Bubonic Plague

In the large, sometimes uncritical literature in the history of bubonic plague, the earliest, unimpeachable reference to the plague in classical antiquity is that provided by Rufus of Ephesus. There are also a considerable number of Greco-Roman descriptions of and references to epidemics in our sense of the term (or, in Greek and Latin, Xoyog [whence our word plague] and pestis pestilentia). These were of various kinds, usually unidentifiable, with various degrees of morbidity and mortality, and not always chronologically or geographically positioned. The most famous were those of the Iliad, the "plague of Athens,"

and the "plague of Justinian." Many different communicable diseases have been proposed for these "epidemics" (a term that in Hippocrates' Epidemics does not always mean what we mean by an epidemic disease; see Deichgraber 1933). Likewise, many different diseases have been proposed for the less well known, but equally sporadic and frightening epidemics whose echoes frequently resound in classical texts, such as those of Karl Jax, Jiirgen Grimm, and Jean-Marie André. Some of those epidemic diseases may have been bubonic plague but, save for the description by Rufus and the acknowledged existence of the plague of Justinian (sixth century A.D.), the evidence is inconclusive. The likelihood of bubonic plague cannot be dismissed totally, however, because there is good evidence, first, that the plague was endemic in the Near East in the preclassical period and, second, that the Greeks and Romans had frequent contact with the people of the Near East from the sixth century B.C. onward and could easily have contracted diseases thereby. It is, finally, almost certain that bubonic plague was not unknown in late antiquity, as Byzantine reports by Paul of Aegina and Arabic and early Western medieval reports testify.

It is, then, in the context of the later stages of Greco-Roman civilization that one must consider the passage from Rufus noted at the beginning of this section. Rufus of Ephesus, a highly regarded physician and medical writer, lived during the reign of the emperor Trajan (A.D. 98-117). He is known to have been active in Rome and to have spent some time in Egypt. A short passage referring to the buboes typical in a case of plague was preserved, presumably because of its unusual interest, by the later (fourth-century) Greek physician Oribasius in his chapter on buboes. Because of its historical importance, I have translated the passage from Rufus:

The buboes termed pestilential are the most fatal and the most acute, especially those that are seen in Libya, Egypt, and Syria, as reported by Dionysius the Kyrtos. Diosco-rides and Poseidonius have studied especially the plague (Xoir)oç) which occurred in Libya in their time. They have said that [it was characterized by] high fever, pain, disturbance (caicrtaoLç) of the entire body and the formation of large buboes, hard and non-suppurating. They develop not only in the ordinary places but also in the groins and the neck. (Translated from Oribasius.)

It may be noted that buboes had been mentioned many centuries earlier by Hippocrates. Sometimes they meant glands, but in other cases they seemed to refer to the large lymphatic swellings associated with the plague. Because Hippocrates does not assign a name to the disease of which the buboes are one of the most dramatic signs, it is difficult to decide whether bubonic plague was known to him.

Before Oribasius, Aretaeus referred to pestilential buboes of the liver, whereas Pliny the Elder referred to a plant, bubonium, whose name derived from the fact that it was considered especially beneficial for swellings of the groin (inguinum). These bits and pieces of information (and undoubtedly others exist), especially when coupled with references to "pestilential times" by Marcus Aurelius and Aristides, suggest that bubonic plague may have been implicated, more often than we have recorded, in the numerous outbreaks and epidemics, though not recognized as a discrete clinical entity.

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