The beginning of the plague in Justinian’s empire is fairly well characterized by John of Ephesus, Procopius, and Evagrius Scholasticus. Each of these authors left accounts of the plague from different view points but with some striking similarities. They note that it begins in the Egyptian port of Pelusium spreading east and west, first reaching Alexandria in the west and eventually Constantinople to the east the next year. Constantinople knew it was coming for months before it arrived. All they could do was wait in dread for it to reach them. Procopius, an archivist for Emperor Justinian, was in Constantinople when it arrived and described its effects:
“And in the second year it reached Byzantium in the midst of spring, where I happened to be staying at the time. And it came thusly. Many people saw spirits of divine beings in human form of every kind, and as it happened, those who encountered them thought that they were struck, in this or that part of the body, by the man they had met; and immediately seeing this apparition they were so seized by the disease. Now at first those who met these creatures tried to turn them aside by uttering the holiest of names and exorcising them in other ways as best one could, but they accomplished absolutely nothing, for even in sanctuaries, where the most of them fled for refuge, they were dying constantly. But later on they were unwilling to even listen to their friends when they called them, and they shut themselves up in their rooms and pretended not to hear, although the doors were being beaten down, fearing that he who was calling was one of the spirits. But in the case of some, the pestilence did not come this way, but they saw a vision in a dream and seemed to suffer the very same thing at the hands of the creature who stood over them, or else to hear a voice prophesising that they were written down in the number of those who were to die. But with most it happened that the disease seized them without being made aware of what would come by a waking vision or a dream.” (Cunha & Cunha, p. 14-15).
Procopius then goes on to give a good detailed description of the symptoms:
A “sudden fever…but the body showed no change in its original color, neither was it as hot as expected when struck by a fever, nor did any inflammation occur…but the fever was of such a lethargic kind….[within a couple of days] a bubonic swelling developed there in the groin of the body, which is below the abdomen, but also in the armpit, and also behind the ear and at different places on the thighs… Up to this point, then, everything occurred in the same way all who had taken the disease. But from then on very distinct differences developed for there ensued for some a deep coma, with others violent delirium…For those who were under the spell of the coma forgot all who were familiar to them, and seemed to lie, sleeping constantly. And if anyone cared for them, they would eat without waking, but some were neglected, and these would die directly through lack of sustenance. But those who were seized with delirium suffered from insomnia and were victims of distorted imagination, for they suspected men where coming to them to destroy them, and they would become excited and rush off in flight, crying at the top of their voices….
They also had great difficulty in the matter of eating, for they could not easily take food. And many perished through lack of any man to care for them, for they were overcome with hunger, or threw themselves from a height. And in those cases where neither come nor delirium came on, the bubonic swelling became worse and the sufferer, no longer able to endure the pain, died. …
In some cases death came immediately, in others, after many days; and with some the body broke out with black pustules about as large as a lentil and these did not survive even one day, but all succumbed immediately. Vomiting of blood ensued in many, without visible cause, and immediately brought death. …
Now in those cases where the swelling rose to an unusual size and a discharge of pus had set in, it happened that they escaped from the disease and survived for clearly the acute condition of the swelling found relief in that direction, and this proved in general, and indication of returning health….And with some of them the tight withered, in which case, though the swelling was there, it did not develop the least suppuration. With others who survived, the tongue did not remain unaffected, and they lived on either lisping or speaking incoherently and with difficulty.” (Cunha & Cunha, p. 14-16)
This description fits bubonic plague quite well. His description of the fever is odd; is it really fever or just fatigue, or both? The “bubonic swelling” fits a bubo in the major lymphoid networks of the groin, thighs, arm pits and neck. The mental changes are due to septicemia, which all fatal cases have before death. We should consider that a significant number of deaths were accidental/suicidal secondary to the delirium, and apparently significant numbers from neglect. This will increase the mortality rate over what we see today.
The two side effects that he describes in survivors are from the buboes. Destruction of the lymph system and potentially damage to smaller blood vessels could cause the leg to shrivel. The tongue is more interesting. Difficutly in speech can be explained by buboes behind the ear and around the back of the jaw. The bubo and surrounding infection could damage the cranial nerves. The hypoglossal nerve would have the greatest effect on speech but the glossopharyngeal nerve or the vegas nerve could also alter speech and swallowing.
All quotes come from:
Procopius (1981) Histories of the wars. Dewing HB (trans.) Leob Classical Library, Harvard University Press, Cambridge quoted in Cunha, CB & Cunha, BA. (2008) “Great Plagues of the Past and Remaining Questions” pp. 1-20 in Paleomicrobiology: Past Human Infections. D. Raoult & M. Drancourt, Eds. Springer-Verlag, Berlin Heidelberg.