Following the outbreak of Covid-19, a disease known as coronavirus, stories about the Black Death are seemingly in the news more than ever. It is estimated that 50 million people died as a result of the deadly plague. But what caused the disease? Where did it start? And what were its symptoms? Here's your guide to the illness that ravaged Europe between 1347 and 1348...


Questions answered by Professor Samuel Cohn and Professor Tom Beaumont James

What was the Black Death?

In the Middle Ages, the Black Death, or ‘pestilencia’, as contemporaries called various epidemic diseases, was the worst catastrophe in recorded history. Some dubbed it ‘magna mortalitas’ (great mortality), emphasising the death rate.

It destroyed a higher proportion of the population than any other single known event

It destroyed a higher proportion of the population than any other single known event. One observer noted “the living were scarcely sufficient to bury the dead”. No one could be sure what caused the deadly plague.

When was the Black Death?

The plague arrived in western Europe in 1347 and in England in 1348. It faded away in the early 1350s.

What were the symptoms of the Black Death?

Symptoms of the Black Death included swellings – most commonly in the groin, armpits and neck; dark patches, and the coughing up of blood.

Medieval observers – and their modern counterparts in 19th-century China and 20th-century Vietnam, observing more recent outbreaks – noted that different strains of the disease took from five days to as little as half a day to cause death.

How many people died because of the Black Death?

In Europe, it is thought that around 50 million people died as a result of the Black Death over the course of three or four years. The population was reduced from some 80 million to 30 million. It killed at least 60 per cent of the population in rural and urban areas. In fact, in some places such as a village on an estate in Cambridgeshire manorial rolls attest that 70 per cent of its tenants died in a matter of months in 1349, and the city of Florence tax records drawn up shortly before and after the Black Death suggest that its toll may have been about the same in 1348.

It is thought that around 50 million people died as a result of the Black Death

Some communities such as Quob in Hampshire were wiped out; many rural communities went into decline (and were in time deserted). We know that some populations survived, but medieval people had no such knowledge – all they believed was that everyone would certainly die.

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The plague skipped over or barely touched some European villages, and may not have infected at all vast regions (such as ones in northern German-speaking lands). Given the state of record-keeping and preservation, we will probably never be able to estimate the Black Death’s European toll with any precision.

What remedies were used to treat the Black Death?

Medieval people believed that the Black Death came from God, and so responded with prayers and processions. Some contemporaries realised that the only remedy for plague was to run away from it – Boccaccio’s Decameron is a series of tales told among a group of young people taking refuge from the Black Death outside Florence.

There was no known remedy, but people wanted medicines

There was no known remedy, but people wanted medicines: Chaucer commented that the Doctor of Physic made much ‘gold’ out of the pestilence. The plague bacteria were identified in Asia in the 1890s, and the connection with animals and fleas established.

Modern antibiotics can combat plague, but these are under threat from mutating diseases and immunity to antibiotics’ effects.

Where did the Black Death originate, and what areas did it affect?

Breaking out in ‘the east’, as medieval people put it, the Black Death came north and west after striking the eastern Mediterranean and Italy, Spain and France.

It then came to Britain, where it struck Dorset and Hampshire along the south coast of England simultaneously. The plague then spread north and east, then on to Scandinavia and Russia.

How did the Black Death spread? Was it because of black rats transmitting the plague to humans via fleas?

Not only textbooks but serious monographs on the Black Death and its successive waves of plague into the early 19th century in Europe go on about rats (usually “black ones”) and fleas without qualification. But what is the evidence?

No contemporary observers described any epizootic [animal epidemic] of rats or of any other rodents immediately before or during the Black Death, or during any later plagues in Europe – that is, until the ‘third pandemic’ at the end of the 19th century. Yet in subtropical regions of Africa and China, descriptions of ‘rat falls’ accompanying a human disease with buboes in the principal lymph nodes reach back at least to the 18th century.

As for fleas, unlike during the ‘third pandemic’, when plague cases and deaths followed closely the seasonal fertility cycles of various species of rat fleas, no such correlations are found with the Black Death or later European plagues before the end of the 19th century.

The lethality of the Black Death arose from the onslaught of three types: bubonic, pneumonic and, occasionally, septicaemic plague.

Who was most affected by the plague? Did the Black Death mainly affect poor people?

Old and young. Men and women. All of society – royalty, peasants, archbishops, monks, nuns and parish clergy – was affected. No subset of people was immune to the Black Death.

Contemporary chroniclers list important knights, ladies, and merchants who died during the Black Death. Many wealthy and well-fed convents, friaries, and monasteries across Europe lost more than half of their members, with some becoming extinct.

Both artisan and artistic skills were lost or severely affected, from cathedral building in Italy to pottery production in England. Artists such as the Lorinzetti brothers of Siena were victims, and the English royal masons, the Ramseys, died. There were shortages of people to till the land and tend cattle and sheep.

By the third or fourth wave of plague in the last decades of the 14th century, burial records and tax registers suggest that the disease had evolved into one that largely affected the poor.

Which areas were worst hit by the Black Death?

In 1348–49, some of the worst-hit regions were in mountainous and in relatively isolated zones, such as in Snowdonia in Wales or the mountain village of Mangona in the Alpi fiorentine, north of Florence, whose communications with cities were less frequent than places further down the slopes and closer to cities.

The experiences of these isolated villages may have been similar to small mining villages in Pennsylvania or in South Africa, or Inuit settlements in Newfoundland under attack by another highly contagious pandemic, the Great Influenza of 1918–19, in which they experienced mortalities from 10 to 40 per cent – many times higher than in New York City or London.

For reasons that are difficult to explain, cities such as Milan and Douai in Flanders, both major hubs of commerce and industry, appear to have escaped the Black Death in 1348 almost totally unscathed.

In the case of Milan, only one household fell victim to the disease, at least according to chronicles, and the plague was successfully contained. Meanwhile, Douai chronicles, monastic necrologies, and archival records (recording, for example, the deaths of magistrates, and last wills and testaments) show no certain signs of the plague entering that city until the plague of 1400.

Listen to Elma Brenner examine the state of healthcare in the Middle Ages and reveal some unusual remedies that were offered for people with injuries or diseases:

Did the Black Death result in the massacre of Jews or the blaming of other minorities?

In German-speaking lands, France along the Rhine, and parts of Spain, municipal governments, castellans, bishops, and the Holy Roman Emperor accused Jews of spreading the Black Death by poisoning foodstuffs and water sources, and massacred entire communities of men, women, and babies for these supposed crimes.

The accusations and massacres, however, were not universal between 1348 and 1351. Massacres did not arise in the British Isles (where, at least in England, Jews had been expelled in 1290 by Edward I), and no clear evidence pinpoints any such violence in Italy (except for the Catalans in Sicily). Nor are any massacres recorded in the Middle East.

Where did the first ‘quarantine’ take place?

The phrase ‘quarantine’ (the exclusion and isolation of those coming from infected regions, or of others suspected of carrying plague, to avoid them mixing with uninfected populations for a certain number of days) was coined in Venice in the early 15th century, based on a 40-day period of isolation (with Biblical resonances). But the city of Ragusa [present-day Dubrovnik] had beaten the Venetians to the punch in 1377 with a plague ‘quarantine’ of 30 days.

By the early modern period, ‘quarantine’ often had been curtailed further. The period deemed necessary to isolate suspected carriers in Milan during its plague of 1557–75, for instance, had dropped to eight daysfor certain categories of suspicion.

Were efforts to reduce the spread of the Black Death in vain?

Cities that managed to keep plague beyond their borders were those that devised and implemented quarantine: border controls at city gates, harbours, and mountain passes; individual health passports (which identified a person and certified where he or she came from), and other related measures such as spy networks to signal when a plague had erupted in a foreign city or region.

Cities that managed to keep plague beyond their borders were those that devised and implemented quarantine

Ragusa was a pioneer in this regard, with its earliest ‘quarantine’ and its increasingly sophisticated measures to isolate the infected and control its borders during the late 14th and 15th centuries. Its last plague was in 1533, while in England it was 1665–56, in the Baltic region 1709–13, and Northern Africa and the Middle East the 19th century. Many Italian regions followed Ragusa’s lead, and after them, other regions of western and central Europe.

Listen to historian Jane Whittle on at how the devastating plague of the 1340s significantly reshaped the economy and society of England:

Did the church recognise anyone who sacrificed their lives to help those afflicted during the Black Death?

From October 1347 in Sicily to the early 1350s further north, contemporary chroniclers decried the abandonment of sick family members, and criticised clergymen and doctors who were ‘cowardly’ in reneging on their responsibilities to escape the plague’s vicious contagion. However, occasionally contemporary writers also praised those who stayed on to nurse the afflicted, and who often lost their lives in so doing.

Curiously, the church did not recognise any of these martyrs during the Black Death with elevations to beatitude or sanctity.

The first to be so recognised did not appear until the 15th century, and those who intervened to help those afflicted by the plague (that is, during their own lifetimes and not as post-mortem miraculous acts) remained rare even during 16th and 17th centuries.

How quickly did the Black Death spread?

It is thought that the Black Death spread at a rate of a mile or more a day, but other accounts have measured it in places to have averaged as far as eight miles a day. It is thought that the Black Death travelled 30 to 100 times faster over land than the bubonic plagues of the 20th century; indeed, Scientists in South Africa, New Orleans, and other places affected by bubonic plague in the early 20th century devised experiments to clock their plague’s spread, and found it moved no faster than eight miles a year. It spread so slowly because modern bubonic plague was a rodent disease – and often one dependent on the house rat.

These extreme differences in the spread of the Black Death and the bubonic plagues of modern times are seen despite the revolutions in transport with steam power, railway, and, by the early 20th century, automobiles.

As COVID-19 dominates the news, Laura Spinney draws historical parallels with other pandemics in history and asks what we might learn from disease outbreaks in the past:

Was the Black Death a one-off occurrence?

No. There have been three identified so-called ‘pandemics’. First, there was a significant international epidemic in the sixth century AD.

Second, starting with the Black Death – its deadliest attack – plague later returned to Britain in 1361 (when it affected especially younger and elderly people); 1374, and regularly until it disappeared shortly after the Great Plague of 1665.

Third, the disease broke out once more in Asia in the 1890s, and established new foci, where it is still found in animal populations today.

Will the Black Death return?

In fact, the disease has never gone away. An outbreak in Surat in India in the early 1990s caused panic across the world. The death of a herdsman in Kyrgyzstan in 2013 from bubonic plague was wildly exaggerated in the media.

Samuel Cohn is professor of medieval history at the University of Glasgow and author of Cultures of Plague: Medical Thinking at the End of the Renaissance (Oxford University Press, 2010).

Tom Beaumont James is a professor of archaeology and history at the University of Winchester.


This article is an amalgamation of two articles published on HistoryExtra in October 2015 and November 2014