1 00:00:06,700 --> 00:00:14,020 Shops were boarded up. The streets were almost empty and there was a stench of death in the air. 2 00:00:14,020 --> 00:00:21,110 Francesco was just trying to get hold of a few vegetables. Florence seemed deserted these days. 3 00:00:21,110 --> 00:00:28,610 It meant that for a while he'd been able to hear the distant echo of horses hooves on the cobblestone roads bouncing from house to house. 4 00:00:28,610 --> 00:00:35,780 And now the sound broke out into the streets ahead. The whole train of carriages heading his way at some speed. 5 00:00:35,780 --> 00:00:42,490 He scampered to the walls and peered back as it comes to. It was full of the dead. 6 00:00:42,490 --> 00:00:51,220 Maybe neighbours shocked, nervous blacksmiths, people who need it all on their way down to the grave in either the. 7 00:00:51,220 --> 00:00:57,760 Soon there'll be another carriage load on the way. That was the only life in the city. 8 00:00:57,760 --> 00:01:03,660 The bodies look bloated with blackened toes and fingers hanging over the sides of the car. 9 00:01:03,660 --> 00:01:09,820 And as the winds hit, each Flagstad hands jumped and found as if they were waiting in. 10 00:01:09,820 --> 00:01:23,060 A cold chill crept along his spine. And as he turned back into the street, two dogs sprinted past him, chasing after the dead. 11 00:01:23,060 --> 00:01:31,780 Welcome to the 14th century to the third episode of our history of pandemic's season, we've already heard about the plague. 12 00:01:31,780 --> 00:01:32,930 If it wasn't, 13 00:01:32,930 --> 00:01:43,690 then about humanity's first genuine recorded with plague and now you'll discover what we do and don't know about its most notorious outbreak. 14 00:01:43,690 --> 00:01:54,320 The Black Death is a gruesome name, well matched with a grim disease, and both the epithet and the infection have survived to the modern period. 15 00:01:54,320 --> 00:02:01,960 But first, we should cheque back in with my colleague, Dr. Bloche Agouti, who can remind us what exactly the plague is. 16 00:02:01,960 --> 00:02:08,360 Well, essentially, the plague is an acute life-Threatening infectious disease caused by gram negative interest, 17 00:02:08,360 --> 00:02:11,890 only a bacterium called Yesenia pestis. So you see it. 18 00:02:11,890 --> 00:02:15,890 This often infects small rodents like rats, mice, squirrels. 19 00:02:15,890 --> 00:02:22,250 That's kind of where it likes to hang out. And it's usually transmitted to humans through the bite of an infected flea, 20 00:02:22,250 --> 00:02:27,860 although there are other transmission routes that it can take with only since the 19th century 21 00:02:27,860 --> 00:02:33,230 even understood that it was a bacterium that caused such an infamous thing as the plague, 22 00:02:33,230 --> 00:02:38,050 which before then it was thought to be some kind of punishment from God or my Ismar. 23 00:02:38,050 --> 00:02:47,210 So essentially something caused from bad smells. Future isn't matter, the cost of sick people just rather than actually being a microorganism. 24 00:02:47,210 --> 00:02:53,880 So that's a reminder of what plague is. But how did the black outbreak start? 25 00:02:53,880 --> 00:02:58,660 To find the answer to that was someone in Glassco. I need you to call. 26 00:02:58,660 --> 00:03:04,840 My name is Samuel Cohn and I'm professor of mediaeval history at the University of Glasgow. 27 00:03:04,840 --> 00:03:17,110 For the last 20 years, more than 20 years, I've been working on principally the black cat, but on diseases and for the human reactions to diseases. 28 00:03:17,110 --> 00:03:25,380 And on this side, I finish and 2018, a rather large book, at least in terms of pages. 29 00:03:25,380 --> 00:03:30,250 And in terms of the scope, geographical scope and the temporal. 30 00:03:30,250 --> 00:03:40,570 So I spoke with Oxford University Press titled Epidemics Hate and Compassion from the Plague of Athens to AIDS. 31 00:03:40,570 --> 00:03:44,600 I was keen to learn from where the outbreak first emerged. 32 00:03:44,600 --> 00:03:51,670 That narrative evidence is that it enters Europe coming from those that we support. 33 00:03:51,670 --> 00:03:57,130 And it arrives in the fall of thirteen forty seven. 34 00:03:57,130 --> 00:04:01,510 We know about earlier bouts with dystonia pestis. 35 00:04:01,510 --> 00:04:10,810 This type of disease that we now think like that was that goes back at least five thousand years ago to the Bronze Age. 36 00:04:10,810 --> 00:04:12,520 Now, this is not recorded. 37 00:04:12,520 --> 00:04:25,840 This is computed evidence that stems from genome sequencing and phylogenetic trees of the ancestry and the splits of different strands. 38 00:04:25,840 --> 00:04:34,980 Oh, you're. Over these shootings now for the Black Death, whether it is more virulent or just could spread much more efficiently. 39 00:04:34,980 --> 00:04:44,590 Is it another question that the genome sequencing, I think, hasn't really gotten a hold of and may not ever be able to get a hold? 40 00:04:44,590 --> 00:04:52,450 But if it is right, there is this notion of a big bang that occurred someplace and there's a lot of disputing about this. 41 00:04:52,450 --> 00:05:00,310 This is really very much up in the air now, someplace properly and the plateau of Mongolia, China. 42 00:05:00,310 --> 00:05:03,970 This goes back depending on who you're reading to. 43 00:05:03,970 --> 00:05:07,220 Even the they need a level of the 12th century. 44 00:05:07,220 --> 00:05:13,930 But does it really seem to be spreading out of that area through different trade droughts and to the 14th century? 45 00:05:13,930 --> 00:05:24,140 And then we have a key point that's take it not from genetic studies, apart from archaeology, yet this goes back to the 1880, actually. 46 00:05:24,140 --> 00:05:31,900 Actually, this is the gravestones, numerous gravestones from the story in Christian communities. 47 00:05:31,900 --> 00:05:44,410 And that part where China meets with the Russians steps the high plateaus around the lake of all, which is just to the west of Pakistan. 48 00:05:44,410 --> 00:05:54,820 So very close to China. And there we have this this Semin nation of these Christian communities through their gravestones. 49 00:05:54,820 --> 00:06:04,930 So they go back further. So we know that the increase in mortality is about the same ratio that we find with the Black Death. 50 00:06:04,930 --> 00:06:09,710 We have that data. So if you want to call that recorded, in some ways it is recorded. 51 00:06:09,710 --> 00:06:12,520 It's on it's recorded in stone. 52 00:06:12,520 --> 00:06:21,940 The problem is that there's been keen interest in both gravesites since the techniques of genome sequencing have been developed. 53 00:06:21,940 --> 00:06:27,580 However, no one has been able to use that information to connect back, 54 00:06:27,580 --> 00:06:35,480 go straight to plague or leave it know that it's really in the same ballpark as the same disease as what the Black Death was. 55 00:06:35,480 --> 00:06:44,590 So the court is out there and unfortunately, in the 1880 80s, so soon afterwards, a lot of that evidence was removed. 56 00:06:44,590 --> 00:06:46,960 Then it seems a be destroyed. 57 00:06:46,960 --> 00:06:59,440 But there are other settlement Schoop to be investigated slightly before it gets to Messine, Sicily and October, or maybe slightly here or there. 58 00:06:59,440 --> 00:07:07,900 By the time the chroniclers pay attention to it, but it goes on another route, a completely different crowd. 59 00:07:07,900 --> 00:07:14,580 It seems that area to Constantinople and it hits Constantinople slightly early. 60 00:07:14,580 --> 00:07:19,270 And it has its own Farrukh curious little twists and turns. 61 00:07:19,270 --> 00:07:23,380 It gets the Masino before it gets to Florence or in Heller. 62 00:07:23,380 --> 00:07:27,250 It goes to Florence by probably Jeno. 63 00:07:27,250 --> 00:07:36,280 Was that general word down the piece of pizza then across and it's moved across land is is slightly slower than by sea. 64 00:07:36,280 --> 00:07:43,870 You get a strike of it as early as this summer. The debit copes in 13 48. 65 00:07:43,870 --> 00:07:51,930 But then for some reason in the Netherlands, we don't see it really blossoming until between forty nine. 66 00:07:51,930 --> 00:07:53,560 You've really had. 67 00:07:53,560 --> 00:08:05,340 A significant outbreak, this disease travels as fast as any disease back contemporaries had ever experienced, and especially over long distances. 68 00:08:05,340 --> 00:08:12,060 And much more quickly than modern Yersinia pestis of the third and deadly. 69 00:08:12,060 --> 00:08:17,550 Even with the benefit of railways, horrible fields stinks. 70 00:08:17,550 --> 00:08:23,470 So that's how the outbreak started. I also wanted to know how the disease spread. 71 00:08:23,470 --> 00:08:27,630 Yesenia pestis usually likes to be transmitted around small rodents. 72 00:08:27,630 --> 00:08:33,990 So that is their chosen host, especially the black rats, which makes you know about the practise rats. 73 00:08:33,990 --> 00:08:38,430 What happens is you've got two main cycles. You've got the ensuing tick cycle. 74 00:08:38,430 --> 00:08:43,830 So the plague back to your sexily at no rates within populations of regions without causing excessive die off, 75 00:08:43,830 --> 00:08:48,780 which is quite important because it means that the fleas that are associated with those 76 00:08:48,780 --> 00:08:53,940 rodents can continue to live off those animals and serve as Long-Term Reservoirs. 77 00:08:53,940 --> 00:09:02,280 So that's what usually happens in nature. You don't happen at these all tick cycle so other species can become infected by the plague, 78 00:09:02,280 --> 00:09:06,150 which could cause an outbreak amongst animals that are used to having the plague. 79 00:09:06,150 --> 00:09:10,440 And then you get a lot of die off of those animals and then they're fleas. 80 00:09:10,440 --> 00:09:14,640 Want to jump off to whatever's in their response to get a blood meal. 81 00:09:14,640 --> 00:09:18,930 And that's when humans can become accidental hosts. So essentially, 82 00:09:18,930 --> 00:09:28,140 there are passive or active ways that humans can get caught up in these cycles because you have a symbiotic cycle which essentially in the wild life. 83 00:09:28,140 --> 00:09:33,720 So you have wylder agents and their fleas kind of circulating the plague amongst themselves. 84 00:09:33,720 --> 00:09:38,910 And then you've got an urban cycle. So he's got more domestic type rodents like mice, 85 00:09:38,910 --> 00:09:46,960 which you might find around the house and say the wild rodents are kind of become close to the domestic rodents. 86 00:09:46,960 --> 00:09:51,030 Their sleep can then jump from the wild cycle into the urban cycle. 87 00:09:51,030 --> 00:09:59,970 And then those domestic rodents, like the mice, come and go into human habitats and then their fleas can jump to humans that way. 88 00:09:59,970 --> 00:10:05,820 So that's essentially why you tend to find outbreaks of plague at the moment in really rural areas, 89 00:10:05,820 --> 00:10:10,080 areas where humans have settled too close to wildlife, deforestation. 90 00:10:10,080 --> 00:10:17,850 So that you can have the silvertail cycle of plague meat, the urban cycle of say, and then jump on to humans by accident. 91 00:10:17,850 --> 00:10:25,020 One thing I've always wondered about the Black Death is whether that name would have been used at the time. 92 00:10:25,020 --> 00:10:34,110 I use the word black death mainly to talk about thirty, forty eight or thirty or forty seven to fifty to have the plague afterwards. 93 00:10:34,110 --> 00:10:43,820 Contemporaries did understand this disease, says the same disease, even though they could see changes in it for candidates. 94 00:10:43,820 --> 00:10:53,920 I think they were right. They, they, they did. Just so people, especially botanists, could study diseases in the 20th century, they think, 95 00:10:53,920 --> 00:10:58,740 oh, you know, in the Middle Ages they knew nothing and they called everything plague. 96 00:10:58,740 --> 00:11:09,330 Well, that is the colloquial is. Yes. And they make big distinctions based on clinical and epidemiological level. 97 00:11:09,330 --> 00:11:12,960 They didn't call it black death. They had different names for it. 98 00:11:12,960 --> 00:11:18,690 Like the great mortality is one that I repeated over and over again later. 99 00:11:18,690 --> 00:11:23,300 I think the word pestilence, true plague become more common. 100 00:11:23,300 --> 00:11:31,020 Plague becomes a problem. And now they don't use the late Middle Ages, especially the early voting period. 101 00:11:31,020 --> 00:11:38,040 They use the word plague often for other things, like the track that they're talking about here, 102 00:11:38,040 --> 00:11:42,440 though, the plague of heresy or even earlier is the plague. 103 00:11:42,440 --> 00:11:50,480 So popular rebels, the rabble. But when they're talking about disease, it's often very clear they're talking about the devil. 104 00:11:50,480 --> 00:11:58,440 The big word that comes in in the early voting period is that there are called top kill the Bacon H. 105 00:11:58,440 --> 00:12:06,780 And I studied the word contagion, which I think is interesting because before the black death, with that word, with use, it is by chroniclers. 106 00:12:06,780 --> 00:12:11,760 It was barely used by people in the medical profession. But disease it was. 107 00:12:11,760 --> 00:12:20,250 But it's hard to find it much harder to find amongst products when they talk about contagion. 108 00:12:20,250 --> 00:12:26,650 It mainly had to do with heresy. But the spread of heresy or popular rebellion. 109 00:12:26,650 --> 00:12:37,830 But the black death changes, despite all the sudden top kill becomes almost a daily word and not a word just for a beat. 110 00:12:37,830 --> 00:12:45,150 And people do that. Do we know whether this disease was the same strain we discussed in Episode two 111 00:12:45,150 --> 00:12:49,560 and the same one that will go on to discuss when it returns in the 17th century? 112 00:12:49,560 --> 00:12:55,740 There are essentially three different main. Manifestations of plague. 113 00:12:55,740 --> 00:13:02,590 So you've got your bubonic plague, which is the most well-known, and where the bank gets its name. 114 00:13:02,590 --> 00:13:10,980 You cap the swollen purity of bleeding lymph nodes, which then become black, and people have nausea, vomiting, the joint pains. 115 00:13:10,980 --> 00:13:15,450 And essentially, this was quite common in the 14th century. 116 00:13:15,450 --> 00:13:18,960 And you had a case fatality rate of about 36 percent. 117 00:13:18,960 --> 00:13:27,870 Then you've also got the pneumonic plague, which is essentially the fever, the shortness of breath, he says, which is coughing out the blood. 118 00:13:27,870 --> 00:13:33,180 And then you have you can have person to person spread with this form of plague. 119 00:13:33,180 --> 00:13:36,450 And this is the one that has the most epidemic potential. 120 00:13:36,450 --> 00:13:42,840 So I think there are sometimes people that think that different types, because with the people at play, 121 00:13:42,840 --> 00:13:51,490 they don't think they can't see how they would have had so much death with a version of plague that doesn't transmit as easily. 122 00:13:51,490 --> 00:13:57,330 However, bubonic plague can actually become pneumonic plague because you can get it as 123 00:13:57,330 --> 00:14:02,580 a secondary consequence of having people take to lunch and then back to you. 124 00:14:02,580 --> 00:14:08,610 You can see the lungs and treat a second during monic, take that away and then spread from person to person. 125 00:14:08,610 --> 00:14:17,640 Or you can have the primary pneumonic plague version, which essentially is when people directly breathe in aerosols which have plague 126 00:14:17,640 --> 00:14:22,310 bacilli hanging in them and they can get them pneumonic plague directly. 127 00:14:22,310 --> 00:14:26,640 And I also found out that you can get pneumonic plague from coughing animals. 128 00:14:26,640 --> 00:14:31,350 And before I was reading about the plague, I didn't actually realise that animals could cough. 129 00:14:31,350 --> 00:14:37,560 I was thought of it as a quite a human thing. But apparently cats and dogs can cough and you can catch the plague from them. 130 00:14:37,560 --> 00:14:44,670 The final version is set to see McLay, which I can either be caused from the progression of chronic plague and pneumonic plague, 131 00:14:44,670 --> 00:14:51,600 then seeding into a bloodstream infection and both forms compressed to this all day. 132 00:14:51,600 --> 00:14:57,030 You can have a direct septicaemia form because Plake has got some kind of genetic 133 00:14:57,030 --> 00:15:01,860 mutations that allow it to directly go through the guts and get into the bloodstream. 134 00:15:01,860 --> 00:15:07,320 And it's very difficult then to link that to bubonic plague because you don't have the buboes which are 135 00:15:07,320 --> 00:15:15,130 well known and characterised and drawn in images and pictures from the 14th century that sounded horrific. 136 00:15:15,130 --> 00:15:20,640 And from my reading about this outbreak, I knew that the mortality rates were equally horrendous. 137 00:15:20,640 --> 00:15:23,210 So I cheque back in with Sam on the numbers. 138 00:15:23,210 --> 00:15:30,680 The ones I know are in Cambridgeshire, where you have up to 76 percent of the population of these villages being wiped out. 139 00:15:30,680 --> 00:15:35,970 But three miles down the road, other villages which were only five percent. 140 00:15:35,970 --> 00:15:44,060 And I think that no one repeats this but the Italian chronicler mocktail Ballade, 141 00:15:44,060 --> 00:15:52,770 who took up writing this long chronicle of Flight 13 48 because his brother Jovani had died from the plague. 142 00:15:52,770 --> 00:16:03,180 He had a beautiful metaphor about a hailstorm, destroyed one field and then skips over the next few or like the clouds on this, 143 00:16:03,180 --> 00:16:10,740 somewhere's warning that fragments the light shines on some areas of another area. 144 00:16:10,740 --> 00:16:17,610 I think this is an aspect of play which doesn't work, which has some regional aspects, 145 00:16:17,610 --> 00:16:27,570 but mainly with the with the injury, with in the countryside having these very different mortality fortunes. 146 00:16:27,570 --> 00:16:32,810 I wondered whether the stories of graveyards piling up with bodies in some places, 147 00:16:32,810 --> 00:16:39,600 the ones that the historical records would corroborate or actually talks about the great day it goes and the great fraternity. 148 00:16:39,600 --> 00:16:46,860 So I think the lowest the workers have come in from the countryside and overcharge charge extortionate breaks. 149 00:16:46,860 --> 00:16:57,080 And you get that going on through Manzoni. You know, the pomace his policy of the same being the horror of these or not, 150 00:16:57,080 --> 00:17:05,880 that causes these people who collect the bodies for the grave and the bills being piled into the wagons. 151 00:17:05,880 --> 00:17:11,970 I think the best stories actually for that come in the 16th and 17th centuries. 152 00:17:11,970 --> 00:17:14,280 That's when the literature really piles up. 153 00:17:14,280 --> 00:17:23,490 And I think it's you find much more on these on these great figures on the terror really of rounding up these bodies. 154 00:17:23,490 --> 00:17:27,570 Some of them are still alive and they fall off. 155 00:17:27,570 --> 00:17:38,580 There probably are these burial alive. There's one notary who writes a Chronicle plague in Venice. 156 00:17:38,580 --> 00:17:53,180 Seventy five or six books out of this window when there's one train of horse drawn carriages that take the dead bodies in one direction. 157 00:17:53,180 --> 00:17:58,340 Another strain that passes under his window that takes them down to the plaza, 158 00:17:58,340 --> 00:18:07,700 ready to be quarantined in the other direction, and people on the streets think that this is the only life in the city. 159 00:18:07,700 --> 00:18:15,040 Sort of like Prophet 19 at the beginning of lockdown when the only place in the city was going to be going either to the pharmacy, 160 00:18:15,040 --> 00:18:19,100 signify the or the grocery store. But I guess not as good wishes. 161 00:18:19,100 --> 00:18:23,540 It was very ghoulish indeed. 162 00:18:23,540 --> 00:18:30,920 So terrible. In fact, the contemporary writer Francesco Petrarch wrote that future generations wouldn't 163 00:18:30,920 --> 00:18:37,730 understand how awful it would be to be alive in a city full of funerals and empty homes. 164 00:18:37,730 --> 00:18:41,990 He has two basic reflections around 13 48 in his letters. 165 00:18:41,990 --> 00:18:51,470 He talks about how gets to the end of time, whether it's a sense of the collapse of a civilisation, of a whole society of the world. 166 00:18:51,470 --> 00:18:57,640 You know, the Chronicle is also like, again, on your little Torah says we pray. 167 00:18:57,640 --> 00:19:07,190 It's my baby because of the world. When you think about it and you read about places like Philadelphia in 1918 when things were overwhelmed, 168 00:19:07,190 --> 00:19:13,100 hospitals did go over the level, as we're seeing perhaps now. 169 00:19:13,100 --> 00:19:20,210 And this was happening in Philadelphia in October, 18 bodies not being buried. 170 00:19:20,210 --> 00:19:27,710 And then you look at the mortality rates and what Carletti rate of Philadelphia was around two percent mortality rate. 171 00:19:27,710 --> 00:19:34,730 I think we get for a place like Florence, a place that is about seventy five percent. 172 00:19:34,730 --> 00:19:43,580 It's hard to imagine, given the infrastructure these people have, the medical knowledge they had, how they cope at all. 173 00:19:43,580 --> 00:19:47,810 Why? Because society didn't collapse at this point. 174 00:19:47,810 --> 00:19:56,990 I thought it would be interesting to find out more about how symptoms were described by contemporary writers and whether, as I've heard said, 175 00:19:56,990 --> 00:20:02,930 this was where the famous nursery rhyme reference to bring a ring a roses came from the ring around 176 00:20:02,930 --> 00:20:10,700 the roses at the general clinical sign of a pack plague or a black death and subsequent plagues. 177 00:20:10,700 --> 00:20:22,010 What you do find is that not only do you get the buboes and the principal left, but you also get these the spread of black postals, 178 00:20:22,010 --> 00:20:28,820 which is extraordinarily rare with in play and even through the early morning period doctors this on. 179 00:20:28,820 --> 00:20:37,250 This has been the most deadly form. Now, one thing that does change that way, we have to look back and think about changes. 180 00:20:37,250 --> 00:20:43,550 The 15th and 16th, 17th century is pneumonic plague, pneumonic plague, because it's very rare. 181 00:20:43,550 --> 00:20:49,430 And some of the doctors reflect back. They go back to they see they read it as surely act. 182 00:20:49,430 --> 00:20:55,370 And these subscriptions and they say plague just doesn't operate that way. 183 00:20:55,370 --> 00:20:57,770 We don't find this. 184 00:20:57,770 --> 00:21:07,130 And there are some incidents of it, but it's extraordinarily rare and it can spread just as fast as it did in thirteen, forty eight. 185 00:21:07,130 --> 00:21:11,210 It's just much better contained than it was at thirteen forty eight. 186 00:21:11,210 --> 00:21:19,940 Like the real revival and I think a change in the strength of the disease in the 17th century in places like Genoa and Naples, 187 00:21:19,940 --> 00:21:21,510 Milan to a certain extent, 188 00:21:21,510 --> 00:21:29,780 then it's where you have 50 percent or more of the population, city populations and the countryside being levelled by just two seats. 189 00:21:29,780 --> 00:21:34,310 Even then, there's no description of new panic play. 190 00:21:34,310 --> 00:21:47,970 These are people who get some sort of skin disorders when they go in further with this to be to the whole medical the medical side. 191 00:21:47,970 --> 00:21:59,600 This is very interesting. And what you have, what the Black Death really does create is a new medical genre that was promised by the 16th century, 192 00:21:59,600 --> 00:22:03,530 the most populous form of any medical text. 193 00:22:03,530 --> 00:22:14,510 And this is the plague. Tax and base become increasingly written in the vernacular and written for communities and not just for other doctors to read. 194 00:22:14,510 --> 00:22:26,960 So they go from these so long citation, so classical and Arabic authorities stacking one to the other to what they call experimentation, 195 00:22:26,960 --> 00:22:37,820 what they say are their discoveries and treatment of these of these seats and also, more importantly, preventative measures. 196 00:22:37,820 --> 00:22:43,460 It's interesting, with the beginning of Crovitz 19, the instructions we were getting. 197 00:22:43,460 --> 00:22:49,750 Well, you wash your hands, cover your face. Know, you could read that in the public. 198 00:22:49,750 --> 00:22:53,700 Thirty, forty eight so much, but I think 13. Thirteen. 199 00:22:53,700 --> 00:22:54,360 Seventeen. 200 00:22:54,360 --> 00:23:03,510 They were really big on washing your hands and doing things that we're not doing well, wearing things like using vinegar and rosewater in your nose. 201 00:23:03,510 --> 00:23:08,130 A lot more attention to the nose than with cold at night. I don't know. 202 00:23:08,130 --> 00:23:13,450 Well, perhaps I'd better pay more attention to my nose over the next few months. 203 00:23:13,450 --> 00:23:21,790 I also thought it would be important to understand how these messages were being conveyed and about the role of the medical profession. 204 00:23:21,790 --> 00:23:25,960 Well, a lot of the impetus for this new health care is coming from secular governments, 205 00:23:25,960 --> 00:23:33,550 not coming necessarily from the church, even though hospitals are increasing as the institution. 206 00:23:33,550 --> 00:23:38,590 It depends where you are. But in Italy, this is a university positions. 207 00:23:38,590 --> 00:23:43,560 Doctors are part of the clergy. That's extraordinarily rare. 208 00:23:43,560 --> 00:23:49,150 So less so in England where you can be a for friar and a doctor. 209 00:23:49,150 --> 00:23:58,510 No cases like that come to mind. I'm sure that must must've been something. And even you have a whole system that goes back before the flock. 210 00:23:58,510 --> 00:24:03,430 In cities like Siena and Florence, where you have and it still exists today. 211 00:24:03,430 --> 00:24:09,220 This is a good tourist to the doctors who are appointed by the city. 212 00:24:09,220 --> 00:24:15,580 Municipal appointments to give give free medical assistance. 213 00:24:15,580 --> 00:24:20,530 And so I know that maybe this is when I first started going to Italy. 214 00:24:20,530 --> 00:24:27,640 Sometimes people got very sick. They would call out these these doctors. 215 00:24:27,640 --> 00:24:37,300 Now, one thing that does happen with plague and with the doctors, I think is looking at the causes of Flaig canonically. 216 00:24:37,300 --> 00:24:43,690 We know that the first call so Flaig, of course, is God, but we don't want to play God too much. 217 00:24:43,690 --> 00:24:49,300 So it's our sense. But doctors really don't repeat this that much. 218 00:24:49,300 --> 00:24:56,080 They don't bother with it. And by the 16th century, when they're questioned about it, they become pretty blunt. 219 00:24:56,080 --> 00:25:02,170 They say, look, I'm a doctor and as a doctor, I'm interested in natural causes. 220 00:25:02,170 --> 00:25:07,490 If you want to know about super natural causes, go to a theologian. 221 00:25:07,490 --> 00:25:14,320 And I think that there is this growing sexualisation about what the causes of plague are. 222 00:25:14,320 --> 00:25:21,480 And I think more and more, as you march into the 16th century, certainly by the time upfront pastoral, 223 00:25:21,480 --> 00:25:29,440 it is about contagion and it's about conditions like the supply of water and the physicians themselves. 224 00:25:29,440 --> 00:25:35,770 We have to give them credit in these early Graig traps that often they throwing up their hands. 225 00:25:35,770 --> 00:25:44,830 So give the show the act in a certain extent. Reflecting back on 13 Forty-Eight when he's writing in the second 13 63. 226 00:25:44,830 --> 00:25:45,860 He says, look, 227 00:25:45,860 --> 00:25:54,220 we've never seen a disease like this in history before and he even does something that mediaevalist the mediaeval people don't usually do. 228 00:25:54,220 --> 00:25:59,250 He goes back to biblical history. The history of plagues in Libby. 229 00:25:59,250 --> 00:26:06,700 And he says there's been no plague in the past that can equal the plague we are experiencing now. 230 00:26:06,700 --> 00:26:11,760 And we just don't know what to do. We don't have any remedy. We don't know any cure. 231 00:26:11,760 --> 00:26:16,600 Then he goes on to suggest he says, look, we're in the dark here. 232 00:26:16,600 --> 00:26:22,030 And you get a symbolists. Such since this happens with doctors every now and then, they do become unpopular. 233 00:26:22,030 --> 00:26:29,920 This happens in 1918. The great influenza doctors, some of them say, yes, yes, it's a bacterium and this is a new vaccine. 234 00:26:29,920 --> 00:26:34,470 We have four other doctors. So it's sort of saying we don't know this. 235 00:26:34,470 --> 00:26:40,610 This this is something this type of flu, if it is flu, it's a different type of flu. 236 00:26:40,610 --> 00:26:50,410 We just do not so sure. And it's one of those periods where nurses got more credit and got more praise from doctors. 237 00:26:50,410 --> 00:27:00,720 I'd read about sham doctors during this period, like the doctor making much doled out to the student Chaucer describes. 238 00:27:00,720 --> 00:27:08,320 But I didn't know how prevalent these practises would have been. Actually, the word is used as charlatans, but it's not that's so pejorative. 239 00:27:08,320 --> 00:27:16,210 This our word charlatans. They were they were people who connected with the and that these, you know, these magic cures. 240 00:27:16,210 --> 00:27:22,260 So it's all over the place. But the real negative statements about doctors are really in 13, 48. 241 00:27:22,260 --> 00:27:31,200 And then I think there's a change in opinion. And I've looked at that one of it on your little Toora, which is the major chroniclers, 242 00:27:31,200 --> 00:27:36,190 and says, well, one thing, he's talking to his audience of seeing these, 243 00:27:36,190 --> 00:27:45,760 if you want to go see your great soldier all the more quickly and you want to lose your money, just get a doctor, they'll kill you faster. 244 00:27:45,760 --> 00:27:52,030 By the 15th century, one week, we know that doctors salaries continue to decline. 245 00:27:52,030 --> 00:28:03,040 And by one comparison, they become the wealthiest profession, at least at Florence, by by about Circo 14. 246 00:28:03,040 --> 00:28:08,040 Sometime in the 15th century, they go beyond the lawyers, their status. 247 00:28:08,040 --> 00:28:11,560 Does the what this much take still a risky profession? 248 00:28:11,560 --> 00:28:22,800 Well, perhaps because of the risks, their salaries cut and and and the chronicles become less hostile towards one very long chronicle. 249 00:28:22,800 --> 00:28:28,460 A very, really interesting clinical funking chronicle by Jovani Marvella here. 250 00:28:28,460 --> 00:28:33,160 It's also an advice book for his own family, says, look, in Plake time, 251 00:28:33,160 --> 00:28:39,160 it's best to get hold of a good doctor, but it's not going to necessarily save. 252 00:28:39,160 --> 00:28:45,700 But the analogy he makes is to going into battle with or without a shield for good doctors. 253 00:28:45,700 --> 00:28:53,980 She'll have to play. So there's a certain sort of respect for what they're doing, what they know. 254 00:28:53,980 --> 00:29:01,080 Even though some of the actors still may strike us as a bit strange and maybe counterproductive. 255 00:29:01,080 --> 00:29:10,840 Like my favourite one, which is your skin, the anus or the genitals of either a rooster or a hen, 256 00:29:10,840 --> 00:29:17,740 and you put it on top of your boy and let the anus of the genitals suck up the poison. 257 00:29:17,740 --> 00:29:24,420 We shouldn't generalise too much. After all, they're also telling us to clean out our nostrils and wash our hands. 258 00:29:24,420 --> 00:29:30,180 Right? Well, I don't think I'll be trying that. However, 259 00:29:30,180 --> 00:29:39,390 this wider discussion did make me reflect on whether there were any longer term consequences of this dramatic experience for the medical profession. 260 00:29:39,390 --> 00:29:45,970 What also happens that one has to be careful with this is the evolution of hospitals. 261 00:29:45,970 --> 00:29:50,460 But the big moment of really the founding of any of the big, 262 00:29:50,460 --> 00:29:56,910 important hospitals was before the fact that hospitals take on much more specialist 263 00:29:56,910 --> 00:30:02,040 roles and much more of a definition of hospital that we have today than they had before. 264 00:30:02,040 --> 00:30:08,590 Often things called hospitals were just sort of places where priests and other clergy, 265 00:30:08,590 --> 00:30:16,920 they spend the night for free along the roadside and now they become really hospitals and their take on specialisations, 266 00:30:16,920 --> 00:30:25,500 different types of medical treatment. And this is, I think, goes back to follow. 267 00:30:25,500 --> 00:30:30,090 It seems like this pandemic left a huge mark on a whole range of areas. 268 00:30:30,090 --> 00:30:39,120 One thing that's rather striking is that the slower populations recover their populations. 269 00:30:39,120 --> 00:30:41,970 It seems the better it was for the economy. 270 00:30:41,970 --> 00:30:52,860 In the case in point eight, which goes up to the industrial revolution, first thing guess winning and recovery is pretty black population. 271 00:30:52,860 --> 00:31:01,980 The century with Florence recover its pre black population sometime after 1850. 272 00:31:01,980 --> 00:31:11,790 Well, after last, tourists come on the back as a money maker and industrial revolution. 273 00:31:11,790 --> 00:31:14,130 That's quite a statistic. 274 00:31:14,130 --> 00:31:24,090 Before we finished, I was keen to hear a medical perspective on why the Black Death has become so infamous and where we are today with the disease. 275 00:31:24,090 --> 00:31:29,100 So I cheque back in with Bloche Eguchi from Oxford Vaccine. 276 00:31:29,100 --> 00:31:38,180 The death rate is very, very high with plague. Before we had the antibiotics and yes, remember, most of these blades happened before the 19th century. 277 00:31:38,180 --> 00:31:43,110 They weren't even close to having antibiotics or were we even close to having an 278 00:31:43,110 --> 00:31:47,880 understanding of what the plague was before there was understanding of germ theory. 279 00:31:47,880 --> 00:31:51,660 And so nobody knew where this disease was coming from. 280 00:31:51,660 --> 00:31:54,060 They were fighting an invisible enemy. 281 00:31:54,060 --> 00:32:01,680 They had the plague doctors, but they had absolutely no actual clue about what was going on and had close to zero percent success rates. 282 00:32:01,680 --> 00:32:07,410 And if they were successful, it was it was luck that that person had a strong enough immune system. 283 00:32:07,410 --> 00:32:11,820 It ravages an area very quickly, especially if you've got the pneumonic form. 284 00:32:11,820 --> 00:32:21,930 There's about a 24 hour incubation period, which means people can get sick rapidly if it enters into an area every one person can spread to. 285 00:32:21,930 --> 00:32:29,640 Seven people only takes 24 hours to get ill. So you literally before your eyes seeing half the population die. 286 00:32:29,640 --> 00:32:33,420 That's frightening to anyone. The way it looked, frightened people. 287 00:32:33,420 --> 00:32:38,910 It's called the Black Death because of the fact that you've got all of this necrosis and dead tissue. 288 00:32:38,910 --> 00:32:45,120 You've got the swollen buboes, the lymph nodes under the armpits and the neck and in the groyne, 289 00:32:45,120 --> 00:32:48,930 which essentially were becoming black because they were haemorrhagic. 290 00:32:48,930 --> 00:32:53,010 So it looked frightening. And people even used to paint on this. 291 00:32:53,010 --> 00:33:01,680 So nobody died without having these disfiguring Edgell actual sized things on them, 292 00:33:01,680 --> 00:33:06,060 marking them almost with death at the time, especially the the 14th century. 293 00:33:06,060 --> 00:33:13,320 They thought that it was related to a wrath from God. So there's people who were afraid then that they're getting punished for their sins. 294 00:33:13,320 --> 00:33:18,530 And it allowed the uprising of movements like the judgements in Germany and such. 295 00:33:18,530 --> 00:33:20,280 That pram wasn't helping. 296 00:33:20,280 --> 00:33:27,360 And people did actually start turning away from religion following these pandemics and moving more toward science and philosophy, 297 00:33:27,360 --> 00:33:31,350 because no matter how much pressure was made, it didn't save people. 298 00:33:31,350 --> 00:33:33,780 It didn't matter how rich people were. They would die. 299 00:33:33,780 --> 00:33:40,620 People were seeing their neighbours die before their their eyes were abandoning their relatives, abandoning their friends. 300 00:33:40,620 --> 00:33:46,080 People weren't even doing last rites. Priests were too afraid to come and lay hands. 301 00:33:46,080 --> 00:33:49,520 There weren't enough people alive to bury the dead. 302 00:33:49,520 --> 00:33:54,930 So they literally had dead bodies piled up in the streets. The smells were horrific. 303 00:33:54,930 --> 00:33:59,100 These things, the fact that it happened so fast. Most people died. 304 00:33:59,100 --> 00:34:04,050 And you could see before your eyes. But nobody had any understanding of what was going on. 305 00:34:04,050 --> 00:34:11,010 That was frightening. If it happens today, people have an understanding that there is a bacterium involved and we can visualise it. 306 00:34:11,010 --> 00:34:18,630 And we do have some tools against it. However, even with antibiotics, antibiotics, I think can reduce death rates to about 15 percent. 307 00:34:18,630 --> 00:34:21,060 But that's only if recognise, that's what it is. 308 00:34:21,060 --> 00:34:28,760 I mean, most of the population don't even believe the plague exists outside of biblical times, including some doctors in some areas. 309 00:34:28,760 --> 00:34:32,720 If you had the pandemic, it would be difficult to recognise that was what was going on. 310 00:34:32,720 --> 00:34:39,380 But if you're not treated within 24 hours, you will die. And then everybody around you who's within two metres of you might die. 311 00:34:39,380 --> 00:34:47,060 And that's frightening how fast it happens. The fact that most people don't survive it if they don't get antibiotics. 312 00:34:47,060 --> 00:34:51,770 And you can literally see populations decrease before your eyes. 313 00:34:51,770 --> 00:34:56,060 And they look scary, too. And that's not the only reason. 314 00:34:56,060 --> 00:35:01,790 It's a scary disease. Plague is also being used in war as a biological weapon. 315 00:35:01,790 --> 00:35:02,480 That's bullshit. 316 00:35:02,480 --> 00:35:11,750 Outlined in the 14th century, soldiers used to throw corpses of people who died of played over the wall into enemy soldiers and kill people. 317 00:35:11,750 --> 00:35:17,450 That way. If he's heard of Unit 731, that was the Japanese over China, 318 00:35:17,450 --> 00:35:24,200 they were involved in research and development of experimental epidemic treating bio warfare weapons. 319 00:35:24,200 --> 00:35:28,310 And they used these assaults against the Chinese populous front World War Two. 320 00:35:28,310 --> 00:35:35,240 And they essentially flew low flying planes over China and now play infected fleas, 321 00:35:35,240 --> 00:35:39,290 which they bred in their laboratories to be spread amongst Chinese cities. 322 00:35:39,290 --> 00:35:45,960 And this was 1942 41. So you had a military aerial spraying which killed tens of thousands of people on plague. 323 00:35:45,960 --> 00:35:53,240 And by the end of World War Two, we found documentation of something called Operation Cherry Blossoms at night. 324 00:35:53,240 --> 00:35:58,490 And essentially, Japan had planned to use plague as a biological weapon against San Diego and California. 325 00:35:58,490 --> 00:36:07,850 And they created these porcelain bombs which were filled with infected fleas and they were actually scheduling to launch it in September 22nd, 1945. 326 00:36:07,850 --> 00:36:10,790 As we know, Japan surrendered a few weeks earlier. 327 00:36:10,790 --> 00:36:17,540 But this frightened America to this to the point where they decided to push for a vaccine against plague. 328 00:36:17,540 --> 00:36:26,150 And we're not only interested in a vaccine for self-defence against biological weapons because plague is still very much around today. 329 00:36:26,150 --> 00:36:30,200 We finally discovered that it was your senior pestis that was causing the plague. 330 00:36:30,200 --> 00:36:37,790 It wasn't until nineteen forty seven that streptomycin, which is an antibiotic they found out used, 331 00:36:37,790 --> 00:36:47,350 was finally starting to be used in these kind of epidemics. And then they saw kind of the mortality from the epidemics go down from about 63 percent, 332 00:36:47,350 --> 00:36:55,100 19, 40 to 50 to about 20 percent after 1950 to the start of the 21st century. 333 00:36:55,100 --> 00:37:02,030 And what you had a lot of during this time was a lot of outbreaks that happened during periods of war. 334 00:37:02,030 --> 00:37:07,190 So during the Vietnam War, you had a breakdown in public health services and creation of refugees. 335 00:37:07,190 --> 00:37:15,550 And you had an outbreak of cases. We thought maybe there was a possible outbreak of cases during the Arab Spring in 2011. 336 00:37:15,550 --> 00:37:18,560 Then we don't actually have much information about that. 337 00:37:18,560 --> 00:37:26,460 And then we also have quite enough information that during World War two, they had a lot of plague cases in outbreaks. 338 00:37:26,460 --> 00:37:36,020 And we've got Albert Camus, who located his novel The Past in Iran in 1945, because they had some money to play cases then. 339 00:37:36,020 --> 00:37:45,050 Nowadays, it's more likely that you get a plague epidemic when there is a breakdown in sanitary practises or chaos in the middle of wars. 340 00:37:45,050 --> 00:37:52,140 So you have a lot of these unstable countries that are being affected and a lot of poor countries as well. 341 00:37:52,140 --> 00:37:56,690 And I think the worst affected at the moment is Madagascar. 342 00:37:56,690 --> 00:38:04,040 And that accounts for about 95 percent of all the imported cases. They have about 500 cases a year. 343 00:38:04,040 --> 00:38:12,500 They have an outbreak every year. They kind of have a plague season which runs between December and eight floors. 344 00:38:12,500 --> 00:38:17,500 Their last massive epidemic was in 2017, which is actually outside the plague season. 345 00:38:17,500 --> 00:38:20,600 It was caused by just one guy was a 31 year old man. 346 00:38:20,600 --> 00:38:26,990 He travelled from the Central Highlands and then he travelled via the capital city in a crowded bus. 347 00:38:26,990 --> 00:38:31,130 And he ended up that two hundred people or more action died. 348 00:38:31,130 --> 00:38:35,570 He got bubonic plague out in the highlands and then developed pneumonic plague. 349 00:38:35,570 --> 00:38:41,030 And he managed the seemed the biggest epidemic that we have had in the last few years. 350 00:38:41,030 --> 00:38:47,630 And it was around this time because it also had the Ebola outbreak that kind of happened a few years before that. 351 00:38:47,630 --> 00:38:52,430 Then governments and health organisations started thinking, right, 352 00:38:52,430 --> 00:39:01,400 we need to try to figure out ways to kind of get ahead of these kinds of epidemic causing organisms that can lead onto pandemics. 353 00:39:01,400 --> 00:39:09,590 Now, just briefly, I think it's something quite important to mention with that climate is that there are main ways that plague can be passed over. 354 00:39:09,590 --> 00:39:15,680 So you've got the bite of the infected flu, which we talked about, and this is the type that you get the the on type from. 355 00:39:15,680 --> 00:39:20,360 And then you you have direct contact with infectious produce fluids. 356 00:39:20,360 --> 00:39:28,590 So this can be from Hongta still infected animals or or like you said, getting back to Scratchpad infected tatt. 357 00:39:28,590 --> 00:39:32,220 So this is why you can usually have an epidemic of demonic plague, 358 00:39:32,220 --> 00:39:41,400 because you can have hunters in the village that go out and skim an infected animal and then they managed to get the plague that way. 359 00:39:41,400 --> 00:39:47,400 But then you've got the inhalation of respiratory droplets. And this is where you can get the person to person spread. 360 00:39:47,400 --> 00:39:51,440 And now the epidemics of plague that we're having these days are more of this form. 361 00:39:51,440 --> 00:39:57,780 And this is a really dangerous form because it only takes about 24 hours minimum to get sick from this. 362 00:39:57,780 --> 00:40:05,310 And to be able to pass it on to somebody else, you can die within 72 hours from it before you even realise that you have it. 363 00:40:05,310 --> 00:40:11,900 You've passed onto somebody else. And every person that has been on it, they can spread it to several other people. 364 00:40:11,900 --> 00:40:20,850 Then you can have an explosion of plague. But the ones we get in other countries, like in Mongolia, say, which we actually get every year, 365 00:40:20,850 --> 00:40:24,160 is the oral transmission, which people don't usually know or talk about. 366 00:40:24,160 --> 00:40:28,890 And we have sporadic cases in the media involving individuals in Mongolia, China. 367 00:40:28,890 --> 00:40:34,050 And this is usually from the consumption of poorly cooked meat or slaughtered sick animals. 368 00:40:34,050 --> 00:40:36,300 And this illustrates how deadly trade can be. 369 00:40:36,300 --> 00:40:45,540 Because China was born on July this year, there was a 15 year old boy in western Mongolia who died from phonic plague after eating infected moment. 370 00:40:45,540 --> 00:40:53,140 They had to have a lockdown, essentially of the local area, according to the health minister and also a few months before that. 371 00:40:53,140 --> 00:40:59,610 I think you may. There was a couple from Mongolia who died from eating an infected mom. 372 00:40:59,610 --> 00:41:06,660 So these days we have these foredeck forms. You do get this all transmission from eating this infected meat. 373 00:41:06,660 --> 00:41:14,310 And also, I think in Saudi Arabia and they describe pharyngitis in the 20th century in Jordan as well. 374 00:41:14,310 --> 00:41:20,380 And this is what actually surprised me think that the plague bacterium that we have now is evolved from a senior seed, 375 00:41:20,380 --> 00:41:27,660 a typical osis, because it that's an Terek bacterium and it's retained quite a lot of the same genes. 376 00:41:27,660 --> 00:41:38,160 So it has the ability to infect through the enteric area, all of which led a group at Oxford some years ago to start working on a vaccine for plague. 377 00:41:38,160 --> 00:41:46,140 And they've now reached an exciting stage. We have been working on the plague vaccine, which we have actually manufactured now. 378 00:41:46,140 --> 00:41:50,700 We are planning on starting the trial in a month or two. 379 00:41:50,700 --> 00:41:53,370 Once we've gotten approvals in place. 380 00:41:53,370 --> 00:42:03,630 Professor Christine Wolly and Dr Christine Donald at the University of Oxford Vaccine Group who have actually created invented this vaccine. 381 00:42:03,630 --> 00:42:12,990 And it's Andrew Pollard, who is the chief investigator for the Oxford Cosied vaccine, who is actually the chief investigator for this this trial. 382 00:42:12,990 --> 00:42:17,310 I wrote the protocol for the trial along with colleagues, 383 00:42:17,310 --> 00:42:25,110 and we'll be putting that forth to kind of have a phase one vaccine trial will be inviting and a few young, 384 00:42:25,110 --> 00:42:32,160 healthy people to essentially test the safety and immunogenicity of this plague vaccine. 385 00:42:32,160 --> 00:42:37,140 There isn't actually a licenced vaccine at the moment, although there have been attempts in the past. 386 00:42:37,140 --> 00:42:44,820 So they had a formalin killed wholesale vaccine, which was safe and used for military personnel during the Vietnam War. 387 00:42:44,820 --> 00:42:48,900 But there were loads of adverse reactions and most of this is required. 388 00:42:48,900 --> 00:42:58,080 You also had the live attenuated and virulent some investors vaccine, but there were loads of safety concerns and severe side effects. 389 00:42:58,080 --> 00:43:04,440 It's rarely used. It wasn't even used during the Madagascar outbreak. That's how bad they thought the side effects from it were. 390 00:43:04,440 --> 00:43:11,880 You've got live attenuated, genetically attenuated strains, which had good safety and retained protective efficacy, 391 00:43:11,880 --> 00:43:16,170 but still had some side effects in animal models and safety concerns. 392 00:43:16,170 --> 00:43:24,210 And I think lossy have protein based sabeen vaccines. These are in clinical trials, I think in the US and China possibly. 393 00:43:24,210 --> 00:43:27,310 But there's a problem of multiple doses required. 394 00:43:27,310 --> 00:43:33,900 We're not sure that they'll actually protect against pneumonic plague, which is what we're hoping our vaccine will be able to protect against some. 395 00:43:33,900 --> 00:43:38,790 As I said, the pneumonic form is the one that the epidemic potential when people breathe, 396 00:43:38,790 --> 00:43:43,660 then plague bacilli from the spittle of people who've coughed, essentially. 397 00:43:43,660 --> 00:43:50,970 And you have the plague bacilli hanging inside that spittle and it can hang around for about an hour. 398 00:43:50,970 --> 00:43:55,440 And then somebody comes them and breathes it in and it's the most deadly form of plague. 399 00:43:55,440 --> 00:44:02,700 So that's what we're hoping our vaccine is going to be used against, and we're hoping it will rapidly induce immune responses. 400 00:44:02,700 --> 00:44:06,360 We're going to try to see if we can just get it in one kind of injection, 401 00:44:06,360 --> 00:44:13,080 iron injection, so that during an epidemic it can be used and deployed quickly. 402 00:44:13,080 --> 00:44:17,190 So, yes, we're going to be awesome to volunteers, Sue. 403 00:44:17,190 --> 00:44:22,010 And it will be starting in Oxford next time on Future Makers. 404 00:44:22,010 --> 00:44:28,380 We journey forward in time to the last of our four plague and arrive in 17. 405 00:44:28,380 --> 00:44:33,870 Century Europe, where the great pestilence has once again returned. 406 00:44:33,870 --> 00:44:40,020 I hope you can join me then for the next episode of our history of pandemic season. 407 00:44:40,020 --> 00:44:47,750 I'm Peter Milliken, and you've been listening to Future Makers. 408 00:44:47,750 --> 00:44:54,920 Feature makers was created in-house at the University of Oxford and presented by Professor Peter Milliken from Harvard College. 409 00:44:54,920 --> 00:45:01,420 A voice actor today was Tom Wilkinson, and the score for the series was designed and created by Richard Watts. 410 00:45:01,420 --> 00:45:05,950 The series is written and produced by Steve Richard and me, Ben Howard. Thank you. 411 00:45:05,950 --> 00:45:12,790 On behalf of the whole team for listening to the history of pandemics, we'd love as many people as possible to hear it. 412 00:45:12,790 --> 00:45:17,712 So if you could spread the word to your friends and family, we'd really appreciate it.