Infectious Diseases


The Black Death of 1347-50


The Black Death (more recently known as the Black Plague) was a devastating pandemic that first struck Europe in the mid-14th century (1347–1350). Starting in Asia, the Black Death reached Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in the Crimea), and killed twenty million Europeans in six years, a quarter (or one-third?) of the total population and up to a half in the worst-affected urban areas. A series of plague epidemics also occurred in large portions of Asia and the Middle East during the same period, which indicates this outbreak was actually a worldwide pandemic.

The 200 million victims constituted the largest death toll from any known epidemic of any disease. Many scientists and historians believe the Black Death was an incidence of bubonic plague. A strong presence of the more contagious pneumonic and septicemic varieties increased the pace of infection, spreading the disease deep into inland areas of the continents.

Plague continued to strike parts of Europe throughout the 1400s, 1500s, and 1600s with varying degrees of intensity and fatality. Researchers still do not agree on why large outbreaks of the infection have never returned to Europe. However, changes in hygiene habits and strong efforts toward public health and sanitation probably had a significant impact on the survival of the disease.

The same disease is thought to have returned to Europe every generation with varying degrees of intensity and fatality until the 1700s. Notable late outbreaks include the Italian Plague of 1629-1631, the Great Plague of London (1664–65), and the Great Plague of Vienna (1679). Researchers still do not agree on why large outbreaks of the infection have never returned to Europe. However, changes in hygiene habits and strong efforts toward public health and sanitation probably had a significant impact on the survival of the disease.

The initial 14th-century European event was called the "Great Mortality" by contemporary writers and, with later outbreaks, became known as the "Black Death" because of a striking symptom of the disease, called acral necrosis, in which sufferers' skin would blacken due to subdermal hemorrhages. Historical records attribute the Black Death to an outbreak of Bubonic plague, an epidemic of the bacterium Yersinia pestis spread by fleas with the help of animals like the black rat (Rattus rattus), although today's experts debate both the microbiological culprit and mode of transmission.

The result of the plague was not just a massive decline in population. It irrevocably changed Europe's social structure, was a disastrous blow to Europe's predominant organized religion, the Roman Catholic Church, caused widespread persecutions of minorities like Jews and lepers, and created a general mood of morbidity that influenced people to live for the moment, unsure of their daily survival.

Pattern of the Pandemic

The bubonic plague was endemic in populations of infected ground rodents in central Asia, and was a known cause of death among migrant and established populations in that region. However, it is not entirely clear where the 14th-century pandemic started. There is speculation that it originated somewhere around northern India, but the more popular theory places the first cases in the steppes of central Asia. From there, it was carried east and west by traders and Mongol armies along the Silk Road.

Whether or not this theory is accurate, it is clear that several preexisting conditions such as war, famine, and weather contributed to the severity of the Black Death. A devastating civil war in China between the established Chinese population and the Mongol houses raged between AD 1205 and AD 1353. This war disrupted farming and trading patterns, and led to episodes of widespread famine. A so-called "Little Ice Age" had begun at the end of the thirteenth century. The disastrous weather reached a peak in the first half of the fourteenth century with devastating results worldwide.

In the years 1315 to 1322 a catastrophic famine, known as the Great Famine, struck all of Northern Europe. Food shortages and skyrocketing prices were a fact of life for as much as a century before the plague. Wheat, oats, hay and consequently livestock were all in short supply and their scarcity resulted in hunger and malnutrition. The result was a mounting human vulnerability to disease due to weakened immunity. The European economy entered a vicious cycle in which hunger and small scale disease reduced the productivity of laborers, and so the grain output suffered, causing the grain prices to increase. The famine was self-perpetuating, devastating places like Flanders and Burgundy as much as the Black Death was to devastate all of Europe.

A typhoid epidemic was to be a predictor of the coming disaster. Many thousands died in populated urban centers, most significantly Ypres. In 1318 a pestilence of unknown origin, sometimes identified as anthrax, hit the animals of Europe. The disease targeted sheep and cattle, further reducing the food supply and income of the peasantry and putting another strain on the economy. The increasingly international nature of the European economies meant that the depression was felt across Europe. Due to pestilence, the failure of England's wool exports led to the destruction of the Flemish weaving industry. Unemployment bred crime and poverty.

Asian Outbreak

The central Asian scenario agrees with the first reports of outbreaks in China in the early 1330s. The plague struck the Chinese province of Hubei in 1334. During 1353–54, more widespread disaster occurred. Chinese accounts of this wave of the disease record a spread to eight distinct areas: Hubei, Jiangxi, Shanxi, Hunan, Guangdong, Guangxi, Henan and Suiyuan (a historical Chinese province that now forms part of Hubei and Nei Mongul provinces), throughout the Mongol/Chinese empires. Historian William McNeill noted that voluminous Chinese records on disease and social disruption survive from this period, but that modern scholarship in neither the East nor the West has dealt with these references.

It appears that movement by the Mongols and merchant caravans inadvertently brought the plague from central Asia to the Middle East and Europe. The plague was reported in the trading cities of Constantinople and Trebizond in 1347. In that same year the Genoese possession of Kaffa, a cathedral city and seaport on the Crimean peninsula in modern day Ukraine, came under siege by an army of Crimean Tatar warriors, backed by Venetian forces. Their objective was disruption of a trading empire Genoa had established in Kaffa. In 1347, a terrible sickness began to strike the besieging army. According to accounts, so many died that the survivors had little time to bury them and bodies were stacked like cords of firewood against the city walls. Although the Tatar/Venetian alliance broke off the siege, the disease had already spread to the city.

The Black Death Comes to Europe

Since China was one of the busiest of the world's trading nations, it was only a matter of time before the outbreak of plague in China spread to western Asia and Europe. In October of 1347, a fleet of Genoese trading ships fleeing Kaffa on the Black Sea, one of the key links in trade with China, reached Messina, Sicily. Many of those on board were either dead or infected with the plague. Within days the disease spread to the city and the surrounding countryside. An eyewitness tells what happened:

"Realizing what a deadly disaster had come to them, the people quickly drove the Italians from their city. But the disease remained, and soon death was everywhere. Fathers abandoned their sick sons. Lawyers refused to come and make out wills for the dying. Friars and nuns were left to care for the sick, and monasteries and convents were soon deserted, as they were stricken, too. Bodies were left in empty houses, and there was no one to give them a Christian burial."

It is presumed that the ships carried infected rats and/or fleas. Some ships were found grounded on shorelines, with no one aboard remaining alive. Looting of these lost ships also helped spread the disease. From there, the plague spread to Genoa and Venice by the turn of 1347-48.

The disease struck and killed people with terrible speed. The Italian writer Boccaccio said that its victims often "ate lunch with their friends and dinner with their ancestors in paradise."

Agnolo di Tura, of Siena, wrote in his Description of the Black Death (after 1347):

"The mortality in Siena began in May. It was a cruel and horrible thing... It seemed that almost everyone became stupefied seeing the pain. It is impossible for the human tongue to recount the awful truth. Indeed, one who did not see such horribleness can be called blessed. The victims died almost immediately. They would swell beneath the armpits and in the groin, and fall over while talking. Father abandoned child, wife husband, one brother another; for this illness seemed to strike through breath and sight. And so they died. None could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices. In many places in Siena great pits were dug and piled deep with the multitude of dead. And they died by the hundreds, both day and night, and all were thrown in those ditches and covered with earth. And as soon as those ditches were filled, more were dug. I, Agnolo di Tura... buried my five children with my own hands... And so many died that all believed it was the end of the world."

From Italy the disease spread northwest across Europe, striking France, Spain, Portugal, and Great Britain by June 1348, then turned and spread east through Germany and Scandinavia from 1348 to 1350, and finally to north-western Russia in 1351. The plague largely spared some parts of Europe, including the Kingdom of Poland and parts of Belgium and the Netherlands.

The Plague's Progress

The plague presented itself in three interrelated forms. The bubonic variant (the most common) derives its name from the swellings or buboes that appeared on a victim's neck, armpits or groin. These tumors could range in size from that of an egg to that of an apple. Although some survived the painful ordeal, the manifestation of these lesions usually signaled the victim had a life expectancy of up to a week. Infected fleas that attached themselves to rats and then to humans spread this bubonic type of the plague. A second variation - pneumonic plague - attacked the respiratory system and was spread by merely breathing the exhaled air of a victim. It was much more virulent than its bubonic cousin - life expectancy was measured in one or two days. Finally, the septicemic version of the disease attacked the blood system. (See Clinical Aspects of the Plague.)

Having no defense and no understanding of the cause of the pestilence, the men, women and children caught in its onslaught were bewildered, panicked, and finally devastated.

The Italian writer Giovanni Boccaccio lived through the plague as it ravaged the city of Florence in 1348. The experience inspired him to write The Decameron, a story of seven men and three women who escape the disease by fleeing to a villa outside the city. In his Introduction to the fictional portion of his book, Boccaccio gives a graphic description of the effects of the epidemic on his city:

"The symptoms were not the same as in the East, where a gush of blood from the nose was the plain sign of inevitable death; but it began both in men and women with certain swellings in the groin or under the armpit. They grew to the size of a small apple or an egg, more or less, and were vulgarly called tumours. In a short space of time these tumours spread from the two parts named all over the body. Soon after this the symptoms changed and black or purple spots appeared on the arms or thighs or any other part of the body, sometimes a few large ones, sometimes many little ones. These spots were a certain sign of death, just as the original tumour had been and still remained.

No doctor's advice, no medicine could overcome or alleviate this disease, An enormous number of ignorant men and women set up as doctors in addition to those who were trained. Either the disease was such that no treatment was possible or the doctors were so ignorant that they did not know what caused it, and consequently could not administer the proper remedy. In any case very few recovered; most people died within about three days of the appearance of the tumours described above, most of them without any fever or other symptoms.

The violence of this disease was such that the sick communicated it to the healthy who came near them, just as a fire catches anything dry or oily near it. And it even went further. To speak to or go near the sick brought infection and a common death to the living; and moreover, to touch the clothes or anything else the sick had touched or worn gave the disease to the person touching. "

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

Middle Eastern outbreak

The plague struck various countries in the Middle East during the pandemic, leading to serious depopulation and permanent change in both economic and social structures. The disease first entered the region from southern Russia. In AD 1347, Muslim leader Malik Asraf, of the Jalayird dynasty, returned with his troops to Baghdad from a military action in Tabriz (near modern Azerbaijan) where the plague was raging. This same military troop promptly placed the town of Hasan Buzurg, near Baghdad, under siege but had to abort when plague struck the army and spread to Baghdad itself.

By autumn 1347, the plague reached Alexandria in Egypt, probably through the port's trade with Constantinople and ports on the Black Sea. During 1348, the disease traveled eastward to Gaza, and north along the eastern coast to cities in Syria and Palestine, including Asqalan, Acre, Jerusalem, Sidon, Damascus, Homs, and Aleppo. In 1348–49, the disease reached Antioch. The city's residents fled to the north, most of them dying during the journey, but the infection had been spread to the people of Asia Minor.

Mecca became infected in 1349. The people of Mecca blamed the disease on non-believers entering the city, but it is more likely to have arrived with Muslim pilgrims from surrounding infected areas. During the same year, records show the city of Mawsil (Mosul) suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. In 1351, Yemen experienced an outbreak of the plague. This coincided with the return of King Mujahid of Yemen from imprisonment in Cairo. His party may have brought the disease with them from Egypt.


The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries, and finally disappeared suddenly after 1665-1666, with the last major outbreak, known as the Great Plague of London. According to the bubonic plague theory, one possible explanation for the disappearance of plague from Europe may be that the black rat (Rattus rattus) infection reservoir and its disease vector was subsequently displaced and succeeded by the bigger Norwegian, or brown, rat (Rattus norvegicus), which is not as prone to transmit the germ-bearing fleas to humans in large rat die-offs (see Appleby and Slack references below). The Great Fire of London in 1666, sometimes credited as helping end the plague outbreak, contributed to the ascendancy of brown rats in England. The Great Fire of London may have killed off any remaining plague bearing rats and fleas, which led to a decline in the plague.


Bubonic plague theory

Alternative explanations

Recent scientific and historical investigations have led researchers to doubt the long-held belief Black Death was an epidemic of bubonic plague. For example, in 2000, Gunnar Karlsson (Iceland's 1100 Years: The History of a Marginal Society) pointed out that the Black Death killed between half and two-thirds of the population of Iceland, although there were no rats in Iceland at this time. Rats were accidentally introduced in the 19th century, and have never spread beyond a small number of urban areas attached to seaports. In the 14th century there were no urban settlements in Iceland. Iceland was unaffected by the later plagues which are known to have been spread by rats.

In 1984, published The Black Death: A Biological Reappraisal, where he argued that the climate and ecology of Europe and particularly England made it nearly impossible for rats and fleas to have transmitted bubonic plague. Combining information on the biology of R. rattus, R. norvegicus, and the common fleas X. cheopis and P. irritans with modern studies of plague epidemiology, particularly in India, where the R. rattus is a native species and conditions are nearly ideal for plague to be spread, Twigg concludes that it would have been nearly impossible for Y. pestis to have been the causative agent of the beginning of the plague, let alone its explosive spread across all of Europe and England. Twigg also shows that the common theory of entirely pneumonic spread does not hold up. He proposes, based on a reexamination of the evidence and symptoms, that the Black Death may actually have been an epidemic of pulmonary anthrax caused by B. anthracis.

In 2001, epidemiologists Susan Scott and Christopher Duncan from Liverpool University proposed the theory that the Black Death might have been caused by an Ebola-like virus, not a bacterium. Their rationale was that this plague spread much faster and the incubation period was much longer than other confirmed Yersinia pestis plagues. A longer period of incubation will allow carriers of the infection to travel farther and infect more people than a shorter one. When the primary vector is humans, as opposed to birds, this is of great importance. Studies of English church records indicate an unusually long incubation period in excess of 30 days, which could account for the rapid spread, topping at 5 km/day. The plague also appeared in areas of Europe where rats were uncommon like Iceland. Epidemiological studies suggest the disease was transferred between humans (which happens rarely with Yersinia pestis), and some genes that determine immunity to Ebola-like viruses are much more widespread in Europe than in other parts of the world. Their research and findings are thoroughly documented in Return of the Black Death: The World's Greatest Serial Killer.

In a similar vein, historian Norman F. Cantor, in his 2001 book In the Wake of the Plague, suggests the Black Death might have been a combination of pandemics including a form of anthrax, a cattle murrain. He cites many forms of evidence including: reported disease symptoms not in keeping with the known effects of either bubonic or pneumonic plague, the discovery of anthrax spores in a plague pit in Scotland, and the fact that meat from infected cattle was known to have been sold in many rural English areas prior to the onset of the plague. see ISBN 0060014342


There is still a thriving majority of historians that support the bubonic plague as cause, and so counterarguments have been drawn in defense of the bubonic plague theory.

The uncharacteristically rapid spread of the plague could be due to low levels of immunity in that period's European population. Historical examples of pandemics of other diseases in populations without previous exposure, such as smallpox and tuberculosis amongst American Indians, show that the low levels of inherited adaptation to the disease cause the first epidemic to spread faster and to be far more virulent than later epidemics among the descendants of survivors. Also, the plague returned again and again and was regarded as the same disease through succeeding centuries into modern times when the Yersinia bacterium was identified.

In addition, it was previously argued that tooth pulp tissue from a 14th-century plague cemetery in Montpellier tested positive for Y. pestis DNA. However, such a finding was never confirmed in any other cemetery. In September 2003, a team of researchers from Oxford University tested 121 teeth from 66 skeletons found in 14th-century mass graves. The remains showed no genetic trace of Yersinia pestis, and the researchers suspect that the Montpellier study was flawed.



See also: Medieval demography.

Information about the death toll varies widely by area and from source to source. Approximately 25 million deaths occurred in Europe alone, with many others occurring in northern Africa, the Middle East and Asia.

Estimates of the demographic impact of plague in Asia are based on both population figures during this time and estimates of the disease's toll on population centers. The initial outbreak of plague in the Chinese province of Hubei in 1334 claimed up to 90 percent of the population, an estimated five million people. During 1353–54, outbreaks in eight distinct areas throughout the Mongol/Chinese empires may have caused the death of two-thirds of China's population, often yielding an estimate of 25 million deaths.

It is estimated that between one-third and one-half of the European population died from the outbreak between 1348 and 1350. As many as 25% of all villages were depopulated, mostly the smaller communities, as the few survivors fled to larger towns and cities. The Black Death hit the culture of towns and cities disproportionately hard; some rural areas, for example, Eastern Poland and Lithuania, were so isolated that the plague made little progress. Cities were the worst off because of the population densities and close living quarters making disease transmission easier.

The precise demographic impact of the disease in the Middle East is impossible to calculate. Mortality was particularly high in rural areas, including significant areas of Palestine and Syria. Many surviving rural people fled, leaving their fields and crops, and entire rural provinces are recorded as being totally depopulated. Surviving records in some cities reveal a devastating number of deaths. The 1348 outbreak in Gaza left an estimated 10,000 people dead, while Aleppo recorded a death rate of 500 a day during the same year. In Damascus, at the disease's peak in September and October 1348, a thousand deaths were recorded every day, with overall mortality estimated at between 25 and 38 percent. Syria lost a total of 400,000 people by the time the epidemic subsided in March 1349. In contrast to some higher mortality estimates in Asia and Europe, scholars believe the mortality rate in the Middle East was less than one-third of the total population, with higher rates in selected areas.

Socio-economic effects

The governments of Europe had no effective response to the crisis because no one knew its cause or how it spread. Most monarchs instituted measures that prohibited exports of foodstuffs, condemned black market speculators, set price controls on grain, and outlawed large-scale fishing. At best, they proved mostly unenforceable, and at worse they contributed to a continent-wide downward spiral. The hardest hit lands, like England, were unable to buy grain abroad, from France because of the prohibition, and from most of the rest of the grain producers because of crop failures from shortage of labor. Any grain that could be shipped was eventually taken by pirates or looters to be sold on the black market. Meanwhile, many of the largest countries, most notably England and Scotland, had been at war, using up much of their treasury and exacerbating inflation. In 1337, on the eve of the first wave of the Black Death, England and France went to war in what would become known as the Hundred Years' War. This, another of the crises of the fourteenth century, would deplete the treasuries, manpower, and infrastructure of both kingdoms throughout and beyond the worst of the plague. Malnutrition, poverty, disease and hunger, coupled with war, growing inflation and other economic concerns made Europe in the mid-fourteenth century ripe for tragedy.

The plague did more than just devastate the medieval population; it caused a substantial change in economy and society in all areas of the world. Economic historians like Fernand Braudel have concluded that Black Death began during a recession in the European economy that had been under way since the beginning of the century, and only served to worsen it. As a consequence, it greatly accelerated social and economic change during the 14th and 15th centuries. First, the church's power was weakened, and in some cases, the social roles it had played were replaced by secular ones. It also led to peasant uprisings in many parts of Europe, such as France (the Jacquerie rebellion), Italy (the Ciompi rebellion, which swept the city of Florence), and in England (the English Peasant Revolt).

The Black Death should have opened the way to increased peasant prosperity. Europe had been overpopulated before the plague, and a reduction of 30% to 50% of the population should have meant less competition for resources: more available land and food, and higher wages. However, for reasons that are still debated, population levels in fact continued to decline until around 1420 and did not begin to rise again until 1470, so the initial Black Death event on its own does not entirely provide a satisfactory explanation to this extended period of decline in prosperity. See Medieval demography for a more complete treatment of this issue and current theories on why improvements in living standards took longer to evolve. The great population loss brought economic changes based on increased social mobility, as depopulation further eroded the peasants' already weakened obligations to remain on their traditional holdings. In Western Europe, the sudden scarcity of cheap labor provided an incentive for landlords to compete for peasants with wages and freedoms, an innovation that, some argue, represents the roots of capitalism, and the resulting social upheaval caused the Renaissance and even Reformation. In many ways the Black Death was good for peasants, at least in Western Europe, because of the shortage of labor they were in more demand and had more power, and because of the reduced population, there was more fertile land available; however, the benefits would not be fully realized until 1470, nearly 120 years later, when overall population levels finally began to rise again.

In Eastern Europe, by contrast, renewed stringency of laws tied the remaining peasant population more tightly to the land than ever before through serfdom. Sparsely populated Eastern Europe was less affected by the Black Death and so peasant revolts were less common in the 14th and 15th centuries, not occurring in the east until the 16th through 19th centuries. Since it is believed to have in part caused the social upheavals of 14th- and 15th-century Western Europe, some see the Black Death as a factor in the Renaissance and even the Reformation in Western Europe. Therefore, historians have cited the smaller impact of the plague as a contributing factor in Eastern Europe's failure to experience either of these movements on a similar scale. Extrapolating from this, the Black Death may be seen as partly responsible for Eastern Europe's considerable lag in scientific and philosophical advances as well as in the move to liberalise government by restricting the power of the monarch and aristocracy. A common example is that England is seen to have effectively ended serfdom by 1550 while moving towards more representative government; meanwhile, Russia did not abolish serfdom until an autocratic tsar decreed so in 1861.

On top of all this, the plague's great population reduction brought cheaper land prices, more food for the average peasant, and a relatively large increase in per capita income among the peasantry, if not immediately, in the coming century. However, the upper class often attempted to stop these changes, initially in Western Europe, and more forcefully and successfully in Eastern Europe, by instituting laws which barred the peasantry from certain actions or material goods. A good example of this is the sumptuary laws which were passed throughout Europe which regulated what people (particularly of the peasant class) could wear, so that nobles could ensure that peasants did not begin to dress and act as a higher class member with their increased wealth. Another tactic was to fix prices and wages so that peasants could not demand more with increasing value. This was met with varying success depending on the amount of rebellion it inspired; such a law was one of the causes of England's 1381 Peasants' Revolt.


As with other natural and man-made social disasters, renewed religious fervor and fanaticism bloomed in the wake of Black Death. In many parts of Europe, rumors circulated that Jews caused the plague by deliberately poisoning wells. Fierce pogroms frequently resulted in the death or banishment of most of the Jews in a town or city. By 1351, 60 major and 150 smaller Jewish communities had been exterminated, and more than 350 separate massacres had occurred. This persecution was often done, not solely out of religious hatred, but as a way of attacking the Kings or Church who normally protected the Jews; indeed, Jews were often called the Kings property. It was a way of lashing out at the institutions who had failed them. Because fewer Jews died from the Black Death, in part due to rabbinical law which called for a lifestyle that was, in general, cleaner than that of a medieval villager, and Jewish ghettos which kept them more separate from the general population, inevitably Jews looked suspicious. This, coupled with the fact that the elite members of the Jewish community, such as rabbis and bankers, were participating in a mystical religion known as the Kabbalah, placed notable blame on Jews. An important legacy of the Black Death was to cause the eastward movement of what was left of north European Jewry to Poland and Russia, where it remained until the 20th century.

Lepers were also singled out and persecuted, indeed exterminated throughout Europe. Anyone with a skin disease such as acne or psoriasis was thought to be a leper, and leprosy was believed to be an outward sign of an inner defect of the soul. Both Jews and lepers were persecuted because they became scapegoats for the disasters of society.


Typical attire of the medical workers. The beak is a primitive gas mask, stuffed with substances (such as spices and herbs) thought to ward off the plague. "Doctor Schnabel von Rom" (English: "Doctor Beak of Rome") engraving by Paul Fürst (after J Columbina).

Doctors did what they could, but the plague seemed irresistible. Even the most expert physicians could do little more than help strengthen people's resolve and build morale.

Although the government had medical workers try to prevent the plague, the plague persisted. Most medical workers quit and journeyed away because they feared getting the plague themselves.

"When the government acts to prevent or control a calamity, but the calamity persists, people turn to cures. Many believed that the disease was transmitted upon the air, probably because the smell from the dead and dying was so awful. So, the living turned to scents to ward off the deadly vapors. People burned all manner of incense: juniper, laurel, pine, beech, lemon leaves, rosemary, camphor and sulfur. Others had handkerchiefs dipped in aromatic oils, to cover their faces when going out. Another remedy was the cure of sound. Towns rang church bells to drive the plague away, for the ringing of town bells was done in crises of all kinds. Other towns fired cannons, which was new and made a comfortingly loud ding. There were no ends to talismans, charms, and spells that could be purchased from the local wise woman or apothecary. Many people knew of someone's friend or cousin who had drank elderberry every day, or who had worn a jade necklace, and who had survived the dreaded disease." (Knox, pg. 10)

Others suggested special diets, courses of bleeding, new postures for sleeping and many other remedies. The very rich tried medicines made of gold and pearls. The terrible truth was that nothing worked. Flight was the best option, and if one could not fly, then all that remained was resignation and prayer.

The cure of sound was another remedy. Towns rang church bells to drive the plague away, for the ringing of town bells was done in crises of all kinds. Other towns fired cannons, which were new and which made comfortingly loud din.

And there was to end of talismans, charms and spells that could be purchased from the local wise woman or apothecary. People were desperate for a cure and would try anything, no matter how outlandish or strange.

There were methods that did work. "Cities were hardest hit and tried to take measures to control an epidemic no one understood. In Milan, to take one of the most successful examples, city officials immediately walled up houses found to have the plague, isolating the healthy in them along with the sick. Venice took sophisticated and stringent quarantine and health measures, including isolating all incoming ships on a separate island. But people died anyway, though fewer in Milan and Venice than in cities that took no such measures. Pope Clement VI, living at Avignon, sat between two large fires to breath pure air. The plague bacillus actually is destroyed by heat, so this was one of the few truly effective measures taken." (Knox pg. 9)

The science of alchemy was affected by the plague. As a specialty and method of treatment, it was considered the norm for most scientists and doctors prior and during the Black Death. However, after the plague had taken its toll, the practice of alchemy slowly began to wane. The citizenry began to realize that, in most cases, it did not affect the progress of the epidemic and that some of the potions and "cures" used by many doctors throughout Christendom and the Islamic world only helped to worsen the condition of the sick. Liquor (distilled alcohol), originally made by alchemists, was commonly applied as a remedy for the Black Death, and as a result the popularity and consumption of liquor in Europe rose dramatically after the plague.


  • (no longer online) - Dr. E. L. Skip Knox, Boise State University, 17 August 1995

See also: Miracle healing


The Black Death led to cynicism toward religious officials who could not keep their frequent promises of curing plague victims and banishing the disease. No one, the Church included, was able to cure or even explain the plague. In fact, most thought it spread somehow through air, calling it miasma. This increased doubting of the clergy. Pope Clement VI reigned during the plague years in Europe during a time when the papacy was based in Avignon, France. This period in papal history, known as the Babylonian Captivity to its detractors, was a concurrent cause of the people's lack of faith in the Catholic Church. The Avignon popes were seen as having subordinated themselves to the French monarchy, and their ineffectiveness regarding the Black Death only compounded the common man's disillusionment.

Flagellants practiced self-flogging to atone for sins. The movement became popular after general disillusionment with the church's reaction to the Black Death.

Extreme alienation with the church culminated in either support for different religious groups which grew tremendously during the opening years of the Black Death (angering church and political officials greatly), or to an increase in interest for more secular alternatives to problems facing European society and an increase of secular politicians.

One of the fanatic religious groups was a 13th and 14th century movement called the Flagellant Brahren. The flagellants believed that the plague was a punishment for human sin, and that by scourging themselves they could show mankind's repentance.

Flagellant groups spontaneoulsy arose across northern and central Europe in 1349, except in England. The German and Low Countries movement, the Brothers of the Cross, is particularly well documented. They travelled in parties of from 50 to 500 men, and were highly organized. Led by a layman - the master - they moved from town to town to perform their rituals.

They wore white robes [marked front and back with a red cross?] and marched across Germany in 33 5-day campaigns of penance, only stopping in any one place for no more than a day, 33 days referred for one day for each year of Jesus' earthly life. They established their camps in fields near towns and held their rituals twice a day. The ritual began with the reading of a letter, claimed to have been delivered by an angel and justifying the Flagellants' activities. Next the followers would fall to their knees and beat themselves with scourges studded with iron spikes, gesturing with their free hand to indicate their sin and striking themselves rhythmically to songs, known as Geisslerlieder, until blood flowed from their many wounds from the spikes that embedded themselves in the torn flesh. Sometimes the blood was soaked up in rags and treated as a holy relic.

Originally members were required to receive permission to join from their spouses and prove they could pay for their food. However, some towns begun to notice that sometimes flagellants brought the plague to towns where it had not yet surfaced. Therefore, later they were denied entry. They responded by increased physical penance.

Persecution of the Jews

In Switzerland, it was a common belief that the Jews were poisoning the waters supplies. In some towns, all the Jews were rounded up and burned to death. Those Jews who had been lucky  enough  to be spared by the plague, found their death.

The establishment focused their attacks on church corruption and their promotion of a wave of savage anti-Semitism, and their exhibitions were highly influential. Initially the Catholic Church tolerated the Flagellants and individual monks and priests joined in the early movements. By the 14th century the Church was less tolerant and the rapid spread of the movement was alarming for the masses worshipped the flagellands as living martyrs. Clement VI officially condemned them in a bull of October 20, 1349 and instructed Church leaders to suppress the Flagellants. This position was reinforced in 1372 by Gregory XI who associated the Flagellants with other heretical groups, notably the Beghards. They were accused of heresies including doubting the need for the sacraments, denying ordinary ecclesiastical jurisdiction, and claiming to work miracles. In Germany they claimed they could resurrect emperor Frederick II. [More on the flagellants.]

The Black Death also hit the monasteries very hard because of their close quarters and their kindness in helping the sick, so that there was a severe shortage of clergy after the epidemic cycle. This resulted in a mass influx of new clergy members, most of whom did not share the life-long convictions and experiences of the veterans they replaced. This resulted in abuses by the clergy in years afterwards and a further deterioration of the position of the Church in the eyes of the people.

Other social effects (music and art)

The tone of despair appears eventually in the art of the times, though not immediately. By the later 1300s, when many parts of Europe had been visited two or three times by the disease, there appears a strain of grisly morbidity that is still compelling.

The general mood was one of pessimism, and the art turned dark with representations of death. The Dies Irae was created in this period as was the popular poem La Danse Macabre and the instructive and popular Ars moriendi ("the art of dying"). See also The Decameron.

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

One striking example can be seen in tomb sculptures. A great lord was buried in a sarcophagus: the body was in a coffin, which in turn was in a larger stone casing that was usually decorated. The sides might be decorated with religious carvings, but the lid of the tomb often held the likeness of the one entombed.

Where previously these sculptures showed the lord in his armor with his sword and shield, or the lady in her best clothes, and both in full bloom of health, around 1400 we begin to see a disturbing change. The sculptures of some (only some -- this was never the dominant style) show half-decomposed bodies with parts of the skeleton clearly visible. The clothes draping the body were rags, and some showed worms and snails burrowing in the rotting flesh.

It was and is a ghastly sight. The knight's tomb is a reassuring denial of death; the face composed and well-featured, the accoutrements of busy life all about. But the cardinal's tomb tells the brutal truth: all flesh is grass. Normally, we prefer to close our eyes to this, but this sculptural style will not let us. It's disturbing to see, but equally disturbing is the thought that such grimness could find a place as an artistic style.

Black Death in Literature


The specter of the Black Death dominated art and literature thoughout the generation that experienced it. Much of the most useful manifestations of the Black Death in literature, to historians, comes from the accounts of its chroniclers, often the only real way to get a sense of the horror of living through a disaster on such a scale. A few were famous writers, philosophers and rulers, but most were quite ordinary people who happened to work in a job requiring literacy, a rare talent. For example, Agnolo di Tura the Fat, of Siena, records his experience:

Father abandoned child, wife husband, one brother another; for this illness seemed to strike through the breath and sight. And so they died. And none could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices … great pits were dug and piled deep with the multitude of dead. And they died by the hundreds both day and night... And as soon as those ditches were filled more were dug … And I, Agnolo di Tura, called the Fat, buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who wept for any death, for all awaited death. And so many died that all believed it was the end of the world. This situation continued [from May] until September.

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

Alas! our ships enter the port, but of a thousand sailors hardly ten are spared. We reach our homes; our kindred…come from all parts to visit us. Woe to us for we cast at them the darts of death! …Going back to their homes, they in turn soon infected their whole families, who in three days succumbed, and were buried in one common grave. Priests and doctors visiting…from their duties ill, and soon were…dead. O death! cruel, bitter, impious death! …Lamenting our misery, we feared to fly, yet we dared not remain.

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

Then the grievous plague came to the seacoasts from Southampton, and came to Bristol, and it was as if all the strength of the town had died, as if they had been hit with sudden death, for there were few who stayed in their beds more than three days, or two days, or even one half a day.

In addition to these personal accounts, many presentations of the Black Death have entered the general consciousness as great literature which discuss the Black Death, are generally recognized as some of the best works of their era. For example, the major works of -

  • Boccaccio, The Decameron - excerpts
  • Petrarca (Eng. Petrarch)
  • Geoffrey Chaucer, The Canterbury Tales - Le Duchesse
  • William Langland, Piers Plowman,
  • Marchione di Coppo Stefani, The Florentine Chronicle

Inspired by Black Death, Danse Macabre is an allegory on the universality of death and a common painting motive in late-medieval periods.
This image is the Dance of Death in the German printed edition, folio CCLXI recto from Hartman Schedel's Chronicle of the World (Nuremberg, 1493) thought to be created by Michael Wolgemut (b. 1434, Nürnberg, d. 1519, Nürnberg). There was also a Latin printed edition of the same year. It seems not to be by Hans Holbein the Younger, as often stated. He was not alive at the time of its publication in 1493.

La Danse Macabre, or the Dance of death, is an allegory on the universality of death, expressing the common wisdom of the time that no matter ones station in life, the dance of death united all. It consists of the personified Death leading a row of dancing figures from all walks of life to the grave—typically with an emperor, king, pope, monk, youngster, beautiful girl, all in skeleton-state. They were produced under the impact of the Black Death, reminding people of how fragile their lives were and how vain the glories of earthly life were. The earliest artistic example is from the frescoed cemetery of the Church of the Holy Innocents in Paris (1424). There are also works by Konrad Witz in Basel (1440), Bernt Notke in Lübeck (1463) and woodcuts by Hans Holbein the Younger (1538). Israil Bercovici claims that the Danse Macabre originated among Sephardic Jews in 14th century Spain (Bercovici, 1992, p. 27).


Because of its resounding recurrence throughout modern history, and its symbolism and connotation, the subject of or setting during the Black Death has also become commonplace in modern literature. The relatively new medium of film has given writers and producers an innovative venue to portray the plague with more realism than ever. The Swedish movie classic Det sjunde inseglet (The Seventh Seal) is a 1957, film directed by Ingmar Bergman, is most notable for the scene in which a medieval knight (played by Max von Sydow) plays chess with the personification of Death, with his life resting on the outcome of the game. The knight returns from the Crusades and finds that his home country is ravaged by Black Death. To his dismay, he discovers that Death (Bengt Ekerot) has come for him too. In order to buy time he challenges Death to a match of chess, which allows him to reach his home and be reunited with his wife. The film explores the purpose of life and loss of faith, as the protagonist questions God's existence. The final scene of The Seventh Seal depicts a kind of Danse Macabre.

The 1988 science fiction film The Navigator: A Mediaeval Odyssey portrayed a group of 14th century English villagers who dig a tunnel to 20th-century New Zealand, with the aid of a boy's vision, to escape the Black Death. Also, Connie Willis's Hugo award-winning science fiction novel Doomsday Book (1993, ISBN 0553351672) imagines a future in which historians do field work by traveling into the past as observers. The protagonist, a historian, is sent to the wrong year, arriving in England just as the Black Death is starting.

It has been alleged (since 1961) that the Black Death inspired one of the most enduring nursery rhymes in the English language and its counterparts, including Italian:

Ring around a rosie, a pocket full of posies,
Ashes, ashes, we all fall down.
Giro, giro tondo, casca il mondo,
Casca la terra, tutti giù per terra.

However, this explanation is a literary interpretation [1] without historical supporting evidence.


  • Note 1: See R.I. Moore, The Formation of a Persecuting Society, Oxford, 1987 ISBN 0631171452 and David Nirenberg, Communities of Violence, 1998, ISBN 069105889X -

Primary sources:

  • Giovanni Boccaccio (The Decameron) -
  • Petrarch -

Primary sources - accounts by:

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

Secondary sources:

  • Appleby, Andrew B. “The Disappearance of the Plague: A Continuing Puzzle.” Economic History Review 33, 2, 1980 161-173.
  • Deaux, George (1969). The Black Death 1347. New York: Weybright and Talley. ISBN 0241015146.
  • Derr, Mark. "New Theories Link Black Death to Ebola-Like Virus." The New York Times, Science Section, October 2, 2001.
  • Dols, Michael W. (1977). The Black Death in the Middle East. Princeton University Press, Princeton, New Jersey. ISBN 069103107X.
  • Gottfried, Robert S (1983). The Black Death. New York: The Free Press. ISBN 0029123704.
  • Herlihy, David (1997). The Black Death and the Transformation of the West. Cambridge: Harvard UP. ISBN 0674076133 , This text is a definitive short text on the Black Death.
  • Kelly, John (2005). The Great Mortality, An Intimate History of the Black Death, the Most Devastating Plague of All Time. HarperCollins Publisher Inc., New York, NY. ISBN 0060006927
  • Marks, Geoffrey (1971). The Medieval Plague: The Black Death of the Middle Ages. New York; Doubleday. ISBN 0385006306.
  • McNeill, William H. (1976). Plagues and People. New York: Anchor Books. ISBN 0385121229.
  • Scott, Susan and Duncan, Christopher. (2004). Return of the Black Death: The World's Greatest Serial Killer. West Sussex; John Wiley and Sons. ISBN 04700900006
  • Slack, Paul. “The Disappearance of the Plague: An Alternative View.” Economic History Review 34, 3. 1981 469-476.
  • Ziegler, Phillip (1969). Black Death. ISBN 0061315508

Secondary sources online:

  • The History Guide "Satan Triumphant: The Black Death" -
  • Symptoms, causes, pictures of bubonic plague -
  • BBC news story on controversy over Black Death origins -
  • Examination of "Ring around the Rosy"'s relationship to the plague -
  • Black Death Overview from BBC -
  • Plague and Public Health in Renaissance Europe (Primary source documents and analysis) -

Related events (see

  • Great Famine of 1315-1317
  • Great Plague
  • Hundred Years' War
  • Plague of Justinian
  • Popular revolt in late medieval Europe
  • Plague Riot
  • Third Pandemic
  • Abandoned village
  • Little Ice Age
  • Avignon papacy
  • Peasants' Revolt



See also:

  • Black Death and the Jews 1348-1349 CE -

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This page compliments of Marisa Ciceran

Created: Monday, September 26, 2005: Last Updated: Monday, November 11, 2013
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