The disease was bubonic plague

No pestilence had ever been so fatal, or so hideous. Blood was its Avatar and its seal—the redness and the horror of blood. . . . The scarlet stains upon the body and especially upon the face of the victim, were the pest ban which shut him out from the aid and from the sympathy of his fellow-men. . . . And the rumor of this new presence having spread itself whisperingly around, there arose at length from the whole company a buzz, or murmur, expressive of disapprobation and surprise—then, finally, of terror, of horror, and of disgust.

And now was acknowledged the presence of the Red Death. He had come like a thief in the night. . . .

IN OCTOBER 1347, two months after the fall of Calais, Genoese trading ships put into the harbor of Messina in Sicily with dead and dying men at the oars. The ships had come from the Black Sea port of Caffa in the Crimea, where the Genoese maintained a trading post. The diseased sailors showed strange black swellings about the size of an egg or an apple in the armpits and groin. The swellings oozed blood and pus and were followed by spreading boils and black blotches on the skin from internal bleeding. The sick suffered severe pain and died quickly within five days of the first symptoms.

As the disease spread, other symptoms of continuous fever and spitting of blood appeared instead of the swellings or buboes. These victims coughed and sweated heavily and died even more quickly, within three days or less, sometimes in 24 hours. In both types everything that issued from the body—breath, sweat, blood from the buboes and lungs, bloody urine, and blood-blackened excrement—smelled foul. Depression and despair accompanied the physical symptoms, and before the end "death is seen seated on the face."

The disease was bubonic plague, present in two forms: one that infected the bloodstream, causing the buboes and internal bleeding, and was spread by contact; and a second, more virulent pneumonic type that infected the lungs and was spread by respiratory infection. The presence of both at once caused the high mortality and speed of contagion. So lethal was the disease that cases were known of persons going to bed well and dying before they woke, of doctors catching the illness at a bedside and dying before the patient. So rapidly did it spread from one to another that to a French physician, Simon de Covino, it seemed as if one sick person "could infect the whole world." The malignity of the pestilence appeared more terrible because its victims knew no prevention and no remedy.

The physical suffering of the disease and its aspect of evil mystery were expressed in a strange Welsh lament which saw "death coming into our midst like black smoke, a plague which cuts off the young, a rootless phantom which has no mercy for fair countenance."

Woe is me . . .

And Darkness and Decay and the Red Death held illimitable dominion over all.

—Barbara W. Tuchman, A Distant Mirror

Painting: Pablo Picasso, Head of a Woman