CHAPTER IV

Into his great poem ‘On the Nature of Things’ (De Rerum Natura) Lucretius has grafted a description of the plague of Athens, converting the record of Thucydides into Latin hexameter verse. His prime motive in its introduction is to show that the chief phenomena of nature, and pestilence as one of these, all harmonize with the atomic theory, that he has adopted from Democritus and Epicurus. Lucretius indeed propounds an atomic explanation of pestilence, consonant in its main features with the doctrines of his contemporary Asclepiades. We can reason of the imperceptible, he argues, only from our knowledge of the perceptible. Our eyes see clouds descend from the sky, and noxious vapours rise as mists from the land. Our minds then may not unreasonably infer, that pestilence also either comes down from heaven by the medium of clouds, or rises up from the rain-sodden earth by the medium of mist. In each manner the atmosphere becomes impregnated with noxious atoms that distemper it. These particles enter our bodies, either by the air we breathe, or by the food and drink they have contaminated, and thus provoke infection. Such, he holds, was the cause of the plague of Athens.

The views of Lucretius as to the proximate causes of pestilence are almost identical with those of his contemporary, Diodorus Siculus. With each of them moisture, as cloud or mist, distempers the air or damages food, and so finds entry into lungs or stomach. With each an ill wind may engender pestilence: with Lucretius, by bringing a harmful to replace a beneficent atmosphere: with Diodorus Siculus, by failing to cool the air to an appropriate temperature, thus causing fever. ToLucretius clouds, mists, and winds are carriers of noxious particles. In this atomic theory of infection he faintly foreshadows the doctrine of particulate poisons, that held the field of scientific speculation within the memory of living men. But even so Lucretius came less near the truth than his great contemporary Varro,[92]who actually ascribes disease in animals to living organisms beyond the range of human vision (‘crescunt animalia quaedam minuta, quae non possunt oculi consequi, et per aera, intus per os ac nares perveniunt atque efficiunt difficiles morbos’).

To Lucretius pestilence is a purely natural process, in which there is no place for the handiwork of gods. Of this theme, in varying applications, he is a fierce exponent throughout the length and breadth of his poem. Perhaps it is for this reason that he chose the narrative of Thucydides as the basis of his poem, for Thucydides, too, referred epidemic pestilence to natural causation, not to the special act of any god. Like Thucydides, too, Lucretius accepts without reserve the doctrine of contagion:

Qui fuerant autem praesto contagibus ibantAtque labore.(Those who had stayed near at hand would die of contagionand the toil.)

Qui fuerant autem praesto contagibus ibantAtque labore.

(Those who had stayed near at hand would die of contagionand the toil.)

Pestilence, too, affords Lucretius a rare text for the exposure of the hollow sham of state-worship, which represented now all that survived of religion in Rome. We have seen how much of Roman religion had its origin from time to time in the necessity of exorcising pestilence: and we have seen how popular superstition revivified the ritual of popular atonement. Now the Sibylline books are consulted. Now a nail is driven into the temple of Jupiter. Now Apollo is brought to Rome, and a temple erected in his honour. Now Aesculapius comes in the form of a serpent to deliver Rome: now Hygieia. Now sacrifices are offered and feasts setout before the statues of the gods. This is the fabric that Lucretius, fired with iconoclastic zeal, would fain demolish, not as the enemy of religion, but as the ruthless enemy of religious sham.

In literary form this part of the great Lucretian poem falls far below the rest. The poem as a whole possesses a rugged grandeur of its own, but this terminal portion, while retaining all the ruggedness, has lost most of the grandeur. It gives the impression of having been merely rough cast, to await the polishing, which, owing to the premature death of the poet in 55b.c., it never received. Fault also may be found with the literary substance, for in places he misunderstands the language of Thucydides, and misrepresents his meaning. Again, he incorporates here and there fragments of Hippocrates and fancies of his own into the record of Thucydides, as though all disease presented a single clinical facies. For example, he reproduces ascorthe καρδία of Thucydides, which the latter used, as did Hippocrates, for the cardiac end of the stomach. Again, he misinterprets Thucydides with regard to the effect of the disease on the extremities. He represents στερισκόμενοι τούτων asferro privati, whereas clearly Thucydides means that the parts sloughed off, not that they were amputated. It would seem that Lucretius was versed in the Greek language of his day, but that language was no longer the Greek of Thucydides and Plato. Nor does Lucretius scorn the full licence that Horace accords to the poet, and exigencies of metre sometimes compel him not to adhere strictly to his model: thus he transforms the critical days into the eighth and ninth. One long passage beginning

Multaque praeterea mortis tum signa dabantur

consists of various excerpts from Hippocrates turned into Latin verse. These are gathered from such diverse parts of the Hippocratic writings, as to indicate considerable acquaintance withthem. The lineaments of the Hippocratic facies are reproduced in detail. The fact is that Lucretius was more anxious for the picturesqueness than for the accuracy of his description, provided always that the logical soundness of the main thesis and its didactic purpose were not compromised thereby.

In his picture of the mythical plague that afflicted the people of Aegina, Ovid[93]exacts contributions alike from Thucydides, Lucretius, and Vergil, while there are certain features that bear a strong resemblance to Diodorus Siculus. His story is that Minos, King of Crete, the second king of the name, goes in quest of allies to the island of Aegina, and courts unsuccessfully the aid of its king Aeacus. As soon as he has departed, Cephalus comes as ambassador from Athens and obtains help from Aeacus, who gives him an account of the pestilence that had formerly raged in Aegina, and dwells on its marvellous repeopling. Ovid maintains sufficient independence of his models for us to be able to gather something at least of current ideas of pestilence, set though it is in an atmosphere of antiquity. At first the disease was referred to natural causation and so was combated by medicines:

Dum visum mortale malum tantaeque latebatCausa nocens cladis, pugnatum est arte medendi.Exitium superabat opem, quae victa iacebat.

The tendency was now to regard pestilence as a natural process, until it overstepped habitual limitations, and triumphantly defied the resources of orthodox medicine. Then popular imagination saw in it the hand of a god, and forthwith set it outside the confines of recognized pathology. So now Ovid ascribes the Aeginetan plague to the anger of Juno, because the island was named after her adulterous rival Aegina, who was carried there by Jupiter, and by him became the mother of Aeacus, King of Aegina. But side by side with this Ovid lays stress onvarious meteorological phenomena, that accompanied or preluded the pestilence—the earth encompassed with gross darkness, a drowsy heat in the clouds, and persistent hot winds, as though he believed in some close causal connexion. He conceives the virus to be communicable in water, for fountains and lakes were deemed to be infected, and the rivers tainted with the venom of innumerable snakes. He dwells at length on the epizootic, and elaborates this feature far more even than Livy, and true to the habitual character of Roman pestilence, he makes it precede the human epidemic. He holds fast the doctrine of contagion, which he conceives to be transmitted by the dead as well as the living. Ovid’s description of pestilence unmasks his shallow nature. He shows himself to be no more and no less than an elegant literary trifler. One feels in the easy flow of his verse and the light vagaries of his picturesque imagination an unconcern and indifference to the horrible realities he handles. He has no power, like Thucydides, to plumb the depths of pathos, and the reader turns from his catalogue of sufferings with no emotion of horror, still less with one of sympathy. One looks in vain for some vestige of the moral earnestness of Lucretius. Even for his deities the springs of action reside in the lowlier human passions. Caprice and jealousy move Juno to send the pestilence: humanity is the sport of these infirmities. When man’s conception of Divine Providence had sunk so low, it was well that Imperial Rome should be without religion.

Manilius,in hisAstronomica,[94]composed about the Christian era, asserts with confidence, that comets presage pestilence. The belief is probably far older than Manilius, though it is difficult to cite exact authorities. Livy[95]speaks of a bright light in the sky before the plague of 462b.c.; ‘coelum ardere visum est plurimo igni’: and Dionysius of Halicarnassus[96]recounts the lighting up of a fire in the heavens before that of 450b.c.: ἐν οὐρανῷ σέλα φερόμενα καὶ πυρὸς ἀνάψεις.Allusions such as these would seem to signify the appearance of a comet. Vergil[97]is even more explicit:

Non secus ac liquida si quando nocte cometaeSanguinei lugubre rubent, aut Sirius ardor,Ille sitim morbosque ferens mortalibus aegrisNascitur, et laevo contristat lumine coelum.

Of their supposed malign influence on human affairs in general there is no doubt. Tacitus[98]assigns to them even a political significance, for he says that in popular opinion they always portend a revolution to kingdoms.

Seneca,[99]in hisPhysical Science, makes the specific statement that ‘after great earthquakes it is usual for a pestilence to occur’. The concurrence of the two had been mentioned previously by Thucydides, Diodorus Siculus, Livy, and others, but Seneca would seem to be the first to attempt to define the exact relation of the one to the other. In the Campanian earthquake ofa.d.63 a flock of 600 sheep had perished mysteriously, near Pompeii. Seneca conceives that earthquakes liberate poisonous fumes imprisoned in the earth, or pent up in marshes, which serve to taint the air. Flocks suffer most, he thinks, because they live in the open, and also drink the poison-laden water. They feed too with heads close to the ground and so receive the concentrated venom, before it has become diluted: and then he adds: ‘If it had issued in greater volume, it would have injured man too, but the abundant supply of pure air counteracted it, before it could rise high enough to be breathed by any human being.’ And he proceeds: ‘The better is ever conquered by the worse. Even that pure air of heaven changes then to pestilential. Thence come sudden and continuous deaths, and portentous forms of disease, that spring from unexampled causes. Thedisaster is long-or short-lived according to the strength of the sources of infection. Nor does the plague cease, until the freedom of heaven and the tossing of the winds have banished that fatal air.’

Seneca had probably stumbled on the true explanation of the death of the Campanian sheep, for Geikie says that after an eruption of Mount Vesuvius the escape of carbonic acid gas has been known to suffocate hundreds of hares, partridges, and pheasants. Seneca, in conformity with the learned opinion of his time, regards volcanoes and earthquakes as closely allied phenomena. Earthquakes were regarded as the product in the main of violent commotion of the air. Niebuhr, like Seneca, expressed a firm belief in earthquakes and volcanic eruptions as causes of pestilence, a thesis that many writers have sought to substantiate. It is tempting, even to-day, to speculate on migrations of rats set in motion by subterranean activity. But a careful survey of a sufficient series of earthquakes and plagues lends little support to such a proposition. Each may occur alike before or after, with or without the other, and their frequent concurrence in ancient history denotes no more than that the eyes of historians were focused, almost exclusively, on a narrow tract of land around the shores of the Mediterranean, in which earthquakes were and are notoriously of frequent occurrence. Two years after the great earthquake Campania was devastated by a hurricane, and Rome desolated by pestilence. Tacitus[100]says that the pestilence swept away ‘all classes of human beings without any such derangement of the atmosphere as to be visibly apparent. Yet the houses were filled with dead bodies and the streets with funerals.’ Tacitus declares unhesitatingly for the production of pestilence by natural and not by supernatural agency.

The yeara.d.79 is ever memorable for the destruction ofHerculaneum and Pompeii. It was followed by pestilence, which Dion Cassius attributes to ashes from Vesuvius. Dust had been suspect from the remotest ages of antiquity. At the time of the Exodus Moses was told to sprinkle dust before heaven. ‘And it shall become dust in all the land of Egypt, and shall be a boil breaking forth with blains upon man.’ Livy and Plutarch each attributed the plague that broke out among the Gauls, when besieging Rome under Brennus, to the dust and ashes of the houses they had burnt. Philo, too, ascribes a pestilence of about the yeara.d.92 to hot dust irritating the skin.

Dion Cassius[101]mentions a plague that broke out in the reign of Domitian (a.d.81-96), and which may be the same as that mentioned by Philo. ‘Certain individuals’, he says, ‘poisoned needles and set to work to prick whomsoever they wished: several who were pricked died without knowing anything about it: but some of the scoundrels were denounced and punished; and that happened not only in Rome, but over all the world so to say.’ Some initial punctiform eruption may perhaps have simulated a needle-prick. Belief in the dissemination of pestilence by the cutaneous inoculation of poison was destined to flourish for many centuries. Dion Cassius[102]himself repeats the statement in the case of another pestilence in the reign of Commodus (a.d.187): ‘In the reign of Commodus occurred the most violent sickness I have ever known: at Rome two thousand persons often died in a single day. But many died, not only in Rome, but in all parts of the empire, in another manner: scoundrels, poisoning little needles with certain noxious substances, transmitted the disease in this way for pay: this had been done already in the reign of Domitian.’ For three years then famine and pestilence worked hand in hand to ruin Rome, and the people in their fury clamoured for a victim. A pleasantsacrifice was handy in the Phrygian freedman Cleander, the greedy and infamous minister of Commodus. It was eagerly bruited that Cleander had hoarded wheat, and the maddened populace, surging to the palace of Commodus, clamoured for the head of the hated favourite. The Emperor, fearful for his own life, at the instance of the women of his court demanded that the head of Cleander should be thrown from the palace to the people. The spectacle of this bloody expiation appeased the fury of the rabble. On the advice of his physicians[103]Commodus himself beat a hasty retreat to Laurentum, to seek an antidote in the scent of its abundant laurels. Those who remained in Rome filled their noses and ears with sweet ointments, to neutralize the pestilential exhalations from infected bodies and from the contagious atmosphere. At last a Roman emperor is found, in presence of pestilence, consulting—not the Sibylline books, not the oracle, not the omens—but a physician, and obeying his instruction. Medicine has tardily come into her own, and Pliny’s sarcasm, that Rome prospered for 600 years without physicians, has lost its sting. But we shall see presently that the hour for professional exaltation is not yet.

The great Antonine plague—the long plague, as Galen calls it, for it lasted no less than fifteen years[104]—was brought to Rome from the East by the Syrian army of Verus, abouta.d.165. Ammianus Marcellinus[105]sets its commencement in the sacrilegious folly of some Roman soldiers at the sack of the city of Seleucia. These men wrenched from its site a statue of Apollo, and from a narrow aperture beneath its pedestal the pestilence escaped, carrying death wherever it went. Julius Capitolinus (c.a.d.300) confirms the statement of Ammianus Marcellinus, except in that he traces the source of origin to a small golden coffer in this same temple of Apollo. Carried thence bythe victorious army to Rome, it found there conditions favourable to its propagation in an already existing famine, in the accumulation of the soldiery, and in the concourse of spectators, who had come to see the triumph of the joint emperors duly celebrated. Of the mortality at Rome no figures exist, but it is said to have been very great. Dead bodies were so numerous, that they were carried to burial heaped up in carts. Aurelius[106]paid the dead the tribute of a public funeral, and erected statues to the memory of many men of high estate. His philosophy, though proof against religious belief, showed itself not proof against religious superstition. The whole pagan ritual of expiation was paraded on behalf of the distracted city. The neglected worship of the gods was revived with renewed vigour, and the aid of those most powerful to help in such circumstances was eagerly invoked. A lustration was solemnly performed for the purification of the city, and alectisterniumcelebrated for seven whole days. The people were readily infected with the contagion of their sovereign’s superstition, and from this time may be dated a brief revival of the worship of the effete pagan deities. Aurelius sought even to appease the anger of the national gods by a persecution of the Christians, whose religion was an insult to their majesty. The Christian chronicler, Orosius,[107]attributes the pestilence actually to the persecution of the Christians that had broken out in Asia and Gaul before its commencement. All that is known for certain is, that such a persecution was a consequence, if not a cause as well. An engraved blood-coloured jasper, preserved in Paris, and figured in theHistoire de l’Académie des Inscriptions et Belles-Lettres, survives to commemorate the sacrifices by which Marcus Aurelius sought to charm away the plague. Duruy[108]describes its features:

‘Marcus Aurelius as sovereign pontiff: on his veiled head a globe, symbol of his sovereign power: behind him an augur’s staff: facing the Emperor Rome helmeted and Aesculapius with horns: under Aurelius, Hygieia or Health: lastly the head of Faustina. The Sagittarius, who occupies the centre, marks the time of the sacrifices, offered in November or December.’

Some have inferred from a passage of Julius Capitolinus that Marcus Aurelius himself died of this pestilence ina.d.180. In describing his death-bed, Capitolinus says that he took a hasty farewell of his son, for fear of communicating his malady to him.

Niebuhr considers that the ancient world never recovered from the havoc of this pestilence. To it he traces the decadence of Roman literature and art in the years that followed, and points to analogous results in Greece from the plague of Athens, and in early German and early Florentine literature from the Black Death ofa.d.1348. But the seeds of decay in the empire of Rome had already been sown, as they had been in the empire of Athens before the Peloponnesian War. Pericles himself had warned the Athenians at the outset of the far-reaching consequences of failure. We shall see too hereafter that in the case of the early Florentine literature other more potent influences than pestilence were concerned in its temporary effacement. The lesson to be learnt from a comprehensive survey of the history of pestilence would seem rather to be this, that with the community, as with the individual, the sound constitution throws off the effects of a sickness that strikes right home, when the resisting power is impaired. Such was assuredly the case with the interminable sequence of plagues that assailed Rome in adolescence as well as in adult life. But as decadence and decrepitude beset the body politic, the wounds of pestilence went deeper and left abiding scars.

The Antonine plague bequeathed one ill-starred legacy to the profession of medicine. Every sovereign has the physicians he deserves, and Galen was physician to Marcus Aurelius. At the first onset of the pestilenceGalen made off to Campania, and finding no safety there took ship to Pergamus. Thence, after two years’ absence, he returned at the summons of the emperors, and after a brief stay in Rome joined them at Aquileia, where pestilence tracked him down again.

Cowards die many times before their death.

Courage, however, and medical acumen are by no means constant companions, and for many centuries, in face of pestilence, physicians, and among them Morgagni and Sydenham, were doomed to follow the example of Galen as faithfully as they cherished his precepts.

Galen has been regarded generally as the leading authority on the medical aspects of the Antonine plague, but the value of Galen’s testimony is not enhanced by the investigation of these attendant circumstances. The physician who takes flight at the outset is little likely subsequently to observe the disease carefully, constantly, and at close quarters: nor is it surprising to find that much of his symptomatology is borrowed directly either from Thucydides or Hippocrates. The striking picture of Thucydides must needs dominate the mind of the man who studies medicine in his arm-chair, so that we are prepared to find Galen asserting the identity of the Antonine pestilence with the plague of Athens. Here and there passages are lifted almostverbatimfrom Thucydides. For example, Galen[109]says that the sick man’s body did not seem hotter than normal to the touch, but that he suffered an intolerable inward burning. The skin was not yellow, but reddish and livid. The transference of οὔτε χλωρόν from Thucydides shows that he is copying Thucydides, and is not describing what he himself saw. Again, the description of the eruption, though far more precise and complete than that by Thucydides, shows his influenceclosely, and now and again falls into his actual words, as in ἐξήνθησεν ἕλκεσιν ὅλον τὸ σῶμα. The same also is true of the more general symptoms[110]of the disease, such as the insistence on the characteristic appearance of the inflamed eyes, and the redness of mouth, tongue, and fauces.

There is the ring of the charlatan, too, in Galen’s use and advocacy of Armenian bole as an antipestilential specific, in striking contrast to the crude disavowal of all remedies by Thucydides. Galen[111]says that ‘all those who used it were promptly cured’—one wonders at Galen’s flight—‘those who felt no effect from it died: no other remedy could replace it’—and then he sublimely concludes, ‘that those, with whom the remedy failed, were incurable.’ This Armenian bole was merely an argillaceous earth brought from Persia and Armenia, which owed its red colour to oxide of iron. Galen used it as an astringent for wounds and ulcers before he vaunted it as a specific for pestilence. Internally, at any rate, it must have been almost inert in medicinal doses, and as Galen adduces no evidence in support of his crude dictum, we need be at no pains to justify our incredulity.

There is reason to think that the Antonine plague was not one and the same disease throughout its course. Had it been so, we should have expected from Galen something in the nature of a single clinical picture, rather than casual references scattered throughout his voluminous writings.

In describing the character of the eruption and its transformations, Galen[112]certainly seems to have small-pox in mind. At a certain stage the eruption broke out all over the body in the form of ἐξανθήματα μέλανα (a dark efflorescence), probably of haemorrhagic type. When itulcerated, a crust (ἐφελκίς) formed on the surface, which became detached, and then everything proceeded to a cure. A scar remained after the separation of the crust, comparable to the ‘pitting’ of small-pox. In some cases ulceration did not occur, but the exanthem was rough and scaly and became detached like a skin: in this condition all got well. Galen gives some indication of the course of the disease in one who recovered. ‘A young man on the ninth day had his whole body covered with ulcers, as had most of those who recovered. Then he was seized with a cough, and three days after the ninth he was in a condition to go into the country for convalescence.’ The day after the cough set in, he expelled during a paroxysm of coughing a crust just like those of the cutaneous ulcers. Galen had previously examined his mouth and fauces, and had detected no signs of ulceration. He could also swallow both liquids and solids without any difficulty. To determine whether the crust came from his gullet or no, Galen administered a draught of vinegar and mustard; and from the absence of pain attending this drastic procedure he concluded that it must have come from the larynx and not from the gullet. Destructive ulcerations of the larynx have been recorded in rare instances in the course of small-pox, but such a condition would certainly preclude a journey to the country after the lapse of two days. It would be less impossible after the expulsion of a diphtheritic membrane.

It would be unprofitable to follow Galen further into the features of the pestilential fever he details, for, as we have said, it is quite uncertain that these are the features of a single disease. Indeed, apart from the evidence of Galen’s writings, it would be reasonable to presume the reverse from such knowledge as we have of other prolonged periods of pestilence.

Before leaving Galen we may say that he postulates a dual causation of pestilence: on the one hand, great irregularity of the seasons inducinga pestilential state of the atmosphere: on the other, a vitiated condition of the human body, due to contaminated food, rendering it liable to fever from very slight causes. The atmospheric factor, no doubt, would seem to be confirmed by the universality of the disease, while the greater severity of the disease and perhaps its special incidence as well among the ill-fed and destitute would seem to incriminate the resisting power of the individual.

The plague ofa.d.252, during the joint imperialty of Gallus and Hostilian, rivalled the Antonine pestilence both in virulence and duration. Hostilian was one of the first victims, though his death was commonly ascribed to the hand of Gallus. Eusebius[113]says that the disease had already worked havoc in Alexandria and Egypt, before it reached Rome. In some cities of Rome and Greece the daily mortality rose as high as 5,000,[114]and with greater or less virulence the disease spread over the whole known world.[115]Eusebius attributes the pestilence to moulds deposited from the air, a belief that we shall meet again in the course of the Great Plague of London.

Cyprian, the Christian bishop of Carthage, has left us some details of the symptoms in his eloquent homily ‘De Mortalitate’, which St. Augustine admired so greatly. Eusebius and Cyprian are both intent on extolling the self-sacrificing zeal with which the Christians laid down their lives in the service of the sick. Their writings help us to appreciate the contempt of suffering generated in the mind of the early enthusiasts of Christianity by living perpetually in the presence of persecution and in the fear of death. We know from the manner in which Cyprian[116]yielded himself to the sword of the executioner that the spirit of the ‘Sermo de Mortalitate’ permeated his whole being. In this sermon we may still read the glowing appeal of Cyprian to his hearers to seek courage and consolation in repentance for their sins.

Cedrenus[117]was so impressed with the infectiveness of the disease that he believed it might be communicated by a look, as Plato had conceived to be true of ophthalmia. Trebellius Pollio[118]recounts the association of terrestrial and other portents. Volcanoes awoke to fresh activity: earthquakes occurred and rumblings of the earth were heard: the sky was darkened for days: chasms yawned in the ground: great tidal waves overwhelmed many cities. It seemed as though the end of the world, foretold by the Christians, was at hand. In Rome the Sibylline books were consulted, and they prescribed the easy atonement of a sacrifice to Jupiter Salutaris.

Eusebius[119]is the chief authority for the pestilence ofa.d.302, during the reign of Maximian. It was accompanied by famine, so that the people were reduced to eating grass, and as many died of starvation as of disease. The famished dogs fought over the corpses of the dead, and the people slaughtered them wholesale, lest they should go mad and attack the living.

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