Category Archives: microbiology

The Black Death in the Ottoman Empire and Ragusan Republic


Nükhet Varlık. Plague and Empire in the Early Modern Mediterranean World: The Ottoman Experience 1347-1600. Cambridge University Press, 2015.

Zlata Blažina Tomic and Vesna Blažina  Expelling the Plague: The Health Office and the Implementation of Quarantine in Dubrovnik, 1377-1533. McGill-Queens University Press, 2015.  [Dubrovnik = Ragusa]. [An English edition of  Blažina-Tomić, Zlata. Kacamorti i kuga. Utemeljenje i razvoj zdravstvene službe u Dubrovniku. [The Cazamorti and the Plague: Founding and Development of the Health Office in Dubrovnik] Zagreb: HAZU, 2007.]

Comparing the Ragusan Republic to the Ottoman Empire is a little like comparing an ant to an anteater, but nevertheless they managed to coexist as neighbors throughout the plague years. They were both carved out of the relic of the Byzantine empire. If you have never heard of the Ragusan Republic, that is probably because the city of Ragusa is now called Dubrovnik and the republic was limited to that small coastal area of modern Croatia. It was one of the smallest city states of the Mediterranean world. On the other hand, by 1600 the Ottoman Empire included almost all of what had been the Eastern Roman Empire or Byzantine Empire.

It seems natural to assume that the larger, more powerful nation should be able to do everything better, but when it comes to public health the opposite is often true. Quarantines are much easier to develop and maintain in a smaller state with limited points of access like Ragusa. The fact that smaller wealthy states often have better health care does not prevent contemporaries from still expecting the larger state to do better. Expectations are rarely realistic. The Ottoman empire was not well understood by contemporary Europeans and the growth of the empire over the 14th and 15th centuries terrified them. The second plague pandemic hit the Ottoman empire at least as hard as elsewhere and yet, it continued to grow. This alone gives the Ottoman experience a unique position in plague history.

Each book naturally is focused on their unique contributions to plague studies. Varlık reconstructs the movements of the plague on a grand scale as it ebbed, flowed, and pulsed through the Ottoman empire by 1600 encompassing about a third of the Mediterranean rim. It has become clear that we can not understand the Black Death without the Ottoman experience. Tomic and Blažina provide a microhistory of the public health and medical practices in the single city of Ragusa (Dubrovnik). They remind us that even in a city that was extremely diligent with their quarantine measures, security and economics often trump public health and that medical care was a contracted service to meet the needs of city administrators.

Turning to the Ottoman empire first, Varlık has to begin with some damage control on assumptions about the Ottomans. She made me grateful that I don’t have any assumptions about the Ottomans to be be undone; sometimes its good to be a blank slate. This is an important chapter for historians who deal with opinions of 14th centuries sources and their impact on subsequent historiography.  For most of us, the Ottoman experience during the Black Death as been a black hole in history– until now.

Her chapter on the natural history of the plague in Ottoman lands is a gold mine of information on fleas and hosts. It is clear that there were plenty of black rats in Constantinople at the onset of the Black Death and Istanbul in subsequent epidemics. Fleas and lice were such a common way of life that people who did not have fleas or lice were considered suspect of either being lepers or having foul body odor! (p. 34) This is the kind of historical evidence we need for most regions of the world with plague histories.

In most of the book, Varlık traces the trajectory of the plague to Constantinople / Istanbul and the rest of the Ottoman empire ultimately through four phases. When the Black Death first arrived, Constantinople was still part of the Byzantine empire and the Ottomans were a small Anatolian group. This was followed by three phases of plague activity from the time the Ottoman’s conquered Constantinople, renaming it Istanbul. In the first phase (1453-1517), the Ottomans were besieged by plague imported from the West in multiple ‘waves’. Remarkably, it did not check population or urban growth. Plague pulsed in and out of the empire’s regional networks during the second phase (1517-1570). By the third phase (1570-1600), Istanbul has transformed to a plague hub reflecting its centralizing role in the empire. She finished the last section of the book with a discussion of new understandings of the plague and social experience of the Ottomans during the plague.

Varlık looks forward to others examining other contemporary major states like the Hapsburg empire for comparative analysis. Personally, I look forward to a comparison between the first pandemic in the Roman/Byzantine Empire and the second pandemic among the Ottoman Empire. It is essentially the same territory, both seated from Constantinople / Istanbul. Did Roman Constantinople have the same ‘capital effect’ that Varlık outlines in this book?  An obvious difference being that the Ottomans waxed during the second pandemic, while Byzantium waned from the first pandemic onward. What role, if any, did the plague have in their polical trajectories? The rise of the Ottomans straight through the second pandemic should make people pause in their eagerness to claim the first pandemic doomed the Roman empire.  Or did their political trajectories explain how plague was transmitted within or through the respective empires? I suspect the later is the right question. I rather suspect, as Varlık shows here, that the plague is reflecting social and political changes rather than causing those changes. And, this does not diminish the importance of the plague in any way.

Pivoting to the Ragusan Republic, the scale has shrunk so much that it seems like a different world (even though the Ottoman’s had hegemony over Ragusa for part of the period covered). The entire Ragusan Republic was perhaps on par with a medium size Ottoman city. Comparing the differences in attitude toward each other between Ragusa and Istanbul in these two books is interesting. The Ragusan Republic had a peculiar organization owing to its foundation by a group of Byzantine businessmen, who created a state to allow their business and lifestyle to continue but with little if any political or religious ambitions.  Due to its small size it had to contract most professionals like physicians, surgeons, and clergy from outside the republic, primarily from Italy. Their position on the frontier between Christendom and Islamic lands gave them unusual religious independence especially considering they had to import their clergy.

Ragusa’s primary claim to plague fame is having established the first quarantine zone to protect the city of Ragusa. Fair enough, though as small as the republic was, the protected zone was limited to the city of Ragusa itself with its peripheral islands used for isolation of the sick and quarantine of the suspected. Their plague program had to be set up and maintained while business continued in the city. Ragusa was too small to stop imports. It couldn’t feed itself, much less keep its economy moving enough to pay for the security it needed, with its port closed. They were in constant fear that the plague would make them vulnerable to conquest by their neighbors.

Tomic and Blažina utilize a unique archive of government actions and contracts for health services to reconstruct the health care program of Ragusa. Their interaction with the physicians they contracted for services was fascinating. First, physicians never were in control or even had a significant influence on the function of the health office. They were contracted like any other professional. During plague outbreaks, they granted leaves of absence to the regular physicians that they valued. They were apparently too important to risk during the plague (p. 173). They then contracted specific plague physicians (medi pestis) who were only allowed to evaluate suspected plague cases and treat those who had plague. I previously wrote about one of their plague doctors here. They were not allowed to do other services and had to live in essentially quarantined due to their contact with possible plague victims. These plague doctors were paid by the state and were required to treat people of all classes the same, so the poor could expect to have the same attention as the wealthy. Ragusa’s health office was an experiment in socialized medicine. Those interested in the evolution of public health should be interested in this book.

Between these two books the eastern Mediterranean can begin to take the pivotal place that its geography suggests it must have in understanding the second plague pandemic. In the 15th and 17th century the Ottoman Empire linked together the three continents all ravaged by the pandemic. In the decades leading up to 1600 when Istanbul became a plague hub, it reflected Istanbul’s essential role in controlling all movement within the empire and thus within this connecting zone between the three continents. Tracking the plague may well inform political and economic history as well as the history of health in this critical region.

Contracting a Plague Doctor, Ragusa 1526

We all have mental images of plague doctors but very rarely do we actually find much information about who they were or what they were contracted to do. Deep in the archives of the medieval city of Ragusa (modern Dubrovnik, Croatia) a rare set of documents gives us a unique glimpse at one of these men.

Painting of Ragusa, 1667. Currently housed in the archives of Dubrovnik (Public domain)
Painting of Ragusa, 1667. Currently housed in the archives of Dubrovnik, Croatia (Public domain)

Ragusa, the capital of the Ragusan Republic, was a little different from most medieval cities. Here doctors were contracted and paid by the state. A plague doctor was expected to treat both patricians and commoners alike. The position of plague doctor (medicus pestis) was a specialty. Plague doctors were not allowed to treat patients with other conditions or illnesses.

On New Year’s Eve 1526 Ivan Mednić (Johannes Mednich de Catharo) of Kotor (87 km south of Ragusa) proposed his services  as a plague doctor (medicus pestis) to the Senate of Ragusa. His goal is clear. He wants to establish his family as citizens of Ragusa, where his father Pavao had been born. His stresses this linkage in his proposal along with his desire to care for the people of his paternal city. He promised to diligently care for people with or suspected of having the plague with treatment including bloodletting and lancing buboes.  Mednić also appended recipes of plague remedies that he suggests they may verify with other physicians.

In return for these services for a year, Mednić made an unusual request: in addition to his treatment supplies, a salary of 200 ducats paid in three equal installments plus 3 ducats per month for life for his five sons. His wife Ruža and daughter are not mentioned in the proposal. The Ragusan Senate accepted the proposal on the same day it was filed with only amendments to the unusual clause on payments to his sons. The lifetime terms for his sons were only to be paid if he stayed more than one year, and then only while the sons remained productive citizens of the city of Ragusa. If he did not meet his obligations or the sons left Ragusa, they would not get paid. If Mednić died during his year of service, including from the plague, the remainder of his salary would not be paid but his sons would continue to receive their 3 ducats per month. Still no mention of payments for the care of his wife and daughter if he died. In their recent book on plague in Ragusa (Dubrovnik), Tomić and Blažina assure us that these are generous terms. It was typical in the neighboring Italian city states for the unpaid portion of a physician’s salary to not be paid if they died while working. The stipend for Mednić’s sons is, in their opinion, unprecedented.

Ivan Mednić is mentioned in the archives as a dedicated physician who came when ever needed to diagnose or treat people suspected of plague. He was also called on to confirm plague as the cause of death and testify in cases of quarantine violations. One of his surviving patients, a poor commoner, was convicted of breaking quarantine for which he was hung while another surviving patient, a patrician, broke similar quarantine rules and got off with an apology to the court. Mednić had to be comfortable with his role in enforcing quarantine laws imposed even on long surviving patients. His thoughts on the matter are unknown. He managed to survive Ragusa’s worst plague epidemic that claimed the lives of approximately 25% of its population. The chronicles all agree that 20,000 commoners perished, plus varying numbers of patricians and other officials depending on the source.

Prior to petitioning to become a plague doctor in Ragusa, Mednić had been trained as a surgeon in Venice and worked for several years as a surgeon in Kotor. After the plague was over, Mednić was hired by the city of Ragusa as a surgeon once again. He would continue to incise abscesses, as he had done with plague buboes, and would also do trepanations, set broken bones and other treatments done by contemporary surgeons. He also vowed to assume the duties of a plague doctor again if the epidemic returned. Thankfully, it did not. With the plague gone, competition for medial services grew and the Senate was able to contract his services for the year of 1658 for 100 ducats and free residence in the city (worth 15 ducats), half his previous fee as a plague doctor. His sons did continue to receive their stipend. He could also supplement his income with additional fees for private patients that could be substantial. On March 12, 1529, Mednić signed a pre-treatment contract to treat one patient’s syphilitic lesions for 8 ducats. Compared to the 15 ducat evaluation of his free residence in the city, it was a very good supplement indeed.  Mednić’s gamble taking the plague doctor’s position seems to have paid off earning the family a comfortable and enduring place in Ragusa.


Zlata Blažina Tomić and Vesna Blažina. Expelling the Plague: The Health Office and the Implementation of Quarantine in Dubrovnik, 1377-1533. McGill-Queen’s University Press, 2015. p. 165, 174-179, 189, 305.

Summer reading


summer 2

The summer is officially over this week so its time for my quarterly reading update. I read a more eclectic mix of topics this summer than usual. These are just those that really stood out as being useful for my purposes. I hope you find something of interest!


  • Gregory Aldrete. Floods of the Tiber in Ancient Rome. 2006.
  • Robert Sallares, Malaria and Rome: A History of Malaria in Ancient Italy, 2002
  • Nukhet Varlik. Plague and Empire in the Early Modern Mediterranean: The Ottoman Experience 1347-1600. Cambridge UP, 2015
MA Thesis

Katharine Dean. Modeling plague transmission in Medieval European cities. (2015, June 1). MA Thesis.  Oslo.


  • Kimura, H., Saitoh, M., Kobayashi, M., Ishii, H., Saraya, T., Kurai, D., et al. (2015). Molecular evolution of haemagglutinin (H) gene in measles virus. Scientific Reports, 1–10. doi:10.1038/srep11648
  • Scheidel, W. (2015). Death and the City: Ancient Rome and Beyond. Available at SSRN 2609651.
  • Smith-Guzmán, N. E. (2015). The skeletal manifestation of malaria: An epidemiological approach using documented skeletal collections. American Journal of Physical Anthropology, n/a–n/a.
  • Sigl, M., Winstrup, M., McConnell, J. R., Welten, K. C., Plunkett, G., Ludlow, F., et al. (2015). Timing and climate forcing of volcanic eruptions for the past 2,500 years. Nature.

  • Kostick, C., & Ludlow, F. (2015). The dating of volcanic events and their impact upon European society, 400-800 CE (Vol. 5, pp. 7–30). Post-Classical Archaeologies.

  • Schats, R. (2015). Malaise and mosquitos: osteoarchaeological evidence for malaria in the medieval Netherlands. Analecta Praehistoricaleidensia, 45, 133–140.
  • Eisen, R. J., Dennis, D. T., & Gage, K. L. (2015). The Role of Early-Phase Transmission in the Spread of Yersinia pestis. Journal of Medical Entomology, tjv128–10.