THE SECOND PLAGUE PANDEMIC AND

ITS RECURRENCES IN THE

MIDDLE EAST: I347-I8941)

BY

MICHAEL W. DOLS
(Hayward)

In recorded history there have been three major plague pandemics

of considerable medical and historical importance: the Plague of

Justinian in the mid-sixth century, the Black Death in the mid-four-

teenth century, and the Bombay Plague in the late nineteenth century.
Apart from the high mortality rates and the dramatic consequences
caused by plague at these times, each pandemic initiated a long series
of plague epidemics with significant cumulative effects on human
societies 2). The purpose of this paper is to survey the recurrences
of plague that extended from the introduction of the second pandemic,
the Black Death, into the Middle East until the nineteenth century 3).
First, the historical sources for establishing a plague chronology
in the Middle East, particularly Egypt and Syria, will be reviewed.
It is clear that plague frequently recurred in this region for over half
a millennium, but the dating and the determination of the nature
of the plague outbreaks are fairly imprecise. Nevertheless, an attempt

1) This paper has been greatly improved at various stages of preparation by

the advice of Professors Ira Lapidus and Andr6 Raymond. I am particularly grateful
to Professor Frank Gilliard, who read the paper with meticulous care and helped
me to refine my thinking on a number of points.
2) The cumulative importance of plague recurrences in the late Middle Ages
has been emphasized by David Neustadt (Ayalon) in his study of the mamluk
army: "The Plague and Its Effects Upon the Mam13k Army", Journal of the Royal
Asiatic Society (London, 1946), pp. 67-73.
3) This survey is a natural sequence to my monograph, The Black Death in the
Middle East (Princeton, 1977); for the history of plague in Islamic society before the
Black Death, see my "Plague in Early Islamic History", Journal of the American
Oriental Society, vol. 94, no. 3 (New Haven, 1974), pp. 371-83.

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will be made to describe the periodicity and nature of the plague

recurrences. The rapidity as well as the rapacity of these outbreaks
raise the obvious of plague endemicity
question in the Middle East;
the persistence of plague in the Middle East can largely be attributed
to virulent plague foci that bordered the region. This survey will
not deal with a further and more difficult question: the extent of
human destruction caused by these plague epidemics. Yet, for indi-
vidual Muslims, lacking any effective medical understanding of the
disease, plague posed the threat of death in a particularly horrible
form. It is proper to conclude with a general description of the char-
acter of the collective response to plague by Muslim society and
its explanation.

I. Sources

Plague (ticfin)was a well recognized disease in late medieval Muslim

society because of its effects on early Islamic history. Drawing on

principally the works of Hippocrates and Galen, the Arabic physicians

adequately described the disease and transmitted the classical miasmatic

explanation for its etiology. However, it is not until the Black Death
that we have entirely accurate medical observations of plague and
historically reliable accounts in the Arabic sources. The Arabic sources
are primarily the plague treatises and the chronicles.
The treatises are devoted exclusively to the topic of plague. At
the time of the Black Death in Andalusia, three treatises were composed
that are mainly medical works. No such predominantly medical tracts
on plague have been found in the Middle East although plague was
discussed in most of the standard medical compendia that were written
both before and after the Black Death. On the other hand, the religious
scholars eulamä» throughout the Middle East composed treatises
of a largely legal nature that interpreted the disease according to

pious traditions (apädïth), instructed the reader on proper conduct

during an epidemic, and gave some peripheral medical advice. In

addition, these works usually ended with a chronology of plague
occurrences from early Islam until the writer's own time. These

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treatises virtually form a genre of religio-legal literature, occasioned

by the reappearances of plague until the end of the nineteenth
century 4).
The treatises are important obviously for their chronicling of plague
epidemics but, also, for the evidence of sustained concern by the
religious elite in arguing both for and against the religious tenets

regarding plague. The tenets were: plague is a mercy and a martyrdom

for the faithful Muslim and a punishment for the infidel; a Muslim
should neither enter nor flee a plague-stricken region; and plague
is non-contagious, being sent directly by God 5). The difficulty of

accepting this fearful disease as a blessing and a martyrdom, of not

fleeing for protection, and of not observing contagion/infection

(particularly in instances where highly infectious pneumonic plague
were present) made men question the wisdom of the religious precepts.
The treatises are repetitive concerning this subject matter although
they often supply original observations, particularly regard to with
plague symptomatology, of contemporary plague epidemics. In
one respect, the series of plague tracts show an increasing interest
in pseudo-medical or magical methods of prevention and treatment.
It would be hazardous to conclude that this is evidence for the decline
of medical practice; the discussion of magical I practices
may only
indicate a greater recognition by the of communal
activity,
which had always existed side by side with accepted medical practices.
Finally, the plague treatises explain to a great extent the Muslim
attitude toward plague, which was increasingly unintelligible to

European observers in the Middle East.

The historical chronicles are relatively abundant for the Black
Death and the recurrences of plague during then latter half of the

4) See Appendix 3 to The Black Death in the Middle East. I have been unable
to discover comparable treatises from Andalusia or North Africa after the Black
Death to the nineteenth century. Nor have any such plague treatises written in
Persian or Turkish come to my knowledge; because of the religious nature of
these tracts, they appear to have been composed only in Arabic.
5) See Jacqueline Sublet, "La Peste prise aux rets de la jurisprudence; le traite
d'Ibn Hagar al-CAsqaläni sur la peste", Studia Islamica, vol. 3 3 ?Paris, pp.
141-49, and The Black Death in the Middle East, p. 109 et pa.r.rim.

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Mamluk Period in Egypt and Syria,

although we have, to my know-

ledge, only one complete eye-witness account of the Black Death

itself 6). These chronicles diminish sharply in quality and quantity

in the last half of the fifteenth century, and we are no longer supplied
with the specific descriptions of epidemics which enable us to determine
with a fair degree of accuracy the duration and nature of the epidemics.
If the epidemic is plague, it is also important to distinguish among
the various forms of the disease because of their demographic effect-
whether bubonic, septicaemic, or pneumonic.
From the late fifteenth century the Arabic sources may be supple-
mented by information from European observers, including merchants
and pilgrims, doctors and diplomats, whose reports increase in number
from the fifteenth to the nineteenth century, as Western involvement
in the Middle East increases. The subject of plague alone inspired
a large European literature, especially among doctors, who gave

conflicting interpretations and advocated conflicting prophylaxes.

By and large, this literature is surprisingly uninformative for our

purposes despite some interesting accounts, such as those of the

English doctors Alexander Russell') and his brother, Patrick Russell 8),
on plague in Aleppo in the mid-eighteenth century.
In the foreigners' accounts the descriptions of plague outbreaks
and the responses of Muslim communities are stereotyped. Especially
unreliable are the exaggerated figures for population and for plague

mortality rates. Nor are the epidemics usually dated with precision.
The imprecision may have been due to many factors, not the least
of which was an ignorance of the native language; also the introduction
of quarantine for the European communities in the Middle East may
have effectively isolated many voyagers from any serious contact
with the disease and its victims. In any case, the inadequacy of the

6) See my "Ibn al-Wardi's Risdlab al-naba) Can al waba', A Translation of a

Major Source for the History of the Black Death in the Middle East", Near Eastern
Numismatics, Iconography, Epigrapby and History: Studies in Honor of George C. Miles,
ed. by Dickran K. Kouymjian (Beirut, 1 974), pp. 443-4j j .
7) Natural History of Aleppo (London, I 7 j 6).
8) Treatise on the Plague, z vols. (London, 1791).

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European reports is presently not compensated for by the records

of the Ottoman Empire, which have not been sufficiently investigated.
Unpublished Turkish and Arabic sources may eventually supply
the needed data concerning plague. With the exception of the pioneering
work of Dr. Siheyl Unver, we are poorly informed about Turkish
medical history in particular. Because of this dearth of oriental sources,
the subsequent discussion of the periodicity and nature of plague
recurrences will be divided at 15 17, when the Ottoman Empire con-

quered most of the Arab Middle East.

With the cessation of plague from Western Europe, the heightened
concern of European doctors with plague in the Middle East cor-

responded with an increased academic interest in the history of plague,

particularly in Europe-almost a fascination with a disease that no

longer posed the threat of death but still posed an historical riddle.
The various historical studies barely concealed the authors' attempts
to unravel the mystery of plague by ingenious but mistaken hypotheses.
This historical literature on plague
epidemics, particularly the Black
Death, reached its culmination the publication
with of Georg Sticker's

Abbandlu,-igen aus der Seucbengesebiebte utid Seuebenlebre, a chronology of

plague epidemics and interpretation, in two volumes in 1908-1910.

At the same time, the pathology of plague was being elucidated
as the result of the modern scientific study of the third pandemic
of plague that gained international attention
1894. in Since then,
considerable work has been done
on the biological and epidemiological

aspects of plague; gradually historical studies of plague epidemics

have taken cognizance of this advance. Until recently, most historical

descriptions of plague in the twentieth century have relied heavily

on Sticker's work, which is generally reliable for Europe, but is un-

fortunately deficient for the Middle East. The recent interest in plague

epidemics in this region reflects not only a legitimate interest in non-

European medicine but, more important, a genuine concern for the

broader questions of social history 9).

9) The most important historical study of plague and its recurrences is the recent
work of J.-N. Biraben, Les Hommes et la peste en France et dans les pays européens et

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II. The Periodicity and Nature of Plague Recurrence

The accompanying graphs, which cover the entire

period 1347
to 1894, should be used with caution for a number of reasons 10).
For the Middle East, the conversion of dates to the Christian calendar
has tended to inflate the number of plague years, particularly where
the duration of an epidemic is imprecise. Furthermore, the very detailed
reports of plague in Europe, as in England, in the later centuries

méditerranéens, z vols. (Paris, 1975-76). It is comprehensive for Europe, particularly

France, and contains an exhaustive bibliography (vol. 2, pp. 186-413). However,
Biraben's interpretation is marred by the untenable thesis that the human flea was
the essential vector of bubonic plague epidemics in Europe and his failure to discuss
pneumonic plague. Furthermore, the study is unsatisfactory in its account of plague
epidemics in the Middle East and North Africa. For the former, see The Black
Death in the Middle East; and for the latter, see the following : Jean Marchika, La
Peste en Afrique septentrionale : histoire de la peste en Algerie de iS,;o (Algiers,
I927); Edouard Bloch, La Peste en Tunisie (aperfu historique et épidémiologique),Dissert.
(Faculty of Medicine, Paris), Tunis, 1929; Paul Sebag, "La Peste dans le Regence de
Tunis aux XVIIe et XVIIIe si?cles", IBLA, no. 109 (Tunis, 1965), pp. 35-48;
and Lucette Valensi, "Calamit6s d6mographiques en Tunisie et en M6diterran6e
orientale aux XVIIIe et XIXe siecles", Annales, vol. 24, no. 6 (Paris, 1969), pp.
1540-61.
Io) The reported plague epidemics have been compiled from the following
works: (i) Sticker, Abbandlungen aus der Seucbengescbichteund Seuchenlehre, vol. I ;
(z) Appendices I and 3 to The Black Death in the Middle East; (3) Wu Lien-Teh,
A Treatise on Pneumonic Plague (Geneva, igz6); (4) Andr6 Raymond, Artisans et
Commerfants au Caire au XVIIIe siecle, z vols. (Damascus, 1974), and idem, "Les
Grandes Epidemics de peste au Caire aux XVIIe et XVIIIe siecles", Bulletin d' Études
Orientales (Institut Fran?ais de Damas), vol. 25 (Damascus, 1973), pp. 2.03-10;
(5) Ibn Jumcah, Les Gouverneurs de Damas sous les Mamlouks et les premiers Ottomans
trans. by Henri Laoust (Damascus, 19, 2); (6) A. S3heyl
(6J8-11J6/1260-1744),
Unver, "Sur 1'histoire de la peste en Turquie", Comptes-Rendues, The Ninth Inter-
national Congress of the History of Medicine (Bucharest, September, 1932), ed.
by Victor and Victoria Gomoin, pp. 479-83; (7) Marchika, La Peste en Afrique
septentrionale; (8) Bloch, La Peste en Tunisie; (9) M. A. Loir, "Histoire de épidémies
de pest ? Tunis", Rev. Scient., 4th series, vol. I 3 ?Paris, I goo), pp. 3 9 S -99 ?(Io)
Biraben, Les Hommes et la peste en France, vol. I, pp. 363-449; and (I I) the European
accounts of individual epidemics contained in the Voyages de Egypte (1400-1700),
Tnstitut Francis d'Archeologie Orientale (Cairo, I97I- ). For a discussion
of plague among European travelers to Egypt, particularly Wild, di Wolmar,
and Pugnet, see L. Keimer, "Quelques Details Oubli6s ou Inconnus sur le vie
et les publications de certains voyageurs europeens venus en Egypte pendant les
derniers siecles", Bulletin de l'Institut vol. 3I (Cairo, 1949), pp. 12.1-75,
especially pp. 1 3 8- , 9.

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create a mistaken impression of serious and sustained outbreaks,

whereas they were usually of local incidence causing a low mortality.
On the other hand, the reports for the Middle East are far less complete
and, therefore, do not emphasize minor recurrences. In addition,
the selection of geographical areas in the graphs was made to emphasize
the epidemics in the Middle East and, secondly, to offer some meaning-
ful correlation with the better documented European outbreaks and
the reported epidemics in India. The regions of Europe, North Africa,
and Southwest Asia have been given their modern names. For some

regions there is a definite redundancy, especially with regard to the

plague focus in Kurdistan, which will be discussed below. Despite

their weaknesses, the graphs do show the relative distribution of

plague epidemics in adjacent regions at various times and suggest

the probable courses of transmission. The graphs, also, make us
more of our faulty knowledge
aware of plague outbreaks in the Middle
East compared to our extensive knowledge of European epidemics;
especially, the lack of information for the sixteenth century in the
Middle East raises the constant doubt whether there were no plague

epidemics in some years or we lack the necessary documentation.

Therefore, the charts should only be regarded as a provisional basis
for further investigation.

I. 1347-1517

Plague recurred during the one hundred and seventy years between
the outbreak of the Black Death (1347) and the conquest of Egypt
and Syria by the Ottomans in I j I7. In Upper and Lower Egypt,
plague epidemics are cited for fifty-five years (including the Black

Death) of this total period of time; in Syria, fifty-one years. Without

regarding the intensity or nature of the outbreaks, we may make a
number of observations about them, in spite of the lack of complete
historical-medical evidence.
In Egypt from 1347 to 1317 there were apparently twenty major
epidemics of plague, if a major epidemic is defined as one that extended

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beyond the seaports to the interior of the country In this period,

plague appeared on the average of every eight to nine years; alto-
gether, plague is cited in sixty out of 170 years. For Syria-Palestine,
there appear to have been eighteen major epidemics 12). Between
i 348 and I j I7, plague occurred on the average of every nine and a
half years; plague is cited in forty out of z 7o years.
These epidemic cycles in Egypt and Syria may be compared to those
in Europe. In France, from the Black Death until 1536, there were
sixteen principal epidemics that took place approximately every eleven
to twelve years; plague has been documented for 176 out of 1 89 years.
For Europe in general in this period (1 347-1 j 34), there were seventeen

major epidemics that reappeared about every I I.I years 13). Despite
the lack of detailed documentation for each area, the cycles of epidemics
in the Middle East and Europe appear quite comparable.
Of greater demographic and historical importance than the cyclical
pattern of these plague recurrences is the nature of the outbreaks
themselves. The appearance of pneumonic plague, either alone or,
as is usual, in conjunction with bubonic plague, is important because it is
probably the most infectious epidemic disease and is almost always
fatal 14). On the other hand, bubonic plague is one of the least contagious

epidemic diseases and causes few deaths According to Dr. Wu

II) 1347-49, 136o-64, 1373-75, 1379-81, 1388-89, 1397-98, 1403-17, 1410-II,

1415-19, 1429-3°> 1438-39, 1444-49, 1459-6o, 1468-69, 1476-77, 1492., 1498,
ISo4-oS? ISI3-I4.
12) 1348-49, I3Gz-G3, 1380-81, 1393, I4o9-II, 1416-17, I4.22-23, 1429-30,
1437-38, 1445, 1459-6o, 1468-69, 1476-77, 149I-9z, 1497-98, 1504, 1311-14.
13) For more detailed analysis, see Biraben, Les Hommes et la peste en France,
vol. I, pp. I I8-29.
14) L. Fabian Hirst, The Conquest of Plague: A Study of the Evolution of Epidemiology
(Oxford, 19 5 3), P. 29.
I S ) For the earlier plague epidemics in Islamic history, which followed the
Plague of Justinian, the presence of pulmonary infection cannot be established
with certainty. However, its presence seems probable and allows us to suggest
a recurrent retardation in population. At the initial outbreak of plague in Constanti-
nople in S 42, Procopius states that "many dropped down from a sudden vomiting
of blood". (History of the Wrars, ed. and trans. by H. B. Dewing [New York,
pp. 450-73.) Beside mentioning this important symptom of pneumonic plague,
he also remarked that plague occurred in all seasons and caused a great mortality-

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Lien-Teh, the
present-day medical authority on pneumonic plague,
there are norecords of pneumonic plague until the Black Death,
with the curious exception of one epidemic in Provence in 1 329 16).
Concerning the Black Death, there can be no question that the pul-
monary form of plague occurred alongside the bubonic and septicaemic
forms in the outbreaks in Asia, Africa, and Europe.
Parenthetically, the Black Death certainly began in inner Asia
and spread outward, as Wu Lien-Teh has alleged 117) . But there is
no apparent basis for his strong belief, which is reiterated by all other
medical writers, that the"original home of plague" must have been
in central Asia. This may be true, but there is no historical evidence
for it. On the contrary, it appears more likely, given the history of

all consistent with pneumonic plague outbreaks. What is not consistent is his state-
ment about the non-infectious nature of the pandemic, which may be explained
by Procopius' belief in the pestilence as a special act of God-like the later Muslim
interpreters of plague-and therefore non-infectious. Evagrius Scholasticus described
the pandemic that appeared in Antioch, his home, in 54z and caused a high death
rate in the cities of Syria. Evagrius stated that plague reappeared in cycles; the
second year of each indiction was particularly severe and sometimes occurred in
winter. Moreover, Evagrius commented: "Then falling upon the throat, [plague]
soon put an end to life in all that were thus seized". (The Ecclesiastical History,
ed. by Bidez and Parmentier [London, 1898], book 4, section 29.) The precise
symptoms of plague in the early Islamic period are not fully described in the Arabic
sources, as they are for the Black Death and its reappearances in the later Middle
Ages. Yet, in one instance, the quotation from pre-Islamic medical works by the
Muslim physicians concerning plague is informative. The famous physician ar-Razi
quoted Ahrun the Priest on plague; the latter was an Alexandrian doctor who
lived about the time of the birth of Islam and wrote The Medical Pandects, the earliest
medical work to be translated into Arabic (Manfred Ullmann, Die Mediqin im Islam
[Leiden, 1970], pp. 87-89). In the citation by ar-Razi, Ahrun described the spitting
of blood among the signs of plague infection (ar-Razi, Kitib hdivi fs t tibb [ Hyderabad,
1955-68], vol. 17, p. 4). This is the earliest clear description, to my knowledge,
of pneumonic plague and lends weight to the probability of pneumonic plague
during the early Islamic era.
i 6) A Treatise on Pneumonic Plague, p. z (taken from Sticker, Abhandlungen, vol.
I, p. 41).
i 7) Ibid. ; Wu Lien-Teh, "The Original Home of Plague", Far Eastern Association
of Tropical Medicine: Transactions of the Fifth Biennial Congress (Singapore, 192 3),
ed. by A. L. Hoops and J. W. Scharff (London, 1924), pp. 286-304. Professor John
Norris has made the unwarranted assertion that the Black Death originated in
Kurdistan and Iraq ("East or West? The Geographical Origin of the Black Death",
Bulletin of the History of Medicine, vol. 5 i, no. i [Baltimore, 1977], pp. 1-24).

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epidemics in the ancient Mediterranean world and particularly of

the Plague of Justinian, that the original plague focus was in Africa
and spread to central Asia, where it became entrenched among the
wild rodent population, especially the tarabagan 18). With regard
to the biochemical
properties of Pasteurella pestis, glycerol-positive
strains (or according to Devignat's classification, var. antiqua) exist
in both central Asia and central Africa. The pandemics of the sixth
and the fourteenth centuries were both probably
by glycerol- caused

positive strains, beginning in central Africa and

central Asia respect-
ively. The differentiation of plague bacilli with the aid of glycerol
tests does distinguish plague in specific regions (var. orientalis [ glycerol-
negative] in Egypt, Palestine, Morocco, etc.; var. mediaevalis [mixed]
in Kurdistan and southeast
Russia). It is still uncertain whether the
biochemical nature causes a fundamental difference in the epidemiology
of plague although it has been suggested that pneumonic plague
is caused by glycerol-positive strains 19). Adding to the complexity
of the problem of plague in the Middle East,
therefore, is the presence
of all three biochemical types of plague bacilli, even though their

epidemiological characteristics are still undetermined.

For Europe, it is generally accepted that the Black Death-in its
bubonic, septicaemic, and pneumonic forms-caused a dramatic
decline in population, a decline made even more precipitious by the
periodic reappearances of plague. However, recent historical study
has critically questioned the nature of these plague recurrences in

Europe ?nd the demographic effects that had earlier been attributed
to them. Professor Bean has examined the later plague appearances
and has refuted the validity of the thesis that continued outbreaks
of plague caused continued population decline, as suggested by other

18) Wu Lien-Teh, "Plague in Wild Rodents, Including the Latest Investigations

into the Role Played the Tarabagan", Far Eastern Association of Tropical Medicine:
Transactions of the Fifth Biennial Congress, pp. 3 04-40.
Robert Pollitzer, Plague, WHO Monograph Series, no. 2.2.(Geneva,
pp. Io2-03 ; idem, "A .Review of Recent Literature on Plague", Bulletin of the World
Health Organiqation, vol. z3, nos. 2-3 (Geneva, pp. 3 z6-z8.

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scholars 2°). His criticism of these epidemics is based on a study of

their characteristics, of their mortality rates, and of their chronology
in England in the fourteenth and fifteenth centuries.

Particularly important for Bean's study is the fact that pneumonic

plague is distinguished by its symptom of spitting blood as a result

of massive infection of the lungs. This form of plague tends to occur

primarily in the winter 21). Furthermore, a comparison of mortality

from the various plague occurrences would also indicate the presence
of pneumonic plague by the marked increase in the death rate. Bean
has concluded that the instances of pneumonic plague after the Black
Death in Europe were indeed rare 22). His conclusion is supported

by the observation that the plague reappearances, specifically in

England, were gradually limited in geographical scope, which would

be indicative of contagious (i.e. bubonic) and not infectious (i.e.
pneumonic) epidemics. Similarly, the leading medical historian of

plague has written that "primary infectious pneumonic plague played

an insignificant part in the spread of plague in Europe after the decline
of the Black Death except, perhaps, in a few Russian epidemics
Altogether, the lack of persuasive evidence for pneumonic plague
after the Black Death in Europe should lead to a much lower estimation

20) J. M. W. Bean, "Plague, Population and Economic Decline in England

in the Late Middle Ages", The Economic History Review, znd series, vol. i (ig6z-63),
pp. 423-37· The disputed hypothesis for continued demographic decline in England
because of plague may be found in John Saltmarsh, "Plague and Economic Decline
in England in the Later Middle Ages", Cambridge Historical Journal, vol. 7 (1941),
pp. 23-41.
zx) Wu Lien-Teh, A Treatise on Pneumonic Plague, pp. 3-4. However, there are
striking exceptions to this rule that affect the Middle East. Since the outbreak of
the last pandemic in this century, pneumonic plague has shown a tendency to recur
regularly, as has bubonic plague, in Upper Egypt, where the season of infection is
exceptionally hot and dry. "In all probability the chief effect of cold is to promote
the congregation of human beings together in badly ventilated rooms and so facili-
tate the exchange of the microbes of air-borne disease, the climatic conditions
being secondary". (Hirst, The Conquest of Plague, p. 2.21; see also the remarks of
Pollitzer, Plague, pp. 1$)
22) Bean, "Plague, Population and Economic Decline", p. 4z6.
23) Hirst, The Conquest of Plague, p. 34; see also Wu Lien-Teh, A Treatise on
Pneumonic Plague, p. 7.

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of plague mortality for these plague recurrences or the investigation

of other concomitant demographic factors reducing population,
if there was a sustained population decline in the late fourteenth
and fifteenth centuries
24).
Bean's criteria
may be applied to the material for the plague recur-
rences in Egypt and Syria during the same period. In the Middle
East, we are faced with a remarkable difference in the nature of plague
reappearances. The historical evidence shows that pneumonic plague
recurred regularly after the Black Death
consequently and suggests
a significant demographic effect. Using the methods of examination

applied to plague in Europe, we find the Arabic sources clearly des-

cribing the expectoration of blood, the rapid course of the infection,
the appearance of plague in winter months, and the general or "na-
tional" character of these epidemics.
As for the
comparative mortality of successive plague epidemics
in the Middle East, the precise but very limited mortality figures given
by the contemporary historians, particularly for Cairo in the fifteenth

century, are very poor indices for severity and do not allow us to
draw any firm conclusions. The figures from the Cairene dïwän al
mawiritb al hasbriyab are very fragmentary and the comparison of
relative severity is not satisfactory because the dïwän accounts were

usually quoted for the more serious plague epidemics, which included
the pneumonic form of plague, and generally not for the milder epi-
demics. Where limited comparison of severity can be made in the

early fifteenth century between what are believed

to be non-pneumonic
and pneumonic plague epidemics, the evidence is consistent, except
for the year r4I6. In this year the diwin figures are as high as those

z4) Modern studies of late medieval European population suggest an "overpopu-

lation" in the thirteenth century, followed by a steady but gradual demographic
decline before the Black Death. The pandemic and later epidemics, as well as other
demographic factors, are considered to have accelerated the decline and were not
an absolute "Malthusian check" to population growth. This view leads correctly
to the more careful examination of a declining birth rate of the population itself,
caused by deteriorating economic and social conditions (see Herlihy, "Population,
Plague and Social Change in Rural Pistoria, I20I-I430", The Economic History,
Review, znd series, vol. i 8 [ 1 968],pp.

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of 1429-1430 or 1459-1460, where there is strong evidence of pneumonic

plague. The plague epidemic of 1416 began in the spring, and the
brief historical
description by al-Maqrizi does not mention
the dis-
tinctive signs of pneumonic plague. Secondary pneumonic plague
may have broken out, especially in Upper Egypt. Such plague may
cause rapid death without any signs of coughing or expectoration 25).
It is quite possible, however, that the epidemic was accompanied
by other communicable diseases. In general, the statistical data for
measuring relative severity are far too few-there are only
thirty-six
statements of daily mortality rates for these plague years-either
to substantiate or challenge the conclusions drawn from the other
evidence for pneumonic plague outbreaks.
Despite our lack of quantitative data satisfactorily to gage the
levels of mortality for successive epidemics, the pneumonic type
of plague occurred in Egypt, based on Bean's other criteria, at the

following times:1347-1349 (Black Death), I374-I37S? 1379-1380,

1403-1404, I4Io-I4I I, 1429-1430, 1438, 1449, and 146026) . From the
Black Death to z 460, pneumonic plague occurred in sixteen years out
of one hundred and thirteen years on the average of every 14.6 years.
The average of intervals is deceiving, since the most outstanding
characteristic of the recurrent pneumonic epidemics is the gradual
leveling in the duration of alternating long and short intervals. From
the Black Death to 1460, the intervals are:
The frequency and intensity of such epidemics within each generation
would have effectively prevented the population from successively

replacing its numbers and may indicate either no growth or an absolute

demographic decline.
An absolute decline is highly probable because of the short-term
human immunity to plague and the fact that the disease struck primarily

z , ) Pollitzer, Plague, pp. 44, -46.

z6) In some cases, these epidemics may be related to those in Syria-Palestine.
Parenthetically, a pneumonic plague epidemic may have occurred in Tabriz in the
winter of 1488: "Suddenly in the beginning of the winter the cloud of the plague
for the second time [ ?], covered the hills and plains of Tabriz". (Vladimir
Minorsky, Persia in AD T478-I4YO[London, p. 87)

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young women and children, thus greatly limiting fertility and replace-
ment. The same phenomenon is noted by chroniclers and physicians
in Europe, where young women and children formed a disproportionate
share of the plague victims Yet, Bean and others have criticized
the assumption that frequent plague outbreaks would have resulted
in population decline by comparing the epidemics to recent and
more fully documented experiences of epidemic diseases in areas
similar to medieval England, such as the peasant population of India.
The comparison shows that severe death rates from epidemics are
followed by rapid rises in the birth rate, which enable the population
to recover its pre-epidemic levels. Short-run demographic decline

may decrease the number of dependents on

and, alongsurvivors
with a rise in living standards, permit marriage at an earlier age 28). The
comparison makes us alert to the resilence of population and its ability
to recover under favorable conditions. But it does not describe the

demographic situation in the Middle East, where recurrent pneumonic

plagues were an over-riding factor.
The study of plague epidemics in England by Bean does make us
highly skeptical of a prolonged demographic decline in Europe. On
the other hand, the same criteria for the plague recurrences in the
Middle East strengthen the case for repeated and substantial reductions
in population after the Black Death. This decline was aided by other
unfavorable demographic factors, both natural and man-made, that
retarded population recovery in the later Mamlük Period.

2. I j 1 7- 1 8 94 _

Plague continued to recur after I j 17 in Egypt and Syria, although

there is even less certainty about its outbreaks than for the previous
period. From i 5 i 7, plague epidemics are reported in 133 years out t
of a total of 377 years in Upper and Lower Egypt. After an apparent

z7) Bean, "Plague, Population and Economic Decline", p. 431.

z8) Ibid., pp. 43 i-4z. Although this may be true of rural India, it is doubtful
whether it is actually applicable to medieval England, where as Bean has shown
plague epidemics became an increasingly urban phenomenon.

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lull in Egypt and Syria following the Ottoman conquest, a major

epidemic appears to have taken place in the I j 70s. There were ap-
proximately thirty-three major epidemics between z S 7z and i 865 29).
During this period of 294 years, serious plague epidemics appeared
on the average of about every nine years. For Syria-Palestine, plague
epidemics are reported in seventy-nine out of a total of 377 years.
It is estimated that there were twenty major epidemics between z s 7z
and 1865 30). During this period, it is suggested that serious plague

epidemics took place at intervals of about every fifteen years 31).

It should be emphasized that this calculation does not include local
outbreaks, especially in the Mediterranean ports.
In general, we can see that plague epidemics were no more frequent
in the Middle East than in Europe up to the late seventeenth century-
the plague in Marseille being the constant exception to any generali-
zation about western
Europe. While plague epidemics in the Middle
East are conspicuous to us as they were to contemporary witnesses
in the eighteenth and nineteenth centuries, it is surprising how com-

paratively rare they were in the Middle East in the sixteenth and
seventeenth centuries. In one instance, the lack of severe plague
epidemics in the sixteenth century corresponds to
resurgence the
of Anatolian population that has been clearly established 32).
What we cannot judge accurately is the severity of the major epi-
demics from the late fifteenth to the late eighteenth centuries in the
Middle East; specifically, it is unclear from the available sources

z9) 157z-76, IfgO-gI, 1603, I6I9-zz, 1643-44, 1667, 1685-87,

1696-97, 1701, 1705, 1717-19, 17z6-27, 1731, 1734, 1736, 1757, 1759-6o,
I7g3-g5? 1788, 1 790-9 1 , 1 794, 1797-1801, IHOf, 1810-11, 1813-16, 1824, IBjx-4f,
1 8 j 3 , 1 8 j 7, 1 8 6 j .
30) 1?71, 1?9, IG42-q.4, 1669-70, 1676, I7I7,
1728-33, 1741-44, I7fg-G2, 1773, 1796-99, i8z6, I828, 1831-34, 1838, I84o-q.I.
31) For comparable figures for France and Europe, see Biraben, Les Hommes
et la peste, vol. I, pp. 118-29.
32) See M. A. Cook, Population Pressure in Rural Anatolia, I4Jo-I6oo (London,
1972), and R. C. Jennings, "Urban Population in Anatolia in the Sixteenth Century:
A Study of Kayseri, Karaman, Amasya, Trabzon, and Erzurum", International
, journal of Middle East Studies, vol. 7, no. 1 (Cambridge, 1 976), pp. 2 I- 5 7-

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whether pneumonic plague outbreaks occurred. Therefore, we cannot

propose, as we have done in the earlier period, a significant demographic

effect of these epidemics. Although we are uncertain about the general

scope of population in Egypt and Syria during this period, it is evident

from the Ottoman census records that the Syrian population was

declining in the sixteenth century 33). Furthermore, Ray- Professor

mond's work on plague epidemics in Cairo in the seventeenth and

eighteenth centuries suggests an appreciable destruction of Egyptian

population in contrast to the resurgence of European population at

the same time 34). Nevertheless, it must be shown that pneumonic

plague was present in these epidemics before a serious mortality rate

can be assigned to plague.
While other areas of the Middle East were
certainly affected by
plague epidemics between 1347 and 1 894, as indicated by the graphs,
it does not seem profitable to calculate their cycles. The data are more
scarce and unreliable for these regions than for Egypt and Syria,
but the information is significant in showing the remarkable longevity
of plague in the Middle East, and in a number of cases, it shows the

geographical distribution of an epidemic. This is particularly important

when we come to consider the foci of plague that largely determined
the direction and frequency of epidemics.

III. Plague Foci Affecting the Middle East

On the basis of geographical and historical evidence from the pandemic

that began in 1 894 in the Far East, we can determine the independent
endemic foci of plague apart from new localities that have since become
endemic centers by the introduction of extraneous infection, e.g.
South Africa, California, Java, etc. The study of Wu Lien-Teh has

clearly established these foci of plague indigenous to the rodent popu-

33) lsmer Lutfi Barkan, "Essai sur les donn6es statistiques des registres de recense-
ment dans l'empire Ottoman aux XVe et XVIe siecles", The Journal of the Economic
and Social History of the Orient, vol. i (Paris, I 9 j 8), p. z7.
34) Raymond, "Les Grandes gpid6rnies", pp. 209-10 ; see also Max Meyerhof,
"La Peste en ggypte a la fin du XVIII siecle et le M6decin Enrico di Wolmar",
La Revue Midicale vol. i, no. 2 (I 9 I 3), pp. 132.-37, 164-7 7 -

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lation 35). These endemic foci were either invigorated by the Black
Death or created during the subsequent period of plague occurrences
(secondary plague foci). The latter seems to be the case especially
for Benghazi (Tripolitania) in the nineteenth century; previously,
North Africa was subject to infection from sea trade and caravan
traffic from central Africa 36). In turn, Benghazi formed the starting-

point for overland caravans to the east and west.

importantly, More
the Middle East is so placed as to be at the crossroads of a number
of endemic foci of plague, which accounts for the numerous and seem-

ingly chaotic occurrences of plague since the Black Death. By land and
sea, trade has promiscuously carried plague over the entire region,

giving the appearance of plague endemicity throughout the Middle

East.
The endemic foci that may be said to be the generators of recurrent

plague during our period in the Middle East appear to be the fol-

lowing : central Asia, western Arabia (Assir), western Asia with

its center in Kurdistan, central Africa, and northwestern India. From
our point of view, the Kurdish region calls for special attention.
Recent studies of Kurdistan have demonstrated that plague is endemic
to the entire area north of the Zagros Mountains in Persia and stretches
across the south of Turkey and the north of Iraq and Syria as far
as the Euphrates; judging by the endemicity and bio-chemical nature
of the plague bacillus, we can extend this focus also to southeastern
Russia through the Caucasus Mountains.
As Sticker has asserted, Kurdistan seems to have developed as a
serious focus of plague in the mid-sixteenth century; thereafter,
recurrences took
place approximately every twenty years 37). Growing
in strength in the late eighteenth century, plague expanded, and we
can attribute to the Kurdish focus many of the plague outbreaks
in Persia, Mesopotamia, Armenia, northern Syria, Georgia, and the
Caucasus region during the nineteenth century. It should be noted

"The Original Home of Plague", pp. 286-304; Pollitzer, Plague, pp. 14-15.
36) "The Original Home of Plague", pp. 289-90.
37) Sticker, Abhandlungen, vol. 2, pp. 8 3-8 S .

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that the numerous plague outbreaks in Asia Minor and Syria in the

eighteenth century and the first half of the nineteenth century were
largely due to this focus and not to the customary passage of plague
in the Levant from older foci 38).
As in the important case of Kurdistan, we can see from the graphs
that at certain times there were new waves of plague infection spreading
out from endemic foci. Wu Lien-Teh has emphasized this phenomenon
with regard to plague radiating out from central Asia to distant

regions in the nineteenth century 39). Before the nineteenth century,

the paths of epidemics in the Middle East can be partially traced at

specific periods. The best known was the common transportation

of plague from Constantinople to
Alexandria, ports which were
not truly endemic foci of plague but were entrepots not only of travelers
and commerce but also of disease Although a constant victim
of plague, Egypt was not a real endemic center 41). Professor Raymond
has demonstrated that plague entered the country by the ports-Alex-
andria and Rosetta-and progressed inland in 1718, 1736, and

1785. On the other hand, Sticker has stressed the importation of

plague from central Africa through the Sudan to Egypt and North

3 8) M. Baltazard and B. Seydian, "Enqu8te sur les conditions de la pest au Moyen-

Orient", Bulletin of the World Health Organization, vol. z3, nos. 2-3 (Geneva, y6o),
pp. 1 , 7-69 ;"Etude de 1'6pid6n-iiologie de la peste dans le Kurdistan iranien", Bulletin
de la Sociétéde patbologie exotique, no. 6 (1963), pp. IO??-I260. Modern epidemiological
study of this focus may incidentally have solved one historical riddle: the lack
of historical information for the Black Death in most of Persia. Because of an absence
of rats, the Black Death may have been relatively insignificant. Plague in Kurdistan
is totally dependent on some highly susceptible meriones (gerbils). Where there
have been violent epidemics, interhuman transmission has been dependent on the
human flea (Pulex irratans), usually a poor vector of plague. Moreover, the recent
epidemics in this region rarely include pneumonic plague.
39) Wu Lien-Teh, "The Original Home of Plague", pp. 301-02.
40) Daniel Panzac has reached the same conclusions about Smyrna in the eight-
eenth century: plague was not endemic to the region but was introduced by sea
from Constantinople and Alexandria, and by caravan from Kurdistan ("La Peste
a Smyrne au XVIIIe siecle", Annales, vol. 28[ 973], pp. I o7 I -9 3).
41) Wu Lien-Teh, "The Original Home of Plague", pp. 290-91; Raymond,
"Les Grandes pp. 208-09 (in addition to the works cited by Raymond,
see the discussion of Edward Brown, The Travels and Adventures [Cairo, 1974],
p. 40 3).

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Africa 42). In addition, we can assume the probable transmission of

plague to Egypt by land and sea from North Africa, Syria-Palestine,

western Arabia (especially because of the pilgrimage traffic), and
India. Conversely, Egyptians were surely responsible for carrying
plague outward in all directions. The spread of plague infection
over long distances has always been governed solely by the movements
of men (including tribal migrations) and merchandise.
The vulnerability of
Syria-Palestine to plague is comparable to
that of Egypt 43) although it is clearly impossible to assign the origin
and direction of transmission for every reported plague epidemic.
Without falsifying the picture by over-simplification, our understanding
of the plague foci makes the otherwise chaotic outbreaks in the Middle
East explicable.

IV. The Muslim Response to Plague

The reactions of Muslim society to plague epidemics over the

long period following the Black Death were generally consistent

and conform to what we know of the character of the response to
the Black Death itself 44). I have suggested elsewhere that the apparently
pacific, collective, and controlled Muslim reaction to the Black Death
were primarily the result of religious beliefs. This appears to be true

up to the twentieth century; the continuity of plague treatises attests

to the importance of the religious interpretation of plague for guiding
communal behavior and limiting intellectual discussion.
The strength of this interpretation can be seen in the European
accounts of plague epidemics in the Middle East, which increased
from the fifteenth century. The Muslims appeared to the foreigner

42) Abhandlungen, vol. I, p. 407; vol. z, pp. 79-81. Plagues in Egypt from the
Sudan: 1696, 1736 (?), 1794, I800, 1829, 1845-59, 1865, 1874, 1889, 1897, 1900,
1902; in North Africa from central Africa: I58o, 1696, 1736, 1794, 18oo, 1829,
184?-?9,i86?,1874,1889,1897,1900,1902.
43) Ibid., vol 2, p.
44) The Black Death in the Middle East, pp. 281-3°1; see also Panzac, "La Peste
a Smyrne", pp. 1086-91, who is particularly informative about the reactions of the
native non-Muslim population, about whom we would like to know a great deal
more in the Middle East.

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 I8I

to display a remarkable disregard for protection against contagion.

The Muslim attitude toward disease, with the ultimate threat of death,
must have gone a long way in creating the Western impression of
a "fatalistic" society and religion as a whole.
There are a number of specific characteristics of Muslim social
behavior that persisted throughout our period besides the failure
to take preventive measures against contagion. Numerous Europeans
(Rocchetta, Br6mond,, Brown, Volney, et al.) observed the customary

selling of clothes and belongings of the plague victims in the markets;

needless to say, from our modern understanding of plague, we know
that this only aided the spread of the disease. The Europeans also
shared with the native Muslims
a foreknowledge of the probable plague
years and the plague seasons. The latter was especially predictable
in Egypt, where practically every European who visited Cairo and
discussed plague remarked that plague began in the spring, increased

during the khamsïn (the hot southerly wind), and ended abruptly in

June 45). Plague might appear irregularly in Cairo during the autumn
and last through the winter, causing a considerable mortality; it is

possible that the Europeans, like the medieval Arabic writers, may
have been witnessing the difference between pneumonic outbreaks
in the winter and the usual bubonic
epidemics in the spring.
In any case, the change in climatic conditions in Cairo affected the

etiology of plague, particularly with respect to the flea, and accounts

for this seasonal variation; the differences in climate also explain the
variation of plague seasons and theplague's severity throughout
the Middle East., Incidentally, a number of the European visitors
to Cairo (Brown, Coppin, de Monconys) remark on the common
nuisance of fleas although this is never related directly to
plague.
Finally, there is no evidence for any significant change in the tradi-

4S) Sticker, Abhandlungen, vol. z, p. 240. The following Europeans may be added
to Sticker's sources: Harant, Coppin, von Harff, Brown, Palerne, Teufel, Bremond,
Rocchette, von Lichtenstein, and Volney. See also Raymond, "Les Grandes Epi-
d6mies", p. zo9 ; Meyerhof, "La Peste en l3gypte", p. 136; and Brown, The Travel
and Adventure.r, p. 403, n. 147.

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tional methods of plague prevention and treatment except for the

European importation of quarantine,
appearswhich to have been

largely confined to the

European communities 46). From our point
of view, the rejection of quarantine shows the strength of Muslim

religious beliefs 47). Until the twentieth century, there was no effective
medical defense
against plague in the East or the West; with slight
variation, medical treatment continued to be derived from Hippocrates
and Galen and their medieval Arabic commentators.
The cruel recrudescence of plague in the Middle East did not bring
about any advance in the medical understanding of the disease. It
was only with the advent of the third pandemic in the Far East, recalling
the horrors of the Black
Death, that modern scientific methods were
applied to the
study of plague. The relatively recent discovery of the

pathology of plague has created a totally new approach to control

and medical treatment. This knowledge of plague pathology has
also enabled us to unravel, for the most part, the morbid mystery of
the Black Death and its recurrences into modern times.
In conclusion, the culling of native and foreign sources has produced
an appreciable amount of evidence for us to outline broadly the peri-
odicity of plague epidemics in the Middle East. Without regard to
existing levels of population or plague mortality rates, it is possible
to suggest on the basis of the periodicity and the nature of plague
epidemics that the disease caused a drastic decline of population
from the mid-fourteenth century and that Middle Eastern population
did not begin to increase again until the second half of the fifteenth
century, when pneumonic plague apparently disappeared. Ceteris

46) There were partial attempts at quarantining land and sea trade coming from
infected regions. This was the case in Tunisia during the eighteenth century with
regard to ships arriving from the Levant and caravans traveling from Algeria
(see Sebag, "La Peste dans le Regence de Tunis", pp. 4i-42, and Valensi, "Calan-iit6s
d6mographiques en Tunisie", pp. 1 , 49-, o).
47) This rejection of quarantine methods, and the implicit belief in contagion,
by Muslims is well illustrated by the popular opposition to the advise of Hammudah
ibn 'Abd al-Aziz, who advocated European methods of plague control during
the severe plague epidemic in Tunis in i 784-8 (Sebag, "La Peste dans le Regence
de Tunis", pp. 44-4 S ).

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paribu.r, the relative infrequency and mildness of plague epidemics

in this region in the sixteenth and seventeenth centuries would not
have greatly hampered population growth; however, the increased
number of serious epidemics in the eighteenth and early nineteenth
centuries would have been unfavorable to
growth.such Generally,
this pattern of plague epidemics conforms to Professor Raymond's
hypothesis for the pattern of Cairene population from the Black
Death to the early nineteenth -
century 48).
Our survey of epidemics makes clear that plague was a constant

danger, but it was not truly endemic to the Middle East, outside
of the foci of plague in Kurdistan and western Arabia. Rather, the
Middle East has been a very vulnerable intersection of paths of epi-
demics that were carried by men and their cargo. Plague was confronted
ideologically, if not by a medical understanding, by a well-formulated
and acknowledged religious explanation. Thus, the perception of
the disease was largely shaped by the Islamic religion and found
visible expression in religious
practices. Medical practice can never
be divorced entirely from its social and religious context.
Because of the historical importance of plague, its students are
challenged to define more closely the nature of its outbreaks and to
estimate their influence
on population. In general, no more important
task confronts social historians of the Middle East than to investigate
the demography of the medieval and early modern periods. For the
medical historian, the study of plague should evoke a comparable
interest in the history of other diseases that have vitally affected Middle
Eastern society.

48) Andr6 Raymond, "La Population du Caire, de Maqrlzi a la Description de

Bulletin Orientales (Institut Frangais de Damas), vol. z (Damascus,
1977), PP. 201-15.

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