"Medieval" Madagascar

"Medieval" Madagascar: Plague and Inequality 

The Current Outbreak of Plague isn't a Throwback, But a Sign of Modern World 

A guest post by Monica H. Green. 
Dr. Green is Professor of History at Arizona State University. 
Follow her on Twitter @monicaMedHist 

I see dead people. That’s my job. I’m a historian.

But in the past five years, I have seen many millions more dead people than I ever thought I would as a historian of medicine. In the past five years, I have had the experience of slowly realizing that the Black Death—the massive outbreak of plague that struck in the middle of the 14th century—likely affected many millions more people than we ever imagined in our wildest nightmares.

In most of the maps we see when we study this period of history, in most of the texts we read, we are usually taught to think of the Black Death as a pandemic that struck only the Mediterranean and Europe. We teach the Black Death through the stories of Boccaccio, telling us of social breakdown from the perspective of elite Florentines who could afford to escape the city, leaving others to their fate. We learn of the Black Death from manorial records in England, which show tenant after tenant having to pay the heriot, a kind of death tax, in order to inherit land from their deceased relatives. We cringe with horror listening to Ibn al-Wardi, writing from Aleppo, recount the terrifying progression of the plague across the Middle East and into North Africa.

But what we haven’t seen or heard, what we haven’t previously perceived, are the many millions of people beyond the Mediterranean who may have also been struck by the disease. Geneticists now talk of a “Big Bang” in plague’s history, a sudden branching out, an explosive expansion of the causative organism of plague, Yersinia pestis, sometime in the late 13th or early 14th century. This expansion of plague created four new branches in plague’s evolutionary tree. One “branch” went westward, reaching the Black Sea and then the Mediterranean. Two branches likely stayed fairly local in central Eurasia, and may have affected wild animal populations more than humans.

Minimum spanning phylogenetic tree of 133 Y. pestis genomes, with major historical events marked. From Y. Cui et al. 2013, fig. 1A, with additions by M. H. Green. Reproduced with permission.

But the fourth branch spread out just as widely as the first. Strains called by scientists 2.MED and 2.ANT can now be found across almost all of Eurasia, from Jilin Province in northeast China to Turkey and even Algeria, from Russia and Mongolia to Tibet and India. Perhaps as much as two-thirds of Eurasia, and maybe even major parts of Africa, were affected by this pandemic, which spawned continuing outbreaks for centuries.

How do we know this? Because strains of plague initially created in the 14th century still exist in the world today. The evolutionary history that I have just given has been made possible by the fact that this organism still persists on four of the five inhabited continents of the world. Plague outbreaks are not a routine experience for most of us today, but that is not because we ever “conquered” the disease. Plague has never been eradicated, and it won’t be. Rather, we have established an uneasy détente with the organism. We know where it lives, we know how it behaves. And we watch it. Closely.

And that’s why those of us who know plague are watching the situation currently unfolding in Madagascar with increasing alarm. The current toll of 1192 cases and 124 deaths already makes this one of the largest outbreaks in years. Equally alarming is the fact that, of the 22 administrative districts in Madagascar, 14—two-thirds—are reporting cases. This is a plague outbreak out of control.

Why is Madagascar suffering from this “medieval” disease? Because it’s part of the modern world. I live in “medieval” Arizona, a state—like most of the American West—where plague has also insinuated its way into the wild rodent population. Plague arrived in Madagascar and the American Pacific coast about the same time, around 1900, and for the same reason: it was being transported all over the world in the holds of steamships coming out of Hong Kong’s harbor. In both Madagascar and America, it spread inland, finding new hosts and taking up permanent residence.

Plague has changed very little in the past 700 years. It hasn’t had to. We control plague nowadays by using insecticides to get rid of the fleas that transmit the disease from host to host and by controlling rodent infestations. But plague never went away. Only our daily awareness of it did.

What is happening in Madagascar shouldn’t be happening. We know how to monitor this terrifying disease and we know how to control it. We know that a standard arsenal of antibiotics can halt an infection, if it is given very quickly after exposure. We also know that, if not controlled, plague has one of the highest mortality rates of any disease in history.

What we have not yet learned is a lesson the microbial world has been trying to teach us since the 14th century: we’re all connected. Madagascar is suffering now not because it is trapped in its medieval past. Madagascar was indeed connected to a larger world in the Middle Ages, but we have no evidence that plague reached it then. Rather, Madagascar is suffering from plague now because of its connections to the modern global economy. The mining, the textile production, even the very vanilla we use everyday has made Madagascar part of this global economy.

I see dead people in the past. And I cannot save them except by recovering their stories. The people of present-day Madagascar, however, are not beyond our reach. Or beyond our responsibility. We are all connected.

There's Nothing Medieval about Trump

Columnists keep wanting to distance us moderns from Trump, but he's as modern as it gets. 

GUEST POST by Eric Weiskott

In an interview for The Guardian last week, philosopher Daniel Dennett was asked whether “deep thinking” is what’s needed in the current political climate. He responded:

Yes. From everybody. The real danger that’s facing us is we’ve lost respect for truth and facts. People have discovered that it’s much easier to destroy reputations for credibility than it is to maintain them. It doesn’t matter how good your facts are, somebody else can spread the rumour that you’re fake news. We’re entering a period of epistemological murk and uncertainty that we’ve not experienced since the middle ages.

These are the words of someone totally unacquainted with the Middle Ages. It’s not just that the picture of the medieval period as an endless cycle of ignorance and repression is wrong (it is), but the picture itself is a modern one. It’s an effect of the Enlightenment and secularization, which retrospectively created premodernity. Ironically, by describing American politics as a regression to a medieval past, Dennett is reifying the very ideology that created ‘the Middle Ages’ in the first place. There’s no there there—no real confrontation with the past and no meaningful comparison.

Dennett isn’t alone. Lou Mastriani writes for NorthJersey.com that “Donald Trump has taken us back to medieval times.” David Brooks thinks the Trump administration “is more like a medieval monarchy than a modern nation-state. It’s more ‘The Madness of King George’ than ‘The Missiles of October.’” (Note: George III reigned in the nineteenth century!) Katty Kay opines for the BBC that Trump’s White House “acts like some medieval court.” Louis René Beres at Arutz Sheva, describing Trump’s presidency as “forged in an atmosphere of determined unreason and anti-thought,” identifies it with the prediction of what he terms “resurrected medieval darkness” in W. B. Yeats’s poem “The Second Coming.” And this is just from the past week.

These statements are historically ignorant. They’re also a window onto modern liberal subjects’ sense of the world. 

The real payoff of assigning current politics to the distant past is to protect the notion of a just society, ruled by reason. The notion of a society ruled by reason stands in need of protecting because, well, it keeps bumping up against reality. Indeed, this notion has always been a fantasy, a way of papering over the violence and imperialism of modernity.

You don’t get Hume without the transatlantic slave trade. You don’t get Kant without the Holocaust. The just and rational world projected by Enlightenment philosophers turned out to be a space of whiteness called “Europe,” cloaked in universalism. Enlightenment has winners and losers across the world in 2017.

None of this is to say that the various ideas and practices we now call the Enlightenment were a bad thing. Historicism teaches us that transhistorical judgments are problematic, in any case, since there exists no position outside history from which to judge. The crucial point is that the Enlightenment inculcated new forms of hegemony even as it promised new forms of liberation. If you are sure enlightenment has been good to you, that is because you live in the historical alleyways opened up by enlightenment. You are the product of enlightenment and its beneficiary. One of the minor exports of Enlightenment thought was the idea of the Middle Ages, the negative mirror image of secularist modernity.

So when Dennett makes an offhand reference to “the middle ages,” all that historical baggage is packed in yet goes unacknowledged. He means, approximately, ‘a period of epistemological murk and uncertainty that we’ve not experienced since what I imagine my rationalist, secularist self would feel in the Middle Ages.’ So stated, the sentiment is obviously devoid of historical content. Ultimately, Dennett’s appeal is an appeal to whiteness, scientism, secularism, and related ideological formations. Any of my colleagues in medieval studies will recognize this rhetorical move. It’s the same move that made Anglo-Saxons and West Africans appear primitive to nineteenth-century white Europeans. (Notice how modernity transects both space and time.) Medievalists have learned to disarm this line of reasoning by asking, “‘Primitive’ to whom? On what grounds? For whose benefit? At whose expense?” The idea that Trump is making America medieval again deserves to be greeted with the same skepticism, and for the same reason.

Dennett’s historical attitude is bound up with his own reflexive disdain for religious belief and religious institutions, a habit of thought characteristic of secularist modernity. (Every medievalist has been asked by a friend or family member, “How can you study such a religious period?”) Tellingly, Dennett remarks that “the rise of theocracy in America” is one of the few threats that can spur him to political activism. He admits to resenting politics in general, because “I simply must take time out from what I’d really like to be doing to think about the political near future.” Needless to say, the luxury of escaping politics is only afforded to those with substantial privilege and security. Dennett’s comments on organized religion suggest what’s at stake for him when he does choose to drop the pretense that his work is apolitical. Like Stephen Greenblatt, Dennett is invested in anti-religious polemic, in vindicating secularization as absolute social progress.

Like racial slavery, the scientific method, ISIS, the automobile, and phenomenology, Trumpism is an irreducibly modern response to modern conditions. Trump isn’t taking us back to the Middle Ages because history only points in one direction. We can learn much from the violence of the past, but not by wishing away the violence of the present.

Eric Weiskott teaches medieval English poetry at Boston College; he's working on a book about the division of the past into medieval and modern periods.

Who Knows Anything? - Journalism, Caesarean Section, and the Production of Knowledge

The New York Times ran a story about an amazing c-section survival in 1337. But historians of medieval medicine don't think it happened. 

By Monica H. Green

On Wednesday, 23 November 2016—the day before the Thanksgiving holiday in the U.S.—the New York Times ran what it likely assumed to be a “fun fact” story, a minor historical discovery on a slow news day. Under the category, “What in the World” and headlined “A Breakthrough in C-Section History: Beatrice of Bourbon’s Survival in 1337,” the Times piece recounted how Czech researchers had found “an apparent case” of a Caesarean section performed on the recently married, 19-year-old medieval queen of Bohemia.

The piece would likely have quickly become ephemera had it not been picked up by Twitter. There, the case of Beatrice reached the attention of historians specializing in medieval women’s history and medieval medical history. It immediately provoked skepticism.

In our heightened debates about “Fake News,” we should give more thought to how “knowledge” (“unfake news”) is produced and disseminated. In this case, the curtain that needs to be pulled back is the process of peer review.

To the historian of medicine, the study bears all the pitfalls of amateurish oversight. It takes no account of the past thirty years of scholarly literature in either the history of medieval obstetrics (or women’s history more broadly), nor the history of medieval surgery or anesthesia. Peer review by historians of medieval medicine would have quickly identified these problems. It seems, however, that the piece was only refereed by physicians.

What is peer review?

Peer review involves works being sent out, before publication, to other scholars who work on similar questions to the item under review. They assess the piece in terms of its coverage of the existing literature in a field, the originality of its question, and the rigor of its methods. Based on those criteria, publication (or not) is recommended.

But who are “peers”? In the case of medical history, that is a major issue. Are peers physicians who have been trained in modern medicine, who have treated living patients, excised real tumors, autopsied fresh cadavers? Or are they historians who have been trained in the languages, cultures, archives, and traditions of the past? Researchers who have both MDs and PhDs exist, but are rare. The authors of the Czech C-section study self-identify as a physician, a member of the philosophy faculty, and a historian, all at the Charles University in Prague: an impressive interdisciplinary team. The reviewing process should have involved scholars with a similar range of competence.

The argument of the study hangs on the slimmest thread of evidence, the meaning of the Latin word incolumitate in two versions of a letter sent out under the queen’s name after the birth. Incolumis, according to the Latin dictionary commonly known by its authors’ names, Lewis and Short, means simply “unimpaired, uninjured, in good condition, still alive, safe, sound, entire, whole.” Its medieval usage is comparable. Yet from that single word, and from other accounts written a century or more after the said birth (leaving plenty of time for a private event to have mushroomed into legend), the authors deduce that the queen must have undergone a C-section. Since she clearly survived, the “operation” must have been successful.

There are legitimate grounds to debate the linguistic weight of the word incolumitate, and legitimate grounds to debate the political context in which this still uncrowned queen had to assert her right to the consort’s throne. There are also medical grounds to question the interpretation. Could not incolumitas here mean, for example, that Beatrice, still a teenager, had survived the birth without the crippling damage that obstetric fistula is known to visit upon girls being forced to bear children too young? Unfortunately, neither this scenario, nor many other possible obstetrical outcomes, all of which are well-known from medieval records, are assessed here.

National pride and international spin

The study appeared earlier this year in the national Czech journal of gynecology, meant, apparently, to provide an interesting reflection on national history to the country’s obstetrical specialists.[1] For its original audience, its speculations about the nation’s medieval history were no doubt fascinating. Once its message was amplified internationally by the New York Times, however, it suddenly became “a breakthrough,” a major scientific discovery. Antonin Parizek (“a noted obstetrician and expert on medical history,” according to the Times, and the study’s lead author), seems to be the only person interviewed for the news story. The unsubstantiated interpretation of incolumitate now becomes a fact of history: “Beatrice most likely passed out during delivery,” Parizek is quoted as saying, “and was believed dead … The surgeons opened her only to save and baptize the child. The pain from the operation then likely led to her awakening.”

In short, this is fiction. But, presented as “fact” by the New York Times, it becomes accepted as truth by a world-wide audience. The word “apparent” is the only qualifier given, and other statements—such as the reference to “other archival sources” without clarification that they postdate the birth by anywhere from one to five centuries—mislead the reader.

As noted above, the New York Times piece appears in a section of the newspaper called “What in the World.” This section is meant to circulate news stories coming from other national news outlets, and this one may have been picked up from Czech media. That is certainly a worthy, and indeed, necessary goal in our globalized world. But just as “local knowledge” is needed to interpret the nuances of language and culturally coded behaviors, so local academic knowledge is needed to explain how published work is generated in different professional fields.

The New York Times has given us a prime example of how fake news is generated. In this case, the news is not “fake.” The Czech study really was published. But the implication that it reflected any kind of consensus on what historians believe about women’s medical history was absolutely false.

“What in the world,” indeed.

---

Monica H. Green is a historian of medicine and global health. A professor of History at Arizona State University, she has published extensively on the history of medieval women’s healthcare, including her award-winning book, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (Oxford University Press, 2008). Many of her works, including her comprehensive bibliography on women and medicine in the Middle Ages, can be found on her Academia.edu page.

[1] Thanks to Roberto Labanti for this reference. Thanks as well to Maaike van der Lugt, Katharine Park, and Fernando Dias de Avila Pires for helpful comments.

What do you do when someone tells you they are thinking about suicide?

When someone brings up thoughts of suicide to you, you have already done something right. 

This is a repost with permission. Amy McNally is a musician in Madison and a friend. Please share this. There is someone in your social circle who needs to read this. 

Originally posted by sweetmusic_27 at International Survivors of Suicide Loss Day 2014

November 22 is International Survivors of Suicide Loss Day.

Four years ago, my mother committed suicide. I still struggle coming to terms not only with her death, but with my family's wider history of suicide. My maternal grandfather and great-uncle died by suicide, my sister made an attempt, and I have struggled with depression and suicidal thoughts since puberty.

When I talk about these things, people shy away. It's a frightening subject, but if we want to help people who are suicidal, we need to understand what suicide really means, how it works, and how to respond to people contemplating it. Remember, talking about suicide does not cause someone to be suicidal. If you're worried about someone, it is safe to bring up the topic of suicide.

Suicide is the act of taking one's own life, and suicidality - the tendency toward or risk of suicide - is an illness like any other. Some people have this sickness temporarily, others fight it their whole lives. In my family, it's hereditary. All too often, it's fatal. It takes over your mind and body and you die from it. When that happens, as a society, we tend not to talk about it too much. It’s a very quiet killer, rendered quieter by stigma, taboo, awkwardness, and misconceptions.

Suicide is not selfish. Imagine that your thoughts and emotions make up a house. My mother's mental house faded around the edges. Room by room, the space available to her shrank until she was left a hallway, trapped in a narrow place. It's not that she was thinking of herself; it's that she couldn't think of anyone, anything.

It’s nobody’s fault when this medical condition takes hold. As many as one in six people become seriously suicidal at some point in their lives. While it is not directly caused by depression, anxiety, drug use, or other risk factors, about 90% of suicidal people have mental issues that involve or worsen seriously suicidal thoughts. These issues can be treated.

If someone brings up the topic of suicide with you, don't panic. Don’t lecture, and don’t make demands. Start by listening. Someone reaching out to you is a very good sign. First of all, it means they trust you. Second, if an individual is sharing these thoughts with you, there is something stopping or delaying them from completing suicide. It is safe to ask, "What's stopping you, and how can we focus on that?"

Here are some other “do’s” and “don’ts” for such a conversation. We all need to be ready to support our friends and family.

Do try to have the conversation in private. Don't promise to keep the contents of the conversation private, though. It's important that you be willing to get help if someone you know is in crisis.

Do try to say something, even if it's "wow, I'm sorry," or "well, crap." You don’t have to instantly become a perfect therapist. A friend of mine reached out to some of her friends, and they reacted with silence. "You could have heard a pin drop," she told me. "Nobody said a thing." It made her feel distanced, alone.

If the person you're talking to mentions a certain means of committing suicide, it's safe to bring up ways to remove or limit that means. "Do you want me to keep your gun for a while? Do you keep ammo in the house?" "When you say you're thinking about swallowing pills, are they pills you have? Can you get someone to dose out a week at a time instead of having the whole bottle around?" "You mentioned slitting your wrists. Is looking at knives or razors hard for you? I can come over and help you get those things out of the house for a while. Want to go shopping for an electric shaver together?" Bringing this up is not harmful and will not give anyone ideas. Don't press for action, just let them know there are options.

Later, check back in. Be ready for things not to suddenly be better. The mental issues surrounding suicidality don't go away quickly. If you can, try to communicate that it's okay to still be struggling.

There are many resources for those who are suicidal or talking to people who are considering suicide. America's Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255) and anyone in crisis can use their online chat to talk to a counselor. Similarly, IMAlive is an online chat-based Hopeline staffed by trained volunteers, and the Kristin Brooks Hope Center's Hopeline phone number is 1-800-442-HOPE (4673).

If you're suicidal, there are people who can help. If you are not, the odds are that somebody in your life will be or has been before, and you can still help by being willing to educate yourself and others, and being willing to say the word "suicide."

When someone brings up thoughts of suicide to you, you have already done something right. You’re the one they trust, you’re the one who feels safe. "Suicide" is a scary word, but talking about it doesn't kill you, and being ready to listen might help someone live.

Every time you share this post or other information on suicide, you help to fight the stigma, break the taboo, and dispel the myths. Feel free to link back to this. Feel free to comment here with other links and resources and stories. Feel free to talk to me about suicide.

The Human Scale: What we miss when we compare disasters like Ebola and the Black Death

This is a guest post written by Ellen Arnold, PhD, 
Assistant Professor of History at Ohio Wesleyan University. 

 
"Perhaps the biggest thing missing from comparisons between Ebola and the bubonic plague, or in fact between any of these large scale tales of epidemic and pandemic disaster, is the human scale."

I am an environmental and cultural historian—I work on the Middle Ages, and one of the classes that I teach on a regular basis is a class on the Black Death that is, at its core, a course in comparative disease and disaster history. In 2009 I started the class with discussions of Swine Flu. In 2013 we began not with the Middle Ages, but with parts of Susan Sontag’s “AIDS and its Metaphors.” We read about cholera, and the flu pandemic, HIV/AIDS and cancer. I ask students to make links across time and across cultures, to think about the ways that humans interact with ecosystems of disease and the ways that human society constructs ideas about illness, how groups and individuals respond to disease, and the role of culture in human/disease interactions. And so I have been following coverage of the recent, devastating Ebola outbreak not only as a concerned citizen, but also as a teacher interested in the ways that people imagine and interpret disease.

The ways that we as moderns understand, interpret, and talk about disease have long and complex history. The history of the way that we frame and interact with diseases has taught us important lessons about both human health and human cultures. And modern disease studies have helped us learn a LOT more about the Black Death. Recent DNA analysis of both human remains and microbes and cemetery excavations have rekindled academic and popular interest in the medieval plague, and have added a lot of nuance to many public discussions of the deadly disease. And so, as I read Mark Perry’s essay using the panic over Ebola to direct readers to that most famous of pandemics, the Black Death, I was hoping for, well, I don’t know.

The article rehashes all the old standard stories about the plague— it was “caused” by Mongol armies using biological warfare; it swept uncontrollably through Europe, was composed of three diseases (here he is wrong), it devastated the economy, led to persecutions and hatred, and, (and here’s the core) killed an unimaginably large number of people. (I could write a whole essay on how misguided and oversimplified these main, predictable stories are, but I won’t.) Instead, I’d like to focus on the ways that we are missing real opportunities to do meaningful historical comparisons when we use death tolls as our primary index for comparison.

National Geographic

The main comparative point that Perry is making is one of death toll—a statistical comparison. Ebola, he argues, “is not nearly as deadly as [the disease] which, well, plagued the world in the 14th century.” He is not alone in this. Despite some more nuanced attempts to compare specific public health policies (see Rebecca Rideal’s take on UK border control efforts and this NPR piece on some recent research), comparisons between the plague and other diseases fixate on the death toll. Ty Burr, writing for the Boston Globe, amidst an interesting essay on cultural expectations of disease, writes: “Some perspective: The Centers for Disease Control estimates that influenza kills 3,300 to 49,000 people in the United States per year; statistics are much debated, but the point is that they’re more. Bubonic plague — the Black Death of the Middle Ages — reached London around Nov. 1, 1348; by February, 200 people were dying per day. The 1918 influenza epidemic that killed 30 to 50 million worldwide landed in Boston at the end of August; by the end of October, 195,000 Americans had died.” A National Geographic article presents this graphically, with lives lost turned into giant lotto-balls (blood-red to signify blood and danger).

Shocking, yes—but helpful? Perhaps the biggest thing missing from comparisons between Ebola and the bubonic plague, or in fact between any of these large scale tales of epidemic and pandemic disaster, is the human scale.

Today we routinely hear disasters quantified and measured against one another. Natural disasters are newsworthy when they are “the worst” or “the highest,” droughts when they are “the most extensive.” Material damages are quantified, to determine if disasters qualify as the “most expensive” (or problematically, expensive enough to merit aid), and human loss of life becomes part of the tally of scale. Given our new record-keeping abilities to assess and compare both scale and impact, and also the reality of increasingly global scales of environmental disasters in the post-Industrial (or anthropocene) world, it is unsurprising that generally only the “worst” medieval and pre-modern disasters are commonly discussed: Pompeii, the Black Death, the diseases of the Columbian exchange, etc.. All disasters, no matter their scale, affect individuals and communities, and leave their traces in communities, families, ecosystems, and human memory.

Source: http://www.andrecarrilho.com/

In August, André Carrilho drew a striking illustration (discussed here and reproduced left) of media response to the Ebola outbreak. What makes this image so powerful, besides the painfully brutal way it throws our racism at us, is the de-individualization of all the sick people. These people are identical (save color) in their identities as suffering bodies. Their personas eclipsed by their identities as victims. They are statistics.

Here is where the premodern can help—can open up conversations about not just mass mortality, but about individual response. Though so many modern accounts of the Black Death focus on gruesome deaths, medieval writers remind us that past the fear and the pain, there was another dimension to the plague—it created absences.

In the wake of the plague, Petrarch wrote an agonized letter:

“Where are our dear friends now? Where are the beloved faces? Where are the affectionate words, the relaxed and enjoyable conversations? What lightning bold devoured them? What earthquake toppled them? What tempest drowned them? What abyss swallowed them? There was a crowed of us, now we are almost alone. We should make new friends—but how, when the human race is almost wiped out; and why, when it looks to me as if the end of the world is at hand? Why pretend? … Look, even as we speak we too are slipping away, vanishing like shadows.” (Petrarch, letter from Parma, tran. In Horrox, The Black Death, 248-249).

Each dot on a map of Ebola victims was a whole person, with a family and a faith and friends—each person killed in this outbreak leaves giant holes in their family, their local economy, and their social networks. Though it is tempting to look to the medieval world and see in it a “there but for the grace of God and penicillin” lesson, it is much more fruitful to see in the voices of long ago reminders that all lives matter, that diseases on all kinds of global scales are about the sickness, susceptibility, salvation, and (one hopes) survival of individuals.