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In Europe, the Medieval Warm Period ended sometime towards the end of the 13th century, bringing the "Little Ice Age"[20] and harsher winters with reduced harvests. In northern Europe, new technological innovations such as the heavy plough and the three-field system were not as effective in clearing new fields for harvest as they had been in the Mediterranean because the north had poor clay soil,[18] and the potato, otherwise ideal for Northern Europe, was an American crop unknown in Europe at the time. Food shortages and rapidly inflating prices were a fact of life for as much as a century before the plague. Wheat, oats, hay and consequently livestock were all in short supply. Their scarcity resulted in malnutrition, which increases susceptibility to infections due to weakened immunity. Consistently high fertility rates, at five or more children per woman throughout Europe, resulted in high population growth rates and contributed to food shortages. In the autumn of xxxx, heavy rains began to fall, followed by several years of cold and wet winters.[18] The already weak harvests of the north suffered and the seven-year famine ensued. In the years xxxx to xxxx, a catastrophic famine, known as the Great Famine, struck much of northwest Europe. It was arguably the worst in European history, reducing the population by perhaps more than 10 percent.[18]The plague disease, generally thought to be caused by Yersinia pestis, is enzootic (commonly present) in populations of fleas carried by ground rodents, including marmots, in various areas including Central Asia, Kurdistan, Western Asia, Northern India and Uganda.[21] Nestorian graves dating to xxxx?9 near Lake Issyk Kul in Kyrgizstan have inscriptions referring to plague and are thought by many epidemiologists to mark the outbreak of the epidemic, from which it could easily have spread to China and India.[22] In October xxxx, medical geneticists suggested that all three of the great waves of the plague originated in China.[10] In China, the 13th century Mongol conquest caused a decline in farming and trading. However, economic recovery had been observed in the beginning of the 14th century. In the xxxxs a high frequency of natural disasters and plagues led to widespread famine, starting in xxxx, with a deadly plague arriving soon after.[23] The 14th-century plague killed an estimated 25 million Chinese and other Asians during the 15 years before it entered Constantinople in xxxx.[24] However, according to George Sussman, the first obvious medical description of plague in China dates to xxxx.[25]The disease may have travelled along the Silk Road with Mongol armies and traders or it could have come via ship.[26] By the end of xxxx, reports of plague had reached the seaports of Europe: "India was depopulated, Tartary, Mesopotamia, Syria, Armenia were covered with dead bodies".[27]There appear to have been several introductions into Europe. It reached Sicily in October xxxx carried by twelve Genoese galleys,[29] where it rapidly spread all over the island. Galleys from Caffa reached Genoa and Venice in January xxxx, but it was the outbreak in Pisa a few weeks later that was the entry point to northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseille.[30]The plague struck various countries in the Middle East during the pandemic, leading to serious depopulation and permanent change in both economic and social structures. As it spread to western Europe, the disease entered the region from southern Russia also. By autumn xxxx, the plague reached Alexandria in Egypt, probably through the port's trade with Constantinople, and ports on the Black Sea. During xxxx, the disease travelled eastward to Gaza, and north along the eastern coast to cities in Lebanon, Syria and Palestine, including Ashkelon, Acre, Jerusalem, Sidon, Damascus, Homs, and Aleppo. In xxxx?49, the disease reached Antioch. The city's residents fled to the north, most of them dying during the journey, but the infection had been spread to the people of Asia Minor.[citation needed]Medical knowledge had stagnated during the Middle Ages. The most authoritative account at the time came from the medical faculty in Paris in a report to the king of France that blamed the heavens, in the form of a conjunction of three planets in xxxx that caused a "great pestilence in the air".[38] This report became the first and most widely circulated of a series of "plague tracts" that sought to give advice to sufferers. That the plague was caused by bad air became the most widely accepted theory. The word plague had no special significance at this time, and only the recurrence of outbreaks during the Middle Ages gave it the name that has become the medical term.The importance of hygiene was recognised only in the nineteenth century; until then it was common that the streets were filthy, with live animals of all sorts around and human parasites abounding. A transmissible disease will spread easily in such conditions. One development as a result of the Black Death was the establishment of the idea of quarantine in Dubrovnik in xxxx after continuing outbreaks.[39]The historian Francis Aidan Gasquet, who had written about the 'Great Pestilence' in xxxx[41] and suggested that "it would appear to be some form of the ordinary Eastern or bubonic plague" was able to adopt the epidemiology of the bubonic plague for the Black Death for the second edition in xxxx, implicating rats and fleas in the process, and his interpretation was widely accepted for other ancient and medieval epidemics, such as the Justinian plague that was prevalent in the Eastern Roman Empire from 541 to 700 CE.[40]This interpretation was first significantly challenged by the work of British bacteriologist J. F. D. Shrewsbury in xxxx, who noted that the reported rates of mortality in rural areas during the 14th-century pandemic were inconsistent with the modern bubonic plague, leading him to conclude that contemporary accounts were exaggerations.[40] In xxxx zoologist Graham Twigg produced the first major work to challenge the bubonic plague theory directly, and his doubts about the identity of the Black Death have been taken up by a number of authors, including Samuel K. Cohn, Jr. (xxxx), David Herlihy (xxxx), and Susan Scott and Christopher Duncan (xxxx).[40]A variety of alternatives to the Y. pestis have been put forward. Twigg suggested that the cause was a form of anthrax and N. F. Cantor (xxxx) thought it may have been a combination of anthrax and other pandemics. Scott and Duncan have argued that the pandemic was a form of infectious disease that characterise as hemorrhagic plague similar to Ebola. Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of large number of rats in the archaeological record of the medieval waterfront in London and that the plague spread too quickly to support the thesis that the Y. pestis was spread from fleas on rats and argues that transmission must have been person to person.[47][48] However, no single alternative solution has achieved widespread acceptance.[40] Many scholars arguing for the Y. pestis as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus, smallpox and respiratory infections. In addition to the bubonic infection, others point to additional septicemic (a type of "blood poisoning") and pneumonic (an airborne plague that attacks the lungs before the rest of the body) forms of the plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms.[32]In October xxxx, the open-access scientific journal PLoS Pathogens published a paper by a multinational team who undertook a new investigation into the role of Yersinia pestis in the Black Death following the disputed identification by Drancourt & Raoult in xxxx.[49] Their surveys tested for DNA and protein signatures specific for Y. pestis in human skeletons from widely distributed mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this new research, together with prior analyses from the south of France and GermanyRenewed religious fervor and fanaticism bloomed in the wake of the Black Death. Some Europeans targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims",[58] lepers[58][59] and Roma, thinking that they were to blame for the crisis. Lepers, and other individuals with skin diseases such as acne or psoriasis, were singled out and exterminated throughout Europe.The Black Death had a profound impact on art and literature throughout the generation that experienced it. Many of the most useful manifestations of the Black Death in literature, to historians, comes from the accounts of its chroniclers. Some of these chroniclers were famous writers, philosophers and rulers such as Boccaccio and Petrarch. Their writings, however, did not reach the majority of the European population. Petrarch's work was read mainly by wealthy nobles and merchants of Italian city-states. He wrote hundreds of letters and vernacular poetry, and passed on to later generations a revised interpretation of courtly love.[62] There was one troubadour, writing in the lyric style long out of fashion, who was active in xxxx. Peire Lunel de Montech composed the sorrowful sirventes "Meravilhar no·s devo pas las gens" during the height of the plague in Toulouse.The Local Government Act of xxxx was the first systematic attempt to impose a standardised system of local government in England. The counties of England at the time (today known as the historic counties, since the major boundary changes of xxxx) were used as the basis of the system. A second Act in xxxx (Local Government Act xxxx) also created a second tier of local government. Henceforth, all administrative counties and county boroughs would be divided into either rural or urban districts, allowing more localised administration.The statutory counties formed the basis for the so-called 'administrative counties'. However, it was felt that large cities and primarily rural areas in the same county could not be well administered by the same body. Thus 59 "counties in themselves", or 'county boroughs', were created to administer the urban centres of England. These were part of the statutory counties, but not part of the administrative counties.A Local Government Commission was wound up in xxxx, and replaced with a Royal Commission (known as the Redcliffe-Maud commission). In xxxx it recommended a system of single-tier unitary authorities for the whole of England, apart from three metropolitan areas of Merseyside, Selnec (Greater Manchester) and West Midlands (Birmingham and the Black Country), which were to have both a metropolitan council and district councils. This report was accepted by the Labour Party government of the time despite considerable opposition, but the Conservative Party won the June xxxx general election, and on a manifesto that committed them to a two-tier structure.In xxxx, new changes to local government were made whereby a number of new unitary authorities were created in areas which previously had a 'two-tier' system of counties and districts. In five shire counties the functions of the county and district councils were combined into a single authority; and in two counties the powers of the county council were absorbed into a significantly reduced number of districts.The abolition of regional development agencies and the creation of Local enterprise partnerships were announced as part of the June xxxx United Kingdom budget.[44] On 29 June xxxx a letter was sent from the Department of Communities and Local Government and the Department for Business, Innovation and Skills to local authority and business leaders, inviting proposals to replace regional development agencies in their areas by 6 September xxxx.[45]On 7 September xxxx, details were released of 56 proposals for local enterprise partnerships that had been received.[46][47] On 6 October xxxx, during the Conservative Party Conference, it was revealed that 22 had been given the provisional 'green light' to proceed and others may later be accepted with amendments.[48] 24 bids were announced as successful on 28 October xxxx.[49]The reforms arising from the Local Government Act of xxxx resulted in the most uniform and simplified system of local government which has been used in England. They effectively wiped away everything that had gone before, and built an administrative system from scratch. All previous administrative districts ? statutory counties, administrative counties, county boroughs, municipal boroughs, counties corporate, civil parishes ? were abolished.The aim of the act was to establish a uniform two tier system across the country. Onto the blank canvas, new counties were created to cover the entire country; many of these were obviously based on the historic counties, but there were some major changes, especially in the north.This uniform two-tier system lasted only 12 years. In xxxx, the metropolitan county councils and Greater London were abolished. This restored autonomy (in effect the old county borough status) to the metropolitan and London boroughs. The Local Government Act (xxxx) established a commission (Local Government Commission for England) to examine the issues, and make recommendations on where unitary authorities should be established. It was considered too expensive to make the system entirely unitary, and also there would doubtlessly be cases where the two-tier system functioned well. The commission recommended that many counties be moved to completely unitary systems; that some cities become unitary authorities, but that the remainder of their parent counties remain two-tier; and that in some counties the status quo should remain.The rate-capping rebellion was a campaign within English local councils in xxxx which aimed to force the Conservative government of Margaret Thatcher to withdraw powers to restrict the spending of councils. The campaign's tactic was that councils whose budgets were restricted would refuse to set any budget at all for the financial year xxxx?86, requiring the Government to intervene directly in providing local services, or to concede. However, all 15 councils which initially refused to set a rate eventually did so, and the campaign failed to change Government policy. Powers to restrict council budgets have remained in place ever since.In xxxx, the Lieutenancies Act was passed. This firmly separated all local authority areas (whether unitary or two-tier), from the geographical concept of a county as high level spatial unit. The lieutenancies it established became known as ceremonial counties, since they were no longer administrative divisions. The counties represent a compromise between the historic counties and the counties established in xxxx.While the xxxx Labour government devolved power to Wales, Scotland and Northern Ireland, it refused to created a devolved Assembly or parliament for England, planning instead to introduce eight regional assemblies around England to devolve power to the regions. In the event, only a London Assembly (and directly elected Mayor) was established. Rejection in a referendum of a proposed North-East Assembly in xxxx effectively scrapped those plans. A pre-condition of having a regional assembly was for the whole area to move to unitary authority status. Since the xxxx general election the government has floated the idea of voluntary mergers of local councils, avoiding a costly reorganisation but achieving desired reform. For instance, the guiding principles of the government's "New Localism" demand levels of efficiency not present in the current over-duplicated two-tier structure.A second Act in xxxx (Local Government Act xxxx) also created a second tier of local government. Henceforth, all administrative counties and county boroughs would be divided into either rural or urban districts, allowing more localised administration. The municipal boroughs reformed after xxxx were brought into this system as special cases of urban districts. The urban and rural districts were based upon, and incorporated the sanitary districts which had been created in xxxx (with adjustments, so that districts did not overlap two counties).The Act also provided for the establishment of civil parishes. The xxxx Act formed an official system of civil parishes, separated from the ecclesiastical parishes, to carry on some of these responsibilities (others being transferred to the district/county councils). However, the civil parishes were not a complete third-tier of local government. Instead, they were 'community councils' for smaller, rural settlements, which did not have a local government district to themselves. Where urban parish councils had previously existed, they were absorbed into the new urban districts.By xxxx, it was clear that the piecemeal system that had developed over the previous century in response to the vastly increased need for local administration could no longer cope. The sanitary districts and parish councils had legal status, but were not part of the mechanism of government. They were run by volunteers; often there was no-one who could be held responsible for the failure to undertake the required duties. Furthermore, the increased "county business" could not be handled by the Quarter Sessions, nor was it appropriate to do so. Finally, there was a desire to see local administration performed by elected officials, as in the reformed municipal boroughs. The Local Government Act was therefore the first systematic attempt to impose a standardised system of local government in EnglandThe counties of England at the time (now known as the historic counties, since the major boundary changes of xxxx) were used as the basis of the system. The counties themselves had undergone some boundary changes in the preceding 50 years, mainly to remove enclaves and exclaves. The act called for the creation of statutory counties, based on the ancient/historic counties, but completely corrected for enclaves and exclaves, and adjusted so that all settlements were completely within a single county. These statutory counties were to be used for non-administrative functions: "sheriff, lieutenant, custos rotulorum, justices, militia, coroner, or other". With the advent of elected councils, the offices of lord lieutenant and sheriff became largely ceremonial.They died by the hundreds, both day and night, and all were thrown in ... ditches and covered with earth. And as soon as those ditches were Because 14th-century healers were at a loss to explain the cause, Europeans turned to astrological forces, earthquakes, and the poisoning of wells by Jews as possible reasons for the plague's emergence.[18] The governments of Europe had no apparent response to the crisis because no one knew its cause or how it spread. The mechanism of infection and transmission of diseases was little understood in the 14th century; many people believed only God's anger could produce such horrific displays.There were many attacks against Jewish communities.[60] In August xxxx, the Jewish communities of Mainz and Cologne were exterminated. In February of that same year, the citizens of Strasbourg murdered 2,000 Jews.[60] By xxxx, 60 major and 150 smaller Jewish communities were destroyed.[61]I "...ends the debate about the etiology of the Black Death, and unambiguously demonstrates that Y. pestis was the causative agent of the epidemic plague that devastated Europe during the Middle Ages."[50]The study also found that there were two previously unknown but related clades (genetic branches) of the Y. pestis genome associated with medieval mass graves. These clades (which are thought to be extinct) were found to be ancestral to modern isolates of the modern Y. pestis strains Y. p. orientalis and Y. p. medievalis, suggesting the plague may have entered Europe in two waves. Surveys of plague pit remains in France and England indicate the first variant entered Europe through the port of Marseille around November xxxx and spread through France over the next two years, eventually reaching England in the spring of xxxx, where it spread through the country in three epidemics. Surveys of plague pit remains from the Dutch town of Bergen op Zoom showed the Y. pestis genotype responsible for the pandemic that spread through the Low Countries from xxxx differed from that found in Britain and France, implying Bergen op Zoom (and possibly other parts of the southern Netherlands) was not directly infected from England or France in xxxx and suggesting a second wave of plague, different from those in Britain and France, may have been carried to the Low Countries from Norway, the Hanseatic cities or another site.[50]The results of the Haensch study have since been confirmed and amended. Based on genetic evidence derived from Black Death victims in the East Smithfield burial site in England, Schuenemann et al. concluded in xxxx "that the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer exist."[51] A study published in Nature in October xxxx sequenced the genome of Y. pestis from plague victims and indicated that the strain that caused the Black Death is ancestral to most modern strains of the disease.[5]It is recognised that an epidemiological account of the plague is as important as an identification of symptoms, but researchers are hampered by the lack of reliable statistics from this period. Most work has been done on the spread of the plague in England, and even estimates of overall population at the start vary by over 100% as no census was undertaken between the time of publication of the Domesday Book and the year xxxx.[45] Estimates of plague victims are usually extrapolated from figures from the clergy.In addition to arguing that the rat population was insufficient to account for a bubonic plague pandemic, sceptics of the bubonic plague theory point out that the symptoms of the Black Death are not unique (and arguably in some accounts may differ from bubonic plague); that transference via fleas in goods was likely to be of marginal significance and that the DNA results may be flawed and might not have been repeated elsewhere, despite extensive samples from other mass graves.[40] Other arguments include the lack of accounts of the death of rats before outbreaks of plague between the 14th and 17th centuries; temperatures that are too cold in northern Europe for the survival of fleas; that, despite primitive transport systems, the spread of the Black Death was much faster than that of modern bubonic plague; that mortality rates of the Black Death appear to be very high; that, while modern bubonic plague is largely endemic as a rural disease, the Black Death indiscriminately struck urban and rural areas; and that the pattern of the Black Death, with major outbreaks in the same areas separated by 5 to 15 years, differs from modern bubonic plague?which often becomes endemic for decades with annual flare-ups.[40]Walløe complains that all of these authors "take it for granted that Simond's infection model, black rat ? rat flea ? human, which was developed to explain the spread of plague in India, is the only way an epidemic of Yersinia pestis infection could spread", whilst pointing to several other possibilities.[46]Anthrax skin lesionMore recently other forms of plague have been implicated. The modern bubonic plague has a mortality rate of 30?75% and symptoms including fever of 38?41 °C (100?106 °F), headaches, painful, aching joints, nausea and vomiting, and a general feeling of malaise. If untreated, of those that contract the bubonic plague, 80 percent die within eight days.[42] Pneumonic plague has mortality rate of 90 to 95 percent. Symptoms include fever, cough, and blood-tinged sputum. As the disease progresses, sputum becomes free flowing and bright red. Septicemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation). In cases of pneumonic and particularly septicemic plague the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes.[43]"Many modern scholars accept that the lethality of the Black Death stemmed from the combination of bubonic and pneumonic plague with other diseases and warn that every historical mention of 'pest' was not necessarily bubonic plague...In her study of 15th-century outbreaks, Ann Carmichael states that worms, the pox, fevers and dysentery clearly accompanied bubonic plague."[44]The dominant explanation for the Black Death is the plague theory, which attributes the outbreak to Yersinia pestis, also responsible for an epidemic that began in southern China in xxxx, eventually spreading to India. The investigation of the pathogen that caused the 19th-century plague was begun by teams of scientists who visited Hong Kong in xxxx, among whom was the French-Swiss bacteriologist Alexandre Yersin, after whom the pathogen was named Yersinia pestis.[40] The mechanism by which Y. pestis was usually transmitted was established in xxxx by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several days after feeding on an infected host. This blockage results in starvation and aggressive feeding behaviour by the fleas, which repeatedly attempt to clear their blockage by regurgitation, resulting in thousands of plague bacteria being flushed into the feeding site, infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts, keeping the disease endemic; and a second that lack resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic.[40]Mecca became infected in xxxx. During the same year, records show the city of Mawsil (Mosul) suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. In xxxx Yemen experienced an outbreak of the plague, coinciding with the return of King Mujahid of Yemen from imprisonment in Cairo. His party may have brought the disease with them from From Italy,the disease spread northwest across Europe, striking France, Spain, Portugal and England by June xxxx, then turned and spread east through Germany and Scandinavia from xxxx?50. It was introduced in Norway in xxxx when a ship landed at Askøy, then spread to Bjørgvin (modern Bergen) but never reached Iceland.[31] Finally it spread to northwestern Russia in xxxx. The plague spared some parts of Europe, including the Kingdom of Poland and isolated parts of Belgium and the Netherlands.[citation needed]Plague was reportedly first introduced to Europe at the trading city of Caffa in the Crimea in xxxx. After a protracted siege, during which the Mongol army under Jani Beg was suffering the disease, they catapulted the infected corpses over the city walls to infect the inhabitants. The Genoese traders fled, taking the plague by ship into Sicily and the south of Europe, whence it spread north.[28] Whether or not this hypothesis is accurate, it is clear that several existing conditions such as war, famine, and weather contributed to the severity of the Black Death."