Brooke Holmes on Plague in Antiquity and Today

During the global crisis brought on by the COVID-19 pandemic, scholars from across the humanities have been pausing to reflect on what their fields can offer to a world that has been forced to reckon with unprecedented circumstances. While classicists will be wary of drawing superficial comparisons between our current crisis and the ancient Mediterranean world, the knowledge that humans have faced the trauma of disease in other times and places can provide perspective. Perhaps we can even hope to learn something from the experiences of those who  came before us.

Though it might sound naïve in the abstract, the cliché of learning from history was validated for me when I recently spoke via Zoom with Brooke Holmes, a professor at Princeton and an expert on ancient Greco-Roman medicine. Highlights from that conversation are presented below.

The interviewer, William Dingee, is a PhD candidate in the Department of Classics.

WD: Let’s start with some background. Does the ancient Greek medical tradition think closely about epidemics? How does their conception of this kind of disease differ from ours?

BH: To begin with, we need to be careful about terminology. The Hippocratic physicians do think about what they would term “epidemics.” However, when they think about these diseases, what they are doing is trying to assess the seasonal and environmental conditions that contribute to waves of disease within a certain population in a given place. Does the disease affect people who are older or younger? Men or women? People with certain constitutions?

This, however, is different from “plague,” or loimos. The Hippocratics don’t really talk about plague, in the sense that they don’t focus on why or how humans spread diseases beyond focusing on environmental factors. This is a conspicuous absence in the learned medical tradition that begins with the Hippocratic Corpus.

Why doesn’t their system account for plague? The Hippocratics don’t like the idea of diseases carried by miasmata, a kind of pollution, in part because they aren’t diseases that they can do anything about at the level of individuals. One text that refers to disease carried by “polluted” (memiasmenon) air only recommends that one try to breathe less. Of course, this sounds like crazy advice, but right now we’re all finding ourselves holding our breath when we end up too close to people on the street.

The other argument for why you don’t see the codification of plague in learned medical texts is that miasma is a religiously tinged word, which is associated with a substance that has pathogenic qualities because of blood-guilt that can be transferred from one person to another. So one way of understanding what the Hippocratics are doing is that they are developing a vocabulary around disease that does not overlap with the terrain of magico-religious healers.

When you get to Galen, you’ve reached the apex of a tradition of “naturalizing” medicine, which sought to move away from “pollution” and toward the body in explaining disease. In Galen, there’s a clear anxiety about plague in part because of its seeming randomness. All kinds of people can get sick, and that doesn’t support a narrative which is really important to medicine in this period: what you do to your body will determine whether or not you get sick. If disease is random, there can be no ethics of illness and the care of the body.  And this ethics is very important to Galen.

This is where I see some echoes of ancient discourse in what we are experiencing today: the need to have recourse to underlying conditions as a way to counteract our anxieties about the randomness of disease and perhaps for those who consider themselves healthy to persuade themselves that they don’t “deserve” to get sick. The idea that the space of the patient’s body is a ground where one can address the possibility of getting sick accords more agency not only to doctors, but also to patients, who are assumed to be responsible for keeping themselves healthy. It therefore allows morality into questions of disease in insidious ways, while displacing attention from the structural factors that, for example, prevent access to healthcare—which is a major issue in the current pandemic, particularly for people of color in the US.

WD: The pre-medical or perhaps extra-medical concept of disease as caused by miasma brings the heroic world of Homeric poetry and Greek tragedy to mind. What do these texts tell us about an earlier religious discourse around disease and emergent traditions of medical thought?

BH: Well, most famously, extant Greek literature begins, in the Iliad, with a plague in the camp of the Achaeans at Troy. In this case, there’s an interesting connection between the suffering of the army’s population and the body of the leader Agamemnon. The priest of Apollo does not punish Agamemnon himself, but the king’s extended body, his subject people. We observe something similar at the beginning of Oedipus Tyrannus, where the leader’s guilt results in punishment for the wider population.

When we come to miasma, two texts in tragedy in particular strike me as quite interesting to compare: Euripides’ Herakles and Sophocles’ Oedipus at Colonus. In Sophocles, miasma is physical. It is on Oedipus’s body, and nobody can touch him except his daughters. When Theseus meets Oedipus, Sophocles stages the frustration of the incapacity to touch when Theseus goes to thank Oedipus, but has to pull back because of the miasma. In Euripides, by contrast, when Theseus shows up at the end of the play and Herakles tells him that he can’t touch him because of the miasma, Theseus insists that they are friends and he can greet him. So, in a very Euripidean way, the ending of the Herakles performs a kind of disbelief in the miasma. It is possible that Euripides reflects a skepticism around physically transmitted blood-guilt that may be arising in connection with naturalizing medicine in this period.

WD: Perhaps the most famous account of plague that survives from ancient Greece is Thucydides’ account of the plague of Athens during the Peloponnesian war. What stands out about his description?

BH: Thucydides’ account provides an interesting perspective on the question of whether the ancients had a medical concept of person-to-person transmission of disease. In giving his account of the Athenian plague, Thucydides tells us that doctors who had contact with the sick suffered the most, another really poignant detail for our present moment. We have to imagine that the doctors were seeing what Thucydides did, and are noting person-to-person transmission, which is why it is all the more remarkable that this is not showing up in how they theorize disease.

Thucydides is the first moment when we really see empirical recognition of person-to person-contagion. Interestingly, in Iliad I, the plague begins around animals, perhaps revealing some recognition of the zoonotic origin of some diseases that are devastating to humans. The text, however, doesn’t have much use for this fact. This ultimate lack of interest in the underlying causes of the disease can also be observed in Thucydides, who says that he won’t offer causes for the plague, only a description of what it looked like. What Thucydides is really interested in is the breakdown of society. So for him the illness of the doctors is not so much a pathological fact as an example of the failure of technē, of the learned sets of skills and bodies of knowledge that were supposed to support a civil society.

Thucydides is also surprising in that he seems to have some idea of acquired immunity. What is quite poignant, again, is that Thucydides tells us that people who survive the plague and become immune begin to believe that they are almost immortal. It is a reminder that these are not epidemiological facts for Thucydides, but rather factors that affect human nature.

WD: As you note, Thucydides seems to know that the plague spread by means of person-to-person contact, and it seems highly unlikely that there was not at least some anecdotal awareness of the contagiousness of disease in antiquity. Even if the medical writers are resistant to miasmaas a paradigm for understanding illness, one would expect the idea of contagion to show up somewhere in ancient discourse.

BH: There is awareness of contagion on some level as a problēma, something difficult to explain. So in the problēmata tradition we do find discussions of contagion, but here it is treated in the context of sympatheia, a process by which physical or emotional experiences are shared between living beings. The ancients knew, for instance, that eye diseases were contagious, but thought that this was because the eye was particularly susceptible to mimēsis, or imitation. The paradigm of contagion here is contagious yawning, or contagious urination among livestock. So the issue does come up, but is treated under a different heading than we would expect, and their concept of it does not resemble modern germ theories of disease transmission.

WD: How did other fields of knowledge in antiquity respond to the reluctance among medical writers to theorize plague? What can we learn from this material?

BH: The way that Thucydides uses plague to serve his purposes as a historiographer can help us to understand why plague shows up more generally in the literary and philosophical tradition. Why, for instance, does the plague show up at the end of book six of Lucretius? Lucretius, as an Epicurean, has in many ways a more robust theory of plague than can be found in the medical writers. But why does he end with it? His point is not simply about disease. I think people have it right who view the plague at the end as a test. If you can read this description of plague without fear of death, you pass. If you read it and you want to start hoarding toilet paper, go back to the beginning.

As with Thucydides, plague is important in authors like Lucretius not for epidemiological reasons, but because it provides an opportunity to make a point about the care of the soul. There’s a direct relationship between the lacuna within medical writers around plague and the use of plague in other traditions to meditate on the relationship between what happens to the body and the health of the soul and of society.

In many ways, historiography and philosophy are trying to import an empirical and naturalizing framework derived from medicine and apply a system developed for the care of the body to something beyond our biological being. The soul suffers as well. It has its own diseases. It needs its own therapy, its own technē. That is what Thucydides is doing. He does borrow from the physicians, but he emphasizes something that we still need to understand: this is not just a disease of the body.

We’re facing major moral and psychological crises right now, and a lot of the pain is not biological. That’s where I think that the ancient material is so important. It is precisely the medical codification of the body as an object and the reduction of disease to the body that produces the attempt in moral philosophy or historiography to understand suffering as a human problem that involves parts of us that cannot be captured by the body. This is a problem that we still struggle with. We’re getting sick because we are bodies, but we aren’t just bodies. Our response has to go beyond keeping people alive on ventilators.