Plague! PARENT MANUAL. February Shelagh A. Gallagher With contributions from William J. Stepien PROBLEM STUDIES FOR ONE.

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1 PROBLEM STUDIES FOR ONE Engagement Plague! Inquiry and Investigation February 2014 Definition PARENT MANUAL Shelagh A. Gallagher With contributions from William J. Stepien Resolution Debriefing Royal Fireworks Press Unionville, New York

2 This curriculum unit is the result of a collaborative effort among classroom teachers, school administrators, and curriculum experts. With deep gratitude, I would like to thank Linda P. Robinson, Martha Wrenn, Elizabeth Jenkins, Carol Brugh, and Paula Webb for their contributions to this work. Project Evaluator: James J. Gallagher, University of North Carolina at Chapel Hill. Pilot test sites in Wilson, NC: Darden Vick Middle School Forest Hills Middle School Toisnot Middle School Funded in part by Jacob K. Javits Gifted and Talented Program, United States Department of Education Grant #R206A70003 Copyright 2014, Royal Fireworks Publishing Co., Inc. All Rights Reserved. Royal Fireworks Press PO Box First Avenue Unionville, NY (845) fax: (845) mail@rfwp.com website: rfwp.com ISBN: Printed and bound in Unionville, New York, on acid-free paper using vegetable-based inks at the Royal Fireworks facility. 7f4

3 Table of Contents Engagement Inquiry and Investigation Definition Resolution Debriefing Part I: Introduction to Plague!...2 Elements of a Problem Study...3 Assessment: The Problem Log and Performance Rubrics...6 Unit Summary...7 Summary of Unit Activities, Assessments, and Generalizations...8 Sample Schedule...9 Part II: Preparing for Plague!...10 The Flow of the Problem...11 Content Background for Parents...12 Problem Narrative: The Storyline for Plague!...16 Preparing to Teach the Unit...20 Setting the Stage...22 Problem Engagement Rubric...23 Part III: Lesson Plans for Plague!...24 Problem Engagement...25 Welcome to the Middle Ages...27 The Plague Is Coming!...38 Inquiry and Investigation...46 Researching Learning Issues...47 How Risky?...52 When Will the Pestilence Arrive?...55 What Could Happen?...63 A Visit from the Doctor and the Priest...68 Problem Definition...78 Direct and Indirect Effects...79 What s Our Problem?...84 Problem Resolution...91 What s Possible?...92 A Presentation to the Council of the People...95 Problem Debriefing...98 Making Connections...99 Appendix A: Resources...103

4 Part I: Introduction to Plague! Plague! Parent Manual 2

5 Elements of a Problem Study Why Is This Called a Problem Study and Not Problem-Based Learning? This unit is a close cousin to the Problem-Based Learning unit Black Death, which was designed for traditional classrooms or groups of homeschooled students. The primary difference between the two is that this unit was designed for an individual child to complete along with a parent or instructor. While this required relatively minor shifts in lesson structure, it constitutes a substantial shift from the fundamental philosophy of Problem-Based Learning (PBL). One of the premises that gave rise to PBL was that children need to learn how to collaborate in order to be prepared for life and work in the 21st century. As a result, a chief aim of PBL is for a group of students to become effective collaborators. Naturally, this aim is impossible to achieve when a child is working on his or her own! For a long time I was stuck between my fealty to PBL founder Howard Barrows, whose philosophy I respect, and my desire to offer problem-based curriculum to children in all instructional settings. However, it is clear that individually homeschooled children can benefit from many other aspects of PBL. Even if they won t learn skills in collaboration, they can engage in the story-like nature of the curriculum, acquire skill in self-directed learning, and immerse themselves in the content at both factual and conceptual levels. The name change is my compromise. Out of respect to Howard Barrows and his vision of PBL, I have altered the name of these single-student units to problem studies. This unit is a direct parallel to the Problem-Based Learning unit Black Death in all other respects. The Ill-Structured Problem In this problem study unit, learning begins with an ill-structured problem that has been carefully constructed to guide a child to a specific topic. The ill-structured problem engages the child s natural curiosity by drawing on the power of storytelling. Intrigued by the problem, the child asks questions that lead into the study of the core content area. Because the ill-structured problem is designed to encourage the child to ask questions about important curricular content, parents can focus on helping the child acquire skills of gathering and analyzing information. When used in a history curriculum, the ill-structured problem presents a pivotal historic event, allowing the child to experience the story that makes history fascinating. The Stakeholder Role During the problem study unit, the child is asked to consider the problem from the perspective of a central stakeholder. When properly handled, the stakeholder role helps the child experience the habits of mind used by people in different professions or living in different circumstances. In Plague!, the child is required to think like a government official, using values and priorities that represent concern for the public good. Parents or other instructors play an instrumental role in making the problem come alive by encouraging the child to stay in the designated role and requiring him or her to treat the role more seriously than surface play acting. Evidence suggests that this immersion into learning experiences can enhance academic performance (Langer, 1990). Langer, E. J. (1990). Minfulness. Reading, PA: DaCapo Books. 3 Plague! Parent Manual

6 Coaching Instead of Teaching Although this problem study unit is designed to help children become more self-directed learners, it is not intended to be an independent study. Rather, the unit alternates between independent work, such as research and Problem Log assignments, and guided activities, such as critical thinking assignments in which the parent or instructor helps the child gain new insight. Becoming an effective inquiry-based instructor takes time, support, and practice. This unit has been designed to provide enough structure for parents to feel comfortable experimenting with inquiry-based instruction and to provide those with more experience with tools to use according to their pedagogic needs. Parents are given a Content Background for Plague!, which provides a historical context of the unit, including a description of the disease, how the plague began in Europe, and conditions in Italy before and after the plague. A Problem Narrative is included to help parents understand the storyline of the problem from the first day to the final discussion. Lesson plans are included that will ensure that the child thinks analytically and reflectively. A specific emphasis is placed on conceptual reasoning. Parents new to inquiry-based instruction can use these resources as a way to create a scope and sequence of events and can take comfort knowing that the child will have a rich learning experience while engaging with core content. Parents who feel secure with inquiry-based learning are encouraged to use the resources as flexible tools rather than as a prescribed course of instruction. Embedded Instruction in Plague! The ill-structured problem leads the child to content required in the core curriculum. This allows parents to use the child s questions as the basis of instruction, empowering the child s sense of inquiry. Because the core content emerges naturally through the problem, parents are free to bring greater depth and breadth to the child s study by helping him or her acquire the tools needed to become a self-directed learner. Self-directed learning encompasses an enormous variety of skills, attitudes, and behaviors, so it is important that parents are selective, making specific choices about which skills and tools to work on with the child in any given problem. The teachers who helped develop and pilot test the PBL unit Black Death helped guide the selection of skills and tools embedded in this unit. Because this was the first PBL experience for both teachers and students, they made the following requests: (1) enhance the engagement value of the story, (2) limit the quantity of arcane language, and (3) emphasize higher-order thinking. Enhance Engagement. The first goal was achieved by writing a unit that requires the child to solve the problem using only information available in The information is delivered by a series of visitors dressed in period clothing who provide much of the necessary information orally. Using live actors (parents and other adults) to deliver information achieves other goals, including sustaining engagement among academically disengaged children and promoting active listening skills. Parents are encouraged to take the same approach if possible, but written narratives are provided for parents who do not have ready access to adults to play the various roles in the unit. Limit Arcane Language. Studying history through primary resource documents is important; however, excessive use of documents with unfamiliar cadence and vocabulary can dampen motivation. The child will work with some print primary resources in Plague!, but he or she can get information from other sources as well. Oral accounts provided by the visitors provide one source of information; these are supported by written summaries of their statements. The child also receives some background about the culture of the Middle Ages through brief written vignettes that describe different aspects of town life. The only lesson that actually requires the child to read arcane language is at the end of the unit, when he or she must read and interpret the Ordinances of Sanitation in a Time of Mortality. Parents who wish to Plague! Parent Manual 4

7 increase the emphasis on reading primary source material can use the materials provided in the accompanying Resource Book and CD. Emphasize Higher-Order Thinking. Lessons in the unit emphasize teaching the child how to work with information. Key question sets are included as templates to encourage depth of thought; both the embedded instruction lessons and the Problem Log exercises require the child to use data to make reasonable inferences, discriminate between important and unimportant information, and ask specific, researchable questions. Using a circle map, the child draws inferences about the direct and indirect effects of the plague on the social and economic life of a community. A Venn diagram helps the child see where information from a doctor and priest converge. The child will analyze the Ordinances of Sanitation to determine if they apply to the situation in Lucca and then synthesize all of the gathered information in order to create a specific problem definition. Conceptual Reasoning. The central concept in Plague! is risk. The concept is first introduced as the child analyzes a picture of a medieval town and recognizes that crowded living conditions, unsanitary habits, and pervasive malnutrition make the population vulnerable to a number of risks. The child is introduced to a risk map that plots the significance of risk along two continuums: (1) the likelihood that a risky or threatening situation will occur, and (2) its potential level of impact. Toward the end of the unit, the child will discuss whether available solutions remove risk or reduce vulnerability. Throughout the unit, activities guide the child to understand five generalizations about risk: 1. Vulnerability increases the potential impact of risk. 2. Features of the environment affect the likelihood of risk. 3. Risks like disease can affect both physical and societal health. 4. People in different professions take different approaches to risk. 5. The magnitude of risk can be reduced by removing a threat or reducing vulnerability. Alignment of Plague! with National Curriculum Standards This unit was designed for 10- to 13-year-old children and was pilot tested in several sixth-grade classrooms in Wilson, North Carolina. Because the unit is driven primarily by student questions, it could easily be used with older children and, depending on developmental readiness, with younger children. The unit was developed to meet regional and national middle school social studies objectives. Charts on the Resource CD show the alignment of the unit with the National Standards for History, the National Council for Social Studies Standards, and selected objectives from the Common Core State Standards for Literacy in History/Social Studies, Science, and Technical Subjects. Language arts standards are covered as the child reads primary documents, compares differing perspectives on the problem, discusses pertinent issues, and writes a description of his or her proposed solutions. 5 Plague! Parent Manual

8 Assessment: The Problem Log and Performance Rubrics Problem Log A number of assessments are used to gather evidence of the child s understanding, analysis, and reflection about the problem. These are gathered in the Problem Log, a portfolio that shows the child s progress through the problem. Assignments in the Problem Log take a variety of forms, including: Summaries. Summaries are used to gather knowledge about what the child has learned or values most about the information he or she is learning. The simple question What do you know about the problem right now? or a directive to Summarize what we have learned in the problem today gives the child a chance to put diverse pieces of information together and provides a quick impression of whether or not he or she is attending to important information. Critical Thinking Activities in Context. The child calculates distance on maps, analyzes the rate at which disease spreads, creates a specific definition of the problem, and judges the usefulness of solutions as he or she investigates the problem. Graphic Organizers. Graphic organizers are included to help the child synthesize and draw deeper meaning from information. Each of the graphic organizers achieves a slightly different goal: a risk map aids conceptual thinking, a Venn diagram helps the child compare information from two different sources, and a circle map is used to demonstrate direct and indirect consequences of the pestilence. Reflective Moments. The child s growing awareness of the nature of the problem, his or her skill as a problem solver, and his or her ability to remain flexible as the problem changes are all assessed through Reflective Moments, quick writing prompts that encourage the child to contemplate the nature of learning as he or she continues to work on the problem. Performance Rubrics Rubrics are valuable tools, but they are most helpful when used conservatively. Ideally, rubrics introduce children to meaningful criteria for quality work. As a child works with rubrics, he or she will begin to internalize the criteria, which should ultimately make the rubric obsolete. Overuse of rubrics makes children dependent rather than independent. Self-directed learning is integral to a problem study. Assessment of written work is not adequate to capture the development of this essential life skill, yet it is sometimes hard to communicate to children the expectations for behaviors associated with self-directed learning. The Problem Engagement Rubric (p. 23) is a tool designed to: (1) communicate expectations to the child, (2) help the child set his or her own goals, and (3) assess the child s progress toward different dimensions of self-directed learning. The Research Rubric (p. 50) helps define the expectations for making the most of time spent pursuing learning issues. The Presentation Rubric (p. 96) guides the child toward a successful presentation of the solution to the problem. Plague! Parent Manual 6

9 Unit Summary The Summary of Unit Activities, Assessments, and Generalizations on the following page provides a synthesis of the activities, assessments, and conceptual generalizations in each lesson of the unit. The Activities column shows whether the lesson in question requires the child to build his or her knowledge base by actively working with information, analyzing information using in-context activities or graphic organizers, extending understanding by drawing conclusions about the situation, or making inferences about what might work to solve the problem. The Assessments column indicates the level and type of thinking required of different assessment assignments. The Generalizations column indicates which generalization(s) are the focus of each lesson. Frequently, key questions for the lessons will lead directly to discussion of the generalization(s). 7 Plague! Parent Manual

10 Summary of Unit Activities, Assessments, and Generalizations Activities Assessments Generalizations Building Knowledge Active Analysis Extending Understanding Research/ Summaries Thinking in Context Analysis Reflective Moment Performance Rubrics Problem Engagement Welcome to the Middle Ages The Plague Is Coming! Researching Learning Issues Inquiry and Investigation How Risky? When Will the Pestilence Arrive? What Could Happen? A Visit from the Doctor and the Priest Problem Definition Direct and Indirect Effects What s Our Problem? Problem Resolution What s Possible? A Presentation to the Council of the People Problem Debriefing Making Connections Generalizations: 1. Vulnerability increases the potential impact of risk. 2. Features of the environment affect the likelihood of risk. 3. Risks like disease can affect both physical and societal health. 4. People in different professions take different approaches to risk. 5. The magnitude of risk can be reduced by removing a threat or reducing vulnerability. Plague! Parent Manual 8

11 Sample Schedule The sample schedule presented below outlines a three-week plan for Plague!. Parents teaching this unit for the first time can use this schedule as a guide. Parents who feel comfortable with the flow of inquiry-based instruction should feel free to make modifications according to the child s needs. It would be easy to integrate fieldtrips, projects, and additional materials or to accommodate further self-direction and research time. This unit benefits from many primary resources available on the Internet, including both first-hand accounts and artwork from the era. Many of these are compiled on the unit CD. Interviews with experts such as historians or physicians could present different perspectives on the problem. Motivated children could follow the unit with independent study projects investigating the various branches of the problem, including the aftermath of the plague in medieval Europe, the second outbreak of plague in England in 1665, or the contemporary incidence and treatment of plague. Sample Three-Week Schedule Monday Tuesday Wednesday Thursday Friday Problem Engagement Welcome to the Middle Ages Problem Engagement The Plague Is Coming! Inquiry and Investigation Researching Learning Issues, How Risky? Inquiry and Investigation When Will the Pestilence Arrive? Inquiry and Investigation What Could Happen? Inquiry and Investigation A Visit from the Doctor and the Priest Problem Definition Direct and Indirect Effects Problem Definition What s Our Problem? Problem Resolution What s Possible? Problem Resolution A Presentation to the Council of the People Problem Debriefing Making Connections 9 Plague! Parent Manual

12 Part II: Preparing for Plague! Plague! Parent Manual 10

13 The Flow of the Problem Engagement Problem study progresses in phases: Problem Engagement, Inquiry and Investigation (with Problem Definition embedded), Problem Resolution, and Problem Debriefing. Inquiry and Investigation Definition Problem Engagement. The child meets the problem with the presentation of the opening scenario. By the end of the child s exploration of the opening scenario, he or she will have completed the Learning Issues Board and will be prepared to engage in research. Inquiry and Investigation. The child gathers answers to questions on the Learning Issues Board using a variety of methods and resources. After completing this research, the child analyzes the data and makes connections between the research and the problem. Most of the lessons in Inquiry and Investigation have no specific order; use the materials flexibly based on the child s readiness. Problem Definition. Eventually, the child will have acquired a clearer understanding about the real nature of the problem. At this point, he or she is ready to prepare a careful definition of the problem, including both the issues to resolve and the constraints that limit his or her options. Resolution Problem Resolution. The child develops options to solve the problem, or at least improve the situation. Often at this phase, the child may find that there are several possible good ideas, but they aren t all useful. This helps the child make an important transition from seeing solutions as right or wrong to evaluating which are better or worse in the current circumstances. Debriefing Problem Debriefing. Once the problem is resolved, the child reviews his or her pathway through the problem, including the content learned and the way he or she came to think about various issues with the actual historical situation. As the child reflects on what happened, help to reinforce his or her content knowledge, and identify what practices helped or hindered progress toward a solution. 11 Plague! Parent Manual

14 Content Background for Parents The Black Death was the worst pandemic in human history, killing at least one-third of the population in a 30-year span. No other disease has killed so many people so quickly. The outbreak of plague in the 1300s is considered by many to be a pivotal point in history, both because of the immediate devastation to the population and because it caused fundamental changes in social and economic structures. Yersinia Pestis Historians once thought that there was only one form of plague: bubonic plague. However, modern DNA research has revealed that plague has one source but many variations. The agent that caused the Black Death is the Yersinia pestis bacterium. While this bacterium is commonly known as the source of bubonic plague, it actually manifests in four different forms, each of which may have been active during the mass epidemic in This information actually resolves a long-standing controversy, as many historians have speculated that bubonic plague alone could not have caused the level of devastation experienced in Europe in the late 1300s. The most common form of plague was the bubonic plague. Victims of bubonic plague suffered from headaches, weakness, and feverish chills. Within days of becoming infected, painful swellings the size of eggs, called buboes (for which the bubonic plague is named), erupted in the lymph nodes of the groin and armpits. Typically, black or purplish spots, formed by subcutaneous bleeding, appeared on the skin. Most victims died within five days of showing symptoms. Though highly contagious, this form of the plague is not transmitted from human to human. The bubonic plague is transferred by the flea Xenopsylla cheopsi, which lives on black rats and other rodents. Fleas are vectors for the disease carriers immune to infection. Fleas feed on blood, particularly the blood of rats. An infected flea will transmit the disease to a rat, and the tainted rat blood will then infect other fleas. Humans catch this form of plague when they are bitten by infected fleas. Because rats and humans lived in close quarters during medieval times, transmission was relatively easy. Pneumonic plague infects the lungs, with death resulting from vomiting blood, coughing, and choking. Unlike bubonic plague, pneumonic plague is transferable from human to human by inhaling infected water droplets of an infected person (i.e., through a sneeze or cough) or through contact with infected blood. Pneumonic plague kills up to 95% of its victims. Of the two remaining forms of plague, septicemic plague attacks the bloodstream; death comes within hours often before a person even begins to show symptoms. Enteric plague devastates digestive systems; like septicemic plague, it is so swiftly fatal that victims were dead before a medieval doctor could even begin treatment. Spread of the Black Death Most historians believe that the first major outbreak of the Black Death in human populations was in Mongolia around By 1346, it had spread into the lands along the Black Sea. The plague was introduced to Europe as a result of a conflict between Turkish Muslims (Tartars) and merchants from Genoa, Italy. Both groups had trading relationships in Kaffa (today called Feodosiya) on east shores of the Black Sea, and they vied for dominance. Seeking protection, the Genoans retreated to a walled compound, where they skirmished with the Tartars for many months. When the Black Death arrived, it killed Tartars in great numbers. Survivors reportedly catapulted the bodies of the dead over the walls of the compound Plague! Parent Manual 12

15 so as to infect the Genoans. Though it is not likely that the plague was spread in this way, the Genoans fearfully escaped in ships and headed home for Italy, unaware that they were carrying infected rats with them. Some of the Genoese ships arrived in the Sicilian port of Messina in October On the ships were infected sailors, and the disease quickly spread to the local human and rodent populations. Soon, the residents of Catania, a nearby town, also began to die, and within weeks the disease raged across Sicily. Other ships took infected rats to diverse ports along the coast, providing many routes for infection to travel throughout Europe. The plague may have been devastating under any circumstances; however, Italy was already weakened by decades of famine, civil strife, and economic depression. The country had not yet recovered from the Great Famine caused by torrential rains in the early decades of the century. In addition, the region was entering into the Little Ice Age, which brought unprecedented rain and cold to Italy. Adding to the problem, medieval towns were crowded and unsanitary. Livestock lived in houses crammed with many people, refuse was simply thrown into the streets, and chamber pots were unceremoniously dumped from open windows (which is the reputed source of the familiar call, Look out below! ). Vulnerable to disease, millions of Italians quickly succumbed to the pestilence as it swept up the peninsula. Parallel devastation was experienced in France, Germany, Spain, Austria, Switzerland, Hungary, and eventually England. Outbreaks of the disease occurred in cities, towns, and villages throughout most of the known world. The rich were less likely than the poor to fall victim, but all social classes suffered devastating losses. Everywhere, people died horrible deaths in their homes, on the streets, and in the fields. Animals died as well: dead dogs, cats, rats, and livestock lay rotting alongside human bodies. Towns ceased to exist. Crops spoiled in the fields. Searching for Reasons Religious Reasoning Many religious leaders claimed that God had sent the Black Death as a punishment for the sins of humanity, such as avarice, usury, adultery, blasphemy, and other forms of immoral living. Others blamed the devil. All were urged to pray and cleanse their spirits. The appeal to prayer found a receptive audience, as most people of that era put more faith in their religious beliefs than in medical science. Religious pilgrimages, the construction of new shrines, and public processions of piety became commonplace attempts to gain spiritual strength in the fight against the plague. Not all clerics tried to stave off the disease, however; many stressed an acceptance of God s will. Some people accused phantoms of spreading the Black Death, in particular an apparition called the Plague Maiden, who is often portrayed in plague art. Many panic-stricken Europeans claimed to have witnessed her ghostly form sailing into one home after another to spread her deadly contagion. Comets also were blamed. Sometimes people took spiritual matters into their own hands, launching their own crusades against the disease. The biggest such campaign was the Flagellant Movement. This movement urged atonement for personal sins and an end to the plague through public acts of penitence and self-abasement. The group acquired its name because its members often used flagella, or barbed whips, to beat their own backs in public demonstrations. The Flagellants, sometimes numbering in the thousands, marched on bare feet from one community to the next, striking themselves with whips, praying, singing, and seeking forgiveness, often in the middle of town squares. Pope Clement VI eventually ordered an end to their activities, and by 1350 the movement ceased to exist. 13 Plague! Parent Manual

16 The fear generated by the Black Death provided opportunity to persecute already-marginalized groups. Witches, gypsies, Muslims, lepers, and other minorities often were accused of starting the plague and were murdered by crazed mobs. The worst abuses, however, were exacted on the Jewish population. Despite condemnation from the papacy, mobs across Europe tortured tens of thousands of Jews, often savagely, in revenge for allegedly spreading the disease with secret poisonous potions. Medical Reasoning Basing their opinions on the teachings of ancient Greeks, many physicians of the 14th century suggested that bad air caused by foul odors that had been released by earthquakes, decaying corpses, or stagnant water had caused the disease. Dampness in general was suspect, as were winds from the south. Astrology also was consulted; when asked by Pope Clement VI to explain the presence of the Black Death, a panel of doctors in Paris concluded that a conjunction of the planets Saturn, Mars, and Jupiter at 1 p.m. on March 20, 1345, caused the disease. Another school of thought based on Greek medicine suggested that the disease resulted from an imbalance of the humors phlegm, blood, black bile, and yellow bile. Balancing the humors involved reducing consumption of meat and increasing bread, nuts, and onion variants (garlic is, in fact, a natural antibiotic). Burning herbs and pleasant-smelling wood was recommended to counterbalance foul-smelling air. People carried herb bouquets as a similar defensive measure. Bowls of milk and pieces of bread were left out to soak up bad air. Southern windows remained closed so as to block infected air. Doctors also recommended avoiding hot baths, physical exertion, daytime slumber, and overindulgence in sweets. Physicians advised people to purge their minds of all ideas of death and to think only pleasant thoughts. They devised numerous preventive and healing potions (a recipe for one is included in this unit); none were successful. Above all, doctors urged their patients to pray for good health. In addition to these preventive measures, medieval physicians relied on the most advanced medical knowledge available to cure those stricken by the Black Death. For the first time, the Church allowed doctors to perform autopsies in order to search for a cure. Many doctors bled their patients with leeches. Some punctured buboes to release evil vapors, or they applied dead toads or poultices directly to these swellings to absorb the toxins. To protect themselves from the plague, doctors wore unusual outfits comprised of a mask with a long nose, a hat, and a floor-length robe. The nose of the mask was filled with herbs to shield the doctor from foul air, and often the robe was coated in wax to create a protective barrier. Ironically, fleas would nest in the wax, increasing the likelihood that a doctor would be infected. Human Response The Black Death caused widespread panic and social chaos. Stores closed, and trade was limited. Crops and livestock were abandoned. The plague infected art as well. Paintings portray scenes of victims on their death beds or more macabre images of rattling skeletons bringing the pestilence. Poetry, stories, and diaries recount the experiences of plague victims. Daily life was lived in extremes; fear, rancor, suspicion, violence, bacchanalian revelry, and resignation appeared alongside nobler responses of altruism, self-sacrifice, and heroism. However, fear was by far the most common response. Being surrounded by constant death caused lasting psychological trauma among the living. Hard-pressed to maintain a semblance of law and order, those left in charge of towns and cities passed anti-plague ordinances, such as the Ordinances of Pistoia, to try to regulate public behavior and limit the spread of disease. These ordinances often imposed restrictions on travel both in and out of city limits. The sick were quarantined in plague hospitals, where they invariably died. In Milan, officials ordered laborers to seal up the homes of plague victims, locking both infected and uninfected people inside. Disposal of Plague! Parent Manual 14