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st。
The affection of the stomach； often mentioned in vague terms； and occasionally as a vomiting of blood； was doubtless only a subordinate symptom； even if it be admitted that actual hematemesis did occur。 For the difficulty of distinguishing a flow of blood from the stomach； from a pulmonic expectoration of that fluid； is； to non…medical men； even in common cases； not inconsiderable。 How much greater then must it have been in so terrible a disease； where assistants could not venture to approach the sick without exposing themselves to certain death？ Only two medical descriptions of the malady have reached us； the one by the brave Guy de Chauliac； the other by Raymond Chalin de Vinario； a very experienced scholar； who was well versed in the learning of the time。 The former takes notice only of fatal coughing of blood； the latter； besides this； notices epistaxis； hematuria； and fluxes of blood from the bowels； as symptoms of such decided and speedy mortality； that those patients in whom they were observed usually died on the same or the following day。
That a vomiting of blood may not； here and there； have taken place； perhaps have been even prevalent in many places； is； from a consideration of the nature of the disease； by no means to be denied； for every putrid decomposition of the fluids begets a tendency to hemorrhages of all kinds。 Here； however； it is a question of historical certainty； which； after these doubts； is by no means established。 Had not so speedy a death followed the expectoration of blood； we should certainly have received more detailed intelligence respecting other hemorrhages； but the malady had no time to extend its effects further over the extremities of the vessels。 After its first fury； however； was spent； the pestilence passed into the usual febrile form of the oriental plague。 Internal carbuncular inflammations no longer took place； and hemorrhages became phenomena； no more essential in this than they are in any other febrile disorders。 Chalin； who observed not only the great mortality of 1348； and the plague of 1360； but also that of 1373 and 1382； speaks moreover of affections of the throat； and describes the back spots of plague patients more satisfactorily than any of his contemporaries。 The former appeared but in few cases； and consisted in carbuncular inflammation of the gullet； with a difficulty of swallowing； even to suffocation； to which； in some instances； was added inflammation of the ceruminous glands of the ears； with tumours； producing great deformity。 Such patients； as well as others； were affected with expectoration of blood； but they did not usually die before the sixth； and； sometimes； even as late as the fourteenth day。 The same occurrence； it is well known； is not uncommon in other pestilences； as also blisters on the surface of the body； in different places； in the vicinity of which； tumid glands and inflammatory boils； surrounded by discoloured and black streaks； arose； and thus indicated the reception of the poison。 These streaked spots were called； by an apt comparison； the girdle； and this appearance was justly considered extremely dangerous。
CHAPTER IIICAUSESSPREAD
An inquiry into the causes of the Black Death will not be without important results in the study of the plagues which have visited the world； although it cannot advance beyond generalisation without entering upon a field hitherto uncultivated； and； to this hour entirely unknown。 Mighty revolutions in the organism of the earth； of which we have credible information； had preceded it。 From China to the Atlantic； the foundations of the earth were shakenthroughout Asia and Europe the atmosphere was in commotion； and endangered； by its baneful influence； both vegetable and animal life。
The series of these great events began in the year 1333； fifteen years before the plague broke out in Europe： they first appeared in China。 Here a parching drought； accompanied by famine； commenced in the tract of country watered by the rivers Kiang and Hoai。 This was followed by such violent torrents of rain； in and about Kingsai； at that time the capital of the empire； that； according to tradition； more than 400；000 people perished in the floods。 Finally the mountain Tsincheou fell in； and vast clefts were formed in the earth。 In the succeeding year （1334）； passing over fabulous traditions； the neighbourhood of Canton was visited by inundations； whilst in Tche； after an unexampled drought； a plague arose； which is said to have carried off about 5；000；000 of people。 A few months afterwards an earthquake followed； at and near Kingsai； and subsequent to the falling in of the mountains of Ki…ming…chan； a lake was formed of more than a hundred leagues in circumference； where； again； thousands found their grave。 In Houkouang and Honan； a drought prevailed for five months； and innumerable swarms of locusts destroyed the vegetation； while famine and pestilence； as usual； followed in their train。 Connected accounts of the condition of Europe before this great catastrophe are not to be expected from the writers of the fourteenth century。 It is remarkable； however； that simultaneously with a drought and renewed floods in China； in 1336； many uncommon atmospheric phenomena； and in the winter； frequent thunderstorms； were observed in the north of France； and so early as the eventful year of 1333 an eruption of Etna took place。 According to the Chinese annuals； about 4；000；000 of people perished by famine in the neighbourhood of Kiang in 1337； and deluges； swarms of locusts； and an earthquake which lasted six days； caused incredible devastation。 In the same year； the first swarms of locusts appeared in Franconia； which were succeeded in the following year by myriads of these insects。 In 1338 Kingsai was visited by an earthquake of ten days' duration； at the same time France suffered from a failure in the harvest； and thenceforth； till the year 1342； there was in China a constant succession of inundations； earthquakes； and famines。 In the same year great floods occurred in the vicinity of the Rhine and in France； which could not be attributed to rain alone； for； everywhere； even on tops of mountains； springs were seen to burst forth； and dry tracts were laid under water in an inexplicable manner。 In the following year； the mountain Hong…tchang； in China； fell in； and caused a destructive deluge； and in Pien… tcheon and Leang…tcheou； after three months' rain； there followed unheard…of inundations； which destroyed seven cities。 In Egypt and Syria； violent earthquakes took place； and in China they became； from this time； more and more frequent； for they recurred； in 1344； in Ven…tcheou； where the sea overflowed in consequence； in 1345； in Ki…tcheou； and in both the following years in Canton； with subterraneous thunder。 Meanwhile； floods and famine devastated various districts； until 1347； when the fury of the elements subsided in China。
The signs of terrestrial commotions commenced in Europe in the year 1348； after the intervening districts of country in Asia had probably been visited in the same manner。
On the island of Cyprus； the plague from the East had already broken out； when an earthquake shook t