Patrick Russell, A Treatise of the Plague: Containing an Historical Journal and Medical Account of the Plague, at Aleppo, in the Years 1760, 1761, and 1762: Also, Remarks on Quarantines, Lazarettos, and the Administration of the Police in times of Pestilence: To Which Is Added, an Appendix, Containing Cases of the Plague and an Account of the Weather during the Pestilence Season (London: Printed for G.G. J. and J. Robinson, 1791)
Francis A. Countway Library of Medicine, Rare Books 1.Msp.1791.5
The Contagious Mediterranean
From 18th-century Britain, the Ottoman experience of plague seemed at once quite distant and, terrifyingly, near at hand. By the time Patrick Russell’s Treatise of the Plague… at Aleppo was published in 1791, over a century had passed since England’s last major outbreak in London in 1665, and half a century had passed since Western Europe’s last major outbreak in Marseille in 1720. The Marseille outbreak, however, left Europeans with continued anxiety about the resurgence of plague and a committed view on where it would come from: that “perpetual Seminary of the Plague,” the Ottoman Empire.
Patrick Russell was well-positioned to describe the experience of plague in the Ottoman Empire to a European audience. Born in Edinburgh in 1727, Russell was trained as a physician, arriving in Aleppo in 1750 and serving as physician to the English Levant Company factory from 1753 until 1771. He replaced his half-brother, Alexander Russell, in this role. The brothers worked together on Alexander’s 1757 Natural History of Aleppo, which also contained a range of reflections on the city’s experience of plague. Patrick Russell’s Treatise of the Plague… at Aleppo sprawls over six sections and nearly 800 pages, combining a granular description of the social, environmental, and medical experience of plague in Aleppo with a series of reflections on lazarettos, quarantine, and policing.
A number of factors motivated physicians such as Patrick Russell, based in the Ottoman Empire, to write about the plague. For one, the direct observation of plague patients—a key component of medical discourses in the period—was impossible in Western Europe during Russell’s career. The treatment and observation of plague patients in Aleppo offered the opportunity to produce new medical knowledge and thereby advance in one’s scholarly and medical career. More specifically to the case at hand, Russell penned his Treatise of the Plague to convince English authorities to re-commit to the system of quarantines and lazarettos that he saw as “the only means” to prevent the return of plague to England. This was an intervention in a live British debate over the practices and a repudiation of those who argued that quarantine would inhibit British trade in the Mediterranean. Relatedly, in order to make decisions regarding quarantines and to award bills of health in an informed manner, Russell argued that European authorities required access to a detailed and trustworthy account of the experience of plague in the Levant, something that he felt “has often been strangely misrepresented in Britain.” As Alex Chase-Levenson notes, “quarantine depended on knowledge,” something difficult to come across in reliable forms in this instance.
As Nükhet Varlık has shown, early modern European travelers who wrote about Ottoman plague had the complex task of writing on a subject whose contours were dominated for most readers by a crude trope, that of the “fatalist Turk.” This stereotype asserted that the Ottomans had a pious objection to mitigating the spread of plague and, in particular, fleeing from it. The concept was inherited from Ogier Ghiselin de Busbecq, who interpreted comments made by the sultan Süleyman in 1561 to this effect. With the waning of plague in Western Europe in the 18th century, Turkish fatalism became a useful device for philosophes eager to connect the persistence of Ottoman plague to the empire’s moral and spiritual alterity. This device, however, was increasingly disconnected from the European travel narratives themselves. Writers like the prominent English diplomat Paul Rycaut often described with some accuracy the Ottoman debates on the proper theological and medical responses to plague, including the widespread preference for flight. Despite being widely read, these more nuanced accounts were little integrated into Europe’s broader and simplistic conception of Ottoman plague.
This context sheds light on Russell’s persistent attempts to certify his account as dependable. His Treatise presented a complex portrait of Ottoman Aleppo’s myriad responses to plague pandemic, including flight. Believing it a matter of British public health to correct “misrepresentations relevant to the Levant,” Russell hoped to prove to his readers the reliability of his “intelligence” and, accordingly, reflected in his Treatise on the forms of deceit and discretion that made his task so challenging. Although they may not have done much to amend the crude popular perceptions of Ottoman plague, these reflections open a window onto the information networks by which Russell learned about plague in Aleppo and provide fleeting depictions of the Aleppans who played a role therein.
The first of the six major sections of Russell’s Treatise is “An Historical Journal of the Plague at Aleppo, Anno 1760, 1761, and 1762.” The “Historical Journal” reveals at close range the perceived challenges and methods of producing descriptive knowledge regarding plague pandemic in the early modern world and the distinct politics of plague information in 18th-century Aleppo. In the “Historical Journal,” Russell offers a week-by-week description of the extent of the plague in various neighborhoods of Aleppo and surrounding towns, the number of weekly deaths in the city, the symptoms of patients he treated, the vectors by which plague spread in other areas of the Eastern Mediterranean, the decisions of residents to flee, and the activities of Aleppo’s medical providers and Europeans residing in the city.
Russell punctuated these entries with “weekly bills of mortality” which list the number of “Turkish,” “Christian,” and “Jewish” burials for each week of the month. The London that Russell left for Aleppo was one in which the Company of Parish Clerks’ weekly bills of mortality were highly valued and produced within a concerted institutional framework. By contrast, Aleppo seemed to Russell “a country where no registers are kept, and where neither the police nor public curiosity bestow any attention on such matters.” To mend this lack, Russell relied on a city-wide network of informants. He hired a number of individuals to spend their days at funeral sites tallying the number of dead—four or five employed to observe “Turkish” funerals and one for Christian funerals. Russell then synthesized their results into tables printed in his journal.
We catch glimpses in Russell’s journal of other individuals in Aleppo who provided the quantitative and qualitative data that made their way into the Treatise of the Plague. Russell consulted frequently with “washers of the dead,” those tasked with ritually washing the city’s corpses in preparation for burial. Working every day with the city’s infected bodies, they reported to Russell on exactly who was dying each week: Turks or Arabs, residents of one or another neighborhood. Russell also relied heavily on the washers of the dead in deciding when the plague had in fact ceased in the city. By the summer of 1762 the plague had clearly waned, causing some to overconfidently declare its absence from the city. The washers’ direct contact with infected bodies proved otherwise.
Power, danger, and authority were divided unequally within Russell and his informants’ efforts to learn about illness in Aleppo. Regarding those he hired to observe the funeral sites, Russell himself notes that “In truth, the task, if faithfully executed, is attended with danger.” Russell does not reveal what became of the six hired observers. We do learn, however, that “most” of “the priests of the several nations, appointed to attend the infected” perished during the epidemic as well as many of the city’s grave-diggers and washers of the dead. These groups’ direct exposure to infected bodies placed them both in a unique position to provide reliable information to Russell and in immense danger. Russell, meanwhile, after spending the first two years of the epidemic roving Aleppo to provide care to the city’s ill, retreated into quarantine in the pandemic’s third year. From then on, all information in the Historical Journal was shouted by Russell’s informants or passed up in a copper bucket into a second-story window in the factory of the English Levant Company. Unable to verify the intelligence gathered on the other side of the window, Russell offered that his bills of mortality were not “absolutely exact” given that the “fidelity” of his informants “must often be suspected.”
Russell’s attitude of suspicion was in part born of a general conviction that Aleppo’s inhabitants were lying to him about their symptoms and knowledge of plague’s presence in the city. Russell devoted an entire chapter of his Treatise to this topic, titled “The natives constantly attempt to conceal the distemper from the Europeans…” which notes specific instances ranging from the individual patient to the coordinated efforts of the region’s mercantile networks. Russell frequently cared for the city’s ill only to find that they or their caretakers had hidden buboes from him, hoping not to be diagnosed with plague, quarantined, and separated from their families. On a larger scale, Russell reports that the presence of plague in numerous cities in the Levant was “carefully kept secret” from the European consuls present in those cities for as long as possible. Even Russell’s trusted washers of the dead concealed buboes from Russell when detection would disadvantage mercantile groups in the city. The longer plague went undetected by the Europeans the fewer restrictions on commerce local merchants would face, allowing for clean bills of health to propel goods across the Mediterranean. This made Russell’s information-gathering a threat to the city government and merchants of Aleppo. Indeed, Russell castigated the city’s elite in his treatise for continuing to avoid any mention of plague at festive gatherings long after the “lower people” had begun speaking freely about the disease’s clear presence in the city. Russell’s visit to a plague-afflicted area—early in the outbreak while there were still hopes of concealing its spread—was observed by the servant of a powerful local merchant and reported to Aleppo’s governor. Upon being summoned to speak with the governor, Russell denied having any knowledge of the plague’s spread or using this information to inform the European consuls, allowing him to continue to move freely in the city. His hired assistants and informants, however, were not always so lucky, one being temporarily imprisoned for collecting plague-related information on Russell’s behalf.
Russell’s gathering and disseminating information about infectious disease was a highly political process. The intelligence printed in his Treatise of the Plague was mediated by strained relationships, the exact contours of which we catch only glimpses in Russell’s text. Paid employees combed the city for information to bring back to Russell, fearing both infection and imprisonment. Washers of the dead, unpaid and even less acknowledged, alternately detailed and lied to Russell about the symptoms found on dead and infected bodies, symptoms often concealed from European eyes during the life of the diseased. Once information was passed into Russell’s hands it had immediate financial implications, especially for those involved in the Mediterranean trade, causing the European factories to “lock up” and preventing ships from receiving bills of health that would allow them to set sail for European ports. Russell and his Treatise stood perilously between two ends of the “contagious” Mediterranean, each eyeing the other with suspicion.
 Patrick Russell, A Treatise of the Plague: Containing an Historical Journal and Medical Account of the Plague, at Aleppo, in the Years 1760, 1761, and 1762: Also, Remarks on Quarantines, Lazarettos, and the Administration of the Police in times of Pestilence: To Which Is Added, an Appendix, Containing Cases of the Plague and an Account of the Weather during the Pestilence Season (London: Printed for G.G. J. and J. Robinson, 1791). Harvard’s Countway Library of Medicine holds two copies of Russell’s Treatise. The copy digitized for the Contagion project, 1.Msp.1791.5., contains an inscription listing James Jackson as the volume’s owner as of 1801. Jackson was a prominent professor at the Harvard Medical School and founder of the Massachusetts General Hospital. In 1801, Jackson had recently returned from two years of medical education in London. See “Jackson, James MD; Catalog Number: 707” in Catalog of Arts and Artifacts, Massachusetts General Hospital.
 Richard Mead, A Short Discourse concerning Pestilential Contagion: And the Methods to Be Used to Prevent It (London: Printed for Sam. Buckley…, and Ralph Smith…, 1720). The belief that plague was brought to Marseille in 1720 from the Levant by the ship Grand-Saint-Antoine has been recently challenged by paleogenetic evidence that the Marseille outbreak likely stemmed from local Western European plague reservoirs and not re-introduction from the Levant. See Kirsten Bos et al., “Eighteenth Century Yersinia Pestis Genomes Reveal the Long-term Persistence of an Historical Plague Focus,” ELife 5 (2016): E12994; Ann G. Carmichael, “Plague Persistence in Western Europe: A Hypothesis,” in Pandemic Disease in the Medieval World: Rethinking the Black Death, ed. Monica Green (Amsterdam: Arc Humanities Press, 2014), 157–91. On the association of plague with the “orient,” both post-Marseille and in a longer view see Junko Thérèse Takeda, Between Crown and Commerce: Marseille and the Early Modern Mediterranean (Baltimore: Johns Hopkins University Press, 2011); Nükhet Varlık, “‘Oriental Plague’ or Epidemiological Orientalism?: Revisiting the Plague Episteme of the Early Modern Mediterranean,” in Plague and Contagion in the Islamic Mediterranean, edited by Nükhet Varlık (Amsterdam: Arc Humanities Press, 2017), 57–87.
 See Alexander Russell, The Natural History of Aleppo, and Parts Adjacent. Containing a Description of the City, and the Principal Natural Productions in its Neighbourhood; together with an Account of the Climate, Inhabitants, and Diseases; particularly of the Plague, with the Methods used by the Europeans for their Preservation (London: G.G. and J. Robinson, 1756). On the Russells in Aleppo see Maurits van den Boogert, Aleppo Observed: Ottoman Syria through the Eyes of Two Scottish Doctors, Alexander and Patrick Russell (Oxford: Oxford University Press, 2010) and Janet Starkey, The Scottish Enlightenment Abroad: The Russells of Braidshaw in Aleppo and on the Coast of Coromandel (Boston: Brill, 2018).
 Similar instances include the plague writings of Mordach Mackenzie, a British physician, from Istanbul in the mid-18th century. See for example Mordach Mackenzie, “An Account of the Plague at Constantinople: In a Letter from Mordach Mackenzie, M. D. to Sir James Porter, His Majesty’s Envoy Plenipotentiary at Brussels, and F. R. S.,” Philosophical Transactions (1683–1775) 54 (1764): 69–82.
 Nükhet Varlık, “New Science and Old Sources: Why the Ottoman Experience of Plague Matters,” in Pandemic Disease in the Medieval World: Rethinking the Black Death, ed. Monica Green (Amsterdam: Arc Humanities Press, 2014), 193–227.
 Russell, Treatise, 393.
 Consider the comments of Russell’s contemporary, the physician Mordach Mackenzie, who wrote “to what purpose keep ships in Sandgate-Creek for weeks, and even months, without landing and serening the goods? I hope you will allow, there is little to be feared from the bodies of men, who get in good health from Smyrna to England, which voyage is seldom performed in less than 7 or 8 weeks”; Mordach Mackenzie, “Extracts of Several Letters of Mordach Mackenzie, M. D. concerning the Plague at Constantinople,” Philosophical Transactions (1683–1775) 47 (1751): 385. On the relationship between trade and quarantine debates, see also Alex Chase-Levenson, The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860 (Cambridge: Cambridge University Press, 2020); Birsen Bulmuş, Plague, Quarantines, and Geopolitics in the Ottoman Empire (Edinburgh: Edinburgh University Press, 2012).
 Chase-Levenson, The Yellow Flag, 38.
 See Nükhet Varlık, Plague and Empire in the Early Modern Mediterranean World: The Ottoman Experience, 1347–1600 (New York, NY: Cambridge University Press, 2015), 72–89.
 Varlık, Plague and Empire, 73, 75.
 Varlık, Plague and Empire, 86.
 Varlık, Plague and Empire, 83.
 See, for example, Russell, Treatise, 22.
 Although “Mohammedan” is used at times to refer to Muslims, Russell here and elsewhere refers to Muslims as “Turkish.” See Russell, Treatise, 222, 40, respectively.
 On the London bills of mortality see Niall Boyce, “Bills of Mortality: Tracking Disease in Early Modern London,” The Lancet 395, no. 10231 (2020): 1186–87.
 Russell, Treatise, 32. Whether or not this was an accurate assessment is unclear, given the evidence that meticulous mortality statistics were kept in 16th-century Aleppo and that mortality statistics were kept in general in various Ottoman cities throughout the 18th century. See Varlık, Plague and Empire, 258.
 Despite consistently reporting the number of Jewish burials, Russell does not mention having employed someone to observe Jewish funerals. Given that the Europeans in Aleppo were in close contact with the city’s Jewish merchants, this suggests that Russell was able to tally the number of Jewish dead via informal communication with members of the city’s Jewish population. See Russell, Treatise, 20.
 On this ritual in an Islamic, Ottoman context, see Edhem Eldem, Death in Istanbul: Death and Its Rituals in Ottoman-Islamic Culture (Istanbul: Ottoman Bank Archives and Research Center, 2005), 56–58. It should be noted that Jewish and Christian burial rituals also involve washing. Russell does not specify the rite with which these washers of the dead were associated. On Ottoman washers of the dead, see also Varlık, Plague and Empire, 264.
 Russell, Treatise, 27.
 Russell, Treatise, 32.
 Russell, Treatise, 65.
 Russell, Treatise, 51.
 Russell, Treatise, 32.
 Russell, Treatise, 351.
 Russell, Treatise, 22, 30.
 See, for example, Russell Treatise, 4, 26, and 358.
 Russell, “Appendix,” in Treatise, iv.
 Russell, Treatise, 30.
 Russell, Treatise, 358.
 Russell, Treatise, 358.
 On the suspicion that structured Mediterranean plague encounters, see Aaron Shakow, “Marks of Contagion: The Plague, the Bourse, the Word, and the Law in the Early Modern Mediterranean, 1720–1762” (PhD diss., Harvard University, 2009). On plague in the Western Mediterranean see Ruth Mackay, Life in a Time of Pestilence: The Great Castilian Plague of 1596–1601 (Cambridge: Cambridge University Press, 2019); Abigail Agresta, “From Purification to Protection: Plague Response in Late Medieval Valencia,” Speculum 95, no. 2 (2020): 371–95. Kristy Wilson Bowers, Plague and Public Health in Early Modern Seville (Rochester: University of Rochester Press, 2013); also see Edna Bonhomme, “Plagued Bodies and Spaces: Medicine, Trade, and Death in Ottoman Egypt and Tunisia, 1705–1830 CE,” (PhD diss., Princeton University, 2017).