Outsiders on the Inside: Italian Jewish Ghettos and Cholera in the 1830s

Italian Health Boards and Jewish Ghettos

In Italy, the Conservatori di Sanità or, health boards, were first established in the fourteenth century in response to the Black Death, and as plague epidemics became a recurrent issue that demanded coordinated responses from the state, these temporary institutions were made permanent. By the mid-sixteenth century capitals and other major cities throughout Northern Italy had permanent health boards, and this trend soon expanded to include smaller towns and even villages. ‘All Boards, whether permanent or provisional, whether located in a major city or in a small community, acted under the orders and strict control of – and were directly answerable to – the central Boards of the capitals’. ¹⁴ The reason for this structure was twofold, for it served to legitimize local boards as well as ‘parry the opposition and … protect [them] from obstructive interferences’. ¹⁵ By the sixteenth century, the health boards were established fixtures of Italian governments, with the Venetian Board considered to be a model for other health boards. Its statutes stated:

that the following matters fell under [their] control and jurisdiction: the marketing of meat, fish, shellfish, game, fruit, grain, sausages, oil, wine, and water; the sewage system; the activity of the hospitals; beggars and prostitutes; burial, cemeteries and pesthouses; the professional activity of physicians, surgeons and apothecaries; the preparation and sale of drugs; the activity of hostelries and the Jewish community. ¹⁶

In light of these historical conceptions regarding the very nature of Jews, it is not unexpected that scholars have surmised that one of the primary motivations for Pope Paul IV’s bull, Cum Nimis Absurdum, issued in 1555, calling for the segregation of Jews across Christendom, was to prevent the spiritual, moral and physical contamination of the Christian population through contact with the Jews living amongst them. ¹⁹ Isolating the Jews, and requiring the use of a distinguishing mark upon their clothing to clearly identify them to the Christian population, is not unlike the measures taken when an individual is quarantined, and functioned to mark the Jews of Italy, and elsewhere, as fundamentally ‘other’. The creation of Jewish ghettos within the Italian cities which did not expel them, between the mid-sixteenth to the mid-seventeenth century, clearly delineated spaces for Jews that were ‘outside’ the main part of the urban environment, although they were established inside the very heart of the city. ²⁰ The ghettos of Italy, as they would come to be known upon adoption of the name of the Jewish quarters previously created in Venice, were distinctly different from the Jewish quarters found throughout the rest of Europe in the centuries to follow. They were walled (with all exterior windows and doors which overlooked Christian areas covered over), gated and locked enclaves where all Jews were required to live. ²¹ The first ghetto created based on the dictates of Cum Nimis Absurdum was established just weeks after it was issued, in Rome, on the banks of the Tiber. Confinement was only one element of change resulting from the implementation of this papal bull. Others included the limitation of having only one synagogue, and the requirement for all Jews to wear distinguishing clothing or other signs to identify and warn Catholics who the Jews were among them. Jews were also restricted in their professions and could not hire Christian servants or otherwise fraternize with their Christian neighbours. These restrictions remained in place, at varying levels of enforcement, for nearly three centuries.

Following the Roman example, ghettos were soon introduced across the northern Italian peninsula. In Tuscany, Cosimo I, who wished to be elevated to the rank of Grand Duke, soon enacted many of the papal guidelines contained within Cum Nimis Absurdum, and thus ended the traditional toleration of Jews by the Medici family. In 1567 Tuscan Jews were ordered to wear a distinguishing yellow badge. In 1569, granted the rank of Grand Duke by Pope Pius V, Cosimo I had attained the title he sought, yet he continued to implement additional dictates of the papal bull, including cancelling all the banking licences of the Da Pisa family in 1570. ²² During October of that same year, Jews residing in and around Florence were mandated to move to the city and take up residence in a ghetto constructed near the Basilica of Santa Maria del Fiore. In Ferrara, the Dukes of Este had also traditionally been tolerant of the Jews, even granting refuge to those fleeing persecution in other areas. A dynamic, multi-cultural Jewish community had developed in Ferrara, and by the mid-sixteenth century there were 11 synagogues in the area. ²³ With the death of Alfonso II in 1597, this tradition ended as Ferrara fell under the jurisdiction of Pope Clement and the region was absorbed into the Papal States. The ghetto of Ferrara was established in 1627, in an area near the cathedral where many Jewish families were already in residence, and its creation resulted in a pronounced decline of what had been a ‘great center of Jewish life’. ²⁴ In the nearby Duchy of Modena, where the court of Cesare of Este relocated after the death of Alfonso II, the ghetto was not established until 1638. ²⁵ Many Jews had elected to follow the court from Ferrara to Modena; however, pressure from the Church ultimately led to the creation of a ghetto there as well. Here, as in the other ghettos, the perimeter was sealed – doorways and windows facing the Christian areas were bricked over and gates were installed on any streets that still maintained access to the outside city – and so they remained until Napoleon conquered the peninsula. Italian Jews briefly experienced emancipation and the rights of citizenship under Napoleonic rule, but the ghetto system and other restrictions were reinstated following his defeat, as the peninsula returned to the previous political structures of the Ancien Régime restored by the Congress of Vienna. The Italian peninsula, and all of Europe, however, soon faced another invader. Cholera recognized neither political nor religious distinctions, nor was this threat defeated as quickly as Napoleon.

Europe Encounters the Asiatic Invader – Cholera

The nineteenth century was marked by significant change and upheaval. Beginning with the French revolution and through the decline of absolutism, to the rise of secularism and the birth of the modern nation-state, the economic, political and religious landscape of Europe was dramatically altered over the course of the century. Scientific advances also transformed the fundamental understanding of the natural world, especially in the realm of medicine. Traditional medical knowledge and practice based on Hippocratic and Galenic theories were discredited with the development of germ theory, and medical histories of the century tend to be written as triumphant narratives of scientific progress over these ineffective and flawed traditional theories. These traditional medical theories did not, however, lose their hold on either governments or the general public until near the end of the century. This reality is reflected in David S. Barnes’ assertion that during the Great Stink of Paris in 1880 there was a ‘remarkable degree of consensus’ between the citizens of Paris and government officials on two key points, ‘first, that the smells represented an urgent danger to the public health, and second, that the authorities … bore a corresponding urgent responsibility to do something about them. The deep-rooted familiarity and persistence of the first thesis and the novelty of the second in 1880, among other things mark the Great Stink as a historical watershed’. ²⁶

Although I do not wish to challenge this statement, the Italian health boards had been charged with addressing issues related to the management of miasmic odours long before this time, and the overall health and sanitation of cities had been a governmental concern in Italy for decades, if not centuries, before this Parisian ‘watershed’ moment. In the centuries preceding the initial cholera pandemics, both the cause and treatment of disease were based upon the tenets of humoral and miasmic theory, originally proposed by Hippocrates around the fourth century BCE. His ideas were elaborated and expanded upon by Galen in the second century, and these theories ultimately became the paradigm on which all medical knowledge was founded within western civilization. Humoral theory contends that illness, or an increased susceptibility to contracting illness, occurs when there is an imbalance in the bodily humours of yellow bile, blood, black bile and phlegm, and emphasizes individual constitutional disposition, lifestyle and environmental factors. Miasmic theory complements humoral theory, for it operates on the belief that disease is caused by air contaminated with poisons released from decaying matter or other atmospheric disturbances. Air contaminated with miasmic poisons was readily identifiable due to its foul odour. Individuals could contract a disease through breathing air fouled by miasmic poisons, or by contact with objects that had been in a miasmic environment and were therefore covered with these same poisons. During the seventeenth and eighteenth centuries, authorities, both governmental and medical, increasingly focused on local sources of miasma – ‘unburied corpses, stagnant pools of water, and accumulations of filth, not to mention the unhygienic habits of the poor. It was thought that unclean persons, or those suffering from the plague, could communicate the disease to other people by corrupting the air around them’. ²⁷ This understanding led to further strengthening the use of quarantines for both people and goods during episodes of epidemic disease crisis. ²⁸ The theories of miasma and humoral medicine shaped the manner in which governments responded to the threat posed by cholera, and emphasized the control of environmental sources of foul smells, as well as the general health of the population.

Cholera was in many ways the premier disease of the nineteenth century, and was a fundamental component in the development of modern public health. Vibrio cholerae was first isolated in 1854 by Filipo Pacini of Florence, although it is the work of Robert Koch in 1883–1884 which is more well-known. ²⁹ According to the World Health Organization, cholera is divided into seven pandemics, the first from 1817 to 1823, and then 1829–1849, 1852–1859, 1863–1879, 1881–1896, 1899–1923, and 1961 to the present for the remaining six episodes. During the first several pandemic episodes of cholera the reality that microscopic bacteria could be, and were, a source of fatal, epidemic disease was unknown. As cholera swept across Europe during the second pandemic, it struck with seeming abandon and rapidly claimed its victims, often within 48 hours of the onset of symptoms. The normal course of the disease began with abdominal distress not unlike food poisoning, and as it progressed, the sufferer voided a large volume of brown or yellow diarrhoea, accompanied by vomiting, stomach pain and abdominal cramping. Within hours, as dehydration set in, the victim reportedly experienced overwhelming thirst, and simultaneously lost the ability to speak. It was in this later stage that copious amounts of virtually clear diarrhoea containing small, white particulates would be expelled. This discharge was given the descriptive name of ‘rice-water stool’, and was considered the indelible hallmark of the disease. Much like the plague, a disease capable of killing on this magnitude demanded a response from the local and regional governments. In urban environments, disease struck the poor with a higher frequency, and could therefore, reinforce religious, racial and class distinctions with little consideration given to the inequities of accessibility to adequate water, food and basic sanitation, which was, and remains, inherent in the divide between the upper and middle classes and the urban poor. As early as 1830 the connection between cholera and the terrible living conditions of the urban poor was gaining acceptance, although its seemingly arbitrary nature confounded many trying to combat the disease. However, upon reaching Europe, cholera was also increasingly linked to filth, with the subsequent interpretation that the poor were not only the most susceptible to the disease, they were now also the cause, and, they were, moreover, viewed as bearing responsibility for its presence. ³⁰ It is therefore unsurprising that the majority of efforts in campaigns against epidemic outbreaks concentrated on eliminating miasmic sources, quarantine measures to prevent miasmic transmission between places, and the humoral balance of individuals. ³¹

Combatting Miasma and Preserving Bodily Humours

As cholera initially advanced upon the continent, regional governments across Italy implemented precautionary measures. On 1 February 1830, the Governor of the Province of Modena called for inspections of the parishes of the city, including the ghetto, and an assessment of the quality of the air and the adequacy of ventilation to prevent the air from becoming impregnated with putrid substances, as well as an evaluation of the overall healthiness of the houses. The responsibility for conducting these inspections was delegated to the Conservatori di Sanità and the Commissioni di Beneficenza, with reports completed and submitted to the General Assembly by the first of May along with suggestions to remedy any deficiencies identified by the inspectors. ³² On 16 March 1830, distinguished members of the court, the chancellor, and the Jewish Massaro, inspected the poorest section of the Modena ghetto. Many of the residences were simply identified as miserabile, however, some entries provided more detailed information. One explained that the inspected apartment consisted of two rooms and a kitchen and was occupied by a family of five. Another residence was listed as being very clean, whereas nearby there was a family who was identified as poor and who lived with the residue from plucking chickens. ³³ Suggestions on how to better distribute inhabitants of a household were also presented, such as the comment that in the house of Isaac Benedetto Formiggini it would be better to allocate two occupants to each room, except the kitchen, and that the three smallest children could be lodged together. There is no indication of whether these suggestions were enforced, but this documentation does reflect the ghetto as being included in the inspection process, which was mandated to occur across all the parishes in the city. Moreover, the inclusion of the Jewish leadership illustrates cooperation between the Christian municipal authorities and the ghetto.

Secular authorities were not alone in their concerns regarding cholera. In 1831, Cardinal Tommaso Bernetti, Secretary of State, Prefect of the Holy See, issued the Regolamento Sanitario. In the opening line of this document Bernetti refers to ‘Cholera Morbus’ as an imposing illness, followed by the explanation that these regulations were developed due to the great alarm that had arisen in all nations due to the threat of this disease. ³⁴ He continued, thanking God that the disease was well away from Italian domains and commended the governments who were either in contact with, or in close proximity to infected areas to take energetic measures to drive away the danger, and to prevent communication of the disease. ³⁵ The remainder of the regulation contains detailed measures aimed at preventing the spread of cholera.

Bernetti first called for the appointment of a five-member medical committee composed of honest citizens, a doctor and either the parish priest or a clergyman, and suggested that in larger, more densely populated areas, the number of committee members be increased to include representatives from each area of the city. He then outlined the responsibilities of these committees. The requirements included the cleaning of the streets at least once a week, the removal of deposits of manure, as well as the cleaning of all stables at least twice each week, and the need to guard against the accumulation of sordid, filthy waters. These sanitation committees were also responsible for conducting inspections of the homes of the needy, to identify what provisions could be made to improve their situation, and to additionally inspect the hospitals to ensure they are well run, adequately staffed and stocked with appropriate medical supplies. Furthermore, detailed instructions requiring doctors to report, or denounce, all who were taken ill were included within the section on hospital oversight. Within the regulation, Bernetti also called for the drainage of marshy areas and standing water, and the clearing of cesspits in order to prevent their deadly effluvia from introducing pestilential agents, which spoil the air, into the environment. Further instructions were included which charged the committees with ensuring the drinking water supplies were adequately protected and authorized them to apply to the governmental authority for the appropriate and immediate provisions necessary for protecting the safety of this resource. ³⁶ Finally, Bernetti called for active philanthropic efforts from the prosperous members of the community to help provide healthy foodstuffs in order to improve the overall health and standard of living for all members residing within the community.

The second section of the regulation provided guidelines for actions required in the event that cholera, or some other contagious, epidemic disease were to affect individuals residing within Italian domains. The first requirement was to immediately isolate the person or people struck by the disease, to fumigate their rooms with nitriche or muranitriche, as well as disinfecting their clothing, and to implement any other sanitation measures indicated by the local medical doctor. If the individuals stricken by disease could not be isolated within the confines of their own homes without an increased risk to those who lived nearby, they were required to be transported to the hospital for care and treatment. If adequate space was not available within the existing hospital(s), then it was the responsibility of the community to designate additional locations, lazarettos, and provide for their daily operational costs through charitable contributions. Additional guidelines on how to handle the burial of the dead were outlined, including the requirement to transport corpses, preferably covered or in an enclosed box, late at night, with the bodies interred in deep pits and covered with a layer of lime, or, if the corpse was to be placed within a tomb, the tomb was to be sealed with a heavy cover stone, and then fumigated. Bernetti stated that internment was to be accomplished as rapidly as possible, without consideration for religious concerns. ³⁷

As these requirements were aligned with traditional medical theory and practice, as well as with the more contemporary perceptions that equated filth and poverty with disease, it is not surprising that one of the inspections called for in the Regolamento Sanitario issued by Bernetti, was conducted in the houses of the indigent of the ghetto of Ferrara, and that the overall assessment of living conditions was predominantly focused upon issues related to overcrowding, cleanliness, ventilation and air quality. Conducted by the deputies of the health board and accompanied by Signore Lampronti, identified as Consul of the Community of the Ghetto, as well as by Moisè Finzi, and Samuele Tedeschi, the initial inspection record indicated the house number, the street name, the name of the head of the household, and included detailed observations of the inspectors. ³⁸ The poor of the Jewish ghetto were concentrated in the areas of Vigna Tagliata, Strade dei Sabbioni and Viccolo Gatta Marcia in 42 homes, which served to accommodate over fifty families. These homes were often excessively crowded – frequently seven to ten people occupied a single room. At Vigna Tagliata, 3100, the home of Isach Ascoli and six of his relatives, the inspector observed the house was very filthy and although it consisted of two rooms, one was very small and both had very low ceilings and were in need of extensive cleaning, and concluded the environment was very unhealthy. At this same address the family of Giuseppe Rossi, also consisting of seven people, lived in a single room with very bad air caused by rubbish and the overall foul state of the adjoining courtyard. At Gatta Marcia, 3129, the entrance was dirty, and the family of Benvenuta Felici consisted of five people living in one room, which was also used as a kitchen and was very greasy. Also in this house was Angelo Pisa, who lived with his wife, sister, and six children in one room with an alcove. It was noted that the window overlooked a small, filthy courtyard. The final comment for this property suggested giving the Pisa family the entire house and relocating the Felici family in order improve the situation. In addition to these observations, there were frequent comments made by the inspectors concerning the need to clear and clean the drains, as well as the latrines, and to remove manure from the courtyards. There were also recurring annotations regarding the amount of light inside the buildings, the level of available sources of ventilation, and the apparent quality of the ambient air. ³⁹

The summary of the inspection, written as a second, separate document by the inspectors, detailed many of the changes that should be made to improve the living conditions of the poor of the ghetto. The inspectors sought to impose a maximum number of people who could occupy a property, and linked this number to the amount of bed space available within a residence. Further to this determination, they allowed that the ground floor could be occupied, as well as the upper floors, when there was adequate ventilation, for ventilation was considered a critical element for the prevention of miasmic conditions. They also stated that sleeping in a room without windows would not be tolerated, and further detailed that if the window was narrow, where possible, it should be made larger. The inspectors do not, however, go as far as suggesting that the doors and windows of the ghetto that overlooked the Christian areas of the city be reopened, a step that would have likely improved ventilation to the entire area. Adequate separation between family groups was also recommended. The inspectors further indicated the public Fondo di Beneficenza, or charity fund, could be used to provide additional beds to facilitate separation, and suggested not having more than three persons sharing a bed. ⁴⁰ The use of public funds for improving the living conditions for Jewish inhabitants of the ghetto is worth specifically noting. The Italian authorities were not only suggesting modifications inside the ghetto, they were willing to allocate financial resources towards these improvements. Measures of this nature are far removed from what could be expected in the treatment of the resident outsider in times of crisis. ⁴¹

In regards to general cleanliness, the inspectors ordered that the excessively filthy, dark, unventilated narrow and poorly maintained courtyards were cleared of all uncleanness and filth, that these areas should be immediately whitewashed where necessary, and then maintained by being swept on a daily basis. Additionally, in areas with stagnation, the underground drains were to be restored, with the cleaning and restoration completed by the owners or lessors of the property, based on the directions provided by the health board, and the inspectors further determined if the work was not completed there would be penalties and fines assessed against the owners. Furthermore, the inspectors stated that if the owner or lessor could not meet the expenses for said repairs, then the health office would provide assistance. The report concluded that the most important aspect of what was required by the Commissione di Sanità was the overall improvement in air quality, and charged the Trustees of the Jewish Community to ensure the appropriate measures were taken to clean the ghetto and remedy the deficiencies indicated by the inspection, conferring upon them the powers of officers of public authority. ⁴²

In Florence a similar process was followed, and it is not surprising to discover that nearly half the expenditures listed in the report of expenses to ‘preserve this city from the invasion of Cholera’ during August to December 1835 were allocated for the cleaning of the streets, disinfecting the rooms occupied by the local poor, and the construction of a public slaughterhouse. ⁴³ There are additional public expenditures during this period that were specifically related to the ghetto and the Mercato Vecchio, which both bordered and included one of the main gates allowing entry into the ghetto of Florence. Contractors were hired and paid a total of 104 Lira to repair the paving over the sewer on Via dei Succhiellinai at the gates of the ghetto as well as for the expurgation and restoration of this same sewer line. ⁴⁴ Twenty-five Lira were provided to allow for work completed to repair the urine drain located in the Piazza del Olio, and an additional 164 Lira were allocated to expurgate and restore the existing sewer in the Mercato Vecchio. All of these expenditures were unanimously passed during the months of November and December of 1835. ⁴⁵

Similar, although much more detailed, measures related to sewers are found in Ferrara during this same period. Following an inspection of the ghetto, the minutes from a meeting of the Municipal Health Commission on 10 August 1835 recorded that it was of the utmost importance to provide the maximum level of cleanliness in latrines and areas where chamber pots were kept, to increase the ventilation of wet rooms, and to ensure the removal of filth from inside houses and courtyards. The Commission then cited the regulations of 1831 as justification to renew the deputies, the Capi-Strada, of the Jewish community to oversee such efforts. Additional deficiencies identified for correction included relocating the geese kept by the residents to an area previously designated in 1831, the removal of accumulations of filth both inside homes and in courtyards, the clearing of existing drains, and the construction of additional ones linked to the storm-water drains to improve the overall level of drainage and cleanliness of the streets and courtyards. The Commission further stated that if these items were not attended to directly and to the level outlined in the 1831 regulations, then the municipal authorities would contract out the work, and the expense would be repaid by the Jewish community. The final page of this report also contained results of a visit to the hospital made by Dr Poletti in which he indicated the need to increase the ventilation in the room containing the men’s latrines by enlarging the windows, to wash the room daily with chlorinated water in order to destroy the stinking fumes, and to install a pump, similar to that which already existed in the women’s area, in order to increase the supply of water to this location. Improvements to the women’s halls were also called for, such as the construction of a second latrine and the need to improve the level of cleanliness and the amount of ventilation. ⁴⁶

What is most interesting in this document, however, is that the committee believed it appropriate to propose the re-opening of the original doors of the houses in the ghetto, in order to decrease the accumulation of rubbish, as well as to improve the air quality in the ghetto. They further stated the belief that neither the government nor the Archbishop would be opposed to an initiative of this nature, since the gates of the ghetto were permanently open. ⁴⁷ This proposal indicates a shift in perspective not apparent in the 1831 inspection reports, which only called for the enlarging of narrow windows where possible: it addresses the reality that the enclosed microcosm of the ghetto could benefit from the removal of the physical blockage of windows and doors which open onto areas populated by Christians. Opening these doors would also allow for increased levels of movement into and out of the ghetto, for although the gates may have remained open, there was still limited access to the internal space of the ghetto due to the fact that there were only five points of entry and exit for the entire area. This simple statement reveals a tremendous shift in attitude about the level of separation between Jews and Christians, and although it may be based solely on fear posed by the threat of cholera, it is not one that appears previously within the records.

As these actions have illustrated, the municipal governments of these three communities embraced the tenets of miasmic theory and believed it was vitally important to limit noxious odours in order to achieve and maintain the highest level of air quality possible to prevent epidemic cholera from attacking the city and its inhabitants. There is not a singling out of the Jews, or a sense of equating them as a vector, or source, of disease. Nor is there evidence of placing responsibility for the epidemic on them. Those who subscribed to the prevailing doctrines surrounding the miasmic transmission of disease understood it to operate much in the same manner as fermentation.

As in the process of fermentation itself, a minute quantity of some ‘virus’ seemed to be able to induce a particular change in a much larger volume of material. Thus it explained how the atmosphere could serve as a medium for the transmission of disease; ubiquitous and necessary to man’s existence, the air could become the source of illness through its very indispensability. ⁴⁸

Humoral medical doctrine, as previously stated, proposed that when the four bodily elements were in harmony that individual health was the naturally resulting state. Poverty, with its accompanying lack of resources, and more specifically, an inadequate, and often compromised, food supply, was recognized by these officials as a weakness that could ultimately impact the community at large. On 28 August 1835, when cholera was reported within several regions of Italy, as well as within the Grand-Duchy of Tuscany, the Florence health board discussed how improving diets by allowing the consumption of meat on all days of the week could serve to ward off disease and preserve health. ⁴⁹ A unanimous vote of all 12 members of the council determined that the Archbishop should write to obtain a dispensation from the Holy Father and relax the rigorous discipline of abstaining from the consumption of meat on Friday, Saturday, and other traditional religious fast days. ⁵⁰ Although such dispensation would not be necessary for the Jewish community, it does illustrate the health board’s effort to combat and counter the cholera epidemics through exploiting all the avenues of defence. This is further illustrated by the amounts annotated within the expense report of August to December 1835 to ‘preserve this city from the invasion of Cholera’ in Florence of almost 1300 Lira for meat and other edible foodstuffs to help support the overall health of the population. This document does not indicate if any of these foodstuffs were distributed within the ghetto of Florence.

In Ferrara, however, there is clear evidence that the health boards did actively assess the availability and quality of the food supplies within the ghetto. As previously related in the discussion of the 1831 inspection based upon the Regolamento Sanitario, prosperous members of the community were encouraged to engage in charitable efforts to ensure adequate sustenance levels for the needy and poor of the ghetto. Additionally, the inspection of the ghetto in 1835 indicated that it was observed that unhealthy food including, but not limited to, fruit was being offered for sale, and that the deputies were to proceed rigorously against this in accordance with the ordinances from 27 September 1831 and 2 April 1832. ⁵¹ Perceiving this hazard, the health commission decided to reissue the publication on the instructions and methods for preserving individual healthiness. ⁵²

Although the foundational elements surrounding miasmic and humoral medical theories are frequently derided in light of modern medical knowledge and our understanding of the role of bacteria and viruses in infectious disease, it is important to remember that some of the measures adopted by the health boards were in fact, effective. The injunctions to clean the refuse and dung heaps from the city streets and courtyards, the clearing, repair and maintenance of the sewers, the protection of the water supply, and efforts to improve the overall health of local citizens were all important strategies in mitigating the effects and transmission of disease, especially a disease with a faecal-oral mode of transmission of infection. Moreover, as these sources illustrate, the ghettos and their Jewish inhabitants were incorporated into the overall plan for attempting to ensure the safety of the cities and their residents from the threat of cholera. Unfortunately, these measures would not be enough to prevent cholera from advancing upon the Italian peninsula.

Cholera Strikes

The cholera outbreaks for the years 1835–1837 hit the regions of Italy with varying degrees of severity. Sicily was struck the most devastating blow, suffering a mortality rate of close to 36 out of every 1000 people, with a resulting death count of nearly 70,000. Lombardy suffered the next highest death rate of 13 out of every 1000 people and a total loss of life exceeding 32,000. In the Papal States 6731 deaths resulted from 11,915 cases. The Grand-Duchy of Tuscany had a slightly lower mortality rate of slightly fewer than two deaths per 1000 residents, totalling 2562. The Duchy of Modena escaped with minimal fatalities, and only 51 people were claimed by the disease, at a rate of less than one person per 10,000 inhabitants. That the situation could have been much different is exemplified by the number of lives lost in the neighbouring Duchy of Parma, where 5483 people died from contracting the cholera bacteria, at a rate of almost 12 per 1000. ⁵³

The rapid manner in which cholera attacked made it psychologically unmanageable: those who succumbed to it often died within a matter of hours, and the manner of their death was horrifying to nineteenth-century sensibilities which were increasingly focused on maintaining privacy regarding bodily functions. ⁵⁴ In addition to the preventative measures taken towards managing filth, Italian health boards were responsible for the functioning of hospitals, and some of the strategies related to this are found in both Ferrara and Modena. In Ferrara, the Health Commission detailed logistical provisions related to hospitals, medical supplies and the staffing of doctors, pharmacists, phlebotomists and priests in these facilities. Within the details of the inspection conducted in Ferrara and reported on 10 August 1835, is also found a note in which the Health Commission emphasized as critical the need to designate a suitable location for the isolation of anyone who was attacked by a disease generally considered to be contagious. ⁵⁵ The commission determined that the owners of such a property would be compensated for the loss, and that the costs incurred for making these provisions would be drawn from the Fondo de Beneficenza in accordance with the guidelines of article 13 of the Regolamento Sanitario. ⁵⁶

Approximately a month later, one of the main items under deliberation by the Health Committee on 3 September 1835 was the need to identify buildings appropriate for use as hospitals in the event of a cholera epidemic. ⁵⁷ Those selected included the former convent of Montara, the areas of San Giorgio and San Lucia, with the Palazzo Montecalini ⁵⁸ proposed as the hospital of the Jews. The Health Committee suggested the white buildings of San Nicolo and Casa Fornari in Via Squazzatori could be used if more space was required, and it was further noted that the Jesuit priests might offer the convent of San Bartolomeo for housing beggars, as these individuals are most likely to contract and spread infection. ⁵⁹ Clearly, the Health Commission viewed beggars, not Jews, as posing the greatest risk to the community: they were the outsiders, people without a legitimate place. Again, as with miasmic threats, the tradition of associating both individual Jews and Jewish communities with disease is not reflected in the records.

By November 1835, the situation across Italy was deteriorating and Cordones Sanitare were implemented. Italian health boards had long experience of establishing such preventative measures, as well as enacting quarantines when epidemics threatened, having adopted similar protocols since the fifteenth century in response to the plague epidemics. ⁶⁰ A notizia from the Ministry of Foreign Affairs of Modena on 8 November 1835 details the implementation of these restrictions, stating that only those in possession of a certificate of health from a recognized authority would be allowed entry into the duchy. All others were subject to a 10-day quarantine, and if they or their goods had travelled from regions that were known to be in the throes of a cholera outbreak, they were subject instead to a 14-day quarantine. The following day the Counselor of State declared that a formal Cordone Sanitare between the Este domains and the Papal States was in effect. ⁶¹

Almost a year later, the Azienda Ebraica, or Jewish community, petitioned on 17 July 1836 for relief from the tax burden of supporting cholera victims. The council warned that it was necessary, for the public benefit under such extraordinary circumstances, for the city to fund such necessary measures as has been done in similar cases. ⁶² This appears to have been agreed to, and, in August 1836, the council approved a proposal outlining the structural modifications required to transform a local building into a cholera hospital (lazaretto) for the Jewish community of Modena, which lists in great detail which windows and doors should be closed up by the masons and which should remain uncovered in order to provide both light and ventilation. Windows located too close to other homes were to be bricked over in order to prevent the spread of unhealthy fumes from the hospital to the surrounding neighbourhood. ⁶³ This determination again underscores the belief in the primacy of miasma as a source of disease transmission.

Cholera threatened again the following year, and in July 1837, a request from the Giudici Alle Vittovaglie was made to the Podestà to reinstate the lazaretto for the Jews: the Governor and other ministers apparently visited the site. ⁶⁴ The Council also drafted a letter that called for stocking the hospital with the appropriate medical supplies, fuel. A cart for transporting corpses to the cemetery, and confirmed that the physical modifications had been made to a suitable standard, and only minor repairs to the building were needed. It concluded with the request for an estimation of expenses for equipping the hospital, which was delegated to the Pulizia Amministrativa. ⁶⁵ This directive again illustrates municipal involvement and the use of public funds in providing resources to the inhabitants of the ghetto in the overall preparation of the city for an invasion of cholera.

Conclusion

It has been suggested that many European governments initially relied on strategies developed during plague epidemics when responding to the threat of cholera. ⁶⁶ The actions taken by these three cities’ municipal health boards support this conclusion, albeit with the additional emphasis placed on mitigating miasmic influences in alignment with the eighteenth-century trend which prioritized environmental factors. ⁶⁷ The reliance on the quarantine of foreigners and outsiders, cordons sanitaire between various states, and sanitation efforts within the city walls illustrate bureaucratic acceptance of, and adherence to, the prevailing medical theories and doctrinal practices. Furthermore, cholera initially appeared to conform to the humoral/miasmic medical paradigm, and many of the steps taken by the Italian health boards were in fact effective in combatting cholera due to its faecal/oral mode of transmission. However, the institutional values reflected in the bureaucratic records of these three cities is not a fear of disease transmission through contact-based contamination from the Jewish communities and their respective ghettos, as had occurred across the European continent during many of the plague episodes. Rather, what is reflected is a recognition that epidemic disease was a universal community issue and responses to this threat required the implementation of preventative measures and pragmatic responses across the confessional divisions embodied in the physical walls and gates of the ghettos.

Although not scientifically accurate, the foundational tenets of miasmic and humoral medical theory facilitated the understanding of disease as a communal issue – one that must be addressed across the entire urban landscape. Jews residing in the ghettos of these three cities were not identified as a source of disease and subjected to standards or protocols different to, or more stringent than, those implemented across the entire community. They do not appear to have been subjected to stricter regulatory requirements than their Christian counterparts. Furthermore, they received public funds for improving living conditions within the ghetto, and for the creation and maintenance of hospitals. They may have been outsiders in regards to the confessional divisions between Christianity and Judaism as expressed by the walls of ghetto, but they were insiders in relation to the urban environment.

As we have seen, the actions recorded in these sources illuminate the reality of ongoing administrative connections between the ghetto and the municipal authorities – the Jewish ghetto was not a hermetically sealed enclave inside the city walls and unconnected to the larger community – rather it was integrated into the overall planning and protection of the urban landscape in light of the external threat posed by the alien invader of Asiatic cholera. Moreover, we do not find accusations that Jews were the source of disease, or were actively engaged in its spread, nor were there violent pogroms against them, as was the case during the initial plague epidemics. ⁶⁸ Although the ghetto system had been restored with the return of absolutist power structures following Napoleon’s defeat, the Jewish residents were incorporated into city planning and defensive measures against the Asiatic invader of cholera. ⁶⁹ This evidence shows that even a traditional outsider can be integrated within the community, when there is a strong enough impetus for inclusion.