Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This an excellent submission as far as it goes. The argument is that there is something to be learned from identifying the (or one of the major) biological challenges, name the varieties of malaria, facing the crusaders in the Eastern Mediterranean in the High Middle Ages. This identification, according to the author, implicitly has social implications (lines 74-88), so that what comes from understanding the precise impact of malaria will modify Cunningham’s and Arrizabalaga’s view that “attempting a diagnosis of a pre-modern disease using modern scientific definitions is pointless.” I’m not sure the author actually shows it isn’t pointless, but I do feel he’s on to something. And he’s not heavy handed. He recognizes the virtue in being careful in the tradition of Cunningham and Arrizabalaga, whose approach of not drawing overly strong conclusions from modern diagnoses “has great value”.

 The major weakness of the submission is the incompatibility of its claim in the title that the period covered is the years 1000-1400. In fact, the author does not consider the crusades from the 1240s to 1400, which would provide much relevant material. I would urge the author either to rise to the challenge and incorporate these crusades or, less happily, simply to change the title’s dates to 1000-1240.

A few minor points follow:

            I do not understand the phrase “as that of the sun decreased” in line 56.

            I do not know what’s missing in the phrase “in an of known disease risk” in lines 272-73.

            I think “with killed” (line 478) should be “which killed.”

            In line 550, the word “of” is missing between “arrival” and “Philip II.”

Comments for author File: Comments.pdf

Author Response

I greatly appreciate you taking the time to read my manuscript, and for the thoughtful comments and suggestions. In response to your comments/suggestions:

Comment 1: The major weakness of the submission is the incompatibility of its claim in the title that the period covered is the years 1000-1400. In fact, the author does not consider the crusades from the 1240s to 1400, which would provide much relevant material. I would urge the author either to rise to the challenge and incorporate these crusades or, less happily, simply to change the title’s dates to 1000-1240.

Response:  Your point is well taken; I do have plenty of material to extend the study temporally to 1400, and geographically to include Cyprus, the Nile Valley of Egypt and much of N. Africa.  I made an editorial decision to limit the current article due to concerns about overall length, etc.  I appreciate your admonishment to "step up to the challenge" of extending the study, and I plan to do just that in a series of later articles.  Instead I have changed the title to "The Rage of the Dog Star: Spatio-temporal risk of malaria in the Eastern Mediterranean during the Crusader Era (c. 1000 – c. 1240)."

Comment 2:  I do not understand the phrase “as that of the sun decreased” in line 56.

Response: It should read "as the heat of the sun decreased".  Error fixed.

Comment 3:  I do not know what’s missing in the phrase “in an of known disease risk” in lines 272-73.

Response: Should read "in a region of known disease risk." Error fixed.

Comment 4: I think “with killed” (line 478) should be “which killed.”

Response: You are correct. Error fixed.

Comment 4:  In line 550, the word “of” is missing between “arrival” and “Philip II.”

Response: Error fixed.

Again, you have my sincere thanks for your comments.  You and the other reviewers have all provided relevant, thoughtful and collegial remarks, and as I'm sure you are aware that's not always the case in peer-review. 

 

Reviewer 2 Report

Comments and Suggestions for Authors

Please see the attached review. This reviewer very much likes the paper and suggests it is accepted after minor revisions.

Comments for author File: Comments.pdf

Author Response

I appreciate your willingness to read this draft, and I have found your extensive remarks to be thoughtful and quite helpful.  The additional references to recent works is especially appreciated, and your overall comments have made this a better article. Here are my responses to your comments:

Comment 1: The abstract states that multiple forms of malaria were endemic in the
Mediterranean Basin from classical antiquity. We now have plasmodium genomes
that long pre-date classical antiquity, so this should be changed to “existed in the
Mediterranean Basin long before classical antiquity until eradication”. Cite this
paper....

Response: Fair point; change made to draft.

Comment: Line 28: please tell readers that Albert was a contemporary.

Response: Done.

Comment: Please provide the Latin for quartan fever used by William of Malmesbury (line 61).

Response: febrim quafrtanam iniit. Added in parentheses in text.

Comment: This reviewer absolutely does not agree with the important statement made in the
introduction that “malaria is well attested throughout the Mediterranean from the
fifth century BC” (lines 92-93). That is simply not true and that statement really must
change, considering how unfounded it is. The evidence is very spotty there is no
doubt. That the author repeatedly jumps from high medieval evidence for malaria to
19th century evidence for malaria (sections 4, 5 and 6) in the Levant itself makes it
clear that this statement is wrong.

Response:  This comment and what follows (I won't paste it all here) is clearly your central concern with the draft.  I will admit that "attested throughout the Mediterranean" is an overgeneralization and I will gladly provide qualification to that statement both temporally and geographically.

Comment:  This reviewer would still caution against using
high medieval and 19th century evidence to argue malaria was present across
all the intervening centuries in the same places. There is no evidence for that.

Response: Nowhere do I argue that, though your point is well taken.  I use 19th/20th century data as it is when we get actual quantitative data, and it does suggest how specific regions were capable of harboring endemic malaria under the right circumstances. It also supports the validity of the risk model itself. I'm using the evidence that we possess. And I do note in several places where modern disease patterns mirror the medieval, such as with Armenian Cilicia. Again, I am happy to qualify my statements to make them more careful, but I'm leaving the modern data in.

Comment: As such, on line 280, this review strongly recommends more caution:
“Unsurprisingly, assuming long continuity in the presence of the disease,
Robert Guiscard’s…” or at least “Perhaps unsurprisingly then, Robert
Guiscard’s…”. 

Response: "Unsurprisingly" does not refer to any long term continuity of the disease, but to the presence of extensive marshlands in the immediate environs of the siege.  I will clarify.

Comment: The author states ‘thousands of distinct species exist’ of plasmodia, but there are
more than 250, but not thousands.

Response: Noted.  Error fixed.

Comment: What is the ‘east’ referred to on line 154, the Levant? Please be clearer.

Response: Noted.  "East" changed to "Mediterranean"

Comment: In the otherwise great section on immunological naivety, the author will have to deal
with the two falciparum genomes recovered from medieval people north of the Alps
in the first paper cited in this review. It seems falciparum did exist north of the Alps
in the medieval period. The author might simply state on the basis of current
evidence that it seems falciparum presence was limited north of the Alps.

Response: I never said that falciparum didn't exist north of the Alps; "few northern Europeans would have encountered....", but I am changing that statement to being more clear and adding a citation to Michel et. al.

Comment: When citing Sallares 2002 on lines 157-158, the author should also cite:

Response: Done. Very helpful references. 

Comment: Several recent works deal with historical malaria coinfections, emphasizing their
potential importance. They could be cited on lines 191-192 in addition to Sallares
2002 p. 62 which briefly addresses this issue

Response: This is extremely helpful.  I have added a brief discussion of the concept of "syndemic", a neologism I haven't encountered til now, several paragraphs earlier than you suggested, as that is where I first introduced the issue of comorbidities. 

Comment: In discussing the various bits of evidence for fever in section 4, the author might
stress that were one exposed multiple times the cycle of fevers would be less distinct
(not clearly tertian or quartan or quotidian). Sallares and Newfield, among the works
the author cites, stress this, but the reader would do well if reminded, as it helps
explain the lack of clear cyclicality.

Response: Valid point.  Sentence & citation added to that paragraph.

Comment: Does the author anywhere note that Arabic sources are not extensively used here
and that that is work that is required going forward? If not, I would remark on that in
the conclusion. Also worth noting would be whether short-term climate change
encouraged epidemics of malaria, a topic Wilson refers to in the paper referenced
above. Indeed, climate change could help explain why some years were particularly
bad for malaria and others not in the Crusader period.

Response: I do use one Arabic source (Ibn Shaddad), and there is a great deal of discussion in medieval Arabic literature relevant to malaria, but none was relevant to the situations in this particular article.  There is a lot of evidence in Arabic chroniclers regarding malaria in Egypt, and I'm working up a separate article on the Crusades and Egypt that will utilize those sources.  For Palestine there is relatively little, save Ibn Shaddad, though Usama Ibn Munqidh has a number of references to dropsy, possibly related to malaria. I've added another paragraph to the conclusion that addresses this, among other things.

Comments: Your concerns about the Browning model.

Response:  Yes, the model has limitations, which Browning (a friend & former colleague of mine), is fully aware of.  It is a large scale, low resolution model, and palaeoclimatological and palynological data likely wouldn't work well at that resolution.  However, where it would work well is smaller scale, localized risk models, like Pickel's modelling of the Pontine marsh region around Rome, etc.  That's another avenue of future work that I mention in the additional paragraph in the conclusion.

 

 

Reviewer 3 Report

Comments and Suggestions for Authors

The article intersects two significant yet distinct fields: the Crusades and the history of medicine. The author articulates their perspective clearly, demonstrating expertise in both the humanities and scientific disciplines.

At times, the author employs a broader chronological approach, connecting events separated by considerable periods to highlight local tendencies. Given the scarcity of sources from the Crusades era, this methodology is generally effective for examining pre-industrial societies. However, as the author states in the paper, it is equally important to remain attentive to the specificities of individual historical contexts, acknowledging the constraints imposed by the limited availability of sources.

The historical context could be further enriched by incorporating recent general studies alongside the classical works already well-cited in the paper. For instance, in Italy, the contributions of Antonio Musarra, Giuseppe Perta, and Michele Campopiano may provide valuable insights. However, the decision to include these references ultimately rests with the author.

In my opinion, the article is already suitable for publication.

Author Response

I appreciate you taking the time to read this manuscript, and your kind and thoughtful remarks. 

Comment: The historical context could be further enriched by incorporating recent general studies alongside the classical works already well-cited in the paper. For instance, in Italy, the contributions of Antonio Musarra, Giuseppe Perta, and Michele Campopiano may provide valuable insights. However, the decision to include these references ultimately rests with the author.

Response: Given the quick turnaround we are trying to achieve on this article I am unlikely to include these authors at this time, but I am ordering a number of Musarra's works for a different article I am working on at the moment. 

Again, my sincere thanks for reviewing this draft.

 

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Author,

this is a very interesting and relevant paper, which enriches the scholarship on the Crusades with medical data and explains dynamics that so far tended to be explained mostly from the political, social and cultural perspectives. 

There are some minor suggestios to improve your work:

1. It looks like there are some double spaces between words.

2. Please revise the final references according to the journal's citation guidelines.

3. The title: your paper deals with a space that excedes the Crusader Levant, by including Italy and the Balkans, so I would suggest reformulating the title to reflect that that you deal with territories through which the crusaders passed on their way to the Levant. Your's it is a dynamic approach and it is worth stating it in the title. Also, the time framework is not exactly 1000-1400, I would change it to "the Crusading period", 11th-15th cents." or, simply, the Middle Ages, or medieval crusades. 

4. I would like to know something more about your project and creating the GIS layers used for the study, both by you and your colleagues. Please, include a brief description in the Methodology.

5. Finally, if I may, I would like to suggest widening the scope of your study to more static issue: the medical causes of death of medieval queens. Besides pregnancies and complications around childbirth, some of them passed away due to diseases such as malaria. Such was the case, for example, of Constanza of Aragon, queen of Sicily, who died in Catania, a very clear foco of malaria according to your map. 

I am looking forward to reading the published version of your paper.

Best wishes,

 

Author Response

I greatly appreciate your taking the time to read my manuscript and provide comments and suggestions.  Here are my responses to your comments:

Comment 1: It looks like there are some double spaces between words.

Response:  I am editing those out.

Comment 2: Please revise the final references according to the journal's citation guidelines.

Response: I am editing that as well.

Comment 3: The title: your paper deals with a space that excedes the Crusader Levant, by including Italy and the Balkans, so I would suggest reformulating the title to reflect that that you deal with territories through which the crusaders passed on their way to the Levant. Your's it is a dynamic approach and it is worth stating it in the title. Also, the time framework is not exactly 1000-1400, I would change it to "the Crusading period", 11th-15th cents." or, simply, the Middle Ages, or medieval crusades. 

Response:  Another reviewer made a similar comment, and I have changed the title to "The Rage of the Dog Star: Spatio-temporal risk of malaria in the Eastern Mediterranean during the Crusader Era (c. 1000 – c. 1240)." to better reflect the geographic and temporal constraints of the current work.

Comment 4:  I would like to know something more about your project and creating the GIS layers used for the study, both by you and your colleagues. Please, include a brief description in the Methodology.

Response: I have added a bit more on the overall methodology.

Comment 5: Finally, if I may, I would like to suggest widening the scope of your study to more static issue: the medical causes of death of medieval queens. Besides pregnancies and complications around childbirth, some of them passed away due to diseases such as malaria. Such was the case, for example, of Constanza of Aragon, queen of Sicily, who died in Catania, a very clear foco of malaria according to your map.

Response: Yes, I agree that Constanza's death fits the overall pattern, and will include that.  In digging around a bit about her I noticed that many of the Aragonese soldiers she brought to Sicily in August 1209 perished in an epidemic immediately after their arrival at Palermo, also fitting the spatio-temporal pattern. Thanks for the suggestion!

I truly appreciate your thoughtful and highly relevant comments.