The Black Death Transformed: Disease and Culture in Early Renaissance Europe.

Samuel K. Cohn. The Black Death Transformed: Disease and Culture in Early Renaissance Europe.

London: Arnold, 2002. xii + 318 pp. index. tbls. bibl. $65 (cl), $22 (pbk). ISBN: 0-340-70646-5 (cl), 0-340-70697-3 (pbk).

Hippocrates' first aphorism suggests not only that life is short, but that medical judgment is difficult. Diagnosis is even more difficult after centuries have passed. This fact is central to this book's thesis; it also accounts for its inevitable weakness.

If Professor Cohn is correct, histories of the Black Death and the epidemics which followed must be revised, for they have been attributed incorrectly to the Yersina pestis bacillus and mislabeled "bubonic." He argues that modern researchers--historians and medical writers alike--systematically ignored or misconstrued evidence, damaging our understanding of epidemic disease and perhaps even of the Renaissance itself.

Cohn does not share other historians' "emotional attachment to the Black Death as modern bubonic plague" (53). He is so sweeping in his condemnation of others' positions on the issue that his own may not be given the attention it deserves. Although proof of a falsity is logically very difficult, he has marshaled so much evidence for presence of an illness other than modern plague that medical historians will need to come to terms with this book.

Working primarily in northern Italy, England, and France, reading scores of chronicles and plague tracts, and compiling statistics from thousands of burial records, obituaries, and wills, Cohn finds evidence of epidemics that do not match modern plague's contagion, speed of transmission, seasonality, social characteristics of its victims, mortality rates, or the massive death of rats.

Only about a sixth of the contemporary sources studied by Cohn mention skin disorders ("spots" or boils), but large buboes, generally in the groin area where fleas bite, are the typical sign of modern plague. More of his sources are impressed with the epidemiology of peste, its "universal" nature, a very high level of mortality, and great speed at which it spread and killed. None of these are characteristics of modern plague, despite common misperceptions due to the "heavy hand" of histories of the Black Death.

Moreover, modern plague is seasonal, its climatic regularities indicating an insect (flea) vector, but late medieval epidemics could occur at any time and persist throughout the year despite wide fluctuations in temperature and humidity. Although Cohn can distinguish Mediterranean and northern seasonal patterns of deaths in time of plague, neither pattern fits that of modern plague or the fertility cycle of the rat flea. He does not mention the human flea thesis that others have used to account for plague's epidemiology, but he does reject the common "pneumonic transmission" hypothesis as a mere device to "mend the paradigm" (42).

Epidemics are defined by pathogens, but more especially by how they spread. Plague's "universal" scope and terrible mortality were its main features, and it was called "great" (later historians labeled it "Black") because of its horrendous mortality. It was also distinguished by the speed at which it spread and by its extremely contagious nature. None of these are features of modern rat-based bubonic plague, even in its pneumonic form, as Cohn learned from twentieth-century research, especially from the Indian Plague Commission. Modern plague tends to strike the same area in annual cycles, but plagues in the century after the Great Death arrived at intervals, typically of about nine years. Later in the Renaissance the cycle was more like the modern pattern, with plagues spiraling downward in their frequency and mortality. Cohn leaves "plague's enigmatic seasonality" for scientists to solve (187).

Cohn's secondary thesis is that "Renaissance optimism" (242), along with "a new sense of progress and even triumph over the natural world" (244), may be due to European adaptation (acquired immunity) to the peste, a success claimed by medical science of the time. He notes a cultural shift from the original supernatural and eschatological responses to plague to a more rational discussion of signs, treatments, and recipes. The "new confidence" (233) found in plague treatises warrants further study by cultural historians. His argument that medical scientists and historians have been influenced by each other's understandings (and misunderstandings)--causing them even to misinterpret their own findings--is also interesting and might be tested on other diseases and historical problems.

Having dealt with so much, but often incomplete or conflicting, information, Cohn raises more questions than he can answer. For example, after the first plague, women fared better than men, but plague seemed to be a disease especially of children, while modern plague tends to strike young adults of both sexes. Likewise, modern plague affects rich and poor alike, while the poor suffered particularly in the late medieval period, offering an interesting problem for social and political historians. Mortality statistics are affected by how individual causes of death are determined, and by whom. Cohn acknowledges that "doctors were not always referring to the same disease" (86). Ultimately, the questions of whether epidemics were caused by only one disease and whether Y. pestis was involved may have to await microbiological or archeological evidence.

There may be no convincing case for Y. pestis, but the evidence pointing elsewhere, while considerable, is circumstantial. We are left with a "suspicious but not proven" verdict; rejection of the old paradigm is premature. Still, thanks to Cohn, we know more about what questions to ask and evidence to seek.

For other discussions of the inconclusive state of the matter, see Christine M. Boeckl, Images of Plague and Pestilence: Iconography and Iconology (2000), who brings evidence from art history to bear on the Y. pestis hypothesis, while A. Lynn Martin's Plague? Jesuit Accounts of Epidemic Disease in the 16th Century (1996) raises more serious objections to the "classic" plague model. Cohn does not list either in his extensive bibliography.

DAVID O. MCNEIL

San Jose State University