event of a possible war. Some major universities of China were also moved out of Harbin, including Harbin Military Academy of Engineering (predecessor of Changsha's National University of Defense Technology ) and Harbin Institute of Technology (Moved to Chongqing in 1969 and relocated to Harbin in 1973). National economy and social service have obtained significant achievements since the Chinese economic reform first introduced in 1979. Harbin holds the China Harbin International Economic and Trade Fair each year since 1990. Harbin once housed one of the largest Jewish communities in the Far East before World War II. It reached its peak in the mid-1920s when 25,000 European Jews lived in the city. Among them were the parents of Ehud Olmert , the former Prime Minister of Israel . In 2004, Olmert came to Harbin with an Israeli trade delegation to visit the grave of his grandfather in Huang Shan Jewish Cemetery, which had over 500 Jewish graves identified. On 5 October 1984, Harbin was designated a sub-provincial city by the Organization Department of the CCP Central Committee . The eight counties of Harbin originally formed part of Songhuajiang Prefecture whose seat was practically located inside the urban area of Harbin since 1972. The prefecture was officially merged into Harbin city on 11 August 1996, increasing Harbin's total population to 9.47 million. Harbin hosted the third Asian Winter Games in 1996. In 2009, Harbin held the XXIV Winter Universiade . A memorial hall honoring Korean nationalist and independence activist Ahn Jung-geun was unveiled at Harbin Railway Station on 19 January 2014. Ahn assassinated four-time Prime Minister of Japan and former Resident-General of Korea Itō Hirobumi at No.1 platform of Harbin Railway Station on 26 October 1909, as Korea on the verge of annexation by Japan after the signing of the Eulsa Treaty . South Korean President Park Geun-Hye raised an idea of erecting a monument for Ahn while meeting with Chinese Communist Party general secretary Xi Jinping during a visit to China in June 2013. After that China began to build a memorial hall honoring Ahn at Harbin Railway Station. As the hall was unveiled on 19 January 2014, the Japanese side soon lodged protest with China over the construction of Ahn's memorial hall. Human settlement in the Harbin area dates from at least 2200 BC during the late Stone Age . Wanyan Aguda , the founder and first emperor (reigned 1115–1123) of the Jin dynasty (1115–1234), was born in the Jurchen Wanyan tribes who resided near the Ashi River in this region. In AD 1115 Aguda established Jin's capital Shangjing (Upper Capital) Huining Prefecture in today's Acheng District of Harbin. After Aguda's death, the new emperor Wanyang Sheng ordered the construction of a new city on a uniform plan. The planning and construction emulated major Chinese cities, in particular Bianjing ( Kaifeng ), although the Jin capital was smaller than its Northern Song prototype. Huining Prefecture served as the first superior capital of the Jin Empire until Wanyan Liang (the fourth emperor of the Jin Dynasty) moved the capital to Yanjing (now Beijing ) in 1153. Liang even went to destroy all palaces in his former capital in 1157. Wanyan Liang's successor Wanyan Yong ( Emperor Shizong ) restored the city and established it as a secondary capital in 1173. Ruins of the Shangjing Huining Prefecture were discovered and excavated about 2 km (1.2 mi) from present-day Acheng's central urban area. The site of the old Jin capital ruins is a national historic reserve, and includes the Jin Dynasty History Museum [ zh ] . The museum, open to the public, was renovated in late 2005. Mounted statues of Aguda and of his chief commander Wanyan Zonghan (also Nianhan) stand in the grounds of the museum. Many of the artifacts found there are on display in nearby Harbin. After the Mongol conquest of the Jin Empire (1211–1234), Huining Prefecture was abandoned. In the 17th century, the Manchus used building materials from Huining Prefecture to construct their new stronghold in Alchuka . The region of Harbin remained largely rural until the 19th century, with over ten villages and about 30,000 people in the city's present-day urban districts by the end of the 19th century. A small village in 1898 grew into the modern city of Harbin. Polish engineer Adam Szydłowski drew plans for the city following the construction of the Chinese Eastern Railway , which the Russian Empire had financed. The Russians selected Harbin as the base of their administration over this railway and the Chinese Eastern Railway Zone . The railways were largely constructed by Russian engineers and indentured workers. The Chinese Eastern Railway extended the Trans-Siberian Railway , substantially reducing the distance from Chita to Vladivostok and also linking the new port city of Dalny ( Dalian ) and the Russian naval base of Port Arthur ( Lüshun ). The settlement founded by the Russian-owned Chinese Eastern Railway quickly turned into a boomtown , growing into a city within five years. The majority of settlers in Harbin came from all over the Russian Empire. There were many Ukrainians, Poles, Jews, Georgians, and Tatars . The city was intended as a showcase for Russian imperialism in Asia and the American scholar Simon Karlinsky , who was born in Harbin in 1924 into a Russian-Jewish family, wrote that in Harbin "the buildings, boulevards, and parks were planned—well before the October Revolution —by distinguished Russian architects and also by Swiss and Italian town planners", giving the city a very European appearance. Starting in the late 19th century, a mass influx of Han Chinese arrived in Manchuria, and taking advantage of the rich soils, founded farms that soon turned Manchuria into the "breadbasket of China" while others went to work in the mines and factories of Manchuria, which become one of the first regions of China to industrialize. Harbin became one of the main points through which food and industrial products were shipped out of Manchuria. A sign of Harbin's wealth was that a theater had established during its first decade and in 1907 the play K zvezdam by Leonid Andreyev had its premiere there. During the Russo-Japanese War (1904–05), Russia used Harbin as its base for military operations in Manchuria. Following Russia's defeat, its influence declined. Several thousand nationals from 33 countries, including the United States, Germany, and France, moved to Harbin. Sixteen countries established consulates to serve their nationals, who established several hundred industrial, commercial and banking companies. Churches were rebuilt for Russian Orthodox , Lutheran/German Protestant , and Polish Catholic Christians. Chinese capitalists also established businesses, especially in brewing, food, and textiles. Harbin became the economic hub of northeastern China and an international metropolis. The rapid growth of the city challenged the public healthcare system. The worst-ever recorded outbreak of pneumonic plague spread to Harbin through the Trans-Manchurian railway from the border trade port of Manzhouli . The plague lasted from late autumn of 1910 to spring 1911 and killed 1,500 Harbin residents (mostly ethnic Chinese), or about five percent of its population at the time. This turned out to be the beginning of the large so-called Manchurian plague pandemic , which ultimately claimed 60,000 victims. In the winter of 1910, Dr. Wu Lien-teh (later the founder of Harbin Medical University ) was given instructions from the Foreign Office, Peking, to travel to Harbin to investigate the plague. Dr. Wu asked for imperial sanction to cremate plague victims, as cremation of these infected victims turned out to be the turning point of the epidemic. The suppression of this plague pandemic changed medical progress in China. Bronze statues of Dr. Wu Lien-teh were built in Harbin Medical University to remember his contributions in promoting public health, preventive medicine, and medical education. The first generation of Harbin Russians were mostly the builders and employees of the Chinese Eastern Railway. They moved to Harbin in order to work on the railroad. At the time Harbin was not an established city. The city was almost built from scratch by the builders and early settlers. Houses were constructed, furniture and personal items were brought in from Russia. After the Manchurian plague epidemic, Harbin's population continued to increase sharply, especially inside the Chinese Eastern Railway Zone. In 1913 the Chinese Eastern Railway census showed its ethnic composition as: Russians – 34,313, Chinese (that is, including Hans , Manchus etc.) – 23,537, Jews – 5,032, Poles – 2556, Japanese – 696, Germans – 564, Tatars – 234, Latvians – 218, Georgians – 183, Estonians – 172, Lithuanians – 142, Armenians – 124; there were also Karaims , Ukrainians , Bashkirs , and some Western Europeans. In total, 68,549 citizens of 53 nationalities, speaking 45 languages. Research shows that only 11.5 percent of all residents were born in Harbin. By 1917, Harbin's population exceeded 100,000, with over 40,000 of them being ethnic Russians. Immediately after the February Revolution of 1917 Harbin Soviet was organized. It sought to seize control over the Chinese Eastern Railway and to defend Russian citizens in Manchuria . The Bolshevik Martemyan Ryutin was the chairman of the Harbin Soviet. After Russia's Great October Socialist Revolution in November 1917, the new Soviet government in Russia recognized the Harbin Soviet as its representation in Manchuria and placed Russian citizens in Manchuria under its protection. Subsequently, the Harbin Soviet requested recognition of the local taotai . On December 12, 1917, Bolsheviks seized control over the Harbin Soviet, pressuring Mensheviks and Socialist-Revolutionaries to leave the body. Through Golos Truda the Harbin Soviet declared itself as the government of the area. On December 18, 1917, the Harbin Soviet declared the Chinese Eastern Railway administrator Dmitry Horvat dismissed and directed its militia to seize control of the railway installations. The Bolshevik militia was soon confronted by Chinese troops and Horvat loyalists, who disarmed and deported some 1,560 Bolshevik fighters. Ryutin went underground. In 1920 more than 100,000 defeated Russian White Guards and refugees retreated to Harbin, which became a major center of White Russian émigrés and the largest Russian enclave outside the Soviet Union . Karlinsky noted that a major difference with the Russian émigrés who arrived in Harbin was: "Unlike the Russian émigrés who went to Paris or Prague or even to Shanghai, the new residents of Harbin were not a minority surrounded by a foreign population. They found themselves instead in an almost totally Russian city, populated mainly by people with roots in the south of European Russia." The city had a Russian school system, as well as publishers of Russian-language newspapers and journals. The Russian Harbintsy [lower-alpha 2] community numbered around 120,000 at its peak in the early 1920s. Many of Harbin's Russians were wealthy, which sometimes confused foreign visitors who expected them to be poor, with for instance the American writer Harry A. Franck in his 1923 book Wanderings in North China writing the Russian "ladies as well gowned as at the Paris races [who] strolled with men faultlessly garbed by European standards", leading him to wonder how they had achieved this "deceptive appearance". The Harbin Institute of Technology was established in 1920 as the Harbin Sino-Russian School for Industry to educate railway engineers via a Russian method of instruction. Students could select from two majors at the time: Railway Construction or Electric Mechanic Engineering. On 2 April 1922, the school was renamed the Sino-Russian Industrial University. The original two majors eventually developed into two major departments: the Railway Construction Department and the Electric Engineering Department. Between 1925 and 1928 the university's Rector was Leonid Ustrugov , the Russian Deputy Minister of Railways under Nicholas II before the Russian Revolution , Minister of Railways under Admiral Kolchak 's government and a key figure in the development of the Chinese Eastern Railway . The Russian community in Harbin made it their mission to preserve the pre-revolutionary culture of Russia. The city had numerous Russian language newspapers, journals, libraries, theaters, and two opera companies. One of the famous Russian poets in Harbin was Valery Pereleshin , who started publishing his intensely homoerotic poetry in 1937 and was also one of the few Russian writers in Harbin who learned Mandarin. The subject of Pereleshin's poetry caused problems with the Russian Fascist Party , and led Pereleshin to leave Harbin for Shanghai, and ultimately to the United States. Not all of the Russian newspapers were of high quality, with Karlinsky calling Nash put' , the newspaper of the Russian Fascist Party "the lowest example of gutter journalism that Harbin had ever seen". Nikolai Baikov , a Russian writer in Harbin was known for his novels of exile life in that city together with his accounts of his travels across Manchuria and the folklore of its Manchu and Chinese population. Boris Yulsky , a young Russian writer who published his short stories in the newspaper Rubezh was considered to be a promising writer whose career was cut short when he gave up literature for activism in the Russian Fascist Party and cocaine addiction. Moya-tvoya (mine – yours), a pidgin language that was a combination of Russian and Mandarin Chinese that had developed in the 19th century when Chinese went to work in Siberia, was considered essential by the Chinese businesspeople of Harbin. In the early 1920s, according to Chinese scholars' recent studies, over 20,000 Jews lived in Harbin. After 1919, Dr. Abraham Kaufman played a leading role in Harbin's large Russian Jewish community. The Republic of China discontinued diplomatic relations with the Russian Republic in 1920, leaving many Russians stateless. [ further explanation needed ] When the Chinese Eastern Railway and government in Beijing announced in 1924 that they agreed the railroad would employ only Russian or Chinese nationals, the émigrés were forced to announce their ethnic and political allegiance. Most accepted Soviet citizenship. [ citation needed ] The Chinese warlord Zhang Xueliang , the "Young Marshal" seized the Chinese Eastern Railway in 1929. The Soviet military force quickly put an end to the crisis and forced the Nationalist Chinese to accept the restoration of joint Soviet-Chinese administration of the railway. Japan invaded Manchuria outright after the Mukden Incident in September 1931. After the Japanese captured Qiqihar in the Jiangqiao Campaign , the Japanese 4th Mixed Brigade moved toward Harbin, closing in from the west and south. Bombing and strafing by Japanese aircraft forced the Chinese army to retreat from Harbin. Within a few hours, the Japanese occupation of Harbin was complete. With the establishment of the puppet state of Manchukuo , the so-called " pacification of Manchukuo " began, as volunteer armies continued to fight the Japanese. Harbin became a major operations base for the infamous medical experimenters of Unit 731 , who killed people of all ages and ethnicities. All these units were known collectively as the Epidemic Prevention and Water Purification Department of the Kwantung Army . The main facility of the Unit 731 was built in 1935 at Pingfang District , approximately 24 km (15 mi) south of Harbin urban area at that time. Between 3,000 and 12,000 citizens, including men, women, and children, —from which around 600 every year were provided by the Kempeitai —died during the human experimentation conducted by Unit 731 at the camp based in Pingfang alone, which does not include victims from other medical experimentation sites. Almost 70 percent of the victims who died in the Pingfang camp were Chinese , including both civilian and military. Close to 30 percent of the victims were Russian. The Russian Fascist Party had the task of capturing "unreliable" Russians living in Harbin to hand over to Unit 731 to serve as the unwilling subjects of the gruesome experiments. Some others were Southeast Asians and Pacific Islanders from the colonies of the Empire of Japan , and a small number of the prisoners of war from the Allies of World War II (although many more Allied POWs were victims of Unit 731 at other sites). Prisoners of war were subjected to vivisection without anesthesia, after being infected with various diseases. Prisoners were injected with inoculations of disease, disguised as vaccinations, to study their effects. Unit 731 and its affiliated units (Unit 1644 and Unit 100 among others) were involved in research, development, and experimental deployment of epidemic-creating biowarfare weapons in assaults against the Chinese populace (both civilian and military) throughout World War II. Human targets were also used to test grenades positioned at various distances and in different positions. Flame throwers were tested on humans. Humans were tied to stakes and used as targets to test germ-releasing bombs , chemical weapons , and explosive bombs . Twelve Unit 731 members were found guilty in the Khabarovsk War Crime Trials but later repatriated. Others received secret immunity by the Supreme Commander of the Allied Powers , Douglas MacArthur , before the Tokyo War Crimes Tribunal in exchange for their biological warfare work in the Cold War for the American Forces. Chinese revolutionaries including Zhao Shangzhi , Yang Jingyu , Li Zhaolin , Zhao Yiman continued to struggle against the Japanese in Harbin and its administrative area, commanding the main anti-Japanese guerrilla army- Northeast Anti-Japanese United Army —which was originally organized by the Manchurian branch of the Chinese Communist Party (CCP). The army was supported by the Comintern after the CCP Manchurian Provincial Committee was dissolved in 1936. Under the Manchukuo régime and Japanese occupation, Harbin Russians had a difficult time. In 1935, the Soviet Union sold the Chinese Eastern Railway (KVZhD) to the Japanese, and many Russian emigres left Harbin (48,133 of them were arrested during the Soviet Great Purge between 1936 and 1938 as "Japanese spies" ). Most departing Russians returned to the Soviet Union, but a substantial number moved south to Shanghai or emigrated to the United States and Australia. By the end of the 1930s, the Russian population of Harbin had dropped to around 30,000. Many of Harbin's Jews (13,000 in 1929) fled after the Japanese occupation as the Japanese associated closely with militant anti-Soviet Russian Fascists , whose ideology of anti-Bolshevism and nationalism was laced with virulent anti-Semitism. The Kwantung Army-sponsored and financed the Russian Fascist Party, which after 1932 started to play an over-sized role in the Harbin's Russian community as its thugs began to harass and sometimes kill those opposed to it. Most Jews left for Shanghai , Tianjin , and the British Mandate of Palestine . In the late 1930s, some German Jews fleeing the Nazis moved to Harbin. Japanese officials later facilitated Jewish emigration to several cities in western Japan, notably Kobe , which came to have Japan's largest synagogue.The Soviet Army took the city on 20 August 1945 and Harbin never came under the control of the Nationalist Government , whose troops stopped 60 km (37 mi) short of the city. The city's administration was transferred by the departing Soviet Army to the Chinese People's Liberation Army in April 1946. On 28 April 1946, the communist government of Harbin was established, making the 700,000-citizen-city the first large city governed by the communists. During the short occupation of Harbin by the Soviet Army (August 1945 to April 1946), thousands of Russian emigres who had been identified as members of the Russian Fascist Party and fled communism after the Russian October Revolution, were forcibly deported to the Soviet Union. After 1952 the Soviet Union launched a second wave of immigration back to Russia. By 1964, the Russian population in Harbin had been reduced to 450. The rest of the European community (Russians, Germans, Poles, Greeks, etc.) emigrated from 1950 to 1954 to Australia, Brazil, Canada, Israel, and the US, or were repatriated to their home countries. By 1988 the original Russian community numbered just thirty, all of them elderly. Modern Russians living in Harbin mostly moved there in the 1990s and 2000s, and have no relation to the first wave of emigration. [ citation needed ] Harbin was one of the key construction cities of China during the First Five-Year Plan period from 1951 to 1956. 13 of the 156 key construction projects were aid-constructed by the Soviet Union in Harbin. This project made Harbin an important industrial base of China. During the Great Leap Forward from 1958 to 1961, Harbin experienced a very tortuous development course as several Sino-Soviet contracts were cancelled by the Soviet Union. During the Cultural Revolution many foreign and Christian things were uprooted. On 23 August 1966, Red Guards stormed into St. Nicholas Cathedral, burned its icons on the streets while chanting xenophobic slogans before destroying the church. As the normal economic and social order was seriously disrupted, Harbin's economy also suffered from serious setbacks. One of the main reasons of this setback is with its Soviet ties deteriorating and the Vietnam War escalating, China became concerned of a possible nuclear attack. Mao Zedong ordered an evacuation of military and other key state enterprises away from the northeastern frontier, with Harbin being the core zone of this region, bordering the Soviet Union . During this Third Front Development Era of China, several major factories of Harbin were relocated to Southwestern Provinces including Gansu , Sichuan , Hunan and Guizhou , where they would be strategically secure in the event of a possible war. Some major universities of China were also moved out of Harbin, including Harbin Military Academy of Engineering (predecessor of Changsha's National University of Defense Technology ) and Harbin Institute of Technology (Moved to Chongqing in 1969 and relocated to Harbin in 1973). National economy and social service have obtained significant achievements since the Chinese economic reform first introduced in 1979. Harbin holds the China Harbin International Economic and Trade Fair each year since 1990. Harbin once housed one of the largest Jewish communities in the Far East before World War II. It reached its peak in the mid-1920s when 25,000 European Jews lived in the city. Among them were the parents of Ehud Olmert , the former Prime Minister of Israel . In 2004, Olmert came to Harbin with an Israeli trade delegation to visit the grave of his grandfather in Huang Shan Jewish Cemetery, which had over 500 Jewish graves identified. On 5 October 1984, Harbin was designated a sub-provincial city by the Organization Department of the CCP Central Committee . The eight counties of Harbin originally formed part of Songhuajiang Prefecture whose seat was practically located inside the urban area of Harbin since 1972. The prefecture was officially merged into Harbin city on 11 August 1996, increasing Harbin's total population to 9.47 million. Harbin hosted the third Asian Winter Games in 1996. In 2009, Harbin held the XXIV Winter Universiade . A memorial hall honoring Korean nationalist and independence activist Ahn Jung-geun was unveiled at Harbin Railway Station on 19 January 2014. Ahn assassinated four-time Prime Minister of Japan and former Resident-General of Korea Itō Hirobumi at No.1 platform of Harbin Railway Station on 26 October 1909, as Korea on the verge of annexation by Japan after the signing of the Eulsa Treaty . South Korean President Park Geun-Hye raised an idea of erecting a monument for Ahn while meeting with Chinese Communist Party general secretary Xi Jinping during a visit to China in June 2013. After that China began to build a memorial hall honoring Ahn at Harbin Railway Station. As the hall was unveiled on 19 January 2014, the Japanese side soon lodged protest with China over the construction of Ahn's memorial hall. Harbin, with a total land area of 53,068 km 2 (20,490 sq mi) , is located in southern Heilongjiang province and is the provincial capital. The prefecture is also located at the southeastern edge of the Songnen Plain , a major part of China's Northeastern Plain . The city center also sits on the southern bank of the middle Songhua River . Harbin received its nickname The pearl on the swan's neck , since the shape of Heilongjiang resembles a swan. Its administrative area is rather large with latitude spanning 44° 04′−46° 40′ N, and longitude 125° 42′−130° 10' E. Neighbouring prefecture-level cities are Yichun to the north, Jiamusi and Qitaihe to the northeast, Mudanjiang to the southeast, Daqing to the west, and Suihua to the northwest. On its southwestern boundary is Jilin province. The main terrain of the city is generally flat and low lying, with an average elevation of around 150 metres (490 ft) . The territory that comprises the 10 county-level divisions in the eastern part of the municipality consists of mountains and uplands. The easternmost part of Harbin prefecture also has extensive wetlands , mainly in Yilan County , which is located at the southwestern edge of the Sanjiang Plain . Under the Köppen climate classification , Harbin features a monsoon -influenced humid continental climate ( Dwa ). Due to the Siberian high and its location above 45 degrees north latitude, the city is known for its cold weather and long winter. Its nickname Ice City is well-earned, as winters in the city are dry and freezing cold, with a 24-hour average in January of only −17.3 °C (0.9 °F) , although the city sees little precipitation during the winter and is often sunny. Spring and autumn constitute brief transition periods with variable wind directions. Summers can be hot, with a July mean temperature of 23.7 °C (74.7 °F) . Summer is also when most of the year's rainfall occurs, and more than half of the annual precipitation, at 539 millimetres (21.2 in) , occurs in July and August alone. With monthly percent possible sunshine ranging from 45 percent in December to 60 percent in September, the city receives 2,340 hours of bright sunshine annually; on average precipitation falls 99 days out of the year. The annual mean temperature is 5.2 °C (41.4 °F) , and extreme temperatures have ranged from −42.6 °C (−45 °F) to 39.2 °C (103 °F) . Under the Köppen climate classification , Harbin features a monsoon -influenced humid continental climate ( Dwa ). Due to the Siberian high and its location above 45 degrees north latitude, the city is known for its cold weather and long winter. Its nickname Ice City is well-earned, as winters in the city are dry and freezing cold, with a 24-hour average in January of only −17.3 °C (0.9 °F) , although the city sees little precipitation during the winter and is often sunny. Spring and autumn constitute brief transition periods with variable wind directions. Summers can be hot, with a July mean temperature of 23.7 °C (74.7 °F) . Summer is also when most of the year's rainfall occurs, and more than half of the annual precipitation, at 539 millimetres (21.2 in) , occurs in July and August alone. With monthly percent possible sunshine ranging from 45 percent in December to 60 percent in September, the city receives 2,340 hours of bright sunshine annually; on average precipitation falls 99 days out of the year. The annual mean temperature is 5.2 °C (41.4 °F) , and extreme temperatures have ranged from −42.6 °C (−45 °F) to 39.2 °C (103 °F) . The sub-provincial city of Harbin has direct jurisdiction over 9 districts , 2 county-level cities and 7 counties .Harbin has the largest economy in Heilongjiang province. In 2013, Harbin's GDP totaled RMB501.08 billion, an increase of 8.9 percent over the previous year. The proportion of the three industries to the aggregate of GDP was 11.1:36.1:52.8 in 2012. The total value for imports and exports by the end of 2012 was US$5,330 million. In 2012, the working population reached 3.147 million. In 2015, Harbin had a GDP of RMB 575.12 billion. The chernozem soil in Harbin is one of the most nutrient rich in all of China, making it valuable for cultivating food and textile-related crops. As a result, Harbin is China's base for the production of commodity grain and an ideal location for setting up agricultural businesses. Harbin also has industries such as light industry, textile, medicine, food, aircraft, automobile, metallurgy, electronics, building materials, and chemicals that help to form a fairly comprehensive industrial system. Several major corporations are based in the city. Harbin Electric Company Limited , Harbin Aircraft Industry Group and Northeast Light Alloy Processing Factory are some of key enterprises. Power manufacturing is a main industry in Harbin; hydro and thermal power equipment manufactured here makes up one-third of the total installed capacity in China. According to Platts , in 2009-10 Harbin Electric was the second largest manufacturer of steam turbines by worldwide market share, tying Dongfang Electric and slightly behind Shanghai Electric. Harbin Pharmaceutical Group, which mainly focus on research, development, manufacture and sale of medical products, is China's second-biggest pharmaceutical company by market value . Harbin International Trade and Economic Fair has been held annually since 1990. This investment and trade fair cumulatively attracting more than 1.9 million exhibitors and visitors from more than 80 countries and regions to attend, resulting over US$100 billion contract volume concluded according to the statistics of 2013. Harbin is among major destinations of FDI in Northeast China, with utilized FDI totaling US$980 million in 2013. After the 18th regular meeting between Sino-Russian Prime Ministers between Li Keqiang and Dmitry Anatolyevich Medvedev in October 2013, two sides come to make an agreement that the Harbin International Trade and Economic Fair will be renamed "China-Russia EXPO" and be co-sponsored by the Chinese Ministry of Commerce, Heilongjiang Provincial government, the Russian Ministry of Economic Development and Russia's Ministry of Trade and Industry. In the financial sector, Longjiang Bank and Harbin Bank are some of the largest banks in Northeast China, with headquarters in Harbin. The latter ranks fourth by competitiveness among Chinese city commercial banks in 2011. In commerce, there is Qiulin Group , which owns Harbin's largest department store . Songbei Economic Development Zone is located in Songbei District of Harbin. The zone has a planned area of 5.53 square kilometers. Electronics assembly & manufacturing, food and beverage processing are the encouraged industries in the zone. Many regional and provincial headquarters of large enterprises such as the China Datang Corporation , China Netcom and China Telecom have joined in this district, preliminary constituting the economy concentration zone of the local headquarters. Regional Scientific research centers including Harbin Science and Technology Innovation Center and Harbin International Agricultural Science and Technology Innovation Center are also located in this development zone. Profit from these major research institutes, Harbin ranked ninth among 50 major Chinese cities in scientific and technological innovation ability in scientific and technological competitiveness ranking in 2006, as well as ranking sixth among Chinese cities in the amount of scientific and technological achievements. Harbin Economic and Technological Development Zone (HETDZ) is one of the 90 national economical development zones of China. It was set up in June 1991, and was approved by the State Council as a national development zone in April 1993. In December 2012, Harbin High Technology Development Zone was merged into HETDZ. In 2009, the hi-tech zone was separated from HETDZ again. The area now has a total area of 18.5 square-kilometers in the centralized parks, subdivided into Nangang and Haping Road Centralized Parks. The 12.2 square-kilometers Yingbin Road Hi-tech Centralized Park, which was formerly part of HETDZ, is currently under the administration of Harbin High and New Technology Industry Development Zone since 2009. Nangang Centralized Park: designated for the incubation of high-tech projects and research and development base of enterprises as well as tertiary industries such as finance, insurance, services, catering, tourism, culture, recreation and entertainment, where the headquarters of large famous companies and their branches in Harbin are located. Yingbin Road Centralized Park: mainly focus on high-tech incubation projects, high-tech industrial development. Haping Road Centralized Park: designated for a comprehensive industrial basis for the investment projects of automobile and automobile parts manufacturing, medicines, foodstuffs, electronics, textile; Automobile production and assembly raw material processing are the encouraged industries in this region. Harbin High and New Technology Industry Development Zone is one of the 56 national High and New Technology Industry Development Zones of China. The zone was first set up as a provincial level development zone in 1988, and was approved by the State Council as a national development zone in 1991 respectively. It has 23.9 square-kilometers of built-area totally, and subdivided into two parts: Science and Technology Innovation Town and High-tech Industrial Development Zone. Songbei Economic Development Zone is located in Songbei District of Harbin. The zone has a planned area of 5.53 square kilometers. Electronics assembly & manufacturing, food and beverage processing are the encouraged industries in the zone. Many regional and provincial headquarters of large enterprises such as the China Datang Corporation , China Netcom and China Telecom have joined in this district, preliminary constituting the economy concentration zone of the local headquarters. Regional Scientific research centers including Harbin Science and Technology Innovation Center and Harbin International Agricultural Science and Technology Innovation Center are also located in this development zone. Profit from these major research institutes, Harbin ranked ninth among 50 major Chinese cities in scientific and technological innovation ability in scientific and technological competitiveness ranking in 2006, as well as ranking sixth among Chinese cities in the amount of scientific and technological achievements. Harbin Economic and Technological Development Zone (HETDZ) is one of the 90 national economical development zones of China. It was set up in June 1991, and was approved by the State Council as a national development zone in April 1993. In December 2012, Harbin High Technology Development Zone was merged into HETDZ. In 2009, the hi-tech zone was separated from HETDZ again. The area now has a total area of 18.5 square-kilometers in the centralized parks, subdivided into Nangang and Haping Road Centralized Parks. The 12.2 square-kilometers Yingbin Road Hi-tech Centralized Park, which was formerly part of HETDZ, is currently under the administration of Harbin High and New Technology Industry Development Zone since 2009. Nangang Centralized Park: designated for the incubation of high-tech projects and research and development base of enterprises as well as tertiary industries such as finance, insurance, services, catering, tourism, culture, recreation and entertainment, where the headquarters of large famous companies and their branches in Harbin are located. Yingbin Road Centralized Park: mainly focus on high-tech incubation projects, high-tech industrial development. Haping Road Centralized Park: designated for a comprehensive industrial basis for the investment projects of automobile and automobile parts manufacturing, medicines, foodstuffs, electronics, textile; Automobile production and assembly raw material processing are the encouraged industries in this region. Harbin High and New Technology Industry Development Zone is one of the 56 national High and New Technology Industry Development Zones of China. The zone was first set up as a provincial level development zone in 1988, and was approved by the State Council as a national development zone in 1991 respectively. It has 23.9 square-kilometers of built-area totally, and subdivided into two parts: Science and Technology Innovation Town and High-tech Industrial Development Zone. The 2010 census revealed total population in Harbin was 10,635,971, representing a 12.99 percent increase over the previous decade. The built-up area, made up of all urban districts but Acheng and Shuangcheng not urbanized yet, had a population of 5,282,083 people. The encompassing metropolitan area was estimated by the OECD (Organisation for Economic Co-operation and Development) to have, as of 2010 [ update ] , a population of 10.5 million. The demographic profile for the Harbin metropolitan area in general is relatively old: 10.95 percent are under the age of 14, while 8.04 percent are over 65, compared to the national average of 16.6% and 8.87 percent, respectively. Harbin has a higher percentage of males (50.85 percent) than females (49.15 percent). Harbin currently has a lower birth rate than other parts of China, with 6.95 births per 1,000 inhabitants, compared to the Chinese average of 12.13 births. Most of Harbin's residents belong to the Han Chinese majority (93.45 percent). Ethnic minorities include the Manchu , Hui , and Mongol . In 2000, 616,749 residents belonged to minority ethnicities, among which the vast majority (433,340) were Manchu , contributing 70.26 percent to the minority population. The second and third largest minority groups were Koreans (119,883) and Hui nationalities (39,995). The Catholic minority is pastorally served by the Apostolic Administration of Harbin , a missionary pre-diocesan jurisdiction. It also has the Eastern Catholic former cathedral of the Russian Catholic Apostolic Exarchate of Harbin . The badly damaged Church of the Iver Icon of the Mother of God was previously used by Russian soldiers of the Outer Amur Military Region, then garrisoned in Harbin. A small percentage of the city's population consists of Muslims. Daowai Mosque is located in Harbin and is the largest mosque in Heilongjiang province. Harbin had a small Jewish community centered on Zhongyang Main Street, which was home to many European Jewish refugees. The 2010 census revealed total population in Harbin was 10,635,971, representing a 12.99 percent increase over the previous decade. The built-up area, made up of all urban districts but Acheng and Shuangcheng not urbanized yet, had a population of 5,282,083 people. The encompassing metropolitan area was estimated by the OECD (Organisation for Economic Co-operation and Development) to have, as of 2010 [ update ] , a population of 10.5 million. The demographic profile for the Harbin metropolitan area in general is relatively old: 10.95 percent are under the age of 14, while 8.04 percent are over 65, compared to the national average of 16.6% and 8.87 percent, respectively. Harbin has a higher percentage of males (50.85 percent) than females (49.15 percent). Harbin currently has a lower birth rate than other parts of China, with 6.95 births per 1,000 inhabitants, compared to the Chinese average of 12.13 births. Most of Harbin's residents belong to the Han Chinese majority (93.45 percent). Ethnic minorities include the Manchu , Hui , and Mongol . In 2000, 616,749 residents belonged to minority ethnicities, among which the vast majority (433,340) were Manchu , contributing 70.26 percent to the minority population. The second and third largest minority groups were Koreans (119,883) and Hui nationalities (39,995).The Catholic minority is pastorally served by the Apostolic Administration of Harbin , a missionary pre-diocesan jurisdiction. It also has the Eastern Catholic former cathedral of the Russian Catholic Apostolic Exarchate of Harbin . The badly damaged Church of the Iver Icon of the Mother of God was previously used by Russian soldiers of the Outer Amur Military Region, then garrisoned in Harbin. A small percentage of the city's population consists of Muslims. Daowai Mosque is located in Harbin and is the largest mosque in Heilongjiang province. Harbin had a small Jewish community centered on Zhongyang Main Street, which was home to many European Jewish refugees. The Harbin local culture is based on Han culture , combined with Manchu culture and Russian culture. This combination of cultures influences the local architecture style, food, music, and customs. The city of Harbin was appointed a UNESCO City of Music on 22 June 2010 as part of the Creative Cities Network . Harbin is renowned for its culinary tradition. The cuisine of Harbin consists of European dishes and Northern Chinese dishes mainly typified by heavy sauce and deep-frying. [ better source needed ] One of the most famous dishes in Northeastern Chinese cuisine is Guo Bao Rou , a form of sweet and sour pork. It is a classic dish from Harbin that originated in the early 20th century in Daotai Fu ( pinyin : Dà otái Fǔ ). It consists of a bite-sized pieces of pork in a potato starch batter , deep-fried until crispy. They are then lightly coated in a variation of a sweet and sour sauce, made from freshly prepared syrup , rice vinegar, sugar, flavoured with ginger, cilantro, sliced carrot and garlic. The Harbin Guobaorou is distinct from that of other areas of China, such as Liaoning, where the sauce may be made using either tomato ketchup or orange juice. Rather the Harbin style is dominated by the honey and ginger flavours and has a clear or honey yellow colour. Originally the taste was fresh and salty. In order to fete foreign guests, Zheng Xingwen, the chef of Daotai Fu, altered the dish into a sweet and sour taste. Usually, people prefer to go to several small or middle size restaurants to enjoy this dish, because it is difficult to handle the frying process at home. Demoli Stewed Live Fish is one among other notable dishes in Harbin, which is originated in a village named Demoli on the expressway from Harbin to Jiamusi. The village is now Demoli Service Area on Harbin-Tongjiang Expressway. Stewed Chicken with Mushrooms, Braised Pork with Vermicelli, and quick-boil pork with Chinese sauerkraut are also typical authentic local dishes. Since Russia had a strong influence on Harbin's history, the local cuisine of Harbin also contains Russian-style dishes and flavor. There are several authentic Russian-style restaurants in Harbin, especially alongside the Zhongyang Street. A popular regional specialty is Harbin-style smoked savory red sausage . This product, which is similar to mild Lithuanian and German sausages, tend to be much more of European flavours than other Chinese sausages. In 1900, Russian merchant Ivan Yakovlevich Churin founded a branch in Harbin, which was named Churin Foreign trading company ( pinyin : Qiulin Yanghang ; Russian: Цюлинь Ð¯Ð½Ñ Ð°Ð½ ) selling imported clothes, leather boots, canned foods, vodka, etc., and began to expand sales network in other cities in Manchuria. The influx of Europeans through the Trans-Siberian Railway and Chinese Eastern Railway, increased demand of European flavor food. In 1909, Churin's Sausage Factory was founded, and first produced European flavor sausage with the manufacturing process of Lithuanian staff. Since then, European style sausage has become a specialty of the city. A Russian style large round bread 大列巴 dà liě ba , derived from the Russian word khleb for "bread" is also produced in Harbin's bakeries. Dalieba is a miche like sourdough bread. First introduced to the locals by a Russian baker, it has been sold in bakeries in Harbin for over a hundred years. Dalieba's sour and chewy taste is different from other traditional soft and fluffy Asian style breads in other parts of China. Kvass , a Russia-originated fermented beverage made from black or regular rye bread , is also popular in Harbin. Madier (" 马迭尔 ", derived from "Modern") ice-cream provided in the Zhongyang Street is also well known in northern China. This ice cream is made from a specific traditional recipe and it tastes a little salty but more sweet and milky. Besides its headquarters in Harbin, it also has branches in other major Chinese cities including Beijing, Shanghai, etc. Manchu cuisine has mostly disappeared from Harbin. Harbin, the capital of Heilongjiang Province, is situated in the northeast of the Northeast China Plain. It is a Famous Historical and Cultural City with an infusion of foreign culture. It is also popular as a city universally prestigious for its snow and ice culture. Summer and winter are the best occasions to visit Harbin as it is a cool resort in the short lovely summer and a fascinating ice kingdom in the harsh cold and long winter. Harbin is known for its European-style structures, for example, the popular Saint Sophia Cathedral, the design on Central Street, and the Baroque compositional complex in Lao Daowai (Old Town). Harbin in winter shows a large number of ice figures and offers many ice and snow activities for sightseers. Along with facilitating the world's greatest Ice and Snow Festival, Harbin flaunts the world's biggest indoor ski park, which is inside the Wanda Harbin Mall (counting six ski slants up to 500 meters in length). Located in northern Northeast China, Harbin is the northernmost among major cities in China. Under the direct influence of the Siberian Anticyclone , the average daily temperature is −19.7 °C (−3.5 °F) in winter. Annual low temperatures below −25.0 °C (−13.0 °F) are not uncommon. Nicknamed "Ice City" due to its freezingly cold winter, Harbin is decorated by various styles of Ice and snow Sculptures from December to March every year. The annual Harbin International Ice and Snow Sculpture Festival has been held since 1985. Although the official start date is 5 January each year, in practice, many of the sculptures can be seen before. While there are ice sculptures throughout the city, there are two main exhibition areas: enormous snow sculptures at Sun Island (Taiyang Dao, a AAAAA-rated recreational area on the opposite side of the Songhua River from the city) and the separate "Ice and Snow World" that operates each night with lights switched on, illuminating the sculptures from both inside and outside. Ice and Snow World features illuminated full-size buildings made from blocks of 2–3 feet thick crystal clear ice directly taken from the Songhua River, which passes through the city. The sculptures inside the exhibition ground takes 15,000 workers to work for 16 days. In early December, ice artisans cut 120,000 cubic metres (4.2 million cubic feet) of ice blocks from Songhua river's frozen surface as raw materials for the ice sculptures' show. Massive ice buildings, large-scale snow sculptures, ice slides, festival food and drinks can also be found in several parks and major avenues in the city. Winter activities in the festival include Yabuli Alpine Skiing , snow mobile driving, winter-swimming in Songhua River , and the traditional ice-lantern exhibition in Zhaolin Garden, which was first held in 1963. Snow carving and ice and snow recreations are famous nationwide, especially among Asian countries including Korea, Japan, Thailand and Singapore. The "Harbin International Ice and Snow Festival" is one of the four largest ice and snow festivals in the world, along with Japan's Sapporo Snow Festival , Canada's Quebec City Winter Carnival , and Norway's Holmenkollen Ski Festival . Every November, the city of Harbin sends teams of ice artisans to the United States to promote their unique art form. It takes more than 100 artisans to create ICE!, the annual display of indoor Christmas-themed ice carvings in National Harbor, Maryland; Nashville, Tennessee; Kissimmee, Florida ; and Grapevine, Texas. Founded in 1908, the Harbin Symphony Orchestra was China's oldest symphony orchestra. Harbin No.1 Music School was also the first music school in China, which was founded in 1928. Nearly 100 famous musicians have studied at the school since its founding, said Liu Yantao, deputy chief of Harbin Cultural, Press and Publication Bureau. Every year, thousands of youngsters start their music dreams in this city, and the "Harbin Summer Music Concert" serial activities that always be held in the every year's summer present the music passion of the locals. UNESCO recognizes China's Harbin as "The Music City" as part of the Creative Cities Network in 2010. Harbin Summer Music Concert ('Concert' for short) is a national concert festival, which is held on 6 August every two years for a period of 10~11 days. During the concert, multiple evenings, concert, race and activities are held. The artists come from all over the world. The 'Harbin Summer Music Month', which was then renamed as 'Harbin Summer Music Concert', was held in August 1958. The first formal Concert was held on 5 August 1961 in Harbin Youth Palace, and kept on every year until 1966 when the Cultural Revolution started in China. In 1979, the Concert was recovered and from 1994, it has been held every two years. As a part of 2006 Harbin Summer Music Concert's opening ceremony, a 1,001-piano concert was held in Harbin's Flood memorial square located at the north end of Central Street ( Chinese : 中央大街 ; pinyin : Zhōngyāng Dà jiē ) on 6 August 2006. Repertoires of the ensemble consisted of Triumphal March , Military March , Radetzky March and famous traditional local song On The Sun Island . This concert set a new Guinness World Record for largest piano ensemble, surpassing the previous record held by German artists in a 600-piano concert. In 2008, the 29th Harbin Summer Music Concert was held on 6 August.Harbin is renowned for its culinary tradition. The cuisine of Harbin consists of European dishes and Northern Chinese dishes mainly typified by heavy sauce and deep-frying. [ better source needed ] One of the most famous dishes in Northeastern Chinese cuisine is Guo Bao Rou , a form of sweet and sour pork. It is a classic dish from Harbin that originated in the early 20th century in Daotai Fu ( pinyin : Dà otái Fǔ ). It consists of a bite-sized pieces of pork in a potato starch batter , deep-fried until crispy. They are then lightly coated in a variation of a sweet and sour sauce, made from freshly prepared syrup , rice vinegar, sugar, flavoured with ginger, cilantro, sliced carrot and garlic. The Harbin Guobaorou is distinct from that of other areas of China, such as Liaoning, where the sauce may be made using either tomato ketchup or orange juice. Rather the Harbin style is dominated by the honey and ginger flavours and has a clear or honey yellow colour. Originally the taste was fresh and salty. In order to fete foreign guests, Zheng Xingwen, the chef of Daotai Fu, altered the dish into a sweet and sour taste. Usually, people prefer to go to several small or middle size restaurants to enjoy this dish, because it is difficult to handle the frying process at home. Demoli Stewed Live Fish is one among other notable dishes in Harbin, which is originated in a village named Demoli on the expressway from Harbin to Jiamusi. The village is now Demoli Service Area on Harbin-Tongjiang Expressway. Stewed Chicken with Mushrooms, Braised Pork with Vermicelli, and quick-boil pork with Chinese sauerkraut are also typical authentic local dishes. Since Russia had a strong influence on Harbin's history, the local cuisine of Harbin also contains Russian-style dishes and flavor. There are several authentic Russian-style restaurants in Harbin, especially alongside the Zhongyang Street. A popular regional specialty is Harbin-style smoked savory red sausage . This product, which is similar to mild Lithuanian and German sausages, tend to be much more of European flavours than other Chinese sausages. In 1900, Russian merchant Ivan Yakovlevich Churin founded a branch in Harbin, which was named Churin Foreign trading company ( pinyin : Qiulin Yanghang ; Russian: Цюлинь Ð¯Ð½Ñ Ð°Ð½ ) selling imported clothes, leather boots, canned foods, vodka, etc., and began to expand sales network in other cities in Manchuria. The influx of Europeans through the Trans-Siberian Railway and Chinese Eastern Railway, increased demand of European flavor food. In 1909, Churin's Sausage Factory was founded, and first produced European flavor sausage with the manufacturing process of Lithuanian staff. Since then, European style sausage has become a specialty of the city. A Russian style large round bread 大列巴 dà liě ba , derived from the Russian word khleb for "bread" is also produced in Harbin's bakeries. Dalieba is a miche like sourdough bread. First introduced to the locals by a Russian baker, it has been sold in bakeries in Harbin for over a hundred years. Dalieba's sour and chewy taste is different from other traditional soft and fluffy Asian style breads in other parts of China. Kvass , a Russia-originated fermented beverage made from black or regular rye bread , is also popular in Harbin. Madier (" 马迭尔 ", derived from "Modern") ice-cream provided in the Zhongyang Street is also well known in northern China. This ice cream is made from a specific traditional recipe and it tastes a little salty but more sweet and milky. Besides its headquarters in Harbin, it also has branches in other major Chinese cities including Beijing, Shanghai, etc. Manchu cuisine has mostly disappeared from Harbin. Harbin, the capital of Heilongjiang Province, is situated in the northeast of the Northeast China Plain. It is a Famous Historical and Cultural City with an infusion of foreign culture. It is also popular as a city universally prestigious for its snow and ice culture. Summer and winter are the best occasions to visit Harbin as it is a cool resort in the short lovely summer and a fascinating ice kingdom in the harsh cold and long winter. Harbin is known for its European-style structures, for example, the popular Saint Sophia Cathedral, the design on Central Street, and the Baroque compositional complex in Lao Daowai (Old Town). Harbin in winter shows a large number of ice figures and offers many ice and snow activities for sightseers. Along with facilitating the world's greatest Ice and Snow Festival, Harbin flaunts the world's biggest indoor ski park, which is inside the Wanda Harbin Mall (counting six ski slants up to 500 meters in length). Located in northern Northeast China, Harbin is the northernmost among major cities in China. Under the direct influence of the Siberian Anticyclone , the average daily temperature is −19.7 °C (−3.5 °F) in winter. Annual low temperatures below −25.0 °C (−13.0 °F) are not uncommon. Nicknamed "Ice City" due to its freezingly cold winter, Harbin is decorated by various styles of Ice and snow Sculptures from December to March every year. The annual Harbin International Ice and Snow Sculpture Festival has been held since 1985. Although the official start date is 5 January each year, in practice, many of the sculptures can be seen before. While there are ice sculptures throughout the city, there are two main exhibition areas: enormous snow sculptures at Sun Island (Taiyang Dao, a AAAAA-rated recreational area on the opposite side of the Songhua River from the city) and the separate "Ice and Snow World" that operates each night with lights switched on, illuminating the sculptures from both inside and outside. Ice and Snow World features illuminated full-size buildings made from blocks of 2–3 feet thick crystal clear ice directly taken from the Songhua River, which passes through the city. The sculptures inside the exhibition ground takes 15,000 workers to work for 16 days. In early December, ice artisans cut 120,000 cubic metres (4.2 million cubic feet) of ice blocks from Songhua river's frozen surface as raw materials for the ice sculptures' show. Massive ice buildings, large-scale snow sculptures, ice slides, festival food and drinks can also be found in several parks and major avenues in the city. Winter activities in the festival include Yabuli Alpine Skiing , snow mobile driving, winter-swimming in Songhua River , and the traditional ice-lantern exhibition in Zhaolin Garden, which was first held in 1963. Snow carving and ice and snow recreations are famous nationwide, especially among Asian countries including Korea, Japan, Thailand and Singapore. The "Harbin International Ice and Snow Festival" is one of the four largest ice and snow festivals in the world, along with Japan's Sapporo Snow Festival , Canada's Quebec City Winter Carnival , and Norway's Holmenkollen Ski Festival . Every November, the city of Harbin sends teams of ice artisans to the United States to promote their unique art form. It takes more than 100 artisans to create ICE!, the annual display of indoor Christmas-themed ice carvings in National Harbor, Maryland; Nashville, Tennessee; Kissimmee, Florida ; and Grapevine, Texas.Founded in 1908, the Harbin Symphony Orchestra was China's oldest symphony orchestra. Harbin No.1 Music School was also the first music school in China, which was founded in 1928. Nearly 100 famous musicians have studied at the school since its founding, said Liu Yantao, deputy chief of Harbin Cultural, Press and Publication Bureau. Every year, thousands of youngsters start their music dreams in this city, and the "Harbin Summer Music Concert" serial activities that always be held in the every year's summer present the music passion of the locals. UNESCO recognizes China's Harbin as "The Music City" as part of the Creative Cities Network in 2010. Harbin Summer Music Concert ('Concert' for short) is a national concert festival, which is held on 6 August every two years for a period of 10~11 days. During the concert, multiple evenings, concert, race and activities are held. The artists come from all over the world. The 'Harbin Summer Music Month', which was then renamed as 'Harbin Summer Music Concert', was held in August 1958. The first formal Concert was held on 5 August 1961 in Harbin Youth Palace, and kept on every year until 1966 when the Cultural Revolution started in China. In 1979, the Concert was recovered and from 1994, it has been held every two years. As a part of 2006 Harbin Summer Music Concert's opening ceremony, a 1,001-piano concert was held in Harbin's Flood memorial square located at the north end of Central Street ( Chinese : 中央大街 ; pinyin : Zhōngyāng Dà jiē ) on 6 August 2006. Repertoires of the ensemble consisted of Triumphal March , Military March , Radetzky March and famous traditional local song On The Sun Island . This concert set a new Guinness World Record for largest piano ensemble, surpassing the previous record held by German artists in a 600-piano concert. In 2008, the 29th Harbin Summer Music Concert was held on 6 August.Harbin Summer Music Concert ('Concert' for short) is a national concert festival, which is held on 6 August every two years for a period of 10~11 days. During the concert, multiple evenings, concert, race and activities are held. The artists come from all over the world. The 'Harbin Summer Music Month', which was then renamed as 'Harbin Summer Music Concert', was held in August 1958. The first formal Concert was held on 5 August 1961 in Harbin Youth Palace, and kept on every year until 1966 when the Cultural Revolution started in China. In 1979, the Concert was recovered and from 1994, it has been held every two years. As a part of 2006 Harbin Summer Music Concert's opening ceremony, a 1,001-piano concert was held in Harbin's Flood memorial square located at the north end of Central Street ( Chinese : 中央大街 ; pinyin : Zhōngyāng Dà jiē ) on 6 August 2006. Repertoires of the ensemble consisted of Triumphal March , Military March , Radetzky March and famous traditional local song On The Sun Island . This concert set a new Guinness World Record for largest piano ensemble, surpassing the previous record held by German artists in a 600-piano concert. In 2008, the 29th Harbin Summer Music Concert was held on 6 August.Harbin is notable for its combination of Chinese and European architecture styles. Many Russian and other European style buildings are protected by the government. The architecture in Harbin gives it the nicknames of "Oriental Moscow" and "Oriental Paris" in China. Central Street , one of the main business streets in Harbin, is a remnant of the bustling international business activities at the turn of the 20th century. First built in 1898, The 1.4 km (0.87 mi) long street is now a veritable museum of European architectural styles: Baroque and Byzantine façades, little Russian bakeries and French fashion houses, as well as non European architectural styles: American eateries, and Japanese restaurants . The Russian Orthodox church, Saint Sophia Cathedral , is also located in the central district of Daoli. Built in 1907 and expanded from 1923 to 1932, it was closed during the Great Leap Forward and Cultural Revolution periods. Following its designation in 1996 as a national cultural heritage site (First class Preserved Building), it was turned into a museum as a showcase of the history of Harbin city in 1997. The 53.35 m (175.0 ft) -tall Church, which covers an area of 721 square meters, is a typical representative of Byzantine architecture. Many citizens believe that the Orthodox church damaged the local feng shui , so they donated money to build a Chinese Buddhist monastery in 1921, the Ji Le Temple . There were more than 15 Russian Orthodox churches and two cemeteries in Harbin until 1949. The Communist Revolution , and the subsequent Cultural Revolution , and the decrease in the ethnic Russian population, saw many of them abandoned or destroyed. Today, about 10 churches remain, while services are held only in the Church of the Intercession in Harbin . The Harbin Railway Administration, formerly known as the Middle East Railway Administration, commonly known as the "big stone house", was built in 1902, destroyed twice and rebuilt in 1904 and 1906. [ citation needed ] Harbin Grand Theatre is located in the cultural center of Songbei District , Harbin. It provides 1600- and 400-seat venues. The architecture uses the external design of the heterogeneous hyperbolic surface. The Harbin Grand Theatre is a landmark building in Harbin. It is built in accordance with the water and is consistent with the surrounding environment. It embodies the concept of the landscape and landscape of the north. As a public building facility, the theatre provides people and visitors with different spatial experiences from the theatre, landscape, square and stereoscopic platform. During the design process, architect Ma Yansong has set up a unique sightseeing corridor and viewing platform in the Grand Theatre . Visitors are able to overlook the surrounding wetland and enjoy the unique natural wetland scenery of Harbin. After the completion of the Harbin Grand Theatre , the public can enjoy opera, symphony, ballet and drama performances in various function rooms.Central Street , one of the main business streets in Harbin, is a remnant of the bustling international business activities at the turn of the 20th century. First built in 1898, The 1.4 km (0.87 mi) long street is now a veritable museum of European architectural styles: Baroque and Byzantine façades, little Russian bakeries and French fashion houses, as well as non European architectural styles: American eateries, and Japanese restaurants . The Russian Orthodox church, Saint Sophia Cathedral , is also located in the central district of Daoli. Built in 1907 and expanded from 1923 to 1932, it was closed during the Great Leap Forward and Cultural Revolution periods. Following its designation in 1996 as a national cultural heritage site (First class Preserved Building), it was turned into a museum as a showcase of the history of Harbin city in 1997. The 53.35 m (175.0 ft) -tall Church, which covers an area of 721 square meters, is a typical representative of Byzantine architecture. Many citizens believe that the Orthodox church damaged the local feng shui , so they donated money to build a Chinese Buddhist monastery in 1921, the Ji Le Temple . There were more than 15 Russian Orthodox churches and two cemeteries in Harbin until 1949. The Communist Revolution , and the subsequent Cultural Revolution , and the decrease in the ethnic Russian population, saw many of them abandoned or destroyed. Today, about 10 churches remain, while services are held only in the Church of the Intercession in Harbin . The Harbin Railway Administration, formerly known as the Middle East Railway Administration, commonly known as the "big stone house", was built in 1902, destroyed twice and rebuilt in 1904 and 1906. [ citation needed ]Harbin Grand Theatre is located in the cultural center of Songbei District , Harbin. It provides 1600- and 400-seat venues. The architecture uses the external design of the heterogeneous hyperbolic surface. The Harbin Grand Theatre is a landmark building in Harbin. It is built in accordance with the water and is consistent with the surrounding environment. It embodies the concept of the landscape and landscape of the north. As a public building facility, the theatre provides people and visitors with different spatial experiences from the theatre, landscape, square and stereoscopic platform. During the design process, architect Ma Yansong has set up a unique sightseeing corridor and viewing platform in the Grand Theatre . Visitors are able to overlook the surrounding wetland and enjoy the unique natural wetland scenery of Harbin. After the completion of the Harbin Grand Theatre , the public can enjoy opera, symphony, ballet and drama performances in various function rooms.As the center of winter sports in China, Harbin has hosted the 1996 Winter Asian Games and the 2009 Winter Universiade . Along these events, many famous winter sports athletes come from Harbin. Olympic medalists include short track star Wang Meng (six-time medalist); long track skater Zhang Hong ( 2014 Sochi , gold medal); and pairs figure skaters Shen Xue and Zhao Hongbo ( 2002 Salt Lake City , bronze medal; 2006 Turin , bronze medal; and 2010 Vancouver , gold medal), Zhang Dan and Zhang Hao ( 2006 Turin , silver medal), Pang Qing and Tong Jian ( 2010 Vancouver , silver medal), and Sui Wenjing and Han Cong ( 2022 Beijing , gold medal; 2018 Pyeongchang , silver medal). Harbin has an indoor speed skating arena, the Heilongjiang Indoor Rink . Opened in 1995, it is the oldest one of seven in China. Mutual cooperation of the Far Eastern State Academy of Physical Culture and the Harbin Institute of Physical Education started an exchange of sports and cultural delegations, holding of sports, training of Chinese students in Khabarovsk , Russia and Harbin. Russian side started to have plans to introduce bandy to China while Harbin has good preconditions to become one of the strong points of this sport in China. The national team is based in Harbin, and it was confirmed in advance that they would play in the 2015 Bandy World Championship . The Chinese team came 16th in a field of 17 teams, edging out Somalia. Mr Zhu, president of the sport university , is a member of the Federation of International Bandy council. In December 2017, an international student tournament will be played. While Chinese bandy is still in its initial stages, it is expected that Harbin even more will become the driving force behind the domestic development, for example via opening the Federation of International Bandy office for development and promotion in Asia. Heilongjiang Ice City Football Club currently play their home soccer matches at Harbin International Conference Exhibition and Sports Center , a 50000-seater stadium. The team gained promotion to China's second tier for the 2018 season when they came first in the 2017 China League Two division. KRS Heilongjiang are a professional ice hockey team based in the city. A member of the Russian-based Supreme Hockey League and one of two Chinese teams in the league. The team is affiliated with the Kontinental Hockey League side, also based in China, HC Kunlun Red Star . An indoor ski resort opened in Harbin in 2017 and laid claim to be the world's largest of its kind. It will make it possible to enjoy down-hill skiing all year round. The 1996 Asian Winter Games were held in Harbin. While ice games were mainly held in Harbin city, the skiing events were held in Yabuli ski resort , Shangzhi City . In the frame of this campaign to assert its role on the world scene, Harbin hosted the 2009 Winter Universiade . Local Government spent 3.6 billion yuan for this event, with 2.63 billion used in construction and renovation of its sport infrastructure for this Universiade. Harbin hosted the Asian Basketball Confederation Championship in 2003, in which China won the championship on their home court for the thirteenth time. Harbin bid to host the 2010 Winter Olympics , which was ultimately awarded to Vancouver, Canada. The second China-Russia University Winter Sports Carnival was inaugurated 12 December 2017. This marked the first international bandy in Harbin. The Russian participation came from DVGAFK [ ru ] in Khabarovsk among men and IrGTU in Irkutsk among women. Being the national centre of bandy, Harbin organised Division B of the 2018 Bandy World Championship and China improved its placing to 12th from a total field of 16 teams. The 1996 Asian Winter Games were held in Harbin. While ice games were mainly held in Harbin city, the skiing events were held in Yabuli ski resort , Shangzhi City . In the frame of this campaign to assert its role on the world scene, Harbin hosted the 2009 Winter Universiade . Local Government spent 3.6 billion yuan for this event, with 2.63 billion used in construction and renovation of its sport infrastructure for this Universiade. Harbin hosted the Asian Basketball Confederation Championship in 2003, in which China won the championship on their home court for the thirteenth time. Harbin bid to host the 2010 Winter Olympics , which was ultimately awarded to Vancouver, Canada. The second China-Russia University Winter Sports Carnival was inaugurated 12 December 2017. This marked the first international bandy in Harbin. The Russian participation came from DVGAFK [ ru ] in Khabarovsk among men and IrGTU in Irkutsk among women. Being the national centre of bandy, Harbin organised Division B of the 2018 Bandy World Championship and China improved its placing to 12th from a total field of 16 teams. Located at the junction of "T-style" mainline system, Harbin is an important railway hub of the Northeast China Region. Harbin Railway Bureau is the first Railway Bureau established by People's Republic of China Government, of which the railway density is the highest in China. Five conventional rail lines radiate from Harbin to: Beijing (Jingha Line) , Suifenhe (Binsui Line) , Manzhouli (Binzhou Line) , Beian (Binbei Line) and Lalin (Labin Line) . In addition, Harbin has a high-speed rail line linking Dalian , Northeast China's southernmost seaport. In 2009, construction began on the new Harbin West Railway Station with 18 platforms, located on the southwestern part of the city. In December 2012, the station was opened, as China unveiled its first high-speed rail running through regions with extremely low winter temperatures. with scheduled runs from Harbin to Dalian. The weather-proof CRH380B bullet trains serving the line can accommodate temperatures from minus 40 degrees Celsius to 40 degrees Celsius above zero. China's most northerly high-speed railway, Harbin–Qiqihar Intercity Railway, opened for revenue service on 17 August 2015. The rail links three largest principal cities in Heilongjiang including Harbin, Daqing and Qiqihar. Harbin–Jiamusi and Harbin–Mudanjiang Intercity railways both opened for public service in 2018, connecting the provincial capital to major prefectural level cities Mudanjiang and Jiamusi. The city's main railway stations are the Harbin Railway Station , which was first built in 1899 and expanded in 1989. The main station is rebuilt in 2017, and now is still under construction; the Harbin East Railway Station , which opened in 1934; and the Harbin West Railway Station , which was built into the city's high-speed railway station in 2012. Another main station, Harbin North Railway Station , opened for public service in 2015, along with new built Harbin-Qiqihar Passenger Railway. Direct passenger train service is available from Harbin Railway Station to large cities including Beijing, Shanghai, Tianjin, Guangzhou, Jinan, Nanjing and many other major cities in China. Direct high-speed railway service began operation between Harbin West and Shanghai Hongqiao stations on 28 December 2013, and shorten the journey time to 12 hours. As an important regional hub in Northeast China, Harbin has an advanced highway system. Major highways that pass through or terminate in Harbin include the Beijing–Harbin, Heihe–Dalian, Harbin–Tongjiang, Changchun–Harbin, and Manzhouli–Suifenhe highways. Harbin Taiping International Airport , which is 35 kilometres (22 miles) away from the urban area of Harbin, is the second largest international airport in Northeast China. The technical level of flight district is 4E, which allows all kinds of large and medium civil aircraft. There are flights to over thirty large cities including Beijing , Tianjin , Shanghai , Nanjing , Qingdao , Wenzhou , Xiamen , Guangzhou , Shenzhen , Shenyang , Dalian , Xi'an and Hong Kong. In addition there are also scheduled international flights between Harbin and Russia, Singapore , Malaysia and South Korea. In June 2015, The first LCC international air routes to Japan, specifically the city of Nagoya was to begin. Because of the freight capability limitation, construction of the T2 Terminal began on 31 October 2014. The 160,000-square-meter T2 Terminal was scheduled to be finished in 2017, and will increase the freight capacity of the airport to three times of the previous. Harbin is also working on T3 which would be shaped like a snow flake, signifying Harbin as an ice city famous for their annual International Ice & Snow Sculpture Festival which places during the heavy winter season. Construction of Harbin Metro started on 5 December 2006. The total investment for the first phase of Line 1 is RMB5.89 billion. Twenty stations were planned to be set on this 17.73 km (11.02 mi) long line starting from Harbin East Railway Station to the 2nd Affiliated Hospital of Harbin Medical University in the west of the city. A metro depot, a command centre and two transformer substations will be built along the line. Most of the line's route follows the air defence evacuation tunnel left from the "7381" Project, which started in 1973 and ended in 1979. The 7381 project was intended to protect Harbin from the former Soviet Union's possible invasion or nuclear attack. The Line 1 of Harbin Metro opened on 26 September 2013. [ citation needed ] It is oriented along the east–west axis of the urban area of Harbin: from north-east (Harbin East Railway Station) to south-west (2nd Affiliated Hospital of Harbin Medical University). Line 2 and Line 3 are under construction. Line 2 runs from Songbei District to Xiangfang District and ringlike Line 3 runs through Daoli, Daowai, Nangang and Xiangfang Districts of Harbin. On 26 January 2017, Phase I of Line 3 opened for public service. Line 3 links Harbin West Railway Station to Yidaeryuan Station, the transfer station between Line 1 and Line 3. In the long term, the city plans to build nine radiating metro lines and a circle line in downtown and some suburban districts, which account for 340 km (211.3 mi) by 2025. Picture References: There are more than 1,900 rivers in Heilongjiang, including the Songhua River , Heilong River and Wusuli River , creating a convenient system of waterway transportation. Harbin harbor is one of eight inland ports in China and the largest of its type in Northeast China. Available from mid-April until the beginning of November, passenger ships sail from Harbin up the Songhua River to Qiqihar , or downstream to Jiamusi , Tongjiang , and Khabarovsk in Russia. Located at the junction of "T-style" mainline system, Harbin is an important railway hub of the Northeast China Region. Harbin Railway Bureau is the first Railway Bureau established by People's Republic of China Government, of which the railway density is the highest in China. Five conventional rail lines radiate from Harbin to: Beijing (Jingha Line) , Suifenhe (Binsui Line) , Manzhouli (Binzhou Line) , Beian (Binbei Line) and Lalin (Labin Line) . In addition, Harbin has a high-speed rail line linking Dalian , Northeast China's southernmost seaport. In 2009, construction began on the new Harbin West Railway Station with 18 platforms, located on the southwestern part of the city. In December 2012, the station was opened, as China unveiled its first high-speed rail running through regions with extremely low winter temperatures. with scheduled runs from Harbin to Dalian. The weather-proof CRH380B bullet trains serving the line can accommodate temperatures from minus 40 degrees Celsius to 40 degrees Celsius above zero. China's most northerly high-speed railway, Harbin–Qiqihar Intercity Railway, opened for revenue service on 17 August 2015. The rail links three largest principal cities in Heilongjiang including Harbin, Daqing and Qiqihar. Harbin–Jiamusi and Harbin–Mudanjiang Intercity railways both opened for public service in 2018, connecting the provincial capital to major prefectural level cities Mudanjiang and Jiamusi. The city's main railway stations are the Harbin Railway Station , which was first built in 1899 and expanded in 1989. The main station is rebuilt in 2017, and now is still under construction; the Harbin East Railway Station , which opened in 1934; and the Harbin West Railway Station , which was built into the city's high-speed railway station in 2012. Another main station, Harbin North Railway Station , opened for public service in 2015, along with new built Harbin-Qiqihar Passenger Railway. Direct passenger train service is available from Harbin Railway Station to large cities including Beijing, Shanghai, Tianjin, Guangzhou, Jinan, Nanjing and many other major cities in China. Direct high-speed railway service began operation between Harbin West and Shanghai Hongqiao stations on 28 December 2013, and shorten the journey time to 12 hours. As an important regional hub in Northeast China, Harbin has an advanced highway system. Major highways that pass through or terminate in Harbin include the Beijing–Harbin, Heihe–Dalian, Harbin–Tongjiang, Changchun–Harbin, and Manzhouli–Suifenhe highways.Harbin Taiping International Airport , which is 35 kilometres (22 miles) away from the urban area of Harbin, is the second largest international airport in Northeast China. The technical level of flight district is 4E, which allows all kinds of large and medium civil aircraft. There are flights to over thirty large cities including Beijing , Tianjin , Shanghai , Nanjing , Qingdao , Wenzhou , Xiamen , Guangzhou , Shenzhen , Shenyang , Dalian , Xi'an and Hong Kong. In addition there are also scheduled international flights between Harbin and Russia, Singapore , Malaysia and South Korea. In June 2015, The first LCC international air routes to Japan, specifically the city of Nagoya was to begin. Because of the freight capability limitation, construction of the T2 Terminal began on 31 October 2014. The 160,000-square-meter T2 Terminal was scheduled to be finished in 2017, and will increase the freight capacity of the airport to three times of the previous. Harbin is also working on T3 which would be shaped like a snow flake, signifying Harbin as an ice city famous for their annual International Ice & Snow Sculpture Festival which places during the heavy winter season. Construction of Harbin Metro started on 5 December 2006. The total investment for the first phase of Line 1 is RMB5.89 billion. Twenty stations were planned to be set on this 17.73 km (11.02 mi) long line starting from Harbin East Railway Station to the 2nd Affiliated Hospital of Harbin Medical University in the west of the city. A metro depot, a command centre and two transformer substations will be built along the line. Most of the line's route follows the air defence evacuation tunnel left from the "7381" Project, which started in 1973 and ended in 1979. The 7381 project was intended to protect Harbin from the former Soviet Union's possible invasion or nuclear attack. The Line 1 of Harbin Metro opened on 26 September 2013. [ citation needed ] It is oriented along the east–west axis of the urban area of Harbin: from north-east (Harbin East Railway Station) to south-west (2nd Affiliated Hospital of Harbin Medical University). Line 2 and Line 3 are under construction. Line 2 runs from Songbei District to Xiangfang District and ringlike Line 3 runs through Daoli, Daowai, Nangang and Xiangfang Districts of Harbin. On 26 January 2017, Phase I of Line 3 opened for public service. Line 3 links Harbin West Railway Station to Yidaeryuan Station, the transfer station between Line 1 and Line 3. In the long term, the city plans to build nine radiating metro lines and a circle line in downtown and some suburban districts, which account for 340 km (211.3 mi) by 2025. Picture References:There are more than 1,900 rivers in Heilongjiang, including the Songhua River , Heilong River and Wusuli River , creating a convenient system of waterway transportation. Harbin harbor is one of eight inland ports in China and the largest of its type in Northeast China. Available from mid-April until the beginning of November, passenger ships sail from Harbin up the Songhua River to Qiqihar , or downstream to Jiamusi , Tongjiang , and Khabarovsk in Russia. Harbin is one of the top 65 cities and metropolitan areas in the world by scientific research output as tracked by the Nature Index . As Harbin serves as an important military industrial base after PRC's foundation, it is home to several key universities mainly focused on the science and technology service of national military and aerospace industry. Soviet experts played an important role in many education projects in this period. Due to the threat of possible war with the Soviet Union, however, several colleges were moved southwards to Changsha , Chongqing , and several other southern cities in China in the 1960s. Some of these colleges were returned to Harbin in the 1970s. The city hosts several major universities in Northeast China , including Harbin Institute of Technology , Harbin Engineering University , Harbin Medical University , Northeast Agricultural University , Harbin University of Science and Technology , Harbin Normal University , Northeast Forestry University , Harbin University , Heilongjiang University of Science and Technology , Heilongjiang University of Chinese Medicine , Harbin University of Commerce , Harbin Sport University , and Heilongjiang University . Notably, Harbin Institute of Technology is consistently ranked as one of the best universities in the world for engineering. HIT was ranked fifth globally in the Best Global Universities for Engineering by U.S. News in 2022. Founded in 1920 with strong support by the Russian diaspora connected with the Chinese Eastern Railway, the university has developed into an important research university mainly focusing on engineering (e.g. in space science and defense -related technologies, welding technology and engineering), with supporting faculties in the sciences, management, humanities and social sciences. The institute's faculty and students contributed to and invented China's first analog computer , the first intelligent chess computer, and the first arc-welding robot. In 2010, research funding from the government, industry, and business sectors surpassed RMB1.13 billion, the second highest of any university in China. Harbin is now headquarters of the 78th Group Army of the People's Liberation Army , one of the three group armies that comprise the Northern Theater Command responsible for defending China's northeastern borders with Russia, Mongolia and North Korea . 23rd Group Army of the PLA used to garrison in Harbin before it was disbanded in a cycle of reductions in 2003.Harbin has town twinning and similar arrangements with approximately 30 places around the world, as well as some other cities within China. For a list, see List of twin towns and sister cities in China → H . In 2009 Harbin opened an International Sister Cities museum. It has 1,048 exhibits in 28 rooms, with a total area of 1,800 square metres (19,375 square feet) . On 3 September 2015, China and Russia signed an agreement to re-open the Russian consulate in Harbin, as the former Soviet consulate was closed in 1962 after the Sino-Soviet split . China will also establish a corresponding consulate in Vladivostok.

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Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Panic_in_the_Streets_(film)/html

Panic in the Streets (film)

September 15, 1950 ( 1950-09-15 ) Panic in the Streets is a 1950 American film noir medical drama / thriller, directed by Elia Kazan . released by 20th Century Fox studios in Hollywood , Los Angeles, California . It was shot exclusively on location in New Orleans, Louisiana , and features numerous scenes around the city and Port of New Orleans along the Mississippi River and showing various New Orleans citizens in speaking and non-speaking roles. The film tells the story of Lieutenant Commander Clinton Reed, an U.S. Public Health officer of the United States Public Health Service (now in the United States Department of Health and Human Services ), Officer / Lt. Cmdr. Reed is played by Richard Widmark and accompanied by a grizzled old veteran detective of the New Orleans Police Department , a captain Tom Warren, portrayed by Paul Douglas . They have only a day or two of frantic intense search and interviews in which to prevent a greater outbreak of a deadly epidemic of pneumonic plague (nicknamed from the Middle Ages / Medieval era pandemic disease in Europe known as the " Black Death "), after Reed determines a waterfront homicide victim is also an index case and the first to be found carrying the disease. Co-stars include Barbara Bel Geddes (as Reed's wife Nancy), Jack Palance (in his film debut) and Zero Mostel – the latter two play crooks, associates of the victim who had prompted the public health investigation. The film was also the debut of Tommy Rettig , (first farm boy owner of collie dog "Lassie" in 1950s TV show " Lassie " who played the Reeds' son. The film was released later on DVD format by 20th Century Fox as part of the "Fox Film Noir collection", along with Laura and Call Northside 777 , on March 15, 2005. The score was composed by Alfred Newman . The film was originally named Port of Entry , subsequently later as Outbreak , and ultimately Panic in the Streets. After brawling over a card game in the wharf area of New Orleans, a man named Kochak, suffering visibly from a flu-like illness, is killed by gangster Blackie and his two flunkies, Kochak's cousin Poldi and a man named Fitch. They leave the body on the docks, and later when the dead man, who carries no identification, is brought to the morgue , the coroner grows suspicious about the bacteria present in his blood and calls Lieutenant Commander Clinton Reed, a doctor and commissioned corps officer of the U.S. Public Health Service . Reed is enjoying a rare day off with his wife Nancy and their son Tommy, but decides to inspect the body. After careful examination, he determines that Kochak had " pneumonic plague ," the pulmonary version of the extremely dangerous deadly contagious bubonic plague . Lieutenant Commander Reed having medical knowledge and experience, springs into action, insisting that everyone who came into contact with the body be inoculated . He also orders that the dead man's identity be traced to determine as well as his comings and goings and anyone else in contact with him during the previous few days. Reed meets with people from the New Orleans Mayor's office , the police commissioner and other city police and public health officials, but they are inexperienced and unfortunately stupidly skeptical of his claims. Eventually, however, his impassioned pleas convince them that they have forty-eight hours to save New Orleans from the plague. Reed must also convince Police Detective Captain Tom Warren who is assigned to the case and the others that the press must not be notified, because previous experiences in other cases told them that report of a plague would spread mass panic and riots and make it far more difficult to search and find the infected line of people. Detective Warren and his men begin to interview Slavic immigrants, as it has been determined by autopsy and scientific evidence testing the blood, that the body may be of Armenian , Czech or mixed blood descent (in this 1950s era of pre - DNA biological heredity knowledge). Burdened by the knowledge that the massive investigation despite their best efforts, has little chance of success (like old saying of "finding a needle in a haystack"), Lt. Cmdr. Reed accuses Police Captain Warren of not taking the threat seriously enough. In turn, Warren admits that he thinks Officer Reed is driven and ambitious and trying to use the situation to further his career. Reed, angry, decides to take matters into his own hands and, acting on a hunch that the man may have entered the city's river port illegally, goes to the nearby National Maritime Union 's hiring hall and passes out copies of the dead man's picture among the seamen / sailors. Although the workers tell Officer Reed that seamen never talk, he still goes to a café next door hoping to find that someone will come forward with a tip. Eventually a young woman shows up and takes Reed to see her friend Charlie, who reluctantly admits that he worked aboard the freighter ship, the S.S. Nile Queen , upon which the already ill man was smuggled. Meanwhile, Fitch, who was questioned by Warren but claimed to know nothing, goes to the crook Blackie and warns him about the investigation. Blackie plans to get out of town, but begins to suspect that his sidekick Poldi received expensive smuggled goods from Kochak, explaining the police's intense investigation of the man's murder. Reed and Warren, (who is now convinced of Reed's integrity), go to the steamship freighter "Nile Queen" and convince the crew to talk by telling them that they will die if the sick man was indeed on their ship. After carrying up a sick cook from the hold , the seamen then permit Reed and Warren to inoculate and question them, revealing in the process that Kochak boarded at Oran in North Africa and was fond of shish kebab . With this lead, Reed and Warren canvas the city's Greek restaurants , and just after they leave one such establishment, Blackie arrives to meet his partner Poldi, who is now very ill. A short time later, Reed receives word that a woman, Rita, has died of the fever and realizes that she was the wife of the Greek restaurant proprietor John Mefaris that he repeatedly questioned before and who apparently had earlier lied about having served food to Kochak and hidden the truth. And now his wife is dead because she told him to lie to the detectives and say he knew nothing. Reed returns back to headquarters to discover that a muckraking investigative newspaper reporter is asking questions about the unusual situation which seems out of control and is threatening to break the story that a pathogenic bacteria is endangering the city. Officer Reed is now impressed when the deeply committed yet unorthodox police detective caption Warren resorts to old-fashioned strong-arm methods and throws the reporter into jail to keep his mouth shut and quiet. Late in the evening, a beleaguered Reed returns home to his family for a cup of coffee and his wife announces that she is pregnant. She then tries to restore her husband's flagging self-confidence and lift up his spirits. A few hours later, Reed and Warren learn that the New Orleans mayor is angry about their treatment of the newspaper reporter and his complaints about press freedom.. The reporter, who has been released, announces that the story will appear in tomorrow's morning paper hitting the streets in four hours, giving Reed and Warren only a little more little time to find their man. Meanwhile, Blackie goes to Poldi's room and tries to force him to reveal information about some smuggled goods, but the dying Poldi is now sick and delirious and only rants nonsensically. Blackie then brings in his own doctor and tells Poldi's grandmother that they will take care of him. Just then, Lt. Cmdr. Reed, having been tipped off by the nurse looking after Poldi, arrives on the scene, and Blackie and Fitch, who are carrying Poldi down the outside stairs, pitch the sick man over the side railing and flee. Reed chases the two to the nearby river docks, where he tries to shout and explain to them about the plague danger. The men run desperately through depots, docks and a warehouse , and under the piers to a tied up small boat and at one point, Capt. Warren shoots and injures Blackie, preventing him from shooting Reed in turn. Blackie accidentally shoots Fitch and then wounded tries to struggle onto a docked ship pulling himself up a rope to the tied-up freighter but, bleeding and exhausted, he is unable to climb over a rat guard on the mooring line , and falls into the water. The men are finally captured and in custody heading for the hospital and jail. His work finally done, Reed heads for home, and on the way, Capt. Warren offers to give him some of the smuggled perfume that Poldi had indeed received from Kochak for Mrs. Reed. Back at his house, Reed hears the blaring radio news announces the resolution of the crisis reporting some details of the story, while a proud Nancy Reed greets her public health officer husband who was responsible for it all.The production of Panic in the Streets underwent several rounds of edits with the effort to abide by the Motion Picture Production Code (Hays Code) . Originally titled Port of Entry , the temporary script of the film was sent on November 11, 1949, to Joseph Breen , the film censor with the Motion Picture Producers and Distributors of America who applied the Production Code to film production. Joseph Breen himself indicated in threads of letters with Colonel Jason S. Joy, the Director of Public Relations of the 20th Century Fox, the changes needed for the script. Suggestions such as "Violet must not be suggestive of a prostitute", "We assume there will be no suggestion that the police officer is killed", and "The scene of Martinez and the mattress falling should not be too realistically gruesome," were made. On December 20, 1949, in Joy's letter responding to the suggestion of Breen, the film had been renamed Outbreak . The sensitive content of the film, especially the scenes pointed out by Breen, were not fully changed until after a of couple back and forth letters that lasted for around 3 months. Ultimately, the film was named Panic in the Streets in the final version of the synopsis on March 8, 1950. Approved by the Production Code Administration (PCA) on March 14, 1950, the film officially entered the production stage. The film failed to recover its costs at the box office which Darryl Zanuck blamed in part on location shooting. He felt if the film had been made for $850,000 it would have been profitable. The New York Times gave the film a mixed review and wrote, "Although it is excitingly presented, Panic in the Streets misses the mark as superior melodrama because it is not without obvious, sometimes annoying exaggeration that demands more indulgence than some spectators may be willing to contribute. However, there is an electric quality to the climax staged in a warehouse on the New Orleans waterfront that should compensate for minor annoyances which come to the surface spasmodically in Panic in the Streets. " Variety magazine liked the film and wrote, "This is an above-average chase meller . Tightly scripted and directed, it concerns the successful attempts to capture a couple of criminals, who are germ carriers, in order to prevent a plague and panic in a large city. The plague angle is somewhat incidental to the cops-and-bandits theme...There is vivid action, nice human touches and some bizarre moments. Jack Palance gives a sharp performance." New Orleans film critic David Lee Simmons wrote in 2005, "The film noir elements come from the movie's use of post-war German Expressionist and Italian Neo-Realist techniques. Kazan admired how the Expressionists used chiaroscuro lighting to heighten emotion, and he related to the Neo-Realists' cinéma vérité portrayals of those living on the margin of society. Panic offered him a chance to explore these styles further by experimenting with cinematography and casting real people. After working with some of the biggest stars in Hollywood – Dorothy McGuire , Spencer Tracy , Katharine Hepburn , Dana Andrews , Gregory Peck and Ethel Barrymore – Kazan wanted to go in the opposite direction. To suit the needs of this picture and his new approach, he recruited not only lesser stars, but also some of his rougher cronies from the New York stage scene, and on top of that several New Orleanians with varied levels of acting experience." Review aggregation website Rotten Tomatoes retrospectively collected 24 reviews and gave the film a score of 96%, with an average rating of 7.46 out of 10. Wins Nominations Venice Film Festival: Golden Lion, Elia Kazan; 1950. Writers Guild of America : WGA Award, Best Written American Drama, Richard Murphy; The Robert Meltzer Award (Screenplay Dealing Most Ably with Problems of the American Scene), Richard Murphy; 1951.The film failed to recover its costs at the box office which Darryl Zanuck blamed in part on location shooting. He felt if the film had been made for $850,000 it would have been profitable. The New York Times gave the film a mixed review and wrote, "Although it is excitingly presented, Panic in the Streets misses the mark as superior melodrama because it is not without obvious, sometimes annoying exaggeration that demands more indulgence than some spectators may be willing to contribute. However, there is an electric quality to the climax staged in a warehouse on the New Orleans waterfront that should compensate for minor annoyances which come to the surface spasmodically in Panic in the Streets. " Variety magazine liked the film and wrote, "This is an above-average chase meller . Tightly scripted and directed, it concerns the successful attempts to capture a couple of criminals, who are germ carriers, in order to prevent a plague and panic in a large city. The plague angle is somewhat incidental to the cops-and-bandits theme...There is vivid action, nice human touches and some bizarre moments. Jack Palance gives a sharp performance." New Orleans film critic David Lee Simmons wrote in 2005, "The film noir elements come from the movie's use of post-war German Expressionist and Italian Neo-Realist techniques. Kazan admired how the Expressionists used chiaroscuro lighting to heighten emotion, and he related to the Neo-Realists' cinéma vérité portrayals of those living on the margin of society. Panic offered him a chance to explore these styles further by experimenting with cinematography and casting real people. After working with some of the biggest stars in Hollywood – Dorothy McGuire , Spencer Tracy , Katharine Hepburn , Dana Andrews , Gregory Peck and Ethel Barrymore – Kazan wanted to go in the opposite direction. To suit the needs of this picture and his new approach, he recruited not only lesser stars, but also some of his rougher cronies from the New York stage scene, and on top of that several New Orleanians with varied levels of acting experience." Review aggregation website Rotten Tomatoes retrospectively collected 24 reviews and gave the film a score of 96%, with an average rating of 7.46 out of 10. Wins Nominations Venice Film Festival: Golden Lion, Elia Kazan; 1950. Writers Guild of America : WGA Award, Best Written American Drama, Richard Murphy; The Robert Meltzer Award (Screenplay Dealing Most Ably with Problems of the American Scene), Richard Murphy; 1951.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Airborne_transmission/html

Airborne transmission

Airborne transmission or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary medicine . The relevant infectious agent may be viruses , bacteria , or fungi , and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, flushing toilets , or any activities which generate aerosol particles or droplets .Aerosol transmission has traditionally been considered distinct from transmission by droplets , but this distinction is no longer used. Respiratory droplets were thought to rapidly fall to the ground after emission: but smaller droplets and aerosols also contain live infectious agents, and can remain in the air longer and travel farther. Individuals generate aerosols and droplets across a wide range of sizes and concentrations, and the amount produced varies widely by person and activity. Larger droplets greater than 100 μm usually settle within 2 m. Smaller particles can carry airborne pathogens for extended periods of time. While the concentration of airborne pathogens is greater within 2m, they can travel farther and concentrate in a room. The traditional size cutoff of 5 μm between airborne and respiratory droplets has been discarded, as exhaled particles form a continuum of sizes whose fates depend on environmental conditions in addition to their initial sizes. This error has informed hospital based transmission based precautions for decades. Indoor respiratory secretion transfer data suggest that droplets/aerosols in the 20 μm size range initially travel with the air flow from cough jets and air conditioning like aerosols, but fall out gravitationally at a greater distance as "jet riders". As this size range is most efficiently filtered out in the nasal mucosa , the primordial infection site in COVID-19 , aerosols/droplets in this size range may contribute to driving the COVID-19 pandemic .Airborne diseases can be transmitted from one individual to another through the air. The pathogens transmitted may be any kind of microbe , and they may be spread in aerosols, dust or droplets. The aerosols might be generated from sources of infection such as the bodily secretions of an infected individual, or biological wastes. Infectious aerosols may stay suspended in air currents long enough to travel for considerable distances; sneezes , for example, can easily project infectious droplets for dozens of feet (ten or more meters). Airborne pathogens or allergens typically enter the body via the nose , throat , sinuses and lungs . Inhalation of these pathogens affects the respiratory system and can then spread to the rest of the body. Sinus congestion, coughing and sore throats are examples of inflammation of the upper respiratory airway. Air pollution plays a significant role in airborne diseases. Pollutants can influence lung function by increasing air way inflammation. Common infections that spread by airborne transmission include SARS-CoV-2 ; measles morbillivirus , chickenpox virus ; Mycobacterium tuberculosis , influenza virus , enterovirus , norovirus and less commonly other species of coronavirus , adenovirus , and possibly respiratory syncytial virus . Some pathogens which have more than one mode of transmission are also anisotropic , meaning that their different modes of transmission can cause different kinds of diseases, with different levels of severity. Two examples are the bacterias Yersinia pestis (which causes plague ) and Francisella tularensis (which causes tularaemia ), which both can cause severe pneumonia, if transmitted via the airborne route through inhalation. Poor ventilation enhances transmission by allowing aerosols to spread undisturbed in an indoor space. Crowded rooms are more likely to contain an infected person. The longer a susceptible person stays in such a space, the greater chance of transmission. Airborne transmission is complex, and hard to demonstrate unequivocally but the Wells-Riley model can be used to make simple estimates of infection probability. Some airborne diseases can affect non-humans. For example, Newcastle disease is an avian disease that affects many types of domestic poultry worldwide that is airborne. It has been suggested that airborne transmission should be classified as being either obligate, preferential, or opportunistic, although there is limited research that show the importance of each of these categories. Obligate airborne infections spread only through aerosols; the most common example of this category is tuberculosis. Preferential airborne infections, such as chicken pox, can be obtained through different routes, but mainly by aerosols. Opportunistic airborne infections such as influenza typically transmit through other routes; however, under favourable conditions, aerosol transmission can occur. Environmental factors influence the efficacy of airborne disease transmission; the most evident environmental conditions are temperature and relative humidity . The transmission of airborne diseases is affected by all the factors that influence temperature and humidity, in both meteorological (outdoor) and human (indoor) environments. Circumstances influencing the spread of droplets containing infectious particles can include pH, salinity, wind, air pollution, and solar radiation as well as human behavior. Airborne infections usually land in the respiratory system, with the agent present in aerosols (infectious particles < 5 μm in diameter). This includes dry particles, often the remnant of an evaporated wet particle called nuclei, and wet particles.A layered risk-management approach to slowing the spread of a transmissible disease attempts to minimize risk through multiple layers of interventions. Each intervention has the potential to reduce risk. A layered approach can include interventions by individuals (e.g. mask wearing, hand hygiene), institutions (e.g. surface disinfection, ventilation, and air filtration measures to control the indoor environment), the medical system (e.g. vaccination) and public health at the population level (e.g. testing, quarantine, and contact tracing). Preventive techniques can include disease-specific immunization as well as nonpharmaceutical interventions such as wearing a respirator and limiting time spent in the presence of infected individuals. Wearing a face mask can lower the risk of airborne transmission to the extent that it limits the transfer of airborne particles between individuals. The type of mask that is effective against airborne transmission is dependent on the size of the particles. While fluid-resistant surgical masks prevent large droplet inhalation, smaller particles which form aerosols require a higher level of protection with filtration masks rated at N95 (US) or FFP3 (EU) required. Use of FFP3 masks by staff managing patients with COVID-19 reduced acquisition of COVID-19 by staff members. Engineering solutions which aim to control or eliminate exposure to a hazard are higher on the hierarchy of control than personal protective equipment (PPE). At the level of physically based engineering interventions, effective ventilation and high frequency air changes, or air filtration through high efficiency particulate filters , reduce detectable levels of virus and other bioaerosols , improving conditions for everyone in an area. Portable air filters, such as those tested in Conway Morris A et al. present a readily deployable solution when existing ventilation is inadequate, for instance in repurposed COVID-19 hospital facilities. The United States Centers for Disease Control and Prevention (CDC) advises the public about vaccination and following careful hygiene and sanitation protocols for airborne disease prevention. Many public health specialists recommend physical distancing (also known as social distancing ) to reduce transmission. A 2011 study concluded that vuvuzelas (a type of air horn popular e.g. with fans at football games) presented a particularly high risk of airborne transmission, as they were spreading a much higher number of aerosol particles than e.g., the act of shouting. Exposure does not guarantee infection. The generation of aerosols, adequate transport of aerosols through the air, inhalation by a susceptible host, and deposition in the respiratory tract are all important factors contributing to the over-all risk for infection. Furthermore, the infective ability of the virus must be maintained throughout all these stages. In addition the risk for infection is also dependent on host immune system competency plus the quantity of infectious particles ingested. Antibiotics may be used in dealing with airborne bacterial primary infections, such as pneumonic plague .

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_diseases_(P)/html

List of diseases (P)

This is a list of diseases starting with the letter "P".Pseudoa–Pseudom Pseudoo–Pseudo-ZPseudoa–Pseudom Pseudoo–Pseudo-ZPseudoa–Pseudom Pseudoo–Pseudo-ZPseudoa–Pseudom Pseudoo–Pseudo-ZPseudoa–Pseudom Pseudoo–Pseudo-Z

Wiki

Pneumonic plague

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Asian Dust

Asian Dust (also yellow dust , yellow sand , yellow wind or China dust storms ) is a meteorological phenomenon that affects much of East Asia year-round and especially during the spring months. The dust originates in the deserts of China , Mongolia , and Kazakhstan , where high-speed surface winds and intense dust storms kick up dense clouds of fine, dry soil particles. These clouds are then carried eastward by prevailing winds and pass over China, North and South Korea , and Japan , as well as parts of the Russian Far East . Sometimes, the airborne particulates are carried much further, in significant concentrations which affect air quality as far east as the United States. Since the turn of the 21st century, coinciding with the rapid industrialization of China, yellow dust has become a serious health problem due to the increase of industrial pollutants contained in the dust. Intensified desertification due to deforestation has been causing longer and more frequent occurrences. The issue has been exacerbated as the Aral Sea of Kazakhstan and Uzbekistan has largely dried up. This started in the 1960s with the diversion of the Amu River and Syr River , as part of a Soviet agricultural program to irrigate Central Asian deserts, mainly for cotton plantations.Some of the earliest written records of dust storm activity are recorded in ancient Chinese literature. It is believed that the earliest Chinese dust storm record was found in the Zhu Shu Ji Nian (Chinese: 竹书纪年; English: the Bamboo Annals). The record said: in the fifth year of Di Xin (1150 BC, Di Xin was the Era Name of the King Di Xin of Shang Dynasty ), it rained dust at Bo (Bo is a place in Henan Province in China; in Classical Chinese : 帝辛五年,雨土于亳 ). The first known record of an Asian Dust event in Korea was in 174 AD during the Silla Dynasty . The dust was known as "Uto (ìš°í† , 雨土)", meaning 'Raining Dirt/Earth', and was believed at the time to be the result of an angry god sending down dust instead of rain or snow. Specific records referring to Asian Dust events in Korea also exist from the Baekje , Goguryeo , and Joseon periods.An analysis of Asian Dust clouds conducted in China in 2001 found that they contain high concentrations of silicon (24–32%), aluminium (5.9–7.4%), calcium (6.2–12%), and iron. Numerous toxic substances were also found, including mercury and cadmium from coal burning . People further from the source of the dust are more often exposed to nearly invisible, fine dust particles that they can unknowingly inhale deep into their lungs, as coarse dust is too big to be deeply inhaled. After inhalation, these particles can cause long term scarring of lung tissue and induce cancer and lung disease. Sulfur (an acid rain component), soot , ash , carbon monoxide , and other toxic pollutants including heavy metals (such as mercury, cadmium, chromium , arsenic , lead , zinc , copper) and other carcinogens , often accompany the dust storms, along with viruses, bacteria, fungi, pesticides , antibiotics , asbestos , herbicides , plastic ingredients, combustion products and hormone -mimicking phthalates . Though scientists had known that intercontinental dust plumes can ferry bacteria and viruses , "most people had assumed that the [sun's] ultraviolet light would sterilize these clouds," says microbiologist Dale W. Griffin, "We now find that isn't true." Research done in 2014 found that China dust consists of fine dust and ultrafine dust particles . Fine dust consists of fine particulate matter (PM). Particles smaller than 10 µm in diameter are classified as fine PM (PM 10 ), while particles smaller than 2.5 µm in diameter are classified as ultrafine PM (PM 2.5 ). Both fine and ultrafine dust particles impose dangers to health. Fine dust particles are small enough to penetrate deep into the lung alveoli . Ultrafine dust particles are so small that they also penetrate into the blood or lymphatic system through the lungs. Once in the bloodstream , ultrafine particles can even reach the brain or fetal organs. The main cause of China dust is desertification of northern China , Mongolia, and Central Asia. Desertification in these regions owe to extensive logging in the forests and extensive harvesting of arable land . The origins of Asian dust are mostly located in developing countries; thus, most of these countries are undergoing rapid population growth. A study pointed to China's deforestation and soil erosion as indirect effects of the nation's booming population. High population growth in China has led to increasing demand for wood for housing and furniture as well as for firewood for cooking and heating. This increase in demand for wood (and firewood) has led to over-cutting of timber . At the same time, there has been an increase in demand for food , which has led to soil erosion due to overgrazing of arable land. For example, the northern part of Shaanxi Province and the Haixi area of Gansu Province was once a deep forest region, but the region now only has treeless mountains. Historically "because peasant farmers continue[d] to rely on low-technology agricultural techniques, they [had] to exploit virgin land to sustain a continually growing population. This led to a vicious cycle. Since traditional agricultural techniques rely heavily on human labor, people continued to have more children, which in turn led to more overgrazing.Perhaps the most important negative effect is on health. Many studies have found Asian dust to have negative effect on respiratory function and increase the occurrence of respiratory disease . Several research studies conducted in Korea and Japan focused on respiratory function performance by measuring peak expiratory flow . These studies found that individuals with respiratory diseases such as asthma suffer from the most adverse effects. There is also evidence that days with Asian Dust coupled with smog lead to increased mortality due to respiratory and cardiovascular diseases among inhabitants in affected regions. A recent study has also found PM 2.5 to have an association with Parkinson's disease and other neurological diseases . The OECD predicted 1,069 premature deaths per million directly attributable to worsening air pollution in South Korea by 2060. Areas affected by the dust experience decreased visibility and the dust is known to cause a variety of health problems, including sore throat and asthma in otherwise healthy people. Often, people are advised to avoid or minimize outdoor activities, depending on severity of storms. For those already with asthma or respiratory infections, it can be fatal. The dust has been shown to increase the daily mortality rate in one affected region by 1.7%. Due to the concerning health effects, residents of affected regions have reduced their exposure to Asian dust by refraining from outdoor activities. Despite the temperature rise to warm levels during spring season, popular outdoor destinations are empty on days with yellow dust advisory or warning. According to a survey in 2019, 97% of Koreans reported that they suffered from physical or mental distress due to Asian dust including fine dust during the time of the survey. Since children are among the most vulnerable to fine dust particles, affected countries have come up with measures to minimize the detrimental effects on children; in 2017, South Korea's Ministry of Education have required all primary to high schools to create indoor spaces for sports and outdoor activities. Similar efforts are arising in professional sports. In 2019, the Korea Baseball Organization changed its regulations to cancel or suspend professional games during a severe fine dust warning. In addition to costs incurred by individuals, the rise of Asian dust has led to mixed pecuniary effects in different industries. First, the airline industry have been experiencing external costs due to the increasing severity of Asian dust. Dust collected on the plane surface can decrease the lift of the wings and react with moisture to corrode the aircraft's surface and decolorize the paint. As a result, during spring, when Asian dust levels are at the highest, airlines with aircraft in the affected region spend time and money to wash dust off their aircraft. Washing dust off a single B747 jumbo jet typically takes 6000 liters of water and eight hours with nine people working. Although cancellations stemming from yellow dust are rare, flights are cancelled due to poor visibility on the most severe days. On the other hand, Asian dust also has led to some positive effects in certain industries. The demand for products to combat Asian dust has increased significantly. During a period of high fine dust levels in 2019, face mask and air purifier sales surged 458% and 414%, respectively, compared to the same period in 2018. The sale of dryers also surged 67% during the same period as outdoor air drying no longer became an option. Calculating the socioeconomic cost of yellow dust is a difficult endeavor. It requires estimating the negative effects on health, opportunity cost of outdoor activities, the cost of preventive measures, as well as the psychological distress. However, a research study estimated the total socio-economic cost of yellow dust using techniques including input-output analysis , integration of environmental-economic evaluation technique, contingent valuation method , etc. According to this study, the total socio-economic cost of yellow dust damage in South Korea in 2002 estimates between US$3.9 billion and $7.3 billion. This accounts for between 0.6% and 1.0% of the nation's GDP and US$81.48 and $152.52 per nation's resident. Another study that focused on the total economic impacts of the yellow dust storms in Beijing concluded that it accounted for greater than 2.9% of the city's GDP in the year 2000. Asian dust is a historically significant contributor of soil nutrients for some North Pacific islands, including Hawaii . Perhaps the most important negative effect is on health. Many studies have found Asian dust to have negative effect on respiratory function and increase the occurrence of respiratory disease . Several research studies conducted in Korea and Japan focused on respiratory function performance by measuring peak expiratory flow . These studies found that individuals with respiratory diseases such as asthma suffer from the most adverse effects. There is also evidence that days with Asian Dust coupled with smog lead to increased mortality due to respiratory and cardiovascular diseases among inhabitants in affected regions. A recent study has also found PM 2.5 to have an association with Parkinson's disease and other neurological diseases . The OECD predicted 1,069 premature deaths per million directly attributable to worsening air pollution in South Korea by 2060. Areas affected by the dust experience decreased visibility and the dust is known to cause a variety of health problems, including sore throat and asthma in otherwise healthy people. Often, people are advised to avoid or minimize outdoor activities, depending on severity of storms. For those already with asthma or respiratory infections, it can be fatal. The dust has been shown to increase the daily mortality rate in one affected region by 1.7%. Due to the concerning health effects, residents of affected regions have reduced their exposure to Asian dust by refraining from outdoor activities. Despite the temperature rise to warm levels during spring season, popular outdoor destinations are empty on days with yellow dust advisory or warning. According to a survey in 2019, 97% of Koreans reported that they suffered from physical or mental distress due to Asian dust including fine dust during the time of the survey. Since children are among the most vulnerable to fine dust particles, affected countries have come up with measures to minimize the detrimental effects on children; in 2017, South Korea's Ministry of Education have required all primary to high schools to create indoor spaces for sports and outdoor activities. Similar efforts are arising in professional sports. In 2019, the Korea Baseball Organization changed its regulations to cancel or suspend professional games during a severe fine dust warning. In addition to costs incurred by individuals, the rise of Asian dust has led to mixed pecuniary effects in different industries. First, the airline industry have been experiencing external costs due to the increasing severity of Asian dust. Dust collected on the plane surface can decrease the lift of the wings and react with moisture to corrode the aircraft's surface and decolorize the paint. As a result, during spring, when Asian dust levels are at the highest, airlines with aircraft in the affected region spend time and money to wash dust off their aircraft. Washing dust off a single B747 jumbo jet typically takes 6000 liters of water and eight hours with nine people working. Although cancellations stemming from yellow dust are rare, flights are cancelled due to poor visibility on the most severe days. On the other hand, Asian dust also has led to some positive effects in certain industries. The demand for products to combat Asian dust has increased significantly. During a period of high fine dust levels in 2019, face mask and air purifier sales surged 458% and 414%, respectively, compared to the same period in 2018. The sale of dryers also surged 67% during the same period as outdoor air drying no longer became an option. Calculating the socioeconomic cost of yellow dust is a difficult endeavor. It requires estimating the negative effects on health, opportunity cost of outdoor activities, the cost of preventive measures, as well as the psychological distress. However, a research study estimated the total socio-economic cost of yellow dust using techniques including input-output analysis , integration of environmental-economic evaluation technique, contingent valuation method , etc. According to this study, the total socio-economic cost of yellow dust damage in South Korea in 2002 estimates between US$3.9 billion and $7.3 billion. This accounts for between 0.6% and 1.0% of the nation's GDP and US$81.48 and $152.52 per nation's resident. Another study that focused on the total economic impacts of the yellow dust storms in Beijing concluded that it accounted for greater than 2.9% of the city's GDP in the year 2000. Asian dust is a historically significant contributor of soil nutrients for some North Pacific islands, including Hawaii . Asian dust is an example of a negative externality on society. Policy choices that favor rapid industrialization and deforestation in China, Mongolia, and other Central Asian regions impose social costs on Eastern countries, such as Korea, Japan, and Russia in the Far East. The main cause of deforestation is extensive logging. Although the production of firewood and other wooden products induce deforestation, which leads to yellow dust as well as other ecological dangers, the social cost of yellow dust is not accounted for in the cost of production . This results in a market failure in which individual producers make decisions based on their private marginal cost - not accounting for the dust - rather than the social marginal cost, which includes the harms from the dust. Under a free market , the quantity of logs and other wooden goods produced exceeds the socially optimal outcome. [ citation needed ] China dust has been a source of international conflict between the Chinese and Korean governments. [ citation needed ] Although the major components of yellow dust are sand and materials from the Earth's crust, various industrial pollutants and their by-products, including mercury, sulfuric acid , nitric acid and cadmium, have made the dust more harmful. Approximately 30% of sulfuric acid and 40% of nitric acid in ambient air in Korea may have migrated from China. To reduce the transboundary pollution from China, scientists have advocated for collaborative actions between Korea and China, including scientific, administrative, and political aspects. In an effort to combat the worsening yellow dust levels, the Korean government has been working with the Chinese government. In January 2018, the two countries met at its 22nd meeting of the Republic of Korea-China Joint Committee on Environmental Cooperation, during which the two countries discussed increasing the cooperative efforts to fight air pollution, including yellow dust and fine dust, and marine pollution. Asian dust is an example of a negative externality on society. Policy choices that favor rapid industrialization and deforestation in China, Mongolia, and other Central Asian regions impose social costs on Eastern countries, such as Korea, Japan, and Russia in the Far East. The main cause of deforestation is extensive logging. Although the production of firewood and other wooden products induce deforestation, which leads to yellow dust as well as other ecological dangers, the social cost of yellow dust is not accounted for in the cost of production . This results in a market failure in which individual producers make decisions based on their private marginal cost - not accounting for the dust - rather than the social marginal cost, which includes the harms from the dust. Under a free market , the quantity of logs and other wooden goods produced exceeds the socially optimal outcome. [ citation needed ]China dust has been a source of international conflict between the Chinese and Korean governments. [ citation needed ] Although the major components of yellow dust are sand and materials from the Earth's crust, various industrial pollutants and their by-products, including mercury, sulfuric acid , nitric acid and cadmium, have made the dust more harmful. Approximately 30% of sulfuric acid and 40% of nitric acid in ambient air in Korea may have migrated from China. To reduce the transboundary pollution from China, scientists have advocated for collaborative actions between Korea and China, including scientific, administrative, and political aspects. In an effort to combat the worsening yellow dust levels, the Korean government has been working with the Chinese government. In January 2018, the two countries met at its 22nd meeting of the Republic of Korea-China Joint Committee on Environmental Cooperation, during which the two countries discussed increasing the cooperative efforts to fight air pollution, including yellow dust and fine dust, and marine pollution. Asian dust is not a new phenomenon. Historically, there have been records of Asian dust occurrences as early as 1150 B.C. in China and 174 A.D. in Korea. However, official weather data show a stark increase in its severity and frequency. In the last half century, the number of days with reports of Asian dust has increased five-fold. According to an analysis on data from Korea Meteorological Administration (KMA), the average number of days with Asian dust in a given year was about two in the 1960s. However, this number has increased to 11 in 2000s. In 1960s and 1970s, each decade had 3 years that were Asian-dust free. However, starting from 2000s, there has not been a single year without Asian dust. In just four months of 2018, Gyeonggi Province of South Korea issued 42 dust warnings and advisories, which has increased from 36 in the same period in 2017. This reflects the increase in average dust concentration level from 132.88 ppm (parts per million) in 2017 to 149 ppm in 2018. The situation is worsening since the dust particles are staying in the air longer. The average duration has increased from 16.3 hours to 19.8 hours in the last two years. Asian dust, in combination with smog and general air pollution, has become so severe that it became a political issue in the South Korean presidential election in 2017. All three main candidates of the election— Moon Jae-in , Ahn Cheol-soo , and Hong Joon-pyo —promised to take measures to alleviate these growing national air pollution problems. In the first few months of 2017, Seoul had twice the number of ultrafine dust warnings, during which people were advised to limit outdoor activities and stay indoors when compared to 2016. Shanghai on April 3, 2007, recorded an air quality index of 500. [ citation needed ] In the US, an index of 300 is considered "hazardous" and anything over 200 is "unhealthy". Desertification has intensified in China, as 1,740,000 km 2 of land is "dry", which disrupts the lives of 400 million people and causes direct economic losses of 54 billion yuan (US$7 billion) per year, SFA figures show. These figures are probably vastly underestimated, as they only take into account direct effects, without including medical, pollution, and other secondary effects, as well as effects to neighboring nations. [ citation needed ] El Niño also plays a role in Asian dust storms, because winter ice can keep dust from sweeping off the land. [ clarification needed ]

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Pneumonic plague

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Braun's lipoprotein

Braun's lipoprotein ( BLP , Lpp , murein lipoprotein , or major outer membrane lipoprotein ), found in some gram-negative cell walls, is one of the most abundant membrane proteins ; its molecular weight is about 7.2 kDa . It is bound at its C-terminal end (a lysine ) by a covalent bond to the peptidoglycan layer (specifically to diaminopimelic acid molecules ) and is embedded in the outer membrane by its hydrophobic head (a cysteine with lipids attached). BLP tightly links the two layers and provides structural integrity to the outer membrane.The gene encoding Braun's lipoprotein initially produces a protein composed of 78 amino acids, which includes a 20 amino acid signal peptide at the amino terminus. The mature protein is 6 kDa in size. Three monomers of Lpp assemble into a leucine zipper coiled-coil trimer. Large amounts of Braun's lipoprotein is present, more than any other protein in E. coli . Unlike other lipoproteins, it is linked covalently to the peptidoglycan. Lpp connects the outer membrane to the peptidoglycan. Lpp is anchored to the outer membrane by its amino-terminal lipid group. In E. coli , one third of Lpp proteins form a peptide bond via the side chain of its carboxy-terminal lysine with diaminopimelic acid in the peptidoglycan layer. The rest of the Lpp molecules are present in a "free" form unlinked to peptidoglycan. The free form is exposed on the surface of E. coli . Lpp, along with another OmpA-like lipoprotein called Pal/OprL ( P0A912 ), maintains the stability of the cell envelope by attaching the outer membrane to the cell wall. Lpp has been proposed as a virulence factor of Yersinia pestis , the cause of plague . Y. pestis needs lpp for maximum survival in macrophages and to efficiently kill mouse models of bubonic and pneumonic plague . Braun's lipoprotein binds to the pattern recognition receptor TLR2 . Lpp induces adhesion of neutrophils to human endothelial cells by activating the latter.

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Pneumonic plague

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Bacterial pneumonia

Bacterial pneumonia is a type of pneumonia caused by bacterial infection . Streptococcus pneumoniae ( J13 ) is the most common bacterial cause of pneumonia in all age groups except newborn infants. Streptococcus pneumoniae is a Gram-positive bacterium that often lives in the throat of people who do not have pneumonia. Other important Gram-positive causes of pneumonia are Staphylococcus aureus ( J15.2 ) and Bacillus anthracis . Gram-negative bacteria are seen less frequently: Haemophilus influenzae ( J14 ), Klebsiella pneumoniae ( J15.0 ), Escherichia coli ( J15.5 ), Pseudomonas aeruginosa ( J15.1 ), Bordetella pertussis , and Moraxella catarrhalis are the most common. These bacteria often live in the gut and enter the lungs when contents of the gut (such as vomit or faeces) are inhaled. Pneumonia caused by Yersinia pestis is usually called pneumonic plague . Atypical bacteria causing pneumonia are Coxiella burnetii , Chlamydophila pneumoniae ( J16.0 ), Mycoplasma pneumoniae ( J15.7 ), and Legionella pneumophila . The term "atypical" does not relate to how commonly these organisms cause pneumonia, how well it responds to common antibiotics or how typical the symptoms are; it refers instead to the fact that these organisms have atypical or absent cell wall structures and do not take up Gram stain in the same manner as gram-negative and gram-positive organisms.Streptococcus pneumoniae ( J13 ) is the most common bacterial cause of pneumonia in all age groups except newborn infants. Streptococcus pneumoniae is a Gram-positive bacterium that often lives in the throat of people who do not have pneumonia. Other important Gram-positive causes of pneumonia are Staphylococcus aureus ( J15.2 ) and Bacillus anthracis .Gram-negative bacteria are seen less frequently: Haemophilus influenzae ( J14 ), Klebsiella pneumoniae ( J15.0 ), Escherichia coli ( J15.5 ), Pseudomonas aeruginosa ( J15.1 ), Bordetella pertussis , and Moraxella catarrhalis are the most common. These bacteria often live in the gut and enter the lungs when contents of the gut (such as vomit or faeces) are inhaled. Pneumonia caused by Yersinia pestis is usually called pneumonic plague . Atypical bacteria causing pneumonia are Coxiella burnetii , Chlamydophila pneumoniae ( J16.0 ), Mycoplasma pneumoniae ( J15.7 ), and Legionella pneumophila . The term "atypical" does not relate to how commonly these organisms cause pneumonia, how well it responds to common antibiotics or how typical the symptoms are; it refers instead to the fact that these organisms have atypical or absent cell wall structures and do not take up Gram stain in the same manner as gram-negative and gram-positive organisms.Bacteria typically enter the lung with inhalation, though they can reach the lung through the bloodstream if other parts of the body are infected. Often, bacteria live in parts of the upper respiratory tract and are continuously being inhaled into the alveoli , the cavities deep in the lungs where gas exchange takes place. Once inside the alveoli, bacteria travel into the spaces between the cells and also between adjacent alveoli through connecting pores. This invasion triggers the immune system to respond by sending white blood cells responsible for attacking microorganisms ( neutrophils ) to the lungs. The neutrophils engulf and kill the offending organisms but also release cytokines that result in a general activation of the immune system. This results in the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid leaked from surrounding blood vessels fill the alveoli and result in impaired oxygen transportation. Bacteria can travel from the lung into the blood stream ( bacteremia ) and can result in serious illness such as sepsis and eventually septic shock , in which there is low blood pressure leading to damage in multiple parts of the body including the brain , kidney , and heart . They can also travel to the area between the lungs and the chest wall, called the pleural cavity . In very some very rare cases, bacterial pneumonia can form from someone throwing up and then falling asleep on their side causing some stomach fluid to funnel into the lungs leading to this infection.Diagnosis is carried out in steps. Patient history is obtained, including the symptoms and their duration, as well as exposure to any risk factors of the disease. A chest X-ray may be performed to check for signs of inflammation and a complete blood count will also be obtained. A sputum sample will also be obtained to ascertain the causative bacteria . This also plays a role in informing treatment options. In some cases, pulse oximetry may also be required as pneumonia is known to deplete oxygen levels in the blood. Other vitals such as pulse and body temperature are also checked. Depending on the general health, severity of the disease and age of the patient, several other tests may be required, such as:Prevention of bacterial pneumonia is by vaccination against Streptococcus pneumoniae ( pneumococcal polysaccharide vaccine for adults and pneumococcal conjugate vaccine for children), Haemophilus influenzae type B , meningococcus , Bordetella pertussis , Bacillus anthracis , and Yersinia pestis .Antibiotics are the treatment of choice for bacterial pneumonia, with ventilation (oxygen supplement) as supportive therapy. The antibiotic choice depends on the nature of the pneumonia, the microorganisms most commonly causing pneumonia in the geographical region, and the immune status and underlying health of the individual. In the United Kingdom , amoxicillin is used as first-line therapy in the vast majority of patients acquiring pneumonia in the community, sometimes with added clarithromycin . In North America , where the "atypical" forms of community-acquired pneumonia are becoming more common, clarithromycin , azithromycin , or fluoroquinolones as single therapy have displaced the amoxicillin as first-line therapy. Local patterns of antibiotic resistance always need to be considered when initiating pharmacotherapy. Another common antibiotic used is called zithromax , this treats many other bacterial infections. In hospitalized individuals or those with immune deficiencies, local guidelines determine the selection of antibiotics. Streptococcus pneumoniae — amoxicillin (or erythromycin in patients allergic to penicillin); cefuroxime and erythromycin in severe cases. Staphylococcus aureus — flucloxacillin (to counteract the organism's β-lactamase ). Chlamydophila pneumoniae — doxycycline Chlamydophila psittaci — erythromycin Mycoplasma pneumoniae — erythromycin Coxiella burnetti — doxycycline Legionella pneumophila — erythromycin, with rifampicin sometimes added. People who have difficulty breathing due to pneumonia may require extra oxygen . An extremely sick individual may require artificial ventilation and intensive care as life-saving measures while his or her immune system fights off the infectious cause with the help of antibiotics and other drugs.Streptococcus pneumoniae — amoxicillin (or erythromycin in patients allergic to penicillin); cefuroxime and erythromycin in severe cases. Staphylococcus aureus — flucloxacillin (to counteract the organism's β-lactamase ).Chlamydophila pneumoniae — doxycycline Chlamydophila psittaci — erythromycin Mycoplasma pneumoniae — erythromycin Coxiella burnetti — doxycycline Legionella pneumophila — erythromycin, with rifampicin sometimes added. People who have difficulty breathing due to pneumonia may require extra oxygen . An extremely sick individual may require artificial ventilation and intensive care as life-saving measures while his or her immune system fights off the infectious cause with the help of antibiotics and other drugs.

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Pneumonic plague

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Keșco

The House of Keșco or Cheșco / Keșcu / Cheșcu ( Russian : Кешко ; English: Keshko , Romanian : Cheșcu ), was the name of an ancient Moldavian Boyar noble family whose members held significant positions in Moldavia and later in the Russian Empire and Romania . Most notable member was Natalia Keshko , who became first modern Queen of Serbia .According to historian Johann Svoboda, the family had its roots in Russia , where members of the family appeared in 1097 as Knyazen in the Principality of Kiev . According to him, the family has descended from the Rurik dynasty , in particular from the Wassilko, Prince of Rostov (1209–1238). Historically, the family was established even before the Principality of Moldova was founded in 1350. They owned the forest on the left bank of the Sereth river, Panka region , Mihodra river valley and founded Lucavăţ , which was all owned by Luca, member of the family. The family is said to be, along with the House of Dragoș , the oldest in this region. Luca's sons Stan and Șerbco were knights at the court of Prince Alexander I of Moldavia . He officially confirmed their family possessions of Lucavăţ , Panka with Mihodra with hereditary rights for their descendants by the document of February 16, 1428. The church of Lucavăţ became first seat of Bishopric of Rădăuți , with its pastor, by proclamation of Prince Stephen the Great of Moldavia became its first Bishop on March 15, 1490. Prince Alexandru Lăpușneanu of Moldavia , grandson of Prince Alexander "the Good", not only confirmed the legality of the certificate issued by his grandfather on May 7, 1565, but also subsequently transferred to the family the co-ownership of a large number of villages in northern Moldova which expanded the land they owned. Later, during 17th century, brothers Vasile, Nicolae and Constantin Căzăcescul were again officially confirmed ownership of all their expanded possessions by Prince Illias III of Moldavia on March 12, 1667. Vasile (Basilius) (1631–1701), the eldest of the above mentioned brothers, married in 1654 Candachia Cocoranul (1635–1688), the daughter of the Boyar Isac Cocoranul. He was, as historian Teodor Bălan wrote, the ancestor of the Counts Wassilko von Serecki , who were later one of the largest landowners in Austro-Hungarian Empire and the only family of ethnic Romanian origin to acquire the title of Count throughout the Empire. It was first mentioned as such in the 17th century. Constantin the Căzăcescul , younger brother of the above mentioned Vasile (Basilius) (1631–1701) and Nicolae, got confirmed in 1667 his noble status and his possessions in the Principality of Moldova by ruling Prince Illias III . His descendants kept using his nickname as their family name, making him an ancestor of the Keshko ( Keșco / Keșcu / Cheșco / Cheșcu ) family, which in turn made them collateral branch of Counts Wassilko von Serecki .Members of the Keshko family served the Russian Empire . As such, they were granted the title of Marshals of Nobility of the Bessarabia Governorate (1812–1917) where they held large properties. Throughout the years they were also incorporated into the Russian nobility , apart from already belonging to Romanian and Moldavian nobility .

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Pneumonic plague

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Primary Health Centre (India)

Primary Health Centre ( PHC s), sometimes referred to as public health centres , are state-owned rural and urban health care facilities in India . They are essentially single-physician clinics usually with facilities for minor surgeries. They are part of the government-funded public health system in India and are the most basic units of this system. As on 31 March 2019 there are 30,045 PHCs in India in which 24,855 are located on rural areas and 5,190 are on urban areas. The idea of creating PHCs in India was set forward by Bhore committee in 1946.Primary Health Centres programmes are listed below: Provision of medical care Maternal-child health including family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases Collection and reporting of vital statistics Education about health National health programmes, as relevant Referral services Training of health guides, health workers, local dais and health assistants Basic laboratory workers First PHC established in 1952.

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Pneumonic plague

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Public health system in India

The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. The need for an efficient and effective public health system in India is large. Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people. Indian healthcare system has been historically dominated by provisioning of medical care and neglected public health. 11.9% of all maternal deaths and 18% of all infant mortality in the world occurs in India, ranking it the highest in the world in 2021. 36.6 out of 1000 children are dead by the time they reach the age of 5. 62% of children are immunized. Communicable disease is the cause of death for 53% of all deaths in India. Public health initiatives that affect people in all states, such as the National Health Mission , Ayushman Bharat , National Mental Health Program, are instilled by the Union Ministry of Health and Family Welfare . There are multiple systems set up in rural and urban areas of India including Primary Health Centres, Community Health Centres, Sub Centres, and Government Hospitals. These programmes must follow the standards set by Indian Public Health Standards documents that are revised when needed. Public health systems in the colonial period were focused on health care for British citizens who were living in India. The period saw research institutes , public health legislation, and sanitation departments, although only 3% of Indian households had toilets at this time. Annual health reports were released and the prevention of contagious disease outbreaks was stressed. At the end of the colonial period, death rates from infectious diseases such as cholera had fallen to a low, although other diseases were still rampant. In modern-day India, the spread of communicable diseases is under better control and now non-communicable diseases, mostly like cardiovascular diseases , are major killers. Health care reform was prioritized in the 1946 Bhore Committee Report which suggested the implementation of a health care system that was financed at least in part by the Indian government. In 1983 the first National Health Policy (NHP) of India was created with the goals of establishing a system with primary-care facilities and a referral system. In 2002, the updated NHP focused on improving the practicality and reach of the system as well as incorporating private and public clinics into the health sphere. In the context of universal health coverage, the recent policy focus in India, there is an attempt to ensure that every citizen should have adequate access to curative care without any financial hardships. Equally relevant is the acknowledgement of social determinants of health as an important determinant of population health and the need to have a public health cadre within the existing health care system. This call for a need to distinguish between 'Public health' system and 'Public' sector health care system as the latter uses public to indicate the primary role of government and not necessarily as population as used in public health. [ citation needed ] Public health funding has been directed to helping the middle and upper classes, as it targets creating more health professional jobs, expanding research institutions, and improving training. This creates unequal access to health care for the lower classes who do not receive the benefits of this funding. Today, states pay for about 75% of the public healthcare system but insufficient state spending neglects the public health system in India. This results in the Out-of-pocket health expenditure by households comprising 60.6% of the total health expenditure of India. Thus, a large number of households are pushed below poverty line every year. [ citation needed ]The healthcare system is organised into primary, secondary, and tertiary levels. At the primary level are Sub Centres and Primary Health Centres (PHCs). At the secondary level there are Community Health Centres (CHCs) and smaller Sub-District hospitals. Finally, the top level of public care provided by the government is the tertiary level, which consists of Medical Colleges and District/General Hospitals. The number of PHCs, CHCs, Sub Centres, and District Hospitals has increased in the past six years, although not all of them are up to the standards set by Indian Public Health Standards. A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national government. Mandates require health staff to be at least two workers (male and female) to serve a population of 5000 people (or 3000 in a remote or hilly areas). Sub Centres also work to educate rural people about healthy habits for a more long-term impact. Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve as larger health clinics staffed with doctors and paramedics. Patients can be referred from local sub centres to PHCs for more complex cases. A major difference from Sub Centres is that state governments fund PHCs, not the national government. PHCs also function to improve health education with a larger emphasis on preventative measures. A Community Health Centre is also funded by state governments and accepts patients referred from Primary Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas. Patients from these agencies can be transferred to general hospitals for further treatments. Thus, CHC's are also first referral units, or FRUs, which are required to have obstetric care, new born/childcare, and blood storage capacities at all hours everyday of the week. Sub District/Sub Divisional/Taluk Hospitals are located in sub-district headquarters and provide more specialized medical services than community health centers. Taluk hospitals are located in taluk headquarters and provide more specialized medical services than community health centers.Taluk Hospital is a secondary healthcare center located in the administrative headquarters of a taluk (Tehsil). Taluk hospitals provide basic medical services to the people of the local community. They have departments for general medicine, pediatrics, obstetrics and gynecology, dermatology, ophthalmology, dentistry, and psychiatry. Taluk hospitals also have a laboratory and a pharmacy that provide diagnostic and treatment services to patients. The hospital has an emergency department that operates 24 hours a day, providing immediate medical attention to patients who require urgent medical care. Taluk Hospitals are set up either by upgrading the existing Community Health Centre (CHCs). They are referred to as Sub-district (sub-divisional) hospital for the purpose of standardisation under the revised guidelines of Indian Public Health Standards ( IPHS ). Taluk Hospitals are below the district and above the block level CHCs. Taluk Hospital serves as a vital connection between the SC (Sub-Centre), PHC (Public Health Centre), CHC (Community Health Centre), and District Hospital on one end. It reduces the workload at the district hospital and cuts travel time for patients in need of emergency care. Sub District hospitals are below the district and above the block level (CHC) hospitals and act as Referral Units for the Tehsil/Taluk/Block population in which they are geographically located. [ citation needed ] District Hospitals are the final referral centres for the primary and secondary levels of the public health system. It is expected that at least one hospital is in each district of India, although in 2010 it was recorded that only 605 hospitals exist when there are 640 districts. There are normally anywhere between 75 and 500 beds, depending on population demand. These district hospitals often lack modern equipment and relations with local blood banks. All India Institutes of Medical Sciences is owned and controlled by the central government. These are referral hospitals with specialized facilities. All India Institutes presently functional are AIIMS New Delhi , Bhopal , AIIMS Bhubaneshwar, AIIMS Jodhpur , AIIMS Raipur , AIIMS Patna and AIIMS Rishiksh . A Regional Cancer Centre is a cancer care hospital and research institute controlled jointly by the central and the respective state governments. Government Medical Colleges are owned and controlled by the respective state governments and also function as referral hospitals. [ citation needed ]A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national government. Mandates require health staff to be at least two workers (male and female) to serve a population of 5000 people (or 3000 in a remote or hilly areas). Sub Centres also work to educate rural people about healthy habits for a more long-term impact. Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve as larger health clinics staffed with doctors and paramedics. Patients can be referred from local sub centres to PHCs for more complex cases. A major difference from Sub Centres is that state governments fund PHCs, not the national government. PHCs also function to improve health education with a larger emphasis on preventative measures. A Community Health Centre is also funded by state governments and accepts patients referred from Primary Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas. Patients from these agencies can be transferred to general hospitals for further treatments. Thus, CHC's are also first referral units, or FRUs, which are required to have obstetric care, new born/childcare, and blood storage capacities at all hours everyday of the week. Sub District/Sub Divisional/Taluk Hospitals are located in sub-district headquarters and provide more specialized medical services than community health centers. Taluk hospitals are located in taluk headquarters and provide more specialized medical services than community health centers.Taluk Hospital is a secondary healthcare center located in the administrative headquarters of a taluk (Tehsil). Taluk hospitals provide basic medical services to the people of the local community. They have departments for general medicine, pediatrics, obstetrics and gynecology, dermatology, ophthalmology, dentistry, and psychiatry. Taluk hospitals also have a laboratory and a pharmacy that provide diagnostic and treatment services to patients. The hospital has an emergency department that operates 24 hours a day, providing immediate medical attention to patients who require urgent medical care. Taluk Hospitals are set up either by upgrading the existing Community Health Centre (CHCs). They are referred to as Sub-district (sub-divisional) hospital for the purpose of standardisation under the revised guidelines of Indian Public Health Standards ( IPHS ). Taluk Hospitals are below the district and above the block level CHCs. Taluk Hospital serves as a vital connection between the SC (Sub-Centre), PHC (Public Health Centre), CHC (Community Health Centre), and District Hospital on one end. It reduces the workload at the district hospital and cuts travel time for patients in need of emergency care. Sub District hospitals are below the district and above the block level (CHC) hospitals and act as Referral Units for the Tehsil/Taluk/Block population in which they are geographically located. [ citation needed ]District Hospitals are the final referral centres for the primary and secondary levels of the public health system. It is expected that at least one hospital is in each district of India, although in 2010 it was recorded that only 605 hospitals exist when there are 640 districts. There are normally anywhere between 75 and 500 beds, depending on population demand. These district hospitals often lack modern equipment and relations with local blood banks. All India Institutes of Medical Sciences is owned and controlled by the central government. These are referral hospitals with specialized facilities. All India Institutes presently functional are AIIMS New Delhi , Bhopal , AIIMS Bhubaneshwar, AIIMS Jodhpur , AIIMS Raipur , AIIMS Patna and AIIMS Rishiksh . A Regional Cancer Centre is a cancer care hospital and research institute controlled jointly by the central and the respective state governments. Government Medical Colleges are owned and controlled by the respective state governments and also function as referral hospitals. [ citation needed ]In 2018, Ayushman Bharat, a flagship scheme of the Government of India, was launched by the Prime Minister of India as recommended by the National Health Policy 2017 to achieve the vision of Universal Health Coverage (UHC). It includes two interrelated components: Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). In 2006, the Public Health Foundation of India was started by the Prime Minister of India as both a private and public initiative. The goal of this organisation is to incorporate more public health policies and diverse professionals into web the healthcare sphere. It also collaborates with international public health organisations to gather more knowledge and direct discussions around needs and improvements to the current system. Oftentimes officials in policy making positions have a gap in their education about public health, and MPH and PhD programs in public health are lacking in their number of students and resources. The Public Health Foundation aims to further these programs and educate more people in this field. The research discovered would be made transparent to the Indian public at large, so that the entire nation is aware of health standards in the country. The Indian government first began to implement community health worker programs in 1977. Community health workers provide advice and support to other women in their community. Sometimes referred to as sakhis , these women capitalize on their familiarity with the community to gain credibility and promote public health measures, usually by leading participatory groups. Community health workers also function to mediate between modern allopathic medicine and traditional indigenous forms of healing, such as by tailoring allopathic health recommendations to include and legitimize traditional beliefs. Community health workers closely cooperate with each other and with other types of health workers (such as auxiliary nurse midwives) to encourage care utilization and deliver health services. Currently, India's largest community health worker program, started in 2005 and now subsumed in the National Health Mission, consists of nearly one million Accredited Social Health Activist , a ratio of one for every 1000 people in rural villages and marginalized urban communities. Community health workers and participatory groups have been shown to change health behaviors and impact health outcomes such as neonatal mortality. Factors for these positive changes include active inclusion and recruitment of a large portion of women in the community, engagement and participation during skill development, and involvement of the community beyond group participation. Community health workers may also serve as community leaders and change-makers by empowering women and demanding policy action to address health inequities. Addressing these social determinants of health has a direct impact on healthcare utilization. For example, empowered women are less likely to face health problems because they are more likely to be aware of problems with their health and therefore more likely to seek care to address these problems. This grassroots intervention strategy often involves partnerships with local hospitals or government-organized non-governmental organizations (GONGOs), who train female volunteers from the community and help organize participatory groups. Though demonstrated to be effective, community health worker programs can be hampered by a lack of monitoring and accountability as a result of governmental decentralization. Community health workers are not government employees but rather volunteers that state governments are responsible for training and financially incentivizing. Health workers may also lack a sufficient understanding of the public health measure they are trying to promote due to inadequate training and resources. The Indian government first began to implement community health worker programs in 1977. Community health workers provide advice and support to other women in their community. Sometimes referred to as sakhis , these women capitalize on their familiarity with the community to gain credibility and promote public health measures, usually by leading participatory groups. Community health workers also function to mediate between modern allopathic medicine and traditional indigenous forms of healing, such as by tailoring allopathic health recommendations to include and legitimize traditional beliefs. Community health workers closely cooperate with each other and with other types of health workers (such as auxiliary nurse midwives) to encourage care utilization and deliver health services. Currently, India's largest community health worker program, started in 2005 and now subsumed in the National Health Mission, consists of nearly one million Accredited Social Health Activist , a ratio of one for every 1000 people in rural villages and marginalized urban communities. Community health workers and participatory groups have been shown to change health behaviors and impact health outcomes such as neonatal mortality. Factors for these positive changes include active inclusion and recruitment of a large portion of women in the community, engagement and participation during skill development, and involvement of the community beyond group participation. Community health workers may also serve as community leaders and change-makers by empowering women and demanding policy action to address health inequities. Addressing these social determinants of health has a direct impact on healthcare utilization. For example, empowered women are less likely to face health problems because they are more likely to be aware of problems with their health and therefore more likely to seek care to address these problems. This grassroots intervention strategy often involves partnerships with local hospitals or government-organized non-governmental organizations (GONGOs), who train female volunteers from the community and help organize participatory groups. Though demonstrated to be effective, community health worker programs can be hampered by a lack of monitoring and accountability as a result of governmental decentralization. Community health workers are not government employees but rather volunteers that state governments are responsible for training and financially incentivizing. Health workers may also lack a sufficient understanding of the public health measure they are trying to promote due to inadequate training and resources. Drawbacks to India's healthcare system today include low quality care, corruption , unhappiness with the system, a lack of accountability, unethical care, overcrowding of clinics, poor cooperation between public and private spheres, barriers of access to services and medicines, lack of public health knowledge, and low cost factor. These drawbacks push wealthier Indians to use the private healthcare system, which is less accessible to low-income families, creating unequal medical treatment between classes.doctors are reluctant to practice in rural areas. [ citation needed ] Low quality care is prevalent due to misdiagnosis, under trained health professionals, and the prescription of incorrect medicines. A study discovered a doctor in a PHC in Delhi who prescribed the wrong treatment method 50% of the time. Indians in rural areas where this problem is rampant are prevented from improving their health situation. Enforcement and revision of the regulations set by the Union Ministry of Health and Family Welfare IPHS is also not strict. The 12th Five-Year Plan (India) dictates a need to improve enforcement and institutionalize treatment methods across all clinics in the nation in order to increase the quality of care. There is also a lack of accountability across both private and public clinics in India, although public doctors feel less responsibility to treat their patients effectively than do doctors in private clinics. Impolite interactions from the clinic staff may lead to less effective procedures. Healthcare professionals take more time off from work than the amount they are allotted with the majority of absences being for no official reason. India's public healthcare system pays salaries during absences, leading to excessive personal days being paid for by the government. This phenomenon is especially heightened in Sub Centres and PHCs and results in expenditure that isn't correlated to better work performance. Clinics are overcrowded and understaffed without enough beds to support their patients. Statistics show that the number of health professionals in India is less than the average number for other developing nations. In rural Bihar the number of doctors is 0.3 for every 10,000 individuals. Urban hospitals have twice the number of beds than rural hospitals do but the number is still insufficient to provide for the large number of patients that visit. Sometimes patients are referred from rural areas to larger hospitals, increasing the overcrowding in urban cities. Overcrowding also increases the likelihood of diseases spreading, particularly in urban, crowded areas of cities. Improper sanitation and waste disposal, even within clinics, can lead to an increased incidence of infectious diseases. 5% of visits to health practitioners are in private clinics or hospitals, many of which are paid for out of pocket. Money is spent on improving private services instead of on funding the public sector. Governmental failure to initiate and foster effective partnerships between the public and private healthcare spheres results in financial contracts that aren't negotiated to help the common man. These contracts would allow the private sector to finance projects to improve knowledge and facilities in the public sphere. Both social and financial inequality results in barriers of access to healthcare services in India. Services aren't accessible for the disabled, mentally challenged, and elderly populations. Mothers are disadvantaged and in many rural areas there is a lack of abortion services and contraception methods. Public clinics often have a shortage of the appropriate medicines or may supply them at excessively high prices, resulting in large out of pocket costs (even for those with insurance coverage). Large distances prevent Indians from getting care, and if families travel far distance there is low assurance that they will receive proper medical attention at that particular time. [ citation needed ] Many government hospitals do not follow the fire safety norms set in the National Building Code of India owing to cost saving measures and the preference for the lowest bidder in construction projects. Due to this there have been frequent news reports of major hospital fires across India. According to a Scroll.in report, the main reason for this vulnerability to electrical short circuits is the lack of dedicated electrical engineers in most hospitals and shortage of government electrical engineers in the various state public works departments. The same report found that between August 2020 to March 2022 there were 122 deaths due to 29 incidents of hospital fires during that period. Low quality care is prevalent due to misdiagnosis, under trained health professionals, and the prescription of incorrect medicines. A study discovered a doctor in a PHC in Delhi who prescribed the wrong treatment method 50% of the time. Indians in rural areas where this problem is rampant are prevented from improving their health situation. Enforcement and revision of the regulations set by the Union Ministry of Health and Family Welfare IPHS is also not strict. The 12th Five-Year Plan (India) dictates a need to improve enforcement and institutionalize treatment methods across all clinics in the nation in order to increase the quality of care. There is also a lack of accountability across both private and public clinics in India, although public doctors feel less responsibility to treat their patients effectively than do doctors in private clinics. Impolite interactions from the clinic staff may lead to less effective procedures. Healthcare professionals take more time off from work than the amount they are allotted with the majority of absences being for no official reason. India's public healthcare system pays salaries during absences, leading to excessive personal days being paid for by the government. This phenomenon is especially heightened in Sub Centres and PHCs and results in expenditure that isn't correlated to better work performance. Clinics are overcrowded and understaffed without enough beds to support their patients. Statistics show that the number of health professionals in India is less than the average number for other developing nations. In rural Bihar the number of doctors is 0.3 for every 10,000 individuals. Urban hospitals have twice the number of beds than rural hospitals do but the number is still insufficient to provide for the large number of patients that visit. Sometimes patients are referred from rural areas to larger hospitals, increasing the overcrowding in urban cities. Overcrowding also increases the likelihood of diseases spreading, particularly in urban, crowded areas of cities. Improper sanitation and waste disposal, even within clinics, can lead to an increased incidence of infectious diseases. 5% of visits to health practitioners are in private clinics or hospitals, many of which are paid for out of pocket. Money is spent on improving private services instead of on funding the public sector. Governmental failure to initiate and foster effective partnerships between the public and private healthcare spheres results in financial contracts that aren't negotiated to help the common man. These contracts would allow the private sector to finance projects to improve knowledge and facilities in the public sphere. Both social and financial inequality results in barriers of access to healthcare services in India. Services aren't accessible for the disabled, mentally challenged, and elderly populations. Mothers are disadvantaged and in many rural areas there is a lack of abortion services and contraception methods. Public clinics often have a shortage of the appropriate medicines or may supply them at excessively high prices, resulting in large out of pocket costs (even for those with insurance coverage). Large distances prevent Indians from getting care, and if families travel far distance there is low assurance that they will receive proper medical attention at that particular time. [ citation needed ]Many government hospitals do not follow the fire safety norms set in the National Building Code of India owing to cost saving measures and the preference for the lowest bidder in construction projects. Due to this there have been frequent news reports of major hospital fires across India. According to a Scroll.in report, the main reason for this vulnerability to electrical short circuits is the lack of dedicated electrical engineers in most hospitals and shortage of government electrical engineers in the various state public works departments. The same report found that between August 2020 to March 2022 there were 122 deaths due to 29 incidents of hospital fires during that period.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Human_flea/html

Human flea

The human flea ( Pulex irritans ) – once also called the house flea – is a cosmopolitan flea species that has, in spite of the common name , a wide host spectrum . It is one of six species in the genus Pulex ; the other five are all confined to the Nearctic and Neotropical realms . The species is thought to have originated in South America , where its original host may have been the guinea pig or peccary . Pulex irritans is a holometabolous insect with a four-part lifecycle consisting of eggs, larvae, pupae, and adults. Eggs are shed by the female in the environment and hatch into larvae in about 3–4 days. Larvae feed on organic debris in the environment. Larvae eventually form pupae, which are in cocoons that are often covered with debris from the environment (sand, pebbles, etc.). The larval and pupal stages are completed in about 3–4 weeks when the adults hatch from pupae, then must seek out a warm-blooded host for blood meals. The flea eggs are about 0.5 mm in length. They are oval-shaped and pearly white in color. Eggs are often laid on the body of the host, but they often fall off in many different places. The larvae are about 0.6 mm in length. They are creamy white or yellow in color. Larvae have 13 segments with bristles on each segment. The larvae feed on a variety of organic debris. The pupa are around 4 x 2 mm. After undergoing three separate molts, the larvae pupate, then emerge as adults. If conditions are unfavorable, a cocooned flea can remain dormant for up to a year in the pupal phase. The adults are roughly 1.5 to 4 mm in length and are laterally flattened. They are dark brown in color, are wingless, and have piercing-sucking mouthparts that aid in feeding on the host's blood. Both genal and pronotal combs are absent and the adult flea has a rounded head. Most fleas are distributed in the egg, larval, or pupal stages.Fleas are a pest species to their hosts, causing an itching sensation that results in discomfort and leads to scratching in the vicinity of the bite. Flea bites generally cause the skin to raise, swell, and itch. The bite site has a single puncture point in the center. Bites often appear in clusters or small rows and can remain inflamed for up to several weeks. This species bites many species of mammals and birds, including domesticated ones. It has been found on dogs and wild canids , monkeys in captivity, opossums , domestic cats , wild felids in captivity, chickens , black rats and Norwegian rats , wild rodents , pigs , free-tailed bats , and other species. It can also be an intermediate host for the flea tapeworm cestode Dipylidium caninum . Fleas can spread rapidly and move between areas to include eyebrows, eyelashes, and pubic regions. Hair loss as a result of itching is common, especially in wild and domestic animals. Anemia is also possible in extreme cases of high-volume infestations. Plague , a disease that affects humans and other mammals, is caused by the bacterium Yersinia pestis . The human flea can be a carrier of the plague bacterium. Plague is infamous for killing millions of people in Eurasia during the Middle Ages. Without prompt treatment, the disease can cause serious illness or death. Today, human plague infections continue to occur in the western United States, but significantly more cases occur in parts of Africa and Asia. Plague is a very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery. People in close contact with very sick pneumonic plague patients may be evaluated and possibly placed under observation. Preventive antibiotic therapy may also be given, depending on the type and timing of personal contact.Fleas are a pest species to their hosts, causing an itching sensation that results in discomfort and leads to scratching in the vicinity of the bite. Flea bites generally cause the skin to raise, swell, and itch. The bite site has a single puncture point in the center. Bites often appear in clusters or small rows and can remain inflamed for up to several weeks. This species bites many species of mammals and birds, including domesticated ones. It has been found on dogs and wild canids , monkeys in captivity, opossums , domestic cats , wild felids in captivity, chickens , black rats and Norwegian rats , wild rodents , pigs , free-tailed bats , and other species. It can also be an intermediate host for the flea tapeworm cestode Dipylidium caninum . Fleas can spread rapidly and move between areas to include eyebrows, eyelashes, and pubic regions. Hair loss as a result of itching is common, especially in wild and domestic animals. Anemia is also possible in extreme cases of high-volume infestations.Plague , a disease that affects humans and other mammals, is caused by the bacterium Yersinia pestis . The human flea can be a carrier of the plague bacterium. Plague is infamous for killing millions of people in Eurasia during the Middle Ages. Without prompt treatment, the disease can cause serious illness or death. Today, human plague infections continue to occur in the western United States, but significantly more cases occur in parts of Africa and Asia. Plague is a very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery. People in close contact with very sick pneumonic plague patients may be evaluated and possibly placed under observation. Preventive antibiotic therapy may also be given, depending on the type and timing of personal contact.Common treatments include body shaving and medicated shampoos and combing. When preventing fleas, it is important to treat both the host and the environment. Household pets should be treated to prevent being infested. Carpets, and other floor surfaces, should be shampooed and vacuumed regularly to prevent fleas. When dealing with an infestation, bedding and clothing that may have been exposed should be washed thoroughly in hot water and kept away from other materials that have not been exposed. In extreme cases, extermination by a professional is necessary.Pulex irritans originated in Central and South America, where it evolved with only one host. Despite the origins of P. irritans , it is now a cosmopolitan species, most likely due to the fur trade after the 18th century, and pet transport in more recent decades. Due to the cosmopolitan distribution of this group, research has been conducted to show that P. irritans individuals, when sampled from Spain and Argentina, only showed significant differences when comparing molecular data. The use of morphometric data, which is often the method for flea identification, showed no significant levels of divergence between the two populations. Combining both morphological and molecular data has identified the possibility of cryptic species . This indicates a need to reconsider taxonomic classifications of these fleas. Studies in Europe and the Mediterranean also found this to be true. Human and cat fleas from Europe and the Mediterranean were studied and show such great variation within their own species that their taxonomy should be reevaluated based on mitochondrial gene heterogeneity.

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Pneumonic plague

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Bioterrorism

Methods Tactics Bioterrorism is terrorism involving the intentional release or dissemination of biological agents . These agents include bacteria , viruses , insects , fungi , and/or their toxins , and may be in a naturally occurring or a human-modified form, in much the same way as in biological warfare . Further, modern agribusiness is vulnerable to anti-agricultural attacks by terrorists, and such attacks can seriously damage economy as well as consumer confidence . The latter destructive activity is called agrobioterrorism and is a subtype of agro-terrorism . Bioterrorism agents are typically found in nature, but could be mutated or altered to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, water, or in food. Biological agents are attractive to terrorists because they are extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus , can be spread from person to person and some, like anthrax , cannot. Bioterrorism may be favored because biological agents are relatively easy and inexpensive to obtain, can be easily disseminated, and can cause widespread fear and panic beyond the actual physical damage. Military leaders, however, have learned that, as a military asset, bioterrorism has some important limitations; it is difficult to use a bioweapon in a way that only affects the enemy and not friendly forces. A biological weapon is useful to terrorists mainly as a method of creating mass panic and disruption to a state or a country. However, technologists such as Bill Joy have warned of the potential power which genetic engineering might place in the hands of future bio-terrorists. The use of agents that do not cause harm to humans, but disrupt the economy, have also been discussed. One such pathogen is the foot-and-mouth disease (FMD) virus, which is capable of causing widespread economic damage and public concern (as witnessed in the 2001 and 2007 FMD outbreaks in the UK), while having almost no capacity to infect humans.By the time World War I began, attempts to use anthrax were directed at animal populations. This generally proved to be ineffective. Shortly after the start of World War I, Germany launched a biological sabotage campaign in the United States, Russia, Romania, and France. At that time, Anton Dilger lived in Germany, but in 1915 he was sent to the United States carrying cultures of glanders , a virulent disease of horses and mules. Dilger set up a laboratory in his home in Chevy Chase , Maryland. He used stevedores working the docks in Baltimore to infect horses with glanders while they were waiting to be shipped to Britain. Dilger was under suspicion as being a German agent, but was never arrested. Dilger eventually fled to Madrid, Spain, where he died during the Influenza Pandemic of 1918 . In 1916, the Russians arrested a German agent with similar intentions. Germany and its allies infected French cavalry horses and many of Russia's mules and horses on the Eastern Front. These actions hindered artillery and troop movements, as well as supply convoys. In 1972, police in Chicago arrested two college students, Allen Schwander and Stephen Pera, who had planned to poison the city's water supply with typhoid and other bacteria. Schwander had founded a terrorist group, "R.I.S.E.", while Pera collected and grew cultures from the hospital where he worked. The two men fled to Cuba after being released on bail. Schwander died of natural causes in 1974, while Pera returned to the U.S. in 1975 and was put on probation. In 1980, the World Health Organization (WHO) announced the eradication of smallpox, a highly contagious and incurable disease. Although the disease has been eliminated in the wild, frozen stocks of smallpox virus are still maintained by the governments of the United States and Russia. Disastrous consequences are feared if rogue politicians or terrorists were to get hold of the smallpox strains. Since vaccination programs are now terminated, the world population is more susceptible to smallpox than ever before. In Oregon in 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by incapacitating the local population. They infected salad bars in 11 restaurants, produce in grocery stores, doorknobs, and other public domains with Salmonella typhimurium bacteria in the city of The Dalles , Oregon . The attack infected 751 people with severe food poisoning . There were no fatalities. This incident was the first known bioterrorist attack in the United States in the 20th century. It was also the single largest bioterrorism attack on U.S. soil. In June 1993, the religious group Aum Shinrikyo released anthrax in Tokyo. Eyewitnesses reported a foul odor. The attack was a failure, because it did not infect a single person. The reason for this is due to the fact that the group used the vaccine strain of the bacterium. The spores which were recovered from the site of the attack showed that they were identical to an anthrax vaccine strain that was given to animals at the time. These vaccine strains are missing the genes that cause a symptomatic response. In September and October 2001, several cases of anthrax broke out in the United States, apparently deliberately caused. Letters laced with infectious anthrax were concurrently delivered to news media offices and the U.S. Congress, alongside an ambiguously related case in Chile . The letters killed five people. There are multiple considerable scenarios, how terrorists might employ biological agents. In 2000, tests conducted by various US agencies showed that indoor attacks in densely populated spaces are much more serious than outdoor attacks. Such enclosed spaces are large buildings, trains, indoor arenas, theaters, malls, tunnels and similar. Contra-measures against such scenarios are building architecture and ventilation systems engineering. In 1993, sewage was spilled out into a river, subsequently drawn into the water system and affected 400,000 people in Milwaukee , Wisconsin. The disease-causing organism was cryptosporidium parvum . This man-made disaster can be a template for a terrorist scenario. Nevertheless, terrorist scenarios are considered more likely near the points of delivery than at the water sources before the water treatment . Release of biological agents is more likely for a single building or a neighborhood. Counter-measures against this scenario include the further limitation of access to the water supply systems, tunnels, and infrastructure. Agricultural crop-duster flights might be misused as delivery devices for biological agents as well. Counter-measures against this scenario are background checks of employees of crop-dusting companies and surveillance procedures. In the most common hoax scenario, no biological agents are employed. For instance, an envelope with powder in it that says, "You've just been exposed to anthrax." Such hoaxes have been shown to have a large psychological impact on the population . Anti-agriculture attacks are considered to require relatively little expertise and technology. Biological agents that attack livestock, fish, vegetation, and crops are mostly not contagious to humans and are therefore easier for attackers to handle. Even a few cases of infection can disrupt a country's agricultural production and exports for months, as evidenced by FMD outbreaks.Under current United States law , bio-agents which have been declared by the U.S. Department of Health and Human Services or the U.S. Department of Agriculture to have the "potential to pose a severe threat to public health and safety" are officially defined as " select agents ." The CDC categorizes these agents (A, B or C) and administers the Select Agent Program , which regulates the laboratories which may possess, use, or transfer select agents within the United States. As with US attempts to categorize harmful recreational drugs, designer viruses are not yet categorized and avian H5N1 has been shown to achieve high mortality and human-communication in a laboratory setting. These high-priority agents pose a risk to national security, can be easily transmitted and disseminated, result in high mortality, have potential major public health impact, may cause public panic, or require special action for public health preparedness. Category B agents are moderately easy to disseminate and have low mortality rates. Category C agents are emerging pathogens that might be engineered for mass dissemination because of their availability, ease of production and dissemination, high mortality rate, or ability to cause a major health impact.These high-priority agents pose a risk to national security, can be easily transmitted and disseminated, result in high mortality, have potential major public health impact, may cause public panic, or require special action for public health preparedness.Category B agents are moderately easy to disseminate and have low mortality rates.Category C agents are emerging pathogens that might be engineered for mass dissemination because of their availability, ease of production and dissemination, high mortality rate, or ability to cause a major health impact.Planning may involve the development of biological identification systems. Until recently in the United States, most biological defense strategies have been geared to protecting soldiers on the battlefield rather than ordinary people in cities. Financial cutbacks have limited the tracking of disease outbreaks. Some outbreaks, such as food poisoning due to E. coli or Salmonella , could be of either natural or deliberate origin. Export controls on biological agents are not applied uniformly, providing terrorists a route for acquisition. Laboratories are working on advanced detection systems to provide early warning, identify contaminated areas and populations at risk, and to facilitate prompt treatment. Methods for predicting the use of biological agents in urban areas as well as assessing the area for the hazards associated with a biological attack are being established in major cities. In addition, forensic technologies are working on identifying biological agents, their geographical origins and/or their initial source. Efforts include decontamination technologies to restore facilities without causing additional environmental concerns. Early detection and rapid response to bioterrorism depend on close cooperation between public health authorities and law enforcement; however, such cooperation is lacking. National detection assets and vaccine stockpiles are not useful if local and state officials do not have access to them. Aspects of protection against bioterrorism in the United States include: On a CNN news broadcast in 2011, the CNN chief medical correspondent, Dr. Sanjay Gupta, weighed in on the American government's recent approach to bioterrorist threats. He explains how, even though the United States would be better fending off bioterrorist attacks now than they would be a decade ago, the amount of money available to fight bioterrorism over the last three years has begun to decrease. Looking at a detailed report that examined the funding decrease for bioterrorism in fifty-one American cities, Dr. Gupta stated that the cities "wouldn't be able to distribute vaccines as well" and "wouldn't be able to track viruses." He also said that film portrayals of global pandemics, such as Contagion , were actually quite possible and may occur in the United States under the right conditions. A news broadcast by MSNBC in 2010 also stressed the low levels of bioterrorism preparedness in the United States. The broadcast stated that a bipartisan report gave the Obama administration a failing grade for its efforts to respond to a bioterrorist attack. The news broadcast invited the former New York City police commissioner, Howard Safir, to explain how the government would fare in combating such an attack. He said how "biological and chemical weapons are probable and relatively easy to disperse." Furthermore, Safir thought that efficiency in bioterrorism preparedness is not necessarily a question of money, but is instead dependent on putting resources in the right places. The broadcast suggested that the nation was not ready for something more serious. In a September 2016 interview conducted by Homeland Preparedness News, Daniel Gerstein, a senior policy researcher for the RAND Corporation, stresses the importance in preparing for potential bioterrorist attacks on the nation. He implored the U.S. government to take the proper and necessary actions to implement a strategic plan of action to save as many lives as possible and to safeguard against potential chaos and confusion. He believes that because there have been no significant instances of bioterrorism since the anthrax attacks in 2001, the government has allowed itself to become complacent making the country that much more vulnerable to unsuspecting attacks, thereby further endangering the lives of U.S. citizens. Gerstein formerly served in the Science and Technology Directorate of the Department of Homeland Security from 2011 to 2014. He claims there has not been a serious plan of action since 2004 during George W. Bush's presidency, in which he issued a Homeland Security directive delegating responsibilities among various federal agencies. He also stated that the blatant mishandling of the Ebola virus outbreak in 2014 attested to the government's lack of preparation. This past May, legislation that would create a national defense strategy was introduced in the Senate, coinciding with the timing of ISIS-affiliated terrorist groups get closer to weaponizing biological agents. In May 2016, Kenyan officials apprehended two members of an Islamic extremist group in motion to set off a biological bomb containing anthrax. Mohammed Abdi Ali, the believed leader of the group, who was a medical intern, was arrested along with his wife, a medical student. The two were caught just before carrying out their plan. The Blue Ribbon Study Panel on Biodefense, which comprises a group of experts on national security and government officials, in which Gerstein had previously testified to, submitted its National Blueprint for Biodefense to Congress in October 2015 listing their recommendations for devising an effective plan. Bill Gates said in a February 18, 2017 Business Insider op-ed (published near the time of his Munich Security Conference speech) that it is possible for an airborne pathogen to kill at least 30 million people over the course of a year. In a New York Times report, the Gates Foundation predicted that a modern outbreak similar to the Spanish Influenza pandemic (which killed between 50 million and 100 million people) could end up killing more than 360 million people worldwide, even considering widespread availability of vaccines and other healthcare tools. The report cited increased globalization , rapid international air travel, and urbanization as increased reasons for concern. In a March 9, 2017, interview with CNBC, former U.S. Senator Joe Lieberman , who was co-chair of the bipartisan Blue Ribbon Study Panel on Biodefense , said a worldwide pandemic could end the lives of more people than a nuclear war. Lieberman also expressed worry that a terrorist group like ISIS could develop a synthetic influenza strain and introduce it to the world to kill civilians. In July 2017, Robert C. Hutchinson, former agent at the Department of Homeland Security , called for a "whole-of-government" response to the next global health threat, which he described as including strict security procedures at our borders and proper execution of government preparedness plans. Also, novel approaches in biotechnology, such as synthetic biology, could be used in the future to design new types of biological warfare agents. Special attention has to be laid on future experiments (of concern) that: Would demonstrate how to render a vaccine ineffective; Would confer resistance to therapeutically useful antibiotics or antiviral agents; Would enhance the virulence of a pathogen or render a nonpathogen virulent; Would increase transmissibility of a pathogen; Would alter the host range of a pathogen; Would enable the evasion of diagnostic/detection tools; Would enable the weaponization of a biological agent or toxin Most of the biosecurity concerns in synthetic biology, however, are focused on the role of DNA synthesis and the risk of producing genetic material of lethal viruses (e.g. 1918 Spanish flu, polio) in the lab. The CRISPR/Cas system has emerged as a promising technique for gene editing. It was hailed by The Washington Post as "the most important innovation in the synthetic biology space in nearly 30 years." While other methods take months or years to edit gene sequences, CRISPR speeds that time up to weeks. However, due to its ease of use and accessibility, it has raised a number of ethical concerns, especially surrounding its use in the biohacking space. In 1999, the University of Pittsburgh 's Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS (Real-Time Outbreak Disease Surveillance) . RODS is designed to collect data from many data sources and use them to perform signal detection, that is, to detect a possible bioterrorism event at the earliest possible moment. RODS, and other systems like it, collect data from sources including clinic data, laboratory data, and data from over-the-counter drug sales. In 2000, Michael Wagner, the codirector of the RODS laboratory, and Ron Aryel , a subcontractor, conceived the idea of obtaining live data feeds from "non-traditional" (non-health-care) data sources. The RODS laboratory's first efforts eventually led to the establishment of the National Retail Data Monitor, a system which collects data from 20,000 retail locations nationwide. On February 5, 2002, George W. Bush visited the RODS laboratory and used it as a model for a $ 300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple , Bush compared the RODS system to a modern " DEW " line (referring to the Cold War ballistic missile early warning system). The principles and practices of biosurveillance, a new interdisciplinary science, were defined and described in the Handbook of Biosurveillance , edited by Michael Wagner, Andrew Moore and Ron Aryel, and published in 2006. Biosurveillance is the science of real-time disease outbreak detection. Its principles apply to both natural and man-made epidemics (bioterrorism). Data which potentially could assist in early detection of a bioterrorism event include many categories of information. Health-related data such as that from hospital computer systems, clinical laboratories, electronic health record systems, medical examiner record-keeping systems, 911 call center computers, and veterinary medical record systems could be of help; researchers are also considering the utility of data generated by ranching and feedlot operations, food processors, drinking water systems, school attendance recording, and physiologic monitors, among others. In Europe , disease surveillance is beginning to be organized on the continent-wide scale needed to track a biological emergency. The system not only monitors infected persons, but attempts to discern the origin of the outbreak. Researchers have experimented with devices to detect the existence of a threat: Some research shows that ultraviolet avalanche photodiodes offer the high gain, reliability and robustness needed to detect anthrax and other bioterrorism agents in the air. The fabrication methods and device characteristics were described at the 50th Electronic Materials Conference in Santa Barbara on June 25, 2008. Details of the photodiodes were also published in the February 14, 2008, issue of the journal Electronics Letters and the November 2007 issue of the journal IEEE Photonics Technology Letters. The United States Department of Defense conducts global biosurveillance through several programs, including the Global Emerging Infections Surveillance and Response System. Another powerful tool developed within New York City for use in countering bioterrorism is the development of the New York City Syndromic Surveillance System. This system is essentially a way of tracking disease progression throughout New York City, and was developed by the New York City Department of Health and Mental Hygiene (NYC DOHMH) in the wake of the 9/11 attacks. The system works by tracking the symptoms of those taken into the emergency department—based on the location of the hospital to which they are taken and their home address—and assessing any patterns in symptoms. These established trends can then be observed by medical epidemiologists to determine if there are any disease outbreaks in any particular locales; maps of disease prevalence can then be created rather easily. This is an obviously beneficial tool in fighting bioterrorism as it provides a means through which such attacks could be discovered in their nascence; assuming bioterrorist attacks result in similar symptoms across the board, this strategy allows New York City to respond immediately to any bioterrorist threats that they may face with some level of alacrity.Export controls on biological agents are not applied uniformly, providing terrorists a route for acquisition. Laboratories are working on advanced detection systems to provide early warning, identify contaminated areas and populations at risk, and to facilitate prompt treatment. Methods for predicting the use of biological agents in urban areas as well as assessing the area for the hazards associated with a biological attack are being established in major cities. In addition, forensic technologies are working on identifying biological agents, their geographical origins and/or their initial source. Efforts include decontamination technologies to restore facilities without causing additional environmental concerns. Early detection and rapid response to bioterrorism depend on close cooperation between public health authorities and law enforcement; however, such cooperation is lacking. National detection assets and vaccine stockpiles are not useful if local and state officials do not have access to them. Aspects of protection against bioterrorism in the United States include: On a CNN news broadcast in 2011, the CNN chief medical correspondent, Dr. Sanjay Gupta, weighed in on the American government's recent approach to bioterrorist threats. He explains how, even though the United States would be better fending off bioterrorist attacks now than they would be a decade ago, the amount of money available to fight bioterrorism over the last three years has begun to decrease. Looking at a detailed report that examined the funding decrease for bioterrorism in fifty-one American cities, Dr. Gupta stated that the cities "wouldn't be able to distribute vaccines as well" and "wouldn't be able to track viruses." He also said that film portrayals of global pandemics, such as Contagion , were actually quite possible and may occur in the United States under the right conditions. A news broadcast by MSNBC in 2010 also stressed the low levels of bioterrorism preparedness in the United States. The broadcast stated that a bipartisan report gave the Obama administration a failing grade for its efforts to respond to a bioterrorist attack. The news broadcast invited the former New York City police commissioner, Howard Safir, to explain how the government would fare in combating such an attack. He said how "biological and chemical weapons are probable and relatively easy to disperse." Furthermore, Safir thought that efficiency in bioterrorism preparedness is not necessarily a question of money, but is instead dependent on putting resources in the right places. The broadcast suggested that the nation was not ready for something more serious. In a September 2016 interview conducted by Homeland Preparedness News, Daniel Gerstein, a senior policy researcher for the RAND Corporation, stresses the importance in preparing for potential bioterrorist attacks on the nation. He implored the U.S. government to take the proper and necessary actions to implement a strategic plan of action to save as many lives as possible and to safeguard against potential chaos and confusion. He believes that because there have been no significant instances of bioterrorism since the anthrax attacks in 2001, the government has allowed itself to become complacent making the country that much more vulnerable to unsuspecting attacks, thereby further endangering the lives of U.S. citizens. Gerstein formerly served in the Science and Technology Directorate of the Department of Homeland Security from 2011 to 2014. He claims there has not been a serious plan of action since 2004 during George W. Bush's presidency, in which he issued a Homeland Security directive delegating responsibilities among various federal agencies. He also stated that the blatant mishandling of the Ebola virus outbreak in 2014 attested to the government's lack of preparation. This past May, legislation that would create a national defense strategy was introduced in the Senate, coinciding with the timing of ISIS-affiliated terrorist groups get closer to weaponizing biological agents. In May 2016, Kenyan officials apprehended two members of an Islamic extremist group in motion to set off a biological bomb containing anthrax. Mohammed Abdi Ali, the believed leader of the group, who was a medical intern, was arrested along with his wife, a medical student. The two were caught just before carrying out their plan. The Blue Ribbon Study Panel on Biodefense, which comprises a group of experts on national security and government officials, in which Gerstein had previously testified to, submitted its National Blueprint for Biodefense to Congress in October 2015 listing their recommendations for devising an effective plan. Bill Gates said in a February 18, 2017 Business Insider op-ed (published near the time of his Munich Security Conference speech) that it is possible for an airborne pathogen to kill at least 30 million people over the course of a year. In a New York Times report, the Gates Foundation predicted that a modern outbreak similar to the Spanish Influenza pandemic (which killed between 50 million and 100 million people) could end up killing more than 360 million people worldwide, even considering widespread availability of vaccines and other healthcare tools. The report cited increased globalization , rapid international air travel, and urbanization as increased reasons for concern. In a March 9, 2017, interview with CNBC, former U.S. Senator Joe Lieberman , who was co-chair of the bipartisan Blue Ribbon Study Panel on Biodefense , said a worldwide pandemic could end the lives of more people than a nuclear war. Lieberman also expressed worry that a terrorist group like ISIS could develop a synthetic influenza strain and introduce it to the world to kill civilians. In July 2017, Robert C. Hutchinson, former agent at the Department of Homeland Security , called for a "whole-of-government" response to the next global health threat, which he described as including strict security procedures at our borders and proper execution of government preparedness plans. Also, novel approaches in biotechnology, such as synthetic biology, could be used in the future to design new types of biological warfare agents. Special attention has to be laid on future experiments (of concern) that: Would demonstrate how to render a vaccine ineffective; Would confer resistance to therapeutically useful antibiotics or antiviral agents; Would enhance the virulence of a pathogen or render a nonpathogen virulent; Would increase transmissibility of a pathogen; Would alter the host range of a pathogen; Would enable the evasion of diagnostic/detection tools; Would enable the weaponization of a biological agent or toxin Most of the biosecurity concerns in synthetic biology, however, are focused on the role of DNA synthesis and the risk of producing genetic material of lethal viruses (e.g. 1918 Spanish flu, polio) in the lab. The CRISPR/Cas system has emerged as a promising technique for gene editing. It was hailed by The Washington Post as "the most important innovation in the synthetic biology space in nearly 30 years." While other methods take months or years to edit gene sequences, CRISPR speeds that time up to weeks. However, due to its ease of use and accessibility, it has raised a number of ethical concerns, especially surrounding its use in the biohacking space. In 1999, the University of Pittsburgh 's Center for Biomedical Informatics deployed the first automated bioterrorism detection system, called RODS (Real-Time Outbreak Disease Surveillance) . RODS is designed to collect data from many data sources and use them to perform signal detection, that is, to detect a possible bioterrorism event at the earliest possible moment. RODS, and other systems like it, collect data from sources including clinic data, laboratory data, and data from over-the-counter drug sales. In 2000, Michael Wagner, the codirector of the RODS laboratory, and Ron Aryel , a subcontractor, conceived the idea of obtaining live data feeds from "non-traditional" (non-health-care) data sources. The RODS laboratory's first efforts eventually led to the establishment of the National Retail Data Monitor, a system which collects data from 20,000 retail locations nationwide. On February 5, 2002, George W. Bush visited the RODS laboratory and used it as a model for a $ 300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple , Bush compared the RODS system to a modern " DEW " line (referring to the Cold War ballistic missile early warning system). The principles and practices of biosurveillance, a new interdisciplinary science, were defined and described in the Handbook of Biosurveillance , edited by Michael Wagner, Andrew Moore and Ron Aryel, and published in 2006. Biosurveillance is the science of real-time disease outbreak detection. Its principles apply to both natural and man-made epidemics (bioterrorism). Data which potentially could assist in early detection of a bioterrorism event include many categories of information. Health-related data such as that from hospital computer systems, clinical laboratories, electronic health record systems, medical examiner record-keeping systems, 911 call center computers, and veterinary medical record systems could be of help; researchers are also considering the utility of data generated by ranching and feedlot operations, food processors, drinking water systems, school attendance recording, and physiologic monitors, among others. In Europe , disease surveillance is beginning to be organized on the continent-wide scale needed to track a biological emergency. The system not only monitors infected persons, but attempts to discern the origin of the outbreak. Researchers have experimented with devices to detect the existence of a threat: Some research shows that ultraviolet avalanche photodiodes offer the high gain, reliability and robustness needed to detect anthrax and other bioterrorism agents in the air. The fabrication methods and device characteristics were described at the 50th Electronic Materials Conference in Santa Barbara on June 25, 2008. Details of the photodiodes were also published in the February 14, 2008, issue of the journal Electronics Letters and the November 2007 issue of the journal IEEE Photonics Technology Letters. The United States Department of Defense conducts global biosurveillance through several programs, including the Global Emerging Infections Surveillance and Response System. Another powerful tool developed within New York City for use in countering bioterrorism is the development of the New York City Syndromic Surveillance System. This system is essentially a way of tracking disease progression throughout New York City, and was developed by the New York City Department of Health and Mental Hygiene (NYC DOHMH) in the wake of the 9/11 attacks. The system works by tracking the symptoms of those taken into the emergency department—based on the location of the hospital to which they are taken and their home address—and assessing any patterns in symptoms. These established trends can then be observed by medical epidemiologists to determine if there are any disease outbreaks in any particular locales; maps of disease prevalence can then be created rather easily. This is an obviously beneficial tool in fighting bioterrorism as it provides a means through which such attacks could be discovered in their nascence; assuming bioterrorist attacks result in similar symptoms across the board, this strategy allows New York City to respond immediately to any bioterrorist threats that they may face with some level of alacrity.Government agencies which would be called on to respond to a bioterrorism incident would include law enforcement, hazardous materials and decontamination units, and emergency medical units, if available. The US military has specialized units, which can respond to a bioterrorism event; among them are the United States Marine Corps ' Chemical Biological Incident Response Force and the U.S. Army 's 20th Support Command (CBRNE) , which can detect, identify, and neutralize threats, and decontaminate victims exposed to bioterror agents. US response would include the Centers for Disease Control . Historically, governments and authorities have relied on quarantines to protect their populations. International bodies such as the World Health Organization already devote some of their resources to monitoring epidemics and have served clearing-house roles in historical epidemics. Media attention toward the seriousness of biological attacks increased in 2013 to 2014. In July 2013, Forbes published an article with the title "Bioterrorism: A Dirty Little Threat With Huge Potential Consequences." In November 2013, Fox News reported on a new strain of botulism, saying that the Centers for Disease and Control lists botulism as one of two agents that have "the highest risks of mortality and morbidity", noting that there is no antidote for botulism. USA Today reported that the U.S. military in November was trying to develop a vaccine for troops from the bacteria that cause the disease Q fever, an agent the military once used as a biological weapon. In February 2014, the former special assistant and senior director for biodefense policy to President George W. Bush called the bioterrorism risk imminent and uncertain and Congressman Bill Pascrell called for increasing federal measures against bioterrorism as a "matter of life or death." The New York Times wrote a story saying the United States would spend $40 million to help certain low and middle-income countries deal with the threats of bioterrorism and infectious diseases. Bill Gates has warned that bioterrorism could kill more people than nuclear war. In February 2018, a CNN employee discovered on an airplane a "sensitive, top-secret document in the seatback pouch explaining how the Department of Homeland Security would respond to a bioterrorism attack at the Super Bowl ." President Donald Trump promoted his first budget around keeping America safe. However, one aspect of defense would receive less money: "protecting the nation from deadly pathogens, man-made or natural," according to The New York Times . Agencies tasked with biosecurity get a decrease in funding under the Administration's budget proposal. For example: "The next weapon of mass destruction may not be a bomb," Lawrence O. Gostin, the director of the World Health Organization's Collaborating Center on Public Health Law and Human Rights, told The New York Times . "It may be a tiny pathogen that you can't see, smell or taste, and by the time we discover it, it'll be too late." Tom Inglesy, the CEO and director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health and an internationally recognized expert on public health preparedness, pandemic and emerging infectious disease said in 2017 that the lack of an internationally standardized approval process that could be used to guide countries in conducting public health experiments for resurrecting a disease that has already been eradicated increases the risk that the disease could be used in bioterrorism. This was in reference to the lab synthesis of horsepox in 2017 by researchers at the University of Alberta . The researchers recreated horsepox, an extinct cousin of the smallpox virus , in order to research new ways to treat cancer. President Donald Trump promoted his first budget around keeping America safe. However, one aspect of defense would receive less money: "protecting the nation from deadly pathogens, man-made or natural," according to The New York Times . Agencies tasked with biosecurity get a decrease in funding under the Administration's budget proposal. For example: "The next weapon of mass destruction may not be a bomb," Lawrence O. Gostin, the director of the World Health Organization's Collaborating Center on Public Health Law and Human Rights, told The New York Times . "It may be a tiny pathogen that you can't see, smell or taste, and by the time we discover it, it'll be too late." Tom Inglesy, the CEO and director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health and an internationally recognized expert on public health preparedness, pandemic and emerging infectious disease said in 2017 that the lack of an internationally standardized approval process that could be used to guide countries in conducting public health experiments for resurrecting a disease that has already been eradicated increases the risk that the disease could be used in bioterrorism. This was in reference to the lab synthesis of horsepox in 2017 by researchers at the University of Alberta . The researchers recreated horsepox, an extinct cousin of the smallpox virus , in order to research new ways to treat cancer. Dissemination: Sponge cake, other food sources Official investigation started after anonymous tip to Ministry of Health and Welfare. He was charged, but was not convicted of any deaths; later implicated in 200 – 400 illnesses and 4 deaths 751 illnesses, Early investigation by CDC suggested the event was a naturally occurring outbreak. Cult member arrested on unrelated charge confessed involvement with the event Aum Shinrikyo experimented with Botulinum toxin , Q fever , Cholera and Anthrax . An attempt was also made at sourcing Ebola from Africa. Several attempts were made between 1990 and 1995, but they failed to cause any casualties due to non-virulent strains and issues with deliver systems. Chemical attacks with sarin would end up killing around 20 people. Infected 12 of her coworkers, she was arrested, convicted, & sentenced to 20 years in prison Suspected perpetrator was a US DOD scientist 22 infected, 5 deaths

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/Urban_plague/html

Urban plague

Urban plague is an infectious disease among rodent species that live in close association with humans in urban areas. It is caused by the bacterium Yersinia pestis which is the same bacterium that causes bubonic and pneumonic plague in humans. Plague was first introduced into the United States in 1900 by rat–infested steamships that had sailed from affected areas, mostly from Asia. Urban plague spread from urban rats to rural rodent species, especially among prairie dogs in the western United States. Common vectors for urban plague are house mice, black rats, and Norway rats. Urban plague can be spread from animals to humans via flea bites and handling of infected fluids and tissues. Human to human infection occurs from droplets that contain plague bacteria which are produced when an infected person coughs.

Wiki

Pneumonic plague

https://api.wikimedia.org/core/v1/wikipedia/en/page/History_of_plague/html

History of plague

Globally about 600 cases of plague are reported a year. In 2017 and November 2019 the countries with the most cases include the Democratic Republic of the Congo , Madagascar , and Peru . Local outbreaks of the plague are grouped into three plague pandemics , whereby the respective start and end dates and the assignment of some outbreaks to either pandemic are still subject to discussion. The pandemics were: However, the late medieval Black Death (roughly 1331 to 1353) is sometimes seen not as the start of the second, but as the end of the first pandemic – in that case, the first pandemic ended in around 1353, and the second pandemic's start would be about 1361. Also various end dates of the second pandemic are given in the literature, ranging from about 1840 to 1890. The word plague is believed to come from the Latin word plāga ("blow, wound") and plangere ("to strike, or to strike down"), via the German Plage ("infestation"). [ citation needed ] Some authors have suggested that the plague was responsible for the Neolithic decline . That is supported by the discovery of a tomb in modern-day Sweden containing 79 corpses buried within a short time, in which the authors discovered fragments of a unique strain of the plague pathogen Yersinia pestis . Plasmids of Y. pestis have been detected in archaeological samples of the teeth of seven Bronze Age individuals from 5000 years ago (3000 BC), in the Afanasievo culture in Siberia, the Corded Ware culture in Estonia, the Sintashta culture in Russia, the Unetice culture in Poland and the Andronovo culture in Siberia. Y. pestis existed over Eurasia during the Bronze Age. Estimates of the age of the most recent common ancestor of all Y. pestis is estimated at 5,783 years Before Present . The Yersinia murine toxin ( ymt ) allows the bacteria to infect fleas, which can then transmit bubonic plague. Early ancestral versions of Y. pestis did not have the ymt gene, which was only detected in a 951 calibrated BC sample. The Amarna letters and the Plague Prayers of Mursili II describe an outbreak of a disease among the Hittites . The First Book of Samuel describes a possible plague outbreak in Philistia , and the Septuagint version says it was caused by a "ravaging of mice". In the second year of the Peloponnesian War (430 BC), Thucydides described an epidemic disease which was said to have begun in Ethiopia , passed through Egypt and Libya , then come to the Greek world. In the Plague of Athens , the city lost possibly one third of its population, including Pericles . Modern historians disagree on whether the plague was a critical factor in the loss of the war. Although this epidemic has long been considered an outbreak of plague, many modern scholars believe that typhus , smallpox , or measles may better fit the surviving descriptions. A recent study of DNA found in the dental pulp of plague victims suggests that typhoid was actually responsible. In the first century AD, Rufus of Ephesus , a Greek anatomist, refers to an outbreak of plague in Libya , Egypt , and Syria . He records that Alexandrian doctors named Dioscorides and Posidonius described symptoms including acute fever, pain, agitation, and delirium. Buboes—large, hard, and non-suppurating—developed behind the knees, around the elbows, and "in the usual places." The death toll of those infected was very high. Rufus also wrote that similar buboes were reported by a Dionysius Curtus, who may have practiced medicine in Alexandria in the third century BC. If this is correct, the eastern Mediterranean world may have been familiar with bubonic plague at that early date. In the second century, the Antonine Plague , named after Marcus Aurelius ' family name of Antoninus and also known as the Plague of Galen, who had first hand knowledge of the disease, may in fact have been smallpox . Galen was in Rome when it struck in 166 AD, and was also present in the winter of 168–69 during an outbreak among troops stationed at Aquileia ; he had experience with the epidemic, referring to it as very long lasting, and describes its symptoms and his treatment of it, though his references are scattered and brief. According to Barthold Georg Niebuhr "this pestilence must have raged with incredible fury; it carried off innumerable victims. The ancient world never recovered from the blow inflected upon it by the plague which visited it in the reign of M. Aurelius." The mortality rate of the plague was 7–10 percent; the outbreak in 165/6–168 would have caused approximately 3.5 to 5 million deaths. [ citation needed ] Otto Seek believes that over half the population of the empire perished. [ citation needed ] J. F. Gilliam believes that the Antonine plague probably caused more deaths than any other epidemic during the empire before the mid-3rd century. [ citation needed ]The Plague of Justinian in AD 541–542 is the first known attack on record, and marks the first firmly recorded pattern of bubonic plague. This disease is thought to have originated in China. It then spread to Africa from where the huge city of Constantinople imported massive amounts of grain, mostly from Egypt, to feed its citizens. The grain ships were the source of contagion for the city, with massive public granaries nurturing the rat and flea population. At its peak, Procopius said the plague was killing 10,000 people in Constantinople every day. The real number was more likely close to 5,000 a day. The plague ultimately killed perhaps 40% of the city's inhabitants, and then continued to kill up to a quarter of the human population of the eastern Mediterranean. [ citation needed ] In AD 588 a second major wave of plague spread through the Mediterranean into what is now France. It is estimated that the Plague of Justinian killed as many as 100 million people across the world. It caused Europe's population to drop by around 50% between 541 and 700. It also may have contributed to the success of the Arab conquests . An outbreak of it in the AD 560s was described in AD 790 as causing "swellings in the glands ... in the manner of a nut or date" in the groin "and in other rather delicate places followed by an unbearable fever". While the swellings in this description have been identified by some as buboes, there is some contention as to whether the pandemic should be attributed to the bubonic plague, Yersinia pestis , known in modern times. From 1331 to 1351, the Black Death , a massive and deadly pandemic originating in China, spread along the Silk Road and swept through Asia, Europe and Africa. It may have reduced the world's population from 450 million to between 350 and 375 million . China lost around half of its population, from around 123 million to around 65 million ; Europe around one third of its population, from about 75 million to about 50 million ; and Africa approximately 1 ⁄ 8 of its population, from around 80 million to 70 million (mortality rates tended to be correlated with population density so Africa, being less dense overall, had the lowest death rate). This makes the Black Death the largest death toll from any known non-viral epidemic. Although accurate statistical data does not exist, it is thought that 1.4 million died in England ( 1 ⁄ 3 of England's 4.2 million people), while an even higher percentage of Italy's population was likely wiped out. On the other hand, north-eastern Germany, Bohemia, Poland and Hungary are believed to have suffered less, and there are no estimates available for Russia or the Balkans. It is conceivable that Russia may not have been as affected due to its very cold climate and large size, hence often less close contact with the contagion. The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to Biraben, plague was present somewhere in Europe in every year between 1346 and 1671. The Second Pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667; subsequent outbreaks, though severe, marked the retreat from most of Europe (18th century) and northern Africa (19th century). According to Geoffrey Parker, " France alone lost almost a million people to plague in the epidemic of 1628–31." In England, in the absence of census figures, historians propose a range of pre-incident population figures from as high as 7 million to as low as 4 million in 1300, and a postincident population figure as low as 2 million. By the end of 1350, the Black Death subsided, but it never really died out in England. Over the next few hundred years, further outbreaks occurred in 1361–62, 1369, 1379–83, 1389–93, and throughout the first half of the 15th century. An outbreak in 1471 took as much as 10–15% of the population, while the death rate of the plague of 1479–80 could have been as high as 20%. The most general outbreaks in Tudor and Stuart England seem to have begun in 1498, 1535, 1543, 1563, 1589, 1603, 1625, and 1636, and ended with the Great Plague of London in 1665. In 1466, perhaps 40,000 people died of plague in Paris. During the 16th and 17th centuries, plague visited Paris for almost one year out of three. The Black Death ravaged Europe for three years before it continued on into Russia, where the disease hit somewhere once every five or six years from 1350 to 1490. Plague epidemics ravaged London in 1563, 1593, 1603, 1625, 1636, and 1665, reducing its population by 10 to 30% during those years. Over 10% of Amsterdam 's population died in 1623–1625, and again in 1635–1636, 1655, and 1664. There were 22 outbreaks of plague in Venice between 1361 and 1528. The plague of 1576–1577 killed 50,000 in Venice, almost a third of the population. Late outbreaks in central Europe included the Italian Plague of 1629–1631 , which is associated with troop movements during the Thirty Years' War , and the Great Plague of Vienna in 1679. Over 60% of Norway's population died from 1348 to 1350. The last plague outbreak ravaged Oslo in 1654. In the first half of the 17th century, the Great Plague of Milan claimed some 1.7 million victims in Italy, or about 14% of the population. In 1656, the plague killed about half of Naples ' 300,000 inhabitants. More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain . The plague of 1649 probably reduced the population of Seville by half. In 1709–1713, a plague epidemic that followed the Great Northern War (1700–1721, Sweden v. Russia and allies) killed about 100,000 in Sweden, and 300,000 in Prussia. The plague killed two-thirds of the inhabitants of Helsinki , and claimed a third of Stockholm 's population. Western Europe's last major epidemic occurred in 1720 in Marseilles , in Central Europe the last major outbreaks happened during the plague during the Great Northern War , and in Eastern Europe during the Russian plague of 1770–72 . The Black Death ravaged much of the Islamic world . Plague was present in at least one location in the Islamic world virtually every year between 1500 and 1850. Plague repeatedly struck the cities of North Africa. Algiers lost 30,000–50,000 to it in 1620–1621, and again in 1654–1657, 1665, 1691, and 1740–1742. Plague remained a major event in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, 37 larger and smaller epidemics were recorded in Constantinople , and 31 between 1751 and 1800. Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population has been wiped out. The Third Pandemic began in China's Yunnan province in 1855, spreading plague to all inhabited continents and ultimately killing more than 12 million people in India and China alone. Casualty patterns indicate that waves of this pandemic may have come from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, transporting infected persons, rats, and cargoes harboring fleas. The second, more virulent, strain was primarily pneumonic in character, with a strong person-to-person contagion. This strain was largely confined to Manchuria and Mongolia . Researchers during the "Third Pandemic" identified plague vectors and the plague bacterium (see above), leading in time to modern treatment methods. [ citation needed ] Plague occurred in Russia in 1877–1889 in rural areas near the Ural Mountains and the Caspian Sea . Efforts in hygiene and patient isolation reduced the spread of the disease, with approximately 420 deaths in the region. Significantly, the region of Vetlianka in this area is near a population of the bobak marmot , a small rodent considered a very dangerous plague reservoir. The last significant Russian outbreak of Plague was in Siberia in 1910 after sudden demand for marmot skins (a substitute for sable ) increased the price by 400 percent. The traditional hunters would not hunt a sick Marmot and it was taboo to eat the fat from under the arm (the axillary lymphatic gland that often harboured the plague) so outbreaks tended to be confined to single individuals. The price increase, however, attracted thousands of Chinese hunters from Manchuria who not only caught the sick animals but also ate the fat, which was considered a delicacy. The plague spread from the hunting grounds to the terminus of the Chinese Eastern Railway and then followed the track for 2,700 km. The plague lasted 7 months and killed 60,000 people. [ citation needed ] The bubonic plague continued to circulate through different ports globally for the next fifty years; however, it was primarily found in Southeast Asia. The 1894 Hong Kong plague had particularly high death rates, 90%. As late as 1897, medical authorities in the European powers organized a conference in Venice , seeking ways to keep the plague out of Europe. Mumbai plague epidemic struck the city of Bombay (Mumbai) in 1896. The disease reached the Territory of Hawaii in December 1899, and the Board of Health's decision to initiate controlled burns of select buildings in Honolulu 's Chinatown turned into an uncontrolled fire which led to the inadvertent burning of most of Chinatown on January 20, 1900. Shortly thereafter, plague reached the continental US, initiating the San Francisco plague of 1900–1904 . Plague persisted in Hawaii on the outer islands of Maui and Hawaii (The Big Island) until it was finally eradicated in 1960. Research done by a team of biologists from the Institute of Pasteur in Paris and Johannes Gutenberg University Mainz in Germany by analyzing the DNA and proteins from plague pits, published in October 2010, reported beyond doubt that all 'the three major plagues' were due to at least two previously unknown strains of Yersinia pestis and originated from China. A team of medical geneticists led by Mark Achtman of University College Cork in Ireland reconstructed a family tree of the bacterium and concluded in an online issue of Nature Genetics published on 31 October 2010 that all three of the great waves of plague originated from China. Plague cases were massively reduced during the second half of the 20th century, but outbreaks still occurred, especially in developing countries. Between 1954 and 1997, human plague was reported in 38 countries, making the disease a re-emerging threat to human health. Between 1987 and 2001, 36,876 confirmed cases of plague with 2,847 deaths are reported to the World Health Organization . In the 21st century, fewer than 200 people die of the plague worldwide each year, mainly due to lack of treatment. Plague is considered to be endemic in 26 countries around the world, with most cases found in remote areas of Africa . The three most endemic countries are Madagascar , the Democratic Republic of the Congo and Peru . Outbreaks with dozens of deaths occurred in Madagascar in 2014 and 2017 , in India in 1994 , and Congo in 2006. During 1995, plague was confirmed in the United States from nine western states. Currently, five to 15 people in the United States are estimated to catch the disease each year — typically in western states. The reservoir is thought to be mice. In the U.S., about half of all fatal cases of plague since 1970 have occurred in New Mexico . There were two plague deaths in the state in 2006, the first fatalities in 12 years. In New Mexico, four people were diagnosed with the plague in 2015; one died. In 2016, four were diagnosed and all were treated with success. Three others were diagnosed by late June in 2017. Vegetation such as pinyon and juniper trees are thought to support rodents such as the prairie dog and rock squirrel, with their fleas, according to Paul Ettestad of the New Mexico public health department. As well, pets can bring back fleas from dead rodents, he said. The CDC indicates that over the past century, plague in the U.S. has been most common in the areas of northern New Mexico, northwestern Arizona and southern Colorado. There was an outbreak of the bubonic plague in the Nyimba district of Eastern Zambia in 2015. Epidemiologists estimated a basic reproduction number of 1.75 with a 95 percent confidence interval ranging from 1.51 to 1.98. This is almost certainly substantially lower than how the plague propagated during the Black Death pandemic of the fourteenth century with the with living conditions and existing genetic diversity in the human population at that time.

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National Family Health Survey

The National Family Health Survey (NFHS) is an India-wide survey conducted by the Ministry of Health and Family Welfare , Government of India , with the International Institute for Population Sciences serving as the nodal agency. In 1992–93, the first round of the National Family Health Survey was conducted in three phases. The main objective of the survey was to collect reliable and up-to-date information on fertility , family planning , mortality , and maternal and child health . Subsequently, three other rounds were conducted between 1998 and 2016. The latest survey is NFHS 5, which started in 2019. However, the survey was stalled amid the COVID-19 associated lockdown . Eventually, the NFHS-5 findings were released in December 2020. Based on these findings, the ministry has set up a technical expert group to improve indicators pertaining to Malnutrition , Stunting , Anaemia , and C-Section .

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Pneumonic plague

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Hantavirus pulmonary syndrome

Hantavirus pulmonary syndrome ( HPS ) is one of two potentially fatal syndromes of zoonotic origin caused by species of hantavirus . These include Black Creek Canal virus (BCCV), New York orthohantavirus (NYV), Monongahela virus (MGLV), Sin Nombre orthohantavirus (SNV), and certain other members of hantavirus genera that are native to the United States and Canada. Specific rodents are the principal hosts of the hantaviruses including the hispid cotton rat ( Sigmodon hispidus ) in southern Florida , which is the principal host of Black Creek Canal virus. The deer mouse ( Peromyscus maniculatus ) in Canada and the Western United States is the principal host of Sin Nombre virus . The white-footed mouse ( Peromyscus leucopus ) in the eastern United States is the principal host of New York virus. In South America , the long-tailed mouse ( Oligoryzomys longicaudatus ) and other species of the genus Oligoryzomys have been documented as the reservoir for Andes virus . Initially, HPS has an incubation phase of 2–4 weeks, in which patients remain asymptomatic. Subsequently, patients can experience 3–5 days of flu-like prodromal phase symptoms, including fever , cough, muscle pain , headache, lethargy, shortness of breath , nausea, vomiting and diarrhea. In the following 5–7 day cardiopulmonary phase, the patient's condition rapidly deteriorates into acute respiratory failure , characterized by the sudden onset of shortness of breath with rapidly evolving pulmonary edema , as well as cardiac failure , with hypotension, tachycardia and shock. In this phase, patients may develop acute respiratory distress syndrome . It is often fatal despite mechanical ventilation and intervention with diuretics . [ citation needed ] After the cardiopulmonary phase, patients can enter a diuretic phase of 2–3 days characterized by symptom improvement and diuresis . Subsequent convalescence can last months to years. As of 2017, patient mortality in the US from HPS is 36%. The virus can be transmitted to humans by a direct bite or inhalation of aerosolized virus, shed from stool, urine, or saliva from a natural reservoir rodent. In general, droplet and/or fomite transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms. The preferred method for diagnosis of Hantavirus Pulmonary Syndrome is serological testing which identifies both acute (IgM) and remote infections (IgG); however, PCR may also be used to identify early infections. Rodent control in and around the home or dwellings remains the primary prevention strategy, as well as eliminating contact with rodents in the workplace and at campsites. Closed storage sheds and cabins are often ideal sites for rodent infestations. Airing out of such spaces prior to use is recommended. People are advised to avoid direct contact with rodent droppings and wear a mask while cleaning such areas to avoid inhalation of aerosolized rodent secretions. There is no cure or vaccine for HPS. Treatment involves supportive therapy, including mechanical ventilation with supplemental oxygen during the critical respiratory-failure stage of the illness. Although ribavirin can be used to treat hantavirus infections, it is not recommended as a treatment for HPS due to unclear clinical efficacy and likelihood of medication side effects. Early recognition of HPS and admission to an intensive care setting offers the best prognosis . Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States . It was identified by Dr. Bruce Tempest. It was originally called Four Corners disease , but the name was changed to Sin Nombre virus after complaints by Native Americans that the name "Four Corners" stigmatized the region. It has since been identified throughout the United States. [ citation needed ]

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Pneumonic plague

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The China Study

The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health is a book by T. Colin Campbell and his son, Thomas M. Campbell II. The book argues for health benefits of a whole food plant-based diet . It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition. The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease , diabetes , breast cancer , prostate cancer , and bowel cancer . The book is "loosely based" on the China–Cornell–Oxford Project , a 20-year study that looked at mortality rates from cancer and other chronic diseases from 1973 to 1975 in 65 counties in China, and correlated this data with 1983–84 dietary surveys and blood work from 100 people in each county. The authors conclude that people who eat a predominantly whole-food, vegan diet —avoiding animal products as a source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates —will escape, reduce, or reverse the development of numerous diseases. They write that "eating foods that contain any cholesterol above 0 mg is unhealthy." The book recommends sunshine exposure or dietary supplements to maintain adequate levels of vitamin D , and supplements of vitamin B 12 in case of complete avoidance of animal products. It criticizes low-carb diets , such as the Atkins diet , which include restrictions on the percentage of calories derived from carbohydrates. The authors are critical of reductionist approaches to the study of nutrition, whereby certain nutrients are blamed for disease, as opposed to studying patterns of nutrition and the interactions between nutrients. The book was first published in 2005. A revised and expanded edition was published in 2016. The book has also been published in German, Polish, Slovenian, Italian, Chinese, Japanese, Korean, Romanian, Swedish and Urdu. Sanjay Gupta , CNN's chief medical correspondent, said in his documentary The Last Heart Attack in 2011 that The China Study had changed the way people all over the world eat. Former American president Bill Clinton became a supporter when he adopted a plant-based diet after a heart attack. Wilfred Niels Arnold, professor of biochemistry at the University of Kansas Medical Center , reviewed the book in Leonardo reviews in 2005: "[T]he authors anticipate resistant and hostile sources, sail on with escalating enthusiasm, and furnish a working hypothesis that is valuable. In fact, the surprising data are difficult to interpret in any other way." Harriet Hall , writing for Science-Based Medicine , said that the book had references that do not support directly the claims made by the authors and that it did not explain the exceptions to his data, such as high rates of stomach cancer in China. Stephan Guyenet reviewing the book for Red Pen Reviews commented that The China Study is a "scholarly and well-written book" but three of its key scientific claims are "not very well supported overall".

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Pneumonic plague

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Anganwadi

Anganwadi ( Hindi pronunciation: [ ãːɡɐnɐʋaːɖiː ] ) is a type of rural child care centre in India .It was started by the Indian government in 1975 as part of the Integrated Child Development Services program to combat child hunger and malnutrition . Anganwadi in Hindi means "courtyard shelter" in English. A typical Anganwadi center provides basic health care in a village. It is a part of the Indian public health care system. Basic health care activities include contraceptive counseling and supply, nutrition education and supplementation, as well as pre-school activities. The centres may be used as depots for oral rehydration salts , basic medicines and contraceptives. As of 31 January 2013 [ update ] , as many as 13.3 lakh (a lakh is 100,000) Anganwadi and mini-Anganwadi centres (AWCs/mini-AWCs) are operational out of 13.7 lakh sanctioned AWCs/mini-AWCs. These centres provide supplementary nutrition, non-formal pre-school education, nutrition, and health education, immunization, health check-up and referral services of which the last three are provided in convergence with public health systems. While as of latest 31 March 2021, 13.87 lakh Anganwadi and mini-Anganwadi centres (AWCs/mini-AWCs) are operational out of 13.99 lakh sanctioned AWCs|AWC/mini-AWCs with the following categorization in the quarterly report : State/UT wise details of growth monitoring in Anganwadi Centers - Total children:-89.1+ lakh Total No. of AWCs/Mini-AWCs with Drinking water facility:-11.9+ lakh Total No. of AWCs/Mini-AWCs with toilet facility:-10+ lakh Other miscellaneous on rented/govt. buildings, nutritional coverage, pre-school education, vacant/in-position/sanctioned posts of AWWs/AWHs/CDPOs/ Supervisors , etc. Despite decades of impressive growth, India has an acute shortage of doctors. The doctor population ratio in 2019-20 was 1:1456; against the WHO recommended level of 1:1000. Through the Anganwadi system, the country is trying to meet its goal of providing affordable and accessible healthcare to local populations. Anganwadi workers have the advantage over the physicians living in the same rural area, which gives them insight into the state of health in the locality and assists in identifying the cause of problems and in countering them. They also have better social skills and can therefore more easily interact with the local people. [ citation needed ] As locals, they know and are comfortable with the local language and ways, are acquainted with the people, and are trusted. Public policy discussions have taken place over whether to make Anganwadis universally available to all eligible children and mothers who want their children there. This would require significant increases in budgetary allocation and a rise in the number of Anganwadis to over 16 lakh. The officers and their helpers who staff Anganwadis are typically women from poor families. The workers do not have permanent jobs with comprehensive retirement benefits like other government staff. Worker protests (by the All India Anganwadi Workers Federation) and public debates on this topic are ongoing. There are periodic reports of corruption and crimes against women in some Anganwadi centers. There are legal and societal issues when Anganwadi-serviced children fall sick or die. In announcing the 2022 budget, then Indian Finance Minister Nirmala Sitharaman stated that salaries would be increased for Anganwadi workers to ₹20,105 per month and for helpers to ₹10,000 per month. But with minuscule increment in the overall umbrella budget of just 0.7%. It has been allocated ₹20,263 crore for the next fiscal, as compared to last year's allocation of ₹20,105 crore. As compared to revised estimate of ₹199999.55 crore there is a 1.3% increase. In March 2008 there was debate about whether packaged foods (such as biscuits) should become part of the food served. Detractors, including Nobel Prize winner Amartya Sen , argued against it, saying that it will become the only food consumed by the children. Options for increasing partnerships with the private sector are continuing. In a major initiative, the work of Anganwadis is being digitized, starting with the 27 most economically disadvantaged districts in Uttar Pradesh: Bihar, Madhya Pradesh, Rajasthan, Odisha and Andhra Pradesh. In March 2021, Anganwadis' workers were provided with a smartphone app to record data that will be integrated with the health ministry, which is involved in carrying out immunization, health check-ups, and nutrition education under Integrated Child Development Services . They were informed that failure to upload digitally-entered records could result in salary and food suspension. Difficulties emerged with this smartphone app's reportedly being hard to use, being written in only English, and demanding more memory than cheap smartphones have. Anganwadi employees, mostly women who earn less than $150 a month, if they even have smartphones, experienced repeated crashes of this app or found that they do not understand enough English to use it. Many lack phone reception and electricity in their villages and ask why meticulously written ledgers, used for years, no longer suffice. In order to ensure growth monitoring of children and home visits, an incentive of Rs. 500 and Rs. 250 is provided per month to Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs). The Integrated Child Development Services scheme did not have provision for the construction of AWC buildings as this was envisaged to be provided by the community except for the North Eastern States. For them, financial support was provided for construction of AWC buildings since 2001-02 at a unit cost of ₹175,000. As part of the strengthening and restructuring the ICDS scheme, the government approved a provision of construction of 200,000 Anganwadi centre buildings at a cost of ₹450,000 per unit during XII Plan period in a phased manner with a cost-sharing ratio of 75:25 between centre and states (other than the NER, where it will be at 90:10). Further, construction of AWC has been notified as a permissible activity under the Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA). The construction of AWC buildings can be taken up in convergence with MNREGA. Planned renaming of few schemes under new umbrella term i.e. Saksham Anganwadi and Poshan 2.0 includes anganwadi services, Poshan Abhiyan, scheme for adolescent girls, and national creche scheme. UNICEF and the UN Millennium Development Goals of reducing infant mortality and improving maternal care are the impetus for increasing focus on the Anganwadis. Workers and helpers are expected to be trained per WHO standards.

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Pneumonic plague

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Black Death in England

The Black Death was a bubonic plague pandemic, which reached England in June 1348. It was the first and most severe manifestation of the second pandemic , caused by Yersinia pestis bacteria . The term Black Death was not used until the late 17th century. Originating in Asia, it spread west along the trade routes across Europe and arrived on the British Isles from the English province of Gascony . The plague was spread by flea-infected rats, as well as individuals who had been infected on the continent. Rats were the reservoir hosts of the Y. pestis bacteria and the Oriental rat flea was the primary vector. The first-known case in England was a seaman who arrived at Weymouth , Dorset, from Gascony in June 1348. By autumn, the plague had reached London, and by summer 1349 it covered the entire country, before dying down by December. Low estimates of mortality in the early 20th century have been revised upwards due to re-examination of data and new information, and a figure of 40–60% of the population is widely accepted. The most immediate consequence was a halt to the campaigns of the Hundred Years' War . In the long term, the decrease in population caused a shortage of labour, with subsequent rise in wages, resisted by the landowners, which caused deep resentment among the lower classes. The Peasants' Revolt of 1381 was largely a result of this resentment, and even though the rebellion was suppressed, in the long term serfdom was ended in England. The Black Death also affected artistic and cultural efforts, and may have helped advance the use of the vernacular. In 1361–1362 the plague returned to England, this time causing the death of around 20% of the population. After this the plague continued to return intermittently throughout the 14th and 15th centuries, in local or national outbreaks. From this point its effect became less severe, and one of the last outbreaks of the plague in England was the Great Plague of London in 1665–1666.It is impossible to establish with any certainty the exact number of inhabitants in England at the eve of the Black Death , and estimates range from 3 to 7 million. The number is probably at the higher end, and an estimate of around 6 million inhabitants seems plausible. Earlier demographic crises—in particular the Great Famine of 1315–1317 —had resulted in great numbers of deaths, but there is no evidence of any significant decrease in the population prior to 1348. England was still a predominantly rural and agrarian society; close to 90 per cent of the population lived in the countryside. Of the major cities, London was in a class of its own, with perhaps as many as 70,000 inhabitants. Further down the scale were Norwich , with around 12,000 people, and York with around 10,000. The main export, and the source of the nation's wealth, was wool. Until the middle of the century the export had consisted primarily of raw wool to cloth makers in Flanders . Gradually though, the technology for cloth making used on the Continent was appropriated by English manufacturers, who started an export of cloths around mid-century that would boom over the following decades. Politically, the kingdom was evolving into a major European power, through the youthful and energetic kingship of Edward III . In 1346, the English had won a decisive battle over the Scots at the Battle of Neville's Cross , and it seemed that Edward III would realise his grandfather Edward I 's ambition of bringing the Scots under the suzerainty of the English crown. The English were also achieving military success on the Continent. Less than two months before the Battle of Neville's Cross, a numerically inferior English army led by the king himself won a spectacular victory over the French royal forces at the Battle of Crécy . The victory was immediately followed by Edward laying siege to the port city of Calais . When the city fell the next year, this provided the English with a strategically important enclave that would remain in their possession for over two centuries. The term "Black Death"—which refers to the first and most serious outbreak of the second pandemic—was not used by contemporaries, who preferred such names as the "Great Pestilence" or the "Great Mortality". It was not until the 17th century that the term under which we know the outbreak today became common, probably derived from Scandinavian languages. It is generally agreed today that the disease in question was plague , caused by Yersinia pestis bacteria . These bacteria are carried by fleas , which can be transferred to humans through contact with rats . Flea bites carry the disease into the lymphatic system , through which it makes its way to the lymph nodes . Here the bacteria multiply and form swellings called buboes , from which the term bubonic plague is derived. After three or four days the bacteria enter the bloodstream, and infect organs such as the spleen and the lungs . The patient will then normally die after a few days. A different strain of the disease is pneumonic plague , where the bacteria become airborne and enter directly into the patient's lungs. This strain is far more virulent, as it spreads directly from person to person. These types of infection probably both played a significant part in the Black Death, while a third strain was more rare. This is the septicaemic plague, where the flea bite carries the bacteria directly into the blood stream, and death occurs very rapidly. A study reported in 2011 of skeletons exhumed from the Black Death cemetery in East Smithfield , London , found Yersinia pestis DNA. An archaeological dig in the vicinity of Thornton Abbey in Lincolnshire was reported in the science section of The Guardian for 30 November 2016, not only confirming evidence of the Y. pestis DNA in the human remains exhumed there but also dating the remains to mid-1349. Genotyping showed that it was [at that time] a newly evolved strain, ancestor of all modern strains and proved the Black Death was bubonic plague. Modern medical knowledge suggests that because it was a new strain, the human immune system would have had little or no defence against it, helping to explain the plague's virulence and high death rates. The Black Death seems to have originated in Central Asia , where the Y. pestis bacterium is endemic in the rodent population. It is unknown exactly what caused the outbreak, but a series of natural occurrences likely brought humans into contact with the infected rodents. The epidemic reached Constantinople in the late spring of 1347, through Genoese merchants trading in the Black Sea . From here it reached Sicily in October that same year, and by early 1348 it had spread over the entire Italian mainland. It spread rapidly through France, and had reached as far north as Paris by June 1348. Moving simultaneously westward, it arrived in the English province of Gascony around the same time. It is impossible to establish with any certainty the exact number of inhabitants in England at the eve of the Black Death , and estimates range from 3 to 7 million. The number is probably at the higher end, and an estimate of around 6 million inhabitants seems plausible. Earlier demographic crises—in particular the Great Famine of 1315–1317 —had resulted in great numbers of deaths, but there is no evidence of any significant decrease in the population prior to 1348. England was still a predominantly rural and agrarian society; close to 90 per cent of the population lived in the countryside. Of the major cities, London was in a class of its own, with perhaps as many as 70,000 inhabitants. Further down the scale were Norwich , with around 12,000 people, and York with around 10,000. The main export, and the source of the nation's wealth, was wool. Until the middle of the century the export had consisted primarily of raw wool to cloth makers in Flanders . Gradually though, the technology for cloth making used on the Continent was appropriated by English manufacturers, who started an export of cloths around mid-century that would boom over the following decades. Politically, the kingdom was evolving into a major European power, through the youthful and energetic kingship of Edward III . In 1346, the English had won a decisive battle over the Scots at the Battle of Neville's Cross , and it seemed that Edward III would realise his grandfather Edward I 's ambition of bringing the Scots under the suzerainty of the English crown. The English were also achieving military success on the Continent. Less than two months before the Battle of Neville's Cross, a numerically inferior English army led by the king himself won a spectacular victory over the French royal forces at the Battle of Crécy . The victory was immediately followed by Edward laying siege to the port city of Calais . When the city fell the next year, this provided the English with a strategically important enclave that would remain in their possession for over two centuries. The term "Black Death"—which refers to the first and most serious outbreak of the second pandemic—was not used by contemporaries, who preferred such names as the "Great Pestilence" or the "Great Mortality". It was not until the 17th century that the term under which we know the outbreak today became common, probably derived from Scandinavian languages. It is generally agreed today that the disease in question was plague , caused by Yersinia pestis bacteria . These bacteria are carried by fleas , which can be transferred to humans through contact with rats . Flea bites carry the disease into the lymphatic system , through which it makes its way to the lymph nodes . Here the bacteria multiply and form swellings called buboes , from which the term bubonic plague is derived. After three or four days the bacteria enter the bloodstream, and infect organs such as the spleen and the lungs . The patient will then normally die after a few days. A different strain of the disease is pneumonic plague , where the bacteria become airborne and enter directly into the patient's lungs. This strain is far more virulent, as it spreads directly from person to person. These types of infection probably both played a significant part in the Black Death, while a third strain was more rare. This is the septicaemic plague, where the flea bite carries the bacteria directly into the blood stream, and death occurs very rapidly. A study reported in 2011 of skeletons exhumed from the Black Death cemetery in East Smithfield , London , found Yersinia pestis DNA. An archaeological dig in the vicinity of Thornton Abbey in Lincolnshire was reported in the science section of The Guardian for 30 November 2016, not only confirming evidence of the Y. pestis DNA in the human remains exhumed there but also dating the remains to mid-1349. Genotyping showed that it was [at that time] a newly evolved strain, ancestor of all modern strains and proved the Black Death was bubonic plague. Modern medical knowledge suggests that because it was a new strain, the human immune system would have had little or no defence against it, helping to explain the plague's virulence and high death rates. The Black Death seems to have originated in Central Asia , where the Y. pestis bacterium is endemic in the rodent population. It is unknown exactly what caused the outbreak, but a series of natural occurrences likely brought humans into contact with the infected rodents. The epidemic reached Constantinople in the late spring of 1347, through Genoese merchants trading in the Black Sea . From here it reached Sicily in October that same year, and by early 1348 it had spread over the entire Italian mainland. It spread rapidly through France, and had reached as far north as Paris by June 1348. Moving simultaneously westward, it arrived in the English province of Gascony around the same time. In this year, in Melcombe, in the county of Dorset, a little before the Feast of St. John the Baptist, two ships, one of them from Bristol, came alongside. One of the sailors had brought with him from Gascony the seeds of the terrible pestilence and through him the men of the town of Melcombe were the first in England to be infected. Grey Friars' Chronicle According to the chronicle of the grey friars at King's Lynn , the plague arrived by ship from Gascony to Melcombe ( Weymouth ) shortly before the Feast of St. John the Baptist on 24 June 1348. Other sources mention different points of arrival, including Bristol and Southampton . Though the plague might have arrived independently at Bristol later, the Grey Friars' Chronicle is considered the most authoritative account. If it is assumed that the chronicle reports the first outbreak of the plague, rather than its actual arrival , then the arrival most likely happened around 8 May. From Weymouth the disease spread rapidly across the south-west. The first major city to be struck was Bristol. The disease reached London in the autumn of 1348, before most of the surrounding countryside. This had certainly happened by November, though according to some accounts as early as 29 September (Michaelmas). It travelled to London by three principal routes: overland from Weymouth, through Salisbury and Winchester ; overland from Gloucester ; and along the coast by ship. The full effect of the plague was felt in the capital early the next year. Conditions in London were ideal for the plague: the streets were narrow and flowing with sewage, and houses were overcrowded and poorly ventilated. By March 1349 the disease was spreading haphazardly across all of southern England. During the first half of 1349 the Black Death spread northwards. A second front opened up when the plague arrived by ship at the Humber , after which it spread both south and north. In May it reached York , and during the summer months of June, July and August, it ravaged the north. Certain northern counties, like Durham and Cumberland , had been the victim of violent incursions from the Scots, and were therefore left particularly vulnerable to the devastations of the plague. Pestilence is less virulent during the winter months, and spreads less rapidly. The Black Death in England had survived the winter of 1348–49, but during the following winter it subsided, and by December 1349 conditions were returning to relative normality. It had taken the disease around 500 days to traverse the entire country. Various methods of treatment were used, including sweating , bloodletting , and forced vomiting and urinating. Symptoms of the illness included blotches, hardening of the glands under the groin and underarms, and dementia. During the initial phase of the disease, bloodletting was performed on the same side where the physical manifestations of the buboes or risings appeared. For instance, if a rising appeared on the right side of the groin the physician would bleed a vein in the ankle on the same side. To provoke sweating , medicines such as Mithridate , Venice-Treacle , Matthiolus , Bezoar-Water , Serpentary Roots and Electuarium de Ovo were used. Sweating was used when measures were desperate; if a patient had tokens , a severe version of risings , the physician would wrap the naked patient in a blanket drenched in cold water. This was only done while the patient still had natural heat in his system. The desired effect was to make the patient sweat violently and thus purge all corruption from the blood which was caused by the disease. Another practice was the use of pigeons when treating swellings. Swellings which were white in appearance and deep were unlikely to break, and were anointed with Oil of Lillies or Camomil . Once the swelling rose to a head and was red in appearance and not deep in the flesh, it was broken with the use of a feather from a young pigeon's tail. The feather's fundament [ clarification needed ] was held to the swelling to try to draw out the venom. However, if the swelling dropped and became black in appearance, the physician had to be cautious when drawing the cold from the swelling. If it was too late to prevent, the physician would take the young pigeon, cut it open from breast to back, break it open and apply the pigeon (while still alive) over the cold swelling. The cupping therapy was an alternative method which was heated and then placed over the swellings. Once the sore was broken, the physician would apply Mellilot Plaister with Linimentum Arcei and heal the sore with digence [ clarification needed ] . Although historical records for England were more extensive than those of any other European country, it is still extremely difficult to establish the death toll with any degree of certainty. Difficulties include uncertainty about the size of the total population, as described above, but also uncertainty about the proportion of the population that died from the plague. Contemporary accounts are often grossly inflated, stating numbers as high as 90%. Modern historians give estimates of death rates ranging from around 25% to more than 60% of the total population. The pioneering work in the field was made by Josiah William Russell in his 1948 British Medieval Population . Russell looked at inquisitions post mortem (IPMs)—taken by the Crown to assess the wealth of the greatest landowners after their death—to assess the mortality caused by the Black Death, and from this he arrived at an estimate of 23.6% of the entire population. He also looked at episcopal registers for the death toll among the clergy, where the result was between 30 and 40%. Russell believed the clergy was at particular risk of contagion, and eventually arrived at an overall mortality rate of "only" 20 per cent. Several of Russell's assumptions have been challenged, and the tendency since has been to adjust the assessment upwards. Philip Ziegler , in 1969, estimated the death rate to have been around one third of the population. Jeremy Goldberg , in 1996, believed a number closer to 45 per cent would be more realistic. A 2004 study by Ole Jørgen Benedictow suggests the exceptionally high mortality level of 62.5 per cent. Assuming a population of 6 million, this estimate would correspond to 3,750,000 deaths. Such a high percentage would place England above the average that Benedictow estimates for Western Europe as a whole, of 60 per cent. Many historians have not accepted such a high death rate. In 2016, Carenza Lewis reported the results of a new method of assessing the death toll. She argued that pottery before and after the Black Death is datable because there was a change at that time from the high medieval to the late medieval style, and that counts of pottery of each type therefore provide a useful proxy for long term changes in population. She and her colleagues analysed pottery sherds from test pits in more than 50 continuously occupied rural settlements in eastern England, and found a decline in the number of pottery producing pits of 45 per cent. Norfolk had the greatest drop of 65 per cent, while there was no drop in 10 per cent of settlements, mostly commercial centres. Archbishop Zouche of York issued a warning throughout the diocese in July 1348 (when the epidemic was raging further south) of "great mortalities, pestilences and infections of the air". The Great Mortality, as it was then known, entered Yorkshire around February 1349 and quickly spread through the diocese. The clergy were on the front line of the disease, bringing comfort to the dying, hearing final confessions and organising burials. This, almost by necessity, put them at a greater risk of infection. Estimates suggest that the death rate of clergy in some parts of the archdiocese could have been as high as 48 per cent. This is reflected in the Ordination Register, which shows a massive rise in ordained clergy over the period—some being recruited before the arrival of plague in a clerical recruitment drive, but many once plague had arrived, replacing those who had been killed. In 1346, 111 priests and 337 acolytes were recruited. In 1349, 299 priests and 683 acolytes are named, with 166 priests being ordained in one session alone in February 1350." Russell had trusted the IPMs to give a true picture of the national average, because he assumed death rates to be relatively equal across the social spectrum. This assumption has been proven wrong, and studies of peasant plague mortality from manor rolls have returned much higher rates. This could be a consequence of the elite's ability to avoid infection by escaping plague-infected areas. It could also result from lower post-infection mortality among those more affluent, due to better access to care and nursing. If so, this would also mean that the mortality rates for the clergy—who were normally better off than the general population—were no higher than the average. ...destructive Death (who seizes young and old alike, sparing no one and reducing rich and poor to the same level) has lamentably snatched from both of us our dearest daughter, (whom we loved best of all, as her virtues demanded). Edward III in a letter to King Alfonso of Castile The manorial records offer a good opportunity to study the geographical distribution of the plague. Its effect seems to have been about the same all over England, though areas like East Anglia , which had frequent contact with the Continent, were severely affected. On a local level, however, there were great variations. A study of the Bishop of Worcester 's estates reveals that, while his manors of Hartlebury and Hanbury had a mortality rate of only 19 per cent, the manor of Aston lost as much as 80 per cent of its population. The manor rolls are less useful for studying the demographic distribution of the mortality, since the rolls only record the heads of households, normally an adult male. Here the IPMs show us that the most vulnerable to the disease were infants and the elderly. There seem to have been relatively few deaths from the Black Death at higher levels of society. The only member of the royal family who can be said with any certainty to have died from the Black Death was in France at the time of her infection. Edward III's daughter Joan was residing in Bordeaux on her way to marry Pedro of Castile in the summer of 1348. When the plague broke out in her household she was moved to a small village nearby, but she could not avoid infection, and died there on 2 September. It is possible that the popular religious author Richard Rolle , who died on 30 September 1349, was another victim of the Black Death. The English philosopher William of Ockham has been mentioned as a plague victim. This, however, is an impossibility. Ockham was living in Munich at the time of his death, on 10 April 1347, two years before the Black Death reached that city. Although historical records for England were more extensive than those of any other European country, it is still extremely difficult to establish the death toll with any degree of certainty. Difficulties include uncertainty about the size of the total population, as described above, but also uncertainty about the proportion of the population that died from the plague. Contemporary accounts are often grossly inflated, stating numbers as high as 90%. Modern historians give estimates of death rates ranging from around 25% to more than 60% of the total population. The pioneering work in the field was made by Josiah William Russell in his 1948 British Medieval Population . Russell looked at inquisitions post mortem (IPMs)—taken by the Crown to assess the wealth of the greatest landowners after their death—to assess the mortality caused by the Black Death, and from this he arrived at an estimate of 23.6% of the entire population. He also looked at episcopal registers for the death toll among the clergy, where the result was between 30 and 40%. Russell believed the clergy was at particular risk of contagion, and eventually arrived at an overall mortality rate of "only" 20 per cent. Several of Russell's assumptions have been challenged, and the tendency since has been to adjust the assessment upwards. Philip Ziegler , in 1969, estimated the death rate to have been around one third of the population. Jeremy Goldberg , in 1996, believed a number closer to 45 per cent would be more realistic. A 2004 study by Ole Jørgen Benedictow suggests the exceptionally high mortality level of 62.5 per cent. Assuming a population of 6 million, this estimate would correspond to 3,750,000 deaths. Such a high percentage would place England above the average that Benedictow estimates for Western Europe as a whole, of 60 per cent. Many historians have not accepted such a high death rate. In 2016, Carenza Lewis reported the results of a new method of assessing the death toll. She argued that pottery before and after the Black Death is datable because there was a change at that time from the high medieval to the late medieval style, and that counts of pottery of each type therefore provide a useful proxy for long term changes in population. She and her colleagues analysed pottery sherds from test pits in more than 50 continuously occupied rural settlements in eastern England, and found a decline in the number of pottery producing pits of 45 per cent. Norfolk had the greatest drop of 65 per cent, while there was no drop in 10 per cent of settlements, mostly commercial centres. Archbishop Zouche of York issued a warning throughout the diocese in July 1348 (when the epidemic was raging further south) of "great mortalities, pestilences and infections of the air". The Great Mortality, as it was then known, entered Yorkshire around February 1349 and quickly spread through the diocese. The clergy were on the front line of the disease, bringing comfort to the dying, hearing final confessions and organising burials. This, almost by necessity, put them at a greater risk of infection. Estimates suggest that the death rate of clergy in some parts of the archdiocese could have been as high as 48 per cent. This is reflected in the Ordination Register, which shows a massive rise in ordained clergy over the period—some being recruited before the arrival of plague in a clerical recruitment drive, but many once plague had arrived, replacing those who had been killed. In 1346, 111 priests and 337 acolytes were recruited. In 1349, 299 priests and 683 acolytes are named, with 166 priests being ordained in one session alone in February 1350." Archbishop Zouche of York issued a warning throughout the diocese in July 1348 (when the epidemic was raging further south) of "great mortalities, pestilences and infections of the air". The Great Mortality, as it was then known, entered Yorkshire around February 1349 and quickly spread through the diocese. The clergy were on the front line of the disease, bringing comfort to the dying, hearing final confessions and organising burials. This, almost by necessity, put them at a greater risk of infection. Estimates suggest that the death rate of clergy in some parts of the archdiocese could have been as high as 48 per cent. This is reflected in the Ordination Register, which shows a massive rise in ordained clergy over the period—some being recruited before the arrival of plague in a clerical recruitment drive, but many once plague had arrived, replacing those who had been killed. In 1346, 111 priests and 337 acolytes were recruited. In 1349, 299 priests and 683 acolytes are named, with 166 priests being ordained in one session alone in February 1350." Russell had trusted the IPMs to give a true picture of the national average, because he assumed death rates to be relatively equal across the social spectrum. This assumption has been proven wrong, and studies of peasant plague mortality from manor rolls have returned much higher rates. This could be a consequence of the elite's ability to avoid infection by escaping plague-infected areas. It could also result from lower post-infection mortality among those more affluent, due to better access to care and nursing. If so, this would also mean that the mortality rates for the clergy—who were normally better off than the general population—were no higher than the average. ...destructive Death (who seizes young and old alike, sparing no one and reducing rich and poor to the same level) has lamentably snatched from both of us our dearest daughter, (whom we loved best of all, as her virtues demanded). Edward III in a letter to King Alfonso of Castile The manorial records offer a good opportunity to study the geographical distribution of the plague. Its effect seems to have been about the same all over England, though areas like East Anglia , which had frequent contact with the Continent, were severely affected. On a local level, however, there were great variations. A study of the Bishop of Worcester 's estates reveals that, while his manors of Hartlebury and Hanbury had a mortality rate of only 19 per cent, the manor of Aston lost as much as 80 per cent of its population. The manor rolls are less useful for studying the demographic distribution of the mortality, since the rolls only record the heads of households, normally an adult male. Here the IPMs show us that the most vulnerable to the disease were infants and the elderly. There seem to have been relatively few deaths from the Black Death at higher levels of society. The only member of the royal family who can be said with any certainty to have died from the Black Death was in France at the time of her infection. Edward III's daughter Joan was residing in Bordeaux on her way to marry Pedro of Castile in the summer of 1348. When the plague broke out in her household she was moved to a small village nearby, but she could not avoid infection, and died there on 2 September. It is possible that the popular religious author Richard Rolle , who died on 30 September 1349, was another victim of the Black Death. The English philosopher William of Ockham has been mentioned as a plague victim. This, however, is an impossibility. Ockham was living in Munich at the time of his death, on 10 April 1347, two years before the Black Death reached that city. Among the most immediate consequences of the Black Death in England was a shortage of farm labour, and a corresponding rise in wages. The medieval world-view was unable to interpret these changes in terms of socio-economic development, and it became common to blame degrading morals instead. The landowning classes saw the rise in wage levels as a sign of social upheaval and insubordination, and reacted with coercion. In 1349, King Edward III passed the Ordinance of Labourers , fixing wages at pre-plague levels. The ordinance was reinforced by Parliament's passing of the Statute of Labourers in 1351. The labour laws were enforced with ruthless determination over the following decades. These legislative measures proved largely inefficient at regulating the market, but the government's repressive measures to enforce them caused public resentment. These conditions were contributing factors to the Peasants' Revolt in 1381. The revolt started in Kent and Essex in late May, and once the rebels reached London they burnt down John of Gaunt 's Savoy Palace , and killed both the Chancellor and the Treasurer . They then demanded the complete abolition of serfdom , and were not pacified until the young King Richard II personally intervened. The rebellion was eventually suppressed, but the social changes it promoted were already irreversible. By around 1400 serfdom was virtually extinct in England, replaced by the form of tenure called copyhold . It is conspicuous how well the English government handled the crisis of the mid-fourteenth century, without descending into chaos and total collapse in the manner of the Valois government of France. To a large extent this was the accomplishment of administrators such as Treasurer William de Shareshull and Chief Justice William Edington , whose highly competent leadership guided the governance of the nation through the crisis. The plague's greatest effect on the government was probably in the field of war, where no major campaigns were launched in France until 1355. Another notable consequence of the Black Death was the raising of the real wage of England (due to the shortage of labour as a result of the reduction in population), a trait shared across Western Europe, which in general led to a real wage in 1450 that was unmatched in most countries until the 19th or 20th century. The higher wages for workers combined with sinking prices on grain products led to a problematic economic situation for the gentry . As a result, they started to show an increased interest for offices like justice of the peace , sheriff and member of parliament . The gentry took advantage of their new positions and a more systematic corruption than before spread. A result of this was that the gentry as a group became highly disliked by commoners. The omnipresence of death also inspired greater piety in the upper classes, which can be seen in the fact that three Cambridge colleges were founded during or shortly after the Black Death. England did not experience the same trend of roving bands of flagellants , common on the continent. Neither were there any pogroms against the Jews , since the Jews had been expelled by Edward I in 1290. The high rate of mortality among the clergy naturally led to a shortage of priests in many parts of the country. The clergy were seen to have an elevated status among ordinary people and this was partly due to their purported closeness with God, being his envoys on earth. However, as the church itself had given the cause of the Black Death to be the impropriety of the behaviour of men, the higher death rate among the clergy led the people to lose faith in the Church as an institution—it had proved as ineffectual against the horror of Y. pestis as every other medieval institution. The corruption within the Catholic priesthood also angered the English people. Many priests abandoned the terrified people. Others sought benefits from the rich families who needed burials. The dissatisfaction led to anti-clericalism and the rise of John Wycliffe , an English priest. His ideas paved a path for the Christian reformation in England. Some people did not lose their Christian faith, if anything it was renewed; they began to long for a more personal relationship with God—around the time after the Black Death many chantries (private chapels) began to spread in use from not just the nobility, but to among the well-to-do. This change in the power of the papacy in England is demonstrated by the statutes of Praemunire . The Black Death also affected arts and culture significantly. It was inevitable that a catastrophe of such proportions would affect some of the greater building projects, as the amount of available labour fell sharply. The building of the cathedrals of Ely and Exeter was temporarily halted in the years immediately following the first outbreak of the plague. The shortage of labour also helped advance the transition from the Decorated style of building to the less elaborate Perpendicular style . The Black Death may also have promoted the use of vernacular English, as the number of teachers proficient in French dwindled, contributing to the late-14th-century flowering of English literature, represented by writers such as Geoffrey Chaucer and John Gower . Among the most immediate consequences of the Black Death in England was a shortage of farm labour, and a corresponding rise in wages. The medieval world-view was unable to interpret these changes in terms of socio-economic development, and it became common to blame degrading morals instead. The landowning classes saw the rise in wage levels as a sign of social upheaval and insubordination, and reacted with coercion. In 1349, King Edward III passed the Ordinance of Labourers , fixing wages at pre-plague levels. The ordinance was reinforced by Parliament's passing of the Statute of Labourers in 1351. The labour laws were enforced with ruthless determination over the following decades. These legislative measures proved largely inefficient at regulating the market, but the government's repressive measures to enforce them caused public resentment. These conditions were contributing factors to the Peasants' Revolt in 1381. The revolt started in Kent and Essex in late May, and once the rebels reached London they burnt down John of Gaunt 's Savoy Palace , and killed both the Chancellor and the Treasurer . They then demanded the complete abolition of serfdom , and were not pacified until the young King Richard II personally intervened. The rebellion was eventually suppressed, but the social changes it promoted were already irreversible. By around 1400 serfdom was virtually extinct in England, replaced by the form of tenure called copyhold . It is conspicuous how well the English government handled the crisis of the mid-fourteenth century, without descending into chaos and total collapse in the manner of the Valois government of France. To a large extent this was the accomplishment of administrators such as Treasurer William de Shareshull and Chief Justice William Edington , whose highly competent leadership guided the governance of the nation through the crisis. The plague's greatest effect on the government was probably in the field of war, where no major campaigns were launched in France until 1355. Another notable consequence of the Black Death was the raising of the real wage of England (due to the shortage of labour as a result of the reduction in population), a trait shared across Western Europe, which in general led to a real wage in 1450 that was unmatched in most countries until the 19th or 20th century. The higher wages for workers combined with sinking prices on grain products led to a problematic economic situation for the gentry . As a result, they started to show an increased interest for offices like justice of the peace , sheriff and member of parliament . The gentry took advantage of their new positions and a more systematic corruption than before spread. A result of this was that the gentry as a group became highly disliked by commoners. The omnipresence of death also inspired greater piety in the upper classes, which can be seen in the fact that three Cambridge colleges were founded during or shortly after the Black Death. England did not experience the same trend of roving bands of flagellants , common on the continent. Neither were there any pogroms against the Jews , since the Jews had been expelled by Edward I in 1290. The high rate of mortality among the clergy naturally led to a shortage of priests in many parts of the country. The clergy were seen to have an elevated status among ordinary people and this was partly due to their purported closeness with God, being his envoys on earth. However, as the church itself had given the cause of the Black Death to be the impropriety of the behaviour of men, the higher death rate among the clergy led the people to lose faith in the Church as an institution—it had proved as ineffectual against the horror of Y. pestis as every other medieval institution. The corruption within the Catholic priesthood also angered the English people. Many priests abandoned the terrified people. Others sought benefits from the rich families who needed burials. The dissatisfaction led to anti-clericalism and the rise of John Wycliffe , an English priest. His ideas paved a path for the Christian reformation in England. Some people did not lose their Christian faith, if anything it was renewed; they began to long for a more personal relationship with God—around the time after the Black Death many chantries (private chapels) began to spread in use from not just the nobility, but to among the well-to-do. This change in the power of the papacy in England is demonstrated by the statutes of Praemunire . The Black Death also affected arts and culture significantly. It was inevitable that a catastrophe of such proportions would affect some of the greater building projects, as the amount of available labour fell sharply. The building of the cathedrals of Ely and Exeter was temporarily halted in the years immediately following the first outbreak of the plague. The shortage of labour also helped advance the transition from the Decorated style of building to the less elaborate Perpendicular style . The Black Death may also have promoted the use of vernacular English, as the number of teachers proficient in French dwindled, contributing to the late-14th-century flowering of English literature, represented by writers such as Geoffrey Chaucer and John Gower . The Black Death was the first occurrence of the second pandemic , which continued to strike England and the rest of Europe more or less regularly until the 18th century. The first serious recurrence in England came in the years 1361−62. Little is known about the death rates caused by these later outbreaks, but the so-called pestis secunda may have had a mortality of around 20 per cent. Genetic analysis performed on remains recovered from the abbey of St. Mary's Graces dating between 1353 and 1364 found the pPCP1 plasmid, a plasmid only found in Yersinia pestis and not the related environmental agent Yersinia pseudotuberculosis , revealing that this outbreak was also caused by Yersinia pestis just as the initial outbreak had been. This epidemic was also particularly devastating for the population's ability to recover, since it disproportionately affected infants and young men. This was also the case with the next occurrence, in 1369, where the death rate was around 10−15 per cent. Over the following decades the plague would return—on a national or a regional level—at intervals of five to 12 years, with gradually dwindling death tolls. Then, in the decades from 1430 to 1480, the disease returned in force. An outbreak in 1471 took as much as 10–15 per cent of the population, while the death rate of the plague of 1479–1480 could have been as high as 20 per cent. From that point outbreaks became fewer and more manageable, due largely to conscious efforts by central and local governments—from the late 15th century onward—to curtail the disease. This included quarantines on people and goods coming from infected places, bans on public gatherings (such as fairs), enforced household quarantine for the infected (known as 'locking up') and quarantines on ships and crews coming from ports where Plague outbreaks had occurred. From the early seventeenth century there was also greater use of quarantine facilities, called pesthouses , in preference to household quarantine. Some of these, such as the Forlorn Hope Pesthouse established by Bristol in 1665–6, appear to have been proper quarantine hospitals, staffed by doctors. The establishment of such a hospital may help to explain why the death rate in Bristol in the 1665–66 outbreak was "only" c.0.6 percent. This was much lower than the mortality rate of 10–20 percent witnessed in Bristol's Plague epidemics of 1565, 1575, 1603–1604 and 1645. The Great Plague of 1665–66 was the last major outbreak in England. It is best known for the famous Great Plague of London , which killed 100,000 people (20 per cent of the population) in the capital. Other places hit hard included Eyam in Derbyshire, Derby itself and Norwich .

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Pneumonic plague

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Abby Sciuto

Abigail "Abby or Abbs" Beethoven Sciuto / ˈ ʃ uː t oʊ / is a fictional character from the American television series NCIS . She is portrayed by Pauley Perrette ; in the season 10 episode "Hit and Run," a young Abby was played by Brighton Sharbino in flashbacks. The character of Abby was introduced in the episodes "Ice Queen" and "Meltdown" of the television show JAG (which together served as the backdoor pilot for NCIS ), and up until May 2018 appeared in every episode of NCIS, in addition to being featured on the show's spin-offs, NCIS: Los Angeles (two episodes) and NCIS: New Orleans (two episodes). The role made Perrette one of 2011's most popular actresses on U.S. primetime television, according to Q Score . Abigail is a forensic scientist at the Naval Criminal Investigative Service headquarters at the Washington Navy Yard , with expertise in ballistics, digital forensics, and DNA analysis. In the first episode of the seventh season, " Truth or Consequences ", DiNozzo, while under the influence of a truth serum , describes her as "a paradox wrapped in an oxymoron smothered in contradictions in terms. Sleeps in a coffin. Really, the happiest Goth you'll ever meet." The character's gothic style of dress and her interest in death and the supernatural contrast with her generally hyperactive demeanor and enthusiasm about her work. [ unreliable source? ] On October 4, 2017, Perrette announced that she would be departing the show at the conclusion of season 15. CBS aired her final episode on May 8, 2018.Prior to taking up a career in acting, Pauley Perrette had studied at John Jay School of Criminal Science in New York, having previously aspired "to work with animals, be in a rock 'n' roll band, or be an FBI agent." She eventually began acting, later saying "There's no drug that I ever did that worked as well as being an actor. What you're looking for with substance abuse is escape. But with acting, you can escape into 1,000 different things without almost killing yourself doing it. Acting is a total drug!" Perrette was cast for the role of Abby Sciuto in 2003. On the subject of her character's creation and its purpose, she said "[NCIS creator] Don Bellisario told me that when he created Magnum, P.I. he wanted to introduce a Vietnam vet who defied the negative stereotype. So with Abby, he wanted to take an alternative-style person with tattoos and make her someone who is happy, totally put together and successful. All the script said about her was: black hair, caffeinated and smart...She's completely unaware that anybody thinks she looks weird. She thinks she looks pretty and never calls herself anything other than happy. And I fight for that." Child actress Brighton Sharbino was cast to portray 10-year-old Abby for the season 10 episode " Hit and Run ", which featured several flashbacks to a young Abby. Sharbino, who strongly resembled Perrette, reportedly spent time with the latter "in part to pick up on the NCIS vet's mannerisms and such." Abby is portrayed as having a gothic style of dress, including black dresses and T-shirts, miniskirts, and goth jewelry, including anklets and toe rings . She wears pigtailed dyed hair (due to Perrette's hair being dyed as she is a natural blonde ) and has at least nine tattoos on her neck, arms, back, ankle, and other places. Her neck choker appears to be one of her favorite pieces of jewelry. While some of the tattoos are Perrette's and real, others are makeup, such as the large cross on her back applied on occasions when Perrette shows her bare back on camera. The spider web on her neck is not real, either, as producer Bellisario wanted the character to have a tattoo that would be visible (almost) all the time. However, Perrette has expressed dislike for the spider tattoo, saying, "It only takes a few minutes to do, but it feels like old chewing gum," and had wished for an episode where her character Abby would have it removed. Other character quirks include Abby having a stuffed hippo named "Bert" that makes flatulent /farting noises when squeezed, which has been used for comic effect when Abby is upset. She decorates some of the areas in her lab with toys such as "Bleeding Edge Goth" dolls and "Teddy Scares". The Teddy Scare 'Rita Mortis' can be seen sitting next to her computer monitor. Abby's biggest pet peeve, as revealed in season five's "Lost and Found" by Timothy McGee , is people who claim to be vegetarians, but still eat chicken; her second-biggest pet peeve is people who mishandle evidence. Pauley Perrette commented, "Don (Bellisario) wanted to do Abby as an alternative-lifestyle person, but not as a junkie or a thief. She might be the smartest person on television." When asked about her depiction of a goth character, she responded that Abby "wouldn't call herself anything but Abby...What she represents is a smart, capable chick that cannot be reduced to a stereotype." Abby drives a candy-apple red 1930/31 Ford Model A coupe bearing a Washington, DC, personalized vanity plate "4NS CHIK" which is prominently featured in season five's " Dog Tags ". She previously drove a hearse (mentioned in "Hiatus, Part I"), which ran poorly and had bald tires. Like Gibbs, Abby enjoys caffeine, primarily in the form of large cups of a fictional drink called "Caf-Pow". At times, when she is worried about the caffeine interfering with her sleep, she drinks "No-Caf-Pow" instead. (According to Perrette, the cups were originally filled with Hawaiian Punch , but when she stopped eating and drinking refined sugar, unsweetened cranberry juice was used in its place.) When changing the artwork in her lab during "Hung Out to Dry", she states that she has a "Chagall feeling", a reference to Marc Chagall , a Jewish Belarusian artist whose main works came from fantasy and dreams. Her favorite term for something out of the ordinary is "hinky". It is also shown that she enjoys attending concerts, but her failure to wear earplugs at one of them left her with temporary hearing loss the next day, forcing her to ask DiNozzo for help analyzing some audio evidence. Abby has shown a tendency to become very agitated, to the point of near-panic, if any of the team is seriously hurt. When Gibbs was admitted to the hospital, Abby ended up on the verge of a nervous breakdown, pacing back and forth while delivering a rambling, disjointed stream-of-consciousness plea that explained (among other things) how close Gibbs and she were, the reason she was arriving after visiting hours, how she felt about Gibbs being injured, and how important it was to her that Gibbs not die from his injuries. Abby developed a fondness for Butch, a Navy sniffer dog , in the season five episode "Dog Tags". She renamed it "Jethro" in honor of Gibbs, because it was "handsome and quiet" like him. The dog was framed for the murder of a petty officer, as the dog was found at the murder victim's house, but Abby proved Jethro's innocence. Afterwards, Abby forced McGee to adopt the dog, much to his dismay (as Jethro had attacked him earlier in the episode). Abby would have preferred to adopt Jethro herself, but her landlord did not allow tenants to have pets.Sciuto is portrayed as having a happy, normal childhood. Her younger brother, Luca, was first mentioned by name in the season-nine episode " Enemy on the Hill ". He appears in season 10 in a flashback. Luca was portrayed by Tyler Ritter in Season 13 NCIS: New Orleans crossover episodes "Sister City (Part I)" and "Sister City (Part II)". She also mentioned that she has a niece and that her grandmother was an Olympic swimmer who won a silver medal. She has mentioned several uncles, including one named Teddy who owned a bar, one named Horace whom she referred to as Horace "the Haggler" during an episode, and one named Larry who apparently wore knee-high socks and fanny packs. Both her parents are deceased, although when they passed is never mentioned. Abby is a hearing child adopted by deaf parents and likes her music loud. In the episode "Seadog", Gibbs tells Tony that Abby knows how to use sign language because both of her parents were deaf. Abby has stated that she dreams of visiting the Galápagos Islands , Dollywood , and Israel before she dies. Abby graduated with full honors from Louisiana State University with a triple major in sociology , criminology , and psychology . She earned her master's degree from Georgia State University in criminology and forensic science . Sciuto's interest in forensics came from living near a wrecking yard and being intrigued by the cause and effect of the wrecks. A season nine episode "Enemy on the Hill," reveals that Abby has another brother, Kyle (played by Daniel L. Rivas ), who is her biological brother, as it is revealed that Abby is in fact adopted. She appears well-versed in her field of study; she is rarely stumped by the puzzles that Gibbs' team presents to her. Abby has been shown to have skills in traditional forensics, computer forensics , and hacking . She has implied that she has a PhD in chemistry. It has been shown that she does all the work on the evidence herself. In season three, she was given an assistant named Charles "Chip" Sterling . She revolted, but eventually learned to put up with him. However, their working partnership did not last long, as Abby later discovered Sterling had framed DiNozzo for murder. Exposed, Chip threatened her with a knife; she promptly subdued him, hog-tied him with duct tape, and insisted on being allowed to work alone from then on, something to which then-Director Jenny Shepard agreed. It has also been mentioned numerous times that she is a devout Roman Catholic and is on a bowling team with several nuns. In the 2009 NCIS: Los Angeles episode " Random On Purpose ," Abby is described as being in her late 20s, suggesting she was born in the early 1980s. (Actress Perrette was born in 1969, and was 40 when this episode first aired.) However, in a flashback in the 2013 NCIS episode "Hit and Run," Abby is shown to be 10 years old in the early 1980s, implying that she was born in the early 1970s. In the Season 15 episodes "One Step Forward" and "Two Steps Back;" Clayton Reeves , an MI6 agent, dies protecting Abby from a hitman hired to kill her. She is severely wounded in the attempt, but recovers and tracks down the man who arranged the hit―a black-ops expert whom she had encountered several years earlier. She tricks him into believing that she has spiked his coffee with a fatal dose of cyanide, then offers to give him the antidote in exchange for his confession; the ploy succeeds and he is quickly arrested by the agents. Abby subsequently resigns from NCIS to accompany Reeves' body back to England and start a charity in honor of Reeves and his mother to help the homeless.In the Season 15 episodes "One Step Forward" and "Two Steps Back;" Clayton Reeves , an MI6 agent, dies protecting Abby from a hitman hired to kill her. She is severely wounded in the attempt, but recovers and tracks down the man who arranged the hit―a black-ops expert whom she had encountered several years earlier. She tricks him into believing that she has spiked his coffee with a fatal dose of cyanide, then offers to give him the antidote in exchange for his confession; the ploy succeeds and he is quickly arrested by the agents. Abby subsequently resigns from NCIS to accompany Reeves' body back to England and start a charity in honor of Reeves and his mother to help the homeless.The character of Abby gets along well with all the rest of the team. She is very fond of Ducky, who uses her full name, Abigail. She is called Abby or Abs by almost everyone else, except Director Leon Vance, who calls her Ms. Sciuto. Abby is fiercely loyal to the team, and considers them family, which is shown by her distress when one or more of them is in serious danger. Likewise, the team are generally fond of her and describe her as "the favorite". Before her death in the line of duty, Special Agent Caitlin "Kate" Todd was a close friend of Abby's. They often hung out after work, and Abby is one of the few characters on the show to know what Kate's tattoo actually is. She is friendly with Medical Assistant Jimmy Palmer. She has helped him with an autopsy and Rolfed him when he injured himself in the morgue in " Life Before His Eyes ". In "Newborn King", Palmer brings his future father-in-law, Ed Slater, to NCIS. Later in the episode, McGee visits Abby to see she has locked the two in the back room. Jimmy states if Slater had not made a comment about Abby's tattoo, then they would not be in time out, implying he took Abby's side. Jimmy also chose Abby to be his "best woman" at his wedding in " The Missionary Position ". In the episode "Crescent City", she is shown to have a relationship with Senior Special Agent Dwayne Cassius Pride, who runs the New Orleans NCIS office. Gibbs is depicted as having a close (father/daughter-like) relationship with Abby, who is initially one of only two characters (the other one being Ducky) to have no fear of him. Gibbs is often seen giving Abby kisses on the cheek, and hugging her, especially when she does good work on her cases. He often brings her a fresh Caf-Pow when he arrives at the lab for information on a case, whether or not she has called him down to tell him about it. Gibbs generally tolerates Abby's goth dress style, knowing that she does a great job in her work, but often has to ask her to get to the point when she starts rambling. Abby sometimes turns to Gibbs when she needs to talk about something personal that is bothering her and he helps by listening to her. Both Gibbs and Abby are proficient with American Sign Language , as Abby grew up with deaf parents. On several occasions, Abby has been described as "the favorite", a fact that does not escape the rest of the team, but they do not begrudge her for it. Gibbs is also very protective of Abby, especially when she is in very serious danger. For example, in the episode "Bloodbath", she was threatened by a hit man hired by a defendant in a case in which she was testifying, which was also complicated by an ex-boyfriend, Mikel Mawher (guest star, Vincent Young ), against whom she had a restraining order, but who then called her in violation of the order. When Gibbs found out about this, he pointedly told Mikel, "The only reason you're still able to walk is because I never heard about you until today!" Sometimes, that protectiveness extends from the rest of the team, as well. For example, in the episode "Spider and the Fly", Alejandro Rivera came to NCIS and began to threaten Abby for not sending in a report about the murder of Pedro Hernandez, Rivera's father, whom Gibbs had killed 20 years previously in revenge for Hernandez killing Gibbs' first wife, Shannon, and young daughter, Kelly. The entire team, including Ducky and Vance, ordered him to leave her alone and to not harass her, or to be escorted forcibly from NCIS Headquarters. Rivera eventually left of his own accord, but was later arrested for attempting to kill Gibbs and his father at a safehouse, and accidentally killing his sister, Paloma. Gibbs' concern for Abby's safety is such that he will even drop his trademark cup of coffee if she is in serious danger. Twice this occurred: in the episode "Kill Ari" when Ari shot at her while she was in her lab, the other time was in the episode "Driven" when she was trapped inside an experimental Humvee , which had been rigged to fill with exhaust fumes and suffocate its occupants. Abby is portrayed as cold to Ziva David upon her arrival at NCIS as she, like the rest of the team, was still grieving over Kate Todd's death and the fact that Ziva was Ari Haswari's half-sister. Abby would scribble over pictures of Ziva and frequently mispronounce her surname to annoy her. Later, upset by Ziva's calm response to Gibbs being injured in a bombing, Abby slapped her. Abby eventually came around, and she and Ziva became good friends. This was solidified in the episode "Capitol Offense" when Ziva bought Abby a " chocoholic 's choice" cupcake in gratitude for giving her a place to stay while her home was being fumigated for termites. After the cupcake unexpectedly vanished, Abby used her knowledge of forensics to prove McGee had stolen it, angering the rest of the team. Ziva flinched away from Abby's hugs at first, not understanding why she did so, but eventually came to accept them with more ease. In the season-seven finale, Abby was shown to be present at Ziva's citizenship ceremony , along with Ducky, McGee, and Jimmy Palmer. Later in the episode " Gone ", the two bonded more when Ziva took in a teenaged girl who witnessed her father's murder and best friend's kidnapping as they both tried to help the girl feel at ease throughout the ongoing investigation. After Ziva's father was gunned down in " Shabbat Shalom ", Abby was shown baking cookies in an attempt to help her feel better. Abby's relationship with Tony is a friendly one, with the two making friendly, non-hostile jibes at each other, and squabbling about various topics, such as movies and personal possessions. Abby is perhaps the only member of the NCIS cast who displays a love and knowledge of movies that even comes close to matching Tony's. In "Twilight", after Tony narrowly avoids being part of an explosion on his first day back from sick leave after getting pneumonic plague, she runs at him and hugs him so hard he nearly falls over. In the episode, "Frame-Up", she almost single-handedly unravels the forensic evidence used to frame Tony of murder to clear his name, then subdues the killer – her assistant Chip Sterling – when he threatens her with a knife. The explosion of Tony's car in "Bury Your Dead" causes her to become increasingly obsessed with her work, to prevent thoughts of his possible death. In "Reunion", after Tony, McGee, and Gibbs rescue Ziva from Somalia , Abby starts with a rant criticizing Ziva for her continuing mistrust of Tony, which, in trademarked Abby fashion, ends with her saying how worried she was about Ziva, and hugging her. This then sparks a confrontation between Tony and Ziva that causes their relationship to be restored to normal. Tony would sometimes join Abby in her lab and act like Gibbs when he was absent. When Abby was in a coma, Tony was shown to be very worried about her, to the point he did not call McGee by any last name joke. Abby had a relationship with McGee which she stated that she would like to keep casual during season one. Although the relationship ended late in the same season, they both have exhibited jealousy when someone of the opposite sex pays attention to the other. Some erotic teasing and tension continues between the two for the next several seasons, implied through such facts as McGee's apparent ability to describe the inside of Abby's bedroom in his novel. After finding out Abby sleeps in a coffin, he said, "You told me it was a box sofa," indicating he has at least stayed over. The implications went farther when he added, "I can't believe I slept in a coffin," and she impishly replied, "Not just slept." In the episode "Bloodbath" when Abby's life is threatened and the team sends her home with McGee, Abby is revealed at one point to have kept a toothbrush at McGee's apartment. Their flirtation became less prominent in later seasons, and TV Guide Senior Critic Matt Roush suggested this was due to the producers' apprehension about using romance within the series to an excess. He reasoned, "pairing up all four members of Gibbs' team romantically might seem like overkill, and the Tony-Ziva dynamic (even if not exactly acted upon) is so integral to the show's core that I'm not surprised they've kept McGee and Abby on more of a loving-sibling level." He further opined that he "wouldn't expect it to change". Abby is called Abigail by Ducky, who addresses her by her full first name often. Though in the episode "Faking It", he thanked her and called her by using the name "Abby" instead of "Abigail". Abby used to have a fear of autopsy tables, which she shares with Ducky in episode 16 of season one, "Bête Noire" when Ducky and Kate are held hostage. The fear, although mostly overcome, can be brought back by major trauma, as seen in episode 2 of season 10.Gibbs is depicted as having a close (father/daughter-like) relationship with Abby, who is initially one of only two characters (the other one being Ducky) to have no fear of him. Gibbs is often seen giving Abby kisses on the cheek, and hugging her, especially when she does good work on her cases. He often brings her a fresh Caf-Pow when he arrives at the lab for information on a case, whether or not she has called him down to tell him about it. Gibbs generally tolerates Abby's goth dress style, knowing that she does a great job in her work, but often has to ask her to get to the point when she starts rambling. Abby sometimes turns to Gibbs when she needs to talk about something personal that is bothering her and he helps by listening to her. Both Gibbs and Abby are proficient with American Sign Language , as Abby grew up with deaf parents. On several occasions, Abby has been described as "the favorite", a fact that does not escape the rest of the team, but they do not begrudge her for it. Gibbs is also very protective of Abby, especially when she is in very serious danger. For example, in the episode "Bloodbath", she was threatened by a hit man hired by a defendant in a case in which she was testifying, which was also complicated by an ex-boyfriend, Mikel Mawher (guest star, Vincent Young ), against whom she had a restraining order, but who then called her in violation of the order. When Gibbs found out about this, he pointedly told Mikel, "The only reason you're still able to walk is because I never heard about you until today!" Sometimes, that protectiveness extends from the rest of the team, as well. For example, in the episode "Spider and the Fly", Alejandro Rivera came to NCIS and began to threaten Abby for not sending in a report about the murder of Pedro Hernandez, Rivera's father, whom Gibbs had killed 20 years previously in revenge for Hernandez killing Gibbs' first wife, Shannon, and young daughter, Kelly. The entire team, including Ducky and Vance, ordered him to leave her alone and to not harass her, or to be escorted forcibly from NCIS Headquarters. Rivera eventually left of his own accord, but was later arrested for attempting to kill Gibbs and his father at a safehouse, and accidentally killing his sister, Paloma. Gibbs' concern for Abby's safety is such that he will even drop his trademark cup of coffee if she is in serious danger. Twice this occurred: in the episode "Kill Ari" when Ari shot at her while she was in her lab, the other time was in the episode "Driven" when she was trapped inside an experimental Humvee , which had been rigged to fill with exhaust fumes and suffocate its occupants.Abby is portrayed as cold to Ziva David upon her arrival at NCIS as she, like the rest of the team, was still grieving over Kate Todd's death and the fact that Ziva was Ari Haswari's half-sister. Abby would scribble over pictures of Ziva and frequently mispronounce her surname to annoy her. Later, upset by Ziva's calm response to Gibbs being injured in a bombing, Abby slapped her. Abby eventually came around, and she and Ziva became good friends. This was solidified in the episode "Capitol Offense" when Ziva bought Abby a " chocoholic 's choice" cupcake in gratitude for giving her a place to stay while her home was being fumigated for termites. After the cupcake unexpectedly vanished, Abby used her knowledge of forensics to prove McGee had stolen it, angering the rest of the team. Ziva flinched away from Abby's hugs at first, not understanding why she did so, but eventually came to accept them with more ease. In the season-seven finale, Abby was shown to be present at Ziva's citizenship ceremony , along with Ducky, McGee, and Jimmy Palmer. Later in the episode " Gone ", the two bonded more when Ziva took in a teenaged girl who witnessed her father's murder and best friend's kidnapping as they both tried to help the girl feel at ease throughout the ongoing investigation. After Ziva's father was gunned down in " Shabbat Shalom ", Abby was shown baking cookies in an attempt to help her feel better.Abby's relationship with Tony is a friendly one, with the two making friendly, non-hostile jibes at each other, and squabbling about various topics, such as movies and personal possessions. Abby is perhaps the only member of the NCIS cast who displays a love and knowledge of movies that even comes close to matching Tony's. In "Twilight", after Tony narrowly avoids being part of an explosion on his first day back from sick leave after getting pneumonic plague, she runs at him and hugs him so hard he nearly falls over. In the episode, "Frame-Up", she almost single-handedly unravels the forensic evidence used to frame Tony of murder to clear his name, then subdues the killer – her assistant Chip Sterling – when he threatens her with a knife. The explosion of Tony's car in "Bury Your Dead" causes her to become increasingly obsessed with her work, to prevent thoughts of his possible death. In "Reunion", after Tony, McGee, and Gibbs rescue Ziva from Somalia , Abby starts with a rant criticizing Ziva for her continuing mistrust of Tony, which, in trademarked Abby fashion, ends with her saying how worried she was about Ziva, and hugging her. This then sparks a confrontation between Tony and Ziva that causes their relationship to be restored to normal. Tony would sometimes join Abby in her lab and act like Gibbs when he was absent. When Abby was in a coma, Tony was shown to be very worried about her, to the point he did not call McGee by any last name joke.Abby had a relationship with McGee which she stated that she would like to keep casual during season one. Although the relationship ended late in the same season, they both have exhibited jealousy when someone of the opposite sex pays attention to the other. Some erotic teasing and tension continues between the two for the next several seasons, implied through such facts as McGee's apparent ability to describe the inside of Abby's bedroom in his novel. After finding out Abby sleeps in a coffin, he said, "You told me it was a box sofa," indicating he has at least stayed over. The implications went farther when he added, "I can't believe I slept in a coffin," and she impishly replied, "Not just slept." In the episode "Bloodbath" when Abby's life is threatened and the team sends her home with McGee, Abby is revealed at one point to have kept a toothbrush at McGee's apartment. Their flirtation became less prominent in later seasons, and TV Guide Senior Critic Matt Roush suggested this was due to the producers' apprehension about using romance within the series to an excess. He reasoned, "pairing up all four members of Gibbs' team romantically might seem like overkill, and the Tony-Ziva dynamic (even if not exactly acted upon) is so integral to the show's core that I'm not surprised they've kept McGee and Abby on more of a loving-sibling level." He further opined that he "wouldn't expect it to change". Abby is called Abigail by Ducky, who addresses her by her full first name often. Though in the episode "Faking It", he thanked her and called her by using the name "Abby" instead of "Abigail". Abby used to have a fear of autopsy tables, which she shares with Ducky in episode 16 of season one, "Bête Noire" when Ducky and Kate are held hostage. The fear, although mostly overcome, can be brought back by major trauma, as seen in episode 2 of season 10.In the NCIS: Los Angeles episode "Random on Purpose", Abby, having been previously seen on video conference or talking to someone from her lab in Washington, DC, arrived in Los Angeles to meet the Office of Special Projects (OSP) team as she informed them she was investigating a serial killer called the Phantom who had murdered 15 people all over the country and had also left no DNA or even physical evidence at the scenes. Having already formed a strong friendship with Eric Beale, Abby developed friendships with the OSP team, including G. Callen ( Chris O'Donnell ), Sam Hanna ( LL Cool J ), and most notably the operations manager Hetty Lange ( Linda Hunt ), who commented that Abby is "the first NCIS employee [she] has ever met with a sense of style". Kensi Blye, another NCIS Special Agent, who is an expert in forensics, praised Abby for her high levels of thinking, stating that she lived up to the hype. Abby was later kidnapped by the Phantom, later revealed to be a law firm receptionist named Tom Smith, who sought to kill her to keep his identity a secret, as he hoped to go around killing more people, having developed something of a taste for it. Although Vance mentioned that Gibbs and the NCIS Major Case Response Team were en route to Los Angeles to rescue her, Abby was saved due to the efforts of the OSP team and was later seen telling Gibbs and McGee on a video-conferencing link that she was okay. To date, Abby has not returned to Los Angeles nor has she reappeared in any video-conference calls which strongly suggests that her appearances in season one were just one-offs.During the first season of NCIS , Ross Warneke from The Age wrote of the character, "Her role is pivotal in the show because, as with so many crime series these days, the forensics laboratory is the scene of much of the action. Perrette's only shortcoming is her diction. Am I the only one who has difficulty understanding her?" In January 2005, Bill Keveney from USA Today compared the characters on NCIS to those on Magnum, P.I. and commented, "the tattooed Abby, the presumed slacker who is anything but, is Bellisario's not-what-she-appears-to-be tribute to Magnum, a functioning, well-balanced Vietnam vet who contrasted many depictions of the era." The New York Times writer Bill Carter described Abby as "television's only regular goth personality" in October of the same year. Later in the show's run, reception continued to be mostly positive, with some critics regarding her as "easily the most outgoing and affectionate member of the group". In 2009, David Martingale of Star-Telegram wrote, "Abby Sciuto, a forensics scientist who, with her caffeine-fueled high energy and kooky Goth/cheerleader wardrobe, is one of a kind". June Thomas from Slate Magazine noted in November 2011 that, "Abby may look like a freak, but she's a church-going patriot." She has been described as "spacy" and "a witty, lovable personality with forensic skills that are even greater than her charm." C. Coville from Cracked criticized the choice to describe Abby's age as "late twenties" in her 2009 guest appearance on NCIS: Los Angeles , finding it unbelievable for someone who "has still somehow picked up a PhD in chemistry, bachelor's degrees in sociology, criminology, and psychology, and good knowledge of hacking and computer forensic science". In March 2011, AOL named Abby as number 95 on a list of the 100 Most Memorable Female TV Characters. In April 2013, a study by E-Poll Market Research listed Pauley Perrette and Cote de Pablo, who portrays Ziva David , among the top 10 most appealing celebrities in America. Perrette and de Pablo were ranked as numbers 5 and 3 respectively.

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Accredited Social Health Activist

An Accredited Social Health Activist ( ASHA ) is a community health worker employed by the Ministry of Health and Family Welfare (MoHFW) as a part of India's National Rural Health Mission (NRHM). The mission began in 2005; full implementation was targeted for 2012. The idea behind the Accredited Social Health Activist (ASHA) was to connect marginalized communities to the health care system. The target was to have an "ASHA in every village" in India. In July 2013, the number of ASHAs was reported to be 870,089. In 2018, this number became 939,978. The ideal number of ASHAs envisaged was 1,022,265. ASHAs are women trained to act as health educators and health promoters in their communities. The Indian MoHFW describes them as: ...health activist(s) in the community who create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. Their tasks include: Motivating women to give birth in hospitals, Bringing children to immunization clinics, Encouraging family planning (e.g., surgical sterilization), Treating basic illness and injury with first aid, Keeping demographic records, and Improving village sanitation. ASHAs also serve as a key communication mechanism between the healthcare system and rural populations. An ASHA acts as a depot holder for essential provisions being made available to all habitations like: Oral Rehydration Salts (ORS) Therapy, Iron Folic Acid (IFA) Tablets, Chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms. Their responsibilities can be classified into: Counseling: Breast Feeding Skilled birth attendance Prevention of diseases Community sensitization: Health Nutrition Related government programs Provision of drugs: Malaria Tuberculosis Diarrhoea Escort: Ante- and Post-natal care Institutional delivery Immunization Diabetes test Family planning Diagnosis Malaria Pregnancy Survey of health and related events Others Community mobilization Health planning Participation in community health and allied activitiesAlthough ASHAs are considered volunteers, they receive outcome-based remuneration and financial compensation for training days. For example, if an ASHA facilitates an institutional delivery she receives ₹ 600 (US$7.50) and the mother receives ₹ 1,400 (US$18) . ASHAs also receive ₹ 150 (US$1.90) for each child completing an immunization session and ₹ 150 (US$1.90) for each individual who undergoes family planning. ASHAs are expected to attend a Wednesday meeting at the local primary health centre (PHC); beyond this requirement, the time ASHAs spend on their CHW tasks is relatively flexible. [ citation needed ] An ASHA's monthly salary has two components: [ citation needed ] A fixed component of Rs. 4,000/- (USD 53/- approximately), and Incentives that vary from Rs. 5,000/- (USD 67/- approximately) to Rs. 8,000/- (USD 107 approximately), including a "COVID Bonus". The average monthly salary comes to around Rs. 10,000/- (USD 133/- approximately).A baseline survey was taken at the district level, for fixing decentralized monitoring goals and indicators. Community monitoring is at the village level. The Planning Commission is the ultimate agency for monitoring outcomes. External evaluation is taken up at regular intervals. [ citation needed ]

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