Plagues and Peoples (45 page)

35.
II, 48, R. Crawley translation.

36.
Since measles requires a population of over 400,000 to achieve a stable pattern of infection in modern times, and since the population of Athens was only about 155,000 in 430
B.C
., according to Gomme, op. cit., p. 47, the behavior of the disease does match well with that of modern measles, as Shrewsbury argues. Yet this does not suffice to identify it, since smallpox or some other kind of infection that has no contemporary descendant might also have behaved in the same way.

37.
Ancient Chinese medical writers have little to say about contagious eruptive fevers, according to A. Chamfrault,
Traité de Médicine Chinoise
, I, 722. Historians, however, often mentioned unusual epidemics among other natural disasters. At my behest, Dr. Joseph Cha prepared a digest of such mentions which appears in the Appendix.

38.
For an estimate of when and how the two canonical texts of ancient Indian medicine took shape, see H. R. Zimmer,
Hindu Medicine
(Baltimore, 1948), p. 45.

39.
So far as I can tell, this tradition arose among British medical officers in India in the nineteenth century who accepted uncritically claims made by practitioners of traditional Indian medicine to an immemorial antiquity for their authoritative texts. But once having entered the English-speaking world, such views, in the absence of any countervailing tradition, attained an enhanced virulence. For recent reaffirmations of this view, cf. T. Aidan Cockburn,
The Evolution and Eradication of Infectious Diseases
, p. 60; C. W. Dixon,
Smallpox
(London, 1962), p. 188.

40.
Cf. the multiple designations of syphilis in the sixteenth century.

41.
Traditional Indian medical writers refer clearly to malaria, to skin diseases, and to infection by worms, but none of the important civilized diseases—smallpox, measles, diphtheria, and the rest—are clearly recognizable from the Sanskrit phrases. Cf. Jean Filiozat,
La Doctrine Clas-
sique de la Médicine Indienne, Ses Origines et Ses Parallèles Grecs
(Paris, 1949); G. B. Mukhapadhaya,
History of Indian Medicine
, 3 vols. (Calcutta, 1923–29); O. P. Jaggi,
Indian Systems of Medicine
[History of Science and Technology in India, 4], (Delhi, 1973).

42.
Imperfect sixteenth-century records of how infections spread among Amerindians of North America, far outrunning direct contacts with infection-bearing whites, prove that in suitable circumstances an infection can propagate itself among quite thinly scattered human settlements across hundreds and perhaps (depending on where the infection started) even thousands of miles. On evidences of this phenomenon, cf. below,
Chapter IV
.

43.
Pliny,
Natural History
, XIX, 1, records a few unusually speedy voyages: Alexandria to Puteoli in less than nine days; Cadiz from Ostia in seven days; Ostia to Africa in two.

44.
Albert Herrmann,
Die Alten Seidenstrassen zwischen China und Syrien
(Berlin, 1910), pp. 3–9, 126. It is not entirely clear what China imported from the West. “Blood sweating horses” were the main imperial
desiderata
in the first years; the resumption of trade in the first century
A.D
. may have led to an export mainly of metals (including precious metals) from Roman territory eastward.

45.
W. McGovern,
Early Empires of Central Asia
(Chapel Hill, 1939), and René Grousset,
L’Empire des Steppes
(Paris, 1939).

46.
Herrmann, op. cit., p. 9.

47.
G. Coedès,
Les Etats Hindouisés d’Indochine et d’Indonésie
, (Paris, 1948), and H. G. Quaritch-Wales,
The Making of Greater India
(London, 1951), give political and cultural details.

48.
R. E. M. Wheeler,
Rome Beyond the Imperial Frontiers
, (London, 1954), pp. 174–75; Coedès, op. cit., p. 38.

49.
Wheeler, op. cit., pp. 146–50.

50.
Strabo,
Geography
, 17, 1.13, “In earlier times, at least, not so many as twenty vessels would dare to traverse the Arabian Gulf … but at the present time even large fleets are despatched as far as India and the extremities of Aethiopia, from which most valuable cargoes are brought to Aegypt.… ” H. L. Jones, trans., Loeb Library edition.

51.
Diffusion of disease along caravan routes continued to occur in the nineteenth to twentieth centuries, and was sometimes more or less accurately recorded by European medical officers. For details of one such process—the spread of relapsing fever with the salt trade of east Africa—see Charles M. Good, “Salt, Trade, and Disease: Aspects of Development in Africa’s Northern Great Lakes Region,”
International Journal of African Historical Studies
, 5 (1972), 543–86. This offers a quite exact analogy to the way in which other diseases presumably must have spread along ancient caravan routes of Central Asia.

52.
Thorkild Jacobsen and Robert M. Adams, “Salt and Silt in Ancient Mesopotamian Agriculture,”
Science
, 128 (1958), 1251.

53.
Conveniently catalogued by Georg Sticker,
Abhandlungen aus der Seuchengeschichte
I, 20–21.

54.
Suetonius,
Lives of the Caesars
, “Nero” 39:1, says 30,000 persons died in the city of Rome in the autumn of that year.

55.
So Sticker, op. cit., p. 21, following the weighty opinion of August Hirsch,
Handbook of Geographical and Historical Pathology
, Charles Creighton, trans., 3 vols. (London, 1883–86), I, 126.

56.
In recent times when such a familiar disease as measles penetrated a previously unaffected community, initial die-off of up to 25 per cent has been observed, due largely to a breakdown of elementary nursing services. The classic example of this sort of disaster was recorded by William Squire, “On Measles in Fiji,” Epidemiological Society of London,
Transactions
, 4 (1877), 72–74. What happened in Fiji in the 1870s corresponds well enough to what seems to have happened in a small Egyptian town, where records show a 33 per cent decrease of population between
A.D
. 144–46 and 171–74. Cf. A. E. R. Boak, “The Populations of Roman and Byzantine Karanis,”
Historia, 4
(1955), 157–62. For an account of how lethal measles still can be among primitive peoples, see James V. Neel et al., “Notes on the Effect of Measles and Measles Vaccine in a Virgin Soil Population of South American Indians,”
American Journal of Epidemiology
, 91 (1970), 418–29.

57.
Scholarly opinion is now pretty well agreed that decay of Roman population began under the Antonine emperors. Cf. A. E. R. Boak,
Manpower Shortage and the Fall of the Roman Empire in the West
(Ann Arbor, 1955), pp. 15–21; J. F. Gilliam, “The Plague under Marcus Aurelius,”
American Journal of Philology
, 82 (1961), 225–51.

58.
So Boak,
Manpower Shortage
, p. 26.

59.
It is customary to call the disease al-Razi described smallpox, and so it may have been. Cf. August Hirsch,
Handbook of Geographical and Historical Pathology
, I, 123. But confusion between smallpox, measles, and scarlet fever remained chronic among Arabic and European medical writers from al-Razi’s time until the sixteenth century. Ibid., I, 154–55.

60.
Gregory of Tours,
History of the Pranks
, O. M. Dalton, trans. (Oxford, 1927), V, 8:14. “A great pestilence raged among the people during this year, great numbers were carried off by various malignant diseases, the symptoms of which were pustules and tumors.… ”

61.
For a clear reference to pustules and fever, cf. Galen,
Methodi Medendi
, XII. For a defense of Galen’s behavior during the epidemic (he left Rome and returned home to Asia Minor), see Joseph Walsh, “Refutation of the Charges of Cowardice against Galen,”
Annals of Medical
History
, 3 (1931), 195–208. This is a better article than its title might suggest.

62.
By definition, with the breakup of effective central administration, data disappear upon which estimates of population over wide territories might be based. An effort to guess at the decay of Roman population by projecting from the putative size of populations within walled cities has been made by J. C. Russell, “Late Ancient and Medieval Population,”
American Philosophical Society Transactions
, 48 (1958), 71–87. He finds a population decay of 50 per cent between Augustan times and
A.D
. 543, but his method is open to objection, and the data on which his calculations are based remain both fragmentary and dubiously accurate.

63.
For example, Eusebius,
Ecclesiastical History
, VII, 21–22.

64.
Cyprian,
De Mortalitate
[Mary Louise Hannon, trans.] (Washington, D.C., 1933), pp. 15–16.

65.
Procopius,
Persian Wars
, II, 22.6–39. Justinian himself fell ill but recovered.

66.
Cf. the chart and admirable maps of the periodicity and geographic extent of epidemics between 541 and 750 presented in J. N. Biraben and Jacques LeGoff, “La Peste dans le Haut Moyen Age,”
Annales: Economies, Sociétés, Civilisations
, 24 (1969), 1492–1507.

67.
Hirsch, op. cit., I, 494–95.

68.
Cf. M. A. C. Hinton,
Rats and Mice as Enemies of Mankind
(London, 1918), p. 3.

69.
Cf. J. F. D. Shrewsbury,
A History of Bubonic Plague in the British Isles
(Cambridge, 1970), pp. 71–131; Biraben and LeGoff, op. cit.; J. C. Russell, “That Earlier Plague,”
Demography
, 5 (1968), 174–84. For details of modern understanding of the epidemiology of plague, R. Pollitzer,
Plague
(World Health Organization, Geneva, 1954) is the best source.

70.
For maps of twentieth-century plague endemicity see Geddes Smith,
Plague on Us
(New York, 1941), p. 320; D. H. S. Davis, “Plague in Africa from 1435 to 1949,” World Health Organization,
Bulletin, 9
(1953), 665–700; Robert Pollitzer,
Plague and Plague Control in the Soviet Union: History and Bibliography to 1964
(New York, 1966).

71.
Cf. J. F. D. Shrewsbury,
The Plague of the Philistines
(London, 1964); Hans Zinsser,
Rats, Lice and History
, pp. 80–81.

72.
Procopius,
Persian Wars
, 23:1.

73.
Michael W. Dois, “Plague in Early Islamic History,”
Journal of the American Oriental Society
, 94 (1974), 371–83. Cf. also Biraben and LeGoff, op. cit., maps on pp. 1504, 1506.

74.
Biraben and LeGoff, op. cit., pp. 1499, 1508, make these suggestions and appropriate tentativeness.

75.
Cf. Charles Creighton, A History of Epidemics in Britain, 2 vols.,
2nd edition (New York, 1965) [original publication Cambridge, 1891–4], I, 409; J. F. S. Shrewsbury, “The Yellow Plague,” Journal of the History of Medicine, 4 (1949), 15–47; Wilfrid Bonser, “Epidemics During the Anglo-Saxon Period,” Journal of the British Archaeological Association, 3rd series, 9 (1944), 48–71.

76.
Bonser, op. cit., pp. 52–53.

77.
Cf. the classic report, Peter Ludwig Panum,
Observations Made During the Epidemic of Measles on the Faroe Islands in the Year 1846
, reproduced in English translation in
Medical Classics
, III (1938–39), 829–86. In this epidemic, 6,000 of 7, 782 inhabitants got the measles, which had not visited the islands since 1781; but only about 102 died. Ibid., p. 867.

78.
This task was performed for me by Dr. Joseph Cha. This compilation is by no means perfect: further combing of ancient sources would probably add to the roster of epidemics and might alter the apparent pattern of frequencies this table suggests. On the other hand, really major epidemic disasters are probably here recorded fully; and it is these that principally interest me. For this reason and because Dr. Cha’s list is clearly superior to either of the older lists of Chinese epidemics available in print, it seemed well to reproduce it here.

79.
K. Chimin Wong and Wu Lien-teh, History of Chinese Medicine: Being a Chronicle of Medical Happenings in China from Ancient Times to the Present Period, 2nd ed. (Shanghai, 1936), p. 28.

80.
Translation by Joseph Cha. Wong and Wu Lien-teh simply skip the passage referring to
A.D
. 653, no doubt on the ground that it is a later interpolation; but since the text has clearly been tampered with, the whole passage might also be late. The time of Chien-wu is a regnal title: but unfortunately two Chinese emperors took this regnal name; the second occupied the throne for a single year—
A.D
. 317; the first reigned thirty years,
A.D
. 25–55.1 have been unable to pin down the reference to fighting barbarians at Nan-yang; this would perhaps settle the choice between
A.D
. 317 and
A.D
. 25–55. Western medical men have accepted
A.D
. 317 as the date for the arrival of smallpox in China since at least the 1860s. Cf. C. A. Gordon,
An Epitome of the Reports of the Medical Officers of the Chinese Imperial Customs from 1871 to 1882
(London, 1884), p. 74. But no really scholarly investigation seems to underlie this view.

81.
Wu Lien-teh,
Plague
, p. 11. He translates the 610 text by Cha’o Yuan-fang as follows: The disease “comes on abruptly with high fever together with the appearance of a bundle of nodes beneath the tissues. The size of the nodes ranges from a bean to a plum.… The nodes may be felt to move from side to side under the skin. If prompt treat
ment is not given, the poison will enter the system, cause severe chill and end in death.”