The Black Death
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The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a bubonic plague 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 an ...
and
North Africa North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...
from 1346 to 1353. It is the most fatal pandemic recorded in human history, causing the deaths of people, peaking in
Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a subcontinent of Eurasia and it is located entirel ...
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 amon ...
''
Yersinia pestis ''Yersinia pestis'' (''Y. pestis''; formerly '' Pasteurella pestis'') is a gram-negative, non-motile, coccobacillus bacterium without spores that is related to both ''Yersinia pseudotuberculosis'' and ''Yersinia enterocolitica''. It is a facult ...
'' spread by fleas, but it can also take a secondary form where it is spread by person-to-person contact via aerosols causing septicaemic or
pneumonic plague Pneumonic plague is a severe lung infection caused by the bacterium ''Yersinia pestis''. Symptoms include fever, headache, shortness of breath, chest pain, and coughing. They typically start about three to seven days after exposure. It is one ...
s. The Black Death was the beginning of the
second plague pandemic The second plague pandemic was a major series of epidemics of plague that started with the Black Death, which reached Europe in 1348 and killed up to half of the population of Eurasia in the next four years. Although the plague died out in most pl ...
. 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 Central Asia, also known as Middle Asia, is a subregion, region of Asia that stretches from the Caspian Sea in the west to western China and Mongolia in the east, and from Afghanistan and Iran in the south to Russia in the north. It includes t ...
or
East Asia East Asia is the eastern region of Asia, which is defined in both Geography, geographical and culture, ethno-cultural terms. The modern State (polity), states of East Asia include China, Japan, Mongolia, North Korea, South Korea, and Taiwan. ...
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 pop ...
with the
Golden Horde The Golden Horde, self-designated as Ulug Ulus, 'Great State' in Turkic, was originally a Mongol and later Turkicized khanate established in the 13th century and originating as the northwestern sector of the Mongol Empire. With the fragme ...
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 eli ...
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 pop ...
(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, are ...
living on the black rats that travelled on Genoese ships, spreading through the Mediterranean Basin and reaching
North Africa North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...
,
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 la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth (Old Norse), Tsargrad ( Slavic), Qustantiniya ( Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...
,
Sicily (man) it, Siciliana (woman) , population_note = , population_blank1_title = , population_blank1 = , demographics_type1 = Ethnicity , demographics1_footnotes = , demographi ...
, 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 Vector most often refers to: *Euclidean vector, a quantity with a magnitude and a direction *Vector (epidemiology), an agent that carries and transmits an infectious pathogen into another living organism Vector may also refer to: Mathematic ...
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 Kyrgyzstan,, pronounced or the Kyrgyz Republic, is a landlocked country in Central Asia. Kyrgyzstan is bordered by Kazakhstan to the north, Uzbekistan to the west, Tajikistan to the south, and the People's Republic of China to the ea ...
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 The Mongol invasions and conquests took place during the 13th and 14th centuries, creating history's largest contiguous empire: the Mongol Empire ( 1206-1368), which by 1300 covered large parts of Eurasia. Historians regard the Mongol devastatio ...
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 Late Middle Ages or Late Medieval Period was the period of European history lasting from AD 1300 to 1500. The Late Middle Ages followed the High Middle Ages and preceded the onset of the early modern period (and in much of Europe, the Renai ...
(the first one being the
Great Famine of 1315–1317 The Great Famine of 1315–1317 (occasionally dated 1315–1322) was the first of a series of large-scale crises that struck Europe early in the 14th century. Most of Europe (extending east to Russia and south to Italy) was affected. The famine ...
) 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 In demographics, the world population is the total number of humans currently living. It was estimated by the United Nations to have exceeded 8 billion in November 2022. It took over 200,000 years of human prehistory and history for th ...
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 Crisis of the Late Middle Ages was a series of events in the fourteenth and fifteenth centuries that ended centuries of European stability during the Late Middle Ages. Three major crises led to radical changes in all areas of society: demog ...
), 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 Murrain (also known as distemper) is an antiquated term for various infectious diseases affecting cattle and sheep. The word originates from Middle English ''moreine'' or ''moryne'', as a derivative of Latin ''mori'' "to die". The word ''murra ...
) 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 Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
as black – is very old.
Homer Homer (; grc, Ὅμηρος , ''Hómēros'') (born ) was a Greek poet who is credited as the author of the ''Iliad'' and the ''Odyssey'', two epic poems that are foundational works of ancient Greek literature. Homer is considered one of the ...
used it in the
Odyssey The ''Odyssey'' (; grc, Ὀδύσσεια, Odýsseia, ) is one of two major ancient Greek epic poems attributed to Homer. It is one of the oldest extant works of literature still widely read by modern audiences. As with the ''Iliad'', th ...
to describe the monstrous Scylla, with her mouths "full of black Death" ().
Seneca the Younger Lucius Annaeus Seneca the Younger (; 65 AD), usually known mononymously as Seneca, was a Stoic philosopher of Ancient Rome, a statesman, dramatist, and, in one work, satirist, from the post-Augustan age of Latin literature. Seneca was born in ...
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. He ...
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 In the archaeology of Southwest Asia, the Late Neolithic, also known as the Ceramic Neolithic or Pottery Neolithic, is the final part of the Neolithic period, following on from the Pre-Pottery Neolithic and preceding the Chalcolithic. It is some ...
-
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 ''Yersinia pestis'' (''Y. pestis''; formerly '' Pasteurella pestis'') is a gram-negative, non-motile, coccobacillus bacterium without spores that is related to both ''Yersinia pseudotuberculosis'' and ''Yersinia enterocolitica''. It is a facult ...
'' 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. He ...
; 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- Republican period of ancient Rome. As a polity, it included large territorial holdings around the Mediter ...
before the reign of
Trajan Trajan ( ; la, Caesar Nerva Traianus; 18 September 539/11 August 117) was Roman emperor from 98 to 117. Officially declared ''optimus princeps'' ("best ruler") by the senate, Trajan is remembered as a successful soldier-emperor who presi ...
, six centuries before arriving at Pelusium in the reign of
Justinian I Justinian I (; la, Iustinianus, ; grc-gre, Ἰουστινιανός ; 48214 November 565), also known as Justinian the Great, was the Byzantine emperor from 527 to 565. His reign is marked by the ambitious but only partly realized ''renova ...
. In 2013, researchers confirmed earlier speculation that the cause of the
Plague of Justinian The plague of Justinian or Justinianic plague (541–549 AD) was the first recorded major outbreak of the first plague pandemic, the first Old World pandemic of plague, the contagious disease caused by the bacterium ''Yersinia pestis''. The dis ...
(541–542 CE, with recurrences until 750) was ''Y''. ''pestis''. This is known as the
first plague pandemic The first plague pandemic was the first historically recorded Old World pandemic of plague, the contagious disease caused by the bacterium ''Yersinia pestis''. Also called the early medieval pandemic, it began with the Plague of Justinian in 541 ...
. 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 (
Guangzhou Guangzhou (, ; ; or ; ), also known as Canton () and alternatively romanized as Kwongchow or Kwangchow, is the capital and largest city of Guangdong province in southern China. Located on the Pearl River about north-northwest of Hong Kon ...
). 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 ''Yersinia pestis'' (''Y. pestis''; formerly '' Pasteurella pestis'') is a gram-negative, non-motile, coccobacillus bacterium without spores that is related to both ''Yersinia pseudotuberculosis'' and ''Yersinia enterocolitica''. It is a facult ...
'', 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
rodent Rodents (from Latin , 'to gnaw') are mammals of the order Rodentia (), which are characterized by a single pair of continuously growing incisors in each of the upper and lower jaws. About 40% of all mammal species are rodents. They are n ...
s, including
marmot Marmots are large ground squirrels in the genus ''Marmota'', with 15 species living in Asia, Europe, and North America. These herbivores are active during the summer, when they can often be found in groups, but are not seen during the winter, ...
s, in various areas, including
Central Asia Central Asia, also known as Middle Asia, is a subregion, region of Asia that stretches from the Caspian Sea in the west to western China and Mongolia in the east, and from Afghanistan and Iran in the south to Russia in the north. It includes t ...
,
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 North India is a loosely defined region consisting of the northern part of India. The dominant geographical features of North India are the Indo-Gangetic Plain and the Himalayas, which demarcate the region from the Tibetan Plateau and Central ...
,
Uganda }), is a landlocked country in East Africa. The country is bordered to the east by Kenya, to the north by South Sudan, to the west by the Democratic Republic of the Congo, to the south-west by Rwanda, and to the south by Tanzania. The sou ...
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 hi ...
, 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 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 Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found else ...
, 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 ...
.


DNA evidence

Definitive confirmation of the role of ''Y. pestis'' arrived in 2010 with a publication in ''
PLOS Pathogens ''PLOS Pathogens'' is a peer-reviewed open-access medical journal. All content in ''PLOS Pathogens'' is published under the Creative Commons "by-attribution" license. ''PLOS Pathogens'' began operation in September 2005. It was the fifth journa ...
'' 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 ge ...
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 without ...
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 gen ...
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 ...
'' 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 The third plague pandemic was a major bubonic plague pandemic that began in Yunnan, China, in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately led to more than 12 million deaths in India and China (and perha ...
and as the descendant of the strain responsible for the
Plague of Justinian The plague of Justinian or Justinianic plague (541–549 AD) was the first recorded major outbreak of the first plague pandemic, the first Old World pandemic of plague, the contagious disease caused by the bacterium ''Yersinia pestis''. The dis ...
. 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 The Tian Shan,, , otk, 𐰴𐰣 𐱅𐰭𐰼𐰃, , tr, Tanrı Dağı, mn, Тэнгэр уул, , ug, تەڭرىتاغ, , , kk, Тәңіртауы / Алатау, , , ky, Теңир-Тоо / Ала-Тоо, , , uz, Tyan-Shan / Tangritog‘ ...
Mountains in
Kyrgyzstan Kyrgyzstan,, pronounced or the Kyrgyz Republic, is a landlocked country in Central Asia. Kyrgyzstan is bordered by Kazakhstan to the north, Uzbekistan to the west, Tajikistan to the south, and the People's Republic of China to the ea ...
.


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 evidenc ...
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 Domesday Book () – the Middle English spelling of "Doomsday Book" – is a manuscript record of the "Great Survey" of much of England and parts of Wales completed in 1086 by order of King William I, known as William the Conqueror. The manus ...
of 1086 and the poll tax 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 physics, ...
is used to match the spreading patterns and the means of transmission. A research in 2018 challenged the popular hypothesis that "infected rats died, their flea parasites could have jumped from the recently dead rat hosts to humans". It suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of death toll because the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, which contradict historical death data. Lars Walløe complains that all of these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of ''Yersinia pestis'' infection could spread", whilst pointing to several other possibilities. 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
flea 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 ...
s during the
second plague pandemic The second plague pandemic was a major series of epidemics of plague that started with the Black Death, which reached Europe in 1348 and killed up to half of the population of Eurasia in the next four years. Although the plague died out in most pl ...
.


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 Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus, and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure. ...
,
smallpox Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
and
respiratory infection Respiratory tract infections (RTIs) are infectious diseases involving the respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection (URI or URTI) or a lower respiratory tract infection (LRI ...
s. 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 Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
announced the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. 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 The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour. Anatomy The pulp is the neurovascular bundle centr ...
, 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 In medicine, public health, and biology, transmission is the passing of a pathogen causing communicable disease from an infected host individual or group to a particular individual or group, regardless of whether the other individual was previou ...
. 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 housefor 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 geneticist Medical genetics is the branch tics in that human genetics is a field of scientific research that may or may not apply to medicine, while medical genetics refers to the application of genetics to medical care. For example, research on the caus ...
s led by Mark Achtman that analysed the genetic variation 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 The Tian Shan,, , otk, 𐰴𐰣 𐱅𐰭𐰼𐰃, , tr, Tanrı Dağı, mn, Тэнгэр уул, , ug, تەڭرىتاغ, , , kk, Тәңіртауы / Алатау, , , ky, Теңир-Тоо / Ала-Тоо, , , uz, Tyan-Shan / Tangritog‘ ...
mountains on the border between
Kyrgyzstan Kyrgyzstan,, pronounced or the Kyrgyz Republic, is a landlocked country in Central Asia. Kyrgyzstan is bordered by Kazakhstan to the north, Uzbekistan to the west, Tajikistan to the south, and the People's Republic of China to the ea ...
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 ...
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 i ...
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 evidenc ...
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 ...
; 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 la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth (Old Norse), Tsargrad ( Slavic), Qustantiniya ( Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...
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 The Black Sea is a marginal mediterranean sea of the Atlantic Ocean lying between Europe and Asia, east of the Balkans, south of the East European Plain, west of the Caucasus, and north of Anatolia. It is bounded by Bulgaria, Georgia, Rom ...
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 The Mongols ( mn, Монголчууд, , , ; ; russian: Монголы) are an East Asian ethnic group native to Mongolia, Inner Mongolia in China and the Buryatia Republic of the Russian Federation. The Mongols are the principal member ...
armies and traders, or it could have arrived via ship, but this theory is still contested. It is speculated that rats aboard
Zheng He Zheng He (; 1371–1433 or 1435) was a Chinese mariner, explorer, diplomat, fleet admiral, and court eunuch during China's early Ming dynasty. He was originally born as Ma He in a Muslim family and later adopted the surname Zheng conferr ...
's ships in the 15th century may have carried the plague to
Southeast Asia Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical south-eastern region of Asia, consisting of the regions that are situated south of mainlan ...
,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
, and Africa. Research on the Delhi Sultanate and the
Yuan Dynasty The Yuan dynasty (), officially the Great Yuan (; xng, , , literally "Great Yuan State"), was a Mongol-led imperial dynasty of China and a successor state to the Mongol Empire after its division. It was established by Kublai, the fift ...
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 Asia ...
. Monica H. Green suggests that the reason why other parts of
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 ...
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 pop ...
in 1347. During a protracted siege of the city, in 1345–1346 the Mongol
Golden Horde The Golden Horde, self-designated as Ulug Ulus, 'Great State' in Turkic, was originally a Mongol and later Turkicized khanate established in the 13th century and originating as the northwestern sector of the Mongol Empire. With the fragme ...
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 eli ...
, 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 The Black Sea is a marginal mediterranean sea of the Atlantic Ocean lying between Europe and Asia, east of the Balkans, south of the East European Plain, west of the Caucasus, and north of Anatolia. It is bounded by Bulgaria, Georgia, Rom ...
to
Constantinople la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth (Old Norse), Tsargrad ( Slavic), Qustantiniya ( Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...
, 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 Byzantine Empire, Eastern Roman Empire, to Fall of Constantinople, its fall to the Ottoman Empire in 1453 AD. On ...
,
John VI Kantakouzenos John VI Kantakouzenos or Cantacuzene ( el, , ''Iōánnēs Ángelos Palaiológos Kantakouzēnós''; la, Johannes Cantacuzenus;  – 15 June 1383) was a Byzantine Greek nobleman, statesman, and general. He served as grand domestic under ...
, who wrote a description of the disease modelled on
Thucydides Thucydides (; grc, , }; BC) was an Athenian historian and general. His '' History of the Peloponnesian War'' recounts the fifth-century BC war between Sparta and Athens until the year 411 BC. Thucydides has been dubbed the father of " scienti ...
'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 an ...
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 (man) it, Siciliana (woman) , population_note = , population_blank1_title = , population_blank1 = , demographics_type1 = Ethnicity , demographics1_footnotes = , demographi ...
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
Marseille Marseille ( , , ; also spelled in English as Marseilles; oc, Marselha ) is the prefecture of the French department of Bouches-du-Rhône and capital of the Provence-Alpes-Côte d'Azur region. Situated in the camargue region of southern Fra ...
s. From Italy, the disease spread northwest across Europe, striking France,
Spain , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = ''Plus ultra'' (Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , i ...
(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 ...
in the spring of 1348), Portugal and
England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
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 o ...
) and
Iceland Iceland ( is, Ísland; ) is a Nordic island country in the North Atlantic Ocean and in the Arctic Ocean. Iceland is the most sparsely populated country in Europe. Iceland's capital and largest city is Reykjavík, which (along with its s ...
. 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 ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...
, 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. 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 la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth (Old Norse), Tsargrad ( Slavic), Qustantiniya ( Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...
; according to a contemporary witness, from a single merchant ship carrying slaves. By late summer 1348 it reached Cairo, capital of the
Mamluk Sultanate The Mamluk Sultanate ( ar, سلطنة المماليك, translit=Salṭanat al-Mamālīk), also known as Mamluk Egypt or the Mamluk Empire, was a state that ruled Egypt, the Levant and the Hejaz (western Arabia) from the mid-13th to early 16t ...
, 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 ...
was choked with corpses despite Cairo having a medieval hospital, the late 13th century bimaristan 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. That year, in the territory of modern
Lebanon Lebanon ( , ar, لُبْنَان, translit=lubnān, ), officially the Republic of Lebanon () or the Lebanese Republic, is a country in Western Asia. It is located between Syria to Lebanon–Syria border, the north and east and Israel to Blue ...
, Syria,
Israel Israel (; he, יִשְׂרָאֵל, ; ar, إِسْرَائِيل, ), officially the State of Israel ( he, מְדִינַת יִשְׂרָאֵל, label=none, translit=Medīnat Yīsrāʾēl; ), is a country in Western Asia. It is situated ...
, and Palestine, 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 wit ...
, Acre,
Jerusalem Jerusalem (; he, יְרוּשָׁלַיִם ; ar, القُدس ) (combining the Biblical and common usage Arabic names); grc, Ἱερουσαλήμ/Ἰεροσόλυμα, Hierousalḗm/Hierosóluma; hy, Երուսաղեմ, Erusałēm. i ...
,
Sidon Sidon ( ; he, צִידוֹן, ''Ṣīḏōn'') known locally as Sayda or Saida ( ar, صيدا ''Ṣaydā''), is the third-largest city in Lebanon. It is located in the South Governorate, of which it is the capital, on the Mediterranean coast. ...
, and Homs 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 ''Tounsi'' french: Tunisois , population_note = , population_urban = , population_metro = 2658816 , population_density_km2 = , timezone1 = CET , utc_offset1 ...
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 g ...
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 M ...
.
Mecca Mecca (; officially Makkah al-Mukarramah, commonly shortened to Makkah ()) is a city and administrative center of the Mecca Province of Saudi Arabia, and the holiest city in Islam. It is inland from Jeddah on the Red Sea, in a narrow ...
became infected in 1348 by pilgrims performing the Hajj. 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 we ...
sultan of the
Yemen Yemen (; ar, ٱلْيَمَن, al-Yaman), officially the Republic of Yemen,, ) is a country in Western Asia. It is situated on the southern end of the Arabian Peninsula, and borders Saudi Arabia to the Saudi Arabia–Yemen border, north and ...
, al-Mujahid Ali, was released from Mamluk captivity in Egypt and carried plague with him on his return home. During 1348, records show the city of
Mosul Mosul ( ar, الموصل, al-Mawṣil, ku, مووسڵ, translit=Mûsil, Turkish: ''Musul'', syr, ܡܘܨܠ, Māwṣil) is a major city in northern Iraq, serving as the capital of Nineveh Governorate. The city is considered the second larg ...
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. I ...
experienced a second round of the disease.


Signs and symptoms


Bubonic plague

Symptoms of the disease include fever of , headaches, painful aching joints,
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...
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 thigh ...
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 some ...
's description: This was followed by acute
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
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 mu ...
, whose master the Cardinal Colonna died of plague in 1348, noted a distinct form of the disease,
pneumonic plague Pneumonic plague is a severe lung infection caused by the bacterium ''Yersinia pestis''. Symptoms include fever, headache, shortness of breath, chest pain, and coughing. They typically start about three to seven days after exposure. It is one ...
, 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, 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 Florence ( ; it, Firenze ) is a city in Central Italy and the capital city of the Tuscany Regions of Italy, region. It is the most populated city in Tuscany, with 383,083 inhabitants in 2016, and over 1,520,000 in its metropolitan area.Bilan ...
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 (male), (female) en, Hamburger(s), Hamburgian(s) , timezone1 = Central (CET) , utc_offset1 = +1 , timezone1_DST = Central (CEST) , utc_offset1_DST = +2 , postal ...
and Bremen 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, Dou ...
in
Flanders Flanders (, ; Dutch: ''Vlaanderen'' ) is the Flemish-speaking northern portion of Belgium and one of the communities, regions and language areas of Belgium. However, there are several overlapping definitions, including ones related to cultu ...
until the turn of the 15th century, and the impact was less severe on the populations of Hainaut,
Finland Finland ( fi, Suomi ; sv, Finland ), officially the Republic of Finland (; ), is a Nordic country in Northern Europe. It shares land borders with Sweden to the northwest, Norway to the north, and Russia to the east, with the Gulf of B ...
, 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 a ...
, 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 flu ...
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 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 centur ...
, 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 Reforestation (occasionally, reafforestation) is the natural or intentional restocking of existing forests and woodlands (forestation) that have been depleted, usually through deforestation, but also after clearcutting. Management A debat ...
. This may have led to the Little Ice Age.


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 Santayan ...
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 ...
s, foreigners, beggars,
pilgrim A pilgrim (from the Latin ''peregrinus'') is a traveler (literally one who has come from afar) who is on a journey to a holy place. Typically, this is a physical journey (often on foot) to some place of special significance to the adherent of ...
s", lepers, and Romani, blaming them for the crisis.
Leper Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
s, 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 ...
or
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
, 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. 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 Mainz () is the capital and largest city of Rhineland-Palatinate, Germany. Mainz is on the left bank of the Rhine, opposite to the place that the Main joins the Rhine. Downstream of the confluence, the Rhine flows to the north-west, with Ma ...
and
Cologne Cologne ( ; german: Köln ; ksh, Kölle ) is the largest city of the German western state of North Rhine-Westphalia (NRW) and the fourth-most populous city of Germany with 1.1 million inhabitants in the city proper and 3.6 millio ...
were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. During this period many Jews relocated to
Poland Poland, officially the Republic of Poland, is a country in Central Europe. It is divided into 16 administrative provinces called voivodeships, covering an area of . Poland has a population of over 38 million and is the fifth-most populou ...
, where they received a warm welcome from King Casimir the Great.


Social

One theory that has been advanced is that the devastation in
Florence Florence ( ; it, Firenze ) is a city in Central Italy and the capital city of the Tuscany Regions of Italy, region. It is the most populated city in Tuscany, with 383,083 inhabitants in 2016, and over 1,520,000 in its metropolitan area.Bilan ...
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 The Renaissance ( , ) , from , with the same meanings. is a period in European history The history of Europe is traditionally divided into four time periods: prehistoric Europe (prior to about 800 BC), classical antiquity (800 BC to AD ...
. Italy was particularly badly hit by the pandemic, and it has been speculated that the resulting familiarity with death caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife. It has also been argued that the Black Death prompted a new wave of piety, manifested in the
sponsorship Sponsoring something (or someone) is the act of supporting an event, activity, person, or organization financially or through the provision of products or services. The individual or group that provides the support, similar to a benefactor, is k ...
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 The Fall of Constantinople, also known as the Conquest of Constantinople, was the capture of the capital of the Byzantine Empire by the Ottoman Empire. The city fell on 29 May 1453 as part of the culmination of a 53-day siege which had begun o ...
. 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
fief A fief (; la, feudum) was a central element in medieval contracts based on feudal law. It consisted of a form of property holding or other rights granted by an overlord to a vassal, who held it in fealty or "in fee" in return for a form ...
s 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 Florence ( ; it, Firenze ) is a city in Central Italy and the capital city of the Tuscany Regions of Italy, region. It is the most populated city in Tuscany, with 383,083 inhabitants in 2016, and over 1,520,000 in its metropolitan area.Bilan ...
, 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 Feudalism, also known as the feudal system, was the combination of the legal, economic, military, cultural and political customs that flourished in medieval Europe between the 9th and 15th centuries. Broadly defined, it was a way of structur ...
. The word "
quarantine A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
" 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 Mediterran ...
, 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 , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = ''Plus ultra'' (Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , i ...
. 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 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 la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth (Old Norse), Tsargrad ( Slavic), Qustantiniya ( Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...
, 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. I ...
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 hi ...
, 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 The San Francisco plague of 1900–1904 was an epidemic of bubonic plague centered on San Francisco's Chinatown. It was the first plague epidemic in the continental United States. The epidemic was recognized by medical authorities in March 1900, ...
, followed by another outbreak in 1907–1908.


Modern-day

Modern treatment methods include insecticides, the use of antibiotics, 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 Madagascar (; mg, Madagasikara, ), officially the Republic of Madagascar ( mg, Repoblikan'i Madagasikara, links=no, ; french: République de Madagascar), is an island country in the Indian Ocean, approximately off the coast of East Africa ...
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, following the introduction of antibiotics, is 11%, although it may be higher in underdeveloped regions.


See also

*
Second plague pandemic The second plague pandemic was a major series of epidemics of plague that started with the Black Death, which reached Europe in 1348 and killed up to half of the population of Eurasia in the next four years. Although the plague died out in most pl ...
*
Black Death in medieval culture The Black Death in medieval culture includes the effect of the Black Death (1347–1350) on art and literature throughout the generation that experienced it. Although contemporary chronicles are often regarded by historians as the most realistic ...
*
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 lat ...
*
Crisis of the Late Middle Ages The Crisis of the Late Middle Ages was a series of events in the fourteenth and fifteenth centuries that ended centuries of European stability during the Late Middle Ages. Three major crises led to radical changes in all areas of society: demog ...
* Flagellant *
Globalization and disease Globalization, the flow of information, goods, capital, and people across political and geographic boundaries, allows infectious diseases to rapidly spread around the world, while also allowing the alleviation of factors such as hunger and poverty ...
* List of epidemics * Timeline of plague


References


Notes


Citations


Bibliography

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Further reading

* * * * * * * * * * * * * * * * * * *


External links

*
Black Death
at
BBC #REDIRECT 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