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th in medieval europe was caused by a variant of y pestis that may no longer exist 62 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 62 later genomic papers have further confirmed the phylogenetic placement of the y pestis strain responsible for the black death as both the ancestor 63 of later plague epidemics including the third plague pandemic and the descendant 64 of the strain responsible for the plague of justinian in addition plague genomes from prehistory have been recovered 65 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 66 67 further dna evidence also proves the role of y pestis and traces the source to the tian shan mountains in kyrgyzstan 68 alternative explanations 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 69 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 70 71 the oriental rat flea has poor survival in cooler climates and reevaluation suggests the human flea was the principal vector of plague epidemics in northern europe 72 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 73 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 31 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 74 75 this theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic 76 summary academic debate continues but no single alternate explanation for the plague s spread has achieved widespread acceptance 59 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 77 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 66 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 alternate explanations 78 transmission main article black death migration territorial origins according to a team of medical geneticists led by mark achtman yersinia pestis evolved in or near china over 2 600 years ago 79 80 81 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 82 83 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 84 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 85 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 86 the earliest chinese descriptions of the bubonic plague do not appear until the 1640s 87 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 47 epidemics killed an estimated 25 million across asia during the fifteen years before the black death reached constantinople in 1347 88 89 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 83 philip slavin according to john norris evidence from issyk kul indicates a small sporadic outbreak characteristic of transmission from rodents to humans with no wide scale effect 87 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 85 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 87 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 90 others still favor an origin in china 83 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 85 research on the delhi sultanate and the yuan dynasty shows no evidence of any serious epidemic in 14th century india and no specific evidence of plague in 14th century china suggesting that the black death may not have reached these regions 87 85 91 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 92 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 93 richard von glahn monica green suggests that other parts of eurasia outside the west do not contain the same evidence of the black death 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 death 94 another theory is that the plague originated near europe and cycled through the mediterranean northern europe and russia before making its way to china 84 other historians such as john norris and ole benedictaw believe the plague likely originated in europe or the middle east and never reached china 40 norris specifically argues for an origin in kurdistan rather than central asia 90 europe 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 95 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 96 though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants 97 98 as the disease took hold genoese traders fled across the black sea to constantinople where the disease first arrived in europe in summer 1347 99 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 99 nicephorus gregoras while writing to demetrios kydones described the rising death toll the futility of medicine and the panic of the citizens 99 the first outbreak in constantinople lasted a year but the disease recurred ten times before 1400 99 carried by twelve genoese galleys plague arrived by ship in sicily in october 1347 100 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 101 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 102 finally it spread to northern russia in 1352 and reached moscow in 1353 103 104 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 105 106 107 according to some epidemiologists periods of unfavorable weather decimated plague infected rodent populations forcing their fleas onto alternative hosts 108 inducing plague outbreaks which often peaked in the hot summers of the mediterranean 109 and during the cool autumn months of the southern baltic region 110 d among many other culprits of plague contagiousness pre existing malnutrition weakened the immune response contributing to an immense decline in european population 113 west asia and north africa the disease struck various regions in west asia and north africa during the pandemic leading to serious depopulation and permanent change in both economic and social structures 114 by autumn 1347 plague had reached alexandria in egypt transmitted by sea from constantinople via a single merchant ship carrying slaves 115 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 116 the nile was choked with corpses despite cairo having a medieval hospital the late 13th century bimaristan of the qalawun complex 116 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 116 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 115 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 117 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 115 mecca became infected in 1348 by pilgrims performing the hajj 115 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 115 118 during 1349 records show the city of mosul suffered a massive epidemic and the city of baghdad experienced a second round of the disease 119 signs and symptoms a hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black an inguinal bubo on the upper thigh of a person infected with bubonic plague swollen lymph nodes buboes often occur in the neck armpit and groin inguinal regions of plague victims 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 ...
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