Here are excerpts from just two of the 49,100 items Googled under "bubonic plague" as of early March 2003: "The Center for Disease Control and Prevention thinks that [plague and turlaremia] -- along with the anthrax bacteria and the smallpox virus -- pose the greatest hazard to public health, based on their death rates, ease of dissemination and transmission, and potential to inspire public panic...What is plague? An extraordinarily lethal illness caused by the bacterium Yersinia pestis. It takes two main forms:  Bubonic plague. This form of plague caused the Black Death that devastated China, the Middle East, and Europe in the fourteenth century, killing a larger proportion of the world's population than any single war or epidemic since.  Pneumonic plague, which is highly contagious, and more lethal than bubonic plague. If those infected do not receive treatment, their mortality rate can approach 100 percent" (The Council on Foreign Relations, in Cooperation with the Markle Foundation).
"Vaccine maker Avant Immunotherapeutics, Inc. [has] won a U.S. government contract to work on an oral vaccine to protect troops against both anthrax and plague infections...Avant, which is being paid $8 million for the first two years of development, will first have to come up with a plan for developing the vaccine" (Washington (Reuters), January 22, 2003).
If, in today's climate of fear, a gruesome attack of "medieval" plague is among your nightmares, you will be grateful to Samuel Cohn. In The Black Death Transformed and on the lecture circuit he assures us -- evidently without effect on government information and spending -- not only that bubonic plague should be taken off the list of likely bioterror agents, but even that it is entirely unrelated to the pestilential epidemics which are indelibly associated with the later Middle Ages. On the other hand, caveat emptor who expects "a definitive work" -- as promised in a blurb by a veteran medievalist -- on the real causes, nature, and effects of the Great Mortality. If the book is already on its way to becoming a staple of college reading lists, this may be due less to inherent value than to the timeliness of the subject and the assertiveness of the author. A condensed sample of these qualities is available in an article by Samuel Cohn, "The Black Death: End of a Paradigm," American Historical Review 107 (2002): 703-738, which opens with the sweeping claim that "HIV/AIDS and the threat of biological warfare have refueled interest in the Black Death among historians, biologists, and the public..." One wonders to what extent this advertised "relevance" may have propelled the book project at the expense of editorial diligence, for the result is a dazzling and stimulating but deeply flawed study. The author catches the reader's attention with perceptive propositions and lively arguments, but also with supercilious verbiage. He raises serious questions about the commonly proposed identifications of the Black Death and explanations of the Renaissance, but his answers lack nuance and flexibility. He cites a wide range of sources, but his choice and interpretation of the evidence are problematic. Let us look more closely at each of these three areas of ambivalence.
Cohn's presentation is packed and colorful, more reminiscent of tabloid journalism than of the classroom. He keeps pace with the fascinating themes of death and rebirth, at the risk of getting ahead of them with his breathless enthusiasm. Hints of undue haste may also be found in the untidy syntax, mixed metaphors ("the plague continued building a head of steam" and then "fluctuated," 189), and spelling errors (most egregiously, "innoculable," 11), stylistic blemishes which need not detain us here. On the whole, the author's language, whether descriptive or demonstrative, is direct and occasionally colloquial rather than pedantic; his chapters open with rousing or even startling sentences; and many pages are enlivened by pithy anecdotes or refreshing insights. His tone, however, becomes strident when he is too anxious to draw attention or to underscore his revisionist stance -- or, indeed, to proclaim his superior intelligence. Scornful critiques are shot at esteemed authors, several of whom are still active. Thus, we read that one colleague who is known for his meticulous scholarship, namely Ole Jorgen Benedictow, "simply pushes the evidence aside" (53). An especially abrasive treatment is reserved for the physician-historian Ann Carmichael, who is portrayed as having "claimed confidently" and "generalised" that the 1348 plague was bubonic, with one argument that was "subtler still (and more perplexing)" than another, while she "strove to have it both ways" with a "retrospective diagnosis" (47-49; further, a statement by Carmichael is blatantly misrepresented on p. 234). The common herd of historians have nothing but an "idée fixe" (41) in their "emotional" and "unbending attachment" (53) to the identity between the Black Death and bubonic plague, with their "blinkered focus" on signs and symptoms (139); they greet alternative ideas with "vitriolic rejections" (53), while they "continue to parade before us" nothing but stale documents (241). A shade of smugness colors the sarcastic dismissal of the "triumph" of the French paleomicrobiologists who claim to have found evidence of bubonic plague in the dental pulp of medieval cadavers (248). In addition, this passage, together with several others, makes it seem as if the author is irked by anything resembling a "Francocentric view" (8) and then tries to compensate by glorifying the British as "the unsung heroes" (24; compare pp. 14, n. 39, 25-27, 38, 39). For some, such insinuations and other idiosyncrasies may enhance the allure and impact of the book, but others will find the style not only off-putting but also impeding a nuanced treatment of the issues.
An issue no less weighty than the end of the Middle Ages is at stake in this "revolutionary account" (back cover blurb) of the nature and consequences of the Black Death. First, virtually the entire historiography is demolished in methodical syllogisms which converge in the conclusion that, in direct contrast with the modern bubonic plague caused by Yersenia pestis, the medieval Black Death was highly contagious, it spread rapidly and widely, with seasonal patterns and without demonstrable involvement of fleas or rats, and it caused high mortality. Further unlike the so-called "Third Pandemic" of nineteenth-century Asia, recurrences in premodern Europe were separated by considerable intervals, and the mortality declined with successive waves, which indicates that immunity was developing. The latter supposition provides Cohn with a premise for his second revisionist thesis. Believing that increasing resistance and rapid adaptation to the epidemic turned the European outlook from despondency to boldness, he is certain that this "about-face in confidence" (240) explains the emergence of "a new culture of 'fame and glory'," as he characterizes the early Renaissance (252). The dual thesis and the expansive argumentation should stir renewed discussion and, probably, a revision of important aspects of the Black Death. The challenge of fine-tuning the definition and the etiology of the Great Mortality is best left to historians of epidemics who are less self-assured than the author -- and more knowledgeable than this reviewer. Suffice it to say that, from this vantage point, Cohn's rejection of all correspondence between the Black Death and bubonic plague seems far too categorical. His second thesis, however, is more patently oversimplied, for he claims "to solve a fundamental enigma" by contrasting reactions to the pestilence of 1348 with responses to subsequent epidemics, and by attributing the Renaissance to stunningly quick turns -- "as early as the second plague" (226) -- not only from pessimism to optimism, but also from otherworldly to natural etiologies, and from social excesses to tolerance. Ironically, after attacking (not entirely without ground) the historians who see all epidemics as having the same cultural and psychological effects, Cohn displays an analogous lack of peripheral vision by tying too many late-medieval changes to the Black Death. His view is both narrow and linear when he insists that physicians of the second half of the fourteenth century differed utterly from their immediate predecessors by their "progressive view of the history of medicine made possible by the present plagues" (236), in other words, by their "new sense of progress and even triumph over the natural world" (244). With similarly striking simplicity (and taking liberty in interpreting Nancy Siraisi) he asserts that "the plague experience appears vital to Aristotle's decline in the fourteenth and fifteenth centuries at least as far as medicine is concerned" (70).
The grand theses of The Black Death Transformed are constructed with a mass of imaginatively mined documentation. The citations draw together the vast historiography, arguments are buttressed with a great variety of sources, and an array of graphs illuminates quantified proof. On the other hand, the secondary literature is cited without discrimination between groundbreaking studies and derivative work, between Emmanuel Le Roy Ladurie or David Herlihy and the likes of Norman Cantor. A vaunted profusion of source materials (listed in appendices) comes at the expense of methodical collation. Obsolete editions or unreliable paraphrases are deemed sufficient for some important sources, including, most astonishingly, Guy de Chauliac who is quoted -- far too selectively -- from the 1890 French edition by Edouard Nicaise and from a 1865 general textbook by Heinrich Haeser, rather than from the 1997 definitive and annotated edition of the Latin text by Michael McVaugh. The most substantial problem for the entire book, however, is that much of the evidence is made to fit the theses, often with more legerdemain than in the so-called efforts of other authors to "square the circle" (titles of chapters 1 and 3). For example, as proof of a radical change in the physicians' outlook, their interest in the connection between health and "states of mind" is presented as if it were new, and the age-old concern with the "accidents of the soul" is ignored (241). More consequentially, the categorical differentiation between the Black Death and bubonic plague, in which boils form primarily in the groin, requires that medieval mentions of such buboes be minimized or altered. Thus, repeated references in chronicles to "inguinal" illness are said to add up to nothing more than an "occasional linguistic connection" (64). It is even more astonishing that the famous story of Saint Roch (San Roque, Montpellier and Italy, around 1370) is totally ignored in the discussion of saints' lives, and so is the fifteenth-century iconography in which the saint's inguinal bubo -- sometimes moved down the thigh for the sake of modesty -- is an unmistakable hallmark. (Conversely, the emphasis on the groin as the most commonly affected region in modern bubonic plague is not reconciled with the iconographic significance of the 1799 painting by Antoine Gross, which shows Napoleon touching a bubo in the axilla of a plague victim in Jaffa.)
While the selective use of the evidence may be a troubling yet relatively normal byproduct of the author's passionate belief in his theses, pervasive weaknesses in the interpretation of the cited sources can only undermine his credibility. A limited familiarity with medieval medicine surfaces in many trivial details, such as the characterization of the medicinal simple, Armenian clay, lutum armenicum, as a "concoction" (237). A deeper problem lies in the various imprecise and misleading interpretations which cast doubt on Cohn's perception of medieval plague. This is the case, most notably, when apostemata are translated as "plague scars" (64) and fistulis as "spots" (93), while treatment ex quadam fistula seu apostemate becomes treatment "for pestilential fever and plague sores and ulcers"(74, n. 114). In one passage (95), seven terms for "spots"are lumped together without any consideration for their distinct meaning or their respective place in premodern nosology. Such imprecisions suggest that descriptive evidence is accorded limited esteem. Yet, paradoxically, there is also a tendency to overrate the significance of some testimony, particularly when it supports the generalization that for a group of writers "notions of contagion were not theory-driven but instead came from empirical observation" (117). In the process, the empirical value of observations becomes overstated in translations such as "I have seen this by experience" for sic etiam experientia demonstravit (235). Aside from these instances, for which one is at least able to check the original text, there are far more cases in which only a brief reference is given when a quotation seems indispensable. Some of these cases (including the rough paraphrase of the Journal d'un bourgeois de Paris on 105) may merely tantalize the curious reader, but others compound the problems with the author's credibility. These problems do not just tarnish a potentially brilliant study, but they largely invalidate the theses which were supposed to outshine all prior scholarship.