[Authors and titles are listed at the end of the review]
Epidemics have long held a particular place in the history of medicine. Just before and during the not long past global health crisis, conferences and scientific meetings were being convened on the topic of infectious diseases in antiquity, scrutinizing the written and bio-archaeological evidence on epidemics, examining their contexts and the problems inherent in their elucidation.[1] One such “après-midi d’études,” held virtually at the Université de Liège in May 2021, set out to consider in a comparative perspective the responses which the populations of the Greco-Roman world elaborated in the face of their own epidemics, from that which decimated Athens in the 5th century BCE to the Antonine “plague” in the 2nd century CE, and on to that which raged in the 6th century under Justinian. The volume comprises two parts. The first (Chapters 1–3) offers the texts of the three talks delivered that afternoon:[2] Bruno Rochette (Chapter 1) surveys Greek and Latin literature in search of accounts of historically attested epidemics, Marie-Hélène Marganne (Chapter 2) sheds light on the therapeutic strategies (recourse to religion and magic included) utilized by the ancients, and Antonio Ricciardetto revisits the thirteen private letters on papyrus commonly held to make reference to epidemics. The second half gathers most of the texts discussed by the first two contributors: excerpts from Greek and Roman historians, Latin epic poetry and Christian authors in Chapter 4, and Greek medical texts, primarily those of Hippocrates, Rufus of Ephesus and Galen in Chapter 5. An exhaustive bibliography completes the well-produced volume.
Rochette’s inquiry opens with Thucydides’ account of the Athenian plague of 430 BCE (Thuc. II 47, 2–54, 5) which he deems “l’archétype des récits d’épidémies antiques” owing to its charting the presumed spread of the disease (from Egypt by way of Ethiopia),[3] providing a clinical description of its symptoms and insisting on the moral dimension of the crisis. The author mentions the various attempts at diagnosing the (still) enigmatic sickness and rejects an identification with bubonic plague since Thucydides does not describe its distinctive buboes. A link with the vocabulary of medical writers notwithstanding, the Athenian historian is credited with discerning two fundamental principles unacknowledged by Hippocratic doctors: contagion and acquired immunity.[4] The Thucydidean exemplar is the thread that runs through Rochette’s treatment of six other historical narratives. Of the 31 instances of pestilence in Livy, he selects the one which coursed through Rome in 460 BCE when refugees from the countryside contaminated the city (III 6, 2–3) and that which overtook the Roman army before Syracuse in 212 BCE (XXV 26, 7–11), the account of which emphasizes contagion and the neglect of funerary rites. By contrast with Thucydides, Diodorus of Sicily’s description of the sickness which spread from the Carthaginians’ camp as they lay siege to Syracuse in 396 BCE (XIV 70,4–71,4) gives the Carthaginian ordeal a divine origin. Galen left no detailed description of the Antonine “plague,” transmitted to Rome by the imperial army after its victorious Babylonian campaign in 165 CE. Inscriptional evidence documents the diffusion of the epidemic, its deadly toll on soldiers and the upsurge in oracles, including one peddled by the quack Alexander Abonoteichus. When a pandemic reached Carthage in 252 CE (again from Ethiopia via Egypt) its bishop Cyprian fought the general pessimism with a treatise reminding Christians that death is a reward, not a punishment, and his brief catalogue of symptoms (de mortalitate 14) bears striking similarities to Lucretius’ description of the plague in Athens. Ammianus Marcellinus’ discussion of the destructive fever he witnessed at the siege of Amida in 359 CE (XIX 4) omits the symptoms of the illness, favoring aetiology over Thucydidean semiology. Rochette closes with Procopius’ account of the plague (said to have originated in Egypt) which broke out in Constantinople in 542 (Persica II 22, 1-23, 21). Here he detects the subtle mixture of scientific objectivity (Procopius describes the buboes) and rhetorical elaboration discernible in Thucydides, but the human-centered approach of the classical model is replaced by a Christian outlook focused on divine agency and the hereafter. A glance into Byzantine accounts of epidemic outbreaks confirms Thucydides’ enduring influence.
How did people in the Greco-Roman world protect and care for themselves during a widespread health emergency? As she formulates an answer to this challenging question, Marganne defines the concept of epidemic in antiquity, examines the conditions under which epidemics broke out and, from select concrete examples, analyses the therapeutic strategies available to the sick and their communities. Four options, not mutually exclusive, were on offer: “traditional” or popular medicine, “learned” or dogmatic medicine, religion, and magic.
To Hippocratic doctors, an epidemic is never linked to the notion of transmission through contact; rather, it is due to the influence of identical general conditions (airborne miasma, seasonal factors, local exposure to wind) on each sick person. In ancient medical thought, an illness is either “individual” or “general,” the latter affecting an entire community; it is then called loimos, “pestilence” (pestis, pestilentia, and febris pestilentialis in Latin) and is characterized by sudden onset, fast expansion within a group or a place (army, city, country), oftentimes high fever, and considerable mortality. Marganne’s discussion of therapeutic strategies is not linear but grows organically from the cumulative evidence of concrete examples of devastating epidemics, which themselves afford information about the particularities of their appearance, manifestation and aftermath. She points out that most of the population probably relied on traditional remedies drawn from locally available natural resources and on recipes transmitted orally within families or groups. Dogmatic medicine, the direct heir to the Hippocratic tradition, on the other hand, rejected the concept of contagion (well anchored as it was in an agrarian society familiar with epizootic outbreaks in livestock) and claimed that the presence of miasma in the air caused the spread of disease. Thucydides’ masterful description of the Athenian “plague” becomes the locus for a measured excursus on whether archaeology and paleopathology can confirm beyond doubt the retrospective diagnostic of the disease as either exanthematic typhus or smallpox—they cannot. The historian’s observation that neither doctors, supplications, or oracles proved effective leads to a discussion of religion and magic as healing resources. Indeed, in non-medical literature, Greek and Latin accounts of pestilence caused by the profanation of a sanctuary or the transgression of sacred rules highlight the link between the concept of infection and religious beliefs, a link which explains the recourse to purificatory rites, the isolation of the polluted, and the appeal to magical practices (e.g., amulets, invocation to healing deities, oracular consultations). The Antonine “plague” proved a golden opportunity for a fraud named Alexander who set up the cult, paired with an oracle, of a serpent called Glycon, avatar of Asclepius, at Abonoteichus on the Black Sea. Archaeology confirms the popularity of the oracle, a single dactylic hexameter spoken by the god himself, whose text is quoted by Lucian.[5] The line is attested on an amulet recovered in London in 1989 (reedited by Marganne in 2021) and on a fragmentary inscription found at Antioch of Syria, finds which testify to the diffusion of the disease. On the medical side, Galen reflected indirectly on this epidemic in a lost treatise discussing Thucydides’ handling of the Athenian precedent, while a generation earlier, Rufus of Ephesus, in his περὶ λοιμῶν (also lost), had discussed the causes and treatment of contagious diseases in accordance with Hippocratic theories in a chapter reproduced in the medical encyclopedias of late antiquity and beyond. Before a brief reflection on the Justinianic plague, considered in the context of the profound changes Christianity brought into society and its practices, Marganne sums up her findings on the ruptures in living conditions under which epidemics appear (large concentration of population, movements of people, food insecurity, and environmental changes), on their differing etiologies (miasmatic theory vs. a communis opinio acknowledging infection and contagion), and on the competing therapeutic strategies of dogmatic medicine, religion, and magic.
Prompted by the importance accorded the papyrological evidence in assessing the extent and impact of the epidemics that repeatedly disrupted the Roman empire, Ricciardetto offers an updated and balanced assessment of a body of Greek private letters in which references, actual or inferred, to pestilential events in Egypt have been detected. In so doing, he reexamines the corpus of six letters established by G. Casanova in 1984,[6] to which seven letters are added; that is, 13 letters in all (12 on papyrus and 1 ostracon), ranging in both date and provenance.[7] The author subjects each text and their scholarly elucidation to an exacting reexamination and concludes that not one letter mentions with certainty a pestilential episode; further, he convincingly argues that P.Lond. III 392 and P.Oxy. LV 3816 ought to be removed from the corpus.[8] He cautions against reading our own notion of epidemic disease into ancient texts written by non-medical professionals and judges the attempt to connect the epistolary references to historically attested outbreaks unproductive, given the scant dataset, the vague and often elliptical character of the language, the rare and imprecise mention of symptoms, and the fact that many texts are dated on palaeographical grounds (not to mention that editors sometimes try to date a text from the allusion to an epidemic which they have conjectured!).
In plumbing Greek and Latin literature, the history of medicine, and papyrology, these superb essays, individually and jointly, offer expert reflections and nuanced conclusions on the various contexts in which epidemics broke out in the Greco-Roman world and on the diverse explanations and competing and evolving responses which people gave to the devastating health crises they experienced.
Authors and Titles
Introduction by N. Carlig
- Chapter 1. Rochette, “Les récits d’épidémies historiques dans la littérature grecque et latine de Thucydide à Procope de Césarée.”
- -H. Marganne, “Les stratégies thérapeutiques mises en oeuvre lors des épidémies dans le monde gréco-romain.”
- Ricciardetto, “Les références à des maladies pestilentielles dans les lettres privées grecques de l’Égypte romaine et byzantine.”
- Rochette, “Choix de textes traduits. Textes historiques, poétiques et chrétiens.”
- M.-H. Marganne, “Choix de textes traduits. Textes médicaux.”
Notes
[1] Marganne (35-36) notes events held between 2018 and 2022.
[2] Recordings of the papers are accessible here: https://www.mondesanciens.uliege.be/cms/c_6206516/fr/mondesanciens-conferences
[3] A path examined in S.R. Huebner and B.T. McDonald, “Egypt as a Gateway for the Passage of Pathogens into the Ancient Mediterranean,” Journal of Interdisciplinary History LIV:2 (2023) 163–204. This article and the collection under review are mutually enriching.
[4] There follows a detailed examination of Lucretius’ programmatic adaptation of the Thucydidean account in RN VI 1138–1286.
[5] Φοῖβος ἀκειρεκόμης λοιμοῦ νεφέλην ἀπερύκει, “Phoebus with unshorn hair keeps away the cloud of pestilence” (Lucian, Alex. 36).
[6] “Epidemie e fame nella documentazione greca d’Egitto, ” Aegyptus 64, 163–201.
[7] Casanova’s corpus: P.Mich. VIII 510 (early 2nd c.), SPP XXII 33 (2nd or 3rd c.), P.Oxy. XIV 1666 (3rd c.), P.Strasb. I 73 (3rd c.), PSI IV 299 (end 3rd c.), P.Lond. III 982 = SB XXIV 16282 (late 4th c.). Additional texts: O.KaLa. inv. 652 (end of 1st c.), P.Oxy. LV 3816 (end 3rd/early 4th c.), P.Oxy. LV 3817 (3rd or 4th c.), P.Ross.Georg. III 2 (circa 270), PSI III 211 (5th c.), CPR XXV 34 (mid 7th c.), CPR XXV 29 (mid 7th c.).
[8] Some of the letters, along with mummy labels, death registrations, and administrative documents are discussed in Huebner-McDonald (2023) (supra n. 3) 177, 182–3, 187–8.