BLACK DEATH

In any textbook on infectious diseases the chapter on plague will describe three pandemics of bubonic plague.

The Three Pandemics

The first pandemic–the plague of Justinian–originated in Egypt, erupted in Constantinople in 541 C.E., spread to Ireland by 544, but did not touch England until 120 years later. The second pandemic originated in India, China, or the steppes of Russia. It touched the shores of Western Europe (Messina) in the autumn of 1347, then spread across the continent, striking places as remote as Greenland. The disease recurred periodically through the eighteenth century and possibly into the nineteenth century. Despite claims in some textbooks, the plague of Marseilles in 1720–1721 was not this pandemic's European finale. In 1743 an estimated 48,000 people perished from the plague in Messina, and in 1770–1771, over 100,000 people died in Moscow. The third pandemic began in the mid-nineteenth century, spread slowly through the Chinese province of Yunnan, and did not reach Hong Kong until 1894. From there, steamship commerce aided its transmission across much of the world. However, except for India and a few other subtropical regions, its spread was confined largely to the docks of Sydney, Lisbon, Hamburg, Glasgow, and San Francisco. Instead of millions of deaths as Europeans feared, the death counts in temperate zones rarely surpassed 100.

Were the Three Plagues the Same?

The reason for claiming an identity among these three waves of epidemic rests on the supposedly unmistakable signs of bubonic plague. For the first wave of plague no quantitative records such as burials or last wills and testaments survive, and few narrative sources describe even the signs or symptoms. Paul the Deacon's Historia Langobardorum, written around 790 and describing plague in rural northern Italy in the 560s, is the most explicit. It points to "swellings of the glands … in the manner of a nut or a date" in the groin "and in other rather delicate places followed by an unbearable fever." The Emperor Justinian was afflicted with a boil in the groin and survived. Abbess Aethelthryth in 680 was less lucky; she died from a large boil under her jaw–a strange site for modern plague.

Differences between Medieval and Modern Plague

Few other examples of individual cases of plague can be gleaned from these sources, but the epidemiological clues point to a disease that was not characteristic of the plague whose agent (Yersinia pestis) was discovered in 1894.

The "first pandemic" spread rapidly and caused high mortality, especially among those, such as monks and nuns, who lived under the same roof, suggesting a highly contagious person-to-person airborne disease. In 664 the plague took only 91 days to travel 385 kilometers (239 miles) as the crow flies from Dover to Lastingham, England. By contrast, as the microbiologist Robert Koch commented in 1900, modern bubonic plague is a rat disease in which humans occasionally participate. Because the rat does not travel far, the bubonic plague of the twentieth century moved overland at a rate of about 12 to 15 kilometers (7 to 9 miles) a year. Thus, modern plague, even with the advantage of railways and automobiles, would need 25 years to cover the distance traveled in 3 months by the early medieval plague. Further, no literary or archaeological evidence shows the existence of rats in Anglo-Saxon England and no source mentions any signs or symptoms of this plague in England or Ireland. Despite this lack of evidence, some historians remain convinced that this disease was the bubonic plague discovered at the end of the nineteenth century.

The narrative sources for the "second pandemic" set off by the Black Death of 1347–1352 explode in number and variety. In addition to hundreds of chronicles from abbeys, city-states, and principalities across Europe, the plague tract, written for the most part by university-trained doctors, became one of the earliest forms of "popular literature" by the early fifteenth century. Further, the survival of thousands of last wills and testaments, necrologies, burial records, manorial rolls, and lists of ecclesiastical vacancies allows quantitative analyses of this plague, including its cycles of mortality, its seasonality, and the characteristics of its victims: age, sex, occupation, class, and locality. In addition to these rich sources, citywide burials and "Bills of Mortality" spread from Tuscany to north of the Alps in the late fifteenth century and as early as the 1420s (in Florence) began to indicate causes of death. Yet despite this wealth of information, no evidence links these late medireview and early modern European plagues to any disease carried by rodents and from which rodents were the first to die.

The epidemiological evidence raises further suspicions. First, like the early medieval plague, the second pandemic was a fast mover, spreading in a day as far as modern plague travels in a year. Doctors and chroniclers marveled at the Black Death's lightning-fast transmission and contagion–a word frequently used by doctors and chroniclers, who claimed that the plague spread by breath, touch, and even sight. For later strikes they distinguished plague from other diseases by this epidemiological feature as much as by the bubo. To reconcile the differences between the late medieval and modern plagues, historians and scientists say that the Black Death's speed and contagion relied on its pneumonic form and claim that as with modern plague, once it became airborne, it became "highly contagious" and free from rodents.

However, these claims are mistaken, as Wu Tien Teh discovered with the Manchurian plagues of 1911 and 1922. First, this disease was primarily an infliction of a rodent, tarabagan, whose pelt became a highly-prized commodity in the early twentieth century. Secondly, even in tightly packed train cars Wu observed that the infected rarely passed the disease to fellow passengers. As a consequence the worst-known epidemic of pneumonic plague, that of Manchuria in 1911, infected and killed less than 0.3 percent of the population exposed to the disease as opposed to fatality rates that were as high as 40 percent from the Black Death.

Thirdly, the seasonality of the late medieval plagues does not resemble that of modern plague. Modern plague can be sustained only within a narrow temperature band (50 to 78°F) accompanied by high levels of relative humidity because of its dependence on fleas as its vector. By contrast, bouts of late medieval plague could occur at almost any time of year, including January, in places as inhospitable to modern plague as Norway. Further, in the warmer Mediterranean areas the Black Death and its recurrent strikes peaked consistently at the warmest and driest times of the year (June and July), the least likely time for modern plague to peak in light of the rat flea's fertility cycle in those areas.

Fourthly, modern plague has never attained the mortalities seen with major instances of the Black Death or even with those of many of its minor assaults. In the summer months of 1348 Florence may have lost as much as three-quarters of its population. From manorial records, villages in Cambridgeshire and around St.-Flour (Auvergne) lost 76 percent of their populations, and according to chroniclers, places such as Trapani on the western coast of Sicily were totally abandoned. Further, although later strikes of plague in the seventeenth century were not as widespread as the first wave of the Black Death, they could be equally devastating, as they were for Genoa and Naples in 1656–1657, when two-thirds of those populations were destroyed. By contrast, modern plague has never approximated such levels of human carnage–not even in India, where over 95 percent of the modern plague's casualties have occurred. The highest mortality for any city in any plague year was in Bombay City in 1903, when less than 3 percent of its population perished from plague.

Fifthly, the cycles and trends of the second and third pandemics have been entirely different. Because humans have no natural immunity to Yersiniapestis and cannot acquire immunity, plague cases and mortality in India increased for a decade or more and then jumped randomly from year to year before declining in the 1920s as a result of rats (not humans) acquiring immunity to the pathogen. Similar patterns occurred in Brazil, Thailand, Vietnam, and other subtropical regions later in the century, even after the introduction of DDT, antibiotics, and modern sanitary measures.

Moreover, the age structure of the victims of modern plague did not change over the twentieth century. As with the first strike on virgin-soil populations, those in the prime of life, between ages 20 and 40, are the plague's principal victims. By contrast, the Black Death over its first 100 years shows a remarkable adaptation between its pathogen and human hosts. By the fourth strike in the 1380s the disease was claiming as little as one-twentieth the toll taken in 1348, and as chroniclers across Europe describe and the rare burial records in Siena confirm, it had become largely a childhood disease.

Misleading Similarities

Why have historians and scientists been so certain that the two pandemics were the same? They point to Boccaccio and occasionally to a handful of chroniclers, insisting that their descriptions of swellings point to the unmistakable signs of Yersinia pestis. But first, as health workers in Asia are taught in the early twenty-first century, swellings in the lymph nodes are not unique to plague, hence cultures of the infected regions must be taken. Second, Boccaccio as well as other chroniclers and physicians, from Michele da Piazza in Messina (1347) to doctors of the plague of London (1665), went beyond the bubo to describe various sizes and colors of pustules, rashes, and carbuncles that covered the victims' bodies. Some, such as Geoffrey le Baker in England and Giovanni Morelli in Florence, pointed to these as the more deadly signs, far worse than buboes as large as hens' eggs in the lymph nodes. Moreover, buboes of the late medieval plagues were not confined to the lymph nodes but are described on shins, arms, the face, and under the breasts. By contrast, from over 3,000 clinical reports of plague from hospitals around Bombay City in 1896–1897, only 5 percent of the victims who developed the plague boils had more than one, and in not a single case did those or smaller spots spread over the victims' bodies. Moreover, with modern bubonic plague, from 60 to 75 percent of the plague boils form in the groin because fleas generally bite on or below the shins. However, not a single medieval source points to the groin as the buboes' principal site. Instead, from miracle cures found in saints' lives and doctors' reports, the late medieval boils' usual location was the neck, behind the ears, or on the throat.

Results of the Black Death

Historians have seen the Black Death as responsible for the insurrections of the late fourteenth century, the end of serfdom and feudalism, the rise of vernacular languages, the Reformation, and even modernity at large. Whether the plague can explain such broad and often time-lagged changes is open to debate. Often the immediate and longer-term consequences of the Black Death differed or were the opposite of one another, and its effects varied. For instance, immediately after the Black Death places such as Florence vigorously recouped many of their losses through quick rises in fertility and by drawing migrants from the hinterlands. Curiously this demographic pattern changed in the fifteenth century. Fertility fell perhaps because the disease, although now less lethal, killed greater proportions of those who could replenish population numbers–the young–and cities in northern and central Italy attracted fewer migrants from the countryside. In part this decline stemmed from improved conditions created for peasants by the population losses and the resultant rising demand for agricultural labor.

However, the economic and social consequences of the Black Death and depopulation were not the same across Europe, as worsening conditions for rural labor in Eastern Europe attest. Neither were the Black Death and its successive strikes as "universal" as contemporaries claimed. Plague may not have touched places such as Douai in Flanders until 1400, and population losses in Hainault, Holland, northern Germany, parts of Poland, and Finland were notably lower than they were in many other cities and regions across Europe. Historians have yet to analyze these diverging demographic histories forged by the late medieval plagues or analyze the effects they may have had on economic development and social transitions in the early modern period.

The psychological and cultural consequences of the plague were not uniform over time. In 1348 the clergy, merchants, and physicians evoked God's wrath, looked to the stars, and imagined bizarre happenings in distant lands to explain the Black Death. Except for frenzied acts of expiation–flagellant movements and the burning of Jews–Europeans saw no efficacy in human intervention and looked on doctors' cures as only quickening the pace of death.

However, as early as the second strike of plague in the 1360s, the explanations and immediate reactions to the plague's mass mortalities took an aboutface. Instead of referring to floods of frogs, worms that killed by their stench, and black snows that melted mountains, chroniclers and doctors explained the outbreak of new plagues by turning to the human sphere: wars, poverty, and overcrowding. Physicians recommended remedies and procedures they believed had cured them and their patients, and armed with the repeated experiences of plague, they claimed to have surpassed the ancients in the art of healing. No doubt, such success had less to do with their medicine than with their immune systems. Change from utter despondency over the first plague to a new culture of hope and hubris by the end of the fourteenth century rested on the particular character of the Black Death and its recurring bouts–the swiftness with which late medieval Europeans and the new bacillus (whatever it might have been) adapted to each other.

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