-noun Pathology. intestinal obstruction characterized by lack of peristalsis and leading to severe colicky pain and vomiting.

Laymen terms: After surgery, opiate drugs are given for pain managment (morphine, vicoden, etc) these drugs can put the bowels to "sleep" they have then lost their motility. With loss of motility food and gas cannot pass thru the intestinal tract and extreme discomfort will occcur. Drug are available to reverse Opiate action and also drugs are available to kick start the guts to become active again. Smooth muscle contractions need to occur to move food/gas etc thru the system out of the rectum or stoma if someone had colon surgery. Without such; a person could forseeable die especially if in advanced age. So, ileus is the SLEEPING bowels.

The Black Death, also known as the Black Plague, was a devastating pandemic that first struck Europe in the mid-late-14th century (1347�C1351), killing between a third and two-thirds of Europe's population. Almost simultaneous epidemics occurred across large portions of Asia and the Middle East during the same period, indicating that the European outbreak was actually part of a multi-regional pandemic. Including Middle Eastern lands, India and China, the Black Death killed at least 75 million people. The same disease is thought to have returned to Europe every generation with varying degrees of intensity and fatality until the 1700s. Notable later outbreaks include the Italian Plague of 1629-1631, the Great Plague of London (1665�C1666), the Great Plague of Vienna (1679), the Great Plague of Marseilles in 1720�C1722 and the 1771 plague in Moscow. There is some controversy over the identity of the disease, but in its virulent form the disease appears to have disappeared from Europe in the 18th century. Bubonic plague survives in other parts of the world (Central and Oriental Africa, Madagascar, Asia, some parts of South America) and was responsible for a pandemic in the early 20th century.[citation needed]

The Black Death had a drastic effect on Europe's population, irrevocably changing Europe's social structure. It was a serious blow to the Roman Catholic Church, Europe's predominant religious institution at the time, and resulted in widespread persecution of minorities such as Jews, Muslims, foreigners, beggars and lepers. The uncertainty of daily survival created a general mood of morbidity influencing people to live for the moment, as illustrated by Giovanni Boccaccio in The Decameron (1353).

The initial fourteenth-century European event was called the "Great Mortality" by contemporary writers and, with later outbreaks, became known as the 'Black Death'. It has been popularly thought that the name came from a striking symptom of the disease, called acral necrosis, in which sufferers' skin would blacken due to subdermal haemorrhages. However, the term refers in fact to the figurative sense of "black" (glum, lugubrious or dreadful).[1] Historical records have convinced most scientists that the Black Death was an outbreak of bubonic plague, caused by the bacterium Yersinia pestis and spread by fleas with the help of animals like the black rat (Rattus rattus), however, there are some scientists who question this.[2]

Pattern of the pandemicThe plague disease, caused by Yersinia pestis, is endemic in populations of ground rodents in central Asia, but it is not entirely clear where the fourteenth-century pandemic started. The most popular theory places the first cases in the steppes of Central Asia, though some speculate that it originated around northern India. From there, supposedly, it was carried east and west by traders and Mongol armies along the Silk Road, and was first exposed to Europe at the trading city of Caffa in the Crimea from which it spread to Sicily and on to the rest of Europe.

Whether or not this theory is accurate, it is clear that several pre-existing conditions such as war, famine, and weather contributed to the severity of the Black Death. A devastating civil war in China between the established Chinese population and the Mongol hordes raged between 1205 and 1353. This war disrupted farming and trading patterns, and led to episodes of widespread famine. A so-called "Little Ice Age" had begun at the end of the thirteenth century. The disastrous weather reached a peak in the first half of the fourteenth century with severe results worldwide.

In the years 1315 to 1322 a catastrophic famine, known as the Great Famine, struck all of Northern Europe. Food shortages and sky-rocketing prices were a fact of life for as much as a century before the plague. Wheat, oats, hay and consequently livestock were all in short supply; and their scarcity resulted in hunger and malnutrition. The result was a mounting human vulnerability to disease due to weakened immune systems. The European economy entered a vicious circle in which hunger and chronic, low-level debilitating disease reduced the productivity of labourers, and so the grain output suffered, causing the grain prices to increase. The famine was self-perpetuating, impacting life in places like Flanders and Burgundy as much as the Black Death was later to impact all of Europe.

A typhoid epidemic was to be a predictor of the coming disaster. Many thousands died in populated urban centres, most significantly Ypres. In 1318 a pestilence of unknown origin, sometimes identified as anthrax, hit the animals of Europe. The disease targeted sheep and cattle, further reducing the food supply and income of the peasantry and putting another strain on the economy. The increasingly international nature of the European economies meant that the depression was felt across Europe. Due to pestilence, the failure of England's wool exports led to the destruction of the Flemish weaving industry. Unemployment bred crime and poverty.

Asian outbreakThe Central Asian scenario agrees with the first reports of outbreaks in China in the early 1330s. The plague struck the Chinese province of Hubei in 1334. During 1353�C1354, more widespread disaster occurred. Chinese accounts of this wave of the disease record a spread to eight distinct areas: Hubei, Jiangxi, Shanxi, Hunan, Guangdong, Guangxi, Henan and Suiyuan (a historical Chinese province that now forms part of Hebei and Inner Mongolia), throughout the Mongol and Chinese empires. Historian William McNeill noted that voluminous Chinese records on disease and social disruption survive from this period, but no one has studied these sources in depth.

It is probable that the Mongols and merchant caravans inadvertently brought the plague from central Asia to the Middle East and Europe. The plague was reported in the trading cities of Constantinople and Trebizond in 1347. In that same year, the Genoese possession of Caffa, a great trade emporium on the Crimean peninsula, came under siege by an army of Mongol warriors under the command of Janibeg, backed by Venetian forces. After a protracted siege during which the Mongol army was reportedly withering from the disease, they might have decided to use the infected corpses as a biological weapon. The corpses were catapulted over the city walls, infecting the inhabitants.[3] The Genoese traders fled, transferring the plague via their ships into the south of Europe, from whence it rapidly spread. According to accounts, so many died in Caffa that the survivors had little time to bury them and bodies were stacked like cords of firewood against the city walls.

European outbreak

The Black Death rapidly spread along the major European sea and land trade routes.In October 1347, a fleet of Genovese trading ships fleeing Caffa reached the port of Messina. By the time the fleet reached Messina, all the crew members were either infected or dead. It is presumed that the ships also carried infected rats and/or fleas. Some ships were found grounded on shorelines, with no one aboard remaining alive. Looting of these lost ships also helped spread the disease. From there, the plague spread to Genoa and Venice by the turn of 1347�C1348.

From Italy the disease spread northwest across Europe, striking France, Spain, Portugal and England by June 1348, then turned and spread east through Germany and Scandinavia from 1348 to 1350, and finally to north-western Russia in 1351; however, the plague largely spared some parts of Europe, including the Kingdom of Poland and parts of Belgium and the Netherlands.

Middle Eastern outbreakThe plague struck various countries in the Middle East during the pandemic, leading to serious depopulation and permanent change in both economic and social structures. The disease first entered the region from southern Russia. By autumn 1347, the plague reached Alexandria in Egypt, probably through the port's trade with Constantinople and ports on the Black Sea. During 1348, the disease travelled eastward to Gaza, and north along the eastern coast to cities in Lebanon, Syria and Palestine, including Asqalan, Acre, Jerusalem, Sidon, Damascus, Homs, and Aleppo. In 1348�C49, the disease reached Antioch. The city's residents fled to the north, most of them dying during the journey, but the infection had been spread to the people of Asia Minor.

Mecca became infected in 1349. The people of Mecca blamed the disease on non-believers entering the city, but it is more likely to have arrived with Muslim pilgrims from surrounding infected areas. During the same year, records show the city of Mawsil (Mosul) suffered a massive epidemic, and the city of Baghdad experienced a second round of the disease. In 1351, Yemen experienced an outbreak of the plague. This coincided with the return of King Mujahid of Yemen from imprisonment in Cairo. His party may have brought the disease with them from Egypt.

RecurrenceThe plague repeatedly returned to haunt Europe and the Mediterranean throughout the fourteenth to seventeenth centuries, and although the bubonic plague still exists with isolated cases today, the Great Plague of London in 1665�C1666 is generally recognized as one of the last major outbreaks. The Great Fire of London in 1666 may have killed off any remaining plague bearing rats and fleas, which led to a decline in the plague. The destruction of black rats in the Great Fire may also have contributed to the ascendancy of brown rats in England. According to the bubonic plague theory, one possible explanation for the disappearance of plague from Europe may be that the black rat (Rattus rattus) infection reservoir and its disease vector was subsequently displaced and succeeded by the bigger Norwegian, or brown, rat (Rattus norvegicus), which is not as prone to transmit the germ-bearing fleas to humans in large rat die-offs (see Appleby and Slack references below).

Late outbreaks in central Europe include the Italian Plague of 1629-1631, which is associated with troop movements during the Thirty Years' War, and the Great Plague of Vienna in 1679, which may have been due to a reintroduction of the plague from eastern trading ports.

Causes

Bubonic plague theory

Yersinia pestis seen at 2000x magnification. This bacterium, carried and spread by fleas, is generally thought to have been the cause of millions of deaths.Bubonic and septicaemic plague are transmitted by direct contact with fleas. The bacteria multiply inside a flea, blocking its stomach and causing it to become very hungry. The flea then voraciously bites a host and continues to feed because it is unable to satisfy its hunger. During the feeding process, infected blood carrying the plague bacteria flows from the fleas' stomachs into the open wound. The plague bacteria then has a new host, and the flea eventually dies from starvation.

The human pneumonic plague has a different form of transmission. It is transmitted through bacteria in droplets of saliva coughed up by persons with bloodstream infection (sepsis) or pneumonia, which may have started as the bubonic form of disease. The airborne bacteria may be inhaled by a nearby susceptible person, and a new infection starts directly in the lungs or throat of the other, bypassing the bubonic form of disease.

The ecology of Yersinia pestis in soil, rodent and (possibly & importantly) human ectoparasites are reviewed and summarized by Michel Drancourt in a model of sporadic, limited and large plague outbreaks [1]. Modelling of epizootic plague observed in prairie dogs suggests that occasional reservoirs of infection such as an infectious carcass, rather than 'blocked fleas' are a better explanation for the observed epizootic behaviour of the disease in nature.

An interesting hypothesis about the appearance, spread and especially disappearance of plague from Europe is that the flea-bearing rodent reservoir of disease was eventually succeeded by another species. The black rat (Rattus rattus) was originally introduced from Asia to Europe by trade, but was subsequently displaced and succeeded throughout Europe by the bigger Norwegian or brown rat (Rattus norvegicus). The brown rat was not as prone to transmit the germ-bearing fleas to humans in large die-offs due to a different rat ecology (see Appleby and Slack, secondary references below). The dynamic complexities of rat ecology, herd immunity in that reservoir, interaction with human ecology, secondary transmission routes between humans with or without fleas, human herd immunity and changes in each might explain the eruption, dissemination, and re-eruptions of plague that continued for centuries until its (even more) unexplained disappearance.

Signs and symptomsThe three forms of plague brought an array of signs and symptoms to those infected. Bubonic plague refers to the painful lymph node swellings called buboes. The septicaemic plague is a form of blood poisoning, and pneumonic plague is an airborne plague that forms a first attack on the lungs. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck and armpits, which ooze pus and blood. Victims underwent damage to the skin and underlying tissue until they were covered in dark blotches. This symptom is called acral necrosis. Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land.

The bubonic plague was the most commonly seen form during the Black Death, with a mortality rate of thirty to seventy-five percent and symptoms including fever of 38 - 41 ��C (101-105 ��F), headaches, aching joints, nausea and vomiting, and a general feeling of malaise. The pneumonic plague was the second most commonly seen form during the Black Death, with a mortality rate of ninety to ninety-five percent. Symptoms included slimy sputum tinted with blood. As the disease progressed, sputum became free flowing and bright red. Septicaemic plague was the most rare of the three forms, with mortality close to one hundred percent. Symptoms were high fevers and skin turning deep shades of purple due to DIC (Disseminated intravascular coagulation).

Alternative explanationsRecent scientific and historical investigations have led some researchers to doubt the long-held belief that the Black Death was an epidemic of bubonic plague. For example, in 2000, Gunnar Karlsson (Iceland's 1100 Years: The History of a Marginal Society) pointed out that the Black Death killed between half and two-thirds of the population of Iceland, although there were no rats in Iceland at this time. Rats were accidentally introduced in the nineteenth century, and have never spread beyond a small number of urban areas attached to seaports. In the fourteenth century there were no urban settlements in Iceland. Iceland was unaffected by the later plagues which are known to have been spread by rats.

In addition, it was previously argued that tooth pulp tissue from a fourteenth-century plague cemetery in Montpellier tested positive for molecules associated with Y. pestis. However, such a finding was never confirmed in any other cemetery, nor were any DNA samples recovered. In September 2003, a team of researchers from Oxford University tested 121 teeth from sixty-six skeletons found in fourteenth-century mass graves. The remains showed no genetic trace of Y. pestis, and the researchers suspect that the Montpellier study was flawed.

In 1984, Graham Twigg published The Black Death: A Biological Reappraisal, where he argued that the climate and ecology of Europe and particularly England made it nearly impossible for rats and fleas to have transmitted bubonic plague. Combining information on the biology of Rattus rattus, Rattus norvegicus, and the common fleas Xenopsylla cheopis and Pulex irritans with modern studies of plague epidemiology, particularly in India, where the R. rattus is a native species and conditions are nearly ideal for plague to be spread, Twigg concludes that it would have been nearly impossible for Y. pestis to have been the causative agent of the beginning of the plague, let alone its explosive spread across all of Europe. Twigg also shows that the common theory of entirely pneumonic spread does not hold up. He proposes, based on a re-examination of the evidence and symptoms, that the Black Death may actually have been an epidemic of pulmonary anthrax caused by Bacillus anthracis.

In 2001, epidemiologists Susan Scott and Christopher Duncan from Liverpool University proposed the theory that the Black Death might have been caused by an Ebola-like virus, not a bacterium. Their rationale was that this plague spread much faster and the incubation period was much longer than other confirmed Yersinia pestis plagues. A longer period of incubation will allow carriers of the infection to travel farther and infect more people than a shorter one. When the primary vector is humans, as opposed to birds, this is of great importance. Studies of English church records indicate an unusually long incubation period in excess of thirty days, which could account for the rapid spread, topping at 5 km/day. The plague also appeared in areas of Europe where rats were uncommon like Iceland. Epidemiological studies suggest the disease was transferred between humans (which happens rarely with Yersinia pestis and very rarely for Bacillus anthracis), and some genes that determine immunity to Ebola-like viruses are much more widespread in Europe than in other parts of the world. Their research and findings are thoroughly documented in Return of the Black Death: The World's Greatest Serial Killer. More recently the researchers have published computer modeling (Journal of Medical Genetics: March 2005) demonstrating how the Black Death has made around 10% of Europeans resistant to HIV.

In a similar vein, historian Norman F. Cantor, in his 2001 book In the Wake of the Plague, suggests the Black Death might have been a combination of pandemics including a form of anthrax, a cattle murrain. He cites many forms of evidence including: reported disease symptoms not in keeping with the known effects of either bubonic or pneumonic plague, the discovery of anthrax spores in a plague pit in Scotland, and the fact that meat from infected cattle was known to have been sold in many rural English areas prior to the onset of the plague. It is notable that the means of infection varied widely, from human-to-human contact as in Iceland (rare for plague and cutaneous Bacillus anthracis) to infection in the absence of living or recently-dead humans, as in Sicily (which speaks against most viruses). Also, diseases with similar symptoms were generally not distinguished between in that period (see murrain above), at least not in the Christian world; Chinese and Muslim medical records can be expected to yield better information which however only pertains to the specific disease(s) which affected these areas. See ISBN 0-06-001434-2

Counter-argumentsThe majority of historians support the theory that the bubonic plague caused the black death. Nevertheless, counterarguments have developed.

The uncharacteristically rapid spread of the plague could be due to respiratory droplet transmission, and low levels of immunity in the European population at that period. Historical examples of pandemics of other diseases in populations without previous exposure, such as smallpox and tuberculosis transmitted by aerosol amongst Native Americans, show that the low levels of inherited adaptation to the disease cause the first epidemic to spread faster and to be far more virulent than later epidemics among the descendants of survivors. Moreover, the plague returned again and again and was regarded as the same disease through succeeding centuries into modern times when the Yersinia bacterium was identified.

AsiaEstimates of the demographic impact of the plague in Asia are based on both population figures during this time and estimates of the disease's toll on population centres. The initial outbreak of plague in the Chinese province of Hubei in 1334 claimed up to ninety percent of the population, an estimated five million people. During 1353�C54, outbreaks in eight distinct areas throughout the Mongol/Chinese empires may have caused the death of two-thirds of China's population, often yielding an estimate of twenty-five million deaths. Japan had no outbreak of plague most likely due to the lack of host rodents.

Europe and Middle EastIt is estimated that between one-third and two-thirds of the European population died from the outbreak between 1348 and 1350. Contemporary observers estimated the toll to be one-third (e.g. Froissart), but modern estimates range from one-half to two-thirds of the population.[4] As many as 25% of all villages were depopulated, mostly the smaller communities, as the few survivors fled to larger towns and cities [citation needed]. The Black Death hit the culture of towns and cities disproportionately hard, although rural areas (where 90% of the population lived[4]) were also significantly affected. A few rural areas, such as Eastern Poland and Lithuania, had such low populations and were so isolated that the plague made little progress. Parts of Hungary and, in modern Belgium, the Brabant region, Hainaut and Limbourg, as well as Santiago de Compostella, were unaffected for unknown reasons (some historians have assumed that the presence of sanguine groups in the local population helped them resist the disease, although these regions would be touched by the second plague burst in 1360-1363 and later during the numerous resurgences of the plague).[4] Other areas which escaped the plague were isolated mountainous regions (e.g. the Pyrenees). Larger cities were the worst off, as population densities and close living quarters made disease transmission easier. Cities were also strikingly filthy, infested with lice, fleas and rats, and subject to diseases related to malnutrition and poor hygiene. According to journalist John Kelly, "[w]oefully inadequate sanitation made medieval urban Europe so disease-ridden, no city of any size could maintain its population without a constant influx of immigrants from the countryside." (p. 68) The influx of new citizens facilitated the movement of the plague between communities, and contributed to the longevity of the plague within larger communities.

In Italy, Florence's population passed from 110,000 or 120,000 inhabitants in 1338 to 50,000 in 1351. Between 60 to 70% of Hamburg or Bremen's population died. In Provence, Dauphin�� or Normandy, historians observe a decrease of 60% of fiscal hearths. In some regions, two thirds of the population was annihilated. In the town of Givry, in the Bourgogne region in France, the friar, who used to note 28 to 29 funerals a year, recorded 649 deaths in 1348, half of them in September. About half of Perpignan's population died in several months (only two of the eight physicians survived the plague). England lost 70% of its population, which passed from 7 million to 2 million in 1400.[4]

All social classes were affected, although the lower classes, living together in unhealthy places, were most vulnerable. Alfonso XI of Castile was the only royal victim of the plague, but Peter IV of Aragon lost his wife, his daughter and a niece in six months. The Byzantine Emperor lost his son, while in the kingdom of France, Joan of Navarre, daughter of Louis X le Hutin and of Margaret of Burgundy, was killed by the plague, as well as Bonne of Luxembourg, the wife of the future John II of France.

Furthermore, resurgences of the plague in later years must also be counted: in 1360-62 (the "little mortality"), in 1366-1369, 1374-1375, 1400, 1407, etc. The plague was not eradicated until the 19th century.

The precise demographic impact of the disease in the Middle East is very difficult to calculate. Mortality was particularly high in rural areas, including significant areas of Palestine and Syria. Many surviving rural people fled, leaving their fields and crops, and entire rural provinces are recorded as being totally depopulated. Surviving records in some cities reveal a devastating number of deaths. The 1348 outbreak in Gaza left an estimated 10,000 people dead, while Aleppo recorded a death rate of 500 a day during the same year. In Damascus, at the disease's peak in September and October 1348, a thousand deaths were recorded every day, with overall mortality estimated at between twenty-five and thirty-eight percent. Syria lost a total of 400,000 people by the time the epidemic subsided in March 1349. In contrast to some higher mortality estimates in Asia and Europe, scholars such as John Fields of Trinity College in Dublin believe the mortality rate in the Middle East was less than one-third of the total population, with higher rates in selected areas.

Socio-economic effects

Monks, disfigured by the plague, being blessed by a priest. England, 1360�C75.The governments of Europe had no apparent response to the crisis because no one knew its cause or how it spread. Most monarchs instituted measures that prohibited exports of foodstuffs, condemned black market speculators, set price controls on grain, and outlawed large-scale fishing. At best, they proved mostly unenforceable, and at worst they contributed to a continent-wide downward spiral. The hardest hit lands, like England, were unable to buy grain abroad: from France because of the prohibition, and from most of the rest of the grain producers because of crop failures from shortage of labour. Any grain that could be shipped was eventually taken by pirates or looters to be sold on the black market. Meanwhile, many of the largest countries, most notably England and Scotland, had been at war, using up much of their treasury and exacerbating inflation. In 1337, on the eve of the first wave of the Black Death, England and France went to war in what would become known as the Hundred Years' War, further depleting their treasuries, population, and infrastructure. Malnutrition, poverty, disease and hunger, coupled with war, growing inflation and other economic concerns made Europe in the mid-fourteenth century ripe for tragedy.

The plague did more than just devastate the medieval population; it caused a substantial change in economy and society in all areas of the world. Economic historians like Fernand Braudel have concluded that Black Death exacerbated a recession in the European economy that had been under way since the beginning of the century. As a consequence, social and economic change greatly accelerated during the fourteenth and fifteenth centuries. The church's power was weakened, and in some cases, the social roles it had played were replaced by secular ones. Also the plague led to peasant uprisings in many parts of Europe, such as France (the Jacquerie rebellion), Italy (the Ciompi rebellion, which swept the city of Florence), and in England (the English Peasant Revolt).

Europe had been overpopulated before the plague, and a reduction of 30% to 50% of the population could have resulted in higher wages and more available land and food for peasants because of less competition for resources. However, for reasons that are still debated, population levels in fact continued to decline until around 1420 and did not begin to rise again until 1470, so the initial Black Death event on its own does not entirely provide a satisfactory explanation to this extended period of decline in prosperity. See Medieval demography for a more complete treatment of this issue and current theories on why improvements in living standards took longer to evolve.

The great population loss brought economic changes based on increased social mobility, as depopulation further eroded the peasants' already weakened obligations to remain on their traditional holdings. In Western Europe, the sudden scarcity of cheap labour provided an incentive for landlords to compete for peasants with wages and freedoms, an innovation that, some argue, represents the roots of capitalism, and the resulting social upheaval caused the Renaissance and even Reformation. In many ways the Black Death improved the situation of surviving peasants. In Western Europe, because of the shortage of labour they were in more demand and had more power, and because of the reduced population, there was more fertile land available; however, the benefits would not be fully realized until 1470, nearly 120 years later, when overall population levels finally began to rise again.

Social mobility as result of the Black Death has been postulated as most likely cause of the Great Vowel Shift, which is the principal reason why the spelling system in English today no longer reflects its pronunciation.

In Eastern Europe, by contrast, renewed stringency of laws tied the remaining peasant population more tightly to the land than ever before through serfdom. Sparsely populated Eastern Europe was less affected by the Black Death and so peasant revolts were less common in the fourteenth and fifteenth centuries, not occurring in the east until the sixteenth through nineteenth centuries. Since it is believed to have in part caused the social upheavals of fourteenth- and fifteenth-century Western Europe, some see the Black Death as a factor in the Renaissance and even the Reformation in Western Europe. Therefore, historians have cited the smaller impact of the plague as a contributing factor in Eastern Europe's failure to experience either of these movements on a similar scale. Extrapolating from this, the Black Death may be seen as partly responsible for Eastern Europe's considerable lag in scientific and philosophical advances as well as in the move to liberalise government by restricting the power of the monarch and aristocracy. A common example is that England is seen to have effectively ended serfdom by 1550 while moving towards more representative government; meanwhile, Russia did not abolish serfdom until an autocratic tsar decreed so in 1861.

On top of all this, the plague's great population reduction brought cheaper land prices, more food for the average peasant, and a relatively large increase in per capita income among the peasantry, if not immediately, in the coming century. However, the upper class often attempted to stop these changes, initially in Western Europe, and more forcefully and successfully in Eastern Europe, by instituting laws which barred the peasantry from certain actions or material goods. A good example of this is the Sumptuary laws which were passed throughout Europe which regulated what people (particularly of the peasant class) could wear, so that nobles could ensure that peasants did not begin to dress and act as a higher class member with their increased wealth. Another tactic was to fix prices and wages so that peasants could not demand more with increasing value. This was met with varying success depending on the amount of rebellion it inspired; such a law was one of the causes of England's 1381 Peasants' Revolt.

PersecutionsRenewed religious fervour and fanaticism bloomed in the wake of Black Death. This spelled trouble for minority populations of all sorts, as Christians targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims and Muslims",[5] and lepers,[6][7] thinking that they were somehow to blame for the crisis.

Lepers, and other individuals with skin diseases such as acne or psoriasis, were singled out and exterminated throughout Europe. Anyone with leprosy was believed to show an outward sign of a defect of the soul.

Traditionally a lightning rod for Christian anger and unease, Jews were charged with having provoked the Plague through their unbelief and sinfulness. Differences in cultural and lifestyle practices between Jews and Christians also led to persecution. Because Jews had a religious obligation to be clean, they did not use water from public wells. Thus Jews were suspected of causing the plague by deliberately poisoning wells. Typically, comparatively fewer Jews died from the Black Death, in part due to rabbinical laws that promoted habits that were generally cleaner than that of a typical medieval villager. Jews were also socially isolated, often living in Jewish ghettos. This isolation may have caused differences in mortality rates which raised suspicions of people who had no concept of bacterial transmission.

Christian mobs attacked Jewish settlements across Europe; by 1351, sixty major and 150 smaller Jewish communities had been destroyed, and more than 350 separate massacres had occurred. This persecution reflected more than religious hatred. In many places, attacking Jews was a way to criticize the monarchs who protected them (Jews were under the protection of the king, and often called the "royal treasure"), and monarchic fiscal policies, which were often administered by Jews. An important legacy of the Black Death was to cause the eastward movement of what was left of north European Jewry to Poland and Russia, where it remained until the twentieth century.

Religion

Flagellants practiced self-flogging (whipping of oneself) to atone for sins. The movement became popular after general disillusionment with the church's reaction to the Black Death.The Black Death led to cynicism toward religious officials who could not keep their promises of curing plague victims and banishing the disease. No one, the Church included, was able to cure or accurately explain the reasons for the plague outbreaks. One theory of transmission was that it spread through air, and was referred to as miasma, or 'bad air'. This increased doubt in the clergy's abilities. Extreme alienation with the Church culminated in either support for different religious groups such as the flagellants, which grew tremendously during the opening years of the Black Death, or to an increase in interest for more secular alternatives to problems facing European society and an increase of secular politicians.

The Black Death hit the monasteries very hard because of their close quarters with the sick, who had come to the monasteries seeking aid, so that there was a severe shortage of clergy after the epidemic cycle. This resulted in a mass influx of new clergy members, most of whom did not share the life-long convictions and experiences of the veterans they replaced. This resulted in abuses by the clergy in years afterwards and a further deterioration of the position of the Church in the eyes of the people.

Other effects

Inspired by Black Death, Danse Macabre is an allegory on the universality of death and a common painting motif in late-medieval periods.After 1350, European culture in general turned very morbid. The general mood was one of pessimism, and the art turned dark with representations of death. The Dies Irae was created in this period as was the popular poem La Danse Macabre and the instructive and popular Ars moriendi ("the art of dying"). See also The Decameron.

The practice of alchemy as medicine, previously considered the norm for most doctors, slowly began to wane as the citizenry began to realize that it seldom affected the progress of the epidemic and that some of the potions and "cures" used by many alchemists only served to worsen the condition of the sick. Liquor (distilled alcohol), originally made by alchemists, was commonly applied as a remedy for the Black Death, and, as a result, the consumption of liquor in Europe rose dramatically after the plague.

In 2006 a scientific study by Dr Thomas van Hoof of Utrecht University suggests that the Black Death contributed to the Little Ice Age. Pollen and leaf data, collected from lake-bed sediments in the southeast Netherlands, supports the idea that millions of trees sprang up on abandoned farmland soaking up carbon dioxide from the atmosphere and thus cooling the planet. The line of research is new and there are questions and further research is needed, but it does pose an interesting theory that man-caused climate change is older than current theories suggest.

A theory put forth by Stephen O'Brien says the Black Death is likely responsible, through natural selection, for the high frequency of the CCR5-��32 genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV, smallpox, and possibly plague [4], though for the latter, no explanation as to how it would do that exists.