Black Death and Plague: The Disease and Medical Thought

Introduction

The history of the Black Death constitutes one of the most interdisciplinary fields of Renaissance and Reformation studies, bringing together not only a wide spectrum of scholars in the humanities and social sciences—students of literature, art history, economics, anthropology, demography—but also scholars across scientific disciplines such as archaeology, biology, zoology, genetics, dentistry, and more. Modern scholarship and enthusiasm for the subject have closely followed major outbreaks of epidemic diseases threatening Europe: the cholera epidemics of the 1830s (when the term “Black Death” became common in the English language for the disease’s outbreak from 1346 to 1352), the spread of bubonic plague (later christened Yersinia pestis) in 1894 to World War I, and most recently, the spread of HIV/AIDS from the mid-1980s to the present.

General Overviews

General works that cut across national boundaries can be divided into two chronological categories: those that concentrate almost exclusively on the Black Death (1346 to 1352), and those that consider the Black Death and successive waves of plague into the 18th or 19th century. For the most part, these works consider the Black Death and plague beyond considerations of the disease itself and analyze its demographic, economic, religious, and psychological consequences (see also the entry titled “Plague and Its Consequences”). During the second half of the 19th century, three multivolume national surveys of the history of epidemics were published, which concentrate on the history of plague. Valuable information can still be gleaned from Corradi 1972–1973 (on Italy), Creighton 1965 (on Britain), and Haeser 1875–1882 (on Europe, but concentrates on German-speaking regions). These titles are especially valuable regarding sources on the Black Death and subsequent plagues. Among the numerous works published during the last fifty years, Benedictow 2004, Bergdolt 1994, Carpentier 1962, Herlihy 1997, and Ziegler 1969 have traced the spread of the Black Death, estimated its mortality, commented on cultural reactions, and have analyzed economic and demographic consequences of plague.

Benedictow, Ole Jørgen. The Black Death, 1346–1353: The Complete History. Woodbridge, UK: Boydell, 2004.
Save Citation »Export Citation »E-mail Citation »
Dedicated to tracking the spread of the Black Death, country by country, argues that the plague was spread by rats and fleas but makes no reference to opposing views of the previous two decades. It gives the highest estimates yet for total plague mortality of Europe, which was 50 percent or more.
Find this resource:
Bergdolt, Klaus. Der Schwarze Tod in Europa: Die Grosse Pest und das Ende des Mittelalters. Munich: C. H. Beck, 1994.
Save Citation »Export Citation »E-mail Citation »
Surveys the path of plague and its consequences, based largely on published chronicles and physicians’ plague tracts; particularly useful are chapters on the physician’s plague tract, Petrarch, and other examples of contemporary literature to evoke the psychological horrors of the Black Death. Reprinted in 1995 and 2000.
Find this resource:
Carpentier, Élisabeth Carpentier. “Autour de la Peste Noire: Famines et épidémies dans l’histoire du XIVe siècle.” Annales: E. S. C. 17 (1962): 1062–1092.
Save Citation »Export Citation »E-mail Citation »
Excellent review of the historiography on the spread of plague from the Middle East across Europe (with map); analyzes the character of the disease (bubonic and pneumonic plague), demographic and economic consequences for the 14th century, medical thought and literature, the psychological ramifications of the persecution of Jews and class hatred; also draws on historical examples and historiography of Spain, France, England, Italy, German-speaking regions, and Poland.
Find this resource:
Corradi, Alfonso. Annali delle epidemie occorse in Italia dalle prime memorie fino al 1850. 8 vols. Bologna, Italy: Forni, 1972–1973.
Save Citation »Export Citation »E-mail Citation »
A chronological listing of diseases and other natural calamities culled largely from chronicles (published and unpublished) and medical writings principally on plagues (plague tracts). Vols. 1 (from pp. 182 on) and 4 (pp. 32–605) cover the period from the Black Death’s first appearance in Messina in October 1347 to 1600. Vol. 2 covers the last two major plague waves in Italy: 1629–1633 and 1656–1657. Originally published 1865–1894.
Find this resource:
Creighton, Charles. A History of Epidemics in Britain. 2 vols. With additional material by D. E. C. Eversley, E. Ashworth Underwood, and Lynda Overnall. London: Cass, 1965.
Save Citation »Export Citation »E-mail Citation »
Vol. 1 considers epidemics in English history from the plague of Bede (664–684) to the Great Plague of London in 1665; concentrates on the Black Death and its recurrent waves. It surveys chronicles, manuscripts, and archival records. Originally published 1891–1894.
Find this resource:
Haeser, Heinrich. Geschichte der epidemischen Krankheiten im Lehrbuch der Geschichte der Medizin und der epidemischen Krankheiten. 3 vols. Jena, Germany: Hermann Dufft, 1875–1882.
Save Citation »Export Citation »E-mail Citation »
Principally vol. 3, Book 2: “The plague epidemics of the fourteenth century” (97–187), surveys theories of the origins of the plague; spread of the disease through Europe, including Russia, Hungary, and Poland, with dates of arrival (according to the chronicle evidence); some demographic estimates, aetiology, and social and moral consequences, such as the flagellants and massacres of Jews; followed by fourteen contemporary sources in the original languages.
Find this resource:
Herlihy, David. The Black Death and the Transformation of the West. Edited by Samuel Cohn Jr. Cambridge, MA: Harvard University Press, 1997.
Save Citation »Export Citation »E-mail Citation »
Three short analytical chapters on the character of the disease, change in economic and demographic systems of Europe, and modes of thought; utilizes a wide variety of primary sources from saints’ lives to statistical analyses of tax records.
Find this resource:
Ziegler, Philip. The Black Death. London: Collins, 1969.
Save Citation »Export Citation »E-mail Citation »
Describes various aspects of the plague placed within national contexts. Most chapters, however, concentrate on England and English sources. The book offers a wide body of published sources considering diverse topics such as the plague’s spread, mortality rates, and the psychological consequences of the Black Death. Its analysis, however, is limited mostly to the years 1347–1352. Reprinted with a new preface in 2003.
Find this resource:
Reference Works

Black Death and plague feature prominently in general encyclopedias of medical history, the history of disease, and textbooks and manuals on infectious diseases. Cook and Zumla 2009, Kiple 1993, and Kohn 2007 all feature studies on the plague (Yersinia pestis), and chapters on it begin with short introductions on the three pandemics of plague: the Justinianic plague of the 6th century; the Black Death of 1347 to the plague of Marseilles, 1720; and the third pandemic, set off in Hong Kong in 1894 when the Swiss biologist, Alexandre Yersin, first correctly cultured the bacillus of this subtropical rodent disease in which “humans occasionally participate,” as the microbiologist Robert Koch described it in 1900. None of these medical textbooks, however, mention that scientists and historians over the past two decades have begun to question the match between the pathology and epidemiology of the first two pandemics on the one hand, and the third on the other.

Cook, Gordon C., and Alimuddin I. Zumla, eds. Manson’s Tropical Diseases. 22d ed. Edinburgh: Saunders Elsevier, 2009.
Save Citation »Export Citation »E-mail Citation »
The most recent edition of Manson’s Tropical Diseases, begun by Patrick Manson in 1898, which has become a standard handbook for healthcare workers in tropical and subtropical countries. As with other texts on infectious diseases, this one fails to reflect the current debate that questions the identity of historical plague.
Find this resource:
Kiple, Kenneth F. ed. The Cambridge World History of Human Disease. Cambridge, UK: Cambridge University Press, 1993.
Save Citation »Export Citation »E-mail Citation »
This is a more up-to-date and reliable guide to the history of disease and plague than Kohn 2008, with chapters on plague, sanitation, and public health (Carmichael, pp. 192–199) and diseases of the Renaissance and early modern Europe (Carmichael, pp. 279–286), which highlight plague.
Find this resource:
Kohn, George Childs, ed. Encyclopedia of Plague and Pestilence: From Ancient Times to the Present. 3d ed. New York: Facts On File, 2007.
Save Citation »Export Citation »E-mail Citation »
Despite its title, this is an encyclopedia of diseases in history. Only a few pages are devoted to the Black Death; later instances of plague and Black Death are listed by city. For plague in Florence, for example, those epidemics of 1347–1348, 1417, 1430, and 1630–1633 are entered. There is no explanation of why these plague years and not others were chosen.
Find this resource:
Collections Of Papers

Collections of essay such as Bulst and Delort 1989 and Nutton 2008 have focused on the medical and epidemiological aspects of late medieval and early modern plague.

Bultst, Neithard, and Robert Delort. Maladies et société (XIIe–XVIIIe siècle): Actes du colloque de Bielefeld, novembre 1986. Paris: Presses de CNRS, 1989.
Save Citation »Export Citation »E-mail Citation »
Examines Black Death and early modern plague in a comparative context with other epidemic diseases afflicting Europe. The character of the diseases and the measures used to combat them are discussed.
Find this resource:
Nutton, Vivian, ed. Pestilential Complexities: Understanding Medieval Plague. London: Wellcome Trust Centre for the History of Medicine at UCL, 2008.
Save Citation »Export Citation »E-mail Citation »
Presentation of a wide variety of positions on the character of historic plague by specialists in pathology, microbiology, paleoarchaeology, and history.
Find this resource:
Sources

There are few collections of sources of the Black Death or subsequent waves of plagues in the original languages (the most prominent exception being Sudhoff 1910–1925 on plague tracts). Also see the Aragonese documents 1348 to 1384 (López de Meneses 1956). In the last fifteen years, however, a number of source collections have appeared in translation, principally in English; most prominent of these is Horrox 1994, and more recently there is Aberth 2005. For German translations of a wide variety of documents on the Black Death, see Bergdolt 1989.

Aberth, John, ed. The Black Death. The Great Mortality of 1348–1350: A Brief History with Documents. Boston: Bedford/St. Martin’s, 2005.
Save Citation »Export Citation »E-mail Citation »
A useful supplement to Horrox 1994; translations mainly of chronicles and secondary plague tracts but includes a wider continental focus, even into Byzantium and the Near East, and more unpublished documents such as last wills and testaments and governmental documents during the plague.
Find this resource:
Bergdolt, Klaus, ed. and trans. Die Pest 1348 in Italien: fünfzig zeitgenössische Quellen. Heidelberg, Germany: Manutius Verlag, 1989.
Save Citation »Export Citation »E-mail Citation »
Fifty short translations from Latin and Italian into German of mostly published sources from 1348 and shortly thereafter, mainly from chronicles, plague tracts, and a few letters.
Find this resource:
Horrox, Rosemary, ed. The Black Death. Manchester, UK: Manchester University Press, 1994.
Save Citation »Export Citation »E-mail Citation »
125 translations—largely from published sources from Italy, France, and central Europe but mainly from England—divided into three parts: narrative accounts, explanations and responses, and consequences. Includes medical, astrological, and religious reactions, the flagellants, burning of Jews, government regulations, and attitudes toward children and labor. Excellent annotations.
Find this resource:
López de Meneses, Amada. Documentos acerca de la peste negra en los dominios de la Corona de Aragón. Saragossa, Spain: Heraldo de Aragón, 1956.
Save Citation »Export Citation »E-mail Citation »
Transcriptions of 157 documents from the archives of the Aragonese crown from 20 April 1348 to 4 May 1384 on a wide range of issues, from the distribution of properties abandoned during the Black Death to persecution of Jews from Barcelona to Mallorca.
Find this resource:
Sudhoff, Karl. “Pestschriften aus den ersten 150 Jahren nach der Epidemie des ‘schwarzen Todes’ 1348.” Archiv für Geschichte der Medizin 6–17 (1910–1925).
Save Citation »Export Citation »E-mail Citation »
Abridged editions of 288 plague tracts from physicians or medical faculties from 1348 to 1500. Often historians have taken this sample as the total production of surviving physicians’ plague tracts or as a representative sample of them across Europe: it is neither. Tracts from France are poorly represented, while those from German-speaking regions are over-represented. These editions range from incipits to what appears to be entire texts. Despite its limitations, this is an indispensable source for the history of medicine and the Black Death.
Find this resource:
British Isles

The British Isles have shown a lively interest in Black Death and plague, ranging from popular introductions such as Cantor 2001 to works by bacteriologists such as Shrewsbury 1970. Works by historians such as Gottfried 1978 and Slack 1990 show interdisciplinary approaches for understanding the demography and psychology of plague.

Cantor, Norman. In the Wake of the Plague: The Black Death and the World It Made. New York: Simon and Schuster, 2001.
Save Citation »Export Citation »E-mail Citation »
Concentrates on the Black Death and its immediate aftermath, principally in England and especially for changes in servility and land tenure; written with verve but of little scholarly value.
Find this resource:
Gottfried, Robert S. Epidemic Disease in Fifteenth-Century England: The Medical Response and the Demographic Consequences. New Brunswick, NJ: Rutgers University Press, 1978.
Save Citation »Export Citation »E-mail Citation »
Employs quantitative methods to examine last wills and testaments gathered from eastern England from 1430 to 1480 and to chart the chronology and seasonality of plague. Compares these trends with impressions gained from contemporary literature. Explains the rise in population of the 1470s as the consequence of higher fertility and not a decline in mortality.
Find this resource:
Shrewsbury, J. F. D. A History of Bubonic Plague in the British Isles. Cambridge, UK: Cambridge University Press, 1970.
Save Citation »Export Citation »E-mail Citation »
Surveys the plague in the British Isles, but principally England from 1348 to 1665. Concentrates on “The Great Pestilence” of 1348 from the perspective of a bacteriologist, arguing that the disease was bubonic, not pneumonic plague, and was dependent on rats and their fleas. Questions the contemporary sources because they do not accord with the epidemiology of Yersinia pestis as seen in the 20th century.
Find this resource:
Slack, Paul. The Impact of Plague in Tudor and Stuart England. 2d ed. Oxford: Oxford University Press, 1990.
Save Citation »Export Citation »E-mail Citation »
Analyzes patterns of plague mortalities from 1486 to England’s last major strike of plague in 1665. Concentrates on towns, comparing mortality trends and the social impact of plagues in provincial cities—such as Norwich, Bristol, Carlisle—with the metropolitan center. Along with administrative sources such as bills of mortality, the work makes extensive use of plague writings by doctors and others to ferret out attitudes toward catastrophe, medicine, and death.
Find this resource:
Italy

Numerous works such as Bowsky 1964, Carpentier 1962, and Herlihy 1967 analyze the Black Death’s impact on government, economy, morality, and religion.

Bowsky, William. “The Impact of the Black Death upon Sienese Government and Society.” Speculum 39 (1964): 1–34.
DOI: 10.2307/2850126Save Citation »Export Citation »E-mail Citation »
Uses a wide range of narrative and archival administrative records to analyze the impact of the Black Death on the Sienese economy and government. Holds that the Black Death created conditions contributing to the fall of the Sienese banking oligarchy called “the Nine.”
Find this resource:
Carpentier, Élisabeth. Une ville devant la peste: Orvieto et la Peste Noire de 1348 Démographie et sociétés 7. Paris: S.E.V.P.E.N., 1962.
Save Citation »Export Citation »E-mail Citation »
From published and archival sources investigates social, political, economic, and moral conditions before, during, and after the Black Death, concluding that the nobility were driven to brigandage and also to become condottieri.
Find this resource:
Herlihy, David. Medieval and Renaissance Pistoia: The Social History of an Italian Town, 1200–1430. New Haven, CT: Yale University Press, 1967.
Save Citation »Export Citation »E-mail Citation »
The Black Death and successive plagues of the 14th century are the prime movers of the economic, social, political, religious, and cultural transformations of this region in central Italy and for the transition from the Middle Ages to the Renaissance.
Find this resource:
France

Works on plague in France have profited from the Annales school of history, utilizing demographic and epidemiological methods for historical research as seen in Biraben 1976 and Lucenet 1985.

Biraben, Jean-Noël. Les hommes et la peste en France et dans les pays européens et méditerranéens. 2 vols. Civilisations et Sociétés 35–36. Paris: Mouton, 1976.
Save Citation »Export Citation »E-mail Citation »
Hailed as the most comprehensive and important 20th-century work on historical plague. Combines the expertise of a practicing physician with historical training in the Annales school. Uses sources across western Europe but concentrates on France, concluding with the plague of Marseilles in 1720.
Find this resource:
Lucenet, Monique. Les grandes pestes en France. Paris: Aubier, 1985.
Save Citation »Export Citation »E-mail Citation »
Surveys the demographic, economic, and cultural consequences of the Black Death and subsequent waves of plague through the 15th century, with specific demographic figures across various regions of France.
Find this resource:
German-Speaking Regions

Works on German-speaking regions range from overviews such as Hoeniger 1882 to archivally focused studies of individual towns or regions such as Höhl 2002.

Hoeniger, Robert. Der schwarze Tod in Deutschland: Ein Beitrag zur Geschichte des vierzehnten Jahrhunderts. Berlin: Eugen Grosser, 1882.
Save Citation »Export Citation »E-mail Citation »
Concentrates on the nature of the disease and its spread throughout Germany, medical thought, and the relationship between the plague and the massacres of Jews. Includes a transcription of the full text of the plague tract of 1382 by the French papal physician Chalin de Vinario.
Find this resource:
Höhl, Monika. Die Pest in Hildesheim: Krankheit als Krisenfaktor im städtischen Leben des Mittelalters und der Frühen Neuzeit (1350–1750). Hildesheim, Germany: Stadtarchiv, 2002.
Save Citation »Export Citation »E-mail Citation »
Charts the interaction of plague, economy, society, and mentality in the town of Hildesheim over four centuries.
Find this resource:
Scandinavian Countries

Works on plague in Scandinavian countries have relied on much less documentation than is available in most other western European countries. Nonetheless, works such as Benedictow 1992 have made bold claims from these limited source materials. Others such as Karlsson 1996 have turned to archaeological studies.

Benedictow, Ole Jørgen. Plague in the Late Medieval Nordic Countries: Epidemiological Studies. Oslo, Norway: Middlealderforlaget, 1992.
Save Citation »Export Citation »E-mail Citation »
Draws bold conclusions based on source materials that are much more limited than in England or places in Continental Europe (especially Italy) to argue that the Black Death and subsequent waves of plague up to the 15th century were Yersinia pestis—bubonic and not pneumonic plague.
Find this resource:
Karlsson, Gunnar. “Plague without Rats: The Case of Fifteenth-Century Iceland.” Journal of Medieval History 22/23 (1996): 263–284.
DOI: 10.1016/S0304-4181(96)00017-6Save Citation »Export Citation »E-mail Citation »
Based on archaeological and epidemiological evidence; argues strenuously that plague (which did not reach Iceland until the early 15th century) was not a rat-based disease. Concludes that the pneumonic plague form of Yersinia pestis “requires the fewest ‘tricks’ on Nature.”
Find this resource:
Spain

Works from Spanish historians such as Betrán 1996, Carreras Panchón 1976, Rubio 1979, and Günzberg Moll 2002 have used a wide range of archival sources such as last wills and testaments and narrative sources to study the epidemiology of plague, the evolution of public health, and the economic and cultural consequences of plague from the Black Death to the early modern period.

Betrán, José Luis. La peste en la Barcelona de los Austrias. Lleida, Spain: Milenio, 1996.
Save Citation »Export Citation »E-mail Citation »
With a wide range of archival sources such as last wills and testaments, notary records, and especially governmental decrees, this work traces the history of plague in the region of Barcelona from the Black Death through the early modern period.
Find this resource:
Carreras Panchón, Antono. La peste y los médicos en la España del Renacimiento. Salamanca, Spain: Universidad, Instituto de Historia de la Medicina Española, 1976.
Save Citation »Export Citation »E-mail Citation »
Concentrates on plague in Spain during the 15th and 16th centuries with an emphasis on plague writing and preventative measures.
Find this resource:
Rubio, Agustín. Peste Negra, crisis y comportamientos sociales en la España del siglo XIV: La cuidad de Valencia (1348–1401). Granada, Spain: Universidad de Granada, 1979.
Save Citation »Export Citation »E-mail Citation »
Uses archival sources such as last wills and testaments and government regulations to investigate the seasonality of the plague, mortality trends over the second half of the 14th century, infant mortality, government reactions, and economic consequences such as wage and price trends in the region of Valencia.
Find this resource:
Günzberg Moll, Jordi. Vida quotidiana a la ciutat de Barcelona Durant la pesta negra (1348). Episodis de la història 329. Barcelona, Spain: Rafael Dalmau, 2002.
Save Citation »Export Citation »E-mail Citation »
Concentrates on last wills and testaments to assess the changes in customs and mentality in Barcelona immediately after the Black Death.
Find this resource:
Eastern Europe And Russia

Fewer studies of plague in eastern Europe and Russia have appeared than in most western European countries. Works such as Alexander 1986 have studied plagues in Russia and eastern Europe that increased in number after 1570 and the public health measures of the 18th century to combat them.

Alexander, John T. “Reconsiderations on Plague in Early Modern Russia, 1500–1800.” Jahrbucher für Geschichte Osteuropas 34 (1986): 244–254.
Save Citation »Export Citation »E-mail Citation »
Explains Russian plagues after 1570 as the result of territorial expansion and trade with the Ottoman Empire. Catherine II developed plague controls based on guidelines that had been practiced in places such as Italy since the 16th century.
Find this resource:
Middle East

Historians of plague in the Middle East such as Dols 1977 and Borsch 2005 have tried to uncover the reasons why reactions to the Black Death and plagues of the late Middle Ages and early modern period differed here so fundamentally from those seen throughout most of western Europe. Scholars such as Panzac 1986 have turned to the later plagues in the Middle East of the 17th to the 19th century to analyze demographic trends and health control measures.

Borsch, Stuart J. The Black Death in Egypt and England: A Comparative Study. Austin: University of Texas Press, 2005.
Save Citation »Export Citation »E-mail Citation »
Agrees with Dols and others that the Black Death was the pivotal moment of Middle Eastern decline. But the study rejects religion as pivotal for understanding the different reactions to the Black Death between the East and West; instead, the land-tenure system of the Mamluks accounted for the critical difference in post-Black Death developments in the East.
Find this resource:
Dols, Michael. The Black Death in the Middle East. Princeton, NJ: Princeton University Press, 1977.
Save Citation »Export Citation »E-mail Citation »
Argues that the Black Death was more devastating, demographically and economically, in the Middle East than in Europe. Also argues that in the last decade of the 14th century, the Mamluk Sultanate “was plunged into a general crisis from which it would never fully recover,” and that Muslim medicine faced the plague with far greater fatalism than in the West.
Find this resource:
Panzac, Daniel. “Alexandrie: peste et croissance urbaine (XVIIe–XIXe siècle).” Revue de l’Occident Musulman et de la Méditéranée 46 (1986): 81–89.
Save Citation »Export Citation »E-mail Citation »
Charts the relationships of plague and demographic growth from 1650 to the mid-19th century.
Find this resource:
Plague Studies Over The Long Term

Several works have surveyed the history of plague from the Black Death to the last big plagues in western Europe (such as Naphy and Spicer 2000) or even over the longer term (such as Brossollet and Mollaret 1994) from the Justinianic plague of the mid-6th century to Yersinia’s discovery at the end of the 19th century

Brossollet, Jacqueline, and Henri Mollaret. Pourquoi la peste? le rat, la puce et le bubon. Paris: Gallimard, 1994.
Save Citation »Export Citation »E-mail Citation »
A short and richly illustrated survey of plague from Procopius’s account in the 6th century to Yersinia’s discovery in 1894 by two microbiologists.
Find this resource:
Naphy, William, and Andrew Spicer. The Black Death and the History of Plagues, 1345–1730. Stroud, UK: Tempus, 2000.
Save Citation »Export Citation »E-mail Citation »
Richly illustrated but without notes; considers the history of plague in Europe from the Black Death to the plague of Marseilles with an afterword on the history of other diseases into the 20th century.
Find this resource:
Character Of The Disease

Even though historians such as David Herlihy, J. F. D. Shrewsbury, and Ann Carmichael found inconsistencies between descriptions of the Black Death and successive bouts of plague through the early modern period with characteristics of Yersinia pestis, few (if any) had questioned the character of historic plague until Graham Twigg’s work (see England). The appearance of buboes and spitting of blood were enough to conclude that the late medieval and early modern plagues were the rodent-based Yersinia pestis spread by rats and their fleas, despite any evidence of epizootics of rats or other rodents immediately preceding or accompanying human plague. From textbook characteristics of the subtropical rodent-based Yersinia pestis historians have imputed characteristics of this disease to describe plague from 1348 to the 18th century: when evidence from the past has failed to accord with characteristics of Yersinia pestis in the 20th century, these historians have tended either to criticize the sources or to discard them altogether. After being initially rejected or ignored, in the late 1990s Twigg’s thesis began to stimulate a vigorous debate, and it sparked new research using models of epidemiology and techniques for recovering ancient-DNA from dental pulp of skeletons believed to be buried in Black Death (and later plague) pits.

Scientific Contributions Using Ancient DNA

Those using techniques to uncover ancient DNA of Yersinia pestis in dental pulp from grave pits of the Black Death and the early modern period can be divided into two camps. One group—the Marseilles group (Aboudharam, et al. 2005, Raoult, et al. 1998, Raoult 2000, Drancourt and Raoult 2004)—argues their findings prove conclusively that the agent of the Black Death and later European plagues of the early modern period was Yersinia pestis. Others (Antoine 2008, Prentice, et al. 2004, Pusch, et al. 2004, Gilbert, et al. 2004) have criticized these results and the methods employed by this first group. Although they have not denied that the agent could have been Yersinia pestis, the second group maintains that no positive results have yet been recovered from the plague burial sites they have excavated. These include well-known plague pits such as the Royal Mint site in London. Often these papers are technical, absorbed in questions of methods and techniques of detection.

Aboudharam, Gérard, Michel Drancourt, Olivier Dutour, Hélène Martin, Didier Raoult, and Michel Signoli. “Validation de la saisonnalité des décès et authenticité biologique de la nature de l’épidémie.” In La saison d’une peste (avril–septembre 1590). Le cimetière des Fédons à Lambesc (Bouches-du-Rhone). Edited by Bruno Bizot, Dominique Castex, Patrick Reynaud, and Michel Signoli, 63–67. Paris: CNR Editions, 2005.
Save Citation »Export Citation »E-mail Citation »
Argues that the DNA of Yersinia pestis has been recovered from dental pulp of plague victims in these graves that date back to 1590.
Find this resource:
Antoine, Daniel. “The Archaeology of ‘Plague’.” In Pestilential Complexities: Understanding Medieval Plague. Edited by Vivian Nutton, 101–114. London: Wellcome Trust Centre for the History of Medicine at UCL, 2008.
Save Citation »Export Citation »E-mail Citation »
Shows the complexities and problems of detecting ancient DNA of Yersinia pestis from the teeth of Black Death victims and questions the conclusions of the Marseilles group.
Find this resource:
Drancourt, Michel, and Didier Raoult. “Molecular Detection of Yersinia pestis in Dental Pulp.” Microbiology 150 (2004): 263–264.
DOI: 10.1099/mic.0.26885-0Save Citation »Export Citation »E-mail Citation »
Defends methods for detecting the DNA of Yersinia pestis from Black Death corpses.
Find this resource:
Gilbert, M. T. P., Jon Cuccui, William White, Niels Lynnerup, Richard W. Titball, Alan Cooper, and Michael B. Prentice. “Absence of Yersinia pestis–specific DNA in Human Teeth from Five European Excavations of Putative Plague Victims.” Microbiology 150 (2004): 341–354.
DOI: 10.1099/mic.0.26594-0Save Citation »Export Citation »E-mail Citation »
Reports the absence of Yersinia pestis DNA in five plague sites across Europe.
Find this resource:
Prentice, Michael B., T. Gilbert, and A. Cooper. “Was the Black Death Caused by Yersinia pestis?” Lancet: Infectious Diseases 4.2 (2004): 72.
DOI: 10.1016/S1473-3099(04)00923-5Save Citation »Export Citation »E-mail Citation »
Shows the problems of detecting ancient DNA of Yersinia pestis from late medieval and early modern graves and argues that the investigations into well-known plague pits have thus far recovered no positive results.
Find this resource:
Pusch, Carsten, Lila Rahalison, Nikolaus Blin, Graeme J. Nicholson, and Alfred Czarnetzki. “Yersinial F1 Antigen and the Cause of Black Death.” Lancet: Infectious Diseases 4 (2004): 484–485.
DOI: 10.1016/S1473-3099(04)01099-0Save Citation »Export Citation »E-mail Citation »
From German gravesites, questions the conclusions and methods of the Marseilles group.
Find this resource:
Raoult, Didier, Gérard Aboudharam, Eric Crubézy, Georges Larrouy, Bertrand Ludes, and Michel Drancourt. “Detection of 400-year-old Yersinia pestis DNA in Human Dental Pulp: An Approach to the Diagnosis of Ancient Septicemia.” Proceedings of the National Academy of Sciences 95 (October 1998): 12637–12640.
DOI: 10.1073/pnas.95.21.12637Save Citation »Export Citation »E-mail Citation »
Argues that the DNA of Yersinia pestis has been recovered from dental pulp in 16th-century French plague pits.
Find this resource:
Raoult, Didier. “Molecular Identification by ‘Suicide PCR’ of Yersinia pestis as the Agent of Medieval Black Death.” Proceedings of the National Academy of Sciences 97 (2000): 12800–12803.
DOI: 10.1073/pnas.220225197Save Citation »Export Citation »E-mail Citation »
Defends methods for detecting the DNA of Yersinia pestis from ancient plague victims and claims to have found it in the teeth of a child and two adults in plague graves of Montpellier dating to the mid-14th century.
Find this resource:
Epidemiology, Signs, and Symptoms

The arguments for and against the Black Death and successive waves of plague through the early modern period have focused more on the epidemiological and symptomatic evidence, where in fact historians can better contribute to the debate by utilizing a wide variety of historical sources, both narrative and archival, that lend themselves to statistical analysis. From these sources, works from historians and epidemiologists such as Cohn 2002 and Christakos, et al. 2005 have measured not only the speed of the disease’s transmission and how it spread from town to town and across regions of Europe but also its seasonality, plague cycles, and mortality trends indicating patterns of adaptation between human hosts and pathogen and characteristics of victims (their ages, sex, wealth, occupations). In addition, works from historians such as Cohn 2009 and Carmichael 2008 have examined the numbers, positions, and types of swelling and other skin disorders and various symptoms. Others such as Nutton 2008 have questioned the significance of ascertaining the ancient DNA of the Black Death for understanding historic plague.

Carmichael, Ann. “Universal and Particular: The Language of Plague, 1348–1500.” In Pestilential Complexities: Understanding Medieval Plague. Edited by Vivian Nutton, 43–51. London: Wellcome Trust Centre for the History of Medicine at UCL, 2008.
Save Citation »Export Citation »E-mail Citation »
Examines the rich evidence presented in the Milanese necrologies—physicians’ diagnoses of death for the entire urban population—and contends that this evidence shows the unmistakable signs and symptoms of bubonic plague (Yersinia pestis).
Find this resource:
Christakos, George, Ricardo A. Olea, Marc L. Serre, Hwa-Lung Yu, and Lin-Lin Wang. Interdisciplinary Public Health Reasoning and Epidemic Modelling: The Case of Black Death. Berlin: Springer, 2005.
Save Citation »Export Citation »E-mail Citation »
From primary sources across Europe, uses stochastic modeling to chart the transmission, speed, and mortality of the Black Death from 1347 to 1352. Creates “space-time” maps, showing that the propagation velocity of plague spread at an order of magnitude faster than that of modern bubonic plagues overland, even in the Indian subcontinent, where it spread most devastatingly and vastly in modern times from 1896 to 1920.
Find this resource:
Cohn, Samuel K., Jr. The Black Death Transformed: Disease and Culture in Early Renaissance Europe. London: Hodder, 2002.
Save Citation »Export Citation »E-mail Citation »
From narrative sources and archival records such as last wills and testaments, necrologies, and burial records, argues that no matter what the pathogen may have been, the epidemiology of the Black Death and successive waves of plague to 1500 were significantly different from Yersinia pestis.
Find this resource:
Cohn, Samuel K., Jr. Cultures of Plague: Medical Thought at the End of the Renaissance. Oxford: Oxford University Press, 2009.
Save Citation »Export Citation »E-mail Citation »
From an investigation of 8000 plague cases examined by physicians at Milan from 1452 to 1523. Chapter 2 concludes that the signs and symptoms of the early modern plague were significantly different from any observed since Yersinia’s discovery in 1894.
Find this resource:
Nutton, Vivian. “Introduction.” In Pestilential Complexities: Understanding Medieval Plague. Edited by Vivian Nutton, 1–16. London: Wellcome Trust Centre for the History of Medicine at UCL, 2008.
Save Citation »Export Citation »E-mail Citation »
Goes against the views of scholars such as Michael Drancourt and Lars Walløe, who argue that once it is agreed that the agent of historic plague was Yersinia pestis, the debate is over. Holds that this identification “adds very little to what the historian could gain from the sources” and “is unhelpful and potentially misleading.”
Find this resource:
England

The debate on the epidemiology of plague and the character of the disease has been most hotly debated from English sources both for the latter Middle Ages (Twigg 1984, Theilman and Cate 2007) and the early modern period (Scott and Duncan 2001). See also British Isles.

Scott, Susan, and Christopher J. Duncan. Biology of Plagues: Evidence from Historical Populations. Cambridge, UK: Cambridge University Press, 2001.
DOI: 10.1017/CBO9780511542527Save Citation »Export Citation »E-mail Citation »
From epidemiological models and evidence from northern England using parish burial records and family reconstruction techniques, argues that the Black Death and later historic plagues were not Yersinia pestis but hemorrhagic plague similar to recent outbreaks of ebola in Sudan and Zaire.
Find this resource:
Theilmann, John, and Frances Cate. “A Plague of Plagues: The Problem of Plague Diagnosis in Medieval England.” Journal of Interdisciplinary History 37.3 (2007): 371–393.
DOI: 10.1162/jinh.2007.37.3.371Save Citation »Export Citation »E-mail Citation »
Is critical of recent studies that question whether the Black Death was Yersinia pestis. Revives older claims that the much greater rates of mortality and speed and efficiency of transmission of the Black Death can be explained by (1) a combination of various diseases striking at the same moment, (2) pneumonic plague, and (3) pulex irritans as the flea vector.
Find this resource:
Twigg, Graham. The Black Death: A Biological Reappraisal. London: Batsford, 1984.
Save Citation »Export Citation »E-mail Citation »
Principally from English evidence, argues that the epidemiology of the Black Death and successive plagues differed significantly from that of Yersinia pestis, especially in regard to the speed of transmission, contagion, and the seasonality of the two plague epochs.
Find this resource:
Italy

The work of Ann Carmichael has been central to understanding the signs, symptoms, and epidemiology of Italian plagues for the late Middle Ages (Carmichael 1986) and the early modern period (Carmichael 1998).

Carmichael, Ann G. Plague and the Poor in Renaissance Florence. Cambridge, UK: Cambridge University Press, 1986.
Save Citation »Export Citation »E-mail Citation »
From Florentine archival sources—the Catasto of 1427 and Libri dei morti—argues that the Black Death and plagues of the early 15th century were bubonic plague (Yersinia pestis), combined with other diseases, including smallpox and measles. These other diseases account for the plague’s high contagion, rapid spread, and combination of various skin disorders such as black bumps.
Find this resource:
Carmichael, Ann G. “Epidemics and State Medicine in Fifteenth-century Milan.” In Medicine from the Black Death to the French Disease. Edited by Roger French, Jon Arrizabalaga, and Andrew Cunningham, 221–247. Aldershot, UK: Ashgate, 1998.
Save Citation »Export Citation »E-mail Citation »
In this essay, along with other articles, Carmichael has examined the rich public health archives of the Milanese state during the second half of the 15th and early 16th centuries to investigate the clinical practices of Milanese doctors who examined plague corpses.
Find this resource:
Northern Europe and German-Speaking Regions

The quantitative epidemiological research of Eckert 1996 has explored the patterns of plague transmission in central Europe.

Eckert, Edward A. The Structure of Plagues and Pestilences in Early Modern Europe: Central Europe, 1560–1640. Basel, Switzerland: Karger, 1996.
Save Citation »Export Citation »E-mail Citation »
A quantitative analysis of 850 parish burial records plotting the spatial-temporal distribution of plague sites in seven successive plague cycles from 1560 to 1640; discerns two patterns of transmission: a maritime pattern based on long-range ship transport and an internal one with decade-long waves that spread throughout most of northern Europe.
Find this resource:
Scandinavia

Despite the paucity of sources for Scandinavian countries, especially ones that lend themselves to quantitative analysis, research and debate on the character of historic plague has been particularly vigorous, as seen in Moseng 2009 and Walløe 1995.

Moseng, Ole Georg. “Climate, Ecology and Plague: The Second and Third Pandemic Reconsidered.” In Living with the Black Death. Edited by Bisgaard, Lars and Leif Søndergaard, 23–46. Odense; University Press of Southern Denmark, 2009.
Save Citation »Export Citation »E-mail Citation »
In contrast to those who argue that plagues past and present are easily identifiable and that the signs of the two plague epochs are “unmistakable,” this work follows Pollitzer on 20th-century plague and argues that plague is “so protean” that any generalizations are misleading. Nonetheless, Moseng concludes that, despite the manifold variations and protean nature of modern plague, the Black Death must have been Yersinia pestis.
Find this resource:
Walløe, Lars. Plague and Population: Norway 1350–1750. Oslo, Norway: Det Norske Videnskaps-Akademi, 1995.
Save Citation »Export Citation »E-mail Citation »
Argues from clinical evidence in chronicles and physicians’ tracts that the disease was a combination of bubonic and pneumonic plague and that the flea vector was probably the human flea.
Find this resource:
The Justinianic Plague

Because of the paucity of sources, study of the character of the Justinianic plague has not been as rich as that of the Black Death and early modern plague. Little 2007 has, however, brought this plague into the debate on the character of historic plague.

Little, K. Lester, ed. Plague and the End of Antiquity: The Pandemic of 541–750. Cambridge, UK: Cambridge University Press, 2007.
Save Citation »Export Citation »E-mail Citation »
Although the Justinianic plague is the subject of this book, many of the essays compare descriptions from this much less documented plague with that of the Black Death, concluding that both were Yersinia pestis.
Find this resource:
Plague And Medical Thought

Literature on plague and medical thought focuses on a new genre of plague writing that, in effect, begins with the Black Death, the plague tractatus. Considerations of this literature, which especially in countries north of the Alps engaged theologians as well as university-trained physicians, splits into two branches: one centered on the Black Death with forays into the 15th century and the other on the 16th and 17th centuries. When these tracts are considered over the long term, this historiography has stressed continuity, not change.

Plague Tracts of the Black Death and Later Middle Ages

Most analysis of plague writing turns on the origins of the genre with the Black Death and the years immediately afterward (see Arrizabalaga 1994, Campbell 1931, Chase 1985, and Coville 1938). Several have investigated changes in the genre (Cohn 2002, Sanger 1916; others have branched beyond the tracts of Christian Europe to compare these with Jewish (Barkai 1998) and Islamic tracts (Conrad 1981).

Arrizabalaga, Jon. “Facing the Black Death: Perceptions and Reactions of University Medical Practitioners.” In Practical Medicine from Salerno to the Black Death. Edited by Luis García-Ballester, Roger French, Jon Arrizabalaga, and Andrew Cunningham, 237–288. Cambridge, UK: Cambridge University Press, 1994.
Save Citation »Export Citation »E-mail Citation »
Analyzes the earliest plague treatises of the Black Death, maintaining that the concept of contagion was present at the outset and was not a later development showing “city laymen’s ‘healthy’ empiricism” as “opposed to the aerist and miasmatic views of university physicians.”
Find this resource:
Barkai, Ron. “Jewish Treatises on the Black Death (1350–1500): A Preliminary Study.” In Medicine from the Black Death to the French Disease. Edited by Roger French, Jon Arrizabalaga, Andrew Cunningham, and Luis García-Ballester, 6–25. Aldershot, UK: Ashgate, 1998.
Save Citation »Export Citation »E-mail Citation »
Claims that Jewish physicians produced a great quantity of plague treatises for the late Middle Ages (but names only five); these did not mention contagious nature of the plague and described the causes of the plague mostly as God’s punishment.
Find this resource:
Campbell, Anna. The Black Death and Men of Learning. New York: Columbia University Press, 1931.
Save Citation »Export Citation »E-mail Citation »
Concentrates on fourteen plague tracts of the Black Death period (1348 to c. 1350, including one Muslim tract) with a few after the second plague such as John of Burgundy’s in 1365. Considers their reliance on ancient and earlier Arabic authorities such as Avicenna and astrology; also examines the Black Death’s effect on lawsuits, universities, and education in the second half of the 14th century.
Find this resource:
Chase, Melissa P. “Fevers, Poisons, and Apostemes: Authority and Experience in Montpellier Plague Treatises, 153–169.” In Science and Technology in Medieval Society. Edited by Pamela O. Long. New York: New York Academy of Sciences, 1985.
Save Citation »Export Citation »E-mail Citation »
One of the few essays to investigate plague tracts not abridged in the Sudhoff collections. Concentrates on the earliest Montpellier tracts and maintains that the concept of contagion was a novelty of Black Death plague tracts, distinguishing them from earlier discussions of epidemics by Avicenna and previous authorities.
Find this resource:
Cohn, Samuel. The Black Transformed: Disease and Culture in Early Renaissance Europe. London: Arnold, 2002.
Save Citation »Export Citation »E-mail Citation »
Stresses change in medical writing on plague from the Black Death to successive waves of plague, from utter despondency to confidence in curing the disease.
Find this resource:
Conrad, Lawrence I. “Arabic Plague Chronologies and Treatises: Social and Historical Factors in the Formation of a Literary Genre.” Studia Islamica 54 (1981): 51–93.
Save Citation »Export Citation »E-mail Citation »
Focuses on the plague tract of Ibn Abi Hajala, written between 1362 and 1375, the earliest known from the eastern lands of Islam, which contains details of pestilential signs and symptoms.
Find this resource:
Coville, Alfred. “Écrits contemporains sur la peste de 1348 à 1350.” In Histoire littéraire de la France. Vol. 37, pp. 325–390. Paris: Imprimerie Nationale, 1938.
Save Citation »Export Citation »E-mail Citation »
Survey of late medieval literature on plague in France, focusing on plague treatises but including poetry, letters, and religious writing. Stresses the importance of and differences between the Montpellier and Parisian tracts. A useful corrective to Sudhoff’s neglect of French medical writing.
Find this resource:
Singer, Dorothea Waley. “Some Plague Tractes (Fourteenth and Fifteenth Centuries).” Proceedings of the Royal Society of Medicine 9.2 (1916): 159–214.
Save Citation »Export Citation »E-mail Citation »
One of the few essays to discuss change over the first two centuries of plague, maintaining that “the doctrine of miasma shakes off its temporary association with astrology, while phlebotomy yields to other prophylactic and therapeutic measures.”
Find this resource:
Plague Writing of the Renaissance and Early Modern Period

With printing, writing on plague increased dramatically and, in places such as Italy, began to fantail to a broad community of writers beyond academic physicians and the occasional cleric. Interest in the rhetoric, style, and storytelling of these publications has been a relatively new interest of historians of medicine and others. For analysis of the genre and its changes in Europe generally, see Maclean 2002, and for the importance of Fracastoro on ideas of contagion, see Nutton 1990.

Maclean, Ian. Logic, Signs, and Nature in the Renaissance: The Case of Learned Medicine. Cambridge, UK: Cambridge University Press, 2002.
Save Citation »Export Citation »E-mail Citation »
Argues for the continuity of Galenic medical education and reasoning (which include approaches to plague) during the Renaissance and early modern period well into the 17th century.
Find this resource:
Nutton, Vivian. “The Reception of Fracastoro’s Theory of Contagion: The Seed That Fell among the Thorns?” OSIRIS, 2d ser. 6 (1990): 196–234.
DOI: 10.1086/368701Save Citation »Export Citation »E-mail Citation »
Although offering more than plague studies, this article highlights Fracastoro’s seminal importance on medical understanding of plague in the second half of the 16th century.
Find this resource:
Treatments North of the Alps

Outside Italy, England (Slack 1979 and Wear 2000) and France (Brockliss and Jones 1997) have been the two major areas for the analysis of early modern plague writing and its significance for medical thought.

Brockliss, Lawrence, and Colin Jones. The Medical World of Early Modern France. Oxford: Oxford University Press, 1997.
Save Citation »Export Citation »E-mail Citation »
Despite claims to break from the “grand narrative” of medical history with progress coming only with the Enlightenment, argues that medical thought and education remained fundamentally Galenic until the end of the 17th century and that the “plague script” remained much the same from Gregory of Tours account in 588 to physicians’ tracts during the plague of Marseilles in 1720.
Find this resource:
Slack, Paul. “Mirrors of Health and Treasures of Poor Men: the Uses of the Vernacular Medical Literature of Tudor England.” In Health, Medicine, and Mortality in the Sixteenth Century. Edited by Charles Webster, 237–273. Cambridge, UK: Cambridge University Press, 1979.
Save Citation »Export Citation »E-mail Citation »
Considers 16th-century English health literature, in which writings on plague constituted the third largest category of medical writing. Sees them as derivative and conservative.
Find this resource:
Wear, Andrew. Knowledge and Practice in English Medicine, 1550–1680. Cambridge, UK: Cambridge University Press, 2000.
Save Citation »Export Citation »E-mail Citation »
A wide reading of medical texts from the Renaissance recovery of Galen in Greek to the English Helmontians of the second half of the 17th century. Argues for continuity in medical thinking over these centuries and with plague in particular. The foundations of Galenic medicine were undermined only after plague had disappeared from England.
Find this resource:
Italy

To date, most work on plague writing has been conducted on Italy from its vast reservoirs of archival and early printed material. Some have stressed continuity or even the absence of any evolution in medical thought (Henderson 1989, Zitelli and Palmer 1980); others have charted change (Carmichael 1991, Cohn 2009, and Preto 1978).

Carmichael, Ann. “Contagion Theory and Contagion Practice in Fifteenth-Century Milan.” Renaissance Quarterly 44 (1991): 213–256.
DOI: 10.2307/2862709Save Citation »Export Citation »E-mail Citation »
Argues that discussions of plague contagion and public health controls postdate the mid–15th century and that in both cases the Milanese were leaders.
Find this resource:
Cohn, Samuel. Cultures of Plague: Medical Thought at the End of the Renaissance. Oxford: Oxford University Press, 2009.
Save Citation »Export Citation »E-mail Citation »
Argues that plague and medical thought about plague evolved from 1348 to the 18th century. One dramatic caesura in thought came with the plague crisis of 1575–1578 in Italy, when academically trained physicians and others challenged old maxims of Renaissance medicine and Galenic principles.
Find this resource:
Henderson, John. “Epidemics in Renaissance Florence: Medical Theory and Government Response.” In Maladies et société (XIIe –XVIIIe siècles): Actes du colloque de Bielefeld novembre 1986. Edited by Neithard Bulst and Robert Delort, 167–186. Paris: Éditions du Centre National de la Recherche Scientifique, 1989.
Save Citation »Export Citation »E-mail Citation »
Stresses continuity in medical thought on plague from the Black Death to the plague of 1522 in Florence.
Find this resource:
Preto, Paolo. Peste e società a Venezia nel 1576. Vicenza: N. Pozza, 1978.
Save Citation »Export Citation »E-mail Citation »
Especially Part 2, “Public Opinion and Popular Sensibility during Plague,” examines principally the plague tracts of 1575–1577 to comment on disputes and popular sentiments such as an underlying anti-Semitism, fear, and persecution of plague spreaders. Concludes that 16th-century physicians did not understand the disease, which Preto assumes was spread by rats and their fleas.
Find this resource:
Zitelli, Andreina, and Richard J. Palmer. “La teorie mediche sulla peste e il contesto veneziano.” In Venezia e la peste 1348–1797. Edited by Orazio Pugliese, 21–28. Venice: Marcilio, 1980.
Save Citation »Export Citation »E-mail Citation »
Argues that medical thought on plague during the late Middle Ages to the early modern period remained trapped in classical theory and did not recognize plague’s contagiousness.
Find this resource:
Plague Prevention and Public Health

Works on plague and public health have concentrated on 17th century Italy. Best known of these are the short books of Carlo M. Cipolla that were written in the 1970s and 1980s on 17th-century Tuscan towns (see Tuscany). At present no study surveys the map or chronology of key institutions such as permanent Public Health Boards or lazaretti or preventive measures such as quarantine, the issuing of plague passports, and other legislative measures. Instead, notable examples have been taken from places such as Milan and Venice during the first hundred years of plague with occasional notes on their developments elsewhere.

Italy

Most work on public health before the 18th century has concerned Italy, which led the way in the public control of infectious diseases and especially plague. Beyond Tuscany, and general surveys (Cosmacini 1988), this work has concentrated on the two leaders in public health: Milan (Albini 1982) and Venice (Palmer 1978, Stevens 2007). More recently, scholars have examined plague and public health measures in other cities, such as Genoa (Benvenuto 1996) and Rome (Fosi 2007).

Albini, Giuliana. Guerra, fame, peste: crisi di mortalità e sistema sanitario nella Lombardia tardomedioevale. Bologna, Italy: Capelli, 1982.
Save Citation »Export Citation »E-mail Citation »
Traces the development of governmental measures and the creation of administrative institutions for combating plague from the 14th-century Visconti government to the 16th century.
Find this resource:
Benvenuto, Grazia. La peste nell’Italia della prima età moderna: Contagio, rimedi, profilassi. Bologna, Italy: CLUEB, 1996.
Save Citation »Export Citation »E-mail Citation »
Part 3, “Strutture,” concentrates on the late 16th and 17th centuries and principally Genoa; considers governmental plague “emergency measures,” such as the news networks of plague outbreaks.
Find this resource:
Cosmacini, Giorgio. Storia della medicina e della sanità in Italia: Dalla peste europea alla guerra Mondiale, 1348–1918. 3d ed. Rome: Laterza, 1988.
Save Citation »Export Citation »E-mail Citation »
Cosmacini’s story of “sanitary systems” covers only the first hundred years following the Black Death with the standard dates of first appearances of Ragusa’s quarantine (a Trentina) in 1377 and Venice’s lazaretto (1423), but little on the spread and development of health board institutions and legislation.
Find this resource:
Fosi, Irene, ed. La Peste a Rome (1656–1657). Rome: Università Roma Tre-CROMA, 2007.
Save Citation »Export Citation »E-mail Citation »
Various essays in this collection stress the effectiveness of plague measures (quarantine, plague hospitals, strict border controls, and plague passports) masterminded in large part by Girolamo Gastaldi in Rome, where comparatively low levels of mortality occurred during the plague of 1656–1657.
Find this resource:
Palmer, Richard J. “The Control of Plague in Venice and Northern Italy, 1348–1600.” PhD thesis. University of Kent at Canterbury, 1978.
Save Citation »Export Citation »E-mail Citation »
Although concerned principally with Venice and with the 16th century, this remains the most comprehensive study of public health and institutional reforms to combat plague and other epidemics in late medieval and early modern Italy.
Find this resource:
Stevens, Jane E. “The Lazaretti of Venice, Verona, and Padua (1520–1580).” PhD thesis. Cambridge University, 2007.
Save Citation »Export Citation »E-mail Citation »
From archival records and early published books examines the building of lazaretti and public health policies in Padua, Verona, and Venice, mainly in the 16th century. Concentrates on Venice and its records.
Find this resource:
Tuscany

Because of the archival work of Carlo Cipolla (Cipolla 1973, Cipolla 1976, Cipolla 1977, Cipolla 1981, Cipolla 1992) public health in Florence and Tuscany has been more intensely studied here than anywhere else, despite the fact that this region lagged behind the north of Italy, principally the territorial states of Milan and Venice. Others have added to this rich historiography (Ciofo 1984, Calvi 1989) but with the exception of Henderson 2006, this work has centered on Florence and the plague of 1629–1633.

Calvi, Giulia. Histories of a Plague Year: The Social and the Imaginary in Baroque Florence. Translated by Dario Biocca and Bryant T. Ragan Jr. Berkeley: University of California Press, 1989.
Save Citation »Export Citation »E-mail Citation »
From the records of Florence’s health board (Sanità) focuses on offenses against public controls, the symbolism of disease, and the canonization of Domenica da Paradiso during the plague of 1629–1633.
Find this resource:
Ciofo, Marisa Brogi. “La peste del 1630a Firenze con particolare riferimento ai provvedimenti igenico-sanitari e sociali.” Archivio Storico Italiano 142 (1984): 47–75.
Save Citation »Export Citation »E-mail Citation »
Chronicles plague measures implemented by Florence’s health board.
Find this resource:
Cipolla, Carlo M. Cristofano and the Plague: A Study in the History of Public Health in the Age of Galileo. London: Collins, 1973.
Save Citation »Export Citation »E-mail Citation »
Focuses on the struggles faced by Prato’s health board officer, Cristofano di Giulio Ceffini, during the plague of 1630, hampered by limitations imposed by Florence and meager financial resources; nonetheless, shows the advances of states’ defenses against epidemics compared with earlier approaches attempts of Italian city-states in 1348.
Find this resource:
Cipolla, Carlo M. Public Health and the Medical Profession in the Renaissance. Cambridge, UK: Cambridge University Press, 1976.
Save Citation »Export Citation »E-mail Citation »
Valuable and colorful examples of the development of health board controls in Italy and changes in the medical profession from the Black Death to Italy’s last major pandemic in 1656–1657, but fails to investigate of these changes systematically.
Find this resource:
Cipolla, Carlo M. Faith, Reason, and the Plague: A Tuscan Story of the Seventeenth Century. Translated by Muriel Kittel. Brighton, UK: Harvester, 1977.
Save Citation »Export Citation »E-mail Citation »
A colorful micro-history of the superstitions and foibles of combating plague in rural Tuscany: “Ignorance of the pathogen and of the mechanisms of propagation of the disease meant that preventive measures were little better than shots in the dark.” A condemnation of early modern practices based on present-day assumptions that the 17th-century plagues were the rat-based Yersinia pestis.
Find this resource:
Cipolla, Carlo M. Fighting the Plague in Seventeenth-Century Italy. Madison: University of Wisconsin Press, 1981.
Save Citation »Export Citation »E-mail Citation »
Concentrates on plague in Pistoia and Prato in 1630–1631. Tries to explain how public health regulations had some efficacy even though the officials and physicians had supposedly completely erroneous theories on the disease (presumably the rat-based Yersinia pestis).
Find this resource:
Cipolla, Carlo M. Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age. Translated by Elizabeth Porter. New Haven, CT: Yale University Press, 1992.
Save Citation »Export Citation »E-mail Citation »
Using the archives of the Florentine health magistracies in the early 17th century, attempts to explain how properly observed facts were assembled to shore up the erroneous paradigm of Galenic medicine.
Find this resource:
Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul. New Haven, CT: Yale University Press, 2006.
Save Citation »Export Citation »E-mail Citation »
Concentrates on hospitals in early modern Florence, stressing that care of bodies and care for souls were not contradictory approaches. Charts the history of Florence’s first plague hospital, San Bastiano, founded in the 1490s. Concludes that the strict separation of the plague-inflicted from the ill in other hospitals made low mortality rates possible in the latter even during plague years.
Find this resource:
Other Countries

Far less research on public health and the importance of plague in shaping new bureaucratic structures and preventative measures before the 18th century has been extended to regions north of the Alps. Exceptions are Bowers 2007 for 16th-century Seville, Kinzelbach 2001 for 16th-century southern German imperial towns, and Slack 1990 for 16th- and 17th-century England.

Bowers, Kirsty. “Balancing Individual and Communal Needs: Plague and Public Health in Early Modern Seville.” Bulletin of the History of Medicine 81 (2007): 335–358.
DOI: 10.1353/bhm.2007.0020Save Citation »Export Citation »E-mail Citation »
A counterpoise to the negative impressions of early modern plague health controls painted by Cipolla. Using municipal records of Seville for two plagues at the end of the 16th century, shows the successful blend of keeping trade alive while imposing quarantine and other plague controls.
Find this resource:
Kinzelbach, Annemarie. “Hospitals, Medicine, and Society: Southern German Imperial Towns in the Sixteenth Century.” Renaissance Studies 15 (2001): 217–228.
DOI: 10.1111/j.1477-4658.2001.tb00117.xSave Citation »Export Citation »E-mail Citation »
From archival sources of four southern German towns, studies the “medicalization” and specialization of hospitals in the 16th century with specific indications of hospitals for the “great pox” but is less clear on the building of so-called pesthouses.
Find this resource:
Slack, Paul. “Public Authority and a Policy for Control.” In The Impact of Plague in Tudor and Stuart England. 2d ed. By Paul Slack, 199–226. Oxford: Oxford University Press, 1990.
Save Citation »Export Citation »E-mail Citation »
Stresses the backwardness of England in plague prevention compared to the Continent. London’s first pesthouses, vigorous use of quarantine, and communication networks for intelligence of plague in foreign ports did not evolve until the end of the 16th or 17th century.
Find this resource:
The Disappearance Of Plague In Europe

The debate continues as to what extent was human intervention—the developed use of quarantine, lazaretti, intelligent networks of governmental plague reports, and cordons sanitaires—responsible for the disappearance of plague from Europe by the 18th century. Did it instead depend on a transmutation of the bacillus, growing immunity of humans, immunity of rats, or the supposed disappearance of the black rat from Europe? With comparative research, some have stressed the importance of political developments of health boards and disease control (Christensen 2009, Eckert 2000, Panzac 1986, Restifo 1994, Slack 1981); others have remained skeptical of the efficacy of human intervention and disease control before the 19th century (Appleby 1980).

Appleby, Andrew B. “The Disappearance of Plague: A Continuing Puzzle.” Economic History Review 33.2 (1980): 161–173.
DOI: 10.1111/j.1468-0289.1980.tb01821.xSave Citation »Export Citation »E-mail Citation »
A skeptical view of the effectiveness of quarantine and other traditional plague measures in the eradication of plague from Europe. Hypothesizes that it resulted from rats acquiring immunity to the bacillus.
Find this resource:
Christensen, Peter. “Appearance and Disappearance of the Plague: Still a Puzzle?” In Living with the Black Death. Edited by Lars Bisgaard and Leif Søndergaard, 11–22. Odense:University Press of Southern Denmark, 2009.
Save Citation »Export Citation »E-mail Citation »
Analyzes the plague history of Denmark between 1550 and 1712. Compares the relatively late development of public plague measures in northern countries with the Italian experience, concluding that the Italian system of controls were effective.
Find this resource:
Eckert, Edward A. “The Retreat of Plague from Central Europe, 1640–1720: A Geomedical Approach.” Bulletin of the History of Medicine 74 (2000): 1–28.
Save Citation »Export Citation »E-mail Citation »
Compares the patterns of plague transmission through central Europe, 1560–1640 and 1640–1720, finding fewer waves introduced across the seas for the later period. Finds a significant difference after 1640 in the effectiveness of internal plague controls with a transition from local community quarantine to larger state-imposed systems of plague control.
Find this resource:
Panzac, Daniel. Quarantaines et lazarets: l’Europe et la peste d’Orient, XVIIe–XXe siècles. Aix-en-Provence, France: Edisud, 1986.
Save Citation »Export Citation »E-mail Citation »
Describes the systems of quarantine and “cordons militaires” constructed during the 18th century to prevent plague spreading from the Ottoman Empire into Europe.
Find this resource:
Post, John D. “Famine, Mortality, and Epidemic Disease.” Economic History Review 29 (1976): 14–37.
DOI: 10.1111/j.1468-0289.1976.tb00238.xSave Citation »Export Citation »E-mail Citation »
Argues that plague lifted from Europe in the 17th and 18th centuries because of improvements in nutrition, housing, hygiene, and public health.
Find this resource:
Restifo, Giuseppe. Le ultime piaghe: le pesti nel mediterraneo (1720–1820). Milan: Selene, 1994.
Save Citation »Export Citation »E-mail Citation »
Describes the 18th-century international implementation of plague controls that had appeared in Italian cities such Milan and Venice in the late 14th century. Argues that the systematic use of these traditional antiplague measures eradicated plague from Europe.
Find this resource:
Slack, Paul. “The Disappearance of Plague: An Alternative View.” Economic History Review n.s. 34.3 (1981): 469–476.
DOI: 10.1111/j.1468-0289.1981.tb02081.xSave Citation »Export Citation »E-mail Citation »
Of three possibilities—a change in the microorganism, improvement in the urban environment, and human action (notably the use of quarantine and other health policies)—argues that third best explains the chronological and geographical patterns of the plague’s decline and disappearance.