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{{Short description|1346–1353 pandemic in Eurasia and North Africa}}
{{dablink|This article concerns the mid fourteenth century [[pandemic]]. For other outbreaks and a microbiological perspective, see [[Bubonic plague]].}}
{{redirect|The Plague|other uses|The Plague (disambiguation)|and|Black Death (disambiguation)}}
[[Image:Black Death.jpg|thumb|350px|Illustration of the Black Death from the [[Toggenburg]] Bible (1411)]]
{{Pp-vandalism|small=yes}}
The '''Black Death''', or The '''Black Plague''', was one of the most deadly [[pandemic]]s in human history. It began in South-western or [[Central Asia]] and spread to [[Europe]] by the late 1340s. The total number of deaths worldwide from the pandemic is estimated at 75 million people; there were an estimated 20 million deaths in Europe alone. The Black Death is estimated to have killed between a third and two-thirds of [[Medieval demography|Europe's population]].<ref name="barry"> Stéphane Barry and Norbert Gualde, "The Greatest Epidemic of History" ("La plus grande épidémie de l'histoire", in ''[[L'Histoire]]'' n° 310, June 2006, pp.45-46, say "between one-third and two-thirds"; [[Robert Gottfried]] (1983). "Black Death" in ''[[Dictionary of the Middle Ages]]'', volume 2, pp.257-67, says "between 25 and 45 percent".</ref>
{{Use British English|date=August 2016}}
{{Use dmy dates|date=January 2020}}
{{Infobox pandemic
| name = Black Death
| image = File:1346-1353 spread of the Black Death in Europe map.svg
| image_size = 400px
| alt = The spread of the Black Death in Europe and the [[Near East]] (1346–1353)
| caption = The spread of the Black Death in [[Europe]], [[North Africa]], and the [[Near East]] (1346–1353)
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| disease = [[Bubonic plague]]
| virus_strain =
| location = [[Eurasia]] and [[North Africa]]<ref name="plague-drug-resistant">{{cite magazine |author-last=Lawton |author-first=Graham |date=25 May 2022 |title=Plague: Black death bacteria persists and could cause a pandemic |url=https://www.newscientist.com/article/mg25433880-400-plague-never-went-away-now-it-could-re-emerge-in-drug-resistant-form/ |url-status=live |editor-last=Wilson |editor-first=Emily |editor-link=Emily Wilson (journalist) |magazine=[[New Scientist]] |location=London |issn=0262-4079 |archive-url=https://web.archive.org/web/20220530221812/https://www.newscientist.com/article/mg25433880-400-plague-never-went-away-now-it-could-re-emerge-in-drug-resistant-form/ |archive-date=30 May 2022 |access-date=31 May 2022}}</ref>
| first_reported =
| first_outbreak =
| first_case =
| date = 1346–1353
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| confirmed_cases =
| recovery_cases =
| deaths = 25,000,000 – 50,000,000 (estimated)
| territories =
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}}


The '''Black Death''' was a [[bubonic plague]] [[pandemic]] that occurred in [[Europe]] from 1346 to 1353. It was one of the [[list of epidemics|most fatal pandemics]] in human history; as many as {{nowrap|50 million}} people<ref name="lead numbers"/> perished, perhaps 50% of Europe's 14th century population.<ref>{{cite news|url=https://economictimes.indiatimes.com/markets/stocks/news/economic-life-after-covid-19-lessons-from-the-black-death/articleshow/74870296.cms?from=mdr|title=Economic life after Covid-19: Lessons from the Black Death|newspaper=The Economic Times|date=29 March 2020|access-date=4 April 2020|archive-date=21 June 2020|archive-url=https://web.archive.org/web/20200621020454/https://economictimes.indiatimes.com/markets/stocks/news/economic-life-after-covid-19-lessons-from-the-black-death/articleshow/74870296.cms?from=mdr|url-status=live}}</ref> The disease is caused by the [[Bacteria|bacterium]] ''[[Yersinia pestis]]'' and spread by [[Flea|fleas]] and through the air.{{sfn|Haensch|Bianucci|Signoli|Rajerison|2010}}<ref>{{cite web|title=Plague|url=https://www.who.int/mediacentre/factsheets/fs267/en/|website=World Health Organization|access-date=8 November 2017|date=October 2017|archive-url=https://web.archive.org/web/20150424065540/http://www.who.int/mediacentre/factsheets/fs267/en/|archive-date=24 April 2015|url-status=live}}</ref> One of the most significant events in European history, the Black Death had far-reaching population, economic, and cultural impacts. It was the beginning of the [[second plague pandemic]].<ref>{{Cite web|url=https://jmvh.org/article/the-history-of-plague-part-1-the-three-great-pandemics/|title=The History of Plague – Part 1. The Three Great Pandemics| vauthors = Firth J |date=April 2012|publisher=jmvh.org|url-status=dead|archive-url=https://web.archive.org/web/20191002022050/https://jmvh.org/article/the-history-of-plague-part-1-the-three-great-pandemics/|archive-date=2 October 2019|access-date=14 November 2019}}</ref> The plague created religious, social and economic upheavals, with profound effects on the course of European history.
The same disease is thought to have returned to Europe every generation with varying [[virulence]] and mortaliies until the 1700s.<ref>[http://www.infoplease.com/cig/dangerous-diseases-epidemics/bubonic-plague.html Epidemics of the Past—Bubonic Plague]</ref> During this period, more than a hundred plague epidemics swept across Europe.<ref>[http://education.guardian.co.uk/higher/artsandhumanities/story/0,12241,1218631,00.html Black Death blamed on man, not rats]</ref> On its return in 1603, the plague killed 38,000 [[Londoners]].<ref>[http://www.1911encyclopedia.org/Plague Plague - LoveToKnow 1911]</ref> Other notable seventeenth-century outbreaks were the [[Italian Plague of 1629-1631]], the [[Great Plague of Seville]] (1647-1652), the [[Great Plague of London]] (1665–1666),<ref>[http://urbanrim.org.uk/plague%20list.htm A List of National Epidemics of Plague in England 1348-1665]</ref> the [[Great Plague of Vienna]] (1679). There is some controversy over the identity of the disease, but in its virulent form, after the [[Great Plague of Marseille]] in 1720–1722<ref>[http://www.beyond.fr/history/plague.html Plague History Provence]</ref> and the [[Plague Riot|1771 plague in Moscow]] it seems to have disappeared from Europe in the eighteenth century.


The origin of the Black Death is disputed.<ref name="lead origin" /> Genetic analysis suggests ''Yersinia pestis'' bacteria evolved approximately 7,000 years ago, at the beginning of the [[Neolithic]],<ref>{{cite journal |last1=Susat |first1=Julian |last2=Lübke |first2=Harald |last3=Immel |first3=Alexander |last4=Brinker |first4=Ute |last5=Macāne |first5=Aija |last6=Meadows |first6=John |last7=Steer |first7=Britta |last8=Tholey |first8=Andreas |last9=Zagorska |first9=Ilga |last10=Gerhards |first10=Guntis |last11=Schmölcke |first11=Ulrich |last12=Kalniņš |first12=Mārcis |last13=Franke |first13=Andre |last14=Pētersone-Gordina |first14=Elīna |last15=Teßman |first15=Barbara |last16=Tõrv |first16=Mari |last17=Schreiber |first17=Stefan |last18=Andree |first18=Christian |last19=Bērziņš |first19=Valdis |last20=Nebel |first20=Almut |last21=Krause-Kyora |first21=Ben |display-authors=1 |title=A 5,000-year-old hunter-gatherer already plagued by Yersinia pestis |journal=Cell Reports |volume=35 |issue=13 |date=29 June 2021 |doi=10.1016/j.celrep.2021.109278 |pmid=34192537 |doi-access=free }}</ref> with flea-mediated strains emerging around 3,800 years ago during the late [[Bronze Age]].<ref>{{cite journal |last1=Spyrou |first1=Maria A |last2=Tukhbatova |first2=Rezeda I |last3=Wang |first3=Chuan-Chao |last4=Andrades Valtueña |first4=Aida |last5=Lankapalli |first5=Aditya K |last6=Kondrashin |first6=Vitaly V |last7=Tsybin |first7=Victor A |last8=Khokhlov |first8=Aleksandr |last9=Kühnert |first9=Denise |last10=Herbig |first10=Alexander |last11=Bos |first11=Kirsten I |last12=Krause |first12=Johannes |title=Analysis of 3800-year-old Yersinia pestis genomes suggests Bronze Age origin for bubonic plague |journal=Nature Communications |volume=9 |date=2018 |issue=1 |page=2234 |doi=10.1038/s41467-018-04550-9 |pmid=29884871 |pmc=5993720 |bibcode=2018NatCo...9.2234S |display-authors=1 }}</ref> The immediate territorial origins of the Black Death and its outbreak remain unclear, with some evidence pointing towards [[Central Asia]], China, the [[Middle East]], and Europe.<ref>{{Cite news |url=https://www.nytimes.com/2010/11/01/health/01plague.html |title=Europe's Plagues Came from China, Study Finds |work=The New York Times |date=31 October 2010 |access-date=24 February 2017 |archive-date=4 November 2010 |archive-url=https://web.archive.org/web/20101104083917/http://www.nytimes.com/2010/11/01/health/01plague.html |url-status=live |last1=Wade |first1=Nicholas }}</ref>{{sfn|Sussman|2011|p=354}} The pandemic was reportedly first introduced to Europe during the [[Siege of Caffa|siege of the Genoese trading port of Kaffa]] in [[Crimea]] by the [[Golden Horde]] army of [[Jani Beg]] in 1347. From Crimea, it was most likely carried by [[Oriental rat flea|fleas]] living on the [[black rat]]s that travelled on [[Republic of Genoa|Genoese]] ships, spreading through the [[Mediterranean Basin]] and reaching [[North Africa]], [[West Asia]], and the rest of Europe via [[Constantinople]], [[Sicily]], and the [[Italian Peninsula]].<ref>{{Cite web |url=https://www.britannica.com/event/Black-Death |title=Black Death &#124; Causes, Facts, and Consequences |access-date=1 August 2019 |archive-date=9 July 2019 |archive-url=https://web.archive.org/web/20190709135155/https://www.britannica.com/event/Black-Death |website=Encyclopædia Britannica |url-status=live }}</ref> There is evidence that once it came ashore, the Black Death mainly spread from 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 (epidemiology)|vector]] was [[rat flea]]s causing bubonic plague.{{sfn|Snowden|2019|pp=49–53}}<ref>{{Cite web |title=Plague |url=https://www.who.int/news-room/fact-sheets/detail/plague |access-date=2024-07-23 |website=www.who.int |language=en |archive-date=30 April 2018 |archive-url=https://web.archive.org/web/20180430115308/https://www.who.int/news-room/fact-sheets/detail/plague |url-status=live }}</ref><ref>{{Cite news |last=McCoy |first=Terrence |date=2021-10-26 |title=Everything you know about the Black Death is wrong |url=https://www.washingtonpost.com/news/morning-mix/wp/2014/03/31/everything-you-know-about-the-black-death-is-wrong-say-the-bones/ |access-date=2024-07-23 |newspaper=Washington Post |language=en-US |issn=0190-8286 |archive-date=27 August 2016 |archive-url=https://web.archive.org/web/20160827172208/https://www.washingtonpost.com/news/morning-mix/wp/2014/03/31/everything-you-know-about-the-black-death-is-wrong-say-the-bones/ |url-status=live }}</ref> 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 have been unrelated to the 14th century [[Mongol invasions and conquests|Mongol conquests]] previously postulated as the cause.<ref>{{Cite web |date=2022-06-15 |title=Mystery of Black Death's origins solved, say researchers |url=https://www.theguardian.com/society/2022/jun/15/mystery-black-death-origins-solved-plague-pandemic |access-date=2022-06-15 |website=The Guardian |language=en |archive-date=15 June 2022 |archive-url=https://web.archive.org/web/20220615232333/https://www.theguardian.com/society/2022/jun/15/mystery-black-death-origins-solved-plague-pandemic |url-status=live }}</ref><ref name="Spyrou 1–7">{{Cite journal |last1=Spyrou |first1=Maria A. |last2=Musralina |first2=Lyazzat |last3=Gnecchi Ruscone |first3=Guido A. |last4=Kocher |first4=Arthur |last5=Borbone |first5=Pier-Giorgio |last6=Khartanovich |first6=Valeri I. |last7=Buzhilova |first7=Alexandra |last8=Djansugurova |first8=Leyla |last9=Bos |first9=Kirsten I. |last10=Kühnert |first10=Denise |last11=Haak |first11=Wolfgang |date=2022-06-15 |title=The source of the Black Death in fourteenth-century central Eurasia |journal=Nature |volume=606 |issue=7915 |language=en |pages=718–724 |doi=10.1038/s41586-022-04800-3 |pmid=35705810 |pmc=9217749 |bibcode=2022Natur.606..718S |s2cid=249709693 |issn=1476-4687}}</ref>
The fourteenth-century eruption of the Black Death had a drastic effect on Europe's population, irrevocably changing Europe's social structure. It was a serious blow to the [[Roman Catholic Church]] and resulted in widespread persecution of minorities such as Jews, foreigners, beggars and lepers. The uncertainty of daily survival created a general mood of [[morbidity]] influencing people to "live for the moment", as illustrated by [[Giovanni Boccaccio]] in ''[[The Decameron]]'' (1353).


The Black Death was the second great natural disaster to strike Europe during the [[Crisis of the Late Middle Ages|Late Middle Ages]] (the first one being the [[Great Famine of 1315–1317]]) and is estimated to have killed 30% to 60% of the European population, as well as approximately 33% of the population of the Middle East.{{sfn|Aberth|2010|pp=9–13}}{{sfn|Alchon|2003|p=21}}<ref>{{Cite web| vauthors = Howard J |date=6 July 2020|title=Plague was one of history's deadliest diseases{{snd}}then we found a cure|url=https://www.nationalgeographic.com/science/health-and-human-body/human-diseases/the-plague/ |website=National Geographic|access-date=3 December 2020|archive-date=2 December 2020|archive-url=https://web.archive.org/web/20201202201701/https://www.nationalgeographic.com/science/health-and-human-body/human-diseases/the-plague/ |url-status=dead}}</ref> There were further outbreaks throughout the Late Middle Ages and, also due to other contributing factors (the [[Crisis of the Late Middle Ages]]), the European population did not regain its 14th century level until the 16th century.{{efn|Declining temperatures following the end of the [[Medieval Warm Period]] added to the crisis.}}<ref>{{cite journal | vauthors = Galens J, Knight J |title=The Late Middle Ages |journal=Middle Ages Reference Library |year=2001 |volume=1 |url=http://ic.galegroup.com/ic/whic/ReferenceDetailsPage/ReferenceDetailsWindow?displayGroupName=Reference&prodId=WHIC&action=e&windowstate=normal&catId=&documentId=GALE%7CCX3426200028&mode=view&userGroupName=holl83564&jsid=33d6ba6bd380219c2073e86fda0b07d0 |publisher=Gale |access-date=15 May 2020 |archive-date=16 December 2019 |archive-url=https://web.archive.org/web/20191216115220/http://ic.galegroup.com/ic/whic/ReferenceDetailsPage/ReferenceDetailsWindow?displayGroupName=Reference&prodId=WHIC&action=e&windowstate=normal&catId=&documentId=GALE%7CCX3426200028&mode=view&userGroupName=holl83564&jsid=33d6ba6bd380219c2073e86fda0b07d0 |url-status=live }}</ref> Outbreaks of the plague recurred around the world until the early 19th century.
== The Great Death==


==<span id="Etymology"></span><span id="Name"></span><span id="Naming"></span>Names==
Medieval people called the fourteenth century catastrophe either the "Great Pestilence," the "Great Death," or the "Great Plague."<ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 327. </ref> Contemporary writers then referred to the event as the "Great Mortality"; the term "Black Death" was introduced for the first time in 1833. <ref> Ibid. </ref> It has been popularly thought that the name came from a striking late-stage sign of the disease, in which the sufferer's skin would blacken due to subepidermal hemorrhages ([[purpura]]), and the extremities would darken with gangrene ([[acral necrosis]]). However, the term most likely refers to the figurative sense of "black" (glum, lugubrious or dreadful).<ref>Stéphane Barry and Norbert Gualde, "The Biggest Epidemic of History" (''La plus grande épidémie de l'histoire'', in ''[[L'Histoire]]'' n°310, June 2006, pp.38 (article from pp.38 to 49, the whole issue is dedicated to the Black Plague, pp.38-60)</ref>
European writers contemporary with the plague described the disease in Latin as {{Langx|la|pestis|label=none|link=no}} or {{Langx|la|pestilentia|link=no|lit=pestilence|label=none}}; {{Langx|la|epidemia|links=no|lit=epidemic|label=none}}; {{Langx|la|mortalitas|link=no|lit=mortality|label=none}}.<ref name=":1">{{Citation|title=Black Death, n.|url=https://www.oed.com/view/Entry/280254|work=Oxford English Dictionary Online|year=2011|edition=3rd|publisher=Oxford University Press|language=en-GB|access-date=2020-04-11|archive-date=22 May 2021|archive-url=https://web.archive.org/web/20210522013812/https://www.oed.com/view/Entry/280254|url-status=live}}</ref> In English prior to the 18th century, the event was called the "pestilence" or "great pestilence", "the plague" or the "great death".<ref name=":1" />{{sfn|Bennett|Hollister|2006|p=326}}<ref>John of Fordun's ''Scotichronicon'' ("there was a great pestilence and mortality of men") {{harvnb|Horrox|1994|p=84}}</ref> 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.<ref name=":1" />


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.<ref name=":1" /> "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 {{Langx|da|den sorte død|lit=the black death}}.<ref name=":1" /><ref>{{cite book | vauthors = Pontoppidan E |title=The Natural History of Norway: … |date=1755 |publisher=A. Linde |location=London |page=24 |url=https://archive.org/details/naturalhistoryNc2Pont/page/n57}} From p. 24: "Norway, indeed, cannot be said to be entirely exempt from pestilential distempers, for the Black-death, known all over Europe by its terrible ravages, from the years 1348 to 50, was felt here as in other parts, and to the great diminution of the number of the inhabitants."</ref> 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]]: {{Langx|is|svarti dauði}}, {{Langx|de|der schwarze Tod}}, and {{Langx|fr|la mort noire}}.<ref name=":2">{{Cite journal| vauthors = d'Irsay S |date=1926|title=Notes to the Origin of the Expression: ≪ Atra Mors ≫|journal=Isis|volume=8|issue=2|pages=328–32 |doi=10.1086/358397|jstor=223649|s2cid=147317779|issn=0021-1753}}</ref><ref>The German physician [[Justus Hecker|Justus Friedrich Karl Hecker]] (1795–1850) cited the phrase in Icelandic (''{{lang|is|Svarti Dauði}}''), Danish (''{{lang|da|den sorte Dod}}''), etc. See: {{cite book |last1=Hecker |first1=J. F. C. |title=Der schwarze Tod im vierzehnten Jahrhundert |trans-title=The Black Death in the Fourteenth Century |date=1832 |publisher=Friedr. Aug. Herbig |location=Berlin, (Germany) |page=3, footnote 1 |url=https://archive.org/details/bub_gb_LhoqAAAAYAAJ/page/n11 |language=German |access-date=19 July 2024 |archive-date=29 April 2016 |archive-url=https://web.archive.org/web/20160429081540/https://books.google.com/books?id=LhoqAAAAYAAJ&pg=PA3 |url-status=dead }}</ref> Previously, most European languages had named the pandemic a variant or calque of the {{Langx|la|magna mortalitas|lit=Great Death}}.<ref name=":1" />
Because the Black Death was, according to historical accounts, characterized by [[bubo]]es (swellings in lymph nodes), like the late nineteenth century Asian [[Bubonic plague]]. Scientists and historians at the beginning of the twentieth century assumed that the Black Death was an outbreak of the same disease, caused by the [[bacterium]] ''[[Yersinia pestis]]'' and spread by [[flea]]s with the help of animals like the [[black rat]]. (''Rattus rattus''). However, this view has recently been questioned by scientists and historians, as described in section 3.2.<ref>[http://www.liv.ac.uk/newsroom/press_releases/2004/05/black_death.htm New research suggests Black Death is lying dormant]</ref><ref>{{cite book
| last = Cohn
| first = Samuel K.
| authorlink =
| coauthors =
| title = The Black Death Transformed: Disease and Culture in Early Renaissance Europe
| publisher = A Hodder Arnold
| date = 2003
| location =
| pages = 336
| url =
| id= ISBN 0-340-70646-5 }}</ref>


The phrase 'black death' – describing [[Thanatos|Death]] as black – is very old. [[Homer]] used it in the [[Odyssey]] to describe the monstrous [[Scylla]], with her mouths "full of black Death" ({{Langx|grc|πλεῖοι μέλανος Θανάτοιο|translit=pleîoi mélanos Thanátoio}}).<ref>Homer, ''Odyssey'', XII, 92.</ref><ref name=":2" /> [[Seneca the Younger]] may have been the first to describe an epidemic as 'black death', ({{Langx|la|mors atra}}) but only in reference to the acute lethality and dark [[prognosis]] of disease.<ref>Seneca, ''Oedipus'', 164–70.</ref><ref name=":2" /><ref name=":1" /> The 12th–13th century French physician [[Gilles de Corbeil]] had already used ''{{lang|la|atra mors}}'' to refer to a "pestilential fever" ({{Langx|la|febris pestilentialis|label=none}}) in his work ''On the Signs and Symptoms of Diseases'' ({{Langx|la|De signis et symptomatibus aegritudium|label=none}}).<ref name=":2" /><ref>{{Cite book|url=https://archive.org/details/egidiicorbolien02rosegoog|title=Egidii Corboliensis Viaticus: De signis et symptomatibus aegritudium|publisher=In aedibus B.G. Teubneri| vauthors = de Corbeil G |date=1907| veditors = Valentin R |location=Harvard University|language=la|orig-year=1200}}</ref> The phrase {{Langx|la|mors nigra|lit=black death|label=none}}, 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" ({{Langx|la|De judicio Solis in convivio Saturni|label=none}}), which attributes the plague to an astrological [[conjunction (astrology)|conjunction]] of Jupiter and Saturn.<ref>On page 22 of the manuscript in [http://gallica.bnf.fr/ark:/12148/btv1b9078277z/f25.image Gallica] {{Webarchive|url=https://web.archive.org/web/20161006064435/http://gallica.bnf.fr/ark:/12148/btv1b9078277z/f25.image |date=6 October 2016 }}, 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;).
==Plague migration==
* A more legible copy of the poem appears in: Emile Littré (1841) [http://www.persee.fr/web/revues/home/prescript/article/bec_0373-6237_1841_num_2_1_451584?_Prescripts_Search_tabs1=standard& "Opuscule relatif à la peste de 1348, composé par un contemporain"] {{Webarchive|url=https://web.archive.org/web/20140722010105/http://www.persee.fr/web/revues/home/prescript/article/bec_0373-6237_1841_num_2_1_451584?_Prescripts_Search_tabs1=standard& |date=22 July 2014 }} (Work concerning the plague of 1348, composed by a contemporary), ''Bibliothèque de l'école des chartes'', '''2''' (2) : 201–43; see especially p. 228.
The plague disease, caused by ''[[Yersinia pestis]]'', is [[enzootic]] in populations of ground [[rodents]] in central Asia, but it is not entirely clear where the fourteenth-century pandemic started. The most popular theory places the first cases in the [[steppe]]s of [[Central Asia]], though some speculate that it originated around northern [[India]], and others, like scholar Michael W. Dols, argue that the historical evidence concerning epidemics in the Mediterranean and specifically the [[Plague of Justinian]] point to a probability that the Black Death originated in Africa and spread to central Asia, where it then became entrenched among the rodent population. <ref> Michael W. Dols, "The Second Plague Pandemic and Its Recurrences in the Middle East: 1347-1894" ''Journal of the Economic Social History of the Orient''vol. 22 no. 2 (May 1979), 170-171. </ref> Neverthless, from central Asia it was carried east and west along the [[Silk Road]], by [[Mongol]] armies and traders making use of the opportunities of free passage within the [[Mongol Empire]] offered by the [[Pax Mongolica]]. It was reportedly first introduced to Europe at the trading city of [[Theodosia|Caffa]] in the [[Crimea]] in 1347. After a protracted siege, during which the Mongol army under [[Janibeg]] was suffering the disease, they catapulted the infected corpses over the city walls to infect the inhabitants. The [[Republic of Genoa|Genoese]] traders fled, bringing the plague by ship into Sicily and the south of Europe, whence it spread.<ref>[http://www.channel4.com/history/microsites/H/history/a-b/blackdeath.html The Black Death]</ref>
* See also: Joseph Patrick Byrne, ''The Black Death'' (Westport, Connecticut: Greenwood Press, 2004), [https://books.google.com/books?id=yw3HmjRvVQMC&pg=PA1 p. 1.] {{Webarchive|url=https://web.archive.org/web/20160426053818/https://books.google.com/books?id=yw3HmjRvVQMC&pg=PA1 |date=26 April 2016 }}</ref> 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.<ref name=":1" />
Whether or not this hypothesis is accurate, it is clear that several pre-existing conditions such as war, famine and weather contributed to the severity of the Black Death. A devastating civil war in China between the established Chinese population and the Mongol hordes raged between 1205 and 1353. This war disrupted farming and trading patterns, and led to episodes of widespread famine.


The historian Cardinal [[Francis Aidan Gasquet]] wrote about the Great Pestilence in 1893{{sfn|Gasquet|1893}} and suggested that it had been "some form of the ordinary Eastern or bubonic plague".{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}}{{efn|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 [[Byzantine Empire|Eastern Roman Empire]] from 541 to 700&nbsp;CE.{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}}}} In 1908, Gasquet said use of the name ''{{lang|la|atra mors}}'' for the 14th-century epidemic first appeared in a 1631 book on Danish history by [[Johannes Isacius Pontanus|J.&nbsp;I. Pontanus]]: "Commonly and from its effects, they called it the black death" (''{{lang|la|Vulgo & ab effectu atram mortem vocitabant}}'').{{sfn|Gasquet|1908|p=7}}<ref>Johan Isaksson Pontanus, ''Rerum Danicarum Historia'' ... (Amsterdam (Netherlands): Johann Jansson, 1631), [https://books.google.com/books?id=HaExAQAAMAAJ&pg=PA476 p. 476.] {{Webarchive|url=https://web.archive.org/web/20160504221100/https://books.google.com/books?id=HaExAQAAMAAJ&pg=PA476|date=4 May 2016}}</ref>
The [[Medieval warm period]] ended sometime towards the end of the fourteenth century, bringing harsher winters and reduced harvests. In the years 1315 to 1322 a catastrophic famine, known as the [[Great Famine of 1315-1317|Great Famine]], struck all of [[Northern Europe]]. The famine came about as the result of a large population growth in the previous centuries, with the result that Europe had become overpopulated in the early fourteenth century; the number of Europeans began to exceed the reduced productive capacity of the land and farmers.<ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 326. </ref> In Northern Europe, new technological innovations such as the heavy plow and the [[Crop rotation|three-field system]] were not as effective in clearing new fields for harvest as they were in the Mediterranean because the north had poor, clay-like, soil. <ref> Ibid. </ref> Food shortages and skyrocketing prices were a fact of life for as much as a century before the plague. Wheat, oats, hay, and consequently livestock were all in short supply, and their scarcity resulted in hunger and malnutrition. The result was a mounting human vulnerability to disease, due to weakened immune systems. The European economy entered a [[vicious circle]] in which hunger and chronic, low-level debilitating disease reduced the [[productivity (economics)|productivity]] of labourers, and so the grain output suffered, causing grain prices to increase. This situation was worsened when landowners and monarchs like Edward I of England (r. 1272-1307) and Philip IV of France (r. 1285-1314), out of a fear that their comparatively high standard of living would decline, raised the fines and rents of their tenants. <ref> Ibid., 327. </ref> Standards of living then fell drastically, diets grew more limited, and Europeans as a whole experienced more health problems. In autumn of 1314, heavy rains began to fall which led to several years of cold and wet winters. The already weak harvests of the north suffered and the seven-year famine ensued. The Great Famine was the worst in European history, and carried away at least ten percent of the population. <ref> Ibid. </ref>


==Previous plague epidemics==
This was the economic and social situation in which the predictor of the coming disaster, a [[typhoid]] (Infected Water) epidemic, emerged. Many thousands died in populated urban centres, most significantly [[Ypres]]. In 1318 a pestilence of unknown origin, sometimes identified as [[anthrax]], targeted the animals of Europe, notably sheep and cattle, further reducing the food supply and income of the peasantry. This put another strain on the economy. The increasingly international nature of the European economies meant that the depression was felt across the whole continent. <!--not related to Black Death:Unemployment bred crime and poverty.-->
{{Main|Plague (disease)|First plague pandemic}}
[[File:Yersinia pestis fluorescent.jpeg|thumb|''[[Yersinia pestis]]'' (200 × magnification), the bacterium that causes plague<ref>{{cite web|title=Plague Backgrounder|url=http://www.avma.org/public_health/biosecurity/plague_bgnd.asp|publisher=Avma.org|archive-url=https://web.archive.org/web/20080516012329/http://www.avma.org/public_health/biosecurity/plague_bgnd.asp|archive-date=16 May 2008|access-date=3 November 2008}}</ref>]]


Research from 2017 suggests plague first infected humans in Europe and Asia in the [[Late Neolithic]]-[[Early Bronze Age]].{{sfn|Andrades Valtueña|Mittnik|Key|Haak|2017}} 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.<ref>Zhang, Sarah, "[https://www.theatlantic.com/science/archive/2018/12/4900-year-old-case-plague-sweden/577315/ An Ancient Case of the Plague Could Rewrite History] {{Webarchive|url=https://web.archive.org/web/20191113183612/https://www.theatlantic.com/science/archive/2018/12/4900-year-old-case-plague-sweden/577315/ |date=13 November 2019 }}", ''The Atlantic'', 6 December 2018</ref>{{sfn|Rascovan|Sjögren|Kristiansen|Nielsen|2019}} 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]].{{sfn|Spyrou|Tukhbatova|Wang|Valtueña|2018}}
===Asian outbreak===
The scenario that would place the first outbrak in central Asia agrees with the first reports of outbreaks in [[China]] in the early 1330s. The plague struck the Chinese province of [[Hubei]] in 1334. On the heels of the European epidemic, more widespread disaster occurred in China during 1353–1354. Chinese accounts of this wave of the disease record a spread to eight distinct areas: Hubei, [[Jiangxi]], [[Shanxi]], [[Hunan]], [[Guangdong]], [[Guangxi]], [[Henan]] and [[Suiyuan]],<ref>Suiyuan was a historical Chinese province that now forms part of [[Hebei]] and [[Inner Mongolia]].</ref> throughout the Mongol and Chinese empires. Historian [[William McNeill]] noted that voluminous Chinese records on disease and social disruption survive from this period, but no one has studied these sources in depth.


The symptoms of bubonic plague are first attested in a [[literary fragment|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]].{{sfn|Green|2015|pages=31ff}} In 2013, researchers confirmed earlier speculation that the cause of the [[Plague of Justinian]] (541–549 CE, with recurrences until 750) was ''Y''. ''pestis''.<ref>{{cite web |url=http://phys.org/news/2013-05-modern-lab-ages-plague-dna.html |title=Modern lab reaches across the ages to resolve plague DNA debate |publisher=phys.org |date=20 May 2013 |access-date=22 March 2020 |archive-url=https://web.archive.org/web/20190727034311/https://phys.org/news/2013-05-modern-lab-ages-plague-dna.html |archive-date=27 July 2019 |url-status=live }}</ref><ref>{{cite web |url=http://news.nationalpost.com/2014/01/28/plague-dna-found-in-ancient-teeth-shows-medieval-black-death-1500-year-pandemic-caused-by-same-disease/ |title=Plague DNA found in ancient teeth shows medieval Black Death, 1,500-year pandemic caused by same disease |work=National Post |date=28 January 2014 | vauthors = Cheng M |access-date=22 March 2020 |archive-url=https://archive.today/20140129115824/http://news.nationalpost.com/2014/01/28/plague-dna-found-in-ancient-teeth-shows-medieval-black-death-1500-year-pandemic-caused-by-same-disease/ |archive-date=29 January 2014 |url-status=live }}</ref> 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."<ref>{{Cite book|url=https://books.google.com/books?id=KjLHAOE7irsC&pg=PA41|isbn=9781843832140|title=The Black Death, 1346-1353: The Complete History|year=2006|publisher=Boydell Press|access-date=18 March 2023|archive-date=26 March 2023|archive-url=https://web.archive.org/web/20230326164814/https://books.google.com/books?id=KjLHAOE7irsC&pg=PA41|url-status=live}}</ref> 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.<ref>{{Cite book |url=https://books.google.com/books?id=HkI3EAAAQBAJ&pg=PA130 |title=The Complete History of the Black Death |year=2021 |publisher=Boydell & Brewer |isbn=9781783275168 |access-date=18 March 2023 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326164814/https://books.google.com/books?id=HkI3EAAAQBAJ&pg=PA130 |url-status=live }}</ref>
It is probable that the [[Mongols]] and merchant caravans inadvertently brought the plague from central Asia to the Middle East and Europe. The plague was reported in the trading cities of [[Constantinople]] and [[Trabzon|Trebizond]] in 1347. In that same year, the [[Republic of Genoa|Genoese]] possession of [[Theodosia|Caffa]], a great trade emporium on the [[Crimea]]n peninsula, came under siege by an army of [[Mongol]] warriors under the command of [[Janibeg]], backed by [[Republic of Venice|Venetian]] forces. After a protracted siege during which the Mongol army was reportedly withering from the disease, they might have decided to use the infected corpses as a [[biological weapon]]. The corpses were catapulted over the city walls, infecting the inhabitants.<ref>Svat Soucek. ''A History of Inner Asia''. [[Cambridge University Press]], 2000. ISBN 0-521-65704-0. p. 116.</ref> The Genoese traders fled, transferring the plague via their ships into the south of Europe, whence it rapidly spread. According to accounts, so many died in Caffa that the survivors had little time to bury them and bodies were stacked like cords of firewood against the city walls.


==14th-century plague==
===European outbreak===
[[Image:Bubonic plague map 2.png|thumb|450px|The Black Death rapidly spread along the major European sea and land trade routes]]


===Causes===
In October 1347, a fleet of Genovese trading ships fleeing Caffa reached the port of [[Messina, Italy]]. By the time the fleet reached Messina, all the crew members were either infected or dead. It is presumed that the ships also carried infected rats and/or fleas. Some ships were found grounded on shorelines, with no one aboard remaining alive. Looting of these lost ships also helped spread the disease. From there, the plague spread to [[Genoa]] and [[Venice]] by the turn of [[1347]]–[[1348]].


====Early theory====
From [[Italy]] the disease spread northwest across Europe, striking [[France]], [[Spain]], [[Portugal]] and [[England]] by June 1348, then turned and spread east through [[Germany]] and [[Scandinavia]] from 1348 to 1350. It was introduced in Norway in 1349 when a ship landed at [[Askøy]], then proceded to spread to [[Bjørgvin]] (modern [[Bergen]]). Finally it spread to north-western [[Russia]] in 1351; however, the plague largely spared some parts of Europe, including the [[Piast Poland#The Kingdom of Later Piasts (1295–1370)|Kingdom of Poland]] and isolated parts of [[Belgium]] and [[The Netherlands]].
{{Main|Theories of the Black Death}}


A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" ([[miasma theory]]).{{sfn|Horrox|1994|p=159}} 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.{{sfn|Kelly|2006}}{{Page needed|date=October 2024}} 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.<ref>{{cite book | vauthors = al-Asqalani IH |title=Badhl aI-md'On fi fadi at-ld'an |location=Cairo |url=https://archive.org/details/Library.mmn_20150901/mode/2up}}</ref><ref>{{cite thesis |vauthors=Legan JA |title=The medical response to the Black Death |date=2015 |type=B.A. |work=Senior Honors Projects |number=103 |url=https://commons.lib.jmu.edu/honors201019/103 |publisher=James Madison University |access-date=3 December 2020 |archive-date=19 October 2021 |archive-url=https://web.archive.org/web/20211019202939/https://commons.lib.jmu.edu/honors201019/103/ |url-status=live }}</ref>
===Middle Eastern outbreak===
The plague struck various countries in the Middle East during the [[pandemic]], leading to serious depopulation and permanent change in both economic and social structures. As it spread to western Europe, the disease also entered the region from southern Russia. By autumn 1347, the plague reached [[Alexandria]] in [[Egypt]], probably through the port's trade with [[Constantinople]] and ports on the [[Black Sea]]. During 1348, the disease traveled eastward to [[Gaza]], and north along the eastern coast to cities in [[Lebanon]], [[Syria]] and [[Palestine]], including [[Asqalan]], [[Acre, Israel|Acre]], [[Jerusalem]], [[Sidon]], [[Damascus]], [[Homs]], and [[Aleppo]]. In 1348–49, the disease reached [[Antioch]]. The city's residents fled to the north, most of them dying during the journey, but the infection had been spread to the people of Asia Minor.


====Predominant modern theory====
[[Mecca]] became infected in 1349. During the same year, records show the city of [[Mawsil]] (Mosul) suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. In 1351, Yemen experienced an outbreak of the plague. This coincided with the return of King Mujahid of [[Yemen]] from imprisonment in [[Cairo]]. His party may have brought the disease with them from Egypt.
{{Multiple image
|align = right
|direction = horizontal
|image1 = Xenopsylla chepsis (oriental rat flea).jpg
|width1 = 214
|caption1 = The [[Oriental rat flea]] (''Xenopsylla cheopis'') engorged with blood. This [[species]] of flea is the primary [[vector (epidemiology)|vector]] for the transmission of ''[[Yersinia pestis]]'', the organism responsible for spreading bubonic plague in most plague epidemics. Both male and female fleas [[hematophagy|feed on blood]] and can transmit the infection.
|image2 = Flea infected with yersinia pestis.jpg
|width2 = 180
|caption2 = Oriental rat flea (''Xenopsylla cheopis'') infected with the ''[[Yersinia pestis]]'' [[bacteria|bacterium]] which appears as a dark mass in the gut. The foregut (''proventriculus'') of this flea is blocked by a ''Y. pestis'' [[biofilm]]; when the flea feeds on an uninfected [[host (biology)|host]] ''Y. pestis'' is regurgitated into the wound, causing infection.
}}


Due to [[Crisis of the Late Middle Ages#Climate change and plague pandemic correlation|climate change in Asia]], rodents began to flee the dried-out grasslands to more populated areas, spreading the disease.{{sfn|Tignor|Brown|Liu|Shaw|2014|p=407}} The plague disease, caused by the bacterium ''[[Yersinia pestis]]'', is [[enzootic]] (commonly present) in populations of fleas carried by ground [[rodent]]s, including [[marmot]]s, in various areas, including [[Central Asia]], [[Kurdistan]], [[West Asia]], [[North India]], [[Uganda]], and the western United States.{{sfn|Ziegler|1998|p=25}}<ref>{{Cite web|url=https://www.cdc.gov/plague/maps/index.html|title=Maps and Statistics: Plague in the United States|date=25 November 2019|website=[[Centers for Disease Control and Prevention]]|access-date=8 April 2020|archive-date=8 April 2020|archive-url=https://web.archive.org/web/20200408090846/https://www.cdc.gov/plague/maps/index.html|url-status=live}}</ref>
===Recurrence===
In [[England]], in the absence of census figures, historians propose a range of pre-incident population figures from as high as 7 million to as low as 4 million in 1300, and a post-incident population figure as low as 2 million.<ref>Secondary sources such as the ''Cambridge History of Medieval England'' often contain discussions of methodology in reaching these figures that are necessary reading for anyone wishing to understand this controversial episode in more detail.</ref> By the end of 1350 the Black Death had subsided, but it never really died out in England over the next few hundred years: there were further outbreaks in 1361-62, 1369, 1379-83, 1389-93, and throughout the first half of the fifteenth century. Plague often killed 10% of a community in less than a year - in the worst epidemics, such as at [[Norwich]] in 1579 and [[Newcastle upon Tyne|Newcastle]] in 1636, as many as 30 or 40%. The most general outbreaks in Tudor and Stuart England, all coinciding with years of plague in [[Germany]] and the [[Low Countries]], seem to have begun in 1498, 1535, 1543, 1563, 1589, 1603, 1625 and 1636.<ref>[http://www.bbc.co.uk/radio4/history/voices/voices_salisbury.shtml Spread of the Plague]</ref>


''Y. pestis'' was discovered by [[Alexandre Yersin]], a pupil of [[Louis Pasteur]], during an [[1894 Hong Kong plague|epidemic of bubonic plague]] in Hong Kong in 1894; Yersin also proved this bacterium was present in rodents and suggested the rat was the main vehicle of transmission.{{sfn|Arrizabalaga|2010}}<ref>{{Cite journal| vauthors = Yersin A |year=1894|title=La peste bubonique a Hong-Kong|url=https://gallica.bnf.fr/ark:/12148/bpt6k58345103/f54|journal=Annales de l'Institut Pasteur: Journal de microbiologie|volume=8|issue=9|pages=662–67|issn=0020-2444|via=Gallica|access-date=12 April 2020|archive-date=12 April 2020|archive-url=https://web.archive.org/web/20200412092843/https://gallica.bnf.fr/ark:/12148/bpt6k58345103/f54|url-status=live}}</ref> 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 [[midgut]]s had become obstructed by replicating ''Y. pestis'' several days after feeding on an infected host.<ref>{{cite journal |last1=Simond |first1=P.-L. |title=La propagation de la peste |journal=Annales de l'Institut Pasteur |date=October 1898 |volume=12 |issue=10 |pages=625–687 |url=https://www.biodiversitylibrary.org/item/22266#page/633/mode/1up |trans-title=The spread of the plague |language=French |access-date=18 July 2024 |archive-date=18 July 2024 |archive-url=https://web.archive.org/web/20240718010607/https://www.biodiversitylibrary.org/item/22266#page/633/mode/1up |url-status=live }} From p. 674: ''"Nous avon pratiqué un certain nombre de fois l'examen microscopique du contenu intestinal des puces recueillies sur les rats spontanément pestiférés, et dans plusieurs cas nous avons constaté la présence d'un bacille morphologiquement semblable à celui de la peste."'' ("We carried out a number of times microscopic examinations of the intestinal contents of fleas [which were] collected from rats [which had become] infected with plague, and in several cases we noted the presence of a bacillus [which was] morphologically similar to that of the plague.")</ref> This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try to clear the blockage via [[vomiting|regurgitation]], resulting in thousands of plague bacteria flushing into the feeding site and infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as [[host (biology)|host]]s, keeping the disease [[endemic (epidemiology)|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 typhus|epidemic]].{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}}
The plague repeatedly returned to haunt Europe and the Mediterranean throughout the fourteenth to seventeenth centuries, and although bubonic plague still occurs in isolated cases today, the [[Great Plague of London]] in [[1665]]–[[1666]] is generally recognized as one of the last major outbreaks. The [[Great Fire of London]] in 1666 may have killed off any remaining plague-bearing rats and fleas, which led to a decline in the plague.


====DNA evidence====
Late outbreaks in central Europe include the [[Italian Plague of 1629-1631]], which is associated with troop movements during the [[Thirty Years' War]], and the [[Great Plague of Vienna]] in 1679.
[[File:Bubonic plague victims-mass grave in Martigues, France 1720-1721.jpg|thumb|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&nbsp;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.{{sfn|Haensch|Bianucci|Signoli|Rajerison|2010}}{{efn|In 1998, Drancourt et al. reported the detection of ''Y. pestis'' DNA in human dental pulp from a medieval grave.<ref>{{cite journal | vauthors = Drancourt M, Aboudharam G, Signoli M, Dutour O, Raoult D | title = Detection of 400-year-old Yersinia pestis DNA in human dental pulp: an approach to the diagnosis of ancient septicemia | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 95 | issue = 21 | pages = 12637–12640 | date = October 1998 | pmid = 9770538 | pmc = 22883 | doi = 10.1073/pnas.95.21.12637 | bibcode = 1998PNAS...9512637D | doi-access = free | issn=0027-8424}}</ref> Another team led by [[Marcus Thomas Pius Gilbert|Tom Gilbert]] cast doubt on this identification{{sfn|Gilbert|Cuccui|White|Lynnerup|2004}} and the techniques employed, stating that this method "does not allow us to confirm the identification of Y. pestis as the [[etiology|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 [[bacteremia|bacteraemia]]s in historical epidemics still awaits independent corroboration".}} They assessed the presence of [[DNA]]/[[RNA]] with [[polymerase chain reaction]] (PCR) techniques for ''Y. pestis'' from the [[dental alveolus|tooth socket]]s 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 [[disease causative agent|causative agent]] of the epidemic plague that devastated Europe during the Middle Ages".{{sfn|Haensch|Bianucci|Signoli|Rajerison|2010}} 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".{{sfn|Bos|2011}}
==Causes of bubonic infection==
===Bubonic plague theory===
[[Image:Yersinia pestis fluorescent.jpeg|thumb|right|''[[Yersinia pestis]]'' seen at 2000x magnification. This bacterium, carried and spread by fleas, is generally thought to have been the cause of millions of deaths]]


Later in 2011, [[Kirsten Bos|Bos]] et al. reported in ''[[Nature (journal)|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''.{{sfn|Bos|2011}}
Plague and the ecology of ''[[Yersinia pestis]]'' in soil, and in rodent and (possibly and importantly) human [[ectoparasite]]s are reviewed and summarized by Michel Drancourt in modeling sporadic, limited and large plague outbreaks.<ref>{{cite web
| last = Drancourt,
| first = M.
| authorlink =
| coauthors = Houhamdi, L; Raoult, D.
| title = Yersinia pestis as a telluric, human ectoparasite-borne organism
| work = Infectious Diseases
| publisher = [[The Lancet]]
| date =
| url = http://dx.doi.org/10.1016/S1473-3099(06)70438-8
| accessdate = }} </ref> Modelling of epizootic plague observed in prairie dogs suggests that occasional reservoirs of infection such as an infectious carcass, rather than "blocked fleas" are a better explanation for the observed [[epizootic]] behaviour of the disease in nature.<ref>{{cite web
| last = Webb,
| first = Colleen T.
| authorlink =
| coauthors = Christopher P. Brooks, Kenneth L. Gage, and Michael F. Antolin
| title = Classic flea-borne transmission does not drive plague epizootics in prairie dogs
| work = Infectious Diseases
| publisher = [[Proceedings of the National Academy of Sciences]]
| date = [[April 7]] [[2006]]
| url = http://www.pnas.org/cgi/reprint/0510090103v1the apples
| format=pdf
| accessdate = 2006-12-12 }} </ref>


Later genomic papers have further confirmed the [[phylogenetics|phylogenetic]] placement of the ''Y. pestis'' strain responsible for the Black Death as both the ancestor{{sfn|Spyrou|Keller|Tukhbatova|Scheib|2019}} of later plague epidemics—including the [[third plague pandemic]]—and the descendant{{sfn|Wagner|Klunk|Harbeck|Devault|2014}} of the strain responsible for the [[Plague of Justinian]]. In addition, plague genomes from prehistory have been recovered.{{sfn|Rasmussen|Allentoft|Nielsen|Orlando|2015}}
An interesting hypothesis about the [[epidemiology]]— the appearance, spread and especially disappearance— of plague from Europe is that the flea-bearing rodent reservoir of disease was eventually succeeded by another species. The [[black rat]] (''Rattus rattus'') was originally introduced from Asia to Europe by trade, but was subsequently displaced and succeeded throughout Europe by the bigger [[brown rat]] (''Rattus norvegicus''). The brown rat was not as prone to transmit the germ-bearing fleas to humans in large die-offs due to a different rat ecology.<ref>Appleby and Slack, secondary references.</ref> The dynamic complexities of rat ecology, [[herd immunity]] in that reservoir, interaction with human ecology, secondary transmission routes between humans with or without fleas, human herd immunity and changes in each might explain the eruption, dissemination, and re-eruptions of plague that continued for centuries until its (even more) unexplained disappearance.


DNA taken from 25 skeletons from 14th-century London showed that plague is a strain of ''Y. pestis'' almost identical to that which [[21st-century Madagascar plague outbreaks|hit Madagascar in 2013]].<ref name=guardian/><ref>{{Cite news|url=https://www.bbc.co.uk/news/science-environment-26770334|title=Black Death skeletons unearthed by Crossrail project| vauthors = Morgan J |date=30 March 2014|work=BBC News|access-date=20 August 2017|language=en-GB|archive-url=https://web.archive.org/web/20171225001808/http://www.bbc.co.uk/news/science-environment-26770334|archive-date=25 December 2017|url-status=live}}</ref> Further DNA evidence also proves the role of ''Y. pestis'' and traces the source to the [[Tian Shan]] mountains in [[Kyrgyzstan]].<ref>{{cite web|url=https://www.cnn.com/2022/06/15/health/black-death-plague-source-identified-scn/index.html|publisher=CNN|last=Hunt|first=Katie|title=DNA analysis reveals source of Black Death|date=June 15, 2022|access-date=June 18, 2022|archive-date=18 June 2022|archive-url=https://web.archive.org/web/20220618150441/https://www.cnn.com/2022/06/15/health/black-death-plague-source-identified-scn/index.html|url-status=live}}</ref>
====Signs and symptoms====
The three forms of plague brought an array of signs and symptoms to those infected. Bubonic plague refers to the painful [[lymph node]] swellings called [[bubo]]es, mostly found around the base of the neck, and in the armpits and groin. The septicaemic plague is a form of blood poisoning, and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck and armpits, which oozed pus and bled. Victims underwent damage to the skin and underlying tissue, until they were covered in dark blotches. Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land.


====Alternative explanations====
The [[bubonic plague]] was the most commonly seen form during the Black Death, with a [[mortality rate]] of thirty to seventy-five percent and symptoms including [[fever]] of 38 - 41 °[[Celsius|C]] (101-105 [[Fahrenheit|°F]]), [[headache]]s, painful aching joints, [[nausea]] and [[vomiting]], and a general feeling of [[malaise]]. Of those who contracted the bubonic plague, 4 out of 5 died within eight days. <ref>Rebecca Totaro, ''Suffering in Paradise: The Bubonic Plague in English Literature from More to Milton'', (Pittsburgh: Duquense University Press: 2005), p. 26.</ref> [[Pneumonic plague]] was the second most commonly seen form during the Black Death, with a [[mortality rate]] of ninety to ninety-five percent. Symptoms included fever, cough and blood-tinged [[sputum]]. As the disease progressed, sputum became free flowing and bright red. Septicaemic plague was the least common of the three forms, with [[mortality]] close to one hundred percent. Symptoms were high fevers and purple skin patches ([[purpura]] due to DIC ([[Disseminated intravascular coagulation]])).
Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague 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#Great Britain|poll tax]] of the year 1377.{{sfn|Ziegler|1998|p=233}} Estimates of plague victims are usually [[extrapolation|extrapolate]]d from figures for the clergy.


[[Mathematical modelling]] is used to match the spreading patterns and the means of [[transmission (medicine)|transmission]]. In 2018 researchers 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 the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data.<ref>{{cite news| vauthors = Guarino B |date=2018-01-16|newspaper=[[The Washington Post]]|url=https://www.washingtonpost.com/news/speaking-of-science/wp/2018/01/16/the-classic-explanation-for-the-black-death-plague-is-wrong-scientists-say/|title=The classic explanation for the Black Death plague is wrong, scientists say|archive-url=https://archive.today/20180122005044/https://www.washingtonpost.com/news/speaking-of-science/wp/2018/01/16/the-classic-explanation-for-the-black-death-plague-is-wrong-scientists-say/|archive-date=22 January 2018|access-date=2 April 2020|url-status=live}}</ref><ref>{{cite news|title=Rats May Not Be to Blame for Spreading the 'Black Death'| vauthors = Rettner R |publisher=[[Live Science]]|date=2018-01-17|url=https://www.livescience.com/61444-black-death-cause-found-transmission.html|access-date=2 April 2020|archive-date=28 March 2020|archive-url=https://web.archive.org/web/20200328004408/https://www.livescience.com/61444-black-death-cause-found-transmission.html|url-status=live}}</ref>
David Herlihy<ref>Herlihy, ''The Black Death and the Transformation of the West'' (1997) Harvard University Press: Cambridge, MA, p. 29.</ref> identifies another potential sign of the plague: freckle-like spots and rashes. Sources from Viterbo, Italy refer to "the signs which are vulgarly called ''lenticulae''," a word which bears resemblance to the Italian word for freckles, ''lentiggini''. These are not the swellings of buboes, but rather "darkish points or pustules which covered large areas of the body."


[[Lars Walløe]] argued that 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".{{sfn|Walløe|2008|p=69}} Similarly, [[Monica Green (historian)|Monica Green]] has argued that greater attention is needed to the range of (especially non-[[commensalism|commensal]]) animals that might be involved in the transmission of plague.{{sfn|Green|2015|pages=31ff}}
===Alternative explanations===
Recent scientific and historical investigations have led some researchers to doubt the long-held belief that the Black Death was an epidemic of bubonic plague. For example, in 2000, Gunnar Karlsson<ref>Karlsson, ''Iceland's 1100 Years: The History of a Marginal Society''</ref> pointed out that the Black Death killed between half and two-thirds of the population of [[Iceland]], although there were no rats in Iceland at this time. Rats were accidentally introduced in the nineteenth century, and have never spread beyond a small number of urban areas attached to seaports. In the fourteenth century there were no urban settlements in Iceland. Iceland was unaffected by the later plagues which are known to have been spread by rats. However, without a rodent reservoir, pneumonic plague can be transmitted from human to human by respiratory transmission, and bubonic and septicemic plague can be transmitted from human to human by human-biting fleas.


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.<ref>{{Cite news | vauthors = Kennedy M |title=Black Death study lets rats off the hook |journal=The Guardian |isbn=978-0-7524-2829-1 |place=London |url=https://www.theguardian.com/world/2011/aug/17/black-death-rats-off-hook |year=2011 |access-date=14 December 2016 |archive-url=https://web.archive.org/web/20130827191239/http://www.theguardian.com/world/2011/aug/17/black-death-rats-off-hook |archive-date=27 August 2013 |url-status=live }}</ref>{{sfn|Sloane|2011}} This theory is supported by research in 2018 which suggested transmission was more likely by body lice and [[Oriental rat flea|flea]]s during the [[second plague pandemic]].{{sfn|Dean|Krauer|Walløe|Lingjærde|2018}}
In addition, it was previously argued that tooth pulp tissue from a fourteenth-century plague cemetery in [[Montpellier]] tested positive for molecules associated with ''Y. pestis''. Similar findings were reported in a 2007 study, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17479906&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum "''Yersinia pestis Orientalis'' in remains of ancient plague patients."]</ref> but other studies have yielded negative results. In September 2003, a team of researchers from [[University of Oxford|Oxford University]] tested 121 teeth from sixty-six skeletons found in fourteenth-century mass graves. The remains showed no genetic trace of ''Y. pestis'', and the researchers suspect that the Montpellier study was flawed.


====Summary====
In 2002, Samuel K. Cohn published the controversial article, “The Black Death: End of the Paradigm.”<ref>Samuel. K Cohn, “The Black Death: End of a Paradigm,” The American Historical Review 107 (2002): 703-738.</ref> In the article Cohn argues that the medieval and modern plagues were two distinct diseases differing in their symptoms, signs and epidemiologies.<ref>Ibid., 703.</ref> Cohn asserts that the agent causing the bubonic plague, ''Yersinia pestis'', “was first cultured at Hong Kong in 1894.” <ref>Ibid.</ref> In turn, the medieval plague that struck Europe, according to Cohn, was not the bubonic plague carried by fleas on rats as traditionally viewed by scientists and historians alike.<ref>Ibid.</ref>
Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance.{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}} 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 tract infection|respiratory infection]]s. In addition to the bubonic infection, others point to additional [[Sepsis|septicemic]] and [[Pneumonia|pneumonic]] forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms.<ref name="Byrne2004pp21-9">{{harvnb|Byrne|2004|pp=21–29}}</ref> 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.<ref name="guardian" /> Currently, while [[osteoarchaeology|osteoarcheologist]]s 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.{{sfn|Snowden|2019|pp=50–51}}
Cohn’s argument that medieval plague was not rat-based is supported by his claims that the modern and medieval plagues hit in different seasons, had unparalleled cycles of recurrence, and varied in the manner in which immunity was acquired. The modern plague reaches its peak in seasons with high humidity and a temperature of between 50 and 78 degrees, as rats’ fleas thrive in this climate.<ref>Ibid., 725.</ref> In comparison, the Black Death is recorded as hitting in periods where rats’ fleas could not survive, i.e. hot Mediterranean summers above 78 degrees Fahrenheit.<ref>Ibid.</ref> In terms of recurrence, the Black Death on average did not resurface in an area for between five and fifteen years after it hit.<ref>Ibid., 727.</ref> Contrastingly, modern plagues often hit an affected area yearly for an average to eight to forty years.<ref>Ibid.</ref> Last, Cohn presents evidence displaying that individuals gained immunity to the Black Death during the fourteenth century, unlike the modern plague. He states that in 1348 two-thirds of those suffering from plague died in comparison to one-twentieth by 1382.<ref>Ibid.</ref> Statistics contrastingly display that immunity to the modern plague has not been acquired.


===Transmission===
Cohn also points out that in the latter part of the nineteenth century buboes appeared mostly on an infected person's groin, while medieval primary sources indicate that the Black Death caused buboes to appear on necks, armpits, and groins. This difference, he argues, ties in with the fact that fleas caused the modern plague and not the Black Death. Since flea bites do not usually reach beyond a person's ankles, in the modern period the groin was the nearest lymph node that could be infected. As the neck and the armpit were often infected during the medieval plague, it appears less likely that these infections were caused by fleas on rats. <ref> Samuel K. Cohn, ''The Black Death Transformed: Disease and Culture in Early Renaissance Europe'' (London: Edward Arnold Publishers, 2002), 81.</ref>
{{Main|Black Death migration}}


====Lack of hygiene====
In 1984, Graham Twigg published ''The Black Death: A Biological Reappraisal'', where he argued that the climate and ecology of Europe and particularly England made it nearly impossible for rats and fleas to have transmitted bubonic plague. Combining information on the biology of ''[[Rattus rattus]]'', ''[[Rattus norvegicus]]'', and the common fleas ''[[Xenopsylla cheopis]]'' and ''[[Pulex irritans]]'' with modern studies of plague epidemiology, particularly in India, where the ''R. rattus'' is a native species and conditions are nearly ideal for plague to be spread, Twigg concludes that it would have been nearly impossible for ''Yersinia pestis'' to have been the causative agent of the plague, let alone its explosive spread across Europe. Twigg also shows that the common theory of entirely pneumonic spread does not hold up. He proposes, based on a re-examination of the evidence and symptoms, that the Black Death may actually have been an epidemic of pulmonary [[anthrax]] caused by ''[[Bacillus anthracis]]''.
The importance of [[hygiene]] was not recognized until the 19th century and the [[germ theory of disease]]. Until then streets were usually unhygienic, with live animals and human parasites facilitating the spread of [[transmission (medicine)|transmissible disease]].<ref>{{Cite journal|date=2019-11-14|title=Erratum to: The Path to Pistoia: Urban Hygiene Before the Black Death|journal=Past & Present|issue=251|pages=e2|doi=10.1093/pastj/gtz060|issn=0031-2746|doi-access=free}}</ref>


By the early 14th 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.{{sfn|Kelly|2006|pp=16-17}} Pigs, cattle, chickens, geese, goats and horses roamed the streets of medieval London and Paris.
In 2001, [[epidemiology|epidemiologists]] Susan Scott and Christopher Duncan from [[Liverpool University]] proposed the theory that the Black Death might have been caused by an [[Ebola virus|Ebola]]-like [[virus (biology)|virus]], not a bacterium. Their rationale was that this plague spread much faster and the incubation period was much longer than other confirmed ''Y.pestis''-caused plagues. A longer period of incubation will allow carriers of the infection to travel farther and infect more people than a shorter one. When the primary [[vector (biology)|vector]] is humans, as opposed to birds, this is of great importance. Studies of English church records indicate an unusually long incubation period in excess of thirty days, which could account for the rapid spread, topping at 5 km/day. The plague also appeared in areas of Europe where rats were uncommon, areas such as [[Iceland]]. Epidemiological studies suggest the disease was transferred between humans (which happens rarely with ''Yersinia pestis'' and very rarely for ''Bacillus anthracis''), and some [[gene]]s that determine immunity to Ebola-like viruses are much more widespread in [[Europe]] than in other parts of the world. Their research and findings are thoroughly documented in ''Return of the Black Death: The World's Greatest Serial Killer.'' More recently the researchers have published computer modeling<ref> [http://jmg.bmj.com/cgi/content/abstract/42/3/205 ''Journal of Medical Genetics'': March 2005]</ref> demonstrating how the Black Death has made around 10% of Europeans resistant to HIV.


Medieval homeowners were supposed to police their housefronts, including removing animal dung, but most urbanites were careless. William E. Cosner, a resident of the London suburb of Farringdon Without, received a complaint alleging that "men could not pass [by his house] for the stink [of] . . . horse dung and horse piss." 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.{{sfn|Kelly|2006|pp=16-17, 68}}
In a similar vein, historian [[Norman F. Cantor]], in his 2001 book ''In the Wake of the Plague'', suggests the Black Death might have been a combination of pandemics including a form of [[anthrax disease|anthrax]], a cattle [[murrain]]. He cites many forms of evidence including: reported disease symptoms not in keeping with the known effects of either bubonic or [[pneumonic plague]], the discovery of anthrax spores in a [[plague pit]] in [[Scotland]], and the fact that meat from infected cattle was known to have been sold in many rural English areas prior to the onset of the plague. It is notable that the means of infection varied widely, from human-to-human contact as in Iceland (rare for plague and cutaneous ''Bacillus anthracis'') to infection in the absence of living or recently-dead humans, as in Sicily (which speaks against most viruses). Also, diseases with similar symptoms were generally not distinguished between in that period (see ''murrain'' above), at least not in the Christian world; Chinese and Muslim medical records can be expected to yield better information which however only pertains to the specific disease(s) which affected these areas.


Early Christians considered bathing a temptation. With this danger in mind, [[Benedict of Nursia|St. Benedict]] declared, "To those who are well, and especially to the young, bathing shall seldom be permitted." [[Agnes of Rome|St. Agnes]] took the injunction to heart and died without ever bathing.{{sfn|Kelly|2006|pp=71-72}}
====Counter-arguments====
Historians who believe that the Black Death was indeed caused by [[bubonic plague]] have put forth several counterarguments.


====Territorial origins====
The uncharacteristically rapid spread of the plague could be due to respiratory droplet transmission, and low levels of immunity in the European population at that period. Historical examples of pandemics of other diseases in populations without previous exposure, such as [[smallpox]] and [[tuberculosis]] transmitted by aerosol amongst [[Indigenous peoples of the Americas|Native Americans]], show that the first instance of an epidemic spreads faster and is far more virulent than later instances among the descendants of survivors, for whom natural selection has produced characteristics that are protective against the disease.
According to a team of [[medical genetics|medical geneticist]]s led by [[Mark Achtman]], ''Yersinia pestis'' "evolved in or near China" over 2,600 years ago.<ref>{{cite web |url=https://www.medicalnewstoday.com/articles/206309#1 |title=Origins Of The Black Death Traced Back To China, Gene Sequencing Has Revealed |work=Medicalnewstoday.com | vauthors = Nordqvist C |date=1 November 2010 |access-date=13 December 2021 |url-status=live |archive-url=https://web.archive.org/web/20220717060853/https://www.medicalnewstoday.com/articles/206309 |archive-date=17 July 2022}}</ref><ref>{{cite news| vauthors = Wade N |url=https://www.nytimes.com/2010/11/01/health/01plague.html|title=Europe's Plagues Came From China, Study Finds|date=31 October 2010|work=[[The New York Times]]|access-date=25 March 2020|url-status=live|archive-url=https://web.archive.org/web/20101104083917/http://www.nytimes.com/2010/11/01/health/01plague.html|archive-date=4 November 2010|quote=The great waves of plague that twice devastated Europe and changed the course of history had their origins in China, a team of medical geneticists reported Sunday, as did a third plague outbreak that struck less harmfully in the 19th century.&nbsp;... In the issue of ''[[Nature Genetics]]'' published online Sunday, they conclude that all three of the great waves of plague originated from China, where the root of their tree is situated.&nbsp;... The likely origin of the plague in China has nothing to do with its people or crowded cities, Dr. Achtman said. The bacterium has no interest in people, whom it slaughters by accident. Its natural hosts are various species of rodent such as marmots and voles, which are found throughout China.|author-link=Nicholas Wade}}</ref>{{sfn|Morelli|Song|Mazzoni|Eppinger|2010}} Later research by a team led by Galina Eroshenko placed its origins more specifically in the [[Tian Shan]] mountains on the border between [[Kyrgyzstan]] and China.<ref name="pmid29073248">{{cite journal | vauthors = Eroshenko GA, Nosov NY, Krasnov YM, Oglodin YG, Kukleva LM, Guseva NP, Kuznetsov AA, Abdikarimov ST, Dzhaparova AK, Kutyrev VV | display-authors = 6 | title = Yersinia pestis strains of ancient phylogenetic branch 0.ANT are widely spread in the high-mountain plague foci of Kyrgyzstan | journal = PLOS ONE | volume = 12 | issue = 10 | pages = e0187230 | date = 2017 | pmid = 29073248 | pmc = 5658180 | doi = 10.1371/journal.pone.0187230 | bibcode = 2017PLoSO..1287230E | doi-access = free }}</ref>{{sfn|Slavin|2019}} However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of ''Y. pestis'' in the Caucasus region previously thought to be restricted to China.<ref name = "spyrou">{{cite journal | vauthors = Spyrou MA, Tukhbatova RI, Feldman M, Drath J, Kacki S, Beltrán de Heredia J, Arnold S, Sitdikov AG, Castex D, Wahl J, Gazimzyanov IR, Nurgaliev DK, Herbig A, Bos KI, Krause J | display-authors = 6 | title = Historical Y. pestis Genomes Reveal the European Black Death as the Source of Ancient and Modern Plague Pandemics | journal = Cell Host & Microbe | volume = 19 | issue = 6 | pages = 874–881 | date = June 2016 | pmid = 27281573 | doi = 10.1016/j.chom.2016.05.012 | doi-access = free }}</ref> 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.<ref name="telegraph china">{{Cite news |url=https://www.telegraph.co.uk/news/worldnews/asia/china/8102278/Black-Death-may-have-originated-in-China.html |title=Black Death may have originated in China |journal=The Daily Telegraph |date=1 November 2010 | vauthors = Moore M |access-date=2 April 2018 |archive-url=https://web.archive.org/web/20171018235115/http://www.telegraph.co.uk/news/worldnews/asia/china/8102278/Black-Death-may-have-originated-in-China.html |archive-date=18 October 2017 |url-status=live }}</ref> 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.<ref>{{cite book | vauthors = Creighton C |title=A History of Epidemics in Britain |location=Cambridge |publisher=At the University Press |date=1891 |page=153}}</ref> The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s.{{sfn|Sussman|2011}}


[[Nestorianism|Nestorian]] gravesites dating from 1338 to 1339 near [[Issyk-Kul]] have inscriptions referring to plague, which has led some historians and [[epidemiology|epidemiologist]]s 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.<ref name="Spyrou 1–7"/> Epidemics killed an estimated 25&nbsp;million across Asia during the fifteen&nbsp;years before the Black Death reached [[Constantinople]] in 1347.<ref>{{Cite book |url=https://books.google.com/books?id=tzRwRmb09rgC&pg=PA31 |title=Encyclopedia of plague and pestilence: from ancient times to the present |vauthors=Kohn GC |publisher=Infobase Publishing |year=2008 |isbn=978-0-8160-6935-4 |page=31 |access-date=16 October 2015 |archive-url=https://web.archive.org/web/20190331195953/https://books.google.com/books?id=tzRwRmb09rgC&pg=PA31 |archive-date=31 March 2019 |url-status=live}}</ref><ref>{{harvnb|Hecker|1859|p=21}} cited by Ziegler, p. 15.</ref>
Michael McCormick, a historian offering the idea that bubonic plague was indeed the source of the Black Death, explains how archaeological research has confirmed that the black or "ship" rat was indeed present in Roman and medieval Europe. Also, the DNA of ''Y. pestis'' has been identified in the teeth of human victims, the same DNA which has been widely believed to have come from the infected rodents. <ref> Michael McCormick, "Rats, Communications, and Plague: Toward an Ecological History," ''Journal of Interdisciplinary History'' '''34''' (2003): 25. </ref> He does not refute the point that there exists a pneumonic expression of ''Y. pestis'' transmitted by human-to-human contact, but he states that this does not spread as easily as previous historians have imagined. The rat, according to him, is the only plausible agent of transmission that could have led to such a wide and quick spread of the plague. This is because of rats' proclivity to associate with humans and the ability of their blood to withstand very large concentrations of the bacillus. <ref> Ibid., 2. </ref> When rats died, their fleas (which were infected with bacterial blood) found new hosts in the form of humans and animals. The Black Death tapered off in the eighteenth century, and according to McCormick, a rat-based theory of transmission could explain why this occurred. The plague(s) had killed a lot of the human host population of Europe and dwindling cities meant that more people were isolated, and so geography and demography did not allow rats to have as much contact with Europeans. Slacking communication systems also hindered the replenishment of decimated rat colonies. <ref> Ibid., 23. </ref>


{{blockquote|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.{{sfn|Slavin|2019}}|Philip Slavin}}
==A Malthusian crisis==
In addition, various historians have adopted yet another theory for the cause of the Black Plague, one that points to social, agricultural, and sometimes economic causes. Often known as the [[Malthusian]] limit, scholars use this term to express, and/or explain, certain tragedies throughout history. In his 1798 ''Essay on the Principle of Population'', [[Thomas Malthus]] asserted that eventually humans would reproduce so greatly that they would go beyond the limits of food supplies; once they reached this point, some sort of "reckoning" was inevitable. While the Black Death may appear to be a "reckoning" of this sort, it was in fact an external, unpredictable factor and does not therefore fit into the Malthusian theory. In his book, ''The Black Death and the Transformation of the West'', [[David Herlihy]] explores this idea of Plague as an inevitable crisis wrought on man in order to control the population and human resources. In the book, ''The Black Death; A Turning Point in History?'' “implies that the Black Death’s pivotal role in late medieval society... was now being challenged. Arguing on the basis of a neo-Malthusian economics, revisionist historians recast the Black Death as a necessary and long overdue corrective to an overpopulated Europe” .


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.{{sfn|Sussman|2011}} 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.<ref name="telegraph china" /> Additionally, 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 its role in the spread of plague less likely.{{sfn|Sussman|2011}} 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.{{sfn|Sussman|2011|p=328}}
Herlihy examines the arguments against the Malthusian crisis, stating “if the Black Death was a response to excessive human numbers it should have arrived several decades earlier” due to the population growth of years before the outbreak of the Black Death. Herlihy also brings up other, biological factors that argue against the Plague as a "reckoning" by arguing “the role of famines in affecting population movements is also problematic. The many famines preceding the Black Death, even the ‘great hunger’ of 1314 to 1317, did not result in any appreciable reduction in population levels”. Finally Herlihy concludes the matter stating, “the medieval experience shows us not a Malthusian crisis but a stalemate, in the sense that the community was maintaining at stable levels very large numbers over a lengthy period” and states that the phenomenon should be referred to as more of a deadlock, rather than a crisis, to describe Europe before the epidemics.


Others still favor an origin in China.{{sfn|Slavin|2019}} The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside [[Mongols|Mongol]] armies and traders, or possibly arriving via ship—however, 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.<ref name="telegraph china" />
==Consequences==
===Depopulation===
''See also: [[Medieval demography]].''


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 14th-century China, suggesting that the Black Death may not have reached these regions.{{sfn|Sussman|2011}}<ref name="telegraph china"/>{{sfn|Benedictow|2004|pp=48–49}} Ole Benedictow argues that since the first clear reports of the Black Death come from [[Kaffa (city)|Kaffa]], the Black Death most likely originated in the nearby plague focus on the northwestern shore of the [[Caspian Sea]].{{sfn|Benedictow|2004|pp=50–51}}
Figures for the [[death toll]] vary widely by area and from source to source as new research and discoveries come to light. According to medieval historian [[Philip Daileader]] in 2007<ref>[[Philip Daileader]], ''The Late Middle Ages'', audio/video course produced by [[The Teaching Company]], 2007. ISBN 978-1-59803-345-8</ref>:
<blockquote>The trend of recent research is pointing to a figure more like 45% to 50% of the European population dying during a four-year period. There is a fair amount of geographic variation. In Mediterranean Europe and Italy, the South of France and Spain, where plague ran for about four years consecutively, it was probably closer to 70% to 75% of the population. In Germany and England . . . it was probably closer to 20%.</blockquote>


{{blockquote|Demographic historians estimate that China's population fell by at least 15 per cent, 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.{{sfn|von Glahn|2016|p=440}}|Richard von Glahn}}
====Asia====
Estimates of the demographic impact of the plague in Asia are based on both population figures during this time and estimates of the disease's toll on population centers. The initial outbreak of plague in the [[China|Chinese]] province of [[Hubei]] in 1334 claimed up to ninety percent of the population, an estimated five million people. During 1353–54, outbreaks in eight distinct areas throughout the [[Mongol Empire|Mongol/Chinese empires]] may have possibly caused the death of two-thirds of China's population, often yielding an estimate of twenty-five million deaths.<ref>[http://www.experiencefestival.com/a/Black_Death_-_Consequences/id/617544 Black Death - Consequences]</ref> Japan had no outbreak of plague.{{Fact|date=February 2007}}


Monica Green suggests that other parts of [[Eurasia]] outside the west do not contain the same evidence of the Black Death, 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 Death.{{sfn|Green|2020}} Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China.<ref name="spyrou" /> Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China.{{sfn|Sussman|2011|p=354}} Norris specifically argues for an origin in Kurdistan rather than Central Asia.{{sfn|Sussman|2011|p=328}}
====Europe and Middle East====
It is estimated that between one-quarter and two-thirds of the European population died from the outbreak between 1348 and 1350.<ref name="barry" /><ref name="gottfried" /> Contemporary observers, such as [[Jean Froissart]], estimated the toll to be one-third -- less an accurate assessment than an allusion to the [[Book of Revelation]] meant to suggest the scope of the plague.<ref>Jean Froissart, ''Chronicles'' (trans. Geoffrey Brereton, Penguin, 1968, corrections 1974) pp.111</ref> Many rural villages were depopulated, mostly the smaller communities, as the few survivors fled to larger towns and cities leaving behind [[abandoned village]]s.<ref>Joseph Patrick Byrne (2004). ''The Black Death''. ISBN 0313324921 - Page 64.</ref> The Black Death hit the culture of towns and cities disproportionately hard, although rural areas (where most of the population lived) were also significantly affected. A few rural areas, such as [[Poland|Eastern Poland]] and [[Lithuania]], had such low populations and were so isolated that the plague made little progress. Parts of [[Hungary]] and, in modern Belgium, the [[Duchy of Brabant|Brabant]] region, [[County of Hainaut|Hainaut]] and [[Limbourg]], as well as [[Santiago de Compostella]], were unaffected for unknown reasons (some historians<ref> Stéphane Barry and Norbert Gualde, "The Biggest Epidemic of History" (''La plus grande épidémie de l'histoire'', in ''[[L'Histoire]]'' n°310, June 2006, pp.45-46</ref> have assumed that the presence of resistant blood groups in the local population helped them resist the disease, although these regions would be touched by the second plague outbreak in 1360-1363 and later during the numerous resurgences of the plague). Other areas which escaped the plague were isolated mountainous regions (e.g. the [[Pyrenees]]). Larger cities were the worst off, as population densities and close living quarters made disease transmission easier. Cities were also strikingly filthy, infested with lice, fleas and rats, and subject to diseases related to malnutrition and poor hygiene. According to journalist John Kelly, "[w]oefully inadequate sanitation made medieval urban Europe so disease-ridden, no city of any size could maintain its population without a constant influx of immigrants from the countryside."(p. 68) The influx of new citizens facilitated the movement of the plague between communities, and contributed to the longevity of the plague within larger communities.


====European outbreak====
In Italy, [[Florence]]'s population passed from 110,000 or 120,000 inhabitants in 1338 to 50,000 in 1351. Between 60 to 70% of [[Hamburg]] and [[Bremen (city)|Bremen]]'s population died. In [[Provence]], [[Dauphiné]] or [[Normandy]], historians observe a decrease of 60% of fiscal hearths. In some regions, two thirds of the population was annihilated. In the town of [[Givry]], in the [[Bourgogne]] region in [[France]], the friar, who used to note 28 to 29 funerals a year, recorded 649 deaths in 1348, half of them in September. About half of [[Perpignan]]'s population died in several months (only two of the eight physicians survived the plague). England lost 70% of its population, which passed from 7 million to 2 million in 1400.<ref name="Barry"/>
{{quote box
|align = right
|width = 25em
|quote = The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in [[Dorsetshire]], where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive.
... But at length it came to [[Gloucester]], yea even to [[Oxford]] and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive.
|source = [[Geoffrey the Baker]], ''Chronicon Angliae''<ref>{{cite book|title=Galfridi Le Baker de Swinbroke, Chronicon Angliae temporibus Edwardi II et Edwardi III| vauthors = Baker G | veditors = Gilles AJ |url= https://archive.org/details/galfridilebaker00gilegoog|archive-url=https://archive.org/details/galfridilebaker00gilegoog/page/n27|archive-date=3 August 2008| location=Londini|publisher=apud Jacobum Bohn| year=1847|orig-year=1350| lccn = 08014593 | ol =6996785M| via=[[Internet Archive]]|language=la, en}}</ref>
}}


Plague was reportedly first introduced to Europe via [[Republic of Genoa|Genoese]] traders from their port city of [[Feodosia|Kaffa]] in the [[Crimea]] in 1347. During a [[Genoese–Mongol Wars|protracted siege]] of the city in 1345–1346, the Mongol [[Golden Horde]] army of [[Jani Beg]]—whose mainly [[Tatar confederation|Tatar]] troops were suffering from the disease—[[biological warfare|catapulted infected corpse]]s over the city walls of Kaffa to infect the inhabitants,{{sfn|Wheelis|2002}} though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants.{{sfn|Barras|Greub|2014|ps= "In the Middle Ages, a famous although controversial example is offered by the [[siege of Caffa]] (now Feodossia in Ukraine/Crimea), a Genovese outpost on the Black Sea coast, by the Mongols. In 1346, the attacking army experienced an epidemic of bubonic plague. The Italian chronicler Gabriele de' Mussi, in his ''Istoria de Morbo sive Mortalitate quae fuit Anno Domini 1348'', describes quite plausibly how plague was transmitted by the Mongols by throwing diseased cadavers with catapults into the besieged city, and how ships transporting Genovese soldiers, fleas and rats fleeing from there brought it to the Mediterranean ports. Given the highly complex epidemiology of plague, this interpretation of the Black Death (which might have killed >25 million people in the following years throughout Europe) as stemming from a specific and localized origin of the Black Death remains controversial. Similarly, it remains doubtful whether the effect of throwing infected cadavers could have been the sole cause of the outburst of an epidemic in the besieged city."}}<ref>{{Cite book| vauthors = Byrne JP |url=https://books.google.com/books?id=5KtDfvlSrDAC|title=Encyclopedia of the Black Death|publisher=ABC-CLIO|year=2012|isbn=978-1-59884-253-1|location=Santa Barbara, California|pages=65|language=en|chapter=Caffa (Kaffa, Fyodosia), Ukraine|access-date=8 May 2020|archive-date=4 June 2020|archive-url=https://web.archive.org/web/20200604122924/https://books.google.com/books?id=5KtDfvlSrDAC|url-status=live}}</ref> As the disease took hold, Genoese traders fled across the [[Black Sea]] to [[Constantinople]], where the disease first arrived in Europe in summer 1347.<ref name=":5">{{Cite book| vauthors = Byrne JP |title=Encyclopedia of the Black Death|publisher=ABC-CLIO|year=2012|isbn=978-1-59884-254-8|location=Santa Barbara, California.|pages=87|chapter=Constantinople/Istanbul|oclc=769344478}}</ref>
All social classes were affected, although the lower classes, living together in unhealthy places, were most vulnerable. [[Alfonso XI of Castile]] was the only royal victim of the plague, but [[Peter IV of Aragon]] lost his wife, his daughter and a niece in six months. The [[Byzantine Emperor]] lost his son, while in the [[kingdom of France]], [[Joan II of Navarre|Joan of Navarre]], daughter of [[Louis X of France|Louis X ''le Hutin'']] and of [[Margaret of Burgundy, Queen of Navarre|Margaret of Burgundy]], was killed by the plague, as well as [[Bonne of Bohemia|Bonne of Luxembourg]], the wife of the future [[John II of France]].


The epidemic there killed the 13-year-old son of the [[Byzantine Empire|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]], noting the spread of the Black Death by ship between maritime cities.<ref name=":5" /> [[Nicephorus Gregoras]], while writing to [[Demetrios Kydones]], described the rising death toll, the futility of medicine, and the panic of the citizens.<ref name=":5" /> The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400.<ref name=":5" />
Furthermore, resurgences of the plague in later years must also be counted: in 1360-62 (the "little mortality"), in 1366-1369, 1374-1375, 1400, 1407, etc. The plague was not eradicated until the 19th century.


Carried by twelve Genoese galleys, plague arrived by ship in [[Sicily]] in October 1347;<ref>Michael of Piazza (Platiensis) ''Bibliotheca scriptorum qui res in Sicilia gestas retulere'' Vol 1, p. 562, cited in Ziegler, 1998, p. 40.</ref> 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 into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in [[Marseille]]s.<ref>De Smet, Vol II, ''Breve Chronicon'', p. 15.</ref>
The precise demographic impact of the disease in the [[Middle East]] is very difficult to calculate. Mortality was particularly high in rural areas, including significant areas of Palestine and [[Syria]]. Many surviving rural people fled, leaving their fields and crops, and entire rural provinces are recorded as being totally depopulated. Surviving records in some cities reveal a devastating number of deaths. The 1348 outbreak in [[Gaza]] left an estimated 10,000 people dead, while [[Aleppo]] recorded a death rate of 500 a day during the same year. In [[Damascus]], at the disease's peak in September and October 1348, a thousand deaths were recorded every day, with overall mortality estimated at between twenty-five and thirty-eight percent. Syria lost a total of 400,000 people by the time the epidemic subsided in March 1349. In contrast to some higher mortality estimates in Asia and Europe, scholars such as John Fields of [[Trinity College, Dublin|Trinity College]] in Dublin believe the mortality rate in the Middle East was less than one-third of the total population, with higher rates in selected areas.


[[Black Death in Italy|From Italy]], the disease spread northwest across Europe, [[Black Death in France|striking France]], [[Black Death in Spain|Spain]], Portugal, and [[Black Death in England|England]] by June 1348, then spreading east and north [[Black Death in Germany|through Germany]], Scotland and Scandinavia from 1348 to 1350. It was introduced [[Black Death in Norway|into Norway]] in 1349 when a ship landed at [[Askøy]], then spread to Bjørgvin (modern [[Bergen]]).{{sfn|Karlsson|2000|page=111}} Finally, it [[Black Death in Russia|spread to northern Russia]] in 1352 and reached [[Moscow]] in 1353.<ref>{{cite book |last1=Byrne |first1=Joseph P. |title=Encyclopedia of the Black Death |date=16 January 2012 |publisher=Bloomsbury Publishing USA |isbn=978-1-59884-254-8 |page=245 |url=https://books.google.com/books?id=FkzEEAAAQBAJ |language=en}}</ref><ref name="Belich">{{cite book |last1=Belich |first1=James |title=The World the Plague Made: The Black Death and the Rise of Europe |date=25 June 2024 |publisher=Princeton University Press |isbn=978-0-691-21916-5 |page=42 |url=https://books.google.com/books?id=P3frEAAAQBAJ |language=en |quote=Northern Russia was hit in 1352, beginning in towns close to the Baltic, Novgorod, and Pskov, and reaching Moscow in 1353.}}</ref> Plague was less common in parts of Europe with less-established trade relations, including the majority of the [[Basque Country (greater region)|Basque Country]], isolated parts of Belgium and [[Black Death in the Netherlands|the Netherlands]], and isolated Alpine villages throughout the continent.{{sfn|Zuchora-Walske|2013}}{{sfn|Welford|Bossak|2010}}<ref>{{cite journal | vauthors = Curtis DR, Roosen J | title = The sex-selective impact of the Black Death and recurring plagues in the Southern Netherlands, 1349-1450 | journal = American Journal of Physical Anthropology | volume = 164 | issue = 2 | pages = 246–259 | date = October 2017 | pmid = 28617987 | pmc = 6667914 | doi = 10.1002/ajpa.23266 }}</ref>
===Socio-economic effects===
[[Image:Plague victims blessed by priest.jpg|thumb|270px|Monks, disfigured by the plague, being blessed by a priest. England, [[1360]]–[[1375|75]].]]
The [[government]]s of Europe had no apparent response to the crisis because no one knew its cause or how it spread. In 1348, the plague 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 fifty percent of the population to die. Europeans living in isolated areas suffered less, and monasteries and priests were especially hard hit since they cared for the Black Death's victims. <ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 329. </ref> Because fourteenth century healers were at a loss in explaining the cause, Europeans turned to astrological forces, earthquakes, and the poisoning of wells by Jews as possible reasons for the plagues emergence. <ref> Ibid. </ref> No one in the fourteenth century considered rat control a way to ward off the plague, and people began to believe only God's anger could produce such horrific displays. As a result, Christians began to attack Jews to please God and end the plague. For example, in August of 1349, the Jewish communities of Mainz and Cologne were exterminated. In February of that same year, Christians murdered two thousand Jews in Strasbourg. <ref> Ibid., 329-330. </ref> Where government authorities were concerned, most [[monarchs]] instituted measures that prohibited exports of foodstuffs, condemned [[black market]] [[speculators]], set [[price controls]] on grain, and outlawed large-scale fishing. At best, they proved mostly unenforceable, and at worst they contributed to a continent-wide downward spiral. The hardest hit lands, like England, were unable to buy grain abroad: from France because of the prohibition, and from most of the rest of the grain producers because of crop failures from shortage of labour. Any grain that could be shipped was eventually taken by [[piracy|pirates]] or [[looters]] to be sold on the black market. Meanwhile, many of the largest countries, most notably England and [[Scotland]], had been at war, using up much of their [[treasury]] and exacerbating [[inflation]]. In [[1337]], on the eve of the first wave of the Black Death, England and France went to war in what would become known as the [[Hundred Years' War]], further depleting their treasuries, population, and [[infrastructure]]. Malnutrition, poverty, disease and hunger, coupled with war, growing inflation and other economic concerns made Europe in the mid-fourteenth century ripe for tragedy.


According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts,{{sfn|Samia|Kausrud|Heesterbeek|Ageyev|2011}} inducing plague outbreaks which often peaked in the hot summers of the Mediterranean{{sfn|Cohn|2008}} and during the cool autumn months of the southern [[Baltic region]].<ref>[https://books.google.com/books?id=JcdONPwL2wC&dq=(2004)+Städtesystem+und+Urbanisierung+im+Ostseeraum+in+der+frühen+Neuzeit:+Wirtschaft,+Baukultur+und+historische+Informationssysteme:+Beiträge+des+wissenschaftlichen+Kolloquiums+in+Wismar+vom+4.+und+5.+September+2003+(LIT,+Munster,+Germany).+German&pg=PA7 Stefan Kroll]{{Dead link|date=October 2023 |bot=InternetArchiveBot |fix-attempted=yes }}, Kersten Krüger (2004). LIT Verlag Berlin. {{ISBN|3-8258-8778-2}}</ref>{{efn|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 [[gerbillinae|gerbil]]s.<ref>{{cite magazine|title=Bubonic plague was a serial visitor in European Middle Ages|url=https://www.sciencenews.org/article/bubonic-plague-was-serial-visitor-european-middle-ages|last= Baggaley |first=Kate |date=24 February 2015|magazine=Science News|access-date=24 February 2015|archive-url=https://web.archive.org/web/20150224160907/https://www.sciencenews.org/article/bubonic-plague-was-serial-visitor-european-middle-ages|archive-date=24 February 2015|url-status=live}}</ref>{{sfn|Schmid|Büntgen|Easterday|Ginzler|2015}}}} Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population.<ref name="Baten">{{Cite journal|vauthors=Baten J, Koepke N|date=2005|title=The Biological Standard of Living in Europe during the Last Two Millennia|url=https://academic.oup.com/ereh/issue.|journal=European Review of Economic History|volume=9|issue=1|pages=61–95|via=EBSCO|doi=10.1017/S1361491604001388|hdl=10419/47594|hdl-access=free|access-date=4 February 2020|archive-date=13 December 2021|archive-url=https://web.archive.org/web/20211213222853/https://academic.oup.com/ereh/issue.|url-status=live}}</ref>
The plague did more than just devastate the medieval population; it caused a substantial change in economy and society in all areas of the world. Economic historians like [[Fernand Braudel]] have concluded that Black Death exacerbated a [[recession]] in the European economy that had been under way since the beginning of the century. As a consequence, social and economic change greatly accelerated during the fourteenth and fifteenth centuries. The church's power was weakened, and in some cases, the social roles it had played were replaced by secular ones. Also the plague led to [[Popular revolt in late medieval Europe|peasant uprisings]] in many parts of Europe, such as France (the [[Jacquerie rebellion]]), Italy (the [[Ciompi rebellion]], which swept the city of [[Florence]]), and in England (the [[English Peasant Revolt]]).


====West Asian and North African outbreak====
Europe had been overpopulated before the plague, and a reduction of 30% to 50% of the population could have resulted in higher wages and more available land and food for peasants because of less competition for resources. However, for reasons that are still debated, population levels declined after the Black Death's first outbreak until around 1420 and did not begin to rise again until 1470, so the initial Black Death event on its own does not entirely provide a satisfactory explanation to this extended period of decline in prosperity. See [[Medieval demography]] for a more complete treatment of this issue and current theories on why improvements in living standards took longer to evolve.
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.{{sfn|Green|2018}}


By autumn 1347, plague had reached [[Alexandria]] in Egypt, transmitted by sea from [[Constantinople]] via a single merchant ship carrying slaves.<ref name=":6">{{Cite book| vauthors = Byrne JP |url=https://books.google.com/books?id=5KtDfvlSrDAC|title=Encyclopedia of the Black Death|publisher=ABC-CLIO|year=2012|isbn=978-1-59884-253-1|location=Santa Barbara, California|pages=51|language=en|access-date=8 May 2020|archive-date=4 June 2020|archive-url=https://web.archive.org/web/20200604122924/https://books.google.com/books?id=5KtDfvlSrDAC|url-status=live}}</ref> By late summer 1348, it reached [[Cairo]], capital of the [[Mamluk Sultanate]], cultural center of the [[Muslim world|Islamic world]], and the largest city in the [[Mediterranean Basin]]; the [[Bahri dynasty|Bahriyya]] child sultan [[an-Nasir Hasan]] fled and more than a third of the 600,000 residents died.<ref name=":7">{{Cite book| vauthors = Byrne JP |title=Encyclopedia of the Black Death|publisher=ABC-CLIO|year=2012|isbn=978-1-59884-254-8|location=Santa Barbara, California|pages=65–66|chapter=Cairo, Egypt|oclc=769344478}}</ref> The [[Nile]] was choked with corpses despite Cairo having a medieval hospital, the late 13th-century [[bimaristan]] of the [[Qalawun complex]].<ref name=":7" /> The historian [[al-Maqrizi]] described the abundant work for grave-diggers and practitioners of [[Islamic funeral|funeral rite]]s; plague recurred in Cairo more than fifty times over the following one and a half centuries.<ref name=":7" />
The great population loss brought economic changes based on increased social mobility, as depopulation further eroded the peasants' already weakened obligations to remain on their traditional holdings. In the wake of the drastic population decline brought on by the plague, authorities in Western Europe worked to maintain social order through instituting wage controls.<ref>Simon A. C. Penn and Christopher Dyer, “Wages and Earnings in Late Medieval England: Evidence from the Enforcement of the Labour Laws,” The Economic History Review, New Series 43, no. 3 (Aug., 1990): 356-357. http://www.jstor.org/ (accessed September 8, 2007).</ref> These governmental controls were set in place to ensure that workers received the same salary post-plague as they had before the onslaught of the Black Death.<ref>Ibid.</ref> Within England, for example, the Ordinance of Labourers, created in 1349, and the [[Statute of Labourers]], created in 1351, restricted both wage increases and the relocation of workers.<ref>Ibid., 357.</ref> If workers attempted to leave their current post, employers were given the right to have them imprisoned.<ref>Ibid.</ref> The Statute was strictly enforced in some areas. For example, 7,556 people in Essex County were fined for deviating from the Statute in 1352.<ref>Joseph P. Byrne, The Black Death, (London: Greenwood Predd, 2004), 65.</ref> However, despite examples such as Essex County, the Statute quickly proved to be difficult to enforce due to the scarcity of labour.


{{anchor|plague-in-palestine}}{{anchor|plague-in-syria}}
In Western Europe, the sudden shortage of cheap labour provided an incentive for landlords to compete for peasants with wages and freedoms, an innovation that, some argue, represents the roots of [[capitalism]], and the resulting social upheaval ''caused'' the [[Renaissance]] and even [[Reformation]]. In many ways the Black Death and its aftermath improved the situation of surviving peasants, notably by the end of the 15th century. In Western Europe, labourers gained more power and were more in demand because of the shortage of labour. In gaining more power, workers following the Black Death often moved away from annual contracts in favour of taking on successive temporary jobs that offered higher wages.<ref>Penn and Dyer, 366.</ref> Workers such as servants now had the opportunity to leave their current employment to seek better paying, more attractive positions in areas previous off limits to them.<ref>Ibid.</ref> Another positive aspect of the period was that there was more fertile land available to the population; however, the benefits would not be fully realized until 1470, nearly 120 years later, when overall population levels finally began to rise again.
During 1347, the disease travelled eastward to [[Gaza City|Gaza]] by April; by July it had reached [[Damascus]], and in October plague had broken out in [[Aleppo]].<ref name=":6" /> That year, in [[Syria (region)|the territory]] of modern [[Lebanon]], [[Syria]], [[Israel]], and [[Palestine (region)|Palestine]], the cities of [[Ascalon]], [[Acre, Israel|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.<ref>{{cite web|url=https://www.thegreatcourses.com/courses/an-economic-history-of-the-world-since-1400.html|title=An Economic History of the World since 1400|website=English|access-date=23 May 2018|archive-url=https://web.archive.org/web/20180725223220/https://www.thegreatcourses.com/courses/an-economic-history-of-the-world-since-1400.html|archive-date=25 July 2018|url-status=live}}</ref> Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa.{{sfn|Kelly|2006}}{{page needed|date=May 2021}}


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]].<ref name=":6" />
Social mobility as result of the Black Death has been postulated as most likely cause of the [[Great Vowel Shift]], which is the principal reason why the spelling system in English today no longer reflects its pronunciation.


[[Mecca]] became infected in 1348 by pilgrims performing the [[Hajj]].<ref name=":6" /> In 1351 or 1352, the [[Rasulid dynasty|Rasulid]] sultan of the [[Yemen]], al-Mujahid Ali, was released from Mamluk captivity in Egypt and carried plague with him on his return home.<ref name=":6" /><ref>{{Cite book| vauthors = Sadek N |chapter-url=https://books.google.com/books?id=P-pGDwAAQBAJ&pg=PT956|title=Medieval Islamic Civilization: An Encyclopedia – Volume II: L–Z|publisher=Routledge|year=2006|isbn=978-1-351-66813-2| veditors = Meri J |language=en|chapter=Rasulids|access-date=8 May 2020|archive-date=27 July 2020|archive-url=https://web.archive.org/web/20200727114216/https://books.google.com/books?id=P-pGDwAAQBAJ&pg=PT956|url-status=live}}</ref> During 1349, records show the city of [[Mosul]] suffered a massive epidemic, and the city of [[Baghdad]] experienced a second round of the disease.<ref>{{Citation |title=The Black Death and the Rise of the Ottomans |date=2014 |work=Natural Disasters in the Ottoman Empire: Plague, Famine, and Other Misfortunes |pages=21–60 |editor-last=Ayalon |editor-first=Yaron |url=https://www.cambridge.org/core/books/natural-disasters-in-the-ottoman-empire/black-death-and-the-rise-of-the-ottomans/D83E412C0BB3C092E79683722AFFFC33 |access-date=2024-03-02 |place=Cambridge |publisher=Cambridge University Press |doi=10.1017/CBO9781139680943.004 |isbn=978-1-107-07297-8}}</ref>
In [[Eastern Europe]], by contrast, renewed stringency of laws tied the remaining peasant population more tightly to the land than ever before through [[serfdom]]. Sparsely populated Eastern Europe was less affected by the Black Death and so peasant revolts were less common in the fourteenth and fifteenth centuries, not occurring in the east until the sixteenth through nineteenth centuries. Since it is believed to have in part caused the social upheavals of fourteenth- and fifteenth-century Western Europe, some see the Black Death as a factor in the Renaissance and even the Reformation in Western Europe. Therefore, historians have cited the smaller impact of the plague as a contributing factor in Eastern Europe's ''failure'' to experience either of these movements on a similar scale. Extrapolating from this, the Black Death may be seen as partly responsible for Eastern Europe's considerable lag in scientific and philosophical advances as well as in the move to liberalise government by restricting the power of the monarch and [[aristocracy]]. A common example is that England is seen to have effectively ended [[serfdom]] by 1550 while moving towards more [[representative government]]; meanwhile, [[Russia]] did not abolish serfdom until an autocratic [[tsar]] decreed so in 1861.


===Signs and symptoms===
On top of all this, the plague's great population reduction brought cheaper land prices, more food for the average peasant, and a relatively large increase in per capita income among the peasantry, if not immediately, in the coming century. Since the plague left vast areas of farmland untended, they were made available for pasture and put more meat on the market; the consumption of meat and dairy products went up, as did the export of beef and butter from the Low Countries, Scandinavia and northern Germany. However, the upper class often attempted to stop these changes, initially in Western Europe, and more forcefully and successfully in Eastern Europe, by instituting [[sumptuary law]]s. These regulated what people (particularly of the peasant class) could wear, so that nobles could ensure that peasants did not begin to dress and act as a higher class member with their increased wealth. Another tactic was to fix prices and wages so that peasants could not demand more with increasing value. This was met with varying success depending on the amount of rebellion it inspired; such a law was one of the causes of the 1381 [[Peasants' Revolt]] in [[England in the Middle Ages|England]].
[[File:Acral gangrene due to plague.jpg|thumb|A hand showing how [[wikt:acral|acral]] [[gangrene]] of the [[digit (anatomy)|finger]]s due to [[bubonic plague]] causes the skin and [[tissue (biology)|flesh]] to [[necrosis|die]] and turn black]]
[[File:Plague bubo.jpg|thumb|An inguinal [[bubo]] on the upper thigh of a person infected with bubonic plague. Swollen [[lymph node]]s (''buboes'') often occur in the neck, armpit and groin (''inguinal'') regions of plague victims.]]


===Persecutions===
====Bubonic plague====
Symptoms of the plague include fever of {{convert|38|–|41|°C|°F}}, headaches, [[arthralgia|painful aching joint]]s, [[nausea]] and vomiting, and a general feeling of [[malaise]]. Left untreated, 80% of victims die within eight days.<ref>R. Totaro ''Suffering in Paradise: The Bubonic Plague in English Literature from More to Milton'' (Pittsburgh: Duquesne University Press, 2005), p. 26</ref>
[[Image:1349 burning of Jews-European chronicle on Black Death.jpg|thumb|250px|The burning of Jews in 1349 (from a European chronicle written on the Black Death between 1349 and 1352)]]


Contemporary accounts of the pandemic are varied and often imprecise.{{efn|In Britain "the special symptoms characteristic of the plague of 1348–9 were four in number:— (1) Gangrenous inflammation of the throat and lungs; (2) Violent pains in the region of the chest; (3) The vomiting and spitting of blood; and (4) The pestilential odour coming from the bodies and breath of the sick."<ref name=gasquet>{{cite book |last1=Gasquet |first1=Francis Aidan |title=The Great Pestilence (A.D. 1348-9), Now Commonly Known as the Black Death |date=29 May 2014 |url=https://www.gutenberg.org/ebooks/45815 |language=English}}</ref>}} The most commonly noted symptom was the appearance of [[bubo]]es (or ''gavocciolos'') in the groin, neck and armpits, which oozed pus and bled when opened.<ref name=Byrne2004pp21-9/> [[Giovanni Boccaccio|Boccaccio]]'s description:
As previously mentioned in reference to the plagues sociocultural impacts, renewed religious fervor and fanaticism bloomed in the wake of Black Death. This spelled trouble for minority populations of all sorts, as some Christians targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims",<ref> David Nirenberg, ''Communities of Violence'', op.cit. </ref> lepers<ref>R.I. Moore ''The Formation of a Persecuting Society'', Oxford, 1987 ISBN 0-631-17145-2</ref><ref>David Nirenberg, ''Communities of Violence'', 1998, ISBN 0-691-05889-X</ref> and gypsies, thinking that they were to blame for the crisis.


{{Blockquote | style=font-size:100% |In men and women alike it first betrayed itself by the emergence of certain [[neoplasm|tumour]]s in the groin or armpits, some of which grew as large as a common apple, others as an egg&nbsp;... 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 [[disease|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.<ref>{{Citation| vauthors = Boccaccio G |title=Decameron|year=1351|title-link=The Decameron}}</ref><ref>{{cite web | vauthors = Mark JJ |title=Boccaccio on the Black Death: Text & Commentary |url=https://www.worldhistory.org/article/1537/boccaccio-on-the-black-death-text--commentary/ |website=[[World History Encyclopedia]] |date=3 April 2020 |access-date=20 April 2021 |archive-date=20 April 2021 |archive-url= https://web.archive.org/web/20210420181944/https://www.worldhistory.org/article/1537/boccaccio-on-the-black-death-text--commentary/ |url-status=live }}</ref>{{efn|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.{{sfn|Ziegler|1998|pages=18–19}}}}}}
[[Leprosy|Lepers]], and other individuals with skin diseases such as [[Acne vulgaris|acne]] or [[psoriasis]], were singled out and exterminated throughout Europe. Anyone with leprosy was believed to show an outward sign of a defect of the soul.


This was followed by acute [[fever]] and [[hematemesis|vomiting of blood]]. Most people died two to seven days after initial infection. Freckle-like spots and rashes,<ref>{{cite book | vauthors = Herlihy D | date = 1997 | title = The Black Death and the Transformation of the West | location = Cambridge, Massachusetts | publisher = Harvard University Press | isbn = 978-0-674-07613-6 | page=29}}</ref> which may have been caused by [[pulicosis|flea-bite]]s, were identified as another potential sign of plague.
Differences in cultural and lifestyle practices between Jews and Christians also led to persecution. Jews were charged by some with having provoked the Plague. Because Jews had a religious obligation to be clean, they did not use water from public wells. And so as previously mentioned, Jews were suspected of causing the plague by deliberately poisoning wells. Typically, comparatively fewer Jews died from the Black Death, in part due to [[Kashrut|rabbinical laws]] that promoted habits that were generally cleaner than that of a typical medieval villager. Jews were also socially isolated, often living in Jewish ghettos. Because isolated people were less likely to be infected, there were differences in mortality rates between Jews and non-Jews and this led to raised suspicions in people who had no concept of bacterial transmission.


====Pneumonic plague====
Christian mobs attacked Jewish settlements across Europe; by 1351, sixty major and 150 smaller Jewish communities had been destroyed, and more than 350 separate massacres had occurred. This persecution reflected more than ethnic hatred. In many places, attacking Jews was a way to criticize the monarchs who protected them (Jews were under the protection of the king, and often called the "royal treasure"), and monarchic fiscal policies, which were often administered by Jews. An important legacy of the Black Death was to cause the eastward movement of what was left of north European Jewry to Poland and Russia, where it remained until the twentieth century.
[[Lodewijk Heyligen]], whose master Cardinal [[Giovanni Colonna (cardinal, 1295–1348)|Giovanni Colonna]] died of plague in 1348, noted a distinct form of the disease, [[pneumonic plague]], that infected the lungs and led to respiratory problems.<ref name=Byrne2004pp21-9/> Symptoms include fever, cough and [[hemoptysis|blood-tinged sputum]]. As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90–95%.{{sfn|Byrne|2004|p=8}}


====Septicemic plague====
Women also faced persecution during the Black Death. Within areas of the Middle East, notably in [[Cairo]], women became scapegoats when the plague struck.<ref>Joseph P. Byrne, The Black Death, (London: Greenwood Predd, 2004), 108.</ref> In 1438, the sultan of Cairo was informed by his religious lawyers that the arrival of the plague was Allah’s punishment for the sin of fornication.<ref>Ibid.</ref> In accordance with this theory, a law was set in place stating that women were not allowed to make public appearances as they may tempt men into sin.<ref>Ibid.</ref> Joseph P. Byrne in his book, ''The Black Plague'', describes that this law was only lifted when “the wealthy complained that their female servants could not shop for food.”<ref>Ibid.</ref>
[[Septicemic plague]] is the least common of the three forms, with an untreated mortality rate near 100%. Symptoms are high fevers and purple skin patches ([[purpura]] due to [[disseminated intravascular coagulation]]).{{sfn|Byrne|2004|p=8}} In cases of pneumonic and particularly septicemic 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.{{sfn|Byrne|2004|p=8}}


===Consequences===
In the Muslim world, particularly in [[Makkah]], the disease was blamed on non-believers who had entered the city.
{{Main|Consequences of the Black Death}}


===Religion===
====Deaths====
[[File:Nuremberg chronicles - Dance of Death (CCLXIIIIv).jpg|thumb|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.]]
[[Image:Flagellants.png|thumb|right|Flagellants practiced self-flogging (whipping of oneself) to atone for sins. The movement became popular after general disillusionment with the church's reaction to the Black Death]]


There are no exact figures for the death toll; the rate varied widely by locality. Urban centers with higher populations suffered longer periods of abnormal mortality.<ref>{{cite journal | vauthors = Olea RA, Christakos G | title = Duration of urban mortality for the 14th-century Black Death epidemic | journal = Human Biology | volume = 77 | issue = 3 | pages = 291–303 | date = June 2005 | pmid = 16392633 | doi = 10.1353/hub.2005.0051 | s2cid = 5993227 }}</ref> Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia.<ref name="ABC/Reuters">{{cite news|url=http://www.abc.net.au/science/articles/2008/01/29/2149185.htm|title=Black death 'discriminated' between victims (ABC News in Science)|date=29 January 2008|access-date=3 November 2008|url-status=live|archive-url=https://web.archive.org/web/20161220120404/http://www.abc.net.au/science/articles/2008/01/29/2149185.htm|archive-date=20 December 2016|publisher=Australian Broadcasting Corporation}}</ref><ref name="Black Death's Gene Code Cracked">{{cite news|url=http://archive.wired.com/medtech/health/news/2001/10/47288|title=Black Death's Gene Code Cracked|magazine=Wired|date=3 October 2001|access-date=12 February 2015|archive-url=https://web.archive.org/web/20150426160438/http://archive.wired.com/medtech/health/news/2001/10/47288|archive-date=26 April 2015|url-status=live}}</ref><ref name="De-coding the Black Death">{{cite news |url=http://news.bbc.co.uk/2/hi/health/1576875.stm |title=De-coding the Black Death |work=BBC News |date=3 October 2001 |access-date=3 November 2008 |archive-url=https://web.archive.org/web/20170707042715/http://news.bbc.co.uk/2/hi/health/1576875.stm |archive-date=7 July 2017 |url-status=live }}</ref>{{Better source needed|reason=200 million number seems high, see talk page|date=April 2020}} A study published in 2022 of pollen samples across Europe from 1250 to 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.<ref>{{Cite journal|last1=Izdebski|first1=A.|last2=Guzowski|first2=P.|last3=Poniat|first3=R.|last4=Masci|first4=L.|last5=Palli|first5=J.|last6=Vignola|first6=C.|last7=Bauch|first7=M.|last8=Cocozza|first8=C.|last9=Fernandes|first9=R.|last10=Ljungqvist|first10=F. C.|last11=Newfield|first11=T.|date=2022-02-10|title=Palaeoecological data indicates land-use changes across Europe linked to spatial heterogeneity in mortality during the Black Death pandemic|journal=Nature Ecology & Evolution|volume=6|issue=3|language=en|pages=297–306|doi=10.1038/s41559-021-01652-4|pmid=35145268|pmc=8913360 |bibcode=2022NatEE...6..297I |s2cid=246750095|issn=2397-334X}}</ref> The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere."
The Black Death led to cynicism toward religious officials who could not keep their promises of curing plague victims and banishing the disease. No one, the Church included, was able to cure or accurately explain the reasons for the plague outbreaks. One theory of transmission was that it spread through air, and was referred to as [[Miasma theory of disease|''miasma'']], or 'bad air'. This increased doubt in the [[clergy|clergy's]] abilities. Extreme alienation with the Church culminated in either support for different religious groups such as the [[flagellant]]s, which from their late 13th century beginnings grew tremendously during the opening years of the Black Death, or to an increase in interest for more secular alternatives to problems facing European society and an increase of secular [[politicians]].


The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert Gottfried writes that as early as 1351, "agents for [[Pope Clement VI]] calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the [[Book of Revelation]], a favorite medieval source of information."{{sfn|Gottfried|2010|p=77}} [[Ole J. Benedictow]] proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century.<ref>{{cite journal |last1=Noymer |first1=Andrew |title=Contesting the Cause and Severity of the Black Death: A Review Essay |journal=Population and Development Review |date=2007 |volume=33 |issue=3 |pages=616–627 |url=https://pure.iiasa.ac.at/id/eprint/8461/1/RP-07-05.pdf |access-date=13 December 2023 |issn=0098-7921 |archive-date=1 January 2024 |archive-url=https://web.archive.org/web/20240101022834/https://pure.iiasa.ac.at/id/eprint/8461/1/RP-07-05.pdf |url-status=live }}</ref><ref name="Benedictow" />{{efn|Norwegian historian Ole Benedictow suggests: {{Blockquote | style=font-size:100% | 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.<ref name="Benedictow">Ole J. Benedictow, [http://www.historytoday.com/ole-j-benedictow/black-death-greatest-catastrophe-ever "The Black Death: The Greatest Catastrophe Ever"], ''History Today'' Volume 55 Issue 3 March 2005 ({{Webarchive|url=https://web.archive.org/web/20161103234057/http://www.historytoday.com/ole-j-benedictow/black-death-greatest-catastrophe-ever |date=3 November 2016 }}). Cf. Benedictow, ''The Black Death 1346–1353: The Complete History'', Boydell Press (2012), pp. 380ff. ISBN 9781843832140</ref>}}}} According to medieval historian [[Philip Daileader]], it is likely that over four years, 45–50% of the European population died of plague.<ref name="Daileader" />{{efn|According to medieval historian [[Philip Daileader]],{{Blockquote | style=font-size:100% | 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&nbsp;... it was probably closer to 20%.<ref name="Daileader">[[Philip Daileader]], ''The Late Middle Ages'', audio/video course produced by [[The Teaching Company]], (2007) {{ISBN|978-1-59803-345-8}}.</ref>}}}}
The Black Death hit the [[monastery|monasteries]] very hard because of their close proximity with the sick, who sought refuge there, so that there was a severe shortage of clergy after the epidemic cycle. This resulted in a mass influx of hastily-trained and inexperienced clergy members, many of whom knew little of the discipline and rigor of the veterans they replaced. This led to abuses by the clergy in years afterwards and a further deterioration of the position of the Church in the eyes of the people.


The overwhelming number of deaths in Europe sometimes made mass burials necessary, and some sites had hundreds or thousands of bodies.<ref name=":3">{{cite journal | vauthors = Antoine D |title=The Archaeology of 'Plague' |journal=Medical History |date=2008 |volume=52 |issue=S27 |pages=101–114 |doi=10.1017/S0025727300072112 |s2cid=16241962 |doi-access=free }}</ref> 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.<ref name=":3" /> 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.<ref name="Cohn 2010">{{cite book | vauthors = Cohn SK |chapter=Black Death, social and economic impact of the |url=https://www.oxfordreference.com/view/10.1093/acref/9780198662624.001.0001/acref-9780198662624-e-0907 |title=The Oxford Dictionary of the Middle Ages |year=2010 | veditors = Bjork RE |publisher=Oxford University Press |doi=10.1093/acref/9780198662624.001.0001 |isbn=978-0-19-866262-4 |access-date=11 April 2020 |archive-date=11 April 2020 |archive-url= https://web.archive.org/web/20200411222452/https://www.oxfordreference.com/view/10.1093/acref/9780198662624.001.0001/acref-9780198662624-e-0907 |url-status=live }}</ref>
===Other effects===
[[Image:Holbein-death.png|thumb|right|Inspired by Black Death, ''[[Danse Macabre]]'' is an allegory on the universality of death and a common painting motif in late-medieval periods]]


In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die.{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}} 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 to 50,000 in 1351. At least 60% of the population of [[Hamburg]] and [[Bremen]] perished,<ref>{{cite web | vauthors = Snell M |url= http://historymedren.about.com/od/theblackdeath/a/greatmortality_2.htm |title=The Great Mortality |publisher=Historymedren.about.com |access-date=19 April 2009 |year=2006 |archive-url=https://web.archive.org/web/20090310140601/http://historymedren.about.com/od/theblackdeath/a/greatmortality_2.htm |archive-date=10 March 2009 |url-status=live }}</ref> and a similar percentage of Londoners may have died from the disease as well,<ref name="guardian">{{cite news |url= https://www.theguardian.com/science/2014/mar/29/black-death-not-spread-rat-fleas-london-plague |title= Black death was not spread by rat fleas, say researchers |first=Thorpe |last=Vanessa |date= 29 March 2014 |newspaper= The Guardian |access-date= 29 March 2014 |archive-url= https://web.archive.org/web/20140330010701/http://www.theguardian.com/science/2014/mar/29/black-death-not-spread-rat-fleas-london-plague |archive-date= 30 March 2014 |url-status= live }}</ref> leaving a death toll of approximately 62,000 between 1346 and 1353.{{sfn|Tignor|Brown|Liu|Shaw|2014|p=407}}{{efn|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.{{sfn|Dick|Pringle|Sloane|Carver|2015}}}} Florence's tax records suggest that 80% of the city's population died within four months in 1348.{{r|Cohn 2010}} Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450.<ref>{{cite book|title=Peasant Fires: The Drummer of Niklashausen| vauthors = Wunderli R |publisher=Indiana University Press|page=52|isbn=978-0-253-36725-9|year=1992}}</ref> The disease bypassed some areas, with the most isolated areas being less vulnerable to [[contagious disease|contagion]]. Plague did not appear in [[French Flanders|Flanders]] until the turn of the 15th century, and the impact was less severe on the populations of [[County of Hainaut|Hainaut]], [[Medieval Finland|Finland]], northern Germany, and areas of Poland.{{r|Cohn 2010}} Monks, nuns, and priests were especially hard-hit since they cared for people ill with the plague.{{sfn|Bennett|Hollister|2006|p=329}} The level of mortality in the rest of Eastern Europe was likely similar to that of Western Europe in the first outbreak, with descriptions suggesting a similar effect on Russian towns, and the cycles of plague in Russia being roughly equivalent.<ref name="Belich"/>
After 1350, [[Culture of Europe|European culture]] in general turned very morbid. The general mood was one of pessimism and the art turned dark with representations of death.


[[File:Doutielt3.jpg|thumb|upright=1.3|Citizens of [[Tournai]] bury plague victims]]
The practice of [[alchemy]] as medicine, previously considered to be normal for most doctors, slowly began to wane as the citizenry began to realize that it seldom affected the progress of the epidemic and that some of the potions and "cures" used by many alchemists only served to worsen the condition of the sick. [[Liquor]], originally made by alchemists, was commonly applied as a remedy for the Black Death, and, as a result, the consumption of liquor in Europe rose dramatically after the plague. The Church often tried to meet the medical need.
In 1382, the physician to the [[Avignon Papacy]], Raimundo Chalmel de Vinario ({{Langx|la|Magister Raimundus|lit=Master Raymond}}), observed the decreasing mortality rate of successive outbreaks of plague in 1347–1348, 1362, 1371 and 1382 in his treatise ''On Epidemics'' ({{Langx|la|De epidemica|label=none}}).<ref name=":4">{{Cite book| vauthors = Byrne JP |chapter-url=https://books.google.com/books?id=5KtDfvlSrDAC&pg=PA354|title=Encyclopedia of the Black Death|publisher=ABC-CLIO|year=2012|isbn=978-1-59884-253-1|location=Santa Barbara, California|pages=354|language=en|chapter=Vinario, Raimundo Chalmel de (Magister Raimundus; Chalmelli; Chalin; d. after 1382)|access-date=24 December 2020|archive-date=13 June 2021|archive-url=https://web.archive.org/web/20210613035405/https://books.google.com/books?id=5KtDfvlSrDAC&pg=PA354|url-status=live}}</ref> 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.<ref name=":4" /> By the 1380s in Europe, the plague predominantly affected children.{{r|Cohn 2010}} Chalmel de Vinario recognised that [[bloodletting]] was ineffective (though he continued to prescribe bleeding for members of the [[Roman Curia]], whom he disliked), and said that all true cases of plague were caused by [[medical astrology|astrological factor]]s and were incurable; he was never able to effect a cure.<ref name=":4" />


The populations of some Italian cities, notably [[Florence]], did not regain their pre-14th century size until the 19th century.{{sfn|Nauert|2006|page=106}} Italian chronicler [[Agnolo di Tura]] recorded his experience from [[Siena]], where plague arrived in May 1348:
During the period of the Black Death and the Great Plague of London, plague doctors visited victims of the plague to verify whether they had been afflicted or not, take their pay, and leave. Most were unqualified to do even this, as the qualified doctors fled, knowing they could do nothing for those affected by the plague. Their outfit consisted of a hat to show that the man was a doctor, a mask to protect the face which included crystal eyes to protect the wearer's eyes and the beak which was stuffed with spices or herbs to purify the air that the doctor breathed, a wooden stick to push away victims who would get too close to him, a pair of leather gloves to protect the hands, a gown waxed from the exterior, and full length boots. It was believed at the time that the plague was spread only through the air and not through the flea bites of the fleas living on the black rat. This was why the doctors stuffed herbs and spices in their masks or carried them somewhere on their person. The waxed clothing may have helped prevent fleas latching on and even prevented respiratory droplet infection. This outfit might not have been worn often, as most of the doctors fled at the earliest signs of plague.
{{blockquote|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.<ref>[http://www.u.arizona.edu/~afutrell/w%20civ%2002/plaguereadings.html Plague readings] {{Webarchive|url=https://web.archive.org/web/20080829223455/http://www.u.arizona.edu/%7Eafutrell/w%20civ%2002/plaguereadings.html |date=29 August 2008 }} from P. M. Rogers, ''Aspects of Western Civilization'', Prentice Hall, 2000, pp. 353–65.</ref>}}


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.<ref>{{cite web|url=http://old.nationalreview.com/interrogatory/kelly200509140843.asp|title=Q&A with John Kelly on The Great Mortality on National Review Online| vauthors = Lopez KJ |date=14 September 2005|publisher=Nationalreview.com|url-status=dead|archive-url=https://web.archive.org/web/20120216075334/http://old.nationalreview.com/interrogatory/kelly200509140843.asp|archive-date=16 February 2012|access-date=9 November 2016}}</ref> The Black Death killed about 40% of Egypt's population.<ref>[http://countrystudies.us/egypt/57.htm Egypt – Major Cities] {{Webarchive|url=https://web.archive.org/web/20130117011718/http://countrystudies.us/egypt/57.htm |date=17 January 2013 }}, ''U.S. Library of Congress''</ref> 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 within eight months.<ref name=":7" /> By the 18th century, the population of Cairo was halved from its numbers in 1347.<ref name=":7" />
Although the Black Death highlighted the shortcomings of medical science in the medieval era, it also led to positive changes in the field of medicine. As described by David Herlihy in ''The Black Death and the Transformation of the West,'' more emphasis was placed on “anatomical investigations” following the Black Death. <ref>David Herlihy, The Black Death and the Transformation of the West, (Massachusetts: Harvard University Press, 1997), 72.</ref> How individuals studied the human body notably changed, becoming a process that dealt more directly with the human body in varied states of sickness and health.<ref>Ibid.</ref> Further, at this time, the importance of surgeons became more evident.<ref>Ibid.</ref>


====Economic====
In 2006 a scientific study by Dr. Thomas van Hoof of [[Utrecht University]] suggests that the Black Death contributed to the [[Little Ice Age]]. Pollen and leaf data, collected from lake-bed sediments in the southeast [[Netherlands]], supports the idea that millions of trees sprang up on abandoned farmland soaking up [[carbon dioxide]] from the atmosphere and thus cooling the planet.<ref>{{cite web
It has been suggested that the Black Death, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens.<ref>{{cite web | url=https://www.science.org/content/article/black-death-fatal-flu-past-pandemics-show-why-people-margins-suffer-most | title=From Black Death to fatal flu, past pandemics show why people on the margins suffer most | access-date=1 January 2023 | archive-date=1 October 2021 | archive-url=https://web.archive.org/web/20211001204644/https://www.science.org/content/article/black-death-fatal-flu-past-pandemics-show-why-people-margins-suffer-most | url-status=live }}</ref>
| last = Ravilious
| first = Kate
| title = Europe's chill linked to disease
| publisher = [[BBC]]
| date = [[27 February]] [[2006]]
| url = http://news.bbc.co.uk/2/hi/science/nature/4755328.stm
| accessdate = 2006-12-12 }}</ref>


But along with population decline from the pandemic, wages soared in response to a subsequent labour shortage.{{sfn|Scheidel|2017| pages =292–93, 304}} In some places rents collapsed (e.g., lettings "used to bring in £5, and now but £1.")<ref name=gasquet/>{{rp|158}}
A theory put forth by Stephen O'Brien says the Black Death is likely responsible, through [[natural selection]], for the high frequency of the [[CCR5|CCR5-Δ32]] genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV, smallpox, and possibly plague,<ref>{{cite web
| last = Jefferys
| first = Richard
| coauthors= Anne-christine d'Adeskyftyyty
| title = Designer Genes
| publisher = HIV+ Long Term Non Progresors
| date = March 1999
| url = http://www.aidsinfonyc.org/hivplus/issue3/ahead/genes.html
| accessdate = 2006-12-12 }}</ref> though for the latter, no explanation as to how it would do that exists.


However, many labourers, artisans, and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation.{{sfn|Munro|2004|p=352}} Landowners were also pushed to substitute monetary rents for labour services in an effort to keep tenants.<ref>{{Cite web|url=https://www.britannica.com/event/Black-Death|title=Black Death &#124; Causes, Facts, and Consequences|website=Encyclopædia Britannica|url-status=live|archive-url=https://web.archive.org/web/20190709135155/https://www.britannica.com/event/Black-Death|archive-date=9 July 2019|access-date=26 November 2019}}</ref> Taxes and tithes became difficult to collect, with living poor refusing to cover the share of the rich deceased, because many properties were empty and unfarmed, and because tax-collectors, where they could be employed, refused to go to plague spots.<ref name=gasquet/>{{rp|158}}
The Black Death also inspired European architecture to move in two different directions; there was a revival of Greco-Roman styles that, in stone and paint, expressed Petrarch's love of antiquity and a further elaboration of the Gothic style. <ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 374. </ref> Late medieval churches had impressive structures centered on verticality, where one's eye is drawn up towards the high ceiling for a religious experience bordering on the mystical. The basic Gothic style was revamped with elaborate decoration in the late medieval period. Sculptors in Italian city-states emulated the work of their Roman forefathers while sculptors in northern Europe, no doubt inspired by the devastation they had witnessed, gave way to a heightened expression of emotion and an emphasis on individual differences. <ref> Ibid., 375. </ref> A tough realism came forth in architecture as in literature. Images of intense sorrow, decaying corpses, and individuals with faults as well as virtues emerged. North of the Alps, paintings reached a pinnacle in precise realism with the Flemish school of [[Jan Van Eyck]] (c. 1385-1440). The natural world was reproduced in these works with meticulous detail bordering on photography. <ref> Ibid., 376. </ref>


The trade disruptions in the [[Mongol Empire]] caused by the Black Death was one of the reasons for its collapse.<ref>{{Cite web |last=Getz |first=Trevor |title=READ: Unit 3 Introduction – Land-Based Empires 1450 to 1750 |url=https://www.khanacademy.org/humanities/world-history-project-ap/xb41992e0ff5e0f09:unit-3-land-based-empires/xb41992e0ff5e0f09:3-0unit-3-overview/a/read-unit-3-introduction-land-based-empires-1450-to-1750 |url-status= |archive-url= |archive-date= |access-date=2024-04-19 |website=[[Khan Academy]] |language=en}}</ref>
==Black Death in literature==
===Contemporary===
The Black Death dominated art and literature throughout the generation that experienced it. Much of the most useful manifestations of the Black Death in literature, to historians, comes from the accounts of its chroniclers, and often the only real way to get a sense of the horror of living through a disaster on such a scale. A few of these chroniclers were famous writers, philosophers and rulers (like [[Giovanni Boccaccio|Boccaccio]] and [[Petrarch]]). Their writings, however, did not reach the majority of the European population. For example, Petrarch's work was read mainly by wealthy nobles and merchants of Italian city-states. He wrote hundreds of letters and vernacular poetry of great distinction and passed on to later generations a revised interpretation of [[courtly love]]. <ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 372. </ref> Although romances continued to be popular throughout the period, the courtly tradition began to face increasing competition from ordinary writers who became involved in producing gritty realist literature, inspired by their Black Death experiences. This was a new phenomenon, made possible because vernacular education and literature, as well as the study of Latin and classical antiquity, flourished like never before and became more accessible in the fourteenth century. <ref> Ibid., 370 </ref> For example, Agnolo di Tura, of [[Siena]], records his experience:
<blockquote>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, called the Fat, 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. This situation continued [from May] until September.</blockquote>


====Environmental====
The scene Di Tura describes is repeated over and over again all across Europe. In [[Sicily]], Gabriele de'Mussi, a [[Notary public|notary]], tells of the early spread from [[Crimea]]:
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]].<ref>{{Cite news|url=http://news.bbc.co.uk/2/hi/science/nature/4755328.stm|title=Europe's chill linked to disease|date=27 February 2006 |first=Kate |last=Ravilious |work=BBC News |access-date=28 February 2006|archive-url=https://web.archive.org/web/20060427004011/http://news.bbc.co.uk/2/hi/science/nature/4755328.stm|archive-date=27 April 2006|url-status=live}}</ref>
<blockquote>Alas! our ships enter the port, but of a thousand sailors hardly ten are spared. We reach our homes; our kindred…come from all parts to visit us. Woe to us for we cast at them the darts of death! …Going back to their homes, they in turn soon infected their whole families, who in three days succumbed, and were buried in one common grave. Priests and doctors visiting…from their duties ill, and soon were…dead. O death! cruel, bitter, impious death! …Lamenting our misery, we feared to fly, yet we dared not remain.</blockquote>


====Persecutions====
[[Henry Knighton]] tells of the plague’s coming to England:
{{See also|Persecution of Jews during the Black Death}}
<blockquote>Then the grievous plague came to the sea coasts from Southampton, and came to Bristol, and it was as if all the strength of the town had died, as if they had been hit with sudden death, for there were few who stayed in their beds more than three days, or two days, or even one half a day.</blockquote>
[[File:Doutielt1.jpg|thumb|upright=1.5|Jews being [[death by burning|burned at the stake]] in 1349. Miniature from a 14th-century manuscript ''Antiquitates Flandriae'' by [[Gilles Li Muisis]]]]


Renewed religious fervor and [[fanaticism]] increased in the wake of the Black Death. Some Europeans targeted "various groups such as [[Persecution of Jews during the Black Death|Jews]], [[friar]]s, foreigners, beggars, [[pilgrim]]s", lepers,{{sfn|Nirenberg|1998}}{{sfn|Moore|1987}} and [[Romani people|Romani]], blaming them for the crisis. [[Leprosy|Leper]]s, and others with skin diseases such as [[acne]] or [[psoriasis]], were killed throughout Europe.
Friar [[John Clyn]] witnessed its effects in [[Leinster]], after its spread to [[Ireland]] in August 1348:<ref>Williams, Dr. Bernadette. (2007).''The Annals of Ireland by Friar John Clyn''. Dublin: Four Courts Press. ISBN 978 1 84682 034 2</ref><blockquote>That disease entirely stripped vills, cities, castles and towns of inhabitaints of men, so that scarcely anyone would be able to live in them. The plague was so contagious that thous touching the dead or even the sick were immediately infected and died, and the one confessing and the confessor were together led to the grave ... many died from carbuncles and from ulcers and pustles that could be seen on shins and under the armpits; some died, as if in a frenzy, from pain of the head, others from spitting blood ... In the convent of Minors of [[Drogheda]], twenty five, and in [[Dublin]] in the same order, twenty three died ... These cities of Dublin and Drogheda were almost destroyed and wasted of inhabitants and men so that in Dublin alone, from the beginning of August right up to Christmas, fourteen thousand men died ... The pestilence gathered strength in [[Kilkenny]] during [[Lent]], for between Christmas day and 6 March, eight Friars Preachers died. There was scarcely a house in which only one died but commonly man and wife with their children and family going one way, namely, crossing to death."''</blockquote>


Because 14th-century healers and governments were at a loss to explain or stop the disease, Europeans turned to [[astrology|astrological]] forces, earthquakes and the [[well poisoning#Medieval accusations against Jews|poisoning of wells by Jews]] as possible reasons for outbreaks.{{sfn|Bennett|Hollister|2006|p=326}} Many believed the epidemic was a [[divine retribution|punishment by God]] for their sins, and could be relieved by winning [[God's forgiveness]].<ref>{{Cite web|url=https://www.worldhistory.org/article/1541/religious-responses-to-the-black-death/|title=Religious Responses to the Black Death|date=2020|website=World History Encyclopedia|access-date=14 November 2022|archive-date=14 November 2022|archive-url=https://web.archive.org/web/20221114035304/https://www.worldhistory.org/article/1541/religious-responses-to-the-black-death/|url-status=live}}</ref>
In addition to these personal accounts, many presentations of the Black Death have entered the general consciousness as great [[literature]]. For example, the major works of Boccaccio (''The Decameron''), Petrarch, [[Geoffrey Chaucer]] (''[[The Canterbury Tales]]''), and [[William Langland]] (''[[Piers Plowman]]''), which all discuss the Black Death, are generally recognized as some of the best works of their era.


There were many attacks against Jewish communities.<ref name=JewishEncyclopedia>[http://jewishencyclopedia.com/view.jsp?artid=1114&letter=B Black Death] {{Webarchive|url=https://web.archive.org/web/20110804223403/http://www.jewishencyclopedia.com/view.jsp?artid=1114&letter=B |date=4 August 2011 }}, Jewishencyclopedia.com</ref> In the [[Strasbourg massacre]] of February 1349, about 2,000 Jews were murdered.<ref name=JewishEncyclopedia/> In August 1349, the Jewish communities in [[Mainz]] and [[Cologne]] were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed.<ref>[http://www.jewishhistory.org.il/history.php?startyear=1340&endyear=1349 "Jewish History 1340–1349"] {{Webarchive|url=https://web.archive.org/web/20071102055241/http://jewishhistory.org.il/history.php?startyear=1340&endyear=1349 |date=2 November 2007 }}.</ref> During this period many Jews relocated to [[Kingdom of Poland (1025–1385)|Poland]], where they received a welcome from King [[Casimir III the Great|Casimir the Great]].{{sfn|Gottfried|2010|p=74}}
''La [[Danse Macabre]]'', or the ''Dance of death'', is an [[allegory]] on the universality of death, expressing the common wisdom of the time: that no matter one's station in life, the dance of death united all. It consists of the [[personification|personified]] Death leading a row of dancing figures from all walks of life to the grave — typically with an emperor, king, pope, monk, youngster, beautiful girl, all in skeleton-state. They were produced under the impact of the Black Death, reminding people of how fragile their lives were and how vain the glories of earthly life. The earliest artistic example is from the [[fresco]]ed cemetery of the Church of the Holy Innocents in Paris (1424). There are also works by [[Konrad Witz]] in [[Basel]] (1440), [[Bernt Notke]] in [[Lübeck]] (1463) and woodcuts by [[Hans Holbein the Younger]] (1538). [[Israil Bercovici]] claims that the ''Danse Macabre'' originated among [[Sephardic Jew]]s in fourteenth century [[Spain]] (Bercovici, 1992, p. 27).


====Social====
The poem "The Rattle Bag" by the Welsh poet [[Dafydd ap Gwilym]] (1315-1350 or 1340-1370) has many elements that suggest that it was written as a reflection of the hardships he endured during the Black Death. It also reflects his personal belief that the Black Death was the end of humanity, the Apocalypse, as suggested by his multiple biblical references, particularly the events described in [[the Book of Revelation]].
{{See also|Black Death in medieval culture}}
[[File:The Triumph of Death P001393.jpg|thumb|[[Pieter Brueghel the Elder|Pieter Bruegel]]'s ''[[The Triumph of Death]]'' reflects the social upheaval and terror that followed the plague, which devastated medieval Europe.]]


One theory that has been advanced is that the Black Death's devastation of [[Florence]], between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the [[Renaissance]]. Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on [[spirituality]] and the [[afterlife]].{{sfn|Tuchman|1978}}{{efn|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.{{sfn|Hatty|Hatty|1999|p=89}}}} It has also been argued that the Black Death prompted a new wave of piety, manifested in the [[patron#Arts|sponsorship]] of religious works of art.<ref>{{cite web |url=https://www.ucalgary.ca/applied_history/tutor/endmiddle/bluedot/blackdeath.html |title=The End of Europe's Middle Ages: The Black Death |url-status=dead |archive-url=https://web.archive.org/web/20130309162102/http://www.ucalgary.ca/applied_history/tutor/endmiddle/bluedot/blackdeath.html |archive-date=9 March 2013 |access-date=5 April 2007 |website=University of Calgary}}</ref>
{| class="infobox"
|
''Adieu, farewell earths blisse,''<br/>
''This world uncertaine is,''<br/>
''Fond are lifes lustful joyes,''<br/>
''Death proves them all but toyes,''<br/>
''None from his darts can flye;''<br/>
''I am sick, I must dye:''<br/>
''Lord, have mercy on us.''<br/>
<p>
: <small>(''"A Litany in Time of Plague"''</small><br/>
: <small>by Thomas Nashe)</small>
|}


This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors,{{sfn|Brotton|2006}} in combination with an [[Greek scholars in the Renaissance#Contribution of Greek scholars to the Italian Renaissance|influx of Greek scholars]] after the [[Fall of Constantinople#Impact on the Renaissance|fall of the Byzantine Empire]].<ref>{{Cite web |title=Fall of Constantinople {{!}} Facts, Summary, & Significance {{!}} Britannica |url=https://www.britannica.com/event/Fall-of-Constantinople-1453 |access-date=2023-02-15 |website=Encyclopædia Britannica |language=en |archive-date=19 August 2020 |archive-url=https://web.archive.org/web/20200819143934/https://www.britannica.com/event/Fall-of-Constantinople-1453 |url-status=live }}</ref> 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.{{sfn|Netzley|1998}}{{better source needed|date=April 2020}}
[[Thomas Nashe]] also wrote a sonnet about the Plague entitled "A Litany in Time of Plague" which was part of ''Summers last will and Testament'' (1592). He made countryside visits to remove himself from London in fear of the Plague.


Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of [[fief]]s and city-states frequently managed by the Catholic Church.<ref name=":0">{{Cite journal| vauthors = Garrett L |date=2005|title=The Black Death|journal=HIV and National Security|url=https://www.jstor.org/stable/resrep05754.7|pages=17–19|access-date=3 December 2020|archive-date=14 October 2020|archive-url=https://web.archive.org/web/20201014214527/https://www.jstor.org/stable/resrep05754.7|url-status=live}}</ref> 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.<ref name=":0" /><ref>{{Cite web|title=Medieval Life {{!}} Boundless World History|url=https://courses.lumenlearning.com/boundless-worldhistory/chapter/medieval-life/|access-date=2020-12-03|website=courses.lumenlearning.com|archive-date=8 February 2021|archive-url=https://web.archive.org/web/20210208080639/https://courses.lumenlearning.com/boundless-worldhistory/chapter/medieval-life/|url-status=live}}</ref> 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 contributed to the destabilization of [[feudalism]].<ref>{{Cite web |title=Black Death: The lasting impact |url=http://www.bbc.co.uk/history/british/middle_ages/black_impact_01.shtml |url-status=live |archive-url=https://web.archive.org/web/20200410122047/http://www.bbc.co.uk/history/british/middle_ages/black_impact_01.shtml |archive-date=10 April 2020 |access-date=14 April 2020 |website=BBC}}</ref>{{sfn|Haddock|Kiesling|2002}}
Additionally see [[Aleksandr Pushkin]]'s verse play, "Feast in the Time of the Plague".


The word "[[quarantine]]" has its roots in this period, though the practice of isolating people to prevent the spread of disease is older. In the city-state of [[Republic of Ragusa|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".<ref name="Sehdev">{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–1072 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}</ref>
The Black Death quickly entered common [[folklore]] in many European countries. In Northern Europe, the plague was personalized as an old, bent woman covered and hooded in black, carrying a broom and a rake. Norwegians told that if she used the rake, some of the population involved might survive, escaping through the teeth of the rake. If she on the other hand used the broom, then the entire population in the area were doomed. The Plague-hag, or ''Pesta'', were vividly drawn by the painter [[Theodor Kittelsen]].


All institutions were affected. Smaller monasteries and convents became unviable and closed. Up to half parish churches lost their priest, apart from the parishioners. Religious sensibilities changed:<ref name=gasquet/>
Women during and after the Black Death also benefited from the growing importance of vernacular literature because a broader cultural forum became available to them which had previously been restricted to men by the Latin church. And so, they began writing and fostering through patronage the writings and translations of others. <ref> Judith M. Bennett and C. Warren Hollister, ''Medieval Europe: A Short History'' (New York: McGraw-Hill, 2006), 366. </ref> For example, in France, Christine de Pizan (1364-1430) became the first woman in Europe to support herself by writing. She wrote in many different literary forms, such as an autobiography and books of moral advice for men and women, as well as poetry on a wide range of topics. In her treatise ''The Letter to the God of Love'', she effectively rebutted Jean de Meun's anti-feminist diatribes found in his conclusion of ''Romance of the Rose.'' <ref> Ibid., 374 </ref> Her rebuttal is important because it marked the first instance in European history where a woman wrote about the slanders women had long endured. It also led to a debate among de Meun and Pizan sympathizers which lasted until the sixteenth century. <ref> Ibid. </ref>
{{quote|"[...]looking back into the past, the history of the Church during the Middle Ages in England appears one continuous and stately progress. It is much nearer to the truth to say that in 1351 the whole ecclesiastical system was wholly disorganised, or, indeed, more than half ruined, and that everything had to be built up anew.[...] To secure the most necessary public ministrations of the rites of religion the most inadequately-prepared subjects had to be accepted, and even these could be obtained only in insufficient numbers.[...]The immediate effect on the people was a religious paralysis. Instead of turning men to God the scourge turned them to despair[...] In time the religious sense and feeling revived, but in many respects it took a new tone, and its manifestations ran in new channels[...]characterised by a devotional and more self-reflective cast than previously.[...]<br/>The new religious spirit found outward expression in the multitude of guilds which sprang into existence at this time, in the remarkable and almost, as it may seem to some, extravagant development of certain pious practices, in the singular spread of a more personal devotion to the Blessed Sacrament, to the Blessed Virgin, to the Five Wounds, to the Holy Name, and other such manifestations of a more tender or more familiar piety.[...]At the close of the fourteenth century and during the course of the fifteenth the supply of ornaments, furniture, plate, statues painted or in highly decked "coats," with which the churches were literally encumbered as time went on, proved a striking contrast to the comparative simplicity which characterised former days, as witnessed by a comparison of inventories.[...]<br/>In fact, the fifteenth century witnessed the beginnings of a great middle-class movement, which can be distinctly traced to the effect of the great pestilence[...]|source= Cardinal [[Francis Aidan Gasquet]]<ref name=gasquet/>{{rp|xvii}} }}


===Modern===
==Recurrences==
The Black Death has been used as a subject or as a [[Setting (fiction)|setting]] in modern literature and media. This may be due to the era's resounding impact on ancient and modern history, and its [[symbolism]] and connotations.


===Second plague pandemic===
[[Albert Camus]]'s novel ''[[La Peste]]'' deals with the coming of a plague to Algeria.
{{Main|Second plague pandemic}}
[[File:Great plague of london-1665.jpg|thumb|upright|The [[Great Plague of London]], in 1665, killed up to 100,000 people.]]
[[File:Paul Fürst, Der Doctor Schnabel von Rom (coloured version).png|thumb|upright|A [[plague doctor]] and his typical [[plague doctor costume|apparel]] during the 17th-century outbreak]]


The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries.{{sfn|Porter|2009|p=25}} According to Jean-Noël Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671 (although some researchers have cautions about the uncritical use of Biraben's data).{{sfn|Hays|1998|p=58}}{{sfn|Roosen|Curtis|2018}} The second pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667. Subsequent outbreaks, though severe, marked the plague's retreat from most of Europe (18th&nbsp;century) and North Africa (19th&nbsp;century).{{sfn|Hays|2005|p=46}}
[[Roger Zelazny]]'s novel ''[[Nine Princes in Amber]]'' has his protagonist abducted from his birthland and taken to plague-torn England to die.


Historian George Sussman argued that the plague had not occurred in East Africa until the 1900s.{{sfn|Sussman|2011}} However, other sources suggest that the second pandemic did indeed reach sub-Saharan Africa.{{sfn|Green|2018}}
[[Edgar Allan Poe]]'s short story "[[The Masque of the Red Death]]" ([[1842 in literature|1842]]) is set in an unnamed country during a fictional plague that bears strong resemblance to the Black Death. This possibility is furthered by the climax of the story taking place in a black room.<ref>http://www.cummingsstudyguides.net/Guides2/Masque.html Cummings Study Guide for "The Masque of the Red Death"</ref>


According to historian [[Geoffrey Parker (historian)|Geoffrey Parker]], "France alone lost almost a million people to the plague in the epidemic of 1628–31."{{sfn|Parker|2001|p=7}} In the first half of the 17th century, a plague killed some 1.7 million people in Italy.<ref>Karl Julius Beloch, ''Bevölkerungsgeschichte Italiens'', volume 3, pp. 359–60.</ref> More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century [[Habsburg Spain|Spain]].{{sfn|Payne|1973|loc=Chapter 15: The Seventeenth-Century Decline}}
Nobel prizewinner [[Sigrid Undset]]'s novel ''[[Kristin Lavransdatter]]'' features the outbreak of the plague in 14th century [[Norway]].


The Black Death ravaged much of the [[Muslim world|Islamic world]].<ref>{{cite web|url=https://www.ucalgary.ca/applied_history/tutor/islam/mongols/blackDeath.html |title=The Islamic World to 1600: The Mongol Invasions (The Black Death) |publisher=Ucalgary.ca |access-date=10 December 2011 |url-status=dead |archive-url=https://web.archive.org/web/20090721033845/http://www.ucalgary.ca/applied_history/tutor/islam/mongols/blackDeath.html |archive-date=21 July 2009 }}</ref> Plague could be found in the Islamic world almost every year between 1500 and 1850. Sometimes the outbreaks affected small areas, while other outbreaks affected multiple regions.<ref>{{Cite book | vauthors = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: N–Z | url = https://archive.org/details/encyclopediaofpe00jose/page/519/ | publisher = ABC-CLIO | year = 2008 | page = 519 | isbn = 978-0-313-34103-8 }}</ref> Plague repeatedly struck the cities of North Africa. [[Algiers]] lost 30,000–50,000 inhabitants to it in 1620–1621, and again in 1654–1657, 1665, 1691, and 1740–1742.{{sfn|Davis|2004}} 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.<ref name=":7" /> Plague remained a major event in [[Ottoman Empire|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.<ref>{{cite book |author1=Université de Strasbourg |author2=Institut de turcologie, Université de Strasbourg |author3=Institut d'études turques, Association pour le développement des études turques|title=Turcica|publisher=Éditions Klincksieck|year=1998|page=198}}</ref> [[Baghdad]] has suffered severely from visitations of the plague, and sometimes two-thirds of its population had died.{{sfn|Issawi|1988|p=99}}
[[Connie Willis]]'s [[Hugo Award]]-winning science fiction novel [[Doomsday Book (novel)|''Doomsday Book'']] imagines a future in which historians do field work by travelling into the past as observers. The protagonist, a historian, is sent to the wrong year, arriving in England just as the Black Death is starting. Likewise, [[Kim Stanley Robinson]]'s [[Alternate history (fiction)|alternate history novel]] ''[[The Years of Rice and Salt]]'' presents a future dramatically changed by the Black Death, in which Christian Europe was almost completely destroyed and played no major role in future history. Also in [[Michael Crichton]]'s book [[Timeline (novel)|''Timeline'']], a character is transported through time to a village that is apparently affected by the Black Death.


===Third plague pandemic===
Three novels by Ann Benson play on parallels between the Black Death and emerging diseases in the modern world. In ''The Plague Tales'' (1998), ''Burning Road'' (2000) and ''The Physician's Tale'' (2007), Benson shifts back and forth between the fourteenth century and a world sometime not very long after the present that has been devastated by an antibiotic-resistant bacterium. She weaves in allusions to many of the early plague sources and even modern fiction like [[Geraldine Brooks]]' ''Year of Wonders.''
{{Main|Third plague pandemic}}
[[File:World distribution of plague 1998.PNG|thumb|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.<ref>[http://www.sciencemag.org/cgi/content/full/321/5890/773 Infectious Diseases: Plague Through History] {{Webarchive|url=https://web.archive.org/web/20080817135739/http://www.sciencemag.org/cgi/content/full/321/5890/773 |date=17 August 2008 }}, sciencemag.org</ref> 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]], for whom the pathogen was named.{{sfn|Christakos|Olea|Serre|Wang|2005|pp=110–14}}
''[[Eifelheim (novel)|Eifelheim]]'' by [[Michael Flynn]] depicts the interactions between an isolated German village and a group of stranded extraterrestrials as the plague advances (1348-9).


Twelve plague outbreaks in Australia between 1900 and 1925 resulted in 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''.<ref>[http://sydney.edu.au/medicine/museum/mwmuseum/index.php/Bubonic_Plague_comes_to_Sydney_in_1900 Bubonic Plague comes to Sydney in 1900] {{Webarchive|url=https://web.archive.org/web/20120210023117/http://sydney.edu.au/medicine/museum/mwmuseum/index.php/Bubonic_Plague_comes_to_Sydney_in_1900 |date=10 February 2012 }}, University of Sydney, Sydney Medical School</ref>
''[[Temple of the Winds]]'', the fourth book in the fantasy series ''[[The Sword of Truth]]'' by [[Terry Goodkind]], centers around a plague that is very similar to the Black Death.


The first North American plague epidemic was the [[San Francisco plague of 1900–1904]], followed by another outbreak in 1907–1908.{{sfn|Chase|2004}}{{sfn|Echenberg|2007}}{{sfn|Kraut|1995}}
[[Melanie Rawn]]'s fantasy novel, ''[[Dragon Prince]]'', shows how a plague-like epidemic affects nobility somewhat less than commoners.


===Modern-day===
It has been alleged (since 1961) that the Black Death inspired one of the most enduring nursery rhymes in the English language, ''[[Ring a Ring O'Roses]], a pocket full of posies, / Ashes, ashes (or ah-tishoo ah-tishoo), we all fall down.'' However, there are no written records of the rhyme before the late [[19th century]] and not all of its many variants refer to ashes, sneezing, falling down or anything else that could be connected to the Black Death.<ref>{{cite web
Modern treatment methods include [[insecticide]]s, the use of [[antibiotic]]s, 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.<ref>{{Cite web |url=http://www.scidev.net/en/health/antibiotic-resistance/news/drugresistant-plague-a-major-threat-say-scient.html |title=Drug-resistant plague a 'major threat', say scientists |date=23 March 2007 |first=T.V. |last=Padma |website=SciDev.net |url-status=live |archiveurl=https://web.archive.org/web/20120719034621/http://www.scidev.net/en/health/antibiotic-resistance/news/drugresistant-plague-a-major-threat-say-scient.html |archivedate=19 July 2012}}</ref> Another outbreak in Madagascar was reported in November 2014.<ref>{{cite web |url=https://www.who.int/csr/don/21-november-2014-plague/en/ |title=Plague – Madagascar |date=21 November 2014 |publisher=World Health Organisation |access-date=26 November 2014 |archive-url=https://web.archive.org/web/20190502001426/https://www.who.int/csr/don/21-november-2014-plague/en/ |archive-date=2 May 2019 |url-status=dead }}</ref> In October 2017, the [[21st-century Madagascar plague outbreaks|deadliest outbreak of the plague]] in modern times hit Madagascar, killing 170 people and infecting thousands.<ref>{{Cite news|url=https://www.wsj.com/articles/madagascar-wrestles-with-worst-outbreak-of-plague-in-half-a-century-1510788541|title=Madagascar Wrestles With Worst Outbreak of Plague in Half a Century |first1=Alexandra |last1=Wexler |first2=Amir |last2=Antoy |date=16 November 2017|work=[[The Wall Street Journal]]|access-date=17 November 2017|language=en-US |archive-url= https://web.archive.org/web/20171117010725/https://www.wsj.com/articles/madagascar-wrestles-with-worst-outbreak-of-plague-in-half-a-century-1510788541|archive-date=17 November 2017|url-status=live}}</ref>
| title = Ring Around the Rosie
| work = Urban Legends References Pages
| publisher = www.snopes.com
| url = http://www.snopes.com/language/literary/rosie.htm
| accessdate = 2006-12-12 }}</ref>


An estimate of the [[case fatality rate]] for the modern [[Plague (disease)|plague]], after the introduction of [[antibiotic]]s, is 11%, although it may be higher in underdeveloped regions.<ref>{{cite web|url=https://www.cdc.gov/plague/faq/index.html|author=Centers for Disease Control (CDC)|title=FAQ: Plague|date=24 September 2015|access-date=24 April 2017|archive-url=https://web.archive.org/web/20190330171757/https://www.cdc.gov/plague/faq/index.html|archive-date=30 March 2019|url-status=live}}</ref>
The relatively new medium of film has given writers and film producers an opportunity to portray the plague with more visual realism. One of the best known and most expansive depictions of the black plague as art is the movie classic ''[[The Seventh Seal]]'', a 1957 film directed by [[Ingmar Bergman]]. The knight returns from the [[Crusade]]s and finds that his home country is ravaged by the Black Death. To his dismay, but not surprise, he discovers that Death has come for him too. The final scene of ''The Seventh Seal'' depicts a kind of ''Danse Macabre''. The [[1988]] [[science fiction]] film ''[[The Navigator: A Medieval Odyssey]]'' portrayed a group of [[14th-century]] [[England|English]] [[village]]rs who dig a tunnel to [[20th-century]] [[New Zealand]], with the aid of a boy's vision, to escape the Black Death.


==See also==
The Black Metal band [[1349 (band)|1349]] is named after the year the Black Death spread through Norway.
* [[Flagellant]]
* [[Globalization and disease]]


==Footnotes==
''[[Danse Macabre (album)|Danse Macabre]]'' by [[The Faint]] is a techno dance album alluding to the Black Death.
{{Notelist|30em}}


===Citations===
The legendary unproduced Hollywood script "Harrow Alley" is set during the 1665 plague outbreak in London.
{{reflist|22em|refs=
<ref name="lead numbers">Sources for deaths: {{harvnb|Aberth|2021|page=1}}; {{harvnb|Benedictow|2021|pp=869–877}}; {{harvnb|Christakos|Olea|Serre|Wang|2005}}{{page needed|date=December 2023}}</ref>
<ref name="lead origin">'''Sources for origins'''
*{{Cite web|url=https://edition.cnn.com/2019/11/23/asia/plague-china-history-intl-hnk-scli/index.html|title=Black Death in China: A history of plagues, from ancient times to now |website=CNN|date=24 November 2019 |url-status=live|archive-url=https://web.archive.org/web/20200306011659/https://edition.cnn.com/2019/11/23/asia/plague-china-history-intl-hnk-scli/index.html|archive-date=6 March 2020|access-date=24 March 2020}}
* {{harvnb|Benedictow|2004|pp=50–51}}
* {{harvnb|Bramanti|Stenseth|Walløe|Lei|2016|pp=1–26}}
* {{Cite web|url=https://www.britannica.com/event/Black-Death|title=Black Death {{!}} Causes, Facts, and Consequences|website=Encyclopædia Britannica|language=en|access-date=2020-03-01|archive-url=https://web.archive.org/web/20190709135155/https://www.britannica.com/event/Black-Death|archive-date=9 July 2019|url-status=live}}
* {{harvnb|Sussman|2011}}</ref>}}


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THEY ALL ARE GAY CAUSE OF THE BLACK DEATH
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* {{cite book |vauthors=Munro J |chapter=Before and After the Black Death: Money, Prices, and Wages in Fourteenth-Century England |year=2004 |title=New Approaches to the History of Late Medieval and Early Modern Europe |publisher=The Royal Danish Academy of Sciences and Letters |pages=335–364 |chapter-url=https://mpra.ub.uni-muenchen.de/15748/1/MPRA_paper_15748.pdf |access-date=21 May 2020 |archive-date=15 January 2020 |archive-url=https://web.archive.org/web/20200115230318/https://mpra.ub.uni-muenchen.de/15748/1/MPRA_paper_15748.pdf |url-status=live }} {{open access}}
* {{cite book | vauthors = Nauert CG |title=The A to Z of the Renaissance|date=2006|publisher=Scarecrow Press|isbn=978-1461718963 }}
* {{cite book | vauthors = Netzley PD |title=Life During the Renaissance |location=San Diego |publisher=Lucent Books, Inc. |year=1998 |isbn=978-1560063759 }}
* {{cite book | vauthors = Nirenberg D |title=Communities of Violence |year=1998 |publisher=Princeton University Press |isbn=0-691-05889-X}}
* {{cite book | vauthors = Parker G |year=2001 |title=Europe in crisis, 1598–1648 |publisher=Wiley-Blackwell |isbn=0-631-22028-3 }}
* {{cite book |vauthors=Payne SG |year=1973 |title=A History of Spain and Portugal, Volume 1 |url=http://libro.uca.edu/payne1/payne15.htm |publisher=University of Wisconsin Press |access-date=3 January 2009 |archive-date=27 March 2017 |archive-url=https://web.archive.org/web/20170327015606/http://libro.uca.edu/payne1/payne15.htm |url-status=live }}
* {{cite book | vauthors = Porter S |title=The Great Plague |year=2009 |publisher=Amberley Publishing |isbn=978-1-84868-087-6 }}
* {{cite journal | vauthors = Rascovan N, Sjögren KG, Kristiansen K, Nielsen R, Willerslev E, Desnues C, Rasmussen S | title = Emergence and Spread of Basal Lineages of Yersinia pestis during the Neolithic Decline | journal = Cell | volume = 176 | issue = 1–2 | pages = 295–305.e10 | date = January 2019 | pmid = 30528431 | doi = 10.1016/j.cell.2018.11.005 | doi-access = free }}
* {{cite journal | vauthors = Rasmussen S, Allentoft ME, Nielsen K, Orlando L, Sikora M, Sjögren KG, Pedersen AG, Schubert M, Van Dam A, Kapel CM, Nielsen HB, Brunak S, Avetisyan P, Epimakhov A, Khalyapin MV, Gnuni A, Kriiska A, Lasak I, Metspalu M, Moiseyev V, Gromov A, Pokutta D, Saag L, Varul L, Yepiskoposyan L, Sicheritz-Pontén T, Foley RA, Lahr MM, Nielsen R, Kristiansen K, Willerslev E | display-authors = 6 | title = Early divergent strains of Yersinia pestis in Eurasia 5,000 years ago | journal = Cell | volume = 163 | issue = 3 | pages = 571–582 | date = October 2015 | pmid = 26496604 | pmc = 4644222 | doi = 10.1016/j.cell.2015.10.009 }}
* {{cite journal |vauthors=Roosen J, Curtis DR |year=2018 |title=Dangers of Noncritical Use of Historical Plague Data |journal=Emerging Infectious Diseases |volume=24 |issue=1 |pages=103–10 |doi=10.3201/eid2401.170477 |doi-access=free |pmc=5749453 }}
* {{cite journal | vauthors = Samia NI, Kausrud KL, Heesterbeek H, Ageyev V, Begon M, Chan KS, Stenseth NC | title = Dynamics of the plague-wildlife-human system in Central Asia are controlled by two epidemiological thresholds | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 108 | issue = 35 | pages = 14527–14532 | date = August 2011 | pmid = 21856946 | pmc = 3167548 | doi = 10.1073/pnas.1015946108 | doi-access = free | bibcode = 2011PNAS..10814527S }}
* {{cite book | vauthors = Scheidel W |author-link =Walter Scheidel |title=The Great Leveler: Violence and the History of Inequality from the Stone Age to the Twenty-First Century |publisher=Princeton University Press |year=2017 |isbn=978-0691165028}}
* {{cite journal | vauthors = Schmid BV, Büntgen U, Easterday WR, Ginzler C, Walløe L, Bramanti B, Stenseth NC | title = Climate-driven introduction of the Black Death and successive plague reintroductions into Europe | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 112 | issue = 10 | pages = 3020–3025 | date = March 2015 | pmid = 25713390 | pmc = 4364181 | doi = 10.1073/pnas.1412887112 | doi-access = free | bibcode = 2015PNAS..112.3020S }}
* {{cite journal | vauthors = Slavin P |title=Death by the Lake: Mortality Crisis in Early Fourteenth-Century Central Asia |journal=Journal of Interdisciplinary History |volume=50 |number=1 |date=Summer 2019 |pages=59–90 |doi=10.1162/jinh_a_01376 |s2cid=162183994 |doi-access=free |hdl=1893/29711 |hdl-access=free }}
* {{cite book | vauthors = Sloane B |title=The Black Death in London |date=2011 |isbn=978-0-7524-2829-1 |place=London |publisher=The History Press Ltd }}
* {{cite book | vauthors = Snowden FM | title = Epidemics and Society: From the Black Death to the Present | place = New Haven, Connecticut | publisher = Yale University Press | year = 2019 | isbn = 978-0-300-19221-6}}
* {{cite journal | vauthors = Spyrou MA, Tukhbatova RI, Wang CC, Valtueña AA, Lankapalli AK, Kondrashin VV, Tsybin VA, Khokhlov A, Kühnert D, Herbig A, Bos KI, Krause J | display-authors = 6 | title = Analysis of 3800-year-old Yersinia pestis genomes suggests Bronze Age origin for bubonic plague | journal = Nature Communications | volume = 9 | issue = 1 | pages = 2234 | date = June 2018 | pmid = 29884871 | pmc = 5993720 | doi = 10.1038/s41467-018-04550-9 | bibcode = 2018NatCo...9.2234S }}
* {{cite journal | vauthors = Spyrou MA, Keller M, Tukhbatova RI, Scheib CL, Nelson EA, Andrades Valtueña A, Neumann GU, Walker D, Alterauge A, Carty N, Cessford C, Fetz H, Gourvennec M, Hartle R, Henderson M, von Heyking K, Inskip SA, Kacki S, Key FM, Knox EL, Later C, Maheshwari-Aplin P, Peters J, Robb JE, Schreiber J, Kivisild T, Castex D, Lösch S, Harbeck M, Herbig A, Bos KI, Krause J | display-authors = 6 | title = Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes | journal = Nature Communications | volume = 10 | issue = 1 | pages = 4470 | date = October 2019 | pmid = 31578321 | pmc = 6775055 | doi = 10.1038/s41467-019-12154-0 | author18 = S Kacki | author19 = FM Key | author16 = K von Heyking | author17 = SA Inskip | author14 = R Hartle | author15 = M Henderson | author12 = H Fetz | author13 = M Gourvennec | author10 = N Carty | author11 = C Cessford | author5 = EA Nelson | author6 = A Andrades Valtueña | author7 = GU Neumann | author8 = D Walker | author9 = A Alterauge A | bibcode = 2019NatCo..10.4470S | author30 = A Herbig | author31 = KI Bos | author32 = J Krause | author29 = M Harbeck M | author28 = S Lösch | author23 = J Peters | author22 = P Maheshwari-Aplin | author21 = C Later | author20 = EL Knox | author27 = D Castex | author26 = T Kivisild | author25 = J Schreiber | author24 = JE Robb }}
* {{cite journal | vauthors = Sussman GD | title = Was the black death in India and China? | journal = Bulletin of the History of Medicine | volume = 85 | issue = 3 | pages = 319–355 | year = 2011 | pmid = 22080795 | doi = 10.1353/bhm.2011.0054 | s2cid = 41772477 | url = https://academicworks.cuny.edu/lg_pubs/52 | access-date = 1 February 2022 | archive-date = 5 April 2022 | archive-url = https://web.archive.org/web/20220405101419/https://academicworks.cuny.edu/lg_pubs/52/ | url-status = live }}
* {{Cite book | vauthors = Tignor A, Brown E, Liu P, Shaw R, Jeremy P, Benjamin X, Holly B |title=Worlds Together, Worlds Apart, Volume 1: Beginnings to the 15th Century |publisher=W.W Norton & Company|year=2014|isbn=978-0-393-92208-0|location=New York, London}}
* {{cite book | vauthors = Tuchman B |author-link=Barbara Tuchman |year=1978 |title=A Distant Mirror |publisher=Knopf |isbn=0-394-40026-7}}
* {{cite journal | vauthors = Wagner DM, Klunk J, Harbeck M, Devault A, Waglechner N, Sahl JW, Enk J, Birdsell DN, Kuch M, Lumibao C, Poinar D, Pearson T, Fourment M, Golding B, Riehm JM, Earn DJ, Dewitte S, Rouillard JM, Grupe G, Wiechmann I, Bliska JB, Keim PS, Scholz HC, Holmes EC, Poinar H | display-authors = 6 | title = Yersinia pestis and the plague of Justinian 541-543 AD: a genomic analysis | journal = The Lancet. Infectious Diseases | volume = 14 | issue = 4 | pages = 319–326 | date = April 2014 | pmid = 24480148 | doi = 10.1016/S1473-3099(13)70323-2 }}
* {{cite journal | vauthors = Walløe L | title = Medieval and modern bubonic plague: some clinical continuities | journal = Medical History. Supplement | volume = 27 | issue = 27 | pages = 59–73 | year = 2008 | pmid = 18575082 | pmc = 2632865 | doi = 10.1017/S0025727300072094 }}
* {{cite journal | vauthors = Welford M, Bossak BH |title=Revisiting the Medieval Black Death of 1347-1351: Spatiotemporal Dynamics Suggestive of an Alternate Causation: Black death spatiotemporal dynamics |journal=Geography Compass |date=June 2010 |volume=4 |issue=6 |pages=561–575 |doi=10.1111/j.1749-8198.2010.00335.x }}
* {{cite journal | vauthors = Wheelis M | title = Biological warfare at the 1346 siege of Caffa | journal = Emerging Infectious Diseases | volume = 8 | issue = 9 | pages = 971–975 | date = September 2002 | pmid = 12194776 | pmc = 2732530 | doi = 10.3201/eid0809.010536 | doi-access = free }}
* {{cite book | vauthors = Ziegler P |title=The Black Death |year=1998|publisher=Penguin Books |isbn=978-0-14-027524-7 }} 1st editions 1969.
* {{cite book | vauthors = Zuchora-Walske C |title=Poland |location=North Mankato |publisher=ABDO Publishing |year=2013 |isbn=978-1-61783-634-3}}
{{refend}}


==Selected sources and further reading==
==Further reading==
{{refbegin|30em}}
===References===
* {{cite journal | vauthors = Alfano V, Sgobbi M |title=A fame, peste et bello libera nos Domine: An Analysis of the Black Death in Chioggia in 1630 |journal=Journal of Family History |date=January 2022 |volume=47 |issue=1 |pages=24–40 |doi=10.1177/03631990211000615 |s2cid=233671164 }}
{{reflist|2}}
* {{Cite book | vauthors = Armstrong D |title = The Black Death: The World's Most Devastating Plague |publisher = The Great Courses |year = 2016 |asin = B01FWOO2G6 |url = http://www.thegreatcourses.com/courses/the-black-death-the-worlds-most-devastating-plague.html |access-date = 16 October 2016 |archive-date = 18 October 2016 |archive-url = https://web.archive.org/web/20161018203714/http://www.thegreatcourses.com/courses/the-black-death-the-worlds-most-devastating-plague.html |url-status = live }}
* {{cite book | vauthors = Bailey M |title=After the Black Death: Economy, society, and the law in fourteenth-century England |date=2021 |publisher=Oxford University Press |isbn=978-0-19-259973-5 }}
* {{cite journal | vauthors = Barker H |title=Laying the Corpses to Rest: Grain, Embargoes, and Yersinia pestis in the Black Sea, 1346–48 |journal=Speculum |date=2021 |volume=96 |issue=1 |pages=97–126 |doi=10.1086/711596 |s2cid=229344364 }}
* {{cite book |last1=Cantor NF |title=In the wake of the plague : the Black death and the world it made |date=2015 |orig-year=2001 |location=New York |isbn=978-1-4767-9774-8 |edition=First Simon & Schuster paperback |publisher= Simon & Schuster }}
* {{cite book | vauthors = Cohn Jr SK |title=The black death transformed : disease and culture in early Renaissance Europe |date=2002 |publisher=Arnold |location=London |isbn=978-0-340-70646-6}}
* {{cite book | vauthors = Crawford DH |title=Deadly Companions: How Microbes Shaped Our History |date=2018 |publisher=Oxford University Press |isbn=978-0-19-881544-0 }}
* {{cite book | vauthors = Dols MW |title=The Black Death in the Middle East |date=2019 |publisher=Princeton University Press |location=Princeton, N.J. |isbn=978-0-691-65704-2}}
* {{cite journal | vauthors = Dols MW |title=The Comparative Communal Responses to the Black Death in Muslim and Christian Societies |journal=Viator |date=January 1974 |volume=5 |pages=269–288 |id={{ProQuest|1297911710}} |doi=10.1484/J.VIATOR.2.301626 }}
* {{cite journal | vauthors = Dols MW | title = Geographical origin of the Black Death: comment | journal = Bulletin of the History of Medicine | volume = 52 | issue = 1 | pages = 112–120 | date = 1978 | pmid = 352447 | id = {{ProQuest|1296259982}} }}
* {{cite journal | vauthors = Duncan CJ, Scott S | title = What caused the Black Death? | journal = Postgraduate Medical Journal | volume = 81 | issue = 955 | pages = 315–320 | date = May 2005 | pmid = 15879045 | pmc = 1743272 | doi = 10.1136/pgmj.2004.024075 }}
* {{Cite book |title=Plagues and Peoples | vauthors = McNeill WH |year=1976 |publisher=Anchor/Doubleday |isbn=978-0-385-11256-7 }}
* {{cite journal | vauthors = Pamuk S |title=The Black Death and the origins of the 'Great Divergence' across Europe, 1300–1600 |journal=European Review of Economic History |date=December 2007 |volume=11 |issue=3 |pages=289–317 |doi=10.1017/S1361491607002031 }}
* {{cite book | vauthors = Scott S, Duncan CJ | year =2001 | title =Biology of Plagues: Evidence from Historical Populations | place = Cambridge| publisher = Cambridge University Press | isbn = 978-0-521-80150-8 }}
* {{cite journal | vauthors = Schuenemann VJ, Bos K, DeWitte S, Schmedes S, Jamieson J, Mittnik A, Forrest S, Coombes BK, Wood JW, Earn DJ, White W, Krause J, Poinar HN | display-authors = 6 | title = Targeted enrichment of ancient pathogens yielding the pPCP1 plasmid of Yersinia pestis from victims of the Black Death | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 108 | issue = 38 | pages = E746–E752 | date = September 2011 | pmid = 21876176 | pmc = 3179067 | doi = 10.1073/pnas.1105107108 | doi-access = free | bibcode = 2011PNAS..108E.746S }}
* {{cite book | vauthors = Shrewsbury JF |title=A History of Bubonic Plague in the British Isles. |date=2005 |publisher=Cambridge Univ Pr |isbn=978-0-521-02247-7}}
* {{cite book | vauthors = Twigg G |title=The Black Death : a biological reappraisal |date=1985 |publisher=Schocken Books |location=New York |isbn=978-0-7134-4618-0 |edition=1st American}}
{{refend}}


===Primary sources===
==External links==
{{Commons category|Black Death}}
* [[Giovanni Boccaccio]] (''[[The Decameron]]'')
* {{In Our Time|Black Death|b00bcqt8|Black_Death}}
* [[Petrarch]]
* [https://www.bbc.co.uk/history/british/middle_ages/black_01.shtml Black Death] at [[BBC]]
*[[Elijah ben Abraham]] ("[[Kitab majannat al-ta’un wa-l-wba.]])
*[[Lisan al-Din Ibn al-Khatib.]] ("A Very Useful Inquiry into the Horrible Sickness.") 1349-1352.


{{Black Death}}
====Primary sources online====
{{Epidemics}}
*[http://www.themediadrome.com/content/articles/blackdeath.htm Henry Knighton's account]
{{History of infectious disease}}
*[http://housatonic.net/Documents/627.htm Agnolo di Tura's account] <!--I can't seem to find the full text online!-->
{{Authority control}}
*[http://www.brown.edu/Departments/Italian_Studies/dweb/plague/perspectives/de_mussi.shtml Gabriele de' Mussi's account]
*[http://www.brown.edu/Departments/Italian_Studies/dweb/plague/perspectives/marchionne.shtml Marchionne di Coppo di Stefano Buonaiuti's account]
*[http://www.brown.edu/Departments/Italian_Studies/dweb/plague/perspectives/petrarca2.shtml A Petrarch account] and [http://www.brown.edu/Departments/Italian_Studies/dweb/plague/perspectives/petrarca.shtml More quotes from Petrarch]


{{Ireland topics}}
=== Secondary sources ===
* Appleby, Andrew B. "The Disappearance of the Plague: A Continuing Puzzle", Economic History Review 33, 2 (1980) 161-173
* Deaux, George (1969). ''The Black Death 1347''. New York: Weybright and Talley. ISBN 0-241-01514-6
* Derr, Mark. "New Theories Link Black Death to Ebola-Like Virus" ''The [[New York Times]]'', Science Section, [[October 2]] [[2001]]
* Dols, Michael W. (1977). ''The Black Death in the Middle East'' Princeton University Press, Princeton, New Jersey. ISBN 0-691-03107-X
* Gottfried, Robert S (1983). ''The Black Death''. New York: The Free Press ISBN 0-02-912370-4
* Herlihy, David (1997). ''The Black Death and the Transformation of the West''. Cambridge: Harvard UP. ISBN 0-674-07613-3. This text is a definitive short text on the Black Death
* Kelly, John (2005). ''The Great Mortality, An Intimate History of the Black Death, the Most Devastating Plague of All Time''. HarperCollins Publisher Inc., New York, NY. ISBN 0-06-000692-7
* Marks, Geoffrey (1971). ''The Medieval Plague: The Black Death of the Middle Ages'' New York; Doubleday. ISBN 0-385-00630-6.
* McNeill, William H. (1976). ''Plagues and People''. New York: Anchor Books. ISBN 0-385-12122-9.
*Scott, Susan and Duncan, Christopher. (2004). ''Return of the Black Death: The World's Greatest Serial Killer'' West Sussex; John Wiley and Sons. ISBN 0-470-09000-6
* Slack, Paul. “The Disappearance of the Plague: An Alternative View.” Economic History Review 34, 3 (1981) 469-476.
* [[Barbara W. Tuchman|Tuchman, Barbara W.]] (1978), ''A Distant Mirror: the Calamitous 14th Century.'', Alfred A. Knopf, New York, 1984. ISBN 0-394-40026-7. Chilling account of the Black Death, as part of European history 1300 - 1450.
* Williams, Dr. Bernadette. (2007).''The Annals of Ireland by Friar John Clyn''. Dublin: Four Courts Press. ISBN 978 1 84682 034 2
* [[Philip Ziegler|Ziegler, Philip]] (1969). ''Black Death''. ISBN 0-06-131550-8
*William, Daniel. The Black Death. New York: Medieval & Renaissance Texts & Studies, 1982.

====Secondary sources online====
*[http://www.1911encyclopedia.org/Plague Plague - LoveToKnow 1911]
*[http://www.britannica.com/eb/article-9015473/Black-Death "Black Death"]. In ''[[Encyclopædia Britannica]]'' Online.
* [http://www.historyguide.org/ancient/lecture29b.html ''The History Guide'' "Satan Triumphant: The Black Death"]
* [http://www.emedicine.com/EMERG/topic428.htm Symptoms, causes, pictures of bubonic plague]
* [http://www.themiddleages.net/plague.html Overview of the black death]
* [http://news.bbc.co.uk/hi/english/health/newsid_1925000/1925513.stm BBC news story on controversy over Black Death origins]
* [http://www.snopes.com/language/literary/rosie.htm Examination of "Ring around the Rosy"'s relationship to the plague]
* [http://www.bbc.co.uk/history/british/middle_ages/black_01.shtml Black Death Overview from BBC]
* [http://jefferson.village.virginia.edu/osheim/intro.html Plague and Public Health in Renaissance Europe]. Primary source documents and analysis.
* [http://www.pbs.org/wnet/secrets/case_plague/ Secrets of the Dead . Mystery of the Black Death] [[PBS]]
* [http://www.shtetlinks.jewishgen.org/Myadel/pandemics.htm Pandemics in Eastern Europe]


[[Category:Black Death| ]]
[[Category:Plague pandemics]]
[[Category:14th-century health disasters]]
[[Category:1340s]]
[[Category:1350s]]
[[Category:Eurasian history]]
[[Category:Eurasian history]]
[[Category:History of Asia]]
[[Category:History of medieval medicine]]
[[Category:Early Modern period]]
[[Category:Medieval health disasters]]
[[Category:History of the Middle East]]
[[Category:Second plague pandemic]]
[[Category:Late Middle Ages]]
[[Category:Causes of death]]
[[Category:Medical disasters]]
[[Category:Pandemics]]

{{Link FA|de}}
{{Link FA|pt}}
{{Link FA|sv}}

[[af:Swart Dood]]
[[ar:موت أسود]]
[[an:Peste negra]]
[[bs:Crna smrt]]
[[bg:Черна смърт]]
[[ca:Pesta Negra]]
[[cy:Pla Du]]
[[da:Den sorte død]]
[[de:Schwarzer Tod]]
[[et:Must surm]]
[[el:Μαύρη Πανώλη]]
[[es:Peste Negra]]
[[eo:Nigra morto]]
[[eu:Izurri Beltza]]
[[fr:Peste noire]]
[[gd:Am Bàs Dubh]]
[[ko:흑사병]]
[[hr:Doba kuge]]
[[id:Kematian Hitam]]
[[is:Svarti dauði]]
[[it:Peste nera]]
[[he:המוות השחור]]
[[lv:Melnā nāve]]
[[lt:Juodoji mirtis]]
[[ms:Maut Hitam]]
[[nl:Zwarte Dood]]
[[ja:ペスト]]
[[no:Svartedauden]]
[[nn:Svartedauden]]
[[nds:Swart Dood]]
[[pl:Czarna śmierć]]
[[pt:Peste negra]]
[[ro:Moartea neagră]]
[[ru:Чёрная смерть]]
[[scn:Pesti bubbònica]]
[[simple:Black Death]]
[[sk:Čierna smrť]]
[[sl:Črna smrt]]
[[sr:Црна смрт]]
[[fi:Musta surma]]
[[sv:Digerdöden]]
[[th:กาฬโรคระบาดในยุโรป]]
[[tr:Kara ölüm]]
[[zh:黑死病]]

Latest revision as of 04:34, 18 December 2024

Black Death
The spread of the Black Death in Europe and the Near East (1346–1353)
The spread of the Black Death in Europe, North Africa, and the Near East (1346–1353)
DiseaseBubonic plague
LocationEurasia and North Africa[1]
Date1346–1353
Deaths
25,000,000 – 50,000,000 (estimated)

The Black Death was a bubonic plague pandemic that occurred in Europe from 1346 to 1353. It was one of the most fatal pandemics in human history; as many as 50 million people[2] perished, perhaps 50% of Europe's 14th century population.[3] The disease is caused by the bacterium Yersinia pestis and spread by fleas and through the air.[4][5] One of the most significant events in European history, the Black Death had far-reaching population, economic, and cultural impacts. It 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.[7] Genetic analysis suggests Yersinia pestis bacteria evolved approximately 7,000 years ago, at the beginning of the Neolithic,[8] with flea-mediated strains emerging around 3,800 years ago during the late Bronze Age.[9] The immediate territorial origins of the Black Death and its outbreak remain unclear, with some evidence pointing towards Central Asia, China, the Middle East, and Europe.[10][11] The pandemic was reportedly first introduced to Europe during the siege of the Genoese trading port of Kaffa in Crimea by the Golden Horde army of Jani Beg in 1347. 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, West Asia, and the rest of Europe via Constantinople, Sicily, and the Italian Peninsula.[12] There is evidence that once it came ashore, the Black Death mainly spread from 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.[13][14][15] 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 have been unrelated to the 14th century Mongol conquests previously postulated as the cause.[16][17]

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% to 60% of the European population, as well as approximately 33% of the population of the Middle East.[18][19][20] There were further outbreaks throughout the Late Middle Ages and, also due to other contributing factors (the Crisis of the Late Middle Ages), the European population did not regain its 14th century level until the 16th century.[a][21] 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'.[22] In English prior to the 18th century, the event was called the "pestilence" or "great pestilence", "the plague" or the "great death".[22][23][24] 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.[22]

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.[22] "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'.[22][25] 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.[26][27] Previously, most European languages had named the pandemic a variant or calque of the Latin: magna mortalitas, lit.'Great Death'.[22]

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, romanizedpleîoi mélanos Thanátoio).[28][26] 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.[29][26][22] 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).[26][30] 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.[31] 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.[22]

The historian Cardinal Francis Aidan Gasquet wrote about the Great Pestilence in 1893[32] and suggested that it had been "some form of the ordinary Eastern or bubonic plague".[33][b] In 1908, Gasquet said 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).[34][35]

Previous plague epidemics

Yersinia pestis (200 × magnification), the bacterium that causes plague[36]

Research from 2017 suggests plague first infected humans in Europe and Asia in the Late Neolithic-Early Bronze Age.[37] 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.[38][39] 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.[40]

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.[41] In 2013, researchers confirmed earlier speculation that the cause of the Plague of Justinian (541–549 CE, with recurrences until 750) was Y. pestis.[42][43] 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."[44] 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.[45]

14th-century plague

Causes

Early theory

A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" (miasma theory).[46] 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.[47][page needed] 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.[48][49]

Predominant modern theory

The Oriental rat flea (Xenopsylla cheopis) engorged with blood. This species of flea is the primary vector for the transmission of Yersinia pestis, the organism responsible for spreading bubonic plague in most plague epidemics. Both male and female fleas feed on blood and can transmit the infection.
Oriental rat flea (Xenopsylla cheopis) infected with the Yersinia pestis bacterium which appears as a dark mass in the gut. The foregut (proventriculus) of this flea is blocked by a Y. pestis biofilm; when the flea feeds on an uninfected host Y. 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.[50] 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, West Asia, North India, Uganda, and the western United States.[51][52]

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 bacterium was present in rodents and suggested the rat was the main vehicle of transmission.[53][54] 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.[55] This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try to clear the blockage via regurgitation, resulting in thousands of plague bacteria flushing into the feeding site and 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.[33]

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][c] 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".[58]

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.[58]

Later genomic papers have further confirmed the phylogenetic placement of the Y. pestis strain responsible for the Black Death as both the ancestor[59] of later plague epidemics—including the third plague pandemic—and the descendant[60] of the strain responsible for the Plague of Justinian. In addition, plague genomes from prehistory have been recovered.[61]

DNA taken from 25 skeletons from 14th-century London showed that plague is a strain of Y. pestis almost identical to that which hit Madagascar in 2013.[62][63] Further DNA evidence also proves the role of Y. pestis and traces the source to the Tian Shan mountains in Kyrgyzstan.[64]

Alternative explanations

Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague 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.[65] 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. In 2018 researchers 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 the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data.[66][67]

Lars Walløe argued that 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".[68] 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.[41]

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.[69][70] This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic.[71]

Summary

Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance.[33] 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 septicemic and pneumonic forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms.[72] 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.[62] 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.[73]

Transmission

Lack of hygiene

The importance of hygiene was not recognized until the 19th century and the germ theory of disease. Until then streets were usually unhygienic, with live animals and human parasites facilitating the spread of transmissible disease.[74]

By the early 14th 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.[75] 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 careless. William E. Cosner, a resident of the London suburb of Farringdon Without, received a complaint alleging that "men could not pass [by his house] for the stink [of] . . . horse dung and horse piss." 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.[76]

Early Christians considered bathing a temptation. 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.[77]

Territorial origins

According to a team of medical geneticists led by Mark Achtman, Yersinia pestis "evolved in or near China" over 2,600 years ago.[78][79][80] Later research by a team led by Galina Eroshenko placed its origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China.[81][82] However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region previously thought to be restricted to China.[83] 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.[84] 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.[85] The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s.[86]

Nestorian gravesites dating from 1338 to 1339 near Issyk-Kul 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.[17] Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347.[87][88]

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.[82]

— 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.[86] 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.[84] Additionally, 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 its role in the spread of plague less likely.[86] 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.[89]

Others still favor an origin in China.[82] The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside Mongol armies and traders, or possibly arriving via ship—however, 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.[84]

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 14th-century China, suggesting that the Black Death may not have reached these regions.[86][84][90] 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.[91]

Demographic historians estimate that China's population fell by at least 15 per cent, 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.[92]

— Richard von Glahn

Monica Green suggests that other parts of Eurasia outside the west do not contain the same evidence of the Black Death, 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 Death.[93] Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China.[83] Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China.[11] Norris specifically argues for an origin in Kurdistan rather than Central Asia.[89]

European outbreak

The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in Dorsetshire, where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive. ... But at length it came to Gloucester, yea even to Oxford and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive.

Geoffrey the Baker, Chronicon Angliae[94]

Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the Crimea in 1347. During a protracted siege of the city in 1345–1346, the Mongol Golden Horde army of Jani Beg—whose mainly Tatar troops were suffering from the disease—catapulted infected corpses over the city walls of Kaffa to infect the inhabitants,[95] though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants.[96][97] As the disease took hold, Genoese traders fled across the Black Sea to Constantinople, where the disease first arrived in Europe in summer 1347.[98]

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, noting the spread of the Black Death by ship between maritime cities.[98] Nicephorus Gregoras, while writing to Demetrios Kydones, described the rising death toll, the futility of medicine, and the panic of the citizens.[98] The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400.[98]

Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347;[99] 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 into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles.[100]

From Italy, the disease spread northwest across Europe, striking France, Spain, Portugal, and England by June 1348, then spreading 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).[101] Finally, it spread to northern Russia in 1352 and reached Moscow in 1353.[102][103] Plague was less common in parts of Europe with less-established trade relations, including the majority of the Basque Country, isolated parts of Belgium and the Netherlands, and isolated Alpine villages throughout the continent.[104][105][106]

According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts,[107] inducing plague outbreaks which often peaked in the hot summers of the Mediterranean[108] and during the cool autumn months of the southern Baltic region.[109][d] Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population.[112]

West 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.[113]

By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves.[114] By late summer 1348, it reached Cairo, capital of the Mamluk Sultanate, cultural center 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.[115] The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th-century bimaristan of the Qalawun complex.[115] The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites; plague recurred in Cairo more than fifty times over the following one and a half centuries.[115]

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.[114] That year, in the territory of modern Lebanon, Syria, Israel, and Palestine, the cities of Ascalon, 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.[116] Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa.[47][page needed]

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.[114]

Mecca became infected in 1348 by pilgrims performing the Hajj.[114] 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.[114][117] During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease.[118]

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 plague include fever of 38–41 °C (100–106 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Left untreated, 80% of victims die within eight days.[119]

Contemporary accounts of the pandemic are varied and often imprecise.[e] 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.[72] 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.[121][122][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,[124] which may have been caused by flea-bites, were identified as another potential sign of plague.

Pneumonic plague

Lodewijk Heyligen, whose master Cardinal Giovanni Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague, that infected the lungs and led to respiratory problems.[72] 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 90–95%.[125]

Septicemic plague

Septicemic plague is the least common of the three forms, with an untreated mortality rate near 100%. Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation).[125] In cases of pneumonic and particularly septicemic 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.[125]

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. Urban centers with higher populations suffered longer periods of abnormal mortality.[126] Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia.[127][128][129][better source needed] A study published in 2022 of pollen samples across Europe from 1250 to 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.[130] The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere."

The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert Gottfried writes that as early as 1351, "agents for Pope Clement VI calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the Book of Revelation, a favorite medieval source of information."[131] Ole J. Benedictow proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century.[132][133][g] According to medieval historian Philip Daileader, it is likely that over four years, 45–50% of the European population died of plague.[134][h]

The overwhelming number of deaths in Europe sometimes made mass burials necessary, and some sites had hundreds or thousands of bodies.[135] 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.[135] 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.[136]

In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die.[33] 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 to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished,[137] and a similar percentage of Londoners may have died from the disease as well,[62] leaving a death toll of approximately 62,000 between 1346 and 1353.[50][i] Florence's tax records suggest that 80% of the city's population died within four months in 1348.[136] Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450.[139] The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion. Plague did not appear 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.[136] Monks, nuns, and priests were especially hard-hit since they cared for people ill with the plague.[140] The level of mortality in the rest of Eastern Europe was likely similar to that of Western Europe in the first outbreak, with descriptions suggesting a similar effect on Russian towns, and the cycles of plague in Russia being roughly equivalent.[103]

Citizens of Tournai bury plague victims

In 1382, 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 1347–1348, 1362, 1371 and 1382 in his treatise On Epidemics (De epidemica).[141] 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.[141] By the 1380s in Europe, the plague predominantly affected children.[136] Chalmel de Vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the Roman Curia, whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he was never able to effect a cure.[141]

The populations of some Italian cities, notably Florence, did not regain their pre-14th century size until the 19th century.[142] 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.[143]

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.[144] The Black Death killed about 40% of Egypt's population.[145] 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 within eight months.[115] By the 18th century, the population of Cairo was halved from its numbers in 1347.[115]

Economic

It has been suggested that the Black Death, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens.[146]

But along with population decline from the pandemic, wages soared in response to a subsequent labour shortage.[147] In some places rents collapsed (e.g., lettings "used to bring in £5, and now but £1.")[120]: 158 

However, many labourers, artisans, and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation.[148] Landowners were also pushed to substitute monetary rents for labour services in an effort to keep tenants.[149] Taxes and tithes became difficult to collect, with living poor refusing to cover the share of the rich deceased, because many properties were empty and unfarmed, and because tax-collectors, where they could be employed, refused to go to plague spots.[120]: 158 

The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse.[150]

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.[151]

Persecutions

Jews being burned at the stake in 1349. Miniature from a 14th-century manuscript Antiquitates Flandriae by Gilles Li Muisis

Renewed religious fervor and fanaticism increased in the wake of the Black Death. Some Europeans targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims", lepers,[152][153] 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.[23] Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning God's forgiveness.[154]

There were many attacks against Jewish communities.[155] In the Strasbourg massacre of February 1349, about 2,000 Jews were murdered.[155] In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed.[156] During this period many Jews relocated to Poland, where they received a welcome from King Casimir the Great.[157]

Social

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

One theory that has been advanced is that the Black Death's devastation of Florence, between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the Renaissance. Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife.[158][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.[160]

This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors,[161] in combination with an influx of Greek scholars after the fall of the Byzantine Empire.[162] 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.[163][better source needed]

Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of fiefs and city-states frequently managed by the Catholic Church.[164] 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.[164][165] 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 contributed to the destabilization of feudalism.[166][167]

The word "quarantine" has its roots in this period, though the practice 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".[168]

All institutions were affected. Smaller monasteries and convents became unviable and closed. Up to half parish churches lost their priest, apart from the parishioners. Religious sensibilities changed:[120]

"[...]looking back into the past, the history of the Church during the Middle Ages in England appears one continuous and stately progress. It is much nearer to the truth to say that in 1351 the whole ecclesiastical system was wholly disorganised, or, indeed, more than half ruined, and that everything had to be built up anew.[...] To secure the most necessary public ministrations of the rites of religion the most inadequately-prepared subjects had to be accepted, and even these could be obtained only in insufficient numbers.[...]The immediate effect on the people was a religious paralysis. Instead of turning men to God the scourge turned them to despair[...] In time the religious sense and feeling revived, but in many respects it took a new tone, and its manifestations ran in new channels[...]characterised by a devotional and more self-reflective cast than previously.[...]
The new religious spirit found outward expression in the multitude of guilds which sprang into existence at this time, in the remarkable and almost, as it may seem to some, extravagant development of certain pious practices, in the singular spread of a more personal devotion to the Blessed Sacrament, to the Blessed Virgin, to the Five Wounds, to the Holy Name, and other such manifestations of a more tender or more familiar piety.[...]At the close of the fourteenth century and during the course of the fifteenth the supply of ornaments, furniture, plate, statues painted or in highly decked "coats," with which the churches were literally encumbered as time went on, proved a striking contrast to the comparative simplicity which characterised former days, as witnessed by a comparison of inventories.[...]
In fact, the fifteenth century witnessed the beginnings of a great middle-class movement, which can be distinctly traced to the effect of the great pestilence[...]

— Cardinal Francis Aidan Gasquet[120]: xvii 

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.[169] According to Jean-Noël Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671 (although some researchers have cautions about the uncritical use of Biraben's data).[170][171] The second pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667. Subsequent outbreaks, though severe, marked the plague's retreat from most of Europe (18th century) and North Africa (19th century).[172]

Historian George Sussman argued that the plague had not occurred in East Africa until the 1900s.[86] However, other sources suggest that the second pandemic did indeed reach sub-Saharan Africa.[113]

According to historian Geoffrey Parker, "France alone lost almost a million people to the plague in the epidemic of 1628–31."[173] In the first half of the 17th century, a plague killed some 1.7 million people in Italy.[174] More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain.[175]

The Black Death ravaged much of the Islamic world.[176] Plague could be found in the Islamic world almost every year between 1500 and 1850. Sometimes the outbreaks affected small areas, while other outbreaks affected multiple regions.[177] Plague repeatedly struck the cities of North Africa. Algiers lost 30,000–50,000 inhabitants to it in 1620–1621, and again in 1654–1657, 1665, 1691, and 1740–1742.[178] 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.[115] 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.[179] Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population had died.[180]

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.[181] 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, for whom the pathogen was named.[33]

Twelve plague outbreaks in Australia between 1900 and 1925 resulted in 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.[182]

The first North American plague epidemic was the San Francisco plague of 1900–1904, followed by another outbreak in 1907–1908.[183][184][185]

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.[186] Another outbreak in Madagascar was reported in November 2014.[187] In October 2017, the deadliest outbreak of the plague in modern times hit Madagascar, killing 170 people and infecting thousands.[188]

An estimate of the case fatality rate for the modern plague, after the introduction of antibiotics, is 11%, although it may be higher in underdeveloped regions.[189]

See also

Footnotes

  1. ^ Declining temperatures following the end of the Medieval Warm Period added to the crisis.
  2. ^ 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.[33]
  3. ^ In 1998, Drancourt et al. reported the detection of Y. pestis DNA in human dental pulp from a medieval grave.[56] Another team led by Tom Gilbert cast doubt on this identification[57] 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".
  4. ^ 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.[110][111]
  5. ^ In Britain "the special symptoms characteristic of the plague of 1348–9 were four in number:— (1) Gangrenous inflammation of the throat and lungs; (2) Violent pains in the region of the chest; (3) The vomiting and spitting of blood; and (4) The pestilential odour coming from the bodies and breath of the sick."[120]
  6. ^ 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.[123]
  7. ^ 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.[133]

  8. ^ 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%.[134]

  9. ^ 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.[138]
  10. ^ 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.[159]

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Bibliography

Further reading