Epidemics in the Mediterranean: History of a Problem

José Enrique Ruiz-Domènec

Full professor of Medieval History, Autonomous University of Barcelona

When Lord Acton, editor of The Cambridge Modern History, recommended that his colleagues deal with a problem rather than a period, little did he imagine that in 2020 the spread of a pandemic related to Covid-19 would be sage advice for many of us. Since this virus arrived in our lives around January – it had appeared in China in mid-November 2019 –, I have spent time exploring in depth the entangled paths, very often written by witnesses shocked by the loss of lives, of epidemics in history, and I have drawn some conclusions related to the Mediterranean area that I wish to set out in this article.

The text I offer here is a concise overview of the epidemics that spread through the Mediterranean world in the last three thousand years, since the arrival of the peoples of the sea, around 1177 BC. As Professor Eric H. Cline likes to say, I have conducted the study taking the long view of the effect of contagious diseases over the course of the events. The limited interest until recent times in this aspect of material civilisation openly contrasts with the importance attached to it by classical, medieval and modern authors. For the Greek Thucydides, the greatest of them all from the classical era, pestilence is so firmly established in society that, when reading the chapters of his History of the Peloponnesian War on the outbreak of typhoid fever in Athens in 430 BC, one experiences a feeling of powerful recognition of the scope of the contagion, albeit a discouraging feeling because of the persistence of epidemics. Thucydides perfectly describes Athenians’ attitude to the epidemic: he gives us such an accurate image that we must view his narrative as an expression of a society in existential crisis. Moreover, the account of plagues in Exodus is an expression of the death throes of a people as a punishment from God faced with the proud resistance of the pharaoh of Egypt.

The description of the Athens “plague” today we know it was not plague but typhus – is, theoretically, the history of a people submitted to the challenge of a plague that attacks their defences and threatens to put an end to their way of life. When the convictions that had forged the era of Pericles collapse, Thucydides moves to the very core of the epidemics and then understands that it is a test for Athenian society, greater even than the Persians’ attack in Marathon or the fire in the city, earlier than Salamis and Plataea. But history becomes entangled: the conflict with Esparta, known as the Peloponnesian War, transforms Greek civilisation into a paradoxical state of permanent crisis, mainly because it is a war designed by Athens to export freedom to peoples, which, to achieve it, needs to subject them all. Life was invaded by an unbearable lightness. Family values, the backbone of Greek society, collapse at a time that needs answers. In this respect, as Arnold Toynbee pointed out, in history every challenge requires a response.

In the Roman Empire, epidemics were common and there were many, some of them serious, that marked the future of Roman society

After the 430 BC plague and the subsequent war, the response has a name: Hellenism (coined by Droysen in the 19th century), and there was much resistance to it, especially in Athens, with Demosthenes, or in Thebes, with General Epaminondas. But, in the end, the law of history is implemented and the response to the challenge shapes a new era.

The Roman Empire

Over the years, the miseries caused by the epidemic were forgotten, but not Thucydides’ text. In the Roman Empire, epidemics were common and there were many, some of them serious, that marked the future of Roman society, even at a very late age, as in the times of Marcus Aurelius. Thus, for example, the so-called “Antonine plague” emerged, which in reality was a hemorrhagic smallpox that, according to the historian Ammianus Marcellinus in History, “loaded with the force of incurable disease […] the whole world from the borders of Persia to the Rhine and Gaul with contagion and death.” Life itself had become impossible. The renowned physician Galen, a firsthand witness of the epidemic, described the symptoms: black exanthems that after two days dry and fall off, ulcerating pustules all over the body, diarrhoea, fever and a feeling of hotness in those affected; in some cases bloody faecal matter, damaged voice and bloody cough due to the sores that appear on the face and adjacent areas. Between the ninth and twelfth day of the appearance of exanthems, the disease becomes more virulent and it is then when the mortality rate is at its highest.

Emperor Marcus Aurelius himself was infected with smallpox while on the battlefields in his long confrontation with the Marcomanni tribes of the Danube and died in 180.

Epidemic vs. Pandemic

The last one thousand five hundred years, in contrast to what happened in previous periods, have been aware of the need to distinguish between an outbreak of the many that have been, are and will be, from a widespread epidemic, which is usually called a pandemic. It is a matter of scale; an issue of which the unquestionable master was the historian Procopius, born in Caesarea in Palestine in the early 6th century. His work submerges us into the mind of a character with his or her private affairs revealed (consider the efficient portrait of Empress Theodora) and in the movement of the troops of General Belisarius in North Africa or Italy. Of course, his Secret History is a post-catastrophe work but the catastrophe he speaks of is not the decline and fall of the Roman Empire, as Edward Gibbon noted in the 18th century, but the great epidemic of bubonic plague that hung over Constantinople and other Byzantine cities in the year 542.

In the initial pages of the Secret History we see Procopius’ first observations: “About this time Belisarius suffered another misfortune. The people of Byzantium were ravaged by the pestilence of which I have already spoken. The Emperor Justinian was attacked by it so severely that it was reported that he had died.” While Procopius reviews the events and prepares himself to provide a description in the manner of Thucydides, his mentor at that time, he sees himself driven to look much further, to link the plague with the climate change that he notices in the Mediterranean, with the advance of the desert almost to the beaches of North Africa. Procopius is amazed by this coincidence, and writes sentences that show the path to understand the effect of an epidemic of global reach in the world order. Then come the current historians, with William Rosen first, who identify the flea of the black rat as the vector of the plague as it carried a bacterium that at the time was completely unknown, the yersinia pestis, which was discovered by the distinguished doctor Alexander Yersin. And thus we reach an interesting conclusion.

Signoria of Florence.

While Procopius reviews the events and prepares himself to provide a description in the manner of Thucydides, his mentor at that time, he sees himself driven to look much further, to link the plague with the climate change that he notices in the Mediterranean

It turned out that Procopius was right. Now that epidemiology studies have entered the study of history, we know that an epidemic bears the macula of social tragedy. Because, of course, the contagion spread unstoppably, without barriers to halt it and, naturally, what the pandemic does is to suddenly transform world geopolitics. In the case of Byzantium, it meant the emergence of Islam in the Mediterranean basin, which gradually took hold of the important towns in Asia Minor and North Africa. Moreover, in this expansion it left the door open for Longobards, or Lombards, to settle in the Po Valley (giving the current Lombardy region its name), and for the Franks to begin their expansive adventure towards Italy and Spain, which finally led to the germination of the Carolingian Empire. Some years ago, Henry Pirenne stated that without Mohammed Charlemagne was inconceivable; today we can argue that without the bubonic plague in the 6th century the formation of the Carolingian Empire is unthinkable.

The challenge-response thesis is structured upon a recognisable idea that we owe to Arnold Toynbee; and it is not a trite topic: in this case, it consists of introducing in the narration of a period of history a problem that determines the course of events: the problem, in this specific case, of a large-scale epidemic of bubonic plague in the 6th century. It is recognised that, in that exact moment, the Mare Nostrum ceased to be a value and gave way to a sea divided into several civilisations, fragmented in their turn into complex religious systems. By expressing the significance of an event of nature, Procopius and those who followed him sought to neutralise its effects. It is a way of doing history that wants us to know that it knows that we know that it knows. What I have just said is not gibberish: it is the actual proof that, from Evagrius Scholasticus in the 6th century to Albert Camus in the 20th century, the plague is “the concern of all of us.”

The Black Death

But the history of the great epidemics in the Mediterranean does not end here. In the mid16th century the bubonic plague appeared again, this time called the “Black Death”, with a dramatic overtone in the definition and the mode of spread. It is a catastrophe however you look at it. Because of the high death toll, the cultural resonance it had (Giovanni Boccaccio’s Decameron is just one of the most famous examples), the social effect acquired by challenging the world of open horizons, especially the routes of caravans that went through Central Asia and that had turned this region of the world into a microbial common market, as Emmanuel Le Roy Ladurie noted; and, lastly but not least importantly, because of the change in the pictorial space detected in Pisa, Florence and Siena, to which the historian Millard Meiss devoted one of the most famous books in art history: Painting in Florence and Siena after the Black Death.

This ambience in the 14th century Mediterranean paves the way, in response, for a serious decision to change the world order; it is the threshold of what, in the 19th century, Jacob Burckhardt called the civilisation of the Renaissance

Giovanni Villani, who left his chronicle uncompleted after dying during the first moments of the plague, describes what he fears could be understood as a commonplace: in this case, the nostalgic account of the retrospection of an urban society that had become the appendix of the market. He acknowledges the lack of rigour in confronting a disordered growth of mercantilism and urban life. It is Boccaccio who openly expresses the central metaphor of the problem of an epidemic: the plague is a lesson in the arrogance of men. We all know it, he does not need to say anything in this respect; just to describe in one hundred stories (ten each day) the sociography of a world that is vanishing as a result of the plague. Here emerges the analogy between the old urban customs and the spread of the plague. And if we want other examples, he only has to point out the highly emotional reactions to erase any indulgence of the society that had believed it had conquered the world. Through Boccaccio’s mediation it is possible to follow the fears and desires for change.

The stories ironically describe the nostalgic pleasure of returning to a time when you could see the processions of flagellants who, with the rope around their necks, wandered the roads of Italy and other countries seeking divine mercy. This culminates in a reverie in the dances of death and the emergence of a culture of the macabre. It is a fluid yet effervescent movement, as Emil Durkheim would say, full of bleeding epiphanies and deliriums, with expressions charged with popular emotion, without any friction with the ideals of the new life that had so interested Dante.

This ambience in the 14th century Mediterranean paves the way, in response, for a serious decision to change the world order; it is the threshold of what, in the 19th century, Jacob Burckhardt called the civilisation of the Renaissance. Today it can be said unequivocally that the Renaissance would not have been possible had it not been preceded by the Black Death. It was the challenge of the epidemic that motivated such a creative response.

17th Century

In 1630 the bubonic plague arrived in the Mediterranean again. Two years earlier it had been detected in the city of Lyon with terrible consequences, according to Monique Lucenet, its best scholar. It is the fear begun in the 14th century that returns both unexpectedly and tragically.

The plague, along with typhus, smallpox and other contagious diseases, is linked to the appearance of the Little Ice Age, the climate change that turned many Mediterranean fields into desert. People had nothing to eat and took up banditry, which became endemic in that century. In The Betrothed, by Giuseppe Manzoni, the couple, fleeing the evil Duke Don Alvaro, meet up in the Lazaretto in Milan, where those infected with the plague arrived.

It was a truly horrible experience that left close to a million dead in its wake. One of the main cities that still gave life to the Mediterranean world was reduced to a provincial town. But the tragedy had only just begun. Thus, in the 1650s, the plague spread throughout the Mediterranean to bring desolation to towns and villages. When it reached Naples, the authentic Mediterranean metropolis in the 17th century, with its four and five-storey houses (the skyscrapers of the time) and its half a million inhabitants, the plague became especially destructive. In addition to killing half the population, it left indelible traces in the urban imaginary, as can be seen in the painting The Market at Naples, by Domenico Gargiulo, also known as Micco Spadaro. This painting tells us how the period saw the epidemic.

What the war, or the climate, or the change in trade networks had not done, the epidemic did: it created a mezzogiorno from which one must escape as quickly as possible

Basically it is the expression of the horror, which moved the following year, with the same levels among the population, and later to the northern cities such as Venice, Verona, Padua and Genoa. What the war, or the climate, or the change in trade networks had not done, the epidemic did: it created a mezzogiorno from which one must escape as quickly as possible. It was a rupture between the south and the north although, to certify this, Protestant Europe had to feel the effect of the epidemic; thus, it reached Amsterdam in 1664 and London in 1665-66, with an outstanding witness: Daniel Defoe, author of the memorable Journal of the Plague Year.

The response to this epidemic was the Enlightenment, the Age of Reason, which established the Mediterranean as a space of nostalgia where young English people went on the Grand Tour to reaffirm the progressive sense of history. It was the geography of a slow decline that collided in form and grandeur with the fall and decline of the Roman Empire, a pan-Mediterranean empire, needless to say.

From Naples, Giambattista Vico denies this idea of the progress of history, and insists on his thesis of the corsi and ricorsi, where he questions the idea that the progress of the Enlightenment will lead to the suppression of the great epidemics.

Epidemics in the Modern Age

There were many warnings that it was not the end of the epidemics, above all in the 19th century, with cholera the most widely reported causing a state of generalised anxiety, as noted by the historian Olaf Briese. However, they were never great epidemics, although their death toll was immense, as happened with the Russian flu of 1889, which caused almost a million deaths. They lacked global reach to be considered pandemics.

However, the tower of Western Atlantic European pride overcame reason, leading the world to a Great War (known as World War I) after the assassination of Archduke Franz Ferdinand of Austria in Sarajevo, and before what can be considered the last great epidemic to date took place (I do not put the current Covid-19 on this list because it has not yet travelled its entire journey): the inaccurately named Spanish flu in 1918-1920.

It was a flu caused by the mutation of the A H1N1 virus, extraordinarily deadly. By the end of the cycle, fifty million people had died. Spain was the most affected Mediterranean country, with nearly three hundred thousand dead and eight million infected. This flu proves that the thesis of sustained development, of evolutionary growth, is false: the image of a developed civilisation is simply an excess of the supremacist ego, which soon overflows to become racism and xenophobia. For a time, after the flu epidemic, society manages to feel a desire for improvement, but then submerged anger emerges, as it always does, and the Mediterranean slips towards fascism, in Italy, and its imitators in Spain and other places: in any case, why was colonialism hardening?

From spring 2020 it can be said that coronavirus was “the concern of all of us”, like a blanket of silence covering all the cities of the Mediterranean, denying their eternal image of people in the streets and squares

Once the possibility of cultural authenticity of movements such as Futurism was diluted in D’Annunzio’s project in Fiume, a possible substitute is introduced: world events. Are these the answer to the challenge of the epidemic? During the local and world wars in the 1930s and 1940s, the entire Mediterranean world had the same attitude. The health crisis never really ended. The Germans attacked Greece as part of the plan to destroy the international order in the Mediterranean and replace it with the dominance of the Wehrmacht force, a movement that ended the lives of many Sephardic communities that had made their home in the Great Sea. The war also never really ended. There were another 70 years ahead to determine if, indeed, world events would mark the direction of history awaiting another great epidemic: decolonisation, Arab socialism, the Israeli-Arab wars, the Suez crisis, the independence of Algeria and much more until reaching the spring of 2020 with the spread of Covid-19.

The Current Crisis

From spring 2020 it can be said, paraphrasing Albert Camus in The Plague, that coronavirus was “the concern of all of us”, like a blanket of silence covering all the cities of the Mediterranean, denying their eternal image of people in the streets and squares. The boredom of the lockdown appears transplanted in the form of apathy towards public leaders. The decisions taken seriously forget what happened in other great epidemics, the plague of the 17th century more than any other, because it was this that fractured society, the one that created a mezzogiorno, a comfort zone for tourists and a burden for locals. And in the midst of this feeling, once again, world events, like the war in Syria or the migrants crossing the Mediterranean in fragile boats, are conditioned by a world that has decided to stop. And until the new time arrives, it keeps waiting, always waiting.