How the Black Death Worked

by Molly Edmonds

Hulton Archive/Getty Images

The Black Death in a European town
In his introduction to "The Decameron" (circa 1351), Italian author Giovanni Boccaccio captures the uncertainty
and fear that accompanied the Black Death's sweep through Europe from 1347 to 1351. It could have been caused
by the influence of celestial bodies or by God's wrath, Boccaccio wrote. Physicians had no idea what to do with the
tumors and black spots that ravaged victims' bodies. And worse, the people turned on each other. Parents
abandoned children; husbands turned their backs on their wives. The streets were filled with the dead, and
neighbors sometimes learned of a death next door by the smell. The living didn't have time to mourn; Boccaccio
says that due to the large number of dead and the fear of their presence, "a dead man was then of no more account
than a dead goat would be today."
The symptoms of the Black Death were gruesome: Tumors covered the body -- some of them as big as an egg or
apple, Boccaccio wrote. A large neck tumor might permanently cock a person's head in the opposite direction.
Purplish splotches also covered the body. These were nicknamed "God's tokens," because God usually took the
sufferer soon after they appeared. The sick even smelled like they were going to die. Bad breath and odors indicated
they were rotting from the inside.
Medieval writers tell us that the fevers resulted in delirium -- madmen wandered the streets, shouting wildly. The
sick vomited incessantly or coughed up blood. Pus and blood oozed from sores. Once the symptoms started to
appear, the victim was a ticking time bomb and died within days. No one knew what to do. There wasn't enough
space in the graveyards, so the bloated bodies were left in the street. Dogs ate corpses while babies cried hungrily
beside their dead mothers.
When all was said and done, about 25 million people died in the epidemic, approximately one-third of Europe's
population at the time.

How did the black death spread?


The Black Death moved through Europe astonishingly fast. Take a look at some of the stops on its path.
Because Europe was trading with the East, some medieval Europeans were aware of a mysterious disease sweeping
through Asia in the 1330s. From Central Asia, the disease moved along an established trade route, passing through
Turkestan and the Black Sea Region (Crimea and the Byzantine Empire).
In 1347, Kaffa, a town in modern-day Ukraine that was a Genoese trading post, came under attack by a Tartar army.
When the Tartars were killed by the plague, the Genoese at first rejoiced: God had answered their prayers and
punished their enemy. But that celebration ended when the Tartars began launching the corpses of plague victims
over the walls of the city, hoping that the smell of rot would kill everyone in town. The smell didn't kill the
Genoese, of course, but the disease did. The panicked Genoese threw the corpses back or submerged them in
water. But it was no use; they were already exposed. As the dying Tartars retreated, the Genoese fled by ship to
Sicily, taking the deadly disease with them to Europe.
Kaffa wasn't the only eastern trading port on the Black
Death's path, but Genoa's ships took the blame for
Why is it called the Black Death?
bringing the pestilence. Once it hit Europe, the Black
Many think that the Black Death got its name from the
Death moved fast, traveling at an average speed of 2.5
blackened tumors that covered the victims' bodies. But
miles per day (4 km per day) [source: Duncan, Scott].
it's more likely a mistranslation of the Latin term for
From the Mediterranean ports, the disease took two
the plague, Atra mors. "Atra" can be translated as
paths; one through France that eventually made its way
either "terrible" or "black."
to England and Ireland, and one through Italy that went

to Austria and Germany.

People living through the Black Death did not call it by
Written accounts state that the disease was frightfully
that name. What they called it translates roughly to the
contagious, and that death occurred only a few days after "Great Mortality" or the "Big Death." People began
symptoms appeared. Other than this, people seemed to using the phrase "Black Death" in the eighteenth
have no idea what was happening. Many felt that God's century, to distinguish between the deaths of
wrath was ravaging the earth and that the end of the
1347-1351 and the plague that struck London in 1665.
world was near. Some theorized that Jews were
contaminating the water supply. Both of these ideas
spurred extreme responses that we'll explore in the next
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section.
When people began dying in France, King Philip VI turned to the Paris College of Physicians, the most highlyregarded medical authorities of the time, to learn the cause. The physicians produced a report that blamed the mass
deaths on an event that occurred at 1 p.m. on March 20, 1345 -- the triple conjunction of the planets Saturn, Jupiter
and Mars in Aquarius. The report explained that Jupiter, a wet and hot planet, soaked up evil vapors from Earth.
And Mars, a dry planet, ignited the vapors and spread them through the air, which is how Europe got enveloped in
a fog of death.

Reaction to the Black Death

Because the physicians blamed the Black Death on an evil, polluted
fog, logical recommendations to prevent the fever involved avoiding Quarantines
these miasmas, or corruptions of air.
Because no one was quite sure how the Black
Death was spreading, many simply chose to
Fires were a popular method of warding off miasmas. They were
avoid anyone with symptoms. Some towns
burned at street corners; even the pope sat between two large fires.
built pestilence houses, where the sick could be
People were urged to burn aromatic woods, but other scents would
taken to die. Others boarded up entire houses
do as well, including rosemary, amber, musk and fragrant flowers.
as soon as someone inside took ill. Those who
When they walked, people took their scents with them, carrying
could afford to do so fled to the countryside.
packets of herbs. Some plague-proofed their homes by putting

glazes over the southern windows to block the polluted southern

Venice began the practice of isolating ships
wind. People were advised not to eat meat or figs and to avoid
until it could be determined that no one on
activities that would open the pores to a miasma, including bathing, board was sick. Holding periods started at 30
exercising and physical intimacy. Stranger recommendations
days, but when it was determined that wasn't
long enough, the wait lengthened to 40 days, or
circulated as well, including not sleeping during the daytime and
"quaranti giorni" in Italian. While unofficial
avoiding sad thoughts about death and disease.
isolation measures had been used in the past,
Many medieval tracts address how to avoid sickness, but we know
the Venetian guidelines provided us with the
very little about how medieval doctors tried to cure the disease. It's
word "quarantine."
possible they believed nothing could be done. Most medieval cures
involved bloodletting, which was an attempt to draw poison out of
the body. And we know some physicians tried to rupture and drain
the buboes.
But many people instead turned to the church for a cure, praying that God would end the great pestilence. Religious
reactions took two extreme forms: the rise of the flagellants and the persecution of Jews.


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Procession of the flagellants
The Brotherhood of the Flagellants had appeared earlier in Europe, but rose up in great numbers in Germany in
late 1348. They believed the Black Death was the punishment of God and took it upon themselves to try to appease
him. The Flagellants marched barefoot throughout Europe, whipping themselves with scourges, or sticks with
spiked tails. Enormous crowds gathered to watch the ritual beatings, complete with hymns and prayers for God's
forgiveness. The pope was initially tolerant of the movement, but he denounced them in 1349, and the Flagellants
disappeared, seemingly overnight.
The Flagellants were also extremely anti-Semitic, but they weren't the only ones. While anti-Semitism was already on
the rise in Europe, it reached a fever pitch when many came to believe that Jews were poisoning the wells and
causing the Black Death. Because Jews at this time usually lived apart from Christians in separate quarters, they were
in effect already quarantined when the Black Death hit the towns, so they had high survival rates.
Vengeful Christians burned Jews at the stake or set buildings filled with entire communities on fire. Some Jews
responded by setting their own homes on fire before the angry mobs did it for them. Others converted to
Christianity on the spot to save themselves. While the attacks on Jews were widespread throughout Europe, some
of the highest casualties were in Germany. Few Jews were left in that country by the time the plague ended.
!

Effects of the Black Death

The Black Death reared its head sporadically in Europe over the next few centuries. But by 1352, it had essentially
loosened its grip. Europe's population had been hard hit, which had an economic impact. The workforce had been
destroyed -- farms were abandoned and buildings crumbled. The price of labor skyrocketed in the face of worker
shortage, and the cost of goods rose. The price of food, though, didn't go up, perhaps because the population had
declined so much.
The Black Death did set the stage for more modern medicine and spurred changes in public health and hospital
management. Frustrated with Black Death diagnoses that revolved around astrology and superstition, educators
began placing greater emphasis on clinical medicine, based on physical science. While schools initially had to close
for lack of educators, the plague eventually drove growth in higher education. New schools were established,
sometimes specifically mentioning in their charters that they were trying to address the decay in learning and gaps in
education left by the Black Death.
People who survived the Black Death era generally suffered a communal crisis of faith. Rather than becoming more
religious in thanksgiving to God for their survival, people harbored doubts. They had turned to the church for an

answer to the plague, and the church had been able to offer no help. Additionally, priests, who, along with doctors,
had the highest rate of contact with the diseased, also had one of the highest rates of fatalities. Several new
heretical movements sprang up. Those who still clung to their faith were more likely to do so in a very personal
manner. Many began to build private chapels.

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Danse macabre art: Townspeople flee under the watchful gaze of skeletons
Feeling, essentially, that God had turned his back on them, the people reacted to the end of the Black Death by
turning their backs on him. They engaged in wild debauchery to celebrate being alive. They held gluttonous
banquets, drank, wore extravagant clothing and gambled. It was clear through the art of the time, though, that
people still had death on their minds. The danse macabre, or dance of death, is an allegorical concept that was
expressed in drama, poetry, music and visual art. The danse macabre usually shows a procession or dance between
the living and the dead. The range of figures shown is meant to show that death will come for everyone, and the
various activities depicted are a reminder that death could always be right around the corner.
Geneticists are continuing to document the effects of the Black Death on Europe's population today. Analysis has
shown that genetic diversity in England is much lower than it was in the eleventh century, perhaps because so many
people died in the 1300s. While the rest of Europe does not show a lowered amount of genetic variation, that may
be due to increased migration patterns in other places.
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Causes of the Black Death

In 1894, during an outbreak of disease in Hong Kong and India known as the Third Pandemic, bacteriologists
Alexander Yersin and Shibasaburo Kitasato, working independently of each other, identified the bacteria that caused
plague. This bacterium came to be called Yersinia pestis, when Yersin showed it to be the causative agent of the
plague in India. Working backwards, Yersin determined that plague was the cause of the Black Death as well, due to
the medieval records of large tumors.
Yersinia pestis is usually transmitted from rodent to flea to rodent. Humans are normally only targeted by fleas when
there are no rodents left. When a flea bites a healthy rodent, the blood from the rodent goes directly to the flea's
stomach, easing hunger. But when a flea bites a rodent infected with Y. pestis, the bacterium-riddled blood gets stuck
in the flea's foregut. The bacteria will grow, engorging the flea. The flea constantly feels hungry because nothing is
getting to its stomach. In response to hunger pangs, the flea feeds greedily on more rodents. It spreads the disease
by regurgitating the infected blood into healthy rodents. When the rats start to die off, fleas swarm the remaining
rodents. Finally, when all the rats have died, the fleas turn to people.

Was the Black Death a Virus?

Matthias Grunewald/Bridgeman Art Library/Getty Images

A man suffering from buboes and splotches
Textbooks tell us that the bubonic plague caused the Black Death. But not everyone is convinced. Since 1984,
scientists have put forward alternative explanations for the Black Death. For example, sociologist Susan Scott and
biologist Christopher J. Duncan claim that a hemorrhagic fever, similar to the Ebola virus, caused the Black Death.
And others blame anthrax or say that some now-extinct disease was the culprit.
Bubonic plague just doesn't make sense, they argue. The symptoms, the high mortality rate, the speed at which the
disease spread, and the way the disease spread -- none of it jibes with typical bubonic plague.
Medieval accounts of symptoms don't match the symptoms of modern-day bubonic plague, either. Accounts
describe buboes covering the entire body. But today, buboes would most commonly show up in the groin area, and
aren't likely to spread all over the body. Additionally, medieval accounts mention awful odors, bruise-like splotches
and disrupted nervous systems that resulted in delirium and stupor -- none of this happens with modern-day
bubonic plague.

If the Black Death was caused by the bubonic plague, then the mortality rate was much higher than it should have
been, they argue. The bubonic plague is fairly curable; even untreated, bubonic plague has a mortality rate of about
60 percent [source: Kelly]. If mostly everyone affected died, some feel that a hemorrhagic fever, with no cure, was
the more likely culprit.
Proponents of these new theories also point out that bubonic plague usually
moves very slowly. But the Black Death swept across Europe at enormous
DNA Evidence
speed, especially given the fact that transportation was pretty undeveloped at
In an attempt to determine if Yersinia
the time. A hemorrhagic fever, in comparison, has a longer incubation period, pestis was to blame for the Black
in which people are contagious, but not yet symptomatic. People might have
Death, scientists have been turning to
spent that incubation period traveling, inadvertently spreading the fever more
DNA evidence. In the late 1990s, a
rapidly. Writings from the Black Death also indicate that people were extremely group of paleomicrobiologists was
contagious, so much so that people were scared to be in the same town as the
able to remove dental pulp from
corpses buried in mass gravesites in
infected. But modern-day plague outbreaks are nowhere near as contagious.
France. They reported finding the
Virus advocates find other problems with the rat-and-flea bacterial infection
DNA of Y. pestis in the samples,
theory. Since fleas only attack humans after all rat hosts have died, then there
seeming to confirm the plague
should have been a large die-off of rats before the Black Death. There's no
theory. However, in a later study,
evidence for a rat disappearance. Additionally, fleas require high temperatures
samples from five gravesites from all
and humidity to survive, which means that the plague should have essentially
over Europe were used, and scientists
died out in winter months. It did not.
were unable to confirm these results.
None of this reasoning has won over the scientific community yet. It's difficult The teeth exhumed from other
gravesites did not contain elements
to truly know what the Black Death was like. The only evidence we have are
of Y. pestis.
the written accounts of the time, and these accounts provide few details.
Obviously, the people who wrote them didn't use our technical language for
diagnosing and describing diseases. What they described as a tumor may not
have been a tumor at all, by our modern-day medical standards.
Sources:

Barris, Colin. "Black Death casts a genetic shadow over England." New Scientist, August 2007. (Feb. 4, 2008)
http://www.newscientist.com/article.ns?id=dn12393.

"Black Death." Encyclopedia Britannica. 2008. Encyclopedia Brittanica Online Library Edition. (Feb. 4, 2008)
http://www.library.eb.com/eb/article-9015473.

Boccaccio, Giovanni. The Decameron. Trans. J.M. Rigg. (Feb. 4, 2008)

http://www.stg.brown.edu/projects/decameron/engDecIndex.php

Cohn, S.K. and L.T. Weaver. "The Black Death and AIDS: CCR5-

http://history.howstuffworks.com/middle-ages/black-death6.htm