Black Death

The **Black Death** was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe in the years 1346–1353.[1][2][3] Although there were several competing theories as to the cause of the Black Death, analyses of DNA from people in northern and southern Europe published in 2010 and 2011 indicate that the pathogen responsible was the *Yersinia pestis* bacterium, resulting in several forms of plague, including the bubonic plague.[4][5]

The Black Death is thought to have originated in the arid plains of Central Asia, where it then travelled along the Silk Road, reaching Crimea by 1343.[6] From there, it was most likely carried by Oriental rat fleas living on the black rats that were regular passengers on merchant ships. Spreading throughout the Mediterranean and Europe, the Black Death is estimated to have killed 30–60% of Europe's total population.[7] In total, the plague may have reduced the world population from an estimated 450 million down to 350–375 million in the 14th century.[8] The world population as a whole did not recover to pre-plague levels until the 17th century.[9] The plague recurred occasionally in Europe until the 19th century.

The plague created a series of religious, social, and economic upheavals, which had profound effects on the course of European history.

## Chronology:

### Origins of the disease:

The plague disease, caused by *Yersinia pestis*, is enzootic (commonly present) in populations of fleas carried by ground rodents, including marmots, in various areas including Central Asia, Kurdistan, Western Asia, Northern India and Uganda.[10] Nestorian graves dating to 1338–1339 near Lake Issyk Kul in Kyrgyzstan
 have inscriptions referring to plague and are thought by many
epidemiologists to mark the outbreak of the epidemic, from which it
could easily have spread to China and India.[11] In October 2010, medical geneticists suggested that all three of the great waves of the plague originated in China.[12] In China, the 13th-century Mongol conquest
 caused a decline in farming and trading. However, economic recovery had
 been observed at the beginning of the 14th century. In the 1330s, a
large number of natural disasters and plagues led to widespread famine,
starting in 1331, with a deadly plague arriving soon after.[13]
 Epidemics that may have included plague killed an estimated 25 million
Chinese and other Asians during the 15 years before it reached Constantinople in 1347.[14][15]
The disease may have travelled along the Silk Road with Mongol armies and traders or it could have come via ship.[16] By the end of 1346, reports of plague had reached the seaports of Europe: "India was depopulated, Tartary, Mesopotamia, Syria, Armenia were covered with dead bodies".[17]

Plague was reportedly first introduced to Europe via Genoese traders at the port city of Kaffa in the Crimea in 1347. After a protracted siege, during which the Mongol army under Jani Beg was suffering from the disease, the army catapulted the infected corpses over the city walls of Kaffa to infect the inhabitants. The Genoese traders fled, taking the plague by ship into Sicily and the south of Europe, whence it spread north.[18]
 Whether or not this hypothesis is accurate, it is clear that several
existing conditions such as war, famine, and weather contributed to the
severity of the Black Death.

### European outbreak:

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

There appear to have been several introductions into Europe. The
plague reached Sicily in October 1347, carried by twelve Genoese
galleys,[19] and rapidly spread 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.[20]

From Italy, the disease spread northwest across Europe, striking
France, Spain, Portugal and England by June 1348, then turned and spread
 east through Germany and Scandinavia from 1348 to 1350. It was
introduced in Norway in 1349 when a ship landed at Askøy, then spread to Bjørgvin (modern Bergen) and Iceland.[21]
 Finally it spread to northwestern Russia in 1351. The plague was
somewhat less common in parts of Europe that had smaller trade relations
 with their neighbours, including the majority of the Basque Country, isolated parts of Belgium and the Netherlands, and isolated alpine villages throughout the continent.[22][23]

Modern researchers do not think that the plague ever became endemic
in Europe or its rat population. The disease repeatedly wiped out the
rodent carriers so that the fleas died out until a new outbreak from
Central Asia repeated the process. The outbreaks have been shown to
occur roughly 15 years after a warmer and wetter period in areas where
plague is endemic in other species such as gerbils.[24][25]

### Middle Eastern Outbreak:

The plague struck various regions in the Middle East during the pandemic,
 leading to serious depopulation and permanent change in both economic
and social structures. As it spread to western Europe, the disease
entered the region from southern Russia also. By autumn 1347, the plague
 reached Alexandria in Egypt, probably through the port's trade with Constantinople, and ports on the Black Sea. During 1347, the disease travelled eastward to Gaza, and north along the eastern coast to cities in Lebanon, Syria and Palestine, including Ashkelon, Acre, Jerusalem, Sidon, Damascus, Homs, and Aleppo. In 1348–1349, the disease reached Antioch.
 The city's residents fled to the north, most of them dying during the
journey, but the infection had been spread to the people of Asia Minor.[*citation needed*]

Mecca became infected in 1349. During the same year, records show the city of Mawsil (Mosul) suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. In 1351 Yemen experienced an outbreak of the plague, coinciding with the return of Sultan al-Mujahid Ali of Yemen from imprisonment in Cairo. His party may have brought the disease with them from Egypt.[*citation needed*]

## Signs and symptoms:

A hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black

An inguinal bubo on the upper thigh of a person infected with bubonic plague. Swollen lymph glands (*buboes*) often occur in the neck, armpit and groin (*inguinal*) regions of plague victims.

Contemporary accounts of the plague are often varied or imprecise. The most commonly noted symptom was the appearance of buboes (or gavocciolos) in the groin, the neck and armpits, which oozed pus and bled when opened.[26] Boccaccio's description is graphic:
The only medical detail that is questionable in Boccaccio's
description is that the gavocciolo was an 'infallible token of
approaching death', as, if the bubo discharges, recovery is possible.[28]

This was followed by acute fever and vomiting of blood. Most victims
died two to seven days after initial infection. Freckle-like spots and
rashes,[29] which could have been caused by flea-bites, were identified as another potential sign of the plague.

Some accounts, like that of Lodewijk Heyligen, whose master the Cardinal Colonna died of the plague in 1348, noted a distinct form of the disease that infected the lungs and led to respiratory problems[26] and is identified with pneumonic plague.

## Causes:

The Oriental rat flea (*Xenopsylla cheopis*) engorged with blood. This species of flea is the primary vector for the transmission of *Yersinia pestis*, the organism responsible for bubonic plague in most plague epidemics. Both male and female fleas feed on blood and can transmit the infection.

Oriental rat flea (*Xenopsylla cheopis*) infected with the *Yersinia pestis* bacterium which appears as a dark mass in the gut. The foregut (*proventriculus*) of this flea is blocked by a *Y. pestis* biofilm; when the flea attempts to feed on an uninfected host *Y. pestis* is regurgitated into the wound, causing infection.

Medical knowledge had stagnated during the Middle Ages. The most authoritative account at the time came from the medical faculty in Paris in a report to the king of France that blamed the heavens, in the form of a conjunction of three planets in 1345 that caused a "great pestilence in the air".[32]
 This report became the first and most widely circulated of a series of
plague tracts that sought to give advice to sufferers. That the plague
was caused by bad air became the most widely accepted theory. Today,
this is known as the miasma theory. The word *plague*
 had no special significance at this time, and only the recurrence of
outbreaks during the Middle Ages gave it the name that has become the
medical term.
The importance of hygiene was recognised only in the nineteenth
century; until then it was common that the streets were filthy, with
live animals of all sorts around and human parasites abounding. A
transmissible disease will spread easily in such conditions. One
development as a result of the Black Death was the establishment of the
idea of quarantine in Dubrovnik in 1377 after continuing outbreaks.[33]

The dominant explanation for the Black Death is the plague theory, which attributes the outbreak to *Yersinia pestis*,
 also responsible for an epidemic that began in southern China in 1865,
eventually spreading to India. The investigation of the pathogen that
caused the 19th-century plague was begun by teams of scientists who
visited Hong Kong in 1894, among whom was the French-Swiss
bacteriologist Alexandre Yersin, after whom the pathogen was named *Yersinia pestis*.[34] The mechanism by which *Y. pestis* was usually transmitted was established in 1898 by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating *Y. pestis*
 several days after feeding on an infected host. This blockage results
in starvation and aggressive feeding behaviour by the fleas, which
repeatedly attempt to clear their 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 lack resistance. When the second population dies, the
 fleas move on to other hosts, including people, thus creating a human epidemic.[34]

The historian Francis Aidan Gasquet wrote about the Great Pestilence in 1893[35]
 and suggested that "it would appear to be some form of the ordinary
Eastern or bubonic plague". He was able to adopt the epidemiology of the
 bubonic plague for the Black Death for the second edition in 1908,
implicating rats and fleas in the process, and his interpretation was
widely accepted for other ancient and medieval epidemics, such as the Justinian plague that was prevalent in the Eastern Roman Empire from 541 to 700 CE.[34]

An estimate of the mortality rate for the modern bubonic plague,
 following the introduction of antibiotics, is 11% (by the US Centers
for Disease Control (CDC)), although it may be much higher in
economically or medically underdeveloped regions.[36] Symptoms of the disease include fever of 38–41 °C (100–106 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Left untreated, of those that contract the bubonic plague, 80 per cent die within eight days.[37] Pneumonic plague has a mortality rate of 90 to 95 per cent. Symptoms include fever, cough, and blood-tinged sputum. As the disease progresses, sputum becomes free-flowing and bright red. Septicemic plague is the least common of the three forms, with a mortality rate near 100%. Symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation).
 In cases of pneumonic and particularly septicemic plague, the progress
of the disease is so rapid that there would often be no time for the
development of the enlarged lymph nodes that were noted as buboes.[38]

A number of alternative theories – implicating other diseases in the
Black Death pandemic – have also been proposed by some modern scientists
 (see below – "Alternative Explanations").

### DNA evidence:

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

In October 2010, the open-access scientific journal *PLoS Pathogens* published a paper by a multinational team who undertook a new investigation into the role of *Yersinia pestis*
 in the Black Death following the disputed identification by Drancourt
and Raoult in 1998. They assessed the presence of DNA/RNA with polymerase chain reaction (PCR) techniques for *Y. pestis*
 from the tooth sockets in human skeletons from mass graves in northern,
 central and southern Europe that were associated archaeologically with
the Black Death and subsequent resurgences. The authors concluded that
this new research, together with prior analyses from the south of France
 and Germany,[39] "ends the debate about the cause of the Black Death, and unambiguously demonstrates that *Y. pestis* was the causative agent of the epidemic plague that devastated Europe during the Middle Ages".[40]

The study also found that there were two previously unknown but related clades (genetic branches) of the *Y. pestis* genome
 associated with medieval mass graves. These clades (which are thought
to be extinct) were found to be ancestral to modern isolates of the
modern *Y. pestis* strains *Y. p. orientalis* and *Y. p. medievalis*, suggesting the plague may have entered Europe in two waves. Surveys of plague pit remains in France and England indicate the first variant entered Europe through the port of Marseille
 around November 1347 and spread through France over the next two years,
 eventually reaching England in the spring of 1349, where it spread
through the country in three epidemics. Surveys of plague pit remains
from the Dutch town of Bergen op Zoom showed the *Y. pestis*
 genotype responsible for the pandemic that spread through the Low
Countries from 1350 differed from that found in Britain and France,
implying Bergen op Zoom (and possibly other parts of the southern
Netherlands) was not directly infected from England or France in 1349
and suggesting a second wave of plague, different from those in Britain
and France, may have been carried to the Low Countries from Norway, the Hanseatic cities or another site.[40]

The results of the Haensch study have since been confirmed and
amended. Based on genetic evidence derived from Black Death victims in
the East Smithfield
 burial site in England, Schuenemann et al. concluded in 2011 "that the
Black Death in medieval Europe was caused by a variant of *Y. pestis* that may no longer exist."[41] A study published in *Nature* in October 2011 sequenced the genome of *Y. pestis*
 from plague victims and indicated that the strain that caused the Black
 Death is ancestral to most modern strains of the disease.[5]

DNA taken from 25 skeletons from the 14th century found in London have shown the plague is a strain of *Y. pestis* that is almost identical to that which hit Madagascar in 2013.[42][43]

### Alternative Explanations:

The plague theory was first significantly challenged by the work of
British bacteriologist J. F. D. Shrewsbury in 1970, who noted that the
reported rates of mortality in rural areas during the 14th-century
pandemic were inconsistent with the modern bubonic plague, leading him
to conclude that contemporary accounts were exaggerations.[34]
 In 1984 zoologist Graham Twigg produced the first major work to
challenge the bubonic plague theory directly, and his doubts about the
identity of the Black Death have been taken up by a number of authors,
including Samuel K. Cohn, Jr. (2002 and 2013), David Herlihy (1997), and Susan Scott and Christopher Duncan (2001).[34]
It is recognised that an epidemiological
 account of the 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 plague in
England, and even estimates of overall population at the start vary by
over 100% as no census was undertaken between the time of publication of
 the Domesday Book and the year 1377.[44] Estimates of plague victims are usually extrapolated from figures from the clergy.

In addition to arguing that the rat population was insufficient to
account for a bubonic plague pandemic, sceptics of the bubonic plague
theory point out that the symptoms of the Black Death are not unique
(and arguably in some accounts may differ from bubonic plague); that
transference via fleas in goods was likely to be of marginal
significance; and that the DNA results may be flawed and might not have
been repeated elsewhere, despite extensive samples from other mass
graves.[34]
 Other arguments include the lack of accounts of the death of rats
before outbreaks of plague between the 14th and 17th centuries;
temperatures that are too cold in northern Europe for the survival of
fleas; that, despite primitive transport systems, the spread of the
Black Death was much faster than that of modern bubonic plague; that
mortality rates of the Black Death appear to be very high; that, while
modern bubonic plague is largely endemic as a rural disease, the Black
Death indiscriminately struck urban and rural areas; and that the
pattern of the Black Death, with major outbreaks in the same areas
separated by 5 to 15 years, differs from modern bubonic plague—which
often becomes endemic for decades with annual flare-ups.[34]

McCormick has suggested that earlier archaeologists were simply not
interested in the "laborious" processes needed to discover rat remains.[45]
 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.[46] Similarly, Green has argued that greater attention is needed to the range of (especially non-commensal) animals that might be involved in the transmission of plague.[47]

A variety of alternatives to the *Y. pestis* have been put forward. Twigg suggested that the cause was a form of anthrax, and Norman Cantor
 (2001) thought it may have been a combination of anthrax and other
pandemics. Scott and Duncan have argued that the pandemic was a form of
infectious disease that they characterise as *hemorrhagic* plague similar to Ebola.
 Archaeologist Barney Sloane has argued that there is insufficient
evidence of the extinction of a large number of rats in the
archaeological record of the medieval waterfront in London and that the
plague spread too quickly to support the thesis that the *Y. pestis* was spread from fleas on rats; he argues that transmission must have been person to person.[48][49] However, no single alternative solution has achieved widespread acceptance.[34] Many scholars arguing for the *Y. pestis*
 as the major agent of the pandemic suggest that its extent and symptoms
 can be explained by a combination of bubonic plague with other
diseases, including typhus, smallpox
 and respiratory infections. In addition to the bubonic infection,
others point to additional septicemic (a type of "blood poisoning") and
pneumonic (an airborne plague that attacks the lungs before the rest of
the body) forms of the plague, which lengthen the duration of outbreaks
throughout the seasons and help account for its high mortality rate and
additional recorded symptoms.[26] In 2014, scientists with Public Health England
 announced the results of an examination of 25 bodies exhumed from the
Clerkenwell area of London, as well as of wills registered in London
during the period, which supported the pneumonic hypothesis.[42]

## Consequences:

### Death Toll:

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.[50] It killed some 75 to 200 million people in Eurasia.[1][2][3] According to medieval historian Philip Daileader in 2007:
A death rate as high as 60% in Europe has been suggested by Norwegian historian Ole Benedictow:

The most widely accepted estimate for the Middle East, including
Iraq, Iran and Syria, during this time, is for a death rate of about a
third.[53] The Black Death killed about 40% of Egypt's population.[54] Half of Paris's population of 100,000 people died. In Italy, the population of Florence was reduced from 110,000–120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished,[55] and a similar percentage of Londoners may have died from the disease as well.[42]
 While contemporary reports account of mass burial pits being created in
 response to the large numbers of dead, recent scientific investigations
 of a burial pit in Central London found well-preserved individuals to
be buried in isolated, evenly spaced graves, suggesting at least some
pre-planning and Christian burials at this time.[56] Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450.[57]
 In 1348, the plague spread so rapidly that before any physicians or
government authorities had time to reflect upon its origins, about a
third of the European population had already perished. In crowded
cities, it was not uncommon for as much as 50% of the population to die.[34]
 The disease bypassed some areas, and the most isolated areas were less
vulnerable to contagion. Monks and priests were especially hard-hit
since they cared for victims of the Black Death.[58]

### Persecutions:

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

Renewed religious fervour and fanaticism bloomed in the wake of the
Black Death. Some Europeans targeted "various groups such as Jews,
friars, foreigners, beggars, pilgrims",[59] lepers,[59][60] and Romani, thinking that they were to blame for the crisis. Lepers, and other individuals with skin diseases such as acne or psoriasis, were singled out and exterminated throughout Europe.
Because 14th-century healers were at a loss to explain the cause,
Europeans turned to astrological forces, earthquakes, and the poisoning
of wells by Jews as possible reasons for the plague's emergence.[61]
 The governments of Europe had no apparent response to the crisis
because no one knew its cause or how it spread. The mechanism of
infection and transmission of diseases was little understood in the 14th
 century; many people believed only God's anger could produce such
horrific displays.[*citation needed*]

There were many attacks against Jewish communities.[62] In February 1349, the citizens of Strasbourg murdered 2,000 Jews.[62] In August 1349, the Jewish communities in Mainz and Cologne were exterminated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed.[63]

### Recurrence:

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries.[64] According to Biraben, the plague was present somewhere in Europe in every year between 1346 and 1671.[65] The Second Pandemic
 was particularly widespread in the following years: 1360–1363; 1374;
1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531;
1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640;
1644–1654; and 1664–1667. Subsequent outbreaks, though severe, marked
the retreat from most of Europe (18th century) and northern Africa
(19th century).[66] According to Geoffrey Parker, "France alone lost almost a million people to the plague in the epidemic of 1628–31."[67]
In England, in the absence of census figures, historians propose a
range of preincident population figures from as high as 7 million to as
low as 4 million in 1300,[68] and a postincident population figure as low as 2 million.[69]
 By the end of 1350, the Black Death subsided, but it never really died
out in England. Over the next few hundred years, further outbreaks
occurred in 1361–1362, 1369, 1379–1383, 1389–1393, and throughout the
first half of the 15th century.[70]
 An outbreak in 1471 took as much as 10–15% of the population, while the
 death rate of the plague of 1479–1480 could have been as high as 20%.[71] The most general outbreaks in Tudor and Stuart England seem to have begun in 1498, 1535, 1543, 1563, 1589, 1603, 1625, and 1636, and ended with the Great Plague of London in 1665.[72]

In 1466, perhaps 40,000 people died of the plague in Paris.[73] During the 16th and 17th centuries, the plague was present in Paris around 30 per cent of the time.[74]
 The Black Death ravaged Europe for three years before it continued on
into Russia, where the disease was present somewhere in the country 25
times between 1350 and 1490.[75] Plague epidemics ravaged London in 1563, 1593, 1603, 1625, 1636, and 1665,[76] reducing its population by 10 to 30% during those years.[77] Over 10% of Amsterdam's population died in 1623–1625, and again in 1635–1636, 1655, and 1664.[78] Plague occurred in Venice 22 times between 1361 and 1528.[79] The plague of 1576–1577 killed 50,000 in Venice, almost a third of the population.[80] Late outbreaks in central Europe included the Italian Plague of 1629–1631, which is associated with troop movements during the Thirty Years' War, and the Great Plague of Vienna in 1679. Over 60% of Norway's population died in 1348–1350.[81] The last plague outbreak ravaged Oslo in 1654.[82]

In the first half of the 17th century, a plague claimed some 1.7 million victims in Italy, or about 14% of the population.[83] In 1656, the plague killed about half of Naples' 300,000 inhabitants.[84] More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain.[85] The plague of 1649 probably reduced the population of Seville by half.[86] In 1709–1713, a plague epidemic that followed the Great Northern War (1700–1721, Sweden v. Russia and allies)[87] killed about 100,000 in Sweden,[88] and 300,000 in Prussia.[86] The plague killed two-thirds of the inhabitants of Helsinki,[89] and claimed a third of Stockholm's population.[90] Europe's last major epidemic occurred in 1720 in Marseille.[81]

The Black Death ravaged much of the Islamic world.[91] Plague was present in at least one location in the Islamic world virtually every year between 1500 and 1850.[92] Plague repeatedly struck the cities of North Africa. Algiers lost 30 to 50 thousand inhabitants to it in 1620–1621, and again in 1654–1657, 1665, 1691, and 1740–1742.[93] 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.[94] Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population has been wiped out.[95]

### 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.[96]
 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*.[97]
The first North American plague epidemic was the San Francisco plague of 1900–1904, followed by another outbreak in 1907–1908.[98][99][100][101][102][103][104]
 From 1944 through 1993, 362 cases of human plague were reported in the
United States; approximately 90% occurred in four western states:
Arizona, California, Colorado, and New Mexico.[105]

Modern treatment methods include insecticides, the use of antibiotics, and a plague vaccine. The plague bacterium could develop drug resistance and again become a major health threat. One case of a drug-resistant form of the bacterium was found in Madagascar in 1995.[106] A further outbreak in Madagascar was reported in November 2014.[107]

## Names:

The 12th-century French physician Gilles de Corbeil's *On the Signs and Symptoms of Diseases* (Latin: *De signis et sinthomatibus egritudinum*) uses the phrase "black death" (*atra mors*) to refer to a pestilential fever (*febris pestilentialis*).[108]

Writers contemporary with the plague referred to the event as the "**Great Mortality**"[109] or the "**Great Plague**".[61][*clarification needed*]

The phrase "black death" (*mors nigra*)
 was used in 1350 by Simon de Covino or Couvin, a Belgian astronomer,
who wrote the poem "On the Judgment of the Sun at a Feast of Saturn" (*De judicio Solis in convivio Saturni*), which attributes the plague to a conjunction of Jupiter and Saturn.[110] In 1908, Gasquet claimed that use of the name *atra mors* for the 14th-century epidemic first appeared in a 1631 book on Danish history by J. I. Pontanus: "Commonly and from its effects, they called it the black death" (*Vulgo & ab effectu atram mortem vocatibant*).[111]
 The name spread through Scandinavia and then Germany, gradually
becoming attached to the mid 14th-century epidemic as a proper name.[112] In England, it was not until 1823, that the medieval epidemic was first called the Black Death.[113]

## See Also:

* *Black Death* (film)
* Black Death in England
* CCR5, a human gene hypothesised to be associated with the plague
* Crisis of the Late Middle Ages
* *Cronaca fiorentina* (*Chronicle of Florence*); a literary history of the plague, and of Florence up to 1386, by Baldassarre Bonaiuti
* Danse Macabre
* Death
* *Doomsday Book*, a science fiction novel written by Connie Willis
* Four thieves vinegar; a popular French legend saying this recipe provided immunity to the plague
* Geisslerlieder
* Globalisation and disease
* Last outbreak of bubonic plague in England (1906–1918)
* Plague doctor
* Plague doctor costume
* Ring a Ring o' Roses
* Timeline of plague
* *The Seventh Seal*, a film directed by Ingmar Bergman

## References

10. Ziegler 1998, p. 25.
13. The Cambridge History of China: Alien regimes and border states, 907–1368, p. 585.
17. Hecker 1859, p. 21 cited by Ziegler, p. 15.
19. Michael of Piazza (Platiensis) *Bibliotheca scriptorum qui res in Sicilia gestas retulere* Vol 1, p. 562, cited in Ziegler, 1998, p. 40.
20. De Smet, Vol II, *Breve Chronicon*, p. 15.
22. Zuchora-Walske, Christine, Poland, North Mankato: ABDO Publishing, 2013.
26. Byrne 2004, pp. 21–29
28. Ziegler 1998, pp. 18–19.
29. D. Herlihy, *The Black Death and the Transformation of the West* (Harvard University Press: Cambridge, Massachusetts, 1997), p. 29.
32. Horrox 1994, p. 159.
35. Gasquet 1893.
37. R. Totaro *Suffering in Paradise: The Bubonic Plague in English Literature from More to Milton* (Pittsburgh: Duquesne University Press, 2005), p. 26
38. Byrne 2004, p. 8.
39. see also
41. Schuenemann VJ, Bos

K, DeWitte S, Schmedes S, Jamieson J, Mittnik A, Forrest S, Coombes BK,
Wood JW, Earn DJD, White W, Krause J, Poinar H (2011): Targeted enrichment of ancient pathogens yielding the pPCP1 plasmid of Yersinia pestis from victims of the Black Death. PNAS 2011; published ahead of print 29 August 2011, doi:10.1073/pnas.1105107108

3. Ziegler 1998, p. 233.
7. .
8. .
10. Philip Daileader, *The Late Middle Ages*, audio/video course produced by The Teaching Company, (2007) ISBN 978-1-59803-345-8.
11. Ole J. Benedictow, "The Black Death: The Greatest Catastrophe Ever", *History TodayVolume 55 Issue 3 March 2005* (http://www.historytoday.com/ole-j-benedictow/black-death-greatest-catastrophe-ever). Cf. Benedictow, *The Black Death 1346–1353: The Complete History*, Boydell Press (7 Dec. 2012), pp. 380ff.
13. Egypt – Major Cities, *U.S. Library of Congress*
17. J. M. Bennett and C. W. Hollister, *Medieval Europe: A Short History* (New York: McGraw-Hill, 2006), p. 329.
18. David Nirenberg, *Communities of Violence*, 1998, ISBN 0-691-05889-X.
19. R.I. Moore *The Formation of a Persecuting Society*, Oxford, 1987 ISBN 0-631-17145-2.
20. J. M. Bennett and C. W. Hollister, *Medieval Europe: A Short History* (New York: McGraw-Hill, 2006), p. 326.
21. Black Death, Jewishencyclopedia.com
22. "Jewish History 1340–1349".
23. "*The Great Plague*". Stephen Porter (2009). Amberley Publishing. p. 25. ISBN 1-84868-087-2.
24. J. N. Hays (1998). "*The burdens of disease: epidemics and human response in western history.*". p. 58. ISBN 0-8135-2528-4.
25. "*Epidemics and pandemics: their impacts on human history*". J. N. Hays (2005). p. 46. ISBN 1-85109-658-2.
26. Geoffrey Parker (2001). "*Europe in crisis, 1598–1648*". Wiley-Blackwell. p. 7. ISBN 0-631-22028-3.
27. *The Black Death in Egypt and England: A Comparative Study*, Stuart J. Borsch, Austin: University of Texas
28. Secondary sources such as the *Cambridge History of Medieval England*

```
often contain discussions of methodology in reaching these figures that

```

 are necessary reading for anyone wishing to understand this
controversial episode in more detail.

4. Plague Archived 7 June 2013 at the Wayback Machine., 1911 Edition of the Encyclopædia Britannica
5. Vanessa Harding (2002). "*The dead and the living in Paris and London, 1500–1670.*". p. 25. ISBN 0-521-81126-0.
6. Byrne 2004, p. 62.
7. Vanessa Harding (2002). "*The dead and the living in Paris and London, 1500–1670.*". p. 24. ISBN 0-521-81126-0.
8. "Plague in London: spatial and temporal aspects of mortality", J. A. I. Champion, *Epidemic Disease in London*, *Centre for Metropolitan History Working Papers Series*, No. 1 (1993).
9. Geography, climate, population, economy, society. J.P. Sommerville.
10. "*Crisis and Change in the Venetian Economy in the Sixteenth and Seventeenth Centuries*". Brian Pullan. (2006). p. 151. ISBN 0-415-37700-5.
11. "*Medicine and society in early modern Europe*". Mary Lindemann (1999). Cambridge University Press. p. 41. ISBN 0-521-42354-6.
14. Karl Julius Beloch, *Bevölkerungsgeschichte Italiens*, volume 3, pp. 359–60.
16. The Seventeenth-Century Decline, S. G. Payne, *A History of Spain and Portugal*
17. "*Armies of pestilence: the effects of pandemics on history*". James Clarke & Co. (2004). p. 72. ISBN 0-227-17240-X
19. "*Bubonic plague in early modern Russia: public health and urban disaster*". John T. Alexander (2002). Oxford University Press US. p. 21. ISBN 0-19-515818-0.
21. "*Stockholm: A Cultural History*". Tony Griffiths (2009). Oxford University Press US. p. 9. ISBN 0-19-538638-8.
24. "*Christian Slaves, Muslim Masters: White Slavery in the Mediterranean, the Barbary Coast and Italy, 1500–1800*". Robert Davis (2004). ISBN 1-4039-4551-9.
26. "*The Fertile Crescent, 1800–1914: a documentary economic history*". Charles Philip Issawi (1988). Oxford University Press US. p. 99. ISBN 0-19-504951-9.
27. Infectious Diseases: Plague Through History, sciencemag.org
28. Bubonic Plague comes to Sydney in 1900, University of Sydney, Sydney Medical School
36. Human Plague – United States, 1993–1994, Centers for Disease Control and Prevention
37. Drug-resistant plague a 'major threat', say scientists, SciDev.Net.
39. See: Stephen d'Irsay (May 1926) "Notes to the origin of the expression: atra mors," *Isis*, **8** (2): 328–332.
40. As seen in John of Fordun's *Scotichronicon*, where he writes "there was a great pestilence and mortality of men".
	* On page 22 of the manuscript in Gallica, Simon mentions the phrase "*mors nigra*" (Black Death): "*Cum rex finisset oracula judiciorum / Mors nigra surrexit, et gentes reddidit illi*;" (When the king ended the oracles of judgment / Black Death arose, and the nations surrendered to him;).
	* A more legible copy of the poem appears in: Emile Littré (1841) "Opuscule relatif à la peste de 1348, composé par un contemporain" (Work concerning the plague of 1348, composed by a contemporary), *Bibliothèque de l'école des chartes*, **2** (2) : 201–243; see especially p. 228.
	* See also: Joseph Patrick Byrne, *The Black Death* (Westport, Connecticut: Greenwood Press, 2004), p. 1.
41. Francis Aidan Gasquet, *The Black Death of 1348 and 1349*, 2nd ed. (London, England: George Bell and Sons, 1908), p. 7. Johan Isaksson Pontanus, *Rerum Danicarum Historia* ... (Amsterdam (Netherlands): Johann Jansson, 1631), p. 476.
42. The German physician Justus Hecker (1795–1850) cited the phrase in Icelandic (*Svarti Dauði*), Danish (*den sorte Dod*), etc. See: J. F. C. Hecker, *Der schwarze Tod im vierzehnten Jahrhundert* [The Black Death in the Fourteenth Century] (Berlin, (Germany): Friedr. Aug. Herbig, 1832), page 3.
43. The name "Black Death" first appeared in English in:
	* "Mrs. Markham" (pen name of Elizabeth Penrose (née Cartwright)), *A History of England*

```
... (Edinburgh, Scotland: Archibald Constable, 1823). In the 1829

```

edition, the relevant text appeared on pages 249–250, where, about the
English king Edward III, she wrote: "Edward's successes in France were
interrupted during the next six years by a most terrible pestilence — so
 terrible as to be called the black death — which raged throughout
Europe, and proved a greater scourge to the people than even the
calamities of war." (For further information about this book and Mrs.
Penrose, see: Wikisource and the Oxford Dictionary of National Biography).

1. * See also: J. L. Bolton, "Looking for *Yersinia pestis*: Scientists, Historians and the Black Death" in: Linda Clark and Carole Rawcliffe, ed.s, *The Fifteenth Century XII: Society in an Age of Plague* (Woodbridge, England: Boydell Press, 2013), p. 15.

The name "Black Death" was spread more
widely when in 1833, Benjamin Guy Babington published an English
translation of J. F. C. Hecker's book *Der schwarze Tod im vierzehnten Jahrhundert* as: J. F. C. Hecker with Benjamin Guy Babington, trans., *The Black Death in the Fourteenth Century* (London, England: A. Schloss, 1833).

## Further reading

* Cantor, Norman F. (2001), *In the Wake of the Plague: The Black Death and the World It Made*, New York, Free Press.
* Cohn, Samuel K. Jr., (2002), *The Black Death Transformed: Disease and Culture in Early Renaissance Europe*, London: Arnold.
* Herlihy, D., (1997), *The Black Death and the Transformation of the West*, Cambridge, Massachusetts: Harvard University Press.
* Scott, S., and Duncan, C. J., (2001), *Biology of Plagues: Evidence from Historical Populations*, Cambridge: Cambridge University Press.
* Shrewsbury, J. F. D., (1970), *A History of Bubonic Plague in the British Isles*, London: Cambridge University Press.
* Twigg, G., (1984), *The Black Death: A Biological Reappraisal*, London: Batsford.
* 1st editions 1969.

## External links

* Black Death on *In Our Time* at the BBC.
* Black Death at BBC