HIST 123 Quiz 1 and Midterm Flashcards
How was Corona in 2019 first recognized?
Originally a group of scientists reported a mysterious case of pneumonia. It was found to be coronavirus.
What are Coronaviruses?
- A virus dirst identified and named in 1968.
- Have evidence of coronavirus epidemics from the late 19th century (1890s).
- Wuhan pneumonia as a novel coronavirus: Covid (SARS-CoV-2)
- SARS-Cov-2: Severe Acute Respiratory Syndrome Coronavirus 2.
How long have we be able to given virus’s identity in laboratories?
Only able to do since the 1920s (Germ Theory)
- but we’ve diseases well before 1920.
What was the “Wuhan Pneumonia”?
- Question of naming
- First name given to Covid 19 (SARS-Cov-2)
- Process of naming is an important thing done very intentionally.
What were the steps of Coronavirus/Process?
- Identity given in the laboratory.
- “Wuhan pneumonia”
- ‘Spillover’ of an animal virus.
Why is the process of naming a disease important?
- Bc it can lead to social issues, economic issues (eg. not buying certain types of meat), lax preventative measures (eg. not worrying about the Spanish Flu bc you’re not in Spain)
What can disease names include?
- Generic descriptive terms (clinical symptoms, physiological processes and anatomical or pathological references/systems affected).
- Age group, population of patients (eg. juvenile, pedriatric)
- Time course, epidemiology, origin (acute, chronic, contagious, zoonotic)
- Severity
- Seasonality (winter, summer)
- Environment (coastal, subterranean)
- Causal pathogen and related descriptors (coronavirus, influenza; novel, variant; subtype)
- Year (+/- a month) on first detection or reporting
- Arbitrary identifier (alpha, beta)
What can’t disease names include?
- Geographic locations; cities, countries, regions, continents (Eg. the Spanish Flu, Lyme Disease, Japanese encephalitus)
- People’s names
- Species/class of animal or food (eg. Swine flu, monkey pox)
- Cultural, population, industry or occupational references (occupational, nurses)
- Terms that incite undue fear (death, fatal, epidemic)
What was Covid (2019) traced to?
- Covid virus traced to a specific animal market in Wuhan China,
-> came from our interaction with other animals -> it was in animals before it spread to humans and became transmissable by humans. - Measles and influenza also started as animal diseases.
-> Our relationships with other animals (ecological; habitat, climate, how closely we interact with them) has a big impact on history of disease.
What is an example of microscopic pathogens as powerful agents in human history?
Eg. Germ Theory -> ppl believed disease were curses from Gods, eg. being caught in the rain.
What is endemic disease?
the amount of a disease that is usually present in a community.
- When Hinshaw said Coronavirus is endemic, it was bc there was Covid around for a while, and it was normal to have a certain level of Covid (bc it wasn’t eradicated).
What is an outbreak?
An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.
What is Syphilis’ Relationship to Alberta?
Alberta, especially Edmonton or northern Alberta has especially bad increase in number of cases of syphilis.
-> Outbreak is current
- Can have serious consequences for pregnant people (but can be treated if caught early).
Outbreaks are smaller than what?
- Epidemic
- Epizootics
- Pandemics
What is an epidemic?
when an infectious disease spreads rapidly to many people.
What is an epizootic?
An outbreak of disease in other than human animals.
What is a pandemic?
An epidemic spread over several countries or continents, usually affecting a large number of people.
-> March 2019 named Covid as pandemic -> caused things to close down -> everybody needed to prepare for it.
What was the 1918 Influenza Pandemic Like?
- Worldwide diffusion
- Can have an epidemic that is not everyone everywhere all at once
- Pandemics do not impact ppl all the same in all parts of the world
How do Epidemics occur?
Epidemics occur when you bring together a DISEASE-CAUSING AGENT and SUSCEPTIBLE HOSTS.
- Eg. Malaria-carrying mosquito and a susceptible person.
- the more vulnerable to disease: v young, v old, immunocompromised (not always the same ppl who are more vulnerable) -> Eg. Spanish Flu: men and women in 20s more vulnerable.
What are the different ways epidemics can arise?
- Novel pathogens
- Pathogens becoming more virulent (evolution of pathogens)
- (Old) pathogens moving to a new place (eg. Europeans bringing pathogens to indigenous ppls (colonization); eg through trade goods -> Climate change (pathogens that previously didn’t survive in other habitats is now finding their habitats extended -> eg. Zike virus moving from hot places to other places that have become hotter)
- The easier spread of a pathogen, so that more susceptible ppl are exposed. (Eg. Industrial Revolution -> lots of ppl suddenly coming together, poor hygiene, bad working conditions)
- Changes in susceptibility of hosts (Eg. Vaccines vs anti-vaxxers: advent of vaccines -> weren’t susceptible; now with anti-vaxxers, we have ppl who are now more susceptible to disease and who spread it to others) (eg. Famine: changes ppls susceptibility to disease and can make it more widespread)
Since when has disease received its identity from laboratories?
The 19th century.
- And each disease is typically understood to have a single material cause (virus, bacteria)
- Alongside awareness of the “social determinants of health: non-medical factors that influence health outcomes -> eg. ppl choosing not to wear masks, poverty, stress levels leading to being immunocompromised, concentration of ppl and resources available; religious beliefs.
What is a Pathogen?
An organism causing disease to its host, with the severity of the disease symptoms referred to as virulence.
- Pathogens include: viruses, bacteria, fungi and parasites.
What are some Fungis?
- Ringworm (avoid by drying yourself off thoroughly, washing hands after petting animals, change socks and underwear everyday)
- Candida infections (called thrush when it infects the mouth, throat, esophagus)
- Blastomycosis
- Pneumocystis pneumonia (PCP) caused by the fungus: Pneumocystis jirovecii.
What are parasites?
Include things that are usually fairly large, cells share many features with human cells.
- May transit or not transmit disease
- Lives on or in a host organism and gets its food from or at the extent of that organism.
How big are Parasites?
- Malaria -> caused by microparasite
- Hookworm -> macroparasite.
-> Both cause anemia.
What is Bacteria?
Small: 1 to 5 um are prokaryotes
- Free-living or parasitic
- Organisms (just a very small one)
- Play many important roles in nature
- Both a source of disease
- And a source of antibiotics, used to treat disease
- Cannot be seen without assistance
- First microscope from mid 17th c.
What are viruses?
- Much smaller than bacteria
- Only visible with the intervention of microscopes
- Even before they could see the viruses, they knew they were causing sickness
- Knew of their existence from late 19th cent.
-> First was tobacco mosaic virus in 1892
-> First animal virus, 1898m foot-and-mouth disease
-> First human virus c. 1900, yellow fever virus
When did Ancient Greece deal with Malaria?
- 12th c. BCE to 600 CE
- Had own understanding of health and sickness
What was Ancient Greek Medicine Like?
Healing through: divination (prophecy), exorcism, pharmaceutical remedies
- Believed that people who were sick could do sth to heal.
- Mix of spiritual and practical beliefs and healing techniques.
(herbs), and surgery.
- Diet
-> as both a positive and negative influence (source of ill health and treatment for poor health)
Who was Asclepius?
Skilled doctor in c. 1200 BCE (mentioned in Homer’s Illiad)
- A real person -> later honoured as a hero and worshipped as a God. -> (his son, Machaon (from the words for battle and knife) labelled as the father of surgery. -. fighting a nd healing through surgery using knives.
- In myth, he was known as the son of Apollo (the Greek God of healing, truth, prophecy) and a mortal princess.
- The centaur Chiron (famous for wisdom and knowledge of medicine) taught Asclepius and later his son, Machaon.
- Divine origins of medical expertise
- Eventually he was killed by Zeus, who feared that Asclepius would render all people immortal (and so killed him)
-> religious cult spread across much of Greece and Rome
What was the Theatre of Epidaurus?
- theatre built between 4th and 2nd c. BCE
- could seat up to 12,300 people.
- Hosted music and drama contests, as well as performance related to the worship of Ascelpius. -> folk festival but for the God of Healing.
- Abaton at Epidaurus, the main site for healing the sick.
-> Enclosed areas where ppl could sleep and dream.
-> Would be followed by an incubation sleep where you would have dreams and visions.
What was the significance of sleep and dreams in Ancient Greek Medicine?
- God of Sleep, Epnos.
- Incubation sleep was a ritual sleep to induce a dream.
- Incubation sleep: images of Aslepius (as a proponent of incubation sleep) attended by Hygiea, treating a sleeping woman.
- Incubation sleep: sleep monitored by priests, included baths, maybe drugs, instructions on what to eat and what not to eat.
- DREAMS as DIAGNOSTIC of particular conditions and SOURCES OF INSIGHT into HOW TO HEAL A PERSON.
Who was Hippocrates?
c. 460 BCE - c. 370 BCE
- Real person
- Trained in Kos Asclepion
-Kos included Temple of Apollo (God of Healing)
-> Spiritual and natural healing beliefs
What did the Hippocratic Corpus Include?
- Body of ~70s works (also called treatises)
- Several different authors, including Hippocrates
- Continuity with Asclepius
- CHANGE: newer ideas about nature:
-> Beginning of shift from supernatural to natural explanation
> Non-Gods related causes for diseases: -> epilepsy might be genetic bc it seemed to pass through families; tuberculosis having natural causes (eg. drought) - DETAILED DESCRIPTIONS OF SYMPTOMS
Writings about SURGICAL PRACTICES, PHARMACUETICALS - Hippocratic oath: DO NO HARM.
Was there Humoural Theory in Hippocratic Writings?
Yes!
- Said: Human body contains blood, phlegm, yellow bile, black bile.
- “Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed.”
- “Pain occurs when one of the substances presents either a deficiency or an excess, or is separated from the body and not mixed with the others.”
- Thought to be 4 humours -> in order to be in good health, those 4 humours had to be in balance.
- Sth did cause the humours to become unbalanced: mainly diet; they would say if u were drinking too much wine or eating too much meat, that could make them become unbalanced. -> anger or a curse could also cause an imbalance.
What did the Humours in Ancient Greek Medicine Correspond to?
Corresponded to the 4 elements of matter.
- As described by Empedocles, Greek philosopher and contemporary of Hippocrates.
Humour: Blood -> corresponded to air (hot and wet qualities)
Humour: Phlegm -> corresponded to water (cold and wet qualities)
Humour: Yellow bile -> corresponded to fire (hot and dry)
Humour: Black bile -> corresponded to Earth (cold and dry)
Epidemic and Hippocrates Corpus
- Epi = on
- demos = the people
- 7 books in Hippocratic corpus titled Epidemics
- Described disease “which circulates or propagates in a country”
- books 1 and 3 are lists of disease with descriptions of clinical cases.
What is Malaria?
A parasite.
- Mosquito responsible for Malaria -> Anopheles
- First infected mosquito
2. first person infected ->
3. infected liver cells -
4. infected red blood cells ->
5. second infected mosquito ->
6. second infected person
What are the 2 major Malaria parasites ?
- Plasmodium falciparum
- Plasmodium vivax
What are 5 malaria parasites?
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium malariae
- Plasmodium ovale
- Plasmodium knowlesi
What are the characteristics of the malaria parasite, Plasmodium Falciparum?
- Severe anemia
- Untreated -> epilepsy, blindness, cognitive impairments, coma, death
- Mortality in young children
- After repeated infections, survivors develop some immunity.
- If survived to age of 5, relapses and complications.
What are the characteristics of the malaria parasite, Plasmodium vivax?
- Debilitates/sickens during fevers
- Can get more severe after relapses
- Death if undernourished or compromised immune system.
- Death rate rarely exceeds 1%
- Seasonal infections, most active in summer
- All age groups
What was Malaria in Ancient Greece like?
- Established as early as 8th c. BCE, most likely arrived from south (Africa) or east (Asia minor)
- 6th c. BCE poems describe intermittent or recurring fevers - key symptom
By 400 BCE most common disease
How did Hippocrates describe Malaria in Hippocrates’ On Epidemics?
- 2 Kinds of malaria: one with recurrent fevers every 2nd day (tertian) (P. vivax or P. ovale)
- Hippocrates did not describe the symptoms that follow from infection by Plasmodium falciparum.
-> Rare at this time
-> Became established in Europe by 2nd century CE. - Described those living near marshes had enlarged spleens. -> claimed bc of smelly air and bad water.
-> swollen belly sign of malaria
How did people in Ancient Greece and Rome try to deal with Malaria?
- Drained marshes -> found less fever -> but didn’t realize it was the mosquitos causing the problem
- Mal - bad; aria - air (marshes)
- Ancients associated mosquitos with disease but not with malaria
- Mosquitos, parasites, and humans
- And proximity to water -> marshlands
- Speculated on environmental causes of disease (if you drained a marsh, got rid of mosquito habitat -> less disease/malaria)
- Change over time: spread of more virulent P. falciparum into Roman Empire
- Malaria became a (at time fatal) disease of children.
Who was Galen?
- 129 to 216 CE
- Greek physician who practiced in the Roman Empire
- Influential among medieval Christians and Early Muslims
- Hippocrates and humours (related/similar to humours)
- Anatomical study (importance of dissection to perform surgery and for research)
- Practiced dissection as a way to try and understand the body.
- Disease as located in different organs
- Scientific but as PREOCCUPIED WITH MORALITY as a CAUSE of disease: sickness from ignorance, harshness, improper behaviour
- proper behaviour (diet and conduct) could prevent most disease.
- Practiced under Roman Empire
- Families could perform rituals and sacrifices to maintain health, but would call in foreigners (like Greeks) as physicians.
- Physicians in Greece more akin to craftsmen.
What was Medicine in Greco-Roman Antiquity Like?
- No distinction between medicine/science and religion
- Physicians remained associated with Asclepian temples (left those as they were even during war -> sites were associated with healing and health -> bc romans also worshipped Asclepius.
- Sacrifices, offerings, prayers all essential parts of healing.
- Practice of medicine relatively unspecialized.
-> two exceptions: Obstetrics (pregnancy and birth -> predominantly practice by women in Greece and Rome) and the care of the eyes.
What do we mean by ‘Plague’?
- General language (pestilent, plague, fever)
-> back then, it was a generic term to refer to sickness or a plague. - Some of the ancient epidemics have well-known causes: some pathogens leave traces on skeletons or other genetic materials.
- Others remain unclear -lack of pathogenic evidence on human remains.
- Rise of epidemic diseases and spread, alongside agriculture and urbanization. -> the denser the human populations, the more opportunities for diseases to spread and more opportunity for new diseases to arise.
What were the Ancient Plagues?
- Plague of Athens (430-426) in Ancient Greece
- Antonine Plague (164-180 CE) in Roman Empire
- Plague of Justinian (541-549) in the Byzantine Empire
When was the plague of Athens?
430-426 BCE in Ancient Greece
When was the Antonine Plague?
164-180 CE in the Roman Empire
When was the Justinian Plague?
541-549 CE in the Byzantine Empire
What was Ancient Greece like Prior to, and during, the Plague of Athens?
- Ancient Greek economy rested on transport of goods by ship -> they traded wine and olive oil for grains, etc.
- Through this system, saw the rise of polis (the city state) and urban centre (with acropolis or harbour controlling surrounding territory, called a chora) -> were large urban centres in the ancient world as well -> large collections of ppl -> play big role in disease.
- Big ones were Syracruse, Athens
- There was also the Peloponnesian War:
-> two of these city states (Athens and Sparta) came to fight each other -> engulfed rest of Greek world in a large scale war) -> in order to get tthe navy to wear out the Spartans, Pericles destroyed fields -> led to large number of peasants coming into the city due to war in the countryside -> more ppl
What was the Peloponnesian War’s effect on Plague of Athens
two of these city states (Athens and Sparta) came to fight each other
-> engulfed rest of Greek world in a large scale war)
-> in order to get the navy to wear out the Spartans, Pericles destroyed fields
-> led to large number of peasants coming into the city due to war in the countryside -> more ppl -> would eventually lead to easier spread of plague
- and during plague people said that the plague was a result of the Polyponnesians poisoning the water (Thucydides)
Who was Thucydides
- 460-400BCE
- One of the earliest historians.
- General during the Peloponnesian War
-> detail oriented: tried to capture everything in as much detail as possible
-> History of the Peloponnesian War
What was the Plague of Athens?
- In 430 BCE epidemic brought from Egypt by ship to Piraeus.
- Raged for 2 years
- Many deaths, including Pericles in 429 BCE.
- Described at length by Thucydides
- Mass graves:
-> couldn’t practice proper rituals (reason for mass graves)
-> found 90 complete skeletons (might have contained as many as 150)
-> No soil between the bodies -> suggested they were buried in a panic.
What was Thucydides Account of the Plague?
- “…bodies of dying men lay one upon another, and half-dead people rolled about in the street, and in their longing for water, near all the fountains.”
- “…the customs which they had hitherto observed regarding burial were all thrown into confusion, and they buried their dead each one as he could.”
- Claimed it first began in parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the King’s country.
- In Athens, it first attacked the population of Piraeus -> which was the occasion of their saying that the Polyponnesians had poisoned the reservoirs
- Set out to simply explain the symptoms so that they may be recognized -> claimed to have had the disease himself
What was the Plague of Athens (illness)?
- Typhus?
-> bc of symptoms: fever, pustules, rash on extremities - Doctor’s Disease
-> a lot died bc they dealt with and saw the plague most often - Or multiple epidemics?
-> disease synergies? (having one disease makes you susceptible to another; or having one provides immunity for another)
What’s Thucydides relationship to the Plague Narrative?
- Established the patterns of the Plague Narrative
- The concept that it came from “over there” (and specifically Ethiopia)
- Poisoned reservoirs (role of an enemy using disease to undermine the ppl, biological warfare)
-> personal experience - Did these actually happen? Or is it just part of the plague narrative?
What was the effect of the Plague of Athens? (430-426 BCE) What came from it?
- Detailed description and foundational plague narratives
- Unknown pathogen/uncertainty
- Arose because of war, and had an impact on the war’s outcome.
-> demoralized Athenians
-> Weakened their military strength
-> And blockage meant that Spartans were not infected, and led to win by Spartans
What is the Relationship/Correlation between Trade and Disease
- Trade and Disease Routes
- Pandemics picked up during the time of Alexander the Great (356-323)
- Increased reports of plague and disease after opening to trade
What Effect Did Plagues have in the Roman World?
- There were more frequent reports after trade increased with population centres to the east (Mesopotamia, India, China) -> but also have plague narrative formula for Thucydides)
- Epidemic in 461 BCE described by Livy (Roman historian) when cattle and ppl died and corpses thrown into the Tiber. (plague narrative?)
- Carthaginian siege of Syracruse in 396 BCE ended when attackers killed by a plague
- Cult of Asclepius introduced in Rome to avert a pestilence in 293 BCE.
What was the Antonine Plague?
- Plague in Roman Empire from 164-180 CE
- The worst plague
- The cult of Asclepius
- aka Plague of Rome
- Marcus Aurelius Antoninus emperor 140-180 CE (named after him)
- Plague brought to Rome in 164 BY TROOPS that had served on the EUPHATES
- Killed as much as 1/3 of the population
- Lasted for 15 years throughout much of Asia Minor and Europe
- Broke out again in 189 CE -> caused mass mortality in Rome, as many as 2000 deaths a day.
-> don’t know what caused it (similar to plague of Athens)
When was the Plague of Rome/Antonine Plague?
164-180 CE in the Roman Empire
What was Galen’s Account of the Plague?
- Galen says that he was unaffected by the disease, although it killed almost all the slaves he had in Rome.
-> he fled but was forced to come back to Rome.
-> and killed many of the people around him. - Said that he knew how to treat the sick, but did not have the time. -> similar to Thucydides -> said he was there, he knows that happened -> but he was a doctor -> said he knew how to treat it, but it was too chaotic for him to treat it.
-> was maybe making it up to give him more authority. - DESCRIBED SYMPTOMS: Higher fever, inflammation of mouth and throat, thirst, pustules on the skin (about 9 days after the first infection)
-> smallpox?
-> first outbreak of smallpox in part of Europe? -> so Galen would not have had any preexisting exposure -> immunologically naive.
What does it mean to be Immunologically naive?
To have no previous exposure with a novel pathogen.
- Has never dealt with or encountered the pathogen, so they would be immunologically naive.
What was the Plague of Justinian?
- 541-549 CE
- Byzantine Empire (476-1453 CE)
- Justinian Plague or First Plague Pandemic
- Yersinia pestis – same pathogen responsible for the Black Death -> Bubonic, septicemic, or pneumonic forms
- Bacteria spread by fleas (vectors) from rats (reservoir) to humans (susceptible population)
- Zoonosis
- Swept through Asia minor, Africa, and ultimately Europe between 541 and 544
- Arrived in Constantinople on 542
- Justinian himself got sick and survived.
-> consequences of this plague and his name had big impact on his empire. - Thought to originate in reservoirs in Africa and Asia
-> as goods were shipped from these places through imperial trade routes it brought this pathogen and rats together -> when they arrived in Constantinople from Egypt, grain storehouses were a great breeding ground for rates and more of the disease.
What were the causes of the Plague of Justinian?
- Trade -> rats and grains (thought to originate in reservoirs in Africa and Asia
-> as goods were shipped from these places through imperial trade routes it brought this pathogen and rats together -> when they arrived in Constantinople from Egypt, grain storehouses were a great breeding ground for rates and more of the disease.) - Climatic changes -> colder temps, disrupted harvests
- Procopius described the plague in Constantinople in his Secret History (written shortly after the plague, c. 550-562 CE)
- Described experience of plague (many attributed the illness to the touch of a supernatural being that happened in their dreams -> didn’t let anyone visit them, barred their doors -> lack of access to food, resources lead to quicker death)
- Supernatural beings
What were the symptoms of the Justiniac Plague? (according to Procopius)
- Plague of Justinian (541-549 CE)
- Mild fever
- Within days developed bubonic swellings
- Most then fell into a coma or delirium (some became paranoid and suicidal)
- Most died within days (unless buboes filled with pus -> then recovered)
- Doctors had difficulty predicting course of disease or success of treatments (difficult to feed and care for the sick)
- Contact with the sick did not seem to increase chances of falling ill.
What was the death toll of the Justinian Plague?
- Estimated at 5000/day for 4 months.
- 20-40% of inhabitants.
- Food shortages likely hastened deaths of plague victims.
What were the Effects of the Plague of Justinian (541-549 CE)?
- Justinian’s court fell into chaos -> triggered a crisis in gov’t.
- Combined with floods and earthquakes at the same time, disrupted agriculture -> famine
- Losses in population meant losses in tax revenues
- Plague spread by Justinian armies, but disruption meant that he was unable to hold territories.
- Estimated to have killed 25-30 million ppl, 25% population of Byzantine Empire
- First Plague Pandemic: recurred every 3-4 years for 225 years, disappearing in 750 CE.
- Spread as far as Gaul and Britain
- End of classical world? -> diminished trade, decline of cities, rise of feudalism, fatalistic beliefs
What is Paleogenetics?
Study of genetic material from the past.
- aDNA = ancient DNA
- Study. migrations (when arrived, how changed in relation to environment)
- PCR = polymerase chain reactions
-> take a DNA sample and make lots of copies to study.
- In 2005 -> use PCR to work with DNA for bones and teeth
-> Value for study of those disease that leave genetic traces (eg. plague)
Eg. a mummified body of Asru a temple chantress, dating from c. 700 BCE. Immunocytochemistry was used to identify that she had schistosomiasis.
- Eg. Spanish Flu
- Challenges: methodological issues; ethical issues (ppls bodies, burial sites), expertise and interdisciplinarity (work from own expertise and have to work with others bc skills are quite different)
What can Paleogenetic Evidence provide us with?
- Evidence of what the disease was
- Evidence of how the disease spread… and how many people were affected and in what ways
- But not evidence of how ppl responded
- And NOT evidence of the social, economic, political effects of the disease
- and more often than not, we don’t have physical evidence, but we might still want to identify a disease in addition to answering some questions.
Who was Procopius?
A Byzantine historian who documented the Justinian Plague.
When was the Middle Ages or Medieval Period from?
300 - 800 CE to c. 1350-1550
(preceded by Antiquity, followed by Early Modern Period in European history)
What were the differences between Ancient Mediterranean and Medieval Europe?
ANCIENT MEDITERRANEAN
- Long-distance trade and military campaigns
- Significant urban centres (Athen, Rome, Constantinople)
- Relatively advanced urban sanitation
- Sophisticated political systems
MEDIEVAL EUROPE
- Far more rural and agricultural
- Poor sanitation
- Highly fragmented political authority
- Literary was rare
What happened after Plague of Justinian? (541-750CE)
Major epidemics were largely absent from Europe until plague returned in the 14th century.
-> not continuous, recurs during that period.