Black Death

Origin The origin of the Black Death is disputed. [ 1 ] Genetic analysis suggests Yersinia pestis bacteria evolved approximately 7,000 years ago, at the beginning of the Neolithic , [ 2 ] with flea-mediated strains emerging around 3,800 years ago during the late Bronze Age . [ 3 ] The immediate territorial origins of the Black Death and its outbreak remain unclear, with some evidence pointing towards Central Asia , China, the Middle East , and Europe. [ 4 ] [ 5 ] The pandemic was reportedly first introduced to Europe during the siege of the Genoese trading port of Caffa in Crimea by the Golden Horde army of Jani Beg in 1347. From Crimea, it was most likely carried by fleas living on the black rats that travelled on Genoese ships, spreading through the Mediterranean Basin and reaching North Africa , West Asia , and the rest of Europe via Constantinople , Sicily , and the Italian Peninsula . [ 6 ] There is evidence that once it came ashore, the Black Death mainly spread from person-to-person as pneumonic plague , thus explaining the quick inland spread of the epidemic, which was faster than would be expected if the primary vector was rat fleas causing bubonic plague . [ 7 ] [ 8 ] [ 9 ] A 2026 study published in Nature identified the oldest known evidence of plague outbreaks in human remains, finding traces of Yersinia pestis DNA in the teeth of 18 ancient hunter-gatherers from four cemeteries near Lake Baikal in Siberia. Carbon dating revealed two outbreaks, with the earliest cases dating to approximately 5,500 years ago — some 200 years earlier than previously established. Researchers concluded the disease likely spread initially from marmots through contact with raw organs or infected hides, and also transmitted between people through respiratory means. Many victims were young children, with three young girls buried side by side among the dead. [ 10 ] Patient zero There has been a quest to find "patient zero", the earliest known victim(s) with evidence of the Black Death. [ 11 ] In 2022, in an article called " The source of the Black Death in fourteenth-century central Eurasia ", researchers pointed to the earliest victims of the plague found at two cemeteries in the Chüy Valley near Lake Issyk-Kul in modern Kyrgyzstan. [ 12 ] Here graves had tombstones with Syriac inscription, providing the name of the deceased, year of death and often the cause of death, showing a spike due to "pestilence" in 1338–1339. [ 13 ] The article reported DNA data to provide genetic evidence from the teeth of seven individuals from the two cemeteries at Kara-Djigach and Burana finding evidence of Yersinia pestis . This confirms that the Yersinia pestis strain found in Kyrgyzstan predates and was the direct ancestor of the Black Death strains that devastated Europe and the Middle East starting in 1346–1347. [ 14 ] ^ Cite error: The named reference lead origin was invoked but never defined (see the help page ). ^ Susat, Julian; et al. (29 June 2021). "A 5,000-year-old hunter-gatherer already plagued by Yersinia pestis" . Cell Reports . 35 (13) 109278. doi : 10.1016/j.celrep.2021.109278 . PMID   34192537 . ^ Spyrou, Maria A; et al. (2018). "Analysis of 3800-year-old Yersinia pestis genomes suggests Bronze Age origin for bubonic plague" . Nature Communications . 9 (1): 2234. Bibcode : 2018NatCo...9.2234S . doi : 10.1038/s41467-018-04550-9 . PMC   5993720 . PMID   29884871 . ^ Wade, Nicholas (31 October 2010). "Europe's Plagues Came from China, Study Finds" . The New York Times . Archived from the original on 4 November 2010 . Retrieved 24 February 2017 . ^ Sussman 2011 , p. 354. ^ "Black Death | Causes, Facts, and Consequences" . Encyclopædia Britannica . Archived from the original on 9 July 2019 . Retrieved 1 August 2019 . ^ Snowden 2019 , pp. 49–53. ^ "Plague" . www.who.int . Archived from the original on 30 April 2018 . Retrieved 23 July 2024 . ^ McCoy, Terrence (26 October 2021). "Everything you know about the Black Death is wrong" . Washington Post . ISSN   0190-8286 . Archived from the original on 27 August 2016 . Retrieved 23 July 2024 . ^ "Ancient teeth from Siberia rewrite the plague's timeline, dating back to over 5,500 years ago" . Associated Press via WTOP News. 17 June 2026 . Retrieved 22 June 2026 . ^ The Black Death: Patient Zero TV Documentary, Apple TV , 2025 ^ Spyrou, Maria A.; Musralina, Lyazzat; Gnecchi Ruscone, Guido A.; Kocher, Arthur; Borbone, Pier-Giorgio; Khartanovich, Valeri I.; Buzhilova, Alexandra; Djansugurova, Leyla; Bos, Kirsten I.; Kühnert, Denise; Haak, Wolfgang (15 June 2022). "The source of the Black Death in fourteenth-century central Eurasia" . Nature . 606 (7915): 718– 724. Bibcode : 2022Natur.606..718S . doi : 10.1038/s41586-022-04800-3 . ISSN   1476-4687 . PMC   9217749 . PMID   35705810 . S2CID   249709693 . ^ "Origins of the Black Death identified" . Mpg.de . Retrieved 3 May 2026 . ^ "Mystery of Black Death's origins solved, say researchers" . The Guardian . 15 June 2022. Archived from the original on 15 June 2022 . Retrieved 15 June 2022 .

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14th-century plague Causes Early theory Main article: Theories of the Black Death A report by the Medical Faculty of Paris stated that a conjunction of planets had caused "a great pestilence in the air" ( miasma theory ). [ 1 ] Some Muslim doctors cautioned against trying to prevent or treat a disease sent by God. Others adopted preventive measures and treatments for plague used by Europeans. These Muslim doctors also depended on the writings of the ancient Greeks. [ 2 ] [ 3 ] Predominant modern theory Due to climate change in Asia , rodents began to flee the dried-out grasslands to more populated areas, spreading the disease. [ 4 ] The plague disease, caused by the bacterium Yersinia pestis , is enzootic (commonly present) in populations of fleas carried by ground rodents , including marmots , in various areas, including Central Asia , Kurdistan , West Asia , North India , Uganda , and the western United States. [ 5 ] [ 6 ] Y. pestis was discovered by Alexandre Yersin , a pupil of Louis Pasteur , during an epidemic of bubonic plague in Hong Kong in 1894; Yersin also proved this bacterium was present in rodents and suggested the rat was the main vehicle of transmission. [ 7 ] [ 8 ] The mechanism by which Y. pestis is usually transmitted was established in 1898 by Paul-Louis Simond and was found to involve the bites of fleas whose midguts had become obstructed by replicating Y. pestis several days after feeding on an infected host. [ 9 ] This blockage starves the fleas, drives them to aggressive feeding behaviour, and causes them to try to clear the blockage via regurgitation , resulting in thousands of plague bacteria flushing into the feeding site and infecting the host. The bubonic plague mechanism was also dependent on two populations of rodents: one resistant to the disease, which act as hosts , keeping the disease endemic , and a second that lacks resistance. When the second population dies, the fleas move on to other hosts, including people, thus creating a human epidemic . [ 10 ] DNA evidence Skeletons in a mass grave from 1720 to 1721 in Martigues , near Marseille in southern France, yielded molecular evidence of the orientalis strain of Yersinia pestis , the organism responsible for bubonic plague. The second pandemic of bubonic plague was active in Europe from 1347, the beginning of the Black Death, until 1750. Definitive confirmation of the role of Y. pestis arrived in 2010 with a publication in PLOS Pathogens by Haensch et al. [ 11 ] [ a ] They assessed the presence of DNA / RNA with polymerase chain reaction (PCR) techniques for Y. pestis from the tooth sockets in human skeletons from mass graves in northern, central and southern Europe that were associated archaeologically with the Black Death and subsequent resurgences. The authors concluded that this new research, together with prior analyses from the south of France and Germany, "ends the debate about the cause of the Black Death, and unambiguously demonstrates that Y. pestis was the causative agent of the epidemic plague that devastated Europe during the Middle Ages". [ 11 ] In 2011 these results were further confirmed with genetic evidence derived from Black Death victims in the East Smithfield burial site in England. Schuenemann et al. concluded in 2011 "that the Black Death in medieval Europe was caused by a variant of Y. pestis that may no longer exist". [ 14 ] Later in 2011, Bos et al. reported in Nature the first draft genome of Y. pestis from plague victims from the same East Smithfield cemetery and indicated that the strain that caused the Black Death is ancestral to most modern strains of Y. pestis . [ 14 ] Later genomic papers have further confirmed the phylogenetic placement of the Y. pestis strain responsible for the Black Death as both the ancestor [ 15 ] of later plague epidemics—including the third plague pandemic —and the descendant [ 16 ] of the strain responsible for the Plague of Justinian . In addition, plague genomes from prehistory have been recovered. [ 17 ] DNA taken from 25 skeletons from 14th-century London showed that plague is a strain of Y. pestis almost identical to that which hit Madagascar in 2013 . [ 18 ] [ 19 ] Further DNA evidence also proves the role of Y. pestis and traces the source to the Tian Shan mountains in Kyrgyzstan . [ 20 ] Alternative explanations Researchers are hampered by a lack of reliable statistics from this period. Most work has been done on the spread of the disease in England, where estimates of overall population at the start of the plague vary by over 100%, as no census was undertaken in England between the time of publication of the Domesday Book of 1086 and the poll tax of the year 1377. [ 21 ] Estimates of plague victims are usually extrapolated from figures for the clergy. Mathematical modelling is used to match the spreading patterns and the means of transmission . In 2018 researchers suggested an alternative model in which "the disease was spread from human fleas and body lice to other people". The second model claims to better fit the trends of the plague's death toll, as the rat-flea-human hypothesis would have produced a delayed but very high spike in deaths, contradicting historical death data. [ 22 ] [ 23 ] The Oriental rat flea has poor survival in cooler climates and reevaluation suggests the human flea was the principal vector of plague epidemics in Northern Europe. [ 24 ] Lars Walløe argued that these authors "take it for granted that Simond's infection model, black rat → rat flea → human, which was developed to explain the spread of plague in India, is the only way an epidemic of Yersinia pestis infection could spread". [ 25 ] Similarly, Monica Green has argued that greater attention is needed to the range of (especially non- commensal ) animals that might be involved in the transmission of plague. [ 26 ] Archaeologist Barney Sloane has argued that there is insufficient evidence of the extinction of numerous rats in the archaeological record of the medieval waterfront in London, and that the disease spread too quickly to support the thesis that Y. pestis was spread from fleas on rats; he argues that transmission must have been person to person. [ 27 ] [ 28 ] This theory is supported by research in 2018 which suggested transmission was more likely by body lice and fleas during the second plague pandemic . [ 29 ] Summary Academic debate continues, but no single alternative explanation for the plague's spread has achieved widespread acceptance. [ 10 ] Many scholars arguing for Y. pestis as the major agent of the pandemic suggest that its extent and symptoms can be explained by a combination of bubonic plague with other diseases, including typhus , smallpox , and respiratory infections . In addition to the bubonic infection, others point to additional septicemic and pneumonic forms of plague, which lengthen the duration of outbreaks throughout the seasons and help account for its high mortality rate and additional recorded symptoms. [ 30 ] In 2014, Public Health England announced the results of an examination of 25 bodies exhumed in the Clerkenwell area of London, as well as of wills registered in London during the period, which supported the pneumonic hypothesis. [ 18 ] Currently, while osteoarcheologists have conclusively verified the presence of Y. pestis bacteria in burial sites across northern Europe through examination of bones and dental pulp , no other epidemic pathogen has been discovered to bolster the alternative explanations. [ 31 ] Transmission Main article: Black Death migration Territorial origins According to a team of medical geneticists led by Mark Achtman , Yersinia pestis "evolved in or near China" over 2,600 years ago. [ 32 ] [ 33 ] [ 34 ] Later research by a team led by Galina Eroshenko placed its origins more specifically in the Tian Shan mountains on the border between Kyrgyzstan and China. [ 35 ] [ 36 ] However more recent research notes that the previous sampling contained East Asian bias and that sampling since then has discovered strains of Y. pestis in the Caucasus region previously thought to be restricted to China. [ 37 ] There is also no physical or specific textual evidence of the Black Death in 14th century China. As a result, China's place in the sequence of the plague's spread is still debated to this day. [ 38 ] According to Charles Creighton, records of epidemics in 14th-century China suggest nothing more than typhus and major Chinese outbreaks of epidemic disease post-date the European epidemic by several years. [ 39 ] The earliest Chinese descriptions of the bubonic plague do not appear until the 1640s. [ 40 ] Nestorian gravesites dating from 1338 to 1339 near Issyk-Kul have inscriptions referring to plague, which has led some historians and epidemiologists to think they mark the outbreak of the epidemic ; this is supported by recent direct findings of Y. pestis DNA in teeth samples from graves in the area with inscriptions referring to "pestilence" as the cause of death. [ 41 ] Epidemics killed an estimated 25 million across Asia during the fifteen years before the Black Death reached Constantinople in 1347. [ 42 ] [ 43 ] The evidence does not suggest, at least at present, that these mortality crises were caused by plague. Although some scholars, including McNeill and Cao, see the 1333 outbreak as a prelude to the outbreaks in Europe from the late 1340s to the early 1350s, scholars of the Yuan and Ming periods remain skeptical about such an interpretation. Nonetheless, the remarkably high mortality rates during the Datong mortality should discourage us from rejecting the possibility of localized/regional outbreaks of plague in different parts of China, albeit differing in scale from, and unrelated to, the pandemic mortality of the Black Death. What we lack is any indication of a plague pandemic that engulfed vast territories of the Yuan Empire and later moved into western Eurasia through Central Asia. [ 36 ] — Philip Slavin According to John Norris, evidence from Issyk-Kul indicates a small sporadic outbreak characteristic of transmission from rodents to humans with no wide-scale effect. [ 40 ] According to Achtman, the dating of the plague suggests that it was not carried along the Silk Road , and its widespread appearance in that region probably postdates the European outbreak. [ 38 ] Additionally, the Silk Road had already been heavily disrupted before the spread of the Black Death; Western and Middle Eastern traders found it difficult to trade on the Silk Road by 1325 and impossible by 1340, making its role in the spread of plague less likely. [ 40 ] There are no records of the symptoms of the Black Death from Mongol sources or writings from travelers east of the Black Sea prior to the Crimean outbreak in 1346. [ 44 ] Others still favor an origin in China. [ 36 ] The theory of Chinese origin implicates the Silk Road, the disease possibly spreading alongside Mongol armies and traders, or possibly arriving via ship—however, this theory is still contested. It is speculated that rats aboard Zheng He 's ships in the 15th century may have carried the plague to Southeast Asia , India , and Africa. [ 38 ] Research on the Delhi Sultanate and the Yuan dynasty shows no evidence of any serious epidemic in 14th-century India and no specific evidence of plague in 14th-century China, suggesting that the Black Death may not have reached these regions. [ 40 ] [ 38 ] [ 45 ] Ole Benedictow argues that since the first clear reports of the Black Death come from Kaffa , the Black Death most likely originated in the nearby plague focus on the northwestern shore of the Caspian Sea . [ 46 ] Demographic historians estimate that China's population fell by at least 15 per cent, and perhaps as much as a third, between 1340 and 1370. This population loss coincided with the Black Death that ravaged Europe and much of the Islamic world in 1347–52. However, there is a conspicuous lack of evidence for pandemic disease on the scale of the Black Death in China at this time. War and famine – and the diseases that typically accompanied them – probably were the main causes of mortality in the final decades of Mongol rule. [ 47 ] — Richard von Glahn Monica Green suggests that other parts of Eurasia outside the west do not contain the same evidence of the Black Death, because there were actually four strains of Yersinia pestis that became predominant in different parts of the world. Mongol records of illness such as food poisoning may have been referring to the Black Death. [ 48 ] Another theory is that the plague originated near Europe and cycled through the Mediterranean, Northern Europe and Russia before making its way to China. [ 37 ] Other historians, such as John Norris and Ole Benedictaw, believe the plague likely originated in Europe or the Middle East, and never reached China. [ 49 ] Norris specifically argues for an origin in Kurdistan rather than Central Asia. [ 44 ] European outbreak The seventh year after it began, it came to England and first began in the towns and ports joining on the seacoasts, in Dorsetshire , where, as in other counties, it made the country quite void of inhabitants so that there were almost none left alive. ... But at length it came to Gloucester , yea even to Oxford and to London, and finally it spread over all England and so wasted the people that scarce the tenth person of any sort was left alive. —  Geoffrey the Baker , Chronicon Angliae [ 50 ] Plague was reportedly first introduced to Europe via Genoese traders from their port city of Kaffa in the Crimea in 1347. During a protracted siege of the city in 1345–1346, the Mongol Golden Horde army of Jani Beg —whose mainly Tatar troops were suffering from the disease— catapulted infected corpses over the city walls of Kaffa to infect the inhabitants, [ 51 ] though it is also likely that infected rats travelled across the siege lines to spread the epidemic to the inhabitants. [ 52 ] [ 53 ] As the disease took hold, Genoese traders fled across the Black Sea to Constantinople , where the disease first arrived in Europe in summer 1347. [ 54 ] The epidemic there killed the 13-year-old son of the Byzantine emperor , John VI Kantakouzenos , who wrote a description of the disease modelled on Thucydides 's account of the 5th century BCE Plague of Athens , noting the spread of the Black Death by ship between maritime cities. [ 54 ] Nicephorus Gregoras , while writing to Demetrios Kydones , described the rising death toll, the futility of medicine, and the panic of the citizens. [ 54 ] The first outbreak in Constantinople lasted a year, but the disease recurred ten times before 1400. [ 54 ] Carried by twelve Genoese galleys, plague arrived by ship in Sicily in October 1347; [ 55 ] the disease spread rapidly all over the island. Galleys from Kaffa reached Genoa and Venice in January 1348, but it was the outbreak in Pisa a few weeks later that was the entry point into northern Italy. Towards the end of January, one of the galleys expelled from Italy arrived in Marseilles . [ 56 ] From Italy , the disease spread northwest across Europe, striking France , Spain , Portugal, and England by June 1348, then spreading east and north through Germany , Scotland and Scandinavia from 1348 to 1350. It was introduced into Norway in 1349 when a ship landed at Askøy , then spread to Bjørgvin (modern Bergen ). [ 57 ] Finally, it spread to northern Russia in 1352 and reached Moscow in 1353. [ 58 ] [ 59 ] Plague was less common in parts of Europe with less-established trade relations, including the majority of the Basque Country , isolated parts of Belgium and the Netherlands , and isolated Alpine villages throughout the continent. [ 60 ] [ 61 ] [ 62 ] According to some epidemiologists, periods of unfavorable weather decimated plague-infected rodent populations, forcing their fleas onto alternative hosts, [ 63 ] inducing plague outbreaks which often peaked in the hot summers of the Mediterranean [ 64 ] and during the cool autumn months of the southern Baltic region . [ 65 ] [ b ] Among many other culprits of plague contagiousness, pre-existing malnutrition weakened the immune response, contributing to an immense decline in European population. [ 68 ] West Asian and North African outbreak The disease struck various regions in the Middle East and North Africa during the pandemic , leading to serious depopulation and permanent change in both economic and social structures. [ 69 ] By autumn 1347, plague had reached Alexandria in Egypt, transmitted by sea from Constantinople via a single merchant ship carrying slaves. [ 70 ] By late summer 1348, it reached Cairo , capital of the Mamluk Sultanate , cultural center of the Islamic world , and the largest city in the Mediterranean Basin ; the Bahriyya child sultan an-Nasir Hasan fled and more than a third of the 600,000 residents died. [ 71 ] The Nile was choked with corpses despite Cairo having a medieval hospital, the late 13th-century bimaristan of the Qalawun complex . [ 71 ] The historian al-Maqrizi described the abundant work for grave-diggers and practitioners of funeral rites ; plague recurred in Cairo more than fifty times over the following one and a half centuries. [ 71 ] During 1347, the disease travelled eastward to Gaza by April; by July it had reached Damascus , and in October plague had broken out in Aleppo . [ 70 ] That year, in the territory of modern Lebanon , Syria , Israel , and Palestine , the cities of Ascalon , Acre , Jerusalem , Sidon , and Homs were all infected. In 1348–1349, the disease reached Antioch . The city's residents fled to the north, but most of them ended up dying during the journey. [ 72 ] The pandemic spread westwards from Alexandria along the African coast, while in April 1348 Tunis was infected by ship from Sicily. Tunis was then under attack by an army from Morocco; this army dispersed in 1348 and brought the contagion with them to Morocco, whose epidemic may also have been seeded from the Islamic city of Almería in al-Andalus . [ 70 ] Mecca became infected in 1348 by pilgrims performing the Hajj . [ 70 ] In 1351 or 1352, the Rasulid sultan of the Yemen , al-Mujahid Ali, was released from Mamluk captivity in Egypt and carried plague with him on his return home. [ 70 ] [ 73 ] During 1349, records show the city of Mosul suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. [ 74 ] Signs and symptoms A hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black An inguinal bubo on the upper thigh of a person infected with bubonic plague. Swollen lymph nodes ( buboes ) often occur in the neck, armpit and groin ( inguinal ) regions of plague victims. Bubonic plague Symptoms of the plague include fever of 38–41 °C (100–106 °F), headaches, painful aching joints , nausea and vomiting, and a general feeling of malaise . Left untreated, 80% of victims die within eight days. [ 75 ] Contemporary accounts of the pandemic are varied and often imprecise. [ c ] The most commonly noted symptom was the appearance of buboes (or gavocciolos ) in the groin, neck and armpits, which oozed pus and bled when opened. [ 30 ] Boccaccio 's description: In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg ... From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. [ 77 ] [ 78 ] [ d ] This was followed by acute fever and vomiting of blood . Most people died two to seven days after initial infection. Freckle-like spots and rashes, [ 80 ] which may have been caused by flea-bites , were identified as another potential sign of plague. Pneumonic plague Lodewijk Heyligen , whose master Cardinal Giovanni Colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague , that infected the lungs and led to respiratory problems. [ 30 ] Symptoms include fever, cough and blood-tinged sputum . As the disease progresses, sputum becomes free-flowing and bright red. Pneumonic plague has a mortality rate of 90–95%. [ 81 ] Septicemic plague Septicemic plague is the least common of the three forms, with an untreated mortality rate near 100%. Symptoms are high fevers and purple skin patches ( purpura due to disseminated intravascular coagulation ). [ 81 ] In cases of pneumonic and particularly septicemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes. [ 81 ] Consequences Main article: Consequences of the Black Death Deaths Inspired by the Black Death, The Dance of Death , or Danse Macabre , an allegory on the universality of death, was a common painting motif in the late medieval period. There are no exact figures for the death toll; the rate varied widely by locality. Urban centers with higher populations suffered longer periods of abnormal mortality. [ 82 ] Some estimate that it may have killed between 75,000,000 and 200,000,000 people in Eurasia . [ 83 ] [ 84 ] [ 85 ] [ better source needed ] A study published in 2022 of pollen samples across Europe from 1250 to 1450 was used to estimate changes in agricultural output before and after the Black Death. The authors found great variability in different regions, with evidence for high mortality in areas of Scandinavia, France, western Germany, Greece, and central Italy, but uninterrupted agricultural growth in central and eastern Europe, Iberia, and Ireland. [ 86 ] The authors concluded that "the pandemic was immensely destructive in some areas, but in others it had a far lighter touch ... [the study methodology] invalidates histories of the Black Death that assume Y. pestis was uniformly prevalent, or nearly so, across Europe and that the pandemic had a devastating demographic impact everywhere." The Black Death killed, by various estimations, from 25 to 60% of Europe's population. Robert Gottfried writes that as early as 1351, "agents for Pope Clement VI calculated the number of dead in Christian Europe at 23,840,000. With a preplague population of about 75 million, Clement's figure accounts for mortality of 31%-a rate about midway between the 50% mortality estimated for East Anglia, Tuscany, and parts of Scandinavia, and the less-than-15% morbidity for Bohemia and Galicia. And it is unerringly close to Froissart's claim that "a third of the world died," a measurement probably drawn from St. John's figure of mortality from plague in the Book of Revelation , a favorite medieval source of information." [ 87 ] Ole J. Benedictow proposes 60% mortality rate for Europe as a whole based on available data, with up to 80% based on poor nutritional conditions in the 14th century. [ 88 ] [ 89 ] [ e ] According to medieval historian Philip Daileader , it is likely that over four years, 45–50% of the European population died of plague. [ 90 ] [ f ] The overwhelming number of deaths in Europe sometimes made mass burials necessary, and some sites had hundreds or thousands of bodies. [ 91 ] The mass burial sites that have been excavated have allowed archaeologists to continue interpreting and defining the biological, sociological, historical, and anthropological implications of the Black Death. [ 91 ] The mortality rate of the Black Death in the 14th century was far greater than the worst 20th-century outbreaks of Y. pestis plague, which occurred in India and killed as much as 3% of the population of certain cities. [ 92 ] In 1348, the disease spread so rapidly that nearly a third of the European population perished before any physicians or government authorities had time to reflect upon its origins. In crowded cities, it was not uncommon for as much as 50% of the population to die. [ 10 ] Half of Paris's population of 100,000 people died. In Italy, the population of Florence was reduced from between 110,000 and 120,000 inhabitants in 1338 to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished, [ 93 ] and a similar percentage of Londoners may have died from the disease as well, [ 18 ] leaving a death toll of approximately 62,000 between 1346 and 1353. [ 4 ] [ g ] Florence's tax records suggest that 80% of the city's population died within four months in 1348. [ 92 ] Before 1350, there were about 170,000 settlements in Germany, and this was reduced by nearly 40,000 by 1450. [ 95 ] The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion . Plague did not appear in Flanders until the turn of the 15th century, and the impact was less severe on the populations of Hainaut , Finland , northern Germany, and areas of Poland. [ 92 ] Monks, nuns, and priests were especially hard-hit since they cared for people ill with the plague. [ 96 ] The level of mortality in the rest of Eastern Europe was likely similar to that of Western Europe in the first outbreak, with descriptions suggesting a similar effect on Russian towns, and the cycles of plague in Russia being roughly equivalent. [ 59 ] Citizens of Tournai bury plague victims In 1382, the physician to the Avignon Papacy , Raimundo Chalmel de Vinario ( Latin : Magister Raimundus , lit.   ' Master Raymond ' ), observed the decreasing mortality rate of successive outbreaks of plague in 1347–1348, 1362, 1371 and 1382 in his treatise On Epidemics ( De epidemica ). [ 97 ] In the first outbreak, two thirds of the population contracted the illness and most patients died; in the next, half the population became ill but only some died; by the third, a tenth were affected and many survived; while by the fourth occurrence, only one in twenty people were sickened and most of them survived. [ 97 ] By the 1380s in Europe, the plague predominantly affected children. [ 92 ] Chalmel de Vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the Roman Curia , whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he was never able to effect a cure. [ 97 ] The populations of some Italian cities, notably Florence , did not regain their pre-14th century size until the 19th century. [ 98 ] Italian chronicler Agnolo di Tura recorded his experience from Siena , where plague arrived in May 1348: 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 ... 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. [ 99 ] The Black Death killed about 40% of Egypt's population. [ 100 ] In Cairo, with a population numbering as many as 600,000, and possibly the largest city west of China, between one third and 40% of the inhabitants died within eight months. [ 71 ] By the 18th century, the population of Cairo was halved from its numbers in 1347. [ 71 ] Economic It has been suggested that the Black Death, like other outbreaks through history, disproportionately affected the poorest people and those already in worse physical condition than the wealthier citizens. [ 101 ] But along with population decline from the pandemic, wages soared in response to a subsequent labour shortage. [ 102 ] In some places rents collapsed (e.g., lettings "used to bring in £5, and now but £1.") [ 76 ] : 158  However, many labourers, artisans, and craftsmen—those living from money-wages alone—suffered a reduction in real incomes owing to rampant inflation. [ 103 ] Landowners were also pushed to substitute monetary rents for labour services in an effort to keep tenants. [ 104 ] Taxes and tithes became difficult to collect, with living poor refusing to cover the share of the rich deceased, because many properties were empty and unfarmed, and because tax-collectors, where they could be employed, refused to go to plague spots. [ 76 ] : 158  The trade disruptions in the Mongol Empire caused by the Black Death was one of the reasons for its collapse. [ 105 ] Environmental A study performed by Thomas Van Hoof of the Utrecht University suggests that the innumerable deaths brought on by the pandemic cooled the climate by freeing up land and triggering reforestation . This may have led to the Little Ice Age . [ 106 ] Persecutions See also: Persecution of Jews during the Black Death Jews being burned at the stake in 1349. Miniature from a 14th-century manuscript Antiquitates Flandriae by Gilles Li Muisis Renewed religious fervor and fanaticism increased in the wake of the Black Death. Some Europeans targeted "various groups such as Jews , friars , foreigners, beggars, pilgrims ", lepers, [ 107 ] [ 108 ] and Romani , blaming them for the crisis. Lepers , and others with skin diseases such as acne or psoriasis , were killed throughout Europe. Because 14th-century healers and governments were at a loss to explain or stop the disease, Europeans turned to astrological forces, earthquakes and the poisoning of wells by Jews as possible reasons for outbreaks. [ 109 ] Many believed the epidemic was a punishment by God for their sins, and could be relieved by winning God's forgiveness . [ 110 ] There were many attacks against Jewish communities. [ 111 ] In the Strasbourg massacre of February 1349, about 2,000 Jews were murdered. [ 111 ] In August 1349, the Jewish communities in Mainz and Cologne were annihilated. By 1351, 60 major and 150 smaller Jewish communities had been destroyed. [ 112 ] During this period many Jews relocated to Poland , where they received a welcome from King Casimir the Great . [ 113 ] Social See also: Black Death in medieval culture Pieter Bruegel 's The Triumph of Death reflects the social upheaval and terror that followed the plague, which devastated medieval Europe. One theory that has been advanced is that the Black Death's devastation of Florence , between 1348 and 1350, resulted in a shift in the world view of people in 14th-century Italy that ultimately led to the Renaissance . Italy was particularly badly hit by the pandemic, and the resulting familiarity with death may have caused thinkers to dwell more on their lives on Earth, rather than on spirituality and the afterlife . [ 114 ] [ h ] It has also been argued that the Black Death prompted a new wave of piety, manifested in the sponsorship of religious works of art. [ 116 ] This does not fully explain why the Renaissance occurred in Italy in the 14th century; the Renaissance's emergence was most likely the result of the complex interaction of the above factors, [ 117 ] in combination with an influx of Greek scholars after the fall of the Byzantine Empire . [ 118 ] As a result of the drastic reduction in the populace the value of the working class increased, and commoners came to enjoy more freedom. To answer the increased need for labour, workers travelled in search of the most favorable position economically. [ 119 ] [ better source needed ] Prior to the emergence of the Black Death, the continent was considered a feudalistic society, composed of fiefs and city-states frequently managed by the Catholic Church. [ 120 ] The pandemic completely restructured both religion and political forces; survivors began to turn to other forms of spirituality and the power dynamics of the fiefs and city-states crumbled. [ 120 ] The survivors of the pandemic found not only that the prices of food were lower but also that lands were more abundant, and many of them inherited property from their dead relatives, and this probably contributed to the destabilization of feudalism . [ 121 ] [ 122 ] The word " quarantine " has its roots in this period, though the practice of isolating people to prevent the spread of disease is older. In the city-state of Ragusa (modern Dubrovnik , Croatia), a thirty-day isolation period was implemented in 1377 for new arrivals to the city from plague-affected areas. The isolation period was later extended to forty days, and given the name "quarantino" from the Italian word for "forty". [ 123 ] All institutions were affected. Smaller monasteries and convents became unviable and closed. Up to half parish churches lost their priest, apart from the parishioners. Religious sensibilities changed: [ 76 ] ... looking back into the past, the history of the Church during the Middle Ages in England appears one continuous and stately progress. It is much nearer to the truth to say that in 1351 the whole ecclesiastical system was wholly disorganised, or, indeed, more than half ruined, and that everything had to be built up anew. ... To secure the most necessary public ministrations of the rites of religion the most inadequately-prepared subjects had to be accepted, and even these could be obtained only in insufficient numbers. ... The immediate effect on the people was a religious paralysis. Instead of turning men to God the scourge turned them to despair ... In time the religious sense and feeling revived, but in many respects it took a new tone, and its manifestations ran in new channels[...]characterised by a devotional and more self-reflective cast than previously. ... The new religious spirit found outward expression in the multitude of guilds which sprang into existence at this time, in the remarkable and almost, as it may seem to some, extravagant development of certain pious practices, in the singular spread of a more personal devotion to the Blessed Sacrament, to the Blessed Virgin, to the Five Wounds, to the Holy Name, and other such manifestations of a more tender or more familiar piety. ... 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