Black Death

The Black Death (also known as the Pestilence, the Great Mortality or simply, the Plague[a]) was
a bubonic plague pandemic occurring in Afro-Eurasia from 1346 to 1353. It is the most fatal
pandemic recorded in human history, causing the death of 75–200 million people in Eurasia and
North Africa,[1] peaking in Europe from 1347 to 1351.[2][3] Bubonic plague is caused by the
bacterium Yersinia pestis spread by fleas, but it can also take a secondary form where it is
spread person-to-person contact via aerosols causing septicaemic or pneumonic plagues.[4][5]
 Black Death

The spread of the Black Death in Europe, North Africa, and the Near East (1346–1353)

Disease Bubonic plague

Location Eurasia and North Africa[1]

Date 1346–1353

Deaths 75,000,000–200,000,000 (estimated)

The Black Death was the beginning of the second plague pandemic.[6] The plague created
religious, social and economic upheavals, with profound effects on the course of European
history.

The origin of the Black Death is disputed. The pandemic originated either in Central Asia or East
Asia but its first definitive appearance was in Crimea in 1347.[1][7] From Crimea, it was most
likely carried by fleas living on the black rats that travelled on Genoese ships, spreading through
the Mediterranean Basin and reaching North Africa, Western Asia, and the rest of Europe via
Constantinople, Sicily, and the Italian Peninsula. There is evidence that once it came ashore, the
Black Death mainly spread person-to-person as pneumonic plague, thus explaining the quick
inland spread of the epidemic, which was faster than would be expected if the primary vector
was rat fleas causing bubonic plague.[8] In 2022, it was discovered that there was a sudden
surge of deaths in what is today Kyrgyzstan from the Black Death in the late 1330s; when
combined with genetic evidence, this implies that the initial spread may not have been due to
Mongol conquests in the 14th century, as previously speculated.[9][10]

The Black Death was the second great natural disaster to strike Europe during the Late Middle
Ages (the first one being the Great Famine of 1315–1317) and is estimated to have killed 30
percent to 60 percent of the European population, as well as about one-third of the population of
the Middle East.[11][12][13] The plague might have reduced the world population from
c. 475 million to 350–375 million in the 14th century.[14] There were further outbreaks throughout
the Late Middle Ages and, with other contributing factors (the Crisis of the Late Middle Ages),
the European population did not regain its level in 1300 until 1500.[b][15] Outbreaks of the plague
recurred around the world until the early 19th century.

Names

European writers contemporary with the plague described the disease in Latin as pestis or
pestilentia, 'pestilence'; epidemia, 'epidemic'; mortalitas, 'mortality'.[16] In English prior to the 18th
century, the event was called the "pestilence" or "great pestilence", "the plague" or the "great
death".[16][17][18] Subsequent to the pandemic "the furste moreyn" (first murrain) or "first
pestilence" was applied, to distinguish the mid-14th century phenomenon from other infectious
diseases and epidemics of plague.[16]

The 1347 pandemic plague was not referred to specifically as "black" in the time of occurrence
in any European language, though the expression "black death" had occasionally been applied to
fatal disease beforehand.[16] "Black death" was not used to describe the plague pandemic in
English until the 1750s; the term is first attested in 1755, where it translated Danish: den sorte
død, lit. 'the black death'.[16][19] This expression as a proper name for the pandemic had been
popularized by Swedish and Danish chroniclers in the 15th and early 16th centuries, and in the
16th and 17th centuries was transferred to other languages as a calque: Icelandic: svarti dauði,
German: der schwarze Tod, and French: la mort noire.[20][21] Previously, most European languages
had named the pandemic a variant or calque of the Latin: magna mortalitas, lit. 'Great Death'.[16]

The phrase 'black death' – describing Death as black – is very old. Homer used it in the Odyssey
to describe the monstrous Scylla, with her mouths "full of black Death" (Ancient Greek: πλεῖοι
μέλανος Θανάτοιο, romanized: pleîoi mélanos Thanátoio).[22][20] Seneca the Younger may have
been the first to describe an epidemic as 'black death', (Latin: mors atra) but only in reference to
the acute lethality and dark prognosis of disease.[23][20][16] The 12th–13th century French
physician Gilles de Corbeil had already used atra mors to refer to a "pestilential fever" (febris
pestilentialis) in his work On the Signs and Symptoms of Diseases (De signis et symptomatibus
aegritudium).[20][24] The phrase mors nigra, 'black death', was used in 1350 by Simon de Covino
(or Couvin), a Belgian astronomer, in his poem "On the Judgement of the Sun at a Feast of
Saturn" (De judicio Solis in convivio Saturni), which attributes the plague to an astrological
conjunction of Jupiter and Saturn.[25] His use of the phrase is not connected unambiguously with
the plague pandemic of 1347 and appears to refer to the fatal outcome of disease.[16]

The historian Cardinal Francis Aidan Gasquet wrote about the Great Pestilence in 1893[26] and
suggested that it had been "some form of the ordinary Eastern or bubonic plague".[27][c] In 1908,
Gasquet claimed that use of the name atra mors for the 14th-century epidemic first appeared in
a 1631 book on Danish history by J. I. Pontanus: "Commonly and from its effects, they called it
the black death" (Vulgo & ab effectu atram mortem vocitabant).[28][29]

Previous plague epidemics

Yersinia pestis (200 × magnification), the bacterium which causes plague[30]

Research from 2017 suggests plague first infected humans in Europe and Asia in the Late
Neolithic-Early Bronze Age.[31] Research in 2018 found evidence of Yersinia pestis in an ancient
Swedish tomb, which may have been associated with the "Neolithic decline" around 3000 BCE, in
which European populations fell significantly.[32][33] This Y. pestis may have been different from
more modern types, with bubonic plague transmissible by fleas first known from Bronze Age
remains near Samara.[34]
The symptoms of bubonic plague are first attested in a fragment of Rufus of Ephesus preserved
by Oribasius; these ancient medical authorities suggest bubonic plague had appeared in the
Roman Empire before the reign of Trajan, six centuries before arriving at Pelusium in the reign of
Justinian I.[35] In 2013, researchers confirmed earlier speculation that the cause of the Plague of
Justinian (541–542 CE, with recurrences until 750) was Y. pestis.[36][37] This is known as the first
plague pandemic. In 610, the Chinese physician Chao Yuanfang described a "malignant bubo"
"coming in abruptly with high fever together with the appearance of a bundle of nodes beneath
the tissue."[38] The Chinese physician Sun Simo who died in 652 also mentioned a "malignant
bubo" and plague that was common in Lingnan (Guangzhou). Ole Jørgen Benedictow believes
that this indicates it was an offshoot of the first plague pandemic which made its way eastward
to Chinese territory by around 600.[39]

14th-century plague

Causes

Early theory

The most authoritative contemporary account is found in a report from the medical faculty in
Paris to Philip VI of France. It blamed the heavens, in the form of a conjunction of three planets
in 1345 that caused a "great pestilence in the air" (miasma theory).[40] Muslim religious scholars
taught that the pandemic was a "martyrdom and mercy" from God, assuring the believer's place
in paradise. For non-believers, it was a punishment.[41] Some Muslim doctors cautioned against
trying to prevent or treat a disease sent by God. Others adopted preventive measures and
treatments for plague used by Europeans. These Muslim doctors also depended on the writings
of the ancient Greeks.[42][43]

Predominant modern theory

 The Oriental rat flea (Xenopsylla Oriental rat flea (Xenopsylla
cheopis) engorged with blood. This cheopis) infected with the
species of flea is the primary vector Yersinia pestis bacterium which
for the transmission of Yersinia pestis, appears as a dark mass in the
the organism responsible for gut. The foregut (proventriculus)
spreading bubonic plague in most of this flea is blocked by a Y.
plague epidemics. Both male and pestis biofilm; when the flea
female fleas feed on blood and can feeds on an uninfected host Y.
transmit the infection. pestis is regurgitated into the
wound, causing infection.

Due to climate change in Asia, rodents began to flee the dried-out grasslands to more populated
areas, spreading the disease.[44] The plague disease, caused by the bacterium Yersinia pestis, is
enzootic (commonly present) in populations of fleas carried by ground rodents, including
marmots, in various areas, including Central Asia, Kurdistan, Western Asia, North India, Uganda
and the western United States.[45][46]

Y. pestis was discovered by Alexandre Yersin, a pupil of Louis Pasteur, during an epidemic of
bubonic plague in Hong Kong in 1894; Yersin also proved this bacillus was present in rodents
and suggested the rat was the main vehicle of transmission.[47][48] The mechanism by which Y.
pestis is usually transmitted was established in 1898 by Paul-Louis Simond and was found to
involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several
days after feeding on an infected host. This blockage starves the fleas and drives them to
aggressive feeding behaviour and attempts to clear the blockage by regurgitation, resulting in
thousands of plague bacteria being flushed into the feeding site, infecting the host. The bubonic
plague mechanism was also dependent on two populations of rodents: one resistant to the
disease, which act as hosts, keeping the disease endemic, and a second that lacks resistance.
When the second population dies, the fleas move on to other hosts, including people, thus
creating a human epidemic.[27]

DNA evidence
Skeletons in a mass grave from 1720 to 1721 in Martigues, near Marseille in southern France, yielded molecular evidence
of the orientalis strain of Yersinia pestis, the organism responsible for bubonic plague. The second pandemic of bubonic
plague was active in Europe from 1347, the beginning of the Black Death, until 1750.

Definitive confirmation of the role of Y. pestis arrived in 2010 with a publication in PLOS
Pathogens by Haensch et al.[4][d] They assessed the presence of DNA/RNA with polymerase
chain reaction (PCR) techniques for Y. pestis from the tooth sockets in human skeletons from
mass graves in northern, central and southern Europe that were associated archaeologically
with the Black Death and subsequent resurgences. The authors concluded that this new
research, together with prior analyses from the south of France and Germany, "ends the debate
about the cause of the Black Death, and unambiguously demonstrates that Y. pestis was the
causative agent of the epidemic plague that devastated Europe during the Middle Ages".[4] In
2011, these results were further confirmed with genetic evidence derived from Black Death
victims in the East Smithfield burial site in England. Schuenemann et al. concluded in 2011 "that
the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer
exist".[51]

Later in 2011, Bos et al. reported in Nature the first draft genome of Y. pestis from plague victims
from the same East Smithfield cemetery and indicated that the strain that caused the Black
Death is ancestral to most modern strains of Y. pestis.[51]

Since this time, further genomic papers have further confirmed the phylogenetic placement of
the Y. pestis strain responsible for the Black Death as both the ancestor[52] of later plague
epidemics including the third plague pandemic and as the descendant[53] of the strain
responsible for the Plague of Justinian. In addition, plague genomes from significantly earlier in
prehistory have been recovered.[54]

DNA taken from 25 skeletons from 14th century London have shown plague is a strain of Y.
pestis almost identical to that which hit Madagascar in 2013.[55][56] Further DNA evidence also
proves the role of Y. Pestis and traces the source to the Tian Shan Mountains in Kyrgyzstan.[57]

Alternative explanations

It is recognised that an epidemiological account of plague is as important as an identification of

symptoms, but researchers are hampered by the lack of reliable statistics from this period. Most
work has been done on the spread of the disease in England, and even estimates of overall
population at the start vary by over 100% as no census was undertaken in England between the
time of publication of the Domesday Book of 1086 and the poll tax of the year 1377.[58]
Estimates of plague victims are usually extrapolated from figures for the clergy.

Mathematical modelling is used to match the spreading patterns and the means of
transmission. A research in 2018 challenged the popular hypothesis that "infected rats died, their
flea parasites could have jumped from the recently dead rat hosts to humans". It suggested an
alternative model in which "the disease was spread from human fleas and body lice to other
people". The second model claims to better fit the trends of death toll because the rat-flea-
human hypothesis would have produced a delayed but very high spike in deaths, which
contradict historical death data.[59][60]

Lars Walløe complains that all of these authors "take it for granted that Simond's infection
model, black rat → rat flea → human, which was developed to explain the spread of plague in
India, is the only way an epidemic of Yersinia pestis infection could spread", whilst pointing to
several other possibilities.[61] Similarly, Monica Green has argued that greater attention is needed
to the range of (especially non-commensal) animals that might be involved in the transmission
of plague.[35]

Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of
numerous rats in the archaeological record of the medieval waterfront in London and that the
disease spread too quickly to support the thesis that Y. pestis was spread from fleas on rats; he
argues that transmission must have been person to person.[62][63] This theory is supported by
research in 2018 which suggested transmission was more likely by body lice and fleas during
the second plague pandemic.[64]

Summary

Although academic debate continues, no single alternative solution has achieved widespread
acceptance.[27] Many scholars arguing for Y. pestis as the major agent of the pandemic suggest
that its extent and symptoms can be explained by a combination of bubonic plague with other
diseases, including typhus, smallpox and respiratory infections. In addition to the bubonic
infection, others point to additional septicaemic (a type of "blood poisoning") and pneumonic (an
airborne plague that attacks the lungs before the rest of the body) forms of plague, which
lengthen the duration of outbreaks throughout the seasons and help account for its high
mortality rate and additional recorded symptoms.[65] In 2014, Public Health England announced
the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well
as of wills registered in London during the period, which supported the pneumonic
hypothesis.[55] Currently, while osteoarcheologists have conclusively verified the presence of Y.
pestis bacteria in burial sites across northern Europe through examination of bones and dental
pulp, no other epidemic pathogen has been discovered to bolster the alternative explanations.[66]

Transmission

Lack of Hygiene

The importance of hygiene was recognised only in the nineteenth century with the development
of the germ theory of disease; until then streets were commonly filthy, with live animals of all
sorts around and human parasites abounding, facilitating the spread of transmissible
disease.[67]

By the early fourteenth century so much filth had collected inside urban Europe that French and
Italian cities were naming streets after human waste. In medieval Paris, several street names
were inspired by merde, the French word for "shit". There were rue Merdeux, rue Merdelet, rue
Merdusson, rue des Merdons, and rue Merdiere—as well as a rue du Pipi.[68]

Pigs, cattle, chickens, geese, goats, and horses roamed the streets of medieval London and
Paris. Medieval homeowners were supposed to police their housefronts, including removing
animal dung, but most urbanites were as careless as William E. Cosner, a resident of the London
suburb of Farringdon Without. A complaint lodged against Cosner charges that "men could not
pass [by his house] for the stink [of]. . . horse dung and horse piss."[69]

One irate Londoner complained that the runoff from the local slaughterhouse had made his
garden "stinking and putrid", while another charged that the blood from slain animals flooded
nearby streets and lanes, "making a foul corruption and abominable sight to all dwelling near." In
much of medieval Europe, sanitation legislation consisted of an ordinance requiring
homeowners to shout, "Look out below!" three times before dumping a full chamber pot into the
street.[70]
Early Christians, who thought self-abnegation a cardinal virtue, considered bathing, if not a vice,
then a temptation. "Who knows what impure thoughts might arise in a tub of warm water? With
this danger in mind, St. Benedict declared, "To those who are well, and especially to the young,
bathing shall seldom be permitted." St. Agnes took the injunction to heart and died without ever
bathing."[71]

Territorial origins

According to a team of medical geneticists led by Mark Achtman that analysed the genetic
variation of the bacterium, Yersinia pestis "evolved in or near China" over 2,600 years
ago.[72][73][74] Later research by a team led by Galina Eroshenko places the origins more
specifically in the Tian Shan mountains on the border between Kyrgyzstan and China.[75][76]
However more recent research notes that the previous sampling had a very heavy East Asian
bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region that
were previously thought to be restricted to China.[77] There is also no physical or specific textual
evidence of the Black Death in 14th century China. As a result, China's place in the sequence of
the plague's spread is still debated to this day.[78] According to Charles Creighton, records of
epidemics in 14th century China suggest nothing more than typhus and major Chinese
outbreaks of epidemic disease post-date the European epidemic by several years.[79] The
earliest Chinese descriptions of the bubonic plague do not appear until the 1640s.[80]

Nestorian graves dating to 1338–1339 near Issyk-Kul in Kyrgyzstan have inscriptions referring to
plague, which has led some historians and epidemiologists to think they mark the outbreak of
the epidemic; this is supported by recent direct findings of Y. pestis DNA in teeth samples from
graves in the area with inscriptions referring to "pestilence" as the cause of death.[10] Epidemics
killed an estimated 25 million across Asia during the fifteen years before the Black Death
reached Constantinople in 1347.[81][82]

The evidence does not suggest, at least at present, that these mortality
crises were caused by plague. Although some scholars, including
McNeill and Cao, see the 1333 outbreak as a prelude to the outbreaks in
Europe from the late 1340s to the early 1350s, scholars of the Yuan and
Ming periods remain skeptical about such an interpretation.
Nonetheless, the remarkably high mortality rates during the Datong
mortality should discourage us from rejecting the possibility of
localized/regional outbreaks of plague in different parts of China, albeit
 differing in scale from, and unrelated to, the pandemic mortality of the
Black Death. What we lack is any indication of a plague pandemic that
engulfed vast territories of the Yuan Empire and later moved into
western Eurasia through Central Asia.[76]

— Philip Slavin

According to John Norris, evidence from Issyk-Kul indicates a small sporadic outbreak
characteristic of transmission from rodents to humans with no wide-scale impact.[80] According
to Achtman, the dating of the plague suggests that it was not carried along the Silk Road, and its
widespread appearance in that region probably postdates the European outbreak.[78] There are
no records of the symptoms of the Black Death from Mongol sources or writings from travelers
east of the Black Sea prior to the Crimean outbreak in 1346. Finally, the Silk Road had already
been heavily disrupted before the spread of the Black Death. Western and Middle Eastern traders
found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making spread of the
plague less likely.[80]

Others still favor an origin in China[76] or even Kurdistan, and not Central Asia. According to the
theory of Chinese origin, the disease may have traveled along the Silk Road with Mongol armies
and traders, or it could have arrived via ship,[78] but this theory is still contested. It is speculated
that rats aboard Zheng He's ships in the 15th century may have carried the plague to Southeast
Asia, India, and Africa.

Research on the Delhi Sultanate and the Yuan Dynasty shows no evidence of any serious
epidemic in fourteenth-century India and no specific evidence of plague in fourteenth-century
China, suggesting that the Black Death may not have reached these regions.[80][78][83] Ole
Benedictow argues that since the first clear reports of the Black Death come from Kaffa, the
Black Death most likely originated in the nearby plague focus on the northwestern shore of the
Caspian Sea.[84]

Demographic historians estimate that China's population fell by at least

15 percent, and perhaps as much as a third, between 1340 and 1370.
This population loss coincided with the Black Death that ravaged
Europe and much of the Islamic world in 1347–52. However, there is a
conspicuous lack of evidence for pandemic disease on the scale of the
Black Death in China at this time. War and famine – and the diseases
 that typically accompanied them – probably were the main causes of
mortality in the final decades of Mongol rule.[85]

— Richard von Glahn

Monica H. Green suggests that the reason why other parts of Eurasia outside the west do not
contain the same evidence of the Black Plague is because there were actually four strains of
Yersinia pestis that became predominant in different parts of the world. Mongol records of
illness such as food poisoning may have been referring to the Black Plague.[86] Another theory is
that the Black Death originated near Europe and cycled through the Mediterranean, Northern
Europe, and Russia before making its way to China.[77] Other historians such as John Norris and
Ole Benedictaw believe the Black Death likely originated in Europe or the Middle East and never
reached China.[87]

European outbreak

Plague was reportedly first introduced to The seventh year after it began, it came to England
Europe via Genoese traders from their port and first began in the towns and ports joining on the
city of Kaffa in the Crimea in 1347. During a seacoasts, in Dorsetshire, where, as in other
protracted siege of the city, in 1345–1346 counties, it made the country quite void of

the Mongol Golden Horde army of Jani Beg, inhabitants so that there were almost none left alive.

whose mainly Tatar troops were suffering ... But at length it came to Gloucester, yea even to
from the disease, catapulted infected Oxford and to London, and finally it spread over all
corpses over the city walls of Kaffa to infect England and so wasted the people that scarce the
the inhabitants,[89] though it is more likely tenth person of any sort was left alive.

that infected rats travelled across the siege Geoffrey the Baker, Chronicon Angliae[88]
lines to spread the epidemic to the
inhabitants.[90][91] As the disease took hold,
Genoese traders fled across the Black Sea to Constantinople, where the disease first arrived in
Europe in summer 1347.[92]

The epidemic there killed the 13-year-old son of the Byzantine emperor, John VI Kantakouzenos,
who wrote a description of the disease modelled on Thucydides's account of the 5th century
BCE Plague of Athens, but noting the spread of the Black Death by ship between maritime
cities.[92] Nicephorus Gregoras also described in writing to Demetrios Kydones the rising death
toll, the futility of medicine, and the panic of the citizens.[92] The first outbreak in Constantinople
lasted a year, but the disease recurred ten times before 1400.[92]
Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347;[93] the
disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in
January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point to
northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in
Marseilles.[94]

From Italy, the disease spread northwest across Europe, striking France, Spain (the epidemic
began to wreak havoc first on the Crown of Aragon in the spring of 1348),[95] Portugal and
England by June 1348, then spread east and north through Germany, Scotland and Scandinavia
from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at Askøy, then
spread to Bjørgvin (modern Bergen) and Iceland.[96] Finally, it spread to northwestern Russia in
1351. Plague was somewhat more uncommon in parts of Europe with less developed trade with
their neighbours, including the majority of the Basque Country, isolated parts of Belgium and the
Netherlands, and isolated Alpine villages throughout the continent.[97][98][99]

According to some epidemiologists, periods of unfavourable weather decimated plague-infected

rodent populations and forced their fleas onto alternative hosts,[100] inducing plague outbreaks
which often peaked in the hot summers of the Mediterranean,[101] as well as during the cool
autumn months of the southern Baltic region.[102][e] Among many other culprits of plague
contagiousness, malnutrition, even if distantly, also contributed to such an immense loss in
European population, since it weakened immune systems.[105]

Western Asian and North African outbreak

The disease struck various regions in the Middle East and North Africa during the pandemic,
leading to serious depopulation and permanent change in both economic and social
structures.[106] As infected rodents infected new rodents, the disease spread across the region,
entering also from southern Russia.

By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from
Constantinople; according to a contemporary witness, from a single merchant ship carrying
slaves.[107] By late summer 1348 it reached Cairo, capital of the Mamluk Sultanate, cultural
centre of the Islamic world, and the largest city in the Mediterranean Basin; the Bahriyya child
sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died.[108] The Nile was
choked with corpses despite Cairo having a medieval hospital, the late 13th century bimaristan
of the Qalawun complex.[108] The historian al-Maqrizi described the abundant work for grave-
diggers and practitioners of funeral rites, and plague recurred in Cairo more than fifty times over
the following century and half.[108]
During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus,
and in October plague had broken out in Aleppo.[107] That year, in the territory of modern
Lebanon, Syria, Israel, and Palestine, the cities of Ashkelon, Acre, Jerusalem, Sidon, and Homs
were all infected. In 1348–1349, the disease reached Antioch. The city's residents fled to the
north, but most of them ended up dying during the journey.[109] Within two years, the plague had
spread throughout the Islamic world, from Arabia across North Africa.[41] The pandemic spread
westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by
ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in
1348 and brought the contagion with them to Morocco, whose epidemic may also have been
seeded from the Islamic city of Almería in al-Andalus.[107]

Mecca became infected in 1348 by pilgrims performing the Hajj.[107] In 1351 or 1352, the Rasulid
sultan of the Yemen, al-Mujahid Ali, was released from Mamluk captivity in Egypt and carried
plague with him on his return home.[107][110] During 1348, records show the city of Mosul
suffered a massive epidemic, and the city of Baghdad experienced a second round of the
disease.

Signs and symptoms

A hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black
An inguinal bubo on the upper thigh of a person infected with bubonic plague. Swollen lymph nodes (buboes) often occur
in the neck, armpit and groin (inguinal) regions of plague victims.

Bubonic plague

Symptoms of the disease include fever of 38–41 °C (100–106 °F), headaches, painful aching
joints, nausea and vomiting, and a general feeling of malaise. Left untreated, of those that
contract the bubonic plague, 80 percent die within eight days.[111]

Contemporary accounts of the pandemic are varied and often imprecise. The most commonly
noted symptom was the appearance of buboes (or gavocciolos) in the groin, neck, and armpits,
which oozed pus and bled when opened.[65] Boccaccio's description:

In men and women alike it first betrayed itself by the emergence of certain
tumours in the groin or armpits, some of which grew as large as a common
apple, others as an egg ... From the two said parts of the body this deadly
gavocciolo soon began to propagate and spread itself in all directions
indifferently; after which the form of the malady began to change, black spots
or livid making their appearance in many cases on the arm or the thigh or
elsewhere, now few and large, now minute and numerous. As the gavocciolo
had been and still was an infallible token of approaching death, such also
were these spots on whomsoever they showed themselves.[112][113][f]

This was followed by acute fever and vomiting of blood. Most people died two to seven days
after initial infection. Freckle-like spots and rashes,[115] which could have been caused by flea-
bites, were identified as another potential sign of plague.

Pneumonic plague

Lodewijk Heyligen, whose master the Cardinal Colonna died of plague in 1348, noted a distinct
form of the disease, pneumonic plague, that infected the lungs and led to respiratory
problems.[65] Symptoms include fever, cough, and blood-tinged sputum. As the disease
progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate
of 90 to 95 percent.[116]

Septicaemic plague

Septicaemic plague is the least common of the three forms, with a mortality rate near 100%.
Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular
coagulation).[116] In cases of pneumonic and particularly septicaemic plague, the progress of the
disease is so rapid that there would often be no time for the development of the enlarged lymph
nodes that were noted as buboes.[116]

Consequences

Deaths

Inspired by the Black Death, The Dance of Death, or Danse Macabre, an allegory on the universality of death, was a
common painting motif in the late medieval period.

There are no exact figures for the death toll; the rate varied widely by locality. In urban centres,
the greater the population before the outbreak, the longer the duration of the period of abnormal
mortality.[117] It killed some 75 to 200 million people in Eurasia.[118][119][120] A study published in
2022 of pollen samples across Europe between 1250 and 1450 was used to estimate changes in
agricultural output before and after the Black Death. The authors found great variability in
different regions, with evidence for high mortality in areas of Scandinavia, France, western
Germany, Greece and central Italy, but uninterrupted agricultural growth in central and eastern
Europe, Iberia and Ireland.[121]

The mortality rate of the Black Death in the 14th century was far greater than the worst 20th-
century outbreaks of Y. pestis plague, which occurred in India and killed as much as 3% of the
population of certain cities.[122] The overwhelming number of deceased bodies produced by the
Black Death caused the necessity of mass burial sites in Europe, sometimes including up to
several hundred or several thousand skeletons.[123] The mass burial sites that have been
excavated have allowed archaeologists to continue interpreting and defining the biological,
sociological, historical, and anthropological implications of the Black Death.[123]

According to medieval historian Philip Daileader, it is likely that over four years, 45–50% of the
European population died of plague.[124][g] Norwegian historian Ole Benedictow suggests it could
have been as much as 60% of the European population.[125][h] In 1348, the disease spread so
rapidly that before any physicians or government authorities had time to reflect upon its origins,
about a third of the European population had already perished. In crowded cities, it was not
uncommon for as much as 50% of the population to die.[27] Half of Paris' population of 100,000
people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000
inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and
Bremen perished,[126] and a similar percentage of Londoners may have died from the disease as
well,[55] with a death toll of approximately 62,000 between 1346 and 1353.[44][i] Florence's tax
records suggest that 80% of the city's population died within four months in 1348.[122] Before
1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000
by 1450.[128] The disease bypassed some areas, with the most isolated areas being less
vulnerable to contagion. Plague did not appear in Douai in Flanders until the turn of the 15th
century, and the impact was less severe on the populations of Hainaut, Finland, northern
Germany, and areas of Poland.[122] Monks, nuns, and priests were especially hard-hit since they
cared for people with the Black Death.[129]
Citizens of Tournai bury plague victims

The physician to the Avignon Papacy, Raimundo Chalmel de Vinario (Latin: Magister Raimundus,
lit. 'Master Raymond'), observed the decreasing mortality rate of successive outbreaks of plague
in 1347–48, 1362, 1371, and 1382 in his 1382 treatise On Epidemics (De epidemica).[130] In the
first outbreak, two thirds of the population contracted the illness and most patients died; in the
next, half the population became ill but only some died; by the third, a tenth were affected and
many survived; while by the fourth occurrence, only one in twenty people were sickened and
most of them survived.[130] By the 1380s in Europe, it predominantly affected children.[122]
Chalmel de Vinario recognized that bloodletting was ineffective (though he continued to
prescribe bleeding for members of the Roman Curia, whom he disliked), and claimed that all true
cases of plague were caused by astrological factors and were incurable; he himself was never
able to effect a cure.[130]

The most widely accepted estimate for the Middle East, including Iraq, Iran, and Syria, during this
time, is for a death toll of about a third of the population.[131] The Black Death killed about 40% of
Egypt's population.[132] In Cairo, with a population numbering as many as 600,000, and possibly
the largest city west of China, between one third and 40% of the inhabitants died inside of eight
months.[108]

Italian chronicler Agnolo di Tura recorded his experience from Siena, where plague arrived in
May 1348:

Father abandoned child, wife husband, one brother another; for this
illness seemed to strike through the breath and sight. And so they died.
And none could be found to bury the dead for money or friendship.
Members of a household brought their dead to a ditch as best they
could, without priest, without divine offices ... great pits were dug and
 piled deep with the multitude of dead. And they died by the hundreds
both day and night ... And as soon as those ditches were filled more
were dug ... And I, Agnolo di Tura ... buried my five children with my
own hands. And there were also those who were so sparsely covered
with earth that the dogs dragged them forth and devoured many bodies
throughout the city. There was no one who wept for any death, for all
awaited death. And so many died that all believed it was the end of the
world.[133]

Economic

With such a large population decline from the pandemic, wages soared in response to a labour
shortage.[134] On the other hand, in the quarter century after the Black Death in England, it is
clear many labourers, artisans, and craftsmen, those living from money-wages alone, did suffer a
reduction in real incomes owing to rampant inflation.[135] Landowners were also pushed to
substitute monetary rents for labour services in an effort to keep tenants.[136]

Environmental

A study performed by Thomas Van Hoof of the Utrecht University suggests that the innumerable
deaths brought on by the pandemic cooled the climate by freeing up land and triggering
reforestation. This may have led to the Little Ice Age.[137]

Persecutions

Jews being burned at the stake in 1349. Miniature from a 14th-century manuscript Antiquitates Flandriae
Renewed religious fervour and fanaticism bloomed in the wake of the Black Death. Some
Europeans targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims",
lepers,[138][139] and Romani, blaming them for the crisis. Lepers, and others with skin diseases
such as acne or psoriasis, were killed throughout Europe.

Because 14th-century healers and governments were at a loss to explain or stop the disease,
Europeans turned to astrological forces, earthquakes, and the poisoning of wells by Jews as
possible reasons for outbreaks.[17] Many believed the epidemic was a punishment by God for
their sins, and could be relieved by winning God's forgiveness.[140]

There were many attacks against Jewish communities.[141] In the Strasbourg massacre of
February 1349, about 2,000 Jews were murdered.[141] In August 1349, the Jewish communities
in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities
had been destroyed.[142] During this period many Jews relocated to Poland, where they received
a warm welcome from King Casimir the Great.[143]

Social

Pieter Bruegel's The Triumph of Death reflects the social upheaval and terror that followed plague, which devastated
medieval Europe.

One theory that has been advanced is that the devastation in Florence caused by the Black
Death, which hit Europe between 1348 and 1350, resulted in a shift in the world view of people in
14th-century Italy and led to the Renaissance. Italy was particularly badly hit by the pandemic,
and it has been speculated that the resulting familiarity with death caused thinkers to dwell
more on their lives on Earth, rather than on spirituality and the afterlife.[144][j] It has also been
argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of
religious works of art.[146]

This does not fully explain why the Renaissance occurred in Italy in the 14th century. The Black
Death was a pandemic that affected all of Europe in the ways described, not only Italy. The
Renaissance's emergence in Italy was most likely the result of the complex interaction of the
above factors,[147] in combination with an influx of Greek scholars following the fall of the
Byzantine Empire. As a result of the drastic reduction in the populace the value of the working
class increased, and commoners came to enjoy more freedom. To answer the increased need
for labour, workers travelled in search of the most favorable position economically.[148]

Prior to the emergence of the Black Death, the workings of Europe were run by the Catholic
Church and the continent was considered a feudalistic society, composed of fiefs and city-
states.[149] The pandemic completely restructured both religion and political forces; survivors
began to turn to other forms of spirituality and the power dynamics of the fiefs and city-states
crumbled.[149][150]

Cairo's population, partly owing to the numerous plague epidemics, was in the early 18th century
half of what it was in 1347.[108] The populations of some Italian cities, notably Florence, did not
regain their pre-14th century size until the 19th century.[151] The demographic decline due to the
pandemic had economic consequences: the prices of food dropped and land values declined by
30–40% in most parts of Europe between 1350 and 1400.[152] Landholders faced a great loss,
but for ordinary men and women it was a windfall. The survivors of the pandemic found not only
that the prices of food were lower but also that lands were more abundant, and many of them
inherited property from their dead relatives, and this probably destabilized feudalism.[153][154]

The word "quarantine" has its roots in this period, though the concept of isolating people to
prevent the spread of disease is older. In the city-state of Ragusa (modern Dubrovnik, Croatia), a
thirty-day isolation period was implemented in 1377 for new arrivals to the city from plague-
affected areas. The isolation period was later extended to forty days, and given the name
"quarantino" from the Italian word for "forty".[155]

Recurrences

Second plague pandemic

The Great Plague of London, in 1665, killed up to 100,000 people.

A plague doctor and his typical apparel during the 17th Century Outbreak.

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to
17th centuries.[156] According to Jean-Noël Biraben, the plague was present somewhere in
Europe in every year between 1346 and 1671.[157] (Note that some researchers have cautions
about the uncritical use of Biraben's data.[158]) The second pandemic was particularly
widespread in the following years: 1360–63; 1374; 1400; 1438–39; 1456–57; 1464–66; 1481–
85; 1500–03; 1518–31; 1544–48; 1563–66; 1573–88; 1596–99; 1602–11; 1623–40; 1644–54;
and 1664–67. Subsequent outbreaks, though severe, marked the retreat from most of Europe
(18th century) and northern Africa (19th century).[159] The historian George Sussman argued that
the plague had not occurred in East Africa until the 1900s.[80] However, other sources suggest
that the Second pandemic did indeed reach Sub-Saharan Africa.[106]

According to historian Geoffrey Parker, "France alone lost almost a million people to the plague
in the epidemic of 1628–31."[160] In the first half of the 17th century, a plague killed some 1.7
million people in Italy.[161] More than 1.25 million deaths resulted from the extreme incidence of
plague in 17th-century Spain.[162]

Contemporaneous painting of Marseille during the Great Plague in 1720

The Black Death ravaged much of the Islamic world.[163] Plague was present in at least one
location in the Islamic world virtually every year between 1500 and 1850.[164] Plague repeatedly
struck the cities of North Africa. Algiers lost 30,000–50,000 inhabitants to it in 1620–21, and
again in 1654–57, 1665, 1691, and 1740–42.[165] Cairo suffered more than fifty plague
epidemics within 150 years from the plague's first appearance, with the final outbreak of the
second pandemic there in the 1840s.[108] Plague remained a major event in Ottoman society
until the second quarter of the 19th century. Between 1701 and 1750, thirty-seven larger and
smaller epidemics were recorded in Constantinople, and an additional thirty-one between 1751
and 1800.[166] Baghdad has suffered severely from visitations of the plague, and sometimes two-
thirds of its population had died.[167]
Third plague pandemic

Worldwide distribution of plague-infected animals, 1998

The third plague pandemic (1855–1859) started in China in the mid-19th century, spreading to
all inhabited continents and killing 10 million people in India alone.[168] The investigation of the
pathogen that caused the 19th-century plague was begun by teams of scientists who visited
Hong Kong in 1894, among whom was the French-Swiss bacteriologist Alexandre Yersin, after
whom the pathogen was named.[27]

Twelve plague outbreaks in Australia between 1900 and 1925 resulted in well over 1,000 deaths,
chiefly in Sydney. This led to the establishment of a Public Health Department there which
undertook some leading-edge research on plague transmission from rat fleas to humans via the
bacillus Yersinia pestis.[169]

The first North American plague epidemic was the San Francisco plague of 1900–1904,
followed by another outbreak in 1907–1908.[170][171][172]

Modern-day

Modern treatment methods include insecticides, the use of antibiotics, and a plague vaccine. It
is feared that the plague bacterium could develop drug resistance and again become a major
health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in
1995.[173] A further outbreak in Madagascar was reported in November 2014.[174] In October
2017, the deadliest outbreak of the plague in modern times hit Madagascar, killing 170 people
and infecting thousands.[175]
An estimate of the case fatality rate for the modern bubonic plague, following the introduction of
antibiotics, is 11%, although it may be higher in underdeveloped regions.[176]

See also

Second plague pandemic

Black Death in medieval culture

Black Death in England

Crisis of the Late Middle Ages

Flagellant

Globalization and disease

List of epidemics

Timeline of plague

References

Notes
a. Other names include Great Mortality (Latin: magna mortalitas, lit. 'Great Death', common in the 14th
century), atra mors, 'black death', the Great Plague, the Great Bubonic Plague or the Black Plague.

b. Declining temperatures following the end of the Medieval Warm Period added to the crisis

c. He was able to adopt the epidemiology of the bubonic plague for the Black Death for the second edition
in 1908, implicating rats and fleas in the process, and his interpretation was widely accepted for other
ancient and medieval epidemics, such as the Plague of Justinian that was prevalent in the Eastern
Roman Empire from 541 to 700 CE.[27]

d. In 1998, Drancourt et al. reported the detection of Y. pestis DNA in human dental pulp from a medieval
grave.[49] Another team led by Tom Gilbert cast doubt on this identification[50] and the techniques
employed, stating that this method "does not allow us to confirm the identification of Y. pestis as the
aetiological agent of the Black Death and subsequent plagues. In addition, the utility of the published
tooth-based ancient DNA technique used to diagnose fatal bacteraemias in historical epidemics still
awaits independent corroboration".

e. However, other researchers do not think that plague ever became endemic in Europe or its rat population.
The disease repeatedly wiped out the rodent carriers, so that the fleas died out until a new outbreak from
 Central Asia repeated the process. The outbreaks have been shown to occur roughly 15 years after a
warmer and wetter period in areas where plague is endemic in other species, such as gerbils.[103][104]

f. The only medical detail that is questionable in Boccaccio's description is that the gavocciolo was an
"infallible token of approaching death", as, if the bubo discharges, recovery is possible.[114]

g. According to medieval historian Philip Daileader,

The trend of recent research is pointing to a figure more like 45–50% of the European
population dying during a four-year period. There is a fair amount of geographic
variation. In Mediterranean Europe, areas such as Italy, the south of France and
Spain, where plague ran for about four years consecutively, it was probably closer to
75–80% of the population. In Germany and England ... it was probably closer to
20%.[124]

h. Norwegian historian Ole Benedictow suggests:

Detailed study of the mortality data available points to two conspicuous features in
relation to the mortality caused by the Black Death: namely the extreme level of
mortality caused by the Black Death, and the remarkable similarity or consistency of
the level of mortality, from Spain in southern Europe to England in north-western
Europe. The data is sufficiently widespread and numerous to make it likely that the
Black Death swept away around 60% of Europe's population. The generally assumed
population of Europe at the time is about 80 million, implying that around 50 million
people died in the Black Death.[125]

i. While contemporary accounts report mass burial pits being created in response to the large number of
dead, recent scientific investigations of a burial pit in Central London found well-preserved individuals to
be buried in isolated, evenly spaced graves, suggesting at least some pre-planning and Christian burials
at this time.[127]

j. The Black Death caused greater upheaval to Florence's social and political structure than later epidemics.
Despite a significant number of deaths among members of the ruling classes, the government of
Florence continued to function during this period. Formal meetings of elected representatives were
suspended during the height of the epidemic due to the chaotic conditions in the city, but a small group
of officials was appointed to conduct the affairs of the city, which ensured continuity of government.[145]

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18. John of Fordun's Scotichronicon ("there was a great pestilence and mortality of men") Horrox 1994, p. 84

19. Pontoppidan E (1755). The Natural History of Norway: … (https://archive.org/details/naturalhistoryNc2Po

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from the years 1348 to 50, was felt here as in other parts, and to the great diminution of the number of
the inhabitants."

20. d'Irsay S (1926). "Notes to the Origin of the Expression: ≪ Atra Mors ≫". Isis. 8 (2): 328–32.
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issn/0021-1753) . JSTOR 223649 (https://www.jstor.org/stable/223649) . S2CID 147317779 (https://a
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21. The German physician Justus Friedrich Karl Hecker (1795–1850) cited the phrase in Icelandic (Svarti
Dauði), Danish (den sorte Dod), etc. See: J. F. C. Hecker, Der schwarze Tod im vierzehnten Jahrhundert
[The Black Death in the Fourteenth Century] (Berlin, (Germany): Friedr. Aug. Herbig, 1832), p. 3. (https://ar
chive.org/details/bub_gb_LhoqAAAAYAAJ/page/n38) Archived (https://web.archive.org/web/2016042
9081540/https://books.google.com/books?id=LhoqAAAAYAAJ&pg=PA3) 29 April 2016 at the Wayback
Machine

22. Homer, Odyssey, XII, 92.

23. Seneca, Oedipus, 164–70.

24. de Corbeil G (1907) [1200]. Valentin R (ed.). Egidii Corboliensis Viaticus: De signis et symptomatibus
aegritudium (https://archive.org/details/egidiicorbolien02rosegoog) . Bibliotheca scriptorum medii aevi
Teubneriana (in Latin). Harvard University: In aedibus B.G. Teubneri.

25. On page 22 of the manuscript in Gallica (http://gallica.bnf.fr/ark:/12148/btv1b9078277z/f25.image)

Archived (https://web.archive.org/web/20161006064435/http://gallica.bnf.fr/ark:/12148/btv1b9078277
z/f25.image) 6 October 2016 at the Wayback Machine, Simon mentions the phrase "mors nigra" (Black
Death): "Cum rex finisset oracula judiciorum / Mors nigra surrexit, et gentes reddidit illi;" (When the king
ended the oracles of judgment / Black Death arose, and the nations surrendered to him;).
A more legible copy of the poem appears in: Emile Littré (1841) "Opuscule relatif à la peste de 1348,
composé par un contemporain" (http://www.persee.fr/web/revues/home/prescript/article/bec_0373
-6237_1841_num_2_1_451584?_Prescripts_Search_tabs1=standard&) Archived (https://web.archiv
e.org/web/20140722010105/http://www.persee.fr/web/revues/home/prescript/article/bec_0373-62
37_1841_num_2_1_451584?_Prescripts_Search_tabs1=standard&) 22 July 2014 at the Wayback
Machine (Work concerning the plague of 1348, composed by a contemporary), Bibliothèque de
l'école des chartes, 2 (2) : 201–43; see especially p. 228.

See also: Joseph Patrick Byrne, The Black Death (Westport, Connecticut: Greenwood Press, 2004), p.
1. (https://books.google.com/books?id=yw3HmjRvVQMC&pg=PA1) Archived (https://web.archive.
org/web/20160426053818/https://books.google.com/books?id=yw3HmjRvVQMC&pg=PA1) 26
April 2016 at the Wayback Machine

26. Gasquet 1893.

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Further reading

Alfano V, Sgobbi M (January 2022). "A fame, peste et bello libera nos Domine: An Analysis of the Black
Death in Chioggia in 1630". Journal of Family History. 47 (1): 24–40. doi:10.1177/03631990211000615 (h
ttps://doi.org/10.1177%2F03631990211000615) . S2CID 233671164 (https://api.semanticscholar.org/
CorpusID:233671164) .

Armstrong D (2016). The Black Death: The World's Most Devastating Plague (http://www.thegreatcourses.
com/courses/the-black-death-the-worlds-most-devastating-plague.html) . The Great Courses.
ASIN B01FWOO2G6 (https://www.amazon.com/dp/B01FWOO2G6) . Archived (https://web.archive.org/
web/20161018203714/http://www.thegreatcourses.com/courses/the-black-death-the-worlds-most-deva
stating-plague.html) from the original on 18 October 2016. Retrieved 16 October 2016.

Bailey M (2021). After the Black Death: Economy, society, and the law in fourteenth-century England. Oxford
University Press. ISBN 978-0-19-259973-5.

Barker H (1 January 2021). "Laying the Corpses to Rest: Grain, Embargoes, and Yersinia pestis in the
Black Sea, 1346–48". Speculum. 96 (1): 97–126. doi:10.1086/711596 (https://doi.org/10.1086%2F711
596) . S2CID 229344364 (https://api.semanticscholar.org/CorpusID:229344364) .

Cantor NF (2015). In the wake of the plague : the Black death and the world it made (First Simon &
Schuster paperback ed.). New York. ISBN 978-1-4767-9774-8.

Cohn Jr SK (2002). The black death transformed : disease and culture in early Renaissance Europe.
London: Arnold. ISBN 978-0-340-70646-6.

Crawford DH (2018). Deadly Companions: How Microbes Shaped Our History. Oxford University Press.
ISBN 978-0-19-881544-0.

Dols MW (2019). The Black Death in the Middle East. Princeton, N.J.: Princeton University Press.
ISBN 978-0-691-65704-2.

Dols MW (January 1974). "The Comparative Communal Responses to the Black Death in Muslim and
Christian Societies". Viator. 5: 269–288. doi:10.1484/J.VIATOR.2.301626 (https://doi.org/10.1484%2FJ.V
IATOR.2.301626) . ProQuest 1297911710 (https://search.proquest.com/docview/1297911710) .

Dols MW (1978). "Geographical origin of the Black Death: comment". Bulletin of the History of Medicine.
52 (1): 112–120. PMID 352447 (https://pubmed.ncbi.nlm.nih.gov/352447) . ProQuest 1296259982 (htt
ps://search.proquest.com/docview/1296259982) .

Duncan CJ, Scott S (May 2005). "What caused the Black Death?" (https://www.ncbi.nlm.nih.gov/pmc/arti
cles/PMC1743272) . Postgraduate Medical Journal. 81 (955): 315–320. doi:10.1136/pgmj.2004.024075
(https://doi.org/10.1136%2Fpgmj.2004.024075) . PMC 1743272 (https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC1743272) . PMID 15879045 (https://pubmed.ncbi.nlm.nih.gov/15879045) .

von Glahn R (2016), The Economic History of China: From Antiquity to the Nineteenth Century
 Green MH (29 December 2020). "The Four Black Deaths". The American Historical Review. 125 (5): 1601–
1631. doi:10.1093/ahr/rhaa511 (https://doi.org/10.1093%2Fahr%2Frhaa511) .

McNeill WH (1976). Plagues and Peoples. Anchor/Doubleday. ISBN 978-0-385-11256-7.

Pamuk S (December 2007). "The Black Death and the origins of the 'Great Divergence' across Europe,
1300–1600". European Review of Economic History. 11 (3): 289–317. doi:10.1017/S1361491607002031
(https://doi.org/10.1017%2FS1361491607002031) .

Slavin P (Summer 2019). "Death by the Lake: Mortality Crisis in Early Fourteenth-Century Central Asia".
Journal of Interdisciplinary History. 50 (1): 59–90. doi:10.1162/jinh_a_01376 (https://doi.org/10.1162%2Fj
inh_a_01376) . S2CID 162183994 (https://api.semanticscholar.org/CorpusID:162183994) .

Scott S, Duncan CJ (2001). Biology of Plagues: Evidence from Historical Populations. Cambridge:
Cambridge University Press. ISBN 978-0-521-80150-8.

Shrewsbury JF (2005). A History of Bubonic Plague in the British Isles. Cambridge Univ Pr. ISBN 978-0-
521-02247-7.

Twigg G (1985). The Black Death : a biological reappraisal (1st American ed.). New York: Schocken Books.
ISBN 978-0-7134-4618-0.

External links

Wikimedia Commons has media related to Black Death.

Black Death (https://www.bbc.co.uk/programmes/b00bcqt8) on In Our Time at the BBC

Black Death (https://www.bbc.co.uk/history/british/middle_ages/black_01.shtml) at BBC

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