4— The Plague Epidemic of 1835: Background and Consequences
1. The standard monograph on plague, which includes a brief history, is Robert Pollitzer, Plague (Geneva: World Health Organization, 1954). continue
L. Fabian Hirst, The Conquest of Plague: A Study of the Evolution of Epidemiology (Oxford: Clarendon Press, 1953), is particularly enlightening for the nonspecialist. More general are Charles E. Winslow, The Conquest of Epidemic Disease (Princeton: Princeton University Press, 1943); and Hans Zinsser's classic, Rats, Lice and History (Boston: Little, Brown and Co., 1935). The old, classic histories of epidemics include details on individual outbreaks: H. Haeser, Lehrbuch der Geschichte der Medizin und der Epidemischen Krankheiten, Vol. II: Geschichte der Epidemischen Krankheiten, 2d ed. (Jena: Friedrich Mauke, 1865); August Hirsch, Handbook of Geographical and Historical Pathology, I: Acute Infective Diseases (London: New Sydenham Society, 1883), 494-544; George Sticker, Abhandlungen aus der Seuchengeschichte und Seuchenlehre, I: Die Pest, Pt. I: Die Geschichte der Pest, Pt. II: Die Pest als Seuche und als Plag (Giessen: Alfred Toepelmann, 1908, 1910). There is a voluminous literature on the fourteenth-century Black Death and the persistence of plague in individual areas of Europe into the early modern period, particularly for the Italian states, France, and England. For the Middle East, two works are indispensable: Alfred von Kremer, "Ueber die grossen Seuchen des Orients nach arabischen Quellen," Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften (Philosophisch-Historische Classe), 96, Bk. 1, Vienna 1880, 69-156; and Michael W. Dols, The Black Death in the Middle East (Princeton: Princeton University Press, 1977). This inquiry has benefited from the impressive comparative study by Jean-Noel Biraben, Les Hommes et la Peste en France et dans les Pays Européens et Méditerranéens, 2 vols. (Paris and The Hague: Mouton, 1975-76).
2. Hirsch, 525; Hirst, 284.
3. Etienne Pariset, Mémoire sur les causes de la peste et sur les moyens de la détruire (Paris, 1847), quoted in P. et H., L'Egypte sous la domination de Méhémet Aly, 99-100.
4. A. B. Clot-Bey, De la Peste (Paris: Fortin, Masson et Cie., 1840), 213-223, 233-234.
5. Hirst, 288.
6. Pierre Nicolas Hamont, "Sur l'état hygiènique de l'Egypte," Annales de l'hygiène publique VI, no. 1 (1831): 481. See Louis Aubert-Roche, De la Peste ou Typhus d'Orient (Paris: n.p., 1840), passim; and Victor Schoelcher, L'Egypte en 1845 (Paris: Pagnerre, 1846). British physicians who held similar views were R. R. Madden, Travels in Turkey, Egypt, Nubia and Palestine, 2 vols. (London: Henry Colburn, 1829), and William H. Yates, The Modern History and Condition of Egypt, 2 vols. (London: Smith Elder and Co., 1843).
7. Clovis René Prus, Rapport a l'Académie Royale de Médecine sur la Peste et les Quarantaines (Paris: J. B. Bailliere, 1846).
8. Dols, 93-94; Winslow, 100-101; Hirst, 25, 40, 46-50.
9. Ahmad ibn cAli al-Maqrizi, Kitab al-Suluk li-macrifat Duwal al- soft
Muluk, 2 vols. (Cairo: n.p., 1936-1958); M. Quatremère, trans., Suluk, histoire des Sultans Mamelouks d'Egypte, 2 vols. (Paris: n.p., 1837-1842), II, 772-787.
10. Dols, 23-25, 109-121. For some of the traditions, see Muhammad ibn Ismai'il Al Bukhari, Sahih: Les Traditions Islamiques, trans. O. Houdes (Paris: Ernest Leroux, 1914), Bk. LXXVI, Medicine, 69, 72, 82-83, 88, 89.
11. Dols, 121-142. Among the illustrations in Biraben, op. cit., II, 160ff., is a magic formula in Arabic which was used as a protection against plague. Such inscriptions were suspended around the neck in a locket; or, inscribed on a wooden tablet, the inscription was washed off and the rinse water swallowed as a preventive or cure.
12. Ahmad Issa Bey, Histoire des Bimaristans (Hâpitaux) a l'Epoque Islamique (Cairo: Paul Barbey, 1928), 31-37, points out that the bestequipped hospitals in Cairo in the fourteenth century and following included wards for fevers, but there is no mention in contemporary accounts of segregated facilities for plague patients.
13. Pollitzer, 483-518; Hirst, 28-34. Several writers, including Hirst, distinguish a third type of plague, septicemic, wherein the infection immediately enters the bloodstream, buboes have no time to form, and the course of the disease is rapid and invariably fatal.
Bubonic plague is characterized by the bubo, a swelling of the lymphatic gland located nearest the point of inoculation by a flea bite. The other form of the disease, pneumonic or pulmonary plague, is spread from person to person by airborne droplets of sputum coughed or sneezed by the infected person. Pneumonic plague is nearly always fatal, whereas a substantial proportion of bubonic plague cases—as high as 40 percent—have recovered in past epidemics.
14. Michael Dols, "The Second Plague Pandemic and Its Recurrences in the Middle East: 1347-1894," Journal of the Economic and Social History of the Orient 22 (1979): 183.
15. Ahmed Mohammed Kemal, ed., Epidemiology of Communicable Diseases (Cairo: Anglo-Egyptian Bookshop, 1958), 233-268; James S. Simmons et al., Global Epidemiology, 5 vols. (Philadelphia: J. B. Lippincott, 1951), 20-21.
16. To explain the anomaly of pneumonic plague in Upper Egypt, it has been suggested that extreme aridity may cause irritation of the respiratory system and pulmonary susceptibility to infection. When men from the Said who worked in the port cities returned to their native villages infected with plague, they might arrive home, according to Wakil, with pneumonic plague complications caused by the long journey; in overcrowded, poorly ventilated housing, the infection would spread like wildfire. Abd al-Wahid al-Wakil, The Third Pandemic of Plague in Egypt: Historical, Statistical and Epidemiological Remarks on the First Thirty-two Years of lts Prevalence (Cairo: continue
Egyptian University, 1932), quoted and referenced in Pollitzer, 32-34, 513: Hirst, 221; J. Davis, "Plague in Africa," WHO Bulletin, IX (1953): 665-700. Fleming M. Sandwith, The Medical Diseases of Egypt, 2 vols. (London: Henry Kimptom, 1905), I, 172-174.
17. Patrick Russell, A Treatise of the Plague (London: G. G. J. and J. Robinson, 1791), 266-267; P. et H., 99. According to Lane, p. 495, the feast of laylat al-nuqta or "Night of the Drop [of Dew]" referred to an old belief that a miraculous drop of dew fell into the Nile and caused it to rise.
18. Russell, 2; Madden, I, 218-219; Constantin-François Volney, Voyage en Egypte et en Syrie (Paris: Volland et Desenne, 1787), 143; de Salle, II, 187; Belzoni, 1.
In addition to an adequate rat and rat-flea density, the propagation of plague requires optimum meteorological conditions—a temperature range between 68°F and 78°F in a moderately moist atmosphere—in which Xenopsylla cheopsis may breed and efficiently transmit plague. This is the temperature range that has been found to prevail during the plague "season" in nearly all parts of the world subject to severe epidemics of bubonic plague, according to Hirst, 263, 272, 301-303.
The meteorological conditions favorable for optimum proliferation of rat fleas thus moved slowly down the Nile, accompanying warmer and more humid weather, in the progression suggested by Wakil as follows (Pollitzer, Plague, 33):
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19. Dr. Paolo Asalini in Clot-Bey, De la Peste, 417-419; also Madden, I, 252-257; Kinglake, 161; and Volney, 142.
20. Clot-Bey, De la Peste, xxii, 361, 416.
21. John Bowring, Observations on the Oriental Plague and on Quarantine as a Means of Arresting Its Progress (Edinburgh: n.p., 1838), included as Appendix F in Report on Egypt and Candia, 213.
22. Dominique J. Larrey, "Mémoires et observations sur plusieurs maladies qui ont affecté les troupes de l'armee française pendant l'expédition d'Egypte . . .," Description de l'Egypte, Etat Moderne (Paris: Imprimerie Imperiale, 1899), I, 465; René Desgenettes, Histoire Médicale de l'Armée continue
d'Orient (Paris: Firman, Didot, Frères, 1830), 16. Virtually all members of the French medical corps wrote that their experience in Egypt confirmed their view that plague was contagious.
23. AI-Jabarti, VI, 45-46, 53, 155.
24. Ibid., VI, 106-107.
25. Ibid., VI, 282-283.
23. AI-Jabarti, VI, 45-46, 53, 155.
24. Ibid., VI, 106-107.
25. Ibid., VI, 282-283.
23. AI-Jabarti, VI, 45-46, 53, 155.
24. Ibid., VI, 106-107.
25. Ibid., VI, 282-283.
26. Desgenettes, 206-210.
27. AI-Jabarti, VI, 307-308.
28. Ibid., VIII, 341; IX, 9, 78, 83, 119, 137, 297-299, 330.
29. Ibid., IX, 18.
30. Ibid., IX, 19-20, 22, 83-84, 106.
31. Ibid., IX, 297-299.
27. AI-Jabarti, VI, 307-308.
28. Ibid., VIII, 341; IX, 9, 78, 83, 119, 137, 297-299, 330.
29. Ibid., IX, 18.
30. Ibid., IX, 19-20, 22, 83-84, 106.
31. Ibid., IX, 297-299.
27. AI-Jabarti, VI, 307-308.
28. Ibid., VIII, 341; IX, 9, 78, 83, 119, 137, 297-299, 330.
29. Ibid., IX, 18.
30. Ibid., IX, 19-20, 22, 83-84, 106.
31. Ibid., IX, 297-299.
27. AI-Jabarti, VI, 307-308.
28. Ibid., VIII, 341; IX, 9, 78, 83, 119, 137, 297-299, 330.
29. Ibid., IX, 18.
30. Ibid., IX, 19-20, 22, 83-84, 106.
31. Ibid., IX, 297-299.
27. AI-Jabarti, VI, 307-308.
28. Ibid., VIII, 341; IX, 9, 78, 83, 119, 137, 297-299, 330.
29. Ibid., IX, 18.
30. Ibid., IX, 19-20, 22, 83-84, 106.
31. Ibid., IX, 297-299.
32. Madden, I, 252-257.
33. Clot-Bey, Aperçu Générale sur l'Egypte, I, 192, 188-194; II, 327, 328; Bowring, 80-81; Arthur E. Crouchley, The Economic Development of Modern Egypt (London: Longmans, Green and Co., 1938), 82, 90, 92, 93, 96.
34. French translation enclosed in FO 78/376, Campbell, 9 May 1839.
35. ENA, Index Cards: Health;
36. Order to Zaki Effendi, chef du cabinet of the Khedivial Divan dated 14 Sha'ban 1250 (16 December 1834), French translation enclosed in FO 78/376, Campbell, 9 May 1839.
37. Order to Zaki Effendi dated 14 Ramadan 1250 (14 January 1835), French translation enclosed in FO 78/376, Campbell, 9 May 1839; AE, CCC, Alexandrie, vol. 26, De Lesseps, 20 January 1835.
38. FO 78/260, Thurburn, 9 March 1835; Clot-Bey, De la Peste, 409.
39. AE, CCC, Alexandrie, vol. 26, De Lesseps, 18 February 1835.
40. Order to Zaki Effendi dated 12 Shawwal 1250 (11 February 1835), French translation enclosed in FO 78/376, Campbell, 9 May 1839.
41. FO 78/260, Thurburn, 9 March 1835, AE, CCC, Alexandrie, Vol. XXVI, De Lesseps, 14 March 1835; Cattaui, II, 265.
42. ENA, Index Cards: Health:
43. Clot-Bey, Mémoires, 286-287. At the end of March, Ibrahim Pasha could no longer tolerate the confinement of three months' isolation and left for Syria; he had been preceded by Muhammad Ali who fled the capital for Upper Egypt and at the end of March set up a temporary court at Isna. Cattaui, FO 78/257, Campbell, 24 March, 29 March 1835.
44. ENA, Index Cards: Health:
45. Ibid., register no. 62, doc. no. 551, 26 dhi al-hijja 1250 (25 April continue
1835); register no. 54, doc. no. 485, 17 dhi al-hijja 1250 (16 April 1835); register no. 57, doc. no. 559, 28 dhi al-hijja 1250 (27 April 1835); Summaries;
44. ENA, Index Cards: Health:
45. Ibid., register no. 62, doc. no. 551, 26 dhi al-hijja 1250 (25 April continue
1835); register no. 54, doc. no. 485, 17 dhi al-hijja 1250 (16 April 1835); register no. 57, doc. no. 559, 28 dhi al-hijja 1250 (27 April 1835); Summaries;
46. Clot-Bey, De la Peste, 427-428. Since schools were not staffed with physicians, the acting director of schools, Muharram Bey, was instructed to provide care for any students who might fall sick. ENA, Summaries,
47. Clot-Bey, De la Peste, 299-300, 310, 330, 428-429.
48. ENA, Index Cards: Health,
49. FO 78/260, Thurburn, 9 March 1835; Campbell, 23 March 1835; Thurburn, I April 1835; Campbell, 25 November 1835; AE, CCC, Alexandrie, vol. 26, De Lesseps, 14 March 1835; Mimaut, 31 March 1835; Cattaui, II, 256-266, 281; Dr. Koch, chief physician for the Egyptian fleet, letter to Dr. Clot, quoted in Clot-Bey, De la Peste, 319.
50. ENA, Index Cards: Health,
51. Clot-Bey, De la Peste, 316.
52. ENA, Index Cards: Health,
53. FO 78/257, Campbell, 15 April 1835; Cattaui, II, 288-289; Clot-Bey, De la Peste, 301.
54. AE, CCC, Alexandrie, vol. 26, De Lesseps, 8 April 1835, Mimaut, 10 April 1835.
55. Alexander W. Kinglake, Eothen (London: J. M. Dent and Sons, Ltd., 1908), 155-173. Ceremonies following death, like ritual purity, were important to the people of Cairo. Although burials were simple, funeral ceremonies were often elaborate and prolonged for prominent persons; see the description in Lane, 516-534.
56. Cattaui, II, 299, 321-322, 334.
57. ENA, Summaries,
(21 June 1835); ibid., portfolio 7, register no. 61, order no. 182, 6 rabi alawwal 1251 (2 July 1835); order no. 186, 8 rabi al-awwal 1251 (4 July 1835).
58. Cattaui, II, Pt. I, 338-339; AE, CCC, Alexandrie, vol. 26, De Lesseps, 20 May, 5 June 1835.
59. AE, CCC, Alexandrie, vol. 26, De Lesseps, 20 May 1835, 26 June 1835; FO 78/257, Campbell, 25 June 1835; Cattaui. Clot-Bey, De la Peste, 310, wrote that the government had expropriated 600 houses left vacant; Campbell reported the number as 1,200. De Lesseps cited the governor of Cairo as announcing that 75,000 had perished in the capital and that the government had taken over 1,200 houses. Edward Lane wrote (p. 3) that Cairo had lost one-third of its population, i.e., 80,000 people, and that 200,000 died in all Egypt; Lane claimed that it was government policy to report only one-half of the actual mortality during the epidemic. Justin A. McCarthy in "Nineteenth-Century Egyptian Population," Middle East Studies XII, no. 3 (October 1976): 13-15, suggests a total death toll of perhaps 500,000 by adopting the twentieth-century pattern of plague distribution and projecting 55 percent of the total mortality to Upper Egypt, where the present-day locus of the disease exists. This is not a valid assumption for the nineteenth century because while basin irrigation still prevailed, the annual Nile flood periodically flushed out rats in the irrigation dikes, preventing the rat-flea concentration required to trigger and sustain an epidemic. It is true that the temperature and humidity were the same then as they are now, but the requisite rat, flea, and human populations were not in place in 1835.
60. FO 78/257, Campbell, 25 June 1835; FO 78/260, Campbell, 16 October 1835; AE, CCC, Alexandrie, vol. 26, De Lesseps, 26 June 1835; Cattaui, II, Pt. I, 339, 344, 359, 411.
61. ENA, Summaries,
62. FO 78/321, Campbell, 7 November 1837.
63. De la Peste, 352-357; Mémoires, 288-290. Of four condemned criminals who slept in plague victims' beds, wore their clothing, or were inoculated with plague patients' blood or bubo pus, two developed symptoms and one died. Although Clot referred to Desgenettes's similar experiment in autoinoculation in 1799, he did not include his conclusion (pp. 87-88) that the failure of the inoculation to produce plague "simply indicated that the conditions necessary for its occurrence are not well determined."
64. In 1855, Clot claimed that his "proof" of the nontransmissibility of plague twenty years earlier had resulted in the virtual abolition of quarantines in France and England, i.e., in Marseilles and Malta; Nassau W. Senior, continue
Conversations and Journals in Egypt and Malta, 2 vols. (London: Sampson Low et al., 1882), II, 197. Clot must share the credit, however, with John Bowring, who did much to publicize the views of Dr. James Laidlaw, surgeon to the European Hospital in Alexandria, who also became convinced that plague was not communicable during the epidemic in 1835; Bowring, 222-223.
65. Clot-Bey, Mémoires, 287, 292. ENA, Summaries,
66. Clot-Bey, De la Peste, 411-412.
67. ENA, Summaries,
68. Bowring, 30-33.
69. Clot-Bey, De la Peste, 318-320.
70. ENA. Index Cards, Subject: Health,
71. Clot-Bey, De la Peste, 410. Clot probably was referring to "l'affaire Aubert-Roche"; the French consul general had to order Aubert expelled from the country because he resisted quarantining one of his patients who was suffering from plague, insulted the president of the Board of Health (the British consul general), and struck the health warden; AE, CCC, Alexandrie, vol. 26, Mimaut, 28 October, 24 November 1835.
72. A. F. Bulard de Meru, De la peste orientale d' après les matériaux recueillis à Alexandrie, au Caire, à Smyrne et à Constantinople pendant les années 1833-1838 (Paris: n.p., 1839), gives full details of all the establishments that escaped plague during the epidemic in 1835. Unfortunately, the book was not available to the writer, who had to confine these observations to sites specifically mentioned in the European consuls' reports. Bulard, another member of the Plague Commission, became as convinced that plague was communicable as Clot was certain that it was not; they became bitter enemies and attacked each other personally in their writings.
73. Clot-Bey, De la Peste, 301; Cattaui, II, Pt. II, 9.
74. Louis Aubert-Roche, letter to the Gazette Médicale de Marseille, dated 10 June 1836, quoted in Clot-Bey, De la Peste, 299.
75. FO 78/260, Campbell, 25 November 1835; FO 78/271, Campbell, 12 December 1836. ENA, Index Cards: Health,
no. 12, 2 Ramadan 1251 (23 December 1835). ENA, Summaries,
76. Cattaui, II, Pt. I, 314.
77. Notification of the Board of Health dated 23 November 1835; translation from Italian enclosed in FO 78/260, Campbell, 25 November 1835.
78. The director of the first British Board of Health in Egypt observed that in the plague epidemic of 1899-1904, resistance against removal of the sick for hospitalization caused both Egyptians and Europeans to conceal the early cases of an outbreak; the rural Egyptians were especially clever in hiding their sick in the fields or their dead in boxes under beds or even in unused ovens. To encourage notification, the government found it effective to enforce isolation of contacts of all undeclared cases of plague. Fleming M. Sandwith, The Medical Diseases of Egypt, 2 vols. (London: Henry Kimpton, 1905), 1, 195, 199.
79. Cattaui, II, pt. 2, 3-4.