Le Infezioni in Medicina, n. 3, 193-201, 2011 Le infezioni Epidemic waves of the Black nella sto - Death in the Byzantine Empire ria della medicina (1347-1453 AD) Ondate epidemiche della Morte Nera nell’Impero Bizantino Infections (1347-1453 d.C.) in the history of medicine Costas Tsiamis 1, Effie Poulakou-Rebelakou 2, Athanassios Tsakris 3, Eleni Petridou 1 1Department of Hygiene, Epidemiology and Medical Statistics, Athens Medical School, University of Athens, Greece; 2Department of History of Medicine, Athens Medical School, University of Athens, Greece; 3Department of Microbiology, Athens Medical School, University of Athens, Greece n INTRODUCTION a small geographical area is impressive; it is ba - sically a case of “all against all”. The Republics he completeness of the Byzantine historiog - of Venice and Genova held strategic and eco - raphy of the plague epidemics in the 14 th and nomically important areas in the region after T15 th century cannot be compared with that the 4 th Crusade (1204) and were in permanent of the West. References made to the plague are conflict with the Byzantines for control of the often in conjunction with other concurrent his - Aegean Sea and the trade roads [2, 3]. torical events. The political turmoil and the de - In the east, the Ottoman Turks of Asia Minor cline experienced by the Empire in the 13 th and exert pressure on the Empire of Trebizond, in - 14 th century gradually changed the mentality of vading the Balkan Peninsula, detaching Greek Byzantine scholars. Military defeats, civil wars, territories of the Byzantine Empire, while fight - earthquakes and natural disasters were joined by ing with Venice, Genova and the Knights of the plague, which exacerbated the people’s sense Saint John of Rhodes for control of the sea [4, 5]. that they were doomed by God [1]. In South Greece, the Frankish principality of Lack of valid demographic data and the literary Achaia and the Byzantine Despotate of Mistras ambiguities raise questions about the actual are interlocked in permanent battle for control size and mortality rate of these epidemics in the of the region [6]. In the west, wars between the Byzantine Empire. Literary excesses aside how - Byzantine Despotate of Epirus, the Serbs, the ever, these descriptions are an invaluable Albanian warlords, the Kings of Taranto, the source for the study of the disease outbreaks in French Royal House of D’Anjou and Venice, are Byzantium in the 14 th and 15 th century. also regular. It is characteristically reported that only in Western Greece and the Ionian Islands, The “Byzantine World” during the Black Death in the period from 1300 to 1453, there were period more than 50 short or long term campaigns [7]. The 14 th and 15 th century could be characterized Trying to save the Frankish Duchy of Athens, as the deathbed anxiety of an empire that is on - the Catalan and the Florentine dukes of Athens ly a shadow of its glorious past. The empire is served the interests of the Ottomans and at the dismembered and now holds only a few is - same time their relations with Venice and the lands, some territories and castles scattered all Byzantine emperors are at the edge [8, 9]. over mainland Greece. In the South-eastern During the period 1347-1453, all the rival par - Mediterranean, the political and military situa - ties in the region were affected by plague. Yet, tion is complex, with ever changing alliances. the historical events and military operations The complexity and political instability of such show that the regular occurrence of the disease 194 2011 was not an obstacle to decisions and plans for Epirus. The Despotate was a Byzantine state in controlling such an important strategic and eco - western Greece, which was conquered by the nomic region as the south-eastern Mediter - Czar of Serbs, Stefan Dusan, in 1347-48 taking ranean. advantage of the anarchy and disruption caused by the first major plague epidemic in The plague epidemics of the Byzantine Empire du - 1347. In 1368, the death toll would rise dramat - ring the 14th century ically in Ioannina, the capital of the Despotate; After the outbreak of the plague in the Genoese according to the Chronicle of Ioannina, it left colony of Caffa in Crimea in 1346, Constantino - thousands dead and many Greek widows, ple was the first city to be affected in 1347 AD which the Serbian despot Thomas Preliubovic [10, 11]. At this time, the Byzantine civil war be - forced to marry Serbian soldiers [22]. tween the Empress Zoe and Viceroy John Kan - From the correspondence of the scholar Dim - takouzenos was over with winner Kantak - itrios Kydonis we learn of the existence of plague ouzenos as the new emperor (1346-1355). When in Thessaloniki and around areas in 1372 [18]. Kantakouzenos was dethroned in 1355, he be - During this period the Byzantines refused the al - came a monk; alongside political events, his liance with the Serb warlord Ugljesa against Ot - writings described the great epidemic of 1347 tomans. After the death of Ugljesa at the battle of AD. The disease spread like lightning, and Chernomen, the Byzantines besieged his capital death affected all ages and social strata, accord - Seres, near Thessaloniki, during the epidemic. ing to historians of the plague, the deposed Em - The next report, in 1374, concerns the Despotate peror Kantakouzenos and the historian of Epirus again and the spread of the epidemic to Nikephoros Gregoras [12-14]. It is interest to the Peloponnese [18, 19, 21, 22]. While the epi - note the absence of other diseases before the ap - demic in Ioannina is at its peak, the Albanian pearance of the epidemic, according to Kantak - warlord Liossa, conquered the neighbouring ouzenos’ narrative [12]. Kantakouzenos de - town Arta, which also suffers from the plague, scribes the disease’s symptoms in detail, notably creating an Albanian Despotate and attack Preli - the lung infection, strong chest pains, haemopt - ubovic’s Ioannina without being deterred by the ysis and intense thirst, the lethargy and death of disease. In 1375, the plague appears in Crete and patients; many believe this description matches tortures its population until 1376, while in 1378 it the pulmonary form of the disease [13-15]. reigns in the monastic community of Mount In 1347, apart from Constantinople, the plague Athos [23]. was spread to the islands of Aegean (Limnos The years from 1376 to 1381 were a period of in - and Euboea), the island Crete, the second tense warfare in the Aegean between Venice and largest city of the empire Thessaloniki in North - Genova, in connection with the claim of Tene - ern Greece, Trebizond in Minor Asia and the dos, a small island that controlled the entry to Venetian naval bases of Methone and Koroni in the straits of Gallipolis and was granted by the the Peloponnese [14-17]. In 1348 the situation Byzantines to Venice following an agreement [8]. showed no signs of improving with “the unex - During this Italian war, in 1379-80, the epidemic pected sword of death” falling on the new pos - appears to have hit the Genoese colony Peran in session of the Order of the Knights of Saint John Constantinople, introduced by the Genoese fleet. (the island Rhodes), the Venetian ports of Six years after the last outbreak, the Principality Cyprus and the inner Peloponnese in southern of Achaia in the Peloponnese was hit again in Greece [18]. After fourteen years, the plague 1381-82 [18, 24]. During the plague of Pelopon - would return to Constantinople in 1361, when nese, a group of mercenaries from Navarra the Ottomans occupied part of Thrace and pre - (Spain) and Gascony (France), changed their pared to besiege Adrianopolis (today Edirne in plans about the siege of the Catalan Duchy of Turkey) and the capital. Trade relations with Athens and decided to attack the Frankish Prin - the Empire of Trebizond carry the disease from cipality of Achaia in the midst of the epidemic. Constantinople to the Black Sea in 1362. In the Their plan proved effortlessly fruitful and after same year, epidemics broke out in Crete, few weeks they conquered the Principality. Cyprus, Limnos and Peloponnese [18-20]. The A series of letters by Dimitrios Kydonis denotes plague of Constantinople did not recede before spread of the epidemic in Constantinople in 1364, while in the Peloponnese, Adrianopolis 1386. Kydonis complains that he can not get to and Crete it dominated until 1365 [19, 21]. In Italy, where he seeks to negotiate aid from the 1368, the disease would affect the Despotate of Catholic Church against the Turkish threat and 195 2011 the capital seems to be cut off from the rest of have reports indicating the existence of the epi - the world [18]. Kydonis’ correspondence offers demic in Cyprus and Constantinople [19, 26, 28]. few clues to allow us to understand if this in - We also have a reference to the existence of the ability to leave Constantinople was due to a de - plague in Cyprus in the following year, while tention of all departures or to a lack of sailors for the disease travels back to Koroni and Methone manning ships. In 1388, an outbreak is suspect - and from there to Corfu in 1410, together with ed in the Duchy of Athens and, the following the Venetian fleet [19, 21, 31]. A request by the year, Crete will be once again tortured by the Provveditore of Corfu to the Venetian Senate in plague [19, 25]. During the epidemic, the army 1410 for the emergency mission of archers raises of the dethroned, by the Catalans, Florentine suspicions of many victims amongst the ranks of Duke of Athens, Nerio Acciaioli, re-occupied the soldiers on the island.