THE PLAGUE AND ALEPPO 1 Running Head: THE PLAGUE AND ALEPPO
The Effects of Bubonic Plague Outbreaks on the Infrastructural Developments of the City of Aleppo Anastasia M. Bohon ARCH 531E May 6, 2018
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Abstract The word ‘plague’ is derived from the Latin word for epidemic but has grown to refer specifically to the Yersinia pestis bacteria and the destruction that it caused throughout history. The worst outbreak of the plague happened in the middle of the 14th century and there is detailed documentation concerning the progression and effects of the disease throughout Europe as well as on a global scale. However, there is little research available concerning how the plague affected the development of the Middle East. It’s not unknown that the plague continues to reemerge multiple times across history which would lead one to believe that some more information would be readily available. The plague in Europe so thoroughly reorganized the social structure and construction of the cities that one would assume that the trend would be the same for Middle Eastern cities. This essay seeks to analyze the possibilities of potential research into one of the main Middle Eastern cities that was at the crossroads of the East and the West along the oceanic, sea-based, land, and silk road trade routes - the city of Aleppo. Aleppo has a long history in the present-day northern Syria as having connections to major cities of Constantinople (Istanbul), Damascus, Alexandria, Gaza, Baghdad, Trebizond, and so forth. However, despite these connections and intellectual reputation, there is little known about how the devastating disease reorganized the city and social structures.
THE PLAGUE AND ALEPPO 3 The Effects of Bubonic Plague Outbreaks on the Infrastructural Developments of the City of Aleppo The Black Death, or the bubonic plague, is a common topic of discussion when looking into the development of European infrastructure. Conducting research on this topic in the context of the European city typically yields detailed analyses of the progression of the disease through each city, country, and continent as a whole. However, there is very little condensed research in a single journal or book that details the progression and impact of the disease on the development of Middle Eastern cities. Across history since the infamous 1347 plague outbreak, there are dozens of documented cases of outbreaks in Aleppo alone let alone the Levant and greater Middle East. Even today, Syria is considered today to have an increased threat level of a potential outbreak of the plague. (Foundation for the Support of International Medical Training, 2016) It is unacceptable that there is so little research into the development of the city’s social interactions and infrastructure development concerning the devastation that ensues after an epidemic as deadly as the plague; therefore this topic should be further researched using Aleppo as a case study in order to better our understanding of the typical interactions of ordinary residents and visitors. The Black Death The Black Death was a term coined in medieval Europe during the largest plague outbreak in recorded human history. Although throughout history and legend, “plagues” have troubled civilization for millennia; the plague refers to a specific strain of bacteria that has been a recurring epidemic worldwide. Yersinia Pestis Although the bubonic plague is the most familiarly known, there are three variations of the plague: bubonic, septicemic, and pneumonic. The plague itself is caused by an infection of Yersinia pestis bacteria. All three forms of the plague are considered to be a zoonosis that is transferred to humans via ectoparasite bites, typically flea bites. (Foundation for the Support of International Medical Training, 2016) It is commonly thought that small rodents transmit the disease, as was the case in medieval Europe; however, the rodents carry the disease throughout an area with their fleas spreading the disease through the rodent population. Only once the rodent has perished will the flea search for a new host and therefore transmit the bacteria to humans. (Hawley, 2013) There are several other methods of contamination that include consumption of infected animals and inhaling aerosol droplets from an infected person’s lungs. The bubonic plague is the most common of the three versions. The bubonic plague is always the starting point of the plague and can evolve into the other two versions if left
THE PLAGUE AND ALEPPO 4 untreated. The incubation period for the disease is typically two to eight days following infection before symptoms begin to show. Plague symptoms include a sudden onset of fever, chills, weakness, and headache. The bubonic plague specifically targets the lymph nodes therefore causing them to swell. The swollen nodes, or buboes, are typically found in the groin, armpit, or neck areas and are the most obvious indication of a plague victim. The other two versions, septicemic and pneumonic, are significantly less common. Septicemic plague occurs when the bacteria primarily resides in the blood stream. The bacteria multiplies so rapidly that the victim succumbs before developing buboes. Pneumonic plague is often a secondary occurrence to the bubonic plague but can exist on its own. In this version, the bacteria either infects the lungs via the bloodstream or by directly inhaling aerosol droplets from another infected person’s coughing. These two version are nearly always fatal if antibiotic treatment is delayed. (Hawley, 2013) In Europe Preceded by the Great Famine, the second largest plague outbreak in recorded history and by far the most widely known began in China in 1334 and lasted almost three centuries. The disease spread to Sicily in 1347 through aquatic trade routes and more specifically, the rats on the ships that carried the disease. Based on journals from a Franciscan friar named Michele da Piazza who was an eyewitness, it is clear how unprepared the Sicilians were when the disease arrived at their docks. (Tramontana, 1963) Many of those providing medical care were so unfamiliar with the disease that it led to more casualties. The disease was often misidentified as smallpox or even treated as a disease of the soul. (Lundquist & Vollmer, 2015) Common ways of treating the plague at this time included washing with vinegar and water, bleeding and lancing the buboes, sanitation increases, eggshell and marigold medicines, and witchcraft. (Trueman, 2015) This pandemic is responsible for approximately 25 million deaths due to the disease itself or lack of knowledge on how to treat it. (Kishlansky & Stater, 2003) After the main outbreak began to wane, the plague became romanticized during the Renaissance as an indication of Biblical events. As stated in Revelation 6:2-8, the Biblical Four Horsemen of the Apocalypse include war, famine, pestilence, and death. After the war and disease had ravaged Europe continuously for almost three hundred years, the Four Horsemen gained popularity as harbingers of the End of Days. Many artists took the inspiration from the horrors they were witnessing and turned them into awesomely terrifying paintings. (Appendix A) Traditionally, pestilence, or plague, and death ride together as the combination causes the most widespread and damaging apocalyptic events. In the years following, the entire socioeconomic structure of traditional municipalities was upended. The survivors of the plague had to cope with the intense loss of family, friends, livelihoods, and faith in their religions. (Kishlansky & Stater, 2003) The lack of labor allowed
THE PLAGUE AND ALEPPO 5 for intense economic growth and the ability to overthrow feudalism. Several peasant revolts broke out across Western Europe, the Great Schism definitively separated Europe, and the migration of destroyed communities rocketed Europe as a whole into a new era. Although Europe had mostly recovered from the pandemic, the other parts of the world that had suffered at the same time continued to experience extreme disorganization and a steep decline in economic growth. Many of the Middle Eastern empires collapsed and didn’t see improvement until they were absorbed into the Ottoman Empire in the 16th century. (The Editors of Encyclopaedia Britannica, 2016) Europe may have spent the second half of the 14th century rebuilding, but the rest of the world spent the next two centuries trying to survive past the next outbreak. The Plague Today The annihilation of the population of Europe in 1347 is by far the most colloquially known instance of the plague. However, there have been consistent local outbreaks across the globe potentially as early as 1000 B.C.E. (Kahn, 2003) Typically outbreaks in modern times are found in rural areas of second and third world countries. (Appendix B) The most recent outbreak occurred in Madagascar in 2017. Madagascar and other African countries are used to seeing periodic small outbreaks of the bubonic plague, but this case was different. It was centralized in an urban setting and the country’s infrastructure and response teams were not prepared for the disease to spread as quickly as it did. (Bichell, 2017) The plague is still a very real threat in some areas of the world. According to the World Health Organization, there are approximately one to two thousand cases reported every year. Cases within the United States are typically localized in in states in the Western region. (Appendix C) The average number of cases annually within the United States is one to seventeen. (Centers for Disease Control and Prevention, 2018) Untreated plague has a mortality rate of 30-100%. This rate can be significantly decreased to approximately 15% with early intervention and antibiotic treatment. Typical antibiotics used are streptomycin or tetracycline. (World Health Organization, 2018) There is no cure for the plague. Quarantine of victims, rodent control, and insecticides are methods that can reduce the risk of contracting the plague. In 1967, the World Health Organization implemented an intense global eradication program that stopped the consecutive outbreaks across the globe. There has been a significant decrease in outbreaks within urban settings, but periodic small outbreaks will continue to occur on a rural level until a definitive cure can be found. Aleppo The city of Aleppo predates Islam by several hundred years and is thought to be one of the oldest continuously inhabited cities. As seen through the readings conducted throughout the
THE PLAGUE AND ALEPPO 6 semester, the Islamic city is based around the various social centers. In Aleppo, those centers include the citadel, the Great Mosque, the baths, and the various bazaars. In the 18th Century By the start of the 18th century, Aleppo was the third largest city in the Ottoman Empire following Constantinople and Cairo respectively. (The Editors of Encyclopaedia Britannica, 2016) The city was enjoying an unprecedented surge in wealth due to the silk trade with Persia as well as the European Christian population that had moved to the city for economic opportunities. The city had already expanded to absorb the citadel into the fabric in the previous century. By the mid-18th century, the city had outgrown the original walls and new forms of safety had to be implemented. The mid to late 18th century saw a decline in prosperity due to the collapse of the Safavid dynasty and therefore a fall in the production of Persian silk. There was also a decrease in land-based trade therefore putting a greater emphasis on Ottoman port cities rather than those further inland. (The Editors of Encyclopaedia Britannica, 2016) Many of the European merchants left Aleppo for the port cities thereby furthering the economic decline. This all may have been a result of an outbreak of the plague in the mid-18th century, but mots texts focus on the economics and the Europeans. Since the city had been largely spared by the Crusades, its fundamental Islamic fabric was preserved. The citadel had kept its artifacts dating back to 10,000 B.C.E. safe and preserved the culture that had been growing for millenium. The city itself was originally only located on the west bank of the Queiq River and expanded from there. As a result, much of the city is preserved throughout its history despite the frequent changing of caliphates. Some features are missing, such as the original nine gates of the Mamluk city, but many were adapted to the needs of the people at the given point in history. (Russell & Russell, 1794) However, as a result of the intense stress the city was under for the majority of the century, the culture and architecture was not further developed and therefore little is known about it. Urban Infrastructure The foundations of the city’s planning was constructed during the Roman Empire as is shown through the Greco-Roman city grid, with main streets leading to forums. Originally, Aleppo may have had a cardo maximus and a decumanus maximus; however, over the centuries following the fall of the Empire, the city took on a more natural growth. There is still evidence of the gridiron scheme in some areas of the city but the majority is comprised of narrow, winding footpaths built for carts and horses at the most. At the dawn of the 18th century, the city’s streets were evidence of Aleppo’s testament to being a medieval city. Aleppo has a strong sense of natural zoning that was completely unplanned. The separation of the khans, the mosques and synagogues, residential neighborhoods, and other
THE PLAGUE AND ALEPPO 7 public works allowed for a natural status of peace to penetrate the city. The neighborhoods of the city worked within themselves to promote safe and clean places to live. Research Although there has been significant research on how the plague affected the Middle East throughout different periods in history, there does not seem to be much research into the effects of the epidemic on the infrastructure of the city. The Second Plague Pandemic killed 40-60% of the population of Europe, the Middle East, Asia, and Northern Africa. Arrival of the Plague Most records of the spread of the plague through Asia into Europe show that the disease was spread both by land and sea trade routes. The first major outbreak in the Middle East occurred in Mecca in 1349, more than a full year after the outbreak in Sicily. Most likely, the plague came to Mecca via Chinese trade routes that made stops in India. There are documented cases of plague victims in Alexandria and Constantinople late in 1347; it’s thought that the outbreaks in these cities came via sea trade routes in the Mediterranean. Stranger still, the plague did not reach Damascus until summer of 1348 via Alexandria and Gaza. (Snell, 2017) As shown in Appendix D, the disease most likely reached Aleppo in late 1348 via trade routes with Damascus. However, as previously mentioned, the outbreaks did not stop when the epidemic did. Between 1343 and 1466, Constantinople had eleven major outbreaks and continued to have outbreaks for some time after. (Kahn, 2003) Proposal The overall city layout of the city has not changed significantly over the course of its history and it can be therefore assumed that most historic accounts on the layout of the city are accurate regardless of the period. According to the medical journals of Alexander and Patrick Russell, the two Scottish physicians were researching the history of Aleppo immediately before the 1760s plague outbreak. The two brothers were confined to the city to prevent a further epidemic and therefore began making housecalls to treat the infected. The Russells kept detailed documentation of each victim they treated in the appendices of the books they wrote while in the city. Additionally, Alexander and Patrick kept detailed notes on the inhabitants of the city in their two volume series on the natural history of Aleppo. The first volume is entirely dedicated to the rituals, diets, entertainments, religious sects, harems, and so forth of the various cultures within the city. The second volume delves into the inhabitants that are not Islamic and how they contributed to the fields of literature, medicine, and science. As a result, the information is available and ready in its simplest format to be dissected and investigated. There is evidence that there is a need for research to be conducted as well as a
THE PLAGUE AND ALEPPO 8 mapping of the spread of the outbreak through the city. By looking at the specific breakout in mid-18th century Aleppo, significant insight may be gained in terms of defining the patterns and rates of human interaction in the Islamic city on a daily basis. Methodology Initially, the greatest hurdle will be finding the sociological information on the structure of the neighborhoods in a historical context. Cities like Aleppo are always changing in terms of their demographic and unspoken boundaries. Maps of the current neighborhoods exist but the likelihood of the boundaries being concrete, as it is with cities such as New York, is small to none. The need for research into this would be primary since it will be the foundation of the mapping of the outbreaks as well as the best way to infer where the primary means of social contact will occur. The next step would be to create a comprehensive map of the city detailing where the social centers and neighborhoods existed. The map should be an overlay on the current street maps (see Appendix E) of the city to create a structure for the ensuing research. The first task would be to detail the public areas within and without the city infrastructure. Things to specifically note would be: mosques, other places of worship, bazaars or souks, madrasas, khans, fountains and wells, gates, cardo maximus and decumanus maximus, public baths, etc. Neighborhood boundaries should be the second thing denoted on the map while allowing for the blurring of boundaries in the case of inaccurate labellings. The neighborhoods can be determined by primary documents, certain public services offered in that area, or as a last resort, current demographic data. After the map of the city has been compiled, the next step would be to compile a database based off the accounts of the Russell brothers’ medical findings. The main things to note are within the accounts are: the family structures, the nationality or ethnicity of the victim, and the faith followed. Then an attempt would be made to identify a general area in the neighborhood where the victims might have lived. For example, a large family that lives in one of the inner compounds within a city block has a different interaction style than a young man residing in a khan on the outskirts of a neighborhood. The next step would be to investigate how the daily lives of the residents of Aleppo typically ran. Most people tend to stick to a routine unless otherwise disrupted. This would give an indication as to where and when the majority of interactions between potentially infected people and the healthy would be. For example, there is a call to pray at the mosque at noon on Fridays which would lead to a massive interaction on a weekly basis. However, the Sabbath for Jews is on Saturday and Christians attend church on Sunday. This would demonstrate the localized interactions based on the faith’s required attendance. As a result, the likelihood of
THE PLAGUE AND ALEPPO 9 having a massive outbreak in the Jewish quarter on a Monday (allotting for the minimum two day incubation period) would be significantly greater than one on a Thursday. A further investigation into the dynamics of the city through cross-referencing other texts would be needed. The complete dialogue of the social interactions within the city in the late 18th century should be chronicled. This will allot for any discrepancies that may be found within the Russells’ firsthand accounts that can be biased. The best way to conduct this cross-referencing would be to work with a series of other historians with knowledge on the topics and are able to access the texts that are written in languages other than English. Conclusions The plague is still an active disease and a real threat to underdeveloped communities in rural Africa, Asia, and the Middle East. The ideal of eradicating the disease is still a distant dream for the World Health Organization and other health organizations. However, over the past seven hundred years the world has learned much about how to control the disease as well as how to treat it in both rural and urban settings. As a result, the fabric of the world after the Second Plague Pandemic was fundamentally altered and shoved into a new age of advancement. Much is known about the development and reactions after the epidemic was controlled; however, little has been compiled about the impacts within the Middle East. There are primary resources out there that detail the exact happening of outbreaks in cities such as Aleppo but not much has been done outside of a medical context. By mapping the plague cases in an outbreak across a city with focus on cultural neighborhoods and social centers, one might be able to define the daily interactions of the ordinary citizens within the city. There is much research left to be done on this topic as well as many unanswered questions. The amount of potential information and history that can be learned from further investigation of the impact of epidemics like the plague on the infrastructure and social culture of the Middle Eastern cities is astronomical and necessary
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Appendix A
Figure A. Woodcraft Painting of the Four Horsemen of the Apocalypse. From Dürer (1498).
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Appendix B
Figure B. Reported Plague Cases Globally 2010-2015. From Centers for Disease Control and Prevention (2018).
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Appendix C
Figure C. Reported Plague Cases in U.S. Over the Past Fifty Years. From Centers for Disease Control and Prevention (2018).
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Appendix D
Figure D. Infographic Map Detailing the Spread of the Second Plague Pandemic in 1348 in Europe, the Middle East, and Northern Africa. From Snell (2017).
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Appendix E
Figure E. Screenshot of Street Map of the City of Aleppo. From Google Maps (2018).
