Diseases of Western Antiquity

There are good reasons for believing that diseases and complaints of various kinds and degrees of severity were as much a part of everyday life in classical antiquity as were the assorted battle wounds and injuries so dramatically portrayed from Homer onward. This is indicated not only by the surviving Greek and Latin medical texts and the fragments preserved in Greco-Egyptian papyri, but also by the large corpus of nonmedical Greek and Latin texts, some of which are still being read today. In poetry, tragedy, and comedy, in history and annals, in philosophy and theology, as well as in botanical, agricultural, and pharmacological texts, illness and health and life and death constitute distinctive motifs.

To be certain, the evidence, both written and nonwritten, has survived in different states of preservation. It permits us, nonetheless, to reconstruct in part the intellectual and technological achievements of our past. Large gaps, however, exist in our knowledge of that past, and the absence of crucial details has led to hypotheses and inferences that cannot be tested directly.

Our knowledge of the diseases of classical antiquity stands somewhere between demonstrative certainty and complete ignorance. There is, after all, a sizable body of Greek and Latin medical texts, and it, in turn, has generated an even larger body of secondary literature. But for all that, our knowledge of the diseases of classical antiquity is far from complete. There are several reasons for its incompleteness, but it is important to keep in mind the enormous differences between the conceptual bases of the modern medical sciences and those of antiquity. These differences have important consequences in any attempt to identify the diseases of classical antiquity and to understand their effects.

One significant consequence is primarily philological: Many Greek and Latin medical terms cannot be rendered adequately by any single term in most modern languages. A case in point is the specialized vocabulary denoting diseases, used primarily though not exclusively by the ancient medical writers. Obviously this has a bearing on the study of disease. Some ancient medical terms appear to cover an indeterminately wider range of meaning than is expressed by their modern equivalents. For example, lepra (Xejtga)

and gonorrhea (yovoggriia), mean something more than the modern clinical entities whose names they bear; in fact, it is not altogether certain that lepra denoted Hansen's disease or that gonorrhea denoted the disease that today is positively diagnosed only by the presence of gonococcus.

A second consequence, far more formidable than the philological one just noted, concerns the very foundations of classical medicine. Beginning with Hippocrates, and accepted by the better medical writers throughout classical antiquity, was the notion of disease as a process. Regardless of the philosophical theory that supported the etiology, whether hu-moralism or solidism, a disease, theoretically, could be described as a series of stages with a predictable outcome. Each of those stages normally occupied a narrowly circumscribed period of time, such as 7,14, or 20 days. Associated with the chronological development was a series of changes in the condition of the patient, each of which was described in specific, though not necessarily unique, terms representing the symptom or symptoms associated with that specific stage of the disease. It is with respect to the latter point that grave difficulties are encountered in an attempt to identify some of the diseases of classical antiquity. First of all, it was widely believed that some diseases were capable of passing into or changing into another disease. The latter was then characterized by its distinctive symptom or symptoms, which often were similar to the principal symptom or symptoms that characterized the original disease process. The newly arisen disease was then regarded as a species of the disease from which it originated at a certain stage in the morbid process. Then it too ran its predictable course, although therapeutic intervention (drug therapy, regiminary therapy, or surgery) might alter its course.

There was considerable discussion in antiquity concerning the proper nomenclature and, of course, therapy of these so-called species or varieties of a disease; and as one might guess, there was little agreement concerning details, especially with regard to their classification. On one issue, however, there was agreement and that was the widely adopted classification of diseases as acute or chronic. In the main, acute diseases were characterized by a sudden onset, a clearly circumscribed febrile stage, and the involvement of a specific localized area, frequently the respiratory or digestive system. As such, most of our infectious diseases were regarded as acute diseases in classical antiquity. Those disease processes in which a clearly demarcated febrile stage was absent and whose outcome could not be predicted on the basis of a specified sequence of stages fell into the larger, less organized category of chronic disease (e.g., gout, lead poisoning, and scurvy).

Because it was not possible to base an etiology on specific microscopic, pathological organisms, close attention was paid to the description of symptoms at each stage of the disease process, from onset to outcome. Thus, many of the so-called species or varieties of a disease acquired distinctive names; these were based on a few of the salient symptoms or on a consistent clinical pattern, the latter resembling what later came to be called a syndrome (literally, a "running together" of symptoms).

It must be stressed, finally, that ancient therapeutics was almost wholly symptomatic. Consequently, the large body of literature surviving from classical antiquity must be used with due recognition of the fact that the illnesses for which the many hundreds of recipes and remedies were designed must be considered, in the main, to be symptoms and syndromes.

These caveats notwithstanding, some of the diseases of classical antiquity can be identified with assurance and others can be identified with degrees of confidence that vary in proportion to both the quality and the quantity of the evidence at our disposal. In either case, however, efforts have been made to summarize the etiologic, epidemiological, and pathological evidence in such a fashion that the diseases of classical antiquity can be correlated historically with the same diseases viewed in later terms.

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