What Disease was Plague?

On the Controversy over the Microbiological Identity of Plague Epidemics of the Past

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In recent decades, alternatives to the established bubonic-plague theory have been presented as to the microbiologcal identity and mechanism(s) of spread of historical plague epidemics. In this monograph, the six important alternative theories are intensively discussed in the light of the historical sources, the central primary studies and standard works on bubonic plague and the alternative microbiological agents, insofar as they are testable. These seven theories are incompatible and at least six of them must be untenable. In the author’s opinion, the arguments against the bubonic-plague theory and for all alternative theories are untenable. This monograph therefore also has been written also as a standard work on bubonic plague, giving a broad and in-depth presentation of the medical, epidemiological and historical evidence and the methodological tenets for identification of historical diseases by comparison with modern medical knowledge.
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Biographical Note

Ole J. Benedictow, Cand. Philol. in History (1961), University of Oslo, Emeritus Professor of History at the University of Oslo. He has published extensively on historical plague epidemics and medieval demography including The Black Death 1346-1353. The Complete History (Boydell&Brewer 2004), The Black Death and Later Plague Epidemics in Norway (in Norwegian, Unipub 2002), and The Medieval Demographic System of the Nordic Countries (Middelalderforlaget, 2nd ed. 1996).

Review Quotes

"En líneas generales, Benedictow articula el libro en torno a tres ejes principales. Así, en el primero se encarga de definir las condiciones básicas para el desarrollo de la plaga bubónica en la Europa medieval, en el segundo pormenoriza las características definitorias de la epidemia y por último, una vez perfilado el cuadro de qué es y qué sabemos de la Peste Negra, se lanza a desmontar las teorías alternativas que han ido surgiendo en los últimos años, señalando sus defectos de forma y contenido."
- Alberto Reche (IEM), Medievalia, 2012, No. 15, 366-368 pp.

Table of contents

List of Figures and Tables xiii
Preface xv

PART ONE: THE ISSUE
1. The Issue and the Problems 3
Introduction 3
The Human-Flea Theory of Plague Epidemiology 9
The Revisionists 16

PART TWO: HOW S.K. COHN MAKES PHYSICIANS AND HISTORIANS “SQUARE THE CIRCLE”
2. The Ethics of Scholarly Work 25
Introduction 25
How Cohn Makes Medical Scientists “Square the Circle” 26
Hankin 1: Cohn’s Attack on Hankin’s Observation of Inverse Correlation between Mortality and Population Density 34
Hankin 2: A Brief Study of Cohn’s Technique of Argument 38
“The Ugly Americans” 44
Cohn’s Accusations of Racism against J. Ashburton Thompson and L.F. Hirst 46
How Cohn Makes “Historians Square the Circle” 54
The Attack on Schofi eld (and Benedictow and L. Bradley) 62

PART THREE: BASIC CONDITIONS FOR BUBONIC PLAGUE IN MEDIEVAL EUROPE
3. Rats 73
Introduction: How to Study Rats in History 73
The Nature of Rats and the Frame of Reference of the Medieval Mind 78
The Question of the Presence of Rats and the Methodological Fallacy of Inference ex silentio 85
Ars Moriendi Rattorum: Where Have all the Dead Rats Gone? 91
Zoobiological and Zoogeographical Arguments on the Question of Signifi cant Presence of Black Rats in Medieval Europe 98
The Signifi cance of Evolutionary Th eory and Adaptation by Selection 116
Rat Bones: Material Evidence of the Presence of Rats in the Middle Ages 122
Sociology of Rat-Based Plague 142

4. The Spread of Bubonic Plague over Distances 151
Contiguous Spread and Metastatic Spread 151

5. Mortality in India 194
Effects of the Anti-epidemic Eff orts by British Colonial Authorities 194

6. Was Historical Plague a Viral or Bacterial Disease? The Question of Immunity 205
Introduction 205
Re-infection or Immunity? 212
Did Plague Become a Child Disease aft er the Black Death? 218
Plague according to Social Class, Age and Gender 235
A Demographic Case Study: Th e Necrology of the Monastery of San Domenico in Camporegio 245
The Real Problem and its Solution: Marriage Rates and Fertility Rates aft er the Black Death 268

PART FOUR: DEFINING FEATURES
Introduction: Concept of Defining Feature 277

7. Defining Feature 1: Latency Periods 279

8. Defining Feature 2: Inverse Correlation between Mortality Rate and Population Density 289
Introduction 289
More Data on the Inverse Correlation in India and Historical Europe 291
Scott and Duncan and the Correlation between Population Density and Mortality 301
Epilogue: Sweating Sickness and the Inverse Correlation 311

9. Defining Feature 3: Buboes as a Normal Clinical Feature in Epidemics 312
General Introduction 312
Contemporary Notions and Observations of Buboes (and Associated Secondary Clinical Manifestations) 322
Scott and Duncan: The Problem of Buboes 334
Cohn: The Problem of Buboes 340
Cohn and Boccaccio: Buboes, Pustules and Spots 359

10. Defining Feature 4: DNA of Yersinia pestis from Plague Graves 381

11. Defining Feature 5: Seasonality of Bubonic Plague 396
Introduction: Bubonic Plague’s Association with Moderately Warm Temperatures and Seasons 396
Seasonality of Historical Bubonic-Plague Epidemics with Emphasis on the Transseasonal Form 398
The Seasonality of Plague and Mortality in England 1340–1666 420
Duration of Vacancies in Parish Benefices during the Black Death 436
Temporal Relationship between the Territorial Spread of the Black Death and Increase in Institutions 463
Summary and Conclusion 482


PART FIVE: THE ALTERNATIVE THEORIES
Introduction: The History and Essence of the Alternative Theories 487

12. The Beginning: Th e Alternative Theories of Shrewsbury and Morris 489
Shrewsbury: the Composite, Low-Intensity Theory 489
Morris: The Primary Pneumonic Theory 491

13. Gunnar Karlsson’s Alternative Theory: That Historical Plague was Pure Epidemics of Primary Pneumonic Plague 493
Introduction 493
Karlsson and Benedictow 495
Could Plague Have Come to Iceland from Anywhere? 502
Pure Epidemics of Primary Pneumonic Plague: Fact or Fiction? 511
Primary Pneumonic Plague in Manchuria: A Model for Iceland? 514
The Spontaneous Decline of Epidemics of Primary Pneumonic Plague 518
The Icelandic Climatic Th eory of Primary Pneumonic Plague 528
Mortality Rate of the Purported Plague Epidemics in Iceland 530
Summary: Why There Never Was a Plague Epidemic in Iceland 533
Was the Black Death in Bergen (Norway) 1349 Primary Pneumonic Plague? 536
Summary and Conclusion 550

14. Twigg’s Alternative Theory 553
Introduction 553
Th e Alternative Theory of Anthrax 555
Th e Historical Basis: The Use of Obsolete and Peripheral Studies 560
Th e Telluric-Miasmatic Th eory of Anthrax 562
Th e Pace of Spread of Plague 566
Anthrax and the Name Black Death 571
Anthrax’s Historical Association with Other Epizootics among Domestic Animals and Plague 574
Th e Black Death’s Origin and Spread and the Anthrax Theory 580
Twigg’s Demographic Argument 595
Concluding Remarks 608

15. The Alternative Theory of Scott and Duncan 610
Introduction 610
Disparaging Views of Historians and Physicians: Motive and Objective 611
The Material Scholarly Basis of Scott and Duncan’s Alternative Theory 615
The Demography of Historical Plague 628
The Reed-Frost Theory of Epidemiology 633
The Filoviridal Theory of Historical Plague: A Study in Academic Fiction 636
The Significance of Autopsies 653
Th e African Confinement 661
Summary and Conclusion 662

16. Cohn’s Alternative Theory 664

Epilogue 673 Appendix 1 Black Death Mortality in Siena: The Material Provided by the Necrology of the Monastery of San Domenico in Camporegio and Summarized in Table 5 675
Appendix 2 Th e Accounts of the Icelandic Epidemics of 1402–4 and 1494–5 Given in Icelandic Annals 680
Appendix 3 Th e Extrinsic Incubation Period and the Structure and Composition of the Latency Period 682
Glossary 688
Bibliography 693
Index of Subjects 717
Index of Geographical Names and People 730
Index of Names 740

Readership

All those interested in medical history, the Black Death and the history of later plague epidemics, and the discussion of their microbiological identity and demographic effects.

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