tween individual and general disease, including a notion of
cause and, as a consequence, of treatment. Th ese physicians
concluded that individual diseases, aff ecting a single patient,
result from the alimentary habits of the patient (even though
several individuals using the same diet can suff er of the same
disease). Such diseases could be cured by changing the diet
and compensating for the insuffi ciencies or rectifying the
improper diet. General diseases, aff ecting an entire group,
are provoked, it was thought, by a corruption of the air (the
so-called miasmas, that is, impurities fl oating in the air and
resulting from any kind of pollution). Th ey could be cured by
applying a proper pharmaceutical therapy that rectifi ed the
damages caused by the disease.
Th ere was no notion of a treatment that could eliminate
the cause of the disease. Th e concept of the impact of the en-
vironment on the health conditions of a population is further
refi ned in the famous Hippocratic treatise Airs, Waters, Places,
traditionally dated to the second half of the fi ft h century b.c.e.
and attributed to a physician from the school of Kos. A dis-
tinction was made between the constant conditions of a place
(provoking the endemic diseases, that is, those peculiar to a
particular population or place) and the occasional conditions,
independent from the place itself, but coming from external
factors and causing a general disease. Th e word epidêmios was
applied to diseases aff ecting a large number of patients, with-
out implying any notion of contagion. Th e word constitutes
the title of seven books in the so-called Hippocratic collection
describing the diseases present in a specifi c place at a moment
of the year and aff ecting a certain number of patients.
ROME
BY ALAIN TOUWAIDE
Historical sources, including those of the Roman historian
Livy (64 or 57 b.c.e.–12 or 17 c.e.), the Greek philosopher Di-
onysius of Halicarnassus (born ca. 60 b.c.e.), and the Greek
historian Polybius (ca. 200–ca. 118 b.c.e.), report outbreaks
of epidemic diseases in the Roman world shortly aft er the
foundation of the Roman Republic (509 b.c.e.) at a higher fre-
quency than those in the Greek world. Th is apparently higher
frequency might be the result of better record keeping; Roman
historians relied on the tradition of annales, which recorded
the notable events of each year. According to the descriptions
by the historians who recorded the annales, epidemics oft en
were linked with military expeditions, wars, food shortages,
famines, and natural calamities aff ecting crops. In some
cases epidemic diseases also were described as coming from
cattle. While some of these epidemics arose from local condi-
tions, others were introduced into the Roman world from the
west or the south. Th e Athenian epidemic in 430 b.c.e. might
have been carried westward; Rome was struck in 428 b.c.e.,
according to Livy. In Sicily epidemics were said to have been
introduced repeatedly by troops from the Athenian expedi-
tion of 413 b.c.e. through the outbreak in 212 b.c.e. among
Roman and Carthaginian troops
Th e best-known epidemic in the Roman world was the
so-called Antonine plague. Th is was a series of epidemics,
including two major outbreaks, in 165 c.e. and in 180 c.e.,
respectively, that struck the Roman population under the An-
tonine emperors (138–192 c.e.). Th e disease was introduced
into the Roman world from Mesopotamia by the troops from
the expedition against the Parthians, which began in 162 c.e.
and was led by Lucius Aurelius Verus (r. 161–169 c.e.). In 165
c.e. the Roman troops were aff ected by the disease and re-
treated. Th ey spread the disease westward to Italy and Rome.
Th e epidemic progressed to Gaul and into Germany as far as
the Rhine. Th e emperors Lucius Verus and Marcus Aurelius
(r. 161–180 c.e.) died of the epidemic. Th e Greek physician
Galen (129–ca. 199 c.e.), who stayed in Rome at that time, es-
caped from the city and did not return until 169, when he was
summoned by the emperor. Th e death toll is thought to have
been extremely high throughout the empire. Th race, for ex-
ample, supposedly lost half of its population. Such a mortality
rate has been attributed to the high level of urbanization of
the Roman Empire, as opposed to the fragmentation of the
Greek world in smaller cities.
Th e nature of epidemic diseases in Rome has been ad-
dressed frequently in medical and historical literature. Be-
cause the epidemics of 428 b.c.e. in Rome supposedly came
from the East, and since the so-called plague of Athens of 430
b.c.e. has been identifi ed as smallpox, one conclusion is that
the Roman epidemic represented the introduction of small-
pox to the West. A similar hypothesis has been made for the
Antonine plague. According to this view, this was the second
attack of smallpox in the West, which proceeded according
to a pattern of diff usion east to west from Mesopotamia. An-
other identifi cation of the plague of Athens as typhoid fever,
however, contradicts the traditional history of the diff usion
of smallpox.
Th e categorization of diseases according to their geo-
graphical diff usion, chronological frequency, and statistical
importance was initiated by Galen. He developed a threefold
categorization: First, sporadic diseases are those of a single
individual at a certain moment. Second, epidemic diseases af-
fect a high number of individuals at the same time in a single
place. Th ird, endemic diseases are those that are perpetually
common in a single place. A few more general notions, prob-
ably of popular wisdom, can be found in the Historia natu-
ralis (Natural History), by the Roman scholar Pliny (23–79
c.e.). Th ey include the observation that diseases followed cer-
tain patterns; for example, epidemics moved from south to
north and almost never in the opposite direction, they did
not start during the winter, and they never lasted more than
three months.
As in the Greek world, the cause of epidemic disease was
considered to be miasmas, or particles of a corrupted nature
fl oating in the air that people inhaled. Th erapeutic methods
among the Romans reproduced those of Greek medicine but
were augmented with a new pharmaceutical strategy: com-
pound medicines associating many ingredients. Th is strategy,pandemics and epidemics: Rome 827