Exhaustive Note: Epidemics and Pandemics in the Ancient Mediterranean

Etymology and Conceptual Scope of Mass Illness

• Epidemic: Derived from the Greek words describing an illness that fell "upon" ($epi$) everyone within a "city" ($dēmos$).

• Pandemic: Derived from the Greek words describing an illness that fell upon "all" ($pan$) of the "cities" ($dēmoi$) of the known world.

• As noted in Chapter 3, the epidemiological conditions of ancient Mediterranean cities were ideal for pathogens to flourish and for communicable illnesses to spread quickly.

• While some contagious diseases remained contained within a single city, others spread more widely to become regional or global pandemics.

Infrastructure as a Pathogen Vector

• Local outbreaks frequently exploded into full-blown pandemics because communities across the Mediterranean were connected by basic infrastructure.

• Infrastructure Specifics: The Romans constructed approximately $250,000\,\text{miles}$ of roads.

• These roads served multiple purposes:

  • Making travel and trade between regions more accessible.

  • Becoming a primary vector by which illnesses spread between distant communities.

• The Transmission Process: As people moved between regions, they carried local strains of pathogens. Because these strains were novel to the faraway communities they reached, those populations had no pre-existing immunity to them.

• Consequently, the most devastating epidemics were consistently centered in densely populated urban environments.

Case Study: The Plague of Athens ($430$--$427\,\text{BCE}$)

• Context: The plague exploded within Athens while the city was under siege during the Peloponnesian War.

• Living Conditions: Athenian citizens living in the countryside sought protection within the city's fortified walls. This led to highly concentrated living conditions that exacerbated the spread of communicable illness.

• Military Impact:

  • Transmission was rampant in the close quarters of army encampments and naval ships.

  • One eyewitness reported that the epidemic destroyed his unit, killing $1,050$ out of $4,000$ hoplites in just $40\,\text{days}$.

  • Contemporary remarks described naval ships struck by the plague as "floating tombs."

• Estimated Death Toll: Scholars estimate that in three years, the plague killed $75,000$--$100,000$ people in Athens, wiping out $25\%$--$35\%$ of the city’s total population.

Case Study: The Justinianic Plague ($541$--$543\,\text{CE}$)

• Context: Centered in the city of Constantinople during the reign of the Emperor Justinian.

• Reported Death Tolls: Accounts from the time claim that daily deaths reached $10,000$--$16,000$ people.

• Scholarly Revision: Historians believe the contemporary reports of daily death tolls were likely inflated. However, even conservative estimates conclude the plague killed between one-third ($1/3$) and one-half ($1/2$) of the entire population of Constantinople.

The Human and Physical Experience of Mass Disease

• Primary Historical Sources:

  • Thucydides: An Athenian general and historian who provided a firsthand report on the Plague of Athens (Text 18).

  • Procopius: An ancient historian who provided reports on the Justinianic plague (Text 19).

• Physical Agony and Symptoms (Justinianic/Procopius):

  • Fever and extreme fatigue.

  • Violent delirium.

  • Bloody vomiting.

  • Bubos: Swollen, blackened lymph nodes that sometimes discharged pus (associated with the Justinianic plague and the 14th-century Black Death).

• Atmospheric Impact:

  • Because the digging of mass graves could not keep pace with the deaths, corpses were strewn about the city, piled on seashores, or thrown into the sea.

  • A "putrefying stench" permeated the city.

• Emotional and Psychological Distress:

  • Caregivers and family members felt hardship, disgust, and repulsion.

  • Fear of contagion led people to avoid even beloved friends.

  • Overwhelming grief was caused by death and the inability to perform proper burial rites.

Ethical and Moral Crisis in Caregiving

• Abandonment: Fear of contagion prevented some from offering aid, leading to the sick being abandoned to perish alone.

• Selfless Nursing: Other individuals provided care at the expense of their own health.

• Procopius’s Account of Caregiving: Caregivers were "driven to exhaustion" because the sick required constant surveillance. Sufferers in delirium would fall out of bed and roll on the floor, requiring them to be physically "pushed and pulled" to remain still.

• Because of the difficulty of this labor, contemporary observers often pitied the caregivers as much as the patients themselves.

Impact on Societal Structures and Norms

• Positive Social Shift: Some accounts report people setting aside long-standing enmity for former rivals to unite in mutual care.

• Social Disorder and Economic Halt:

  • People abandoned work due to fear or weariness.

  • Agriculture failed: Grain and fruit rotted in fields; livestock (cattle, sheep, goats, pigs) roamed wild.

  • Production and trade came to a complete halt, creating food and supply shortages.

  • Riots and Looting: Desperation led to lawlessness as markets became empty.

• Psychological Fatalism: Many believed they would die soon or that the end of the world had arrived, leading to the abandonment of all social norms and legal constraints.

Religious and Medical Sense-making

• Religious Explanations: Mass illness was viewed as divine punishment. People flocked to sanctuaries to atone for sins and petition gods for relief.

• Miasma Theory:

  • Based on the Greek and Latin term for "stained" air adverse to health.

  • Theorized that the cause was something shared by the community, specifically the air they all breathed.

  • Miasma was believed to derive from putrefying matter, such as stagnant marshy waters or unburied human corpses on battlefields or in mass graves (theories held by Diodorus of Sicily and Galen).

• Hippocratic Medical Advice (based on Miasma):

  • Advised people to flee the region with contaminated air.

  • If flight was impossible, people were advised to reduce food and drink intake to become thinner and take in fewer, shallower breaths of "bad air."

Failure of Interpretation and Remedy

• Inexplicability: Pandemics often remained incomprehensible to the people surviving them.

• Clinical Frustration: Procopius noted that physicians could not understand the illness even after dissecting bubonic swellings from corpses.

• Arbitrariness: Thucydides and Procopius noted there was no predictable pattern as to who was spared and who was struck down. A remedy that helped one patient might prove useless or harmful to another. This arbitrary nature made the epidemics especially frightful.

Modern Diagnostic Methods: Paleogenetics

• Traditional Approach (Symptomatology):

  • Attempted "retrospective diagnosis" by matching ancient descriptions with modern illnesses (e.g., smallpox, typhus, influenza).

  • Problems: Assumes eyewitnesses were objective (forgetting they wrote for dramatic/horrific effect) and ignores the fact that pathogens mutate and change symptoms over time.

• The Modern Shift (Paleogenetics):

  • A more exact approach developed in the last two decades.

  • Case Study: $Yersinia pestis$: Scientists unearthed remains from cemeteries where plague victims were buried. Geneticists extracted and sequenced pathogen DNA from the human remains.

  • Findings: DNA sequencing identified the bacterium $Yersinia pestis$ as the culprit for the 14th-century Black Death. Comparing this to remains from other sites confirmed that $Yersinia pestis$ was responsible for three separate pandemics:

    1. The Justinianic Plague ($6\text{th century}$).

    2. The Black Death ($14\text{th century}$).

    3. A pandemic in the $19\text{th century}$.

Text 18: Thucydides' Detailed Account (The Plague of Athens)

• Thucydides (c. $460$--$395\,\text{BCE}$): An Athenian general and historian who caught the plague himself and survived. His account (Book 2. 47-54) is based on personal observation and interviews.

• Origin and Spread:

  • Believed to have started in Ethiopia (beyond Egypt) and spread through Egypt, Libya, and Persian territory.

  • Entered Athens suddenly, first affecting the port of Peiraeus. Citizens initially alleged the Peloponnesians had poisoned the wells.

• Virulence: The mortality rate was highest among doctors because of their frequent exposure. Religious supplications and oracles were found to be completely useless.

• Symptom Progression in Thucydides' Document:

  • Sudden onset in healthy individuals.

  • Head: High fever, reddening/inflammation of the eyes.

  • Internal: Bleeding of the throat/tongue, foul-smelling breath ($pneuma$).

  • Respiratory: Sneezing, hoarseness, violent cough.

  • Gastrointestinal: Turmoil in the stomach, voiding of every known form of bile, intense pain, empty retching, and violent spasms.

  • Extensive Body Effects: Body was reddish and livid with small pustules and ulcers. Sufferers felt intense internal burning heat; many threw themselves into cisterns to satisfy an insatiable thirst.

  • Duration: Most died from internal fever within $6$ to $8\,\text{days}$. If they survived that, it progressed to the bowels with heavy ulceration and liquid diarrhea.

  • Residual Effects: Survivors often lost extremities (genitals, fingers, toes) or their sight. Some suffered total amnesia (loss of memory), unable to recognize themselves or friends.

• Environmental Observation: While many bodies lay unburied, carrion birds and dogs that preyed on human flesh either disappeared or died if they ate the corpses.

• Social Breakdown in Athens:

  • Cros-infection: People "died like sheep" while caring for others.

  • Psychological Shift: Survivors felt "fond hope" they were immune to all future diseases because the plague did not strike the same person twice fatally.

  • Overcrowding: Rural refugees lived in stifling huts where the dead and dying were piled on top of each other.

  • Sacrilege: Sancturaries occupied as shelters were filled with corpses; funeral customs were abandoned. People burned their dead on others' pyres or threw bodies on already lit fires.

  • Lawlessness: Prosperity shifted rapidly to those previously poor. People pursued immediate physical pleasure, believing life and wealth to be fleeting. "Immediate pleasure… became the new honor and the new value."

Supplemental Information: Figure 36 and Historical Misconceptions

• The Hippocrates Illustration: A medieval manuscript of "On Epidemics" shows Hippocrates treating an Athenian plague victim with a visible bubo in the groin.

• Historical Accuracy Warning: Contrary to the illustration, reports from the Plague of Athens do not describe bubos. Buboes were symptoms of the Justinianic Plague and the Black Death, which the medieval illustrator anachronistically projected backward in time.

• Biographical Myth: Stories of Hippocrates visiting Athens during the plague were invented by later biographers and were not contemporary facts.