The epidemic would appear to have been some form of the ordinary Eastern or bubonic plague. Together, however, with the usual characteristic marks of the common plague, there were certain peculiar and very marked symptoms, which, although not universal, are recorded very generally in European countries. In its common form the disease showed itself in swellings and carbuncles under the arm and in the groin. These were either few and large—being at times as large as a hen's egg—or smaller and distributed over the body of the sufferer. In this the disease does not appear to have been different from the ordinary bubonic plague, which ravaged Europe during many centuries, and which is perhaps best known in England as so destructive to human life in the great plague of London in 1665. In this ordinary form it still exists in Eastern countries, and its origin is commonly traced to the method of burying the dead in vogue there. The special symptoms characteristic of the plague of 1348-9 were four in number:— (1) Gangrenous inflammation of the throat and lungs; (2) Violent pains in the region of the chest; (3) The vomiting and spitting of blood; and (4) The pestilential odour coming from the bodies and breath of the sick. In almost every detailed account by contemporary writers these characteristics are noted. And, although not all who were stricken with the disease manifested it in this special form, it is clear that, not only were many, and indeed vast numbers, carried off by rapid corruption of the lungs and blood-spitting, without any signs of swellings or carbuncles, but also that the disease was at the time regarded as most deadly and fatal in this special form. "From the carbuncles and glandular swellings," says a contemporary writer, "many recovered; from the [p008] blood-spitting none."[16] Matteo Villani, one of the most exact writers about this plague at Florence, says that the sick "who began to vomit blood quickly died;"[17] whilst Gui de Chauliac, the Pope's physician at Avignon, who watched the course of the disease there and left the most valuable medical account of his observations, says that the epidemic was of two kinds. The first was marked by "constant fever and blood-spitting, and from this the patient died in three days;" the second was the well-known and less fatal bubonic plague. The characteristic symptoms of this epidemic, noted in numerous contemporary accounts, appear to be identical with those of the disease known as malignant pustule of the lung; and it would appear probable that this outbreak of the plague must be distinguished from every other of which there is any record. "I express my profound conviction," writes an eminent French physician, "that the Black Death stands apart from all those which preceded or followed it. It ought to be classed among the great and new popular maladies."[18]