scandinavia from 1348 to 1350. it was introduced into norway in 1349 when a ship landed at askøy, then spread to bjørgvin (modern bergen) and iceland. finally, it spread to northwestern russia in 1351. plague was somewhat more uncommon in parts of europe with less developed trade with their neighbours, including the majority of the basque country, isolated parts of belgium and the netherlands, and isolated alpine villages throughout the continent. according to some epidemiologists, periods of unfavourable weather decimated plague-infected rodent populations and forced their fleas onto alternative hosts, inducing plague outbreaks which often peaked in the hot summers of the mediterranean, as well as during the cool autumn months of the southern baltic region. among many other culprits of plague contagiousness, malnutrition, even if distantly, also contributed to such an immense loss in european population, since it weakened immune systems. western asian and north african outbreak the disease struck various regions in the middle east and north africa during the pandemic, leading to serious depopulation and permanent change in both economic and social structures. as infected rodents infected new rodents, the disease spread across the region, entering also from southern russia. by autumn 1347, plague had reached alexandria in egypt, transmitted by sea from constantinople; according to a contemporary witness, from a single merchant ship carrying slaves. by late summer 1348 it reached cairo, capital of the mamluk sultanate, cultural centre of the islamic world, and the largest city in the mediterranean basin; the bahriyya child sultan an-nasir hasan fled and more than a third of the 600,000 residents died. the nile was choked with corpses despite cairo having a medieval hospital, the late 13th century bimaristan of the qalawun complex. the historian al-maqrizi described the abundant work for grave-diggers and practitioners of funeral rites, and plague recurred in cairo more than fifty times over the following one and a half centuries. during 1347, the disease travelled eastward to gaza by april; by july it had reached damascus, and in october plague had broken out in aleppo. that year, in the territory of modern lebanon, syria, israel and palestine, the cities of ashkelon, acre, jerusalem, sidon and homs were all infected. in 1348–1349, the disease reached antioch. the city's residents fled to the north, but most of them ended up dying during the journey. within two years, the plague had spread throughout the islamic world, from arabia across north africa. the pandemic spread westwards from alexandria along the african coast, while in april 1348 tunis was infected by ship from sicily. tunis was then under attack by an army from morocco; this army dispersed in 1348 and brought the contagion with them to morocco, whose epidemic may also have been seeded from the islamic city of almería in al-andalus. mecca became infected in 1348 by pilgrims performing the hajj. in 1351 or 1352, the rasulid sultan of the yemen, al-mujahid ali, was released from mamluk captivity in egypt and carried plague with him on his return home. during 1348, records show the city of mosul suffered a massive epidemic, and the city of baghdad experienced a second round of the disease. signs and symptoms a hand showing how acral gangrene of the fingers due to bubonic plague causes the skin and flesh to die and turn black an inguinal bubo on the upper thigh of a person infected with bubonic plague. swollen lymph nodes (buboes) often occur in the neck, armpit and groin (inguinal) regions of plague victims. bubonic plague symptoms of the disease include fever of 38–41 °c (100–106 °f), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. left untreated, of those that contract the bubonic plague, 80 percent die within eight days. contemporary accounts of the pandemic are varied and often imprecise. the most commonly noted symptom was the appearance of buboes (or gavocciolos) in the groin, neck and armpits, which oozed pus and bled when opened. boccaccio's description: in men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg ... from the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. as the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. this was followed by acute fever and vomiting of blood. most people died two to seven days after initial infection. freckle-like spots and rashes, which could have been caused by flea-bites, were identified as another potential sign of plague. pneumonic plague lodewijk heyligen, whose master the cardinal colonna died of plague in 1348, noted a distinct form of the disease, pneumonic plague, that infected the lungs and led to respiratory problems. symptoms include fever, cough and blood-tinged sputum. as the disease progresses, sputum becomes free-flowing and bright red. pneumonic plague has a mortality rate of 90 to 95 percent. septicaemic plague septicaemic plague is the least common of the three forms, with a mortality rate near 100%. symptoms are high fevers and purple skin patches (purpura due to disseminated intravascular coagulation). in cases of pneumonic and particularly septicaemic plague, the progress of the disease is so rapid that there would often be no time for the development of the enlarged lymph nodes that were noted as buboes. consequences main article: consequences of the black death deaths inspired by the black death, the dance of death, or danse macabre, an allegory on the universality of death, was a common painting motif in the late medieval period. there are no exact figures for the death toll; the rate varied widely by locality. in urban centres, the greater the population before the outbreak, the longer the duration of the period of abnormal mortality. it killed some 75 to 200 million people in eurasia. a study published in 2022 of pollen samples across europe between 1250 and 1450 was used to estimate changes in agricultural output before and after the black death. the authors found great variability in different regions, with evidence for high mortality in areas of scandinavia, france, western germany, greece and central italy, but uninterrupted agricultural growth in central and eastern europe, iberia and ireland. the mortality rate of the black death in the 14th century was far greater than the worst 20th-century outbreaks of y. pestis plague, which occurred in india and killed as much as 3% of the population of certain cities. the overwhelming number of deceased bodies produced by the black death caused the necessity of mass burial sites in europe, sometimes including up to several hundred or several thousand skeletons. the mass burial sites that have been excavated have allowed archaeologists to continue interpreting and defining the biological, sociological, historical and anthropological implications of the black death. according to medieval historian philip daileader, it is likely that over four years, 45–50% of the european population died of plague. norwegian historian ole benedictow suggests it could have been as much as 60% of the european population. in 1348, the disease spread so rapidly that before any physicians or government authorities had time to reflect upon its origins, about a third of the european population had already perished. in crowded cities, it was not uncommon for as much as 50% of the population to die. half of paris' population of 100,000 people died. in italy, the population of florence was reduced from between 110,000 and 120,000 inhabitants in 1338 down to 50,000 in 1351. at least 60% of the population of hamburg and bremen perished, and a similar percentage of londoners may have died from the disease as well, with a death toll of approximately 62,000 between 1346 and 1353. florence's tax records suggest that 80% of the city's population died within four months in 1348. before 1350, there were about 170,000 settlements in germany, and this was reduced by nearly 40,000 by 1450. the disease bypassed some areas, with the most isolated areas being less vulnerable to contagion. plague did not appear in douai in flanders until the turn of the 15th century, and the impact was less severe on the populations of hainaut, finland, northern germany and areas of poland. monks, nuns and priests were especially hard-hit since they cared for people with the black death. citizens of tournai bury plague victims the physician to the avignon papacy, raimundo chalmel de vinario (latin: magister raimundus, lit. 'master raymond'), observed the decreasing mortality rate of successive outbreaks of plague in 1347–48, 1362, 1371 and 1382 in his 1382 treatise on epidemics (de epidemica). in the first outbreak, two thirds of the population contracted the illness and most patients died; in the next, half the population became ill but only some died; by the third, a tenth were affected and many survived; while by the fourth occurrence, only one in twenty people were sickened and most of them survived. by the 1380s in europe, it predominantly affected children. chalmel de vinario recognised that bloodletting was ineffective (though he continued to prescribe bleeding for members of the roman curia, whom he disliked), and said that all true cases of plague were caused by astrological factors and were incurable; he himself was never able to effect a cure. the most widely accepted estimate for the middle east, including iraq, iran and syria, during this time, is for a death toll of about a third of the population. the black death killed about 40% of egypt's population. in cairo, with a population numbering as many as 600,000, and possibly the largest city west of china, between one third and 40% of the inhabitants died within eight months. italian chronicler agnolo di tura recorded his experience from siena, where plague arrived in may 1348: father abandoned child, wife husband, one brother another; for this illness seemed to strike through the breath and sight. and so they died. and none could be found to bury the dead for money or friendship. members of a household brought their dead to a ditch as best they could, without priest, without divine offices ... great pits were dug and piled deep with the multitude of dead. and they died by the hundreds both day and night ... and as soon as those ditches were filled more were dug ... and i, agnolo di tura ... buried my five children with my own hands. and there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. there was no one who wept for any death, for all awaited death. and so many died that all believed it was the end of the world. economic it has been suggested that the plague, like some others in history, disproportionately affected the poorest people, who were already in generally worse physical condition than the wealthier citizens. nevertheless, with such a large overall population decline from the pandemic, wages soared in response to a labour shortage. on the other hand, in the quarter century after the black death in england, it is clear many labourers, artisans and craftsmen, those living from money-wages alone, did suffer a reduction in real incomes owing to rampant inflation. landowners were also pushed to substitute monetary rents for labour services in an effort to keep tenants. environmental a study performed by thomas van hoof of the utrecht university suggests that the innumerable deaths brought on by the pandemic cooled the climate by freeing up land and triggering reforestation. this may have led to the little ice age. persecutions jews being burned at the stake in 1349. miniature from a 14th-century manuscript antiquitates flandriae by gilles li muisis renewed religious fervour and fanaticism bloomed in the wake of the black death. some europeans targeted "various groups such as jews, friars, foreigners, beggars, pilgrims", lepers and romani, blaming them for the crisis. lepers, and others with skin diseases such as acne or psoriasis, were killed throughout europe. because 14th-century