Egypt should hold a special place in historical plague research. Plague returned to Egypt on a regular basis for at least 1300 years. The first plague pandemic was first reported in Egypt in c. 541 and consistently reappeared through the 19th century. Alan Mikhail’s study (1) on 18th century Ottoman Egypt brings up a number of questions on the nature of plague persistence and transmission. Mikhail argues that plague was a regular feature in an environmental pattern of flood, plague, famine and drought in late medieval through early modern Egypt.
We have a habit of studying the past in blocks of time that correspond to political history. Mikhail argues that there was no change in the frequency of plague over the entire time frame from the medieval period (Mamluk period) through Ottoman Egypt. The coming of the Ottomans in 1517 made no change that he could detect in plague frequency. By his count, plague was reported in 193 out of 547 years from 1347 to 1894. This comes out to an outbreak on average every nine years (1); it visited every generation several times. At this frequency, they feared the plague but no longer fled before it.
Geographic Context
Mikhail rests much of his argument on historic claims that there was no endemic foci of plague in Egypt. I would like to see more scientific documentation for that claim. His footnotes are to secondary history sources. Today, Egypt does lack an endemic foci; there have been no cases of plague in Egypt since 1947 (2). Yet, this is not proof that there wasn’t one in the past. His argument is based on the claim that plague was always imported into Egypt at its ports on the Mediterranean or through Sudan. From Antiquity through early modern times, Egypt was a global transportation hub no matter who was politically in control.
“What mattered most was that plague functioned as though it were endemic. Although it was not epidemiologically endemic, plague was historically endemic in Egypt because of the consistency of its incidence and, more important, because it functioned as a regular force in the Egyptian environment, similar to famine, flood, and drought.” (Mikhail, 2008, p. 258-259)
Epidemiologically endemic vs historically endemic? To be epidemiologically endemic, ie. really endemic, there must be a reservoir of disease in the environment that produces a relatively constant level of disease. Assuming for the moment that Mikhail is correct that plague outbreaks always came from imported disease, then it is analogous to yellow fever epidemics in the 18th-19th century America. Large deadly epidemics were triggered by imported disease that transmitted well, but the environment was not capable of supporting an endemic state. Eight epidemics in the United States between 1793 and 1905 is nearly as often as plague was visiting Egypt by Mikhail’s estimate but I don’t feel comfortable calling it historically endemic.
Mikhail goes on to discuss how late medieval and early modern observers considered the plague to be endemic to Egypt, favoring miasmatic theories that focused vapors released from the soil. Clearly from his discussion no one in Egypt, visitor or native, considered the plague to be always imported. This sharply contrasts with European accounts during the second and third plague pandemic when people readily identified ships as the source of contagion. Likewise, ships were well known to be the source of Yellow Fever.
Plague of 1791
Mikhail uses the Cairo plague of 1791 and its context as a case study for how the plague fit into a cycle of environmental disasters. He tracks the origins of this cycle to a flash flood that followed a heavy rain on 14 October 1790. Many of the people were gone on annual pilgrimage to Mecca and Madina, returning home to whole destroyed neighborhoods, grain storage facilities and damaged the fields. Mikhail predicts that the damage was great enough to trigger a famine (though this is apparently not recorded). At the same time, rats were migrating into the city from the damaged countryside to feed on the wet grain supplies and corpses exposed in the cemetery by the flood.
Descriptions of the 1791 plague are somewhat confusing, Mikhail asserts that it was an outbreak of bubonic plague rather than pneumonic or septicemic plague largely because of the hit – and – miss nature of plague fatalities. His primary source indicates that although the sick were cared for in their homes, emirs died at a much higher rate than their wives. I have to wonder though if their deaths were just recorded at higher rates because of their political and economic importance and the seclusion of many Egyptian women.
American John Antes visiting Cairo in the last 18th century described the plague there this way:
“It [plague] perhaps takes one or two only out of twelve, fifteen or more, and those sometimes die in the arms of others, who with all the rest, escape unhurt. There are instances of two people sleeping in one bed, one of whom shall be carried off by it, and the other remain unaffected. … there are buboes in the arm-pits, or the soft part of the belly, with a few purple spots, or carbuncles, on the legs. When the bubos break, and discharge a great deal of matter, such patients may chance to recover…The sick commonly complain of intolerable heat, and say they feel as if thrown into a fire.” (Mikhail, 2008, p. 265-266).
Buboes primarily in the axilla, as Antes suggests, may indicate that most of the flea bites are coming from reaching into grain stores.
The plague of 1791 was just one part of a cycle of environmental disasters in 1790-1791. Although this cycle began with flooding, the normal spring flood of the Nile was low and in Egypt, this predicts drought and famine. Subsequent price inflation exacerbated the famine. In the spring of 1792 peasants tried to farm only to turn up “only worms and rats” who competed with them for what was left of the surviving crops and fruit. This large rat population would have also been moving into Cairo searching for grain stores. The final famine brought predictable price inflation and political unrest as the Ottomans tried to reserve food for themselves and didn’t see to the needs of the Egyptians.
Season of Plague in Egypt
Where the plague begins, northern or southern Egypt, seems to have effected the timing of the plague. People feared plague that arrived from the south more than those that began in the Mediterranean ports. Mikhail reports that plague in Upper Egypt (the south) ran from March to May, in mid-Egypt from April to June, and in the delta and Mediterranean ports from May to October. The flea’s intolerance to the climbing dry summer heat that travels from south to north over the late spring and summer accounts for this rolling plague season. So if a plague begins in the south and travels north ahead of rising summer temperatures, the death toll of the plague throughout Egypt will be much greater. If it starts at a Mediterranean port and travels south, then we have two waves heading toward each other and the summer heat ends the plague. Egyptians believed that risk of plague was over for the year by mid-June. In 1791 the plague arrived in late winter, peaked in early spring, and dwindled by summer.
A fair amount has been written lately comparing epidemiology of the Black Death with the third pandemic and other modern outbreaks. The shifting Egyptian plague season a good reminder of how important local climate is to insect transmitted disease.
In conclusion, although I don’t think this paper settles the question of whether plague was endemic to late medieval — early modern Egypt or not, he does argue persuasively that plague was a regular enough feature of the Egyptian environment that it should be considered as part of a cycle of environmental disaster that regularly visited Egypt. Mikhail also reminds us of Egypt’s importance in the study of plague up to early modern times.
References
- Alan Mikhail, . (2008). The Nature of Plague in Late Eighteenth-Century Egypt Bulletin of the History of Medicine, 82 (2), 249-275 DOI: 10.1353/bhm.0.0031
- Tarantola A, Mollet T, Gueguen J, Barboza P, & Bertherat E (2009). Plague outbreak in the Libyan Arab Jamahiriya. Euro surveillance : bulletin europeen sur les maladies transmissibles = European communicable disease bulletin, 14 (26) PMID: 19573511
Contagions 
I hardly think this could be bubonic plague that haunted Egypt 1790-91, because if so the large rat population that moved into Cairo in 1792 would have been dead already before people would get infected. Also John Antes suggest that the disease in question was not that contagious when he says that only two out of 10-15 would die from it. I would definetly seek another explanation here.
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