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You can't really compare the two. Smallpox is a specific disease. The black death was an outbreak of an unknown disease during a specific time period of history.

No one is 100% sure what disease caused the black death. Historians believe the black death may have been either bubonic plague or anthrax; but other types of plague may have been the cause.

Either way your question is comparable to asking:

"What is worse: a war or a gun?

The black death being the war, a period of history where plagues were spreading and killing people. The gun being small pox, a specific disease with known causes and treatments.

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If you assume the black death was caused by Bubonic Plague than you could ask the question:

What is worse bubonic plague or smallpox?

I believe the bubonic plague is worse than smallpox.

Compare:

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Smallpox is spread by close contact (airborne) with already infected people. After a 12 day incubation period the symptoms are extreme forms of viral infections similar to extreme cases of influenza and skin lesions. Or basically a very bad flu or cold along with an extreme version of itchy chicken pox like lesions. Mild cases are about 30% fatal, cases that present with ruptures and hemorrhaging are closer to 100% fatal.

Treatments given within the first few days have a higher chance of working. Treatment given later than that are mostly just to manage symptoms and try to make the patient comfortable while the body tries to fight off the virus.

Patients who survive may be left with scarring from the pox marks that can cover up to 100% of the skin surface.

Preventive vaccinations are nearly 100% effective and have essentially eliminated the disease in the United States and countries where it is readily available.

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Bubonic Plague is spread by fleas and rodents, any infected vermin that bites humans. Symptoms present within 2-5 days of exposure.

The first symptom is painful, swollen lymph glands, called buboes commonly found in the armpits, groin or neck. Due to its bite-based form of infection, BP is often the first step of a series of illnesses. Some of these other illness combination are also very infectious and allow person-to-person spread.

Additional symptoms include : chills, high fever, random muscle pain, severe headaches, seizures, painful swelling, blood vomiting, bloody urination, coughing. As the symptoms progress pain becomes severe as the body is essentially decaying and decomposing while the person is still alive, this results in black dots scattered throughout the body.

Untreated, bubonic plague has a 90% mortality rate. However, if caught in time, modern antibiotics are more than 80% effective, reducing the mortality rate below 20% if treated early enough.

If symptoms have already presented, than some permanent damage to skin and internal organs may remain after treatment.

Bubonic plague is now rare in most developed parts of the world where proper sanitation and pest control are practiced, it is still a problem in poverty stricken areas where fleas and rodents are present.

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Note: this is a very brief summary of these two diseases, you should consult a competent medical text reference for more accurate details.

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Q: What is worse the black death or smallpox?
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