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The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a
bubonic plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well ...
pandemic occurring in
Western Eurasia Eurasia (, ) is the largest continental area on Earth, comprising all of Europe and Asia. Primarily in the Northern and Eastern Hemispheres, it spans from the British Isles and the Iberian Peninsula in the west to the Japanese archipelago a ...
and North Africa from 1346 to 1353. It is the most fatal pandemic recorded in human history, causing the deaths of people, peaking in Europe from 1347 to 1351. Bubonic plague is caused by the
bacterium Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
'' Yersinia pestis'' spread by fleas, but it can also take a secondary form where it is spread by person-to-person contact via
aerosol An aerosol is a suspension of fine solid particles or liquid droplets in air or another gas. Aerosols can be natural or anthropogenic. Examples of natural aerosols are fog or mist, dust, forest exudates, and geyser steam. Examples of anthropo ...
s causing septicaemic or pneumonic plagues. The Black Death was the beginning of the second plague pandemic. The plague created religious, social and economic upheavals, with profound effects on the course of European history. The origin of the Black Death is disputed. The pandemic originated either in Central Asia or East Asia before spreading to
Crimea Crimea, crh, Къырым, Qırım, grc, Κιμμερία / Ταυρική, translit=Kimmería / Taurikḗ ( ) is a peninsula in Ukraine, on the northern coast of the Black Sea, that has been occupied by Russia since 2014. It has a po ...
with the Golden Horde army of
Jani Beg Jani Beg ( fa, , tt-Latn, Canibäk), also known as Djanibek Khan, was a Khan of the Golden Horde from 1342 to 1357, succeeding his father Öz Beg Khan. Reign With the support of his mother Taydula Khatun, Jani Beg made himself khan after el ...
as he was besieging the Genoese trading port of Kaffa in
Crimea Crimea, crh, Къырым, Qırım, grc, Κιμμερία / Ταυρική, translit=Kimmería / Taurikḗ ( ) is a peninsula in Ukraine, on the northern coast of the Black Sea, that has been occupied by Russia since 2014. It has a po ...
(1347). From Crimea, it was most likely carried by
fleas Flea, the common name for the order Siphonaptera, includes 2,500 species of small flightless insects that live as external parasites of mammals and birds. Fleas live by ingesting the blood of their hosts. Adult fleas grow to about long, a ...
living on the
black rat The black rat (''Rattus rattus''), also known as the roof rat, ship rat, or house rat, is a common long-tailed rodent of the stereotypical rat genus ''Rattus'', in the subfamily Murinae. It likely originated in the Indian subcontinent, but is n ...
s that travelled on Genoese ships, spreading through the Mediterranean Basin and reaching North Africa,
Western Asia Western Asia, West Asia, or Southwest Asia, is the westernmost subregion of the larger geographical region of Asia, as defined by some academics, UN bodies and other institutions. It is almost entirely a part of the Middle East, and includes Ana ...
, and the rest of Europe via Constantinople, Sicily, and the Italian Peninsula. There is evidence that once it came ashore, the Black Death mainly spread person-to-person as pneumonic plague, thus explaining the quick inland spread of the epidemic, which was faster than would be expected if the primary vector was
rat flea A rat flea is a parasite of rats. There are at least four species: * Oriental rat flea (''Xenopsylla cheopis''), also known as the tropical rat flea, the primary vector for bubonic plague * Northern rat flea (''Nosopsyllus fasciatus''). Accordin ...
s causing bubonic plague. In 2022, it was discovered that there was a sudden surge of deaths in what is today Kyrgyzstan from the Black Death in the late 1330s; when combined with genetic evidence, this implies that the initial spread may not have been due to Mongol conquests in the 14th century, as previously speculated. The Black Death was the second great natural disaster to strike Europe during the Late Middle Ages (the first one being the Great Famine of 1315–1317) and is estimated to have killed 30 percent to 60 percent of the European population, as well as about one-third of the population of the Middle East. The plague might have reduced the world population from to 350–375 million in the 14th century. There were further outbreaks throughout the Late Middle Ages and, with other contributing factors (the Crisis of the Late Middle Ages), the European population did not regain its level in 1300 until 1500. 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 or ; ; . In English prior to the 18th century, the event was called the "pestilence" or "great pestilence", "the plague" or the "great death". 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. 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. "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 . 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 In linguistics, a calque () or loan translation is a word or phrase borrowed from another language by literal word-for-word or root-for-root translation. When used as a verb, "to calque" means to borrow a word or phrase from another language w ...
: , , and . Previously, most European languages had named the pandemic a variant or calque of the . The phrase 'black death' – describing Death as black – is very old. Homer used it in the Odyssey to describe the monstrous
Scylla In Greek mythology, Scylla), is obsolete. ( ; grc-gre, Σκύλλα, Skúlla, ) is a legendary monster who lives on one side of a narrow channel of water, opposite her counterpart Charybdis. The two sides of the strait are within an arrow's ra ...
, with her mouths "full of black Death" (). Seneca the Younger may have been the first to describe an epidemic as 'black death', () but only in reference to the acute lethality and dark prognosis of disease. The 12th–13th century French physician
Gilles de Corbeil Gilles de Corbeil ( Latin: ''Egidius de Corbolio'' or ''Egidius Corboliensis''; also ''Aegidius'') was a French royal physician, teacher, and poet. He was born in approximately 1140 in Corbeil and died in the first quarter of the 13th century. H ...
had already used ' to refer to a "pestilential fever" () in his work ''On the Signs and Symptoms of Diseases'' (). The phrase , 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" (), which attributes the plague to an astrological
conjunction Conjunction may refer to: * Conjunction (grammar), a part of speech * Logical conjunction, a mathematical operator ** Conjunction introduction, a rule of inference of propositional logic * Conjunction (astronomy), in which two astronomical bodies ...
of Jupiter and Saturn. 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. The historian Cardinal
Francis Aidan Gasquet Francis Aidan Cardinal Gasquet (born Francis Neil Gasquet; 5 October 1846 – 5 April 1929) was an English Benedictine monk and historical scholar. He was created Cardinal in 1914. Life Gasquet was the third of six children of Raymond Gasquet, ...
wrote about the Great Pestilence in 1893 and suggested that it had been "some form of the ordinary Eastern or bubonic plague". In 1908, Gasquet claimed that use of the name ' 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" (').


Previous plague epidemics

Research from 2017 suggests plague first infected humans in Europe and Asia in the Late Neolithic-
Early Bronze Age The Bronze Age is a historic period, lasting approximately from 3300 BC to 1200 BC, characterized by the use of bronze, the presence of writing in some areas, and other early features of urban civilization. The Bronze Age is the second prin ...
. Research in 2018 found evidence of '' Yersinia pestis'' in an ancient Swedish tomb, which may have been associated with the "
Neolithic decline The Neolithic decline was a rapid collapse in populations between five and six thousand years ago (approximately 3000 BC) during the Neolithic period in western Eurasia. The specific causes of that broad population decline are still debated. While ...
" around 3000 BCE, in which European populations fell significantly. 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. The symptoms of bubonic plague are first attested in a fragment of
Rufus of Ephesus Rufus of Ephesus ( el, Ῥοῦφος ὁ Ἐφέσιος, fl. late 1st and early 2nd centuries AD) was a Greek physician and author who wrote treatises on dietetics, pathology, anatomy, gynaecology, and patient care. He was an admirer of Hip ...
preserved by
Oribasius Oribasius or Oreibasius ( el, Ὀρειβάσιος; c. 320 – 403) was a Greek medical writer and the personal physician of the Roman emperor Julian. He studied at Alexandria under physician Zeno of Cyprus before joining Julian's retinue. H ...
; these ancient medical authorities suggest bubonic plague had appeared in the
Roman Empire The Roman Empire ( la, Imperium Romanum ; grc-gre, Βασιλεία τῶν Ῥωμαίων, Basileía tôn Rhōmaíōn) was the post-Roman Republic, Republican period of ancient Rome. As a polity, it included large territorial holdings aro ...
before the reign of Trajan, six centuries before arriving at
Pelusium Pelusium ( Ancient Egyptian: ; cop, /, romanized: , or , romanized: ; grc, Πηλουσιον, Pēlousion; la, Pēlūsium; Arabic: ; Egyptian Arabic: ) was an important city in the eastern extremes of Egypt's Nile Delta, 30 km to ...
in the reign of Justinian I. In 2013, researchers confirmed earlier speculation that the cause of the Plague of Justinian (541–542 CE, with recurrences until 750) was ''Y''. ''pestis''. This is known as the first plague pandemic. In 610, the Chinese physician
Chao Yuanfang Chao Yuanfang () was a Chinese physician and medical author who was court physician at the Sui Dynasty (581–618 CE) between the years 605 and 616. Traditionally, he had been attributed the co-authorship or authorship of the Chinese medical clas ...
described a "malignant bubo" "coming in abruptly with high fever together with the appearance of a bundle of nodes beneath the tissue." The Chinese physician Sun Simo who died in 652 also mentioned a "malignant bubo" and plague that was common in
Lingnan Lingnan (; Vietnamese: Lĩnh Nam) is a geographic area referring to the lands in the south of the Nanling Mountains. The region covers the modern Chinese subdivisions of Guangdong, Guangxi, Hainan, Hong Kong, and Macau, as well as modern north ...
( 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.


14th-century plague


Causes


Early theory

The most authoritative contemporary account is found in a report from the medical faculty in Paris to Philip VI of France. It blamed the heavens, in the form of a
conjunction Conjunction may refer to: * Conjunction (grammar), a part of speech * Logical conjunction, a mathematical operator ** Conjunction introduction, a rule of inference of propositional logic * Conjunction (astronomy), in which two astronomical bodies ...
of three planets in 1345 that caused a "great pestilence in the air" ( miasma theory). 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. 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.


Predominant modern theory

Due to climate change in Asia, rodents began to flee the dried-out grasslands to more populated areas, spreading the disease. The plague disease, caused by the bacterium '' Yersinia pestis'', is
enzootic Enzootic is the non-human equivalent of endemic and means, in a broad sense, "belonging to" or "native to", "characteristic of", or "prevalent in" a particular geography, race, field, area, or environment; native to an area or scope. It also has ...
(commonly present) in populations of fleas carried by ground rodents, including marmots, in various areas, including Central Asia,
Kurdistan Kurdistan ( ku, کوردستان ,Kurdistan ; lit. "land of the Kurds") or Greater Kurdistan is a roughly defined geo-cultural territory in Western Asia wherein the Kurds form a prominent majority population and the Kurdish culture, languages ...
,
Western Asia Western Asia, West Asia, or Southwest Asia, is the westernmost subregion of the larger geographical region of Asia, as defined by some academics, UN bodies and other institutions. It is almost entirely a part of the Middle East, and includes Ana ...
, North India, Uganda and the western United States. ''Y. pestis'' was discovered by
Alexandre Yersin Alexandre Emile Jean Yersin (22 September 1863 – 1 March 1943) was a Swiss-French physician and bacteriologist. He is remembered as the co-discoverer of the bacillus responsible for the bubonic plague or pest, which was later named in his ...
, a pupil of Louis Pasteur, during an epidemic of bubonic plague in Hong Kong in 1894; Yersin also proved this
bacillus ''Bacillus'' (Latin "stick") is a genus of Gram-positive, rod-shaped bacteria, a member of the phylum ''Bacillota'', with 266 named species. The term is also used to describe the shape (rod) of other so-shaped bacteria; and the plural ''Bacill ...
was present in rodents and suggested the rat was the main vehicle of transmission. The mechanism by which ''Y. pestis'' is usually transmitted was established in 1898 by
Paul-Louis Simond Paul-Louis Simond (30 July 1858 – 3 March 1947) was a French physician, chief medical officer and biologist whose major contribution to science was his demonstration that the intermediates in the transmission of bubonic plague from rats to h ...
and was found to involve the bites of fleas whose
midgut The midgut is the portion of the embryo from which most of the intestines develop. After it bends around the superior mesenteric artery, it is called the "midgut loop". It comprises the portion of the alimentary canal from the end of the foregut a ...
s had become obstructed by replicating ''Y. pestis'' several days after feeding on an infected host. This blockage starves the fleas and drives them to aggressive feeding behaviour and attempts to clear the blockage by regurgitation, resulting in thousands of plague bacteria being flushed into the feeding site, infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts, keeping the disease endemic, and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human
epidemic An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time. Epidemics of infectious d ...
.


DNA evidence

Definitive confirmation of the role of ''Y. pestis'' arrived in 2010 with a publication in '' PLOS Pathogens'' by Haensch et al. They assessed the presence of DNA/ RNA with
polymerase chain reaction The polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies (complete or partial) of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it (or a part of it) ...
(PCR) techniques for ''Y. pestis'' from the
tooth socket Dental alveoli (singular ''alveolus'') are sockets in the jaws in which the roots of teeth are held in the alveolar process with the periodontal ligament. The lay term for dental alveoli is tooth sockets. A joint that connects the roots of the ...
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
causative agent In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a ger ...
of the epidemic plague that devastated Europe during the Middle Ages". In 2011, these results were further confirmed with genetic evidence derived from Black Death victims in the
East Smithfield East Smithfield is a small locality in the London Borough of Tower Hamlets, east London, and also a short street, a part of the A1203 road. Once broader in scope, the name came to apply to the part of the ancient parish of St Botolph withou ...
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". Later in 2011,
Bos ''Bos'' (from Latin '' bōs'': cow, ox, bull) is the genus of wild and domestic cattle. ''Bos'' is often divided into four subgenera: ''Bos'', ''Bibos'', ''Novibos'', and ''Poephagus'', but including these last three divisions within the ge ...
et al. reported in ''
Nature Nature, in the broadest sense, is the physical world or universe. "Nature" can refer to the phenomena of the physical world, and also to life in general. The study of nature is a large, if not the only, part of science. Although humans are p ...
'' 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''. Since this time, further genomic papers have further confirmed the
phylogenetic In biology, phylogenetics (; from Greek φυλή/ φῦλον [] "tribe, clan, race", and wikt:γενετικός, γενετικός [] "origin, source, birth") is the study of the evolutionary history and relationships among or within groups o ...
placement of the ''Y. pestis'' strain responsible for the Black Death as both the ancestor of later plague epidemics including the third plague pandemic and as the descendant of the strain responsible for the Plague of Justinian. In addition, plague genomes from significantly earlier in prehistory have been recovered. DNA taken from 25 skeletons from 14th century London have shown plague is a strain of ''Y. pestis'' almost identical to that which hit Madagascar in 2013. Further DNA evidence also proves the role of ''Y. Pestis'' and traces the source to the Tian Shan Mountains in Kyrgyzstan.


Alternative explanations

It is recognised that an
epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evid ...
account of plague is as important as an identification of symptoms, but researchers are hampered by the lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, and even estimates of overall population at the start vary by over 100% as no census was undertaken in England between the time of publication of the Domesday Book of 1086 and the
poll tax A poll tax, also known as head tax or capitation, is a tax levied as a fixed sum on every liable individual (typically every adult), without reference to income or resources. Head taxes were important sources of revenue for many governments fr ...
of the year 1377. Estimates of plague victims are usually
extrapolate In mathematics, extrapolation is a type of estimation, beyond the original observation range, of the value of a variable on the basis of its relationship with another variable. It is similar to interpolation, which produces estimates between kn ...
d from figures for the clergy.
Mathematical modelling A mathematical model is a description of a system using mathematical concepts and language. The process of developing a mathematical model is termed mathematical modeling. Mathematical models are used in the natural sciences (such as physi ...
is used to match the spreading patterns and the means of
transmission Transmission may refer to: Medicine, science and technology * Power transmission ** Electric power transmission ** Propulsion transmission, technology allowing controlled application of power *** Automatic transmission *** Manual transmission ** ...
. A research in 2018 challenged the popular hypothesis that "infected rats died, their flea parasites could have jumped from the recently dead rat hosts to humans". It suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of death toll because the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, which contradict historical death data.
Lars Walløe Lars Walløe (born 20 May 1938) is a Norwegian academic, chemist, physiologist, and scientific adviser to the Norwegian government. He was Head of Norwegian Delegation to the Scientific Committee of the International Whaling Commission (IWC); a ...
complains that all of these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of ''Yersinia pestis'' infection could spread", whilst pointing to several other possibilities. Similarly, Monica Green has argued that greater attention is needed to the range of (especially non-
commensal Commensalism is a long-term biological interaction (symbiosis) in which members of one species gain benefits while those of the other species neither benefit nor are harmed. This is in contrast with mutualism, in which both organisms benefit fro ...
) animals that might be involved in the transmission of plague. 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. This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic.


Summary

Although academic debate continues, no single alternative solution has achieved widespread acceptance. Many scholars arguing for ''Y. pestis'' as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus, smallpox and respiratory infections. In addition to the bubonic infection, others point to additional septicaemic (a type of "blood poisoning") and pneumonic (an airborne plague that attacks the lungs before the rest of the body) forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms. In 2014, Public Health England announced the results of an examination of 25 bodies exhumed in the
Clerkenwell Clerkenwell () is an area of central London, England. Clerkenwell was an ancient parish from the mediaeval period onwards, and now forms the south-western part of the London Borough of Islington. The well after which it was named was redisco ...
area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. 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.


Transmission


Lack of hygiene

The importance of
hygiene Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
was recognised only in the nineteenth century with the development of the
germ theory of disease The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade ...
; until then streets were commonly filthy, with live animals of all sorts around and human parasites abounding, facilitating the spread of transmissible disease. By the early fourteenth century so much filth had collected inside urban Europe that French and Italian cities were naming streets after human waste. In medieval Paris, several street names were inspired by merde, the French word for "shit". There were rue Merdeux, rue Merdelet, rue Merdusson, rue des Merdons, and rue Merdiere—as well as a rue du Pipi. Pigs, cattle, chickens, geese, goats, and horses roamed the streets of medieval London and Paris. Medieval homeowners were supposed to police their housefronts, including removing animal dung, but most urbanites were as careless as William E. Cosner, a resident of the London suburb of Farringdon Without. A complaint lodged against Cosner charges that "men could not pass
y his house Y, or y, is the twenty-fifth and penultimate letter of the Latin alphabet, used in the modern English alphabet, the alphabets of other western European languages and others worldwide. According to some authorities, it is the sixth (or sevent ...
for the stink f . . 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. Early Christians, who thought self-abnegation a cardinal virtue, considered bathing, if not a vice, then a temptation. "Who knows what impure thoughts might arise in a tub of warm water? With this danger in mind, St. Benedict declared, ''"To those who are well, and especially to the young, bathing shall seldom be permitted."'' St. Agnes took the injunction to heart and died without ever bathing."


Territorial origins

According to a team of medical geneticists led by
Mark Achtman Mark Achtman FRS is Professor of Bacterial Population Genetics at Warwick Medical School, part of the University of Warwick in the UK. Education Achtman was educated at the University of Manitoba where he was awarded a Master of Science degree i ...
that analysed the
genetic variation Genetic variation is the difference in DNA among individuals or the differences between populations. The multiple sources of genetic variation include mutation and genetic recombination. Mutations are the ultimate sources of genetic variation, b ...
of the bacterium, ''Yersinia pestis'' "evolved in or near China" over 2,600 years ago. Later research by a team led by Galina Eroshenko places the origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China. However more recent research notes that the previous sampling had a very heavy East Asian bias and that sampling since then has discovered strains of ''Y. pestis'' in the Caucasus region that were previously thought to be restricted to China. 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. 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. The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s.
Nestorian Nestorianism is a term used in Christian theology and Church history to refer to several mutually related but doctrinarily distinct sets of teachings. The first meaning of the term is related to the original teachings of Christian theologian N ...
graves dating to 1338–1339 near
Issyk-Kul Issyk-Kul (also Ysyk-Köl, ky, Ысык-Көл, lit=warm lake, translit=Ysyk-Köl, , zh, 伊塞克湖) is an endorheic lake (i.e., without outflow) in the Northern Tian Shan mountains in Eastern Kyrgyzstan. It is the seventh-deepest lake in th ...
in Kyrgyzstan have inscriptions referring to plague, which has led some historians and
epidemiologist Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evid ...
s to think they mark the outbreak of the
epidemic An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time. Epidemics of infectious d ...
; 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. Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347. 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. 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. There are no records of the symptoms of the Black Death from Mongol sources or writings from travelers east of the Black Sea prior to the Crimean outbreak in 1346. Finally, the Silk Road had already been heavily disrupted before the spread of the Black Death. Western and Middle Eastern traders found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making spread of the plague less likely. Others still favor an origin in China or even Kurdistan, and not Central Asia. According to the theory of Chinese origin, the disease may have traveled along the Silk Road with Mongol armies and traders, or it could have arrived via ship, but this theory is still contested. It is speculated that rats aboard Zheng He's ships in the 15th century may have carried the plague to Southeast Asia, India, and Africa. Research on the Delhi Sultanate and the Yuan Dynasty shows no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague in fourteenth-century China, suggesting that the Black Death may not have reached these regions. 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 The Caspian Sea is the world's largest inland body of water, often described as the world's largest lake or a full-fledged sea. An endorheic basin, it lies between Europe and Asia; east of the Caucasus, west of the broad steppe of Central Asi ...
. Monica H. Green suggests that the reason why other parts of Eurasia outside the west do not contain the same evidence of the Black Plague is because there were actually four strains of ''Yersinia pestis'' that became predominant in different parts of the world. Mongol records of illness such as food poisoning may have been referring to the Black Plague. Another theory is that the Black Death originated near Europe and cycled through the Mediterranean, Northern Europe, and Russia before making its way to China. Other historians such as John Norris and Ole Benedictaw believe the Black Death likely originated in Europe or the Middle East and never reached China.


European outbreak

Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the
Crimea Crimea, crh, Къырым, Qırım, grc, Κιμμερία / Ταυρική, translit=Kimmería / Taurikḗ ( ) is a peninsula in Ukraine, on the northern coast of the Black Sea, that has been occupied by Russia since 2014. It has a po ...
in 1347. During a protracted siege of the city, in 1345–1346 the Mongol Golden Horde army of
Jani Beg Jani Beg ( fa, , tt-Latn, Canibäk), also known as Djanibek Khan, was a Khan of the Golden Horde from 1342 to 1357, succeeding his father Öz Beg Khan. Reign With the support of his mother Taydula Khatun, Jani Beg made himself khan after el ...
, whose mainly
Tatar The Tatars ()Tatar
in the Collins English Dictionary
is an umbrella term for different
troops were suffering from the disease, catapulted infected corpses over the city walls of Kaffa to infect the inhabitants, though it is more likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants. As the disease took hold, Genoese traders fled across the Black Sea to Constantinople, where the disease first arrived in Europe in summer 1347. The epidemic there killed the 13-year-old son of the
Byzantine emperor This is a list of the Byzantine emperors from the foundation of Constantinople in 330 AD, which marks the conventional start of the Eastern Roman Empire, to its fall to the Ottoman Empire in 1453 AD. Only the emperors who were recognized as le ...
, John VI Kantakouzenos, who wrote a description of the disease modelled on Thucydides's account of the 5th century BCE
Plague of Athens The Plague of Athens ( grc, Λοιμὸς τῶν Ἀθηνῶν}, ) was an epidemic that devastated the city-state of Athens in ancient Greece during the second year (430 BC) of the Peloponnesian War when an Athenian victory still seemed within r ...
, but noting the spread of the Black Death by ship between maritime cities.
Nicephorus Gregoras Nicephorus Gregoras (; Greek: , ''Nikephoros Gregoras''; c. 1295 – 1360) was a Greek astronomer, historian, and theologian. Life Gregoras was born at Heraclea Pontica, where he was raised and educated by his uncle, John, who was the Bisho ...
also described in writing to
Demetrios Kydones Demetrios Kydones, Latinized as Demetrius Cydones or Demetrius Cydonius ( el, Δημήτριος Κυδώνης; 1324, Thessalonica – 1398, Crete), was a Byzantine Greek theologian, translator, author and influential statesman, who served a ...
the rising death toll, the futility of medicine, and the panic of the citizens. The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400. Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347; the disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point to northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles. From Italy, the disease spread northwest across Europe, striking France, Spain (the epidemic began to wreak havoc first on the
Crown of Aragon The Crown of Aragon ( , ) an, Corona d'Aragón ; ca, Corona d'Aragó, , , ; es, Corona de Aragón ; la, Corona Aragonum . was a composite monarchy ruled by one king, originated by the dynastic union of the Kingdom of Aragon and the County of Ba ...
in the spring of 1348), Portugal and England by June 1348, then spread east and north through Germany, Scotland and Scandinavia from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at
Askøy Askøy is a municipality in Vestland county, Norway. The island municipality is located in the Midhordland district of the county, sitting in a large group of islands immediately northwest of the city of Bergen. The administrative centre of the ...
, then spread to Bjørgvin (modern
Bergen Bergen (), historically Bjørgvin, is a city and municipality in Vestland county on the west coast of Norway. , its population is roughly 285,900. Bergen is the second-largest city in Norway. The municipality covers and is on the peninsula ...
) and Iceland. Finally, it spread to northwestern Russia in 1351. Plague was somewhat more uncommon in parts of Europe with less developed trade with their neighbours, including the majority of the Basque Country, isolated parts of Belgium and the Netherlands, and isolated Alpine villages throughout the continent. According to some epidemiologists, periods of unfavourable weather decimated plague-infected rodent populations and forced their fleas onto alternative hosts, inducing plague outbreaks which often peaked in the hot summers of the Mediterranean, as well as during the cool autumn months of the southern
Baltic region The terms Baltic Sea Region, Baltic Rim countries (or simply the Baltic Rim), and the Baltic Sea countries/states refer to slightly different combinations of countries in the general area surrounding the Baltic Sea, mainly in Northern Europe. ...
. Among many other culprits of plague contagiousness, malnutrition, even if distantly, also contributed to such an immense loss in European population, since it weakened immune systems.


Western Asian and North African outbreak

The disease struck various regions in the Middle East and North Africa during the pandemic, leading to serious depopulation and permanent change in both economic and social structures. As infected rodents infected new rodents, the disease spread across the region, entering also from southern Russia. By autumn 1347, plague had reached
Alexandria Alexandria ( or ; ar, ٱلْإِسْكَنْدَرِيَّةُ ; grc-gre, Αλεξάνδρεια, Alexándria) is the second largest city in Egypt, and the largest city on the Mediterranean coast. Founded in by Alexander the Great, Alexandri ...
in Egypt, transmitted by sea from Constantinople; according to a contemporary witness, from a single merchant ship carrying slaves. By late summer 1348 it reached Cairo, capital of the Mamluk Sultanate, cultural centre of the Islamic world, and the largest city in the Mediterranean Basin; the Bahriyya child sultan
an-Nasir Hasan An-Nasir Badr ad-Din Hasan ibn Muhammad ibn Qalawun (1334/35–17 March 1361), better known as an-Nasir Hasan, was the Mamluk sultan of Egypt, and the seventh son of an-Nasir Muhammad to hold office, reigning twice in 1347–1351 and 1354–1361. ...
fled and more than a third of the 600,000 residents died. The
Nile The Nile, , Bohairic , lg, Kiira , Nobiin: Áman Dawū is a major north-flowing river in northeastern Africa. It flows into the Mediterranean Sea. The Nile is the longest river in Africa and has historically been considered the longest ri ...
was choked with corpses despite Cairo having a medieval hospital, the late 13th century
bimaristan A bimaristan (; ), also known as ''dar al-shifa'' (also ''darüşşifa'' in Turkish) or simply maristan, is a hospital in the historic Islamic world. Etymology ''Bimaristan'' is a Persian word ( ''bīmārestān'') meaning "hospital", with ''b ...
of the
Qalawun complex The Qalawun complex ( ar, مجمع قلاون) is a massive pious complex in Cairo, Egypt, built by Sultan al-Mansur Qalawun from 1284 to 1285. It is located at Bayn al-Qasrayn on al-Mu'izz street and like many other pious complexes includes a hosp ...
. The historian
al-Maqrizi Al-Maqrīzī or Maḳrīzī (Arabic: ), whose full name was Taqī al-Dīn Abū al-'Abbās Aḥmad ibn 'Alī ibn 'Abd al-Qādir ibn Muḥammad al-Maqrīzī (Arabic: ) (1364–1442) was a medieval Egyptian Arab historian during the Mamluk era, kn ...
described the abundant work for grave-diggers and practitioners of
funeral rite A funeral is a ceremony connected with the final disposition of a corpse, such as a burial or cremation, with the attendant observances. Funerary customs comprise the complex of beliefs and practices used by a culture to remember and respect th ...
s, and plague recurred in Cairo more than fifty times over the following one and a half centuries. 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 )), is an adjective which means "white-colored mixed with black". , motto = , image_map = , mapsize = , map_caption = , image_map1 = ...
. That year, in the territory of modern Lebanon, Syria, Israel, and
Palestine __NOTOC__ Palestine may refer to: * State of Palestine, a state in Western Asia * Palestine (region), a geographic region in Western Asia * Palestinian territories, territories occupied by Israel since 1967, namely the West Bank (including East J ...
, the cities of
Ashkelon Ashkelon or Ashqelon (; Hebrew: , , ; Philistine: ), also known as Ascalon (; Ancient Greek: , ; Arabic: , ), is a coastal city in the Southern District of Israel on the Mediterranean coast, south of Tel Aviv, and north of the border with ...
, Acre, Jerusalem, Sidon, and
Homs Homs ( , , , ; ar, حِمْص / ALA-LC: ; Levantine Arabic: / ''Ḥomṣ'' ), known in pre-Islamic Syria as Emesa ( ; grc, Ἔμεσα, Émesa), is a city in western Syria and the capital of the Homs Governorate. It is Metres above sea level ...
were all infected. In 1348–1349, the disease reached
Antioch Antioch on the Orontes (; grc-gre, Ἀντιόχεια ἡ ἐπὶ Ὀρόντου, ''Antiókheia hē epì Oróntou'', Learned ; also Syrian Antioch) grc-koi, Ἀντιόχεια ἡ ἐπὶ Ὀρόντου; or Ἀντιόχεια ἡ ἐπ� ...
. The city's residents fled to the north, but most of them ended up dying during the journey. Within two years, the plague had spread throughout the Islamic world, from Arabia across North Africa. 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 Almería (, , ) is a city and municipality of Spain, located in Andalusia. It is the capital of the province of the same name. It lies on southeastern Iberia on the Mediterranean Sea. Caliph Abd al-Rahman III founded the city in 955. The city gr ...
in
al-Andalus Al-Andalus translit. ; an, al-Andalus; ast, al-Ándalus; eu, al-Andalus; ber, ⴰⵏⴷⴰⵍⵓⵙ, label= Berber, translit=Andalus; ca, al-Àndalus; gl, al-Andalus; oc, Al Andalús; pt, al-Ândalus; es, al-Ándalus () was the Mu ...
. Mecca became infected in 1348 by pilgrims performing the
Hajj The Hajj (; ar, حَجّ '; sometimes also spelled Hadj, Hadji or Haj in English) is an annual Islamic pilgrimage to Mecca, Saudi Arabia, the holiest city for Muslims. Hajj is a mandatory religious duty for Muslims that must be carried o ...
. In 1351 or 1352, the
Rasulid The Rasulids ( ar, بنو رسول, Banū Rasūl) were a Sunni Muslim dynasty who ruled Yemen from 1229 to 1454. History Origin of the Rasulids The Rasulids took their name from al-Amin's nickname "Rasul". The Zaidi Shi'i Imams of Yemen were ...
sultan of the Yemen,
al-Mujahid Ali Al Malik Al-Mujahid Asad ad-Din Shirkuh II was the Ayyubid emir of Homs from 1186–1240. He was the son of An-Nasir Muhammad ibn Shirkuh, grandson of Shirkuh and second cousin of Saladin. His domains also included Palmyra and ar-Rahba. ...
, was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1348, records show the city of Mosul suffered a massive epidemic, and the city of
Baghdad Baghdad (; ar, بَغْدَاد , ) is the capital of Iraq and the second-largest city in the Arab world after Cairo. It is located on the Tigris near the ruins of the ancient city of Babylon and the Sassanid Persian capital of Ctesiphon ...
experienced a second round of the disease.


Signs and symptoms


Bubonic plague

Symptoms of the disease include fever of , headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Left untreated, of those that contract the bubonic plague, 80 percent die within eight days. Contemporary accounts of the pandemic are varied and often imprecise. The most commonly noted symptom was the appearance of
bubo A bubo (Greek βουβών, ''boubṓn'', 'groin') is adenitis or inflammation of the lymph nodes and is an example of reactive lymphadenopathy. Classification Buboes are a symptom of bubonic plague and occur as painful swellings in the thighs ...
es (or ''gavocciolos'') in the groin, neck, and armpits, which oozed pus and bled when opened.
Boccaccio Giovanni Boccaccio (, , ; 16 June 1313 – 21 December 1375) was an Italian writer, poet, correspondent of Petrarch, and an important Renaissance humanist. Born in the town of Certaldo, he became so well known as a writer that he was somet ...
's description: 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, which could have been caused by flea-bites, were identified as another potential sign of plague.


Pneumonic plague

Lodewijk Heyligen Lodewijk Heyligen (also known as Ludovicus Sanctus de Beeringhen, Lodewijk Heiligen, Ludovicus Sanctus, Heyliger of Beeringhen, Ludwig van Kempen and Louis van Campen) (1304, Beringen, Belgium – 1361, Avignon) was a Flemish Benedictine monk and ...
, whose master the Cardinal Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague, that infected the lungs and led to respiratory problems. Symptoms include fever, cough, and blood-tinged sputum. As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90 to 95 percent.


Septicaemic plague

Septicaemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches (
purpura Purpura () is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, ...
due to disseminated intravascular coagulation). In cases of pneumonic and particularly septicaemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes.


Consequences


Deaths

There are no exact figures for the death toll; the rate varied widely by locality. In urban centres, the greater the population before the outbreak, the longer the duration of the period of abnormal mortality. It killed some people in Eurasia. A study published in 2022 of pollen samples across Europe between 1250 and 1450 was used to estimate changes in agricultural output before and after the Black Death. The authors found great variability in different regions, with evidence for high mortality in areas of Scandinavia, France, western Germany, Greece and central Italy, but uninterrupted agricultural growth in central and eastern Europe, Iberia and Ireland. 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. The overwhelming number of deceased bodies produced by the Black Death caused the necessity of mass burial sites in Europe, sometimes including up to several hundred or several thousand skeletons. 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. According to medieval historian
Philip Daileader Philip Daileader is a professor of history at The College of William & Mary in Virginia. He was born in Queens, New York, on October 25, 1968, and grew up in Central Islip, New York. He attended St. Anthony's High School in Smithtown and then S ...
, it is likely that over four years, 45–50% of the European population died of plague. Norwegian historian Ole Benedictow suggests it could have been as much as 60% of the European population. In 1348, the disease spread so rapidly that before any physicians or government authorities had time to reflect upon its origins, about a third of the European population had already perished. In crowded cities, it was not uncommon for as much as 50% of the population to die. Half of Paris' population of 100,000 people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and
Bremen Bremen ( Low German also: ''Breem'' or ''Bräm''), officially the City Municipality of Bremen (german: Stadtgemeinde Bremen, ), is the capital of the German state Free Hanseatic City of Bremen (''Freie Hansestadt Bremen''), a two-city-state con ...
perished, and a similar percentage of Londoners may have died from the disease as well, with a death toll of approximately 62,000 between 1346 and 1353. Florence's tax records suggest that 80% of the city's population died within four months in 1348. Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450. The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion. Plague did not appear in
Douai Douai (, , ,; pcd, Doï; nl, Dowaai; formerly spelled Douay or Doway in English) is a city in the Nord département in northern France. It is a sub-prefecture of the department. Located on the river Scarpe some from Lille and from Arras, ...
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. Monks, nuns, and priests were especially hard-hit since they cared for people with the Black Death. The physician to the
Avignon Papacy The Avignon Papacy was the period from 1309 to 1376 during which seven successive popes resided in Avignon – at the time within the Kingdom of Arles, part of the Holy Roman Empire; now part of France – rather than in Rome. The situation aro ...
, Raimundo Chalmel de Vinario (), observed the decreasing mortality rate of successive outbreaks of plague in 1347–48, 1362, 1371, and 1382 in his 1382 treatise ''On Epidemics'' (). 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. By the 1380s in Europe, it predominantly affected children. Chalmel de Vinario recognized that
bloodletting Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily f ...
was ineffective (though he continued to prescribe bleeding for members of the Roman Curia, whom he disliked), and claimed that all true cases of plague were caused by astrological factors and were incurable; he himself was never able to effect a cure. 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. The Black Death killed about 40% of Egypt's population. In Cairo, with a population numbering as many as 600,000, and possibly the largest city west of China, between one third and 40% of the inhabitants died inside of eight months. Italian chronicler
Agnolo di Tura Agnolo di Tura (14th century) was a chronicler from Siena, Italy. He was also a shoemaker and tax collector. He married a woman named Nicoluccia, who was of a higher class than he was. Agnolo di Tura was determined to rise in the world (his wife k ...
recorded his experience from
Siena Siena ( , ; lat, Sena Iulia) is a city in Tuscany, Italy. It is the capital of the province of Siena. The city is historically linked to commercial and banking activities, having been a major banking center until the 13th and 14th centuri ...
, where plague arrived in May 1348:


Economic

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


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 The Little Ice Age (LIA) was a period of regional cooling, particularly pronounced in the North Atlantic region. It was not a true ice age of global extent. The term was introduced into scientific literature by François E. Matthes in 1939. Ma ...
.


Persecutions

Renewed religious fervour and
fanaticism Fanaticism (from the Latin adverb ''fānāticē'' ren-''fānāticus''; enthusiastic, ecstatic; raging, fanatical, furious is a belief or behavior involving uncritical zeal or an obsessive enthusiasm. Definitions Philosopher George Santayana ...
bloomed in the wake of the Black Death. Some Europeans targeted "various groups such as Jews,
friar A friar is a member of one of the mendicant orders founded in the twelfth or thirteenth century; the term distinguishes the mendicants' itinerant apostolic character, exercised broadly under the jurisdiction of a superior general, from the o ...
s, foreigners, beggars, pilgrims", lepers, and
Romani Romani may refer to: Ethnicities * Romani people, an ethnic group of Northern Indian origin, living dispersed in Europe, the Americas and Asia ** Romani genocide, under Nazi rule * Romani language, any of several Indo-Aryan languages of the Roma ...
, blaming them for the crisis. Lepers, and others with skin diseases such as
acne Acne, also known as ''acne vulgaris'', is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and po ...
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 Astrology is a range of divinatory practices, recognized as pseudoscientific since the 18th century, that claim to discern information about human affairs and terrestrial events by studying the apparent positions of celestial objects. Dif ...
forces, earthquakes, and the poisoning of wells by Jews as possible reasons for outbreaks. Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning
God's forgiveness Forgiveness, in a psychological sense, is the intentional and voluntary process by which one who may initially feel victimized or wronged, goes through a change in feelings and attitude regarding a given offender, and overcomes the impact of t ...
. There were many attacks against Jewish communities.Black Death
, Jewishencyclopedia.com
In the
Strasbourg massacre The Strasbourg massacre occurred on February 14, 1349, when several hundred Jews were publicly burnt to death, and the rest of them expelled from the city as part of the Black Death persecutions. Starting in the spring of 1348, pogroms aga ...
of February 1349, about 2,000 Jews were murdered. In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. During this period many Jews relocated to Poland, where they received a warm welcome from King
Casimir the Great Casimir III the Great ( pl, Kazimierz III Wielki; 30 April 1310 – 5 November 1370) reigned as the King of Poland from 1333 to 1370. He also later became King of Ruthenia in 1340, and fought to retain the title in the Galicia-Volhynia Wars. He w ...
.


Social

One theory that has been advanced is that the devastation in Florence caused by the Black Death, which hit Europe between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy and led to the Renaissance. Italy was particularly badly hit by the pandemic, and it has been speculated that the resulting familiarity with death caused thinkers to dwell more on their lives on Earth, rather than on
spirituality The meaning of ''spirituality'' has developed and expanded over time, and various meanings can be found alongside each other. Traditionally, spirituality referred to a religious process of re-formation which "aims to recover the original shape o ...
and the
afterlife The afterlife (also referred to as life after death) is a purported existence in which the essential part of an individual's identity or their stream of consciousness continues to live after the death of their physical body. The surviving e ...
. It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art. This does not fully explain why the Renaissance occurred in Italy in the 14th century. The Black Death was a pandemic that affected all of Europe in the ways described, not only Italy. The Renaissance's emergence in Italy was most likely the result of the complex interaction of the above factors, in combination with an influx of Greek scholars following the fall of the Byzantine Empire. As a result of the drastic reduction in the populace the value of the working class increased, and commoners came to enjoy more freedom. To answer the increased need for labour, workers travelled in search of the most favorable position economically. Prior to the emergence of the Black Death, the workings of Europe were run by the Catholic Church and the continent was considered a feudalistic society, composed of fiefs and city-states. 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. Cairo's population, partly owing to the numerous plague epidemics, was in the early 18th century half of what it was in 1347. The populations of some Italian cities, notably Florence, did not regain their pre-14th century size until the 19th century. The demographic decline due to the pandemic had economic consequences: the prices of food dropped and land values declined by 30–40% in most parts of Europe between 1350 and 1400. Landholders faced a great loss, but for ordinary men and women it was a windfall. The survivors of the pandemic found not only that the prices of food were lower but also that lands were more abundant, and many of them inherited property from their dead relatives, and this probably destabilized feudalism. The word " quarantine" has its roots in this period, though the concept of isolating people to prevent the spread of disease is older. In the city-state of Ragusa (modern
Dubrovnik Dubrovnik (), historically known as Ragusa (; see notes on naming), is a city on the Adriatic Sea in the region of Dalmatia, in the southeastern semi-exclave of Croatia. It is one of the most prominent tourist destinations in the Mediterranea ...
, 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".


Recurrences


Second plague pandemic

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to Jean-Noël Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671. (Note that some researchers have cautions about the uncritical use of Biraben's data.) The second pandemic was particularly widespread in the following years: 1360–63; 1374; 1400; 1438–39; 1456–57; 1464–66; 1481–85; 1500–03; 1518–31; 1544–48; 1563–66; 1573–88; 1596–99; 1602–11; 1623–40; 1644–54; and 1664–67. Subsequent outbreaks, though severe, marked the retreat from most of Europe (18th century) and northern Africa (19th century). The historian George Sussman argued that the plague had not occurred in East Africa until the 1900s. However, other sources suggest that the Second pandemic did indeed reach Sub-Saharan Africa. According to historian Geoffrey Parker, "France alone lost almost a million people to the plague in the epidemic of 1628–31." In the first half of the 17th century, a plague killed some 1.7 million people in Italy. More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain. The Black Death ravaged much of the Islamic world. Plague was present in at least one location in the Islamic world virtually every year between 1500 and 1850. Plague repeatedly struck the cities of North Africa.
Algiers Algiers ( ; ar, الجزائر, al-Jazāʾir; ber, Dzayer, script=Latn; french: Alger, ) is the capital and largest city of Algeria. The city's population at the 2008 Census was 2,988,145Census 14 April 2008: Office National des Statistiques d ...
lost 30,000–50,000 inhabitants to it in 1620–21, and again in 1654–57, 1665, 1691, and 1740–42. 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. 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.
Baghdad Baghdad (; ar, بَغْدَاد , ) is the capital of Iraq and the second-largest city in the Arab world after Cairo. It is located on the Tigris near the ruins of the ancient city of Babylon and the Sassanid Persian capital of Ctesiphon ...
has suffered severely from visitations of the plague, and sometimes two-thirds of its population had died.


Third plague pandemic

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. 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 Alexandre Emile Jean Yersin (22 September 1863 – 1 March 1943) was a Swiss-French physician and bacteriologist. He is remembered as the co-discoverer of the bacillus responsible for the bubonic plague or pest, which was later named in his ...
, after whom the pathogen was named. Twelve plague outbreaks in Australia between 1900 and 1925 resulted in well over 1,000 deaths, chiefly in Sydney. This led to the establishment of a Public Health Department there which undertook some leading-edge research on plague transmission from rat fleas to humans via the bacillus ''Yersinia pestis''. The first North American plague epidemic was the San Francisco plague of 1900–1904, followed by another outbreak in 1907–1908.


Modern-day

Modern treatment methods include
insecticide Insecticides are substances used to kill insects. They include ovicides and larvicides used against insect eggs and larvae, respectively. Insecticides are used in agriculture, medicine, industry and by consumers. Insecticides are claimed to ...
s, the use of
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...
s, and a
plague vaccine Plague vaccine is a vaccine used against ''Yersinia pestis'' to prevent the plague. Inactivated bacterial vaccines have been used since 1890 but are less effective against the pneumonic plague, so live, attenuated vaccines and recombinant protein ...
. It is feared that the plague bacterium could develop
drug resistance Drug resistance is the reduction in effectiveness of a medication such as an antimicrobial or an antineoplastic in treating a disease or condition. The term is used in the context of resistance that pathogens or cancers have "acquired", that is ...
and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995. A further outbreak in Madagascar was reported in November 2014. In October 2017, the deadliest outbreak of the plague in modern times hit Madagascar, killing 170 people and infecting thousands. An estimate of the
case fatality rate In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people diagnosed with a certain disease, who end up dying of it. Unlike a disease's mortality rate, the CFR does not take int ...
for the modern
bubonic plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well ...
, following the introduction of
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...
s, is 11%, although it may be higher in underdeveloped regions.


See also

* Second plague pandemic * Black Death in medieval culture *
Black Death in England The Black Death was a bubonic plague pandemic, which reached England in June 1348. It was the first and most severe manifestation of the second pandemic, caused by ''Yersinia pestis'' bacteria. The term ''Black Death'' was not used until the l ...
* Crisis of the Late Middle Ages * Flagellant * Globalization and disease * List of epidemics *
Timeline of plague Bubonic plague is one of three types of plague caused by the plague bacterium (''Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as well a ...


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Black Death
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BBC #REDIRECT BBC Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
{{Authority control Plague pandemics 14th-century health disasters 1340s in Asia 1340s in Europe Eurasian history History of medieval medicine History of the Middle East Medieval health disasters Second plague pandemic 1350s in Europe Causes of death 1350s in Asia