The Black Death: The Greatest Catastrophe Ever | History Today The Black Death: The Greatest Catastrophe Ever Email Ole J. Benedictow describes how he calculated that the Black Death killed 50 million people in the 14th century, or 60 per cent of Europe’s entire population. The disastrous mortal disease known as the Black Death spread across Europe in the years 1346-53. The frightening name, however, only came several centuries after its visitation (and was probably a mistranslation of the Latin word ‘atra’ meaning both ‘terrible’ and ‘black)’. Chronicles and letters from the time describe the terror wrought by the illness. In Florence, the great Renaissance poet Petrarch was sure that they would not be believed: ‘O happy posterity, who will not experience such abysmal woe and will look upon our testimony as a fable.’ A Florentine chronicler relates that, All the citizens did little else except to carry dead bodies to be buried [...] At every church they dug deep pits down to the water-table; and thus those who were poor who died during the night were bundled up quickly and thrown into the pit.

In the morning when a large number of bodies were found in the pit, they took some earth and shovelled it down on top of them; and later others were placed on top of them and then another layer of earth, just as one makes lasagne with layers of pasta and cheese. The accounts are remarkably similar. The chronicler Agnolo di Tura ‘the Fat’ relates from his Tuscan home town that ... in many places in Siena great pits were dug and piled deep with the multitude of dead [...] And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. The tragedy was extraordinary. In the course of just a few months, 60 per cent of Florence’s population died from the plague, and probably the same proportion in Siena. In addition to the bald statistics, we come across profound personal tragedies: Petrarch lost to the Black Death his beloved Laura to whom he wrote his famous love poems; Di Tura tells us that ‘I [...] buried my five children with my own hands’.

The Black Death was an epidemic of bubonic plague, a disease caused by the bacterium Yersinia pestis that circulates among wild rodents where they live in great numbers and density. Such an area is called a ‘plague focus’ or a ‘plague reservoir’. Plague among humans arises when rodents in human habitation, normally black rats, become infected. The black rat, also called the ‘house rat’ and the ‘ship rat’, likes to live close to people, the very quality that makes it dangerous (in contrast, the brown or grey rat prefers to keep its distance in sewers and cellars). Normally, it takes ten to fourteen days before plague has killed off most of a contaminated rat colony, making it difficult for great numbers of fleas gathered on the remaining, but soon- dying, rats to find new hosts. After three days of fasting, hungry rat fleas turn on humans. From the bite site, the contagion drains to a lymph node that consequently swells to form a painful bubo, most often in the groin, on the thigh, in an armpit or on the neck. Hence the name bubonic plague.

The infection takes three–five days to incubate in people before they fall ill, and another three–five days before, in 80 per cent of the cases, the victims die. Thus, from the introduction of plague contagion among rats in a human community it takes, on average, twenty-three days before the first person dies. When, for instance, a stranger called Andrew Hogson died from plague on his arrival in Penrith in 1597, and the next plague case followed twenty-two days later, this corresponded to the first phase of the development of an epidemic of bubonic plague. And Hobson was, of course, not the only fugitive from a plague-stricken town or area arriving in various communities in the region with infective rat fleas in their clothing or luggage. This pattern of spread is called ‘spread by leaps’ or ‘metastatic spread’. Thus, plague soon broke out in other urban and rural centres, from where the disease spread into the villages and townships of the surrounding districts by a similar process of leaps. In order to become an epidemic the disease must be spread to other rat colonies in the locality and transmitted to inhabitants in the same way.

It took some time for people to recognize that a terrible epidemic was breaking out among them and for chroniclers to note this. The timescale varies: in the countryside it took about forty days for realisation to dawn; in most towns with a few thousand inhabitants, six to seven weeks; in the cities with over 10,000 inhabitants, about seven weeks, and in the few metropolises with over 100,000 inhabitants, as much as eight weeks. Plague bacteria can break out of the buboes and be carried by the blood stream to the lungs and cause a variant of plague that is spread by contaminated droplets from the cough of patients (pneumonic plague). However, contrary to what is sometimes believed, this form is not contracted easily, spreads normally only episodically or incidentally and constitutes therefore normally only a small fraction of plague cases. It now appears clear that human fleas and lice did not contribute to the spread, at least not significantly.

The bloodstream of humans is not invaded by plague bacteria from the buboes, or people die with so few bacteria in the blood that bloodsucking human parasites become insufficiently infected to become infective and spread the disease: the blood of plague-infected rats contains 500-1,000 times more bacteria per unit of measurement than the blood of plague-infected humans. Importantly, plague was spread considerable distances by rat fleas on ships. Infected ship rats would die, but their fleas would often survive and find new rat hosts wherever they landed. Unlike human fleas, rat fleas are adapted to riding with their hosts; they readily also infest clothing of people entering affected houses and ride with them to other houses or localities. This gives plague epidemics a peculiar rhythm and pace of development and a characteristic pattern of dissemination. The fact that plague is transmitted by rat fleas means plague is a disease of the warmer seasons, disappearing during the winter, or at least lose most of their powers of spread. The peculiar seasonal pattern of plague has been observed everywhere and is a systematic feature also of the spread of the Black Death.

In the plague history of Norway from the Black Death 1348-49 to the last outbreaks in 1654, comprising over thirty waves of plague, there was never a winter epidemic of plague. Plague is very different from airborne contagious diseases, which are spread directly between people by droplets: these thrive in cold weather. This conspicuous feature constitutes proof that the Black Death and plague in general is an insect-borne disease. Cambridge historian John Hatcher has noted that there is ‘a remarkable transformation in the seasonal pattern of mortality in England after 1348’: whilst before the Black Death the heaviest mortality was in the winter months, in the following century it was heaviest in the period from late July to late September. He points out that this strongly indicates that the ‘transformation was caused by the virulence of bubonic plague’. *** Another very characteristic feature of the Black Death and plague epidemics in general, both in the past and in the great outbreaks in the early twentieth century, reflects their basis in rats and rat fleas: much higher proportions of inhabitants contract plague and die from it in the countryside than in urban centres.

In the case of English plague history, this feature has been underlined by Oxford historian Paul Slack. When around 90 per cent of the population lived in the countryside, only a disease with this property combined with extreme lethal powers could cause the exceptional mortality of the Black Death and of many later plague epidemics. All diseases spread by cross-infection between humans, on the contrary, gain increasing powers of spread with increasing density of population and cause highest mortality rates in urban centres. Lastly it could be mentioned that scholars have succeeded in extracting genetic evidence of the causal agent of bubonic plague, the DNA-code of Yersinia pestis, from several plague burials in French cemeteries from the period 1348-1590. It used to be thought that the Black Death originated in China, but new research shows that it began in the spring of 1346 in the steppe region, where a plague reservoir stretches from the north-western shores of the Caspian Sea into southern Russia. People occasionally contract plague there even today.

Two contemporary chroniclers identify the estuary of the river Don where it flows into the Sea of Azov as the area of the original outbreak, but this could be mere hearsay, and it is possible that it started elsewhere, perhaps in the area of the estuary of the river Volga on the Caspian Sea. At the time, this area was under the rule of the Mongol khanate of the Golden Horde. Some decades earlier the Mongol khanate had converted to Islam and the presence of Christians, or trade with them, was no longer tolerated. As a result the Silk Road caravan routes between China and Europe were cut off. For the same reason the Black Death did not spread from the east through Russia towards western Europe, but stopped abruptly on the Mongol border with the Russian principalities. As a result, Russia which might have become the Black Death’s first European conquest, in fact was its last, and was invaded by the disease not from the east but from the west. The epidemic in fact began with an attack that the Mongols launched on the Italian merchants’ last trading station in the region, Kaffa (today Feodosiya) in the Crimea.

In the autumn of 1346, plague broke out among the besiegers and from them penetrated into the town. When spring arrived, the Italians fled on their ships. And the Black Death slipped unnoticed on board and sailed with them. *** The extent of the contagious power of the Black Death has been almost mystifying. The central explanation lies within characteristic features of medieval society in a dynamic phase of modernisation heralding the transformation from a medieval to early modern European society. Early industrial market-economic and capitalistic developments had advanced more than is often assumed, especially in northern Italy and Flanders. New, larger types of ship carried great quantities of goods over extensive trade networks that linked Venice and Genoa with Constantinople and the Crimea, Alexandria and Tunis, London and Bruges. In London and Bruges the Italian trading system was linked to the busy shipping lines of the German Hanseatic League in the Nordic countries and the Baltic area, with large broad-bellied ships called cogs. This system for long-distance trade was supplemented by a web of lively short and medium-distance trade that bound together populations all over the Old World.

The strong increase in population in Europe in the High Middle Ages (1050-1300) meant that the prevailing agricultural technology was inadequate for further expansion. To accommodate the growth, forests were cleared and mountain villages settled wherever it was possible for people to eke out a living. People had to opt for a more one-sided husbandry, particularly in animals, to create a surplus that could be traded for staples such as salt and iron, grain or flour. These settlements operated within a busy trading network running from coasts to mountain villages. And with tradesmen and goods, contagious diseases reached even the most remote and isolated hamlets. In this early phase of modernisation, Europe was also on the way to ‘the golden age of bacteria’, when there was a great increase in epidemic diseases caused by increases in population density and in trade and transport while knowledge of the nature of epidemics, and therefore the ability to organise efficient countermeasures to them, was still minimal. Most people believed plague and mass illness to be a punishment from God for their sins. They responded with religious penitential acts aimed at tempering the Lord’s wrath, or with passivity and fatalism: it was a sin to try to avoid God’s will.

Much new can be said on the Black Death’s patterns of territorial spread. Of particular importance was the sudden appearance of the plague over vast distances, due to its rapid transportation by ship. Ships travelled at an average speed of around 40km a day which today seems quite slow. However, this speed meant that the Black Death easily moved 600km in a fortnight by ship: spreading, in contemporary terms, with astonishing speed and unpredictability. By land, the average spread was much slower: up to 2km per day along the busiest highways or roads and about 0.6km per day along secondary lines of communication. As already noted, the pace of spread slowed strongly during the winter and stopped completely in mountain areas such as the Alps and the northerly parts of Europe. Yet, the Black Death often rapidly established two or more fronts and conquered countries by advancing from various quarters. Italian ships from Kaffa arrived in Constantinople in May 1347 with the Black Death on board. The epidemic broke loose in early July. In North Africa and the Middle East, it started around September 1st, having arrived in Alexandria with ship transport from Constantinople.

Its spread from Constantinople to European Mediterranean commercial hubs also started in the autumn of 1347. It reached Marseilles by about the second week of September, probably with a ship from the city. Then the Italian merchants appear to have left Constantinople several months later and arrived in their home towns of Genoa and Venice with plague on board, some time in November. On their way home, ships from Genoa also contaminated Florence’s seaport city of Pisa. The spread out of Pisa is characterized by a number of metastatic leaps. These great commercial cities also functioned as bridgeheads from where the disease conquered Europe. In Mediterranean Europe, Marseilles functioned as the first great centre of spread. The relatively rapid advance both northwards up the Rhône valley to Lyons and south-westwards along the coasts towards Spain – in chilly months with relatively little shipping activity – is striking. As early as March 1348, both Lyon’s and Spain’s Mediterranean coasts were under attack.

En route to Spain, the Black Death also struck out from the city of Narbonne north-westwards along the main road to the commercial centre of Bordeaux on the Atlantic coast, which by the end of March had become a critical new centre of spread. Around April 20th, a ship from Bordeaux must have arrived in La Coruña in northwestern Spain; a couple of weeks later another ship from there let loose the plague in Navarre in northeastern Spain. Thus, two northern plague fronts were opened less than two months after the disease had invaded southern Spain. Another plague ship sailed from Bordeaux, northwards to Rouen in Normandy where it arrived at the end of April. There, in June, a further plague front moved westwards towards Brittany, south-eastwards towards Paris and northwards in the direction of the Low Countries. Yet another ship bearing plague left Bordeaux a few weeks later and arrived around May 8th, in the southern English town of Melcombe Regis, part of present-day Weymouth in Dorset: the epidemic broke out shortly before June 24th.

The significance of ships in the rapid transmission of contagion is underscored by the fact that at the time the Black Death landed in Weymouth it was still in an early phase in Italy. From Weymouth, the Black Death spread not only inland, but also in new metastatic leaps by ships, which in some cases must have travelled earlier than the recognized outbreaks of the epidemic: Bristol was contaminated in June, as were the coastal towns of the Pale in Ireland; London was contaminated in early August since the epidemic outbreak drew comment at the end of September. Commercial seaport towns like Colchester and Harwich must have been contaminated at about the same time. From these the Black Death spread inland. It is now also clear that the whole of England was conquered in the course of 1349 because, in the late autumn of 1348, ship transport opened a northern front in England for the Black Death, apparently in Grimsby. *** The early arrival of the Black Death in England and the rapid spread to its southeastern regions shaped much of the pattern of spread in Northern Europe.

The plague must have arrived in Oslo in the autumn of 1348, and must have come with a ship from south-eastern England, which had lively commercial contacts with Norway. The outbreak of the Black Death in Norway took place before the disease had managed to penetrate southern Germany, again illustrating the great importance of transportation by ship and the relative slowness of spread by land. The outbreak in Oslo was soon stopped by the advent of winter weather, but it broke out again in the early spring. Soon it spread out of Oslo along the main roads inland and on both sides of the Oslofjord. Another independent introduction of contagion occurred in early July 1349 in the town of Bergen; it arrived in a ship from England, probably from King’s Lynn. The opening of the second plague front was the reason that all Norway could be conquered in the course of 1349. It disappeared completely with the advent of winter, the last victims died at the turn of the year. The early dissemination of the Black Death to Oslo, which prepared the ground for a full outbreak in early spring, had great significance for the pace and pattern of the Black Death’s further conquest of Northern Europe.

Again ship transport played a crucial role, this time primarily by Hanseatic ships fleeing homewards from their trading station in Oslo with goods acquired during the winter. On their way the seaport of Halmstad close to the Sound was apparently contaminated in early July. This was the starting point for the plague’s conquest of Denmark and Sweden, which was followed by several other independent introductions of plague contagion later; by the end of 1350 most of these territories had been ravaged. However, the voyage homewards to the Hanseatic cities on the Baltic Sea had started significantly earlier. The outbreak of the Black Death in the Prussian town of Elbing (today the Polish town of Elblag) on August 24th, 1349, was a new milestone in the history of the Black Death. A ship that left Oslo at the beginning of June would probably sail through the Sound around June 20th and reach Elbing in the second half of July, in time to unleash an epidemic outbreak around August 24th.

Other ships that returned at the end of the shipping season in the autumn from the trading stations in Oslo or Bergen, brought the Black Death to a number of other Hanseatic cities both on the Baltic Sea and the North Sea. The advent of winter stopped the outbreaks initially as had happened elsewhere, but contagion was spread with goods to commercial towns and cities deep into northern Germany. In the spring of 1350, a northern German plague front was formed that spread southwards and met the plague front which in the summer of 1349 had formed in southern Germany with importation of contagion from Austria and Switzerland. *** Napoleon did not succeed in conquering Russia. Hitler did not succeed. But the Black Death did. It entered the territory of the city state of Novgorod in the late autumn of 1351 and reached the town of Pskov just before the winter set in and temporarily suppressed the epidemic; thus the full outbreak did not start until the early spring of 1352. In Novgorod itself, the Black Death broke out in mid-August.

In 1353, Moscow was ravaged, and the disease also reached the border with the Golden Horde, this time from the west, where it petered out. Poland was invaded by epidemic forces coming both from Elbing and from the northern German plague front and, apparently, from the south by contagion coming across the border from Slovakia via Hungary. Iceland and Finland are the only regions that, we know with certainty, avoided the Black Death because they had tiny populations with minimal contact abroad. It seems unlikely that any other region was so lucky. How many people were affected? Knowledge of general mortality is crucial to all discussions of the social and historical impact of the plague. Studies of mortality among ordinary populations are far more useful, therefore, than studies of special social groups, whether monastic communities, parish priests or social elites. Because around 90 per cent of Europe’s population lived in the countryside, rural studies of mortality are much more important than urban ones. Researchers generally used to agree that the Black Death swept away 20-30 per cent of Europe’s population. However, up to 1960 there were only a few studies of mortality among ordinary people, so the basis for this assessment was weak.

From 1960, a great number of mortality studies from various parts of Europe were published. These have been collated and it is now clear that the earlier estimates of mortality need to be doubled. No suitable sources for the study of mortality have been found in the Muslim countries that were ravaged. The mortality data available reflects the special nature of medieval registrations of populations. In a couple of cases, the sources are real censuses recording all members of the population, including women and children. However, most of the sources are tax registers and manorial registers recording households in the form of the names of the householders. Some registers aimed at recording all households, also the poor and destitute classes who did not pay taxes or rents, but the majority recorded only householders who paid tax to the town or land rent to the lord of the manor. This means that they overwhelmingly registered the better-off adult men of the population, who for reasons of age, gender and economic status had lower mortality rates in plague epidemics than the general population. According to the extant complete registers of all households, the rent or tax-paying classes constituted about half the population both in the towns and in the countryside, the other half were too poor.

Registers that yield information on both halves of the populations indicate that mortality among the poor was 5-6 per cent higher. This means that in the majority of cases when registers only record the better-off half of the adult male population, mortality among the adult male population as a whole can be deduced by adding 2.5-3 per cent. Another fact to consider is that in households where the householder survived, other members often died. For various reasons women and children suffer higher incidence of mortality from plague than adult men. A couple of censuses produced by city states in Tuscany in order to establish the need for grain or salt are still extant. They show that the households were, on average, reduced in the countryside from 4.5 to 4 persons and in urban centres from 4 to 3.5 persons. All medieval sources that permit the study of the size and composition of households among the ordinary population produce similar data, from Italy in southern Europe to England in the west and Norway in northern Europe. This means that the mortality among the registered households as a whole was 11-12.5 per cent higher than among the registered householders.

Detailed study of the mortality data available points to two conspicuous features in relation to the mortality caused by the Black Death: namely the extreme level of mortality caused by the Black Death, and the remarkable similarity or consistency of the level of mortality, from Spain in southern Europe to England in north-western Europe. The data is sufficiently widespread and numerous to make it likely that the Black Death swept away around 60 per cent of Europe’s population. It is generally assumed that the size of Europe’s population at the time was around 80 million. This implies that that around 50 million people died in the Black Death. This is a truly mind-boggling statistic. It overshadows the horrors of the Second World War, and is twice the number murdered by Stalin’s regime in the Soviet Union. As a proportion of the population that lost their lives, the Black Death caused unrivalled mortality. This dramatic fall in Europe’s population became a lasting and characteristic feature of late medieval society, as subsequent plague epidemics swept away all tendencies of population growth. Inevitably it had an enormous impact on European society and greatly affected the dynamics of change and development from the medieval to Early Modern period.

A historical turning point, as well as a vast human tragedy, the Black Death of 1346-53 is unparalleled in human history. Ole J. Benedictow is Emeritus Professor of History at the Universtiy of Oslo, Norway. Further Reading: Black Death in Asia | Bubonic Plague Black Death in Asia | Bubonic Plague History of Central Asia Black Death in Asia | Bubonic Plague A horse pulls a wagon-load of dead bodies during the 1910-12 bubonic plague outbreak in Manchuria, China. Hulton Archives / Getty Images By Kallie Szczepanski Updated October 27, 2015. The Black Death , a medieval pandemic that was likely the bubonic plague, is generally associated with Europe. This is not surprising, since it killed an estimated 1/3 of the European population in the 14th century. However, the plague started in Asia - and it devastated many areas of that continent, as well. Unfortunately, the course of the pandemic in Asia is not as thoroughly documented as it is for Europe.

However, the Black Death does appear in records from across Asia in the 1330s and 1340s. The disease spread terror and destruction wherever it arose. Origins of the Black Death: Many scholars believe that the Black Death began in north-western China, while others cite south-western China or the steppes of Central Asia. We do know that in 1331, an outbreak erupted in the Yuan Empire ; it may have hastened the end of Mongol rule over China. In 1334, this disease killed 5 million people in Hebei Province - about 90% of the population. As of 1200, China had a total population of more than 120 million, but a 1393 census found only 65 million Chinese surviving. continue reading below our video 10 Facts About the Titanic That You Don't Know Some of that missing population was killed by famine and upheaval in the transition from Yuan to Ming rule, but many millions died of bubonic plague. From its origin at the eastern end of the Silk Road , the Black Death rode trade routes west.

At Central Asian caravanseries and Middle Eastern trade centers, it infected people all across Asia. What is Bubonic Plague: The bubonic plague is caused by the bacterium Yersinia pestis, which lives in the guts of fleas. The fleas are most commonly found on rodents - rats, marmots, prairie dogs, squirrels - but can also feed on humans. When an infected flea bit a human, it would transmit the yersinia bacterium into the person's bloodstream. After 4-6 days, the victim would develop swollen lymph nodes and a black cyst at the site of the bite. Next, purple bruise-like lumps, called buboes, would form all over the victim's skin. The disease also attacked the nervous system, causing delirium or stupor. Death would follow in a matter of days for 50-60% of sufferers. The Black Death Spreads across Asia: Ibn al-Wardi, a Syrian writer who would later die of the plague himself in 1348, recorded that the Black Death came out of "The land of Darkness" ( Central Asia ).

From there, it spread to China, India , the Caspian Sea and "land of the Uzbeks," and thence to Persia and the Mediterranean. The Egyptian scholar Al-Mazriqi noted that "more than three hundred tribes all perished without apparent reason in their summer and winter encampments, in the course of pasturing their flocks and during their seasonal migration." He claimed that all of Asia was depopulated, as far as the Korean Peninsula . (Orent, 106) The Black Death Strikes Persia: The Central Asian scourge struck Persia just a few years after it appeared in China - proof, if any is needed, that the Silk Road was a convenient route of transmission for the deadly bacterium. In 1335, the Il-Khan (Mongol) ruler of Persia and the Middle East, Abu Said, died of bubonic plague during a war with his northern cousins, the Golden Horde. This signaled the beginning of the end for Mongol rule in the region. An estimated 30% of Persia's people died of the plague in the mid-14th century.

The region's population was slow to recover, in part due to the political disruptions caused by the fall of Mongol rule and the later invasions of Timur (Tamerlane). Devastation at Issyk Kul: Archaeological excavations on the shores of Issyk Kul, a lake in what is now Kyrgyzstan , reveal that the Nestorian Christian trading community there was ravaged by bubonic plague in 1338-39. Issyk Kul was a major Silk Road depot, and has sometimes been cited as the origin point for the Black Death. It certainly is prime habitat for marmots, which are known to carry a virulent form of the plague. It seems more likely, however, that traders from further east brought diseased fleas with them to the shores of Issyk Kul. Whatever the case, this tiny settlement's death rate shot up from a 150-year average of about 4 people per year, to more than 100 dead in 1338-39.

The Plague in Western Central Asia: Although specific numbers and anecdotes are hard to come by, different chronicles note that Central Asian cities like Talas , in modern-day Kyrgyzstan; Sarai, the capital of the Golden Horde in Russia; and Samarkand, now in Uzbekistan , all suffered outbreaks of the Black Death. It is likely that each population center would have lost at least 40% of its citizens, with some areas reaching death tolls as high as 70%. The Mongols Spread Plague at Kaffa: In 1344, the Golden Horde decided to recapture the Crimean port city of Kaffa from the Genoese, Italian traders who had taken the town in the late 1200s. The Mongols under Jani Beg instituted a siege, which lasted until 1347, when reinforcements from further east brought the plague to the Mongol lines.

An Italian lawyer, Gabriele de Mussis, recorded what happened next: "The whole army was affected by a disease which overran the Tartars [Mongols] and killed thousands upon thousands every day." He goes on to charge that the Mongol leader "ordered corpses to be placed in catapults and lobbed into the city in hopes that the intolerable stench would kill everyone inside." This incident is often cited as the first instance of biological warfare in history. However, other contemporary chroniclers make no mention of the putative Black Death catapults. A French churchman, Gilles li Muisis, notes that a "calamitous disease befell the Tartar army, and the mortality was so great and widespread that scarcely one in twenty of them remained alive." However, he depicts the Mongol survivors as surprised when the Christians in Kaffa also came down with the disease. Regardless of how it played out in fact, the Golden Horde's siege of Kaffa certainly did drive refugees to flee on ships, bound for Genoa. These refugees likely were a primary source of the Black Death that went on to decimate Europe.

The Plague Reaches the Middle East: European observers were fascinated but not too worried when the Black Death struck the western rim of Central Asia and the Middle East. One recorded that "India was depopulated; Tartary, Mesopotamia , Syria , Armenia were covered with dead bodies; the Kurds fled in vain to the mountains." However, they would soon become participants rather than observers in the world's worst pandemic. In "The Travels of Ibn Battuta," the great traveler noted that as of 1345, "the number that died daily in Damascus [Syria] had been two thousand," but the people were able to defeat the plague through prayer. In 1349, the holy city of Mecca was hit by the plague, likely brought in by infected pilgrims on the hajj . The Moroccan historian Ibn Khaldun , whose parents died of the plague, wrote about the outbreak this way: "Civilization both in the East and the West was visited by a destructive plague which devastated nations and caused populations to vanish. It swallowed up many of the good things of civilization and wiped them out... Civilization decreased with the decrease of mankind.

Cities and buildings were laid waste, roads and way signs were obliterated, settlements and mansions became empty, dynasties and tribes grew weak. The entire inhabited world changed." More Recent Asian Plague Outbreaks: In 1855, the so-called "Third Pandemic" of bubonic plague broke out in Yunnan Province , China. Another outbreak, or a continuation of the Third Pandemic (depending upon which source you believe) sprang up in China in 1910. It went on to kill more than 10 million, many of them in Manchuria . A similar outbreak in British India left about 300,000 dead in 1896-98. This outbreak began in Bombay (Mumbai) and Pune, on the country's west coast. By 1921, it would claim some 15 million lives. With dense human populations and natural plague reservoirs (rats and marmots), Asia is always at risk of another round of bubonic plague. Fortunately, timely use of antibiotics can cure the disease today.

Legacy of the Plague in Asia: Perhaps the most significant impact that the Black Death had on Asia was that it contributed to the fall of the mighty Mongol Empire . After all, the pandemic started within the Mongol Empire, and devastated peoples from all four of the khanantes. The massive population loss and terror caused by the plague destabilized Mongolian governments from the Golden Horde in Russia to the Yuan Dynasty in China. The Mongol ruler of the Ilkhanate Empire in the Middle East died of the disease, along with six of his sons. Although the Pax Mongolica had allowed increased wealth and cultural exchange, through a reopening of the Silk Road , it also allowed this deadly contagion to spread rapidly westward from its origin in western China or eastern Central Asia. As a result, the world's second-largest empire ever crumbled and fell. Sources: Benedictow, Ole Jorgen. The Black Death, 1346-1353: The Complete History, Woodbridge, CT: Boydell Press, 2004. Marshall, Robert. Storm from the East: From Ghengis Khan to Khubilai Khan, Berkeley: University of California Press, 1993.

McNeill, William Hardy. Plagues and People, New York: Anchor Books, 1976. Orent, Wendy. Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease, New York: Simon & Schuster, 2004. Epidemics of the Past: Bubonic Plague Epidemics of the Past A pocket full of posies, Ashes … ashes, We all fall down. A familiar nursery rhyme that children have recited as a harmless play song for generations ironically refers to one of Europe's most devastating diseases. The bubonic plague, better known as the “The Black Death,” has existed for thousands of years. The first recorded case of the plague was in China in 224 B.C.E. But the most significant outbreak was in Europe in the mid-fourteenth century. Over a five-year period from 1347 to 1352, 25 million people died. One-third to one-half of the European population was wiped out!

The first symptoms of bubonic plague appeared within days after infection: fever, headache, and a general feeling of weakness, followed by aches in the upper leg and groin, a white tongue, rapid pulse, slurred speech, confusion, and fatigue. By the third day, a painful swelling of the lymph glands in the neck, armpits, and groin occurred, and these enlarged areas were called “buboes.” Bleeding under the skin followed, causing purplish blotches. Dark-ringed red spots on the skin from infected fleabites, or “ring around the rosy,” eventually turned black, producing putrid-smelling lesions. The victim's nervous system collapsed, causing extreme pain and bizarre neurological disorders. This was the inspiration for “Dance of Death” rituals. Fragile nasal capillaries led to excessive sneezing. By the fourth day, wild anxiety and terror overtook the sufferer. Finally, a sense of resignation registered as the skin blackened, giving rise to “The Black Death.” The simplistic words in the famous nursery rhyme capture the essence of plague's horror.

Infectious Knowledge The excessive sneezing of plague suffers led Pope Gregory VII to coin “God Bless You” as a holy response when someone sneezes. The rhyme also describes highly aromatic flowers and herbs, the “pocket full of posies,” that people carried with them and held near their faces to ward off the horrid odor associated with the plague. Many corpses were uncharacteristically cremated—the “ashes, ashes,”—and finally, death would come, and we would “all fall down.” Plague infects both people and rodents, with rodents helping to transmit it further within the population. Fleas feeding on infected rodents can transmit the disease to people as well. Once infected, people can infect others by coughing, sneezing, or close talking. The origin of “The Black Death” dates to an outbreak in China during the 1330s. During this period, China was an important trading nation, and international trade via the Silk Road helped create the world's first pandemic. Plague-infected rats on merchant ships spread the disease to western Asia and Europe.

In the fall of 1347, Italian merchant ships with crewmembers dying of plague docked in Sicily, and within days the disease spread to the city and the surrounding countryside. The disease killed people so quickly that the Italian novelist Giovanni Boccaccio, whose father and stepmother died of plague, wrote that “its victims ate lunch with their friends and dinner with their ancestors in paradise.” By August, the plague had spread as far north as England. Infectious Knowledge The English writer Daniel Defoe, the author of Robinson Crusoe, wrote graphically about the plague years 1664-1665. “It is scarce credible what dreadful cases happened in particular families every day.

People in the rage of the distemper, or in the torment of their swellings, which was indeed intolerable, running out of their own government, raving and distracted, and oftentimes laying violent hands upon themselves, throwing themselves out at their windows, shooting themselves, mothers murdering their own children in their lunacy, some dying of mere grief as a passion, some of mere fright and surprise without any infection at all, others frightened into idiotism and foolish distractions, some into despair and lunacy, others into melancholy madness.” For five years, the disease would disappear in winter, when fleas were dormant, and resume its killing spree each spring. The impact of the plague was enormous, as governments, trade, and commerce virtually ceased. Faith in religion decreased because many clergy died and prayer failed to prevent sickness and death. Because trade was difficult, the prices of goods were grossly inflated. A decimated work force required higher wages, leading to peasant revolts in England, France, Belgium, and Italy. The disease receded in 1353, but never really went away. Smaller outbreaks continued for centuries, affecting all of European society, rich and poor.

Two hundred years of recurring death immeasurably changed government, the arts, science, and religion. Plague epidemics ravaged London in 1563, 1593, 1603, 1625, 1636, and 1665, reducing its population by 10 to 30 percent during those years. The Italian plague of 1630 claimed between 35 and 69 percent of the population. The German plagues between 1709 and 1713 were equally devastating, and in 1720, plague reduced the population of Marseille by 40 percent. The bubonic plague is believed to have killed 137 million people during its 400-year reign of terror. Solving the Plague Mystery In 1894, two scientists, Alexandre Emile Jean Yersin and Shibasaburo Kitasato, seperately described organisms they found in the swollen lymph nodes, blood, lungs, liver, and spleen of dead plague patients. To confirm their findings, they used cultures taken from patient specimens to infect a variety of animals. All the animals died within days.

The same rod-shaped organisms found in the original specimens were also found in the animal organs. Life cycle of the Black Plague, as the bubonic plague is sometimes called. On the island of Formosa, residents considered handling dead rats a risk for developing plague. These observations led P. L. Simond in the late 1890s to suspect that fleas might play a role in the transmission of plague. He observed that people contracted plague only if they were in contact with recently dead rats. They were not affected if they touched rats that were dead for more than 24 hours. Simond showed that the rat-flea transmitted the disease. In a now classic experiment, a healthy rat separated from direct contact with a recently killed plague-infected rat, died of plague after the infected fleas jumped from the first rat to the second. Buboes: Signs of the Plague Unlike smallpox, the plague is still a threat in some parts of the world. Yersinia pestis, the bacterium that causes bubonic plague, is transmitted through rat-tainted fleabites in densely populated cities and in countries with poor hygiene, or in the open country from infected wild rodents.

The most common form of human plague is a swollen and painful lymph gland that forms buboes. Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and lives in a region with infected rodents, rabbits, or fleas. Infection of the lungs causes the pneumonic form of plague, resulting in a severe respiratory illness. This form of the disease can spread rapidly and is more highly fatal. A person usually becomes ill with bubonic plague two to six days after being infected. When left untreated, the plague-causing bacteria invade the bloodstream and kill 50 to 90 percent of people who get it. Antibiotic therapy effectively treats bubonic plague. Pneumonic plague is more difficult to treat, and even with antibiotics, victims can die from it. Pneumonic plague occurs when the infectious bacteria infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness, and a cough that produces blood or watery sputum. The pneumonia progresses over two to four days and, without early treatment, death ensues. Can I Catch the Plague? Bubonic plague is still prevalent in more than 20 countries.

In the United States, the last rat-borne epidemic occurred in Los Angeles in 1924-1925. Since then sporadic cases have occurred, mostly in western states. Sources of cases today are wild rodents, especially squirrels, prairie dogs, and other burrowing rodents. Plague is found in parts of Russia and China and regularly occurs in Madagascar. Severe outbreaks have occurred in recent years in Kenya, Tanzania, Zaire, Mozambique, and Botswana. Plague also has been reported in western and northern Africa. In South America, plague is found in parts of Bolivia, Peru, Ecuador, and Brazil. There is no plague in Australia, and Europe has not seen a case for more than 50 years. Why Is Yersinia So Successful? Potent Fact The genome sequence is the entire complement of DNA in the cells of an organism. Mapping the genome sequence of the bug that causes plague was valuable because it helped researchers to learn about its evolution. The large number of genetic changes in the organism over time explain its ability to succeed as a disease-causer over hundreds of years. Genome sequences are becoming available for more and more organisms. The human genome has been sequenced as well.

There are many useful pieces of information that will help us fight all kinds of infectious and genetic diseases that come from sequencing of genomes. A team of scientists recently mapped the entire genetic structure (or genome sequence) of Yersinia pestis, the plague-causing bacterium. The genome displays many irregularities due to genetic exchange with other microorganisms, and many of its genes appear to have been acquired from other bacteria and viruses. The evidence suggests that plague has undergone large-scale genetic change leading to rapid evolution, which makes it able to adapt to survive in many different environments. Plague Vaccine Plague vaccines have been used since the late nineteenth century, but their effectiveness is uncertain. Vaccination reduces the incidence and severity of disease resulting from the bite of infected fleas, but it isn't 100 percent effective. The plague vaccine is licensed for use in the United States and is available for adults at high risk—people who live in the western United States, people who will be in parts of the world where plague is still endemic, and people who are around rodents. Severe inflammatory reactions are common, and plague vaccine should not be given to anyone with a known hypersensitivity to beef protein, soya, casein, or phenol.

Finally, the vaccination routine is complex and requires frequent boosters to maintain its effectiveness. Excerpted from The Complete Idiot's Guide to Dangerous Diseases and Epidemics © 2002 by David Perlin, Ph.D., and Ann Cohen. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc. History | Plague | CDC History ShareCompartir A person wearing a hat, a mask suggestive of a bird beak, goggles or glasses, and a long gown. The clothing identifies the person as a "plague doctor" and is intended as protection. Descriptions indicate that the gown was made from heavy fabric or leather and was usually waxed. The beak contained pungent substances like herbs or perfumes, thought at the time to purify the air and helpful in relieving the stench. The person also carries a pointer or rod to keep patients at a distance. (Library of Medicine) Plague has a remarkable place in history and has had enormous effects on the development of modern civilization.

Some scholars have even suggested that the collapse of the Roman Empire may be linked to the spread of plague by Roman soldiers returning home from battle in the Persian Gulf in 165 AD. For centuries, plague represented disaster for people living in Asia, Africa and Europe and because the cause of plague was unknown, plague outbreaks contributed to massive panic in cities and countries where it appeared. Numerous references in art, literature and monuments attest to the horrors and devastation of past plague epidemics. We now know that plague is caused by a bacterium called Yersinia pestis that often infects small rodents (like rats, mice, and squirrels) and is usually transmitted to humans through the bite of an infected flea. In the past, black rats were the most commonly infected animals and hungry rat fleas would jump from their recently-dead rat hosts to humans, looking for a blood meal. Pneumonic plague, a particular form of plague infection, is instead transmitted through infected droplets in a sick person's cough. Three Major Plague Pandemics The Justinian Plague The first recorded pandemic, the Justinian Plague, was named after the 6th century Byzantine emperor Justinian I.

The Justinian Plague began in 541 AD and was followed by frequent outbreaks over the next two hundred years that eventually killed over 25 million people (Rosen, 2007) and affected much of the Mediterranean basin--virtually all of the known world at that time. "Black Death" or the Great Plague The second pandemic, widely known as the "Black Death" or the Great Plague, originated in China in 1334 and spread along the great trade routes to Constantinople and then to Europe, where it claimed an estimated 60% of the European population (Benedictow, 2008). Entire towns were wiped out. Some contemporary historians report that on occasion, there were not enough survivors remaining to bury the dead (Gross, 1995). Despite the vast devastation caused by this pandemic, however, massive labor shortages due to high mortality rates sped up the development of many economic, social, and technical modernizations (Benedictow, 2008). It has even been considered a factor in the emergence of the Renaissance in the late 14th century.

Modern Plague The third pandemic, the Modern Plague, began in China in the 1860s and appeared in Hong Kong by 1894. Over the next 20 years, it spread to port cities around the world by rats on steamships. The pandemic caused approximately 10 million deaths (Khan, 2004). During this last pandemic, scientists identified the causative agent as a bacterium and determined that plague is spread by infectious flea bites. Rat-associated plague was soon brought under control in most urban areas, but the infection easily spread to local populations of ground squirrels and other small mammals in the Americas, Africa, and Asia. These new species of carriers have allowed plague to become endemic in many rural areas, including the western U.S. However, as a bacterial disease, plague can be treated with antibiotics, and can be prevented from spreading by prompt identification, treatment and management of human cases. Applications of effective insecticides to control the flea vectors also provide assistance in controlling plague. Plague lab, San Francisco.

(Library of Medicine) Recent Outbreaks The most recent plague epidemics have been reported in India during the first half of the 20th century, and in Vietnam during wartime in the 1960s and 1970s. Plague is now commonly found in sub-Saharan Africa and Madagascar, areas which now account for over 95% of reported cases (Stenseth, 2008). Plague as a Weapon of War As a highly contagious disease with an extremely high mortality rate if left untreated, Yersinia pestis has been used as a weapon of biological warfare for centuries. Some warfare strategies have included catapulting corpses over city walls, dropping infected fleas from airplanes, and aerosolizing the bacteria during the Cold War (Stenseth, 2008). More recently, plague raised concern as an important national security threat because of its potential for use by terrorists. File Formats Help: 7 Worst Killer Plagues in history (worst diseases, epidemics in history) - ODDEE 7 Worst Killer Plagues in history 10/15/2007 1 Smallpox (430 BC?

- 1979): Killed more than 300 million people worldwide in the 20th century alone, and most of the native inhabitants of the Americas Smallpox (also known by the Latin names Variola or Variola vera) is a contagious disease unique to humans. Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 30–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors. Smallpox killed an estimated 60 million Europeans, including five reigning European monarchs, in the 18th century alone. Up to 30% of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors became blind.

As for the Americas, after the first contacts with Europeans and Africans, some believe that the death of 90 to 95 percent of the native population of the New World was caused by Old World diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. In Mexico, when the Aztecs rose up in rebellion against Cortés, outnumbered, the Spanish were forced to flee. In the fighting, a Spanish soldier carrying smallpox died. After the battle, the Aztecs contracted the virus from the invaders' bodies. When Cortes returned to the capital, smallpox had devastated the Aztec population. It killed most of the Aztec army, the emperor, and 25% of the overall population. Cortés then easily defeated the Aztecs and entered Tenochtitlán, where he found that smallpox had killed more Aztecs than had the cannons. Smallpox was responsible for an estimated 300–500 million deaths in the 20th century.

As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature. 2 Spanish Flu (1918 - 1919): Killed 50 to 100 million people worldwide in less than 2 years In 1918 and 1919, the Spanish Flu pandemic killed more people than Hitler, nuclear weapons and all the terrorists of history combined. (A pandemic is an epidemic that breaks out on a global scale.) Spanish influenza was a more severe version of your typical flu, with the usual sore throat, headaches and fever. However, in many patients, the disease quickly progressed to something much worse than the sniffles. Extreme chills and fatigue were often accompanied by fluid in the lungs. One doctor treating the infected described a grim scene: "The faces wear a bluish cast; a cough brings up the blood-stained sputum.

In the morning, the dead bodies are stacked about the morgue like cordwood." If the flu passed the stage of being a minor inconvenience, the patient was usually doomed. There is no cure for the influenza virus, even today. All doctors could do was try to make the patients comfortable, which was a good trick since their lungs filled with fluid and they were wracked with unbearable coughing. The "bluish cast" of victims' faces eventually turned brown or purple and their feet turned black. The lucky ones simply drowned in their own lungs. The unlucky ones developed bacterial pneumonia as an agonizing secondary infection. Since antibiotics hadn't been invented yet, this too was essentially untreatable. The pandemic came and went like a flash. Between the speed of the outbreak and military censorship of the news during World War I, hardly anyone in the United States knew that a quarter of the nation's population -- and a billion people worldwide -- had been infected with the deadly disease. More than half a million died in the U.S. alone; worldwide, more than 50 million.

3 Black Death (1340 - 1771): Killed 75 million people worldwide The Black Death, or The Black Plague, was one of the most deadly pandemics in human history. It began in South-western or Central Asia and spread to Europe by the late 1340s. The total number of deaths worldwide from the pandemic is estimated at 75 million people; there were an estimated 20 million deaths in Europe alone. The Black Death is estimated to have killed between a third and two-thirds of Europe's population. The three forms of plague brought an array of signs and symptoms to those infected. Bubonic plague refers to the painful lymph node swellings called buboes, mostly found around the base of the neck, and in the armpits and groin. The septicaemic plague is a form of blood poisoning, and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck and armpits, which oozed pus and bled. Victims underwent damage to the skin and underlying tissue, until they were covered in dark blotches.

Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land. The bubonic plague was the most commonly seen form during the Black Death, with a mortality rate of thirty to seventy-five percent and symptoms including fever of 38 - 41 °C (101-105 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Of those who contracted the bubonic plague, 4 out of 5 died within eight days. Pneumonic plague was the second most commonly seen form during the Black Death, with a mortality rate of ninety to ninety-five percent. The same disease is thought to have returned to Europe every generation with varying virulence and mortalities until the 1700s. During this period, more than 100 plague epidemics swept across Europe. On its return in 1603, the plague killed 38,000 Londoners.

Other notable 17th century outbreaks were the Italian Plague of 1629-1631, the Great Plague of Seville (1647-1652), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679). There is some controversy over the identity of the disease, but in its virulent form, after the Great Plague of Marseille in 1720–1722 and the 1771 plague in Moscow it seems to have disappeared from Europe in the 18th century. The fourteenth-century eruption of the Black Death had a drastic effect on Europe's population, irrevocably changing Europe's social structure. It was a serious blow to the Roman Catholic Church and resulted in widespread persecution of minorities such as Jews, foreigners, beggars and lepers. The uncertainty of daily survival created a general mood of morbidity influencing people to "live for the moment", as illustrated by Giovanni Boccaccio in The Decameron (1353).

4 Malaria (1600 - today): Kills about 2 million people per year Malaria causes about 400–900 million cases of fever and approximately one to three million deaths annually — this represents at least one death every 30 seconds. The vast majority of cases occur in children under the age of 5 years; pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change in which areas are at risk of this disease since 1992. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. Consequently, the majority of cases are undocumented. Malaria is one of the most common infectious diseases and an enormous public-health problem. It's parasites are transmitted by female Anopheles mosquitoes.

The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. The disease is caused by protozoan parasites of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. 5 AIDS (1981 - today): Killed 25 million people worldwide Acquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed approximately 3.1 million (between 2.8 and 3.6 million) lives in 2005 (an average of 8,500 per day), of which 570,000 were children.

UNAIDS and the WHO estimate that the total number of people living with the human immunodeficiency virus (HIV) has reached its highest level. There are an estimated 40.3 million (estimated range between 36.7 and 45.3 million) people now living with HIV. Moreover, almost 5 million people have been estimated to have been infected with HIV in 2005 alone. The pandemic is not homogeneous within regions with some countries more afflicted than others. Even at the country level there are wide variations in infection levels between different areas. The number of people living with HIV continues to rise in most parts of the world, despite strenuous prevention strategies. Sub-Saharan Africa remains by far the worst-affected region, with 23.8 million to 28.9 million people living with HIV at the end of 2005, 1 million more than in 2003. Sixty-four percent of all people living with HIV are in sub-Saharan Africa, as are more than 77% of all women living with HIV. South & South East Asia are second most affected with 15%.

The key facts surrounding this origin of AIDS are currently unknown, particularly where and when the pandemic began, though it is said that it originated from the apes in Africa. 6 Cholera (1817 - today): 8 pandemics; hundreds of thousands killed worldwide In the 19th century, Cholera became the world's first truly global disease in a series of epidemics that proved to be a watershed for the history of plumbing. Festering along the Ganges River in India for centuries, the disease broke out in Calcutta in 1817 with grand - scale results. When the festival was over, they carried cholera back to their homes in other parts of India. There is no reliable evidence of how many Indians perished during that epidemic, but the British army counted 10,000 fatalities among its imperial troops. Based on those numbers,, it's almost certain that at least hundreds of thousands of natives must have fallen victim across that vast land. Cholera sailed from port to port, the germ making headway in contaminated kegs of water or in the excrement of infected victims, and transmitted by travelers.

The world was getting smaller thanks to steam-powered trains and ships, but living conditions were slow to improve. By 1827 cholera had become the most feared disease of the century. The major cholera pandemics are generally listed as: First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and some would argue that we are in the Eighth: 1991 to the present. Each pandemic, save the last, was accompanied by many thousands of deaths. As recently as 1947, 20,500 of 30,000 people infected in Egypt died. Despite modern medicine, cholera remains an efficient killer. 7 Typhus (430 BC?

- today): Killed 3 million people between 1918 and 1922 alone, and most of Napoleon's soldiers on Russia Typhus is any one of several similar diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. The first description of typhus was probably given in 1083 at a convent near Salerno, Italy. Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history.

During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions. Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816-19, and again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849.

In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. During World War I typhus caused three million deaths in Russia and more in Poland and Romania. De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Following the development of a vaccine during World War II epidemics occur only in Eastern Europe, the Middle East and parts of Africa. From the Web

Question: What disease killed approximately 40% of Europe's population in 1346-1353?
Answer: Black Death