Black Death in England

Black Death in England

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The Black Death in England was a bubonic plague pandemic, which reached England in 1348, and killed perhaps half the population, dying down in 1349. It was the first and most severe manifestation of the Second Pandemic, caused by the Yersinia pestis bacteria.

Originating in China, it spread west along the trade routes across Europe and arrived on the British Isles from the English province of Gascony. The plague seems to have been spread by flea-infected rats, as well as individuals who had been infected on the continent. Rats were the reservoir hosts of the Y. pestis bacteria and the Oriental rat flea was the primary vector.

The first known case in England was a seaman who arrived at Weymouth, Dorset, from Gascony in June 1348.[1] By autumn, the plague had reached London, and by summer 1349 it covered the entire country, before dying down by December. Estimates of mortality have tended to rise, owing to closer research into the lives of the peasantry, rather than just the better-documented landowning minority, and the figure of half the population is generally accepted.

The English government handled the crisis well, and the country did not experience the extreme reactions that were seen elsewhere in Europe. The most immediate consequence was a halt to the campaigns of the Hundred Years' War. In the long term, the decrease in population had caused a shortage of labour, with subsequent rise in wages, resisted by the landowners, which caused deep resentment among the lower classes. The Peasants' Revolt of 1381 was largely a result of this resentment, and even though the rebellion was suppressed, in the long term serfdom was ended in England. The Black Death also affected artistic and cultural efforts, and may have helped advance the use of the vernacular.

In 1361–62 the plague returned to England, this time causing the death of around 20% of the population. After this the plague continued to return intermittently throughout the 14th and 15th centuries, in local or national outbreaks. From this point on its impact became less severe, much due to conscious government efforts. One of the last outbreaks of the plague in England was the Great Plague of London in 1665-66.

The term "Black Death" was not used of the first outbreak until the 17th Century.


  • Background 1
    • England in mid 14th Century 1.1
    • The Black Death 1.2
  • Progress of the plague 2
  • Medical Practice 3
  • Victims 4
    • Death toll 4.1
    • Social distribution 4.2
  • Consequences 5
    • Economic, social and political effects 5.1
    • Religious and cultural consequences 5.2
  • Recurrences 6
  • See also 7
  • References 8
  • Sources 9


The Battle of Crécy established England as a military power.

England in mid 14th Century

It is impossible to establish with any certainty the exact number of inhabitants in England at the eve of the Black Death, and estimates range from 3 to 7 million.[2] The number is probably in the higher end, and an estimate of around 6 million inhabitants seems likely.[3] Earlier demographic crises − in particular the Great Famine of 1315–1317 − had resulted in great numbers of deaths, but there is no evidence of any significant decrease in the population prior to 1348.[4] England was still a predominantly rural and agrarian society; close to 90% of the population lived on the countryside.[5] Of the major cities, London was in a class of its own, with perhaps as many as 70,000 inhabitants.[6] Further down the scale were Norwich, with around 12,000 people, and York with around 10,000.[5] The main export, and the source of the nation's wealth, was wool. Until the middle of the century the export had consisted primarily of raw wool to cloth makers in Flanders. Gradually though, the technology for cloth making used on the Continent was appropriated by English manufacturers, and around mid-century started an export of cloths that would boom over the following decades.[7]

Politically, the kingdom was evolving into a major European power, through the youthful and energetic kingship of Edward III.[8] In 1346, the English had won a decisive battle over the Scots at the Battle of Neville's Cross.[9] Though in the long run it was not to be, it seemed at the time that Edward III would realise his grandfather Edward I's ambition of bringing the Scots under the suzerainty of the English crown.[10] Also on the continent the English were experiencing military success. Less than two months before Neville's Cross a numerically inferior English army, led by the king himself, won a spectacular victory over the French royal forces at the Battle of Crécy.[11] The victory was immediately followed by Edward laying siege to the port city of Calais. When the city fell the next year, this provided the English with a strategically important enclave that would remain in their possession for over two centuries.[12]

The Black Death

The migration of the Black Death across Europe.

The term "Black Death" – which refers to the first and most serious outbreak of the Second Pandemic – was not used by contemporaries, who preferred such names as the "Great Pestilence" or the "Great Mortality".[13] It was not until the seventeenth century that the term under which we know the outbreak today became common, probably derived from Scandinavian languages.[14] It is generally agreed today that the disease in question was spleen and the lungs. The patient will then normally die after a few days.[17] A different strain of the disease is pneumonic plague, where the bacteria become airborne and enter directly into the patient's lungs. This strain is far more virulent, as it spreads directly from person to person. These types of infection probably both played a significant part in the Black Death, while a third strain was more rare. This is the septicaemic plague, where the flea bite carries the bacteria directly into the blood stream, and death occurs very rapidly.[18]

Though most authorities agree that the Black Death was caused by Yersinia pestis, there have been several alternatives presented. Graham Twigg, in The Black Death: A Biological Reappraisal (1984), suggested anthrax as the cause of the epidemic.[19] This theory was at least partially supported by Norman Cantor as late as 2002. In his In the Wake of the Plague: The Black Death and the World it Made, he presents evidence that anthrax and bubonic plague coexisted in fourteenth-century Europe.[20] A 2004 study by Susan Scott and Christopher Duncan theorises that a filovirus, similar to the Ebola virus, may have been behind the disease.[21]

The Black Death most likely originated in Central Asia, where the disease is endemic in the rodent population. It is unknown exactly what caused the outbreak, but probably a series of natural disasters brought humans into contact with the infected rodents.[22] The epidemic reached Constantinople in the late spring of 1347, through Genoese merchants trading in the Black Sea.[23] From here it reached Sicily in October that same year, and by early 1348 it had spread all over the Italian mainland.[24] It spread rapidly through France, and had reached as far north as Paris in June 1348. Moving simultaneously westward, it arrived in the English province of Gascony around the same time.[25]

Progress of the plague

In this year, in Melcombe, in the county of Dorset, a little before the Feast of St. John the Baptist, two ships, one of them from Bristol, came alongside. One of the sailors had brought with him from Gascony the seeds of the terrible pestilence and through him the men of the town of Melcombe were the first in England to be infected.

Grey Friars' Chronicle[26]

According to the chronicle of the grey friars at King's Lynn, the plague arrived by ship from Gascony to Melcombe in Dorset – today normally referred to as Weymouth – shortly before "the Feast of St. John The Baptist" on 24 June 1348.[27] Other sources mention different points of arrival, including Bristol and Southampton.[28] Though the plague might have arrived independently at Bristol at a later point, the Grey Friars' Chronicle is considered the most authoritative account.[29] If it is assumed that the chronicle reports the first outbreak of the plague, rather than its actual arrival, then the arrival most likely happened around 8 May.[30]

From Weymouth the disease spread rapidly across the south-west. The first major city to be struck was Bristol.[31] London was reached in the autumn of 1348, before most of the surrounding countryside. This had certainly happened by November, though according to some accounts as early as 29 September.[32] Arrival in London happened by three principal roads: overland from Weymouth – through Salisbury and Winchester – overland from Gloucester, and along the coast by ship.[33] The full effect of the plague was felt in the capital early the next year.[34] Conditions in London were ideal for the plague: the streets were narrow and flowing with sewage, and houses were overcrowded and poorly ventilated.[35] By March 1349 the disease was spreading in a haphazard way across all of southern England.[36]

During the first half of 1349 the Black Death spread northwards. A second front opened up when the plague arrived by ship at the Humber, wherefrom it spread both south and north.[37] In May it reached York, and during the summer months of June, July and August, it ravaged the north.[38] Certain northern counties, like Durham and Cumberland, had been the victim of violent incursions from the Scots, and were therefore left particularly vulnerable to the devastations of the plague.[39] Pestilence is less virulent during the winter months, and spreads less rapidly.[40] The Black Death in England had survived the winter of 1348-49, but during the following winter it gave in, and by December 1349 conditions were returning to relative normalcy.[41] It had taken the disease approximately 500 days to traverse the entire country.[42]

Medical Practice

In order to treat patients infected with the plague, various methods were used including sweating, bloodletting, forced vomiting, and urinating.[43] Within the initial phase of the disease, bloodletting was performed on the same side of where the physical manifestations of the buboes or risings appeared. For instance, if a rising appeared on the right side of the groin the physician would bleed a vein in the ankle on the same side.[44] In the case of sweating, it was achieved with such medicines as Mithridate, Venice-Treacle, Matthiolus, Bezoar-Water, Serpentary Roots and Electuarium de Ovo.[45] Sweating was used when measures were desperate; if a patient had tokens, a severe version of risings, the physician would wrap the naked patient in a blanket drenched in cold water. This measure was only performed while the patient still had natural heat in his system. The desired effect was to make the patient sweat violently and thus purge all corruption from the blood which was caused by the disease.[46]

Another practice was the use of pigeons when treating swellings. Swellings which were white in appearance and deep were unlikely to break and must be anointed with Oil of Lillies or Camomil.[47] Once the swelling rises to a head and is red in appearance and not deep in the flesh, it can be broken with the use of a feather from a young pigeon's tail. The feather's fundament was held to the swelling and would draw out the venom. However, if the swelling dropped and became black in appearance since it had taken in coldness, the physician had to be cautious when drawing the cold from the swelling. If it was too late to prevent, the physician would take the young pigeon, cut her open from breast to back, break her open and apply the pigeon (while still alive) over the cold swelling. The cupping therapy was an alternative method which was heated and then placed over the swellings. Once the sore was broken, the physician would apply Mellilot Plaister with Linimentum Arcei and heal the sore with digence.[48]


Death toll

Although historical records for England were more extensive than those of any other European country,[49] it is still extremely difficult to establish the death toll with any degree of certainty. Difficulties involve uncertainty about the size of the total population, as described above, but also issues regarding the proportion of the population that died from the plague. Contemporary accounts are often grossly inflated, stating numbers as high as 90%.[50] Modern historians give estimates of death rates ranging from around 25% to over 60% of the total population.

The pioneering work in the field was made by Josiah William Russell in his 1948 British Medieval Population. Russell looked at inquisitions post mortem (IPMs) – taken by the crown to assess the wealth of the greatest landowners after their death – to assess the mortality caused by the Black Death, and from this arrived at an estimate of 23.6% of the entire population.[51] He also looked at episcopal registers for the death toll among the clergy, where the result was between 30–40%.[52] Russell believed the clergy was at particular risk of contagion, and eventually concluded with a low mortality level of only 20%.[53]

Several of Russell's assumptions have been challenged, and the tendency since has been to adjust the assessment upwards.[54] Philip Ziegler, in 1969, estimated the death rate to be at around one third of the population.[55] Jeremy Goldberg, in 1996, believed a number closer to 45% would be more realistic.[56] A 2004 study by Ole Jørgen Benedictow suggests the exceptionally high mortality level of 62.5%.[57] Assuming a population of 6 million, this estimate would correspond to 3,750,000 deaths. Such a high percentage would place England above the average that Benedictow estimates for Western Europe as a whole, of 60%.[57] A death rate at such a high level has not been universally accepted in the historical community.[58]

Social distribution

Russell trusted the IPMs to give a true picture of the national average, because he assumed death rates to be relatively equal across the social spectrum.[59] This assumption has later been proven wrong, and studies of peasant plague mortality from manor rolls have returned much higher rates. This could be a consequence of the elite's ability to avoid infection by escaping plague-infected areas. It could also result from lower post-infection mortality among those more affluent, due to better access to care and nursing.[60] If so, this would also mean that the mortality rates for the clergy – who were normally better off than the general population – were no higher than the average.[61]

...destructive Death (who seizes young and old alike, sparing no one and reducing rich and poor to the same level) has lamentably snatched from both of us our dearest daughter, (whom we loved best of all, as her virtues demanded).

Edward III in a letter to King Alfonso of Castile[62]

The manorial records offer a good opportunity to study the geographical distribution of the plague. Its impact seems to have been about the same all over England,[63] though a place like East Anglia, which had frequent contact with the Continent, was severely affected.[64] On a local level, however, there were great variations. A study of the Bishop of Worcester's estates reveal that, while his manors of Hartlebury and Hambury had a mortality of only 19%, the manor of Aston lost as much as 80% of its population.[65] The manor rolls are less useful for studying the demographic distribution of the mortality, since the rolls only record the heads of households, normally an adult male.[66] Here the IPMs show us that the most vulnerable to the disease were infants and the elderly.[67]

There seem to have been very few victims of the Black Death at higher levels of society.[68] The only member of the royal family who can be said with any certainty to have died from the Black Death was in France at the time of her infection. Edward III's daughter Joan was residing in Bordeaux on her way to marry Pedro of Castile in the summer of 1348. When the plague broke out in her household she was moved to a small village nearby, but she could not avoid infection, and died there on 2 September.[69] It is possible that the popular religious author Richard Rolle, who died on 30 September 1349, was another victim of the Black Death.[70] The English philosopher William of Ockham has been mentioned as a plague victim.[71] This, however, is an impossibility. Ockham was living in Munich at the time of his death, on 10 April 1347, two years before the Black Death reached that city.[72]


Economic, social and political effects

Among the most immediate consequences of the Black Death in England was a shortage of farm labour, and a corresponding rise in wages. The medieval world-view was unable to interpret these changes in terms of socio-economic development, and it became common to blame degrading morals instead.[73] The landowning classes saw the rise in wage levels as a sign of social upheaval and insubordination, and reacted with coercion. In 1349, King Edward III passed the Ordinance of Labourers, fixing wages at pre-plague levels. The ordinance was reinforced by parliament's passing of the Statute of Labourers in 1351.[74] The labour laws were enforced with ruthless determination over the following decades.[75]

Peasants' Revolt: rebel leader Wat Tyler is killed on the left, while the young Richard II pacifies the crowd on the right.

These legislative measures proved largely inefficient at regulating the market, but the government's repressive measures to enforce them caused public resentment.[76] These conditions were contributing factors to the Peasants' Revolt in 1381. The revolt started in Kent and Essex in late May, and once the rebels reached London they burnt down John of Gaunt's Savoy Palace, and killed both the Chancellor and the Treasurer. They then demanded the complete abolition of serfdom, and were not pacified until the young King Richard II personally intervened.[77] The rebellion was eventually suppressed, but the social changes it promoted were already irreversible. By around 1400 serfdom was virtually extinct in England, replaced by the form of tenure called copyhold.[78]

It is conspicuous how well the English government handled the crisis of the mid-fourteenth century, without descending into chaos and total collapse in the manner of the Valois government of France.[79] To a large extent this was the accomplishment of administrators such as Treasurer William de Shareshull and Chief Justice William Edington, whose highly competent leadership guided the governance of the nation through the crisis.[79] The plague's greatest effect on the government was probably in the field of war, where no major campaigns were launched in France until 1355.[80]

Another notable consequence of the Black Death was the raising of the real wage of England (due to the shortage of labour as a result of the reduction in population), a trait shared across Western Europe, which in general led to a real wage in 1450 that was unmatched in most countries until the 19th or 20th century.[81] The higher wages for workers combined with sinking prices on grain products led to a problematic economic situation for the gentry. As a result they started to show an increased interest for offices like justice of the peace, sheriff and member of parliament. The gentry took advantage of their new positions and a more systematic corruption than before spread. A result of this was that the gentry as a group became highly disliked by commoners.[82]

Religious and cultural consequences

The omnipresence of death also inspired greater piety in the upper classes, which can be seen in the fact that three Cambridge colleges were founded during or shortly after the Black Death.[83] England did not experience the same trend of roving bands of flagellants, common on the continent.[84] Neither were there any pogroms against the Jews, since the Jews had been expelled by Edward I in 1290.[84] In the long run, however, the increase in public participation may have served to challenge the absolute authority of the church hierarchy, and thus possibly helped pave the way for the Protestant Reformation.

The high rate of mortality among the clergy naturally led to a shortage of priests in many parts of the country.[70] The clergy were seen to have an elevated status among ordinary people and this was partly due to their closeness with God, being his envoys on earth. However, as the church itself had given the cause of the Black Death to be the impropriety of the behaviour of men, the higher death rate among the clergy led the people to lose faith in the Church as an institution − it had proved as ineffectual against the horror of Y. Pestis as every other medieval institution. The corruption within the Catholic priesthood also angered the English people. Many priests abandoned the terrified people. Others sought benefits from the rich families who needed burials. The dissatisfaction led to anti-clericalism and the rise of John Wycliffe, an English priest. His ideas paved a path for the Christian reformation in England. Some people didn't lose their Christian faith, if anything it was renewed; they began to long for a more personal relationship with God − around the time after the Black Death many Chantries (private chapels) began to spread in use from not just the nobility, but to among the well to do.[85] This change in the power of the papacy in England is demonstrated by the statutes of Praemunire.

The Black Death also had a great impact on arts and culture. It was inevitable that a catastrophe of such proportions would have an impact on some of the greater building projects, as the amount of available labour fell sharply. The building of the cathedrals of Ely and Exeter was temporarily halted in the years immediately following the first outbreak of the plague.[86] The shortage of labour also helped advance the transition from the Decorated style of building to the less elaborate Perpendicular style.[87] The Black Death may also have promoted the use of vernacular English, as the number of teachers proficient in French dwindled. This, in turn, would have contributed to the late-fourteenth century flowering of English literature, represented by writers such as Geoffrey Chaucer and John Gower.[88]


In his diaries, Samuel Pepys gave a vivid description of the Great Plague of London; one of the last outbreaks of the Second Pandemic.

The Black Death was the first occurrence of the Second Pandemic,[89] which would continue to strike England and the rest of Europe more or less regularly until the eighteenth century. The first serious recurrence in England came in the years 1361−62. We know less about the death rates caused by these later outbreaks,[90] but this so-called pestis secunda may have had a mortality of around 20%.[91] This epidemic was also particularly devastating for the population's ability to recover, since it disproportionately affected infants and young men.[92] This was also the case with the next occurrence, in 1369, where the death rate was around 10−15%.[91]

Over the following decades the plague would return – on a national or a regional level – at intervals of five to twelve years, with gradually dwindling death tolls. Then, in the decades from 1430 to 1480, the disease returned in force. An outbreak in 1471 took as much as 10-15% of the population, while the death rate of the plague of 1479-80 could have been as high as 20%.[91] From this point on outbreaks became fewer and more manageable. This was to a large extent the result of conscious efforts by central and local governments – from the late fifteenth century onwards – to curtail the disease.[93] By the seventeenth century the Second Pandemic was over. One of its last occurrences in England was the famous Great Plague of London in 1665-66.[94]

See also


  1. ^ The Black Death, 1347, George Deaux, Weybright and Talley, New York, 1969, p. 117
  2. ^ Prestwich 2005, pp. 531–2
  3. ^ Smith, Richard M. (1991). "Demographic developments in rural England, 1300-1348: a survey". In B.M.S. Campbell. Before the Black Death: Studies in The 'Crisis' of the Early Fourteenth Century. Manchester: Manchester University Press. pp. 48–9.  
    • Benedictow 2004, p. 123
  4. ^ Harvey, Barbara F. (1991). "Introduction: The 'Crisis' of the Early Fourteenth Century". In B.M.S. Campbell. Before the Black Death: Studies in The 'Crisis' of the Early Fourteenth Century. Manchester: Manchester University Press. pp. 1–24.  
  5. ^ a b Ziegler 2003, p. 119
  6. ^ Prestwich 2005, p. 473
  7. ^  
  8. ^ Deaux 1969, p. 117
  9. ^ Ormrod 2000, pp. 276–7
  10. ^ Prestwich 2005, p. 245
  11. ^ Prestwich 2005, pp. 317–9
  12. ^ Ormrod 2000, p. 279
  13. ^ "n."death, (subscription required).  
  14. ^ Ziegler 2003, pp. 17–8
  15. ^ Horrox 1994, p. 5
  16. ^ Benedictow 2004, p. 25
  17. ^ Horrox 1994, pp. 5–6
    • Hatcher 2008, pp. 139–40
  18. ^ Horrox 1994, p. 8
  19. ^ Twigg, Graham (1984). "The Black Death: A Biological Reappraisal". London: Batsford Academic and Educational.  
  20. ^  
  21. ^ Scott, Susan; C.J. Duncan (2004). "Return of the Black Death: The World's Greatest Serial Killer". Chichester: Wiley. p. 225.  
  22. ^ Ziegler 2003, p. 13
  23. ^ Horrox 1994, p. 9
    • Hatcher 2008, p. 47
  24. ^ Ziegler 2003, pp. 17, 40
  25. ^ Horrox 1994, pp. 9–10
  26. ^ Gransden, Antonia (1957). "A Fourteenth-Century Chronicle from the Grey Friars at Lynn".   Translation: Benedictow 2004, p. 127
  27. ^ BBC British History - Middle Ages - Black Death Arrival
  28. ^ Ziegler 2003, pp. 119–20
  29. ^ Benedictow 2004, p. 127
    • Hatcher 2008, p. 75
  30. ^ Benedictow 2004, p. 127
  31. ^ Ziegler 2003, pp. 134–5
  32. ^ Deaux 1969, p. 122
  33. ^ Benedictow 2004, p. 134
  34. ^ Ziegler 2003, p. 156
  35. ^ Deaux 1969, pp. 122–3
  36. ^ Ziegler 2003, p. 137
  37. ^ Benedictow 2004, p. 140
  38. ^ Ziegler 2003, p. 182
  39. ^ Ziegler 2003, pp. 184–6
    • Deaux 1969, p. 140
  40. ^ Benedictow 2004, p. 132
  41. ^ Ziegler 2003, p. 129
  42. ^ Benedictow 2004, p. 142
  43. ^ Eminent Physician, "Treatise of the pestilence, with its pre-vision, pro-vision and pre-vention, and the doctor's method of cure. From the manuscript of an eminent physician, who practis'd in the last great plague in London", London: printed for J. Roberts, 1721, p.19
  44. ^ Eminent Physician, "Treatise of the pestilence, with its pre-vision, pro-vision and pre-vention, and the doctor's method of cure. From the manuscript of an eminent physician, who practis'd in the last great plague in London", London: printed for J. Roberts, 1721, p.18
  45. ^ Eminent Physician, 1721, p.19
  46. ^ Eminent Physician, 1721, p.21-22
  47. ^ Eminent Physician, 1721, p.20
  48. ^ Eminent Physician, 1721, p.21
  49. ^ Ziegler 2003, p. 129 Benedictow 2004, p. 383
  50. ^ Ziegler 2003, p. 227
  51. ^ Russell 1948, p. 216
  52. ^ Russell 1948, pp. 220–3
  53. ^ Russell 1948, p. 367
  54. ^ Hatcher 1994, p. 9
  55. ^ Ziegler 2003, p. 230
  56. ^  
  57. ^ a b Benedictow 2004, p. 383
  58. ^ Horrox, Rosemary (2006). "The Black Death, 1346–1353: The Complete History (review)".  
  59. ^ Benedictow 2004, p. 343
  60. ^ Benedictow 2004, p. 377
  61. ^ Benedictow 2004, pp. 342–53
  62. ^ Horrox 1994, p. 250
  63. ^ Horrox 1994, pp. 235–6
  64. ^ Gottfried 1983, pp. 65–6
  65. ^ Bolton 1996, p. 23
  66. ^ Hatcher 2008, p. 152
  67. ^ Russell 1948, pp. 216–8
  68. ^ Prestwich 2005, p. 546
  69. ^ Horrox 1994, p. 246
  70. ^ a b Hatcher 2008, p. 248
  71. ^ Deaux 1969, p. 143
  72. ^ Courtenay, W. J. (2004). "Ockham, William (c.1287–1347)". Oxford Dictionary of National Biography. Oxford: Oxford University Press.  
  73. ^ Hilton 2003, p. 232
  74. ^ Hilton 2003, pp. 152–3
    • Prestwich 2005, p. 548
  75. ^ Ormrod 1996, p. 156
  76. ^ Hatcher 1994, pp. 206, 247
  77. ^  
  78. ^ Gottfried 1983, p. 137
  79. ^ a b Ormrod 1986, pp. 175–88
  80. ^ Prestwich 2005, p. 550
  81. ^ Allen, R.C. ‘The Great divergence in European wages and prices from the middle ages to the First World War’, Explorations in Economic History, 38 (2001), pp. 411–47
  82. ^ Harrison, Dick (2000). Stora Döden (in Swedish). Stockholm: Ordfront. p. 145.  
  83. ^ The three were Gonville and Caius (1348), Trinity Hall (1350) and Corpus Christi (1352); Herlihy 1997, pp. 69–70
  84. ^ a b Harper-Bill 1996, p. 107
  85. ^ Kelly, John (3 January 2006). The Great Mortality; An Intimate History of the Black Death. Harper Perennial. p. 384.  
  86. ^ Lindley 1996, p. 143
  87. ^ Lindley 1996, pp. 129, 137
  88. ^ Ziegler 2003, p. 253
  89. ^ The first was the Plague of Justinian that affected the Byzantine Empire in the sixth to eight centuries A.D., while the Third Pandemic – active from the mid-nineteenth to mid-twentieth century – had its greatest impact on China and India; Benedictow 2004, pp. 35–44
  90. ^ Bolton 1996, p. 27
  91. ^ a b c Gottfried 1983, p. 131
  92. ^ Bolton 1996, p. 37
  93. ^ Ormrod 1996, p. 147
  94. ^ Ziegler 2003, p. 25


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