The trade route from China led through central Asia to the Tauric coast,[10] whence the products of the Orient were transported to Constantinople, at that time the emporium for the three divisions of the earth. Over this route the plague spread into all lands. The terrible disease first appeared in Europe in the maritime cities of Italy, France, and Spain, and in the course of three years gradually but surely spread all over central Europe, Poland, and Russia, climbed the chalk cliffs of England, and ascended to the extreme northern part of Scandinavia. It was attended by strange manifestations, unknown up to that time, such as cramps, heart palpitation, lethargy, and in some cases delirium. Swellings as large as eggs appeared under the arms and knees. Black or blue spots came on various parts of the body, sometimes large and single, sometimes in small groups. At first it was denied that the disease was a pestilence, but when the strange malady spread so rapidly it was recognized as an actual pestilence. There was no other name for it.