Historical Background to the Siege of CaffaД¬affa (now Feodosija, Ukraine) was established by Genoa in 1266 by agreement with the Kahn of the Golden Horde (15). In any event, the Crimea clearly played a pivotal role as the proximal source from which the Mediterranean Basin was infected. However, despite more than a century of speculation about an ultimate origin further east, the requisite scholarship using Chinese and central Asian sources has yet to be done.

Historians generally agree that the outbreak moved west out of the steppes north of the Black and Caspian Seas, and its spread through Europe and the Middle East is fairly well documented ( Figure 1). Known 14th-century sources are of little help they refer repeatedly to an eastern origin, but none of the reports is first-hand. The ultimate origin of the Black Death is uncertain-China, Mongolia, India, central Asia, and southern Russia have all been suggested (see Norris for a discussion of the various theories). The disease that caused this catastrophic pandemic has, since Hecker (6), generally been considered to have been plague, a zoonotic disease caused by the gram-negative bacterium Yersinia pestis, the principal reservoir for which is wild rodents ( 7вЂ“ 11). After analyzing these claims, I have concluded that it is plausible that the biological attack took place as described and was responsible for infecting the inhabitants of Caffa however, the event was unimportant in the spread of the plague pandemic. If this account is correct, Caffa should be recognized as the site of the most spectacular incident of biological warfare ever, with the Black Death as its disastrous consequence. This narrative contains some startling assertions: that the Mongol army hurled plague-infected cadavers into the besieged Crimean city of Caffa, thereby transmitting the disease to the inhabitants and that fleeing survivors of the siege spread plague from Caffa to the Mediterranean Basin. This memoir has been published several times in its original Latin ( 2, 3) and has recently been translated into English (4) (although brief passages have been previously published in translation, see reference ). China, India, and the rest of the Far East are commonly believed to have also been severely affected, but little evidence supports that belief (1).ДЄ principal source on the origin of the Black Death is a memoir by the Italian Gabriele deвЂ™ Mussi. Europe lost an estimated one quarter to one third of its population, and the mortality in North Africa and the Near East was comparable. The Black Death, which swept through Europe, the Near East, and North Africa in the mid-14th century, was probably the greatest public health disaster in recorded history and one of the most dramatic examples ever of emerging or reemerging disease.

Gabriel the plague doctor