8 • The Great Plaguespread the plague from person to person. “All fall down” was the sadness of
sudden death, as people were known to collapse on the streets, sometimes
with few symptoms of the sickness.
By 1352 the killing disease had come almost full circle to the Middle East,
leaving Europe’s survivors to ponder its meaning and take up their lives
again. Then it returned, again and again. Some of the Black Death’s charac-
teristics—such as sneezing and coughing up blood—were missing from
these later visitations, and the disease usually struck down fewer persons in
cities and virtually none in remote country areas. But several continuities, in-
cluding the painful, protruding buboes on victims, remained strong.^15 Com-
mon signs and symptoms were not always mentioned in contemporary ac-
counts, but that did not mean they were absent. A historian of the Black
Death, Rosemary Horrox, suggests that the brevity of some accounts may
have stemmed from a belief that there was nothing new to say about plague
and its effects.^16 Reports by some doctors of curing patients—which histo-
rian Samuel Cohn sees as a sign of the disease’s decline in virulence—look
suspiciously like a public relations gambit. Plague may have changed some-
what, but it remained an extremely deadly disease incapable of being cured.^17
Knowledge about plague acquired over time made its reappearances almost
as frightening as its initial entry into Europe as a new disease.^18
Until the sixteenth century, the plague’s relentless return every six to
twelve years kept the European population well below pre–Black Death lev-
els. The demographic decline had begun before the Black Death from other
causes, including famine, but plague accelerated the crisis. The population of
Florence, which had been luckier than Venice in 1348 , shrank by three-
quarters from the cumulative effect of repeated plague attacks.^19
After 1500 the intervals between outbreaks tended to be longer, up to fif-
teen or even twenty years. And Europe’s population began to grow. But
sooner or later London, Paris, Rome, Barcelona, and other early modern cit-
ies experienced another great plague. Although the loss of population usually
remained under 20 percent, these visitations took more lives, for the post-
1500 population explosion placed more persons in harm’s way. At times the
distemper continued into a second year with significant mortality, and in
some areas it lingered still longer, with occasional further fatalities.^20
Some of these epidemics took as large a proportion of the population as
the Black Death had claimed. Venice, which kept excellent census records (a
rarity at this time), reported 142 , 804 inhabitants in 1624 , before the great epi-
demic of 1630 – 31 ; in 1633 only 98 , 244 residents were counted, a drop of one-
third through death and emigration. Barcelona’s last epidemic in 1651 – 53 ,