4—
The Plague Epidemic of 1835:
Background and Consequences

Since the fourteenth-century Black Death, plague^[1] had played a paradigmatic role as the archetypal pestilential scourge that terrified populations into creating elaborate defense systems against its recurring ravages. In the accelerated pace of trade in the nineteenth century, cholera and yellow fever posed greater threats to exposed societies, but earlier experience with plague not only dictated the practices but also defined the principles for disease control. As a century passed without any recurrence of plague in Western Europe, Atlantic seaboard nations began to challenge the elaborate Mediterranean defense system of military cordons, quarantines, and lazarettos that delayed the movement of goods and persons. But there was no demonstrably sound scientific theory to provide a basis for abandoning the system, and there were enormous vested interests in maintaining it. Dispute over the issues thus revealed irreconcilable differences among policymakers, quarantine establishment functionaries, trading interests, and the medical profession.

In Egypt as well, European physicians split into two camps upholding opposing theories and procedures for the control of plague and therefore all epidemic disease. To compound the confusion, attitudes among European and Egyptian laymen apparently arose from differing experiences with plague over the centuries and divergent

views on socially acceptable behavior during an epidemic crisis. Each community considered the responses of the other's members irrational or reprehensible.

Europeans had long considered Egypt the cradle of the plague, just as they considered India the home of cholera. The theories elaborated over the years to explain why plague appeared to originate in the Nile valley influenced nineteenth-century European official policy and public opinion vis-à-vis Egypt. Periodic outbreaks of plague in the country, recurring almost as regularly as the annual Nile flooding, early led European observers to make a causal connection between the seasonal inundation and plague epidemics. The Galenic notion of disease causation by noxious miasma from decaying organic matter underwent a nineteenth-century elaboration in Egypt: the "cadaveric virus theory" that held plague was a result of a miasmatic poison emanating from soil in which buried human corpses were decomposing.^[2] The most eloquent exponent of the theory was Etienne Pariset, Permanent Secretary to the French Academy of Medicine, who headed a commission to study plague in Syria and Egypt in 1827. Pariset was revolted by the Nile valley graveyards where corpses were annually submerged and surfaced to float on the rising river. He theorized that Egypt must have been free of plague while the ancients practiced embalming and entombing corpses outside the flood area. When Christians substituted burial for embalming, they must have initiated the sixth-century pandemic. The Black Death also must have arisen in Egypt's delta, he said, "because nowhere else in the world does one find . . . extended, flat land which is warm, humid and saturated with animal matter."^[3] The cadaveric virus theory underlay the popular nineteenth-century view that graveyards were seed beds of epidemic disease, particularly plague, and should be removed as far from habitation as possible.

Clot rejected Pariset's hypothesis and other theories that ascribed the genesis of plague in Egypt to the Khamsin, the hot, sand-laden wind from the Sahara, humidity, or stagnant waters. Plague was endemic in Egypt, according to Clot, because meteorological circumstances peculiar to the country endowed it with a "pestilential constitution."^[4] In the meantime, a "localist-miasmatist" hypothesis of disease causation added impetus to the sanitary reform movement in England. Independent of changing medical viewpoints of the time, British sanitary reformers operated on the theory that the stench arising from filth contained noxious particles that were absorbed through

the extensive surface of the thin air vesicles of the lungs. Once ingested, these toxic particles caused disease.^[5]

In France, concern with sanitary improvement as an aspect of social reform added political corollaries to this theory, and the conviction that the extirpation of plague required radical government reform recurs repeatedly in the writings of continental Europeans who traveled in Egypt during the nineteenth century. One example was Hamont, the veterinarian whose criticisms of the viceroy aimed to counterbalance writings by Dr. Clot, Muhammad Ali's articulate admirer. Hamont asserted that the Egyptians' illnesses had social causes: "the frightful state of slavery in which they live, the abominable despotism which weighs on them, the vexations which they must suffer."^[6] The reformist attitude also was evident in a report issued by the French Academy of Medicine in 1846 which declared that investigation in Egypt had demonstrated that plague was not a contagious disease. The academy's commission of inquiry emphasized social causes as primary pathogenic factors in Egypt: accumulations of putrefying animal matter near dwellings, poor and crowded housing, inadequate nutrition, neglect of personal hygiene, and, above all, the governing authorities' lack of initiative to improve the lot of the inhabitants. The academy's report concluded that the progress of civilization was the only preventive against plague and Egypt's greatest need was enlightened, efficient administration.^[7]

Pariset's theory that plague was especially associated with waterlogged lands was being disproved while the academy was studying its report; plague was already retreating from its alleged home in lowland Egypt, and it persisted longest in the highlands—in the foothills of the Himalayas, among the mountains of western Arabia, in the Kurdish highlands, and in the Chinese hinterland of Yunnan. The French academy's finding incriminating social and environmental health hazards as pathogenic factors was admirable as a general principle, but it was not an adequate guide for dealing with the specific threat of importing plague with trade in commodities.

Unlike the common people of Europe, who were terrified of plague and were convinced that it was extremely contagious, the majority of Egyptian Muslims at the outset of the nineteenth century apparently had no fear of infection by contact with the disease. They seemed to consider plague simply one among the many trials of living, and they scorned the precautions resident Europeans practiced during plague "season" in Egypt. The usual explanation of that time

for the Egyptians' indifference toward plague—"Muslim fatalism"—is too facile to be accepted without qualification.

Some of the medieval Arab physicians had recognized the principle of infectivity as well as miasmatic toxicity in disease transmission,^[8] and the Egyptian historian, al-Maqrizi, who wrote a generation after the Black Death, described the plague epidemic's spread in terms of both contagion and miasma.^[9] However, the notion of contagion or infectivity of plague was never generally admitted in Egypt or other Muslim lands, according to Michael Dols, the historian of plague in the Middle East. He suggests that there was a consensus on the plague based on three hadith, or traditions: a Muslim should not enter or flee from a plague-stricken land; the plague represents martyrdom and mercy from God for a Muslim and punishment for an infidel; and there is no transmission of disease. Although the literal interpretation of these traditions appears to be an exhortation for resignation to inevitable death, Dols points out there was a gap between prescription and practice in Muslim communities during a plague epidemic.^[10] There were also a great number of magical beliefs and practices to soften the likelihood of martyrdom and to supplement unavailing medical remedies. This modified religious-cultural attitude apparently remained one of the shared views of the Islamic community.^[11]

Nevertheless, between the fifteenth and nineteenth centuries, other factors must have fortified the Egyptians' apparent "indifference" toward plague. One possible explanation may be the fact that the panic and dread, which Egyptians and Europeans shared during the trauma of the Black Death, were not institutionalized in pesthouses in Muslim lands. Isolation in these facilities psychologically reinforced fear of plague in Europe.^[12] There is also the fact that, unlike pneumonic plague, bubonic plague is observably not contagious.^[13] After the fifteenth century, pneumonic plague broke out in Egypt only at infrequent intervals, and Egyptians may have become accustomed to relatively mild, localized outbreaks of bubonic plague.^[14]

The third pandemic of plague, which erupted in Egypt in 1899 after an absence of fifty-five years, has been studied exhaustively and has provided data for suggesting a normal season, incidence, and epidemiological pattern for the disease. Those "normal" conditions did not necessarily exist in the early nineteenth century, however. One of the anomalies of plague in the Nile valley is a locus of

pneumonic plague in Upper Egypt around Asyut. According to epidemiologists, only the Egyptian littoral's Mediterranean climate is naturally vulnerable to plague, and Egypt south of Cairo normally is too hot and dry to be susceptible to enzootic plague were it not for the Nile irrigation system. The port cities, Damietta, Rosetta, and Alexandria, had a greater abundance of rats, but the embankments of canals in agricultural areas provided harborage for rats that fled the floodwaters in August and took refuge in the dovecotes on house roofs or in the houses themselves.^[15] However, the Khedive Ismail first extended irrigation to Upper Egypt in the 1860s, and the British introduced perennial irrigation with the first Aswan Dam, built between 1898 and 1902. A permanent rat flea population of sufficient density to cause an epidemic in the Said was therefore unlikely until the late nineteenth century. Temporary concentrations of rats and fleas at optimum meteorological conditions, however, could and occasionally did trigger an epidemic in Upper Egypt.^[16]

European residents in Egypt believed that plague was always imported from Turkey, Asia Minor, Syria, or Crete, but they shared the Egyptians' observation that the plague season had easily defined limits. When plague broke out in Cairo, both Franks and Egyptians assured visitors the scourge would decline by the end of June when hot weather set in. Egyptians looked forward to the plague's disappearance when they celebrated "al-Nuqta, " the annual rise of the Nile, which normally occurred in Cairo around the summer solstice.^[17] Travelers called the Egyptians fatalist "predestinarians" when they bought and sold in the markets the clothing of those who had died during the last plague season after al-Nuqta. European residents in Egypt, like the Franks in Syria, celebrated "the death of the plague" on St. John's Day, June 26, a festive occasion for friends to visit and congratulate each other on having escaped the last visitation. Some European travelers scorned both traditional observances as Muslim and Christian "superstitution," but a few noted that empirical observation lay behind the local customs: it was "well known that extreme heat checks the plague in the same manner as the cold season."^[18]

Except for their common recognition of this phenomenon, Franks and Egyptians held opposed views on the plague. The Italians who settled in Egypt and the Levant evidently brought with them a strong conviction of the communicability of plague, which had raged as late as 1743 in Sicily. They were terrified of the disease and took

stringent precautions to avoid exposure to it. Many travelers to the eastern Mediterranean commented on the Franks' rigorous selfimposed quarantine during the plague season; following is a summary of a description by one of the medical officers in the French occupation forces.

When the Franks living in Egypt were certain that plague had broken out in the country, they retired to their homes, closed all the doors, and did not communicate with anyone until the feast of Saint John. One servant not included in isolation was designated proveditore (sutler). This man deposited all provisions bought in the market in the home's outer courtyard. The porter washed all the articles of food in urns of water and all money in vinegar and fumigated all papers over a stove, handling them with tongs. Domestic animals were caged, and if they escaped from the premises during the epidemic, they were destroyed. Besides keeping all the doors closed, the Franks sealed all small openings in the walls and shot any stray animals that entered the premises. Some physicians in the Frank community carried their safeguards to extreme lengths. One doctor rode abroad on a saddle covered with wax cloth, with a guard of four servants. Garbed in a protective suit with a mantle of oilcloth, he felt the pulse of patients through a leaf of tobacco with his fingers dipped in oil. This was virtually the same costume worn by physicians during the Marseilles plague in 1720.^[19]

Enlightened Europeans of the nineteenth century ridiculed these precautions and pointed out that Muslim Egyptians scorned them as well. While most foreigners ascribed the Egyptians' indifference to fatalism, Clot wrote that their conviction that plague was not contagious was based on long experience. He described their view as follows: "We have cared for our fathers, our children and our brothers, and we have not contracted the disease; if plague is really contagious, why does it carry off Franks who observe quarantine?" According to Clot, "the ignorant" believed that it was a scourge sent from God, while "enlightened" Muslims thought that the infection was present in the air, therefore impossible to escape by isolation.^[20]

John Bowring used the Egyptian example to support his case against quarantines and asserted that the Muslim Egyptians never neglected plague patients among friends and relatives, unlike the Christians, among whom instances of inhuman desertion occurred. Such unhesitating self-exposure could not be attributed to fatalism alone, he said, for "I could never discover that the doctrine of

fatalism led them to subject themselves unnecessarily to other diseases and dangers."^[21]

Bowring and Clot were both special pleaders for the abolition of quarantines. But the views of al-Jabarti, the historian who recorded the antiplague measures adopted during the French occupation and the early years of Muhammad Ali's rule, may be representative of educated Egyptian opinion. Al-Jabarti gives the impression that he saw plague as a natural phenomenon, an endemic, periodically recurring disease caused by miasmas, as well as one of the human trials permitted by God. During the plague epidemic of 1798–99, the French issued many orders to control the spread of the disease. Early preventive measures seemed to be based on miasmatic principles, but as soldiers returned from the plague-stricken expedition to Syria, rigorous quarantine procedures were instituted and public health in Cairo came under strict surveillance.^[22] Al-Jabarti accepted the early measures but disapproved of the later restrictive regulations. When the authorities prohibited burials in cemeteries in inhabited areas, he agreed with the theory underlying this order. "It was said that miasmas accumulated in cavities in the earth; that these cavities were cooled in the winter by the water of the Nile, by rain and humidity; and that [afterward] the miasmas expanded into the air and brought the plague." The French also ordered all clothing, furniture, and other effects of deceased persons aired on the roofs of houses for two weeks, he pointed out, "dissipate the bad odors which could have engendered plague." Al-Jabarti observed that the measure was opposed by the masses, who, "in their ignorance, saw in it only a means to learn what each one possessed. However, they [the authorities] had no other objective but to destroy miasmas and to prevent an epidemic."^[23]

Al-Jabarti had no sympathetic comments, however, for an order commanding immediate notification of any suspected cases of plague and threatening severe penalties for noncompliance: shaykhs in the quarters who had information about the disease and did not inform the commandant would receive 100 lashes as penalty for negligence; leaders of the religious confessions who did not report death resulting from bubonic plague in their communities would be punished with death; men or women who washed the dead, who recognized or suspected that a dead person was stricken with buboes, and who did not report this within 24 hours would also be punished with death.^[24] From all accounts, the plague of 1798–99 struck Alexandria severely

but spared Cairo, and there was no necessity to enforce these Draconian regulations.

When plague broke out again in February 1801, however, the French immediately established quarantines and cordons, according to al-Jabarti.

They [the French] exercised the greatest severity in the application of sanitary measures [which] harass the people and frighten them. When someone fell ill, the doctor visited him, and if he was recognized as stricken with plague, he was immediately transferred to quarantine without any of his family being able to see him afterwards. . . . If he recovered, he returned home; otherwise they had him buried, fully clothed. . . . His house remained closed for four days, and all his clothes were burned, . . . if any passerby was imprudent enough to touch the door of the house or to overstep the boundary drawn around it, he was immediately arrested by the guards and sent to quarantine. . . . Those individuals who undertook to wash the dead, to carry them or bury them, . . . left their quarantine only to perform their functions. These measures . . . induced many inhabitants to leave Cairo to settle in the villages.^[25]

The plague of 1801 took a high toll among the inhabitants of Cairo as well as the French forces; according to the army's chief physician, the mortality among the people averaged 100 a day during April, and a total of 2,937 died of plague during that month alone.^[26] Even greater ravages occurred in Upper Egypt, no doubt from pneumonic plague. Al-Jabarti chronicled this phenomenon and included a letter from his friend, Shaykh Hasan al-Attar, dated May 1801.

Plague raged in all Upper Egypt, but especially in the city of Asyut, where more than 600 persons died every day. Such a scourge has never been seen in the memory of man. I think the country lost two-thirds of its population. The streets are deserted; friends or relatives only learn of the death of those near to them long after the event for everyone is absorbed in his own family's misfortunes. Corpses remain in the houses for days on end, for only after a great deal of trouble can one find biers, washers and porters. The scourge's attacks showed preferences for men and especially young men; it spared neither the virtuous nor the shaykhs, thus the celebration of religious ceremonies has been suspended as a result of the deaths of imams and muezzins. Artisans are also wanting; for a whole month I have not been able to find a barber to shave my head. . . . The most eminent and distinguished person [notable] has no more than ten people to conduct him

to his final resting place, and those ten are paid for the service. The entire city is plunged in mourning; wherever one passes one finds only corpses and biers, only moaning and weeping are to be heard. The crops are still standing; there is no one to harvest them, and soon the wind will have dispersed them.^[27]

Al-Jabarti does not mention plague again until December 1812, when news of an outbreak in Constantinople caused Muhammad Ali to establish a quarantine in Alexandria. The latter part of his chronicle describes plague epidemics in 1813 and 1815 and mentions rumored outbreaks in 1814, 1819, and 1821. From these accounts we learn that, as in Europe during the sixteenth and seventeenth centuries, a pattern of official activity developed during the plague "season."

In January, when plague usually broke out in one of the port cities, quarantine was established at Alexandria and Damietta, and Muhammad Ali sent his sons and household retainers to join Ibrahim Pasha, then governor of Upper Egypt. During the early years, the pasha secluded himself in Giza; later he went into isolation in his own palace at Shubrah. As a Muslim head of state, Muhammad Ali ordered the reading of Bukhari's Sahih in the mosque at al-Azhar and public recitations of the Koran every evening. Sometimes he had alms distributed to the poor and to orphans in Cairo's schools, enjoining them to pray to God to avert the pestilence.^[28]

When plague appeared in Cairo in 1813, the police ordered all the inhabitants to air their clothing outdoors; they were to sweep and sprinkle the streets and keep them clean thereafter. Al-Jabarti noted that Ibrahim was as terrified of plague as his father. When he was recalled from Asyut in 1813 to receive the title of governor of Upper Egypt from the Ottoman sultan's special envoy, Ibrahim traveled by boat to Giza, bypassing Cairo. On arrival, he ordered all the people who had accompanied him to bathe and wash their clothing in the Nile before landing, whereupon the boat was sunk. "All this because of fear of plague and of death," observed al-Jabarti.^[29]

These comments on fear of death probably exemplified the believing Muslim's attitude of detachment, which Europeans identified as fatalism. "It was believed that quarantine prevented plague; . . . and the Pasha and persons in his entourage also had become convinced of it, for they were very attached to life in this world." His descriptions of the rigorous quarantine imposed on Giza repeated disapprov-

ingly, "all this because of fear of plague and death." They went so far in Giza, he wrote, as to prevent boats from crossing the Nile. Only official communications to the viceroy were transferred across the river, on two boats held in readiness opposite each other at Old Cairo and at Giza.

If his lieutenant . . . sent him a paper, this paper, after being disinfected with resin and sulphur (fumes), was passed to the boatman on the Cairo side by means of a long [cleft] stick; he in turn approached the other boat and passed the paper, also by means of a long stick. The second boatman again used a similar stick to pass the letter to someone on the riverbank. The latter dipped the letter in vinegar, fumigated it, and delivered it to the Pasha.

The ruthless treatment of the people in Giza particularly aroused al-Jabarti's indignation. For three consecutive years, they were ordered out of the city during the plague season if they did not have sufficient provisions to tide them over sixty days' detention while the pasha remained in quarantine. In 1814, he wrote, many of the inhabitants had to spend the night in the open country, with their children and belongings, because they had been given only three days' notice to evacuate and to reach another city. Moreover, many soldiers who did not want to be locked in the city also left, and they robbed the evacuees of their belongings and their draft animals. "The inhabitants of Giza suffered a great deal . . . all because of pure fear."^[30]

In 1816, al-Jabarti recorded the death of the viceroy's son, Haj Ahmad Tusun Pasha, presumably from plague. And when plague broke out in 1819, Muhammad Ali ordered all high-ranking functionaries in the government to observe quarantine. They secluded themselves like the Christians and did not admit anything into their homes from outside. "These precautions frightened the population," al-Jabarti claimed.^[31] An epidemic in 1824 lingered on the following year, according to a visiting physician, and by this time, in Alexandria there was a pesthouse for Europeans "of the lower orders" which was dismal in the extreme.^[32]

The Epidemic of 1834–1836

During the interval between the plague epidemics of 1824 and 1834, far-reaching changes had heightened the Egyptian govern-

ment's concern about the threat to Egypt's manpower from epidemic disease. Muhammad Ali had transformed the country's agricultural economy by introducing perennial irrigation and replacing subsistence cultivation with cash crops in demand on the world market; state monopolies of exports, especially cotton, augmented revenues increased by more extensive cultivation and taxation. Alexandria revived as the principal port of the eastern Mediterranean, and rehabilitation of the old canal linking Alexandria with the Nile—renamed the Mahmudiya—provided passage for Egyptian commodities to the Mediterranean and the European market. Launching a military campaign to win Syria's raw materials for his industrialization program in Egypt, the viceroy built up a military force that effectively challenged Ottoman control of the Levant. Large numbers of men were mobilized to work in the dockyards and Arsenal in Alexandria and in numerous factories producing material for the military establishment. Technical schools were training specialists for the government and military bureaucracies, and state primary schools were reaching out to the younger generation.

The rising traffic in Egyptian ports, the rehabilitation of Alexandria and the Mahmudiya Canal, and increased production of cotton also attracted many foreign commercial agents; from sixteen in 1822, their number approached seventy by 1834. No longer restricted to segregated caravansaries, the foreign merchants built European-style villas in the new port area of Alexandria or along the banks of the Mahmudiya Canal. After Muhammad Ali gained control of Syria, many European governments transferred their consuls general from the Levant ports to Alexandria, and twenty-five consular agents soon joined the business representatives there.^[33]

The first cholera epidemic in 1831 had invaded the country when the Egyptian army was poised for its first campaign in Syria and had killed 150,000 people, including 7,000 men in military service, during a scant two-month siege. It had a traumatic effect on the pasha; clearly, the day had passed when he could retire to Shubra Palace during the plague season and ignore the epidemic preying on the country. When plague broke out in Alexandria in November 1834, therefore, the government was prepared to uphold any measures recommended by the consular Quarantine Board and to institute its own controls as well.

Within that month, the Egyptian government representative on the Quarantine Board, who was also the chief of police of Alexandria,

had to exercise his enforcement power as the board members zealously hurried to issue regulations that provoked fierce opposition among the city's Muslims. In December the corps of ulama in Alexandria addressed a petition to the viceroy protesting outrageous measures: investigators were examining the nude corpses of deceased Muslims, which was "not in harmony with the law." Moreover, they were transporting families of persons who allegedly died of plague outside the city, placing them in quarantine, a tyrannical measure that removed the poor from their work and deprived them of their daily bread. The families of the deceased and their household effects were being carried off in carts at night by torchlight, and the noise of these sinister processions was shattering peace of mind and arousing terror among the people. Some were throwing their dead into the streets so that no one could identify them; others were fleeing and abandoning the corpses in their houses. It was evident, the petition pointed out, that quarantine would never be successful among Muslims for they were not afraid of plague. However, now if someone were afflicted, he would not mention it for fear of being removed from his home.^[34]

Muhammad Ali immediately ordered the police chief to instruct the Quarantine Board members to avoid any measures that might conflict with Islamic law or offend Muslims. They should not require examination of bodies, or the destruction of corpses of Muslims by quicklime, or the removel of families of the deceased outside their homes. It would be sufficient to designate a cemetery in an isolated location outside Alexandria, where graves could be dug to the proper depth. "Compromised" families could be quarantined in their own homes, under surveillance, for the prescribed period, and the government would provide daily rations for the needy among them. The board members also should solicit the advice of two shaykhs who had signed the petition in future discussions of control measures.^[35]

At the same time, to ensure that work at the dockyards would continue uninterrupted, the viceroy approved the board's proposal to place the entire Arsenal under quarantine. He opposed sending the workers' families back to their home villages as a potential threat to the rural communities' health and proposed instead housing the families temporarily in army tents, while the workers' huts were leveled and replaced with new barracks.

As the number of deaths from plague rose to more than 100 during December, the Quarantine Board ordered a cordon sanitaire around

Alexandria to contain the epidemic. This time opposition came from the European merchants in Alexandria, who claimed they would suffer from the suspension of trade. "Do not listen to such excuses," the viceroy ordered his secretary. "Quarantine aims to protect the entire population, therefore it is a lesser evil adopted to avoid a greater one.^[36] In January, additional Quarantine Board measures for Alexandria included airing and exposing to sunlight the household effects of all inhabitants; whitewashing the interior of all dwellings; daily removal of rubbish from courtyards and passageways; disinfecting and whitewashing all workshops in the Arsenal; and mandatory bathing and an issue of new clothing for all workers in the Arsenal.^[37]

The Egyptians apparently continued to evade isolating the sick. Fear of being transported to the lazaretto caused people to hide the stricken, and illness was rarely reported to the Quarantine Board until it had ended in death. To avoid discovery of plague, families buried their dead in the courtyards or under the floor of the house or secretly deposited their corpses in the streets at night.^[38] As the number of cases multiplied, the city notables and ulama again protested to the board that dividing families was contrary to custom and tradition. According to the French consul, Muhammad Ali had the shaykhs quarantined in their own homes, in Frank fashion, and threatened them with seven months' penal labor if they did not set a good example to the public.^[39]

Resistance to the isolation of those stricken with plague apparently mounted as the epidemic spread and claimed more victims. Early in February, Muhammad Ali ordered his secretary to take action, invoking religion in the following terms:

The aversion of the inhabitants of Alexandria to health measures rises from their ignorance. . . . the adoption of appropriate measures to ward off the evil is authorized by the precepts of religion, and aims only at the general welfare. Since the plague . . . is a scourge emanating from His divine will, fleeing the wrath of God to take refuge in His mercy is not contrary to the sacred law. . . . One cannot deny that the reigning disease is contagious; and what God has said by . . . His Prophet: "Flee my vengeance, as you would flee the presence of the lion," does this not apply to contagion? . . . Do not the fleet, the hospitals, and the Arsenal, which have been protected from the prevailing scourge by observing sanitary regulations, thanks be to God, provide adequate evidence?

Consequently, the health measures in force will not be relaxed in

the slightest. . . . You will therefore assemble the notables of the city, the chief of police, the directors of hospitals . . . in order to adopt the most effective measures for the welfare of the city.^[40]

As the epidemic grew more intense and the number of deaths rose from day to day, it proved impossible to enforce the regulations. The quarantine of infected homes was lifted early in March, and, since plague was already raging outside Alexandria, the cordon sanitaire was abandoned.^[41]

There was alarm in Cairo as soon as the epidemic was declared in Alexandria, and the viceroy immediately ordered the people to maintain cleanliness of their persons and their premises to avert the disease.^[42] In January, all high-ranking government functionaries and the European community hastened into seclusion. According to Clot, the Egyptians and Turks were amused by the Franks' panic and took few precautions; they feared the government's isolation more than the plague.^[43] In April, when the number of new plague cases was approaching a thousand a day, the military Medical Council proposed evacuating the entire city population, but the viceroy disagreed, suggesting that assembling a large number of people would be more likely to propagate the disease than segregating some among them.^[44]

If enforcing restrictive measures on the entire population of Alexandria or Cairo proved infeasible, the government nevertheless did not relax quarantine regulations for hospitals, schools, military garrisons, the fleet, and all government installations, including factories, as well as the ruling family's palaces and harems. In Cairo and Alexandria, cordons had been ordered around all hospitals early in December: only those physicians who felt obliged to continue their service outside the institution were exempted from detention. The military Medical Council instructed physicians in all hospitals and government installations to isolate immediately any suspected cases of plague in tents remote from the establishment, to bury the dead in graves six feet deep, and to report the number of deaths daily to the health authorities.^[45]

Supervisors at the installation under quarantine were enjoined to observe traditional Frank precautions against admitting any objects "susceptible" to contagion: papers and letters should be immersed in vinegar and fumigated with chlorine fumes; wood and other fuel were to be exposed to the air for twenty-four hours before entry to the premises. Finally, government physicians were to remain at their

posts but to avoid contact with the plague-stricken in order to continue attending other patients. "Whatever your opinion, you are to consider plague a contagious disease and to act accordingly," Dr. Clot ordered.^[46]

Ezbekiyah, the military hospital for the Cairo garrison, was reserved exclusively for plague patients and, according to Clot, accommodated more than 3,000 during the epidemic. Government personnel suffering from other illnesses were sent to a hospital outside Cairo. All the special training schools in the Cairo area—the cavalry school in Giza, the artillery school in Tura, the music school at Khanka, and the Polytechnic school at Bulaq—maintained strict quarantine over their students. At the polytechnic, where 150 students were confined in the main building ringed by a military cordon, we are told that the school director, Hekekyan-Bey, enforced detention by standing guard at his window with a loaded rifle, threatening to shoot the first person who attempted to break the quarantine.^[47]

In Alexandria, all barracks were quarantined and surrounded by a double ring of barriers and sentinels. Rigorous quarantine was maintained among the 6,000 workers at the Arsenal; when a case of plague appeared, the individual was removed immediately to a lazaretto near the Mahmudiyah Naval General Hospital. All workers who had been in contact with a plague patient had to undergo temporary detention, a bath, and a change of clothing.^[48] Similar regulations applied to the fleet; if plague broke out among naval personnel, the individual was evacuated immediately to the Mahmudiyah lazaretto, and the vessel was placed under quarantine for eleven days. Toward the end of March, when the epidemic reached its peak in Alexandria, claiming 180 to 200 deaths a day, the fleet at anchor in the harbor set out for Crete.^[49]

The plague epidemic of 1835 was notable for extending into areas rarely touched by the disease—Upper Egypt as far as Thebes and west into Fayyum province. As the plague made fresh inroads in all directions, public baths were ordered closed for the duration of the epidemic,^[50] and many regiments garrisoned in cities or villages were evacuated to the desert.^[51] Recruitment for the armed forces was suspended, and the war minister was reprimanded for having permitted conscription to continue when some recruits died en route from their villages.^[52] As the epidemic expanded throughout the Nile valley, Muhammad Ali fled to his palace in Shubrah, where he maintained rigorous quarantine: all avenues to the palace were surrounded by a

double barrier guarded by 400 men.^[53] By mid-April, plague had begun to wane in Alexandria and mortality figures dropped below 100 a day; in Cairo, however, the epidemic was reaching its peak, carrying off 600 to 1,000 victims daily.^[54]

One of the few foreign visitors in Cairo during the plague year of 1835 vividly described the psychological terror that gripped even the most self-assured traveler in the empty, echoing streets of the city, which had become a charnel house. Arthur Kinglake must have stayed in Cairo at the very peak of the epidemic for he observed that during the nineteen days he spent in the city, the mortality rose from 400 to 1,200 a day. During that time, almost everyone he had contact with perished: the Levantine banker who accepted his letters of credit with iron tongs and purified them with the smoke of burning aromatics, his landlord, his donkey boys, a magician whose performances he had watched, and the Bolognese doctor he had consulted when feeling unwell. Kinglake noted a preoccupation with cleanliness during the epidemic. "It is said that when a Mussulman finds himself attacked by the plague he goes and takes a bath," but he apparently did not learn that it was motivated by the Muslim's concern to die in a state of ritual purity.^[55] One of the features of the epidemic that he found most disquieting was the steady procession of funerals every day from dawn until noon; the passing of howling mourners was so incessant that Kinglake believed one-half of the inhabitants of Cairo must have perished.

As the epidemic raged through May and into June, Cairo and Alexandria took on the appearance of ghost towns; virtually the entire surviving population had withdrawn into isolation and all normal activity came to a halt. Europeans began to count off the days to the onset of the Nile flood and took heart in the old-timers' observation that plague never extended beyond the feast of Saint John. If summer had not been late this year, we might be rid of this "eternal epidemic," one of the consuls wrote.^[56]

Apparently relying on the reliability of this seasonal phenomenon, Muhammad Ali abandoned isolation on June 21. Public officials were notified that quarantine restrictions were lifted and they were to resume normal activity on that date. European consuls left the viceroy's palace for Cairo and Alexandria, making way for provincial governors summoned to Shubrah to take up long-neglected administrative matters. Early in July, quarantine was lifted from military units and schools.^[57]

No one in Egypt needed the evidence of official mortality figures to convince him that the plague epidemic that tapered off at the end of June 1835 had been one of the worst in Egypt's recent history. "Only now, when the mind is no longer excessively absorbed by the fear of contagion, have we begun to realize the enormity of the evil," the Russian consul wrote. "Those who have lived longest in Egypt do not remember a plague as terrible as this last." Many villages had lost half of their inhabitants, especially men twenty to forty years old, agriculture had suffered an irreparable loss of labor, and wide areas formerly cultivated were now wasteland. In Giza almost three-fourths of the village's 2,400 inhabitants had perished. Rosetta had lost two-fifths of the survivors of the cholera epidemic and in two months had dwindled to a village of 4,000 souls.^[58]

Compilations of the official mortality figures gave the total number of deaths from plague in Alexandria as 7,800 for the period January through mid-June, and in Cairo, the mortality was reported to be around 34,600 from mid-March until mid-June. All the consuls declared these figures gross underestimates. Functionaries charged with burial rights confirmed that the daily number of deaths in Cairo had been at least 1,000 for the last twenty-two days of April, and on some days, mortality had exceeded 2,000. It was believed that 20,000 of the 80,000 Copts in Cairo had perished and that members of other confessions had succumbed in proportionate numbers. The government reportedly had sequestered 1,200 homes left vacant by the death of all members of the family. Whether the discrepancy arose from the Egyptians' refusal to report deaths in the family or whether it was the government's policy to release only partial statistics, a consensus held that the official figure indicated only one-half of the total mortality and that at least 75,000 had died in Cairo, perhaps 200,000 in all Egypt.^[59] Although all the figures are open to question, table 1 gives a rough indication of the distribution of the disease as it appeared to observers at the time.

Relief was general when the epidemic waned at the end of June, but sporadic individual outbreaks suddenly increased in September.^[60] Again, the government appears to have been unsuccessful in separating the sick and the well in Alexandria. On the viceroy's orders, officials attempted to convince the leading notables and ulama of the city that it was their duty to isolate those stricken with plague and to place their families under observation. They were assured that the well-off could take with them in detention anything they wished and

the poor would have all their needs provided at government expense; moreover, heads of families who failed to report outbreaks of plague in their households would be executed. Neither promises nor threats availed to stop evasion of the regulations, for another khedivial message later bade the ulama to forbid Muslims to bury the dead in their courtyards, "because that is one of the things which brings about diseases."^[61]

Officially and technically, the great plague epidemic ended October 30, 1837, when Consul General Patrick Campbell, president of the Quarantine Board for that month, notified the viceroy's government that no cases of plague had appeared in Egypt during the preceding forty days. In reporting to his own government, the British consul general pointed out that Egypt had been officially in an epidemic state for forty months, from July 1834 to November 1837.^[62]

Since European governments based their commercial policies vis-à-vis Egypt on their conclusions drawn from observations during the plague epidemic, it is worthwhile to note again the divergent attitudes

toward control measures in Egypt. The viceroy and upper-level government officials were convinced that plague was contagious and had adopted rigorous Mediterranean quarantine practices. The majority of the Egyptian people, however, either did not believe plague was contagious or believed it was morally reprehensible to try to escape inevitable death; perhaps many held both views. Certainly, they abhorred the isolation and detention procedures of quarantine as outrageous invasions that disrupted the solidarity of family life, to be resisted as long as possible.

European physicians in Egypt at the time were similarly divided. In Alexandria, the majority Italian staff of the quarantine service was committed to rigorous contagionist theories and procedures. In Cairo, the military Medical Council was headed by Dr. Clot, a leading opponent of both the principle and practice of quarantine. Many of his like-minded colleagues served in the Egyptian fleet, in military units, in government installations, and in schools and hospitals.

At the onset of the epidemic, Clot created the official Egyptian Plague Commission to settle the dispute of whether or not plague was communicable. Members of the commission examined many cases of plague and conducted one hundred postmortems without special precautions. They carried out several experiments exposing human subjects to plague sufferers' effects or inoculating them with the victims' pus or blood. Clot inoculated himself three times with the blood of a plague patient with no effect. The results convinced him and many of his colleagues that plague was not communicable.^[63]

While the views of Clot and his anticontagionist colleagues decisively influenced official policies in France, England, and Austria,^[64] they did not undermine the Egyptian government's stand. Clot wrote that when he announced to the viceroy that he and other European physicians would form a commission to investigate the disease and that they would treat plague like other ailments, Muhammad Ali accused the doctors of foolhardiness, called their decision a "piece of madness," and advised them to observe quarantine.^[65]

Although he considered them useless, Dr. Clot did not oppose quarantines at government installations; they were reassuring precautions good for mental hygiene, he wrote; besides, they were ordered by Muhammad Ali.

In spite of our ideas on the uselessness of . . . all the isolation measures . . . we had to submit to the law, to respect prejudices and pub-

lic opinion; as chief of the service we were required to draft instruction for . . . quarantines which we made mandatory.^[66]

Other European physicians in Egyptian government service were not as scrupulous in observing Clot's directive, "Whatever your opinion, you are to consider plague a contagious disease and to act accordingly." As early as January 1835, the War Ministry dismissed the European chief physician, Louis Aubert-Roche, and the Turkish supervisor at the marines' hospital in Alexandria for failing to enforce quarantine.^[67]

Noncompliance with quarantine regulations appears to have been common among members of the navy medical corps, who were able to function independently of the authorities in Cairo and Alexandria. Perhaps typical of the European attitude were statements made by Dr. Abbott, naval surgeon aboard the Abu Qir , a line vessel with a crew of more than 1,000 men. Abbott declared that he never observed "any kind of quarantine or fumigations" because he felt these precautions were useless. Consequently, when the fleet was ordered to Crete at the peak of the epidemic in Alexandria, he dispensed with "the usual ceremony of fumigation" of supplies, including tarbooshes, blankets, and woolen clothing; nor did he prevent the wives and relatives of the sailors from bringing additional blankets and clothing on board ship the day before sailing.^[68]

Similar views were expressed by Dr. Koch, head of the navy medical corps and chief surgeon for the Egyptian fleet and a known noncontagionist. In a letter to Clot, Koch described the circumstances that convinced him that plague was not contagious.

One day I received from the Admiral the command to order all sailors on board their respective ships and to prevent all communication between them and people in the infected quarters of the city. All the dwellings through which the disease had passed were to be cleaned, fumigated and whitewashed, and effects used by plague patients were to be burned. . . . Many sailors . . . brought from their homes blankets and clothing which had served the sick as well as the healthy. And not a case of plague appeared in the squadron. . . . However, during the voyage to Crete and at Crete itself, in rigorous quarantine, several cases of plague broke out on board different ships.^[69]

It was inevitable that evasion of the regulations would come to the attention of the pasha and arouse his wrath. Orders to have sea-

men stricken with plague removed to the Mahmudiya lazaretto and to impose an eleven-day quarantine on the ship and crew were not being followed, the viceroy observed in a directive to the admiral of the fleet; navy physicians were neglecting surveillance of personnel stricken with the pestilence. The body of one who had died had been discovered in the Mahmudiya Canal with an 88-pound iron weight around his neck. Since the signs of the disease on his body had been lanced, this could have been performed only by those physicians who were failing to transfer the stricken men to isolation. The admiral was ordered to punish the offenders severely and to warn all medical personnel that His Highness would treat them harshly if they failed to carry out their responsibilities.^[70]

Apparently Koch was one of many European physicians discharged from government service for failure to comply with official regulations. Clot was bitter in blaming the quarantine service medical staff in Alexandria. "Ardent partisans of contagion," they were hostile toward colleagues who held different opinions and expressed their resentment in official reports that caused many physicians to be dismissed, he claimed.^[71]

Was Quarantine Effective Protection Against Plague?

Opposed to Dr. Clot and his noncontagionist colleagues' evidence of their failure to transmit plague by exposure, contact, and inoculation, the contagionists could only point to the (admittedly relative) immunity of those who went into seclusion during the epidemic. The issue was: were the quarantine procedures enforced by the Egyptian government effective at all or were they, as the Egyptians no doubt saw them, simply additional hardships inflicted on an already suffering populace? On this point, Clot and his miasmatist colleagues were weak, for positive evidence outweighed the negative, and the establishments that escaped plague during the epidemic were those isolated from the community. The Music School at Khanka, ordered into quarantine in an old army depot, had no plague cases among its students, and the Polytechnic School, where Hekekyan-Bey personally stood guard, was spared throughout the epidemic. Both the Arsenal, where 6,000 workers were effectively detained by a military cordon, and the viceroy's palace at Shubra,

where elaborate restrictions were enforced, were struck only after quarantine regulations were lifted.^[72]

The partisans of noncontagion neglected to mention in their writings what the European consuls reported in 1836: plague broke out primarily among those who had been quarantined the year before—workers in the Arsenal, navy personnel, and students in schools. Clot wrote that in spite of rigorous quarantine maintained over 300 inmates at Shubrah Palace, three servants died of plague; but he failed to specify that the deaths occurred in 1836, after quarantine had been lifted.^[73] The miasmatists also allowed no margin for human error or neglect in the preventive measures and declared that a single case of plague in an establishment under quarantine invalidated the principle of isolation. Clot's colleague, Aubert-Roche, emphatically denied the efficacy of protective barriers and asserted, "It is wrong to say the Mahmudiya hospital did not suffer from plague; after six months of quarantine, one of the orderlies was attacked."^[74]

Although neither side to the dispute recognized it at the time, the cumbersome, hit-or-miss quarantine procedures traditionally excluded and destroyed stray animals, which must have kept infected rats and fleas from the segregated premises. The government regulations also eliminated fleas by burning clothing and bedding used by the plague striken. For populations at risk, like the 6,000 workers at the Arsenal, government measures extended to leveling their huts and building new barracks, or at least cleaning, fumigating, and whitewashing the dwellings.

Although it had proved infeasible to enforce controls over all the citizens of Alexandria or Cairo at the peak of the epidemic, as we have seen, the viceroy allowed no relaxation in restrictions on government service personnel. The British consul general, Patrick Campbell, reported that "the Pasha gives every support, as well by his example, as by his orders, to the efforts of the Quarantine Board." During his presidency of the board, Campbell had quarantined the entire Twenty-second Regiment garrisoned in Alexandria for eleven days when a single case of plague broke out in the unit. He also ordered the admiral of the fleet quarantined, and we know that the order was enforced, for government records include an official reprimand to the admiral for protesting the restriction. Two ship commanders were sentenced to seven years penal labor for breaking quarantine before the end of the prescribed detention period. And

when one of Ibrahim Pasha's officers in Syria reportedly violated quarantine, he inquired what penalty European regulations prescribed; informed the usual punishment was death, he had the officer summarily tried and executed.^[75]

As for the pasha's daughter-in-law who was quarantined, Muhammad Ali ruled his own family with an iron hand and there was no question of noncompliance with regulations. When Saïd accompanied the fleet to Crete, provincial officials decided to waive quarantine restrictions for the young prince, but his first question on arrival was how many days of detention he had to undergo.^[76]

In November 1835, the Quarantine Board issued new regulations "to avoid misunderstanding" in future outbreaks of plague. All houses where plague appeared would be placed in thirty days quarantine and fumigated. Stricken individuals with means could be attended by their own physicians, while those in need would be removed to the lazaretto and attended by the Quarantine Board's medical officers.^[77]

It appears that Europeans resident in Egypt later followed the Egyptians' example of hiding the sick or the dead during an outbreak of plague,^[78] but at this time, it was common for them to resist quarantine by force. These incidents often became armed confrontations between Quarantine Board officials and police, on one side, and a crowd of supporters for the family threatened with detention, on the other. We are told that the viceroy, "tired of these scenes," instructed the police that in cases where Europeans resisted enforcement of regulations, they should call on them three times to comply and fire if they continued to resist after the third summons.^[79]

The enforcement of domestic quarantine for plague ceased to be a major problem when the disease mysteriously declined in the 1840s. But the main point of contention between miasmatists and contagionists—the necessity for maintaining traditional maritime quarantines—remained a bitterly disputed issue, seriously impeding efforts to control outbreaks of cholera, which, unlike plague, continued to ravage the civilized world throughout the nineteenth century.

The history of the international Quarantine Board that Muhammad Ali commissioned in 1831 reveals that in the dispute over quarantines, economic and political factors shaped the board's policies, rather than technical or humanitarian. We shall survey that history next.