There isn’t much evidence that the Indian Himalayan site is very old at all. Surgery such as amputations, cauterization, removal of cataracts, dental extractions, and even trepanning (perforating the skull to relieve pressure on the brain) were practiced. China) being the original focus and the African focus dating to about the 14th-15th century. Observation, palpation, feeling the pulse, and urine examination would be the tools of the doctor throughout the Middle Ages. Modern genetic diversity and biogeography points toward just the opposite with the eastern Asian steppe (Mongolia/N. Sussman notes that McNeill’s influential Plagues and Peoples argues that plague foci in the Indian Himalayas and in central Africa are much earlier and more likely to be the source of the first plague pandemic (6th century) than the endemic strip along the Eurasian Steppe that McNeill dated to the 14th century. For the most part, modern historians have accepted their accounts of plague in China and India without scientific or historical evidence from China and India themselves. Witnesses of the Black Death fueled by traveler’s stories imagined that all the known world was stricken, embellishing their writing accordingly. Western legends of the Black Death in the Far East go back to contemporary 14th century accounts of the plague in Europe and the Middle East. Inhabitants there were sickened by the plague by early July. Rats carrying infected fleas boarded ships bound for Constantinople (today Istanbul in Turkey), capital of the Byzantine Empire. The bacterium Yersinia pestis (and not all historians agree this was the culprit) likely traveled from China to the northwestern shores of the Caspian Sea, then part of the Mongol Empire and by the spring of 1346, Italian merchants in the Crimea, specifically the Genoese-dominated city of Kaffa (today Feodosiya in the Ukraine) brought the disease west. Most historians today generally agree that the plague was likely spread through Eurasia via these trade routes by parasites carried on the backs of rodents.

Italian city-states such as Venice and Genoa had trading ports in the eastern Mediterranean and the Black sea-trade that made these cities among the wealthiest cities in Europe. Growing stability in Europe in the late middle ages made possible extensive trade between East and West and within Europe itself.

Middle ages plague