Ep 130 Cocoliztli: We do love a salty dish

them suddenly. They died quickly from this awful Oh yeah, it's this episode is loaded with quotes, Karen. That particular quote was from an anonymous Nahua, author of the anal state Techamachalco from the epidemic of Coco Leeseley in fifteen seventy six. Okay, hi, I'm Aaron Welsh.

this once densely populated and vibrant land. Quote in times past that town had a large population, according to the older people, and now it just seems like ruins of houses, and for the many fruit trees there are in the surroundings among which the Indians usually have their towns, especially being in the hot lands like it is, but with the coco Litli. There was such a very large pestilence and mortality in that land that everything was destroyed and

now there are scarcely two hundred inhabitants whoa yeah. And while they name drop cocolitle specifically there, it was far from the only factor in the tremendous population losses and cultural devastation experienced by indigenous populations in Mexico following first contact with European colonizers in the sixteenth century. And if you'll just allow me to get on a soapbox for

a little bit. Even though the focus of today's episode is on just one of those factors, cocoliteslei, which we'll spend a lot more time about, I don't want to lose sight of that fact that this cultural and population devastation was multifactorial. That we can't take this disease cocolitsli, or these epidemics out of their historical context without considering

everything else that was going on at the time. Retrospective diagnosis is a tricky enough business as it is, and ignoring all of the social and political factors that played a role in the spread of disease, it's only going to further limit our ability to say anything about whether Cokolitsli was rodent associated or waterborn. For way too long, many historians have over emphasized the effects that pathogens alone had on the population declines of indigenous peoples living in

the America's following European contact. The concept of quote unquote virgin soil epidemics, as in the idea that these pathogens that Europeans were more acquainted with and brought with them to the New World, that these pathogens were more devastating

to immunologically naive populations. This concept has been overly used in the construction of these like Eurocentric Jared diamond esque histories, where the strong conquered the weak and took what was rightfully theirs because nature i e. Pathogens determined that they were the victors. Right.

of traditional cultural practices. Germs weren't acting alone here in more ways than one, Like, yes, there were devastating smallpox epidemics that cannot be ignored, that cannot be debated, and yes, there were also horrific measles outbreaks and influenza epidemics and so one and so forth. But it's not like in those like eighties action movies where the bad guys take turns fighting the one good guy. It's like multiple pathogens were all circulating at the same time, all the bad

guys were fighting all at once. And this isn't to downplay the enormous mortality rates that we see during these epidemics, upwards of sixty to eighty percent of the entire population in some cases, but it's just to try to present a more nuanced view you of where those numbers, those mortality rates might be coming from. Death from disease absolutely maybe increased by malnutrition or coinfection with another pathogen, or weakened health from forced labor or fewer people to care

for the sick, like societal collapse. The layers of protection from getting sick or dying from illness in many cases had been entirely stripped away, and I think sometimes that can get lost in looking at these epidemics from like a purely biological microbiological epidemiological focus, I guess, and I think this is especially important to remember when we're trying to go through and guess which pathogen might be responsible for Coco litesle and be like, wow, there's no known

pathogen that causes such high mortality rates. Like well, of course, because it's not just one loan pathogen. But anyway, keeping all that in mind, LAO, let's turn to Coco Leathsley. What were the Coco Leitsli epidemics? In short, they were a series of epidemics of undetermined cause that swept through much of Mexico and the rest of meso America during the sixteenth, seventeenth, eighteenth, and possibly even the nineteenth centuries. Huh.

At least thirteen distinct epidemics according to one paper I read. But today I'm only going to be focusing on the two most devastating Coco Leathsley epidemics, one that began in fifteen forty five and the other in fifteen seventy six, since they have the most documentation and had the most apparently impact on the population. But to better understand how these epidemics happened when they did and the impact they had.

Let's do a little bit stage setting. In fifteen nineteen, the Spanish conquistador Hernando Cortes and his crew landed in Mexico, where they claimed the land for the Spanish crown and proceeded to travel inland until they reached toto che Lan, the massive capital of the Aztec Empire, or specifically the Mashka people. Aztec is kind of a political term I learned that means really just the three tribes that controlled a lot of Mexico at the time, and one of

these tribes, the most powerful, was the Meshika. Anyway, shortly after arriving in to notche Chielan and being showered with please go away gifts of silver and gold and textiles, the Spanish then took the Meshika emperor of the city as prisoner, Montezuma for a year until he was killed. And skipping over a whole lot of history here, that really sort of kicked off the beginning of Spanish colonial rule in Mexico. Like that is not even beginning to

get into that's not even surface level. There's so much more history there. But basically things changed very quickly in that Aztec Empire, from political organization to wealth distribution, cultural practices to daily life. Agriculture shifted under Spanish rule as domestic animals were introduced and the dominant crops switched from maize, squash, amorants, beans, and peppers to wheat so that the Spanish could make European style bread. Lakes were drained to prevent flooding or

to provide more arable land for farming. Taxation or tributes grew enormously in demand, pretty much beyond anyone's means, and as a result, nutrition really suffered, especially since there were a series of droughts throughout the sixteenth century that we'll talk maybe a little bit more about later on. Many indigenous people were enslaved or forced to do labor, or

displaced from their homes and land. Even clothing changed, apparently with an emphasis on European style clothing, along with fewer baths, since it was the Spanish belief at the time that

bathing daily was bad for your health. Now, all of these changes did not take place everywhere or at the same time throughout Mesoamerica, but life certainly changed for everyone, and I came across a paper about Coco Lethsley by mar and Kirakoff from two thousand, where the authors wrote that, quote certainly, the policies of the Spanish colonial regime were harsh in many ways, but no more so than those of the Aztec imperial regime had been end quote I mean wrong, and I think to claim that is to

kind of undermine the drastic effects that the Spanish regime had on life for indigenous peoples. So anyway, when Cortes and his crew landed in fifteen nineteen, Mexico was home to a population of around twenty two million people, and the major city, ten Ochtreetlan had approximately two hundred and fifty thousand to three hundred thousand occupants, which was five times the size of London at the same time. Oh wow,

with an incredibly intricately connected society. But within the century, millions upon millions of people would be dead from a combination of disease and the major upheaval of Spanish rule. And the first disease to make itself felt with smallpox, which began to spread in fifteen twenty, only a year after Cortes arrived. Eight million people died during the smallpox epidemic. Oh, out of a population of twenty two million.

no less terrifying or devastating. So finally getting to Coco Ltsley in fifteen forty five, Coco Lethsley struck for seemingly the first time. Over a dozen early Spanish and indigenous contemporary accounts describe a deadly disease that swept through Mexico and the rest of meso America. Bernardino des Sahagoon, Franciscan scholar who witnessed this epidemic, wrote, quote, in the year fifteen forty five, there was a huge and universal pestilence where in all of New Spain most of the people

who lived there died. At the time of this pestilence. I was in Mexico City, in the part of tlate Loco, and I buried more than ten thousand bodies. And at the end of the pestilence, I became ill and almost died end quote hm. Importantly, Sahogoon also lived to see the second epidemic of Cocolitsli in fifteen seventy six, which he described as being very similar to the one in fifteen forty five, and he ultimately died in a third Cocolitsi epidemic in fifteen ninety.

later when going through the possible pathogens. Children and young adults were said to be the most affected, although again sort of sources are not entirely consistent on this point, but this is supported by evidence from burial grounds in southern Mexico where the Mishtek peoples lived, and these burial grounds show that a young people were disproportionately buried and b bodies were stacked vertically, suggesting that the deaths happen too quickly for individual graves to be dug which is

the norm. So definitely like this is considered an epidemic graveyard.

And someone who was writing about the fifteen forty five Cocleaedsli epidemic like sixty years after it happened, wrote that quote blood flowed from the mouth, eyes, nose, and anus end quote of all people poor and noble alike, and that the bodies were eaten by dogs and coyotes. Okay, I think just like emphasizing the speed with which this

killed and how many people are killed. Another Franciscan friar and eyewitness to both the fifteen forty five and fifteen seventy six coco Leedes epidemics used the term pujamiento de sangre, meaning abundant bleeding or full bloodiness, and said it was characterized by blood fevers. Notably, though, this same author used the Spanish word for Typhus Tabardillo for the fifteen seventy

six epidemic, and remember he saw both of them. But in general, this fifteen forty five Cocolitsi epidemic was described by most eyewitnesses as distinct from other European introduced diseases including smallpox, measles epidemic, typhus, pertussis, and malaria. So in total, an estimated five to fifteen million people died, said to be about eighty percent of the indigenous population.

you're sick, then who's caring for you? So I think that's where we have to kind of remember where those mortality numbers are coming from.

bewilderment to see the people die. Many were dead and others almost dead, and nobody had the health or strength to help the diseased or bury the dead. In the cities and large towns, big ditches were dug, and from morning to sunset the priests did nothing else but bury the dead bodies and throw them into the ditches without any of the solemnity usually reserved for the dead, because the time did not allow otherwise. At night they covered

the ditches with dirt. It lasted for one and a half years and with great excess in the number of deaths.

But the vast majority of cases were concentrated in like a four hundred mile radius in Mexico, where it spread from the dry plains of the north to the densely populated subtropical valleys of central Mexico, leaving almost no place unscathed except for perhaps the coastal areas. According to some, the spread seemed to slow by October fifteen seventy eight, so it's like two years after, but then increased again in August fifteen seventy nine, ending finally in the middle

of fifteen eighty one. The effect was truly devastating in Mexico. More than two million people died during this epidemic, half of the population fifty one point three six percent to be precise. And we can be so precise because censuses were conducted a few years before the epidemic and a few years after.

house to house. And it was without order, even though divine disposition would have had it well ordered, because it struck one neighborhood and then jumped to another far away, sparing the one closer by, and in the same home. It took some and spared others, only to return four or six months later to claim the healthy. This was

observed by all end quote hmmm. He added that quote, these poor indios are half what they were in number, and the half that return are wasted, weary, and miserable because everyone has either succumbed to the pestilence or escaped it. And even today the sorrowful ones who survived are still preoccupied with their loved ones who continue to suffer. End quote. So the Spanish, who seem to be less affected by the disease, although ASTERISK did keenly feel its impacts in

other ways, namely economical. The accountant of the Royal Treasury of New Spain wrote, quote, the illness and death of the natives have been so great that they have been completely diminished, so much so that in many pueblos in this great land, fewer than half the population remains, and in others less than a third, And so our profits are less than they were. The absence of natives in these lands is so great that it seems unfathomable that

they could have been brought to this point. The profits are far less, and our expense is ever greater because of the tremendous hardship, and the whole land is in misery, affliction and need end.

were used were from were written by Spanish colonizers. And only more recently do we have people the Nahua people who's who also wrote down histories like those are being translated and then taken into account in these retellings, and

so it's interesting, very interesting. Yeah. Yeah, but cocolitesle, this epidemic especially threatened Spanish rule and colonial order because of sheer population loss, not just economically but also culturally, fewer people to convert to the new religion and to rule over. And so okay, at this point we've established that this is a pretty deadly disease. Now let's go through how

this one was described. Yeah. Again, the Nahwat word cocolitesli or hue cocolitsli was used to mean pestilence or great pestilence, and the Spanish also used malpestillencia, pestilencia universal bad or universal pestilence. It was discussed as distinct from the other known epidemic diseases, and was generally seen as something new, something unfamiliar. Some reports describe young people being disproportionately affected, while others say it attacked all ages. No animal deaths,

domestic or wild were mentioned. When it comes to symptoms, there's actually a medical description by doctor Fernando Hernandez, who is the physician in chief of New Spain. It's very long, so brace yourself, but I think you're going to find it very interesting.

was followed by delirium and seizures. Then hard and painful nodules appeared behind one or both ears, along with heartache, chest pain, abdominal pain, tremor, great anxiety, and dysentery. The blood that flowed when cutting a vein had a green color or was very pale, dry and without serocity. In some cases, gangreen and Sphacilus aka necrosis invaded their lips, pudental regions and other regions of the body with putrefact members, blood flowed from the ears, and in many cases blood

truly gushed from the nose. Of those with recurring disease, almost none was saved. Many were saved if the flux of blood through the nose was stopped in time. The rest died. Those attacked by dysentery were usually saved if they complied with the medication. The abscesses behind the ears were not lethal if somehow their size was reduced, either by spontaneous maturation or given exit by perforation with catteries.

The liquid part of the blood flowed or the puss was eliminated, and with it the cause of disease was also eliminated, as was the case of those with abundant and pale urine. At autopsy, the liver was greatly enlarged. The heart was black, first draining a yellowish liquid and then black blood. The spleen and lungs were black and semi putrefacted. The bile was observed in its container, the abdomen dry, The rest of the body anywhere it was

cut was extremely pale. This epidemic attacked mainly young people and seldom the elder ones. If old people were affected, they were able to overcome the disease and save their lives. The epidemic started in June fifteen seventy six and is not over in December when I am writing these lines. Very few with abdominal distension were saved. At the beginning, the blood was expelled by some without severe disease, then by very few. Vital energy was consumed quickly. End quote A lot to unpack.

appeared many times throughout accounts of this epidemic. Epidemics of coco Elitzley continued, possibly until as recently as the early nineteenth century, although the name used in these later epidemics was mala zowat netlike rash, and it's unclear if the new name meant new disease, or was used in recognition of a new symptom, or was just something else like it's People don't know, but in any case, coco Elitzley, especially the sixteenth century epidemics, has stumped researchers for decades.

The symptoms described, along with the high mortality rate, don't seem to match any known pathogen today, but don't worry, there are still plenty of hypotheses to go around. Historically, epidemic typhus has been a popular guess, and more recently,

heemorrhagic fever possibly associated with rodents. This rodent association is because both the fifteen forty five and fifteen seventy six epidemics occurred during brief intense rainfall preceded by long periods of megadrought, which is very similar to the Four Corners nineteen ninety three huntavirus outbreak, where dear mice proliferated after

that same drought rainfall cycle. Others that have been proposed include plague specifically mnemonic anthrax, sleptosporosis, malaria, diphtheria, Tessis lausborn relapsing fever, and malaria. All of these I just mentioned were proposed based on epidemiological characteristics or descriptions of symptoms,

not physical evidence. Not yet for those anyway. But there is one candidate pathogen for cocolitesle that has gotten a lot of attention recently, and that is Salmonella in Enterica subspecies Enterica saravar paratipee s longest name for an organism ever maybe, but a few years ago, researchers detected Salmonella in Enterica paratifec DNA in ten individuals that were buried during the fifteen forty five coco leisle epidemic in Wahaka

in southern Mexico. Now, the researchers who publish this paper are not claiming that this pathogen was solely responsible for the coco lee epidemics, but instead suggests that it may have acted in concert with other circulating pathogens at the time.

But before we start debating which pathogen is the best candidate, if any, let's maybe learn a bit more about the ones proposed, keeping in mind number one what these diseases looked like, number two, how they're transmitted, number three, case fatality rates, number four, environmental factors, number five old World versus New World origins, and number six that this could have been the work of many factors acting simultaneously. And now, Aaron, I turn it over to you.

not consistently mentioned. And in fifteen seventy six there was that Franciscan scholar who used the word tabardio, which I think means like cloak rash or something like that, Like it refers to the rash from typhus from epidemic typhus, but that long quote from the physician didn't describe it, and in general it was not like it didn't seem to be.

covered all of these things. Do we do Bartonella, we did bartnella erin, we did the literal because there's a few more things that I have on my list that you gave me, and literally the only ones that we haven't covered are unknown hemorrhagic fever, okay, and parvovirus B nineteen, which like it's not that either, right, right, but we'll get there. Everything else we've talked about, So this is really fun and most of my sources are c our

previous episode NICs. But okay, smallpox is out. Measles. We did measles a very very long time ago. Now, measles, while it spread through populations and absolutely caused a lot of morbidity and mortality, the mortality rate is nowhere near what we're seeing with cocoa eatsle. The mortality rate of measles was far far lower. And on top of that, the symptoms really are just nothing like these symptoms that are being described.

not parvovirus B nineteen. It seems to me this is one that we haven't covered, so I'll just briefly mention it and even just doing this little dive on it for this episode. Maybe you want to do parvovirus I do.

where there is this potential. Looks like there's a connection because a lot of the symptoms that you described not necessarily with regards to hemorrhage. But in that fifteen seventy six description of everything being pale and the blood being pale and et cetera, to me, that means we're not having enough red blood cells for one reason or another.

A plastic anemia means that your body stops making red blood cell else and that's because in the case of parvovirus B nineteen, it's replicating and destroying your red blood cell precursors. Replicating in and destroying your red blood cell precursors interesting, and so it can cause this transient usually anemia where you basically can't make any more red blood cells, which can be really dangerous. But again, it doesn't happen

in everyone. It's not killing people outright, it's not causing this massive amount of hemorrhage, et cetera, et cetera.

was the most deadly. And with pneumonic plague, generally the symptoms very much were pneumonia, like you had symptoms predominantly in the lungs, and people tended to die from respiratory failure and not from hemorrhage like it sounds like happened here. Yeah, I will say that mneumonic plague is something that killed people very rapidly when it happened, often in as little as twenty four hours. And the untreated fatality rate for

pneumonic plague is nearly one hundred percent. Yeah, So is it possible that there was plague going on that was causing bubonic, mneumonic, even septoscemic plague. I mean, it certainly seems possible that that was circulating me.

It would rear up every now and then. You know, there were epidemics of plague that happened on a regular basis, And so I think given its sort of like formative impact on medicine, Yeah, I would think that it would have been described or recognized as plague, like it was well known, it was familiar, and the other thing too.

And maybe this is a little unfair, but like most papers seem to also kind of discard it or like you mention it as this was one of the ones considered or has been suggested, right, So like maybe we should be giving it a more fair shake, but I think that we have.

Bartanella hensley, which causes cat scratch disease. And the symptoms don't quite fit, especially this hemorrhage. I really just keep coming back to the hemorrhage part of it.

So could it be that there was a different species of Bartnella perhaps or the same species but causing infection in a slightly different way during that time.

But it also is just a more protracted illness. This was something taking place over the course of one to four weeks, and people were dying at the end of this very protracted illness, which is not what was described okay, and cocoletes.

would have been able to find it and that. But you know, that doesn't mean at all that it's not Bartonella just because they didn't find it. Like again, these are very few samples in one specific region. That doesn't mean that that is what happened all over Mexico. But anyway, just thought that's interesting. But yeah, I think based on the duration, like I don't know, it.

is one of the first symptoms. There's generally a lot of GI symptoms like nausea and vomiting and diarrhea. Rashes tend to occur only pretty late in the course of disease, so they're definitely not like an everyone feature, and they're not like a predominant feature, I guess. But what does tend to be, especially in severe disease, is signs of organ dysfunction like jauntice because of damage to the liver, like kidney dysfunction, which tends to be what ends up

killing people, okay, like hemolytic anemia. Okay, right, So a lot of things are kind of ticking boxes. We do also see in leptosperosis when it's severe disease, signs of bleach, signs of hemorrhage, and this is usually because of a decrease in platelets. But in general, it's mild bleeding. It's petikia like little pinpoint purple spots. You can, however, see more severe bleeding like massive gastrointestinal or pulmonary hemorrhage, and pulmonary hemorrhage tends to be what kills people in the

case of leptosporosis. But this is not something that happens for everyone who gets leptosporosis.

to end. There's really not a lot of description of hemorrhage at all when it comes to epidemic typhus. There's

not the hemolytic anemia, there's not the jaundice. There does often tend to be a rash, and rash is something that is often described as associated with epidemic typhus, and we talked in that Typhus episode about the difficulties with those historic descriptions of rash because rash appears very differently on different colored skin, and so it's thought that maybe rash was actually less common or maybe more common, et cetera.

But in any case, rash is definitely something that is described as associated with typhus, and the disease here tends to last for two to three weeks, So again we're talking about something that tends to have a much longer course of illness. Yeah, so I think less likely to be epidemic typhus. Okay, so we're almost done with this long list, and we've come to the few that I think are either the best contenders or that we, like you said, maybe have a little bit of evidence to

suggest maybe. Okay, so let's go through these last couple and then we'll regroup, shall we. H. So one of the last is hauntavirus hantavirus. There are many different hauntaviruses. Hantaviruses are RNA viruses, so, like you mentioned, we would never know, at least not as of this point. Yeah, and they're generally spread by aerosolized rodent excrement, so like rodent p has to get in your face in order

to get a hanted virus symptom. Wise, because there are many different types of hantaviruses that have been found in different parts of the globe, some of the symptoms do seem to fit fairly well. And certainly snombree virus has a mortality rate of like forty to fifty percent or even higher than that in some outbreaks that we've seen. The symptoms tend to be fevers, headaches, dizziness, body ache, so it can present kind of like more like the

flu than what it sounds like. The descriptions of this particular outbreak of coco eatsy work, but it can also have nausea, vomiting, abdominal pain, diarrhea, And when hantaviruses cause severe disease, there's a couple different forms or a couple

different manifestations that they can take. One, which is what tends to be caused by synombree virus, is a cardiopole lemonary disease which causes death within twenty four to twenty eight hours, like within a day usually, and the symptoms are caused by vascular permeability, by your blood vessels just leaking everywhere and fluid and blood just leaking out of

these leaky blood vessels. So while we don't necessarily tend to see like pure hemorrhage, we certainly see leaky blood vessels in hantavirus infections in syndome brain infection, specifically in other hantaviruses like Hatan virus and Pumla virus, we do see more hemorrhage potentially, and we tend to see a cardio renal syndrome more than a cardiopulmonary syndrome because I

know cocoliti, we didn't really see pulmonary. We didn't really see lung involvement described, but we did see potentially kidney involvement described, and so we do see that in a cardiorenal form of a hantavirus. But what we tend to see is just that your kidneys stop working and you stop making pee and then you die because of kidney failure. So I don't know, it doesn't it doesn't.

a fever. But there's a few things about typhoid that really stick out to me as not fitting with your description of Coco Latsle. Some of them include the fact that this fever you mentioned in those descriptions that the fever was constant, but the fever of typhoid is usually described as not which just constant, but getting progressively worse, Okay, day after day and rising over the course of a

couple of weeks. Right, So already we don't quite fit. Also, classic typhoid, and we talked about this in our typhoid episode has a relative bredacardia, which means that your heart rate does not increase with that fever, and the description from the fifteen seventy six outbreak very nicely specifically said that you see really high heart rates, and in typhoid

it's less likely for that to happen. Additionally, rash is a really common description of typhoid infection, and this rash, it tends to be salmon colored little spots starting on the trunk and then kind of spreading outwards from there.

And then it's usually not until the third of this illness that you start to see GI symptoms like abdominal pain or diarrhea, and that is when we can see some bleeding from the intestinal tract, we can see bloody diarrhea, and potentially this infection spreading to the bloodstream where you can get hepatosplenomegaly, which is again where your liver and your spleen starts to swell, and that seems to have been described in that fifteen seventy six outbreak, where you

have your liver and your spleen becoming abnormally large and all of your organs just getting super messed up. But other than that, we don't really see a lot of bleeding. We don't really see a lot of neurologic manifestations, so we don't really tend to see the delirium, we don't really tend to see the seizures. That kind of thing is much less likely in typhoid, but certainly mortality rate ranged from ten to thirty percent, so the most part

if untreated with typhoid. But it is spread fecal oral, so easily spread person to person. And there's of course the carrier state i e. Typhoid mary yep, meaning that it would be really easy for this to be something that could spread across a country because people could be

carrying it an asymptomatic for a really long time. But in general, I feel like it's interesting and we'll talk I know a little bit more about this that this happens to be the pathogen that has been found in people who likely died during this outbreak, because it seems to me like the least good fit in terms of symptoms.

different setting than historically. And this also applies to typhus, to hauntaviruses, etc. Another thing that I also wonder about is like virulence plasmids how and I don't remember this from our typhoid episode, Like whether there are different subspecies or seravars that contain different virulence plasmids and some are much more deadly or can cause different weets of symptoms

or whatever. But yeah, okay, let's talk to me about hemorrhagic fever viruses and then we'll sort of do like a compare and contrast.

a few different categories. So we have feloviruses, which include of course Marberg and ebolaviruses we've talked about both of those. We have flavaviruses, which we've talked about many of these. This includes the dengay viruses and yellow fever virus, as well as a few other born and mosquito born viruses.

The bunia viruses which include rift valley fever that we have not yet covered, Crimean congo hemorrhagic fever virus, and of course the hantaviruses, which includes Nombavirushton virus, et cetera, et cetera, as well as a virus called it a really great name, severe fever with thrombocytopenia syndrome virus that is a tickborn virus found in China.

a good handle on their reservoirs. We don't have a good handle on infection, like how things are spread. So just like in my pocket, I'm banking on an arena virus.

or like even able to be observed. I guess right, Yeah, I know, I wish I had that answer. Okay, but let me ask you a question real quick. Okay, what causes nose blade? What's happening in a nose bleed?

closer to where your nose opening is. Okay, yeah, and you have this like plexus of vessels that if that mucosa gets dried out or if there's any trauma to it, can just very easily start to bleed from that plexus of vessels. This can also happen if you have say thrombocytopenia, that is, you don't have any platelets to be able to clot any bleeding that happens there. So there's a lot of different things that can potentially cause that anterior bleeding.

There's also posterior nose bleeds that happen farther back in your nose, and those tend to be more commonly from that type of bleeding disorder or like disease in the blood vessels, say, from like atherosclerosis or something like that. Okay, And those posterior nose bleeds can be massive and like really difficult to stop.

major things that I would think about. Thrombaside opinia is when we don't have enough platelets, And we've talked in a number of our episodes now about how essential our platelets are to be able to stop bleeding when it starts. So because your nose just happens to be a place much like your gingiva, like in our vitamin C episode way back when we talked about how you get bleeding from the gums because you just don't have like any collagen left. And so it's not even about in that

case not being able to stop bleeding. It's just that that's a place that's really easy to bleed from. Okay, your nose is very similar. Same thing with your eyes, and you described maybe seeing bloodshot eyes. So the mucosa of your eyes is just another place where things are very thin and there's a lot of really small blood vessels.

So if you have a tendency towards bleeding because you say, don't have any platelets to stop bleeding, then little tiny blood vessels breaking can lead to large amounts of bleeding.

to clot properly, you could potentially see nosebleeds. Now that being said, there are a lot of diseases that are considered like hemorrhagic diseases of some kind we don't usually see described like actual and we've talked about this in a few episodes, Like it doesn't usually mean that you're just bleeding out of places like hemorrhagic doesn't often mean the way that you think of hemorrhage with where like blood is just gushing out of orifices.

were mentioned primarily in that account by that physician. So excessive thirst, continuous and high fever, headache, confusion, delirium, rapid pulse, nasal hemorrhage, bleeding from mouth, eyes, ears, genitals, tongue black and dry, swollen lymph nodes in neck, jaundice, chest pain, bloody stool, stomach pain, sometimes rash. Autopsy showed enlarged liver, black heart, dry stomach, black lungs urine green or black,

then pale, and no notable respiratory symptoms. The disease seemed to have a three to five day duration, incredibly high case fatality rate with the overall mortality rate of like fifty to eighty percent, again not necessarily attributable to one pathogen alone, and there was actually that. One Franciscan scholar, Sahagoon, wrote that quote many died of hunger and because no

one was able to care for them. In many cases, every member of a household fell ill without a single person left to give them even a cup of water to the sick end quote. So it has also been described as disproportionately attacking young adults and adolescents, and it also has been said to have disproportionately affected the indigenous population. Not all accounts describe this, and I do kind of want to get into this in a little more detail because I think it can help maybe resolve the question

of Old World versus New World pathogen. If this disproportionate impact on indigenous populations was a true phenomenon, where was that coming from? Was it socioeconomic factors? So one person described that people who were quote rich, well dressed, and with a comfortable living were not affected by the disease

end quote. So was it just socioeconomic factors? And so it was a New World disease that everyone was in theory immunologically susceptible to But it was just that the indigenous population, who had been suffering the greatest losses due to forced labor and minds, ridiculous taxation, et cetera. Spanish witnesses did recognize this disproportion impact and the living conditions and how it affected the rate of disease. Quote. The reason why so many Indians die of pestilence is a

god secret. I do not find any better answer than that in the past, the Indians were not as badly mistreated and oppressed as they are today. With heavy workloads. They are skinny and delicate. The disease finds them overworked and without resistance, so they are finished. End quote. Okay, so if we do New World, then for the most part, socioeconomic factors and living conditions would explain the difference in

susceptibility or attack rate or mortality rate. If it's an old world pathogen, it's probably a combination of those things.

Socioeconomic factors are still there, they're not going away. But it also might be something about if it's an old world pathogen quote unquote more familiar to the immune systems of the Spanish colonizers, and there is a little bit of evidence in this respect, because if socioeconomic status meant that you were not only protected from getting super sick if you did get infected, but that it also prevented you from getting infected, then we would still see high

death rates among those who were exposed to disease, if that makes sense. And so you have a bunch of these Spanish members of these religious orders who did a lot of the caring for the ill and a lot of the burying of the bodies, these priests and so on, and they are not described as having high death rates, nor are the Spanish physicians that performed so many autopsies

without the slightest bit of ppe. So one author also suggested that maybe the reason for the disparity in these mortality or attack rates is that the root of transmission

was somehow unique to the indigenous populations. We don't know what the root of transmission was, but given that the Spanish colonizers and indigenous populations lived pretty similar day to day lives at that point, or at least not terribly drastically different in terms of like completely separate lives, it doesn't necessarily seem like it was that I don't know, because if the disease was transmitted through direct contact lice, fleas,

blood or other bodily fluids, respiratory droplets, mosquitoes, or water, there's really no way that the Spanish would have just been completely spared if they had been as susceptible. So okay, that was my sort of new world, ole world thing. Root of transmission we don't know. We can compare the spread of cocolites to the other epidemics that were happening in the sixteenth century, and it seems very similar to those that were spread person to person, like smallpox, chicken pox,

and measles. We can go over some of the other possible roots of transmission too, like waterborne or lousborne, or like a rodent reservoir. We kind of already touched on that geography. Again, we only have a few accounts to rely on, but it seems like everywhere was impacted, with the possible exception of some of the coastal areas. There

are many different reasons why that could be. Maybe a less ferrulent variant of the disease made it there, people were more immune, or the vector or reservoir wasn't as prevalent or just something else interrupted transmission, could be a whole lot of things going on.

to get all screwed up. And so I think it's an interesting question about like the symptoms, Does whatever disease that actually cause this have to include every one of those symptoms? Which symptoms do we concentrate on first? Which accounts are reliable? Like what if this physician never actually performed an autopsy and he's just hearing word of mouth.

Then you have a physician who's looking at someone and saying, these are the things you're experiencing, versus someone who's like, this is what I'm experiencing, Like it's an interesting, I don't know, interesting questions, but but yeah, let's sort of get into a few of these things. So I feel like the New World versus Old World discussion plays a role in the hemorrhagic fever virus potential.

few reasons. One because then I would expect I don't know, something similar to have been reported somewhere else first, right, But I think that that argument stands for like any pathogen that was brought over, right, if it was something that was brought over, how could it be something brand

new that hadn't been seen by the Spanish conquistadors beforehand. Yeah, right, And that is the part that I think makes it so hard to think could it have been anything that was brought over, right, unless it was something that was brought I don't.

the mucus membranes. And was it truly trauma level hemorrhagic We don't know, but it's very likely that if you're having this degree of hemolytic anemia, that you're also having issues with your other blood cells, including your platelets, which means that you're going to be at risk of bleeding, even if it's just the like your nose is constantly dripping and not truly a faucet coming out of it, right yeah.

During the Cocolaitzlei epidemics. Typhus was a recognized disease, but most people did not use the name for typhus to describe what was happening. But there is a precedent for typhus being described with more superlative or extreme names, like those that emphasize the severity of infection, and there exists at least one description from the late fifteenth early sixteenth

centuries of typhus causing a severe nosebleed. The Italian physician Frakastorius wrote, quote, I have often seen cases where three pounds of blood burst from the nostrils, yet the patient died soon after end quote. And so I got a little bit curious about typhus and nose bleeds, and so I just put the words nose bleed and typhus into Google scholar and what I actually got were primarily results for typhoid. And that's something I remember from doing those episodes.

Typhus and typhoid weren't really distinguished as separate diseases until like the early to mid eighteen hundreds or so, because they do have similar courses of disease and would also tend to proliferate during similar times of like chaos or unrest or war, even though they're transmitted differently. Epidemic typhus via lice, typhoid, fecal oral Also, I kept coming across the phrase abdominal typhus that actually means typhoid, which was very confusing for me. I was like, but what is it? So?

But I don't entirely know whether or not tabardillo, the Spanish word for typhus, was also historically used for typhoid, or whether it was distinguished from typhoid, I don't know. But in any case, so going back to my Google scholaring, what I found were a bunch of historical reports of

nosebleed in people with this abdominal typhus aka typhoid. A report of a typhoid outbreak associated with oysters that was published in nineteen thirty nine describes nosebleed as a cardinal symptom of typhoid and says that in that particular outbreak, it was the most common symptom observed and in young kids. Delirium also seems to be a common symptom that we found in a different paper, but in this oyster paper,

hemorrhage happened to be the most common complication. Another paper from nineteen thirty four describes a case study of typhoid fever with hemorrhagic onset. Quote. In August nineteenth, nineteen thirty three, at about three am, the patient suffered a sudden, profuse nosebleed. A physician was consulted, who packed her nose. The bleeding, however, continued, and the patient was admitted to the hospital end quote. And typhoid, as we talked about, can be transmitted by

asymptomatic carriers. I know that they're different diseases, but paratife C DNA has been found in an eight hundred year old skeleton of a woman in Trondheim, Norway, so that

suggests an old world origin of at least paradifec. So I think that, you know, like I said, there's a lot that historically may have been reported and may have been attributed falsely to some of these diseases like typhoid, and searching for typhus and nose bleeds or typhoid and nose bleeds is certainly cherry picking Google scholar, But I just find that interesting because I was curious whether there

had ever been something like that reported before. And then also I came across when I was looking for nose bleeds, I came across the fact that black tongue is often another characteristic of typhus slash typhoid people. I've seen it in both.

something that circulates and can be present in people. But knowing that it's not likely to end up in someone's dental pulp upon death unless it was in their bloodstream is very interesting.

symptoms and the time course don't seem to fit. Not to mention, and I think this is where I really wish that we had a little bit more data, like granular data on how rapidly this was spreading through homes and through families, right, because when you get down as well to the incubation period of something like a typhoid, we're looking at a much longer incubation period than we are for many of the viral hemorrhagic fevers, and again

viral hemorohagic fevers. This is really really broad. But thinking of more of the bunya viruses or the viruses which seem more likely candidates than the flavaviruses and the filoviruses in this case, right, I think that the time course fits a little bit better. Not to mention the mortality rate.

I mean, again, we would likely be looking at something that is causing a disproportionately high mortality rate because of the population that it's affecting, or because it was a particularly virulent strain or sero of VR or sub subsero VAR. But it still just seems to me to fit better in terms of the time course, in terms of how rapid the disease was, in terms of how it seems to have spread. But we don't know. We don't have that granular of data.

How accurate is everything? How much evolutionary gap there is between what pathogens exis then and what they look like today. How much is our care of these pathogens today influenced by the hospital systems by being able to give someone iv, antibiotics whatever. For these conditions that we're treating. We're going to do the best we can at putting ourselves in that time period, but we are super limited by both that time period as well as our own biases.

in interpreting that data. What it makes me feel like is it's amazing that we've been able to identify the causative agent of any outbreaks.

supplemental information. It was the best supplemental information I've ever read. Do not sleep on it. I absolutely really appreciated the amount of work that people put into that. And then finally, if you want to get a little bit more background on the history of the Aztec Empire and Mesoamerica, there's a great book called Fifth Son by Kamila Townsend that I really enjoyed.

they did not read it. And I also have a couple of really great papers on the pathogenesis and the like molecular pathogenesis of all of the different viral hamorrhagic fevers, so if you want to read more about all of those, and then a bonus one on parvovirus just as a teaser for a future episode. But you can find the list of our sources from this episode and all of our episodes on our website This podcast will Kill You dot com under the episode stap.