- Robert Sallares
Disease, the main cause of death in antiquity, is a topic for which there are more sources than for most aspects of life in the ancient world, thanks principally to the Hippocratic corpus (see Hippocrates (2)), Aretaeus, and the numerous works of Galen. Additional information may be obtained from palaeopathology, the study of diseases found in human skeletal remains. Ancient medical literature concentrates on chronic and endemic diseases, rather than the major epidemic diseases. In fact the Greek word ἐπιδήμιος, in a medical context, means ‘endemic’ rather than ‘epidemic’.
Malaria and tuberculosis are the most prominent diseases in ancient literature. Malaria occurred in antiquity in three forms, vivax, the commonest, falciparum, the most dangerous, and quartan, which has the longest periodicity. All three produce periodic fevers recurring every two or three days which were noticed easily, if not understood, by ancient doctors. The epidemiology of malaria in antiquity resembled that of recent times. In the highly seasonal Mediterranean climate malaria occurs mainly in the summer and autumn and affects adults at least as much as children, helping to explain its importance for ancient doctors. It depends for its transmission on certain species of mosquitoes, and was probably absent from some regions where these vectors did not occur. It is not necessarily associated with marshy environments. The chronology of the spread of malaria in the Mediterranean is disputed. All three types existed in Greece in the 4th cent. bce, but it is uncertain how long before that falciparum malaria had been present. The disease which struck the Athenian forces outside Syracuse during the Peloponnesian War may have been falciparum malaria, which was not yet present in Attica, but this interpretation is controversial. The hypothesis of W. H. S. Jones that the spread of malaria caused the decline of ancient Greek civilization is an exaggeration. However there is no doubt that malaria spread widely in central and southern Italy during the Late Republic and Early Roman Empire and had a major impact on human populations. It has also been argued that malaria did not exist in Sardinia before Phoenician and Roman colonization.
Tuberculosis mostly affected young adults. One Hippocratic text describes it as invariably fatal, probably an exaggeration, but Aretaeus gives the best ancient description of tuberculosis. Both human pulmonary and bovine tuberculosis were present in antiquity. It was probably common in crowded urban centres.
Ancient authors say hardly anything about childhood diseases, but enteric diseases such as infantile viral diarrhoea and amoebic dysentery probably accounted for most of the high infant mortality observed in cemeteries. Chickenpox, diphtheria, mumps, and whooping cough are all described in connection with attacks on adults, but there is no definite evidence for measles or rubella in antiquity. Cholera was absent. The presence of influenza is uncertain, but the common cold certainly existed. Leprosy was probably endemic in the near east in the bronze age and spread slowly westwards in the Hellenistic period. It probably only occurred sporadically. There is no conclusive evidence for gonorrhoea or syphilis, but some sexually transmitted diseases certainly existed, such as genital herpes and trachoma. The latter was also the main infectious cause of blindness. Brucellosis from contaminated goat's milk was common at Herculaneum. Heart disease is not prominent in ancient literature, but palaeopathology suggests that underlying conditions such as atherosclerosis were common. Some cancers were well known. Galen states that breast cancer was common. Aretaeus described diabetes.
Some chronic malnutrition diseases were quite common, especially in childhood, e.g. iron-deficiency anaemia, rickets, bladder-stone disease, and night blindness. The Greeks and Romans also took an interest in diseases of plants and animals because of their importance in agriculture. See plague.
- W. H. S. Jones, Malaria: A Neglected Factor in the History of Greece and Rome (1907).
- M. D. Grmek, Diseases in the Ancient Greek World (1989. Fr. orig. 1983).
- L. A. Graumann, Die Krankengeschichten der Epidemienbücher des Corpus Hippocraticum (2000).
- J. R. Sallares, Malaria and Rome (2002).
- J. R. Sallares, A. Bouwman and C. Anderung, Medical History 2004, 311–28.