Black Death

This article concerns the mid fourteenth century pandemic. For other outbreaks and a microbiological perspective, see Bubonic plague.

Illustration of the Black Death from the Toggenburg Bible (1411)

The Black Death, or The Black Plague, was one of the most deadly pandemics 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 Europe's population.

The same disease is thought to have returned to Europe every generation with varying virulence and mortaliies until the 1700s. During this period, more than a hundred plague epidemics swept across Europe. On its return in 1603, the plague killed 38,000 Londoners. 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), 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 and the 1771 plague in Moscow it seems to have disappeared from Europe in the eighteenth century.

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 Great Death

Medieval people called the fourteenth century catastrophe either the "Great Pestilence," the "Great Death," or the "Great Plague." Contemporary writers then referred to the event as the "Great Mortality"; the term "Black Death" was introduced for the first time in 1833. 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).

Because the Black Death was, according to historical accounts, characterized by buboes (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 fleas 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.

Plague migration

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 steppes 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. 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 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 Genoese traders fled, bringing the plague by ship into Sicily and the south of Europe, whence it spread.

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 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, 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. In Northern Europe, new technological innovations such as the heavy plow and the 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. 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 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. 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.

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.

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, 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.

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 Trebizond in 1347. In that same year, the Genoese possession of Caffa, a great trade emporium on the Crimean peninsula, came under siege by an army of Mongol warriors under the command of Janibeg, backed by 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. 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.

European outbreak

The Black Death rapidly spread along the major European sea and land trade routes

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.

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 Kingdom of Poland and isolated parts of Belgium and The Netherlands.

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, 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.

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.

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. 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 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.

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.

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.

Causes of bubonic infection

Bubonic plague theory

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

Plague and the ecology of Yersinia pestis in soil, and in rodent and (possibly and importantly) human ectoparasites are reviewed and summarized by Michel Drancourt in modeling sporadic, limited and large plague outbreaks. 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.

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. 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.

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 buboes, 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.

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 °C (101-105 °F), headaches, 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. 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)).

David Herlihy 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."

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 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.

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, but other studies have yielded negative results. In September 2003, a team of researchers from 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.

In 2002, Samuel K. Cohn published the controversial article, “The Black Death: End of the Paradigm.” In the article Cohn argues that the medieval and modern plagues were two distinct diseases differing in their symptoms, signs and epidemiologies. Cohn asserts that the agent causing the bubonic plague, Yersinia pestis, “was first cultured at Hong Kong in 1894.” 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.

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. 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. In terms of recurrence, the Black Death on average did not resurface in an area for between five and fifteen years after it hit. Contrastingly, modern plagues often hit an affected area yearly for an average to eight to forty years. 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. Statistics contrastingly display that immunity to the modern plague has not been acquired.

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.

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.

In 2001, epidemiologists Susan Scott and Christopher Duncan from Liverpool University proposed the theory that the Black Death might have been caused by an Ebola-like 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 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 genes 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 demonstrating how the Black Death has made around 10% of Europeans resistant to HIV.

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, 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.

Counter-arguments

Historians who believe that the Black Death was indeed caused by bubonic plague have put forth several counterarguments.

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 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.

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. 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. 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.

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” .

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.

Consequences

Depopulation

See also: Medieval demography.

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:

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%.

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 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/Chinese empires may have possibly caused the death of two-thirds of China's population, often yielding an estimate of twenty-five million deaths. Japan had no outbreak of plague.

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. 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. Many rural villages were depopulated, mostly the smaller communities, as the few survivors fled to larger towns and cities leaving behind abandoned villages. 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 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 Brabant region, Hainaut and Limbourg, as well as Santiago de Compostella, were unaffected for unknown reasons (some historians 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.

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'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.

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 of Navarre, daughter of Louis X le Hutin and of Margaret of Burgundy, was killed by the plague, as well as Bonne of Luxembourg, the wife of the future John II of France.

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.

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 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.

Socio-economic effects

Monks, disfigured by the plague, being blessed by a priest. England, 1360–75.

The governments 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. 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. 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. 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 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.

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 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).

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 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. 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. 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. If workers attempted to leave their current post, employers were given the right to have them imprisoned. 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. However, despite examples such as Essex County, the Statute quickly proved to be difficult to enforce due to the scarcity of labour.

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. 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. 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.

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.

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.

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 laws. 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.

Persecutions

The burning of Jews in 1349 (from a European chronicle written on the Black Death between 1349 and 1352)

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", lepers and gypsies, thinking that they were to blame for the crisis.

Lepers, and other individuals with skin diseases such as 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.

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 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.

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.

Women also faced persecution during the Black Death. Within areas of the Middle East, notably in Cairo, women became scapegoats when the plague struck. 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. 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. 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.”

In the Muslim world, particularly in Makkah, the disease was blamed on non-believers who had entered the city.

Religion

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

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, or 'bad air'. This increased doubt in the clergy's abilities. Extreme alienation with the Church culminated in either support for different religious groups such as the flagellants, 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 hit the 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.

Other effects

Inspired by Black Death, Danse Macabre is an allegory on the universality of death and a common painting motif in late-medieval periods

After 1350, European culture in general turned very morbid. The general mood was one of pessimism and the art turned dark with representations of death.

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.

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.

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. 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. Further, at this time, the importance of surgeons became more evident.

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.

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-Δ32 genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV, smallpox, and possibly plague, though for the latter, no explanation as to how it would do that exists.

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. 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. 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.

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 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. 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. For example, Agnolo di Tura, of Siena, records his experience:

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.

The scene Di Tura describes is repeated over and over again all across Europe. In Sicily, Gabriele de'Mussi, a notary, tells of the early spread from Crimea:

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.

Henry Knighton tells of the plague’s coming to England:

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.

Friar John Clyn witnessed its effects in Leinster, after its spread to Ireland in August 1348:

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."

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.

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 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 frescoed 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 Jews in fourteenth century Spain (Bercovici, 1992, p. 27).

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.

Adieu, farewell earths blisse, This world uncertaine is, Fond are lifes lustful joyes, Death proves them all but toyes, None from his darts can flye; I am sick, I must dye: Lord, have mercy on us. ("A Litany in Time of Plague" by Thomas Nashe)

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.

Additionally see Aleksandr Pushkin's verse play, "Feast in the Time of the Plague".

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.

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. 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. 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.

Modern

The Black Death has been used as a subject or as a 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.

Albert Camus's novel La Peste deals with the coming of a plague to Algeria.

Roger Zelazny's novel Nine Princes in Amber has his protagonist abducted from his birthland and taken to plague-torn England to die.

Edgar Allan Poe's short story "The Masque of the Red Death" (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.

Nobel prizewinner Sigrid Undset's novel Kristin Lavransdatter features the outbreak of the plague in 14th century Norway.

Connie Willis's Hugo Award-winning science fiction 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 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, a character is transported through time to a village that is apparently affected by the Black Death.

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.

Eifelheim by Michael Flynn depicts the interactions between an isolated German village and a group of stranded extraterrestrials as the plague advances (1348-9).

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.

Melanie Rawn's fantasy novel, Dragon Prince, shows how a plague-like epidemic affects nobility somewhat less than commoners.

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.

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 Crusades 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 English villagers who dig a tunnel to 20th-century New Zealand, with the aid of a boy's vision, to escape the Black Death.

The Black Metal band 1349 is named after the year the Black Death spread through Norway.

Danse Macabre by The Faint is a techno dance album alluding to the Black Death.

The legendary unproduced Hollywood script "Harrow Alley" is set during the 1665 plague outbreak in London.

THEY ALL ARE GAY CAUSE OF THE BLACK DEATH

Selected sources and further reading

Primary sources

• Giovanni Boccaccio (The Decameron)
• Petrarch
• 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.

Primary sources online

• Henry Knighton's account
• Agnolo di Tura's account
• Gabriele de' Mussi's account
• Marchionne di Coppo di Stefano Buonaiuti's account
• A Petrarch account and More quotes from Petrarch

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.
• 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
• 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

• Plague - LoveToKnow 1911
• "Black Death". In Encyclopædia Britannica Online.
• The History Guide "Satan Triumphant: The Black Death"
• Symptoms, causes, pictures of bubonic plague
• Overview of the black death
• BBC news story on controversy over Black Death origins
• Examination of "Ring around the Rosy"'s relationship to the plague
• Black Death Overview from BBC
• Plague and Public Health in Renaissance Europe. Primary source documents and analysis.
• Secrets of the Dead . Mystery of the Black Death PBS
• Pandemics in Eastern Europe